Back Page: Let's Get Gutsy

We all know that pharma is facing hard times: cut-throat competition, regulatory constraints, patent expirations, rusty pipelines, rising generics, falling revenues—and, perhaps most important, a firestorm of consumer anger over drug prices and safety now being restoked by the new Democratic Congress. Nevertheless, industry persists in "staying the course"—sound familiar?—rather than charting a bold new strategy. Its two top priorities remain opposing government price controls and thwarting patent laws favorable to generics. These defensive tactics are hardly the hallmark of leadership.

Pam Maraldo

The lion's share of pharma's effort has been directed at the arcane world of FDA regulations, patents, and intellectual-property issues. But the public's upset emerges from a far deeper issue: the belief that companies are not doing what's best for the public. True, the industry has begun to respond to the outcry over soaring drug prices, safety fears, and other issues. PhRMA has launched PR efforts aimed at the public, the press, and politicians, touting industry's long list of costly, socially responsible, and effective programs helping patients. But to many consumers, it's just window dressing.

What pharma badly needs is an offensive strategy that will position it very differently. Consider this seven-point proposal for new leadership a first pass.

Eric Lister, MD

1. Envision a health-literate public. Compared to the strides that have been made in medical treatment in recent years, the use of technology to get important health information to consumers is sorely lagging. Pharma should take DTC advertising to the next level, and begin to make technology an enabler. Consider structural designs that bring pharma closer to consumers' daily lives, like dispensing prescriptions through ATM machines. Consumers could get safety, dosing, and related drug information as easily as they can access bank balances.

2. Campaign to prevent mistakes in drug administration. Medical errors are the nation's third leading cause of death and are often related to drug misuse, overuse, or underuse. Manufacturers have a responsibility to ensure that their drugs are being used properly. New strategies, from patient-friendly labels to innovative Internet outreach, could be initiated to promote appropriate usage.

3. Address the epidemic of noncompliance. Relinquishing this responsibility to physicians clearly has not worked. Conference after conference has been held on how to improve adherence, to little avail. New approaches are needed, like bringing nurses and consumers together to learn about certain chronic diseases and providing compliance strategies as a constant companion to prescriptions.

4. Make friends with public interest groups. CEOs glad-handing on Capitol Hill should regularly include business and consumer leaders—especially as globalization means a growing intolerance of high healthcare costs in corporate America. Brand-name companies are an easy mark for anger by those who have to pay the bills: private insurers, self-insuring companies or government programs. Forging closer ties and greater education will go a long way.

5. Admit the pharma business goes beyond just providing pills. Pharma needs to realize that, like it or not, it is in the business of providing healthcare rather than pills. Funding new models to address the pressing issue of the uninsured is a good place to start. Like Wal-Mart, which is using nurse practitioners to make affordable care accessible, pharma could also court nurses as an important group of prescribers. Rather than spending in a shotgun approach to establish brand identity, companies should invest resources in sustained experiments, such as Bayer's efforts to teach physicians communication skills or Pfizer's study of disease management in Florida.

6. Establish new doctor-industry partnership. Relationships have soured in recent years under a barrage of attacks from prominent physicians, starting with Marcia Angell, former editor of The New England Journal of Medicine. Again and again, pharma responds belatedly and weakly to ethical challenges, such as calls for the posting of all study data. Only by leading the dialogue on ethics—in research, education, marketing, and sales—can its credibility be reestablished.

7. A robust pipeline that deliver drugs of real value. The ultimate test for the industry is its ability to deliver scientific breakthroughs. R&D budgets have soared over the past 20 years, reaching $26 billion last year. Yet rising prices, high profits, and ultracompetitive marketing of so many me-too drugs do not square with the public. The pharmaceutical industry must emphasize that it is developing drugs that target the underlying molecular causes of disease. Informing the public about the drug-discovery process through documentaries and op-eds, and other methods, would help create allies when it comes to legislative challenges.

Pam Maraldo is senior associate for Ki Associates. She can be reached at PJMaraldo@aol.com

Eric Lister, MD, is the managing partner for Ki Associates. He can be reached at Kiassoc@aol.com