Back Page: The Post-Trust World

We live in a post-trust society. The public no longer puts its faith in industry or regulators. And one of the industries they trust least is Big Pharma. Poll after poll, from Harris to Gallup, shows trust in this sector at an all-time low, hovering just above the oil and tobacco industries. This attitude has been fueled by outside observers who argue that the industry is driven by greed, and that profits are put before patients' health. And of course, the situation is not helped by the extensive, rather critical media coverage of both Big Pharma and the FDA, post COX-2.

Ragnar Lofstedt

For the industry, the real question that emerges is this: If public trust has been damaged, how can Big Pharma and its regulatory agencies best rebuild it? There are two basic tacks the industry could take. It could, of course, continue with the status quo. That is, Big Pharma could simply accept the idea of operating in a world in which firms and regulators routinely battle with critics, using an army of PR consultants.

The alternative would be to confront the public trust crisis head-on, first, by understanding why it has come to pass and, second, by developing proactive risk communication strategies to counteract it. I take the view that pharma executives should prefer the latter over the former.

The research on public perception of risk, starting with such founding academics as Baruch Fischhoff, Ortwin Renn, and Paul Slovic, identified a series of variables that help explain why people perceive one risk more than another. Their findings showed for example, that people are up to a thousand times more worried about involuntary risks (being forced to live next to a cell phone tower) than they are about voluntary ones (using a cell phone), and that people are more willing to accept risks they feel they control (driving a car) than risks they do not control (being flown in an airplane). Similarly, people worry more about unfamiliar risks (bird flu) than about familiar ones (common flu) and are more concerned about high-kill-size risks (airplane accidents) than low-kill-size ones (car accidents).

More worryingly, a number of researchers in the area of risk communication are coming to see trust as the variable with the highest power to explain why people are more conscious of some risks than others. Indeed research shows direct correlations between high levels of public perceived risk and low levels of public trust, and vice versa. These factors, originally developed to better understand public concerns with regard to nuclear power, have been tried and tested in numerous cultures and settings, and on different technologies.

These factors also apply to the pharmaceutical sector. Pharma products are often seen as involuntary risks, something that they actually do not control or understand, produced by firms they do not trust. No wonder noncompliance levels remain stubbornly high.

At present, Big Pharma is not conducting enough research on these social aspects of risk. This is clearly a mistake. Would it not be useful via qualitative research methodologies, such as ethnographic interviews and cognitive-mapping (mental models) exercises, to attempt to map out in detail how the public perceives Big Pharma and the products it sells?

Such exercises, if conducted correctly, will help Big Pharma to develop proactive risk communication strategies to cope with a variety of situations, from possible drug recalls to revealing information about drug impurities or pharmaceuticals in the environment. They would also aid in developing more realistic negotiation strategies with regulators. For too long Big Pharma has hidden behind its own scientific data or some cleverly crafted PR statement, rather than taking the lead on addressing the roots of public distrust. To do this requires courage, vision, and strong leadership. Those are qualities Jeffrey Kindler and the other pharma CEOs have in abundance.

Ragnar Lofstedt is director of the King's Centre for Risk Management, King's College London. He can be reached at ragnar.lofstedt@kcl.ac.uk