Forging Alliances

Successful partnerships with third-party organizations such as patient and caregiver advocacy groups, professional associations, and thought leaders are powerful medicine for pharma companies.

When the process works, those relationships provide vital support-both for a company's business objectives and for the advocacy partners' missions and goals.

This article discusses the public relations discipline of ally and advocacy development as an important business tool and explains how, when done right, building effective alliances with patient, caregiver, and professional groups and experts is a win0win proposition.

Partnering with advocacy groups and thought leaders at major research institutions helps to

• recruit participants for clinical trials

• speed the development and approval process for new therapies

• inform healthcare providers, patients, and their caregivers about new and safer options for treating chronic and life-threatening diseases

• diffuse industry critics by delivering positive messages about the healthcare contributions of pharma companies to legislators, the media, and other key stakeholders

• influence changes in healthcare policy and regulations to expand patient access to, and coverage for, earlier diagnoses and treatments.

Vocal Power

Advocacy groups and thought leaders are critical to pharma companies' success because they are the credible voice of patients, caregivers, and healthcare providers. Effective pharma partnering links company messages with those of influential organizations and individuals when all find common ground. Without such allies, a skeptical journalist may see a company's messages and information as self-serving and describe them as such to their audiences.

All pharma activities-product launches, clinical trials, CME programs, disease awareness, and patient screening and education initiatives-benefit from having respected third-party advocates as members of the pharma marketing team.

Add PR To Partnership

Journalists want to interview credible people such as celebrity spokespersons and patients who can publicly discuss their personal experiences with a disease and its treatment, as well as advocacy experts and physician thought leaders who can report clinical trial results and describe in lay terms why a new drug makes a difference.

Those partnerships are based on mutual trust and respect. Jeffrey Winton, vice-president of global public relations for Pharmacia, talks about its advocacy partners: "Although they work with us, we don't always see eye-to-eye on everything. They are their own people. We don't try to dictate what they say to whom. As a result it's given us greater credibility. Once you start watering down the messages that those groups and experts want to tell, you might as well forget the value of working with them."

An Early Model

For years, pharma companies' connections with patient advocacy groups were limited to corporate financial contributions to create goodwill, with no expectation of a measurable return for the company and no real role, as a partner with the donor company, for the advocacy group to play. Most corporations were uncomfortable with the idea of "partnering" with advocacy groups, because they often saw them as activists, unsympathetic to the profit interests of big business.

Of particular concern to pharma companies were the vocal activism and agenda of the AIDS groups. Until the early 1980s, pharma companies created relationships primarily with professional groups representing physicians, and rarely communicated directly with patients.

The AIDS community-desperate for access to treatment and promising new drugs-effectively amplified their voices and actions to force change. Pharma, healthcare providers, insurers, and government finally responded by including those groups in a continuing dialogue about every aspect of care. They've been at the table ever since.

Finding a fit

Soon thereafter, breast cancer groups began to organize and politicize their issues. They modeled their efforts after the AIDS groups to achieve share of voice, disease awareness, research funding, patient education programs, and coverage for diagnostic testing and treatments. At that time, only a few forward-thinking pharma companies recognized the potential return in building true alliances with patient groups. (See PE, "Discovery! Oncology," June 2002 and PE, "HBA's 2002 Woman of the Year Leads Transformation," April 2002.)

That model was again used in the late 1980s by Schering-Plough to create the national Prostate Cancer Awareness Week campaign, supported by S-P's marketing efforts for Eulexin (flutamide), a prostate cancer therapy.

Partners in that program included Cancer Care, the National Cancer Institute, AARP, the American Foundation for Urologic Disease, the Association of Community Cancer Centers, and the National Association of Community Health Centers. At a time when diseases of the male sexual anatomy were not discussed publicly, their common objective was to inform men age 40 and older-and their families-about the importance of annual testing for prostate cancer, one of the most curable cancers when detected early. During the campaign's three-year run, awareness spread. The topic was no longer taboo, and more than 250,000 men received well-publicized free screenings at clinics across the country.

Today's Advocacy

"Gone are the days when companies just handed out big checks to groups with no discussion afterward," says Winton. "Now, we seek opportunities with groups that not only help them achieve their goals and objectives, but also help us move our business along."

Today, advocacy organizations are smarter about leveraging influence. They still value unrestricted contributions but also welcome cutting-edge information about clinical trials, new therapies, professional or technical support, and other in-kind contributions that help them better serve their patient communities. They have found ways to gain company resources to benefit their constituents without losing their independence. Many of those groups now are run like successful corporations, with a mission, a business plan with goals and objectives, an active board of directors, and accountability to their constituents and contributors.

Some retain consultants to help evaluate and tailor partnership proposals to best fit the pharma company's mission. "When you look at not-for-profit community groups over the past 10–15 years, they've become increasingly sophisticated. We have to approach them at that level, and treat them as customers, not vendors," says Kristen Williams, senior manager of ally development for AstraZeneca.

Pharma companies are gaining a better understanding of advocacy group cultures and how to identify common goals. "Those shared agendas mean enormous benefits for patients and corporate sponsors alike," says Karen Miller, ally development director for AstraZeneca. "Some patient advocacy organizations still have misconceptions about working with pharma companies which must be overcome before all parties can reach common ground." According to Miller, proving worthy of a group's trust takes time, and the burden of proof is on the pharma company.

Seasoned Players

There are many fine examples of advocacy allies at work in the industry.

In oncology. Because cancer groups are among the most seasoned advocates, prime examples of successful ally partnering continue to be found at companies with strong oncology pipelines.

Those relationships create an im-portant patient link to clinical trials that can hasten a drug's approval. Recognizing that connection, Pharmacia has worked for the past three years with the Coalition of National Cancer Cooperative Groups, an alliance of national cancer trial organizations, to increase awareness of, and participation in, clinical trials.

"We've completed a number of successful programs together to educate some of the less experienced patient advocacy groups about the importance of clinical trials in oncology and what those trials offer as therapeutic options to patients who want to get more directly involved in driving their treatment," says Karen Carolonza, director of public relations and advocacy development for Pharmacia. "We've gotten a very positive response from those education efforts. That work also gives us the chance to identify new potential allies for future collaboration."

Often, advocacy group partners can serve another vital function: identifying patients who fit certain profiles according to their gender, age, disease stage, physician, history of therapies, and locale and who will make good interview candidates for the media.

"As an industry, we are always looking to tap into what the patient's needs are at a particular stage of a disease and understand how our drugs work for them," says Catherine Cantone, senior manager of public relations and advocacy development at Pharmacia. "Once we've gained their trust, those groups help us find and reach out to patients in a variety of ways that are mutually beneficial. Of course, that is always done with the patient's permission."

Cantone has a special appreciation for the sensitivity needed to work well with advocacy groups and the patients they represent. Prior to joining Pharmacia, she served on the staff of the Leukemia and Lymphoma Society.

That experience is helpful when marketers feel under pressure to "get a group to do something" for marketing support without knowing much about how those organizations operate. "It is important to find the middle ground between what the marketing people want for results and what a group finds acceptable according to its objectives and limitations," says Cantone. "Having been on both sides, I try to explain that perspective to marketing, so they can better understand what's realistic."

Successful partnering also helps pharma create more patient-friendly and culturally sensitive education materials. Companies should involve volunteer health organizations and multicultural groups early in the re-view process-before announcement and distribution plans are made, not after the fact.

In women's health. Last year, in a crowded hormone replacement therapy (HRT) market replete with confusion and controversy, Pharmacia wanted to cut through the clamor to promote its newly acquired, plant-derived HRT therapy, Activella (estradiol/norethindrone) to target a audience-women ages 45–55 and their physicians. The product helps women manage menopause symptoms and controls breakthrough bleeding.

Concurrently, the American Medical Women's Association (AMWA), a professional organization of female physicians, many specializing in ob/gyn and internal medicine, was looking for ways to engage its members and enhance its reputation with women as a credible source for menopause information. It was a good fit, so a partnership was born.

Pharmacia and AMWA sponsored "Speaking with an Active Voice," an innovative, nationwide grant program recognizing inspired, mid-life women who want to make a difference. The program created a platform for both physician and celebrity spokespeople to promote product messages and educate women about actively managing their menopausal symptoms.

Women were encouraged to apply for grants for new or ongoing projects to improve their communities or themselves and speak to their healthcare providers about menopause.

"To amplify our PR efforts, we coordinated with our direct-to-consumer and e-marketing groups," says Kristin Elliott, Pharmacia's senior director of public relations and advocacy development. The program was so successful, it surpassed planned objectives.

"We reached almost 40 million women 45 and older with our messages and received more than 1,100 grant applications and a huge volume of traffic on the AMWA and Activella websites," reports Elliott. "Research showed that many of these women acted on their newfound knowledge. Everyone was pleased with the results."

In other areas of aging. Now, more patient and professional groups are working with the industry to help meet the healthcare needs of the rapidly growing older adult population.

Pharmacia and Ortho-McNeil recently co-sponsored efforts by a special task force of the American Geriatrics Society, with a membership of more than 6,000 physicians and healthcare workers, to update guidelines for doctors to help their older patients manage pain. "It was very hands-off on our part," says Tom Berry, a physician assistant by profession and associate director of public relations and advocacy development for Pharmacia. "The Society's task force reviewed the literature and determined that the COX-2s should be included in the new guidelines. We supported the American Pain Society on a similar initiative and continue to work with them to leverage their guidelines. We also are building a relationship with the American Academy of Pain Management. That issue is of growing importance to geriatricians and older patients alike, especially the aging baby boomers."

Advocacy groups, pharma companies, the healthcare system, educational institutions, and government agencies also are recognizing the needs and challenges of caregivers.

In the late 1990s, Eisai became aware of the burdens placed on family members caring for older relatives when it was conducting research related to Aricept (donepezil), its Alzheimer's treatment, which it co-promotes with Pfizer. In re-sponse, Eisai formed an advisory council of experts on the subject, including members from AARP, the Alzheimer's Association-Greater New Jersey Chapter, the Hospice Association of America, the Interfaith Caregivers Alliance, the National Alliance for Caregiving, the National Association for Home Care, the National Council on the Aging, the National Family Caregivers Association, and Towson University's Department of Gerontology.

Over a three year period, they developed and field-tested Caring to Help Others: A Training Manual for Preparing Volunteers to Assist Caregivers of Older Adults, perhaps the most comprehensive volunteer caregiver training resource available to community organizations.

"Family caregivers often balance full-time jobs with caring for older family members," says Bill Sheldon, president of Eisai and chair of the advisory council. "By helping community groups enhance or create volunteer caregiver programs, we can increase the pool of skilled volunteer caregivers in communities to improve the quality of care for older adults-and the lives of their families. It was the right thing to do."

Since January 2001, the manual has been available free of charge to qualified nonprofit organizations-those that already have an administrative and program structure in place and a system for recruiting, screening, training and supporting volunteers and have or, are ready to establish, a program for training volunteer support caregivers of older adults. Thousands of copies have been distributed and requests are still coming in. The entire manual is also available online.

For setting that new standard for excellence in training, earlier this year Eisai and its nine advisory council partners received the American Society on Aging's Brookdale Award for Best Practices in Human Resources and Aging. "Candidates for employment are impressed with a company that would take on something like that on," says Sheldon. "So, it also has helped in our recruitment efforts."

Managing the Advocacy Network

Traditionally, pharma senior management has not supported the creation of centralized systems for reporting, maintaining, and sharing information about advocacy relationships across functional areas.

Managers in marketing, sales, policy, government affairs, and public relations have tended to build proprietary networks to meet their functional needs. Each has been reluctant to share allies with others in the company because of their need to maintain control and protect those relationships. As a result, many advocacy relationships overlap, causing inefficiency and double dipping.

But a new trend is emerging. As more companies embrace a team spirit, they also are recognizing the value of public relations and advocacy development across functions and the need to centrally manage and share information about those partnerships. Pharmacia created a global web-based management tool called G.R.O.U.P (Global Resource on Organizations United with Pharmacia) that stores advocacy information from of all of Pharmacia's divisions in one place.

"We track events, funding opportunities, and key contact persons, have a link to each organization's website, and a notes sections where we document each transaction, interaction, and activity. That information is available to everyone in the company," says Berry, who manages the database. In the near future, more pharma companies are likely to use similar management tools for reporting advocacy development. Greater collaboration, transparency, and efficiency also should make for stronger third-party alliances and public relations at a time when the pharma industry needs all the friends it can get.