Four Steps To Credibility

THERE is a lot of talk these days about the importance of the pharmaceutical industry establishing trust with the American public. The prevailing public opinion is that the pharmaceutical industry puts its own interests above the general good, emphasizing business over health.

Even though drugs make up less than 20 percent of healthcare costs and recent changes to Medicare have expanded drug coverage, consumers complain about the price of drugs and the value for the money. Health authorities question industry's interpretation of clinical data and single out drug promotion as misleading and encouraging inappropriate use. In fact, industry is working hard on several fronts to demonstrate its commitment to patients and improving health, but a lack of credibility continues to haunt it.

The political and regulatory environment has also worsened the situation. In May, the Senate passed a bill that would give FDA new power to police industry on drug safety, mandate label changes, regulate advertising, and restrict use of medications that present serious risks to patients. The Senate was reacting to a loss of confidence in FDA and its ability to adequately regulate the industry.

Turning this situation around relies, in part, on the delivery of fair and comprehensive information about the value and risks of medicines and recognition among healthcare stakeholders that the industry alone can't solve what's wrong with the healthcare system. Better public health education—with an early focus on nutrition, exercise, and the avoidance of disease-provoking behaviors—would do more than drugs to improve health and reduce healthcare costs.

But information coming from pharma can also be improved to better educate the public and dramatically reduce the criticism that is so often evident in media coverage. Like the pharmaceutical industry, the media is a business too. And the media have what industry needs: access to millions and the credibility to carry its messages. But reporters have limited time. They need audiences coming back for more, and controversy sells. It is a Darwinian world.

Building a brand and a company's credibility in such a world requires a commitment to rigorous science and even more rigorous and open communications. We are moving in that direction more vigorously now than at any other time in recent memory, but such change, urged upon by so many stakeholders, requires more of everyone. Here is what industry might do with its communications to accelerate the process:

1 SET APPROPRIATE EXPECTATIONS AROUND CLINICAL TRIAL INFORMATION

Too often, we promise miracles rather than realistic improvements. Or we declare the science conclusive when other interpretations are clearly viable. The industry needs to avoid high-stakes debates over the proper use of drugs. We can do a better job by examining what we know—and don't know—about a medication when it is introduced and by developing and communicating more content to doctors and patients across a brand's lifecycle for more informed decisions. Today, it often seems as if patients and payers know more about a new drug within the first 12 months than the maker has learned during its development, and they are sharing the information widely. Over time, critics make their case felt, as they did with antidepressants and COX-2s. When voices are raised, brand leaders should examine the evidence and take the concerns seriously. If the brand's reputation and the company's integrity are to be preserved, a responsive tone must be set by those at the top of the organization.

2. CUS ON TARGET MARKETS, NOT THE WORLD

Many DTC advertisements have made the mistake of trying to drive product demand among the mass consumer market rather than a specific group of patients. With such broad appeal, audiences sometimes had trouble distinguishing Claritin from Clairol and Nexium from Nike. The problem with targeting the entire world is that drugs rarely work for everyone—and the entire world doesn't care about a brand's message, only about its ethics. Powerful product advertising messages link brand names to life and health, but also to profit in the minds of a skeptical public. And there's the rub: The more popular or prolific a brand becomes, the more likely it is to encounter criticism and controversy. This pharma literacy is a fertile breeding ground for detractors whose mission is "protecting" the public interest. It also makes new product launches, and new disease-awareness campaigns, highly suspect to the world outside a target marketplace. There are some very important reasons to cross the bridge between the target market and the rest of the world—to sensitize supporters and opponents, for example—but knowing when and why (and which communications disciplines to use) should be part of the analysis.

3 ACCEPT PRIVATE IS PUBLIC

This lesson has been learned more than once, but it can't be stressed enough. Even with the need to protect intellectual property and keep competitors at a disadvantage, our communications can have a huge impact on how the company is perceived. Think of your brand as a reflection of the corporate mission, credo, and reputation. What does the company stand for? What does your communication about a brand—to the sales force, the media, physicians, patients, investors—say about your company and its character?

4. RELY ON SCIENCE AS THE BACKBONE OF THE BRAND PROMISE AND MAINTAIN A PATIENT FOCUS EVEN IN THE FACE OF NEGATIVE NEWS

Today, brands are more valuable and more vulnerable than ever before and, consequently, when a new medical insight emerges that challenges our thinking about the safety or efficacy of a brand, the first impulse might be to deny it. When a medical insight is gleaned from a large or small study—often independent, but not always so—it can be misinterpreted as a marketing threat.

The temptation may be to say the finding is an anomaly or attribute it to a class effect or a fault in the design of the study. But while the concerns for the business may seem paramount, they should never delay the need for further fact finding, particularly where outside consultation might protect the brand and possibly the public health.

The debate about the appropriate use of antidepressants to treat young people is a case in point. As concerns about antidepressants and suicide emerged, pharmaceutical companies dismissed the insights. Later, when those claims were substantiated, companies were criticized for concealing unfavorable clinical trial data. The FDA was ridiculed well for dragging its heels and silencing its own staff members who believed the drugs were dangerous for some kids.

Blaming antidepressants is a simplistic answer to the question of why some children attempt suicide, but, ultimately, the drugs were on trial and received black-box warnings. Despite the turmoil and initial backlash caused by the public hearings, industry and FDA ultimately benefited by taking a mutual gains approach to the problem—a model we should embrace more often in these situations. They acknowledged the concerns of others (parents and critics), offered contingent commitments to minimize impacts (black-box warning and monitoring recommendations for all antidepressants), and accepted responsibility and shared power by encouraging joint fact finding (with companies and independent experts at Columbia University).

In effect, all parties acted in a trustworthy fashion to protect the public health. More than 15 medical, advocacy, and government organizations contributed to a new Web site www.parentsmedguide.org) to help educate and guide those with questions about depression and medications. (Unfortunately, a disclaimer exists on the site: No pharmaceutical funding was used in the preparation and maintenance of this guide or the Web site.)

Clearly, industry has a ways to go to earn the trust it desires and, on many levels, deserves. But the media will continue to remind us how far we have to go and whether, for many Americans, the pharmaceutical industry is part of the cure or part of the problem. For an industry confronting such a question, it's important that all companies do well.

Richard Chamberlain is president of Chamberlain Communications Group, an inventive Health company. He can be reached at rchamberlain@chamberlainpr.com