Wednesday, February 04, 2009

Pharma: Earn Back Your Trust Before Hell Freezes Over

Yesterday, I posted comments made by Pfizer's global PR chief, Ray Kerins, who asked "How in the hell do we [the pharmaceutical industry] have such a bad reputation?" (see here).

His "core strategy" for improving Pfizer's reputation and model for other pharmaceutical companies is to "engage and educate" more journalists more often.

It's not Kerins' fault that he sees better PR as the solution to Pharma's image problem -- he is, after all, "PR chief" (AdAge's moniker, not mine). Hell may well freeze over, however, before the PR-only strategy works.

The industry, like the economy, needs more than cheerleading PR to regain the trust of consumers and physicians. I included some suggestions for real actions pharmaceutical companies can take to improve their image and I received other suggestions from commenters to my post and from S&R Blog, which I just discovered.

Kim D. Slocum, who has worked in the biopharma industry for over three decades and now is “retired” but doing consulting work for the industry, said this:
"The industry's problem is equal parts 'image' and 'business practices.' Both are going to have to be addressed and the latter probably has to precede the former. Sales & marketing models (with the ongoing set of fairly ugly revelations that appear in the press on a regular basis) have to change dramatically. It's hard to have a good image when many of the major firms in the business are or recently have been operating under Federal Corporate Compliance Agreements.

"The industry's salvation probably lies at least partly in the one thing folks are running away from as fast as possible--comparative effectiveness review. That process done well (with industry help on how to analyze data properly) could at one stroke reduce patient co-pays, thereby eliminating the out-of-pocket optics problem. It would also cut the need to spend 20%-30% of revenues on promotion by a significant amount as well, thereby ameliorating another big image issue. That might actually offer up the possibility of improving profitability while also improving the public perception of the industry.

"Finally, industry needs to be paying a good deal more attention to the bigger environmental & policy issues that can have such a large effect on business conditions. In part, industry got into this mess because it largely ignored things like multi-tier co-pay models (which simultaneously raised patients' out of pocket spending on pharmaceuticals and their ire at the industry) until the process was well advanced. This game is now about to get replayed in the specialty Rx arena and the fallout will be considerable.

"Industry can't simply invent its way out of these problems, as much as it might like to. However, by understanding its channel partners (such as employers, CMS, and health plans) and working with them more collaboratively, it can probably get to an equitable solution for all concerned. That would do more to enhance the image of the research-based firms than just about anything else."
Kim, I believe, was on the R&D side of the business before he retired, which may explain his views on the commercial side of the business. “Sales & marketing is the single biggest budget block on any firm's income statement," he told me. "DTC [direct-to-consumer advertising] is now a big line item, the ROI is questionable and it draws a lot of political fire," he added (see "The Future of DTC Advertising," Pharma Marketing News, REPRINT#81-01).

Don Schindler, another commenter and a digital marketing strategist, also mentioned promotion as a problem:
"Drug companies (to me) are a lot like the oil companies. Even though they are doing tons and tons of research, people and media focus on their profit. You profit in good times and bad times by having a necessity with a healthy margin.

"They also spend a ton on push DTC TV marketing. The constant 'screaming' about the population's disease problems is really, really depressing. ED, depression, anxiety. Just because you have the money doesn't mean you need to burn it openly and ignoring my actual needs.

"I'm working with my first pharma client and I'm surprised by the regulations that keep pharma companies from connecting with their consumers (FDA regs). Pharma companies (health in general) is so open until it comes to drugs. Then everything is behind iron curtains. The FDA seriously needs to reconsider this. It is effecting the drug company's reputation the most.

"Stop beating me up with interruptive advertising (calling it awareness) and start engaging me when I need you - with online education and my doctor's CME."
I am not sure what Don meant about "iron curtains," but it could have something to do with hiding negative clinical trial data from the public and from physicians. His comment on "interruption" vs engagement "when needed" is interesting and is good advice for Pharma PR people as well.

Speaking of interruption and physicians, I found this post ("It’s Time To Earn Back The Trust – Part 1 — The Sales Representative") on the S&R Blog:
"After 37 years in the pharmaceutical business I can finally say that I am embarrassed by the industry that once gave me great pride, confidence and a feeling of really contributing to the good of society. Yes, the pharmaceutical industry has contributed to our overall well being with amazing innovation, life-saving therapies, improvement in our lives, longer life and immense cost savings. But a great deal of formerly well-deserved respect for this industry has evaporated as it has lost the trust of its most important customer – the physician. How do I come to that conclusion? I listen, I read, and I watch.

"Our industry has lost much of its clout by marginalizing its greatest asset: its sales force. The pharmaceutical detail rep was once regarded as a valuable, credible source of information. Physicians looked to the “detail man” for information about new and existing products, insights into how these products were most effectively used, and the presentation of clinical data that supported the efficacy and safety of any given product.

"Yet over the course of 15-20 years, the 'detail man/woman' has lost the shine and presence that once existed. Fewer and fewer physicians will now see pharmaceutical representatives. Yes, that is often because of increased demands upon their time, but also because many physicians now find the representatives less informative, less trustworthy, and less engaging. Many physicians look at sales reps as mere 'lunch delivery' people. How did this happen?

"It happened for a number of reasons. A recent conversation with a group of physicians indicated that the sales reps no longer brought anything of value to the discussion. And this is something I have heard, read, and watched for the last 5 years. According to this group of physicians, reps typically had watered-down sales presentations, used poorly designed sales materials, and spouted 'robot-like' information that centered only on what the company wanted the physician to know.

"Another reason often mentioned is that today’s sales representatives are not very knowledgeable about the products they sell, much less the diseases that these products are supposed to treat. Many physicians have stated that it is hard to believe a sales presentation when the rep simply does not understand the disease, its processes and the pharmacology of how a given product acts.

"Adding further fuel to the discussion is a continuing suspicion that the pharma companies are not totally coming clean with their data. Reps are simply repeating the 'good' data but will not discuss the fair balance and sometimes negative data that often comes years after the product has been released. This nagging suspicion has brought many physicians to the level where they simply don’t trust anything that the company says, be it the sales representative, promotional materials, even educational presentations.

"So, amongst all this skepticism, how might the industry proceed to reinstall the trust, confidence and relationships that were once so welcome?

"First, retool the sales force. Make reps knowledgeable by providing high quality levels of training on disease state, pharmacology, and the products that these reps are asked to sell. This also means that reps need to understand their competition as well as they do their own product to be able to effectively differentiate their product where possible.

"Second, provide sales reps with effective and efficient sales presentation skills. It’s not just about the presentation of product information. It’s also about listening, hearing, and understanding the physicians’ concerns and recognizing that your product can’t be everything to every patient. Understand the product’s limits and speak about them honestly.

"Third, stop scrubbing data. Present the real data, the real truth and make sure that the physician truly understands the appropriate types of patients and conditions that best suit the use of your product. This is a critical factor in bringing back the trust and credibility.

"Finally, help the sales reps build relationships with their physicians. Provide them not only with the real product and disease information that they can share, but also provide them with the tools and services that make the physician’s office life easier – e.g. reliable, unbiased patient information; real and balanced educational opportunities; a sales rep with personality and common sense.

"The industry will only regain a presence and place at the table by providing highly qualified and knowledgeable sales reps. That is the first piece of the trust puzzle. More to come later!"
I don't know who the poster is, but he/she also makes a point about transparency (ie, "not totally coming clean with their data"). I can't wait to read Part II!

So, we've discussed Pharma's image as it relates to both consumers and physicians and some ideas on how the industry must CHANGE -- not just TALK -- to address the problem. I welcome your comments and suggestions.


  1. Great article, John.

    Coincidentally, earlier today I posted a somewhat related article titled "What Is The Proper Relationship Between Doctors, Patients, And Drug Companies", which provides on overview of five different and distinguished points of view on this important social policy issue. The full version of the underlying five relatively short articles, which appear in the February 3, 2009 edition of BMJ [British Medical Journal], are available for FREE to those who are interested in reading more.

    Here is a link to my blog post:

    Keep up the good work.

    Tom Lamb

  2. Anonymous10:44 AM

    Thanks for posting my comment. What I meant by Iron Curtains was the lock down on information pertaining to their products. I want to know both the good and the bad.

    In today's age everything is free including information and I should be able to get it, ask questions about it and talk to someone that can intelligently answer my questions via the way I want to talk (chat, email, blogs, phone).

    The FDA needs to open it up for customers to directly engage these pharma companies and have more conversations. We need to know there are real people behind the scenes (which I suspect there are) and let them really talk about why their products are so important to me.

    Over 145 million people are online searching for health while over 60 million U.S. adults are Health 2.0 consumers – reporting to use health blogs, online support groups, prescription rating sites, and other health-related social media applications. - Manhattan Research

    But pharma has its hands tied in touching this environment and becoming a useful source for us without the spin.

    The pharma companies should be using those expensive lobbies to go after changing the FDA.

  3. Anonymous9:55 AM

    Great post, John. And thanks for posting a story from the S&R Blog.

    The author was Dave Recht, CEO of S&R Communications Group, and I really think the TRUST issue between pharma companies and physicians needs to be highlighted in more columns like yours and ours.

    Ayubu Azizi
    S&R Blog

  4. Anonymous10:01 AM

    From the perspective of a former veteran big pharmaceutical representative:

    A Brief Manifesto Designed For Employed Pharmaceutical Representatives

    The word, ‘Manifesto’ is one of Latin origin, and means ‘to make public’. It’s an open statement of standards related to good behavior based on principles.
    What will follow are not in any way directives or rules you should adopt in order to be successful. Nor am I as a veteran ex-big pharmaceutical representative suggesting the contents are an outline of an ideal pharmaceutical representative. So, these are some simple, yet possibly preferred, ideas I wish to offer to those who are pharmaceutical representatives regarding the nature of their vocation, and the image of your industry as it exists today that needs to be improved:
    Never park your free company car closest to the entrance of a doctor’s office or clinic. Obviously, both places treat sick people- some worse than others. Aim for the back of the parking lot. Exercise is good for you. Others need that ideal parking space more than you do. Show some consideration.
    Upon entering a medical location, such as a doctor’s office, if you happen to notice more than one pharmaceutical representative sitting in what may be a small waiting room, leave immediately and return at another time. Don’t be so insistent or persistent that you disrupt those in that waiting room who need to see the doctor much more than you do.
    Conversely, a similar suggestion is that if you enter a waiting room of a doctor’s clinic, and there are no other drug representatives, and only a few patients waiting to be seen by the health care provider, consider striking up a conversation with one of these patients as you both wait to see the health care provider. This rarely if ever happens- drug reps having a nice conversation with a patient in such a manner. You know, they are not Lepers, and you might provide some public relations for the industry that employs you.
    Make an effort not to become vexed if you are unable to see one of your targeted prescribers that you desperately feel a need to speak with, or else you will view yourself to be a complete failure at your vocation.
    More importantly, if such a health care provider accepts your promoted drug samples from you without you interacting with them, this in itself will influence their prescribing habits more than you may realize. So I suggest you visit such offices, regardless if you see the prescriber or not. You still will or may have a positive effect on what you feel you need to do with your job.
    However, if you have an opportunity to be invited into the medical office to ‘check samples’, which means an opportunity to speak with the health care provider, make an effort to read the environment in this patient treatment area you are a guest in at this time.
    For example, are staff members in this patient treatment area moving quickly? Do they appear overwhelmed? Are you not receiving any eye contact or dialogue from such staff members? Does the health care provider seem less than jovial? If so, don’t discuss any business issues at such times. The doctor and his or her staff have more concerning issues than your presence there, and certainly more concerning than any needs you feel you may have. Likely, you will visit this same location again and again.
    As you continue with your career, strive to learn as much as you can about not only the benefits of the medications you promote, but also the disease states for which they treat. You are, or should be, viewed as somewhat of an expert with both. So many others in your profession are a bit apathetic regarding any interest with medical issues, and the importance of restoring the health of others. Quite frankly, if you have no interest in medicine or health care, you should consider another job.
    Furthermore, and as with so many other pharmaceutical representatives, I’ve read those aggressive and angry statements from other pharmaceutical representatives on the ever so popular Cafepharma website- that great bathroom wall where others express their anger in the written word. I know your concerns as a pharmaceutical representative, as well as the ridiculous activities you are required to do by your employer at times that either appear or in fact are pointless and absurd.

    With this said, I suggest you not be in a constant state of understandable anger or unhappiness as you work during the day visiting those in the medical community. People, including pharmaceutical representatives, are more transparent that you may realize (psychopaths are an exception). Those in the medical community that you interrupt (and you do) would rather not view you as upset or joyless if you are fortunate enough to visit them at their medical facilities. Attempt to make yourself in a presentable mood before entering such medical location. Who knows? You might actually make another’s day. Try gently to make medical staff laugh appropriately, for example.

    Also of particular note, and this applies in particular to rather large pharmaceutical corporations, there seems to be a constant theme with their sales forces: Members of these sales teams are always striving to make a favorable impression for their employer- specifically their manager. This in itself is understandable and not necessarily a bad thing to do in the corporate world.

    Yet do not ever confuse creative or innovative acts that may be misperceived by you, and are actually unethical if not criminal activities you may engage in upon your own discretion, or upon a recommendation from another employee you work with at your pharmaceutical company. It happens often at times, and it is not a good thing for many others. So I suggest that you learn about laws relevant to your profession as a pharmaceutical representative. There are many, and you are likely not told these legal statutes and acts mandated by lawmakers by your employer at all.

    Why do pharmaceutical representatives follow at times directions of this nature by their superiors, as uncomfortable as it may be for them at times?

    This happens for two reasons: First, it’s understandable with a pharmaceutical representative that if their superior directs them to implement certain activities related to their employer’s objectives, it is reasonable to conclude that such acts planned deliberately are in fact ethical and legal. So rarely do pharmaceutical representatives ever question what they are told to do by their employers and managers. To be clear, this scenario of potential wrongdoing is possible, yet not always.

    For example, do not ever engage in what is called quid pro quo. This is Latin as well, and means, ‘this for that’. For example, just because you buy the staff of a medical office lunch, or leave the health care providers samples of your promoted products, or placed a fancy TV in their medical clinic- these gifts do not mean in any situation that the doctor owes you prescriptions for the medications that you promote to such doctors. If your sales numbers are down, do not blame the medical professionals in your territory in such a way, and it happens at times.

    Finally, there are certain intrinsic human traits that others rarely discussed or examined, and I believe they should be acknowledged. Examples include qualities such as character, integrity, or kindness- as well as honesty. I’m not suggesting that you consider such moral and ethical concepts if they are of no importance to you. What I am suggesting is that you discover the meaning of such words and at least consider the possibility of acquiring such traits within you if they are absent. At the very least, consider the value of such traits, and this may be for your benefit as you continue through your lifespan.

    Thank you for your time,

    A seasoned pharmaceutical representative.

  5. Anonymous6:54 PM

    I think there is one reason the physician's see less value in their representatives...the FDA demands "mandated ignorance". Use a single word or phrase that the FDA does not like (even if it is 100% correct and accurate) and it could cost a company BILLIONS of dollars. Never mind talking about disease states outside the PI focus, how other physicians are using the drug or the latest research, even if it is from JAMA or NEJM without the expressed written consent of the company, lawyers, FDA, and can not share that information.

    Until the government and the industry can come to a reasonable and valuable way to exchange information, than Mandated Ignorance is the mantra of the current sales rep.


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