PRESCRIPTION MARKETING: Trying to reach consumers is a hard task for UK drug companies, reports Julian Tyndale-Biscoe

It is hard to imagine a UK sector in which it can take 12 years and cost £350m to develop a licence for a product, yet it is a criminal offence to then promote that product to consumers.

Even worse, a sector where product patents are lost overnight, leaving the way clear for rivals to market generic versions and wipe millions in revenue from the original patent-holder. But this is the pharmaceuticals market.

Pharmaceutical companies are not only facing increased competition and regulatory hurdles, but also a drop in research and development and downward price pressure.

Research and development is one key battlefield. Companies must have products in their decade-long pipe-line. But the investment required to develop a drug is a deterring factor, and the sector is facing up to a shortage of R&D activity.

"Everyone knows Pfizer is likely to make its numbers for the next two or three years," says Jan Leschly, chief executive of venture capitalist firm CARE Capital and former chief executive of SmithKline Beecham. "But what happens in three to four years if it doesn't have new drugs in the pipeline? If it hasn't been more productive in R&D, it won't continue with it."

Merger growth

Pharmaceutical companies are banking on faster development times and higher success rates cutting the cost of developing drugs. But in the meantime, there has been a huge growth in merger activity, much of which has been driven by a lack of drugs in the larger firms' pipelines.

Datamonitor analyst Linda McNamara thinks licensing partnerships and mergers - such as the acquisition of Pharmacia by Pfizer in April - will become commonplace. "Big firms are interested in acquiring smaller companies to boost pipelines. Johnson & Johnson, for example, has a history of such practice with the acquisition of Centocor, and has since moved on to Scios and the Link Spine Group."

Yet no matter how much faster development times become, or how many mergers are made, it remains an offence to promote prescription-only drugs to UK consumers.

The only people manufacturers can advertise to directly are health professionals, such as GPs. And these ads have to fall within guidelines drawn up by the Association of the British Pharmaceutical Industry (ABPI) that go well beyond the legal requirements controlling the advertising of prescription medicines. The guidelines are administered by the Prescription Medicines Code of Practice Authority.

This is not the case in the US or New Zealand, where drug companies are free to advertise directly to consumers - and spend billions doing so.

The pharmaceutical companies are obviously in favour of adopting this approach. Some in the UK agree, maintaining that consumers would be better-informed if they could be approached directly.

John Young, marketing director at Pfizer, argues that evidence shows consumer ads in the US have led to more patients being appropriately diagnosed and treated for diseases such as diabetes.

"We believe that provision of information can make a significant difference by helping to raise awareness of serious medical conditions and encouraging patients to discuss their condition with their doctor or another healthcare professional," says Young. "Although provision of information on medicines to consumers would need to be done in a way appropriate to the UK, there are significant benefits for consumers and the NHS in patients simply having access to information on medicines that their doctors have."

However, it is unlikely that the UK will adopt the US approach.

One reason is that the US is moving even further down the road of self-regulation. Continued government crackdowns have resulted in some of the biggest healthcare fraud settlements in US history - in June, AstraZeneca agreed to pay $355m (£221m) to settle charges over the way it priced and marketed prostate cancer drug Zoladex.

These settlements have stung the Pharmaceutical Researchers and Manufacturers of America (PhRMA) into action. The body has updated its ethical code on advertising to professionals in an attempt to ward off government regulation.

Fair market

Consumer advertising of drugs could also give large pharmaceutical firms a distinct market advantage, meaning it is unlikely to be allowed in the UK. Experts believe it would mean the end of the road for small and medium-sized companies. "There would be such an increase in spend that they would be wiped out," claims Michael Clarke, international marketing director at Shire Pharmaceuticals.

But perhaps the most significant sign that the UK will not adopt direct-to-consumer activity was the introduction of guidelines by the Medicines and Healthcare Regulatory Agency (MHRA) in December on the promotion and sale of drugs (see box).

The agency takes the stance that a campaign should not encourage an individual to approach a prescriber to request a particular medicine. The guidelines question whether the disease awareness campaigns, used by many pharmaceutical companies to raise awareness of conditions for which consumers require their drugs, are promotion or education.

Pharmaceutical companies have tried several ways to engage and influence consumers: PR, online and SMS - all of which focus on informing consumers about the disease, rather than promoting any particular drug.

One such PR campaign was 'Ticket to Health', fronted by actress Joanna Lumley, which was conducted in 2000 to raise awareness of travel health.

It highlighted the number of travellers to 'at-risk' destinations who fail to get advice or protection before travelling.

The activity was sponsored by GlaxoSmithKline (GSK) and backed by third-party organisations such as the British Travel Health Association, Association of British Travel Agents and Royal College of Nursing. Media coverage was extensive, meaning GSK was able to raise awareness of the need for its travel vaccines for diseases such as tetanus and hepatitis A and B.

Setting up web sites that focus on long-term conditions such as asthma and heart disease is another approach.

Although these sites don't point consumers directly to a drug, pharmaceutical companies are often mentioned as sponsors. The view taken here is that many patients actively seek information on the internet and are asking more from their doctors. This is more often the case with the less deferential under-50s.

Sponsored by Janssen-Cilag, whose drugs include contraceptive pill Cilest, www.evriwoman.co.uk was launched in June to provide an overview of contraception methods and related information on sex and relationships.

Meanwhile, www.actionasthma.com offers support and advice for sufferers of asthma and their families.

It was developed by Allen and Hanbury's, now part of GSK, whose asthma treatments include Seretide, Beconase and Becotide.

The site offers news on the latest research as well as the chance to e-mail questions to an expert. A key element of this kind of information campaign is the chance for pharmaceutical companies to strike up a relationship with patients with whom they would otherwise have no direct contact.

Consumer techniques

But using online and offline awareness campaigns is being overtaken by consumer marketing techniques borrowed from sectors such as FMCG. Text messaging, for example, is becoming popular.

Gloria Gibbons, chief executive of healthcare communications agency Shire Health, says: "We believe consumer marketing techniques applied to pharmaceutical marketing can give a completely different perspective to a challenge and we have seen them deliver outstanding results."

Gibbons highlights the current approach Shire has taken with EVRA, the first contraceptive patch, launched in June. Although a prescription medicine, research among 18- to 35-year olds showed that many users wanted to be reminded when to change their patch. Text messages are now sent to remind them to replace their patch once a week. Shire also ran a press launch for EVRA.

Recent NOP research showed launch activity had generated 49% awareness among the target audience (women aged 16- to 45-years-old) within a month.

Gibbons says Shire Health is running multi-channel programmes that begin by communicating with consumers. She talks of "taking their hand and walking them to our space", where it is possible to build brand relationships with consumers.

A spokeswoman for AstraZeneca says that it is the highly competitive nature of the market that is forcing companies to be a lot more creative and focus on consumer needs.

"AstraZeneca is looking at getting more customer insight and we have internal initiatives that are designed to help us deliver what the consumer actually wants," she says.

Faced with tough controls on the way drugs are marketed, this creative focus is crucial for any pharmaceutical company that wants to stay one step ahead.

UK GUIDELINES

Guidelines were developed by the Medicines and Healthcare Regulatory Agency (MHRA) in conjunction with the Association of the British Pharmaceutical Industry (ABPI) and published in December 2002.

They were necessary because disease awareness campaigns are becoming a popular feature of medical information in the UK and the principles set out to ensure these campaigns remain effective but do not break the law.

- Disease awareness campaigns must be used to increase awareness of a disease, rather than promote a medicine. Thus, many pharmaceutical manufacturers sponsor web sites or awareness campaigns in conjunction with charities, rather than promote a specific drug.

- A campaign may make reference to the availability of treatment options, but must not encourage individuals to approach a prescriber with a request for a specific medicine.

- The source of the campaign should be clearly identifiable.

- In instances where there is only one or very few leading treatments, it is important that the campaign focuses on health and disease education, with details of where to get advice.

- Campaigns must give information that is accurate, up to date, substantiated, comprehensive, balanced and fair, as well as readable and accessible.

UK PROMOTIONAL METHODS

Prohibited by law from marketing their drugs directly to consumers, pharmaceutical marketers are tapping into mainstream marketing techniques to reach consumers.

INTERNET: For individuals who are not yet patients or are simply trying to find out more about their condition, specialist web sites can be used. These are not brand-specific and are usually sponsored by a company in conjunction with charities.

E-MAIL AND SMS: For existing patients. The focus is on trying to ensure they keep taking the product, so pharmaceutical firms are starting to use e-mail and text messaging to remind consumers when they need a prescription. The Data Protection Act means patients have to sign up for such services.

POINT OF SALE: Manufacturers can issue point-of-sale material to healthcare professionals to give out when prescribing a certain drug. It can also be given to pharmacists to give patients when they dispense a treatment.

PR: Used by pharmaceutical marketers when launching drugs such as EVRA, the first contraceptive patch, or disease awareness campaigns.

CONSUMER OPINION OF DTC* ADS

Inform people of new treatments 84%

Encourage people to find out more about

the condition a drug treats 83%

Alert people to symptoms of a condition they may have 80%

Are used responsibly by the industry 64%

Scare people into thinking they have conditions they don't 61%

Cause tension between doctors and patients 36%

Source: Prevention Magazine

*Direct to consumer

A GP'S PERSPECTIVE

Dr Andrew Herd,GP, Spennymoor, County Durham

With the last dregs of the coffee supped at 8.30am, I call the first patient, settle in the chair and rouse myself to wakefulness.

"Good morning, doctor. Have you seen the MyPharma web site? I only ask because I read the most fascinating article there about my condition and I was wondering what comments you might like to pass on it, in view of the medication the practice has maintained me on.

"If you take a look on page 40 of this print-out it says that the meta-analysis of the trials definitely points to using an ACE IV inhibitor in combination with a low dose of Apropanol, rather than the diuretic and ACE II that you have had me on for the past ten years. And anyway, shouldn't you have been checking my creatinine rather more often?"

Go on, you come up with a good reply to that one. GPs are by their very nature generalists. We are at our most vulnerable when a patient hits us with a pinpoint attack like the one described above. And on the whole, I am grateful it doesn't happen too often. Although we are seeing the beginning of a move toward shared responsibility for care, most GPs still lack experience of how to deal with super-informed patients, and encountering one can be extremely stressful.

It has always been a nightmare of mine that pharmaceutical companies might gain the right to advertise direct to patients, because (with due respect) the best medicine is always driven by a healthy dose of scepticism.

The wider perspective is the first casualty of aggressive marketing campaigns.

The worst case of a marginally effective viral remedy being relentlessly pushed on primetime TV during an epidemic might overwhelm primary care's capacity to cope with demand.

And yet, with restraint, coupled with adequate regulation, a different approach to information dissemination might benefit everyone, informing the patient to a level that allows decisions to be taken in partnership with their doctor.

Consultations like the one I outlined above are rare at present, and though their incidence is increasing, GPs are far more likely to be confronted with a crumpled newspaper clipping than a crisp stack of computer print-outs.

But times are changing and, with careful management, the web might yet become the primary portal for health education.

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