On the heels of ABC's Peter Jennings special, "Bitter Medicine," which aired Wednesday, May 29, 2002, one can make a strong case that the pharma industry has a lot of fence mending to do. The program charged that direct-to-consumer advertising acts as a ruse to foist drugs on a gullible public, that pharma's big legal guns manipulate patent laws to squelch competition, and that the industry is unilaterally motivated by profit.

In the show's aftermath, the Wall Street Journal (June 13, 2002) published the results of a joint poll with NBC News showing that distrust of pharma companies is at an all-time high. The report says the public's low regard for the industry could influence the outcome of legislative and regulatory issues in which it has a stake. As Congress considers steps to bring down drug prices, 54 of those polled expressed negative views about pharmaceutical makers, and 39 percent said prescription prices "are the least justified" of price increases among a list of consumer commodities. Public anger once directed toward managed care companies is now directed toward pharma.

Although few in the industry would agree that "Bitter Medicine" was a balanced account of industry practices, pharma's silence has been surprising. Alan Holmer, president of the Pharmaceutical Research and Manufacturers of American (PhRMA), ventured an overly measured response to Jenning's accusations, citing the high cost of developing drugs and bringing them to market.

The lack of industry reaction only reinforces the public's perception of an "evil empire" interested exclusively in profits. Whether the public's irritation is based on reality or perception is not the issue. A constant barrage of negative news coverage aimed at an entire industry invariably places that industry in the cross hairs of public attention. Despite the facts, people act on perceptions and prejudices. Public fears lead to high anxiety and fuel changes in the body politic. Laws are often shaped in response to those changes in popular opinion. The movement in many states to impose new regulatory constraints on pharma companies reflects that trend on one hand and furthers it on the other. Provider organizations have begun to push back at pharmas as well. According to the Health Care Advisory Board, "Boston's Massachusetts General Hospital has instituted a new policy designed to restrict pharmaceutical company sales representatives' access to the hospital." Once the pride of America, the pharmaceutical industry is now under attack.

The key to reversing that erosion in popular support involves a slow and thoughtful process of healing and reconstituting the relationship between the industry and its many publics: funding agencies, providers, and consumers. What it needs is a new customer-centric vision based on a deep understanding of public needs.

The problem is that the media has defined the public debate. Now, pharma companies must take immediate steps to reframe it. Unless they can effectively take the lead in reshaping dialogue with each of their publics, they face the danger of squandering a rich public legacy.

Listen, Learn, Empathize The industry must listen to the critics, then reframe the conversation based on what they say. Many forces, including fears about healthcare cost increases, consumer activism, and availability of healthcare information, herald the need for a new consumer-centered focus that begins with active listening to consumers and providers alike. Inviting public dialogue would be a bold first step. Building on the extraordinary contributions that pharma companies have made to people around the world, industry leaders will serve each other and consumers by encouraging healthcare consumers to voice their needs and desires.

In this interactive age, if properly educated and aware, consumers can become champions of pharmaceutical innovation. Of course, fostering a new image amid high public anxiety over terrorism, volatility in equity markets, and the economy will call for unusual leadership. In an environment in which the high-profile scandals of Enron and Worldcom have all but shattered public trust in corporate leadership, there are formidable obstacles. The situation demands a visible demonstration of leaders' social awareness-and empathy in particular-to soothe the public's negative emotions, calm their fears, and assuage their anger.

Empathy-communicating an understanding of the experience of another-is essential to establishing trust, and it is a critical aspect of leadership. In addition, an empathic perspective is key to fine tuning messages that will help place the industry in greater contact with the public. That falls into the domain of what author/psychologist Daniel Goleman calls "primal leadership," or tuning into the emotional channels that create resonance between people.

Industry communications should be aimed at taking people's feelings into account. Bold messages-such as "We will make every attempt possible to make sure that the people who need medications receive them"-show that individual concerns are being given thoughtful consideration and will earn high marks from the public.

Trying to please everyone is futile.

But the present situation calls for an up-front honesty and sensitivity showing that the industry understands the public's healthcare challenges and not just its own bottom line.

Change the Debate The industry must move to change the terms of engagement and shift the battle to a new plane. It must educate the public to see the big clinical picture and not just drug costs in isolation. The industry could demonstrate pharmaceuticals' value with messages such as "Let's look at medicines as a vehicle to contain costs, instead of containing costs as the vehicle for access to medications. Research shows that proper use of medications saves consumers money."

Greater access to pharmacologic therapies has allowed and will continue to allow consumers to avoid costly hospitalization. It has offered relief from disabling illness and alleviated suffering. Jennings gave lip service to those points, but a more deliberate response from selected industry spokespersons could have made a vastly stronger impression. Instead, the public heard simply that industry spokesmen "chose not to comment."