PR's Cognitive Approach
Would you eat spinach from California? Would you feed your dog pet food from China? Even now, the repercussions of the notifications
that those products have a serious risk associated with them persist. The problem isn't only that the media communicated the
objective messages of the risk, but that there was a "social amplification" of those risk messages played out in Congress
and in reports of regulatory bodies, then communicated repeatedly in the media.
This same type of social amplification has significantly complicated risk communications. Vioxx is a classic case study. After
Vioxx was withdrawn, lack of support of the drug safety surveillance system and Congressional inquiries continued to communicate
and to amplify the perception of problems associated not only with Vioxx, but with the entire healthcare system.
The public's understanding of Vioxx's risks was greatly influenced by the resultant publicity. Attitudes about the drug, Merck,
and FDA were continuously created and updated by processing the press accounts through means both active (e.g., by reading)
and passive (e.g., by listening to TV in the background). Because media coverage—not necessarily objective information—drives
the amplification of risk, public relations will play a heightened role in the new Culture of Drug Safety.
Risk-First DTC
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Companies need to tap PR experts who can draw on more personal communications with patients. This is particularly important
when major risks are disclosed and when consumers "reform" their perceptions of a product to integrate the new information.
Cognitive psychologists say the information patients have received most recently is more available in memory and is most likely
to influence decisions. Therefore, it follows that companies that wish to compete will have to understand what consumers believe
and why they believe it—and learn how to balance newly formed beliefs with effective messaging. The new "risk-first DTC" ads
for Celebrex are one example of this approach. (See "Risk-First DTC".) Evaluations, whether conducted online, through periodic
surveys, or formal RiskMAP reviews of patients' and physicians' beliefs about drug safety, will be increasingly important
to influence and maintain a "fair perception" in the minds of prescribers and users.
A New Supply Chain of Information
The advertising and PR industry is always looking for new ways to reach and influence physicians, patients, and the public.
Now the pharmaceutical industry, out of necessity, is also looking for new avenues. Expect pharma companies to look to consumer
goods (not necessarily consumer agencies) for ideas.
The omnipresence of the Web and the ease of market entrance means medication- or health-related Web sites will continue to
grow. Consumers and physicians will gain more control over the content of these sites as they contribute and influence what
is communicated online. What some are calling Web 2.0—essentially, community-based participation on the Internet—will evolve
rapidly and will significantly change the power relationship in terms of the information supply chain.
Within the pharma industry, the transmission of information has traditionally been "top-down"—that is, from marketers to customers.
Expect an increase in "bottom-up" communications. This happens when customers initiate the communication and pharma companies
are the passive audience. One example is the recent arrangement between the American Medical Association and Sermo, an online
physician-only community. Doctors are free to post any information on the site, but they mostly use it to ask other docs about
their treatment experiences.
How can pharma participate in such a bottom-up form of communication, where the audience (in the case of Sermo, physicians)
initiates and controls the dialogue? Sermo is still working out the details, however, it appears that pharma will need to
adapt to a new role as a information resource for doctors with little ability to control messages and communications. This
appears to fit better into the medical-communications and medical-science-liaison "buckets" than classical marketing communications.
(Full disclosure: I consult with Sermo and some other companies with innovative communication models.)
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