Of all the things that agencies don't want you to know, this is the biggest secret: your corporate reputation often doesn't matter much.

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The truth is that none of them can point to much research that shows any link between what people think of a pharma company and how much money it makes. A few corporate reputation programs do work, but most are, at best, a tax write-off. Some crisis management programs pay for themselves but most just produce big binders that people use to decorate their offices.

How do I know this, and why should you believe me rather than the extraordinarily well-paid people from all those ad and PR agencies? I used to run subsidiaries of several of those companies (Hill & Knowlton and what's now Publicis, for example), and I've consulted for others. Baird's CMC (the group where I'm co-Chairman) has run major market research programs evaluating the reputational impact of various disasters and of corporate social responsibility programs for five of the top ten pharma companies. Of course, I have to be careful telling you exactly what I've found out: clients deserve confidentiality and former employers deserve to have their intellectual property protected, but there are a few major principles that have run through the last 25 years of my professional experience. Here, for instance, is how your stakeholders see you:

Policymakers and those who influence them ("civil society" in the jargon) cannot differentiate well between Big Pharma companies. Ask them who has the best reputation and the answers are unlikely to follow a predictable pattern: in the US, a few more will mention Merck or Johnson & Johnson than others; in Europe, some will mention national champions but even they are unlikely to be able to tell you why they feel the way they do. A tiny number will differentiate on the basis of pricing or corporate decisions, and even those that do are often wrong about which companies they perceive as good or bad.

Health activists are obsessed by intellectual property, patents and tiered pricing. Or they seem to be: we did global research in a red-hot policy area among community opinion leaders. We guaranteed their anonymity and then asked them to talk about the big health policy issues. None spontaneously mentioned anything remotely close to patents or drug pricing. When we prompted, many said that this was a game played by governments, insurers and companies. They, as activists, would play the part expected of them, but they did not take it very seriously. Could any of them pick out companies that were particularly good or bad on these issues? After a lot of prompting, about two in ten could and they usually picked the market leaders. For 99.99 percent of the world, patent pools, voluntary licensing agreements and differential pricing are meaningless.

Consumers do, of course, care about how much they personally pay for medicines, which is why pharma companies are so much more unpopular in the US (where most people pay something) than in, say, the UK (where very few pay anything at all), but consumers in most countries do not think there are expensive companies and good value companies. (If they did, I'm not sure of the impact: an Indian friend was horrified that I was taking an Indian brand of painkiller—he only bought the equivalent, imported European brand that cost 25 times more and must, therefore, be better, he thought.)

Prescribers differentiate on the basis of products or of research that they have been exposed to firsthand. In a few areas, patient support programs and patient compliance programs are starting to build enough corporate reputation to justify some price premium. In no area can you find a significant number of prescribers who refuse to prescribe (or even say they are less likely to prescribe) products from a particular company because of the corporation's behavior. If you were going to see this at all, you would see it in HIV where groups such as the AIDS Healthcare Foundation and ACT-UP have called for boycotts of one product or another. We have looked very hard, but have never found it.