Successful partnerships with third-party organizations such as patient and caregiver advocacy groups, professional associations, and thought leaders are powerful medicine for pharma companies.	

When the process works, those relationships provide vital support-both for a company's business objectives and for the advocacy partners' missions and goals. 	

This article discusses the public relations discipline of ally and advocacy development as an important business tool and explains how, when done right, building effective alliances with patient, caregiver, and professional groups and experts is a win0win proposition. 	

Partnering with advocacy groups and thought leaders at major research institutions helps to 	

speed the development and approval process for new therapies

inform healthcare providers, patients, and their caregivers about new and safer options for treating chronic and life-threatening diseases

diffuse industry critics by delivering positive messages about the healthcare contributions of pharma companies to legislators, the media, and other key stakeholders 

influence changes in healthcare policy and regulations to expand patient access to, and coverage for, earlier diagnoses and treatments.   

Advocacy groups and thought leaders are critical to pharma companies' success because they are the credible voice of patients, caregivers, and healthcare providers. Effective pharma partnering links company messages with those of influential organizations and individuals when all find common ground. Without such allies, a skeptical journalist may see a company's messages and information as self-serving and describe them as such to their audiences.				

All pharma activities-product launches, clinical trials, CME programs, disease awareness, and patient screening and education initiatives-benefit from having respected third-party advocates as members of the pharma marketing team. 	

Journalists want to interview credible people such as celebrity spokespersons and patients who can publicly discuss their personal experiences with a disease and its treatment, as well as advocacy experts and physician thought leaders who can report clinical trial results and describe in lay terms why a new drug makes a difference. 	

Those partnerships are based on mutual trust and respect. Jeffrey Winton, vice-president of global public relations for Pharmacia, talks about its advocacy partners: "Although they work with us, we don't always see eye-to-eye on everything. They are their own people. We don't try to dictate what they say to whom. As a result it's given us greater credibility. Once you start watering down the messages that those groups and experts want to tell, you might as well forget the value of working with them."	

For years, pharma companies' connections with patient advocacy groups were limited to corporate financial contributions to create goodwill, with no expectation of a measurable return for the company and no real role, as a partner with the donor company, for the advocacy group to play. Most corporations were uncomfortable with the idea of "partnering" with advocacy groups, because they often saw them as activists, unsympathetic to the profit interests of big business.				

Of particular concern to pharma companies were the vocal activism and agenda of the AIDS groups. Until the early 1980s, pharma companies created relationships primarily with professional groups representing physicians, and rarely communicated directly with patients.	

The AIDS community-desperate for access to treatment and promising new drugs-effectively amplified their voices and actions to force change. Pharma, healthcare providers, insurers, and government finally responded by including those groups in a continuing dialogue about every aspect of care. They've been at the table ever since. 	

Soon thereafter, breast cancer groups began to organize and politicize their issues. They modeled their efforts after the AIDS groups to achieve share of voice, disease awareness, research funding, patient education programs, and coverage for diagnostic testing and treatments. At that time, only a few forward-thinking pharma companies recognized the potential return in building true alliances with patient groups. (See PE, "Discovery! Oncology," June 2002 and PE, "HBA's 2002 Woman of the Year Leads Transformation," April 2002.) 	

That model was again used in the late 1980s by Schering-Plough to create the national Prostate Cancer Awareness Week campaign, supported by S-P's marketing efforts for Eulexin (flutamide), a prostate cancer therapy. 	

Partners in that program included Cancer Care, the National Cancer Institute, AARP, the American Foundation for Urologic Disease, the Association of Community Cancer Centers, and the National Association of Community Health Centers. At a time when diseases of the male sexual anatomy were not discussed publicly, their common objective was to inform men age 40 and older-and their families-about the importance of annual testing for prostate cancer, one of the most curable cancers when detected early. During the campaign's three-year run, awareness spread. The topic was no longer taboo, and more than 250,000 men received well-publicized free screenings at clinics across the country.	

"Gone are the days when companies just handed out big checks to groups with no discussion afterward," says Winton. "Now, we seek opportunities with groups that not only help them achieve their goals and objectives, but also help us move our business along." 				

Today, advocacy organizations are smarter about leveraging influence. They still value unrestricted contributions but also welcome cutting-edge information about clinical trials, new therapies, professional or technical support, and other in-kind contributions that help them better serve their patient communities. They have found ways to gain company resources to benefit their constituents without losing their independence. Many of those groups now are run like successful corporations, with a mission, a business plan with goals and objectives, an active board of directors, and accountability to their constituents and contributors.	

Some retain consultants to help evaluate and tailor partnership proposals to best fit the pharma company's mission. "When you look at not-for-profit community groups over the past 10–15 years, they've become increasingly sophisticated. We have to approach them at that level, and treat them as customers, not vendors," says Kristen Williams, senior manager of ally development for AstraZeneca. 	

Pharma companies are gaining a better understanding of advocacy group cultures and how to identify common goals. "Those shared agendas mean enormous benefits for patients and corporate sponsors alike," says Karen Miller, ally development director for AstraZeneca. "Some patient advocacy organizations still have misconceptions about working with pharma companies which must be overcome before all parties can reach common ground." According to Miller, proving worthy of a group's trust takes time, and the burden of proof is on the pharma company. 				

There are many fine examples of advocacy allies at work in the industry.				

In oncology. Because cancer groups are among the most seasoned advocates, prime examples of successful ally partnering continue to be found at companies with strong oncology pipelines.	

Those relationships create an im-portant patient link to clinical trials that can hasten a drug's approval. Recognizing that connection, Pharmacia has worked for the past three years with the Coalition of National Cancer Cooperative Groups, an alliance of national cancer trial organizations, to increase awareness of, and participation in, clinical trials.	

"We've completed a number of successful programs together to educate some of the less experienced patient advocacy groups about the importance of clinical trials in oncology and what those trials offer as therapeutic options to patients who want to get more directly involved in driving their treatment," says Karen Carolonza, director of public relations and advocacy development for Pharmacia. "We've gotten a very positive response from those education efforts. That work also gives us the chance to identify new potential allies for future collaboration."	

Often, advocacy group partners can serve another vital function: identifying patients who fit certain profiles according to their gender, age, disease stage, physician, history of therapies, and locale and who will make good interview candidates for the media.	

"As an industry, we are always looking to tap into what the patient's needs are at a particular stage of a disease and understand how our drugs work for them," says Catherine Cantone, senior manager of public relations and advocacy development at Pharmacia. "Once we've gained their trust, those groups help us find and reach out to patients in a variety of ways that are mutually beneficial. Of course, that is always done with the patient's permission."	

Cantone has a special appreciation for the sensitivity needed to work well with advocacy groups and the patients they represent. Prior to joining Pharmacia, she served on the staff of the Leukemia and Lymphoma Society.	

That experience is helpful when marketers feel under pressure to "get a group to do something" for marketing support without knowing much about how those organizations operate. "It is important to find the middle ground between what the marketing people want for results and what a group finds acceptable according to its objectives and limitations," says Cantone. "Having been on both sides, I try to explain that perspective to marketing, so they can better understand what's realistic." 	

Successful partnering also helps pharma create more patient-friendly and culturally sensitive education materials. Companies should involve volunteer health organizations and multicultural groups early in the re-view process-before announcement and distribution plans are made, not after the fact. 	

In women's health. Last year, in a crowded hormone replacement therapy (HRT) market replete with confusion and controversy, Pharmacia wanted to cut through the clamor to promote its newly acquired, plant-derived HRT therapy, Activella (estradiol/norethindrone) to target a audience-women ages 45–55 and their physicians. The product helps women manage menopause symptoms and controls breakthrough bleeding. 	

Concurrently, the American Medical Women's Association (AMWA), a professional organization of female physicians, many specializing in ob/gyn and internal medicine, was looking for ways to engage its members and enhance its reputation with women as a credible source for menopause information. It was a good fit, so a partnership was born. 	

Pharmacia and AMWA sponsored "Speaking with an Active Voice," an innovative, nationwide grant program recognizing inspired, mid-life women who want to make a difference. The program created a platform for both physician and celebrity spokespeople to promote product messages and educate women about actively managing their menopausal symptoms.	

Women were encouraged to apply for grants for new or ongoing projects to improve their communities or themselves and speak to their healthcare providers about menopause.	

 "To amplify our PR efforts, we coordinated with our direct-to-consumer and e-marketing groups," says Kristin Elliott, Pharmacia's senior director of public relations and advocacy development. The program was so successful, it surpassed planned objectives.	

 "We reached almost 40 million women 45 and older with our messages and received more than 1,100 grant applications and a huge volume of traffic on the AMWA and Activella websites," reports Elliott. "Research showed that many of these women acted on their newfound knowledge. Everyone was pleased with the results."    	

In other areas of aging. Now, more patient and professional groups are working with the industry to help meet the healthcare needs of the rapidly growing older adult population. 	

Pharmacia and Ortho-McNeil recently co-sponsored efforts by a special task force of the American Geriatrics Society, with a membership of more than 6,000 physicians and healthcare workers, to update guidelines for doctors to help their older patients manage pain. "It was very hands-off on our part," says Tom Berry, a physician assistant by profession and associate director of public relations and advocacy development for Pharmacia. "The Society's task force reviewed the literature and determined that the COX-2s should be included in the new guidelines. We supported the American Pain Society on a similar initiative and continue to work with them to leverage their guidelines. We also are building a relationship with the American Academy of Pain Management. That issue is of growing importance to geriatricians and older patients alike, especially the aging baby boomers."               	

Advocacy groups, pharma companies, the healthcare system, educational institutions, and government agencies also are recognizing the needs and challenges of caregivers.	

In the late 1990s, Eisai became aware of the burdens placed on family members caring for older relatives when it was conducting research related to Aricept (donepezil), its Alzheimer's treatment, which it co-promotes with Pfizer. In re-sponse, Eisai formed an advisory council of experts on the subject, including members from AARP, the Alzheimer's Association-Greater New Jersey Chapter, the Hospice Association of America, the Interfaith Caregivers Alliance, the National Alliance for Caregiving, the National Association for Home Care, the National Council on the Aging, the National Family Caregivers Association, and Towson University's Department of Gerontology.	

Over a three year period, they developed and field-tested Caring to Help Others: A Training Manual for Preparing Volunteers to Assist Caregivers of Older Adults, perhaps the most comprehensive volunteer caregiver training resource available to community organizations.	

"Family caregivers often balance full-time jobs with caring for older family members," says Bill Sheldon, president of Eisai and chair of the advisory council. "By helping community groups enhance or create volunteer caregiver programs, we can increase the pool of skilled volunteer caregivers in communities to improve the quality of care for older adults-and the lives of their families. It was the right thing to do." 	

Since January 2001, the manual has been available free of charge to qualified nonprofit organizations-those that already have an administrative and program structure in place and a system for recruiting, screening, training and supporting volunteers and have or, are ready to establish, a program for training volunteer support caregivers of older adults. Thousands of copies have been distributed and requests are still coming in. The entire manual is also available online.	

For setting that new standard for excellence in training, earlier this year Eisai and its nine advisory council partners received the American Society on Aging's Brookdale Award for Best Practices in Human Resources and Aging. "Candidates for employment are impressed with a company that would take on something like that on," says Sheldon. "So, it also has helped in our recruitment efforts."     	

Articles

Features

Successful partnerships with third-party organizations such as patient and caregiver advocacy groups, professional associations, and thought leaders are powerful medicine for pharma companies.

Forging Alliances

In an organizational environment characterized by downsizing and zero-based budgeting, public relations no longer can convincingly argue that the function is justified without evidence of measurable results.	

Successful brand building relies heavily on consumer awareness, product credibility, and creating and maintaining relationships-all desired outcomes of public relations, a versatile discipline that is designed to influence behavior. But how does anyone measure influence? Furthermore, how does a company define the specific behavior it wants to influence and whether or not the behavior changed? Without a solid understanding of what to measure, how can management tell if the results of a marketing and public relations program justify the investment? 	

With shrinking budgets and rising expectations, few companies can afford to allocate financial and staff resources for a business function that can't quantify its value. This article examines the need for clear, concise methods for measuring the success of public relations programs and identifies steps to ensure that the measurement is made.	

For years, the success of a public relations campaign was measured in terms of the number of "hits" or media placements secured. In that sense, quantity was king. The "true value" of each placement was often viewed in terms of a media equivalency rating that estimated the value of each PR placement compared with traditional advertising. PR pros would chant, "Advertising you pay for... PR you pray for," as college interns diligently cut and pasted together impressive looking media-clip books to submit as justification for a month's invoice.				

Although it's true that media placements are a desired outcome of a PR campaign-one that offers a quantifiable number to help judge the success of a specific tactic-it's ineffective for measuring the success of the overall effort. With regard to media hits, the value lies in quality, not quantity. A well-written press release may find itself among the pages of a widely circulated publication, but if the publication fails to target the right audience, the placement offers little real value. Also, media coverage per se does not guarantee a successful program-or a change in behavior or attitudes.	

Today's pharma executives, who rely on marketing and PR programs to support nearly every aspect of the business from new product launches to crisis communications, want a clear-cut justification of PR programs. They look for the desired PR output in media placements, white papers, and speaking engagements, as well as the number of times a spokesperson is quoted, and key messages that are communicated. But now they also look for the quality of PR outcomes, such as how target audiences receive, pay attention to, understand, retain, and act on the messages directed at them.				

Fortunately, pharma companies and their PR agencies can take concrete steps to gauge the success or shortcomings of a public relations program. 	

Demonstrating the Value of Public Relations	

Include measurement methods and projected results. When writing a plan, PR professionals should include an overview of program objectives and projected results to serve as benchmarks for evaluating program results. Those results should be tied to the company's business objectives. If the company's goal is to achieve a 20 percent market share for a specific product, it's important to show how the PR program contributes to that goal.	

Identify the analysis methodology and budget for it. No one evaluation tool is universally applied. According to Guidelines and Standards for Measuring and Evaluating PR Effectiveness, published by the Institute for Public Relations Commission on PR Measurement and Evaluation, useful techniques often employed in combination include media content and placement analysis, cyberspace analysis, trade show and event measurement, polls and surveys-both pre- and post-test studies-and focus groups. 	

In planning the evaluation mechanisms, managers should take care to collect reactive and anecdotal data such as:	

How does PR identify and measure incoming call-center calls? 

How does it measure e-mail and mail response to articles?

If an executive bylines an article, does he or she get calls?

When salespeople make calls, do prospects remember having read or heard of the recent articles or news coverage in question?

Have website traffic patterns changed, and if so, how?

Know which messages are important. Developing key messages ensures that all parties involved are familiar with, and agree on, the most important information to convey to the public. The communication must articulate a company's or a product's positioning and differentiation. Those messages provide a useful benchmark for measuring how well they communicate them in PR materials, how well the media coverage reflects them, and how target audiences perceive and remember them. 	

Craft messages for different audiences. Key messages should be tailored to each audience. The "one size fits all" approach to developing messages is likely to meet the needs of only one group and alienate others. Shareholders, employees, consumers, medical professionals, and the media each have different vocabularies, needs, and interests. When explaining pharma's position on why medication costs are increasing rapidly, the content and vocabulary of the message to consumers should be different from the one directed toward policy makers. Messages to consumers may be as direct and basic as "The many new medications coming to the market help save lives and improve the quality of life for many Americans, yet they come at a cost that forces us to answer the question: "'Who will pay?'" Messages for employer audiences could focus on their particular stake: "New medications can improve the health of your employees, increase their productivity, and avoid expensive hospitalizations."	

Test messages. Target audiences may not as easily understand what makes sense to the management team and its public relations executives. Before implementing a PR campaign, it is important to test key messages among several audiences, including members of the media. Informal roundtable discussions and focus groups are an excellent way to interact with specific consumer segments and gather valuable information regarding the audience's understanding of messages and their reaction to them. Information obtained from those consumers allows PR professionals to refine communications as needed, before launching a PR program.	

Successfully communicate key messages. An extensive collection of press clippings offers little value if it fails to achieve the desired goal. Many constituents get their news from online news services and read the release in its entirety. Instead of using news releases as vehicles to interest reporters in doing a story, companies now use them to communicate directly to target audiences.  				

Consequently, it's important to assess the content of each release for its target audiences. Are messages clear? Is the release stripped of jargon? Do the headline and lead communicate the most important and compelling news? Managers must apply the analysis to other PR communications such as speeches, white papers, articles, pitch letters, and events. 	

Campaign managers should analyze interviews to see if they are in line with the overall goals of the media relations campaign, paying close attention to what worked well and what they should do differently in the future. They must consider the nature of each media clip. Was the story positive? Did it feature the company prominently or merely mention it? Did it highlight key messages? If so, which ones? Where did the story appear and how effective is that outlet in reaching the desired audience? Did the release appear on websites and online services as well as in print and broadcast media? Who attended a PR-planned speaking engagement and did attendees reflect the target audience?  	

Guidelines measuring the effectiveness of media coverage should include	

the media outlet, including its size, scope, and frequency

degree of exposure-mention, feature, or interview

audience and reach-the circulation and readership

subject and topic-who or what was mentioned and in what context. Was the placement an interview, an exclusive profile of the company, or a round up including the competition? If so, how prominently was the company featured?

subjective variables-was the tone positive, negative, or neutral?

Measure changes in awareness, attitudes, and opinions. After all is said and done-the special event is over, the large-scale marketing promotion has come to a close, and the reporters have gone home-how did things change? Did the campaign influence policy makers? Did it make consumers aware of a new therapy? Do physicians understand the advantages of one brand-name pharmaceutical over another?	

Companies can use opinion awareness and comprehension studies to determine the extent to which the target audience received, paid attention to, understood, and was influenced by the message. In general, surveys produce quantifiable data from which they can make projections about larger audiences; focus groups offer qualitative data, which must be interpreted more subjectively. Companies can conduct surveys by phone, mail, fax, e-mail, and websites-as well as in person at shopping malls and through business leads received.	

Recall and retention studies offer valuable insight about the audience's ability to differentiate between the recall of an advertisement and a PR placement-an important con-sideration, because many pharma companies simultaneously conduct advertising and PR campaigns.    	

Analyze changes in media attitude and attention such as frequency of ad placements and tone of coverage.	

One method for evaluating awareness that is often overlooked is to track the kind of reception received by pharma sales reps when they call on prospects. Are prospects familiar with the company and its products? Have they read previous news articles about the company?  	

Measure changes in behavior. How has the PR effort contributed to a change in behavior? Short-term measurement markers include PR's ability to generate calls, e-mails, website visits, and requests for information through the website, call center, or e-mail solicitations. To tie the campaign's effectiveness to generation of sales leads, an internal mechanism must track those responses and ascertain whether they became qualified leads.  	

Long-term measurements of behavior change could include an increase in market share, sales made to leads generated by the PR campaign, changes in physician's prescribing patterns, the inclusion of a medication on more health plan formularies, patients' requests to receive a medication, or an increase in patient compliance.  	

Managers must evaluate the PR function in terms of its ability to advance the pharma company's mission and achieve its goals. The goal of a PR outcome analysis is to ensure that the program meets the company's needs to secure true value for its marketing dollar. Therefore, the development and execution of a PR outcomes analysis is as important as the development and execution of the overall campaign.	

In an organizational environment characterized by downsizing and zero-based budgeting, public relations no longer can convincingly argue that the function is justified without evidence of measurable results.

Burden of Proof

The pharma industry has traditionally defined effective public relations by the number of positive press clips a campaign generates.	

In some cases, several big placements in top media outlets have justified a PR campaign's budget. But not anymore. Clients and their PR counsel must adopt a new definition of high-value partnership. Although pharma company marketing staffs have been downsized, expectations for public relations initiatives have not. Consequently, PR agencies have the opportunity to help pharma marketers deliver on, and exceed, their management's expectations-with a higher return on investment. That is why PR professionals must do more than simply generate great media coverage and provide additional business value. This article offers five ways the new breed of PR counselor goes beyond getting "good ink" to become a true marketing and business partner.	

Trained PR professionals can establish early mo-mentum for a compound by maximizing communications opportunities during the period of clinical trial patient recruitment.				

A delayed clinical trial carries more than just a price tag of $680,000 or more per day. The cost of lost opportunities-market exclusivity, leadership positioning, and thought leader loyalty-are immeasurable. Often, success correlates significantly with how efficiently the pharma company moves a candidate toward marketing approval.	

Clinical trial recruitment/PR strategies are useful in recruiting volunteers into clinical studies and creating a climate of anticipation for a promising new therapy.  	

CTR/PR played an important role in advocating the potential value of Taxotere (docetaxel) as a cancer treatment. When Aventis (then Rhone Poulenc Rorer) initiated Phase III studies, Bristol-Myers Squibb had already launched the first drug in the category, Taxol (pacilitaxel), and had built impressive support from the Department of Health and Human Services, thought leaders, and physicians. At that time, Taxotere was perceived as a me-too drug, making it the target of competitive bashing.	

Yet, based on their own experience, investigators called Taxotere the most effective single agent since the introduction of Adriamycin (doxorubicin), the gold standard of the time. As local television, radio, and newspaper reporters developed stories about enrollment opportunities, they interviewed the clinical team to better understand the trial and drug under study. Through PR efforts, investigators shared hands-on scientific knowledge about Taxotere with the medical community and advocacy groups-enhancing understanding of the product's potential. Taxotere's value was ultimately recognized and today is a billion-dollar blockbuster. 	

CTR/PR intervention also saves time. A patient recruitment effort for a central nervous system treatment study recently cut an estimated 96 weeks from the enrollment process. The campaign combined the impact of an emotionally compelling, call-to-action radio ad about the study with on-site investigator support-local market publicity, advocacy relations, and direct mail descriptions of the trial targeted to referring physicians. Tactics recommended by the PR agency generated 68 percent of trial participants compared with 32 percent at sites without such an initiative.	

R&D project leaders, marketing managers, and PR practitioners should share the responsibility for efficiently moving a product from clinical trials to market. In terms of both clinical and marketing goals, the payoff can be huge. 	

According to research conducted by Forrester, 60 percent of the pharma industry now uses consumer relationship marketing (CRM) technologies to enhance marketing and sales efforts. PR professionals can support that trend by implementing news-worthy e-marketing programs that create brand buzz and build proprietary databases. 				

By facilitating a partnership between the manufacturer of a leading antide-pressant and AmericanGreetings.com, PR used a national health education day to launch a brand-name consumer e-mail marketing campaign. The initiative was designed to reach the 420,500 women between the ages of 25 and 54 who had signed up for a weekly health e-newsletter from AmericanGreetings.com.	

The targeted women received a brief e-mail message from the sponsoring company alerting them to National Depression Screening Day-the news vehicle that created the message's sense of urgency. Consumers then linked to a separate mini-site that hosted a branded interactive self-assessment quiz that let viewers determine if they might be suffering from depression. At the end of the quiz, they received an offer for a free subscription to the Harvard Health Newsletter, along with the opportunity to receive more information about the brand. 	

That case represents another example of how PR professionals can go beyond traditional media relations to support pharma goals. More than 8,000 people who identified themselves as depressed had significant interaction with the brand by simply scrolling through the quiz. Nearly 6,000 names were captured for the client's patient database at a cost of $3.95 per name, compared with about $87.50 per acquisition for off-line direct mail. Further increasing the return on investment was the aggressive media outreach to top-tier general news and health websites. As a result of persistent pitching, the URL for the branded depression quiz ran free of charge on at least a dozen websites known to be visited by the company's target audience.  	

Marketers should always consider working with PR to capitalize on their e-marketing expertise, particularly in light of this statistic provided by Vividence: 72 percent of consumers that visit a brand-name website request the medication. One PR e-marketing tactic for Imitrex (sumatriptan), GlaxoSmithKline's migraine medicine, generated more than 140,000 website visits in less than three weeks using several clever messages sent during the holidays, such as "Sending warm wishes for a headache-free holiday" and "Tis the season for . . . migraines!!?" 	

The new guidelines of the PhRMA Code on Interactions with Healthcare Professionals state that interactions with physicians must be ethical and contribute to the treatment of patients and enhance the practice of medicine. What can pharma companies do to get more face time with physicians without violating the code? One strategy employed by PR professionals is to leverage grassroots community outreach programs that build patient referrals and maximize community networking opportunities for a physician's practice. Those programs, which represent a true public service, can also become branded extensions of a company's DTC program. In competition to build their practices, doctors recognize the benefit of participating in educational and screening events that feature their services.				

Two opportunities for patient outreach lead to physician bonding-bringing the event to the doctor or the doctor to the event. An example of the former is the effort executed by Wyeth in partnership with Impact Health, a clinical marketing organization located in Wayne, Pennsylvania. Equipped with a turnkey grassroots education program, reps invited select practices to participate in bone mineral density screenings that positioned physicians as expert community resources. That program offered a public health benefit that addressed the fact that 30 million women in the United States are at risk for low bone mass or osteoporosis, which is directly responsible for more than 72,000 deaths and $17 billion in medical costs annually.	

Inviting physicians to appear at already established health awareness events gives sales reps another reason to increase their face time with physicians. PR professionals can work with companies to stage educational events at employer sites, retail stores, senior communities, and HealthExpo, the high-touch marketing channel which partners with state fairs. Physicians enjoy speaking at screenings and assessments implemented at those venues-often in collaboration with third-party disease groups with high credibility. Those events contribute to the treatment of patients and en-hance the practice of medicine. The new marketing guidelines mandate that a legitimate third party organization or community group set up such activities. Furthermore, they must not be disguised entertainment nor are physicians allowed to receive anything of personal benefit to them or their families.	

PR practitioners can help pharma companies increase sales by applying social marketing principles to product market research. Social marketing defines a target audience's fundamental barriers to, and motivations for, behavioral change. If marketers can change behavior, sales will increase. For in-stance, a company provides cigarette smokers with a motivational program that helps them overcome barriers to quitting, and it will sell more nicotine patches. 				

To capitalize on social marketing's effectiveness, PR professionals should get involved in the research process early so they can determine several key factors:	

What will motivate the target audience to change behavior?

What barriers prevent people from taking a beneficial action?

How can a PR program address those motivations or barriers?

How will PR support the consumer's decision?  

Where on the "change continuum" is the target: pre-contemplative, contemplative, or relapse? What communication tools must be used?

Will the communication reach the target with the right message at the appropriate stage in the continuum? 

Answers to those questions help PR professionals design more effective programs. Although not-for-profit and government organizations have used that approach for years, few pharma companies design programs using social marketing research to motivate patients to act. One published example of its effective use is Schering-Plough's campaign for hepatitis C. The company's research found that posters placed on public transportation reached target consumers who needed screening for possible infection. The American Liver Foundation was flooded with calls from people wanting to know more about risk factors and what drug to take to prevent transmission of the disease. 	

Today PR professionals must counsel their clients against a backdrop of polarizing issues. Every public pharma company faces increased government scrutiny as stakeholders measure management's credibility and integrity. It is critical, in the wake of the recent business scandals, that companies act quickly to protect their hard-earned reputations, which took years and billions of dollars to build. Experienced PR professionals can help clients identify and manage corporate governance issues using comprehensive diagnostic tools and processes.				

Government relations will also grow in importance, because matters involving R&D, DTC, and access to affordable prescription drugs remain top issues in Congress. Hearings and congressional debate aired by free media will have a significant impact on public sentiment. The PR challenge is compounded by state attorneys general who have initiated legal challenges to reduce prescription drug costs. 	

They are using the courts because there is a growing perception that legal action is the most expeditious way to effect change. What this portends from a communications and PR standpoint is that juries, judges, and public sentiment may have as much influence as Congress in regulating the cost of pharma treatments. So, although government relations will continue to be a priority, perhaps the best strategy to affect regulatory activity is to improve the overall industry image and public perception among those who may someday serve on a jury. 	

Foundation PR represents a viable strategy for accomplishing that. For years, pharma companies have worked effectively to make strategic social investments that address the needs of the disadvantaged, increase access to medicines, and apply industry's tangible assets and intellectual capital to some of the most pressing social issues. And yet, their best efforts and most significant philanthropy programs are often misunderstood or unrecognized. 	

PR professionals can help ensure that the social investments of pharma companies are well known thereby establishing the industry as an engine of innovation that can extend and improve human lives. Great media coverage about the pharma industry's philanthropic efforts and other innovations go a long way toward enhancing the industry's image. 	

But the new breed of public relations professionals will do more than generate positive press clips for their clients. To affect a company's bottom line and its corporate reputation, they will also have a diverse counseling repertoire that makes them valued business partners.	

The pharma industry has traditionally defined effective public relations by the number of positive press clips a campaign generates.

Beyond Great Media Coverage

Investors have lost confidence in the market. Specifically, they have lost confidence in the information coming out of corporate America.	

Since the beginning of the year, the S&P Supercomposite Pharmaceutical Index has decreased 32 percent and the S&P Supercomposite Biotechnology Index is down 37 percent. That is bad news for small companies that need capital to fund their research.	

On the bright side, there is investor interest in the healthcare sector. It is still seen as one of the market's growth areas. But for those looking to raise money, the scrutiny is high and valuations are low. For profitable companies, growth strategies are the focus. Investors looking for development companies seek those with late stage products or a clear game plan and an execution capability offering metrics to gauge progress. 	

For emerging companies with good science, Big Pharma is still looking for partners and investments that will enhance its pipeline and valuations. Those companies must stay visible as well as ensure news about them is is well understood and that it gets the attention of the relevant analysts and the media. 	

What can corporate executives do to improve the situation?  There is only one place to start-at one's own company. 				

PR professionals can highlight the manager's expertise. An experienced management team carries a lower risk than one new to public companies or new to developing and bringing drugs to market. PR can prominently display the curriculum vitae of top managers, scientific advisory board members, and board of directors on the company's website.	

Outline the company's objectives, accomplishments met, and goals for the future. A track record of meeting expectations and goals is a risk reducer. Set reasonable expectations for earnings and accomplishments. Fight the urge to set unrealistic timelines and goals. Missing an important metric or deadline will harm credibility with management and raises investors fear of risk.	

Put together data that outlines metrics set and accomplished over the last three to five years. Use it as a slide in corporate presentations and recount it in news releases. 	

Endorsement by those who are well regarded in the industry is also a risk reducer. Highlight partnerships and investors clearly on the website and in  all news releases. Companies also are judged by the company they keep. Underscore the "burn rate" and where money is being deployed each quarter. Clearly sharing that the company is spending money prudently decreases the risk concern of investors.	

Don't wait for the hard questions related to recent developments and proposals. PR pros should reinforce confidence by offering information such as the composition and compensation of the board of directors and the make-up of board committees. If the company needs to make changes based on recent events and regulatory recommendations, take the initiative. Announce the planned changes.	

Investors and analysts are scrutinizing quarterly reports as never before. Erase the term pro-forma from the corporate vocabulary. Be prepared to discuss earnings after the company expenses stock options. In fact, put that in a news release and join those companies already announcing they will do so. 	

Now is not the time to pull back on investor and public relations. Companies need good strategic communications counsel-inside and outside. Consultants are usually more likely to be objective and forthright with management. Even if the news is bad, communicating it is a necessity. Remember, bad news is often less risky to the market than no news at all.  	

The web is the first place that investors and media seek information. Ensure that information on the company's site is current, complete, and includes the items previously mentioned. Add a section on corporate governance.	

Finally, get on the road. Visit shareholders. Make sure they understand the business model and strategy. Keep them informed and up to date and they will be more likely to stay vested in the company.	

Investors have lost confidence in the market. Specifically, they have lost confidence in the information coming out of corporate America.

Communicate With Confidence

As healthcare struggles to reinvent itself, a confluence of major societal forces has irrevocably changed both the business world and the healthcare landscape.	

Those forces include globalization; market deregulation and privatization of businesses; new conduits of information such as the internet, telecommunications, and media; increasingly complex and technologically sophisticated products; and an unprecedented erosion of trust in corporations and institutions. The changes have also had direct and profound impact on the pharma industry and on the vigor of larger healthcare business, resulting in new communications opportunities and challenges. 	

This article describes communications techniques that address healthcare market trends and needs. It discusses how those techniques are essential and interrelated because of the many stakeholders that pharma companies must reach and relate to, not just once or twice, but in a continuing, mutually beneficial way. 	

The growing importance of building relationships among influencers results from several significant trends:				

Changed stakeholder dynamics that have created a three-dimensional sphere of influencers in constant interaction so that public relations professionals can no longer distribute information merely through linear lines of communication. (See "The Relationship Network," page 20.)

New standards and expectations for healthcare companies and their brands so they deliver a more rigorous, honest, and socially responsible product.

New channels and expectations for information that guides patient loyalty and decisions through access to, and dialogue with, stakeholders. The internet chat room may now pull as much weight with consumers as a product insert-and possibly more.

Above all, an aura of uncertainty hangs over the US economy, and the pharma industry in particular. As soon as the public spotlight falls on a certain area-accounting, management investment practices, the role of directors, or product safety-that area changes not only for the company under scrutiny but often for all companies perceived to share similar attributes. A negative regulatory ruling can, and often does, bring down the entire public pharma sector, not just the stock of the company in-volved. There's no better example of the powerful effect uncertainty can exert over established practices than the new PhRMA Code on Interactions with Healthcare Professionals, which went into effect on July 1, 2002. It affects the way pharma companies handle entertainment, consultants, healthcare practices, and medical education. As a result, companies must find new ways of communicating within the code's ethical boundaries. That will take some trial and error because the rules are still being rewritten. 	

Companies and brand owners find it increasingly difficult to control the market. Branding has been reborn as a business unto itself and not just a promise made to consumers in the marketing of products. The communication must be reinforced over time through consistent messages. Branding requires that actions and messages directed at stakeholders be uniquely relevant to each subset of each target group, as well as integrated and aligned. 	

Brand and company success re-quire building and maintaining trust through open, interactive exchange of information. Consumer activism, the increasing focus on social responsibility, a stronger link between brand identification and corporate reputation, and brands that deliver "experiences"-such as allergy medication taken at a baseball game, not just products, are all solid reasons for investing in relationship building among stakeholders. 	

In the world of pharmaceuticals and healthcare, there are four dominant constituents with which PR personnel must build and maintain relationships.	

Prescribers. This group includes doctors, nurse practitioners, and in some parts of the world, pharmacists. Also included in the category are medical trade reporters and editors. In the past, prescribers had the first and last word about a treatment regimen. They were the source of all information and, with few exceptions their wisdom went unquestioned. Today, open communications channels, a more informed and cynical public, and the do-it-yourself nature of information retrieval have toppled that group from its pedestal. 	

Investors. Individual and institutional investors, analysts and portfolio managers, financial and business trade journalists, business partners, and current and potential employees all require attention from PR professionals. Who'd have guessed that Wall Street analysts' persistent questions about pipeline products' viability might change how a large pharma company prioritizes its research? Or that companies only be judged not only on the basis of their science but also for their ability to maintain a strong balance sheet and make their quarterly numbers-and defend their patents in the courtroom?  	

Consumers. Patients, their caregivers, and immediate acquaintances such as neighbors and relatives as well as personal health reporters make up the third category. This group is unlimited-virtually every human has played one of those roles at some point in life. 	

Overseers. This category consists of regulators, thought leaders, formulary directors, and anyone else who has an impact on pricing, market accessibility, and exerting external controls. 	

The information and communication needs of each group are distinct. PR exists to create and facilitate lines of communication to build relationships among them. Although there have been profound changes in the ways that media spread that communication through talk programming and pop culture, media is not the be-all and end-all of public relations. 	

PR is not short for press release. Rather it is about creating trust, understanding, and awareness. It's about facilitating communications among internal and external stakeholders and coordinating numerous functions, including corporate communications, finance, science, knowledge, and marketing. 	

Following are some burgeoning areas of current PR practices: 	

This subset of investor and financial communications was at the forefront of company attention in the late 1980s, along with issues such as social responsibility and executive compensation. It faded into the background for a while, to resurface again as a result of the recent accounting scandals.	

 Transformed during the last decade, public affairs is now another PR function, largely because healthcare-with the government as a payer and protector of the citizenry, has become a political issue. The entire industry-its pharma and managed care subsets-has come under scrutiny. Both policy makers and shareholders continually question and challenge its business models. In the healthcare arena, issues management has become an integral part of success: If a company can't or won't manage the issues, the issues will manage the company. The benefits-such as fewer hospital stays for patients who comply with their medication program-of every new product, service, or technology must be rationalized and leveraged to gain policy makers' approval. 	

Obtaining appropriate coverage and reimbursement for a product is essential today; it is a function of issues management. How the attributes of the product are positioned to persuade payers to provide appropriate coverage and reimbursement is as fundamental to any product's success as regulatory approval. There's no guarantee of coverage for any approved product and no guarantee that, even if covered, the level of reimbursement will approach the actual price of the product. Thus, it is incumbent on the company to develop open lines of communications to convey the message that reimbursement be adequate. PR professionals, who have established lines of communication, can advocate for beneficial policy changes. 	

Health-related companies share a common attribute: they are all, without exception, capital-hungry. Financial and investor public relations come into play as critical components of capital formation for the company. A stable, supportive shareholder base can do more to keep the cost of capital low and help raise critical funds than all the media blitzes in the world. On the accounting side, a key new activity is communicating the value of intangibles-such as corporate social responsibility, trustworthiness, and being a high-quality employer-and what they add to the pharma and biotech businesses. 	

Corporate governance is again coming to the forefront. Companies need to assess and benchmark themselves against peers' corporate governance practices in a whole range of areas. Credibility is essential. Thus, the task at hand for PR professionals is to communicate management competence and compliance, both consistently and credibly.	

 This evolving discipline has become particularly important in the last six months, as basic trust in senior management has eroded. Ten years ago, healthcare providers were near the top of the public's most-trusted list. That trust has withered away. Former partners are now enemies. Motivations are suspect. The internet and the changing model of how information flows and is managed has short-circuited the relationship between corporate spokespersons and the public, making that arena more complex to manage. Even beyond the high-profile cases, trust in the leadership of US companies has eroded. Corporate reputations must be managed and integrated with social responsibility, especially in the pharma and managed care industries, which have been under everyone's microscope, not just the government's. Companies need to study models of good citizenry and determine how they, too, can achieve that stature.	

 The direct-to-consumer (DTC) trend has refocused the attention of PR professionals as well as advertisers in an effort to grab a share of the public's attention. Sponsorships of entertainment events and product endorsements by sports and media personalities are just one new twist. It is critical to understand the importance of public relations in the media mix: DTC does not begin and end with advertising alone. 	

 Third-party messages are an essential means of communication for validating scientific credibility, for legitimizing products, for building brand and disease awareness, and for building defenses against crises. As advocates develop louder voices, pharma companies must forge alliances and win allies. Those partnerships can be complex to manage, take a long time to develop, and require a strong foundation of trust. The golden rules of advocacy relations are to start early to build relationships among key stakeholders such as third-party professional groups, consumers, authors, and healthcare providers, and to find the quid pro quo with advocates. 	

 According to Pew Internet and American Life research, six million individuals go online to research health-related topics every day. It's not just the internet, but also the interactive nature of today's society that drives companies' healthcare relationship management opportunities. The internet is a digital marketing tool that can help create and enhance relationships among stakeholders.	

So what does PR stand for? It stands for powerful relationships. The heart of PR is third-party credibility. It may not be able to eliminate the uncertainty that permeates today's environment, but it can be used as a means to master it, through building the relationships and offering responsible, credible, and substantive information and content through multiple communications channels.	

As healthcare struggles to reinvent itself, a confluence of major societal forces has irrevocably changed both the business world and the healthcare landscape.

Thriving Amid Uncertainty

If pharma companies want to be trusted sources of information in today's healthcare environment, they cannot afford to mislead anyone.	

The recent business scandals and growing demands for corporate responsibility will have an impact on the pharma industry that goes well beyond financial practices. The confidence crisis is forcing corporations in all sectors to confront a variety of social and ethical issues, but pharma companies are likely to face exceptional challenges. 	

Consumers already are more critical of pharma than most other industries. The general public is conflicted between the reality of pharmaceuticals as a business that needs to generate profits to invest in new cures and the perception that the industry puts profits before people. Public confidence in the reliability of the information and clinical data provided by pharma companies has been weakened further by recent revelations about the dangers of hormone therapy-a treatment long promoted by the industry as essential to post-menopausal women's health. In this difficult environment, it is especially important for pharma to reexamine the standards for disseminating information about drugs in the pipeline. 	

Every year, pharma companies spend millions of dollars promoting clinical trial results and investigational compounds. How that information is communicated affects stock prices, company reputations, and the potential rewards of senior management.	

How should companies address those challenges in a socially responsible way? When is it appropriate to publicize scientific data? Should news reporters limit coverage to large, controlled, late-stage trials? How should media convey scientific data? The Journal of the American Medical Association recently raised those questions when it published a theme issue on the peer review process in biomedical publications. Two studies specifically address growing concerns about reporting scientific data to the public. 	

An examination of press releases issued by scientific journals found that such communications exaggerated the value of data and failed to include the role of industry funding. In a separate study, the same group determined that abstracts from national medical meetings received news coverage without prior evaluation by the scientific community. The authors expressed particular concern about the types of abstracts that received attention, because many were based on preclinical findings or studies involving small patient populations. Approximately one-quarter of the study data presented at medical meetings and promoted through press releases remained unpublished in scientific journals up to three years after the event. Although the authors fault journal editors and meeting organizers for the preliminary coverage of medical news, those issues ultimately have a negative impact on the pharma industry and the agencies that serve the industry.	

Wall Street's financial expectations impose new pressure on the industry to communicate data at an early stage. The resulting news coverage affects both patients and physicians. According to a Wall Street Journal article, "Leaky Lid on Science News" by S. Hensley, et al., July 25, 2002, one study found that news coverage of scientific data also influences clinicians who cite studies that appear in the lay press more often than studies that do not. Investors regularly use information released by the pharma industry for progress reports and financial analyses. 	

With careful planning and appropriate language, communicators can disseminate scientific data responsibly, both to the public, and to the Street. Reports of clinical trial data always should include the type of study, such as placebo-controlled or double-blind, as well as the number of patients in all arms of the study population. Second, press releases should express data numerically rather than by description, provide both absolute and relative percentages, and clearly indicate statistical significance or trends. Third, communicators should only use adjectives such as "landmark" or "breakthrough" when a study is truly a landmark or the data represents significant new learning. Finally, press releases should reveal investigators' relationships with study sponsors.	

The burden of appropriately reporting data to the media and the public rests on the pharma industry. Failure to provide suitable reports may result in the requirement that FDA approve all communications before they are distributed. Or, the industry could impose a set of guidelines on itself for the presentation of scientific data to the public. Such self-regulation would ensure that data are conveyed accurately and reported responsibly. In so doing, public relations counselors could help pharma companies be perceived as more trusted sources of clinical information.	