The Image Makers

Health information is a global fundamental right. By making it informative as well as communicative would not only make it 'user friendly', but would take the pharmaceutical industry and its business to an entire new level. Aashruti Kak explores the business side of communication

Healthcare business communication may have existed since long, but its role in the post product patent regime, with the entrance of multinational companies (MNCs) in India—and hence, tough competition—has been central to keep brands alive and kicking. "The role has been designing support 'show and tell' materials for the medical representatives (MRs) to use when they meet the doctors for various products," says Dr Mehul Shukla, President, Lintas Healthcare. "It now has become more brand building and not just medical communications leaflets, extending to 360 degree doctor/patients/care giver connect programmes," he adds.

Cashing in on this shift in role, past few years have seen big advertising agencies moving into healthcare communication, setting up separate healthcare divisions, to cater specifically to companies that want their 'India specific' brands to enter the Indian market. Considering that in healthcare, communicating the needs, dispelling myths and clearing misconceptions is highly important; the move has been more than welcome by pharma companies. In addition, launching a healthcare communication and marketing arm has also provided these agencies an alternate source of revenue. Some examples include Lintas (Lintas Healthcare launched in 2001), Suddler & Hennessey, Ogilvy & Mather, FCB Ulka, Euro RSCG Life and the most recent, Publicis Worldwide with the launch of Publicis Healthcare.

"India is now the most remarkable in pharma marketing and development, one of the most volatile markets. Looking at all the figures for India, if the value of the pharma market is around Rs 500-900 crore, the value of communication space within that is about Rs 300-400 crore, which is probably because of the explosive nature of pharma and healthcare markets. Putting a figure to it is an act of purist optimism." says John Cahill, Group President, Regional Director and Representative Director, McCann Healthcare Worldwide. According to Cahill, when McCann Healthcare started, about 70 percent of its clients were pharma companies. In markets like China and Japan, 60 percent of its clients are pharmacos, and in Australia its 50 percent. "Approximately 65 percent of clients at Lintas Healthcare (India) constitute pharma companies. Their investments in communication are approximately two to five percent of their brand revenues. For Lintas Healthcare the percentage revenue from pharmacos would be about 65-70 percent," says Shukla.

Increasingly, the market is also seeing a change to wellness (curative to preventive), which is why most of the agencies have built expertise in wellness as well. At the global level, there is a stable of agencies competing with each other in the healthcare business communication space, namely, WPP, Ogilvy & Mather (O&M), Doyle Dane Bernbach (DDB) from the Omnicon Group, Publicis Healthcare and so on. Among the local freelancers who have been with pharma companies since ages, some agencies are Mudra Healthcare, Indegene, McCann Healthcare, O&M: Healthworld, R K Swamy, Suddler & Hennessey (WPP), Oxygen Healthcare, Sorento Healthcare, and so on.

At your service

"You will start to see by way of public private partnerships, participation in health programmes, corporate social responsibility — also the willingness to dialogue at a level with doctors, patients, governments is already upon us. We just need to give it a little more time" - John Cahill Group President, Regional Director and Representative Director McCann Healthcare Worldwide

"There are major signs that the marketing teams in this industry are looking beyond just talking and communicating with doctors. But most of the communication is still conservative. Experimental and aggression is still a while away, unless the campaign of Ipill is something that we hold on to forever." - Dr Mehul Shukla President Lintas Healthcare

"Each pharma company may want different strategies to be executed pertaining to its needs," says Cahill. "What we try to do with them is to improve the overall spectrum management—product launches, getting endorsements from key opinion leaders, continued education to prescribers, always gets a better market potential for a brand," he adds. These agencies partner with pharma companies as they move from the molecule stage to the market. He continues, "We can make information more meaningful in the life of a user-prescribing doctor, key opinion leader, or a trial, a patient or a consumer using the product to improve health. In order to facilitate public health we hold efficient communication programmes in collaboration with various governments, we also work with various NGOs and the industry as well through public private partnerships (PPPs)."

Shukla says, "Strategies differ based on the marketing problem that communication needs to address. There is certainly a preference of limiting the entire marcom (marketing communications) to prints and gifts (mainly Indian pharmacos)."

Most of these agencies provide services for pre-launch market preparations, managed entry programmes, new product launches, refreshing existing brands, extending life of old brands, strategic planning, brand development, concept, copy and design, advertising, detailing materials, direct marketing, meetings support, training programmes, conferences and exhibitions, electronic media, full print and production services.

A good example of services provided is McCann Healthcare's service platform—'A day in a lab to a day in life'. "Our service platform is a roadmap to how a healthcare product comes to life—be it a drug, a new chemical entity (NCE) or a chemical in food—it always starts with evidence (does it work, does it change anything, does it improve life and so on). The commercial value of the brand is highly dependent on the evidence, run by key opinion leaders and industry individuals as well," explains Cahill. He continues, "We have experts (Complete Medical Group) in dealing with evidence, making it meaningful, and discerning education materials to doctors. At the same time they create evidence working with CROs." Moving forward, the evidence starts taking the clothing and mantle of the brand, using the emotional attachment, offering doctors what the brand can offer him, and then it moves into the education of the prescribers. Then the evidence reaches the patient as they use the drug and he/she is educated on the proper use of the medication.

Cahill elaborates, "There are a lot of stakeholders that are going to get involved in the chemical entity of a brand, and there is going to be a lot of communication sources required, that is where we focus—how can we make these stakeholders more powerful and informed, and what all will be necessary to do that?" The complexities of talking to so many stakeholders have to be addressed. Talking to key opinion leaders, government regulators, politicians, prescribing doctors, nurses, pharmacists in a more organised manner enables them to build on collective wisdom leading to more successful launches, better speed to market for NCEs and brands. He continues, "It makes sense to group it all together and make a platform, we call it the 'brand management platform', which is now available in India. Some healthcare communication organisations may have various parts of this platform, but they haven't put it together in the way we have." He adds, "You would be surprised that the way a key opinion leader talks to another leader, the way he/she talks to a prescriber, a prescriber talks to a patient, is vastly different in US, the UK and Asia, their relationships are different. Which is why we have rebuilt our service at a local level."

Not subtle anymore?

So, are pharma companies in India shifting from subtle to aggressive communication? "Not yet," says Shukla. "There are major signs that the marketing teams in this industry are looking beyond just talking and communicating with doctors. But most of the communication is still conservative. Experimental and aggression is still a while away, unless the campaign of Ipill is something that we hold on to forever. Except ads like the doctor day greeting etc where mainly the company name and less of their brands are visible, there is not much of surrogate advertising," he adds. According to Cahill, surrogate advertising can be done, if you are looking at disease awareness. "Some of the work we do in markets is to look at how do we improve people's understanding of the disease and make them more informed enough to seek medical advice or intervention," he says.

It is a fine line which separates a brand promotion and advertising and communication designed to educate. This is where the distinctions worldwide for all regulators are becoming a point of interest, says Cahill. "Where we make a difference is that we preserve competence, advertising agencies, and evidence units. So, we are quite clear with the clients which part of the repertoire of the communication part is designed to educate, and we advise that they should be commercially mutual so that the quality of the evidence can be understood. And then, when you feel the need to actually add the brand repertoire (brand in scientific information), then just be overt with it—that this is a promotional piece supported by evidence. I am sure that most of the pharmacos understand the need of that," he says.

In the absence of direct-to-consumer advertising of prescription medicines, pharmacos have to communicate the appropriate scientific benefits of their brands to doctors to drive the market. Because of ever increasing competition and lack of time inside the doctor's chambers pharmacos use other ways to influence the doctor by the way of incentives, which could become unethical. "It's a hot potato. I think as long as doctors are not being coerced into making ill informed decisions, its fine,” says Cahill. “The US is examining the current regulation that would enable companies and communication agencies to embark upon educational and promotional activities. Our platform clearly delineates education from promotion. I think the regulators will also be waiting to reach that destination," he says.

'Villanous corporate'

Considering that the pharma industry is always in the deep of all controversies and rumours, what can these communication agencies do to 'buff up' the industry's image? "Tough one, I think the entire process has to begin with a conscious effort from the industry to be more proactive in delivering healthcare knowledge and investing into an informed patient," says Shukla.

"When you play in health there are always irrational and highly emotional concepts, one of them being—'should I be making money from health'. The industry has been through a number of years; the dissonance lies in the way the industry may have tackled questions in the past," opines Cahill. It is true that there is a consciousness building all over the world, which is moving towards a better understanding of what are the true values that it should be supporting. "I think you will start to see by way of public private partnerships, participation in health programmes, corporate social responsibility, engagement in long green activities—also the willingness to dialogue at a level with doctors, patients, governments is already upon us. We just need to give it a little more time," he adds.

The world is changing, even drug marketing may move to a new level, where issues about accessibility will slowly be taken care of, partnerships between stakeholders and industry would rise, therefore, would cast out the thought that maybe we are moving towards a more social marketing approach in healthcare, even for the pharma industry. According to Shukla, the future of healthcare business communication is big, simply because healthcare as a sector is still in its infancy. It will be more of audio-visual than print. Brand building shall be the key driver, rather than just medical informative product literatures. "Brands are still important, brands are still strong. We now need to have a good look, particularly at emerging markets, how we communicate and do so in marketing and manufacturing of drugs so that we can address issues," concludes Cahill.

aashruti.kak@expressindia.com