Krish Kapoor, Bedrock Healthcare Communications
Medical communications (“medcomms”) agencies supply the pharmaceutical industry (“pharma”) with communications and marketing materials to help these companies better connect with patients and healthcare professionals. With trends for international harmonisation and consensus competing with resurgent nationalism, along with falling trust in the industry and the rise of emerging markets, the robust pharmaceutical industry is likely to face significant challenges in coming years. How will pharma and medcomms weather these changes, and what will medcomms look like in the years to come?
Performance pressure: pharma and medcomms today
In recent decades, biomedical science and the pharmaceutical industry in particular have made great strides in addressing a wide range of diseases, many of which were once terminal. Formerly untreatable diseases such as HIV, haemophilia or rheumatoid arthritis are now chronic conditions, managed through long-term use of medication, along with monitoring and support from healthcare professionals. During these transformational decades, healthcare has developed into an incredibly competitive and noisy market. With the low-hanging fruit of drug discovery already picked, pharmaceutical companies are finding the return on investment from their research and development is falling, increasing pressure to invest in only the most promising products, and to ensure that everything possible is done to ensure a drug’s success, even before launch. Accordingly, pharmaceutical companies spend a significant and ever-increasing proportion of their revenue on sales and marketing activities, often more than is spent on R&D (Fig. 1) (BacterioScan, 2016; Dobrow, 2016).
The medcomms industry offers marketing consultancy services to pharmaceutical and healthcare companies, advising them on how best to deliver accessible information about medicines and their use, and supporting the formulation and delivery of promotional and educational campaigns. While this includes pharmaceutical advertising, it is much broader including topics such as disease awareness, and unlike consumer advertising, these campaigns are obliged to be firmly backed up by clinical data.
Medcomms agencies offer their clients a wide range of services, commonly including the publication of clinical trial results, organisation of conferences and symposia, creation of educational assets for healthcare professionals, promotional materials for prescribing physicians, or educational leaflets or websites for patients. With a broad client base, and an even broader range of audiences, many in the industry are armed with both postgraduate qualifications and expertise in science communications – i.e. the ability to dissect clinical data, and turn it into a coherent message for the audience in question, be that in spoken, print, or digital media, all of which have distinct places in medical marketing campaigns (Fig. 2).
A changing world
Over the last few years, information technology has transformed communication, particularly internationally, by breaking down borders, slashing timescales. Accordingly, leading clinicians and researchers have influence which stretches across the globe, and everyone from politicians to healthcare professionals and patients increasingly aware of geographic discrepancies in drug approvals and healthcare delivery.
As a result of these trends, healthcare standards between the more economically developed countries of the world have increasingly harmonised. While the drug approval processes of the major regulatory agencies still differ (Van Norman, 2016) steps are being taken to bring their processes into alignment, particularly for urgently needed drugs such as novel antibiotics (Mezher, 2017). Adherence to international standards for pharmaceutical labelling (ISO 11238), medical device manufacture (ISO 13485) and conducting clinical trials (e.g. ISO 14155), for example, are all also increasingly important. This harmonisation extends into medcomms too, with three of the key bodies in medical writing, the American Medical Writers Association (AMWA), the European Medical Writers Association (EMWA) and the International Society for Medical Publications Professionals (ISMPP), collaborating to develop a global gold-standard for medical writing (Clifford, 2017).
Despite the above trends towards harmonisation, it is difficult to ignore recent shifts in political climates away from integration. Political opinion across Europe has shifted towards a more nationalist and Eurosceptic mood, most evident with the ongoing Brexit saga, and more recently the results of national and regional elections in Hungary, Italy, Sweden, Germany and Spain. On a more international level, tariffs are being raised and trade wars initiated between the USA and many other countries. At the time of writing, it’s difficult to tell whether this is a mere hiccup in the shift towards a more interconnected world, or a new trend back towards the primacy of the nation state, but there is widespread concern regarding how these factors may impact on, international healthcare industry, including the movement of life-saving medications across borders (Liu, 2018). Within Europe, Brexit is likely to have significant impact on the medcomms and pharma industries, as the UK has been a leading player in both. With the planned departure of Britain from the EU, and the consequent move of the European Medicines Agency from London to Amsterdam, there are some who wonder if the Netherlands’ pharma and medcomms industries will see a boost of investment. It’s also possible that the global pharma industry will prefer to focus on the attractive tax rates of Ireland, the EU’s soon to be largest remaining native English-speaking country. Many medcomms agencies are increasing their footprint on the mainland (PMLive 2017; Jones, 2018a; Jones, 2018b; McConaghie, 2018), to try to ensure smooth business no matter what outcome finally emerges. The medcomms industry already employs a significant cohort of freelancers, often working from home or across borders – and may increasingly rely on these groups until a more certain picture of the future emerges.
Expectation, trust and global opportunity
Healthcare also has another huge problem: while health literacy is (happily) on the increase, trust in the pharmaceutical industry is at an all-time low. This is against a much broader social collapse in trust. During the UK’s Brexit referendum campaign, Michael Gove once stated that “people are tired of experts”, and little since has cast doubt on that assertion. Between concern about fake news and pressure for improved transparency, there’s no doubt that the traditional top-down mechanisms of communication are less and less fit for purpose. In terms of medcomms, this is leading to several transformational shifts. For example, key opinion leaders may be losing ground to the opinions of consensus groups, while patient representatives are finding the greater importance that they deserve. Both prescribers and payers are increasingly sceptical of clinical trial data (where non-adherence and patient comorbidities are the exceptions rather than the rule), favouring real-world evidence collected on larger everyday patient populations wherever possible (though this data is only available once a drug has been launched, and is also notoriously challenging to collect) (Taylor, 2018). More broadly, pharmaceutical companies are also regulated more tightly and scrutinised more heavily than ever before, which has led to a higher standard of communications and sales practices, meaning that the clinical data has never been more crucial to the quality of communications messaging.
Competition within the pharmaceutical industry also means that most companies no longer just market drugs, rather they are becoming suppliers of service packages, of which the drug is a single, albeit major, component – other aspects may include enhanced patient support, physician education, fellowship grants, or patient monitoring and diagnostic services. Though increasing drug costs are probably not the biggest factor in the global rise in healthcare spending, healthcare providers are dealing with incredibly tight budgets so there is an enduring expectation of more for less. Medical communications agencies, insight organisations, and pharmaceutical consultancies can have major roles in helping their clients develop and deliver programmes with maximum impact for minimum cost.
Any discussion of healthcare should never restrict itself to the situation in what might once have been referred to as developed nations (Europe, North America, Australia, Japan, etc.); these countries hold less than a fifth of the global population, and emerging markets have never been more important. Countries like India, China, Brazil, Kenya, Thailand, or Botswana have different healthcare needs (often younger, more rapidly growing populations; with less focus on chronic disease) and different healthcare systems to their historically (though not always contemporary) more economically developed counterparts. As a result, many also have poorer access to healthcare, particularly away from the cities. This means these countries may have half as many healthcare professionals per capita (World Health Organisation, 2018), while geographic and economic barriers may also restrict access to healthcare. Digital health interventions such as smart dispensers or wearables may not yet be totally suitable for large proportions of these countries’ populations, but mobile health interventions such as apps, remote or peer-to-peer diagnostic technology, AI-based diagnostics, or SMS-based platforms offer huge opportunities. Medcomms has typically had less of a role to play in both emerging markets and in digital and mobile health interventions, but this will likely change as both fields mature and move to become more competitive.
Changing with the times
The pharmaceutical and healthcare industries are possibly the most robust industries in the world, together seeking to meet the basic human needs for health and longevity. As a subset of these industries, medcomms is a field with significant security. But while pharma has thrived despite weathering more than a century of change, it is far from immune to the international pressures of economics, politics and technology, and just as pharmaceutical companies have to change to keep with the times, so too will the medical communications industry. Medcomms is also an industry which trades on agility; being adaptable to the needs of different clients and of different markets, but adapting to changes in an international setting requires a different level of agility, and novel strategies may be required to overcome new trade barriers when seeking to win business, or to connect with a changing and more diverse audience worldwide. It remains to be seen whether this changing world will favour the large global communications groups such as McCann, WPP or Omnicom, or the smaller, more agile independent agencies. On top of this all, in years to come, the accelerating pace of technological change is likely to significantly disrupt both the pharmaceutical and healthcare industries, and the practice of medical communications itself. As long as medical communications agencies continue to add value and unique expertise to projects, they will remain an invaluable component of the pharmaceutical industry, but their role and how the pharma industry communicates with healthcare professionals and patients is ever-changing.
An apocryphal Chinese curse condemns the recipient to “live in interesting times”. While working in medcomms has never been boring, the years to come will likely see some very interesting changes indeed.
I would like to thank Fiona Hatch for her support and guidance.
BacterioScan (2016). The financial barrier to developing antibiotics: no big payday for drug companies. [Online] Available at: bacterioscan.com/news/the-financial-barrier-to-developing-antibiotics-no-big-payday-for-drug-companies-2/ [Accessed 14 January 2019]
Clifford R (2017). Global standard for medical writing outlined. [Online] PMLive. Available at: pmlive.com/pharma_news/global_standard_for_medical_writing_outlined_1186333 [Accessed 14 January 2019]
Dobrow L (2016). How is pharma shifting its marketing budgets? [Online] Medical Marketing and Media. Available at: mmm-online.com/home/channel/campaigns/how-is-pharma-shifting-its-marketing-budgets/ [Accessed 14 January 2019]
Jones G (2018a). FCB Health expands into Germany. [Online] PMLive. Available at: pmlive.com/pharma_news/fcb_health_expands_into_germany_1254526 [Accessed 14 January 2019]
Jones G (2018b). Open Health merges with med comms services provider Peloton. [Online] PMLive. Available at: pmlive.com/pharma_news/open_health_merges_with_med_comms_services_provider_peloton_1271611 [Accessed 14 January 2019]
Liu A (2018). Biopharma caught in the crosshairs of U.S.-China trade tussle. [Online] FiercePharma. Available at: fiercepharma.com/pharma/despite-industry-wishes-biopharmaceuticals-caught-crosshairs-u-s-china-trade-war [Accessed 14 January 2019]
MarketingCharts (2016). Medical Marketers’ Budget Allocations. [Online] Available at: marketingcharts.com/industries/pharma-and-healthcare-66049 [Accessed 14 January 2019]
McConaghie A (2018). Optimum expands comms offering to Switzerland. [Online] PMLive. Available at: pmlive.com/pharma_news/optimum_expands_comms_offering_to_switzerland_1273152 [Accessed 14 January 2019]
Mezher M (2017). FDA, EMA and PMDA Plot Harmonized Path for Antibiotics. [Online] Regulatory Focus. Available at: raps.org/regulatory-focus™/news-articles/2017/11/fda,-ema-and-pmda-plot-harmonized-path-for-antibiotics [Accessed 14 January 2019]
PMLive (2017). Nitro Digital expands EMEA management team. [Online] Available at: pmlive.com/pharma_appointments/nitro_digital_expands_emea_management_team_1190864 [Accessed 14 January 2019]
Taylor N (2018). The rise of real-world evidence. [Online] PMLive. Available at: pmlive.com/pharma_intelligence/The_rise_of_real-world_evidence_1226207 [Accessed 14 January 2019]
Van Norman GA (2016). Drugs and Devices: Comparison of European and U.S. Approval Processes. JACC: Basic to Translational Science 1(5), 399–412
World Health Organisation (2018). Global Health Observatory Data: Density of physicians data visualisation tool. [Online] Available at: who.int/gho/health_workforce/physicians_density/en/ [Accessed 13 January 2019]