John, could you please give us an introduction to your current role, as well as a bit about your background?
I currently oversee the European healthcare function at FleishmanHillard, we are a global communications firm of 3,000 people worldwide. Healthcare is one of our most important sectors.
I started my career as a biochemist, but it was the more strategic, commercial parts of the business which interested me, so I began working in medical communications, largely on agency side but also some client assignments.
My core expertise now is strategic marketing for pharma companies, everything from product comms, to market access, value articulation and sometimes, strategic development and issue management. So, my core expertise is pharma but I work with all companies with an interest in health.
How do you think communications activities have changed over the last 5, 10 or 15 years?
When I began, and in the last decade, we have seen an explosion in the number of channels which companies need to use to communicate. There is also a responsibility to send very clear messages to multiple stakeholders, as well as investors and financial audiences. There is an expectation that pharma should be an active stakeholder in the issues and debates that affect access to healthcare and medicine today.
This has led to pharma companies asking their communication strategists to help them become increasingly ‘patient-centric’. Pushing out press releases about commercial milestones just doesn’t cut it any more.
Companies have also become more involved in campaigning, adopting a comms approach usually taken by FMCG companies. Indeed, there are now far more people with an FMCG background sitting within pharma and healthcare businesses to enable this approach.
So, I think all of these things: more channels, the commoditisation of information, a CSR expectation, a desire from the companies to be more patient-centric and perhaps a commitment to achieve their business goals through more campaign-based activities than just simply pushing out news – all of these things are current and relevant in communications.
What is about the FMCG experience that works so well in healthcare?
Pharma companies are using the consumer comms skill set to encourage the public to interact more with their brands, in the way you might interact with a consumer brand. This could be about improving brand recognition of a particular medicine or it could be getting involved with a disease awareness campaign, for example.
I’m very conscious that as medicines become more targeted and personalised, as we understand more about how to use data optimally, and as we understand genetics and therapeutic targeting, it means that more sophisticated and layered communications are needed, we can’t simply rely on reps talking to doctors. That FMCG expertise can perhaps be used to move beyond a historical pharma approach and help maximise opportunities to communicate and educate.
So you’re saying that healthcare companies are trying to encourage brand loyalty but also engage in wider health education?
I think so, and they have big competition now. Healthcare has always been a valuable sector to be in, where corporates can do good business, and as science advances – we are at a time where huge progressions are taking place – many companies, especially tech businesses are seeing ways they can ‘get in on health’. This could be anybody from a company that makes a hospital scanner to somebody who makes a wearable device. So, there is a bit of a gold rush going on and there are a lot of non-traditional companies in the space.
However, if you make a wearable you can talk to the public about it, if you make a pharmaceutical intervention, because of tight regulatory control, you can’t so much. So there are quite a lot of non-pharma competitors who are owning the conversation in health, and pharma definitely would like to catch up with that.
In relation to brand loyalty, there are several considerations here. There is a real trust in the products that healthcare companies produce. By and large, if you are prescribed something by your doctor or you are given something in the hospital, everyone knows it has been through rigorous testing and everyone knows that it is safe. However, from a general CSR point of view, there has been and continues to be, a general mistrust in pharmaceutical companies. They’re often seen as wealthy companies that are more concerned with making a profit than bringing medicines to patients.
The reality is that developing those medicines costs a vast amount of money and companies have to be able to commercialise their products, so they often aren’t making as much as the public might think.
But within all of that, there clearly is a brand, reputation and recognition issue. If you are taking a prescription medicine until recently you haven’t needed to know which company or brand manufactures it. However, now health ministries and healthcare decision makers are looking to the pharma sector to have a voice in shaping the future of healthcare, and that’s a very public debate. So now, there is a public requirement to know more about the big healthcare companies and what they stand for. Consequently, I think companies are trying to find ways to build their brand when they can’t always communicate through the lens of their products.
Is that a more recent thing, that health ministers are looking to the industry to influence the debate?
I think so, nowadays companies are bringing forward technologies which in some cases will take patients to cure. Hepatitis, for example, can now be treated in 8 weeks and patients no longer have hepatitis symptoms, an amazing development. But, at the same time, it is very expensive.
Similarly, if you look at cancer drugs and all that’s been made possible with cancer treatment, it’s not a death sentence any more, we know exactly what kind of patients can be treated. In many cases, because of genetics, there is a good understanding of what the outcomes will be.
So, there’s amazing technology, but healthcare systems, however they are structured, often don’t have the kind of funding needed to pay for this kind of intervention for individual patients.
Society generally is looking at how to measure outputs and outcomes, whether in the short term or long term. and if we do that it would be necessary to create larger healthcare budgets but ultimately the savings would be greater but the system isn’t really ready for the amazing technology and innovation that has come forward in recent times.
The debate is taking place about why it has not been possible to provide a patient with a certain treatment, or why national standards are not being met in certain disease categories. This debate invariably starts in healthcare ministries, but then the healthcare decision makers look to pharma companies to provide more information, calling on them to perhaps discount products or make market adjustments.
At the same time, companies are saying ‘well, OK, but in that case, you have to measure things in a different way so that we can contribute our data to you in a way that you’ll better understand and so we can prove the value of what we can do’. Almost hedge risks together. So everything is a little bit locked up, lots of people are looking for answers, looking for case studies or examples of where it’s been possible to achieve a new kind of output in accordance with a given cost.
And I suppose the key change because presumably there has always been some element of interaction between healthcare companies, is the pace and the pressure to keep up with technological development?
Absolutely. All of a sudden the goal posts are changing, the tech is getting better, the targeting of medicines to individual patients is so much better and the outcomes are far more predictable and can be costed. This development is invariably in areas of medicine that are the most complicated, often in very niche patient groups, a very different situation than proving the benefit of having an aspirin.
How will this play out? How will this tension resolve itself?
It’s not so much a tension, I think individuals get frustrated when it’s impossible to prove the value of something and others can see that value but the system needs to be unlocked to make that treatment, therapy or intervention available.
The good news is that there are clear case studies now emerging where it’s been possible to show how specific outcomes have been achieved for specific patients and I think the more those can be socialised and relied on by access decision makers and payers, the more we will see more medicines coming through.
Although it has been widely criticised, the Cancer Drugs Fund in the UK is like a bridge to that kind of utopia where we can say we recognise there are treatments which wouldn’t normally have been reimbursed on the NHS, or wouldn’t have been until now, but all the evidence is there that they will make a huge difference.
So, that is one example of a government coming up with a funding strategy to make sure patients get access to more medicines than they would otherwise have done.
Whilst that is a different debate in itself, it is interesting that solutions are being made to bridge while we shift the system around. I think, over time, we will see the system catch up with innovation, but we’re just in the time where we are trying to decide how to do it.
What are the main challenges for pharma companies in this era of market disruption?
We have to recognise that some of the newer entrants, particularly the corporate or tech companies, have been able to be faster or quicker than some of the more traditional pharma players.
Invariably the pharma players are still very concerned about litigation. On the one hand, they absolutely do want to be forward-thinking partners and stakeholders in bringing the best therapies they can to patients. But in terms of pushing out information and campaigning, they need to be so careful not to do anything which could lead to misconceptions in their audiences.
One of the key considerations for these companies, which is increased by the amount of data now available and increasingly open channels of communications with patients, is the longstanding concern about adverse event reporting, and the need to respond to everybody that you have reached out to.
So, companies absolutely want to transition to this new world but because of their structures, the way they are organised and put together financially, it can be hard for them to do all that they would want to do.
What has been the impact for the communications industry of the introduction of these non-traditional players?
I think you can see things in two ways. Certainly, in my industry, the communications industry has been instrumental in helping pharma clients go the extra mile and do things now that perhaps ten years ago they would never have done. We routinely interact with our audiences on social media, we post reports differently, we interact with advocacy organisations and other industry stakeholders differently. Things are so different and, from a consulting point of view, working with the traditional players has been good and important business for some of the big communications firms.
You can also look the other way, and consider the opportunities to help new entrants to the healthcare world achieve what some of the smaller pharmas are achieving. That requires them to undergo a great deal of rapid upskilling, understanding how healthcare works, how you can and should work with physicians and healthcare professionals and the regulatory responsibilities that go with that.
So there are opportunities on both sides but certainly, riding the gold rush, if I was starting out as an entrepreneur I would be happier sitting within a tech business looking at a data solution to help unbreak some of the challenges of the day, than perhaps trying to bring forward a medicine.
It’s definitely possible to do far more in terms of developing a next-generation medicine, but the cost is higher and invariably it’s going to treat a smaller, more niche population, but it well may treat it to cure and while that is great, getting that paid for requires you to have a global company with significant financial means and value.
About data: you’ve mentioned how significant it is for the healthcare industry, can you give us any examples of this?
There is a big discussion going on about the design of clinical trials, whereby regulators still require companies to collect a certain kind of data to get a licence and marketing authorisation. They go through the phase I, II, III tests and all the subtext of those categories, but, should it be possible for a regulator to take into account real-world data when licensing a product. Real world evidence is already established in the pharmaceutical business and includes data collected from patients using products in the real world. There is a plethora of this data, what patients say, how they report their experience, how they report their symptoms or alleviation of symptoms. Companies collect and look at this real-world data all of the time.
So, how might it be possible for regulators to use this unsolicited data?
Regulators and licensing bodies are increasingly prepared to look at real-world evidence alongside clinical evidence as part of their decision making when it comes to licensing a product. But real-world evidence data isn’t going to replace clinical data. I think ultimately it will be in the interests of the company to be able to use data collected in the real world when they are making filings, but there has to be an openness for that to take place.
So it’s a huge opportunity, it’s very interesting and certainly, for communicators, it’s a great place to help clients tell a different story. Ultimately, it’s the industry itself and the regulators which will have to play a role in making that data more central in the key decisions about licencing products.
How could a company use that to tell a story?
Well, for example, it’s quite well known that statins control cholesterol and prevent the risk of coronary health disease, and yet many patients report that they don’t get on very well with statins and, quite frankly, don’t feel so good when taking them. There have been many studies which document this and perhaps real-world evidence would help companies identify ways of managing this kind of risk outside of statins.
Also, some categories of medicines are used off-label, to treat diseases which the medicine is not licensed for, with reported success. Maybe bringing forward real-world evidence would help companies to expand and amend these product indications.
You mentioned earlier that healthcare companies find they need to be increasingly accountable as their audiences have grown. Is this something that applies to healthcare communicators? Is there an increased need for communicators to be more accountable than in the past?
Pretty much all the campaigns I’ve worked on have been designed to promote products and drive awareness of how to treat diseases, improving the health and wellbeing of the nation and different communities of patients. Always, there is a good outcome in mind, and this hasn’t changed much, so we haven’t had to change too much about what we do. However, in the time, I have been in the industry some things have changed.
Examples I would call out are, having to be fully transparent in terms of the fees and honoraria companies pay to their medical consultants, their external consultants, the advocacy groups. The patient groups have to be far more open in terms of where the grants and bursaries are coming from and increasingly it’s very important for those groups not to be funded by single companies, but multiple sources.
Also, I think, the pharma industry, because it impacts people’s lives, is not the type of industry to keep a product in the market when it is known it would harm lives, products are withdrawn. Certainly, when it comes to us recommending communications programmes we have to be very mindful about how we go out there and activate programmes, anything that we suggest needs to be broadly appealing, it needs to have multiple sources of input, external approval, credibility, and it’s very important that we don’t ask our companies to perhaps work with just one physician or one patient group or anything of the kind that could cause the audience to ask, is that credible? Is that just one person’s point of view? Because ultimately it’s not authentic when a campaign reaches the public in that way. So we’ve had to take into account all of the additional reporting and transparency requirements of our clients and we have to make sure that our programmes are fully balanced with that.