Yesterday’s post, “Marketing Disguised as PR“, generated some interesting counterpoints and comments from friends in the blogosphere and on the PHARMA-MKTING discussion forum. Seems that I have hit upon something worthy of further discussion; hence this followup.

Fard Johnmar over at Healthcare Vox was the first to respond (see “Pharmaceutical Marketing = Pharmaceutical Public Relations“).

The first issue that Fard raised was the primary role of PR and whether or not PR “plays second fiddle” to marketing. Fard says I asserted that the primary function of PR is to protect a company’s image and damage control. Actually, what I said was “Public Relations (PR) is not just for managing a company’s image and for damage control.” This is a far cry from making a “primary function” claim.

PR Is No Second Fiddle
So, Fard and I are in agreement that PR does NOT play second fiddle to marketing. In fact, that was the main premise of my blog: PR is an important component of pharmaceutical marketing, albeit one that is cloaked in a mystery wrapped in a riddle — in the sense that not nearly as much attention is paid to the “good, bad, and the ugly” aspects of PR marketing as there is to regular pharma marketing.

Not All PR Is Regulated
This leads to another point raised by Fard, who says “So, while one may argue that regulation is inadequate, the public relations profession isn’’t completely free from scrutiny.” Fards points out:

“Public relations materials are assessed by internal pharmaceutical legal and regulatory teams, just like all other promotional items

“Fair balance must be included in all press releases mentioning a study, drug or device”

Yes, of course, if a pharma-sponsored PR piece mentions a drug brand name, fair balance is required. However, in my blog, I was talking ONLY about disease-awareness, unbranded PR, which does not mention a drug brand name.

I am not sure that fair balance is required in a PR piece that mentions a study, if only the scientific name of the drug is mentioned. Could be. I’ll have to research that one.

Celebrity Endorsements
Are PR programs reviewed internally by legal/regulatory? Perhaps some of them are.

But there is undoubtedly a lot of PR activity — such as arranging press interviews with key opinion leaders, celebrities and patients — that is NOT reviewed internally. These spokespeople do NOT have to provide fair balance. They can say whatever pops into their heads and make the most outlandish endorsements with impunity. In addition, when celebrity endorsers in the pay of pharma companies appear on TV interview shows, there often is no disclosure that they are being paid by the sponsor!

Fard says:

“In addition, responsible public relations practitioners inform media about who is sponsoring a promotional effort and put them into contact with company spokespersons, upon request.”

I will limit myself to saying that in a perfect world media would be informed about paid endorsements. That, however, is not the problem. Media also have to disclose the endorsement. So, we have two parties that need to voluntary do the right thing! If the probability of either party doing the right thing is 50%, what’s the combined probability of both doing the right thing? [I don’t know. I flunked probability class.]

No Guiding Principles = Possibility of Stricter Regulation
The problem is that we do not live in a perfect world where business people always do the right thing — hence industry guidelines, ethical standards, and — God forbid! — government regulation. Where is the PR industry’s “Guiding Principles of DTC PR Marketing?” Are they under the desk? Nope. Not there!

What Does “Buy” Mean?
The last issue Fard raises that I would to address is whether or not public relations “buy” media coverage. Let’s take an analogy quiz:

PR “buying” media coverage is most like which of the following:

(1) Buying search words on Google
(2) Buying lunch for physicians in exchange for sitting in at a detail
(3) Buying an ice cream cone

The answer: 2

In the same way that sales reps “buy” — or used to “buy” — physician prescribing, PR people may “buy” media coverage. Of course, no physician worth a nickel would ever admit that they changed their prescribing habits just because they got a free lunch or a free pen — but it happens! Similarly, no reporter will write a favorable story just because he/she was wined and dined at a press conference. What about taken out to a fancy dinner? Golf outing? Significant other included? How much of this goes on? We don’t know — that’s why I say it’s a mystery wrapped inside a riddle.

Traditional pharma marketing is much more transparent and pharma marketers are restrained from using such practices by laws, regulations, and industry guidelines. I don’t know of any such regulation of PR marketing.

More Comments
Comments from Gopalkrishna Iyer, a member of the PHARMA-MKTING online discussion group:

Yes! Spin doctors are having a greater role in marketing of products.

This, primarily, is happening because of the higher levels of clutter that exists in the mindspace of doctors. Marketers are having to resort to more creative (???) ways of getting their message across and making it stick.

As put rightly in your post, “enhancing brand value is actually what marketing is all about” and one does put every idea to use in order to achieve that brand value.

So, whether one calls it “Patient Education” “Disease Awareness” “Disease Mongering” “Patient scaring” or PR, one must not forget that such media stories have always been part of the pharma marketers’ arsenal. The hype created on so many vaccines, cholesterol, HRT etc. are classic examples.

However, in today’s poverty stricken times (in terms hugely distinct advantages of new molecules and in terms of price pressures) marketers are increasingly covering up gaps in communication, creating pressure groups, winding up patients towards their brands and magnifying less significant aspects of disease and therapy through PR.

It is the sign of our times, very much similar to the “gamesmanship” we witness in the sports arena. It is only such drama that has the power to add much needed value to a brand. It is as ethical or unethical as sponsoring a clinical study and then publishing it, or sponsoring a CME on a topic of your advantage over cocktails and dinner.

The greatest influencer of prescriptions still remains the good old scientific data from pre and post marketing clinical trials. The fundamental four of Efficacy, Safety, Convenience & Cost are what finally matters to the physician and patient.

To think that physicians would change their prescribing habits because of newspaper articles or television programs would be simplistic, both, from the marketers’ point of view and the observers’. Yes! it will have some favourable impact on the brands it seeks to indirectly promote, and that can only be achieved by a long and sustained campaign. I also agree that PR can accelerate the marketing process and help maximise sales. Well executed communications do have the power to inspire, to motivate and trigger action. PR can also bring issues out of the closet (Erectile dysfunction) and result in brands such as Viagra become dictionary words.

Whether such PR should be brought within the purview of the ethics committees is another issue altogether. Finally, marketing communications is all about creating meaningful reasons to use your product(s).