Christmas Eve 2010...


Friends---

Christmas is just hours away and 2010 is inching towards its end. A new year is approaching; a year we can hope will be filled with happiness, prosperity and good health for all.

2010 brought Adam to university life, new careers for Michael and Marlene and a major health opportunity for Matt. We mourned the passing of our beloved Bete Noire, the almost magical dog, and Butterball, queen of cats, but still have memories of how they filled our lives with happiness, animal wisdom and fur balls (Butterball, at least).

From our family to yours, a belated happy Hanukkah, a very merry Christmas and rising tides for all!

Marlene, Michael, Matt and Adam Durand

Christmas Eve 2010...

The Incredible Shrinking Health News Hole

Not long ago I had lunch with a former colleague who headed media relations at a multi-national pharmaceutical company. She was lamenting how so many of her former "contacts" at newspapers and magazines had baled out of the traditional news business and either joined web site operators or enlisted on the dark side by joining public relations agencies.

Her observation reminded me of an article I wrote for O'Dwyer's last year, documenting how quickly the news business is decomposing. Here is a version of that article...

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How large is the “news hole” for health care information in the U.S. media? As news outlets reshape themselves, cut costs and focus on areas of most appeal to their viewers and readers, this is a disquieting question for public relations practitioners involved in the medical and pharmaceutical industries. The answer both points to the challenge health care public relations practitioners face and a path forward.

A report published in December 2008 by the Henry J. Kaiser Foundation (www.kff.org) and the Pew Research Center’s Project Excellence in Journalism suggests that health care coverage in national and local media may be shrinking faster than the polar ice caps, leaving those dependent on traditional media for health care information stranded like polar bears on ever-diminishing ice flows of news.

According to this study health news was the 8th most covered subject, with 3.6 percent of media space devoted to the topic. This is three times more coverage than education or transportation, but an asterisk compared to the elections and politics (21.3 percent of the news hole), foreign affairs (13.6 percent), foreign news (11 percent), or even crime (6.6 percent) or disasters and accidents (4.2 percent).

The Kaiser and Pew researchers examined front-page coverage in small, medium and large market newspapers as well as network morning and evening news programs, cable programs, radio and even general interest internet outlets during an 18 month time span in 2007 and 2008,

The network evening news programs (ABC World News Tonight, NBC Nightly News and CBS Evening News) dedicated the largest percentage of their ‘casts to health news—more than 8 percent, outshining newspapers, with 5.9 percent of their front page articles focusing on health care; radio with health comprising 3.6 percent of news coverage; network morning programs (Good Morning America, Today and CBS Morning News) with 3 percent of health programming and online general news outlets such as Yahoo News and MSN dedicating 2.2 percent of their “front pages” to health. Cable outlets, which once helped spearhead health reporting, devoted only 1.4 percent of coverage to health issues.

In terms of the topics most often covered, nearly 42 percent of news covered was disease specific, with cancer, diabetes and obesity, heart disease and AIDS/HIV being the disorders most frequently mentioned. Health policy issues and public health evenly divided the rest of the coverage pie.

The report has some major limitations. The analysis of newspaper coverage only included front-page articles, thus ignoring science and health sections of papers such as The New York Times and Wall Street Journal. It did not include health-dedicated Web sites such as WebMD and HealthCentral.com. Likewise, by focusing on general news broadcasts of the cable outlets, the study did not account for specials produced by experts such as CNN’s Dr. Sanjay Gupta.

Nevertheless, the study quantifies what many have long suspected, that the opportunities in traditional news outlets are shrinking.

Of course, the skimpy news hole for medical news is just one more symptom of the degenerative condition of mainstream media generally. It is no secret that loss of both eyeballs and advertising revenue has led to cutbacks across the news spectrum. The New York Times earlier this month noted that the Cox newspapers chain, owners of The Atlanta Journal-Constitution and other papers has paired its Washington bureau from 30 reporters eight years ago to zilch-o reporters today.

The reduced commitment to health reporting can be observed at annual medical congresses such as The American Heart Association’s Scientific Sessions and the yearly meeting of the American Society of Clinical Oncology. While in years past network news divisions and national newspapers would report on-site from the meeting, increasingly coverage is achieved by phone interviews and wire service reports—if the meetings are covered at all.

For more than a decade, when Americans were surveyed about the domestic issues of most concern to them, health care ranked as issue number one. Even today, with the economic crisis dominating virtually every other subject, Americans remain deeply interested in health and wellness.

Why then, is health news less prominent in coverage? There are several reasons, including the relative complexity of some medical stories, the cost of fielding medical teams and the competition with other subjects. The cable news outlets, once homes to robust medical reporting teams have largely shifted their emphasis to confrontational politics and news “analysis,” leaving less room for straight-forward stories about scientific developments. MSNBC’s “Morning Joe” Scarborough and Fox New’s Bill O’Reilly aren’t that interested in t-cells and microbes.

One observer of the ups and downs of health news is Dr. Bruce Dan, executive medical editor of The Patient Channel on NBC’s Digital Health Network, and a former senior editor at The Journal of The American Medical Association.

Dr. Dan says that when he was starting his journalism career 25 years ago at the ABC affiliate in Chicago, “stations desperately wanted to have their own TV doctors on the air, and they found it advantageous to feature these new doctors and health segments. Week-long sweeps pieces on any number of diseases were heavily-promoted, and breaking news on the latest health topic popped up almost every day.” The novelty, he says, has now worn off, and health news has to compete for coverage with every other topic area. “Ironically, as the number of commercials for pharmaceutical products increases,” he says, “the commitment to news coverage of medicines has decreased.”

Going hand in hand with the less consumer coverage, public relations executives are finding fewer opportunities with the professional press. While a decade ago there were half dozen general interest physician publications, including Medical World News and The Medical Tribune, there are now just memories.

Where do these developments leave us?

The good news—for both consumers, journalists and public relations practitioners—is that while there is less coverage in traditional news outlets, health care information is alive and well in specialty publications and on the internet. For instance, while mental health and illness doesn’t garner much general press attention (commanding just 1.6 percent of news coverage according to the Kaiser/Project Excellence survey), publications such as bp Magazine and Esperanza are offering in-depth coverage of mental illness (bipolar disorder and depression respectively). There are now many publications directed towards individuals with other illnesses such as diabetes, heart disease and HIV infection.

Similarly, there are now scores of Web resources for people interested in mental illness, including MentalHelp.net, SelfhelpMagazine, Mental Health Matters plus the renowned sites of advocacy groups such as the National Alliance on Mental Illness and the Depression and Bipolar Support Alliance.

A lot has been written about the veracity of Web health coverage and it is a concern that most sites do not have the strict fact-checking procedures or traditional commitment to objectivity of conventional news outlets. Over time, however, I believe consumers will gravitate to those sites that offer scientifically accurate and balanced coverage of health and medicine.

The Kaiser/Project Excellence report shows that some topics are simply better covered than others, likely because these diseases are of interest to more people. Cancer, diabetes and heart disease rank high. Alzheimer’s disease and ALS rank low. This suggests what generations of smart public relations people know: to win a placement, “the pitch” must be tailored to show why it would be relevant to the news outlet’s audience. That’s not rocket science, but amazingly the point is often lost.

While the morning news programs have often been regarded as the jackpot placements for health news, prospects for placements on these shows, at least in the all-important first half hour, are dim. “The first half hour of the morning news shows dedicated only about a third as much of their time to health as did their counterpart half-hour news programs that appeared in the evening,” found the Kaiser-Pew report. This suggest that to win a morning placement—rare under any circumstances—public relations people must look beyond the first 30 minutes, usually regarded as the hard news block, and must demonstrate beyond a doubt the relevance of the story to the audiences that view the programs after 7:30 am.

The health care pitch is not dead, it is just harder to achieve in mainstream media. Tina Chiara, a senior media relations specialist at Ruder Finn, notes "contrary to what most may think, there are still many opportunities in traditional media despite the surge of online coverage. Traditional media still exists but with fewer and fewer staff so many reporters are not only open to newsworthy ideas but worthwhile contributions in terms of products, companies and context for stories. You just have to spend more time figuring out what will interest readers and viewers."


Finally, the loss of health care opportunities in traditional media should remind us yet again that public relations must not be equated to press relations. To continue to be so defined is a recipe for slow extinction. Likewise, we can never simply rely on practicing our craft tomorrow the way we did it ten years ago, or even last May. The media world is changing and the opportunities for us are shifting. Some opportunities are gone, while others remain bright and within reach.

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Dead Marketing

Dead Marketing


I am indebted to PRNewser for a brief summary of a great little book, Marketing Lessons from the Grateful Dead: What Every Business Can Learn from the Most Iconic Band in History.

Last weekend I read the book, which took all of about two hours to cover about 150 small pages and roughly nineteen learning from, if not the most iconic band in history, certainly one of the greatest “brands” in rock-n-roll. My connection with the Dead is thin, but not non-existent, I’ll explain that in a moment.

I’m a believer in transplanting wisdom from one field to another, quite different field, hence I instinctively like the proposition that the Dead have a lot to tell us.

Marketing Lesson’s theme, reinforcing a lot of other books, staring with David Ogilvy’s Confesisons of an Ad Man, is that if you try to establish a brand, or attempt to sell a widget just like every other marketer, or widget salesman, you are limited to winning a small-medium or maybe even large helping of the widget pie, but won’t achieve greatness. The Dead didn’t deliberately exclaim, “let’s set rock marketing on its ears;” rather they followed what to them was simply the right path to doing the right thing and the dividends of this strategy were success for thirty years and creating a brand that continues to ensure long after founder Jerry Garcia’s death.

So what did the Grateful Dead do that was so counter-instinctive?

For one, allowing anyone to record their concerts. Imaging if tonight you sashayed into an Eminem concert at Madison Square Garden armed with a tape recorder and a large directional microphone. If you were lucky you’d get thrown out. More likely you’d be busted. But the Dead took a totally opposite approach, even arranging special areas for amateur recorders. It wasn’t simply that they wanted to be nice guys. They instinctive knew that fans would exchange tapes and talk up their concert experiences, thereby creating more buzz and enthusiasm for Deadom. This policy, by the way, didn’t seem to hurt album sales one bit and today there is a vast collection of concert material in the public domain.

Unlike most bands, which toured to support recordings, the Dead again upset the business model: albums were simply a way to reinforce their concert schedule. This might have diminished their relationship with the record label, but established a much stronger revenue base.

Long before anyone ever heard of customer-relationship marketing, Garcia and the boys built band loyalty by rewarding their most ardent fans with special promotions and great seating.

There more in this little book that reaffirms that you don’t need an MBA to by savvy at selling.

Growing up in the San Francisco Bay Area in the sixties and being addicted beyond the point of no return to “folk music” (OMG!), I often saw Jerry Garcia, Bob Weir and Pig Pen, aka Mother McGee’s Uptown Jug Champions, at The Tangent in Palo Alto and Off-Stage in San Jose. Jerry usually presiding over the five-string.

But here’s the defining moment: one evening, my pals and I were wrapping up an evening of body surfing near Pescadaro, south of San Francisco (Don’t ask. We were young and Foolish). Walking by a small club out by the Coast, we noticed some new kids in town. The Grateful Dead. Mother McGee’s boys had traded in the banjos and acoustics for electric guitars and drums. “I can’t believe the Champions have sold out and gone rock-n-roll” I whined. To add insult to injury, they were charging FIVE DOLLARS a ticket to see the show.

“No way I’m going to pay that,” I said. And didn’t.

As the years went by, I saw the Dead in San Francisco, LA, Vegas and New York. But never scored fivedollar tickets.

Four New Ideas—
And How Public Relations Helps Make Them Real


“In Pharma 3.0, companies will not be selling pills as much as managing entire patient experiences…companies will need to build the long-term relationships with patients that will become increasingly integral to their brands.
Ernest & Young “Progressions” Global Pharmaceutical Industry Report
2010

Yes, yes, there are a welter of change agents affecting the pharmaceutical industry and the larger health care enterprise. Many of them have been talked into the ground by industry observers, politicians and members of the health care communications community.
Ernest & Young recently published Progressions, its 2010 Global Pharmaceutical Industry Report. The report is full of good observations, but I was most interested in four seismic changes that they predict are having a profound and for the most part positive influences on health care and health communications.
1. Patient Empowerment Transforms to Patient Responsibility
Kind of sounds like a Republican Party catcall, but it’s a pretty accurate description of where the patient movement is going. Fifteen or twenty years ago we were talking about how the patient was becoming a partner in his or her health care and how the doctor was no longer the god in the white coat.
The democratization of information brought on largely, but not entirely by the Web, accelterated this. But just as the patient now has a voice in treatments, his responsibility towards risk-sharing is also rising. Just look at your drug co-pay scheme. You can receive the latest and greatest medication, vaccine or antibiotic, but you may be asked to contribute $40 or event $80 a month from your pocket for the treatment. Contrast that with a generic medication which may cost you just $10 or $20 dollars.
There are often extremely good reasons for using a newer medication. But as costs rise, the patient (and the doctor) will need to weigh its value versus older generic drugs.
Some predict patient responsibility may become even more urgent as some health care plans and companies consider rewarding employees practicing healthy behaviors or imposing higher insurance rates on over-weight employees or employees who smoke. For a number of reasons penalizing obese employees is bad public policy, but the idea is certainly on the table.
Public relations can help companies explain the relative benefits of branded medications and who should most profit from them. We can also work with companies outside of the health care arena on employee wellness initiatives.
2. The Transformation to Pharma 3.0.
This is Ernst & Young’s term, but the notion is not theirs alone. Pharma 1.0 could be considered “the good old days” in which a blockbuster drug would put wind in a company’s sails for years. A billion dollar molecule could contribute ten, twenty even forty percent of a company’s income. The problem was that as the patent ran out of gas, the company desperately had to refuel with another blockbuster or two. If was much like a treadmill, with its speed constantly increasing.
Pharma 2.0 was the diversification model: sell lots of drugs, but sell other things too, from over-the-counter brands to sutures. Abbott and Baxter led the way with this model, but others caught on as well.
Pharma 3.0 (which nicely merges with patient responsibility) is a new way of looking at the core business of the drug company: rather than simply selling medicines, it is selling health outcomes. So if company X is in the diabetes business, sure, it is developing a glucagon-like peptide analog, but it is also offering disease management programs for physicians and patients, drug persistence programs and other tools to help get the patient to where he or she needs to be.
Public relations plays a integral role here, as we are in a great position to help companies increase patient compliance and persistence through educational programs such as interactive learning modules and other tactics.
3. The New Players and New Partners
Health care companies are enlisting usual and not so usual partners in helping achieve Pharma 3.0. For instance, Bayer Healthcare has linked with Microsoft and the National Multiple Sclerosis Society to create “MyBrainGames” an online mental games center for people with MS.
Bayer has also partnered with Nintendo to create “Didget” a glucometer for kids with type 2 diabetes that can be plugged into a Nintendo game console. Novartis, Vodafone and IBM have created “SMS for Life,” that uses mobile phones and other technologies to manage supplies for people with malaria.
Relatively simply technology is allowing us to do great things. Johnson & Johnson, the federal government and other partners have launched Text4Baby, a service that sends SMS messages about nutrition, health and other important topics to pregnant women, based on their due date. A simple but effective service for women with limited access to other resources.
With so many potential partners in the greater health care space, public relations has far more opportunities for client partnerships. As many of these initiatives are centered on communications, who is better to help out than our industry?
4. The Value Proposition & Value Mining
It doesn’t take a health economist to figure out that in a cost-conscious environment, finding the relative worth of a medication will be the price of entry. There are many ways of looking at comparative effectiveness, far more than we can review here.
There’s a new spin on the value proposition, however. It’s called value mining.
In the old days, clinical trials and outcomes data were the private property of pharmaceutical companies. Outsiders, even clinical investigators, would get information only when the company thought it was time. Not so anymore.
According to Ernst & Young, regional health companies such as Partners in Boston and Intermountain Health in the west are using historical, empirical data to determine effectiveness of drugs already approved by the FDA. Armed with outcomes on thousands of patients, and computers capable of scrutinizing dozens of variables, these companies are running “parallel universe” clinical trials by simply and cheaply examining historical data to see which drugs work best on which patient groups.
Yes, this is turning clinical trials on their heads, looking backward instead of prospectively for outcomes. But how can biopharmaceutical companies deny the value of reams of data on thousands and thousands of patients? Communicating precisely the meaning of these retrospective trials and their implications for payers will be a massive challenge.
Patient responsibility, Pharma 3.0, new players and value mining are four change agents that cannot be ignored. They may not sound as sexy as the profound changes we are seeing as a result of the digital health transformation, but their impact, I believe, will equally great.

2.75 Cheers for Kaiser

2.75 Cheers for Kaiser Permanente

I spent last weekend on the San Francisco Peninsula, primarily attending to my mother, who spent the prior week in the hospital. Mom is 13.75 dog years old, and at that age, well, age becomes a conspirator, and you become its plot.

This becomes relevant since her care at the Redwood City Kaiser Permanente facilities is emblematic of how we can deliver good health care, at a reasonable price, even for those in their late, late years.

Part one. She complained about breathing troubles and scheduled a physician’s appointment at Kaiser. In quickly, diagnosed with chronic obstructive pulmonary disorder and hospitalized all within an afternoon. It helps that the walk-in clinic is a stone’s throw, or wheelchair ride, from the Kaiser hospital.

I am not writing here about her transitory mental confusion, the concern over whether she can continue living alone in a retirement community and the need for at least temporary round-the-clock attendants. We’ll save those for another day.

Part one and a half. The attending physician phoned me and spent all the time required spelling out her medical diagnosis (guarded) and various living arrangement options. I decided to check out the situation myself, hence the visit to the Bay Area.

Part two: the follow-up. I accompanied mom on her follow-up visit, about a week after she was discharged. American Airlines thoughtfully contributed to the drama by cancelling my late evening flight back to New York; my rescheduled return gave me just four hours from Kaiser visit to wheels up. Being a New Yorker, I anticipated the horrors of waiting and waiting for her appointment and grinding teeth trying to get back to SFO on time.

But the nice surprises started the minute we entered the clinic. A short line in a comfortable reception area; the request to pony up $10.00 for her visit (I couldn’t get my blood pressure read for ten bucks here in the Empire State), then a short elevator ride up to “clinic F.”

Clinic F was nicely furnished, with magazines from this century; pictures of the physicians staffing the clinic and their bios nicely displayed on the walls. Moments after arriving, mom’s name was called and she was led to her physician, a woman who’s treated her for several years. I am watching the clock. Not bad.

Thirty minutes later I am called into the exam room, where the attentive physician reviews mom’s chart with me, discusses with both us her medication schedule and answers both our questions with alacrity and no sense that she has to make way for the next patient.

All in all, the report is positive and her health improving, though it’s doubtful there are triathlons in her future.

Kaiser Permanente some time ago computerized its medical records, so everything the physician needed to know is at her fingertips. Oops--one problem: the computer crashes, making it impossible for her to e-mail the on-site pharmacy mom’s new prescriptions. So we move to another exam room and a more cooperative computer.

Time elapsed: ninety minutes; seventy of which were with the physician. Then down to the pharmacy, where an electronic display chimed that mom’s prescriptions were ready. The pharmacist threw in one of those weekly pill dispensers for free.

Outside, we passed through the pleasant gardens soaking in the California sun. Then to the street where the Redwood City policewoman waived the red “no parking” regs, so mom could have an easier time getting into my rental care.

Back to her retirement community, a bid farewell, then off to the airport with plenty of time to make the flight.

How does Kaiser manage great patient care, fast service and pleasant surroundings all wrapped in a $10 co-pay?

Medicare helps and don’t let anyone tell you seniors don’t like it.

The medications Kaiser dispenses are not best in class. When have you been prescribed lovastatin, the first “statin” drug, approved about 25 years ago? But lovastatin works pretty well if you don’t have galloping dyslipidemia.

You won’t find Kaiser doctors in Castle Connolly’s “best doctors in America.” Don’t expect Johns Hopkins or Stanford Med graduates. But they are thoughtful, caring and in mom’s case know primary care medicine as well as anyone you could hope for.

Kaiser’s medical information system is seamless, electronically linking departments, clinics and the pharmacy. But if the computers don’t work, you gotta move.

These points contribute to “how does Kaiser do it,” but they don’t fully answer the question. I’d really like someone to enlighten me.

Someone critical of President Obama’s enacted Patient Protection and Affordable Care Act said that sooner or later all of us will be going to Kaiser-like facilities.

If so, we could do a lot, lot worse.

On Bruce Dan

I spent several hours today catching up on Bruce Dan’s blog: http://brucedan.wordpress.com/. Doctor Dan, if you don’t know of him, is a real-life renaissance man: a medical doctor and a journalist who’s also dabbled in engineering before going to work for the CDC’s Epidemic Intelligence Service.

When I was but a PR pup, I used to pitch Bruce when he was the medical editor at WLS in Chicago. Much later, he was a consultant to my health care practice at Porter Novelli, where I spent most of my career.

Bruce is being treated for a fairly potent form of leukemia and his blog is his classroom, teaching friends, acquaintances, anyone who is interested about the mundane, the horrible and the ridiculousness of a serious illness, from the viewpoint of a physician and a skilled writer. A virtual who’s who in the pantheon of medical journalism weighs in, rooting for Bruce.

Thanks to Bruce, I learned that most people don’t wash their right thumb (or left, if you are left-handed), vastly diminishing the prophylactic powers of soap. Okay, that was kind of funny. But not so funny is the mental, emotional and constitutional mine field people with serious illnesses traverse day in and day out. It is harrowing for someone such as Bruce who has the intelligence and financial resources to cope. So many people, however, are far less fortunate. His observations about this are invaluable if we really care about health care in the U.S.A.

I’ll continue to read his blog—it’s so much more than mine. And wish him all the best for the future.

Declaration of PPT

Does PowerPoint represent a 21st century incarnation of Gresham’s Law, driving to extinction expository writing and good old-fashioned declarative sentences?

I was thinking about this earlier this week when presentation trainer Jim Cameron (jim@mediatrainer.tv) visited my temple of PR mavens to help sharpen their presentation skills. Thanks a million, Jim, for taking the time and volunteering your expertise.

Jim was cautioning younger staffers against using PowerPoint as a presentation crutch (yes, we are all guilty of sometimes just reading the slides instead of using them as a visual aid) and eschewing the river of text that PR people love to pour onto the electo-slides. “Remember, no more than six lines per slide, bullet points, no full sentences.”

It then dawned on me that it’s been several years since I have read a client’s marketing plan, or a public relations proposal that was actually in “Word” format (will Microsoft soon delete Word from its Office suite of applications?). The 20-odd page-marketing plan has given way to the 120 slide “deck.”

So what’s going on here? Not good things, in my opinion. The grim observation from ten ago that college kids, even graduate students, can’t write seems to have been rendered moot, as the perfect antidote to poor writing is simply not to write; rather, slather a verb and a wimpy object onto a slide, preceded by a “*” or “-“. Then add in a chart, graph or picture as the secret sauce and voila, you are a marketing genius.

Of course, what’s missing is the ability to truly tell a story, to add rhythm, detail and the nuances that only come from a written document. So imagine if the Founding Fathers had access to ppt, in lieu of the quill:

“When in the Course of human events it becomes necessary for one people to dissolve the political bands which have connected them with another and to assume among the powers of the earth, the separate and equal station to which the Laws of Nature and of Nature's God entitle them, a decent respect to the opinions of mankind requires that they should declare the causes which impel them to the separation…
We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness. — That to secure these rights, Governments are instituted among Men, deriving their just powers from the consent of the governed, — That whenever any Form of Government becomes destructive of these ends, it is the Right of the People to alter or to abolish it, and to institute new Government, laying its foundation on such principles and organizing its powers in such form, as to them shall seem most likely to effect their Safety and Happiness.

The Declaration of Independence could be jump-started with one slide:

Reasons to Say Ciao to Britain

• Sometime it is prudent to dissolve the political relationship that unites people
• But it must be done carefully; and with good reasons that must be clearly explained
• (Obviously) Good government must strive to help provide life, liberty and the opportunity to be happy. These are priorities!
• Good Government must achieve the buy-in of the people…or else
• It cannot achieve these goals (see bullet 3), it’s okay to replace management

Hmm...

Thinking About Consumers

Thinking About the Consumer

I have been the public relations consultant to many brand teams whose products—medical devices, antibiotics and other therapies—are only marketed to physicians. In many cases, even recently, the product director nixes outreach to the public or to patients, reasoning that since the patient cannot purchase the therapy, why should scarce marketing dollars be earmarked to reach someone without “MD” behind his or her name.

Public relations practitioners instinctly know that it’s easier reaching the general public than the health care professional and often contort reasoning to justify outreach to patients in addition to medics. In the good old days, when marketing dollars fell like pollen on a spring day, virtually all marketers consented to earmark a few hundred thousand smackers to consumer-oriented public relations; after all, what was the harm?

Traditionally, the uber-PR strategies were to either inform consumers about condition XYZ and to prompt them to see their doctor if they thought they were so afflicted or to encourage diagnosed patients to ask their physician about a new treatment for an existing condition. The basis for this “ask” was often a new clinical trial or the word of a celebrity spokesperson. These are still valid strategies for many products.

But as resources contract and as new-minted MBAs who have not been infected with the PR germ join health care companies, we are continuously being challenged to justify reaching patients or consumers. What if the patient doesn’t care a fig about the treatment? What if all she cares about is getting vaccinated against shingles, HPV or dandruff and doesn’t care if the vaccine is manufactured by Merck, Glaxo or Ford Motors? What if the physician historically has selected the treatment and considers one therapy the same its rival?

Then does it matter?

Patient-centered public relations may not matter for some brands. Nevertheless, the question that always has to be asked is “what if…?” What if we could activate patents to ask doctors about treatment options? What if we could get them to understand unique or subtle differences between therapies? What benefits would the company accrue if doctors saw them as a true partner in patient health education? What if we could convince patients to be more compliant or stay on therapy longer? There are lots of disciplines that claim they can achieve these tasks. But can they? If public relations can, we’d be smoking’.

Even for products that are purely physician oriented, there may be substantial benefits to talking to patients, their caregivers and loved-ones and other consumers. Here’s why—

Studies indicate that doctors have a higher regard for pharmaceutical companies that demonstrate (not just claim) that they are helping patients. I recall one study (I think it was from RCC Research) that indicated that doctors would pay extra if they believed that the company was doing a good job in helping the patient manage expectations and the consequences of the disorder. Public relations isn’t the only way to demonstrate this, but it’s a darn good one.

As health care companies migrate from simply selling products to selling the concept of health itself, this may become even more important.

An ingredient of public relations is a comprehensive understanding of patient behavior. Better understanding of the “patient journey” makes for better marketing period.

Finally, add the abiding value of alliance building. The public relations team is generally the keeper of the keys to relationships with third-party organizations or patient advocates. The National Association of XYZ Disorder is not going to hawk one’s product, and yes, they always ask for money. However, advocates can be invaluable to helping smooth the way towards better relationships with key opinion leaders and with payors. One might not need advocates on sunny days, but wait till the storm clouds drift in.

Happy Birthday, etc.

Happy birthday to me…

Rather than a long-winded and whiney essay, on my birthday I thought I’d just catch up on a few developments. Mostly good stuff, but not entirely.

Last weekend Marlene and I spent a few days in California, primarily to celebrate my mom’s birthday. But we got in an extra day in the Napa Valley, that adult Disneyland for those inclined to eat too much and pay too much for wine.

Our winery stops included Patz and Hall, located in an unlikely technology park at the south end of the valley. No rolling hills or singing birds, but the wines—exclusively chardonnays and pinot noirs—more than made up for the lack of a view; as did the small food pairings. Then on to Robert Hall, a new venue for us, where we bought several dark and fruit-filled zinfandels and cabernets. Finally, an old favorite, Newton Cellars, located at the tippy-top of Spring Mountain with a view that truly defines the Napa indulgence. Again spectacular chardonnay, cabs and their secret potion, “The Puzzle” that shape-shifts every year, but is always wonderful.

Dinner was at one of our favorite restaurants, Auberge du Soleil, with breathtaking food, breathtaking views and breathtaking prices. Oh well, we only get out to Napa once a year.

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While in California I finished Robert Hatcher’s The Black Death, a semi-fictional account of the bubonic plague epidemic of 1345-1349, told from the perspective of an English village and its priest. There’s a lot to be learned from an epidemic that killed 40 percent of European inhabitants and helped change the social structure of the continent. But it worries me that I am so fascinate by it.

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Just finished reading the profile of Politico’s Mike Allen in The New York Times Magazine. It’s titled “The Man the White House Wakes Up To,” and it’s a terrific. I discovered Allen early in the 2008 presidential primary campaign, and quickly became addicted to his short and pithy observations.

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Yes, it’s my birthday today, and thank you for those who sent notes (mainly on Facebook). Marlene has invited a few friends over, so we will test-fly those Patz and Hall zinfandels.

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Finally, learned that my former colleague Dr. Bruce Dan has been diagnosed with acute myelocytic leukemia. He’s blogging about experience on the other end of the stethoscope at www.brucedan.wordpress.com. He’s a powerful guy, a powerful writer and a keen observer about medicine in America. Check out his blog and wish him well.

Do you like wine? I do. So my wife and I are taking a micro-vacation to Napa this weekend, so there will be no post this week. But perhaps next week a review of wineries?

PS-- We are also visiting my mom, for her 95th birthday! Wow.

On the New York Times Health and Medical Coverage

The New York Times Reader: Health and Medicine

The week before last I attended a book launch party for Tom Linden, MD, director of the University of North Carolina’s health journalism program and author of The New York Times Reader on Health and Medicine (CQ Press). Linden has also been a contributing journalist with CNBC and Lifetime Medical Television (I believe I first met him more than 25 years ago when I represented Lifetime). Thanks to my pal and colleague Merrill Rose for inviting me.

For those of us interested in the nexus of medical sciences and journalism, this book should float to the top of the gotta have list. It links some of The Times best articles on medicine with analysis of what goes into journalism and interviews with some of The Times primo science reporters, including Dr. Larry Altman, Gina Kolata and Tara Parker Pope.

Lately I have been thinking how rickety is the same-old same-old approach to public relations: jimmy up that inverted pyramid press release (properly de-souled by the legal and regulatory exorcists), spay it out to the “mass media” and hope for the best. Or calling said mass media and pleading for coverage.

The Times writers, speaking through Linden, talk in detail how their articles are inspired, nurtured and created, using many sources of inspiration and sources of facts and opinion. It’s not that public relations folks cannot help created news articles, but the press release is not often the calling card. Instead it’s individualized pitching providing unique, new and perhaps counter-intuitive angles.

Several of the articles reprinted take to task the pharmaceutical industry for promoting off-label drug use (and yes, we have been guilty of this) and cooking studies or finding (again, it’s been known to happen). But only rarely in this good book has Linden or the reporters he interviewed cast a mirror on themselves by suggesting that they too may have personal biases that they must control like personal demons.

He cites Alex Berenson’s 2006 article on Eli Lilly’s alleged off-label promotion of Zyprexa for dementia, which led ultimately to a $1.42 billion fine. The article was illuminating and a great instrument of journalism; but his sources included plaintiff attorneys that had their own axes to grind. Not pointed out by Berenson.

Hats off however to Tara Parker Pope who admits that it’s not just Big Pharma that reporters should be skeptical of: “…we automatically assume a layer of skepticism about anything that is funded by the pharmaceutical industry. Yet we don’t apply that layer of skepticism to research that is funded by the government, by NIH. There’s always an agenda with every piece of research.”

While every reporter seeks that “great quote” that neatly summarizes a developing story, sometimes a second look is prudent, especially in medical reporting. Gina Kolata famously reported a dinner-party remark by James Watson that Judah Folkman “was going to cure cancer.” On reflection, she admits that she should have called him the day after to reconfim the quote. Yes he said it over din-din, but that doesn’t mean that it exactly expresses his sober judgment.

I worry that great medical journalism is in peril—at the signing party Dr. Altman told me he’s taken The Times buy-out and will only occasionally contribute to the great newspaper. As curmudgeonly as he is, we need guys like him, and books like Linden’s to put it all in perspective.

# # #

Adventure.

Many, many years ago I was traveling with some friends through the interior of what was then Yugoslavia. Looking at the map, it seemed we had two ways to get to Dubrovnik on the coast: a four-lane Tito-age highway and a winding path through the mountains. My British pal said, "let's take the hillier road. It should be a spot of adventure." It turned out to be treacherous; in fact, and this is no lie, we enlisted a donkey to haul our car up one dreadful slope. But we got there and the scenery along the way was breathtaking.

What does this have to do with the here and now?

After 16 months as the itinerant public relations gun for hire, or pharma-hand, I am taking a full-time position as U.S. managing director of Resolute Communications, a UK-based medical education and public relations that is expanding its footprint on this side of the Atlantic. Another spot of adventure.

Is this a great time for health care public relations agencies? No and yes.

No, in the context of clients now guarding every dime, demanding ironclad accountability while at the same time looking over their shoulders, wondering if their jobs are on the Grim Reaper’s to-do list. Many legacy agencies, the sort of organizations I’ve worked for most of my career, seem to be struggling to either redefine themselves, (sometimes with disastrous results), or to prove that their bag of tricks is still exactly what clients need. That bag is full of holes, as the challenges biopharm companies face are changing and the tried-and-true tactics are now tried and tired.

But it’s also a wonderful time for health care practices, IF they can demonstrate relevance, if they can show value for the bucks, Euros or yen invested and if they can convince clients that they can give them first-class thoughtful counsel at an affordable price.

Health reform—which President Obama et al. resuscitated like a contemporary Lazarus—will put a premium on disease awareness and health promotion activities; jobs exactly suited for public relations agencies.

The debate about what sort of agencies will flourish in the future—large companies with massive resources or small companies wedded to personalized attention is irrelevant. Big companies can thrive, as can small agencies; the key is their ability to continually adapt to the marketplace and convince clients that public relations strategies can influence consumer behavior in a way that will benefit their brands. Over the past year + I have had met many people who get this. Paul, Donna, Eve and Laura, to name a few (without really naming anyone). I have also met people who don’t get this.

I joined Resolute because I believe its founders understand the need for relevance in an environment where “show me” is essential. Resolute wants to make medical communications more than the sum of its parts and to me, that’s as it should be. This should be an exciting “spot of adventure” for me. Stay tuned.

Thinking Small: Health Care Micro-Trends

I have an article in the current issue of Communique magazine about micro-trends in health care that may impact our business. Here’s an abridged version of it (the entire article can be found at http://www.communiquelive.com/)

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Mark Penn may not have been all that helpful to Hillary Clinton last year, but he did make a powerful contribution our understanding of societal trends with his book (authored with E. Kinney Zalesne), Microtrends—the Small Forces Behind Tomorrow’s Big Changes.

“Microtrends,” he writes, “is based on the idea that the most powerful forces in our society are the emerging, counterintuitive trends that are shaping tomorrow right before us.” He postulates that less than one percent of the American population—3 million people—is enough to set in motion a trend or support a new business.

Those in the health care marketing community are accustomed to worrying about the large forces that have tsunami-like impact on our business. The impact of genomics, digital media and the aging of the population are all-important but easy marks. But lurking below the big waves have always been modest-sized currents that have had lasting and profound effects on health marketing.

Here are five small trends in health care that may rattle the marketplace in the future. I am sure there are others, and would love your feedback about what they are.

1. Home, Sweet Medical Home
An intriguing step towards reducing health costs while improving patient care is the “patient-centered medical home” concept.

A tiny, but influential group of physicians and their patients are opting for this new model of health delivery, in which a primary care physician is paid to coordinate the total care of his or her patients, usually patients with chronic medical conditions. The patient’s medical needs—from preventive medicine to specialist care to nutrition counseling—are coordinated by this single physician who is armed with both high-voltage information technology and a cadre of specialists to whom to refer the patient if necessary.

The medical home doctor’s mission is to preserve and enhance health, not simply to treat diseases. He or she is paid a modest fee for coordinating services and may receive a bonus if the patient’s health improves.

Already the concept is demonstrating its bona fides. In the Pacific Northwest, a study of 9,200 patients using the medical home approach showed a 29 percent reduction in emergency room visits and an 11 percent decrease in hospitalizations compared with a matched control group.

“By employing technology such as e-mail and mobile phones, physicians in the medical home were able to provide better care that included screening tests, management of chronic illnesses and monitoring of medications. These methods also helped physicians ease the workload – 10 percent of medical home doctors and staff felt “burnt out” or emotionally exhausted, as opposed to 30 percent reported from the control group,” reported Healthcare Finance News.

2. The Proud and Portly
The battle to reduce obesity-related illness has taken many forms, from the popularity of low-fat diets to punitive measures such as proposed taxes on soft drinks and higher insurance premiums for overweight individuals. An executive of one health clinic said that given his preferences, he would simply not hire fat people.

Paralleling the war on weight is a movement declaring fat isn’t the devil’s brew.

There are really two separate movements. The first is comprised of the fatalists or nihilists, who may know the risks of obesity, but believe there is nothing they can do to alter their destructive behavior. They are wrong and are playing Russian roulette with their health.

But a vocal and I believe growing subset of individuals is rallying against the shibboleth that thin equals healthy and happy. The New York Times reported recently “Heavier Americans are pushing back now with newfound vigor in the policy debate, lobbying legislators and trying to move public opinion to recognize their point of view: that thin does not necessarily equal fit, and that people can be happy at any size.”

3. Eaters and Self-Treaters
Drugs to ward off health calamities such as stroke and heart attack continue to sell briskly. While prescriptions for these products will continue to increase, in the future we will also see increase sales of food products with substantiated health claims.

Health claims for foods are not necessarily over-inflated or dubious, such as the claims of some dietary supplements. Multiple studies have shown that plant sterols, for instance, when used in combination with statins, are effective in lowering cholesterol by up 17 percent, which is greater than the average five percent benefit seen by doubling a dose of statin. The value of Omega-3 fatty acids in reducing cardiovascular disease and depression has also been confirmed.

Increased drug costs and headlines about under-appreciated safety risks with conventional medications will likely drive some towards “food remedies,” especially when there is compelling evidence that they can be helpful.


4. Welcome to Medicare
While “managed markets” interests the press and policy marketers, most baby boomers, especially middle and upper middle class professionals, are content with the tried and true private fee-for-service model. It is not unusual for an individual to have been treated by the same doctor for 20 or more years. This arrangement has been the gold standard of American medicine and has been responsible for creating the strong bonds between individual doctors and the patients for generations.

But as boomers approach that magical number “65,” will the relationship between the private physicians and the patient change? Will the doctor even be able to keep Mr. Jones, once his private insurance terminates and he enters the land of Medicare?

5. The Old Old
We recognize that our population is aging, however, it is the “old old”, individuals aged over 85 who are gaining market share faster than any other segment of the population. In 2005 there were 5.1 million individuals older than 85 that number is expected to increase to 7.3 million by 2020 and by 2050 will swell again to 21 million, nearly 5 percent of the American population.

As one can imagine, there are substantive and complicated differences between simply older people and the oldest of the old. Depression, for instance, which is the most common mental disorder among the elders, occurs in between 10 percent and 38 percent of the older population though according to The Journal of Allied Health, diagnosis rates are far lower than the actual incidence of the condition. Depression linearly increases with age, as do other diseases such as macular degeneration, Alzheimer’s disease and heart failure.

Fish on the Beach

I was in London this week—the reasons perhaps I will get into in a future post.

One aspect of British health care public relations that I find interesting is how British PR managers have included medical education in their overall offering. In fact, many UK health care practices make more quid on med ed than on traditional health communications.

Fifteen or twenty years ago, public relations firms on this side of the Atlantic had the opportunity to acquire the largely independent, modest-sized organizations that strategized physician messaging and developed and conducted symposia for physicians and medical congresses and supply continuing education programs as supplements in medical journals.

PR fumbled however and most companies never seriously got into the medical education business. Perhaps agencies were too busy counting the bucks showered on them after they were acquired by the large advertising holding companies. Medical education businesses instead were purchased by medical advertising agencies (that in turn were gobbled up by the holding companies).

Flash forward. Medical advertising agencies are now required to either spin off their med education operations or erect mile-high walls separating them from the more commercial side of the business. Fair enough. It really is in everyone’s best interests to keep physician education—which is supposed to be dispassionate and objective—from advertising which is, well, less objective. Many activists, including prominent doctors, are calling for even higher barriers, effectively precluding pharmaceutical companies from sponsoring any medical education activities; which would leave the medical education firms flopping around like beached fish. Not a good scenario for many reasons.

Here’s why this might be important to public relations: one of the most important product communications strategies is to create educational campaigns to help “raise awareness of xyz-itis as a serious medical condition” and to encourage patients to ask their health care professional if they may be at risk for heartbreak of xyz-itis.

Will there be a point at which the critics of commercial medical education might rear-up and say, whoa, commercial public relations firms should not be undertaking public education campaigns, because the firms may be surreptitiously injecting brand messages into campaigns?

Years ago when I was consulting with Searle for an investigational anti-platelet drug we were proscribed from working with the National Heart, Lung, and Blood Institute because Searle wanted to separate the commercial PR (that’s me!) from health education. Was the late, great head of its time?

While there haven’t been many examples since of companies segregating public education from marketing PR, they might do so in the future. As with medical education, will public relationship firms be forced to cleave off public education into separate stand-alone divisions? That would not harm large firms, but be confounding for smaller public relations agencies.

So far, no one is demanding this separation of church and state, but don’t bet the farm that things will always stay the same.

# # #

Last week Newt Gingrich and John C. Goodman, two fulsome but thoughtful conservatives wrote an op/ed in The Wall Street Journal, “Ten GOP Health Ideas for Obama."

Hats off. They offer serious and helpful recommendations—ideas that could be bandied about at the President’s health care summit next week. But even their good ideas are at best half a loaf in the face of America’s health care famine and if they are serious (and if Democrats are), they should re-tool their recommendations to make them more in line with reality.

Here are their proposals (ripped from The Journal, with my invaluable editing) and my comments. Love to know what you think.

• Make insurance affordable (Gingrich and Goodman say).” The current taxation of health insurance is arbitrary and unfair, giving lavish subsidies to some, like those who get Cadillac coverage from their employers, and almost no relief to people who have to buy their own… A step in the right direction would be to give Americans the choice of a generous tax credit or the ability to deduct the value of their health insurance up to a certain amount.”

The Democrats made a similar point and that’s why some are eager to tax so-called Cadillac health care plans. But Gingrich’s and Goodman’s proposal offers little to those without any health care insurance or low-income Americans.


• Make health insurance portable… “Employers should be encouraged to provide employees with insurance that travels with them from job to job and in and out of the labor market. Also, individuals should have the ability to purchase health insurance across state lines. When insurers compete for consumers, prices will fall and quality will improve.”

I don’t know how or why employers would offer insurance that workers can take with them after they leave a job. And government “encouragement” smacks of the regulations conservatives loath. GOPers talk endlessly about purchasing insurance across state lines. That’s not a bad idea but someone has to regulate these policies and as I’ve said, conservatives want less, not more regulation.

• Meet the needs of the chronically ill. “Most individuals with chronic diseases want to be in charge of their own care. The mother of an asthmatic child, for example, should have a device at home that measures the child's peak airflow and should be taught when to change his medication, rather than going to the doctor each time.”

Good for Newt here; he and Goodman are on to something. But they must acknowledge that patient and family education is costly and will add another digit to the federal health care tab. It’s not wrong, it’s just expensive.

“…Having the ability to obtain and manage more health dollars in Health Savings Accounts is a start.”

Liberals say that health saving accounts benefit mainly the well to-do. But with a commitment to educating consumers, encouraging health savings is a good idea.

• Allow doctors and patients to control costs. “…Medicare pays by task—there is a list of about 7,500—but doctors do not get paid to advise patients on how to lower their drug costs or how to comparison-shop on the Web. In short, they get paid when people are sick, not to keep them healthy. So long as total cost to the government does not rise and quality of care does not suffer, doctors should have the freedom to repackage and re-price their services. And payment should take into account the quality of the care that is delivered. Once physicians are liberated under Medicare, private insurers will follow.”

Ah, the catch here is that costs will rise. Then what? And by the way, moderate and liberal Democrats have been talking about improving “quality” at least since Bubba was in the WH.

• Don't cut Medicare. “The reform bills passed by the House and Senate cut Medicare by approximately $500 billion. This is wrong. There is no question that Medicare is on an unsustainable course; the government has promised far more than it can deliver. But this problem will not be solved by cutting Medicare in order to create new unfunded liabilities for young people.”

What conservatives (who in their heart of hearts never liked Medicare in the first place) do not mention is that the cuts to Medicare that congress has proposed are in reality cuts to Medicare Advantage programs, which pay doctors a hefty premium over plain vanilla Medicare. The Obama administration has tried to rein-in costs to pay for HC reform, for which conservatives should be applauding. And I’m sorry, if “unfunded liabilities for young people” mean that individuals—including children—currently without health insurance have some health security, well, just call me a bleeding heart.

• Protect early retirees. “More than 80% of the 78 million baby boomers will likely retire before they become eligible for Medicare. This is often the most difficult time for individuals and families to find affordable insurance. A viable bridge to Medicare can be built by allowing employers to obtain individually owned insurance for their retirees at group rates; allowing them to deposit some or all of the premium amount for post-retirement insurance into a retiree's Health Savings Account; and giving employers and younger employees the ability to save tax-free for post-retirement health.”

This seems like a good idea and one that could be discussed at the White House health care summit next week. But this type of plan must ensure that benefits are available to all employees, not just the better off ones.

• Inform consumers. “Patients need to have clear, reliable data about cost and quality before they make decisions about their care. But finding such information is virtually impossible…”

Fine enough. But doctors also need “clear, reliable data.” The Democrats’ plan includes money for comparative effectiveness studies to examine the effectiveness of some treatments. But conservatives have resisted funding these studies. You can’t have it both ways!

• Eliminate junk lawsuits. “Last year the president pledged to consider civil justice reform. We do not need to study or test medical malpractice any longer: The current system is broken…”

Tort reform is fine as long as individuals seriously wronged or injured can recover reasonable damages. The caps Republicans suggest are simply too low. And “loser pays laws” which Messrs. Gingrich and Goodman advocate would be devastatingly effective in closing off any suits to begin with.

• Make medical breakthroughs accessible to patients. Breakthrough drugs, innovative devices and new therapies to treat rare, complex diseases as well as chronic conditions should be sped to the market. We can do this by cutting red tape before and during review by the Food and Drug Administration and by deploying information technology to monitor the quality of drugs and devices once they reach the marketplace.

I am for faster access to new therapies (after all, pharma companies are my clients). But no one has an appetite for shortcutting the FDA’s safety and effectiveness review process (which some label “red tape.”). And if we are monitoring the quality of drugs and devices post-approval, aren’t we also interested in measuring their effectiveness relative to earlier products?

# # #

Checklist: Check.

I haven’t read Atul Gawande’s new book, “The Checklist Manifesto,” but I am anxious to do so—maybe as soon as I finish David Ploffle’s congratulatory “The Audacity to Win.” But I like the idea Dr. Gawande discusses, as reported on the PBS Newshour (http://www.pbs.org/newshour/bb/health/jan-june10/gawande_02-08.html) and elsewhere. His premise is that in a world of rising magnitudes of complexity, professionals should revert to the most basic of management tools, the simple checklist, to ensure success.

It’s a great example of how something oh so simple can have a major impact on events. An example: in Michigan every hospital adopted a “cleanliness checklist to help control infections. The result: a 2/3 reduction in hospital-acquired infections, the saving of 1,500 lives and a cost savings of more than $200 million.

(The late great television program “ER” incorporated checklists in the surgical settings in one of its final episodes.)

Now down the food chain to health care public relations. The importance of checklists struck me when I was reliving some old business plans account teams developed for p.r. clients. Many were awesome, but others were, well, less so. Two of sand traps public relations executives fall into are the allure of developing everything from scratch or piling one idea (good or bad) on top of another, as if a bigger pile of recommendations is necessarily a better pile.

The most successful teams and agencies may or may not have a new business or a new year planning processes—sometimes I think the “proprietary” processes are so much hooey. But what they will do is ensure that each issue the client faces is addressed and that each audience is accounted for. In order not to go crazy in the business development process, these winning teams will generally follow established checklists mandating when each task must be achieved and who is accountable for it. (I’ve created several such checklists. Let me know if you’d like to see them.)

Checklists: it’s such a simple concept it is amazing that it take a surgeon of Dr. Gawande’s stature to remind us of their importance.

Surgery-related dementia in elderly

Over chardonnay and port Sunday, two friends who are anesthesia experts told me of an interesting observation: Health care professionals are anecdotally reporting that there is a very high rate of dementia in elderly patients following surgery. We are already aware that open-heart surgery patients often have memory lapses and “chemo brain” is a known though not inevitable consequence of chemotherapy.

But this is a newly reported phenomenon and despite being whispered about in hospitals, there are no clinical trials to map out its legitimacy and severity. In fact, my friends say there’s little incentive to fund research in this area since the patients are typically very old and do not have long lives ahead of them.

But as our population becomes hoarier, post-surgery dementia, if confirmed, could become a roadblock to good quality of life in later years. Elderly individuals now are participating in activities undreamed of a generation or two ago. Long distance running, working, gee, even dating, are activities not uncommon even among people in their 80’s. Will they be as eager to go under the knife if they believe that medical procedures designed to help them may in fact hobble their ability to reason, socialize and live independently?

As health care communicators, how will we allay their fears and help them weigh the risks of surgery with possible consequences?

What Happened?

“What we have here is a failure to communicate.”

“The Captain” as played by Strother Martin, Cool Hand Luke, 1967

So how did we get here, Captain? How, after coming to within a millimeter of plugging the leaky ship we call health care, are we now on the verge of the vessel rolling on its side and sinking into an inky sea of name calling and recriminations?

The short answer to “what happened,” of course is Massachusetts. The searing incompetence of Martha Coakley’s senate campaign, a White House political office snoozing at the switch and the genial allure of Scott Brown in the Bay State has made for some very unpleasant mathematics in the Senate.

But more important, by January 1 the public—both in Massachusetts and nationally—had become squirmy to the idea of reforming such a large part of the national economy. While no one poll is Delphic, the sum of polling data suggested that roughly half of Americans had serious doubts about where reform was going.

Two years ago the public was overwhelmingly supportive of a major health care overhaul. A Kaiser Family Foundation/Harvard School of Public Health survey then found that 59 percent of the public supported a universal requirement for families to have insurance and for companies to supply it.

By last summer—just six month ago—public support was still high, while organizations from the American Academy of Family Physicians to labor unions to the pharmaceutical industry both supported reform and opened their checkbooks to lobby their support.

What went wrong was that the administration and the moderates and progressives in congress lost control of the communications war and ever since have been on the defensive.

There was a lot for everyone in the legislation: closing the Medicare drug “doughnut hole,” guaranteeing insurance even if you’ve lost your job and taking steps to moderate health costs. But by its very nature health reform is complex and not very sound bite friendly. The reformers message veered from “health care reform” to “health insurance reform.” No Democrat could convincingly describe how reform would save taxpayers money nor guarantee that taxes would not go up. There was no antidote to the accusation that support from Louisiana and Nebraska were paid for with special earmarks.

Meanwhile, opponents solemnly warned of socialized medicine, death panels, and gutted Medicare. The hostiles played on the understandable concern about the rising cost of government and that no one really understood how much reform would cost us.

In a politically charged environment, the simple message always trumps the complex. Isn’t that the first law of political pr?

What President Obama and his allies failed to do was to boil down reform messaging to the key points that the majority of Americans would like—that it is linked to economic survival, that it would create greater security and that many benefits, such as guaranteed coverage would start the moment the legislation was signed.

The Social Security Act is a massive, jargon-ridden document, yet everyone understands and embraces its basic elements. The President had the opportunity to position health care legislation similarly, but failed to.

Here’s good news if you believe in reform: When you divide health care reform into individual elements the public even now supports it. A Kaiser Family Foundation survey released last Friday confirms this:

“The January Kaiser Health Tracking Poll, conducted before the Massachusetts Senate vote, finds opinion is divided when it comes to the hotly debated legislation, with 42 percent supporting the proposals in the Congress, 41 percent opposing them and 16 percent withholding judgment. However, a different and more positive picture emerged when we examined the public’s awareness of, and reactions to, major provisions included in the bills…

“For example, after hearing that tax credits would be available to small businesses that want to offer coverage to their employees, 73 percent said it made them more supportive of the legislation. Sixty-seven percent said they were more supportive when they heard that the legislation included health insurance exchanges, and 63 percent felt that way after being told that people could no longer be denied coverage because of pre-existing conditions. Sixty percent were more supportive after hearing that the legislation would help close the Medicare “doughnut hole” so that seniors would no longer face a period of having to pay the full cost of their medicines.”

Clearly the Dems bollixed the message.

Where do we go from here? At best it will be months before a new legislative roadmap is drawn. With any luck, the administration and its allies will pair and trim the proposal in a way that will get it back on track with some Republican support. But will not have all of the elements needed to completely right our health care boat and in the meantime millions of Americans will be at risk of losing health coverage and at risk of economic ruin. Conservatives haven’t so much won as the public has lost.

(This note was published earlier this week on Jack O’Dwyer’s Web site. Thank you, Jack.)

The Worst...

The Worst Public Relations Ideas

I can’t resist highlighting some of the worst health care public ideas that have ever cross my ears. Some of these were included in proposals in which I had a hand, so I am not an innocent, snickering bystander. But some I vetoed before they were offered up to clients. Thank God.

The point is that “creativity” is not an exercise in coming up with the most outlandish gimmick, but ideas that advance brand goals. As Benton & Bowles used to say, “if it doesn’t sell, it isn’t creative.”

Can you add to this list? Let me know.

Hummers for Heroes. A large pharmaceutical company wanted recommendations for its AIDS/HIV franchise. One tactical solution, “Hummers for Heroes” was to give away Hummers, those icons of 20^th century excess, to AIDS clinical thought leaders. Just nice gifts for all their hard work. Oy. That one got nixed before the client got his eyes on it.

Skeletons Out of the Closet. We were asked to develop a proposal for launching a new anti-coagulation drug to prevent deep vein thrombosis. One of our strategy expertettes said, “Lets fill the seats at the American College of Cardiology meeting with skeletons.” Huh? She admitted the client wouldn’t agree to it, but said it would demonstrate our creativity. Okay, you’re asking what do skeletons have to do with DVT, or why would ACC allow a stunt. So did we.

Wii Rock. Holding Nintendo Wii tournaments at senior centers to raise awareness of stroke prevention and that new anti-thrombin drug. Hey, that might have been fun.

Bling. Then there was the suggestion to give Alzheimer’s disease patients specially designed jewelry. “Everyone loves a little bling,” said the VP leading the pitch. This one made it to the presentation, but the client was more interested in why we forgot to include nurses and social workers as stakeholders.

Eight is Enough. Any recommendation using Florence Henderson (beyond the first seven times she was included in a proposal).

Tune In, Drop Out. Then there was the recommendation to use Timothy Leary as a spokesman for a pharmaceutical product. No, we weren’t on acid when that one was thought up.

Public Relations 3.0?

P

ublic relations may be yet redefined in the ‘10s as the management of conversations not simply between a company or organization and its stakeholders, but the management of conversations between stakeholders. This constitutes the third step in PR’s evolution.

The early twentieth century view of public relations was not terribly audience friendly. Social scientists such Harold Lasswell, PR pioneer Edward Bernays and journalist cum commentator Walter Lippmann believed democracies should be equipped with muscular propaganda bureaus to help inform and guide the unwashed public. A good examination of this concept is found in an unlikely source, John M. Barry’s book about the 1918 influenza pandemic, The Great Influenza. According to Barry, Lippmann called “society too big, too complex” for the typical citizen, since most citizens were “mentally children or barbarians.” Under the influence of Lippmann and his acolytes, President Wilson created a Committee on Public Information to artfully guide the public’s opinion towards the Great War.

That was PR 1.0. The more enlightened view of the PR arts, which came into focus later in the twentieth century, was “the engineering of consent.” Or as the Public Relations Society of America says, PR ‘helps an organization and its publics adapt mutually to each other.” A variation on this theme that I’ve used for years is that public relations is the creation and management of dialogue between an organization and its stakeholders or audiences.

The central theme here is that public relations must encourage a company to not just communicate to audiences (whether shareholders, customers, government) but to carefully listen to what these audiences are saying about the it and factor this intelligence into both its communications and policies.

Bravo. This makes a lot of sense as far as it goes. But it doesn’t go far enough. As everyone knows, today every individual is to some extent a megaphone or cub reporter. Trust in traditional news outlets is low (just see the always thoughtful Edelman Trust Barometer reports) but faith in outside experts such as physicians or academics is high and trust in individuals “just like me” is sky high.

What this means is that PR 3.0 is not just managing dialogue between the organization and its publics, but managing dialogue between its publics. Not simply arranging for key opinion leader Dr. Jones to talk to the news media about a new treatment for high blood pressure, but fostering talk between Mrs. Smith and Miss Riley about the treatment.

This obviously isn’t easy, and many clients, such as biopharmaceutical companies, shiver at the thought of spreading seeds of dialogue that can’t be recalled or controlled. But the green sprouts of this approach are seen in buzz marketing and our cautious outreach to interested bloggers. In the future we will see more examples of encouraging consumers to “talk among themselves” such as offering disease education videos on company Web sites not just for viewers, but for viewers to pass along to a friend or relative who is interested.

In our strategic approaches to public relations planning, lets remember that we need not simply find ways to communicate our messages, but find ways to encourage others to talk about our brands to their friends, relatives and colleagues.

Sleeping Easier While Facing Pharma PR Challenges

I wrote this a year an a half ago for a public relations journal; the editor asked "what keeps you up at night. It seems as current today as when I wrote it. (I am still not sure whether this blog is going to focus on professional or personal matters; but it seems a lot safer--for now--to cover professional PR matters.

What keeps you up at night? As an agency executive practicing in the health care arena, you recognize that this is an epochal time and perhaps the first time in the brief history of marketing-oriented pharmaceutical PR that forces outside our control threaten the core of our business. How we individually and as an industry respond over the next year or two may very well determine the future growth and prosperity of pharmaceutical public relations.

Government regulation isn’t the bogyman, nor is the health care industry’s reputation. We’ve met those challenges before. The hurdles now facing us are unique and are outgrowths of a health care industry facing its own economic challenges. They include (1) increasing competition from other marketing disciplines, (2) clients’ drive for more accountability and efficiency and ironically, (3) consumers assuming more responsibility for health care decisions. Let me explain.

As everyone is aware, there is increasing pressure on advertising agencies and other communications disciplines to grow both their revenues and their margins. Faced with woes such as criticism of direct-to-consumer advertising, lack of new products to launch and skepticism about the objectivity of continuing medical education programs, ad agencies, medical education firms and others are looking at how they can create patient awareness of diseases and therapy alternatives using non-advertising channels. Their recommendations often look and feel a lot like those lodged in the public relations realm, if you accept that the main responsibility of PR is managing dialogue between a company and its publics.

One needs only to scan BrandWeek or Ad Age to see examples of advertising sidling up to social media channels such as Twitter and Facebook, tools that public relations also embraces. Ten years ago public relations agencies hoped they would control the development of Web sites. That was not to be, as very specialized agencies, often under the wing of ad agencies, seized that business sector. Could the time come when clients look to advertising agencies exclusively for social media, alliance building and loyalty management programs, relegating public relations to meat-and-potatoes media relations?

Under this scenario, public relations would not help set strategy or manage “the big picture.” This is a formula for industry commoditization, not growth.

Thinking about this, you toss fitfully, eyeing the alarm clock.

Related to the challenge coming from other disciplines is our client’s desire for accountability across each marketing engagement. We have beaten to death the observation that clients want to see greater return-on-investment. PR departments and their agencies are trying to address this; agencies in particular claim proprietary ways to measure campaign effectiveness and cost efficiency, each claiming that it has the loadstone. But until there are generally accepted industry standards for measurement, their claims will lack true stopping power. This is a lesson the advertising industry learned long ago.

Accountability also means clients are learning to be more strategic in their public relations spending. Some ask for holding company solutions, saying that they will award a global holding company their communications contracts, expecting that the brightest minds at the parent company level will manage their business. Great if you are Omnicom or WPP, not so good if you are a small independent shop. It’s also great if you have uncovered exactly how your holding company solution will offer the client greater service at less cost. But that’s not easy.

On the other extreme, clients also are recognizing that even the best agency is not best at everything, and they are parsing their business among generalist and specialty firms. So-and-so may be the agency of record, but another company that has built unique expertise in, say, reimbursement tactics will handle that job.

Many clients are zero-based budgeting their public relations accounts, saying, “never mind what we gave you last year, what is needed to do very specific tasks this year.” Starting from scratch can mean scratching for dimes.

Again, you stare at the ceiling, wondering if you can get by on just five hours sleep.

Finally, our clients recognize that economics is weighing very heavily on consumer choice. We all support greater consumer involvement with health care decision-making. However, as the price tag for wellness increases, consumer involvement will also mean sharing responsibility for the cost of care. We are already seeing insurance companies instituting multiple co-pay levels for medicines. You shell out $10.00 monthly for a generic remedy, perhaps $25.00 for one type of branded drug, and up to $45.00 for a super premium pill. Co-pays for new medications may zoom to $75.00 in the near future. As the patient pays more each month, will he or she be as receptive to traditional media placements or celebrity “endorsements?” I may adore Sally Field, but if I can get adequate treatment at a fraction of the cost of the drug she is promoting, her seal of approval will mean little to me.

Public relations—particularly health care agencies—needs to break out of its knee-jerk celebrity infatuation and focus more on the actual drivers of consumer behavior.

None of these issues need be fatal to public relations practitioners. They do mean, however, that challenges have to be addressed without business-as-usual solutions. They mean demonstrating how PR approaches communications problems in ways that smartly separate our discipline from advertising; they mean creating easily understood accountability systems and mean looking not simply at the traditional bag of PR tricks, but rather looking at what it will take to effectively convince patients and consumers to ask a question or take an action or for physicians to prescribe a brand. That’s a lot to think about but if you manage these risks, at night, you can sleep easier.

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The New Year...

So my friend Suzanne said I should start a blog. And why not? I started a family, a health care practice. This morning I started my car. What could be so daunting about a blog?

Suz said write about health care marketing, which I know a lot about. I'll try (though the recession has put me back a peg or two). My younger son said write about him. I'll try, but I'm not supposed to swear on the Web. My other son said talk about how difficult it is to live with a kid with bipolar disorder. I'll try that too, though that gets a little emotional. Politics? Sure, along with 10 billion other bloggers.

So stay tuned. We'll see what's interesting in the New Year.