In the heart of Sydney's Ryde Valley - Australia's drug industry alley - fifty marketing managers and PR advisers from major drug companies, including Pfizer, Bristol-Myers Squibb, Novartis and GlaxoSmithKline [3], pondered the industry's poor public standing.

The drug industry representatives – used to hustling everything from drugs for guys struggling with their love life to cancer cures – were seriously depressed. "I am appalled by our reputation," Group Vice-President Far East Region for Schering Plough, Rod Unsworth, told a panel of industry heavy-hitters discussing "reputation management" at the third Australian Pharma Marketing Congress.

Unsworth, who describes himself as a "passionate" supporter of the industry, bluntly told the mid-May gathering that the drug industry in Australia was way behind even the tobacco industry [4] in its efforts to rebuild its political stocks.

Unsworth warned the panel of the potentially fatal consequences of the Australian industry's defensive posture. "If we say we are going to just look after the opinion leaders and we don't give a damn about the public, we are dead. And if we let the debate be about price, we are dead," he said.

The marketers in the industry, he warned, "will tell you time and time again sell the benefits, do not get into areas of weakness, do not go down that pathway. And yet here we are as an industry headed down the pricing debate led by David Henry [5], led by Norman Swan [6]...," he said.

The drug industry has long viewed Henry, who is Professor of Clinical Phamacology at the University of Newcastle in New South Wales and a consultant to the World Health Organisation, as an effective opponent of their plans to gouge high prices for drugs that deliver comparatively little.

Henry has been one of the architects of Australia's government-funded Pharmaceutical Benefits Scheme (PBS) which provides universal access to subsidized drugs. (Henry is also a founder of Media Doctor [7], a website that scrutinizes media stories on medical issues. Norman Swan in the presenter of the Health Report on the Australian Broadcasting Corporation’s Radio National network.)

New drugs are only included in the PBS where they demonstrably deliver health benefits beyond already listed drugs. Even more infuriatingly for Big Pharma, the price paid for newly listed drugs is benchmarked against prices paid for a comparator generic drug.

In the eyes of the drug industry the PBS would be bad enough if it were confined to Australia. However, as the World Health Organization [8] uses it as a global model on how governments can control the cost of prescription drugs, the drug industry views it as a major obstacle to boosting profits.

Reputation? What reputation?

Unsworth's tobacco industry comparison was also taken up by Bill Curtis [9], the founder of the Sydney-based advertising and medical communications company Curtis Jones Brown [10].

Market research in the U.S., Curtis said, revealed that the tobacco industry had clawed its way back up over the last five years to 25% of survey respondents agreeing with the proposition that the industry was doing a good job for the country. "The pharma industry has collapsed over the last five years down to about 25%," he said.

In recent years the industry has been hit hard by a series of public controversies over everything from the recall of drugs due to their deadly side effects to the lack of disclosure of data from clinical trials.

The drug industry is also facing mounting accusations that its marketing prowess has degenerated into little more than 'disease mongering [11]'.

In their recently released book, Selling Sickness, Australian journalist and guest editor of the British Medical Journal Ray Moynihan and Canadian co-author Alan Cassels powerfully argue that "the industry's promotional machinery is turning too much ordinary life into medical illness in order to expand markets for medications."

Nor is the controversy over 'disease mongering' likely to abate with the first International Conference on Disease-Mongering [12] scheduled to be held in Newcastle, Australia April 12-14, 2006.)

Kristin Austin, director of the public relations company Ruder-Finn [13] and facilitator of the reputation panel, recounted that her company had conducted a survey of media stories on the drug industry in the Sydney and some national media outlets over the preceding twelve months. Outlets included in the unpublished Ruder Finn study included the Sydney Morning Herald, The Australian, the Daily Telegraph, the Australian Financial Review and Australian Doctor.

For every three "positive" stories there were four "negative" stories. Austin explained that a rule of thumb her company used was that "each negative story requires six or seven positive stories to negate people's misgivings."

According to Austin, not only was the industry way behind where it needed to be to overcome public concern but "negative" stories were either critical of the entire industry or a whole class of drugs. On the other hand, she said, positive stories were "about individual products and they are largely generated by said PR companies [14] working for a particular brand."

PR prescription for Big Pharma's headache

Curtis asked panel members to sketch what they would do. Senior Manager of Corporate Affairs External Affairs for Bristol-Myers Squibb, Michael Moore (no relation to the U.S. filmmaker), recounted that the industry had built "third party support [15]" amongst "our key stakeholders in government, among the medical profession and the health consumer representatives."

However, he was far from persuaded that the industry should or could win over a sceptical public. "Whether that wins the hearts and minds of Joe Public out there I don't think it will, and, at the end of the day, I don't think it matters so much because we will still sell product whether or not Mum and Dad in the suburbs like pharmaceutical companies," he said.

Curtis took a different view. "Winning the hearts and minds," he said, "would enable us to support our pricing needs. It might enable the debate about prescription medicines to shift from price to value." (In the drug industry "price" is equated with government moves to contain costs while "value" is interpreted as much higher prices that reward big pharma companies with a premium for their patented "innovative" drugs, even if they are little different from existing drugs).

Greater community support, Curtis suggested, would ensure the industry was "trusted more to talk to consumers." In drug industry parlance 'talking to consumers' means advertising. In the U.S. and New Zealand it takes the form of direct-to-consumer advertising [16] (DTC) where prescription drugs are extensively advertised on television and in magazines.

Elsewhere the drug industry skirts around the ban on DTC advertising by funding 'disease awareness' campaigns that advertise the existence of a particular condition or disease – including sometimes via front groups [17] or company funded patient groups – and urge consumers to consult their doctor. Doctors are simultaneously targeted by another, but largely invisible to the public, marketing campaign.

The adverse public and media reaction to even disease awareness campaigns irritated Curtis. "Why is it that disease awareness advertising, principally on television, is seen as the nasty dark subversive work of an industry that shouldn't be allowed to do this? Answer. Because we are seen to be that sort of industry: manipulative, dark, menacing," he told the conference. (The "we" Curtis was referring to was the drug industry he works for not the PR and advertising industries which he is part of).

Curtis also saw that greater support would enable the drug industry to smother its critics ability to gain media coverage. "We would have a more dominant role in the media because the media wouldn't take quite so many cheap shots at us," he said. "In addition it would allow us to marginalise the half dozen people broadly speaking who have some strong negative antagonistic points of view about our industry.".

The drug industry representatives attending the conference perceived they had little credibility in the broad community. However the dominant view was that the industry was unjustifiably misunderstood, that it is all a perception problem rather than a reality problem. Debacles, such as over the recalled arthritis drug Vioxx, barely rated a mention.

Perhaps the most perceptive comment came from the Director of Healthcare for GlaxoSmithKline, Alex Gosman, who commented that in his eighteen months in the industry he had observed "a lot of group thinking."

"We don't come to grips with what are some of the issues and why some people have some quite legitimate concerns about what the industry does," he said.

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