A European DTC Model

“Difficult?” says the headline over an air-brushed picture of a muscular young man. “Well, we hope it’s got a little easier now that Glaxo SmithKline have combined two essential Aids medicines in one tablet”. And there, alongside the advertising blurb are pictures of the two essential medicines with a little equal sign leading on to a third tablet, emblazoned with a GSK code. An American DTC ad? Actually, this is my pathetic attempt at translating an advertisement running in a Spanish gay magazine alongside ad’s for expensive cosmetics and chic gyms. The ad is entirely legal.

The moral of the story is that Direct-To-Consumer (DTC) communication in the European Union is not as simple as it at first seems. There is a lot of excited posturing about the need for changes to European law to permit more consumer information and choice but, in fact, the major blocks to effective communication may be the culture of the pharmaceutical industry rather than the regulatory environment.

Some patient groups are deeply frustrated over the reluctance of the industry to communicate in ways which are clearly allowed today. Different patient groups have offered to run these initiatives for individual companies or for industry. I know because I have sat in on many of the meetings (although, sadly, most were confidential so I cannot name the guilty). There have been few takers and where industry has become involved it has often sought to re-direct the groups from raising public awareness to changing behaviour by treaters. There are few restrictions on the ability of genuinely independent patient groups to say anything responsible about treatment and its benefits – even if they do it with pharmaceutical money.

A few patient groups have started the work and then gone looking for support. CERT (the Campaign for Effective and Rational Therapy) started out as a collection of Aids activists pushing for access to combination anti-retroviral regimens. Having got universal national access, they were ready to disband. A prominent oncologist asked them to use the same techniques to improve the availability of cancer drugs. They started work with a small group of his colleagues and then looked for pharma funding. After a fairly sensational piece of market research (which showed that the more people had had contact with NHS cancer services, the less confidence they had in them) and some clever lobbying, they got a summit at No.10 Downing Street and a promise to dramatically increase spending on treatment. It was not quite this simple – but it was almost. Why did this require a chance meeting between a group of oncologists and a few Aids activists?

A few companies (Baxter in haemophilia and Schering in multiple sclerosis, to take two) are making interesting use of new technology to promote adherence. Both are using the Internet to deliver reminders, motivation and help for users of their treatments. But Baxter and Schering are quite lonely and no-one is yet using interactive digital TV.

Many other companies tell me they are putting off committing until the patterns of technology use are more stable. Presumably, they are thinking, for example, of the “crippling” turnover of customers for one digital TV company referred to by industry magazine, Television Europe. Well … it turns out this “crippling” rate was a 40percent loss of customers over an eighteen month period. Most pharmaceutical companies dream of keeping 60 percent of patients with a chronic condition on therapy for 18 months. For cholesterol lowering, half are widely reckoned to have dropped out within six months.

There is a digital technology that was used by 58 percent of all mobile phone users in Europe last December. SMS text messages are used by support groups for the elderly, governments, charities and dubious escort services but not by the pharmaceutical industry. Within about 18 months, the geeky amongst us will be walking around with high-powered new mobile phones that deliver streaming video and which could deliver customised, animated colour messages supporting patients on specific therapies. That too, with a few caveats, is entirely legal today.

While the industry stands still, the UK is moving on. Last year, 7.5 million people used NHS Direct, the on-line and telephone enquiry service. It is forecast to be 15 million soon. Trials over interactive TV are underway. This could directly affect industry’s ability to help patients who want better care. Over 20 percent of the callers to NHS Direct said they had done something different to the thing they had planned to do before calling. It would make the ideal antidote to industry when it challenges NICE priorities or the restrictive formularies that Primary Care Trusts seem certain to embrace.

It is not fair to lay all of the blame at the door of in-house lawyers and regulatory experts in the pharma sector. The government seems to have some vision of a high tech future full of public-private partnerships but some of the civil servants at the Department of Health are a bit less enthusiastic and there will be a few backlashes at ambitious DTC efforts. But much more of an obstacle is to be found internally: marketing staff are often evaluated on this year’s returns but bold new efforts to relate to end users tend to pay off over two or three years. This means senior management must lead the effort.

There may be a risk attached to innovation but the cost of inaction is higher: interactive marketing theory has it that those who control the channels of information control the market. We are seeing signs that the best and the brightest of the big pharma companies are finally hiring the expertise to use the powerful array of legal DTC tools available to them right now. It will soon look as vital to European marketing as those cherished TV spots look to US marketers today.