Pharma: Trust Deficit or the Biggest Image Problem ever faced?



It was  Saturday afternoon; April 4th, to be precise.

7-time Tour de France winner and full-time cancer fighter: Lance Armstrong was in his born-state Texas, riding to give a speech in the PhRMA meeting in San Antonio.

From his blackberry he tweeted:

Armstrong tweet.

Less than 15 minutes latter, two Twitter answers:

Answer to Armstrong 1

Answer to Armstrong 2

Surprising? Well not at all.

This phenomenon may be not well recognized by our friends and customers in México but is the big conundrum of a very serious reputation problem for the Pharmaceutical business in the US and some European countries. 

Since some years (there is going to be around 10…) Pharmaceutical business has become the center of very bad opinion and reputation among the general public in he biggest market in the world.

The problem has become more than anecdotical and it’s starting to seriously hurt in the potential benefits that medication and pharmaceutical products would have.

Today, everything a Pharma company does is intrinsically wrong at the eyes of the public. Furthermore, there is a growing “conspiration theory” which –unfortunately- involves many of the most important Pharma companies.

Thus, it is becoming very common to hear stories or arguments about:

  • Vaccine-produced autism being not disclosed or cynically hidden by companies
  • High-end government officials utterly corrupted by Big Pharma
  • Tons of unfavorable information appearing in clinical studies, concealed from public
  • A new paradigm of physician behavior where they (all) are Pharma-driven, or (sort of) Pharma –slaves
  • DTC or DTP information clearly (and routinely) containing misleading information about benefits and side-effects
  • A Pharma meta-power that has taken over the FDA (and local regulatory instaces in other countries)

And so on…

Personally I have to say I don’t believe in those (especially the vaccines topic); although there may be historically some isolated cases that have not been well managed in terms of PR by the Pharma Companies.

Anyway, as mentioned earlier, this is starting to hurt the basic confidence and credibility that a drug would have, many of them used to treat diseases as Alzheimer’s, diabetes, dislipdemia or MS.


How did this happen?

Let’s start with a basic public opinion: Pharmaceutical companies are private businesses… therefore, they have to be evil. At the eyes of the defenders of this axiom, it needs to be a very bad person or company to make business (money) with human health.

In a country which lacks of universal healthcare, where everyone is responsible from paying (at least some part, if not the total) of their insurance; people starts to think what is becoming natural: We are consumers, of products and services, so we deserve to be treated nicely, very nicely.

So, when someone has to pay hundreds of dollars out-of-his/her pocket monthly for their medication (insurance coverage may vary); this person won’t be happy to learn about the good dividends that Pharma stockholders are (at least apparently) gaining.

Pharma business is a legitimate business as many. Additionally, Pharma business has a serious and honest commitment to benefit the public and in many cases to cover the unprotected-ones. There are many stories and reports of the philanthropic activities of the Pharmaceutical companies in the US, Europe, Third-World countries, etc.

The problem is that this is not well transmitted or communicated; thus, the public perception doesn’t change at all.

According to Kathryn Metcalfe (see bellow), VP of Corporate Reputation and Policy Communication at Pfizer, there’s a public belief that Pharmaceutical companies could disappear easily as the government could take over the development and deployment of drugs.

Pharmaceutical Companies are just a painful chain link


Vioxx®Vioxx® didn’t help much.

The Vioxx® case in 2004 ignited the flame in public opinion regarding two points:

1) An important and good-reputation company commercializing a product that could be associated with cardiovascular complications.

2) A failure of the FDA in being more inquisitive regarding full clinical results.

To the eyes of the public this was translated as: “A potentially lethal product commercialized via greed, corruption and gohst-writing; before the complacent eyes of a weak and industry-focused FDA…”.


A vicious circle begins.

It is not secret (nor a surprise) that since the Vioxx® case, FDA has strengthened its policies to a point where the R&D and the launch of new products has been slowed a lot, if not jeopardized.

Again, I’m in total favor of well-applied and proper rules and laws; however it appears that FDA and other local Regulatory instances are behaving pathologically cautious, with the consequent enlargement of the timing and complication of procedures. This is comprehensible when we consider that these instances have a double agenda in which they have to protect the public as well as their political future.

Is FDA becoming tougher than other Regulatory bodies? Are other-country Regulatory offices laxer than FDA?

Apparently a good discussion would begging when looking back at cases like Acomplia® which was fully approved by the FDA European counterparts, just to be busted by suicide-related reports taken into consideration by FDA.

The problem in terms of PR, is that the public is not finding consistency in decisions or reported-data.

An “official” statement would say that everything has been taken into consideration smoothly and by-the-numbers; again, we are not judging the system, but the communication strategy.

Now, in a sort of cynical consideration, some commentaries have appeared in terms that FDA busted Acomplia® just because it came from a European (French FGS!) laboratory.


The day physicians “became stupid…”.

One of the most infamous chapters on the later Pharma-Healthcare relationship history has been the one regarding promotion and advertising (P&A).

PhysicianThere was a time when physicians simply welcomed Pharmaceutical reps in their offices, received a promotional message, may be one or two brand-reminders (or simple gifts) and that was it.

With the pass of the time and with the growing competition, Pharma Companies became more involved and aggressive in their P&A strategies and tactics.

It was a natural trend that at some point, Sales Reps and Marketing people would become involved in strengthening their relationship with their clients (yes, their clients).

It was always assumed that physicians, as professionals with more than 10 years of graduate education, would have the adequate criteria and maturity for adequately marking a line between commercial commitment (?) and professional medical-behavior and ethics. Somehow, some day,  someone, a physician or a physicians’ association began to question that.

It is reasonable to think that there would exist lots of conflicts of interest within someone who owes a full-paid trip to Europe to some big Pharma Company or some physician that has been receiving grants or stipends from their direct work in R&D, or Marketing advising.

However, movements and organizations like No Free Lunch, started to point fingers at apparently insignificant details as promotional pens or lunches, as the direct cause of physicians losing their objectivity and professionalism.

The phenomenon rose to the point where it was politically incorrect and bad perceived (as many things in the USA…) to engage in any kind of contact or receive any kind of free goods from Pharma Companies.

As expected, some Medical Associations started to express their concern for such practices. The fact that many of them were very conservative on their points of view, added more gas to the “unethically driven physicians” campfire.

At some point this concern reached the public. Again, Pharmaceuticals were to be blamed.

Some analysts started to challenge this criterion. In an article published last January 2008 in, Paul H. Rubin questioned the validity of all the fuss and criticism.

Rubin says:

A […] 2000 article in (JAMA) summarized 29 published studies critiquing the interaction between doctors and drug reps… “No study used patient outcome measures.” That is […] there was no evidence of harm to patients caused by doctors and drug reps breaking bread…

Rubin continued:

These articles were written by physicians who by their oaths put patient welfare at the top of the list, but they were critical of the industry based on analyses that totally ignore this measure…

What has been the response of the Pharmaceutical Industry to this debate? Self-restraint.

The PhRMA Code of Interaction with Healthcare Professionals (see image bellow) formally started to apply since January 1st 2009.

PhRMA codeThere are plenty of accepted and not-accepted rules of behavior when dealing with health professionals, enriched with examples and cases to consider.

Whatever the plausible or criticizable, measure and document could be; in our point of view it was not adequately deployed nor communicated to the public.

It is normal that regular people think that “there was always something fishy” that was been “corrected”.

To the general perception again, Pharma guys were the bad guys; otherwise there would not be need of a Code.


Education or “indoctrination”?

Education is expensive. Medical education, more. Continuing Medical Education (CME) could become a nightmare in terms of costs, especially for young or not-so-solvent physicians or associations.

Much of this CME has (had) been sponsored by Pharmaceutical, Biotechnological and Biomedical companies. In different sizes and in different scopes and outcomes, these enterprises had sponsored a great part of the physicians’ need of updating.

Again, at some point, someone thought this was incorrect. A pharmaceutical company could not be involved in education because they became judge-and-part on the communication and messages they were transmitting.

It is true, yes, that sponsors like their messages to be transmitted; thus they will push towards this point.

But it is true as well, that physicians have their own criteria and they have been trained to differentiate and classify good information from bad one. Is it possible then, that patients’ lifes had been jeopardized just because their physicians attended seminars, congresses or even pizza-lectures sponsored by Pharma?

As the new PhRma Code utterly restricts the CME involvement, new problems are starting to rise. Dr. Kevin Pho, one of the most influential opinion leaders and information collectors at the Web 2.0, has wrote several occasions in his blog about this topic. In his last post: If the pharmaceutical industry won’t pay for CME, who will? he expresses his concern that access to CME will become more expensive and difficult for physicians who need the credits to maintain their licenses.

As the CME topic (costs and importance) has not been adequately explained to the public, opinion rejection has been expressed in phrases such as: Would you trust your physician, if you learned that he’s been educated by Pharmaceutical companies?


Direct-to-consumer (DTC) and Direct-to-patient (DTP) advertising have taken their toll in the problem as well.

In many occasions we have expressed our favorable opinion to the right for free information and the right of communication. It is better to know than not to know.

The fact that in the US, DTP exists (as opposite to Canada and Europe), has not change anything in the public perception of the Pharma business. Pharmaceutical Companies are perceived as powerful and capable of having a strong and manipulative opinion and a huge advertising power with no control at all.

A strange phenomenon exists here because as lots people complaint about misleading or excessive information in the media coming from Pharma companies; another big number actually demands to know more.


A well recognized “Trust Deficit”; does someone care?

Richard ClarkAccording to Dick Clark, CEO of Merck in his speech at the end of his term as Chairman of PhRMA; Pharma business urges to repair it’s “Trust Deficit” within the public.

According to Jonathan Rockoff in the WSJ Health Blog, this “was applauded” by his peers… well at least for a moment.

Just some minutes latter, David Brennan, CEO of AstraZeneca, and new PhRMA Chairman mentioned in his inaugural speech:

We’ve gone a long way in remedying the “trust deficit”, defining more transparent ways for us to interact with physicians and clarifying our views on the appropriate use of direct to consumer advertising.

Thank you Dick for your leadership.

That was all.

The rest of his speech was about healthcare reforms (in the US, of course), the need of more freedom (and less interventionism) for R&D, and the many ways PhRMA affiliated companies could help access to medication… and that’s good; unfortunately it was very clear that his speech didn’t include a single word about this “Trust Deficit”, that is an euphemism for Credibility and Reputation crisis.

Worst of all, the core message here was that Pharma Companies really think that they are in the right pathway for mending their image!


Who is who in ethical behavior.

Ethics analyst and writer Chris MacDonald is a very objective and pragmatic studier of ethical behavior. He recently wrote in his blog about an article entitled: Ethics Rankings for Bio-Pharma Companies, where he comments on the Covalence Ethical ranking for 2008, released last January.

In 31 positions going from:

 # 1: GSK and #2: J&J

to 30th: Schering-Plough or 31st: Gilead

and setting Merck at the middle of the list; he wisely asks very precise questions to hypothetical investors, employees or ethics committees.

As he points out, Covalence’s methodology could be not perfect, but the fact of the matter is that there is people out there measuring and a public opinion being influenced by good and bad posts and news.


Pfizer does concern.

As it needs to be blind or very stubborn for not noticing that something is very wrong with the public perception about the Pharma reputation, Pfizer recently addressed the problem with an actual person in a new possition.

Some months ago, it hired Kathryn Metcalfe as VP of Corporate Reputation and Policy Communication.

An academic and a PR person, Metcalfe is in charge of renewing the public perception (an reputation) of the #1 Pharmaceutical Company worldwide.

In a recent interview in, Metcalfe was very honest while mentioned:

Pharmaceutical reputation has diminished significantly. I remember working in this business when it was exciting and noble work. So it is very disappointing to see an industry that continues to do good work in advancing patient health be villanized publicly.

Kathryn Metcalfe is very forthcoming when addressing this reputation issues; she really recognizes that not all the work that has beeen done in the past has been a good one. She punctualizes for

What the industry’s done in the past has not been effective… I want to focus on novel, reputational activities that are going to move the needle…

… I think it’s really hard for anyone working in this space to claim victory in the past when you look at our reputational data and we fall one step above Big Tobacco in some cases, or oil companies.

You can read the complete interview by George Koroneos HERE.


What could be done?

The road to reconciliation and re-gaining of trust and reputation will be a difficult and long one.

There are lots of edges to be polished and holes to be covered before public perception could be mended.

On those measures, as well as public expectation, we will write in a future post. 


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3 Responses to Pharma: Trust Deficit or the Biggest Image Problem ever faced?

  1. Frances Chapman says:

    This is a great post. My answer to the question in the headline is, both.
    I want to mention two very different marketing techniques, no longer used to my knowledge. Their disappearance says something about the problem addressed in in your post.

    First, the oyster parties Marion Labs used to throw at all the state Academy of Family Physicians meetings. Reps were there, but mostly as happy hosts. The physicians knew what products Marion Labs made but they weren’t being pitched. Everyone was just interested in the beer and oysters. The only message was thanks for using our products, we’re glad you think they’re good.

    In the early 1990s, I wrote newsletters for a now defunct medical publisher. Though these newsletters were single sponsor and were a mix of reportage and article summaries, they were completely created by the publisher not the drug company. The company saw them in near final proof and had agreed to make only minor changes. My memory is that they only had corporate branding. The medical publisher has long been out of business.

    The first tactic is probably considered unethical–oysters are expensive–but to my mind pretty harmless. The second has fallen out of favor because companies want to “message” all the time. That is what is killing medical education.

    True medical education could benefit from support (unrestricted funding) from pharmaceutical companies but the relentless pursuit of return on the marketing dollar has encouraged the shaping of the curriculum and content from the very beginning.

    My prescription would be to restrict messaging to journal ads in peer-reviewed journals and specialty throw-aways supported by multiple advertisers. These publications would appreciate the advertising support.

    All other promotion should be directed toward good will and changing the public perception of the industry,not pushing specific products.


  2. Xavier,

    Nice article. There are many things wrong with the PhARMA image; some that can be managed much better and some that actually need change. One thing I would remind the non-US reader is that Americans have a sense of entitlement to health care. The general population believes they should receive every treatment possible no matter the cost. We believe that absolute health care is our birth given right; even if we are 100 lbs over weight, smoke, drink, lack exercise, and even if we do all the good for your health items. We worry second about the cost. This is problematic. It makes for angry patients complaining that treatment cost so much, it makes hospital and doctors shunning patients without insurance (which is totally an unstated rationing device) and it often focuses the “blame” on the cost, i.e., drug, rather than the system as a total which is antiquated and costly.

    Pharma has clearly a lot to learn from the insurance companies which continue to make excellent profits but share less in the “making money off of the sick” mantra. Pharma could do much more to publicize the free medicines they offer and the research they accomplish.

    And yes, there is risk with every foreign item that enters the body that there will be side effects. The FDA has moved to cautious stance, but that is ok, if the companies make efforts to have pools of “in development” products available to those that don’t fit a clinical trial requirements. But this has yet to happen.

    On the doctor front, concerning direct-to-consumer advertising and sales reps. The doctors are in a bind. They want to make a healthy, robust living, which means seeing as many patients as possible, and keeping those patients happy. That means giving them the drugs they ask for, which means direct-to-consumer advertising works. This also means the doctors authority is challenged daily by untrained patients. This requires a new set of soft social skills by the doctors whom are not trained on how to deal with patients, and frankly only receive one three month course on pharmacology in their training. So the system is broken. Doctors should be required to have continuing education, they should pay for it to keep their licenses, but it should not be expensive, which begs the question, then does the government need to fund the teaching? Well so far the government hasn’t so that is why there are pharma reps and company sponsored symposiums.

    There will always be bribery worries in any profitable business model that is regulated by the government. It is unavoidable. However when the profits on the companies as a whole run toward 30%, that is robust enough to question how much are they contributing back to the market, the patient, to the physician, and continued scientific exploration. And then it is the industries responsibility to get that message out if they wish to deflect finger pointing.

    Angela, LarsonPharmaConsult

  3. John Mack says:

    Pharma’s Bad Rep or Bad Rap
    Whatever! The Drug Industry Must Earn Back the Public’s Trust

    Over the years, Harris Interactive has polled Americans about their attitudes toward corporate America. The pharmaceutical industry has consistently received low scores; in 2007, for example, only 26 percent of Americans viewed the industry favorably. Among the 11 industry sectors examined, only tobacco companies had a measurably lower rating.

    Who and/or what is to blame for pharma’s bad reputation? And what should the industry do to win back the public’s trust?

    The “How to Earn Back the Public’s Trust” survey hosted by Pharma Marketing News between February 4, 2009 and March 14, 2009 was designed to answer these questions.

    This article summarizes the results of that survey, including selected comments from respondents and other commentators.

    Topic headings include:

    * Royal Pain from Physicians
    * Is Pharma’s Bad Reputation Deserved?
    * What’s Causing the Bad Reputation?
    * Industry and Its Stakeholders Disagree
    * Suppression of Negative Clinical Data
    * The Media’s Role
    * Is DTC Advertising the Culprit or Just the Poster Boy?
    * What’s the Solution?
    * Transparency Is Key
    * Improve Relations with HCPs
    * The Industry Needs to Re-invent Itself
    * Don’t Look Back, Look Forward

    Order the article here:

    Your readers can use the discount code ‘tw413′ to get a FREE copy!

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