What the Pharmaceutical Industry Must Do to Regain Trust

Pharma has been taking it on the chin for some time now.  It’s been targeted by activists, bloggers, politicians and reformers. Next to Wall Street, it’s one of today’s least trusted industries.

But until last week, much of the industry’s response had the flavor of, “if people only knew the whole story,” or “they just don’t appreciate the good we do.”

Fair enough, perhaps.  But no longer good enough.

Last week, the industry drew negative cover-page articles in two iconic, industry-friendly major publications.

Et tu, Advertising Age? From the trade magazine of an industry that benefits enormously from Pharma comes this tabloid-like headline:

Vytorin Ad Shame Taints Entire Marketing Industry


Cholesterol Drug’s Ad Campaign Turns Into PR Nightmare, Fanning Flames of Public Mistrust of DTC.

Reports that Merck & Co. and Schering-Plough Corp. kept under wraps for more than a year findings that Vytorin does not deliver results it spent more than $100 million advertising to consumers is much more than a PR disaster for the drug’s co-marketers. Coming on the heels of a New York Times story that Pfizer’s $2 billion drug Lyrica treats a condition, fibromyalgia, that a lot of doctors don’t think exists, the Vytorin news is fanning the flames of public mistrust for the $5 billion direct-to-consumer drug industry — and the ad business in general.

"The pharmas are in big trouble in terms of credibility," said brand expert Rob Frankel, who runs his own consultancy at "They’re just above Congress and used-car salesmen."

Talk about biting the hand that feeds you.

But the topper has to be making the cover story on BusinessWeekDo Cholesterol Drugs Do Any Good?


Never mind the typically well-researched and well-written critique of the industry; never mind the bad press Merck and Schering-Plough got for the Vytorin data, coming on the heels of the Vioxx lawsuits; never mind the bevy of critical testimonials the article digs up.

The plain fact is, once Ad Age and BusinessWeek put you on their covers—in nakedly negative terms—it’s time for some basic re-examination.  Low trust is not a surprise to the industry—but this is a wake-up call about the failure of the industry’s response to date.

One of the major pharmaceutical firms (because it’s not likely to be PhRMA, the industry’s trade association) needs to find a voice and take a leadership role—to speak what has become obvious to the world outside Pharma, as represented by leading business publications.

The message is this: the only way to resolve the industry’s trust issues is to become trustworthy—worthy of trust.

• Trust will not be regained by “educating” the public.

• Trust will not be regained by “getting the message out.”

• Trust will not be regained by improving your PR; your PR will be improved by regaining your trust.

• Trust will not be regained by framing it as a problem of image, marketing, or perception.

• Trust will not be regained by coordinating, refining or sharpening talking points; the problem is not getting the message out—it’s listening to the market to hear the message coming in.

The good news is, there are a great number of very well-intentioned, smart people in this industry, who are deeply pained at having been demonized the way they have been.  Some are courageously beginning to face up to it.

It won’t be easy for them. Twenty years of success, blockbuster drugs, and an overdose of marketing culture erects barriers to even their good intent.

Further, any gain in trustworthiness must be broad-based.

It won’t be enough just to help sales forces become listeners, rather than shills—though that will help. It isn’t enough to wean physicians from the “consulting” and “education” fees they reap—though that will help. It isn’t enough to deal with the appearance of conflict in researchers and journals’ affiliations with pharma funding—though that will help. It isn’t enough to seek business models beyond patent-stretching, features-tweaking and disease creation—though that will surely help. 

It is an industry whose beliefs and practices have become encrusted, making its untrustworthiness opaque even to those who most sincerely would reform it.

So, what will it take?

• Courage, for one. Which does exist; there are some fine people in pharma.

• Brains, for aother. Again, pharma is blessed. The trick is to turn those brains loose; to use the courage to think boldly, examine anew.

• Transparency is required too, though even that is hampered by layers of regulation brought upon itself by the industry’s own past practices.

• But above all, the industry needs a sense of urgency.  Not just business urgency, but a personal willingness to face some  shame, or disgust, or revulsion; something that comes from the gut and says, “you know, we are better than this; we can do better than this; and I for one have had it.”

I can’t think of any industry where the trust gap between what is and what could be is larger, and where the social cost of that gap is greater. It is in society’s best interest to have a trusted pharmaceutical industry. At its best, the pharmaceutical industry saves hundreds of thousands of lives, and adds quality of life to millions.   We are paying gazillions in cost, red tape, suspicion, and lost or devalued lives because of its absence.

We should all be rooting for this industry to heal itself.

The first step is admitting you’ve got a problem.

How the Pharmaceutical Industry Can Increase Trust

“You can’t talk your way out of what you behaved your way into,” says Stephen Covey.

But not everyone believes Covey.

NY Times, May 22, 2007.

“Columbia University dismissed its financial aid director yesterday after the release of documents showing he promoted a student loan company in which he had a stake, sending letters to parents and alumni on three occasions praising the lender.”

NY Times, March 21, 2007.

…the year [Dr. Allan Collins]was chosen as president-elect of the National Kidney Foundation, the pharmaceutical company Amgen, which makes the most expensive drugs used in the treatment of kidney disease, underwrote more than $1.9 million worth of research and education programs led by Dr. Collins…In 2005, Amgen paid Dr. Collins at least $25,800, mostly in consulting and speaking fees…

…Dr. Donald Hunninghake served on a government-sponsored advisory panel that wrote guidelines for when people should get cholesterol-lowering pills… eight of [the panel’s] nine members had financial ties to drug makers.

A 2002 survey found that more than 80 percent of the doctors on panels that write clinical practice guidelines had financial ties to drug makers.

Doctors said that lectures were highly educational, and that drug makers hired them for their medical expertise and speaking skills. But former drug company sales representatives said they hired doctors as speakers mostly in hope of influencing that doctor’s prescribing habits.

I don’t wish to engage in pharma-bashing. But Covey’s point needs heeding.

Columbia’s response to conflict was to say that the director, a 1985 graduate of the university, had “abused a position of trust and violated the university policy on conflicts of interest.”

So they fired him.

Covey, presumably, would approve.

Not so in pharma. In recent decades, the business of making and selling drugs has become much less about making and much more about selling. Perhaps that’s why the industry tends to see its trust problem as a marketing or PR issue—’if only the public knew the full truth, they’d trust us.’

Typical is this headline, from an April post by Ipsos research, :

Pharmaceutical Companies Need To Raise Awareness Of Their Social Investments To Improve Industry’s Image

Or this, promoting an interactive web seminar:

How can you safely navigate this politically-charged environment—and keep your business and brands strong? What can you do to restore public trust—even while facing negative campaign rhetoric? Find out at a New WebSeminar—Surviving the Election Wars: Strategies to Build Trust and Defend Brands.

Just to be clear who they view as being in charge of trust and brands:

If you are involved in advertising, marketing, market research, corporate communications, product and brand management, senior management, public affairs, or public relations…This is a program you can’t afford to miss!

PhRMA, the industry association, is a big proponent of the trust-is-a-communications-issue viewpoint. In an article appropriately titled "New PhRMA Leaders Discuss Future of the Industry, Need for More Public Education, " PhRMA’s CEO, ex-congressman Billy Tauzin, says, "“For PhRMA to continue to advocate well for our members, we must begin to correct the misconceptions and the outright fraudulent views that have been created about our work and our products.”

So, how’s it working? Here’s one survey:

43% of US adults believe that pharmaceutical companies fund groups like the American Heart Association and the National Kidney Foundation in order to get more people to buy their products or medicines, whereas only 21% believe it is to demonstrate that the companies care about a health issue supported by the group.

Truth: the pharmaceutical industry is loaded with good, smart, dedicated, well-meaning people. It has saved millions of lives, and improved millions more. It has the potential to do unimagineable good. We need a trusted pharmaceutical industry. But it’s the industry that must do the heavy lifting, not the consumer. The only real way to be trusted is—to be trustworthy.

A friend who does PR for pharma tells me it is difficult to give away drug coverage to lower income people—for free—because people are suspicious.

Covey’s right. You can’t talk your way out of a problem you behaved your way into—ask Imus. You can’t market your way out of structural conflicts of interest—ask Arthur Andersen. You don’t become trustworthy—worthy of trust—via marketing or advertising or PR agencies. That’s throwing water on a grease fire.

Pharma needs a fundamental recontracting with two critical constituencies—patients and physicians. It’s a business thirsting for trust—but trust based on values and behaviors. Not on spin, ads, press releases, awareness improvement and “education.”

We should all be rooting for pharma to make that shift.