There are many “publics” from a pharmaceutical company’s perspective, and each has its own specific needs and orientations. While some people may prefer the term audience or target audience instead of public, the latter term will be used in this chapter. Each public also has its own perspective and viewpoint about the pharmaceutical industry. Publics include all lay people, all patients who use the company’s products, all patients who have the potential to use the company’s products, the local community, lay organizations related to drug or health, and consumer interest groups. Various other publics could also be described (e.g., company employees, company retirees). Pharmaceutical companies deal with publics on local, state, and national levels. In addition to these types of publics, there are divisions based on economics, political and social orientation and other factors,
which makes the task of communicating effectively (i.e., providing the right message to the right group) a challenge for companies and the industry.

There are four major types of relationships of a company with its publics: (a) philanthropic, (b) product-related, (c) symbiotic, and (d) employer. While philanthropic activities have tended to be strongest at the local level (particularly from company foundations) they are tending to become a bit more national in scope. Product-related activities (including support of patient groups) are strongest at the national level. Symbiotic or quid pro quo types of activities may be strong or weak at any level.

Companies interact with the public via direct and indirect methods. Direct methods include direct-to-consumer (DTC) advertising, patient information brochures for those who agree to receive such information, patient assistance programs for financial help with purchasing drugs, websites, and direct telephone or electronic communications. Indirect methods include communication via physicians or other healthcare professionals, and via patient directed organizations.

Pharmaceutical companies hire people who live in the local communities. The company pays taxes and salaries that impact the local economy and interacts in many ways on a daily basis with the community. In some cases, local monies are provided as grants to encourage economic development, and a local company may be a recipient of such funding. It is, therefore, in a company’s interests to do whatever is reasonable to maintain good visibility and relationships with its community. One aspect of company involvement encompasses philanthropic gifts of money or personal services.

The state level often overlaps with both the local and national levels in terms of how it is perceived by pharmaceutical companies. One reason is that many local organizations are also active
at the state level, and many state organizations are also active at the national level.

Companies generally have both philanthropic activities and company interests that are pursued at the state level. Philanthropic activities include support to many cultural, educational, and other organizations located in different parts of the state, as well as some organizations that are statewide. Company interests are also served by providing product-related information to the public.

Symbiotic relationships include providing assistance to legislators and other groups of people (e.g., businessmen). Assistance for legislators could range from support through a company-sponsored political action committee to help in drafting new legislation that may or may not impact the company.

Legislative activities at the state level are described in Chapter 36. Companies strongly support establishing personal contacts with legislators and building positive relationships, even without having any specific lobbying purpose. Therefore, company executives other than just lobbyists often develop professional relationships with local, state, and federal legislators. One type of such contact is for the company to host groups of legislators at a reception with company managers on a periodic basis. Contacts are usually also pursued with individual legislators.

At the national level, pharmaceutical companies usually provide much less money to humanitarian or philanthropic organizations not associated with their drugs or therapeutic uses (e.g., patient support groups) than they do at local and state levels. Companies tend to tie their contributions more directly to their products at the national level. This is primarily because individual pharmaceutical companies used to believe that they were not large enough financially to reach effectively the general public at the national level, although the concept of direct to consumer advertising has drastically changed that perspective. A significant amount of company contributions is made to support both national and international scientific and medical societies, businesses, and meetings or symposia.

Companies donate more than just money. For example, most companies used to donate drugs to charitable agencies that send them to lesser-developed countries, with the assurance that these drugs will not be recycled into normal trade routes, which would be illegal. However, given the challenges of counterfeiting, most companies have stopped doing this.

When proposed activities are associated with a company’s products, it is more likely that the company will become involved as a sponsor. For example, a company may pay for having a brochure printed about a disease that one of its drugs treats. These brochures would then be distributed in various ways by public health agencies or other groups such as patient support groups. A company may help underwrite the cost of a television show dealing with a disease the company’s products treat, even though none of the company’s products are mentioned by name. Over-the-counter drugs are sometimes shown in popular movies based on payment of a “placement fee” and the name of the product is obvious to the movie’s audience.

Various types of educational materials are produced or purchased that are targeted to professional groups. A few companies produce popular-style medical publications that they send out to physicians or lay people (including tapes, CD-Roms, and DVDs), while others concentrate on “throw-away” medical journals. Some practicing physicians, particularly in some hospitals and academic institutions, are putting restrictions or even bans on their staff accepting any gifts from pharmaceutical companies, even if the gift is directly related to patient care and has no reference to the company’s drugs. In other cases, a limit of the value of such gifts is being imposed. The trade associations have passed voluntary guidelines that seek to prevent any gifts that may unduly influence physicians, but the compliance with these guidelines is not measured and it is difficult to know how well they are working, although anecdotal reports are very encouraging in this regard.

In some situations, corporate philanthropy is made via the company and in others via a separate independent foundation. Many companies have established a philanthropic group, either independent of the company’s control or under it. These groups may give money in a highly targeted way that enhances the company’s product profile. On the other hand, donations may be made to the most qualified people with few stipulations. Two of the bestknown groups that provide such money are the Wellcome Trust in the United Kingdom and the Burroughs Wellcome Fund in the United States. Other major philanthropic programs within the pharmaceutical industry include the Abbott Laboratories Fund, Bristol-Myers Fund, Merck Company Fund, Schering-Plough Foundation, Hoffmann-La Roche Foundation, Pfizer Foundation, Sandoz Foundation, and Lilly Endowment. Many large pharmaceutical companies have philanthropic programs.

Charitable contributions and business-related donations are overlapping areas that companies support. Charitable contributions are best made by a centralized company committee that has representatives of the various functions. They generally have a budget of funds that may be apportioned and may have a number of primary groups or themes (e.g., science education, childhood diseases, specific therapeutic area) they support. There are so many possible directions that they can take in giving donations that the company should proactively decide which themes and strategies they wish to focus on. This enables priorities to be established and should create a more marked influence for the company in their chosen area(s).

Another approach to use in making charitable donations is to identify the major groups to which money is given (e.g., education, civic and community groups, health, the arts) and to agree on what percentage of the budgeted money will be allocated to each category. Based on the allocation, the multiyear commitments are first considered to determine the amount remaining. All outstanding requests for funds may then compete for funds in that area. It would be preferable to do this two to six times each year and to limit funds so that all money is not given out the first month that projects compete. A sense of fairness and reasonableness must be used in establishing policies and conducting this exercise.

Business-related donations are made both by the company and by the individual functions. If the request for money is product related then it would generally be defined as a business donation. Professional societies and health issues are usually considered as business related, unless they meet other specified
criteria (e.g., employee volunteering time for a local group). Many companies have “patient assistance programs” that provide funds or drugs to patients who don’t have access to them. This is often done by a third party due to confidentiality and Health Insurance Portability and Accountability Act (HIPAA) concerns, which allows the company to be independent of the decision regarding who gets drug and who does not. National Organization of Rare Disorders (NORD) is a common administrator of these programs.

Companies generally avoid providing information about most of their prescription drugs directly to the public (i.e., “product specific advertising”). Companies refer most patients to their physicians for advice and information when patients call or write letters to the company about medical questions. A company may, however, provide patients with a general pamphlet about a specific disease or refer them to specific websites (i.e., “disease state awareness advertising”). [The Pharmaceutical Research and Manufacturers of America issued voluntary direct-to-consumer advertising guidelines in 2005—in response to a congressional call for a ban on advertising. Most companies appear to be adhering to them. The main tenants of the guidelines can be found on The Pharmaceutical Research and Manufacturers of America’s website (www.phrma.org)]. Companies do not usually send a photocopy of a drug’s labeling to consumers although some patients receive the labeling in the form of a package insert each time they pick up their prescription. Instead, the company may refer patients to the Physicians’ Desk Reference, which is in local libraries and contains the drug labeling for most prescription drugs that do not have generic equivalents. This is the most checked-out book at the New York Public Library, which attests to its popularity as a source of drug information. McMahon, Clark, and Bailie (1987) describes the type and source of information actually presented to patients by healthcare professionals.

Companies have an entirely different attitude about sending information about over-the-counter drugs to patients. Many companies provide information on request, relating both to the disease and to any of their drugs.

Information on risks associated with taking specific drugs is presented to the public by government, academic, and pharmaceutical industry groups both on the web and in various other media. In every advertisement there is a requirement for “fair balance” which makes the pharmaceutical company present the most important risks. The government and pharmaceutical industry usually evaluate a drug’s risk in terms of society or on a broad macro level of how all patients with a disease, or those in a particular population, are affected. The public usually desires the opposite information (i.e., how are they, their families, and friends as individuals affected). Their interest and reaction is usually on this micro-level. This type of information is usually more difficult to determine because it concerns a specific patient who could react in many ways depending on a wide variety of factors. On the other hand, population data refer to averages of many people and can provide overall probability estimates of various types of outcomes.

Public policy within a pharmaceutical company is directed toward influencing public attitudes and behaviors and monitoring legislative and policy issues that will impact the company’s goals. When government policies, institutional policies, or public attitudes support (a) therapeutic substitution, (b) restrictive formularies, (c) price controls in areas where they do not exist, and (d) controls on profits, or many other policies, the companies must act to counter the pressures to implement such policies. Other areas of concern include: