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ISSUE 19 Spring 2012

ISSUE 19 SPRING 2012 INSIDE THIS ISSUE A Letter from Bob Chandler


Driving Success in China in the Year of the Dragon


Health Reform 2012: Lessons for Communicators


Cause-Related Marketing: An Important Cultural & Economic Investment


Harnessing Cultural Integration & Adaptation


German Law for Reforming the Market for Pharmaceuticals


Considering the Challenge Before the Channel: Time for Change in Global Healthcare Marketing


About Chandler Chicco Companies • Allidura Consumer, a global consumer agency that marries traditional healthcare expertise with consumer brand marketing

Since 2007 Chandler Chicco Companies has been part of inVentiv Health. inVentiv Health offers best-in-class Clinical, Consulting and Commercial services to global companies seeking to accelerate performance. With 13,000 employees in 40 countries, inVentiv Health rapidly transforms promising ideas into commercial reality.

• Biosector 2, a global healthcare communications agency that builds brands and grows markets for companies driving innovation in biopharmaceuticals, devices and diagnostics • Brandtectonics, a corporate branding consultancy that empowers clients to become agents of change within their organizations • Chamberlain Healthcare Public Relations, a global healthcare public relations agency redefining and shaping the standards by which information is communicated • Chandler Chicco Agency, the world’s largest pure-play healthcare public relations agency • Chandler Chicco Productions, an event-driven production company that creates experiential initiatives • Determinus, a strategic research and measurement consultancy focused on using research at every level of the communications process

• Haas & Health Partner PR, a leading pure-play healthcare communications agency in Germany • Ingenda Communications, an agency that specializes in developing gender-specific communications programs • Litmus, a medical marketing and education consultancy offering innovative approaches to opinion leader development and mobilization • ‘nition Design, a full-service design company providing visual solutions • SanCom Creative Communications Solutions, a pure-play integrated healthcare communications service provider with a focus on PR and integrated marketing in Germany • SharedVoice PR, an agency that provides full-service integrated communications to health-focused companies • Verstone, a digital and social media company that influences the way individuals, organizations and governments engage and interact online and through mobile device

Learn more at

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A letter from Bob Chandler Chandler Chicco Companies has shown tremendous growth over the past 12 months. Our team has expanded from 275 to 450 people globally, through the addition of new talent and with the support of our parent company, inVentiv Health. We’ve expanded our global footprint and enhanced the types of services we’re able to offer to clients worldwide. Recent global milestones include the acquisition of a firm in Germany, an expanded China office, and the launch of a new communications model with our European offices that maximizes our ability to provide integrated communications solutions. To give you more of a flavor of what we’re doing worldwide, we’ve specifically highlighted our global expertise in this issue of PRimeCut. We continue to believe cultural adaptation is key to communications success. As Robyn Cabarrao writes in this issue, “There is no way around it — cultural adaptation and integration is fundamental to success in an increasingly global marketplace. The ability to understand and embrace cultural dynamics and sensitivities, and therefore successfully communicate across boundaries and borders, is an invaluable lever to global leadership.” You’ll read about inVentiv Health Communications/ Europe (iHCE), a full-spectrum, healthcare specialist “super agency” dedicated to delivering exceptional multichannel international marketing

programs. This group operates under a “Done as One” philosophy, bringing together elite global talent from our best-in-class healthcare marketing specialists to provide our clients with communications approaches that deliver better health outcomes. Fiona Hall, iHCE senior managing director and managing director of Chandler Chicco Companies Europe, describes our vision of delivering communications solutions through seamless specialist teams in a way that aligns with the structural changes taking place within our clients’ organizations. Taking a closer look at Germany, Susanne Buder, of Haas & Health Partner PR and Holger Pohlen of SanCom CSS, two of the agencies we recently acquired, writes about changes in German laws reforming the market for pharmaceuticals. And, Clancey Houston, managing director of inVentiv Health Communications/China, reviews recent political and economic changes that will impact the marketing of healthcare products and services in the world’s largest market. I hope you’ll find the global perspectives — and US insights — valuable in thinking through your own work. That’s our intent. With all the expansion, additions and preparations we’re making for the future, two things remain unchanged: our unending passion for improving global health and our commitment to supporting you.

Best, Bob Chandler

WHAT IS PRimeCut? PRimeCut is a Chandler Chicco Companies publication designed to share our perspectives on trends affecting the industry, our thoughts on best practices and new developments at CCC. We’ve called the publication PRimeCut because we think it represents cuttingedge PR theory and application, and also one of the neighborhoods where we work and live: New York City’s dynamic Meatpacking District. We hope you enjoy it. Comments? Suggestions? Ideas? E-mail us at

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Globally, our clients face increasing complexity in bringing innovative products to market, particularly in the complex landscape that is China. Cost pressures abound, consolidation and joint ventures with local players are reshaping the competitive landscape, and everyone’s watching and has an opinion on what the industry needs to do to address costs while improving health outcomes.

During the Year of the Dragon, what’s the prescription for success in China for brands and businesses intent on capturing as large a share as possible?



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or the first time in close to a decade, we have seen the number expressed for China’s projected growth rate hovering around the magic threshold of 8 percent, a target linked to maintaining sufficient economic growth to sustain employment levels of the country’s vast population. This level of economic buoyancy is particularly significant in a year when China is preparing for a major leadership reshuffle in the late autumn. A slowing in direct foreign investment from Europe, as those markets hold back on capital outflows given the instability in their own backyard, has not helped; continued inflationary pressure is impacting lending and borrowing, leading to other government controls designed to manage the economy and prevent a sharp decline.

Within the realm of healthcare, uncertainties remain about the path for implementation of many aspects of the government’s policies and plans. The recent fury, for example, over a possible government expansion of the competitive tendering system for medicines on the National Essential Drug List highlights the complexities of expanding access, improving quality of care and achieving improved health outcomes, all while addressing the imperative of containing costs. But despite the broader macroeconomic situation and questions about health reform, from most reports, the healthcare industry’s multinational (MNC) players remain positive about the future outlook for business in China. A recent PriceWaterhouseCoopers study went so far as to state that 37 percent of pharma and life science CEOs see China as a top source of future growth.

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And why wouldn’t they? China is continuously described as the world’s most attractive emerging pharmaceutical market. In February 2012, McKinsey & Company noted that China will move into third place amongst the world’s pharmaceutical markets this year, with projected sales of more than $50 billion. Activity from MNC pharmaceutical, device and diagnostics manufacturers is still strong, reflecting a positive view of the market’s perceived potential: Sanofi opened its first regional R&D center in China in 2010 to accelerate the development of therapies and health solutions in the region; in October, AstraZeneca announced plans to invest $200M in a new Chinese factory making intravenous and oral solid medicines; Eli Lilly will inaugurate in 2012 a new R&D center in Shanghai, focused exclusively on diabetes, that will conduct very early-stage research to better understand how diabetes develops and

affects people in China specifically; and GlaxoSmithKline is both augmenting its China-based development facility with a unit dedicated to investigating the principles of traditional Chinese medicine to support modern drug discovery, and expanding its sales reps to extend market coverage.

Key Regulatory Agencies Overseeing Healthcare in China

industry, and reviews imported medical devices and Class III medical devices manufactured in China. Local FDAs, meanwhile, are authorized to issue manufacturing licenses and product registration certificates to manufacturers of lower-class medical devices, and each province may have its own unique requirements and examination processes.

The State Food and Drug Administration (SFDA) oversees drug manufacturing, registration, evaluation and advertising. There are also a number of sub-organizations under SFDA that deal with pharmaceuticals. Most importantly:

The Ministry of Health (MOH) oversees the SFDA, more broadly manages regulatory developments, allocates healthcare resources and conducts medical research and education.

• The Center for Drug Evaluation (CDE) is responsible for the evaluation of drug chemistry, traditional Chinese medicines and biologic products. • The National Institute of the Control of Pharmaceutical and Biological Products (NICPBP) is responsible for drug testing and retesting, and managing national reference standards. The SFDA at the central and local level is the primary government authority with jurisdiction over medical devices. SFDA at the central level supervises the industry and approves medical devices, formulates regulations, oversees medical advertising and adverse events in the

Beyond investment in new facilities and expansion of existing infrastructures beyond Tier 1 cities into China’s broad market, how else can companies bolster their chances of success? As communicators, we believe in helping our clients to engage partners and audiences in dialogue and discussion that drives consensus around pressing healthcare issues, thereby enabling the attitudinal and behavioral shifts among key audiences that improve health outcomes. On the next pages, we take a look at several ways in which this engagement can be enhanced within the China context.

The MOH plays a lesser role in regulating medical devices than the SFDA, but its relevant tasks include drafting medical device regulations, managing postmarket surveillance on medical devices and allocating resources for large-scale medical devices in hospitals. MOH also organizes centralized bidding procurement processes for medical devices, and its International Health Exchange and Cooperation Center (IHECC) is responsible for conducting bidding tenders for largescale medical devices. The National Development and Reform Commission (NDRC) regulates drug pricing.

Source: US-China Business Council



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Go Beyond CSR, Be a Committed Investor in Health

Access Should Be Everyone’s Aim

First and foremost within the China market, business partnerships are essential. Whether with local hospitals, research centers or medical schools, pharma partnerships abound. But today more than ever, global pharma companies need to ensure that they are developing realistic public/private partnerships that truly benefit both parties. They need to press forward with a transition from traditional, transactional relationships to deeper, more substantive and stakeholder-centric collaboration with various government and quasi-governmental groups. Creating respected collaborations that aim beyond product- or even disease-specific targets and consider the drivers behind better quality, greater access and higher efficiency will position businesses as true partners investing in the future health of the nation.

Market access is not just about pricing and reimbursement any more. Today it is about how we can work together to facilitate access to services, access to medicines across a broader geography and, importantly, access to valuable information and education on health and medical care. Access should be a central objective around which all departments and functions rally. Integrate departments around this objective and look to develop real customercentric targeting and an understanding of the broader needs of the payer audience plus their perspective on managing health outcomes within the population they manage. All too often, important business decisions are made in early development with insufficient regard to payers’ preferences or the evolving market access environment, and without the benefit of the greater organization beyond government relations or HEOR departments.

Put the Patient Before Pills and Products

Look to Consumer Empowerment to Power Growth

Akin to after-sales service in other industries, patients and healthcare professionals increasingly are looking for ongoing support and service from the pharmaceutical brand behind their treatment regimen. Look beyond side effects, dosages and drug interactions to consider the ultimate impact on the patient. How can quality of life be maintained and how can your brand be a part of helping to maintain it? By developing a deep understanding of patients and establishing consultative relationships with payers, professionals and providers, a company can keep this goal of improved health firmly at the center.

As China’s healthcare needs continue to shift to preventable, lifestyle-related chronic conditions, the need for individuals to take a greater role in managing their own health is essential, and pharma can help. Numerous patient-driven decisions that go beyond safety and efficacy influence the success or failure of a treatment. This is in no small part because, at the end of the day, the average patient contact with a healthcare professional is limited to a handful of days out of the year, putting a significant portion of the management of their condition in their own hands or those of their caregivers. As people become more aware and active consumers of health, conversion or adherence is supported by helping to empower them through arming them with the knowledge to make smart decisions about care and treatments — for themselves and for their family members.

CHINA’S MINISTRY OF HEALTH DEFINES 2012 PRIORITIES On January 30, 2012, China’s Ministry of Health (MOH) released its list of work priorities for 2012. Though quite broad, the list provides anyone with an interest in the industry an indication of the goals the MOH will pursue in the current year. Source: Translated courtesy of the US-China Business Council

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A Strong Value Story is Invaluable

Think Across the Product Lifecycle

As the use of pharmacoeconomics to define unmet needs and establish the broader impact of a new drug or treatment grows, so should recognition of the importance of crafting a clearly defined value story for an intervention or a treatment. A quality value story demonstrates that it meets a previously unmet need and, for the payer audience in particular, demonstrates that it does so in a cost-effective manner while improving patient outcomes. Once defined, ideally as part of the ongoing evidence development and dissemination process rather than as a singular tactic at a particular end point, a business must effectively communicate its value story, incorporating the nuances of the market in providing flexible and tailored messages that meet the interests and needs of specific audiences.

In an era of cost containment and competition from Chinese generics, businesses need to reach even more stakeholders with their story and engage them on a deeper, more meaningful level — and do so throughout a product’s lifecycle. As China-based clinical trials are increasingly part of global programs, regulatory approvals and other hurdles willing, there are more and more opportunities to employ solutions from across the communications spectrum that support a product at each stage of its maturity, from development through to off-patent strategies.

Go Emotional

While conversations about health and solutions for driving better health outcomes are increasingly cutting across borders and becoming more global in nature, health systems, policies and priorities continue to be distinguished by local market characteristics. One size does not fit all. There must be people on the ground in the market to complement global thinking and programming with a deep understanding of the local regulatory environment, of cultural norms and of the various nuances of social behavior that are at the heart of engaging stakeholders effectively, ultimately helping to achieve China’s long-term goals for health. ■

Every day, with every healthcare decision being made, patients, their caregivers, their loved ones and their physicians engage in emotionally charged and sometimes heart-wrenching decisions. In order to devise the right message that will “flip the switch” and motivate a person to develop a new belief and adopt a new behavior or action, an emotional overlay to the rational elements of a product or treatment’s efficacy is essential. Regardless of channel, examining the patient encounter, that critical moment when a message reaches a person, must include a deep understanding of not just what patients know and believe but also how they feel about their health condition, about the treatment options available to them and their future.

A. Clancey Houston is managing director of inVentiv Health Communications/China, based in Shanghai. She can be reached at

• Further improve the new rural cooperative medical system and promote the comprehensive reform of primary healthcare institutions • Consolidate and improve the national essential drug system to ensure people’s access to basic medication • Actively promote the reform of public hospitals to ensure sufficient public access to health services • Comprehensively promote the gradual equalization of basic public health services, and continue to work on health emergency, disease control, maternal and child health • Enhance medical services and management, and protect healthcare safety

• Strengthen food safety work and safety supervision • Improve the scientific supervisory system of drugs to ensure drug safety • Improve the service level of Chinese medicines and give full play to the advantages and characteristics of traditional Chinese medicine

• Strengthen personnel training, and scientific and technological innovation as well as health information technology to provide strong support for medical reforms • Enhance anti-graft efforts • Coordinate to promote health work in all areas

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So far, 2012 has been a fascinating year in US healthcare policy and the politics of healthcare. Republican presidential candidates have all attacked and promised to repeal “Obamacare,” the often derogatory term universally applied to the Patient Protection and Affordable Care Act signed into law two years ago in April. Yet it seems clear, at the time of this writing, that the Republican Party will nominate Mitt Romney — the Massachusetts governor who passed what some have called the blueprint for “Obamacare” in the Bay State — for president. Americans are not sure whether they favor or oppose President Obama’s healthcare reform, with support running in polls from an April low of 39 percent to almost 50 percent. But, by a wide margin, they are sure that the Affordable Care Act (which we’ll call “the Act”) is unconstitutional. We are anxiously awaiting word from the Supreme Court of the United States as to whether some portion — or all — of the Act is or is not constitutional. While we can hope for a clear answer from the court, most are expecting some sort of split decision … leaving policy makers, insurers and patients to sort out the rest. Many states are moving forward with implementation of the Act, putting in place legislation to create the “insurance exchanges” through which individuals will purchase health insurance beginning in 2014 and working to revise state Medicaid programs to comply with the Act. They do so without knowing whether or not the Act will be operable after the end of June 2012 but they have no choice should the Court decide that at least a portion of the Act remains intact. Meanwhile, Republicans in the House of Representatives have proposed a budget that would make significant changes to both the Medicaid and Medicare programs. This has prompted Democrats — including President Obama — to suggest that the GOP would “end Medicare as we know it.” Some things never change. So far, the Obama campaign seems reluctant to talk about its “signature domestic achievement,” that is, healthcare reform. Many are amazed that Obama continues to allow his opponents to frame the healthcare reform debate. There is no doubt that health reform is complicated. But the Affordable Care Act is more than the individual mandate. It includes provisions that are wildly popular. Maybe they’ll launch an offensive as Election Day moves closer. But, so far, more Americans oppose reform than support it.

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“In healthcare, creating consensus through communication is vital.” Seemingly independent of all this, the healthcare field continues to struggle with the central issue of the day: how to maintain and improve care while reducing costs. But saving money while ensuring every patient has access to the best appropriate care is a challenge. New technologies are often more expensive than their predecessors and, while they improve outcomes, they may well add costs rather than save money. New drug therapies, while improving quality of life, may increase short-term costs. There is one initiative that many are viewing as promising. It is happening independent of healthcare reform and without a mandate from insurers. In April, nine medical specialty societies representing about 375,000 physicians listed 45 tests and procedures they believe are done too often. Some of the tests on their list include routine cancer screening, like colonoscopies and mammograms. They recommend less stress-cardiac imaging, and fewer MRIs and CT scans. They were not suggesting that these tests were never necessary, rather that they should only be ordered in specific, medically appropriate circumstances. But there is already pushback. After all, these are the tests people want. But if we are to begin to reduce the cost of care — or at least slow the rate of growth — we must begin with those elements that will not adversely impact patient outcomes. If these doctor groups are right, many of these tests have no medical purpose. Indeed, they argue, sometimes these tests lead to even more testing and procedures as the result of “false positives.” As a result, unnecessary tests drive up healthcare costs… unnecessarily. This effort is, in many ways, an experiment. But the experiment is unlikely to succeed without appropriate education of both prospective patients and physicians. Today there is little incentive for physicians to limit testing — indeed, many have the opposite incentive. Patients are unlikely to object to their doctor’s orders as long as they are insured. In other words, without a communication program designed to demonstrate the value of limiting medical testing to all stakeholders, the effort is doomed.

In healthcare, creating consensus through communication is vital. President Obama has seen his political opponents define “Obamacare” because he and his party have failed to effectively communicate the reasons why we needed reform and, since 2010, the value of the reform signed into law. Our nation has failed to address obesity and Type 2 diabetes because we have yet to effectively communicate the value of and simple paths to living a healthy, balanced life. And physicians and patients are unlikely to voluntarily limit medical testing without hearing and believing in a compelling reason to do so. Who wins the 2012 election will be based on which side most effectively communicates its point of view and thus persuades the swing voters in the swing states to support their cause. How will healthcare play into this election? Can Governor Romney effectively attack “Obamacare”? Can Romney use healthcare reform to make a larger point about big government and diminution of liberty? Can President Obama tie Romney to the House Republicans’ plans to restructure Medicare? And, perhaps most important, can President Obama finally persuade a majority of Americans that life with “Obamacare” will be better than any alternative? Stay tuned. ■ Al Jackson is managing director of CCC’s Washington, DC office. He can be reached at

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An important cultural and economic investment



he first week of February marks a milestone for the Allidura Consumer team, as we celebrate heart health awareness with our client Diet Coke® and the National Heart, Lung and Blood Institute’s Heart Truth® campaign. Each year as part of The Heart Truth®, female role models like Christie Brinkley, Minka Kelly and Linda Evans waltz down the runway to call attention to heart disease – the number one killer of women.

For the past five years, Diet Coke has been an active supporter of this initiative, not only reaching millions of women — and the men who love them — but also new, younger audiences. The Heart Truth® logo has appeared on Diet Coke cans, Heidi Klum has supported the effort in commercials and thousands of Coca-Cola associates have proudly worn red for heart health. Diet Coke certainly isn’t the first company to align its brand to a cause, and it won’t be the last. Some trace the origins of causerelated marketing back to the ’70s and ’80s with campaigns such as Marriott and the March of Dimes, and the American Express/Statue of Liberty Restoration project. While these companies are credited with popularizing the term “cause-related marketing,” evidence of its existence dates back even further. Legend has it that in exchange for donations to create the Statue of Liberty’s pedestal, Joseph Pulitzer printed donors’ names in his newspaper, thereby increasing his paper’s sales while supporting a worthy cause. Today, however, in the wake of corporate scandals and the advent of the socially conscious millennial generation, causerelated efforts on their own are no longer an option. For some, it’s become one part of a holistic approach to overall corporate reputation. The literature underscores its value and impact. Numerous studies have found that being a good corporate citizen can foster consumer loyalty and turn company brand ambassadors into champions. According to a 2010 McKinsey Report, people are 300 percent more likely to verbally support or give the “benefit of the doubt” to highly regarded companies; 200 percent more likely to consider their products; and 350 percent more likely to purchase products. So, the question is not if but rather how to execute a successful cause-related program. Why, for example, do Yoplait’s Pink Lids resonate with people while Kentucky Fried Chicken’s “Buckets for the Cure” insult the masses? Today, it’s not enough to slap a logo on a product, give money and get “credit” for the effort. It takes careful planning, a solid framework and strong communication to execute a program that will drive value, strengthen reputation, engage stakeholders, build advocates and deliver meaningful

returns. It takes making a cultural and economic investment for the long term.

Communication holds the key to unlocking the value of cause-related programs. What to communicate, where to communicate, and with whom to communicate is almost as important as communicating how much, how often and how significant the partnership is.

WHAT TO COMMUNICATE: Creating an Authentic Connection One of the first steps in developing successful communications around a cause-related program is identifying a program that fits. Too often, cause-related efforts emanate from an executive’s pet project or marketing team’s brand plan. But third-party partners and programs aren’t one-size–fits-all. For corporate communication professionals, getting a seat at the table when these programs are being developed can make all the difference in creating a campaign that sails or fails. Identifying programs and causes that are authentic to the company culture and/or brand and aligned to its purpose creates a solid foundation — one that can drive deep internal and external stakeholder engagement over time. Communicating cause-related marketing efforts is not easy. People are skeptics by nature and intolerant of efforts that they perceive as trying to manipulate the masses. But the human brain is sophisticated; people can rationalize the social need against the business need. In fact, research indicates consumers are more accepting of cause-related efforts when the company is open and transparent about its motives. According to a study cited in the International Journal of Management Reviews, stakeholders were tolerant of self-serving motives as long as the initiative attributed external motives as well. Meaning that, for the most part, people understand and accept that cause-related marketing doesn’t just help society — it can help a company’s bottom line.

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WHERE TO COMMUNICATE: Integrating Across Company Platforms Best-in-class, cause-related campaigns are developed to encompass more than a donation or sponsored event. The effort is devised and tailored to reach a wide variety of key internal and external stakeholders, including employees, consumers, government officials, investors, media and more. Corporate communication teams have a line of sight into all aspects of the business and perhaps are best suited to push an organization or brand to think beyond its immediate function and discipline to get the most value out of an initiative. One great example of this is M.A.C. Viva Glam. In 1994, the then relatively niche makeup company had an idea to donate proceeds from the sale of its limited-edition red lipstick to AIDS research — a rather ho-hum idea. But, being extraordinary communicators, M.A.C. raised the bar for cause-related efforts. Today, the campaign is supported in-store, online, through media and events that engage stakeholders and employees. The constant stream of avant-garde celebrities associated with the effort drives the cultural zeitgeist for the cause while creating a halo for the brand. Each year, millions of men and women anxiously wait for Viva Glam to be introduced, all while generating significant funds for a worthy cause.

TO WHOM TO COMMUNICATE: Engaging All Stakeholders as Brand Advocates With technology making it easier for people to share and receive information from their most trusted sources, their family and friends, “advocacy” and “personal recommendation” have become the new corporate buzz words. In discussing how to build advocacy, experts at the Arthur Page Society stated it best: “building shared belief with decision makers – customers, employees, citizens… is different from raising awareness or delivering information. The belief leads [people] to act.”

To create this belief, there must be constant alignment and realignment of the messages for each audience, and active listening to ensure programs can be quickly adapted and changed based on feedback. These audiences must include employees, customers, government officials, relevant third parties, partners, senior leadership and more. Messages must be tailored and adapted to each of these audiences to address their areas of primary interest. Over time, Diet Coke has enabled its sponsorship of The Heart Truth® to take root throughout all levels of its organization, creating advocates and broad support for the effort. Campaign tactics have evolved based on trends and key learnings, but the message has been communicated with the same essence and inflection. The program launched five years ago with paid and earned media, but today reaches a variety of audiences on packaging, in-store promotions, through social channels such as Instagram and Twitter, at Coca-Cola headquarters and regional offices, and in communiqués to partners and ambassadors. This truly integrated cause program has shown the power of building a shared belief with all audiences important to a brand or company.

Communicating cause-related marketing efforts is not easy. It is a sensitive and delicate matter, one that takes considerable time and attention. Identifying the right partner, communicating the right motive and engaging the right audiences are keys to unlocking a successful campaign. ■ Danielle Dunne leads Chandler Chicco Companies’ Allidura Consumer team. She can be reached at

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Harnessing cultural integration + adaptation By Robyn Cabarrao

There is no way around it — cultural adaptation and integration is fundamental to success in an increasingly global marketplace. The ability to understand and embrace cultural dynamics and sensitivies, and therefore successfully communicate across boundaries and borders, is an invaluable lever to global leadership. While this need to leverage cultural differences constructively is integral to all manner of business, it is absolutely critical to the global healthcare industry. With a rapidly growing and increasingly diverse patient population, it is becoming more and more important for healthcare providers — from the pharmaceutical industry to physicians to payers — to possess strong insights into the cultures that drive and shape patient behaviour. It is about understanding that the values, customs and norms in China, for example, may dictate completely different attitudes toward patient compliance, patient management and patient outcomes than those in a country such as France. As a result of diminishing budgets, pharma is increasingly focusing its attention on delivering broad global communications programmes in the hope that talking to one perceived global culture will not be at the expense of the millions of cultures that transcend countries, cities and communities. This could not, however, be further from the truth because, when put in simple terms, cultural incompetence primarily hurts patients.

As healthcare marketers it is our responsibility to help our colleagues navigate this complex landscape. It is our duty to shift behaviour and drive belief that simply providing the traditional pile of communications, educational materials and resources in a local language is not an efficient or effective way of reaching or mobilising target audiences. If we understand, for example, that any public discussion of sexual health in India is perceived as taboo, or that the patriarch in a typical Middle Eastern household dictates his family’s access to a physician’s counsel, then we are able to effectively empower our clients to demonstrate the cultural intelligence and competence required of leaders in the healthcare industry. Equally, by encouraging increased investment in more culturally engaging or appropriate communications, we’re inevitably helping our clients achieve a core objective — to build their brand equity across all, as opposed to only some, of the relevant audiences. Building virtual bridges between cultures, geographic locations and healthcare communications disciplines is essential. Through our global healthcare network, we are able to tap into local expertise to navigate local and regional strategies, regulatory landscapes and local stakeholder groups. This, combined with access to a variety of thought leaders and experts across the communications spectrum, ensures that clients are presented with highly targeted integrated communications solutions that are founded on cultural intelligence, competence and sensitivity. ■ Robyn Cabarrao manages global affiliate engagement for Chandler Chicco Companies and inVentiv Health Communications/Europe. She can be reached at

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German law for reforming the market for pharmaceuticals (Arzneimittelmarkt-Neuordnungsgesetz, AMNOG) By Susanne Buder and Holger Pohlen

because it did not value the innovative character of the product. Evaluations for other drugs, such as Brilinta (platelet aggregation inhibitor by AstraZeneca) and Incivo (Hepatitis C drug by Janssen), are underway. As of yet, no company has completed the full process with price negotiations.

For many decades, in spite of continuous cost-cutting measures, the German market managed to remain a comfortable place for pharmaceutical companies. Until 2011, that is, when the AMNOG (German Law for Reforming the Market for Pharmaceuticals, Arzneimittelmarkt-Neuordnungsgesetz) became effective. This law marks the culmination of ongoing regulatory efforts toward increased restrictions and regulations by the governing bodies, as well as self-imposed restrictions by the pharmaceutical industry. The AMNOG is mainly aimed at putting an end to free pricing of new product entries of the pharmaceutical industry. In other words, the AMNOG is aimed at reducing costs.

We can clearly see that the AMNOG and its consequences will impact prescription options for healthcare professionals, as well as the provision of patients’ healthcare. It also will impact healthcare marketing: If fewer drugs are entering the German market, there will be fewer marketing and PR opportunities. Once a drug has been launched, it may not be uncommon to see that marketing spend shrink after the first year, when the final price of the drug will be determined.

As it is now, companies still have the advantage of free pricing and reimbursement for innovative products for the first year after launch. Within that timeframe, they must submit a dossier proving additional benefit over existing therapies. Depending on the significance of the additional benefit, companies can negotiate the best possible price for their drug with the GKV-Spitzenverband (National Association of Statutory Health Insurance Funds). Should that benefit not be proven by the Joint Federal Committee (Gemeinsamer Bundesauschuss, G-BA), the product will be grouped with similar drugs and priced accordingly.

However, the new regulatory framework also offers new opportunities that go beyond traditional PR. For one, there will be an increased need for strategic consultancy as to how a new product is to be positioned early on and how its scientific milestones are to be communicated so that the hurdle for not accepting an additional benefit becomes significantly higher for the deciding bodies. Additionally, newly created corporate market access departments may need assistance in mapping out the right target stakeholders, as well as help getting those target stakeholders to speak with them.

The issue that is most discussed, obviously, is the question of what comparable treatment is to be selected — and accepted. As this is determined by the G-BA, it is not necessarily in the interest of the submitting company but rather in the interest of budgets. The most recent and broadly covered example of this new procedure and its negative consequences from a patient perspective pertains to Linagliptine from Boehringer Ingelheim. Being the fourth DPP-4inhibitor in the market, the drug was also developed for patients with chronic renal failure. Boehringer Ingelheim was convinced it could show an additional benefit over sitagliptine, the first DDP-4-inhibitor in the German market. However, the G-BA decided that the drug was to be compared with the former standard of care, sulfonylureas. With the decision to compare with a generic low-price drug as comparable treatment, G-BA set an unfavourable basis for later price negotiations. According to the official company statement, Boehringer Ingelheim refused to launch the product in Germany based on this decision

Another opportunity arising from this new legislation is an increased investment in disease awareness campaigns. Companies may use disease education as a strategic approach for creating patient demand and building patient pressure, thus establishing the product before early benefit assessment is completed. And, finally, further business potential lies within smaller pharmaceutical companies, as most of them have neither the manpower nor the expertise to handle the whole process, from preparing appropriate studies for demonstrating the demanded additional benefit to preparing an adequate value dossier. While the AMNOG certainly will pose challenges for healthcare companies and communications agencies alike, opportunities also abound. As a healthcare specialist and expert integrated “super agency,” we plan on helping our clients take full advantage. ■



benefit assessement by iqwig

g-ba decides about additional benefits


negotiation with gkvspitzenverband

reimbursement price

no reference price

3 months Susanne Buder works at Haas & Health Partner and Holger Pohlen works at SanCom CCS, both located in Eltrille, Germany. Susanne can be reached at Holger can be reached at

6 months

12 months


Time for change in global healthcare marketing by Fiona Hall and Kelly Teasdale

The phrase “think globally, act locally” was coined by the environmental movement in the ’60s. Today that slogan is still being used by the World Health Organisation and is more relevant than ever before. The current worldwide economic downturn is a reminder that the world has become more global. Our increasing financial, commercial and technological connectivity sees us working through business challenges with long-time partners in the USA, Japan and Continental Europe, at the same time as building new working relationships with colleagues in Brazil, Russia, India, China and Turkey. Ironically though, as the global market increases, how we relate to each other is becoming much more local. Against the backdrop of globalisation, we are increasingly sensitive about protecting national regulations and community cultures, and actively seek out conversations with those that are having similar experiences to us in health, work and life. Specialist groups — some of them powerful lobbyists — are therefore multiplying and, facilitated by the virtual world, generating an increased need for expert communicators. For the healthcare industry in a recession and a post-blockbuster boom age, this translates into yet another game-changing slogan: “do more with less” — in other words, reach more specialist stakeholder groups and engage with them on a deeper, more meaningful level with fewer internal resources and the same or less marketing spend. As healthcare marketers, it is our responsibility to adapt the ways in which we work and to revolutionise agency infrastructures and approaches to better serve and support the new age of the healthcare industry. The new and emerging needs of the industry cannot be met by generalist and traditional marketing networks and silo-discipline teams. Clients need partners with the breadth and depth of expertise to navigate global strategies, local regulatory landscapes and multiple stakeholder groups simultaneously, and no one has the time to evolve into those roles.

© Chandler Chicco Companies

So what does the new-era healthcare marketing agency look like? Leadership that includes talent in Asia and the Middle East; local market teams that combine native capabilities with mature market experience and the delivery of integrated and flexible marketing programmes that reach intended audiences with greater speed and relevance, ensuring behavioural change while also delivering financial savings. We have to live change too, not just talk about it. While clients want the promise of efficient multichannel and multinational solutions, they don’t want multiple points of contact and the inconvenience of navigating numerous financial reconciliation processes that continually undermine a seamless team approach. They need a complete overhaul of the traditional outsourced solutions model. The successful marketing agencies of tomorrow will truly put the challenge before the channel, they will be able to draw upon an unrivalled breadth of insight and expertise to frame multi-disciplinary solutions delivered through seamless specialist teams, and they will be much better equipped to work closely with outsourced clinical and sales organisations. At inVentiv Health Communications/Europe, our teams operate under a “done as one” philosophy that brings together multi-disciplinary and multi-national teams from our best-in-class healthcare marketing businesses working under one P&L. Clients are supported by key account managers who have the experience and know-how to build flexible teams as, when and how they need them and to ensure that “flex” happens behind the scenes. Working increasingly closely with inVentiv Health’s clinical research, selling solution and consulting teams on broader commercial solutions, we believe we are ready to lead the revolution in improving outcomes and providing added value. ■

Fiona Hall is senior managing director of inVentiv Health Communications/Europe and managing director of Chandler Chicco Companies Europe. She can be reached at Kelly Teasdale manages network operations for inVentiv Health Communications/Europe and Chandler Chicco Companies Europe. She can be reached at *First published in PR Week – Thought Leader Series, Healthcare – March 9, 2012.

Why Cultural Adaptation is Key to Communications Success