Tunnah’s musings: you talkin’ to me?

Paul Tunnah


I’m guessing most people reading this have at least heard of the film Taxi Driver, from which the quote in the title is derived. It’s a classic moment of movie history, delivered by Robert De Niro in his career defining role as the troubled Travis Bickle. Of course, those who have seen the film will know that the context of the quote is Travis talking only to himself in the mirror, with no-one else listening. In fact, the film critic Roger Ebert labelled the line as the character’s “desperate need to make some kind of contact somehow – to share or mimic the effortless social interaction he sees all around him, but does not participate in.”1

This interpretation of the line could just as easily apply to communication in the modern era. Here we are, trying to grapple with the constant noise of social media, watching endless conversations taking place that we’re often not part of. Add on to that the business context of the pharma industry and all the associated regulations around what you can or can’t say and it’s little wonder it all seems a bit confusing, especially when we don’t always get communication right in the real world, never mind the virtual one.

“That makes us all biased in what we say and what we’re trying to achieve…”

So the recent meeting by the UK’s Healthcare Communications Association (HCA) got me thinking about the fundamentals of communication in the pharma industry.

For me, there were four key themes that emerged from the day:

• Communication bias

• Trust and transparency

• Perception vs. reality

• The role of tech

I’ll try to elaborate on each in turn.

Communication bias – we’re all biased in some way

It’s true – every one of us comes from our own unique viewpoint, shaped by our own experiences and current position. That makes us all biased in what we say and what we’re trying to achieve, which means we all add our own little spin to the story.

This can cause problems for an industry that has to maintain both the highest ethical standards but also achieve a commercial return, as sales doesn’t normally go hand-in-hand with unbiased communication when it comes to “selling the sizzle and not the steak”.

David Tovey, Editor in Chief of the Cochrane Collaboration, summed up the situation pretty well when he observed that conflict of interest and reporting bias are the two key threats to pharma being trusted by external stakeholders. When you see figures presented showing that only a quarter of clinical trial data is published, with a skew towards more positive data seeing the light of day, it does raise some questions about whether this bias is being appropriately managed.

“…conflict of interest and reporting bias are the two key threats to pharma being trusted by external stakeholders.”

But surely prescribers and payers are aware of the merits of different drugs, so should we worry unduly about it? Well that leads onto the second point…

Trust and transparency – the two go hand in hand

Data coming out about trial data going unpublished positions the pharma industry as lacking transparency and that presents real problems when it comes to generating that all-important trust with healthcare providers and patients.

But as with any issue, the first hurdle on the road to finding a solution is acknowledging it exists and a number of external bodies such as Cochrane and the World Health Organization are putting in place regulations to address this. The specifics of these include measures to register all new randomised clinical trials at inception, before patient recruitment, and a call to pass legislation ensuring all trial data is publically available free of charge within 12 months of the end of the randomised trial stage.2

Clearly, such initiatives face some challenges, not least of which is the issue of data protection and protecting the trial participants, but they would also need strict policing to ensure they were enforced in practice. It would be nice to live in a utopian world where this wasn’t needed, but the reality is that in the busy world we live in, such monitoring is needed to keep it front of mind.

Ultimately, as Professor Tim Evans put it through a pre-prepared video presentation, rebuilding the pharma – healthcare provider relationship will take time but is essential in view of the role pharma plays in medical education.

Perception vs. reality – it’s not that bad

If it all sounds a bit gloomy and damning at this point, then that’s probably because we’re focussing on the negative (the bits of the report that say “could do better”) aspects of pharma communication. Sadly, looking at the pharma industry more holistically can be quite depressing sometimes too, with analysis from Dan Mathews (Managing Partner from Accenture) showing that the enterprise value of pharma currently sits predominantly in past and current assets rather than future ones. So something has to change.

But it’s also true that the bad news tends to make better headlines than the good stuff (how many times does the Daily Mail devote its front page to the National Institute of Health and Clinical Excellence (NICE) approving a new cancer treatment?).

“But it’s also true that bad news tends to make better headlines than the good stuff…”

So is it really all that bad?

Well, it was refreshing to hear Stephen Whitehead, the new Chief Executive of the Association of the British Pharmaceutical Industry (ABPI) state the he has “never been so enthusiastic about getting up for work” as part of an impassioned plea to recognise that there is a stark gap between the myth of pharma’s poor reputation and the more positive reality. In fact we would all do well to remember that despite all the problems being faced by pharma right now, it’s an industry that has and continues to achieve a lot of good things.

It’s also fair to point out that there is a good deal of positive communication taking place between pharma the and the prescribers when it comes to joint working initiatives, something which Whitehead sees as critical to helping everyone through the challenges of cost-containment and, in particular, the new value-based pricing assessment.

The role of tech – don’t forget the person

Okay – so you can’t get through many pharma events now, especially not communications ones, without mentioning snazzy new technologies and, dare I mention it again, social media. However, there was a consistency of message from both Matt Evans (Health Unlocked) and Emma Barnett (The Daily Telegraph) to focus on what technology can do rather than on what it is.

It could be argued that some major technology initiatives such as the abandoned £11bn NPfIT project failed because they didn’t properly take account of what the users wanted and how they would use such systems. In other words, technological communication projects, whether they be large scale IT implementations, online communities or simple use of social media tools, will only ever work if they enable users to do what they want quickly and easily.

“…healthcare communication is, at its core, about person to person engagement.”

So my answer to Barnett’s postulated question of whether tech kills the personal relationship would be a clear no – any initiative that doesn’t actually build on and around offline relationships will inherently fail. Or, as Andrew Spong succinctly put it in his workshop – technologies do not carry messages, but they can influence perceptions.

The common thread

Stepping back for a moment, there is a common thread across these areas which highlights that effective healthcare communication is, at its core, about person-to-person engagement. However, you have to be wary of the people and tech that are used to convey your communication, as both can lead to a very different message dropping out the other end than the one you put in.

The conclusion: be aware of what all parties are trying to achieve – pharma, the patient, healthcare providers, payers etc. Keep this in mind when considering what to communicate, how to communicate it and what channels are appropriate to communicate it through. These are fundamental principles that have been around since way before we all went online and they’re not going away anytime soon.

If you don’t get that right, then everything else is irrelevant. No-one will listen and, like our friend Travis Bickle, you might as well talk to yourself in the mirror.


1. “You talkin’ to me” on Wikipedia: http://en.wikipedia.org/wiki/You_talkin’_to_me%3F

2. Press release 5 Oct 2011, The Cochrane Collaboration: http://www.cochrane.org/features/clinical-trials-statement-press-release

About the author:

Paul Tunnah is Founder and Managing Director of www.pharmaphorum.com, the dynamic online information and discussion portal for the pharmaceutical industry featuring news, articles, events / company listings and online discussion. For queries he can be reached through the site contact form or on Twitter @pharmaphorum.

This article was inspired by the 2011 conference of the UK Healthcare Communications Association – “Staying one step ahead”. For more details please visit www.hca-uk.org/.

Is effective communication about technology or people?