Wool, cotton, motor bikes and medical writing

Chris Stevenson

PER Group

There’s a well known phrase about history: history repeats itself – it has to because no one listens.

Is history about to repeat itself in the medical writing industry? Will the lessons of history be learned in time or will some medical writing organisations suffer as other industries have in the past. Let’s take a look at some of the issues here.

Not in my backyard

In a recent discussion with medical writing professionals I was politely reminded that the potential to outsource medical writing to lower cost operations in countries such as India and the Philippines is very low because:

• They don’t know how to write complex medical manuscripts

• Their command of medical English is not good enough

• Time differences and lack of face to face contact are insurmountable problems

• Therefore, the quality of the work is poor and needs significant reworking that reduces any financial advantage from outsourcing the work

Many of us will have heard these arguments, usually put forward by middle and senior managers within medical writing/communications organisations. Well, they would say that, wouldn’t they? Are these arguments genuine, or is there real potential for outsourcing to provide a new option in the development of medical writing content?


“…is there real potential for outsourcing to provide a new option in the development of medical writing content?”

Of course, it is not in the short-term interests of medical writing company managers to agree that outsourcing could work, or to make suggestions on how to overcome the issues. They often find the new ideas challenging and envision a future where their reporting lines are removed and their power base has moved thousands of miles away. Their arguments may be compelling for some of us, but do they take account of all the facts?

In this brief article we will review the issues, destroy a few myths and put forward a reasonable scenario for the future. Let’s start by addressing some of the common comments that are made and look at them objectively.

Outsource organisations don’t know how to write like medical writers

Did medical writers know how to write before they became medical writers? Of course not. We trained them. Indeed, some medical writing companies spend a small fortune every year training new graduate employees to be medical writers. So, people with a good grasp of English can be trained to be medical writers, whether they are in the UK, Europe, the US or India and the Far East. It is merely a matter of training. The classic, and often heard, defence by the traditionally minded managers at medical writing companies is “we sent them a test and they completed it badly”. This is self fulfilling. We would all complete it badly without the prerequisite training. It’s amazing how often you hear this argument put forward, even today. Recently I sent a test to a medical writing company in India and, without stating where it came from, I asked a UK based senior manager in a medical writing company to review the response from the outsource company. They thought the work was very good as a first draft. Outsource operations, with well trained staff, DO know how to write like medical writers.

Their command of the English language is not good enough

At best this is professional snobbery, at worst it is xenophobic. Anyway, as the example above shows, enough organisations have got enough outsourced medical writing done over the last few years to put an end to this condescending comment. I know of at least one pharmaceutical company that has all, or most, of its clinical trial registry (CTR) entries written in India. I also know of at least one medical writing company that has a writing base in India and has reduced its writing costs (and NOT its prices) by almost 70%. The reason it hasn’t changed its prices is because no one can spot the difference between work done in Europe or the US and the work done in India. This proves, if proof were still needed, that high quality work is consistently achievable with an outsourced operation. And think of the improvement to the margins and the pricing flexibility that the outsourcing company has. Talk about competitive advantage!

The distance is a problem

It’s amazing how often you hear this from people at international medical writing companies that have offices around the world and have found ways to work together and share success. Distance is benign and is a problem if you want it to be and a benefit if you want it to be. Enough said on this trivial matter.


“Distance is benign and is a problem if you want it to be and a benefit if you want it to be.”

Are there other types of argument against the outsourcing of medical writing? Indeed there are. A number have been brought to my attention and I deal with them below.

Local people will lose their jobs

Perhaps they will. However, if managed correctly this should not be a big deal. No one is suggesting that all work is outsourced. Perhaps it will work out in a similar way to the situation with freelancers today. A balance will be reached between locally developed content and outsourced content. Of course, it could be argued that if the medical writing industry does not embrace the concept of outsourcing content development then in the long run more jobs will be lost. The UK is full of historic precedents for this. Similar arguments to those above were made to “protect” the UK woollen industry, the UK cotton industry and the UK motor bike and car industries. All of these industries are practically extinct in the UK. The medical writing industry should learn some important lessons from history.

Our clients don’t want outsourced work

Oh yes they do. Some are already outsourcing writing work themselves. No doubt some clients will believe the medical writing company people who say quality and timing will be poor. However, once they recognise that the quality and timing will be indistinguishable from traditional sources and that the price can potentially be a lot lower they will begin to demand improvements in pricing that traditional medical writing operations will struggle to deliver. The similarities to wool, cotton and motor bikes are all too clear.

No one else is doing it

Oh yes they are. They aren’t making it public knowledge because they are too busy enjoying the benefits of it!

Lessons from history

What can we learn from history? Not just from wool, cotton and motorbikes in the UK. How did the German car industry survive the onslaught of cheap reliable cars from the Far East? How did pockets of British industry survive in car manufacturing (think about Rolls Royce, Jaguar) and in clothing (Jaeger, for example)? Clearly, each company responded to the challenge of a new competitor with similar quality and lower costs in their own specific ways. However, generally they did the same things:

• Responded to the challenge, thought about it and acted

• Did not defend their existing operating practices. On the contrary they searched out new ways to do things, to improve quality and add value to their products

• Reviewed their products and developed them to fit the new market (usually by making their product of a very high quality, BMW is a good example)

• Proactively and positively developed operations and marketing that positioned them in the right cost/ value position. They took a leading position in their markets and did not wait for others to move. They recognised that waiting would mean failure.

Be proactive and succeed

Outsourcing of medical writing is already here. It is no longer a concept or strategy. It is an operational reality. Soon, if you are not doing it you will be unusual.


“Outsourcing of medical writing is already here. It is no longer a concept or strategy. It is an operational reality.”

The lessons for the traditional medical writing industry are clear, embrace the change, make your plans, don’t defend outdated and expensive operational models, find the right cost/value position for your business, and act now. However challenging this may seem, it is the preferred option. The alternative is a decline in your business, clients walking away and a reduction in your staff to a level much lower than if you had been proactive. This may not happen overnight, though history tells us it will certainly happen quicker than many people think. As I’ve already stated, it has already begun.

If you view the potential changes as positive you will begin to see the opportunities. Encourage your staff to think how you can make it work, offer them opportunities to visit outsource operations, perhaps even offer them secondments to provide oversight and training. Inform your clients that you are proactively developing improved methods of delivering high quality content, and think of how you can use the new opportunities to provide new types of services and products. If you do the above you will be serving your organisation and staff well, and learning the lessons from history too, all significant accomplishments.

About the author:

Chris Stevenson has worked in the pharmaceutical, marketing services and medical education sectors in the UK, mainland Europe and the USA. He can be contacted at chris.stevenson101@live.com.

Is outsourced medical writing a necessity?