Friday, February 27, 2009

Hide or Seek?

It’s Time for the Healthcare Industry to Find New Footing
There's plenty of blame to go around these days. We’ve all seen angry fingers pointed at the tobacco companies for pushing products they knew to be hazardous and additive. There were hearings before Congress, lawsuits and some new restrictions on marketing to teens.

HMOs came under fire for denying medical claims and access to potentially life-saving interventions. Lawsuits and some high-profile reversals in coverage decisions ensued.

Big oil and oil speculators had us over the figurative barrel when a gallon of gas went over $4.00 a gallon. With the collapsing economy, gasoline prices have fallen by more than 50 percent (though the price of oil has fallen by more than 70 percent).

The list continues with the biopharmaceutical industry. Despite cost assistance programs, there are still too many patients who choose between filling a prescription and buying other necessities. They may not have insurance or their co-pays for medications may be enough to tip a limited budget into the red. There has been some relief with the implementation of the Medicare drug benefit and more has just been promised by President Obama in his address to Congress.

Now, there’s another group to vilify – the financial industry. Predatory lenders, over-compensated CEOs and Ponzi-scheming money (mis)managers.

Though sometimes pushed from the front page by competing bad news from the banking and housing crisis, there are still plenty of stories out there that help fan the flames on healthcare. And they’re not just about cost and access: law suits and investigations on drug promotions, side effects, data disclosure and fraud help to keep the fury fresh. (We all know that a healthy fraction of the drug, device and diagnostic industries’ low reputation is self-inflicted, but that’s a whole other discussion.)

All of this has helped to divert some attention away from the issues and concerns of those healthcare sectors that are involved with discovery and innovation. Indeed, true healthcare reform – expanding access, and improving care and efficiency – will be difficult to achieve unless we enhance our ability to detect, treat, cure and prevent diseases.

So, what kind of visibility should the biopharmaceutical, device and diagnostic sectors be seeking right now, especially when the chairs are empty at HHS, FDA, NIH, CDC and CMS? One option is to do nothing and enjoy the relative calm (compared to what the financial sector is experiencing). To some, it’s schadenfreude – a nice change to see public anger and resentment trained somewhere else. Another option is to fill the void with new ideas, new approaches and reengage our publics.

For a snapshot of the current messages coming out of the key industry trade associations, I went to their web sites. The most prominent feature on PhRMA’s homepage highlights Meredith Baxter’s battle with breast cancer. Also, there are links for prescription assistance, healthcare reform and medicines in development. Likewise, the AdvaMed web site has a number of links to interesting content. However, neither have a clean, clear set of rallying points. BIO is a little closer to at least part of what I think we need. There’s a CNBC interview with association president James Greenwood from their CEO & Investor Conference. He makes a clear connection between healthcare and the economy – the need to “expand access to health care while expanding incentives to innovate.”

Like housing, banking and automobiles, biotech is in a crisis. Perhaps this is one of the messages that needs to be amplified and expanded to gain more relevancy with more audiences. The scary facts are that a quarter of biotech companies have six months or less of cash. Half have 12 months or less. The editorial in the February issue of Nature Biotechnology remarks that “many promising products now face financial oblivion.”

Yes, we need healthcare reform to expand access. Yet, without the underpinnings of new research, and new diagnostics and therapeutics, we will lose the capacity to consistently improve health. The transformation from trial-and-error approaches to DNA-guided medicine, ensuring that we get the right medicine in the right dose, will be pushed back by who knows how long. And, our economic competitiveness, our lead in innovation, will wane.

Certainly, the public doesn’t want to hear that healthcare, like the other sectors mentioned above, is looking for a bail-out. But some heads need to come together and think about new ways to build support for a remarkable but hobbled industry.

Friday, February 20, 2009

The Latest Message War

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The Fight to Win Hearts and Minds Over the Economy
The messaging wars are in full swing over the Obama administration’s plans to reverse the slide in the economy. The latest example is still playing out after yesterday’s commentary by CNBC’s Rick Santelli from the floor of the Chicago Board of Trade. (After hearing about it all day, I became the 220,884th viewer on YouTube.) In a nutshell, Mr. Santelli denounced plans to provide $75 billion to support certain borrowers (“losers”) who face foreclosure. He called for a protest – a “Chicago Tea Party” – against using taxpayer’s money to subsidize someone else’s (and not his) mortgage.

We’ve seen the sides line up. Earmarks, pork, and hand-outs versus stimulus, recovery and investment. Waste versus necessity. House flippers who got caught versus predatory lenders. Socialism versus pragmatism. It’s evident that the middle ground is missing.

Bills are moving through Congress but the process remains ugly. We need a diversity of opinions and ideas but everyone needs to take a quick breath. We need to try really hard to let go of personal agendas and focus on our collective goals. I know, I know, we’re talking about politics – by definition, there’s an agenda. But this situation reminds me of the kind of counsel we’re supposed to give as strategic advisors – tell the client what they need to hear – what’s good for their business – not what we want to tell them.

Clearly, Santelli's message struck a populist chord. We’re supposed to be responsible for ourselves, take responsibility and live with our mistakes. We’re Americans! Yes, fine. I’m with that. Yet, Americans have heart. We volunteer more than any other country. We find strength in our communities. We rush to aid others in times of crisis. Well, this is a crisis.

The messaging mavens are entitled to build whatever walls or bridges they want. In this mortgage crisis, though, it’s interesting to see how “subsidy” has become a dirty word. Here’s where a breath, some perspective, could help. We subsidize all the time. Look at the insurance industry. Non-smokers subsidize smokers. Motorcycle riders who wear helmets subsidize those who do not. Sober people subsidize alcohol and drug treatment programs.

Seventy five billion dollars is, indeed, an enormous sum of money and nearly no one wants to see us spend cash that we don’t have. The scale of all of this is unprecedented. It’s scary. But, it’s been said that desperate times call for desperate measures. That does not mean desperate behavior. When it comes to addressing our problems, we need rational minds crafting rational programs communicated in a rational way.

Monday, February 9, 2009

Betting on Vetting

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Why We Need To Ask (and Answer) Questions
It happens every four years but also in lots of places in between. It’s the political vetting process.

Despite the development of an unprecedented process of detailed queries by the Obama administration (including a seven page survey with 63 separate requests for information), it’s been a banner year for viewing some high-profile nominees go down in flames. These include Tom Daschle for HHS Secretary and Bill Richardson for Commerce Secretary. Either the answers to the questions were inadequate or the vetters themselves were inadequate or both.

Sarah Palin, who remained on the GOP ticket after a much maligned shotgun-wedding-of-a-vetting process, might have been the most talked about case. Yes, there were the serious issues of her readiness to be a heartbeat away from the presidency, the ethics investigation in Alaska, her husband’s DUI arrest and her unwed teenage daughter’s pregnancy. But it communicated more. Reputations suffered. The unraveling episode was a reflection of the McCain team, and of the man himself and his judgment. Some argue that the Daschle and Richardson picks (and throw in Timothy Geithner and Nancy Killefer) cast similar doubts on the President.

Of course, this isn’t new. I’m not a political historian but just off the top of my head I can remember Thomas Eagleton for Vice President in 1972, John Tower for Secretary of Defense in 1989, ZoĆ« Baird for Attorney General in 1993, Bernard Kerick for Homeland Security Secretary in 2004 and Harriet Miers for the Supreme Court in 2005. The reasons for these falls from grace are various, including mental health issues, tax problems, outright corruption and limited qualifications.

Politics is just the tip of the iceberg when it comes to the lack of vetting – just ask those who were ripped off by Bernard Madoff. It’s clear that questions should have been asked but I don’t have an answer on how to overcome blind faith or greed that blinds.

There are several points here:

Taking the time to ask questions – good questions – is essential. But equally essential is the need to receive good answers – truthful answers – in a timely fashion.

The truth will out. Being transparent and honest is the first, best – the only – approach. And, let’s face it, our 24/7 on-line world is relentless in its pursuit of a good story.

We must accept, however, that decisions must get made eventually and that time is often an enemy. The best decision-makers know when collecting more and more information leads to diminishing returns. We need to learn how to manage and accept risk.

If we are to wear an ethical mantle, then we must commit to ethical standards… all the time, not just when it’s easy or convenient or in public. And, we must ensure that those with whom we work or hire also adhere to those principles.

These lessons are not new to professionals in the communications field. Strategic communicators ask questions and gain insight through rigorous analysis of information. They look around the corners, predicting outcomes and the potential unintended consequences of a particular course of action. They prepare scenarios (from those with high probability but little impact to those with low probability but a high potential for damage) and engage in “wargaming” exercises. They develop comprehensive Q&A documents, and pay attention to language and tone. They determine, in advance, who might be an advocate and who might be an adversary. Once prepared, they move forward.

The call from Washington for more transparency and higher standards is a good thing. Openness and sharing information is what democracy is about. Perhaps some day down the road we might learn that sweeping bad or embarrassing news under the rug is bad business. If not, someone will always be around to ask, “What’s that lump under the carpet? Let’s see what’s there!”