If the pharmaceutical industry were personified it would have bitter pills to swallow, might feel aggrieved at being so misunderstood and could benefit from a psychotherapy session, imagines Daniel Kent.
Big Pharma turned up a few minutes early for his appointment. He was dressed in a blue jacket, open collar shirt and casual trousers – smart and professional but not overly corporate or intimidating. He looked to me like an individual who’d been told not to stand out too much.
He greeted me with a firm handshake and a smile. I invited him into my practice room and he sat down quickly, checked his phone was on silent and looked me directly in the eyes. He was used to awkward meetings. He leaned forward with his hands clasped in his lap, eager to begin.
I started by explaining about the therapeutic relationship and confidentiality. I assured him I was not here to tell him what to do or to judge. This was a safe space and he could say whatever he wanted.
Big Pharma looked quizzical.
“I’m a bit taken a-back by the lack of judgement part.” He offered. “I feel like I’m always being judged. Always. No matter what I do…”
I nodded my acknowledgement and let him continue.
“That’s what brought me here.” He added. “People seem so quick to judge me and my motives. It makes me defensive. I don’t feel like they understand what I’m about. I’m helping the world, but it feels like I’m always getting slapped.”
“Have you always felt like this?” I asked.
“For a long time now. I used to have a lot of freedom. I explored, I invented, I created wonderful advancements in health and was mostly left alone. Sure, I made mistakes, but people seemed grateful.”
“Do they not seem grateful anymore?”
“I have to explain myself to absolutely everyone these days.” He responded quickly. “It’s not that people don’t want my products, it’s that everyone wants more and they want them faster. They want them in diseases where there’s no investment or no existing treatments. And….” He looked me in the eye again. “They want all this for less money. Somehow me making a profit has become immoral. Honestly, it feels like I’m not supposed to be a business at all!”
“Not a business at all?” I repeated back to him.
“That’s right.” His smile had faded. “But I am a business. Why don’t people understand that I need to keep making money to bring new medicines? Why won’t they accept there needs to be investment and reward? Governments take my patents away as soon as they can and then wonder why my prices are high. I even have to justify my dinner receipts these days.”
I could hear his phone vibrating in his pocket.
“Have you told anyone how you feel?” I asked.
“I try…” He hesitated for a moment. “Well, I say what I think is the right thing to say. It’s not that it’s untrue, but it’s… sanitised. How do you keep the shareholders and governments happy at the same time? What they want is usually directly opposite.”
“I’m hearing that you feel compromised.” I said.
He gave a shrug and looked down at his black brogues.
“I get defensive.” He spoke quieter now, more reflective. “The lawyers don’t like me to say too much so I speak in standby statements. It can be frustrating because it makes me sound like I don’t care. I’m still not allowed to talk directly to the public even though they can find out loads about me in a 30-second internet search.”
“Your communication has to be approved and this is frustrating.” I echoed back.
“I understand why, but it’s making me sound contrived and distant. I’ve got good things to say. I do wonderful work. But when I’m unable to comment or speak openly, people decide who I am by talking to each other instead. Sometimes this is good, but often I get criticised. How did this happen? I’m one of the good guys!”
Big Pharma was proud of his achievements and what he felt was a huge benefit to society, but he’d never prepared himself for a world where he had to justify himself and where, in the absence of his own engagement, people decided who he was by speaking to each other.
“Have you ever had an unscripted, authentic conversation?” I poised the question knowing the answer.
“Well… no.” His phone buzzed again briefly. No doubt a voicemail from the missed call. “I know that’s what people want, but I’m a little old fashioned. It used to be simpler. I told people who I was and what I was about and they more or less accepted it. I shared data with prescribers and explained to them why my products were good. I placed studies into journals and presented findings at congresses. The doctors talked to each other, but not really to anyone outside the medical world. Apart from the US, the public didn’t really care about me as long as the drugs kept coming. I don’t think they even knew my name. They certainly didn’t talk about me like they do now.
“Everything has changed. Nowadays I need to talk about cost-benefit analysis and market access, I need to declare it every time I invite someone to a meeting and if I dare to respond to inaccurate online posts, the lawyers come down on me like a ton of bricks.”
“So what do you say to people these days? I asked. “What’s changed in your communications?”
“I tell them that I’m patient-centric and that I’ll make my data publically available. I tell them that it costs millions – sometimes billions to bring new drugs to market. I tell them that I’m committed to the communities I help and the economies I’m part of. But…”
He tailed off.
I let the silence breathe for a minute and then encouraged him to go further.
“But… sometimes I stuff it up.” He laughed heartily, like admitting this was a huge relief. “I’ve done things I’m not proud of, but everyone makes mistakes right? I’ve learned from things I’ve done wrong. People don´t forgive me easily. They expect me to be perfect and when there’s so many people to keep happy, sometimes that’s impossible.”
I thought about all he had said for a moment. I’m not in the habit of diagnosing in first meetings, but something stuck in my head. I put it to Big Pharma.
“What I think you’re saying is that nowadays people want and expect authentic engagement from you. You’ve told me that everyone expects you to communicate with them and when you don’t, they’ll get their opinions from other people instead. It makes me think that the solution to how you feel might be easier than you think. What if?…” It was my turn to look directly into his eyes. “What if your behaviour and your communication completely matched? If everything you said was authenticated by your actions? Surely this would solve the problem or at least give you the confidence to stand your ground?”
“It sounds too simplistic.” He responded.
“Simple is good. People respond to authentic behaviour and are far more prepared to forgive your failings if they feel you’re being up front. It’s when they think you’re over-polished or hiding information that they become sceptical.”
“So, I should just say exactly what I mean and do exactly what I say I’m going to do?” Big Pharma was letting the idea permeate. It was going to take a bit of time to get used to it.
“I’ll think about it,” he said, regaining his composure.
“That’s all I’ve got time for.” He continued. He stood up and reached for the phone in his pocket. “I’m sorry, but I’ve received 353 emails since we’ve been talking. I’ve got three data announcements, one product launch, two government meetings and four law suits to deal with before EOD.”
I looked at the clock, we still had 12 minutes left. Big Pharma extended his hand and the smile was back.
“It’s been a pleasure,” he said and reached into his bag, pulling out a serious looking document. “This is just standard boiler plate stuff,” he continued. “You know, side effects, PIs and legal disclaimers.”
“What should I do with it?” I asked, a little confused.
“Oh nothing,” he said casually. “Just covering myself. You’re a member of the general public. I shouldn’t really even be talking to you.”
And with that he left.
Daniel Kent is a Director and Senior Partner at Fleishman-Hillard. For the last 20 years he has worked in healthcare communications, supporting commercial organisations and NGOs. He is also a professional psychotherapist.
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October 15, 2020