Agencies used to tout their expertise in specific areas like advertising, promotions, medical education and public relations. Nowadays, agencies identify themselves as being communications experts—implying that they have expertise throughout the communications spectrum and across all channels. I see the lines increasingly blur as agencies try to expand their expertise just to grab a bigger slice of the pie. How many agencies can truly achieve broader expertise? Or is it just smoke and mirrors?

What makes a communications expert? I suggest it’s about having the right talents represent your agency and then focusing on certain areas as your core competencies. Be specific and not vague like those following the current trend. Being communications experts means you have to bring a diverse group of people to the table who can legitimately discuss everything from branding to strategy to advertising and promotions to public relations to medical to market access to public affairs and more. You can see that the list is long, and for those who call themselves communications “experts” it is necessary to understand what they can really bring to the table, or else you will do your own business a disservice.

So, the issue isn’t that this new era of communications doesn’t exist; it’s a matter of whether your agency can meet the challenge—and, ultimately, your needs. You must ask the right questions of your agency and peel back the layers to understand what they are really experts in—agencies will always say they can do everything. Look beyond the obvious and make sure your agency fulfills the role it promises.

Having just returned from a medical conference this past week, I decided to reflect on my experience from last year at the same congress, just before the promotional guidelines went into effect.  I admit, I have vivid memories of convention floors and seeing the mass of colored bags, each bigger and better than the last one.  I also must confess, that I have seen a particular “giveaway” and asked where it came from, and headed off to that particular company’s booth—not because I was at all interested in their product, but because I was lured by the attractive bag, backpack, or whatever.  I dutifully listened to the message and collected my “treasure” and felt obligated to fill it with literature or other giveaways, only to return to my hotel room and realize there was no way that this collection would fit into my luggage, and was certainly not worth the extra baggage charges if I had to check it. So I abandoned several items of my treasure as I checked out of my hotel.  I am sure I am not the only one who has done this, but I may be one of the few who will ’fess up.

So does the current environment stimulate healthcare professionals’ interest in the exhibit hall?  The primary shift I observed was an increase in pre-meeting invitations to visit a company’s exhibit booth to learn about a procedure, or a product’s place in a therapeutic algorithm, or to participate in a drawing for a medically relevant prize. There are fewer colored bags filled with literature slung over shoulders of congress attendees tempting me to ask, “Where did this come from?” This does, however, make it easier to negotiate the convention floor.  Overall, I found myself more selective of the exhibits I visited and more focused on the content.

It’s not often that I think that enacted legislation is beneficial, but the bottom line is, I think we have managed to elevate our profession and focus on the content— the real reason we come to the exhibit floor.

So my question is, “Is the printed page dead or dying?” We certainly have the need, and, in fact, increasing demand for information from publications. How are we getting this information? Are we all going online to retrieve the information we want? And is it available online? Where are the ads?

Certainly the recent trend of exclusively online journals and open access articles has impacted medical publishing. Online journals have challenged the publishing industry, forcing many journals that were print-only to offer their content online as well to be competitive. If you don’t have a subscription and access to the journal, you can usually pay for a download of the article, again minimizing the need to have a printed journal subscription. A significant number of journals provide free access to many, if not all, of the articles through author-paid fees or decision of the publisher to provide open access. In keeping with our immediate need to know, many journals provide “provisional” pre-publication downloads, so articles can be sourced even before they are officially “published,” again reducing the need to read the printed journal.

This shift affects advertisers and publishers, for sure, but it has a broader reach. Many associations include with their membership a subscription to their respective journal and believe that this offering is the primary reason for membership. If they are forced to put the journal online and provide open access to be competitive, what happens to the membership of the association? Can they bring value to their members beyond the publication? Many associations are re-thinking their business model in light of this shift.

So the questions remain: Is it necessary to maintain subscriptions to specific journals? Will we need libraries to house periodicals? In the future will we download everything to a PDA or a Kindle? If so, where will advertising go? Will there be more banner ads and fewer print ads? Will the highly regarded scientific journals that now publish without advertising succumb to pop-up, Flash, and Google AdWords? Are we seeing the end of the printed page as we know it?

Having gone through numerous RFP processes throughout my career at various agencies, I can confirm that not all RFPs are met with glee when received. Many agencies have a sneaking suspicion that they are part of a cattle call where a dozen or so other agencies made the ‘short-list.’ Others are resentful that they are providing their best thinking and ideas without really knowing the evaluation criteria or scope of work.

RFPs also tend to be unclear and with limited information. Having worked on the client side myself, I don’t really know the rationale for it other than to serve as a medieval torture device. Despite an agency’s best effort to glean more information from the client, many times the information is not forthcoming. This forces the agency to invest time and money into conducting costly research on their own and to blindly go about addressing the request.

And in spite of the efforts put into a pitch, which include time, resources and finances, at the end of the day, the best and smartest agency doesn’t always win. Clients may have been looking to give the incumbent a wakeup call or to keep them on their toes, or they select an agency that they feel most comfortable with – and that’s not necessarily the agency that demonstrated strategic strength or ability to challenge the norm and push the envelope.

While I appreciate that this system will weed out the weaker agencies, it is still a very archaic and more often than not, unfair process. So, in its place, I’d like to propose a different approach. One that allows both parties, client and agency, to start off on equal footing. One that allows the agency to issue a Request for Client (RFC) asking the client to also submit a proposal elaborating on why the agency should work with them, and what their anticipated scope of work would be now and over the next few years. Additionally, the RFC would address how the client expects to work with the agency; what makes the client an ideal partner; what makes their business interesting to the agency; why they are considering the agency as a potential partner.

So what’s the benefit of this approach? Well, I see both parties benefiting. First, it will initiate a relationship that is based on mutual transparency and respect. Second, it will ensure a fair process where those agencies that are selected to participate in the RFP and who ultimately choose to participate are clear that they will be evaluated on the same criteria and scope. And last, the RFC will work to ensure that the selection process will consider not only strategic smarts but will also emphasize the value of a match between the client and agency based on mutual expectations, work styles, skill sets and chemistry. Weighing all these factors will increase the likelihood for long-term partnership success and minimize the agency churn that many clients go through every couple of years or so. Further, this approach will allow both parties to pull together the right talents and resources, and ensure the appropriate amount of time and finances are invested into the effort.

I read an interesting article in AdWeek recently about the Zappos’ agency search and the many frustrations expressed by the agencies involved. It sheds more light on why this process doesn’t have to be as painful as it’s become. To read this article, click here.

Also just for kicks, click here for a hilarious take on dysfunctional client relationships posted on YouTube.

There are concerns that ghostwritten articles in peer-reviewed journals discussing unapproved indications encourage off-label use of a product. But don’t physicians read and draw their own conclusions from the literature? Of course, increased off-label use would increase sales of the product which may be another concern; however, if clinicians don’t see a response, would they continue prescribing the product?

So who should be held accountable for the publication of these articles? What about the journals’ responsibility? They have an editorial board and a peer review process. Isn’t it their responsibility to challenge the interpretation of the data, statistical tests, statements made in the discussion, and conclusions drawn?

Medical writers are essential in our industry. Nearly 50% of abstracts presented at medical meetings are never published as full manuscripts. Can you image what the percentage would be without medical writers? Few journals could survive without the manuscripts medical writers provide to healthcare publications.

It has been my experience with medical writers that their scrutiny of the data is far more thorough than that of the “authors.” Yes, it may be true that the authors, if they wrote the manuscript, would be as critical of the information, but relying solely on clinicians to publish would mean that fewer articles would make it into the medical literature — and certainly not in a timely fashion.

There is no doubt there is a need for transparency and disclosure of the role of a medical writer in the preparation of the manuscript. Significant efforts have been initiated by journals and associations of medical writers to make this happen. Medical publication practice guidelines were proposed in 1998 because of ghostwriting concerns. Revised guidelines, which encourage further transparency and recommend that all contributors be listed with the details of their contributions, will be published later this year. Then it becomes the responsibility of the pharmaceutical industry and healthcare publishing to abide by them so “ghostwriting” disappears from our vocabulary.

It’s all about the net impression.
In essence, the FDA asks that manufacturers not focus only on individual claims or presentations, but rather on the promotion as a whole. According to the FDA, “the ‘net impression’ of the product after viewing the promotion should not convey a deceptive net impression of the product that could be misleading, even if specific individual claims or presentations are not misleading.”

Is it me or is this a bit vague? What defines misleading? That a product demonstrates value to a potential consumer? That it could solve a problem or unmet need? Should it instead communicate to the consumer that you could take it or leave it? Why then, would we advertise?

What did you say?
The FDA implies that manufacturers try to throw too much at consumers and cite that cognitive research demonstrates that all people, regardless of expertise, are only able to think through and process a limited amount of information at a time.

Cognitive overload — okay I get it, but guys, this isn’t going away. There’s a young generation of multi-taskers (or “multi-slackers” as I like to call them) that are gearing up to conquer the world. They’re not worried about cognitive overload, they want more. They watch TV, blog, chat on the Internet and listen to their iPods all at the same time. Let’s not over-generalize or underestimate people’s abilities to filter information appropriately — the human brain is a remarkable thing.

Volume equality?
The FDA goes on to say that risk information should be presented next to benefits and not just in one place. Additionally, that the volume of risk communicated should be similar to the volume of benefits. Yikes, does that mean that in a 60-second TV commercial, the risk information should take up 30-seconds?

Don’t get me wrong. I support and applaud the need for unbiased, non-misleading information, for transparency and the inclusion of material facts that could influence the decision-making process, to ensure the protection of the consumer from fraud and deception. It is, indeed, a rough world out there.

But what are the possible consequences of over-regulation of the drug industry by the FDA? They are going so far as to art direct — how much white space, how to layout the pages. When will it end? The fact remains that the physician is still the gatekeeper. DTC promotion helps inform the public, but the healthcare professional is responsible for weighing the options and ensuring informed decisions, not the drug makers.

If you are interested in commenting on the FDA’s proposed DTC guidelines, the deadline is August 25, 2009. For more information on submitting comments, click here.

For those of you familiar with the process, think of the last speakers’ training meeting you attended, or perhaps organized. The obligatory pre-meeting binder with draft presentations and key references were shipped before the meeting, and attendees were expected to have at least reviewed the materials on the plane en route to the meeting. As attendees scurry to catch their planes on Sunday, hoping to salvage some of the day with their families, clutching their “binders of knowledge,” notes, and perhaps a flash drive of the approved presentation, company personnel heave a sigh of relief that the training is accomplished. Let the programs begin!

But wait, are these speakers really ready to deliver the information, weave a story, and leave behind the message the company has worked so hard to create? Countless hours go into developing the content from company personnel involving medical, marketing, regulatory, legal, and perhaps other departments. Additional agency hours go into making it presentable — choosing background colors of the slide template, reworking scientific charts and tables so they can be seen across the room, and perhaps incorporating animation to demonstrate the mode of action of a drug. But will it be memorable when it is delivered? More importantly, will the audience retain the information and change their behaviors? How many hours have gone into ensuring this?

Studies have shown that the effectiveness of spoken communication is based on the following:

• 55% of meaning is in facial expressions and other body language
• 38% of meaning is paralinguistic or the way the words are said (voice quality and tone)
• 7% of meaning is in the content or words

The bottom line is that communication is more often about performance or delivery of the content than the content itself. Scientific audiences will no doubt pay more attention to the content than Mehrabian’s model of 7%; however, his model should be a red light for us to stop and rethink how speakers deliver the content, and how little time we spend training them on these skills. Why don’t we include these skills more frequently in speakers’ training? Do we just assume that they have been trained because they have spoken for other companies or have delivered presentations at medical congresses? Are we afraid a training session may embarrass or insult them?

We have all experienced how the same content can dramatically differ depending on the speaker’s enthusiasm and level of engagement with the audience; yet, we give little credence to training our speakers on these presentation skills. Recall the presentations that stand out in your mind; maybe the speaker began with a provocative question or polled the audience, included his or her own experience, or engaged the audience by asking for their opinions. Most likely we remember it because of the way it was delivered.

Based on Mehrabian’s model, over 90% of meaning is derived from the speaker’s delivery of the content. Judging by that logic, shouldn’t the amount of time spent on delivery be commensurate with content? When speaking skills are included in the training meeting, usually only 1 hour or 2 hours are allocated to the topic. In this short period of time, speaking consultants skim through the various presentation skills, including:

• Pros and cons of standing behind versus aside the podium
• The importance of posture, body language, maintaining eye contact with the audience, and speaking slowly
• Development of a message map to ensure the core message is delivered succinctly
• How to summarize the key points of a complex slide
• Use of “trigger phrases” to bring back a wandering audience

Hopefully, after covering all of this information, the opportunity remains for each speaker to present and be critiqued on a few slides.

If greater focus is placed on basic speaking and presentation skills, I am sure we will have betters speakers, more interesting programs, higher attendance, and a change in behavior in the attendees. And after all, isn’t that our ultimate goal?