16 October 1998
2,400 words

Well-paid medical writing drifts into marketing,
doctor education and firing up sales reps.
Warning: Don't violate the medical culture

NEW YORK--There's a difference between writing an article as a writer, and writing it as a public relations person, said Alison Kellner, who does both. PR can include writing, but it's market-oriented.

When she works for a hospital or medical practice as a PR or marketing consultant, "they want marketing ideas," she said, at a meeting on medical writing on 15 October 1998. "They want your opinion." When you come in as a writer, they don't want your opinion.

As a marketer, Kellner's job is to understand their marketing needs and figure out the best way to meet those needs, she said at the Writers' Roundtable, an informal group of writers that meets every month in Midtown Manhattan. "They're willing to pay for strategic thinking," she said.

Two other writers at the meeting explained how to write marketing material for pharmaceutical reps, up to and including their climactic product launches, and how to write scripts for doctors' videos without violating the unspoken medical culture.

Press release and the whole package

The best way to meet the client's marketing needs, said Kellner, might be a press release, a brochure, or a newsletter. She might write it herself, or they might hire a writer.

"What I enjoy most is doing the whole package, because I can work with them on the managerial level," said Kellner. "And it pays more."

Kellner started as a journalist, doing police reporting and features, and moved through several medical PR agencies, before working freelance.

Kellner was hired, for example, by a medical communications firm to write a newsletter for the Montifiore Medical Center, Bronx, NY. The firm did the design and layout.

"As writers, we have an opportunity to expand the services we provide," said Kellner. For example, one client was a physician leaving Yale University to start his own practice. She wrote a press release. He was happy with it. She said, "Now what else do you want?" Over the last 4 years, she wrote a brochure, a newsletter, and is now working on a web site. "He does some exciting things, so when I write a press release, I can get it placed easily," she said.

Placement is the part of PR that everybody hates, Kellner added, because it's so frustrating to pitch ideas to media without any assurance they'll use it. But it's the most valuable part of PR, so clients are willing to pay a lot for it.

Kellner writes mostly for consumers, and sometimes for physicians. She found it relatively easy to pick up the medical knowledge on the job. She understands it better after years of experience, but with every new job, and even with her old specialties, there's always a lot to learn. "Rather than being frightened by it, I will come at it as a chance to learn," she said.

"My premise is, if I don't understand something, the ordinary person on the street can't understand it," said Kellner. Other writers use the same premise even when their audience is doctors.

Pharmaceutical launches

Monte Davis has been through 30 pharmaceutical launches. "It's a special niche," he said. A launch is a sales meeting par excellence.

"The stakes are very high," said Davis. The pharmaceutical companies invest $200 to $300 million in developing a new drug. The time between FDA approval and patent expiration is short. There are 2 or 3 competitors 4 to 6 months behind. The company is fighting for "mind share," being thought of in the doctor's mind as the drug of choice, the gold standard. "The market share a company has in the first 90 days is the market share they will have in the next 5 years," he said.

Some of his writing is informational. "I am going to explain a drug for the people who are going out to sell it," said Davis, who has a chemistry degree. The sales forces gets "training in depth," of several hundred hours. Some of the sales reps actually shadow doctors, sitting in as they treat patients, he said. He writes training material in print and other media.

But the launch itself is a motivational event, Davis explained. By that time, the sales force has already learned about the product. "There is an immense value for the pharmaceutical company to have a sales force that is willing to go through barbed wire and eat broken glass," he said. The companies feel that spending a lot of money on a big event is a way of telling the sales force that the company is behind them.

Lavish celebration

The week-long launches, in a lavish venue like Scottsdale or Orlando, sometimes in conjunction with a medical meeting, can have budgets of hundreds of thousands of dollars, sometimes $1 million, "sometimes several million," said Davis. The sales force of hundreds is gathered from around the country in a big tent or auditorium.

The meeting starts with a "whiz-bang high-energy theater piece that themes the meeting," said Davis. Ideally, they'll say that the drug is the first of its kind. If it's not the first of its kind, they'll have to think of something else to say.

"Usually the CEO will make a brief cameo," said Davis. He will say, "The stockholders and the board are counting on you." The VP of sales and marketing will walk them through the current market. "Where does our product have an edge?" they will say. "Where does our product not have an edge? Where is our product--God forbid--inferior?" Live or on videotape, they will see patients and doctors who are "thought leaders."

"This is not new to them," noted Davis. The reps have already had hundreds of hours of training. The presentation should be "superb and exciting." The sales people are feasted and entertained, and sent out to enjoy Scottsdale or Orlando.

The event production houses that Davis works for will write 15 to 20 speeches. "I am part of a team," which might typically have 24 other people on an $800,000 budget. They provide a "meeting in a box," he said. They will have free-standing modules for different parts of the meeting. There is the "high-energy get out and sell" speech. There is patient information. There are Powerpoint templates. They will usually start scheduling the meeting 5 to 6 months beforehand. He may be working non-stop for weeks, talking to research people. Then there are long dead stretches, during which he takes other work. Often, this entire meeting plan is "piled up behind a dam, waiting for FDA approval," he said. When that approval comes, they work frantically.

"Pharmacy sales forces are interesting, because you have people who are working solo," observed Davis. They may be together at a sales meeting like this only once a year.

"I have travelled with reps," said Davis. "It's a hard life."

"You're on your own," said Davis. "You're visiting one hospital pharmacy, one physician your own." The extensive training is designed to make the reps confident when they're on a call. "If the physician is interested in the basic biochemistry or physiology," he said, "you have to be able to do that."

Pharmaceutical reps have laptops, use CD-ROMS, go on-line, and are familiar with new media, said Davis. The companies are now using intranets, which are closed company-wide web sites, as part of their training. One evening a week, the reps get together on-line for a chat. Since the reps only get together once or twice a year, they're trying to use technology to keep them in communication.

The purpose of the training is to "convey a belief in the product that is informed," said Davis. "My work is all about equipping reps for doing that."

"Is it hokey, overblown, wretched excess?" asked Davis. "Yes, but it works."

Videos, media

Richard Bergman writes scripts for videos, slide lecture kits, interactive disks and CD-ROMs, to educate health care professionals and keep them up to date. More recently, he's getting into new business consulting.

It's great work if you can get it, for those who love working with heavy medical content. "I'm being paid to spend my life as a perpetual student," said Bergman. "The work is there. The money's there. It's well paid."

But you probably won't get it. It's very difficult for people without that specific experience to break into the field, said Bergman, who nonetheless gave a few tips.

Bergman's clients are in the medical education industry. "It's a small industry, little known outside the field," he said. The industry is located primarily in New York, New Jersey, and Connecticut, with some presence in California. The business includes independent medical education houses, independent production houses, divisions of ad agencies, and divisions of pharmaceutical companies.

Now he's doing new business consultation. "In order to have these materials prepared, there has to be money," said Bergman. "What precedes the money is proposals. What precedes the proposals is thoughts."

"My skill," said Bergman, "is to perceive the marketing problem, and translate it into a marketing strategy that will meet the need." He will help firms develop proposals that might be funded, and after that, "sometimes no further involvement."

Breaking in: Almost impossible

To do this work, you need to have, at a minimum, a "detailed academic knowledge" of medicine, said Bergman, by traditional education or "however you acquired it."

You have to know the media, and know "how to use the media appropriately for your educational goal," said Bergman.

"You have to be a natural teacher," said Bergman.

"You have to be detail-oriented," said Bergman. Medical writing requires a "huge amount of detail," he said, "with paper trails."

"You have to digest a huge amount of medical information," said Bergman. You can't get it all from books. "You are hired to write something that's so new that it's not printed yet." You have to interview the experts.

It requires "the ability to handle endless revisions," said Bergman. Pharmaceutical firms have medical, legal and marketing reviews. "You have to have a high frustration tolerance."

Content is primary, said Bergman. "You have to let the content drive the video."

"The work is given only to those who have the specific medical writing skill in the field," said Bergman, "to those who have contacts in the field." The only exception is people who have degrees as physicians, pharmacists or nurses. Following the hierarchy, the preference "always goes to the physician or the nurse," he said. "Experience outside of medicine carries no weight."

"Being creative gets absolutely nothing," said Bergman. If anything, producers worry that creative people might let the media dominate the content. "Having a great interest means nothing."

"I wish I could be more optimistic," said Bergman. "If you have those qualifications or something close to it, and are willing to be patient, and are willing to be underpaid, first establish yourself in medical print." If you establish yourself as a very good medical writer, "eventually you'll have a chance to be an underpaid video writer."

Another way is to get a low-level administrative job and work your way up. "It's a wonderful way to learn about the culture," said Bergman.

Medical culture

"Most important," said Bergman, is a "knowledge of medical pharmaceutical agency culture." It is a "unique culture," he said, distinguished by its language and hierarchy. Nobody will tell you about the culture, he said. You just have to know.

"For 7 years, I wrote, produced and directed science films for the National Science Foundation on physics," said Bergman. "I thought that I could transfer this to medical," he said. "Boy, was I wrong."

For example, "I misspelled a drug name," said Bergman. Outside of medicine, no big deal. In medical writing, there is hell to pay. The names of drugs, and people, absolutely must be spelled correctly, he said. "You must check it against an unimpeachable source."

You must always be aware of hierarchies, said Bergman. "Medicine is a priesthood. Always go through the chain of command." He was once working at an independent firm that was producing educational materials for a pharmaceutical company. For months, he had been working with directives from the product manager. One day, he called the product manager directly. "There was hell to pay," he said. "I should have gone through the person I worked with at the firm."

If someone in a position of authority--especially a doctor--tells you to do something, "you do it," said Bergman. "You can edit it out afterwards."

The "thought leaders" want to be treated differently from the run-of-the-mill doctors, added Davis.

Marketing tips

"I've taken advertisements and done promos," said Bergman. "The only thing that has ever gotten me work has been my listing in the American Medical Writers Association freelance directory," he said. "I get easily half a dozen calls per year from companies I've never heard of." In addition, as an AMWA member, he gets the "pink sheets" job listings.

Every medical writer will give a different answer, said Bergman, but "what works for me is, slowly, over the years, personal contact."

Bergman's favorite directory of medical agencies is the annual health care agency review of the magazine Medical Marketing & Media. (Much of the magazine's listings, including a listing of agencies, pharmaceutical companies, organizations, a calendar of events, news of the industry, and links to other useful sites, are at the web site of MMM's publisher, CPS Communications, Inc.) Kellner recommended the Healthcare Businesswomen's Association, Fairfield, New Jersey, (973) 575-0606.

"I have never had any success in cold calling over the phone," said Bergman. However, when you meet someone at a meeting, and talk, and follow it up, "It's not a cold call," he said. "It's a warm call."

Pharmaceutical companies are immense bureaucracies, and it's hard to find someone who has authority to hire you, the medical writers agreed. "I have never figured out how to effectively approach pharmaceutical companies directly," said Bergman. "So I wind up working for the firms that have sold to them. They've earned it." Davis observed that he was working for a production house that took him into a pharmaceutical company for a client meeting, and the account executive said that it was her 15th call.

The next meeting of the Writer's Roundtable will be on 19 November, at 555 W. 57 St., Room 1230. Bergman will give a talk on negotiating. For more information, contact Davis at (973) 378-3738, or by email.

--Norman Bauman