Book Intro

Book Preface

“People are usually unaware of missing information. It’s hard to see what isn’t there. Because of this, people tend to form strong beliefs on the basis of weak evidence.”  (Hochhauser, 2003, p. 12)

This book draws on the MSc course programme in Pharmaceutical Information Management at the School of Informatics, City University, London that began in 1999. It is more fully informed by my industry engagements that extended to 2005 in Europe, USA and Russia.

It is the broad ambition of the book, therefore, to fuse reflections from across this range of activities in which, at various points on the way, I have been Industry Trainer, University Lecturer, Curriculum Co-ordinator, Senior Scientist, company Medical Communicator and, of course, recent MSc student.

These activities, however, have been undertaken not in a vacuum, but at a time of significant social and economic changes in Europe and across the pharmaceutical industry in general. While some of those changes, like the enlargement of the EU, encroach slowly, surely, and inevitably, others, like the pension reform proposals that impact on insurances and healthcare provision in the ‘old’ states, have been, for most of the population, sudden and unforeseen.

Both changes have inevitable far-reaching consequences that impact on all areas of industry and cultural activity, and not least on the working methods and procedures of the pharmaceutical industry itself. At the time of completion of this research, for example, two prominent texts were written by renowned professors in Law and Medicine that severely questioned the ethical legitimacy of the corporate sphere generally (Joel Bakan, British Columbia University, Canada) and the pharmaceutical industry in particular (Marcia Angell, Harvard University, USA). Angell’s caustic account of the industry ran parallel with poll findings that confirmed that “less than 13% of US consumers believed that the information provided by pharmaceutical companies was more trustworthy than healthcare information provided by other organizations” (O’Malley, 2005).

What is understood, however, as “information” and “advertising” is, in the US context, and as we will note below, a relevant issue. The public scepticism underlined in such polls was also perhaps reflective of the outbreak of public relations disasters that characterized much of 2004. The catalogue of calamities from Getz and Kremidas (2005) makes uncomfortable reading:

• In the spirit of more transparency and accounting of special interests, ”Early in 2004, the American Medical Association…called for a government-based clinical trial registry to provide greater disclosure of drug risks…in…clinical trials;

• The New York attorney general filed a lawsuit against GlaxoSmithKline for deliberately suppressing negative clinical trial results for…Paxil;
• Merck withdrew its blockbuster COX-2 inhibitor Vioxx due to the drug’s elevated risks of heart attacks shown in a large clinical trial;
• The Office of the Inspector General next released a survey showing that one-third of FDA scientists have doubts about the agency’s ability to monitor the safety of new therapies during the review and approval process.” (Getz and Kremidas, 2005, p. 60)

So, while the book has been engineered around the specific aims and objectives of an academic course, it is galvanised by wider contextual needs to rethink the provision of drugs in a complex and increasingly sophisticated public sphere. For example, on the question of Big Pharma:-

Just how complex and often uncomfortable that sphere can be in the US is gleaned from Gary Schwitzer’s (2005) revealing research as published in the British Medical Journal and which monitored health policy news coverage from three local US television stations throughout the 2004 US election year, from 1^st January to 2^nd November. An analysis of 326 hours of newscasts from Seattle (KIRO), Chicago (WMAQ), and Tampa (WFLA) led to the following report from the Assistant Professor at the School of Journalism and Mass Communication, University of Minnesota:

“I was shocked by the number of health policy stories, and the time allotted for them. KIRO had only three stories in 10 months, totalling 79 seconds, on any aspect of the George W Bush or John Kerry health proposals in the 2004 presidential campaign. WMAQ had nine stories, totalling less than four minutes, on presidential candidates’ health plans. WMAQ had almost twice that many stories (16) on low-carb diet issues, including commercial-like promotions for new products offered by Wendy’s, Kentucky Fried Chicken, Starbucks and Jack Daniels. WFLA devoted only 84 seconds to the Bush-Kerry health platforms in six stories. Serving the Florida Gulf coast, heavy with senior citizens, WFLA managed only three stories in 10 months on Medicare, totalling less than 2.5 minutes.” (Schwitzer, BMJ, 2005, p. 1089)

In the light of constrained news coverage, it is little wonder that candidates are themselves compromised into the commercial option to get their expensive message across to the electorate. In contrast, therefore, to the dearth of actual news content, station profits were galvanized by the public ‘discussion’ of US health in the form of election advertising, hence,

“In two of the three markets analysed, political ads for campaigns for state and federal offices filled the air during newscasts.…political ads discussed stem research, “government-run” health care, health insurance buying pools, malpractice tort reform, Medicare, diabetes research, stem cell research, abortion, safe water standards, biotech, and cuts to healthcare for children. … During the featured newscasts on WFLA and WMAQ, viewers heard only candidates’ ads on these vital campaign issues, not independent news coverage.” (Schwitzer, BMJ, 2005, p. 1089)

Perhaps one final irony worth noting from Schwitzer’s sobering account is that each of the television stations as covered extensively in his analysis had won a national television award for excellence in journalism just a year before.

This extended account from Schwitzer (2005) serves only to alert us to the vital importance of literacy as an academic theme, a social issue, and a collective goal for all stakeholders. This concern runs as a leitmotif throughout the book, whether it be in the accurate understanding of the EU Directive 2001/20/EC on Clinical Trials by industry professionals and other healthcare providers, or, more alarmingly, in the effectivity of their communications with patients, communities, and, dare we say it, with each other as professional peers and colleagues. As such, the question of literacies, whether they be digital, information, cultural, or media (Robson, 2001) inevitably impacts on all areas of pharmaceutical activity that embraces marketing, documenting, in-house training, or community services. In this last respect the pharmaceutical industry must address wider concerns that touch on literacy levels in the population at large if its role as ‘healthcare provider’ is to be more fully acknowledged and respected in the communities that they serve.

The issue of literacy, therefore, is an inevitable and intimate subtextual motif running through most discussions concerning organisational knowledge and its management. For the purposes of this book, and in the interest of clarifying loaded ambiguities, we take the lead from Hart-Landsberg and Reder (1995) who outline how,

“There has long been an ongoing tension between two broad conceptions of literacy, one centered in a paradigm of individual skills, the other in a paradigm of cultural practice. Within the individual skills paradigm, literacy skills and activities are assumed to develop and operate through processes that are only marginally influenced by the social contexts in which they occur. From the cultural practice perspective, however, literacy is conceived as a set of social or cultural practices that are intimately bound to context.” (Hart-Landsberg and Reder, 1995, p. 1019)

For the purposes of clarity, therefore, this book is grounded on such a definition of literacy that goes beyond the (individual) technical skills-set approach (the ‘retrieval’ model) to embrace central concerns of knowledge management with their own emphasis on how knowledge is generated from information (and, before that, information from data) through shared social practices that would extend to local US news casts. Indeed, the very definition of knowledge management in this respect is itself the subject of much enquiry, since,

“Quite what is involved in KM is a matter for debate. Initially, there was strong emphasis on technology as a means towards promoting the sharing of knowledge, using tools such as intranet, groupware, and indexes of individual expertise. It is now generally agreed that cultural aspects are equally, if not more, important. In this view, the most important aspect is to promote, and facilitate, a willingness to share knowledge; this may require attention to issues as diverse as reward systems, and the design of coffee rooms.” (Bawden and Orna, 2001, p. 43)

It is acknowledged, therefore, that amongst the most vital remits of any company — and a pharmaceutical company is perhaps the best example of this — is the need to capture and encourage the learning loop, which, once meaningfully shared amongst its ‘knowledge workers’, can generate the scientific – and marketing – advances on which the success of the company is ultimately based.

For Bawden and Orna (2001), the Knowledge Management comprises three linked aspects – the technical, the cultural, and the intellectual – and, to repeat, this book focuses attention on aspects of the second and third categories that together consider the ways an organisation ensures “that staff are encouraged in fact, rather than just in abstract, to share knowledge” and “the means by which the knowledge to be managed can be identified — issues of “content” — and the ways in which it can be represented and organized for subsequent access” (Bawden and Orna, 2001, p. 43).

Only a Pipeline?

The emphasis on cultural and intellectual aspects of knowledge management emerges largely from a growing wariness concerning the assumed marvel of technological prowess and its assumed positive impact on corporate working practices. The following account from Davenport (1998) helpfully condenses the ambiguous role of the new technologies as we touch the challenges of the new millennium:

“The low cost of computers and networks has created a potential infrastructure for knowledge exchange and opened up important knowledge management opportunities. The computational power of computers has little relevance to knowledge work, but the communication and storage capabilities of networked computers make them knowledge enablers. Through e-mail, groupware, the Internet, and intranets, computers and networks can point to people with knowledge and connect people who need to share knowledge over a distance …What we must remember is that new technology is only the pipeline and storage system for knowledge exchange. It does not create knowledge and cannot guarantee or even promote knowledge generation or knowledge sharing in a corporate culture that doesn’t favor those activities. The proverbial phrase “if we build it, they will come” does not apply to information technology.” (Davenport, 1998, p. 18)

Whatever dubious concerns there may have been about the impact of new technologies in the working environment, these have no doubt been fuelled by the more recent accounts as gleefully celebrated in the ‘old media’ that have focused on the powerful political and economic dangers that lurk in the public exposure of the ‘private’ corporate e-mail – as former managers of Shell (to take one immediate example) know now to their cost. Such exposures are likely to loop back into e-mail communication practices, which may, as a result, become more cautious in their application and use as workers become increasingly more sophisticated and alert – dare we say literate – to the importance of audience, purpose, and timing of their communications ‘with’ each other.

Taking the lead, therefore, from Davenport (1998) and Bawden and Orna (2001), this book is more focused on those areas of knowledge management that admit to the central importance of establishing a conscious learning culture within organisations that will encourage the software of the knowledge workers to be carefully mined, openly shared, and profitably utilised.

While the book is a record of field research it also makes concerted attempts to serve as a reflective document that charts the tracks from organisational theory and its impact on changing working practices (Chapter One), through the operations of Medical Communications and Medical Writing and its management (Chapters Two and Three), to arrive at a rounded appraisal of learning initiatives (Chapter Four). It ends on a critical point that questions the benign marketing rhetoric that now characterises the contemporary pharmaceutical industry, and, more promisingly, a proposal for future company outreach initiatives for 2006/07 that find their justifications both in the findings and reflections of previous chapters and in emerging publications of 2005 that specifically call for such broad-based advocacy commitments (Getz & Kremidas, 2005)

Diana A. Taylor 2010