The Client

Zila Inc, a pharmaceutical company based in Phoenix, Arizona, USA

The product

OraScreen - a mouthwash screening tool for the early detection of oral (mouth) cancer.

The problem

There are over 5,325* new cases of mouth cancer (squamous cell carcinoma) each year in the UK. With a 41% increase in incidence, it is increasing faster than any other major cancer. Nearly half those affected will die of the disease. Survivors normally have to live with the results of radical surgery to the face, jaws, tongue and neck. Smokers and heavy drinkers are mainly at-risk.

The solution

If detected early mouth cancer can usually be treated.

OraScreen was designed for use by dentists to highlight invisible, asymptomatic early signs of mouth cancer. Early referral to hospital for biopsy and treatment will increase survival rates from below 50% to above 90%.

The distributor

In year 1998 Zila contracted with Stafford Miller to market and distribute OraScreen in the UK.

The marketing support

Since 1994, Scope Dental Professional Relations had been building academic and key influencer relationships for Zila in the UK and were appointed by Stafford Miller in 1998 (paid by Zila) to launch OraScreen to the UK dental market.

Principal tasks for Scope

To create awareness and improve understanding of the mouth cancer issues among hospital professionals in secondary care and dentists in primary care.

To create awareness and understanding of the disease among the general public.

What we did to educate the dental profession:

• Negotiated with the British Dental Association to publish a new title in their series of advice guideline documents for their member dentists ‘Mouth cancer Guidelines for early detection’. Scope wrote (in conjunction with Professor Newell Johnson), designed and printed 30,000 of these documents which were freely distributed to each of the 19,000 BDA members and the balance reserved for exhibition, conference and meeting use. An illustrated explanation of the OraScreen procedure formed part of this official guidance document.
• Negotiated with five leading dental journals to simultaneously publish major editorials on five different aspects of mouth cancer screening.
• Organised a launch meeting for OraScreen during the British Dental Association Annual Conference 1998. Attended by 82 dental VIPs, from the four national Chief Dental Officers downwards and included editorial representatives from all 11 major UK dental publications. Recruited Professor Stephen Porter (Eastman) to be the keynote speaker alongside a KOL dentist (Martyn Amsel).
• Wrote sales and presentation scripts for the Stafford Miller detailing sales force.
• Trained the Stafford Miller sales force to overcome objections and the dentists’ ‘concerns about using the word cancer’ to the patients.

What we did to educate the public:

• Persuaded dental organisations and experts in the disease to release comment and case histories to national and regional press; and gained considerable editorial coverage of the disease and risk factors

In year 2000 Zila severed the agreement from Stafford Miller and decided to open up a Zila Europe operation based in the UK and to employ a contract sales team to sell OraScreen to UK dentists and into Europe. Scope was appointed to provide marketing consultancy, professional relations liaison and to handle PR and dental press advertising.

The new tasks for Scope

To launch Zila Europe and re-launch OraScreen firstly to the UK and subsequently to the wider EU dental market.

To further increase the level of understanding of mouth cancer issues among dental, pharmaceutical and hospital professionals.

To devise a way of influencing government on mouth cancer issues.

To devise a major public awareness campaign.

What Scope did to launch Zila Europe and re-launch OraScreen to the UK dental market:

• We proposed re-branding to rename the product OraTest
• Persuaded 10 professional dental associations from the World Dental Federation through the British Dental Association down to dental insurance companies, to issue statements endorsing the dentist’s professional obligation and opportunity to screen all patients in at-risk groups on routine visits to the dental surgery. And to allow us to freely use these statements as we saw fit.
• Obligation and opportunity was the creative cornerstone of the campaign.
• Negotiated with the British Dental Association to publish a second document for their member dentists ‘Opportunistic mouth cancer screening – a management strategy for oral cancer’. Scope wrote, designed and printed 25,000 copies for distribution to all BDA member dentists plus a reserve.
  Further specific advice on the use of OraTest including illustrated technique and practice marketing materials was included in the publication.
• This document is still available to download from the BDA website as a resource for dental teams.
• A short form OraTest protocol was simultaneously distributed with the BDA News magazine.
• Created, designed, wrote and produced supporting product and scientific literature.
• Created a concentrated programme of dental journal product advertising based on the obligation and opportunity theme.
• Created four model letters for dentists to use inviting patients for testing and referring suspicious lesions to hospital specialists.
• Created and designed a ‘mouth map’ to promote accurate record keeping and as a practical opportunity to monitor changes or progression of lesions.
• Persuaded dental software developers to integrate that mouth map into their dental practice computer systems.
• Wrote and placed 100 press stories on mouth cancer and OraTest in UK dental media during year 2000.
• Developed a Regional Reference Centre concept to utilise regional peer pressure.

What we did to educate the public:

• Created, designed and wrote two explanatory leaflets on mouth cancer screening aimed at patients in language scientifically validated to maximise comprehension.
• Created and designed mouth cancer posters and other display material for dental surgery waiting rooms.
• Wrote consumer press releases for use by dentists with their local press.

What we did to educate Governments:

• Created and formed The Scottish Mouth cancer Action Group in August 2001. A group of experts in public health, oral medicine, surgery and dentistry in collaboration (for the first time ever) from all the major teaching hospitals in Scotland, united in a common cause, as a lobby group.
• Called a meeting of representatives from 30 organisations (Dental, Medical and DoH, BAOMS, Pharmaceuticals, Smoking Cessation, Patient groups etc) to seek unanimity on three key issues.
  1. Never to hold an Mouth cancer Awareness Day again. A day is not long enough. Achieved consensus for an Awareness Week.
  2. Never to hold an Mouth cancer Awareness Week. Mouth Cancer is an easier, more immediate term to the public. Achieved consensus for adoption of the term Mouth Cancer.
  3. To accept standard data on incidence and mortality provided by Scope through Cancer Research UK. Achieved consensus.
• Mouth Cancer Awareness Week was born and the term Mouth Cancer has now percolated into the literature and academia.
• Created and launched the first ‘Mouth Cancer Awareness Week’ as a public information campaign. Devised the MCAW blue ribbon logo to mark the event. This campaign was launched in year 2001.
• The first MCAW campaign (2001) was funded by Zila Europe. The second in 2002 was supported by Oasis Dental Care and certain members of the BDTA.

Landmark events

In May 2002 SOCAG presented the case for greater focus on mouth cancer issues to the Scottish Parliament just 9 months after the group’s inception. As a direct result free dental checks were planned to be re-introduced in Scotland and the Department of Health accelerated their ‘no smoking in public places’ policy.

In July 2002 the Zila Europe management team and the OraTest sales force were dismissed due to economic and corporate political circumstances at Zila Inc. Scope was retained to liaise with customers, process orders and maintain a Zila UK office function.

In 2003 the Scottish government, through ASH Scotland, provided funds of £900,000 for a project to evaluate the success of dental team members in providing their patients with a smoking cessation programme to improve their oral health, and in particular to help prevent patients from developing mouth cancer. Mouth cancer cases have doubled in Scotland since the late 1980s.

In 2003 Eire banned smoking in public places.

In 2003 Scope granted The British Dental Health Foundation the rights to adopt the Mouth Cancer Awareness Week campaign which was supported by Scope and Denplan. We believed that bringing the campaign under the aegis of the BDHF would add status to the exercise and enable greater co-operation from the wider medical and pharmaceutical community by removing any commercial connection with Zila (who refused to support it financially).

• In 2004 just prior to the fourth MCAW campaign, the English government (Department of Health) announced allocation of £100,000 per year for three years to support the Mouth Cancer Awareness Campaign.
• In 2004 just prior to MCAW (7-13 November) Dr Vinod Joshi launched The Mouth Cancer Foundation as a resource for clinicians, patients and the general public.
• 2006 saw a complete ban on smoking in public places in Scotland.
• The 2006 MCAW campaign was launched in November by The Chief Dental Officer for England and the House of Commons venue was paid for by David Cameron (opposition leader).
• In 2007 Richard Horner of Scope was elected a trustee / director of The British Dental Health Foundation with special responsibilities for guiding mouth cancer awareness.
• In 2007 Scotland introduced free dental checks for all or part of their oral health strategy. This initiative is a result of lobbying presence from SOCAG.
• In 2007 there was a complete ban on smoking in public places in England.
• In 2007 once again David Cameron (Leader of the Conservative Party) paid for the House of Commons venue for the event marking the launch of the 2007 Mouth Cancer Awareness Week (11-17 November).
• In January 2008 Scope applied to MHRA on Zila’s behalf for a batch variation for a smaller run of OraTest, due in January 2009.
• In January 2008 Scope applied on Zila’s behalf and assisted with a successful meeting with MHRA to obtain Medical Device status for ViziLite Plus, a new mouth cancer detection product based on chemiluminescence.
• In March 2008 Scope received sample kits of ViziLite Plus which we have distributed to key dentists and opinion leaders for testing and comment.
• In May 2008, Panadent were appointed by Zila to distribute ViziLite Plus in the UK.
• In October 2008 Panadent UK launched ViziLite Plus at the Dental Showcase Exhibition at ExCel London.
• It is now agreed to replace Mouth Cancer Action Week by a month long activity aimed at the dental profession, oral surgeons and consumers. Professional education is top of this agenda.
• In October 2008 Richard Horner was appointed by the BDHF to be Chairman of a new academic/KOL Steering Group to drive forward the newly christened Mouth Cancer Action Month which launched at the Houses of Parliament on 11 November 2009.
• The British Dental Association have asked Richard Horner to review and comment on their updated guidance document for Mouth Cancer Screening (2009).

Additional important achievements

• In 2002 we learned of a paper written by the Centre for Evidence Based Dentistry in Oxford which was extremely negative towards OraTest. This was, in fact, because the authors had misinterpreted its role to be a mass screening tool and not an opportunistic enhancement to routine visual screening in dental practice examinations. The paper was under peer review by the British Dental Journal but our intervention through our relationship with the BDJ commissioning editor ensured that this paper was never published.
  
  
• In 2005 we learned of another negative paper which was on the point of submission, again to the BDJ, from a team of mouth cancer experts at Kings College (people we had worked closely with for some years). Again our intervention persuaded the authors to withdraw from submission because in effect they would be open to criticism of their clinical study protocol because it did not comply with the strict instruction for use of OraTest with its critical 2nd test and hence the results were flawed. After much debate they eventually agreed with this view and the paper was never submitted.
  

We believe this case history illustrates how deeply involved we are in UK dentistry and how this connection justifies our claim to be a Dental Professional Relations company rather than merely describe our activities as PR.