Antidepressants marketing & lobbying & pr

Communication marketing : antidepressants . Group n° 4

Marketing and corporate communication : antidepressants


Table of contents

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14 16

Previous communication Operational effectiveness

Frequency

Motivations

The patient’s journey

Influencing factors

Consumer’s profile

7

8

10

11

Alternatives

Distribution channels

Price

5

6

6

16 Objective

17

Briefing créatif 19

20

24

30

32

Appendix 33


There are 3 types of antidepressants:

1.

Name % Type Lexomil 20,4% Anxiolytic Xanax 8,8% Anxiolytic Prozac 8,6% Antidepressant Stinox 5,9% Hypnotic Temesta 5,3% Anxiolytic Deroxat 5% Antidepressant Lysanxia 4% Anxiolytic Tranxène 3,5% Anxiolytic Inovane 3,3% Hypnotic Effexor 3,1% Antidepressant

I. Why

1. The product

Tricyclic antidepressants: Laroxyl, Anafranil

The oldest ones: they are effective in severe depressions.

Serotonine reuptake inhibitors (SSRI): Seropram, Prozac, Seroxat,Effexor, Ixelor

Their efficiency is quite similar to the tricyclic ones but with less side effects.

Selective re-uptake inhibitors and related drugs:depressions Monoamine oxidase inhibitors:

Marsilid, Moclamine They are much less used, indicated in patients resistant to other categories.

Frequency of consumption of most commonly psychotropic drugs reported and identified by users • Lexomil 20,4 % anxiolytic • Xanax: 8,8 % anxiolytic • Prozac 8,6% antidepressant • Stinox 5,9% Hypnotic • Temesta 5,3% Anxiolytic • Deroxat 5% antidepressant • Lysanxia 4% Anxiolytic • Tranxène 3,5% Anxiolytic • Inovane 3,3% Hypnotic • Effexor 3,1 antidepressant

Product life cycle

Prozac, seroxat and effexor are the most used antidepressants. They belong to the type of selective re-uptake inhibitors and related drug.

We need to focus on the top of mind status, the brand attitude, the brand fidelity and the customer satisfaction.

The antidepressants drugs are currently in transition stage: their growth is currently slow and they are, in our opinion, about to get in maturity stage.

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Decrease (n= 830)

%

Disapearance (n=481)

%

Decrease or disapearance (n=

1311) %

Neurotropic drugs 28,6 29,8 29,1 Psychological support 19,3 16,9 18,4 Psychotherapy 14,3 13,5 14 Information or advice on disease and treatments

2,9 4,4 3,5

Relaxation or meditation exercices 2,7 2,8 2,7 Massage, body manipulations 2,3 0,8 1,4 Alternative medicine, herbs ; homeopathy, acupuncture

9,1 10,4 9,6

Exercises 5,2 5,3 5,2 Other type of treatments 6,8 7,2 7,0 Total 91,2 91,1 90,9 The operational effectiveness of neurotropic drugs is very high. On the other hand, psychological support and psychotherapy seem to alleviate but not cure the disorder. Finally, surprisingly, patient’s information and advice on diseases and treatments are more efficient on making disorders disappear than making them decrease. From the patient’s perspective, antidepressants are considered as so effective that they are perfect placebos. Mark Zimmerman and Tavi Thongy from Rhode Island Hospital published a study comparing antidepressant drugs to a placebo. These studies show an efficiency of 50% to 65% in the groups treated with an antidepressant and 25% to 35% in the placebo groups. This indicates that for a certain proportion of people, there is a placebo effect. 52% of the group with antidepressants and 38% of the placebo saw their condition improved. Psychological support and Psychotherapy got together a relative effectiveness quite comparable with neurotropic drugs. It is to notice that information and advice get a relative effectiveness of 11 percent.

Operational effectiveness

Frequency

5,8!24,3!

15,2!2,9!2,3!

1,4!7,9!

4,3!

12,4!51,6!

44!26,5!

15,7!9,2!

28,3!32,7!

Other type of treatments!Neurotropic drugs!

Psychological support!Information or advice!

Relaxation or meditation exercices!Massage, body manipulations!

Alternative medicine!Exercise!

Efficiency! Frequency!

Anadep, La depression en France, INPES, 2005

Anadep, La dépression en France, INPES, 2005


There is no gender difference in the choice of antidepressants as type of care but men prefer sports, information’s and nutritional advices compared to women that prefer advices, psychotherapy, relaxation and alternative medicines. Men Women Both Neurotropic drugs 17,7 17,8 17,8 Psychological support 14,5 15,5 15,1 Psychotherapy 8 9,6 9,3 Information or advice 9,5 8,9 9,1 Exercises 12,4 10,7 11,3 Relaxation and meditation 5,2 5,5 5,4 Massage, body manipulations

3,1 3,2 3,2

Alternative medecines 8,1 10,5 9,7 St. John's Wort 1,1 1,9 1,6 Phototherapy 0,3 0,5 0,4

● Homeopathy: if the depression is the consequence of: annoyances, grief, bereavement, mental weariness and professional issues.

● Aromatherapy: if the depression is the consequence of sadness. ● Transcranial magnetic stimulation: if the depression is tough and antidepressants are

not working. ● Phytotherapy:

-Griffonia: is a woody climbing shrub, able to increase naturally the serotonin to get a better mood and a better quality of sleep.

4.000!

6.000!

8.000!

1997!1998!1999!2000!2001!2002!2003!2004!2005!2006!2007!2008!2009!2010!2011!

Volume growth!

Distribution of each type of treatment, depending on the number of types of care, by gender (%) • Lexomil 20,4 % anxiolytic • Xanax: 8,8 % anxiolytic • Prozac 8,6% antidepressant • Stinox 5,9% Hypnotic • Temesta 5,3% Anxiolytic • Deroxat 5% antidepressant • Lysanxia 4% Anxiolytic • Tranxène 3,5% Anxiolytic • Inovane 3,3% Hypnotic • Effexor 3,1 antidepressant

2. Market

In thousand

T Three-quarter of the antidepressants growth market is due to the increased doses consumption per patient.

Alternatives

Approximately 36% of patients reported to general practitioner that they have already used alternative medicines versus only 24% on patients who were referred to specialists. Women are almost twice as likely as men to have recourse to this type of treatment.

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nkelinks Evolution des antidépresseurs. 2011.


- St. John's Wort: a natural antidepressant for low depression. The risk/benefit ratio is far better than the antidepressant ratio.1 -Common hawthorn,Passiflora, Bach Flower.

● Nutritherapy: efficient for mood troubles. ● Phototherapy: A team of researchers from the Medical University of Vienna showed

that reduced exposure to sunlight during the winter might induce psychological and physical changes by acting on serotonin receptors.

● Acupuncture: if the depression is the consequence of lack of concentration, insomnia, lack of energy, anxiety, lack of appetite or mood troubles.

● Shiatsu: helps people relax and cope with issues such as stress, muscle pain, nausea, anxiety, and depression.

● Osteopathy: ● Psychotherapy: for every kind of mental disease.

● Pharmalogical circuit ● Self-medical treatment: Internet: In an article by Blanchard S. (2007), referring to the

statements of the General director of the Assays Jean Marimbert, talks about the recent trend of selling drugs, including antidepressants on the Internet. This self-medication undoubtedly contributes to an excessive use of antidepressants in France and then in Belgium.

1N Debrunner, X Simonnet , Revue suisse de viticulture, arboriculture, …, 1998

Distribution channels

We must be highly present on the Internet to cope with self-medication.

Price

7,50 $! 12,50 $!19,00 $!28,50 $!

37,50 $!40,00 $!55,00 $!

65,00 $!75,00 $!75,00 $!

Compared to its main competitors, antidepressants are the cheapest solution.


Pharmaceutical companies do not conduct commercial campaigns but they rather do repetitive direct marketing. Thus, a study by Rosenthal et al. 2003 cited by Donohue, J. M. and Berndt, E. R. (2004) indicates that 12% of the increase of drugs prescription between 1999 and 2000 can be attributed to the use of direct marketing. • “Hoe anders is anders?” (1991) : addressing teenagers in their last two years of high

school. The goal of this project was that teenagers get acquainted with mental health patients by participating in various activities.

• The fortnight on depression: “The Depression in Question: 15 fundamental questions” (2004): two campaigns of 30 radio advertisements. The target that was aimed by the campaign was the whole Belgian population among which specifically more isolated people, those who do not read newspapers nor follow TV programs on depression, which would necessitate, from the start, a personal choice on behalf of the viewers. This campaign was such a success that it was republished. Both campaigns were relayed by the press and by the website (www.depressionenquestion.be); there were striking results concerning the increase in visitors on the League's website.

• The European Alliance Against Depression (2004 – 2008): in 4 stages on the basis of a

pilot project conducted in Nuremberg: Level 1: development of the skills of the general practitioner Level 2: development of the skills of the key stakeholders in society (chemists, professors, PMS centers, pastoral agents, hospital personnel, police agents, penitentiary agents, etc.) Level 3: provide awareness to the public about depression and suicide. Level 4: improve care quality for patients and their entourage in Flanders only and more specifically in East Flanders.

• The Federal Minister of Health, Laurette Onkelinx, unsuccessfully attempted to address

this situation in 2009, by organizing meetings with doctors.

3. Communication

Previous communication

The above demonstrates the potential that the radio offers to get in touch with more isolated people and it proves that the use of a website is appropriate.

The goal of this operation is to reduce the number of suicides through a better process to detect the symptoms and by increasing knowledge on depression. Actually the success rate of this operation uses as KPI the number of suicides before and after. The issue of antidepressants is never tackled.

Doctors shouldn’t be targeted by the campaign.


● Patients feel as if they are not being treated if no medication is prescribed (According to Ehrenberg, A. (1991, p.274)). Medication gives patients the impression of being ''real patients'' whereas other treatments do not give them that same impression.

● Other alternatives are considered as non-scientific or pseudo-science.

Men (N=523)

Women (N=1196)

Total (N=1719)

Loss of interest 68,6% 73,7% 72% Weight changes (> or = to 5kgs)

35,1% 45,2% 41,7%

Sleep changes 72,2% 75,6% 74,5% Exhaustion, loss of energy 79,8% 92,4 88,1% Concentration problems 83,7% 86,1% 85,3% Loss of confidence 65,2% 71,2% 69,1% Thoughts of death 63,7% 70,5% 68,2% Number of secondary symptoms Less than 3 symptoms 10,8% 4,1% 6,4% 3-4 symptoms 28,1% 24,9% 26% 5 symptoms and more 61,1% 71% 67,6%

4. Consumer

It is therefore recommended either to deconsecrate the efficiency of antidepressants either to give credence to alternative treatments.

The patient’s journey

Before the disease:

The DSM-IV and the CDI-SF classify these symptoms into two categories: • The main symptoms (living a period of at least two consecutive weeks where you feel sad,

depressed, hopeless or where you have lost interest in most things for most of the day, everyday)

• The secondary symptoms (mood changes, tiredness/lack of energy (asthenia), loss of interest/ lack of pleasure (anhedonia), involuntary change of weight (increase or decrease of the total weight by 5%), problems sleeping (insomnia or hypersomnia), extreme feeling of guilt, dark thoughts.

During their depression most people do not want to reveal their condition because they consider it as being private matter. The IDEA study (Impact of Depression at work in Europe Audit) shows us that 60% of workers suffering from depression inform their employers of their condition because it is mentioned on their medical sheet and that 25% do not say anything. Only 12% spontaneously tell their superior about their condition. 49% said that they never wanted to say anything to anyone because they considered it as private.

Depression being an

extremely private matter, only certain media should be used either those, which have close connections with the target, or those, which can be consulted in private. Even more, any guilt giving speech should be avoided otherwise they will simply stop listening to the message that we are trying to convey.

Anadep, La depression en France, INPES, 2005


Prescription:

If the patient has 4 symptoms, one of which belonging to the main category, he/she is diagnosed as having a major depressive episode. Afterward, depending on the number of symptoms and the disturbance level, the depressive episode can be:

● Light: 4 or 5 symptoms with slight disturbances ● Mild: 4 or 5 symptoms with mild to severe disturbances or 6 symptoms with slight to

mild disturbances ● Severe: at least 6 symptoms with severe disturbances

Only a general practitioner, a psychiatrist or a neuropsychiatrist can prescribe antidepressants. This chart contains data based on the first prescription of antidepressants from a total of 367.489 new antidepressants users. Category of prescriber % of first

prescription Number of new patients 2008

Total amount of new patients

General practitioner 80% 293.984 367.489 Specialists 20% 73.505 The prescription is excessive: doctors often prescribe antidepressants to people who are simply sad or disillusioned and who have sleeping problems (Zarifian, E., 1994, p.32). This is confirmed by this graph of the prescriptions for only one condition, this dose being insufficient for the treatment.

The traditional “talk about it with your doctor” should therefore be avoided because it is one of the reasons why the consumption of antidepressants is increasing.

42%!

24%!

34%!

General practitioner! Psychiatrist! Neuropsychiatrist !

Delivery of only one packaging by category of prescriber in 2007!

Belgique. Cellule stratégique de Laurette Onkelinx Note d’orientation psycho-medication. 2010.

Belgique. C

ellule stratégique de Laurette O

nckelinx Note d’orientation

psycho-medication. 2010.


Treatment: A treatment by antidepressant is long and divided into 3 phases:

1. The initial phase of treatment (4 to 8 weeks of treatment): to reduce depressive symptoms 2. The consolidation phase (16-20 weeks): to maintain and consolidate remission, to prevent

relapse. 3. The maintenance phase: depending on the patient, it is possible to extend the treatment to

prevent recurrence

Generally, it takes 4-6 weeks to evaluate the therapeutic effect. Depressed patients who have responded favourably to the treatment for a severe episode should continue treatment for six months. According to the database of Socialist Mutual, we observe that 60% of treatments are stopped during the first 3-month interval and 65% of patients discontinue treatment before five months. According to Onkelinx report, the percentage of a single prescription is generally higher among male users.

Influencing factors

1. The time period: • The child delivery and the postpartum period, premenstrual syndrome, menopause: women experience physiological changes, hormonal, which would undermine them. • Seasons: there is a link between the event of major depressive episodes or bipolar episodes and specific times of the year (for example autumn or winter tend to lead to a start of more regular depressive episodes). In our hemisphere the problematic seasons are autumn and winter. In 75% of cases, the first symptoms appear between mid-September and early November [Young et coll., 1997].

We must take account of this observation on the influence of the seasons when we will make our

media planning: we need to intensify the campaign between mid-November and early September, especially during daylight time change and take advantage of the sunnier periods, to save money.

2. The location Wallonia is clearly a larger consumer of antidepressants. We will focus our campaign on these regions. (See appendix 1)


Consumer profile

Gender Women between 18 years old and over consume antidepressants twice as much than men. (18.5% for women and 9.1% for men) According to our calculations based on PharmaNet data, which they are used by the Belgian State, among the sample population of 15 years old and over, the percentage of women who take the antidepressants is 17.2% and 9% for men in 2011. (See appendix 2)

Social status • A woman leads three quarters of single

parent families. It is not single parenthood which is the problem, but the accumulation of difficulties that it creates: usually, single moms with children have lower incomes, lower level of training, a less qualified job, they are more likely to face unemployment...

• 37% of the disabled, nearly four times higher than non-disabled.

Age • Antidepressants are mostly used by people

in the 35-49 age group and even more by the 50-64 age group. (Results from European Study on Epidemiology of Mental Disorders (ESEMeD)* and Annex 2).

• Regarding children and teenagers: the same studies show an increased risk of suicide and self-harming at that age.

Gender Women are more often in the grip of depression than men. (10% for women and 6% for men) •Women: progression through the age groups is almost linear, beginning at 6% to 16%, but declining when reaching the 55-64 age group (8%). •Men: the prevalence of these disorders is 4% from 14 to 34 years old, and then stabilizes at about 6% or 7% until the age of 75. Beyond this age, 8% of men experience depression. (2006. Rapport conseil supérieur d’hygiène)

Social status The analysis of MDE prevalence by occupation and socio-professional category (SPC) shows that farmers generally have a low level of prevalence (1%). Male employees are less affected (1.6%) than the other categories, while women salaried have the highest prevalence (10.0%). More than SPC, it’s especially the fact of being without professional activity or unemployed, which is strongly associated to a middle depression episode (respectively 7.1% and 12.3%). Furthermore, the prevalence is twice as high when unemployment lasts more than 2 years compared to people who are more recently unemployed. (La dépression en France Enquête Anadep 2005) According to our calculations, only 58% of women and 66% of men from 15 to 96 year old who are taking antidepressants are actually in depression

Age On average, the first major depressive episode appears around age 30. Half of these first episodes come out between 19 and 38 years old (La dépression en France Enquête Anadep 2005)

Consumer of antidepressants Prevalence of depression

Single moms, unemployed and disabled are not a target group because we are fighting against unneeded consumption of antidepressants and not against people who really need it.


5. SWOT Opportunities Threats

S W O T

Weaknesses Strengths

We have to act on these weaknesses (addiction and side effects) and to emphasize on antidepressant threats (to provide more information and to act on the Natural/bio side)

Awareness Deep awareness: antidepressants are surely Top of Mind Broad awareness: Almost useless, but not useful

Performance / Perceived quality Attributes / benefits: Antidepressants allow patients to treat their depression while having the impression of being treated physically by a "medicine". Price: The antidepressants are inexpensive and are refundable under certain conditions. Perceived Quality / Superiority: Antidepressants have the best felt efficiency of all other treatments. It seems like the best way to fight against depression but also more scientific.

Imagery Feelings User image: while only 8% of people think that depression is a disease for women, an antidepressant user generally has a more feminine than masculine connotation. The user can also simulate symptoms since no symptom is truly verifiable: he does appear to be faking. The user thus appears to be weak because there is a lack of physical symptoms, which leads to the belief that the person is not sick, so it is hardly conceivable that the user needs a medicine for a non-disease. Usage imagery: Someone who used antidepressants while being confined to their home and who has no other choice but this treatment. Brand feelings: Having the feeling of being finally treated.

Brand Loyalty Antidepressants occupies 51.6% of the market (France 2005) and the satisfaction felt was 29.1% However, according to the pyramid of loyalty, antidepressants are placed on the level customary user who has no reason to change because consumers do not take any measures against antidepressants but are satisfied and have no reason to change.

Other Assets Distribution: the fact that antidepressants are sold in pharmacies among the other drugs gives confidence to the consumer. On the contrary, it is more and more possible to buy antidepressants online without prescription. (Http://www.eurodrugstore.eu/antidepressants__3__fr/prozac__11.html)

6. Brand equity


7. Summary

Who 1. Women (58%) are fewer that men (66%) to consume antidepressants when being

depressed. 2. Wallonia clearly is a greater consumer of antidepressants. It will be necessary to focus

our campaign on that area. 3. Single women or head of the family, unemployed persons and disabled persons aren't

our target because we fight against unjustified consumption of antidepressants. 4. We will not target doctors because it did’nt work in 2009.

What 1. We must act on the top of mind status, the attitude in relation to the brand, the brand

loyalty of the customer's satisfaction. 2. It will be necessary to either demystify the antidepressants effectiveness or make

alternatives more reliable.

How 1. It's necessary to orient people on psychotherapy because it has the same relative

efficiency than antidepressants. 2. It will be necessary to provide information and advice because it has a good relative

efficiency (11%) 3. It will be necessary to avoid ever-making guilty speech; otherwise people will avoid the

message. 4. It will be necessary to create a complicity with the target 5. To avoid the « talk to your doctor » is necessary because doctors are one of the reasons

why the antidepressants consumption increases. 6. We have to act on these weaknesses (addiction and side effects and focus on

antidepressant treats (by providing sources of information always more abundant and by acting on the Natural/bio side)

Media planning 1. It will be necessary to develop a presence on Internet in order to fight self-prescription. 2. Recently, radio proved to be powerful 3. It will be necessary to favour either medias with high target complicity or personal either

with individual media.

When 1. To intensify the campaign, between mid-September and early November, especially

during the daylight time change and to take advantage of good weather to save some budget.


II. Who

1. Segmentation

Geographic segmentation • Wallonia: High consumer of antidepressants • Brussels:Moderate consumer of

antidepressants • Flanders: Light consumer of antidepressants

Gender segmentation • Women: Women are almost twice more subject to use these kinds of treatment than men.

There are more women who take antidepressants while being really in depression. • Men: Are more likely to consume only one box. The feminine target is more selective than men if we are looking for a public who uses not antidepressants advisedly. However, the masculine target shouldn’t be completely ignored inasmuch as this class is the one that consumes more single boxes.

Economic segmentation Because of the alternative costs and the natural tendency of unemployed to be in depression, this class should not be targeted.

Demographic segmentation • 0-18 years old: too young to consume antidepressants. Worse: it's dangerous for them. The

amount of consumers is negligible. • 19-39 years old: it’s the age of the first antidepressant doses: they feel the sensation for the

first time and misunderstand what occurs. They don’t know that they are in depression and their doctors guide them. They represent 50% of the first depressions. The number of consumers is increasing.

• 40-60 years old: It's at least their second depression. They are used to use antidepressants. Their depression may be chronic or episodic. They are aware of the different stakes around the antidepressants. Increasing number of consumers of antidepressants.

• 61-70 years old: Retirement arrives with its inconveniences: stress, unemployment and others

• 70+ years old: Periods of mourning occur which weaken and raise depression. Add to this the placements to retirement homes, which has a big impact on the consumption of antidepressants.

• Main target: Walloon and inhabitant of Brussels female workers between 19 and 39 years old.

• Secondary target: Walloon and inhabitant of Brussels male workers between 19 and 39 years old.

It corresponds to 525,819 people for the main target and 539,090 people for the secondary target. (http://statbel.fgov.be/fr/statistiques/chiffres/population/structure/agesexe/popwal/)

Who 1

Who 2 Who 3

Who 4


We choiced We choose Fishbein and Elaboration likehood model. • E

2. Model

Unmotivated: the patient doesn't feel well and doesn't want to think rationally. He just wants to be cured whatever the solutions.

Able to treat the information: not all the information because some are too complicated for him.

Opportunity: Opportunity to have the information: numerous links on the Internet point to these information. The aim is being motivated in order to find them. It's necessary to choose a peripheral message to motivate them to decrypt our message by simplifying it.

If the consumer thinks rationally and in a holistic way, antidepressants are not the first choice. However this scenario is rare and almost non-existant. It will be necessary to show the different appeals for the alternatives and to try to reduce the sense of effectiveness.

How 7

We either need to process the information peripherally either got the target motivated and able to process the information.

How 8

3. Mapping

Ineffective

Effective

Constraining Unconstraining

Current positioning: antidepressants are moderately constraining medicines, which are effective against depression. Wanted positioning: antidepressants are constraining medicines which efficiency is relative.

We mean by efficiency, the efficiency felt by consumers and all the elements, which can take form of a constraint (price, temporal availability, prescription etcetera.)


III. What

Category awareness 95% Antidepressants are top of mind. We do not want to change the level of awareness: we want to increase awareness scores of the various alternatives. (+10% for alternatives)

Brand knowledge We estimate the knowledge of antidepressants around 35%. We want to increase this knowledge to a 70% level.

Brand liking 29.1% We do not consider the brand liking as a goal of our campaign.

Brand trial 10.7% 10.7% of the Belgian population consumes antidepressants. This corresponds more or less to the Dagmar average. We would like to reduce this figure by 3% for women and 1.5% for men, thereby reducing the number of female patients from 19-39 years old to 15 774 patients and the number of male patient to 8,086 patients.

Brand repurchase 3% We do not have official figures but giving that the Dagmar rule of averages for brand liking and brand trial are relatively close to the average values, we estimate brand repurchase to be around 3%. Our goal is to reduce this total by 0.5% for women and by 0.25% for men. This means that we would like to reduce the number of 19-39 years old female patients who repurchase antidepressants to 4206 and to 1347 for 19-39 years old male patients.

• The main objective is brand knowledge • Secondary objectives: awareness of alternatives, brand trial and brand

repurchase. Marketing objective: Reduce the number of consumers for whom antidepressants consumption is not necessary. This would reduce 355 216 products ingested by the 19-39 years population.

What 1/2

Target: 19 -39 years • Status of top of mind • Change efficiency impression and brand knowledge • Decrease the brand trial

2013

• Target: 40 -60 •Change the brand liking and the brand repurchase

2014

2015

• Check up • Act on what hasn’t worked

2014


• High attention level

• Repetitive

• Expensive • Lack of

complicity

• Previous campaigns have worked well

• High Complicity with the target

• Good for repetitions

• Good combination with the internet

• Inexpensive

• Low attention • Impossible to

thoroughly develop the message

• High Complicity with the target

• Low rereading • Not selective • Low attention • Bad visual

• Complicity with the target • Rereading • Highly Selective • Visual

• Lower attention

• Broad audience • Good for Repetition

• Low Impact • Lack of complicity

• Lack of complicity • Small audience • Expensive

. Complicity with the target • Highly Selective • Informational

• Low impact

• Highly exposed message

Media analysis

We chose tv, radio, display, magazine and internet. We rejected daily press and cinema.


Manner of expression

To establish a connection with our target, we would like to create a brand around our campaign in order to change the identity of the broadcaster. Indeed, we recommend you to speak to the target through a brand dedicated to the campaign instead of speaking on behalf of the State. This would allow us to get a greater complicity with the target so they feel that we advice them for their well-being rather than sermonizing them. With this aim in mind, we created, after a brainstorming in our agency, “Happy”. We chose this brand name because it is a short name, it could almost be the name of a little character and it means “heureux” in French. Furthermore, we could almost speak to our target as if it was the hapiness, which is giving them advice to overcome depression.

We chose the following colors: • Blue: related to dreams, wisdom and serenity. A certain inner calm related to deep things. This

universe is interesting to spread our message. • Green: it evokes hope, opportunity, stability and concentration In addition, it is a mixture of blue

and yellow, which brings again qualities of the blue color adding those of the yellow color (feast, joy, warmth) without the negative meanings of it (the betrayal, lying, deception), which are to avoid because of the need to establish complicity with our target.

• White: This reflects the purity, innocence, but it is especially the opposite of black, darkness and dark thoughts.

Graphic charter

Logo

Our goal was to have a logo with round typography, in a minimalist style and respectful of our graphic charter. Among those we have tried, we chose this one:

How 4


Client: le SPF santé publique, à travers la marque dédiée Happy. Il s’agit d’un service public fédéral belge qui est chargé des matières de santé, de sécurité alimentaire et d’environnement. Contexte : la consommation d’antidépresseurs a augmenté de 65% en dix ans. En 2009, plus d’un million de Belges en ont consommé. . Cette consommation est plus élevée en Wallonie qu’en Flandres ou à Bruxelles mais la situation est devenue telle que l’Etat belge a décidé de prendre les choses en main en lançant une campagne de communication. En effet, les antidépresseurs possèdent des effets secondaires assez nombreux tout en ayant une efficacité relative. Pire, sa consommation peut être dangereuse pour les adolescents et les enfants. Alternatives : homéopathie, aromathérapie, phytothérapie, nutrithérapie, photothérapie, acupuncture, Shiatsu, Ostéopathie et psychothérapie. Cible réelle : La population belge Cible visée:

• Principal : les femmes actives de 19 à 39 ans. (525 819 personnes) • Secondaire : les hommes actifs de 19 à 39 ans. (539 090 personnes)

Objectif marketing: diminuer le nombre de consommateur dont la consommation d’antidépresseurs n’est pas nécessaire. Objectif communication : Changer le statut de top of mind et changer l’efficacité ressentie Positionnement : Les antidépresseurs sont des médicaments contraignants pour qui l’efficacité est relative. Baseline : « Les antidépresseurs, ca n’est pas ton moteur » Promesse : L’efficacité des antidépresseurs est relative. Reason why : Des études ont prouvé que l’efficacité ressentie des antidépresseurs n’est que de 29 % et que l’efficacité relative est de 24%. Cela tend à montrer que l’on est loin d’une efficacité totale. Ton : Complice, captivant/interpellant, calme. Media : Affiches dans les métros et gare, TV, magazines, radio, bannering Do :

• Message interpellant • Utiliser la charte

graphique et le logo d’Happy ( bleu-vert-blanc)

Don’t :

• Pas trop de détails • Pas moralisateur • Pas culpabilisant • Eviter le traditionnel “parlez

en à votre médecin” car ils sont une des raisons pour laquelle la consommation d’antidépresseurs augmente

Briefing créatif


IV. Stratégie créative

1. Baseline

« Les antidépresseurs, ça n’est pas ton moteur » • Antidépresseurs : cela situe clairement de quoi l’on parle. En effet, il est fort possible qu’il

y ait du bruit d’autres campagnes de prévention contre d’autres médicaments, comme nous avons pu le voir avec la campagne actuelle sur les somnifères et calmants. Il faut donc s’isoler de ce bruit en nommant clairement le produit.

• Ca : Nous aurions pu choisir « cela », mais nous avons préféré un langage plus jeune et familier. Par ce choix, nous sommes en accord avec notre conclusion qui nous demandait d’établir un dialogue, et plus particulièrement, avec notre cible.

• Ton : nous renforçons encore ici la proximité que nous souhaitons avec la cible. • Moteur : le mot moteur implique quelque chose qui tourne et qui fait marcher un objet. Cela

illustre bien la dynamique des antidépresseurs. Enfin, nous avons choisi une phrase qui rime pour que la capacité de mémorisation soit plus élevée.

How 4

2. Concept

1. Concept de jeu (v. Appendix 3) Notre premier concept est une publicité oblique qui explore la thématique du jeu. (Quoi de plus complice que le jeu ?) Nous avons utilisé ce type de publicité pour interpeller et pour que les gens prennent du temps à comprendre le message car la mémorisation de notre message met, elle aussi, longtemps. Ainsi, nous avons représenté un flipper/pinball qui aurait besoin d’une pilule pour entrer en marche. En lieu et place de la balle, nous avons notre patient qui après avoir reçu sa pilule peut naviguer entre ses problèmes d’argent, de santé, de couple ou de travail symbolisé au milieu. Une fois qu’il n’arrive plus à voguer à travers ceux-ci, les médecins ou psychiatres lui prescrivent à nouveau des antidépresseurs pour qu’il puisse remonter vivre sa vie. Un jour, les prescriptions ne suivent plus et la mort attend le patient. Enfin, nous avons essayé de stimuler une complicité à l’aide de la headline.

How 4/5


2. Concept de l’autruche (v. Appendix 4) Notre deuxième concept est un concept qui joue sur la métaphore de l’autruche. Dans un soucis d’avoir un message interpellant et épuré, nous utilisons une image déjà socialement construite. En effet, « faire l’autruche », c’est un peu se voiler la face et refuser de prendre en compte la réalité. Se faisant, cela nous permet d’avoir un message non moralisateur car nous n’utilisons pas d’être humain mais un animal. (cfr. How 6 sur le naturel) En questionnant le lecteur de l’affiche avec un « efficace ? » nous souhaitons activer des processus de réflexion internes qui lui font trouver lui-même la réponse : est ce réellement efficace ? Oui/non ? Nous aidons ce même lecteur à comprendre notre message via la boite d’antidépresseurs dans laquelle la tête d’autruche s’enfuit. A terme, nous souhaitons personnifier l’autruche en lui donnant une réelle identité pour que la cible s’y attache. Pour ce faire, nous nous en servirions durant toute la campagne et irions jusqu’à lui procurer un nom : Bea, nom féminin qui provient du latin « heureux ». (Beatus/ Beatitudinem)

Remplit les objectifs Exprime le positionnement Exprime la promesse Complicité Interpellant Calme Epuré Non culpabilisant Déclinable selon les médias 12 24

Concept 2 Concept 1

How 3/5/6


Nous utiliserons donc le concept de l’autruche qui surpasse de loin le concept du jeu pour exprimer le ton, le message et remplir les objectifs que nous souhaitions.

3. Déclinaison

Magazine

Ce concept magazine reprend la même trame que l’affichage : le lecteur prend d’abord connaissance d’un état de fait qu’il connaît déjà : deux autruches avec la tête dans le sol. (Cette fois-ci nous avons fait exprès de ne pas mettre le moindre antidépresseur). Nous retrouvons également la headline « efficace » qui invite le lecteur à répondre à une question sur base de la situation. La page de droite donne la réponse à la question de la page 1. Enfin, nous reprenons la problématique globale à travers la body copy pour qu’une fois que le lecteur ait eu sa propre réponse, nous lui fournissions notre traduction des évènements : le questionnement, la réponse et le call to action. How 3/5/6


Nous reprenons le concept du double page en développant l’histoire :

Body copy Efficace? Pourtant c’est ce que font plus de 10% des Belges en consommant des antidépresseurs chaque année alors que son efficacité est relative. En effet, selon des études, l’efficacité relative des antidépresseurs sur la dépression n’est que de 24%. Ajoutons à cela que près de 50% des Belges en utilisent sans être en dépression. Alors ne faîtes plus l’autruche et consultez notre application ainsi que notre site web http://www.happy.fgov.be pour avoir toutes les informations sur les antidépresseurs et découvrez que de nombreuses alternatives efficaces existent à portée de main ! • Reprise de la headline pour dire que nous allons donner notre propre réponse. On attire

donc ici. Cela répond à notre soucis d’être interpellant • Explication du contexte et promesse • Reason why • Call to action

Script tv : Lieu: dans le trou molletonné Le spot tv commence avec deux autruches qui partagent un même trou dans lequel elles se cachent. • L’une dit à l’autre : Hey hey dis, tu crois qu’on est en sécurité maintenant ? • L’autre autruche : J’en ai bien l’impression. Un dézoom s’opère dévoilant le corps des autruches avec la tête enfuie dans le sol. Deuxième dezoom dévoilant deux guépards affamés observant la scène incrédule. • Le premier : qu’est ce qu’ils ont avalé ceux-là ? • L’autre : aucune idée mais en tout cas, je sais ce que nous, nous allons avaler. Une voix off féminine intervient : Efficace ? Avec un plan avec « Efficace » écrit. C’est pourtant ce que 1 168 300 belges (le chiffre s’affiche à l’écran) font chaque année en consommant des antidépresseurs alors que ce n’est pas la solution dans tous les cas. Un plan s’affiche avec le logo Happy, l’adresse du site web et la baseline écrite. Pour plus d’informations, consulter notre site happy.fgov.be pour découvrir les alternatives. Une autre voix féminine qui sera la même que pour les spots radios: Les antidépresseurs, ca n’est pas ton moteur !

TV

How 3/5

How 4/5/6


Le site internet d’Happy est lui aussi autour du concept de l’autruche. Il sera le même pour toutes les types de public : notre cible mais aussi les autres stakeholders: les journalistes et professionnels. Le menu est une tête d’autruche qui reste enfuie dans le sol lorsque l’on passe sur les antidépresseurs et qui sort de tête lorsque l’on passe aux alternatives. (v Annex 5 & 6) Les sections sont les suivantes : • Les alternatives • Où trouver des alternatives? • Evénements • Concours • L’application

• Statistiques • Les antidépresseurs • Newsletter • Contact • Happy

Les pages proposeront de partager le contenu sur Facebook et Twitter. Le site sera disponible en français, néerlandais et allemand.

Internet

V. How

Communication plan

How 1/2/6


1. Teasing

Description : To create a teasing effect and to get a little “buzz”, we would like to dispatch ostriches with their heads in the ground during a week at various locations of major cities: Liège, Charleroi, Brussels, Mons, Eupen and Namur. Brussels would be the main town in order to play on the overflow effect to the Flemish commuters. On some ostriches, there would be a QR code leading to an online video giving some clues about the origin of these ostriches. The solution would then be given to the press one day before the launch of the display campaign.

Schedule: October 6 to October 12.

2. Display

Description : We chose display for his capacity to reach large audiences and its potential to reach active people. The purpose of the display is to build the brand and baseline awareness. It is for this reason that we will only show our brand, our concept and our baseline: nothing else.

Schedule: Adshel Metro: from October 13 to October 27. Adshel Gare: Station: From October 13 to October 20.

Format: Adshel Metro” and “Adshel Gare” are networks, which seems the most appropriate to reach active people. “Adshel gare” includes stations in Flanders. It may be interesting to make the Flemish knowing our brand because we could target them in next campaigns. Through advertisements in metros, we will also target Flemish commuters coming to Brussels who are very numerous (there are 371,000 daily commuters to Brussels according to the Belgian Statistical Office with 70% of Flemish according to Stratec.

3. Stand

Description : We selected brand activation activities to show us close to the people, listening to them while feeding the brand and pushing alternatives. Every evening during the week of stress in Wallonia, we propose activities around a heated stand and alternatives (massage, essential oils, etc.) in the stations of Wallonia. People waiting for their train will have the opportunity to have a relaxing time and to participate in contests: • One is collective. It is a collective success to unlock: each participant will be photographed

with a smile (those smiles would be available in an Instagram album). A counter will display the number of smiles and if the number of photography reaches a predefined total: rewards are unlocked for a period of one hour. This competition aims to engage people in a collective adventure around the smile, which is the key element of our logo.

The goal of this event is brand awareness and to build the Happy brand attitude with conviviality, smile and complicity.

How 6


4. TV

Description : We chose television for its wide audiences and its capacity to develop fully a message.

Schedule: The campaign will run from October 27 to December 14. We will begin the first week with a rate of 200 GRP. Next came four weeks where we descend to 85 GRP. We will then provide minimum service for 3 weeks with a rate of 75 GRP hoping to take advantage of the high rate of GRP earned during previous weeks. We can afford to have this rate of GRP since other media will support the TV campaign. Then, We voluntarily leave a desired lull to avoid an effect of nervousness against our campaign. Indeed, we need to keep a good brand attitude.

Format: 30 “ spot RTL, RTBF, PLUG RTL, AB4. There is no rational reason behind this choice: we only wanted to have four diverse types of channels to boost OTS while achieving a certain number of GRP/week.

5. Periodical press

Description : We chose the periodical press because it gives us selectivity, complicity already established with the target (usually readers always take the same magazine and are attached to it). The quality of graphics prints allows us to provide an advertisement with visual quality.

Format: We want our advertising to be extremely impactful, which is why we choose a two-page format in “Flair” and “Elle”.

• The other is individual: for each photography taken, each person receives a pill with a smiley on it. The pill must be opened to release a code that you must enter on the Happy website. ! For each loser, a video will be explaining him or her that she or he was among the {Number

of registrants} who have taken a pill of happiness without success, like thousands of Belgians taking antidepressants without really need it.

! Winners will get a message that they are the lucky person among {Number of registrants} taking a happy pill. But as we want his happiness and that happiness can’t be reached by antidepressants, we offer them a thalassotherapy trip.

This will increase traffic on our website while providing us key performance indicators (Number of code introduced / number of pills dispensed)

This event will be declined in Brussels during the month of November with a radio support. This concept will also be resumed the following year at various events (s. Appendix 7) to establish the brand as a major actor in the health sector.

Schedule: From November 17 to November 30.

MP 3


6. Radio

Description : Radio is a very important medium for us. The reasons are easy to understand: • It is a moment of complicity where the user is often alone and listening to a channel that closely

resembles him on a psycho-demographic level. • It is a perfect medium for repetition because it offers a good cost / grp. • It is a medium, which is perfect to target active people at strategic times. (on the way to work, on

the way back to the house) • It is a medium that has proven its strength over previous campaigns • It is a medium that perfectly complements with Internet. Indeed, a study by the VAR, RMB and

Google has proved very concretely that advertising increases on average by 33% the rate of search on Internet compared to normal. This rate may be increased in case of unknown brand (like us) and to 59% if the advertisement mentions the website. It is, thus, a driver to push people to join the Happy website.

We will use the radio to support the tv campaign and the brand activation while mentioning every time the Happy website.

Schedule: • 3 spots will be broadcast between 7 and 9 pm from Monday to Friday during 4 weeks from

November 3 and 4 spots in the last two weeks of the campaign (when the campaign will need more support) and will recall the campaign view at television every evening. (Total: 200 spots)

• 3 spots will be broadcast between 15h and 17h from Monday to Friday for a period of two weeks from November 3, when workers return home tired to invite them to join our stand and have a relaxing time. The number of spot then goes down to 2 spots per day for a week. (Total = 100 spots)

Format: We chose 30 seconds spots because we have a message to convey. We choose Radio Contact and PureFm because they correspond with our target

How 4

MP 2/3


• Dépression • Fatigue • Antidépresseur • Prozac • Serlain • Seroxat • Effexor • Suicide • Envie de suicide • Déprimé • Déprime • Triste • Tristesse • Sans espoir • Perte d’intérêt • Changement

d’humeur

• Fatigué • Manque d’énergie • Baisse d’intérêt • Baisse de plaisir • Insomnie • Idées noires • Désabusés • Stress • Fatigue chronique,

envie de mort • Chagrin • Mal être • Bien être • Malheureux • Abattement • Découragement • Spleen

• Cafard • Psychothérapie • Psychothérapeute • Psychotropes • Psychotoniques • Psychologue • Coup de blues • problèmes personnels • besoin d’aide • Trouble dépressif • Santé mentale • Anxiété • Humeur • Marre de vivre

7. Internet

Description : We consider Internet as the main pillar of our campaign. Indeed, Internet is a medium that allows to communicate with the target when they are alone, which make it possible to establish a link. It is also the main medium of medical research: when someone has symptoms, he decides to look on the Internet at the possible diseases based on them. We must thus be present to counter offers to buy antidepressants online without prescription. This is why we will provide a significant investment on the Internet. We classify media on the Internet into 3 categories: paid, owned and earned.

Paid

Google Ad Words: Google is the entrance platform for medical research. It is therefore very important to control those gateways in order to promote our content. We selected a number of keywords to control:

Note that these keywords should be part of our SEO strategy when we will perform the Happy website.

Community platform: Community platforms are also very important: they are highly selective and therefore enable us a complicity with the target and a coherence with our message, it is a relaxing time for them, an opportunity to reveal their concerns, share their desires and to confide their problems. For this purpose, we made a list of community platform adapted to the target or to the theme of health. (s. Annex 8) From this list, we have chosen:

How 4

MP 1/3


1. Doctissimo: A French website that is devoted to health and well-being. It accounted 9.063 million unique visitors per month according to the Nielsen Panel / NetRatings October 2012. We want the medicine, psychology and health topics in 300 * 250 Premium format . 2. Aufeminin.be and Santé A-Z: Aufeminin.com group is the No. 1 of the female audience in Europe: the audience reaches 11.5 million unique visitors and 373 million page views. (Nielsen Netratings, 2009) There are over 7.4 million unique visitors on aufeminin.com and the coverage for women 25-49 is by 32%. We want the 486 * 60 Banner format on the two portals . From October 27 to December 14. Owned

Website. Smartphone application: A Smartphone application would be launched in Dutch and French allowing to make a diagnosis. This application would propose some alternative solutions based on symptoms. A reference inviting to consult his doctor or psychiatrist must be affixed everywhere. In cases where multiple symptoms are reported, the psychotherapist or physician must be the only proposed solution advocated by the application in order to avoid any risk. The application would also allow to localize alternative shops and psychologists / psychiatrists in the nearest area. The purpose of this application is to show that alternatives can sometimes be used in place of antidepressants. NB: APPscriptions was pointed by the trendswatching.com .(http://www.trendwatching.com/fr/trends/10trends2013/?appscriptions) as one of the 10 trends for 2013!

Earned

We chose to not select Facebook and Twitter among our media. This may seem strange while we recommend a strong presence on Internet and while we are looking for complicity with the target, but there are various reasons for this: • We give priority to human contact rather than contact via computer. • Social networks are long-term investment media and our campaign is a 3 years campaign. After

those 3 years, our Facebook page and twitter account would barely begin to bear fruit. And what about after those 3 years? Abandoned? Happy would be a brand that abandons his community: this is not the brand’s policy we are trying to build.

• Facebook has introduced a few years ago the edgerank. Recently the reach of a post decreased to a rate of 10 to 20% depending on the level of engagement after Facebook decided to promote his own advertising offers for businesses.

How 1/2/6


Media Octobre Novembre Décembre Budget Radio 3 14 188,122 € Télévision 27 14 450,564 € Affichage 13 137,791€ Site Internet-Application 6 25,000 € Stand 13 50,000 € Presse périodique 17-30 56,848 € Google ADS 6 15,000 € Bannering 27 14 26,706 € Street marketing 6 50, 000 € 999,933€

Small messages from Twitter do not allow us to convey our message. Twitter could ultimately be used to communicate our events but it would be necessary to recruit followers whereas a newsletter could achieve the same goal. All these factors explain why an investment on Facebook and Twitter would be a strategic error considering that 50 000 euros + 24 000 euros per year would be necessary to hire a part time community manager and without counting the cost of Facebook ads to recruit a community.

VI. Media planning

We chose to be present on a particular period of the year: the daylight time change. (26th October 2014)

1 M € budget

When 1


13-19 20-26 27-2 3-9 10-16 17-23 24-30 1-6 7-13 Total GRP

TV 200 85 85 85 85 75 75 690 Radio 196 196 163 98 130 130 913 Magazine 59,85 59,85 119,7 Affichage 110 99 209 Total 110 99 200 281 201 307,8 242,8 205 205 2094,5

Media Octobre Novembre Décembre Budget Radio 3 153,081 € Télévision 27 355,685 € Site Internet-Application 13 25,000 € Google ADS 13 15,000 € Street marketing 13 50, 000 € 598766 €

27-2 3-9 10-16 17-23 24-30 Total GRP

TV 250 75 75 75 75 550 Radio 163 163 163 184 673 Total 250 238 238 238 259 1223

For the light budget, we would remove every “build-the-brand” actions except the teasing and would reduce the number of weeks presence. We would keep Internet investments except the bannering because it seems essential for us.

600,000 € budget

The grp magazine is calculated by counting a rereading from 3.5 per magazine

99"200"

281"201"

307,8"242,8" 205" 205"

Total&GRP/&week&

45%"

19%"6%"

14%"

6%" 10%"TV"Radio"Magazine"Af<ichage"Internet"Below"the"line"


250"238" 238" 238"

259"

Total&GRP/&week&

VII. How effective

Before the campaign: we will take the last figures from the Onkelinx Strategic Cell about: the number of antidepressants sold, the number of conditioning per patient as well as the comparison of this with the prevalence of depression. We will conduct a quantitative survey about the awareness of antidepressants and alternatives, and a Likert scale about the feeling of effectiveness and the feeling of constraining of alternatives and antidepressants. Key performance indicators:

• Stand: number of inserted code on the website compared to the number of pills dispensed.

We also want to see if the collective success will be unlocked. Finally, we will compare Brussels and Wallonia to see where it works the better

• Outdoor/Radio/Magazine/TV: the objective for those media is: positioning, brand awareness and achieve the objectives described in the Dagmar model. So, these media will be tested in a survey after the campaign. .

• Teasing: number of tweet on the matter, number of articles on the web and in newspapers • Bannering: click through rate but especially the average time on site after they join our

website. Indeed, we want to know if health portal is a good place for our next campaign • Google adwords : part of people reaching our website by Google AdWords compared to

the rest of the traffic • Website: our main KPI will be the average time spent on site. We want the website to be a

source of information on antidepressants and alternatives. If we got people spending time on our website, it means that we provide them content of interest. Another KPI for this matter will be the page views/ visitors.

After the campaign: We will conduct the same survey while adding questions on awareness of used media (Where have you heard of Happy recently?). In addition to this, we want to achieve a qualitative study about the Happy brand to see if we meet the qualifiers: « nice, solution oriented, competent and complicity ». Finally, we will see if our goals are achieved according to the Onckelinx Strategic Cell. What will interest us is whether the ratio of « people on antidepressants » in relation to the prevalence of depression is lower than before the campaign.

61%"26%"

9%"

4%"TV"

Radio"

Below"the"line"

Internet"


Appendix Appendix 1

Appendix 2

Figures calculated by myself


Appendix 3


Appendix 4


Appendix 5

Appendix 6


Appendix 7 • Salon Life², Marth • Healthpro :, September • Oxyzen, February • “Salon de la santé de Fosse La Ville”, June Appendix 8 1. Doctissimo 2. Au féminin.com 3. www.Forum-depression.com 4. Prevention suicide.be 5. GUIDE SOCIAL: guidesocial.be 6. MEDINET 7. QUESTION SANTE : 8. lasante.be 9. http://www.e-sante.be Forum Appendix 9 !! Price! Specificity! Periodicity! X! Total!

Flair 8640% 2%pages% Hebdo% 2% 20.329,92%€%Elle 15.520 2%pages% Hebdo% 2% 36.518,56%€%RTL! 788% 1GRP% Daily% 100% 92.708,20%€%RTBF! 755% 1GRP% Daily% 100% 88.825,75%€%Plug!RTL! 468% 1GRP% Daily% 245% 134.897,49%€%AB4! 465% 1GRP% Daily% 245% 134.032,76%€%PureFM!7<9! 197% 1%spot% Daily% 100% 23.177,05%€%PureFM!14<17! 105% 2%spot% Daily% 50% 6.176,63%€%Contact!7<9! 1072% 3%spot% Daily% 100% 126.120,80%€%Contact!14<17! 555% 4%spot% Daily% 50% 32.647,88%€%AdShell!Metro! 30000% 5%spot% Hebdo% 2% 70.590,00%€%Adshell!Gare! 57120% 6%spot% Hebdo% 1% 67.201,68%€%Doctissimo! 50% CPM% Daily% 214% 12.588,55%€%Au!feminin! 30% CPM% Daily% 200% 7.059,00%€%Santé!A!Z! 30% CPM% Daily% 200% 7.059,00%€%Site%webD%application% 25000% Convention% Annual% 1% 25.000,00%€%PréDteasing% 25000% Convention% Monthly% 2% 50.000,00%€%Stand% 25000% Convention% Monthly% 2% 50.000,00%€%Google%Ad%words% 5000% Convention% Daily% 3% 15.000,00%€%! % % % % 999.933,26!€!


Appendix 10 !! Price! Specificity! Periodicity! X! Total!

RTL! 788% 1GRP% %Daily% 75% 69.531,15%€%RTBF! 755% 1GRP% %Daily% 75% 66.619,31%€%Plug!RTL! 468% 1GRP% %Daily% 200% 110.120,40%€%AB4! 465% 1GRP% %Daily% 200% 109.414,50%€%PureFM!7<9! 197% 1%spot% %Daily% 100% 23.177,05%€%Contact!7<9! 1072% 1%spot% %Daily% 103% 129.904,42%€%Site!web<Applcation! 25000% Convention% %Annual% 1% 25.000,00%€%Pré<teasing! 25000% Convention% %Monthly% 2% 50.000,00%€%Google!Ad!words! 5000% Convention% %Daily% 3% 15.000,00%€%! % % % % 598.766,84!€!

Bibliography • Cellule stratégique de Laurette Onkelinx, Evolution des antidépresseurs, 2011. • Cellule stratégique de Laurette Onkelinx, Note d’orientation psycho-médication, 2010 • Conseil supérieur d’hygiène, Dépression, dégressivité et suicide, 2008 • Ipsos, IDEA : Impact of Depression at Work in Europe Audit, 2011 • INPES, La dépression en France, 2005. 2010. • La mutualité socialiste, Données socio-économiques et études longitudinales de la

prescription des antidépresseurs, 2008 • N. Debrunner, X Simonnet , Revue suisse de viticulture, arboriculture …, 1998 Solidaris,

Antidépresseur : évolution de la prescription, 2010.

Les antidépresseurs, ça n’est pas ton moteur

Press kit- 2014

Press Release

October 9, 201415, av Heger, 1050 Brussels

Antidepressants: Enough is enough

Effective this October 13,2014, will start the prevention campaign launched by the public health department against excessive and non needed antidepressants usage. Following the publication of the alarming usage indicators, non lucrative association under the control of the federal and regional authorities is created and branded "HAPPY". The anti depressant usage had increased by 65% in 10 years.

Actually, in 2011, 1.168.300 Belgians had at least used them once, and this number is in constant evolution.However as stated by Pharmanet, antidepressants are not efficient for light (usual) form of depression, and dangerously expose patients to side effects.In addition, studies had proven that the perceived efficiency of antidepressants never exceeds 29% and its relative efficiency is 24%. Despite these facts, the patients seem unsatisfied of no drugs is administered to them.

This is how, following then campaign of the public health department and thanks to an appealing slogan, the Happy Association becomes a direct and official source of information for patients, health professionals and other scientists. Happy informs the consumers and direct them toward alternative solutions with the target to decrease women antidepressants' usage by 3% and men usage by 1.5%. Hope is then to reduce by 350,000 units the number of administered antidepressants.

This campaign aims to provide full visibility to the non efficiency of antidepressants in certain cases. It will heavily use all communication channels such as television and radio among others.

The website happy.fgov.be is already available for doctors, journalists and any person interested in getting more information.

In conclusion, Happy positions itself as a source of information and a significant prevention help to approach happiness.

Further presss information: please visit www.happy.fgov.be or contact:

Kim AssakerPR Happy SPF [email protected] : +32 04780087

Table of contentsPress kit 2014

IntroductionPage 4

-Antidepressants in Belgium: figures, risks , alternatives

Page 5- Presentation of Happy

ActionPage 6

-Events , street marketing, stand

Page 7

- Smartphone application, website and other media

3

Sad mood? Significant gain or loss of weight? Insomnia? Fatigue? Many Belgians are hit by these symptoms daily and episodically. When these symptoms persist the patient is diagnosed with depression

Society of Hapiness! ! ! Unfortunately, we live in a society in a constant seeking for happiness and well being and therefore prescription for antidepressants is felt as only remedy. The consumption of these drugs is constantly increasing reaching a yearly growth of 7.9%. The gender distribution for consumption is 18.5% for women and 9.1% for men. However only 10% of women and 6% of men are really depressed showing a non efficient and not needed usage of antidepressants in Belgium.

A relative efficiencyThe observation above is due to the

perception that antidepressants are a cheap (this is a fact), quick (even with a 2-month prescription) and above all efficient. However, it is proven that it is a relative efficiency: actually, only 24% of the patients recognize a diminution of the symptoms or a full recovery. This efficiency percept ion makes the antidepressants an amazing placebos demonstrated by a comparative study showing that 38% of the patients recognized an improvement versus 52%..

Serious warningPubl icat ions highl ight ing the r isks of antidepressants give a serious warning against the situation described above:

•a study by BMC medicine in 2005 highlighted

a high risk of suicidal thoughts w i t h t h e p a r o l e t i n e ant idepressants (Aoropax, Seroxat and their generics). This risk is well demonstrated for children and teenagers which led the FDA to impose a w a r n i n g o n t h e b o x e s stating: increased risk of suicidal thoughts for young adults between 18 and 24 years old.•u s a g e o f S S R I - t y p e antidepressant increases by 1 0 % t h e r i s k o f g a s t r i c hemorrhage (BMJ, September 2001; vol 323: P1-6)

Other studies also highlighted additional risks of side effects such as cerebral vascular accidents, glaucoma, cardiac and sexual disorders, metabolic and respiratory disorders, etc...

AlternativesAlternatives such as massages, herbal medicine, homeopathy, acupuncture, St. John's Wort (natural antidepressant) and psychotherapy. However, these alternatives are not popular and perceived as non efficient.

An additional reason for the non usage of the above alternatives is the doctors who make the prescriptions: they are usually powerless trying to help patients. They therefore prescribe antidepressants. 80% of the first prescriptions are emitted by generalists and the remaining 20% are emitted by specialists.

For all above reasons listed above, It became urgent and mandatory for the public authorities to fight against this c o n s t a n t a n d re g u l a r i n c re a s e i n antidepressant consumption.

ANTIDEPRESSANTS IN BELGIUM

SOME FIGURES

•1,168,300 Belgian patients consumed antidepressants in 2011•67% of antidepressants users are women•A peak is observed between 51 and 55 years (10.55% of patients)•The average conditioning number per patient is 4.40•Those who consume the most conditioning are 66-70 •It costed € 135,955,369 to the Inami in 2011

•The most used antidepressants are prozac (8.6%) the Deroxat (5%) and Effexor (3.1%)

Some phamaceutical companies selling antidepressants• GFK• Eli Lilly• Wyeth• Lundbeck• Pfizer

MORE INFORMATIONhttp://www.happy.fgov.be

6,085,791

antidepressantsconsumed in

2011

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Happy

To raise awareness of the public opinion on the importance of the prevention campaign to reduce significantly the amount of antidepressants consumed in Belgium, the public health department created the non profit organization "happy" under the leadership of Mrs Charlotte Scutnaire.

This non profit organization has the mission to improve the health of the population, fight against the side effects of medication, to decrease the number of addicted patients and finally to protect citizens' health.

During this 3-year campaign, the consumer will be informed, educated and supported by "Happy". Thanks to its powerful and appealing slogan, Happy will advise and direct the consumer of antidepressants to better believe and adopt alternative solutions. Happy will meet these patients at special events and ensure that all the needed information is timely available to them.

Significant budget is allocated to this mission including 1 million euros for the marketing campaign.

Happy is easily visible to all thanks to its 3 distinct colors (white, blue and green). Also, Happy uses appealing slogans such as well being, serenity and happiness.

Les antidépresseurs, ça n’est pas ton moteur

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ActionsTo execute the plan and fulfill its mission, Happy will be visible at various fronts. We list below a sample of the actions that Happy will perform in 2014:

Events

Happy will be visible in many locations such as train stations, on Internet or on display on various boards. The campaign will articulate around Bea the ostrich, who always hide in the sand to protect itself from the external world. This is to be put in parallel to any human who uses antidepressants without considering any alternative solution.

Street marketing

In order to test our new campaign we will display in many cities in Wallonia, pictures of ostriches with their head hidden in the sand. Hopefully these funny and strange animals will raise enough curiosity of the habitants of these cities such as liege, Charleroi, Brussels, Mons, Eupen and Namur.

Stand

The Happy stand will therefore become a forum where information about antidepressants and their alternatives. A question? A detail? An advice? Our hostesses will be more than glad to help the visitors and even more make them test some of the alternatives available at the stand. Moreover, our stand will propose a double sided contest. If you are interested in participating here are the rules:

The contest will be:

•Team-based: you will be photographed with a smile on your face. All these smiles will be grouped in an Instagram album or equivalent. If your picture reaches a total number of xXx views, then you will obtain all the prizes

•Individual-based: for each picture you will receive a pill with a smiley drawn on it. In this pill, you will find a code to reproduce on the Happy web site. This code will give you a chance to win a prize.

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Website

All needed information will be referenced on the happy website www.happy.fgov.be. We will find useful facts on the antidepressants, the alternatives and their cost. We will also reference a contact page, addresses and useful links, a forum and a dedicated application described in the following section

The Smartphone app

A mobile application for smartphones will be developed and allows users to self diagnose. Knowing the symptoms, the Application suggests alternatives and demonstrates their existence and efficiency.

A banner advising to consult a doctor or psychiatrist will appear in various screens of the Application. If multiple symptoms are detected, the generalist or psychiatrist will be the only solution suggested by the Application to avoid any excessive risk taking.

The Application will also allow to locate places were the alternatives are proposed and to direct to psychiatrists close to the current geographical location of the user.

Television, radio and magazine ads

A television campaign will be provided and will feature Bea our ostrich and one of her ostrich friend. Both of them have their heads hidden in the sands and both are watched by 2 predators ready to eat the the 2 ostriches exchange their concerns about their security and safety in this situation. Is hiding in the sand enough to ensure their safe existence?

Similarly, the voice of our 2 ostriches will be aired on the radio to warn on the side effects of the antidepressants. This audio message

will be aired in the morning and late afternoon and will support our tv campaign and will invite auditors to meet us at our stands.

The Happy campaign will also be visible in the subject medias. It will mainly target the press with a health, a well-being, women and men sections.

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Public'Relations:'antidepressants'.'Group'n°'4'

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Public Relations

I.#Introduction#

We consider the Public Relations campaign as a support pillar for our marketing campaign. It will help us to target publics that we do not reach through our marketing campaign (doctors for example). It will also convey to the public essential emotions such as fear and anxiety that we could not pass through due to the brand territory. As a reminder, the values of the brand are:

Sympathy: Happy must be an appreciated brand. Therefore, It must be a brand immune to criticism or controversy.

Complicity: it is the main characteristic of the brand. It must develop complicity field. The brand must not be perceived by the public as having a false speech.''

Oriented solution: Happy doesn't talk about problem, Happy speaks about solutions and hope.

Expertise: during the 3 years of the campaign, Happy wants to be considered as a professional and credible health actor. It cannot afford to be faulted.

Brand#territories#


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1. Alternatives : ils ont pour la plupart

des moyens limités. Il faudra les informer que nous sommes entrés en lutte avec les antidépresseurs et

qu’ils pourront profiter de l’appel d’air pour renforcer notre action à

Given the values and brand territory, it is excluded to communicate in the name of Happy. We will, therefore, communicate in behalf of the Belgian Ministry of Public Health. (Except for the press kit which needs to be on the website)

II.#Key#stakeholder’s#analysis#

1. The public: we already target them in the marketing campaign, which left us few room to maneuver. Considering the budget allowed, it is impossible to directly target them. We will do it through opinion leaders and journalists.

• Main target: 1,064,909 people • Others: 9,943,091 people

Number: Finance Need: Room for maneuver:

2. Prescribers: they may be under the influence of the pharmaceutical lobby by direct marketing, ignorant or sensible about to the prescription of antidepressants. We must educate them while providing solutions to offer to their patients. The room for maneuver is average since we do not have the same budget as pharmaceutical companies which are able to pay 50,000 € for only 40 doctors. (France 2, Laboratoire Pharmaceutiques, un lobby en pleine santé, 2013, http://www.youtube.com/watch?v=KSnuR-mATT0)

• General practitioner: 14,547 people (2011, INAMI) • Psychiatrist: 2249 people (2011, INAMI)


3. Journalists: they are waiting for information but they have to deal with a huge amount of it. So, it is necessary to motivate them to give us a bit of their time and to publish articles on this subject because a high coverage of a subject is more likely to attract politicians attention in order to be placed on the political agenda.

• Specialized press: used to reach an already sensitized public. • General press: used to inform the public about the dangers of side effects.


The complete description of stakeholders is available in appendix 'We are the Belgian Ministry of Public Health. Our stakeholders for this campaign are:'


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We chose journalists, doctors and alternatives as target for our PR campaign

5. Pharmaceutical companies: they have a bigger budget than us and have a powerful lobby: they will do anything to stop us in our efforts.

• Lundbeck:Redomex • GSK : Wellbutrin, Seroxat • Eli Lilly : Cymbalta, Fontex/ Prozac • Wyeth : Efexor • Lundbeck : Cipramil, Sipralexa • Pfizer : Serlain

4. Alternatives: we are struggling with antidepressants and they could take advantage of the current situation to come strengthen our efforts.

• Homeopathy • Phytotherapy Griffonia , St. John's Wort, Common hawthorn, Passiflora, Bach Flower. • Nutrithérapy • Phototherapy • Acupuncture • Shiatsu • Osteopathy • Psychotherapy


III.#Objectives#

We will use the same means that pharmaceutical companies use to fight against them. They use fear and anxiety to push the public to consume drugs. We will use fear to push the public to be afraid of antidepressants. We will then propose alternatives as a solution to this fear and this anxiety. During our marketing campaign we attacked antidepressants in mass media to better promote alternative solutions on the field. We will proceed in the same way for our Public Relations campaign Our objectives are the same than the marketing campaign ones. : brand knowledge ( side effects , risks, etc.) , alternatives awareness ,brand trial and brand repurchase.


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Fear-Anxiety

Journalist

Public

Antidepressants

Doctor

Alternatives

Communication'plan'

IV.#Events#

1.Business Meeting with alternatives Aim: gather them to tell about our campaign. Date: We must give them time to raise funds and to prepare their creative strategies. This is the reason why this is our first action. We will meet them in March and July 2014 Content: we will invite them in a meeting room with lunch provided on site. We need to persuade them to give off some budget to support us by running their own campaign in the same time than ours. For that, we will expose them our media planning and opportunities to fit in it. We also hope that they will help us for our PR campaign by providing materials to get the attention of journalists by massage, essential oils and other relaxing moments before our press conference. We will organize a final meeting to prepare the campaign.


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Guests We will not invite psychiatrists because we are afraid of their links with pharmaceutical companies. We can’t afford the risk of having pharmaceutical companies knowing our media planning and that we are about to run a campaign against them.

• Unio Homeopathica Belgica (UHB) • Société Belge de Phytothérapie et d'aromathérapie : • Centre européen pour la recherche, le développement et l’enseignement de la

nutrithérapie (Cerden) • Centre Européen de Luminothérapie (CELMEN) • Association Belge des Médecins acupuncteurs (ABMA) • Fédération Belge de Shiatsu • Groupement National Représentatif des Professionnels de l'Osteopathie

2. Sending of flyers and a letter to GPs Aim: educate prescribers to rational behavior of prescription. We want to show them that there are other alternatives and inform on antidepressant risks. Date: October 12, 2014. The goal is to support the marketing campaign by sending flyers to doctors. Content: The aim is to start a questioning in their minds about the prescription of antidepressants before the launch of the marketing campaign. We want to convey the message that by their prescription, they do not make their patients happy, but they play the game of pharmaceutical companies. Thus, we will send a letter coupled with a flyer. The Flyer will invite them to visit the website of Happy in order to discover alternatives while the letter resumes studies that have demonstrated that antidepressants are dangerous and quite ineffective. We want flyers to be the first hammer blow of the marketing campaign


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3. Press conference Aim: to convey fear and anxiety about the antidepressant usages to the public through the press. Date: October 10, 2014 or October 17 depending on the marketing budget. Invitations: Press is deluged by press releases; personalized mailings are also more and more used. We want to differentiate ourselves by using a part of our marketing campaign. In addition to ostriches disposed in key areas of major cities, we will pose ostriches 4 days before the press conference in front of mainstream media buildings:

• Flair/ Femmes d’aujourd’hui : Telecomlaan 5-7 1831 Diegem • Elle : Chaussée de Louvain 431D 1390 Lasne • Knack : Rue de la Fusée 50 b2 - 1130 Bruxelles • Le Soir : Rue Royale, 100 1000 Bruxelles • La Libre Belgique : Rue des Francs, 79 1040 Bruxelles • De Standaard : Gossetlaan 30 1702 Groot-Bijgaarden • De Morgen : Arduinkaai, 29 1000 Brussel • Het Laatste Nieuws : Brusselsesteenweg 347 1730 Asse-Kobbegem • RTBF/VRT/RTL Bd Auguste Reyers, 52 1044 Bruxelles • VT4 : Fabrieksstraat 55 1930 Zaventem • La dernière heure : Boulevard Emile Jacqmain 127 1000 Bruxelles

#We will send them, in the same time than some carefully selected bloggers (s. appendix 2), a token representing an antidepressant smiley with writing "Key to Hapiness" on it. We will also send with it a letter that invites them to discover why all these ostriches are located in the city. The press conference: we will place 2 ostriches at the entrance of the building with their head out the ground. To enjoy some privileged access, people will have to use their token at the reception. The press conference will take place as follow: • 10 AM: Journalists welcoming. They will have access to massage, essentials oils and

other relaxation pleasures. The aim is to relax journalists by offering them a feeling of fullness that will contrasts with the information we will provide on antidepressants.

• 11.30 AM: Beginning of the press conference: presentation of the Happy brand, missions and the campaign.

• 11.45 AM: The Happy and fun part ends: we will try to convey doubt and fear about antidepressants: presentation of strategic cell results, 20 years simulation according to actual figures, annual sales of pharmaceutical companies selling antidepressants.

• 12 AM: speech of Prof. Dr. M. De Meyere, Gent university about recent study on young’s suicide because of antidepressants and their side effects.

• 12.30 AM: Q&A • 1 PM: lunch: during the lunch, journalists will have the opportunity to speak privately

with dr. De Meyere as well as the strategic cell members. They will receive a press kit (different than the Happy one) with all statistics and studies.

During the entire press conference, a hashtag “#AntidepressantDay” will be used and shown. We will resume important figures and facts so that journalists just have to retweet it.


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Budget 25'000'euros'en'prostitué'pour'les'journalistes.'''''''''''

V.#Key#performance#indicators#

! We will count:

• The number of articles on antidepressants. • The total number of readers hit. • The number of tweet about the event • The budget spent by alternatives • The portion of Gp’s in the first prescription of antidepressants

! Attention will be paid on the tone of voice of those articles because we want to convey

fears and anxiety.

! We would also want to see the effect of our teasing on the press to see if we should proceed another one next year:

• Number of articles talking about our ostriches • Number of tweet mentioning our ostriches

Finally, we must pay close attention to articles that combine Happy brand and fear or anxiety. If the number is too substantial, we will need to consider a new public relations strategy dissociating Happy from PR actions.


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VI.#Budget#

Business meetings 11x Ostrich 2x Meeting Room 1x Projector 2x Catering Direct mailing 14547x Flyers 14547x Colored envelops 14547x Mailing costs Press conference 1x Location of a conference room Conference speaker 55x Mailing costs 55x Pills 55x Letters Hostesses Alternatives stand Agence fees

1200€ 700€ 125€

1250€

465.50€ 1891€

9234.17€

1800€ 500€

38.5€ 150€

55€ 400€

4690€

2500€ Total: 24999.17€


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I. Appendix 'Appendix'1''We'made'a'strong'analysis'of'stakeholders'in'order'to'show'you'that'we'considered'every'solution'''

• In#bold:'the'important'ones.''• Underlined:'those'that'could'be'interesting.'

Association des pharmaciens :

• ASSOCIATION DES UNIONS DE PHARMACIENS (ASBL) • ASSOCIATION POUR LA MISE AU POINT DE SERVICES COLLECTIFS POUR

LES MEDECINS OMNIPRATICIENS ET SPECIALISTES, DENTISTES, PHARMACIENS, CADRES, PROFESSIONS LIBERALES ET AUTRES PROFESSIONS AYANT LE MEME STATUT SOCIO-ECONOMIQUE (ASBL)

• PHARMACIENS SANS FRONTIERES BELGIQUE (ASBL) • ASSOCIATION DES PHARMACIENS DU CENTRE DES CANTONS DE L'EST

(ASBL) • ASSOCIATION PROFESSIONNELLE DES MEDECINS DENTISTES ET

PHARMACIENS DE LA CLINIQUE LOUIS CATY A BAUDOUR (ASBL) • SEMITI-PHARMACIENS BURUNDAIS EN BELGIQUE (ASBL) • ASSOCIATION DE DEFENSE PROFESSIONNELLE DES PHARMACIENS

INDEPENDANTS (ASBL) • PHARMALOUVAIN, ASSOCIATION ROYALE DES ANCIENS ETUDIANTS DE

PHARMACIE DE L'UNIVERSITE CATHOLIQUE DE LOUVAIN (ASBL) • ASSOCIATION DES PHARMACIENS DE LA PROVINCE DE LIEGE (ASBL)

Unions professionnelles des pharmaciens :

• ASSOCIATION FRANCOPHONE DES PHARMACIENS HOSPITALIERS DE BELGIQUE

• ASSOCIATION BELGE DES PHARMACIENS • ASSOCIATION DES PHARMACIENS DE LA PROVINCE DE LIEGE • ASSOCIATION FRANCOPHONE DES PHARMACIENS HOSPITALIERS DE

BELGIQUE • ASSOCIATION BELGE DES PHARMACIENS HOSPITALIERS • UNION DES PHARMACIENS DE LA REGION DE BRUXELLES CAPITALE -

APOTHEKERSVERENIGING VAN HET BRUSSELS HOOFDSTEDELIJK GEWEST • UNION DES PHARMACIENS DE L'INDUSTRIE PHARMACEUTIQUE • UNION DES PHARMACIENS DU CENTRE • UNION DES PHARMACIENS DE LA MOYENNE BELGIQUE • ASSOCIATION DE DEFENSE PROFESSIONNELLE DES PHARMACIENS INDEPENDANTS

• UNION PROFESSIONNELLE DES MEDECINS, DENTISTES ET PHARMACIENS

Pharmacists#


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DE L'INSTITUT MEDICO CHIRURGICAL ARTHUR GAULLY Société des pharmaciens :

• SOCIETE SCIENTIFIQUE DES PHARMACIENS FRANCOPHONES (ASBL) • SOCIETE BELGE DES PHARMACIENS SPECIALISTES EN BIOLOGIE CLINIQUE

(ASBL) Amicale des pharmaciens :

• AMICALE DES PHARMACIENS DE L'UNIVERSITE LIBRE DE BRUXELLES (ASBL)

Commission des pharmaciens :

• COMMISSION ROLE DE GARDE DES PHARMACIENS DE LA REGION DE BRUXELLES-CAPITALE (ASBL)

Groupement des pharmaciens :

• GROUPEMENT DES PHARMACIENS FRANCOPHONES (ASBL) Cercles étudiants pharmaciens :

• CERCLE DES ETUDIANTS EN PHARMACIE DE L'ULB (ASBL) • CERCLE DES ETUDIANTS EN PHARMACIE DE L'UCL (ASBL) • CERCLE DES ETUDIANTS EN PHARMACIE (ASBL) • CERCLE SCIENTIFIQUE DES ANCIENS ELEVES DE L'INSTITUT DE

PHARMACIE A. GILKINET DE L'UNIVERSITE DE LIEGE (ASBL) Union professionnelle :

• UNION DES PHARMACIENS DE L'INDUSTRIE PHARMACEUTIQUE Association :

• A.P.B - ASSOCIATION PHARMACEUTIQUE BELGE/ALGEMENE PHARMACEUTISCHE BOND (BELGIAN PHARMACEUTICAL ASSOCIATION)

• ASSOCIATION NATIONALE DES GROSSISTES-RÉPARTITEURS EN SPÉCIALITÉS PHARMACEUTIQUES POUR LA BELGIQUE

Pharmaceutical#companies#


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Unions professionnelles des médecins :

•UNION PROFESSIONNELLE BELGE DES MEDECINS SPECIALISTES EN PSYCHIATRIE

•GROUPEMENT DES UNIONS PROFESSIONNELLES BELGES DE MEDECINS SPECIALISTES

•UNION PROFESSIONNELLE BELGE DES MEDECINS SPECIALISTES EN NEUROLOGIE - BELGISCHE BEROEPSVERENIGING DER GENEESHEREN- SPECIALISTEN IN DE NEUROLOGIE

• UNION DE DEFENSE PROFESSIONNELLE DES MEDECINS DES HOPITAUX UNIVERSITAIRES PUBLICS DE BRUXELLES

•UNION PROFESSIONNELLE DES MEDECINS ET DES DENTISTES DE HIS SITE J. BRACOPS

•ASSOCIATION PROFESSIONNELLE DES MEDECINS SCOLAIRES •UNION PROFESSIONNELLE DES MEDECINS DE L'HOPITAL VESALE •UNION PROFESSIONNELLE DES MEDECINS DES CLINIQUES UNIVERSITAIRES

DE BRUXELLES, HOPITAL ERASME Associations :

• ASSOCIATION DES MEDECINS GENERALISTES D'HAM-SUR-HEURE NALINNES (ASBL)

• ASSOCIATION DES MEDECINS GENERALISTES DE LA BASSE-MEUSE (ASBL) • ASSOCIATION DES MEDECINS GENERALISTES DES QUARTIERS NORD-DE

BRUXELLES (ASBL) • RASSEMBLEMENT DES MEDECINS GENERALISTES DU NAMUROIS (ASBL) • ASSOCIATION DES MEDECINS GENERALISTES DU CENTRE ARDENNES (ASBL) • ASSOCIATION DES MEDECINS GENERALISTES D'ANDERLECHT (ASBL) • ASSOCIATION DES MEDECINS GENERALISTES BRUXELLES SUD-EST (ASBL) • ASSOCIATION DES MEDECINS ATTACHES A LA CLINIQUE SAINTE-ANNE-SAINT-REMI (ASBL)

• ASSOCIATION DE MEDECINS HOSPITALIERS DE LA PROVINCE DE LUXEMBOURG (ASBL)

• MEDECINS SANS FRONTIERES (ASBL) • ASSOCIATION DES MEDECINS DE L'HOPITAL SAINT-GEORGES A MONS (ASBL)

• MEDECINS DU MONDE-DOKTERS VAN DE WERELD (ASBL) • ASSOCIATION FRANCOPHONE DES MEDECINS COORDINATEURS ET

CONSEILLERS EN MAISONS DE REPOS ET MAISONS DE REPOS ET DE SOINS (ASBL)

• UNION DE DEFENSE PROFESSIONNELLE DES MEDECINS DU C.H.U. SAINT-PIERRE (ASBL)

• ASSOCIATION DES MEDECINS EXERCANT AUX CLINIQUES SAINT-JOSEPH (ASBL)

Doctors#and#specialists#


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• ASSOCIATION DES MEDECINS DU CENTRE HOSPITALIER DE DINANT (ASBL) • ASSOCIATION DES MEDECINS HOSPITALIERS DE LA CLINIQUE D.

DERSCHEID (ASBL) • ASSOCIATION PLURIDISCIPLINAIRE DES MEDECINS DE L'INSTITUT JULES

BORDET (ASBL) • ASSOCIATION DES MEDECINS ANCIENS ETUDIANTS DE L'UNIVERSITE LIBRE

DE BRUXELLES (ASBL) • MEDECINS DU DESERT (ASBL) • ASSOCIATION DES MEDECINS HOSPITALIERS DES HOPITAUX IRIS SUD (ASBL)

• LE LIEN. ASSOCIATION DES MEDECINS INTERNISTES EXERCANT A LA CLINIQUE SAINT-JOSEPH A SAINT -VITH (ASBL)

• ASSOCIATION DES MEDECINS GENERALISTES DE JODOIGNE (ASBL) • ASSOCIATION DES MEDECINS GENERALISTES DE WALCOURT (ASBL) • ASSOCIATION DES MEDECINS CAMEROUNAIS DE BELGIQUE (ASBL) • ASSOCIATION DES MEDECINS GENERALISTES DE BRAINE-L'ALLEUD ET WATERLOO (ASBL)

• ASSOCIATION DES MEDECINS HOSPITALIERS DE L'A.I.O.M.S. DE BASTOGNE (ASBL)

• ASSOCIATION DES MEDECINS GENERALISTES DE GENAPPE (ASBL) • SOS MEDECINS BRUSSELS (ASBL) • RASSEMBLEMENT DES MEDECINS GENERALISTES DU NAMUROIS (ASBL) • MEDECINS FORMATION WAREMME ET ENVIRONS (ASBL) • ASSOCIATION DES MEDECINS GENERALISTES DE SAINT-GILLES ET DES

COMMUNES AVOISINANTES (ASBL) • ASSOCIATION DES MEDECINS GENERALISTES DU SUD-LUXEMBOURG (ASBL)

• ASSOCIATION FRANCOPHONE DES MEDECINS-CHEFS, DES MEDECINS-DIRECTEURS ET DES DIRECTEURS MEDICAUX (ASBL)

• GROUPE LIEGEOIS DES MEDECINS DE MAISON MEDICALE (ASBL) • LES MEDECINS DE L'ANCIENNE CLINIQUE DES BRUYERES (ASBL) • ASSOCIATION ROYALE DES MEDECINS DIPLOMES DE L'UNIVERSITE DE

LIEGE • FONDS DE SOLIDARITE DES MEDECINS (ASBL) • UNION DES MEDECINS GENERALISTES DE TUBIZE-CLABECQ ET REBECQ (ASBL)

• ASSOCIATION DES MEDECINS GENERALISTES DE HANNUT (ASBL) • ASSOCIATION DES MEDECINS DU CHR CLINIQUE SAINT-JOSEPH - HOPITAL

DE WARQUIGNIES (ASBL) • A.M.G.W., ASSOCIATION DES MEDECINS GENERALISTES DE WAVRE (ASBL) • ASSOCIATION DES MEDECINS DE L'HOPITAL CIVIL DE CHARLEROI (ASBL) • ASSOCIATION DES MEDECINS DU GRAND HOPITAL DE CHARLEROI (ASBL) • ASSOCIATION DES MEDECINS GENERALISTES DE MONT-SAINT-GUILBERT,

CHASTRES, WALHAIN (ASBL) • ASSOCIATION DES MEDECINS DU CENTRE MEDICAL AMERCOEUR (ASBL) • UNION DES MEDECINS GENERALISTES BORAINS (ASBL) • ASSOCIATION DES MEDECINS DE LA CLINIQUE NOTRE-DAME DE FRAMERIES (ASBL)


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• COMITE DES MEDECINS DU CENTRE SOCIO-MEDICAL DE DOUR (ASBL) • ASSOCIATION DES MEDECINS GENERALISTES DE CHAUMONT-GISTOUX (ASBL)

• ASSOCIATION DES MEDECINS GENERALISTES DE LA BASSE-MEUSE (ASBL) • MEDECINS DE FAMILLE DE L'ENTITE SONEGIENNE (ASBL) • ASSOCIATION DE MEDECINS GENERALISTES DE NEUPRE ET ENVIRONS (ASBL)

• ASSOCIATION DES MEDECINS DE LA CLINIQUE ET MATERNITE SAINTE-ELISABETH (ASBL)

• ASSOCIATION DES MEDECINS DE LA CLINIQUE NOTRE-DAME DE GRACE A GOSSELIES

• ASSOCIATION DE MEDECINS SPECIALISTES DU CENTRE HOSPITALIER DE L'ARDENNE, 6800 LIBRAMONT (ASBL)

• ASSOCIATION DES MEDECINS GENERALISTES ENTRE MIDI ET OUEST (ASBL)

• MEDECINS GENERALISTES ASSOCIES (ASBL) • ASSOCIATION DES MEDECINS GENERALISTES DE BRAINE-LE-COMTE (ASBL)

• ASSOCIATION DES MEDECINS GENERALISTES D'OTTIGNIES, COURT- SAINT ETIENNE – BOUSVAL (ASBL)

• GROUPE DES MEDECINS GENERALISTES DE MALMEDY (ASBL) • ASSOSIATION DES MEDECINS DU CENTRE HOSPITALIER NOTRE DAME ET

REINE FABIOLA (ASBL) • ASSOCIATION DES MEDECINS DU GRAND HORNU (ASBL) • ASSOCIATION DES MEDECINS DU SERVICE DE PSYCHIATRIE DE LA

CLINIQUE SAINTE-ANNE - SAINT-REMI - SAINT-ETIENNE (ASBL) • ASSOCIATION DES MEDECINS HOSPITALIERS DES HOPITAUX D'IRIS SUD

SITE ETTERBEEK IXELLES (ASBL) • ASSOCIATION DES MEDECINS DES HOPITAUX SAINT-JOSEPH, A GILLY-SAINTE-THERESE, A MONTIGNIES-SUR-SAMBRE (ASBL)

• ASSOCIATION DES MEDECINS ATTACHES A LA CLINIQUE SAINTE-ANNE-SAINT-REMI (ASBL)

• UNION MEDICALE DES MEDECINS DE LA PROVINCE DE NAMUR (ASBL) • ASSOCIATION DE MEDECINS GENERALISTES DE MONS (ASBL) • L'ASSOCIATION BELGE DES MEDECINS PHARMACEUTIQUES (ASBL) • ASSOCIATION DES MEDECINS GENERALISTES FAMENNE-ARDENNE (ASBL) • ASSOCIATION DES MEDECINS DU CENTRE HOSPITALIER NEW PAUL BRIEN (ASBL)

• ASSOCIATION BELGE INTERMUTUALISTE DES MEDECINS-CONSEILS EN SECURITE SOCIALE (ASBL)

• ASSOCIATION DES MEDECINS GENERALISTES DE LASNE-LA HULPE-RIXENSART (ASBL)

• ASSOCIATION DES MEDECINS GENERALISTES DE GANSHOREN - VERENIGING VAN GANSHORENSE HUISARTSEN (ASBL)

• ASSOCIATION DES MEDECINS MI-TEMPS ET A DEROGATION DES HOPITAUX DE L'UNIVERSITE DE BRUXELLES (ASBL)

• GROUPE DE MEDECINS GENERALISTES DE BRUXELLES SUD EST (ASBL) • ASSOCIATION DE MEDECINS GENERALISTES DE NEUPRE ET ENVIRONS


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(ASBL) • ASSOCIATION DES MEDECINS GENERALISTES DE L'ARDENNE STAVELOTAINE (ASBL)

• ASSOCIATION DES MEDECINS GENERALISTES DE BERCHEM-SAINTE-AGATHE (ASBL)

• ASSOCIATION DES MEDECINS GENERALISTES D'UCCLE ET ENVIRONS (ASBL)

• LES MEDECINS NON HOSPITALIERS DU PAYS VERT (ASBL) • ASSOCIATION DES MEDECINS DES CANTONS DE L'EST DE BELGIQUE (ASBL)

• ASSEMBLEE GENERALE DES MEDECINS DU CENTRE HOSPITALIER REGIONAL (ASBL)

• ASSOCIATION DES MEDECINS GENERALISTES D'EVERE-SCHAERBEEK (ASBL)

• A.M.G.W., ASSOCIATION DES MEDECINS GENERALISTES DE WAVRE (ASBL) • ASSOCIATION DES MEDECINS GENERALISTES DE LA GARDE DE GERPINNES (ASBL)

• ASSOCIATION DES MEDECINS DE TILFF ESNEUX ET ENVIRONS (ASBL) Cercles des médecins :

• CERCLE DES MEDECINS GENERALISTES DE NAMUR OUEST (ASBL) • CERCLE DES MEDECINS GENERALISTES D'AYWAILLE (ASBL) • CERCLE DES MEDECINS D'ANS (ASBL) • CERCLE DES MEDECINS GENERALISTES DE VILLERS-LA-VILLE (ASBL) • CERCLE DES MEDECINS GENERALISTES DE HUY (ASBL) • CERCLE DES MEDECINS GENERALISTES DE GREZ-DOICEAU ET

BEAUVECHAIN (ASBL) • CERCLE DES MEDECINS GENERALISTES DE SPRIMONT (ASBL) • CERCLE DES MEDECINS GENERALISTES DE LA SENNETT (ASBL)

Groupement des médecins :

• GROUPEMENT DES MEDECINS GENERALISTES DE LA REGION DU CENTRE - CELLULE DU CENTRE D'INFORMATIQUE MEDICALE (ASBL)

• GROUPEMENT DES MEDECINS GENERALISTES DE BRUXELLES NORD-OUEST (ASBL)

• GROUPEMENT DES MEDECINS DE LA CLINIQUE PSYCHIATRIQUE HENRI-CHAPELLE (ASBL)

• GROUPEMENT DES MEDECINS DE BINCHE ET ENTITES AVOISINANTES (ASBL)

• GROUPEMENT DES MEDECINS OMNIPRATICIENS DES ENTITES DE PLOMBIERES ET LA CALAMINE (ASBL)

Fédérations :

• FEDERATION DES ASSOCIATIONS DE MEDECINS GENERALISTES DE BRUXELLES (ASBL)

• FEDERATION LIEGEOISE DES ASSOCIATIONS DE MEDECINS GENERALISTES


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(ASBL) • FEDERATION DES MEDECINS GENERALISTES DU CENTRE ET DE BINCHE (ASBL)

• FEDERATION DES ASSOCIATIONS DES MEDECINS GENERALISTES DE LA REGION DE CHARLEROI (ASBL)

• CONFEDERATION DES MEDECINS BELGES - EN NEERLANDAIS : KONFEDERATIE DER BELGISCHE GENEESHEREN (ASBL)

Sociétés

• SOCIETE DE MEDECINS GENERALISTES DE JUPILLE, BELLAIRE, SAIVE ET QUEUE-DU-BOIS (ASBL)

HOMEOPATHY : Unions professionnelles

'• UNIO HOMEOPATHICA BELGICA

Associations

• SOCIETE ROYALE BELGE D’HOMEOPATHIE (ASBL) • ECOLE BELGE D’HOMÉOPATHIE (ASBL) • LES AMIS DE L’HOMÉOPATHIE (ASBL) • ASSOCIATION DES LABORATOIRES PHARMACEUTIQUES AGRÉÉS EN

HOMÉOPATHIE (ASBL) • ASSOCIATION DES PÉDIATRES PRATIQUANTS L’HOMÉOPATHIE (ASBL)

PHYTOTHERAPY : Société :

• SOCIETE BELGE DE PHYTOTHERAPIE ET D’AROMATHERAPIE (ASBL) ACUPUNCTURE Associations

• ACUPUNCTURE SANS FRONTIERES BELGIQUE (ASBL) • ASSOCIATION MÉDICALE D’ACUPUNCTURE MODERNE (ASBL) • CENTRE D’ETUDES DE MEDECINE CHINOISE ET D’ACUPUNCTURE (ASBL) • ASSOCIATION BELGE DES MÉDECINS ACUPUNCTEURS (ASBL)

Unions professionnelles

• ASSOCIATION BELGE DES ACUPUNCTEURS DIPLOMES DE CHINE

Alternatives#


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• UNION PROFESSIONNELLE DES MEDECINS ACUPUNCTEURS DE BELGIQUE

SHIATSU Associations

• KIMURA SHIATSU (ASBL) • O-KI SHIATSU SCHOOL BRUSSELS (ASBL)

Fédération

• FÉDÉRATION BELGE DE SHIATSU (ASBL) OSTHEOPATHY Groupement

• GROUPEMENT NATIONAL REPRÉSENTATIF DES PROFESSIONNELS DE L’OSTÉOPATHIE (ASBL)

Associations :

• LES ENFANTS DE L’OSTÉOPATHIE (ASBL)

• COLLÈGE BELGE D’OSTÉOPATHIE (ASBL) • CENTRE DE RECHERCHE ET D’ÉTUDE DES TRAITEMENTS DIFFÉRENCIÉS

EN OSTÉOPATHIE (ASBL) • GROUPE D’ÉTUDES ET DE RECHERCHE EN KINÉSITHÉRAPIE MANUELLE ET

OSTÉOPATHIE (ASBL) • OSTÉOPATHIE POUR TOUT-PETITS (ASBL) • LES DISPENSAIRES SOCIAUX D’OSTÉOPATHIE (ASBL)

Unions professionnelles

• SOCIÉTÉ BELGE D’OSTHÉOPATHE, UNION PROFESSIONNELLE D’OSTHÉOPATHES BELGES

PSYCHOTHERAPY Associations :

• ASSOCIATION POUR LA PSYCHOTHERAPIE PSYCHANALYTIQUE DE COUPLE ET DE FAMILLE (ASBL)

• CENTRE NOTGER INSTITUT DE FORMATION A LA PSYCHOTHERAPIE (ASBL) • ASSOCIATION FRANCOPHONE DE PSYCHOTHERAPIE CENTREE SUR LA

PERSONNE ET EXPERIENTIELLE (ASBL) • ASSOCIATION POUR LA RECHERCHE EN PSYCHOTHERAPIE

PSYCHANALYTIQUE (ASBL) • INSTITUT DE PSYCHOTHERAPIE CORPORELLE INTEGREE – BELGIQUE

(ASBL)


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• ASSOCIATION BELGE DE PSYCHOTHERAPIE (ASBL) • SENSIBILISATION ET FORMATION EN PSYCHOTHERAPIE (ASBL) • ASSOCIATION NAMUROISE DE PSYCHOTHERAPIE ET SYSTEMICIENS (ASBL) • ASSOCIATION INTERNATIONALE DE PSYCHOTHERAPIE ANALYTIQUE ET EXISTENTIELLE-CENTRE PSY8(SCHAERBEEK)(ASBL)

• ATLANTIS, CHAPITRE DE PSYCHOTHERAPIE INSTITUTIONNELLE (ASBL) • ECOLE BELGE DE PSYCHOTHERAPIE PSYCHANALYTQUE A MEDIATIONS

(PSYCORPS) (ASBL) • GROUPE D'ETUDES EN PSYCHOTHERAPIE ET PSYCHOTHERAPIE INFANTO-

JUVENILE (ASBL) • INSTITUT DE PSYCHOTHERAPIE CORPORELLE INTEGREE – BELGIQUE (ASBL)

• ASSOCIATION DES PSYCHOLOGUES PRATICIENS D'ORIENTATION PSYCHANALYTIQUE (ASBL)

• L'ASSOCIATION DES PSYCHOLOGUES CLINICIENS ET PSYCHOTHERAPEUTES MUSULMANS (ASBL)

• LES PSYCHOLOGUES DU SPORT.BE (ASBL) • FEDERATION BELGE DE PSYCHOLOGUES (ASBL) • ASSOCIATION NATIONALE DES PROFESSIONNELS PSYCHOLOGUES (ASBL) • PSYCHOPREV, ASSOCIATION DES PSYCHOLOGUES CONSEILLERS EN

PREVENTION (ASBL) Unions professionnelles

• ASSOCIATION PROFESSIONNELLE DES NEUROLOGUES ET DES PSYCHIATRES BELGES (ASBL)

• ASSOCIATION PROFESSIONNELLE DES PSYCHIATRES INFANTO-JUVENILE FRANCOPHONES (ASBL)

Fédérations :

• FEDERATION FRANCOPHONE BELGE DE PSYCHOTHERAPIE PSYCHANALYTIQUE (ASBL)

• FEDERATION PROFESSIONNELLE DES PSYCHOLOGUES CLINICIENS ET DES PSYCHOLOGUES PSYCHOTHERAPEUTES (ASBL)

NUTRITHERAPY Sociétés :

• SOCIETE BELGE DES MEDECINS NUTRITIONNISTES##

######


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Appendix'2'#Bloggers##J'Jean'Quatremer'(Journalism)''J'Damien'Van'Achter'(IT/Journalism)'J'Frederik'Tibau'(Journalism)'J'«'Iwry'Twilight'Belgium'»'(Blog)''J'Hugues'Lannoy'(Blog)''J'Laurence'Vanhée'(HR)'J'Fred'Wauters'(Journalism)'J'David'Van'Lochem'(Blog)''J'Fabrice'Distefano'(Blog)''J'Ettore'Rizza'(Journalism)''J'Philippe'Legrain'(Blog)'J'Sophie'Lejoly'(Journalism)''J'Grégory'Lenco'(Journalism)''J'Frédéric'Vandendris'(Blog)'J'Lauranne'Lahaye'(Journalism)'J'Aurore'Sabbe'(Blog)''J'Emme'Comme'(Blog)'#

Public'Affairs:'antidepressants'.'Group'n°'4'

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'''''''' We selected several issues. We illustrated each of those with local articles because the countries of the European Union rule their own Public Health matter. ''''''''''''''''''''''''''''!'''''''''

Public Affairs

I.!Issue!analysis!

1. The overprescription Doctors are experiencing daily difficulties when dealing with: pression at work, unemployment, growing powerty, economic crisis. These difficulties are accompanied by an erosion of social structures ( Metaforum 2010). Patients amplify their problems. Their doctors feels helpless and want to help their patients. Add to this pressure of the pharmaceutical companies. The marketing is somehow driven by the industry with a large impact and influence on the prescribing behavior Finally, there is a conflict of interest: doctors, who are supposed to seek the well-being of patients, serve the pharmaceutical industry’s interests. Negative assessment data and warnings are often drowned in the flood of promotion and advertising. This leads to the medicalization of society. Local articles:

• http://www.inami.fgov.be/drug/fr/statistics-scientific information/pharmanet/pharmaceutical-tables/pdf/2010/tables2010.pdf

• http://www.rtbf.be/info/societe/detail_les-medecins-qui-prescrivent-trop-vont-etre-punis-de-maniere-plus-severe?id=7890421

• http://www.test-achats.be/sante/medicaments/communique-de-presse/les-antibiotiques-trop-vite-prescrits-et-souvent-inutiles

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Topicality

High

Impact on public’s health

High

DG Sanco and Who europe’s room for maneuver

Low


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''''''''''''''''''''''''''''''''''

2. Suicide in Europe Suicide appears to be the primary cause of injury mortality in Europe. Then follow the road accidents and the falls accounting each. for nearly 47,000 deaths. Suicide affects everyone regardless of social class and age. From the point of view of the individual, suicide is rarely seen as an end in itself, but rather as the only possible way to escape the unbereable becoming situation. Men are three times more affected than women. There is a high level of suicide among retired people, unemployed, divorced, childless and citadines living alone. Rates increase during period of economic uncertainty (although poverty is not a direct cause). For the entire European union (s. Appendix 1), the suicide rate declined between 2000 and 2010. The decrease is significant for the 15-19 and over 85 years. In contrast, the suicide rate rose slightly for 50-54 , probably because of the economic crisis. Most suicide victims suffer from psychological disorders. (such as depression) Almost 1 million lives are lost yearly due to suicide, which translates to 3000 suicide deaths every day. For every person who completes a suicide, 20 or more may attempt to end his or her life (WHO, 2012). Local articles

• http://www.lalibre.be/societe/sciences-sante/article/639822/augmentation-du-nombre-de-suicides-en-belgique.html.

• http://fr.medipedia.be/depression/consequences/articles_risque-suicide_360 • http://agora.qc.ca/thematiques/mort/dossiers/belgique_suicide

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'Topicality

High


High


Low

3. Trivialization and denigration of alternatives While the global burden of depression poses a substantial public health challenge, both at the social and economic levels as well as the clinical level, there are a number of alternatives that can effectively address or fight this burden. They are ignored because they are not scientifically proved or because they are not enough promoted. That is why, for common mental disorders such as depression, the most common treatments prescribed are generic antidepressants and psychotherapy. Non-medical treatments are little studied. However, the effectiveness of this non- medicated treatments has been proved by studies (clinical evidence, 2009; Mottran & al..,2008) In addition, the recognition of the title of psychotherapist is not regulated at the moment. Doctors got a lack of information about it. It is, thus, hard for them to prescribe this kind of treatment especially if there is no authorization for reimbursement ( Onkelinx report 2011) '

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'''''''''''''''

'''''''''''''''''''''''''''''''

Local articles

• http://www.levif.be/info/actualite/sciences/l-homeopathie-medecine-alternative-a-succes/article-1195018837305.htm

• http://www.test-achats.be/sante/nc/communique-de-presse/les-patients-satisfaits-de-l-homeopathie

• http://www.express.be/business/fr/economy/les-medecines-alternatives-sont-fondees-sur-un-leurre/146501.htm

• http://www.test-achats.be/sante/nc/communique-de-presse/les-patients-satisfaits-de-l-homeopathie

• http://www.levif.be/info/actualite/sciences/l-homeopathie-medecine-alternative-a-succes/article-1195018837305.htm

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Topicality

Low


Medium- low


Medium- low

4. Depression in Europe Nowadays, we estimate that depression is affecting 350 million people. Each year, approximately 7% of the population suffers from major depression. This proportion goes to 25% in case of mild depression. Depression is an important factor of the global burden of disease and affects people from all communities across the world. The World Mental Health Survey, conducted in 17 countries has shown that about 5% of the population reported an episode of depression in the previous year. Depressive disorders often start very young; depression is the main cause of disability in the world in terms of total years lost due to disability. In some countries, such as Denmark and the Netherlands, up to 50% of sick leave and long-term disability benefits are attributable to mental disorders, primarily depression (WHO, 2008) Local articles:

• http://www.lalibre.be/debats/opinions/article/699375/les-antidepresseurs-par-defaut.html • http://webcache.googleusercontent.com/search?q=cache:XQdGkydF7DQJ:www.mutsoc.b

e/Mutsoc/SalleDePresse/PositiondeLaMutu/cppresse-augmentation-antidepresseurs-nuances.htm+&cd=3&hl=fr&ct=clnk&gl=be

• http://www.rtbf.be/info/societe/detail_la-rilatine-un-medicament-miraculeux-et-sans-danger-pour-nos-enfants?id=7496443

• http://www.lesoir.be/archives?url=/lifestyle/sante/2011-09-06/un-million-de-belges-sous-antidepresseurs-860972.php

• http://www.couplesfamilles.be/index.php?option=com_content&view=article&id=99:la-surconsommation-de-medicaments-et-de-psychotropes-chez-les-personnes-agees&catid=6:analyses-et-reflexions&Itemid=9

• http://www.lalibre.be/societe/sciences-sante/article/566809/medicaments-sur-prescription-le-cout-a-augmente-de-125-pc.html

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'''''''''''''''''''''''''''''''''''''''''''''''''

Topicality

Medium-high


High


Low

5. Bad practices of pharmaceutical companies

1. Creation of a “pseudo” disease In the past, Pharmaceutical companies found cures for diseases; nowadays, they are creating diseases to sell their drugs. In 2007, Pfizer has launched fibromyalgia and Lyrica, which targets mature women with unclear symptoms (general fatigue and muscle pain). No organic lesion was observable. That is why rheumatologists often believe that it’s psychosomatic disease. Now the Lyrica is sold worldwide despite its probable futility and its side effects (insomnia and obesity.) They can get billon by creating new diseases. Some of their findings: seasonal affective disorder, sleeping legs, "premenstrual dysphoric disorder" (bad mood during periods), intermittent explosive disorder (when you are angry while driving), etc.

2. Launch of fake new drugs Pharmaceutical companies launch fake new drugs to sell drugs at high price. When the Prozac became generic in 2003, they launched Zoloft or Deroxat in order to keep premium price. They also launch new drugs only to compete with competitors

3. Problems of side effects report: In 2009, health professionals made only 26,546 reports of side effects and accidents. Most (159,194 cases) came from the pharmaceutical industry. In France, only 2 to 4 drugs are prohibited on annual average. It explains why some issues come out: “In 2003, the British Committee on Safety of Medicines (CSM) advised against treatment with selective serotonin reuptake inhibitors (SSRI’s) other than fluoxetine in children, due to a possible increased risk of suicidal behaviour. A study examined the effects of this official safety warning on general practitioners’ depression diagnosing and prescription behaviour and showed a significant drop in the rates of depression diagnoses and SSRI prescriptions around the time of the CSM advice (but not in the recording of symptoms)“ (Antidepressants briefing, 2013)

Books, articles and videos:

• http://tempsreel.nouvelobs.com/societe/20110907.OBS9899/les-dessous-de-l-industrie-pharmaceutique.html

• http://www.youtube.com/watch?v=KSnuR-mATT • Ben Goldacre, Bad Pharma: How drug companies mislead doctors and harm patients,

2012] ''

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Topicality

High


High


High


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''''

Society of Happiness

In our society, there is no room for weakness. We must be strong at all times and leave no trace of any weakness. If ever there is evidence of weakness, we have to treat it

Creation of new diseases

Growing bad feelings about the State insurances: we believe that people who are unemployed or people who receive money from health insurance are people who are lazy or profiteers.

We need to categorize all these issues. We found that all issues fit in a bigger one: Society of Happiness that creates an overmedicalization issue. Here is a scheme about how we believe it all fits:

The Facebook generation: young people are looking increasingly to show their lives on Facebook in order to show their happiness

Issues Drivers TRENDS

Weak'signals' Weak'signals'

Depression

If people have a weakness, they have to treat it. The placebo effect of antidepressants shows this fact: if we tell you that you are sick, you believe you are.

Suicide in europe « No solution has been

found »

The overprescription “ I want to be cured”

Trivialization and denigration of alternatives

Increase in Health care

Growth of antidepressants sales

Launch of false new drugs

Overmedicalization of society

Drivers'

Wild cards:

• Antidepressants proved to be dangerous for adolescents

• Report on FR2 about pharmaceutical companies practices

• Etc. '

Presence of this phenomenon in the art field: • Music: “I could be the one” by Avicii vs Nicky

Romero , 2013 • Film: Side effects, recently released on 10th

April 2013 • Books: “Bad Pharma: How drug companies

mislead doctors and harm patients » by Ben Goldacre, 2012

Weak'signals'


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By this scheme, we understood that we have to act on drivers and particularly on the first one: “ Creation of new diseases”. Indeed, if we succeed at eradicating this issue, people won’t feel anxious about having a trouble and they will not pressure the doctors to be cured of it. So, doctors will feel less powerless and will not be overprescribing. We situated this issue on the life circle: ''

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Concentrated

Diffuse

Concentrated Diffuse

Benefits'from'Public'Policy'

Costs'from

'Public'

Policy'

Interest'Group'Politics'

Client'Politics'Majoritarian'Politics'

Entrepreneurial'Politics'

LowiGWilson'Matrix''

Time

1'

2'

3'

4'

5' 1. Emergence of our issue : Creation of new diseases.

2. Interest groups : to gather allies 3. Legislation : the ICD could bypass the

DSM-5. 4. Administrative implementation :

make countries implementing the ICD in their governement’s policy

5. Judicial enforcement

Thanks to the lifecycle, we know we have to gather allies for the legislation step. According to the Lowi-Wilson Matrix, we will have a lot of people supporting us. The main challenge for Who Europe and DG Sanco will be to gather them.

Despite the fact that the 11th revision of the ICD has already started. we do not consider us in the legislation stage. Indeed, there is a long way before the ICD comes out (It will continue until 2015) and we still need the support of interest groups.


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Substitutes Magnitude Per capita Numbers Coverage Financial & HR Cost of organising

Low High No information Low

Low

High Low Low

Moderate High No information Low

No info No info No information Low



No info High No information Low



Low Moderate No information Low




No info High No information Low

High High High High

No info No info No information High

European committee for Homeopathy

Moderate Moderate High

European Council for Classical Homeopathy

Moderate Moderate Moderate

LIMHI Moderate Moderate Moderate

International Institute of Phytotherapy

Low Moderate Moderate

European Federation of Herbalism

Low Moderate Moderate

European Phototherapy Center

Moderate No info No info

European Society for Photodynamic Therapy in Dermatology


European Information Center of Phototherapy


European Study Center of Acupuncture


International Council of Medical Acupuncture And Related Techniques


A.P.E.M.E.C.T Moderate Moderate Moderate

European Association of Japanese Traditional Medicine


European Association of Acupuncture


European Federation of Osteopaths


European Association for Psychotherapy

Moderate High Moderate

European federation of Psychotherapy


Demand'side'

Supporting interests

Supply'

Benefits from supporting Ability to generate political action

Prediction

Predicted amount of political actions

ALTERNATIVES!

Low

Low

Low

Low

Low

Low

Low

Low

Low

Low

Low

Low

Low

Low

Low

Low


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The European Health Psychology Society (EHPS) and the European Federation of Psychologists association

Moderate Moderate Moderate High High No information Moderate

European Commission

Low High High

Organization for Economic Cooperation and Development

Low High High

High High High High

High High High High

NGO “Prescrire”

Low High High Low High Moderate Low

Working in the pharmaceutical field

High Low Low Low Moderate Low High

Numbers Coverage Financial & HR Cost of organising

Demand'side'

Opposing interests

Supply'


Prediction


Low Low

PARTNERS!

High

High

NGO!

High

Our Analysis • We deliberately leave the large amount of alternative stakeholders and our lack of information

about them: they sometimes have 3-4 associations or federations by alternative: that's a lot. And when we got information about their budget, it's pretty low: for European Council for Classical Homeopathy, They have only made 48,200 € of total incomes this year. Alternatives should focus their strength into a single entity to have a bigger budget in order to increase their amount of political actions to cope with pharmaceutical companies.'

• The support of the “Prescrire” NGO would have been interesting but they want to keep their independence from any advertisement or pressure groups (it’s even their first rule). We will not lose budget to approach them.

• Once again, we do not trust Psychotherapist association. We believe that their links with pharmaceutical companies is too strong to invite them.'

• The cost to involve our partners in the game is too high.''

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UNIVERSITIES!AND!RESEARCH!INSTITUTES!

Low


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European Association of Hospital Pharmacists

Low High

High

European Society of Clinical Pharmacy

Low High High

High High High High

High High High High

Pharmaceutical group of the European Union

Low High

High

European Association of Pharmaceutical Wholesalers

Low High High

European federation of Pharmaceutical industries and Associations

Low High High

Association of the European Self-Medication Indsutry

Low High High

European Generic Medecines Association

Low High High

Low High High High

Low High Moderate High

Low High High High

Low No info High High

Low High High High

Numbers Coverage Financial & HR Cost of organising

Demand'side'

Opposing interests

Supply'


Prediction


Moderate

Our Analysis Pharmaceutical companies have large financial and human resources. By cons, they are highly isolated. Added to this, they will have to spend a lot of time to be organized and gathered. We must then be extremely fast. Also, we have to isolate them in order to marginalize them playing on stereotypes (“They only want our money.” “They do not fight for our wellness anymore”, etc.''

PHARMACISTS!

Moderate

PHARMACEUTICAL!COMPANIES!

High

High

Moderate

Low

Moderate

High

Despite this distributive politic spreadsheet, we seriously believe that the issue is not about supporting or opposing interests but about neutral interests. If we want to win this, we have to gather neutral interests. In order to do that, we will analyze frames of neutral interests and how pharmaceutical companies are dealing with it.


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Frame of the issue • Citizens: They are not aware of this issue despite the fact that it concerns them. Information

about it is extremely complex: if we want to attract them to us, it will be needed to provide them understandable and shocking information. The marketing of pharmaceutical companies does not target them.

• Doctors: there are those who are aware, those who are naive, ignorant and those who are under the influence. Difficult to distinguish between all the different categories and especially difficult to compete with pharmaceutical companies, capable of providing 50,000 euros to send 40 doctors to travel, to pay 1,500.000 euros to doctors in order to ensure 2580 patients. (France 2, Laboratoire Pharmaceutiques, un lobby en pleine santé, 2013) or to invest 115 billion dollars in marketing to promote the Lexapro (Mikkel Borch-Jacobsen, Maladie à vendre, 2011)

• Journalists need deep and complete information to offer to their readers. We must provide them both original and interesting information. Press conferences with one expert speaker must be avoided. Indeed, if we hold a press conference with an expert, pharmaceutical companies will launch 10 conferences with 50 other experts.

• Politicians have to act for the good of citizens, but sometimes they have to deal with extremely complex matters where they are easily influenced by the pharmaceutical lobby. They need to feel the pressure of citizens to act in our direction.'

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SWOT!'

Opportunities Threats

S W O T

Weaknesses Strengths

For this lobbying campaign, our main threat will be the lobbying of pharmaceutical companies. This lobbying had already worked pretty well for the DCM V according to the “DSM-5 Panel Members' Financial Associations with Industry” study. (s. Appendix 2). DCM IV, which will be released on May 2013, is another threat because it will put ICD in the shade. Our main problem will be our budget, far away from the budget of pharmaceutical companies but we have the advantage to fight for the public good. Finally, alternatives could help us by bothering pharmaceutical companies.


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II.!Information!and!communications!campaign!

Pharmaceutical companies

Doctors

Journalists

Pharmacists

Politicians

How'we'are'going'to'communicate''

How'pharmaceutical'companies'communicate''

Journalists Citizens

Politicians

Doctors

Pharmacists

Pharmaceutical' companies' focus' their' communication' on' doctors,' journalists,' pharmacists' and'politicians.''Those'companies'are'able'to'spend'2'times'our'budget'only'for'40'doctors.'It'would'be'foolish'to'compete'them.'They' forget,'however,'citizens' in' their'communication.'That's'why'we'will'use'citizens' to'unlock'every'other'stakeholders.'

Objectives!

1. We need to gather alternatives to act on « the Trivialization and denigration

of alternatives » issue. Indeed, besides the fact that this is a big issue, it will distract pharmaceutical companies while we are dealing with the real issue.

2. Make the bad practices of pharmaceutical companies public in order to monopolize citizens.

3. Prepare for the introduction of ICD.


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1.Business Meeting with alternatives ! Date: January 2014 and February 2014, before the real lobbying campaign. ! Guests:

• European Committee for Homeopathy • International Institute of Phytotherapy • European Federation of Herbalism • European Phototherapy Center • European Association of Acupuncture • European Federation of Osteopaths

First, we will invite them individually in a meeting room. We need to persuade them to ally together in one federation in order to compete with pharmaceutical companies. We will expose them:

• Our views of the alliance its benefits. • Other federations that we would like to invite

We will ask them individually:

• What they could bring financially in this alliance. • Their personal opinion about of this alliance. • Goals that they would like to achieve against pharmaceutical companies.

After receiving each alternative, we will try to gather every wishes and views into a consensus project. We will then expose them this consensus project during business meeting and try to reach an agreement. Finally, we are going to hold a third business meeting to organize the lobbying campaign in order to promote alternatives and to cope with « the Trivialization and denigration of alternatives » issue.

Objective: Distract pharmaceutical companies while we are dealing with the real issue'


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2. Participatory democracy Date: April 2014 We believe that the best communication strategy to pressure politicians is the political advertising activity because it takes public opinion as witness. We just need to gather public opinion with the intention of showing it to journalists. In order to do this and to show the inconsistencies of the DCM V, we will gather 754 students (because it is the number of Members of the European Parliament) in the European Parliament during a weekend while real members are in Strasbourg. We believe that it would be a good advertisement for Europe to allow students to see how it looks like to be a Member of the European Parliament. If it were not possible to organize it in the European Parliament, we will rent a conference room for this amount of people. We will also try to get Erasmus students in order to represent every European nationalities. Introduction: ! We will give them a briefing explaining what is the DCM V and issues at stake. After

that, they will be gathered in groups and we will ask them to make their own DCM according to what seems relevant to them.

! We will also ask them to tell us what are the most hilarious diseases they had seen

during this weekend. Workshop: For each group of 30, a scientist and a psychiatrist will help them in their task to understand every aspect. During this workshop, some selected journalists and bloggers will be invited to cover the event. In addition, we will rely this action on social networks and everything will be filmed and watchable on a live Youtube channel. It will be also possible for surfers to vote for their most hilarious diseases and to participate in the DCM-V’ from the Web. Results: At the end of the weekend, we will grant our top 3 awards of the most hilarious diseases and compare the DCM-V’ from the students and from the Web with the real DCM V. We believe that the difference will be notable because there are a lot of ridiculous diseases. This difference will be the evidence that the public opinion doesn’t match to pharmaceutical companies interests. It will also be a signal to politicians: “ watch what people without any interest think of this “.


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3. Press conference Date: April 2014 After the workshop, we are going to hold a press conference at the European Commission to present the results. We will provide to each journalist a press kit gathering every information: ! The comparison between DCM-V ‘ and DCM V ! The diseases awarded. ! The “A Comparison of DSM-IV and DSM-5 Panel Members' Financial Associations with

Industry: A Pernicious Problem Persists“ study ! Some abstract of the book “Bad Pharma: How drug companies mislead doctors and

harm patients » ! Some information about the ICD that is going to be released in 2015 We will show them the results from our workshop and the diseases awarded. Our strategy is that specialized media will talk about the comparison between our DCM-V and the real one and that general media will talk about the awards. Since a lot of media and blogs do not have any correspondent in Brussels, we are going to broadcast the press conference on Internet and it will be possible to ask questions by videoconference. We will also show them the other bad practices of the pharmaceutical companies: direct marketing to the doctors and pharmacists, launch of fake new drugs, problem of side effect reports, etc.

Objective: 1. Make the bad practices of pharmaceutical companies public in order to monopolize citizens

2. Prepare for the introduction of ICD '


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III.!Budget!

Business meetings 3x Meeting Room Workshop 1508x Catering 75 experts Internet charges Conference room Press conference 1x Location of a conference room Conference speaker Agence fees

1050€

7540€ 7500€ 2000€ 3500€

0€ 500€

2500€

Total: 24590 €


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'''''Appendix'1''''

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Appendix'2'''''''''''''''''''''' '''''''''''Appendix'3''PHARMACISTS:

1) EUROPEAN ASSOCIATION OF HOSPITAL PHARMACISTS: EAHP is an association of national organizations representing hospital pharmacists at European and international levels. They are 32 member countries. EAPH is mainly funded by member subscriptions, annual congress income, annual congress advertising income and educational grants.

2) EUROPEAN SOCIETY OF CLINICAL PHARMACY Their members are clinical pharmacists, hospital pharmacists, pharmacist communities, researchers and educators. There are 500 members in 53 countries. Members and boss subscriptions, gifts, grants and scientific sessions or publications, mainly fund ESCP.


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PHARMACEUTICAL COMPANIES

1) PHARMACICAL GROUP OF EUROPEAN UNION PGEU assembles pharmacist national associations and pharmacist professional unions in 32 European countries. PGEU is funded by member subscriptions.

2) EUROPEAN ASSOCIATION OF PHARMACEUTICAL WHOLESALERS EAPW brings together 750 pharmaceutical full-line wholesalers in 31 countries.

3) EUROPEAN FEDERATION OF PHARMACEUTICAL INDUSTRIES AND ASSOCIATIONS

The European Federation of Pharmaceutical Industries and Associations (EFPIA) represents the pharmaceutical industry operating in Europe. Through its direct membership of 33 national associations and 39 leading pharmaceutical companies, EFPIA is the voice on the EU scene of 1,900 companies committed to researching, developing and bringing to patients new medicines that will improve health and the quality of life around the world. The Federation is mainly funded by annual member subscriptions.

4) ASSOCIATION OF THE EUROPEAN SELF-MEDICATION INDUSTRY The association brings together 25 national associations in 25 countries.

5) EUROPEAN GENERIC MEDECINES ASSOCIATION The association assembles 52 companies and associations in Europe. There are 1500 people who are employed by the European Generic Medicines Association's companies and associations.

ALTERNATIVES HOMEOPATHY

1) EUROPEAN COMMITTEE FOR HOMEOPATHY (E.C.H.) ECH is about 6500 homeopathic doctors in Europe and 40 associations in 25 countries.

2) EUROPEAN COUNCIL FOR CLASSICAL HOMEOPATHY ECCH represents 6762 individual members. 76 % (5326) of them are practitioners. 27 associations are members in 24 European countries. Funds are provided by member subscriptions. In 2010, the incomes were esteemed to be around 48200 euros.

3) LMHI (LIGA MEDICORUM HOMOEOPATHICA INTERNATIONALIS) LMHI 's members are 70 countries worldwide.


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PHYTHOTHERAPY

1) INTERNATIONAL INSTITUTE OF PHYTOTHERAPY (AUDERGHEM) IIP is unique in Europe. NUTRITHERAPY

1) EUROPEAN FEDERATION OF HERBALISM It's the unique European federation that we have found. PHOTOTHERAPY

1) EUROPEAN PHOTOTHERAPY CENTER

2) EUROPEAN SOCIETY FOR PHOTODYNAMIC THERAPY IN DERMATOLOGY 19 countries are members of the ESPTD.

3) EUROPEAN INFORMATION CENTER OF PHOTOTHERAPY ACUPUNCTURE

1) EUROPEAN STUDY CENTER OF ACUPUNCTURE Unique European study center reported.

2) INTERNATIONAL COUNCIL OF MEDICAL ACUPUNCTURE AND RELATED TECHNIQUES

Their members are 35,000 physicians practicing acupuncture and related techniques, 90 medical acupuncture associations and colleges worldwide. Funds are provided by member subscriptions, gifts, subsides and all others forms of income.

3) A.P.E.M.E.C.T. (EUROPEAN ASSOCIATION FORT TRADITIONAL CHINESE MEDICINE PROMOTION)

4) EUROPEAN ASSOCIATION OF JAPANESE TRADITIONAL MEDICINE

5) EUROPEAN ASSOCIATION OF ACUPUNCTURE

OSTHEOPATHY

1) EUROPEAN FEDERATION OF OSTEOPATHS

The EFO represents 17 country members with one national organization by country. PSYCHOTHERAPY

1) EAP - EUROPEAN ASSOCIATION FOR PSYCHOTHERAPY


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EAP assembles 128 organizations, more than 120.000 psychotherapists in 41 European countries. Funds are provided by admission fees, annual membership fees, certification fees, ECP registration fees, Conference, lectures and meeting fees, contributions, sales from publications, donations, interests and any others forms of income approved by EAP board.

2) EUROPEAN FEDERATION OF PSYCHOTHERAPY The only one European federation reported.

3) EUROPEAN FEDERATION OF PSYCHOLOGISTS ASSOCIATION The EFPA covers 35 countries. 27 of them are UE's members except Romania. Each country is represented by one association.

4) THE EUROPEAN HEALTH PSYCHOLOGY SOCIETY (EHPS)

PARTNERS

1) EUROPEAN COMMISSION

23 000 people are employed by the commission. The Commission awards money in the form of grants in order to implement projects or activities in relation to European Union policies. These grants may be awarded within fields as diverse as research, education, health, consumer protection, protection of the environment, humanitarian aid, etc.

2) ORGANIZATION FOR ECONOMIC COOPERATION AND DEVELOPMENT (OECD)

OECD counts 34 countries, 250 committees, working groups and expert groups. Over 40 000 people examine OCDE's work provided by secretariat each year. OECD is funded by country contributions. The USA is the country that contributes to the more. Budget part1 is around 185 M EUR in 2012 and budget part 2 is around 93 M euros in 2012.


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DOCTORS

Media invited to the press conference 'FRANCE

1) Le Parisien/ Aujourd'hui en France 2) Le Monde 3) Le Figaro 4) Libération 5) La croix 6) Les Echos 7) La Tribune 8) L'humanité 9) International New York Times 10) Métro (gratuit) 11) 20 minutes (gratuit)

BELGIUM

1) Le Soir 2) La Libre Belgique

ITALY

3) La Repubblica 4) Corriere Della Serra

Substitute Magnitude Per capita

Number Coverage Financial and HR resources

Cost of organizing

Predicted amount

of political action

European association of senior hospitals physicians

Low High High Moderate High No information

High Low

European Union of Medical specialists

Low Igh High High High No information

High Low

Standing Committee of European Doctors

Moderate High High High High No information

High Low

European Council for medical orders ( C.E.O.M)

Low High High Moderate High No information

High Low


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5) Il Giornale 6) La Stempa 7) Il Messagero 8) Il Mondo 9) Il Sole 24 Ore 10) Il Foglio 11) Internazionale

SPAIN

4) El Mundo 5) El Periodico 6) El País 7) ABC 8) La Razon 9) La Vanguardia

GERMANY

4) Die Tageszeitung 5) Die Welt 6) Frankfurter Allgemeine 7) Frankfurter Rundschau 8) Hamburger Morgenpost 9) Neues Deutschland 10) Süddeutsche Zeitung

SWITZERLAND

2) L'express 3) Le Temps

PORTUGAL

5) Correio da Manhà 6) Diário de Republica 7) Diário de Notícia 8) Jornal de Notícia 9) O Primerio de Janeiro 10) Publico

UNITED-KINGDOM

4) The Times 5) The Daily Telegraph 6) The Guardian 7) The Independent

NETHERLANDS

5) De Telegraaf 6) The Netherlander 7) De Volkskrant 8) Rotterdams Dagblad


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9) Dagblad de Limburger 10) De Gelderlander 11) NRC Handelsblad 12) De Binnenvaartkant

LUXEMBURG

6) Luxemburger Wort 7) Tageblatt 8) Lëtzebuerger Journal 9) Zeitung vum Lëtzebuerger Vollek 10) Le Quotidien 11) L'Essentiel

Press agency

FRANCE 1) Africa-Press 2) Agence CAPA 3) Agence France-Presse 4) ASP Média 5) News Press

BELGIUM

1) Agence Belga ITALY

1) Agenza Nationale Stampa Associata SPAIN

1) Agence EFE GERMANY

1) Deustche Presse-Agentur 2) DAPD Nachrichtenagentur

PORTUGAL

1) Lusa UNITED-KINGDOMN

1) Spread Pictures 2) Reuters

SWITZERLAND

1) Agence Telegraphique Suisse NETHERLANDS

1) Algemeen Nederlands Persbureau 2) Firat News Agency


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TV FRANCE

1) LCI 2) i>Télé 3) BFM Tv 4) FRANCE 24 5) BFM BUSINESS

ITALY

1) Rai News 2) Class CNBC 3) Sky TG24 4) Repubblica Tv 5) TG Norba 24 6) Tgcom24

SPAIN

1) 24 horas (TVE) 2) CNN+ 3) 3/24 4) Canal Nou 24

GERMANY

1) Deutsche Welle 2) N-tv 3) N24

PORTUGAL

1) SIC Notícias 2) RTPN 3) TVI24

UNITED-KINGDOMN

1) Sky News 2) BBC World News 3) BBC Arabic Television 4) ITV News Channel

SWITZERLAND

1) SRF Info NETHERLANDS

1) NOS Journaal EUROPE

1) CNN International 2) EURO NEWS