“I’ve been lobbied. I am a lobbyist. Lobbying is not a dirty word. It’s a fundamental part of the political process. You should be a lobbyist.” This is how David Bowe, a former Member of the European Parliament and now a professional lobbyist, opened his talk at the Medtronic’s Foundation workshop in Brussels on patient advocacy. I was convinced.

I have always thought of lobbying as a dirty word. It smacks of money, graft, corruption, wining, dining, and deviousness. And it’s true that large, wealthy bodies, particularly corporations, can hire lobbyists and use their resources to achieve more influence than they deserve. But that’s all the more reason why ordinary folk and smaller organisations should lobby. Most lobbyists are not paid, said Bowe. The first people to lobby him when he became an MEP were three men on motorbikes who had ridden all the way from North Yorkshire, his constituency, because they were bothered about a directive going through the European Parliament.

The phrase I use almost more than any other these days is “Whole of society and whole of government.” I’m using the phrase as the only possible answer to the pandemic of non communicable disease, but it’s the only possible answer to almost all other big problems—climate change, global poverty, and access to good medicines. Yet I have felt that I’m above lobbying. I help produce evidence, write pieces, and hope that somebody somewhere will pay attention. Well, it’s clearly not enough. I need to learn to lobby.

Bowe spoke particularly about lobbying in Brussels, but the principles apply everywhere—although he made the point that what works in Washington, a professional and more aggressive form of lobbying, will not work in Brussels, which works much more on consensus. Lobbying in Europe may be particularly important because the European institutions are at the centre of a major economic enterprise, and if your voice can be heard in Europe you not only influence European policies but your influence may ripple around the world. MEPs and people in the commission are very open to lobbying because they lack staff and expertise, and “particularly in the case of the commission,” said Bowe, “they don’t live in the real world.”

To be an effective lobbyist you need to understand how the institutions you are lobbying work, and in the case of the institutions of Europe—the Commission, Council of Europe, European Parliament, and others—that’s particularly complex. There is a whole language to learn—of rapporteurs, directives, subsidiarity, and proportionality. You also need to get know to people—the “desk officer” in the Commission for your issue, the people in the relevant directorate, your MEP. “Brussels,” said Bowe, “works on people talking to each other.” That’s true of all political institutions and perhaps all institutions. Stay aloof and you remain unheard.

Next you must set realistic ambitions and be creative in reaching them. “Politics,” Bowe reminded us, “is the art of the possible.” There is no point wasting your time on the impossible.

Perhaps the most important thing that Bowe said was that you should propose solutions not simply present politicians and officials with problems. I fear that this is where doctors fall down: we are good on problems but less good on solutions. MEPs want to look good, and if you can present them with a workable, evidence based solution to a problem that they can present to the parliament you are likely to achieve something.

Timing is vitally important, said Bowe, as is providing the right messages to the right person in the right way. A winning lobbyist, summarised Bowe, “sets clear realistic objectives, follows the processes, knows the people, has a perfect sense of timing, uses the right instruments at the right time, is equipped with clear concise and relevant messages, tries to demolish the case of the opposition, works for the same goals as the policymaker, and builds alliances.”

Bowe also has advice specifically for the British in the audience. “Don’t be nationalistic and bombastic. Europe doesn’t work that way.”

Richard Smith was the editor of the BMJ until 2004 and is director of the United Health Group’s chronic disease initiative.

Competing interest. RS facilitated two sessions at the workshop, was paid a fee, and had his expenses paid by the Medtronic Foundation. The foundation also gives funding to several of the centres that are funded by the National Heart, Lung, and Blood Institute and the UnitedHealth Chronic Disease Initiative, which RS directs.