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THE PHARMA REVIEWSMARKETING FORUM
Newsletter for the Healthcare Marketer
SEPTEMBER 2009Volume 1 Issue 1
Published by:
SALIL S. KALLIANPUR
Mumbai, India
Social Media Informal and Effective Medium
The Role Of Social Media In Spreading Health Awareness
Does the Pharmaceuticals Industry Need More Regulations?
Unholy Nexus Between Pharmaceutical Companies and Doctors Poor Consumers!
At the intersection of healthcare and life
CONTENTS
SPECIAL FEATURECan reality TV
become a source ofhealth awareness?
What pharmalobbies in India canlearn from the G-20
Summit
SPECIAL FEATURE
Big Pharmas Emerging Markets Strategy
Will Big Pharma Help Develop Emerging Markets Or Simply Milk Them?
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At the Intersection of Healthcare and Life
SALIL S. KALLIANPUR
I am just another guy caught in the quagmire of pharmaceuticalmarketing, trying to get my two cents across through my blog andthis newsletter. I haven't worked outside the pharmaceuticalindustry and outside the sales & marketing function. I sincerely hopethat there will be people from other industries and domains who willdeem it fit to share their views and rich experiences. Last but notleast, I am no John Mack, so do forgive the limitations in viewsexpressed! It is my sincere hope that this newsletter helps each of usunderstand how our work in healthcare marketing intersects withlife, in general, and helps us to become better human beings.
My Two CentsEven as the world, this month, gave way to a New Economic Order where G20 nations replaced G8 asthe new power club, the global healthcare arena continued to grapple with basic issues. A report from theEuropean Centre for Disease showed a need for more antibiotics that are effective against multi drug-resistant bacteria. World leaders committed to new funding for women's and children's health whileconceding that more is needed. Hope arose as a new vaccine showed it could cut risk of HIV and yet
Africa may not get it since health systems in the region are unequipped to deliver a vaccine successfully.The World Health Organization warned that the parasite which causes malaria is increasingly resistant toartemisinin, the best drug available, and this trend could have serious consequences. And, damage to thereputation of drug companies continued as some reputed medical journals exposed articles written bysponsored ghostwriters and companies paid out billions of dollars to settle other regulatory violations.
In a global arena where Asia will emerge as the world's predominant power player, TB, a preventable andcurable disease, still remains one of the worlds major causes of illness and death, resulting in close to 2million deaths in 2007. The majority of TB cases and deaths are concentrated in developing countries,particularly those in Asia and Africa. These unmet basic needs offer great opportunity to BigPharma to
develop sustainable solutions for two of its biggest problems a) develop new markets that can help spurgrowth and b) address the lack of trust within communities in the midst of product recalls and clinical data
controversies. Would BigPharmas strategy for Emerging Markets be to develop them or milk them dry?How will it tackle the onslaught of regulations that are likely to create entry barriers? Would its edge inglobal politics, economics and technology allow it to break away from replicating western business practicesand set up game-changing ones customized for local markets in line with GE and Ford? Thank you forsparing time to read the inaugural issue ofThe Pharma Reviews Marketing Forum Newsletter. I hope you like it!
From the Editors Desk
SALIL S. KALLIANPUR
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At the intersection of healthcare and life
Big Pharmas Emerging MarketsStrategyWill Big Pharma help develop Emerging Markets orsimply milk them?
As developed economies and markets slow down, the global pharmaceutical industry,like other business sectors, is viewing the emerging world to spur global growth. Whilethis is a welcome move, the question is will these businesses look to develop the market orsimply milk them? Recently, the World Bank announced $4.3 billion in loans to India.While these were largely to recapitalize public banks, the need of the hour is s focusedplan to develop infrastructure in the country. Nobel prize winners Joseph Stiglitz andAmartya Sen highlighted the need to develop indicators such as public health and socialwellbeing, amongst others, in a recent report which considers these measures besides theGDP as indicators of prosperity. Will the industry work with the government to make thishappen? According to the Federation of Indian Chambers of Commerce and Industry(FICCI), India needs to spend around $203 billion, if the mission of achieving 'Healthfor all' is to be attained by 2012.The World Development Report 2009 finds that rural-urban gaps in wealth must be reduced quickly. Lagging areas and provinces distantfrom domestic and world markets must be sustained through territorial developmentprograms that bring jobs to the people living there. The most successful nations institutepolicies that make basic living standards more uniform across geography. Theattractiveness of India is the size of the market. Will Big Pharma view this as anopportunity to encourage community based initiatives to include the ~70% of rural
population that still has little or no access to modern healthcare?
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Significantly improving the level of health care is veryimportant in raising the standard of living among
developing countries which in business parlance are
today called Emerging Markets. Analyst reports on
the future of the pharmaceutical industry predict that
the changing dynamics of mature and emerging
markets signify a large upheaval in the way of the
pharmaceutical world. IMS Global Pharmaceuticaland Therapy Forecast shows that growth in
emerging markets is already outstripping growth in
the developed markets of North America, Europe,
and Japan. However, despite pharmas newfound
enthusiasm for emerging markets, these markets will
not transform overnight into less developed versions
of European and U.S. markets. For years, the R&D-
based pharmaceutical industry viewed todays
emerging markets as hostile territory where a
combination of low prices and nonexistent intellectualproperty protection made market entry an
unattractive prospect. Now, many Western
pharmaceutical companies are viewing emerging
markets as a future customer base because these
markets offer a greater growth potential than mature
markets.
Emerging markets will prove to be a very important
part of future corporate growth as long as companies
do not expect overnight miracles and are prepared to
adjust their strategies, product ranges, and pricing to
suit target countries.Josh Ruxin, who writes for the
Huffington Post, estimates that it will take a minimum
of a decade to build the necessary delivery
infrastructure and create the ability to pay for
sophisticated pharmaceuticals in the emerging world
before the pharmaceutical markets there begin to reach
the value and volume of the pharmaceutical markets
that currently exist in the developed world.
There in lies the great opportunity. A chance to
channelize the focus of the global industry for the good
of the people of India. If the industry wants to milk
the market, it must be ready to develop it as well.
After all, sound business sense lies in milking a cow and
not sucking it dry! And, India isa cash cow! Ruxins
experience as Country Director for the Millennium
Village Project in Kigali, Rwanda, where he currently
focuses on comprehensive approaches to fighting
poverty with emphasis on scaling up national health
programs has been that unless industry collaborates
with governments to help improve the people's health,
any attempts to help them lift themselves out of
poverty will ultimately fail. As he puts it, "public health
holds all our efforts together". Public health, however,
is not just drugs and equipment it is the effective
distribution of those drugs to those who need them and
effective use of that equipment to cure disease or keep
people healthy. For both of these, we need health care
infrastructure. We need management systems and
people with leadership skills. This is what big pharma
can provide. But, a conundrum existsif most big
pharma companies jump into emerging markets fortheir growth opportunities, will the influx of
competition and western business practices result in a
mirror image of western markets, but with a lower price
structure? .
BigPharmas Emerging Markets StrategyWill BigPharma help develop Emerging Markets or simply milk them?
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This is highly unlikely. A company no less than
General Electric has realized this. Reuters reported
today that its Chief Executive, Jeff Immelt argued in
an article published yesterday in the Harvard Business
Review, that rather than taking its high-end, high-cost
equipment and finding ways to make it less expensive
for developing-world customers, GE needs to focus
on designing lower-cost technologies that will appeal
to customers in emerging markets. Low cost, high
quality mass customization! If GE doesnt come up
with innovations in poor countries and take them
global, new competitors from the developing world
like Mindray, Suzlon, Goldwind and Haier
will, Immelt notes. Relevance to pharma? If big
pharma like Pfizer, Johnson & Johnson and
GlaxoSmithkline dont look at Indias vast swathes of
rural population as an opportunity, local Indian
generic players will. Indications are that they do!
As GE realized, innovating to create products for
emerging markets can help to find unexpected
markets elsewhere as well. In China, it developed a
$15,000 laptop-based ultrasound machine that sells
for a fraction of the $100,000-plus of the appliance-
sized units it sells to US hospitals. GE, found an
unexpected market for these machines in US
ambulance crews. With far smaller per-capita
incomes, developing countries are more than happy
with high-tech solutions that deliver decent
performance at an ultra-low cost a 50% solution at
a 15% price, Immelt wrote. Pharma has its job cut
out as this difference in bioequivalence will obviously
will not work for medicines.
A 100% solution at 30% of price sounds even better!
Today, public trust in the pharma business is lower
than at any point in living memory with community
baying for increased regulation of the "profiteering"
pharma business model. Restoring this trust will be
crucial to long-term prospects for big pharma. The
pursuit of sustainability in community-based initiatives
has a valuable role to play in rebuilding trust
Last but not least, the watchdog! With big pharma
seriouslyentering India, it will be affected by increased
regulation, even though as I wrote before, the analogy
of the global asset bubble crises showed that it was
some of the most heavily regulated financial institutions
that brought about the ruin. Nevertheless, it would be
unwise to simply reject regulation: the general public
will not understand the underlying benefit that industry
is trying to usher in. Instead, businesses should co-
operate with government to ensure that regulations are
not shaped by an angry backlash due to lack of trust,
but instead target areas where greater restraints on
action may be valuable. The crisis might have had its
genesis in the West, but the poorest, as always, will
suffer the most, for continued lack of access to basic
healthcare. In the current economic landscape, it is
imperative that companies will choose the right survival
strategies that will allow them to evolve successfully.
Charles Darwins theory that animal species evolved to
cope with changing circumstances since nature favors
the survival of the fittest, has a clear parallel with the
biotech and pharma industries now evolve or die is
the rule.
BigPharmas Emerging Markets StrategyWill BigPharma help develop Emerging Markets or simply milk them?
contd
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Clearly, large emerging markets like India are one
of the routes to evolution and future growth. But
it is very important to spare a thought to what
really happens to Indias 700mn population
surviving close to the poverty line? In rural areas,
close to 12% of income is spent on healthcare
and over two-thirds of the population do not
have access to critical medicines. Indeed, for an
impoverished Indian family, healthcare is the
second largest source of expenditure (first being
marriage of a female child). Hospitalized Indians,
on an average spend 58% of their total annual
earnings on healthcare. Over 40% borrow
heavily to cover expenses, and over a quarter fall
below the poverty line because of hospital
expenses [Source: India Pharmaceuticals &
Healthcare Report Q3 2009 Published byBUSINESS MONITOR INTERNATIONAL
LTD.] Disturbingly, what is received in return is
often substandard. For example, almost seven
out of 10 medicines sold in rural India are of
poor quality or are counterfeit. As they fight to
cut costs and identify areas for future growth,
companies should think carefully about whether
their strategy for emerging market is to drive
health or simply business.
BigPharmas Emerging Markets StrategyWill BigPharma help develop Emerging Markets or simply milk them?
contd
SPECIAL FEATURECan reality TV become asource of health awareness?
The 27-year-old British reality TVstar, Jade Goody, who was diagnosedwith cervical cancer, had saidmonths before she died that she may
allow her death to be filmed for areality show. Jade was determined tohave her story told, educate other
young women in similar situationsand do as much as she could toprevent others going through thetrauma of what she faced. SinceGoodys announcement that she hadcancer, the number of women havingcervical smears has gone up over 20percent across Britain, and thatssomething commendable.
Welcome to the era of reality TV, a
place where fiction meets reality.Besides giving the audience the thrilland excitement of live un-editedaction, reality television allows theaudience to be a part of the show.
Reality TV has arrived in India andis here to stay ! Reality shows seem tobe a huge trend on television, andanything that is popular is anopportunity to reach millions with
your messages.
Just as Jade Goody used her last daysto spread awareness on cervicalcancer, the popularity of reality TV inIndia can spread awareness ofdiseases such as polio, malaria, TB,HIV/AIDS, smoking, hypertension,diabetes, birth control and , ofcourse, swine flu.
SALIL S. KALLIANPUR
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At the intersection of healthcare and life
Does the PharmaceuticalsIndustry Need More Regulations?Unholy Nexus Between Pharmaceutical Companiesand Doctors Poor Consumers!
Doctors around the world are known to be pampered by the pharmaceutical industryand critics feel that in doing so, the companies influence doctors to prescribe productsthat may not be in the patient's best interests. Research conducted in India as well asother countries found that, though most of the doctors said that they were not influencedby these incentives, they thought that their colleagues were influenced by thesepromotions. It is also reported that some doctors demand expensive gifts and sponsorshipsfrom companies and those who fail to comply were refused the sales call. This issue bringsinto focus the aspect of marketing ethics in the pharmaceutical industry and medicalprofession. A voluntary code by The Organization of Pharmaceutical Producers of India(OPPI) announced intention of pharmaceutical companies to stop providing incentivesto doctors to influence their prescribing behavior. The code also urged companies todesist from making exaggerated and off-label claims of their products. Does the onus lieonly on companies or do doctors and patients also have a responsibility? Willintroducing regulations in India, that ban doctors from demanding gifts and favors
apart from monitoring expenses of pharmaceutical companies' on promotionalactivities, make doctors more honest? Will continued apathy from consumers on healthrelated issues help the cause? While the issue of corrupt companies and greedy doctors isdeplorable, is regulation the answer? Should the industry be distracted from addressing
broader issues that require to be addressed? Should the consumer suffer?
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ATimes of India report (Sep 16th, 2009) says in whatseems a case of giving the fox the job of guarding the
henhouse, the Govt. of India decided to curb the
practice of bribing doctors for promoting drugs by
allowing pharmaceutical companies to self-regulate
rather than have a legislation to tackle the menace.
The onus of regulating industry practices is already onthe apex body, Organization of Pharmaceutical
Producers of India (OPPI) which routinely reins in
undesirable practices of member companies. OPPI
members account for 70% of the Indian
pharmaceutical market and the body therefore, wields
significant influence over the entire industry.
However, the argument is that of the 53 pharma
members of the OPPI, most members are subsidiaries
of MNCs. While many of these companies also have
their own stringent ethical guidelines applicableglobally regarding interactions with health
professionals, over 25% have figured in bribery cases
in the US. Hence, the fox guarding the henhouse!"
These stringent guidelines are voluntarily adopted by
these companies, often rendering them on a 'not-so-
levelled playing field' against local generic companies
that are not OPPI members. This leaves them outside
the body's sphere of influence and in a position to
freely to what they please. The fact that OPPI
member companies volunteerthis information in thepublic domain seems to be held against them in the
report.
Licensed to Heal or Kill?
I WILL FOLLOW that system of regimen which, according
to my ability and judgment, I consider for the benefit of my
patients, and abstain from whatever is deleterious and
mischievous. I will give no deadly medicine to any one if asked,
nor suggest any such counsel; The Hippocratic Oath
While the practice must not be condoned in any
manner, one must pragmatically examine whetherdoctors being bribed by pharmaceutical companies is
the central issue that impacts your life and mine. The
crux is that when a doctor prescribes medicines that
help manage or cure your ailment, the brand that [s]he
chooses to prescribe is determined by the incentive that
the company offers. This means that the doctor sells
out to the highest bidder. Apart from crude avarice
which means that the doctor and company makes a few
bucks at your and my expense, how does this really
affect you? Does the medicine kill you? No! With 24X7
media, no doctor is stupid enough to risk getting into
that sort of trouble. After all, [s]he has his/her entire
practice, credibility and reputation to protect! Does the
medicine make you better? Sure! It may lighten your
pocket a bit, or not have the effect its meant to have,
but it gets you up and about. Did this happen as a result
of a bribe offered and taken? Maybe! Then isnt the
doctor equally to blame in this case?
So this is not about your life being at risk due to
counterfeit medicines but entirely about the 'unholy
nexus' between big, bad pharmaceutical companies and
greedy doctors to push certain brands over others.
Does the Pharmaceuticals Industry Need MoreRegulations?Unholy Nexus Between Pharmaceutical Companies and Doctors
Poor Consumers!
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The cold truth is that this is not a fraction as grave an
issue as being prescribed or sold fake medicines
(counterfeit drugs). The U.S. based Center for
Medicines in Public Interest predicts that counterfeit
drugsaleswill reach $75 billion globally in 2010, an
increase of more than 90 percent from 2005. The
problem of fake drugs has plagued our community
for many years. Few crimes can be more horrendous
than this one. Indirectly, this is murder in cold blood.
But, despite being a serious health hazard, there has
never been any concerted effort from stakeholders to
counter this hazard that could save millions of
innocent lives. Regulations here anyone? Nah!
Companies bribing corrupt doctors is the place to
focus on!
Health & Wealth
To view this in a different perspective, lets draw a
parallel from another event that was much more life
changing to the common man in its impact. The
global financial crisis. The timing is co-incidental and
drives the analogy. Exactly a year ago the collapse of
Lehman Brothers Holdings Inc. heralded the
underlying problems of the global financial system
and the resultant global credit crunch. This massive
upheaval led to millions of people losing their lives
savings. Worse, they also lost jobs and therefore,
opportunities to steady income and recovery of
household savings.
Why did this happen? Primarily due to the irrational
exuberance - a term that was famously used byAlan
Greenspan to describe the heightened state of
speculative fervor - of the biggest and most respected
financial institutions in the world. Revered names
such as Lehman Bros, Citigroup, Barclays, AIG and
Merrill Lynch amongst many others. These big banks,
the wisest in the world, made humongous asset-backed
investments on the basis of their credibilityand not hard
cash. When these investments (mostly in US-based
housing mortgages) lost value following the market
crash, the banks and their customers went bankrupt.
Instantly, bankers became the villains. Never mind the
fact that these same men and women had helped
millions of ordinary folks multiply their hard earned
cash during the preceding years of economic boom.
Overnight, they turned into scheming, greedy, frothing-
at-the mouth maniacs whose only aim in their lives
seemed to be to swindle hard working people of their
nest eggs! Were they guilty? Of course they were! But
does this absolve investors and the lay public of all
fault? Sounds similar?
Should We Know Better?
Why are ordinary people like you and me so gullible?
Can you be so nave as to entrust your lives savings to
some glib-talking gent who promises to double it in 6
months? The sad fact is yes we can! We can, when
we dont know better. Most of us dont. How many of
us understand personal finance and economics? Do you
know how compound interest works? Do you know
what generates more money a stock or a bond? Do
you know the difference in a company pension plan
and the Public Provident Fund (PPF) offered by the
Govt.? Those of us who understand the way this affects
our savings are still left with a lot of it. However, isnt it
ironical that people who are most knowledgeable, and
experienced, people who make money from handling
Does the Pharmaceuticals Industry Need MoreRegulations?Unholy Nexus Between Pharmaceutical Companies and Doctors
Poor Consumers! contd.
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other people's money retail and institutional
investors, investment bankers and other financial
service professionals were the worst hit by the
crisis? Did they all go nuts at the same time? No. It
was pure greed!
Knowledge, Greed and Regulation
This tells us two important things. One, basic
knowledge helps protect what is dear to us by helping
us make informed decisions. Two, knowing too much
helps one see loopholes in a system and tempts one to
make an easy buck or two. The need for regulation
arises from a lack of awareness. The onus of
protecting whats dear to you lies on who else, but
you? Can government regulations help protect you?
Not if you dont know what to expect. There are
hundreds of laws that are already there to protect you.
Do they? Only if you have a good lawyer.
Most of the healthcare system is more opaque than
the financial one (healthcare policyis probably lesser
known than the financial and banking policy). This
means fewer and fewer people know more and more.
Such a phenomenon creates opportunities for the few
who know a lot to find loopholes and exploit the
system. This creates the need for regulation. Hence,
focus is better applied on creating awareness amongst
the lay man on broader issues concerning personal
health and well-being rather than planting seeds of
suspicion about services provided by good doctors. In
this case, a few rotten apples dont spoil the entire
basket! In case it sounds like I am making a case of
removing all regulations, I am not. All I am saying is
focus on the right issues that require regulation.
Companies bribing doctors to promote one brand over
another is certainly not one of those issues
.
Lack of awareness and information can be dangerous in
matters of wealth and health. Greedy bankers did it for
their fat bonuses and promotions. Investors did it
because they wanted easy money. Both were equally
guilty. The banks created risky financial products
because investors were willing to buy them. Banks
knew about the risks involved investors didnt and
didnt bother to ask or find out. When a person, who is
most likely to value wealth over health, does not
concern himself to ensure that a financial product is
unlikely to rob him of his savings, what are the chances
that he would be concerned about the medicine his
doctor prescribes? Should the banks have informed
customers of every single risk involved in their
products? Yes, they should have.
Similarly, it is the ethical duty of pharmaceutical
companies to not hide information pertaining to drugs
that they market and ensure that doctors get the best
possible information about their products. And they
do! Companies develop marketing programs that are
most likely to appeal to doctors. They also make serious
efforts to discuss the science underlying the products
through their sales, medical and marketing teams. A
more feasible way to provide scientific information to
doctors is at conferences where companies can reach
out to large groups at one time. These conferences are
of two kinds. The first type are conferences organized
by companies. These are purely promotional in nature.
Does the Pharmaceuticals Industry Need MoreRegulations?Unholy Nexus Between Pharmaceutical Companies and Doctors
Poor Consumers! contd.
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Doctors know this and these conferences are in
highest demand. Of course, at t imes, companies
outdo themselves. Such as when they send physicians
on exotic vacations in exchange for listening to
lectures about their drugs for a few hours of the day,
while the rest of the day is quite literally a day at the
beach (or the golf course). OPPI members, mostly
MNCs, as also in their individual capacities, are
obliged to report this type of spending. Spending is
also segregated to account for money spent on
government officials and doctors who can influence
govt. This is all available in the public domain. The
point to be noted here is that onlyBig Pharma does it.
That part of the industry that is most accused of
bribery! The smaller companies who accuse Big
Pharma of charging high profits do nothing but
complain and pretend to be holier-than-thou. The
second type of conferences are annual meetings of the
various medical bodies. Pharmaceutical companies are
held hostage to financially support these conferences.
You may all be aware of this and may feel disgusted.
But, if these meetings are so disgusting then why do
doctors flock to these incentive meetings in droves?
Doctors choose venues, insist on families
accompanying them, select airlines on which they
accumulate mileage points, feel insulted when offered
anything but business class, expect air-conditioned
transport to be at their command around the clock. In
short, they treat such meetings as their annual
vacation. Anything but a serious forum where they
come to upgrade their knowledge, skills and networks.
You must watch the shock on their faces when they
are asked to pay for drinks and food that they order
on room service. This, despite the fact that companies
take care of all meals and refreshments. A doctor does
not spend one singlepenny out-of-pocket when he
attends these meetings. Ideally, as an independent
consultant, he must pay to upgrade his knowledge.
Whats your take on the number of doctors who would
attend a meeting arranged at Rang Sharda Hall (minus
alcohol) at Bandra in Mumbai versus a meeting atTaj
Exotica at Goa? So much for these 'intelligent
knowledge-based professionals How do doctors get
away with not knowing much and not bothering to get
better? Because, as lay people, we don't care! The moot
question is, how many of us are sure that the doctors
who we entrust with our families lives even know what
they are doing. How many of our doctors (at least in
India) have last appeared for an examination to test
their knowledge and skills? Regulations here anyone?
Lets make sure that doctors need to keep abreast of
latest medical developments so that you and I receive
the best possible treatment? Nah! But of course, the
companies are the villains here, arent they? Lets
regulate them!
The Broader Issue
The issue about companies bribing doctors to promote
their medicines is not about the usage of wrong drugs
that can cause you harm. It is about doctors selling out
to the highest bidder. Impact on you and me? We end
up buying brands that may not be the best, buying
medicines that we may not really need (e.g., vitamin
supplements, cholesterol reducers etc.) and help the
doctor [and the company] make his cut. How many of
us protest? How many of us bother to ask the doctor
Does the Pharmaceuticals Industry Need MoreRegulations?Unholy Nexus Between Pharmaceutical Companies and Doctors
Poor Consumers! contd.
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non-governmental bodies and citizen groups to create
health programs that positively impact community at
large.
The TOI report further says that the huge profit
margins on drugs allow companies to effectively bribe
doctors. Small-scale manufacturers of drugs have
maintained that the prices of drugs can easily be
brought down by 50%. Can big pharma do that? The
question is, why should it? The world around us is
undergoing transformational change. This change has
the potential to impact people everywhere. Isnt it sad
that after 62 years of Independence, more than 70%
of Indias population has little or no access to modern
medicine? TheWorld Development Report 2009
focuses on the role that geography plays on economic
development. What this means is that the
governments role is to focus on economic
development alone. To try to spread it out is to
discourage it--to fight prosperity, not poverty. Does
this mean that all economic activity will converge in
cities only and people in villages will continue to die
for lack of basic healthcare services? Of course not!
Development can still be inclusive. For growth to be
rapid and shared, governments must promote
economic integration through avenues such as Public
Private Partnerships (PPP). These are areas where the
cash rich industry has a focused role to play.
Many patient assistance programs run by OPPI
member companies focus on bringing in change
through all or some of these initiatives.
a) Micro-financing projects to create wealth
(jobs/income)
b) Percolate awareness on basic healthcare. In his article
Health Insurance for the Poor: Myths and Realities,
Economic and Political Weekly November 4, 2006,
David M. Dror showed that rural India has a solvent
population and the poor prioritize access to some
healthcare. Hence while access to healthcare is not a big
issue, awareness of facilities available is.
c) Utilizing technology to spread services to masses
penetrative technology such as mobile applications and
tele-conferencing.
The pharmaceutical industry can drive initiatives with
government to ensure that the infrastructure set up
through National Rural Health Mission is utilized in the
best possible way by creating
1. Awareness people know about the facilities
available
2. Access people can afford those services
3. Availability people get the services when they need
them most
4. Applicability people know how to reach the
facilities/services and are not confused about which to
use when
Industry Needs Focus Not Distractions
Healthcare regulations are justified as safety
precautions. But, whatever their purpose, almost all
regulations are best shaped over time by the institutions
that dominate the health-care landscape. This allowsthe industry to often look to deliver best value to
customers and make maximum profit while doing so. It
is in consumers best interests that they be allowed to
continue. The industry needs focus and can do without
distractions.
Does the Pharmaceuticals Industry Need MoreRegulations?Unholy Nexus Between Pharmaceutical Companies and Doctors
Poor Consumers!
SALIL S. KALLIANPUR
contd.
8/14/2019 Pharma Reviews Newsletter Sep09
14/20
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At the intersection of healthcare and life
Social Media Informal andEffective MediumThe Role of Social Media in Spreading HealthAwareness
The more people know about key health issues, the better their chances of early diagnosisand appropriate medical treatment. Unfortunately, health awareness is one of the leastfocused areas by both government and industry. The key objective of creating awarenessis to improve public understanding of health issues in order to increase the odds of earlydiagnosis, better treatment and therapy compliance. How can pharmaceuticalcompanies map and interpret relationships between stakeholders in the health-caremarket? Knowing local networks and understanding different types of influencers in a
network will be of limited value if the Marketing and Sales operations continue workingin the traditional way i.e., merely considering prescribing physicians as the soleinfluencers in healthcare decision making. Knowing more about the network requiresacting and communicating with the network stakeholders in a more tailored way.Using popular social media routes offers opportunities to create avenues to promotehealth awareness and also build the much needed trust between citizen communitiesand companies. Social media is not only being used to connect with people and find newfriends and to develop connections but can also be used to help spread awareness andpromote various social, health and other important issues. 10 years ago, one rarely knewwhere to get information on health except from doctors . Doctors hardly have the time orthe inclination to provide information. So how can social media be used to promotehealth awareness? And how is it already being used? The healthcare space is a goodexample of George Akerlofs market for lemons. Transparency through interactivity ismuch needed if healthcare service providers have to move from outlays to outcomes.
8/14/2019 Pharma Reviews Newsletter Sep09
15/20
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Social Media Informal and Effective Medium
The year 2009 has been declared the International Yearof Astronomy, a global awareness campaign to
help the citizens of the world rediscover their place
in the universe. Interestingly, of the many issues
that torment the human mind, like the refusal to
accept the inevitability of death, is the question if
life, like us on Earth, exists anywhere else in this
colossal cosmos wrote Sitaram Yechuryin aHindustan Times column published today. Human
inquisitiveness urges such a search on cosmic issues
related to health and mortality, yet no one thinks it
fit to understand how his/her healthis affected by
what [s]he does today in the materialistic [or should
I say, real] world. Can someone tell me if there was
an International Year of Health Awareness? This is
uniquely linked to an otherwise unrelated piece [in
the same newspaper] by MITs Dr.Abhijit Banerjee.
Dr. Banerjee commenting on why the healthcaresystems of both the United States and India are
flawed, notes that in India, anyone can become a
doctor by simply deciding to be one.
Whats common to both these situations? Simply the
fact that there is very little or no awareness. As I had
written earlier, in India, a doctor usually does not tell
you what you are suffering from or why he is
sending you for a test, or what medicine he is
injecting into you. This is known in economic terms
as asymmetrical or inadequate information, which
produces the phenomenon described by economist
George Akerlof as a lemon market. Akerlof
characterizes this market by all or some of the
following.
(1) Asymmetry of information, in which no buyers can
accurately assess the value of a product through
examination before sale is made and all sellers can more
accurately assess the value of a product prior to sale
doctors know the real danger [if any] that your ailment
poses to you, the value of the tests [s]he recommends to
you and the necessity of the medicines you are
prescribedYou dont. Do you bother to find out?
2) An incentive exists for the seller to pass off a low
quality product as a higher quality one Familiar? How
many times have pharmacists tried to push one brand over
another saying its the same medicine but a lot cheaper?
Dont we eagerly lap it up?
(3) Sellers have no credible disclosure technology
(sellers with a great product have no way to credibly
disclose this to buyers) can innovator pharma
companies explain why
their products are better and hence priced higher? In
case you are in the mood for pharma bashing,
explain to me why you would pay$399 for an
original iPhone fromApple and flaunt it, when we
all know that a Chinese one costs only$39.56? No
lemon market, this one!
(4) Either there exist a continuum of seller qualities
OR the average seller type is sufficiently low (i.e.
buyers are sufficiently pessimistic about the seller's
quality)
(5) Deficiency of effective public quality assurances
(by reputation or regulation and/or of effective
guarantees / warranties)Strong interconnectivity is observable between
points (4 ) - (5) above, and in two serious issues that
confront the pharmaceutical industry today - a) new
markets that can help spur growth through tough
The Role of Social Media in Spreading Health Aw areness
8/14/2019 Pharma Reviews Newsletter Sep09
16/20
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Social Media Informal and Effective Medium
times hence the forayinto emerging markets or
pharmerging markets and b) lack oftrustwithin
communities in the midst of product recalls and
clinical data controversies. It is inevitable that buyers
(customers) who are driven by prevailing economic
conditions will intensify their search for value-for-
money healthcare services, negotiate harder for lower
cost drugs, and increasingly ask whether a particular
drug is necessary or whether a less costly substitute
exists.
There are two emerging trends that can be utilized by
pharma marketers to engage consumers and spread
awareness thereby improving the symmetry of
information between seller and buyer in the Indian
context: (i) For the internet savvy customer, increased
utility of online social media as an informal and
effective medium for online engagement and (ii) For
the not-so-internet savvy consumers, the emergence
ofhealth counsel providers (term coined bySunil
Chiplunkar)
Usage of Internet based Social Media for Health
Awareness
In the west, physicians and consumers are
transforming the way they access health and pharma
content by shifting to online resources. In a year
during which more people used the Internet than
doctors for health information and healthcare
becomes less affordable for many, online health
resources and tools are emerging as an alternate way
for patients and caregivers to manage healthcare.
It is a matter of time before the trend rages in India. A
recently published report Pharma and Social Media:
The Leaders and Followers, states that the
phenomenon of social media is seeing the creation of
information and interest communities on an unparalled
scale, and health is among the most popular.
For pharmaceutical companies, the potential benefits of
using social media sites are balancedwith the need to
stay within the spirit and letter of regulation. Social
media cuts across geographic, social and economic
boundaries will regulators, especially in countries that
seek to tightly control pharmaceutical marketing, be
able to stem the tide of information and promotion
coming from outside their jurisdiction? Having said
that, using social media can help examine user attitudes
genuine patient information versus rhetorical product
support through brand sponsored discussion groups,
warn of the potential adverse events of getting therapy
this applies across the healthcare value chain; wrong
diagnosis, wrong tests, inhospitable service, high priced
medicines and off-label product use the works!
Social Media Websites:Some of the most popular social
media tools are Twitter, YouTube and Facebook.
Applications like Twitter can be used as an effective
networking tool as it is easily accessible and has a quick-
response system. Also, on Twitter, events are easily
promoted and readers' questions and answers can be
immediately posted, which help gain more audience for
websites that are referred to for increased information.
Brand-sponsored discussion groups:This refers to company
sponsored websites or affinity groups. Companies must
balance between seeking authentic consumer discussion
The Role of Social Media in Spreading Health Aw areness contd.
8/14/2019 Pharma Reviews Newsletter Sep09
17/20
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and feedback and desist from controlling
postings within those groups or chat rooms or seek to
editorialize or comment on postings about promoting
or adopting off-label uses. An example quoted in the
report describes howGardasil used. Facebook to
target its audience, teenage girls. This fan page
however, simply extends the brands website to
Facebook. This is a bad way to use social media
because all of the social features of Facebook are
disabled (for regulatory reasons apparently) by the
brand. These features include the wall, discussion
groups, and user submitted content. So, it uses social
media to effectively reach the brands audience but
prevents users from actually using social tools. By
removing interactivity, this defeats the entire purpose
of using social media tools for creating healthcare
awareness.
Emergence of Health Counsel Providers - Offline
Social Medium
These days, even a person well versed in medical lingo
can become overwhelmed by the complexity of the
health care system. In the West, many patients and
their families who can afford it are turning to patient
advocates for help. The need and therefore the
opportunity is immense in countries like India where
healthcare awareness is negligible and more
importantly vast swathes of the population are barely
literate and hence do not resort to online tools for
information. The options here are therefore face-to-
face counseling or utilizing penetrative technologies
such as mobile phones. Indian counterparts of patient
advocates can be called Health Counsel Providers
(HCPs). Creation of HCPs is a great opportunity for
pharmaceutical companies to create jobs at the bottom
of the pile people who can easily blend into the local
ethos and therefore relate easily to the local community
they service. HCPs can be professionals or
friends/relatives or from the same social circle who can
help a patient decide when and which doctor to visit,
understand diagnosis and treatment, sort out insurance
claims in both urban and rural clientele (micro-finance
ventures are likely to percolate refinancing and
insurance plans) and even accompany the patient on
doctors visits. Over time, they will be able to open
doors to specialists that a patient may not have access
to. This is likely to help consumers make informed
decisions about their own health and improve
information flow between seller and buyer thus
improving trust and confidence.
To borrow from Prof. Nirvikar Singh, University of
California, Santa Cruz, it is time that pharmaceutical
marketers began focusing more on outcomes [results]
than merely on outlays [activities]. This will lead to
increased effort at improving clinical outcomes and
more robust financial management. This must begin
with having a clear view of the path from outlays to
outcomes which can happen when we know which
interventions lead to which improvements, how reliable
the data is, or what the benchmarks should be. It is
important that pharmaceutical marketers hear from the
people affected directly consumers - to do this
effectively. For consumers to talk to us it is necessary to
reach out to them through informal and effective media
to help create symmetrical information and
transparency.SALIL S. KALLIANPUR
Social Media Informal and Effective MediumThe Role of Social Media in Spreading Health Aw areness contd.
8/14/2019 Pharma Reviews Newsletter Sep09
18/20
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What Pharma Lobbies In India Can Learn Fromthe G-20 Summit
SPECIAL FEATUREThe G-20 Summit at Pittsburgh last week forged a new framework for strong,sustainable and balanced global growth. The key highlight was the inclusion of Indiaamongst other emerging countries into the economic power club. Countries such asBrazil, China and India suddenly assumed great importance on the global stage notbecause of their military superiority or because they threaten US world dominance. It ismore to do with the fact that is best described by the scholarMinxin Peias, the worldmoving towards multipolarity.
The intersection here with the Indian healthcare space is that the size of the marketbeckons big businesses. As the market grows in attractiveness and competitiveness,regulators are bound to take notice. These can cause unpleasant entry barriers, rise ofnationalistic pride, unhealthy protectionism and other similar issues. Thisunpleasantness is bound to affect the smooth distribution of opportunities andeconomic development that has the potential to impact and improve millions of lives ofpeople at the bottom of the pyramid.Industry lobbies such as Organization of Pharmaceutical Producers of India (OPPI)that is a member of the International Federation of Pharmaceuticals Manufacturersand Associations (IFPMA), a global body representing the R&D pharmaceutical,biological and vaccine industries, must begin to actively work with the government tosmoothen out issues and ensure lowering of entry barriers for international bestpractices to percolate to India. At Pittsburgh, it was quite remarkable how much of
Prime Minister Singhs policy prescriptions made their way into the final communiqu.This is indeed a great example of excellent diplomatic lobbying by the Indian leaderand one from which the Indian pharma lobbies can learn much. It is emerging thatIndia will have an unprecedented central role in shaping the final outcome of some ofthe most vital negotiations in history.This can be largely attributed to the fact that Dr. Singh brings more to the table thanany other world leader when the discussion turns to economics, and President Obama,appears to have recognized that quickly. The key here is credibility. Dr. Singhs pastrecord seems to have worked for him. Industry chieftains in India must not lose time tocreate similar credibility. While OPPI member organizations undertake many credibleinitiatives, they hardly derive PR mileage from it preferring to lay low instead. Backchannel lobbying, if it happens, certainly delivers too little too less often to be worth theeffort. What is needed is focused and concerted initiatives by the industry to create a
recognized public health improvement drive. And by this I dont mean thepharmaceutical industry alone butall stakeholders in the healthcare business.Its time all the leaders in the healthcare services sector came together to work for thecommon good of the industry just as all leaders of emerging markets stood together toexert their say on the global stage.
SALIL S. KALLIANPUR
8/14/2019 Pharma Reviews Newsletter Sep09
19/20
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My RecommendationsSome Great Ways to Stay Informed!
Books
Magazines
Great book ongeopoliticsand history
Good read onbehavioraleconomics
Helps youunderstand thecurrent state ofaffairs in India
Excellent bookto understand
how moneydefines world
history
A leadingsource of
analysis oninternationalbusiness andworld affairs
Educates andinforms on
Indianbusiness andthe economy
Your portal toglobal politics,economics and
ideas
Serves as abridge betweenacademia and
enterprises
8/14/2019 Pharma Reviews Newsletter Sep09
20/20
http://pharmareviews.blogspot.com
At the intersection of healthcare and life
Thank you for sparing time to read theinaugural issue ofThe Pharma ReviewsMarketing Forum Newsletter.I hope youliked it!
This newsletter will benefit from your feedback andsuggestions. Please feel free to write to me [email protected]@gmail.comwith your comments and
suggestions on how to make this better and moreinteresting.
I would be very happy to receive your suggestionson topics that you think I should include in thismonthly newsletter. If you think I should featuresomething that you wrote, I will be happy to do it.
Salil S. Kallianpur
THE ENDTPRMF VOL. 1 ISSUE 1