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ReviewArticle

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SelfMedication,DoctorandMarketingofOTCProducts
RajeshUttamKanthe ResearchScholar&Faculty,BharatiVidyapeethDeemedUniversity,IMRDA,Sangli. Maharashtra. rajesha19@rediffmail.com ABSTRACT Thispaperreviewscurrentmarketingpracticesinthepharmaceuticalsector,andtheirimpacton consumer and doctor behavior. It identifies negative impacts which include misleading advertising, disease mongering and rising costs.It arguesthe needto move from industry self regulation to an independently monitored code of practice by doctors for pharmaceutical marketing.Whenagreatandnobleprofessionandtheforcesofglobalizationinteract,dramais likely to happen. This has been true where the profession of medicine and the pharmaceutical industryareconcerned.Ondisplay intherelationship betweendoctorsanddrugcompaniesare the magnificence and weaknesses of the medical profession its noble aspirations and its continuing inability to fulfill them. Also on display are the power, social contributions, and occasionalinsincereofaveryprofitableindustrywhoseproductscontributeinimportantwaysto the health and long life of the people, but an industry that at times employs methods that are deeply troubling and even immoral. Rural India and modern India put their thrust on self medication in treating minor ailments not as like in Europeans who put their trust in the neighborhood pharmacist, North Americans rely more on the advice of doctors. In countries wherehealthcareinfrastructuresandeconomiesaredeveloping,opportunitiesexisttolessenthe considerable burden consumers currently put on doctors and help governments reduce their healthcare expenditure. Self medication using over the counter products in India is seen to be common. OTC Products Medicomarketing, is the business of advertising or otherwise promotingthesaleofOTCpharmaceuticalsordrugs. Key words: Doctor, marketing, minor ailments Self medication, over the counter drugs, healthcare 1.Introduction Doctors in India are considered nothing less than gods by most rural people. Their blind faith symbolizes the reverence a doctor holds in the Indian society. Using this powerful position, doctors can reach outto people directly and via media, whenever necessary, to enlighten them about the rational usage of drugs. Doctors can curb use of unethical and irrational drugs by educating patients. They play a vital role in influencing their patients pattern of selecting and administering drugs. Doctors believe that people are not equipped enough to medicate themselves, some encourage people to inculcate selfmeditative habits which will make people moreresponsibletoclaimgoodhealthcarefacilitiesandnonspuriousandauthenticdrugs.They .1 mustinformandinstructpeopleaboutresponsibleselfmedication

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Thefactthatdoctorsincertainruralareasthemselvesareillinformedisaseriousproblemthere havebeeninstanceswheredoctorshaveknowinglynotinformedthepatientsabouttheexistence ofanoverthecounterdrug,inordertoprocurefees.Itistheattitudeofthedoctorsthatneedsto bechanged.Povertyattimesluresthemtopropagateandpromotedrugsthataregiventothem bypharmaceuticalrepresentatives,whogiveincentivesforsuchpromotion.Pharmaceuticaldrug companiesspendcorersofrupeespromotingnewdrugsanddistributingfreesamplestodoctors, though such marketing devices have little impacton physicians and their prescribing behavior. Directtophysician activities accounted for the bulk of spending, spent on a practice called "detailing"visitstophysiciansbypharmaceuticalsalesrepresentativesinordertopromotetheir 2 firm'sdrugs.Freedrugsamplesdistributedduringthesevisits .Asthecostofprescriptiondrugs continues to increase, increased attention is being focused on the role of pharmaceutical marketingpracticesasacauseofhigherdrugprices.Theconcernthatpharmaceuticalmarketing practicescompromisephysicianintegrityandhaveincreasesinpublichealthcostshasprompted governmentactionsatboththeruralandurbanlevels.Thekeypublicpolicyissueistheextentto which the industry's promotional tactics lead to an increase in appropriate versus inappropriate useofdrugsinacosteffectivemanner.Inthestudy,researchersanalyzeddataforthreewidely prescribeddrugsissuedbysome100physicianstoinvestigatetheeffectofpharmaceuticalsales representatives on physician prescribing behavior. For each of the drugs in the study, assessed the effects of changes in the numbers of sales calls and free samples on the number of new prescriptionsissued. Adetailingvisittypicallylastsfivetotenminutes,andinformationaboutadrug'scomposition, 3 therapeutic value, proper dosage and potential side effects is communicated . Although the effects of detailing and sampling differ across drugs, the effects of the marketing activities on physicianprescribingbehaviorrangedfromverysmalltomodestforeachofthedrugsstudied. For the three drugs in the study, results indicated that it would take, on average, from 1to 10 morevisitsbypharmaceuticalsalesrepresentativestoinduceonenewprescription.Itwouldtake 20to73additional freesamplestoinduceonenewprescription.Prescriptiondrugspendingby consumersisprojectedtoremainthefastestgrowingsectorofhealthcarecosts.Oncontraryto 4 popular belief,physiciansare noteasytargetsreadilypersuaded by salespeople, butratherare toughsellsasevidencedbytheminimalinfluenceofsalesactivitiesontheirprescribingbehavior. Themostimportantfactorexplainingthelimitedeffectofsalesrepresentativesisthatphysicians know they have other sources of information. Scientific papers, advice from colleagues and a physician's own training and experience also influence prescribing practices and, most 5 physicians view these sources as far more reliable and trustworthy than salespeople . Additionally, many physicians hold negative attitudes toward sales representatives, Physicians recognize that information presented is biased toward the promoted drug and is unlikely to be objective or even accurate. Thus, physicians often discount information received from a sales representative.Asphysicianshaveaccesstoalternativesourcesof information,whicharemore 6 highly regarded, it is no wonder that the salesperson's influence is minimal . Pharmaceutical marketing aimed directly at consumers might be expected to have greater impact and do this either the pharmaceutical companies should go from mass media advertising or switch their productstoOverthecounter,sothatthemarketingactivitiesarecenteredonconsumersonlyand the role of doctors become minimal,but in country like India When OTCs have taken over prescriptions drug sales where customers recommend and obtain their own medication. This

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causes a great deal of problems for the medical fraternity be it allopathic, homoeopathic or 7 ayurvedic. The study enabled the investigator to understand how the medical practitioner behavesinthefaceofanethicaldilemmawhenhis/herimportancehasbeensubstantiallyeroded 8 by OTC sales. Doctors play an important role in marketing the pharma products . The main objectiveofthispaperistostudyroleplayedbydoctorsinethicallypromotingnonprescriptive 9 drugstothepatientswhovisitinminorailmentsalso. Pharmaceuticalcompaniesarerefocusing their overthecounter (OTC) strategies, as there is increased selfmedication and consumer interest in wellnessfocused OTC products. In fact, the OTC segment is projected to have a higher growth rate than prescription medication. But OTC products require a different set of skills where doctors also play a important role. Peak performance at work and job security are nowmoreimportanttoconsumersmeaningthatpreventiveremedies,convenienceOTCs,energy boosters, brainboosting supplements and formulations for sight and hearing provide growth opportunities, along with contraceptives for women who want to work longer before having 9 children .TheOTCproductwill needtobetreatedasa fast movingconsumergoods(FMCG) product specially while communicating a benefit, ensuring distribution or ensuring consumer friendlypackaging.TheOTCpharma marketis likelytogrowatahigherratecomparedtothe overallpharmamarket.ThebiggestchallengeforpharmacompaniesdealinginOTCproductsis that,unlikethetraditionalpharmamodelofpushinggenericproductsbysellingtodoctors,the OTCsegmentismoreparalleltotheFMCGsegment.Itiscriticaltoinvestinbrandbuildingthat 10 will create a pull for the product directly from the consumers The Indian OTC market is estimated to be about Rs. 7434 crore in 2008 ($ 1.8 billion).Segments such as cough & cold preparations, analgesics, vitamins & minerals and indigestion preparations account for a little overRs.2700crore.TheIndianpharmamarketincomparisonisvaluedatabout$8.4billionin 2009.Itgrewatabout12percentCAGR from2002to2007while it isexpectedtoreach$20 billion by 2015 (CAGR of 16 percent from 2009 to 2015), as per ORG IMS estimates..Traditional medicine (Ayurvedic) accounts for approximately Rs 1600 crore+ while othersegmentssuchasmedicatedskinproducts,topicalOTCmedicines,plastersandbandages, antismokingaids,etccollectivelyaccountforoverRs3000crore. Table1:ToptenIndianbrands Sr.no Leading brands (Sales $Million) 20081638.9 India 1 DaburChyawanprash 75.8 2 Vicks 72.4 3 Boroplus 29 4 Revital 25.4 5 ZanduBalm 28.4 6 Dettol 23.7 7 Liv.52 25 8 Becosules 22.7 9 Hajmola 20.2 10 Iodex 17.6 DataSource:NicholasHallsDB62010 2009 1813.4 84.5 81.9 32.9 30.7 30.5 26.4 25.8 24.9 21.2 20.7 Grth'09/08 10.7 11.5 13.1 13.4 20.7 7.6 11.2 3.4 10.1 4.9 18.2

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Intheworldofethicalpharmaceuticals,thephysicianisstillofprimeimportanceashasbeenthe case in the past. Now, however, new marketing efforts are being directed at the consumer. Primetime television advertising and whole page newspaper ads are happening now, certainly 11 unheardofinthepast .ForOTCpharmaceuticals,thesituationisreversed. Whiletheconsumerhasbeentheprimaryfocusinthepast,andwillcertainlynotbeignoredin . the future, campaigns to medical professionals are becoming more commonplace 12As we can see there are many changes in the roles of physicians and patients ways. TherearemanyissueslikehowtobuildconsumerpreferencestowardstheOTCproducts.There arevariouswaysthroughwhichthepreferencescouldbealtered.Thiscouldbedonethroughthe effectivebrandbuildingoftheOTCproduct.Thesecondissuecouldbeonhowtobuildastrong 13 brandidentityfortheOTCproduct. Theroleofadvertisements,celebrityendorsementsandthe 14 conceptof brandmanagementinbuildinganeffectivebrandimageoftheOTCproduct. 2.Objectives 1. To find out the attitude of the Doctors towards the OTC products as compared to the Rx products. 2. To find how effective is advertising campaigns and other sales promotion tools for OTC products. 3.TounderstandthePhysiciansbehaviorandtheinfluenceofvariousfactorslikeBrand,Media andAdvertisingandpromotionalschemesetctowardsOTCproducts 3.Methodology Theinstrumentusedwasaquestionnairesurveythatwasadministeredtocollectempiricaldata. The Doctors responses were kept confidential in order to encourage openness and disclosure. Thedemographicdatacollectedincludedgender,age,specialty,education,incomeandlocation ofclinic. The attitude of the DOCTORS towards the OTC products as compared to the Rx products askingthemhowfrequentlytheyOTCProductsaremarketedtothem.Thelistofdifferenttools of marketing was created keeping in mind the more popular OTC products. The respondents ratedthequestionsonYES0RNO.Therefore,the items forthe instrumentwereadaptedfrom thevariouspreviousstudiesquotedaboveaccordingtotheirrelevance intheIndiancontext.A totalof200Doctorsweresurveyedontheirareaofspecialtyandlocation(Rural,SemiUrbanand Urban.questionswereincludedaskingrespondentstoindicatetheiragreementonthevariables inthequestionnaire. 4.ResearchMethodology Thesample forthequestionnairewasadministeredtoanonprobabilitysampleof200Doctors fromdifferentpartsofSangliandMirajarea.Thesampleof200doctorsinSangliandMirajarea were surveyed. The location of doctors available in Urban areas 88 which was morethan in

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SemiUrban area 64 and in rural area 48 Thus it was revealed that the doctors were more in UrbanareatheninSemiUrbanareaandlastlyinRuralarea.(Calder,PhilipsandTyhout1981, SprolesandKendal1986). Table2:Demographicprofilesofdoctors Area Urban SemiUrban Rural Total No.ofDoctors 44.00% 32.00% 24.00% 100.00%

88 64 48 200

Table3: DoctorspermittingOTCdrugsinminorailments Minor Ailments Headache Fever Cough/Cold Acidity Pain digestive SkinDisorders Recommend OTC 136 68% 129 64.50% 142 71% 110 55% 133 66.50% 112 56% 143 71.50% RecommendNon OTC 64 32% 71 35.50% 58 29% 90 45% 67 38.50% 88 44% 57 28.50% Total 200 200 200 200 200 200 200 100% 100% 100% 100% 100% 100% 100%

Asetofminorailmentswhichdidntrequiremedicalsupervision,doctorsofallstratapermitted OTC drugsto be used. minor ailments such as Headache the recommendation of OTC is 68% and NonOTC is 32%, for Fever the recommendation of OTC is 64.50% and NonOTC is 35.50%,forcough/ColdtherecommendationofOTCis71%andNonOTCis29%,forAcidity therecommendationofOTCis55%andNonOTCis45%,forPaintherecommendationofOTC is66.50%andNonOTCis33.50%,forDigestivetherecommendationofOTCis56%andNon OTC is 44% and for Skin Disorders the recommendation of OTC is 71.50% and NonOTC is 28.50%.ThusiswasrevealedthatuseofOTCdrugsinminorailmentasfirstlineofdefenseis permittedbydoctors. Table3:DoctorsopiniononincreasedlevelofrelyingonOTCdrugs No.ofdoctorsoutof200 DoctorsOpinion Yes Advertisement 154 77.00% 46 DoctorsDistrust 142 71.00% 58 EasilyAvailable 130 65.00% 70 EducatedCustomers 131 65.50% 69 Effective 152 76.00% 48 LowCost 136 68.00% 64 TimeSaving 144 72.00% 56

No 23.00% 29.00% 35.00% 34.50% 24.00% 32.00% 28.00%

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Table4:DoctorssourceofinformationonOTCdrugs Speciality of Doc/ Sourceof info.

Advertise Educatio Magazine ment n 26.09 1 % 30.43 3 % 4.3 5% 13. 04 % 4.7 1% 8.7 0% 4.3 5% 8.7 0% 1 5 1 6 5 3

Marketing Consumers Total Executive 39.1 3% 26.0 9% 42.3 5% 30.4 3% 34.7 8% 34.7 8% 6 2 6 0 2 2 26.09 2 100.0 % 3 0% 8.70 % 7.06 % 0.00 % 8.70 % 8.70 % 2 100.0 3 0% 8 5 2 3 2 3 2 3 100.0 0% 100.0 0% 100.0 0% 100.0 0%

Gynaecologist 6 Dermatologist 7 General Practice

4.35 9 % 21.7 6 4% 1.18 % 26.0 9% 21.7 4% 13.0 4% 36 7 8 8

3 44.71 4 8 % 34.78 Cardiologist 8 2 % 30.43 Paediatricians 7 1 % 34.78 Other 8 2 %

ThesourcesofinformationonOTCdrugsthatnormallydoctorsgetfrom.Itwasfoundthatmost ofthedoctorgotinformationfromdifferentsources.therewasnosignificantdifferencebetween specializeddoctorsbutaslightdifferencebetweenGeneralpractitionersandSpecialistsdoctor.it was found that Gynecologists were found be positive on entertaining marketing executive 39.13% for information on OTC drugs as these drugs are said to be safe in treating minor ailments during onset of pregnancy ,whereas television advertisements 26% seen by doctors, add information on OTC drugs and companies. Consumers 26.09% also tell doctors about the OTCdrugsontheirearlierexperiencewith thedrugsanddemandthesame. Table5:DoctorspermittingOTCdiv.marketingexecutivestomarketOTCproducts SpecialityofDoc/Sourceof info. Gynaecologist Dermatologist GeneralPractice Cardiologist Paediatricians Other Total Yes 5 4 75 3 4 8 99 22% 17% 88% 13% 17% 35% No 18 19 10 20 19 15 101 78% 83% 12% 87% 83% 65% Total 23 23 85 23 23 23 200 100% 100% 100% 100% 100% 100%

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Table6: DoctorsopiniononOTCdrugsmarketing Opinion FeelsUnethical Patientswilldoubt DoesntGifts DoesntSamples Notrequired Total DoctorsResponses 83 52 30 20 15 200

41.50% 26.00% 15.00% 10.00% 7.50% 100%

Table7:Doctor ResponseonadvertisementsonOTCdrugs SpecialityofDoc/Sourceof Yes info. Gynaecologists 2 9% Dermatologist 3 13% GP 43 50.% Cardiologist Ped Others Total 2 9% 4 17% 2 9% 93 No 21 20 42 21 19 21 107 91% 87% 50% 91% 83% 91% Total 23 23 100% 100% 100%

85 23 100% 23 100% 23 100% 200

The above table no 6.81 presents the opinion of doctors on OTC Products television advertisements.asseenearlierthenegativeresponsetopromoteOTCproductinanyway.Most oftheproductswhichareadvertisedontelevisionareOTC.Doctorsacrossthestratawerefound to be against advertising Drugs on any media. since it is observed that most of the drugs are advertised in health magazines a set of doctors irrespective of their spatiality have developed appositiveattitudetowardstheadvertisementsonTelevision.Thusitwasrevealedthatdoctors do watch television advertisements on drugs and were found to be of the opinion that advertisementwillspreadinformationaboutOTCproductsalongwithmedicalconditions.This will enhance the discussion with patients and build relationship doctors also opined that advertisementwilleducateconsumersonRiskandbenefitsoftheOTCdrugs. Table8: DoctorsresponseonOTCproductsadvertisements 1.Creatingwrongpictureofdoctor Doctor Totalcount % Gynecologists 23 100.00% Dermatologist 23 100.00% GP 85 100.00% Cardiologist 23 100.00% Pedi. 23 100.00% Other 23 100.00%

YES 19 16 34 20 20 18

82.61% 69.57% 40.00% 86.96% 86.96% 78.26%

NO 4 7 51 3 3 5

17.39% 30.43% 60.00% 13.04% 13.04% 21.74%

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Total 200 2.patientstakingchargeofhealth Doctor Total count % Gynecologists 23 100.00% Dermatologist 23 100.00% GP 85 100.00% Cardiologist 23 100.00% Pedi. 23 100.00% Other 23 100.00% Total 200 3.Helpseekingadvertisements Doctor Totalcount % Gynecologists 23 100.00% Dermatologist 23 100.00% GP 85 100.00% Cardiologist 23 100.00% Pedi. 23 100.00% Other 23 100.00% Total 200 4.Companyawareness Doctor Totalcount % Gynecologists 23 100.00% Dermatologist 23 100.00% GP 85 100.00% Cardiologist 23 100.00% Pedi. 23 100.00% Other 23 100.00% Total 200

127 YES 20 7 43 20 7 5

73 NO 3 16 42 3 16 18

86.96% 30.43% 50.40% 86.96% 30.43% 21.74%

13.04% 69.57% 49.60% 13.04% 69.57% 78.26%

YES 10 16 43 18 16 20 123 YES 23 18 64 23 23 20 176

43.48% 69.57% 50.40% 78.26% 69.57% 86.96%

NO 13 7 42 5 7 3 77 NO 0 5 21 0 0 3 24

56.52% 30.43% 49.60% 21.74% 30.43% 13.04%

100.00% 78.26% 75.02% 100.00% 100.00% 86.96%

0.00% 21.74% 24.10% 0.00% 0.00% 13.04%

The above table shows the set of doctors and their opinions on advertisements on television, radio and magazines, newspapers. It was revealed that most of the doctors were against the advertisements in any form during the survey. But as the questions about their opinion were analyzed discussions were found to be more positive and realistic. It was found that doctors irrespective of their specialty were found to be agreed that advertisements were creating a negative picture. It was found that Gynecologists 82.61%, dermatologists 69.57%, GP 40%, Cardiologists 86.96%, pediatrician 86% and others 78.26% were found to be accepting that OTCproductsadvertisementsdocreatewrongandunhealthypictureofdoctorsinOTCdirectto consumer advertismnets, it was also found that doctors across the strata felt OTC drugs are safer in pregnancy and majority of patients will tend to buy these OCT products as they are readilyavailableandundernomedicalsupervision.Itwasalsorevealedthatdoctorswerefound tobeofopinionthatadvertisementswerejusteducatingconsumers,helpingthemtoknowabout thehealth. Itwasfoundthatdoctorsirrespectiveoftheirspecialtywerefoundtobeagreedthat advertisements on OTC drugs will motivate consumers to take charge o there in treating their aliments while creating a negative picture of Doctor on the issue of Cost, waiting period, duration to cure etc. It was found that from the total surveyed doctors almost

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86.96%Gynecologists GP 50.40%,Cardioogists 86.96%, and others 78.26% were found to be accepting that OTC products advertisements will motivate consumer in a wrong way and consumerswillstartavoidingdoctorsandtakechargeoftheirhealthwhereasitwasalsofound that 67.75%dermatologists, pediatrics 68.75% andothers78.26% were againsttheopinion that theconsumerswilltakechargeofhealthonlyafterseeingadvertisementsastheseadvertisements were just a first line of defense and in minor ailments. It was also revealed that doctors were foundtobeofopinionthatadvertisementswerejusteducatingconsumers,helpingthemtoknow aboutthehealth. 5.FindingsandConclusion The surveyed doctors perceived that OTC drug marketing strategies will make the drugs cheaper, easily available at stores and also information of the brand. This will encourage consumers to use OTC drugs as first line of defense and reduce cost on healthcare management.Doctors response was highly negative towards self medication through OTC medicinesacrosstheconsumerstrata.Astheyfeltthatselfmedicationwithleadtotakinghealth in hands and will have detrimental effects. Few Gynecologist and dermatologist t prescribed OTCbrandsinminorailmentsastheyweresafeandeasilyavailable.Doctorswereoftheopinion thatconsumerswillgetmoreinvolvedinhealthmanagementifmoreOTCDrugsareavailable in open market without priscription.this will decrease the Foot falls at their clinic. Hence they wereagainstOTCpromotionsbycompanyrepresentativesattheirclinicsayingthatagainsttheir ethics. The study showed that Doctors in age group and with different specialties were in positiveframeofmindstatingthatOTCproductswillreachtheareaswhereprimaryhealthcare is question market private healthcare cost more even in minor ailment also so .the companies shouldbringdownthecostofOTCproductstoreachthepoor.ThusOTCproductsaremarketed andadvertisedfreelysothatmaximumconsumersareeducatedandtreatminorailmentsathome usingOTCproductsasfirstlineofdefense.SinceitcanbeexpectedthatmoreRxtoOTCswitch willincreasenumberodrugsinOTCcategoryinnearfuture,itmaybevaluabletoconductmore research on group of Consumer who consume OTC Products available to Counters freely and eitherswitchfromtheexistingbrandorcontinuetoearlierbrand.AstudyonmarketingofOTC Products using post office and postman can also be a studied as a channel o marketing OTC drugsatnationalarea. 6.References 1 ColinP.Bradley&etal(1998)PatientsAttitudetooverthecounterdrugs&possible professionalresponsetoselfMedicationsvolume15,OxfordUniversityPress,pp44 50. 2 SureshMadhavan&PrasannaGore(1994)InfluenceofPhysiciansattitudestowardsRx to OTC switches ontheir presenting behavior andoverall, Journal of Pharmaceutical marketingandmanagement,volume8pp55 62 3 DonaldL.Sullivan,StephenW.Bridwell,SujanN.Kulukarslam(1994)AnAssessment ofconsumerpurchasingbehaviorforprivatelabelVsBrandnameOTCproductsinchain pharmacies.,JournalofPharmaceuticalMarketingandmanagementVol 8.pp85 108

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4 Tracy Portner, Mickey C. Smith (1994) College students perceptions of OTC Information,characteristicsJournal,Volume8,pp142161. 5 Patricia Harrington (2002), Nonprescription drug use among university students, JournalofManagedCarePharmacyNovember/December2002(8) pp499508 6 Douglas Ws and Coworker (2008) The role of advertising in communication New OTCDrugsindication,Internetjournalofmedicinethirdworld Medicine,volume4, pp114129 7 Bela.Ganatraa,Vinoj Manning,Suranjeen&Prasad Pallipamulla(2005)Availabilityof MedicalAbortionPillsandtheRoleofChemists:AStudyfromBiharandJharkhand, India,ReproductiveHealthMattersElsevierInc,Volume13,Issue26,pp6574 8 Sheth A Khurana R Khurana V(2008.) Potential liver damage associated with Over thecountervitaminsupplements.JournaloftheAmericanDieteticAssociation108(9): pp15361537. 9 Dineshkumar.Bandetal(1995)ProfileofdruguseinUrbanandruralIndiaJournalof Pharmaeconomics.April2008,pp332346. 10 Vinay R Kamat and Mark Nichter (1998) Pharmacies self medication and pharmaceuticalmarketinginBombayIndia,JournalofPharmacologyandAnthropology, UniversityPressofArazona,TUSCON,USA,Vol5,pp194 212. BiographicalNotes Mr.RajeshUttamisservingasaResearchScholarandalsoasFacultyinBharatiVidyapeeth DeemedUniversity,IMRDA,Sangli.Maharashtra.

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