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At the intersection of healthcare and life

SEPTEMBER 2009
Volume 1 Issue 1

THE PHARMA REVIEWS


MARKETING FORUM
Newsletter for the Healthcare Marketer

CONTENTS

Big Pharma’s Emerging Markets Strategy


• Will Big Pharma Help Develop Emerging Markets Or Simply Milk Them?

Does the Pharmaceuticals Industry Need More Regulations?

• Unholy Nexus Between Pharmaceutical Companies and Doctors – Poor Consumers!

Social Media – Informal and Effective Medium

• The Role Of Social Media In Spreading Health Awareness

SPECIAL FEATURE SPECIAL FEATURE

Can “reality TV” What pharma


become a source of lobbies in India can
health awareness? Published by: learn from the G-20
Summit
SALIL S. KALLIANPUR
Mumbai, India
http://pharmareviews.blogspot.com
https://twitter.com/salilkallianpur
At the Intersection of Healthcare and Life
From the Editor’s Desk

SALIL S. KALLIANPUR
I am just another guy caught in the quagmire of pharmaceutical
marketing, trying to get my two cents across through my blog and
this newsletter. I haven't worked outside the pharmaceutical
industry and outside the sales & marketing function. I sincerely hope
that there will be people from other industries and domains who will
deem it fit to share their views and rich experiences. Last but not
least, I am no John Mack, so do forgive the limitations in views
expressed! It is my sincere hope that this newsletter helps each of us
understand how our work in healthcare marketing intersects with
life, in general, and helps us to become better human beings.

My Two Cents
Even as the world, this month, gave way to a New Economic Order where G20 nations replaced G8 as
the new power club, the global healthcare arena continued to grapple with basic issues. A report from the
European 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 while
conceding 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 to
artemisinin, the best drug available, and this trend could have serious consequences. And, damage to the
reputation of drug companies continued as some reputed medical journals exposed articles written by
sponsored 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 and
curable disease, still remains one of the world’s major causes of illness and death, resulting in close to 2
million 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 spur
growth and b) address the lack of trust within communities in the midst of product recalls and clinical data
controversies. Would BigPharma’s 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 in
global politics, economics and technology allow it to break away from replicating western business practices
and set up game-changing ones customized for local markets in line with GE and Ford? Thank you for
sparing time to read the inaugural issue of The Pharma Reviews Marketing Forum Newsletter. I hope you like it!
SALIL S. KALLIANPUR

http://pharmareviews.blogspot.com
https://twitter.com/salilkallianpur
At the intersection of healthcare and life

Big Pharma’s Emerging Markets


Strategy
Will Big Pharma help develop Emerging Markets or
simply 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. While
this is a welcome move, the question is will these businesses look to develop the market or
simply 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 focused
plan to develop infrastructure in the country. Nobel prize winners Joseph Stiglitz and
Amartya Sen highlighted the need to develop indicators such as public health and social
wellbeing, amongst others, in a recent report which considers these measures besides the
GDP as indicators of prosperity. Will the industry work with the government to make this
happen? According to the Federation of Indian Chambers of Commerce and Industry
(FICCI), India needs to spend around $203 billion, if the mission of achieving 'Health
for 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 distant
from domestic and world markets must be sustained through territorial development
programs that bring jobs to the people living there. The most successful nations institute
policies that make basic living standards more uniform across geography. The
attractiveness of India is the size of the market. Will Big Pharma view this as an
opportunity 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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BigPharma’s Emerging Markets Strategy
Will BigPharma help develop Emerging Markets or simply milk them?

Significantly improving the level of health care is very infrastructure and create the ability to pay for
sophisticated pharmaceuticals in the emerging world
important in raising the standard of living among
before the pharmaceutical markets there begin to reach
developing countries which in business parlance are
the value and volume of the pharmaceutical markets
today called “Emerging Markets”. Analyst reports on
that currently exist in the developed world.
the future of the pharmaceutical industry predict that
the changing dynamics of mature and emerging
There in lies the great opportunity. A chance to
markets signify a large upheaval in the way of the
channelize the focus of the global industry for the good
pharmaceutical world. IMS Global Pharmaceutical
of the people of India. If the industry wants to ‘milk’
and Therapy Forecast™ shows that growth in
the market, it must be ready to ‘develop’ it as well.
emerging markets is already outstripping growth in
After all, sound business sense lies in milking a cow and
the developed markets of North America, Europe,
not sucking it dry! And, India is a cash cow! Ruxin’s
and Japan. However, despite pharma’s newfound
experience as Country Director for the Millennium
enthusiasm for emerging markets, these markets will
Village Project in Kigali, Rwanda, where he currently
not transform overnight into less developed versions
focuses on comprehensive approaches to fighting
of European and U.S. markets. For years, the R&D-
poverty with emphasis on scaling up national health
based pharmaceutical industry viewed today’s
programs has been that unless industry collaborates
emerging markets as hostile territory where a
with governments to help improve the people's health,
combination of low prices and nonexistent intellectual
any attempts to help them lift themselves out of
property protection made market entry an
poverty will ultimately fail. As he puts it, "public health
unattractive prospect. Now, many Western
holds all our efforts together". Public health, however,
pharmaceutical companies are viewing emerging
is not just drugs and equipment – it is the effective
markets as a future customer base because these
distribution of those drugs to those who need them and
markets offer a greater growth potential than mature
effective use of that equipment to cure disease or keep
markets.
people healthy. For both of these, we need health care
infrastructure. We need management systems and
Emerging markets will prove to be a very important
people with leadership skills. This is what big pharma
part of future corporate growth as long as companies
can provide. But, a conundrum exists—if most big
do not expect overnight miracles and are prepared to
pharma companies jump into emerging markets for
adjust their strategies, product ranges, and pricing to
their growth opportunities, will the influx of
suit target countries. Josh Ruxin, who writes for the
competition and western business practices result in a
Huffington Post, estimates that it will take a minimum
mirror image of western markets, but with a lower price
of a decade to build the necessary delivery
structure? .

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BigPharma’s Emerging Markets Strategy
Will BigPharma help develop Emerging Markets or simply milk them?
contd

This is highly unlikely. A company no less than A 100% solution at 30% of price sounds even better!
General Electric has realized this. Reuters reported Today, public trust in the pharma business is lower
today that its Chief Executive, Jeff Immelt argued in than at any point in living memory with community
an article published yesterday in the Harvard Business baying for increased regulation of the "profiteering"
Review, that rather than taking its high-end, high-cost pharma business model. Restoring this trust will be
equipment and finding ways to make it less expensive crucial to long-term prospects for big pharma. The
for developing-world customers, GE needs to focus pursuit of sustainability in community-based initiatives
on designing lower-cost technologies that will appeal has a valuable role to play in rebuilding trust
to customers in emerging markets. Low cost, high
quality mass customization! “If GE doesn’t come up Last but not least, the watchdog! With big pharma
with innovations in poor countries and take them seriously entering India, it will be affected by increased
global, new competitors from the developing world regulation, even though as I wrote before, the analogy
— like Mindray, Suzlon, Goldwind and Haier — of the global asset bubble crises showed that it was
will”, Immelt notes. Relevance to pharma? If big some of the most heavily regulated financial institutions
pharma like Pfizer, Johnson & Johnson and that brought about the ruin. Nevertheless, it would be
GlaxoSmithkline don’t look at India’s vast swathes of unwise to simply reject regulation: the general public
rural population as an opportunity, local Indian will not understand the underlying benefit that industry
generic players will. Indications are that they do! is trying to usher in. Instead, businesses should co-
operate with government to ensure that regulations are
As GE realized, innovating to create products for not shaped by an angry backlash due to lack of trust,
emerging markets can help to find unexpected but instead target areas where greater restraints on
markets elsewhere as well. In China, it developed a action may be valuable. The crisis might have had its
$15,000 laptop-based ultrasound machine that sells genesis in the West, but the poorest, as always, will
for a fraction of the $100,000-plus of the appliance- suffer the most, for continued lack of access to basic
sized units it sells to US hospitals. GE, found an healthcare. In the current economic landscape, it is
unexpected market for these machines in US imperative that companies will choose the right survival
ambulance crews. “With far smaller per-capita strategies that will allow them to evolve successfully.
incomes, developing countries are more than happy Charles Darwin’s theory that animal species evolved to
with high-tech solutions that deliver decent cope with changing circumstances since nature favors
performance at an ultra-low cost — a 50% solution at the survival of the fittest, has a clear parallel with the
a 15% price,” Immelt wrote. Pharma has its job cut biotech and pharma industries now — evolve or die is
out as this difference in bioequivalence will obviously the rule.
will not work for medicines.

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BigPharma’s Emerging Markets Strategy
Will BigPharma help develop Emerging Markets or simply milk them?
contd

Clearly, large emerging markets like India are one


SPECIAL FEATURE
of the routes to evolution and future growth. But
it is very important to spare a thought to what Can “reality TV” become a
really happens to India’s 700mn population source of health awareness?
surviving close to the poverty line? In rural areas, The 27-year-old British reality TV
close to 12% of income is spent on healthcare star, Jade Goody, who was diagnosed
with cervical cancer, had said
and over two-thirds of the population do not months before she died that she may
have access to critical medicines. Indeed, for an allow her death to be filmed for a
reality show. Jade was determined to
impoverished Indian family, healthcare is the have her story told, educate other
young women in similar situations
second largest source of expenditure (first being
and do as much as she could to
marriage of a female child). Hospitalized Indians, prevent others going through the
trauma of what she faced. Since
on an average spend 58% of their total annual Goody’s announcement that she had
earnings on healthcare. Over 40% borrow cancer, the number of women having
cervical smears has gone up over 20
heavily to cover expenses, and over a quarter fall percent across Britain, and that’s
below the poverty line because of hospital something commendable.

expenses [Source: India Pharmaceuticals & Welcome to the era of reality TV, a
Healthcare Report Q3 2009 Published by place where fiction meets reality.
Besides giving the audience the thrill
BUSINESS MONITOR INTERNATIONAL and excitement of live un-edited
LTD.] Disturbingly, what is received in return is action, reality television allows the
audience to be a part of the show.
often substandard. For example, almost seven
Reality TV has arrived in India and
out of 10 medicines sold in rural India are of
is here to stay ! Reality shows seem to
poor quality or are counterfeit. As they fight to be a huge trend on television, and
anything that is popular is an
cut costs and identify areas for future growth, opportunity to reach millions with
companies should think carefully about whether your messages.
their strategy for emerging market is to drive Just as Jade Goody used her last days
health or simply business. to spread awareness on cervical
cancer, the popularity of reality TV in
India can spread awareness of
diseases such as polio, malaria, TB,
HIV/AIDS, smoking, hypertension,
diabetes, birth control and , of
course, swine flu.
SALIL S. KALLIANPUR

http://pharmareviews.blogspot.com
https://twitter.com/salilkallianpur
At the intersection of healthcare and life

Does the Pharmaceuticals


Industry Need More Regulations?

Unholy Nexus Between Pharmaceutical Companies


and Doctors – Poor Consumers!

Doctors around the world are known to be pampered by the pharmaceutical industry
and critics feel that in doing so, the companies influence doctors to prescribe products
that may not be in the patient's best interests. Research conducted in India as well as
other countries found that, though most of the doctors said that they were not influenced
by these incentives, they thought that their colleagues were influenced by these
promotions. It is also reported that some doctors demand expensive gifts and sponsorships
from companies and those who fail to comply were refused the sales call. This issue brings
into focus the aspect of marketing ethics in the pharmaceutical industry and medical
profession. A voluntary code by The Organization of Pharmaceutical Producers of India
(OPPI) announced intention of pharmaceutical companies to stop providing incentives
to doctors to influence their prescribing behavior. The code also urged companies to
desist from making exaggerated and off-label claims of their products. Does the onus lie
only on companies or do doctors and patients also have a responsibility? Will
introducing regulations in India, that ban doctors from demanding gifts and favors
apart from monitoring expenses of pharmaceutical companies' on promotional
activities, make doctors more honest? Will continued apathy from consumers on health
related issues help the cause? While the issue of corrupt companies and greedy doctors is
deplorable, 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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Does the Pharmaceuticals Industry Need More
Regulations?
Unholy Nexus Between Pharmaceutical Companies and Doctors –
Poor Consumers!

A Times of India report (Sep 16th, 2009) says in “what Licensed to Heal or Kill?

seems a case of giving the fox the job of guarding the “I WILL FOLLOW that system of regimen which, according

henhouse”, the Govt. of India decided to curb the to my ability and judgment, I consider for the benefit of my

practice of bribing doctors for promoting drugs by patients, and abstain from whatever is deleterious and

allowing pharmaceutical companies to self-regulate mischievous. I will give no deadly medicine to any one if asked,

rather than have a legislation to tackle the ‘menace’. nor suggest any such counsel;…” The Hippocratic Oath
While the practice must not be condoned in any
The onus of regulating industry practices is already on manner, one must pragmatically examine whether
the apex body, Organization of Pharmaceutical doctors being bribed by pharmaceutical companies is
Producers of India (OPPI) which routinely reins in the central issue that impacts your life and mine. The

undesirable practices of member companies. OPPI crux is that when a doctor prescribes medicines that

members account for 70% of the Indian help manage or cure your ailment, the brand that [s]he

pharmaceutical market and the body therefore, wields chooses to prescribe is determined by the incentive that

significant influence over the entire industry. the company offers. This means that the doctor sells

However, the argument is that of the 53 pharma out to the highest bidder. Apart from crude avarice

members of the OPPI, most members are subsidiaries which means that the doctor and company makes a few

of MNCs. While many of these companies also have bucks at your and my expense, how does this really

their own stringent ethical guidelines applicable affect you? Does the medicine kill you? No! With 24X7

globally regarding interactions with health media, no doctor is stupid enough to risk getting into

professionals, over 25% have figured in bribery cases that sort of trouble. After all, [s]he has his/her entire

in the US. Hence, “the fox guarding the henhouse!" practice, credibility and reputation to protect! Does the

These stringent guidelines are voluntarily adopted by medicine make you better? Sure! It may lighten your

these companies, often rendering them on a 'not-so- pocket a bit, or not have the effect its meant to have,

levelled playing field' against local generic companies but it gets you up and about. Did this happen as a result

that are not OPPI members. This leaves them outside of a bribe offered and taken? Maybe! Then isn’t the

the body's sphere of influence and in a position to doctor equally to blame in this case?

freely to what they please. The fact that OPPI


member companies volunteer this information in the So this is not about your life being at risk due to

public domain seems to be held against them in the counterfeit medicines but entirely about the 'unholy

report. nexus' between big, bad pharmaceutical companies and


greedy doctors to push certain brands over others.

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Does the Pharmaceuticals Industry Need More
Regulations?
Unholy Nexus Between Pharmaceutical Companies and Doctors –
Poor Consumers! contd.

The cold truth is that this is not a fraction as grave an such as Lehman Bros, Citigroup, Barclays, AIG and
issue as being prescribed or sold fake medicines Merrill Lynch amongst many others. These big banks,
(counterfeit drugs). The U.S. based Center for the wisest in the world, made humongous asset-backed
Medicines in Public Interest predicts that counterfeit investments on the basis of their credibility and not hard
drug sales will reach $75 billion globally in 2010, an cash. When these investments (mostly in US-based
increase of more than 90 percent from 2005. The housing mortgages) lost value following the market
problem of fake drugs has plagued our community crash, the banks and their customers went bankrupt.
for many years. Few crimes can be more horrendous Instantly, bankers became the villains. Never mind the
than this one. Indirectly, this is murder in cold blood. fact that these same men and women had helped
But, despite being a serious health hazard, there has millions of ordinary folks multiply their hard earned
never been any concerted effort from stakeholders to cash during the preceding years of economic boom.
counter this hazard that could save millions of Overnight, they turned into scheming, greedy, frothing-
innocent lives. Regulations here anyone? Nah! at-the mouth maniacs whose only aim in their lives
Companies bribing corrupt doctors is the place to seemed to be to swindle hard working people of their
focus on! nest eggs! Were they guilty? Of course they were! But
Health & Wealth does this absolve investors and the lay public of all
To view this in a different perspective, lets draw a fault? Sounds similar?
parallel from another event that was much more life
changing to the common man in its impact. The Should We Know Better?
global financial crisis. The timing is co-incidental and Why are ordinary people like you and me so gullible?
drives the analogy. Exactly a year ago the collapse of Can you be so naïve as to entrust your lives’ savings to
Lehman Brothers Holdings Inc. heralded the some glib-talking gent who promises to “double it in 6
underlying problems of the global financial system months?” The sad fact is – yes we can! We can, when
and the resultant global credit crunch. This massive we don’t know better. Most of us don’t. How many of
upheaval led to millions of people losing their lives’ us understand personal finance and economics? Do you
savings. Worse, they also lost jobs and therefore, know how compound interest works? Do you know
opportunities to steady income and recovery of what generates more money – a stock or a bond? Do
household savings. you know the difference in a company pension plan
Why did this happen? Primarily due to the “irrational and the Public Provident Fund (PPF) offered by the
exuberance” - a term that was famously used by Alan Govt.? Those of us who understand the way this affects
Greenspan to describe the heightened state of our savings are still left with a lot of it. However, isn’t it
speculative fervor - of the biggest and most respected ironical that people who are most knowledgeable, and
financial institutions in the world. Revered names experienced, people who make money from handling

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Does the Pharmaceuticals Industry Need More
Regulations?
Unholy Nexus Between Pharmaceutical Companies and Doctors –
Poor Consumers! contd.

other people's money – retail and institutional removing all regulations, I am not. All I am saying is
investors, investment bankers and other financial focus on the right issues that require regulation.
service professionals – were the worst hit by the Companies bribing doctors to promote one brand over
crisis? Did they all go nuts at the same time? No. It another is certainly not one of those issues
was pure greed! .
Lack of awareness and information can be dangerous in
Knowledge, Greed and Regulation matters of wealth and health. Greedy bankers did it for
This tells us two important things. One, basic their fat bonuses and promotions. Investors did it
knowledge helps protect what is dear to us by helping because they wanted easy money. Both were equally
us make informed decisions. Two, knowing too much guilty. The banks created risky financial products
helps one see loopholes in a system and tempts one to because investors were willing to buy them. Banks
make an easy buck or two. The need for regulation knew about the risks involved – investors didn’t – and
arises from a lack of awareness. The onus of didn’t bother to ask or find out. When a person, who is
protecting what’s dear to you lies on who else, but most likely to value wealth over health, does not
you? Can government regulations help protect you? concern himself to ensure that a financial product is
Not if you don’t know what to expect. There are unlikely to rob him of his savings, what are the chances
hundreds of laws that are already there to protect you. that he would be concerned about the medicine his
Do they? Only if you have a good lawyer. doctor prescribes? Should the banks have informed
customers of every single risk involved in their
Most of the healthcare system is more opaque than products? Yes, they should have.
the financial one (healthcare policy is probably lesser Similarly, it is the ethical duty of pharmaceutical
known than the financial and banking policy). This companies to not hide information pertaining to drugs
means fewer and fewer people know more and more. that they market and ensure that doctors get the best
Such a phenomenon creates opportunities for the few possible information about their products. And they
who know a lot to find loopholes and exploit the do! Companies develop marketing programs that are
system. This creates the need for regulation. Hence, most likely to appeal to doctors. They also make serious
focus is better applied on creating awareness amongst efforts to discuss the science underlying the products
the lay man on broader issues concerning personal through their sales, medical and marketing teams. A
health and well-being rather than planting seeds of more feasible way to provide scientific information to
suspicion about services provided by good doctors. In doctors is at conferences where companies can reach
this case, a few rotten apples don’t spoil the entire out to large groups at one time. These conferences are
basket! In case it sounds like I am making a case of of two kinds. The first type are conferences organized
by companies. These are purely promotional in nature.

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Does the Pharmaceuticals Industry Need More
Regulations?
Unholy Nexus Between Pharmaceutical Companies and Doctors –
Poor Consumers! contd.

Doctors know this and these conferences are in on room service. This, despite the fact that companies
highest demand. Of course, at times, companies take care of all meals and refreshments. A doctor does
outdo themselves. Such as when they send physicians not spend one single penny out-of-pocket when he
on exotic vacations in exchange for listening to attends these meetings. Ideally, as an independent
lectures about their drugs for a few hours of the day, consultant, he must pay to upgrade his knowledge.
while the rest of the day is quite literally a day at the What’s your take on the number of doctors who would
beach (or the golf course). OPPI members, mostly attend a meeting arranged at Rang Sharda Hall (minus
MNCs, as also in their individual capacities, are alcohol) at Bandra in Mumbai versus a meeting at Taj
obliged to report this type of spending. Spending is Exotica at Goa? So much for these 'intelligent
also segregated to account for money spent on knowledge-based professionals‘ How do doctors get
government officials and doctors who can influence away with not knowing much and not bothering to get
govt. This is all available in the public domain. The better? Because, as lay people, we don't care! The moot
point to be noted here is that only Big Pharma does it. question is, how many of us are sure that the doctors
That part of the industry that is most accused of who we entrust with our families’ lives even know what
bribery! The smaller companies who accuse Big they are doing. How many of our doctors (at least in
Pharma of charging high profits do nothing but India) have last appeared for an examination to test
complain and pretend to be holier-than-thou. The their knowledge and skills? Regulations here anyone?
second type of conferences are annual meetings of the Lets make sure that doctors’ need to keep abreast of
various medical bodies. Pharmaceutical companies are latest medical developments so that you and I receive
held hostage to financially support these conferences. the best possible treatment? Nah! But of course, the
You may all be aware of this and may feel disgusted. companies are the villains here, aren’t they? Lets
But, if these meetings are so disgusting then why do regulate them!
doctors flock to these “incentive meetings” in droves?
Doctors choose venues, insist on families The Broader Issue
accompanying them, select airlines on which they The issue about companies bribing doctors to promote
accumulate mileage points, feel insulted when offered their medicines is not about the usage of wrong drugs
anything but business class, expect air-conditioned that can cause you harm. It is about doctors selling out
transport to be at their command around the clock. In to the highest bidder. Impact on you and me? We end
short, they treat such meetings as their annual up buying brands that may not be the best, buying
vacation. Anything but a serious forum where they medicines that we may not really need (e.g., vitamin
come to upgrade their knowledge, skills and networks. supplements, cholesterol reducers etc.) and help the
You must watch the shock on their faces when they doctor [and the company] make his cut. How many of
are asked to pay for drinks and food that they order us protest? How many of us bother to ask the doctor

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Does the Pharmaceuticals Industry Need More
Regulations?
Unholy Nexus Between Pharmaceutical Companies and Doctors –
Poor Consumers! contd.

about the prescription? If we don’t, do we have the In the words of Tom Junod, "“A lot of people think
moral obligation to complain? Are we interested? If government action saved capitalism. It didn’t.
we don’t become aware who is going to stop doctors Capitalism saved capitalism…”.
from getting bribed? Some regulation? The same applies to the pharmaceutical industry as
well. Regulations also stifle competition. In competitive
To briefly go back to the analogy, wasn’t the global markets, high profits serve an important social purpose:
financial crisis the most unsettling event of this encouraging capital to flow to the production of a
century? Shouldn’t governments across the world rein service not adequately supplied. Regulations make the
in their banks and control capital to protect its industry dependent on government to shovel ever-
people? After all wasn’t the crisis aided and abetted by greater resources into health care with one hand, while
a very lax regulatory system except in Asia? Strong restricting competition with the other. In India, on one
regulatory control exercised by Asian Central Banks hand the Govt. invests less than 1% of GDP into
protected millions of Indian investors from the risk of healthcare services and on the other restricts opening
the global crisis reinforcing the theory that more the up the sector to privatization. One of the biggest
regulations, safer the banks. Yet, it was this very problems plaguing the American healthcare system is
strong state-directed lending that led to plenty of bad that the net effect of the endless layers of health-care
loans in Indian banks and required re-capitalization regulation is to stifle competition in the classic
through the liberalization policy of Dr. Manmohan economic sense. The effect of high regulations has
Singh in 1991. Remember those dark days when India created a non-competitive system where services and
had to literally sell its family silver? A combination of reimbursement are negotiated above consumers’ heads
greed and ignorance was the root cause of the by large private and government institutions. And the
financial crisis. A solution to address that cause is not primary goal of any large non-competitive institution is
by strictly regulating the functioning of banks and not cost control or product innovation or better
financial institutions since it does not address the root customer service: it’s maintenance of the status quo.
cause. While broad regulations are necessary to ensure
that bankers don’t become greedy and consumers Driving Profit or Driving Change
become more aware of risk, it is equally important to It is a well known fact that pharmaceutical companies
allow these banks to function in the way they think are cash rich. However, the fact that they give back to
best. Allow them to self-regulate. This requires society is not that well known and speculation is rife
extraordinary intervention from governments across about what happens to the oodles of cash that
the world. Yet the fact that the world seems to be companies make. OPPI/IDMA and other powerful
recovering from the crisis in just a year seems proof industry lobbies must make concerted effort to work
that the henhouse is best guarded by the fox! with medical bodies such as IMA, government and

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Does the Pharmaceuticals Industry Need More
Regulations?
Unholy Nexus Between Pharmaceutical Companies and Doctors –
Poor Consumers! contd.

non-governmental bodies and citizen groups to create a) Micro-financing projects to create wealth
health programs that positively impact community at (jobs/income)
large. b) Percolate awareness on basic healthcare. In his article
Health Insurance for the Poor: Myths and Realities,
The TOI report further says that “…the huge profit Economic and Political Weekly November 4, 2006,
margins on drugs allow companies to effectively bribe David M. Dror showed that rural India has a solvent
doctors. Small-scale manufacturers of drugs have population and the poor prioritize access to some
maintained that the prices of drugs can easily be healthcare. Hence while access to healthcare is not a big
brought down by 50%. Can big pharma do that? The issue, awareness of facilities available is.
question is, why should it? The world around us is c) Utilizing technology to spread services to masses –
undergoing transformational change. This change has penetrative technology such as mobile applications and
the potential to impact people everywhere. Isn’t it sad tele-conferencing.
that after 62 years of Independence, more than 70% The pharmaceutical industry can drive initiatives with
of India’s population has little or no access to modern government to ensure that the infrastructure set up
medicine? The World Development Report 2009 through National Rural Health Mission is utilized in the
focuses on the role that geography plays on economic best possible way by creating
development. What this means is that the 1. Awareness – people know about the facilities
government’s role is to focus on economic available
development alone. To try to spread it out is to 2. Access – people can afford those services
discourage it--to fight prosperity, not poverty. Does 3. Availability – people get the services when they need
this mean that all economic activity will converge in them most
cities only and people in villages will continue to die 4. Applicability – people know how to reach the
for lack of basic healthcare services? Of course not! facilities/services and are not confused about which to
Development can still be inclusive. For growth to be use when
rapid and shared, governments must promote Industry Needs Focus Not Distractions
economic integration through avenues such as Public Healthcare regulations are justified as safety
Private Partnerships (PPP). These are areas where the precautions. But, whatever their purpose, almost all
cash rich industry has a focused role to play. regulations are best shaped over time by the institutions
that dominate the health-care landscape. This allows
the industry to often look to deliver best value to
Many patient assistance programs run by OPPI
customers and make maximum profit while doing so. It
member companies focus on bringing in change
is in consumers’ best interests that they be allowed to
through all or some of these initiatives.
continue. The industry needs focus and can do without
distractions. SALIL S. KALLIANPUR

http://pharmareviews.blogspot.com
https://twitter.com/salilkallianpur
At the intersection of healthcare and life

Social Media – Informal and


Effective Medium
The Role of Social Media in Spreading Health
Awareness

The more people know about key health issues, the better their chances of early diagnosis
and appropriate medical treatment. Unfortunately, health awareness is one of the least
focused areas by both government and industry. The key objective of creating awareness
is to improve public understanding of health issues in order to increase the odds of early
diagnosis, better treatment and therapy compliance. How can pharmaceutical
companies map and interpret relationships between stakeholders in the health-care
market? Knowing local networks and understanding different types of influencers in a
network will be of limited value if the Marketing and Sales operations continue working
in the traditional way i.e., merely considering prescribing physicians as the sole
influencers in healthcare decision making. Knowing more about the network requires
acting and communicating with the network stakeholders in a more tailored way.
Using popular social media routes offers opportunities to create avenues to promote
health awareness and also build the much needed trust between citizen communities
and companies. Social media is not only being used to connect with people and find new
friends and to develop connections but can also be used to help spread awareness and
promote various social, health and other important issues. 10 years ago, one rarely knew
where to get information on health except from doctors . Doctors hardly have the time or
the inclination to provide information. So how can social media be used to promote
health awareness? And how is it already being used? The healthcare space is a good
example of George Akerlof’s “market for lemons”. Transparency through interactivity is
much needed if healthcare service providers have to move from outlays to outcomes.

http://pharmareviews.blogspot.com
https://twitter.com/salilkallianpur
Social Media – Informal and Effective Medium
The Role of Social Media in Spreading Health Awareness

The year 2009 has been declared the International Year (1) Asymmetry of information, in which no buyers can
accurately assess the value of a product through
of Astronomy, a global awareness campaign to examination before sale is made and all sellers can more
“help the citizens of the world rediscover their place accurately assess the value of a product prior to sale –
in the universe”. Interestingly, “…of the many issues doctors know the real danger [if any] that your ailment
that torment the human mind, like the refusal to poses to you, the value of the tests [s]he recommends to
accept the inevitability of death, is the question if you and the necessity of the medicines you are
life, like us on Earth, exists anywhere else in this prescribedYou don’t. Do you bother to find out?
2) An incentive exists for the seller to pass off a low
colossal cosmos” wrote Sitaram Yechury in a
quality product as a higher quality one – Familiar? How
Hindustan Times column published today. Human
many times have pharmacists tried to push one brand over
inquisitiveness urges such a search on cosmic issues another saying it’s the same medicine but a lot cheaper?
related to health and mortality, yet no one thinks it Don’t we eagerly lap it up?
fit to understand how his/her health is affected by (3) Sellers have no credible disclosure technology
what [s]he does today in the materialistic [or should (sellers with a great product have no way to credibly
I say, real] world. Can someone tell me if there was disclose this to buyers) – can innovator pharma
an International Year of Health Awareness? This is companies explain why
uniquely linked to an otherwise unrelated piece [in
their products are better and hence priced higher? In
the same newspaper] by MIT’s Dr. Abhijit Banerjee.
case you are in the mood for pharma bashing,
Dr. Banerjee commenting on why the healthcare
explain to me why you would pay $399 for an
systems of both the United States and India are
original iPhone from Apple and flaunt it, when we
flawed, notes that “…in India, anyone can become a
all know that a Chinese one costs only $39.56? No
doctor by simply deciding to be one.”
lemon market, this one!
(4) Either there exist a continuum of seller qualities
What’s common to both these situations? Simply the
OR the average seller type is sufficiently low (i.e.
fact that there is very little or no awareness. As I had
buyers are sufficiently pessimistic about the seller's
written earlier, in India, a doctor usually does not tell
quality)
you what you are suffering from or why he is
(5) Deficiency of effective public quality assurances
sending you for a test, or what medicine he is
(by reputation or regulation and/or of effective
injecting into you. This is known in economic terms
guarantees / warranties)
as asymmetrical or inadequate information, which
Strong interconnectivity is observable between
produces the phenomenon described by economist
points (4 ) - (5) above, and in two serious issues that
George Akerlof as a lemon market. Akerlof
confront the pharmaceutical industry today - a) new
characterizes this market by all or some of the
markets that can help spur growth through tough
following.

http://pharmareviews.blogspot.com
https://twitter.com/salilkallianpur
Social Media – Informal and Effective Medium
The Role of Social Media in Spreading Health Awareness contd.

times – hence the foray into emerging markets or It is a matter of time before the trend rages in India. A
“pharmerging markets” and b) lack of trust within recently published report Pharma and Social Media:
communities in the midst of product recalls and The Leaders and Followers, states that the
clinical data controversies. It is inevitable that buyers phenomenon of social media is seeing the creation of
(customers) who are driven by prevailing economic information and interest communities on an unparalled
conditions will intensify their search for value-for- scale, and health is among the most popular.
money healthcare services, negotiate harder for lower For pharmaceutical companies, the potential benefits of
cost drugs, and increasingly ask whether a particular using social media sites are balanced with the need to
drug is necessary or whether a less costly substitute stay within the spirit and letter of regulation. Social
exists. media cuts across geographic, social and economic
boundaries – will regulators, especially in countries that
There are two emerging trends that can be utilized by seek to tightly control pharmaceutical marketing, be
pharma marketers to engage consumers and spread able to stem the tide of information and promotion
awareness thereby improving the symmetry of coming from outside their jurisdiction? Having said
information between seller and buyer in the Indian that, using social media can help examine user attitudes
context: (i) For the internet savvy customer, increased – genuine patient information versus rhetorical product
utility of online social media as an informal and support through brand sponsored discussion groups,
effective medium for online engagement and (ii) For warn of the potential adverse events of getting therapy
the not-so-internet savvy consumers, the emergence – this applies across the healthcare value chain; wrong
of health counsel providers (term coined by Sunil diagnosis, wrong tests, inhospitable service, high priced
Chiplunkar) medicines and off-label product use – the works!
Social Media Websites: Some of the most popular social
Usage of Internet based Social Media for Health media tools are Twitter, YouTube and Facebook.
Awareness Applications like Twitter can be used as an effective
In the west, physicians and consumers are networking tool as it is easily accessible and has a quick-
transforming the way they access health and pharma response system. Also, on Twitter, events are easily
content by shifting to online resources. In a year promoted and readers' questions and answers can be
during which more people used the Internet than immediately posted, which help gain more audience for
doctors for health information and healthcare websites that are referred to for increased information.
becomes less affordable for many, online health Brand-sponsored discussion groups: This refers to company
resources and tools are emerging as an alternate way sponsored websites or affinity groups. Companies must
for patients and caregivers to manage healthcare. balance between seeking authentic consumer discussion

http://pharmareviews.blogspot.com
https://twitter.com/salilkallianpur
Social Media – Informal and Effective Medium
The Role of Social Media in Spreading Health Awareness contd.

and feedback and desist from controlling pharmaceutical companies to create jobs at the bottom
postings within those groups or chat rooms or seek to of the pile – people who can easily blend into the local
editorialize or comment on postings about promoting ethos and therefore relate easily to the local community
or adopting off-label uses. An example quoted in the they service. HCPs can be professionals or
report describes how Gardasil used. Facebook to friends/relatives or from the same social circle who can
target its audience, teenage girls. This fan page help a patient decide when and which doctor to visit,
however, simply extends the brand’s website to understand diagnosis and treatment, sort out insurance
Facebook. This is a bad way to use social media claims in both urban and rural clientele (micro-finance
because all of the social features of Facebook are ventures are likely to percolate refinancing and
disabled (for regulatory reasons apparently) by the insurance plans) and even accompany the patient on
brand. These features include the wall, discussion doctor’s visits. Over time, they will be able to open
groups, and user submitted content. So, it uses social doors to specialists that a patient may not have access
media to effectively reach the brand’s audience but to. This is likely to help consumers make informed
prevents users from actually using social tools. By decisions about their own health and improve
removing interactivity, this defeats the entire purpose information flow between seller and buyer thus
of using social media tools for creating healthcare improving trust and confidence.
awareness.
Emergence of Health Counsel Providers - Offline To borrow from Prof. Nirvikar Singh, University of
Social Medium California, Santa Cruz, it is time that pharmaceutical
These days, even a person well versed in medical lingo marketers began focusing more on outcomes [results]
can become overwhelmed by the complexity of the than merely on outlays [activities]. This will lead to
health care system. In the West, many patients and increased effort at improving clinical outcomes and
their families who can afford it are turning to patient more robust financial management. This must begin
advocates for help. The need and therefore the with having a clear view of the path from outlays to
opportunity is immense in countries like India where outcomes which can happen when we know which
healthcare awareness is negligible and more interventions lead to which improvements, how reliable
importantly vast swathes of the population are barely the data is, or what the benchmarks should be. It is
literate and hence do not resort to online tools for important that pharmaceutical marketers hear from the
information. The options here are therefore face-to- people affected directly – consumers - to do this
face counseling or utilizing penetrative technologies effectively. For consumers to talk to us it is necessary to
such as mobile phones. Indian counterparts of patient reach out to them through informal and effective media
advocates can be called Health Counsel Providers to help create symmetrical information and
(HCPs). Creation of HCPs is a great opportunity for transparency.
SALIL S. KALLIANPUR

http://pharmareviews.blogspot.com
https://twitter.com/salilkallianpur
What Pharma Lobbies In India Can Learn From
the G-20 Summit

SPECIAL FEATURE

The 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 India
amongst other emerging countries into the economic power club. Countries such as
Brazil, China and India suddenly assumed great importance on the global stage not
because of their military superiority or because they threaten US world dominance. It is
more to do with the fact that is best described by the scholar Minxin Pei as, the world
moving towards multipolarity.
The intersection here with the Indian healthcare space is that the size of the market
beckons big businesses. As the market grows in attractiveness and competitiveness,
regulators are bound to take notice. These can cause unpleasant entry barriers, rise of
nationalistic pride, unhealthy protectionism and other similar issues. This
unpleasantness is bound to affect the smooth distribution of opportunities and
economic development that has the potential to impact and improve millions of lives of
people 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 Manufacturers
and Associations (IFPMA), a global body representing the R&D pharmaceutical,
biological and vaccine industries, must begin to actively work with the government to
smoothen out issues and ensure lowering of entry barriers for international best
practices to percolate to India. At Pittsburgh, it was quite remarkable how much of
Prime Minister Singh’s policy prescriptions made their way into the final communiqué.
This is indeed a great example of excellent diplomatic lobbying by the Indian leader
and one from which the Indian pharma lobbies can learn much. It is emerging that
India will have an unprecedented central role in shaping the final outcome of some of
the most vital negotiations in history.
This can be largely attributed to the fact that Dr. Singh brings more to the table than
any other world leader when the discussion turns to economics, and President Obama,
appears to have recognized that quickly. The key here is credibility. Dr. Singh’s past
record seems to have worked for him. Industry chieftains in India must not lose time to
create similar credibility. While OPPI member organizations undertake many credible
initiatives, they hardly derive PR mileage from it preferring to lay low instead. Back
channel lobbying, if it happens, certainly delivers too little too less often to be worth the
effort. What is needed is focused and concerted initiatives by the industry to create a
recognized public health improvement drive. And by this I don’t mean the
pharmaceutical industry alone but all stakeholders in the healthcare business.
Its time all the leaders in the healthcare services sector came together to work for the
common good of the industry just as all leaders of emerging markets stood together to
exert their say on the global stage.

SALIL S. KALLIANPUR

http://pharmareviews.blogspot.com
https://twitter.com/salilkallianpur
My Recommendations
Some Great Ways to Stay Informed!

Books

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geopolitics behavioral understand the to understand
and history economics current state of how money
affairs in India defines world
history

Magazines

A leading
Educates and Your portal to Serves as a
source of
informs on global politics, bridge between
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international
business and ideas enterprises
business and
the economy
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https://twitter.com/salilkallianpur
At the intersection of healthcare and life

Thank you for sparing time to read the


inaugural issue of The Pharma Reviews
Marketing Forum Newsletter. I hope you
liked it!

This newsletter will benefit from your feedback and


suggestions. Please feel free to write to me at
salilkallianpur@yahoo.com or
skallianpur@gmail.com with your comments and
suggestions on how to make this better and more
interesting.

I would be very happy to receive your suggestions


on topics that you think I should include in this
monthly newsletter. If you think I should feature
something that you wrote, I will be happy to do it.

Salil S. Kallianpur

http://pharmareviews.blogspot.com THE END


TPRMF VOL. 1 ISSUE 1
https://twitter.com/salilkallianpur September 2009