Brand positioning in India’s prescription drug market
In the first of a series of articles, Dr Rajeshwar Singh, head, Scriptamedica Farmaceutica, gives insights on brand positioning from his forthcoming book What is positioning of a brand? Once upon a time, two expressions dominated the diffuse world of marketing – the word marketing itself being hard to define, except by shouting at a housewife that shopping is NOT marketing. The two phrases were: Unique Selling Proposition (USP) in the domain of consumer marketing, and Unique Prescribing Proposition (UPP) in the restricted field of pharmaceutical marketing of prescription (Rx) brands. USP and to a lesser extent UPP are still in use but are no more vogue words. Perhaps Unique Differentiating Proposition (UDP) fits better in the prevailing brand overlap in India. Over to Al Ries… Positioning, first vocalised in 1970s by Al Ries and Jack Trout in the columns of American journal Advertising Age, rapidly snowballed into a cult. A book under the same title, published in 1981, elevated Al Ries and Jack Trout to the status of new age marketing gurus. Ries and Trout emphasised that „positioning‟ is battle for the consumers‟ mind, and not the market place. The concept caught up rapidly: Pharma marketers smelled gold in the concept, knowing well that different doctors formed their own opinion about a drug because the drug itself behaved differently in different patients having the same problem. The emphasis in the marketing of prescription-only-medicines started shifting from productcentric to patient-centric promotion, as more and more prescribing options started flooding the market – five drugs for constipation, 10 for hyperacidity, 15 for pain relief, 25 for high blood pressure… The time was ripe, and the ground fertile, for positioning to take root in the promotion of Rx brands. Positioning may be the best thing that could have ever happened to India‟s pharma market. 1.b Positioning in US-EU vis-a-vis India
originate from the same stable. was assigned to a brand of beer about to be launched in the British market. in his first job as a cub-copywriter in a UK agency. all SSRIs or selective serotonin reuptake inhibitors. David Ogilvy – the first ‘positioner’… For those PMT people who are keen on finding some differentiating feature in a me-too brand. Thus. the brand manager doubling as a medical copywriter. a Consultancy Service specialising in pharma and medical communications. decide to market more than one SSRI. an advertising sage. because many organisations. Can some semblance of brand positioning be achieved in this cacophony of pseudo product claims? The answer is a guarded YES. depicting more mango-ish mangoes. under the same marquee. and 10 of paroxetine…25 of alprazolam…the obstacles keep mounting.
The author currently heads Scriptamedica Farmaceutica.com
The brand-positioning exercise in India – truly incredible India . an account executive acted as a go-between. chopped currency notes. 15 of sertraline. and do. on forced into writing such asinine line. Without creating a credible brand differential. “my circle is more circular than yours” “my mango-flavoured formulation is more mango-ish than yours” “my tablet is triple-coated: others are double-coated” “my brand is three-and-a-half paise cheaper” One absurdity deserves another … and thus the „visualisers‟ of pharma literature have a whale of a time. visualising „economy‟ of a brand by showing melting coins. omeprazole.thus morphs at best into minimising „brand-blurring‟. He can be contacted at scriptamedica@gmail. in their basket-enlarging wisdom. bar charts of piledup coins. pantoprazole and rabeprazole can. whatever the therapy area. where one-molecule-one-brand is the norm. the brand manager of Prozac (fluoxetine) has to strategise the brand‟s positioning vis-a-vis similar antidepressant brands having as their active ingredient either fluvoxamine or paroxetine or sertraline. The Indian counterpart faces a nearparalysing situation: 20 brands of fluoxetine. the late David Ogilvy had shown the way several decades ago. lansoprazole. more that two PPIs (proton-pump inhibitors). His often-told story is worth repeating (the details vary from one raconteur to another – the essence is as follows). Agency rules did not allow copywriters to be meeting with the client directly. more squarish squares or.In the west.
. The outstandingly outlandish visuals are those which illustrate „mixed-strawberrycherry-pineapple flavours. Ogilvy.
. Ogilvy. keep afire the flame of curiosity… you WILL succeed in differentiating me-too products. irrepressible Ogilvy pleaded that he wanted to visit the brewery where the new brand was being brewed and bottled. with a profound gratitude. is history…Ogilvy goes back to the creative director of agency.” Curious as ever “but what‟s this hissing about?” “Well. was taken to all sections and departments – storage area. The New Thinking Tools… First. garnering the highest number of Oscar-equivalent Cleo and similar national awards. the left over few drops of beer in a bottle dry up.
. the manager continued. relabel and pass on the savings to the customer – hence this in-house washing plant. keep asking questions. While taking a tour of the brewery. recork. the cub copywriter heard a loud. it‟s like this. The manager responded casually “that‟s nothing new. clean them up. remarked Ogilvy. The account executive finally conceded. “Oh! that‟s our bottle washing area” the manager told him dismissively. “Sure”. and creates a campaign with the headline: “Drink So-&-So Beer: it comes to you in bottles sterilised by live steam!” The brand was a hit: and Ogilvy‟s career had hit the skies. Small wonder that the Indian branch of Ogilvy‟s agency. consider these market dynamics. the finished goods warehouse. escorted by the manager.‟‟ “Oh! I see: you actually sterilise each bottle with live steam”. convinces him about the Unique Selling Proposition (USP) for the new brand. That‟s what you are witnessing – a nozzle injects high-pressure steam into each bottle on the revolving platform.The ever-curious. “Can I have a look?‟ Ogilvy persisted. and arranged Ogilvy‟s weekend visit to the brewery. He asked about the sound‟s origin. year after year And countless copywriters (this copywriter included) acknowledge. and refill. has been keeping the flame of creativity alive. and explained on reaching the area “you see it is a practice in the beer industry to get back empty bottles. everyone is doing that!” To which Ogilvy‟s historic response was “but everyone is NOT saying that…” The rest. the fermentation chamber.. though demanding: dig deeper. form an obstinate tartar. as they say. their careers to Ogilvy. Ogilvy‟s recipe is simple. which can be dislodged only with steam. O & M. repetitive hissing noise. In accordance with the protocol for visitors.
the brand manager must learn the nuances of hypertension as well as be a master of the minutiae of antihypertensive pharmacology. 3. 2. 7. 5.Dynamic I . Patient Stratification and Disease Stratification – the two practicable positioning strategies for Rx brands in India Historically. Evolution of Patient Subsets / Cohorts over the centuries reveals the following chronology FROM One nostrum for Human and Animal ailments (in 19th century) TO One panacea for all human ills TO One medicine for each disease TO One medication for each symptom
. 8. Calcium Blockers Beta Blockers Alpha Blockers Diuretics ACE Inhibitors Peripheral Vasodilators Angiotensin Receptor Blockers (ARBs) Nitrates
(ACE = Angiontensin Converting Enzyme) Positioning so many options for the same disease-entity poses clinical challenges of a different kind. Eight Different Modes of Action BUT SAME INDICATION: HYPERTENSION 1. 6. positioning is somewhat helped by the fact that no two persons with high blood pressure have the same „clinical picture‟ even when they are twins. 2. 3. including household remedies as well as of prescription-only medicines. 7.ONE DRUG: SEVEN USES 1. 5. the splitting of patients into subgroups (subsets or cohorts in technical jargon) has been the standard approach in positioning of various medicines. 6. Mercifully. As Antipyretic As Analgesic As Antiarthritic / Anti-inflammatory For Angina Prophylaxis (as an Antiplatelet agent) For Transient Ischemic Attacks‟ (TIA) Prophylaxis For Pregnancy Toxemia Prophylaxis For Alzheimer‟s Disease
THESE ARE CURRENTLY THE SEVEN POSSIBLE USES OF ASPIRIN ALONE … more on the way Dynamic II Eight Different Classes of Drugs. 4. 4.
and third in the domain of Creative Thinking. put your problem in the centre. and start plotting all the attributes and aspects of the problem on lines radiating from the centre. and though hard-to-believe at first.TO One drug each for the same symptom (21st century) in men and women in infants and children in adults and elderly in poor patients and rich patients in dark skinned and light skinned persons Coping with overlapping molecules using new tools and novel approaches There's a way. 2. Buzan's technique.
. is a brilliantly conceived system for capturing and differentiating ideas and insights on any given problem. The three convergent developments can be summarised as follows 1.thanks to three converging developments. All aspects of the problem are scribbled on the same page. How does Mind Mapping operate? Just take a piece of paper. Asthma. is the compilation of clinical guidelines and algorithms for the management of most major clinical conditions: Diabetes. ideas. Tony Buzan and his Mind Mapping tool for stratification In the 1970s. Advances in Diagnostic Technology Firstly. Hypertension. Formal guidelines and algorithms for disease management A second development in medical science. have same coloured pens around. precise and predictable as a result of improved diagnostic techniques and instrumentation. Some of these techniques help in diagnosing a given illness. These have led to the availability of sharper tools for disease stratification. others serve as predictors. clinical medicine has been getting more logical. patient stratification may be the new key to brand differentiation. Stroke. had developed a revolutionary yet disarmingly simple approach to handle complex situations that required clear-headed thinking. a thinking tool called 'Mind Mapping'. as and when they radiate from the mind. an honourable and a scientific way for fine-tuning the promotional message of overlapping molecules . Infertility… Stratification based on algorithms translates into different – and differing – patient-subsets under the same disease segment. Tony Buzan.based learning consultant. 3. you are actually 'mapping' your responses. a UK. Heart Failure. occurring in tandem with diagnostic precision. thoughts. yet others as early markers of impending worsening of a disease. By doing this. two in the field of medicine. Indeed.
keep your attention glued to the 'Hypertension Map'. say hydrochlorothiazide and furosemide. say atorvastatin and simvastatin. Remember. two ARBs. a large pharma organisation – let's call it LPO Labs . disassociating an idea on page 1 from an idea as page 3. all „Thinking Tools‟ are the equivalent of mining equipment: gold.isosorbide mononitrate and isosorbide dinitrate! That's a mind-boggling even for the likes of Al Ries and Jack Trout. and two antithrombotics.has in its antihypertensive range the following entities: Two beta-blockers. Tony Buzan and David Ogilvy. Next the setting.two ACE inhibitors. say candesartan and losartan . Mind Mapping as a Tool for positioning : A Demo Tony Buzan's thinking tool for pharma brand managers can come handy when the need is to achieve a brand differential between apparently conflicting or overlapping brands. c) hypertension offers maximum therapeutic options that work in different ways in different patient subgroups The utility of this tool. rather than listing these in a linear fashion – one below the other. two calcium-channel blockers say amlodipine and diltiazem. and as if this were not enough. two diuretics. say aspirin and clopidogrel. This linear mode cuts off each idea from the ones preceding and following it. diamonds or oil must be there to be mined and extracted. however. or even for the positioning wizards. Hypertension' is the disease that has been selected for this demonstration because of three considerations: a) antihypertensive drugs constitute one of the largest and growing market segments. hinges on a lucid and deep understanding the disease and its treatment modalities. By the same analogy. two nitrates as well . two statins. say ramipril and lisinopril. there must exist a rich matrix of knowledge that can be scooped by Mind Mapping to deliver tangible stratification. To start the exercise. The exercise starts with the Mapping of Hypertension as depicted below. say atenolol and metoprolol . b) hypertension with its wide-spread prevalence provides probably the widest number of patient-subsets than any other medical condition.and reactions across the page. Here we go…
and explore the possibilities for positioning / repositioning Atenolol and Metoprolol. The controversy regarding the relevance of beta-blockers in Diabetes also stands resolved as diabetics are now perceived as 'Coronary Equivalents'. and undergoes hepatic elimination. starting at age 40. metoprolol is lipophilic. beta-blockers have been loosing their long-held primacy in Hypertension. Now. beta-blockers are also staging a comeback in Heart Failure (particularly Metoprolol). even non-diabetics have an age-related decline in kidney function. requiring antianginal cover. may occur to a knowledge-primed brand manager doing this exercise. alongwith a suitable regimen of an ACE-I and a Diuretic for patients of Heart Failure Atenolol. as the preferred antihypertensive for post-MI patients with evidence of diabetes OR Atenolol in post-MI patients with impaired liver-function Metoprolol as an antianginal/ anti-hypertensive / antiarrhythmic cover in elderly post-MI patients with impaired renal function Metoprolol in women patients with hypertension who also have a history of migraine
. among others. The following options. and are therefore undergoing a clinical shift. being preferred in POST-MI patients where their antianginal / antiarrhythmic as well as antihypertensive benefits can be put to good use. While diabetics have nephropathic changes. Metoprolol.Positioning Challenge 1 : Slotting Atenolol / Metoprolol for LPO Labs But first. As if through a back door. Atenolol is hydrophilic and eliminated renally. re-focus on the map („Mapping Hypertension‟). a quick recap of current medical background… Of late.
in their 40's or 50's c) beta-blockers.Positioning Challenge 2 : Slotting Losartan / Candesartan in LPO labs… Again. has probably a slight edge over Losartan. The focus thus shifted to the Renin-AngiotensinSystem (RAS). and Angiotensin Converting Enzyme Inhibitors (ACE-Is) were the outcome (captopril to quinapril. the official positioning of ARBs (losartan being the prototype). d) young. diuretics. Initially.. Losartan for chronic middle-aged hypertensives with diabetes. educated male patients with hypertension complaining of 'reduced quality of life' – a euphemism for erectile dysfunction (which itself is a euphemism for impotence) … the pharmacologists were been forced into looking for alternatives to bring down BP without affecting cardiac output directly. and came up with Angiotensin Receptor Blockers (ARBs). Pharmacologists therefore had another look at RAS.
THAT'S MIND MAPPING IN ACTION… it facilitates disease stratification into patient subsets it facilitates positioning or repositioning of brands and at the very least it minimises brand blurring
Positioning statements for other molecules in the Antihypertensive Range of „LPO‟ Labs may read as: Atorvastatin for all young. Cast now another focussed look on the 'Map' to trigger some positioning ideas for Losartan /Candesartan. who may also be having microalbuminuria. inducing impotence (now 'erectile dysfunction') because all three can affect cardiac output. ACE-Is however were found to induce irritant cough in up to 20 per cent patients. which are largely devoid of the side-effect of cough. you are likely to come up with: Candesartan for the newly-diagnosed. first a quick survey of the clinical considerations Faced with… a) increasing incidence of hypertension in younger population b) people marrying or remarrying late . but found their cough troublesome. young male hypertensives who may not like to exchange their raised BP (hypertension has no symptoms) for cough or impotence. was only for those patients who were well-controlled with an ACE-I. Candesartan. male hypertensives as routine prophylaxis against lifestyle dyslipidemia
. because of its placebo-like side-effect profile and its predictable kinetics.. and even calcium-blockers. 'LIFE' and 'CHARMS' studies firmly established the newer roles of Losartan and Candesartan in many patient subsets such as diabetic hypertensives and chronic hypertensives with left ventricular hypertrophy. and counting ).
Atorvastatin for all post-menopausal hypertensives to reduce the risk of coronary disease Simvastatin as the ideal add-on with Ezetimibe for hypertensives with an adverse lipid profile Isosorbide mononitrate in ischemic hypertensives with chronic stable angina. THUS Along the Trainer–Detailperson-Prescriber Axis. Supporting visuals become relevant and evocative Detailing becomes crisp and brief
Precisely targeted brand positioning resolves many issues. 2002. positioning achieves or fosters Clarity in Training Inputs Clarity in Training Objectives Clarity in a Detailperson‟s mindset Credibility in the Prescriber‟s Mind
Along Medical Department–Brand Manager–Art Department Axis. Some Tangential Benefits of Mind Mapping Benefits of precise brand positioning Target audience gets sharply segmented Appropriate indication gets duly emphasised Product message becomes succinct. and deeper your knowledge of drugs and disease. Clarke. the more the possibilities of arriving at a well-demarcated brand positioning. N. some at the corporate level. for prophylaxis of effort-induced angina
Isosorbide dinitrate for chronic hypertensives with Chronic Stable Heart Failure and similiarly for other molecules or even their fixed-dose combinations. 1998. Churchill Livingstone Useful Websites for Patient Stratification/Evidence-based Medicine
. McDermott & D. The more 'radiant' the mapping. Churchill Livingstone Mind Maps in Medicine P. positioning facilitates or inspires Pin-pointed Information Search Relevant Inputs from the Medical Team Unambiguous Promotional Themes Memorable and Clinically-evocative Visuals
Further reading Mind Maps in Pathology Peter Dervan & Michele Harrison.
Clinical Guidelines <www.org> 3.1.org> 2.org) Mind Manager and FreeMind (it’s really free!)
.ngc. The Cochrane Collaboration (http://www. Medical Algorithms <www.cochrane.medal.