Wednesday, February 27, 2008

Chantix (Champix) or Ashwagandha? The market is 120 million strong in India

At last, Chantix (Brand name in India, Japan, and UK: Champix ) is here ... in India, the last frontier in the smoking cessation market. India is home to one of the largest smoker population - estimated at 120 million. Chantix from Pfizer costs Rs. 10,000 (approx.) for a 12 week course. Chantix is the latest blockbuster from Pfizer - a billion dollar blockbuster drug. Except for a small controversy that Chantix when taken with alcohol may precipitate violent behavior, the drug is well accepted by allopaths. There is also a talk that Chantix may cause suicidal behavior, hence, doctor guidance is very important for taking Chantix. Zyban is a competitor drug that competes in this market space. Compared with Zyban (bupropion), Chantix is shown to be more effective.

It is all about dopamine. Nicotine has an effect in increasing the levels of the neurotransmitter DOPAMINE in the pleasure center of the brain called nucleus accumbens and other centers of the brain (which is shown in the picture above. I got the good picture from HERE). Since nicotine causes stimulation of the nicotinic receptors, it is hard for a smoker to reduce the cravings for nicotine.
The active ingredient is VARENICLINE TARTRATE - a partial agonist of the nicotinic receptor in the brain. Varenicline is a derivative of cysteine - an alkaloid that stimulates nicotinic receptors in the brain. Chantix acts as a partial stimulant (or you can say, partial blocker, when you look at it the other way) of the nicotinic receptor in the brain.

ASHWAGANDHA TOO IS USEFUL AS A SMOKING CESSATION AID: Ashwagandha is well known as Wintercherry. The botanical name is Withania somnifera. The popular rejuvenating herb is an anti-stressor herb. Ashwagandha has a mechanism of action that is a little similar to Chantix. Ashwagandha may help decrease the cravings for nicotine. Withanolides (Withaferin A and B) have an activity in increasing the dopamine levels in the brain. There is an interest to patent the use of withanolides as energy raising nutraceuticals. Thus, Ashwagandha, pharmacodynamically speaking, is useful as a smoking cessation aid. Moreover, the herb rejuvenates the nervous system and relaxes the mind. As such, IF BACKED WITH PERSUASIVE CLINICAL TRIALS, Ashwagandha can be positioned along with smoking cessation drugs like Zyban and Chantix...Ashwagandha is more economical too.

Chantix will cause category expansion.
The increase in number of players in a market segment normally causes 'category market expansion', as the noise level goes up, and concept acceptance gets increased. Savvy Ashwagandha marketers can peg on to this trend too. (Brand name in India, Japan, and UK: Champix )

Monday, February 18, 2008

Creating patient flows: the next big event management opportunity

It is the era of free market economy (or almost!?) in India - the marketing or selling across of ideas, concepts, products, and services is inevitable. Marketing operations need to be intensified to ensure that products and services reach the patients; as patients will not come to the product or medical or healthcare service, through serendipity or just naturally ... there is simply too fierce a competition out there for patients. After all, pharmaceutical products (allopathic, herbals, and homeopathic), healthcare products and services, and the healthcare insurance premium business all run on the one factor: PATIENT FLOW! There is also a phenomenon of explosion of professionalism in India. Branding of healthcare services and products is no more an esoteric subject and the preserve of a few creative and innovative types. All players are attempting to be innovative and creative. Branding and brand building is now recognized as a business necessity & not an indulgence. So healthcare product and service providers are all brand building savvy and interested in this activity. Hence, marketing has become just that tougher, with more competition.
Patients are the bread and butter providers for doctors, clinics, hospitals, pharma companies, para medical professionals, healthcare agencies, and healthcare insurance companies. For the advanced healthcare providers like Narayana Hrudayalaya, Wockhardt, Manipal Hospital ... global medical tourists too provide bread, butter, and jam...! So the focus of healthcare product and service companies is to strengthen the patient flow to their offerings, and develop a loyal base of patient pool (strengthen the word-of-mouth among the prospective and actual patients).
What do you see in the above picture of a line of patients?
In the above picture each person sees opportunity according to his or her needs: the physiotherapist sees arthritic patients in need of his service, the clinician sees patients who will pay him the consultation fees for the service rendered, the Pharmaceutical marketer sees each patient as a potential buyer of his products, the Healthcare insurance company sees prospects for purchasing his insurance products and paying regular premiums, the neighbourhood pharmacist sees a line of potential buyers of his medicines (who will come for prescription encashment, and possibly there will be some auto purchase too by the patients), and the diagnostic lab sees potential for conducting tests. The patient flow is the life of all these business activities.
OH! WHAT IF THE PATIENT FLOW IS L..O..N..G..E..R.. is the wish of all the marketers and the service providers detailed in the above paragraph ... that is the need of the marketer and the healthcare entities... and that need of the marketer or healthcare entity can be addressed by the EVENT MANAGEMENT COMPANIES.

Illustration one:
Osteoarthritis and osteoporosis opportunity: The top ailments in India are osteoporosis and osteoarthritis. The bones become brittle and fragile in the former, and in the latter, there is a breakdown of the cartilage (a rubbery cushion-like tissue in the synovial joints like the knees and hip joints). Calcium based formulations and drugs that increase calcium deposition in bones are prescribed in osteoporosis. Yet the osteoporosis opportunity is not tapped to the full extent. Yes, Pharma companies do conduct OSTEOPOROSIS CAMPS in league with hospitals, but the campaigns are not sustained, mainly sporadic to tap in to some patients and reach the sales figures for the quarter... Imagine a multi crore national project of a company like Elder (marketing Shelcal) ... given to an event management agency whose brief will be to launch SHELCAL BONE WEAKNESS AWARENESS CAMPS in clinics, hospitals, clubs (like Rotary and Lions clubs), women colleges (because women are the most susceptible to osteoporosis), women clubs (Mahila mandals) ... at the non clinic venues, neighborhood doctors can be involved ... this approach through an event management company makes sense since the regular field force has other products to promote and other priorities. What the field force can do is follow up on the doctors. The event management company can follow up through database mailer marketing too ... the brand equity of Shelcal will go up and the sales too in about a year's time ... it is a marketing risk worth taking.

Illustration 2:
The cancer opportunity: There are said to be about 25 lakh patients of cancer at any given time in India. Most are head, neck, oesophageal, and lung cancer cases. In fact, Delhi has the world's highest gall bladder cancer cases (in women), while Bangalore has the world's highest oesophageal cancer cases in women. Thanks, to high tobacco consumption/smoking, Mizoram and generally speaking, the Eastern parts of India have higher incidence of tobacco related cancers. The most important point is that 70% of the cancers are diagnosed at the advanced stage in India, thus chemotherapy drugs become supportive and not the first - line therapy. Now, imagine, a company like Cadila or some other Pharma company launches a sustained cancer detection campaign THROUGH AN EVENT MANAGEMENT COMPANY in certain geographies - like breast cancer detection in urban areas like Mumbai and Delhi, oesophageal cancer in Bangalore, and gall bladder cancer disease in Delhi ... what will be marketing results be for the company and the society?

Event management companies with a single focus for sustained campaigning on specific issues will augment the overall marketing - communication efforts of the Pharma company (including the sales force). The result is a greater brand buzz, market building activity, and increased sales...

There are lots of nitty gritties involved in an approach as the above - controls, feedback systems (can it be online and real time?), follow ups, ROI ... all need to be worked out.

There are several issues that can be handled on a campaign basis by event management companies in league with sponsor brands to ENHANCE PATIENT FLOW:
a) drug induced nutritional deficiency (may be Becosules will be interested)
b) stress and fatigue (may be Revital will be interested)
c) oesphagitis, Barretts oesophagus ( a precancerous condition), and oesophageal cancer (may be Aciloc will be interested)
d) anemia - including masked anemia
e) asthma and respiratory disease camps conducted for retail chains and sponsor brands
f) dermacosmeceutical concepts, retailers, and brands
g) HIDDEN HUNGER in children (which may be of interest for Horlicks)
h) prediabetes and diabetes awareness camps
i) diabetic complication awareness camps
j) obesity awareness (particularly through the simple tape measurement method for recognizing abdominal obesity)
k) nutrition awareness
The scope is wide and the need is real. Thanks for reading this blogpost, please do read all othe blogposts too, scroll down and click on OLDER POSTS if required.

Friday, February 15, 2008

Power retailing

The new trend of retailing is leading to a rise of the retailing power and influencing the availability and consumption of goods and services like never before. In fact, retailing power is squeezing the manufacturers like never before. Walmart's greatest collaborator is Procter and Gamble. The other collaborator is China - the global sourcing hub of Walmart is a place in China called Shenzen. The catchword in retailing is footfalls, and this influences consumption. Thus, Walmart is using its sourcing bargaining power to ensure that goods are purchased by the retailing giant at low prices, and sold at everyday low prices, as per its philosophy. Walmart has used this strategy in dispensing pharma goods at low prices too. Thus, retail chains have a great impact on availability and profitability of manufacturers.
The rise of Private Labels. The rise of Private Labels held particularly by retail giants is giving rise to a new trend in retailing. Consumers are led to private label products on retail shelves. Retail availability influences brand consumption significantly. Private label in India has changed sales trends and consumption patterns. After all, ultimately, the consumer or prospect wants quality goods, availability, and best value-for-money. Retail chains are at the forefront of contact with prospects and customers, hence, they can jack up sales of Private Labels significantly, when they sense it is to their advantage.
Pharma retailing and rise of Private Labels? Pharma retailing is a new phenomenon in India. Subhiksha is the trendsetter Pharma retail chain. Fortis Healthworld, Manipal Cure and Care, Mediplus, Medicine Shoppe, Apollo Phamacy, Trust, Pill and Powder, Aushadi, Reliance Wellness stores, Health and Glow, Gaurdian Lifecare, Global Healthline, CRS Health, Lifeken... are some of the healthcare and Pharma retail chains making waves. Already, chains like Manipal Cure and Care have entered in to exclusive agreements marketing dermacosmeceutical brands like Living Proof. After consolidation of retail space and ramping the nos. of retail outlets of each chain... NEXT WHAT?... OBVIOUSLY IT WILL BE THE RISE OF PRIVATE LABELS IN PHARMA CHAINS...what can stop Subhiksha from retailing its own brand of paracetamol and other analgesics and anti-inflammatory drugs? Lifeken may start its own PRIVATE LABEL of fast moving antibiotics like amoxycillin and cephalexin. Trust is in infact owned by Medreich a Pharma manufacturer. It will be easy for Trust to launch a Private Label range of Pharma goods (both and allopathic and ayurvedic).
There are manufacturers and retailers interested in Pand healthcare retailing: CLICK HERE

Manufacturers in Pharma retailing: Perhaps the first of its kind and a visionary strategy of setting up a manufacturer's retail chain was by The Himalaya Drug Company, Bangalore...This retail initiative primarily serves as a touch and feel brand store, but with the rise of franchising power (both business development format and product distribution format of franchising), this company will end up owning an ecosystem for ensuring effective retailing, availability, and sales of their herbal active range. This retail set up strategy creates independence from muscle flexing from big Pharma retail chains. Already there are health camps being conducted routinely at the Himalaya retail outlets that is leading to increasing footfalls and loyal customer base.

For such retail chains, the next logical step is to launch a branded PRODUCT USERS CLUB. This will help create a database of product users with their characteristics. Mining this data base will help in targeted marketing communication activity, and cross selling and upselling activities. For eg., let us say, a TB patient purchases Liv 52 DS (for management of TB drug induced hepatic dysfunctioning), and joins the HIMALAYA PRODUCT USERS CLUB. This patient later receives a leaflet on Koflet (cough syrup and cough lozenges) through the targeted marketing initiative. Such a customer is likely to revisit the exclusive Himalaya retail chain and purchase Koflet and perhaps other goods. There is enhanced footfalls, and better word-of-mouth through such initiatives.

'Manufacturers to hospitals' marketing relationship. A survey of the high price and high margin oncology chemotherapy drug market shows a new trend. There are some private cancer treatment hospitals particularly 150 bed and above, that are entering in to contract relationships with small quality manufacturers to supply certain onco drugs like docetaxel directly to their pharmacy at highly discounted rates (disintermediation at work). The hospital pharmacy authorities even dictate the price and terms of payment. Branded onco drugs marketed through MRs are now facing such "private label" competition too. These high value brands are also taken for long periods of time. For eg., I met a patient's attender who was purchasing tamoxifen tablets (for the management of breast cancer in the patient) for the past five years. So this business is very attractive for private label Pharma marketers too.

So we observe that POWER RETAILING is a phenomenon that is in tandem with worldwide trends. This phenomenon is changing the landscape of retailing and marketing. Power retailing represents a challenge to manufacturer-marketers, in the Pharma world too.

Thanks for reading this blogpost, I invite you to read all other blogposts too. Thanks...

Friday, February 8, 2008

CLINICAL RESEARCH CITY, a useful concept

I got this great picture for this article from HERE.

By now it is well documented that India is a gung-ho destination for clinical research. Most MNCs find doing clinical trials and other forms of clinical research in India, practical, sound business-sense, and trustworthy. Clinical research is a big money business concept now with high growth potential, just as medical tourism is an attractive option.

Recently, Narayana Hrudayalaya made it it to the headlines, twice. One: this famous institution headquartered in Bangalore has got an international accreditation. And, secondly, Narayana Hrudayalaya in collaboration with Biocon's chairperson, Ms. Kiran Majumdar, is setting up 5000 bed healthcities (Narayana Health City). The concept of Healthcities is to provide world class healthcare (surgical and non surgical), to both international and Indian patients.

Based on the health city concept, it would also be interesting to have a private - public partnership initiative of a CLINICAL RESEARCH CITY, that will ride on the clinical research wave. It is important to note that concepts such as, textile city concept, electronic city concept, Hitech IT city concept, Biotech Park, help create a focussed ecosystem for the concept. Thus, a CLINICAL RESEARCH CITY concept, will create an ecosystem for facilitating the receipt of orders for clinical trials, conduct of the clinical trial or research, and then process the results of the trials (by IT or ITES companies) within the precints of the city itself.

Most of the clinical research right now is not related to drug discovery (in time to come it will gain traction, particularly when new novel drugs like balaglitazone will succeed); it is bioequivalence (BE) and bioavailability (BA) studies that are the bread and butter business of clinical research in India, right now. These studies are done to launch new me-too products in India, and also to establish that generic equivalents are indeed on par with the innovator formulation.

The clinical research city concept will help India tap the chemopharmaceutical (fomulations based on synthetic chemicals), biopharmaceutical (formulations based on biologicals) opportunity, and herbopharmaceutical (herbal formulations) opportunities :

a) The multi billion US dollar generic opportunity. It is said, that a 70 billion USD worth of branded patented drugs will go off patent in 3 - 4 years, and to launch the generic equivalents for exports from India to USA, one needs to conduct BE/BA studies.

b) The biogeneric opportunity. India is said to be on the threshold of scripting a success story in the field of biogenerics, as certain biotech products too are going off patent. And to supply biogenerics, again clinical research studies will be required to establish that the biogeneric equivalent is indeed as safe and efficacious as the innovator brand.

c) For the Phase 4 (post marketing surveillance clinical trials), studies. As pharmacovigilance becomes more and more important, and regulatory standards are raised higher, Phase 4 clinical trials and data will begin to acquire more importance. After all, it was Phase 4 data that drove the proverbial last nail in the coffin of Vioxx. Phase 4 data will require a lot of statistical processing, the CLINICAL RESEARCH CITY can provide such locations for organizations that play on statistical processing.

d) Bioinformatics and personalized medicine is creating the buzz. Bioinformatics and personalized medicine concepts depend on the analysis of the genetics (genome) of a person or group of persons. Based on the genetic profile, therapies and drugs are designed. IBM has a computational biology department that is working in this direction. In fact, the CLINICAL RESEARCH CITY concept will attract such companies working on futuristic and cutting edge technologies to set shop, and thereby strengthen the clinical research ecosystem in India.

e) Drug discovery clinical research (Phase 1 to Phase 3, in particular) will get a filliip. These studies are long drawn and will mean a continuous or long term business for the clinial research provider, and a CLINICAL RESEARCH CITY will help create the ecosystem and confidence for collaboratively working on such projects with innovator companies.

f) Clinical research for herbopharmaceuticals. As regulatory standards raise their bar higher, and the public awareness grows on clinical research, herbopharmaceuticals will not be inured from conduct of good quality clinical research. It is the CLINICAL RESEARCH CITY, which will help such formulators to further strengthen the brand presence and launch new herbopharmaceutical formulations.

ALL IN ALL, A CLINICAL RESEARCH CITY (with a single window system) WILL PROVIDE A DEDICATED LOCATION, AND BUILD AN ECOSYSTEM FOR FURTHERING THE CLINICAL RESEARCH BUSINESS OPPORTUNITY IN INDIA. This concept will also help create the right infrastructure, and cut costs through pooling of certain infrastructural elements and equipment. Thanks for reading this article...please do read all the other articles in this blog.

Tuesday, February 5, 2008


Managing patient perceptions is vital for the commercial success of any drug or therapy today. It is not just the prescriber’s perception about a brand, drug or therapy that matters. The prescriber is very important, but in the age of the empowered patient, and a powerful media (both user created and traditional media), the patient’s perception too is vital and is crucial for the success of the marketing efforts of a drug or healthcare formulation. This is a new dimension in marketing management of pharmaceuticals and healthcare products.

How a Patient-Support Program Increased Therapy Participation 20%, Upped Sales

Tracleer won approval in 2001 as the first oral treatment for pulmonary arterial hypertension, an illness difficult for patients to grasp. Tracleer helps patients control the symptoms, but it has drawbacks. Faced with high patient-dropout rates early on in treatment, the drug's maker needed to change patient perceptions


Managing patient perceptions and CRM with patients is a brand engagement strategy. This enlivens the brand, helps the target audience appreciate the brand attributes and benefits better, and hence makes a person use the brand better in his or her life.

Brand engagement and patient perception

Engagement, a broad term encompassing everything from sampling to product placement to personal service, is the process of forming an emotional or rational attachment to a brand by using it or viewing it in a personally relevant context.

Let us say, Liv 52 (a popular herbal for hepatic dysfunction) is used by the patient on advice of the doctor in cases of hepatic dysfunctioning like nausea or fatigue or outright jaundice. Brand engagement strategies through the doctor to the patient can enlighten the customer that constipation, anal discomfort, and piles too are manifestations of liver dysfunction, and in case a patient suffers such symptoms (at a later date or happens to know a person with such symptoms) the top-of-the-mind recall will be for Liv 52.

Brand engagement can be heightened through an online brand website that provides education and an enhanced experience to the netizen on hepatic dysfunctioning and role of Liv 52.

Brand engagement with patients, increases the perceived value of the product from the viewpoint of the patient. This also enhances the word-of-mouth phenomenon in the patient and medical community.

Similarly, brand engagement strategy is best suited for products in the OTX space, like Women’s Horlicks, Amway products (in 2008 Amway products in India will be promoted to 5000 doctors for recommendations), and Revital (from Ranbaxy) that is officially promoted through a rainbow coalition strategy.

After, fatigue, PAIN is a most common symptom in clinical practice. When the word pain is mentioned, more often than not, the top-of-the-mind recall goes to Crocin (paracetamol) and Moov (the topical joint pain reliever), in India. Brand engagement strategies through the doctor to the patient, can engage the patient on aspects of pain and how pain management products work, what pain tries telling to the body, and how patients can engage their relationships with the doctors to better their pain management strategy.

About brand engagement Mr. Nick says:

So teach your customers well. Remember that knowledge leads to action. Give them the gift of useful and relevant knowledge, and in return they will give you brand loyalty and word-of-mouth.

Overall, strengthening the Pharma product promotion to patients is vital given the current power of media that addresses health issues to patients and society directly, moreover, web 2.0 is redefining the conversations on health issues, and there is a distinct empowerment of patients on health issues. Hence, it is useful for marketers to address patient perception of drugs, therapies and healthcare products.

The above image is from HERE. Thanks for reading this blogpost and kindly do scroll down for reading all the other blogposts, including by clicking on older posts.

Sunday, February 3, 2008

Lord Balaji in Indian Pharma

India is a land of a multitude of Gods. One of the very popular deities is Lord Balaji or Lord Venkateshwara of the Tirumala hills. Routinely Indians make their way to the seven hills, and seek the grace of Lord Venkateshwara for temporal and spiritual gains. In fact, many successful business people in India make Lord Balaji a silent partner, and they donate a predetermined percentage of the profits in the hundi or offering box at the Tirumala temple of Lord Balaji. So what does Lord Balaji have to do with Indian Pharma?

The exciting new drug (Balaglitazone from Dr. Reddy Labs) being developed for diabetes management is named after Lord Balaji.

Balaglitazone is a new drug candidate that is undergoing phase III multi centric clinical trials. Balaglitazone is being developed for the management of type II diabetes. The goal is to market this drug to around 70% of the globe in 2011. Phase III is a significant achievement in the clinical development of the drug; it means that after completion of this clinical study, and the two year carcinogenicity testing of this drug, that is going on, marketing can be taken up. I wonder what marketing plans are being cooked up for this drug. One can expect something striking after all the success of balaglitazone, will be hailed as the coming of a new age in the Indian Pharma Industry.

The success of balaglitazone will be closely watched by international and national Pharma giants. Its success will provide encouragement to the ongoing drug discovery programs of companies like Sun Pharma, Glenmark, Ranbaxy and others.

If balaglitazone becomes a success one can expect that clinical research activities in India will get a major fillip.

Balaglitazone's success will cause a multiplier effect in the confidence of Indian researchers to produce new drugs.

Inventing is one part of the game, marketing is another cup of tea

It is no doubt, that inventing a new drug is a significant milestone in the Indian Pharma industry, however, making it a winner in the market, is another cup of tea. For eg., recollect that the first drug to be invented was a neuromuscular junction blocker chandominium sulphate (named after Chandigarh), which is no where in sight now, Ranbaxy tried to commercialize the product with little success. Similarly, Cipla had tried to make the gugulipids a big product, it is nowhere in sight.

Take a leaf from the launch of Tata Nano

The launch of the motor car Tata Nano was a huge success (yes, it is still not available in the market, come Oct 2008, Tata Nano will be available in India). The Tata Nano launch was memorable for the effective media management and creating a positive buzz ie. positive word-of-mouth. Word-of-mouth is critical in the launch phase. Any negative word-of-mouth at the launch phase, will affect the product establishment. For eg., Exubera was a victim of negative acceptance and disheartening word-of-mouth. In the age of web 2.0 and internet, word gets around faster... a metaanalysis study of rosiglitazone (another glitazone a class to which, balaglitazone too belongs) too has affected the Rx generation of this product. Tata Nano was fantastic in media management, creating the best word-of-mouth - after all, the first impression is the best impression. These skills in creating the right first impact will be crucial for balaglitazone's success.

What needs to be understood
is that in the modern e-age, what counts is not just the confident acceptance by the opinion builder doctors or prescriptions in favor of a product, but the right word-of-mouth in society and in the medical community as a whole. The buzz is equally important. The target audience for the marketing communication activity for balaglitazone is not just the target prescribers, but all other stakeholders in the healthcare system - the pharmacists, para medical staff, health counsellors, diabetes bloggers, and health media - as they have a considerable influence on the adoption of drugs and therapies. The internet has lowered the power that prescribers' wield over the patient community. Furthermore, pharmacovigilance has gained new importance. All these need to be maintained in mind while chalking out the MARKETING COMMUNICATION STRATEGIC PLAN.

The crucial link between market success and balaglitazone will be the MARKETING COMMUNICATION PLAN. It will be interesting how DRL will evolve the marketing communication plan and who the participants will be in putting together the elements of the marketing communication plan for balaglitazone.

This is vital since a lot depends on the marketing success of balaglitazone. After all it is the confidence of the entire nation's Pharma industry that is at stake.

End quote:

“Any communication or marketing professional needs cross-cultural research and communication skills to be able to succeed in the future.”
Mary Tharp

“The single biggest problem in communication is the illusion that it has taken place.” George Bernard Shaw

Many thnks for reading this blogpost, please do scroll down and read all other blogposts, including by clicking on OLDER POSTS. I got the above picture from HERE.