Sunday, April 27, 2008

The healthcare market continues to expand

I got the above great image from here.

It was a pleasant and interesting time for a day at Mysore, this week. As usual, the Pharma market was the epicentre of discussions with my friends and relatives, at a social function. The healthcare market continues to expand due to a host of trends like PCD trend, knowledge empowerment, pandemic diseases, and CLIMATE CHANGE (global warming)...

PCD market operators

Earlier it was not very common to see PCD (propaganda cum distribution) operators in markets. But even a conservative market like Mysore sees at least 15 ex MRs operating propaganda cum distribution operations. Just imagine what would be the status in the aggressive Pharma markets of India viz., Maharashtra (including Mumbai) and Madhya Pradesh + Chhatisgarh (which are the largest Pharma markets in India; it is said that companies that succeed in the markets of these two states, will get good national Pharma marketshare). Equally very aggressive markets are Uttar Pradesh (and Uttaranchal) and Bihar + Chhatisgarh. The point of curiosity was where were the goods getting absorbed? Because, all major and small companies are very aggressive and continue to do good business. Still each PCD is also doing about 2 to 3 lakhs business and making about Rs. 25,000 to Rs. 30,000 profits. This means PCD operators were making it tough for companies, but not cannabalizing the sales significantly. So how are the goods getting absorbed as all established companies too were doing well? Is the market expanding as the number of market operators increase?

More scope for market penetration and prescription potential of products

As such, it appears there is greater scope for market penetration and the prescribing potential of products is not tapped.

Let us consider albendazole as an example. Nelson's textbook of pediatrics recommends regular deworming every 6 months. But in reality this is not happening. Perhaps the pressure to prescribe albendazole due to a large number of market operators is increasing the consumption (and this has medical textbook sanction too).

People do business with people

Thus, if a MR (PCD or company) comes regularly to a doctor with promotional inputs and other strategies to expand the doctor's patient base and help the doctor service his patients better, it is inevitable that consumption increases. It is the pressure of increasing no. of market operators and their strategies that is increasing consumption and thus every market operator makes his money. Moreover, there is very high potential for market penetration and consumption as prescription generation is itself perhaps not in line with the product potential. As explained above albendazole has more theoretical potential of consumption, if one takes in to cognizance that regular deworming needs to be done every six months (for adults and children).

However, PCD operators are finding it tougher to make profits these days due to increased and intense competition.

Similarly let us take the case of the hepatoprotective market.

First some physiological aspects of the liver:

The liver is a strategic organ. The liver, the largest internal organ of the body and a chemical factory, has a major influence on glucose concentration in blood. All absorbed nutrients and chemicals first go to the liver through the mesenteric capillaries and the portal vein. Glucose is converted rapidly to glycogen (storable form of glucose in liver) and then to fats (for storage under the skin as subcutaneous fat ie. adipose tissue) in the liver, and ensuring that systemic concentration of glucose is in the normal range. Similarly, in times of starvation, the liver has the chemical ability to generate glucose from amino acids, fats, and glycogen to ensure normoconcentration of glucose in blood. These chemical reactions are called intermediary metabolism.

Amino acids are used by the liver to manufacture enzymes and other important proteins for eg., angiotensinogen. However, amino acids cannot be stored like glucose. And glucose cannot be converted to amino acids. So amino acids (particularly essential amino acids) are required on a daily basis.

Another very important attribute of the liver is its ability to detoxify. The liver converts xenobiotics (or non nutrient foreign substances) to an easily excretable form. Fat soluble toxins are converted to water soluble substances through the Phase 1 and Phase 2 detoxification reactions. It is for this reason that hydrophilic (water soluble) substances have longer half life (stay in the body for a longer time) and require reduced frequency of dosing (hence, atenolol is a once-a-day therapy); hydrophilic substances undergo less first metabolism however, they cannot cross the blood brain barrier to have effects on the brain (lipophilic substances cross the blood brain barrier easily). Thus, the liver is responsible for detoxifying the blood (removal of toxins, and microbial fragments from the body).

Furthermore, the liver is responsible for electrolyte balance in the blood, fat digestion and assimilation (through bile juice secretion), storage of vital micronutrients, body temperature regulation ...

Today, xenobiotic insults to the liver are higher than ever, and entry of hepatotoxic pollutants in to the body (like alcohol) have a great impact on the liver causing sluggish liver functions that manifest gastrointestinal complaints like anorexia (loss of hunger), nausea, vomiting, dyspepsia (indigestion) and epigastric distress.

And these complaints are ever increasing and consequently increasing the demand for hepatoprotective products. The hepatoprotective need appears to be underserviced given the strategic importance of the liver.

AND ADDED TO THIS IS THE GROWING PURCHASING POWER IN INDIA, which ensure prescription encashment.

Feeling healthy is as important as absence of health

The positive concept of health is not just the absence of disease and infirmity, it is the feeling of being in good. This explains the ever increasing potential of products like the electrolyte energy drinks. The creation of a brand new category of electrolyte energy drinks perhaps indicates an emerging trend of prescription based lifestyle healthcare goods.

What does a prescription represent?

A prescription is a recommendation to purchase and consume particular products. But importantly a prescription is a covenant of trust. It is a trustworthy written advice on what to consume given by a legally sanctioned expert (an important opinion builder) to his or her patient. The prescription represents trust - the most basic emotion between humans. If a doctor generates a very high level of prescriptions it is because of a proportionately very high level of trust and confidence enjoyed by him in his target market of patients.

People consume products and services because of trust

What a marketer does is build trust on the marketed products. People consume the products and services due to this trust. So a doctor's prescription is a part of this 'TRUST CYCLE'. Products for a healthy lifestyle when recommended by way of prescriptions build enormous trust. Prescriptions deliver superior value to the brand. Hence, the success of the new category prescription based healthy lifestyle products like electrolyte energy drinks (

Prescription and non-prescription based healthcare markets are expanding constantly

While increasing purchasing power creates the opportunity for marketers, the actual reason for consumption is patient empowerment through knowledge. It is the knowledge that it is possible to look young that is driving the consumption of skin care products. Similarly, the knowledge that it is possible to overcome lassitude and a low down feeling (sadness and depression) that is driving the consumption of electrolyte energy drinks and neuropsychiatric products. Knowledge to the patients and society in general about healthcare products drives hope and consumption. Marketers actually sell hope, ideas, and images. And marketing has the dimension of knowledge empowerment. Hence, it now time to consider a change of laws in India, to allow advertising of prescription based products in mass media (with a statutory advice that the product will be sold against prescriptions only).

New disease and healthcare trends drive healthcare markets constantly

While knowledge (as we observe above) is empowering and helps expand healthcare markets, the next factor increasing consumption of healthcare products, are new trends (disease and healthcare). For eg., pandemic diseases now are expanding markets for specific products, like antibiotics. The bird flu disease is a pandemic disease.

Social trends like parents wanting their children to do well scholastically is increasing the consumption of milk mix beverages like Horlicks, Amaze, Boost, Complan etc.


Global warming is not about climate change, flash floods, receding water tables, rising sea levels, but there is something more at stake ... THE FERTILITY OF MALES. There is a distinct possibility of global warming and cocktail pollutants disrupting endocrine (hormonal) balance leading to male infertility. It is already established that climate change will increase the incidence of infections.
As climate change is expected to increase infections, these too will indirectly contribute to male infertility. Global warming & raised ozone levels related male infertility is certainly a point to be considered.

So this itself is an opportunity area for healthcare marketers: products and services to offset possible male infertility related to global warming, ozone levels, pollution etc.

So that is the point - various trends in society and environment continue to create healthcare needs and wants and these expand the market continuously.

Thanks for going through this blogpost; feel free to read all other blogposts by clicking on older posts wherever required.

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