Sunday, March 1, 2009

Competition for patients:Participatory Medicine


The foundation of the pharma and healthcare industry is the PATIENT. He or she is the person who is in suffering and requires medical attention. The patient or the healthcare consumer, is the basis of the pharma and healthcare industry.

How does one become a patient?

At the root of it, an individual becomes a patient when he or she is in suffering. At the practical level, an individual becomes a patient based on SIGNS AND SYMPTOMS. Examples of signs and symptoms include pain, discomfort, fever and the not-so-overt signs and symptoms like decrease in BMD (bone mineral density), raised blood lipid level, raised creatinine levels etc. IN the case of preventive healthcare products like functional foods, nutritional supplements, and vaccines, the patient is not in suffering - yet he or she is a patient.

Blood: the lifeline of the healthcare industry

Blood - the liquid connective tissue - is described as the lifeline of the human body. And this amazing fluid is also the lifeline of the pharma and healthcare industry! Almost every disease involves measurements related to blood - eg., blood lipid levels, RA factor (rheumatoid factor) test etc. Many diseases are insidious, and can be discovered through routine tests. For eg., for many, diabetes is discovered through routine blood tests rather than through assessment of overt signs and symptoms. So the importance of blood tests and other clinical tests in apparently normal individuals is very high.

Marketing of pharmaceuticals and healthcare goods is challenging

Pharmaceutical and healthcare goods are meant for consumption by the patient. For this to happen, firstly an individual should get converted to the status of a patient, second, his healthcare provider (mainly a doctor) should recommend or administer the pharmaceutical or healthcare item. Third, in certain countries, the third party payer should agree to pay for the medication or healthcare item. Fourth, the patient should be motivated enough to consume the same (ie., there should be patient compliance). In case the medication or healthcare item is to be consumed for longer periods, it is even more challenging for the healthcare marketer to ensure patient compliance.

This is the reason why there is, today, a focus on the account management approach to marketing of pharmaceuticals and other healthcare goods. When the aspect of product consumption is considered, the physician alone is not the influencer. The payers, hospital authorities who recommend the availability of a product in the pharmacy, pharmacist (or chemist - who has the powers to push the product), and the empowered patient himself are important. Hence, it becomes imperative to manage relationships and engage in fruitful communication between all these important agents of product consumption.

This participatory environment in the practice of medicine with an empowered patient is creating a new ecosystem of healthcare: PARTICIPATORY MEDICINE.

It is a model of medicare where the role of the patient is emphasized. The patient is no more a passive recipient of medical care. The patient is an empowered entity and he or she can influence or control the course of treatment. Powerful healthcare authorities like the NIH are helping craft the environment of participatory medicine. This is because, blogs, internet, message boards and other web 2.0 tools are creating a social media for participatory medicine.

One of the change agents of society catalyzing participatory medicine is obviously the INTERNET. The cyberzone has created a new avatar of the patient: the e-patient. The e-patient is the informed patient who plays a key role in therapy. A classic example of the e-patient is the famous blogger Amy Tenderich of Diabetes Mine.

Pharma marketing some 20 years back was at its simplest: all you had to do was contact the doctor, and get a whole load of prescriptions. The physician was the sole PATRON OF PHARMA PRODUCTS. Then, the pharmacist became important as more and more me-too brands competed for the limited shelf space. And now the payers, authorities with recommendation powers (particularly in hospitals), and slowly but surely the PATIENT himself are becoming important for the consumption of pharmaceutical & healthcare goods. THE ERA OF THE EMPOWERED PATIENT IS NEARING!

Obviously the trend of participatory medicine has enormous impact on marketing and communication efforts of healthcare and pharmaceutical companies. Patient information leaflets, and other communication material to patients will also gain importance - however, they need to be designed in such a way, that the doctor is not offended. The communication should look like supportive to the physician's role as a healer.

An idea particularly for chronic care pharmaceuticals like antiasthmatics and antidiabetics is to have PATIENT EDUCATION WEBSITES hosted by the brand marketer. When the doctor recommends - say an antidiabetic medicine, he can also prescribe a visit to the website to the patient. The patient will in-turn learn about the medicine, importance of blood sugar control, dangers of diabetic complications (like gangrene, neuropathy etc) from the website. He can also register for e-mail product/disease updates on this website. He can also probably enroll for new drug clinical trials (e-recruitment), or the patient can sign in for sms reminders for taking the antidiabetic medicine on time (for eg., every 2.00 pm he can request for sms reminder for taking the dose). (Note: When the patient registers on the product website, the patient needs to mention the doctor who recommended the website to him. In turn, the website can send a thank you e-note to the doctor.).

The fact is that participatory medicine will increase. How to enlarge this trend harmoniously? This is the question: the answer - is to involve the physician community and make the doctor community a channel for empowerment of patients. For eg., doctors can be engaged for speaker sessions wherein doctors will talk to a group of patients (who take a particular brand) on diabetes and medication. Till now, we have opinion builder doctors who talk about therapy to their colleagues (speaking engagements). The next step in a participatory medicine environment is to have opinion builder doctors talk to groups of patients.

The participatory medicine environment opens up new doors for pharma and healthcare marketers. There are two options - either close the eyes and say this is a fad and not a trend. Or two understand the market fluxes and judiciously participate in the participatory medicine environment.

IN ESSENCE, IF THE PHARMA OR HEALTHCARE ITEM SHOULD EXPERIENCE CONTINUED MARKET SUCCESS, THE PATIENT POPULATION FOR THE BRAND OR PRODUCT SHOULD INCREASE CONSTANTLY. Even if the prescriber base for the pharmaceutical does not enlarge significantly, yet, if the patient population goes on increasing, the product will continue to experience good market success.

There are two ways of increasing patient population (or user base) for a product:

a) communicate with more and more prescribers or influencers and ensure they recommend the product to more and more of their patients.
b) empower the individual or patient with education and communication. Encourage word-of-mouth.

The second approach is tricky, since there are regulatory challenges, and the communication should not substitute the doctor's advice. One cannot build sales of a pharmaceutical or healthcare product without doctor support. Thus, a blend of above two approaches needs to be adopted as the trend of participatory medicine is on! Thus, it is wise to focus on both: doctor conversion and patient conversion.

So it is obvious that with the globalization of healthcare and pharmaceuticals, participatory medicine will gain traction.

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Liz Moench said...

Thank you for an excellent article.

As the pioneer of the first D-T-C campaign in the industry for a prescription drug 20+ years ago, I can attest that the evolution of a participatory patient will continue for yet another 20 years.

In the 1990s we saw an evolution of "right to know" and "right to choose" and even participation in clinical trial design by AIDS and cancer patients. In the 2000s we saw patient rights expand to include: "right to understand", "right to blame," “right to quality of life" and more. I believe that it is important to continue to bring information to patients to assist them in their decision-making process. It is for this reason that 20 years ago we again pioneered to bring clinical trials information directly to patients for a cancer drug, and continue to inform patients about clinical trials opportunities across many diseases today.

Thank you again for an excellent article. I welcome the continued dialogue and evolution of the participatory patient!

Sunil S Chiplunkar said...

Thanks for your kind compliments and visit to the blog.

Participatory medicine due to media catalyzed empowerment is a natural outcome. It is a challenge to the new-age pharma and healthcare marketer. One cannot expect the passive patient to continue.