Thursday, April 2, 2009

For better in-clinic experiences

I got the above nice photo from here. The photographer Jeff specializes in physician and medical photos (and other photos) - indeed, a very interesting business model. Obviously, his business model is facilitated by the internet. Many professionals have improved their prospects thanks to the world wide web.

When pharma marketers devise strategies and sales personnel implement strategies and tactics for better prescription generation, and improved sales - the main focus is on constantly improving MR - doctor transactions.

How about a new approach - thinking about improving the in-clinic experiences between patient and doctor?
This is an interesting approach as it is customer-centric. If pharma companies and product promoters focus on enhancing the doctor's in-clinic experiences with patients the relevance of the pharma product or medical device promoter will increase.

The name of the game is RELEVANCE

In the marketing and selling profession, the word RELEVANCE is an important factor. This is particularly so when world-over, doctors are feeling that pharmaceutical selling professionals have less relevance compared to the pre-internet and earlier days. Pharmaceutical selling is based on close and personalized relationships with physicians. This helps push the drug and raise sales. Hence, improving relevance of pharma marketing and sales personnel inside clinics is vital. One approach is when pharma companies become facilitators of better in-clinic experiences between physician and patient.

Approaches to improve the relevance of the pharma marketer/sales person

Dr. as a teacher: The word doctor (Dr.) has its roots in a Latin word that means teacher. The title Dr. in society generally means a person who is learned, and has the potential to be a guide to others in society. As such, today, there is a fund of information on the internet. This has indeed increased the general healthcare literacy. Nevertheless, there is a need for clarifying all the information in to something that is easily assimilated by healthcare consumers and is actionable. This is where the doctor and pharma companies can collaborate for mutual benefits. Pharma companies can create platforms for interactions between patients and doctors/healthcare professionals to understand disease management better. For instance, pharma companies can sponsor fortnightly talks (with high tea) by doctors to their patients on generic health subjects like worm infestation or dehydration, and subtle promotion of products can also be done. Here the doctor educates his patients on health issues. DOCTOR AS A TEACHER!

Software aided prescribing: Pharma companies can play a vital role in bringing sophisticated concepts to help improve prescribing practice on the lines of evidence based prescribing, to make the doctor and patient interactions more efficient and effective in terms of patient outcomes. This will help the pharma companies with improved business results too, and doctors' with improved patient satisfaction.

The imaginary software based concept is given below:

Let us say Cipla the largest pharma company in the retail Indian pharma market
(& some partner companies for this software project) provide a particular software package (as described below) to a prescriber. The uniqueness of this software package is that it provides help only when the doctor prescribes at least one Cipla/partner company brand (since the software package is gifted by Cipla/partner companies):

Imagine the following clinical situation -

a) A patient is diagnosed as having worm infestation
b) The doctor types Bendex in the window
c) Immediately the software becomes active and other windows pop up
d) These new windows provide various inputs that are relevant to the doctor with reference to Bendex
e) One window provides pharmacodynamics, pharmacokinetics, drug interactions, ADRs and dosage guidelines including for specific indications like neurocysticercosis, cystic hydatid disease, and strongyloidiasis (for which Bendex can be prescribed)
f) Another window informs the doctor regarding aspects like possible micronutrient deficiencies related to this brand or patient condition, for eg., worm infestations often cause anemia. The window can auto suggest to check if the patient is looking slightly pale. Hence, the window reminds this fact to the doctor, and autosuggests a Cipla brand of haematinic. If the doctor feels this is a useful suggestion, he or she will click on this haematinic brand and it gets included in the Rx (prescription) (which is a window on the screen)
g) Another window in the meantime automatically links up with the Bendex product website on the internet and provides latest clinical data and other research reports, thus strengthening evidence based prescribing.
h) Assume that this is a software package provided by a consortium of big and small companies.

Now, a window on the screen suggests that mild dehydration and lassitude is common in patients with helminthiasis (or worm infestation) and a pop-up window shows a picture of a leading brand of electrolyte energy drink - with its profile.

The doctor can click on the product photo and the brand gets included in the Rx being generated on the computer screen.

Thus, what the desktop software package is doing is that it is encouraging the doctor to consider all aspects of the patient's condition, and prompting various useful brand options that can be prescribed to the patient.

Often a worm infestation patient suffers from gastrointestinal distress, hence, brand suggestions (in the pop-up windows) on prebiotic/probiotic brands, and proton pump inhibitors can be considered for the above patient of helminthiasis. Finally, the doctor can click on a pop-up window to print patient information leaflet - SIGN ON IT - and give it to the patient along with the printed Rx (which bears his sign).

Will the doctor like such a software? Initially, there will be a brouhaha on the commercial nature (the obvious benefits to pharma marketers) of this IT application, subsequently it will die down, and the adoption will only go northwards, because of its utility. The basic funda in marketing is that anything that increases CONVENIENCE will sell - the beneficiaries will be ready to pay any justifiable price to it. Particularly in semiurban and rural areas, doctors have little time and resources to update themselves on various clinical matters, this software will help in more efficient delivery of patient care.

The above software aided prescribing can include features like: type in symptoms and get a range of possible indications, get auto suggestions on confirmatory lab tests that can be performed, web site urls that will be helpful to get further information related to the diagnosis and prescription ... THE FACT THAT THE SOFTWARE GETS 'ON' ONLY WHEN A CIPLA/PARTNER COMPANY BRAND IS PRESCRIBED ENSURES THAT AT LEAST ONE SPONSOR COMPANY BRAND IS DEFINITELY THERE IN THE Rx.

A boon for pharma marketers Such a software aided prescribing system will help increase brand recall, brand prescribing, and more IMPORTANTLY will help provide market statistical data to pharma marketers (can be uploaded from the software) for eg., which are the common indications for a brand, how many Rx have been generated and so on...

Product or service or idea success - depends on the vacuum it fills

When ranitidine was introduced, it was safer and more effective than cimetidine, ie., it filled in the market gap or vacuum for such a drug, and ranitidine experienced success.

When Liv 52 was launched, clinical data driven Ayurvedic products were not there, and there were no Allopathic formulations to fill this market gap (of liver disease management). Furthermore, Liv 52 was backed with savvy gift oriented marketing, and the result is that it is one of the topmost pharma evergreen growing brands of India. The electrolyte energy drinks category too fits in a market gap for a tasty formulation that delights patients during the management of mild dehydration and lack of energy.

Omeprazole is far more effective than ranitidine, and today omeprazole is a leader generic worldwide, in the management of GERD and acid peptic disease.

Mankind, a relatively new pharma company, has gone on to become a leader company because it recognized the powers of low pricing, and tapping the pharma retailer power.  Today for select brands like Unwanted 72 it is also focusing on the DTC approach.


This is what the biotech companies have done. They have created products like filgrastim (granulocyte stimulating factor) which helps improve neutropenia (which was not possible earlier), erythropoietin is another invention to help anemia in kidney failure patients. Hence, today many people are investing on biogenerics (Merck is going one step ahead - they want to launch a slew of BIO BETTERS!)

Software aided approach for improved in-clinic activity (between doctor and patient) is a futuristic marketing model. We are slowly entering in to an era of SEGMENTED MEDICINE AND PERSONALIZED MEDICINE.

In segmented medicine, drugs are given to certain patients who share a certain genetic commonality. For eg., herceptin is a breast cancer drug, that is given to patients with HER 2 oncogene. This is a case of segmented medicine.

In personalized medicine too drugs are prescribed based on the genetic make-up.

For practice of hi-tech medicine based on segmented medicine and personalized medicine, software aided prescribing is the first step.

For eg., if a patient with breast cancer presents to the doctor, the doctor may begin with typing Cipla's brand of anastrazole - auto suggestions for HER genetic testing etc can be given through the pop-up windows. And the doctor can be helped to practice segmented medicine through the software aided prescribing process (while boosting sales of segmented medicine brands). All this ultimately improve in-clinic doctor and patient experiences that will boost brand sales too.

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