Monday, June 29, 2009

Three cheers: Nandan Nilekani


Gov. Rameshwar Thakur recently left Bangalore as Governor of Karnataka to take up position as the Governor of MP. He bid an emotional adieu saying Bangalore is a great city and full of intellectuals. How, timely comes his observation - our own IT mannina maga (ie., IT son of the soil!!) - Padmabhushan Nandan Nilekani, the billionaire IT czar & Co-Chairman of Infosys, takes up a super national Governmental position as Chairman of Unique Identification Authority of India. It is truly a great honor to a fellow Bangalorean. He will enjoy the status of Cabinet Minister of Union Govt. This move engineered by our PM - Mr. Manmohan Singh, reflects the quality of intellectual climate and people of Bangalore and Karnataka, as opined by the honorable outgoing Governor - Rameshwar Thakur.

What does the Unique Identification Number Project mean to India?

The purpose of this Rs. 100 crores project (Rs. 100 crores is the outlay in the interim budget of 2009 - 2010) is to give every Indian an unique identification number. This would mean harnessing all the conceptual strengths of Nandan Nilekani and his grip on the IT science to create an infrastructure that will electronically document the profile of a citizen and give him a number. This number will in turn be a key for obtaining various Governmental services.

From what we understand of Nandan Nilekani one can expect a superb job done of this project. One can also expect something that Infosys always does: UNDER PROMISE AND BETTER DELIVER! So Nandan will surely do something far more than expected from this project.

Nandan is a true patriot. His sincere love for India is reflected in his book IMAGINING INDIA (click here). It is this sincere love for India that has made him give up his relatively comfortable corporate job of Co-Chairman of Infosys to becoming a Govt. person. Otherwise, there is no need for this man to give up his relatively cushy job in Bangalore and go over to Delhi, roll up his sleeves, and work for what can always become a thankless task if politicking rears up its ugly head (I bet there are many vested interests in politics who want this project to go on very very slowly).

Can this project translate in to something better on the healthcare front?

We are as yet not sure what info the project will gather about a person - besides his date of birth, place of birth, gender, caste, economic status, etc.

Let us assume, the unique number project also gathers data relating to the health status, like whether the person has polio, HIV infection, diabetes, cancer (at the time of profiling) etc on a voluntary basis from the citizen. If this happens, simply put, this database of unique numbers can overnight provide a near accurate picture of health and disease patterns across the country at the press of a button to policy planners, marketers etc. This will give a shot in the arm to the business of analytics...

Analytics is basically a science of analyzing data of say people, events and circumstances and providing a visual representation of the same for refined decision making. Statistical science is used in analytics.

Thus, using analytics one can find the regions where for eg., anemia is more prevalent. Marketers and policy planners can launch specific marketing programs to alleviate this problem. This is but one hypothetical application of the unique identification number project. Let us say that the analytics exercise also provides leads to places where infant mortality, and preterm deliveries are more. Then healthcare planners and marketers can launch product marketing programs in such districts to improve prenatal care.

Basically the dialog should begin now so that healthcare data mining gets embedded in to the genetic code of the Unique Identification Number Project. This input will then provide a great boost to the healthcare policies of India and provide impetus to marketing programs of pharma marketers.

Mr. Nandan - it is truly a great sacrifice - going away from Infosys to a Govt. of India job. To take on a bull by its horns... BEST OF LUCK!! And hats off to your family and close well wishers (including the large hearted Infoscians, after all Infosys as a company is losing services of its charismatic cofounder leader) who are supporting you on this move.

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Saturday, June 27, 2009

Pharma Iatrogenic Death of Michael Jackson

I got the above image from here.
This is a shraddhanjali to one of the greatest global pop music stars - Michael Jackson.

With pharmaceutical marketing becoming all powerful, the death of Michael Jackson is a grim reminder of the importance of iatrogenic complications. Iatrogenesis refers to the complications resulting from medical therapy or advice. Iatrogenesis may follow intake of drugs or pharmacotherapy or surgical therapy. The repeat plastic surgeries had caused a weakened immune system of Michael Jackson. He would often wear a mouth mask. In fact, during a press conference in the recent past, the iconic pop singer's nose had fallen off. Medical therapy and overuse of medications had rendered him highly dependent.

Iatrogenesis can be caused by medical error, negligence, and adverse effects or drug interactions. Thus, the onus is now on pharma industry to market drugs collaboratively and responsibly to ensure that iatrogenic events are minimized.

Importance of being an informed patient

When a person is unhealthy or diseased or struck by illness, it does not imply that the patient has to surrender to the medical profession or pharmaceutical profession. It means the time has come for the patient to use available resources like the internet to educate himself about the disease. Thus, the patient becomes an informed patient, and discusses the therapy options to avoid becoming a victim of iatrogenesis. It is but too naive on the part of patients to abuse potent medicines like narcotic analgesics - through the medical profession. In India, codeine based cough suppressants are freely available and surely are a cause of many an iatrogenic addiction. It is imperative that NGOs, Govts., and other stakeholders (including pharma marketers of codeine based formulations) wake up to the dangers of iatrogenesis and launch an initiative to create informed patients to ensure responsible use of medications including codeine based cough suppressants.

Medical ethics state that the healer (and this includes pharmaceutical profession too) should FIRST DO NO HARM.

Importance of pharmacovigilance

Pharmacovigilance is an important field today. It implies keeping a vigil on the adverse effects (long term and short term) of medicines. Pharmacovigilance is a fast growing pharmacological science. However, there is a long way to go in sensitizing pharmacists, the patient population and medical profession in helping collecting and analysing of pharmacovigilance data. Pharma marketing is busy achieving sales quotas.

Michael Jackson was iconic. His charisma and pop music swayed an entire generation of music listeners. Moonwalk dance steps became a must in every college fest event. 'Beat It' is a glorious number.

Importance of alternative healthcare therapies

Once again the tragic death of Michael Jackson reminds us of being cautious in using medications. The line is thin between abuse and use. His tragic death is a telling story that patients should explore healthy lifestyle options, preventive care, and alternative healthcare therapies like Yoga, and authentic ayurveda.

The goal of businesses is social contribution and profits; not PROFITS and social contributions. Unhealthy profiteering attitudes are but self destructive. The primary goal of medical professionals is to be agents for patient health and not prescribing agents of pharmaceutical marketers. Only responsible marketing and medical practice creates a long term sustainable business model.

The medical case history of Michael Jackson needs to be studied in depth by the medical profession and pharma marketers. The medical case of pop star Michael Jackson is a classic case of iatrogenesis. A grim reminder to all involved in drug research, marketing, and prescribing of the double edged sword that medications are.

I rise with full respect and love for a man who entertained crores of Americans, Indians, and others transcending national borders with his music and dance. One cannot help recollecting an amusing and interesting aspect of Michael Jackson' music:

My father-in-law (Shri A G Patwardhan) was a full time progressive farmer during his youth days. He lives near Dharmasthala. Today, he is more of an astrologer (which was his other passion right from childhood years) and less a farmer, as he is more than 60 years old.

During his hey days of farming, my father-in-law had gained a good reputation for having a nice rubber plantation, this was reported in various local and national media (like The Hindu).

When asked how he managed to have a good plantation particularly because wild boars tended to attack tender rubber saplings during nights, my father-in-law thanked Michael Jackson! My inventive father-in-law had set up audio system among the trees in the plantation. Periodically, at night he would play different types of music as he was experimenting the effects of music on plant growth! He noticed that wild boar attacks were warded off whenever he played Michael Jackson's music at night, particularly 'Beat It'!!

This is a true anecdote. And because of this experimentation, he had become quite popular!!

Such is the persona of Michael Jackson - his music had penetrated in to the microinteriors of India (like Mundaje village where my father-in-law was residing those days). Rural India and urban India had a taste for Jackson music. May Michael Jackson's soul live in peace.

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Sunday, June 21, 2009



Marketing is a play of behaviors (ie., thoughts, words, actions, and deeds). Marketers influence behaviors to help achieve corporate objectives. Customers, particularly informed customers like doctors are not easily influenced by pharma marketers. This is because, doctors co-create (along with the core pharma marketers) the knowledge and use of pharmaceutical products. Hence, they are part of the marketing process ie., value delivery process.

Doctors are different from laymen customers. In the latter, product knowledge ignorance is high. Doctors, on the other hand, are well informed of products and the diseases that the products help manage. Hence, such informed customers are natural participants in the marketing process that produce the consumption of pharmaceutical products. Thus, doctors are not only indirect customers of pharmaceutical companies, they are also in a way co-marketers or co-pharma marketers too.

This represents the binary role of physicians in the medical and pharmaceutical firmament - they help in value delivery to patients - the actual consumers - hence the doctors are marketers. Yet they operate independently as professionals in diagnosis and treatment of patients. Hence, they are also target customers for pharma marketers.

Physicians being at the interface between patients and pharma marketers, have a binary orientation - they participate as marketers in the value delivery process and at the same time from the patient's point of view, they are independent operators in the healthcare system offering diagnosis and treatment skills.

Hence, physicians operate at a very high level on the trust factor with thier patients. They walk on a fine line and need to be highly ethical. If a patient finds out that his prescription is being doctored by the physician to help a pharma company achieve its corporate objective (in return for cash, or speaking engagements, conference seminars, gifts, samples etc) rather than being a treatment necessity, there is a big fall in the trust. This is evident in present day times where the media is all pervasive, fast, accessible, and often we see media activism at play.

This is a double edged sword for pharma companies. When the end customer or consumer does not trust the doctor, it is inevitable the patient does not trust the pharma companies too.

It is in this regard, that producing desired behavioral outcomes in terms of patient compliance, and prescribing behavior becomes very challenging. The very basis of business and health service is trust.

I met an orthopedic patient while traveling aboard a plane recently. He seemed to have become a 'semi-doctor'. Truly I was conversing with an informed patient. This gentleman had in-depth knowledge and had keenly analyzed the various treatment options exercised by his doctors. I was just wondering how tough it would be in years to come for pharma marketers to market their produce in the face of such informed patients. The advent of the informed patient is sure to change the dynamics of pharma product consumption. It is inevitable that pharma companies start working on a mandate of TRUST BASED MARKETING.

To pharma marketers, this means creating an image of being a reliable entity from the point of view of doctors and PATIENTS. When a patient buys a tablet of a calcium supplement on recommendation of a doctor to manage his osteoporosis, the patient should not feel conned or feel he is a victim of a trade - the smiling fast talking academic minded doctor who has a very large influence over his patients and the pharma company who has the doctor in a 'vice-like bear-grip' through a motley of services ranging from speaker assignments, special payments for being an opinion builder doctor, gifts, trips abroad, and other services.

It is time for the regulatory authorities to work on a very pertinent concept of WHITE APRON CRIME (or White Coat Crime)

This basically means a crime committed on a patient by the doctor - the crime being prescribing to satisfy the needs of a pharma company rather than the patient's health need

Who should sit down and define a WHITE APRON (or White Coat) CRIME?

Well, eminent medico legal jurists, pharmaceutical experts and the doctors themselves should create a ethical and legal framework for doctors and pharma marketers to operate by. This will help both the doctors (who are semi-pharma marketers as they are involved in the value delivery process of pharma marketing) and the core pharma marketers retain trust of patients and society at large.

This charter can be called as TRUST BASED PHARMA MARKETING LEGAL CODE FOR DOCTORS AND PHARMA MARKETERS. This legal code can define a WHITE APRON CRIME (committed by doctors - since doctors are semi-pharma marketers), penalties for committing the white apron crime, and the legal and ethical marketing services that can be transparently provided by the core pharmaceutical marketers to doctors who are semi pharma marketers. The code should also lay down the patient rights. It should also ensure that the doctor puts out on his prescription any competing interest - eg. the doctor should declare that he or she has received regular samples of the prescribed product, he has received a good gift for prescribing a certain quantity of the same, and as an opinion builder speaker doctor he should also declare the speaker fees he or she has received from the core pharma marketer.

The initial annoyance will be very high - dissonance will be extremely high with such an initiative. The doctors will spew venom because it will touch their ego, and will downgrade their status as sacrosanct persons of the healthcare profession. However, in the larger interests of the medical and healthcare profession this is very important surgical necessity.

If such strong measures to discipline pharma marketing and prescribing (mal)practices, through defining a WHITE APRON CRIME (or White Coat Crime), are not done (as doctors are actually semi-pharma marketers), the overall image of the medical and pharmaceutical profession will continue to take a beating.


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Friday, June 12, 2009

The valley of death


The valley of death is an interesting concept. It represents the translational gap between innovation and commercialization. A no. of basic medical discoveries fall in to the death valley because nobody is ready to understand and commercialize the product potential in those concepts. The researchers are busy discovering things, the practitioners are busy with patients; the marketers are busy working out profit making and market penetrating strategies. So who will bell the new product concept cat? Enter the translational research team experts, who will try to make a sense of all the lab research, and try and link up the product concepts through the marketers to the prospects; and get it from bench to bed as fast as possible.

Research and new pharmaceutical product development has become very complex. Firstly, new pharmaceutical product development is a big team work, and commercializing is a bigger gamble.

Just recollect how many of the medical breakthroughs of the past were developed - it was through the medical researcher cum healer. Recall the story of small pox vaccine: Edward Jenner (1749 to 1823) is considered as the father of vaccination. He noticed that (pretty?!) milkmaids had a clear complexion (no pock marks of small pox). He surmised that cowpox - a related much milder disease that was contracted from cows conferred them with immunity from small pox. He made a crude vaccine of cowpox virus with the help of a milkmaid Sarah Nelmes by name. Using a thorn as a syringe he infected it in to a 8 year old boy James Phipps on 14.5.1796 (18th Cent.). A few weeks later he daringly injected the boy with small pox. To everyone's relief the boy remained healthy. 200 years down the line - small pox is eradicated worldwide thanks to Edward Jenner. Such was the research trend those days. Today, it is more complex, teamwork and tight regulations are driving research efforts. Hence, the valley of death has also come in to the picture. Traversing this valley requires the translational research experts.

There are hundreds of innovations, yet all do not come to the market, neither do all become commercial successes. Between the cup and the lip ie., the innovators and the ones involved in commercialization there are a lot of issues. For eg., even if a researcher comes up with a grand product concept for malaria, the one's involved in commercializing innovations may not invest on this concept, for the markets' are more attractive for chronic lifestyle therapeutic products and all funds are tied up there.

Molecular medicinal research and biomedical research has made the game of new product development more complex. Basic biomedical discoveries are numerous. There are a lot of therapeutic protein targets being identified. However, where do you put all the efforts and resources for developing a product from the molecular discoveries?? That is where the translational research team comes in to the game. This team comprises of multidisciplinary specialists like pharmacologists, clinicians, and other guys with a marketing sense.

Hybrid marketing and the valley of death

The hybrid marketing concept has a role to play to help good product concepts avoid falling in to the valley of death. In hybrid marketing, practicing opinion builder doctors in the market are involved in the drug development cycle. In hybrid marketing a lot of prelaunch marketing work is done. Thus, by the time the actual launch of the product takes place, there are a set of doctors with confidence on this product and they will help commercialize the product successfully. Pre launch marketing activities can last up to 5 years before the actual launch of the product.

The valley of death is not only about R & D

There are lots of valleys of death in organizations. For eg., there is a valley of death between marketing guys and the sales chaps. The marketing guys are convinced on their marketing concepts, where as the sales guys think they are ivory tower concepts. Sales guys have their own relationship management tools that they feel provide the actual fodder for sales. The finance guys try to figure out where all the money is going down the marketing pipeline. And sometimes their left brain thinking does not appreciate the right brain activities - leading to a valley of death. There is a valley of death between the R & D guys and finance chaps. The latter are always wondering why the R & D dept. is burning so much money while the output is not exciting. The production and quality control guys have a translational gap, which the QA (quality assurance) guys try to fill in. THE FUN TODAY IS TRYING TO WORK ROUND ALL THESE translational gaps or VALLEYS OF DEATH, reconcile the varying points of view, market the concept internally in the organization, and finally help create revenue flows to the organization.

Modern business complexities

The modern business complexities are numerous, there are many translational gaps or valleys of death for new product concepts, product promotional concepts, and other processes. The future belongs to those organizations who can avoid the valleys of death in an organization through improved focus, mutual understanding, trust, and communication. To help avoid translational gaps, HRD people try to put in training programs for better communication, efficiency, and effectiveness. So do the other trainers in marketing depts. too.

Limerick of the day


Mr. Mind did a lot of research
Created did he, a product for the top perch
Mr. Seller had no idea to appreciate
So the product market did depreciate
Alas, the product was in a lurch.
- Sunil S Chiplunkar

Thought for the day


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Sunday, June 7, 2009

Dopamine marketing!

I got the above exciting image from here.

Modern pharmaceutical brands succeed in the market for various reasons. One important process that contributes to this success is documenting, publishing, and communicating of clinical data. This is a very vital process that ensures brand visibility, repeat purchase, confidence building, and top-of-the-mind recall. Getting word-of-mouth between opinion builders and the target audience is crucial for marketing success. Only researching and producing clinical data, documenting, publishing, and communicating this data creates the buzz. This is the main reason for the success of modern medicine.

Contrast this to the traditional healthcare systems, clinical data is not robust, documenting, publishing, and communicating is certainly not as exciting as modern medicine.

Traditional medical and healthcare systems suffer from bad marketing - in particular, the process of documenting, publishing, and communicating. Traditional healthcare knowledge systems have suffered for several years, from ' publicity phobia and secrecy'. Ayurvedic pundits do not reveal the formulae of their medications. Traditional formulations are not as noted for clinical research, documentation, publication, and communication as modern allopathic medicine. The result is that the overall market building suffers. Hence, the traditional healthcare formulations will continue to be sidestream and niche markets, while modern medicines will dominate the healthcare industry as the mainstream medicine.

Life is expansion

If a field of knowldege should expand or grow, well then, it should be alive - there should be a lot of buzz. Not noise - but excitement of failures and successes. People should be talking of the various pros and cons of a therapeutic approach; all growing knowledge is interdisciplinary - if knowledge creators and researchers operate in physical and mental silos - the growth and buzz will certainly be muted. Marketing is crucial.

New heights of pharmaceutical marketing

Those were the good old days of pharma marketing (from the 1950s to 1970s) - researchers would come up with new formulations and give it to the marketing dept. to commercialize and create profits for the company.

However, from the 1990s onwards, this departmental approach to marketing of products is creating more product failures than product successes. It is the age of HYBRID MARKETING. Considerable time and efforts are being spent on PRELAUNCH ACTIVITY - lasting even for up to 5 years before the actual launch of the product. The concept of prelaunch activity reflects the RISE OF THE PROSUMER. The consumer is a part of the production system (hence, the word - PROSUMER). Select opinion builder doctors are nurtured in the marketplace along with drug developmental activities, to ensure that the commercialization activities after the actual launch of the drug or product, will show positive financial results (for the new product).

With such sophisticated marketing approaches of relationship building, documentation, publishing, and communicating it is not a surprise that modern medicines are so powerful in terms of efficacy, safety, supply, mind-share and market share.

The roots are the same - however, the commercialization and development approach is different

If we observe the growth of modern medicines, and traditional medicine science, it is evident that the roots are same, however, the growth, science based marketing, development, and research of modern medicines is unparalleled. This has created high value for the modern medicine industry.

Aspirin (acetyl salicylic acid) the chemical has its roots in the bark of the Willow tree. Most of the antibiotics have been sourced from natural sources. Artemesia annua (a plant) has given a new antimalarial drug - artemether. Penicillin is from the fungus Penicillium notatum. Streptomycin and Cephalosporin range of antibiotics owe their origin to natural sources. Even cardiovascular medicines like digitalis alkaloids for heart failure treatment have natural origins. William Withering the Birmingham physician extracted the active ingredient of foxgloves, DIGITALIS, in 1796. ACE inhibitors are hugely popular antihypertensives and heart failure management drugs. The discovery of ACE inhibitors too has natural serpentine origins.

Nature has provided the molecular templates for both - traditional healthcare and modern medicine marketers, however, modern medicine has taken a clue from these templates, manufactured new moieties, and provided superior well studied, documented, published, and well communicated data for these medicines. Thus, in spite of the adverse reaction possibilities of these potent modern medicines, their usage and consumption, is very high. The reason for the huge size of the market for modern medicines is CLINICAL STUDIES, DOCUMENTATION, PUBLISHING THE SAME, AND COMMUNICATING (through marketers and nonmarketers). This creates the buzz, and confidence, MARKET SIZE ... and yes, a SENSE OF ADDICTION!

What is addiction?

Addiction means obsession, compulsive consumption, or excessive psychological or physical dependence. This includes, cigarette smoking addiction, alcoholism, plastic surgery addiction, video game addiction, crime addiction, money addiction, work addiction, compulsive overeating, pornography addiction and so on. It refers to a person who has lost his or her sense of balance, has a compulsive behavior, and his or her behavior is directed by the substance or the factor of addiction.

Addiction and dopamine

Dopamine is an important neurochemical or neurotransmitter. Dopamine orchestrates motor behavior and reward-driven behavior besides its other physiological functions. This property of dopamine to play a role in reward-driven behavior is important for marketers. Drugs of abuse mimic the physiologic action of dopamine by increasing their firing rate or preventing the uptake of dopamine. So dopamine mediates natural or pathological reinforcement learning. When an unexpected reward is presented midbrain dopamine neurons are activated. Repeated rewards create learnings. When the reward is not given, the dopamine neurons are depressed. SO DOPAMINE PROVIDES A CHEMICAL TEACHING SIGNAL TO CREATE NEW ACQUIRED BEHAVIORS.

Dopamine is a part of the pleasure system of the brain that provides feelings of enjoyment to the person. This also creates reinforcements in the behavior and motivates a person to proactively perform certain tasks. Dopamine is involved in the behavior of prediction of reward, motivation, and thinking. Food, sex, aggression, and drugs cause release of dopamine - and hence, pleasure. Reward anticipation creates firing of dopamine in the brain. WHEN THE REWARD IS GREATER THAN EXPECTED, MORE DOPAMINE IS RELEASED, AND INCREASES THE DESIRE OR MOTIVATION FOR REWARD. Level of desire towards external objects is influenced by levels of dopamine.

So the bottomline is that when pharma marketers through their activities increase levels of dopamine in the mind of prospects towards a brand, you can expect more prescriptions and sales. Hence, pharma marketers will continue to charm their doctors, offer free food (free lunches or food gifts in the clinic), gifts, and other rewards, and motivational tools (like public speaking engagements, prizes and honors for scientific publications, publications with photos in newsletters and other media, and other forms of public acclaims). Pharma marketers of modern medicines are more adept at such marketing approaches than marketers of traditional healthcare products. Hence, modern medicine will continue to dominate.

Pharma marketers of modern medicines are more adept at using such dopamine boosting incentives for their salesmen. Hence, modern medicines will be pushed better than traditional healthcare products.

Ultimately, pleasure or reward driven behavior through boosting of dopamine levels in the brain will create more demand for the product. Pharma marketers are most adept with this form of DOPAMINE MARKETING. So when a pharma company sponsors a cocktail dinner with a great seminar on a pharma brand, please understand that we are working at a very deep level, at the level of neurotransmitter DOPAMINE.

When documentation, publication, and communication is done on a brand a most powerful form of marketing is done, to feed the information addiction of doctors. More the information input, more the pleasure, more the addiction to the information, more the buzz, and more the prescriptions! LONG LIVE DOPAMINE MARKETING!!

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