Sunday, June 5, 2011

Waves of change

Above image from here.

There are strong winds of change in India, there is a major trend in Indian society towards transparency, anti-corruption and clean governance. Swami Ramdev, the Yoga evangelist and social reformer, held a major anti-corruption cum yoga camp at Ram Leela Grounds in Delhi on 4.6.2011. In the wee hours of 5.6.2011, a 5000 strong police force evacuated the thousands who had gathered there using force and tear gas attacks. The winds of change are evident.

Anna Hazare and Swami Agnivesh, both social reformers and Sri Sri Ravishankar, the international peace worker, discoverer of the Sudarshan Kriya pranayama technique, and social reformer are also working hard to strengthen the anti-corruption movement.

Winds of change in pharmaceutical industry

The pharmaceutical industry is not inured to these societal changes. The DoP (Department of Pharmaceuticals) has drafted a Uniform Voluntary Code of Marketing Practices, which will be reviewed after 6 months. This code will be made statutory if there is no voluntary compliance by pharma industry. The chief mover of the voluntary code for pharma marketers is the DoP.

It is interesting to observe that the DoP has asked for feedback on the code of marketing practices for pharma marketers, at binayk.singh@nic.in

This move is keeping with the major trends in Indian society, for increased transparency. Perhaps, world over, it is one-of-its kind move, by a Govt. department, to regulate pharma marketing activities. Overall, one has to appreciate this initiative.

Abroad, including in USA, pharma marketing is a very controversial process. This is because of the huge marketing expenditure on prescribers. There are lots of web pages on the controversial activities of pharma marketers abroad, one just has to search on google.

What should the focus of any pharma marketing code be?

Pharma marketing is a very responsible and critical business function. Pharma marketing activities affect fortunes of pharma enterprises in a big way. If pharma marketing is weak, if the doctor perceives that value delivery is insufficient, then marketing outcomes are dis-satisfactory to pharma enterprises.

The main reason why pharma marketing is a tricky process, is that the patient has no say on the brand purchase. The doctor prescribes the medicine being promoted to him by pharma marketers, and the actual purchase is done by the patient. Thus, hand-in-glove relationships between doctor(s) and pharma marketers serves mutual interests. Hence, the need for a code of marketing conduct today!

Pharma marketing code is an interesting document and reads as a long list of do's and don'ts. In fact, the pharma marketing practice code needs to be marketed, not just put out!!

For instance, the pharma marketing code can be brought out in the form of an illustrated book, with each do's and dont's supported by graphics and any live examples from the market (the brand name and pharma marketer identity can be hidden), this will drive the point home better. If there are no examples to emphasize the points in the code, then the points in the marketing code tend to become ambiguous. Live market examples and supporting graphics will make the code points more clearer.

For eg., in point no. 2.4 of the marketing code, if live examples are provided in form of supporting literatures from market or any other market evidences, then point no. 2.4 will be clearer.

There can also be some disputes, for eg., the word 'new' cannot be used for more than 12 months (says point no. 2.3) (but what if the pharma marketer has gone in for a staggered launch - not nation wide launch, by the time it comes to the last geographical region for new product launch, the time for use of the word 'new' would have expired.) Thus, in such a scenario, a regulator may raise objection, which will affect pharma marketer's marketing strategy. And why should "new" mean only 12 months, why can't it be 3 years? Innovations do not get diffused easily. This "new" point needs to be illustrated by live examples to clarify further.

The marketing code ought to have a VISION STATEMENT. This can provide the spirit of the marketing code for pharma marketers.

For eg., the vision statement can include the following points:

"THE CODE OF MARKETING PRACTICE FOR INDIAN PHARMACEUTICAL INDUSTRY endeavors to promote transparency, put information of relevance to public access, prevent acts of omission and commission that may take place between pharma marketer and prescribers, promote legitimate interests of patients, and ensure that the healthcare system in India is the world's best and absolutely trusted.

THE PHARMACEUTICAL MARKETING CODE ENVISIONS TO MAKE THE PHARMACEUTICAL MARKETING PROCESS A KNOWLEDGE DRIVEN PROCESS, rather than a pure commercial value delivery process. Pharma Marketers will be encouraged to contribute to knowledge dissemination and renewal, which will help patient interest. "

It is the age of the internet, in this vein, the pharma marketing code should emphasize that each pharma marketer should compulsorily provide the complete product monograph of each marketed brand on the company website, the print literatures should provide the relevant URL of marketed brand.

Point 3.5 is well written: that promotional materials should be in good taste and non-offensive, however, live market examples should also be provided to illustrate this point. The same should apply to point no. 3.10

Points no. 4.1 to 4.5 deal with the tricky part of regulating in-clinic activity of Medical Representatives and pharma marketers. MR activity involves striking deals with prescribers and shoring up brand sale values. This means, pharma companies should educate themselves and MRs on the right way of in-clinic transactions.

Doctors should also be provided with education on the pharmaceutical marketing code, so that, they do not make uncomfortable demands. Doctors leverage on their prescribing power to strike rich bargains with pharma marketers.

Merely making a marketing code for pharma marketers is not enough. Doctors should also be aware of the pharma marketing code and should adhere with its provisions.

Points 5.1 to 5.5, on right use of samples: Samples are known to boost sales values, they are also known to end up at pharmacies or are sold at lesser value to patients by pharmacists or doctors. Samples ought to be given free for trial ... however ... Will a mere pharma marketing code ensure right usage of samples?

One way out is ensuring that doctors keep a written document (this is said in point no. 5.5) on a Govt. format, on the samples received by him and the usage of samples ie., to which patient he has given it etc. This document can be periodically checked by DRUG INSPECTORS during their field visits, drug inspectors should be empowered to check this document (kept by doctors). This may help rein misuse of samples. Furthermore, sale of samples by pharmacies should be strictly penalized.

When psychotropic substances are sampled, this becomes more tricky. For eg., it is well known that Corex and Phensedyl are abused "medications" including by doctors and medical students (Corex from Pfizer is sold only in India, no where else in the world!)!! Although, point no. 5.4 says that such psychotropic samples should not be given, pharma marketers should be allowed to sample these, but a record of same should also be kept by doctors.

The tricky part of the code is 6.1 and 6.2. The gluttonous appetite for gifts by doctors, has led to major fortunes for pharma companies, many a Ayurvedic company has its sales running on the oxygen of pharma gifting. If gifts are banned, bust goes the prescription flow!

This even threatens the functioning of product management department, in most companies, their major duty is lining up gifts to be provided month after month!!

Pharma companies gift electronic goods, once I was waiting for my turn to call on a skin specialist, when a MR and his manager walked into the clinic, to gift an electronic audio item, the doctor sent back the MR to fetch another model which he wanted, the doctor was not satisfied with the model being gifted!

Wining and dining, along with the throwing of a seminar by a KOL (Key Opinion Leader doctor) is a regular feature.

Pharma companies are known to gift every thing under the sun!!

If gifts are not provided by MRs, they are shunned by doctors!!

A pharma marketing code for gifting and sponsorship (point nos. 7.1 to 7.7) is not easy to practice!! DOCTORS OUGHT TO KNOW ABOUT THE pharma marketing code for these items too!!

TO BE PRAGMATIC, THE PHARMA MARKETING CODE, SHOULD PROVIDE FOR ETHICAL GIFTING AND SPONSORSHIP PRACTICES. The code should be revised and include a section on ethical gifting and sponsorship practices (relationship marketing).

By inviting a cross-section of views from doctors, pharma marketers and general society members, a frame work for ethical gifting and sponsorship practice should be worked out. Small clinically oriented gifts should in fact be encouraged so that pharma marketers empower prescribers. Relationship marketing has to have an ethical framework, and THE MARKETING CODE SHOULD INCLUDE THE ETHICAL GIFTING AND SPONSORSHIP PRACTICES FRAMEWORK IN A NEW SECTION ON RELATIONSHIP MARKETING PRACTICE.

One way of ensuring ethical gifting, sponsorship and relationship marketing is by ensuring that each and every pharma marketer publishes on a Govt. DoP website, on a monthly basis, the gifts and sponsorship activities done and the names of doctors who are recipients of the same. This will also make doctors wary of asking for and receiving gifts and sponsorships.

THE REST OF THE DOCUMENT FROM DoP ON THE UNIFORM CODE OF MARKETING PRACTICE FOR INDIAN PHARMACEUTICAL INDUSTRY, deals with the system of capturing complaints on pharma marketing malpractices and methods to address the same. As such, the endeavour is quite appreciated, however, in India, all these voluntary concepts will not work!! Only a law may work!! Chalta hai is India, hence, voluntarily following the code will not work.

The pharmaceutical marketing arena is more complex

There are more elements of pharma marketing process which are not covered by the present code.

For eg., pharma marketers provide gifts to pharmacies and retailers, so they may "push" and substitute prescribed pharma brands in favour of the pharma brand that provides best margins or gifts. Retail push marketing is a legitimate marketing effort, however it is a joke like atmosphere, there are companies who provide free goods eg.: 1 box free on purchase of 1 box, or even more!! No free goods go to the patient, it is only to the pharma retailer. The pharma retailer also enjoys the fierce competition between pharma marketers, by getting freebies and free goods (and adjustment of samples!). All these practices are not covered by the present pharma marketing code.

Pharma marketers provide exclusive offers or discounts to chain purchasers or hospitals or dispensing doctors, purchasing the product. The benefits are enjoyed by the traders or these purchasers, the patient does not get the advantage.

Pharmaceutical marketers also produce goods for OTC consumption

Pharma marketers also provide products for OTC consumption (dietary supplements etc). These activities are not addressed exclusively by the pharma marketing document.

PHARMA MARKETING INCLUDES
  • BULK DRUG MARKETING
  • EXCIPIENTS MARKETING TO PHARMA MANUFACTURERS
  • PACKAGING MATERIAL MARKETING TO MANUFACTURING COMPANIES,

and there are interesting 'relationship marketing' practices, here too, which can also be looked into, since these practices also affect the cost price of the product!!

The bright spot is that DoP has begun addressing patient concerns. DoP is trying to discipline the marketing environment. In the end, a disciplined pharma marketing environment will benefit all, including the pharma marketers themselves.

FOR EG., WHEN I WAS TALKING TO A SENIOR PHARMA MARKETING PERSON, HE SAID:"SUNIL, EVEN IF I WANT TO REDUCE SPONSORSHIPS OR GIFTS, I CAN'T -THE MARKET WANTS IT, DOCTORS TAKE IT AS THEIR RIGHT, THEY DEMAND SPONSORSHIPS AND GIFTS, MY FIELD FORCE WANTS GIFTS TO BE GIVEN DURING IN-CLINIC ACTIVITY, THEY FEEL WEAK WITHOUT GIFTS FOR DOCTORS, OR SPONSORSHIPS TO DOCTORS, I HAVE TO COMPLY, THERE ARE PRESSURES OF SALES, GIFTING AND SPONSORSHIPS (of delegate fees, stay, air tickets, vacations, special items, special services like painting the clinic etc), IS A ROUTE THAT WILL HELP ACHIEVE SALES TARGETS. THE FACT, IS NO COMPANY CAN AFFORD TO STOP GIFTING OR GIVING SPONSORSHIPS, ONCE THEY HAVE STARTED IT, IT IS A 'TIGER' - WE HAVE TO RIDE IT AND NEGOTIATE."


CLICK HERE FOR THE UNIFORM CODE OF MARKETING PRACTICE FOR INDIAN PHARMACEUTICAL INDUSTRY.

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3 comments:

Neelam said...

Very nice analysis of the Code highlighting both the positives and shortcomings..Even i agree that the code must contain cases and examples for it to be appealing and acceptable

Sunil S Chiplunkar said...

Thanks Neelamji, for your kind comments, request you to read my blog regularly.

christyjames said...

Great post. You are shared really informative and valuable post. Thanks for sharing.For beginners this is going to be very much useful. Thanks for share and keep sharing further. Many queries are solved through such lessons.
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