Sunday, August 3, 2014

My talk for freshers at a pharmacy college

On 1.8.2014, I had the privilege and pleasure to address fresher pharmacy students and parents at Dayanand Sagar College of Pharmacy (DSCP), Bangalore.

This college is now a well-sought after pharmacy college.  The kind invitation came from Dr. Murugan M Pharma PhD, Principal, DSCP, Bangalore, a progressive and competitive person, who wants to develop this pharmacy college into a prime academic force of our noble profession.

Here we see Dr. Murugan, Principal, DSCP, Bangalore addressing the audience:

The pharmacy college belongs to a well-established group of Bangalore:

The idea of my participation was to build confidence, give insights and motivate: fresher students and parents:

Along with an attractive speech, I provided the main content of my talk as a leave-behind to each attendee:

The main points were as follows:

The following points were given in my speech and leave-behind, for confidence-building.  My talk included good jokes and anecdotes to illustrate the thrust points.  My talk was well-received.

The main idea of the first part of the talk, was to give a bird's-eye view of the status of pharmaceutical industry including its relation with world-business.

India: Pharmacy of the world!

       Indian pharmaceutical goods are recognized for quality and price innovation across the globe: India is the world’s third largest pharma market in terms of volume; as per AIOCD AWACS June 2014 MAT report, retail pharma business is Rs. 77529 crores and value growth was 6.7% (and exports of about Rs. 65000 crores)
       India has more than: 4.5 lakh doctors, 7 lakh pharmacies , 20,000 pharma companies, 200 US FDA approved manufacturing facilities and 2 lakh medical representatives
       India is making the mark in bio-medicines with MABs, rDNA products and other ‘similar biologics’ (Biocon, Strides, IPCA…) & also with indigenous healthcare products
       Medical tourism is boosting global Pharma India
       Cipla has saved 1 crore lives in Africa through their affordable anti -AIDS medicines: India makes 92% of anti-AIDS medications sold world-wide
       Lupin is the 5th largest generic pharma company in US prescription market as per wikipedia; fastest growing in Japan and S Africa; global leader in anti TB bulk drugs and formulations and in 2012 Sun was the 9th biggest generic pharmaceutical company in USA 

       There are global job opportunities for pharmacists: Egs.: in community pharmacies of Gulf; Pharma marketing across the globe – for instance, Sun Pharma has two regional managers in Myanmar (Sun is the No. 1 pharma company in Myanmar and Indian companies control 60% of the  Myanmar pharma market; SUN IS NO. 1 IN INDIA TOO!)

Below is a graphic of the Indian pharmaceutical industry revenues:

The inspiring growth of pharmaceutical exports: 

The next part of my speech was directed to students on how to take advantage of their four to six year study time in this campus; after all, they are giving their beautiful youth years for pharmaceutical learning:

Framework for success

q  Welcome to the global noble profession of Pharmacy

q  Enthusiasm (intense positive emotional energy born from unconditional self-love)
In this part of the speech, I talked about the importance of having enthusiasm come-what-may, so that each individual is able to put in his/her best for learning and be happy

q  Not just exam centered learning strategy: have a career centered learning strategy:
It is unfortunate but true that most students make the mistake of having an exam oriented learning strategy (the focus is only to pass or get good grades).  However, it is more advantageous to have a career oriented learning strategy so that the learnings' enhance employability and create career success.  (I also gave several examples from my work experience)

q  Build the 3 Cs continuously: CHARACTER (reliability), COMPETENCE AND COMMITMENT

q  Learn and practice: memorization techniques and  creative communication (messaging) process (active listening, body language (non-verbal communication), oral and written: conversational communication, inter-gender communication, dyad communication and group communication)
I gave some interesting examples of why communication is vital in marketing or other departments.  I also illustrated importance of memorization techniques like mnemonics.

q  Follow your cultural values and upbringing: do not cross the Lakshman rekha (remember the love that your parents have for you - always)
I exhorted the importance of not crossing the line in student-life, to repent later!

q  Inculcate and practice humility: you will always be fearless and approachable  - you will always have the will and confidence to approach others whenever required; you will be able to tolerate people who give you pain during interactions and finally find strength to transact with them for mutual benefit

q  Be  cheerful, spread cheer,  be self-defensive and cautious

I thank: Dr. Muruganji, Principal, Dayanand Sagar College of Pharmacy, Bangalore, Dr. Geetaji, Prof. and HOD of Pharmacology, and team DSCP: for the kind hospitality and experience.  
I thank you all for reading this blogpost, hope it was useful and interesting, and I request readers to scroll down and read all other blogposts: do click on older posts to read other write-ups, feel free to recommend this blog to your friends. 

Tuesday, July 29, 2014

Preparation meets opportunity

Many of my peers, juniors and some seniors often ask me: on the purposes that each person ought to be having.  Sometimes people feel purpose-less, often there are no assignments - so people feel out-of-place or insecure, or there seem to be irrelevant assignments to be executed or there are assignments which need to be done, but your heart does not belong to it!  So what is the way out?  Well there is an antidote - life is not just about doing the allotted assignments: life is actually something else: it is about PREPARATION!  Life is about practicing, verily, PREPARATION MEETS OPPORTUNITY.  This is in fact, the best theme for life.

Just imagine the life of a committed Hindustani music singer: do you think her life is only about flitting from one music program to another program?  Do you think there are no dry days - when concert opportunities are not there?!

A singer has her major focus on the early morning riyaz: practice session.  It is this preparation time, which gets the maximum focus in her life. The singer focuses on the riyaz or practice session, which is responsible for her concert performances!  So it is preparation-focus, which ought to be every professional's obsession! And then doing the job with aplomb when opportunity comes by!!

Define your professional profile

To start a preparation-focused professional life, begin with understanding your professional profile.  For instance, as a medical representative - your profile will want certain competencies: territory knowledge (doctor and pharmacist profiles, ideal meeting timings, product prescribing behaviors, pharmacist OTC and substitution behaviour, short and quick work routes in the territory)..., detailing skills, basic product profile knowledge, competitor product and activity knowledge, and relationship management knowledge (eg., knowing how to communicate, build rapport, greet people on special occasions like their birthday, submitting greetings on festive occasions - Eid Mubarak to Muslims at end of Ramadan period etc).  

If you are a trainer or product manager, understand the product management concepts and training aspects. Focus on preparing for the deliverables.  A lecturer is not a lecturer until he can give proper lectures!  After understanding the profile requirements and parameters, develop your competencies on those lines continuously!!  That is preparation-focused behaviour.

If you are regular to the fitness center or gym, while going through the exercise and fitness equipment routine, you will realise that there is no end to the no. and types of exercises you can perform.  It can go on and on and on, until you can take it or you have the time and aptitude for it all... same way, there is no end to the depths of knowledge you are trying to master in your professional sphere!  The knowledge and activity stream for preparation is bubbling, continuous and endless!  So preparation is also an endless exercise, with several milestones in the journey for you to keep reaching!!  The biggest room in the world is the room for improvement!!  And therein lies endless opportunity.

Your professional profile is not static!

The mobile phone, whatsapp, facebook, social media, email, ebooks, internet, blogs, biotechnology, rDNA technology, MAB (monoclonal antibody) business ... these were all simply not there in 1992, when I started my work-life after M Pharma...  Now these software and social media tools are great for communicating knowledge, motivating and keeping a tab on things.  We routinely use social media whatsapp for updating marketing campaign work with each other!!  This creates a ripple effect and work dynamism.  Change is the only constant of life!!  So how can the professional profile be static?  Preparation attitude is a continuous process.

Today, training is not about providing knowledge... there is endless information, data, knowledge and insights available in the information superhighway!  The moot point is can you wade through it, get what you want, grasp the essentials, and put it across in an easily assimilable manner!?  Can we engage trainees with the learning and get them excited enough to learn and apply it/practice it!?  Are there interesting ways, using modern technology (web-based, mobile-based or social media based methods) to deliver learning experiences?  If yes, as a trainer, one has to grasp these new ways!!  The same chalk and blackboard method or reading from an attractive powerpoint is not enough!  So that makes a professional trainer's life one of continuous preparation!

Today, that is the need from a trainer!  The challenge for a trainer is to help learners acquire the necessary knowledge units, skill sets, and get them motivated enough to use it in day-to-day working.  It is one thing to handle the visual aid in the training spot, however, the fact is: at doctor clinics' - visual aids are not even opened, if they are, then the visual aid page is flashed for a brief moment - brand name is mentioned, pointer is not used... pay-off sentence is not emphasised... the real challenge is getting learners to learn and apply!

The MAB (monoclonal antibody) market

Take for instance, in 1992, B lymphocytes were mainly in HUP (human physiology) subject.  We learnt that B lymphocytes were a type of agranular leucocytes that produced antibodies which help destroy antigens (foreign bodies) in the blood stream.

But today!?  B lymphocytes are billion dollar business!!  B lymphocytes are used to produce required target antibodies, which have therapeutic, diagnostic and academic uses.  IV (intravenous) infusion: Trastuzumab (humanized mouse based whole antibody) is used for treatment of HER 2 positive breast cancer cases. Various other antibodies are marketed chiefly for treatment of autoimmune diseases, infections and cancer. Antibodies are no more natural biomolecules produced as a part of passive or active immunity by B lymphocytes in the body!  B lymphocytes are vital economic entities: producers of antibody protein molecules that have billlions of dollars in sales!!

Genentech (now a member of Roche group) invented trastuzumab (an antibody: specifically a monoclonal antibody).  Their brand name for this whole antibody IV infusion preparation was HERCEPTIN.  In 1998, the sales of this molecule was 30.50 million USD.  In 2008 annual sales had progressed to 1.38 billion USD (1,382 million USD) - this - only in US market! In the world market (including US market), Herceptin sales was 1.82 billion USD approx. in 2008.

As per Fierce Pharma ( Herceptin had estimated worldwide sales in 2012 of 6.08 billion USD.  The product patent for trastuzumab (Herceptin) expired in 2014 for Europe, and in USA, it will expire in 2018.  In the same report from Fierce Pharma, we observe that Herceptin is ranked no. 8 pharmaceutical product in the world, by sales value in 2012.

Product patent expiry has opened up a market for biosimilar Trastuzumab brands.  The me-too antibody preparations are called biosimilars.  Bangalore based Biocon has launched its me-too biosimilar antibody trastuzumab under brand name: CANMAb.  International generic major Mylan has the brand Hertraz: trastuzumab biosimilar.

CDSCO (Central Drugs Standard Control Organization: has issued a pdf document in their website: GUIDELINES FOR SIMILAR BIOLOGICS: Regulatory Requirements for Marketing Authorization in India.  This is a very good document that provides an insight into the challenging and enigmatic world of similar biologics and thus makes biosimilars or similar biologics a more friendly science.

Production of antibodies from B lymphocytes still appears as a rocket science (!).  It is not as easy as purchasing the chemical active ingredient from a API supplier, sourcing the excipients and punching it all into a marketable form like a tablet (with the help of a BMR (Batch Manufacturing Record), which is also a purchasable item today).  The science and experience for handling production of antibodies from B lymphocytes is still in the preserve of a few companies.

Each B lymphocyte can produce only one type of antibody.  So it can act only on that type of antigen, which has triggered the production of the antibody.  To commercially produce antibodies, there are various companies across the world: contract antibody suppliers.  They produce research grade antibodies and scale it up for clinical use or other uses as per GMP guidelines.  Some of these companies:

A-Bio in Singapore, AbD Serotech, Adar Biotech, Aeres, Affinity Life Sciences, Agri Bio, Alpha Biologics etc.

These companies produce: 1 g to 10 g quantities of the antibody.  Big factories produce upto 10 kg of the antibody.

The general method for commercial antibody production:

a) the antigen protein is isolated and injected into mice (in two doses: primer first loading dose and after 10 days the booster dose)
b) Simultaneously tumour cancer cells are grown by tissue culture: these cancer cells are called myeloma cells
c) B lymphocyte WBC cells from the mice (in whom the antigen protein are injected) are extracted from the spleen of the mice
d) The extract is added to the myeloma cells
e) The result is HYBRIDOMAS (fusion of B lymphocyte cells and myeloma cells) (various chemicals, equipment, techniques are involved in this key step of the antibody production process: polyethylene glycol is a chemical used, viruses are also used...)
f) HAT medium (hypoxanthine - aminopterin - thymine) is used for selection and growth of hybridomas
g) Screening of the hybridomas for ensuring right antibody is produced
h) Further culturing of the select hybridomas
i) Growing the selected hybridomas
j) Harvesting the antibodies
k) Humanization techniques are used to make antibodies "human friendly" so that the human immune system accepts them.

The above major steps is very simplistic sequence of the MAB commercial production science.  There are many things involved here: fermentors and other equipment, enzymes and other chemicals, humidity and temperature control, techniques and procedures, valuable experience and many other small "trade secrets" that companies hold near and dear to them!

If only one antibody is desired then above process is applicable; the selected B lymphocytes and hybridomas will produce only one type of antibody.

If the antibodies are produced from a single clone of cells: they are called MABs or monoclonal antibodies.

When antibodies are produced from several different clones (duplicates) of B lymphocytes they are called polyclonal antibodies.

To ensure India gains, biosimilar manufacturing and marketing expertise (just as we have it for chemical based pharma formulations), the drive at Govt. and NGO level ought to be to give hands-on experiences to do various parts of the MAB (monoclonal antibody) science.  For eg., growing hybridomas, fusing B lymphocytes with myelomas, selection of right hybridomas, lectures on HAT medium and its uses etc.  When people learn by doing, talking, listening and teaching about it all, India will be the gainer and we can make a mark in the world with MAB business too!

The preparation-mindset

Not just individuals, organizations need to have this PREPARATION MEETS OPPORTUNITY mindset. It necessarily means having a knowledge rich immersive internal environment in the company, constant learning engagements in the firm and continuous opportunity spotting strategies for having the right preparation strategies.

Biocon could enter MAB business, through this preparation-mindset.  Individuals too need to have a preparation-mindset so that opportunities can be used.

In a world where the information float has collapsed, insights are shared at the speed of light: preparation for change is the key.  Preparation-mindset is vital

Training and the preparation mind-set

Training is not just about creating learning experiences for skill and knowledge development.  Today, it is about creating and actualizing the preparation-mindset.  Making trainees hungry for change and knowledge, making trainees hungry for preparing for a bigger challenge.  That is about preparation through training.

I thank you for reading this blogpost.  I also dedicate this blogpost to Ms. Le Trang M Pharm (Paris) of Hanoi, Vietnam, discussions with whom triggered this 'preparation meets opportunity' concept. Please do scroll down and read all other posts (click on older posts when required), kindly recommend this blog to your acquaintances.

Friday, July 18, 2014

A marketing grid for ROI and results

Marketing is for happy & enthusiastic persons!  It is for those individuals for whom happiness is a habit and enthusiasm is a way of life!!  Marketing is about creating a value delivery process, which finally creates happiness in the consumer.  Marketing is the creation, communication and delivery of value to enhance the exchange process, market penetration and consumption.  Marketing activities should fuel the buzz: strengthen "word of mouth" among stakeholders.  All in all, it should finally create the “feel good” in the consumer/stakeholders.  And for this, marketers have to be happy: only then can they create happiness in the target audience through their "happy marketing activities"! 

Marketers provide value and benefits.  These create cheer in the beneficiaries.  To create cheerful prepositions, the marketer’s disposition should also be cheerful!  A morose marketer cannot create happiness in the target audience.

Pharmaceutical marketers have more responsibility.  This is because patients (like farmers) do not get to choose/bargain - the price of the purchased pharma product - normally.  For instance, a typical farmer in India, takes his produce to the 'mandi' (agri market) and gets the prevailing price of the mandi for his product (he cannot choose the price for his product).  He gets the price for his product in the mandi as per prevailing rate.  

Similarly, the patient, takes the prescription to the pharmacy, and buys the brand indicated by the doctor: rarely does the patient ask for equivalent unbranded generics or cheaper equivalent brands.  In this regard, even though the patient may have a choice, he is like the farmer who is the price taker (not price maker).  Hence, pharmaceutical marketers (who are the price makers) have a lot of professional burden to justify the price for his or her product.

To make a pharma brand succeed continuously - several approaches are required to pep-up the demand: these include in-clinic activity, in-pharmacy activity, taxi tours, stall activity, group meetings (with sponsored high tea, lunch etc) and specific campaigns: targeting doctors and pharmacists - sometimes nutritionists and other paramedical/allied medical people - are also targeted.

It will be useful if one has a checklist or a grid for day-to-day marketing activities.  Here below is a useful tool, I use for organizing marketing promotional inputs (samples, small gifts, print inputs like literatures, prescription pads…), campaigns and other marketing activities:

In the above grid, marketing work parameters are on the left first column for the hypothetical brand: Happy D3 soft chew tablets (60000 IU).  And the first row gives the categories of people or entities to whom marketing collaterals, activities and campaigns have to be targeted.  So in each cell, the marketing person can plan the activity or collateral or strategy (direction for application of resources and efforts).

The price for instance needs to be put in a different fashion to the doctor; and in different terms to the pharmacy (where the pharmacist will be interested in his margin etc).  Promotion refers to the plan of campaigns, in-pharmacy activities, in-clinic activities etc depending on the target category. 

Thus the idea is to use the above grid to creatively produce inputs and strategies without any loose ends.  This helps bullet-proof marketing activities.  This approach will provide better marketing results.  (If you want to see the above image in bigger size, click on the image).

Pharmaceutical marketing is responsible marketing.  Communication (messaging) and other marketing activities are addressed to educated and important customers/opinion builders.  Scientific accuracy is vital in the communication items.  It is after all a matter of health, life and death.  Pharmaceutical marketers can ill afford to be irresponsible.

In today's challenging scenario pharmaceutical marketers in India, have to creatively produce marketing collaterals, campaigns and strategies: while having to balance three things - marketing costs, profit targets, and justified product price-to-patient.  In today’s context, with NPPA keeping a beagle eye on MRPs of pharmaceutical products, it is inevitable pharma marketers control marketing costs and get the best bang for the marketing buck.  Resource constraint and competitor pressures (in the market) with the focus to deliver best ROI (return-on-investment) is the marketer’s stress today!

And despite all these challenges, pharma marketers should have a happy positive attitude; enthusiastic frame of mind, and pharma marketers have to create happy stakeholders too (patients, patient attenders/family members, doctors, other opinion builders, pharmacies, and intermediaries)!
This blogpost says: three cheers to pharma marketers - whose life is a bubble on water, you never know when it will burst - despite a good track record.  Marketers are not umpires, they are players!  So they get-out, get-hurt, or sometimes lose-out!  This blogpost raises a toast to all the pharma marketers out there who wear their best smiles to suppress the worst stresses.  Marketers smile because it is their best proven engagement tool.  Thanks for reading this blogpost, please scroll down and read all other posts, and kindly recommend this blog to your acquaintances.

Wednesday, July 9, 2014

The growing cholecalciferol (Vit. D3) market

Lanolin, obtained as a bye product of sheep shearing, is a raw material for Vit. D3 manufacture.  Please see this link (click here) for an interesting insight!


* Muscle pains, back pains and general tiredness without any specific reason?  Could be Vit. D3 deficiency!

Do you know!?!

* 50% of the global population suffers Vit. D3 deficiency!

* 80% of the Indian population suffers Vit. D3 deficiency!

Vit. D3, the fat soluble vitamin is more than a metabolic participant, Vit. D3 has hormone-like behaviour in the body.  Vit. D3 is born from cholesterol (an interesting steroid molecule with vital body functions), please see the graphic below (!):

Sources of Vit. D3

Vit. D3 is chiefly synthesized in human skin (and skin of vertebrates) by using UVB rays of sunlight (a photochemical reaction occuring in the epidermis of skin).  Vit. D3 in small amounts is also available in foods: milk, liver, dairy products, eggs, fish, cod liver oil and some plants.  Certain lichen produce Vit. D3 (vegetarian source).

Vit. D3 is commercially synthesized by four companies in the world:

a)      Fermenta Biotech, Mumbai
b)      Dishman Pharmaceuticals, Ahmedabad (their plant is in Netherlands)
c)      DSM (Netherlands company)
d)     Zheijiang Garden (China)

Cholesterol is extracted from wool lanolin/wool alcohols left behind when sheep are sheared.  The cholesterol obtained from wool lanolin, is chemically converted to 7 dehydro cholesterol through a 4 step process.  The 7 dehydro cholesterol is then irradiated with UVB rays and purified to obtain a resin-like substance (Vit. D3). 

Irradiation of milk/organic foods also causes Vit. D3 production in the irradiated substance.

1 IU Vit. D3  = 0.025 microgram
100 IU = 2.50 microgram

Doctors recommend: 60000 IU/week for 4 to 8 weeks, followed by 1 sachet/chewable tablet (each of 60,000 IU) one per week. This is particularly for diabetics.

Recommended upper tolerable limit of Vit. D3 (9 years to 71 years plus, including pregnancy and lactation): 4000 IU/day.

RDA: 400 IU to 600 IU (as per age and patient status).  In elderly it is 800 IU.

Market picture in India

Vit. D3 market is rocking The May 2014 MAT (moving annual total) value is Rs. 252 crores (Rs. 2520 million) and has registered 40.8% growth in comparison to May 2013 MAT value (which was Rs. 179 crores market; MAT MAY 2013).

Vit. D3 is marketed as chewable tablets (biggest segment and fastest growing dosage type) (Rs. 87 crores May 2014 MAT value), capsules (mainly soft gelatin capsules) and sachets (powder).  All contain 60,000 IU/unit.

Uprise D3 (Alkem group), Tayo (Eris) and D3 Must (Mankind) are the top three brands in descending order (with MAT May 2014 values of Rs. 22 crores, Rs. 16 crores and Rs. 6.00 crores respectively). 

Vit. D3 is used in animal feeds, dietary supplements, drugs and for fortification of foods (like milk and other dairy products, milk mix beverage powders etc).

Global 2011 annual market estimate of Vit. D3 is USD: 400 million (40 crores USD or approx. Rs. 2400 crores per annum).

Vitamin D3 has an interesting profile.  This fat soluble vitamin is synthesized through a photochemical reaction in the human skin, and then undergoes interesting chemical changes in the body that are summarized in the below graphic:

In the above graphic, we see how cholesterol is converted to 7 dehydro cholesterol, effect of sunlight that provides UVB radiation converts this cholesterol to previtamin D3, which spontaneously isomerises to cholecalciferol.

The Vit. D3 thus formed is equally broken down fast!  Manufacture of Vit. D3 is a continuous process... but the moot point is DO WE GET ENOUGH SUNLIGHT - atleast 30 minutes a day?!  The answer is NO, for most of us!

Hydroxylation plays an important role for further conversions.  The first hydroxylation in liver by 25 hydroxylase converts cholecalciferol to calcidiol.  The kidneys then convert calcidiol that enters it through blood - to calcitriol. This is the second hydroxylation, where calcidiol (25 hydroxy cholecalciferol) is converted to calcitriol (1,25 di hydroxy cholecalciferol).

The conversion of calcidiol to the active form of Vit. D3: CALCITRIOL is as follows:

Calcitriol is a hormone like substance (chemical messenger): it binds to plasma VDBP (Vitamin D Binding Protein) and circulates in blood.  Calcitriol binds with VDRs (Vitamin D Receptors) that are present in a wide variety of tissues from head to toe, to exert beneficial actions!

Vitamin D3 (through mainly its active metabolite: calcitriol in blood) has important benefits:

1)      Improves intestinal absorption of calcium, zinc, magnesium, iron and phosphate (absorption is mainly in duodenum and jejunum)
2)      Regulates level of calcium and phosphate in blood (along with parathyroid hormone)
3)   Required for bone mineralization (influences osteoblast (cells that help form bone tissue) activity) and normal BMD (bone mineral density)
4)    Required for bone remodeling (also influences osteoclast (cells that cause resorption or removal of calcium from bone) activity)
5)    Vit. D3 stimulates immunity: especially binds with Vit. D3 receptors of monocytes, T cells, and macrophages.  Causes production of CANTHELICIDIN from monocytes, an antimicrobial substance.  This antimicrobial chemical has activity against Mycobacterium tuberculosis
6)      Helps in insulin production and insulin sensitivity at peripheral tissues
7)      Strengthens immunity: helpful in influenza & bacterial vaginosis, useful for monocyte – T cell – B cell functions, and for diabetics/other patients who suffer low immunity (body’s resistance to disease)
8)      Required for bone mineralization in aged, diabetics, postmenopausal women and other target groups: helps reduce falls in elderly
9)      Useful in cancer management: Helps reduce inflammation, has antiangiogenic activity (does not promote extra growth of blood vessels that encourages tumour growth), and decreases cell multiplication (tumour growth)
10)  Supports management of autoimmune diseases: multiple sclerosis, diabetes…
11)  Supports management of Parkinson’s disease
12)  Useful in management of osteomalacia (softening of bones in adults), osteoporosis (increased porosity and fragility of bones, leading to brittle bones) and rickets (weak bones and reduced growth of cartilage in children, leading to decreased height gain, bow legs and susceptibility to fractures): Vit. D3 is required for adequate mineralization of bones
13)  Helpful in fracture healing
14)  Supports management of depression
15)  Useful in heart disease, stroke management and hypertension management (Framingham Heart Study has also supported the benefit of normal Vit. D blood levels: >30 ng/ml)
16)  Pelvic floor abnormality results in urinary and fecal incontinence – it is also linked to low BMD etc: Vit. D3 helps in alleviation of these problems in the aged
17)  Beneficial and supportive for cognition (thinking) and retarding macular degeneration (in eye)
18)  Deficiency causes periodontal disease…
19)  Helps maintain levels of certain important enzymes like nitric oxide synthase, glutathione etc
20)  Supports pregnancy health
21)  Required for nerve function, vasodilation, hormonal activity and neuromuscular junction activity

Vit. D3 is a secosteroid with hormone like activity – regulates over 200 genes in the body

Lack of adequate exposure to sunlight on daily basis is a crucial reason for VDD (Vitamin D Deficiency) (Hypovitaminosis D) or Vit. D3 insufficiency/deficiency in modern life.

Normal levels of Vit. D3

Vit. D3 levels are measured as serum circulating 25 hydroxy cholecalciferol (calcidiol) levels: normal level is minimum: 30 ng/ml (cut-off value) (max. up to 74 ng/ml)

Hypovitaminosis D (VDD: Vitamin D Deficiency)

Vit. D3 insufficiency: 25 hydroxy cholecalciferol (calcidiol) levels: 20 to 29 ng/ml

Vit. D3 deficiency: 25 hydroxy cholecalciferol (calcidiol) levels: less than or equal to 20 ng/ml

VDD is defined as serum (blood plasma) 25 hydroxy cholecalciferol levels below 20 ng/ml.

Target groups of people susceptible to VDD

a)      Incidence of VDD is more in obese
b)      Elderly and those with inadequate exposure to sunlight
c)      Malnutritioned individuals
d)     Breastfed infants and mothers
e)      Diabetics/prediabetics (IGT)
f)       People with fat malabsorption
g)      Patients who have undergone gastric bypass or bariatric surgery
h)      People with dark skin
i)        Patients on anticonvulsants, glucocorticoids, antifungals and anti-AIDS medications
If most of your life is in the "shade" of buildings, vehicles, and offices or homes - it is time to get your 25 hydroxy cholecalciferol blood level tested!  Discuss the above insight on cholecalciferol with your doctor or healthcare provider or well-wishers... it will help you!  WISH YOU GOOD HEALTH!!

Thanks for reading this blogpost, kindly scroll down and read all other blogposts, kindly recommend this blog to your acquaintances.

Saturday, July 5, 2014

Humility: doorway to success

Mr. Ratan Tata, Chairman Emeritus of Tata Sons (Tata group): mature, intelligent, progressive and humble leadership.

Dhirubhai Ambani was an approachable, highly successful, Gujrati businessman: humility was his asset.

The concept of humility is vital.  This attitude is the doorway to enduring success.  Humility means acceptance of situations (positive and negative) with poise, fearlessness and open mind.  Hence, humility helps in continuous learning, adaptation and more success moves.  It makes connectivity possible with the person, since he or she is approachable (due to a humble nature).

Life is a picture of contrasts: like the seasons' of nature, we have to face all sorts of weather patterns!  Cold, heat, monsoon, drizzle, snow... yet our adaptability through knowledge, strength and humility will help us get through the turbulence, and also ensure we experience salubrious weather - with equipoise.


Humility is an interesting concept, which is emphasised often in human behaviour virtues and for good inter-personnel relationships.  Humility is not being a doormat - yet it is not throwing one's weight around.  It is a sense of balance, where fearlessness is not misread as pride, yet the down-to-earth behaviour (as a matter of fact attitude) is not making you a taken-for-granted being.  Humility is a totally tough trait to practice, since it appears different in various contexts.

In some cultures, a person who feels humble is seen as weak, and in other sub-cultures, a humble person may be inferred as inconsequential, not-smart and non-assertive.  A humble person being aloof may be interpreted as a smart, over-confident and proud.  Hence, practice of humbleness is to be done in relation to the cues in one's environment.

So what is the practice of humbleness?

Humility is being approachable, confident (fearless) and cheerful.  Humility helps one manage criticism, hostility and negative strokes, with tact, inventiveness and humour.  Humility helps one keep the mind open for new: ideas, interests, knowledge, adaptations, conversations, learnings, behaviours, approaches, relationships, activities, improvements, progress, successes ... and in short, smiles!  Humility helps maintain poise in the face of adverse or most favourable circumstances!!  Actually, humility, also helps one know the limitations, and the person is consequently, realistic yet assertive, and the person knows when to say - NO: emphatically!  Humility, actuates a person to action, a humble person can approach any individual and do business with!  A humble person is also approachable - ideal trait for business!!

In the spiritual land, humility helps in progress: to realise the connection between the soul-force of an individual (jivatman) and the supreme Soul (paramatman).

So in short, for even-mindedness, approachability, learning, cheer and progress, humility is a major virtue.

In inter-personnel relationships, humility helps engage in mutually acceptable, likable and progressive transactions.  When a person is humble (yet not a doormat) it means the individual is committed to reasonable and mutually beneficial relationship.  That is why humility is a most sought after trait in leadership.

Humble persons are not weak, they are strong, open-minded, fearless, learning oriented, believe in mutualism (win-win), tactful, cheerful and have equipoise!  Humility is then a characteristic, which is infectious!

The nub of the matter is that one should knock off the imagery that being humble means acquiescence and weakness.  Humility is not about compromising and being weak.  A humble person is strong, able to negotiate, smile, be confident (fearless), problem-solving, learning oriented, poised, not agitated, progressive, positive, energetic, approachable and likable.

In organizations, humility as an organizational attribute is key to organizational success.  A humble organizational personality is approachable, confident and enjoys enduring success.  A humble organization is strong due to adaptability.  Humble organizations are business savvy.

Humility, hence, needs to be measured, tracked and actualized as an organizational value, this will contribute to organizational progress.

As a case study, a simple Likert scale questionnaire was administered in a corporate setting: it produced interesting results:

In the above picture we see the results of a simple questionnaire where 28 respondents were asked to respond to a simple statement: I AM USUALLY OPEN-MINDED.  12 people strongly agreed with this statement.  13 people only agreed, while 3 were neutral and none disagreed.  This meant that organizational sample members were mostly open-minded hence, learning oriented.

In the second statement: I AM USUALLY OPEN-MINDED ONLY ON SELECTIVE ISSUES OR SELECTIVE PEOPLE, responses were interesting.  Some sharp respondents highlighted the word ONLY and hence disagreed with the statement because they were open with people on all issues, indicating they were highly confident and humble.  Others strongly agreed, with this statement, meaning that although they were open-minded, they were selectively open-minded on the issue and people involved.  So this means, those who agree and strongly agree with this statement, are selectively humble.  So this implies: 12 people are very humble and 12 people are selectively humble and 4 are neutral. 

This interesting trait of selective humility or selective open-mindedness needs to be understood by managers!

22 people of 28 respondents strongly agreed or agreed that THEY SEEK FEEDBACK FROM PEERS, SENIORS AND JUNIORS EVEN IF IT IS CRITICISM.  3 people were neutral, around 3 employees did not believe in seeking feedback.

An important dimension of humility is SEEKING HELP TO LEARN.  All 28 respondents amazingly believed in seeking help to learn - if they did not know a skill or a relevant learning. A learning oriented organization is an open one and will certainly be more adaptable to the eddies and flows of business environment.  Hence, this valuable trait of SEEKING HELP TO LEARN in the corporate where this Likert scale was administered, is a good phenomenon (since 28 people ie., all respondents showed SEEKING HELP TO LEARN behaviour)!

Open-minded refers to the trait of listening to all views, while learning - definitely requires open-mindedness, but it appears here in this context - that people are ready to learn and are thus open minded especially when it is vital for their job.  

This co-relates well with the first two responses.  We found that most people were open-minded to all issues, and for selective open-mindedness, 12 were open-minded to all issues and 12 people were selectively open-minded, but overall, job oriented learning culture is evident in this setting where the Likert scale was used.

The practice of humility involves COMPLIMENTING OTHERS FOR THEIR ACHIEVEMENT AND SKILLS.  27 people in the surveyed corporate setting agreed they compliment others for their achievements and skills.  There is a strong encouraging culture, it appears in the corporate.

To encourage honest feedback while administering the Likert scale on humility related matters, respondents in this setting, were not required to provide their names on the questionnaire, this approach is well known to help people to come out honestly, when answering.

The challenge at the individual level in business practice or as an employee is to continuously apply what is learnt as theory and also improve one's learnings' constantly through experience.  I did the above Likert psychometric scale for attitudinal survey  for humility in daily work practice as a part of my mission to continuously learn and practice learnings!  My wish is that various concepts should not be only in the books!!  I thank respondents of a particular corporate setting for participating in the above survey.

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Wednesday, June 18, 2014

Leaders remove fears

Where there is fear, there is no intelligence: Jiddu Krishnamurthi

Jiddu Krishnamurthi was an influential Indian philosopher, who motivated individuals to think beyond, self-analyse and become more rational as human beings.  He emphasised reasoning: which, eventually made humans more integrated, mature and self-fulfilled.  He did not adopt the discourse style of communication, he favoured mature conversations and group discussions, which ideally would result in improved intelligence, removal of fears and blossoming of leadership at individual level.  

Why do we need leaders?

Why do people need leaders?  Why can't we lead ourselves?  Why do we need to look up at individuals to give us hope or remove our fears?

Leaders fill the void of intelligence, they remove fear... read on and become a leader!!

Leaders: tap potential, remove fear

Fear is described as an unpleasant feeling or emotion caused by the threat of harm, pain or danger.  Fear is a protective phenomenon, makes people cautious, helps avoid unpleasant experiences.  For instance, fear of damage to feet makes a diabetic subject wear protective footwear during work, play or routine movement activity.  Fear of loss of job, makes an employee turn up at the work-spot or work-place on time.  Fear of loss of increment, motivates an employee to learn and master skill sets required to execute allotted tasks. Fear of loss of job or business make a field person approach doctors, pharmacies or other market operators who can help him generate sales.  Fear is a daily routine parcel of emotions that influences behaviour at work, leisure, play, social transactions and family life.

While at one level, fear helps motivate people in the above manner... positive leadership based on intelligence, values and discipline (conformance to standards of behaviour) also generates above behaviours.  While fear based work or social behaviour is associated with unpleasantness in the mind of the individual; discipline and enthusiasm based work and social behaviour is positive and based on a pleasant state of mind.

When fear is removed, unpleasantness is absent.  Removal of fear is a positive feeling (it makes people joyous and people smile a lot!): it is pleasant and comforting to experience a state of mind where there is no fear.  Women particularly get attracted to leaders: because leaders remove fear or instill confidence in them and this comforts them.  Women naturally get attracted to strong persons, caring individuals and capable gentlemen, because these people can provide resources and remove fears: this comforts women materially and emotionally.  Sri Sri Ravishankar is such a contemporary spiritual leader, who removes fears, radiates hope, generates calmness and pleasantness, smiles infectiously and makes people go to a comfortable state of mind.

As per the profound statement of Jiddu Krishnamurthi, given at the start of this article: intelligence helps remove fear. 

Intelligence has two dimensions:

a) actionable information that has high value: for eg., market intelligence is the procurement of market data, information and insights, which helps in making decisions for new product launches, new product categories, new disease segments, new trends and competitor activity.

b) ability to acquire and apply knowledge and skills: this emphasises the learning aspect of intelligence principle.  The faculty of intelligence implies capacity for judgement, learning, discrimination, making choices, generating alternatives with knowledge, elan and imagination; wit, reasoning, agility, tact, intuition, smartness, ability to grasp, memory, sharpness, communication skill, negotiation ability and poise among other required traits.  New knowledge is continuously created.  New efficient and timely skills are always valued.  Both knowledge and skills are related to intelligence.  

An interesting example is that as per AIOCD AWACS market intelligence report, in 2013 compared to 2012, the fastest growing segment in Indian pharma industry was ANTICANCER drugs: based on this intelligence, one can angle more products to this segment, ensure better coverage by field personnel of cancer treatment departments and oncocare hospitals etc.  Hence, based on this report,  a pharma company may create new me-too brands for this segment, current brands can be focused to a greater extent on this segment and field personnel may be directed to cover oncocare doctors with new focus.

Leaders make ordinary people do extraordinary things, they empower people and make individuals work enthusiastically and willingly towards goals.  If leaders have to do this they need to remove FEARS in people.  Fear is a major factor affecting work and social life.  These fears may be known or unknown to individuals.  For eg., if a leader manager wants his MR to go to a new territory and work: then various forms of fears play in the process:

a) The MR may fear the hardships/pain in locating the potential doctors and pharmacies
b) The MR may fear the tediousness/pain of travel to the new territory 
c) The manager leader may have apprehensions on how the MR will take up the challenge of establishing the brands in a new territory
d) The MR may have hesitations on availability of products in the new market

It is addressing such concerns or forms of fear that helps make people co-operative and success happen.

So in the above scenario, the field manager ought to ideally provide the information in advance to the MR, with regard to best hotels to stay, most comfortable yet business oriented travel plan, data about target doctors - their meeting times, profile and address; target pharmacies, support through product availability at the wholesaler level, motivating communication and supervision, support on SOS basis at the initial basis... This approach of facilitation will remove the fears of the MR and ensure valuable co-operation.

Training and fear removal

Training is building-in required attitude, knowledge and skills: this naturally empowers people to help them manage situations without fear.  Training is a vital input whose main task is to promote organization-wide skill enhancement and collective confidence.  Training of field personnel, helps improve body language, quality of representation and ensures prospects/customers are given abundant confidence.  This helps retain customers, add new customers, provide "feel-good" factor, improve perceived value of the product or service, raise productivity and improve business results.

Leadership vis-a-vis instilling fear!

Many leaders think the opposite: they believe in creating sources of discomfort and fear so that required behaviours are elicited.  Fear motivates people: this is their belief.  Perhaps it does work at one level - but this is misplaced understanding... a better approach in the work environment is to ensure: discipline makes people work.

There is a difference between creating 'fear' and 'instilling values and discipline' among people.  Leaders can engage people or subordinates better for common results, when the focus is on values, discipline, techniques and work execution.  If the focus is on creating fear to obtain people participation, work engagement suffers, involvement or enthusiasm is diluted and there is temporary co-operation (ie., only till the fear factor works). It also sows the seeds for disenchantment, employee turnover and rebellion.


Leadership is a great necessity in all organizations.

A good leader thus:

a) creates fearlessness through intelligence (in oneself, subordinates, peers and the environment as a whole through systems of intelligence gathering and sharing)
b) empowers people: through skill building, talent recognition, rewards, support, facilitation, conveniences, motivation, training and open environment
c) instills values and discipline
d) provides clear deliverables
e) supports people (does not give a problem to a problem - rather he gives a solution for a problem and does not pass the buck to others - trying to get things off his chest to the other person, passing the parcel or not focused only on bulletproofing himself or herself!)

Today, Mr. Narendra Modiji, PM of India has charted out a positive agenda for Indians: his leadership is instilling confidence (removing fears), focused on efficiency, providing defined deliverables and improving skill base.  This is an example of positive leadership based on intelligence (actionable high value information + skills, learning and knowledge).

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Sunday, June 1, 2014

The success experience

Desire for a feeling of success, which actually strengthens self-esteem (unconditional self - love) - is a universal need.  When people show the pathways for success and when individuals  facilitate success through material or motivational inputs, they are highly valued.

One of the best quotes for success was given by an experienced four star general of America: Colin Powell:
He said: success is a result of preparation, hard work and learning from failure.


In pharma marketing, preparation is everything!  The cornerstones of pharma marketing or healthcare marketing to prescribers (the opinion builders) are: in-clinic activity, in-stall or booth activity, in-pharmacy activity, taxi tours and small group meetings. 

During in-clinic activities, the field personnel get just about 2 to 5 minutes (rarely beyond that) to represent their pitch or negotiate for a better output of prescriptions and support for their brands.  It is elevator pitch in action!  For this set of planned calls, each individual has to organize the elements required to create the impact well in advance (samples, visual aids, literatures, small give-aways, talking points etc).  The use of these need to be visualised and choreographed in the mind before delivery.  Talking points have to be revised, so that the right set of talking points can be angled at the right time to the right doctor.

In-stall activities are a prime opportunity to deliver give-aways with good talking points.  Normally, this is the time where the prescribers do not have any patients in mind, they are more free to talk to field personnel, and this advantage can crystallize into solid productive relationships.

In--pharmacy activity refers to the set of activities for OTX (over-the-counter plus prescription) products, done at the pharmacy level.  It includes setting up promotional materials that stimulate POP (point-of-purchase) behavior, as such the thrust of marketing is stimulating consumption, enhancing market penetration, and strengthening word-of-mouth (among all stakeholders) this ensures better sales results.

Taxi tours: are especially important in India, for rural marketing.  Even to this day, stocking products and going on work tours (in taxis) to pharmacies and doctors in semi-rural and rural areas gives a significant jump in sales.  This enhances market penetration and repeat purchases (also creating new buying or prescribing behaviours).

Small group meetings: is an ideal setting for messaging, relationship building and give-aways.  This format for marketing includes various departmental meetings held at hospitals (eg., OBG department meeting etc), in which pharmaceutical marketers can get their time to charm doctors and win their hearts.  People do business with people!!

Hard work

This is the difficult concept: everyone claims to work hard!! So how to judge?  As such, it is total involvement that counts, it makes things happen.  There are qualitative and quantitative parameters of measurement for every job, which helps generate total involvement.  For eg., Medical Representatives are measured by no. of doctor visits, pharmacy visits, personal order booking at pharmacies or dispensing doctors, primary order booking at wholesellers etc.

The South Korean chaebols believe you get what you measure, and if any job cannot be measured it is a dangerous job!  Indra Nooyi states that creating the outputs is very important (this indicates, outputs are measurable and 'felt' or perceivable).  All this goes to say, that work has to be measured, should be measurable, and when there is focus on measurements, reports, feedbacks, rewards, subtle negative reinforcers, and remarks/discussions on various situations to generate better outputs - then involvement or hard work can be generated.

Learning from failures

This is the best part of Mr. Powell's statement for success.  Failures normally occur more than successes. Failures represent situations where the set targets are not met or desired event does not occur.  But each failure in fact is a learning opportunity, it is a part of the process for continuous improvement - NOT A CIRCUMSTANCE THAT SHOULD TRIGGER DEJECTION OR DEPRESSION. Successes can be turned into failure events, when measurement parameters are changed!  When a longer line is drawn against a shorter line, a new benchmark is set!!

When failures happen it means certain desirable situations or expectancies were not created.  It is not a curse or a shame to experience failure.  It only means there were certain elements missing, which did not make the desirable event happen.  It could be due to inadequate personal effort, lack of material supports (documents, samples, gifts, powerpoints, data, money, etc), or improper timing.  A failed event is one from which the lacunae should be identified.  It creates experience and learning: and hence, a better approach will happen the next time.

To learn from failure, the foundation attitude is self-esteem (unconditional self love).  If an individual loves himself, there is positive emotional energy, which charges him/empowers him, to analyse, work hard and improvise.  This attitude will help him defend himself and other stakeholders, it will also help him continuously produce self-joy and contribute to joy-kitty of others.

Colin Powell's sharp and pithy statement about success is a major contribution to the science of success.  If one reflects on the statement - works hard to actualize the statement, only benefits will accrue for the practitioner of success science.

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