Mirror, mirror, which is the trendiest of the trends today?

I got the above very funny image from HERE. Marketers love mirrors! Not just to gaze at themselves, you see - many marketers are narcissists (!), marketers look out for articles and reports that MIRROR trends in markets. It is important to peg new products, product launches, and promotional approaches in line with the market trends for best success. That is why marketers love mirrors!

The weak LES trend

This is an elaboration on an interesting patho-physiological trend. Obesity (particularly abdominal obesity), overconsumption of caffeinated beverages, increased consumption of alcoholic beverages, smoking, excessive indulgence in carbonated or fizzy drinks, over eating - particularly fatty foods, eating and drinking splurges, spicy foods, eating food and drinking milk just before sleeping, sedentary life, increased mental tensions ... all these have led to this peculiar weak LES trend today in society (in both emerging markets and the mature markets - of the advanced countries). It is no wonder that the hottest pharma markets are related to GERD (gastro esophageal reflux disease), indigestion (or dyspepsia), and heartburn. In India, about 25% of the pharma market is the gastrointestinal related market, and the market for acid-peptic diseases is significant.

LES stands for lower esophageal sphincter or cardiac sphincter. This is a circular smooth muscle located between the lower esophagus (or food pipe) and the stomach. The LES plays a very important role, it prevents the regurgitation or backflow of acidic contents of the stomach in to the alkaline environment of the esophagus. If the LES is weak, obviously, the gastric or stomach contents return back in to the esophagus, chronic weakening of LES leads to heartburn, gastro intestinal reflux disease, Barrett's esophagus, and esophageal cancer. The other complications of GERD include chronic cough, asthma, inflammation of the larynx or voice box, respiratory tract infections, esophageal obstruction, esophageal bleeding, esophageal inflammation, presence of blood in stools, difficulty in swallowing, gallstones, ear pain and lung disease.

So for pharma marketers and healthcare activists the weak LES is an opportunity area.

The doctor as a disease manager

This is an interesting twist to the doctor's traditional role as a healer. The market savvy doctor is all too aware of the empowerment process in society thanks to the increasing media power, and the information technology revolution (mainly the internet). Thus, the sagacious doctors are reinventing themselves as disease managers. The doctors not only provide their inputs via prescriptions or surgery, but they also suggest alternative therapies or Yoga themselves or refer the interested patients to Yoga or Reiki or Ayurveda practitioners. Ultimately, this increases the doctor's role as a health care counselor, improves the doctor's image with the patients and enhances his or her practice. Many trend savvy doctors run Yoga or Ayurveda camps on specific days in their nursing homes. Certain gynecologists and obstetricians themselves teach Yoga to pregnant ladies or refer them to the Yoga practitioners. Thus, doctors profit through such wellness clinics. Doctors are redefining themselves and repositioning themselves as disease and wellness managers rather than mere allopathic or ayurvedic practitioners, giving out prescriptions, or conducting surgeries. In fact, certain market savvy doctors have taken a leaf from Swami Ramdev's notebook and are also positioning themselves as lifestyle experts ....

Lifestyle expertise trend

Swami Ramdev is having an amazing run. His pranayama - Yoga - Ayurveda and lifestyle programs on TV are beamed to 150 countries (not just 125 as I had mentioned in my earlier post), his TV audience is perhaps 200 crores. Money is pouring in to his trust for strengthening his activities for the benefit of mankind. Another Yoga teacher from near Delhi - Lalji Maharaj, is following the model of Swami Ramdev.

What do the successes of Swami Ramdev and Lalji Maharaj reflect? The answer is that there is an innate need in society for a healthy and trendy lifestyle. Individuals or organizations satisfying this need for a healthy and trendy lifestyle are gaining an iconic status. So it is clear that marketers and healthcare activists can take note of the hunger for a healthy and trendy lifestyle in society.

Packaging as a differentiator and tool for market success

With product establishment becoming tougher and reinventing or rebooting the product life cycle becoming a necessity, packaging is gaining traction as a differentiator, a tool for reinventing products and product categories, and ensure continued market success. For eg., Zip Pak the resealable packaging technology pioneers and leaders talk of their packaging as a tool for shelf differentiation, perception of product freshness, enhanced consumer convenience, ensuring brand preference, and enhancing brand consumer loyalty. In fact, the vocabulary of packaging is now more oriented towards marketing rather than protection of inner contents and having a production department orientation. Riding on this wave of packaging as a differentiator and tool for market success are companies like Juggat Pharma (pharma division of Jagdale Industries Ltd., Bangalore), who pioneered the presentation of electrolyte energy drinks in aseptic technology Tetra Pak for the first time in prescription market, and have created a product category. Today, this company (info@jagdale.com) is an expert leader in this field and is contract manufacturing electrolyte energy drinks to interested pharma companies. Such is the power of packaging as a tool for differentiation and market success.

Such interesting trends are helping companies and individuals win in the marketplace. Thanks for reading this blogpost. There is a very interesting BLOGPOST HERE (ON POSITIVE MENTAL ATTITUDE). I suggest you read this blogpost too. Please scroll down to read all other blogposts (by clicking on older posts when necessary). Thnks once again.

Telling great stories

I got the above nice picture from HERE. Perhaps it is about a great marketing story on the phone.

Clarification: Telling a great story is to be perceived positively. In India, we often say 'telling stories' to mean saying lies. In marketing however, telling stories means a great pitch - an impelling story that connects with the target audience, and enhances consumption of the product or service.

For successful marketing, telling impelling stories is an important competence. It is the stories that create the buzz and increase the consumption, which is the core of marketing. And it is exactly why the pranayama-Yoga system being promoted by Swami Ramdev is becoming a phenomenal hit. The Indian diaspora is firmly with his health program on TV channel Aastha. The USP of Swami Ramdev's program is the right-before-your-eyes case studies being shared by the Yoga participants. The stories are impelling. The program is full of verve, purpose, and fun. The TV program is a successful presentation of a good pranayama-Yoga concept by Swami Ramdev.

Products and services become successful in the marketplace not only on the basis of the merit of the product; it is good marketing of meritorious products or services. THE ESSENCE OF GOOD MARKETING IS GOOD STORY TELLING.

Swami Ramdev is not only a honest, sincere, and purposeful Yogi - he is very intelligent. Swami Ramdev has understood the importance of good story telling to market his mission and gain audience share. Swami Ramdev's stories on Yoga are inspiring and guiding. Even more sagacious is his strategy of story telling to co-create stories along with the Yoga practitioners in the audience. This engages the audience even better, creates the word-of-mouth (which is again an important goal of marketing), and finally Swami Ramdev ends up producing lifestyle change - which is THE GOAL OF ALL MARKETERS.

Good story telling is the crux of many of allopathic successes and leadership in the marketplace. Every allopathic product is launched with years of research to establish the molecule's safety and efficacy. This creates the fodder for a good story. It is in-depth material. The fodder gets mathematical treatment, in terms of statistical analysis of the pre-clinical and clinical data. And finally, when the molecule and formulation is unveiled, the narrative brings in instant success.

Take for eg., the historic and mega successful launch of Viagra. The story telling starts with the interesting point that the PDE - 5 inhibitor was being investigated for its future application as an antihypertensive vasodilator. Sildenafil citrate's property to help overcome erectile dysfunction or impotence was itself a side effect, that became the product's promotional platform. The narrative of story is interesting right from the brand name potency - VIAGRA (coming from vigor and Niagara). The product finally took off not just because of the clinical trial data back-up to persuade prescribers, it was the worldwide frenzy of media buzz that created the hype, positive imagery, and word-of-mouth for Viagra. The product was seen as HOPE in physical form. True marketers it is said do not sell products or services, they sell ideas, imagery, and HOPE! And the story of Viagra is just that. The story telling of Viagra has been successful even though the emphasis was not on impotence - but the then less popular term erectile dysfunction; the use of this term, created an educational component to the Viagra story telling too, and as they say, rest is history.

Pharmaceuticals and healthcare is yet to see such a successful launch campaign and story telling, after the stupendous success of lifestyle prescription product Viagra.

That is why we say, good stories create eddies that disrupt established trends

The core of good story telling is not the narrative - it is the idea and the novelties. For instance, when Lupin launched their brand of atorvastatin, it was as a heart shaped tablet; the entire internal and external launch marketing campaign was centred on the heart (including cutting a heart shaped cake at inaugurals). The idea of a story is the appeal, it added to brand differentiation. The idea serves as the foundation of story telling.

Good stories trigger enthusiasm and are infectious. The ultimate goal of good stories is to bring about a change in the prescribing or usage pattern with respect to product categories. For eg., when a MR details a good story on how nutrients promote wound healing with clinical reports and clinical case studies, the story becomes impelling and produces the required change in the target audience.

When stories appeal to the intellect and the heart, they persuade, create customer confidence. Stories can grip the target audience. And the required change is produced in the target segment, and the business objectives achieved.

MUCH LEARNING AND CHANGE IN CONSUMER BEHAVIOR, PRESCRIBING BEHAVIOR, AND PURCHASE BEHAVIOR IS BASED ON STORY TELLING. It is for this reason that books like Made in Japan, Akio Morita, or any of the business books that chronicle organizational successes become big hits in the marketplace. The world likes great and impelling stories. When marketers use all the promotional tools available, apply the marketing techniques and tell a great story, the product becomes a success.

Most of the successful products are simple. But they tell a great story.

Thanks for reading the above blogpost, hope it was an impelling story! Please scroll down and do read all other blogposts. Please click on OLDER POSTS wherever required.

The healthcare trend

It is said that one third of the world is afflicted by TB. Many cases abound in India too. Top picture of a TB patient is taken from here.

Trends matter for marketers

A trend is a general tendency or direction. A popular taste of the times. It is something that is in vogue. Marketers constantly sift reports, looking for trends. For instance, the current trend of buying a car for family purpose. Or the famous trend in India is of eating-out (families, relatives and, friends eating-out; oops hope George Bush is not reading this blogpost!!). A major movement in Indian society today is the healthcare trend.

The Pranayama-Yoga-Ayurveda trend created by Baba Ramdev

Ramdev Baba's success is not that of an individual cashing on a trend, it is the ultimate way of a societal leader creating a trend. Ramdev Baba's Pranayama-Yoga program telecast live on Aastha TV channel and the live Yoga camp starts at 5.00 am in the morning. And you have crores of viewers from across 125 countries tuning at that early hour - in India. People brave the weather and conquer sleep to reach his camp at wee hours of the morning for the pranayama - Yoga routine. And the camp attendees are anywhere between 50,000 to 1.25 lakh at each morning camp conducted by Swami Ramdev Baba. And his Yoga camps are more about health, universal love, self-belief, and patriotism rather than abstract spirituality. His pranayama routine is of 7 types and this routine helps people conquer and control chronic disease (cardiovascular and diabetes), cancer, rheumatoid arthritis etc and establish health. Swami Ramdev conducts Yoga-pranayama health camps and not mere abstract religious or spiritual camps. Watch the fervor for establishing good health by tuning on to Swami Ramdev's telecast every day morning at 5.00 am (IST) onwards, on Aastha and you will realize that healthcare is not just a concern or even a mere trend, it is in fact a mega trend ... or more appropriately, a mass movement in India.

The camps conducted by Swami Ramdev are free. This Baba has dedicated his life to popularizing Yoga-pranayama in a scientific way. It is a national and international awakening to the potential benefits of Yoga-pranayama.

The above healthcare movement in India is the opportunity for marketers.

Preventive approach to healthcare pays: the OTX (over-the-counter plus prescription) and OTC (over-the-counter) markets are picking up

The mass awareness on healthcare through the powerful free media in India, and the rising costs of medicare is ensuring that people are considering preventive healthcare to a greater extent than before. A stitch in times saves nine, after all.

FMCG (fast moving consumer goods) and FMHG (fast moving health goods) have been quick to cash in on the healthcare trend in India. Pepsi now has IMA (Indian Medical Association) endorsement for some of its products. Glaxo SmithKline Consumer Healthcare (GSKCH) sales are growing at high double digit rates (25.7% for the Jan - March 2008 quarter) and a net profit growth of 34% as per ET, 7.5.2008, p.no.4. The attraction of this healthcare space is that non-drug healthcare goods do not attract price ceiling diktats from Govt. bodies. Innovative non-drug healthcare goods thus get the double benefit of a mass market (not just prescription market) and freedom from price control. Thus, GSKCH has increased the price of Horlicks and Boost by 7% due to inflationary trends. In the FMHG space, GSKCH is banking on its pharma parentage and looking for increased growth, Glaxo is also launching a slew of specialist nutrition products.

Another case study reflecting the strong trend of healthcare in India is Amway, which has in a decade reached an annual turnover of Rs. 1000 crores riding on a strong wave of nutrition and wellness (as per ET, 7.5.2008, p.no.9). It is interesting to note that for Amway, Kerala is the fastest growing market (probably due to 100% literacy, high per capita income, and health awareness).

Looking at the potential of healthcare, organized Pharma retailing that forms about 2% of the total Pharma retail business in India today, is taking off and growing at 30 to 40%. For eg., the new entrants to the Pharma retail space Hetero and Reginix chains are owned by the pharma manufacturers Hetero Drugs and Grandix Pharma (that owns Reginix).

Welcome to healthcare clutter in the future

But will it mean consolidation? (it is doubtful, read on why...)

With more and more players entering the healthcare sector the inevitable clutter will happen and may see a round of consolidation. But given the penchant for entrepreneurship in Indians and the fact that Indians like to build businesses for the future generations of the family rather than cashing out, consolidation as a trend will not be as pronounced as it happens in the Western markets. There is a basic difference in the psyche of Indians and Westerners. It is not unusual for Westerners to sell off businesses to highest bidders. Then retire and enjoy. But the Indian mentality is different. Indians sell off businesses if their children are not interested in continuing the business or if there are no heirs for the business enterprise. This is the funda. So consolidation will not be easy. And in case some people sell off their businesses, it is only to restart another enterprise sooner or later. That is the entrepreneurial itch in Indians, and the psyche to create businesses for future generations of the family rather than just enjoying the wealth. For Indians, creation and running enterprises are a pooja (or an act of worship) for the well being of one's family and future generations. That is the basic truth of Indian business mindset.

So which way out?

The only way out is sticking to the innovation mantra (ie. doing something novel, the newness factor is important - this novelty value can be related to products, processes or services). It is in this context that the book by C K PRAHALAD AND M S KRISHNAN THE NEW AGE OF INNOVATION becomes important. C K Prahalad is the same management thought leader who inspired entrepreneurs like the Tatas to look for a fortune at the bottom of the pyramid. In a way, C K Prahlad has also added grist to the microfinance movement.

Innovation helps business corporations face and shape the future. Innovation requires application of information technology to harvest information through analytics and create knowledge and generate ideas. Innovation comes through collaboration, co-creation of value with customers, digitization, understanding demographics - technological shifts - and customer shifts, connectivity, and convergence of industry and technology.

Innovation does not require big moolah. An innovative approach to marketing is Pepsi's first to get IMA endorsement for its juices and oats. It is for the first time that Pepsi has used such an approach (three cheers: Indra Nooyi!!!), no where in the world does Pepsi use the health platform as much as it does in India. Similarly Jagdale Industries Ltd., has innovated the electrolyte energy drink category through its thundering success of electrolyte energy drinks (info@jagdale.com). Many big time players have evinced interest in this range and are in talks with Jagdale Ind. Innovation has created this segment. Innovation is required for differentiation - which is good business strategy. Differentiation helps take on clutter and commoditization of products and services. Innovation is not just about big moolah.

Thus, it is clear that only courageous innovation (fortunes favor the brave) that will help players of the healthcare trend in India survive and win in the market place.

Thanks for reading this blogpost, please scroll down and click on OLDER POSTS wherever required to read all other blogposts.

Vive-La-Medical Darpan

This blogpost is not about the mainstream Pharma media in India. It is more about the unsung side of the Pharma business. This blogpost is about a Hindi monthly "MEDICAL DARPAN".

Medical Darpan is a Hindi monthly tabloid published from Bulandshahar, a place in Meerut Dist. of Uttar Pradesh. Medical Darpan is straight and hard hitting. No fancy management jargon here. It reflects the raw unbridled spirit of entrepreneurship of Indians in Pharma business. No Kaizen, CRM, or US FDA terminologies. It is straight business talk. Trade, as it really is.

Consider some of the advertisements in the March 2008 issue:

1) Pentachem, A GMP revised schedule M and ISO 2001:2000 unit in Excise free zone, 1% CST zone. This company offers distributors on monopoly basis has a generic division 125 products, PCD (propaganda cum distribution division) or franchise division offers products in attractive packing, competitive pricing inclusive of promotional materials. Also undertakes contract manufacturing.

2) From Chickpet, Bangalore, Invision offers various products: tablets, capsules, syrup, sachet, dry syrup, injectable, ointment, lotion and IV fluids, over 400 products, for franchisee marketing (similar to PCD marketing).

3) Another very interesting ad without name of company states (however, the contact no. is given): Best deal for Pharma professionals, earn more with promising future by doing own business, a fast growing Pharma company with wide range of excise free top quality branded Pharma products - tablets, capsules, liquids, syrup, injectable, ointments, proteins supplements etc) with immense scope. Promotional materials like visual aid, literatures, catch covers (ie. of samples), reminders, visiting cards, order book (ie. the personal order book) etc are offered. "You reach breakeven point with Rs. 15000 approx, stockist price, per month by earning a profit of Rs. 9000/- - an average salary of MR, if you generate Rs. 50,000 per month you get a profit of Rs. 30,000 (approx.) per month after using 950 samples, and 10% bonus deals (ie. sales promotional offers) on all the products to the retailer."

There are many such advertisements in Medical Darpan soliciting contract manufacturing in excise free zones (even small batches with inventory of just Rs. 5000/-), franchisee marketing tie ups and PCD tie ups. Some of the other companies advertising are Ban Pharma (for Ayurvedics), Bionova Lifesciences of Bangalore for biotech formulations, Amaxy Laboratories of Chandigarh, Lenit Pharmaceuticals of Kangra (Himachal Pradesh), Auspi Medicaments of Delhi, Botons & Blues a part of Invision, Bangalore offering nutraceutical formulations containing hot demand extracts like biotin, lycopene, alphagalactosidase, grape seed extract, Gingko biloba extract etc; Magnus Biotech for antibiotics etc; Imparish Pharmaceuticals of Roorkee UP etc (many many more companies are there). There are many many more companies with biotech products, nutraceutical formulations, antibiotics, various types of formulations including mouthwashes, toothpastes, and gels, allopathic, ayurvedic, food, gym and body builder products, with marketers brand name and monopoly rights, and other latest molecules in Alu-Alu pack, injectables etc in excise free zones, and revised Sch. M. and cGMP manufacturing plants.

This is the market that is unsung but very vibrant - away from the media glare of Economic Times, Business Standard, Financial Express, Express Pharma Pulse, and Chronicle Pharmabiz. But this market is well connected through Medical Darpan and other such media. This vibrant market is not known to many of the top executives of big Pharma companies nor does Medical Darpan reach them. Medical Darpan is not a fancy tabloid, it is raw business. This market reflected by Medical Darpan is not mapped by ORG. Consequently, many top executives do not even know the names of these companies. But their activities are taking Pharma products to the nook and corner of the country, reaching out to the far flung interior and micro interior based RMPs. Healthcare - Pharma business is in full swing.

How do these franchisee and PCD companies succeed despite the might of the Pharma biggies?

Simple it is CRM in action. It is empowerment in practice. It is entrepreneurship in full swing. It is a bottom-up marketing strategy model at work. Let us suppose a MR of a STANDARD COMPANY goes for work. What does he do? He implements the company strategy - meets 10 to 12 doctors, details, samples, gifts, and negotiates some deals based on the guidelines of the company. Does personal order booking at the retailers as per company guidelines. What does the PCD MR do? The PCD MR is the empowered MR. His goals are clear. His resources and limitations are well known to him. This MR has complete knowledge of the profile of the doctor. He services the doctor based on the needs of the doctor, not as per any strategy or guidelines of the company. Thus, the PCD MR can strike better. If the PCD MR visits a clinic and sees a fan not working in the clinic, he gets the fan repaired on the spot. The standard company MR does not have the flexibility based on the values, ethics, and practices of the company. Thus, the PCD MR will win many battles - the standard MR may win the war - but the PCD MR is satisfied with the spoils of winning his battles. The PCD MR for obvious reasons, has a higher sense of ownership in his marketing activities. And there are many such PCD MR operators in the market, they expand the market, nibble at the big Pharma market share, and are the unrecognized forces in the big picture. But they matter. Their market is not accurately mapped. So the size is anybody's guess. Indian Pharma market has brand clutter, generic generic clutter, commodity chatter ...

Consider this: my friend's acquaintance - basically a young engineer who is in to consultancy, training and development in the IT and ITES field, has with his friends floated a small company Madhuban Naturals that is now manufacturing and marketing herbal singles ie. plain Ashawagandha extract, Shatavari extract etc in capsules. Their USP (unique selling preposition) is pomegranate fruit powder extract in capsule form. There must be many such Madhubans in India. Away from the glare of the top media and big companies. That is the unmapped market of healthcare and Pharma India.

I asked such a PCD MR how he sells say, diclofenac in the face of aceclofenac. His answer was interesting. "What diclofenac does is reduce pain and swelling, so does aceclofenac. Some advantages may be there with aceclofenac. But diclofenac does not have such awful disadvantages that it will be discarded by the doctor. So generic diclofenac will continue to sell, the doctor will not replace all his diclofenac prescriptions in favor of aceclofenac. It is ultimately rates (ie. price and margin to retailer and dispensing doctor) and other benefits to the prescribing or dispensing doctor that matter." So that is the bottom line.

Long live Indian entrepreneurship. I dedicate this blogpost to Indian entrepreneurship. Thanks for reading this blogpost, please do read other blogposts, by scrolling down and clicking on 'older posts' when required.

Kidney disease: the silent new epidemic of India

The first image is of the lower back showing the positions of the two kidneys. I got this image from here. And why is Swami Ramdev's image here? Please read on to find out why?!

Consider two very recent conversations that I had ...

A worried colleague shared her concern with me. Her brother-in-law, a diabetic, was found to have kidney failure, and was undergoing dialysis every alternate day. The cost of dialysis was Rs. 4000 (per dialysis). It was no doubt a financial burden to her sister's family along with the emotional agony.

Similarly, a long time field colleague of mine (who is now a first-line field manager in a top Pharma company) shared his anxiety: his aged father a long time insulin dependent diabetic was now undergoing dialysis thrice every week due to failing kidneys.

It is sad but true - India the country with the largest no. of diabetics in the world is on the throes of a yet another silent epidemic - kidney disease. It is not sensationalizing an issue. But open your eyes and ears to the incidence of kidney disease in your social circles, the incidence will shock you.

It is a costly disease

The burden of chronic kidney disease or kidney failure is far too much for the average person to bear. Each dialysis costs about Rs. 4000. Moreover there is a shortage of dialysis machines. It is said that there are just 3000 dialysis machines in India. Another colleague of mine shared his experience in Kerala. At a particular centre, where his sister was treated, he was shocked to notice the long line of people waiting for their turn for dialysis. The situation is getting very grave.

Kidney disease is insidious

The main hazard of kidney disease is that it is a silent killer disease. Almost symptomless. The disease overwhelms the person and announces its arrival only at the last stage.

I asked my first-line manager friend how this deadly disease was diagnosed in his father's case (a chronic insulin dependent diabetic)? He replied: 'Sunil, as such the main complaints were pain in the calf muscles, with spasms, itching, weight gain and a bulky or puffy profile and back pain. There were no 'initial symptoms'. It was, hence, difficult to diagnose at the early stage. The doctor too said that kidney disease does not cause any clear cut initial symptoms. So diagnosis is mostly at the advanced stage and are dialysis cases. It is a very scary picture, Sunil, the doctor said that there is worrying trend of increasing kidney disease cases. He suspects, hyperglycemia and pollutants as causing this problem'.

What my first-line field manager friend added was even more worrying ... "dialysis is a sort of palliative or supportive measure. Although it helps reduce morbidity there is no significant prolongation of life in such patients. It is in fact a sort of business now here in Bangalore. You have got to shell all that cash', he added with frustration, 'yet you know it is not something that can go on like this...'. I could understand my friend's depression.

The only option is education and early detection

The importance of early detection is highlighted here in this link. The most important facts to educate on are:

Kidney disease occurs mainly due to:

a) diabetes (which will hit 57.2 million Indians by 2025 AD) ie. diabetes nephropathy (the obvious leading cause of end stage renal disease in India)
b) hypertension (high blood pressure)
c) iatrogenic kidney disease (or kidney disease as a side effect of drugs like chronic use of pain killers eg., by arthritics); and kidney disease due to inflammation and infection.

The importance of education and early detection is a prime opportunity for social marketing initiatives for marketing antidiabetic and antihypertensive drugs. Direct-to-patient campaigns and patient education campaigns through the prescriber or pharmacist or any other healthcare professional like the nurse, will not only serve to educate the target audience, it will also help in brand building.

The other aspects to educate on: proteinuria (presence of protein in urine, which indicates diabetic nephropathy) and regular urine creatinine level measurement.

Chronic disease caused about 54% of deaths in India in 2005. The fact is that the Pharma market for chronic diseases is booming in India. No wonder that Mixtard a brand of human insulin is one of the top three brands in India. Biocon a company focused on lifestyle and chronic disorder segment is experiencing more that 50% growth. Atorvastatin and ramipril are among the top selling drugs in India and are growing at very high rates. Cardiovascular disease, diabetes, cancer, and chronic respiratory disease are the main chronic diseases... BUT HIDDEN IS THE SILENT EPIDEMIC of CHRONIC KIDNEY DISEASE. READ MORE BY CLICKING HERE.

A focus on prediabetes and prehypertension is required

The words prediabetes (or impaired glucose tolerance) and prehypertension are yet to enter the common man's lexicon. High bp and High blood sugar have already entered the common man's vocabulary. The need to highlight on prediabetes and prehypertension is very important. We have a publicity savvy (and controversy kicking: Dr. Venugopal controversy of AIIMS, smoking and alcohol consumption controversy) Union Minister for Health Dr. Anbumani Ramdoss, perhaps he can pick up this as a theme campaign. While social marketing campaigns of Pharma companies can focus on prediabetes and prehypertension, to bolster their antidiabetic and antihypertensive brands, perhaps big stake holder Pharma companies of the diabetes and hypertension markets can come together, create a common fund, hire a good advertisement agency, and unleash a market building and national awareness campaign on prediabetes and prehypertension. It makes good economic and social service sense.

Liver and kidney disease

As was highlighted by the earlier blogpost, the liver is a strategic organ. Liver is an important organ of detoxification. The load of toxins in the blood is increased by liver stress. So logic dictates that incidence and severity of kidney disease increases in patients with hepatic dysfunctioning or fatty liver or cirrhosis of liver. Hence, it is observed clinically that alcoholics particularly diabetics who consume significant alcohol suffer from kidney disease to a greater extent.

Angiopathy (vasculopathy) and kidney disease

Angiopathy refers to disease of the blood vessels. The first stage is endothelial dysfunction - the integrity and functioning of the first innermost layer of the blood vessel is affected. Endothelial dysfunctioning leads to atherosclerosis (hardening of the blood vessel walls and consequent loss of elasticity). Angiopathy causes impaired blood flow to an organ. Imagine angiopathy in the blood vessels of the kidney and the one connecting to the kidney (ie., renal artery). Renal angiopathy has disastrous consequences on kidney functioning.

Now, one of the complications of diabetes is angiopathy. So add the grave situations together ... angiopathy, liver stress, hypertension, and diabetes. The dangers are very formidable. It is a challenge before our nation.

The problem with insidious diseases

The major problem with insidious diseases like osteoporosis, kidney disease, and angiopathy, is Oh! I do not think it will happen to me. And once it happens the cycle of denial, depression, and acceptance. Insidious diseases come unannounced and curse the sufferer. Beware.

In Yoga we trust

Swami Ramdev (who regularly features in Aastha channel at 5.00 am) is revolutionizing healthcare through pranayama and Yoga. And it works. It is said to work for kidney disease and diabetes too. No harm trying it. PLEASE CLICK HERE. That is why I have put a image of Swami Ramdev at the top of this blogpost obtained from here.

In Ayurveda, punarnava and gokshura are said to support kidney function. And even help revive kidney functions.

Thanks for reading this blogpost, please do read all others by scrolling down and clicking on older posts wherever required.

The healthcare market continues to expand

I got the above great image from here.

It was a pleasant and interesting time for a day at Mysore, this week. As usual, the Pharma market was the epicentre of discussions with my friends and relatives, at a social function. The healthcare market continues to expand due to a host of trends like PCD trend, knowledge empowerment, pandemic diseases, and CLIMATE CHANGE (global warming)...

PCD market operators

Earlier it was not very common to see PCD (propaganda cum distribution) operators in markets. But even a conservative market like Mysore sees at least 15 ex MRs operating propaganda cum distribution operations. Just imagine what would be the status in the aggressive Pharma markets of India viz., Maharashtra (including Mumbai) and Madhya Pradesh + Chhatisgarh (which are the largest Pharma markets in India; it is said that companies that succeed in the markets of these two states, will get good national Pharma marketshare). Equally very aggressive markets are Uttar Pradesh (and Uttaranchal) and Bihar + Chhatisgarh. The point of curiosity was where were the goods getting absorbed? Because, all major and small companies are very aggressive and continue to do good business. Still each PCD is also doing about 2 to 3 lakhs business and making about Rs. 25,000 to Rs. 30,000 profits. This means PCD operators were making it tough for companies, but not cannabalizing the sales significantly. So how are the goods getting absorbed as all established companies too were doing well? Is the market expanding as the number of market operators increase?

More scope for market penetration and prescription potential of products

As such, it appears there is greater scope for market penetration and the prescribing potential of products is not tapped.

Let us consider albendazole as an example. Nelson's textbook of pediatrics recommends regular deworming every 6 months. But in reality this is not happening. Perhaps the pressure to prescribe albendazole due to a large number of market operators is increasing the consumption (and this has medical textbook sanction too).

People do business with people

Thus, if a MR (PCD or company) comes regularly to a doctor with promotional inputs and other strategies to expand the doctor's patient base and help the doctor service his patients better, it is inevitable that consumption increases. It is the pressure of increasing no. of market operators and their strategies that is increasing consumption and thus every market operator makes his money. Moreover, there is very high potential for market penetration and consumption as prescription generation is itself perhaps not in line with the product potential. As explained above albendazole has more theoretical potential of consumption, if one takes in to cognizance that regular deworming needs to be done every six months (for adults and children).

However, PCD operators are finding it tougher to make profits these days due to increased and intense competition.

Similarly let us take the case of the hepatoprotective market.

First some physiological aspects of the liver:

The liver is a strategic organ. The liver, the largest internal organ of the body and a chemical factory, has a major influence on glucose concentration in blood. All absorbed nutrients and chemicals first go to the liver through the mesenteric capillaries and the portal vein. Glucose is converted rapidly to glycogen (storable form of glucose in liver) and then to fats (for storage under the skin as subcutaneous fat ie. adipose tissue) in the liver, and ensuring that systemic concentration of glucose is in the normal range. Similarly, in times of starvation, the liver has the chemical ability to generate glucose from amino acids, fats, and glycogen to ensure normoconcentration of glucose in blood. These chemical reactions are called intermediary metabolism.

Amino acids are used by the liver to manufacture enzymes and other important proteins for eg., angiotensinogen. However, amino acids cannot be stored like glucose. And glucose cannot be converted to amino acids. So amino acids (particularly essential amino acids) are required on a daily basis.

Another very important attribute of the liver is its ability to detoxify. The liver converts xenobiotics (or non nutrient foreign substances) to an easily excretable form. Fat soluble toxins are converted to water soluble substances through the Phase 1 and Phase 2 detoxification reactions. It is for this reason that hydrophilic (water soluble) substances have longer half life (stay in the body for a longer time) and require reduced frequency of dosing (hence, atenolol is a once-a-day therapy); hydrophilic substances undergo less first metabolism however, they cannot cross the blood brain barrier to have effects on the brain (lipophilic substances cross the blood brain barrier easily). Thus, the liver is responsible for detoxifying the blood (removal of toxins, and microbial fragments from the body).

Furthermore, the liver is responsible for electrolyte balance in the blood, fat digestion and assimilation (through bile juice secretion), storage of vital micronutrients, body temperature regulation ...

Today, xenobiotic insults to the liver are higher than ever, and entry of hepatotoxic pollutants in to the body (like alcohol) have a great impact on the liver causing sluggish liver functions that manifest gastrointestinal complaints like anorexia (loss of hunger), nausea, vomiting, dyspepsia (indigestion) and epigastric distress.

And these complaints are ever increasing and consequently increasing the demand for hepatoprotective products. The hepatoprotective need appears to be underserviced given the strategic importance of the liver.

AND ADDED TO THIS IS THE GROWING PURCHASING POWER IN INDIA, which ensure prescription encashment.

Feeling healthy is as important as absence of health

The positive concept of health is not just the absence of disease and infirmity, it is the feeling of being in good. This explains the ever increasing potential of products like the electrolyte energy drinks. The creation of a brand new category of electrolyte energy drinks perhaps indicates an emerging trend of prescription based lifestyle healthcare goods.

What does a prescription represent?

A prescription is a recommendation to purchase and consume particular products. But importantly a prescription is a covenant of trust. It is a trustworthy written advice on what to consume given by a legally sanctioned expert (an important opinion builder) to his or her patient. The prescription represents trust - the most basic emotion between humans. If a doctor generates a very high level of prescriptions it is because of a proportionately very high level of trust and confidence enjoyed by him in his target market of patients.

People consume products and services because of trust

What a marketer does is build trust on the marketed products. People consume the products and services due to this trust. So a doctor's prescription is a part of this 'TRUST CYCLE'. Products for a healthy lifestyle when recommended by way of prescriptions build enormous trust. Prescriptions deliver superior value to the brand. Hence, the success of the new category prescription based healthy lifestyle products like electrolyte energy drinks (info@jagdale.com).

Prescription and non-prescription based healthcare markets are expanding constantly

While increasing purchasing power creates the opportunity for marketers, the actual reason for consumption is patient empowerment through knowledge. It is the knowledge that it is possible to look young that is driving the consumption of skin care products. Similarly, the knowledge that it is possible to overcome lassitude and a low down feeling (sadness and depression) that is driving the consumption of electrolyte energy drinks and neuropsychiatric products. Knowledge to the patients and society in general about healthcare products drives hope and consumption. Marketers actually sell hope, ideas, and images. And marketing has the dimension of knowledge empowerment. Hence, it now time to consider a change of laws in India, to allow advertising of prescription based products in mass media (with a statutory advice that the product will be sold against prescriptions only).

New disease and healthcare trends drive healthcare markets constantly

While knowledge (as we observe above) is empowering and helps expand healthcare markets, the next factor increasing consumption of healthcare products, are new trends (disease and healthcare). For eg., pandemic diseases now are expanding markets for specific products, like antibiotics. The bird flu disease is a pandemic disease.

Social trends like parents wanting their children to do well scholastically is increasing the consumption of milk mix beverages like Horlicks, Amaze, Boost, Complan etc.

IMPORTANT ASPECT REVEALED: BEWARE - CLIMATE CHANGE (global warming) AND POLLUTION ARE HAVING AN IMPACT ON MALE INFERTILITY

Global warming is not about climate change, flash floods, receding water tables, rising sea levels, but there is something more at stake ... THE FERTILITY OF MALES. There is a distinct possibility of global warming and cocktail pollutants disrupting endocrine (hormonal) balance leading to male infertility. It is already established that climate change will increase the incidence of infections. As climate change is expected to increase infections, these too will indirectly contribute to male infertility. Global warming & raised ozone levels related male infertility is certainly a point to be considered.

So this itself is an opportunity area for healthcare marketers: products and services to offset possible male infertility related to global warming, ozone levels, pollution etc.

So that is the point - various trends in society and environment continue to create healthcare needs and wants and these expand the market continuously.

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Great fortunes in the Indian Pharma market

I got the above image from here.

India is a great destination for pharmaceutical and healthcare marketers. I do not recollect any pharma firm (manufacturer, marketer or trader) who has suffered losses - yes some have folded up due to gross mismanagement or lack of interest, but even the loosely managed firms survive and make profits. Such is the nature of this recession proof and growing pharmaceutical and healthcare industry. The reason is that the healthcare needs are vast and growing in India. It is something like the banking sector. Even the largest private bank in India (ICICI) has a savings bank account depositor base of 13 million (1.30 crores) in a population of 1.02 billion (102 crores). (SBI is the largest bank in India, a public sector bank). There is a large population that is 'unbanked'. Similarly, there is a large population that is not served adequately through the pharmaceutical and healthcare players.

The pharmaceutical and healthcare market is really big

India has 604 districts, population of 1.02 billion, and a pool of around 13 lakh odd doctors with some 5.5 lakh pharmacies. So the best company may be covering about 2 lakh doctors. A recent company like Atrimed has a coverage of 20,000 doctors and turns in a healthy financial picture. So the potential is growing and huge. Morever, patients constantly move up the value chain of clinical health offerings, from basic management of acute illnesses (infections, fevers, and transient headaches), to chronic illnesses (cardiovascular disease, respiratory allergies, arthritis, diabetes, and neuropsychiatry disorders) and then on to aesthetic medicine. So, as the purchasing power of the individual grows, there are newer and newer needs that are met by clinical services. The large market for pharmaceuticals and healthcare is hence constantly growing with a growth in the economy of India. It is for this reason that propaganda cum distributors (started by senior MRs or stockists) turn in tidy profits even if their base of doctors is just 50 core doctors per MR.

Let us see the anticancer market for some insights below

Disclaimer: I did this survey two months back and this is based on market buzz. The survey brings the scope of anticancer segment and the challenges in this market segment.

The challenging anticancer market is a roller-coaster ride. The approximate Rs. 500 crore market for anticancer drugs, is controlled by some 1200 medical oncologists (market buzz: at an all India level). So each oncologist can give a business of Rs. 41.6 lakhs per annum of anticancer drugs…

The use of chemotherapy is mainly in a multimodality approach, since most of the cancers are detected at advanced stage, and surgery and radiation therapies are the mainstay. While conversing with a patient’s attender near Bangalore Insititute of Oncology, Bangalore; he shared the information that he was buying Cipla’s tamoxifen tablets for a patient who had undergone lumpectomy (in treatment of breast cancer), for the past 5 years. Along with tamoxifen he was regularly buying Shelcal M tablets. The market for anticancer drugs is high competitive, high value - low volume compared to other Pharma products, and purely prescription driven (hence doctor – company relationships are very important). The roller coaster nature of the market is due to the fact that doctors enter in to annual contracts for prescribing brand(s) in return for some inputs from the company.

Kidwai Inst. Of Oncology, Bangalore does business of about Rs. 80 lakhs to Rs. 100 lakhs per month. While higher molecules are prescribed, routinely moving anticancer drugs are cisplatin, daunorubicin, vinchristine, and vinblastin. Pfizer is a leading company here at Kidwai. A new trend noticed at Bangalore Institute of Oncology, Bangalore is a pharmacy company called HCG that is directly purchasing certain injectable drugs from a manufacturer on their brand name, price and payment terms bypassing MRs and intermediaries. (In fact, this is marketing phenomenon is seen at Apollo Hospitals too, they have some 150 private label brands of analgesics, antipyretics, antiulcerants (including pantoprazole and rabeprazole) and other injectables which are sold to in-patients at Apollo Hospital network). At Bangalore Inst of Oncology, calcium leucovorin, cisplatin, adrinamycin, fluorouracil, oxyplatin, gencitabine, docetaxel, and isophosphamide are fast moving. Filgrastim is making some waves now. While head, neck, oesophageal, and lung cancers are mostly seen, bone and liver cancer too abound.

Auxiliary drugs that move fast include: antiallergics (particularly cetirizine), budesonide nasay spray, calcium tablets, blood products, analgesics, antidepressants, and antibiotics.

Big daddies of this fiercely competitive market are Pfizer, Roche, Nicholas, Alkem, DRL, Claris, Sun, Fulford…some 45 companies are said to control 70 to 80% of the market.

Herbapharmaceutical, OTC (over-the-counter nutritional supplements and healthcare products), wellness, and the alternative healthcare markets are uncluttered and growing

In fact, homeopathy has some 24% of the alternative healthcare market share. The wellness market is seeing some action with Yash Birla group showing interest in entering this segment. The ayurvedic - herbal market, for instance, is dominated by only 3 or 4 companies.

Cipla's growth hunger

Cipla is the number #1 Pharma company in India's retail market. This position is thanks to the aggressive spirit and intellectual hunger in the company. It is said that very few in the Pharma industry in India can even imagine the kind of approaches that Cipla undertakes. The market buzz is that Cipla is overhauling its marketing approaches, something on the following lines:

a) Use of electronic devices in Pharma marketing - through laptops or tablet PCs. This is done to ensure very persuasive marketing communication efforts.

b) closed loop marketing communication: this is related to the use of laptops or tablet PCs in pharma marketing. Essentially here the MR customizes the messaging with the laptop during in-clinic communication based on the conversations with the doctor. In essence, the MR will create a kind of electronic visual aid with his laptop and the MR is able to access relevant clinical reports as he is talking to the doctor and can show the same to the doctor on the screen. This makes better impact and ensures that the doctor gets convinced faster. Read more about closed loop marketing HERE.

c) Key account management: as such, in today's healthcare scenario, there are more than one opinion builders who affect a pharma brand's establishment and consumption. Hence, it is imperative for the MR to understand the full range of people/professionals, who influence the brand's consumption and strategize on how to manage the relationships and marketing communication efforts, for full impact, this concept is called key account management. This is being put slowly in to action by Cipla's marketing dept. You can read more about key account management in Pharma HERE.

Sun Pharma: the quiet conqueror

Sun Pharma is the one of the most profitable Pharma companies in India. In fact, its CMD, Mr. Dilip Shangvi, the billionaire, who shies away from the limelight is one of the richest persons in India. This company is a quiet conqueror but very aggressive and hungry for more - more topline and more bottom line. A company that makes quiet waves.

Piramal Healthcare: success because there was no baggage

The husband - wife team of Piramal Healthcare, entered the Pharma industry through acquisition of Nicholas Laboratories. Rest as they say is history. From a few crores of business the company is now having a turnover of Rs. 3000 crores. The main reason was that Mr. Piramal being new to the Pharma industry, carried no baggage, had a fresh and open mind, brought in management concepts and took the Piramal's pharma business to new heights.

Innovation wins through creation of product categories

Competing interest: the author of this blogpost is employed by Juggat Pharma.

Certain companies like Juggat Pharma have created history by creating product categories - the category created by Juggat Pharma is the tetra pak based product range electrolyte energy drinks for prescription promotion. (www.jagdale.com) This goes to show that innovative and courageous thinking can create records.

The fact that there are great fortunes in the Indian Pharma market is reflected in the Economic Times report dated 17.4.2008, where the reporter, Kiran Kabtta, says domestic growth story boosts Q4 pharma margins.

The above report also states Average estimates point to a 25% annual increase in revenues for domestic pharma companies, though there will be some exceptions to the growth picture. An IMS-ORG MAT report in February valued the home market at Rs 31,900 crore, growing at nearly 15%.

Thanks for going through this blogpost, please feel free to go through the other blogposts, by clicking on OLDER POSTS wherever required.

The healthcare sector in India - is rocking!

The Indian healthcare sector, is the VC's darling, although the sector, as such, has miles to go. As per Mint campaign supplement, dated 7.4.2008, on occasion of World Health Day (7.4.2008), the healthcare sector in India, is relatively recession free, and may grow by four times in 10 years. In 2007, the sector attracted USD 100 million of VC investment, (around Rs. 400 crores), while in 2006, it was USD 41 million. ICICI is bullish about the growth of its new venture, Iven Medicare. While climate change and its impact on health is holding the center stage of various programs, Mumbai is interestingly celebrating this day as a no honking day!

The picture

India has 604 districts and a population about 1.02 billion, As per The Hindu, dated 19.3.2008, p.no. 16, the no. of registered allopaths with MCI is 6,83,582, the population to doctor ratio is 1:1634; there are also more than 6 lakh RMPs and with other qualifications like BAMS, BUMS, etc. There are 271 medical colleges (138 Govt., and 133 private sector). The MBBS intake capacity is 31,172 and PG seats available are 11,005. The hospital bed to population ratio is 1:3500, while it is 5:1000 in developed economies. So pharma marketers are possibly addressing a market of about 13 odd lakhs doctors who influence the consumption of prescription products.

The disease patterns

Cancer: In 1975 - 76, the National Cancer Program was started in India. Every year 8 lakh cases of cancer are detected, and 3 lakh deaths occur due to cancer. By 2026, the no. of cancer cases is expected to go to about 1.4 million.

TB: in the world and India: It is estimated that one third of the world's population is infected by TB. The WHO estimate is that 9.2 million were infected by TB in 2006, but only 5.1 million were diagnosed. So for every 5 cases of TB detected, 4 went undetected. India, China, Indonesia, South Africa, and Nigeria had most of the cases. 7 lakh HIV positive people were diagnosed with TB.

Infections: If one glances, at the top 50 brands (as per ORG IMS, Feb 2008), one will see that Corex (as usual) holds the top 1 position followed by Voveran. And what strikes the pharma marketer is the large no. of antibiotics particularly cephalosporins that are the topper brands. This indicates that a large component of the market is still anti-infectives. With India becoming warmer, the climate change is expected to encourage the spread of infections.

Nutritional deficits: India's economy, plagued with rising inflation (which is now a global phenomenon), will further deepen the problems of nutritional deficits particularly in semi urban and rural India. Already anemia is a major health problem in India.

Lifestyle diseases: While the developed economies are grappling mainly with the battle of plenty (obesity is a major health problem in the advanced West), India is grappling with different lifestyle diseases due to problems like smoking. The other very striking thing about the top pharma brands in Indian market are that they belong to the lifestyle segment. In fact, the third largest brand is a human insulin brand, and new off-the-block company in the branded formulations market - Biocon - is growing at dizzying rates (over 50%). Atorvastatin brands are also doing very well in India, and are among the topper Indian pharma brands. Women's diseases including menopause are seeing a lot of growth opportunity. Click here for a nice review on the lifestyle segment of the Indian pharma market (diseases like diabesity in urban India).

The rural market beckons!!

The Union Budget 2008 - 2009 has given a thrust to the healthcare sector, particularly the rural healthcare segment. And current estimates are that the rural sector will be the engine of growth for the healthcare sector.

The CRAMS sector is going places

With the acquisition of Draxis by Delhi based, Jupiter Biosciences the spotlight is on the CRAMS sector (contract research and manufacturing services) of the healthcare industry.

25% of the Indian pharma market is gastrointestinal-hepatic...

While approximately 25% of the total value of the Indian pharma market is anti-infectives, the next 25% is gastrointestinal - hepatic related, including electrolytes. Management of acid-peptic diseases including heartburn continues to be big business. Liv 52 is the fourth largest Indian pharma brand (ORG Feb 2008).

India: The world's generic basket

Undoubtedly, having an estimated 100 US FDA approved manufacturing plants, and offering value-for-money generic products, India is the world's generic basket (the chance for replicating this success in the biogeneric segment is also bright). The successes in generic product production and marketing, and CRAMS is only because of Indian entrepreneurship and availability of talented people. However, this is leading to a very competitive and...

commoditized pharma marketplace in India.

The large no. of manufacturers and marketers is leading to a high degree of commoditization in the Indian pharma marketplace. There are newer and newer players coming in to the Indian pharma industry, for eg., Atlas the bicycle manufacturer has expanded to the pharma sector, by setting up a world class manufacturing unit. Further, it is becoming a trend for many MRs to start their own propaganda cum distribution model of pharma business.

I got the above image from HERE, this Govt. website also gives further details about the Indian healthcare sector. Kindly scroll down to read other articles (including by clicking on older posts).

Inflation, food shortages, and pharma business

The food crisis and inflation scenario

The world is never the same ... the world is constantly in change ... uncertainties and new forces create new challenges to society. The Financial Express, dated 1.4.2008, p.no.1, highlights the challenges facing Indians. The wholesale price inflation index is now 6.68%, ahead of the RBI's target of 5%, for the week ending 15.3.2008. The Govt., is admittedly very concerned as elections are due ... hence, import duties may drop to zero for food products, staple items (wheat and rice), and edible oil. This is done to try and improve the supply position, and there by ease the pressure on inflation. Globally, the food crisis is deepening and food prices are soaring, due to drought, declining dollar, shift of investment money to commodities trading, and using farm land to grow fuel crops. By 2050, the world population is estimated to be 9 billion, and extra 2.5 billion will live in developing countries. Asia's increasing wealthiness and increasing demand for meat particularly from China has added to the food supply pressure. The world over, in fact, inflation is a concern, the People's Bank of China (PBOC) has commited to reigning in inflation through policy changes. The Japanese market is the second largest economy in the world, after USA, and its industrial production index is closely watched globally. The March 2008 figures are lower than the Feb 2008 figures, and it indicates a bleak economic outlook globally.

Food deficits and impact on health

One of the best ways of studying the impact of food deficits on health and disease patterns is to look at case studies. An example is the US embargo to Cuba. It has been well documented that the embargo has dramatically impacted the health of the average Cuban: please CLICK HERE. However, the Cuban crisis was severe as the embargo covered medicines too.

One of the most important impacts of food deficit induced malnutrition - is the rise in infectious diseases. In fact, in India, 25% of pharma market is the antibiotic market, while another 25% of the market is the gastrointestinal diseases market. Malnutrition is likely to grow these markets further.

Will the market for nutritional support therapies grow?

It is well documented that the healthcare industry in India is booming, this refers to the markets of pharmaceuticals, nutritionals, biotech products, and healthcare services. Let food by thy medicine and thy medicine your food is a popular saying of Hippocrates (the father of medicine). A number of nutritionals are promoted to doctors for prescriptions, and other nutritionals are promoted using the OTX route (where products are promoted to doctors and subliminally to end consumers directly). As the role of food deficits and diseases gets more highlighted, the nutritional market can be expected to boom in the prescription arena - particularly value added low priced nutritionals and nutraceuticals will see increased consumption.

Food deficits :impact on maternal and child health

Among patient categories, the pediatric and women care markets are very attractive given the high rates of patient compliance particularly in the pediatric market. In India, hidden hunger is a long standing problem that exacerbates disease processes and increases susceptibility to infections. The lowered consumption of high nutrition foods is bound to impact on the health of pediatric cases, and women (particularly pregnant and lactating women, where there could be a rise in low birth weight babies). Hence, vitamin supplements, protein preparations, iron supplements, calcium formulations, and other nutraceuticals/nutritionals will possibly see a better market.

Opportunity for corporate social responsibility and business

The food crisis (which cannot be solved overnight) and higher inflation, are bound to have an impact on the health, disease patterns, and stress levels in society. This scenario is an opportunity for healthcare organizations (commercial and non-profit) to offer innovative products and services, and help build a healthier and happier society.

Thanks for reading this blogpost, please scroll down and read all other blogposts. I got the above great image from HERE.

Strategies for 'symptomless diseases'

The greatest challenge for society (healthcare providers, pharmaceutical companies, and patients themselves) is management of what may be called 'symptomless diseases'. For eg., consider GLAUCOMA, DIABETES, HYPERTENSION, END STAGE RENAL DISEASE (ESRD), CANCER AND OSTEOPOROSIS - these diseases, at the start, do not cause typical and powerful symptoms that motivate individuals to consult doctors or healthcare providers. Nomally, pain, fatigue, giddiness, disfigurement, and discomfort are the reasons for individuals to seek medical consultation. But what do you do when certain diseases at the early stage do not cause important symptoms that will motivate individuals to seek medical advice?

6.3.2008 was observed as WORLD GLAUCOMA DAY. There are some chilling statistics about glaucoma as reported in The Times of India, dated 7.3.2008, p.no.8. Glaucoma is the second leading cause of blindness after cataract. 90% of those affected are unaware that they have glaucoma, since it is a painless disease, which spreads fast. By the time patients are aware, they lose up to 70% of vision. Nearly 2.5% to 5% of people aged 40 and above are vulnerable to glaucoma.

Glaucoma usually affects: DIABETICS, THOSE WITH MYOPIA, AND THOSE WHO TAKE STEROIDS FOR A LONG TIME.

Around 67 million people worldwide suffer glaucoma (12% are in India).

OSTEOPOROSIS is popular as the "silent thief". This insidious disease silently makes the bones weak, brittle, and they break easily (resulting in fractures). In fact, in the aged, even severe coughing or sneezing can cause fractures particularly in the vertebrae. Often, the first signs of osteoporosis are low back pain and gum disease (leading to tooth-fall in the aged). It is only when the dip in bone mineral density has crossed a certain threshold level, that osteoporosis becomes apparent physically (such as stooped gait).

Similarly, hypertension is well known as the silent killer. High blood pressure does not always cause clear symptoms.

Cancer is more often than not detected in the later stage in India. More than 70% of detected cancers in India are at the advanced stage.

Diabetes and renal disease are also diagnosed many a times when the diseases have advanced.

SO THE CHALLENGING QUESTION IS HOW TO TACKLE THE ABOVE DISEASES?

In marketing the AIDA (attention, interest, desire, and action) is a very important sequence that is used to engage prospects and customers. Marketing communication efforts always engage the target audience with the above sequence. The idea is to gain attention of the target audience, kindle interest, and stimulate desire, and finally ensure the desired action.

Creating tension is vital in the AIDA sequence. Tension leads to information search behavior and thus, by achieving the required higher level of involvement in the target audience, desired outcomes are obtained.

Let us imagine, the case of Glaucoma. The target audience is obviously the 40 plus age group, particularly diabetics, myopics, and persons on steroids for a long time (like asthmatics, skin allergy patients ...). After identifying the target audience, evolution of marketing messages and choice of media is relevant. To engage the target audience, SOCIAL MARKETING is a good vehicle for brand marketers. This will not only serve the cause of category expansion for the focus brands, it will also subserve the national cause of positive health. The brand engagement strategy should be to educate the target audience and kindle in them the tension for information search behavior and also seek diagnostic help as a preventive strategy. When brand engagement strategies are chalked out through the doctor, brand engagement through opinion builders too is achieved. It is important for social marketing messages to go through opinion builders and also strengthen word-of-mouth in the target audience, about the targeted condition.

THE FORGOTTON PHARMACIST FRONTIER. The pharmacist - medical retailer community is a very strong one and well dispersed in the country. The Indian pharma market is also a strong OTX one. The estimated no. is 5,00,000. Engaging in marketing communication with prospects through pharmacists is a viable strategy for both commercial and noncommercial healthcare marketers. With the development of retail chains, the prospect to exploit the pharmacist medium is better.

It is challenging for healthcare authorities, and pharma marketers to "market" 'consciousness' about "symptomless diseases". It is similar to marketing of preventive care products. It is the next level of challenge to Pharma marketers and healthcare authorities as the market begins to mature in India, and there is an explosion of media power in India. I GOT THE GLAUCOMA IMAGE ABOVE FROM HERE.