INDO CHINA HERBAL AXIS

One of the greatest USPs a nation can have is its heritage. Heritage is something that intrinsically belongs to that nation and these heritage aspects are not offered by any other nation. As part of the heritage of both China and India, we have China’s traditional herbal medicine & healthcare and in India we have our own centuries old systems of herbalism, ayurveda, siddha and unani. One can bank on such heritage aspects as business drivers.

In India, the state of Kerala, positioned as God’s own country, banks on its unique traditions, art, culture and ecological aspects as the drivers of its tourism industry. Thus heritage aspects and marketing of one’s heritage can contribute to the economic growth of a nation or state.

Recently there was a dramatic development in the Asian political scene. It is all thanks to the impact of globalization, better communication and forced, persuaded and/or inevitable shedding of insular positions of countries. We had the historic visit of Mr. Hu Jintao Premier of China to India. During the meeting between the PM of India Mr. Manmohan Singh and Mr. Hu, India and China have pledged after a landmark summit to work faster to end a bitter border dispute, the cause of a brief war in 1962, and double trade between the Asian giants to 40 billion dollars by 2010. In fact, 1/3rd of world’s humanity is in China and India. This Indo China bloc is a big market and these two countries have huge potential to supply quality human resource to the world, besides products and services.

In the distant past shrouded by the mists of time Buddhist monks traveled between China and India. These monks and pilgrims traveling to and fro are said to have carried seeds and seedlings of herbs in their hollow supportive bamboo walking sticks. Thus an herbal culture and heritage has been shared between the China and India for centuries.

The WHO too has noted the herbal heritage and traditional medicine in various countries.

Some important observations in the WHO website include:

• In China, traditional herbal preparations account for 30%-50% of the total medicinal consumption.
• In Ghana, Mali, Nigeria and Zambia, the first line of treatment for 60% of children with high fever resulting from malaria is the use of herbal medicines at home.
• In Europe, North America and other industrialized regions, over 50% of the population have used complementary or alternative medicine at least once.
• In San Francisco, London and South Africa, 75% of people living with HIV/AIDS use TM/CAM.
• 70% of the population in Canada have used complementary medicine at least once.
• In Germany, 90% of the population have used a natural remedy at some point in their life. Between 1995 and 2000, the number of doctors who had undergone special training in natural remedy medicine had almost doubled to 10 800.
• In the United States, 158 million of the adult population use complementary medicines and according to the USA Commission for Alternative and Complementary medicines, US $17 billion was spent on traditional remedies in 2000.
• In the United Kingdom, annual expenditure on alternative medicine is US$ 230 million.
• The global market for herbal medicines currently stands at over US $ 60 billion annually and is growing steadily.
• 25% of modern medicines are made from plants first used traditionally.

On its part, the Kerala state Govt in India has recognized the global herbal trend and reiterated its commitment to participate in this movement and reap the economic benefits too. It is said the global market for herbal drugs is estimated to increase to a total $ 300 billion over the next three years and rise to $five trillion by 2050. With over 45,000 species of medicinal herbs spread over three environmental hotspots in the Western Ghats, Eastern Himalayas and the Andaman and Nicobar islands, India is termed the world herbal garden.

Herbal based businesses including the nutraceutical industry or dietary supplement businesses do not hold the world’s prime stage in terms of commerce and scientific enquiry in commercial R & D centres or corporate sponsored projects. The simple reason for this is that many herbals cannot be patented. (Some years back in a highly publicized case some wise guys in USA tried to patent turmeric and neem too.). Globally most dietary supplements have their origin in Ayurveda or other herbal systems of India and Chinese traditional medicine. Some of the top herbal dietary substances include turmeric, ginger, ashwagandha (Indian ginseng), Chinese ginseng, capsicum oleo resin, Phyllanthus niruri, Andrographis paniculata, Piper nigrum and longum, amla, Azadirachta indica, Picrorhiza kurroa, Eclipta alba, Triphala, Beorhaavia diffusa, Berberis aristata, Safed musli, Carum carvi, Alpinia galanga; Silymarin and Saw palmetto are notable Western herbal contributions. The Vinca alkaloids & taxol are important herbal inspired anti cancer agents.

In this backdrop of the inherent strengths of Indian and Chinese traditional herbal systems and the global herbal opportunity; the Indian and Chinese Govts ought to sit across the table and formulate a common agenda to globalize herbal products through innovative value addition and presentation, production with state of the art machinery and systems, distribution through global channels (including the MLM or multi level marketing format), retailing based on influential scientific communication and scientific marketing communication exercises to enhance demand and consumption.

In such a Govt initiated endeavour, public private participation is a must. Tapping citizens to voice their ideas for this Indo China herbal agenda will help. Beyond this, bringing in powerful consulting companies like Ernst and Young, Delloite consulting etc that play a vital role in globalizing such endeavours by bringing powerful parties to the table and working on the nutraceutical agenda will help the herbal business cause of India and China. A big business opportunity for mass consumption of herbal ingredients originating from India and China is their use in products like soaps (Eg. the ubiquitous presence of aloe vera in many soaps and cosmetics). In fact, worldwide marketing of chyawanprash has immense potential. For this the stake holders and companies need to create a global marketing communication platform and initiatives (say a GLOBAL CHYAWANPRASH INITIATIVE) to inform, inspire and enhance information and consumption of chywanprash worldwide. This will have a great influence on production patterns of the important herbal ingredients among farmers in India. Bankers like ICICI too are vital agencies who can help finance and catalyze initiatives in furthering the India China global herbal business agenda.

Herbal business is a multi billion dollar global opportunity. Further more, giant pharma companies are looking for patent related monopolistic allopathic businesses. Herbal products are not patentable, hence unattractive to big pharma companies. And to grab a market share in the global healthcare biz the primary requirement is a keen marketing sense & market building initiatives for herbal products worldwide, after all business is marketing and advertising (!). Evidence based marketing communication is a must here. Important value wise (herbal) product markets include USA, Japan & Germany.

So here is hoping for valuable inputs from the readers to develop an Indo China herbal agenda.

Prescriber fatigue and product life cycle management

Thursday, March 16, 2006 08:00 IST
Sunil S Chiplunkar

The 20th century business scenario created the profession of "brand building". Branding helps in differentiation, creating loyal customer base, insulating a product from obsolescence and competition, helps command a premium in the market place, reinforces trust with customers and delivers value to customer and company alike. An exciting brand development in the contemporary business scene is the extension of Kingfisher a beverage brand to an exciting airline brand, from a 'product brand' to a 'service brand'. If the 'service airline brand Kingfisher' establishes firmly, the multiplier effect on the brand Kingfisher will be magical! The total brand value of Kingfisher will be literally flying high!!

Today, the Indian pharma industry is a leading light in the global healthcare scenario. The Indian pharma industry is a well entrenched global manufacturer and marketer of APIs, formulations, herbal extracts and nutraceuticals. Moreover, medical tourism and health resort industry is lending wings to the image of India as a quality and value-for-money service oriented healthcare destination. Healthcare products and healthcare services together have over Rs 1 lakh crore business potential.

The robust challenge and opportunity ahead is building global Indian brands - brands that dominate domestically and internationally. In fact, brands like Wockhardt and Himalaya juxtaposed in the 'healthcare service sector' and 'pharma manufacturing and marketing sector' have a solid opportunity to exponentially increase brand value, a-la-Kingfisher.

A curious desi phenomenon

Domestic pharma brand building has an odd challenge: The Indian Patents Act, 1970, which allowed reverse engineering has created a fragmented market with brand clutter. This has led to rising power of retailers and stockists. In at least one Southern Indian state (Kerala) NOC is not given to more than 25 brands of a molecule, by the stockists association. Decades of "me-too new introductions" has commoditized products and lent a character of "promotional differentiation" in the field of pharma marketing and sales. This has also led to a need for "brand variety" by a prescriber, who also zealously guards "prescription secrecy". The cumulative effect of the above scenario is a curious desi phenomenon - prescriber fatigue, an obstacle to brand building, evergreening of brands and product life cycle management.

Several factors are responsible for this curious 'desi' phenomenon including brand clutter, commoditization of products, heavy focus on 'new introductions' and new technological developments.

Prescriber fatigue is indeed a challenge to marketers involved in brand building and product life cycle management.

Product life cycle (PLC) concept

The PLC (product life cycle) concept is a useful tool for analyzing a product's position and applying marketing decisions. PLC is based on the biological life cycle. A seed is planted (introduction stage), it grows (growth stage), matures (maturity state) then later on shrinks and dies. In theory, a product too passes through introduction, growth, maturity, decline and withdrawal stages.

Assuming this cycle to be true, marketing mix decisions are taken. For example, during introduction stage, a market penetration (low price) may be used or a leadership or market skimming pricing for recovering development costs is used. There is also a focus on brand building and promotion to innovators and early adopters. During maturity and decline stages product differentiation is introduced through line extensions and improved product features.

However, this PLC concept is only a guiding tool. Many products fail in the introduction stage. Cyclical maturity phases are also a feature of some products where promotion helps regain customers. The length of each phase varies product to product and brand to brand. Further, decisions taken by marketers greatly influences product fate. And finally there are situations where products bypass certain phases in the PLC. Nevertheless, the PLC is an interesting guiding tool.

Many pharma brands have grown significantly as per ORG JUN 2005 MAT. In 1991, Corex was Rs. 13.9 crores, which is Rs. 87.0 crores; Voveran was Rs. 12.9 crores, which is Rs. 86.2 crores; Becosules was Rs. 25.8 crores, which is Rs. 75.7 crores and Liv 52 was Rs. 17.2 crores, which is Rs. 66.2 crores as per ORG JUN 2005 MAT.

Overcoming prescriber fatigue

The challenge of overcoming prescriber fatigue is indeed exciting to a marketer in his bid to build brands and evergreen brands.

The following vistas are available to overcome prescriber fatigue:

1) Constant creative promotion to internal and external customers
2) Passing the baton generation to generation
3) Post marketing clinical studies and market research
4) Positioning and repositioning exercises
5) Line extensions and product improvements for brand vitality.

Constant creative promotion

A brand with a price advantage can simply be undercut. A brand with a performance advantage can be outflanked by technological development. But a brand with an emotional difference can potentially demand a premium forever - Don Cowley

As can be surmised, brands are vital productive assets. Constant creative promotion for a long time will make a brand financially tastier. A brand then becomes a legend and part of the market consciousness. To maintain and renew brand vitality promotional measures are required at two levels - one at the level of internal customers (the field force) and second at the level of external customers (doctors and chemists).

The 21st century (and the latter part of 20th century) has seen many media revolutions. Yet right from the time when Parke Davis started the world's first 'medical representatives', the field force particularly in India continues to be the dominant medium to communicate and influence the doctors' prescribing habits. Companies like Cipla have added database mailer marketing and advertising successfully to their marketing mix. Nevertheless, the field force is the backbone of product promotional activities in a company. Hence, what the field force does affects a brand's fortunes.

More as a rule than as an exception, achievement of predetermined sales targets takes the front seat 'month end' after 'month end'. Closing of the month sale 'a pharma obsession possesses the field force who take over stockists' premises (and even substockist and doctor attached retailers) during month end. Last minute offers and special sanctions enrich stockists while the company tries to reach the holy grail of the sales target. Achievement of the sales value and ensuring collection becomes the prime job of the field force.

The above actual scenario of many a pharma company becomes a real challenge to a marketer whose duty is brand building and brand renewal. More often, New Introductions (mostly me-too brands) obsesses salesmen and marketers to achieve primary sales, thus contribute to the topline. The secondary sales can then be taken care of through core doctor working. It should be noted that a 'me-too brand' is a new introduction for the company, but the nth brand for the doctor. So often, new introductions themselves pose a challenge to marketers whose goal includes evergreening of core brands.

With MRs focusing on doctor conversions for new introductions, sales targets, collection, stockist and substockist management, doctor deals, chemist deals, special sanctions…'in-clinic' focus for evergreen power brands gets only a 'reminder status'. The MR 'reminds and thanks' the doctor with regard to the well established brands, more often with just some samples or a quick flip of the visual aid "Dr., reminding for Brand X' or 'thank you doctor for Brand X' or mere verbal reminders without even the casual visual aid exposure. This situation is a picture of convenience to all concerned: the marketer can provide a regular promotional effort and input, the doctor can avoid the product presentation with an authoritative 'I KNOW', the MR ducks the detailing, the company shores up the topline through new introductions, stockists and retailers boost their earnings through offers and site facility. Thus, power brands become weaker day by day.

For a marketer to strengthen core brands in the above typical scenario it is even more challenging. A marketer should hence come out with creative approaches that appeal to doctors and field force. A rehash of established strategies and messages to the doctor just won't do. The communication platform has to be worked on keenly. To take FMCG examples even Lifebuoy today talks of both health and beauty; Lux is not just for the female stars, Shah Rukh Khan is lending his slender shoulders to support Lux; Anchor has roped in Rahul Dravid to emphasise the dependability of its electricity oriented products. The marketers' challenge doesn't end with a good communication platform for an old brand. The job includes creating exciting in-clinic activities with the fervor of youth to an old brand, ensuring inspiring moments for internal and external customers. The need for established 'reminder core brands' is innovative communication and in-clinic activity to overcome prescriber fatigue.

Passing the baton generation to generation

The above scenario of reminder promotion ensures power brands are 'reminded' to a trusted set of 'old' doctors, year after year. New introductions obsess the company and evangelically promote them to young doctors and innovators. The medical college hospitals the right centres for evergreening of brands, become theatres for 'new product promotion'. The older brand gracefully ages, the marketing team with all sagacity decides to focus on 'emerging markets' with new introductions, while brand assets are depreciated. As time passes, power brands whiter away with the old generation of doctors. The new generation of doctors is informed about the new brands. Thus, avoiding youthful and fresh campaigns to well established brands, reinforces prescriber fatigue towards the old power brands.

Post marketing clinical studies and market research

Evergreening of old brands requires the brand to have freshness, which can come through 'newness' in the product promotion. Post marketing clinical studies and market research (to understand customer perception) is a vital vista for brand renewal. Clinical studies will help reinforce brand usage, generate comparative benefits vis-à-vis competitor brands and produce knowledge required for brand renewal with contemporary metaphors thus appealing to new and old generations of doctors. This may even extend the therapeutic spectrum of usage. For example, prediabetes and prehypertension are fairly new clinical diagnosis, brands can fortify themselves through clinical studies addressing these new clinical concerns. Post marketing clinical studies and market research will help generate USPs, promotional and talking points for enhanced in - clinic effectiveness and overcoming prescriber fatigue towards old brands.

Positioning and repositioning exercises

The excitement in a marketer's line of activity comes with product positioning, repositioning exercises and creative promotionals. The positioning statement reflects how the brand fits in to the customer's mind, reflecting customer perception of the brand. Based on the newer dimensions of the product and changing market trends, repositioning helps overcome prescriber fatigue and gives a new lease of life to a product. A classic example is aspirin, a NSAID now a mainstay in cardiovascular therapy.

Line extensions and product improvements

Marketing is often described as a value delivery process. Line extensions and product improvements are long used strategies for evergreening of brands and strengthening value delivery process. Very often small innovations like shift from glass bottles to lupolein or polymer packs have rebooted brand values. Line extensions have shored up brand sales. For instance, omeprazole brands have strengthened themselves through launch of omeprazole and domperidone combinations. All in all, value additions through product improvements and line extensions definitely overcome prescriber fatigue.

We see above the changing dynamics of market and regulatory environment makes it imperative to build solid and strong pharma brands. Overcoming prescriber fatigue is one factor that will contribute to evergreening of brands. Some strategies have been discussed above.

- (The author is with Juggat Pharma (Pharma Div of Jagdale Ind Ltd), Bangalore)
http://www.pharmabiz.com/article/detnews.asp?articleid=32366§ionid=46

MARKETING FIRST!

First of all I am happy with the current trends of intensified marketing communication activity through newer and newer means including 'paid blogging' and social network marketing. This makes people put marketing first in the pharma space. And this trend is the way it should be.

Today in India and Bangladesh micro credit is a big thing in the financial domain. How did this happen? This happened because Mohd Yunus of Grameen Bank put the market first, he identified a target market for micro finance and thus realised profits for his firm and made social contributions. ICICI in India is on the same pathway, which is a wise marketing effort.

In fact the bane of the pharma field is the hyperfocus on intellectual property, patents, patent life and evergreening of products. Marketing is not taking the front seat. In fact, the obsession on drug patent(s) and TRIPS is causing much hardship in making drugs and health care products available at an economical price. Morever, having patent rights is itself a great source of income for pharma companies, thus many other good molecules and drugs that are beyond the ken of patents are not picked up for commercialization and/or intensive marketing by big pharma companies. In fact, it is not an exaggeration to say that pharma companies are more in the business of intellectual property, patent holdings & evergreening products rather than marketing products. In fact this innovation led business activity is said to be the highest of profitable business models, where in the focus is on innovation and creating intellectual property and gaining value, rather than marketing products based on target audiences. So who cares about health and societal or market needs when the focus of pharma companies is on intellectual property, patents, monopoly markets for products, profits and big bucks(?)

In fact, google is creating a revolutionary 'flat world' and seamlessly allowing exchange of ideas, information and comments across geographies. Google is doing a great marketing job, they are putting marketing first. And putting marketing first should be the priority for pharma companies too; it should not be patents first for pharma companies. - SUNIL S CHIPLUNKAR

http://pharmamkting.blogspot.com/2006/11/girl-from-google.html

GETTING THE MESSAGE ACROSS

In the pharma industry, there are three main ways of getting our message across. First is the popular VISUAL AID DETAILING. One must necessarily know the text (knowledge), use a pointer, handle the visual aid correctly, use good voice modulation and detail with confidence (ensuring adequate eye contact). However, sometimes in clinical situations, it is not possible to detail with visual aid. Either the doctor is in a hurry or is surrounded by patients. This is where EXTEMPORE DETAILING AND DIALOGUE DETAILING comes in to play. In the former, one must know the product profile points and some important salient benefits by heart. With out a visual aid, the MR makes his interesting sales pitch and gets his message across. In the case of dialogue detailing, the MR engages the doctor in a conversation, puts questions across and tactfully puts product benefits across; thus, wins over customers with effective message transmission.

SELLING IS VERY MUCH A GAME OF CONFIDENCE. The MR gives confidence to the doctor on his products. This confidence in the doctor on the product translates in to prescriptions. And thus, in to sales for the MR. In the game of confidence, a crucial aspect of communication (ie the process of sending message(s) across to the recipient(s)) is BODY LANGUAGE. An important component of the body language is ACTIVE LISTENING. The appearance, dress, gestures, body movements with confidence, eye contact and ability to listen; all play a key role in building confidence and thus generating prescriptions.

Getting the doctor to listen to your message and convincing is an artful experience. The success of your call depends on the barriers to your communication. The most important barrier is defensiveness. The doctor may think you are just a salesman with glib talk out to manipulate him or your detailing may make him look inadequate. Another barrier is the tendency to evaluate or judge rather than listen to you. A very important third barrier is preoccupation (the mind of the doctor is more with his patients or preparation of the OT) rather than being with you. This is why many doctors have a separate time for MRs to visit. There is a famous case study at Alembic: a doctor was just not getting Althrocin in to his pen habit despite regular calls by the MR. Once, it so happened, the doctor was on his way to the urinals and he met the MR on the way. The MR only mentioned ALTHROCIN. While micturating, the mind is usually relaxed. And during this relaxed and free moment the work Althrocin played on the doctor’s mind. Althrocin had entered in to the prescribing habit. This was because the doctor’s mind was not preoccupied. In fact it is routine procedure for Pfizer MRs to make doctor calls when the target doctor is not preoccupied with other things.

Other barriers to successful communication include, language, memory failure and emotional reactions. For instance, the doctor emotionally reacts during conversation with the MR on a delicate issue; this makes message reception ineffective. Assumptions and prejudices too play a role in message transfer. For example, a doctor may think herbal products and nutritionals are unnecessary or placebos. Or the doctor may feel only top Indian companies and MNCs produce quality products. Hence, it is important for the MR to discover the prejudice or assumption in the mind of the doctor and tackle it before making the actual product sales pitch.

ALICE IN "VIOXX" LAND

* “Curiouser and Curiouser! cried Alice”

By now the news of VIOXX (Rofecoxib) voluntary withdrawal by Merck is history. In fact, this will go down as one of the most interesting events in the history of pharmaceutical industry. This event is a telling commentary on the pressures managements of pharma companies bear to perform in the marketplace.

* “ You’re nothing but a pack of cards! ” On 30th September 2004 Merck & Co. announced a voluntary worldwide withdrawal of Vioxx (Rofecoxib), its arthritis and acute pain medication. The company’s decision, effective immediately, was based on new, three-year data from a prospective, randomized, placebo-controlled clinical trial, the APPROVe (Adenomatous Polyp Prevention on Vioxx) trial. In this study, there was an increased relative risk for confirmed cardiovascular events, such as heart attack and stroke, beginning after 18 months of treatment in the patients taking Vioxx compared to those taking placebo.

The withdrawal was done despite the drug doing a blockbuster sales crossing of 2.5 billion dollars globally. In India too, Cox – 2 inhibitors are a losing market. Now with the Rofecoxib controversy, the entire COX-2 inhibitor market is highly uncomfortable. Due to patient empowerment through media and risk free prescribing behaviour of the doctor, a strong prescribing shift in favour of older molecules like Diclofenac, Paracetamol, and Ibuprofen can be expected. Thus, there is a void created by the dying market of the COX-2 inhibitors.

The CEO of Merck who was responsible for the launch of Vioxx, Mr. Raymond Gillmartin is out. (*Quote : “ The queen had one way of settling all difficulties…. “ Off with his head!” “)

* End quote: Alice: “ Would you tell me, please, which way I ought to go from here?”
“ That depends a good deal on where you want to get to,” said the Cat.

Nimesulide revisited

Perception building has been an important component of the marketing warfare involving nimesulide, maintain CJK Simon and Sunil S Chiplunkar

You may recollect that ranitidine was at one time the topmost antiulcerant in the market. So intensive was the promotion, ranitidine achieved success even though ranitidine has side effects of impotence and gynaecomastia (development of breasts and female characteristics in males) in a small percentage of patients. Moreover, ranitidine was premium priced when launched. Further, ranitidine was able to out beat the formidable competitor famotidine which is purported to be a superior H2 receptor blocker and most economical. This is why the marketing gurus Al Ries and Jack Trout called marketing as a war of perceptions. The power of promotion was able to build a favourable perception of ranitidine.

Another example is piroxicam, which was a dud when launched by many companies. However, when a leading pharma company entered with piroxicam, they made it a top grosser NSAID brand in India. So forceful was their promotion, they built a very favourable perception for piroxicam. In this NSAID theatre, a new drama unfolded recently starring nimesulide. Perception building was an important component of the marketing warfare involving nimesulide.

Nimesulide market
As per ORG MAT Nov 2002, the nimesulide oral solids market is worth Rs 170.623 crores with a growth of 18.6 per cent. The leading Indian oral solid brand is worth Rs 53.30 crores as per ORG MAT Nov. 2002. The nimesulide oral liquid market is about Rs 26.50 crores with 2.82 per cent change. So the total retail market for nimesulide is about Rs 200 crores with mainly Indian players. Further, ORG does not cover institutional sales.

The opportunity: In this backdrop just imagine replacing the nimesulide market with some other NSAID by creating a negative perception for nimesulide.

A brief history
Nimesulide was first developed and marketed by Helsinn Healthcare, a privately-owned Swiss company based at Lugano. It was first launched in August 1985. Today, Helsinn’s nimesulide is on the market in more than 50 countries. Helsinn collects and manages wide post-marketing surveillance information based on more than 346 million treatment courses. Nimesulide is effectively used for the treatment of a variety of inflammatory and painful conditions including osteoarthritis in European and Asian countries for more than 15 years. Its marketshare is reported to be fifth amongst the NSAIDs in the worldwide market. In India it was introduced in the early 1990s and there are more than 70 brands.

A pharmaco profile
Nimesulide is a potent analgesic, anti-inflammatory and antipyretic. Nimesulide has a multi-factorial mode of action that sets it apart from other NSAIDs. Nimesulide is a preferential COX-2 inhibitor having around five to 20-fold greater potency against COX-2 than COX-1. Hence, nimesulide possesses a much lower risk for gastroduodenal lesions in comparison to classical NSAIDs.
Nimesulide inhibits the production of oxygen-derived free radicals, monochloramines and hypochlorous acid (which are all proinflammatory) from neutrophils and other inflammatory cells. Free radicals amplify the inflammatory process.
Nimesulide inhibits the release of histamine from mast cells and basophils. In the case of asthmatics, this property is very beneficial since there is no aggravation of asthma. Nimesulide inhibits the production of proinflammatory PAF (platelet activating factor) by neutrophils.
Other anti-inflammatory effects include the fact that nimesulide inhibits phosphodiesterase 4, neutrophil esterase, cartilage collagenase and stromylesin (which are all enzymes that catalyse breakdown of tissues).
Thus, in acute and chronic inflammatory conditions in patients, nimesulide is more effective than placebo and has comparable anti-inflammatory activity to well-established NSAIDs.

Safety
Long term therapeutic use of nimesulide has not caused serious GI symptoms. Also, nimesulide is safe for use in aspirin sensitive asthmatic patients. Nimesulide is beneficial in relieving the symptoms of rhinitis (common cold - where pain and fever may be there), rhinopharyngitis, and secretory otitis media (middle ear infection) with concomitant antibiotic
treatment.
In more than 18 years of marketing experience, nimesulide has proved safe and effective in the symptomatic treatment of a wide range of conditions such as osteoarthritis, tendinitis, bursitis, respiratory tract inflammation, post dental surgery etc.
Clinically observed adverse events are typical as those found with other NSAIDs.
A post-marketing surveillance of nimesulide suspension (50 mg/ml) conducted through 600 paediatricians all over India, has also indicated the absence of nimesulide-related hepatotoxicity in children.
The incidence of rare and unpredictable liver reactions with nimesulide is about 0.1 per one lakh treated patients, which is not higher than most of the other NSAIDs like diclofenac. The individual or inherent risk factors (like genetic factors) of the patient can predispose him or her to increased risk for development of nimesulide associated unpredictable hepatic reactions. This is just as with other drugs.
The wide clinical efficacy with unique pharmacodynamic actions and beneficial gastrotolerability and bronchotolerability in comparison with other NSAIDs may outweigh the relative risk of nimesulide-associated liver reaction (common to the
class of NSAIDs) in the long-term use of the drug.

Endnote
In a cover story, The Hindustan Times (13.2.2003) declared: ‘IMA ends debate: nimesulide is safe.’ The IMA has pointed out that in an exhaustive survey doctors found nimesulide has minimal side effects. The benefits of nimesulide outweigh its adverse effects. Besides, only a handful of countries had banned the drug and most countries like Israel had withdrawn the ban. So this was the drama involving nimesulide - an attractive Rs 200-crore plus retail market.

CJK Simon is manager, Marketing and Sales, while Sunil S Chiplunkar is senior manager, Product and Training, Juggat Pharma, Bangalore
http://www.expresspharmapulse.com/20030313/edit2.shtml

Importance of pharma sales training

Training is a powerful medium to elicit required behavioural modes. Behavioural training is of utmost importance as it contributes to a corporate's identity. By ensuring demonstration and repetitive practice in training sessions behavioural modifications can be achieved.

Training creates an empowered attitude. It results in morale boosting and confidence building. After all, sales is a game of confidence. The company imparts confidence on the products to the MRs first. The MRs in turn ensure confidence among doctors on the brands. When doctors fearlessly use products, the marketing efforts ensure delight. The combination of doctor's delight and doctor's confidence is enough to ensure good consumption of brands, which is the core of marketing.

Learning during training sessions takes place by:
- Listening
- Seeing/reading
- Writing
- Discussions / interacting
- Practise

To train and ensure effective message transmission and reception (by the receiver), it is vital to use the above processes.

Interactive technique

Consider the following illustration to drive home the importance of detailing, by way of an interactive technique:
1) Ask your MR trainees to instantaneously write down the names of five most popular bath soaps in about a minute.
2) Ask a few of the participants to read aloud brand names written by them.
3) Assume LUX is the most popular response
4) Ask the participants why LUX has top-of-the-mind recall? (Is it because of samples or gifts? This can be a corollary query to the participants.)
5) The responses will typically vary from "Constant brand hammering," "Regular advertising", "Models", "Regular usage by participants" and "Availability".

This sort of an interactive opener will not only engage trainees; this will certainly open-the-eyes of MRs/filed personnel to the fact that efficient detailing / communication is a crucial link in brand building. This does not overlook the importance of promotional tools (like leave behind cards, table top items, gifts and samples) in creating brand experiences and brand building.

Training is not just presenting 'new' learning. It comprises a lot of practice sessions and polishing: Typically, a trainer may lay more emphasis to his/her presentation to the trainees. However, this is only a part of the learning game. The more interesting and important part is providing more f time to trainees for practicing the techniques. That is what coaching is all about, making the players play and practice.

The coach should observe, monitor and polish the trainees. This is where real learning takes place resulting in "charged trainees".

Edward de bono and the SIX HATS: Dr. Edward de bono is a revolutionary thought leader of the modern age. He has produced breakthrough concepts to enhance organizational efficiency and effectiveness. A common thread in his works is his attempt to explore beyond traditional thinking and ideation. One of his innovations is parallel thinking as encapsuled in his SIX HAT METHOD. The essence of his SIX HAT METHOD is to look at an issue from different perspectives. By looking at an issue from different angles we get to understand a subject completely and produce fresh ideas. When applied in group meetings, the SIX HAT METHOD helps avoid conformity pressure. It appeals to the audience since it accommodates all thought flows. Best of all it is interactive, encourages discussion, participation and involvement. Overall, using SIX HAT METHOD in-group meetings makes the meeting successful, run faster and free of egoisms.

"Modelling" during training: Most trainees pick up cues and behavioural styles through observation. In the context of explaining how a successful doctor call is to be made, it just doesn't suffice to explain the dos and don'ts. A trainer can drive home the message more successfully by demonstrating a "WRONG DOCTOR CALL" and "RIGHT DOCTOR CALL" typically by asking a MR to be the doctor and trainer being the MR (with a detailing bag). A case to point is the usage of a pointer while detailing. One can very clearly make the point of usefulness of a pointer by detailing a page of the visual aid, once with a pointer (to the audience) and once without a pointer.

Have a packet of chocolates: A handy tool to engage the audience and elicit desired levels of participation and alertness is by use of chocolates. When a participant gives a positive point or answers a query give a chocolate or éclair instantly to the respondent. One can even sense a competition among participants to gain most éclairs. Ensure eager participation through a small sweet device - chocolates, during training session.

End of Training Feedback: The barometers of training or learning effectiveness is CONFIDENCE BUILDING. As referred earlier, sales is a game of confidence, building on the feeling "I AM OK" among trainees. An acid test of training effectiveness is how the learning session results in quantitative results. For this a trainee feedback is useful.

The written feedback at the end of training session should reflect their GAIN IN CONFIDENCE and the visualization of how the knowledge/techniques/practice session will yield quantitative results.

Hence, the typical objective or questionnaire training feedback should include:
A) What did you learn/practice in the training session.
B) Explain with examples how the learning/practice will generate extra sales. Give specific examples where certain techniques/procedures will be employed to generate more results. Typically, a MR may respond (with Dr. names)of how a technique may be applied to get a desired quantitative result.

Training and learning are ongoing processes. These processes can take place in classroom settings, on location, through mailers and even via internet. Training involves information sharing, deeper understanding, gaining wisdom and suitable behavioural modifications to align in the direction of corporate vision and mission. As the going gets tougher it is training, which empowers the system to overcome hurdles. Training creates imagery, after all, "What are really being bought and sold are ideas and images" (Quote: Jeremy Rifkin, Economist and author)

- SUNIL S CHIPLUNKAR

- (The author is Marketing & Training Manager, Juggat Pharma, Bangalore)
http://www.pharmabiz.com/article/detnews.asp?articleid=24616§ionid=50

HYPERFOCUS ON PATENTS - a tragedy for patients

The obsession on drug patent(s) and TRIPS is causing much hardship in making drugs and health care products available at an economical price. Morever, having patent rights is itself a great source of income for pharma companies, thus many good molecules and drugs that are beyond the ken of patents are not picked up for commercialization and/or intensive marketing by pharma companies. In fact, it is not an exaggeration to say that pharma companies are more in the business of intellectual property, patent holdings & evergreening products rather than marketing products. In fact this innovation led business activity is said to be the highest of profitable business models where in the focus is on innovation and creating intellectual property and gaining value, rather than marketing products based on target audiences. So who cares about health and societal or market needs when the focus of pharma companies is on intellectual property, patents, monopoly markets for products, profits and big money.

We have to take a leaf from Mohd. Yunus of Grameen Bank, the 2006 Nobel prize winner for Economics, who identified the poor as a target market and went about in a businesslike manner making financial products (micro credit) available to them. This has made his bank profitable and at the same time given life lines to the poor. ICICI bank in India is working on the same lines. Marketing sense is the most important sense for companies. This sense is more important than the faculty of intellectual property or innovation or R & D of an organisation. In fact, this MARKETING SENSE is even more important to pharma companies.

MARKETING AND DISTRIBUTION OF PHARMA GOODS

Pharmaceutical marketing and distribution is an atypical challenge. For most pharma products prescription generation plays a key role in generating the sale. However, the OTC (over-the-counter) push and OTC pull too play complementary roles depending on the product profile. For instance, certain injectables are a clear-cut case of a specialist prescription product. Analgesics, on the other hand, are under the influence of OTC dynamics. Alternatively, in consumer marketing, the target audience is clearly defined. The media carries the messages. The significant reason for sale in consumer marketing is OTC pull. OTC push also plays a complementary role. The dynamics in consumer marketing are, thus, far simpler. In essence, pharma marketing is a complicated knowledge based marketing challenge where the ‘informed customer’ (doctor/chemist) is a major influencer.

The crucial determinants of pharma sale are:

 In-clinic promotional activities
 OTC pull activities
 OTC push activities

In-clinic promotional activities: These are conducted to persuade, remind, and strengthen brand equity and brand recall. The usual in-clinic promotional activities are –

1. detailing the product with the help of visual aid and LBCs
2. samples, compliments and gift articles to help in brand recall and building prescribing habits
3. negotiated personalized business sponsorships to enable higher prescription based sales
4. Company-MR-Doctor relationship building and relationship marketing.

OTC pull activities: OTC pull results from patients/end consumers demanding the product from chemists, purchasing and consuming the same. This bond between the product and end consumers develops through trust. OTC pull results from:

1. good patient experience with the brand
2. patient/end consumer oriented information and persuasion campaigns
3. informative pack inserts/posters/etc
4. freebies directed towards end consumer (given through doctors/chemists as discounts on repeat purchases or in kind).

OTC push activities: refer to the retailer pushing the sale of certain products. Generic products have highest OTC push. Following reasons impel the retailers to push certain products:

1. an emotion that the pushed product is of quality; gives value-for-money for his customers; gives well being to his customers; so that they will come back to his retail shop for future planned and impulse repeat purchases
2. higher margins/ schemes
3. gifts/freebies with purchased goods to the chemist.

Thus, the above processes stimulate the consumption process in the pharma formulations marketing sector.

The methodologies used for stimulating pharma product consumption are:

 focused customer working
 high call frequency
 maximum call coverage
 mailer/ad reminder support
 feasible service needs to be met

Focused customer working:

The current market clutter and competitive practices have forced most pharma companies to select particular products to a doctor; develop intimate relationships; collaborate with the customer to fulfil service needs in the most economical and feasible manner in line with the policies of the company. The most important aspect is measurement of the customer relationship in terms of the business yield, profitability and customer satisfaction. The prime goals of focused customer (chemists/doctors) working are to ensure product availability, high product consumption, and maximum profit with the highest customer delight.

High call frequency/call coverage/reminder support/personalized services:

The general call frequency used to be once a month. However, competitor activity, promotional clutter, development of society and technology are setting a tone for redefining call frequency.

In the 1970s and earlier for the kind of roads, transportation and communication systems available; and the number of doctors practicing the call coverage used to be 8 to 10 calls per day with a once a month or once in forty five days coverage. Sometimes, the more potential doctors had higher call frequency.

The present scenario in society mandates an evolved approach to communicate promotional messages, remind, inform and persuade prescribers about brands. The evolved approach focuses on higher call frequency (say once in a week for select doctors), maximum call coverage (chemists/doctors – trade and institution) through all modes of transport, harnessing technologies such as internet, mailers, ads in journals and thus promote through multimedia. And this also entails personalized services.

Conference promotion is another crucial aspect akin to event promotion that has gained importance in pharma marketing.

DISTRIBUTION plays a crucial role in product marketing as is well known.

Generally, the company from the warehouse or central depot bills goods to the C&Fs or super stockists as the case may be. From there the goods are billed to stockists for onward dispatch on demand to the chemists. In the present scenario when time is paramount, it is very vital that the products are available in time at the right place, because as the saying goes ‘sale lost is lost. It cannot be recovered’.

Logistics have a very valuable role to play in distribution. Availability of the correct mix of products, selection of the correct mode of transport, trans-shipment of the right mix of products, safe packaging constitutes the logistics and help in cost control, resulting in enhanced profits. All relevant documents like invoices, delivery challans, permits, and certificates must be in order during transportation to avoid delays and thereby avoid inconvenience.

A competent distribution adds to the success of marketing. Overall, pharma marketing and distribution are very challenging tasks in a company’s operations.

-Nandan Talgeri, Distribution Manager and Sunil S Chiplunkar, Senior Product and Training Manager,(now, Sunil is Manager - Marketing and Training) both from JUGGAT PHARMA, BANGALORE

Era of Relationship Marketing

There was a time in pharma marketing in India when quality alone was an important factor. If a company offered quality products it was sure to gain an adequate share in the prescription market. However, the honeymoon with quality did not last long. Quality soon became a qualifier in the rat race to gain market share.

Next was the era of brand equity (brand image) and corporate image. One could influence prescription habits based on brand and corporate image.

Today, brand equity and product quality have become qualifiers in the race for prescription and mind share. Welcome, today, to the ERA OF RELATIONSHIP MARKETING. Relationship marketing has always been the foundation of pharma marketing. However, the accent on relationship marketing has increased thanks to fierce competitive marketing practices in the field of pharma marketing.

CUSTOMER BONDS

The fulcrum of relationship marketing is building customer bonds. The focus in relationship marketing is building a bond between the target doctor/chemist and pharma company. The emphasis in relationship marketing goes beyond promotion of products and services. It includes product promotion, value added services and customer bond building.

Relationship marketing is a communication process. There is a dialog between the customer and the company. Relationship marketing is also about discovering customer needs and servicing them. Indian pharma companies have traditionally excelled in relationship marketing. However, innovator Indian pharma companies like DRL today excel both on the product front and relationship marketing. In fact, the magazine HOUSECALLS from DRL and its S - team have set new standards in pharma relationship marketing. “Housecalls” is a magazine that connects prescriber community and the company. DRL’s S – team is a force of professionals who sell concepts to prospects and soften the ground for its main field force to enter the arena and promote. Himalaya too, with its CAPSULE and other magazines has leveraged highly on relationship marketing. So the key in relationship marketing is two-way communication.

RELATIONSHIP MARKETING WORKS

Pharma markets in India are cruelly competitive. Building differentiation in products and services is becoming difficult. Competitive practices are similar. Pharma companies look and sound the same to the doctor(s). There is in fact, promotional clutter. This is where relationship marketing works in the pharmaceutical field.

Relationship marketing treats doctors not as “prescription generators”. Relationship marketing is emotional – builds feelings of trust, goodwill and mutual respect. Relationship marketing is effective because it is based on the fact that 70% of purchase (prescribing) decisions are made emotionally.

HOW TO MAKE RELATIONSHIP MARKETING WORK?

Relationship marketing will work if two vital questions are asked:

Who are the right target doctors/chemists for the business?
Why do these target doctors/chemists want a relationship with our pharma companies?

After answering the above questions, the next step is chalking out the doctor/chemist list.

Now to these target doctors/chemists a taut communication plan is crucial. The communication should be attractive. And persistent. Regular calls are a key to pharma success and along with it goes TRUST. Trust develops when the pharma marketer has the doctors/chemists best interests at heart for mutual benefits.

Relationship pharma marketing is essential in today’s pharma marketing process. The bottomline: people do business with people.

SUMMARY
1) Relationship marketing is a communication process. It is building bonds with doctors/chemists based on trust, goodwill, mutual benefit and regular two-way communication.
2) Emotion (especially TRUST) is a vital influencer of prescribing habits and purchase decisions.
3) Right target doctors/chemists (based on product features) are vital for relationship marketing.
4) The basic age old fact is: PEOPLE DO BUSINESS WITH PEOPLE.

Author: Sunil S Chiplunkar M Pharma PGDMM
MANAGER - MARKETING & TRAINING
Juggat Pharma, Bangalore