Evidence based marketing

I got the above image from here.

Today the world-over including in urban and rural India, it is well established that there is a nexus between pharma companies and doctors; between doctors and neighourhood pharmacy(ies), and doctors and diagnostic labs. There is a kickback culture at all these link points. Today, it is not whether a doctor takes a cut from such entities or not - it is about how much the doctor takes! Many doctors reason that there is nothing wrong about these commercial understandings as long as patients are not exploited. And doctors do argue: why should we prescribe pharma brands 'for free' - after all, pharma companies are making profits from the sales. Pharma companies are not charitable organizations - goes their argument. Well, each viewpoint has its merits. One cannot cast a Nelson's eye or turn a deaf ear to the logic in each viewpoint.

So where is the truth for pharma marketers?

In the face of such a market picture, pharma marketers are forced to invest in commercial inputs for doctors and chemist-retailers (both clinical and personal) to ensure sales continue. However, the fears are that in a very commercial environment patient interests inevitably get sacrificed, medical profession loses its noble status. The need for a code for promotion has hence been highlighted in the editorial of Chronicle Pharmabiz issue dated17.12.2009. Another hilarious report in Times of India has also lampooned doctor behavior at the national cardiological conference held at Kochi. In such a complex picture of the medical and pharmaceutical profession where is the marketing truth for pharma marketers?

Pragmatic pharma marketers cannot adopt a holier than thou attitude and lose sales due to lack of commercial activity. Yet, the whole truth is that doctors will not prescribe medicines or brands only due to commercial activity. There is a certain truth in pharma marketing from which pharma marketers should never deviate.

Consider a doctor in need of a medication...

Imagine a doctor wants an anticold tablet or an antibiotic for his personal use or for his children! In such a context, which brand will the doctor opt for?! In all probabilties, the doctor will go in for a 'standard' brand. A pharma brand that he trusts - a brand that the doctor finds reliable. A brand from a company the doctor has a good image of, IRRESPECTIVE OF ANY COMMERCIAL ACTIVITY. In fact, in all probabilities, the doctor will choose the brand despite the fact that the company has not done any commercial activity for him. The doctor will not compromise when it comes for self-use or for use by his children.

How did the brand become the doctor's choice brand?

The answer to above question lies in the core truth of pharma marketing ... evidence based marketing. Evidence based medicine (EBM) is the most important method of medical decision making today. EBM is a big science. Pharma marketing that rides on the principles of EBM will strike a chord with doctors. There is a great chance of becoming the doctor's choice brand when pharma marketing does not sacrifice evidence based marketing on the altar of commercial activity. Today, it is unfortunate that many an Indian company believes only in commercial marketing activity. And this is an Achilles heel of marketing attitude. Mere commercial activity will not yield desired marketing outcomes.

EBM (Evidence Based Medicine)

EBM is a paradigm in healthcare. It involves using current evidence in medical literature to provide the best possible care to patients. In the EBM based attitude of the physician, there is a conscentious, explicit, and judicious use of the best evidence in making decisions about the care of individual patients. So the brand of pharma marketing that helps provide the best inputs for practice of EBM will obviously be a fast favorite of physicians. The logic is simple. Better the patient care from a doctor, better will be his practice. Better his practice, better his bargaining power with pharma companies, diagnostic labs and neighbourhood medical shops. So EBM based pharma marketing will help develop strong pharma brands. The impact of evidence based pharma marketing will be better than short-cut commercial activity (which also needs to be done moderately by pharma marketers).

Educational prescriptions

Educational prescriptions refers to prescriptions generated by physicians through the practice of EBM. To generate EBM based educational prescriptions, physicians follow a particular routine. The first standard approach is called the PICO model. PICO stands for Patient, Intervention, Comparison, and Outcome in the process of EBM.

PICO model

In PICO, p that stands for patient refers to the individual or population to whom the information is applied. The pharma marketer ought to position the marketed brand clearly for a specific patient population. For eg., paracetamol 650 mg in the management of viral fevers in adults, for optimal response.

I stands for intervention, and refers to the therapy, exposure or diagnostic test that the doctor is interested in applying to the patient. For a pharma marketer, it is important to market the linkage between product and the patient profile. For eg., positioning of atenolol 25 mg for the management of isolated systolic borderline hypertension is a good strategy.

C stands for comparison. A comparison of the planned intervention is done against the standard intervention. The comparison of planned intervention with placebo is now an outdated thinking. So pharma marketers who compare thier product with a placebo will obviously not be well rated. The marketed products should be compared against a prominent approach and the benefit reiterated for better physician acceptance. Hence, in this vein, a pharma marketer can well subtly imply in his promotional message that his brand of paracetamol 650 mg is better than using two NSAIDs as gastric irritation is lesser.

O stands for outcomes. The doctor is interested in a set of desired patient outcomes. These outcomes should not be surrogate outcomes but ought to actually decrease morbidity and mortality of the patient. In the management of post-tonsillectomy pain, no matter what, a doctor will always prefer an anti-inflammatory agent to paracetamol (which is only an analgesic and antipyretic, without anti-inflammatory property). So in the initial phase of treatment, a doctor is likely to write a NSAID that offers anti-inflammatory property in addition to analgesic and antipyretic properties. Or he will combine it with paracetamol for better patient outcomes.

Technology based EBM

An environment for the practice of EBM is fast being facilitated by new tech devices. For eg., smartphones, PDAs, laptops connected to internet, and other such gadgets are being used by doctors to search medical literature bases for working out the best approach to manage patient outcomes.

Mobile phones with internet search ability and PDAs are being used by doctors for accessing an "evidence cart" for providing best possible bedside interventions. Savvy pharma marketers are providing 'loaded PDAs' with subtle brand marketing, and helping doctors practice EBM to simultaneously gain enhanced Rx share.

DOE versus POEM

In the practice of EBM, many acronyms are used, DOE stands for Disease Oriented Evidence and POEM stands for Patient-Oriented Evidence that Matters. Another important abbreviation in EBM is CAT ie., Critically Appraised Topic.

Let us say a doctor thinks of doing a PSA (prostate specific antigen) test on a patient. While ordering for this test, there is a possibility that the intervention will/may provide DOE to the doctor. However, a positive PSA test may not influence the course of treatment, and the morbidity or mortality of the patient. In other words, this PSA test intervention may not provide good Patient-Oriented Evidence that Matters (POEM). So the doctor might as well postpone this intervention. This is an example of how doctors can take decisions based on EBM searches of medical databases.

Internet helps the process of EBM

With greater role of the internet in society, EBM is receiving a fillip. There are a number of medical sites dedicated to practice of EBM. http://www.cebm.net/ is one such. http://ebm.bmj.com/ is another popular EBM site. EBM practitioners go to this website too: http://www.mclibrary.duke.edu/subject/ebm. This link provides various EBM web links: http://www.emjournalclub.com/EBM_Links.php. The Cochrane library is considered as the "gold standard" of the EBM websites. http://emedicine.medscape.com/emergency_medicine is an interesting EBM site.

Pharma marketers and EBM

Pharma marketers should now learn to operate and become a part of the EBM environment. This means pharma marketers should look beyond the MR based product promotion. It is about becoming a part of the EBM environment on the net. For eg., creating a EBM website while subtly promoting a brand is one such approach. Getting studies done and ensuring that the results are in to the EBM environment is another approach.

Today, Bangalore is living up to its reputation as an innovation hub. Biocon is making public statements that its oral insulin is in the final lap of clinical tests. However, to taste real success, taking IN-105 oral insulin to the EBM environment will be inevitably required in this contemporary world. When doctors using the EBM approach, relate to IN-105 through PICO, and find IN-105 the best option, then the physician's acceptance of this novel drug will be better.

There were the days of experts. These expert innovator doctors would be experienced and well-qualified physicians. Pharma companies would influence them to adopt the new drug, and this would ensure that the new drug would take-off. These expert doctors would also have a following of doctors who would also adopt the new drug. In India, to an extent this is true. However, the international trend and the overall picture is towards EBM. The internet will also provide a definite fillip to EBM.

Convergence tech is the in-thing. Doctors will be able to access a lot of medical literature through convergence tech. This will help doctors provide cutting edge patient care. The modern approach to pharma marketing is to combine commercial inputs with messaging based on clinical evidence (clinical trials, clinical case studies, case series, and clinical opinions/experiences).

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Avatar

I GOT THE ABOVE IMAGE FROM HERE, WHICH FEATURES AN INTERESTING WRITE-UP TOO!

Another word of Indian origin is gaining increased circulation thanks to the phenomenal interest in the latest James Cameron movie - AVATAR (the last airbender)! The excitement is truly engaging. Prospects in target audiences are evincing interest in the latest big budget entertainment product: the movie - Avatar. The watchword in marketing entertainment products is EXCITEMENT. Making the pupils widen is vital!

It is said, old and wise Chinese retail sales persons keenly watch the pupils and the breathing pattern of their prospect-customers while displaying and explaining their wares. When they sense pupils widening with interest, and the breathing getting a trifle heavier, in their prospects, they zoom in for a sales kill!! Excitement is a guide post for sales and marketing individuals.

The investment in making Avatar is massive: Rs. 12000 crores and 15 years of hard work! What a fantastic dedication and risk-taking by James Cameron!!

The launch of movie - avatar reminds pharma marketers of...

VIAGRA!!

In today's push-the-button to communicate world, creating excitement in prospects and customers, is the end-product of marketing activities. Making the prospect-customers breathe heavily, focus their attention on the marketed product, widen their pupils, and creating excited anticipation on their faces is the sensory target (!) of marketing activities!! When Viagra was marketed, Pfizer could achieve such excitement AND WORD-OF-MOUTH among target audiences.

Body language (chiefly facial expressions) and vocalization comprises the maximum of communication process. In fact, marketing research asserts, that 55% of message transfer is body language (including facial expression, eye contact etc), 38% of communication is through vocal tones (ie., vocalization) and 7% is verbalization. However, it is ironic that marketers often, tend to focus on measuring the impact of marketing messages, in terms of verbal feedback, rather than a comprehensive nonverbal feedback.

Marketers logically should measure impact of messaging in terms of change in facial expressions (and body language), vocalization aspects of target audience, and lastly, the verbal feedback of audiences. However, most often than not we measure impact of messaging in the reverse order, although we are aware, nonverbal communication is more important than verbalization!

It is not, just, what we say - it is how we say that matters, it is, how we say and with what nonverbal cues we use that matters!!

Similarly, it is not what the customer says that matters but it is more important to understand, HOW THE CUSTOMER SAYS IT, and IT IS VITAL TO NOTE THE NONVERBAL CUES THAT THE CUSTOMER USES.

If these nonverbal parts of communication are understood by the marketer (and salesman), obviously, then, understanding prospect or customer behavior is more complete and valuable!

So mere detailing of products by MRs, and communicating product benefits through non-MR avenues of communication, to prospects and doctors, and getting feedbacks about prospect-customers' oral reaction will not give a complete picture to the marketer. The ideal feedback from the frontline personnel (and other agencies) should include feedbacks about the body language and vocalization of doctors too (in response to the marketing messages).

If this 360 degree audit of marketing and communication is attempted, then the entire process of marketing messaging and getting feedbacks becomes more complex and challenging! This is the next level of marketing and soliciting marketing feedbacks!

Marketing success and EI

Emotional intelligence (EI) is a very vital component of success. It is not just the marks that count, it is also the REMARKS that count!! EI is very vital for success moments, prospect conversion, doctor conversion, and POB (personal order booking)!

Logical thinking versus feelings! That is the summary of what is EI and intellectual ability (u can tak a test of EI here! That is sms comm for u!).

Ability to identify, understand, and manage feelings, and emotions of oneself and others AND ABILITY TO USE THEM POSITIVELY AND CONSTRUCTIVELY, is defined as EI. It matters a lot in sales and marketing. Hence, salesmanship is defined as follows:

Salesmanship = ED

E = Empathy (ability to put oneself in the other person's shoes)
D = Drive

To have the quality of empathy, one needs to have a high level of EI. In one way, salesmanship is not just logic, it is more of EI at play, since business is about: people doing business with people. In fact, Jeremy Rifkin has also said, people are not buying products and services, THEY ARE BUYING IDEAS AND IMAGES. Images is an appeal to the emotions. The buying and prescribing process is an emotional process too. Trust and anticipated joy, is the vital emotional foundation of the exchange process.

We can learn a lot of marketing and EI in marketing processes, by observing the marketing of entertainment products like movies. The main elements of movie marketing that creates the hype and excitement are of course, the icons, plot, story telling, music-audio, and visuals. These are the very elements of drama that need to be employed even in a very serious business of pharma marketing. To cut through the clutter of generics and brands, novelty is the prime force. This can come by combining elements of EI and movie marketing. Messaging should be engaging and create excitement in prospect doctors. This will help gain favor of prescribers and generate prescriptions.

The Avatar is the new global wave after the Titanic wave. Excitement is the moral of the marketing story of Avatar. Thanks for reading this blogpost, please scroll down, read all other blogposts, click on older posts wherever required, and feel free to recommend this blog to your acquaintances.

Organizational growth & message loops

I GOT THE ABOVE IMAGE FROM HERE.

Life is expansion, and death is contraction, said a seer once. Verily, if we observe, we are normally very happy with changes that represent growth. Each individual or group of individuals with common objectives (ie., organizations) all endeavor for growth. Organizations look for growth in nos. (ie., members in their organization), financial increase in organizational turnover and corporate/brand equity. When these dimensions show positive change, organizations are considered to be growing.

When we say organizational growth we normally mean:

a) increase in organizational members (employee base, manager base, etc)

b) more channel associates and retail points

c) more customers, target prospects, geographical markets, and market segments served

d) increase in products and product lines

e) expansion of the network of associates and associated organizations

f) higher marketing and financial outcomes (sales, ROI, profits, and market share)

g) better corporate/brand equity

Balance is the key to organizational growth

Growth is always multidimensional, if a company has poor market image but hefty profits, can it be called a balanced growth? If the employee base is parlous, with all employees being hard pressed for time, and the internal climate being stress-oriented, can it be called a growing organization? Mind you, if an organization is not growing, it should, logically speaking, be a dying organization. So there are either growing organizations or dying organizations.

Marketing and growing

The essence of marketing (ie., value delivery process of organizations) is to delight customers, expand customer base, retain customer set, increase throughput of customers (for eg., if a doctor is prescribing two products, make him a loyal prescriber for three products), stimulate consumption, penetrate markets deeper and make inroads in to new markets. Marketing envisages a value bundle of offerings to delight customers and achieve the above objectives.

So if marketing is effective, the organization grows - that seems to be a logical inference, vice versa, if marketing is ineffective, the organization does not grow, it starts dying (that sounds harsh, but it is true).

So the idea is to have robust marketing (ie., value delivery) processes in organizations so that the organizations grow.

How do pharma organizations grow?

Pharma organizations are product dependent yet service led organizations. Products become successful based on efficiency and effectiveness of services provided to doctors. There are two classes of pharma products: patented and me-too. The former enjoy monopoly markets for upto 20 years. The latter are in a rat-race for gaining mindshare and prescription share. Services are however very vital. In fact, the marketing game in pharma is augmented product (ie., product + service) that delivers value to target doctors.

Pharma organizations grow through:

a) research products

b) new brands of me-too products

c) innovative technologies that help create newness in the brand (for eg., Tetra Pak technology based products)

d) more MRs for increasing coverage and providing repeat calls

e) new markets (geographical and new prescribing segments)

f) divisions: during 90s, the fervor to launch divisions was at its peak, as pharma companies were fewer and market was uncluttered. Today, divisions are made only after due diligence since risks are greater

h) new strategic initiatives: the reason for listing this point separately is that certain strategic investments of monies and efforts create a transformational growth for companies. For eg., the rainbow coalition of promotion (where Revital was promoted based on OTX model - product promotion is for doctors, and patients) was a strategic investment that has led to Revital becoming the numero uno product for Ranbaxy.

What is organizational growth?

Marketers generally think in terms of the 4Ps - Product, Price, Promotion, and Placement (distribution and retailing) for organizational growth.

The HRD guys think of hiring more people and better personnel, improved work climate, better discipline, superior training, safety, and enhanced benefits (financial and non-pecuniary) as organizational growth.

The manufacturing personnel view more machines, manufacturing plants and more production as organizational growth.

The quality personnel see organizational growth as improved quality standards and more quality certifications like ISO, WHO GMP, US FDA etc.

The financial honchos constantly want surplus cash, reduced cost, higher sales and improved net worth as organizational growth.

The R & D people want better R & D facilities, state-of-the-art research equipment, research journals and information, research chemicals and constant training - they view this as organizational growth.

Hence, organizational growth means different things to different people. Personnel engaged in corporate management try to integrate all these dimensions and provide a balanced growth to the organization.

The critical key for organizational growth: MESSAGE LOOPS (in organizations)

Intra-organizational messaging or communication is a key point that is often given a low priority in organizations. However, communication is the master key for ensuring marked growth of organizations. In large organizations, communication is through well-defined channels. Hence, messages may get lost or often not tapped by people who could find the message useful. In medium and small companies, unofficial channels of message transfer dominate - so subjectivity rules!

Messages represent knowledge. In fact, communication management in organizations is a part of knowledge management. If a critical insight from a field person for eg., let us say the market feedback is that Chikungunya fevers are increasing and, assume, this aspect is not conveyed to the product management team (by the sales team) - then the product management guys will not make any literatures or other strategic inputs for strengthening product promotion in Chikungunya. The loss is ultimately suffered by the organization. Passing around actionable messages are vital. Red tape, organizational politics and inertia of people are the main reasons why messages get lost.

ILLUSTRATIONS:

Let us say, Crocin suspension is introduced in a new easy-to-pour bottle (with a narrow mouth) - when a competitor company field person flashes a message on this novelty, to his superior(s), ideally, the R & D guys should also be kept in the message loop (by the superiors). This will enable R & D to take proactive steps to improve packing and the field person can counter competition from Crocin effectively. BUT DOES THIS HAPPEN?

Another example can be of the trend of using polymer (PET bottles) packs for liquids (oral formulations, particularly for anticough formulations or tonics). These bottles can reduce freight costs, breakage, they are safe for the patients, the fact that they are light and unbreakable helps stockist salesboys send the bottles to microinteriors (this improves market penetration), and the bottles are elegant to look at/feel. When market information comes in favor of PET bottles, if the proper personnel are kept in the message loop, in all probabilities, the pharma company may switch from glass bottles to PET bottles to ensure competitive advantage.

The above examples reflect the importance of COMMUNICATION or message loops.

Looping of messages on performance of competitor products (collected from market data providers or field personnel or stockists etc) will improve decision making. When the right person(s), get the right information (or message) at the right time, decision making is better, organization growth gets a fillip.

These are simple ways of how message loops (communication loops) enable organizations to operate better. This in turn, will enable organizational growth.

Power and organizational growth

Power is the ability to influence and control events, resources and behaviours. Individuals exert power. So do groups of individuals or organizations. Power is of the following types:

Legitimate power: that comes by virtue of birth or position or rank. If a company is a leader in a market segment for eg., Himalaya in the Ayurvedic segment, Juggat Pharma in the electrolyte energy drink segment, FDC in the powder rehydration salt sachet business, GSK in the Indian pharma market, Cipla among the Indian pharma companies ... by virtue of its position or rank it has a high level of legitimate power. The structure of such organizational legitimate powers need to be analysed and activities constantly done to strengthen them. This will ensure organizational growth.

Expertise power: relates to the expertise or knowledge and skill sets of the organization. By virtue of corporate positioning, certain companies get recognition of their expertise power, egs.: Biocon as an expert biotech company, Pfizer as an expert marketer, Himalaya as an expert marketer in the Ayurvedic segment, Juggat Pharma as an expert in the electrolyte energy drink biz, Glenmark and DRL as experts in global generic biz and wannabe innovator companies, Cipla as an expert marketer and market penetration pricing leader ... For organizational growth, one needs to analyze the organizational expertise power and again bank on its expertise pillar for growth.

Connection power: is critical for success and growth in today's society. Relationships with the people who matter, matters for growth! During its heydays as the numero uno Indian pharma company, Ranbaxy was a master in connection power. Getting licences and other approvals or other inputs that help organizational growth comes through connection power. It pays to be well connected!! Always!!

Referral power: is the power to charm people. At the individual level, it comes through looks, behavior, dress sense, style, accent, and such soft powers. Organizations too excel in collective charm and style. In the Ayurvedic segment, Himalaya rides high on referral power. Cipla in its marketing inputs has a lot of referral power. Most of MNCs have a highly rated referral power in clinics that enables them to lead doctors to product patronage. Development of referral power at a collective level in organizations does cast a spell on customers and will boost organizational growth.

Reward power: is the ability of organizations to reward people associated with it, and those who are a part of the organization. Inevitably, those organizations that reward their associates, customers, prospects, members and others, handsomely (yet calculatedly) and appropriately will have clipping growth rates. Rewards can come as freebies to target doctors, gifts and schemes to chemists, gifts and incentives to performers, goodwill gifts to regulators and other business associates, recognitions/promotions to the deserving, and so on. The tact, intelligence, and ability to use reward power (to all members, associate people and associate organizations) can propel organizations to a high level of growth.

Coercive power: is the power to punish. If at all this power needs to be used, it should be only with great tact. What goes around comes back!! So it is very important to use coercive power in a discerning way. The wheel of fortune spares none!! The idea of using organizational coercive power on business associates, vendors, distributors, employees/members and others should always be on basis of fairplay, mutuality, and win-win relationships. Or else organizational growth will get hampered.

Ultimately, organizational growth depends on goodwill. This is because people do business with people. Emotions play a major role in decision making. Even cold-blooded logical decisions have a cold emotion associated with it. Goodwill makes organizations grow. It is undoubtedly true that goodwill (and not illwill) makes organizations grow. Life is growth, and death is degrowth. Life is goodwill and death is illwill.

Thanks for all your GOODWILL in reading this blogpost. Please scroll down and click on older posts wherever required to read all other posts. Kindly recommend this blog to your acquaintances. Cheers!!

MRs: Ambassadors of delight

I GOT THE ABOVE IMAGE AND A VERY GOOD WRITE-UP ON GOA FROM HERE. Mention the word Goa, and the images of joy, stress-free life and happiness surge in the mind. Goa causes dopamine surges in the brain! Dopamine is the "pleasure and learning associated neuro-chemical". Dopamine absence causes anhedonia (inability to experience pleasure). In fact, the right word to describe the Goa experience is DELIGHTFUL. (Check out my other blogpost on dopamine marketing by clicking here!)

When a patient goes to a doctor seeking relief from his trauma, agony or other symptoms, the patient is verily seeking a form of pleasure (delight). Pharmaceutical companies that work on products that provide instant relief (and delight) from clinical problems to the patient, succeed in the marketplace. Viagra is a classic example of such a pharma product that has provided a therapeutic option to doctors/patients suffering from a very personal problem - ED (impotence or erectile dysfunction). Viagra is a product that ultimately helps combat anhedonia (caused by sexual dysfunction).

Anhedonia: the new clinical frontier

Providing relief from pain and discomfort (pleasure is its opposite) is the best pharma marketing approach. When a simple paracetamol syrup is made to taste better or if an anticough preparation is safe, effective, and scores high on ORGANOLEPTIC (such as taste, smell, mouth feel, color etc) qualities, will have better acceptance by patients. Traditional pharma marketing approach is based on providing safety, efficacy, and purity of the pharma formulation. The next-gen approach is to provide safety, efficacy, purity and SUPERIOR ORGANOLEPTIC QUALITIES to help counter anhedonia comprehensively.

When a patient with osteoporosis and joint inflammation approaches an orthopaedician, he or she is looking for relief from symptoms like joint stiffness, joint pain, and joint immobility. This relief ultimately provides pleasure to the patient. The treatment plan of the doctor overcomes joint discomfort related anhedonia, and gives a new set of pleasurable experiences to the patient. Pharmaceutical companies that understand this psyche and need of the patient to be delighted, will succeed better. Pharma companies that will continue to peddle the 'BITTER PILL' will naturally lag behind.

Ayurvedic formulations and organoleptic qualities

One very interesting point is that many a traditional Ayurvedic formulation is a BITTER PILL or liquid! This point makes patient acceptance a great challenge.

The marketing concept of improving anhedonia, has in all probabilities ensured the wide acceptance of Tetra Pak based electrolyte energy drinks in the Indian pharma market. The good acceptance of electrolyte energy drinks is from both - doctors and patients.

Technology to counter anhedonia in pharma marketing

Pharma marketing gives a marketing migraine to many a doctor! The constant flow of MRs and their badgering for more and more Rx in favor of their brands puts a pressure on the doctor's mind, time and causes MR induced irritability too!! Application of technology can help counter this anhedonia of pharma marketing.

CDs: Marketing is getting empowered by electronic devices. CDs are being used to project multimedia material on the benefits of products in clinical settings.

Laptop based multimedia projection: Laptops are being used to highlight points to doctors in lieu of visual aids.

Videoconferencing based marketing events: Hotels offering videoconferencing facilities are being utilized for tele-conferences and cocktail dinners combined - to doctors.

sms and other approaches: E-mail, sms, multimedia mobile phones and other tools are being used for messaging in an engaging way to doctors.

Pharmaceutical formulations and anhedonia

Adoption of technology to formulate pharmaceutical or healthcare formulations that are a pleasure to take, will certainly boost sales. A great application of the same is use of Tetra Pak aseptic technology and juice base to make the concept of electrolyte energy drinks more exciting. When patient delight is boosted, patients are happy with the recommendation given by doctors, and the faith of patients on their doctors' increases.

There are other approaches (besides the aseptic technology) to make formulations more persuasive and encourage patient adherence to recommended regimen. The sustained release formulations help reduce dosing frequency adding to patient convenience and delight. Use of appropriate of flavours and taste enhancing excipients are very valuable. In injectables, a company in India has a technology to make aqueous based diclofenac injectable that reduces patient discomfort and pain at the site of injection.

Anhedonia, product positioning and market success

Pharmaceutical and healthcare formulations perform better in the market when they overcome patient anhedonia. When products are positioned and marketed with the anhedonia concept in mind, patient acceptance is better, resulting in better sales.

A very interesting example is that of gabapentin, its original positioning was as an antiepileptic drug. Today, gabapentin enjoys better sales as a drug for relieving neuropathic pain. If pharma marketers had focussed only on its antiepileptic property, the sales of gabapentin would have been limited. The basic concept is that product positioning approaches and statements should reflect the fact that it will finally help overcome patient anhedonia too ie., overcomes the inability to take pleasure in life's activities.

One does understand that anhedonia is a serious malady. In such serious cases, antipsychotics, anxiolytics, and antidepressants need to be given. However, anhedonia can be relieved through routine medications that help control the underlying cause. Hence, the ability of healthcare formulations to generate delight needs to find a place in the marketing communication activity. The final truth is that those doctors who improve the ability of patients to enjoy life better or improve the capacity of patients to take pleasure in life will have better practice. Emphasis on this point will help pharma marketers ensure that marketing communication is better appreciated by their target doctors.

MRs: the ambassadors of delight

When medical representatives (MRs) are viewed positively as AMBASSADORS OF DELIGHT by doctors, MRs will find better acceptance in the clinics. The ability of product managers and marketing individuals to make this happen through better inputs and strategies is a sign post of successful marketing.

Thanks for reading this blogpost, please scroll down, click on older posts wherever required to read all other posts, feel free to recommend this blog to your acquaintances.

Lord Krishna in pharma marketing

This is certainly a peculiar title for a blogpost!! I got the picture below from here.

Lord Krishna is an avatar or manifestation of the Supreme Being as per Hinduism. Lord Krishna is also considered as the Supreme Being by ISKCONites and other Vaishnava faiths. However, suffice to say, Lord Krishna whom Meerabai and other famous devotees worshipped with fervor is a popular God of Hinduism.

Swami Vivekananda, an iconic monk who rejuvenated India and the West, talking about Lord Krishna, said 'if there is any striking characteristic about him that stands out, then it is CONSTANT WORK WITH DETACHMENT'. Swami Vivekananda makes this observation when talking about Lord Krishna in a book on Karma Yoga.

Karma Yoga is a philosophy that has a lot of influence on Hindus in India. Karma Yoga means working with detachment to results. This is a powerful thought that is confusing at first glance. Karma Yoga philosophy basically means that the Karma Yogi or performer of the Karma (work) concentrates on work to such an extent that the work is done oblivious of the results. This doesn't mean that a person performs nuisance work and says that it is Karma Yoga. The choice of work (or activities) should be proper in line with proper results, however, when the work (or activity) is performed it is done with absolute focus on the activity rather than the result. This is also stated in the Bhagavad Gita (Song of the divine), which was elaborated by Lord Krishna during the Mahabharata war. The Bhagavad Gita reiterates YOUR RIGHT IS TO WORK ALONE, AND NOT TO THE FRUITS OF THY ACTION.

Swami Chinmayananda, the legendary celibate monk who established the Chinmaya mission, in one of his discourses has very beautifully elaborated on this concept, which can be summarized as follows: When a person performs his activities (professional, social, personal etc) with Karma Yoga philosophy, his focus is on performance of actions, and not on the fruits or results. Hence, the concentration is much more. The work is more creative, efficient, and effective. As a consequence, the work output is truly of very high quality. Thus, the doer of activities, inevitably produces results that are in line with the expectancies or targets and the results are wholly justified.

A lot of Karma Yoga philosophy is required in pharma product promotion!!

To succeed in pharma marketing activity during field work, a MR has to prospect for the right set of doctors, having established a line of communication and contact, the MR has to persevere incessantly before establishing concrete sales results. It is not possible to obtain good results in form of proper Rx flow sometimes even after a year of working on the doctor!! During my field managerial days, I had a very mature and dynamic MR, Mr. P S Bhat by name at Mangalore. This senior MR would visit Dr. M, a MD DM consultant, for Rx in favour of Atelol D regularly. However, results were not forthcoming even for 12 months. It so happened during those days when the best buses between Bangalore and Mangalore happened to be the HI-TECH buses, Dr. M did not get a ticket for the overnight journey. The resourceful MR, Mr. P S Bhat, helped out, as he too was travelling from Bangalore to Mangalore. The result was, from the next day, Dr. M entered Atelol D in to his computer and there was periodical flow of Rx in favor of Atelol D (atenolol 50 mg + indapamide 2.5 mg combination). If we analyze this incident, we observe the workings of the Karma Yoga philosophy here. Mr. P S Bhat, by nature a conscentious MR, had in spite of not obtaining desired results, stuck to his schedule of regular visits to Dr. M's clinic. When this MR could provide a small help to Dr. M, mind you, Dr. M accepted the MR's help because over a period of one year, they had established a bond of trust; Dr. M picked up prescribing of Mr. P S Bhat's products.

If Mr. P S Bhat has given up on this doctor after two or three visits, then Dr. M probably would not have recognized Mr. P S Bhat in the first place, and Mr. P S Bhat would not have helped out Dr. M.

The above is a small example of the workings of Karma Yoga philosophy. When applied in true spirit, Karma Yoga philosophy makes a person work with joy, application, creativity, effectiveness, and efficiency.

However, there is a caveat. Let us say, a MR has worked with Karma Yoga philosophy, and instead of the company rewarding him with encouraging and handsome increments and incentives, continues with routine rewards, realising that the MR is very sincere, dumps him with more work and higher targets, then it is incumbent on the MR to lobby his case with his superiors to get a fair deal, in the spirit of Karma Yoga. Karma Yoga is not about becoming a sucker. Karma Yoga is not about accepting circumstances with a sense of defeat, detachment, and depression. KARMA YOGA IS NOT GOING ABOUT IN LIFE IN A PURPOSELESS FASHION. Karma Yoga means, the Karma Yogi is a dynamic, creative, reasonable and energetic person. The Karma Yogi MR has to put forth his case courageously, reasonably, and with the right communciation to establish win-win relationship with his company. Karma Yogis are not sheep but lions as Swami Vivekananda would probably agree.

Life is nettlesome

Life is full of nettles and challenges. Karma Yoga philosophy is a sobering approach to life. It helps take life on, in a constructive spirit. It acts as a bulwark against anxiety and depression, the Karma Yoga approach is positive and helps manage disappointments and challenging circumstances. It needs to be understood in the right sense. Karma Yoga is not about defeatism, it is working with focus on the various approaches and activities with high involvement.

Today, pharma professional life operates in a fast and furious marketplace. Doctors are tougher nuts to crack for the MR. Give and take in relationship has a greater emphasis. Patience is required. A highly intensive NO -HOLDS BARRED result oriented activity will only bring about stress & dissapointments. One needs to work on doctors and product concepts with doggedness for a semblance of acceptable results. In fact, it will require all the Karma Yoga philosophy to produce high involvement, creativity, efficiency and effectiveness.

I am on to Kolkatta, on professional work, next week, Kolkatta and West Bengal is a land that celebrates many festivals, including Lord Krishna. ISKCON has its birth in Chaitanya Mahaprabhu's philosophy who was from Navidvipa (West Bengal). It is somewhat pertinent to recall Lord Krishna this weekend!!

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Team2play

Teams are fast becoming all important in pharma marketing and business. Teams, in fact, are emerging as the important constituents of pharma organizations. In the earlier avatar, individual MRs/employee(s) were important and their behavior determined the business results. Today (and tomorrow), the team (and not an individual MR/employee) will decide marketing outcomes. Today's world is highly interconnected and interdependent. The media and communication systems are so advanced that each MR is not an island but the part of a closely interconnected marketing ecosystem. Hence, operating in the market requires team behavior. Team success = organizational success.I got the above image from here. In the above graphic we see the five Pandava brothers with Draupadi (the common wife). The Pandava brothers operated as a tightly knit team and fought a successful epic war against their couzins (the Kauravas). This event also saw preaching of the Bhagavad Gita (Song of the Lord) on the battlefield.

The Pandava team represents an interesting composition from the point of view of teambuilding. Although it was not binding, the Pandava brothers were glued to each other through thick and thin. They were together during good times and went through adverse circumstances together. They were together despite the Pandava team of brothers being of different temperaments. Their attitudes were different: Yudhishtra, the team leader, was the eldest with legitimate power. He had his weaknesses (like the gambling instinct) - yet was the indisputed leader. Bhima was the all powerful one. Arjuna was highly talented as a warrior. Nakula and Sahadeva were the obedient youngsters. In thier team work, we observe a commitment to the chain of command. This commitment was despite temperamental differences, and different viewpoints on issues. Hence, it is evident the Pandava brothers operated as a team because they had a basic commitment to stay together.

The times are different today. Hence, team building is a great challenge.

Team2play

For team members to build a rapport, team play is vital. We can't get 5 guys and issue an edict that they are a team, and hence they need to co-operate and perform as a team. There are vital elements that create a team.

a) Team members should have individual goals intertwined with the bigger common goal.
b) Team members should communicate.
c) Team members should be very busy with individual and joint activities, events and programs so that there is no time for ego tussles.

Team members should play together to bond! When teams perform and get their well-deserved incentive holiday cum training program together, therein lies a great opportunity for rapport building. It is during such working vacations that certain traits of people get exposed. This in turn raises mutual understanding. Companies like Tetra Pak invest on team building exercises like joint rafting, raft building and short trekking expeditions of the team. Play together, pray together, and stay together!!

Teams and effective working operates on mutualism and win-win relationships

A danger in team work is I SCRATCH YOUR BACK AND YOU SCRATCH MY BACK type of relationships. Such transactions create a rift between organizational objectives and team interests. Organizations suffer due to such relationships. Systems that encourage transparency of data and independent auditing or checking systems can counter such relationships.

Earlier, a MR would be the knight in his territory. Pharma companies would depend on his attitude for success or failure. Today, communication systems forcefully create teams, team play and networks. The MR has to play with the team or get isolated. For eg., companies would get to know the stockist's (wholeseller) closing stock only at the end of the month based on the inputs provided by the MR. Today, there are top pharma companies who get this vital data at the press of the button on a daily basis (since data is updated on a daily basis over internet). Videoconferencing in companies like Pfizer has taken team building and communication to a new level. Mobile phone is used for important broadcasts, for eg., during the merger of Wyeth and Pfizer, 300 odd Pfizer sales reps listened to the MD's talk on mobile at real time (all together at once). So communication systems have rendered the MR a team player rather than a solitary reaper in the market.

Unionism

A bane of pharma marketing is unionism by MRs. Most of the time, unionism does not help either the pharma marketing organization or the careers of MRs. Effective team play with the help of advanced communication systems is a robust barrier to unionism.

Unionism takes roots for two main reasons:

a) collective bargaining power
b) security

Team work based on advanced communication systems, transparency, and data gathering, can put an end to the unionism trend. It will certainly help isolate the strongly union minded personnel.

When reward systems (for incentives and commission) are in place and given based on performance, transparency, communication, team play, and robust data gathering - influence of prejudice decreases. Facts and data get the front seat. This makes people work for rewards. And in turn the trend of unionism is bucked.

Punishments and rewards

It is human nature among the powerful to punish wrongdoings. Powerful people take delight in handing out punishments! And unfortunately, on the other hand, good works are taken for granted. Special recognitions and rewards are not put in to the system for strengthening desired behavioral outcomes. The emphasis is only on punishing unwanted behaviors. The net result is insecurity seeps in and unionism gets strengthened.

When team work and team play is on a steady note based on robust data gathering, systems, communication, and transparency - business outcomes are positive. This bucks any trend of unionism.

The answer to many a pharma marketing challenge is building teams. This is imperative in the context of modern communication and data gathering systems.

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Pray together, stay together

I GOT THE ABOVE IMAGE FROM HERE.

The above picture is that of the famous temple at Tirumalai dedicated to Lord Venkateshwara. Business people in India share their profits with this temple and invoke the Lord's blessings to improve business results.

Ask any investor, entrepreneur or business honcho, about what is on his/her mind, there will be one common answer: "WE ARE IN SEARCH OF THAT ONE BIG IDEA THAT WILL TRANSFORM BUSINESS RESULTS". All business wizards are perennially in search of that one big thing that will increase the scale of their business manifold. It may be a technology, a new market (like say entering the regulated North American market with a 180 day exclusivity for new generic marketing) or a new class of drugs (like the cephalosporin range of antibiotics) that will revolutionize buyer/prescribing behavior ... The intense search for the next big opportunity is what drives businesses.

The world is changing

The new and old media are having a synergistic effect on change in society. The world is integrated by communication technologies like never before. Thoughts are exchanged at lightning speed on the digital media, the web is empowering society and creating an information society, creative minds are finding fodder on the net to generate new insights and ideas, and the net effect is that it is a huge networked and communicative world. A world deep in messaging through the old and new media avenues.

This changing world is not only witnessing messaging like never before, the changing world is also moving capital from one part to another part of the world due to mutual appreciation of opportunities. A tragicomic example of this is how Koda the ex-CM of Jharkhand as part of the GREAT JHARKHAND ROBBERY invested in Liberian mines. Jharkhand is one the most backward states of India. Monies have moved from this state to finance purchasing of mines in Liberia!! Most Indians would have heard the word LIBERIA for the first time, thanks to Koda!! Just as Bofors has become a part of the Indian vocabulary, Liberia will also become a part of the common man's lexicon in India! All this information revolution is thanks to the modern digital media who are carrying messages at real time.

So where is the next big idea?

Now coming back to the haunting questions - WHERE IS THE NEXT BIG THING HAPPENING? WHAT IS THE NEXT BIG THING?! Is the answer to the above questions lying in rDNA technology based products, business of alternative healthcare products, OTC healthcare market in India, new patents, better intellectual property?? ... JUST WHERE IS THE NEXT BIG THING?

There was a time when science and technology was mystical. It was believed that science and technology is the preserve of high IQ people to appreciate, apply, and use SCI-TECH. Today thanks to the information highway, knowledge is available at the press of the button. The internet is becoming more robust and user friendly day-by-day. Information and insights are not hard to come by. So access to science and technology has improved.

WILL PATENT PROTECTION BRING IN THE NEXT BIG THING? Yes and no. Yes - because patented products will bring in some measure of monopoly product markets. But this is the era of patents. Many business and nonbusiness organizations are getting in to the patent game and becoming patent savvy. Having a patent protected market in the current world driven by messaging and product options is not a remedy for providing the next big thing. Patents will only be qualifiers in the game.

The next big thing will be based on the network

It is becoming a highly wired world. Digital, mobile, old media, human and every other type of network is busy criss-crossing messages.

THE NEXT BIG THING WILL BELONG TO and COME FROM THE NETWORKER AND TEAMPLAYER

When ideas, capital, information, and production systems become increasingly available, success in marketing of pharma and healthcare goods will go towards that network or team, which is best at building trust. In a world full of fickleness in terms of messaging, prescribing patterns, buying behaviours, and doubts in the minds of patients, the future belongs to teams who build trust. Companies with the best of teams - in marketing, product innovation, product manufacture, quality initiatives, and communication will win in the market place. Products or ideas or money alone will not guarantee success. There is more and more money in the pharma and healthcare market than there was in the 1970s and 1980s. There is more understanding of the pharma and healthcare market today. In fact, there is a pharma production glut. So the differentiator will come from networks and teamplay, which will make the difference in the marketplace.

Will Pfizer or any other MNC win in tomorrow's marketplace because of its products or intellectual property? Nay, tomorrow's market dominance will belong to the company with the best of teams and networking ability. Messaging, networking and teamplay will make the difference. Today, Pfizer's woes will not be solved by acquiring capacity, scale and mere financial muscle. Today, Pfizer will not rise through acquisitions, it will improve the financial picture only in the short run. New products alone will not redefine the marketing future of companies. Those who network better and build better teams will win in the marketplace. Without emphasis on teamplay and networking, only whistleblowers will gain in the market!!

Henry Ford put it very nicely:

Coming together is beginning,
Keeping together is progress,
Working together is success.

Teamwork is a complex subject. It implies coming together of people with diverse temperaments, different skill sets, from different disciplines, and attitudes who need to be integrated to create outputs in line with the set objectives. The Pfizer's whistleblower case is a classic example of bad teamwork, which has landed the company in a huge quandry. Obviously, teamwork is not easy!!

Traditionally, pharma is bad at teamwork. The traditional emphasis in pharma companies is on individuals - their behaviour and achievements. Not on teams!! This is very much different from engineering companies where it is teamplay that works.

Pharmaceutical industry, today, is losing its mystical status. Earlier, pharma companies were insulated - there was a science and technology barrier that deterred investors from coming in to the field. Today, with the media providing all information and knowledge regarding pharma products, with the reality of a contemporary integrated communication world, the available production systems, rise of the empowered patient, and general commoditization, companies can generate required business results only through teamwork and networking. Gone will be the days, where the single super MR generates all the results. In fact, it is happening today too - actually the share of contribution of teamplay and networking is high in generating the business results. This will only increase as media develop and commoditization increases.

Teamplay and networking for trust building is the next level

To chart a higher growth and raise the company to a higher level, the next big thing will not come from technology alone, or from superior products, it will require organization wide marketing approaches involving messaging, networking and teamwork for trust building. Trust is the main reason for prescribing patterns and consumption of pharma goods. For this messaging, teamwork and networking are the keys.

Teamwork is a new science

Handling business processes that are dependant on individuals who co-ordinate with each other is a different ball game from messaging, teamwork and networking. Managing teams is a great science that requires a paradigm shift in thinking and management. There are issues related to accountability, credit sharing, bonuses, and incentives that need to be looked at differently. When companies gain scale, teams count. For eg., Dr. Reddy Labs, has a S team that independently provides scientific inputs to doctors. This S team softens the ground for medical representatives to enter the market arena and win Rx from doctors. So should the MR take all the credit? This is a simple example, which demonstrates that team science is a new way of thinking.

Tomorrow's new HI TECH product launches will not depend on MR activity alone. Let us imagine, that Biocon completes its oral insulin project successfully- can it afford to launch its first-time-in-the-world oral insulin brand just through MRs?!! It will require high team play to make it successful. Teams will be required to work at the retail level, institutional level, scientific communication level, CME level, web-communication level, mobile messaging level, clinical videoconferencing level ... Pfizer and many other companies are in a muddle exactly because they are doing things in the same old way. Steven Covey has said, IF YOU KEEP DOING THINGS THE SAME WAY, YOU WILL KEEP GETTING THE SAME RESULTS!!

Pharma companies are doing the same things, while the world is achanging. New media are in. Teamworking and networking are becoming the order of the day - while all pharma companies right from Pfizer are becoming more and more individual MR (or sales representative) centric, desperate and getting blown away by whistles!! Perhaps this factor has contributed to the failure of Exubera (inhalational insulin from Pfizer).

There is a brave new world of information & knowledge sharing out there. A new way of working is required. Teamworking and networking is the need of the hour.

While teamworking and networking is a science ...

It is no doubt teamworking and networking is a science -yet there are many things beyond science in managing teams and networking operations. That is where praying helps!! It is said, the family that prays together - stays together. Praying together too is an important dimension of teambuilding! It is done in many companies.

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Marketing effectiveness

When people are happy with the marketing it shows!! But the concept of marketing effectiveness is more complex than it appears. I got the above image from here.

In the imaginary conversation given below, a pharma and business consultant helps solve the pharma marketing effectiveness crisis in a company. Enjoy the conversation (and if you like this blogpost, please scroll down to read all other posts, do click on OLDER POSTS to read all other blogposts, feel free to recommend my blog to your acquaintances, thanks). The Indian pharma industry, as per IDMA Bulletin, 30th July, 2009, p.no.15, has a turnover of Rs. 90000 crores (including exports), and is growing at 15.5%, it is estimated to cross Rs. 1 lakh crores annual turnover, in 2010. So competition is gathering steam and more investors are entering this sector. Hence, pharma marketing effectiveness will certainly engage pharma marketers.

Mr. X is a gray haired seasoned pharma marketing and business consultant, and trainer. His office located on the 11th floor not only provided a panoramic view of the city below, it was a lofty crucible for many thought provoking consultancy viewpoints. This nippy November morning, Mr. X, the consultant, was awaiting the arrival of the proprietor of a medium size pharma firm. This proprietor Mr. Y was noted to be impatient and impulsive.

At about 8.45 am Mr. Y stormed in and without much ado and pleasantries, Mr. Y sank in to the deep sofa gulped down some orange juice offered by Mr. X.

Mr. Y looked sharply at Mr. X, the consultant, and gravely announced:"It is galling, Mr. X, my pharma firm's marketing is truly ineffective. How to make it effective?".

Mr. X:"Now, that is truly a solemn organizational challenge, Mr. Y, tell me, did some doctors' say that your marketing activities or team are ineffective?"

Mr. Y (looks confused):"Actually, it is not like that ..."

Mr. X (interrupts):" OK, then it is got to be the chemists, they are unhappy with your company's marketing effectiveness!"

Mr. Y (a little exasperated):" No way, our pharma company offers bonus offers that are highly competitive. Why, some of our products are 1 + 2! That means, if the chemist buys one box he gets 2 boxes free!! Moreover, with every new product launch we pay their trade association PIS (product information services) fees!! So they better not complain about our marketing effectiveness ..."

Mr. X (the shrewd consultant interrupts once again):"OK, I get it, then it is the marketing blokes who find their marketing inputs and programs ineffective, they are looking for salvation and are bothering you ... right?!"

Mr. Y (almost on top of his voice):"No, Mr. X, it is me!! Yes, it is me!!! I find our pharma company marketing ineffective!!"

Mr. X (pauses, and looks at Mr. Y in the eye):"Quick, don't hesitate, tell me fast, with out thinking too much, quickly reply - What is effective marketing according to you? Don't tell me what is ineffective marketing, I emphasize please tell me, what is 'effective marketing'?"

Mr. Y (hesitates and searches for words, a little taken aback with the sudden twist in the conversation):"It ... well, effective marketing should not be frustrating and demanding ... I mean it should not be a drain of marketing monies ... c'mon there is a limit to the amount of services to doctors and other marketing expenses right?!"

Mr. X:"Let us put it this way, Mr. Y, pharma marketing should be very profitable with a very satisfactory ROI (return - on - investment), the marketing operations should also ensure good sales, growth and availability ie., should be available at most chemist points even in remote areas, Right?!"

"So if you say go to an interior market like say, Mallapur in North Kanara, you want your product available and should be consumed."

Mr. Y:"Yep! You read my mind right..."

Mr. X (adds very fast):"You also want positive feed backs from doctors and chemists. Perchance you meet them in the market or in your social circles, they should appreciate your company products and marketing activities, programs and marketing events, right?!"

Mr. Y (almost delirious with joy):"Yep!! That is marketing! Marketing should give the company a high! It should make me happy!!"

Mr. X:"So you see the point, Mr. Y, pharma marketing effectiveness is a complex subject. It means different things to different constituencies or people."

The gist of the conversation that followed between Mr. X the seasoned consultant and Mr. Y the client is given below:

When pharma marketing operations are dismissed as ineffective, the judgment has only scratched the surface. It is very difficult to diagnose, define and precisely evaluate pharma marketing effectiveness. The marketing functioning is a result of strategic (direction of application of efforts and resources) choices. These choices are at the root of all effectiveness or ineffectiveness.

For instance, it was a strategic choice by Pfizer managers to take up off-label product promotion to doctors and provide "kickbacks" to doctors. After whistleblowers brought this to the attention of lawmakers in USA, Pfizer had to cough up 2.3 billion USD as criminal fine. So the alleged 'ineffectiveness' of the marketing controllers in Pfizer in restraining the whistleblowers is not really operational ineffectiveness, it is a fault of a strategic choice in permitting off-label product promotion and kickbacks to doctors. So, should observers conclude that Pfizer is an ineffective marketer? You see, there is a lot of complexity in assessing pharma marketing effectiveness.

When rofecoxib (Vioxx from Merck) was launched there was great excitement as it was powerfully Cox 2 selective. Apparently, it was safer than diclofenac in terms of gastrointestinal side effects, and more powerful as a pain reliever. However, the cardiovascular adverse events of rofecoxib cast a dark shadow on the market performance of rofecoxib, and it was withdrawn from the market. In turn, this boosted the fortunes of diclofenac - today, Voveran (diclofenac from Novartis) is one of the top three pharma products in the Indian retail pharma market. So should we conclude that the effectiveness of Voveran marketing is very high? Or should we conclude that Vioxx is a classic case of marketing ineffectiveness?

Marketing effectiveness is not just about business results ie., sales, market share and profits. For instance, today, Pfizer is a great marketer in India - it's anticough Corex (which is highly abused by Corex addicts) is the numero uno pharma product in retail Indian pharma market. Internationally, Pfizer is the no. 1 drug maker - its worldwide annual R & D budget in dollar terms is said to be more than the total Indian retail pharma market (ie., more than Rs. 38000 crores) - yet it is a company that has paid 2.3 billion USD as total criminal fine to the Govt. of USA for fraudulent marketing. Novartis on the other hand, in India, has Voveran (diclofenac), which is invariably the no. 2 or no. 3 pharma brand in the Indian retail pharma market. Besides a valid, principle based legal battle on the marketing of Glivec, Novartis has a very clean and professional image in pharma India. It is not the #1 pharma company, yet it is a highly respected and valued pharma company. So whom will you assess as a more effective pharma marketer?, asked Mr. X, the consultant, to Mr. Y, the client. Obviously, Novartis can be rated as a more effective pharma marketer as Novartis has an excellent corporate and brand equity among pharma MNCs in India. So the point is that marketing effectiveness is not a simple assessment in terms of sales, market share and profits. There is much more to marketing effectiveness.

Marketing effectiveness is linked to values, culture, philosophy, processes and outcomes. Marketing effectiveness is linked to three types of variables: causal, intervening and end result.

The causal (cause and effect) variables that influence marketing effectiveness are -

a) Organizational structure - no. of employees, the reporting patterns, the employment assessment systems, training systems, and culture. Pfizer, has highly acclaimed training processes and this has strengthened its messaging activities to doctors.

b) Technology also redefines marketing effectiveness - For eg., a biotech company operating in a less crowded segment, has a marketing edge that adds to the marketing effectiveness.

Another example would be of a company down in South India, which has adopted and pioneered aseptic packaging technology (Tetra Pak technology) and has created a new category of products for prescribers (ie., the electrolyte energy drink category) to improve patient well-being. The Tetra Pak based technology has given a shot in the marketing arm - it has improved marketing effectiveness of this company. Technology certainly redefines marketing effectiveness.

c) Corporate vision, culture, philosophy, and leadership style and practices are all well known to influence marketing activities and hence effectiveness.

There are also intervening variables that influence marketing effectiveness:

These variables are linked to the organizational climate, and the internal state of the organization. The intervening variables of an organization refers to the morale and motivation of employees, the decision making processes, problem solving attitude, skills and competencies, and commitment to objectives. Perhaps it will not be an exaggeration to state that if the intervening variables are weak, then it gives rise to frustration in employees, massive acts of omission and commission, corruption and whistleblowing. Hence, operational working are very vital and they dramatically affect marketing effectiveness.

Lastly, there are end result (output) variables that influence marketing effectiveness:

The output variables are the outputs of the organizational marketing efforts, like perceived quality of the product, sales, profits, market share, costs, conflicts, absenteeism etc.

Thus, we observe, the three sets of variables - causal, intervening, and output all are interconnected and influence marketing outcomes and marketing effectiveness.

Mr. X (the consultant):"So, Mr. Y, in the final analysis, we ought to analyze marketing effectiveness from the point of view of the constituency (ie., the chemist's angle, or doctor's angle, or field personnel's point of view, shareholder's angle or from the viewpoint of the top management). Moreover, effectiveness of pharma marketing is an inclusive subject, it has many dimensions not just ROI (return on investment), sales, market share, or profits. Just think of Pfizer and Novartis. They are very interesting case studies, now tell me, Mr. Y, in the current scenario, which company is more 'marketing effective' Pfizer or Novartis?"

Mr. X (continues):"I think we have had a very long conversation, what I suggest is to see the angle of pharma marketing effectiveness of your company more wholistically, and then let us take our discussion forwards. In our next engagement, we will see where things can be 'tweaked' for the better to ensure that overall marketing effectiveness is better in your pharma company".

Mr. X (thoughtfully adds):"For eg., if I am not mistaken, you have a good product portfolio of chemical based pharma formulations like antibiotics and NSAIDs. However, we are aware, that rDNA technology based products, and wellness based products are the sunrise sectors in healthcare biz. Furthermore, we need to analyze disease and demographic trends, for instance, off hand I can suggest that the onco gyne segment will see more action. Gyn cancers are ever increasing - with women living for 30 to 40 years after menopause, the risk of developing gyn cancer is so much, nearly half of all women are likely to face it. As far as gyn cancers are concerned, anticancer dietary supplements can help, and this is a wellness market opportunity. May be you can have products and services to address this segment?! This in turn, will improve marketing effectiveness.

The concept of marketing effectiveness is not just about market spend on promo inputs and on the field force, there are more issues to it."

Mr. Y: "Thanks a lot for this 'breakfast food for thought' conversation. I am sure I have got some good insights and ideas for improving pharma marketing effectiveness. And here is my consultancy fees payment, hope you don't mind me writing the cheque ... "

Tom and Jerry Pharma Marketing

I GOT THE ABOVE IMAGE FROM HERE.

It is really getting hot ... here in pharma marketing. There were those golden days where pharma companies used to invent a nice drug, appoint medical representatives (MRs) who would go to clinics, the doctors would welcome their presence. In these clinics the MRs would provide a detailing talk with the help of communication aids, give literatures of the clinical data, some samples for the doctor to try out the medication on suitable patients, and this exercise would create prescriptions to ensure sales of the pharma product. As a form of thanksgiving, MRs would provide doctors with small clinically relevant gifts. They were the warm sunny days of pharma marketing.

Slowly however, things got a little more complex with time ... doctors would indirectly require more inducements for prescriptions, and MRs would provide them, to increase sales and earn more incentives.

With time, more companies entered in to the lucrative pharma business and the rat race got more fierce. Doctors would get pampered with cash, gifts, sponsorships to medical conferences and other things and the pharma marketing game became a lot more fiercer. The warm sunny days of pharma marketing gave way to hectic stress filled days of hot oven pharma marketing.

Sales and marketing pressure became the order of the day in pharma companies. Earlier, it was a patronizing atmosphere in pharma companies and at clinics. Managers would patronize their MRs, doctors would patronize MRs and so on. Today, it is a game of pressure tactics, negotiations, inducements and just about everything to generate prescriptions, and sales.

Pfizer: in an unenviable position

The above pharma marketing picture is reflected in La-affaire-Pfizer. Just imagine the predicament of Pfizer. On one hand, there is a huge pressure to maintain the topline and bottomline. On the other hand, the new drug R & D pipeline shows no promise of a blockbuster drug and the pharma market gets commoditized with severe competitive pressures.

Now, if Pfizer does not shore up sales, it will lose its pole position in the global pharma firmament. There is, after all, a lot at stake - shareholder value, share price value, profits, sales, its position as the numero uno pharma company, its reputation, and so on.

In this backdrop, Pfizer did the most logical thing - upped its sales generating tactics. Pfizer focused on strengthening its sales of promising products (like Bextra the withdrawn valdecoxib brand,Geodon (antipsychotic - ziprasidone HCl), Zycox (linezolid) and Lyrica (pregabalin)), and Pfizer even went in to off-label promotion and special services to doctors (kickbacks), which were risky from the legal point of things.

However, Pfizer did it with courage because it still had a mindset of operating in a patronizing atmosphere. BUT LITTLE DID PFIZER REALIZE, THE RULES OF THE GAME HAD CHANGED ...

Whistleblowers took advantage

Whistleblowing is an interesting phenomenon. Whistleblowers are persons who raise concerns about wrongdoings in an organization. Normally, whistleblowers are part of the organization. Whistleblowers voice their concern internally or externally and may take their complaints to legal authorities of the wrongdoings in the organization. If whistleblowers are proved right, the organization pays for it - in terms of criminal fees and also sees its reputation fall. Whistleblowers are not only pharmaceutical personnel, the tobacco industry too has seen a famous whistleblower (Jeffery Wigand). There are governmental and nongovernmental whistleblowers (many of them Indian) too.

This is exactly what happened in La-affaire-Pfizer. Due to wrongdoings of Pfizer in its marketing activities, 6 whistleblowers were paid by Govt. of USA a total of 102 million USD. John Kopchinski got the lion's share of 51.5 milion USD. The other whistleblowers who earned millions include Stefan Kruszewski (29 million USD), Ronald Rainero (9.3 million USD), Glenn DeMott (7.4 million USD), Dana Spencer (2.7 million USD), and Blair Collins (23.54 million USD). Pfizer's marketing activities has been dubbed fraudulent marketing. Pfizer's financial damage due to this event is 2.3 billion USD to resolve the criminal and civil healthcare liability. Of course, it has also damaged Pfizer's reputation too. That is incalculable.

WHAT DOES THIS INDICATE?

Pharma marketing is entering in to a new era of a cat and mouse game. IT IS THE ERA OF TOM AND JERRY MARKETING. Pfizer's historic fine of 2.3 billion USD is a watershed event in the history of pharma marketing. It is a major wake-up call to pharma marketers. Gone are the patronizing days in pharma marketing. There is nothing funny about TOM AND JERRY MARKETING. It is in fact painful to the pharma marketer.

It would not be an exaggeration to say that we may even start having doctors acting as whistleblowers, and others who want to point out wrong doings and make a fast buck (AFTER ALL WHO IS PERFECT? IT IS EASY TO POINT OUT WRONG DOINGS AND PUNISH, BUT IT IS DIFFICULT TO TAKE RISKS TO ACHIEVE AN OBJECTIVE.).

Risks in pharma marketing

The whistleblowing event mirrors the minefields in pharma marketing. Step on a legal mine, even accidentally, and BOOM it goes on the face of the pharma marketer. It is time to put processes above targets. The race for numbers is fraught with risks. Processes in marketing should be robust and bullet proofed. Nos. can wait, there is no point in being No. 1 in the pharma market if you have to cough up billions of dollars AS FINE and get your reputation tainted. In business, reputation is paramount. Goodwill of a concern, if lost, causes incalculable damage. Today, in trader language, Pfizer is only a sophisticated PCD (propaganda cum distribution) company. In India, we have plenty of PCD companies. They cater to every whim and fancy of doctors to gain prescriptions and sales. So it is time to work out processes in pharma marketing that will bullet proof the organization from the legal mine fields.

Pfizer: the master marketer

Pfizer's corporate USP is their marketing ability. If one goes to the crux of Pfizer's controversial marketing tactics one realizes that they once again proved that they (Pfizer) are masters of marketing. All along in their controversial marketing activities, Pfizer positioned Bextra for acute pain, surgical pain, and other unapproved uses, created sales materials and messages, to promote Bextra for these uses, commissioned market research to test its sales materials, confirmed these unapproved messages and allowed the promotion of Bextra for these purposes to continue. So what this indicates is that all the kickbacks and other activities were done to strengthen MESSAGING. Exactly, this is what brings in business. Messaging. This is what Pfizer the master marketer did. It focused on messaging (kickbacks, gifts etc were used to create the platform for messaging). That is the mastery of Pfizer. Its power in the market is not from its gifts, or kickbacks - IT COMES FROM ITS POWER OF MESSAGING. Master marketers are great at messaging. Pity, the messaging tactics backfired for Pfizer in this case.

Pfizer is not really to blame

Pfizer has acted as a professional marketer. One has to realize that in pharma business, pharma marketers message to informed target customers ie., doctors. It is different from consumer marketing, where messaging is done to ignorant customers. Doctors, on the other hand are educated and informed customers. They have the ability to discern, and they are at a liberty to reject messages. Of course, Pfizer the master marketer should take some rap for overzealous marketing, but not so much.

In the case of kickbacks, once again there is no purpose in merely rapping the provider of kickbacks. In fact, the taker of the kickbacks is at greater fault. If Pfizer is guilty of providing kickbacks to doctors, then why are the concerned doctors not booked for taking the kickbacks? Why is the PHARMA MARKETER PILLORIED? The doctor is equally guilty. The doctor who takes kickbacks is no angel!!

This point needs to be addressed in an emergency mode. Doctors guilty of taking kickbacks should be brought to book. They are the ones who patronize kickbacks from pharma companies. If a Govt. official takes a bribe, the Govt. official is arrested. Not the giver of the bribe. In the same way, the doctor who gets pecuniary and other benefits from pharma companies is more guilty of a crime against his patients than the pharma company.

A case for legal off-label product promotion

This is the age of internet and consumer led conversations. The law against off-label pharma product promotion is stone age, preinternet. It is an outdated thought to disallow off-label pharma product promotion. Suitable changes in the system ought to be made to permit valid off-label pharma product promotion. Regulation is fine. But over-regulation is stifling. If fear stalks marketing activities, creativity will be suffocated. When creative business is not permitted, progress is halted. Society suffers. In this web 2.0 era where a nobody like me can comment freely through this blog on La-affaire-Pfizer, a valid off-label pharma product promotion should be permitted, in the best interests of the modern day information society.

There are many aspects to La-affaire-Pfizer. It is easy to call it Pfizergate. It is nice to watch a formidable Goliath take a beating. But this event of La-affaire-Pfizer has many more ramifications to the PHARMA MARKETER COMMUNITY. ALL PHARMA MARKETERS SHOULD JOIN HANDS COMMUNICATE, COLLABORATE, AND RAISE VALID POINTS THAT WILL IMPROVE THE ENVIRONMENT OF PHARMA MARKETING. It is not good to market pharma products with an eye on one's back. There is no fun in pharma marketing if you are policed and in a cat and mouse game. Tom and Jerry is funny to watch, but in marketing it is no fun. Tom and Jerry marketing is most painful.

If Pfizer is trying to muzzle all conversations about La-affaire-Pfizer, thinking it is negative press, well then, it is doing more harm than good. Pfizer should use this event to stir up open debates on the state of pharma marketing today. Pfizer should get on with life, join hands & unite all pharma marketers to create a more open, trusting and transparent pharma marketing field. La-affaire-Pfizer is an invitation event for pharma marketers to join hands, address common issues, and strengthen themselves. No point, sweeping issues under the carpet.

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