Challenges and opportunities

I GOT THE ABOVE IMAGE FROM HERE.

Every year ends and a new year begins after 12 months. Different calendars have different New Year Days. That is the beauty of our world - the amazing diversity in wisdom, faiths, and thought streams. Today, under the influence of the English speaking world, the Gregorian calendar is the most popular in the world, 1st Jan is the New Year Day as per this calendar. However, for people speaking Marathi, Konkani, Telugu, and Kannada, the New Year Day is Ugadi (referred to as Gudi Padva in the state of Maharashtra). On this day, a very thoughtful thing is done - eating a mix of neem leaves and jaggery - bitter & sweet combination. It symbolizes that life is a combination of bitter and sweet events - hence be ready for the same!

Further, in most Indian business organizations, March & April months are interesting, because the financial year in India for most firms is April to March. So there are financial year closing activities in March while simultaneously budgeting and planning activities are done for the new financial year ahead. So it is also a new financial year for most Indian businesses from April 2009. Happy Ugadi and Happy New Financial Year (in slight advance) to all!

Challenges and opportunities

All people have certain peculiar characteristics that define them. As I write this blogpost, two gentlemen come to my mind - they are aged and successful - professionally, socially, and personally. If I try to size them up - it is not just their intellect, sincerity, wisdom, language, physical features, style, or any other such aspect that stands out - it is their unique ability to tackle THREATS (ie., threatening situations) AND CHALLENGES (from their environment), and CONVERT THEM TO OPPORTUNITIES that makes them interesting. I have watched them closely while they have negotiated in tough and threatening situations - ie., their vocalization, body language, ready repartee, eye contact, facial expressions, breathing patterns, presence of mind, preparations when they plan to meet people ... I have realized that there is nothing such as success or failure, it is only a matter of perception, the reality of life is the art and skill to convert challenges or threats in to opportunities to establish win-win relationships ie. mutually beneficial relationships. Each person has his style of converting challenges or threats in to beneficial situations with win-win relationships (temporary or permanent), but they have mastered it. It is great to watch these guys in action, and try & pick up some things along the way.

Regenerative science & the property of stem cells: is a mind boggling yet a simple phenomenon that we encounter often in life. The capacity of the damaged human liver to regenerate & regain original size is a part of the regenerative phenomenon. When a lizard's tail falls off, it can regrow, it is a regenerative property. Regenerative science is creating interesting possibilities, challenges, and opportunities that are firing up product portfolio activities of pharma companies. Big pharma has started investing heavily in to stem cell research & regenerative science. Stem cell science is where perhaps biotech was 10 years back. It is nascent, growing, and future commercial prospects look bright.

Stem cells refers to cells that can grow in to other special cells, tissues, and organs. They are present in both embryo and adults (in the bone marrow and umbilical cord). It is demonstrated that stem cell population increases when there is trauma or stress. Stem cells are involved in the repair and regeneration of damaged tissues. Ayurveda and Yoga says that for the health of the human body, the immune system, hormonal and nervous systems should be strong and healthy. One can concur that Ayurveda and Yoga have indirectly indicated that stem cells too are interlinked with these systems to strengthen and repair the body. Yoga - pranayama and Ayurvedic medicines are supposed to stimulate activity of natural stem cells that help heal the damaged tissues. India and Japan are collaborating on development of stem cell therapies. In stem cell therapy, specific stem cells are introduced in to damaged tissues, to help heal them.

Big Pharma companies like Pfizer are clearly focused on developing future businesses through stem cell based pharmaceutical products. While stem cell therapy based products seem complex and perplexing, products for wound repair using stem cell therapy seem to be the first place to start off, for some companies. Stem cell therapy products for faster fracture healing are also looked into. Here is a link on the market for stem cell products. Stem cell based products market is said to be upward of 872 million USD growing at 10%, and is estimated to become a 1.4 billion USD market by 2013 (mainly a US market).

In India, while the stem cell therapy center initiative has been launched by Apollo group quite some time back, another Manipal group company Stempeutics is consistently making media news for its work. They are developing a stem cell based product for vascular dysfunction that manifests as heart disease, peripheral vascular disorder etc. Bangalore based Stempeutics is indeed doing some admirable work in this field. It is stated that the estimated world-wide market for stem cell based products is 20 billion USD by 2010. This blogger is doing a great job at demystifying the field of stem cell science and putting forth knowledge of this formidable science in simple language. Great going Mr. ANGSUMAN.

Marketing stem cell products

For marketing stem cell based products particularly since this is from a new healing science, the emphasis of regulators would of course be on SAFETY AND EFFICACY. Another important point gaining traction is PHARMACOECONOMICS. When a product or therapy is marketed how does it fare in terms of cost when compared to contemporary therapies? This is a very valid point. Many a times, the focus is on doing something different, patent it, and market it to count in the dollars, with pharmacoeconomics taking the back seat, however, with the media becoming powerful, cost issues need to be justified. There is great challenging work going on in stem cell therapy development, monoclonal antibody business (where Biocon is working avidly in this field to commercialize MAB products to treat cancer, rheumatoid arthritis and such other autoimmune diseases) and other frontier areas.

Downsizing is short term thinking

When such amazing things are happening on the new product development front globally, it is, one feels, extremely shortsighted of companies to downsize (particularly during mergers) just because it will help improve the financial picture of a few quarters. One thing is inventing a new therapy, but marketing is another game. It requires a lot of training, and good marketing activities to make the conceptual product a market success. It requires seasoned marketers and experienced sales & marketing personnel to make the product succeed, so downsizing will be deleterious to the future business of marketing concept pharma products.

Please think twice PHARMA BIG PEOPLE about downsizing ... think beyond a few quarters!!

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Irritability and (de)hydration

I GOT THE ABOVE IMAGE FROM HERE.

When you visit India, for social or business purpose, people talk of a 'quaint Indian custom' - people offer the visitor at home or business premise - first, a glass of water.  This is the first act by the host.  All business negotiations or social discussions begin subsequently.  Along with water, in some homes they offer jaggery or sugar to the visitor.  Many wonder why it is so.  In fact, in the traditional business zones like Gujarat, the hosts' stick to this tradition very firmly. Ever wondered why?

India is a tropical country.  One gets thirsty very fast.  Even if the thirst sensation has not yet occured in the individual (it is a physiological fact that a person gets thirsty only when mildly dehydrated) a person should drink water frequently before he gets thirsty - this helps in homeostasis (maintenance of balance in the body).  A person who is sufficiently hydrated is calm, mentally receptive, and of course healthy.

Imagine negotiating with a person who is dehydrated

An individual who is dehydrated, is basically IRRITABLE.  It is unusual to note that although medical science has recognized irritability as an important symptom of many ailments and diseases like anxiety, depression, diabetes, Parkinsonism etc (CLICK HERE), irritability, a very important and overt symptom of dehydration, is rarely mentioned as so in medical literature.  In fact, dehydration is also an underdiagnozed condition although it can cause many health problems like: chronic constipation, headache, visual disturbance, low back pain, chronic joint pain, renal problems, dry or sticky mouth,hypotension (low blood pressure), increased heart rate - respiratory rate - and pulse rate, fatigue, loss of appetite, indigestion, hyperacidity, heartburn, loss of facial and skin glow ....  Severe dehydration causes seizures, unconsciousness, and even death. 

Now that the summer months have just started, more and more people are susceptible to dehydration, due to heat stress.  The mistake that people do is that they wait for the THIRST SENSATION before hydrating themselves.  This is particularly true of children and the elderly. This can be dangerous, because thirst means mild dehydration has already set in.  A unique thing about the thirst sensation is that after a certain point of dehydration, the thirst sensation becomes dull.  This aggravates dehydration as the person does not feel thirsty.

In particular, the elderly and children are more susceptible to dehydration.  The elderly often suffer from weak sensations and loss of appetite, hence they consume less fluids.  Children have relatively more body water content than adults; hence, they are more susceptible to hypohydration or dehydration.   Many people, when thirsty, drink caffeinated beverages (coffee or tea or cola drinks) or alcoholic drinks, however, caffeine and alcohol are dehydrating rather than being hydrating!  In fact, it would be prudent to consume electrolyte energy drinks as an alternative to water rather than consuming alcoholic or caffeinated beverages.

SO THE MORAL OF THE STORY IS THAT ENSURE EVERY ONE (INCLUDING YOURSELF) IS WELL HYDRATED WHEN CONDUCTING BUSINESS OR SOCIAL TRANSACTIONS.  This will help improve the results of the transaction.  So before yelling at the kids or peers or subordinates - check! Are you hydrated and are the other people hydrated?!  Don't offer coffee or tea or cola drinks at first, offer water or electrolyte energy drinks to ensure hydration (remember children voluntarily drink more of flavored waters). 

Irritability and win-lose relationships

Each person while transacting (socially or in businesses) wants to ultimately establish win-win relationships.  Irritability is the enemy of win-win relationships.  TO ESTABLISH WIN-WIN RELATIONSHIPS (in business & social calls), THERE IS NO ROOM FOR IRRITABILITY - and this can be done by ensuring hydration!  That is why traditional business people of India, offer water first to visitors before business talk.  Before social discussions, Indian hosts offer water to guests and then begin the social talk.  It makes sense doesn't it?!

Dehydration, doctors, and medications

Many medications cause dehydration.  These include stimulants like amphetamines.  Many drugs cause loss of appetite and consequently thirst sensation is diminished, which aggravates dehydration & hence irritability.  

GAD (generalized anxiety disorder) which means excessive worrying, is a common diagnosis in general and psychiatric practice.  Irritability is one dimension of GAD.  While treating GAD, one should consider dehydration too since it aggravates irritability.

Dehydration and irritability: two big markets

Pharma and healthcare marketers have a robust opportunity in helping hydrate healthcare consumers and patients.  This requires a lot of 'education', in the first place, since mild dehydration is not seen by doctors as a serious symptom that needs to be treated,  only serious dehydration associated with vomiting, loss of blood or diarrhea, loss of fluids due to heat stress are taken seriously by-and-large by doctors.   However, mild dehydration too needs to be taken seriously (particularly in children, the elderly, and in patients on drugs that can aggravate dehydration).

The main products for hydration are water (Rs. 1800 crores is the packaged drinking water market in India), fruit juice based products, (the branded fruit juice market is reckoned to be Rs. 1200 crores) , and other hydrating fluids (including electrolyte energy drinks - non fruit juice and fruit juice based).  The prescription based hydrating market is around Rs. 125 crores per annum.  There is significant potential to grow the market for oral hydrating fluids through the OTX route (over-the-counter + prescription).

So this summer, offer hydrating fluids to yourself and your acquaintances.  The quaint Indian custom of offering water is very meaningful - ISN'T IT?!

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The Diabetes Syndrome

I got the above image of Romeo and Juliet from here.

In this famous Shakespearean play Juliet says:

What's it in a name? that which we call a rose
By any other name would smell as sweet;

BUT ALAS, LIFE IS NOT AS SIMPLE AS JULIET THE ROMANTIC LOVER OF ROMEO THINKS. Names are everything. Relationships are forged on names and surnames, employers provide employment based on names and surnames ... many things happen because of the name. Names have a lot of power and relevance in transactions - particularly in business. For example, there are many shoppers who buy any footwear that is branded as Bata - Bata by choice! People are convinced that a Bata product is a quality product and value-for-money buy. Similarly, many patients refuse to buy alternative pharma brands even though they are cheaper (with the same generic). There are patients who want to purchase brands prescribed by the doctor - they dislike substitutions made by the chemist (or pharmacist). In diagnosis, names have a lot of value - for example between diabetes insipidus and diabetes mellitus there is a difference in clinical presentation. Names carry a lot of value, trust, and import.

Do names change?

Oh! Yes!! In social, spiritual, and business life names change, and ownership of names also change hands. After marriage, most women change surnames with pride to show their new identity to society. It is a recognition that she has won a great new life partner. In spiritual life, name change is often resorted to, showing allegiance to a new faith. In business, names are protected with fervor. Brand names are built with passion and protected zealously. The TATA group has an entire department devoted to prevention of misuse of the TATA brand name. Thums Up is the leader cola brand of India. Although it was an Indian brand it has now changed hands - it is owned by The Coca Cola Company today. Names are so powerful that when they are deeply entrenched into the mass consciousness it is difficult to kill them - for example, even though Coca Cola is trying its best to kill or phase out the brand Thums Up, it still rules the cola market in India. The power of the THUMS UP brand name is such that as per this report, even though Thums Up sells in just 30% of the Indian market, it is the largest selling cola of India. As per the report, which cites A C Nielsen figures, Thums Up has 16.4% share of the cola market in India and is the largest selling cola brand of India. So the moral is that names have a lot of value in marketing - and in fact brand name potency is a source of sustainable competitive edge.

In disease management and medical sciences, name changes do take place


The most recent and popular example of name change is the change of IGT (Impaired Glucose Tolerance) to Prediabetes. IGT is a prediabetic state. 4.1 crore Americans are said to suffer from prediabetes. If the fasting blood glucose level is between 100 mg/100 ml of plasma to 125 mg/100 ml of plasma, the condition is defined as prediabetes. Patients of prediabetes are more susceptible to heart, blood vessel, and kidney disease. These patients are just a step away from becoming diabetic.

Why the name change from IGT TO PREDIABETES?

The name IGT was changed to prediabetes for the following reasons:

a) easy to pronounce
b) MORE IMPORTANTLY the new name BRINGS OUT THE RELATIONSHIP WITH DIABETES

In one way prediabetes is the first stage of diabetes. It is possible that the definition of diabetes may be changed to include prediabetes also in the future.

What is diabetes?

All contemporary medical literatures recognize the fact that diabetes (ie., diabetes mellitus) is a SYNDROME OF METABOLIC DISORDERS characterized by hyperglycemia, and defects in insulin production and/or impaired tolerance to insulin effect (ie., peripheral tissues show 'insulin resistance'.). Diabetes implies a group of metabolic diseases.

Diabetes is a disease characterized by hyperglycemia and increased susceptibility to accelerated atherosclerosis (thickening, hardening and loss of elasticity of blood vessel walls & narrowing of blood vessel), cardiomyopathy (disease of the heart), chronic kidney disease, neuropathy (disease of the nerves), angiopathy or vasculopathy (disease of blood vessels), and retinopathy (disease of the retina in the eye). In fact, this link states clearly that diabetes is a syndrome of disordered metabolism.

A syndrome is a set of signs and symptoms that tend to occur together and reflect the presence of a particular disease.

There is a term called METABOLIC SYNDROME. It does not mean diabetes. Metabolic syndrome or Syndrome X is a disorder characterized by high blood pressure, high LDL and cholesterol levels, abdominal obesity, and IGT (or prediabetes). There is increased risk of diabetes and cardiovascular disease in patients suffering from metabolic syndrome.

The bottomline is that diabetes is a syndrome

It is evident that diabetes is a syndrome where the patient has high blood sugar levels, increased thirst, hunger, urination, weight loss, lethargy, irritability, and mental confusion.

WHAT WOULD HAPPEN IF WE CALL DIABETES MELLITUS AS DIABETES SYNDROME?

Firstly, patients, healthcare providers and PHARMA MARKETERS will emphasize that diabetes is not just about lowering blood sugar - it is much more.

It means patients will talk about lowering blood lipids, lifestyle changes to avoid accelerated atherosclerosis, taking care of feet (foot problems are common in diabetics), avoiding and treating skin infections quickly, focusing on ensuring good wound healing, taking precautions to avoid worsening of infections (like respiratory infections) since immunity is weaker in diabetics, ensuring lifestyle practices that promote health of kidneys, taking medications that provide micronutrients to nerves (like methylcobalamin), testing the eyes regularly ....

Healthcare providers including doctors will treat the signs, symptoms, and susceptibilities of a diabetic patient FROM HEAD TO TOE. Normally, when diabetics are treated, the general focus is on normal blood sugar levels - but that is only one part of the treatment game.

FOR PHARMA AND HEALTHCARE MARKETERS this is a radical change in outlook as far as marketing communication and sales activities are concerned. Also it is about offering a bouquet of medications to prescribers which take care of the HEAD TO TOE signs, symptoms, and special susceptibilities of diabetic patients. The approach to sales and marketing management of diabetes will change if the focus of the marketers is on THE DIABETIC SYNDROME. (all signs, symptoms, and special susceptibilities of diabetics from HEAD TO TOE.).

By this name changing exercise, society will stand to benefit. The stakeholders like doctors, healthcare providers, pharmacists, patients, and healthcare/pharmaceutical marketers will of course gain because of the buzz. Hence, the powers-to-be and global healthcare authorities should now focus on a NAME CHANGING EXERCISE, from diabetes to THE DIABETES SYNDROME just as IGT was changed to prediabetes (to signify the importance of the diagnosis). In fact, if a new definition of THE DIABETES SYNDROME is made, prediabetes can also be included under this umbrella term. This will help the cause of global diabetes syndrome management.

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THE KSA FACTOR

I GOT THE ABOVE IMAGE FROM HERE.

The basic purpose of business organizations is SALES AND PROFITS. When these two are not there, the identity and verily the existence of the business organization ceases. It is very evident in these times of recession! The above two are the basics of any business organization.

Needs, wants, desires, GREED, and FEAR drive the consumption of goods and services. It is human nature to continuously upgrade (his/her) requirements. A family that purchases a two bedroom flat, after a short time of satiety, starts dreaming of upgrading to a three bedroom one... and so on. When a marketer fills the information search void of a such a prospect who is seeking answers for his requirements, the marketer gets a 'sales kill'.

The above reflections are true of healthcare and pharmaceutical business too.

Where there are buyers and sellers there are people

Business is about transactions between buyers and sellers, generating profits and customer delight. People make up an organization. And where there are people, there is 'PEOPLE MANAGEMENT'. The key dimensions of people are their KNOWLEDGE, SKILLS, AND ATTITUDE. Training implies processes and activities that enhance knowledge, skills, and attitude of people to improve job efficiency & effectiveness, and business results.

For eg., when a company plans to launch a biosimilar product, there should be knowledge of this concept among the field personnel. The skill to talk about the biosimilar brand is an important trait, and the attitude is also very vital.

Let us say, there is an excellent MR, with a good grounding of knowledge, and above average detailing and negotiating skills; however, if this guy just does not move about in the target market - the issue obviously here is about attitude. All the three aspects are important for business results.

So the question here is HOW TO DEVELOP THE KSA OF A FIELD PERSON?

Here obviously, KSA refers to Knowledge, Skills, and Attitude.

Dribbling the ball

How did Pele become a living legend footballer? The answer is practice - dribbling the ball in practice sessions, simulation training, and strategic activities. The learner is at the centre of the training universe in sports. The trainees do not sit and listen to long lectures or captivating presentations, they are, for most of the time, practicing with the ball. Such practice sessions are arduous, however, they are effective in producing Peles or sales champions.

In pharmaceutical training it is more often than not trainer centred sessions. The trainer puts in a lot of effort to provide captivating presentations, in a bid to motivate the trainees AND BUILD CONFIDENCE. The trainer gives exhaustive lectures on the complexities of the product too. While these are valuable inputs, putting the emphasis on dribbling the ball too is important. It is only when the person practices with concentration that real training gets done.

Modeling

Being a role model is very vital for effective training. When a trainer demonstrates the use of a detailing aid or implementation of a strategy, a lot of learning is imparted to the trainee.

I remember a MR who reported to me when I was a first line manager. This guy was quite experienced and full of zeal. However, during my first joint field working I found a quaint habit - after every few words of detailing he would make a funny PSSST sound. Probably the doctors had got used to this so no eyebrows were raised. I understood that this was a habit to seek sympathy and time. I did not comment. During subsequent doctor calls I requested him to permit me to detail - and I did it for all the remaining calls and remaining days of joint field working.

He used to keenly observe my detailing style in the clinic. Actually, detailing with a visual aid is tricky - one has to modulate the content and extent of detailing depending on the doctor's profile and his mood.

The next month I was in for a pleasant surprise. This guy would detail in every clinic in the same style that I would and his PSSST sound was no more there! I was happy.

Whenever any new visual aid would be given, he would wait for me to use it during the field working, and during the next joint field working he would handle the detailing himself, having picked up the delicate points during my demonstration.

Today, it is good to know he is a second line manager in a good company.

The moral is that MODELING IS USEFUL FOR A TRAINER.

ULTIMATELY BUSINESS RESULTS DEPEND ON THE KSA LEVELS OF THE FIELD PERSONNEL. The KSA levels are developed through continuous training inputs - through mailers, classroom training sessions, meetings, and other formats & tools.

KSA of an organization is very important. The result of the sum of the individual KSAs of employees is greater than the additive sum. That is there is a synergistic effect. 1 + 1 > 2.

KSA is developed in line with the organizational culture and objectives through three techniques:
1) REPITITION
2) PERSUASION
3) DISSONANCE.

One has to repeat, persuade, coax, and sometimes even cause tactful dissonance so that KSA levels are in line with company requirements. This ultimately creates sales, profits, and a sustainable competitive edge in the marketplace.

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Competition for patients:Participatory Medicine

I GOT THE ABOVE ATTRACTIVE IMAGE FROM HERE.

The foundation of the pharma and healthcare industry is the PATIENT. He or she is the person who is in suffering and requires medical attention. The patient or the healthcare consumer, is the basis of the pharma and healthcare industry.

How does one become a patient?

At the root of it, an individual becomes a patient when he or she is in suffering. At the practical level, an individual becomes a patient based on SIGNS AND SYMPTOMS. Examples of signs and symptoms include pain, discomfort, fever and the not-so-overt signs and symptoms like decrease in BMD (bone mineral density), raised blood lipid level, raised creatinine levels etc. IN the case of preventive healthcare products like functional foods, nutritional supplements, and vaccines, the patient is not in suffering - yet he or she is a patient.

Blood: the lifeline of the healthcare industry

Blood - the liquid connective tissue - is described as the lifeline of the human body. And this amazing fluid is also the lifeline of the pharma and healthcare industry! Almost every disease involves measurements related to blood - eg., blood lipid levels, RA factor (rheumatoid factor) test etc. Many diseases are insidious, and can be discovered through routine tests. For eg., for many, diabetes is discovered through routine blood tests rather than through assessment of overt signs and symptoms. So the importance of blood tests and other clinical tests in apparently normal individuals is very high.

Marketing of pharmaceuticals and healthcare goods is challenging

Pharmaceutical and healthcare goods are meant for consumption by the patient. For this to happen, firstly an individual should get converted to the status of a patient, second, his healthcare provider (mainly a doctor) should recommend or administer the pharmaceutical or healthcare item. Third, in certain countries, the third party payer should agree to pay for the medication or healthcare item. Fourth, the patient should be motivated enough to consume the same (ie., there should be patient compliance). In case the medication or healthcare item is to be consumed for longer periods, it is even more challenging for the healthcare marketer to ensure patient compliance.

This is the reason why there is, today, a focus on the account management approach to marketing of pharmaceuticals and other healthcare goods. When the aspect of product consumption is considered, the physician alone is not the influencer. The payers, hospital authorities who recommend the availability of a product in the pharmacy, pharmacist (or chemist - who has the powers to push the product), and the empowered patient himself are important. Hence, it becomes imperative to manage relationships and engage in fruitful communication between all these important agents of product consumption.

This participatory environment in the practice of medicine with an empowered patient is creating a new ecosystem of healthcare: PARTICIPATORY MEDICINE.

It is a model of medicare where the role of the patient is emphasized. The patient is no more a passive recipient of medical care. The patient is an empowered entity and he or she can influence or control the course of treatment. Powerful healthcare authorities like the NIH are helping craft the environment of participatory medicine. This is because, blogs, internet, message boards and other web 2.0 tools are creating a social media for participatory medicine.

One of the change agents of society catalyzing participatory medicine is obviously the INTERNET. The cyberzone has created a new avatar of the patient: the e-patient. The e-patient is the informed patient who plays a key role in therapy. A classic example of the e-patient is the famous blogger Amy Tenderich of Diabetes Mine.

Pharma marketing some 20 years back was at its simplest: all you had to do was contact the doctor, and get a whole load of prescriptions. The physician was the sole PATRON OF PHARMA PRODUCTS. Then, the pharmacist became important as more and more me-too brands competed for the limited shelf space. And now the payers, authorities with recommendation powers (particularly in hospitals), and slowly but surely the PATIENT himself are becoming important for the consumption of pharmaceutical & healthcare goods. THE ERA OF THE EMPOWERED PATIENT IS NEARING!

Obviously the trend of participatory medicine has enormous impact on marketing and communication efforts of healthcare and pharmaceutical companies. Patient information leaflets, and other communication material to patients will also gain importance - however, they need to be designed in such a way, that the doctor is not offended. The communication should look like supportive to the physician's role as a healer.

An idea particularly for chronic care pharmaceuticals like antiasthmatics and antidiabetics is to have PATIENT EDUCATION WEBSITES hosted by the brand marketer. When the doctor recommends - say an antidiabetic medicine, he can also prescribe a visit to the website to the patient. The patient will in-turn learn about the medicine, importance of blood sugar control, dangers of diabetic complications (like gangrene, neuropathy etc) from the website. He can also register for e-mail product/disease updates on this website. He can also probably enroll for new drug clinical trials (e-recruitment), or the patient can sign in for sms reminders for taking the antidiabetic medicine on time (for eg., every 2.00 pm he can request for sms reminder for taking the dose). (Note: When the patient registers on the product website, the patient needs to mention the doctor who recommended the website to him. In turn, the website can send a thank you e-note to the doctor.).

The fact is that participatory medicine will increase. How to enlarge this trend harmoniously? This is the question: the answer - is to involve the physician community and make the doctor community a channel for empowerment of patients. For eg., doctors can be engaged for speaker sessions wherein doctors will talk to a group of patients (who take a particular brand) on diabetes and medication. Till now, we have opinion builder doctors who talk about therapy to their colleagues (speaking engagements). The next step in a participatory medicine environment is to have opinion builder doctors talk to groups of patients.

The participatory medicine environment opens up new doors for pharma and healthcare marketers. There are two options - either close the eyes and say this is a fad and not a trend. Or two understand the market fluxes and judiciously participate in the participatory medicine environment.

IN ESSENCE, IF THE PHARMA OR HEALTHCARE ITEM SHOULD EXPERIENCE CONTINUED MARKET SUCCESS, THE PATIENT POPULATION FOR THE BRAND OR PRODUCT SHOULD INCREASE CONSTANTLY. Even if the prescriber base for the pharmaceutical does not enlarge significantly, yet, if the patient population goes on increasing, the product will continue to experience good market success.

There are two ways of increasing patient population (or user base) for a product:

a) communicate with more and more prescribers or influencers and ensure they recommend the product to more and more of their patients.
b) empower the individual or patient with education and communication. Encourage word-of-mouth.

The second approach is tricky, since there are regulatory challenges, and the communication should not substitute the doctor's advice. One cannot build sales of a pharmaceutical or healthcare product without doctor support. Thus, a blend of above two approaches needs to be adopted as the trend of participatory medicine is on! Thus, it is wise to focus on both: doctor conversion and patient conversion.

So it is obvious that with the globalization of healthcare and pharmaceuticals, participatory medicine will gain traction.

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