Marketing and Integrative Medicine

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The best part of marketing is that its intrinsic dynamic nature forces adaptability - this means you have to constantly learn. One important trend of present times, which is clearly observable, is that people are exploring new ways of establishing health. This includes looking towards alternative and ancient healthcare approaches too. This outlook is powering the process of Integrative Medicine.

What is Integrative Medicine?

Concept wise Integrative Medicine makes a lot of sense. It is a system of medicine that integrates scientific and medical advances with other established healthcare practices. It basically implies having an open mind to look at a healthcare issue from all angles.

For eg., it is well known that hypercholesterolemia is a major healthcare challenge. The raised blood cholesterol levels are clearly linked to increased incidence and severity of cardiovascular (heart and blood vessel) disease. The mainstay approach of managing hypercholesterolemia is consumption of statin drugs. The 13 billion USD blockbuster drug Lipitor (Pfizer's atorvastatin - whose patent will expire in 2010 in Canada and in 2011 in European countries) is a statin drug. However, a less publicized fact about atorvastatin (and other statins) is the drug induced nutrient depletion. Statin drugs deplete the levels of an important antioxidant and energy producing biochemical called CoQ10 (ie., coenzyme Q 10). Depletion of C0Q10 leads to heart failure. So what Integrative Medicine says is - look at the issue holistically. Use a holistic approach to safeguard and manage cardiovascular disease. In this context, Integrative Medicine talks about lifestyle modication, Mediteranean diet and such approaches.

Dr. Stephen Sinatra

This gentleman (Dr. Sinatra), the author of a newsletter HEART, HEALTH AND NUTRITION, advocates an interesting approach of combining conventional modern medical science with nutrition, and other mind body therapies. Holistic and integrative Ayurveda too talks about mind body approaches to healing. Of course the missing element in Ayurveda is that it does not combine modern medical science. This void is filled in by the concept of INTEGRATIVE MEDICINE. For example, Dr. Stephen Sinatra applies the concepts of Integrative Medicine to heart health.

Dr. Sinatra recommends an anti-inflammatory diet. This is strikingly logical. One of the important biomarkers of heart and blood vessel disease is raised levels of C reactive protein. The raised blood levels of C reactive protein is an indicator of general inflammation and infection. In liver failure cases too, blood C reactive protein levels go up. Thus, the Dr. Sinatra recommendation is to consume a lot of anti-inflammatory nutrients. This is the approach of Integrative Medicine.

The future of healthcare marketing is 'INTEGRATIVE MEDICINE MARKETING'

Today we operate in silos - there are allopathic pharma marketers. Ayurvedic pharma marketers. Homeopathic marketers. But what does the patient want? SIMPLE! He or she wants a quick, efficacious, safe AND SUSTAINABLE REMEDY to illnesses and diseases. Besides the patient wants easy access and availability of the remedy. Thus, whether it is modern medicine or not, the above patient requirements have to be met by the healthcare provider or marketer. Hence, a marketing approach that breaks down silos to provide the best therapeutic option will be the futuristic marketing model.

Another aspect of today's business environ is that there are a lot of uncertainties in the pharma industry that need to be overcome to post good business results quarter after quarter. Today, DRL (Dr. Reddy Labs) got itself lucky, thanks to generic sumatriptan sales in USA. They could post a turnover of Rs. 1818 crores (21% growth over last year same quarter) and a net profit of Rs. 244.5 crores (a whopping 120% growth over last year). With Ranbaxy and Wockhardt preoccupied with clearing their own problems, DRL got good orders for generic sumatriptan giving a huge boost to its profits. This bonanza was not anticipated, but it happened. That means quarter after quarter, a lot of uncertainty management is being done to ensure a good financial picture.

The moot question is how long can this go on? Is there an alternative strategy that will help reduce uncertainties? There are two approaches to help reduce uncertainties:

a) NONMARKET STRATEGY

This is an important approach in business management today. A classic example of nonmarket strategy is that of McDonald. This iconic organization in America was besieged by adverse media attention that its products have increased childhood obesity. To save its business, it embarked on an ad blitz that positioned its menu as child health friendly, and it added healthy dishes to its menu. However, it did a lot of other nonmarket strategic work among policy makers in the Govt., NGOs and other entities to help create a positive perception about McDonald and that has helped shore up its business image and results.

NONMARKET STRATEGY refers to the way companies manage relationships and communication with governmental bodies, regulators, nongovernmental organizations (NGOs), media and society as a whole. This aspect is crucial for strong business sustenance. If the overall climate provided by the above entities is conducive to the conduct of business by an organization then results will be favorable and uncertainties will be lesser or manageable.

The need of the hour for Indian pharma companies operating in foreign environments is NONMARKET STRATEGY. This is particularly true when WHO and other bodies under the influence of media and pharma MNCs are trying to define counterfeit pharma products in a way that will go against the business interests of 'generic generic' manufacturers of India.

As a component of NONMARKET STRATEGY, Indian pharma companies should pool resources and expertise to create an organization on the lines of NASSCOM. This body should promote with expert professionalism the Indian business point of view and interests so as to establish win win relationships with all participating entities on a continuous basis. This type of an operation based on NONMARKET STRATEGY will certainly contribute to creating reduced uncertainty in the overall pharma business environment.

The importance of NONMARKET STRATEGY by Indian global pharma companies is all the more important as legal goods are being seized by port officials (such as in Spain) as counterfeit goods under the TRIPS umbrella. NONMARKET STRATEGY is crucial in the present day times for smoothening the environment for favorable conduct of business.

NONMARKET STRATEGY is very important in the domestic milieu too. The reason is that NPPA is an important regulator of pricing of pharma goods. Their actions have immense bearing on profitability, sales value, and shareholder value of pharma companies.

From the point of view of foreign pharma companies, NONMARKET STRATEGY is all the more important because the interpretation of Indian patent laws can have a great bearing on the launch and sales value of their research products. For instance, anticancer drug Glivec (from Novartis) is forever making news in the media for losing its patent battles with marketers of reverse engineered products. Hence, NONMARKET STRATEGY needs to be looked at keenly to create a conducive climate from the point of view of foreign MNCs too.

For global Indian pharma marketers NONMARKET STRATEGY is crucial for reducing uncertainties. One interesting approach could be launching a major advt. and public relations blitz in USA about generics from India. They could collectively pool money and other resources to craft a theme based ad and PR blitz on the lines such as INDIAN GENERICS: quality first - price comfort always! What this ad and PR blitz will do among the doctors, patients, general society, and policy makers (in US govt. and NGOs) is that it will mold a favorable opinion about Indian Generics. They will see these generic products as adding value to American society and not something as coming from a slumdog country! Through an aggressive NONMARKET STRATEGY at an individual and collective level Indian pharma companies marketing globally can create a favorable perception of their products and ensure that business uncertainties are reduced.

b)INVEST IN MARKETING GOODS FOR INTEGRATIVE MEDICINE

Integrative Medicine is clearly the future of healthcare. Patients are certain to be increasingly more empowered (thanks to the internet and media) while transacting with doctors, and they will probably have adult-adult transactions rather than parent-child transactions (between doctor and patient as we often see). In this changed scenario, the demand for nutraceuticals, herbal products, generics, biogenerics and other products in foreign markets will only increase. However, the products can succeed only if they are backed by EVIDENCE BASED MARKETING. Hence, keeping a 5 or 10 year window in mind, it is important Indian pharma companies put their resources and energies to strengthen the practice of INTEGRATIVE MEDICINE. Even as we read this blog, companies like Plethico have benefited by exporting a whole load of nutraceutical and herbal products. This indicates that Integrative Medicine is the future of pharma and healthcare business and hence, we need to adapt.

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Brand recall

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What does a business survive on?

There are many questions we should constantly ask ourselves - like: What is our business? Who are our customers? What value do they expect? Where are our customers? Where are our prospects? Asking such questions helps us titrate to the very foundation of business success.

There is however, one important question we should pose to ourselves: WHAT DOES OUR BUSINESS SURVIVE ON?

The answers are numerous, depending on one's line of thinking. The answers will include: Customers. Revenue. Processes. Innovation. Discipline. Distribution. Production. Quality.

All these are correct answers. However, one answer is the cornerstone. It is BRAND RECALL. The ability of a brand to generate instant unaided brand recall is what makes businesses successful. Brand recall happens in the black box ie., the mind. Everyone from the medical representative to the top management are in a way working indirectly or directly to strengthen brand recall in the market place.

How to strengthen brand recall?

When a person wants to buy an antiseptic solution he or she will invariably think of DETTOL. This brand has immense dominance in its target market. Dettol owns a category. How did it attain this position of brand eminence?

#1 reason is sharp brand positioning - it straddles the antiseptic solution category like a titan. All its sub-brands and products are supporting this positioning. For instance, Dettol soaps and Dettol shaving cream harp on the antiseptic positioning. The brands do not communicate on some other characteristic like say fragrance or soft and smooth skin. There is Dove for a soft skin. So sharp brand positioning is an important key for brand marketing success.

In this regard it is quite hilarious to read that Starbucks (the coffee people in America) will get in to alcohol beverage business!

#2 reason is incessant communication - the pharma marketer's role is not to work out the gift and sampling plans alone. The core activity is working on messaging. The messages should strengthen the basic brand positioning. The messaging formats should be attractive. For this the messaging formats need to be creative.

In pharma marketing, particularly in India, where direct-to-consumer advertising is disallowed for drugs, the MRs are the main communication media. They are not just sample carriers or gift delivery or relationship management personnel. They are the messengers too. Their ability to articulate key talking points makes a dramatic difference in the way a product is perceived. Their approach to handling leave behind literatures in the clinic adds value to the message conveyed by the literatures. This is where training makes a key difference to the confidence and presentation standards of MRs in the clinic.

When MRs successfully manage the message transfer activity inside clinics or in other settings to doctors, BRAND RECALL is strengthened.

Xerox is a classic example of immense brand recall in the photocopying and documentation business category. Tetra Pak owns the aseptic technology domain.

While branding is an important activity, brand communication exercises that strengthen BRAND RECALL is very vital. To improve brand recall, color and logo standardization, high quality communication, and interesting communication tools are essential. Brand recall activity involves a good play of intangibles and tangible inputs.

Translating brand recall to business

While brand recall is a great softener it does not necessarily translate in to good business revenues. Customer conversion and steady prescribing behavior requires more than brand recall. While brand recall generates confidence in the prospect, converting him or her in to a prescriber or customer warrants more activities. This is where closing the sale concept comes in to play. This is the stage where samples, gifts and other negotiated inputs come in to play. However, brand recall communication exercises are crucial starting steps for better business results. If one ignores or underplays brand recall messaging and puts more emphasis on promo inputs like schemes, gifts, sponsorships and samples, the bargaining strength in negotiation goes towards the customers. This is where MNCs like Pfizer score over Indian pharmas. Their brand recall and messaging exercises are so powerful, they gain a strong toe hold during negotiations with customers for prescriptions or personal order bookings.

The moral is to play the brand recall messaging game and then get in to the sales negotiation and closing stage. This approach gives sustained results.

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Why is pharma marketing tricky?

I GOT THE ABOVE IMAGE FROM HERE. The above is the picture of a Harley bike. It is a biker's dream buy. From where does the mystique of a Harley come from? From the engine, or from certain intangibles? Obviously from certainly intangibles. I got the Rolls Royce car image from here. It is another classic example of a legendary car. From where does its brand connect come from? From its engine, interiors ... or from something that is very much intangible about it's brand image. The same is true about Rolex watches.

There are intangible and tangible characteristics in a brand's architecture that gives it the value.

Marketing - the value delivery process - is surely a profession that requires great tact. The main interesting point about marketing is that every body wants to see TANGIBLE, MEASURABLE AND PERCEIVABLE MARKETING OUTCOMES from the various inputs, campaigns and market spend. However, the process of marketing itself involves playing around with intangibles (to generate the tangible results!). This is why marketing is tricky!! In marketing there is a balancing act - between the intangibles and tangibles.

Intangibles of pharma marketing

Intangible refers to something that cannot be perceived with the senses, it cannot be touched, it is not easily measured, it cannot be defined easily ... eg. goodwill of a business.

There are a no. of intangibles and tangibles in pharma marketing. The tangible components of pharma marketing encounters are the samples, literatures, clinical data, patient feedbacks, and product promotional presentations at conferences and by the MR in the clinic. However, pharma sales does not depend on these elements alone. There are many more vital intangibles in pharma marketing that make the difference in sales.

The first intangible of pharma marketing is QUALITY. The word quality is used in its global sense here. It is not just the quality of the product, but the quality of the promotional input, gift, literature, clinical study, quality of discussions by MRs in the chamber ... these qualitative aspects make the vital difference between winning or losing in the Rx market.

The second intangible of pharma marketing is GOODWILL AND IMAGE. Both these are two sides of the same coin. When goodwill is high, so is the image and vice versa is also true.

Merck had a bad experience with rofecoxib. Still, the other products of Merck have not suffered. Despite the negative press for its brand Vioxx (rofecoxib), Merck is still going strong. This means there are many more intangibles that are shoring up Merck. The tangible truth is the failure of Vioxx. But there is tremendous goodwill and image that makes Merck a pharma leader. This is the power of intangibles in marketing.

How to strengthen intangibles?

Recently a seasoned pharma professional and I were talking about pharma marketing. He said something interesting:'Sunil, when an Indian company says something very technical and interesting, it is often not given much weightage by the doctor, but when a MNC MR like the Pfizer guy, talks something less technical and may be even less credible, it will still be better received by the doctor!'. He continued to add, when Glaxo came in to India, they did not have any great products. It was routine stuff. Many other companies had a better product range. But they went on to become a pharma biggie. One factor was that there was a mystique in the corporate brand name of Glaxo. This intangible has certainly played its role in Glaxo's success.

How true!! Many in the pharma marketing profession would have experienced this. Why does this happen? Well it is because there is something very powerful and very intangible at work here.

This powerful intangible thing starts with something as inane as the visiting card - its quality, presentation, the style of logo etc. It adds to the strength in marketing. It is also something as routine as the walk and talk of the MR, this makes the difference in the image imparted to the doctor. The quality of promo inputs makes a great image difference.

Cipla is an example of an early learner in the pharma marketing game who has understood the importance of good presentation and powerful intangibles that help in boosting tangible business results and market acceptance. For instance, their literatures are keenly worked on. There is an understanding in their marketing efforts that their promo inputs (literatures, gifts etc) will act as silent salesmen and have a powerful intangible bearing on improving sales results. This creates the image or credibility that a Cipla enjoys in the market.

Pfizer has historically given high importance to training and presentation by field personnel in the clinic, and this has given it a lead in creating powerful intangibles to favor good tangible results.

Intangible things start with very apparently ordinary things, but they have great influence.

This point has been well appreciated by just one Ayurvedic pharma marketer - Himalaya. And this has made the difference to them. It is due to the heavy investments in the intangibles of pharma marketing game like brand image, training, quality of GIFTS and literatures that has made its products, leaders in the Indian pharma market.

Those who have visualized the importance of playing well with intangibles have succeeded greatly in the marketing process.

Success is balancing intangibles and tangibles

To obtain sustainable success, it requires balancing left brain and right brain activities ie., logic, maths, keeping accounts, and on the other hand giving fillip to creativity, imagination, and innovation. Both these faculties are required for successful business results. The sales guys stand by tangibles but it is intangibles that help them make the sales. Integrating intangibles and tangibles in to a well formulated balanced business strategy is the key to market dominance, in the tricky pharma marketing field!

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Target marketing, THE YOOBOT WAY!

I GOT THE ABOVE IMAGE FROM HERE.

Target marketing pays, because you do not work with a large market spend budget. You work with imagination and creativity to get the best bang for the marketing buck. Some of the best targeted marketing campaigns come from nonprofit organizations. There are two reasons for this -

a) marketing gets a shoestring budget
b) people there work for key result areas - with a passion, with philosophy, a commitment not linked to salary, and social drive.

The British Heart Foundation (BHF) is an example of such a charity that works and funds research, education, and life saving equipment for heart patients. Their main goal is to help heart patients. The target segment of BHF is very clear. The BHF has produced many creative communication campaigns to highlight the importance of heart care.

Their latest captivating and successful campaign is the Yoobot game as part of the food4thought campaign. The interesting goal of this game is to empower kids with thoughts that encourage them to take responsibility of their health. The Yoobot game is a preventive campaign against childhood obesity that plagues modern Western societies. The target segment of this game are children of 11 to 13 years. Yoobots are digital characters created in a game by children who play this game. The children feed their Yoobots with food of their choice, watch it grow, and ultimately based on what they feed, the Yoobot acquires body weight and other characteristics. It gives an idea of how obese Yoobots are more susceptible to heart disease in a very subtle and game like manner. This gives children a first hand feel of what food does to bodies. In one year's time, more than 1 million (10 lakhs) Yoobots have been created. Surveys have revealed that it has enlightened kids on obesity and made them more responsible about eating habits.

It is interesting to note that the target age of the Yoobot game, is 11 to 13, this is the age when children start to make their independent decisions. What a wonderful approach to engage target markets with concepts that inspire, are fun, and obtain desired behaviors without appearing educative. That is target marketing at its best!!

The BHF has also produced other TV advertising campaigns that have delivered the message with sharpness and alacrity. 'DOUBT KILLS' TV campaign was about creating awareness of heart attack. In the initial phase, heart attack was portrayed as a pain that is similar to a belt tightly strapped to the chest. Later, when the desired results of the campaign were not reflected in marketing surveys, BHF started to highlight other symptoms of heart attacks like nausea and vomiting. The idea was to prevent complacency because patients may feel it is indigestion. In fact, time to death due to untreated heart attack is 2 hours. The DOUBT KILLS campaign was then very successful.

Both of the above campaigns have got a thumbs up by the jury of the Marketing Society Awards for Excellence 2009 and BHF has won a Marketing Society award for their Yoobot concept.

Target marketing involves identification of a target market and understanding this segment. The target market may be a geographic segment, demographic segment, or psychographic segment (based on lifestyle). Then based on the target market definition and its characteristics, suitable marketing communication inputs and other activities are designed for best business results.

Target marketing is applied in Indian Pharma marketing by some marketers. Many market launches and product promotional campaigns are being designed for target markets (eg. certain geographic markets, or psychographic markets or demographic markets). This is because focusing most resources to a defined target audience makes the marketing process more efficient, controllable, and helps in quick product establishment due to better follow-up with key prescribers (in case of new product launches). For eg., Cpink a haematinic brand followed up for prescriptions with key obstetric and gynecologic doctors during the launch phase, concentrating powerful resources on them, rather than go for a large geographic segment. Hence, although the market penetration of Cpink is not too high, yet the brand Cpink enjoys good brand sales. The concept of target pharma marketing seems to have a lot of relevance in contemporary times as new product launches have become costly and dicey. Mass prescription marketing is a costly process. Sun Pharma has traditionally been a target market operator. Sun Pharma concentrates on the specialist segments rather than GP segment. This is a demographic cum psychographic target marketing concept.

While one can get a high value through target marketing in pharma, the pitfall is that by depending on certain target segments, the market is narrow and is controlled by the needs, wants, demands, whims and fancies of the prescribers of the target market segment. The company hence, needs to be a good negotiator to operate in narrow target prescriber segments as prescribing doctors in such segments, can call the shots and choices are few for the pharmaceutical marketer.

So the choice of target prescriber segment marketing or mass prescriber segment marketing or OTX (over-the-counter plus prescription) marketing depends on the pharma marketer's philosophy, policies, product profile, and ability to titrate to prescriber requirements with speed.

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