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!!