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THE PHARMA REVIEWSMARKETING FORUM

Newsletter for the Healthcare Marketer

SEPTEMBER 2009Volume 1 Issue 1

Published by:

SALIL S. KALLIANPUR

Mumbai, India

Social Media Informal and Effective Medium

The Role Of Social Media In Spreading Health Awareness

Does the Pharmaceuticals Industry Need More Regulations?

Unholy Nexus Between Pharmaceutical Companies and Doctors Poor Consumers!

At the intersection of healthcare and life

CONTENTS

SPECIAL FEATURECan reality TV

become a source ofhealth awareness?

What pharmalobbies in India canlearn from the G-20

Summit

SPECIAL FEATURE

Big Pharmas Emerging Markets Strategy

Will Big Pharma Help Develop Emerging Markets Or Simply Milk Them?


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At the Intersection of Healthcare and Life

SALIL S. KALLIANPUR

I am just another guy caught in the quagmire of pharmaceuticalmarketing, trying to get my two cents across through my blog andthis newsletter. I haven't worked outside the pharmaceuticalindustry and outside the sales & marketing function. I sincerely hopethat there will be people from other industries and domains who willdeem it fit to share their views and rich experiences. Last but notleast, I am no John Mack, so do forgive the limitations in viewsexpressed! It is my sincere hope that this newsletter helps each of usunderstand how our work in healthcare marketing intersects withlife, in general, and helps us to become better human beings.

My Two CentsEven as the world, this month, gave way to a New Economic Order where G20 nations replaced G8 asthe new power club, the global healthcare arena continued to grapple with basic issues. A report from theEuropean Centre for Disease showed a need for more antibiotics that are effective against multi drug-resistant bacteria. World leaders committed to new funding for women's and children's health whileconceding that more is needed. Hope arose as a new vaccine showed it could cut risk of HIV and yet

Africa may not get it since health systems in the region are unequipped to deliver a vaccine successfully.The World Health Organization warned that the parasite which causes malaria is increasingly resistant toartemisinin, the best drug available, and this trend could have serious consequences. And, damage to thereputation of drug companies continued as some reputed medical journals exposed articles written bysponsored ghostwriters and companies paid out billions of dollars to settle other regulatory violations.

In a global arena where Asia will emerge as the world's predominant power player, TB, a preventable andcurable disease, still remains one of the worlds major causes of illness and death, resulting in close to 2million deaths in 2007. The majority of TB cases and deaths are concentrated in developing countries,particularly those in Asia and Africa. These unmet basic needs offer great opportunity to BigPharma to

develop sustainable solutions for two of its biggest problems a) develop new markets that can help spurgrowth and b) address the lack of trust within communities in the midst of product recalls and clinical data

controversies. Would BigPharmas strategy for Emerging Markets be to develop them or milk them dry?How will it tackle the onslaught of regulations that are likely to create entry barriers? Would its edge inglobal politics, economics and technology allow it to break away from replicating western business practicesand set up game-changing ones customized for local markets in line with GE and Ford? Thank you forsparing time to read the inaugural issue ofThe Pharma Reviews Marketing Forum Newsletter. I hope you like it!

From the Editors Desk

SALIL S. KALLIANPUR


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Big Pharmas Emerging MarketsStrategyWill Big Pharma help develop Emerging Markets orsimply milk them?

As developed economies and markets slow down, the global pharmaceutical industry,like other business sectors, is viewing the emerging world to spur global growth. Whilethis is a welcome move, the question is will these businesses look to develop the market orsimply milk them? Recently, the World Bank announced $4.3 billion in loans to India.While these were largely to recapitalize public banks, the need of the hour is s focusedplan to develop infrastructure in the country. Nobel prize winners Joseph Stiglitz andAmartya Sen highlighted the need to develop indicators such as public health and socialwellbeing, amongst others, in a recent report which considers these measures besides theGDP as indicators of prosperity. Will the industry work with the government to make thishappen? According to the Federation of Indian Chambers of Commerce and Industry(FICCI), India needs to spend around $203 billion, if the mission of achieving 'Healthfor all' is to be attained by 2012.The World Development Report 2009 finds that rural-urban gaps in wealth must be reduced quickly. Lagging areas and provinces distantfrom domestic and world markets must be sustained through territorial developmentprograms that bring jobs to the people living there. The most successful nations institutepolicies that make basic living standards more uniform across geography. Theattractiveness of India is the size of the market. Will Big Pharma view this as anopportunity to encourage community based initiatives to include the ~70% of rural

population that still has little or no access to modern healthcare?


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Significantly improving the level of health care is veryimportant in raising the standard of living among

developing countries which in business parlance are

today called Emerging Markets. Analyst reports on

the future of the pharmaceutical industry predict that

the changing dynamics of mature and emerging

markets signify a large upheaval in the way of the

pharmaceutical world. IMS Global Pharmaceuticaland Therapy Forecast shows that growth in

emerging markets is already outstripping growth in

the developed markets of North America, Europe,

and Japan. However, despite pharmas newfound

enthusiasm for emerging markets, these markets will

not transform overnight into less developed versions

of European and U.S. markets. For years, the R&D-

based pharmaceutical industry viewed todays

emerging markets as hostile territory where a

combination of low prices and nonexistent intellectualproperty protection made market entry an

unattractive prospect. Now, many Western

pharmaceutical companies are viewing emerging

markets as a future customer base because these

markets offer a greater growth potential than mature

markets.

Emerging markets will prove to be a very important

part of future corporate growth as long as companies

do not expect overnight miracles and are prepared to

adjust their strategies, product ranges, and pricing to

suit target countries.Josh Ruxin, who writes for the

Huffington Post, estimates that it will take a minimum

of a decade to build the necessary delivery

infrastructure and create the ability to pay for

sophisticated pharmaceuticals in the emerging world

before the pharmaceutical markets there begin to reach

the value and volume of the pharmaceutical markets

that currently exist in the developed world.

There in lies the great opportunity. A chance to

channelize the focus of the global industry for the good

of the people of India. If the industry wants to milk

the market, it must be ready to develop it as well.

After all, sound business sense lies in milking a cow and

not sucking it dry! And, India isa cash cow! Ruxins

experience as Country Director for the Millennium

Village Project in Kigali, Rwanda, where he currently

focuses on comprehensive approaches to fighting

poverty with emphasis on scaling up national health

programs has been that unless industry collaborates

with governments to help improve the people's health,

any attempts to help them lift themselves out of

poverty will ultimately fail. As he puts it, "public health

holds all our efforts together". Public health, however,

is not just drugs and equipment it is the effective

distribution of those drugs to those who need them and

effective use of that equipment to cure disease or keep

people healthy. For both of these, we need health care

infrastructure. We need management systems and

people with leadership skills. This is what big pharma

can provide. But, a conundrum existsif most big

pharma companies jump into emerging markets fortheir growth opportunities, will the influx of

competition and western business practices result in a

mirror image of western markets, but with a lower price

structure? .

BigPharmas Emerging Markets StrategyWill BigPharma help develop Emerging Markets or simply milk them?


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This is highly unlikely. A company no less than

General Electric has realized this. Reuters reported

today that its Chief Executive, Jeff Immelt argued in

an article published yesterday in the Harvard Business

Review, that rather than taking its high-end, high-cost

equipment and finding ways to make it less expensive

for developing-world customers, GE needs to focus

on designing lower-cost technologies that will appeal

to customers in emerging markets. Low cost, high

quality mass customization! If GE doesnt come up

with innovations in poor countries and take them

global, new competitors from the developing world

like Mindray, Suzlon, Goldwind and Haier

will, Immelt notes. Relevance to pharma? If big

pharma like Pfizer, Johnson & Johnson and

GlaxoSmithkline dont look at Indias vast swathes of

rural population as an opportunity, local Indian

generic players will. Indications are that they do!

As GE realized, innovating to create products for

emerging markets can help to find unexpected

markets elsewhere as well. In China, it developed a

$15,000 laptop-based ultrasound machine that sells

for a fraction of the $100,000-plus of the appliance-

sized units it sells to US hospitals. GE, found an

unexpected market for these machines in US

ambulance crews. With far smaller per-capita

incomes, developing countries are more than happy

with high-tech solutions that deliver decent

performance at an ultra-low cost a 50% solution at

a 15% price, Immelt wrote. Pharma has its job cut

out as this difference in bioequivalence will obviously

will not work for medicines.

A 100% solution at 30% of price sounds even better!

Today, public trust in the pharma business is lower

than at any point in living memory with community

baying for increased regulation of the "profiteering"

pharma business model. Restoring this trust will be

crucial to long-term prospects for big pharma. The

pursuit of sustainability in community-based initiatives

has a valuable role to play in rebuilding trust

Last but not least, the watchdog! With big pharma

seriouslyentering India, it will be affected by increased

regulation, even though as I wrote before, the analogy

of the global asset bubble crises showed that it was

some of the most heavily regulated financial institutions

that brought about the ruin. Nevertheless, it would be

unwise to simply reject regulation: the general public

will not understand the underlying benefit that industry

is trying to usher in. Instead, businesses should co-

operate with government to ensure that regulations are

not shaped by an angry backlash due to lack of trust,

but instead target areas where greater restraints on

action may be valuable. The crisis might have had its

genesis in the West, but the poorest, as always, will

suffer the most, for continued lack of access to basic

healthcare. In the current economic landscape, it is

imperative that companies will choose the right survival

strategies that will allow them to evolve successfully.

Charles Darwins theory that animal species evolved to

cope with changing circumstances since nature favors

the survival of the fittest, has a clear parallel with the

biotech and pharma industries now evolve or die is

the rule.


contd


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Clearly, large emerging markets like India are one

of the routes to evolution and future growth. But

it is very important to spare a thought to what

really happens to Indias 700mn population

surviving close to the poverty line? In rural areas,

close to 12% of income is spent on healthcare

and over two-thirds of the population do not

have access to critical medicines. Indeed, for an

impoverished Indian family, healthcare is the

second largest source of expenditure (first being

marriage of a female child). Hospitalized Indians,

on an average spend 58% of their total annual

earnings on healthcare. Over 40% borrow

heavily to cover expenses, and over a quarter fall

below the poverty line because of hospital

expenses [Source: India Pharmaceuticals &

Healthcare Report Q3 2009 Published byBUSINESS MONITOR INTERNATIONAL

LTD.] Disturbingly, what is received in return is

often substandard. For example, almost seven

out of 10 medicines sold in rural India are of

poor quality or are counterfeit. As they fight to

cut costs and identify areas for future growth,

companies should think carefully about whether

their strategy for emerging market is to drive

health or simply business.


contd

SPECIAL FEATURECan reality TV become asource of health awareness?

The 27-year-old British reality TVstar, Jade Goody, who was diagnosedwith cervical cancer, had saidmonths before she died that she may

allow her death to be filmed for areality show. Jade was determined tohave her story told, educate other

young women in similar situationsand do as much as she could toprevent others going through thetrauma of what she faced. SinceGoodys announcement that she hadcancer, the number of women havingcervical smears has gone up over 20percent across Britain, and thatssomething commendable.

Welcome to the era of reality TV, a

place where fiction meets reality.Besides giving the audience the thrilland excitement of live un-editedaction, reality television allows theaudience to be a part of the show.

Reality TV has arrived in India andis here to stay ! Reality shows seem tobe a huge trend on television, andanything that is popular is anopportunity to reach millions with

your messages.

Just as Jade Goody used her last daysto spread awareness on cervicalcancer, the popularity of reality TV inIndia can spread awareness ofdiseases such as polio, malaria, TB,HIV/AIDS, smoking, hypertension,diabetes, birth control and , ofcourse, swine flu.

SALIL S. KALLIANPUR


7/20




Does the PharmaceuticalsIndustry Need More Regulations?Unholy Nexus Between Pharmaceutical Companiesand Doctors Poor Consumers!

Doctors around the world are known to be pampered by the pharmaceutical industryand critics feel that in doing so, the companies influence doctors to prescribe productsthat may not be in the patient's best interests. Research conducted in India as well asother countries found that, though most of the doctors said that they were not influencedby these incentives, they thought that their colleagues were influenced by thesepromotions. It is also reported that some doctors demand expensive gifts and sponsorshipsfrom companies and those who fail to comply were refused the sales call. This issue bringsinto focus the aspect of marketing ethics in the pharmaceutical industry and medicalprofession. A voluntary code by The Organization of Pharmaceutical Producers of India(OPPI) announced intention of pharmaceutical companies to stop providing incentivesto doctors to influence their prescribing behavior. The code also urged companies todesist from making exaggerated and off-label claims of their products. Does the onus lieonly on companies or do doctors and patients also have a responsibility? Willintroducing regulations in India, that ban doctors from demanding gifts and favors

apart from monitoring expenses of pharmaceutical companies' on promotionalactivities, make doctors more honest? Will continued apathy from consumers on healthrelated issues help the cause? While the issue of corrupt companies and greedy doctors isdeplorable, is regulation the answer? Should the industry be distracted from addressing

broader issues that require to be addressed? Should the consumer suffer?


8/20



ATimes of India report (Sep 16th, 2009) says in whatseems a case of giving the fox the job of guarding the

henhouse, the Govt. of India decided to curb the

practice of bribing doctors for promoting drugs by

allowing pharmaceutical companies to self-regulate

rather than have a legislation to tackle the menace.

The onus of regulating industry practices is already onthe apex body, Organization of Pharmaceutical

Producers of India (OPPI) which routinely reins in

undesirable practices of member companies. OPPI

members account for 70% of the Indian

pharmaceutical market and the body therefore, wields

significant influence over the entire industry.

However, the argument is that of the 53 pharma

members of the OPPI, most members are subsidiaries

of MNCs. While many of these companies also have

their own stringent ethical guidelines applicableglobally regarding interactions with health

professionals, over 25% have figured in bribery cases

in the US. Hence, the fox guarding the henhouse!"

These stringent guidelines are voluntarily adopted by

these companies, often rendering them on a 'not-so-

levelled playing field' against local generic companies

that are not OPPI members. This leaves them outside

the body's sphere of influence and in a position to

freely to what they please. The fact that OPPI

member companies volunteerthis information in thepublic domain seems to be held against them in the

report.

Licensed to Heal or Kill?

I WILL FOLLOW that system of regimen which, according

to my ability and judgment, I consider for the benefit of my

patients, and abstain from whatever is deleterious and

mischievous. I will give no deadly medicine to any one if asked,

nor suggest any such counsel; The Hippocratic Oath

While the practice must not be condoned in any

manner, one must pragmatically examine whetherdoctors being bribed by pharmaceutical companies is

the central issue that impacts your life and mine. The

crux is that when a doctor prescribes medicines that

help manage or cure your ailment, the brand that [s]he

chooses to prescribe is determined by the incentive that

the company offers. This means that the doctor sells

out to the highest bidder. Apart from crude avarice

which means that the doctor and company makes a few

bucks at your and my expense, how does this really

affect you? Does the medicine kill you? No! With 24X7

media, no doctor is stupid enough to risk getting into

that sort of trouble. After all, [s]he has his/her entire

practice, credibility and reputation to protect! Does the

medicine make you better? Sure! It may lighten your

pocket a bit, or not have the effect its meant to have,

but it gets you up and about. Did this happen as a result

of a bribe offered and taken? Maybe! Then isnt the

doctor equally to blame in this case?

So this is not about your life being at risk due to

counterfeit medicines but entirely about the 'unholy

nexus' between big, bad pharmaceutical companies and

greedy doctors to push certain brands over others.

Does the Pharmaceuticals Industry Need MoreRegulations?Unholy Nexus Between Pharmaceutical Companies and Doctors

Poor Consumers!


9/20



The cold truth is that this is not a fraction as grave an

issue as being prescribed or sold fake medicines

(counterfeit drugs). The U.S. based Center for

Medicines in Public Interest predicts that counterfeit

drugsaleswill reach $75 billion globally in 2010, an

increase of more than 90 percent from 2005. The

problem of fake drugs has plagued our community

for many years. Few crimes can be more horrendous

than this one. Indirectly, this is murder in cold blood.

But, despite being a serious health hazard, there has

never been any concerted effort from stakeholders to

counter this hazard that could save millions of

innocent lives. Regulations here anyone? Nah!

Companies bribing corrupt doctors is the place to

focus on!

Health & Wealth

To view this in a different perspective, lets draw a

parallel from another event that was much more life

changing to the common man in its impact. The

global financial crisis. The timing is co-incidental and

drives the analogy. Exactly a year ago the collapse of

Lehman Brothers Holdings Inc. heralded the

underlying problems of the global financial system

and the resultant global credit crunch. This massive

upheaval led to millions of people losing their lives

savings. Worse, they also lost jobs and therefore,

opportunities to steady income and recovery of

household savings.

Why did this happen? Primarily due to the irrational

exuberance - a term that was famously used byAlan

Greenspan to describe the heightened state of

speculative fervor - of the biggest and most respected

financial institutions in the world. Revered names

such as Lehman Bros, Citigroup, Barclays, AIG and

Merrill Lynch amongst many others. These big banks,

the wisest in the world, made humongous asset-backed

investments on the basis of their credibilityand not hard

cash. When these investments (mostly in US-based

housing mortgages) lost value following the market

crash, the banks and their customers went bankrupt.

Instantly, bankers became the villains. Never mind the

fact that these same men and women had helped

millions of ordinary folks multiply their hard earned

cash during the preceding years of economic boom.

Overnight, they turned into scheming, greedy, frothing-

at-the mouth maniacs whose only aim in their lives

seemed to be to swindle hard working people of their

nest eggs! Were they guilty? Of course they were! But

does this absolve investors and the lay public of all

fault? Sounds similar?

Should We Know Better?

Why are ordinary people like you and me so gullible?

Can you be so nave as to entrust your lives savings to

some glib-talking gent who promises to double it in 6

months? The sad fact is yes we can! We can, when

we dont know better. Most of us dont. How many of

us understand personal finance and economics? Do you

know how compound interest works? Do you know

what generates more money a stock or a bond? Do

you know the difference in a company pension plan

and the Public Provident Fund (PPF) offered by the

Govt.? Those of us who understand the way this affects

our savings are still left with a lot of it. However, isnt it

ironical that people who are most knowledgeable, and

experienced, people who make money from handling


Poor Consumers! contd.


10/20



other people's money retail and institutional

investors, investment bankers and other financial

service professionals were the worst hit by the

crisis? Did they all go nuts at the same time? No. It

was pure greed!

Knowledge, Greed and Regulation

This tells us two important things. One, basic

knowledge helps protect what is dear to us by helping

us make informed decisions. Two, knowing too much

helps one see loopholes in a system and tempts one to

make an easy buck or two. The need for regulation

arises from a lack of awareness. The onus of

protecting whats dear to you lies on who else, but

you? Can government regulations help protect you?

Not if you dont know what to expect. There are

hundreds of laws that are already there to protect you.

Do they? Only if you have a good lawyer.

Most of the healthcare system is more opaque than

the financial one (healthcare policyis probably lesser

known than the financial and banking policy). This

means fewer and fewer people know more and more.

Such a phenomenon creates opportunities for the few

who know a lot to find loopholes and exploit the

system. This creates the need for regulation. Hence,

focus is better applied on creating awareness amongst

the lay man on broader issues concerning personal

health and well-being rather than planting seeds of

suspicion about services provided by good doctors. In

this case, a few rotten apples dont spoil the entire

basket! In case it sounds like I am making a case of

removing all regulations, I am not. All I am saying is

focus on the right issues that require regulation.

Companies bribing doctors to promote one brand over

another is certainly not one of those issues

.

Lack of awareness and information can be dangerous in

matters of wealth and health. Greedy bankers did it for

their fat bonuses and promotions. Investors did it

because they wanted easy money. Both were equally

guilty. The banks created risky financial products

because investors were willing to buy them. Banks

knew about the risks involved investors didnt and

didnt bother to ask or find out. When a person, who is

most likely to value wealth over health, does not

concern himself to ensure that a financial product is

unlikely to rob him of his savings, what are the chances

that he would be concerned about the medicine his

doctor prescribes? Should the banks have informed

customers of every single risk involved in their

products? Yes, they should have.

Similarly, it is the ethical duty of pharmaceutical

companies to not hide information pertaining to drugs

that they market and ensure that doctors get the best

possible information about their products. And they

do! Companies develop marketing programs that are

most likely to appeal to doctors. They also make serious

efforts to discuss the science underlying the products

through their sales, medical and marketing teams. A

more feasible way to provide scientific information to

doctors is at conferences where companies can reach

out to large groups at one time. These conferences are

of two kinds. The first type are conferences organized

by companies. These are purely promotional in nature.




11/20



Doctors know this and these conferences are in

highest demand. Of course, at t imes, companies

outdo themselves. Such as when they send physicians

on exotic vacations in exchange for listening to

lectures about their drugs for a few hours of the day,

while the rest of the day is quite literally a day at the

beach (or the golf course). OPPI members, mostly

MNCs, as also in their individual capacities, are

obliged to report this type of spending. Spending is

also segregated to account for money spent on

government officials and doctors who can influence

govt. This is all available in the public domain. The

point to be noted here is that onlyBig Pharma does it.

That part of the industry that is most accused of

bribery! The smaller companies who accuse Big

Pharma of charging high profits do nothing but

complain and pretend to be holier-than-thou. The

second type of conferences are annual meetings of the

various medical bodies. Pharmaceutical companies are

held hostage to financially support these conferences.

You may all be aware of this and may feel disgusted.

But, if these meetings are so disgusting then why do

doctors flock to these incentive meetings in droves?

Doctors choose venues, insist on families

accompanying them, select airlines on which they

accumulate mileage points, feel insulted when offered

anything but business class, expect air-conditioned

transport to be at their command around the clock. In

short, they treat such meetings as their annual

vacation. Anything but a serious forum where they

come to upgrade their knowledge, skills and networks.

You must watch the shock on their faces when they

are asked to pay for drinks and food that they order

on room service. This, despite the fact that companies

take care of all meals and refreshments. A doctor does

not spend one singlepenny out-of-pocket when he

attends these meetings. Ideally, as an independent

consultant, he must pay to upgrade his knowledge.

Whats your take on the number of doctors who would

attend a meeting arranged at Rang Sharda Hall (minus

alcohol) at Bandra in Mumbai versus a meeting atTaj

Exotica at Goa? So much for these 'intelligent

knowledge-based professionals How do doctors get

away with not knowing much and not bothering to get

better? Because, as lay people, we don't care! The moot

question is, how many of us are sure that the doctors

who we entrust with our families lives even know what

they are doing. How many of our doctors (at least in

India) have last appeared for an examination to test

their knowledge and skills? Regulations here anyone?

Lets make sure that doctors need to keep abreast of

latest medical developments so that you and I receive

the best possible treatment? Nah! But of course, the

companies are the villains here, arent they? Lets

regulate them!

The Broader Issue

The issue about companies bribing doctors to promote

their medicines is not about the usage of wrong drugs

that can cause you harm. It is about doctors selling out

to the highest bidder. Impact on you and me? We end

up buying brands that may not be the best, buying

medicines that we may not really need (e.g., vitamin

supplements, cholesterol reducers etc.) and help the

doctor [and the company] make his cut. How many of

us protest? How many of us bother to ask the doctor




12/20


13/20



non-governmental bodies and citizen groups to create

health programs that positively impact community at

large.

The TOI report further says that the huge profit

margins on drugs allow companies to effectively bribe

doctors. Small-scale manufacturers of drugs have

maintained that the prices of drugs can easily be

brought down by 50%. Can big pharma do that? The

question is, why should it? The world around us is

undergoing transformational change. This change has

the potential to impact people everywhere. Isnt it sad

that after 62 years of Independence, more than 70%

of Indias population has little or no access to modern

medicine? TheWorld Development Report 2009

focuses on the role that geography plays on economic

development. What this means is that the

governments role is to focus on economic

development alone. To try to spread it out is to

discourage it--to fight prosperity, not poverty. Does

this mean that all economic activity will converge in

cities only and people in villages will continue to die

for lack of basic healthcare services? Of course not!

Development can still be inclusive. For growth to be

rapid and shared, governments must promote

economic integration through avenues such as Public

Private Partnerships (PPP). These are areas where the

cash rich industry has a focused role to play.

Many patient assistance programs run by OPPI

member companies focus on bringing in change

through all or some of these initiatives.

a) Micro-financing projects to create wealth

(jobs/income)

b) Percolate awareness on basic healthcare. In his article

Health Insurance for the Poor: Myths and Realities,

Economic and Political Weekly November 4, 2006,

David M. Dror showed that rural India has a solvent

population and the poor prioritize access to some

healthcare. Hence while access to healthcare is not a big

issue, awareness of facilities available is.

c) Utilizing technology to spread services to masses

penetrative technology such as mobile applications and

tele-conferencing.

The pharmaceutical industry can drive initiatives with

government to ensure that the infrastructure set up

through National Rural Health Mission is utilized in the

best possible way by creating

1. Awareness people know about the facilities

available

2. Access people can afford those services

3. Availability people get the services when they need

them most

4. Applicability people know how to reach the

facilities/services and are not confused about which to

use when

Industry Needs Focus Not Distractions

Healthcare regulations are justified as safety

precautions. But, whatever their purpose, almost all

regulations are best shaped over time by the institutions

that dominate the health-care landscape. This allowsthe industry to often look to deliver best value to

customers and make maximum profit while doing so. It

is in consumers best interests that they be allowed to

continue. The industry needs focus and can do without

distractions.


Poor Consumers!

SALIL S. KALLIANPUR

contd.


14/20




Social Media Informal andEffective MediumThe Role of Social Media in Spreading HealthAwareness

The more people know about key health issues, the better their chances of early diagnosisand appropriate medical treatment. Unfortunately, health awareness is one of the leastfocused areas by both government and industry. The key objective of creating awarenessis to improve public understanding of health issues in order to increase the odds of earlydiagnosis, better treatment and therapy compliance. How can pharmaceuticalcompanies map and interpret relationships between stakeholders in the health-caremarket? Knowing local networks and understanding different types of influencers in a

network will be of limited value if the Marketing and Sales operations continue workingin the traditional way i.e., merely considering prescribing physicians as the soleinfluencers in healthcare decision making. Knowing more about the network requiresacting and communicating with the network stakeholders in a more tailored way.Using popular social media routes offers opportunities to create avenues to promotehealth awareness and also build the much needed trust between citizen communitiesand companies. Social media is not only being used to connect with people and find newfriends and to develop connections but can also be used to help spread awareness andpromote various social, health and other important issues. 10 years ago, one rarely knewwhere to get information on health except from doctors . Doctors hardly have the time orthe inclination to provide information. So how can social media be used to promotehealth awareness? And how is it already being used? The healthcare space is a goodexample of George Akerlofs market for lemons. Transparency through interactivity ismuch needed if healthcare service providers have to move from outlays to outcomes.


15/20




The year 2009 has been declared the International Yearof Astronomy, a global awareness campaign to

help the citizens of the world rediscover their place

in the universe. Interestingly, of the many issues

that torment the human mind, like the refusal to

accept the inevitability of death, is the question if

life, like us on Earth, exists anywhere else in this

colossal cosmos wrote Sitaram Yechuryin aHindustan Times column published today. Human

inquisitiveness urges such a search on cosmic issues

related to health and mortality, yet no one thinks it

fit to understand how his/her healthis affected by

what [s]he does today in the materialistic [or should

I say, real] world. Can someone tell me if there was

an International Year of Health Awareness? This is

uniquely linked to an otherwise unrelated piece [in

the same newspaper] by MITs Dr.Abhijit Banerjee.

Dr. Banerjee commenting on why the healthcaresystems of both the United States and India are

flawed, notes that in India, anyone can become a

doctor by simply deciding to be one.

Whats common to both these situations? Simply the

fact that there is very little or no awareness. As I had

written earlier, in India, a doctor usually does not tell

you what you are suffering from or why he is

sending you for a test, or what medicine he is

injecting into you. This is known in economic terms

as asymmetrical or inadequate information, which

produces the phenomenon described by economist

George Akerlof as a lemon market. Akerlof

characterizes this market by all or some of the

following.

(1) Asymmetry of information, in which no buyers can

accurately assess the value of a product through

examination before sale is made and all sellers can more

accurately assess the value of a product prior to sale

doctors know the real danger [if any] that your ailment

poses to you, the value of the tests [s]he recommends to

you and the necessity of the medicines you are

prescribedYou dont. Do you bother to find out?

2) An incentive exists for the seller to pass off a low

quality product as a higher quality one Familiar? How

many times have pharmacists tried to push one brand over

another saying its the same medicine but a lot cheaper?

Dont we eagerly lap it up?

(3) Sellers have no credible disclosure technology

(sellers with a great product have no way to credibly

disclose this to buyers) can innovator pharma

companies explain why

their products are better and hence priced higher? In

case you are in the mood for pharma bashing,

explain to me why you would pay$399 for an

original iPhone fromApple and flaunt it, when we

all know that a Chinese one costs only$39.56? No

lemon market, this one!

(4) Either there exist a continuum of seller qualities

OR the average seller type is sufficiently low (i.e.

buyers are sufficiently pessimistic about the seller's

quality)

(5) Deficiency of effective public quality assurances

(by reputation or regulation and/or of effective

guarantees / warranties)Strong interconnectivity is observable between

points (4 ) - (5) above, and in two serious issues that

confront the pharmaceutical industry today - a) new

markets that can help spur growth through tough

The Role of Social Media in Spreading Health Aw areness


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times hence the forayinto emerging markets or

pharmerging markets and b) lack oftrustwithin

communities in the midst of product recalls and

clinical data controversies. It is inevitable that buyers

(customers) who are driven by prevailing economic

conditions will intensify their search for value-for-

money healthcare services, negotiate harder for lower

cost drugs, and increasingly ask whether a particular

drug is necessary or whether a less costly substitute

exists.

There are two emerging trends that can be utilized by

pharma marketers to engage consumers and spread

awareness thereby improving the symmetry of

information between seller and buyer in the Indian

context: (i) For the internet savvy customer, increased

utility of online social media as an informal and

effective medium for online engagement and (ii) For

the not-so-internet savvy consumers, the emergence

ofhealth counsel providers (term coined bySunil

Chiplunkar)

Usage of Internet based Social Media for Health

Awareness

In the west, physicians and consumers are

transforming the way they access health and pharma

content by shifting to online resources. In a year

during which more people used the Internet than

doctors for health information and healthcare

becomes less affordable for many, online health

resources and tools are emerging as an alternate way

for patients and caregivers to manage healthcare.

It is a matter of time before the trend rages in India. A

recently published report Pharma and Social Media:

The Leaders and Followers, states that the

phenomenon of social media is seeing the creation of

information and interest communities on an unparalled

scale, and health is among the most popular.

For pharmaceutical companies, the potential benefits of

using social media sites are balancedwith the need to

stay within the spirit and letter of regulation. Social

media cuts across geographic, social and economic

boundaries will regulators, especially in countries that

seek to tightly control pharmaceutical marketing, be

able to stem the tide of information and promotion

coming from outside their jurisdiction? Having said

that, using social media can help examine user attitudes

genuine patient information versus rhetorical product

support through brand sponsored discussion groups,

warn of the potential adverse events of getting therapy

this applies across the healthcare value chain; wrong

diagnosis, wrong tests, inhospitable service, high priced

medicines and off-label product use the works!

Social Media Websites:Some of the most popular social

media tools are Twitter, YouTube and Facebook.

Applications like Twitter can be used as an effective

networking tool as it is easily accessible and has a quick-

response system. Also, on Twitter, events are easily

promoted and readers' questions and answers can be

immediately posted, which help gain more audience for

websites that are referred to for increased information.

Brand-sponsored discussion groups:This refers to company

sponsored websites or affinity groups. Companies must

balance between seeking authentic consumer discussion

The Role of Social Media in Spreading Health Aw areness contd.


17/20



and feedback and desist from controlling

postings within those groups or chat rooms or seek to

editorialize or comment on postings about promoting

or adopting off-label uses. An example quoted in the

report describes howGardasil used. Facebook to

target its audience, teenage girls. This fan page

however, simply extends the brands website to

Facebook. This is a bad way to use social media

because all of the social features of Facebook are

disabled (for regulatory reasons apparently) by the

brand. These features include the wall, discussion

groups, and user submitted content. So, it uses social

media to effectively reach the brands audience but

prevents users from actually using social tools. By

removing interactivity, this defeats the entire purpose

of using social media tools for creating healthcare

awareness.

Emergence of Health Counsel Providers - Offline

Social Medium

These days, even a person well versed in medical lingo

can become overwhelmed by the complexity of the

health care system. In the West, many patients and

their families who can afford it are turning to patient

advocates for help. The need and therefore the

opportunity is immense in countries like India where

healthcare awareness is negligible and more

importantly vast swathes of the population are barely

literate and hence do not resort to online tools for

information. The options here are therefore face-to-

face counseling or utilizing penetrative technologies

such as mobile phones. Indian counterparts of patient

advocates can be called Health Counsel Providers

(HCPs). Creation of HCPs is a great opportunity for

pharmaceutical companies to create jobs at the bottom

of the pile people who can easily blend into the local

ethos and therefore relate easily to the local community

they service. HCPs can be professionals or

friends/relatives or from the same social circle who can

help a patient decide when and which doctor to visit,

understand diagnosis and treatment, sort out insurance

claims in both urban and rural clientele (micro-finance

ventures are likely to percolate refinancing and

insurance plans) and even accompany the patient on

doctors visits. Over time, they will be able to open

doors to specialists that a patient may not have access

to. This is likely to help consumers make informed

decisions about their own health and improve

information flow between seller and buyer thus

improving trust and confidence.

To borrow from Prof. Nirvikar Singh, University of

California, Santa Cruz, it is time that pharmaceutical

marketers began focusing more on outcomes [results]

than merely on outlays [activities]. This will lead to

increased effort at improving clinical outcomes and

more robust financial management. This must begin

with having a clear view of the path from outlays to

outcomes which can happen when we know which

interventions lead to which improvements, how reliable

the data is, or what the benchmarks should be. It is

important that pharmaceutical marketers hear from the

people affected directly consumers - to do this

effectively. For consumers to talk to us it is necessary to

reach out to them through informal and effective media

to help create symmetrical information and

transparency.SALIL S. KALLIANPUR

Social Media Informal and Effective MediumThe Role of Social Media in Spreading Health Aw areness contd.


18/20



What Pharma Lobbies In India Can Learn Fromthe G-20 Summit

SPECIAL FEATUREThe G-20 Summit at Pittsburgh last week forged a new framework for strong,sustainable and balanced global growth. The key highlight was the inclusion of Indiaamongst other emerging countries into the economic power club. Countries such asBrazil, China and India suddenly assumed great importance on the global stage notbecause of their military superiority or because they threaten US world dominance. It ismore to do with the fact that is best described by the scholarMinxin Peias, the worldmoving towards multipolarity.

The intersection here with the Indian healthcare space is that the size of the marketbeckons big businesses. As the market grows in attractiveness and competitiveness,regulators are bound to take notice. These can cause unpleasant entry barriers, rise ofnationalistic pride, unhealthy protectionism and other similar issues. Thisunpleasantness is bound to affect the smooth distribution of opportunities andeconomic development that has the potential to impact and improve millions of lives ofpeople at the bottom of the pyramid.Industry lobbies such as Organization of Pharmaceutical Producers of India (OPPI)that is a member of the International Federation of Pharmaceuticals Manufacturersand Associations (IFPMA), a global body representing the R&D pharmaceutical,biological and vaccine industries, must begin to actively work with the government tosmoothen out issues and ensure lowering of entry barriers for international bestpractices to percolate to India. At Pittsburgh, it was quite remarkable how much of

Prime Minister Singhs policy prescriptions made their way into the final communiqu.This is indeed a great example of excellent diplomatic lobbying by the Indian leaderand one from which the Indian pharma lobbies can learn much. It is emerging thatIndia will have an unprecedented central role in shaping the final outcome of some ofthe most vital negotiations in history.This can be largely attributed to the fact that Dr. Singh brings more to the table thanany other world leader when the discussion turns to economics, and President Obama,appears to have recognized that quickly. The key here is credibility. Dr. Singhs pastrecord seems to have worked for him. Industry chieftains in India must not lose time tocreate similar credibility. While OPPI member organizations undertake many credibleinitiatives, they hardly derive PR mileage from it preferring to lay low instead. Backchannel lobbying, if it happens, certainly delivers too little too less often to be worth theeffort. What is needed is focused and concerted initiatives by the industry to create a

recognized public health improvement drive. And by this I dont mean thepharmaceutical industry alone butall stakeholders in the healthcare business.Its time all the leaders in the healthcare services sector came together to work for thecommon good of the industry just as all leaders of emerging markets stood together toexert their say on the global stage.

SALIL S. KALLIANPUR


19/20



My RecommendationsSome Great Ways to Stay Informed!

Books

Magazines

Great book ongeopoliticsand history

Good read onbehavioraleconomics

Helps youunderstand thecurrent state ofaffairs in India

Excellent bookto understand

how moneydefines world

history

A leadingsource of

analysis oninternationalbusiness andworld affairs

Educates andinforms on

Indianbusiness andthe economy

Your portal toglobal politics,economics and

ideas

Serves as abridge betweenacademia and

enterprises


20/20



Thank you for sparing time to read theinaugural issue ofThe Pharma ReviewsMarketing Forum Newsletter.I hope youliked it!

This newsletter will benefit from your feedback andsuggestions. Please feel free to write to me [email protected]@gmail.comwith your comments and

suggestions on how to make this better and moreinteresting.

I would be very happy to receive your suggestionson topics that you think I should include in thismonthly newsletter. If you think I should featuresomething that you wrote, I will be happy to do it.

Salil S. Kallianpur

THE ENDTPRMF VOL. 1 ISSUE 1

pharma reviews newsletter sep09

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