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Leverage Increased Focus On ‘Self-Care’ For Better Patient Outcomes

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‘People have been practicing self-care for thousands of years. Now an increase in self-care interventions is shifting the way health care is perceived, understood, and accessed, and adding to the many medicines, diagnostics, and technologies available for people to use by themselves.’ This was articulated in an article titled, ‘Self-care during the COVID-19’, published by the World Health Organization (W.H.O) on June 12, 2020.

That COVID-19 prompts increased focus on self-care was also vindicated by several research studies, including some conducted by global pharma majors, such as GSK, Johnson & Johnson, Sanofi as you will find below. In this article I shall, therefore, deliberate whether an increasing focus on ‘self-care’, as a critical service to patients can fetch better disease treatment outcomes with respective pharma brands in the new normal. Moving in that direction, let us first be on the same page about the definition of ‘self-care’.

‘Self-care’ and its key benefits?

The W.H.O defined self-care as: ‘Your ability to promote health, prevent disease, maintain health, and cope with illness and disability with or without the support of a healthcare provider is known as self-care.’ Regular practice of self-care offers a holistic interlinked benefits to its practitioners, which many people have started experiencing during the COVID-19 pandemic.

As observed by BMI Healthcare, some of these benefits include:

  • Improving your physical health: By committing to looking after your body and becoming more attuned to its needs.
  • Reducing stress and anxiety: By making time for relaxing activities.
  • Boosting self-esteem: By helping to calm your nerves, taking time to relax and look after yourself can have a positive impact on the way you see yourself. Treating yourself with kindness can also make you look upon yourself kindlier. Studies have found that people with higher self-esteem find it easier to deal with setbacks and are more likely to achieve goals of self-improvement.
  • Protecting mental health: By making changes to prioritize self-care can help to manage mental health issues and might even prevent them from getting worse.
  • Fostering better relationships: Happier and healthier you are, the more you can give to a relationship. This is especially important if you are a parent or career. It can be so easy to put someone else’s needs first, but you must look after your own health too.

Pharma companies also echoed that COVID-19 has boosted self-care:

As I wrote above, besides W.H.O, several global pharma majors have also recently conducted their own research studies this area, for several reasons. One such research, shared by GSK Consumer Healthcare and IPSOS on 20 July 2020, reiterated that ‘the COVID-19 pandemic has had a significant impact on people’s behavior and attitudes to self-care.’ The study also endorsed, the pandemic has impacted attitudes towards personal wellbeing and self-care. This gets reflected on the increased importance that many people are now placing on looking after their own and others’ health.

Another article, published in the  Johnson & Johnson website on September 16, 2021, emphasized the same point. The Company reiterated, self-care – a holistic and preventive way to look after one’s health and wellness – is more than a passing trend. It’s a lifestyle shift that’s here to stay – one that has only been accelerated by the COVID-19 pandemic. The paper highlighted, ‘According to one recent national survey, 80% of adults said they intend to be more mindful about practicing self-care regularly after the pandemic. And global research conducted this year found that consumers’ prioritization of wellness has jumped as much as 65% in the past two to three years.’

Recently, even Sanofi in its website acknowledged, ‘COVID-19 highlights Value of self-care as a first line of defense.’ The article added, although, ‘there has been a global trend towards wellness for some time now, but the onset of the COVID-19 pandemic has accelerated it.  It also endorsed that defensive wellness is growing exponentially with people trying to protect their own health alongside their families. So, there has been a shift in attitudes in how people are practicing self-care, especially, as face-to-face consultations with doctors are now more difficult.

Why ‘self-care’ concept got a boost during COVID-19 pandemic?

There are several reasons behind such unprecedented boost in practicing self-care within the global population. The key ones include intense and continuous public messaging by various governments in response to the COVID-19 pandemic, has emphasized the importance of self-care by manifold. Some of these self-caring activities, such as, social distancing, wearing face masks and other preventative hygiene measures, which have been pivotal in the disease control process.

The national campaigns to tackle the virus with various social measures deployed by citizens, in tandem with traditional public health interventions, like testing and contact tracing, have been widely supported by NGOs, media and key influencers in many sectors. The core message has been, staying home or working from home, and observing government guidelines is – ‘doing your bit’ for others, as well as yourself. The same was also well-articulated in a paper – ‘Self-care and health: by all, for all. Learning from COVID-19’, published by the Mitchell Institute, Victoria University, in July 2020.

 ‘Self-care’ messaging in the old and new normal – the key difference: 

Several pharma companies have tried to understand what factors prompted to accelerate the ‘self-care’ process during the pandemic, as compared to the old normal. And what is the key difference in the core messaging content. For example, Sanofi construed that the self-care messages in pre-pandemic period were generally ‘positive’ ones, such as benefits of practicing yoga and other changes in the general lifestyle activities. Whereas, during the pandemic, the message has been very different. It generally revolved round the ‘fear of the unknown’ that can jeopardize lives and livelihoods.

This factor emerged as a powerful motivator in accelerating a shift to life-saving preventative wellness – not just for self, but also for others. An overwhelming sense of uncertainty put a different perspective altogether to ‘self-care’, especially, for people with co-morbidities or pre-existing health conditions, being more vulnerable to die from COVID-19 infection.

Can pharma leverage the win-win opportunity?

A global study by  McKinsey & Company in this area, published on April 08, 2021, vindicated the increasing trend of self-care among global population. Elaborating the point, it said: ‘These days, consumers view wellness through a much broader and more sophisticated lens, encompassing not just fitness and nutrition but also overall physical and mental health and appearance.’ The Company estimated ‘the global wellness market at more than $1.5 trillion, with annual growth of 5 to 10 percent.’ If pharma marketers can leverage this win-win opportunity creatively, brand related self-care measures would also come under this market.

Leveraging increased focus on patients’ self-care:

The fact that an opportunity exists for pharma players to leverage a new opportunity in the ‘self-care’ space, creating win-win treatment outcomes for all, isn’t a new concept. Over a decade, this is being deliberated in the healthcare space. This is evident from an interesting article titled, ‘Helping patients help themselves’, published in the ‘Modern Healthcare’ on June 21, 2010. Acknowledging that “Self-management is critical,” it wrote: “The patient spends one-tenth of 1% of their time in the doctor’s office and the rest of the time on their own. Coming up with good ways to engage them and encourage them to take control and make changes is very important.”

Interestingly, another article carrying exactly the same title – ‘Helping patients help themselves’ – penned by another author, was published after more than a decade – in the ‘Reuters Event’, on November 19, 2021. This author also emphasized: ‘Self-care offers a new way for health care companies to serve patients better, globally and industry collaboration will drive faster progress.’ It reiterated: ‘There’s an opportunity here for healthcare companies to put patients even more at the center of care and to help them achieve better outcomes.’ Pharma marketers, wearing their best creative hats, will find several novel strategic ways to reap a rich harvest from this opportunity. I shall, therefore, won’t step into that area in this article.   

Conclusion:

Ongoing awareness campaigns, encouraging people to take primary ownership of their own health to prevent any serious medical interventions – both for infectious and non-infectious ailments, can be a force multiplier to protect a nation’s health.

Several ‘self-care’ practices during the pandemic like, wearing face masks, maintaining social distancing, hand washing and self-isolation to contain spread of infection, continues. In tandem, as many experts reported, more people are now using digital tools, wearables, symptom trackers – for self-care. Alongside, virtual medical consultation, home care and telehealth services, purchasing medical products and diagnostic services from e-pharmacies, digital health solutions and the likes are also increasing significantly, for the same reason.

Collectively, self-care initiatives have paid rich dividend – in varying degree, almost in every country, notwithstanding some catastrophic onslaught of the virus in many nations, including India. Otherwise, the numbers could have been worse, as many experts project. That said, as the McKinsey & Companysaid: ‘If the pandemic has taught us one thing, it’s that physical and mental health will remain a priority for millions of people across the globe for a long time to come.’ Being in the thick of this process, the drug industry, by and large, has also realized that ‘self-care’ is crucial to ensure better treatment outcomes. This, I reckon, opens a new vista of opportunity for pharma to leverage, with increased focus on most of these ‘self-care’ practices – for business excellence.

By: Tapan J. Ray

Disclaimer: The views/opinions expressed in this article are entirely my own, written in my individual and personal capacity. I do not represent any other person or organization for this opinion.

An Essential ‘Acrobatic Feat’ Remains Relevant Even In Digital Pharma World

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“A manager must, so to speak, keep his nose to the grindstone while lifting his eyes to the hills — quite an acrobatic feat!” This profound statement was articulated by the Management Guru of all-time – Peter F. Drucker, in his book named “The Practice of Management.” This book was published probably before many management experts of today were even born – in 1954. This epic quote of Drucker is in context of the critical requirement to harmonize management decisions affecting the short and the long-term strategic business goals.

While looking at the pharma industry from the above perspective, one may often find, the quality-time spent, especially by its marketers, on ‘lifting their eyes to the hills’ – looking for the early signals on critical changes in future success requirement – is often minimal. Most seem comfortable in ‘keeping their nose to the grindstone’ to deliver the short-term objectives, with a belief that the future brand success factors will replicate the present ones. Thus, honing the current strategies would automatically ensure achieving the long-term requirements.

This prompts a question, should pharma marketers predominantly concentrate on sharpening their traditional marketing tools for near-term excellence or reach out much beyond that? Today’s article will deliberate on this subject, in the context of changing market dynamics and consumer expectations in the today’s world.

Are the brand success parameters changing?

Scores of data-based assessments of progressive changes in the customer value trend, highlight significant shifts from the past, necessitating an overhaul of the value delivery parameters and the system – not just honing. More often than not, such reconditioning could even be disruptive in nature – as may happen with the change to a well-integrated digital marketing system.

For example, until recently pharma brands used to be differentiated primarily based on its intrinsic key features and benefits, like efficacy and speed of recovery, safety and side-effects profile, ease of compliance and nature of drug interactions during concomitant use and more. Today, the parameters of brand differentiation have gone much beyond that, which could have been captured by an astute marketer while ‘lifting his eyes to the hills’, alongside ‘keeping his nose to the grindstone.’

The evolving parameters of brand-differentiation are not just restricted to the features and benefits, but call for unique customer value creation – such as providing a unique treatment experience to patients – understanding their needs, expectations and preferences. This, in turn, change the traditional pharma marketing ball game, as the success ingredients are so different.

Capturing, conceptualizing and delivering customer value, following the traditional pharma marketing tools and processes will increasingly be a daunting task. New digital tools and platforms – well-integrated into the evolving pharma marketing processes, would be necessary to win customers’ share of mind, more effectively than ever before. Nevertheless, value delivery still remains at the core of the pharma marketing system.

Value delivery still remains at the core – with significant changes: 

Value delivery will always remain the core purpose, and a constant factor in pharma marketing initiatives. It was so in the past, is at present, and will continue to be in the future, regardless of changes in the market and customer dynamics.

Nonetheless, what is construed as ‘value’ to capture a sizeable share of consumers’ mind has changed. Traditionally, it has been mostly intrinsic to the organization, revolving around the product features and benefits, as stated earlier. But, today, it is getting more focused on the extrinsic factor – related to the customers.

Thus, creating a unique experience for them with the brand has become the new challenge of change to pharma marketers for performance excellence, as I discussed in one of my recent articles. Consequently, providing this external and well-researched ‘customer-centric value’ has become the new brand differentiator.

While ‘lifting eyes to the hills’, some interesting findings:

Among many others, Decision Support Group (DCG), as well, while ‘lifting their eyes to the hills,’ well-captured the emerging consumer expectations in health care through a detailed study. This was published as ‘Cybercitizen Health Infographic’ on October 27, 2015. Let me paraphrase below some of the important findings of this study:

  • As customers are expecting pharma to provide best-in-class patient experience and associated services in the disease treatment process, marketers need to differentiate brands through these parameters.
  • 59 percent of health care consumers expect brand experiences and services beyond what the physical brand offers.
  • Only 8 percent of the respondents said pharma companies are providing a better customer experience than 2 years ago, while 30 percent said so for doctors, and 21 percent regarding pharmacists.
  • 40 percent of the consumers who value experience as much as drug effectiveness, would pay a little more for a drug or a health procedure.

How is this extrinsic value measured?

As confirmed by several studies, going beyond what a physical pharma brand would offer, the customers, including individuals who pay from the pocket for a disease treatment, measure the value of a drug today differently. It is now predominately by outcomes, the patients’ overall experience during the treatment, and overall – cost-effectiveness of the entire process, and not just the medicine.

Thus, the pharma market is sending a clear signal to the marketers to ‘shape up’ accordingly, soon and start with measuring care by outcomes – going beyond the product features and benefits – just as patients would do. If not, there could be a strong possibility of being ‘shipped out’, as the marketing productivity could head south, with more capable professionals filling up the void.

Commensurate changes in marketing success measurement:

The emerging changes in measuring ‘marketing success’ were aptly demonstrated in the article, ‘Redefining Value: What Value-Based Care Means for Pharma’, published by the Intouch Solutions on July 07, 2016.

It said: ‘Once, success simply meant a “blockbuster” – a drug that sold enough.’ However, this paradigm is shifting. Soon, it will be measured by the value of outcomes with the brand – the positive impact that it creates on the patient’s health, leaving behind a unique treatment experience.

To be successful with the brand, the marketer will, therefore, need to create a genuine, credible and powerful data-based outcome story. It should effectively demonstrate how the unique brand value offerings, supported by services can make it possible. The services may include, among others:

  • Supporting patients in managing their condition as part of their life.
  • Educating patients and helping them feel empowered in the treatment decision making process.
  • Helping patient access to medication.
  • Assisting patients in developing and maintaining a healthy lifestyle.

For many pharma marketers this exercise will involve a strategic shift in their thinking process. Embracing a fundamental change in the way they have been practicing traditional pharma marketing all these years.

Are some of these changes disruptive in nature?

Several of the aforesaid changes may appear disruptive to many, causing a discomfort of moving out of their comfort zones. Some may even try to wish it away, and continue practicing the traditional pathways as long as these help achieving some results. But, not certainly for a long while. In which case, it will be akin to delaying a greater disruption before ultimately getting caught off-guard.

Dr. Vas Narasimhan, Chief Executive of the Swiss pharmaceutical giant Novartis, puts it nicely. He advised, ‘the key to surviving disruption is understanding that a leader needs to be prepared to embrace it – even if that means willfully disrupting yourself.’

However, the good news is, digital transformation of a business makes embracing this change less difficult. Which is why, a number of companies are trying to seriously engage in digital marketing. Let me hasten to add, the ‘digital transformation process’, regardless of promises that many self-styled experts would make, is tough. It makes the organization chart an uncharted frontier and starts from the very top.

Digital transformation follows an arduous path, starting from the very top: 

There are many descriptions of the ‘digital transformation process’. However, the one that appealed to me is the one that comes from the Agile Elephant. It describes the process as follows:

‘Digital transformation is the process of shifting your organization from a legacy approach to new ways of working and thinking using digital, social, mobile and emerging technologies.  It involves a change in leadership, different thinking, the encouragement of innovation and new business models, incorporating digitization of assets and an increased use of technology to improve the experience of your organization’s employees, customers, suppliers, partners and stakeholders.’

The recent examples in this regard that come at the top of my mind, include:

Does digital marketing transform the brand value delivery process? 

Digital marketing facilitates the new and extrinsic brand value delivery process, as the use of this technology is all pervasive in our everyday life. Interestingly, almost all businesses, mostly in the organized sectors and technology startups, are trying to leverage digital technology to create sets of differential customer values.

And then integrating those to the core marketing strategy, for effective delivery of a crafted solution to the patients’ comprehensive needs, will be a challenging task. Moving in this direction, besides creating interactive websites, many drug players are using a number of digital tools, including social media sites, to start with. These are all serving as integrated digital marketing platforms to engage with targeted customers.

It’s apparently a foregone conclusion today that ‘the traditional one-way relationship in our health care system, will soon change to two-way relationship.’ Where interactive digital marketing, social media and other similar platforms, will facilitate building such relationship for a meaningful exchange of information with the target groups, transforming in the healthcare landscape.

Some key transformation areas with the digital marketing system:

As Agile Elephant puts it, the following are a few examples of key healthcare transformation areas with digital marketing:

  • The efficacy of treatment will be transparent with cost-effective data-based outcomes story.
  • Data transparency will follow data visualization enhancing how patient data is communicated to them, or how certain medications and treatments are affecting different areas of the physiological system.
  • Patients will be empowered to play an active role in their health care.
  • Patients disease treatment experience could be optimized across multiple touchpoints’.

Conclusion:

Currently, it appears, most pharma marketers ‘keep their nose to the grindstone’ to continue honing the traditional processes of brand marketing with an expectation for better return. However, if they could find time for ‘lifting eyes to the hills’ with all seriousness, they will be able to sense a shifting paradigm with a new set of marketing success factors. If not done even now, it could perhaps be too late to make amends for business sustainability.

Many may get carried away by the hype of digitalization as a panacea, but this is just a facilitating technology – to be in sync with, among others, the evolving values of pharma customers, through innovative value delivery systems. Regardless of digitalization all around us, the name of the game that differentiate men from the boys in this game, remains – generation of cutting-edge ideas. Only this can transform – effective delivery of differentiated ‘customer value’ into business excellence.

Interestingly, to accomplish this objective meaningfully, the aforesaid ‘acrobatic feat’, as enunciated by Peter Drucker in 1954, remains relevant and essential for pharma marketers, just as all other managers, even in the digital pharma world.

By: Tapan J. Ray 

Disclaimer: The views/opinions expressed in this article are entirely my own, written in my individual and personal capacity. I do not represent any other person or organization for this opinion.

For Affordable Access To Quality Healthcare in India, Invest Where The Mouth Is

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On September 25, 2018, well-hyped Ayushman Bharat – National Health Protection Scheme (AB-NHPS), touted as the largest health scheme in the world, was launched in India. Prior to its launch, while announcing the scheme on August 15, 2018 from the Red Fort,Prime Minister Narendra Modi said: “The healthcare initiatives of the government will have a positive impact on 50 Crore Indians,” as it aims to provide a coverage of Rs 5 lakh per family annually, benefiting more than 10 Crore poor families.

Before this scheme was introduced, there were several public funded health schemes in India, introduced by different governments, like National Rural and Urban Health Mission (NRHM and NUHM), Rashtriya Swasthya Bima Yojana etc. Reports also capture that since independence efforts were ongoing in this area. But none worked, due to shoddy implementation. Let’s await the outcome of yet another new health scheme, introduced by yet another government – AB-NHPS.

According to the Government Press Release of January 11, 2019: Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (PMJAY) aims to provide health coverage during secondary and tertiary hospitalization of around 50 Crore beneficiaries, allocating a sum of up to Rs. 5 Lakh per family per year. The key words that need to be noted is ‘the health coverage during hospitalization’. It also doesn’t cover primary care. Interestingly, some of the larger states, such as Punjab, Kerala, Maharashtra, Karnataka and Delhi are, reportedly, yet to come on board, Odisha has refused to be a part of the scheme.

Conceptually, the above new health initiative, aimed at the poor, is praiseworthy.  However, its relevance in reducing a significant chunk of one of the highest, if not the highest, ‘Out of Pocket (OoP’) expenses towards health in India, raises more questions than answers.

This is because, whether annual ‘OoP’ for health, incurred by the country’s poor population, goes more for hospitalization than Primary Health Care (PHC) involving common illnesses, is rather clear today. In this article, I shall dwell on this subject, supported by credible published research data.

But ‘the Primary Health Care (PHC) is in shambles’:

Since the focus of (AB-NHPS) on ‘secondary and tertiary hospitalization’, one may get a feeling that the primary public health care system in India is, at least, decent.

But the stark reality is different. The article titled, ‘Five paradoxes of Indian Healthcare,’ published inThe Economic Times on July 27, 2018 describes the situation eloquently. It says: ‘While the Supreme Court has held health care to be a fundamental right under Article 21 of the Constitution…The fundamental aspect of health care – the primary health care is in shambles. There is only one primary health care center (often manned by one doctor) for more than 51,000 people in the country.’

In addition, the World Bank Report also flags: ‘The tenuous quality of public health assistance is reflected in the observation that 80 percent of health spending is for private health services, and that the poor frequently bypass public facilities to seek private care.’ Although, World Bank underscored this problem sometime back, it persists even today, sans any significant change.

PHC has the potential to address 90 percent of health care needs:

For the better health of citizens, and in tandem to contain disease progression that may require hospitalization for secondary and tertiary care, government focus on effective disease prevention and access to affordable and high quality PHC for all, is necessary. ‘Evidences gathered by the World Bank have also highlighted that primary care is capable of managing 90 percent of health care demand, with only the remaining 10 percent requiring services associated with hospitals.’

Another article titled, ‘Without Primary Health Care, There Is No Universal Health Coverage,’ published in Life – A HuffPost publication on December 14, 2016, also vindicates this point. It emphasized: ‘Primary health care (PHC) has the potential to address 90 percent of health care needs. However, country governments spend, on average, only one third of their health budgets on PHC.’ The situation in India is no different, either.

This basic tenet has been accepted by many countries with ample evidences of great success in this direction. Curiously, in India, despite the public PHC system being in shambles, the government’s primary focus is on something that happens only after a disease is allowed to progress, virtually without much medical intervention, if at all.

Key benefits of a strong PHC system:

As established by several research papers, such as one appeared in the above HuffPost publication, and also by other research studies, I am summarizing below the key benefits of having an affordable and strong PHC network in the country:

  • Can manage around 90 percent of the population’s health care need, patients would require hospitalization for specialists care only 10 percent of the time.
  • Can help people prevent diseases, like malaria or dengue, alongside effectively assist them in managing chronic conditions, such as hypertension or diabetes, to avert associated complications that may require secondary or tertiary care.
  • At the country level, a strong PHC system would help detect and screen illnesses early, offering prompt and effective treatment. The system, therefore, will support a healthier population, and would ‘offer much more than simple reduction of the costs of a country’s health.’
  • A country can ensure greater health equity by providing PHC advantages of greater accessibility to the community, and across the social gradient.
  • In short: ‘The continuity and doctor–patient relationships offered by family oriented primary care, alongside the patient education, early intervention and treatment, chronic disease management, counseling and reassurance offered to patients would be impossible to provide in a secondary care setting.’

Thus, establishing a robust network of high-quality public PHC facilities in the country is a necessity. Simultaneously, patients should be made aware of visiting the nearest PHC as their first stop for affordable treatment, when they fall ill.

Annual ‘OoP expenses’ more on ‘out-patient care’ than ‘hospitalization’:

For illustration, I shall provide examples from just two studies, among several others, which found, average ‘OoP expenditure’ per family in a year, is more for ‘out-patient care’ than ‘hospitalization.’

Since long, ‘OoP expenditure’ on hospitalization was being considered as the most important reason for impoverishment. Probably, this is the reason why various governments in India, had launched various health schemes, covering hospitalization expenses of a large section of the poor population in the country. The most recent one being – Ayushman Bharat-National Health Protection Scheme (AB-NHPS), often termed as ‘Modicare’, launched in September 25, 2018.

That total ‘OoP expenses’ are more on ‘out-patient care’ than ‘hospitalization’ was emphasized even in the 2016 research article titled, ‘Out-of-Pocket Spending on Out-Patient Care in India: Assessment and Options Based on Results from a District Level Survey,’ published online by PLoS One on November 18, 2016.

Highlighting that ‘OoP spending’ at ‘Out-Patient Departments (OPD)’ or in clinics by households is relatively less analyzed compared to hospitalization expenses in India, the results indicate:

  • Economically vulnerable population spend more on OPD as a proportion of per capita consumption expenditure.
  • ‘Out-patient care’ remains overwhelmingly private and switches of providers -while not very prevalent – is mostly towards private providers.
  • High quality and affordable public providers tend to lower OPD spending significantly.
  • Improvement in the overall quality and accessibility of government OPD facilities still remains an important tool that should be considered in the context of financial protection.

Let me now cite the second example – analyzing the 60th national morbidity and healthcare survey of the National Sample Survey Organization (NSSO), the study found, ‘outpatient care is more impoverishing than inpatient care in urban and rural areas alike.’

Expert committee’s recommendations for focus on ‘primary care’ went unheeded:

That the government focus on public health care should be on PHC, along with prevention and early management of health problems, was recommended by ‘The High-Level Expert Group Report on Universal Health Coverage, for India.’ This committee was instituted by the then ‘Planning Commission’ of the country on November 2011. The report also suggested, such measures would help reduce the need of secondary and tertiary care, significantly. But not much attention seems to have been paid even on these critical recommendations.

Conclusion:

Going by what Indian government says, I believe, its ultimate goal is providing access to affordable Universal Health Care (UHC), for all. That’s indeed commendable. But as various research papers clearly indicates, the country will first ‘need to invest in a ‘primary-care-centered’ health delivery system, if universal access to health care is to be realized, ultimately.

From this perspective, Ayushman Bharat – National Health Protection Scheme (AB-NHPS) may be a good initiative. But it does not seem to merit being the primary focus area of the government in public health care. And, not more than establishing high quality and robust ‘primary health care’ infrastructure, across the country, for all. Nor will AB-NHPS be able to address higher average of out-of-pocket ‘outpatient expenses’ of those people who need help in this area, the most.

Considering the critical public health care issue in India holistically, I reckon, for providing affordable access to health care for all, the top most priority of the Government should be to invest first where the mouth is – to create affordable primary healthcare infrastructure of a decent quality, with easy access for all.

By: Tapan J. Ray   

Disclaimer: The views/opinions expressed in this article are entirely my own, written in my individual and personal capacity. I do not represent any other person or organization for this opinion.

An Interesting demand: No Price Control For OTC Drugs

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Since over a decade, some pharma trade organizations operating in India, have been advocating for a separate regulatory policy for ‘Over The Counter (OTC)’ drugs, which can be legally sold without any medical prescriptions. Such a new policy initiative, if taken by the Indian Government, would call for inclusion of a separate Rule and a Schedule in the Drugs and Cosmetics Act, 1940 and Drugs and Cosmetics Rules, 1945.

In the midst of cacophony related to Intellectual Property (IP) related priority of the industry in multiple areas, OTC drug advocacy took a back-seat, temporarily. Some recent developments indicate, it has again been taken out of the trade associations’ archive, well-dusted, rehashed and re-presented. Today’s key driver is likely to be increasingly stringent drug price control measures of the government. An emphatic demand of the pharma trade associations that OTC drugs should be kept outside drug price control measures, vindicates this point.

In this article, I shall deliberate this issue, especially on raising the same old demand – yet again, and my concerns on the demand of free-pricing for essential OTC drugs, in the Indian context.

OTC drugs – no legal status in India:

Currently, OTC drugs have no legal status in India. However, those drugs which don’t feature under ‘prescription only’ medicines are construed as ‘non-prescription’ drugs and sold over the counter at pharma retail outlets.

Neither is there any concept currently existing in India, which is similar to ‘prescription only to OTC drug switch,’ unlike many developed countries, such as UK, EU and United States. Thus, before proceeding further, let me deliberate on the important point – why is ‘prescription only drug’ to ‘OTC drug’ switch. Let me briefly dwell on this issue, quoting from a neutral source – the World Health Organization (W.H.O).

‘The basic purpose of re-designation of a drug as an OTC product is commercial’:  

The Essential Medicines and Health Products Information Portal – A World Health Organization resource illustrates the point as: After a new drug has been in use as a prescription-only medicine (POM) for an agreed period after licensing – usually five years – and has proved to be safe and effective during that time, regulatory authorities are prepared to consider submissions for re-designating the product where appropriate so that it becomes available for non-prescription “over the counter” (OTC) use.

The article further states: “The basic purpose of re-designation of a drug as an OTC product is frankly commercial; the manufacturer requests the change in the hope that, without the need for a prescription, the sale of the drug will increase. However, the change also has a secondary effect in that the drug will no longer – at least in its OTC form – be primarily funded by a national health system or insurance fund; if he had obtained the drug by private purchase, the patient will pay for it in cash, and this will therefore result in cost savings to the health system.”

Benefits of OTC drugs to patients in the western world:

An article titled, ‘When Rx-to-OTC Switch Medications Become Generic’,published in the U.S. Pharmacist on June 19, 2008, highlights the key benefits of generic OTC drugs to patients, mostly in the western world as follows:

  • Prices for generic OTC versions are lower than those for the branded products.
  • The savings vary from product to product, but they can be as little as 11 percent (some omeprazole generics) to over 75 percent (some loratadine generics).
  • The cost savings can be critical in making self-care decisions.
  • For patients with a chronic, self-treatable medical condition, the addition of a new generic OTC with that indication expands the range of therapeutic options.

Endorsing the point that ‘OTC drug’ cost significantly less than the ‘prescription only drug’ other studies also point out the following:

  • Less lost work time and costs saved by not needing to visit a doctor are important considerations.
  • Growing sophistication and self-reliance among consumers, with increasing interest in and knowledge about appropriate self-medication.
  • Older adults in particular tend to experience increased minor medical problems, such as arthritis, sleeping difficulties, muscle aches and pains, headaches and colds. Thus, as the population ages the demand for non-prescription drugs escalates.

To illustrate the point of greater choice to patients, the article cited an example of allergic rhinitis patients. It pointed out that at one time, such patients had little to choose from other than older (first-generation) antihistamines. When loratadine (Claritin) and cetirizine (Zyrtec) switched from ‘prescription only’ to generic OTC drugs, price-conscious patients got the expanded option to choose from them based on their unique advantages and lower prices.

Benefits of OTC drugs for drug manufacturers:

Several studies concluded the following when it comes to benefits of OTC drugs for the drug manufacturers:

  • When an innovative drug loses patent protection, expanding into OTC segment with the same product can help a lot in the product life-cycle management.
  • Additional revenue with OTC drugs help increasing the concerned company’s both top and the bottom-lines.

Does ‘only prescription drug’ to ‘OTC drug’ switch help Indian patients?

The key benefit that patients derive out of any switch from ‘prescription only drug’ to ‘OTC drug’ switch, has been shown as cheaper price of generic OTC drugs. In India that question doesn’t arise, because an ‘OTC generic drug’ can’t possibly be cheaper than ‘prescription only generic drugs’ of the same molecule. On the contrary, if the demand for putting generic drug outside price control is implemented, it would likely to make ‘OTC generic essential drugs’ more expensive- increasing already high out of pocket (OOP) drug expenses, without benefitting patients, tangibly.

How would OTC drugs help patients in India?

According to reports, pharma trade associations claim that ‘OTC drugs will help Indian patients. Some of the reasons given by them are as follows:

  • Responsible self-medication: Empowers patients to make responsible and wise choices and self-manage their health outcomes.
  • Improves access to medicines: ‘Access to medicines’ in India has long ignored the critical role of the viability of OTC medicine, which could play a critical role in improving access to medicines in India, especially in the remote areas.
  • Help both health system and consumers saving money: OTC medicines save health systems valuable resources and can save consumers time and money.

While the basic purpose of re-designation of a drug as an OTC product is commercial – as articulated in the above article of the W.H.O, it is interesting to note, how it is being camouflaged in India by a trade association. The association demands a brand new OTC drug regulatory policy without any price control, and at the same time says, ‘the patient is at the core of all our activities.’ I wonder how – by increasing the burden of OOP drug expenses for patients? Let me try to fathom it raising some basic questions, in context.

Some basic questions:

While trying to understand each of the above three ‘patient benefits with OTC drugs’, as highlighted by the pharma trade association, I would strive to ferret out the basic questions in this regard, as follows:

  • Responsible self-medication:Fine. But again, won’t it make totally price and promotion deregulated OTC drugs more expensive than the existing equivalents of essential drugs – significantly increasing OOP for patients?
  • Improves access to medicines: Improving drug access comes with increasing affordability, especially in India. With OTC drugs being presumably higher priced than other generic equivalents, how would it improve access? Just to illustrate this point, one pharma trade association has cited examples of the following drugs, for inclusion in the OTC category:

“Paracetamol, Aspirin, Antacids, Topical preparations of certain NSAIDs (Ibuprofen, Diclofenac), Cetirizine, Albendazole, Mebendazole, Povidone‐Iodine preparations, Ranitidine, Ibuprofen (200mg), Normal saline nasal drops, Xymetazoline nasal drops, etc. In addition to all Drugs which are currently under Schedule K.”

If the prices of OTC versions of the above drugs are kept more than the prevailing ceiling prices for essential, would it benefit the patients and improve access to these drugs for them?

  • Help both health system and consumers saving money: Doesn’t the same reason hold good for this one too?

One may also justifiably ask, why am I presuming that OTC drug prices will be more than their non-OTC equivalents? My counter question will be, why is the demand for total regulation of price for OTC drugs? In any case, if a non-schedule drug is included in the OTC category, the question of any price control doesn’t arise in any way.

The current status in India:

Unrestricted sale of ‘prescription only drugs’, including all antibiotics and psychotropic drugs, is rampant in India, causing great harm to the Indian population. In tandem with strict enforcement of the drug dispensing rules in India, a separate patient-friendly category of OTC drugs would certainly help significantly. As a concept, there is no question to it. But the devil is in the detail of demand for the same.

Accordingly, in November 2016, the Drugs Consultative Committee (DCC) formed a sub-committee for charting a regulatory pathway for sale of OTC drugs in India, specifying punitive measures for any violation of the same. As I indicated above, currently, any drug that doesn’t not fall under a prescribed schedule could be sold and purchased without a medical prescription. This panel has sought all stakeholders’ comments and suggestions on the same. Some of the responses from pharma trade associations, as requested for, I have deliberated above. Nevertheless, the bottom-line is, nothing tangible in this regard has happened till date.

Conclusion:

As I envisage – if, as and when it happens, it is also likely to have an adverse impact on the sales and profits of many pharma players. This is primarily because, indiscriminate drug use – irrespective of self-medication or irrational prescription, do fetch good sales for them. But it shouldn’t continue any more – for the benefit of patients.

More importantly, the key argument showcased in favor of OTC drugs in India, seems to be a borrowed one – borrowed from a totally different pharma environment of the western world. Out of Pocket drug expenditure for patients, which is already very high in India, shouldn’t be allowed to go further north. Some of the India-specific intents of pharma trade associations also appear blatantly self-serving, such as total deregulation of price and promotion. It rekindles huge concerns, such as:

  • What could possibly be the key intent behind keeping essential OTC drugs outside existing price control?
  • If so, won’t it open yet another floodgate of hoodwinking price regulation of ‘essential drugs’ through crafty manipulations?

It would be a different matter though, if such OTC drugs do not fall under ‘essential drugs’ category.

Thus, in my overall perspective – ‘no price control for OTC drugs’, is an interesting demand of pharma players, but not surprising in any way – at all.

By: Tapan J. Ray   

Disclaimer: The views/opinions expressed in this article are entirely my own, written in my individual and personal capacity. I do not represent any other person or organization for this opinion.

An Interesting Link: Productivity At Work and Employee Fitness (In 2 Parts)

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Part 1: Physical Fitness

Today’s work environment is much more challenging than ever before. The challenge is undoubtedly multi-factorial. Many of these are external – mostly related to increasing complex, and difficult to fathom uncertainties and surprises in the overall business environment. Nevertheless, its sizeable part keeps generating from within the respective organizations.

These emanate from a wide variety factors, such as changes at the senior management levels or in the key corporate policies of an organization. But more importantly, changing aspirations and outlook of the new generation professionals, in the midst of all complexities of life, often play a catalytic role.

Managing changes in VUCA world:

The Corporate leadership of more and more business organizations, including pharma is fast realizing a hard fact. They are discerning, if the internal challenges are addressed with a systematic short, medium and long-term approaches, it would be possible to navigate through, with a greater degree of success than otherwise, in this Volatile, Uncertain, Complex and Ambiguous (VUCA)) world.

Scientific evidence suggests, encouraging employee fitness in this situation with a comprehensive plan, could considerably help boosting employee productivity to effectively respond to business challenges. I shall discuss this emerging scenario in two successive articles. The Part 1 will dwell on the impact of ‘Physical Fitness’ on employee productivity, and the Part 2 will argue on the relevance of ‘Mental Fitness” in achieving the same.

Working on ‘employee engagement’, including fitness:

To successfully cruise through this tough headwind, many corporate houses are working hard on various ‘employee engagement’ initiatives, to excel in creating the best possible ‘shareholder value’. These cover various hard and soft skills imparted through regular training sessions, in tandem with actively encouraging employee fitness programs at the corporate level, seriously.

There are plenty of reasons for doing so. For example, by keeping the employees away from various non-infectious chronic (NCDs) such as hypertension, diabetes, or enabling them to manage these conditions better, through fitness initiatives, the employers derive some very tangible benefits, as well. These come, over and above offering a sense of wellness to employees – in terms of improvement of per employee productivity.

Proven benefits of fitness initiatives now visible across the world:

To achieve this goal, increasing number of corporate houses around the world of all sizes, are ensuring employee fitness by providing facilities of exercise, even in the workplace.

A Brookings Institute study, titled, ‘Exercise Increases Productivity’ found that ‘regular exercise at work helps increase employees’ happiness and overall productivity in the workplace.’ In a randomized controlled trial, researchers from the University of Georgia concluded that even low to moderate daily exercise can make employees feel more energized within a few weeks. Whereas, the effect of exercise on the mood is immediate.

Another research article, published in the American Journal of Management indicated: ‘If fitness could be increased through some type of fitness program, there would be a noticeable increase in productivity.’

Yet another research publication on the subject commented: “There are clear implications not only for employee wellbeing, but also for competitive advantage and motivation by increasing opportunities for exercising at work.”

Fitness also impacts the way one thinks:

Stating that: ‘Exercise has also been shown to elevate mood, which has serious implications for workplace performance,” the article titled “Regular Exercise Is Part of Your Job”, published by the Harvard Business Review (HBR) on October 03, 2014 discussed another interesting point.

It wrote, when we think about the value of exercise, we tend to focus on the physical benefits, such as lower blood pressure, a healthier heart, a more attractive physique. Besides this fact, there are other compelling evidence suggesting that there is another, more immediate benefit of regular exercise: its impact on the way we think.

Elaborating the point, the author said: Studies indicate that our mental firepower is directly linked to our physical regimen. And nowhere are the implications more relevant than our performance at work, providing the following cognitive benefits into an employee routine at the work place:

  • Improved concentration
  • Sharper memory
  • Faster learning
  • Prolonged mental stamina
  • Enhanced creativity
  • Lower stress

In line with the Brooking Institute study, this article also reiterates that exercise has shown to elevate mood, which has serious implications for workplace performance. On the other hand, feeling irritable is not just an inconvenience. It can directly influence the degree to which one is successful.

Even the results of the Leeds Metropolitan University study show that exercise during regular work hours may boost performance. It also found: “On days when employees visited the gym, their experience at work changed. They reported managing their time more effectively, being more productive, and having smoother interactions with their colleagues. Just as important: They went home feeling more satisfied at the end of the day.”

The most common barrier:

What prevents us from exercising more often? The most common answer to this important question would probably be: ‘I don’t have the time.’ This answer could well be quite legitimate too. However, it also means that fitness programs still assume a low priority to many, despite its scientifically proven work and personal benefits, as the studies indicate.

Conclusion:

Various research studies, including the HBR article, have concluded that the cognitive benefits of exercise resulting significant improvement in employee productivity, can’t be wished away, any longer.  Which is why the research studies establishing the importance of employee fitness to boost their productivity in the workplace, are so compelling.

There is hardly any scope of doubt now that: “Exercise enables us to soak in more information, work more efficiently, and be more productive.”

This scientifically proven narrative now deserves to be practiced at a much wider scale by Indian business organizations. As an effective tool to boost employee productivity, they may wish to increasingly encourage fitness programs at the workplace. Not very strange, though, corporate physical fitness centers – on-site or outsourced, are not too common, just yet, perhaps more within the Indian pharma industry.

When actively encouraged by, particularly the pharma leadership in India, a significant value addition may take place on their ongoing initiatives for improving the much-sought after employee productivity in the workplace, in a win-win way.

By: Tapan J. Ray 

Disclaimer: The views/opinions expressed in this article are entirely my own, written in my individual and personal capacity. I do not represent any other person or organization for this opinion.

Humongous Pharma Corruption: China Ups The Ante…and India?

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In the ‘pharma bribery’ related scandal in China, many postulated that the Chinese Government has cracked down selectively on Multinational Corporations (MNCs) to extend unfair business advantages for its local players.

Media reports of September 2013 indicate that in all probability the intent of the Chinese Government is not to spare homegrown corruption in this area. The country appears to be taking tough measures against both global and local perpetrators of such criminal acts, which have spread their vicious tentacles deep into the booming Chinese pharmaceutical industry.

The report names the following domestic companies:

  • Sino Biopharmaceutical Ltd has set up a team to investigate allegations broadcast on the state television that its majority-owned subsidiary had paid for illegal overseas trips for doctors to Thailand and Taiwan.
  • Privately held Gan & Lee Pharmaceuticals investigating allegations of spending around US$ 130.75 million to bribe doctors to promote their pharmaceutical products over five years.

More MNCs under investigation:

At the same time, international media are reporting names of more and more big global pharma players allegedly involved in this humongous scam, as follows:

  • In July 2013, the British drug maker GlaxoSmithKline (GSK) was allegedly involved in around US$ 490 million deceptive travel and meeting expenses as well as trade in sexual favors. Chinese authorities detained four senior executives of GSK in China to further investigate into this matter.
  • In the same month Chinese police reportedly visited the Shanghai office of another British pharmaceutical major AstraZeneca for investigation related to this scam.
  • In August 2013, Sanofi of France reportedly said that it would cooperate with a review of its business in China after a whistle-blower’s allegations that the company paid about US$ 276,000 in bribes to 503 doctors in the country.
  • Again in August 2013, a former employee of the Swiss pharmaceutical major Novartis has reportedly claimed that her manager urged her to offer ‘kickback’ to doctors to increase use of the cancer drug Sandostatin LAR. She had about US$ 105,000 budget for payments to doctors who prescribed at least 5 doses, aiming for 50 doses in all. She filed the compensation claim of US $817,000 after resigning from the company.
  • In the same month, another whistleblower has reportedly made bribery allegations involving Eli Lilly of the United States and US$ 4.9 million in purported kickbacks to Chinese doctors.
  • In September 2013, media reports indicated that the Chinese authorities are investigating the German pharma major – Bayer over a “potential case of unfair competition”.
  • Another very recent report of September 17, 2013 states, Alcon Eye Care division of Novartis is investigating allegation of fabricated clinical trials to bribe doctors. The report says Alcon outsourced the trials to a third-party research company, which in turn compensated doctors with “research payments”. It is claimed by the whistleblower that Alcon used funds earmarked for “patient experience surveys” on lens implants to bribe doctors at more than 200 hospitals. One doctor received about US$ 7,300, for studying 150 patients. Alcon allegedly spent more than US$ 230,000, on such studies last year.

This list of pharmaceutical companies involved in alleged serious malpractices to boost their sales and profits in China is probably not exhaustive.

However, only time will unravel whether this juggernaut of scams will keep moving unabated despite all high voltage actions, bulldozing patients’ interest.

Crack down on food companies too:

Crack down of the Chinese Government on alleged malpractices has reportedly extended to milk products’ companies too.

Again in August 2013, Mead Johnson Nutrition and Danone were among six dairy companies ordered to pay a combined 669 million Yuan by the Chinese Government for price fixing of their products.

Global industry lobby has a different view point:

In an interview with the BBC, an expert from APCO Worldwide, considered as the giant of the lobbying industry said:

“China’s behavior was very worrisome for foreign companies. They don’t know what’s hitting them right now. The government is resorting to its traditional “toolbox” of coercive methods, including shaming and ordering people to confess that they’ve done wrong so that your penalties can be minimized. They’re just treating foreign companies the way they’ve treated their own for many years, and this is the way the Party does things.”

He continued, “What may be going on is they’re telling foreign companies and they’re telling private companies here: Behave yourself; remember we’re the Party, we’re in charge.”

This is seemingly an interesting way of pooh-poohing serious allegations of bribery and other malpractices by the pharmaceutical companies in China without even waiting for the results of the pending enquiry.

However, such comments coming from an industry lobbying organization or any Public Relations (PR) Agency is not uncommon. That’s their business.

Possible reasons for crack down:

Experts opine that China has a high drug price problem. This is vindicated by the fact that while most developed nations of the world spend not more than 10-12 percent of their healthcare budget on medicines, in China it exceeds 40 percent. This huge disparity is believed to have prompted Beijing’s crackdown on the industry, especially the MNCs that dominate the Chinese pharmaceutical industry with newer drugs. The powerful National Development and Reform Commission (NDRC) of China has already said that it is examining pricing by 60 local and international pharmaceutical companies.

Some other reports point out, low basic salary of the doctors at the 13,500 public hospitals in China, who are the key purchasers of drugs, is the root cause of corruption in the Chinese healthcare industry.

According to McKinsey with estimated healthcare spending of China nearly tripling to US$1 trillion by 2020 from $357 billion in 2011, the country is increasingly attracting pharma and medical equipment companies from all over the world in a very large number.

The fall out:

A recent media report indicates that Chines crackdown on the widespread pharma bribery scandal in the country is quite adversely affecting the sales of both global and local players, as many doctors in the Chinese hospitals are now refusing to see medical representatives for fear of being caught up in this large scam.

Drug expenditure is even more for healthcare in India:

Several studies indicate that Out Of Pocket Expenditure towards Healthcare in India is one of the highest in the world and ranges from 71 to 80%.

According to a 2012 study of IMS Consulting Group, drugs are the biggest expenditure in the total Out Of Pocket (OOP) spend on healthcare as follows:

Items Outpatient/ outside Hospital (%) Inpatient/ Hospitalization (%)
Medicines 63 43
Consultation/Surgery - 23
Diagnostics 17 16
Minor surgeries 01 -
Private Consultation 14 -
Room Charge - 14
Others 05 04

Despite these facts, India has remained virtually inactive in this critical area so far, unlike China, except some sporadic price control measures like, Drug Price Control Order (DPCO 2013) for essential drugs (NLEM 2011), which covers around 18% of the total pharmaceutical market in India.

Universal Healthcare (UHC): A possible answer?

Another interesting study titled, ‘The Cost of Universal Health Care in India: A Model Based Estimate’ concludes as follows:

The estimated cost of UHC delivery through the existing mix of public and private health institutions would be INR 1713 (USD 38) per person per annum in India. This cost would be 24% higher, if branded drugs are used. Extrapolation of these costs to entire country indicates that Indian government needs to spend 3.8% of the GDP for universalizing health care services, although in total (public+private) India spent around 4.2% of its GDP on healthcare (2010) at 11% CAGR from 2001 to 2010 period.

Moreover, important issues such as delivery strategy for ensuring quality, reducing inequities in access, and managing the growth of health care demand need be explored.

Thus, it appears, even UHC will be 24% more expensive after a public spend of staggering 3.8% of the GDP towards healthcare, if branded drugs are used, which attract huge avoidable marketing expenditures, as we have seen in the Chinese pharma industry scandal.

High marketing costs making drugs dearer?

A recent article, captioned “But Don’t Drug Companies Spend More on Marketing?” vindicates the point, though the drug companies spend substantial money on R&D, they spend even more on their marketing related activities, legally or otherwise.

Analyzing six global pharma and biotech majors, the author highlights that SG&A (Sales, General & Administrative) and R&D expenses vary quite a lot from company to company. However, in this particular analysis the range was as follows:

SG&A: 23% to 34%
R&D: 12.5% to 24%

SG&A expenses typically include advertising, promotion, marketing and executive salaries. The author says that most companies do not show the break up of the ‘S’ part separately.

In the pharmaceutical sector all over the world, the marketing practices have still remained a very contentious issue despite many attempts of self-regulation by the industry. Incessant media reports on alleged unethical business practices have not slowed down significantly, across the world, even after so many years of self-regulation. This is indeed a critical point to ponder.

Scope and relevance of ‘Corporate Ethical Business Conducts and Values’:

The scope of ‘ethical business conducts and value standards’ of a company should not just be limited to marketing. These should usually encompass the following areas, among many others:

  • The employees, suppliers, customers and other stakeholders
  • Caring for the society and environment
  • Fiduciary responsibilities
  • Business and marketing practices
  • R&D activities, including clinical trials
  • Corporate Governance
  • Corporate espionage

That said, codes of ethical conduct, corporate values and their compliance should not only get limited to the top management, but must get percolated downwards, looking beyond the legal and regulatory boundaries.

Statistics of compliance to codes of business ethics and corporate values are important to know, but perceptible qualitative changes in ethics and value standards of an organization should always be the most important goal to drive any business corporation and the pharmaceutical sector is no exception.

Foreign Corrupt Practices Act (FCPA): A deterrent?

To prevent bribery and corrupt practices, especially in a foreign land, in 1997, along with 33 other countries belonging to the ‘Organization for Economic Co-operation and Development (OECD)’, the United States Congress enacted a law against the bribery of foreign officials, which is known as ‘Foreign Corrupt Practices Act (FCPA)’.

This Act marked the early beginnings of ethical compliance program in the United States and disallows the US companies from paying, offering to pay or authorizing to pay money or anything of value either directly or through third parties or middlemen.

FCPA currently has some impact on the way American companies are required to run their business, especially in the foreign land.

However, looking at the ongoing Chinese story of pharma scams and many other reports of huge sums paid by the global pharmaceutical companies after being found guilty under such Acts in the Europe and USA, it appears, levy of mere fines is not good enough deterrent to stop such (mal)practices in today’s perspective.

China acts against pharma bribery, why not India? 

Like what happened in China, many reports, including from Parliamentary Standing Committee, on alleged pharma malpractices of very significant proportions, which in turn are making drugs dearer to patients, have been coming up in India regularly, since quite sometime.

Keeping these into consideration, abject inertia of the government in taking tough measures in this area is indeed baffling and an important area of concern.

Conclusion:

The need to formulate ‘Codes of Business Ethics & Values’ and more importantly their effective compliance, in letter and spirit, are of increasing relevance in the globalized business environment.

Unfortunately, as an irony, increasingly many companies across the world are reportedly being forced to pay heavy costs and consequences of ‘unethical behavior and business practices’ by the respective governments.

Intense quarterly pressure for expected business performance by stock markets and shareholders, could apparently be the trigger-points for short changing such codes and values.

There is, of course, no global consensus, as yet, on what is ethically and morally acceptable ‘Business Ethics and Values’ uniformly across the world. However, even if these are implemented in country-specific ways, the most challenging obstacle to overcome by the corporates would still remain ‘walking the talk’ and ‘owning responsibility’.

That said, to uphold patients’ interests, China is already giving the perpetrators of the ongoing humongous pharma scam a ‘run for life’, as it were, despite what the industry lobbyists have been laboriously working on for the world to believe. Today, common patients’ in India being in a much worse situation for similar sets of reasons, should the domestic regulators not now wake up from the ‘deep slumber’, up all antennas, effectively act by setting examples and bring the violators to justice?

By: Tapan J. Ray

Disclaimer: The views/opinions expressed in this article are entirely my own, written in my individual and personal capacity. I do not represent any other person or organization for this opinion.