Tag Archives: Physician

Tame Physicians’ Digital Fatigue With Brand Message Overdose

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“The COVID-19 pandemic forced pharmaceutical companies adopt digital-first marketing models when in-person strategies were inaccessible, but health care practitioners report they’re becoming increasingly inundated with information and the shift to virtual marketing isn’t meeting their needs.” This was the finding of a new research of Indegene, published on March 02, 2022. The survey covers around 1,000 physicians from the U.S., Europe, China, and India.

Currently, many HCPs construe that pharma’s increasing frequency of digital outreach – involving several digital channels and various touch points, primarily to push product-related promotional information, is excessive. Continuity of such feelings could be counterproductive to the desired intent of drug companies.

Therefore, the point that surfaces: Is the digital marketing drive of many pharma marketers, even when the Covid pandemic is in a waning phase, ‘overwhelming’ some Key Opinion Leaders (KOL)? More important is to fathom, how to address it? Today’s article will focus on this emerging issue. Let me begin with a few other key findings of this paper.

Some other key findings of the survey:

Some of the major findings of the above survey include:

  • Digital marketing channels for HCPs most commonly include webinars, social media outreach, emails and text messaging from reps and self-directed web and remote detailing.
  • While HCPs are becoming more familiar with digital technologies, 62% of them feel ‘overwhelmed’ by product-related promotional content they receive from pharma companies through various virtual channels.
  • 70% feel that drug companies are out of touch with their information needs and expectations from new drugs, besides other products and services.
  • 63% HCPs expect pharma companies to share only relevant content with them – over channels of their preferences, and at a time of their convenience, to make the interactions more insightful.

At this point, let us also have a glance at the findings of other recent surveys, as well, in this space.

Other surveys also point in the same direction:

Yes, other surveys also vindicate this point. For example,

A. Just prior to the above study, on December 07, 2021, Accenture published the findings of their own study in this regard, which includes the following:

  • 65% of HCPs feel that several pharma companies have “spammed” them with digital content as the COVID-19 pandemic went through several waves.
  • The firms need to do more to better understand and meet HCP expectations (56%) and their patients (60%) due to COVID-19.
  • When pharma companies do more, 80% of HCPs would be twice as likely to meet the pharma reps with more time and attention.
  • Almost half of the HCPs surveyed (46%) prefer a mix of in-person and virtual meetings focused on the needs of their patients, as the COVID-19 pandemic ends.

B. Another study on this subject was published in PLOS ONE, on April 16, 2021. This study focused on pharma Webinars. As many will be aware, Webinars comprised a major avenue for customer engagement during COVID-19 – creating initial general satisfaction among physicians.

This, in turn, led to an increase in webinar usage in 2020 compared to the same period in 2019, with more than 300% in one study and up to 3250% in another. Which is why, despite the initial satisfaction – over a period, most physicians ‘felt overwhelmed with the number and frequency of webinars.’

Hence, customer satisfaction being crucial in any engagement process, Webinars may now be used with a purpose to complement traditional in-person methods, rather than replacement, study concluded.

What exactly doctors want to know in the new normal?

Against the above new backdrop – the issue is, how can pharma marketers engage the HCPs without overwhelming them, mostly with continuous, too frequent and wave after wave digital contents. This point was addressed in a Fierce Pharma article, published on February 16, 2022. It quoted some doctors saying, such as:

  • “If I’m a [high prescriber], great, remind me about efficacy.”
  • “But I also want to know who’s the right patient for this drug.”
  • “I want to know what access is like.”
  • “What types of patient savings programs are available?”
  • How can I support my patient, so they stay on the drug—because I believe in it.”
  • “If I’m a non-writer, I want to know how the mechanism of action is different?” “How does this drug show up in the guidelines?”
  • “Is there head-to-head data versus another drug?”

Reps digital training demands a fresh focus:

Educating or updating doctors through Continuing Medical Education (CME) programs is an ongoing process for drugmakers. It remained so with remote digital channels during the pandemic, as well. Whereas, selecting digitally savvy reps, training and helping them to be “flexible and efficient” in using digital channels and content, based on HCP preferences – demands a fresh focus.

As some of the above studies also emphasized that significantly reducing the number of reps because of wider use of remote digital platforms, may not be advisable at this juncture. This is despite some companies are now doing it – both globally and locally. For example, on January 12, 2022, Reuters reported: ‘Pfizer to cut U.S. sales staff, as meetings with healthcare providers move to virtual.’

On the contrary, I reckon, most reps will need fresh training to ‘go beyond the product script, particularly if a given doctor has seen plenty of digital product info already.’ The same paper further suggests: “Reps should focus on conversations that make the interactions insightful – and avoid driving product information fatigue.” 

Conclusion:

With the intensity of Covid-19 pandemic subsiding, many HCPs feel that they’re getting too much digital content from pharma companies. While they aren’t totally averse to digital communication, several of them expressed by being increasingly “spammed” as the time progressed.

For making pharma companies’ engagement with their customers in the changing times, this issue needs to be effectively addressed, soon. The companies will need to select and deploy marketers with a deeper understanding of what HCPs are looking for, to make new digitally focused marketing more meaningful to them – fetching greater business return.

Some studies also signaled that significantly reducing the number of reps – as less staff is required for digital engagement with doctors, may not be prudent at this stage. Instead, the companies need to upskill their digitally savvy reps ‘to integrate remote and digital touchpoints successfully with their in-person touchpoints.’

All these new initiatives when taken in tandem and well-integrated manner, will help meet doctors’ engagement preferences. In that process, pharma players will succeed in taming physicians’ digital fatigue with product-communication overdose, especially, in today’s time – making their marketing efforts more productive and meaningful to HCPs.

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.

 

 

Why And How To Be In-Sync With Gen Z As Pharma Paradigm Shifts?

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As science and technology, across the world, are progressing at a scorching pace – Covid-19 pandemic notwithstanding, today’s generations are growing up tech savvy – more than ever before. The trend will keep going north faster and with a steeper gradient. This is being driven by transforming social and economic environments – necessitating quicker solutions to any needs, problems, and expectations.

The current signals, as underscored by an article appeared in the Abbott Website on November 19, 2019: ‘Generation Z’s relationship with technology will also influence how the group relates to healthcare.’ Thus, it’s no secret that millennials approach their health care in drastically different ways than members of the Silent Generation, baby boomers or Gen Z, the article added.

Which is why, gradually shifting paradigm of the pharma industry would also eventually create a brand new one – with the Gen Z population growing at a faster pace. From the above perspective, in today’s article, I shall focus on the importance of this shifting paradigm, especially from the pharma industry perspective, including India.

Expectations and experience of Gen Z are contrasting:

Let me start with the definition of Gen Z. In January 2019, Pew Research defined Gen Z as anyone born after1996, just as ‘anyone born between 1981 and 1996 (ages 23 to 38 in 2019) is considered a Millennial.’ Gen Z grew up with technology, the internet, and social media. Moreover, according to another study of Pew Research, published on May 14, 2020, Gen Z is growing up having experienced catastrophic disruptions in almost all spheres of life and livelihoods, triggered by Covid-19 pandemic. It further ascertained, ‘the oldest Gen Zers have been particularly hard hit in the early weeks and months of the Coronavirus crisis.’

Thus, I reckon, the experience and expectations of many of such Gen Z from business and overall environment around – are quite different from earlier generations. More importantly, they will also have a strong influence on younger ones. Hence, the expected transformation would be much broader than what is currently visible today on the ground.

Some core characteristics of Gen X from pharma business perspective:

Various studies have captured the core characteristics of Gen Z, some of which are very relevant to pharma industry and are worth taking note of – for excellence in business performance. These include the followings:

Digital natives:

As McKinsey & Company highlighted in an article, published on November 12, 2018 that Gen Z is the first generation of true digital natives, and they are expanding. Whereas Millennials were regarded as ‘digital pioneers,’ who bore wit­ness to the explo­sion of tech­nol­o­gy and social media, Gen Z populations are born into a world of peak tech­no­log­i­cal inno­va­tion. In that environment infor­ma­tion is imme­di­ate­ly acces­si­ble and social media becoming increas­ing­ly ubiquitous – endorses another study by the Casey Foundation with its own findings on the core characteristics of Gen Z.

Financial minded:

Finan­cial mind­ed­ness is anoth­er core char­ac­ter­is­tic of Gen­er­a­tion Z for several reasons. A major one being, as discussed – many of them grew up witnessing unprecedented impact on lives and livelihoods caused by Covid-19 pandemic. Several other studies, like the one published recently by the Harvard Pilgrim Healthcare, indicates that millennials and Gen Z are especially sensitive to healthcare costs.

Shrewd consumers and cost-value conscious:

Gen Z show characteristics of shrewd consumers and are also cost-value conscious. Being tech savvy, they are more influenced by fast-expanding digital, world and would like to make well-informed purchasing decisions after evaluating a range of options – both for products and services. They tend to be more influenced by the experience of real-life users, rather than a celebrity endorsement and val­ue per­son­al­ized prod­ucts.

Gen Z to herald metamorphosis of future healthcare:

That it is happening gets retreated in the caption of the Fierce Healthcare article of June 16, 2020 – ‘Industry Voices -Generation Z is a game changer for healthcare.’ It emphasized, ‘Generation Z – are likely to turn the health industry on its head with their unique expectations for how healthcare should be delivered.’

Convenience is such a paramount for Gen Z that they are often willing to forgo a personal relationship with their healthcare provider. Besides, they will come to their physician and provider armed with data, information, and knowledge, unlike the past generations. Consequently, the danger for providers is, if Gen Z doesn’t get that desired convenience, they’ll go elsewhere, the article says. Simultaneously, ‘they also want a trusted adviser who can guide them toward holistic health and wellness.’ Thus, delivering patient-centric care, capitalizing on real-world data and automated care experiences, will be key to the transformative process of healthcare.

A recent survey also vindicates that the transformation has begun:

A recent Accenture healthcare consumer survey reiterated: “The new healthcare consumer is here.” The study clearly signaled a paradigm shift in this space spearheaded by millennials and Gen Z. Some of the survey findings encompass the following areas:

  • This group of healthcare consumer expectations for convenience, affordability and quality are redefining how they engage at each stage of care.
  • They are most dissatisfied with health care’s status quo and more willing to try non-traditional services, such as, virtual care and retail walk-in clinics, which are gaining in popularity and use with them.
  • With greater health care needs, they will increasingly look for services to satisfy their expectations for effectiveness, convenience, efficiency, and transparency.
  • With millennials and Gen Z to become the largest generation in not-too-distant future, they hold the most power to influence future healthcare models.

Some pharma players are tracking Gen Z and the changing paradigm:

Some global majors, such as Abbott, are also writing about it in their website Abbott.com. The Company has noted some of these changes, as follows:

  • Generation Z’s relationship with technology will influence how the group relates to healthcare. While growing up in a fully connected world, they ‘are less likely to have primary care providers and are more likely to use apps for scheduling, viewing medical records and paying bills.’ They are also more receptive to telehealth visits and connected healthcare than previous generations.
  • With the wait times for an appointment with a doctor growing longer, Gen X populations are more likely to use walk-in clinics or opt for urgent care centers which are more convenient.
  • Self-service and convenience play into Gen Z’s interactions with doctor’s and the industry as a whole. They prefer email, texting, and apps to manage their appointments or communications with doctors. Finding ways to communicate with this younger generation in their preferred modes, can help keep them engaged with the industry.
  • Millennials and Gen Z populations are most likely to use a wearable device. They typically reach out to friends or online communities to ask about a particular health condition before speaking with a doctor. Although they aren’t the groups using the more healthcare services, millennials and members of Gen Z are showing what the health industry needs to do to provide the best care.

Size of Gen Z population in India:

According to EY Gen Z survey, released on November 04, 2021, the next decade will be shaped by the maturation of Gen Z, the largest generational cohort in history, where India stands out with a population that includes 375 million people or 27% of the total population in Gen Z. Besides, the survey also underscores the importance of Gen Z in the shifting paradigm of market dynamics for the pharma industry, as well.

Conclusion:

Currently, healthcare industry, in general, and most drug companies, in particular -especially, in India, don’t seem to nurture the fast-growing population of Gen Z with a customer engagement strategy that they can relate to. What these players are currently marketing is mostly aimed at traditional customers, and who still form the majority.

Exploring these evolving changes, I wrote an article in this blog, on November 07, 2016. This was titled ‘Millennial Generation Doctors And Patients: Changing Mindset, Aspirations, And Expectations.’ However, the unprecedented impact of Covid-19 pandemic, alongside rapid advancement and adaptation of digital technology, tools, and platforms, has expedited this process.Apace with these changes the pharma paradigm is also shifting, at a much faster pace than ever before. Which is why, I reckon, it’s important for the entire health care industry in India to be in-sync with Gen Z expectations and engage them, accordingly.

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.

 

Deliver The Best Patient Outcomes With Right High-Tech-High-Touch Combo

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Healthcare is regarded as an industry where high-quality technology and high-quality human touch can’t possibly be separated from each other, ever. Since long, this is considered essential in delivering better treatment outcomes – the core value most patients desire, and buy – directly or indirectly.

Why high-quality technology helps make treatment of various diseases increasingly more effective, is no-brainer. However, amid high decibel ‘digital’ buzz during Covid-19 pandemic, some may also wonder how does ‘high-touch’ help improve treatment outcomes? Against this new backdrop, I shall explore in today’s article: why high-touch is so important for most patients alongside high-tech, and the critical need of striking a right balance between high-tech and high-touch in most areas of healthcare delivery. Let me start with a brief recap of the same in the pharma industry perspective. 

Balancing high-tech and high-touch in pharma – a brief recap:

In a similar context – against the  contemporary market dynamics, I discussed about Pharma’s new and still evolving pathway for digital and F2F customer engagement on February 15, 2021. This is primarily because, today’s patient-centric marketing model has to be on Omnichannel platforms to deliver patient-expected value, effectively – and more.

In this mix, F2F customer engagement process is just one among several channels – but a critical brand demand generation tool, though – giving a feel of ‘high-touch’ – in-person interactions to many key customers. Many studies show, alongside acceptance of ‘high-tech’ digital channels, customer expectations for ‘high-touch’, by and large, continue to exist, even today. Thus, one of the key responsibilities of pharma marketers is to arrive at the optimal combination of in-person F2F engagement channel, and high-tech digital channels for remote engagement.

However, this isn’t the unique need of the new normal. On April 29, 2019, I wrote about the evolving new pathway is a hybrid business model. It is customer-centric and helps create a right blend of high-tech and high-touch approaches. Striking an optimal balance between the two is critical to successful business outcomes. This brings me to the point of the relevance of ‘high-touch’ in healthcare.

The relevance of ‘high touch’ in healthcare:

Since time immemorial, a strong bond of trust-based doctor-patient relationship has remained pivotal in the disease treatment process, across the world. This still exists regardless of the socio-economic status, and degree of patient literacy, including digital – particularly for moderate to severe ailments.

A recent article – ‘High-Touch Telemedicine’, published by CFHA on June 04, 2020, also highlighted, “Touch has been central to the physician-patient relationship for as long as there have been physicians. Patients allow their doctors to touch them in places and in ways that they would allow to no one else.  The gentleness and the carefulness that doctors are trained to use on this touch is a bonding experience that supports healing.  If this trust is violated, if a doctor is unduly forceful or disrespectful, this can be a cause for grievance and even litigation.”

The scientific pertinence of physicians’ high touch for patients:

This point was lucidly elaborated in the above paper. It said, the doctor’s comforting physical touch, and interactional touch, have impacts on the Neuroendocrinology of the patients involved. Thus, physicians’ high touch when used in a benevolent conversation, releases the neuropeptide oxytocin in the brains of both participants. This, among others, helps to improve recognition of emotions, increase mutual trust, so compliments and the recognition of a person’s efforts and successes.

Covid-19 propelled ‘high tech’ in healthcare to a new high sans ‘high touch’:

The Covid-19 pandemic, undoubtedly, propelled healthcare into a virtual world. It triggered the development of a plethora of ‘high tech’ innovations to deliver prompt healthcare to patients suffering from various ailments, even from remote locations. One such example is telehealth. Many healthcare providers, including the Government of India realized that leveraging the potential of ‘Telemedicine’ can effectively address the healthcare needs of a large population, across the world.

That said, I reckon, although, healthcare can’t survive without high tech. But, a high-tech-healthcare, like telemedicine, can’t totally replace high touch, at least, in the treatment process of several moderate to severe ailments.

The Best and the worst-case scenario for only high-tech healthcare:

As studies indicate, only high-technology based healthcare sans high-touch, in the best case scenario, would facilitate affordable access to treatment for more patients, bringing down administrative time and cost, in tandem. Which is why, when Covid-19 pandemic posed unique challenges to providing health care, India’s health policy makers revised the nation’s Telemedicine Practice Guidelines on March 25, 2020. They acknowledged in the manual, high-tech Telemedicine ‘increases timely accessto appropriate interventions, including faster access and access to services that may not otherwise be available’.

Whereas, in a worst-case scenario, only digital access to healthcare may create some barrier to direct physical examination of the patient by the doctor, and their interaction. This may impact patient emotion – so important in the disease treatment process. Thus, although high-tech is essential for the advancement of healthcare, but can’t totally replace a patient’s need for high touch care.

High tech is essential, but can’t replace high touch-based trust:

Several recent papers deliberated this point with umpteen evidences. One such paper was published in the Harvard Business Review on October 30, 2019. The article is titled, ‘AI Can Outperform Doctors. So Why Don’t Patients Trust It?

The research points out, ‘patients are reluctant to use health care provided by medical artificial intelligence, even when it outperforms human doctors. This is because, patients believe that their medical needs are unique and cannot be adequately addressed by algorithms. To realize the many advantages and cost savings that medical AI promises, care providers must find ways to overcome these misgivings.’

The study also found that when health care was provided by AI rather than by a human care provider, patients were less likely to utilize the service and wanted to pay less for it. They also preferred having a human provider perform the service even if that meant there would be a greater risk of an inaccurate diagnosis or a surgical complication.

Given a choice – ‘patients will always highly value and seek out human touch’:

This point was also deliberated in another study, published in the MedCity News on January 14, 2021. Acknowledging: ‘Effective, modern medicine cannot survive without technology,’ it brought to the fore an important finding: ‘Regardless of how intuitive the software – or how advanced the technology – patients will always highly value and seek out human touch’ because of several reasons. Some of which are as follows:

  • Patients believe that their medical needs are unique and cannot be adequately addressed by algorithms. Patient experiences aren’t meant to be 100% digital. And despite the accuracy of computers, humans prefer to seek care from other human beings.
  • Different patients have different emotional needs. Life-altering diagnoses and unforeseen outcomes are best delivered by a living, breathing, feeling individual who can fully understand and address these needs.
  • Physical examinations by a doctor are more reassuring and restorative for patients.

The author concluded, high tech is absolutely necessary for the progress of health care, in general. However, in the foreseeable future, high touch would remain an instrumental part of patients’ healthcare experience.

I believe, one can even experience it as the Covid-19 safety restrictions will start easing, or even now – to some extent. Therefore, ‘healthcare professionals must find a way to blend the sophistication of technology with the power of touch in order to continue improving patient experiences, care, and outcomes’, the paper underscores.

Conclusion:

Just as in the pharma business, a right-mix of high-tech and high-touch is also necessary in overall healthcare space, to deliver the best health outcomes to patients. After initial disruptions, a similar trend is emerging even in the new normal. No doubt, usage of high-tech digital platforms is here to stay, and further improve in the years ahead. But, digitalization alone in the healthcare space, should not be construed as something that can make high-touch totally irrelevant or redundant in a patient’s journey for disease treatment.

The mindset of mutual exclusiveness of high-tech and high-touch, if any, either during patient-treatment or in the customer engagement process needs a revisit. As it appears, it is neither desirable in customer engagement, nor in patient treatment processes – akin to one approach suits all. This is because, healthcare is very personal to patients – more than most other areas. A lot of individual feelings and emotions are involved in patients’ end-to-end journey for treatment, where only high tech-based solutions may not meet all patient expectations – sans high-touch of physicians, as I deliberated above.

Thus, effective integration of high-tech-healthcare with high-touch of physicians, nurses, and some technicians, is evolving as the right way to deliver patient expected values, for better health outcomes. From this perspective, alongside most other stakeholders, astute marketers are realizing that high-tech digitalization isn’t a panacea for effective pharma marketing. Delivering the best patient outcomes with the right high-tech-high-touch combo, is the name of the game.

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.

 

Changing Doctors’ Practice Dynamics With Covid-19 And Beyond

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Unexpectedly, the answer to an onerous question surfaced just around a year’s time. In my article on this blog, written on April 08, 2019, I raised a question – “Would ‘Connected Healthcare’ Catch Pharma Players Off-Guard?” Interestingly, an unexpected and abrupt turn of events in the global healthcare space, including India, triggered by Covid-19 pandemic, signals an early dawn of an evolving reality, related to ‘Connected Healthcare’, in India.

Never ever, I reckon, the Government realized so well that continuation with a fragile public healthcare infrastructure is self-defeating for the country. Allocation of financial resources, at least 2.5 percent of the country’s GDP, for its rejuvenation – powered by AI-based modern digital technology, would help avoid overburden on the healthcare system. This will mean, saving more lives and also a significant reduction of morbidity, especially in a situation, like Covid-19 pandemic. Good health can propel good economy, more effectively.

That’s why, ‘connected healthcare’ – by effectively linking requisite ingredients of all health-related information that medical professionals and the patients would need, appears to be the new reality. This process is being facilitated by rapid acceleration of usage of various digital platforms, by both healthcare consumers and providers. Thus, it is becoming increasing clear now that leveraging digital technology with innovative mindset and a fresh pair of eyes, will be the way forward, in India, as well. It seems very likely, when considered from two angles:

  • What several research data reveals about an increase in usage of digital platforms by healthcare consumers and providers, before and during Covid-19 pandemic. Especially because, this struggle appears to be for a long haul.
  • Most countries are currently struggling to navigate through highly contagious Covid-19 outbreak and simultaneously trying to chart a workable pathway for avoiding similar eventualities in the future.

In this article, I shall try to focus on Covid-19 induced changes in doctors’ practice dynamics – based on research studies, while revisiting the subject on ‘connected healthcare,’ and its relevance now – also in the years ahead.

Research studies capture a new and growing awareness: 

The recent findings from the “Digital Doctor 2020” survey, which is a ‘21-country study of Doctors’ perspectives on digital and connected health, highlight some interesting points. This study was conducted just before the global outbreak of Coronavirus. Some of its findings were also deliberated inan article published in the PharmExec.com on April 23, 2020. The paper is titled, ‘How Prepared Were Physicians for the COVID-19 Digital Upswing? Some of the key points, as reported, are worth noting:

  • Although, the awareness of drug prescribers of different digital technologies related to healthcare is high, how these technologies work in healthcare was unknown to many doctors at the time of the Digital Doctor 2020 survey. It came out that clear benefit statements, will be welcomed when there is such a steep learning curve.
  • Regardless of face-to-face interactions still remaining preferred choice before the pandemic, online channels are on the rise and accelerating with COVID-19 lockdown.
  • Benefits of using connected health devices for patient management and treatment are widely recognized and is believed to play a key role in the future. The respondents agree, even their patients are now more interested in their own health data, as they are gaining control over their weight, diet and physical activities.

Highlighting that their research data over the last few weeks showing increasing usage of digital solution to respond and adapt to the new realities of Covid-19 pandemic, the author of the article concluded: ‘For a long time, digital solutions have often been considered an option; now they have become a necessity.’ To understand the emerging scenario, let us now look at the preferred communication channels of the doctors – pre-Covid-19 outbreak. 

Preferred channels of doctors pre-Covid-19 outbreak:

According to the Ipsos survey of pre-Covid-19 outbreak, face-to-face communication with Medical Representatives (MR) used to be the most favored channel of the doctors, as follows:

Channel Med. Rep Speaker Program Conf. E-detail Journal Ads Med. Liaison E-mail Direct mail Pharma website
Pref. % 35.2 11.7 10.0 8.4 8.4 8.8 8.4 5.0 4.1

However, on April 14, 2020, Ipsos shared the results of their interim research conducted, together with M360, among doctors, conducted during Coronavirus outbreak. The preliminary findings indicate, Covid-19 will permanently alter physician practice dynamics. A clear shift in the engagement model with them – away from in-person detailing, throws several significant questions on the traditional physician engagement template of the pharma players.

It also signals another fundamental change in the physicians’ practice dynamics, as Covid-19 seems to have changed practicality of having face-to-face communication between the representatives and doctors, as before. This situation makes ‘connected healthcare’ a reality – as we move deeper into the everyday- evolving scenario.

Some unexpected and significant changes surfaced in a month: 

The above research also flagged, the following two important changes, among several others, triggered by the Coronavirus outbreak:

  • The mean number of sales representative visits dropped from 15.7 before the Coronavirus outbreak to 1.3 in just the following month, during the pandemic 
  • Overall preference and effectiveness of e-detailing also improved, significantly, where any non-personal communication and interaction with drug companies, either through sales representatives or by others, were considered as e-detailing. 

This brings me back to the question, how are doctors feeling about this never before shift in their practice dynamics?

How are doctors feeling about a never before shift in their practice dynamics?

The ongoing research on this critical area captures a new reality, where many doctors, especially those who are not directly engaged in combating the Covid-19 pandemic, are clearly feeling a shift in their practice dynamics. Curiously, the new feeling of a shift also includes, the way these doctors interact with different drug companies, mostly through their Medical Representatives.

These inklings of the doctors are expected to get translated into some fundamental changes in the real-life situation, as we all sail through the life-changing time caused by Covid-19. Especially, considering the requirements of a new normal – social distancing, wearing a mask always while on outdoor, and several other norms as prescribed from time to time.

‘Connected healthcare,’ is expected to take its place on the center stage:

In this situation, ‘connected healthcare,’ which used to be more discussed than practiced, is expected to take its place on the center stage. It is necessary in the present situation for remote consultations, primarily for chronic ailments – for effective disease management and treatment. More so, as in the current situation individual health awareness of a large population, even in India, is increasing with an accelerated speed, perhaps more than ever before.

Thus, this is the right time to focus on ‘connected healthcare’, powered by AI-based digital technology. It has immense potential to help the Indian population getting immediate medical attention at a lower cost, with an improved access, for all. Though these are early days, it appears the ball has started rolling in the right direction, as the recent draft guidelines of the Indian Council of Medical Research (ICMR) indicates: ‘Patient can WhatsApp, SMS or email consent for Covid-19 clinical trials.’

Conclusion:

Still today, there is no sign of even temporary flattening the disease progression curve in India. As on May 10, 2020 morning, the recorded Coronavirus cases continue to climb sharply to 62,939 with 2,109 deaths, which is rising in India faster than most other countries. On May 07, 2020, AIIMS director again warned that Covid-19 pandemic is yet to peak in the country. “According to modeling data and the way our cases are increasing, it is likely that peak can come in June and July,” he added.

But is it getting worse? Despite stringent lockdown, there has been a surge in cases, which can also be attributed to higher levels of testing. However, from a doubling rate of 11.5 days on May 3, it has shortened to 10.3 days, which means that cases are doubling in quicker time. Each set of 10,000 cases is now increasing at a more rapid pace than the preceding set, highlighted an editorial of a leading news daily.

With a vaccine still elusive, the government had been banking mostly on the lockdown to break the chain of transmission of the virus. Meanwhile, the World Health Organization (WHO) has said: ‘Deliberately infecting healthy people with Coronavirus may speed Covid vaccine studies,’ reflecting more uncertainties in this area. It is also not likely that the country will cease to have any problems with its fragile public healthcare infrastructure and delivery system, even after flattening the disease progression curve.

Along with many other Covid-19 induced life-impacting changes, doctors’ practice dynamics are also expected to undergo a metamorphosis, lasting for an indefinite period. Consequently, I reckon, it’s about time, even for the pharma industry to voluntarily adopt ‘connected healthcare’ as a future way of life. One can get a glimpse of it in the Covid-19 clinical trial draft guidelines of the ICMR. Nonetheless, ‘connected healthcare’ comes with a clear signal of reducing the cost of healthcare and improved patient access, having the potential to effectively mitigate a sizeable part of the precipitated healthcare crisis, caused by Coronavirus.

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.

Multi-channel Engagement: A New Normal In Pharma Marketing

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The 2015 Report of AffinityMonitor reconfirms that access to important doctors for pharma Medical Representatives (MRs) continues to decline. Now, fewer than half of all doctors are truly accessible to the MRs, down from nearly 80 percent in 2008. In other words, though MRs continue to be the best way to engage the average physician, this “best way” is steadily getting worse.

However, for physician engagement, all digital channels put together to rank the second highest. These include both digital “push”, such as, email or alerts sent to a physician’s smart phone – followed by telemarketing, direct mail; and digital “pull”, such as content that doctors can access on their own from the Internet, and peer interactions, like webinars.

With the new digital channels emerging, pharma companies will have a wider range of promotional and engagement channels to reach out to not just the doctors, but also other important stakeholders. Additionally, various non-personal marketing channels could also help pharma companies overcome the declining trend of restricted access to physicians for MR.

No single channel works for all physicians:

Although, no single channel works for all physicians, as each doctor has a unique preference for how he or she wants to receive information across various channels, most doctors will engage with pharma players in some way. The findings of this report are based on data compiled from more than 100 pharma brands, including engagements with 632,000 physicians across a wide range of specialty areas, and more than 123 million individual physician interactions.

The report suggests that by understanding those channels on a physician level, and targeting their marketing and promotion accordingly, pharma companies can hone the effectiveness of each physician engagement, and thereby improve sales and marketing productivity considerably, for excellence in business.

Similar trend in India with varying degree of difficulty:

Similar trend, though with varying degree of difficulty, can be noticed in India, as well. Over the past several years, many top pharma companies have been already experiencing the steadily declining quality of access of pharma MRs to many important doctors.

This is primarily due to the number of patients coming to these busy practitioners is fast increasing, and as the doctors are trying to see all these patients within the same limited time that was available to them, as in the earlier days. In tandem, their other obligations of various kinds, personal or otherwise, are also overcrowding the same highly squeezed time space.

Thus, an increasing number of MRs, which has more than doubled in the past decade, is now fiercely competing to get a share of lesser and lesser available time of the busy medical practitioners. Added to this, a gross mismatch between the inflow of doctors with similar prescription potential and ever increasing inflow of patients, is making the situation worse.

Reevaluating traditional marketing and sales communication models:

In this complex scenario, the key challenge before the pharma players is how to make sales communication with the busy medical practitioners more productive?

Consequently, many pharma companies, across the globe, have started reevaluating their traditional sales communication models, which are becoming increasingly expensive with diminishing returns from the MR calls.

As I discussed in some other article, a few drug companies have commenced using various interesting multi-channel digital platforms, though mostly fall under the traditional pharma sales communication process.

I shall now briefly glance over the trend of responses of the Indian pharma companies over a couple decades, to meet these challenges of change.

MR based Experimentations:

With a strong intent to squarely overcome this challenge, many Indian pharma players initially tried to experiment with several different MR based approaches, in various permutations and combinations. It was initially directed to make the prescription generation process more productive, by equipping the MR with a wide range of soft skills.

Some pharma players also tried to push up the overall sales productivity through additional rural market coverage to Tier IV cities and below. Quite a few of them succeeded in their endeavor to create profitable business models around the needs of hinterland and rural geographies.

These pharma players, though quickly realized that extra-urban geographies require different tactical approaches, broadly remained stuck to the traditional marketing and sales communication models. These approaches include, differentiated product portfolio, distribution-mix, pricing/packaging and promotional tools, considering most the doctors are not as busy as their counterparts in the metro cities and large towns.

Strategic marketing based experimentations:

Several changes were also made in the strategic marketing areas of pharma business, though most of these, if not all, were imbibed from the global marketing practices of that time. These were well captured in an IMS report of 2012. Some of these strategic marketing shifts were as follows:

  • Strategic Business Unit Structure (SBU): To bring more accountability, manage evolving business needs and use the equity of organization for reaching to the middle of the accessible pyramid.
  • Therapy Focus Promotion: Generally seen where a portfolio is specialized, therapy focused, and scripts are driven through chosen few doctors; generally, in chronic segment.
  • Channel Management: Mostly adopted in OTC /OTX business; mature products with wider portfolio width.
  • Hospital Task Force: Exclusively to manage the hospital business.
  • Specialty Driven Sales Model: Applicable in scenarios where portfolio is built around 2 or 3 specialties.
  • Special Task Force: Generally adopted for niche products in urban areas, such as fertility clinics or for new launches where the focus is on select top rung physicians only.
  • Outsourced Sales Force: Generally used for expansion in extra-urban geographies or with companies for whom medico marketing is secondary (such as OTC or Consumer Healthcare companies).

Pharma MNCs did more:

In addition, to increase sales revenue further, many pharma MNCs engaged themselves in co-promotion of their patented products with large local or global pharma companies operating in India, besides out-licensing. A few of them pushed further ahead by adopting newer innovative promotional models like, Patient Activation Teams, Therapy Specialists, or creating patient awareness through mass media.

Realizing quickly that patients are increasingly becoming important stakeholders in the business, some of the pharma MNCs started engaging them by extending disease management services, along with a clever mix of well-differentiated tangible and intangible product related value offerings, such as, Counseling, Starter kits, Diagnostic tests, Medical insurance, Emergency help, Physiotherapy sessions, and Call centers for chronic disease management, to name a few. Concerned doctors used to be reported about the status of the patients, who were not required to pay anything extra for availing these services from the MNC pharma companies.

Nevertheless, despite all these, declining productivity of the traditional pharma sales communication models continued, predominantly from the extremely busy and very high value medical practitioners/experts/specialists, as mentioned above.

The critical point that remained unaddressed:

At that time, pharma sales communication kept focusing on customer/market types and characteristics. Most companies missed the emerging order of unique customer preferences towards the medium of sales communication, and differentiated message requirements for each doctor. Not many pharma players could probably realize that MR’s quality of access to doctors for productive sales communication would emerge as one of the most critical issues, and become increasingly complex.

Leveraging technology for an effective response:

Amid all these experimentations with pharma sales and marketing models, a few companies did ponder over leveraging technology to chart a novel pathway for effectively addressing this emerging challenge. They tried to ascertain:

  • Whether the traditional sales approach would continue to be as relevant as opposed to digitally customized sales applications?
  • Whether MRs would continue to remain as relevant in all areas of pharma prescription generation process, in the years ahead?

First major venture in e-marketing:

Towards this direction, in 2013, Pfizer reportedly started using digital drug representatives to market medicines, leaving the decision in doctors’ hands as to whether they would want to see them.

Prior to that, in 2011, a paper published in the WSJ titled, “Drug Makers Replace Reps With Digital Tools” stated that pharmaceutical companies in the United States are downsizing their sales force with increasing usage of iPad applications and other digital tools for interacting with doctors.

Lot many other fascinating experimentations with pharma e-marketing have now commenced in several places of the world, many with considerable initial success. However, most of these efforts seem to be swinging from one end of ‘face-to-face’ sales communication with doctors, to the other end of ‘cyber space driven’ need-based product value sharing with customers through digital tool kits.

Blending the right communication-mix is critical:

Coming back to the AffinityMonitor 2015 Research Report, today pharmaceutical and biotech companies have at their disposal more than a dozen of promotional channels to include in their strategy, spanning across, from traditional methods to digital ones.

Some physicians still want to interact with MRs, others restrict MR detailing, as they prefer to get the required information from various credible websites, directly, and from their peers. One doctor may prefer to regularly use a mobile application for product information, while another similar physician may rarely wish to surf the Web for information to achieve the same purpose. Some others may simply not engage with any sales communication no matter what the channels are. Although overall accessibility to MRs is getting more restricted, some doctors are still more accessible than others, the report finds.

Segmenting doctors by their accessibility to personal promotion, such as, MRs and by non-personal promotion like other channels, including digital, allows pharma companies to identify potential gaps in their marketing approach.

For example, of the 54 percent of doctors who are less accessible to MRs, 15 percent show good accessibility to other channels. In other words, those doctors haven’t closed the door for good, just yet. Pharma companies can still reach them, provided they use the right approach, the report suggests. Drug companies would, therefore, require gathering specific information doctor-wise, and customizing both the medium and the message for effective brand value delivery, accordingly.

Sales and marketing avalanche too isn’t working:

This study revealed that a pharma company’s top 100 doctors receive as high as 423 contacts a year, and the top 10 doctors receive more than 600 each year. Given such volume, it’s easy to imagine how doctors can start to get buried under an avalanche of sales and marketing. It’s also easy to see how even the right message, in the right channel, to the right doctor, could get lost in all the noise, and may even create a bad customer experience for many physicians, the report concludes.

Conclusion:

The decline in pharma MR’s quality of access to physicians for brand communication is now well documented. Moreover, ‘one size fits all’ type of message, delivered even by the best of MRs, is unlikely to be productive in the changing macro environment.

Therefore, the right knowledge of whether a doctor would prefer to engage through traditional marketing and sales communication methods by meeting with an MR, or would just prefer to get his/her required information through any digital medium, is critical for success in the new ball game. This in turn will help generate the desired level of prescription support for any pharma brand.

Still, a majority the doctors’ choices in India would, possibly, involve MRs, while a good number of other important doctors’ choices may probably be independent of them. Nevertheless, from this emerging trend, it’s clear now that multi-channel engagement would be a new normal in pharma sales and marketing, sooner than later.

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.

Declining MR Access to Doctors Prompts Increased Digital Engagement

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The trigger point for a disruptive change in the pharma marketing playbook now seems to be not just on the horizon, but could soon move to a countdown stage, in India.

On Friday, September 16, 2016, at a seminar on the Uniform Code of Pharmaceutical Marketing Practices (UCPMP) organized at Bengaluru, Sudhanshu Pant, Joint Secretary (Policy), Department of Pharmaceuticals (DoP), India, reportedly said that the mandatory UCPMP is now in its last leg of clearance with the Union Government, after incorporating the inputs received from the pharma industry and other stakeholders.

He clearly articulated in his address, once a level playing field is created with mandatory UCPMP, both the pharma industry and the medical professionals will be restricted to offer and receive freebies, respectively, which is the in-thing today to generate prescriptions from the doctors.

“Our intent is that the new code should be followed in letter and spirit. It is not a draconian law, but penalties are stringent. We are enforcing fines. The violation of this code could also lead to suspension of product marketing,” the joint secretary further clarified.

Signals a forthcoming change:

Effective implementation of the mandatory UCPMP across India, could catalyze significant changes in the allegedly dubious pharmaceutical marketing process in India, revolving round ‘give and take’ of enticing ‘freebies’ to the prescribers. According to several reports, some of these practices are followed in the guise of ‘brand-reminders’, and several others fall under ‘events associated with Continuing Medical Education (CME), mostly arranged in various exotic places around the world, with associated hospitalities and equivalents. Besides, there exists a host of different kinds of ‘carrots for prescriptions’ of numerous types, forms and costs, as highlighted frequently by the national and international media.

Nevertheless, it is widely believed by many that Medical Representatives (MR) in India are having virtually no access barrier to meet the doctors, as a large number of both the receivers and the givers of the freebies have allegedly financial interest ingrained on meeting each other.

This scenario, I reckon, will change in India with the strict enforcement of mandatory UCPMP by the Government, curbing any possible misadventure by any stakeholder in the space of ethical pharma marketing practices that would impact the health interest of patients, directly.

Drawing a similar example:

One relevant example for India could be drawn from what happened in the United States (US) in this area, relatively recently. To contain wide-spread unethical pharma marketing practices in the US, President Obama administration enacted the Physician Payment Sunshine Act, effective August 1, 2013. This new law, that requires detailed disclosures from both the physicians and the pharma players on giving and accepting the freebies, limited the financial interest of the prescribers to meet with the MRs several times in a year, for face to face product detailing. Consequently, MR access to prescribers for the same started becoming increasingly more challenging.

A number of studies indicate, a large number of doctors have now started considering the delivery of a frequent barrage sales message an avoidable noise, when alternative highly user-friendly platforms are available to keep them up-to-date on various brands.

In the same way, as the new mandatory UCPMP will come into effect in India, it is quite likely that pharma companies operating in the country would start facing similar challenges with MRs visits, especially, to the important busy doctors and for similar reasons.

Digital channels are gaining strength:

With MRs access to physicians gradually declining, many pharmaceutical companies are trying to make the best use of a gamut of customized, innovative marketing approaches pivoted on various digital platforms. These initiatives are primarily to supplement effective engagement with the doctors to generate increasing prescription demand, and in a more user-friendly manner.

The latest study on trend:

There are many studies in this area, but I shall quote the latest one. According to a 2016 study of the global sales and marketing firm ZS Associates: “The number of digital and non-personal contacts that the pharmaceutical industry now has with physicians exceeded its number of sales rep visits to doctor offices.”

Analyzing the data from 681,000 health care providers who actually engage with pharmaceutical and biotech manufacturers across promotional channels, and more than 40,000 pharmaceutical sales representatives (MRs), the study reported, among others, the following:

  • 44 percent of physicians are “accessible” (that is, they met with more than 70 percent of sales reps who try to meet with them). This is a decline from 46 percent in 2015 and nearly 80 percent in 2008.
  • 38 percent of physicians restricted access (that is, they met with 31 to 70 percent of reps who try to meet with them).
  • 18 percent of physicians “severely” restricted access (that is, they meet with 30 percent or fewer reps who try to meet with them).
  • More than half (53 percent) of marketing outreach to physicians now takes place through “non-personal” promotion, such as email and mobile alerts, as well as direct mail and speaker programs.
  • The remainder of marketing to physicians (47 percent) still takes place through in-person interactions with sales reps (MRs).
  • Today’s physician estimates that he or she already spends 84 hours per year – about two full work weeks – interacting with pharma companies via digital and other non-personal marketing channels.
  • Around 74 percent of the physicians use their smartphones for professional purposes.

Another interesting point also emerges from the report. Despite the fact that non-personal communications, including digital, comprise 53 percent of marketing outreach most drug companies still allocate around 88 percent of their total sales and marketing budget to the sales force.

Increasing ‘online professional networks’ for doctors:

Keeping pace with this change several online professional networks for doctors are coming up. One such example is Doctors.net.uk. This is claimed to be the largest and most active online professional network for all UK doctors. Each day over 50,000 doctors make use of Doctors.net.uk to network with colleagues and view information.

This particular online facility provides the doctors with a range of free secure services including an email service, clinical forums, accredited education and medical news, which help them to keep up to date, and to easily maintain their Continuing Professional Development (CPD).

Some digital initiatives of pharma companies:

Here, I would quote just a couple of interesting examples out of several others:

For continuous online engagement with doctors:

In January 2013, the top global pharma major Pfizer launched an online digital platform for the doctors named ‘Pfizerline’. It provides access to the latest information on Pfizer products ‘when, where and how’ the doctors want it. As claimed by the company, ‘Pfizerline’ is regularly updated and forms part of the company’s ongoing commitment to keep the doctors informed about their products and services.

Some say that with ‘Pfizerline’, ‘Pfizer has begun using digital drug representatives to market medicines, leaving the decision as to whether they want to see them in doctors’ hands.’

For new product launch:

According to the Press Release published by PMLive, the first in the pharmaceutical industry ‘digital marketing only’ campaign was launched by Abbott for its Low Dose HRT brand, in November 2013.

The campaign reportedly reached to 9,000 doctors, 45 percent of the NHS population of obstetricians and gynecologists, and nearly 23 percent of GPs who engaged with Abbott’s Low Dose HRT brand via professional network Doctors.net.uk.

According to Abbott, as quoted in this report, the digital campaign, which included interactive case studies, clinical paper summaries and an ask the expert section, helped increase the brand’s market share, with a continuous month-on-month growth in sales in 2013.

I am quoting these two examples, just to illustrate the point that serious experimentations with digital marketing for serious business initiatives, such as, doctor engagement and product launch, have already commenced.

Conclusion:

For better physician engagement, while preparing for a likely future scenario in India, any effective brand marketing strategy on digital platforms would call for in-depth understanding of the target audience preferences on the specific information needs and marketing channels. This customized approach needs to be harnessed to deliver the right message, to the right customer, through right platforms, and at a time of preferred by each prescriber.

The ball game of pharma marketing is gradually but surely changing. Clear signals are now coming from various Governments to the pharma companies to jettison the widely perceived unethical practices of alluring the drug prescribers with ‘freebies’ of different kinds and values, against patients’ health interest.

Unless various third parties come-up just to camouflage continuation of the same unethical marketing practices of many companies, at a cost, getting unfettered MR access to busy prescribers is likely to be increasingly more challenging. Otherwise, effective enforcement of mandatory UCPMP is likely to usher-in this change in India, sooner, just as what the ‘Physician Payment Sunshine Act’ did in the US. The countdown for the new paradigm in the country is expected to commence soon, as reportedly articulated by the Joint Secretary (Policy) of the Department of Pharmaceuticals, recently.

However, there are a couple of points to ponder. It is also widely believed, even today, and also in the US that, while various digital platforms offer never before opportunity to effectively engage with ‘difficult to meet’ prescribers, their use should be prudent and well thought of. Any mass-scale and imprudent general switch to digital communications, is unlikely to fetch the best outcome, to meet with this evolving challenge of change, at least, in the foreseeable future.

At the same time, if pharma companies continue increasing investment in less expensive digital communications sans diligent homework for scaling up, the prescribers may feel so overwhelmed that they will start ignoring them, just as what’s happening with frequent MRs’ visits. Hence, for sustainable business excellence while confronting with forthcoming disruptive changes, the notes of the pharma marketing playbook need to be recomposed, afresh.

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. 

Pharma And Healthcare: Mounting ‘Trust Deficit’ In Post Halcyon Days

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Although a radical transformation in the field of medicine and path breaking advances of medical sciences are in progress, the healthcare system as whole, including the pharma industry, as voiced by many, is fast losing its human touch and values. This is mainly because a large number of patients feel that they are being financially exploited in the entire medical treatment chain, as their ailments become primary means of making money…more money by many others .

A new and interesting book, authored by a practicing cardiologist, titled “Doctored: The Disillusionment of an American Physician”, which has just been released in August 2014, also unfolds with self-example a dysfunctional healthcare system and stark realities of practicing medicine even in the ‘Mecca’ of medicine – the United states.

The author eloquently highlights the malaise and cronyism affecting a sizeable number within the medical profession, being hand in gloves with a large constituents of the pharma industry. Medical practice seems to have now become just as any other ‘make-money’ endeavor; not quite different from what the pharma business has metamorphosed into, over a period of time.

A heartless game played by shrewd minds:

In a situation like this, a heartless game is being played by shrewd business savvy minds, at the cost of patients, making healthcare frightfully expensive to many.

As the above new book narrates, many pharmaceutical companies are coming to the fore to exploit the situation for commercial gain. In the book the author confesses, to make extra cash, he too accepts speaking fees from a pharmaceutical company that makes a cardiac drug he prescribes. He candidly admits enjoying the paid speeches on that specific pharma company’s drugs to influence other doctors, usually arranged at exotic places over fancy dinners. The author does not fail in his part to admit that the drug he touts on behalf of the pharma company turns out to be no better than other cheaper alternatives.

In this beautifully written memoir, the author Dr. Sundeep Jauhar tries to bring to light many complex problems of the healthcare system and alleged involvement of global pharma companies to drive the medical treatment costs up at a galloping pace. All these are being driven by various malpractices in pursuit of making quick bucks.

There are some compelling health policy, public spending on health and infrastructure related issues too, specifically for India, which are not the subject of my today’s discussion.

In this article, I shall neither dwell on the above book any further, but briefly deliberate on how all these, much too often repeated instances, are giving rise to mounting ‘Trust Deficit’ of the stakeholders, involving both the pharma industry and the medical profession at large and yet, quite intriguingly, they seem to remain unbothered.

The Halcyon days and after:

When we take a glimpse into the recent history of pharma and healthcare industry, it would be quite possible to convince ourselves that the overall situation, focus and mindset of the drug industry honchos and members of the medical profession were quite different, even a few decades ago. Those were the ‘Halcyon Days’.

At that time, pharmaceutical industry used to be one of the most admired industries of the world and people used to place the doctors almost in the pedestal of God.

Unlike today, when the drugs meant for the treatment of even widely prevalent dreaded diseases, such as, Cancer, Hepatitis C and HIV are not spared from maximum stretch pricing, the grand vision of the Global Chief Executives, in general, used to extend much beyond of just making profits. So were the doctors christened by the Hippocratic Oath. Yes, I repeat, those were the ‘Halcyon Days’.

Just to cite an example, in 1952, George Wilhelm Herman Emanuel Merck, the then President of Merck & Co was quoted on the front cover of the ‘Time Magazine’, epitomizing his following vision for the company:

“Medicine is for people, not for the profits”.

Having articulated this vision with so much of passion and clarity, Merck did not just walk the talk, in tandem, he steered an up swing in the company’s valuation over 50 times, proving beyond an iota of doubt that it is possible to give shape to his vision, if there is a will.

Today, in post ‘Halcyon Days’, for many of those who follow the history and development of the knowledge driven pharma and healthcare industry, this grand vision is no more than a sweet memory. Though the bedrock of pharma industry is innovation, is it inclusive? Is it benefitting the majority of the global population? No one believes now that “Medicine is for people, not for the profits”.

Thus, it was no surprise to many, when in 2012 while vocalizing its anguish on specific pharma mega malpractices ‘The Guardian’ came out with a lashing headline that reads as follows:

‘Pharma Overtakes Arms Industry To Top The League Of Misbehavior.’

Ignoring the reality:

Many people believe that all these are happening, as the global pharma industry refuses to come out of its nearly absurd arrogance created by spectacular business successes, over a very long period of time, with a large number of blockbuster drugs and the massive wealth thus created.

It appears, the pharma industry, by and large, cannot fathom just yet that its business model of 1950 to perhaps 1990, has lost much of relevance at the turn of the new millennium with changing aspirations and values of people, governments and the civil society at large.

Key reasons of distrust:

If we make a list from the global and local reports, the following are some of the key examples:

  • Media reports on pharmaceutical companies directly paying to doctors for writing prescriptions of high priced drugs to patients.
  • A growing belief that the pharma industry spends disproportionately more on sales & marketing than on R&D, which eventually increases the drug prices.
  • Unabated reports in the media of various pharma malpractices from across the world, including hefty fines amounting to billions of dollars, paid by many global pharma players.
  • A widespread belief that for commercial gain, the industry often hides negative clinical trial results, which go against patients’ health interest.

A recent survey:

According to a recent ‘Healthcheck Survey’ of the drug business by ‘Eye for Pharma’:

  • 42 percent of the respondents indicated that image of pharma is not getting any better among average people.
  • More than one-third said they are not sure or remained neutral on the subject.
  • 19 percent within the group are optimistic about improving image of pharma.

Though, it was reported that almost half of the respondents believe the industry knows what to do to gain standing and only 24 percent think pharma is clueless about how to regain its reputation, the commentators on the survey results are skeptical that companies are willing to do what it takes. This is predominantly because the pharma players do not know what would be the immediate financial impact, if the corrective measures were taken.

2014 developments in India:

In August 2014, a premier television news channel of India – NDTV exposed some blatant violations of medical guidelines involving both the doctors and the pharmaceutical companies in the country. The crew of NDTV carried out a sting operation (video), pretending to be medical representatives of a Delhi based new pharma company. The video clipping showed three doctors resorting to malpractices for which the pharma companies pay them heavily, though illegally.

This particular sting operation by NDTV could arrest the attention of the new Union Minister of Health Dr. Harsh Vardhan, whose reaction on tweeter was:

“One more sting operation on doctors exposing greed and readiness to shed professional ethics. I again appeal to brother doctors – show spine!”

Based on this public expose, the Medical Council of India (MCI), which is supposed to serve as the watchdog for doctors and overall medical practices, was compelled to conduct an enquiry on professional misconduct against those three doctors through its Ethics Committee. MCI has the power to cancel licenses of the erring medical practitioners.

Soon thereafter, one of the three Delhi doctors, who were caught on camera taking bribes in exchange of prescribing drugs, was reportedly arrested and the other two doctors were summoned by MCI for further investigation.

Just before this incident an article published in the well-reputed British Medical Journal (BMJ) on 08 May 2014 highlighted, “Corruption ruins the doctor-patient relationship in India”. The author David Berger wrote, “Kickbacks and bribes oil every part of the country’s healthcare machinery and if India’s authorities cannot make improvements, international agencies should act.”

I deliberated a part of this issue in one of my earlier blog posts titled “Kickbacks And Bribes Oil Every Part of India’s Healthcare Machinery”.

Interestingly, a couple of months earlier to this BMJ report, the Competition Commission of India (CCI) issued notices for various illegal practices in the pharma industry. These notices were served, among others, to pharma industry associations, chemists associations, including individual chemists & druggists, stockists, wholesalers and even to some local and global pharma majors.

In February 2014, the CCI reportedly issued a warning of severe penalties and prosecution to various bodies in the pharmaceutical industry indulging in anti-competitive practices even after giving undertakings of stopping the illegal practices, for which they were summoned for deposition before the commission earlier.

The CCI has now called upon the public through a public notice to approach it for curbing the malpractices that amount to anti-competitive in nature, adversely impacting interests of the consumer.

I reckon, all these actions are fine, but the bottom-line is, pharma and healthcare malpractices still continue unabated at the cost of patients, despite all these. Unable to garner adequate resources to pay for the high cost of treatment, which is fuelled by virtually out of control systemic malfunctioning, the families of a large number of patients are reportedly embracing abject poverty each year.

Pharma and healthcare continue to remain unbothered:

It is also not surprising that despite global uproar and all these socio-commercial issues, including pressure on drug prices, pharma and healthcare continue to march on the growth path, without any dent in their business performance particularly on this count.

Just to give an example, Moody Investor Services have highlighted just last week that India’s pharmaceutical market is set to experience continuing double-digit growth, faster than most other markets of the industry.

Lack of significant financial impact on the overall business performance on account of the alleged misconducts, barring USFDA imports bans, further reduces the possibility of a sense urgency for a speedy image makeover of the industry by doing the right things, in an organized manner.

The reason behind this inertia is also understandable, as expenditure on healthcare is not discretionary for the patients. To save lives of the near and dear ones, almost everybody, irrespective of financial status, try to garner resources to the maximum possible, whatever it costs.

Urgent remedial measures necessary:

Effective remedial measures to allay public distrust in all the above areas, in tandem with working out well-networked and inclusive innovation models, I reckon, would prove to be more meaningful today. This would facilitate not just in increasing the market access, but also for cost-effective innovation of new products leveraging the complex science of evolving biology. Let me reiterate, all these should be woven around the center piece of patients’ interest, without an exception.

I hasten to add here that some green shoots in this area have already started becoming visible, as some global industry constituents, though small in number, are articulating their new vision and the uncharted path that they intend to follow. Keeping a tab on the speed of spread of these green shoots would be important.

It is really a matter of conjecture now, whether the visible green shoots, as seen today would perish or not over a period of time. Nonetheless, that possibility is always there, if the concerned companies decide afresh that the efforts required for a long haul are not sustainable due to intense short-term performance pressure. Hence, it is not worth the financial risk taking.

In that scenario, they would continue with their existing business model of achieving the financial goals by selling the high priced medicines to the privileged few of the rich countries and to affluent people living in the other parts of the world, depriving millions of patients who desperately need those drugs, but are unable to afford.

Conclusion: 

Alleged malpractices in pharma and healthcare business operations, might not have hit any of the constituents really hard in financial terms just yet. However, the humongous ‘Trust Deficit’ of stakeholders, including the government, is gradually compelling them to face tougher resistance in operating the key business levers. Such resistance is increasingly coming in drug pricing, clinical trial requirements and related disclosure, marketing practices and even in the arena of Intellectual Property Rights (IPR).

On the part of the government, it is important to realize that self-regulations of various business and marketing practices have miserably failed in India for the pharmaceutical industry, just as it has failed in many other parts of the world, self-serving hypes often created by the global pharma associations in this regard notwithstanding. Besides the China saga and other reported scandals, billions of dollars of fines levied to the global pharma players, since last so many years, for a large number of malpractices would vindicate this point. It is worth noting that even these hefty fines are pittance, as compared to mind-boggling profits that these companies make on patented drugs with the adopted means. Hence, many of them would possibly feel that this risk is worth taking.  Similarly, lackadaisical implementation of MCI guidelines for the medical profession brings shame to the country, as evidenced by the article in the BMJ.

As self-regulation by the industry has proved to be nothing more than an utopia, it is about time for the new government to come out with strict, yet transparent and fair regulation, ensuring its effective implementation, to kill all these malpractices, once and for all, writing an apt epitaph to draw the final curtain to this chronicle.

That said, conscious efforts towards a mindset-changing approach for inclusive progress and growth by majority of pharma players and a sizeable number within the medical profession, would surely help reducing the ‘Trust Deficit’ of the stakeholders.

This much desirable transformation, if materializes, would enable both the pharma and healthcare industry to retrieve, at least, a part of the past glory. The constituents of the industry undoubtedly deserve it, just for the very nature of business they are engaged in.

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.

 

No More Payment for Prescriptions: Pharma at A Crossroads?

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  • “ARE there different and more effective ways of operating than perhaps the ways we as an industry have been operating over the last 30, 40 years?”
  • “TRY and make sure we stay in step with how the world is changing.”

Those are some introspective outlooks of Sir Andrew Witty – the Chief Executive of GlaxoSmithKline (GSK) related to much contentious pharmaceutical prescription generation processes now being practiced by the drug industry in general, across the world.

The ‘Grand Strategy’ to effectively address these issues, in all probability, was still on the drawing board, when Sir Andrew reportedly announced on December 16, 2013 that GSK:

  • Will no longer pay healthcare professionals to speak on its behalf about its products or the diseases they treat to audiences who can prescribe or influence prescribing.
  • Will stop tying compensation of sales representatives to number of prescriptions the doctors write.
  • Will stop providing financial support to doctors to attend medical conferences.

These iconoclastic intents, apparently moulded in the cast of ethics and values and quite possibly an outcome of various unpleasant experiences, including in China, is expected to take shape worldwide by 2016, as the report indicates.

Acknowledgment of unbefitting global practices:

Reacting to this announcement, some renowned experts, as quoted in the above report, said, “It’s a modest acknowledgment of the fact that learning from a doctor who is paid by a drug company to give a talk about its products isn’t the best way for doctors to learn about those products.”

The world envisages a refreshing change:

A December 11 article in the Journal of American Medical Association (JAMA) stated that there exists a serious financial ‘Conflict of Interest (COI)’ in the relationship between many Academic Medical Centers (AMCs) and the drug and medical device industries spanning across a wide range of activities, including:

  • Promotional speakers
  • Industry-funded ‘Continuing Medical Education (CME)’ programs
  • Free access of sales representatives to its faculty, trainees and staff
  • The composition of purchasing and formulary committees

Such types of relationships between doctors and the pharmaceutical companies across the world, including in India, as studies revealed, have been custom crafted with the sole purpose of influencing prescription behavior of doctors towards more profitable costlier drugs, many of which offer no superior value as compared to already available cheaper generic alternatives.

Cracking the nexus is imperative:

Yet another report says, “Ghost-writing scandals, retracted journal papers, off-label marketing settlements, and a few high-profile faculty dust-ups triggered new restrictions at some schools.”

To address this pressing issue of COI, cracking the Doctor-Industry alleged nexus, which is adversely impacting the patients’ health interest, is absolutely imperative. An expert task force convened by the ‘Pew Charitable Trusts’ in 2012, made recommendations in 15 areas to protect the integrity of medical education/training and the practice of medicine within AMCs.

Some of those key recommendations involving relationships of medical profession with pharmaceutical companies are as follows:

  • No gifts or meals of any value
  • Disclosure of all industry relationships to institutions
  • No industry funded speaking engagement
  • No industry supported Continuing Medical Education (CME)
  • No participation at industry-sponsored lectures and promotional or educational events
  • No meeting with pharmaceutical sales representative
  • No industry-supported clinical fellowships
  • No ghostwriting and honorary authorship
  • No ‘Consulting Relationship’ for product marketing purpose

The above report also comments, “if medical schools follow new advice from a Pew Charitable Trusts task force, ‘No Reps Allowed’ signs will soon be on the door of every academic medical center in the United States.”

MNC pharma associations showcase voluntary ‘Codes of Marketing Practices’: 

Most of the global pharma associations have and showcase self-regulating ‘Codes of Pharmaceutical Marketing Practices’. However, the above GSK decision and hefty fines that are being levied to many large global companies almost regularly in different countries for marketing ‘malpractices’, prompt a specific question: Do these well-hyped ‘Codes’ really work on the ground or are merely expressions of good intent captured in attractive templates and released in the cyberspace for image building?

Global status overview:

In this context an updated article of December 11, 2013 states that Medical Faculty, Department Chairs and Deans continue to sit on the Board of Directors of many drug companies. At the same time, many pharma players support programs of various medical schools and teaching hospitals through financial grants.  Company sales representatives also enjoy free access to hospital doctors to promote their products.

In most states of the United States, doctors are required to take accredited CMEs. The pharmaceutical industry provides a substantial part of billions of dollars that are spent on the CME annually, using this support as marketing tools. This practice is rampant even in India.

The above article also highlights incidences of lawsuits related to ‘monetary persuasion’ offered to doctors. In one such incidence, two patients reportedly fitted with faulty hips manufactured by Stryker Orthopedics discovered that the manufacturer paid their surgeon between US$ 225,000 and US$ 250,000 for “consultation services,” and between US$ 25,000 and US$ 50,000 for other services.

However, since August 2013, ‘Physician Payment Sunshine Act’ of the United States demands full disclosure of gifts and payments made to doctors by the pharma players and allied businesses. Effective March 31, 2014, all companies must report these details to the Centers for Medicare & Medicaid Services (CMS), or else would face punitive fines as high as US$1 million per year. CMS would publish records of these payments to a public website by September 31, 2014. India needs to take a lesson from this Act to help upholding ethics and values in the healthcare system of the country.

Overview of status in India:

As reported by both International and National media, similar situation prevails in India too.

Keeping such ongoing practices in mind and coming under intense media pressure, the Medical Council of India (MCI) on December 10, 2009 amended the “Indian Medical Council (Professional Conduct, Etiquette and Ethics), Regulations 2002″ for the medical profession of India. The notification specified stricter regulations for doctors in areas, among others, gifts, travel facilities/ hospitality, including Continuing Medical Education (CME), cash or monetary grants, medical research, maintaining professional Autonomy, affiliation and endorsement in their relationship with the ‘pharmaceutical and allied health sector industry’.

However, inability of the Indian regulator to get these guidelines effectively implemented and monitored, has drawn sharp flak from other stakeholders, as many third party private vendors are reportedly coming up as buffers between the industry and the physicians to facilitate the ongoing illegal financial transactions, hoodwinking the entire purpose, blatantly.

Moreover, it is difficult to fathom, why even four years down the line, the Department of Pharmaceuticals of the Government of India is yet to implement its much hyped ‘Uniform Code of Pharmaceutical Marketing Practices (UCPMP)’ for the entire pharmaceutical industry in India. 

Learning from other self-regulatory ‘Codes of Pharma Marketing Practices’, in my view, a law like, ‘Physician Payment Sunshine Act’ of the United States, demanding public disclosure of gifts and all other payments made to doctors by the pharma players and allied businesses, would be much desirable and more meaningful in India.

Conclusion:

Research studies do highlight that young medical graduates passing out from institutions enforcing gift bans and following other practices, as mentioned above, are less likely to prescribe expensive brands having effective cheaper alternatives.

The decision of GSK of not making payments to any doctor, either for participating or speaking in seminars/conferences, to influence prescription decision in favor of its brands is indeed bold and laudable. This enunciation, if implemented in letter and spirit, could trigger a paradigm shift in the the prescription demand generation process for pharmaceuticals brands.

However, this pragmatic vow may fall short of stemming the rot in other critical areas of pharma business. One such recent example is reported clinical data fabrication in a large Japanese study for Diovan (Valsatran) of Novartis AG. Had patient records been used in their entirety, the Kyoto Heart Study paper, as the report indicates, would have had a different conclusion.

That said, if all in the drug industry, at least, ‘walk the line’ as is being demarcated   by GSK, a fascinating cerebral marketing warfare to gain top of mind brand recall of the target doctors through well strategized value delivery systems would ultimately prevail, separating men from the boys.

Thus, the moot point to ponder now:

Would other pharma players too jettison the decades old unethical practices of ‘paying to doctors for prescriptions’, directly or indirectly, just for the heck of maintaing ethics, values and upholding patients’ interest?

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.