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Why Is ‘Empathy’ Central In Pharma’s Digital World?

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While pharma industry’s late realization of its slower pace of reform is widely criticized, it did demonstrate a resilience in facing several challenges of change, caused by Covid-19 pandemic to keep the business going. This was witnessed in many areas of customer-value delivery systems of various companies, also in India.

That said, digitalization notwithstanding, a critical soft skill has now emerged as central for a long-term success in the patient engagement process. A transformation is now much warranted in this area, as it remains generally neglected, even today. This space involves – target-audience specific marketing communication – with well-researched, and contemporary content materials that each patient can relate with one’s needs and expectations from a brand.

Many marketers may be missing out on this nuanced, yet a critical space while striving to make their stakeholder engagement more productive for business. In this article, I shall focus on the art of leveraging this critical soft skill set – ‘empathy’, to fetch better dividend from such initiatives of pharma marketers.

An empathetic intent of what customers need and expect is critical: 

‘Empathy’ isn’t totally a revolutionary idea in marketing. But Covid-19 related disruptions in peoples lives and livelihoods, have brought the issue at the center stage of even pharma marketing. In depth understanding or an empathetic intent of what the customers need, expect and are looking for, has emerged as a key requirement of today’s marketing success.

According to studies, with changing patient expectations, preferences, and power to influence treatment decision-making choices, traditional ‘source dominated messages’ are making lesser business impact to their ‘receivers’. The old way of ‘talking at’ the stakeholders with brand messages, gives many receivers a feel that the message is brand biased. It doesn’t encourage them to express their point of view on the same.

Many bright pharma marketers have started understanding the need to listen to and ‘talk with’ them – before and after messaging – to prepare the right personalized content for key customers, and evaluate their business effectiveness, thereafter. This is a nuanced, yet a critical area, which we all need to accept and act upon to ensure a fundamental change in the customer engagement process.

The fundamental difference between the two:

Various experts have acknowledged and explained a fundamental difference between ‘talking at’ and ‘talking with’ conversations. Some these are as follows:

“Talking at someone” is generally used when the message doesn’t intend to offer a reasonable scope for exchange of ideas, or to engage in a conversation, or to express a contrarian viewpoint on a brand or service. Probably, the content doesn’t encourage or elicit any kind of response, especially the negative ones.

Whereas ‘talking with someone’ intends to start a conversation with the brand between the company and the stakeholders. I hasten to add, there are occasions when these two terminologies are interchangeably used. That doesn’t really matter. What does matter is – ‘talking with someone’ requires a critical soft skill. This is called ‘empathy.’ It is so essential – because of today’s need to establish an emotional connect with customers – for any brand or service.  

Empathy is essential – remote or digital marketing notwithstanding:

This point was captured in the IBM article, published on August 12, 2020, as it highlighted the Covid pandemic induced rapid transformation in the digital behavior of many consumers in different business areas. This triggered several rapid, path-breaking, and consumer-friendly innovation, even in the health care space. As a result, people witnessed, among many others, a wider use of telehealth, rapid adoption of e-commerce/e-pharmacies, besides a significant swing towards the digital-first economy.

The IBM article also underscored the need of similar transformation in some other critical areas, like marketing, especially to keep pace with the change in digital behavior and expectations of a growing population. ‘People are increasingly demanding authentic connections, helpful information and personalized support from brands,’ as the paper added.

Meeting this demand and further nurturing the same, send a clear signal to pharma marketers to gain deep insight of ‘this new consumer journey,’ the paper reiterated. Thus, in the contemporary business scenario, the marketers would require – ‘to create a sense of empathy and personal connection by scaling your brand voice, delivering valuable content and recommendations, and learning directly from your consumers in the digital ecosystem’- the author emphasized.

It’s now visible in the customer engagement process of several industries:

If one carefully notices a company’s messaging – both its content and the format, it won’t be difficult to sense a transformation taking place in this area for most other industries. The content of the message and the communication format/platform, now appear to be quite dynamic, personalized, and built on a robust pillar of the critical soft skill – empathy, or rather – empathy-based marketing.

Shifting from marketing-centric thinking to customer-centric thinking:

According to an expert group in this area: ‘Empathy-based marketing is about walking into your customer’s shoes to understand their experience and how we can better help them get what they want. You don’t want to think like the customer. You want to BE the customer.’

While trying to do so, a marketer would need to move away from marketing-centric thinking to customer-centric thinking and speak from the customers’ perspective and at their motivational level. Empathy-based marketing, therefore, encompasses the following ideas:

  • Empathizing with target-customer’s experience by going into their world.
  • Thinking like them while solving a problem and understanding each step they may take to solve it.
  • Looking for ways to help customers make their lives better.
  • Providing customers with what they want by understanding what motivates them and not what you want them to have.
  • Helping them identify and solve problems.
  • Empowering employees who are directly in touch with customers and provide them resources, training, and tools, accordingly.

In pharma – its personal or in-person selling – but the messaging is not:

As we know, in pharma the selling process is generally personal. Company representatives personally meet individual customer to deliver a brand message to generate prescription demand. Patient engagement processes too, remain broadly the same, at times with minor variations, though. Despite a great opportunity to deliver unique personalized messages through empathy-based marketing that recognizes individual value and expectation – traditionally, one-size-fits-all type of contents continue to prevail.

Leverage technology to create empath-based marketing:

The challenge is moving towards a whole new digital world order. In this space marketers would require working with a huge volume of credible and contemporary data on target customers, markets, the interplay of different emotional factors. A well thought through analytics-based study, would play a critical role to get a feel of empathy for selected customers. This would, then, be the bedrock to strategize a productive and personalized engagement with them. Leveraging modern technology would be essential to attain this goal.

What would ‘empathy’ construe in pharma marketing:

According to MM+M: “Empathy includes making sure your brand not only understands the condition that a patient has, but also the experience of having that condition, encompassing both the physical and emotional impact.’ People are expecting a reflection of empathy from the pharma players in their engagement process. Patients and consumers can figure out an empathetic message when they see it. They know when a brand ‘gets it’ and when ‘it doesn’t.’ Thus, it’s important that ‘marketers don’t just preach empathy, but they also practice empathy themselves, the paper highlighted.

Today’s marketing mostly addresses the fundamental needs of patients: 

As the above MM+M paper highlighted - at a fundamental level, patients just want to get better and feel better and manage their condition effectively. On this premise, most patient engagement initiatives, basically, try to address these fundamental needs, in different ways. However, as the research reveals, the above approach would not generally try to empathize with the target audience. Companies now move beyond the hard facts of medical conditions – their symptoms and relief.

According to the above study, today’s marketers would, simultaneously need to: “Find out what life is like for them. Is it a long, complex, frustrating process to access their treatment? What emotional toll does the disease have on them? On their loved ones? Are they scared? Depressed? Like a method actor, I will soak up everything I can about this person and close my eyes and become them.”

Conclusion:

In the contemporary changing market` dynamics, pharma markers can boost the brand performance either by generating increasingly more prescriptions from the existing brand prescribers, or by creating new prescribers. This is an eternal truth and is expected to remain so, as one can foresee today.

As this metamorphosis keeps rolling on, it will necessarily require healthcare marketers to gain contemporary and data-based customer insight – with an empathetic mindset. It’s essential for them to create the ‘wow factor’ – for patients to get the ‘wow feeling,’ because they will be getting a workable solution that they were looking for – to get relief from an ailment. It will, in turn, help most drug companies to overcome the trust-barrier, giving a feel to the customers that the brand and the company do care for them – not just serve the corporate vested interests.

Thus, empathy-based marketing leadership, armed with this critical skill, will also build a long-term and trust-based relationship with stakeholders for better business outcomes. According to a recent research study, published in the Forbes Magazine, on September 19, 2021, ‘empathy’ emerged as one of the most important leadership skills, especially, in the post pandemic business environment, for various reasons.

Consequently, in today’s scenario, only science-based brand engagement with patients can’t possibly help achieve the desired goals any longer. Thus, I reckon, honing the unique soft skill – ‘empathy’, has become central for pharma marketers’ professional success in the digital world – more than ever before.

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.

 

 

Using Selling Simulator For New Drug Launch In The New Normal

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The reverberation of unparalleled business disruptions in healthcare caused by Covid pandemic, extends across its value chain – from patients and families to clinicians and pharmaceutical companies. Consequently, even many diehards or staunchly tradition-bound pharma marketers were being prompted to reimagine their marketing model, to keep the business going.

Some of these areas include, customer preferred engagement channels, platforms and associated remote or virtual training inputs – necessary for effective execution of new strategic marketing models for the evolving new normal. A few of them are also moving in this direction – garnering requisite wherewithal.

“But it has also left some of them paralyzed by uncertainty. Should they invest now in transforming their commercial model or wait to see how things play out?” This palpable dilemma of many pharma marketers, was well captured in a recent McKinsey & Company article - ‘Reshaping pharma’s strategy in the next normal,’ published on December 15, 2020.

In a situation like this, one of the critical challenges is the successful launch of new pharma products amid changing customer behavior, product expectations and other associated uncertainties. ‘As pharmaceutical companies reshape their commercial models to prepare for the uncertainties ahead, personalization and digital enablement will be crucial to launch success in the new environment,’ underscored the above article.

As many of us will know, quality training and development inputs for the same, remain a vital prerequisite before the sales force hits the marketing battle ground. Isn’t that also a challenge in the prevailing market situation? Could digitalization of the company provide a solution to this critical sales force training issue for the same, in the new normal? This article will delve into this area.

Digitalization is a basic step – the challenge is much beyond that:

As I wrote in my article dated October 07, 2019, disruptive digital transformation in pharma sales and marketing is indeed a necessary basic step. It will also help to leapfrog in the field staff training and development process by imbibing leading-edge technologies, such as AI, for giant leaps to higher growth trajectories. But, ‘Digitalization’ isn’t a panacea, either.

This was also echoed in another recent article on ‘Pharmaceutical Marketing in The New Normal’, published in the Forbes magazine on August 11, 2021. It wrote, ‘even the best, most advanced digital tools won’t help if reps are not properly trained.’ This is due to multiple factors. Let me elaborate the point from a new product launch perspective.

New normal brings unprecedented changes – no footsteps to follow:

The extent and depth of personalization required in any effective customer engagement process for successful outcomes, has undergone a fundamental shift. Today, personalization of content, channels and platforms is a necessity and no longer an option. In the new normal one size doesn’t fit all. Consequently, sales force training process, particularly for a new drug launch, has also become personalized, with simulation of new expectations and requirements of each market becoming a key ingredient, more than ever before.

Simulated sales training still not too common in pharma:

That personalized and simulated sales force training is still not too common in the pharma industry, was also captured in the February 2020 ‘The Voice of the Sales Rep study’ of the sales research firm – SalesFuel. It reported, just 30% of sales reps in the pharma industry are now getting personalized sales training based on individual needs. This study was done in the United States, and the same percentage is expected to be much less in India.

In this context, the above Forbes article also noted that at an elementary level, reps should be proficient in video conferencing and virtual CME basics, such as, screen sharing, lighting, cameras, and the likes. There could also be occasions when they may need to teach even some of the physicians for whom, as well, this type of engagement is new. Thus, simulation training may possibly play a critical role to make the sales force future ready, always.

Besides, gaining deeper insights of customers, market dynamics, and tailoring the content of personalized engagement, accordingly, will be a critical part of personalized training through simulation, especially for new product launch in the new normal.  

Doctors availing product and treatment related online services: 

While navigating through acute disruption of life during Covid pandemic, several doctors have learnt to use digital channels and platforms to avail product or new therapy related information directly, instead of through sales reps. And that too, as they want, when they want and the way they want, gaining a discretionary choice. Several surveys, such as,  2020 Accenture research, also reported many doctors want either virtual or a mix of virtual and in-person meetings with pharmaceutical reps, even after the pandemic ends.

Available studies also give a sense that the future overall trend in pharma is unlikely to be a replication of pre-Covid time, prompting the players to reimagine their customer engagement format. For example, a contemporary ‘Real Time Covid-19 Barometer Survey of physicians,’ by Sermo, found that ‘67% believe pharmaceutical companies could improve communications with HCPs and could do more to help physicians make prescribing decisions.’

Hence, even with the much-reduced threat from Covid infection, as and when it will happen, the same trend is likely to change the scope and traditional toolkit for future new brand launch, as well. Hence, pharma companies would, need to change their sales training architecture, accordingly – like simulation training – always keeping one ear on the ground.

Proven edge of simulation training in healthcare during Covid-19:

There are several studies in this area in different parts of the world. To illustrate the point, let me quote a Canadian study, published by ResearchGate in December 2020. It made several important points, which I summarized, as below.

The study elucidates, healthcare resources were strained to previously unforeseeable limits because of COVID-19 pandemic, in most countries. The unprecedented nature of disruption in health systems prompted the emergence of rapid simulation training for critical just-in-time COVID-19 education. The aim was to improve preparedness for giving high quality care to rapidly increasing number of Covid infected patients, including caregivers, across all healthcare sectors.

The researchers found that simulation training was pivotal for healthcare provider learning, alongside new systems integration, development of new processes, workflows, checklists, protocols, and in the delivery of quality clinical care to all concerned.

To cope with the new reality, triggered by the Covid pandemic, as also demonstrated by several other studies, simulation training has the potential to deliver the best learning outcomes. Some may obviously would seek a little more clarity in understanding what exactly is a simulation training that I am referring to.

What exactly is simulation training?

It won’t be terribly difficult for pharma marketers to understand what exactly simulation training in pharma sales and marketing is. As the name suggests, simulation is a replication of what happens or may happen in a real-life situation. In this particular case, it involves the simulation of changing pharma customers and market behavior and expectations, in the new normal.

Thus, a simulation training process, say for a new brand launch, would create virtual market scenarios by replicating all recent changes in customer behavior/expectations and the market dynamics – of a specific territory. This is usually done with AI based computer software, designed to help sales force learning of a real-life situation, without being in the thick of it on the ground. In simulated training, the selected trainees interact with technology, rather than reading notes or listening through the lectures of persons having similar insights.

The selling simulators are cost-effective and provides better outcomes:

Besides being cost-effective, simulation training is also considered a 24-carat way of developing new skills, and also assessing how well the trainees are translating the new learnings into practice. No wonder why even the US National Library of Medicine, after evaluation and review of several research studies, has acknowledged that simulation training imparts learning ‘just like a real thing.’

How will it work on the new product launch?

In pharma sales and marketing area, the simulation of customers’ post-pandemic new needs and expectations, can be simulated by developing a ‘selling simulator’ for new product launch, in the new normal. These simulators will integrate AI-based software with game dynamics or gamification, creating a virtual field situation for sales reps to continuously learn and hone their new-product launch skills. The required contemporary skills may often be unique in nature, beyond the traditional pathways, even where there are no footsteps to follow.

Why simulation training for a new drug launch will add greater value?

This  query is also well deliberated in the McKinsey & Company article - ‘Reshaping pharma’s strategy in the next normal,’ published on December 15, 2020, with the Covid pandemic as the backdrop. It underscores, ‘it is clear that major shifts in the way that healthcare professionals (HCPs) interact with pharma companies will present a challenge for the traditional launch model, with its reliance on face-to-face meetings with physicians and its “one size fits all” approach to engagement.’

The study further points out that “the traditional pharma commercial model will likely struggle to adapt to a different world. When reps venture back into the field, they will need to address the plurality and access challenges of the new interaction landscape. To do that, they will need to consider a new approach to launches: one that is digital, local, and personalized.”

This changing need will call for a new genre of training, and I think, simulation training for pharma reps will prove to be more productive in this area.

Conclusion:

Many uncertainties in the pharma business continue, even after the second wave of Covid pandemic, with the Damocles sword of its third wave hanging over the head, including the Indian population. In the current volatile pharma business environment, as an article on the subject, published by the Pharmaceutical Executive on July 30, 2021, articulates – the challenges of remote work mean that training approaches must be adaptable and engaging.

Simulation training, with its power to engage learners, and developed for strategically minded, and data-literate sales teams, would become a key component of the future pharmaceutical sales training landscape. This is destined to happen regardless of whether delivered on site or in remote training formats. From this perspective, I reckon, with a well thought-out – AI-driven selling simulator, especially for new product launch, to start with, could be a potential game changer in yet mostly untried new normal.

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 Sales Post Covid-19 Lockdown

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Disruptions from Covid-19 pandemic have caused limited access to physicians for Pfizer’s marketing and sales teams have had. If ‘the novel Coronavirus pandemic hamstringing the company’s sales team,’ there could be a slowdown in new prescriptions and a sales hit in the second quarter, said the global CEO of Pfizer, on April 28, 2020. He further said, ‘new prescriptions for a range of its products will decline as patients continue avoiding in-office physician visits.’

Pfizer is not only the company facing such situation. In fact, the entire pharma industry is encountering a tough headwind for the same reason. However, being very specific on the quantum of sales hit – on the same day, ‘Merck, with a heavy presence in physician-administered drugs’, predicted an adverse impact of US$ 2.1Billion on sales, from COVID-19.

Physical absence of, virtually the entire pharma field force in the field for strict compliance of social distancing during the lockdown period, causing a crippling effect on the new prescription demand generation activity. This possibility was hardly imagined by anyone in the industry. Which is why, the current situation is too challenging for pharma sales and marketing leadership teams to respond, with a sustainable strategic approach. Moreover, most of them don’t yet seem to be accustomed with charting any pivotal demand generation activity, sans field force.

Further, the meaning of ‘Patient-Centricity’ in the post lockdown period – still maintaining ‘social distancing’ norms, is expected to undergo considerable changes. This may include development of newer health care practices for many customers, which they started practicing during the lockdown period. However, no one can exactly predict, as on date, whether such changes will continue for a long term, as we move on. In this article, I shall deliberate on a likely scenario in the pharma selling space post Covid-19 outbreak, based on research studies. This is primarily because Covid-19 could be with us for a long time.

Covid-19 could be with us for a long time:

As reported, on the day 35 into the world’s largest lockdown, India, reportedly, was failing to see an easing of new cases similar to what hot spots such as Spain and Italy have recently experienced with more intensive Covid-19 outbreaks. Even today, the scale and duration of the pandemic are very uncertain, so will be the necessity of maintaining social or physical distancing guidelines. This possibility gets vindicated by what the Director General of the World Organization said on April 22, 2020: ‘Make no mistake: we have a long way to go. This virus will be with us for a long time.’ Thus, shutdowns in different forms, is expected to continue for some time in India.

‘Covid-19 pandemic to last for minimum two years’ with its consequent fallout also on the pharma industry:I

Interestingly, ‘India began its containment measures on March 25, when its outbreak showed only 564 cases.’ As on May 03, 2020, the recorded Coronavirus cases in India have sharply climbed to 39,980 and 1,323 deaths. India is now expected to prepare exiting the 54-day lockdown in phases from May 17, 2020, with a few limited relaxations even before that date. However, as the BBC news of April 9, 2020 also points out, the country may not afford to lift the lockdown totally – everywhere, for everyone and for all the time, anytime soon, for obvious reasons.

The April 30, 2020 report from the Center for Infectious Disease Research and Policy at the University of Minnesota, confirms this situation. It says: ‘The Coronavirus pandemic is likely to last as long as two years and won’t be controlled until about two-thirds of the world’s population is immune.’ This is because of the ability to spread from asymptomatic people, which is harder to control than influenza, the cause of most pandemics in recent history. Thus, the Coronavirus pandemic is likely to continue in waves that could last beyond 2022, the authors said.

Many countries around the world are already facing similar issues for exiting Covid-19 lockdown. It has been observed that easing the lockdown is a tricky policy choice, as it triggers a fresh wave of infection, as recently happened in advanced countries, such as, Singapore and several other nations.

It is, therefore, clear now that shutdowns need to continue in different forms in India as different waves of Covid-19 infections strike, in tandem with scaling up of requisite testing and health infrastructure to manage those outbreaks, effectively.  Consequently, its impact on the pharma industry is likely to continue with its unforeseen fallout, prompting the same old question, yet again, why the oldest commercial model remains pivotal in the pharma industry.

The oldest commercial model remains pivotal in the pharma industry:

About a couple of years ago from now, an interesting article of IQVIA, titled, ‘Channel Preference Versus Promotional Reality,’ highlighted an important fact. It said, one of the oldest commercial models of using medical or sales representatives to generate product demand through personal communication with each doctor, and other key stakeholders, is still practiced in the pharma industry, both as a primary medium and also to communicate the message.

The same model continues in the pharma industry, regardless of several fundamental challenges in the business environment. Curiously, erosion of similar models in many other industries, such as financial and other services, in favor of various highly effective contemporary platforms, is clearly visible. Some of these fundamental challenges involve an increasing number of both, the healthcare professionals and also patients they treat, moving online.

This has been happening since some time – long before Covid-19 outbreak. Today, many patients want contemporary information on the disease-treatment process, available alternatives and the cost involved with each. These patients also want to communicate with their peers on the disease for the same reasons, before they take a final decision on what exactly they would like to follow. A similar trend is visible, at a much larger scale, with medical professionals, including top drug prescribers.

Healthcare customers’ increasing digital preference was captured well before the Covid-19 outbreak:

The rise of digital communication as a global phenomenon, was deliberated in the June 04, 2019 ‘Whitepaper’ of IQVIA, titled ‘The Power of Remote Personal Interactions.’ It captured an increasing digital preference of healthcare customers much before Covid-19 outbreak. For example, according to IQVIA Channel Dynamics data1, there was a 26 percent decline in total contact minutes for face-to-face detailing in Europe, since 2011.

Another 2018 IQVIA survey reported, 65 percent to 85 percent of representatives were saying that access to physicians is becoming harder. The paper also indicated that the rise of digital and multichannel communication with healthcare professionals has been far from uniform across countries, with Japan leading the world, followed by the United States.

India is an emerging power in the digital space, today. Thus, I reckon, it has immense opportunity to leverage digital platforms in healthcare, especially to effectively address the current void in the demand generation activity of drug companies. The key question that needs to be answered: Are pharma customers developing new habits during, at least, the 54-day national lockdown period?

‘It takes about 18 days to 254 days for people to form a new habit’:

According to a study, titled ‘How are habits formed: Modelling habit formation in the real world,’ published on July 16, 2009, in the European Journal of Social Psychology, it takes anywhere from 18 days to 254 days for people to form a new habit. Thus, changing preferences of many healthcare consumers, including doctors and patients, at least, in the 40-day period of national lockdown in India, may trigger a change in habits of many patients. This change may further evolve over a period a time.

Such changes would demand a new and comprehensive ‘Patient-Centric’ approach from pharma players, as well, having a clear insight on the dynamics of the changes. Gaining data-based insight on the same, pharma sales and marketing leadership would need to develop a grand strategy to deliver ‘patient-group’ specific desired outcomes. One of these approaches could be, triggering non-personal sales promotion on digital platforms.

Triggering non-personal sales promotion on digital platforms:

Dealing with future uncertainty calls for non-conventional and innovative strategies, such as, generating brand prescription effectively even without personal promotion. Thus, to tide over the current crisis, triggering non-personal sales promotion on digital platforms, appears to be the name of the game. In a 2018 IQVIA survey, looking at the multi-channel landscape in life sciences, 54 percent of the 250 respondents from pharma and biotech were found already using virtual interactions, such as e-Detailing, or were planning to assess the approach.

What is required now is to rejuvenate the initiative, with a sense of great urgency. Covid-19 pandemic has the possibility and potential to expedite a strong pull in this direction, responding to a new ‘customer-centric’ approach, as prompted by the evolving scenario, triggered during the 54-day long stringent lockdown period. This is especially considering the fact that it takes about 18 days to 254 days for people to form a new habit.

Further, as Bloomberg reported on May 02, 2020, “coming up with a vaccine to halt Covid-19, in a matter of months isn’t the only colossal challenge. The next big test: getting billions of doses to every corner of the world at a time when countries increasingly are putting their own interests first,” which may take quite time.

Conclusion:

One thing for sure, the sudden outbreak of Covid-19 pandemic has made all ongoing and robust strategic business plans somewhat topsy-turvy. Most pharma companies were compelled to floor the break-pedal of several business operations, including prescription demand generation activity of field sales forces, during the lockdown period.

At this time, many healthcare consumers, including patients, tried various remote access digital platforms to continue with their treatment or for a new treatment of common ailments, besides procurement of medicines. Two primary drivers, in combination with each other, prompted those individuals to try out the digital mode. One, of course, the stringent lockdown norms, and the other being the fear of contracting Covid-19 infection, if the prescribed personal distancing standards are breached – just in case.

This position may lead to two possibilities – one, involving the patients and the doctors and the other, involving field staff/doctors/hospitals/retailers, etc. During, at least, the 54-day long lockdown period, if not even beyond May 17, 2020 – those patients may develop a sense of convenience with the digital platforms. This may lead to a new habit forming, which has the potential to create a snowballing effect on others – through word-of-mouth communication. The process may signal a shift on what ‘Patient-Centricity’ currently means to the pharma players.

The other one, I reckon, involves with the continuation of strict social or physical distancing norms for an indefinite period. This could seriously limit field-staff movement and meeting with the doctors, hospitals/retailers, besides many others, and more importantly would lead to a significant escalation of cost per call. The question, therefore, is: Will pharma selling remain as before, post Covid-19 lockdown? Most probably not. If so, a new task is cut out, especially for the Indian pharma leadership team, to chart a new ‘Patient-Centric’ digital pathway, in pursuit of sustainable 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.

Buying Physicians’ Prescriptions in Cash or Kind: A Global (Dis)Order?

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Recently a European business lobby reportedly raised its voice alleging pharma Multinational Corporations (MNCs) in China have been ‘unfairly targeted’ by a string of investigations into bribery and price-fixing cases despite their generally ‘strong legal compliance’ and has suggested that China ‘must step back.’

Two comments of this European lobby group, presumably with full knowledge of its past records, appear indeed intriguing, first – ‘unfairly targeted’ and the second – ‘China must step back’, that too when a reportedly thorough state investigation is already in progress.

Reality is all pervasive:

However, while looking over the shoulder, as it were, an altogether different picture emerges and that reality seems to be all pervasive.

Over the past several decades, the much charted sales and marketing frontier in the pharmaceutical industry has been engagement into a highly competitive ‘rat race’ to create a strong financial transactional relationship, of various types and forms, with the physicians, who only take the critical prescription decisions for the patients. Most of the times such relationships are cleverly packaged with, among many others,  a seemingly noble intent of ‘Continuing Medical Education (CME)’ by the companies concerned.

Increasingly, across the globe, more questions are now being raised whether such pharmaceutical business practices should continue even today. These voices are gradually getting louder fueled by the recent moves in the United States to ‘separate sales and marketing related intents of the drug industry from the practice of medicine’, especially in large medical teaching hospitals, in tandem with the enactment and practice of ‘Physician Payment Sunshine Act 2010’.

A recent article titled, “Breaking Up is Hard to Do: Lessons Learned from a Pharma-Free Practice Transformation”, published in the ‘Journal of the American Board of Family Medicine’ deliberated on an interesting subject related to much talked about relationship between the doctors and the pharmaceutical players.

The authors argue in this paper that significant improvement in the quality of healthcare in tandem with substantial reduction in the drug costs and unnecessary medications can be ensured, if the decision makers in this area show some willingness to chart an uncharted frontier.

‘Questionable’ relationship in the name of providing ‘Medical Education’:

‘The Journal of Medical Education’ in an article titled “Selling Drugs by ‘Educating’ Physicians” brought to the fore the issue of this relationship between the pharma industry and individual doctors in the name of providing ‘medical education’.

The article flags:

“The traditional independence of physicians and the welfare of the public are being threatened by the new vogue among drug manufacturers to promote their products by assuming an aggressive role in the ‘education’ of doctors.”

It further elaborates that in the Congressional investigation in the United States on the cost of drugs, pharma executives repeatedly stated that a major expenditure in the promotion of drugs was the cost of ‘educating’ physicians to use their products.

The author then flagged questions as follows:

  • “Is it prudent for physicians to become greatly dependent upon pharmaceutical manufacturers for support of scientific journals and medical societies, for entertainment and now also for a large part of their ‘education’?”
  • “Do all concerned realize the hazards of arousing wrath of the people for an unwholesome entanglement of doctors with the makers and sellers of drugs?”

Financial conflicts in Medicine:

Another academic paper of August 13, 2013 titled, “First, Do No Harm: Financial Conflicts in Medicine” written by Joseph Engelberg and Christopher Parsons at the Rady School of Management, University of California at San Diego, and Nathan Tefft from the School of Public Health at the University of Washington, states:

“We explored financial conflicts of interest faced by doctors. Pharmaceutical firms frequently pay physicians in the form of meals, travel, and speaking fees. Over half of the 334,000 physicians in our sample receive payment of some kind. When a doctor is paid, we find that he is more likely to prescribe a drug of the paying firm, both relative to close substitutes and even generic versions of the same drug. This payment-for-prescription effect scales with transfer size, although doctors receiving only small and/or infrequent payments are also affected. The pattern holds in nearly every U.S. state, but it is strongly and positively related to regional measures of corruption.”

On this paper, a media report commented:

“The findings – based on recently released data that 12 companies have been forced to make public as a result of US regulatory settlements – will rekindle the debate over the limits of aggressive pharmaceutical marketing, which risks incurring unnecessarily costly medical treatment and causing harm to patients.”

A call for reform:

The first paper, as quoted above, titled “Breaking Up is Hard to Do” reiterates that even after decades, individual practitioner still remains the subject to undue influence of the pharmaceutical companies in this respect. It categorically points out:

“The powerful influence of pharmaceutical marketing on the prescribing patterns of physicians has been documented and has led to fervent calls for reform at the institutional, professional, and individual levels to minimize this impact.”

The rectification process has begun in America:

Interestingly, even in the United States, most physicians practice outside of academic institutions and keep meeting the Medical Representatives, accept gifts and drug samples against an expected return from the drug companies.

Many of them, as the paper says, have no other process to follow to become ‘pharma-free’ by shunning this hidden primitive barrier for the sake of better healthcare with lesser drug costs.

To achieve this objective, many academic medical centers in America have now started analyzing the existing relationship between doctors and the drug companies to limit such direct sales and marketing related interactions for patients’ interest.

This unconventional approach will call for snapping up the good-old financial transactional relationship model between the doctors and Medical Representatives of the Pharma players, who promote especially the innovative and more costly medicines.

An expensive marketing process:

The authors opine that this is, in fact, a very powerful marketing process, where the pharmaceutical players spend ‘tens of billions of dollars a year’. In this process more than 90,000 Medical Representatives are involved only in the United States, providing free samples, gifts along with various other drug related details.

The study reiterates that deployment of huge sales and marketing resources with one Medical Representative for every eight doctors in the United States, does not serve the patients interests in any way one would look into it, even in terms of economy, efficacy, safety or accuracy of information.

“But Don’t Drug Companies Spend More on Marketing?”

Yet another recent article, captioned as above, very interestingly argues, though the drug companies spend good amount of money on R&D, they spend much more on their marketing related activities.

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.

A worthwhile experiment:

Removing the hidden barriers for better healthcare with lesser drug costs, as highlighted in the above “Breaking Up is Hard to Do” paper, the researchers from Oregon State University, Oregon Health & Science University and the University of Washington outlined a well conceived process followed by one medical center located in central Oregon to keep the Medical Representatives of the pharmaceutical companies at bay from their clinical practice.

In this clinic, the researchers used ‘a practice transformation process’ that analyzed in details the industry presence in the clinic. Accordingly, they educated the doctors on potential conflicts of interest and improved patient outcomes of the clinical practice. The concerns of the staff were given due considerations. Managing without samples, loss of gifts, keeping current with new drugs were the key concerns.

Based on all these inputs, various educational interventions were developed to help the doctors updating their knowledge of new drugs and treatment, even better, through a different process.

The experiment established, though it is possible to become “pharma free” by consciously avoiding the conflicts of interest, implementation of this entire process is not a ‘piece of cake’, at least not just yet.

Need for well-structured campaigns:

The researchers concluded that to follow a “pharma sales and marketing free” environment in the clinical practice, the prevailing culture needs to be changed through methodical and well-structured campaigns. Although, initiation of this process has already begun, still there are miles to go, especially in the realm of smaller practices.

One researcher thus articulated as follows:

“We ultimately decided something had to be done when our medical clinic was visited by drug reps 199 times in six months. That number was just staggering.”

Where else to get scientific information for a new drug or treatment?

The authors said, information on new drugs or treatment is currently available not just in many other forum, but also come with less bias and more evidence-based format than what usually are provided by the respective pharmaceutical companies with a strong motive to sell their drugs at a high price to the patients. 

The paper indicated that there are enough instances where the doctors replaced the process of getting information supplied by the Medical Representatives through promotional literature with monthly group meetings to stay abreast on the latest drugs and treatment, based on peer-reviews.

‘Academic detailing’:

In the process of ‘Academic detailing’ the universities, and other impartial sources of credible information, offer accurate information without bias, whenever sought for. In the United States, some states and also the federal government are reportedly supporting this move now, which is widely believed to be a step in the right direction.

Moves to separate sales and marketing of the drug industry from the practice of medicine:

As stated above, there are many moves now in the United States to ‘separate the sales and marketing influence of the drug industry from the practice of medicine’, especially in large medical teaching hospitals, as the paper highlights.

The study also reported that of the 800,000 physicians practicing in the United States only 22 percent practice in the academic settings and 84 percent of primary care physicians continue to maintain close relationships with the pharmaceutical companies.

Citing examples, the new report indicated various tangible steps that primary care physicians can possibly take to effectively mitigate these concerns.

Emerging newer ways of providing and obtaining most recent information on new drugs and treatment together with educating the patients will hasten this reform process.

A commendable move by the Medical Council of India:

Taking a step towards this direction, the Medical Council of India (MCI) vide a notification dated December 10, 2009 amended the “Indian Medical Council (Professional Conduct, Etiquette and Ethics), Regulations 2002″. This move was welcomed by most of the stakeholders, barring some vested interests.

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’. These guidelines came into force effective December 14, 2009.

With this new and amended regulation, the MCI, on paper, has almost imposed a ban on the doctors from receiving gifts of any kind, in addition to hospitality and travel facilities related to CMEs and others, from the pharmaceutical and allied health sector industries in India.

Moreover, for all research projects funded by the pharmaceutical industry and undertaken by the medical profession, prior approval from the appropriate authorities for the same will be essential, in addition to the ethics committee.

Although maintaining a cordial and professional relationship between the pharmaceutical industry and the doctors is very important, such relationship now should no way compromise the professional autonomy of the medical profession or any medical institution, directly or indirectly.

It is expected that the common practices of participating in private, routine and more of brand marketing oriented clinical trials would possibly be jettisoned as a pharmaceutical strategy input.

However, inability of the Indian regulator to get these guidelines effectively implemented  and monitored has drawn sharp flak from all 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.

No such government guidelines for the industry yet:

MCI under the Ministry of Health, at least, came out with some measures for the doctors in 2009 to stop such undesirable practices.

However, it is difficult to fathom, why even almost 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.

‘Physicians payment induced prescriptions’ – a global phenomenon:

Besides what is happening in China today with large pharma MNCs alleged involvement in bribery to the medical profession soliciting prescriptions of their respective drugs, world media keep reporting on this subject, incessantly.

For example, The Guardian in its July 4, 2012 edition reported an astonishing story. Since quite some time many pharmaceutical giants are being reportedly investigated and fined, including out of court settlements, for bribery charges related to the physicians.

In another very recent article titled “Dollars for Docs Mints a Millionaire” the author stated as follows:

“The companies in Dollars for Docs accounted for about 47 percent of U.S. prescription drug sales in 2011. It’s unclear what percentage of total industry spending on doctors they represent, because dozens of companies do not publicize what they pay individual doctors. Most companies in Dollars for Docs are required to report under legal settlements with the federal government.”

In India, deep anguish of the stakeholders over this issue is also getting increasingly reverberated all across, without much results on the ground though. It has also been drawing attention of the patients’ groups, NGOs, media, Government and even the Parliament of the country. 

Another article titled, “Healthcare industry is a rip-off” published in a leading business daily of India states as follows:

“Unethical drug promotion is an emerging threat for society. The Government provides few checks and balances on drug promotion.”

Physician Payment Sunshine Act of 2010:

To partly address this issue under President Obama’s ‘Patient Protection Affordable Care Act’, ‘Physician Payment Sunshine Act’ came into force in the United States in 2010. 

Under this Act, any purchasing organization that purchases, arranges for, or negotiates the purchase of a covered drug, device, biological, or medical supply or manufacturer of a covered drug, device, biological, or medical supply operating in the United States, or in a territory, possession, or commonwealth of the United States is required to publicly disclose gifts and payments made to physicians.

Penalty for each payment not reported can be upto US$ 10,000 and the penalty for knowingly failing to submit payment information can be upto US$ 100,000, for each payment.

Centers for Medicare and Medicaid Services (CMS) has already released their ‘Physician Payment Sunshine Act’ reporting templates for 2013. The templates apply for reports dated August 1, 2013 – December 31, 2013.

Should the Government of India not consider enacting similar law in the country  without further delay?

Conclusion:

That said, these well-researched papers do establish increasing stakeholder awareness and global concerns on the undesirable financial influence of pharma players on the doctors. Product promotion practices of dubious value, especially in the name of ‘Continuing Medical Education (CME), seem to strongly influence the prescribing patterns of the doctors, making patients the ultimate sufferer.

The studies will help immensely to establish that achieving the cherished objective of a ‘pharma sales and marketing free’ clinic is not only achievable, but also sustainable for long.

The barriers to achieving success in this area are not insurmountable either, as the above article concludes. These obstacles can easily be identified and overcome with inputs from all concerned, careful analysis of the situation, stakeholder education and identifying most suitable alternatives.

Thus, I reckon, to effectively resolve the humongous ‘physician payment induced prescriptions’ issue for the sole benefit of patients, it is about time for the pharmaceutical players to make a conscientious attempt to shun the ‘road much travelled, thus far, with innovative alternatives. However, the same old apprehension keeps lingering:

“Will the mad race for buying physicians’ prescriptions in cash or kind, much against patients’ interest, continue to remain a global (dis)order, defying all sincere efforts that are being made today?  

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.