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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.

 

 

With Covid’s Second Wave ‘A Nation In Distress’ – Why?

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If someone tries to see a silver lining in the disruptive Covid-19 pandemic, besides its vaccine rollout in some countries, there will be at least one. As of April 17, 2021- over 119 million patients (India – over 12 million), reportedly, have recovered out of 141 million (India – over 15 million) of Covid infected patients.

But this can’t mask the grim reality of over 18 million patients remain still infected, with over 3 million deaths (India – 175,673), since the beginning of the Covid menace. In the Indian perspective, this is the highest ever incidence of death – in absolute numbers – for any reason, so far. Now comes the Covid second wave with its more devastation onslaught on human lives and other consequences for the nation.

In this article, I shall explore this area, as apparently a Tsunami-like the second Covid wave starts sweeping across the India states, posing a greater danger than the first one, to the lives and livelihoods of millions of Indians, yet again. Let me start with a perspective, leading to the current situation.

No clinically proven drugs, as yet:

There aren’t any definite or clinically proven drugs after completion of Phase III studies, as yet, for curing patients from Covid infection. Nor are there any such well proven vaccines with fully known efficacy, safety, time interval between two doses, duration of prevention from Covid infection, in the future. All drugs and vaccines are currently being used under ‘emergency use’ approval by country drug regulators, based on interim results.

At the very onset of Covid-19 first wave, other than some attempts of repurposing older drugs, the world did not have any proven drugs to fight against this deadly infection. The old antimalarial drug Hydroxychloroquine – was tried first, followed by other medications, such as, Lopinavir/Ritonavir. Both created a huge global demand and subsequent shortages, including in the pharmacy of the world– India. Subsequently, W.H.O discontinued hydroxychloroquine and lopinavir/ritonavir treatment arms for COVID-19 based on interim clinical trial data. These results showed, hydroxychloroquine and lopinavir/ritonavir produce little or no reduction in the mortality of hospitalized COVID-19 patients when compared to standard of care.

At the beginning of the second wave of Covid-19, one of the latest repurposed drugs – remdesivir that is being widely used, especially for hospitalized patients, is also facing a shortage, even in the pharmacy of the world. Interestingly, even ‘Remdesivir has little or no impact on survival, WHO trial shows’.

Also – no clinically fully proven Covid-19 vaccines, as yet:

Possibly, the second-best antidote as of date, against rapidly mutating Covid-19 – after Covid-appropriate behavior by all, comes vaccines. All comes with ‘emergency use’ approval, based on interim results only, and with several challenges. These include efficacy against all mutating Covid-19 variants, exact safety profile, dosage interval and duration of protection. Interestingly, on April 16, 2021, Pfizer indicated that ‘Covid-19 vaccine recipients will “likely” need a third dose between six to 12 months after they’re fully vaccinated and suggested vaccinations for coronavirus could be needed every year.’ In this evolving scenario, Indian experts also acknowledge that - abidance to the defined health norms stays as a lifeguard, and will remain so for an indefinite period.

Several countries, including India, are making, and gradually expanding requisite arrangements to vaccinate their population. Whereas a large number of countries – mostly in the developing world, are still awaiting access to Covid vaccines. Meanwhile, another issue has started bothering many, which the April 10, 2021 issue of The Guardian had captured in its headline – ‘Global Covid vaccine rollout is threatened by a shortage of vital components,’ besides manufacturing capacity constraints compared to the current demand.

Global challenges with Covid vaccines in 2021:

As things have progressed with Covid vaccines, thus far, the year 2021 doesn’t seem to be a smooth run to vaccinate people across the world, deriving a significant outcome against the battle of this global menace. This gets vindicated by the following numbers, as published in the ‘Down to Earth’ magazine on April 13, 2021.

  • According to the Johns Hopkins University, United States, as of April 12, 2021, only 773 million Covid-19 vaccines had been administered across the world. This means, only a little more than 2 per cent of the world’s adult population, has been inoculated so far.
  • According to data analytics firm Airfinity, the world will manufacture 9.5 billion doses by the end 2021. Whereas immediate global need exceeds 14 billion doses to vaccinate the entire adult population.
  • According to Gavi – The Vaccine Alliance, this represents almost three times the number of vaccines the world was producing in the pre-pandemic period for other diseases.

In the midst of these, inoculation with, at least, two major Covid-19 vaccines – one from AstraZenecaand other from Johnson & Johnson, have raised safety concern in the United States and many European countries. These ongoing developments complicate Covid vaccine challenges further.

The Indian scenario – ‘a nation in distress?’

Despite building new and a workable emergency health infrastructure by several state governments to combat Covid-19 pandemic, the fierce attack of the second wave with mutating Covid-19 virus, has already made these bursting at the seams. The article - ‘A tsunami of cases’: desperation as Covid second wave batters India, appeared in ‘The Guardian’ on April 14, 2021, captures this desperate struggle of the nation. Another recent report depicted with grim pictures, how India is grappling with the second wave of Covid-19, terming it as ‘a nation in distress.’ There are enough indications that India’s fragile health infrastructure has already collapsed in some places.

According to another news item on April 14, 2021, more than 111 million people has been vaccinated in India, by that time. Notably, this number was achieved after fears of AstraZeneca’s Covishield vaccine shortages, which subsequently prompted the Indian Government to temporarily halt its exports by the Pune-based vaccine manufacturer – Serum Institute of India (SII).

Going by another estimate, if the current momentum continues, India would be able to vaccinate 40% of its population by December 2021, and 60% of the population by May 2022. The report cautions that ‘the non-availability of vaccines may scuttle the pace.’ As per the W.H.O release, three in five Indians need to be vaccinated, to reach herd immunity. For which, the country needs 145 crore doses of vaccine by May 2022. India currently has the capacity to manufacture 100 crore-130 crore doses per year, as per a Rajya Sabha committee report. Another report of April 10, 2021 also highlights, ‘at least 10 states in India have reported a vaccine shortage and many vaccine centers have been reported shut.’

My wife and I also experienced the Covishield vaccine shortage in Mumbai. Our scheduled online appointment for vaccination through Co-Win website of the Government at Sir HN Reliance Hospital,Girgaon, Mumbai, for April 17, 2021, was cancelled. At past 10 pm on April 16, 2021, the hospital rang us up to inform that they have closed their Covid vaccination center till fresh vaccine stocks reach them.

To combat the Covid pandemic – ‘Pharmacy of the World’ goes local:

Yes, to combat the Covid pandemic, the ‘Pharmacy of the World’ goes local for some critical Covid drugs and vaccines, several times in the past. This happened earlier with drugs, like Hydroxychloroquine, when India banned its export to cater to the domestic need for Covid treatment. It happened again now, as ‘Remdesivir, API and formulation were placed under Export ban on 11.04.2021.’

Similarly, India has now, reportedly, put a temporary hold on all major exports of the AstraZeneca’sCoronavirus vaccine (Covishield in India), made by the SII, amid an increase in domestic demand due to a surge in infection. As the news item highlights: ‘It will also affect supplies to Gavi, the W.H.O backed vaccine alliance, through which more than 190 participating economies – 98 higher-income and 92 low and middle-income, are expected to get vaccine doses.’ Such temporary measures are now necessary for India to effectively respond to India’s Covid fight – especially the vaccine crunch.

India’s current vaccine imbroglio, as Covid second wave strikes hard:

Besides the SII, a second Indian company — Hyderabad-based Bharat Biotech, was given permission in January for emergency use of its Covaxin, developed in collaboration with the ICMR. Although, Bharat Biotech can make 12.5 million doses each month, these will be a small proportion of the doses administered in the country, so far.

To effectively respond to the prevailing vaccine crunch, Indian Government already approved the ‘emergency use’ of Sputnik V vaccine, which will be imported till its domestic production commences. Further, the country’s health authorities have now decided to consider the grant of ‘emergency use’ approval of several other internationally developed vaccines, such as, Pfizer – BioNTech double-dose vaccine and Johnson & Johnson’s single-shot vaccine. At least, till then, India’s vaccine imbroglio to vaccinate all adult population in the country, irrespective of age – particularly when Covid second wave is not sparing the young adults, is expected to continue.

Conclusion:

The jaw-dropping pandemic situation, and the pathway to deal with this crisis, especially in India, is getting increasingly complicated in every passing day. As reported on April 16, 2021, Covid-19 is now fooling RT-PCR tests – the most reliable type of Covid test as on date. It is so alarming because: ‘A false negative report is bad for the patient as they might delay consulting a doctor. It’s also bad for others, as the patient might not isolate, and spread the virus around,’ as the report underscores. It has started happening because: ‘Multiple mutations in the coronavirus over 15 months are making parts of it unrecognizable to lab tests.’

Experts are trying to fathom, whether or not more people are dying in India’s Covid second wave, as compared to the equivalent time period of the first wave. This causes an added cause of great concern because, in the six months before the start of the second wave (from September 2020 to January 2021), India’s overall case fatality rate (CFR) was only around 1.1%. This means only 1.1% of cases resulted in deaths. Currently, at the very beginning of the second wave, CFR has already increased to 1.3% and remains below peak levels seen in the first wave – as of date.

Above all, many people – virtually from all social, political, religious and economic strata, are openly flouting the basic norms of Covid appropriate behavior, as daily seen on different TV news channels. Ironically, these are happening at a time, when Indian health care infrastructure is creaking against the enormous and devastating power of the second wave Covid pandemic.

‘Pharmacy of the world’ has also gone local for some critical Covid-19 drugs and vaccines, to save lives and livelihoods of the Indian population, having no other better alternative in sight, at this hour. Isn’t this a sign of ‘A Nation in Distress’ that makes a fervent appeal to all of us, at least, to behave properly – by religiously following the lifesaving Covid guidelines?

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.

 

Shape of Future Pharma Operations – Emerging A Pragmatic Outlook?

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Just as newer reports come almost every day on safety, efficacy, dosage interval or span of immunity of Covid vaccines, similar reports are also reaching us about the possible future shape of pharma sales and marketing operations. Some hardcore optimists, apparently more from India, still believe that current changes in pharma customer behavior are mostly transient. All business processes will eventually fall in their traditional grooves, as the Covid menace disappears from our lives soon.

No doubt, several studies are also bringing out a number of respondent doctors’ preferences on reverting to F2F engagements, programs and events. Nonetheless, most other experts, including several large global pharma majors, believe that the future shape of business operations won’t be quite the same as the past. There are better ways to be more effective, leveraging the changing environment. Accordingly, they have initiated actions, reimagining the pathway of new operational frontiers. In this article, I shall explore the evolving pragmatic outlook in just two of these action areas:

  • The new and unique role of medical representatives
  • Digital health care solutions as a new growth opportunity

New role of medical representatives:

A recent survey published by Reuters Events Pharma on December 18, 2020, revealed that 30% of the respondents still expect that Medical Reps’ (MR) face-to-face access to HCPs would return to the status quo ante of Covid pandemic restrictions. However, a majority of 70% felt that the old normal is unlikely return as such. The study also brought out that the size and disposition of sales teams are under review by many of pharma players and smaller field forces look likely, as the industry moves on.

My personal experience with the Indian Pharma Industry sources suggests, when a Covid pandemic wave starts finding its peak, the feeling of the above 70% prevails. However, when the same wave climbs down from its peak to a transient trough, a large number of Indian companies and experts tend to feel somewhat akin to what the above 30% expressed in the Reuters Events Pharma survey. The process gets repeated with the emergence of the next wave.

Alongside, as the above survey also finds out, most physicians are no longer expecting – brand-driven high sales pitches, during any MR-Doctor interaction or the engagement process. Instead, they are increasingly looking for insights – in an integrated, personalized and value-driven interactions with the Reps.

Considering this as a trend of over last one year or so, it is likely that MR-doctor interactions will now need to be on digital and omnichannel platforms to deliver a personalized and value driven an experience to the customers. In this environment, the field force may be smaller in size than what it used to be in early 2020 but will have a unique new role to play. This process will come with a new challenge, especially to those inbred companies, who are still undecided about the road ahead for business excellence, in the new normal.

Three new pharma leadership challenges:

Apparently, a large number of domestic drug companies, irrespective of size and scale of operations still feel comfortable to be in the old comfort zone that had propelled the business in a growth trajectory. Most pharma sales and marketing staff members, at several levels, have grown within the industry, consistently delivering high performance.

This situation by itself, as the above research paper revealed, poses three fresh challenges for many companies to make their field-staff ready to play a unique and fresh role in e-marketing. Thus, the three new knots to untie in the virtual world, are the following:

  • Currently, most MRs are not proficient in selling in virtually,
  • They are being led by people who have also never sold virtually,
  • They are being trained by people who also have never sold virtually.

MRs will continue to have a role to play even in the digital world:

To overcome the above challenges, today’s reality prompts new L&D needs of pharma’s new e-environment. And from this perspective, I think, they would need professional domain experts’ hand-holding, at least, in the transition phase of digital marketing. Some companies have initiated this process for greater sales force effectiveness, since 2019. A recent example in this area may be quoted from a report on October 01, 2019.

The article highlights, ‘AstraZeneca sales reps have some new help in the coaching department, resulting improved interactions and better development of sales reps’ strengths. While leaders still manage reps, artificial intelligence—in the form of data generated from thousands of field-coaching forms—now adds machine-learned analysis and advice.’

Thus, it is worth noting that MRs will continue to play an important role, alongside remote digital marketing using omnichannel or multi-channel engagement platforms. The same also came out clearly in the latest study from healthcare consultancy ZoomRx, reported on April 08, 2021, where its findings raised an important question - ‘Did pharma overshoot digital sales rep calls?’ This dilemma was prompted by the study charts reflecting a decline in its effectiveness, during this specific survey period.

Thus, in my opinion, a hybrid business model for better performance will be more effective in the new normal. However, ascertaining the right mix of digital and MR’s in-person interactions, may pose a challenge for many pharma marketers.

Entry into digital health solutions – an opportunity for growth: 

Before Covid pandemic, digital therapeutics or digital health solutions were not an unknown area for several pharma companies, as a growth booster in the modern world. But, it wasn’t explored so intensively as it is being discussed today, for the same. A recent paper titled, ‘Digital health during COVID-19: lessons from operationalizing new models of care in ophthalmology,’ published in The Lancet on February 01, 2021, vindicates this point.

The paper emphasized, due to Covid pandemic ‘the traditional face-to-face patient–physician care model has had to be re-examined in many countries, with digital technology and new models of care being rapidly deployed to meet the various challenges of the pandemic.’ It further highlighted, these new models incorporate digital health solutions such as telehealth, AI based decision support for triaging, besides clinical care, and home monitoring.

Global pharma majors, such as Novartis, have publicly acknowledged on January 21, 202 that ‘digital innovation looks set to dominate the 2021 healthcare agenda.’ The statement said, COVID-19 was a catalyst for change in healthcare during 2020 and an accelerator for digital health. Similarly, 2021 looks set to continue the revolution – exploiting ‘an explosion of interest, traction and scale’ in the potential for digital solutions. These would not only support remote working, but also keep the very fabric of business, healthcare, education, and essential services in operation.

Other important and recent examples of digital health care solutions: 

Witnessing the COVID-19 pandemic pushing more people toward virtual doctor visits over the last one year, AstraZeneca, as reported on April 06, 2021, is preparing for it in the new normal, through a novel project with Massachusetts General Hospital. The Company is now in the process of establishing and validating its ‘recently launched digital health platform, designed to help patients with chronic illnesses manage their conditions without stepping foot into the academic medical center’s clinic.’

Similarly, several other companies, are also investing to be early entrants with user friendly state of the art technology in this space. Interestingly, many of these ventures were reported during March and April 2021.

Conclusion:

Arthur Miller’s play ‘Death of a Salesman,’ broadly addressed the loss of identity and a man’s inability to accept change within himself and society. Although, the book depicts a larger philosophical perspective of life – many pointed out similar issues in the drug industry perspective, as well.

Nonetheless, many studies have established, pharma MRs have been effectively delivering, since long, the endpoint deliverables, as expected of them – sales. However, the question that still haunts many – can this core process be re-imagined for greater efficiency and effectiveness at a lesser cost, harnessing modern technology. An article, published in the Pharmaphorum on March 11, 2011, has also suggested – ‘in the wake of the COVID-19 pandemic, there is an even greater need to re-examine the rep’s role. How can a field force evolve to deal with current challenges and be future-fit for the way we will be working in the post-pandemic world?’ 

There is no confusion today that MRs’ will have a key role to play in pharma’s digital endeavor. However, the key purpose of having them has evolved during the pandemic. Such as, from being an efficient way to achieve personal communication objectives – to be an orchestrator for physicians to navigate the difficult landscape, providing them a differentiated service. For this purpose, I reckon, a hybrid business model for better performance, will be more effective in the new normal, while quickly adapting to digital transformation. However, arriving at the right mix of digital and MR’s in-person interactions, may pose a challenge for many pharma marketers, as it will be a company-specific need.

Similarly, the criticality of leveraging opportunities to provide remote delivery of digital health care solutions to patients, has also come onto the radar of many pharma players, during this difficult time. Several players have already added this area as a lucrative business expansion platform – many more are expected to follow. Thus, in my view, the fast-evolving data-based trends are now giving a pragmatic shape to future pharma operations – especially on the new and unique role of medical representatives and the relevance of digital health care solutions, as a growth opportunity.

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.

How Pharma To Stay Relevant To Customers In The New Digital World

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Covid-19 vaccination has commenced in India on January 16, 2021, as in several other countries of the world. A few million Indians, across the country have already received their first shot, according to media reports. But, this isn’t the endgame of pandemic by any measure. Covid-19 will get over – only when it gets over.

Interestingly, on March 07, 2021, the Union Health Minister claimed, ‘the country is in the end game of the COVID-19 pandemic. Curiously, the very next day – the Indian Medical Association IMA termed it as: ‘Unauthorized political statements on Covid-19 pandemic invokes a false sense of security.’ Moreover, vindicating the IMA statement, the Coronavirus trend report, updated as on March 05, 2021 clearly demonstrated that ‘The pandemic is far from over.’

As a fallout of this pandemic, alongside many other nations of the world, most industries in India are going through a recovery process of disruptive changes in the business processes, after a harrowing time. Pharma industry is no exception in this area. Recreating contemporary operational processes to excel in the new normal, would call for not only jettisoning many practices from the old normal by the new ones, but also the creative deployment of the precious resources, by each pharma players.

Accordingly, the need for avant-garde digital-based customer engagement services, is gathering winds on the sails of the ships of pharma marketers, signaling a ‘never before’ urgency to move in this direction. It’s a new business imperative to survive, perform, and excel in pharma. At the same time, the industry also should examine other critical changes required in its primary interfaces with customers, in today’s fast evolving scenario.

This process would involve redefining the new roles of some critical positions in the organization. Today’s article will explore how pharma will stay relevant to its customers, increasingly getting more and more involved in the new digital practices.

Some key challenges in pharma digital strategy:

One of the key challenges for a productive ‘company – physician engagement’, in the new normal, is to be available at any preferred time of customers’ choice and the way they want. This may include, both virtual and in-person F2F engagements, along with customized contents for the same. This need is universal and, by and large, remains the same for key stakeholders of all drug companies.

This point was further reinforced, in the February 22, 2021 article on capacity building in the digital space, published in Reuters Events, Pharma. It focused on demands in new era of ‘digital-first customer engagement’, where content creation and omnichannel engagement also play equally vital roles.

Besides, the paper emphasized, today’s need is investing in the type of contents that add clinical value, as opposed to overtly commercial marketing type material. The primary task for marketers is now, therefore, to use updated, high-quality, neutral content on customer engagement platforms that will offer value – the customers are looking for – and not just values from a company’s self-serving perspective. From this angle, the new content model prompts greater customer involvement for meaningful outcomes.

In tandem, company staff members – including medical representatives, need to acquire multi-tasking expertise, being equipped with – required digital knowledge, skills on using digital platforms and ascertaining individual key customers’ engagement needs. Whereas a company’s digital strategist will work on “digital initiatives, solutions, products and how those will be integrated locally.” Thus, this is not about making everyone a digital expert, as the article underscores.

Need to redefine work processes and realigning the staff members:

As the above article from Reuters Events reconfirms, the digital approach that several pharma players were taking even a year or two ago is redundant in the new normal. Amid rapid transformation in the drug business, ‘pharmaceutical industry can no longer act like ostriches. Digital is no longer a fancy add-on, it’s an integral part of everything we do,’ the study highlighted.

Thus, to move in this direction effectively, pharma companies would require redefining many work processes and realign the staff members in sync with their new roles, accordingly. Further elaborating this point, the Accenture study – ‘A digital booster dose for health care,’ identified a few such roles that will undergo a metamorphosis to meet with post Covid challenges. Following are some, where urgent transformations required are, as follows:

 A.   ‘Intelligent representatives’ – not just ‘medical representatives’: 

In the current scenario, rep’s engagement process with the medical profession calls for leveraging specific intelligence based on behavioral preferences. This is fast emerging as a key requirement. Thus, the paper underscores: “Armed with a closed-looped CRM, representatives can effectively use data insights to plan, deliver and report calls.” I also indicated earlier – to succeed in this effort, individual skill sets, such as digital awareness and analytics will be of great use. The core objective is, looking through physicians’ eyes to understand their needs and solve problems by ‘serving customers as individuals, not as numbers in a call roster,’ the study emphasized.

B.  ‘Customer experience managers’ – not just ‘brand managers’: 

While using omnichannel digital platforms, doctor-patient interactions become more content dependent. Accordingly, brand managers’ role will be pivotal to facilitate a uniform interaction experience across all channels.

Therefore, for targeted communication, better understanding of doctors and patients and how they want to be engaged, is a key requirement. Which is why, brand managers will have to acquire skills, such as content management for continuous engagement across multiple channels. This is now absolutely necessary for effective branding in fostering a new genre of ‘customer-brand relationship’ model, across the company.

C. ‘Helping doctors manage their practice and patients better’ – not just ‘brand marketing’: 

‘Think beyond the patients’ – suggests the Accenture survey. This is because, virtualization of healthcare is all about doctors making further customizations into how they operate, both clinically (teleconsultation) and commercially (payments). This is, another important area where pharma companies can further differentiate themselves, by helping doctors manage their practice and patients better. The process entails acquiring critical skills in disease awareness, identifying key gaps that impact patient experience and clinical outcomes, alongside various digital engagement tools to perform these functions.

Conclusion:

The current year is expected to witness flooring of the gas pedal, as it were, in pharma’s digital transformation process, while navigating through humongous challenges on the way. The process includes, redefining work processes and realigning the staff members to establish a new customer-brand relationship’, based on Covid triggered changes in the customer behavior.

A quantum improvement in the usage of digital tools and platforms, alongside targeted content creation will be pivotal in pharma’s customer relationship management to excel in the changing business environment. Many doctors and patients have already signaled their acceptance for digital or virtual interactions, besides some well identified F2F engagements with relevant and personalized data-driven content as they expected from each drug company.

This need arises when one considers the findings of another Accenture Survey. It reported, while 39% of doctors want all medical representative meetings to be virtual, even post pandemic, ‘around 10% of key doctors still want to go back to pre-COVID-19 norms for in-person meetings.’ Thus, the point to ponder in this area is how to structure these F2F meetings for highly productive outcomes.

However, it’s also a reality that during Covid days, doctors wanted to interact with the Medical Reps more than what they used to do in the past. This offers a huge opportunity to drug companies in leveraging pharma rep’s interaction to accurately understand their customer-insight. Consequently, the new approach will help pharma companies, not only in staying relevant to its customers in the digital world, but also, to keep themselves prepared to face similar challenges in the future, proactively.

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.

 

Covid Propels Healthcare Into A Virtual World: A New Growth Driver For Pharma?

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Amid ongoing Covid pandemic, most discussions on pharma specific ‘digitalization’ initiatives continue to predominantly hover around its traditional business growth drivers. In fact, even before the Covid time, it was no different, in a smaller scale and with a lesser intensity, though.

Incidentally, since quite some time, with the explosion of different types of web-based businesses, offering opportunities to buy and receive, virtually everything, at one’s doorstep, many things started changing rapidly. Almost all businesses started offering the state of the art, easy to use smartphone app-based e-commerce solutions, in different formats, to grow their businesses. Alongside, more and more people started managing their daily needs and wants online, even in India. Intriguingly, despite the availability of telemedicine, telehealth and e-pharmacies, even in the old normal, most people continue to prefer in-person health care solutions, including buying medicines.

Then came a bolt from the blue – the unprecedented global health crisis, caused by Covid-19. Almost overnight, amid requirements of maintaining stringent personal measures to keep Covid at bay, making in-person doctor-calls for brand demand generation activities, posed a great challenge. Doctors, too, became hesitant to meet general patients and medical representatives, in that situation. Thus, to keep the business up and running, most pharma companies gave top priority in finding out a digital solution for the brand demand generation processes. Interestingly, this was happening, when many patients, especially those with non-Covid ailments, also faced a similar situation to meet their health care needs.

Finding no other viable alternatives, many patients were pushed to search for a robust digital solution for health care needs, as well – just as they were already meeting their other regular needs – online. In that sense, Covid propelled many patients to step into a new virtual world of healthcare - telehealth or telemedicine. As mentioned above, although, these services were up there in pre-Covid days, many patients, apparently rediscovered them, in a new Avatar, to get relief from ailments and also save their lives.

On a hindsight, it appears, why the need to leverage telehealth or telemedicine in that crisis, did not appear to be a priority for most pharma companies to foster patient-centric growth of the business. Thus, continuing with the core concept of my previous article, – this article, will focus on the possibility of pharma spearheading the process, aiming for a win-win outcome – boosting access to high quality affordable care for all, on the one hand. And simultaneously, harnessing this new growth driver to excel in the business, on the other.  

Telehealth or e-health will grow just as other e-businesses, unhindered: 

With the Government of India issuing guideline for telemedicine practices on March 25, 2020 and later, on May 12, 2020, publishing those guidelines in the gazette, ‘Telemedicine’ has been made a high priority health care enabler. The notified guidelines also make telemedicine consultation provided by a Registered Medical Practitioner (RMP) under the Indian Medical Council Act, 1956, legally permissible. In addition, effective October 01, 2020, Telemedicine costs will be covered under medical insurance in accordance with the Insurance Regulatory and Development Authority of India’s (IRDAI) new guidelines.

The net effect of these measures will not just help reduce pressure on the fragile public healthcare infrastructure of the country, but will also expand access to lower cost and high-quality private care to a large number of people.  

Telemedicine is here to stay and be a key pharma growth driver:

With Covid propelling health care into virtual platforms, providing and receiving medical care through telehealth has become a necessity for many people, for different reasons. However, the question that surfaces, will patients return to the old normal, if and when the pandemic ends?

The article – ‘3 reasons telehealth is here to stay,’ published by the MedCity News on October 09, 2020, presents a practicing physician’s perspective on this issue. The author envisages, ‘telemedicine will continue to gain traction with my colleagues and most likely, become a permanent clinical option for patient care.’ Going by such hands-on experience, I reckon, telemedicine will continue to grow for several important reasons, such as:

  • Technology to make telehealth increasingly user friendly: Ongoing IT innovation is making telehealth platforms simple and more effective for doctors and a large number of patients belonging to all age groups. “All they have to do is click a link on their smartphones, which is sent to them via text automatically.” Thus, these tools will increasingly become the best option for treating a broad range of conditions, long after the pandemic subsides.
  • Telemedicine costs are covered under medical insurance, now: Effective October 01, 2020,Telemedicine costs will be covered under medical insurance, even in India. Moreover,‘Telemedicine’ has now been made a high priority health care enabler, carrying a permanent legal status in India. 
  • Health Equity and affordable care: Access to affordable health care is not evenly distributed across the India. Telehealth can help fill these gaps, with increased affordable access for all, even in rural India, as patient location won’t be a problem in getting prompt and quality care at a low cost.

From the above perspective, it appears, it’s high time for pharma to leverage Telemedicine and Telehealth as a major growth driver, powered by innovative business strategies.

Is there any difference between Telemedicine and Telehealth?

Very often these two words are used interchangeably. Mostly because, both telemedicine and telehealth are the practice of medicine using technology to deliver care at a distance.

Telemedicine offers remote clinical services, such as, virtual consultations, diagnosis, prescriptions, preventative care, monitoring via telecommunication platforms, including text, video chat, wearable devices or even phone calls. Whereas, telehealth, in addition, can include remote non-clinical services, such as health care training, administrations and continuing medical education.

Reasons for pharma’s cashing on this new growth driver at a low cost:

Besides Government’s support to telehealth and telemedicine, growing health care consumer demand and user-friendly technologies, are catapulting virtual care to the mainstream health care delivery systems. In tandem, driven by unique and long-term value offerings, telemedicine is being increasingly recognized as a critical means to get prompt care for minor but urgent ailments. Consequently, moreusers are getting attracted to its convenience and benefits, which may have a snowballing effect. Some of which are as follows:

  • Prompt access to disease treatment services, as and when needed by patients, without any long waiting time, for any reason.
  • Significant health care cost saving for all – more for rural population who will be able to avoid long distance travel, involving both time and money, besides associating hassles.
  • Prompt follow-up consultation facilities, will help avoid disease complications, reducing the burden to hospitals for secondary or tertiary care.
  • Further, pharma can offer even greater patient satisfaction by leveraging virtual healthcare platforms, as these will help ensure more effective follow-up and enhanced treatment convenience than traditional in-person visits. Several studies, such as the article, published in ‘The American Journal of Managed Care,’ on January 15, 2020, vindicate this point.

In short, accelerating rate of use – with the increasing need for prompt, easy and affordable access to care, are driving telemedicine to be an integral part of healthcare service delivery system. Which is why, expansion of pharma business in this new virtual space, with well-integrated collaborative strategies, could prove to be a key growth driver – over a long period of time.

Moreover, there doesn’t seem to be any need to deploy a large and cost-intensive field force, as is usually followed for expansion of pharma business in newer areas. This is because, ‘telemedicine requires a different approach to promotion.’

Telemedicine requires a different approach to promotion

That telehealth requires a different approach to marketing and promotion from traditional pharma marketing, was deliberated by ZS in the article -‘Four telemedicine myths for pharma to avoid,’ published on July 05, 2020. The paper underscored, ‘instead of building brand awareness and engaging patients in education and information, telehealth promotion needs to drive patients to take one specific action: call today!’ It further elaborated:

  • Brands that bury the telehealth link on page 8 of their website or make linking to a physician one of more than 20 different calls to action, will find low patient engagement and low pull through.
  • As virtual health care is here to stay, telehealth itself should be a strategy for active promotion, by optimizing the steps to get patients connected to a physician in the shortest and the easiest way possible.

From this perspective, brands that will find the right pathway for engaging in telehealth, will reap the benefits of increased engagement with patients and telehealth physicians. To achieve this objective, with a robust, commercial strategy, the first step for each brand will start with understanding the needs of patients and physicians that needs to be addressed on priority. Then comes, mapping out how the brand will get used to meet those needs.

Conclusion:

We are still in the midst of an unprecedented new Coronavirus pandemic. As of October 18, 2020 morning, India recorded a staggering figure of 7,494,551 of Coronavirus cases with 114,064 deaths.

With the pandemic severely curbing most patients’ access to care – following the traditional process, Covid propelled health care into a virtual world, almost in no time. Telemedicine brought to the fore, its game changing potential to provide expanded access to high quality and affordable health care, through multiple channels, sans physical presence. Location of a patient or of a competent physician isn’t an issue, any longer, in the disease treatment process. With telemedicine patients will be able to get treated as and when they will want.

The future of Telehealth or telemedicine appears to be promising even beyond Covid time, with more people preferring digital platforms for affordable and more convenient medical care than in-person visits. With virtual care getting integrated into traditional health care delivery systems, pharma players will need to explore this space, as a new growth driver – for wider reach, and greater share of mind of customers for their respective brands.

For Telemedicine to be successful – benefitting a vast majority of both urban and rural populations, country’s health policy makers and, especially the pharma industry should work in unison. Only then, the net outcome will offer a win-win situation – both for the Government and also for the drug industry. It will help expand access to high quality and affordable care to all – seamlessly, irrespective of location. Consequently, pharma marketers will get access to another powerful business growth driver – in telemedicine. Its time about time for all to act – sooner the better.

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.

 

Shifting Pharma Supply Chain Strategy From Global To Local

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Alongside large-scale disruptions of many critical industrial operations, Covid-19 global pandemic took the wind out of the sail of pharma supply chain, as well, at the very onset of lockdowns. This happened in many countries around the world, including the largest global pharma market – the United States, and also in ‘the pharmacy of the world’ – India.

That there were such disruptions in India, both in procurement and logistics, during the national lockdown, was widely reported in the media. Besides product non-availability, cost of goods also went up significantly in several cases.

From this perspective, I shall deliberate in this article, how different countries are contemplating to respond to any similar crisis in the future, primarily to safeguard patients’ health interest, despite some opposition, though. To drive home the points, I shall cite examples from India and the United States, as specified above.

Supply Chain vulnerability of the ‘largest pharma market of the world’:

There are several examples to vindicate such vulnerability, both for the US and also India. From the US perspective, the country’s supply of generic and branded medicines are, reportedly, heavily rely on emerging markets, like India and China.

This point has now ‘come under close scrutiny of the American policy makers, as COVID-19 sends shockwaves through the industry. According to the US Food and Drug Administration, China and India represent 31 percent of the plants that are registered with the US to supply Active Pharmaceutical Ingredients (API), as of August 2019. The details are as hereunder:

Place

United States

European Union

India

China

Rest of the world

Canada

%

28

26

18

13

13

2

It is worth noting, the number of facilities in China supplying APIs has, reportedly, more than doubled since 2010 – to 13 percent of all those serving the US market.

Examples from India:

The outbreak of Coronavirus had just not shut factories in China - impacting supplies and leading to fears of a shortage of drugs and medicines. It happened in India, too. Several critical supply chain issues were reported during this period. For example,  a major Indian drug manufacturing hub - Baddi,reportedly, was either shut down or operated with reduced capacity, since COVID-19 pandemic related national lockdown.

Its impact also got captured by the twitter handle of the former USFDA Commissioner – Scott Gottlieb. He twitted, “Drug supply chain at risk as Asia’s largest pharmaceutical manufacturing hub in Baddi (an industrial town in southwestern Solan district of Himachal Pradesh, India) is declared a #COVID19 containment zone – forcing many pharma units to slow or stop operations.”

Supply Chain vulnerability of the ‘pharmacy of the world’:

Supply Chain vulnerability related to the domestic issues in India, can possibly be sorted out by the country’s decision-making authorities. However, the country’s vulnerability arising out of the reasons originating in the other countries, needs a greater priority focus of the nation.

As is widely known – India caters to about 20 percent of the world’s generic drug supply. However, according to Bloomberg, 70 percent of the country’s imports of APIs come from China, ‘totaling US$ 2.4 billion of India’s US$ 3.56 billion in import spending for those products each year.

Consequently, ‘pharma companies in the country are dependent on China for two-thirds of the chemical components needed to make them.’ Exposures of such nature are now coming on to the center table – mostly triggered by Covid-19 pandemic, both in India, as well as in the United States.

India is reevaluating its import dependence from China:

To illustrate this point, let me begin with some related recent developments. While reevaluating the import dependence, India has taken both immediate and medium to long term measures – at the policy level.

The immediate reaction of India to Covid-19 outbreak, was to shift focus on local with restricted export of common medicines, such as paracetamol and 25 other pharmaceutical ingredients and drugs made from China. Curiously, prior to the national lockdown, on March 17, 2020 by a written reply the Government had informed the Indian Parliament about the import of APIs /drugs and the extent of the country’s dependence on China for the same.

Be that as it may, to protect the local interest, the above ban was followed by another export ban of the age-old malarial drug - hydroxychloroquine, ‘touted by President Trump as a possible weapon in the fight against Covid-19,’ but has been in short supply, globally. Interestingly, India produces around 47 percent of the U.S. supply of hydroxychloroquine. Thus, understandably, Indian Government had to partially lift this ban after the U.S. President Donald Trump sought supplies for the United States.

For medium longer-term measures, while announcing a ₹20 lakh crore stimulus package, Prime Minister Narendra Modi articulated that Covid-19 pandemic had taught India to ramp up domestic production and create supply chains to meet internal demands. Earlier, for safeguarding ‘national healthcare security’, the Government had allocated US$ 1.2 billion for the pharma industry to be self-reliant, by reducing its import dependence, especially for APIs. The government also wants to finance the construction of three bulk drugs with an investment of ₹300 Crores.

The United States is reevaluating import dependence from one region:

The Fierce Pharma article of June 03, 2020 also reported a shifting focus of supply chain from global to local, as the United States seeks to ‘onshore’ drug production, with the fallout of Covid-19 pandemic looming large on its drug supply chain.

U.S. legislators have argued that ‘U.S. reliance on drugs made or sourced outside the country has created a security issue that could be addressed by erecting parallel supply chains stateside and eliminating reliance on potential bad actors abroad.’ Accordingly, they have put forward ‘a raft of legislation’ that would seek to “onshore” drug manufacturing at the expense of major producers abroad.

Its biggest obstacle could be the pharma industry and its lobbyists:

Nevertheless, the same article also underscores that the biggest obstacle to that plan could be the pharmaceutical industry and its lobbyists on Capitol Hill. This is because, PhRMA - the industry’s biggest lobbying group, has pushed back against Congressional support for a supply chain shake-up. It said, “Policymakers must take a long-term, more holistic look at global pharmaceutical manufacturing supply chains before jumping to rash proposals that may cause significant disruptions to the U.S. supply of medicines.”

Will it happen in India?

My article, published in this blog on February 03, 2020, also focused on this issue. There I had emphasized, about five years back - the Government of India had also announced on February 25, 2015 – terming ‘2015 – Year of Active Pharmaceutical Ingredients’ (API). This came after ascertaining that over-dependence on imports of bulk drugs or API, especially from China, is detrimental to India’s health interest. This decision was also in sync with the freshly announced, and well-publicized government objective regarding ‘Make in India’, I wrote.

Two years down the line from the above date, on July 15, 2017, eHEALTH publication also deliberated on this issue in an article – ‘Why over dependence on APIs imported from China is harmful for India?’ However, not much change has been witnessed till date, in this regard. The same vow is now being taken afresh. Nonetheless, let me hasten to add, Covid-19 has changed the life of all – in several respects. Thus, no one can possibly vouch with a high degree of certainty what can happen hereafter, as we move on.

Conclusion:

As the ‘Lockdown. 05’ or ‘Unlock down. 01’ begins in India – the ‘pharmacy of the world, as on June 02, 2020 morning, the recorded Coronavirus cases in the country reached 247,040 with 6,946 deaths. India is now racing ahead with its number Covid-19 cases, surpassing Italy and Spain, occupying the global fifth rank, in this regard. Whereas, the top ranked pharma market in the world – the United States, where Covid-19 struck hard before India, recorded 1,988,545 cases with 112,096 deaths, on the same day.

Thus, the need to have a fresh look at the strategic design of pharma supply chain is being felt in both these countries. The requirement for becoming less global and more local is attracting a priority focus of Governments in both countries. With an increasing State-push for safeguarding the health security of the country, the need to reshape pharma supply chain – call it transient or otherwise, is now more palpable 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.

 

UCPMP: Vacillating Between ‘The Perfect’ And ‘The Real’ World?

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In the ‘perfect world’ one takes ‘perfect decisions’, while in the ‘real world’ one takes a ‘real decision’ – as the saying goes. In tandem, a raging debate continues on what is ‘perfect’ and what is ‘real’, in the world we live in today. This may cause a dilemma to many, which seems to be all pervasive today. Understandably, many critical industry practices and processes are also a part of this quagmire. The pharma industry, the world over, including India, is no exception, where such dilemma and debates span across virtually all the business domains of the industry.

However, in this article, I shall focus only on one specific issue – alleged pharma marketing malpractices that continue unabated, regardless of severe punitive measures in many cases, from several parts of the world. Has it then become a universal ‘culture’ in this area? For greater clarity, let me start the ball rolling by trying to understand the line that differentiates ‘the perfect world’ norms from ‘the real world’ ones.

Understanding the ‘line’ between the ‘Perfect World’ and the ‘Real World’:

I reckon, in ‘the perfect world’ people develop ideal values, ethical standards and practices. The social, business and economic environments also encourage and promote an uncompromising value system that culminates into perfect and desirable behavioral traits for all. Consequently, there are no grey areas in the ethics and value judgement, especially regarding what is ‘right’ and what is ‘wrong’.

Whereas, in ‘real world’, the surrounding social, business and economic environment usually encourages and promotes self-serving interests, mostly from the shelter of ‘perfect world,’ as we shall see later. There also appears to be a flexibility in the overall value system – drawn around different guidelines, for preferred behavior and practices in most spheres of life. Consequently, one can spot many grey areas in that space, which are subject to different interpretation by different people. ‘Exceptions’ to the preferred behavior are also many.

As construed by many, one contemporary and broad example could perhaps be, the ethics, values and governance – enshrined in the Indian Constitution, arguably belong to the ‘perfect world.’ The same for ‘the real world’ is, what the majority of the population, including those who are governing the country demonstrate through words, deeds and action on the ground.

Living in ‘the real world’ – most expect others to practice ‘the perfect world’ norms:

Although, most people, including several different entities, actually prefer to live in ‘the real world,’ following commensurate practices and exceptions – generally expect others to practice ‘the perfect world’ norms – following commensurate ethics and values. Governments usually, try to exhibit that they want all citizens to be in ‘the perfect world’. However, under pressure of different nature, their policy enforcement arms keep maintain the status-quo of ‘the real world.’

Let me illustrate this point from the Indian perspective, with some recent examples related to the prevailing Uniform Code of Pharmaceutical Marketing Practices (UCPMP) in the country. Here itself, we shall find, even the Government machinery vacillating between the both worlds.

Government vacillating between ‘both worlds’:

A recent media report related to the ongoing allegation on pharma marketing malpractices in India raised a controversy. It reported, on January 13, 2020 – ‘PM Modi warns pharma companies not to bribe doctors with women, foreign trips and gadgets,’ during his meeting with the senior officials from top drug-makers. This move was, reportedly, triggered by the report of “Support for Advocacy and Training to Health (SATHI)” – an NGO.

Prior to this, on May 03, 2018, it was also widely reported, “Prime Minister Narendra Modi recently opened a Pandora’s box by condemning the allopathic doctors of the country during an interaction called ‘Bharat ki Baat, Sab ke Saath’ with the diaspora in London. The PM condemned the Indian doctors on charges of corruption and malpractice. He emphasized on the doctor-industry nexus and shared concerns on the fallout of such a relationship.”

The above statements, as reported, reflect deep anguish of the Prime Minister for violation of ethics and values in pharma marketing practices – as expected in the ‘Perfect World.’ Following this outburst at the top echelon of the country’s governance hierarchy, the logical general expectation is, commensurate action by the Department of Pharmaceuticals (DoP), at least, to contain those contentious practices.

But, the Government seems to be vacillating: 

Instead, just after a few weeks from what was quoted in the above January 2020 report – on February 09, 2020 another media report highlighted something that confirms vacillation of the Indian Government from ‘the perfect world’ to ‘the real world’, albeit too frequently, on this issue.

Despite UCPMP being in force for all drug companies to abide by, voluntarily, since January 2015, the situation in this area hasn’t improved a bit, which the DoP also seems to be well aware of. The obvious question, therefore, that follows: Is the DoP on the same page as PM Modi?

Interestingly, despite the PM’s assertion in this regard, the DoP Secretary, reportedly, kept playing the same old tune even after 5 years of the UCPMP’s unsuccessful implementation. He again repeated: “We have strictly instructed all the stakeholders to follow the code voluntarily. If not complied seriously, the department will bring in stricter regulations at the time to come and also think about making it mandatory for effective compliance.” This threat, from the ‘perfect world’ perspective, continues with the ‘real world’ understanding for action.

The possible reason for the above vacillation:

Many consider, intense lobbying by the pharma associations as the possible reason for vacillation of the Government. This is vindicated by another report of January 17, 2020 that claimed, a powerful Indian industry association has sought multiple tweaks in the current UCPMP – meant for voluntary implementation by the drug industry in India. Two of these, among several others, were reported as follows:

  • Relaxed rules for the distribution of free samples.
  • Permission for doctors to work at pharmaceutical companies.

As reported, this proposal of the industry has been floated among pharmaceutical companies, for comments. ‘Once approved by all member companies, it will be sent to Department of Pharmaceuticals secretary P.D. Vaghela.’ However, it appears, there doesn’t seem to be anything new in it, as news archives reveal, similar proposals were submitted by the Indian drug industry associations, in the past, as well.

At this stage, let me hasten to add that the above January 2020 report, quoting the Indian PM’s anguish, was denied by a domestic industry association by a statement.

The first report was denied – albeit vaguely – by an industry association:

Curiously, the January 2020 report was denied by the domestic Industry Association - Indian Pharmaceutical Alliance (IPA) by releasing a statement. It said, the meeting convened by the Prime Minister Narendra Modi with the healthcare industry on January 01, 2020 was to discuss future road map for growth of the industry.

It further emphasized, the focus of the discussion was to promote research and development, build an innovation ecosystem, improve access to high-quality medicine and strengthen global competitiveness of the industry. The purpose was to take the industry to the next level and leverage opportunities going forward in the pharmaceutical sector. “There was no discussion on uniform code of pharmaceutical marketing practice in the meeting,” the statement added.

However, this statement appears rather vague to many, as it doesn’t emphatically deny that the PM did not say or mean those words, regardless of the context. Neither, the PMO, reportedly, has done so, as yet.

Probably because of this reason, another news article reported on January 15, 2020 that the Indian Medical Association, the country’s largest body of doctors, urged Prime Minister Narendra Modi to “prove, deny, or apologize (for)” the purported statement attributed to him asking pharmaceutical companies ‘not to bribe doctors with foreign trips, gadgets and women.’ I am still not aware of any response from the PMO on the same. Hence, some people find the industry association’s statement, especially considering the core issue under discussion today, albeit vague.

Some key findings on UCPMP:

Be that as it may, as I indicated in one of my previous articles in this blog, a survey report by Ernst and Young titled, “Pharmaceutical marketing: ethical and responsible conduct”, was released in September 2011 on the UCMP and MCI guidelines. It highlighted some of the following points:

  • More than 50 percent of the respondents are of the opinion that the UCPMP may lead to manipulation in recording of actual sampling activity.
  • Over 50 percent of the respondents indicated that the effectiveness of the code would be very low in the absence of legislative support provided to the UCPMP committee.
  • 90 percent of the respondents felt that pharma companies in India should focus on building a robust internal control system to ensure compliance with the UCPMP.
  • 72 percent of the respondents felt that the MCI did not stringently enforce its medical ethics guidelines.
  • Just 36 percent of the respondents felt that the MCI’s guidelines would have an impact on the overall sales of pharma companies.

Although, this report may be a bit dated, its key findings don’t seem to have changed much as on date. It is also worth noting that there are umpteen examples of similar malpractices in the pharma industry, globally.

Conclusion:

“Compared to a strictly controlled manufacturing environment, the marketing environment for the pharmaceutical industry in India is less regulated, but will move towards greater regulation in times to come”, predicted ‘The Global Guide to Pharma Marketing Codes,’ a few years ago. The situation remains unchanged.

Alongside controversy over pharma firms allegedly ‘bribing’ medical professionals, the Alliance of Doctors for Ethical Healthcare (ADEH), a network of doctors from across the country has demanded that the UCPMP framed five years ago be made mandatory, as another media report highlighted on January 21, 2020.

But the reality is, the Government wants the drug industry to follow ‘the perfect world’ ethics and values in marketing practices to safeguard patients all round interest. Whereas, the drug industry wants the policy makers to appreciate the business compulsions of ‘the real world’ and introduce exceptions to the rules.

Both the stances are unlikely to meet a common ground, because general population expects the Government to adhere to ethics and values of ‘the perfect world’, in health care. Whereas, in public, pharma industry leaders often take vows of practicing so, but seem to act differently in ‘the real world’ situation, expanding the credibility gap.

In the perceivable future, it appears unlikely that the Government’s ‘perfect world’ expectations, and the ‘real world’ actions of most pharma players will be in sync with each other. Unless, of course, either the Government moves away from ‘the real world’ marketing ethics and values – safeguarding patient interest, to meet ‘real world’ expectations of the industry, or make pharma players to fall in line with ‘the perfect world’ expectance, by making the UCPMP mandatory.

Is the question, therefore, how to take a ‘perfect world’ decision for the people’s health interest, in the ‘real world’ of the pharma industry? Till this issue is resolved, UCPMP will continue to exist, but no more than a ‘toothless tiger’, as it were.

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.

 

 

Honing Patient Outcomes With WHDs

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On November 01, 2019, San Francisco-based Fitbit, Inc. announced that it has entered into a definitive agreement to be acquired by Google LLC for approximately US$ 2.1 billion. Many believe, though, the value of Fitbit lies in the health data that its wearables capture for its large base of users.

According to the CEO of Fitbit, currently the Fitbit brand supports more than 28 million active users around the globe who rely on these wearable products ‘to live a healthier, more active life.’ With Google’s resources and global platform, Fitbit will be able to accelerate innovation in the wearables category, scale faster, and make health even more accessible to everyone, he added.

The article – ‘The Real Reason Google Is Buying Fitbit,’ published in the Time magazine on November 04, 2019 makes some interesting points, such as the following:

  • The fast-growing healthcare tech space could be worth US$24 billion by 2020, says an estimate from Statista.
  • Although, Google has been working on cardiovascular health, diabetes and more, it hasn’t been publicly pushing healthcare as a business proposition, just yet.
  • Whereas, Google’s rivals, most notably Apple, have embraced healthcare as the next big battleground in the tech world, attracted by the promises of big profits for those who can help simplify a byzantine healthcare system.

Nonetheless, the Fitbit acquisition would facilitate Google’s entry into the Wearable Health Devices (WHDs) market in a big way, alongside other big players, such as, Apple and Samsung.

Driven by the most likely scenario of increasing usage and usefulness of WHDs, several pharma players are sniffing huge underlying commercial opportunity in this space, alongside being demonstrably patient-centric. Thus, my today’ article will deliberate whether or not WHDs will be able to offer a cutting edge to innovative drug marketers, by continually honing patient outcomes. Let me initiate this discussion by fathoming the importance of WHDs in the fast transforming digital world.

The importance of WHDs in the digital world:

‘Mary Meeker‘s 2019 Internet Trends Report’ highlights, about 51 percent of the global population is now connected to the internet, with the majority of users based in China, India and the United States. However, global internet user growth has slowed down by 6 percent and it’s becoming increasingly harder to get the rest of the world online.

In this background, especially - ‘As patients become more involved in making decisions about their health care, research shows, the result is increased satisfaction and improved health outcomes.’Consequently, the report spotlights healthcare digitization where consumer adoption of digital health tools is increasing rapidly. Some of the top areas, in terms of their speed of adoption, were listed as follows:

  • Online Health Information
  • Online Provider Reviews
  • Mobile Tracking
  • Wearables
  • Live Video Telemedicine

This gives a sense of how fast the WHDs are gaining importance for the consumers. Interestingly, Intouch Group also points out that wearables are now being used more to manage a diagnosis rather than just fitness trackers. Adding further, it pointed out – ‘Apple’s ResearchKit is an example of what CEO Tim Cook calls the “democratization of healthcare,” in that it provides health data directly to consumers so they can manage their health.’

A recent study on the scope of wearables: 

The scope of WHDs was aptly corroborated in a recent article – ‘The Rise of Wearable Technology in Health Care,’ published in the JAMA Network Open on February 01, 2019. The paper concludes, the general principle of commercially available ubiquitous wearable computers bodes well for our future ability to measure, track, and understand patient physiological data and behavior both in the hospital and at home.

The ability to capture such data, then applying machine learning to get the evolving health trends and sending alerts to patient accordingly – nurses, and physicians are instantaneously getting empowered to deliver patient outcomes. The fact that the alert can come easily via the patients’ smartphones that a significant part of the global population now carries with them, leading to further democratization of health care.

The Economist  also predicted, by 2020 – 80 percent of the adult population of the world would have a smartphone in their pocket. Therefore, this development opens up an entirely new world of real-time data acquisition, monitoring, and intervention, the paper underscored.

Giving a relevant example, it highlighted: ‘On December 6, 2018, Apple rolled out a software upgrade that turns the Apple Watch Series 4 into a personal electrocardiogram.’ The researchers further added, while WHDs’ fidelity may not yet exactly match medical-grade monitors and devices, these are “good enough” coupled with around-the-clock capabilities, real-time data capture, storage, and analytics and seem likely to provide real value.

The opportunities with WHDs:

Both from the health and business perspectives, WHDs are opening new vistas of opportunities for all stakeholders in the healthcare space, such as, patients, doctors, care providers and also pharma companies. This was enunciated in several studies, such as one, titled ‘Wearable Health Devices – Vital Sign Monitoring, Systems and Technologies,’ published by Sensors (Basel, Switzerland) on July 25, 2018.

This paper also reiterated: ‘Wearable Health Devices (WHDs) are increasingly helping people to better monitor their health status both at an activity/fitness level for self-health tracking and at a medical level providing more data to clinicians with a potential for earlier diagnosis and guidance of treatment. The technology revolution in the miniaturization of electronic devices is enabling to design more reliable and adaptable wearables, contributing to a world-wide change in the health monitoring approach.’

Thus, a big excitement is currently palpable around the technology related to WHDs. Many more opportunities are expected to unfold for continuation of the ascending trend. With the entry of big global tech giants such as, Apple and now Google, besides scores of small startups, WHDs of many types have started entering into the healthcare, carrying a promise to improving outcomes and creating a unique patient experience in the disease treatment process.

Improves outcomes, creates a unique disease treatment experience:

Echoing many other experts in this area, I also believe that WHDs have covered a lot of ground by now – expanding its usage from fitness trackers to diagnosis of disease and then monitoring the progress both during and after treatment. Current usages of WHDs are mostly for non-infectious chronic diseases, such as diabetes, cardiovascular conditions, sleeping disorders, obesity and treatment compliance, besides others. The list is gradually expected to expand.

Apparently, encouraged by this trend, more pharma players are now moving into this area for significant brand value for augmentation through better patient outcomes – apace with providing a unique disease treatment experience for suffering individuals.

The scope in India:

As WHDs have a close link with both Internet and Smartphone penetration, let me try to weigh the potential of the wearables, in view of the current status of both in the country.

According to the India Internet 2019 Report by Internet and Mobile Association of India (IAMAI), the following three points are indeed noteworthy, besides others:

  • With 451 million monthly active internet users at the end of financial year 2019, India is now second only to China in this regard.
  • Urban India with 192 million users had almost the same number of users as rural India. However, in terms of percentages or penetration, given the disparity of population distribution in urban and rural India, urban India had a considerably higher penetration level.
  • In rural India, a sizable portion does not have access to the Internet, and provides a huge opportunity for growth which will contribute to an increase in the overall Internet population over the next few years, it said.

Similarly, according to the Statista report, for 2017, the number of smartphone users in India was estimated to reach 299.24 million, with the number of smartphone users worldwide forecast to exceed 2.3 billion users by that time, and was projected to be nearly 2.7 billion by 2019.

These numbers speak for themselves on the underlying opportunities of WHDs – both globally and locally. Accordingly, large pharma players have already started teaming up to deliver better patient outcomes, leveraging the value of WHDs.

Pharma players teaming up to deliver better patient outcomes with WHD:

There are several such examples. Nevertheless, to illustrate the point, let me cite one such recent instance of Abbott Laboratories announcing a deal on February 20, 2019 with Novo Nordisk to make diabetes management easier by linking technologies of the two companies. The deal will allow integration of insulin dose data for Novo Nordisk’s pre-filled and connected pens with its ‘FreeStyle’ Libre mobile app and cloud-based system.

‘Abbott’s ‘FreeStyle’ Libre Continuous Glucose Monitoring (CGM) system will read glucose levels through a sensor that can be worn on the back of the upper arm eliminating the need for routine finger pricks. Through the FreeStyle LibreLink app users can capture and view their real-time glucose levels, their eight-hour glucose history, and how their glucose is currently changing on their smartphone.’

Yet another report highlighted, ‘Google sister-company Verily is teaming with big pharma on clinical trials.’ On May 21, 2019, the company announced strategic alliances with the pharmaceutical companies Novartis, Sanofi, Otsuka and Pfizer to help it move more deeply into the medical studies market. The goals for Verily, and its pharma partners, are to reach patients in new ways, make it easier to enroll and participate in trials, and aggregate data across a variety of sources, including the electronic medical record or health-tracking wearable devices,’ the report emphasized.

Conclusion:

It seems clear that in the rapidly transforming digital world, many drug companies are realizing the criticality of making their business operations sine qua non with the evolving trend is essential. This is not just for the organization progress, but also for long-term survival of the business. In the midst of this exciting technological environment, the potential value of WHDs to deliver better patient outcomes is being brought to the fore, primarily by the pure tech companies.

Figuring out the magnitude of the new opportunity, several pharma companies have thrown their hats in the ring, primarily in the form of collaborative deals. This ushers in a new phase in the healthcare space. Mostly because, such initiatives will have to be patient-centric for providing a unique patient experience with the drugs, in the disease treatment process. As India too, is taking rapid strides for penetration of digital technology in its ‘Health for All’ initiatives, the use of WHDs for better and cost-effective patient outcomes isn’t a pipe dream, any longer.

The evolving scenario, therefore, opens yet another door for the pharma players to grow their business, not just with drugs offering differential value, but also by making even a ‘me-too’ drug perform better, leveraging the potential of WHDs, effectively. From this perspective, continuously honing patient outcomes with WHDs, appears to be a unique tool for pharma marketers to make use of – in search of 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.