TM

MEDICINMAN
December 2013 | www.medicinman.net

Field Force Excellence

Editorial

Herzberg,
Motivation and
Indian Phar...
Anup Soans | Editorial: The MAP of Motivation

When we look at Indian pharma field force working
conditions job dis-satisf...
CONTENTS (Click to navigate)
1. Sales vs. Marketing: the customer doesn’t
care! .............................................
E
E

SALES VS. MARKETING

THE CUSTOMER DOESN’T CARE!
In the war between sales and marketing, the customer is hurt the most...
Salil Kallianpur | Sales Vs. Marketing - the Customer Doesn’t Care!

“

The lone, redfaced ‘field
manager’ who
pulled the ...
Salil Kallianpur | Sales Vs. Marketing - the Customer Doesn’t Care!

“

The conflict
between sales
and marketing
apart fro...
  | yyy                       

xxx
E                         

...
REGISTRATIONS OPEN
FOR PHARMA DELEGATES
Event**

Express Early Bird
(upto 30th Nov’13)*

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Showcase Your Products and Services, Networ...
E

THE RURAL
HEALTHCARE
LANDSCAPE IN
INDIA
Serving the rural patient is an opportunity for and the
responsibility of healt...
Soumalya Chatterjee | The Rural Healthcare Landscape in India

Biased Reality
1.	 Less than 20 % of Rural population have ...
Soumalya Chatterjee | The Rural Healthcare Landscape in India

“

Health information system

The Integrated
Disease
Survei...
Soumalya Chatterjee | The Rural Healthcare Landscape in India

“

The Way Forward

The ultimate goal
of a great nation
wou...
MEDICINMAN Academy

Learning and Development Programs for Pharma Sales and Marketing Professionals

Pharma-specific Traini...
E

DIFFERENTIATING
THROUGH ON-THE-JOB
COACHING
Coaching is a day-to-day
activity and not a one-off event.

K. Hariram

I

...
K. Hariram | Differentiating through On-the-job Coaching

In most of the companies the oft repeated statement
from the Sal...
E

MASTERY, AUTONOMY AND
PURPOSE IN FIELD FORCE
EXCELLENCE
Understanding Significance of Mastery, Autonomy and
Purpose in ...
Anup Soans | Mastery, Autonomy and Purpose in Field Force Excellence

behavior, market dynamics and internal resources by ...
Anup Soans | Mastery, Autonomy and Purpose in Field Force

Yet, significantly, both companies were successful in
their own...
Anup Soans | Mastery, Autonomy and Purpose in Field Force Excellence
What then is MAP? As Stephen Covey says, “begin with ...
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Conta...
E

FREE MEDICINES OR BETTER
HEALTH? Salil Kallianpur

OPINION

A

“

While the availability
of free generics can be
a deci...
Salil Kallianpur: Free Medicines or Better Health?

“

Mr. Gandhi must
outline the measures
he would put into place
to pre...
E

IMPROVING THE EFFICIENCY OF MRs

P

harmaceutical companies spend crores in order to
market their brands, and medical r...
Aniruddha Malpani: Improving the Efficiency of MRs

“

Pharmaceutical
companies need
to invest in better
ways of ensuring
...
E

KNOWLEDGE FOR THE
FIELD FORCE SERIES
Oral Anti-Diabetic
Agents-II
Dr Amit Dang

C

ontinuing with the oral antidiabetic...
E

BOOK REVIEW

BAD PHARMA:
HOW MEDICINE IS BROKEN
AND HOW WE CAN FIX IT
By Ben Goldacre; Publishers: Harper Collins, Lond...
Prof. Vivek Hattangadi | Book Review: Bad Pharma by Ben Goldacre

“

HR, Training, and
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MAP of Motivation for Pharma Field Force

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Inside this Issue

1. Sales vs. Marketing: the Customer Doesn’t Care! by Salil Kallianpur

In the war between sales and marketing, the customer is hurt the most.

2. The Rural Healthcare Landscape in India by Soumalya Chatterjee

Serving the rural patient is an opportunity for and the responsibility of healthcare companies in India.

3. Differentiating through On-the-job Coaching by K. Hariram

Coaching is a day-to-day activity and not a one-off event.

4. Mastery, Autonomy and Purpose in Field Force Excellence by Anup Soans

MAP enables field sales people to see the big picture and use their abilities to implement strategies systematically even in the absence of oversight.

5. Free Medicines or Better Health? by Salil Kallianpur

The underlying assumption of Rahul Gandhi’s manifesto is that merely providing medicines free would help improve the health and the productivity of the nation. In isolation that is simply not true.

6. Improving the Efficiency of MRs by Dr. Aniruddha Malpani

Pharmaceutical companies need to invest in better ways of ensuring that their MRs get quality face to face time with the doctor.

7. Knowledge for the Field Force Series by Dr. Amit Dang

Oral Anti-Diabetic Agents – II

8. Book Review: Bad Pharma: How Medicine Is Broken and How We Can Fix It by Ben Goldacre reviewed by Prof. Vivek Hattangadi

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Transcript of "MAP of Motivation for Pharma Field Force"

  1. 1. TM MEDICINMAN December 2013 | www.medicinman.net Field Force Excellence Editorial Herzberg, Motivation and Indian Pharma Field Force Work-life balance is a major job satisfier for Gen X and Gen Y. Pharma needs to factor this in to attract and retain talent. W hen I posted this illustration (fig. 1) on Facebook (FB) with the caption – “Why a 5 Day Week May Actually Increase Productivity”, it touched a raw nerve and evoked tremendous response from Indian pharma field force people. Theories on motivation have been evolving over time. The most recent work to have captured the attention of academics and practitioners alike is the well researched and well articulated book by Daniel Pink “Drive: the Surprising Truth about What Motivates Us”. Field sales people working in most Indian companies have 24x7x365 schedule, leaving them with hardly any quality time for family, friends or just relaxing. This has an adverse impact on motivation and performance. Tired and stressedout Medical Reps are not the most effective people and this is reflected in the large number of less than effective field sales calls. Concepts like SFE will be far more effective when combined with fundamental aspects of job satisfaction that leads to motivation and superior performance. “ (fig. 1) “ Indian Pharma needs to look afresh at field force motivation than simply using the outdated carrot and stick method, which has only led to very high attrition and steep drop in quality of people being attracted to pursue a career in pharma field sales. ” It was Frederick Herzberg, who first developed the two-factor theory that states that there are certain factors in the workplace that cause job satisfaction, while a separate set of factors cause dissatisfaction. Herzberg brought clarity by saying that job satisfaction and job dissatisfaction are separate factors and act independently of each other.
  2. 2. Anup Soans | Editorial: The MAP of Motivation When we look at Indian pharma field force working conditions job dis-satisfiers outnumber job satisfiers. Indian Pharma needs to look afresh at field force motivation than simply using the outdated carrot and stick method, which has only led to very high attrition and steep drop in quality of people being attracted to pursue a career in pharma field sales. Even top MNC’s are having a tough time attracting and retaining talent. I have covered this topic in detail in the article – “Understanding Significance of Mastery, Autonomy and Purpose in Field Force Excellence”. (See page 18) The MedicinMan Excellence Awards are an effort in the direction of increasing job satisfiers and removing job dis-satisfiers. To know more, be there at Brand Drift and FFE 2014 on 7th and 8th Feb 2014. Follow me on FB, LinkedIn and Twitter to get a pulse of the Indian Pharma’s field force - and marketing news, views, learning and development. I welcome your thoughts and ideas on how pharma field force can be made an attractive and satisfying career. This would certainly have a positive business impact on the flagging Indian Pharma growth prospects as indicated by a recent IMS report, which I have also shared on FB. Meet the Editor Anup Soans is an Author, Facilitator and the Editor of MedicinMan. Write in to him: anupsoans@medicinman.net Connect with Anup Soans on LinkedIn | Facebook | Twitter Visit anupsoans.com. MEDICINMAN Pharma Sales & Marketing Conference 2014 FFE | BRAND DRIFT | AWARDS 7th - 8th February 2014 Courtyard Marriott, Mumbai See page 7
  3. 3. CONTENTS (Click to navigate) 1. Sales vs. Marketing: the customer doesn’t care! ..........................................................................4 In the war between sales and marketing, the customer is hurt the most. Salil Kallianpur 2. The Rural Healthcare Landscape in India.......................................................................11 Serving the rural patient is an opportunity for and the responsibility of healthcare companies in India. Soumalya Chatterjee 3. Differentiating through on-the-job coaching..............................................................14 Coaching is a day-to-day activity and not a one-off event. K. Hariram 4. Mastery, Autonomy and Purpose in Field Force Excellence .................................................18 MAP enables field sales people to see the big picture and use their abilities to implement strategies systematically even in the absence of oversight. Anup Soans 5. Free Medicines or Better Health? ..............23 The underlying assumption of Rahul Gandhi’s manifesto is that merely providing medicines free would help improve the health and the productivity of the nation. In isolation that is simply not true. Salil Kallianpur 6. Improving the Efficiency of MRs..................25 Pharmaceutical companies need to invest in better ways of ensuring that their MRs get quality face to face time with the doctor. Dr. Aniruddha Malpani, MD 7. Oral Anti-Diabetic Agents-II.........................27 Dr. Amit Dang 8.Book Review: Bad Pharma: How Medicine Is Broken and How We Can Fix It by Ben Goldacre .............................................................................28 Prof. Vivek Hattangadi MedicinMan Volume 3 Issue 12 | December 2013 Editor and Publisher Anup Soans CEO Chhaya Sankath COO Arvind Nair Chief Mentor K. Hariram Advisory Board Prof. Vivek Hattangadi; Jolly Mathews Editorial Board Salil Kallianpur; Dr. Shalini Ratan; Shashin Bodawala; Prabhakar Shetty; Vardarajan S; Dr. Mandar Kubal; Dr. Surinder Kumar International Editorial Board Hanno Wolfram; Renie McClay Executive Editor Joshua Soans MedicinMan Academy: Prof. Vivek Hattangadi, Dean, Professional Skills Development Letters to the Editor: anupsoans@medicinman.net
  4. 4. E E SALES VS. MARKETING THE CUSTOMER DOESN’T CARE! In the war between sales and marketing, the customer is hurt the most. Salil Kallianpur A few days ago, this picture put up by Anup Soans on his Facebook (FB) page (see below) elicited 201 ‘likes’, 323 ‘shares’ and 76 comments (as of Nov 2nd). The popularity of this post intrigued me not because it was something that had never happened earlier - Anup is quite popular on social media - but since it quickly assumed an accusatory tone and one of grievance. Although I have no way to ascertain it, I am sure the cartoonist meant the picture to be something else before another creative person labeled the drummer as the ‘CEO’, the workers on the train cart as ‘head office managers’ and the lone person pulling the train cart with its heavy load of people as the ‘field manager’. Salil Kallianpur is Commercial Head - Classic Brands Center of Excellence, GSK. He is a well-known pharma blogger and social media enthusiast. salilkallianpur.wordpress.com 4 | MedicinMan December 2013
  5. 5. Salil Kallianpur | Sales Vs. Marketing - the Customer Doesn’t Care! “ The lone, redfaced ‘field manager’ who pulled the cart didn’t seem to convey to anyone that while it was his job to further the organization towards its planned goal, it could well be a rotating assignment ” While the picture is a bit exaggerated, the way it was perceived on the FB post seemed to turn the entire concept of teamwork on its head. Despite a little prodding by the author, not one person looked at this as representing teamwork. It did not occur to anyone that the CEO might be seen to be making an effort to keep the functions of the organization (if we assume the train cart to be one) in a smooth rhythm so that efficiency increases – a concept best demonstrated by the famous Kerala boat races. No one thought it fantastic that all ‘head office managers’ were working as one team towards furthering the objectives of the organization without pushing an individual agenda. The lone, red-faced ‘field manager’ who pulled the cart didn’t seem to convey to anyone that while it was his job to further the organization towards its planned goal, it could well be a rotating assignment and when he pulled the cart up to a certain point – or goal – he could then hop on board the cart and begin to assist the other ‘head office managers’ with their work while someone on board took up the task of pulling the cart. I found it very interesting that most people who commented seemed to do so in a pattern. They all seemed to convey that sales and marketing operated in different silos and not as two arms of the organization; marketing personnel know little about what sales personnel do and more often than not ‘force’ their ideas on them. A few gentlemen, who tried to support the marketing function, either did so feebly or their arguments were quickly drowned out. I was reminded of the ongoing social media battle between supporters of two major political parties, which could be understood as that of opposing ideologies and goals. In this case however, sales and marketing people seemed to worry more about which function was better, more important or needed more effort and not on how different functions within the organization work in tandem to help it attain its goal. The ‘war’ between sales and marketing goes back a long time and spans across industries. However, it is also well documented that this lack of alignment ends up hurting organizational performance. Time and again, both groups stumble (and the organization suffers) because they don’t work together. There is no doubt that when sales and marketing work well together, companies see substantial improvement on important performance metrics: sales cycles are shorter, market-entry costs go down, and the cost of sales is lower. References: 1. ‘Ending the War between Sales and Marketing’: Philip Kotler, Neil Rackham, Suj Krishnaswamy; Harvard Business Review July-August 2006. 5 | MedicinMan December 2013 As the HBR says1 , the conflict between sales and marketing apart from being economic, is cultural in nature. This is true in part because the two functions attract different types of people. Marketers are deemed to have more formal education than salespeople. They are expected to be highly analytical, data oriented, and project focused, always thinking about building competitive advantage for the future. Sales teams do not appreciate it as much as they should because they perceive it to happen behind a desk in air-conditioned offices rather than out in the field. Salespeople, in contrast, spend their time talking to existing and potential customers. They’re skilled relationship builders; they’re expected to not only be savvy about customers’ willingness to buy but also intuitively know which products will fly and which will die. They want to keep moving.
  6. 6. Salil Kallianpur | Sales Vs. Marketing - the Customer Doesn’t Care! “ The conflict between sales and marketing apart from being economic, is cultural in nature. This is true in part because the two functions attract different types of people. ” They’re used to rejection, and it doesn’t depress them. They live for closing a sale. It’s hardly surprising that these two groups of people find it difficult to work well together. Yet there is not a more opportune moment to harness the skills of both teams than the current one. The pharmaceutical industry in India just hiccupped. From the customer facing side, new regulations such as the new pricing policy has just made medicines more affordable. However, a clamp-down on clinical trials has put the launch of new, innovative medicines on the back-burner for the moment. Also, there is no inflow of foreign capital into the sector putting capital expansion plans of companies on hold. Additionally, more and more Indian companies derive their real growth in earnings from serving overseas markets. In such a scenario, the last thing a customer would appreciate is a chasm between internal departments in an organization that hamper his ability to provide services to his patients. Corporate equity is at potential risk if information flow on products is delayed because the marketing team does not respond to requests from the sales team or if crucial travel information of a KOL traveling to an international conference is withheld. While I will not attempt to offer solutions or debate them here, I want to leave you with some thoughts. Why is it so difficult for colleagues within the same organization to work together? Isn’t everyone trying to do the same thing i.e. attain market leadership? How does it matter where you work or what you do? Aren’t you proud of what you are doing? Are we getting into the quicksand of wanting to do someone else’s role? At the risk of sounding preachy, I’d like to invoke the Bhagvad Gita here which extols us to merely do our duty and not worry about someone else. Just excelling at what we do helps us to create great value – tangible and otherwise. Cumulatively, this ever-expanding pool of excellence is the fuel that propels organizations from being good to becoming great. So instead of worrying about why others fail, let us continue to focus on our own success. If the red-faced man in the picture didn’t pull the train cart, how would it move forward? If the men on board didn’t tighten the bolts on the track and pat down the stones of the ballast, how would that section of the track become secure? If the CEO didn’t beat the drum to a rhythm, how would the overall efficiency of the team increase and progress be achieved? Now if the red-faced man was constantly badgered by the ones on board, would he pull the cart? If he stopped pulling the cart, would the whole team (organization) move? Would the CEO then really matter? 6 | MedicinMan December 2013 As economic growth continues at its anemic pace, we’re all looking for ways to make our operations more productive. Bridging the sales-vs.-marketing divide is a way of achieving this. Let us change our perspective. It will make a positive impact on customers. We know well that customers these days are too mobile, too connected, and too informed to tolerate any gap between what one department says and another does. So, if we allow sales and marketing to operate in silos, at the end of the day, do you really think the customer cares? He would just move on to the next company.
  7. 7.   | yyy                         xxx E                               MEDICINMAN Pharma Sales                 & Marketing Conference 2014     FFE | BRAND DRIFT | AWARDS                       7th - 8th February 2014     Courtyard Marriott, Mumbai FIELD FORCE                    EXCELLENCE     å   The most awaited            Pharma                         is here.                conference of the year      Registrations open now!                    BRAND DRIFT                 å  Pharma’s       Excellence           Awards          Biggest Players.  At the One Conference                           that Matters.        |      2013   7 MedicinMan December                    Sponsorships Invited
  8. 8. REGISTRATIONS OPEN FOR PHARMA DELEGATES Event** Express Early Bird (upto 30th Nov’13)* Early Bird (1st Dec’13 to10th Jan’14)* Regular (11th Jan’14 onwards)* 4,200/- 5,500/- 7,000/- 5,900/- 7,000/- 8,500/- BD + FFE 10,100/- 12,500/- 15,500/- AWARDS only 3,900/- 5,100/- 6,000/- Brand Drift 2014 (BD) only FFE 2014 (FFE) only FOR NON-PHARMA DELEGATES & SERVICE PROVIDERS Event** Express Early Bird (upto 30th Nov’13)* Early Bird (1st Dec’13 to10th Jan’14)* Regular (11th Jan’14 onwards)* 7,000/- 9,000/- 12,000/- 11,000/- 15,000/- 18,000/- BD + FFE 18,000/- 24,000/- 30,000/- AWARDS only 6,000/- 8,000/- 10,000/- Brand Drift 2014 (BD) only FFE 2014 (FFE) only To Register, get in touch with us: Anup Soans: +91-934-2232-949 | anupsoans@gmail.com Arvind Nair: +91-987-0201-422 | arvindnair123@gmail.com
  9. 9. NOMINATIONS INVITED MedicinMan Excellence Awards for Outstanding Indian Pharma Professionals 2014 Organized by Knowledge Media Venturz MedicinMan invites nominations in the following award categories: Sales Awards Marketing Awards Academic Awards Special Category Outstanding Medical Rep Outstanding Product/Brand Manager Outstanding Pharma Academician Oustanding CEO/President/ Country Head Outstanding Front-line Manager Outstanding Group Product Manager Outstanding Second-line Manager Outstanding Marketing Manager Outstanding Senior Sales Manager Outstanding SBU Head Outstanding Sales Training Professional Outstanding Business Intelligence Professional Oustanding Pharma Education Institution (for D.Pharm, B.Pharm & M.Pharm) Oustanding Pharma Management Education Institution (PGDM & MBA) Outstanding HR Professional Outstanding Medical Advisor Outstanding Support Services Professional Outstanding SFE Professional Outstanding Head of Sales Processing Fee: INR 1,000/- Processing Fee: INR 1,000/- Processing Fee: INR 5,000/- Processing Fee: INR 5,000/- All nominations must be sent in the following format: 1. Brief description about the nominated candidate/service provider with photograph/website details. 2. Brief description about the nominated candidate/service provider’s achievements to be considered for the Award 3. All nominations must be certified by two senior managers HR/Sales/Marketing of General Manager and above. In case of Service Providers the Nomination must be attested by two General Manager level executives of the company to which the service was provided. 4. Complete Contract details of Nominees as well as the nominating Managers with mobile, email, LinkedIn, Twitter and Facebook handles. 5. All Nominees and nominating Managers must connect with Anup Soans, Editor of MedicinMan on LinkedIn, Twitter and Facebook for verification. 6. All nominations must be from currently employed professionals working in companies with a turnover of Rs 50 crores and above with a minimum field force of 300 people. 7. Incomplete Nominations will be rejected. 8. The decision of the MedicinMan jury will be the final arbiter in short-listing and selecting candidates for the Awards. All cheques/payments to be made in favor of “Knowledge Media Venturz” payable at Mumbai and sent along with nominations to: Anup Soans Editor - MedicinMan 101 North Forte 22, North Road, Cooke Town St. Thomas Town Post Office Bangalore - 560084
  10. 10. SPONSORS INVITED Pharma’s Biggest Players. At the One Conference that Matters. Showcase Your Products and Services, Network, Grab Your Share of the Mind. Sponsorship Opportunities 1. The Thought Leader 2. The Market Heavyweight 3. The Nimble Fighter The Thought Leader is for those companies who have complete confidence to be the No.1 service provider to Pharma in their domain. This Exclusive package entitles you to the following business options: The Market Heavyweight is for those companies with a consistant track record, looking to grow their share of the market and mind. Business options: This Lightweight option gives you access to the big players without hurting your wallet. 1) Co-Naming Rights: Presence in the Conference’s Official Title “YOUR_NAME_HERE FFE 2013”. 2) Privilege to be on the CEO panel plus adress the audience for 20 minutes. 3) Twelve Full-page Advertisements/Advertorials/Articles in MedicinMan. 4) 10 Complimentary Pharma Delegate Registrations Plus 5 Complimentary Delegate Registrations for Company Officials. 1) Privilege to address the audience for 15 minutes at a relevant session. 2) 5 Complimentary Pharma Delegate Registrations plus 3 Complimentary Delegate Registrations for Company Officials. 3) 6 Full-page Ads in MedicinMan. 4) Prominent Display of Brand on all Conference Collaterals Before, During and After the Conference. (for specifics, please get in touch). 1) Privilege to address the audience for 10 minutes at a relevant session. 2) 3 Complimentary Delegate Registrations for Company Officials. 3) 2 Full-page Ads in MedicinMan. 4) Prominent Display of Brand on all Conference Collaterals Before, During and After the Conference. (for specifics, please get in touch). 5) Prominent Display of Brand on all Conference Collaterals Before, During and After the Conference. (for specifics, please get in touch) Event Organized by: All three packages can be customized to suit your communication needs. Contact us for details. Anup Soans: +91-93422-32949 | anupsoans@gmail.com Arvind Nair: +91-987-0201-422 | arvindnair123@gmail.com
  11. 11. E THE RURAL HEALTHCARE LANDSCAPE IN INDIA Serving the rural patient is an opportunity for and the responsibility of healthcare companies in India. Soumalya Chatterjee A few months back, I went for joint fieldwork in a remote village of Madhya Pradesh. I was working in a Government hospital when a mother came with her 2-3 year old baby to meet the Doctor. The baby was suffering from high fever and weakness along with yellowness in nails, skin and eyes .It appeared to be a case of Jaundice but unfortunately, the doctor without any test or diagnosis, penned down ‘Typhoid’ in the prescription pad and prescribed Cefixime. This incident motivated me to write this article and throw some light on Healthcare in Rural India. “ The causes of health inequalities lie in the social, economic and political mechanisms that lead to social stratification according to income, education, occupation, gender and race or ethnicity. ” Soumalya Chatterjee is Asst. Product Manager at IPCA - 67% 11 | MedicinMan December 2013
  12. 12. Soumalya Chatterjee | The Rural Healthcare Landscape in India Biased Reality 1. Less than 20 % of Rural population have access to proper healthcare facilities (PwC CII report-2010) 2. Low level of Government spending on Healthcare at 1 % of GDP (Business Monitor International forecast-2011) 3. Doctor to Patient ratio in Rural areas is 1:20000 while in Urban counterpart, the ratio is 1:250 (WHO report,2012) 4. 7 out of 10 medicines in Rural India is substandard/ counterfeit (WHO report, 2012) 5. 30 % of population travel more than 30 km seeking healthcare in Rural India 6. Most of the Healthcare personnel in Rural settings is BHS, BHMS or BAMS while in Urban India, most of them are MBBS. 7. Healthcare is a low priority when it comes to income allocation by a common villager (7-8%) while it is 16-17% in a Urban household (PwC CII report-2010) Root Causes 1. Not attractive enough for private sector “ Less than 20 % of Rural population have access to proper healthcare facilities (PwC CII report-2010) ” ØØ Distributed population ØØ Not enough money and so called ROI is minimal (Corporate selfishness) ØØ Incentive missing ØØ Lack of proper infrastructure 2. People, who can afford, prefer private settings over Public and those who can’t, prefer traditional or indigenous form of medicine which is not much effective. 3. Inadequate financial resources for the health sector and inefficient utilization result in inequalities in health. 4. Affordability is a major constraint as majority of rural population earns less than 80 Rs/day. 5. Limited accessibility of Rural India to Healthcare facilities. The causes of health inequalities lie in the social, economic and political mechanisms that lead to social stratification according to income, education, occupation, gender and race or ethnicity. Government Intervention Health system strengthening The Ministry of Health and Family Welfare (MOHFW) plays a key role in guiding India’s public health system. The National Rural Health Mission (NRHM) launched by the Government of India is a leap forward in establishing effective integration and convergence of health services. 12 | MedicinMan December 2013
  13. 13. Soumalya Chatterjee | The Rural Healthcare Landscape in India “ Health information system The Integrated Disease Surveillance Project was set up to establish a dedicated highway of information relating to disease occurrence required for prevention and containment at the community level, but the slow pace of implementation is due to poor efforts in involving critical actors outside the public sector. ” 13 | MedicinMan December 2013 The Integrated Disease Surveillance Project was set up to establish a dedicated highway of information relating to disease occurrence required for prevention and containment at the community level, but the slow pace of implementation is due to poor efforts in involving critical actors outside the public sector. GRAM VAANI (developed by IIT-D) It’s an innovative initiative by Government foreseeing the technological advancements .It uses the mobile platform to reach to remote places and guiding the villagers to treat and prevent diseases. The success rate of this campaign is still questionable. Besides all this, as per the scenario, there has been launch of Expanded Program of Immunization in 1974, Primary Health Care enunciated at Alma Ata in 1978, eradication of Smallpox in 1979, launch of polio eradication in 1988, FCTC ratification in 2004 and COTPA Act of 2005 The Pharma Connection Apart from NGOs like Deepalaya and SMILE foundation that works exclusively for Rural Healthcare development, there are Pharma companies that are not far behind when it comes to CSR. Some of the useful initiatives by Pharma companies are listed below: 1. Novartis -Arogya Parivar is Novartis’ rural marketing initiative, wherein it markets a portfolio of drugs for common ailments like diarrhea. 2. Pfizer- Pfizer runs project Sanjeevani so that it can reach out to Tier II and below areas. The project is mainly for its mature portfolio, to extend the PLC of the Brands. 3. Novo Nordisk - They have set up mobile clinics all over Goa to diagnose people with diabetes. 4. Eli Lilly- Has a tie up with Self Employed Women’s Association (SEWA) in Ahmedabad to educate, diagnose and treat people for tuberculosis
  14. 14. Soumalya Chatterjee | The Rural Healthcare Landscape in India “ The Way Forward The ultimate goal of a great nation would be one where the rural and urban divide has reduced to a thin line, with adequate access to clean energy and safe water, where the best of health care is available to all, leading to a healthy nation that is one of the best places to live in. ” 1. Health education to the community should be a prime function of the health workers and village level functionaries 2. Health research system-need for strengthening research infrastructure in the departments of community medicine and foster partnership with state health services 3. Organizing and conducting nutrition education and food hygiene concepts in the community and in schools 4. Survey and identify resources of safe water and to carry out proper analysis of the water. Arrangements should be made for regular purification of water through chlorination. 5. Organize the people and resources for constructing household and community latrines, and making arrangements for collection and disposal of human and animal wastes. 6. Progressively almost all deliveries should be conducted under aseptic conditions by trained health personnel i.e. the dais or female multi-purpose workers. 7. Intervention programs can be really helpful where diseases like diarrhea, respiratory infections and other serious infections can be prevented by immunization, thereby reducing mortality. 8. More concentrated attention has to be given to younger couples with low parity – a holistic focus toward family planning. In all the above mentioned endeavors, functionaries of other sectors such as social and women’s welfare, education, agriculture and animal husbandry, panchayats and voluntary agencies like mahila mandals and youth clubs can contribute very significantly. The Healing Touch The ultimate goal of a great nation would be one where the rural and urban divide has reduced to a thin line, with adequate access to clean energy and safe water, where the best of health care is available to all, leading to a healthy nation that is one of the best places to live in. The ultimate yardstick for success would be if every Indian, from a remote hamlet in Bihar to the city of Mumbai, experiences the change. At least if, we, or the person reading the article is being proactive and contribute to eliminating the cause, there would be a sea change in the existing scenario because tiny droplets make a mighty ocean. 14 | MedicinMan December 2013 “The health of people is the foundation upon which all their happiness and all their powers as a state depends”
  15. 15. MEDICINMAN Academy Learning and Development Programs for Pharma Sales and Marketing Professionals Pharma-specific Training: Medical Representatives Field Sales Managers Product Managers Senior Managers Signature Programs for Medical Representatives KA$H=CASH KNOWLEDGE  ATTITUDES  SKILLS  HABITS Constructed on the fundamental premise that a Medical Representative’s success depends on his Knowledge, Attitudes, Skills and Habits (KA$H). Representatives seek success in their personal and professional lives but look for it in the wrong places leaving them frustrated. Companies and bottom-lines suffer when the front-line is not fully engaged. KA$H=CASH is a high-engagement module for customer-facing employees. In Any Profession, More KA$H = More Cash Signature Programs for Front-line Managers SuperVision for the SuperWiser Front-line Manager. Based on the best-selling book by Anup Soans, this program is for new and experienced Front-line Managers who would like to get breakthrough performance from their teams. SuperVision for the SuperWiser Front-line Manager focuses on topics such as Team Building, Emotional Intelligence, Situational Leadership, Coaching and more. VALUE ADD: Psychometric Assessment* CONTACT: anupsoans@gmail.com | +91-934-2232-949 | www.medicinman.net
  16. 16. E DIFFERENTIATING THROUGH ON-THE-JOB COACHING Coaching is a day-to-day activity and not a one-off event. K. Hariram I n one of my recent interactions with a group of Pharma Line (First and second line) Managers, a doubt with regard to ON THE JOB COACHING was shared by them. “I have 7 sales people in my team. I have to manage sales and I am accountable and answerable for the results month on month. So when I work with my team members, I have to meet important Doctors, manage stockists, handle administrative work, etc. So, where do i find time for meaningful coaching, sustain the same including timely feedback?” K. Hariram is the former MD (retd.) at Galderma India. He is Chief Mentor at MedicinMan and a regular contributor. khariram25@yahoo.com 16 | MedicinMan December I realized that this concern was not something to be brushed aside and was coming out as genuine concern from many line managers. They probably did not have the comfort of sharing with their own bosses.
  17. 17. K. Hariram | Differentiating through On-the-job Coaching In most of the companies the oft repeated statement from the Sales Head is “I do not care what or how you do. Get me the numbers”. So when the leader of the sales team gives very little or no importance to ‘on the job ‘ coaching, how do we expect the line managers to look at it as a means to sustained sales revenues! Let us clearly understand one thing. If COACHING has to be integrated into the day to day managerial function and revenue generation has to be through the sales people on a sustainable basis, then the selling process has to be a well oiled mechanism. More importantly, “ COACHING has to be an integral part of organizational culture flowing from the top to the bottom. Let us clearly understand one thing. If COACHING has to be integrated into the day to day managerial function and revenue generation has to be through the sales people on a sustainable basis, then the selling process has to be a well oiled mechanism. More importantly, COACHING has to be an integral part of organizational culture flowing from the top to the bottom. ” 17 | MedicinMan December I have always believed that COACHING impacts the following: 1. Sales members’ alignment with the organizational objectives. 2. Greater amount of self awareness self confidence. 3. Unwavering commitment to goals. 4. Behavioral changes that add momentum to performance. 5. Fostering a performance culture. Somewhere I read a saying, “In order to grow, you have to let go”. In the crowded market place where the differentiating factors are becoming narrow, how many Sales Managers are willing to look at COACHING as an opportunity to evolve and transform their sales team’s culture as the biggest competitive edge ? Often, to achieve or evolve, you do not have to do great things. Simply challenging the ‘status quo’ and ‘changing the limiting beliefs’ result in dramatic improvements. This change or evolution starts with YOU...the Sales Head.
  18. 18. E MASTERY, AUTONOMY AND PURPOSE IN FIELD FORCE EXCELLENCE Understanding Significance of Mastery, Autonomy and Purpose in Field Force Excellence MAP enables the field sales people to see the big picture and use their abilities to implement strategies systematically and consistently even in the absence of daily oversight. Anup Soans S trategy Execution - The MAP of Motivation and Performance Getting the field force trained and deployed is a challenge that constantly engages the time, efforts and money of every organization and its managers. Field force effectiveness is at the crux of implementing new product strategies to enable the organization to meet its short and long term goals without resorting to high-cost unethical practices that eventually lead to unacceptable and unsustainable outcomes as the Chinese experience clearly demonstrate. Getting the product strategy right, is the job of marketing people and done properly, many do get it right. It is in the implementation that most of them fail to get desirable levels of success. In well managed companies, crafting the product strategy is a robust process of analysing and understanding various factors that influence customer 18 | MedicinMan December 2013
  19. 19. Anup Soans | Mastery, Autonomy and Purpose in Field Force Excellence behavior, market dynamics and internal resources by a select few people, but implementation of product strategy is a task done by hundreds and often thousands of field sales people every day. So, while the product strategy remains robust and relatively stable, the implementation is dynamic and has to factor in the abilities and motivation of the field force. The role, responsibility and contribution of field sales managers in aligning their teams with the right product “ strategy for each product/product category are critical. Yet, often it is not recognized, much less addressed in Balancing the tasks of achieving sales targets for existing products and implementing the strategy for new product launches as well as existing products is a daunting task and very quickly, the new product is also merged into the basket of existing products and promoted using the tactics employed to promote the existing products. An effective field force is one that is able to make the distinction between the need to promote existing products without losing sight of the strategy for new products to ensure future sales growth of the organization. ” 19 | MedicinMan December a systematic manner. Given the multiple tasks that the field force has to accomplish every day, their focus shifts quickly from strategy orientation to executing tactics that take them closer to their most important task of achieving sales targets. Sales targets have to be achieved within shorter timeframes of monthly, quarterly and annual. Whereas implementing product strategy requires longterm orientation and faithful adherence to execution of strategy components, even when results are not immediately seen or measurable. Balancing the tasks of achieving sales targets for existing products and implementing the strategy for new product launches as well as existing products is a daunting task and very quickly, the new product is also merged into the basket of existing products and promoted using the tactics employed to promote the existing products. An effective field force is one that is able to make the distinction between the need to promote existing products without losing sight of the strategy for new products to ensure future sales growth of the organization. This requires a high degree of competence and motivation, which the field force is not often equipped with, leading to sub optimal results and loss of strategic action that is needed to penetrate the market and position new products as the future growth drivers. This is one reason why the Indian Pharma has failed to establish significant brands in the recent past. At the Brand Drift 2011, two mega brands Januvia and Zerodol were discussed by Sanjeev Navangul and Nandakumar Shetty in a well moderated session by Vikas Dandekar and the key to their success was clear strategy and solid execution. What was remarkable was the diversity of strategy and approach of the two companies.
  20. 20. Anup Soans | Mastery, Autonomy and Purpose in Field Force Yet, significantly, both companies were successful in their own way in adhering to implementing the strategy faithfully with the field force people doing a splendid job of complementing the work of marketing people. The synergy between the strategy creators and executors contributed to creating mega brands. MSD and IPCA are as different as chalk and cheese, yet in their different ways, they were successful in not only crafting a great strategy but in executing them to create great value for their companies, while making the work of field force meaningful, interesting and rewarding. Companies need to focus as much on the people who execute the strategy as much as they do in creating a strategy. What makes the field force an asset to the company in executing strategies effectively? Good companies begin by selecting the right people in terms of Excerpts from Daniel Pink’s Book - Drive Carrots sticks are so last century. For 21st century work, we need to upgrade to autonomy, mastery purpose, says, Daniel Pink in the Drive, a new insight into what really works when it comes to human motivation. When it comes to motivation, there’s a gap between what science knows and what business does. Our current business operating system, which is built around external, carrot-and-stick motivators doesn’t work and often does harm. We need an upgrade. And the science shows the way. This new approach has three essential elements: 1. Autonomy – the desire to direct our own lives. 2. Mastery — the urge to get better and better at something that matters. 3. Purpose — the yearning to do what we do in the service of something larger than their abilities. They also focus on matching the pedigree of the people with the culture of the organization. For example, a Mankind field sales person, who has done a great job in executing the simple commitment focused strategy of Mankind may not fit into the complex and unbending work culture of an MNC. Secondly, people should be selected not only for their qualifications and skills, but more importantly, for their mindset as it has the largest impact along with motivation on their inclination to work without supervision. The job of a field sales person is largely autonomous and many good sales people love this aspect of their work. Autonomy is also one of the key factors of intrinsic motivation along with Purpose and Mastery described by Daniel Pink in his book, “Drive: the Surprising Truth about What Motivates Us”. I call it the MAP of intrinsic ourselves. motivation – all three are necessary to ensure a mindset http://www.danpink.com/drive-the-summaries/ of performance in the face of challenges. MAP enables the field sales people to see the big picture and use their abilities to implement strategies systematically and consistently even in the absence of daily oversight. Systems like SFE are extremely useful in aligning the work of the field force with the strategy of the company. But SFE is an external regulator unlike MAP, which is an internal driver. SFE alone is insufficient as the experience of many companies show. SFE when combined with MAP can be the driver of compliance and achievement as it brings about synergy between what companies want field force people to do and what people themselves value as 20 | MedicinMan December meaningful.
  21. 21. Anup Soans | Mastery, Autonomy and Purpose in Field Force Excellence What then is MAP? As Stephen Covey says, “begin with the mastery and use it to its fullest. But a sales person who can end in mind”. The primary motivator of intrinsic motivation see and appreciate the purpose of his daily tasks will take according to Daniel Pink, is purpose. Without purpose, time and efforts to gain the mastery needed to perform it is impossible to engage people’s physical, intellectual autonomously and effectively. and emotional energies fully. Purpose brings meaning to So, an effective field force is one, which can clearly mundane work. Without purpose, work is repetitive and understand and appreciate its purpose, is equipped with quickly loses meaning, especially in the case of field sales mastery needed to deliver this purpose and thus be people - when they cannot see the big picture of product empowered with autonomy to be motivated to perform strategy in their seemingly disconnected work of meeting not only when monitored by senior managers and systems disinterested doctors. but are motivated intrinsically to appreciate the purpose of The second factor of intrinsic motivation is autonomy. their work and thus make a meaningful contribution to the Nobody likes to be watched over, all the time. But execution of strategies consistently. autonomy without mastery is not only ineffective but can MAP is the internal compass that is always active and points be dangerous as well and lead people to use unethical the field force in the right direction intrinsically without too means to achieve their targets. The third factor of intrinsic much directives from others. motivation is mastery. Good companies do focus on equipping their field force with mastery of knowledge, skills and systems like SFE. Emphasising mastery without clarifying the purpose is like putting the cart before the horse. Unless the field force people see purpose of their daily tasks, they will not be empowered from within to gain So make the purpose clear, train, coach and facilitate mastery and then give field force the autonomy to transform work into work-oh-frolic and performance into perforomance! For More on Strategy Execution and Field Force Excellence, attend Brand Drift and FFE 2014 at The Courtyard Marriott, Mumbai on 7th and 8th February 2014. Our Authors Abdul Basit Khan Dr. Shalini Ratan Ajay Kumar Dua Dr. Surinder Kumar Amlesh Ranjan Sharma Amrutha Bhavthankar Dr. Ulhas Ganu Andris A. Zoltners Geetha G H Anthony Lobo H. J. Badrinarayana Aparna Sharma Hakeem Adebiyi Arvind Nair Hanno Wolfram Atish Mukherjee Hitendra Kansal B. Ramanathan Iyer Gopalkrishna Chayya Sankath Jasvinder Singh Craig Dixon Banga Devanand Chenuri Javed Shaikh Venkat Jitendra Singh Dinesh Chindarkar John Gwillim Dr. Amit Dang Jolly Mathews Dr. Aniruddha Joshua Mensch Malpani K Hariram Dr. Hemant Mittal K. Satya Mahesh Dr. Neelesh Bhandari Ken Boyce Dr. S. Srinivasan Mahendra Rai Mala Raj Manoj Kumar Mayank Saigal Milan Sinha Mohan Lal Gupta Neelesh Bhandari Neha Ansa Nishkarsh Likhar Noumaan Qureshi Parveen Gandhi Pinaki Ghosh PK Sinha Prabhakar Shetty Vivek Hattangadi Rachana Narayan Rajesh Rangarajan Ralph Boyce Renie McClay Richa Goyel Richard Ilsley RM Saravanan Sagar S. Pawar Salil Kallianpur Salil Kallianpur Sally E. Lorimer Sandhya Pramanik Sanjay Munshi Shafaq Shaikh Shalini Ratan Sharad Virmani Shiv Bhasin Spring Sudhakar Subba Rao Chaganti Sudhakar Madhavan Tony O’Connor V. Srinivasan Varadharajan K. Vijaya Shetty Vishal V. Bhaiyya Vishal Verma Vivek Hattangadi William Fernandez MEDICINMAN invites contributions from Pharma professionals on topics related to Field Force Excellence. See: www.medicinman.net/author-guidelines for more information. 21 | MedicinMan December 2013
  22. 22. W100/FIELD FORCE PRODUCTIVITY TOOLS NOW AT ONLY INR 100*. MRP Rs. 799/- MRP Rs. 599/- *Exclusive corporate offer. Contact anupsoans@gmail.com | +91-93422-32949 for more details.
  23. 23. E FREE MEDICINES OR BETTER HEALTH? Salil Kallianpur OPINION A “ While the availability of free generics can be a decision that could change the lives of hundreds of millions of Indians, the proposal runs the risk of being overly simplistic and potentially dangerous. The underlying assumption here is that merely providing medicines free would help improve the health and the productivity of the nation. In isolation that is simply not true. ” 23 | MedicinMan December 2013 few days ago, the Vice President of the Indian National Congress party, Mr. Rahul Gandhi tweeted that his party would implement the free medicines scheme for the poor across India. Since the tweet coincided with Mr. Gandhi’s visit to Rajasthan, it can only be assumed that he was touting a relatively successful scheme that his party’s government runs in the state. Sometime last year, India announced a $5.4 billion policy to provide free medicine to its people. This was the outcome of the report of the High Level Expert Group appointed by the Planning Commission in 2011 to look into the broader issue of Universal Health Coverage (UHC), a key requirement to improve social indices in India. While the availability of free generics can be a decision that could change the lives of hundreds of millions of Indians, the proposal runs the risk of being overly simplistic and potentially dangerous. The underlying assumption here is that merely providing medicines free would help improve the health and the productivity of the nation. In isolation that is simply not true. Health is a concept that far exceeds doctors, hospitals and medicines. You need these only when you have to treat a condition. The concept of keeping good health is to prevent anything from affecting you mentally, physically or spiritually. When the government decides that the first step towards UHC is free medicines, it is a step forward gone horribly wrong. It means that the government will do little to keep you in good health and will come up with hare-brained schemes even after you fall ill, leaving you to largely fend for yourself. This is not to say that receiving free medicines is not a great idea. To the sick and the infirm, it will provide succor to millions who have to otherwise pay for it from their pockets. The problem is in its implementation. That Rajasthan did well with the scheme – as did a few other states – is well studied. However the fact that its nation-wide scale up was shelved demonstrates the government’s sheer lack of confidence. Here’s why. Currently, less than 35% of India’s population has access to health care. This means approximately 2 out of 3 residents in India do not have a medical facility (clinic or primary health centre) to go to or a doctor to consult, much less be able to get a prescription and buy medicines. Even the 1 out of 3 residents, who have access to a medical facility, barely get to see a trained medical professional. This is because of an acute shortage of trained staff and chronic absenteeism – doctors get their salaries from the government anyway and prefer to spend more time at their private clinics where they can charge for their services. And if the patient is lucky to see a doctor and get a prescription, chances are that the medical stores will be out of stock. The medicines are either not purchased and delivered to the stores or sold into the private market for a hefty profit.
  24. 24. Salil Kallianpur: Free Medicines or Better Health? “ Mr. Gandhi must outline the measures he would put into place to prevent corruption in the tenders floated for the purchase of high quality medicines, create adequate storage facilities, tackle absenteeism of medical professionals in public hospitals and ensure constant supplies. These are just a few issues. And going by the way the Public Distribution System has shaped up over the last few decades, there is enough room for skepticism. ” 24 | MedicinMan December 2013 If this is the state of affairs when only 420 million people are anywhere close to accessing health care, imagine the sheer grit, determination and resources needed to scale this up to 1.2 billion Indian citizens and a few million other residents1. Is it any wonder then that today 80% of doctors, 26% of nurses, 49% of beds, 78% of ambulatory services and 60% of in-patient care are provided by the private sector?2 Providing free medicines is indeed a laudable idea but one that is fraught with impracticality. Mr. Gandhi must outline the measures he would put into place to prevent corruption in the tenders floated for the purchase of high quality medicines, create adequate storage facilities, tackle absenteeism of medical professionals in public hospitals and ensure constant supplies. These are just a few issues. And going by the way the Public Distribution System has shaped up over the last few decades, there is enough room for skepticism. So, what is the alternative? Given that India vies for the title of “Pharmacy to the World”, it is safe to assume that there is no domestic shortage of production of medicines. The difficult part is to ensure that the medicines are of good quality. If the FDA can tighten the noose on Indian suppliers of generic medicines to the USA, there is no reason why the Indian regulatory agency cannot do it for its own residents. By ensuring the quality of medicines, the government can rely on the open market mechanism that influences the consumption of health care. The naysayers will do well to merely check on the systematic rot and neglect that public sector pharmaceutical companies have been put through by the government to understand why manufacturing has to be private-sector dependent. The delivery system would also be efficient since it has to be competitive and competent. The huge saving thus accruing to the Government could be utilised to step up public investments in rural and urban health infrastructure and services, thereby generating employment and income opportunities -- both directly and indirectly. For the genuinely needy, `medicine vouchers/stamps’ could be supplied through the Panchayat Raj or local government machinery that could be strengthened and empowered for the purpose. But all this services the sick and is a drain on the economy. Countries with the most efficient health care systems are those that prevent illness through early detection combined with community-based primary care to limit more costly upstream interventions. India faces enormous challenges such as high disease prevalence, unregulated and fragmented health-care delivery system, non-availability of adequate skilled human resource and inadequate finances to name a few. To address these challenges there has to be a paradigm shift in health policies. While the planners of his government have realized that the central government is not ready to set up a scheme of this scale in the face of such challenges, it seems Mr. Gandhi is more optimistic about it.
  25. 25. E IMPROVING THE EFFICIENCY OF MRs P harmaceutical companies spend crores in order to market their brands, and medical representatives (MRs) are the heart and soul of the sales department. The sales force is the key link between the pharmaceutical company and their most important customer – the doctor. This is why pharma companies employ an army of MRs and invests a lot of money in helping them to nurture relationships with doctors, which they then hope will translate into increased sales of their brands. This is the age-old traditional model which companies have employed for decades; and because it has been so successful in the past, companies spend lot of money in training their MRs on how to present themselves to doctor; and how to position their brands, so they can compete successfully with the hundreds of other brands in the market. MRs are taught how to use collaterals; and how to educate the doctor about the features and benefits of their brands. Because so many of the brands are just me-too clones of each other, MRs are also taught to flatter doctors and keep them happy by gifting them with pens and other freebies; and they routinely leave behind samples of their medicines, in the hope that the doctor will prescribe these over the hundreds of alternatives he has available to him today. While this model has worked well in the past, it has started to lose its sheen. In the past, doctors would depend upon MRs to educate them about the new molecules in the market and help them keep abreast of the latest advances in the field of medicine. MRs used to be respected because they were the major source of scientific knowledge for many practicing doctors. However, doctors today have far more efficient ways of learning about medical advances online. Also, a lot of doctors are very suspicious about the information provided by the MR, because they understand that this is contaminated by commercial influences and is not always trustworthy or reliable. Dr. Aniruddha Malpani, MD is the Medical Director at Malpani Infertility Clinic in Mumbai. 25 | MedicinMan December 2013 Most doctors treat MRs as salesmen who are good only for providing free samples and other freebies. They make the MRs wait for hours on end and will often demand incentives to prescribe their brands. The Indian government is cracking down on this unhealthy pharma-doctor nexus and the Medical Council of India is no longer willing to turn a blind eye to this unethical behavior. This is why pharmaceutical companies will need to discover better ways of influencing doctors.
  26. 26. Aniruddha Malpani: Improving the Efficiency of MRs “ Pharmaceutical companies need to invest in better ways of ensuring that their MRs get quality face to face time with the doctor. This is the key to allowing them to be able to establish personal relationships with the doctor. They do this by sponsoring medical conferences for example, but this has become a very competitive space which can be very expensive and offers limited reach. ” Pharmaceutical companies need to invest in better ways of ensuring that their MRs get quality face to face time with the doctor. This is the key to allowing them to be able to establish personal relationships with the doctor. They do this by sponsoring medical conferences for example, but this has become a very competitive space which can be very expensive and offers limited reach. A better way of doing this is by creating tools for their MRs which they can then provide to doctors to help them get more patients. Doctors would be very favorably disposed to any company which helped them increase their practice and improve their income by keeping their patients satisfied! Here’s a real life success story of how PEAS (www.peasonline.com), a company in which I am an angel investor has done just that ! It’s a fact of life that patients are becoming more demanding today; and doctors need to invest in educating their patients in order to keep them loyal. One of the key differences amongst doctors is the quality of their communication with patients, which is why doctors today are providing patients with educational materials viz. handouts, books, videos, DVDs and more. They find that not only is this a very effective marketing tool, it also helps to increase patient loyalty; differentiates themselves from competing doctors; and helps mitigate the risk of malpractice as it shows that they have educated the patient about possible risks and complications. A clever pharmaceutical company is now providing these patient education DVDs free of cost to leading doctors. These are high quality animations, rich in scientific content, which are available in various Indian regional languages. The magic sauce is that the pharmaceutical company is personalizing these DVDs with 2 minutes of introduction video of the doctor about the condition and how it is his endeavor to provide best of medical care. The doctor now has a corporate DVD which acts as a very effective marketing tool, which he can provide free to all his patients! The response from doctors has been mind-blowing. They have been regularly asking the MR’s to replenish their stock of DVD’s. On the other hand, MRs are very happy as well, as they no longer need to wait for hours to see the doctor – he is now inviting them to his clinic! The common feedback from most of the Sales Representatives is: “Though it’s a tough task coordinating the video shoot, it’s worth every penny. Thanks to this activity, we got an opportunity to spend more time with the doctor on this single day than we have had over the last few years put together! 26 | MedicinMan December 2013 Not only does this create a lot of good will, it allows the MR to form a close personal relationship with the doctor – and this has to be music to the ears of any Marketing Head !
  27. 27. E KNOWLEDGE FOR THE FIELD FORCE SERIES Oral Anti-Diabetic Agents-II Dr Amit Dang C ontinuing with the oral antidiabetic agents, in this issue we will discuss the biguanides and thiazolidinediones which are also known as Insulin sensitizers. Both these agents lower blood sugar by improving the response to insulin without increasing the secretion of insulin. Biguanides Metformin is the only currently available biguanide. It is the drug of first choice among newly diagnosed patients of type 2 DM. Metformin can be used alone or in combination with other oral antidiabetic agents or insulin. The main mechanism of action of metformin is decrease in synthesis of glucose in the liver. The excess of glucose produced in the liver is a major source of high blood sugar levels in patients having type 2 DM. It also increases the glucose uptake and use by target tissues of the body like muscle and liver; and thus corrects resistance (decreased response) to the action of insulin in the body. It is different from insulin secretagogues (sulfonlyureas) as it has no action on the secretion of insulin. It also decreases the absorption of sugar from the intestines and increases the use of glucose by the different organs of the body like muscle and liver. Metformin also corrects the increased lipid levels in the body. The patients may lose weight because of decrease in appetite. Hypoglycemia can occur when used with insulin, so dose adjustment of insulin is required. Dr. Amit Dang is Director at Geronimo Healthcare Solutions Private Limited. 27 | MedicinMan December 2013 Patients may have nausea with use of metformin. It should not be given to patients having some disease of kidney or liver, should be avoided in case of acute myocardial infarction (heart attack); should be used carefully among patients more than 80 years of age. Rarely, it can lead to lactic acidosis and long term use can interfere with absorption of vitamin B12. Metformin is also used among females having polycystic ovarian disease. Thiazolidinediones The second group of insulin sensitizers is thiazolidinediones and Pioglitazone is the only drug available from this group. Pioglitazone can be used alone or in combination with other oral antidiabetic agents or insulin. Earlier, troglitazone and rosiglitazone were available in the market, but now these are not available because of hepatotoxicity due to troglitazone and cardiac effects due to rosiglitazone. Pioglitazone was banned in India earlier this year due to the increased risk of development of urinary bladder cancer, but the later the decision was revoked. Pioglitazone is the drug of second choice among patients who fail to or have contraindications to use of metformin therapy. These drugs do not increase the release of insulin from the pancreas. Pioglitazone has a different target from metformin, and regulates the fat and glucose metabolism and increases the response of the body tissues (like muscle, fat tissues and liver) to insulin. Patients taking pioglitazone should be regularly monitored for liver enzyme levels. Patients may have weight gain due to increase in body fat and retention of fluid. This group is associated with an increased chance of osteopenia (bones become less strong and dense) and increased risk of fracture of bones. Pioglitazone is also used among patients with polysyctic ovarian disease. The rest of the oral antidiabetic agents will be covered in the next issue.
  28. 28. E BOOK REVIEW BAD PHARMA: HOW MEDICINE IS BROKEN AND HOW WE CAN FIX IT By Ben Goldacre; Publishers: Harper Collins, London Vivek Hattangadi B ad Pharma acclaimed as the ‘Book of The Year’ (2012) by ‘The Times’ has ruffled the medical and the pharma industry alike and prompted the British Parliament to ask why all trial results aren’t made public. Bad Pharma opens with a very strong statement by the author Ben Goldacre: “We like to imagine that doctors are familiar with research literature when in reality, much of it is hidden by the drug industry. We would like to imagine that doctors are well educated when in reality much of their education is funded by the industry. We like to imagine that regulators only let effective drugs in the market, when in reality they approve hopeless drugs, with data on side effects casually withheld from doctors and patients”. Ben Goldacre takes readers through some significant cases and shows how you do not need a pharmaceutical degree to spot bad pharmaceutics. Prof. Vivek Hattangadi is a Consultant in Pharma Brand Management and Sales Training at The Enablers. He is also visit-ing faculty at CIPM Calcutta (Vidyasagar University) for their MBA course in Pharmaceutical Management. vivekhattangadi@theenablers.org 28 | MedicinMan December 2013 Doctors and patients need good scientific evidence to make informed prescription decisions. Sadly, companies conduct bad trials on their own drugs, which misrepresent and overstate the benefits by design. When trials produce results which do not conform to the desired results of the study, the data is simply buried. In fact, even statutory bodies withhold vitally important data from the doctors and patients who need it most. Doctors and patient groups have stood by too, and failed to protect the patients. Instead, they take money and favours, in a world so fractured that medics are now educated by the drugs industry. Ben Goldacre says that the damage is pervasive and deep, right to the roots of modern medicine. These problems know no borders, and affect us all. For instance, in India itself, prompted by pharma marketers, clinical trials on
  29. 29. Prof. Vivek Hattangadi | Book Review: Bad Pharma by Ben Goldacre “ HR, Training, and Line Managers should combine synergistically and resolve the problem of not getting good people, attrition rate is very high, the available people have very poor communicating ability, etc. and help organizations to march towards a better and bright future. a product (dapoxetine) for PME (premature ejaculation) were carried out on mentally ill patients. Goldacre comes out very strongly on such trials when he says: “Risky ‘first-in-man’ trials are conducted on homeless people; but more than that, full clinical trials are being globalised, and a new development that has that has arisen suddenly in only the last couple of years. That raises serious ethical problems because trial participants in developing countries are often unlikely to benefit from expensive new drugs; but it also raises interesting new problems for trusting the data”. The book has missed out one important issue which perhaps is not relevant to the British and the western world i.e. irrational fixed drug combinations (FDCs). This is a problem related solely to the Indian pharma industry. Such irrational FDCs are even not available in the ‘so-called underdeveloped countries’ like neighbouring Bangladesh and Nepal. This book is a must read for all associated with the pharmaceutical industry and who wish to tread the path of good marketing practices. ” MEDICINMAN Pharma Sales Marketing Conference 2014 FFE | BRAND DRIFT | AWARDS 7th - 8th February 2014 Courtyard Marriott, Mumbai See page 7 29 | MedicinMan December 2013

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