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  2. 2. Position of Johnson and Johnson vis-à-vis competition in the industry INDUSTRY CHARACTERISTIC FEATURES: Sutures (also known as stitches) are divided into two kinds – those which are absorbable and will break down harmlessly in the body over time without intervention, and those which are non-absorbable and must be manually removed if not left indefinitely. • Sutures to be placed internally would require re-opening if they were to be removed. Sutures which lie on the exterior of the body can be removed within minutes, and without re-opening the wound. As a result, absorbable sutures are often used internally while non-absorbable sutures are used externally • Sutures to be placed in a stressful environment, for example the heart (constant pressure and movement), the bladder (adverse chemical presence) or the bones (very high tensile forces) may require specialized or stronger materials to perform their role The characteristic features of the sutures industry are: • Surgeon specific industry • Infiltration of low priced products from small vendors like Futura surgicare • High degree of human intensive processes so cannot employ automation to reap the scale of economy Scanning of the Market Environment: -Makes policies on patent protection -Exercises price control Government -Derives strength from their core Integration competencies -Sales force MRs with other businesses -Consumers Force of Suture Medical -Customers Patients Profession Industry-Effects the national market byinternational laws International -Enables safe products Technology Influence Country Status -Defines market potential Fig-1: Eight Forces 1                                                              1    
  3. 3. INDIAN SUTURE MARKE T ANALY N E YSIS: Key Pla ayers in the market: e Indian su uture market is majorly d dominated by 5 major pl y layers Figure-2: Ind mpanies2 dustry share of com Figure-3: Perceptu map of compan 3 F ual nies SWOT Analysis of JnJ-Ethic f con Strength S Weakne ess * There is increasing pressu within the mar s ure rket to reduce price in line with es* Etthicon has been the global leader in the wound closure business as well a in e t e as medical bbudgets.India . JnJ Ethicon Gro a oup Has biggest market share in Ind this indicates a m dia, * Challen nges have been fac within JnJ Eth ced hicon group where a reduction instron position for the group. ng the marke demand for key products (Vicryl a Monocryl) has been identified et and s* Th business model adapted by JnJ Eth he hicon fundamental uses the adapta lly ation as these p products have been replaced by low cost local sutures by many nof en ntrepreneurial valu in order to retain an edge within the market place. ues practition ners.* Wo orking with intensive scientific notio JnJ Ethicon uti ons ilises a varied expanse * Monoc suture has not been as successfu in India as it was in other parts of cryl ul sof pr roblem solving tec chniques in order to challenge the sta o andard practice and d the worldd.capittalise on growth th hrough emerging markets which enab associated m bles * Monocryl market had ju reached 3 crore in 10 years. With a smaller ust es hgrowwth. playing fi even if we upg field grade 100% of exi isting Monocryl ussers, a 3 cr* Th use of independe offices workin as standalone un provides the he ent ng nits topline w would not justify a new product.oppoortunity to develop concepts with cultural consideratio which can prov p ons ve * Ethico is not able to ad on dvertise in mainline media as these w wereimpoortant when launch hing a product in any country. a ethical/prrescription product and not OTC. ts Jn nJ‐Ethicon Oppor rtunity Threat t* Jn Ethicon Group h developed new products (plus su nJ has w utures) with regula atory * There i a high level of c is competition for ma arket.approvals, which provi ides the opportuni to grow the exis ity sting product * Suture are fast becomin a commoditized category. Many n es ng d newportffolio. comprommised quality/low c producers hav entered into the market. cost ve* E Ethicon team had converted 18% of Vicryl users to plu as Ethicon’s repl to V us ly Competittion was able to sell the finished goo at nearly half th price of ods he Ethicon p products.the lo cost threat to V ow Vicryl. They succeesfully moved the s surgeon higher on the n * Chinese Imports have st tarted hitting India hospitals. anbene ladder rather th competing on cost and hence kee the value intact. efit han c ept * There i no surity about w would happe to the brand extension of a is what enThe same strategy may work for Monocr y ryl. product (M Monocryl) which had already receiv a lukewarm response from ved* W the developme of WTO rules to prevent the avai With ent t ilability of cheap Indian Su urgeons.medi products, there is the opportunit to reduce the lev of lost profit du ical e ty vel ue * Next ggeneration topical s skin adhesives may replace suture m y market in the longto low cost competitorrs. run by re edefining it with m methods to close th skin using no su he utures at all . J-Ethicon4 Figure-4: SWO Analysis of JnJ OT                                                              2 Annexure-2, Envidea Case , 3 http://www.r researchandmarke 51976/sutures_ind dia_private_limited d_medical_equipm ment 4 http://www.j    
  4. 4. STRATEGIZING THE LAUNCH OF MONOCRYL PLUS BY ETHICON KEY ISSUESThe “plus” variants of Vicryl and Monocryl are essentially strategic products to counter thecommoditization of the suture market. Instead of confronting the low cost producers and Chineseexporters (who played on aggressive pricing) head on, J & J introduced innovated variants withantibacterial coating to prevent bacterial colonization. The success in upgrading 18% of Vicryl users toVicryl Plus and attaining positive bottom line impact is difficult to replicate in the case of Monocryl Plus.The reasons are: • Difference in the market size of Vicryl (Rs.80Crore) and Monocryl (Rs.3Crore). In the case of Monocryl, even a 100% up gradation would not make significant impact • Positioning of Monocryl suture restricting its use only to skin closures, and contraindicating it for deeper layers, Cardiac tissues and Neurological tissues • Since the use of sutures is skill driven, an important concern is to educate the surgeons and instill confidence in the new product to ensure adoption • The constraint of not being able to talk in the mainline media, and the uphill task of being able to transform a “push” product into a “pull” product, sought by the dealers, surgeons and the end consumers, i.e. the patients • The lukewarm response of Monocryl in the Indian market did not set up a conducive backdrop for launch of Monocryl Plus PRE-LAUNCH PLANMarket SegmentationThe customer net for the suture market is quite complicated and interlinked. The first interface of the firm(J & J) is with the Medical Representatives (MR), who show-case the product to the physicians, surgeons,etc. The end consumer is the patient who rarely exercises a voice in the choice of the suture.The variables for segmenting the different categories of the customer segments are quite different. 1. The doctors and the physicians are classified on the basis of the following variables: • Prescribing habits of the doctors • Degree of openness towards adopting new technology products Experimentalists Progressive Early adopters or Innovators Traditionalists • Patient Load (Size of the practice) • Accessibility times of the doctors • Specialization of the doctors • Sensitivity of the physicians to varied promotion schemes, and ethical stands taken. • Relationship with doctors – Emphasis on inner circle of doctors for brand recommendation 2. The end users or the patients are classified on the basis of the following variables: • Level of keenness towards participation in the decision of surgical products use • Level of awareness of surgical products like sutures • Demographic – age, type of illness • Geographic – Tier I/Tier II/ Tier III city of residence/treatment, urban or rural • Economic strata of the society - Directly reflects the willingness to pay for premium products 3. The wholesalers/retailers/stockists • Though this is not an OTC product, regular surgical equipment suppliers of government hospitals should be offered Monocryl Plus at discounted rate5 to facilitate the bidding for tenders6                                                            5 This is subject to the comfort level of company in giving out such discounts. Also, precautionary measures should be applied so that the productreaches the targeted customers at the discounted rate6 Government hospitals purchase surgical equipment through tender. (Primary Interview – Dr. Ashok Sinha, IMA Bihar Chapter)  
  5. 5. Defining Target SegmentsCustomersAs for the doctors, who would recommend the use of Monocryl Plus products, we aim at the followingtarget segments in the order of priority:Fig-5: Target Market for Monocryl Plus 7We base our recommendations on the premise that since Monocryl plus gives better results than othercompeting brands in case of cardiovascular, gynecological and general surgery, so doctors in thesesegments will be susceptible to upgrading to Monocryl Plus, thereby making them potential market forMonocryl Plus.ConsumerPopulation BreakupFigure-6: Population Breakup8Consumer Behavior9Following conclusion can be reached in terms of the attitude of different income group householdstowards the medical facility they want to avail themselves of. Social Class Nursing homes Private hospitals Governmental Hospitals Total High 72(86.7%) 11(13.3%) - 83 Middle 45(97.8%) 1(1.2% ) - 46 Low/Very Low 2(5%) - 38(95% ) 40Table-1: Consumer behavior for medical facilities selection Social Class Nursing homes Private hospitals Governmental Hospitals High 72(60.5%) 11(91.6%) - Middle 45(37.8%) 1(8.4%) - Low/Very Low 2(1.2%) - 38(100%) Total 119 12 38 Table-2: Share of different Socio-economic classes of patients in various medical facilities                                                            7 Case Facts8 2NMRERXPuh0E&hl=en&ei=paR5SoynHY7a6gOoh_yhBQ&sa=X&oi=book_result&ct=result&resnum=9#v=onepage&q=&f=false  
  6. 6. Targeting Strategy Concluding from the above data, the following targeting strategy is recommended for Monocryl Plus:- • Target only high and middle social sections in tier I/II cities for mass marketing and spreading awareness • For private nursing homes, design the campaign for both high and medium social class • For private hospitals, design the campaign for only high class Strategic Positioning of Monocryl Plus Monocryl Plus should be positioned as an innovative product with first in class approach, which would make a paradigm shift in the surgical stitching. Key attributes • Low tissue reactivity • High tensile strength - Consistent absorption rate with a predictable decrease in tensile strength • Half-life of 7 to 14 days Monocryl Plus Suture provides wound support for approximately 14 days • Slippery surface - makes it easier to pass Smoothness of Monocryl Plus Suture results in less tissue drags than gut sutures and braided synthetic absorbable sutures Monocryl Plus Suture needs fewer stitch granulomas than braided stitch • Excellent first throw hold for easy and secure wound approximation • Protection for Surgical site Infections (SSI)10 Applications and Uses Presently Monocryl Plus is mostly being used in • Cosmetic Surgery Monocryl Plus dissolvable suture allows finer approximation of edges and gives excellent results, when they are used to close the incisions by subcuticular stitching11 However, due to unique attributes and benefits offered by Monocryl Plus, we may also target the following specialties:- • Cardio Vascular Surgery Though contraindicated for use in Cardio Vascular Surgery, primary interviews have revealed that transparent Monocryl would be preferred suture in Cardio Vascular Surgery since it offers high tensile strength and longer half life, along with low tissue reactivity12 • General Surgery 13 Knotless surgery offered by Monocryl Plus saves a lot of time, and with increasing operating room charges this is viewed positively by general surgeons14 • Gynecological Surgery Absorbable monofilament sutures (like Monocryl Plus) are preferred by many surgeons for fascial closure of a transverse incision. These sutures are often used with midline incision closures in gynecologic surgeries. It is believed that using a delayed absorbable suture in a mass closure of all layers of the abdominal wall is efficient and safe15 • Oral Surgery Microbial load is significantly lower when absorbable monofilament Monocryl is used16                                                             10 SSIs account for more than 20% of all healthcare-acquired infections. Over 60% of surgical site infections (SSIs) occur at the incision. Monocryl Plus Suture, with itsadvanced antibacterial technology, creates a zone of inhibition around the suture that kills pathogens and inhibits bacterial colonization of the suture.11 Primary Survey – Dr. Ashok Kumar Sinha, IMA Bihar Chapter Primary Survey – Dr. Kiran Kumari, Gynecologist, Patna13 General surgery, despite its name, is a surgical specialty that focuses on abdominal organs, e.g. intestines including esophagus, stomach, small bowel,colon, liver, pancreas, gallbladder and bile ducts, and often the thyroid gland (depending on the availability of head and neck surgery specialists). They alsodeal with diseases involving the skin and hernias. These surgeons deal mainly in the Torso.14 Primary Survey – Dr. Ashok Kumar Sinha, IMA Bihar Chapter15    
  7. 7. Communication and PromotionFor surgical products (like suture), the response gathered in the first year of the launch is what decidesthe fate of the product. Any product that initially takes a beating at the hands of the customers, is leastlikely to come up again and capture the market share, because a loss of trust and confidence, in the case ofhealth related products, gives it a negative stand.We must take care of this fact before reaching out to communicate with the doctors and the endconsumers (patients). Before launching Monocryl Plus, the pre-launch strategy must be clearly laid out.If we plot the riskiness associated with the use of product and the degree of rationality required in makingthe choice, we arrive at the following figure (Figure-7).Hence the choice of sutures by the physicians/surgeons isdictated by a high degree of rationality and the risk associatedwith the use of product. Therefore, communicating keyinformation to the doctors is very important. Literaturesuggests two schools of thought, used for communication withthe doctors: Medical School which relies totally on facts tokeep a knowldege user uptodate with the latest technologiesand the Psycho-Behavorial School which emphasizes thefocus on repeated messages, brand recall, and the role playedby noise (marketing communication from other products) and Figure-7: Communication Matrix for health professionalsethical issues.We suggest a combination of both approaches to be adopted by Ethicon in getting its message across.Strategies to communicate with the doctorsThe key here is to Inform and communicate that staying abreast of technology adds value. • Advertise in medical newsletters, journals and magzines • Communicate to doctors personally via telemarketing and web marketing using digital media • Hold seminars, symposiums & workshops for familiarising surgeons with the product • Send samples of the Monocryl Plus suture along with “Monocryl theme” gifts through MRs • Display posters and calendars in the hospitals and nursing homes • Use Doctor Mailing cards ( with the product message on one side and the harmful effects of surgical site infections on the ther side of the postcard). Keep a structured feedback and followup mechanism for all the unaccepted parcels • Get endorsed by medical forums,like Indian Association of Cardiovascular & Thoracic Surgeons. • Tie-up with with medical colleges for interaction with students, with the purpose of familiarising them with Monocryl PlusThe other channel to bank upon is that of the well trained Medical Representatives. Whereas anadvertisement in the mass media gets an attention span of atmost 5-6 seconds, an MR gets a personalizedattention span of 2-3 minutes, and works onrelationship management with the doctors. Hence, Productive Prescription of Effort Monocryl Plusincentivize the MRs. The dynamics of interactionbetween doctors and MRs is illustrated in figure-8. UnproductiveThe various stages right from the communication of Wasted Effort Adoption and Use Effort of Monocryl Plusnew product launch, illustrating its benefits and theadoption of the product can be explained in terms ofthe stages listed below: Make a call Evaluation of Monocryl to a doctor Plus vis-à-vis other brands Awareness Arise Interest Sales Proposition leading to persuasion and Trust and Satisfaction Repeat Preference Confidence in Purchase Availability of the product Dissatisfactio Trial Brand Confidence and Trust in the eyes of the Relationship opinion leaders Repeat Purchase Figure-8: dynamics of interaction between a doctor and an MR Mass adoption of the product  
  8. 8. We can illustrate a sample message in print media for doctor in the following figure:-Strategies to communicate with the patients:The key here is to Reassure the patients that Monocryl Plus offers safety and hygiene that no otherproduct to date offers. This would be the most significant step in transforming this “push” product into a“pull” product. • Use digital media advertisements, like on the dedicated audio-video devices in the waiting area in clinincs and hospitals • Use print media for Monocryl Plus advertisements • Use the Monocryl Plus and mnemonics on the consultants’ visiting cards and the stationery • Keep brochures and printed material available in the medicine shopsWe can illustrate a sample message in print media for patient in the following figure:-Other smart strategies • Influence Purchase committee of the government and private hospitals for guiding their purchase intention towards Monocryl plus. • Bulk clients like Fortis and Max hospital can be offered17 o Tailored product packaging and delivery at competitive prices o Consulting services to nurses on how to reduce wastage by decreasing the notoriously high rate of opened, unused and discarded products                                                            17 The cost of this strategy has not been included in the marketing budget because this would be subjected to the management of the hospitalconcerned  
  9. 9. Strategi Advanta Focus ic age Synergy w the diffe with erent business segments of Johnson & Johnson, and strategy for Monocryl Plus to s f d r leverage t strengths of all sister co the o ompanies is represented be elow:-Core CompetC tency                                     C Company                         Leveraging si ister compan nies’ strength hs ‐One of the world’s most  • Le everage brand name, promote respected brandss in surgical  Monocryl as hig M ghly innovative e and safe and health care.  ovative ‐Famous for Inno ET THICON N product of Ethic con. products ‐Well known in CCardio  • Associate with C Cordis productts in Cardio   Vascular Segmen nt  Vascular Segmeent, to influenc ce Doctors ‐ Famous for its c commitment  CORDIS C nd make them an m switch to Mon R&D  M O‐Strong training n‐ network  • Use training nettwork of Depuy raining to surge tr y, provide  eons for using Monocryl N‐Strong marketing and sales ‐distribution netwd work  DEPUY D • Use marketing a and sales distri network of Depuy to enhance ibution  e reach of  O Monocryl M C‐Strong brand rep‐ putation in  •D Devise joint pro omotion schemmes with  R minimally invasive and open msurgical procedurs res   Ethic con End do‐ Monocryl (as a non‐invasive p M Et thicon) to leve product of  erage brand name in  Y   Surgery S minimally invasive  and open s m surgical  procedures. L ‐Well known for its range of ‐ • Use brand repute of JJHS to promote   infection prevent tion products  Monocryl as a in M nfection‐free ssuture JJHS • Use network of JJHS to promo f Monocryl , sp of ote usage  pecially in nurs sing homes  P  an nd mini hospitals. L‐Strong Professio‐ onal  • Use Professiona al Education ne etwork,  UEducation network E provide ‘hands‐ ‐on’ Monocryl experience  EISE o surgeons.  to S‐Strong service network for ‐ Bu usinesss  • Use service netw usage of Monoc work of BKC to o promote  cryl by their clients.Operational ExceO ellence, Global Process OG Outsourcing  Kno owledgge and Knowledge Da Development  Centre C            
  10. 10. IMPLEMENTATION PLAN Segmentation of Medical Facilities18 City Private Hospitals Government Hospitals Nursing Home Total Tier -1 425 2188 24807 27420 Tier -2 390 516 11128 12034 Tier -3 35 2046 14065 16146 Total 850 4750 50000 Table-3: Segmentation of Medical Facilities Roadmap and Costing for promotion of Monocryl Plus19 Mile stones‐T‐Communicate to  ‐Communicate to surgeons ‐Communicate to surgeons ‐Communicate to surgeonssurgeons via mobiles,  via mobiles, emails and MRs    via mobiles, emails and MRs    via mobiles, emails and MRs   emails and MRs      Tier  Tier  Tier  Tier  Tier  Tier    Tier  Tier  Tier   Tier  Tier  Tier  I  II  III  I  II  III  I  II  III  I  II  III  PH  35%  40% 40% PH 25% 20% 25% PH  10% 10% 0%PH  30%  30%  35%  GH  30%  35% 25% GH 30% 30% 30% GH  20% 15% 25%GH  20%  20%  20%  NH  35%  40% 35% NH 20% 20% 35% NH  20% 15% 15%NH  25%  25%  15%  ‐Advertisements in MIMS,  ‐Advertisements in MIMS,  ‐Advertisements in MIMS, ‐Advertisements in MIMS,  SIMS (Medical Journals)  SIMS (Medical Journals)  SIMS (Medical Journals) SIMS (Medical Journals)  ‐10 workshops in tier I cities  ‐1 presentation in 25  ‐2 seminars in each tier I ‐2 one day symposiums in  and 10 workshops in tier II  different government  and II cities with invitation every tier I cities  cities with invitation to all  colleges across tier I, II, III  to all the surgeons in tier III   surgeons from tier III cities  cities on Monocryl plus  cities    2 months 4 months 6 months 8 monthsNo. of Medical 12300 No. of Medical 19724 No. of Medical 13728 No. of Medical 9848Facilities to be Facilities to be Facilities to be Facilities to becovered covered covered coveredExpense on MRs Rs. Expense on MRs Rs. Expense on MRs Rs. Expense on MRs Rs. 3200000 5150000 3600000 2600000Expense on Mobile Rs. Expense on Mobile Rs. Expense on Mobile Rs. Expense on Mobile Rs.advertisements 100000 advertisements 130000 advertisements 110000 advertisements 90000Expense on e-mail Rs. Expense on e-mail Rs. Expense on e-mail Rs. Expense on e-mail Rs.advertisements 50000 advertisements 70000 advertisements 60000 advertisements 50000Cost of Rs. Cost of Rs. Cost of Rs. Cost of Rs.advertisements in 350000 advertisements in 350000 advertisements in 350000 advertisements in 350000MIMS and SIMS MIMS and SIMS MIMS and SIMS MIMS and SIMSExpense on Rs. Expense on Rs. Expense on Rs. Expense on Rs.symposiums 1200000 workshop 2000000 presentation 250000 seminar 1400000Total Projected Rs. Total Projected Rs. Total Projected Rs. Total Projected Rs.Cost 4900000 Cost 7700000 Cost 4370000 Cost 4490000 Projected Cost                                                              Total Projected Cost = Rs.2.146Crores 18 Assumptions:- • The percentage share of different types of medical facilities has been constant since March 2005. • 19 Assumptions: • An MR takes about 2 months to communicate about the product and get a confirmed response from all the potential customers in his area of operation (positive/negative). • An MR can visit 4 potential customers in a day. • A typical week-work for an MR is of 6 days. • We have set the aggressive targets considering qualified sales force and competitive position of Ethicon vis-à-vis other players. • Average expense on one MR = Rs. 50000 per month (including all travel expenses and benefits). • Average price of magazine advertisement = Rs. 90,000 per magazine per month • Average cost of mobile advertisement = Rs. 4 to Rs. 5 per prospect per month (For the applicable size of prospects in this case) • Average cost of e-mail advertisement = Rs. 2 to Rs. 3 per prospect per month (For the applicable size of prospects in this case) • Average cost of one day symposium = Rs.2,00,000 • Average cost of one seminar = Rs. 1,00,000 • Average cost of one workshop = Rs.100000 • Average cost of one presentation = Rs. 10000    
  11. 11. REVENUE  PROJECTI ION FOR M MONOCRYL L PLUS  Target Segment of S t Surgeons Annual potential rrevenue per surgeon Specializ zation No of Doctor rs Target SSegment Total annual revenue of E Ethicon Rs.83Crore e (Yes/No)) from 52500 Surgeons wit current th General SSurgeons 20000 Yes product porttfolio Gynecolo ogists 25000 Yes Adjusted To annual rev otal venue of Rs.90Crore e Plastic Su urgeons 1000 Yes Cardiac SSurgeons 500 Yes Ethicon from 52500 Surg m 20 geons with Orthoped dic 6000 No Monocryl Plus Total 52500 Average ann potential revenue nual l Rs.16225 Total Nu umber of surg geons in target Segment = 46 t 6500 per Surgeonn Table-4: Ta arget Segment of Surgeons S Table‐5: Annual potential revenue e per surgeon  Nummber of Hospitals Conta acted Number of Su N urgeons Con ntacted Number of s N surgeons per hospital is smo h oothened out Total Number of Hospitals = 5 H 55600 To Number o Surgeons = 46500 otal of a average for calculation as Phase - (Month 2) -1 12300 22% 10230 purpose. Thus percentage p s, Phase - (Month 4) -2 32024 58% 26970 2 o surgeons contacted is of Phase - (Month 6) -3 45752 82% 38130 3 equal to the p e percentage of Phase - (Month 8) -4 55600 100% 46500 4 hospitals conta h acted Table-6: Ph hase-wise details of established cont o tacts   Numbe of Surgeons Contacted er C 0 10230 10230 26970 26970 38130 38130 46500 0 Con ntacts already est tablished with the targets, conver rsion in processMonth  1  2  3  4  5  6  7  8  9  10  1 11  12 13  14  15  16  17  18  19 9  0 1023 1023 2697 4743 3 5859 9207 10044 15857 15 5857 23390 233 390 28830 28830 34271 34271 35945 35945 37 0 7200 21 Numbe of Surgeons Converted er Figure-9: P Projected Reven nues Revenue from one sur rgeon in a fin nancial year = Annual Ear rning from on surgeon*(n ne number of mmonths left after c conversion/12 2) Assumptions:- • C CAGR = 9%22 2 • N Number of Su urgeons contacted/converte in a phase are considered to be cont ed tacted/conver rted at th end of the phase for calc he p culation purpoose Total l Projected Rev venue in 5 yea ars = Rs.304.45 5Crore                                                              20 Assuming p price index for Moonocryl plus = 130 extrapolating from Case Facts (Ann 0 m nexure-5) We conside taking over of Vicryl/ Vicryl Plus m er Vi market by Monocr plus as an oppo ryl ortunity as it provi ides a better bottom line.. m 21 We are suc ccessful in converti 80% of our est ing tablished touch po oints. However, thi happens in a pha is ase-wise manner o 10% will be converted imm l mediately o 20% mor will be converte after 3 months re ed o 35% mor will be converte after 4 more mo re ed onths o 15% mor will be converte after one year o first contact re ed of 22 pload/Indian_Phar rma.pdf