Pharma Field Force Excellence


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Inside This Issue

1. What the Doctor Wants from the MR
by Dr. Aniruddha Malpani, MD

Doctors want MRs who are knowledge workers, willing and able to partner with him to better serve his patients.

2. The Marks of a True Professional
by Rachana Narayan

A True Professional is one who has achieved a high standard of “Personal Quality” in everything from dressing sense to professional knowledge and inter-personal relationships.

3. Paradigm Shift
by Sharad Virmani

How Pharma companies can survive and thrive in the New DPCO era.

4. The Single-Minded Success of Sachin Tendulkar
by RM Saravanan

What Gen-Y can learn from the cricket-or-nothing attitude of the Little Master.

5. Catch People Doing Things Right
by K. Hariram

FLMs must proactively engage their team in doing the right things and doing things right.

6. Building Sales Teams from Scratch
by Anup Soans

Every team goes through the stages of Forming, Storming and Norming before they can start Performing

7. Observational Research in Healthcare
by Javed Shaikh & Shafaq Shaikh

8. Patient Reported Outcome Measures in Pharmacoeconomics
by Mahendra Rai & Nishkarsh Likhar

Published in: Health & Medicine, Business
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Pharma Field Force Excellence

  1. 1. FFE 2013 - the annual flagship event of MedicinMan - isless than 7 days away. Two important issues are being calledup for discussion this FFE - Business Intelligence andEmployee Engagement and their contribution to Field ForceProductivity.Engagement of the Field Force lies at the heart of our workat MedicinMan (See MedicinMan May 2013). Whenemployees are fully engaged, they are happier with theirjobs and contribute more to the organization. Which is whywe have a full panel discussion on the relationship betweenEmployee Engagement and Field Force Productivity at FFE2013. On the panel are industry thought leaders and long-time patrons of MedicinMan.At MedicinMan, we think we have a good understandingof what Employee Engagement looks like. Over the 20-oddissues released, we have read stories of individuals rising togreat heights in their lives and careers because they weremeaningfully engaged in their work as Medical Reps andFront-line Managers.Not in the least, our own work in delivering high-qualitycontent and constantly improving the magazine sinceinception - all at zero cost to the reader - is testimonyto what belief in ones vision and mission can produce.Participation by Pharma Professionals at the highest levelsof industry in FFE 2013, is an affirmation of our beliefs andwork.If you havent booked your spot at FFE, dont panic, we stillhave a limited number of seats available. Please go to theregistration on page 28. -MMMEDICINMANField Force ExcellenceTMJune 2013 | www.medicinman.netFFE 2013.Saturday, 8th June 2013 | Courtyard Marriott, Mumbai
  2. 2. Opportunities& ChallengesField ForceProductivity:The #1 Learning Opportunity for SeniorManagers to Enhance Field Force Productivity.FFE 20135x10 15 20 25 30 35 40 45 50 55 60yDate: Saturday, 8th June 2013Theme:FieldForceProductivityPlace: Courtyard Marriott, MumbaiINside> Faculty> Agenda> Objectives> registration on Pg. 28U} @=AGUzz  }8 U } z   =AG a 8MEDICINMANField Force ExcellenceSaturday, 8th June 2013 | Courtyard Marriott, Mumbai
  3. 3. 1. What the Doctor Wants from the MR..............4Doctors want MRs who are knowledge workers,willing and able to partner with him to better servehis patients.Dr. Aniruddha Malpani, MD2. The Marks of a True Professional.....................8A True Professional is one who has achieved ahigh standard of “Personal Quality” in everythingfrom dressing sense to professional knowledge andinter-personal relationships.Rachana Narayan3. Paradigm Shift..................................................11How Pharma companies can survive and thrive inthe New DPCO era.Sharad Virmani4. The Single-Minded Success of SachinTendulkar..............................................................15What Gen-Y can learn from the cricket-or-nothingattitude of the Little Master.RM Saravanan5. Catch People Doing Things Right ..................18FLMs must proactively engage their team in doingthe right things and doing things right.K. Hariram6. Building Sales Teams from Scratch................21Every team goes through the stages of Forming,Storming and Norming before they can startPerformingAnup Soans7. Observational Research in Healthcare..........25Javed Shaikh & Shafaq Shaikh8. Patient Reported Outcome Measures inPharmacoeconomics...........................................29Mahendra Rai & Nishkarsh LikharContents (click to navigate)MedicinMan Volume 3 Issue 6 | June 2013Editor and PublisherAnup SoansCEOChhaya SankathCOOArvind NairChief MentorK. HariramAdvisory BoardProf. Vivek Hattangadi; Jolly MathewsEditorial BoardSalil Kallianpur; Dr. Shalini Ratan; ShashinBodawala; Prabhakar Shetty; Vardarajan S;Dr. Mandar Kubal; Dr. Surinder KumarInternational Editorial BoardHanno Wolfram; Renie McClayExecutive EditorJoshua SoansMedicinMan Academy:Prof. Vivek Hattangaadi, Dean, ProfessionalSkills DevelopmentMedicinMan ChangeMakersSaurabh KumarMake a difference in Pharma. Join MedicinManChangeMakers. Write in to our editor to find outmore:anupsoans@medicinman.netLetters to the Editor: anupsoans@medicinman.net4
  4. 4. E4 | MedicinMan June 2013What the Doctorwants from theMedical REpDr. Aniruddha Malpani, MD is the MedicalDirector at Malpani Infertility Clinic in Mumbai.“”Sneaky underhand sales techniques justdo not work. Just like you don’t likepushy salespeople, neither do doctors!If you want the doctor to listen to you,you need to earn his trust and respect.How can you do this? Remember thatdoctors are experts. They take pride intheir scientific knowledge base. Theyare impressed by representatives whoare knowledgeable and well-informed.Many doctors will be happy to userepresentatives as a valuable source ofcontinuing medical education, but youneed to earn his respect in order to do so.One of the most challenging tasksfor you as a healthcare field forceexecutive is to engage with doc-tors. Physicians are perhaps the most im-portant component in pharmaceutical salesbecause they write the prescriptions thatdetermine which medicines will be used bypatients. Influencing the physician is the keyto pharmaceutical sales and traditionallythis was done by encouraging sales repre-sentatives to create a personal relationshipwith the doctor. Medical representativescall upon physicians regularly, and hopeto influence his prescribing by providingdrug information, free drug samples, andfreebies such as pens and pads. You hope tobuild a relationship with the doctor, whichyou can leverage to influence him to writeyour brand. This is still the prevalent modeltoday; but is broken for many reasons.
  5. 5. 5 | MedicinMan June 2013What the Doctor Wants from the Medical Rep | Aniruddha Malpani, MDThe good news is thatthere are now excellentresources availableonline, which you canuse to ensure you arewell-informed aboutmedical advances . Manyare free – for example,MedlinePlus and GoogleScholar.If you keep yourselfupdated, you can offer toact as a research assistantfor your doctor. Doctorsare busy people and maynot have time to searchthe medical literaturethemselves. If you can dothis for them, they will seeyou as a valuable ally!For one, many doctors do not seerepresentatives anymore. Theyfeel that they simply eat into theirprecious time without adding anyvalue to their practice. Thus, Iwill only see representatives once– and will request them to emailme if there is information theywant to share with me. If I findit of interest, I will give them anappointment to make a presenta-tion. This allows me to maximisemy productivity- and ensures thatI don’t waste the representative’stime either!Sneaky underhand sales tech-niques just do not work. Just likeyou don’t like pushy salespeople,neither do doctors! Don’t insulttheir intelligence by trying toflatter them or manipulate them –doctors are not stupid! Sales ployssuch as “closing the physician”, “challenging them”, and “gettingthem to commit” can turn themoff and this is one of the reasonsmany doctors refuse to see pharmarepresentatives. Don’t damageyour relationship with the doctor!Sadly, most reps have becomecynical. They feel doctors respondonly to flattery , freebies and in-ducements. This is why they focuson polishing their social skills, inorder to try to make the doctor afriend. While this works, this is avery short-term strategy, whichis likely to fail over time. Doctorsdo not consider representatives tobe their peers – they will often justtreat them as a source of freebies.How successful a representativeyou are will depend upon how wellyou can talk to the doctor. If youwant the doctor to listen to you,you need to earn his trust andrespect.How can you do this ? Rememberthat doctors are experts. They takepride in their scientific knowledgebase. They are impressed by repre-sentatives who are knowledgeableand well-informed. Many doctorswill be happy to use representa-tives as a valuable source of con-tinuing medical education, but youneed to earn his respect in orderto do so.This is why you need to updateyour personal medical and scien-tific knowledge base if you want tocommand the doctor’s respect andattention. How can you do so? It’simportant that you take the initia-tive –don’t wait for your companyto teach you. If you do so, this is agreat opportunity for you to standout from your peers!The good news is that there arenow excellent resources avail-able online, which you can useto ensure you are well-informedabout medical advances . Many arefree – for example, MedlinePlusand Google Scholar. If you keepyourself updated, you can offer toact as a research assistant for yourdoctor. Doctors are busy peopleand may not have time to searchthe medical literature themselves.If you can do this for them, theywill see you as a valuable ally!Can you help them to prepare apresentation for a conference? Orhelp them to publish an article in amedical journal ?Can you do a PubMed search ?Why not ? Teach yourself – don’texpect to be spoon fed . You canalways ask your company’s Med-ical Services Dept for help if youare stuck! You can offer to emailyour doctors with the latest infor-mation. If you become the “go-toexpert” in a particular niche, yourdoctors will turn to you if theywant more information!The doctor should not just see youas a salesman, but as a well-wisherand ally! What value can you addto his life? Can you show him howto use medical productivity appsfor his mobile? Can you help himto create his own website? Canyou help him to use Facebook andLinkedIn?“
  6. 6. 6 | MedicinMan June 2013What the Doctor Wants from the Medical Rep | Aniruddha Malpani, MDIf you invest in educatingyourself, the satisfactionyou will get from doingyour job well will increaseenormously! This willboost your self-esteem –and as you start to respectyourself, your doctorswill respect you as well.The good news is that asspecialists become busier,representatives are goingto be able to find moreopportunities to be ofservice to them.Times are changing – and youneed to change with them! Med-ical representative compensationhas historically been sales-based:sell more drugs, make more mon-ey. Doctors know a rep is incen-tivized to sell more to make more.However, global leaders such asGSK are aiming to remove finan-cial incentives from the equation.Pharma reps still receive a mixof salary and bonus, but GSK hasreplaced individual sales targetswith new targets measuring theoverall performance of the salesteam and feedback from custom-ers. This new system also evaluatesa rep’s scientific knowledge as wellas the ability to communicate thatinformation.Other pharmaceutical companieswill soon follow GSK’s lead. How-ever, why wait for your companyto do so? You should take theinitiative and do this of your ownaccord – for purely selfish reasons!Remember that there is muchmore to life than just counting thenumber of boxes of medicines youhave sold! You need to be engagedand in order to enjoy your job, youneed to add value and believe thatyou are doing something con-structive with your life.If you invest in educating yourself,the satisfaction you will get fromdoing your job well will increaseenormously! This will boost yourself-esteem – and as you start torespect yourself, your doctors willrespect you as well. The good newsis that as specialists become busier,representatives are going to be ableto find more opportunities to be ofservice to them.Start to think of how you cancontribute to making the worlda healthier place, by helping thedoctor to do a better job! -AM“Missing something important?You can access all past issues of MedicinMan at: sure to Subscribe on our website (top-right corner: stay up-to-date with us.
  7. 7. The most exciting part of the conference: FFE 2013 begins with the CEO Roundtable. Pharma Leaders have theopportunity to interact freely and set the tone of the event. Participants have the opportunity to interact directlywith the CEOs during Q & A.Sujay Shetty,Partner & Lead,Pharma & LifeSciences, PwC.ShaktiChakraborty,Group President,Lupin.Ganesh Nayak,COO & ExecutiveDirector,Zydus Cadila.Bhaskar Iyer,Divisional VP,India CommercialOperations, AbbottHosted by Organized by Knowledge Media CME for Brand BuildingPresented by:FacultyLess than 7DAys to Go.RegisterNow!Saturday,June8,2013|CourtyardMarriott,Mumbai 8CEO Roundtable:Field Force Productivity: Opportunities & ChallengesAweSumFFE 20135x10 15 20 25 30 35 40 45 50 55 60yDate: Saturday, 8th June 2013Theme:FieldForceProductivityPlace: Courtyard Marriott, MumbaiFFE 2013 Registration on Page 28
  8. 8. E8 | MedicinMan June 2013The Marksof a trueProfessional.A True Professional is one who has achieved a high standard of “PersonalQuality” in everything from dressing sense to professional knowledge andinter-personal relationships.Rachana Narayan is a Trainer at A Menarini India Pvt. Ltd.She has previously worked in Medico-Marketing Dept. atTorrent Pharmaceuticals.Let me confess that I am not writingthis as an expert in groomingnor do I possess some technicalqualification for the same. Yet, very oftenI have been suggested to pen down mythoughts on grooming and presentationand making that first impression the bestone. Grooming is actually the result of theethics, habits and discipline that peopleacquire over the course of many years fromtheir parents, family, friends and learning,that makes them different from others.The degree to which a person varies intheir inter-personal and presentation skillsdepends not only on their educationalbackground but also on the trans-regionalexposure a person has received during her/his lifetime.To me grooming is a very narrow term,that in isolation cannot trigger the desiredresult. It may lead to grabbing attention butattention without respect may be dangerousat times. So, I prefer to call it ACHIEVINGPERSONAL QUALITY, which is abroader term and always leaves room forimprovement.Achieving quality in self, just like inany other product, does not comespontaneously. In fact it needs a lot ofunderstanding, rehearsals, learning frompast experiences and eliminating harmfulpersonality aspects. To me, some of thoseaspects of personality, which will rendersatisfactory Personal Quality for self as wellas others, come from following:
  9. 9. E“The Marks of a True Professional | Rachana Narayan9 | MedicinMan June 20131Dressing Sense: Appropriatedressing as per body type and oc-casion is a must to grab apprecia-tive attention. In professional businesssettings, it needs to be more orthodox.The more you are covered, the betterfor you. Dressing should make you feelcomfortable and confident. Selectionof colours as per skin type is an art andcomes with trial. In case of doubt, plainlight colours are always best and whiteand black always tops the list for anyskin type. In sales especially, dress-ing has a direct correlation with salesresults.Ornaments and jewelery should beminimal and delicate. Pearl necklacesor gold chains with small diamondpendants give authentic professionallook to ladies. One could also go forlightweight imitation jewelery match-ing with dress colour.2Gestures: A confident gesturewith pleasant smile and goodeye contact is the first aspect ofgrabbing attention. Openness to other’sthoughts makes a person reliable andtrustworthy. It’s always the innermostdesire of every human being to beheard and that one quality makes theperson Mr./Mrs. Dependable.As per a study, smiling, as a positivegesture of acceptance, has been shownto increase sales success rate by 20%.3Personal Hygiene: This is oneaspect without which even thehighest standards of etiquettesfail to leave a mark. Cleanliness andgood body odor, even though they maynot provide any added advantage, willbe a big turn-off if neglected.4Tone of voice: Tone of voiceis always neglected but voicemodulation helps in creating animpression that lasts even after the per-son has gone. This is one of the aspectswhich may help salesmen to create alasting impression. All good speakershave mastery in this.5Communication Skills: As perthe research done by Adler R.,it has been estimated that 70%of our time is spent communicating –writing, speaking or listening. Hence,spending that time judiciously is veryimportant. In order to communicateeffectively, Harvard Business Reviewrecommends communication to havethree elements: credibility, emotionalconnection and logic. Communicationwhich instills trust, provides emotionalneed satisfaction and is backed by logicalways stands out and creates a positiveimage of the person. This also leads to ahigher closing ratio in sales.6Knowledge: A good imageis built on the foundation ofsound knowledge. Knowledgehere is not restricted to the productand processes alone. It also includeshaving command over the language,information about the environmentand the customer. Knowledge enhancescompetency, boosts the confidence andprovides the intellect to handle queriesefficiently.7Personal and inter-personalrelationships: It is now a provenfact that it is not only knowledgebut also people skills that take a personto the top.A survey from the Menlo Park done in2011 found that 48 % of workers be-lieved that being courteous to co-work-ers can greatly affect a person’s careerand accelerate advancement. Anotherresearch from Harvard University, theCarnegie Foundation and the StanfordResearch Institute linked 85% of jobsuccess to people skills. Thus, a personwithout good relationship skills withcolleagues cannot achieve success inthe long run.In today’s era of social networking,people skills have come to acquire amuch more important role. We arenothing but the impression we leaveon others. Whether we want or not, weare always in the process of creating animpression about ourselves. There arepeople judging us and spreading themessage that ultimately decides oursuccess with them and in life.Hence, concentrating on the smallaspects of PERSONAL QUALITY cancreate a big impact on life. Joyce Broth-ers, rightly said, “A strong, positiveself-image is the best possible prepara-tion for success”. -RNWe are nothing but theimpression we leave onothers. Whether we wantor not, we are always inthe process of creatingan impression aboutourselves. There arepeople judging us andspreading the messagethat ultimately decidesour success with themand in life.
  10. 10. 10 | MedicinMan June 2013Key Questions for Discussion:1. What is the role of Business Intelligence in enhancing Field Force Productivity?2. Can accurate Business Intelligence lead to an optimized Field Force structure?3. Can Business Intelligence help Field Force optimize physician targeting?FacultyBusiness Intelligence forField Force ProductivityVikas Dandekar,India Bureau Chief,Elsevier BusinessIntelligenceSalil KallianpurCommercial Head -Classic Brands Centerof Excellence, GSKDr. Viraj SuvarnaMedical Director,Boehringer IngelheimAmeesh MasurekarFounder Director - AIOCDPharmasofttech AWACSSaturday,June8,2013|CourtyardMarriott,Mumbai 8Hosted by Organized by Knowledge Media Venturz.Presented by:www.aiocdawacs.comPANEL DISCUSSIONFFE 20135x10 15 20 25 30 35 40 45 50 55 60yDate: Saturday, 8th June 2013Theme:FieldForceProductivityPlace: Courtyard Marriott, MumbaiFFE 2013 Registration on Page 28Less than 7DAys to Go.RegisterNow!
  11. 11. 11 | MedicinMan June 2013Finally the tiger has come out of cage.The New Drug Policy came into force on 15 May,2013.The Government of India, on May 16, announced the NewDrug Policy, which brings 348 drugs and 652 formulationsin the Essential Drugs List thus reducing their cost by about25-30%.What this means for MNC’s & Pharma Majors is:ØØ Volume ErosionØØ Shrinking ProfitsØØ Increased Operating Cost to Sales RatioThe impact of this price reduction could be around 40-60%for many products promoted by MNC’s and pharma majorsin India.Incidentally all MNC’s and pharma majors have high MRP’sand sizeable volumes for most of their products which fallin these 27 therapeutic segments and therefore they areexpected to take a severe hit in turnover and profits.By conservative estimates, the expected erosion in turnoverof MNC’s and pharma majors could be 12% to 20% and theexpected erosion in profits around 20% - 25%.To top this off will be the additional pressure from thepharma retailers where the margins have been reducedfrom 20% to 16%. This powerful lobby would be pressur-izing Pharma Companies for more freebies to compensatetheir margin loss.In recent years, most of the MNC’s and pharma majorshave expanded their field force to capitalize by maximizingtheir volume share of these key brands from rural marketsThe Rural Markets mainly support these Key Brands.Now with reduced prices and profits it will become difficultfor them to sustain many of these markets.Sharad Virmani is Vice President, Marketing andSales at Comed Chemicals and Pharmaceuticals.virmanis@gmail.comHow to survive in the New-DPCO era.P R D GA AMiS H F TIE
  12. 12. 12 | MedicinMan June 2013Paradigm Shift: How to Survive in the New DPCO Era | Sharad VirmaniThe pressure will also mount on urban markets to compensatethese volumes through other products.Race will now begin to build new big brands which fall outsidethis list of essential drugs.Rising operating costs to sales / profits would be the key con-cern.Outsourced Field Force - The NewParadigm.It’s time to change business tactics.To cut down the rising costs and optimize profits, the bestavailable alternative for MNC’s and pharma majors is to useoutsourced field force.The Advantages of using Outsourced Field Force:1Cut Operating Costs: improving market access and pene-tration at lower cost.ØØ Manpower can be employed at 30-40% less salaries com-pared to internal employees.ØØ 20-30% lesser daily allowances compared to internal em-ployees.ØØ Decrease internal headcount.ØØ Reduced overheads.ØØ Reduced fixed costs.2Grow Share of Voice - Increase Revenue:ØØ Promote brands which are in essential drugs list.ØØ Parallel promotion of key brands with different brandnames to optimize market share.ØØ Target niche segments.ØØ Promote matured brands – leaving the company field forceto focus on new products.ØØ Target new customer degments – no customer overlap.ØØ Promotion at retail counters to maximize gains from brandequity – capitalizing on the OTC appeal of the product.3Flexibility for upsizing or downsizing quickly as needed –a Commercialization risk mitigation strategy against futureunexpected events, such as pipeline disappointments, negativeFDA action and competitive threats.4 Eliminate fixed payroll and benefits costs.5Reduce legal expense and exposure due to the Outsourcedfirm covering Human Resources issues.This is the right time for MNC’s and big pharma companies toexplore CSO (Contract Sales Force) in India.The big question is which out-sourced business model to use:1. Regional Franchisees or2. MNC-managed Contract Sales Organizations (CSOs)To cut down the rising costsand optimize profits, thebest available alternativefor MNC’s and pharma ma-jors is to use out-sourcedField Force.
  13. 13. 13 | MedicinMan June 2013Paradigm Shift: How to Survive in the New DPCO Era | Sharad VirmaniRegional FranchiseesRegional Franchisee’s are State operators – mainly well-to-doC&F’s.Shortcomings of regional franchisees are:ØØ Infrastructure issues.ØØ Cash mobility.ØØ Manpower not willing to work under franchisee as they donot have credibility and national presence.ØØ High Attrition rates.ØØ Lack of a professional culture and environment.ØØ Short-term commitment.Shortcomings for Companies working with Local Franchi-sees:ØØ Cumbersome multiple window operation with state-wisecontracts.ØØ Monitoring from multiple windows is a problem.ØØ Resource sharing through multiple points – increased over-heads costs.ØØ Dilution of message.The Best bet is:MNC-Managed CSO (Contract SalesForce)Benefits:ØØ Professionalism – accountability and commitment.ØØ Single contract.ØØ Prior experience of managing CSO operations in multiplecountriesØØ Single window operation / single command.ØØ Confidence and job security of employees.ØØ Uniform message.ØØ Established infrastructure.ØØ Credibility and national presence.ØØ Single point resource sharing – reduced overheads forparent company.ØØ Cost economy.ØØ Cash inflow and financial security.ØØ Long term commitment.ØØ Lower attrition rates.Time has come for MNC’s and big pharma companies to changetheir paradigms, shift gears and explore the emerging opportu-nity of contract sales force business to leverage business advan-tage and optimize profits. -SV
  14. 14. Employee Engagement:A New Paradigm in Field Force Productivity.FacultyK. Hariram,Former MD (retd.),Galderma India.Amlesh RanjanAssociate Director,SanofiDeep BhandariDirector, Marketing andSales Excellence, UCBModerator:Anup SoansEditor, MedicinManS. MohanGM & Head, Training &Development, RanbaxySaturday,June8,2013|CourtyardMarriott,Mumbai 8Hosted by Organized by Knowledge Media Venturz.Pharma’s Premier Branding Event“Pharmodeling for Healthcare: KAM & Market Access”Session Lead: Amlesh Ranjan, Assoc. Director, Sanofi“Role Clarity for Field Sales Managers to Enhance Field Force Productivity”Session Lead: K. Hariram, Former MD (retd.), Galderma IndiaPresented by:PANEL DISCUSSIONPower Session 1Power Session 2 :BRAND DRIFTwww.branddrift.comFFE 20135x10 15 20 25 30 35 40 45 50 55 60yDate: Saturday, 8th June 2013Theme:FieldForceProductivityPlace: Courtyard Marriott, MumbaiFFE 2013 Registration on Page 30Less than 7DAys to Go.RegisterNow!
  15. 15. 15 | MedicinMan June 2013I’m sure, there are many talented cricketers butin terms of longevity, records and adaptabilityto changing needs of the game, Sachin Ten-dulkar scores over everyone.How is Sachin Tendulkar able to play for 23 longyears with the same intensity? How is Sachin ableto have all the world records? How is this masterblaster able to adapt to the changing needs of thegame? These are questions I keep asking myself. Ihad received many answers earlier. But today, I hada realization, which transformed me much.I realized that many cricketers, when they were try-ing to make it to the Indian Cricket Team, probablyhad a back-up option in their mind. There is a pos-sibility that their sub-conscious mind would havetold them – “Play cricket. Do your best to get intothe Indian Cricket Team. In case, you miss a career“If there is no cricket, then there isno life for me.” Sachin Tendulkar’scricket-or-nothing attitude is what hasset him apart from other cricketers.Here’s what Gen-Y can learn from theLittle Master.The Single-MindedSuccessof SachinTendulkar.RM. Saravanan is a corporate trainer and author of the books -‘Reveal Your Genius’ and ‘The Winning Edge. He was formerlyManager - Training at Chiron Panacea |
  16. 16. 16 | MedicinMan June 2013The Single-Minded Success of Sachin Tendulkar | RM Saravananin cricket, don’t worry, as you can takeup a corporate job, since you are welleducated or you have an option to takecare of your family business.”Whereas for Sachin Tendulkar, there wasno option and his dominant thoughtwould have been – ‘I will play cricket. Ifthere is no cricket, then there is no lifefor me’.Since there was no back-up option forSachin, he could bring an insatiablepassion and hunger to his game and thatmade him one of the most completebatsmen of the century.Success flows like a waterfall to all giftedplayers, but the same success will flowlike tsunami to a man, who doesn’t havean option of failure in his mind. I realizetoday that having an option is the firststep towards under-utilizing oneself.It is a fact. Let us see few examples tounderstand this:A sales professional, who thinks of only‘one target’, will invariably achieve, aswell as surpass the target compared tothe sales professional, who thinks ‘2targets’ - option 1 and option 2.A working professional, who thinks ‘I’llgrow in this organization’, will invariablygrow in the organization compared tothe professional, who thinks ‘I’ll growhere or there or elsewhere’.An employee, who wants to be an entre-preneur, will be successful in his venturesooner or later if he resigns from his joband demonstrates single-minded focusin his business, compared to a personwho continues to be an employee butparallely starts a business and thinks thatif he gets success in business, then he’llquit his job.An organization, that thinks that it cangroom its employees as they are thefuture, will continue to develop strongprofessionals and in the process, retaintheir employees as compared to anorganization, which keeps back-up can-didates ready if someone resigns. Theywill never be able to develop people, asthey are already thinking that peoplemay leave.Do you feel not having options isstressful? It may be stressful but that isa positive stress. The moment one hasmore than one option, he is sending aclear signal to the Universe that he is notconfident of achieving the first one.Having options is like tying a bicycle toyour bike and thinking that if the bikebreaks down, then you’ll take the cycle.It is not possible to travel at full speedin such a manner. If you tie a bicycle toyour bike it will actually make you travelmore cautiously.There is one more reason why havingone option or one goal will help im-mensely. When you have only one focus,you send a message to the Universe thatyou have faith in this goal, in this ven-ture, in this organization etc. And it is afact of life that faith never fails.Let’s throw the options away. It is enoughthat we played safe so far. When we haveone goal and one focus, we will entuallyachieve it. Even if we fall short, what isthe worst that can happen to us? Anoth-er solution will automatically come insearch of us when we needed it. Let ustrust and step forward in the direction ofour dreams confidently.I would like to end this article with thequote of Swami Vivekananda:“Take up one idea. Make that one ideayour life; dream of it; think of it; live onthat idea. Let the brain, the body, muscles,nerves, every part of your body be fullof that idea, and just leave every otheridea alone. This is the way to success, andthis is the way great spiritual giants areproduced.” -RMSWhen you have onlyone focus, you senda message to theUniverse that youhave faith in thisgoal, in this venture,in this organization.And it is a fact oflife that faith neverfails.“”
  17. 17. AgendaSaturday,June8,2013|CourtyardMarriott,Mumbai 808.30 - 09.20 Networking Breakfast09.30 Keynote Address: Shakti Chakraborty, Group President, Lupin10.00 CEO RoundtableModerator: Sujay Shetty, Partner & Lead, Pharma & Life Sciences, PwCPanel Members: Shakti Chakraborty - Group President, LupinGanesh Nayak - COO & Executive Director, Zydus CadilaBhaskar Iyer - Divisional VP, India Commercial Operations, Abbott11.30 Panel Discussion: ‘Business Intelligence for Field Force Productivity’Moderator: Vikas Dandekar - India Bureau Chief, Elsevier Business IntelligencePanel Members: Ameesh Masurekar - Founder Director, AIOCD Pharmasofttech AWACSSalil Kallianpur - Classical Brands Centre of Excellence, GSKDr. Viraj Suvarna - Medical Director, Boehringer Ingelheim13.00 - 14.00 Lunch14.00 Panel Discussion: ‘Employee Engagement: The New Paradigm in Field Force Productivity’Moderator: Anup Soans, Editor, MedicinManPanel Members: Deep Bhandari - Director, Marketing and Sales Excellence, UCBK. Hariram - Former MD (retd.), GaldermaAmlesh Ranjan - Assoc. Director, SanofiMohan Sheshadri - GM & Head, Training & Development, Ranbaxy16.00 Power Session 1: ‘PharModeling for Healthcare: KAM & Market Access’Amlesh Ranjan - Assoc. Director, Sanofi16.30 Power Session 2: ‘Role Clarity for Field Sales Managers to Enhance Field Force Productivity’K. Hariram - Former MD (retd.), Galderma17.00 Closing RemarksHosted by Organized by Knowledge Media Venturz.FFE 20135x10 15 20 25 30 35 40 45 50 55 60yDate: Saturday, 8th June 2013Theme:FieldForceProductivityPlace: Courtyard Marriott, MumbaiFFE 2013 Registration on Page 28Less than 7DAys to Go.RegisterNow!
  18. 18. 18 | MedicinMan June 2013Let us look at a very familiar scenario. In thequarterly cycle meeting there is an analysisof number of calls, visit frequency and callaverages. The concerned sales person whose callaverage is low is put down in front of everybody andvirtually ripped apart. Most often the concernedFLM is also included in this exercise in front of hisown team members or the FLM is in for a surprisewith regard to this revelation. The Sales Manager,feels that he has done his job and his ego is satisfied.The ritual continues quarter after quarter withminimal impact on sales.Do the managers concerned realize the purposebehind such an activity? Have they achieved theirpurpose? Do they know that this has an impact onthe day to day revenue generation for which they areresponsible? By doing this have they changed thebehaviors of those concerned? Is there any coachingdone with regard to this? Million dollar questions, Isuppose.Among the most important role of line managers isthe willingness and ability to inspect performanceaccording to expected standards, and thecommitment to reinforce what is learned throughfeedback, consistent messages and coaching.If you don’t inspect what you expect, you no longerCatch PeopleDoingThingsRight*.K. Hariram is the former MD (retd.) at GaldermaIndia. He is Chief Mentor at MedicinMan and aregular*Title borrowed from Ken Blanchard.E
  19. 19. Catch People Doing Things Right | K. Hariramhave the right to expect it. Inspecting what you expect is simplyholding people accountable for those behaviors, actions, attitudesand decisions that contribute to results. Every line manager hasaccess to data of those where expectations have been set.So monitoring and giving periodic feedback for course correctionand the immediacy of action helps in avoiding ritualizing suchthings. The results will follow. Also, the sales team membergets projected in proper light in front of middle and seniormanagement team. A sense of pride, self esteem and sense ofaccomplishment gets reinforced. This also provides opportunityto CATCH PEOPLE DOING THINGS RIGHT (KennethBlanchard).Here are four ways to ensure consistency in expecting andinspecting:1. Set clear expectations (not vague ones like ‘improve callaverage, meet more frequently’ etc)2. Teach, train and educate them.3. Reinforce the training in meetings, assignments, coaching etc.4. Inspect (monitor) regularly whatever you expect and redirectimmediately. -KH“The Sales Managerwho berates his team,feels that he has donehis job and his ego issatisfied. The ritualcontinues quarter afterquarter with minimalimpact on sales.Abdul Basit KhanAjay Kumar DuaAmlesh RanjanAmrutha BhavthankarAndris A. ZoltnersAnthony LoboAparna SharmaArvind NairAtish MukherjeeB. RamanathanChayya SankathCraig DixonDevanand ChenuriVenkatDinesh ChindarkarDr. Amit DangDr. AniruddhaMalpaniDr. Hemant MittalDr. Neelesh BhandariDr. S. SrinivasanDr. Shalini RatanDr. Surinder KumarSharmaDr. Ulhas GanuGeetha G HH. J. BadrinarayanaHakeem AdebiyiHanno WolframHitendra KansalIyer GopalkrishnaJasvinder SinghBangaJaved ShaikhJitendra SinghJohn GwillimJolly MathewsJoshua MenschK HariramK. Satya MaheshKen BoyceMahendra RaiMala RajManoj KumarMayank SaigalMilan SinhaMohan Lal GuptaNeelesh BhandariNeha AnsaNishkarsh LikharNoumaan QureshiParveen GandhiPinaki GhoshPK SinhaPrabhakar ShettyVivek HattangadiRachana NarayanRajesh RangarajanRalph BoyceRenie McClayRicha GoyelRichard IlsleyRM SaravananSagar S. PawarSalil KallianpurSalil KallianpurSally E. LorimerSandhya PramanikSanjay MunshiShafaq ShaikhShalini RatanSharad VirmaniShiv BhasinSpring SudhakarSubba Rao ChagantiSudhakar MadhavanTony O’ConnorV. SrinivasanVaradharajan K.Vijaya ShettyVishal V. BhaiyyaVishal VermaVivek HattangadiWilliam FernandezOur AuthorsMedicinMan invites contributions from Pharma professionals on topics related to Field ForceExcellence. See: for more information.
  20. 20. FFE 2013 is India’s premier event for FieldForce Excellence by MedicinMan.The old methods of increasing field force num-bers will only mean increasing inefficiencies.Moreover, arbitrary targets and unachievableincentives has made the field force wary andweary and attrition is at an all time high.The Challenges faced by Pharma in India ismanifold:• Patent expiration and fewer blockbusters• Stringent regulatory compliance• Intense competition and• Heightened cost pressuresThis, coupled with social activism, decreasedface-time with Doctors, and commoditizationof the market, make questions of Field ForceProductivity all the more important.In these circumstances, the urgent questionsfor senior pharma managers are:1. What are Pharma CEOs thinking about therole of Field Force in the changed market sce-nario?2. What is the role of Business Intelligence inenhancing Field Force Productivity?3. How to attract and retain Gen-Y talent? Whatis Employee Engagement?4. What is PharModeling? How can KAM (KeyAccount Management) lead to increased FieldForce Productivity?5. How can Role Clarity of Field Sales Manag-ers lead to increased Field Force Productivity?Every year at FFE, MedicinMan brings togeth-er industry thought-leaders to deliberate on themost pressing issues facing the Pharma FieldForce in India.Join us at FFE 2013 to learn, share and set theagenda on Field Force Excellence for the yearahead.Who Should Attend: Senior Managers inSales and Marketing, Training, HR, SFE, SFAand other Field Force related functions.Why Attend: Do not miss out on this oppor-tunity to learn about the best practices in FieldForce Excellence from industry thought leaders,network with industry peers and pharma deci-sion-makers and take home an action-plan forField Force Excellence in U } z 8Saturday,June8,2013|CourtyardMarriott,MumbaiFFE 20135x10 15 20 25 30 35 40 45 50 55 60yDate: Saturday, 8th June 2013Theme:FieldForceProductivityPlace: Courtyard Marriott, MumbaiObjectivesHosted by Organized by Knowledge Media Venturz.FFE 2013 Registration on Page 28
  21. 21. 21 | MedicinMan June 2013BuildingSalesTeamsFromScratchOne of the key functions of a Front-lineManager is to act as the glue that holdsMRs together as a team for a commonpurpose and objective. The FM must understandthe process and dynamics of transforming a groupof strangers into a single, cohesive unit. FMs mustunderstand the personality traits of MRs and be ableto harness the strength of each personalityUnderstanding the four distinct stages of Forming,Storming, Norming and Performing will enablenew FMs to be effective team-builders. In addition,Rapport-building, Communication skills,Empathetic leadership and Coaching skills areneeded to build sales teams.Among the most important role of line managers isthe willingness and ability to inspect performanceaccording to expected standards, and thecommitment to reinforce what is learned throughfeedback, consistent messages and coaching.Understanding the process of team-formation can avert much distress for the FLM.Each team goes through stages of FORMING, STORMING, and NORMING before theycan start PERFORMING. This knowledge is of vital importance to the team manager.E
  22. 22. 22 | MedicinMan June 2013Building Sales Teams from Scratch | Anup SoansFORMING: A sales team may beformed to launch a new division or toachieve a specific marketing/strategicobjective. The first stage for any teamis to come together. At this stage, theteam can perform only routine tasks.It is possible to function for years atthis level, doing the same things inthe same ways and remaining as agroup of individuals, like the Indiantennis duo Leander Paes and MaheshBhupathi. FMs must foster FORMINGby being empathetic, asking probingquestions, active listening, discoveringthe personalities of his MRs, and doingthings together. FMs must take the leadin FORMING the purpose, goals anddirections for the team.STORMING: At this stage, conflictserupt, as MRs seem to becomeuncooperative, raise objections, andbecome frustrated and hostile. MRsbecome angry at each other as well asat the whole idea of working togetheras a team. While this may make theFM feel like a failure, it is actually amajor step forward. If the team is tosurvive, workable solutions must befound by accommodating differences.Useful skills at this stage are patience,consensus-building, flexibility, andan ability to see past the STORMINGclouds to the goal.NORMING: Eventually, the stormblows over and the team enters a periodof calm. Solutions to problems andconflict seem possible. A unique set ofNORMS for teamwork appears. TheseNORMS may be outside the officialrules, but the team members acceptthem. The danger at this stage is forgood ideas to be withheld becausepeople do not want to stir things up.After all, things have barely settleddown after the storm. Useful skills atthis stage are trust, a willingness totake risks, innovation and the ability torecognise and measure progress.PERFORMING: At this stage,disagreements are resolved amicablyin a win-win manner. MRs becomeconfident and trust their FM andfeel safe to take risks. New ideas andways of solving problems are pursued.Activities that will help the teamremain productive without gettingstuck include taking calculated risks,disagreeing constructively, and seekingout challenges.Teams do not remain permanentlyat the Performing stage. A Storm canerupt at any time. The pressure of theneed to perform or an unexpected lossof a major business account such asa large institutional deal can triggera storm. Losing or gaining a new MRalways returns the team to the Formingstage. Changing FMs can also have thesame effect. Successful teams usuallyrecover from setbacks and get back toPerforming quickly. However, whena team drops into a previous stage, itmust work its way back through allthe intermediate stages again, withoutskipping any of them.To produce PERFORMING teams,FMs must focus on three critical areas:1Clear purpose and measurablegoals: Teams need a unifyingpurpose. Develop a commonpurpose for your team that unites youand your MRs. Make each MR writedown the team’s goal and compare theresults. It may surprise you to discoverthat there are as many versions of thegoal as there are MRs. Instead of forcingyour version on the MRs, make eachMR re-define his statement to reflectthe goals clearly.2Interdependence and Pride inbelonging: All team membersmust recognise and accept theirinterdependence. Teams must have aninterdependent working relationshipin order to exist. Otherwise, all youEventually, the stormblows over and theteam enters a periodof calm. Solutionsto problems andconflict seempossible. A uniqueset of NORMS forteamwork appears.These NORMS maybe outside theofficial rules, butthe team membersaccept them.“
  23. 23. 23 | MedicinMan June 2013Building Sales Teams from Scratch | Anup SoansAnup Soans is the authorof“HardKnocks for theGreenHorn”, SuperVision forthe SuperWiser Front-lineManager”and“Repeat Rx”.He is a facilitator ofLearning and DevelopmentPrograms for Managers andMedical Reps at India’s topPharma article has beenextracted from the book“SuperVision for theSuperWiser Front-lineManager” by Anup Soans.The book is widely used as aLearning and Developmentresource by India’s toppharma companies.There is a special 1+1 FREEoffer currently available onthe book. See page 24 fordetails.will have is a group of individualperformers, like the Indian cricket teama great team of individuals on paper,but poor in collective performance.Interdependency happens whenteam members depend on eachother to produce a combined outputthat is superior to their individualperformance. FMs must build pride inthe team. How does a small countrysuch as Sri Lanka or South Africaproduce such a fine cricket team?Taking pride means being committed towinning and not taking loss as a matterof Karma. When the team wins, everymember must feel joyful about it, as thisis essential to winning the next timetoo. MRs who contribute to the successof other members must be recognisedand rewarded suitably.3Commitment andAccountability: MRs must becommitted to mutual goals.Without commitment, the team’sperformance suffers. Individual MRsmust be given specific assignments forwhich they must be held accountable.A lack of commitment to team effortnegatively affects enthusiasm andreduces effectiveness. Ask MRs todescribe what frustrates them in tryingto be committed to the team, withoutaccusing them of not being committed.Remove barriers that prevent themfrom acting on their commitment. HoldMRs accountable for the tasks entrustedto them. Goals and plans must clearlyreflect organisational objectives toensure the support of senior managersfor your team’s success.Ultimately, the team’s success isdependent on the talents, abilities andattitudes of its members. FMs mustactively seek out MRs who have theright combination of talent, intelligence,abilities and attitude, to give them acompetitive advantage on the field.Talented MRs are intelligent peoplewith abilities and the attitude to achievepre-determined sales objectives.While recruiting, FMs must takestock of a candidate’s talents in termsof performance potential, the abilityto handle a variety of customers andother factors. MRs must be assessed notonly on intellectual skills, but also softskills such as emotional intelligence,creativity, the ability to work in a team,and the willingness to learn and share.ConclusionCompanies generally look for talentonly at higher levels of management.Today, pharmaceutical companiesrequire talented FMs and MRs whohave the ability to look at problemsfrom different perspectives and a highdegree of creative and non-linearthinking to achieve business results.Intense competition and the consequentneed for speed make the top-downmanagement approach ineffective.Decisions need to be made at the fieldlevel. As pharmaceutical field sales getmore and more challenging, FMs alongwith their senior managers have toidentify, incubate and develop teams oftalented MRs who can make better andfaster decisions that address the needsof the doctor/customer effectively.While it may be easier to manageaverage performers through mediocremanagement skills, the imperativefor modern-day FMs is to upgradetheir abilities constantly and be able toattract and retain talented MRs whosebreakthrough performances can bemodels for other MRs. -AS
  24. 24. Buy 1 get 1 free !MRP Rs. 799/- MRP Rs. 599/-For Individuals*Buy SuperVision for the SuperWiser Front-line Manager and Get HardKnocks for theGreenHorn FREE.For Corporates*INR 500/- for a set of SuperVision for the SuperWiser Front-line Manager (1 copy)and HardKnocks for the GreenHorn (1 copy) for purchase of 50 sets and above.*Inclusive of Shipping to One Location.Please pay through bank transfer to SB account no. *07141000006761* of “Anup Soans” HDFC Bank, Mosque Road, FrazerTown Branch, Bangalore – 560005. RTGS/NEFT IFSC: HDFC0000714 and inform by email and SMS - | +91-93422-32949.Or you can send a cheque favoring “Anup Soans” to:Anup Soans101 - North Forte Apts;22, North Road,Cooke Town,St. Thomas Town P.O.Bangalore - 560084Field Force Excellence Tools for Individuals and Corporates
  25. 25. 25 | MedicinMan June 2013In an observational study investigators observesubjects and measure variables of interest withoutassigning treatments to the subjects. The treatmentthat each subject receives is determined beyond the con-trol of the investigator1.Observational research methods are employed withina number of different scientific disciplines used in thepharmaceutical industry, for example, epidemiology,pharmacoepidemiology, statistics, health economicsand outcomes research, and survey research. However,methodologies and terminology differences exist acrossthose disciplines. The terms epidemiology, pharmacoep-idemiology, observational, outcomes, noninterventional,nonexperimental, real-world, and registry are used inter-changeably in association with observational research2.Applications of Observational Research.Observational research is an integral part of clinicaldevelopment, life cycle management, and drug safetysurveillance evaluations. Observational research is not ascientific discipline in itself, but a methodology central toa number of scientific disciplines. On the drug develop-ment and life cycle management continuum, companiesfrequently use observational research studies to:ØØ Define patient populations suitable for clinical trials.ØØ Define the natural history of a disease and patients’responses to treatment.ØØ Standardize outcome measurements.ØØ Provide help in the design of long-term clinical out-Knowledge for the Field Force Series- EMERGING AREAS IN HEALTHCARE -OBSERVATIONAL RESEARCH IN HEALTHCAREUUUUUUUUUUUUJaved Shaikh is a Consultant (HEOR,Pricing, Reimbursement and MarketAccess) at Capita India, Mumbai.cpnjaved@gmail.comShafaq Shaikh is an Associate(HEOR, Pricing, Reimbursementand Market Access) at Capita India,Mumbai.shafaq07@gmail.comE
  26. 26. 26 | MedicinMan June 2013Observational Research in Healthcare | Shafaq Shaikh & Javed Shaikhcome trials, to increase oppor-tunities for patient follow-up.ØØ Improve patient-reportedoutcome measures for clinicaltrials.ØØ Contribute to drug safetyevaluations, including riskmanagement strategies andeffectiveness evaluations of riskminimization activities.ØØ Evaluate the comparativeeffectiveness between approvedproducts under conditions ofusual care.ØØ Identify health care resourc-es and costs associated withtreatment.ØØ Identify drug utilization pat-terns for approved treatments.Observational Research Methods.The three key, and most com-mon, epidemiologic observationalresearch study designs, found invirtually all epidemiology and phar-macoepidemiology reference textbooks are3:1. Cohort study2. Case-control study3. Cross-sectional study1. Cohort StudiesThese are the best method for de-termining the incidence and naturalhistory of a condition. The studiesmay be prospective or retrospectiveand sometimes two cohorts arecompared.Prospective cohort studies: A groupof people is chosen who do not havethe outcome of interest (for exam-ple, myocardial infarction). Theinvestigator then measures a varietyof variables that might be relevantto the development of the condition.Over a period of time the peoplein the sample are observed to seewhether they develop the outcomeof interest (that is, myocardialinfarction).In single cohort studies those peoplewho do not develop the outcome ofinterest are used as internal con-trols. Where two cohorts are used,one group has been exposed to ortreated with the agent of interest andthe other has not, thereby acting asan external control.Retrospective cohort studies: Theseuse data already collected for otherpurposes. The methodology is thesame but the study is performedpost-hoc. The cohort is “followedup” retrospectively. The study periodmay be many years but the time tocomplete the study is only as longas it takes to collate and analyse thedata.Salient Features:ØØ Cohort studies describe inci-dence or natural history.ØØ They analyse predictors (riskfactors) thereby enabling calcu-lation of relative risk.ØØ Cohort studies measure eventsin temporal sequence therebydistinguishing causes fromeffects.ØØ Retrospective cohorts whereavailable are cheaper andquicker.ØØ Confounding variables are themajor problem in analysingcohort studies.ØØ Subject selection and loss tofollow up is a major potentialcause of bias.2. Case-Control StudiesA case-control study identifiespatients on the basis of an outcomeof interest, using either incidentor prevalent cases, and is generallyconsidered to be a retrospectivestudy design. Cases are defined aspatients who have experienced theReferences1. Porta M (editor). A dictionary of epidemiology. 5th.edition. New York: Oxford University Press, 2008.2. Black, N. Education and Debate: Why We NeedObservational Studies to Evaluate the Effectiveness ofHealthcare. BMJ 1996; 312:1215-1218.3. Mann, CJ. Observational Research Methods. ResearchDesign II: Cohort, Cross-sectional and Case control Studies.Emerg Med J, 2003; 20:54-60 doi:10.1136/emj.20.1.54.In an observationalstudy investigatorsobserve subjects andmeasure variables ofinterest without assign-ing treatments to thesubjects. The treatmentthat each subject re-ceives is determinedbeyond the control ofthe investigator.“
  27. 27. ”Observational Research in Healthcare | Shafaq Shaikh & Javed Shaikh27 | MedicinMan June 2013outcome of interest, for example,a disease under study (e.g. atrialfibrillation), or an adverse event ofinterest (e.g. veno-occlusive dis-ease). Controls are selected on thebasis of being free of the outcomeof interest and representative ofthe source population from whichthe cases arise. Exposures are thenassessed by looking backwards intime at patients’ medical records orpatient interviews. The case-controldesign is often used to identify andcharacterize the etiology of rarediseases because of its efficiency interms of its ability to inform withrespect to cost and time.Salient Features:ØØ Case-control studies are simpleto organize.ØØ Retrospectively compare twogroupsØØ Aim to identify predictors of anoutcome.ØØ Permit assessment of the influ-ence of predictors on outcomevia calculation of an odds ratio.ØØ Useful for hypothesis genera-tion.ØØ Can only look at one outcome.ØØ Bias is a major problem.3. Cross-sectional StudiesIn a cross-sectional study, individ-uals are assessed at a single point intime with respect to an exposure ofinterest and outcome under study.The distinguishing feature of across-sectional study is the inabil-ity to establish a time sequenceof events between exposure andoutcome; therefore, cross-sectionalstudies cannot be used for causal as-sessments. However, they are usefulin the effectiveness evaluations ofrisk management strategies and as-sociated risk minimization activities.The cross-sectional study design isalso useful for survey research, andin knowledge, attitudes and practic-es (KAP) studies of patients and orhealth care providers.Salient Features:ØØ Cross sectional studies are thebest way to determine preva-lence.ØØ Are relatively quick.ØØ Can study multiple outcomes.ØØ Do not themselves differentiatebetween cause and effect or thesequence of events.SummaryThe use and scope of observationalresearch studies within the pharma-ceutical industry has increased overpast decades to include clinical, pa-tient-reported, economic, and otherhealth outcomes endpoints, therebygiving value to multiple stakehold-ers for as many different purposes.Unlike randomized clinical trials,observational studies allow for theevaluation of the use and effectsof healthcare products (includingdrugs, biologics, devices, vaccines)under conditions of usual care in areal world setting.Globally, the use of real-worlddata in demonstrating the value ofmedical technologies is increasing-ly relevant to reimbursement andmarket access decision making.Whether prospective, retrospectiveor cross-sectional, observationalresearch has a critical and growingrole to play in driving a better un-derstanding of the health outcomesof medical technologies, and sup-porting appropriate product use ineveryday clinical practice. -SS & JSGlobally, the use of real-worlddata in demonstrating thevalue of medical technologiesis increasingly relevant toreimbursement and marketaccess decision making. Wheth-er prospective, retrospective orcross-sectional, observationalresearch has a critical andgrowing role to play in drivinga better understanding of thehealth outcomes of medicaltechnologies, and supportingappropriate product use ineveryday clinical practice.“
  28. 28. 28 | MedicinMan June 2013FFE 2013 RegistrationRegistrationHosted by Organized by Knowledge Media Venturz.Delegate Fee for FFE 2013Pharma Delegates - INR 8,500 + 12.36% service taxService Providers - INR 9,500 + 12.36% service taxRegister Online at or submit the details below by ChequePayment must be made in INR by Cheque / Bank Draft and must be received priorto the conference. Cheques to be issued in the name of “Knowledge Ventures”,payable at Mumbai.Send Cheques to:Arvind Nair,The Event Secretariat,B-205, Ahimsa Enclave,Off New Link road, Chincholi,Malad West,Mumbai - 400064.Pay by Account TransferNEFT DETAILSBank: ICICI BANKBranch: Malad Link Road Branch, 6/7 Linkway Estate,Malad (West), Mumbai - 400064.Account Name: Knowledge VenturesAccount Type: CurrentAccount No: 122105500002IFSC Code: ICIC0001221Personal Details (To be sent along with details of payment)Name:Company:Designation:Address: Email: Mobile:Details of Cheque/ NEFT Transfer:
  29. 29. 29 | MedicinMan June 2013Patient ReportedOutcome Measures inPharmacoeconomicsApatient-reported outcome (PRO) is a directsubjective assessment by patients about aspectsof their health, including symptoms, function,emotional well-being, quality of life, utility, and satisfac-tion with treatment. PROs evaluate the impact and func-tional implications of the disease or treatment to reflecttheir interpretation of the experience, which is influencedby their internal standards, intrinsic values, and expecta-tions of the patient.The World Health Organization (WHO) defines health asa state of complete physical, mental, and social well-being.The WHO’s International Classification of Functioning,Disability, and Health (ICF) was developed to provide astandard language and framework to describe and mea-sure health and health-related states. Within the ICF sys-tem, health outcomes are classified according to the effectupon body function, body structure, limitations in activi-ties, and limitations in participation. Health outcomes thatmeasure body function include measures of physiologicalfunctions of body systems (e.g., ejection fraction, glucoselevel, depression, pain, etc).Health-related quality of life (HRQoL) instruments mea-sure the broad concept of health (physical, mental, andsocial well-being) by inquiring into the extent of difficultywith activities of daily living (including work, recreation,and household management) and how difficulties affectrelationships with family, friends, and social groups,capturing not only the ability to function within theseroles, but also the degree of satisfaction derived fromdoing them. HRQoL instruments often contain items thatmeasure body function (e.g., pain, depression, anxiety)and limitations with activities and participation.Economic analyses include methods to evaluate differenteffects (death, effects of stroke on HRQoL, effect of reduc-tion in acne on HRQoL) in the same metric. One way tocreate the same units is through the concept of preferenc-es. Utilities and values are different types of preferences.Whether dealing with utilities or values depends on howquestions on measurement instruments are framed; areparticipants being asked to consider outcomes that arecertain (values) or uncertain (utilities).The Standard Gamble is the classical method of measuringutility, based directly on the axioms first presented by vonNeumann and Morgenstern (utility theory) that describeshow a rational individual “ought” to make decisions whenfaced with uncertainty. The Time Trade-Off2 is a measureof values. It asks participants to imagine living their livesin their current health states and to contrast this withthe alternative of perfect health in exchange for a shorterlifespan (preference-based measured). The administratorprovides alternatives of years of life in the present healthstate versus years of life in perfect health.Patient-reported outcome measures provide informationgathered directly from the patients about their experienceswith the disease and its treatment. Because of the uniqueperspective offered by patient-reported instruments, directmeasurement of health from the patient’s perspective ispopular and has replaced more objective measures asthe primary outcome of interest for a broad spectrum ofclinical conditions. To make wise management decisions,patients and clinicians need to know the magnitude of theeffect of treatments on a variety of outcomes, includingpatient-reported outcomes. Investigators must choose aninformative method to present their findings to enhancethe interpretability and applicability of their results in aclinical setting. -MR & NLReferences:1. Von Neumann J, Morgenstern O. Theory of Games andEconomic Behaviour. Princeton, NJ: Princeton UniversityPress. 1944.2. Torrance GW, Thomas WH, Sackett DL. 1972. A utilitymaximization model for evaluation of health care programs.Health Serv Res 7(2):118–33.Mahendra Rai & Nishkarsh Likharmahendra.rai@gmail.comE
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