Doctor’s Day with a Difference! - MedicinMan July 2018

MEDICINMANJuly 2018| www.medicinman.net Indian Pharma’s First Digital Magazine Since 2011
TM
DOCTOR’S DAY WITH
A DIFFERENCE!
L
ast-mile-connectivity is a humon-
gous challenge for pharmaceuti-
cal companies and in healthcare
delivery in general. Pharmaceutical
companies depend on their field force
to deliver the intended message to
doctors, without distortion, at regular
intervals. Right message, to the right
doctors, at the right frequency, is what
ensures brand registration and recall.
If the strategies designed by marketing
managers must bear desired fruit, it de-
pends on how well the field force is able
to execute the strategy every day. Giv-
en the challenges of hyper-competition
and the sheer number of pharma com-
panies with their multiple divisions,
just meeting the doctor has become
an onerous task, often unrewarding.
Medical Reps must face the ire of their
sales managers as well as that of physi-
cians and patients as they scramble for
face time with doctors. Medical Reps
are rarely appreciated or recognized at
public functions.
Against such a background, it must
have been a heartening experience
for Medical Reps of Mangalore to be
felicitated at a public function for their
talents, hobbies and contribution to
society by an eminent cardiologist, Dr.
Padmanabh Kamath, an alumnus of
CMC Vellore and Prof. and Head of Car-
diology at Kasturba Medical College
and Hospital Mangalore. MedicinMan
featured Dr. Padmanabh Kamath’s in-
spiring gesture in our March 2018 issue
and felicitated him at our conference
“Pharmaceutical Marketing in the New
Age” in the presence of pharma CEOs
and C-suite executives from leading In-
dian pharmaceutical companies.
Editorial
1 | MedicinMan July 2018
Anganwadi workers at a function to celebrate Doctor’s Day in Mangaluru. Picture Credits:
mangalorean.com

 Editorial | A Doctor’s Day with a Difference!
On Doctor’s Day – July 1, Dr. Padmanabh Kamath
did an encore by bringing together over 200 An-
ganwadi workers, the last-mile-connectors of pri-
mary health care, especially in rural areas. The DHO
of Mangalore, Dr. Ramakrishna Rao was also felici-
tated for his tireless work in making the PHCs de-
liver their intended benefit to the poorest of poor.
The Anganwadi workers, most of them women,
were dressed in their finest, to savor a rare moment
of public recognition at the IMA Hall in Mangalore.
Pharma leaders present on the occasion – Deepak
Naik, Managing Director of a Centaur Pharmaceuti-
cals’ Health ‘N’ U , Amit Bakhri Vice President of As-
tra Zeneca, Vijay Charlu, President of Corona Rem-
edies, Shirish Samak, VP of Micro Labs and Vikas
Khare, VP of JB Chemicals expressed their sincere
appreciation of the contribution of Anganwadi
workers. As part of their company’s CSR activities,
they presented over 200 top quality water purifiers
and nebulizers to the Anganwadi workers.
Dr. Padmanabh Kamath had once again identi-
fied the importance of last-mile-connectors and
instead of himself being felicitated on Doctor’s
Day, he began a new initiative of recognizing and
rewarding the last-mile-connectors of healthcare
delivery. In my conversation with Dr. Padmanabh
Kamath, he recounted the difficult conditions in
which the Anganwadi sewaks worked, often bare-
foot. He appreciated their grassroots knowledge
of every family under their care, their health status
from immunization to maternal nutrition, contra-
ception and general wellbeing. Rural healthcare is
unthinkable without the Anganwadi workers, PHCs
and the government doctors, who rarely are appre-
ciated for their humongous contribution.
“
On Doctor’s Day – July 1, Dr.
Padmanabh Kamath did an encore
by bringing together over 200
Anganwadi workers, the last-mile-
connectors of primary health care,
especially in rural areas. The DHO
of Mangalore, Dr. Ramakrishna Rao
was also felicitated for his tireless
work in making the PHCs deliver
their intended benefit to the poorest
of poor.
Anup Soans - Editor, MedicinMan introduces the pharma BU
heads at the gathering. Picture Credits: mangalorean.com
District Health Officer Dr. Ramakrishna is felicitated for his service.
Picture Credits: mangalorean.com
Dr. Padmanabh Kamath, Prof. and Head of Cardiology at
Kasturba Medical College and Hospital Mangalore addresses the
gathering. Picture Credits: mangalorean.com

 Editorial | A Doctor’s Day with a Difference!
Dr. Padmanabh Kamath is a skilled interventional
cardiologist. His experience and insights gained
from treating thousands of patients is formidable.
Yet what is remarkable about Dr. Padmanabh Ka-
math is his simplicity and approachability. He is
well-aware of the importance of the role of security
guards in the hospital as much as he is about his
nursing staff, paramedics, residents and colleagues
and takes conscious steps to ensure their moti-
vation and wellbeing. Truly, great leaders are not
those with an aura but those like Dr. Padmanabh
Kamath, who are willing to roll-up their sleeves and
get into the trenches and make a difference where
it matters. He is a fine example of what our Chief
Mentor, Hariram Krishnan often says, “be an island
of excellence in an ocean of mediocrity.”
As Salil Kallianpur rightly points out in his recent
blog, “New tech such as AI can often be spoken of
to solve problems, but one forgets that technology
is only an enabler and is not a substitute. It is only
as good as its supportive infrastructure. Amazingly,
the government believes that AI, and not fixing the
inherent problems that are rotting the healthcare
sector from the inside, can play a major role here.
In the backdrop of India’s stretched and limited ba-
sic healthcare infrastructure, at one level the strat-
egy for AI is indeed a bit like putting the cart be-
fore the horse.” [https://salilkallianpur.wordpress.
com/2018/06/28/india-looks-to-artificial-intelli-
gence-to-solve-health-infra-problems/]
Well, it’s heartening to see that many medical prac-
titioners like Dr. Padmanabh Kamath have put their
priorities right by equipping and educating grass
root workers. We at MedicinMan are glad that we
have been privileged to interact and learn from
doctors like Dr. Padmanabh Kamath. We will keep
the efforts and engagement going and look for-
ward to support from pharma industry leaders to
widen the scope of meaningful engagement. M
“
Truly, great leaders are not those
with an aura but those like Dr.
Padmanabh Kamath, who are
willing to roll-up their sleeves and
get into the trenches and make a
difference where it matters. He is
a fine example of what our Chief
Mentor, Hariram Krishnan often
says, “Be an island of excellence in
an ocean of mediocrity.”

CONTENTS
Our mission is to collectively improve the pharma
sales and marketing ecosystem - leading to better
relationships with doctors and better outcomes for
patients.
MedicinMan Volume 8 Issue 7 | July 2018
Editor and Publisher
Anup Soans
Chief Mentor
K. Hariram
Executive Editor
Salil Kallianpur
Editorial Board
Prof. Vivek Hattangadi; Deep Bhandari; Hanno
Wolfram; Renie McClay
Letters to the Editor: anupsoans@medicinman.net
1. Doctor’s Day with a Difference! ...................1
MedicinMan reports on a unique celebration of the
special day in Mangaluru, Karnataka, organized
by a prominent city surgeon and professor and
honoring the work of anganwadi workers, medical
representatives and the District Health Officer.
Editorial
2. Briefing the Design Agency: A Skill Oft-
NeglectedbyPharmaBrandManagers..............7
The design brief can make or break a brand
campaign; here's how to get it right.
Vivek Hattangadi
3. Indian Pharma Highlights for June 2018 .....11
The Indian pharma market clocked 10,460 Crores
for month of June with a robust growth at 12.8%.
Here are the biggest winners.
IQVIA
4. Pharma's Silver Lining Continues to Broaden
...........................................................................15
Salil Kallianpur, Executive Editor, MedicinMan,
comments on the IQVIA numbers for June 2018
Salil Kallianpur
5. Pharmacology Refresher: Drugs Acting on
the Nitric Oxide Pathway ..............................17
The nitric oxide pathway in the human body is key to
the treatment of a variety of diseases from angina to
erectile dysfunction
Dr. Anand Lakhar
6. Philips Launches India’s 1st Future Health
Index..............................................................20
The FHI is "a research-based platform that helps
to determine the readiness of countries to address
global health challenges"
Press Release
7. Book Review: Encyclopedia of Nobel
Laureates .........................................................22
Connect with Anup on LinkedIn | Facebook | Twitter
Anup Soans is an L&D Facilitator,
Author, Pharma Consultant.
muckrack.com/anupsoans/articles
Meet the Editor

Sessions at DigiStorm 2018
INTENT & STRATEGY
Session 1: Competing Successfully in the Digital
Economy Keynote Address followed by panel discussion
Keynote Speaker: Amit Mookim – Managing Director,
South Asia – IQVIA (formerly IMS Health)
Outcomes from the session:
1. How is the digital economy replacing the old?
2. How much has pharma or healthcare matured in the
digital economy?
3. What are the common mistakes that business lead-
ers make when planning to compete in the digital
economy?
CONTENT
Session 2: Competing Successfully in the Digital
Economy Customer Engagement – the Role of Content
Marketers must use customer data cleverly to create en-
gagement opportunities
1. “What is the ROI” – how do you define ROI here,
what parameters can be measured to define success
2. What are the key challenges for pharma marketers
to‘go-digital’and how to overcome them
3. “Content is king”– how do we know what is the best
content to create? Is content best created or curat-
ed?
4. “If content is king, distribution is queen” – under-
standing channel preferences of customers and tai-
lor-making content
5. Must a digital strategy be multi-channel? If so, what
is the role of integration?
Presented by MedicinMan. In partnership with KDPMA.
Pharma in the Digital Economy.
DigiStorm 2018
Bangalore Edition
11th
September, Lalith Ashok
Registrations Open.
Mobile communications, the cloud, advanced
analytics, and the Internet of Things are
among the innovations that are starting to trans-
form the healthcare industry in the ways they have
already transformed the media, retail, and banking
industries.
Pharma executives are well aware of the disruptive
potential and are experimenting with a wide range
of digital initiatives. Yet many find it hard to deter-
mine what initiatives to scale up and how, as they
are still unclear what success looks like in the digital
economy.
Competing in the digital economy needs a funda-
mental change in mindset. Here:
ØØ Business model – not selling products but en-
gaging customers
ØØ Currency – not money, but data
ØØ Competitive advantage – not quality of product
but quality of experience that you can offer to
customers.
To be prepared for the digital economy, you need
INTENT, CONTENT, STRATEGY and SKILLS. These are
the 4-pillars of any digital strategy. DigiStorm 2018
is a great opportunity where you can understand the
Intent, Content, Strategy and Skills required to com-
pete profitably in the digital economy.

SKILLS
Session 3:What does a pharma professional look like
in the‘new world’ : New skill sets in a hyper-connected
world.
Presentation followed by panel discussion
Outcomes from the session:
1. What does the“new”pharma professional look like?
2. The role of technology in L&D for sales/marketing
teams
3. The role of technology for self-development
Session 4: Presentation and Open House Discussion
with Digital Service Providers to Pharma
Reasons to Attend
1. Understand the need for an integrated multichan-
nel strategy to be adopted in the business model
2. Discover how you can make your multichannel mar-
keting smarter using customer data you already
have
3. See how to define ROI by replacing “measurement
plans”with“engagement plans”.
4. Explore the unique considerations for building inte-
grated plans and content in multichannel marketing
5. Learn about the new skills required for a marketing
professional in the new hyperconnected world.
Who Should Attend
This one-day seminar is designed for professionals
from pharmaceutical & biotechnology organizations
with the following responsibilities:
Leadership
ØØ Business Unit Directors
ØØ Commercial Excellence Directors
ØØ Chief Marketing Officers
ØØ Chief People Officers, Chief Human Resource Offi-
cers
Marketing
ØØ Vice-President and Heads of marketing
ØØ Brand Management
ØØ Product Management
Digital Marketing
ØØ eMarketing/Digital Marketing
ØØ Multichannel/Channel Marketing
ØØ Multichannel Analytics
ØØ Integrated Marketing
ØØ Social Media
ØØ Digital Media
Marketing Innovation
ØØ Interactive Services
ØØ Customer Experience
ØØ Customer Engagement
ØØ Global Marketing
ØØ Mobile Marketing
DigiStorm 2018
Bangalore Edition
Workshop Leader: Salil Kallianpur -
Partner and Co-Founder at The Digital
Transformation Lab and Executive Edi-
tor at MedicinMan
Keynote Speaker: Amit Mookim –
Managing Director, South Asia, IQVIA
Fees for Pharma Delegates [exclusive of GST @ 18%]
Delegate type
Early Bird Registration
(on or before 15th
August)
Registration after
15th August
Individual registrations ₹ 9,950/- ₹ 14,500/-
Group registrations (5 or more
from the same organisation)
₹ 8,500/- ₹ 14,500/-
KDPMA member rates ₹ 7,500/- ₹ 9,950/-
To register, send payment and delegate details to: Anup Soans
anupsoans@gmail.com | +91-968680-2244
Payment by account transfer
Account Holder: MedicinMan Private Limited
Account Number: 50200021794640
Bank Name: HDFC Bank
Address: 102, Chawla Regency, Mosque
Road,
Bangalore - 560005
IFSC Code: HDFC0000714
GSTIN: 29AAKCM5650R2ZI
Fees for Service Providers [exclusive of GST @ 18%]
Speaking opportunity for 15
minutes + Panel membership + 2
delegate passes
Speaking opportunity for 5
minutes + Panel membership +
2 delegate passes
2 delegate passes
₹ 2,00,000/- ₹ 1,00,000/- ₹ 50,000/-

About Our Partner
Karnataka Drugs and Pharmaceuticals Manufacturers'
Association (KDPMA) was founded in 1965 (as an infor-
mal association) and registered in 1998. Today KDPMA
is the flagship association of pharmaceutical manufac-
turers. KDPMA has around 65 members companies com-
prising of small, medium and large scale units including
multinationals and Govt enterprises operating in Karna-
taka.
Objectives:
1. To promote fellowship, unity and cooperation
among the Drugs and Pharmaceutical Manufactur-
ers of the state in general and among the members
of the Association in particular.
2. To promote the adoption of Good Manufacturing
Practices, sound quality control measures and eth-
ical trade practices by the Drugs & Pharmaceutical
Manufacturers.
3. To safeguard and promote the interests of the Drugs
& Pharmaceutical Industry in the state and to take
and pursue such steps as may be necessary or feasi-
ble in pursuance of this objective.
DigiStorm 2018
Bangalore Edition
Sunil Attavar - President, KDPMA and
Chairman and Managing Director,
Group Pharmaceuticals Limited

S
ome time back, I was at a leading design agency
in Ahmedabad. Work was in progress for their
pharma client’s printed promotional material. I
saw a young pharma brand executive with six month's
experience, sitting next to the designer, instructing
him on how to design a visual aid page, what fonts to
use and which colors to use. After four hours, when I
was about to leave, the brand executive was still with
him. Out of curiosity, I enquired about this particular
designer. He had graduated in commercial art from
one of the finest colleges of Mumbai, J.J. School of Art,
Mumbai, more than two decades back. And here he
was, learning from a baby in brand management, on
how to design promotional material.
This is a familiar story in the Indian pharmaceutical in-
dustry. The brand manager spends days together on
a job which is someone else’s. And the other person
is more competent, better experienced and profes-
sionally qualified. Many of them are graduates from
MS University, J.J. School of Art or National Institute of
Design.
It is not the brand manager’s job to sit alongside a de-
signer. His job is very rich - critical thinking, innovating,
and overseeing how to make the field excel in strate-
gy execution. He needs to invest his time strategizing
how to evolve his brand into a mega-brand rather than
micromanaging the designer.

Briefing the Design Agency
A skill oft-neglected by pharma brand managers
Vivek Hattangadi
The design brief can make or break a brand
campaign; here's how to get it right.

 Vivek Hattangadi | Briefing the Design Agency: A Skill Oft-neglected by Pharma Brand Managers
Briefing the designers or the design agency is an
art of communication. If you want the designer to
produce his best work, always provide a detailed
written brief that can be discussed before anything
is committed. As a brand manager, since your re-
sponsibility involves marketing communication,
then briefing an agency, whether a top one like
Medulla Communications or a small time freelanc-
er, is one of the most important things you do.
Why is a written brief so important?
A written brief provides vital information about
your brand. While writing the brief, it not only en-
courages you to think about what you are trying to
achieve, it helps you communicate aims and objec-
tives of your brand more effectively.
A brief is also your chance to outline your expec-
tations.
Designers will give their best when you avoid mi-
cromanagement. How you brief, determines what
you get back. Output is directly proportionate to
the input – i.e. the briefing. Recall the old computer
term "GIGO" – Garbage In, Garbage Out? The same
applies here. The head of a leading agency once
remarked: “My clients get the work they deserve”.
Good briefing will produce superior results faster
and at lower cost.
The problem today is that too many pharma brand
managers underestimate the importance of a de-
tailed written design brief. Knowing how to write
a design brief that’s thorough and then articulate,
are skills which every brand manager should devel-
op. A well articulated brief gives the designer the
right directions. It saves time and boosts the out-
put.
By learning and understanding what an excellent
design brief should entail, the brand manager can
bridge the gap of understanding between her
and the designer. Before you can understand how
to write a design brief successfully, you’ll need to
understand what it is, and what it can do for your
brand.
“
Briefing the designers or the design
agency is an art of communication.
If you want the designer to produce
his best work, always provide
a detailed written brief that can
be discussed before anything is
committed.

In simple terms, a design brief is a document that
helps the designer to know in-depth, the scale,
scope, and core details of the task he is being as-
signed. It explains the brand inside out. It is a
blueprint that not only helps the creative team,
but helps you to shape up the overall strategy and
goals for the brand.
First things first! If you want your design to be
creatively effective, then you need to be sure that
your designer understands your business and your
brand thoroughly.
The designer expects a high-quality, highly-de-
tailed brief from the brand manager. Your brief
must inform design decisions which can guide the
flow of work, from conception to completion.
A good creative brief will tell and answer some of
these basic questions.
ØØ Why is your brand so special?
ØØ What do you want to be done to add value to
your special brand?
ØØ In which segment is the brand?
ØØ Who is your target audience?
ØØ What is the patient profile?
ØØ What is the personality you want to give to
your brand?
Tell him about the USPs for your brand and your
Value Proposition; share the positioning statement
of your brand. Give a small note on the disease con-
ditions including its symptoms and expected out-
come after your brand gets prescribed. Prepare this
note in simple layman’s language. Imagine you are
giving this brief to an 11-year old child studying in
a vernacular language school.
These are only some of the many questions you
can think about.
Take the time to provide all of the pertinent
details of your brand and strategic thinking.
“
In simple terms, a design brief is a
document that helps the designer to
know in-depth, the scale, scope, and
core details of the task he is being
assigned. It explains the brand inside
out. It is a blueprint that not only
helps the creative team, but helps
you to shape up the overall strategy
and goals for the brand.

Only then you’ll enable the creative team to deliver
great work. While it’s a good idea to go into detail,
keepinmindthatyoudon’twanttogointosomuch
detail that your brief becomes overwhelming.
Make it informative, yet digestible. Before the work
starts, ensure that both you and the designer have
discussed and reached an understanding on every-
thing outlined in the brief.
And one last thought - do all great brand cam-
paigns come from great briefs? No! But the chances
of getting good if not great work are increased sig-
nificantly by a brief into which some real thought
has been invested.
Good briefing is not an option; it is an imperative. I
am often overawed by the excellent thoughts that
go into the designing every issue of our very own
MedicinMan and I congratulate the agency and
Anup Soans. M
“
And one last thought - do all great
brand campaigns come from great
briefs? No! But the chances of
getting good if not great work are
increased significantly by a brief
into which some real thought has
been invested.
Vivek Hattangadi is a
Consultant in Pharma
Brand Management and
Sales Training at The En-
ablers. He is also visiting
faculty at CIPM Calcutta
(Vidyasagar University)
for their MBA course in
Pharmaceutical Management.
vivekhattangadi@theenablers.org

13 | MedicinMan March 2018
T
he Indian Pharmaceutical Market (IPM) clocked
Rs. 125,186 crores and grew at 7.8% as of MAT
June 2018. It clocked 10,460 Crores for month
of June with a robust growth at 12.8%. Retail grew at a
much stronger rate at 15.8%.
Strong growth seen in the month of June 2018 are ow-
ing to the effect of GST implementation in 2017 where
June 2017 was the first month impacted in the GST era.
Growth for June 2017 was a mere 1% owing to it being
the transition month just before GST was implemented
in July 2017.

INDIAN PHARMA
HIGHLIGHTS FOR
JUNE 2018
Market highlights for the month of June 2018
brought to you by IQVIA

Strong growths were seen both among Top 10 and
Rank 11-20 companies with both set of companies
growing at 14% for the month of June 2018. In fact,
8 of the Top 10 players grew in double digits with
Alkem with 18% growth topping the charts. Intas
with growth of 21% and Glenmark with 22% were
the only 2 players among Top 20 to show a growth
of more than 20%.
In terms of the Top 10 brands the performance was
mixed with Brands like Mixtard (24%), Novomix
(29%), Thyronorm (31%) and Shelcal (42%) grow-
ing robustly in comparison as against below par
growths for Top Oral Anti-Diabetes brands like Gly-
comet-GP (4%), Janumet (6%) and Galvus Met (8%).
Indian companies showed a strong combined
growth of 13% as compared to MNCs growing
slightly slower at 11%. Chronic Therapy with a
growth of 15% continued its strong performance
and grew 1.4 times faster than Acute therapies
which showed a 11% growth.
Cardiac continued to be No. 1 for the month of June
2018 and grew slightly better than the IPM with a
 IQVIA | Pharma Highlights

growth of 14%. Telmisartan and Combinations
with a growth of 21% contributed strongly to the
growth of the therapy. Other molecules like Rosu-
vastatin (12%), Atorvastatin (8%), Metoprolol (13%)
also showed a decent growth. While the top brand
Rosuvas (5%) grew below par, other top 10 brands
like Telma (22%), Telma H (28%), Cilacar (37%) re-
flected a strong growth.
Gastro Intestinal therapy grew slower than the
IPM owing to poor growth of few top molecules/
segments like Ranitidine Oral Solids (4%), Diges-
tive Inc. Enzymes Liquids (4%) and Omeprazole +
Domperidone (5%). Strong growth from the larg-
est molecules Pantoprazole + Domperidone (19%)
and Rabeprazole + Domperidone (13%) however
ensured a double-digit growth of 10% for the ther-
apy. Among top brands while No. 1 and 2 brands
Pan and Pan-D respectively grew strongly at 24%
and 26%, Spasmo-Proxyvon+ showed a heavy
degrowth of (-38%). Even Aciloc (6%) and Zinetac
(1%) grew much below par.
Anti-Infective therapy’s growth of 4% was much
slower as compared to other top therapies. This
was mainly owing to top molecules like Cefixime
Oral Solids (0%), Ceftriaxone + Sulbactam (-1%) etc.
However, other top molecule Amoxicillin and
Clavulanic Acid Solids grew at 13% and Azithro-
mycin Oral Solids being the fastest growing mole-
cule among top 10 with a growth of 15%. Among
top brands Clavam (35%) and Mikacin (34%) were
among the fastest growing while Moxikind-CV
(-4%) and Magnex (-5%) were the only two de-
growing brands in the top 10.
Anti-Diabetics therapy saw launch of two new mol-
ecule combinations this month with Boehringer
Ingelheim launching Jardiance Met (Empagliflozin
+ Metformin) and Glyxambi (Empagliflozin + Lina-
gliptin).

WhiletheTherapyshowedanoverallrobustgrowth
of 17%, it was majorly driven by Insulin and Insulin
Devices growing combined at 26%. Oral Antidia-
betics on the other hand showed average growth
of 14% which was majorly due to its top two mole-
cules Glimepiride + Metformin (9%) and Sitagliptin
+ Metformin (11%) growing at a slower pace. Also,
de-growth for Sitagliptin (-15%) and Voglibose
(-2%) had an effect. Amongst Top brands, the No.
1 brand Novomix showed roust growth of 24% but
2nd ranked brand Glycomet-GP (4%) grew sub-
stantially slower.
Among other top 10 therapies, Vitamins / Minerals
/ Nutrients (14%), Derma (23%) and Respiratory
(15%) boosted growth for the IPM, others like Pain
/ Analgesics (9%), Neuro / CNS (11%) and Gynaec.
(11%) grew at a slower pace. - IQVIA

A
fter almost a year of desolation and worry, the
last two months seem to have finally brought
in heartening news for the Indian Pharmaceu-
tical Industry.
Last month, Aurobindo’s Unit-4 at Hyderabad and Sun
Pharma’s largest facility at Halol went on to clear the
US-FDA observations. This allowed them to resume
supplies to US, the world’s largest pharma market.
Then, market data showed that domestic demand had
significantly increased. The market recorded 10.8%
growth in May 2018 after a long break of 17 months.
Double digit growth was last recorded in Nov 2016 af-
ter which the double whammy of demonetization and
GST had hit in full force.
The data for June 2018 released by IQVIA – an agen-
cy that tracks market performance of key companies
– showed that the industry growth had improved to
12.8% for the month. While the annual growth on
a MAT basis is still short of double digits at 7.8%, the
spurt in growth for the last few months is very heart-
ening.
Of course, this spurt comes off a low base as June 2017
had seen the full impact of GST as distributors dras-
tically cut down inventories to adjust to a single-tax
regime. Yet, in April, senior industry executives had
alluded to significant pick-up in demand in the do-
mestic market. It is good news that the return to dou-
ble-digit growth in May has not only continued but
has strengthened in June.

PHARMA’S SILVER
LINING CONTINUES
TO BROADEN
Salil Kallianpur, Executive Editor, MedicinMan
comments on the IQVIA numbers on the Indian
Pharma Market for June 2018
Salil Kallianpur

 Salil Kallianpur | Pharma's Silver Lining Continues to Broaden
Among companies powering the double-dig-
it growth, 8 out of the top 10 have registered
growth above 10%. This signals a much-need-
ed focus on domestic business to capture
value as the market stabilizes and grows.
Alkem recorded the fastest growth at 18% while
Abbott at 16%, Cipla at 15% and Lupin at 14%,
followed closely. Macleods, Zydus, GSK and Sun
grew in double digits while Mankind and Torrent
grew slower than the market. This lift in market de-
mand is a definite plus as these companies are well
placed to extract value through an optimal mix of
the right product portfolio and profits.
Product portfolio is important here as it is the
chronic segment that is driving growth as distrib-
utors revert to increasing inventories after the
GST-related dust has settled. Chronic segments
grew 1.4 times faster than the acute segments. This
means that more of those stocks are in the market
and more patients are buying medicines for the
month rather than just for a few days or weeks.
A possible dampener to the growth can be the re-
cent Niti Aayog recommendation to the Dept of
Pharmaceuticals to include non-scheduled drugs
under price control by amending the DPCO 2013.
Currently the prices of only 850 brands are con-
trolled and the amendment can mean that almost
the entire market comes under price regulation.
This is significant because another key factor to the
high market growth is the launch of 6130 brands
over the last 24 months. Placing all of them under
price control will not just stifle margins but also sig-
nificantly bring down new product launch oppor-
tunities for companies.
Therefore, while the silver lining definitely contin-
ues to broaden, dark clouds hovering over India’s
pharma industry haven’t yet blown over. M
Salil Kallianpur is Partner
and Co-Founder at The Digi-
tal Transformation Lab. He is a
pharma veteran having worked
with industry leaders like No-
vartis, Pfizer and GSK.

T
he nitric oxide (NO) pathway is one of the most
widely targeted pathways for treatment of
cardiovascular disease. The Nobel Prize was
awarded in 1998 to Drs. Furchgott, Murad and Ignarro
for their role in the discovery of NO. In this article I will
briefly revise the NO pathway and the different drugs
targeting this pathway
Figure 1 gives a nice overview of the NO pathway. This
figure is from the Katzung textbook of basic and clini-
cal pharmacology.
In the endothelial cells, L-Arginine is converted to
L-Citrulline and in this process NO is released as a
by-product. NO then diffuses to the vascular smooth
muscle cell and stimulates soluble Guanylyl Cyclase
(sGC) which then results in formation of cGMP and ac-
tivation of Protein Kinase G {PKG}. PKG is downstream
of cGMP. It is not shown in the figure 1. Activation of
cGMP and PKG causes dephophosphorylation of the
Myosin Light chain which results in relaxation of the
vascular smooth muscle.

Dr. Anand Lakhkar
Pharmacology Refresher
Figure 1
DRUGS ACTING ON THE
NITRIC OXIDE PATHWAY

 Dr. Anand Lakhar | Pharmacology Refresher: Drugs Acting on the Nitric Oxide Pathway
Let us do a quick review of how the contraction
mechanism of a vascular smooth muscle cell oper-
ates. Vasoconstrictors cause an influx of calcium in
the vascular smooth muscle cell. This calcium acti-
vates Myosin Light Chain Kinase (MLCK) which phos-
phorylates the myosin light chains so that the myo-
sin cross-bridges bind the actin filaments and there
is contraction of the vascular smooth muscle. The
enzyme Phosphodiesterase-5 (PDE-5) causes degra-
dation of cGMP and terminates its action
Pharmacological Targeting of the NO
Pathway
Drugs targeting the NO pathway are:
1. Organic Nitrates – The organic nitrates are the
most commonly used NO donor drugs.
Mechanism: The prototype is nitroglycerin. Nitro-
glycerin is denitrated by glutathione S -transferase
in the smooth muscle and other cells. As a result, free
nitrite ion is released which is then converted to ni-
tric oxide. They relax large arteries as well as large
veins. These drugs increase the collateral blood flow,
decrease ventricular volume and arterial blood pres-
sure. All of these are beneficial in patients of Angina.
Indications: The main use of these drugs is for treat-
ment of Angina.
Side-effects: Reflex Tachycardia due to the vasodila-
tory effect can increase myocardial oxygen require-
mentinpatientsofAngina.Othersideeffectsinclude
orthostatic hypotension, throbbing headache. Use
of nitrates can result in development of tachyphylax-
sis (rapidly diminishing response to successive doses
of a drug which renders it less effective).
Drugs: Nitroglycerin, isosorbide mononitrate, isosor-
bide dinitrate
PDE-5 inhibitors – These drugs inhibit
the enzyme PDE-5
Mechanism: By inhibiting PDE-5, they prevent the
degradation of cGMP thereby leading to a pro-
longed vasodilatory effect.
Indications: 1) Pulmonary Arterial Hypertension
2) Erectile Dysfunction
Side-effects: Headache, heart-burn, sudden hearing
loss
Drug Interactions: PDE-5 inhibitors should not be
given with nitrates since it can lead to a dangerous
decrease in blood pressure
Drugs: Sildenafil (Viagra), tadalafil, vardenafil

 Dr. Anand Lakhar | Pharmacology Refresher: Drugs Acting on the Nitric Oxide Pathway
Activators of sGC:
Mechanism: By activating sGC, these drugs stimu-
late the formation of cGMP and thus lead to a va-
sodilatory effect.
Indications: 1) Chronic Thromboembolic Hyperten-
sion 2) Pulmonary Arterial Hypertension
Side Effects: Hypotension, Headache, GI Disorders
Drugs: Riociguat
Potential New Agents:
1. Dehydroepiandrosterone (DHEA) – There are
some reports indicating that DHEA can also affect
the NO pathway. It directly activates PKG by a non
NO, non cGMP dependent mechanism known as
PKG dimerization(1, 2, 3)
. It is being investigated as a
potential therapeutic agent for treatment of pul-
monary hypertension⁵ and other vascular diseases.
2. δ-aminolevulinic acid (ALA) is also being investi-
gated to treat pulmonary hypertension. It acts by
activating sGC⁴.
Dr. Anand Lakhar is Man-
ager, Medical Affairs and
Clinical Research, India
and South Asia for Anaes-
thesiology, Critical Care
and Oncology at Frese-
nius-Kabi
References:
1) Lakhkar A, Dhagia V, Joshi SR, et al.
20-HETE-induced mitochondrial su-
peroxide production and inflammatory
phenotype in vascular smooth muscle is
prevented by glucose-6-phosphate de-
hydrogenase inhibition. American Jour-
nal of Physiology - Heart and Circulatory
Physiology. 2016;310 (9):H1107H1117.
doi:10.1152/ajpheart.00961.2015.
2) Lakhkar Anand & Raj Joshi, Sachindra
& A.Gupte, Sachin. (2014). Regulation
of cGMP by glucose-6-phosphate de-
hydrogenase through PDE5 In coronary
artery. https://www.researchgate.net/
publication/297713864_Regulation_
of_cGMP_by_glucose-6-phosphate_de-
hydrogenase_through_PDE5_In_coro-
nary_artery
3) Patel, D., Kandhi, S., Kelly, M., Neo, B.
H., & Wolin, M. S. (2014). Dehydroepi-
androsterone promotes pulmonary artery
relaxation by NADPH oxidation-elicited
subunit dimerization of protein kinase G
1α. American Journal of Physiology - Lung
Cellular and Molecular Physiology, 306(4),
L383–L391.
4) Alhawaj, R., Patel, D., Kelly, M. R., Sun,
D., & Wolin, M. S. (2015). Heme biosyn-
thesis modulation via δ-aminolevulinic
acid administration attenuates chronic hy-
poxia-induced pulmonary hypertension.
American Journal of Physiology - Lung
Cellular and Molecular Physiology, 308(7),
L719–L728.
5) de la Roque, Dumas E, Savineau, JP,
Metivier, AC, Billes, MA, Kraemer, JP,
Doutreleau, S. Dehydroepiandrosterone
(DHEA) improves pulmonary hypertension
in chronic obstructive pulmonary disease
(COPD): A pilot study. Ann Endocrinol (Par-
is) 2012;73:20–5.
6) Katzung TextBook of Basic and Clinical
Pharmacology, 11th Edition
Figure 2 summarizes the different classes of drugs
which target the NO pathway. Drugs like nitroglyc-
erin act as NO donors, sildenafil is an inhibitor of
PDE-5 and prevents degradation of cGMP, ALA and
riociguat are activators of sGC which in turn goes
and activates cGMP while DHEA is a direct activator
of PKG M

R
oyal Philips (NYSE: PHG, AEX: PHIA), a global
leader in healthcare technology today launched
its first edition of India’s Future Health Index
(FHI), a research-based platform that helps to de-
termine the readiness of countries to address global
health challenges and build sustainable, fit for pur-
pose, national health systems. The focus of this data
is on the crucial role of technologies, access to health-
care services and efficiency of the healthcare system.
Commenting on the launch, Rohit Sathe, President –
Philips India Healthcare says, “The FHI study confirms
that India has a shortage of skilled healthcare pro-
fessionals along with a low number of hospital beds.
It also provides us with excellent insights about the
awareness that healthcare practitioners and the pop-
ulation, have about the role of technologies in aiding
healthcare delivery. This readiness to adopt technolo-
gy can be a key driver in delivering treatment to pa-
tients in tier II & III cities in India. This, in addition to
government’s increased focus on providing healthcare
access to all, will serve as an impetus to Philips in inno-
vating solutions to deliver connected healthcare.”
KEY FINDINGS OF FUTURE HEALTH INDEX 2018
1. Lack of access, due to low skilled physician density
and a low number of hospital beds, most impede value
• India’s below average access score is driven by a
lack of skilled healthcare professionals per 10,000
populations - 29 vs. 109 average, the lowest score
across all countries 16 countries surveyed

Press Release
PHILIPS LAUNCHES
INDIA’S 1ST
FUTURE
HEALTH INDEX

 Press Release | Philips Launches India’s 1st Future Health Index
• Another barrier to value is the low number of
hospital beds (7 per 10,000 population vs. 38
per 10000 on average), suggesting that health-
care needs cannot necessarily be met
• While top hospitals and clinics in metro cities
may boast of having cutting-edge technolo-
gies, semi-urban and rural areas are yet to fully
leverage the potential of digital healthcare
2. Despite a lower-than-average data analytics
score, Indian healthcare professionals are open to
the use of futuristic technology (AI, virtual reality,
etc.) in healthcare, even more so than the general
population
• Two-thirds (36%) of healthcare professionals
believe AI health tracker wearables/apps on
smartphones would have the greatest impact
on improving healthcare today if it were avail-
able. Among the general population, one-in-
five (18%) agree.
3. Healthcare professionals could become key
promoters of connected care technologies, as
they consider themselves highly knowledgeable
about connected care devices and believe in a fu-
ture where everyone owns them to manage their
health, potentially boosting data collection and
analytics in India
• Seven-in-ten (73%) healthcare professionals
are knowledgeable about connected care
technologies, with one-in-seven (17%) saying
they are extremely knowledgeable
• About as many healthcare professionals (70%)
see a future where everyone owns connected
devices/computer software/mobile phone ap-
plications to help manage their health
• 9 in 10 healthcare professionals (89%) who
have had any patients sharing information
from connected care technology agree their
patients understand how to properly use the
devices
Post the success of Public Private Partnership (PPP)
model of delivering healthcare in India, Philips with
this survey will now be looking at tackling these
challenges. It reveals India’s overall satisfaction
with the healthcare system and digital tools that
can play in delivering more integrated and sustain-
able healthcare. The inferences and learnings from
this will help Philips to look at plausible answers
and solutions through its various approaches. M

T
he Encyclopedia of Nobel Laureates (1901–
2017) published by Panther Publishers show-
cases brief biographical sketches and summary
of individual achievements of the 923 Nobel Prize win-
ners in the last 117 years since the time the first Nobel
Prize was awarded. Conferred on“people who work for
the greatest benefit of mankind”, as per the last will of
Alfred Nobel, himself a scientist who wrote poetry and
drama, as well as worked for the promotion of peace,
the Nobel Prize recognizes scientific, literary and hu-
manistic accomplishments.
Encapsulating the complicated works of great men
and women individually behind the betterment of hu-
manity, Encyclopedia of Nobel Laureates (1901–2017)
also provides an insight into the life and work of Alfred
Nobel, his will that led to the formation of The Nobel
Foundation, The Nobel Trust, Prize awardees of each
discipline, making and designing of the medals and
diploma that accompany the cashaward.
Prof. Ulf Larsson, a Senior Curator at the Nobel Muse-
um in Stockholm, has provided the foreword, and says
- "The history of the Nobel Prize is ongoing. Following
it involves not just one, but several magnificent voyag-
es along humanity’s lines of development in our time.

Book Review

 Book Review | Encyclopedia of Nobel Laureates: 1901-2017
As a source of impetus and guidance for such voy-
ages, this book fulfills an important mission".
The book carries an Introduction by former Presi-
dent Dr. APJ Abdul Kalam who also inaugurated
the Nobel Prize exhibition when it visited India in
October 2014, and an ardent follower of the Prize
himself.
This comprehensive work is an authoritative study
of the Nobel Phenomena and the lucidity of style
makes this work a must for all those seeking defini-
tive information on the Nobel Laureates. M
--
P. T. Rajasekharan has been captivated by the No-
bel Phenomenon for decades. A molecular biologist
by training and a serious student of science, he has
passionately followed and documented the works of
many a Nobel Laureate since his college days.
Dr. Ulf Larsson is Senior Curator of the Nobel Muse-
um, Stockholm. He is the author of several publica-
tions, including Alfred Nobel: Networks of Innovation,
(Science History Publications: 2008)
“
Prof. Ulf Larsson, a Senior Curator
at the Nobel Museum in Stockholm,
hasprovidedtheforeword,andsays
- "The history of the Nobel Prize is
ongoing. Following it involves not
just one, but several magnificent
voyages along humanity’s lines
of development in our time. As a
source of impetus and guidance for
such voyages, this book fulfills an
important mission".

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