The document discusses the challenges facing the Indian pharmaceutical industry, highlighting the ineffectiveness of mega sales forces and a need for change in sales strategy. It argues for a shift from product-centric tactics to a more strategic approach focused on understanding patient needs, improving customer satisfaction, and adapting digital technologies for better engagement. The editorial emphasizes the importance of alignment between sales, marketing, and medical affairs to ensure meaningful communication and value in healthcare delivery.

1. TM
MEDICINMAN
March 2014 | www.medicinman.net
Field Force Excellence
Since 2011
WHEN WILL
PHARMA SALES GET
ITS ACT TOGETHER?
Editorial
Behind Indian pharma’s rosy growth numbers lies a murky reality that will
come to haunt the industry if it refuses to change its ways.
H
1 | MedicinMan March 2014
as Indian Pharma’s efforts to increase its share of the voice
through mega field forces led to the physician saying, “Spare me
the noise” in exasperation? How many Medical Reps (MRs) meet
the criteria when it comes to delivering real value to physicians they call
on? Sure, there are companies that still deliver some value to physicians
through their field force – these are tiny islands of excellence in a sea
of mediocrity. The top 30 pharma companies with seventy percent
market share have field forces in the region of 3000 to 5000 MRs and
line managers. What percentage of this number actually delivers an
acceptable ROI? The sheer number of MRs calling on physicians has led
many hospitals to deploy positively hostile measures to stop them from
entering the premises except on designated days and time. Menacing
security guards are a new hurdle that MRs have to overcome to snatch
30 seconds from the increasingly reluctant-to-meet physician. This is
in addition to the myriads of hurdles that they already face – chemists
unwilling to stock, but blatantly substituting with brands that give
maximum profits and distributors asking for money from hapless MRs
and line managers to finance the purchase of goods that do not have a
robust secondary demand. Surely, mega field forces are ineffective and
their era is coming to an end?

2. Anup Soans | Editorial: When Will Pharma Sales Get Its Act Together?
“
On one hand we have market
reports that trumpet the double
digit growth of Indian Pharma.
But insiders say that cooked up
sales figures where stocks keep
rotating between distributors
instead of being consumed by
patients is a bubble waiting to
burst even in some of the best
run companies. This is one
of the main reasons for high
attrition – people want to move
on before being caught with
their pants down!
”
KAM – Key Account Management
MSL – Medical Science Liaison
2 | MedicinMan March 2014
Indian Pharma is unlikely to attract talent – why would
anyone want to be abused and tasked with so many
unpleasant chores every day? The job satisfaction
quotient of an MR has reached its nadir in most mega
field forces, where he is just a dispensable commodity.
Companies that are keen to make a difference will have
to find alternatives to rise above the cacophony created
by mega sales forces or be drowned in unethical market
practices that make IPL scams look like street side
cricket. It is becoming increasingly difficult to assess the
effectiveness of mega sales forces that do little more
than peek-a-boo calls in the corridors and then get busy
with their experienced sales managers in managing
numbers through a dubious network of distributors.
Perhaps, it is time to take the entire distribution network
out of the ambit of sales teams and put in place supply
chain specialists who can monitor and manage the
movement of products more effectively. Anyway this task
of ‘managing’ distributors takes most of the time of line
managers, who should instead be spending that time on
developing the skills of their team members. This is also
perhaps the only way to eradicate the unethical practices
that have become institutionalized by way of managing
sales through Excel sheets instead of coaching MRs to
generate prescriptions. Field forces must be spending
time learning more about physicians and their patients to
gain insights that can be useful in in-clinic interactions.
On one hand we have market reports that trumpet the
double digit growth of Indian Pharma. But insiders say
that cooked up sales figures where stocks keep rotating
between distributors instead of being consumed by
patients is a bubble waiting to burst even in some of the
best run companies. This is one of the main reasons for
high attrition – people want to move on before being
caught with their pants down! With USFDA breathing
hard on Indian Pharma, the pressure on domestic sales
will increase even more and nobody has any innovative
ideas to expand the market or to address the unmet
needs of physicians and patients, both of whom are
looking for better experience, real value, and positive
outcomes.
In the present scenario, several companies introduce
a particular product or product combination without
the least understanding of the needs of patients. The
emphasis is not on helping the physician better manage
his patients but on how many prescriptions can a
particular doctor give and what is needed to be given in
return as gratification. The current crop of executives in
sales and marketing may be dyed-in-the-wool to make
the shift from current unproductive practices. Indian
Pharma may need to look outside its perimeter for talent
who can bring value to customers and satisfaction to
patients and employees. We at MedicinMan have written
about the importance of KAM in understanding and
managing the business objectives of doctors as well
as MSLs who can communicate science that helps the

3. Anup Soans | Editorial: When Will Pharma Sales Get Its Act Together?
“
Indian Pharma will have to shift
its focus from tactical, productcentric sales approach through
mega field forces to a more
strategic mindset, which creates
effective segmentation based on
patient profiles and other relevant
differentiators and not just the
specialty of the doctor and manage
them through smaller, nimbler
teams of KAMs and MSLs.
”
doctor to better understand patient’s needs and ensure
better outcomes. Perhaps it’s too early to do away with
the large number of field forces, but the best among
them can be picked up and prepared for KAM and MSL
roles that deliver value to customers and satisfaction to
patients.
Indian Pharma will have to shift its focus from tactical,
product-centric sales approach through mega field forces
to a more strategic mindset, which creates effective
segmentation based on patient profiles and other relevant
differentiators and not just the specialty of the doctor
and manage them through smaller, nimbler teams of
KAMs and MSLs. Pharma will need better insight into how
patients become aware of their ailment, how they choose
a doctor and the lifetime value of patient compliance.
Patient data – patient’s perception of benefits and side
effects of a particular drug/therapy will hold the key to
effective physician communication, longterm sales and
new product introduction. Doctors will value information
about patient’s experiences and perceptions, which
will help them to better manage their patients. Better
alignment between sales, marketing and medical affairs
can create brands that resonate with customer’s aspiration
and patient’s need.
Pharma will have to learn from other industries like the
wellness sector, which have made rapid strides despite
questionable credentials and claims by resonating with
customer aspirations. Pharma’s own communication
capability leaves much to be desired – there is hardly any
creativity or imagination to fire the enthusiasm of sales
people or physicians. The packaging is mundane, product
information is not very useful and the patient’s mind
is filled with concerns of side effects instead of hopes
of wellness. Pharma product managers have failed to
communicate the role and benefits of modern medicine
in ensuring good health.
GlaxoSmithKline has fired the first salvo by structuring the
emoluments if its field force around customer satisfaction
instead of sales targets. This is commendable and one
hopes that this is the beginning of a new era in pharma
business at least for the companies who want to make a
difference by being different.
Meet the Editor
Anup Soans is an Author, Facilitator and the
Editor of MedicinMan.
Write in to him: anupsoans@medicinman.net
Connect with Anup Soans on LinkedIn | Facebook | Twitter
Visit anupsoans.com.
Indian Pharma is known for its entrepreneurial spirit
and has demonstrated this by setting up more than
20,000 manufacturing units and an equally large number
of propaganda cum distribution companies. Many of
these have been started by pharma employees who saw
the opportunity to serve a niche specialty market or
geographic area. Transforming senior MRs and managers
with demonstrated abilities into entrepreneurs in charge
of their own micro-businesses is another opportunity that
is worth exploring given India’s vast geographic spread
both in cities and rural markets. Customer satisfaction
and employee satisfaction are the pillars around which
successful future pharma companies will be built. -AS

4. CONTENTS (Click to navigate)
1. Indian Medical Advisors Summit 2014.............5
Photo essay and briefing.
Dr. Amit Dang
2. Digital Pharma...................................................7
MedicinMan Volume 4 Issue 3 | March 2014
Editor and Publisher
Anup Soans
CEO
Chhaya Sankath
Digital is changing the fundamentals of the
marketplace. Here’s how pharma can keep pace.
COO
Chandan Kumar
Chief Mentor
Arvind Nair
K. Hariram
3. Selling Across Cultures ..................................9
Chapter extract from the new book The Art of
Modern Sales Management by Renie Mcclay
Anup Soans and Joshua Soans
4. What You Measure is What Gets Done ...12
Performance metrics are often a trade-off between
ease and value. Is “calls-per-day” a meaningless
metric that needs immediate replacement?
Hanno Wolfram
Advisory Board
Prof. Vivek Hattangadi; Jolly Mathews
Editorial Board
Salil Kallianpur; Dr. Shalini Ratan; Shashin
Bodawala; Prabhakar Shetty; Vardarajan S;
Dr. Mandar Kubal; Dr. Surinder Kumar
International Editorial Board
Hanno Wolfram; Renie McClay
Executive Editor
Joshua Soans
5. Book Review: Unhealthy Practices ............15
MedicinMan Academy:
Review of the new work of fiction by Dr. Sumit
Ghoshal.
Development
Anup Soans
Prof. Vivek Hattangadi, Dean, Professional Skills
Letters to the Editor: anupsoans@medicinman.net

5. E
E
INMAS 2014
I
Indian Medical Advisor’s Summit - Feb 22, 2014
NMAS 2014 - Indian Medical Advisors Summit held on February
22, was a memorable day for Medical Affairs professionals. INMAS
2014 - Indian Medical Advisors Summit, convened by Dr. Amit
Dang, Founder and Director, Geronimo Healthcare Solutions was
held at “The Lalit”, Mumbai to interact, learn, share new ideas, best
practices and case studies. INMAS 2014 was attended by over 100
delegates from Indian as well as MNC pharma companies and post
graduate students of pharmacology.
Highlights of INMAS 2014
• Dr. Viraj Suvarna, Medical Director, Boehringer Ingelheim, keynote
speaker, set the tone by saying that the role of medical advisors was
not a dilemma between medical affairs and business, but that they
should own the business and their actions must flow from this sense
of ownership.
• Dr. Amit Garg, Head, Emerging Markets, Dr. Reddy’s Laboratories,
explained how social media can be utilized to initiate, recruit and
alter the outcomes of late phase studies.
• Dr. Ganesh Kadhe, AVP – Medical Affairs and Clinical Operations,
Wockhardt, speaking on internal and external stakeholder management, emphasized the need for GMAP or Good Medical Affairs Practices. He stressed that medical advisors should also excel in strategic
thinking, basic commercial skills, cross-functional collaboration and
teamwork.
• Dr. Prashant Desai, Director – Medical Affairs, Janssen Pharmaceuticals, J & J, spoke on “How to make credible scientific presentations”
by incorporating the six pillars of credibility - Ideation, Information,
Influence, Integrity, Impact and Ignition.
5 | MedicinMan March 2014
• Dr. Aju Abraham Varghese, Sr. Medical Manager, Regional Medical
Affairs, Pfizer India explained the role of field based Regional Medical Advisor (RMA) and their ability to respond to medical queries in
real time adding much value to the efforts of field force.

6. INMAS 2014
• Dr. Rohit Arora, Director – Marketing (Paediatrics), Sanofi Pasteur India, spoke on “What
medical advisor needs to know about regulatory expertise and NDAC (New Drug Advisory
Committee) expectations.
• Dr. Santosh Jha, Director – Medical Regulatory, Takeda Pharmaceuticals, talked about GPP
(Good Promotional Practices) and marketing or
science - what should be medical advisor’s priority? He stressed that GPP has been created to
ensure that pharmaceutical companies should
operate under the framework of high values of
integrity and ethics keeping patient safety as
its topmost priority.
Dr. Viraj Suvarna
Dr. Qayum Mukaddam
• Dr. K. Karunakar Reddy, Head of Medical
Affairs, Dr. Reddy’s Laboratories gave lot of
insight on off-label as well as on-label use of
medicines and on the importance of medical
advisors to be updated on various regulations
across the globe.
• Dr. Vinita Satyavrat, Head – Scientific and
Medical Affairs, Abbott Nutrition International
- India, gave insight about the driving forces
and challenges faced the Indian nutraceutical
industry and the competencies and skill sets
needed by medical advisors venturing into
nutraceutical sector.
Dr. Prashant Desai & Dr. Amit Garg
Dr. Rohit Arora
• Sharad Tyagi, Managing Director, Boehringer
Ingelheim told the audience “What industry
expects from the medical fraternity”. He said
that Medical Affairs is the only function in a
pharma company which can truly bridge the
gaps between science and business. According
to him, they are probably the only people who
understand the “Why”, “What” and “How” of
pharma business.
• Finally Dr. Qayum Mukaddam summarized the
take home messages for the delegates from
the summit and gave them insight into career
perspectives for medical advisors.
INMAS 2014 was moderated by Anup Soans,
Editor @ MedicinMan.
Dr. Aju Abraham Varghese
Anup Soans
Editor - MedicinMan
For further details: Log on to: http://inmas.org/
or write to admin@inmas.org
Photo-essay continued on page 17.
6 | MedicinMan March 2014

7. E
DIGITAL PHARMA
Digital is changing the fundamentals of the
marketplace. Here’s how pharma can keep pace.
Chandan Kumar
I
ndian Pharma market is a red ocean with thousands of
companies offering a plethora of me-too products. Their
promotion also tends to be me-too as product mangers change
companies frequently and implement the strategies of their
previous company again and again. In this scenario, companies
can gain the advantage of being first-movers in adopting
digital technology to effectively differentiate their products and
promotion.
Digital technology has many advantages over paper-based static
information systems. Doctors have also developed a fatigue to
paper based visual aids. Promotions through videos, animations and
multimedia demonstrations can offer more evidence in less time
and make the promotion interactive. Virtual promotions though
videos, podcasts, blogs can widen the scope of interaction and
Chandan Kumar is working in
healthcare publishing as an Acquisitions
Editor. His area of Interest is Healthcare
Marketing & Value Innovation.
ckumar21@in.com
http://www.linkedin.com/in/pharmtech
@pharmacrat
increase the time with doctors and engage patients as well.
Virtual Intelligence
Hand held devices have the potential to be virtual libraries
accessible anywhere at the doctor’s convenience, instead of
intruding into his productive time in the clinic. They can serve as
an excellent support system in managing needs of patients. Some
pharma companies are working on location based virtual services as
7 | MedicinMan March 2014
part of their digital marketing effort to give point of care services.

8. Chandan Kumar | Digital Pharma
“
• Pfizer has developed a mobile app which helps
patients with overactive bladder to locate nearby
Digital technology is
enabling companies
to connect directly
with patients using
the patient’s location
to provide details of
nearby healthcare
facilities and other
important disease
management
information through
virtual intelligence.
”
restrooms. (Detrol LA and Toviaz are products for
incontinence).
• MSD has also developed an app for patients
with allergy. Based on the user’s location, the app
offers information on pollen counts and details of
nearby physicians and pharmacy stores. (Product
- Claritin)
• Boehringer Ingelheim is steering a project in
which phones and tablets can be paired with
glucose meters to give instant alert/advice to
diabetic patients through their phone/tablet.
Thus, digital technology is enabling companies to
connect directly with patients using the patient’s
location to provide details of nearby healthcare
facilities and other important disease management
information through virtual intelligence.
Social Media
Social media has presented a new opportunity but the
critical task is to introduce social media marketing in
such a way that it benefits both company and patients
without violating regulatory norms.
Social media is a cost-effective platform for
personalised interaction and collaboration with endusers like patients and patient groups. Most companies
are still trying to understand the real potential of social
media, but some have already initiated social media
engagement programs.
• J & J and Pfizer have launched YouTube channels
and are considered as dynamic and responsive
pharma companies on Facebook and Twitter.
• Sanofi has also used YouTube to deliver
information without mentioning product names;
working within the guidelines.
There is an acute shortage of professionals in Indian
Pharma with the expertise to drive digital marketing.
The need is to find and attract the right professionals
who have a clear understanding of the digital world
and the opportunities to create a new wave of digital
pharma marketing. With over a billion people active in
the digital world, virtual intelligence and social media
will become more and more important to the pharma
8 | MedicinMan March 2014
industry’s marketing efforts.

9. MEDICINMAN
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Pharma-specific Training:
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Representatives seek success in their personal
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At each stage of this Four Stage process the Representative acquires measurable skills and competencies
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Company’s may choose to deliver a program as a webinar - giving the advantage of scale and lowering costs.
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Customized issues of
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All programs are fully customizable. A pre-program questionnaire is used to capture the
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for continued learning and development. The same may be procured from the author at a
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Management Games
Audio/Visual
Interactive Classroom Training
Simulation
Learning-by-reflection
Case Studies

12. E
Book Extract
SELLING
ACROSS
CULTURES
A new book by Renie McClay published by ASTD Press is
apt for the global executive with a local vision. “The Art
of Modern Sales Management” has 12 chapters, each
written by a leader in the field from around the world.
Below is an extract from the chapter contributed by
Anup Soans and Joshua Soans.
Download a free chapter of the
book here.
I
n 1991, when India opened up its markets to the world
economy, a billion people joined the global market.
They were made up of over 2,000 ethnicities, 1,576
“mother tongues”, 8 [major] religions, and thousands
of local dietary and religious practices. Multinationals
entering the Indian market would have to successfully
navigate this cultural jungle to survive and thrive.
The fact that McDonald’s, the world’s largest seller of
beef products, has a thriving business in India, the land
of the sacred cow, is proof that cultural differences are
Renie McClay, MA, CPLP, has been a dynamic
performance improvement professional for
20 years. She has been successful in sales,
management, and learning and performance
roles at several Fortune 500 companies (Kraft,
Pactiv, and Novartis). Founder of Inspired
Learning LLC, she continues to bring her
passion and practical approach to all project
work. Inspired Learning LLC does design and
delivery of energetic programs and projects
around the world.
only a barrier when a company fails in its due diligence.
McDonald’s has a strict “no-beef, no-pork” policy in
India since the cow is widely worshiped by Hindus and
consumption of pork is forbidden in Islam. Instead the
fast-food chain has a variety of vegetarian and chicken
dishes in local flavors and is considered to be just as
‘Indian’ by urbanites as is curry and naan. Because of
its cultural astuteness the world over, McDonald’s has
become the poster boy for ‘glocalization’ – the art of being
global in character but local in spirit. -AS JS
Purchase the book on ASTD to read the
complete chapter.
12 | MedicinMan March 2014

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14. E
WHAT YOU MEASURE,
IS WHAT GETS DONE!
Performance metrics are often a trade-off between
ease and value. Is “calls-per-day” a meaningless
metric that needs immediate replacement?
“
If you measure
number of calls per
day of your field
force, your field
force will deliver
calls per day and
little else.
”
Hanno Wolfram
I
n Harvard Business Review and a number of pharmaceutical companies, discussions around KPIs currently appear
to be hot. Evidence arises that sales, market share and calls
per day are measures of the past and becoming more and
more obsolete.
For example, if you measure speed you need two metrics:
distance and time.
William Hewlett is said to be the originator of the statement:
“You only can manage what you measure”. The subsequent
addition “… what you measure gets done” is more common
sense than a pearl of wisdom.
Human beings act on what can be measured: setting your
car’s display to average speed or fuel consumption will make
a big difference to the way you drive. Your behaviour while
driving will change by the measure you choose. It might be
worth a try!
It works the same way in business: if you have punch clocks in
your offices or factories, time in the premises will be measured. Metrics will be “in/out” time. Employees will be in and
out as measured and required. If you measure number of
calls per day of your field force, your field force will deliver
calls per day and little else.
Hanno Wolfram is Managing Director at
Innov8 GmbH, Germany.
Write to Hanno: hanno@innov8.de
14 | MedicinMan March 2014
The tragedy of outdated measures is very evident when in Asia
many calls of medical representatives merely last 20 seconds
- in Europe they call it “spot-calls” - and in www.cafepharma.
com you can read about “drive-by calls” and “inflated numbers”
of calls reported. It is not really surprising that the reduction in
field force headcount often does not harm pharma’s top-line.
In pharma tradition such calls are part of KPIs. In many
cases KPIs suffer from two things: the undefined word “performance”, standing for something different in every one’s
understanding and the neglect of the original intention of Key
Performance Indicators:

15. Hanno Wolfram | What You Measure, Is What Gets Done!
“
“Everyone in the organization pulls the same rope at
the same end into the same direction.”
Any metric or
measure must be
manageable. Jason
Jordan wrote in
HBR (Jan. 2014):
“As much as sales
managers talk about
“managing revenue”
or “managing market
share”, Business
Results are ultimately
unmanageable.””
”
Usually there are two categories or sets of metrics:
1. Input or effort and 2. Outcome or result.
Central questions are:
1. If you measure field-force activities or results why
not call them measures of activities or results? The
only alternative is to define, share and make sure that
everyone understands identically what “performance”
means in your company.
2. Whatever you measure must fully match and support the company objective. If your objective is “client
satisfaction”, you must measure it. Remember: Improvement of top or bottom line is the “raison d’être”
of an enterprise and hardly a meaningful measure.
3. Any metric or measure must be manageable. Jason
Jordan wrote in HBR (Jan. 2014): “As much as sales
managers talk about “managing revenue” or “managing market share, but ” Business Results are ultimately
unmanageable.”
Measures or KPIs must be defined in support of the
company objective and strategy. Novel thoughts and
managerial action might already be overdue. -HW
MISSING SOMETHING IMPORTANT?
You can access all past issues of MedicinMan at: http://medicinman.net/archives.
Be sure to SUBSCRIBE on our website (top-right corner: www.medicinman.net) to stay up-to-date with us.
15 | MedicinMan March 2014

16. E
Treatment Compliance
Survey among diabetic
patients
Rashmi Thosar
Medicines don’t work if people don’t take them! And yet,
medicines are neglected the most. Attitudes are contagious!
They derive our behaviour towards what we do and thus is of
significance even in understanding patient non-adherence to
medication, especially in chronic diseases.
Estimates of medication non-adherence rates typically range
from 30% - 60%. With an estimated 50% non-adherence
in chronic conditions, segmenting patients based on their
attitudes is critical to evolving adherence models. Brandcare
studies behaviors and attitudes of diabetics in India.
Rashmi Thosar is CEO, Brandcare and a leading professional in
healthcare communications and advertising in India; she has been at
the helm of leadership at Brandcare and over the years and has been
instrumental in its transformation to the top 5 healthcare agencies in
India.
Our Authors
Abdul Basit Khan
Dr. Shalini Ratan
Ajay Kumar Dua
Dr. Surinder Kumar
Amlesh Ranjan
Sharma
Amrutha Bhavthankar
Dr. Ulhas Ganu
Andris A. Zoltners
Geetha G H
Anthony Lobo
H. J. Badrinarayana
Aparna Sharma
Hakeem Adebiyi
Arvind Nair
Hanno Wolfram
Atish Mukherjee
Hitendra Kansal
B. Ramanathan
Iyer Gopalkrishna
Chayya Sankath
Jasvinder Singh
Craig Dixon
Banga
Devanand Chenuri
Javed Shaikh
Venkat
Jitendra Singh
Dinesh Chindarkar
John Gwillim
Dr. Amit Dang
Jolly Mathews
Dr. Aniruddha
Joshua Mensch
Malpani
K Hariram
Dr. Hemant Mittal
K. Satya Mahesh
Dr. Neelesh Bhandari
Ken Boyce
Dr. S. Srinivasan
Mahendra Rai
Mala Raj
Manoj Kumar
Mayank Saigal
Milan Sinha
Mohan Lal Gupta
Neelesh Bhandari
Neha Ansa
Nishkarsh Likhar
Noumaan Qureshi
Parveen Gandhi
Pinaki Ghosh
PK Sinha
Prabhakar Shetty
Vivek Hattangadi
Rachana Narayan
Rajesh Rangarajan
Ralph Boyce
Renie McClay
Richa Goyel
Richard Ilsley
RM Saravanan
Sagar S. Pawar
Salil Kallianpur
Salil Kallianpur
Sally E. Lorimer
Sandhya Pramanik
Sanjay Munshi
Shafaq Shaikh
Shalini Ratan
Sharad Virmani
Shiv Bhasin
Spring Sudhakar
Subba Rao Chaganti
Sudhakar Madhavan
Tony O’Connor
V. Srinivasan
Varadharajan K.
Vijaya Shetty
Vishal V. Bhaiyya
Vishal Verma
Vivek Hattangadi
William Fernandez
MEDICINMAN invites contributions from Pharma professionals on topics related to Field Force
Excellence. See: www.medicinman.net/author-guidelines for more information.
16 | MedicinMan March 2014

17. E
BOOK REVIEW
UNHEALTHY PRACTICES
By Dr. Sumit Ghoshal; Notion Press
Anup Soans
Dr Sumit Ghoshal, a medical doctor and healthcare writer,
weaves a colourful tapestry of his vast experience in his
first fictional work – Unhealthy Practices.
If you thought that only pharma executives had sales
targets, Unhealthy Practices narrates the tremendous
sales pressure that doctors in corporate hospitals have to
endure to survive. The work pressure that young residents
have to endure is no different from that of Medical Reps.
Like many senior field sales managers, there is Dr. Naresh,
who has given his best years to the hospital and is axed
for not generating enough revenue. This pressure on revenue generation is what drives unethical practices both
in pharma industry and hospitals. Patients of doctors who
do not pull in enough revenue are denied a place in the
hospital’s busy ICU. This interplay of necessity, job security,
duty and ethics is woven into a fine story in which some
doctors compromise and a few others struggle to find a
fine balance between ethics, livelihood and Unhealthy
Practices.
Pharma executives will also appreciate the predicament
of the busy pharma marketing executive, Harish whose
hectic work-life renders his wife, Pratibha susceptible to
alcohol, parties and finally the attention and advances of
a neighbour.
17 | MedicinMan March 2014
Unhealthy Practices an excellent read and one of the few
that I have read in a single sitting – a challenge in today’s
digital world. Dr. Sumit Ghoshal has done a wonderful job
of writing a human interest story that engages the reader
throughout. Those of us who have been in the pharma
industry and have worked in Mumbai may even end
up speculating the identity of the hospital and doctors.
Unhealthy Practices depicts the current scenario in Indian
healthcare very accurately.

18. Anup Soans | Book Review: Unhealthy Practices by Sumit Ghoshal
“
Pharma executives
will also appreciate
the predicament of
the busy pharma
marketing executive,
Harish whose hectic
work-life renders
his wife, Pratibha
susceptible to
alcohol, parties and
finally the attention
and advances of a
neighbour.
”
18 | MedicinMan March 2014
The reader can relate to the predicament of honest
doctors and the compulsions of businessmen running
hospitals in a city like Mumbai.
There is plenty of excitement, thrill and suspense as the
struggle for control of Gopalji Damji Hospital unfolds.
Unhealthy Practices is a welcome trend and a must read
by every healthcare professional. The language is simple
and lucid and engages the reader without taxing them
with difficult words. Unhealthy Practices reminded me of
The Citadel, probably the finest work of medical fiction
by another physician, A.J. Cronin in 1937. Although, the
medical world has not changed much since 1937 in terms
of ethical dilemmas of doctors, The Citadel has been
credited with laying the foundation for the introduction
of the NHS. Hopefully, Unhealthy Practices will also lead to
discussion and action to make the Indian medical fraternity more transparent and accountable.
Excerpts from Unhealthy Practices
When the management of Gopalji Damji Hospital decides
to compulsorily retire a number of its most senior doctors,
no one expects the matter to snowball into a major public
relations disaster. But this is precisely what happens. One
of the trustees, Prashant Kadakia, leaks the story to a
friendly newspaper reporter, whose own father had died
in the same hospital just two months before.
Meanwhile in the hospital, a tussle for control is going on.
The employees demand a heavy bonus, which the trustees cannot afford. The employees threaten to go on strike.
The adverse publicity continues until the board decides to
replace the Medical Director. The trustee, Kadakia, opens
another avenue with the help of some Indian friends
living in the US. They infuse the necessary funds to get the
hospital on its feet again but the real challenge is to overthrow the existing board of trustees and get the hospital
going again. To succeed in this and to become chairman
himself, Kadakia has to walk a tight rope, and douse a
number of fires that threaten to cripple the institution
forever. -AS

19. INMAS 2014 - Speakers, Audience and Organisers