Wednesday, May 20, 2015

On-job fearlessness: a necessity

On-job fearlessness: a necessity

The most important quality among sales personnel is fearlessness.  A pharmaceutical Medical Representative (MR) has to knock on clinic doors of the most qualified medical personnel.  It can be intimidating!  Yet the MR has to do it with elan, smile, authority, confidence (fearlessness) and tactfully.  Getting the message across to prospects and committed doctors, who are sophisticated, highly qualified, wealthy, intelligent, dedicated to superordinate goals … is a challenging task, the essential requirement for this job - being confidence (fearlessness).

People work due to various motivations, an entire body of literature is available on this issue, most popular being the Maslow’s hierarchy of needs.  It is safe to surmise that people work constantly to be in a state of perceived security (absence of fear of loss or absence of need).

In any case, day-to-day working takes place due to several factors including:
a)      Dutifulness
b)      Habit
c)      Fear
d)     Greed
e)      Need for subsistence and meeting family requirements (including children’s education)
f)       Desire for high level experiences (eg., luxuries etc)
g)    Emotional bonding with co-workers or with the institution (where work is being performed)
h)    Work ethic: where work opportunity itself is seen as a reward rather than being an instrument for meeting one’s material and other needs
i)     Work as an engagement for joy, keeping oneself from boredom and ensuring mental well-being (psychosomatic health), for many being away from productive work contributes to negative thoughts, depression and lack of self-worth (loss of self-love)
j)        Need to be secure and comfortable in present and future time
k)      Superordinate goals or higher ideals (eg., workers in NGOs)

Yet the most important quality for performing any job is fearlessness (a response behavior characterized by confidence).  On-job fearlessness has many benefits:
a)      On-job fearlessness is not being a contrarian, anarchist, Mr. Blunt, irreverent or an upstart … it means being comfortable with oneself and others, ensuring effective on-job communication and transactions
b)      On-job fearlessness is infectious and positive: healthy confidence makes others confident.  In sales personnel, on-job confidence, gives an appeal to the salesman’s persona.  It makes the prospects and doctors comfortable - their confidence level too gets a boost. 
c)      On-job confidence (absence of fear) is required for success: fortunes favour the bold!  A courageous salesperson will create confidence in prospects and customers about his or her product.  This confidence in the customer or prospect creates the prescribing decision in doctors, or purchase decision in customers.  Generating confidence in customers and influencers like doctors, is the key for success events
d)     On-job confidence creates a base for adaptability:  Learning from experiences is a key to career growth and ability to contribute.  On-job confidence gives a person the drive for learning and apply them in situations, including critical ones, such as during crisis management
e)      On-job confidence is a morale booster: being confident in the work-spot means having presence of mind and even-mindedness in the face of risks, uncertainties and volatilities

In day-to-day activities, experience of fear and greed are commonplace happenings.  The intensity of these emotions varies, which depends on the person’s psychological profile and actual circumstance.  

Ability to manage these emotions, unlocks opportunities.  A MR may get intimidated with a doctor’s in-clinic intellectual aggressiveness and authoritarian bearing.  The MR may cower down and avoid such doctors – settling to meet less – intimidating (but less business potential) doctors.  Hence, the MR’s fear has created loss of opportunity in this scenario.

If a doctor is intimidating, one can ‘fight or flee’.  Another approach is getting a grip on these emotions and participating in the transactions to ensure win-win relationship.  This comes through training and knowledge (wisdom and experience).  Hence, it is said by Rabindranath Tagore: Where the mind is without fear and the head is held high … where knowledge is free…

Lack of confidence, also hampers doctor-call efficiency and effectiveness of a MR.  A less-confident MR will likely make a postman-call, with very minimal impact.  A confident MR or executive will have more elan.

Fear and greed are facts of life!  They are key emotions to help us understand the situation.  However, using one’s reasoning, patience and imagination, one can control the response behavior to replace fear with cautious confidence, and greed with tempered desire, so that various achievements can be notched up in a balanced way.

Confidence is not being flamboyant … such sales-personnel are often hollow, covering their inner fears with a cloak of aggressive flamboyancy. 

The pharmaceutical industry is an ocean of opportunity for confident participants.  People who know how to manage their fears are exploiting the market opportunities.  In post-independent India, over the 60 plus years, many pharma personnel and institutions have gathered experience, learning, knowledge and hence fearlessness, it is translating into major growth for pharma organizations.  The Rs. 88,110 crores Indian pharmaceutical industry is having a MAT growth 14.1%.  Welcome to confidence, welcome to opportunity … here is the Indian pharmaceutical industry.

Monday, January 5, 2015

UCPMP: a glimmer of hope is the pharmacies!

The confused look!  From here!!

So at last, here it is UCPMP: Uniform Code of Pharmaceutical Marketing Practices!  A code of conduct to reign in aggressive pharma marketers (like me?!).  The UCPMP has provided a very strict and puritanical code of conduct when it comes to providing "inputs" to prescribers.  It is assumed/implied UCPMP is applicable to allopathic and other medical practitioners.  Regarding non-drug products prescribed by doctors (such as dietary supplements, foods etc), the UCPMP is not explicitly expressing its views.  However, the spirit of the document is stark clear, to cleanse the Augean stables in pharma-medical market; and try to give a better deal to the patient. 

Two things of the UCPMP stand out, which impact day-to-day marketing activity:

1) Samples to be provided only on signed and dated request by qualified prescribers - and pharma marketer has to limit sampling to just three patient dosages!  We pharma marketers have to keep a tab and records of such samples given (and better still collect remarks from prescribers) (sales stocks converted to samples without stamp of FREE MEDICAL SAMPLE - NOT FOR SALE, cannot be given!)


Although I got the photocopy of UCPMP (duly signed by Mr. Raj Kumar, Under Secretary, GOI) ... last month ... I am yet to come out of the "shock").  Slowly ... I am doing what others are doing ... peeping into the market and reading the reports in media to size up the situation and start re-plotting marketing strategems!!

The immediate impact of this important document - UCPMP - is that TECHNICAL MARKETING, detailing and training will get a major focus. 

During in-clinic activity and in-stall or booth activity:  it will depend on influence and persuasive power of the pharma marketer and communicator.  Jo dikhta hain bikhta hain.  Mere handing over of samples, gifts and sponsorships will no more provide the market demand impetus or stimulus.  Persuasive communication - based on rationale, creating positive emotions and a rigid ethical format - is the need of the hour.  This is easily said - than done.  It means marketing will upgrade from soldiering to incorporating significant intellectual activity. 

Learning and training will be the lodestones of pharma marketing, if one follows UCPMP to the T, along with it - creative ethical persuasive value-added product promotional materials (that cannot be compliments or gifts!) will be required as collaterals to communication and field activity.

However, UCPMP will cause significant pain to doctors - pharma marketers will also be a confused lot. 

The UCPMP is so serious, it makes the owner or head of marketing organization responsible for adherence to this code of conduct.

Right now - it is a voluntary code of conduct, however, OPPI is lobbying to make it a mandatory or a statutory code of conduct...


Oh! Yes!!  The UCPMP is a document focused on disciplining the pharma marketer and prescriber relationship. 

It has left out the relationship between pharma marketer and pharmacies; and the understandings between the pharmacies and doctors.  These market realities are too knotty for GOI to decipher.

Therein lies our opportunity!

We can continue with the bonus offer schemes, provide freebies to pharmacies ... and see if there can be a way to reach prescribers through the pharmacies (without actually contravening the UCPMP) ...

So mum's the word!!  The UCPMP does not use the word pharmacy or medical shop anywhere... only agents/third party distributors are referred to, so the pharmacy coast is clear

A new dimension of pharma marketing UCPMP has entered the pharma marketer's arena (along with the Drugs and Magic Remedies (Objectionable Advertisements) Act, 1954).  Let us hope for the best!

Thanks for reading this blogpost, please scroll down and read others, click on older posts icon as and when required, and feel free to recommend this blog to your colleagues!

Sunday, August 3, 2014

My talk for freshers at a pharmacy college

On 1.8.2014, I had the privilege and pleasure to address fresher pharmacy students and parents at Dayanand Sagar College of Pharmacy (DSCP), Bangalore.

This college is now a well-sought after pharmacy college.  The kind invitation came from Dr. Murugan M Pharma PhD, Principal, DSCP, Bangalore, a progressive and competitive person, who wants to develop this pharmacy college into a prime academic force of our noble profession.

Here we see Dr. Murugan, Principal, DSCP, Bangalore addressing the audience:

The pharmacy college belongs to a well-established group of Bangalore:

The idea of my participation was to build confidence, give insights and motivate: fresher students and parents:

Along with an attractive speech, I provided the main content of my talk as a leave-behind to each attendee:

The main points were as follows:

The following points were given in my speech and leave-behind, for confidence-building.  My talk included good jokes and anecdotes to illustrate the thrust points.  My talk was well-received.

The main idea of the first part of the talk, was to give a bird's-eye view of the status of pharmaceutical industry including its relation with world-business.

India: Pharmacy of the world!

       Indian pharmaceutical goods are recognized for quality and price innovation across the globe: India is the world’s third largest pharma market in terms of volume; as per AIOCD AWACS June 2014 MAT report, retail pharma business is Rs. 77529 crores and value growth was 6.7% (and exports of about Rs. 65000 crores)
       India has more than: 4.5 lakh doctors, 7 lakh pharmacies , 20,000 pharma companies, 200 US FDA approved manufacturing facilities and 2 lakh medical representatives
       India is making the mark in bio-medicines with MABs, rDNA products and other ‘similar biologics’ (Biocon, Strides, IPCA…) & also with indigenous healthcare products
       Medical tourism is boosting global Pharma India
       Cipla has saved 1 crore lives in Africa through their affordable anti -AIDS medicines: India makes 92% of anti-AIDS medications sold world-wide
       Lupin is the 5th largest generic pharma company in US prescription market as per wikipedia; fastest growing in Japan and S Africa; global leader in anti TB bulk drugs and formulations and in 2012 Sun was the 9th biggest generic pharmaceutical company in USA 

       There are global job opportunities for pharmacists: Egs.: in community pharmacies of Gulf; Pharma marketing across the globe – for instance, Sun Pharma has two regional managers in Myanmar (Sun is the No. 1 pharma company in Myanmar and Indian companies control 60% of the  Myanmar pharma market; SUN IS NO. 1 IN INDIA TOO!)

Below is a graphic of the Indian pharmaceutical industry revenues:

The inspiring growth of pharmaceutical exports: 

The next part of my speech was directed to students on how to take advantage of their four to six year study time in this campus; after all, they are giving their beautiful youth years for pharmaceutical learning:

Framework for success

q  Welcome to the global noble profession of Pharmacy

q  Enthusiasm (intense positive emotional energy born from unconditional self-love)
In this part of the speech, I talked about the importance of having enthusiasm come-what-may, so that each individual is able to put in his/her best for learning and be happy

q  Not just exam centered learning strategy: have a career centered learning strategy:
It is unfortunate but true that most students make the mistake of having an exam oriented learning strategy (the focus is only to pass or get good grades).  However, it is more advantageous to have a career oriented learning strategy so that the learnings' enhance employability and create career success.  (I also gave several examples from my work experience)

q  Build the 3 Cs continuously: CHARACTER (reliability), COMPETENCE AND COMMITMENT

q  Learn and practice: memorization techniques and  creative communication (messaging) process (active listening, body language (non-verbal communication), oral and written: conversational communication, inter-gender communication, dyad communication and group communication)
I gave some interesting examples of why communication is vital in marketing or other departments.  I also illustrated importance of memorization techniques like mnemonics.

q  Follow your cultural values and upbringing: do not cross the Lakshman rekha (remember the love that your parents have for you - always)
I exhorted the importance of not crossing the line in student-life, to repent later!

q  Inculcate and practice humility: you will always be fearless and approachable  - you will always have the will and confidence to approach others whenever required; you will be able to tolerate people who give you pain during interactions and finally find strength to transact with them for mutual benefit

q  Be  cheerful, spread cheer,  be self-defensive and cautious

I thank: Dr. Muruganji, Principal, Dayanand Sagar College of Pharmacy, Bangalore, Dr. Geetaji, Prof. and HOD of Pharmacology, and team DSCP: for the kind hospitality and experience.  
I thank you all for reading this blogpost, hope it was useful and interesting, and I request readers to scroll down and read all other blogposts: do click on older posts to read other write-ups, feel free to recommend this blog to your friends. 

Tuesday, July 29, 2014

Preparation meets opportunity

Many of my peers, juniors and some seniors often ask me: on the purposes that each person ought to be having.  Sometimes people feel purpose-less, often there are no assignments - so people feel out-of-place or insecure, or there seem to be irrelevant assignments to be executed or there are assignments which need to be done, but your heart does not belong to it!  So what is the way out?  Well there is an antidote - life is not just about doing the allotted assignments: life is actually something else: it is about PREPARATION!  Life is about practicing, verily, PREPARATION MEETS OPPORTUNITY.  This is in fact, the best theme for life.

Just imagine the life of a committed Hindustani music singer: do you think her life is only about flitting from one music program to another program?  Do you think there are no dry days - when concert opportunities are not there?!

A singer has her major focus on the early morning riyaz: practice session.  It is this preparation time, which gets the maximum focus in her life. The singer focuses on the riyaz or practice session, which is responsible for her concert performances!  So it is preparation-focus, which ought to be every professional's obsession! And then doing the job with aplomb when opportunity comes by!!

Define your professional profile

To start a preparation-focused professional life, begin with understanding your professional profile.  For instance, as a medical representative - your profile will want certain competencies: territory knowledge (doctor and pharmacist profiles, ideal meeting timings, product prescribing behaviors, pharmacist OTC and substitution behaviour, short and quick work routes in the territory)..., detailing skills, basic product profile knowledge, competitor product and activity knowledge, and relationship management knowledge (eg., knowing how to communicate, build rapport, greet people on special occasions like their birthday, submitting greetings on festive occasions - Eid Mubarak to Muslims at end of Ramadan period etc).  

If you are a trainer or product manager, understand the product management concepts and training aspects. Focus on preparing for the deliverables.  A lecturer is not a lecturer until he can give proper lectures!  After understanding the profile requirements and parameters, develop your competencies on those lines continuously!!  That is preparation-focused behaviour.

If you are regular to the fitness center or gym, while going through the exercise and fitness equipment routine, you will realise that there is no end to the no. and types of exercises you can perform.  It can go on and on and on, until you can take it or you have the time and aptitude for it all... same way, there is no end to the depths of knowledge you are trying to master in your professional sphere!  The knowledge and activity stream for preparation is bubbling, continuous and endless!  So preparation is also an endless exercise, with several milestones in the journey for you to keep reaching!!  The biggest room in the world is the room for improvement!!  And therein lies endless opportunity.

Your professional profile is not static!

The mobile phone, whatsapp, facebook, social media, email, ebooks, internet, blogs, biotechnology, rDNA technology, MAB (monoclonal antibody) business ... these were all simply not there in 1992, when I started my work-life after M Pharma...  Now these software and social media tools are great for communicating knowledge, motivating and keeping a tab on things.  We routinely use social media whatsapp for updating marketing campaign work with each other!!  This creates a ripple effect and work dynamism.  Change is the only constant of life!!  So how can the professional profile be static?  Preparation attitude is a continuous process.

Today, training is not about providing knowledge... there is endless information, data, knowledge and insights available in the information superhighway!  The moot point is can you wade through it, get what you want, grasp the essentials, and put it across in an easily assimilable manner!?  Can we engage trainees with the learning and get them excited enough to learn and apply it/practice it!?  Are there interesting ways, using modern technology (web-based, mobile-based or social media based methods) to deliver learning experiences?  If yes, as a trainer, one has to grasp these new ways!!  The same chalk and blackboard method or reading from an attractive powerpoint is not enough!  So that makes a professional trainer's life one of continuous preparation!

Today, that is the need from a trainer!  The challenge for a trainer is to help learners acquire the necessary knowledge units, skill sets, and get them motivated enough to use it in day-to-day working.  It is one thing to handle the visual aid in the training spot, however, the fact is: at doctor clinics' - visual aids are not even opened, if they are, then the visual aid page is flashed for a brief moment - brand name is mentioned, pointer is not used... pay-off sentence is not emphasised... the real challenge is getting learners to learn and apply!

The MAB (monoclonal antibody) market

Take for instance, in 1992, B lymphocytes were mainly in HUP (human physiology) subject.  We learnt that B lymphocytes were a type of agranular leucocytes that produced antibodies which help destroy antigens (foreign bodies) in the blood stream.

But today!?  B lymphocytes are billion dollar business!!  B lymphocytes are used to produce required target antibodies, which have therapeutic, diagnostic and academic uses.  IV (intravenous) infusion: Trastuzumab (humanized mouse based whole antibody) is used for treatment of HER 2 positive breast cancer cases. Various other antibodies are marketed chiefly for treatment of autoimmune diseases, infections and cancer. Antibodies are no more natural biomolecules produced as a part of passive or active immunity by B lymphocytes in the body!  B lymphocytes are vital economic entities: producers of antibody protein molecules that have billlions of dollars in sales!!

Genentech (now a member of Roche group) invented trastuzumab (an antibody: specifically a monoclonal antibody).  Their brand name for this whole antibody IV infusion preparation was HERCEPTIN.  In 1998, the sales of this molecule was 30.50 million USD.  In 2008 annual sales had progressed to 1.38 billion USD (1,382 million USD) - this - only in US market! In the world market (including US market), Herceptin sales was 1.82 billion USD approx. in 2008.

As per Fierce Pharma ( Herceptin had estimated worldwide sales in 2012 of 6.08 billion USD.  The product patent for trastuzumab (Herceptin) expired in 2014 for Europe, and in USA, it will expire in 2018.  In the same report from Fierce Pharma, we observe that Herceptin is ranked no. 8 pharmaceutical product in the world, by sales value in 2012.

Product patent expiry has opened up a market for biosimilar Trastuzumab brands.  The me-too antibody preparations are called biosimilars.  Bangalore based Biocon has launched its me-too biosimilar antibody trastuzumab under brand name: CANMAb.  International generic major Mylan has the brand Hertraz: trastuzumab biosimilar.

CDSCO (Central Drugs Standard Control Organization: has issued a pdf document in their website: GUIDELINES FOR SIMILAR BIOLOGICS: Regulatory Requirements for Marketing Authorization in India.  This is a very good document that provides an insight into the challenging and enigmatic world of similar biologics and thus makes biosimilars or similar biologics a more friendly science.

Production of antibodies from B lymphocytes still appears as a rocket science (!).  It is not as easy as purchasing the chemical active ingredient from a API supplier, sourcing the excipients and punching it all into a marketable form like a tablet (with the help of a BMR (Batch Manufacturing Record), which is also a purchasable item today).  The science and experience for handling production of antibodies from B lymphocytes is still in the preserve of a few companies.

Each B lymphocyte can produce only one type of antibody.  So it can act only on that type of antigen, which has triggered the production of the antibody.  To commercially produce antibodies, there are various companies across the world: contract antibody suppliers.  They produce research grade antibodies and scale it up for clinical use or other uses as per GMP guidelines.  Some of these companies:

A-Bio in Singapore, AbD Serotech, Adar Biotech, Aeres, Affinity Life Sciences, Agri Bio, Alpha Biologics etc.

These companies produce: 1 g to 10 g quantities of the antibody.  Big factories produce upto 10 kg of the antibody.

The general method for commercial antibody production:

a) the antigen protein is isolated and injected into mice (in two doses: primer first loading dose and after 10 days the booster dose)
b) Simultaneously tumour cancer cells are grown by tissue culture: these cancer cells are called myeloma cells
c) B lymphocyte WBC cells from the mice (in whom the antigen protein are injected) are extracted from the spleen of the mice
d) The extract is added to the myeloma cells
e) The result is HYBRIDOMAS (fusion of B lymphocyte cells and myeloma cells) (various chemicals, equipment, techniques are involved in this key step of the antibody production process: polyethylene glycol is a chemical used, viruses are also used...)
f) HAT medium (hypoxanthine - aminopterin - thymine) is used for selection and growth of hybridomas
g) Screening of the hybridomas for ensuring right antibody is produced
h) Further culturing of the select hybridomas
i) Growing the selected hybridomas
j) Harvesting the antibodies
k) Humanization techniques are used to make antibodies "human friendly" so that the human immune system accepts them.

The above major steps is very simplistic sequence of the MAB commercial production science.  There are many things involved here: fermentors and other equipment, enzymes and other chemicals, humidity and temperature control, techniques and procedures, valuable experience and many other small "trade secrets" that companies hold near and dear to them!

If only one antibody is desired then above process is applicable; the selected B lymphocytes and hybridomas will produce only one type of antibody.

If the antibodies are produced from a single clone of cells: they are called MABs or monoclonal antibodies.

When antibodies are produced from several different clones (duplicates) of B lymphocytes they are called polyclonal antibodies.

To ensure India gains, biosimilar manufacturing and marketing expertise (just as we have it for chemical based pharma formulations), the drive at Govt. and NGO level ought to be to give hands-on experiences to do various parts of the MAB (monoclonal antibody) science.  For eg., growing hybridomas, fusing B lymphocytes with myelomas, selection of right hybridomas, lectures on HAT medium and its uses etc.  When people learn by doing, talking, listening and teaching about it all, India will be the gainer and we can make a mark in the world with MAB business too!

The preparation-mindset

Not just individuals, organizations need to have this PREPARATION MEETS OPPORTUNITY mindset. It necessarily means having a knowledge rich immersive internal environment in the company, constant learning engagements in the firm and continuous opportunity spotting strategies for having the right preparation strategies.

Biocon could enter MAB business, through this preparation-mindset.  Individuals too need to have a preparation-mindset so that opportunities can be used.

In a world where the information float has collapsed, insights are shared at the speed of light: preparation for change is the key.  Preparation-mindset is vital

Training and the preparation mind-set

Training is not just about creating learning experiences for skill and knowledge development.  Today, it is about creating and actualizing the preparation-mindset.  Making trainees hungry for change and knowledge, making trainees hungry for preparing for a bigger challenge.  That is about preparation through training.

I thank you for reading this blogpost.  I also dedicate this blogpost to Ms. Le Trang M Pharm (Paris) of Hanoi, Vietnam, discussions with whom triggered this 'preparation meets opportunity' concept. Please do scroll down and read all other posts (click on older posts when required), kindly recommend this blog to your acquaintances.

Friday, July 18, 2014

A marketing grid for ROI and results

Marketing is for happy & enthusiastic persons!  It is for those individuals for whom happiness is a habit and enthusiasm is a way of life!!  Marketing is about creating a value delivery process, which finally creates happiness in the consumer.  Marketing is the creation, communication and delivery of value to enhance the exchange process, market penetration and consumption.  Marketing activities should fuel the buzz: strengthen "word of mouth" among stakeholders.  All in all, it should finally create the “feel good” in the consumer/stakeholders.  And for this, marketers have to be happy: only then can they create happiness in the target audience through their "happy marketing activities"! 

Marketers provide value and benefits.  These create cheer in the beneficiaries.  To create cheerful prepositions, the marketer’s disposition should also be cheerful!  A morose marketer cannot create happiness in the target audience.

Pharmaceutical marketers have more responsibility.  This is because patients (like farmers) do not get to choose/bargain - the price of the purchased pharma product - normally.  For instance, a typical farmer in India, takes his produce to the 'mandi' (agri market) and gets the prevailing price of the mandi for his product (he cannot choose the price for his product).  He gets the price for his product in the mandi as per prevailing rate.  

Similarly, the patient, takes the prescription to the pharmacy, and buys the brand indicated by the doctor: rarely does the patient ask for equivalent unbranded generics or cheaper equivalent brands.  In this regard, even though the patient may have a choice, he is like the farmer who is the price taker (not price maker).  Hence, pharmaceutical marketers (who are the price makers) have a lot of professional burden to justify the price for his or her product.

To make a pharma brand succeed continuously - several approaches are required to pep-up the demand: these include in-clinic activity, in-pharmacy activity, taxi tours, stall activity, group meetings (with sponsored high tea, lunch etc) and specific campaigns: targeting doctors and pharmacists - sometimes nutritionists and other paramedical/allied medical people - are also targeted.

It will be useful if one has a checklist or a grid for day-to-day marketing activities.  Here below is a useful tool, I use for organizing marketing promotional inputs (samples, small gifts, print inputs like literatures, prescription pads…), campaigns and other marketing activities:

In the above grid, marketing work parameters are on the left first column for the hypothetical brand: Happy D3 soft chew tablets (60000 IU).  And the first row gives the categories of people or entities to whom marketing collaterals, activities and campaigns have to be targeted.  So in each cell, the marketing person can plan the activity or collateral or strategy (direction for application of resources and efforts).

The price for instance needs to be put in a different fashion to the doctor; and in different terms to the pharmacy (where the pharmacist will be interested in his margin etc).  Promotion refers to the plan of campaigns, in-pharmacy activities, in-clinic activities etc depending on the target category. 

Thus the idea is to use the above grid to creatively produce inputs and strategies without any loose ends.  This helps bullet-proof marketing activities.  This approach will provide better marketing results.  (If you want to see the above image in bigger size, click on the image).

Pharmaceutical marketing is responsible marketing.  Communication (messaging) and other marketing activities are addressed to educated and important customers/opinion builders.  Scientific accuracy is vital in the communication items.  It is after all a matter of health, life and death.  Pharmaceutical marketers can ill afford to be irresponsible.

In today's challenging scenario pharmaceutical marketers in India, have to creatively produce marketing collaterals, campaigns and strategies: while having to balance three things - marketing costs, profit targets, and justified product price-to-patient.  In today’s context, with NPPA keeping a beagle eye on MRPs of pharmaceutical products, it is inevitable pharma marketers control marketing costs and get the best bang for the marketing buck.  Resource constraint and competitor pressures (in the market) with the focus to deliver best ROI (return-on-investment) is the marketer’s stress today!

And despite all these challenges, pharma marketers should have a happy positive attitude; enthusiastic frame of mind, and pharma marketers have to create happy stakeholders too (patients, patient attenders/family members, doctors, other opinion builders, pharmacies, and intermediaries)!
This blogpost says: three cheers to pharma marketers - whose life is a bubble on water, you never know when it will burst - despite a good track record.  Marketers are not umpires, they are players!  So they get-out, get-hurt, or sometimes lose-out!  This blogpost raises a toast to all the pharma marketers out there who wear their best smiles to suppress the worst stresses.  Marketers smile because it is their best proven engagement tool.  Thanks for reading this blogpost, please scroll down and read all other posts, and kindly recommend this blog to your acquaintances.

Wednesday, July 9, 2014

The growing cholecalciferol (Vit. D3) market

Lanolin, obtained as a bye product of sheep shearing, is a raw material for Vit. D3 manufacture.  Please see this link (click here) for an interesting insight!


* Muscle pains, back pains and general tiredness without any specific reason?  Could be Vit. D3 deficiency!

Do you know!?!

* 50% of the global population suffers Vit. D3 deficiency!

* 80% of the Indian population suffers Vit. D3 deficiency!

Vit. D3, the fat soluble vitamin is more than a metabolic participant, Vit. D3 has hormone-like behaviour in the body.  Vit. D3 is born from cholesterol (an interesting steroid molecule with vital body functions), please see the graphic below (!):

Sources of Vit. D3

Vit. D3 is chiefly synthesized in human skin (and skin of vertebrates) by using UVB rays of sunlight (a photochemical reaction occuring in the epidermis of skin).  Vit. D3 in small amounts is also available in foods: milk, liver, dairy products, eggs, fish, cod liver oil and some plants.  Certain lichen produce Vit. D3 (vegetarian source).

Vit. D3 is commercially synthesized by four companies in the world:

a)      Fermenta Biotech, Mumbai
b)      Dishman Pharmaceuticals, Ahmedabad (their plant is in Netherlands)
c)      DSM (Netherlands company)
d)     Zheijiang Garden (China)

Cholesterol is extracted from wool lanolin/wool alcohols left behind when sheep are sheared.  The cholesterol obtained from wool lanolin, is chemically converted to 7 dehydro cholesterol through a 4 step process.  The 7 dehydro cholesterol is then irradiated with UVB rays and purified to obtain a resin-like substance (Vit. D3). 

Irradiation of milk/organic foods also causes Vit. D3 production in the irradiated substance.

1 IU Vit. D3  = 0.025 microgram
100 IU = 2.50 microgram

Doctors recommend: 60000 IU/week for 4 to 8 weeks, followed by 1 sachet/chewable tablet (each of 60,000 IU) one per week. This is particularly for diabetics.

Recommended upper tolerable limit of Vit. D3 (9 years to 71 years plus, including pregnancy and lactation): 4000 IU/day.

RDA: 400 IU to 600 IU (as per age and patient status).  In elderly it is 800 IU.

Market picture in India

Vit. D3 market is rocking The May 2014 MAT (moving annual total) value is Rs. 252 crores (Rs. 2520 million) and has registered 40.8% growth in comparison to May 2013 MAT value (which was Rs. 179 crores market; MAT MAY 2013).

Vit. D3 is marketed as chewable tablets (biggest segment and fastest growing dosage type) (Rs. 87 crores May 2014 MAT value), capsules (mainly soft gelatin capsules) and sachets (powder).  All contain 60,000 IU/unit.

Uprise D3 (Alkem group), Tayo (Eris) and D3 Must (Mankind) are the top three brands in descending order (with MAT May 2014 values of Rs. 22 crores, Rs. 16 crores and Rs. 6.00 crores respectively). 

Vit. D3 is used in animal feeds, dietary supplements, drugs and for fortification of foods (like milk and other dairy products, milk mix beverage powders etc).

Global 2011 annual market estimate of Vit. D3 is USD: 400 million (40 crores USD or approx. Rs. 2400 crores per annum).

Vitamin D3 has an interesting profile.  This fat soluble vitamin is synthesized through a photochemical reaction in the human skin, and then undergoes interesting chemical changes in the body that are summarized in the below graphic:

In the above graphic, we see how cholesterol is converted to 7 dehydro cholesterol, effect of sunlight that provides UVB radiation converts this cholesterol to previtamin D3, which spontaneously isomerises to cholecalciferol.

The Vit. D3 thus formed is equally broken down fast!  Manufacture of Vit. D3 is a continuous process... but the moot point is DO WE GET ENOUGH SUNLIGHT - atleast 30 minutes a day?!  The answer is NO, for most of us!

Hydroxylation plays an important role for further conversions.  The first hydroxylation in liver by 25 hydroxylase converts cholecalciferol to calcidiol.  The kidneys then convert calcidiol that enters it through blood - to calcitriol. This is the second hydroxylation, where calcidiol (25 hydroxy cholecalciferol) is converted to calcitriol (1,25 di hydroxy cholecalciferol).

The conversion of calcidiol to the active form of Vit. D3: CALCITRIOL is as follows:

Calcitriol is a hormone like substance (chemical messenger): it binds to plasma VDBP (Vitamin D Binding Protein) and circulates in blood.  Calcitriol binds with VDRs (Vitamin D Receptors) that are present in a wide variety of tissues from head to toe, to exert beneficial actions!

Vitamin D3 (through mainly its active metabolite: calcitriol in blood) has important benefits:

1)      Improves intestinal absorption of calcium, zinc, magnesium, iron and phosphate (absorption is mainly in duodenum and jejunum)
2)      Regulates level of calcium and phosphate in blood (along with parathyroid hormone)
3)   Required for bone mineralization (influences osteoblast (cells that help form bone tissue) activity) and normal BMD (bone mineral density)
4)    Required for bone remodeling (also influences osteoclast (cells that cause resorption or removal of calcium from bone) activity)
5)    Vit. D3 stimulates immunity: especially binds with Vit. D3 receptors of monocytes, T cells, and macrophages.  Causes production of CANTHELICIDIN from monocytes, an antimicrobial substance.  This antimicrobial chemical has activity against Mycobacterium tuberculosis
6)      Helps in insulin production and insulin sensitivity at peripheral tissues
7)      Strengthens immunity: helpful in influenza & bacterial vaginosis, useful for monocyte – T cell – B cell functions, and for diabetics/other patients who suffer low immunity (body’s resistance to disease)
8)      Required for bone mineralization in aged, diabetics, postmenopausal women and other target groups: helps reduce falls in elderly
9)      Useful in cancer management: Helps reduce inflammation, has antiangiogenic activity (does not promote extra growth of blood vessels that encourages tumour growth), and decreases cell multiplication (tumour growth)
10)  Supports management of autoimmune diseases: multiple sclerosis, diabetes…
11)  Supports management of Parkinson’s disease
12)  Useful in management of osteomalacia (softening of bones in adults), osteoporosis (increased porosity and fragility of bones, leading to brittle bones) and rickets (weak bones and reduced growth of cartilage in children, leading to decreased height gain, bow legs and susceptibility to fractures): Vit. D3 is required for adequate mineralization of bones
13)  Helpful in fracture healing
14)  Supports management of depression
15)  Useful in heart disease, stroke management and hypertension management (Framingham Heart Study has also supported the benefit of normal Vit. D blood levels: >30 ng/ml)
16)  Pelvic floor abnormality results in urinary and fecal incontinence – it is also linked to low BMD etc: Vit. D3 helps in alleviation of these problems in the aged
17)  Beneficial and supportive for cognition (thinking) and retarding macular degeneration (in eye)
18)  Deficiency causes periodontal disease…
19)  Helps maintain levels of certain important enzymes like nitric oxide synthase, glutathione etc
20)  Supports pregnancy health
21)  Required for nerve function, vasodilation, hormonal activity and neuromuscular junction activity

Vit. D3 is a secosteroid with hormone like activity – regulates over 200 genes in the body

Lack of adequate exposure to sunlight on daily basis is a crucial reason for VDD (Vitamin D Deficiency) (Hypovitaminosis D) or Vit. D3 insufficiency/deficiency in modern life.

Normal levels of Vit. D3

Vit. D3 levels are measured as serum circulating 25 hydroxy cholecalciferol (calcidiol) levels: normal level is minimum: 30 ng/ml (cut-off value) (max. up to 74 ng/ml)

Hypovitaminosis D (VDD: Vitamin D Deficiency)

Vit. D3 insufficiency: 25 hydroxy cholecalciferol (calcidiol) levels: 20 to 29 ng/ml

Vit. D3 deficiency: 25 hydroxy cholecalciferol (calcidiol) levels: less than or equal to 20 ng/ml

VDD is defined as serum (blood plasma) 25 hydroxy cholecalciferol levels below 20 ng/ml.

Target groups of people susceptible to VDD

a)      Incidence of VDD is more in obese
b)      Elderly and those with inadequate exposure to sunlight
c)      Malnutritioned individuals
d)     Breastfed infants and mothers
e)      Diabetics/prediabetics (IGT)
f)       People with fat malabsorption
g)      Patients who have undergone gastric bypass or bariatric surgery
h)      People with dark skin
i)        Patients on anticonvulsants, glucocorticoids, antifungals and anti-AIDS medications
If most of your life is in the "shade" of buildings, vehicles, and offices or homes - it is time to get your 25 hydroxy cholecalciferol blood level tested!  Discuss the above insight on cholecalciferol with your doctor or healthcare provider or well-wishers... it will help you!  WISH YOU GOOD HEALTH!!

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