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( By Dr Aniruddha Malpani )

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Chapter 13 - Promoting Information Therapy is good for pharmaceutical companies

Mrs Sethi's persistent dry and itchy skin condition was recently diagnosed by her dermatologist as 'Eczema',a fairly common condition in the medical world. However, Mrs Sethi was not too familiar with it. She went to the chemist to buy the ointment that her doctor had prescribed.

She read the leaflet accompanying the tube, and instead of reassuring her, it accentuated her fears. The side-effects section made her feel that the medicine would worsen her condition, not realizing that such undesirable effects were only reported in large doses and in extreme cases. If the pharma company had provided more understandable and patient-friendly information along with the standard leaflet, it would greatly help assuage Mrs Sethi's fears.

In the past, pharmaceutical companies were held in high regard because the drugs they helped to discover saved lives and helped fight diseases. Today, on the other hand, they get lots of bad press. They are seen to be greedy because they overcharge for their drugs; they waste a lot of money on advertising; they develop drugs which 'treat' unimportant lifestyle issues; and are thought to be unethical because they indulge in underhand practices to encourage doctors to prescribe their medications.

The good news is that Information Therapy provides a great opportunity for pharmaceutical companies to restore their tarnished reputations - and companies which adopt this will become market leaders. Pharma companies have to reach out to two distinct segments - doctors and patients. Let's look at both of these individually, and see how Information Therapy can help pharma companies to do a better job. Traditionally, drugs were prescribed by doctors, and pharma companies spent a lot of money convincing doctors to prescribe their brands. This has become increasingly harder, as the market has become very crowded, and there are lots of 'me-too' brands.

The traditional way companies influenced doctors to dispense their brands was by using medical representatives (reps or MRs). Their role was to establish a personal relationship with the doctor and then to leverage this relationship to cajole the doctor into prescribing their brands. However, this became increasingly difficult, and many companies started resorting to underhand practices (such as bribing doctors or sponsoring them for overseas medical trips) in order to favour their brands. It is also a fact that MRs are no longer very effective.

Doctors have wised up to their tricks, and since they are so busy, many will no longer even agree to see reps anymore!

MRs are an expensive resource, and many companies find that they no longer provide value for money. Since they cannot give the doctor expensive gifts (providing costly freebies to doctors is now illegal under the new Medical Council of India rules), they no longer enjoy as much clout with doctors as they once did.

Pharma companies who want to continue influencing doctors will have to adopt new techniques and many have learnt that providing Information Therapy is a much more cost-effective and ethical solution. Companies have always provided educational materials about their drugs, but a lot of this used to be biased and incomplete. Instead of this, if they now invest in providing doctors with Information Therapy tools - both for continuing medical education for the doctor and for his patients, this is likely to be far more useful to the doctor. A doctor's professional knowledgebase is his most powerful asset and doctors need to be well-informed and up-to-date. Merck has taken a leadership role in ensuring doctors in the U.S. are updated, by providing them with free access to many medical textbooks and journals through their portal, www. Indian companies are starting to follow in their footsteps by gifting medical books and medical journal subscriptions to doctors. Many have started offering doctors free subscriptions to the world's largest online medical library, MDConsult at index.htm, thus creating a win-win situation.

Most Indian doctors now have an internet connection, but many still do not use this for their professional activities. This is a great opportunity for a forward-thinking pharma company. By providing a subscription to MDConsult, the company is encouraging doctors to go online daily to keep abreast of all the latest information. They can then use these online channels to market their products to doctors, without having to spend on MRs! E-detailing is soon going to become the most prevalent method of reaching out to doctors, since it is inexpensive and can be tracked very efficiently. It can be delivered to the doctor's desktop, and it is much easier to reach many more doctors through this route.

As a new generation of computer-savvy doctors in India becomes the leaders in their field, this will become an increasingly popular option. It has been predicted that in 2020, the pharmaceutical industry will spend 90% of its marketing communications budget on digital channels and 10% on face-to-face channels. Medical education will be delivered in a multi-media format and will most often be consumed in doctor's offices. It will be the norm for the pharmaceutical industry to deliver 'whole products' and not just medicines. These will include services and information to add value and deliver better patient outcomes. International medical conferences will still happen, but more than 90% of the content consumption from these meetings will happen remotely and digitally.

While the traditional customer for the pharma company was originally the doctor, marketing to the end-user (the patient or the consumer) has become increasingly important. Doctors write the prescriptions, but it is the patients who actually take the medicines! Since pharma companies want to reach out to consumers directly, they now spend a lot of money on DTC - direct to consumer marketing. This is still in its nascent stages in India, but given the huge impact it has had in the

USA on increasing drug sales, it is simply a matter of time until Indian companies start using DTC in a big way. However, DTC has backfired since pharmaceutical companies in the U.S. have suffered an image problem by releasing dishonest

DTC campaigns, which have been heavily criticized. Indian companies need to be smart and learn from these mistakes. Rather than spend on DTC, which is seen to be advertising, they need to invest in creating disease specific websites that focus on providing Information Therapy to the patient. Disease management is 'trust marketing' - patients log on to websites because they want to learn how to manage their illnesses - and a pharmaceutical company which provides them with reliable information will be seen as trustworthy.

Any time a patient takes a drug, he has lots of questions about it. What are the side-effects? Risks? Complications? A study showing that patient compliance with treatment for high blood pressure was less than 50% revealed the following interesting facts. Many patients are afraid of medications, their side-effects, and the lacklustre attitude of their doctors.

If we need to improve patient compliance, we need to analyse the patient's perspective - and we can do this by putting patients in charge of their game plan, so they can become active partners in their healthcare. A patient who understands why he needs to take medications for high blood pressure all his life does not need cajoling or bullying!

Patients need answers to their questions about their medicines, but doctors and pharmacists are often too busy to answer 'routine' questions. This is why pharma companies are required to provide patient information leaflets with their drugs - but sadly, these leave a lot to be desired. They are hard to read - and even harder to understand! Clever companies can use the patient information leaflet as a valuable tool to establish a direct digital relationship with the patient.

The leaflet could provide the website address where the company provides more information about that drug and the disease it helps to treat. Since the information is online, it can be very detailed and extensive, and this can inspire confidence in the patient. Patients could register on the site and get their questions answered by medical experts, thus getting their doubts resolved. They could sign up for an ezine which would allow the company to provide them with more information about their ailments and available treatments. This kind of permission marketing can help companies to build a database which is worth its weight in gold! The site could act as a nucleus for the formation of online patient-support groups, and expert patients could provide valuable feedback to the company about their wants and needs. This is a major opportunity and will allow clever companies to build a direct relationship with patients - something which is especially important for patients with chronic illnesses. The lifetime value of these patients can be enormous, but sadly, no Indian company has yet taken the initiative in reaching out to these patients, who are now spending a lot of their time online.

Information Therapy gives pharma companies an opportunity to reach these influential patients, because it allows them to create a partnership with the patient. Patient education programs can increase patient adherence and retention and provide an excellent return on investment. For example, patient counselling tools for physicians can increase calls from physicians requesting MRs to come back to the clinics and replenish these tools. Digital, customized patient progress self-monitoring tools can motivate patients to stay in therapy, helping both doctors and patients.

Patient education by pharma companies is not new and Eli Lilly and Co. began its Diabetes Interactive Network in the

USA in the mid-1990s. However, Indian companies have failed to use the internet to bond with their patients. They can learn a lot from pharma companies abroad, which invest extensively in Information Therapy to improve patient compliance. For example, in Australia, Mirixa uses a web- based clinical system to enable pharma companies to use community pharmacists to deliver personalised medication- related patient care. This increases customer loyalty and improves their market share. Pharma companies that offer their patients online value added services to help them manage their disease have already seen how helpful this is. An excellent example is by Biogen which sells Interferon for the management of multiple sclerosis. Why aren't other companies using similar tools? One possibility is that they are worried about whether these sites are compliant with Indian regulations. It is true that they need to be careful since the information which they provide is in the public domain. This means that it cannot be about marketing their product - it has to be about helping the patient manage his disease. This is why Information Therapy can be so helpful - it helps the pharma company focus on the patient's need, and not on their product!

Progressive pharma companies all over the world are using facebook and other forms of social media to reach out to their patients. The affluent Indian is already online, but Indian pharma companies are still lagging behind. If they use Information Therapy to empower patients, they will be able

to reach out to many more Indians - and the general public will once again see the pharmaceutical industry in a positive light and as being an important player in improving human health.