Regain Credibility and Relevance of Pharma Marketing in India

https://www.bodysatva.com/bodysatva.com/in/c/Books/21

abstract from ‘HOP in the Mind’ by Prabhakar Shetty

During the early 1970s and early 1980s the concept of USP (Unique Selling Proposition) worked very well for the pharmaceutical salespersons. Communications were designed to project a USP which had a significant ‘usage pull’ as described by Rosser Reeves. The major pharmaceutical companies were the pioneers or innovators and a significant number of their ‘brand names’ were mentioned in the text books. The therapeutic index of Sarabhai Chemicals or Parke-Davis were much sought-after by the medical profession as handy quick-reference books. The salespersons of such companies were welcomed by Doctors and the interactions were generally cordial or even jovial. The quality and performance of their products was consistent and reliable. Many of the companies providing authentic information had a very high credibility.                                       

Credibility Gap

Coinciding with the opening of the pharmaceutical industry for new players, in the 1980’s came the introduction of the price control regime. A steady stream of ‘me too’ branded generics and combination drugs were introduced in the market. When the USPs got blurred, the companies began to depend on their creativity and credibility for improving ‘brand image’. Somewhere along the path of creativity, the focus and seriousness of the communication was lost. When applying the ‘brand image’ concept to pharmaceutical communications, the serious and serial blunders started.

Whatever applies to the marketing of consumer goods and commodities cannot be blindly applied to pharmaceutical marketing. The increasing competition resulted in more frequent and frenzied communication. Creativity blossomed, and Doctors were flooded with attractive posters, calendars, prescription pads, exotic gifts and table top reminders. The materials received by the Doctor on a single day would occupy his whole table. Even though the prescriptions continued to be on the merits of the product, this practice continues till date, because everybody believes that the Doctor needs reminders. Only if the Doctor is convinced, and has included the product in his 'hierarchy of priorities' - HOP, reminders help to reinforce and strengthen the position in the HOP.

The visuals shown for drawing attention and arousing interest must have a ‘usage pull’. The visuals used must convey the brand promise, a superior benefit, address an unmet need or hint at an emotionally satisfying outcome for the patient. Most of the interest arousers were frivolous or completely irrelevant. Almost all companies adopted the Visual Aid Folder (VAF) as a communication aid. Soon the VAF became a bulky folder with the selling stories of dozens of products of a company. Each product’s story began with an ‘interest arouser’ page trying to build an image, association with relief or visualize a problem that needed to be solved. The interest arouser would show a great promise and the moment the salesperson moves to the next page, it turns out to be the 50th branded generic of an existing molecule. The Doctor who sees about 15-20 salespersons in day will be easily fatigued and irritated by the barrage of frivolous and misdirected ‘interest arousers’. Claims of efficacy or superiority were exaggerated without scientific backing and thereby causing a credibility gap. Very often the claims are wrong, misleading or presented out of context. We can’t afford to get too creative with scientific facts.

The AIDA model of influencing a customer’s buying behavior is generally quite useful in pharmaceuticals too. In the markets where products have patent protection, the AIDA model is quite successful. In the Indian scenario, it may not take the customer beyond the ‘awareness’ stage because there are dozens of brands of the same molecule. More creativity leads to a momentary hope of something unique, but results in further loss of credibility.

This credibility gap has been steadily increasing over the years and today (2018) Doctors seek verification of claims from various sources. They verify from multiple sources on the internet and consult colleagues and peers. The scepticism extends to newer emerging concepts also, when it is conveyed by the MR. The concepts of Endothelial Dysfunction and Metabolic Syndrome were initially greeted with scepticism or denial. Universal acceptance of the newer concepts is now taking 2-3 years, because many Doctors do not trust the results of clinical trials unless it is published by very reputed journals.

It is heartening to note that amidst this chaotic scenario, many domestic companies have maintained and improved their image and credibility. The companies with high credibility back up every claim and sentence with references from reputed medical journals and text books. The claims are presented in the right context with appropriate precautions and warnings and about possible adverse effects and their frequency.

The time has now come for a ‘code of ethical marketing practices’ to be applied by the industry before it is enforced by the Authorities. Collective self-regulation by the pharma industry will go a long way in restoring the credibility of the pharma industry and salespersons. It is never too late to adopt ethical practices of promoting products and regain the credibility of information presented by pharmaceutical companies.

Relevance 

“Research shows that being useful and relevant is the only way to get customers to tune-in” (Kate Sirkin)

The marketing and sales communication should take cognizance of what is already knownto the Doctor and avoid repeating well known facts mechanically or in isolation. Complete knowledge of the Doctor’s prescribing habits, likes and dislikes must be ascertained through accurate market intelligence. Individualized communication that addresses the specific needs of the Doctor will be relevant.  

Remember that the Doctor is an expert in his field and that our messages are being conveyed by amateurs, as compared to the Doctors. Certain catch phrases like ‘most effective’, ‘most economical’, ‘first time in India’, ‘freely available’ and ‘no side-effects’ were frequently used by MRs of various companies. These phrases had become meaningless and irrelevant even in the late 1970s but is used with alarming frequency even in 2018. Attracting and holding the attention of the Doctor was difficult even during that period. The personal friendship or relationship of the MR with the Doctor played a very important part in generating steady business.

The marketing communications were largely ‘skippable’ or of ‘low relevance’ to Doctors even during that period, except when new information was provided. Doctors were eager to lay their hands on emerging scientific information, which was occasionally provided by some pharmaceutical companies. Along with the initial pleasantries; the most frequently heard question was, “What’s new”? The most frequently heard mumbled response is “I know”. It is a signal that the window of attention is yet to open. The first step would be to transform it into ‘I now listen’ by opening the ‘window of attention’ for more than 5 seconds and engaging the Doctor in a dialogue. The communication loop is completed only when the customer responds. During a dialogue the conscious as well as the subconscious mind of the customer gets involved and the evaluation process begins. This is the beginning of the journey into and within the HOP.

Surveys conducted during that era also, indicated that Doctor’s preferred crisp, clear, precise and useful information presented in a logical sequence without repetition. They expected the MR to be pleasant, soft spoken, service-oriented, honest and sincere too.

As a Group Product Manager of Parke Davis in 1993, I was among the first to gift ‘annual subscriptions’ of International Medical Journals to over a 1000 Physicians and Cardiologists. The child-like delight on the faces of Cardiologists was a treat to watch. That was ‘new, useful and relevant’ at that point of time! The novelty wore off in a few years when Doctors could directly subscribe international journals.

Corporate involvement became essential to be relevant to the Medical Profession. Conducting seminars, group meetings, round table meetings, participating in professional associations’ meetings and sponsoring medical education initiatives became an integral part of the promotional mix.

The era of ‘Positioning’ (Al Ries and Jack Trout) was a boon to pharmaceuticals, because the claims became specific to niche indications and the tendency of broad generalized claims diminished significantly. Positioning was better suited for pharmaceutical marketing and sales, even though the concept of USP continues to reign supreme. To some extent relevance was being restored. Like the USP, the Positioning can also be easily copied by other branded generics, but a subtle change had begun. The medical profession started supporting the first product in the market or the innovators as compared to the later entrants. Al Ries and Jack Trout were being proved right in most of the therapy segments. On a macro scale the first entrant or the innovators became brand leaders. On a micro scale where the salesperson operates, the situation is different. The brand leaders may not be represented at all in the area, or the Doctor may have his unique priorities. The salesperson must deal with the individual HOP of each Doctor.

By the late 1990s, Doctors were well informed about prospective new chemical entities (NCEs) that were likely to be marketed in India. Hence when NCEs were launched, the Doctor had prior knowledge about the molecules and the only thing new was the brand name decided by the company. The launch of an NCE would trigger at least a dozen companies to follow suit, each with their own brand name. Soon a sense of scepticism would set in and the ‘new’ would turn into ‘well known news’ and no meaningful differentiation was possible.

Advocacy of a molecule or a therapy protocol, at seminars became one the main reasons for a product or product category to enter the ‘hierarchy of priorities’- HOP in the mind of the Doctor. Many pharmaceutical companies seek endorsements from key opinion leaders or KOLs as they are popularly called. The frequent seminars and continuing medical education programs, conducted by various professional associations of medical specialists, provides a platform for Doctors to share clinical experiences and consult peers. These interactions have a very great credibility factor and strongly influence the prescribing patterns.

Many companies stayed relevant by virtue of their close relationship with KOLs and educational initiatives. Many companies engage the patients and Doctors ‘patient education’ initiatives and ‘detection camps’ which help people to prevent or detect diseases early and begin timely treatment. The leading companies have been ‘very resourceful in being relevant’ to the Medical Profession and have entrenched themselves in the minds of a majority of the Doctors. The resourceful companies ‘engage’ the Doctor by sponsoring educational courses which are relevant to the Doctor and develop emotional bonding with him.

The advent of the internet increased the dissemination of scientific information further. Despite an initial (early 2000) reluctance to adopt new technology, Doctors are now generally internet savvy. The need for information from the Indian pharmaceutical industry has nosedived and is now limited to mundane things like price, dosage forms, packaging, availability and additional services, if any.

As the pipeline of NCEs dwindled, the burgeoning number of companies started launching exotic combinations and the selling efforts became frenetic. The Doctors began restricting the time allotted to salespersons. Pharmaceutical companies with a large list of branded generics, launched multiple divisions. Doctors rarely found anything useful, relevant or new in pharmaceutical communications. Numerous divisions of the same company meet a Doctor, frequently with different brands of the same molecule or formulation. Therefore, the attention span has steadily declined and is probably below 5 seconds in 2018. This is tune with research on consumer behavior globally as explained in Marketing 4.0 by Philip Kotler. It is called the “skippable world’s five-second challenge”.

To add to the mess, innumerable companies insist that salespersons should meet many Doctors 2-4 times in a month. This kind of a directive emanates from the erroneous belief that Doctors cannot remember the brand. This is preposterous because Doctors have excellent memories. The ‘one shoe fits all’ approach of using the VAF is outdated by decades according to the person who pioneered it for a specific situation. Listening to obvious and often irrelevant information from 15-20 salespersons each day, makes the Doctor ignore practically all pharmaceutical communications.

Misdirected communication based on wrong market feedback results in further irrelevance. Frequently the products promoted to the Doctor are distant even from the periphery of the Doctor’s ‘hierarchy of priorities’- HOP.

The products introduced or promoted to the Doctor must match the corporate image or expertise of the company. Cognitive Dissonance comes into play when the ‘perceived image’ of a company does not match with the products sold by them. The subconscious mind simply rejects the input because it is not conforming to the deeply embedded image of the company. GSK is known for innovative products, but it’s brand of Amoxycillin bombed in the market. Innovators are expected to launch NCEs or innovative products. If a company has an established range of products in a therapy segment, it is very difficult to make a foray into other segments. Companies launch separate specialty divisions for that purpose. Likewise, companies with a strong image in other sectors like steel, tyres, petroleum, electronics or textiles made no headway in their pharmaceutical business.

The entire pharmaceutical industry gets vague and non-quantified information about an individual Doctor’s prescription (Rx) habits and patterns. A very significant number of repeat purchases and self-medication also happens. It is impossible for the retailer to give accurate information. A better way of gathering market intelligence is described in the book.

Despite the apparently irrelevant reminders for a long laundry list of products, Doctors continue to grant interviews to salespersons, with the hope that someday he may come across a useful product or concept worth adopting and including in his armoury.

If a Doctor does not prescribe a product, it is because he is yet to decide. We are yet to give him a strong reason to prescribe!

At this point it is worth noting that the Doctor does not have a cure for most of the major chronic inflammatory diseases like Diabetes, Hypertension, Arthritis, Asthma, Cancer, Cardiovascular and Neuro-degenerative diseases. All that he can do is mitigate their suffering or delay the progression of the disease till the inevitable end. The Doctor is searching for solutions to serious intractable diseases and today he is surfing the internet quite frequently and attending seminars and CME programs.

To regain credibility and relevance.

If our selling proposition resolves a problem or an unmet need, we shall be useful and relevant. Sometimes it could be a service to Patients, like the Caregivers Programs for Alzheimer’s disease patients or Cancer patients. This will help us stay relevant to Doctors.

The communication package of the pharmaceutical industry depends heavily on the robust marketing principles used for consumer advertising. However, most of the principles need to be adapted for pharmaceutical marketing. The critical differences and adaptations needed for pharmaceutical marketing are described in my book 'HOP in the Mind'.

The Marketing and Sales Team must undergo periodic training and coaching to individualize the communication to the specific needs of each Doctor. They must regularly update their scientific knowledge to understand the needs and the hierarchy of priorities of each Doctor.

Managers can become more relevant if they coach and guide their subordinates to enter the HOP and convert Doctors. Managers are generally promoted from the ranks for their seniority or relatively better sales performances and that does not make them managers or leaders. A few companies provide classroom training in managerial and leadership skills. Internalization of the skills is however, a long drawn out process.

Today, Doctors and the salespersons perceive no use for the Manager, who makes the joint sales call. Most of them are as ignorant as the salesperson and are unable to contribute usefully during the sales call. They do not perceive any objective for the sales call nor any sense of purpose because they are unaware of the Doctor’s HOP and deliver a standardized monologue communication which is mostly irrelevant. Doctors easily differentiate between the committed well informed manager and the mere spectator. In the presence of the manager, most Doctors tolerate a little bit more of the irrelevant communication, out of sympathy for the salesperson. However, knowledgeable and service-oriented managers are remembered well by the Doctors and it facilitates future interactions too.

The manager must be able to answer queries and have ready access to relevant information. The manager must be able to involve in a relevant dialogue, be fully aware of the specific use of his product and its comparative aspects versus many molecules in the therapy segment. He should be able resolve conflicts amicably and mature enough to respect and accept the Doctor’s professional judgement. One of the objectives before, during and after the call must be to set an example worthy of emulation by any salesperson. The manager’s visit is less frequent than that of the salesperson and therefore he has a very important role in projecting a good image of the company.

Inspiring leadership can make a huge difference in this scenario. An educated, motivated, useful, resourceful and happy salesperson will be welcomed by Doctors and this may go a long way in making us relevant again.

‘Be aware, useful and resourceful to remain relevant’

The whole gamut of pharmaceutical communications to Doctors needs to undergo a major upheaval. Digital media should now be part of the promotional mix, since it is now a routine for patients and Doctors to verify many aspects online. Product specific or therapy segment wise websites can help the Doctor and the patient to quickly access relevant information and ensure proper compliance to medication.

The concept of Maxi-Marketing (by Stan Rapps and Tom Collins) needs to be revisited by all those wish to get on to the digital marketing bandwagon. The concept was maybe a little before its time. With digital technology, it is now feasible to ‘elicit a response’ and also engage the customer in a long-standing relationship. The promotional spend and efforts can be focused on interested, engaged, emotionally satisfied and high-yielding customers. 

Leaders of pharmaceutical companies should now put their heads together and arrive at some viable solutions. The era of promoting a dozen products in a visit, is now over. Pharmaceutical salespersons need to prepare well and focus on only one product in a visit and remind a couple of other products which the Doctor may be prescribing. This will be far more productive for the salesperson and less stressful for the Doctor. Communications should be tailor-made for each individual Doctor with a clear understanding of his ‘hierarchy of priorities’ - HOP. This will be perceived as professional competence and will go a long way in regaining credibility and relevance for our communications.

Apparently this appears to be a tall order. However, in practice it is very productive and yields consistent results faster and with more certainty. Needless to emphasize that it prevents the enormous wastage of time and effort, that is happening in the current circumstances. We need to be aware of the Doctor’s needs and address them with relevant communication supported by confirmatory evidence.

Let’s Reinvent pharmaceutical marketing and become useful and relevant again. 

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