Patient communications needs an accelerated push

Business has only two functions, said Milan Kundera, a Czech author and playwright: marketing and innovation. And nowhere is his saying more visible than in the pharmaceutical industry.

In most instances, marketing is the process by which goods and services make their way from the manufacturer to the end user or customer. For the pharmaceutical industry, however, it’s a little more nuanced and complicated; it doesn’t fit into the same general box.

Instead, think of pharmaceutical marketing as a well-organised information system. For physicians, it’s about the access, availability, effectiveness and efficacy of specific medicines, whether old or new, patented or generic. For patients, the information system aims to provide an understanding of benefits – and risks or side-effects – of consuming medicines.

Which, of course, brings up the issue of marketing budgets and numbers, a touchy subject, and often polarising when compared with other numbers. An analysis by American Health Insurance Plans (AHIP)[1] found that in 2020, 7 of the top 10 global pharmaceutical companies spent more on sales and marketing than they did on new drug research and development (R&D).

GSK ($15 billion on sales and marketing against $7 billion on R&D), Abbvie ($11 and $8 billion), Johnson and Johnson ($22 and $12 billion) and Bayer ($18 and $8 billion) were among the biggest spenders, the other three being Pfizer ($12 and $9 billion), Sanofi ($11 and $6 billion) and Novartis $14v and $9 billion).

For these 10 companies, sales and marketing expenditure exceeded R&D spending by 37 per cent, or $36 billion. Bristol Myers Squibb, Roche and Merck – the remaining three companies – spent more on R&D than on marketing.

What about Indian pharmaceutical companies? Citizen Civic Action Group, a Chennai-based non-profit did a similar 8-year analysis[2] (2008-2009 to 2016-17) comparing marketing and R&D expenses of the 7 largest Indian firms, found that in two cases – Sun Pharma and Cadila Healthcare – marketing expenses exceeded R&D spending. Over the 8-year time-frame, however, R&D spending (INR 41,590.51 crore) exceeded marketing (INR 34,186.95 crore).

The comparison, however, can lead to a false dichotomy, depending on how it is used. Marketing is built around sustaining current products; R&D is a strategic decision that aimed at addressing longer-term, future product development. The common thread across all pharma markets, however, is that close to 90 per cent of all marketing expenses is aimed at the healthcare provider – the physician – rather than at the patient, who is the end-user.

In addition, scientific advancement – the decoding of the human genome – and application of computer technologies – big data analytics and artificial intelligence – have dramatically altered the pharmaceutical marketing landscape. In India, so has regulation, which changed the medical representative-physician relationship forever.

Here’s how.

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For one thing, marketing has to shift from being about the drug – the ‘Product’ – to being about the patient. Not just marketing, but the orientation of the healthcare delivery system is now about the patient. The diagram alongside represents the changed relationship, a change that also irrevocably changes the ‘purpose’ of pharmaceutical marketing.

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For another, the democratisation of health information – thanks to the internet – is helping patients and families in doing their own research about their conditions and related drugs and therapies, especially with respect to non-communicable diseases (NCDs) – diabetes, cardio-vascular diseases (CVD), cancer and chronically obstructive lung diseases (COPD) – that account for over 60 per cent of all deaths in India today.

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Third, the 4Ps of traditional marketing have to be rewritten. ‘Place’ or ‘Promotion’ are ineffective if a fifth P for ‘Patient’ is excluded. When you put the patient at the centre – as the diagram referenced above does – the relative positions of the other stakeholders in the healthcare delivery system also have to adjust.

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Participants in the healthcare system increasingly speak of ‘patient centricity’. Which brings up another ‘P’ that is hotly contested in this particular industry’s context: ‘Price’, that in India is subject to intense regulation. Given the nation’s socio-economic fabric, affordability jostles with access to be given priority.

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For a moment, reconsider the composition of marketing expenditure in pharma. Data from past studies[3] indicates that 56 per cent of marketing spending by companies goes to free samples, 25 per cent to field staff or medical representatives;’ visits to doctors, and about 12.5 per cent on direct-to-consumer advertising (but only in the US and New Zealand). The rest includes ‘others’ such as continuing medical education or CME.

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What’s missing, or escapes mention?

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The recalibration of marketing expenditure between direct-to-provider and direct-to-patient should include effective ‘patient communications’ as a significant component. That needs a multi-disciplinary approach that incorporates disease awareness, disease management and integrated health management into most healthcare conversations, enabled by and with healthcare technology.

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Patient communications is going to matter much more than provider conversations now; it moves control over health management from provider to patient. Ultimately, that’s what patient centricity is all about. Why should that matter?

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Think Maya Angelou, activist and poet: “I have learned that people will forget what you said, they will forget what you did, but they will never forget how you made them feel.” After all she knew why the caged bird sings.

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Christina A. Dsouza is a Healthcare Communications Professional. This article first appeared in @ETBrandEquity: https://brandequity.economictimes.indiatimes.com/blog/upgrading-the-pharmaceutical-marketing-model/90789822

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[1] https://www.ahip.org/news/articles/new-study-in-the-midst-of-covid-19-crisis-7-out-of-10-big-pharma-companies-spent-more-on-sales-and-marketing-than-r-d

[2]https://www.cag.org.in/sites/default/files/database/commitment_of_indian_pharmaceutical_companies_today_to_their_primary_calling_of_curing_diseases_-_a_study.pdf

[3] https://en.wikipedia.org/wiki/Pharmaceutical_marketing