Translating invention into commercial reality

Innovation has always played an important part in the Pharma industry. Since the Darzi report stated that the healthcare system in the UK has a legal requirement to encourage innovation, innovation has become even more of a hot topic. What are the challenges in developing innovative ideas and driving innovation into Pharma marketing? And what are the skills required to meet and overcome those challenges and achieve successful and sustainable market access for new, innovative therapies?

So What is Innovation?

There are many definitions of innovation. At its most basic level innovation is simply the implementation of new ideas. In fact ‘innovation’ is often confused with creativity.

A good explanation of the difference between the two comes from Theodore Levitt, an American economist and professor at Harvard Business School.

“CREATIVITY is thinking up new things. INNOVATION is doing new things”.

Take for example the use of social media. Whilst its use as a part of the healthcare media mix it is not a new idea.  Johnson &Johnson has innovated in utilising a range of new media to achieve marketing objectives across a range of its healthcare brands.

• In Attention Deficit Hyperactivity Disorder (ADHD) the company sponsors a  Facebook® Page to build awareness of adults with ADHD called, ‘ADHD Allies™’.
• And the ADHD Moms™ Facebook Page for mothers of children with ADHD which has attracted more than 8,000 fans since its launch.
• Then there is the “J&J Health Channel” on YouTube which provides educational videos for a range of relevant conditions again including ADHD www.youtube.com/user/JNJhealth that has over 2000 subscribers with over 200,000 channel views and nearly 2 million upload views in only 2 years.

The IBM personal computer was an innovation that changed both the computer industry and society’s attitude to computers. Yet the IBM personal computer contained no new ‘inventions’; indeed the team creating it were charged with taking ‘off-the-shelf’ components already available and bringing them together in an inexpensive and user-friendly way which was above all suitable for home use.

Focussed Innovation

A good start point for innovation is to focus thinking on the key challenges, opportunities and problems facing our brands; gaining a clear understanding of the issues and what needs to be changed.

An example of this focussed innovation is the new bladeless Air Multiplier fan from Dyson, which developed out of a defect in the ‘Airblade’, the energy-efficient hand drier launched in 2006. Despite its jet-like exhaust, engineers noticed that the Airblade was actually trapping a large amount of air inside. Curious about this failure they questioned what could be done with this trapped high-speed air and, using an airfoil-shaped ramp they succeeded in amplifying the airflow 15 times, creating a smooth, powerful airflow, with no need for fast-spinning blades.

Barriers to innovation

However, many organisations are not great at innovation. Too often ‘rules’ are conformed to too rigidly, seriously limiting the motivation to do things differently. Just how often do we hear the words, “But that’s the way things are”? Those charged with coming up with improving the way the organisation works often fear their suggestions will be seen as wrong, impractical or too ‘off-the-wall’, perhaps because those in positions of authority are too quick to criticise, make instant judgements, and above all lack vision.

All too often companies look at new ideas through the lens of what has been done before and look to the future in the context of what has gone before, using existing assumptions and models as the starting point. The result is often a series of incremental improvements to existing products or processes, simply trying to refine or rehash old ideas, but more efficiently.

In the words of Rosabeth Moss Kanter, American business speaker and consultant,

‘Mindless habitual behaviour is the enemy of innovation’.

The process of innovation

The innovation process can be seen has having three distinct stages: invention, translation and commercialisation. This three-stage concept was first outlined by Bruce D Merrifield, US Assistant Secretary of Commerce, in a speech entitled ‘Forces of change affecting high technology industries’ as long ago as 1986:

1.         Invention

The starting point in building innovation into marketing – the invention stage – is to identify and isolate specific ideas, which could be used to address our identified brand challenges however outlandish they may seem, irrespective of whether they might work or not. This can be done in a group setting, in a workshop or ‘brainstorming’ session. Valuable fuel for developing ideas comes from looking at case studies to explore what others have done when addressing similar challenges. Scavenging ideas, learning from others success and failure, both inside and outside healthcare can work well:

“Keep on looking for novel ideas that others have used successfully. Your idea has to be original only in its adaptation to the problem you are working on” Thomas Edison

Specific creative thinking tools such as “reversal” or “random stimulus” can also add real value in triggering ideas

The aim is to generate a wide range of ideas. In the initial stages it is crucial not to get mired in the precise detail of any ideas suggested, nor to be overly judgemental.

The next stage is to isolate the key ideas with sufficient promise to develop further. If there are still too many, apply simple screening rules such as rejecting those that will take too long to implement (say more than a year), and select only those deemed to be ‘innovative’.

2.         Translation /idea building

‘A new idea is delicate. It can be killed by a sneer or a yawn; it can be stabbed to death by a joke, or worried to death by a frown on the right person’s brow’, wrote Charles H Brower in Advertising Age.

“Green housing” helps protect delicate ‘seedling’ ideas, just as a greenhouse protects young plants from the elements, allowing them to grow. The idea behind green housing is to develop and adapt the idea to address the business challenge to make it workable while not being critical or identifying what is wrong. It is therefore vital to suspend judgement until the principle of the idea is fully understood.

Key now is to drive out the essence of the idea by considering what it is trying to achieve, what are the essential components, how the concept can be built on, and what barriers need to be overcome to translate the idea into commercial reality?  Above all, it is about ambition – just what can be achieved by the idea?

Take for example the idea for Risk-sharing programmes for payers. The aim of these programmes is to provide reassurance to payers that their investment in a drug will deliver clinical outcomes plus encourage prescribers to use the product.   They key components would be clinical success criteria, a refund element if success were not achieved, defined timescales, process and legal contracts as required.

3.         Commercialisation or Prototype development

Then think through the detail and consider how an idea could be implemented – the commercialisation stage. The aim is to develop a commercial prototype that translates the idea into what it would look like in practice. It is important still to suspend judgement at this stage, and particularly crucial not to judge whether the idea is affordable or sufficient implementation resource is available. Consider who will be involved (customers and internal personnel), how long the idea/process will take to set up, and what resources, capabilities and competencies will be required.  Also important is to consider what customers’ reaction is likely to be.

In developing a prototype the checklist should consider:

• What is the objective?
• Who is this aimed at?
• How will it work (e.g. inputs/outputs, monitoring etc)?
• Who needs to be involved (internally, externally, and for approval)?
• How long to set it up?
• What resources are needed (financial, human)?
• What are the anticipated results?

For the Risk-sharing example above, developing the prototype is all about the detail of the idea. When such a scheme was developed for once yearly bisphosphonates for treating Osteoporosis in Germany this involved putting in place

• Tracking of patients using the product
• Measurement systems to track the number of fractures which occurred on treatment
• Reimbursing the insurer for drug costs in patients where fractures occurred during the first year of treatment

In conclusion

Using this three-stage process of Invention, idea building, and prototype development it will become clear which ideas are the most interesting, are the best fit with the product/company ambition and offer the best ROI, both locally and for global development. The process also identifies the support and process required to make it happen and keep the idea on track, resulting in a pilotable offering to take forward to the market.

The American historian William Pollard once said that ’Learning and innovation go hand in hand. The arrogance of success is to think that what you did yesterday will be sufficient for tomorrow.’

Translating innovation into practice

1. Identify the brand challenges/barriers or opportunities to which you would most like to apply focused innovation
2. Gain a clear understanding of the issues – the better you understand the problems the easier it is to develop the answers
3. Collect ideas like a magpie:

• Look at how others have addressed similar challenges,
• Bring together brains from marketing, sales, medical etc to provide multiple perspectives
• Maximise the brainpower in the room using creative thinking techniques

1. Collect ideas which offer potential and develop them
2. Build a detailed prototype of what the idea will look like in practise.

About The Author

Gerard Doherty is a Managing Consultant.

Originally published in PM Europe, July 2011

Well now we know. The dust has settled at Westminster, and, for the time being at least, the age of ‘blockbuster’ Government majorities is over, and a new era of collaboration and coalition is dawning. Whether the coalition which emerges from all of this (I am writing this less than a week after the election) survives and thrives remains to be seen.

Perhaps our politicians should be learning from the pharma industry, as they seek to come to terms with the new order, because the era of the blockbuster – the equivalent of a thumping Commons majority – has been on the wane for some time. Instead, those who are bringing new brands to market are increasingly resorting to co-promotion arrangements.

Licensing deals are expected to account for more than a third of revenue for the top 20 pharma companies by 2012 – up from just 17.5% in 2002.

The motivations for this are clear: the molecule owner is seeking to share commercial risk and exploit their partner’s therapy area experience; the partner gets to maintain a presence in the key therapy area.

When a co-promotion works, it brings all sorts of benefits: maximised share of voice through the promotional impact of a larger sales force, with that increased sales force capacity ensuring a successful launch; reduced initial promotional costs through sharing marketing responsibility; boosting sales force expertise in a new market by working alongside a more experienced marketer; and sharing the promotional investment risk of entering a new market.

And yet, it is estimated that 60 per cent of co-promotion alliances fail within five years, as defined by a failure to achieve the revenues expected by the partners at the start of the collaboration, which then leads to each partnering company viewing the agreement as ineffective.

Clearly there are some specific challenges to making a co-promotion work. The prospective partner has to be attracted to the deal in the first place, which can mean a relatively low profit share being offered to the molecule owner. Obviously, there will be an element of reliance on the more experienced partner in the market to drive the promotional strategy. And last but certainly not least comes the challenge of integrating and managing two essentially separate sales forces.

Given that the industry is set to see many more of these co-promotion and licensing deals, it is vital that we learn how to manage them effectively. There are some core skills and competencies which need to be developed to make it work, encompassing branding (to develop a shared vision), people management (to enable conflict resolution) and negotiating skills (to ensure a fair deal for each partner).

A Shared Vision

One driver of success commonly identified by participants in successful partnership is the development at the outset of a shared team vision for the partnership. This can provide a clear understanding of what success will look like for each participant, and also for the partnership.

As a general rule, it is differences in company culture which lead to the biggest points of potential tension. If one culture is slow-moving and the other rapid, for example, or, one takes a more scientific approach and the other a more commercial approach, then unless these differences are addressed, the partnership could be headed for failure.

To avoid this requires common goals and objectives for the co-promotion brand team working in the local market. It also demands that the partners align their ways of working on each topic where there is interaction between the two companies, as far as is achievable given the constraints imposed by the rest of each partners business, before they implement the co-promotion.

It is likely that the co-promotion will support a global brand with a global brand vision. To complement this brand vision, the local co-promotion team could well develop a team vision setting out what the goals of the local team are, based on insights about the individuals within the team and the organisations they work for. The components of the brand and team visions will be the same, but the focus of the team vision will be those who work within the team and the wider audience across each partner company

The two key words there are ‘goals’ and ‘insight’. If these can be brought together to create something which is sustainable, credible, differentiating, motivating and meaningful, then a powerful team vision will emerge.

That means establishing early on the scope of each partner’s aspirations for the alliance, in both a quantitative way, answering the question ‘how big?’ and a qualitative way, defining how significant the aspirations, and how the hoped-for success of the brand will alter the organisation for which individual team members work. It is a question of agreeing not just what the partnership can be, but what the partners want it to be to meet each individual company’s goals.

Insight is important because it allows each partner to understand their own and their partner’s thinking, how each will look at the market opportunity, and what each party’s strategy really is.

Out of this should come a set of core values, which are the active words which reflect the shared team vision, and which both partners wish to associate with the team over time. Crucially, these need to be demonstrated not just in the brand vision, but also in the tone of voice and style of all communications associated with it.

Getting The Structure Right

Guaranteeing a harmonious co-promotion team at the start of the agreement may be impossible, but taking the time at the outset to design the processes which will facilitate collaborative working and help efficient decision making is likely to pay dividends for the team in the long term. Putting in place conflict resolution procedures often serves as a good way of avoiding conflict in the first place; the development of a team charter setting out how individuals should work within the team acts to limit the frustrations which could poison the effective working of the team..

To determine what the team structure might look like, it is necessary to think about a number of factors, including the key activities and outputs that the joint team will be expected to deliver, which of these will be delivered collaboratively and which exclusively within one of the partners, and what overall behaviours will assist in that delivery.

A good starting point is to allocate the key tasks and outputs which have been identified in the co-promotion’s marketing plan by discipline. So, for example, the strategic plan and the marketing communications plan will need to be undertaken by the Marketing function; Phase IV and KOL management by the Medical function; customer management and targeting by the Sales function; tracking and monitoring, along with ad hoc research by the Business Intelligence function; AE reporting and licence renewals by the Regulatory function; and so on.

Once you have identified these functional responsibilities, you can now start to create a structure where it is explicit whether each activity will be the responsibility of one partner (and if so, which one), or a shared responsibility. This way there is no room left for doubt about who is responsible for what, and thus far fewer opportunities for conflict further down the line.

It is important here to think about the informal structure as well as the formal structure. Often, informal contact plays a big part in oiling the wheels of success for partnerships, but if you don’t think about how that informal contact will work in advance, you risk losing control of the situation, with the possibility of conflict, misunderstanding, or worse.

So a structure and protocols need to be put in place that cover communication, approval and sign off procedures, conflict resolution and reward and recognition.

Negotiating A Solution

“In business you don’t get what you deserve, you get what you negotiate” – wise, if slightly clichéd, words from the negotiating guru, Chester L. Karrass. But it has some resonance here, because the initial negotiations to set up the joint venture are vital if it is to be long-lived. After all, it will only flourish if both partners feel that they are getting something out of it.

Experience suggests that these first negotiations can be tricky, as each side comes to the table with a relatively fixed idea of what the co-promotion will look like. But it’s worth remembering that however committed the other party appears to be to their position, they would not be involved in negotiating if they were not willing to consider moving towards an agreement.

Preparation is the key here, and each party should enter the negotiations having identified and prioritised areas that need to be agreed under a local contract. It is important to have examined the likely position of the potential partner, as well as identified their underlying interests. Such negotiations often break down either because a lack of confidence leads to concessions being given away too quickly and/or easily, or because an inflexible position is adopted, which focuses on the party’s own wants, rather than on achieving an outcome which is a genuine win:win.

12 Steps To Clarity

If open communication is vital to a successful partnership, then clarity is the underlying foundation to this. To make a co-promotion work, you must develop an action plan which sets out clearly the responsibilities within the partnership (i.e. who does what), the key deliverables, and the timing.

With this in mind, let me close by suggesting 12 questions which you should be confident you can answer in order to manage successfully a co-promotion:

1. Do you have a shared vision, values and strategy for the brand?
2. Have you aligned your financial and market share goals and milestones?
3. Have you identified the investment requirements and budgets by year, and agreed the percentage splits between partner companies?
4. Have you undertaken joint strategic and operational planning, including approval processes and an implementation plan?
5. Have you aligned the operating teams across the various functional disciplines?
6. Have you agreed whether individual companies will have any independent operating freedom within the joint venture, and if so, are you clear in which areas, under what circumstances, and to what budget level?
7. Have you aligned the sales teams and territories; established reporting systems; clarified how ETMS and CRM information will be exchanged; agreed sales KPIs?
8. Have the sales teams been trained, and their language aligned?
9. Are contract terms watertight? Are roles and responsibilities clear? Is authority – by discipline and overall –sufficiently clear?
10. Have inter-company communications channels been set up, including establishing a co-promotion ‘dictionary’?
11. Are financial and reporting procedures aligned?
12. Have processes for arbitration and conflict resolution been put in place

Managing A Co-Promotion: Some Dos and Don’ts

Do:

• Agree in advance:
  • The contribution of each party to promotional and market access programme, and why
  • The competencies and skills each partner will provide
  • Individual measures of success, and contribution to the overall programme

• Define and agree clearly the parameters for negotiation
• Define at the outset timelines and deadlines for process, and identify interdependencies
• Identify and outline scenarios, contingencies and triggers
• Define what is outside the scope of the agreement

Don’t:

• Allow ambiguity in the ownership of the agreement
• Indulge in opportunistic conversations – keep communications within the scope of the agreement
• Allow egos to get in the way, especially if this leads to ignoring customer needs
• Hoard information

The Author

Gerard Doherty is Managing Consultant at The MSI Consultancy.

Originally published in PM (Pharmaceutical Marketing), June 2010

The healthcare industry is changing. In Pharma, the new rising commercial leaders, business unit heads, marketing managers, have both business and team responsibility. Change is a given, the time frame for which the organisation is vulnerable is up for grabs!

What are the core skills needed to retain drive behind business objectives and manage a team in this new changing landscape?

Time for change

So, why is change on the agenda? The current drug development and commercialisation model is simply not working is the answer. New medicines discovery and approval is down; generic competition is fiercer than ever, and blockbusters are a rarity. Our industry is entering a new health landscape, and its success will be determined by how well risks are navigated and opportunities created and seized.

One way to survive the changing environment is through mergers and acquisitions. Companies go through the pain and challenge of mergers and acquisition with the vision that the larger merged organisation will be able to generate more value than the separate entities.

Whilst in many cases there is a positive impact on factors such as revenue growth and product pipelines, surveys suggest that M&A frequently impact negatively on operational excellence initiatives, information technology systems and infrastructure, culture and understanding, and, most critically, staff morale and performance.

Marketing leaders have their skills tested to new limits whilst an organisation morphs and adapts for survival within this changed environment. The skills required to drive the commercial success of the brands through a cross functional team of skilled individuals during change takes on a new dimension. The team needs nurture, adjustments need to be made, and team dynamics need re-evaluating before focus can be restored.

However, irrespective of internal pressure and change, it is paramount that the organisation regains its focus; with minimal impact on business objectives and deliverables in order to fulfil commitments to patients and customers and remain competitive. At this point in time, the threat to success is not the competition, the products, or the market; it is our people.

What is it about change?

Change is necessary, yet nothing is as upsetting to your people as change. Change can generate uncertainty, confusion and even a sense of loss; principally emotional responses that need to be treated with sensitivity and understanding.

From a business perspective, this has a significant knock on effect, creating the potential to cause dramatic loss of focus, falling quality and decreased productivity, which can take deep hold and not release its grip until individuals have moved through their ‘change curve’, which, if left to their own devices can take any length of time.

The change curve, a behavioural model of group and individual reactions, describes a number of stages moving from satisfaction; denial, resistance, exploration, hope and finally commitment. This tool in itself provides marketing leaders with valuable insight and a way of tracking how people are feeling and once diagnosed appropriate support and guidance can then be offered.

The obvious problem is that during times of change, the preoccupation with internal and personal politics, the consequent falling productivity and missed deadlines all have a detrimental impact; exposing our business and making it vulnerable.

It is a known fact that in the competitive environment that is the pharmaceutical industry, we thrive on companies going through any type of change. Why? Because we know their eye is off the ball and we have an opportunity to step in and take advantage. The longer a company takes to regroup the better for the competition – our feast continues until order is restored.

It is not surprising, therefore, that change creates opportunity for others; our business plans are implemented through our people; without the focus of our people on the business, objectives are left unmet and achieving our commercial goals undone.

Mark Sanborn, an internationally renowned leadership development speaker, succinctly states “Your success in life isn’t based on your ability to simply change. It is based on your ability to change faster than your competition, customers and business.”

The role of the marketing leader is therefore not to prevent problems or even slow the regularity of change, instead it is to focus on accelerating the individuals within the team to accept, adapt and commit to it. The ability to work together as a team and quickly tackle any and all situations, or decide not to, is your ultimate competitive advantage. The quicker a team can re-form, align and work together towards clear objectives the less time we are vulnerable as an organisation.

Balance of heart and mind

The key aim of any commercial manager, be they business unit head, marketing manager, or general manager is to improve the performance of the organisation. This means not just focusing on the figures. Successful marketing management involves recognition of not just the price and product but also strategic analysis, contingencies, risk, delivery, strong customer and suppliers relationships and getting the right people on board to deliver the business plan objectives.

Despite a likelihood of proven business acumen and significant commercial success, managers may not have the required level of people management skills, such as change leadership, team development, conflict resolution etc  to overcome situations where this change, whether internal or external, impacts the team’s ability to deliver against the plan objectives.

Every manager has a level of man management skill. To be commercially successful you have to collaborate, influence and negotiate with people irrespective of managing a team yourself.

However, how polished are these skills? How confident are you that new commercial leaders have the breadth of skills needed to drive teams to function optimally during times of change? Will change, whether it is new process, new thinking or new behaviours; gain results and be adopted quickly and effectively?

Whose role is it anyway?

Individuals within a team hold the responsibility to do their best, which is different for every person and depends on a wide variety of factors (health, maturity, stability, experience, personality, motivation, etc).

In addition to commercial direction, the responsibility for managing, leading, developing and inspiring the team resides with their manager. The marketing leader’s role is to facilitate and enable each member of the team individually from an objective standpoint and measure their performance against specific business deliverables.

This is a complex role; one which we need to ensure we are not scared of but instead treat like the ocean; with the respect it deserves; because to get this wrong jeopardises the future success of the organisation.

In order to overcome fear we need to understand it. Look at the role from every angle and appreciate the connections between leadership, commercial management and people management and understand how that relates to the business plan deliverables. Through change people need a constant; the anchor point for every individual is the plan.

Adapting to and accepting the change?

Firstly, it is important to clearly establish the nature of the change for the team. If the team is newly formed then the requirements start at a different point from say an experienced team facing loss of exclusivity on a product.

Once the team position has been established, the leaders have to then decide which ‘people management’ skills need to be adopted on top of the ‘business management’ skills to address the scale and nature of the issue.

Leading teams through change

Change leadership is defined as the strong, visible and aligned leadership of the end-to-end of the implementation process. The business plan therefore, roots every individual and gives common purpose during times of change.

Whatever the change or changes you are trying to implement with your team, the change has to start with you. Evaluate how this change may impact the plan. Will it mean less resource? Does the change mean you have acquired more products within your therapy area and now your resource is spread thinly? Do tasks need to be redeployed and you need buy-in from your team to take on extra responsibilities? Does the team need to expand or get smaller? How do you ensure that everyone is still doing a thorough job?

The role of the leader is to provide a strong ‘vision’ of where the organisation/business needs to get to and what that will look like when you get there. Taking steps to bring the team with you along the way is key to keeping the business plan on track and making your ‘vision’ a reality that others will want to be a part of.

Communication is key. Communicate, model and reinforce on an ongoing, committed basis the change you want to see in others. As a leader of a cross functional team it is imperative that this can translate across roles and functions e.g. marketing, medical, sales, public relations, training, clinical research etc and bring the plan to life for all involved.

Understanding of how the process of change impacts on performance can be advantageous when planning; especially as during the transition state, performance and productivity undoubtedly plummets. Knowing and understanding this and preparing for it during the business planning phase can help you minimise risk.

Leadership – which style suits your team and goals

Leadership style is the manner and approach of providing direction, implementing plans, and motivating people. Kurt Lewin (1939) led a group of researchers to identify different styles of leadership. This early study has been very influential and established three major leadership styles;

Authoritarian or autocratic; when leaders tell their employees what they want done and how they want it accomplished, without getting the advice of their followers.

Participative or democratic; the leader including one or more employees in the decision making process (determining what to do and how to do it). However, the leader maintains the final decision making authority.

Delegative or Free Reign; in this style, the leader allows the employees to make the decisions. However, the leader is still responsible for the decisions that are made.

Although good leaders use all three styles, with one of them normally dominant, bad leaders tend to stick with one. The implications of the change to the business will inevitably necessitate adaptation of your leadership style as the team goes through different phases of the change. For example if the team is at a point of fear or anger, a consequence could be paralysis of action, it may then be necessary to adopt a more authoritarian approach.

Through understanding the leadership style that you naturally display and that which would best suit your team at each phase; you can ensure that your leadership is followed and you build a high performing team.

Developing high performing teams

Change may have altered your team, you may have a new team, it may be a different size, occupy a different remit. An inclusion or exclusion of even one individual will give rise to a new dynamic which may necessitate reforming of boundaries through team building techniques.

This needs careful management. Our industry often suffers from ‘The Apollo Syndrome’ where teams of highly intelligent people often perform worse than teams made up of more mixed ability. So members will need to be managed and supported appropriately.

Development, either individual or team is a method to keep motivation and productivity high. What are the main criteria for development? I.e. who should be developed, why and how?  Do you develop everyone who asks for it or do you think more strategically; to meet the key strategic goals? Should it be used as reward or for retention purposes?

It is widely accepted that the 70:20:10 development philosophy is the best way to develop individuals: through on-the-job experience (70%); relationships, networking and feedback (20%); and formal training opportunities (10%).

The majority of development should ideally and can be achieved on the job, through stretching individuals while supporting them with constructive feedback and coaching. Something that requires sophisticated people management skill to perform successfully and although talked about at length within organisations is seldom executed well. As a leader do you have the necessary skills and knowledge to facilitate this process?

In conclusion

It is clear that people management skill and ability are inextricably linked to commercial success. Recognising the vulnerability of the business during change and understanding the process and tools to enable change to happen is critical. This equips leaders to make predictions of the pitfalls and opportunities relating to performance that are likely to impact on the plan and help marketing teams get back in the game following change. After all, our plans, our strategies our objectives are but words without the individuals who implement them.

It is crucial to ensure that leaders are confident to manage the complex and diverse reactions we humans have to change and restore calm and focus, using the business plan as an anchor point. We have all encountered someone during our career that we have referred to as being ‘not a people person’ and can recall the negative impact it had on us within our career development and ability to perform effectively. It is therefore safe to say that these skills do not come naturally to everyone. The process and techniques however can be learned and applied to any situation to ensure our teams are supported to put our values into action and make vision a reality.

The Author

Theodora Anastasi is a Consultant at The MSI Consultancy

Originally published in Pharmafocus,  February 2010

Paul Stuart-Kregor goes in search of maximum organisational innovation.

The pharmaceutical market has changed out of all recognition over the past decade or two – and continues to change at an alarming rate.  So the pharma industry has had to be good at responding to that change, given that the environment in which it operates is in a constant state of flux, driven by political imperatives, technological advances and regulatory strictures.  By and large we have coped well with these constantly shifting sands.

However, one area in which the industry does not seem, as a rule, to have kept up with the pace of change is the way in which companies organise themselves.  Innovation has been the lifeblood of our industry but with R&D productivity decreasing we need to look at driving success in other ways.  To what extent have we introduced innovation into our business models – or do we tend to favour the ‘tinkering at the edges’ approach?

Historically, the traditional ‘blockbuster’ approach, with large sales forces and high promotional spend to achieve a high share of voice throughout the entire product lifecycle, worked well and delivered good profits.  This in turn led to the growth of ‘mega’ organisations with ever-increasing promotional muscle, and economies of scale realised through ‘mass marketing’.

However, not even the most nostalgic and change-averse marketer can claim that this model is relevant today.  We can now see that the organisation of marketing around product, brand, therapy or franchise marketing teams in silos, supported by functional specialists (market research, health economics, medical, etc) can lead to ivory tower thinking, divorced from reality and, worse still, from the customer – as well as a lack of synergy across brands and conflict for limited resources.

More importantly, there are a number of pressures which are driving the imperative for change, forcing companies to re-evaluate their business models.

Pressure For Change

External factors come into play here: the healthcare environment in pretty much every country is going through radical changes due to shifts in the social, economic and political climate, with the UK leading the way in some respects.  A major part of this has been the challenge of funding healthcare, which has resulted in the introduction of a number of new stakeholders and hurdles at local, national and supra-national levels, with a shared agenda of driving down prices and controlling costs.

Consequently the focus on accessing and influencing one type of customer, the prescriber, and influencing their perception of product performance is long gone.  Instead we must work with a wider customer base whose needs are broader and more diverse than having a (marginally) better product.

Within the industry, the productivity of R&D functions continues to decline, with fewer products coming to market.  ‘Blockbuster’ products are increasingly rare: in the 1990s, over 90 per cent of NCEs introduced had sales of less than $500m worldwide, and this situation is not likely to improve anytime soon, if ever.  Because of this, companies are changing their R&D strategy, with a greater focus on speciality product and niche market sectors such as oncology.

The complex task of building and supporting these specialist franchises in multiple therapy areas, while at the same time maintaining existing product portfolios, is forcing companies to significantly alter their cost bases to maintain profitability.  This inevitably means looking at the efficiency of the organisational model.

Because of all of this, the existing, traditional model is not working.  So what is the alternative?  Actually, there is no single solution; the right operating model has to be developed to fit each company’s market, portfolio and competitive situation.

The Principles Of Organisational Design

If we are to set about re-designing our organisations to make them fit for purpose, we must understand two things: the kind of competitive market in which we are operating (about which more later); and the basic principles of organisational design.

Different parts of an organisation play different roles in the creation of products and services, and their delivery to customers.  Mintzberg argued in the ground-breaking paper entitled ‘The Structuring of Organisations’ that any organisation consists of five basic parts:

1. The Strategic Apex: the people charged with the overall responsibility for the leadership of the organisation.
2. The Operating Core: the people who perform the day-to-day work which is directly related to the delivery of product/services to customers.
3. The Middle Line: the middle managers who direct and supervise the operating core, linking day-to-day operations with the strategic goals as set by the apex.
4. Support Staff: functions which support the organisation outside the normal operating flow of activities.
5. Technostructures: the specialists/experts who design the systems and processes of the organisation that support the overall workings of the business.  Examples include product planning and forecasting experts, IT, R&D personnel, recruitment and training staff.

The organisational designer needs to understand and take into consideration the appropriate interaction of each of these elements when developing an operating model which best ‘fits’ an organisation’s needs.  All of which is fine – but if our aim is to achieve a customer-focussed organisational model, then surely the most important consideration should be the nature of the market in which we are trying to compete.

Customer Need At The Hub

Many businesses – and not just in the pharma industry – organise themselves in a way which is easiest for HR managers.  This can result in cosy, stale environments, when the driving force becomes internal convenience, not innovation.

If your model is going to be truly customer-focussed, then commercial and market needs should be at its hub.  Traditional marketing structures don’t always do this.  Organising marketing around product, brand, therapy area or franchise marketing teams, based in silos and supported by functional specialists, inevitably results in people in those functional specialisms leaving the marketing thinking to the marketers in that silo.  This suggests that they have nothing to contribute to understanding and meeting customer needs, which is patently nonsense, and an almost negligent waste of real customer knowledge and expertise.

I mentioned that there was no ‘one size fits all’ solution to reinventing the organisational model.  The approach you take has to depend on your market environment.  Most pharma companies now have to go far beyond influencing prescribers; acceptance must now be gained from a whole range of different stakeholders such as pharmacoeconomists and HTA bodies, regional gatekeepers, and local care networks.  Engaging with each of these stakeholders requires different skills, capabilities, roles and organisational structures to meet market needs and compete effectively.

Whilst every company’s situation is different, I would argue that there are four basic types of market sector, each of which will require a different approach to creating the organisational model (although they all share the imperative that customer needs should be at the centre of things).

Blockbuster: Typically centred on brands with a strong value proposition, in relatively uncomplicated and often primary care markets.  These are products with therapeutic benefit, patent protection and in some cases value added services.  Structurally, this category is typically characterised by large primary care field forces and significant promotional expenditures with most focus on driving physicians’ adoption.

Me too/generic market: This is where the blockbusters give way to an increasing number of similar products or generic alternatives.  Once the basic requirements for efficacy and safety have been satisfied, and there are many me-too competitors, the nature of competition focuses on exploiting small advantages, unique niches or segments where the product can differentiate itself from the competition. However, given the relatively slight differences between options, purchasers focus upon minimising the acquisition cost of treatment.  Focus is on who can achieve the lowest prices whilst reassuring customers that all other important factors are at least equal – so managing the cost base is the driving force.

Speciality Therapy Area: Products in this sector are typically prescribed by specialist physicians e.g. Oncologists, Gastroenterologists.  Smaller target audiences allow for greater focus, with more targeted sales and marketing activities. The need for large sales forces and significant promotional spend is reduced; it becomes more important to be at the forefront of scientific innovation, generating a steady stream of clinical data.  Medical and marketing interactions should be to inform and guide medical opinion. There are often multiple stakeholders in the purchasing and prescribing decision process which requires appropriate market access capability.  Competitive advantage comes through ‘thought leadership and shaping activities’ rather than dominating through advertising and promotion.

Rare and Orphan Disease Indications: Drugs in this sector are generally life-saving, address a significant unmet clinical need – and may be the only product available to treat a very rare condition.  Typically they are highly priced and are prescribed by a limited number of ultra specialists.  The model therefore needs to focus on key opinion leaders and patients, along with market access, which in this case is not limited to securing permission to prescribe but importantly includes sourcing the funds for these extremely expensive therapies.  Commercialisation of these products requires an integrated disease management approach, incorporating sales, marketing, medical and market access. Being first to market is critical.  Partnering with key centres to establish best treatment practices, risk sharing programmes is critical and involves the provision of bespoke solutions.

Common Success Factors

Each of these categories requires a different, bespoke approach, as the needs of each market are clearly very different.  But there are also some commonalities which will ensure that the organisational model is fit for purpose, a set of structural success factors which ensure that customer focus and innovation come to the fore.

One key factor is that marketing cannot just be left to the marketers – all functions need to be involved, which is why true multi-functional teams play a key role in many successful organisational models.  By involving non-marketers in the marketing process, you open it up from marketing communications to being more strategic.  Multi-functional teams don’t even have to be led by a marketer – it could be a medic.  A controversial suggestion to make in the pages of Pharmaceutical Marketing magazine, perhaps – but we must be ready to think innovatively.

The model organisation is one in which business plans – and marketing plans – are developed from a viewpoint of a vision for the future that is truly understood from both the corporate and the customer’s perspective – not just the marketing ‘pigeon-hole’.

It is one where clinical trial planning and evidence can be used at an early stage to provide segment-specific marketing information, and focus marketing resources where they will be most effective.

It is one where functional specialists, with their own perspective of the customer, contribute to building the whole picture of the customer and their needs.

Finally, it is one where everyone who has to implement the strategy is involved in its development – so that the organisation has the flexibility to adapt to those ever-changing market conditions.

The Author

Dr Paul Stuart-Kregor is Director of The MSI Consultancy.

Originally published in Pharmaceutical Marketing, February 2010

Sandwiched between the national policy makers and the local delivery Trusts are ten regional Strategic Health Authorities. The decisions they make have a big bearing on the pharmaceutical industry – so how should we be influencing those decisions? Gerard Doherty says that understanding their agenda is key.

In the shifting sands that is the NHS structure, one of the most difficult tasks for the pharmaceutical industry is that of identifying who is making the decisions, and more importantly finding ways to influence that decision making process.

Whilst the individual clinician – so long the focus of the industry’s sales and marketing efforts – still exerts some influence, there is now a whole raft of other bodies which in effect make most of the choices which will determine the success or otherwise of many of the pharma industry’s products. So getting the right messages in front of the right people is both complex and absolutely necessary.

We are now at the situation where we have three tiers involved in the process. At the national level are the policy makers. At the local level you have the bodies that we all interact with as much as possible, those closest to the patients themselves: the PCTs.

Since 2006, sandwiched in the middle, have been ten Strategic Health Authorities (SHAs), rationalised from the 28 which were first created in 2002. With a new statutory obligation on them to drive innovation in the NHS (see box), they have been much in the news.

But what is their purpose? What value are they to the industry? Why and when might we want to interact with them? And how should we go about doing this? Should we be taking the same approach as we do elsewhere in the NHS?

Essentially they are there to ensure that national policy is implemented on the ground. In addition, although there are many things that the PCTs can happily manage at a local level, some areas of the health service require a broader view.

The two key things which SHAs do that make them important for pharma are Mass Service Provision and, in particular, Area Specialist Commissioning. The former is about providing services which, by their nature, need to be organised at a regional level to ensure effective use of scarce NHS resources such as Dexa scanning for management of osteoporosis. It’s a question of economies of scale, keeping provision within a region, but not necessarily within a locality.

Regional or National Outlook?

The rather more important area for us is Area Specialist Commissioning. The ten SHAs have a specialist commissioning role across a raft of therapy areas, things like paediatric intensive care and children’s and young people’s oncology. And as we shall see, their role here is as much national as regional, so they play a big part in shaping policy.

The specialist commissioners are within the SHA; their job is service provision for those specialist areas, and they will dictate what that service provision looks like. Knowing how that commissioning cycle works, and what and who influences them, is key to influencing these important decisions. If you can reach and influence the right people, it is going to have a multiplying effect, which is much more effective and cost-efficient than trying to do this on a PCT by PCT basis.

There are 35 specialist commissioning areas, and one SHA will take the national lead in each. This means that the SHAs are de facto working on a national basis, albeit that they are individually regional bodies – in effect making common policy decisions and then ‘imposing’ these on a local level.

One of the big issues here is trying to eliminate health inequality – so-called ‘postcode prescribing’. The SHAs are trying to come to a consensus; so unless there is a really good reason, they won’t want to do anything different from everyone else. There will be occasions where individuals SHAs don’t buy into the national consensus, usually driven by geography or demography. But these are the exceptions rather than the rule, and overall the SHAs are driving towards equality of access in all regions.

From a pharma point of view, you could argue that this is making life a bit easier, because if we accept that knowing the market is crucial, it’s much easier to do this on a common basis. In effect the SHAs are implementing regional, super-regional and national policies, and that consistency simplifies matters.

So you wouldn’t expect necessarily to be driving different policies in each SHA; what you want to do is make sure there is a positive view of what you are doing across all SHAs –although you might focus on the one which has the responsibility and which is taking the national lead for your particular therapy area.

Pick Your Target

But even if we know that one SHA is taking the lead in a particular therapy area, we still need to know exactly who is making the key decisions – and just as importantly, who might influence that decision maker.

At first sight, the Specialist Commissioners are the obvious target, but in fact there are so many influencers who are better targeted, who are providing the Commissioners with the information and the evidence they need to take the commissioning decisions.

The Commissioners are the decision-makers; but they are not the experts. They may be making commissioning decisions in an area of medicine in which they are not specialists. And they are not going to take advice directly from the pharma companies, because they will view them as having a vested interest, and they couldn’t have an educated conversation with them.

In fact, the Commissioners are basing their decisions on the evidence they get from others (especially Public Health Consultants), so it makes sense that the biggest influence that pharma can have is to ensure that those influencers are armed with quality evidence.

In organisations which are taking decisions about the prioritisation of budgets, the role of patient associations are also significant. These are a very voluble way of getting things up the priority list. So you need to cultivate your patient group relationships, because they an influencer group taken seriously by the key people within the SHAs, as well as the public health professionals who are advising them.

Unless SHAs have the condition your drug is for high on their priority list, then you won’t succeed. Patient groups are lobbying for ‘their’ therapy area on a national level, although SHAs are of course interacting with patient groups in those areas where they are taking a national specialist lead, which is another reason for knowing the specific interests of each SHA.

Align Your Agenda

So within – and around – the SHA structure there are a number of different roles, each of which need to be approached in different ways, and with different messages, or at least difference emphasis of messages. But the overarching principle is align your agenda with theirs, and don’t try and sell too much – simply demonstrate how you are meeting their needs, you need to sell to their priorities.

SHAs approach budget planning in exactly the same way that we do in industry, and it’s useful to know their timetable. From June onwards, they are looking at the investment requirements and the priorities for the following year. By September, they have the first-cut investment plan, which is then debated and redrawn during the months leading up to December. The plan is approved in January, coming into effect with the new year in April. If SHAs are important for your own therapy area, then you need to think about whether you should be aligning your brand planning cycle with the SHA planning cycle.

Although some in-year budgeting on a reactive basis does happen (based on ‘exceptionality’ rules), you really must interact with this planning process way in advance, because they much prefer planned budgeting.

SHAs make much use of horizon scanning, looking at what is potentially going to impact on budgets. This is commissioned nationally, but the SHAs use it as an important resource, so it is equally important for pharma. If you can influence the horizon scanning process, it will indirectly influence the SHAs in the decisions that they make on a regional and national lead level.

You can’t influence the outcome of horizon scanning but you can affect the direction by providing information. Disclosure is a good idea, by all means give full information so that the conclusion of the horizon scanning is accurate; but then, make sure you know what the horizon scanning is saying, because that is the information that the SHA will be using to influence its own decisions. You need to link what you are saying to the SHAs to what they are reading in the horizon scanning reports.

SHA priorities are not just about cost, but they also consider delivery of therapies and all the other issues involved. So you need to be thinking about the other implications of your medicines – for example if they work in conjunction with other therapies or approaches. The SHA is there to take that overview of the bigger picture.

Pharma should be thinking not in terms of being a supplier of drugs, but as being one of a chain of suppliers of therapeutic solutions, which means understanding what our place is in that alongside others as well. Be aware that you are not the whole picture.

To influence the decisions being taken at SHA level, pharma needs to understand what their priorities are, and then make sure that the way it positions itself means that the pharma company is seen as having priorities which mirror them.

That means undertaking early dialogue with them – at a senior level – to ensure that you understand exactly what is going to be important to the SHA; and it also means early disclosure of information and in particular good quality evidence to help influence that prioritisation process.

But it also means making sure that your agenda is – and is seen to be – aligned with theirs. As with so many parts of the NHS, there is still an innate wariness about conflict of interest, and credibility is key. That means you must have a consistency of brand message – you can’t be saying different things to SHAs just because you think that will convince them that your priorities are aligned; you must be saying the same thing to NICE, SHA, PCTs and all other influencers.

And although there might be regional specifics, remember that there are only ten SHAs, so they will talk to each other and will be looking for consistency of policy.

Now that the SHA structure has settled, and given their new obligations such as innovation (which are not, as we have seen, backed up with significant amounts of extra money), the door is open for pharma to have an influence on the important commissioning decisions being taken at SHA level.

That means getting the message across to all sorts of people, both within the SHAs (directors, specialist commissioners) and external people and bodies which will have a big influence ion their decisions (public health consultants, patient groups, PCTs, horizon scanners, national policy makers).

Above all, it means building a consistent brand message which shows that your aims are aligned with their agenda. Despite the common suspicion of the industry, SHAs have realised that they have to work with the industry to achieve their aims. It’s now up to us to make sure we play their game to overcome that suspicion.

The Author

Gerard Doherty is a Managing Consultant at the MSI Consultancy Ltd.

Originally published in InPharm,  November 2009

It’s a myth that retaining staff is easy in a recession.  Although, as jobs are lost the attraction of staying put will always be stronger, the best people – the ones you really need to hold on to, especially in a downturn – will always be able to find another job.  And they are not just motivated by salary but are planning a long-term career, plus looking for employers who will help them achieve that. Read More…

There’s no job for life any more, so if employers show no loyalty to staff, why should employees be loyal in return? Isn’t all just about looking after number one these days? Will staying loyal to an employer lead to career advancement and more money, or do you have to ‘jump ship’ from time to time? And if you do, how can you be sure you’re jumping onto a better ship, rather than into the shark-ridden sea? Paul Stuart-Kregor examines the issues and finds out if loyalty is still important – or has been sacrificed at the altar of self-interest.

Loyalty certainly featured more prominently in the careers of past generations. Unfortunately, economic necessity has encouraged organisations to make some harsh and expedient decisions about staff.

Many healthcare professionals have experienced mergers and acquisitions and resultant redundancy, or reductions in head count driven by commercial and pipeline issues. So it is no longer unusual to hear of people we know being made redundant.

Companies appear to have largely abandoned the implicit contract that traditionally promised employment security in exchange for loyalty. What they gained was agility – the freedom to use redundancies, for instance, to renew or adjust the corporate talent mix as business needs changed.

So, we can no longer expect ‘loyalty’ to pay off across the board, nor can we automatically expect favourable treatment just because we have worked for an organisation for a number of years. In the current turbulent economic times, but also as business dictates at other times, companies have to make hard-nosed commercial decisions, and will continue to do so.

People believe this has created a cultural shift in attitude, towards a ‘dog eat dog’ mentality, with an emphasis on competition, with people continually moving for career advancement. Some even suggest that staying put in one place for too long can be seriously career limiting.

So where did this idea of ‘jumping ship to get ahead’ come from? To a great extent, talk about the end of job security and one-employer careers coincided with the last big round of general company downsizing and outsourcing in the mid-1990s. Employers wanted the flexibility to adjust their workforce, and the concept of building careers by changing jobs gained momentum.

Now many people believe that the workplace has changed, and the perception that job security retired with your grandparents has become part of the accepted wisdom – but it may be more urban myth than reality.

A recent study by a University of British Columbia sociologist suggests the old-fashioned work model of staying with one employer may still be the best route to success, despite the typical career advice given to young workers that they need to change jobs to get ahead.

Using data from a US national longitudinal study that tracked 6,000 young workers during their first 12 years in the labour market across a number of industry sectors, along with details from dozens of previous pieces of research, the study found that career mobility comes with a price for workers.

The study found that workers who changed jobs several times during the first five years in the labour market did see their wages increase with each move but the trend reversed if their mobility continued.

After these first few years in the workforce, when employers expect people to change jobs more frequently to find the right fit, the study discovered that each job change reduced the worker’s wages by a little more than one per cent. So changing jobs a half-dozen times means a worker would earn about six per cent less than someone who stayed with the same employer. Workers with higher than average mobility also spent more time out of the workforce. This suggests that in general you start to lose after five years of working if you haven’t found your place in the right role.

Why? The evidence suggests that future employers may well be more willing to overlook a move early on in your career if they understand that the reason was legitimate (relocating for family reasons, a failure to launch a product). Frequent moves later on (more than two or three over the course of say five years) can be extremely damaging. Although you may have great reasons for making a move, frequent moves suggest a lack of stability or commitment, and may lead some prospective employers to question whether the worker is capable or willing to hold down a particular job for long – and that’s a difficult stigma to overcome.

Now clearly the typical career path in healthcare has a slightly different sequence and timeline to other sectors. Most of us spend some time in the field during the early years, either as part of a graduate scheme or as the first point of entry into the industry. The net result is that for the first two to four years we are ‘earning our spurs’ with the new organisation. It is then that you need to decide what to do.

If the job or the organisation suits you, then the study evidence suggests that the best move is to stay put and try to move up. Real benefits do seem to come from long-term jobs and stability.

So what if we do stay put?

Here at MSI we have worked with many people who have stayed with the same client organisation for a number of years, and there is no doubt they have done very well. They have generally moved up within the organisation to more senior and better rewarded positions.

But the path to bigger and better things is not always smooth or timely. And therein lies the rub.

There is no doubt that large global organisations offer significant, perhaps even greater, opportunities to follow a variety of career paths, always recognising that job security is never a given, but finding the opportunity to move up can be the challenge. After all, the pyramid gets smaller as we move towards the top, which means fewer positions and fewer options, if you are considering what might ‘appear’ to be the traditional career development path.

How do we judge whether our current employer offers us the best ‘future’? To answer that, let’s reflect on why people move.

First and foremost, a perceived feeling of ‘going nowhere’, exemplified by a lack of progression. For example, those feelings as you look back over your year at Christmas thinking ‘I have been doing the same old, same old, what will be different about next year?’

Then there is that feeling that nobody cares – there have been cutbacks in staff but no reduction in workload. You are taking work home in the evenings, working weekends, replying to your Blackberry when on holiday; yet there is neither recognition of your commitment, nor any reward visible.

Boredom often plays a part as well. People need new challenges and stimulation. If your employer is not providing that stimulation, maybe it’s time to move on.

Money plays a part. While we tend to view raw salary as a hygiene factor, if we do not feel we are being adequately rewarded for what we are doing, then it can be the final straw that causes us to look for pastures new. Often it is coupled with one or a number of the previous reasons.

For some of us, we need to feel we are developing. Middle-managers in particular are often keen to develop their skills, partly to help with advancement and marketability, but also due to a more personal need to ‘grow’. If you are constantly meeting others people who are getting support and development in this area and feel left out, perhaps it’s time to find an employer that is prepared to invest in you. After all, we don’t want to be so constantly in “task mode” that there is no time for career or personal-development.

Coupled with this is need to know where our career future lies. Forward-thinking companies have proper talent management programmes which provide employees with a career path. Even better, the proposed career path meets that employee’s personal and particular aspirations, not merely driving progression up the traditional management ladder.

Obviously there are also issues with ‘lack of fit’ (e.g. personality clashes, different values), but if this happens in a new job, rather than jumping onto a better ship, we may well have fallen into the shark-ridden sea. That is, we have chosen the wrong option! Alternatively, if it is happening in an existing job, it’s time to go.

Avoiding the shark-ridden sea

I am a strong believer in the right shaped peg for the right shaped hole. I have had direct reports who were obviously in the wrong job, but failed to acknowledge the issue and tried to carry on regardless. That only leads one way. Better we make the right decision in the first place or acknowledge what we need and make the change.

So how do we avoid falling in with the sharks? In part it is the converse of why people leave, but it is also about understanding what you are looking for.

To gain ‘commitment’, good employers provide employees with structured development programmes and/or the opportunity to ‘grow’ through variety, stretch and challenge. The best development programmes are not purely top down, but recognise the that their employees are bright people and so have a right to be involved in crafting their own destiny, allowing the employee to determine in part their own development.

But it more than formal development that helps us grow. The opportunity to try or be exposed to new experiences is a fundamental element of personal growth. Good jobs offer people stretch and variety, whilst providing the necessary support to ensure people swim not sink.

None of us likes to feel like a small cog in a huge machine, even though that might be the reality. It is important to most people that their efforts are appreciated. Whilst remuneration is important, none of us actually comes to work purely for the salary. Most of us like to feel valued and appreciated for what we do. Specific regular appreciation can go an awfully long way to ensuring employee commitment. If we want to employ bright and intelligent, then we need to recognise that they are not fooled by fake flattery, such as “you are doing a great job”. It needs to be specific and reflect a genuine interest in that individual and their performance.

When looking at your next job move it’s really important to look at the long term and think of yourself in two jobs’ time. If the prospective new employer cannot give you an idea of where you go next, after successfully fulfilling the initial role, walk away. They only want you for your current knowledge, skill and experience and are less likely to help you maximise your potential.

Finally, we all hold certain things dear – professional achievement, for example, or family life, or financial security. Research shows that many successful people feel a disconnect between their daily activities and their deepest desires – and more worryingly and an inability to do anything about it.

When considering the next job move consider what really matters to you. Make a list of what is important to you. Then you can judge how well a future job appears to help you achieve those personal values; it may be a sensible work-life balance to allow you to spend quality time with a young family, it may be the freedom to do things your way. Be clear about what you want out of a job, and the choice will become easier.

Commitment rather than loyalty

Perhaps ‘loyalty’ is the wrong word in this day and age; there is still a backbone of employers who value hard work, high levels of competence and commitment to the company, a more modern take on ‘loyalty’. There is no guarantee of continued employment these days, but employers are looking for commitment.

However, now there is an imperative for employers to earn that commitment, and consequent hard work from their employees. That requires a similar ‘contract’ between employer and employee to that of previous generations – based, as before, on mutual benefit. But now the ‘contract’ is not just about loyalty and longevity of service.

The modern work ‘contract’ demands recognition of a two-way commitment: as employees we will give 100 per cent commitment and effort, provided the employer helps us meet our career aspirations and matches our values.

When looking at your next job move it’s really important to look at the long term and think of yourself in two jobs’ time. It’s crucial to consider whether the move you’re contemplating now is going to help you towards that goal or merely be marking time.

The Author

Dr Paul Stuart-Kregor is Director of The MSI Consultancy.

Originally published in Pharmafocus, May 2009

I’m sure that everyone reading Pharmafocus Europe is convinced of the value of their brand. Why then do so many of us find it hard to demonstrate this self evident value to other people and in particular, those who have the power to influence whether our brand is used or not and to what extent? Surely this should be relatively straight forward? Well, not if you do not take the time out to consider what ‘value’ is and what it really means.

What is Value – and why do we need to demonstrate it?

Potentially this is difficult to define when individual people derive different levels of value from the same product or service. Our sense of value can also be influenced by other people and in particular people whose opinions we trust. So what do we mean by value?

Value is derived when the perception of the benefits of a product or a service are in line with the cost; simple enough but perhaps in our industry we do not consider this in enough detail. And too often we concentrate only on the value that comes from the functional benefits of our products (i.e. efficacy and safety), without thinking about the equally important emotional aspects of the value our brand brings. Potentially, this shows a lack of real insight into what drives the decision-making processes of our customers – and without that insight, we have limited chance of boosting the uptake of our products by them.

We all know that most healthcare systems are creaking at the seams, trying to manage the ever increasing cost of healthcare delivery without major reforms to that system, because that would be a very courageous thing for politicians to do. Coupled with this, R&D costs are soaring as pipelines continue to fail to bring radically new and innovative therapies to market and at the other end patents are being successfully challenged by generic manufacturers. Hence, no surprise then, that companies are looking to maximise their profits on any new products that make it to market. Net result? Immediate conflict with the healthcare system’s need to control costs.

Pharmaceuticals are a soft target for healthcare systems to come looking for savings. Why? I would argue because we have not established their value with key stakeholders, be that on the macro or micro level.

At the macro level, politicians and payers focus on cost and can introduce various cost cutting schemes because the voting public allow them to do so. Why? Because in the main the voters are not focusing on our industry and therefore do not care; we have not done enough to demonstrate the value that we as an industry bring to overall healthcare. I say in the main, because when the voting public can be made to care, they can have an impact as demonstrated in areas such as cancer. Perhaps we should learn from this and our industry can and needs to do more to demonstrate that spending the money on medicines does represent good value.

But that is an issue for industry-wide representation to tackle. More pertinent for most individual companies and their brand managers is demonstrating value at the micro level – that is to payers and prescribers (although let’s not forget that payers are to some extent pawns of the government, and in some respects therefore it is not in their interests to open their eyes to value, because their job is to follow political will, which in turn means to control costs).

Generally, though, as far as stakeholders within each country’s healthcare system goes, uptake of a particular product will be dependent on them believing that it adds value, by whatever measure they use to assess that value – and as we shall see, those measures are not all cost-based.

So now more than ever pharmaceutical brands need to demonstrate their value if they are to be successful.

At what level does value need to be demonstrated?

At a national level we often think about value in relation to new products and securing reimbursement and
funding. In this situation we easily slip into jargon use and bandy around terms such as the “value proposition” and “target value profile”, sometimes without fully appreciating what these terms should mean. But these words are not just meaningless jargon – we really do need to start ’valuing the value proposition’.

Often it is the responsibility of the market access or professional communications team to develop and communicate this to payer or budget holding customers, and may even be developed independent of the marketing team to the point where the market access aspiration differs from the marketing position.

This can happen because ‘getting a foot in the door’ (i.e. a profitable price and reimbursement) is most likely to be the market access position at launch. Marketing on the other hand are trying to maximise speed of uptake and maximal sales. If the two are developed in isolation, they can look completely different, and then lead to intra-company confusion. You might laugh, but we have seen this done.

The development of the Value Proposition is not a stand-alone process, but should be part of an integrated and collaborative effort with other marketing principles and must be an integral part of Brand development. Therefore the Brand Positioning and Value Proposition should not be developed in isolation, but rather they should support and shape each other.

The power of cross-functional working – having all your key internal stakeholders aligned with what you are trying to achieve, and making sure they are clear about what role they play in terms of delivery – has to be the way forward for success, otherwise you end up with left hands and right hands not knowing what is going on. Working cross functionally to fully understand payers’ needs, where the common ground is and more importantly what they will value is going to give you the best chance of success.

Shaping phase III studies may well form a key part of this and all corporations, big and small, need to have a horizon that extends beyond their home market when considering which comparators should be built into the programme and how these can drive health economic outcomes. Local marketers have a duty to inform Global teams as to what may be required and here, a detailed understanding of payer needs and motivations are immensely powerful when it comes to these discussions with your Global colleagues.

An element of flexibility is also helpful, especially if through good segmentation you can demonstrate even more value in patient sub-populations; it may prove a more effective strategy to gain reimbursement at a good price in these patients and then look to develop your patient pool overtime, linked to the clinical development. An argument that could hold true for your internal as well as your external stakeholders.

But what about existing products; products that have already gained reimbursement and have a place in treatment pathways, is there a need to demonstrate value further in this situation?

Clearly the answer is yes, and this may be where market access and marketing fail to mesh effectively. After all, if you believe that one product is better value compared to the next then you will buy it more frequently, or in our case use it more. Quite often, this need is translated by marketers into the Value Added Programme, which invariably is an educational package aimed at either the prescriber or the patient. Not that there is anything wrong with this approach, other than it is perhaps getting a little tired can be treated with an element of scepticism if aimed at prescribers and in some cases does not truly link to the intrinsic value in the brand itself.

The key question is: do these initiatives go far enough to add real value? A great example of what I mean here is Fresenius Health Care, which agrees reimbursement models to deliver dialysis to patients suffering from chronic kidney failure. They have a model called the ’Comprehensive Price Payment’, which is an integrated and quality-driven approach that bundles a variety of dialysis related services and products that in turn require the implementation and functioning of an integrated disease management model to achieve health benefits, quality improvements and system rationalisation.

This is possible because they offer products and services for the entire dialysis value chain; put plainly, they get paid for servicing a healthcare system’s dialysis needs. OK that’s great, but what if you do not have that infrastructure to be a total solution? Well, the principle is still sound; how can we help you to meet your healthcare needs in a way that is both acceptable and profitable?

Time to get emotional

So what is missing from our communication? If we go back to our definition of value, we can represent it as: Perceived Value = Perceived Benefits – Price.

Traditional pharmaceutical marketing is all about converting features of our product to benefits, isn’t it? We have all been taught to use the ’which means that’ phrase, surely that does the job? Well, no. All too often our communications focus purely on the functional benefits of efficacy and safety. Why is that not enough? Because we have not split ’benefit’ down into its component parts.

Ask any FMCG marketer and they will tell you that we derive both functional benefits and emotional benefits from the products that we buy. Just think about a man buying a car or a woman buying shoes and you’ll understand immediately what I am talking about. These are not buying decisions that are based purely on functional attributes – they contain higher levels of emotional benefit.

Can this be done in pharma? With the right communication I would argue that it can. Let me give you an example. Shire in the UK had a product for Alzheimer’s disease, Reminyl, launched after Aricept (Eisai/Pfizer), and was challenging for market share. Their initial communication was based on the functional claim that Reminyl slowed cognitive decline in Alzheimer’s patients for up to four years. Benefit over Aricept as far as prescribers were concerned? Minimal. Treating this disease is not about MME scores; GPs were not just concerned about cognitive function, they cared about the patient, and even more so if the patient had a partner. Hence, with insight, this communication was changed to a couple holding hands and the plea “Help us to hold on for as long as we can”. Far more emotive, far higher benefit to a would be prescriber. And the result? A much faster uptake of the product.

The trouble is that we often ignore or forget about the emotional benefit when it comes to marketing pharmaceuticals; after all, doctors are educated and rational people who make decisions based on hard facts and clinical data, aren’t they? But the fact remains that doctors are people too and therefore the principle holds true for them, even more so in some cases given that they enter into medicine in order to help people. The ’which means that’ phrase may get us some of the way, but to tap fully into the higher emotive needs and benefits, we need to generate a deeper insight into what really matters to our prescribers.

Without understanding this other side to benefit we are left with just being able to satisfy functional needs. Not that we should be dismissive of this, as this must be a minimum requirement, but it does not help to differentiate our brand from others that can claim similar things. So how do you uncover this level of insight?

Well constructed market research, using well thought out discussion guides and a range of different techniques can go past top line functional needs and start to get at a deeper level of understanding that can lead to true insight. Yes, it takes time and yes it takes investment, but it is a modest investment for the potential return that it can yield.

You need to understand how certain beliefs drive behaviour, and then try to think about what is underpinning those beliefs. What is your key business objective, and what change in behaviour do you need to bring about in any particular customer or group of customers?

Often this is a question of constantly asking the question ‘why?’ in research, drilling down beyond the top-line responses to really understand what drives behaviour. And don’t forget, these drivers will be different for each segment of your market; generally managers and budget holders are looking at populations, whereas prescribers tend to look at individuals.

Demonstrating Value

At whatever level, in a continent which is increasingly taking a more global view of health economics, we as an industry have to be demonstrating the value of what we bring to the table, and in a way which goes way beyond the ‘givens’ of price, efficacy and safety. In fact, the drive towards viewing health economics not just in individual budgetary silos, but in a more holistic way, should help us –spending from the drug budget can be justified by demonstrating to stakeholders the value in achieving the wider health outcomes.

But this is not happening at an even pace across Europe. The UK has had NICE for years, and therefore the industry has had to get better at HTA submissions, which in turn has generated useful debate about treatment approaches and the value of new medicines within the context of overall healthcare outcomes. In some European countries this is not the case; affiliates seem less ready to challenge current approaches to disease management.

Whatever the national environment, right across the continent there is an increasing need for the pharma companies to work harder at convincing all stakeholders about the positive value that its products brings to the over all healthcare picture. The trade off for us may be that we have to be more realistic with our ambitions and focus on selected patient groups where real value can be demonstrated, rather than everyone with the disease. The benefit though is that if we can be seen as true partners working alongside the healthcare system to bring true value to patients, then we will be knocking at an open door.

The Author

Gavin Gandy is a senior Consultant at The MSI Consultancy.

Article originally published in Pharmafocus

Given the way the title is worded, I can almost hear a collective ‘No’ being shouted, so let’s be clear about what is actually meant here.  Most US-based organisations do have local country affiliate marketing departments or European partners with local marketers who clearly know their own markets.  Therefore what we are referring to here is the “Global” strategy and associated campaign that emanates from the Global team; a team who in reality are often based in the US and made up of US marketers, perhaps with one or two colleagues from other parts of the globe and if you are really lucky, maybe one person who has worked in one market in Europe.  Is this sounding familiarly like a global team you know?  Given that context then, is it any wonder that battles rage when it comes to implementing global campaigns in Europe.  After all, Europe is a collection of vastly different markets in terms of culture, structure and regulation, so unless you have a detailed knowledge of these differences, how can you hope to be effective?

Where does it go wrong?

It would be easy to just point the finger at the make up of the global teams as being the main reason why global campaigns are seen as less suitable for European markets. However, most global teams do work hard at trying to understand the individual markets that they are responsible for.  So why does it go wrong?

Quite often, one of the key causes of difficulty is the point at which European input is sought in the asset commercialisation process. For US-based companies the domestic market is often the largest, so Phase III studies are commonly designed to provide data against comparators that are most relevant for this market with other regions not necessarily taken into consideration.  As a result, this can have huge implications to the desired value proposition and therefore local access and claims that can be made in promotion once the license is granted.

But if global teams work hard to understand issues in European markets with or without consultation with European colleagues, why does this happen? Experience would suggest that because European responsibility is often divided amongst global team members for practical reasons e.g. managing contact, communication and travel, etc. and this leads to a fragmented view of the issues.

Coupled with this, individual marketing teams in Europe do tend to focus on why and how their market is different, so their focus tends to be more on the communication cascade to customers rather than the overall strategic challenge for the brand.

These two issues can lead to conflicting needs, requiring a compromise, which is resolved by the global team making decisions on the basis of individual market potential. Consequently the net result is the decision will favour the US view.

If we as European marketers can bring ourselves to consider the strategic context more, we would find a surprising amount of commonality and consistency that exists between markets, presenting a more consolidated European view rather than an assortment of 27 individual situations.

Another source of difficulty is how communication is handled.  Contact and communication between EU affiliates and Global teams can be confined to organising meetings around the larger events such as congresses or specific Global team meetings, where all markets are present rather than on an ‘as required’ basis.  This makes it very hard to check understanding, to ensure that what has been heard is what has been said, leaving the door open to misunderstanding and confusion, especially when your first language is not English.

Native English speakers often forget or do not think about the mental gymnastics that most European affiliates have to go through translating what has been said, thinking about it and then maybe formulating some questions, by which time the conversation has often moved on.

This is not just restricted to conversations either; a good example of this from past experience of working in a European team was when a simple diagram to support the segmentation approach was introduced, to aid understanding.  However, in the ensuing workshop, animated discussions with German and Polish colleagues seemed out of context with the main purpose of the workshop, which was to consider the application of the segmentation approach in their market.  They seemed to be totally focused on the diagram, saying that it would never work in their markets.  So what were the issues?

1. They thought that the diagram was meant to be the new campaign visual (!) and therefore would not be understood by customers (true);
2. They thought that it was implying that we should ignore the main segment where our existing business was being generated and switch all activity to focus on the newer segments where the brand proposition was less well established (not the intention).

Fortunately, we were able to resolve this after much eye-bulging discussion once we realised the source of the confusion.

The issue that most readers will identify with though lies in what is delivered by the global team.  All too often this is finished campaign materials, sales aids, advertising, etc. and does not place enough or any focus on the core elements of the brand, such as the Brand Vision, Brand Essence, Core Values and Brand Proposition.  Visuals in particular can be inappropriate for different markets and are most open to subjective opinion, leading to the inevitable response “this will never work in my market“.

Should we bother with a global or common approach?

Given the issues highlighted above, wouldn’t it be easier to let markets develop their own marketing strategies and campaigns to suit their uniquely individual markets?  Surely this would result in a much more effective approach and therefore maximise a brand’s potential?  Well, if that were true, then why to consumer companies dedicate so much resource to establishing and defending their brands?

Given the choice, would you rather buy the rights to the Coca-Cola brand or all their offices, production, bottling and distribution facilities? There are tangible benefits to global branding, from both a company and a customer point of view.

Company benefits include economies of scale in production and distribution, more efficient marketing, creation of a strong marketing platform that allows different brands or variants for different market segments to retain an association with the parent brand, consistent brand imagery at international congresses and symposia.  In essence, they help build barriers to local and global competitors and enhance price and margin.

And the most compelling reason in our industry; the data we have to support our brands is the data that is consistent in all markets. Hence the core product and its supporting evidence is the same.

How can we improve the situation?

We may need support from senior management to ensure that the European voice is listened to and that the dialogue starts earlier.  Asset commercialisation teams need to be put in place around Phase II to allow input and guidance to the Phase III programme, ideally comprised of representatives from the major regions.  If you do not have a European Brand Team structure then you need to have an EU spokesperson who can act as a regional representative for the brand.  However, regional representation needs to be just that, i.e. it should not have individual market bias and members of the commercialisation team need to adopt a common sense approach to resolving points of difference.

As European marketers we need to focus more on what’s the same rather than what’s different.  More often than not, the key strategic challenge for any one brand is consistent across Europe. Do we really need 27 different interpretations of the same data?

Regular communication or meetings between the global team and EU representative or market representatives should occur. However in the latter case, practical issues dictate that you cannot meet with every market in Europe.  Common sense needs to be applied but global teams need to go beyond just the top 5 markets in Europe and include representation from other commercially important markets or regions within Europe too.

There are clear benefits to having a common approach to brand marketing, to make sure global teams don’t try and provide finished materials, but rather provide guidance, data blocks, formats and a framework.  More importantly, ensure that the Brand Vision, Brand Positioning and the Core Brand Proposition are well thought through, robust plus agreed and communicated clearly.  Remember the mental gymnastics that have to be performed by country affiliates who do not have English as their first language.  Allow local tailoring within set limits, to ensure that appropriate visuals, appropriate tonality and translation issues can be accommodated.  Remember, some words in English just don’t translate.

Conclusion

No matter where head office is based there are benefits to global branding and a common approach. We’ve picked on the US, but the principles apply to any global team that focuses mainly on their domestic region. European marketers need to be more assertive about their needs and they need to communicate this at a point where it can make a difference.  However, as Europeans, we need to stop focusing on why our market is different and start looking for common issues and challenges.  In turn, global teams need to stop thinking of global campaigns as the finished article and communicate more around the brand architecture (brand vision, brand value equation, core values, brand positioning and brand proposition) and have the flexibility to allow some local tailoring that can accommodate local needs and customs.  If we can achieve this, we can start to reap the benefits of establishing true Brands that our consumer colleagues currently enjoy.

The Author

Gavin Gandy is a Senior Consultant at The MSI Consultancy.

Originally published in PM Europe, June 2009

Analysts have said for years that the pharmaceutical industry has far too many separate companies when compared to other industry sectors, based on the relative market shares. The current round of mergers and acquisitions therefore seem to be inevitable, given the challenges the industry faces – but it is not as simple as that.

A recent report suggested that the current pharma industry sales and marketing model will be non-functional in the next ten years, with the role of the traditional sales representative becoming largely obsolete.

Why? Because the balance of power is shifting towards those who pay for medicines, with governments and insurers the ultimate arbiters of pricing and value, reimbursement and, more fundamentally, prescribing decisions. Generic versions of highly successful molecules are now more commonly available (65 per cent of previous blockbuster drugs for common diseases such as hypertension and diabetes are now sold generically in the US, and the figure is 70 per cent in Central and Eastern Europe), making it increasingly difficult to create commercial blockbusters.

Hence, products alone and mass market approaches are unlikely to guarantee success and the long-term future of pharmaceutical companies.

This is partly why we see a mad rush into specialist medicines. The global market for specialist brands accounted for 44 per cent of worldwide prescription drug spending last year and has been estimated to be twice the size of the current market for all prescription drugs by 2020.

But the latest approach by GSK and Pfizer to combine their HIV operations and set up a new entity is an interesting move. It appears that the new company (GSK will initially hold an 85 per cent equity interest in the new company and Pfizer’s stake will be 15 per cent in the UK firm, though that ratio could change as the portfolio changes) will have products worth £1.6 billion a year on the market, operating profits of £870 million and ‘an industry-leading pipeline’ with a potential 19 per cent market share.

What makes this particularly interesting is that the NewCo will have dominance in the market that should allow it to ‘change the rules of the game’ in line with the key drivers in the environment.

What will drive future success is how companies can add the value, not who can sell most pills. Rather than selling medicines, pharma companies will need to be working in partnership with the payers to help meet their agendas of promoting health, improving quality of life and reducing healthcare costs.

Managing networks of external alliances, negotiating with governments and health insurers, liaising with secondary care specialists and communication with patients will be the key skills required in future, all of which the NewCo should have in spades.

So watch this space!

If cars get MOTs why not people?

For many years it seems as though the NHS has been more of a fire-fighting than a true health care system, struggling to deal with the consequences of ill health rather than preventing problems in the first place. The recent increased focus on preventative medicine may well be too little to late given that, for example, new cases of type II diabetes in the UK increased by an incredible 74 per cent in just six years.

The Government intends to press ahead with the new ‘Health MOTs’ for the over 40s as part of this focus on disease prevention, to better the health of the nation, tackle health inequalities, and help the NHS cope with the increasing demands of an ageing population.

Under the plans, everyone in England will be invited to undergo a free health check aimed at identifying those at risk of developing serious and expensive-to-manage/treat illnesses such as coronary heart disease, stroke, diabetes and kidney disease, as well as better inform people of these conditions. The government claims this will help to save 650 lives and prevent 1,600 heart attacks every year.

The health check will be centred on questions regarding patients’ general health, lifestyles, family medical history, height and weight measurements, cholesterol and where necessary blood glucose tests, and will be followed up with a personal assessment of disease risk and recommendations on how to best reduce it – at an annual cost of around £330 million.

The intention is that the screening programme should be fully implemented by 2012/13, with the health checks ideally available at not only GP surgeries and health centres, but also walk-in centres and pharmacies to ensure ready access.

The potential issue with this is the pressure it could put on an already overstretched general practice. We all now about the ‘worried well’. On the surface it seems that those people who are likely to take advantage of this are not those who would benefit most. Added to which, surely a large part of this high risk group is already being picked up, given that many of the key questions appear to be already asked by GPs.

Right intention but I am not sure it is the right solution? Only time will tell.

You can’t have your cake and drink it

No surprises that people have been blissfully unaware of the calorie content of alcohol. Did you know that a glass of wine has the same calories as a small slice of cake? Me neither – I thought the cake would be far higher! But even more frightening: just eating one chocolate biscuit more than you need a day can lead to a 5kg weight gain in a year.

So folks, you have a choice – that glass of wine or dessert? Up to you; I know which I would prefer; but everything in moderation.

The Author

Dr Paul Stuart-Kregor is a Director at the MSI Consulancy.

Originally published in Pharmafocus, June 2009

You probably know the type: successful people who apparently ease through their careers, seemingly running on invisible, smooth rails towards advancement and success. Leading a charmed life, they always seem to be in the right place at the right time, they always seem to be in complete control of their own destiny, and they always seem to be doing better than you are.

Are they just lucky? Or well-connected? Or perhaps it’s ‘old school tie’. It’s tempting to explain away the fact that others seem to be having a more successful career than you in these terms, because it passes on the responsibility for your less than satisfactory career path onto factors you cannot influence. But the fact is – and you know this really – that to a great extent your destiny is in your own hands. Whilst you can’t totally control your career, you can do lots to ensure that you maximise the chances of success, whatever life throws at you.

It’s strange that whilst we plan for most of the important things in our life – climbing the property ladder, pensions, family and so on – so many of us rely on what seems like chance to see us through the thing which will pre-occupy most of us for a good 40 years: our career.

Now it’s true that many careers are often established by chance. I know of one PR man – now running his own successful agency – who fell into that particular career path because he agreed, on a drunken night in a student bar, to be the press agent for a gerbil with political aspirations (it’s a long story). Serendipity is a wonderful thing, and there will always be an element of it in anyone’s career. But trusting entirely to chance is a mistake. The worst thing is to drift from job to job, with no clear idea of what you want to achieve.

The answer is to have a clear career plan, and nowhere is that more important than in the fast-changing world of pharma. It’s surprising how few people in our industry have one – and that is why the favoured few seem to do so well. If you want to join them, you must start planning for success.

The first thing to think about is what success looks like for you. The answer to this question will be different for every individual, so only you can answer this. What factors are important for you: money; status; job satisfaction; power; work/life balance – you will be able to add in others. After all success is a very personal internal thing. A colleague asked me the other day if I was happy with what I had achieved. I found it really hard to answer the question as I had never thought about it that way.

If you’re feeling particularly negative, you can approach things from the other direction: what makes your career less successful than you want it to be: getting stuck in a rut or a ‘dead-end’ job; constantly being at the mercy of more successful colleagues; no job satisfaction; watching bitterly as peers get better jobs, and so on. Sometimes we have to realise what we don’t want before we can focus on what we do.

Future Proof Yourself

It’s a common mistake to think that a career plan can give you control over your own destiny. The reality is that no-one is in total control of their destiny; outside influences have a nasty habit of intervening (as many city bankers are finding out to their cost). So to my mind a career plan is more about future-proofing yourself, in other words ensuring you are a good ‘catch’ for a company, should you be – or choose to be – on the ‘outside’ of a corporate downsizing or a merger/takeover.

On the biggest scale, that is about being able to demonstrate that you have added value to the organisations you have worked for. That means planning to gain the relevant experience, whether in terms of brands, therapy areas or functional expertise. You need to have achieved demonstrable success, a good track record of performance.

Of course, planning for your career will ideally commence before you start it, so that you can lay down the ‘foundations’ for that career in terms of qualifications. The extent to which this is necessary varies by market: in eastern Europe a medical or pharmacy degree is vital, whereas in the UK it’s generally about being a graduate ‘plus’.

Even if you didn’t start planning at university stage, there are still several ‘foundations’ you need to lay as your career progresses, which have little to do with qualifications. Once you are a few years into your career, things like intelligence, action orientation, the ability to work within large organisations with matrix management, managing upwards and working the corporate environment all count, as much if not more so than your degree. Your initial qualification might get you onto your career ladder in the first place. It is these more corporate skills which will propel you up it.

And let’s not forget the huge importance of building good networks as you build your career – this should be a central plank of your career plan.

If you can’t entirely control your destiny, it is certainly easy enough to lose control of it completely. The people who have done this always seem to be in the wrong place at the wrong time: working for the wrong companies, or on insignificant brands, or not getting enough experience while working on a brand, perhaps becoming a specialist in only one element of the marketing mix too soon (partly because they haven’t planned to gain the broad range of experience first).

Planning For Success

Now a reasonable question at this stage might be: my career is going to be 40 years or so; how can I possibly plan to such a timescale? It’s a fair point. Would someone setting out on their career in pharma in 1968 have been able to foresee the many changes in the industry during the subsequent years? Of course not.

But a career plan is not about mapping every detail of your career. Rather, it’s about knowing what you really want. So your plan should be structured enough to know what you are looking for, and with a view to the different pieces of the career puzzle that you need to accumulate. In my view, that means it’s about planning as far ahead as the next job and the one after that, but with a view to building a broad and attractive CV for the future. I should point out that when I say the next job that might be a different role within the same organisation – I’m not saying you have to up sticks every 18 months to build a career.

The key is knowing what your goals are, and only you can set these – there is no off-the-shelf, one-size-fits-all career plan (and beware of careers consultants who tell you there is). Think of your career plan as a map to help you get to where you need to go. There’s no point having a map unless you have decided on a destination. You’ll simply drift around aimlessly, although at least with a map you won’t be lost. You just won’t be moving forward.

Given that you can’t possibly know what the future is going to throw at you, I would steer clear of having one, big goal for your career. Far better to set yourself a series of smaller goals. The vital thing is to review those goals – and your progress towards them – regularly. In the early stages of your career this will need to be very regular (once a year or even more frequently), whereas you might feel more confident that your goals are going to remain more stable later in your career.

Of course, there’s no point having a plan if you don’t then implement it. So your career plan should include some specific actions. It’s likely that these will be varied, but may well include some of the following: gaining more qualifications (does an MBA fit in there somewhere perhaps?); building up your network of contacts both in the industry and outside; gaining a wider range of experience, perhaps through spending some time outside the industry in consultancy.

Turbo-Charge Your CV

A good career plan will help you turbo-charge your range of experience, provided it is clear, focussed and realistic. Whilst you will never be in total control of your career, because of external factors, market changes and the fact that other human beings will have an influence on it, a career plan can help you take back control over your own destiny, and help you ensure that you end up in the job you have always dreamt of, giving you the satisfaction, money, status or any other measure of success you choose.

It’s never too late to start. It doesn’t matter if you are just entering the industry, or if you’re a grizzled ‘old-timer’ with 25 years under your belt, the message is clear: if you want to run your career, and not let it run you, then you need to take hold of it and plan it. What are you waiting for?

How well-planned is your career?

What will you be doing just before you retire?
a. I’m going to be Chief Executive/Marketing Director/Sales Director/Medical Director (delete as appropriate)
b. I’m going to be in a role which makes the most of my skills and which I really enjoy
c. I’ll wait and see what happens

How did you get into your current role?
a. I applied for it – I apply for every promotion going
b. I applied for it, because I saw it would give me a valuable experience and let me learn new skills
c. I fell into it

How is your career progressing compared to the cohort you entered the industry with?
a. Most of them report to me
b. I seem to be happier and more successful than average; but I still keep in touch with them
c. I haven’t seen most of them since I was overlooked for promotion for the third time

Do you enjoy your job?
a. I enjoy being at the top– that’s all that counts, isn’t it?
b. Yes, it’s really satisfying, and a good part of my life
c. It pays the bills, but I live for weekends and holidays

How much do you earn?
a. Loads – that’s how I measure my success
b. I’m happy with what I earn, but I aspire to earn more
c. Nowhere near enough – I seem to be paid less than everybody else

Your answers
Mostly (a): You are perhaps confusing status with career success. There are many more measures – you need to be planning for a more fulfilling career (although there is nothing wrong with ambition).
Mostly (b): You seem to have your career well-planned – congratulations. Are you reviewing your plan on a regular basis, and updating it as your circumstances change?
Mostly (c): You are drifting into terminal career unhappiness – you need a plan.

Creating a Successful Career Plan

1. Keep doing it
Career planning is not something you do once at the start of your career. It needs to be done on a regular basis, and this requires some discipline. Set aside some dedicated time to thinking about your career plan on a regular basis – perhaps twice a year. This is best done out of the office, so perhaps it’s a day on the weekend when you can shut out the day-to-day and concentrate on thinking about your future.

2. Monitor your progress
How have you performed against your career plan since you last reviewed it? Part of any strategic planning progress should be evaluating how well you are doing against plan, and the same goes fro your career plan.

3. Think about your personal aspirations
You will be much more successful – and much happier – if your career path mirrors your own personal likes and dislikes. The best way to see if your career is in tune with these is to list them. Write down the things you like doing and the things you hate doing. Then map your career path alongside these – if it falls mainly into your ‘dislikes’ category, you need to re-evaluate your career plan. Conversely, if it matches your ‘likes’, then your plan is probably on the right track.

4 Keep your CV up to date
Not for the reason you might think. A CV is useful all the time, not just when you are looking for a new job. Keeping the record of your achievements and accomplishments up to date means that when you come to build and/or review your career plan, some half-forgotten success may spur you into thinking about a new career direction, or help you realise where your strengths are.

5. Set clear and SMART goals
If your career plan is your route map to success, then setting clear goals establishes a destination for your career journey. Given that this journey is likely to last 40 years, it’s a good idea to have interim stop-off points, just as you would on a long journey. Your goals need to be realistic, yet stretching. Bear in mind that you will probably end up tweaking (or even drastically changing) these goals as your career progresses, and as you develop as a person.

6. Grab every development opportunity
Even if training you are offered doesn’t seem relevant now, always grab the opportunity – you just don’t know what skills and what knowledge will be important in the future. And you also need to be proactive in finding new training and development opportunities, and taking advantage of them, even if you have to do so off your own back. Remember that development opportunities can mean much more than traditional, structured training.

7. Believe in yourself
You couldn’t market a product that you didn’t believe in, and essentially your career plan is a marketing plan for yourself. If you have done it correctly, your plan will reflect your strengths and those things which motivate you – and that puts you in a good position to be able to see it through.

8. Be really good at what you do
After all, the cream always rises to the top!

The Author

Dr Paul Stuart-Kregor is Director of The MSI Consultancy.

Originally published in Pharmafocus in May 2009

Pharma marketing training is too often driven by a woolly agenda rather than by genuine business need, argues Gerard Doherty.  It’s time to apply the same rigorous return on investment treatment to training that we do to our marketing plans, he argues.

As Team GB came home from Beijing, laden with a record haul of medals, it won’t have escaped anyone’s notice just how we managed to punch above our weight in the sporting arena for the first time in ages – a massive investment in training facilities and expertise giving our boys and girls the winning edge. Read More…

Patient involvement in decision-making is widely regarded as an important feature of good-quality healthcare. Policy-makers have been particularly concerned to ensure that patients are informed about and enabled to choose between relevant treatment options, but what is not clear is how patients understand and actually value involvement.

There is not doubt that there is wide variation from West to East. In the UK the patient is being placed firmly at the centre of policy making, as can be seen from the initiatives that have been launched to date e.g. “Our health, our care, our say: a new direction for community services ”. Recently proposals have also been made for individual budgets for patients with long-term chronic conditions, such as mental illness and diabetes. This would give patients greater choice of treatment and allow them to develop their own package of care, mixing clinical and alternative therapies to meet their individual needs. Evidence from the US has shown that this can improve satisfaction, reduce the use of acute services and improve value for money. There is a clear view in the US that the person who has the most at stake when it comes to healthcare decisions i.e. the patient – should be involved in research, advocacy and all segments of the health care system.

However, that is easier said than done as demonstrated by The Picker Institute’s analysis of trends from national patient surveys in England between 2002 and 2007. It revealed that there has been almost no improvement to patient engagement in those five years, despite it being the supposed goal of increased NHS funding and policy reform over that period. Specifically, they found that Information needs are not always met; information about patients isn’t shared with them; many patients want more involvement in decisions but find that shared decision-making isn’t widely practised; patients don’t receive enough help with self-care and finally, patients aren’t actively encouraged to give their views.

A recent 2007 study in 11 European countries in patients over 70 showed that they do want to be involved in their care but their definition of involvement is more focused on the ‘caring relationship’, ‘person-centred approach’ and ‘receiving information’ than on ‘active participation in decision making’. What is apparent is that the desire for involvement in decision making is highly heterogeneous so an individual approach for each patient in the ageing population is needed in order to address the specific needs and requirements of patients.

This study built on findings from an earlier 2004 study of GPs in the same countries. Most GPs thought that involving older patients had positive outcomes. GPs saw patient involvement as a process taking place solely during consultations. The main barrier for GPs was lack of consultation time. Barriers related to older patients were their feelings of respect for doctors (and so an unwillingness to question them), their lack of experience in being involved and possible mental and physical impairments. To conclude, increasing involvement of older patients is not easy and will only be effective when GPs have adopted a more developed concept of patient involvement and are supported with the different methods for achieving this.

In contrast, the situation further east is less well developed. Take Lithuania for example. In a 2004 study the majority of polled women and men (84.6% and 72.6%) recognized health as a very important value in their life and as the most important among other social values. The overall mean of trust in health care system was 41.3%, trust in physicians was 69.9%, implementation of right to health care was 48.9%, concern about health care was 96.5% but patient impact in health care decisions was only 19.1%. Nearly half of respondents (47.4%) preferred the informative general practitioner-patient interaction model, which was realised in most cases (58.8%). Partnership (shared decision-making) as an interaction model was expected by 37.2% of respondents but only realised in every sixth case in primary care.

Younger and more educated Lithuanians trusted less in the health care system, but were more motivated to play an active role in health care decision-making. The informative model of doctor-patient was dominant, while ‘partnership’ was expected by patients but not frequently practised.

Other studies have shown that patients’ expectations of involvement in decisions about their care differed significantly between West and East, with people in Spain and Poland exhibiting a much greater preference for a paternalistic style than those in Switzerland and Germany, while those in Sweden, Slovenia, Italy and the UK occupied the middle ground. Nevertheless, dissatisfaction with the perceived opportunities for involvement in treatment decisions was also highest in Spain and Poland, suggesting that significant numbers of people in these countries are frustrated with the paternalistic approach, notwithstanding the prevailing culture.

Current models and measures of patient involvement in treatment decision-making tend to focus on communication within consultations and/or on the patient’s use of information to consider the selection of one treatment option from a well-defined set. These narrowly focused models and measures may obscure the relevance of patient involvement in decision-making for some health care contexts and limit investigations of the relationships between patient involvement in decision-making and health care outcomes.

However, patients can be involved not only because of what they say and do to influence a decision, but also by virtue of what they think and feel about their roles, efforts and contributions to decision-making and their relationships with their clinicians, encompassing the full range of activities associated with decision-making.

A recent study among patients with diabetes showed they associated involvement in decision-making with a number of features relating to the ethos and feel of healthcare encounters (welcoming; respectful; facilitative of patients’ contributions; and non-judgemental); communication about health problems (practitioners attending to patients’ views and patients feeling listened to; practitioners giving clear explanations based on their professional knowledge and patients understanding these); and communication about treatments (practitioners explaining treatment rationales in ways that patients understand and enabling patients to feel they have a say).

In practice this means that clinicians who aspire to facilitate patient involvement in decision-making need to look beyond the way they discuss health care options with patients. They should also consider how they might enable patients to engage in the full range of decision-making activities and to develop a positive sense of involvement in these activities and with their clinicians. They need to consider the way they discuss problems in consultations as well as to the provision of information about treatment options and the scope patients have to influence decisions.

To achieve patient-centred healthcare the International Alliance of Patients’ Organizations (IAPO) believes that healthcare must be based on the following Five Principles:

1. Respect – Patients and carers have a fundamental right to patient-centred healthcare that respects their unique needs, preferences and values, as well as their autonomy and independence.

2. Choice and empowerment – Patients have a right and responsibility to participate, to their level of ability and preference, as a partner in making healthcare decisions that affect their lives. This requires a responsive health service which provides suitable choices in treatment and management options that fit in with patients’ needs, and encouragement and support for patients and carers that direct and manage care to achieve the best possible quality of life. Patients’ organizations must be empowered to play meaningful leadership roles in supporting patients and their families to exercise their right to make informed healthcare choices.

3. Patient involvement in health policy – Patients and patients’ organizations deserve to share the responsibility of healthcare policy-making through meaningful and supported engagement in all levels and at all points of decision-making, to ensure that they are designed with the patient at the centre. This should not be restricted to healthcare policy but include, for example, social policy that will ultimately impact on patients’ lives. See IAPO’s Policy Statement at: www.patientsorganizations.org/involvement.

4. Access and support – Patients must have access to the healthcare services warranted by their condition. This includes access to safe, quality and appropriate services, treatments, preventive care and health promotion activities. Provision should be made to ensure that all patients can access necessary services, regardless of their condition or socio-economic status. For patients to achieve the best possible quality of life, healthcare must support patients’ emotional requirements, and consider non-health factors such as education, employment and family issues which impact on their approach to healthcare choices and management.

5. Information – Accurate, relevant and comprehensive information is essential to enable patients and carers to make informed decisions about healthcare treatment and living with their condition. Information must be presented in an appropriate format according to health literacy principles considering the individual’s condition, language, age, understanding, abilities and culture.

However, many of the healthcare delivery systems in Europe are struggling with all of this due to the fragmented and individual nature of healthcare. Responsiveness to patients is now seen as a key characteristic of effective health systems but unfortunately, in many countries there is a long way to go.

The Author

Paul Stuart Kregor is a Director at The MSI Consultancy.

Originally published in

Forecasting the impact of specific marketing activities is challenging, and marketers receive little formal training or the tools to support doing it properly. To ensure success, Pharma companies require a consistent best-practice approach to ROI, enabling measurement and monitoring of current plans, and forecasting of future activities. Arguing that a market model should be the backbone of robust ROI forecasts, Dr Paul Stuart-Kregor introduces some new thinking and innovative tools to help Pharma marketers put ROI into practice.

Introduction

Marketing is under increasing pressure to demonstrate how it can add value, particularly to justify expenditure. Marketers are often seen as the people who spend money, whilst front-line sales personnel ‘deliver results’. This is a common perception among management across many industries, in no small part due to we marketers inability to demonstrate what we actually do to help drive business forward.

With the lack of a consistent requirement historically to justify marketing expenditure on its return, we are starting in what feels like a vacuum. Without a bank of historical evidence on which activities deliver what results, either in direct sales or the necessary precursors to a prescription e.g. awareness or intention to prescribe, it is hard to know what ROI we can expect.

This may seem incredible given the wealth of data we have within our Industry. And there’s the rub. The data we have is often at a high level, with no established ‘cause and effect’ relationship to understand exactly what has contributed to those end results. The data providers do offer services where they interrogate their data sets and look for correlations, but in reality this is again at macro level. Providers suggest they can optimise the overall promotional mix but without that ‘cause and effect’ link you have to ask whether this is truly optimal.

Therefore, we need to consider how we fill this vacuum and build a discipline in healthcare marketing that shows how marketing adds value and demonstrates real return on investment. Simple…!

“It’s easy when you set SMART objectives” however, how many of us really do set specific, measurable, achievable, realistic and timed objectives for everything we do? There is often no direct logical link between what’s needed to change prescribers’ behaviour and hence drive business, and what’s proposed in our marketing plans.

The challenge is to understand the process by which we generate prescriptions and to what effect we can influence it. Within primary care, (the largest part of the market), the ‘share of voice’ sales model persists and is difficult to step away from; more noise generates more results but we have not seen any improvement from a linear return over the years, which cannot continue in the current climate.

With the shift in focus from primary to secondary care in many companies, this is going to be more challenging given most marketers have primary not secondary care experience, and driving returns in secondary care is even more complex.

Where do we start?

It’s back to first principles – we need to understand where our business comes from and how we generate that business through our activities. We need to build models that predict how our activity will change behaviour, and that behaviour involves prescribers, patients and how they use medicines.

Recently, many organisations have begun using the ‘Patient Flow’ as a tool in understanding how we arrive at our market share. But the Patient Flow is a relatively blunt analytical tool; it provides an overview of how many patients end up on your drug, and where we lose people in the process from presentation to prescription. It doesn’t identify ‘why’ or which particular activity changes behaviour.

We also need to model how our annual sales are generated: how many doctors prescribe, how many patients they prescribe for, what their prescribing patterns are and how the patients use our brand.

We then have a model, an extension of the Patient Flow, explaining where revenue is currently generated and could be generated in the future, that provides the basis for modelling and measuring marketing and sales activity.

Key strategic levers

To be profitable, activities must relate to identified opportunities to maintain and/or drive sales or profit in our model; our ‘levers for growth’.

Each of these levers will require us to change or support existing behaviour, be that of a prescriber, a non-prescribing influencer or the patient themselves. What we need to do in broad terms to change that behaviour represent our ‘Key Strategic Levers’.

You might think you do that already, however, when reviewing brand plans we often see a familiar set of activities with little thought to what really needs to happen to move a particular doctor’s behaviour in a specific market.

To make ROI analysis work, we need to be clear about what behaviour and the scale of change we must achieve to impact the Key Strategic Lever (KSL) e.g. access to screening resources if doctors are failing to identify or correctly diagnose patients; audit tools to help identify sub-optimally treated patients if we are trying to drive brand switch.

This will then enable us to set Key Performance Indicators (KPIs) for each KSL.

Deciding on the appropriate activities

Undoubtedly, the ‘share of voice’ model, executed through face-to-face meetings between doctors/representatives, has historically been an effective way of developing business for Pharma. However, with the advent of prescribing controls, medicines management and imposed targets, changing behaviour of prescribers has become increasingly complex.

Prior to 2003 Prosser and Walley showed there were a number of different influences on prescribing behaviour:

Factors influencing GP Prescribers (from Prosser and Walley, 2003)

Source: Prosser and Walley (2003), New drug uptake: qualitative comparison of high and low prescribing GPs’ attitudes and approach, Family Practice 2003, 20: 583-591.p. 585

However, that was before the Quality Outcomes Framework (QOF) and the new PCT structures and processes began to bite.

We know there are now various activities that affect prescribing in addition to the traditional mechanisms. Reports show these operate at different levels in the healthcare system. At the national or international levels, evidence on treatments and drugs presented in authoritative journals was a significant influence, as was NICE. At the PCT level, influences include publication of local guidelines, newsletters, site visits by prescribing advisers, and Scriptswitch. At practice level, the professional experience of the GP, clinical needs of the patient, patient demand, peer networks, and drug company representatives may influence prescribing.

It is rarely one specific activity that delivers prescriptions. It’s more likely that we need numerous complimentary and sequential activities to achieve our objectives, moving our customers through the adoption and usage process. So, it’s critical to be clear about the process needed to achieve that change.

The principle is the same: identify what behaviour and the scale of the change we must achieve to impact the KSL. However, now there are some significant inhibitors and potentially opposing drivers to our aims, e.g. defined guidance on when and how long to use particular classes of drugs in treating specific conditions or patients, it means historical views on what ROI an activity may deliver are potentially obsolete.

With forecasting, we often become dependent on analogues, so could we use the same approach for ROI? Not really since with the new environment and influences there is little applicable history or guide to an activity’s expected ROI.

We must look for fresh insight into the probable impact of a specific activity on a KSL. Customers stated propensity to change in light of an activity/information is a good starting point. However, this will often need to be followed-up by a more discreet approach e.g. choice-based conjoint analysis, where customers choose between different product and service packages made up of the benefits of the proposed different activities in your campaign, be they educational initiatives, or dedicated resource or practice tools.

What about the ’soft’ activities?

The problem of less tangible ‘softer’ activities, such as awareness and interest, is that their financial impact is less direct but it is still intrinsically there. We must think through the string of additive effects and identify the relevant, measurable KPIs.

Conclusions

Putting ROI marketing into practice is not complex in principle but can be challenging to implement at first. We often see ROI analysis that tests returns on ill conceived activities which weren’t derived from an understanding of where the opportunity to drive sales exists.

The key is to understand where our revenue is generated, by building a model based on the Patient Flow, to provide the basis for modelling and measuring marketing and sales activity. Then by identifying where and what behaviour change is required to achieve our business objectives, we can set appropriate KPIs which we can measure.

Finally we build a set of profitable activities to achieve those KPIs, and measure the ROI accordingly.

Simple!

The Author

Paul Stuart-Kregor is a Director at The MSI Consultancy Ltd

Article originally published in Pharmaceutical Marketing, August 2008

In the days when the pace of change was much slower in the pharma industry, many a good career was built on finding a niche and becoming a specialist in it. This is no longer the case: what might once have been prudent career-building is now pigeon-holing – and it is the kiss of death for a long-lasting career.

In these days of constant and fast-paced change, a varied cv with lots of different experience is what will stand you in good stead. That means changing roles – and probably employers – much more frequently. Paul Stuart-Kregor argues that some lateral thinking is required to build a sustainable and successful career in pharma – and he has some unexpected tips about how to achieve the perfect cv.

With flattening organisational structures and lower head counts, building a commercial career in pharma is quite a challenge. Unfortunately, those organisations that are not ‘knowledge-based’ (i.e. depend upon people and their expertise) are highly likely to cut people – so choosing the right company to join in the first place is key.

Obviously, you should look at their performance historically, but more importantly what is coming. The old model of super-blockbuster products that power the financial engine is becoming less and less applicable. Now companies are looking to extract maximum value from assets with smaller potential, in an increasingly budget conscious market. This should move us way from the old ‘boom-and-bust’ cycles of the past, which is no bad thing.

A healthy pipeline of future products that will enter markets that are less price sensitive and open to generic competition is one way of ensuring a more positive future financial picture and hence more secure employment. It will also mean that the atmosphere in the company is more likely to be positive and upbeat, focused on doing the right things, rather than defending budgets.

Something else to consider when choosing prospective employers is their approach to ‘talent management’. Too often we have conversations with people over a beer after work which demonstrate that good talent management is not the norm. By ‘talent management’ I mean a structured process of identifying and nurturing people within the organisation so their commercial skills are developed, in line and along with their career aspirations.

Good companies explain not only the next move but the one after that. Then a secondment into sales does not seem like being sent to Alcatraz with a life sentence, but rather six months of valuable experience en route to becoming a more customer-focussed marketer.

The traditional route in ‘commercial’ pharma has been sales and on to sales management, or sales into marketing. Depending on your particular strengths one or other is perfectly valid. However, having experience of each other’s role can certainly help dialogue between the two disciplines and improve implementation. Even if you have come into marketing through a graduate entry scheme, then gaining sales experience is an important part of building the CV.

But what are companies looking for from future employees? Well, I cannot talk from a structured research base, but looking at recent people’s moves I can hazard a guess.

Companies who do not develop their own talent look to buy it in; and they are looking to tick a certain number of boxes.

These can be in a particular therapy area and/or specific functional expertise. Generally the former seems to be what they are looking for rather than the later, particularly at junior levels and in smaller companies. However, as you get more senior then success in all the strategic as well as operational areas of marketing or sales becomes increasingly important.

The danger however is that you become siloed i.e. an expert in a narrow therapeutic field, which then limits your future options. So you need to ensure that even though you have been ‘bought in’ to work in a particular therapy area, you can move across therapy areas later, so that you broaden your experience and hence your marketability. But: beware the ‘jack-of-all-trades’ tag if you only have a superficial level of experience in a number of therapy areas. You need to spend enough time in one area that you can demonstrate you have made a difference.

The same applies with functional expertise. Some larger companies pigeon-hole marketers, particularly junior ones, so that all they ever do is related to one area of the marketing mix. Again, a dangerously narrow base, unless you want to become an expert and make your fortune that way! So look to broaden your experience of the marketing mix in the early years.

While functional expertise seems to be hard to measure, even with assessment centres, there is no doubt that this is the foundation on which all else is built. The trouble is that many companies are focussed on the immediate results rather than the more medium-to-long term. The result is that people are busy ‘doing’, but may not be provided with the knowledge and skills to develop that critical foundation.

While experience is a key part of learning, more and more so in the modern era, there is a definite need for mental ‘processes’ or ‘frameworks’ that can guide the individual through solving the increasingly complex competitive commercial challenges we face now and will face in the future. Without those ‘processes’ or ‘frameworks’ life gets quite tough.

In our experience many pharmaceutical companies have not provided these in the recent past. More and more are doing it now but there is still a huge need and a gap between where people are and where they need to be.

One place to get both the breadth of functional and therapy area expertise can be, dare I say it, on the ‘other side of the fence’. While thinking about stepping outside a pharmaceutical company may seem like career suicide, and in some cases where longevity of service is the name of the game then this may be true, there is no doubt that a period of time on the service side can turbocharge your knowledge. The right consultancy, of which there are a core few, provides process, range of experience, both in therapy area and commercial challenge.

Above all it is building a logical CV that makes you an attractive asset: a range of therapeutic area experience, demonstrable functional expertise and a successful track record. Where you do that is not necessarily so important but rather having a rounded track record is what matters.

The Author

Dr Paul Stuart-Kregor is a Director of The MSI Consultancy

Originally published in PM, July 2008

In the days when the pace of change was much slower in the pharma industry, many a good career was built on finding a niche and becoming a specialist in it. This is no longer the case: what might once have been prudent career-building is now pigeon-holing – and it is the kiss of death for a long-lasting career.

In these days of constant and fast-paced change, a varied cv with lots of different experience is what will stand you in good stead. That means changing roles – and probably employers – much more frequently. Paul Stuart-Kregor argues that some lateral thinking is required to build a sustainable and successful career in pharma – and he has some unexpected tips about how to achieve the perfect cv.

With flattening organisational structures and lower head counts, building a commercial career in pharma is quite a challenge. Unfortunately, those organisations that are not ‘knowledge-based’ (i.e. depend upon people and their expertise) are highly likely to cut people – so choosing the right company to join in the first place is key.

Obviously, you should look at their performance historically, but more importantly what is coming. The old model of super-blockbuster products that power the financial engine is becoming less and less applicable. Now companies are looking to extract maximum value from assets with smaller potential, in an increasingly budget conscious market. This should move us way from the old ‘boom-and-bust’ cycles of the past, which is no bad thing.

A healthy pipeline of future products that will enter markets that are less price sensitive and open to generic competition is one way of ensuring a more positive future financial picture and hence more secure employment. It will also mean that the atmosphere in the company is more likely to be positive and upbeat, focused on doing the right things, rather than defending budgets.

Something else to consider when choosing prospective employers is their approach to ‘talent management’. Too often we have conversations with people over a beer after work which demonstrate that good talent management is not the norm. By ‘talent management’ I mean a structured process of identifying and nurturing people within the organisation so their commercial skills are developed, in line and along with their career aspirations.

Good companies explain not only the next move but the one after that. Then a secondment into sales does not seem like being sent to Alcatraz with a life sentence, but rather six months of valuable experience en route to becoming a more customer-focussed marketer.

The traditional route in ‘commercial’ pharma has been sales and on to sales management, or sales into marketing. Depending on your particular strengths one or other is perfectly valid. However, having experience of each other’s role can certainly help dialogue between the two disciplines and improve implementation. Even if you have come into marketing through a graduate entry scheme, then gaining sales experience is an important part of building the CV.

But what are companies looking for from future employees? Well, I cannot talk from a structured research base, but looking at recent people’s moves I can hazard a guess.

Companies who do not develop their own talent look to buy it in; and they are looking to tick a certain number of boxes.

These can be in a particular therapy area and/or specific functional expertise. Generally the former seems to be what they are looking for rather than the later, particularly at junior levels and in smaller companies. However, as you get more senior then success in all the strategic as well as operational areas of marketing or sales becomes increasingly important.

The danger however is that you become siloed i.e. an expert in a narrow therapeutic field, which then limits your future options. So you need to ensure that even though you have been ‘bought in’ to work in a particular therapy area, you can move across therapy areas later, so that you broaden your experience and hence your marketability. But: beware the ‘jack-of-all-trades’ tag if you only have a superficial level of experience in a number of therapy areas. You need to spend enough time in one area that you can demonstrate you have made a difference.

The same applies with functional expertise. Some larger companies pigeon-hole marketers, particularly junior ones, so that all they ever do is related to one area of the marketing mix. Again, a dangerously narrow base, unless you want to become an expert and make your fortune that way! So look to broaden your experience of the marketing mix in the early years.

While functional expertise seems to be hard to measure, even with assessment centres, there is no doubt that this is the foundation on which all else is built. The trouble is that many companies are focussed on the immediate results rather than the more medium-to-long term. The result is that people are busy ‘doing’, but may not be provided with the knowledge and skills to develop that critical foundation.

While experience is a key part of learning, more and more so in the modern era, there is a definite need for mental ‘processes’ or ‘frameworks’ that can guide the individual through solving the increasingly complex competitive commercial challenges we face now and will face in the future. Without those ‘processes’ or ‘frameworks’ life gets quite tough.

In our experience many pharmaceutical companies have not provided these in the recent past. More and more are doing it now but there is still a huge need and a gap between where people are and where they need to be.

One place to get both the breadth of functional and therapy area expertise can be, dare I say it, on the ‘other side of the fence’. While thinking about stepping outside a pharmaceutical company may seem like career suicide, and in some cases where longevity of service is the name of the game then this may be true, there is no doubt that a period of time on the service side can turbocharge your knowledge. The right consultancy, of which there are a core few, provides process, range of experience, both in therapy area and commercial challenge.

Above all it is building a logical CV that makes you an attractive asset: a range of therapeutic area experience, demonstrable functional expertise and a successful track record. Where you do that is not necessarily so important but rather having a rounded track record is what matters.

The Author

Dr Paul Stuart-Kregor is a director of The MSI Consultancy.

Originally published in PM (Pharmaceutical Marketing), July 2008

Dr Paul Stuart-Kregor argues that although global branding is a fact of life in the pharma industry, local marketers must keep the customer firmly in the front of their minds when validating whether the global approach will work in their market – or whether they need to argue for local adaptation.

Pharma is by its nature a globalised business, and therefore standardised, globalised brand strategies are a fact of life. Even though marketing is a complex discipline, influenced by all sorts of factors including culture and the local business environment, sometimes a global approach makes sound strategic sense, even when that decision is made with the knowledge that it may not always be best for a brand’s local competitiveness.

No-one likes being told what to do, especially when they regard themselves as experts in their own market, which is why local marketing teams are sometimes resistant to global strategies. But this is one area where it is important to be objective, rather than letting emotional considerations, or feelings of dented professional pride, get in the way.

That said, as in so many areas, we can learn from the fmcg sector. Here, there was a realisation long ago that a ‘one size fits all’ approach doesn’t always work, and that a ‘glo-cal’ approach, where the core brand values are expressed in an appropriate way for local markets, often works better. Whilst consistency in every market is desirable, sometimes it is simply wrong to impose it on all markets.

But pharma is not the same as fmcg. Given that pharma brands are based on evidence and there is one common evidence base, it’s not hard to see why a global branding strategy is so attractive to international marketers. There are clear financial and commercial benefits in developing global brands in our sector, with both time and cost efficiencies, as well as keeping control (something which is very attractive to corporate entities operating in a multi-national environment).

The ‘New’ Europe

The accession to the EU in 2004 of ten new and very different countries brought with it perhaps unrealistic expectations that the ‘European’ market (and of course, this extends well beyond the boundaries of even an expanded EU) would bring about a more homogenous market, making the implementation of brand consistency, and beyond that a centrally determined brand strategy, considerably easier.

But the emergence of new markets, whether inside the EU or further east, doesn’t alter the fact that the European marketing environment has always been disparate. So just how realistic is it to take a global brand and impose it on such a varied marketplace?

This new European environment is not an amorphous mass of 450 million people opened up to the delights of free trade. As we should all be aware by now, it is in fact a collection of unequal markets, some with low-wage, low-cost and in some cases low-regulation economies.

This brings about a series of challenges to pharma marketers who are trying to implement a global brand. Issues such as pricing, regulation and attitudes to generics surely pose an insurmountable barrier to achieving consistency across different markets.

Four years on from the accession of the ten new countries into the EU, we can see that some of the initial fears about parallel importing and lack of harmonisation were overstated. Membership has already had a beneficial effect on these countries, and as they grow steadily richer, their populations are coming to expect better levels of healthcare, and their health systems are slowly being given more resources to deliver it – all of which is good news for the industry.

At the same time, and this has a big resonance for the attempt to promote brand consistency across different local markets, the unprecedented free movement of people across the continent – predominantly from east to west – is starting to break down cultural barriers, opening up the opportunity for pan-European initiatives to find receptive audiences. Only by this breaking down of national emotional barriers as well as physical borders will pharma businesses be able to create truly pan-European brand campaigns, benefiting from the cross-fertilisation of people and processes.

So far, so good. But does this mean that the European market is ready to adopt and implement the so-called ‘Global Brand’?

The Global Brand

What exactly do we mean by a global brand? Is it about the same name, logo and imagery? Not necessarily. Too often the perception is that if we have the logo and imagery in every country we will have a global brand. Not true – just ask General Motors, whose Vauxhall Nova would have bombed in Spain, where ‘Nova’ means ‘doesn’t go’!

In the pharma world as well, there are well-documented right-thinking examples of where a global brand strategy didn’t mean an inflexibility when it came to the execution of marketing communications in different markets. Responsiveness to the market context determines the treatment. Pfizer’s Celebrex was launched in many markets with a ‘power’ positioning, taking advantage of its first-to-market status in most places. But as it wasn’t first-to-market in the UK, where Vioxx had already made this territory its own, Celebrex had to adopt a completely different positioning message in this market. However, the rest of the brand, it’s vision, values and overall benefits remained the same.

Brands are about benefits, both functional and emotional, values and relationships. Those need to be built country by country, based on the needs and values of the target customers and their perceptions of the competitive set. Essentially, there are four potential scenarios, based on the extent to which brand values and brand identification are globally consistent or inconsistent, and where a particular local market sits will determine the extent to which it is appropriate for the global brand to be implemented in the local market.

1. The ‘Purely Local’, where both brand identification and brand values are globally inconsistent: this scenario is relevant where the local situation means that a global approach is inappropriate (e.g. it is purely a local brand), and allows the strongest appeal to local customer and market needs. But with no tie-in to ‘larger thinking’, there is the danger of inefficient i.e. costly,marketing.

2. The ‘Label’, where brand identification is globally consistent, but where brand values are globally inconsistent: this scenario has the danger that it has the illusion of a brand, but can lead to the use of inappropriate materials at local level, with the temptation to adopt ‘global’ executions where other elements of branding are not consistent.

3. The ‘Value Set’, where the brand values are globally consistent, but where brand identification is globally inconsistent: this still represents a global brand, with consistent core thinking but different executions. This scenario is appropriate where local customs or history dictate the need for differences, or where there are problems locally with the global brand identity – perhaps for legal or cultural reasons. The danger here is overstretch and/or lazy marketing.

4.The ‘Complete Brand’, where both brand values and brand identification are globally consistent: this is the ideal, provided it is real. This scenario delivers the full customer and company benefits of a global brand, and offers the highest level of potential marketing efficiency.

In practice, there is rarely a black and white answer as to where any brand sits, and the pharma marketer needs to assess all sorts of brand and market drivers to gain a better picture of whether the approach in any given market veers towards the local or the global.

I would argue that there are six elements which make up a complete strategic pharma brand, and it’s useful to understand what these are when you are considering the extent to which such a brand can be implemented locally:

* Brand Vision & Core Values: the aspirations and personality for the brand, derived from the brand’s objectives and insights about the market
* Brand Value Equation: the balance of functional, emotional and/or value for money benefits, derived from our understanding of customers, their personas, needs and drivers
* Product Positioning: the ‘who’, ‘what’, ‘where’ and ‘when’, which also requires an insight into competitors, and their brands and messages to ensure the brand is competitive and differentiated
* USP: the ‘why’, derived from our product’s unique characteristics
* Brand Positioning: what we want the customer to ‘know’, ‘believe’, ‘do’ and ‘feel’, which follows from the product attributes, consequences and the emotional benefits
* Core Proposition: the single, consistent, over-arching proposition: what makes our brand meaningful, credible, differentiated, motivating and sustainable

All of these six elements come together to form the complete strategic brand, and the international marketing team will have put this together. But how much of each element needs to be globally consistent? For example, the USP may be global, but it can be expressed differently in different local markets.

Having A Say

Ideally, the understanding that local teams have of their markets will be tapped into during the development of the strategic brand, so that local needs are taken into consideration. A global brand should be something which develops from within every market that the brand will interact with, rather than simply being imposed from above by the international marketing team sitting in their marble and glass palaces in say New Jersey!

Audiences in Europe will always react better to a Europe-centric marketing approach than to a US-centric one – or at least a global approach in which the importance of the European market is recognised, as is the particular market needs of our disparate but nevertheless converging markets.

Rather than just accepting what comes from ‘on high’, European marketers must constantly question whether there is a better way of doing things at a local level that fits within the global strategy. Pharma is strong as an industry because it is global, but to survive and thrive we must not be scared of standing up for a European point of view while the global strategy is being developed.

In the end, if the global brand is consistent with local needs and you have the same competitive set, then the global strategy should be adopted locally – this should be the default position. If this is not the case, then a local execution may be appropriate. But either way, any local execution must not conflict with the global strategy, must fit under global umbrella, with the same brand values. In this sense it is the global which should inform the local, more than the local ploughing its own furrow.

European markets are generally important enough globally to have some input into the creation of the global brand. The understanding of the local market can only come from local marketing teams, and in major markets this can be used to influence the global brand strategy. With well structured and value input we can create better global brands, rather than have poor ones imposed on us!

The important thing for European and global marketers to recognise is that global brand does not always mean global advertising execution. Fmcg has shown us the value of allowing or even providing for local advertising by creating a series of adverts from which countries can choose. In many cases the global brand should be relevant to the local market. What marketers often focus on is purely the advert, potentially missing the point and getting into unnecessary arguments. Implementing a global brand will often be the appropriate approach, but adjusting the local execution may be necessary, but it needs an objective not an emotional assessment.

The Author

Dr Paul Stuart-Kregor is a Director at The MSI Consultancy

Article originally published in Pharmaceutical Marketing Europe, June 2008

More than any other industry, pharmaceuticals cannot exist in a one-market ‘bubble’ – and this means that dealing with different cultures is inevitable. Expansion of the EU eastwards, and the emergence of new markets outside the EU, has exacerbated this, and any marketer who regards Europe – from Russia to Portugal – as one homogenous ‘European’ whole is heading for disaster, says Dr Paul Stuart-Kregor.

We often refer to Europe in discussions as if it represents a single homogenous entity. Those of us who live here know that the continent cannot be regarded as such. In fact, commercial Europe is becoming even more diverse. For example, the accession of ever-more Eastern European states seems already to have shifted the centre of gravity away from the usual epicentre of the EU5. If Turkey was to join the EU, is it really still a ‘European’ market or a more Eurasian one? And we must also take into account the countries perceived as part of the European market – especially Russia – which are not part of the EU.

So to what extent can Europe be regarded as one, single market – and if so can this unity sensibly be managed by a European team?

The process of EU accession and legislation harmonisation has driven a positive change towards a more predictive regulatory and intellectual property environment. By the implementation of various Directives, in terms of data exclusivity 8 + 2 + 1 rule, Bolar provision and relevant registration procedures (Centralised Procedure, Decentralised Procedure and Mutual Recognition Procedure), the EU has contributed to a more single European medicines market.

There is no doubt that this is an attempt to standardise medicines and their approval across the EU, but this does not mean that marketing of those medicines can be to a standard formula across Europe, not least as there are European countries that are top of mind yet not part of the EU.

In this way we can say that there is technically one market, but even then, we know that there is no guarantee that we will gain the same registration status in each EU country, nor the same reimbursement; and the accession countries have time to normalise their local situations.

So why is cutting the European cake an issue now?

More and more we are seeing the centralisation of strategic thinking in European or International teams based in Europe, with local operating countries implementing the defined strategy. There is a natural tendency to focus on the obvious, the countries where there are the most people and therefore the greater number with the condition for which our brand offers a solution. The problem is that size may not be everything. For example, the UK is among the top five European countries on size but in some therapy areas (e.g. specific cancers), the true opportunity is smaller than it should be due to funding restrictions.

On top of this, the potential reduction in the scale and profitability of the US market means that maximising growth in Europe is going to become increasingly important.

So unless that thinking is based on a sound segmentation of the market, then the strategy devised may be sub-optimal, not providing the necessary competitive differentiation and relevant support to access the opportunities. What we are not talking about (yet) is a pan-European behavioural or attitudinal based segmentation, as perhaps the car industry might consider (and BMW did in fact execute). Rather, we are looking at an opportunity-based selection process that can lead into a macro-level need-based segmentation on which our European brand strategy can be built.

Options for slicing the cake

The traditional way of looking at the individual countries within Europe has been on population and hence prevalence of our target conditions. Thus we always think of the Top Five in Europe as Germany, France, UK, Spain and Italy, the EU5. For a time it looked as if Poland would break into that group to establish an EU6 given it has a population of 39m people and was becoming increasingly linked to the other major markets within the EU. Turkey has an even larger population at 70m so on paper would represent a significant opportunity if we just looked at population, as would Russia at 143m.

However, recent reforms in Poland, driven as ever by the affordability of healthcare, have meant that Poland has lost its pre-eminence as a potentially major market. Perhaps this gives us one clue to how we might consider selecting opportunities within Europe.

Maybe it’s not just about size but economic performance. Gross domestic product (GDP) is a common measure of the wealth of a country. If you look at Poland’s GDP in 2005, it was around $530bn, but if you then calculate GDP per capita for Poland it is $19,889 (Source: OECD). To put that in context, if you look at Austria’s GDP it is less at $283bn but per capita it is $34,393, above the EU average, suggesting that a higher level of healthcare is affordable in Austria when compared to Poland.

For reference, Hungary has a population of 10m, GDP of $176bn and GDP per capita of $17,483, whilst Turkey, with a more significant population of 70m, has a GDP of $556bn resulting in a GDP per capita of $7,711, one quarter the EU average. Russia with a population of 143m and a GDP of $764bn has a per capita GDP of $5,342. Hence, total health spending accounted for 10.2 per cent of GDP in Austria in 2005, more than one percentage point higher than the OECD average of 9.0 per cent. In Poland it was 6.2 per cent and in Turkey 7.6 per cent. If you look at that as health spending per capita then Austria is $3,519, far lower than the US, Norway and Switzerland, but higher then Poland at $867 and Turkey at $586. Health spending tends to rise with income: in general, OECD countries with higher GDP per capita tend to spend more on health.

According to OECD Health Data, health spending has grown faster than GDP in every OECD country except Finland between 1990 and 2004. It accounted for 7 per cent of GDP on average across OECD countries in 1990 but reached 8.9 per cent in 2004, up from 8.8 per cent in 2003, which is good news. However, the public share of health spending has fallen in countries such as Poland, Hungary and the Czech Republic, which had a relatively high public share of health spending in 1990.

For countries in transition like Bulgaria and Romania, but also in most of the new accession Central and Eastern European (CEE) countries, the low purchasing power of an ageing and ailing population and a highly restricted state budget to get whole or partial reimbursement for their treatment results in the extremely high social demand for effective cost containment policies for pharmaceuticals. As a result, the socio-political change which the above States are experiencing is having a serious impact on the macro and microeconomics of the healthcare sector in CEE, where branded and generic medicines play a vital part.

Paying the drugs bill

Indeed, the major problem of the national healthcare policies is the lack of sufficient budgetary resources, an average of 4.2 per cent of the GDP for the last six years in Bulgaria. In Romania, the budget assigned to the healthcare system accounts for 3.6 per cent of GDP, as compared to an average of 5.3 per cent in Central and Eastern European countries and 8.5 per cent in the old EU member states.

As mentioned before, healthcare costs are under increased pressure in Europe, especially in transition countries, and this will force new member governments to introduce more effective price cutting or budget control measures. The Czech healthcare system underwent a minor revolution on 1st January 2008, as patients are now asked to pay a small fee each time they visit their doctor. Czechs enjoyed free healthcare during four decades of communist rule and in the past 17 years of capitalism. But from 1st January, Czech patients will be asked to pay 30 crowns (£0.83; 1.1 euros) for each visit to the doctor, and 60 crowns for each day spent in hospital. Not huge but still a significant change.

Interestingly, if you look at who pays for drugs, in 2004 public coverage of spending on drugs was lowest in Poland (37%). By comparison, more than two-thirds of spending on drugs was paid by public sources in Austria, France, Germany, Spain and Sweden.

So, as decision-makers are increasingly interested in maximising value from healthcare investment, pharmacoeconomics criteria are being introduced into the pricing and reimbursement for medicines decision-making process as a trend throughout whole Europe. All this creates a favourable policy environment to raise reimbursed volumes for generics and to optimise value for innovative products without therapeutic alternatives, yet pressure on prices and health economics based on results of medicinal therapies must be considered.

Consequently, if as commercial people we are to maximise return on investment, we need to consider the whole value proposition as it relates to the economic status of our target markets.

A three speed system?

Moving on, according to a recent report covering all 27 European Union members, as well as Norway and Switzerland (Euro Health Consumer Index – EHCI), Europe has a three speed healthcare system.

There is a small group of countries – Austria, Netherlands and France – which compete for pre-eminence in excellence, separated only by minor differences; followed by Switzerland and Germany they make up the top five. These are followed by a middle group of adequate performers, the Nordic countries of Sweden, Norway, Finland and Denmark, with a tail of under-achievers. No country in the index achieves more than 80 per cent of their potential, so all remain in need of some reform.

If you look at healthcare systems in Europe they fall into one of two types: Bismarck healthcare systems based on social insurance, where there is a multitude of insurance organisations, Krankenkassen etc, who are organisationally independent of healthcare providers: and Beveridge systems where financing and provision are handled wholly or partially within one organisation, such as the NHS of the UK, countries of Nordic states etc.

The results of EHCI 2007 show that the top five countries, which fall within 36 points on a 1000-point scale, all have dedicated Bismarckian healthcare systems. There is then a gap of 30 points to the first Beveridge country (Sweden) in sixth place. While not at all arguing that the Bismarck-type healthcare systems are in every way superior, the EHCI report seems to suggest that for total customer value, the Bismarck model wins over the Beveridge.

In southern Europe, Spain and Italy provide good healthcare services. However, real excellence in southern European healthcare seems to be dependent on the consumers’ ability to afford private healthcare as a supplement to public healthcare. The CEE member states are doing surprisingly well; however, readjusting from planned to consumer-driven economies takes time.

Which model works best?

As ever it depends! Size alone is not enough, as we can see from considering the situations of Poland and Turkey.

As commercial people we need to consider how best to work in a complex arrangement of different nation states. Operationally there are logical geographic considerations which maximise operational effectiveness e.g. EU5 plus perhaps Austria, Switzerland, Netherlands and Belgium; North – the Nordic countries; Central – CEE; SE Europe – Turkey, Greece and the Balkans.

To a great extent this also reflects the economic, healthcare spending power and hence market potential. There is no doubt that the budgets in CEE and SE Europe are under more pressure than in the larger more affluent markets.

This then suggests that the strategies we employ will need to take into account very different spending power by country. The consequence of this is a need to be able to demonstrate the full value of our innovative, branded medicine over other less expensive perhaps generic options. Alternatively, the use of risk sharing models may become more normal in the less well developed markets than in the EU5.

As for priorities, we could stick to the ‘old’ way of considering the EU5 as our prime focus, but that ignores other potentially up and coming parts of Europe where there is definitely new business to be had.

In conclusion, Europe appears to be more heterogeneous than ever, which makes European marketing an increasing challenge. There are a number of different ways to slice the cake; you pays your commercial ‘money’ and makes your own choice. There definitely is not a one-size-fits-all solution.

The Author

Paul Stuart-Kregor is a Director of The MSI Consultancy

Originally published in Pharmafocus, June 2008

When a healthcare professional relative of mine diagnosed with an inoperable brain tumour was told by a close friend that knowing when she was going to die was a gift, you can imagine that her reaction was not positive.

But think about it. Would you rather go relatively quickly or decline over a long period, gradually losing your faculties and control of bodily functions? Or as the best selling author Terry Pratchett put it recently more eloquently than me when talking about living with his diagnosis of early-onset Alzheimer’s disease, a condition that “strips away your living self a bit at a time”.

That is why the 59-year-old fantasy author, who appeared at a conference for the Alzheimer’s Research Trust (ART), has pledged a million dollars (around £500,000) to research. He told the conference: “I’d like a chance to die like my father did – of cancer, at 86. Before he went to spend his last two weeks in a hospice, he was bustling around the house. He talked to us right up to the last few days, knowing who we were and who he was. Right now, I envy him.”

Dementia does not have the “heroic glamour” of cancer to put it in his words – as he told the ART conference: “It’s a shock and a shame to find out that money for [Alzheimer's] research is three per cent of that which goes to find cancer cures. Perhaps that is why I know three people who have survived brain tumours but no one who has beaten Alzheimer’s.”

The World Health Organisation has calculated that, when it comes to disability in the over-60s, dementia is responsible for about 11 per cent, cardiovascular disease for about 5 per cent, and cancer for 2.4 per cent. In January, the House of Commons Public Accounts Committee was told that dementia costs the UK economy £17 billion a year, more than stroke, heart disease and cancer put together! Yet the Alzheimer’s Research Trust points out that only £11 is spent on UK research into Alzheimer’s for every sufferer, compared with £289 for every cancer patient. Have we got our priorities wrong?

As I have discussed before, even accessing drugs is difficult. As Pratchett noted wryly: “The NHS kindly allows me to buy my own Aricept because I’m too young to have Alzheimer’s for free, a situation I’m OK with in a ‘want to kick a politician in the teeth’ kind of way.”

It’s about time that our NHS started to get its priorities right. The proportion of people over 65 is increasing and will continue to increase. That means dementia is going to become an increasing reality for more and more of us. People with dementia have a really hard time, as do the families that care for them, but the usual approach is to shut them away in homes, and forget about them. Hardly a world-class healthcare system!

NHS ‘the sick man of Europe’

So says the think tank Civitas who recently published their new report “Why the NHS is the sick man of Europe”. They contend that despite record increases in funding over the last decade, with public spending on the NHS nearing £100 billion, the performance and productivity of the health service has been steadily declining. Yes, the money and the reforms have produced some notable achievements – particularly on waiting times and falling cancer and CHD mortality rates – but there are some fundamental issues to resolve.

Civitas believes that the root of the problem is not the world-class doctors, nurses or even managers who work in the NHS, but the system they are working in that prevents patients from taking control of their health care and prevents frontline professionals from revolutionising services for their patients’ benefit. Civitas feels that where you live, and how much you shout, accounts for much in the standard of treatment you can expect.

Civitas sees two symptoms: first, inequity. For example, Lord Darzi’s interim report that documents the gap in life expectancy between the most and least deprived areas in England as nearly ten years (for men), and it’s getting worse. There is a deeper issue of the quality of care a patient receives in the NHS which appears to depend on education, intelligence and connections (i.e. ‘he who shouts loudest’), and where you are treated (e.g. there is a fourfold variation in mortality rates between NHS organisations for coronary artery bypass graft (CABG) operations).

Secondly, inefficiency – NHS productivity, according to the latest estimates by the Office of National Statistics, has fallen by an average of one per cent per annum over the past ten years. And finally, unhealthy outcomes – the NHS still languishes at the bottom of European league tables on cancer survival rates, much closer to the performance of Poland and the Czech Republic than the best performers Sweden, Finland and Switzerland.

Civitas sees the crux of the problem as the fact that the NHS has never found a satisfactory mechanism to assess clinical need, or the demand for health care, and allocate resources accordingly.

Given these problems, how then can the government justify that the NHS is now heading for a £1.8 billion surplus for 2007/08? If you provide a ‘budget’ to achieve certain objectives then why is there a need to deliver a surplus? Beats me! Maybe that’s why I am not a politician.

The Author

Paul Stuart-Kregor is a Director at The MSI Consultancy

Originally published in Pharmafocus, April, 2008

There is no doubt that the pharmaceutical industry is a global industry. The importance of geographically diverse markets to the overall success of a brand and the company is clear. With developing markets becoming more significant, this global perspective will be increasingly important, and therefore standardised, globalised brand strategies are a fact of life which we will need to live with.

With the growing complexity that results from being global, it is very easy for a company to be tempted to try and centralise decision making, adopt a ‘global’ marketing approach, and insist that all countries follow that approach. It can work, of that there is no doubt, but it is clearly not the optimal approach.

It can be very tempting to see Europe as one entity, particularly for our American cousins, but as we all know, just because we are part of an Economic Union does not mean we are the all same. The extension of the EU, and the consequent proliferation of countries under one ‘banner’, is also likely to lead to attempts to develop a pan-European strategy within the global context.

Is a ‘European’ approach really feasible?

The first question to ask is what exactly we mean by a ‘European’ marketing approach? If we focus on marketing only, then we are talking about branding, overall strategy to include focus segments, positioning, messaging, pricing and implementation.

If by a ‘European’ approach we mean every country following exactly the same strategy and doing exactly the same thing then the answer is obvious – no.

However, there are obvious commonalities across markets in how medical thinking develops and is then put into practice. Again, it is not totally consistent across all markets, but there are common threads, in most therapeutic areas. Added to which the clinical database for the molecule is in many cases fixed, so we cannot significantly change the supporting evidence.

So, even though marketing is a complex discipline, influenced by all sorts of factors including culture and the local business environment, sometimes a pan-European approach to strategy makes good sense.

What is required to market successfully across the continent?

This is not just about a ‘top down’ approach; rather, it is about developing the best solution for as wide a geographic base as possible.

The simplistic answer is to go for a rigid definition of strategy by a European Regional Team which is then implemented to the letter by the local markets. We all know that is not the right way to go. People need to be more than operators; after all we are not computers!

So what exactly is a pan-European brand? Is it about the same name, logo and imagery? Not necessarily. Hence the need to ensure all markets fully understand those key parameters.

The key is to define what the brand is going to stand for in the target customers’ minds, i.e. its value proposition and positioning. It is also vital to be clear about what it will NOT stand for. Once we have defined that ‘box’ then each market knows where it can operate and into areas where it must not stray.

What we must not confuse is strategy and implementation. Strategy may be consistent but local execution may be different, due to local market forces and different competitive sets.

For example, Pfizer’s Celebrex was launched in many markets with a ‘power’ positioning, taking advantage of its first-to-market status in most places. But as it wasn’t first-to-market in the UK, where Vioxx had already made this territory its own. Celebrex had to adopt a completely different message set in this market while being true to the core global brand.

Alternatively, communicating the key global or pan-European brand values does not mean an inflexibility when it comes to the execution of marketing communications in different markets. Pfizer’s Lipitor used different visuals – and indeed different names – in different markets, yet the global brand strategy meant that the core message and values (more potent on LDL-C, extended efficiency on TG, simplicity of use) remained the same.

A significant challenge in the era of ‘managed markets’ is price and pricing strategy. Different countries use different approaches but most if not all European markets have some form of constraint on prescribing and or price.

With the increased use of reference pricing across Europe it is increasingly important to maintain an effective price corridor. If that means maintaining price in one market at the expense of local sales to ensure that the pan-European and hence profit can be maintained then so be it. Pfizer have done that with atorvastatin in Germany, where they have decided not to reduce the price to that of the Festebetrag.

Clearly there are implications for corporate and brand perception where price is maintained in a low cost market, but if the value proposition is strong enough this should not have a negative impact elsewhere. In addition, if the value proposition is strong, a proportion of patients may still be willing to pay; in Pfizer’s case 20% of them, based on market share. The impact on corporate perception may be more challenging; is it ethical to not market a product in a country to maintain price? Only time will tell.

In summary, pan-European is a necessity and a reality. Doing it well is the challenge, as it requires significant skills on the part of the European marketers to ensure that it is not all about the lowest common denominators.

The Author

Dr Paul Stuart-Kregor is a director of The MSI Consultancy.

Originally published in PM Europe, February 2008

The pharma industry ought to boast some of the best marketers in the world. We attract an almost exclusively graduate intake, bringing in some of the best minds and brightest intellects. The challenges facing the pharma marketer are certainly changing, but then that’s probably true in most sectors. But few would seriously argue that as an industry we are right at the forefront of marketing excellence.

The question, given the quality of the raw material we attract, is why not? Surely our marketers are up to the job. So are they getting the guidance, help and support they need – and if not, where can they find it? Are we giving them the tools to perform?

Lots of difficult questions, and the temptation is to answer them with a series of inaccurate generalisations. Of course, there are many examples of true excellence in marketing departments throughout pharma, but I think it is safe to argue that there is also a lot of raw potential not being realised, because marketers are not being given -and in reality perhaps not even seeking – the development they need to build their skills and face the new challenges which are emerging.

The implications of this situation are clearly negative. Even if there was once a ‘golden age’, when competition was slight and the marketing job was relatively simple (and in reality that situation probably never existed), then things have certainly changed now. A considerably more complex customer structure, diverse market needs beyond the pure ‘efficacy safety tolerability’ play, increased competition and decreased differentiation have all made the marketer’s job still harder.

So are pharma marketers up to the job? In reality, this question should be split into two: are they intellectually capable? And do they have the training and experience necessary?

It’s difficult to answer anything other than ‘yes’ to the first question. The industry is stuffed with clever people; we attract some of the very best brains. All around the world, pharma marketing departments boast a remarkably similar group of people, in terms of intellect and attitude. So the raw material should certainly be equal to the task.

But what are our marketers receiving the training and development to give them the tools they need to do the job? This is the real issue, and it’s one which needs addressing if we are to avoid the parallel dangers of ineffective marketing, unmotivated individuals and unacceptable levels of staff churn.

Whilst everyone says that the job of pharma marketing is getting harder, a more accurate way of putting it would be that the job is getting more complex. There are far more things for the pharma marketer to consider, many more options on how they choose to deploy their time and resources. Issues such as market access, gaining access to funding for products whilst driving prescriber demand, and taking account of the impact of consumer influence – these are all things which were previously absent from the traditional pharma/prescriber axis.

A Curious Contrast

If you want to see what I mean about the lack of support given to marketers, you only need to look at the contrasting way we tackle preparing new sales people and new marketers for the job. A new member of the sales force will undergo a rigorous, intense induction, spending many weeks going through a training process before being let loose on real live customers.

Does that happen in marketing? Very rarely. Whether a new marketer comes via the traditional rep route, or whether from outside the industry, they are usually thrown in at the deep end and expected to learn on the job.

Why is this? Maybe because it’s always been done like that, or because so many who are already in the industry have come from the sales force. Clearly the scale is different: even a small pharmaco will have sufficient throughput of new reps to make developing a training structure viable, but the same cannot be said for marketing..

This gives marketing departments a great supply of people proving themselves in the field. This is the ultimate test of a marketing strategy – how it works in front of the customer. So the ‘sales to marketing’ career route makes a lot of sense.

But – and it’s a big but – the ability to succeed in the sales force does not necessarily translate into being an effective marketer. Wherever they enter marketing from, new product managers are often dropped straight into a relatively small team where lots of things need doing, right now. They are expected to hit the ground running, an attitude often perpetuated by managers who had the same experience and, like many consultants’ attitudes to the long hours endured by junior doctors, take a ‘I did it, so you should too’ stance.

But if we accept that a comprehensive training programme will make for a better and more effective sales person in the long term, then why do we not think the same when it comes to marketing?

All of this means that our marketers are not as developed for the job as they could be. They certainly have the intellectual capacity to be so, but they are not being given the tools and techniques to help their decision-making. So their capability ends up being dependent on their particular team’s clarity about tackling the task.

This is a bit like being taught to drive by your dad when you were 17. If you happened to have a dad who himself had been taught to drive well, then you stood a better chance of a thorough grounding yourself. But if he learnt from his dad, who also didn’t teach him particularly well, you stand no chance of becoming a good driver. So it is with marketers – because much of the learning is on the job and team-based, the quality of learning will be dependent on the quality of the team – as well as the time they can spend developing you.

With fragmented training, you may learn some or even most of what you need to know, but it’s unlikely that it will all fit together when you try and relate that knowledge to developing clear brand strategies and marketing plans. It’s all a bit hit and miss.

Clarity and Structure

So if the quality of training is largely dependent on the team, and especially the manager, what can they do to ensure that it meets the needs of both the individual and the company?

The first – and obvious – answer is that there has to be a clear and structured training programme which directly relates both to the competencies expected of the individual and what they need to be doing on a daily basis.

An A to Z of marketing is required with each part of the process leading logically to the next. Whilst most marketing plans across the industry address the same elements, such as segmentation, stakeholder mapping,, what is often missing is a route map of how to make all the elements of the plan fit together. Without this logical route-map it is not surprising the new product manager can get lost in the detail

To achieve this requires a mindset which concentrates not on process, but on outputs. If we teach our marketers that strategic thinking means creating graphs and spreadsheets, and that they should concentrate on operational detail, of course they will not see the bigger picture and become truly strategic thinkers. Too often the requirements of the current sales year, and how to achieve those, displace any thinking about why any given strategy might, or might not, be appropriate.

And don’t think that this training structure is only needed for new recruits into marketing. Even those ‘old-timers’ who have years of experience are facing many new challenges. Even if the marketing basics haven’t changed, the market has, and now marketers need additional tools and understanding to be able to identify who the new customers are, and to understand their needs. Or even just structured time out to think differently.

Never has continuing professional development been so important. And yet continuing professional development is, with a few exceptions, almost non-existent within the pharma marketing sector. Once someone is in place and is up to speed, it seems to be assumed that they will somehow gain the new skills they need through a process of osmosis.

Even for those companies with the foresight to provide training for new marketers the provision for senior marketers is almost always insufficient, and often recognised by the companies as being so. We can see a number of reasons for this, on top of the obvious one that people are busier than ever, and getting the job done always seems to take precedence over planning for future skills needs.

Perhaps there is a reluctance amongst more senior staff to admit, either to themselves or to others, that they need development. Many organisations have a culture in which it is assumed that their senior people should be capable of doing the job and performing at the top of their game.

This macho stance is dreadfully short-sighted. Yes, of course we expect our senior people to perform. But if we want them to be innovative to meet these new marketing challenges, and also if we want them to be happy, motivated and loyal, then we must provide them with the support to meet their development needs. Then they could do an even better, and a more enjoyable job.

Training ROI

In time and money terms, training is often viewed as a drain on resources. But just as we invest in research and development, marketing communications and sales forces – and expect to see a return – then pharma companies must view developing their marketing people as an investment. And as with any investment, they should be able to see a measurable return on that investment.

But marketing is more difficult to benchmark than sales, so some clarity is needed here. What are we expecting of our product managers? What is their current performance, and how can we compare it, both internally across the company, and externally across the industry?

Sadly, the basics of performance measurement – appraisals – are rarely rigorously applied for marketing staff when compared to the sales team- . How well they are done depends both on the culture of the organisation and the attitude of the individual manager. But if we don’t measure our people’s competencies and outputs against a clear idea of what we want them to do, then how can we hope to gain an insight into the return we are getting for investment in training? Just as any business process, training and development must be shown to add value.

The Needy Marketer

We shouldn’t view the fact that many marketers in our industry are ‘needy’ as a negative; we should accept that it’s a fact, and be pleased that most are willing and eager to learn to become more effective. Most realise that there is a constant need to evolve, and even if they are the best at something today, there is no guarantee that will still be the case tomorrow.

Because we recruit some of the brightest intellects into our industry, our people are often sponges for learning, and if we don’t fulfil their development needs we lose out in two ways: they will be less effective, and they will look elsewhere for the intellectual fulfilment that bright people always seek.

So those responsible for the effectiveness of marketing departments don’t have a choice. They should take a leaf out of the sales book and make sure that their new marketers are thoroughly grounded with the skills and tools they need to do the job, and not just assume they will learn as they go along. That means a structured approach, even where the numbers are relatively small.

They should have a clear idea of what their marketers should aspire to, both in terms of competencies and outputs. Then it’s a question of assessing where their teams are against these aspirations, and identifying the gaps.

This process will give you a clear idea of the learning outcomes you want to achieve, how any learning relates to what marketers actually do in their job, and what both employer and individual marketer are getting back as a return for their investment in time and money.

We are finally accepting that we need to understand our customers’ need, and fulfil them accordingly, to be effective. Now we must turn that same attitude towards the very people we are asking to do that, and make sure that our marketers are no longer needy as well.

Filling The Gaps

The most common shortcomings in pharma marketing competencies, from the point of view of senior marketers and product managers.

Senior Marketers

* Advanced strategy: predicting the future market, how to fit company capabilities to the market, dealing with portfolio brands….
* Innovation: How to do things differently
* Competitor Insight: Gaining insight into our competitors’ attitudes motivations and imperatives and hence predicting their actions (including war gaming)
* Market Access: Mapping the customer network, understanding key stakeholder needs and fitting company resources to key stakeholders

Brand Managers

* Strategic Marketing Planning: The A-Z of marketing and how to build a competitive plan for the brand
* Market Access: who are our key stakeholders, what our messages should be (including the value proposition) and how to communicate
* Segmentation: How to gain competitive advantage though segmentation

The Author

Gerard Doherty is a Managing Consultant at The MSI Consultancy.

Originally published in Pharmafocus, January 2008

Introduction

When first presented to a doctor, a new product is generally assessed against and slotted into current practice. The net result is the product is compared to existing treatments and as we all know runs the risk of being only used where the doctors can themselves see a need, for example the ‘difficult to treat’ patient and/or where their treatments of choice have failed. That demands that as marketers we ensure effective, differentiated and meaningful positioning of our product from the outset.

But no matter how effective we are in positioning our product, there comes a time when we have soaked up all the available capacity in the market and so sales and/or market share growth begins to slow. That is to start considering Market Shaping/Market Development or Market Expansion, not when growth has stalled completely.

A number of factors should taken into consideration when deciding which approach to take and when, not least where the levers for growth lie and our own market position.

Logic suggests Market Shaping/Market Development comes first. Why? Because this is about changing current management or treatment practice of an existing market, rather than encouraging more patients in to see doctors, a slower and more expensive process, even when you have the ability to appeal directly to consumers.

Clearly if this is a relatively new or significantly underdeveloped market then Market Expansion will come much sooner, perhaps even before launch, as was the case with Viagra. Generally though, Market Expansion comes later, when the product has established a strong position in the existing market, to help ensure that the benefit of more patients being treated is felt by your product and not the competitors.

Developing or Shaping the Market by Increasing Patients Treated

How you develop or shape the market will depend on the specific situation in that market. If we use the patient flow (or patient pyramid) as our guide there can be a number of reasons why patients are not currently being treated. Our challenge is to identify where this is occurring in that patient flow, identify the barriers to current or more extensive treatment and any associated inhibitors; easier said than done in some cases. We then need to determine how best to change current practice or thinking by providing the ‘solution’ which may or may not be a medicine.

Firstly, patients may not actually be receiving prescriptions. They may have been identified and diagnosed as having the condition to which we can provide a solution, but they are not currently receiving a prescription medicine. After all, the first tenet of medicine is ‘do no harm’ so doctors may delay treating a patient at all, or suggest using something other than a prescription medicine. This can often be the case in early stages of a condition, perhaps when it is asymptomatic, and the doctor does not see an urgent need to treat..

Here we therefore need to demonstrate the sequelae of not treating these patients and convince the doctors of the need to treat early. This can be quite challenging when there may be no acute or apparently pressing need. Enlisting the help of acknowledged and respected ‘experts’ to change thinking and provide the evidence is therefore going to be crucial. However, this does not necessarily mean the traditional national or international key opinion leader (KOL). In many cases for general practitioners, a local specialist to whom the doctor refers patients can be just as or even more powerful in helping doctors see the need to treat the non or under treated patients.

Clearly if targets to which doctors agree they should be treating are lowered, this results in a larger potential patient population. Treatment of dyslipidaemia has changed significantly since the introduction of statins. Lower targets than the current 5 mmol/l for total cholesterol (as in the Quality Outcomes Framework or QOF) and 3 mmol/l for LDL-C are now being proposed (4 and 2 mmol/l to be exact), especially in high risk cases, such as those patients with established cardiovascular disease or diabetes, which is quite a challenge for doctors given the nature of the dose response for statins.

Another option is to develop the ‘thinking’ behind treatment. Once primary objectives have been achieved in the majority of the patient population, it is common to see goals being extended. For example, treating hypertension was initially about achieving a healthy blood pressure. However, now that available treatments have increased the chances of success, secondary goals are coming into play, for example protective effects on end organs to avoid damage.

It is important to remember that achieving behaviour change takes time. Firstly, there is a need for evidence to establish the benefit, then developing consensus on when and how best to treat patient populations will be vital before getting this is accepted in everyday practice. We know that here in the UK if it is not in QOF then it is not a priority within primary care.

Do not underestimate the challenge. Doctors will have already started to treat those patients with an obvious and pressing need. We need to demonstrate how to identify these other patients and why they should consider treatment i.e. change motivation and prescribing behaviour.

Obviously there is a limit to how far we can push this, particularly in this age of cost-effectiveness, evidence and restricted budgets. Unless we can convince the key decision makers of the need to treat then we may be facing a thankless task and perhaps risk losing credibility, potentially limiting any future development.

Developing the market through better diagnosis

Another area to consider is non-treated patient recognition or diagnosis. As we know, some patients are not actually diagnosed or are not diagnosed with the condition from which they are actually suffering.

There can be a number of reasons for this. In this day and age, unless there is a ‘test’ and a hard number which defines the disease or condition, then a straight forward diagnosis can be a challenge. We take it for granted that diagnosis is doctor’s key role, however it is more of an art than a science in some cases. Different diseases can present in the same way or one can mask another which makes the doctors life difficult. They do not deliberately miss the diagnosis rather it may be the nature of the condition or a lack of knowledge. In some cases they may give the patient a different, more palatable label, particularly if the treatments are very similar, but in general this is not deliberate.

Again we need to understand why this is happening. Is it a lack of knowledge? Is it down to diagnostic skill? Is there a lack of motivation to ‘look’ for or perhaps even treat these patients? Do doctors just not recognise the issue? GPs are generalists after all and see many different conditions.

Unless we can unlock the reasons behind it we may well throw lots of time, effort and money at the problem but to no avail. We will need to bring the issue of lack of recognition or appropriate diagnosis to their attention, in a non-threatening non-critical way. Telling a doctor he has got it wrong in an area that is considered a major skill is not going to produce positive results!

Once we understand the main reasons for this under diagnosis we can provide the ‘solution(s)’. Again there will be a requirement for consensus on the need to diagnose in particular patient groups, based on the consequences of not treating optimally. Working on the ‘whole’ undiagnosed population is just not going to be effective. Doctors will see that as a cynical attempt to build sales. Rather we have to create that elusive win-win, by uncovering a need, getting doctors to recognise and then act upon it.

Sometimes it may be that there is no simple way for prescribers to identify the relevant patients. In this instance some companies have needed to develop a specific test to identify the appropriate patient for treatment with their medicine. A good example is Herceptin and HER2 positive breast cancer. Just having the test does not necessarily mean treatment will be optimal for all suitable patients, but it will make a big difference.

Also, having the diagnostic test or tool does not necessarily mean it will be used. After all, you can give away tools but as with all things in life, those that are ‘free’ often do not create any real feeling of value in the recipient. They may just sit on a shelf somewhere.

We need to encourage the doctor to actually use the test or tool in their daily practice, and that is all about motivation. Doctors have to see the need and the value, to them, their practice and or their patients before they will do something different. Similar strategies to those for extending treatment are appropriate.

Sometimes what gets in the way of suitable patient identification or diagnosis is not the lack of will but lack of resources, usually time. Hence the classic, and now perceived by many UK general practitioner’s as the standard, solution being to provide a people resource to do the necessary screening, after the provision of asthma nurses by GlaxoWellcome many years ago.

However, all of these efforts to change doctor behaviour will be unsuccessful if there is not some form of positive feedback to show the doctor that they are doing the right thing, achieving positive results and making a difference.

Increasing Patient Presentation

It is always tempting to think that encouraging more patients to present to the doctor is the secret to developing the market. The problem is, if the doctor cannot readily diagnose or identify the appropriate patient, and is not willing to prescribe a suitable treatment, then much of that effort is wasted.

Hence Market Expansion is all about timing.

The majority of marketers will know that in an established market this is really suitable for the market leader. However, there are situations when a strong Number 2 in the whole market or even a more focussed player who is dominant in a particular segment can benefit from Market Expansion. It is all about linking the appropriate patients to your product in the doctor’s mind (aka effective, differentiated and meaningful positioning), and the more we can use patient pictures to help doctors make the link the better. After all, that is what they do, link patients to treatments.

The problem with Market Expansion is that it can be a slow and expensive process as we are trying to change patient behaviour in an environment when we cannot speak directly to them about our product.

Clearly we can raise awareness of the disease and encourage interest in seeking a solution, but what we do not want to do is encourage large numbers of the ‘worried well’ to seek treatment. Doctors already have many of those, and it will do us no favours if we are seen to add significantly to this group.

Once again it is about first establishing the recognition, consensus, appropriate action and positive feedback, and removing any significant barriers (e.g. resource and or funding, as is the case with Alzheimer’s for example) before encouraging new patients to seek treatment – not the other way round.

Do you need to develop or expand the market?

Market Development and Market Expansion are challenging, time and resource consuming strategies. They definitely have their place at the appropriate time in the lifecycle of many products.

However, many marketing strategies seem to focus far too much on new patient, and also prescriber, capture. Are we sure that we have exhausted the potential among existing patients, that is are we maximising compliance and adherence? Too often this way to increase sales is ignored.

So next time you start thinking about Market Development or Market Expansion, make sure you are also focusing on your existing patients.

The Author

Dr Paul Stuart-Kregor is a Director at The MSI Consultancy.

Article originally published in Pharmaceutical Marketing, December 2007

Dr Paul Stuart-Kregor argues that a period spent on the consultants’ side of the fence is a big plus point in a pharma marketing career.

For most pharmaceutical marketers, true career planning is not something which is very structured, or even much thought about. For most, the tried and tested route through a science degree, a spell on the road as a rep, followed by the move into product management, and then climbing the greasy pole to more senior marketing positions, is something that they assume will be the secret to future success.

Because it’s such a well-worn road, few consider stepping off it and trying another route. Which is strange, because whilst the traditional path works for some, many more can end up frustrated that they are not fulfilling their potential or achieving what they feel they are capable of.

As our industry rationalises, centralises and consolidates, this situation could well become more common. Fewer companies means less opportunity to gain a variety of experience, which in the long run is bound to hold a career back.

I’m not going to suggest that there is a magic bullet to overcome this problem of lack of opportunity, but it has always been a mystery to me why so few great marketers are reluctant to step outside the industry to spend a period (or indeed, the rest of their career) in consultancy.

Now, I should at this point declare an interest. I am a Director of The MSI Consultancy, which is a consultancy specialising in helping the pharmaceutical industry. Yes, that gives me a partial view; but I have also worked on the client side and genuinely believe that many pharma marketing careers, especially those of the most talented people, could be massively boosted by spending some time on the other side of the fence.

It’s difficult to think of anywhere else you could accelerate your career as rapidly and as comprehensively. The equivalent of years of experience can be gained in a relatively short period of time, as well as learning new skills and creating the kind of networks most pharma marketers can only dream of.

So what motivates someone to step outside the ‘safety’ of the industry (although I would contend that is now a fallacy) and into consultancy? What are the benefits and pitfalls? And why do so many in our industry view – wrongly – such a move as career suicide?

To find out, I’ve been speaking with two new colleagues, both of whom have very recently taken the plunge. They are both experienced pharma marketers, with gold standard careers within the industry. Neither has been forced through circumstance to seek employment in consultancy – they have both taken the decision positively.

Dr Richard Jones joined MSI in May after a career spanning 20 years experience in the pharmaceutical sector, most recently as International Marketing Manager in the International and GI Unit at Shire Pharmaceuticals. So why did he decide to make the move at this point in his career?

“I had worked within a rapidly-growing pharma company for a number of years in various senior marketing and commercial positions and had reached a point where I was looking for totally different challenges. I had been approached by other pharma companies with offers for senior international roles within global teams but I saw the challenges being very similar to what I had already faced, albeit for differing brands/therapeutic areas.

“By moving to a role in consultancy, I felt I would be exposed to many different companies and get a better understanding of different operational models and modus operandi. I would also be exposed to many different challenges through the various and varied projects I would be working on, and at differing levels – global teams, local teams, market shaping, re-launching brands and so on.

“I saw this as a great opportunity to have a broader experience base and to attain a fuller understanding of this industry.”

Although at an earlier stage in his career, Michael Salmon is also keen to expand his marketing and strategic skill set beyond his brand manager experience. After five years at AstraZeneca – including winning their annual Marketing Excellence award in 2005 – he became a consultant with MSI in July.

“I feel consultancy experience will provide me with broader skills through working with multiple companies and projects, and hence be more employable in the long term. A consultant role can also allow you to go deeper and specialise in the areas that you prefer – for example an area of marketing like quantitative marketing.

“With consultancy you are able to work with multiple companies and therapy areas in a short time frame. Another advantage is that you do more thinking as opposed to doing – the latter being a predominant part of brand management.”

It has to be said that working in consultancy is not for everyone. It is certainly a different way of working, and although the perception that consultants work longer and harder than their industry colleagues may not be entirely accurate, the nature of the job means that there are probably more immediate commercial pressures.

The flip side to this is a world which is far removed from the politics and strictures of big company life, a significant attraction for some who make the move. “To a certain extent, you can dictate your working environment and eventually determine your projects,” says Jones. “This is different to working in the industry – although it does depend very largely on your client’s demands. However, your life revolves less around e-mails and meetings, and more about thinking and analysis.

“You need to be prepared to ‘close’ potential sales as a consultant to maintain and open new accounts. This is essential, as no matter how good a consultant you are, you are only successful if you get the business. In the industry, the customer/client sets are mainly internal, and whilst ideas and recommendations are ‘sold’, the transactions are normally not financial. Therefore, a consultant needs to be prepared to sell and go after the business.”

Perhaps the biggest fear is that moving across to consultancy will close the door to returning to the industry at some stage in the future. In reality, this concern is unfounded – I have seen many people successfully build up their skill sets in consultancy before taking them back into the industry, usually at a much more senior level than left.

“I have no concerns about moving back into pharma companies, consultancy experience would be a huge advantage,” says Salmon. “It will allow me to develop contacts in multiple companies, and an understanding of multiple therapy areas. It will also potentially open doors in more strategic roles or higher level roles in pharma companies as opposed to pure marketing roles.”

Jones agrees: “There is a tendency to view the agency side as the “dark side”, with associated connotations. Having stepped over the line, there is a fear of not being able to cross back. I personally do not share this fear, and indeed see having consultancy experience as a key factor in my personal development plan which will greatly benefit me in the future.”

The key point here, is that those who succeed in their careers and get where they want to go have a plan – what Richard Jones calls his ‘personal development plan’. This forces you to work out what skills, experience and networks you need to build up to achieve what you want to (and indeed identify what those goals are in the first place).

Although it won’t be for everyone, a period spent working in consultancy, gaining a much wider variety of experience and skills, as well as the commercial nous which becomes more and more vital the further up the corporate tree you want to go, can be very beneficial.

Although the fear does exist that leaving the industry will be an irreversible step, the opposite is true: the skills and experience you gain working alongside multiple clients makes you more attractive to future employers. And that’s the best way of avoiding that frustrating career stagnation in a role which is underusing your abilities.

The Author

Dr Paul Stuart-Kregor is a Director of The MSI Consultancy Ltd

Article originally published in Pharmaceutical Marketing, August 2007

Every year at about this time or a little earlier, we start the process of ‘strategic’ planning.

The annual planning process, for all its focus on analysis, or template completion, can easily fall into the apparently comfortable tactic of merely updating the activity from last year’s plans. Often, however, what is really needed is a fresh approach which can pay dividends.

Approaches to planning differ, depending upon the attitude and culture of the company involved, which in turn affect the relative importance given to different elements of the process and the output. Some companies are heavily financially oriented, making the desired output more focused on numbers than the thinking behind those numbers. Other organisations focus heavily on the resource implications of the tactical plan, and particularly sales force allocation and efficiency.

Not all companies perform truly strategic (long -term) market-centred planning, but all companies generally aim to produce a set of financial forecasts. The major differences are in the way they get there and as a consequence the basis on which those forecasts are derived.

First and foremost, the organisation needs to be clear about what issues can get in the way of developing a sound strategic plan before deciding on an appropriate approach.

Clearly all planning is driven to an extent by profit and financial forecasts but there is a need to be clear what else the plan has to deliver for the organisation, the individual, and the brand – the planning ‘need’ – otherwise the process used may be sub-optimal. Why does the organisation need a plan? What is it meant to deliver over and above the financial projections?

Many companies are often unaware of the issues and constraints that will affect the planning process and output , for example the local operating company situation. Are the right resources, the right experience and the right information available at a local level to develop and complete the plan? Can the local markets get the right quality of information they need to drive good quality thinking? If not, then how can this be provided to ensure the right level of thinking is achieved? It could also be that the chosen approach is too sophisticated or inappropriate to deliver the required answers. For example, the process may have all the ‘standard’ elements of analysis but there is no thought given to what each element is telling them.

All companies do have a structured process but if the process does not drive the necessary thinking then the resulting plans can be limited. If the process does not challenge the planners to consider different ways of doing things but is merely a set of agreed templates and a time line for deliverables, the resultant forecast simply becomes a straight line projection from historical sales data, and activity remains the same as last year no matter whether or not things are changing in the market. This is the apparently ‘safe’ option but it rarely maximises return on investment and is often not safe at all.

Above all the process needs to raise the right questions, stimulate debate both internally and with external stakeholders, and force conclusions to be drawn from the analysis and interpretation of information that can then form the basis for strategy development.

And finally, senior management by their actions and questions often demonstrate that all they are really interested in are the numbers, with no challenge or credence given to the thinking behind those numbers. Even though a thorough process is used to arrive at a market -based forecast, senior management just focus on the revenue with/without profit Sometimes the budget or forecast even comes before the planning/thinking in time, and at other times it is ‘imposed’ so the plan reflects how to achieve it, not whether it is at all achievable.

There are three very different approaches to strategic planning in our experience:

The data-driven approach is based on hard data collected from a variety of sources, both primary panels and syndicated data, from which a market model is then built by brand from the bottom up. Issues are then identified but there seems to be no real focus on what drives success in local markets, or on what competitors will do and the impact of their actions. This approach can simply lead to ‘more of the same’, making a projection based on the previous year and no real change in approach, with the whole focus being on next year’s revenue. While many companies may not use such an apparently numbers-focused approach they still act in the same way, with the forecast being the key, rather than the rationale behind it.

To overcome the inevitable local variances in both resource and/or experience and to ensure a consistent base for review, many companies utilise a template-led approach . This consists of a pre-defined plan with key headings that can be amplified or contracted, but with certain key elements which must be completed. This option works well as it provides a structured process for analysis, with check questions at each stage. However in some cases we have seen that such an approach can still be very financially focused. Sometimes it does not analyse the brand and company strengths and weaknesses in a meaningful market-centred manner, to enable a market -led SWOT analysis and often there is still not enough competitive focus.

The next level is often seen in the ‘marketing excellence’ approach, where the organisation provides an integrated planning tool comprising standard marketing planning software. In a sophisticated example this allows local working but is linked into a central supporting database, with aspects that can be adapted and others that are fixed. The beauty of such a process is that it is transparent, allowing a clear overview of who is performing well, and enabling experience and successes to be shared. However when this is a relatively new process people tend to take time to get to grips with the process resulting in ‘doing the process’ rather than really thinking about what each step is telling them. Moreover for this approach to be used effectively, senior management must understand the process very well so that they can interrogate the people who are developing the plan.

Efforts to plan correctly often fail due to poor alignment between personal and corporate goals – people are often rewarded for achieving short-term deliverables with secure outcomes rather than longer term brand building and innovation or driving change.

In summary the key issues in strategic planning are:

• Not being clear about the planning ‘need’
• Not being aware of the issues and constraints that will affect the planning process and output
• Approach too sophisticated or not appropriate to deliver the required answers
• The financial forecast is all that matters, with the thinking behind those forecasts being ignored or not challenged/considered
• Process not challenging people to think or act differently
• Insufficient external focus: environment and/or competitors
• Lack of real focus on (new) opportunities for growth
• Poor expertise at local level
• More tactical/operational than strategic focus

So what works well in overcoming some of these inherent problems? Ensure a complete and effective structured process to develop the analysis base. Output should focus on alternative scenarios and ‘what ifs’ working from a base plan. Thereby, focusing on incremental growth and type of incremental drivers that need to be addressed. Build market -based forecasts by brand at country level. This requires country plans and budgets built from bottom up by brand and forecasts linked to hard data and clear market maps. Allow enough time for countries to make amendments based on sound strategic thinking and then finalise forecasts  do not just use Excel formulas. Balance the need for a ‘quick’ solution with a complete process (analysis and review). Value the process, including through management attitude, and align management with the strategy.

Key imperatives are to ensure a complete and effective structured process to develop the analysis base, with structured external and internal analysis, and check questions at each stage. The process should be transparent, reviewed by management so that the output is seen by senior management during budget process. Multi-functional teams should build plans with all key stakeholders involved, but led by marketing.

Recent surveys show that where companies use a good formal process, satisfaction with strategic planning is higher. Companies are looking more and more at processes that drive to different strategies and/or activities. However, there is a demand for a stronger link in pharma between action and reaction, i.e. if we do X then €Y will result.

Strategic planning should prepare executives to face the strategic uncertainties ahead, and serve as the focal point for creative thinking about the company or the brand’s vision and direction. It should also be about making choices between competing priorities, focusing on strategic as well as operational issues. This will ensure that progress against the strategic plan is monitored.

There are a number of ‘tricks of the trade’ that help in strategic planning. Among the best practice companies, executives who carry out strategy also make it, and plans reflect goals and challenges. It is important to use any plan to identify growth opportunities, both within and outside the core business. Monitoring progress against the strategic plan is critical and a key area for improvement.

It is important also that planning meetings are true ‘conversations’. Simple ‘tricks’, such as having only a small number of the right people in the meeting, can pay dividends. The process also takes time, so more than one meeting is required. It is also important to avoid combining strategy reviews with discussions of budgets and financial targets because when the two are considered together, short-term financial issues tend to dominate at the expense of long-term strategic ones.

The ideal process leads to strategic decisions that allow the company to meet goals and challenges. It assesses risks as well as benefits, but is based on fact, focusing on strategic issues, and is therefore not merely tactical. The ideal process ensures that those who will carry out strategy are involved in developing it, builds shared understanding of market dynamics, and emphasises discussion of issues not process.

Planning should build ‘prepared minds’ through dialogue to make sure that all decision makers involved have a solid understanding of the business, its strategy, and the assumptions behind that strategy. Then it will be possible for them to respond swiftly to challenges and opportunities as they occur during the year. No strategy process can guarantee great flashes of creative insight, but much can be done to increase the odds that they will occur. The process can be used to challenge assumptions and open people up to new thinking.

Core questions to answer in a strategic plan:

• What is the scope/nature/dynamics of the market?
• For what purpose, where, who is the customer?
• How big are the opportunities? Where are the opportunities for growth?
• Where are the most attractive opportunities?
• What external factors/major events could have a positive or negative impact on my markets?
• What are the key segments?
• What capability is required to successfully compete? Where am I strong, where am I weak?
• Which segments represent the most attractive commercial opportunities now and over the planning period?
• What are the critical success factors?
• What strategy or strategy options should we consider to evaluate optimal return?
• What key business objectives should we aim to achieve?
• Which strategy makes commercial sense  what would I recommend?
• What specific actions are required to successfully implement the chosen strategy?
• What performance areas need monitoring

The Author

Paul Stuart Kregor is a Director of the MSI Consultancy Ltd

Article originally publised in Pharmaceutical Marketing, June 2007

Introduction

In recent years, the pharmaceutical industry has experienced a difficult period whereby productivity has not kept pace with increases in R&D investment. To counter this issue, an increasing number of companies have been focusing on drug repurposing, i.e. the development of novel uses for existing drugs. Although repurposing of drugs is not new to the pharmaceutical industry; large companies using classical life-cycle management strategies often extend drug use into new indications to preserve or extend the value of a pharmaceutical brand. A clear example of such a classic approach can be seen with. Seroxat and the extension of the product’s original license for the treatment of depression, to a much broader range of uses including; treatment of social anxiety disorder, obsessive compulsive disorder, post traumatic stress disorder and panic disorder. Of the 50 top selling brands in 2004, 84% have had additional indications approved since their initial launch in the US, and a further 6% are known to have subsequent indications in development. However, the appearance of companies founded exclusively on drug repurposing reflects a general trend today that seeks to maximise the investment in R&D and reduce the risks of drug development to the industry.

The benefits to the R&D organisation of repurposing are clear. There is a significant reduction in risk as the start point is an approved compound with established safety and bioavailability profiles, proven formulation and manufacturing routes, and well-characterised pharmacology. Therefore, repurposed compounds can enter clinical trials quickly, and at a lower investment cost than completely new chemical entities (NCEs), while avoiding two of the common areas for failure of NCEs, namely human safety issues and pharmacokinetic profiles.

Case Study

To illustrate, Requip (GSK) and Mirapex (Boehringer Ingelheim) were not developed from scratch for Restless Leg Syndrome. Both products were already licensed and established for use in Parkinson’s disease. For the repurposing organisation there is some additional expense for a Phase IV study in support of the new indication, in applying for the SNDA, as well as for marketing the new indication once it is approved, however, nothing like what it had already cost the companies to discover ropinirole and paramexipole and take them through pre-clinical, Phase I, II, and III trials in the first place for the original indications in Parkinson’s disease.. After all the cost to develop a new chemical entity was in excess of $800m in 2001 (Tufts Center for Drug Development), current Eli Lilly estimates put the cost of a new medical entity at $1.2 billion and they forecast it will reach $2bn by 2010… The result – weekly new prescriptions for Requip in the US quadrupled in Q1 2006 after it was launched for RLS in Q2 2005.

Two types of drug repurposing

Known compound-new target

Drug repurposing is based on two core principles. The first is that a single molecule often acts on multiple targets. Taking advantage of this, one repurposing approach focuses on the identification of secondary or so-called “off-target” drug actions, followed by the development of the compound in a new indication where the secondary target is relevant. Historically, compounds with such marked off-target effects have been considered “dirty” because of the side effects they induce. However, the undesirable side effect of a compound in one indication may sometimes provide a desirable effect in another indication. This is the “known compound-new target” approach.

Known mechanism-new indication

The second principle is that mechanisms relevant to one disease or biological process are often involved in several biological processes. So, the second repurposing approach is to establish the relevance of a known drug to a new disease. Sometimes scientific links have been established between the mechanism and the disease, and between the mechanism and the compound, but not between the compound and the disease. At other times, the link between the compound and the mechanism is well established, but the new medical significance of the target is discovered by chance during clinical studies of the compound’s original indication. Repurposing efforts based upon the new medical potential of a known compound is a “known mechanism-new indication” approach.

One of the most significant and well known examples of the “known compound-new target” approach is the revitalization of thalidomide by Celgene in the US. Thalidomide was originally prescribed in the 1950s for nausea and insomnia in pregnant women However, as has been well documented, its use caused severe birth defects in children whose mothers took the drug in the first trimester of pregnancy. . In a surprising 1965 article, an Israeli doctor reported the remarkable effects thalidomide had had in alleviating complications of leprosy. It was later discovered, that in addition to its sedative effect, thalidomide had antiangiogenic and immunomodulatory effects, including the inhibition of TNF alpha… In 1998, Celgene received approval from the US Food and Drug Administration (FDA) to market Thalomid® (thalidomide) as a treatment for leprosy. Since its release, Thalomid has become the flagship product for Celgene, now with an additional indication for multiple myeloma, and through controlled clinical trials and FDA compassionate-use programs, the drug has been found to be effective in treating a myriad of disorders, including certain mycobacterial and autoimmune diseases, HIV and AIDS-related afflictions, cancer, and miscellaneous skin conditions.

Merck’s finasteride, originally prescribed to treat prostate enlargement and marketed in the UK under the name Proscar, presents a clear example of the “known mechanism-new indication” repurposing approach. In the early 1990s, finasteride, which blocks conversion of testosterone to dihydrotestosterone, was also discovered to prevent male pattern baldness. Commissioned clinical studies on the compound then revealed that finasteride,at much lower doses than used to treat prostate conditions (1 mg rather than 5 mg), could be used to treat male pattern baldness, reducing the chances of side effects. As a result, in December 1997 the FDA approved finasteride for the treatment of hair loss in men under the brand name Propecia.

Marketing challenges

Many people may have the incorrect perception that drugs that have found a new purpose are ‘me-too’ drugs, with all the negative associations linked to such molecules. However, that is not necessarily the case. Not least if they offer a solution to a previously untreated or untreatable condition, or where current treatments do not meet customers’ needs, such as with thalidomide and its use in the treatment of leprosy. Conversely, when they are perceived as ‘lifestyle’ drugs e.g. Propecia, then the challenge to make the medical profession consider them relevant can be significant

The essential issues that face repurposed drugs are market exclusivity (in the face of possible generic competition), differentiation (from the original indication) and the issue of what is known as a ‘dirty’ molecule.

Market exclusivity

However, although there can be exclusivity benefits to line extensions, US and EU regulatory reform has reduced effectiveness of indication expansion as a standalone generic protection strategy. An additional indication only extends exclusivity for one year in the EU. Indication expansion must therefore be paired with a method to differentiate the product in the new use, preventing off-label uptake of generics in the new indication (see figure 1).

Fig. 1

As a consequence, the challenge for the brand originator is to establish a sufficiently strong presence in the market to be able to withstand generic competition, if it comes. Even if direct competition does not occur, there is always the risk of off-label use of the generic. This requires sufficient time ahead of loss of exclusivity. Marketing alone may not provide the necessary brand protection, hence the need for formulation or other additional barriers e.g. new method of use patents. For example, Requip was first launched for use in Parkinson’s in 1996 and then for RLS in 2004 in the EU and 2005 in the US. Requip is not due to lose protection for the active ingredient until 2007 in the USA and 2008 in Europe, and GSK have filed a new application for Requip CR, which should help to maintain the brand’s position in the market.

Differentiation

A truly differentiated value proposition is the classic marketing challenge in our increasingly competitive markets, and is no less an issue for a repurposed drug as for the original molecule. Without demonstrable ‘value’ then as ever it will fall foul of NICE and or PCT prioritisation.

If there is a clear and recognised unmet medical need that the newly repurposed molecule can satisfy better than existing treatments, then differentiation is not an issue initially. In some cases it may even be easier for the repurposed drug than the original molecule as it may be first into an undeveloped market. Hence Propecia had limited competition when originally launched for male pattern baldness.

However, the challenge is often to overcome the cynicism that the pharmaceutical industry is ‘creating a disease’ what has become known in the press as disease mongering if the new indication is not well recognised Restless Leg Syndrome (RLS) had this problem initially, even though the condition was clearly described in 1944 by Professor Karl-Axel Ekbom, is common (in the US, up to 8% of the population may have RLS) and may be under-diagnosed. However it is now well recognised by such bodies as the National Institute of Neurological Disorders and Stroke in the US, has been reviewed by Bandolier in the UK and has a definitive guideline for treatment.

In many cases the real marketing challenge is to develop the market from a relatively low base, while also differentiating and positioning the brand effectively.

What about dirty molecules? – STEPS program for Thalomid

So how did Thalomid overcome the issue of tetragenocity?

When the FDA accepted the benefits of Thalomid® outweighed the risks, they alerted the manufacturer that the drug would be approved provided Celgene submitted plans for a controlled distribution system and agreeable labelling. Over the next few months, Celgene worked with FDA, the Centers for Disease Control and Prevention, the Canadian Thalidomide Victims Association and numerous professional health organizations to craft the most restrictive distribution and monitoring program in the history of FDA. With the System for Thalidomide Education and Prescribing Safety (S.T.E.P.S. ®) Program in place, on July 16, 1998, FDA approved Thalomid® for Erythema nodosum leprosum (ENL).

This innovative, restricted distribution system is included as part of the Thalomid® (thalidomide) prescribing information. Clearly, the S.T.E.P.S.® program was developed because of the toxicity associated with foetal exposure to Thalomid® (thalidomide) and to minimize the chance of foetal exposure to Thalomid® (thalidomide). Celgene Haematology Oncology Consultants and Customer Care representatives work with patients, prescribers and pharmacists in the S.T.E.P.S® program.

The S.T.E.P.S.™ Program consists of five general components: 1) Registration of patients, participating physicians and pharmacies; 2) Required pregnancy testing before and throughout thalidomide treatment; 3) Counselling in effective contraception; 4) Comprehensive physician, pharmacist, and patient education; and 5) Patient informed consent.

Since its inception, over 125,000 individuals have taken advantage of Celgene’s innovative S.T.E.P.S.® program in order to receive the potential therapeutic benefits of Thalomid® (thalidomide).

Summary

The key issues companies need to take into account when pursuing drug repurposing, are firstly to recognise that while they will be marketing the same molecule, it will be aimed at meeting very different needs and therefore represents a very different and distinct opportunity with its own unique challenges.

Therefore, companies need to undertake a thorough process of analysis, insight, and strategic thinking to ensure they thoroughly understand the unique challenges they face, rather than simply thinking this is an ‘add-on’ to the original business.

In many ways the repurposed drug needs to be separated and treated as a separate business opportunity, while ensuring the marketing in the new therapy area does not undermine that in the original.

Subsequently, the usual marketing challenges will be applicable to the repurposed drug, namely the need for differentiation and clear positioning and targeting to the relevant healthcare professionals, particularly since the molecule is likely to be known for treating another, potentially very different problem and possibly used by a different group of prescribers.

Finally, there is the additional challenge of market exclusivity if the molecule has lost its patent protection already, however few companies are likely to undertake repurposing without some degree of protection.

The Author

Dr Paul Stuart-Kregor is a Director at The MSI Consultancy.

Originally published in Pharmaceutical Marketing (PM), April 2007

How many pharma marketers, faced with the annual ‘chore’ of writing a strategic plan, have decided not to take the risk of injecting new thinking into next year’s plan, but have instead decided to stick with the tried and tested thinking which appears to have worked in the previous year?

If you are guilty of this, you are not alone – but you are taking a bigger risk than you realise.

Too often the process of strategic planning takes the ’safe’ route of doing more of the same. This can be for a number of reasons – including laziness – but the most common is sticking with what you know, playing safe and taking the route of apparently lowest risk.

But this approach is actually hazardous, because low-risk can mean low initiative, as it tends to excludes new thinking. And it is this which can often break a brand out from simply plodding along. Only when the market is not changing is there an excuse at all for such a ’same-old’ approach – and there is not one part of the healthcare world where the market is standing still. So why are so many strategic plans?

If it ain’t broke…

If you take a look at most pharma industry strategic plans, there is generally little real difference between current plans and those from three years ago. Yes there are some changes but it is very much tinkering at the margins. Indeed, I have actually come across so-called strategic planners who simply indulge in a little cutting and pasting to change some dates, and hey presto, this year’s plan is complete. Difficult to believe, but depressingly true.

Why is this? The answer is that too many marketers in our industry try to play it safe, taking the view that being risk-averse is the best way of surviving in a world where new thinking can sometimes be viewed with suspicion. If it ain’t broke, don’t fix it, runs the old saying, which translates into: last year’s plan worked, so let’s carry on with doing the same thing.

But the truth is that this approach is anything but safe. Can there really be anyone working in pharmaceutical marketing who really believes that the market is standing still? We are in an environment of constant change (and if we’re honest we always have been), but that change is moving at a faster pace than ever before.

Although this change might not match some of the volatility seen in some consumer markets, comparing the marketplace today with that of just a few years ago shows marked differences. The problem is that, in general, pharma marketers will only change what they are doing when they see a significant, sudden change in the market – for example the launch of a new competitor. Strategic thinking shouldn’t take this reactive approach; it should evolve with the market place and so should our plans.

Plan to Succeed

So why is getting the strategic plan so important? To some extent, if you need to ask this question you shouldn’t be in marketing at all, in this or any other industry. But even otherwise competent marketers don’t always realise just how important planning is in achieving success in the market.

There’s little doubt that some view the planning cycle as a chore, mainly designed to keep senior management happy. But a well-crafted plan actually makes the marketer’s job easier, clearly identifying objectives, breaking them down into manageable chunks, and giving a framework for measuring success.

Equally important, of course, is the role of the plan in making a case for the allocation of the necessary resources to achieve those objectives, in the face of conflicting bids from elsewhere within the company.

A well thought-out and written plan will enable the marketer to have a dialogue with management to help them understand the issues, the solutions, and the resources needed. Crucially, it will enable senior management to look at the risk-benefit balance, and decide if it warrants allocating the resources requested.

To do this, they need to know not just that the proposed strategy has worked in the past, but could it work better, and will it continue to work in the near to medium future.

Unfortunately, too many marketers don’t know what works and what doesn’t, and this stems from a lack of understanding of how customers make their prescribing decisions, and how we truly compete in the market. In other words, good strategic planning needs sound insight – and this means constantly looking afresh at the market, and ensuring new thinking is undertaken based on a true understanding of customers and why they do what they do. Obvious, really, but still relatively uncommon.

Insight

Perhaps one of the reasons that pharma marketers appear to be so risk-averse is that they don’t truly understand what drives prescribing behaviour. If a particular strategy appears to work, there is often a worry that changing it with a view to making it work better might cut out the bit which is delivering results.

This is in part understandable – but the key is not to be conservative and unchanging – it is to build a better understanding of why customers make the decisions they do. That way, new and creative thinking can be based on sound foundations, and any risk-taking becomes calculated and consequently less hazardous – and far more likely to yield results.

Too many people in our industry don’t really know what the steps to success looks like, so measuring it becomes nigh on impossible. In that case, how can they be sure that their plans are sound, other than by sticking with what they know, what has worked in the past to deliver (the best?) results?

Unless you understand how prescribing decisions are made, you can’t measure how successful you are being in influencing those decisions. In too many of the plans I see, the criteria for measurement are based on input and/or activity measures, rather than output or business gain measures.

New thinking in strategic planning needs to be driven by new behaviour from customers. The key is having the insight in what is driving customer change.

It’s no good simply looking at historic behaviour, based on simple data. That will only tell you what has happened, whereas planning is all about looking ahead to what is about to happen. To be able to do this as accurately as possible means looking at the drivers behind the figures, and understanding what trends will continue into the period being planned for.

That in turn means that the marketers needs to think about three things: where my business is currently coming from; how my customer is changing; where my business will come from in the future and therefore, what I need to do differently.

Risk-Averse

Because this whole process involves making judgements about the future, there is an element of risk involved. But it’s vital to emphasise that in this context, ‘risk’ and ‘hazards’ are two different things.

Risk is the basis of enterprise, but successful entrepreneurs understand that they must do everything to minimise uncertainty, so that any risk is taken on a calculated basis. That doesn’t mean always playing it safe and taking no risk at all.

Unfortunately in the pharma industry, there is too often a reluctance for individuals to stick their heads above the parapet, sometimes exacerbated by a corporate ‘blame’ culture. As we know, this can stifle creative thinking, and lead to stagnation and paralysis – which is why it’s so important that marketers are given both the skills and the encouragement to undertake new thinking.

That is very different to reckless risk-taking. There is a middle ground between stultifying risk-aversion and reckless, gung-ho chancing. It’s called calculated risk, and it’s based on true understanding of the market.

Take a look at any truly different and successful pharma marketing campaign. It’s likely that it will stand out precisely because it has dared to be different. However, if that daringly different approach is based on customer insight, and sound knowledge of the market, it’s not really a risk at all. It just looks so to the uninitiated.

In fact, it’s far more risky to do the same-old, tried and tested things based on no insight, even if at first glance this appears to be the safe option.

Do Different

So how can we encourage new thinking during the strategic planning process? How can we convince marketers that they need to ‘do things differently’, and break away from the cycle of simply repeating what has come before?

This change in mindset has to come from managers, who must challenge their teams to think in a different way. The way to do this is to give them the skills to gain real insight into the marketplace, so that they see for themselves the changes in customer behaviour and prescribing drivers – then the need to adapt plans and make them evolve will become self-evident.

It’s not about teaching them to write better plans. It’s about equipping them with the ability to gather the right data, to analyse that data to provide the right information, and then to translate that information into genuine insight.

We do have a tendency to over-complicate the process. Good marketing comes from talking to customers. New thinking doesn’t have to be blue sky thinking. It can be as simple as reflecting changing attitudes in the market.

Creative or Methodical?

It has been said that strategic planning is an oxymoron, because strategy is about creativity, and planning then grinds that creativity out of you. This is more false than true. Whilst there is a grain of truth there, the balance between creativity and process is possible to achieve – provided that we accept a relevant definition of creativity in this context.

It is a fairly commonly held view that the research that underpins the process of gaining market insight is the ‘uncreative’ end of marketing, and that its rather disciplined approach tends to stifle creative thought, which many marketers still view as the lifeblood of their profession.

But in fact a sound understanding of the market can create a structure in which that creative thought can be channelled, ensuring that it translate that understanding into winning strategies which will help achieve the objectives outlined in the plan.

If this sounds like an uncomfortable attempt to inject some science into what many view as the ‘art’ of marketing, then perhaps it is – and I don’t apologise for that. In all areas of marketing, and not just the traditional ‘creative’ areas of marketing communications, a balance of creativity underpinned by a methodical analytical approach is called for.

At the strategic planning stage, this combination is vital. Get the critical decisions wrong at this stage, and no matter how much creativity is injected at the tactical stage, you are doomed to failure.

New Thinking

If pharma strategic plans are to deliver the continuing success for the industry, then they require a massive injection of new thinking, based on a sound understanding of our changing marketplace.

Too often pharma marketers, on approaching the task of writing a strategic plan, take the view that there has to be a very good reason to change what has come before. I would argue that the opposite should be the case.

Change should be the default position; planning for the same again should only happen if there is a compelling reason for it. Playing safe, and/or a lack of understanding of the market, should play no part in the process.

Often, the marketers who are most admired by their peers are those who are prepared to go out on a limb, who are perceived as risk-takers, who are regarded as ‘thinking outside the box’.

Their success is certainly based on the willingness to embrace the new, to explore innovative ways of achieving their objectives. But the common denominator which binds them all is that their perceived risk-taking is firmly footed on an extensive knowledge and sound understanding of their customers. They recognise that their markets are constantly changing; they take the time and effort to understand what is driving those changes; and they incorporate this into their new thinking when they are planning.

It’s time for pharma marketers to follow their lead.

The Author

Dr Paul Stuart Kregor is a Director of The MSI Consultancy Ltd.

Article originally published in Pharmafocus, March 2007

As an industry, we spend millions and millions of pounds chasing new patients who might benefit from our products. From GP advertising to huge sales forces, expensive symposia to extensive medical education programmes, disease awareness campaigns to supporting patient action groups.

And yet here’s the strange thing: once we have them in the net, we let as many of half of them go again very quickly. Haven’t we heard of the expression ‘A bird in the hand…’? If we could just approach the effectiveness of our market-acquisition activity in our market-retention strategies, the returns could be huge.

I’m talking here about compliance; actually, I’m talking about adherence, and I’ll explain the difference in a minute.

Too often the industry wrings its hands and complains that the ‘healthcare system’ is not doing enough to ensure that patients prescribed drugs actually take them – and that that same system is ignoring pharma when it comes to initiatives to tackle the problem. I suggest that is substantially wrong. The problem is the total lack of proactivity (with a few honourable exceptions) within the industry to take a leading role in developing such partnerships.

There are many examples of stand-alone industry initiatives to improve compliance, but why does the industry seem to want to go it alone? Is this a case of pharma once again looking introspectively, regarding compliance as its own problem which it must solve alone. Does the industry truly believe that only it is concerned with the problem, and so it must press on alone to find a solution? If so, it is deluding itself.

The industry’s own self-interest actually coincides with everybody else’s here (including the patients’ and the funders’). Patient compliance is something which affects Government, doctors, pharmacists, funders, insurance companies, the industry, and not least the patient themselves.

So why is there so little collaboration between these stakeholders to combat ‘health illiteracy’, changing the way that patients view their therapy, to give long-term healthcare cost savings, brand retention and better consumer relationships – as well as boosting industry return on investment?

Why are we leaving it to the ’system’ to boost adherence? Why aren’t we doing more? And what should we be doing to build really effective partnerships to keep hold of those patients we spend so much trying to acquire?

Concord taking off?

Much has been written on the subject, especially with the emergence of the concept of concordance in recent years. But concordance is only part of the solution. We should get our terminology right first.

What I am addressing here is adherence. That, according to the World Health Organisation, is “the extent to which a person’s behaviour – taking medication, following a diet, and/or executing lifestyle changes, corresponds with agreed recommendations from a health care provider.”

That is very close to compliance, which is a measure of patient behaviour – the extent to which patients adhere to the agreed ‘treatment’ approach, which is larger than but also includes how they take the medicines they have been told to take, in other words, according to the prescribed instructions.

The concept of concordance is a different part of trying to at least solve the same problem (i.e. adherence). Concordance, according to the Medicines Partnership, is about “shared decision making about medicines – and other treatments – between a healthcare professional and a patient, based on a partnership where the patient’s expertise and beliefs are fully valued.” An important partnership, then, but one from which the industry appears to be excluded.

To realise just what is at stake for the industry here, let’s try to get a grip on just how big the problem is. Despite the cynical view about ‘lies, damn lies and statistics’, the figures are pretty clear.

At any one time, 70% of the UK population is taking medicines to treat or prevent ill-health or enhance well-being, with many long-term illnesses now tackled via prescription medicines. This incidentally has led to a growth in prescription drug spending in the UK from £3.4bn in 1994 to £6.1bn in 2001, over 10% of the total NHS spend. So it’s an important part of our country’s health care strategy.

Studies show that 28% of people are not adhering to the prescription within just ten days of taking a new medication – and that doesn’t count those who don’t fill the first prescription. This includes those who stopped of their own accord, those who intentionally missed a dose, and those who unintentionally missed a dose.

These distinctions are important, because different approaches are required for each category – we’ll look in more detail at the reasons for non-adherence in a moment.

When it comes to medicines prescribed for chronic conditions, the Medicines Partnership estimates that 50% are not taken as prescribed, with some conditions such as asthma experiencing a staggering 80% non-adherence rate.

What’s more, while patients simply forgetting to take their medicine or renew their prescription will always be a problem, a worrying 61% of all non-adherence is reckoned to be ‘intentional’ – mainly fears about side-effects, worries about costs, or simply not believing that they need the drug.

Mutual Gain

Clearly this is a worry for the pharmaceutical industry, because patients not taking their medicine, especially in chronic conditions, means fewer sales and the need to spend marketing resources finding new patients. On that basis, funders should be quite pleased!

But of course it’s not as simple as all that. The consequences of non-adherence are far-reaching, and end up being a concern to everyone. For the patient, it can lead to ill-health and reduced quality of life, and ultimately reduced life expectancy.

This in turn can lead to avoidable costs elsewhere in the NHS – much better to have a condition controlled via medication than treated in an expensive hospital bed. So ultimately the arguable short-term financial gain to the health care system ends up being a longer-term drain on resources.

And wider society also loses out if a healthy, economically-active person, managing their condition so that they can get on with their everyday life, suddenly becomes inactive through illness, constituting and economic ‘double-whammy’ of expensive treatment-seeker and ex-contributor to the wider economy.

In addition, the pharma company takes a hit in terms of lost revenues, especially for chronic conditions, and just as importantly, negative perceptions about their drug efficacy and tolerability.

The weakness of the go-it-alone option that many in the industry seem to be adopting is shown when you start to look at the reasons given by patients in research as to why they don’t use their medicines optimally.

The fact of the matter is many patients start from the point where they believe that the potential harm from any medicine outweighs any benefits. The balance between the belief in the necessity of the prescribed medication – especially long-term – and concerns about the long-term effects and possible dependence is tipped towards non-adherence.

It’s difficult to see what the industry can do to turn this perception around on its own. Only better communication between health care professionals and patients can allay these fears, so pharma has to be engaging with HCPs, as well as all those who influence them, to build real partnerships which give doctors the tools with which to tackle these real patient issues.

As long as communication directly with patients is forbidden – and realistically, even if it were not, given the poor reputation for self-interest our industry enjoys in the eyes of the general public – we need the collaboration of all health care professionals to drive up adherence. We should be pushing at an open door, given that their agenda, or at least its objectives, is pretty similar to ours.

And we should not forget the complexity of the problem; from not filling the initial prescription, through refusal to make behavioural changes, incorrect dosing, forgetting or skipping doses, to self-termination of the medication for whatever reason, each problem needs to be addressed separately. The widely hailed concordance concept is one good tool to tackle this, but how can this work if there is not similar concordance between all of the stakeholders involved in providing patient care?

The Industry’s Role

So what should our role be in these partnerships? Well. Let’s put aside for one moment the role of driving them (I’ll come back to that). The main role of the pharmaceutical industry in any society should be to develop safe and efficacious therapies. Full stop. Your shareholders might disagree, preferring instead to concentrate on profit alone, but in any stakeholder partnership, developing good therapies is the pharma industry’s primary role.

So developing drugs which work, have fewer side effects, and which are easy – or at least easier – to administer would go some way to playing a useful role in promoting adherence. But because medicines are for patients, and patients only benefit if they use them optimally, the industry’s role needs to go further than that, and needs to step into the area of information.

If we are agreed that concordance, where there is a real consultation process between a patient and their health care professional, is an effective way to go, or at least more effective than simply expecting the patient to do what they are told, then increased and broader patient knowledge is vital to make this process work. So the industry can play a role in ensuring that the dialogue which takes place between the patient and their doctor, nurse, pharmacist or other HCP achieves the best outcome for everybody involved.

All patients want to be more involved in decisions about treatment; even amongst the older generation who have traditionally accepted that ‘doctor knows best’ there is a majority demanding more involvement – and this proportion rises dramatically amongst younger age groups. Only a third of patients want no involvement in treatment decisions.

Pharma understands this well, but it is not getting the message across to HCPs. Studies have shown that doctors underestimate the degree to which they instruct patients, and consistently over-estimate the degree to which they consult and elicit their views.

Like it or not, doctors are listening less to the industry. So an industry-led compliance campaign will only ever have limited effect. Which is why the industry should be driving true stakeholder partnerships by demonstrating shared goals, shared concerns and a win-win mindset. HCPs participating in a true partnership involving them, patient groups, funders, Government and industry are more likely to listen to the message. – such as Roche’s Mellibase approach that provides doctors and patients with the support to drive better motivation and hence better adherence through driving motivation.

So why isn’t it happening? Perhaps post HSC, the industry is still reluctant to open itself to accusations of self-interest in promoting such partnerships. But are we really so unconfident that we can’t persuade other stakeholders that we have a confluence of interest?

Let’s leave the last word to Asta Moller of the International Council of Nurses, who addressed a recent conference on adherence, pleading with the industry to get more involved.

“Seek out the guidance of nurses organisations and their leaders,” she said. “Work with these organisations, and with individual nurses. Bring training, useful tools for their patients, resources for their community initiatives. Get as close as you can to those whom you seek to help. Draw from the knowledge and experience of nursing to help shape your goals and strategies.”

Health care stakeholders are crying out for us to drive partnerships which will ultimately increase our return on investment. What are we waiting for?

The Author

Dr Paul Stuart-Kregor is a Director at The MSI Consultancy.

Originally published in Pharmaceutical Marketing, 2006

In the first two articles we discussed the value and the issues in taking this approach. Now I want to address the ‘how’ from the marketers point of view.

Doctors, like all human beings, are rational and rationalising in even measure. That is, they will take a reasoned approach to their decision-making, at least when first evaluating their prescribing choice. However, they will also use a rationalised argument to defend their position.

One of the significant issues in the current and future healthcare environment is to demonstrate the ‘value’ to the doctor of intervening with your brand, given the ready availability of cost-effective alternatives.

So we need to address the different layers in the rational decision-making hierarchy; then we need to provide a rational ‘value based’ justification for that prescribing behaviour as and when the doctor has adopted our brand in his or her repertoire.

Clearly the foundation for that hierarchy is the brand’s performance against the traditional, functional criteria – efficacy, safety and tolerability. But this is unlikely to be a trigger or motivator to change prescribing behaviour, more an entry-level requirement. As such, it is the first layer we need to understand and address with our brand but only to ensure we establish our credibility to be able to ‘play’ in this market.

Sometimes, we may need first to establish the scientific foundation for our brand, and not just if we have a different mode-of-action, to ensure we have a firm basis for our functional arguments. Do not assume that general practioners always have a deep understanding of the scientific rationale on which your brand is based.

However, remember this is just entry level,: not, as demonstrated by much pharmaceutical messaging, the essence.

We need to dig deeper to provide clear, compelling reasons why our brand should be chosen. Increasingly, in our experience, this is going to require demonstrable patient populations where the (marginal) benefits of our brand are/could be of benefit.

Only when specific management situations are discussed do priority issues/needs, concerns and dissatisfactions emerge in a meaningful way that enable us to truly understand what makes the doctor do something different – i.e. the triggers and motivators.

We all know doctors intervene in different patient situations for medical reasons (e.g. relative risk), and these can be an important part in hitting the right buttons. Intervention can also be related to the particular patient’s situation – the ‘value’ that treating that patient represents. This is a sub-conscious judgement that GPs commonly make. Capturing the elements of this decision can potentially provide a compelling trigger to prescribing.

Assuming we do not have a significant medical reason and clear meaningful functional product advantage, the doctor is more likely to make the effort to change embedded prescribing practice if we can get them to buy in emotionally to our promise.

The performance of Seretide in the UK, when the more emotive ‘moments’ campaign kicked in, provides one of the best examples of this in recent years. It worked on the clinical level (i.e. an efficacy promise), and the emotional (i.e. satisfaction) level, based on the real ‘insight’ of what it feels like to be an asthma sufferer.

So as we look at each of the management situations we need to understand the more emotional framework we can tap into.

Digging deep is the answer. Only by using specific and meaningful management situations will the priority issues/needs, concerns and dissatisfactions emerge in a way in which we can identify them. Then we can understand true motivators to prescribe and the triggers we need to push, on clinical, personal and emotional levels, ensuring we satisfy them at each level.

If, as we suggested right at the beginning of this series of articles, getting the brand messages in chime with the prescriber’s own drivers is crucial to making the proposition truly compelling, then this kind of ‘digging deep’ is a key part to gaining that elusive competitive advantage.

The Author

Dr Paul Stuart-Kregor is a Director at The MSI Consultancy.

‘What is marketing excellence in pharmaceuticals and how do you know if you are truly excellent?

The drive for competitive advantage in an industry that has over the years needed to become more sophisticated in its marketing and sales approach is heating up. Now more than ever companies like GlaxoSmithKline, Novartis and Sanofi-Aventis are seeking to embed ‘Marketing Excellence’ throughout their companies to stay ahead.

This is hardly a surprise when companies are being squeezed by their customers both payers and clinicians to bring products to market that represent good ‘value’ propositions. This demand is where Marketing Excellence comes in; working both more efficiently but above all more effectively to add value to the brand, beyond the molecule– some of which can be passed to the customer while the rest is retained.

Accepting there are always industry leaders and followers, this article is for those individuals who not only don’t want to be left behind, but also ideally want to be trail blazers inside their companies to genuinely embed Marketing Excellence to achieve commercial success.

Questions the feature will tackle are:

• What is “Marketing Excellence”?

• How is “Marketing Excellence” defined?

• How do you know if you are truly excellent?

What is Marketing Excellence?

Marketing: the president of the Chartered Institute of Marketing declared: “Isn’t a function. It is an attitude of mind.” Many will wonder how an attitude of mind can be researched, developed, protected and above all evaluated to drive excellence.

Add to this the many different definitions of marketing and marketing excellence to be found in books and papers on the subject – most of which involve doing things to customers – and the confusion mounts.

To reach a workable definition of ‘Marketing Excellence’ let’s start with the Marketing process which can best be described as a process for:

• defining markets;
• understanding and anticipating the needs of the customer groups;
• monitoring competitor activity and understanding competitive advantage
• putting together (superior) value propositions to meet those needs;
• profitably and in a competitive environment
• communicating these value propositions to those in the organisation responsible for delivering them and getting these people to buy into their role;
• playing an appropriate part in delivering these value propositions
• monitoring and reviewing the perceptions of customers and the value actually delivered.

So marketing might be defined as effective deployment of resources and competencies to satisfy target customers, by delivering superior value profitably and then going out and DOING IT, all in a sustainable way in a competitive market!

It is no surprise then that ‘Marketing Excellence’, judging by the many ‘awards’, is often seen as operational e.g. effectiveness of a marketing campaign.

While this is an end result of the marketing process and is part of what marketing is trying to achieve it is not all there is to ‘Marketing Excellence’ in my opinion. Not least as one marketing campaign is transient and/or short term– surely excellence is about sustaining that performance.

‘Marketing Excellence’ can and should be viewed from both an external and internal perspective. However, you must recognise that ‘Excellence’ by definition is subjective, and what is judged as excellent may change over time.

However, there are some core principles that I believe will underpin ‘Marketing Excellence’ event though viewpoints of what is excellent may change over time.

Externally, the only marker of true value is whether the customer perceives that you have excelled or not. Therefore the marketing process or function is not an end in itself its a process to enable this to happen.

Internally, it is reflected in the whole attitude, vision, culture, and approach to how marketing is practised – striving for the best result, both external (customer value) and internal (effectiveness plus brand value) at all levels. These are the ‘enablers’ that help drive excellence.

So ‘Marketing Excellence’ could be defined as:

“Right brand, right benefits, right relationship
that continues to deliver value that meets or exceeds customer expectations
in their relationship with the brand and the company over time,
as judged by target customers,
and that maximises the value of the brand to the company
in a competitive market to achieve the commercial goals of the organisation”

‘Marketing Excellence’ therefore demands a combination of high quality information, insightful analysis, creative interpretation and response in order to develop sustainable competitive advantage through differentiated offerings.

Understanding the market and the customer; true customer insight – the danger of seeing what everyone else sees.

Most pharmaceutical companies have access to a huge volume of information about their market place which has to be sorted and interpreted effectively.

The driver of marketing excellence is not the amount of information available, the real crux is whether that information REALLY tells the marketing strategy decision-maker what she or he needs to know to develop the value proposition for the target customers.

Marketing excellence has to be about asking the right questions of the right people in the first place, and sometimes having the eyes and ears to see something different.

Once the ‘excellent marketer’ has gained a better understanding of the market, they are better positioned to choose where to compete and where not to compete.

Segmentation – the final marketing frontier

The basis for segmentation is a key factor in the process of understanding customers and developing real insight. It is fundamental to the success of any resulting marketing or business strategy.

Effective segmentation is one of the most difficult challenges for any marketer in the pharmaceutical industry and the most critical success factor in any marketing or business strategy. Too often the supposed segmentation models developed are targeting with a different name. They are not customer needs and motivators based.

Marketing Excellence has to be about uncovering the best segmentation scheme for your business. Notice, also, that I used the word “uncover”. Segments exist out there in the market place; we do not create them in our office or ivory tower.

Developing the value proposition

The second most difficult and equally critical success factor in developing excellent marketing strategies (after segmentation, see above) is that of creating a winning value proposition. The value proposition is the expression of superior customer benefit that you offer, together with the value that you expect to gain in return for delivering those customer benefits better than your competitors.

It MUST address the key needs on which the customer bases their ‘buying’ decision AND connect with the customer.

Successful implementation

Having identified and understood the market place, chosen where and how to compete, you must make it happen. This may seem rather obvious, but many excellent strategies have failed due to poor implementation – hardly ‘excellence’!

Successful implementation is dependent upon excellent planning and communication.

In order to develop and implement winning marketing and business strategies it is essential to have a clearly defined, well thought-out, understood and accepted process.

This process must be comprehensive in its coverage and description of what needs to be done, by whom and in what sequence. The process must also be compatible with the other processes needed to run a corporation and interfaces must be clearly understood and seamless. The driving elements of these processes must be absorbed into the culture of the corporation, if they are to be truly effective.

Profitably

Increasingly competitive markets put pressure on the organisations resources and the financial returns. Marketing Excellence has to include delivering the desired results in the most profitable way, not merely matching competitors spend.

Monitoring the value delivered

By establishing and monitoring key performance indicators of customer value, the excellent marketer ensures that the implementation of their strategy stays on track and/or evolves as required. The starting point is to assess customer satisfaction in the context of the definition of ‘Marketing Excellence’ i.e. versus customer needs & expectations.

Innovation based on insight

True excellence does not stop there! The excellent marketer will be the one who can stay ahead of the competitor by anticipating the next standard and being the FIRST to create that offering as a differentiator.

Excellent marketers continuously learn, both from their own activities and performance and from that of others.

They capture and share the knowledge in order to maximise learning across and within the organisation. There is an openness to accept and use ideas from all stakeholders. Excellent marketers look beyond today and today’s capabilities, to constantly challenge the status quo and seek opportunities for continuous innovation and improvement that add value.

Does Pharma live up to ‘Marketing Excellence’ particularly with all the restrictions imposed?

To exemplify the ideal of Marketing Excellence to which pharma should aspire requires taking a broad view of what currently represents marketing right across the pharmaceutical industry and beyond, looking at highly respected marketing in other fields, such as FMCG, business to business and financial services.

Pharma is not different from other industries in needing to develop and maintain customer satisfaction. The challenge is even more acute now that the ‘value proposition’ needs to be far more than just the chemical entity.

I are sure that many companies think they are excellent at marketing, but do customers feel that the company delivers the “right brand, right benefits, right relationship that continues to deliver value that meets or exceeds customer expectations”? I doubt it.

Recent examples of Marketing Excellence include the original Orange telecoms proposition that evolved and stood the test of time for nearly 15 years, creating huge value for consumers and organisation alike.

Orange looked at the existing telecoms market with a new vision, that broke the mould – that the future was about wireless communication.

They worked hard to understand consumers, their needs and frustrations (customer insight).

Perceptive market research led to a proposition initially for business customers (segmentation) that was about satisfying needs and overcoming frustrations across the whole package rather than just competing on features of product (innovation) by being the first to introduce call packages for example (value proposition).

They were prepared to challenge established norms, including the marketing mix, not addressing the mix until they understood the benefits the consumer was looking for (successful implementation)!

The result was a paradigm shift in the telecoms market.

Moreover, the ethos never changed:

Step 1: Clearly developed value proposition that evolved with the customer.

Step 2: Execution that added to the core ethos across the whole mix.

Step 3: Consistency of brand values and relevancy of the value proposition (excellence over time)

Other examples of continued marketing excellence outside pure pharma include among others Durex, the ubiquitous Coke.

Unfortunately pharma examples of Marketing Excellence seem to be few and far between. However, Cipramil and Zyprexa seem to represent some of the best in recent times.

Managing Marketing Excellence – the “Marketing Excellence Dashboard”

The starting point for Marketing Excellence is to assess customer satisfaction in context with the definition of ‘Marketing Excellence’ i.e. versus customer needs & expectations.

Once you understand the gaps goals & targets can then be linked to those customer needs & expectations. In addition, loyalty issues can be researched – what do customers currently feel about the brand; how committed customers are to the brand, and how likely are they to switch,

The ultimate aim is to understand the business drivers of customer satisfaction needs & loyalty issues and then measure & action them.

Particularly when aiming to establish Marketing Excellence around specific brands or therapeutic categories, and to “standardise” the marketing approach across a number of markets (e.g. sales regions within a country; countries within the European operation) the “Marketing Excellence Dashboard” approach can be extremely useful.

Some of this data is likely to be readily available from internal or external sources; other information, particularly “softer” measures, may require the setting up of regular monitoring to generate the necessary data.

The advantage of the dashboard concept is that it standardises the data required from different markets and that having a common approach ensures that individual markets are focusing on the more important aspects of marketing.

Conclusions

“Marketing Excellence” and the customer are inseparable.

Marketing departments must be externally focussed on value generation that meets or exceeds customer expectations, as they change over time.

Perhaps marketing performance needs refocusing and to be monitored in a different way with the key performance indicators being external not internal.

Internal process and communication issues need to be managed as these are fundamental enablers of ‘Marketing Excellence’.

The Author

Dr Paul Stuart-Kregor is a Director at The MSI Consultancy.

Getting your brand messages – both rational and emotional – to link with your target prescriber’s own drivers is perhaps the single most effective way of ensuring your overall brand proposition is compelling. And this is even more important in the current environment for products which have minor points of differentiation, where small incremental advantages need to be exploited not in isolation, but as an integrated whole.

Understanding what motivates each group of prescribers to choose particular treatments is crucial to enabling marketers to define compelling, differentiating positioning and – vitally – motivating brand messages.

The answer lies in insightful research – but too often the research conducted by the pharmaceutical industry fails to provide the fuel needed. This might seem strange given the amount of time and money we spend on market research, but if you approach the task in the wrong way then it is unlikely you will find the right answers.

One of the problems lies with the marketing teams that commission the research in the first place. Whilst they may recognise the problem (for example that they do have a relatively me-too product), and whilst they may appreciate that market research is going to help provide the answer, too often they go about it in the wrong way.

We see large and extensive research qualitative studies used to first scope the market landscape, then the product profile is used to understand the perceived positives and negatives or to flesh out prescribers needs. However, without truly probing as to the value of the product features in the context of the prescribers roles and responsibilities, the end result is a very traditional top-level analysis that focuses only on the obvious parameters of efficacy, safety and tolerability, in whatever guise. . When this is then validated through quantitative research there is the perception that the necessary depth of understanding has been achieved.

However, the resulting segmentation and/or positioning and messages are very similar if not the same as everyone else, and could have been identified with less time and money. No surprise then that the resulting strategy is very standard and offers only illusory competitive advantage.

In addition, the way the research is approached has its limitations. Researchers are researchers, they will ask and answer questions as defined. In many cases the research will be piloted, in line with accepted good practice, to test the discussion guide and make sure the information required is being gathered.

However, no one seems to check, at the pilot stage, whether that information is going to help address the challenges that the brand faces; whether the quality of the insight is going to provide the fuel needed to develop a competitive advantage. If not, then the methodology needs to change. Instead what happens is the research runs its course, valid the answers to the questions asked are provided but no real edge results.

Finally, there is a problem when it comes to global launches of new products. If you review the ‘ideal’ research plan leading up to a product launch, as proposed by EphMRA, the sheer volume of research is incredible, covering as it does market, customers, trademark, packaging, pricing, forecasting, detail aid testing etc. The insight market research task is handed over to Business Intelligence who are also trying to cover all the other bases.

The end result is that they follow a traditional ‘road map’ ticking all the boxes as they go. All the research is completed but we are no better off in understanding the true triggers and motivators of prescribing behaviour.

The Author

Dr Paul Stuart-Kregor is a Director at The MSI Consultancy.

Decreasing differentiation between products, a shorter time in which to achieve return on investment (with the consequent increased pressure to gain quicker peak sales), and a difficult environment in which competitive and portfolio pressures are greater than ever – all mean that gaining (product/brand) competitive advantage is ever-more difficult.

Understanding what motivates each group of prescribers to choose particular treatments is crucial to overcoming these challenges by enabling marketers to define compelling, differentiating positioning and – vitally – motivating brand messages.

What exactly do we mean by ‘Triggers and Motivations’ when it comes to prescribing? Many pharma marketers often look only at their brands’ performance versus the straight forward, entry level clinical needs of the clinician and the patient when trying to understand prescribing decisions.

The problem with this view is that the definition is too narrow, and results in each brand coming up with the same default answer: that the only triggers to prescribing are efficacy, safety and tolerability. Although these are of course important, this thinking results in everyone acting the same; just take a look at the brand advertising in GP journals to see what I mean.

What we need is real insight which requires the marketer to delve into the direct, indirect, current and latent triggers and motivations.

To do this we have to look at the different layers of doctor’s thinking which lead them to make a particular prescribing decision.

Clearly the base level clinical needs must to be taken into account, as this will be the starting point of any prescribing decision: efficacy, safety and tolerability. But these are areas in which achieving a competitively advantageous point of differentiation is increasingly difficult.

Finding other triggers and motivations means understanding on one level the prescriber’s priority issues and needs, and these may not be purely functional, on other the ‘nice to have’s’ in product performance Finally, it may be that even more personal, aspirational and emotional factors play a part.

The marketer has to decide in which layer they should anchor the brand positioning to create or maintain that change in prescribing behaviour (although it will always be important to address the ‘entry level’ criteria in some way).

Let’s take as an example the treatment of hypertension. At a macro level, each GP has a treatment path mindset, set in context with when and where they use existing treatments. The ‘step wise’ approach, based on habit and previous practice, is likely to be the most powerful influence in their mindset, followed by the expectation of polytherapy and making a choice based on guidelines and patient differentiators (reinforced by the current patient status).

The general view among prescribers is that their current treatment strategy works, and therefore a new brand will need to have a credible rationale to change that – routine, habit and inertia all work against such a new treatment, which will also generally be at a disadvantage on cost and lack of familiarity, as well as the depth and breadth of available data.

So the approach taken by, for example, Zanidip, based on efficacy and tolerability, is unlikely to work – because it doesn’t offer enough differentiation in meaningful or motivating clinical terms.

So ‘outer layer’ trigger areas need to be explored to help leverage the importance of certain choice criteria where your brand can and/or does perform better than your competitors. These potentially marginal differences can be made much more important when you can give the prescriber a suitable contextual reference or anchor.

Getting the messages – both rational and emotional – in chime with the prescriber’s own drivers is perhaps the single most effective way of amplifying how compelling the overall proposition is. And this is even more true for products which have minor points of differentiation, where small incremental advantages need to be exploited not in isolation, but as an integrated whole.

The Author

Dr Paul Stuart-Kregor is a Director at The MSI Consultancy

Viewing a product portfolio as a group of independent entities means missing opportunities to maximise potential. A thought-through, interdependent approach to portfolio management is the way forward – but this requires a new way of thinking, argues Gerard Doherty of The MSI Consultancy.

Whilst the prospect of a single-product company might seem attractive – no in-fighting over resource allocation, no conflicts of interest, no trade-offs between products – the reality is that no pharma company is like that. And a good thing too, because such a company would be vulnerable, with all its eggs in one basket, and what’s more, a basket with built-in obsolescence.

So therefore the pharmaceutical company must necessarily manage a whole portfolio of products, with all that that entails. And yet many marketers think of each of their products individually, attempting to manage them to maximum effect, whilst in some cases only giving a cursory nod to the wider corporate strategy.

It is inevitable that such an approach will mean failure to maximise the overall potential of the pharmaco. So how do you reconcile the apparently conflicting needs of various elements of your portfolio, balancing the need to achieve corporate goals against the need to maximise the potential of each individual product?

Whose responsibility?

The need for managing the company’s entire portfolio may be recognised at Board level, but often the structures of pharmacos mean that the reality is somewhat different at the coalface. Individual marketers might understand the theory, but as they usually have responsibility for one product – or at best one therapeutic area. Few marketers have responsibility for an entire portfolio so few are in a position to practice, or gain experience of, true portfolio management.

In addition, the reality is that brand management structures are often set up to ‘compete’ for internal resources, with each brand manager fighting for the best resource mix and investment for their product, irrespective of the bigger picture. So individual brand managers may give little thought to maximising anything other than individual elements within it.

This is the traditional model, although we are at last starting to see a change. Some companies are now expecting to see strategies from individual brand managers, which at least take into account the context of the overall company situation.

For individual marketers, this means that they must gain a true understanding of how a portfolio develops, how individual products within it are interdependent, and how to approach resource allocation to ensure that the whole range of products – rather than just the one they have responsibility for – can maximise performance.

There is a competitive imperative at play here as well: with falling margins, fewer new products, and a closer focus on the value that marketing can add, portfolio management will become an increasingly important skill for the marketer who is striving to achieve ‘excellence’ (which of course is all of them, isn’t it?).

Because of their wider corporate responsibility, there is an important role for the Business Unit Manager, who may be able to take a wider overview than the product-focussed brand manager.

So marketers need to start thinking of their ’own’ products not as individual entities, but rather as pieces in a jigsaw puzzle. They need to accept rational assessments of each product’s strengths and weaknesses, allowing resources to be allocated not to those areas whose guardians are best at bidding for them, but to where they are genuinely needed to achieve the company’s strategic aims, whether those are maximum profit, sales growth, market share, or whatever.

The classic approach

Every marketer will be familiar with the Boston Consulting Group (BCG) matrix, which was developed to enable a company to start to think about setting an appropriate strategic objective for each element of its business: building, holding ‘harvesting’ or divesting. The main thrust was to identify the cash generators and the cash users.

However, much like a company balance sheet, the BCG matrix only represents a snapshot of the situation at any given time. And much like a lot of theory, it can be associated with prescriptive, textbook solutions to that situation. And we all know that real life does not pan out like the textbook says it should – at least not always.

The BCG matrix focuses only on market position versus opportunity growth – very limited criteria by which to assess opportunities and capabilities.

The model works on the assumption that being a market leader is what generates cash. Whilst this might be true, it’s also true that a strong number two in the marketplace can also be profitable, meaning it’s not a ‘Problem Child’ or ‘Question Mark’ at all.

The classic BCG model was designed to assist in decision-making at a global level, where the customers, the individual product markets and/or a variety of different scenarios are not considered. But clearly this is very limiting: how can any portfolio management strategy ignore the customer? What about the interaction of several product or therapy-based strategies? This particular approach is therefore not helpful in guiding and assessing the merits of individual product strategies that are developed within the portfolio.

In fact, the task is rather more complicated than can be approached with simplistic solutions – inevitably. So we must look elsewhere to find an effective solution.

Defining the portfolio

Perhaps a good starting point is to redefine exactly what a portfolio is. It isn’t simply a collection of different products, it represents far more than that. In essence, a portfolio, especially in the pharmaceutical context, is a mix of opportunities and risks. It is only by understanding this concept that we can develop a meaningful strategy for managing the portfolio.

Any portfolio of products and/or service presents a company with a range of different market-based opportunities. The concept of return on investment is (finally) well understood within our industry, and the portfolio manager needs to look at the revenue likely to be generated relative to the investment required, in order to establish which is the most likely strategy to meet, or exceed, business objectives.

But it’s not just about RoI, it’s also about managing risk. That risk comes from a number of directions, and it’s important to understand and quantify the various risks before such decision can be taken. The risk can come from the market environment, from competitiveness, and from the company’s own capability to meet market needs.

The aim of any portfolio management strategy should be to optimise the investment so that the balance is achieved on the following three scales:

• Risk versus return
• Maintenance versus growth
• Short-term versus long-term

So how do you go about achieving that perfect balance? The key is to look at the total portfolio as a whole, rather than as its constituent parts separately. It’s no good planning to spend resources on one element of the portfolio without giving some thought as to when and where resources will be needed elsewhere, otherwise you run the risk that resources will all be needed at the same time.

Inevitably, then, there will be an element of prioritisation, and difficult decisions to be made about conflicting priorities. The traditional structure of pharmacos means that this process pits marketers against each other, whereas an approach which focuses on the portfolio as a whole means that marketers will subjugate their own individual product needs to the greater need of the corporate whole (in theory at least).

Looking at the bigger picture means that the portfolio manager can also review different options in a dispassionate way. Clearly it is important that this review is undertaken in the context of individual brands having developed good quality strategic options based on a sound and transparent analytical foundation, using key marketing principles.

Only then can the portfolio manager look at different permutations and combinations of options (by brand) to assess which ones represent the best balance of risk and return over the defined time period, recognising that there may need to be short-term investment for longer-term strength (another advantage of looking at the wider picture: the ability to let the ‘Cash Cows’ subsidise investment in other products for the longer term).

Things to Consider

In developing the portfolio strategy, there are some important considerations to take into account. Thinking through these points should help provide some clarity, and may make what at first sight seems a daunting task appear rather more manageable.

Consider how you can group the portfolio by ‘clumping’ – i.e. linking products together to achieve synergies in return on investment? This is classic Ansoff: Can we present new products to existing customers we are already calling on?

Should you follow the ‘halo’ strategy – allowing weaker parts of the portfolio to feed off the star performers, seeing them as a marginal cost in investment terms? Or does this weaken the return from a sure-fire profit-maker?

Consider what should be the criteria for forming these clumps – therapeutic area; a particular compound; different technologies, a developed competence? Or even, God forbid, particular unmet market needs!

Assessing the Portfolio Strategy

So how do you know that any potential portfolio management strategy is going to be effective? What are the criteria for assessing strategies before implementing them, in order to give the best possible chance that they will succeed?

Any such strategy begins with a set of strategic goals; then it is a case of developing potential scenarios to develop and test strategic options to make sure they are going to meet – or exceed – those goals. This approach will enable marketers to compare the business performance characteristics of any potential strategies.

Scenarios are compared using performance (key metrics, timing and magnitude of results), risk (probability of meeting goals), and portfolio composition (synergies and economies). Key elements of each are:

Performance:

• Consistency with Vision/Mission/Goals
• Sales value/growth
• Profit value/growth
• NPV
• Market Share
• Return on Investment

Level of risk – chance of success:

• Competitive environmental fit
• Market environment fit (political)
• Capability fit (skills)
• Capacity fit (resources)

Focus of company resources – synergies?

• Synergistic Effects
• Corporate Fit

The Successful Portfolio Strategy

Of course, every pharmaceutical company is different. The mix of products in any one portfolio will be unique, both in terms of the therapeutic areas in which those products operate, and the stage in their lifecycles. Most likely it will be a mixture of everything from pipeline through to patent-expired products. But there are certain fundamental truths which can be applied to every portfolio when it comes to planning and managing for success.

First, and most importantly, marketers need to view their individual products as interdependent – different pieces of the same jigsaw – not in an individual way. As we have seen, this will require new thinking.

Secondly, the strategy must have as its first priority the corporate strategic aims of the company: maximum profit, maximum sales growth, maximum market share, or whatever is the corporate priority. Not those of individual products and their specific teams. The key is to subjugate the individual product to the good of the corporate whole.

Of course, to achieve this, long-term thinking is required. Given the short-term nature of much of our industry’s reward mechanisms, and the rapid turnover of marketing staff, perhaps this will also require new structures and new methods of measuring success, other than immediate profit.

Grouping products within a portfolio makes the whole strategy manageable, and easier to implement. The first step towards this is a thorough portfolio review, understanding where each product fits, and looking ahead so that pipeline products can be included in the strategy.

Finally, any strategy has to be reactive to market changes, so a degree of flexibility has to be built in – including in planning the allocation of resources to meet the strategy.

We can’t be in a world where we can concentrate on one product, where life is simple and there are no conflicting demands on resources. But by viewing a company’s portfolio as a whole, we achieve the next best thing: a strategy where RoI is maximised, where each product gets the investment it needs within a secure and sustainable corporate environment.

The Author

Gerard Doherty is a Senior Consultant at The MSI Consultancy

Most pharmaceutical companies are multinational, operating across many different markets. But what are the practicalities of maintaining brand consistency while, at the same time, taking into account local cultural environments?

In the globalized pharmaceutical industry, standardized global branding is a fact of life.

In reality, however, marketing is a complex discipline influenced by culture, business environment and a host of other factors. So a standardized global approach may not always be best for a brand’s local competitiveness.

Fast moving consumer goods (FMCG) brands realized some time ago that the ‘one size fits all’ approach does not always work; it is often better to express the core values of a brand in an appropriate way for local markets. Sometimes this can even come down to changing brand names. Unilever’s Becel and Flora both promise lower cholesterol but use different brand names, and Proctor & Gamble call their decongestants Wicks in Germany but Vicks in the UK. The same principle applies throughout pharmaceuticals. What works well in one region may not fit with the culture, prescribers or markets in another. Identical brand attributes cannot simply be imposed in all markets.

Cultural branding, however, is more than just using a different brand name. As we know, a brand is the sum of the tangible and intangible characteristics that differentiate it and make the brand unique in the minds of the customer. Strong brands have a clear vision of what they stand for and satisfy a customer’s needs beyond the functional.

A brand is exemplified by its core values. The ‘brand value equation’ combines the functional/tangible benefits, the emotional/intangible benefits and the ‘value perception’ to create the overall ‘brand value’.

Emotion and motivation

How does a successful brand maintain its connection with the customer? The acid test is whether doctors are motivated to prescribe the brand. Motivation is based on emotions – the words emotion and motivation both originate from the same Latin verb meaning ‘to move’. In order to motivate someone we must move them emotionally.1

Aristotle was the first to recognize the power of emotion to persuade others. He stated that logical argument consists of logos (logic), ethos (character) and pathos (emotion). What applied in ancient Greece still applies today. The best way to get someone’s attention is to stimulate an emotional response.

This is why the most effective advertisements are not informational but emotional. The feelings evoked by an advertisement often have no ‘logical’ connection to the product. What is important is linking the desired emotion with the brand.2

Consequently, understanding how to tap into that emotion, and translate it into a compelling proposition is key, and unlikely to be achievable on a purely global basis.

Communicating the message

Crucial in communicating the brand is the customer frame of reference. We all internalize communications using our own experiences, so the meanings we impose on messages we receive from advertisements vary from culture to culture. Any communication that is developed outside that cultural frame of reference can be misunderstood or not understood at all.

Yet in marketing today, particularly pharmaceutical marketing, messages and communications tend to be developed by a small group, often distanced (both culturally and physically) from the markets in question. Consequently, the local target customer may not understand the message, resulting in little or no chance of us achieving our marketing objectives.

In an industry such as pharmaceuticals, dominated as it is by the US, the situation is often made worse by a lack of understanding of European culture and its variety. Clearly, audiences in Europe will react better emotionally to a Europe-centred marketing approach than a US centric one. It is therefore vital that European marketers work together to challenge the dominance of American imposed approaches that can be unsuitable. But any Europe-focused solution has to be flexible enough to take account of the wide range of cultures and markets within Europe.

The consistency dilemma

The world pharmaceuticals market is vast but 40% of global sales are in the US. This results in some global strategists, usually those in the US, believing that brand consistency is key without any consideration of cultures in other markets. Particularly if the domestic US marketing strategy is successful, it may simply be rolled out across the world.

The desire to retain consistency over the basic brand proposition is understandable, particularly in a climate demanding increasing return on investment.

But how then do we build truly global brands, with consistent propositions, values and brand messages, while ensuring effective emotive connection? We have what seems to be a contradiction: the internal need for a strong global brand versus the importance of local market, economic and cultural conditions.

Know your market

Central to successful implementation is the old adage: “think global, act local” (also known as the ‘glo-cal’ approach.) This does not necessarily mean adapting the brand itself, but rather knowing when to adjust the campaign to suit local cultural or marketing needs while still ensuring that the local core proposition remains consistent with the overall global brand vision.

It is vital to understand the stage of market development and consequent perception of issues. Take the issue of sexual health in men with benign prostatic hypertrophy (BPH). This aspect of BPH is well understood in France, but hardly considered by GPs in the UK. So a different approach is needed in these two markets.

What to change

What is needed is an agreed process for assessing the global brand proposition against local market conditions. Local marketers must be able to demonstrate objectively that their local situation necessitates departing from that proposition.

Generally the value/equity and core values of a brand should be consistent globally. The brand vision, the brand positioning and the core proposition (the added value the brand brings to customers, both functionally and emotionally) are unlikely to change.

In deciding how to use a global campaign local marketers should first consider whether the brand values would work in their local market. Are their customers different (if so, how?) and are their customers’ needs different? Looking at the brand, does it add value in the same way locally as it does in other markets? Can the brand’s core values be expressed and represented in the same way?

In pharma, other national and cultural questions are important. How do patients in the local market access healthcare? How is healthcare delivered to patients? What are the attitudes and behaviours of key stakeholders in the therapeutic area? How do decision makers make ‘value’ judgements (for example, which patients are important to treat)?

What may change then is the emphasis of the campaign, or particularly the emotive communication to reflect the needs and aspirations of each local market, not the core brand.

Meeting the challenge

Marketing success depends on understanding what drives a culture. Simply knowing the right handshake or how to eat in company is not enough. But if ‘commercial imperialism’ is to give way to a more collaborative approach it is equally important to address the attitude of European marketers. European marketers must learn not to simply accept the global edict from ‘the powers that be,’ nor should they be seen as always disagreeing. They should be objective in their assessment of whether or not there might be a better way of doing things at a local level.

The pharmaceutical industry is strong as an industry because it is global, but to survive and thrive marketers must not be afraid to stand up for the European point of view. Cultures remain dramatically different, and healthcare professionals respond to brand and product messages presented in a way that is appropriate to them.

1. Goleman D. Emotional Intelligence. Bantam Books, New York, 1995.
2. David Walsh and Douglas A Gentle ‘Slipping under the radar: Advertising and the mind’ (In press) In L. Riley & I. Obot (Eds.) Drinking it in: Alcohol Marketing and Young People. World Health Organization, Geneva, Switzerland.

The Author

Dr Paul Stuart-Kregor is a Director at The MSI Consultancy.

Originally published in European Pharma. Exec., January 2006