August 2012

~ F I E L D F O R C E E XC E L L E N C E ~

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P H A R M A | M E D I C A L D E V I C E S | D I A G N O S T I C S | S U R G I C A L S

A BroadSpektrum Healthcare Business Media’s Corporate Social Responsibility Initiative

Vol. 2 Issue 8

MedicinMan

Editorial

www.medicinman.net

Why Do We Fail to Get Results?

Many pharma companies are adopting coaching to trans-

form the way their field force is working. However, while

most are excited with the concept of coaching, they are

frustrated with the results, because their focus is on the

wrong indicators. They imagine that one or two rushed up

sessions in a beach resort will transform the behavior of

their managers from sales bullies to performance coaches!

In pharma we focus only on sales; not on changing the

knowledge, skills and attitude of the MRs/FLMs/SLMs.

As a result, their capabilities and behavior remain the

same, but we expect better/more from them.

This is insanity and hence the results are disappointing.

As in sports, we must discover the learning needs of field

force people and then coach people to change their inef-

fective ways of working.

Good sportspeople become great sportspeople through

great coaching and continuous practice. Doctors and law-

yers call their profession as 'practice' because they are con-

stantly learning through practice, CME and other profes-

sional development programs.

Companies like GSK, Pfizer, Eli Lilly once pioneers in

people development are today paying billions of scarce

dollars in fines to FDA for unethical practices. Surprising-

ly when it comes to getting results from doctors, they

seem to get the options right and are pleased with the out-

comes… till they have to pay the heavy penalties to FDA.

If only a fraction of this money was spent on Coaching

their people to do the right things !

When it comes to any developmental activities including

coaching, pharma does not have or has limited funds.

When it comes to CRM for doctors the funds are unlim-

ited ! What do you think is the learning field force gets

from these ACTIONS ? People pay attention to what you

do and where you put your money and not what you pay

lip-service to.

COACHING FOR CHANGE "If you focus on results, you will never change. If you focus

on change, you will get results." - Jack Dixon

Coaching is great. But good stuff doesn‟t come cheap. At FFE

2012, Mr. Girdhar Balwani, Managing Director Invida, had this

to say about their experience as an outsourced field force ser-

vice provider – “Pharma companies want good, fast and cheap

service. What they don‟t realize is that they can pick two of the

options but the third one is not an option but an OUTCOME

based on the other two options. You can have good and fast if

you‟re willing to spend a lot of money. You can have fast and

cheap, but the quality will be poor. You might even be able to

get good and cheap, if you‟re willing to wait a long time.”

The MedicinMan Poll on LinkedIn (see Page 14) is another

clear indicator to show that employees are aware of what is

needed to progress as professionals and businesses. Are the de-

cision-makers willing to FOCUS on CHANGE? ▌

in.linkedin.com/in/anupsoans

@anupsoans

facebook.com/anup.soans

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4

“India lives in its villages.” - Mahatma Gandhi

And after so many years, we still wonder – is there a busi-

ness in rural markets?

According to census 2011, out of 1.2 billion Indians,

68.84% live in Rural India.

Rural India is undergoing a tremendous change – machines

are replacing man and tools and as a result farmers and their

families have a lot of time for non-farming activities.

According to census 2011, 91.21 million households in ru-

ral India have access to phone, compared to 64.67 million

households in Urban India. Computer is not a magic-box or

a genie for a rural folk anymore. There are 8.64 million

households with a computer in rural India. Internet usage in

rural India has overtaken usage in urban India - more Inter-

net users in rural India than in urban. TV and dish antennas

are common sight in rural India. 56 millions households

have a TV, compared to 60 million urban households.

Government is aggressively spending for rural develop-

ment. Active steps are being taken to improve healthcare.

Rashtriya Swasthya Bima Yojna (RSBY) was launched in

2008. Its purpose is to cover all BPL families with a health

insurance of Rs. 30,000/ (government or private hospital

treatment, no age limit and pre-existing ailments are also

IS THERE BUSINESS IN RURAL MARKETS?

covered).

One thousand more PG seats are sanctioned for private

medical colleges, and 4000 more seats are created in exist-

ing government colleges. Land required to open a medical

college is being reduced from 25 to 20 acres. To meet the

shortage of teachers in medical colleges, age-bar for faculty

position is being increased from 65 to 70 yrs. To encourage

rural healthcare, 50% PG seats are allocated to doctors

working in rural areas.

There is narrowing of rural urban divide due to:

1. Better income from farming

2. Increasing income from non-farming avenues and im-

migrants

3. Industry projects in rural areas

4. Infrastructure development

5. Increase in literacy and awareness

6. Affordability of technology & white goods

Income from non-farming sector is increasing. Now around

50% income in rural India is being generated from trade,

food processing, industry, and money brought back by emi-

grants. Better procurement prices for crops, a run of good

monsoons, cash crops, etc. have increased disposable in-

come. Rural folks are buying cars, flat screen TVs, micro-

waves and high-end mobile phones. Rural income is 43%

of national income. In terms of absolute numbers disposa-

ble income and middle class is more in rural India. Litera-

cy is improving in rural India - there are 493 million lit-

erates in rural India, 285.4 million in urban.

In spite of its huge potential, as indicated by various param-

eters mentioned earlier, rural markets‟ contribution to phar-

ma remains abysmal; even its growth, over the past few

years, has been suboptimal. What are the factors that are

preventing the rural pharma market to achieve its potential?

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2009 2010 2011 2012

RURAL

CLASS II TO VI

METROS

CLASS I TOWNS

By Dr. Surinder Kumar Sharma,

Head - Strategy & Business Development, TTK Healthcare Ltd.

5

Road Blocks

Inadequate Infrastructure

There are gaping holes both in government as well as

private sector‟s initiatives to create a good healthcare

infrastructure. There are gross inadequacies - be it the

number of hospitals, dispensaries, staff, or doctors

(only 1 doctor per 3000 people in rural area, compared

to 2/3000 in urban). Quacks rule the roost. 60% of rural

diseases do not get treated at all.

Lack of awareness

Lack of awareness towards diseases, even the highly

prevalent ones, continues. Superstition and belief in

witchcraft is still rampant. Most of folks still believe

that diseases are due to God‟s curse, and have fatalistic

attitude towards health and disease.

Lack of affordability

Many drugs remain expensive. Rural masses have

stronger value for money. A few days‟, or a little, suf-

fering is preferred to spending money on medicines.

Poor accessibility

Highly disbursed markets make distribution expensive

and a logistic nightmare. Maintaining cold-chain or

special storage conditions is a challenge due to erratic

electricity supply. To establish a dependable distribu-

tion system in interiors one needs strategic approach,

rather than tactical, as ROI period is long.

What is the way forward?

To develop rural markets, one needs a multipronged

approach, and need to:

1. Improve Healthcare System

2. Create Awareness

3. Provide Affordability

4. Ensure Accessibility

Improving healthcare system

It shall be viewed as a community responsibility and

corporations shall take active responsibility. Various

steps that can be taken to develop and robust healthcare

system in rural India are:

1. Partnering with government, NGOs and other key

stake holders

2. Training rural doctors and supporting staff

3. Providing microfinance to doctors, retails, etc. to

create healthcare infrastructure

Some of the initiatives taken in this area are:

1. MSD India launched Project Transcend, a program

to train GPs on evidence based management of dia-

betes.

2. Sanofi Aventis‟ PRAYAS - a program to meet rural

India‟s healthcare needs and to bridge the gap by

training rural doctors - plan to train 150,000 doctors

across India.

Creating awareness

1. Educating rural masses about safe and reliable remedies

for common ailments

2. Partnering with rural institutions and NGOs

3. Making use of annuals fairs, weekly haats and mandis

to spread awareness

Some aspiring initiatives, which have done good to both

company as well as masses are:

1. Novo Nordisk Education Foundation is undertaking

massive diabetes control program that involves screen-

ing, spreading awareness and training doctors.

2. SPARSH, a multilingual helpline for diabetics to sup-

port Januvia and Janumet.

3. NPL had run „Teach more, reach more‟ campaign to

educate masses about epilepsy.

4. J&J‟s Mobile health for mothers helped many.

Providing affordability

1. Making medicine more affordable is very important.

Companies can think of differential pricing strategy for

rural areas, e.g. Microsoft has low prices for its products

for students.

2. Rural healthcare insurance can help decreasing the bur-

den of payment on the individuals

3. Training medical staff for cost effective disease man-

agement may help in establishing trust in allopathic

medicines.

Arogya Parivar (Healthy Family), a low-profit social initia-

tive developed by Novartis, is a good example. This pro-

gram is proved to be a commercially sustainable program.

Ensuring Accessibility

Highly disbursed market and thinly populated area make

setting an effective distribution system a nightmare. Main-

taining cold chain etc becomes very difficult due to frequent

power failures. Various options could be:

1. Company delivery vans

2. Pooling of resources by collaborations between compa-

nies to set up viable distribution channels

3. Developing products suitable for rough storing condi-

tions

4. Mobile clinics and mobile pharmacies

5. Post offices duplicating as pharmacies

Ranbaxy and Pfizer have formalized an alliance with ITC to

penetrate the rural markets for their over-the-counter (OTC)

products.

Traditionally Indian companies, especially mid- & small-

size, have a better penetration in rural and class II-VI mar-

kets. Now multinationals (Indian & foreign) are becoming

more aggressive in these markets. Every other day, there is

news of some or other company hiring to enter into rural

markets. In view of these developments, mid- & small-size

companies need to be proactive to make the most of the new

markets created by these companies and, more importantly,

to protect their current business in these markets.▌

MedicinMan August 2012

MedicinMan August 2012

To maintain the tempo generated by

Brand Drift and FFE 2012, MedicinMan will

be hosting the 1st BREAKFAST FOR THE BRAIN on

Friday 7th September 2012 in Mumbai from

0830 AM to 1000 AM.

Where Pharma Business Leaders Brainstorm

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CONTACT

Arvind @ 9870201422 or email - arvindnair@medicinman.net or

Chhaya @ 98674421131 or email - chhaya@medicinman.net at Mumbai or

Anup @ 09342232949 or email - anupsoans@medicinman.net at Bangalore

BBBRAINRAINRAIN

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MedicinMan

MedicinMan August 2012

7

I am regularly asked this question by my pharma clients

and my usual response is what Einstein said: "if you can't

explain it simply then you don't understand it well

enough," i.e. the fundamental reason that KAM fails is the

over complication of the process. I have worked on KAM

implementations for 8 years across various healthcare

companies and use this experience to model what makes

KAM successful. I have condensed the factors into “the 3

golden rules.”

1. Align to business strategy

2. Right people/right skills

3. Align business process

If any of these rules are neglected then KAM falters.

However, in a quest to refine the rules and identify com-

mon reasons which may fall outside these, an invitation

was extended to members of an interested group (Pharma

KAM) on LinkedIn to participate in a discussion about:

“What is the main reason that KAM fails in Pharma.”

This group is focused upon account management in Phar-

ma and has active discussions on a range of topics associ-

ated with the management of key accounts.

The group highlighted several areas as potential reasons

for failure of KAM. I summarized them below and linked

them to the relevant golden rule where appropriate.

The comments above shows that there are several factors

which can lead to the failure of KAM in the pharma indus-

try. I grouped them into 3 general categories for simplici-

ty.

I. No clear understanding of what KAM actually

means in the pharma market, this is demonstrated in the

“understanding KAM”. KAM isn‟t just a sales person‟s

state of mind. It is a business methodology, which needs

to be in the company‟s DNA. The challenge for Pharma is

whether full KAM is needed (KAM teams working with

customer teams to deliver integrated partnerships sharing

common objectives) or just good account management

(sales people identifying who the key decision makers are

and interacting with them more effectively when deliver-

Why Does Key Account Management Often Fail in Pharma?

ing your value proposition). As one respondent put it “I think it

would be useful to define KAM in various levels. Basic, Inter-

mediate and Advanced. This way people will have a roadmap to

adopt KAM.” Defining what needs to be achieved determines

the skills, capabilities and structures companies need. If you are

not clear at the outset, then its successful implementation is un-

likely.

Lack of clarity around what type of KAM you are striving will

inevitably lead to the second factor.

II. Lack of organisational support.

1.Senior managers who structure the DNA of the company do

not buy in to KAM

2.No buy in from relevant stakeholders who may be required to

interface with customers

3.No supporting HR structures

4. Appraisals and reviews don‟t drive KAM behaviours such as

KAM teams or long term planning

5.No supporting business process e.g. CRM still focuses on ac-

tivity and individual customers rather than profitability and de-

cision making units

In reality an effective KAM approach needs to originate from

the top of the organisation to create the right KAM mindset

company wide

III. Lack of skills and capabilities. Once again, if you are not

clear what needs to be achieved then you can‟t be clear what

competencies are required. It is critical to get the appropriate

person for the appropriate role, as one respondent put it: role

clarity is of utmost importance; the only reason for failure is

not understanding the role properly.

Whilst the 3 golden rules still stand, this feedback shows that

they are best understood when supplemented specifically with

the common mistakes that need to be avoided.

Hakeem Adebiyi, Managing Director,

Hands Associates Ltd

hakeem@handsassociates.com

www.hands-associates.com

8

MedicinMan August 2012 MedicinMan August 2012

General Categories Comments Golden

Rule

Organizational support –

leadership

KAM often doesn’t have backing of senior management

Asking questions like: Why, Who, How KAM is the beginning of developing

effective KAM approaches originating at the top of the organization and

works on creating the right mindset towards KAM; companywide.

The strategy isn’t clear across the organization

We don’t spend enough time shaping the DNA of the company

Because they don’t have the backing of the organization in its entirety to do-

ing business in an account centric and KAM led manner

Functions will still be organized in their traditional way and KAMs will still be

treated as 'sales force' i.e. a route to market amongst many others

1

Organizational support –

processes and structures

Functions still arranged in their traditional way

KAM’s still just seen as a sales force

3

Skill Gap Identifying the customers need and aligning their needs with yours

Do they have the commercial acumen-if not coach them, do they understand

business per se and business planning-if not give them the knowledge, do they

ask the right questions-if not train/coach them

2

Understanding of KAM KAM is a state of mind

KAM requires commercially aware sales people

A commercially astute KAM will, given the correct personal internal motiva-

tion (i.e. "state of mind"), understand intuitively the importance of focusing on the

new decision makers, rather than the traditional target list - the latter often being

based on historical factors that may not still be valid.

Only reason for failure is not understanding the role properly

1

2

KAM on the Web

1. In the post blockbuster and share-of-the-voice era, Pharma will have to deliver a lot more value: http://www.pharmaphorum.com/2012/07/27/kam-future-pharma-sales-model/

2. KAM in the Harvard Business Review: http://blogs.hbr.org/cs/2012/07/how_to_succeed_at_key_account.html#comment-589214138

Contributed by Hanno Wolfram, MD at Innov8 GmbH, Germany

9 9

9

MedicinMan August 2012

Success is a personal matter: team members can work toward it at their own speed,

provided there is constant progress. Given below are practical and easily implementa-

ble strategies. You may ask the team members to build on one at a time and gradually

add more.

1. SET GOALS.

If you don't know where you're going, you will never get there. It is as simple as that.

2. WRITE IT DOWN.

With many things happening every day, it may be hard to focus on real important mat-

ters. Writing out goals and consistently reviewing them keeps them fresh in your mind.

3, DRAW OUT A SCHEDULE.

Use anything such as a gadget, pen and paper, Daily to-do list or a planner to build

your goals into your schedule.

4. PLAN.

Knowing where you are going is one thing. Equally important is to decide, how you will get there.

5. KEEP AN IDEA PAD.

Note down the ideas as they occur to you. The mind gets free to focus on other things. This will help to preserve and

review on ideas and to work on it later.

6. LEARN EVERY DAY.

Read a few pages of a book, any interesting articles from a newspaper, or e-zines, try and pick up a new skill- or the

one that you don't often use.

7. EXECUTE.

Goad yourself to action and measure your progress.

8. NOTE YOUR SUCCESSES.

Observe any small or incremental progress. Do not discount the small victories. Remember, each small win motivates

you to greater ones.

9. GIVE YOURSELF TIME TO THINK.

Taking time to stop, sit and think is very important. Allowing time to review your day or a meeting gives you tremen-

dous insight that inspires change.

" Your ability to connect with your team members directly impacts their level of engagement. The more engaged your

team is, the better the results ".

Steps to LEAD your sales team to WIN

K.HARIRAM, Former MD - Galderma

MedicinMan August 2012

India is slowly catching up with the fatigue levels of its

western counterparts when it comes to Doctor – Medical

Rep relationship. But the Indian healthcare landscape and

situation are entirely different and hence the reasons for

fatigue are also different, although there are many similari-

ties in the challenges faced in terms of access to doctors.

The problem of plenty and popular perceptions often obfus-

cate real issues. This is more so in India, where nearly

3,00,000 Medical Reps (MRs) jostle for time with 5,00,000

doctors (The figures are only indicative). Majority of these

MRs are merely an appendix whose main task is to

„remind‟ the doctors of their branded generics in a market

overcrowded with 60,000 branded generic drugs.

In general, how receptive are doctors to meeting MRs?

How critical is the product or service offered by the compa-

ny to the doctor‟s practice determines the quality of rela-

tionship between the doctor and the MR.

Doctors are receptive to different MRs differently - an on-

cologist will be keen to meet an MR from a pharma compa-

ny, which has a patented anti cancer monopoly products.

Most of the information regarding the drug and the latest

clinical trials reports will be provided through the MR. The

same oncologist will also meet MRs from other companies

marketing anti cancer drugs to keep himself abreast of de-

velopments relating to launch of products at different price

points. For example, the oncologist who has been seeing the

MR from Bayer (Nexavar) regularly will also be keen to

meet the MRs from Cipla and Natco who have now intro-

duced generic Sorafenib at a fraction of the price of

Nexavar. But this equation will change when ten more

pharma companies jump into the bandwagon and market

Sorafenib – then it is the marketing strategy of the company

and the skill of the MR that will determine the receptivity.

The same oncologist will also like to keep in touch with

MRs from various pharma companies who market products

needed by a cancer patient. This could be as mundane as a

cough syrup with a new combination of more effective anti-

tussives or a marketer of high-end pain relievers. The on-

cologist will also like to meet and receive samples of nutri-

tion products as well as meet an MR marketing anxiolytics

and anti-depressants. But his priority will always be to meet

MRs from oncology product companies like Bayer, not only

for product and disease related information but also to know

the latest happenings in his field and what his peers are do-

ing. A good MR is one who blends science with the social to

keep the busy doctor in the loop of happenings that matter to

him. A good MR might even begin the conversation with

general or specific information about what is happening in

other oncology treatment centers. Once the doctor is aware

of the value that MRs brings to the interaction, he will al-

ways make time to meet them. As medical practice becomes

more and more corporate oriented, the role of MRs will

change as the decision-making shifts from doctors to hospi-

tal managers. But the need for information still remains and

so the role of MRs might evolve but it will remain as long as

modern medicine is practiced.

This is true of every medical specialty. For most doctors,

meeting with MRs is a part of their daily work. What they

would want is adherence to basic norms of interaction. Sev-

eral doctors have remarked that the social skills of MRs have

been going down steadily - MRs are unable to connect with

doctors. This continuous reinforcement of poor social expe-

rience because of the lack of basic training is one of the main

reasons for general lack of receptivity by doctors.

The Indian education system follows a 10 years of schooling

followed by 2 years of pre-university education. In the earli-

er days till the 80s most MRs studied science together with

future doctors and engineers in the 2 years of pre-university

education. Thus a natural bonding occurred. It was not unu-

sual for an MR to meet his pre-university classmate, who

became a doctor. This initial comfort level in interacting

with doctors went a long way in creating confidence and rap-

port. All this changed rapidly with the rise of IT and BPO

sectors especially in the urban areas. Students who did not

get into medical or engineering colleges had many other op-

tions other than pharma field sales. And for students who

study B.Pharm, field sales is the last and often temporary

career option. The steady decline of quality of people enter-

ing pharma field sales is one of the main reasons in addition

to other reasons that make Doctor – MR interaction uninter-

esting.

While most doctors still maintain a high degree of decorum

in their attire and sophisticated demeanor in their approach –

the same cannot be said of the majority of MRs. Their attire

is sloppy, their demeanor unprofessional and their approach

diffident. This creates a natural barrier for receptivity. MRs

who are high on social skills and good in their technical

skills still receive very good reception from doctors.

MRs must offer tangible value to increase the doctor‟s recep-

tivity. Either their products have to be unique or their social

skills endearing and their technical skills valuable. When all

three are present, the receptivity is high; when they are poor,

the receptivity also decreases.

What Benefits do Doctors Derive from Meeting Medical Reps?

MedicinMan August 2012

Is there a particular time of day or week when doctors

are more receptive to meeting with MRs?

This would entirely vary from doctor to doctor. Some

generalizations can be made. For example most General

Practitioners (GPs) would have the same schedule

throughout the week and hence everyday would be more

or less the same, unless he practices in different localities.

With specialists, it will depend on their schedules. The

MR has to find out the various affiliations that a special-

ist has in hospitals and academia to discover the best time

and place to meet him.

What are the most common topics of discussion be-

tween doctors and MRs?

This depends again on the company and its offerings.

When it comes to oncology product companies like

Bayer, the oncologist would certainly be eager to know

more about Nexavar and will ask questions about the

most appropriate ways to use the product safely and ef-

fectively; how other oncologists are using it and what is

their experience. But the same cannot be said for an MR

who is promoting the 160th brand of Amlodipine or some

other irrational combination of vitamins, minerals and

trace elements - all rolled into one – only the brand name

matters and the benefits that the doctor will derive by

prescribing the product.

For physicians who aren't experienced in meeting

with MRs, what's the most valuable advice you feel

you can give them about making these meetings as

productive as possible?

Physicians entering the profession should make the most

of the opportunity of meeting MRs - they will benefit the

most. Provided the MRs are well trained, which other

source will offer so much information in such short peri-

od of time in the convenience of one‟s own clinic? Be-

sides let‟s remember that well trained MRs with B.Pharm

are an excellent source of information about drugs. Over

time, Doctors will learn to distinguish between the good

and the not-so-good and can make an informed decision

about meeting MRs.

Even experienced and busy practitioners can benefit im-

mensely by meeting MRs who are well trained. By ask-

ing for information that they need, they can create a tailor

-made information source that is easy and simple to ac-

cess. Most well trained MRs will be only too happy to

serve the information needs of doctors. The new genera-

tions of graduates passing out of college are digital na-

tives and can be a great source of knowledge for the doc-

tor to learn about technology, social media and newer

trends in technology. The talents of MRs, the tools that

they use and the training that they receive go a long way

in making the Doctor – MR relationship beneficial to

both.

MRs are an integral part of the cycle beginning with drug

research and leading to marketing; usage by patients and

feedback on the results – both efficacy and ADRs. This

loop needs to be maintained, as the feedback from doc-

tors to MRs is as important as the information provided

to doctors by MRs for the progress of modern medicine.

Both doctors and MRs need to find new ways and new

tools that will make this relationship mutually rewarding.

Indian Pharma business leaders need to apply their minds

to address this issue by engaging doctors at all levels to

know their expectations and reinvent their discourse with

doctors through MRs. In the future MRs will be more of

Information Editors and Technology Partners who under-

stand the business and economics of modern medicine

and help medical practitioners to increase their efficiency

and effectiveness in delivering total patient care and satis-

faction.▌

MedicinMan August 2012

MedicinMan Editorial Team

Post FFE 2012 Post FFE 2012 Post FFE 2012 MedicinMan MedicinMan MedicinMan Klout at an All Time High!Klout at an All Time High!Klout at an All Time High!

Post FFE, MedicinMan’s

social media influence as

measured by the social

media analytics website

Klout has hit an all-time

high of 71. MedicinMan

wishes to thank all its read-

ers, followers and well-

wishers for following and

sharing MedicinMan con-

tent.

In this section on pharmacology, we would like to let

you know about the important terminologies related to

pharmacokinetics. Pharmacokinetics is a commonly

used term while comparing two drugs. It refers to what

the body does to a drug. Four pharmacokinetic proper-

ties (absorption, distribution, metabolism and elimina-

tion) determine the speed of onset of drug action, the

intensity of drug‟s effect and duration of drug action

(Figure 1) once the drug is administered to the patient.

Absorption is the transfer of a drug from its site of ad-

ministration to the blood stream. The rate and efficiency

of absorption depend on the route of administration of

the drug (enteral or parenteral). For drugs given by the

intravenous route, absorption is complete, i.e. the total

dose of the drug given reaches the blood circulation.

Drug absorption by other routes like the oral route is not

complete. This may be due to the presence of food or

drugs in the gastrointestinal tract. Drug absorption is

also determined by various factors like the ionic state of

drug; the uncharged drug is better absorbed than the

charged state.

The second step is the distribution of the drug which

refers to movement of drug into the interstitial tissue and

intracellular fluids in the human body. The distribution

of drug depends on blood flow to different organs (e.g.

brain, liver and kidney have greater blood flow as com-

pared to skeletal muscles leading to quicker distribution

to these organs), extent of plasma protein binding, lipid

solubility of the drug etc. Plasma protein binding, anoth-

er commonly used term of pharmacokinetics refers to

the binding of drugs to the plasma proteins (usually al-

bumin). Bound drugs are pharmacologically inactive.

Metabolism or biotransformation refers to chemical

alteration of drug in the body. The liver is the major site

for drug metabolism. The reactions are often called as

Phase I and Phase II reactions. Cytochrome P-450

(CYP450) enzymes located in the liver are responsible

for Phase I reactions. Some of the drugs (e.g. rifampicin)

can induce the synthesis of some particular enzymes

(CYP2C9), thus the co-administration of drugs with ri-

fampicin can lead to excessive metabolism of the second

drug thereby decreasing their plasma concentration. Con-

versely, some drugs (e.g. ketoconazole) inhibit an enzyme

and thus increase the plasma concentration of co-

administered drugs leading to their toxicity. So, both the

enzyme inducers and inhibitors can lead to clinically signif-

icant drug-drug interactions.

The final step is the elimination of the drug and its metabo-

lites from the body in urine, bile or feces. Renal excretion is

the most common mechanism of drug elimination. This ex-

plains the rationale of dose adjustment requirement in pa-

tients with impaired renal function. The drugs having an

alternative route of elimination (fecal route) are safer in

patients with severe renal impairment.

In the next issue, we would be discussing the terminologies

related to clinical applications of phar-

macokinetics.▌

Schematic representation explaining Phar-macokinetics

MedicinMan August 2012 MedicinMan August 2012

The Basics of

Pharmacology

Pharmacokinetics

12

Dr. Amit Dang

Director at Geronimo Healthcare Solutions Private Limited

True to the Health 2.0 global culture, the first meet-up of

Health 2.0 Mumbai chapter captured in its essence newer

health ideas, technology, medias and health innovations. The

gathering had a variety of people from diverse backgrounds

of technology, pharma, hospitals, digital agencies, start-ups

etc. But they gathered here with one objective – to connect

the varied dots of healthcare and create a complete picture.

The setting was completely informal and unconventional.

As it rained outside, the MIG club in Mumbai rained with

health ideas. Dinesh Chindarkar, Health 2.0 Mumbai Chap-

ter leader, presented the concept and introduced Health 2.0

philosophy to the audience. This was followed by a video

from the co-founder of Health 2.0 – also an Indian – Indu

Subaiya – who specially crafted a message for the Mum-

baikars from Los Angeles.

This was followed by a presentation by Dr. Shalini Ratan,

who shared her observation about how technology is affect-

ing Doctor & Patient behaviours & changing outcomes. She

also shared a project of telemedicine for rural markets that

she was involved with.

The pharma industry was represented by quite a few people.

Mumbai Monsoon Magic – Healthcare meets Technology

at Health 2.0 Mumbai Chapter Meet–Up!

Dr. Amit Bhargava, VP (Medical) - Alkem, presented his

thoughts about what pharma expects from technology and

how the two can be united. He also mentioned about the Big

Data specific to India that can be generated with pharma

partnership for medicines and patients.

Pankaj Dikholkar Chief Manager, Strategic Marketing Ser-

vices – Abbott, gave parallel examples from other industry

of the effectiveness of newer medias. He also emphasised on

the opportunity that existed since increasing number of con-

sumers & patients in India are searching online for health

solutions.

Aditya Patkar emphasised on how websites & electronic

medical records are emerging trends amongst Doctors and

slowly becoming mandatory. Dr. Neelesh Bhandari shed

light on how social media is changing the way Doctors are

connecting with patients and also how it is benefitting them

to access information. This is where a dire need for Social

Media training is needed for physicians.

Ashwin Bonde Sr. Manager, MCM – MSD, shared his

thoughts on leveraging newer channels for marketing in

pharma and how going the unconventional way is the need

of the hour.

Shreekant Pawar, co-founder of Farasbee – a start-up and

sponsor of the event, demonstrated his product – Diabeto

that helps connect Glucometers to smartphones in a unique

way. He enthralled the audience with the friendliness of the

device for physically & visually handicapped people too and

urged pharma to create products that were patient – centric

and offered value.

Dinesh Chindarkar thanked the audience and promised to

have more diverse speakers and more frequent meet-ups to

cultivate brighter, innovative patient – centric health ideas &

technology solutions. This was followed by discussions &

networking over coffee.▌

Dinesh Chindarkar, Health 2.0 Mumbai

Chapter Leader Addresses the Audience

Dr. Shalini Ratan, member - MedicinMan Edit Team, interacts with participants. Chhaya Sankath, CEO of MedicinMan is seen chatting

with Dr. Neelesh Bhandari in the background.

While companies are experiencing high levels of

attrition and lack of employee productivity,

MedicinMan Poll clearly shows job satisfaction

factors that can lead to reversal of the current

lose – lose situation. Link to MedicinMan Poll

results and comments - http://linkd.in/MDfst

Organizations can conduct their own surveys

regularly to discover unique job satisfiers that

bring about Employee Engagement instead of

waiting to conduct „exit interview‟ which does

not benefit anybody.

MedicinMan Poll insights also show the

importance of need for Front-line Managers to

gain insights into people motivation and

engagement factors to function as people

leaders and business managers as written in the

book – “SuperVision for the SuperWiser Front-line

Manager.”

In the above poll conducted by MedicinMan,

441 respondents were asked to choose one of

the 5 options as most important job satisfiers,

salary being equal. The majority of the respond-

ents were from the 18 – 29 age group, followed

by the 30 – 36 and 45+ age groups.

Q

SatisfactionJob

>>> A MedicinMan Poll to Ascertain Employee Perspectives | MedicinMan August 2012

Salary Being Equal,

What Will You Choose

as Important to Job

Satisfaction?

Salary Being Equal, What Will You Choose as Important to Job Satisfaction?

>>> A MedicinMan Poll to Ascertain Employee Perspectives | MedicinMan August 2012

Learning and Development emerged as the No.1 job satisfier, especially among the 18 – 29 age

group respondents. This is an important feedback for employers – Young people are aware of the

importance and need to acquire skills at the workplace to further their career aspirations.

How many Pharma Companies are offering Learning and Development as one of their main of-

fering to attract, develop and retain talent?

>>> A MedicinMan Poll to Ascertain Employee Perspectives | MedicinMan August 2012

1. Learning and Development Opportunities

Work – Life Balance emerged as the second most important job satisfier reflecting the need for a

more balanced work-life. This was a common factor across age groups and is one of the main

reasons for attrition as employees leave to get a temporary respite from work-life imbalance in

the new job. This feedback is important for line managers and HR managers that people want not

only to work, but have a balanced life as well. The need is a bit more pronounced in 30 – 36 age

group, as this is the stage in life when they have to cope with important personal life issues such as

marriage and arrival of children. The 45+ age group also expressed this as an important job satisfi-

er. Companies that take note of these employee aspirations will be able to move ahead in the

area on people management.

1. Work-Life Balance

>>> A MedicinMan Poll to Ascertain Employee Perspectives | MedicinMan August 2012

>>> A MedicinMan Poll to Ascertain Employee Perspectives | MedicinMan August 2012

>>> A MedicinMan Poll to Ascertain Employee Perspectives | MedicinMan August 2012

>>> A MedicinMan Poll to Ascertain Employee Perspectives | MedicinMan August 2012

This was followed by Inspiring Work Environment – mostly by the 37 – 44 and 45 + age group, who have by

now moved to comfortable office jobs or have lesser field work as part of their work. It is significant that the

18 – 29 and 30 -36 age groups did not consider Inspiring Work Environment high on their list of job satisfiers.

Probably they are aware and have accepted the rigors of field working as essential part of their work.

3. Inspiring Work Environment

>>> A MedicinMan Poll to Ascertain Employee Perspectives | MedicinMan August 2012

>>> A MedicinMan Poll to Ascertain Employee Perspectives | MedicinMan August 2012

For the 18 – 29 age group, Good Immediate Manager and seniors were important and this is a significant

pointer that has emerged in all polls and discussions – the need to develop Front-line Managers as good

people managers. When an individual performer gets promoted on the basis of his sales record, his focus will

be on his areas of strength and not the areas needed to be an effective Front-line Manager. The sales pres-

sures also make it difficult for Front-line Manager to be „GOOD‟ to people and it multiplies the work pressure

leading to high attrition.

4. Good Immediate Manager & Seniors

Surprisingly growth and promotions came last on the list. Again this was the top need of the 30 – 36 age

group, signifying the social importance of growth in career prospects. The 18 -29 age was next in line with

growth as a job satisfier decreasing significantly among the 37 – 44 and 45+ age groups

5. Growth and Promotions

People management is not some esoteric art. Companies that take note of employee aspirations will be able to

attract, motivate and retain people but also deliver higher productivity as Engaged Employees are 50% – 80%

more productive and the key to Employee Engagement is Job Satisfaction.

The Half-Time Coach

A Psychometric Assessment-based Feedback and

Feed-forward Program for FLMs and SLMs

What do you expect

your FLMs and SLMs

to be good at?

1. Management Games

Relearning by Reflection,

Feedback by Observation

2. Case Studies

3. Movie Clippings

What are you doing to ensure that

they gain proficiency in the desired

skills?

Contact: anupsoans@medicinman.net

Ph. +91 93422 32949

The Half-Time Coach is delivered by Anup Soans, Editor MedicinMan &

Author of SuperVision for the SuperWiser Front-line Manager, HardKnocks for the

GreenHorn and RepeatRx