October 2012

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

TM

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 10

MedicinMan

Editorial

www.medicinman.net

A year into operations and things are moving at rapid

pace for us at MedicinMan. After pulling off Brand

Drift 2012 and FFE 2012, we are now readying for

Brand Drift 2013 and FFE 2013 in February 2013.

The 1st Breakfast for the Brain was a grand success

and there‟s a report on Page 10 by Amlesh Ranjan,

who moderated the proceedings and coined the

acronym, B4B.

The 2nd B4B will be held on Friday, 5th October at the

Courtyard Marriott, Andheri East, Mumbai from 0815

AM to 1000 AM.

The outcome of the 1st B4B - we now have Medicin-

Man Academy to conduct skill certification programs

for pharma professionals from entry to senior levels in

sales, marketing, L & D, SFE, KAM etc;

Our First Skill Certification Program for Pharma Sales

Trainers will be in December 2012

Dr. S. Srinivasan who was Sr. VP at Aventis will kick

start our skill certification process as Dean, Medical

Education of MedicinMan Academy. This issue has

three articles by Dr. Srinivasan. We believe that every

pharma field sales person must be knowledgeable

about common medical conditions and we begin this

issue with “Understanding CHF”. Let us know your

thoughts on this.

This issue is power packed with articles from veterans

like Anthony Lobo, who has worked for 37 years as a

Medical Rep and has demonstrated that one can work

MEDICINMAN–THE ACTION BEGINS

- Anup Soans, Editor

in a highly professional manner even in challenging

situations. Anthony Lobo has written on the lost art of

listening – an increasingly important skill in a noisy

world.

Prof. Vivek Hattangadi continues the second part of his

Objection Handling – an excellent and comprehensive

treatment of an important skills area for MRs and

FLMs as well as training managers.

Dr. Surinder Kumar has written on Decision Making –

an important skill for aspiring and practicing managers.

“10 Steps to Success” by V. Srinivas is a reminder for

Medical Reps on the essentials of pharma field sales.

Dr. Amit Dang continues his series on Pharmacology,

making this issue of MedicinMan a wholesome learn-

ing exercise to produce knowledgeable and confident

field sales people.

Finally, my third book, Repeat Rx is now available as

an eBook on Amazon.com, for reading on the Kindle,

iPad as well as the PC and Mac.▌

4. The Ten Commandments of

Listening.

A refresher on what it takes to be a

good listener with practical tips.

Anthony Lobo

7. Handling Objections with

Confidence. (Part 2)

Four more techniques for Medical

Reps to handle objections from

Doctors with ease

Prof. Vivek Hattangadi

10. Breakfast for the Brain

A report on the 1st Breakfast for the

Brain hosted by MedicinMan at

Courtyard Marriott, Mumbai.

Amlesh Ranjan

12. Feedback - An Important Tool for

Coaching

How to constructively incorporate

feedback into the coaching process

K. Hariram

15. Birth Pangs of Medico-marketing

A personal story on the initial days

of medico-marketing and learnings

from the field.

Dr. S. Srinivasan

16. Ten Steps to Reach the Summit

Simple pointers for success in phar-

ma field sales

V. Srinivasan

Contents

CLICK TO NAVIGATE. 17. High-flying Herbals

Keeping a tab on the growing herbal

and natural remedies market

Dr. S. Srinivasan

18. SPECIAL FEATURE: Decision Making

and Common Biases

A look at common cognitive biases that

plague pharma decision-makers and

make good intentions go terribly awry

Dr. Surinder Kumar

22. Pharmacology Essentials - Pharmaco-

kinetics Parameters

Concepts of volume of distribution,

clearance, absorption, half-life, oral

bioavailability explained

Dr. Amit Dang

23. Boehringer Launches “Syrum”

A look at the Facebook game launched

by Boehringer Ingelheim

John Gwillim

24. Infiltration - A Chronic Infection in

Pharma Field Sales

Products meant for sale in one territory

end up in another causing much frus-

tration to the field force

Hot on Linkedin

25. Understanding Congestive Heart

Failure

A Field Force Knowledge Series

Dr. S. Srinivasan

Editor and Publisher: Anup Soans Chief Mentor: K. Hariram Advisory Board: Vivek Hattangadi, Jolly Mathews

Editorial Board: Salil Kallianpur, Dr. Shalini Ratan, Shashin Bodawala, Prabhakar Shetty, Varadarajan S,

Dr. Mandar Kubal, Dr. Surinder Kumar MedicinMan Academy: Dr. S. Srinivasan, Dean, Medical Education

Now Available as an Ebook on

Calling → Connecting → Consulting → Collaborating

Repeat Rx

REPEAT Rx is the first-of-its-kind skill certification and competency

building program for creating trust and building relationships with Doctors

leading to lasting relationships and generating Repeat Rx.

REPEAT Rx is conceptualized and developed by Anup Soans who is the

Editor of MedicinMan and author of the widely read “HardKnocks for the

GreenHorn” and “SuperVision for the SuperWiser Front-line Manager.”

Visit: http://amzn.com/B009G3SJ1Y

eith Davis, the author of Organizational Behavior: Human

Behavior at Work has dealt with Listening, and lists The Ten

Commandments of Listening as:

#1. Stop Talking.

#2. Put The Talker At

Ease.

#3. Show Him That You

Want To Listen.

#4. Remove Distractions.

#5. Empathize With Him.

#6. Be Patient.

#7. Hold Your Temper.

#8. Go Easy On Argu-

ments And Criticism.

#9. Ask Questions.

#10. Stop Talking!

The Ten

Commandments

of Listening.

Surely all of us believe that having heard so much for so

long, we must all be good listeners. Are hearing and

listening the same? We have described listening as Ac-

tive, and Passive. Pundits today harp on Aggressive

Listening!

# Listening is with the mind;

hearing with the senses.

# Listening Is Conscious; an

Active Process Of Eliciting

Information, Ideas, Atti-

tudes and Emotions

# Listening is Interpersonal,

Oral Exchange

A common fallacy is that since the objective is handed

down by a higher up it should be accepted without ques-

tion. “Believe in my wisdom” is a cliché commonly used

by managers to ram down unanimity. Coercion dis-

suades active participation, and leaves the team uncon-

vinced that they are on the right track. Team mates

would want to follow a leader not be herded by a

commander. Yes, this manager might curry favor with

the superior, but apart from not really carrying the team

along, better ideas might stay buried with those who

have them. An apt note for such managers: “it is better

to shut your mouth and let others think you are a

fool, that to open your mouth and confirm it”.

MedicinMan October 2012 >>> Listening Skills | Page 4 ← Home MedicinMan Ocotber 2012 >>> Listening Skills

Anthony Lobo

Common fallacies about listening are numerous, but as most

field sales people are compelled to sit through weekly meet-

ings because the higher ups lack a clear idea of how to pro-

ceed, it would be fair to stick to the bugs in these meetings,

as that is where most of the listening should happen.

# Listening is not my problem!

# Listening and hearing are

the same

# Good readers are good lis-

teners

# Hearing what we expect to

hear, than what is actually

said.

# Thinking about how to rebut

the speaker, rather than ac-

cept his view.

# Not paying attention, or

talking when we should be

listening.

# Listening skills are difficult

to learn.

A Few Barriers to Aggressive Listening:

# No motivation.

# Negative listening attitude.

# Selective listening.

# Poor interpersonal relations

To students of law, Latin legal maxims are like bullet points

of a power point presentation. „Audi alteram partem „ is a

Latin Phrase that literally means „Hear the other side before

you speak‟.

Lawyers are on opposite sides; in a sales team every member is

on the same side. To generate momentum and create maximum

impact, every team member must be convinced that the approach

to achieving the objective is right. A team leader is part of a team,

and should not appear to function apart from the team. Based on

past experience members may vary approaches, still achieve

success, or even surpass expectations. How to be an Aggressive

Listener:

# You must want to listen

# Admit biases, and accept re-

sponsibility for understanding.

# Encourage verbal participation,

restrain the urge to judge .

# Make notes, involve physically,

avoid negative mannerisms.

# Recognize the focus of the

speaker, the main idea and de-

tails of the oral message.

Epictetus, a Greek philosopher (AD 55) is credited with some

unforgettable pointers about listening, among which, I‟d like to

share two with you

i) First learn the meaning of what you say, and then speak.

ii) Nature has given to man two ears and one mouth, so that you

may hear twice as much as you speak.

We hear so much, but have we learnt to listen? Listening twice as

much as we speak might help us achieve twice as much. ▌

MedicinMan Ocotber 2012 >>> Listening Skills | Page 5 ← Home

Anthony Lobo started life as a

Medical Representative in Warner

Hindustan Limited in 1974, moved

into Parke Davis India Limited in

1985 consequent to a merger of the

two companies, and Pfizer in 2002

after another merger, retiring in 2011.

He has seen mergers and acquisi-

tions, their unpleasant side of internal

change, secondary sale to primary

dumping, and the transition from a

demand generating to an over the

counter pharmaceutical field force.

MedicinMan Academy

To register, email: anupsoans@gmail.com

17th, 18th & 19th December, 2012 at Mumbai

Fee: ` 22,500/- per participant.

Early bird fee: ` 19,500/- (for registrations before 30th October 2012)

e saw in the September 2012 Issue of MedicinMan

that there is no such term as „objection handling‟.

On the other hand, the actual term is „encashing the

opportunities‟. Establishing a business relationship

with a doctor is a lot like walking on a balance

beam and, if you are able to handle the opportuni-

ties he gives you, you will be able to have a sus-

tained relationship.

Now let us look at why objections are raised in the

first place.

» You have neglected to present all of the prod-

uct benefits.

» Benefits may have been presented, but not the

right benefits. In other words, you may have

failed to probe for real needs.

» Rapport hasn't been established with the doc-

tor.

» The product has not been targeted to the right

doctor. Just imagine Colimex Drops being pro-

moted to a cardiologist?

» Communication and body language are poor

that you don’t sound confident or knowledge-

able.

» Extraneous reasons for which neither you, nor

the brand nor the company are responsible.

Handling objections

with confidence. (Part 2)

Whenever an objection is raised, it should be addressed im-

mediately; or else it may be a lost opportunity; a lost pre-

scription! Procrastinating may result in:

» The doctor not listening further to our detailing.

» The doctor may feel that we are hiding something.

» The doctor may feel that even you perceive it as a

problem – that would be very dangerous.

» The doctor may think that you are not able to answer

because you do not know the answer, which is a poor

reflection on you. If you do not have an immediate

answer, assure him that you will find out and inform.

The worst scenario, it may appear that you are not interested

in the doctor‟s opinion and you may lose him forever.

While handling objections:

A. Be positive!

» Use positive body language and smile.

» Do not take objections personally.

B. Listen - be an aggressive listener.

» Ask questions, nod your head at appropriate times.

» Show him that you are genuinely interested in what he

says.

Here are few more methods in addition to what we learnt in

the September 2012 Issue.

Prof. Vivek Hattangadi

MedicinMan October 2012 >>> Objection Handling | Page 7 ← Home

1. Deflection Method You can handle an objection by deflecting it, i.e. by

changing the direction. First listen to what the doc-

tor says. Understand his concerns, which should

also reflect in your body language. Then continue as

if nothing had happened. You can tell him that you

will come back to his point later. It is possible you

won‟t have to. Give an excuse, such as not having

information or having to talk to somebody else lat-

er.

In the examples which follow, many are from my

days when I was a medical representative with

Carter-Wallace. We had just introduced possibly

the most interesting and effective product in those

days for infantile colic, Colimex Drops. It contained

dicyclomine (an antispasmodic) and dime-

thylpolysiloxane (an antiflatulent).

Doctors loved its efficacy, but the kids hated its

taste – very bitter. Nevertheless, it was my favorite

brand and always wanted it to be brand leader in my

territory.

Once I was meeting a very influential doctor from

Kalol, an ex-town of Ahmedabad, Dr. S.M. Rao.

He was a GP with dominant pediatric practice. I

was introducing Colimex drops to him. He liked the

concept. He opened the sample bottle and put a

drop on his tongue. “Aagh! It‟s very bitter!” he ex-

claimed “I shall never prescribe Colimex Drops till

you change its taste.”

I knew that dicyclomine had an inherent bitter taste

and there was no way to mask it. I was wondering

what to do. I too put a drop on my tongue mirrored him

and made a face. “Yes, it‟s bitter. I shall definitely con-

vey this to our R&D” I said and then deflecting the

objection I asked him “But what do you feel about the

concept behind Colimex Drops, like when at midnight

a mother brings her child to you with burping, ab-

dominal gaseous distension with severe colicky pain?”

Dr. Rao looked at me and said “Yes, and this is a very

common problem here. Mothers do not know the right

techniques of breast feeding”. And then he went on for

half an hour explaining that condition to me and how

Colimex could be useful. In fact he was detailing Co-

limex Drops to me. Finally he said “Tell your company

to prepare a patient-education poster on the right way

to breast feed a child. And make sure that Colimex

Drops are available with all the retailers here. I do not

want a single prescription to come back”.

I deflected the objection, yet acknowledged and accept-

ed his objection. He went on to become my Colimex

brand ambassador in Kalol.

2. Empathy Method In this method, first empathize with the doctor and tell

him that you understand how he feels. Then tell them

about another doctor who also felt the same way. Then

tell them how the other doctor found that things were

not so bad when he actually used it.

I was meeting a well known pediatrician from Ahmed-

abad Dr. Arvind Kothari who was reluctant to prescribe

Colimex drops because of its bitter taste. I said “I do

understand how you feel about the taste of Colimex

Drops, and how the infants would respond to its taste.

Even Dr. M.V. Dudhia (who was his teacher and HOD,

Pediatrics, V.S. Hospital, Ahmedabad) felt the same

way. But when he prescribes Colimex Drops, he tells

the mother to keep the dropper at the back of the mouth

and then administer Colimex Drops. Well, he told me

that he receives so many phone calls from mothers

thanking him for the relief he has given to the infant!”

“Okay” said Dr. Kothari “is this what he does? Well,

let me also try this technique too” and he went on to

become a prolific prescriber of Colimex Drops.

By empathizing with the doctor, you are in harmony

and creating rapport for building long term relations.

MedicinMan Ocotber 2012 | Page 8 Handling objections with confidence. (Part 2)

3. Curiosity When a doctor says that he does not want to pre-

scribe your product, you can become curious. Do not

just ask 'Why?‟ but express curiosity and interest.

Diovol Suspension, an antacid, was our ace product.

RCPA revealed that Dr. Vinod Rawal was a heavy

prescriber of Digene (from Boots), the most im-

portant competitor for Diovol Suspension. I met him

regularly for about a year but not a single prescrip-

tion for Diovol. Finally one day I asked him “Doctor,

just of out curiosity, could you please tell me why

you have not prescribed Diovol? Tell me the reason

doctor and I shall be very happy.”

Dr. Rawal smiled. “I believe you know Hoshang

Kanga, the medical representative of Boots? We

studied together for 11 years in school. Forget about

Diovol Suspension as long as Hoshang is with

Boots”.

“Thank you for mentioning the name Diovol Suspen-

sion, doctor. At least now I know the reason”, I said

with a smile. “I always thought my presentation was

poor or maybe you do not like me. I am relieved” He

too smiled, but the last sentence “…as long as he is

in Boots” kept on reverberating in my ears.

I kept on persisting and one day during RCPA, I

found a flow of prescriptions of Diovol Suspension

from Dr. Rawal. I was pleasantly surprised. I asked

the retailer what happened. He too smiled and told

me that Hoshang has migrated to Canada. Persis-

tence pays and if you know the reason why a doctor

does not prescribe your products, it will help you.

But very important, in such cases, when trying to

find the reason, complement your actual words with

strong body language and make sure you take care of your

tone. You should appear non-threatening and not in 'closing

mode'. The doctor may well relent and give you the infor-

mation you need.

4. Humor When a doctor objects do not respond with negative emo-

tions such as anger or frustration. Defuse the tension with

gentle humor, maybe feigning shock or poking fun at your-

self, BUT NEVER AT THE DOCTOR. Be careful not to

make the doctor the object of humor.

Another true episode, this time with Dr. Chinubhai Shah

who never prescribed Colimex Drops. One day I told him

“Well I think Colimex Drops will start crying if you don‟t

prescribe”. I took out a bottle of sample, showed the bottle

and said “Dr. Chinubhai, Colimex Drops are already shed-

ding drops of tears – see this”

Dr. Chinubhai burst out laughing and not

only started prescribing Colimex Drops but also took up an-

other product, Walamycin, outright

Receiving an objection can be very frustrating. It is very

easy for emotions to leak out. By adding humor, you can

show that you are not offended by their refusal. BUT I RE-

PEAT, NO HUMOR ON THE DOCTOR!

Well my message to all young friends, improve your com-

munication skills and speak with confidence. Your technical

knowledge i.e. product knowledge will certainly go a long

way in getting the confidence you need. ▌

Caricatures © Vivek Hattangadi

Prof. Vivek Hattangadi is a

Consultant in Pharma Brand

Management and Sales Training

at The Enablers. He is also visit-

ing faculty at CIPM Calcutta

(Vidyasagar University) for their

MBA course in Pharmaceutical

Management.

vivekhattangadi@theenablers.org

http://in.linkedin.com/in/profvivekhattangadi

(This is the image of Colimex Drops

sample pack then)

MedicinMan October 2012 | Page 9 Handling objections with confidence. (Part 2)

he First Breakfast for the Brain, let us call it B4B, started

with some background information and purpose sharing to set

the context and the tone for a quality interaction and ex-

change.

Pharma in India, a crowded industry, with an increasing diffi-

culty for meaningful differentiation, depends even more on its

Field Force to make an impact on the key customers.

Why call them Field Force? Why Pharma? Sandip, COO,

Max mobile took off with these highly provocative questions.

Varadrajan, Merck Serono talked about learning from other

industries and creating benchmarks for training and certifica-

tion. Vidyut, USV emphasized on Grooming, Self Esteem

and also need to simplify the message. Madhu, Zydus batted

for overall Capability. Dr. Srinivasan advocated the im-

portance of making Medical knowledge and communication,

relevant. Nandkumar Shetty, ex-Zydus pushed for soft skill

and full training. Smita mentioned training as a function of

strategic importance. Dr. Nitin Malekar opined that a Medi-

cal Representative who is trained well is received and treated

well by the Doctors. Milind, Abbott spoke about the need for

field based training combined with class room training.

Sagar, PwC mentioned the difficulties of the frontline roles

and suggested to use certification as an effective filter and

also a business model which addresses the value chain in its

entirety. Ms. Balraj od Kingpins Management Consultancy

put forth self-esteem, as a critical factor for field force. Ra-

manathan, Ranbaxy urged all to make training practical.

Increasingly Lesser time from the Doctors, makes the job

even more difficult. Overall there is a low value perception

by the Doctors for the Medical Representative‟s visit. Can we

help evolve the quality of Reps through a certification based

training which measures up to set benchmark? Can we have

the due balance between Knowledge and Skill on one hand

and classroom and field based learning on the other?

Number pressure often dilutes the drive for quality. Trade

management training is not imparted and the same can be

very useful. The gap between the ground reality and the train-

ing needs to be bridged.

“Breakfast for the Brain” hosted by MedicinMan...

First Line Managers have a critical role and their equation

with the field force often determines the gap between success

and failure. Newer roles like KAM and Specialty Reps are the

possible answers to the emerging opportunities. We also need

to look at sales models focused on relationships, partnerships

and value based selling.

Keeping in mind the above, we will put a task force in place

to work towards certification for the Pharma field force in

India. Chhaya Sankath will head the task force and we will

have the key professionals from the industry who will like to

volunteer for this important project for the industry.

Pharma‟s destiny is determined in the Doctor‟s chamber and

it is the Field force, whose Will, Knowledge and Skill drives

the success. Thus Field Force Excellence is one of the most

strategic lever requiring all-round support and attention.

Someone has rightly said:

“In a commercial organization, You should either be sell-

ing or, supporting someone, who is.” ▌

Amlesh Ranjan

MedicinMan October 2012 >>> Report | Page 10 ← Home

Topic: Skill Certification for Pharma Field Force

Friday, 7th September, 2012 - Courtyard Marriott, Mumbai.

Amlesh Ranjan is Associate Director

at Sanofi.

THEME

Attracting Entry-level Talent from Pharma and Science Colleges into

Pharmaceutical Sales and Marketing

Venue

Courtyard Marriott Int‟l Airport (Opposite Sangam BIG Cinemas, Andheri Kurla Road, Andheri East)

Time

0815 - 1000 on Friday

5th October 2012

Contact

Arvind @ 9870201422 or email arvindnair@medicinman.net

Chhaya @ 9867421131 or email chhaya@medicinman.net

Anup @ 9342232949 or email anupsoans@medicinman.net

our call average is low”, “your total number of doctor

coverage is below expectation‟, “your reports are always

coming late”, “your sales is not up to the mark”, „your

KOLs‟ connect is very poor”.

Does this sound very familiar?

Though these statements appear like comments, they are

all, in fact, FEEDBACK.

What is feedback? In an organizational context, feedback is the information

sent to an individual or a group about its prior behavior so

that they may adjust their current and future behavior to

achieve the desired result.

Feedback comes in three forms:

I. Negative feedback:

It describes a perceived negative behavior, without pro-

posing a resolution. It is used to point out what the sales

person did not do or how much he did less than the ex-

pected behavior, etc. All the examples mentioned as in-

troduction are examples of negative feedback. By merely

pointing out the negative behavior, the manager is not

going to achieve anything, other than de-motivating the

sales person.

Most often we come across this form of feedback, think-

ing that we are being specific by pointing out only what

has not been done or what was wrongly done. We as-

sume that we are not wasting time nor beating around the

bush by doing so. In the process, we miss out the most

important angle…the human element, which looks for

positive strokes and redirection for improved perfor-

mance.

MedicinMan October 2012 >>> Coaching | Page 12 ← Home

feedback—an important

tool for coaching.

K. Hariram

To get the desired result, how to convey negative feed-

back?

Do it without de-motivating or demoralizing the other

person

» "Feedback is best given at the earliest opportunity.

» Give the feedback calmly and with a sense of guid-

ance and correction.

» Even negative feedback should focus on the positive

while still identifying areas for further growth and

better outcomes

“Earlier, you were prompt in mailing your reports. But

since two months, they are coming late, by a week. What

could be the reason? If you are facing any problems, feel

free to share them with me so that I will see if I can help

you to overcome the problems in future.”

Even a person doing an excellent job looks forward to

appreciation. This is handed out through POSITIVE

FEEDBACK

II. Positive feedback

Applies to situations where the sales person did a good

job. It consists of simple praise, but is even more power-

fully reinforcing when the FLM specifically highlights

why or how the sales person did a good job. So to be ef-

fective, describe the positive behavior.

“I thought you did a great job on the sales call. You were

asking the doctor a lot of important, open-ended ques-

tions to understand what he needed, rather than just talk-

ing about price and telling him about our product.”

Another form of feedback, which helps by redirecting

behavior, is CONSTRUCTIVE FEEDBACK.

III. Constructive feedback

Highlights how the sales person could do better next

time. It needs to be conveyed objectively with emphasis

on specific, measurable and observable facts.

Constructive feedback involves Identifying and com-

municating the problem behavior and offering an appro-

priate action plan.

“I‟d like to talk with you a moment; please come into my

office. I have noticed that you have been in the office,

rather than in the field, and this is a problem. Your re-

sponsibility is to spend 90% of your time on the field

calling on doctors and retailers, and you are not doing

that.”

“Why I am pointing out this is because we are in a very

competitive market and your current doctor customers are

being targeted by our competitors. You need to stay close

with them and always be providing value. We have talked

about you making at least ten doctor calls a day to bring

in the revenue growth we are expecting of you. What can

I do to help you?”

Providing feedback is one of the FLM‟s most important

skills. Positive feedback is used to reinforce desired

behavior. Constructive feedback relates to areas in need

of improvement. It is important to provide your sales peo-

ple with both forms of feedback in order to improve and

maintain quality performance. It establishes a connection

between what sales people are doing and how their

actions are perceived by others.

It means conveying or sharing with your sales person

what he did in a specific situation, and also highlight the

impact of the same. This forms the basis for direction and

what is the expected action plan, as a way forward.

Remember:

» Even though you, as a manager, may dislike giving

feedback, your sales people expect it and need it.

» Most complaints are never about the necessity to

improve, but how a manager inappropriately han-

dled the situation.

» When correctly given, feedback helps improve per-

formance while promoting professional and personal

growth in the sales people

MedicinMan October 2012 | Page 13 feedback—an important tool for coaching.

» Providing feedback can improve sales people‟s morale

and reduce confusion regarding expectations and current

performance.

» Feedback should NOT be limited to the times you do

Performance Evaluations. It‟s an ongoing process

between the manager and his team.

How to make feedback effective?

» Come to an agreement about the

issues

» Acknowledge the sales person‟s

feelings

» Focus on „ behaviors/skills and not

the „person‟

» Give the specific picture of desired

skill/behavior

» Suggest practical steps

» Balance negatives and positives:

provide constructive actions

» Verify with questions: ask for the

sales person‟s recap

» Jointly arrive at a plan

» Invite the sales person to asses own

performance first

» Offer support for future

K. Hariram is the former

MD of Galderma.

This is the 3rd article in a series on

“Coaching” by K. Hariram

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he year, 1975. The place: a doctors‟ meeting in Pune. I had

just “re-migrated” to India after a few years of teaching cum

research in CWRU School of Medicine, Cleveland, Ohio. I

had also dared to change horses mid-stream as it were to join

the then-rare breed of pharma medical advisors to occupy a

cabin in the marketing head quarters of a big MNC-cum-

Indian pharma at that time.

As the doctors‟ chat got warmer with a few gulps of the elixir

of life, a prosperous looking GP asked me what I do to make a

living. When I said, medico-marketing, he literally choked on

his drink wondering what language I was speaking. “Where is

your clinic?” was his next question and when I said I had

none, he decided to ignore me for the rest of the evening as

though I am an aborigine from Swaziland.

HO howlers. Back in the head office, when I repeated the term medico-

marketing, I was ridiculed by my medical boss whose visiting

card said, Senior Medical Advisor, Medical Research Divi-

sion. When I protested that my research days were over when I

left Cleveland, he sternly reminded me that the word research

had to be there for tax purposes, and rules are rules.

The marketing head was very happy with me, though I never

reported to him directly. I spent a whole lot of time with prod-

uct managers and field managers, especially the first level,

riding pillion with them and drinking cutting chai by the road-

side and at times even gobbling chicken biryani for 5 bucks a

plate en route to the airport.

New learning. Boy, did I learn a lot about our products that way. And what a

learning it was, well beyond the formidable board covers of

Goodman & Gilman that we were told to swear by. The more I

learnt totally new things about our products through „med

Birth pangs of

“medico-marketing” Dr. S. Srinivasan

reps‟ and inquisitive doctors, the more I felt like announc-

ing to the pharma world of yore that I was not a medical

advisor but a medico-marketing manager, rubbing shoul-

ders with no one but the guy in the field whatever his visit-

ing card said, and enjoying it all to the core and asking for

an encore too.

Mind you, new learning never happened (and it never hap-

pens) unless you force yourselves into new situations and

new difficulties. While many medical advisors were happy

to intellectualize in the air-conditioned comfort of their

cabins, I relished the rough and tumble of the market

place, come rain or shine, hell or high water. For instance,

I would work myself into anti-competitive duels, take a

few punches but give back at least as many, if not more.

After coming home, the licking of the wounds was painful

as well as insightful to say the least.

Many stories to tell. In the 37 years that went past since that Pune meeting of

doctors, I have gathered several stories which I hope to

share with you. I am sure, you have many good stories to

tell too and I am keen to hear them and learn a thing or

two, right here, right now.

Before I say bye for now, let me give you a tip on medico-

marketing career building, or even life in general. Become

a good story teller and everybody will eat out of your

hand. ▌Wanna hear more and tell more? Wait till next

month!

MedicinMan October 2012 >>> Personal Growth Story | Page 15 ← Home

Dr. S. Srinivasan was Sr. VP at Aventis. He assumes

responsibility as Dean, Medical Education of

MedicinMan Academy.

Step 1. Active doctors coverage list, total number of Doctors, and

specialty-wise breakup, should be exactly as per strategy.

Step 2.

Right Doctor for right products chosen after thorough

understanding of the potential of each Doctor, the brands he

is currently prescribing, etc. through proper RCPA.

Step 3. No compromise on efforts, i.e. call norms, frequency of

visits, and exposure norms as per strategy, must be

achieved month after month.

Step 4. No deviations in working, from approved tour programme.

Step 5. Sampling, Camps, Campaigns, Special promotions, etc.

must be strictly executed as per strategy.

Step 6. Communication – i.e. detailing for each product – must be

bang on target 100% as per strategy.

Step 7. Prescriber base (i.e. Number of Doctors prescribing the

products) should be as wide as possible. While it is under-

standable that 20-30% of Doctors may be big volume con-

tributors, rest all should be contributing something worth-

while to the kitty.

Step 8. Personal Order Booking (POB) must be booked every day

to ensure availability of products being promoted at all

counters. Check for near expiry stocks at retail counters, and

ensure they are liquidated quickly.

Step 9.

Review the state of affairs often, like product wise prima-

ry sales, secondary sales, conversion of Doctors, efforts put

in, etc. and then take corrective measures immediately

wherever required. If you are provided with online reporting

system, then lot of analysis/status reports are available to

you at the click of a button, thus make the best use of tech-

nology for betterment.

Step 10. Make earning of big incentive amounts a habit, rather

than making a few hundred rupees extra through expense

statement.

These ten commandments, if implemented in all sincerity,

should definitely take any Pharma Medical Representative

to success. Line Managers, to taste same success, must en-

sure strict implementation of strategy, some of which are

described above, by each and every Medical Rep in the

team.▌

MedicinMan October 2012 >>> Steps to Success | Page 16 ← Home

Ten steps to reach the summit. V. Srinivasan

V. Srinivasan has headed Sales Administra-

tion & HR functions in reputed Pharma

Companies, with over 300 published articles

on Pharma Management in India and

abroad. He can be reached at:

Email: shridhar1956@rediffmail.com

Mob: 8056168585

ost of you must be dealing largely with allopathic

medicines where the rules of the promotional game

are pretty much set for decades, barring a few „zara

hatke‟ strategies in recent times. Whether you are

selling the „original brand‟ or a branded generic or a

generic-generic, your instincts and reflexes stay es-

sentially in the same ballpark.

But times are changing, and changing fast. Of late

many of you must be feeling the heat of the fast-

emerging herbal market which might well be throw-

ing a spanner in the works for some of your products,

especially in the chronic therapy segments like arthri-

tis, asthma, psoriasis and so on. Without getting into

the whys and hows of how this happened, let us

acknowledge that gone are the days when the

„traditional‟ (read allopathic) marketers looked down

upon herbals as uncouth country cousins not worthy

of even half a nod as they are forced to look at the

size of this humongous market.

HighHighHigh---flying herbalsflying herbalsflying herbals

Billion US$, SME Times News Bureau, 6 March, 2010

Good news and bad news

Getting into herbals is an attractive proposition for many marketing

heads, especially those who are crunched by price-controlled, branded

generics where the bottom line gets eroded too fast for comfort. The good

news about herbals is that they are outside of price control and composi-

tional constraints, so you get to play with the top line to ensure a good

bottom line. But the same good news can turn bad if your competitor

plays fast and loose on both counts and tweaks the composition and the

price a bit too often for your comfort.

Clever play of terminology

While we can‟t get into the details here, we should know how to use ter-

minologies to our advantage. Depending on the situational need, a herbal

can become, in promotional slant, a nutraceutical, a phytochemical, a cos-

meceutical, a complementary medicine, a traditional medicine, a wellness

promoter, a natural balancer, and so forth. No matter what term your mar-

keting department chooses to use, you must be adept at communicating it

with conviction and confidence.

Rx route vs others

As of now, most herbals are promoted through the „ethical‟ route of de-

tailing leading up to a prescription that is dispensed by a chemist. This is

largely because it is the only game we know well, thanks to our decades-

long entrenchment in the prescription market. But all this can, and will,

change pretty fast. There are other options like DTC, OTC, OTX etc

which converge as well as diverge depending on your convenience and

confidence level.

In short, wait and watch and adapt as the herbal story is just unfolding. It

could well become a Pandora‟s box for the marketers as well as the con-

sumers of healthcare in the not-too-distant future. ▌

Markets 2010 Projected 2015

Europe 35 70

North America 6.5 25

China 4.0 12

India 1.5 3

Others 13 30

Total 60 140

MedicinMan October 2012 >>> Market Insight | Page 17 ← Home MedicinMan October 2012 >>> Special Feature

Dr. S. Srinivasan

ll of us, from a field representative to a CEO, frequently

make various decisions, business as well as personal.

These decisions are supposed to be rational and objec-

tive decisions made after carefully evaluating all pros

and cons.

Though all of us claim to be objective while making a

decision, scientific research suggests the contrary. In

spite of our best efforts to be objective and rational, our

biases and thinking errors influence our decisions. Con-

sequently, our decisions are frequently the outcome of

our hunches, impulses, emotions, convenience, or lim-

ited experience, rather than a sound judgment.

Everybody, regardless of age, gender, education, or

intelligence, is prone to biases.

Bias, and the subsequent error in judgment, is the most

important reason of wrong, and sometimes catastrophic,

business decisions.

First question that comes to our mind is why we, owner

of an intelligent and rational mind, fall prey to biases?

Our forefathers had lived in a highly unpredictable

world, where they needed to make quick decisions

based on limited knowledge. Imagine a man in savan-

nas, who upon noticing a movement in a nearby bush,

immediately assumed it be to some dangerous animal

and ran for his life. Such quick decisions, though many

times having erred on the cautious side, paid by increas-

ing their chances of survival.

Over a span of generations, our mind has developed

strategies to make quick decisions based upon readily

accessible though incomplete information such as past

personal experience, intuitive judgment, common sense,

educated guess, etc,. These strategies, also called heu-

ristics, shorten our decision making time and save us

from getting bogged down by details, and therefore are

highly energy efficient.

This system, of taking quick decisions in an unpredicta-

ble situation, has provided us with a great evolutionary

advantage and helped survival of our species. Therefore,

heuristics have become an integral part of our cognition

(mental process).

While these strategies (heuristics, experience-based tech-

niques, or mental shortcuts) are of great help in our day-to-

day efficient functioning, they can also lead to thinking

errors, which adversely affect our judgment, and subse-

quently, business decisions.

Behavior research has firmly established that our many

decisions, and some times the very crucial ones, are strong-

ly biased. Daniel Kahneman, a psychologist, received No-

bel Prize in Economics for his work in this area.

Though numerous biases have been identified, I will brief-

ly discuss only some of the most common biases.

Conformation bias. While making decisions, we assume that we have gathered

all relevant information and have based our decision upon

it. However, we tend to seek and collect information that

goes well with our preconceived notions or beliefs, and

ignore or discount the information that is contrary to our

existing beliefs. We even tend to interpret the data in a way

that suits our pre-judgment.

Dr. Surinder Kumar Sharma

Decision making and

common biases.

HighHighHigh---flying herbalsflying herbalsflying herbals

MedicinMan October 2012 >>> Special Feature | Page 18 ← Home

We read books, watch movies, or socialize with people

that support „our way of thinking‟. Unknowingly, we gath-

er more and more evidence to support our assumptions,

beliefs and views.

No wonder, most of us, as we age, tend to become more

rigid, more judgmental, more obstinate; and unfortunately,

more stupid.

To simplify, we tend to give too much weight to the infor-

mation that support our decision, and too little to the evi-

dence which contradicts it.

Examining all the available evidence with objectivity, dig-

ging deeper into contradictory evidence, resisting tempta-

tion to dismiss the uncomfortable information, maintain-

ing intellectual honesty, and keeping a devil‟s advocate in

us will help us to overcome this very common and most

dangerous bias.

Bounded awareness or

extreme focus bias. While making decisions, we frequently tend to overlook

crucial information due to our extreme focus only on one

aspect of the matter, especially when the information is

unexpected.

Our mind is tuned to detect and construct patterns from

the available information, but it constructs or detects pat-

terns only in conformity with its pre-existing knowledge

and experiences. Therefore, we are prone to miss or ignore

an unexpected or a newly developing pattern, which in

reality may be very important for an accurate judgment.

Many times slowly occurring changes do not appear to be

of importance to us, and are not acknowledged until they

become so obvious, and usually too late.

A drug company, too much focused on drug‟s efficacy or

on making profits, may miss the magnitude of

impact resulting from a „seemingly innocuous‟

adverse effect.

Many strategic-disasters, such as fall of Enron,

Challenger‟s crash, Polaroid‟s bankruptcy, have

happened due to failure to recognize small, but

crucial information.

Thorough „threats and weaknesses analysis‟, a

keen eye on changing business environment, and

most importantly, taking an outsider‟s perspec-

tive, help us to avoid this bias.

Status quo or comfort

zone bias. When we make decisions, we have a tendency to prefer

alternatives that perpetuate status quo, or ensure that we

remain within our comfort zones.

A comfort zone is a behavior state in which a person oper-

ates in an anxiety-neutral, emotionally comfortable situa-

tion.

Most of us tend to avoid novel or challenging situations,

and make new decisions under these constrains.

Conventionally, it is wiser to stick to the confines of one‟s

reach, familiar, existing capability; but in the fast changing

world, where new developments in technology are redefin-

ing the norms and boundaries, staying at

the same spot could be fatal.

One of the main reasons of organizations

failing to meet the market challenges is

that the decision makers hesitate to make

decisions that challenge status quo. Per-

haps the reason is if they maintain status

quo, they can always blame the market

forces for their failure; whereas onus of

taking an unconventional decision, if

turns out to be a wrong one, will fall only

on them – organizational culture is to be blamed.

“Our mind is tuned to detect

and construct patterns from

the available information in

conformity with its pre-existing

knowledge and experiences…

Many times slowly occurring

changes do not appear to be

of importance to us, and are

not acknowledged until they

become so obvious, and usual-

ly too late.”

Decision making and common biases. MedicinMan October 2012 | Page 19

When meeting after meeting you are discussing the same

issues, without arriving at a solution, you are perhaps

avoiding tough decisions. Reflect if status quo will help you

in meeting your objectives, or you need to change course.

Ask yourself, „if today you start afresh, will you do this

thing, in the same way? Or, will you do this thing at all?‟

And mostly change is not as traumatic as assumed; many

times it is liberating - we often overestimate the effort need-

ed to change.

Sunk cost or escalation

of commitment bias. We have tendency to continue to support unsuccessful en-

deavors, sometimes with an escalated commitment. Strange-

ly, we not only tend to stick with the obviously gone-wrong

projects, but we continue to further invest in such projects.

By habit, more we invest in something (financially or emo-

tionally), harder it is for us to give up that investment.

This sunk-cost fallacy resulted in continued involvement of

USA in Vietnam in 60s-70s, and more recently in Iraq,

where dollars spent and lives lost justified the continued

involvement.

One of the main reasons of getting sucked up by „sunk cost

bias‟ is - we are strongly conditioned not to waste. There-

fore, we continue investing, because, otherwise, the sunk

cost will have been „wasted‟.

In business scenario, perhaps more important reason is,

managers have a strong urge to prove (or not mature enough

to admit their mistake) that their decision was right, and

commit higher than justified resources to influence the out-

come.

To avoid Sunk Cost bias - take a fresh look at your project/

decisions at every milestone; get periodic evaluation by in-

dependent party; Be alarmed on hearing statements like „

we have already invested so much…‟; and most importantly,

avoid creating a mistake-fearing culture in your organiza-

tion.

Availability bias. We tend to base their judgments on information that is read-

ily available to us. Especially the information that evokes

strong emotional reaction, is vivid, and is encountered re-

cently, tends to be more available to our memory and color

our decisions. The availability bias creeps in due to our un-

conscious process that operates on the notion that "if you

can think of it, it must be important."

Recent behavior or one failure of a person, otherwise with

impeccable record, given more weightage during perfor-

mance evaluation, is one example of availability bias in

business environment.

Many times, we end up tweaking our plans based upon a

sundry remark or some inconsequential information, only

because we came across it just before the review or meeting.

Whenever an anecdote, or a single event, is used to „justify‟

an idea, it is the availability heuristic which is in play.

Basing your decisions on statistical data and logic helps

avoiding this bias.

Anchoring Bias. Mind gives disproportionate amount of importance to the

first information it receives – initial impressions carry undue

weight relative to the information received later.

In other words, first-information learned about a subject

strongly influences our future decision making and infor-

mation analysis.

This bias is due to common human tendency to rely too

heavily on one trait or piece of information while making

decisions.

This bias more frequently come into picture during negotia-

tions. During price negotiations, especially for services

where benchmark is hazy, subsequent discussion is often

based upon the first-price quoted by the service provider.

Similarly, sales expectations and investment plan of the next

year is prepared based on previous year numbers, rather than

on the market potential.

Evaluating everything with a fresh mind and, giving every

information, irrespective of when the information was re-

ceived, equal attention will help avoiding this thinking error.

An independent bench marking, or creating internal stand-

ard for services, will help to cut a better deal.

“Managers have a strong urge

to prove that their decision was

right, and commit higher than

justified resources to influence

the outcome.”

Decision making and common biases. MedicinMan October 2012 | Page 20

Halo effect bias. Halo effect is a bias when one overarching positive trait of a

person drastically improves his rating for his other positive

traits as well. For example attractive people are rated better

than real for their education, intelligence, friendliness and hon-

esty.

This effect works in a very wide range of situations – a hand-

some boy is considered more intelligent and better behaved,

and a good looking criminal gets away with a lighter sentence.

This effect creeps up in our mind due to difficulty of mind to

hold two conflicting ideas, beliefs, values, or emotions, simul-

taneously. Therefore, if a person is extremely good in one posi-

tive trait, he is assumed to be good in other positive traits as

well.

It is commonly acknowledged bias while hiring and fixing

compensations. However, it has even deeper implications -

suggestions of a manager, who is successful in one department,

are given undue weightage while taking decision of a function-

ally different department.

(A reverse-halo effect, called devil‟s effect, is also equally

common, where a person with one undesirable trait is harshly

judged as overall scoundrel. One error by an otherwise great

person demonizes him and all good done by him are totally

forgotten - history is full of fallen heroes.)

Want to overcome this bias – just be a little skeptical.

HIPPO effect. Though technically not a bias, HIPPO effect is a very im-

portant cause of wrong business decisions. HIPPO stands for

the Highest Placed Person in Office (or Highest Placed Per-

son‟s Opinion).

Many good projects get scrapped or irrelevant tasks initiated,

or otherwise nicely progressing project reworked; just because

the HIPPO said so – your wish is my command, my lord.

Though we believe ours‟ to be a rational and humane society,

just look around – how many managers are being

(professionally) killed or maimed, simply because they have

antagonized the HIPPO?

Many times it is due to the Halo effect bias on part of the sub-

ordinates, or due to narcissism of the HIPPO – he does not

know, what he does not know.

HIPPO should spend more time in encouraging others to give

ideas/opinions and listening to them, rather than throwing ide-

as. Final decision shall be best left to the experts in a particu-

lar field.

Bias blind spot. We are smart in picking up other‟s biases, but we fail to realize

our own biases.

We are strongly biased towards our own capabilities and short-

comings. We overrate ourselves for positive attributes, and

underrate ourselves in undesired attributes.

It is very difficult, and almost impossible, to get insight into

our own biases because biases work at the subconscious level.

HB Shaw has aptly said, „It is not only the most difficult thing

to know oneself, but the most inconvenient one, too.‟

Though, being a devil‟s own advocate may help up to some

extent, the best way to uncover your blind spots is to keep a

critic near you. Kabir has said, “Nindak niyare rakhiye angan

kuti chhabay, bin pani saaban bina nirmal kare subhay” A

contextual translation is - Keep a critic very close to you, for

he purifies your mind.

Quick decision-making strategies (Heuristics) serve a very

useful role in our day to day functioning. They are of great

evolutionary significance and have helped us in reaching the

current level of perfection. However, when we have sufficient

time and resources to arrive at a crucial decision, falling back

on these strategies prevents us from arriving at the best deci-

sion.

A little more knowledge, awareness, patience, and objectivity

during decision making will help us a great deal in minimizing

our biases in our professional as well personal life. Remember,

it is often the small changes that have the biggest

impact. ▌

| Page 16 ← Home Decision making and common biases. MedicinMan October 2012 | Page 21 MedicinMan October 2012 >>> Pharmacology for the Rep

Dr. Surinder Kumar Sharma

is Head - Strategy & Business

Development, TTK Healthcare.

n the last issue, the term pharmacokinetics was discussed under the

four headings of absorption, metabolism, distribution and excre-

tion. Pharmacokinetic parameters are derived from the measure-

ment of drug concentrations in blood or plasma. The key pharma-

cokinetic parameters and their importance for the dose regimen and

dose size are shown in the Figure 1. These are bioavailability, vol-

ume of distribution, clearance and elimination t1/2.

Bioavailability (F) is defined as the fraction of the administered

drug reaching the systemic circulation as intact drug. Bioavailabil-

ity is highly dependent on both the route of administration and the

drug formulation. For example, drugs that are given intravenously

exhibit a bioavailability of 100%, since the entire dose reaches the

systemic circulation as intact drug. However, for other routes of

administration, the bioavailability is less than 100%.

Volume of Distribution (Vd) is a hypothetical volume of fluid into

which the drug is disseminated. This mathematically determined

value gives a rough indication of the overall distribution of a drug

in the body. For example, a drug with a Vd of approximately 13 L

(i.e., interstitial fluid plus plasma water) is probably distributed

throughout extracellular fluid but is unable to penetrate cells [as

total body water (42L)=intracellular volume (28L)+ extracellular

volume (14L)]. In general, the greater the Vd, the greater

the diffusibility of the drug. Most drugs bind to plasma

proteins such as albumin and α-1-acid glycoprotein. Vd

becomes clinically important as it is assumed that only

unbound (free) drug is available for binding to receptors,

being metabolized by enzymes, and eliminated from the

body. Thus, the free fraction of drug is important.

Clearance (CL) is used to describe the efficiency of irre-

versible elimination of drug from the body. It is the meas-

ure of the body‟s efficiency in eliminating drug from the

systemic circulation. More specifically, clearance is de-

fined as the volume of blood from which drug can be com-

pletely removed per unit of time (e.g. 100 mL/minute).

Clearance can involve both metabolism of drug to a me-

tabolite and excretion of drug from the body. Clearance of

drug from different organs is additive. Renal clearance of

a drug results in its appearance in urine.

Half-life of the drug (t1/2) is the time during which half of

the drug is eliminated from the body. Half-life determina-

tion is very useful, as it can be used to evaluate the dura-

tion of action of the drug and for how long a drug is ex-

pected to remain in the body after termination of dosing,

the time required for a drug to reach steady state (when the

rate of drug entering the body is equal to the

rate of drug leaving the body) and often the

frequency of dosing.

All these parameters help in deciding the

dosing frequency and also the dose adjust-

ment which is required in patients with re-

nal or hepatic impairment. ▌

Pharmacology essentials: pharmacokinetic parameters

Volume of Distri-

bution Clearance Absorption

Half-life Bioavailability

Dosing regimen:

How often?

Dosing regimen:

How much?

Dr. Amit Dang

MedicinMan October 2012 >>> Pharmacology for the Rep | Page 22 ← Home

Dr. Amit Dang is Director at

Geronimo Healthcare Solu-

tions Pvt. Ltd.

Boehringer

ogether with many pharma and digital professionals, I at-

tended the launch of Boehringer‟s new Facebook game

Syrum at the London Science Museum last week. With

waiters in lab coats and cocktails in test tubes, the atmos-

phere was convivial and full of icebreakers of various types.

The Syrum game itself appears a significant step for phar-

ma‟s publicly-facing digital activities. In the intentions of

its primary creator, Boehringer‟s John Pugh, the platform

wasn‟t built with product or therapy area awareness in

mind, rather – much as Farmville isn‟t intended to appeal to

an audience with an interest in farming – the game is meant

to be an entertaining mass-market way to highlight the val-

uable work that the industry does.

As with any digital initiative, however, its success will be

judged by its appeal to its target audience and this raises

some interesting questions: is an educational game an ap-

propriate strategy? Is the game actually fun and rewarding

to play? And how will Boehringer ultimately judge the suc-

cess of this very public initiative?

At the launch, I spent some time with John and discussed

Syrum‟s long gestation period and journey to get to the

point of a successful beta launch. I was particularly interest-

ed in the development process itself. Was the game a prod-

uct of the lean, agile, user-centred processes common to

most of the Silicon Valley originated (or inspired) start-ups

playing in both healthcare and wider sectors?

The length of the development process would seem to sug-

gest this wasn‟t the case. Syrum was first announced on

Boehringer‟s Facebook page back in June 2011, and Pugh

admitted to have preferred to have “done things differently”

testing “with small groups on elements of the games”, but

was prevented from taking this approach due to “technical

snags”. Nevertheless, in common with agile product devel-

opment the game is apparently “set up in a modular way, so

elements can change.”

Pugh is also open about the fact that some core assumptions

– including the game‟s functionality, core audience demo-

graphic and the level of promotional spend within Facebook

itself – are yet to be fully determined, and his attitude is

refreshing: “this is a true experiment; we don‟t know where

it will end.”

From my point of view, regardless of whether Syrum suc-

ceeds or fails as a game-based initiative, it still provides a

strong statement to the world about Boehringer‟s position

as a pharma company with an outside-the-box approach and

a strong commitment to innovating for its audiences.

Perhaps more importantly, the very public nature of the

launch and publicly accessible success stats in the form of

Facebook likes and Twitter followers for the game‟s mascot

Professor Syrum will help the industry focus on what re-

turns they really want (and should really expect) from their

digital initiatives – in this case, is the return to be found in

enduring engagement with a generation of increasingly

pharma-friendly gamers, or is it in the wider media cover-

age of the initiative itself?

Only time will tell, but for now I need to get back to the

lab…▌

Launches Syrum

MedicinMan Ocotber 2012 >>> Industry Insight | Page 23 ← Home

Jon Gwillim

MedicinMan October 2012 >>> Hot on LinkedIn

Jon Gwillim is the Founder and CEO at

PatientsCreate.com, the worlds first

patient centric crowdsourcing platform,

supported by regulators, pharma and

patient groups. It aims to empower pa-

tients to help improve health outcomes.

Join him on LinkedIn: uk.linkedin.com/

in/jongwillim

Email: jon@patientscreate.com

nfiltration of products can be likened to a chronic infection,

which has created the room for counterfeit products. A

brand, which travels from one territory to the other, eventu-

ally comes back to the origin. Infiltration is killing well-

established brands by losing market share to competitors

and counterfeit products. The root cause for infiltration is

companies trying to achieve the sales by short-term means.

Although this is being done at the lower level, the responsi-

bility lies with top management.

Some promotional tools that are responsible for Infiltration:

1. Unrealistic targets, which are not matching with market

potential of territories and people. This gives undue sales

pressure to high volume HQs, which try to achieve targets

through unethical means. This decreases attention on low

performing HQs that need corrective steps to improve the

skills of field sales people, distribution system etc.

2. Companies giving large quantity of samples of estab-

lished brands. The practice of distributing samples and gifts

has degenerated into a rat race among pharma companies,

leading to using these inputs for adjustments in rates at

stockist level

3. Companies sanctioning special institutional rates of prod-

ucts without verifying with the institutional distributors.

Lack of monitoring and verification brings the products into

the retail market and leads to price adjustment in one territo-

ry for sending the product to another territory.

4. Companies sanctioning sponsorship budgets for activities

like doctors meet, medical camps and CMEs without proper

verification. This leads to using the sanctioned amount for

adjusting the price of products in the market.

5. Monetary incentives to field staff – often field staff ma-

nipulate the sales by adjusting the product price, by giving

out of some percentage from the incentive, which they

might earn.

6. Companies giving special rates for large quantity to dis-

tributors - this gives advantage to financially sound distribu-

tors who play on their margin and sell the products to other

parts.

MedicinMan October 2012 >>> Hot on LinkedIn | Page 24 ← Home

Infiltration–a chronic infection

in pharma field sales.

7. Companies not analyzing the secondary sales of HQs and

not focusing on the secondary to primary sales ratio.

Infiltration has other side effects, which affect companies in

the long term.

New field staff are not able to tackle this serious threat

- they get frustrated and leave the company.

HQs who get trapped in this malpractice continue to get

sales without putting in genuine efforts.

Established brands, which after price adjustment land in

wholesale „mandis‟, give rise to counterfeit products, dam-

aging the sale of genuine brands of the company. Moreover

these low quality counterfeit products reach in retail market,

which gives low response to the patient ailment, thereby

spoiling the image of the company and product. This proves

to be harmful in the long term for the company as a whole.

Infiltration is a serious problem that needs urgent attention

from the top management as well as from field sales people

to remedy the unethical and unhealthy practices that are

detrimental to patients, doctors, companies and sales people

in the long run.▌

Ajay Kumar Dua

Ajay Kumar Dua is a senior Pharma

Profesional.

LinkedIn: in.linkedin.com/pub/ajay-

kumar-dua/14/520/996

eart failure is a condition in which the heart can't pump

enough blood to meet the body's needs. In some cases, the

heart can't fill with enough blood. In other cases, the heart

can't pump blood to the rest of the body with enough

force. Some people have both problems.

The term "heart failure" doesn't mean that the heart has

stopped or is about to stop working. Nor is it the same as

heart attack which is myocardial infarction. However,

heart failure is a serious condition that requires medical

care.

The condition can affect the right side of the heart only, or

it can affect both sides of the heart. Most cases involve

both sides of the heart.

Right-side heart failure occurs if the heart can't pump

enough blood to the lungs to pick up oxygen. Left-side

heart failure occurs if the heart can't pump enough oxygen

-rich blood to the rest of the body.

Right-side heart failure may cause fluid to build up in the

feet, ankles, legs, liver, abdomen, and the veins in the

neck. Right-side and left-side heart failure also cause

shortness of breath and fatigue (tiredness).

The leading causes of heart failure are diseases that dam-

age the heart. Examples include coronary heart disease

(CHD), high blood pressure and diabetes. Other causes are

cardiomyopathy (disease of heart muscle), valvular heart

disease, arrhythmias, congenital heart defects. These are

described in greater detail elsewhere in this book.

The most common signs and symptoms of heart failure

are:

Shortness of breath or trouble breathing (dyspnea)

Fatigue (tiredness)

Swelling in the ankles, feet, legs, abdomen, and veins

in the neck

All of these symptoms are the result of fluid buildup in the

body. When symptoms start, the patient may feel tired and

short of breath after routine physical effort, like climbing

stairs.

As the heart grows weaker, symptoms get worse. The

patient feels tired and short of breath after getting dressed

or walking across the room. Some people have shortness

of breath while lying flat (called orthopnea) because the

lungs get more congested in that position which is re-

lieved by gravity while sitting up.

Understanding congestive heart failure.

MedicinMan October 2012 >>> Field Force Knowledge Series | Page 25 ← Home

Field Force Knowledge Series.

Dr. S. Srinivasan

Fluid buildup from heart failure also causes weight gain,

frequent urination, and a cough that's worse at night and

when you're lying down. This cough may be a sign of acute

pulmonary edema, a condition in which too much fluid

builds up in your lungs. The condition requires emergency

treatment.

Diagnostic Tests. No single test can diagnose heart failure. Clinical history and

physical examination play the major part in diagnosis. The

following investigations are performed in appropriate cases.

» ECG

» Chest X-ray

» Echocardiography

» Doppler ultrasound

» MRI

» Nuclear Heart Scan

» Stress test

» Cardiac catheterization / coronary angiography

» BNP (Brain natriuretic peptide) blood levels raised

» Thyroid function tests

Treatment. The most important is to treat the underlying cause like high

blood pressure, valvular heart disease, congenital heart dis-

ease etc.

Lifestyle Changes.

A Heart Healthy Diet

A healthy diet includes a variety of vegetables and fruits. It

also includes whole grains, fat-free or low-fat dairy products,

and protein foods, such as lean meats, eggs, poultry without

skin, seafood, nuts, seeds, beans, and peas.

A healthy diet is low in sodium (salt) and solid fats

(saturated fat and trans fatty acids). Too much salt can cause

extra fluid to build up in the body, making heart failure

worse. Saturated fat and trans fatty acids can cause un-

healthy blood cholesterol levels, which are a risk factor for

heart disease.

A healthy diet also is low in added sugars and refined grains.

Refined grains come from processing whole grains, which

results in a loss of nutrients (such as dietary fiber). Examples

of refined grains include white rice and white bread. A bal-

anced, nutrient-rich diet can help the heart work better.

Getting enough potassium is important for people who have

heart failure. Some heart failure medicines deplete the potas-

sium in the body. Lack of potassium can cause very rapid

heart rhythms that can lead to sudden death.

Potassium is found in foods like white potatoes and sweet

potatoes, greens (such as spinach), bananas, many dried

fruits, and white beans and soybeans.

Fluid Intake It's important for people who have heart failure to drink the

correct amounts and types of fluid. Drinking too much fluid

can worsen heart failure. Alcohol is bad for a failing heart.

Other Lifestyle Changes » Control obesity

» Physical exercise

» Quitting smoking

» Enough rest

Medicines » Diuretics (water or fluid pills) help reduce fluid buildup

in the lungs and swelling in the feet and ankles.

» ACE inhibitors lower blood pressure and reduce strain

on the heart. They also reduce the risk of a future heart

attack

» Aldosterone antagonists trigger the body to get rid of

salt and water through urine. This lowers the volume of

blood that the heart must pump.

» Angiotensin receptor blockers relax blood vessels and

lower blood pressure to decrease heart's workload.

» Beta blockers slow heart rate and lower blood pressure

to decrease your heart's workload.

» Isosorbide dinitrate/hydralazine hydrochloride helps

relax blood vessels so the heart doesn't work as hard to

pump blood.

» Digoxin makes the heart beat stronger and pump more

blood. ▌

MedicinMan October 2012 >>> Field Force Knowledge Series | Page 26 ← Home

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