The year 2009 has been declared the International Year of Astronomy, a global awareness campaign to “help the citizens of the world rediscover their place in the universe”. Interestingly, “…of the many issues that torment the human mind, like the refusal to accept the inevitability of death, is the question if life, like us on Earth, exists anywhere else in this colossal cosmos” wrote Sitaram Yechury in a Hindustan Times column published today. Human inquisitiveness urges such a search on cosmic issues related to health and mortality, yet no one thinks it fit to understand how his/her health is affected by what [s]he does today in the materialistic [or should I say, real] world. Can someone tell me if there was an International Year of Health Awareness? This is uniquely linked to an otherwise unrelated piece [in the same newspaper] by MIT’s Dr. Abhijit Banerjee. Dr. Banerjee commenting on why the healthcare systems of both the United States and India are flawed, notes that “…in India, anyone can become a doctor by simply deciding to be one.”
What’s common to both these situations? Simply the fact that there is very little or no awareness. As I had written earlier, in India, a doctor usually does not tell you what you are suffering from or why he is sending you for a test, or what medicine he is injecting into you. This is known in economic terms as asymmetrical or inadequate information, which produces the phenomenon described by economist George Akerlof as a lemon market. Akerlof characterizes this market by all or some of the following.
(1) Asymmetry of information, in which no buyers can accurately assess the value of a product through examination before sale is made and all sellers can more accurately assess the value of a product prior to sale – doctors know the real danger [if any] that your ailment poses to you, the value of the tests [s]he recommends to you and the necessity of the medicines you are prescribed. You don’t. Do you bother to find out?
(2) An incentive exists for the seller to pass off a low quality product as a higher quality one – Familiar? How many times have pharmacists tried to push one brand over another saying it’s the same medicine but a lot cheaper? Don’t we eagerly lap it up?
(3) Sellers have no credible disclosure technology (sellers with a great product have no way to credibly disclose this to buyers) – can innovator pharma companies explain why their products are better and hence priced higher? In case you are in the mood for pharma bashing, explain to me why you would pay $399 for an original iPhone from Apple and flaunt it, when we all know that a Chinese one costs only $39.56? No lemon market, this one!
(4) Either there exist a continuum of seller qualities OR the average seller type is sufficiently low (i.e. buyers are sufficiently pessimistic about the seller’s quality)
(5) Deficiency of effective public quality assurances (by reputation or regulation and/or of effective guarantees / warranties)
Strong interconnectivity is observable between points (4 ) – (5) above, and in two serious issues that confront the pharmaceutical industry today – a) new markets that can help spur growth through tough times – hence the foray into emerging markets or “pharmerging markets” and b) lack of trust within communities in the midst of product recalls and clinical data controversies. It is inevitable that buyers (customers) who are driven by prevailing economic conditions will intensify their search for value-for-money healthcare services, negotiate harder for lower cost drugs, and increasingly ask whether a particular drug is necessary or whether a less costly substitute exists.
There are two emerging trends that can be utilized by pharma marketers to engage consumers and spread awareness thereby improving the symmetry of information between seller and buyer in the Indian context: (i) For the internet savvy customer, increased utility of online social media as an informal and effective medium for online engagement and (ii) For the not-so-internet savvy consumers, the emergence of health counsel providers (term coined by Sunil Chiplunkar)
Usage of Internet based Social Media for Health Awareness
In the west, physicians and consumers are transforming the way they access health and pharma content by shifting to online resources. In a year during which more people used the Internet than doctors for health information and healthcare becomes less affordable for many, online health resources and tools are emerging as an alternate way for patients and caregivers to manage healthcare. It is a matter of time before the trend rages in India. A recently published report Pharma and Social Media: The Leaders and Followers, states that the phenomenon of social media is seeing the creation of information and interest communities on an unparalled scale, and health is among the most popular. For pharmaceutical companies, the potential benefits of using social media sites are balanced with the need to stay within the spirit and letter of regulation. Social media cuts across geographic, social and economic boundaries – will regulators, especially in countries that seek to tightly control pharmaceutical marketing, be able to stem the tide of information and promotion coming from outside their jurisdiction? Having said that, using social media can help examine user attitudes – genuine patient information versus rhetorical product support through brand sponsored discussion groups, warn of the potential adverse events of getting therapy – this applies across the healthcare value chain; wrong diagnosis, wrong tests, inhospitable service, high priced medicines and off-label product use – the works!
Social Media Websites: Some of the most popular social media tools are Twitter, YouTube and Facebook. Applications like Twitter can be used as an effective networking tool as it is easily accessible and has a quick-response system. Also, on Twitter, events are easily promoted and readers’ questions and answers can be immediately posted, which help gain more audience for websites that are referred to for increased information.
Brand-sponsored discussion groups: This refers to company sponsored websites or affinity groups. Companies must balance between seeking authentic consumer discussion and feedback and desist from controlling postings within those groups or chat rooms or seek to editorialize or comment on postings about promoting or adopting off-label uses. An example quoted in the report describes how Gardasil used Facebook to target its audience, teenage girls. This fan page however, simply extends the brand’s website to Facebook. This is a bad way to use social media because all of the social features of Facebook are disabled (for regulatory reasons apparently) by the brand. These features include the wall, discussion groups, and user submitted content. So, it uses social media to effectively reach the brand’s audience but prevents users from actually using social tools. By removing interactivity, this defeats the entire purpose of using social media tools for creating healthcare awareness.
Emergence of Health Counsel Providers – Offline Social Medium
These days, even a person well versed in medical lingo can become overwhelmed by the complexity of the health care system. In the West, many patients and their families who can afford it are turning to patient advocates for help. The need and therefore the opportunity is immense in countries like India where healthcare awareness is negligible and more importantly vast swathes of the population are barely literate and hence do not resort to online tools for information. The options here are therefore face-to-face counseling or utilizing penetrative technologies such as mobile phones. Indian counterparts of patient advocates can be called Health Counsel Providers (HCPs). Creation of HCPs is a great opportunity for pharmaceutical companies to create jobs at the bottom of the pile – people who can easily blend into the local ethos and therefore relate easily to the local community they service. HCPs can be professionals or friends/relatives or from the same social circle who can help a patient decide when and which doctor to visit, understand diagnosis and treatment, sort out insurance claims in both urban and rural clientele (micro-finance ventures are likely to percolate refinancing and insurance plans) and even accompany the patient on doctor’s visits. Over time, they will be able to open doors to specialists that a patient may not have access to. This is likely to help consumers make informed decisions about their own health and improve information flow between seller and buyer thus improving trust and confidence.
To borrow from Prof. Nirvikar Singh, University of California, Santa Cruz, it is time that pharmaceutical marketers began focusing more on outcomes [results] than merely on outlays [activities]. This will lead to increased effort at improving clinical outcomes and more robust financial management. This must begin with having a clear view of the path from outlays to outcomes which can happen when we know which interventions lead to which improvements, how reliable the data is, or what the benchmarks should be. It is important that pharmaceutical marketers hear from the people affected directly – consumers – to do this effectively. For consumers to talk to us it is necessary to reach out to them through informal and effective media to help create symmetrical information and transparency.