Is it time for pharma leaders to focus on positive social and patient impact as business drivers?

Anup Soans questions whether it's time for the industry to re-engage governments, civil society and other stakeholders and focus on positive social and patient impact as business drivers?

We are moving from a world of problems, which demand speed, analysis, and elimination of uncertainty to solve, to a world of dilemmas, which demand patience, sense-making, and an engagement of uncertainty.

Denise Caron

The Pharmaceutical industry is experiencing uncertainty, scrutiny and downright condemnation by civil society, activists, patient advocacy groups; even the judiciary has been harsh in its observations and scale of penalty.

Like most businesses, the pharma industry is also focused on top lines and bottom lines. And this focus has led to investments in R&D; Outsourcing; M&A and other strategic moves that either increased toplines or improved bottomlines.

The positive social impact of the pharmaceutical industry in improving overall health parameters as reflected in the increased life expectancy, polio free India and a host of others have been relegated to inside pages of newspapers and social media, while misdemeanours make headlines. This makes it imperative for pharma business leaders everywhere to re-engage governments, civil society and other stakeholders. And what better way to engage than by doing constructive work in the area of patient centered health care¹.

This article is written with Indian pharma leaders in mind. However, given the global impact of Indian generics and the humongous potential of the Indian health care market, the article should be of interest to global pharma leaders who are scanning or are already engaged in doing business in emerging markets like India.

Empowered by information and technology, society has undergone a sea change. And the pharma industry instead of adapting to these changes, has sought to insulate itself from the external turbulence by lobbying, lying and litigation to maintain status quo. The emergence of Social Media has created a vibrant but volatile civil society that does not care for the economic theories that, in their perception, benefits only large corporations and rich people. The Arab Spring and the ensuing chaos is a reflection of people's frustration with the existing equations between governments, businesses, and people. Wall Street protests prove that this frustration is not limited to developing countries alone. Societies all over the world are experiencing an upheaval leading to a power shift.

"This makes it imperative for pharma business leaders everywhere to re-engage governments, civil society and other stakeholders."

The leadership skill-set needed by pharma industry leaders in this changed world is vastly different from the one they managed in the comforts of their weather controlled silos. Now the heat from the street can be felt as pharma industry leaders face a plethora of issues that impact their top and bottom lines.

1. Heightened vigilance by regulatory authorities even in developing countries.

2. Increased social activism against unethical promotional practices by pharma companies leading to stronger laws and guidelines like UCPMP by Indian government and MCI guidelines for doctors by professional statutory bodies like Medical Council of India. The Chinese crackdown on bribes for prescription to doctors shows that society and governments are unwilling to subsidize the social and economic costs of inefficient ways of doing business.

3. Increased participation of governments in the health of its citizens even in developing countries like India. In the last American election, health care was a major issue to the extent that it was called Obama Care. Civil society activism combined with media reporting and judicial pro-activism will not permit elected governments to sit by and watch large sections of voters unable to access health care, while pharma companies lobby and litigate to maintain their profitability. Governments will come out with aggressive legislations like DPCO – to control the prices of essential medicines as well as invoke compulsory licensing to prevent inaccessibility of patented products like Glivec and Nexavar to large population of patients.

4. Increased cases of compulsory licenses as in the case of Nexavar and judicial activism in ignoring patent claims of MNCs as in the case of Glivec in India. The pressure brought in by activists and patient advocacy groups are beginning to impact judicial outcomes in favor of patients and not patents.

5. Increasing number of whistle blowers in pharma as in the case of Ranbaxy and GSK and others in China.

6. Ambiguity and changes / reversals in policy making in terms of permitting pharma MNCs to invest in Indian pharma companies. Mylan's acquisition of Agila has finally been cleared by the Indian government after considerable uncertainty. The post buy-out conditions imposed on Mylan is quite complex.

In short, the balance has shifted in favor of patients and civil society claims Vs intellectual property claims, despite India becoming a party to TRIPS. Pharma leaders must become sensitive to the changing equations and accept the new reality that government, civil society and judicial activism cannot be managed any more with lobbying, lying and litigation. The times we are now living in is best described by the acronym VUCA², coined by the US military post 9/11. Volatility – Rate of Change; Uncertainty – unclear about the present situation and future outcomes; Complexity – multiplicity of key decision factors and Ambiguity – lack of clarity about the meaning of an event. VUCA is a state of constant flux, which business leaders can counter only by having a clear cut Vision – an intent that seeks to create a future; Understanding – stop, look and listen; Clarity – make sense of the chaos and Agility – wirearchy (social networks) is rewarded over hierarchy.

"The leadership skill-set needed by pharma industry leaders in this changed world is vastly different from the one they managed in the comforts of their weather controlled silos."

Rather than reacting to VUCA, pharma leaders must sit together and envision a future in which the patient experiences better outcomes by a technology-empowered physician assisted by the pharma industry. Several pharma thinkers like Hanno Wolfram³ have clearly articulated the need for pharma leaders to move beyond the pill and become health care companies. This needs Vision, Understanding, Clarity and Agility to counter VUCA effectively; not an easy commodity that can be acquired by engaging some tired and retired consultants. The new challenge needs new experts from diverse fields who can envisage a future where health outcomes for patients can be clearly demonstrated within acceptable economic costs. The health care consumer market is certainly large enough but it cannot be catered to with the current mindset of top lines and bottom lines. It needs a new mindset that sees the convergence of computers, social media, mobile devices, big data and such other new world dynamics as an enabler of better health care for all. Health care needs a Facebook model, which enables users to connect without paying, yet creating enough value through their connections.

"The pressure brought in by activists and patient advocacy groups are beginning to impact judicial outcomes in favor of patients and not patents."

The future will belong to pharma companies that can transform themselves into health care players who have the interest of patients at the core and work on improving market accessibility by partnering with governments rather than lobbying and litigation. Most pharma leaders are not prepared to face challenges presented by the VUCA world, which can neither be wished away nor are easy to deal with.

A recent global study by Dr. Salim Yusuf of McMaster University, Canada, published in the JAMA shows that one third of the people surveyed were not aware that they were suffering from hypertension, much less taking any medication to control it⁴. This is where the potential lies for pharma companies to move away from being profit and physician centric to become patient centric and help people to become more aware of health issues and better manage their health through regular checkups and treatment compliance. This is a win-win scenario where the physician instead of slamming the door on drug reps will now welcome their initiatives to partner with them in managing the humongous problem of the global epidemic of life style diseases. Hypertension and diabetes are now affecting even the poorer sections of society in India. There are literally hundreds of such indications, from anaemia to zoonosis, which affect millions of people in both developing as well as developed countries. India produces 70,000 pharmacy graduates and two million science graduates a year, who can easily be drafted into a task-force to create health awareness as part of their curriculum. Twenty thousand registered Indian pharma companies already employ close to a million field force that are mostly unwelcome at the doctor's clinic. According to a Bloomberg report a leading cardiologist in Mumbai gives less than 30 seconds to drug reps⁵. Will pharma companies continue such wasteful deployment of field force or transform them into a patient centric task force and become partners with physicians? The opportunity is staring us in the face, but pharma leaders continue to ignore it like the elephant in the room. Salil Kallianpur another Indian pharma thinker questions this in his blog, "Continuous Improvement or Insanity?"

Will pharma leaders rise to the occasion? Or will a technology company with a visionary leader, like Bill Gates who has already impacted health care delivery in big way, look to health care as the next big opportunity. They could acquire pharma companies that produce quality generic drugs and leverage mobile technology post the acquisition of Nokia into a health care player with whom governments already have a great rapport? Kodak invented not just films; they also invented the first digital camera. Now mobile device companies have become camera makers by default, while Kodak has filed for bankruptcy.

Welcome to the new disruptive VUCA world, the future is indeed volatile, uncertain, complex and ambiguous. Do Indian and global pharma leaders have the vision, understanding, clarity and agility to respond to the challenge to fix the broken model and deliver health care to all or will they go the Kodak way despite obvious strengths?

References:

1. Who's Really Putting Patients First?

http://www.slideshare.net/slideshow/embed_code/9566655#

2. MedicinMan, September 2013, VUCA – The New Normal

http://medicinman.net/

3. MedicinMan, September 2012, Hanno Wolfram, Sell, Sell, Sell or Deliver Value

4. JAMA, September 4, 2013, Salim Yusuf, DPhil et. al., Prevalence, Awareness, Treatment, and Control of Hypertension in Rural and Urban Communities in High-, Middle-, and Low-Income Countries

5. Businessweek, September 8, 2011 Welcome to India, the Land of the Drug Reps http://www.businessweek.com/magazine/welcome-to-india-the-land-of-the-drug-reps-09082011.html