Britain’s pharmaceutical industry invested a record £10 million a day in the search for new medicines last year and generated a best-ever annual trade surplus of £3 billion to help the UK’s ailing balance of payments. At the same time wider use of innovative medicines by the NHS, particularly for cancer, coronary heart disease and mental health have saved thousands of lives. But we still spend twice as much as a nation on both holidays and alcohol than on medicines. Figures released by the Association of the British Pharmaceutical Industry (ABPI) in its 2003 Annual Review show:

• Investment in UK research and development topped £3.5 billion - nearly £10 million a day.

• Pharmaceutical companies account for nearly a quarter of all UK business R&D.

• 25 of the world’s top-selling 100 medicines were discovered and developed in the UK, more than any other country except the USA.

• Exports by the industry reached a record £11.8 billion and a trade surplus for Britain of £3.1 billion over pharmaceutical imports.

• Jobs in the industry increased to 83,000 and generated another quarter of a million in the wider economy.

• Sales to the NHS rose to £9.5 billion a year yet continued to represent only 12 per cent of total NHS expenditure.

• In real terms, NHS medicines prices are more than 15 per cent lower than ten years ago.

• The average prescription now costs the NHS around £11, while a day in hospital costs an average £200.

• As a nation we spend 40p per person a day on medicines but 76p on holidays and 88p on alcohol.

"Britain remains near the bottom of the international league in terms of spend on medicines and use of the latest modern treatments. This is a record of investment and achievement that is unmatched by any other industry in Britain and in which the UK is truly a world leader,” said Dr John Patterson, President of the ABPI. Our medicines have proved a world-class success and are absolutely key to the future of the NHS in its ambitions to become a world-class service. I am delighted to see many more thousands of patients lives are being saved or improved by medicines as a result of our discoveries and improved treatment within the NHS. But there remains much more that could and should be done to ensure all patients benefit from the use of modern medicines. Postcode prescribing across the UK continues to be a major problem and our place in the international health league is still low.” Latest international data shows that spend on medicines accounts for 0.88 per cent of GDP in the UK. Countries such as France and Spain spend 1.34 per cent, Italy 1.12 per cent and Germany 1.02. A survey of ten leading industrial nations around the world puts Britain one from bottom in the use of the latest medicines launched in the past five years.

The enormous progress in the treatment of coronary heart disease (CHD) announced by the Government’s report on the National Service Framework for the disease is applauded by the Association of the British Pharmaceutical Industry. The report, Winning the War on Heart Disease, reveals that deaths from cardiovascular disease fell by more than 23 per cent between 1995/97 and 2000/02; and eight in ten heart attack patients received life-saving thrombolysis treatment within thirty minutes of hospital arrival in 2003, compared with less than four in ten in 2000.

Welcoming the report, and the huge strides that have been made in cardiac services, ABPI Director of Medicine Dr Richard Tiner said: “The pharmaceutical industry is at the forefront of developments which continue to play an important part in these improvements. This highlights the fact that investing in medicines is frequently a life-saver. For example, more than 1.8 million people - over 3 per cent of the population - are now receiving statins for lowering cholesterol levels and that number is rapidly increasing. It is estimated that this is saving about 6-7,000 lives a year, as well as reducing the number and severity of heart attacks. “Also, the development of medicines to help people give up smoking are making a great contribution to saving lives as well as reducing the cost of more expensive health care,” said Dr Tiner.

The Association of the British Pharmaceutical Industry (ABPI) applauds the targeting of the Government’s extra £100 million research and development funding per year by 2008 on research into the treatment and cure of Alzheimer’s, stroke, diabetes and mental health, as well as developing new medicines for children. “This is excellent news for clinical research in general as well as these priority disease areas,” said Director General Dr Trevor Jones. He also welcomed the creation of the UK Clinical Research Collaboration (UKCRC), which will bring together the NHS, Medical Research Council, medical charities and industry to speed up the development of new medicines and treatments. “This investment in collaboration and partnership means more patients will benefit from the latest scientific and medical advances, and will give more patients the opportunity to participate in clinical trials,” said Dr Jones. The extra funding will be used to:

• fund specialist research into the three most common diseases affecting older patients - Alzheimer’s, stroke and diabetes;

• bring together existing paediatric research centres to deliver faster progress in developing medicines for children;

• expand the research network within the National Institute of Mental Health for England.

CONTRACT FACTS 40-45!

40. Selling in Mental Health: There are only 41 points available for mental health as a therapeutic topic but interestingly another 4 points appear in medicines management chapter (identifying non attendees for those who receive regular neuropleptic injections). So pharma companies need to really see where products may be aligned to aid in achieving these. By far the largest weight goes to review of patients with long term mental health problems (23 out of the 41 points). These problems will need a value-added-service approach.

41. THINK POINT PF: I am a little perturbed at the vagueness of mental health in the GMS contract. Of the 41 points, 7 points for creating a register, 11 points for dealing with lithium and the rest on the ‘review’ of the patient. This review covers 3 areas: physical health of the patient, co-ordination with secondary care services and – review of prescribed medication. The maximum threshold is 90% so there is a lot of room to manoeuvre if practices want to take an interest in earning their points this way. But notoriously, dealing with mental health, sorting out medication, trying to improve patients lives is often just too lethargic for primary careto take initiative on. I think that pharma companies are going to really have to consider far more than just ‘product features and benefits’ here. Unless a company has created a serious attempt at ‘branding’ themselves as leaders in mental health with the offer and ability to gear themselves as main players at the primary/secondary care interface then there is a danger that the GMS contract changes nothing for patients in this section of our society. Worryingly, the absence of specifics (for example – why is depression not even mentioned once?) with lots of points created ‘vaguely’ may result in an apathy here (that already exists). Without pharma companies pushing the envelope in mental health I worry for the sanity of all of us! Don’t forget that secondary care is still leading on trends and referrals for new ideas. Primary Care is good at blocking new drugs and cutting budgets, but secondary care is still where leading therapies are tried, new advances advocated and KOLs will still want to do the best for this group of NHS ‘clients’.

42. Selling in Epilepsy: There are even fewer points in epilepsy management as there are in mental health! Of the 16 points available, the creation of a register of patients who are on anti-epileptics (2 points) is the easiest. The rest of the 14 points apply only to 16yr and above and cover 3 areas: seizure frequency and medication review (4 points each) needs to be done within the last 15 months. The % patients convulsion free within the last year is worth an extra 6 points.

43. THINK POINT PF: Come on epilepsy companies! What are you waiting for! Sure there are not many total points for epilepsy but with a little help from you and your company we can get this topic done and dusted. Think about your product – what’s the data like on seizure frequency? Do you have medical information versus another competitor or as an add on showing seizure free in patient groups? Then get this data in front of us! Companies who are not dealing with patient groups here are missing out – it’s the way forward and epilepsy is no exclusion here. One problem I have noticed is that primary care often just wants to ‘refer’ everything. Fair enough – let the specialist organise care plan and juggle treatment. But the patient needs babysitting’ in primary care and with out good review secondary care management becomes more akin to complicated interference. Pharma companies that can smooth out this process will be on to a winner. Tolerability of anti-epileptic medication is a key area for problems and data is often confusing and conflicting. I am yet to meet a company representative that can make this clear! I am as confused as the rest of them! Finally, care for the patient needs. Driving license problems, prejudice in public, weight problems and behavioural interactions are all peripheral to care but often central to the patient. Ask yourself – does my company take this seriously! If not – change their view – or change the company you work for.

44. Selling in Respiratory: Life is very heated here. Lots of strong products. Lots of very committed competitors. Significant and increasingly vocal patient voice and lots of points! Having recently presented at the annual British Lung Foundation patients & carers group I found the whole experience deeply moving. I had to tone down the humour as significant laughter caused respiratory distress. I had never really appreciated how significant that was.

45. THINK POINT PF: There is a total of 117 points in respiratory medicine split unequally between asthma (72 points) and COPD (45 points). This is such a competitive area to sell within. Some companies have significant ‘branding’ in respiratory medicine (Allen & Hanbury’s) which represent almost unparalleled commitment to airways disease. This has led to original and diversified strategies from other pharma companies (ie Altana’s patient initiatives) which are proving impressive. Companies torn between asthma and COPD would do well to see how the new GMS contrasts the 2 diseases. To produce a register of asthma patients is 7 points whereas COPD registers obtain 5 points. Confirming diagnosis with spirometry in asthma patients 8yr+ provides 15 points compared to COPD which provides 10 points if reversibility is also documented. Lesson – spirometers are desirable and so is the avoidance of so-called ‘doctor diagnosed asthma or COPD. It appears that objective measurements are wanted. Ongoing management of asthma provides the remaining 50 points though when examined in detail, the ‘asthma review; will give 20 points. The rest comes from recording smoking status, offering smoking cessation and jabbing with influenza vaccine. Strange in that whilst most of us do not deny the importance of smoking or flu jab, there appears nothing very specific tailored to asthma therapy as has been described. In fact, even if you hit all the above points, anyone treating or selling within the asthma disease area will know that this will not necessarily provide good control of the disease. Ongoing management of COPD provides 30 points (equally provided by 5 areas). Whilst smoking status, smoking cessation advice and flu jabs also feature, here we also see 6 points for recording a FEV1 and another 6 points for checking inhaler technique. I think companies may feel something more tangible to focus on here. Inhaler technique is an onerous task and one that pharma companies will begin to seek out as a service add-on. Just thinking back to my BLF presentation – what if every patient in that room had their inhaler technique checked before entering the room! Just a matter of time before this starts to happen in local areas and surgeries. What’s more – why was inhaler technique left off from asthma? Is it less important that they know how to use inhalers than those with COPD? Also of significance look at the maximum thresholds for achieving the asthma quality indicators versus achieving COPD indicators… surprised? I am.   

What is MRSA? MRSA stands for methicillin-resistant Staphylococcus aureus. The term is used to describe a number of strains of the bacteria, Staphylococcus aureus that are resistant to a number of antibiotics, including methicillin.

What is Staphylococcus aureus?

Staphylococcus aureus is a group of bacteria that live on the surface of people’s skin and inside the nose. It is normally harmless: most people who are carrying it are totally unaware that they have it. In fact, it is thought that up to 30% of the general UK population carries these bacteria in their nose or on their skin. This group of bacteria can be spread quite easily from person to person through contact.

Why is MRSA a concern?

Problems occur if Staphyloccocus aureus bacteria are able to enter the body through a cut or wound. Most healthy people have strong immune systems and are able to fight off a Staphylococcus aureus infection themselves and have only mild symptoms. However, people with weakened immune systems (for example due to other illnesses) or who have undergone surgery (for example heart surgery or hip replacement) can develop more serious problems. In more vulnerable people, Staphyloccocus aureus bacteria have been known to cause boils, abscesses, impetigo, septic wounds, heart-valve problems and toxic shock syndrome. In extreme cases, it can result in death. People with weakened immune systems who have been infected with Staphylococcus aureus require treatment with antibiotics to help clear the infection. The concern with MRSA strains of bacteria is that they are resistant to a number of the antibiotics that are normally used to treat Staphylococcus aureus infections.

How is MRSA treated?

Because MRSA is resistant to a number of different antibiotics, it is harder to treat than non-resistant bacteria. However, MRSA is not resistant to every antibiotic and most strains of MRSA can still be treated with vancomycin, teicoplanin and mupirocin. For people with weakened immune systems who have become infected with MRSA, the best treatments are with the antibiotics vancomycin or teicoplanin. These two antibiotics are given as injections or through an intravenous drip and so are only given to people in hospital. Certain groups of people are at a higher risk of infection with MRSA. For this reason, some healthy people are screened for MRSA by having a swab of their skin or inside of their nose taken. If these healthy people are found to be carrying MRSA on their skin or in their noses, they are normally treated with an antibiotic cream - mupirocin. This is applied to the affected areas of the body. This is done to reduce the chance of the bacteria entering the body through an open wound and the chance of other people catching MRSA.

Where does MRSA come from?

MRSA has appeared for three reasons: the widespread use of antibiotics, genetic selection and our dislike of tablets. Bacteria are constantly evolving because their genes are constantly changing. The result of this is that some of the bacteria will have more resistance to a certain antibiotic than others. So, when the weaker bacteria encounter that antibiotic, they are killed. But the more resistant ones will take longer to die. If these more resistant bacteria are not killed off, they will survive and multiply. Their “offspring” will have this resistance to the antibiotic and further changes to their genes will mean that some will be even more resistant to the antibiotic. Over time this combination of bacterial genetic change and our dislike of taking tablets has resulted in strains of Staphylococcus aureus that are resistant to many of today’s antibiotics. Normally these strains are resistant to just one or two antibiotics but, as in the case of MRSA, they can be resistant to more. This is why doctors encourage us to finish the whole course of antibiotics when we are prescribed them. The antibiotic will rapidly kill off the weaker bacteria and we will start to feel better. Many doctors believe that if we stop taking the antibiotic at this point, the stronger bacteria will survive and could produce more drug-resistant “offspring”. If the next person who is infected also fails to finish the whole course of the antibiotic, then even more resistant bacteria will result. For this reason, it is thought that this can all be avoided if we take the whole course of antibiotics in the first place: by taking all the tablets, all the bacteria (including the more resistant ones) should be killed off and no offspring can be produced.

Why is MRSA particularly important in hospitals?

MRSA is particularly important in hospitals for three reasons: 1) Hospitals contain a large number of people with weakened immune systems who could become infected with MRSA and develop unwanted symptoms 2) Many of the patients in a hospital have an intravenous drip or a catheter that creates a “wound” through which MRSA can enter the body 3) In some hospitals, people are in close proximity to each other, which increases the chances of MRSA infecting patients. However, in others patients stay in separate rooms, which helps to lower this risk hospitals offer many opportunities for Staphylococcus aureus bacteria to encounter a wide range of antibiotics and, through genetic change and survival, develop resistance to all of them.

What is done to protect people?

If a person is suspected of being infected with MRSA, a swab of the infected wound or a sample of blood or urine is taken. Any bacteria in the sample are grown in a laboratory and then identified. The results can take several days as it takes this long for the bacteria to grow. If a healthy person is found to be carrying MRSA, they are normally treated with an antibiotic cream - mupirocin. This is applied to the affected areas of the body. This is done to reduce the chance of other people catching MRSA. If a person with a weakened immune system is infected with MRSA, they are treated with either vancomycin or teicoplanin. At the moment, very few strains of MRSA are resistant to either of these two antibiotics. These two antibiotics are given as injections or through an intravenous drip and so are only given to people in hospital. In hospital, to prevent other patients becoming infected, people with MRSA are treated using “barrier nursing” techniques. This form of nursing means that the person may be placed in a separate room and they will be treated by doctors and nurses who will be wearing disposable gloves and aprons. To prevent other people from becoming infected with MRSA, the gloves and aprons will be disposed of and hands will be washed before the healthcare professionals treat another patient. It is worth mentioning that such measures are often used in hospitals and the use of gloves or aprons does not automatically mean that a person has MRSA.

What can be done to keep antibiotic resistance under control?

In the wider world, there is now concern that antibiotic resistance could continue to develop to the point where some bacteria are resistant to all antibiotics. To stop this from happening, the medical profession has taken a number of steps: 1. Reducing its levels of antibiotic prescribing by no longer prescribing antibiotics for viral infections. For example, many coughs and colds are caused by viruses and antibiotics will have no effect whatsoever. In the past, antibiotics were prescribed to help prevent co-infection with bacteria, however this only served to increase antibiotic resistance and has been stopped. 2. Encouraging patients to finish their whole course of antibiotics, regardless of whether they feel better earlier or not. This measure is particularly important in preventing resistant bacteria from surviving and multiplying. 3. Using infection control measures in hospitals, including handwashing between patients, to minimise the chances of bacteria being passed from one patient to another. Further information External resources: Health Protection Agency: MRSA information for patients NHS Direct: MRSA information Centers for Disease Control: MRSA factsheet For consumer-friendly and reliable health information on over 200 conditions, treatments and living healthily, visit BUPA's website at: www.bupa.co.uk

Times are tight in pharma, and getting tighter. With record numbers of drugs reaching patent expiration, smaller pipelines, pricing and political pressures and increasing costs, pharma is feeling the squeeze from every direction. And sales forces, once immune to such concerns, are under the gun to gain efficiencies at a time when they are being asked to deliver bigger than ever before.

CONNECTING WITH DOCTORS is more difficult than ever, making it tougher on sales teams to deliver on growing expectations and putting sales force effectiveness centre stage for pharma sales organisations. At eyeforpharma’s 2nd Annual Pharmaceutical Sales Force Effectiveness Conference in Barcelona, Spain last month, European thought leaders from across the industry came together to share best practices and strategies for building leaner, more productive sales teams.

Change management - a major hurdle for SFE

The event, which drew more than 350 mid- to senior-level executive attendees from leading pharmaceutical organisations, focused on SFE strategy and implementation. Leandro Herrero, CEO of the Chalfont Project, a UK-based consultancy, kicked off the conference with a thought-provoking examination of the importance of the human component in the implementation of new sales and marketing business processes. According to Herrero, the majority of problems encountered when implementing SFE initiatives can be traced back to vision and strategy issues and change management roadblocks on the people side of the equation. And Herrero’s presentation set the predominant theme for the rest of the conference, with nearly every talk coming back to the importance of the “human side“ of strategy and implementation for every stakeholder from the sales representatives and managers themselves to doctors, formulary decision makers, auxiliary care givers (such as nurses and pharmacists) and, ultimately, patients. One difficult hurdle pharma faces, according to Eduard Vidovic, Head of Training for Sanofi Synthelabo, is abandoning a sales culture and model that has been so productive in the past. “There is a resistance to change well-established sales practices,“ he said. “Information collected by reps is not readily shared - and there are no real incentives to do so. And without that kind of information, segmenting and targeting fails, leaving us to play a numbers game to ensure the best customers are “hit.“ SFE leaders can capitalise on the people component, however, Gregory Cordano, Project Director Sales Force Effectiveness at Schering-Plough, advised by looking to the field force as a source of innovation. “Work backwards from the field and build technologies and processes around what works for them,“ he said.

 Processes and systems - cogs in a larger wheel

Like the pieces of a complicated puzzle, however, delegates discovered that truly successful SFE initiatives rely on a variety of important and complex “cogs“ coming together in harmony to create a smoothly functioning and productive “wheel.“ Laurent Schockmel, SVP Global Operations CRM Pharma for CEGEDIM, stressed the importance of supporting processes through segmentation and targeting, territory alignment, sales force management, integration of customer data and performance measurement. Integration of customer data becomes critical to developing what David MacMurchy of Dendrite calls customer intimacy. “Access to quality data and detailed customer information, allows you to deliver value to the customer, while simultaneously increasing profitability,“ MacMurchy said. “Successful sales and marketing is about how you create a value proposition that is shared with your customers, enabling both to profit from the relationship. That‚s true intimacy.“ But understanding who the customer is has become increasingly difficult. As Tina Billet, Supplementary Prescribing Manager for Janssen- Cilag, told delegates, the face of the customer is changing. “Nurses and pharmacists, who were once influencers, are now customers and will soon overtake doctors as the leading prescribers,“ she said. “Pharma is now challenged with adjusting its sales tactics to address this new audience of prescribers. And it‚s not as group sales reps necessarily understand.“ Rising promotional pressure coupled with declining returns will require pharma companies to build organisational flexibility to sustain accessibility of business intelligence and reactivity, Pierre Morgon, General Manager of Yamanouchi France, told delegates. To meet these challenges Morgon and his colleagues have launched a PMCIA technology initiative to provide enhanced customer management tools to its sales organisation. The technology, Morgon said, will facilitate new roles for Yamanouchi‚s sales staff, promoting synchronised interactions across all channels.

Global versus local strategies - What works best?

Nina Felton, VP of Sales Optimisation Consulting Services at IMS Health, told delegates there are advantages and disadvantages to globalisation. Globalisation, she said, brings benefits such as economies of scale, consistency of practices and faster learning through sharing of best practices. However, it also results in increased overhead, lack of innovation and diminished responsiveness to local customers. According to Mark Langston, Senior European Business Manager, and Ivan Blanarik, Head of Marketing and Sales Portugal, at Boehringer Ingelheim, when it comes to implementation, global thinking is important. During a European field force initiative launched at Boehringer in 2001, their teams have found that strong leadership and commitment is vital to success, since top-down implementations can be challenging. They also recommend “modular“ implementation - splitting the process into “digestible“ parts - to drive success.

Valuable benchmarking, learning and networking

There was one point on which nearly everyone at the conference could agree upon: the event offered a valuable opportunity to measure progress against industry benchmarks and afforded tangible take-home learnings and tools to be applied within individual organisations. Delegate and speaker feedback was overwhelmingly positive, with many deeming it the pharma sales event of the calendar. And anticipation was already running high for the 3rd annual event‚s Sales Effectiveness Awards ceremony, recognising organisations and individuals involved in industry-leading sales force effectiveness strategies and implementations in 2004.

I noticed in the PF Company Perception, Motivation and Satisfaction 2003 Survey that development appeared as one of the top four answers to the question, “what motivates you?” Representatives also stated that they thought their development was one of the three top motivating factors that they were ”least satisfied with.”

DEVELOPMENT ALSO APPEARED as one of the top four motivating factors for Key Account Managers, NHS Liaison, and First Line Management, yet it seems that this does not have the same priority for their employers. Often, if there is a development programme in place, it consists of mainly product training rather than personal development So, perhaps it’s not surprising that in the PF survey, the top of “most satisfied with” response was Belief, i.e in the present products sold. Having spent over twenty five years in the pharmaceutical industry as a Medical Representative, Regional Business Manager and Training Director, I thought it was about time I ventured into pastures new to research, re-energise and reassure myself of my belief. That is, that you need to develop people as much as you need to ensure that product knowledge is in place, before you can expect to see an improvement in business results.

I spent a year working for a London consultancy, and during that time worked in a number of different business sectors, including Advertising, IT and Architecture and Design. This experience opened my eyes regarding the amount of time that pharmaceutical companies spend training their people on their products, and how little time they spend helping their people direct that knowledge in front of their customers. So, I wonder how much pharmaceutical companies invest every year in product training versus people skills development? I hear from many representatives, that whilst some companies are doing a good job, others offer little, if anything, in the way of personal development. However, it’s not enough just to offer a development course. Unlike product training, which is knowledge or skills based, personal development requires behavioural change, and that can be difficult to bring about. Traditional training courses simply do not work very well. Why is that? Often it is because the training isn’t followed up in the field, but more often, it’s because the training offered doesn’t capture imaginations. I’ve been trying to answer the question “what else can be done?” I thought about my own children and their learning. Frankly, I was rarely able to help them with their homework, as it was too hard for me! They seemed to be able to cope, in fact, they usually learnt better when I wasn’t involved – learning to drive being a classic example. I decided that was because I was too serious and task focused. They learnt best when there was no pressure, they were having fun and they didn’t feel they were letting me down by not knowing how to do something. We don’t like to be sold to, but we like to buy. Similarly, we don’t want to be taught, but we like to learn! I took this approach whilst working in London with customers outside the industry, as this gave me the opportunity to try new ideas, and I found that my beliefs were reflected in an approach known as Accelerated Learning.

So what does Accelerated Learning mean?

Accelerated Learning adds fun and colour to learning - this produces better results, as people learn faster and can apply these skills more quickly. It means that we can:

Cover more content in less time Make theory easier for delegates to understand Give plenty of opportunity to practice Make learning memorable Facilitate learning by spending time on application to the job Have fun Accelerated Learning involves learning techniques that keep everybody involved, enthusiastic and interested throughout the experience. Lectures usually only keep ones interest for 20 minutes, and that is why we adopt the approach of participation throughout the programme. Accelerated Learning means that the following must be delivered: Well researched and tailored programmes to ensure that content is appropriate and based on the needs of the delegates and the company Management support is elicited in order to follow up these programmes A variety of stimulants, e.g. music, movement, and hands on exercises! Accelerated Learning takes into account the demands of a rapidly changing and increasingly competitive environment, where companies need innovative employees who generate breakthrough solutions to business challenges. Accelerated Learning recognises that people have a wide range of learning styles, and there are many effective techniques available to meet these different needs. A recent survey showed that delegates want: to be entertained to be shown how to apply learning into their actual job activity (but not conventional role play) to have a trainer who is good at their job to have fun not to work too hard -or it seems so a good environment - a nice lunch, fruits and treats a fast, lively pace a trainer who is truly enthusiastic and inspirational to be challenged, but not embarrassed . Last year, I set up The Portland Partnership with Mark Murphy. We share the view that you need to offer strategic people solutions and then deliver them in an exciting and enjoyable environment to optimise people’s business performance. We have applied all these principles when running courses with our customers, and we have seen some great successes, most notably whilst working with In2Focus on a Foundation Management Programme. It is important that the company we work with has the same shared beliefs, and that they genuinely believe in giving their people the best possible personal development, which, through Accelerated Learning, produces both accelerated results in the field and career progression, through the In2Focus Accelerated Development Programme. Let’s take a look at some of the results Chris Smith joined In2Focus back in April 2002 having spent a successful and happy 8 years at Sanofi. Chris had worked in a variety of roles, which helped him develop others, such as training and coaching. Looking for new challenges when he joined In2Focus, he soon expressed his interest in moving into regional management. Chris followed the Management Development Career Pathway within In2Focus and to support his development plan had been given additional responsibilities in the team by his line manager including, recruitment, training and coaching. In April 2003 Chris took part in the first In2Focus Foundation Management Programme, which is a classroom based training module. The course is split into two parts, an initial three-day module, followed quickly by a two-day module. Management is all about achieving results through the efforts of others, and the course is carefully designed to provide the new manager with the practical skills and abilities to manage a team effectively. “What a fantastic and really fun learning experience this was” says Chris. “This was by far and away the best training course that I have ever attended. The superb blend of presentations and practical exercises seemed to work perfectly. The course was fun and a real buzz, and, for me, had just the right balance of theoretical and experiential learning. It gave me the insight into the regional managers job that I needed, and provided me with practical real life scenarios to cope with.” Shortly after the training was completed, Chris was appointed as an RBM for the In2Focus Otsuka team. Reflecting on the usefulness of the course, Chris said, ”This aspect of my learning has proved to be truly invaluable in my experience as a Regional Business Manager so far. The course and the ongoing advice and support framework provided by In2focus has set me up to succeed in handling the challenges of line management both positively and effectively.” Kate Wilkey joined In2Focus as a nurse advisor in late 2001. Kate had previously worked in the NHS in several major hospitals and also had 15 months experience as a nurse advisor. Kate had been promoted from Nurse Advisor to Senior Nurse Advisor, then to Principle Nurse Advisor and just recently to Nurse Liaison Manager. Kate said “I have been extremely fortunate and have been given lots of opportunities to shine and progress. My role as Nurse Liaison Manager seems like the perfect job for me and I was well prepared for line management by the Foundation Management Programme and my manager’s developmental input. The Foundation Management Programme itself was a great course. I came away having learnt so much. The trainers were fantastic; they made the course so much fun and used so many different teaching mediums including videos, presentations and lots of role-play. Good constructive feedback helped you see the areas you were good at and the areas that you needed to work on. The whole course made me really take a step back and think carefully about what kind of manager I really wanted to be and taught me to think carefully about my responsibilities to others as a manager. This was truly the best course I have ever been on.” It seems that from the experiences of Chris and Kate that Accelerated Learning works well in developing people to reach their career goals and allows them to learn quickly in a fun progressive environment. To ensure the programme and training provided is of a high quality, the Institute of Leadership and Management sit in on sessions run by The Portland Partnership. In recognition of the high quality programme being delivered, they offer membership to delegates who go through the structured Accelerated Development Programme, and offer employees ongoing support through their management careers. So if personal development is top of your priority list and you want to learn and grow in a new and exciting environment, then Accelerated Learning is the way forward. Certainly my experiences to date using these new techniques show that if you can be entertained, have fun, be challenged, be active and work in a progressive environment the results can be amazing. So my advice is try it, it may be the best thing you ever do! Susan Glenn is a Director of The Portland Partnership, which specialises in offering people skills programmes, using accelerated learning techniques. For further information on the range of services offered by The Portland Partnership, contact Susan on susan@portlandpartnership.com or Mark Murphy on mark@portlandpartnership.com or call on 01494 670264

Historically, pharmaceutical marketing has always been detailing of pharmaceutical products to physicians by medical reps, product sampling to doctors, and conduction of promotional events. Due to increasing competition in the market in the recent past there has been a paradigm shift in pharmaceutical marketing with an increase in promotional spending. Pharmaceutical companies are spending a considerable amount of money on Direct–To-Consumer (DTC) advertising in media such as television, radio, the Internet, and print. How effective is DTC advertising in actual transformation to sales and its relevance has had different views from different sections and is still debatable. The magnitude of the effect of DTC advertisements on numerous factors – the demand for drugs, public perception of drug safety, prescribing trends, public health, drug costs, and overall health care costs – has not yet been accurately quantified.

 Media advertising has started playing an important role in the promotion mix recently. However, unlike fast-moving consumer goods, the rules of the game in pharmaceutical marketing are different. In the prescription drugs business it is the physician that decides on the medicines a patient needs to take for a particular illness. The impact of DTC advertising and the influence of the patients on the drugs prescribed by the doctor is limited according to a research study “The Impact Of Direct-To-Consumer Advertising On Physician-Patient Relationship” conducted by Kathryn J. Aikin of the Division of Drug Marketing, Advertising, and Communications (DDMAC), FDA. Some of the key findings of the study are that DTC advertisements increase awareness and that patients still consider doctors as the number one information source about treatments and illnesses. Brand-specific requests by patients are likely to be accommodated by physicians. According to the study a vast majority of patients that had asked about a specific brand had a condition that the drug treats.

Relationship Between DTC Advertising and Physicians’ Prescribing Behaviour

It is interesting to note that there is a synergy that is developing between DTC advertising and doctor sampling. Patients that see the products being advertised on television often get free samples from their doctors along with their prescriptions. In fact, some companies advertise free samples and urge potential patients to benefit out of the limited offer of these. It has also been found in the research conducted by the National Institute for Healthcare Management (NIHCM) Foundation that doctors prescribed 25 percent more prescriptions for the 50 most heavily (DTC) advertised drugs (aggregated) compared to 4.3 percent more scripts for all other drugs combined. Sales of the top 50 most heavily advertised drugs rose an aggregated 32 percent from 1999 to 2000 compared to 13.6 percent for all other drugs combined. The study also found circumstantial evidence that the sales of three oral antihistamine drugs, Claritin, Allegra, and Zyrtec, all approved in early to mid 90s have been substantially boosted due to heavy DTC advertisement campaigns from 1998 to 2000. The impact on the sales due to heavy DTC advertising seems to have a more profound influence on the lifestyle disorders category. Companies use a DTC marketing approach for drugs to treat conditions that consumers understand and for drugs that may be used for self-treatment. Thus, drugs to treat allergies, pain, arthritis, gastrointestinal upset and ulcers, asthma, diabetes, high cholesterol, and depression have been widely promoted. According to a study conducted by NDC Health the top five promotion spenders are Pfizer, GSK, Merck, J&J, and AstraZeneca, in that order. DTC spending constitutes 25 percent to 30 percent of their total promotional expenditure. Pfizer leads others by spending $1.4 billion in promotions and has four products in the top retail dollar sales namely Lipitor, Celebrex, Zoloft, and Norvasc. Refer Chart-1 for the top four DTC advertised products in 2002 and their global financial performance in 2002 and 2003. According to statistics the overall brand awareness of PROCRIT among chemo patients rose from 3 percent to 53 percent after the DTC campaign and the sales of PROCRIT soared by 29 percent to $3 billion in 2000. Levitra, the new introduction for treating erectile dysfunction in men from Bayer and GSK, has gained 50 percent of new scripts in its first month on the market. Levitra promotion has been intense in places where men gather such as posters at airports, national TV news, sports programs, and NFL games. Pharma companies seem to be gung-ho about the positive impact DTC advertising has on their sales, while maintaining a stand that health information in advertisements increase understanding of medical conditions and prompt patients to see their doctors. Their optimism is supported by the fact that more than 20 of the top 50 heavily advertised drugs also figure in the 50 best selling drugs list. However, it is also important to note that it is only ‘blockbuster’ drugs that are heavily advertised and these products are also aggressively promoted to doctors with heavy sampling. Patients’ attitude over DTC advertisements is also becoming less positive though there is an increase in the number of doctor visits and prescriptions handed out. While the influence of DTC is good on sales, questions arise as to who actually ends up footing these expensive advertising bills.

Background

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