"The patient has become a consumer of health"

Easy Pod: Launch video for a growth hormone device from Merck Serono. The first time ever an Rx product was launched without a voiceover and won the 1st Grand Global Award for McCann Healthcare globally (Read Amar Urhekar's description of this piece later in the story)

What is the difference in healthcare advertising in India versus the rest of APAC?

I think there are three aspects. One, is that India is still a very generically-driven market. Generally what happens in the rest of the world is that when a molecule (drug) is researched and patented, then that company gets the exclusive rights to market it in that country and globally for a certain period. But in India, we never respected the product patent; we only respected the process patent, which meant that whoever created the molecule didn’t matter as long as we could produce the same molecule in a different way, and market it.

So, it was great from a India perspective, because then a drug like Plavix, which is the world’s largest blood thinning agent, from an international pricing structure would cost Rs 800 a tablet in India and that’s drastically unaffordable. But because of our process patent regulation, there are Indian companies selling it for Rs 5. That disparity was massive, but it’s changing now (since 2005, when we accepted the WTO norm and now it’s becoming a more branded marketing industry). What’s happening is that many large, successful molecules from the West were already launched before 2005, so there are generics available. Therefore, the price point is so low that the activities that you do are also different. Imagine if you’re the only brand and company marketing a molecule in that country for 10 years, what you do in terms of market-shaping activities, or disease-gravity campaigns are different. There’s a lot of high value work that’s done on molecules and brands outside of India. In India, it’s more mass, consumption driven, which is why the value output is a bit low from the communications perspective.

The second difference is that everything is OTC in a way in India. But if you look at APAC or the West, there are Rx drugs and then there are OTC drugs. The rules and regulations are different, and so, there is a certain skill set that’s needed to talk to the consumer. That’s a bit less in the Indian context. In Japan, which molecule will be converted from Rx to OTC over the next five years and why, has already been agreed upon.

The third aspect is that of medical communications. A customer relationship management exercise in India is drastically different from what we do in the rest of APAC. The conversation around science is a bit low, it’s more about relationships (in other parts, there’s more of a balance, because the science is a rule; every doctor has to participate in a continuous medical education programme). I’m not saying Indian pharmaceutical companies don’t update the doctors, but updating from a brand perspective and then from an educational perspective are two different things.

Communication actually comes at the far end of the channel, after rules and regulations. There are a lot more ways in which even we as an advertising agency are engaged with clients. For instance, in China, we worked with the FDA to set up the OTC guidelines (what it should or shouldn’t advertise, not showing the face of the patient, showing the symptoms but not the relief).

Why do you think that healthcare advertising agencies aren’t able to play that kind of role in India?

They have and they will. The onus is on us in more ways than one, as to how do we continue to position ourselves as the healthcare communications network in India.

This is our tenth year as McCann Healthcare in India, but we were also the first dedicated healthcare agency in the Indian context by an MNC network like McCann. What has happened is that our journey for the past 10 years has been superbly exciting, but it’s also about getting the quick wins and the low hanging fruit. So with regard to partnering with the government or Ministry of Health, that happens after the market has matured to a certain level. I think we’re getting there very fast: we’re talking to the Ministry of Health, the Public Health Foundation and other organisations in terms of how we can be involved. We’re talking to educational institutions in terms of what a good healthcare communications course should be all about.

Our effort in the last ten years has been to apply good communications practices to healthcare: simple things like consistency in branding, consumer insights, understanding the role of the pharmacist, doctor and chemist, improving the role of the medical representative and his communication with the doctor.

Are there action plans for epidemics and emergencies when they hit?

We try to galvanise our resources globally at that time, in terms of which markets or geographies have been affected the most. We’ve now expanded our relationships by working with public organisations, private companies and the academia (versus the traditional model of working only with private). We work with the Ministry of Health, NGOs like UNICEF, and have a global tie-up with the Harvard School Of Public Health. We also work with the University of Kyoto. As an example, we reached out through McCann Erickson in Pakistan to the local governments after the floods to highlight what would happen when people go back to their homes in Sindh, after the rescue and relief work was over. When they go back to nothing, that’s when Post Traumatic Stress Disorder could hit, and it could become an epidemic. As a communications agency, our role isn’t that high as yet, but we’re galvanising resources across WHO and the Harvard School to figure out how we can help later.

What do you think about remuneration for a network specialist agency when there are smaller players in the market?

I don’t think we have that problem. In my career in healthcare communications in McCann in India and APAC, we haven’t had a single brand which has been regionally or globally aligned. We are a network agency but we don’t have network brands. We are always fighting and winning businesses locally. What we try and synergise are our experiences and learnings as a value addition for our clients.

In my early days of running the agency in India in 2001, we used to work with pharma companies like USV. Most local and MNC pharma companies in India were working with smaller agencies; their rate cards and charging systems were drastically different from ours. But we were able to convince clients of the value we could bring and USV in fact was such a progressive company, that they were our first retainer fee clients, and it was at par with what an FMCG client would pay a McCann Erickson.

I really think it’s about the day to day value addition that we bring to clients.

What are the challenges in healthcare communications?

I could break this into two or three buckets: the single most important trend that is going to affect healthcare communications, as it is affecting other kinds of communication, is the spread of digital, and access to information. If you look at the relationship between the doctor and the patient over the last 20 years, we’ve monitored a change in the terminology. Our parent’s generation would say "I went to see the doctor but the clinic was closed." Another generation would call the doctor’s clinic a "dukaan" (shop). So from "clinic" to "shop", there’s a significant commercialisation of his practice.
The second is that the patient has become more of a consumer of health, rather than a sufferer of health problems. The blind trust has vanished, thanks to Google. There are some very smart doctors and hospitals who have adapted to this trend, where they assume the patient is going to walk in with a certain level of information. If you go to social forums like PatientsLikeMe, there’s so much you can know about health and wellness even before you go to the doctor. And that’s changing because the influencers are far more.

I think it’s unfairly difficult for pharma companies. In non-pharma industries, information helps you to make a choice, and you can buy another biscuit or milk brand if you aren’t happy with your choice. But in health, it’s unfair that consumers start thinking they’re the experts. And they’re not; all they’re getting is syndicated information. So, pharma companies and hospitals have to provide the information and data for those who need it, but at the same time the respect and the diagnosis forte is still with the doctor.

The same is the case with social media: everyone says you have to be on Twitter, but what should an MNC tweet about – a new molecule or drug or implication? But it’s difficult because you can’t control the conversation and you’re talking about health. Last year on January 13, 2010 at 10.23am, thousands of people came on the streets of London and overdosed on homeopathy pills, basically to say it doesn’t work. That is consumer activism of sorts, and what should a homeopathy company do to react to it? These things just spiral into a big ball that you can’t control.

The jury’s still out on the impact of digital on the healthcare industry. It is going to be significant.
The second thing that will impact healthcare and healthcare communications is regulations. Governments are not spending enough and with the world going through the recession (and the budget cuts and austerity cuts) I don’t think healthcare budgets are going to increase, which means it will be more private pay. In other parts of the world, like Japan, it is a big issue.

What would you see as the opportunities in healthcare communications?

First is the opportunity of the way consumers think about health. There is a rise in the acceptance of alternative medicine. Second, is with vaccines and biotechnology, the way you treat diseases is also going to be very different. I think the opportunities are far more than the problems, because the latter are foreseen.

To quote an example with the negative and positive, if governments want to cut their contribution to healthcare costs, can there be another world view where they say we will continue to pay till you are well? In ancient China, emperors used to pay their doctors to keep them well and not to treat their illness. That’s something healthcare companies should look for. Nobody wants to be an illness customer; they want to be a wellness customer. So the more our communication becomes wellness oriented (not just from a health perspective but a holistic point of view), the better it could be.
The third opportunity is the wellness industry, that is worth more than a trillion dollars and that happened overnight. India is a classic case of wellness products – from companies like Coca-Cola, Unilever, Pepsico, Britannia.

Where is the line between McCann Erickson and McCann Healthcare for a brand like Coca-Cola?

There is a very clear line. Coca-Cola is our client in Japan for McCann Healthcare and McCann Erickson, but less for the latter.

Love Body Ginger Drink: Dedicated advertorials in Asahi Medical communicated the benefits of ginger as endorsed at Round Table meetings of professionals

We work very closely with Coca-Cola in terms of product development and evidence generation. When they launched a new brand in Japan called Love Body, we actually helped them conceive the entire product in terms of what the ingredients should be and what health benefits it should provide and how we can wage communication programmes around that. The first variant was for Love Body Ginger. We went through all the syndicated research on scientific evidence on ginger; then we did Japan-specific ginger research; we spoke to doctors and they supported the health benefits of ginger (it helps your nerve sympathetic system, and therefore helps you lose weight and keep fit).

On the basis of that experience, we worked on Coke’s water brand called Aquarius. Coke does hydration campaigns in summer, but as a healthcare communication, we went with hard evidence to Coke that hydration is actually a big problem in winter. So last year, Coke did a massive campaign for Aquarius in winter for the first time and we’re sponsoring a snow festival in Hokaido. That’s how a healthcare agency can challenge a creative agency.

Aquarius: Issues related to dehydration in winter were communicated at winter festivals. The first time Aquarius water brand participated at Snow Festival in Hokkaido.

Can a creative agency be challenged though in terms of creative output in healthcare communications, and how much of it goes into scam?

The healthcare industry is pretty naïve in that sense; we really don’t have the wherewithal to do scams in the industry terminology; the barriers are also very high. The opportunity for good communication is phenomenal, because right now the work that is done isn’t sexy, it isn’t creative enough. The moment we talk of a disease, you show the organ affected. The pharma industry is so regimented that every communication is fast, safe and efficacious. Our opportunity is to break the mould. Last year, we won the Grand Global (the most reputed healthcare award) in the prescription category, for some work we did in Japan. This was for a growth hormone device called Easy Pod– it’s a difficult product to communicate because it’s directed at mothers and there’s a lot of emotional trauma about the baby not growing properly. Our competitors typically went overboard communicating the science. We actually launched this product in Japan, with no voiceover, no science and no bar charts or graphs – with everything communicated in a three-minute video, showing a happy, healthy, growing girl.