Ayurveda ( is a system of medicine with historical roots in the Indian subcontinent.

[2] Globalized and

modernized practices derived from Ayurveda traditions are a type of alternative medicine.[3][4] In
countries beyond India, Ayurvedic therapies and practices have been integrated in
general wellness applications and in some cases in medical use.[5][page needed]
The main classical Ayurveda texts begin with accounts of the transmission of medical knowledge
from the Gods to sages, and then to human physicians.[6] In Sushruta Samhita (Sushruta's
Compendium), Sushruta wrote that Dhanvantari, Hindu god of Ayurveda, incarnated himself as a
king of Varanasi and taught medicine to a group of physicians, including Sushruta.[7][8] Ayurveda
therapies have varied and evolved over more than two millennia.[2] Therapies are typically based on
complex herbal compounds, minerals and metal substances (perhaps under the influence of early
Indian alchemy or rasa shastra). Ancient Ayurveda texts also taught surgical techniques,
including rhinoplasty, kidney stone extractions, sutures, and the extraction of foreign objects.[9][10]
Although laboratory experiments suggest it is possible that some substances used in Ayurveda
might be developed into effective treatments, there is no scientific evidence that any are effective as
currently practiced.[11][dubious – discuss] Ayurveda medicine is considered pseudoscientific.[12] Other
researchers consider it a protoscience, or trans-science system instead.[13][14] In a 2008 study, close
to 21% of Ayurveda U.S. and Indian-manufactured patent medicines sold through the Internet were
found to contain toxic levels of heavy metals, specifically lead, mercury, and arsenic.[15] The public
health implications of such metallic contaminants in India are unknown.[15]
Some scholars assert that Ayurveda originated in prehistoric times,[16][17] and that some of the
concepts of Ayurveda have existed from the time of the Indus Valley Civilization or even
earlier.[18] Ayurveda developed significantly during the Vedic period and later some of the non-Vedic
systems such as Buddhism and Jainism also developed medical concepts and practices that appear
in the classical Ayurveda texts.[18] Doṣa balance is emphasized, and suppressing natural urges is
considered unhealthy and claimed to lead to illness.[19] Ayurveda treatises describe three
elemental doṣas viz. vāta, pitta and kapha, and state that equality (Skt. sāmyatva) of
the doṣas results in health, while inequality (viṣamatva) results in disease. Ayurveda treatises divide
medicine into eight canonical components. Ayurveda practitioners had developed various medicinal
preparations and surgical procedures from at least the beginning of the common era.[20]

Contents

 1Eight components
 2Principles and terminology
 3Practice
o 3.1Diagnosis
o 3.2Treatment and prevention
o 3.3Substances used
o 3.4Panchakarma
 4Current status
o 4.1India
o 4.2Other countries on the Indian subcontinent
o 4.3Outside the Indian subcontinent
 5Classification and efficacy
o 5.1Research
 5.1.1Use of toxic metals
 6History
o 6.1Main texts
 o 6.2Illnesses portrayed
o 6.3Further development and spread
 7Footnotes
 8See also
 9References
 10Further reading
 11External links

Eight components[edit]
The earliest classical Sanskrit works on Ayurveda describe medicine as being divided into eight
components (Skt. aṅga).[21][22] This characterization of the physicians' art, "the medicine that has eight
components" (Skt. cikitsāyām aṣṭāṅgāyāṃ चचचचचचचचचचचचचचचचचचचचचचच), is first found in
the Sanskrit epic the Mahābhārata, c. 4th century BCE.[23] The components are:[24][25][26]

 Kāyachikitsā: general medicine, medicine of the body

 Kaumāra-bhṛtya (Pediatrics): Discussions about prenatal and postnatal care of baby and
mother, methods of conception; choosing the child's gender, intelligence, and constitution; and
childhood diseases and midwifery.[27]
 Śalyatantra: surgical techniques and the extraction of foreign objects
 Śhālākyatantra: treatment of ailments affecting ears, eyes, nose, mouth, etc. ("ENT")
 Bhūtavidyā: pacification of possessing spirits, and the people whose minds are affected by such
possession
 Agadatantra/Vishagara-vairodh Tantra (Toxicology): It includes subjects about epidemics, toxins
in animals, vegetables and minerals. It as well contain keys for recognizing those anomalies and
their antidotes.
 Rasāyantantra: rejuvenation and tonics for increasing lifespan, intellect and strength
 Vājīkaraṇatantra: aphrodisiacs and treatments for increasing the volume and viability of semen
and sexual pleasure. It also deals with infertility problems (for those hoping to conceive) and
spiritual development (transmutation of sexual energy into spiritual energy).

Principles and terminology[edit]

Further information: Mahābhūta
Shown in the image is Nagarjuna, known chiefly for his doctrine of the Madhyamaka (middle path). He wrote
the medical works The Hundred Prescriptions and The Precious Collection, among others.[28]

The three doṣhas and the five elements from which they are composed.

The word "ayurveda" is Sanskrit: आयु र्वेद, Āyurveda, meaning knowledge of life and longevity.[25]
The central theoretical ideas of Ayurveda developed in the mid-first millennium BCE, and show
parallels with Sāṅkhya and Vaiśeṣika philosophies, as well as
with Buddhism and Jainism.[29][30] Balance is emphasized, and suppressing natural urges is
considered unhealthy and claimed to lead to illness.[19] For example, to suppress sneezing is said to
potentially give rise to shoulder pain.[31] However, people are also cautioned to stay within the limits
of reasonable balance and measure when following nature's urges.[19] For example, emphasis is
placed on moderation of food intake,[32] sleep, and sexual intercourse.[19]
Ayurveda names seven basic tissues (dhatu), which are plasma (rasa), blood (rakta), muscles
(māmsa), fat (meda), bone (asthi), marrow (majja), and semen (shukra). Like the medicine of
classical antiquity, Ayurveda has historically divided bodily substances into five classical elements,
(Sanskrit) panchamahabhuta, viz. earth, water, fire, air and ether.[33] There are also
twenty gunas (qualities or characteristics) which are considered to be inherent in all matter. These
are organized in ten pairs: heavy/light, cold/hot, unctuous/dry, dull/sharp, stable/mobile, soft/hard,
non-slimy/slimy, smooth/coarse, minute/gross, and viscous/liquid.[34]
Ama (a Sanskrit word meaning "uncooked" or "undigested" ) is used to refer to the concept of
anything that exists in a state of incomplete transformation. With regards to oral hygiene, it is
claimed to be a toxic byproduct generated by improper or incomplete digestion.[35][36][37] The concept
has no equivalent in standard medicine.
Ayurveda also names three elemental bodily humors, the doshas (called Vata, Pitta and Kapha), and
states that a balance of the doshas results in health, while imbalance results in disease. One
Ayurvedic view is that the doshas are balanced when they are equal to each other, while another
view is that each human possesses a unique combination of the doshas which define this person's
temperament and characteristics. In either case, it says that each person should modulate their
behavior or environment to increase or decrease the doshas and maintain their natural state.
In medieval taxonomies of the Sanskrit knowledge systems, Ayurveda is assigned a place as a
subsidiary Veda (upaveda).[38] Some medicinal plant names from the Atharvaveda and other Vedas
can be found in subsequent Ayurveda literature.[39] The earliest recorded theoretical statements
about the canonical models of disease in Ayurveda occur in the earliest Buddhist Canon.[40]

Practice[edit]
Ayurvedic doctors regard physical existence, mental existence, and personality as their own units,
with each element being able to influence the others.[clarification needed] This is a holistic approach used
during diagnosis and therapy, and is a fundamental aspect of Ayurveda. Another part of Ayurvedic
treatment says that there are channels (srotas) which transport fluids, and that the channels can be
opened up by massage treatment using oils and Swedana (fomentation). Unhealthy, or blocked,
channels are thought to cause disease.[41]

Diagnosis[edit]
Ayurveda has eight ways to diagnose illness, called Nadi (pulse), Mootra (urine), Mala (stool), Jihva
(tongue), Shabda (speech), Sparsha (touch), Druk (vision), and Aakruti (appearance).[42] Ayurvedic
practitioners approach diagnosis by using the five senses.[43] For example, hearing is used to
observe the condition of breathing and speech.[33] The study of the lethal points or marman marma is
of special importance.[34]

An Ayurvedic practitioner applying oils using head massage.

Treatment and prevention[edit]
Two of the eight branches of classical Ayurveda deal with surgery (Śalya-cikitsā and Śālākya-tantra),
but contemporary Ayurveda tends to stress attaining vitality by building a healthy metabolic
system and maintaining good digestion and excretion.[34] Ayurveda also focuses on exercise, yoga,
and meditation.[44] One type of prescription is a Sattvic diet.
Ayurveda follows the concept of Dinacharya, which says that natural cycles (waking, sleeping,
working, meditation etc.) are important for health. Hygiene, including regular bathing, cleaning of
teeth, tongue scraping, skin care, and eye washing, is also a central practice.[33]

Substances used[edit]
Plant-based treatments in Ayurveda may be derived from roots, leaves, fruits, bark, or seeds such
as cardamom and cinnamon. In the 19th century, William Dymock and co-authors summarized
hundreds of plant-derived medicines along with the uses, microscopic structure, chemical
composition, toxicology, prevalent myths and stories, and relation to commerce in British
India.[45] Animal products used in Ayurveda include milk, bones, and gallstones. In addition, fats are
prescribed both for consumption and for external use. Consumption of minerals,
including sulphur, arsenic, lead, copper sulfate and gold, are also prescribed.[33] The addition of
minerals to herbal medicine is called rasa shastra.
Ayurveda uses alcoholic beverages called Madya,[46] which are said to adjust the doshas by
increasing Pitta and reducing Vatta and Kapha.[46] Madya are classified by the raw material and
fermentation process, and the categories include: sugar-based, fruit-based, cereal-based, cereal-
based with herbs, fermentated with vinegar, and tonic wines. The intended outcomes can include
causing purgation, improving digestion or taste, creating dryness, or loosening joints. Ayurvedic texts
describe Madya as non-viscid and fast-acting, and say that it enters and cleans minute pores in the
body.[46]
Purified opium[47] is used in eight Ayurvedic preparations[48] and is said to balance the Vata and
Kapha doshas and increase the Pitta dosha.[47] It is prescribed for diarrhea and dysentery, for
increasing the sexual and muscular ability, and for affecting the brain. The sedative and pain-
relieving properties of opium are considered in Ayurveda. The use of opium is found in the ancient
Ayurvedic texts, and is first mentioned in the Sarngadhara Samhita (1300-1400 CE), a book on
pharmacy used in Rajasthan in Western India, as an ingredient of an aphrodisiac to delay male
ejaculation.[49] It is possible that opium was brought to India along with or before Muslim
conquests.[48][50] The book Yoga Ratnakara (1700-1800 CE, unknown author), which is popular
in Maharashtra, uses opium in a herbal-mineral composition prescribed for diarrhea.[49] In
the Bhaisajya Ratnavali, opium and camphor are used for acute gastroenteritis. In this drug, the
respiratory depressant action of opium is counteracted by the respiratory stimulant property of
Camphor.[49] Later books have included the narcotic property for use as analgesic pain reliever.[49]
Cannabis indica is also mentioned in the ancient Ayurveda books, and is first mentioned in
the Sarngadhara Samhita as a treatment for diarrhea.[49] In the Bhaisajya Ratnavali it is named as an
ingredient in an aphrodisiac.[49]
Ayurveda says that both oil and tar can be used to stop bleeding,[33] and that traumatic bleeding can
be stopped by four different methods: ligation of the blood vessel, cauterisation by heat, use of
preparations to facilitate clotting, and use of preparations to constrict the blood vessels. Oils are also
used in a number of ways, including regular consumption, anointing, smearing, head massage,
application to affected areas,[51][failed verification] and oil pulling. Liquids may also be poured on the patient's
forehead, a technique called shirodhara.
Cataract in human eye – magnified view seen on examination with a slit lamp. Cataract surgery is mentioned in
the Sushruta Samhita, as a procedure to be performed with a jabamukhi salaka, a curved needle used to
loosen the obstructing phlegm and push it out of the field of vision. The eye would later be soaked with warm
butter and then bandaged.[52]

Panchakarma[edit]
According to Ayurveda, panchakarma are techniques to eliminate toxic elements from the body.[53]

Current status[edit]

A typical Ayurvedic pharmacy, Rishikesh.

Based on the World Health Assembly resolution on traditional medicine (WHA62.13, compare as
well the 2008 Beijing declaration on traditional medicine[54]), the WHO has established a traditional
medicine strategy, which involves, among other complementary health systems,
Ayurveda.[55][page needed] The first previous global strategy was published in 2002 and dealt especially
with herbal medicines. The current version (2014-2023) is beginning to consider aspects of
Traditional and Complementary Medicine practices and practitioners and whether and how they
should be integrated into overall health service delivery.[55] It is as well part of the 2013 WHO, WIPO,
WTO TRIPS study on health innovation and access to medicines.[56]
The WTO[57] mentions Ayurveda in its intellectual property strategy. Traditional medicine, including
Ayurveda, contributes significantly to the health status of many communities, and is increasingly
used within certain communities in developed countries. Traditional medicine has a long history of
use in health maintenance and in disease prevention and treatment, particularly for chronic
diseases.[citation needed] Suitable recognition of traditional medicine is an important element of national
health policies and has a well important basis for new products with significant export
potential.[57] WTO, WIPO and WHO ask for respect for both the economic value and the social and
cultural significance of traditional knowledge and supports documentation of traditional medical
knowledge and enhanced regulation of quality, safety and efficacy of such products. The WHO
paper asks to integrate traditional and complementary medicine services, where appropriate, into
health care service delivery and self-health care and to promote an improved universal health
coverage by doing so.[55]

India[edit]
See also: Healthcare in India

Tulsi-flower (holy basil), an Ayurvedic herb

According to some sources, up to 80 percent of people in India use some form of traditional
medicine, a category which includes Ayurveda.[58][59]
In 1970, the Indian Medical Central Council Act which aimed to standardise qualifications for
Ayurveda practitioners and provide accredited institutions for its study and research was passed by
the Parliament of India.[60] In 1971, the Central Council of Indian Medicine (CCIM) was established
under the Department of Ayurveda, Yoga and Naturopathy, Unani, Siddha medicine and
Homoeopathy (AYUSH), Ministry of Health and Family Welfare, to monitor higher education in
Ayurveda in India.[61] The Indian government supports research and teaching in Ayurveda through
many channels at both the national and state levels, and helps institutionalise traditional medicine so
that it can be studied in major towns and cities.[62] The state-sponsored Central Council for Research
in Ayurvedic Sciences (CCRAS) is designed to do research on Ayurveda.[63] Many clinics in urban
and rural areas are run by professionals who qualify from these institutes.[60] As of 2013, India has
over 180 training centers offer degrees in traditional Ayurvedic medicine.[44][64]
To fight biopiracy and unethical patents, in 2001 the government of India set up the Traditional
Knowledge Digital Library as a repository for formulations of various systems of Indian medicine,
such as Ayurveda, Unani and Siddha.[65][66] The formulations come from over 100 traditional Ayurveda
books.[67] An Indian Academy of Sciences document quoting a 2003-04 report states that India had
432,625 registered medical practitioners, 13,925 dispensaries, 2,253 hospitals and a bed strength of
43,803. 209 under-graduate teaching institutions and 16 post-graduate institutions.[68] Insurance
companies cover expenses for Ayurvedic treatments in case of conditions such as spinal cord
disorders, bone disorder, arthritis and cancer. Such claims constitute 5-10 percent of the country's
health insurance claims.[69]
Maharashtra Andhashraddha Nirmoolan Samiti, an organisation dedicated to fighting superstition in
India, considers Ayurveda to be pseudoscience.[70]
In 9 November, 2014, India formed the Ministry of AYUSH. National Ayurveda Day is also celebrated
in India on the birth of Lord Dhanvantari (Dhanteras). In 2018, it was celebrated on 5 November.[71]

Other countries on the Indian subcontinent[edit]

About 75%-80% of the population of Nepal use Ayurveda,[72][73] and it is the most practiced form of
medicine in the country.[74]

Ayurveda spas are common in Sri Lanka, and some functions as home-based income generating activity.

The Sri Lankan tradition of Ayurveda is similar to the Indian tradition. Practitioners of Ayurveda in Sri
Lanka refer to Sanskrit texts which are common to both countries. However, they do differ in some
aspects, particularly in the herbs used.
In 1980, the Sri Lankan government established a Ministry of Indigenous Medicine to revive and
regulate Ayurveda.[75] The Institute of Indigenous Medicine (affiliated to the University of Colombo)
offers undergraduate, postgraduate, and MD degrees in Ayurveda Medicine and Surgery, and
similar degrees in unani medicine.[76] In the public system, there are currently 62 Ayurvedic hospitals
and 208 central dispensaries, which served about 3 million people (about 11% of Sri Lanka's
population) in 2010. In total, there are about 20,000 registered practitioners of Ayurveda in the
country.[77][78]
According to the Mahavamsa, an ancient chronicle of Sinhalese royalty from the sixth century C.E.,
King Pandukabhaya of Sri Lanka (reigned 437 BCE to 367 BCE) had lying-in-homes and Ayurvedic
hospitals (Sivikasotthi-Sala) built in various parts of the country. This is the earliest documented
evidence available of institutions dedicated specifically to the care of the sick anywhere in the
world.[79][80] Mihintale Hospital is the oldest in the world.[81]

Outside the Indian subcontinent[edit]

Ayurveda is a system of traditional medicine developed during antiquity and the medieval period,
and as such is comparable to pre-modern Chinese and European systems of medicine. However,
beginning in the 1960s, Ayurveda has been advertised as alternative medicine in the Western world.
Due to different laws and medical regulations in the rest of the world, the unregulated practice and
commercialisation of Ayurveda have raised ethical and legal issues. In some instances, Ayurvedic
practices or terminology have also been adapted specifically for Western consumption, notably in
the case of "Maharishi Ayurveda" in the 1980s. In some cases, this involved active fraud on the part
of proponents of Ayurveda in an attempt to falsely represent the system as equal to the standards of
modern medical research.[82][83][84]
Baba Hari Dass was an early proponent who helped bring Ayurveda to the US in the early 1970s. He
taught classes derived from the Suśrutha Saṃhitā and the Charaka Saṃhitha, leading to the
establishment of the Mount Madonna Institute, College of Ayurveda, Ayurveda World, and Ayurvedic
pharmacy.[clarification needed] He invited several notable Ayurvedic teachers, including Vasant Lad, Sarita
Shrestha, and Ram Harsh Singh. The Ayurvedic practitioner Michael Tierra wrote that "[t]he history
of Ayurveda in North America will always owe a debt to the selfless contributions of Baba Hari
Dass."[85]
In the United States, the practice of Ayurveda is not licensed or regulated by any state. Practitioners
of Ayurveda can be licensed in other healthcare fields such as massage therapy or midwifery, and a
few states have approved schools teaching Ayurveda.[86]

Classification and efficacy[edit]

Although laboratory experiments suggest it is possible that some substances in Ayurveda might be
developed into effective treatments, there is no evidence that any are effective in
themselves.[discuss][11] According to Cancer Research UK, no significant scientific evidence has shown
effectiveness of Ayurvedic medicine for the treatment of any disease, although massage and
relaxation are often beneficial for some cancer patients and there are indications from animal studies
that some herbal products used in Ayurveda might be explored further.[64]
Today, ayurvedic medicine is considered pseudoscientific on account of its confusion between
reality and metaphysical concepts.[12] Other researchers debate whether it should be considered
a protoscience, an unscientific, or trans-science system instead.[13][14][87]
A review of the use of Ayurveda for cardiovascular disease concluded that the evidence is not
convincing for the use of any Ayurvedic herbal treatment for heart disease or hypertension, but that
many herbs used by Ayurvedic practitioners could be appropriate for further research.[88]
Research into ayurveda has been characterized as pseudoscience. Both the lack of scientific
soundness in the theoretical foundations of ayurveda and the quality of research have been
criticized.[87][89][90][91]

Research[edit]
In India, research in Ayurveda is undertaken by the Ministry of AYUSH, an abbreviation for the
Department of Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy, through a
national network of research institutes.[92]
In Nepal, the National Ayurvedic Training and Research Centre (NATRC) researches medicinal
herbs in the country.[93]
In Sri Lanka, the Ministry of Health, Nutrition and Indigenous Medicine looks after the research in
Ayurveda through various national research institutes.
Use of toxic metals[edit]
Rasa shastra, the practice of adding metals, minerals or gems to herbal preparations, may include
toxic heavy metals such as lead, mercury and arsenic.[15] The public health implications of metals in
rasa shastra in India is unknown.[15] Adverse reactions to herbs are described in traditional Ayurvedic
texts, but practitioners are reluctant to admit that herbs could be toxic and that reliable information
on herbal toxicity is not readily available. There is a communication gap between practitioners of
modern medicine and Ayurveda.[94]
Some traditional Indian herbal medicinal products contain harmful levels of heavy metals, including
lead.[95] A 1990 study on Ayurvedic medicines in India found that 41% of the products tested
contained arsenic, and that 64% contained lead and mercury.[58] A 2004 study found toxic levels of
heavy metals in 20% of Ayurvedic preparations made in South Asia and sold in the Boston area, and
concluded that Ayurvedic products posed serious health risks and should be tested for heavy-metal
contamination.[96] A 2008 study of more than 230 products found that approximately 20% of remedies
(and 40% of rasa shastra medicines) purchased over the Internet from U.S. and Indian suppliers
contained lead, mercury or arsenic.[15][97][98] A 2015 study of users in the United States found elevated
blood lead levels in 40% of those tested, leading physician and former U.S. Air Force flight
surgeon Harriet Hall to say that "Ayurveda is basically superstition mixed with a soupçon of practical
health advice. And it can be dangerous." [99][100]
Heavy metals are thought of as active ingredients by advocates of Indian herbal medicinal
products.[95] According to ancient Ayurvedic texts, certain physico-chemical purification processes
such as samskaras or shodhanas (for metals) 'detoxicify' the heavy metals in it.[101][102] These are
similar to the Chinese pao zhi, although the Ayurvedic techniques are more complex and may
involve physical pharmacy techniques as well as mantras. However, these products have
nonetheless caused severe lead poisoning and other toxic effects.[97] Between 1978 and 2008, "more
than 80 cases of lead poisoning associated with Ayurvedic medicine use [were] reported
worldwide".[103] In 2012, the U.S. Centers for Disease Control and Prevention (CDC) linked Ayurvedic
drugs to lead poisoning, based on cases where toxic materials were found in the blood of pregnant
women who had taken Ayurvedic drugs.[104]
Ayurvedic practitioners argue that the toxicity of bhasmas comes from improper manufacturing
processes, contaminants, improper use of Ayurvedic medicine, quality of raw materials and that the
end products and improper procedures are used by charlatans.[102]
In India, the government ruled that Ayurvedic products must be labelled with their metallic
content.[105] However, in Current Science, a publication of the Indian Academy of Sciences, M. S.
Valiathan said that "the absence of post-market surveillance and the paucity of test laboratory
facilities [in India] make the quality control of Ayurvedic medicines exceedingly difficult at this
time".[105] In the United States, most Ayurvedic products are marketed without having been reviewed
or approved by the FDA. Since 2007, the FDA has placed an import alert on some Ayurvedic
products in order to prevent them from entering the United States

A PESTLE ANALYSIS FOR PHARMACEUTICAL INDUSTRY-

It never ceases to amaze me why so many businesses fail to take the time to look at the macro and
the micro environments when completing their business plans and strategies. These external forces
will play a big part in shaping the final outcome of the ultimate corporate achievement. Yet, most
managers focus only on internal factors and it is fair to say that sales growth and profits remain high
on their agenda.
The macro environment tends to have a long term impact and requires extensive research. Couple
this with the fact that many managers are over worked and under resourced and we begin to see
why the process is often not completed. There is no published evidence to confirm this hypothesis,
just anecdotal hearsay.
The remainder of this article will illustrate an example of a Macro or PESTLE analysis for the
pharmaceutical industry. It is set at a very general level but it can be used as a template or adapted
to be more specific if required:

Political
There is now growing political focus and pressure on healthcare authorities across the world. This
means that governments will be looking for savings across the board. Some of the questions the
industry should ask are:

 What pressures will be put on pricing?

 What services will be cut?
 Will the same selection of drugs be available to everyone?

In addition to this, could there be more harmonization of healthcare systems across Europe or the
USA? What impact will reforms have on insurance models?

Economic
The global economic crisis still exists yet government reports still show that the spend on healthcare
per capital continues to grow. Will the current healthcare models exist tomorrow? The growth in
homecare (as seen in the Nutrition sector) demonstrates how nursing services have moved to the
private sector and have become a key business offering.
The reduction in consumer disposable income will have an impact on those countries using health
insurance models particularly where part payment is required.
These economic pressures are seeing an increased growth in strategic buying groups who are
forcing down prices.
Increased pressure from shareholders has caused a consolidation of the industry: more mergers and
acquisitions will take place over the coming years.

Social / Culture
The increasing aging population offers a range of opportunities and threats to the pharmaceutical
industry. The trick will be to capitalise on the opportunities.
There is also the problem of the increasing obesity amongst the population and its associated health
risks.
Patients and home carers are becoming more informed. Their expectations have changed and they
have become more demanding. Public activism has also increased through the harnessing of new
social networking technologies. How can pharmaceutical companies get closer to consumers without
over stepping the regulatory boundaries?

Technological
Technological advancements will create new business prospects both in terms of new therapy
systems and service provisions. The online opportunities will see the growth in:

 New info and Communications technologies.

 Social Media for Healthcare.
 Customized Treatments.
 Direct to Patient Advertising.
 Direct to patient communications.

Legislation
The pharmaceutical industry has many regulatory and legislative restrictions. There is also a growing
culture of litigation in many countries. The evolution of the internet is also stretching the legislative
boundaries with patient’s demanding more rights in their healthcare programmes.

Environmental
There is a growing environmental agenda and the key stake holders are now becoming more aware
of the need for businesses to be more proactive in this field. Pharma companies need to see how
their business and marketing plans link in with the environmental issues. There is also an
opportunity to incorporate it within their Corporate Social Responsibility programmes. Marketing and
new product development should identify eco opportunities to promote as well.
The information above illustrates just a fraction of the likely macro factors involved in the
pharmaceutical industry. A better way to summarise it would be in a table:

2.2. PROMOTION IN PHARMACEUTICAL INDUSTRY India has one of the fastest growing pharmaceutical
markets in the world and its market size has nearly doubled in the last five years. The country’s
pharmaceutical market is expected to reach US $20 billion by 2015 from US$11.5billion in 2009 at a
CAGR of 11.7% and establish its presence among the world’s leading 10 markets (Ernst and Young2009).
However the pharmaceutical industry in the country is highly competitive with a large number of
multinational and domestic players vying for a greater pie of the market. These pharmaceutical firms
focus intensely on promotions targeted at doctors to achieve their goals. Promotional tools like
complimentary gifts and other incentives tend to influence the physicians (Dongre and Mahadevappa,
2010). Promotion the fourth marketing mix tool, stands for the various activities the company
undertakes to communicate its products merits and to persuade target consumers to buy them. (kotler
1999) The marketing communication mix (also called promotion mix consists of four major tools :
Advertising : any paid form of non-personal presentation and promotion of ideas , goods or goods by an
identified sponsor, :Sales promotion : Short term incentives to encourage purchase or sale of a product
or a service, Public relations : A variety of programs designed to improve , maintain or protect a
company or a Chapter 2 Literature Review 22 product image, Personal selling : Oral presentation in a
conversation with one or more prospective purchasers for the purpose of making sales. However, an
important or perhaps overlooked explanation for the uniformity of drug use relates to the potential
influence of pharmaceutical promotion. In contrast to surgical or medical procedures, for which no
concerted educational effort conveys evidence for what does and does not work, the pharmaceutical
industry has the resources to disseminate these types of messages and routinely does so (Robert W.
Dubois 2003). Based on information approved by the FDA (Division of Drug Marketing, Advertising,and
Communications), journal advertisements, visits to physicians, and convening of continuing education
seminars convey coherent information about a drug’s characteristics and its potential role in therapy.
Thus, physicians (and patients)see and hear the evidence frequently. This repeated and consistent
“education” can promote a more uniform approach and reduce variation. The impact of promotion is
neither uniformly efficient nor inefficient from a societal perspective. Those who view this area
simplistically will have a tendency to “throw the baby out with the bathwater”—that is, to eliminate
something of benefit while removing something that is perceived to be useless. There is no obvious
regulatory change that would selectively limit “relatively inefficient” promotional efforts. Proposals for
stricter regulation should consider their potential impact on the desirable outcomes that accrue from
pharmaceutical promotion. Physicians who prescribe medicaments to patients are the preferred target
group of sales promotion by pharmaceutical industry (Mitt. 2004). As studies Chapter 2 Literature
Review 23 show, pharmaceutical advertising actually exerts some influence on a physician's knowledge
and habit of prescribing medicine, to the point of even inducing him to give preference to a special drug.
Information on pharmaceuticals given by advertisements may contain some potential of bias, instead of
offering the physician a chance of objectives additional training. Free gifts from the pharmaceutical
industry may easily plunge a physician into a conflict of interest while giving therapy with drugs. The gift
relationship established between him and pharmaceutical enterprises is apt to mutate to some sort of
commitment he owes to the givers. Favoring, a drug which has come about through the influence of
advertising, can thus violate the principles of "good prescribing". For a treatment which contains
potential for bias and a conflict of interest cannot possibly match the profession's principles of
responsibility, fostering informed choice (autonomy), protecting the patient from harm (non-
malfeasance), acting in a patient's best interest (beneficence), and promoting equity in health care
(justice).Each physician should therefore be aware of possibly belonging to a preferred target group
pharmaceutical sales promotion is aiming at. He should take an independent attitude while acquiring
knowledge, and critically view the adequateness of free gifts he is offered. Even students of medicine
should be encouraged to critically reflect on the necessary and essential relationship to pharmaceutical
industries so that it may be molded according to the benefit of the patients. In assessing the ethical
implications of drug marketing techniques directed at physicians, the authors consider the impact of
these techniques on the principles of autonomy, nonmaleficence, and beneficence that underlie the
Chapter 2 Literature Review 24 physician patient relationship(Freeman and Kaatz 1987). They contend
that the aggressive promotional efforts and elaborate gratuity system in which pharmaceutical sales
representatives engage may insidiously weaken the physician's commitment to base prescribing
decisions solely on the best interests of the patient. Pharmaceutical marketing is a specialized field
where medical representatives form the backbone of entire marketing effort (Taneja and Arora 2006).
Pharmaceutical companies also appoints medical representatives and assigns them defined territories.
(Priya and Rajyalakshmi 2006) A regular visit by a smart medical representative is the best tool of
promotion for a pharmaceutical company. Presenting good quality literature, journals and sponsorship
for conferences or personal tours are preferable promotional tool in comparison to organization of free
camps, personal gifts, medicine samples or any other incentive. (Patrick 2008) Maintaining contact is
especially relevant for products intrinsically linked to customer’s concerns. Health related products fall
into this category, since many people are responsive to communication regarding their well being.
Overall sales growth in the U.S. prescription market moderated to 3.8% last year from 8% in 2006,
according to IMS Health, a provider of market intelligence to the pharmaceutical and health care
industries (Morrison 2008). The slowdown reflects the numerous challenges facing pharmaceutical
companies today: fewer new-product approvals, the loss of exclusivity of branded medicines, the
leveling of year-over-year growth from the Medicare Part D program and the effect of Chapter 2
Literature Review 25 safety issues, including a significant number of product withdrawals. It's clearly a
fairly sophisticated audience, probably a bit more skeptical than average," he said. "You have to be
specific about the discrete problem you're solving and the solution you're delivering. The marketing
message needs to be tuned to their language and their way of thinking, using vocabulary that resonates
with them and describes what they do and think about-accurately."As in every other industry, marketers
are increasingly turning online to deliver those messages. Though companies targeting their customers
and prospects online were previously concerned with how much traffic they were driving, the focus now
is on meeting the users' needs and giving them greater control over how they get relevant information
at the time of engagement, he said. "That really is a dramatic shift from the way communications have
occurred historically. Though marketers are drawn to the cost-effectiveness and measurability of online
marketing, more traditional methods remain a staple in reaching pharmaceutical executives. 2.3.
PROMOTIONAL TOOLS USED BY PHARMACEUTICAL INDUSTRY Pharmaceutical companies in India use
medical representative, advertising, journals and mailers, patient and retailer communication as a part
of their marketing strategy (Bhangle, 2007). Medical representatives are used for marketing products to
physicians and to exert some influence over others in the hierarchy of decision makers. Typically, sales
force expense comprises an estimated 15-20 percent of annual product revenues, the largest item on
the balance sheet. Pharmaceutical companies are realizing that the brands used for common ailments
like the common cold and coughs are increasingly being Chapter 2 Literature Review 26 purchased over
the counter (OTC). Thus, there is a tremendous potential to build these brands into “mega brands” just
by promoting them directly to consumers, and some pharmaceutical companies are already working in
this direction. Focusing on rural India, is not a strategy known to be very popular with pharmaceutical
companies, though commonly used by smaller ones. Normally companies rely on key opinion leaders in
metros, but some start in rural and semi-rural markets. Foreign multinational companies in India are
launching branded generics- off patent drugs not discovered or developed by the parent – to widen
their reach in Indian pharmaceutical market (Bisserbe 2009). Role of marketing in pharmaceutical
industry is increasing and inspiration by successful brands known from consumer goods market
influenced pharmaceutical companies enough to switch their attention to branding initiatives (Bednarik
2005). The research was conducted in the sample of psychiatrists in the Czech Republic. It was
concluded that pharmaceutical brand is likely to develop differently than the same of consumer goods
products-it seems to be built predominantly on long-term positive experience. Marketing’s role in this
process of developing a pharmaceutical should lie in finding relevant product position and building
brand identity compliant with real product capabilities. All this can be established with choosing the
right mix of promotional tools. General marketing studies in the area of the relative importance of
promotional tools have considered personal selling, and advertising (Thompson , 1966). Another study
conducted by (Taneja and Arora 2006)was based on analysis of different promotional tools used by
pharmaceutical Chapter 2 Literature Review 27 industry viz., physicians samples , medical equipments as
gift, greeting on birthdays and anniversaries with cake’s and gifts, regular visits of medical
representative or manager, subscription of journals, sponsorship for personal tours, textbook as gift,
participation by company in CMEs /conferences, promotion through internet/websites/ sms,
sponsorship for stay in conferences, organization of free disease detection camps, high value personal
gifts, sponsorship for travel expenses in conferences, product literature and updates, personality of
medical representative and manger, low value gifts. All the age groups give equal importance to the
thirteen type of promotional tools except three types of promotional tools i.e., medical equipments as
gift, textbook as gift and participation by companies in CMEs and conferences. In India, drug promotion
tools used by pharmaceutical companies can be broadly represented as medical representatives,
samples, advertisements (in journals, DTCA, mailers), conducting conferences, symposium and scientific
meetings and gifts(scholarly and non-schoalrly). Lal A. (2001) has comprehensively enlisted the
promotional activities by pharmaceutical industry in India, which include the activities of medical
representatives, drug advertisements to physicians, provision of gifts and samples, drug package inserts,
direct-toconsumer advertisements, periodicals, telemarketing, holding of conferences, symposium and
scientific meetings, sponsoring of medical education and conduct of promotional trials. Chapter 2
Literature Review 28 More specifically, it would be of benefit to pharmaceutical marketers to ascertain
to what extent prescribing decisions are influenced by company’s own promotional tools and relevant
interpersonal / organizational influences beyond marketers’ immediate control. (Evans and Beltramini
1986) Age also has also been found to be influencing prescription behaviour since older physicians were
more likely to solicit prescription drug information from sales representatives than were their younger
peers. According to IMS Health Report younger physicians (under 45 years) are more responsive to
edetailing program than older physicians’ (IMS 2004). It was further reported that physicians were likely
to solicit information from conferences and conventions (Beltramini 1986). It was reported that
physicians were offered gifts, trips and cash awards by pharmaceutical companies during the promotion
of their drugs(Conlan 1991). It was described that the importance of information sources is ranked in the
following order by physicians i.e., direct mail, journal advertising, detailing and meetings and
conferences (William 1991). Suggested that office items like patient record forms and prescription pads
are more effective since they are perceived to be less promotional(Baker 1992). Commercially
sponsored information varies in terms of its usefulness to and influence on physicians. (Choi and
Lee2007)It was found that physicians are receptive towards web as a source of prescription drug
information and Direct to Consumer promotions on web. It was found that advertisements in
professional media play an essential connect between pharmaceutical company and physician (Tebbey
2004). It was mentioned in one of the study that journal advertisements are a preferred source of
Chapter 2 Literature Review 29 information for physicians, presented in line with physicians’
utility(Castagnoli 2002). Detailing has been found to have positive impact on prescriptions written
(Manchanda and Chintagunta 2004). Medical representative amount to 80% of all promotional
expenditure, as quoted for anti-ulcer category drug (Wittink 2002). Due to ever decreasing ROI
pharmaceutical companies are using e-detailing as a complimentary approach to detailing (Alkhateeb
and Doucette 2008). Also, convenience, quality of information and incentives are the common reasons
for physicians’ adoption of e-detailing. 2.3.1. Medical Representative McCurry devised the following
classification of sales positions: Deliverer, Order taker, Missionary, Technician and Demand creator
(Kotler1992). Missionary sales man refers to those positions where the sales person is not expected or
permitted to take an order but is called on only to build goodwill or to educate the actual or potential
user( e.g., the medical ‘detailer’ representing an ethical pharmaceutical house). The pharmaceutical
industry in Japan employs about 42,000 medical representatives (Charles, Rietbroek, Johns, 1997).
Marketing pharmaceuticals in Japan: background and the experience of US firms. A regular visit by a
smart medical representative is found to be the best tool of promotion for a pharmaceutical company.
Text refers to medical representative as a missionary sales man. The missionary sales person is not
expected or permitted to take an order but is called on only to build goodwill or to educate the actual or
potential user (Kotler 1992). Detailing came out to be most powerful pharmaceutical marketing
instrument in the process (Campo K Chapter 2 Literature Review 30 et al. 2005). A survey was conducted
of 235 residents at a large, Midwest teaching hospital to understand how marketing activities influence
physician’s impressions of the pharmaceutical industry. It was found that physician form more positive
impression of pharmaceutical sales representative when the reps provide accurate information, are
trustworthy and behave ethically (Creyer and Hrisistodoulakis 1998). When physicians form more
positive impressions of pharmaceutical sales representatives, they tend to believe that pharmaceutical
industry understands their needs as well. And when physicians feel that pharmaceutical industry
understands their needs, they hold a more positive attitude towards the pharmaceutical industry
overall. (Brand and Kumar 2003) mentioned that medical representative form the best medium for
building trusted and valued relationships with targeted physicians. Use of medical representatives for
marketing products to physicians and to exert some influence over others in the hierarchy of decision
makers has been a time-tested tradition (Bhangale 2008). Typically, sales force expense comprises an
estimated 15 – 20 per cent of annual product revenues, the largest line item on the balance sheet.
Pharmaceutical firms in the United States currently tend to set physician-level detailing efforts according
to past prescription volume (Manchanda, Rossi, and Chintagunta 2004). Researchers in marketing and
economics have studied the impact of firms’ marketing activities (e.g., detailing) and feedback from
patients on the diffusion of new drugs within and across physicians (see Manchanda et al. 2005).
Detailing is the single largest marketing activity in the pharmaceutical Chapter 2 Literature Review 31
industry; it has more than three times the expenditure of the second largest activity: direct-to-consumer
advertising (Wittink 2002). 2.3.2. Advertising FDA’s regulation of Direct-to-Consumer pharmaceutical
advertising requires fair balance between the communication of risk and benefit information (Davis
2012). The fair balance requirement has stimulated a significant amount of research focused on the
communication of risk information with much less investigation of the communication of benefit and
efficacy information. This is unfortunate, since fair balance cannot be achieved if consumers do not have
an accurate understanding of how well a drug works. This research uses content analysis to determine
how efficacy information is communicated on branded pharmaceutical websites. The content analysis is
based on the creation of a media-neutral framework for the classification of efficacy descriptions. The
content analysis of 63 branded pharmaceutical websites showed that less than 5% of all drugs provide a
complete, specific, and numeric description of drug efficacy while nearly 80% describe drug efficacy
exclusively in vague and general terms. Implications of the findings for the regulation of Direct to
Consumer communications via branded drug websites are presented. Authors sought to examine the
impact of direct-to-consumer advertising (DTCA) and pharmaceutical promotion to physicians on the
likelihood that (1) an individual diagnosed with depression received antidepressant medication and that
(2) antidepressant medication was used for the appropriate duration. A quasi-experimental design was
used to examine treatment patterns of Chapter 2 Literature Review 32 30,621 depressed individuals
whose insurance claims were included in the Market Scan database from 1997 through 2000. The main
explanatory variables were spending on DTCA, detailing to physicians, and free samples for 6
antidepressant medications. Individuals diagnosed with depression during periods when class-level
antidepressant DTCA spending was highest (cumulative spending more than US 18.5 million dollars) had
32% higher relative odds of initiating medication therapy compared with those diagnosed during periods
when DTCA spending was lowest (P < 0.0001). Free samples of medications dispensed to physicians had
no effect on odds of initiating antidepressant use. Class-level DTCA spending on antidepressants had a
small positive effect on the duration of antidepressant use, whereas DTCA spending for the specific
medication taken by an individual had no effect on treatment duration. Detailing spending at the class
or product level had no significant effect on duration of treatment with an antidepressant medication.
Our results suggest that DTCA of antidepressants was associated with an increase in the number of
people diagnosed with depression who initiated medication therapy. DTCA was associated with a small
increase in the number of individuals treated with antidepressants who received the appropriate
duration of therapy. Promotion to physicians was not associated with either the initiation of treatment
with an antidepressant or with the duration of therapy. Direct to Consumer Advertising (DTCA) has been
found to be influencing consumers for the duration for which the therapy was taken. Although not much
data could be found on drug advertisements in medical journals but during pilot Chapter 2 Literature
Review 33 survey it was found that advertising in medical journals acts as a good source of
information(Donohue, Berndt, Rosenthal, Epstein and Frank 2004). Pharmaceutical drug manufacturers
employ a variety of promotional techniques (Michael et al 2009). For example, journal advertising
reflects advertising expenditures for prescription products appearing in medical journals aimed at
physicians. In addition, office/hospital promotional contact includes costs associated with the personal
selling activities of pharmaceutical representatives who are directed to office- and hospital-based
physicians and directors of pharmacies. This type of interaction is often referred to as detailing because
the sales representative details the unique attributes associated with a particular drug. In many cases,
sales representatives will detail more than one drug during a single appointment with a physician.
Product sampling reflects the sampling activities of pharmaceutical representatives that are directed to
office-based physicians. During a routine contact or detailing of a physician, sales representatives
typically leave the physicians complementary samples to distribute to patients when prescribing a drug
for the first time. Finally, DTC advertising is aimed directly at patients and includes expenditures for
pharmaceutical prescription products in media such as television, radio, newspaper, magazine, the
Internet, and outdoor advertising. Although DTC advertising has grown considerably, it is largely
concentrated on a small portion of drugs, and most brands are not advertised at all to consumers
(Calfee 2007). Detailing in pharmaceutical industry is defined as the process of communicating the
pharmaceutical product message to health care professionals (HCPs, Chapter 2 Literature Review 34
primarily clinicians) (Banerjee, Dash, Kumar 2011). In reality, for pharma representative, actual detailing
lasts for only few minutes, but the preparation and waiting time is very long. As a result, there is an
increasing trend of using interactive e-detailing, video e-detailing and other physicians’ online forums.
Edetailing is one of such selling process recently adopted by pharmaceutical companies in India for
communicating product messages to the HCPs. As this is a new way of communication, not much is
known about the views of physicians about E-detailing. The study attempted to understand the role of
different demographic, social, and behavioral variables behind acceptability of e-detailing by physicians
of India. The result from ordered probit estimation reveals that the professional service representative
(PSR) visit, invitation, and detailing type have a positive impact on the probability of acceptance of e-
detailing. Moreover, it can be seen that marginal increase in the PSR visit, invitation, and detailing type
increases the probabilities of e-detailing acceptability among physicians. One can see that, in India,
physicians consider e-detailing as more of complimentary in nature to ensure a holistic effect of
pharmaceutical marketing communication. 2.3.3. Sponsorships and gifts It's no secret that some drug
companies pay for doctors to attend medical conferences in exotic locales (Weintraub 2007). Others
treat them to pricey meals and pass out pens and Post-it notes branded with product names. All told,
drug and medical-device makers dole out an estimated $19 billion worth of gifts to physicians every
year. Maintaining contact with patients is especially relevant for products intrinsically linked to
customer’s concerns Chapter 2 Literature Review 35 (Patrick, 2008). During a qualitative analysis of the
physicians' decision process for drug prescription, it was found that free conference participation
influences drug choice in some situations (Campo et al. 2005). 2.3.4. Samples Not simply medical
representative but also prescription drug samples have been reported to be influencing physician
prescription behavior. Free drug samples serve as a marketing tool (Cutrona et al 2008)., Drug samples
are of current interest because of their influence on prescription and potential impact on patient
safety(Groves , Sketris and Tett 2003). Also the researchers have deliberated that very little research has
been conducted into the use and misuse of prescription drug samples( Halifax 2003). However, studies
have established that free drug samples have positive and statistically significant effect on number of
new prescriptions issued by a physician(Mizik and Jacobson 2004). Prescription drug samples, as used by
the pharmaceutical industry to market their products, are of current interest because of their influence
on prescribing, and their potential impact on consumer safety. Very little research has been conducted
into the use and misuse of prescription drug samples, and the influence of samples on health policies
designed to improve the rational use of medicines. This is a topical issue in the prescription drug debate,
with increasing costs and increasing concerns about optimizing use of medicines. This manuscript
critically evaluates the research that has been conducted to date about prescription drug samples,
discusses the issues Chapter 2 Literature Review 36 raised in the context of traditional marketing theory,
and suggests possible alternatives for the future (Groves, Sketris and Tett 2003). Physicians may learn
about prescription drug effectiveness directly from the firm via detailing or from patient experience.
Patient-mediated learning is aided by the use of free drug samples (Bala, Bhardwaj and Yuxin 2013). The
effective use of samples is hampered by a lack of understanding of its exact return on investment
implications. We seek to fill this gap by incorporating the physician's sample allocation behavior in the
firm's decision making. We uncover the following implications for firms as well as policy makers. First,
we find that the optimal sampling level for a drug category is a nonmonotonic function of patient
payment ability and the price of the drug. Second, an increase in the cost of samples can lead to an
increase in sampling and a decrease in detailing when the physician's propensity to provide sample
subsidies is high. Third, when future market growth is expected to be high (early stage product life cycle
and/or chronic drugs) and sampling efficiency is low, the use of sampling is profitable for the firm but
leads to lower market coverage than when sampling is disallowed. Although information gathering
about specific drugs is the key reason behind physicians meeting the pharma FLE, other reasons include
obtaining free samples and staying in touch with developments in medical practice(Lexchin 1989). The
promotional activities of the company are represented by the samples that a representative of the
company offers the physician in a typical sales call (Franklin and Chitturi 2009). A review of the extant
literature shows Chapter 2 Literature Review 37 that researchers have long recognized the importance
of this variable (Carter et al. 2006; Gönül et al. 2001; Iizuka and Jin 2003; Manchanda and Chintagunta
2004; Mizik and Jacobson 2004; Parsons and Abeele 1981). This form of promotion is of particular
importance in the pharmaceutical industry: the physician’s acceptance of the sample represents a
certain degree of commitment to use the product. Furthermore, the sample often is used by the
physician to provide the patient an initial supply of the drug. 2.4. PRESCRIPTION DRUG INFORMATION
SOURCE Physician use of particular types of prescription drug information source has received
considerable attention in literature. Numerous studies have focused on physician use of pharmaceutical
firm prescription drug information e.g., journal advertising, sales representatives, and direct mail
literature (Hemminki, 1975).Attention has also been given in a general sense to the effects of intra-firm
and inter-firm communications on purchasing decisions (Martillar, 1971). In the specific area of
pharmaceutical marketing consideration was given to the influence of advertising in medical journals
(Wegner, 1960)), and also to a comparison of medical journal and direct mail advertising (Ferber, 1958).
These studies, however, appear to overlook the relative importance of the various influencing factors
(Parasuraman 1981). Perceived usefulness of drug information sources by was investigated conducting a
physician survey (Evans and Beltramini 1986). On applying statistical tools it was found that physicians’
perceptions differ amongst various groups like general practitioners/ specialists and younger/ older
physicians. It was found that physician subgroups differ in the Chapter 2 Literature Review 38
importance they attach to drug information sources. It was also stated in the study that physicians seek
drug information from journal articles, followed by colleagues and conventions. There is evidence of
different classification terminology adopted by various authors. Organizational sources discussed above
have been renamed as the commercial sources of information (Vancelik et al. 2007). It was found that
commercial sources of information have greater influence than scientific sources on general
practitioners' (GPs) prescribing behavior in under developed and developing countries. Their study was
aimed at studying the self-reported impact of pharmaceutical promotion on the decision-making
process of prescription of GPs in Eastern Turkey. Study was conducted on 152 GPs. It was reported that
the commercial information provided by medical representatives was highly influential on their decision
making process of prescription. It was reported that physicians were likely to solicit information from
conferences and conventions (Evans and Beltramini 1986). Trade meetings are ranked among the three
top information sources amongst physicians for product information (Goldmerg, Lorimer and Goldmerg
Mim 2006). Manufacturer sponsored sources of information (e.g advertising and sales representatives)
have received the most attention in the physician prescribing literature(Rabin 1972; Walton
1980)though in general physicians have been found to place relatively limited importance on journal
and direct mail advertising, research results indicate that physician awareness and recall of journal
advertising and direct mail correlate with their prescribing of particular drugs(Walton Chapter 2
Literature Review 39 1980).Several studies have indicated that physicians view detail people as poor
sources of information, generally disapprove of those physicians who use detail people (Bauer and
Wortzel 1966; Hess 1974; Stolley et al. 1972). However contradictory findings have indicated that
physician drug preferences do correlate with their preference for detail people, particularly in low risk
prescription situations. In fact, one early study found detail people to be the information source most
frequently utilized by physicians at that time(Coleman, Katz and Menzel 1957). Social interaction or
“peer effect” may also act as an information source because non specialist physicians may rely on
prominent physicians(Nair et.al 2010). However there has been little empirical evidence that these
opinion leaders matter. One of the study conducted found no peer effects at all on prescription
behaviour (Van De Bulte and Lillien 2001). There are little or no chances for opinion leaders to act as an
information source (Watts and Dodds 2007). Interpersonal influences are discussions with colleagues,
associates and friends whereas organizational influences are hospital ward rounds, in-practice
discussions as well as doctor’s experience with products in their working situation (Pitt and Nel 1988).
Several studies have found that extensive use of journal articles is more frequent among physician
opinion leaders, that journal articles are used more frequently as the severity of patient disease
increases, and that journal article usage is related to needs for both new drugs and general prescribing
information. Journal articles appear to be highly credible sources of prescribing information; however
what remains unclear is what characteristics of journal articles physicians perceive as Chapter 2
Literature Review 40 important when assessing the usefulness of one article over another. Physicians,
with their training in diagnostics, are likely to be critical in their evaluation of research findings reported
in information sources. Thus, the usefulness of a journal article is likely to be a function of physicians’
perceived importance of certain information source characteristics such as the prestige of the journal,
the author(s) of the article, and the quality of the article’s research design (Evans and Beltramini 1986).
Moreover, physicians were most likely to solicit prescription drug information from journal articles,
followed by colleagues and conventions (Evans et al 1986). Though pharmacists were referred in the
physician prescribing behaviour literature, but they are found as a weak source of information. In one of
the studies it was found that physician specialty subgroups rated past experience with a pharmacist as
an important information source characteristic in contradiction to their perceived likelihood of using
pharmacists as an information source for prescribing purposes(Evans and Beltramini 1986). Variation in
physician use of both commercial and non-commercial (journal articles, colleagues and to some extent,
pharmacist)drug information sources also has been found in studies controlling for physician
specialization and years in practice (Hemminki 1975). It was reported in one study that non-commercial
sources (i.e., journal articles, colleagues and conventions) were preferred over commercial sources
(Evans and Beltramini 1986). In addition to medical journal articles, colleagues have been found to be
important sources of information for new drugs and/or when the physiology of the disease is not very
well Chapter 2 Literature Review 41 understood. In general, colleagues appear to perform a vital
function early in the adoption phase of new drugs or in high-risk situations. Though studies have found
that physician opinion leaders frequently attend out of town medical meetings (Rodgers 1983), little is
known about how physicians select among their colleagues for prescribing information purposes. The
context of our analysis is physicians’ prescription drug choice. An asymmetric social interaction or “peer
effect” arises in this setting because nonspecialist physicians may rely on prominent physicians, the
“opinion leaders,” to help reduce the uncertainty about their prescription choices. The role of opinion
leaders becomes most salient when changes occur in the therapeutic environment because these
typically lead to increased uncertainty about drug efficacy among the non-specialist physicians. The
pharmaceutical industry believes in the existence of such opinion leaders and has invested in targeting
marketing activities at opinion leaders (Cutting Edge Information 2004). However, to date, there has
been little empirical evidence that opinion leaders “matter” (i.e., significantly influence the opinions and
behaviour of other physicians). No asymmetries were found in peer effects between nominators and
their opinion leaders’ adoption patterns for a new drug (Coleman, Katz, and Menzel 1966). More recent
work using the same data as that study finds no peer effects at all (Van den Bulte and Lillien 2001).
Finally, using computational models of network tipping, Watts and Dodds (2007) also find little or no
role for opinion leaders. Chapter 2 Literature Review 42 Promotion mix of the company influences the
physicians’ prescription behavior. Promotional tools employed by the marketers act as an information
source. They play along with other information sources like colleagues, medical association, chemists,
hospitals and patients. Physician on the basis of the credibility he attaches to each of the information
source gets influenced. This influence guides the physician prescription behavior. In the pharmaceutical
context, if opinion leaders’ actions have a true causal effect on other physicians’ prescription behavior,
marketing effort directed at these opinion leaders will generate a multiplier effect. The multiplier arises
because an incremental sales call to an opinion leader increases the opinion leader’s prescriptions,
which in turn induces the physicians he or she influences to prescribe more. The extent to which net
prescriptions are higher as a result of these cross-physician spillovers is the “social multiplier” (Becker
and Murphy 2000).Opinion leaders are typically physicians who have an academic title with the
department of a medical school and have contributed peer-reviewed publications (Tan 2003). Industry
reports suggest that the pharmaceutical industry spends anestimated 24% of its new product
commercialization budgeton opinion leader activities (Cutting Edge Information 2004). Patients
increasingly request their physicians to prescribe specific brands of pharmaceutical drugs (Stremersch,
Landsman and Venkataraman 2013). A popular belief is that requests are triggered by direct-to-
consumer advertising (DTCA). We examine the relationship between DTCA, patient requests, and
prescriptions for statins. We find that although the effect of requests on Chapter 2 Literature Review 43
prescriptions is significantly positive, the mean effect of DTCA on patient requests is negative, yet very
small. More interestingly, both effects show substantial heterogeneity across physicians, which we
uncover using a hierarchical Bayes estimation procedure. We find that specialists receive more requests
than primary care physicians but translate them less into prescriptions. In addition, we find that the
socio-demographic profile of the area a physician practices in moderates the effects of DTCA on
requests and of requests on prescriptions. For instance, physicians from areas with a higher proportion
of minorities (i.e., blacks and Hispanics) receive more requests that are less triggered by DTCA and are
accommodated less frequently than physicians from areas with a lower proportion of minorities. Our
results challenge managers to revisit the role of DTCA in stimulating patient requests. At the same time,
they may trigger public policy concerns regarding physicians' accommodation of patient requests and
the inequalities they may induce. Given the possibility that physicians might be uncertain about the
quality of the new drug, researchers have typically assumed physicians learn about drug quality in a
Bayesian way, with detailing and patient feedback providing the information for such learning (Chan,
Narasimhan, and Xie 2007; Currie and Park 2002; Narayanan and Manchanda 2009). Various researchers
have demonstrated that physicians learn from multiple sources of information (e.g., Ching 2010a, b;
Ching and Ishihara2010, 2012; Coscelli and Shum 2004; Narayanan and Manchanda 2009; Narayanan,
Manchanda, and Chintagunta 2005) and that physicians are willing to sacrifice current utility by
experimenting with a new drug to obtain information that enables them to Chapter 2 Literature Review
44 make better future decisions (e.g., Crawford and Shum 2005; Ferreyra and Kosenok 2011). 2.5.
EFFECTIVENESS OF PROMOTIONAL TOOLS The relationship between pharmaceutical companies and
medical professionals should serve the patients’ best interests and improve the use of medicine in
society. A study was conducted in Yemen in 2012 to explore the current status of pharmaceutical
promotion and its influence on healthcare professionals’ practices and behaviour. A qualitative
approach was used to gain a better understanding of the current status of pharmaceutical promotions
and its influence on the quality use of medicine among healthcare professionals in Yemen. A total of five
themes were identified from the interview analysis: evaluation of current pharmaceutical promotions,
types and importance of promotional techniques, the importance of satisfying doctors’ needs, the
influence of the economic situation and the influence of doctor/medical representative interactions on
the medicine dispensers’ business behaviour. It was concluded that all of the offered promotional items
were in exchange for the doctors’ prescriptions. The participants assured us that pharmaceutical
companies use unfavourable promotional methods to ensure that their products sell. They also believed
that the doctors’ low income and the patients’ inability to afford medications was a suitable
environment for unethical pharmaceutical promotion. Doctors benefitted from this situation by
demanding that pharmaceutical companies satisfy their needs, either scientifically or personally.
Chapter 2 Literature Review 45 The absence of official regulation encourages such an environment. (Al-
Hamdi, Hassali Ahmad and Ibrahim, 2012) Pharmaceutical and biotechnology companies are beginning
to establish a significant corporate social media presence, but the extent to which tools such as Twitter
are being utilized to discuss and disseminate newly available scientific data remains poorly understood.
A study analyzed over 3400 tweets generated by attendees at a major global scientific conference in
order to better understand the actual extent and nature of pharmaceutical and biotechnology industry
discourse via Twitter. The pharmaceutical industry and its support service providers were the largest
segment of ASCO Twitter oncology community users, but unlike physicians, predominantly utilized this
medium for promotional dialogue as opposed to clinical news or clinical management discussion. The
total number of pharmaceutical companies that utilized Twitter on site as an adjunct to other public
relations channels was small (Chaudhry and Aafia 2011). Food and Drug Administration (FDA) on April
2009 released warning letters to 14 major pharmaceutical companies about search engine advertising,
effectively curtailing an aspect of internet marketing by pharmaceutical industry. These warning letters
were posted to the public on 3 April 2009. Given that the efficient market hypotheses suggest that stock
prices fully reflect all publicly available information and are unbiased indicators of firm value, this article
presents an analysis of stock market reactions of pharmaceutical firms around the time of the FDA
announcement, using both regular and abnormal returns. Two groups of firms were analyzed, those that
Chapter 2 Literature Review 46 received the warning letters and those that did not receive the letters.
We find a significantly negative stock market reaction for both groups of firms, suggesting that the
letters had negative impact on shareholder's value to the industry as a whole. The results indicate that
internet marketing is important, and thus it is imperative that the industry works in tandem with the
FDA to develop better guidelines on the appropriate use of the internet for the marketing of
pharmaceuticals. The cost for pharmaceutical firms for not utilizing the internet capabilities to
communicate value to the stakeholders can be significant (Jambulingam and Sharma 2010). The article
discusses the usage of technologies by pharmaceuticals companies such as AstraZeneca to boost sales
force effectiveness (McGuire 2008). It informs that AstraZeneca's sales force is equipped with
technologies having interactive detailing capabilities such as laptop computer and handheld device to
record all information in making interactive calls. Other pharmaceutical companies have provided
customer services portals including MerckServices.com, Lillysamplecenter.com, and Pfizerpro.com. The
article presents research on advertising and marketing management by the U.S. pharmaceutical industry
(Saxton 2011). It is considered whether pharmaceutical companies should present similar advertising to
their two target audiences of physicians and patients, or if they should customize advertising for each
target market. It is found that a consistent advertising message strategy was unrelated to advertising
effectiveness. Similarity of presentation of advertising was negatively related to its effectiveness even
when patients were the dominant Chapter 2 Literature Review 47 factor in brand choice. Findings are
said to indicate the need for narrowly targeted advertising aimed at customers' needs.

MARKETING COMAPIGN

Most pharmaceutical companies face many challenges when it is time to

market their products. The pharmaceutical industry is highly regulated, and
it’s also an industry which is known for attracting litigation attorneys
looking for false claims. There are a wide range of various pharmaceutical
marketing strategies you are able to choose from in order to attract the
attention of prescribing physicians as well as their patients. Below are
eleven strategies to help you successfully market your pharmaceutical
company.

1. Don’t Neglect Your Social Media

Presence
Remember that content is crucial for attracting the attention of your
prospects. Content is what drives engagements, so make sure that you
strike the right balance between being overly promotional and publishing
content that the viewer wants to see. As one of the newer pharmaceutical
marketing tactics to be used by drug manufacturers, social media is often
used to get attention online. Because many physicians use social media to
market their practices, there is a high chance they will be checking social
media. Patients also get information online about treatments for their
health conditions, so be sure to address both audiences in your drug’s
social media campaigns.

2. Be Sure To Build Relationships

Having good relationships with physicians is a key aspect of being a
successful pharmaceutical marketer. The reason is that physicians want to
prescribe pharmaceutical products from sales reps that they know and trust.
Physicians feel a sense of responsibility to their patients.

3. Offer Free Samples

Physicians whom receive free samples of a product are more likely to
prescribe it. They are able to hand these out directly to their patients who
will be able to try your product for free without risk. This is one of the
more traditional methods of pharmaceutical marketing, and it is quite
effective in being able to reach a large number of people. However, this
strategy can walk a fine line between ethics, as many health care networks
ban doctors from taking samples. While effective, it pays to do this in a
responsible manner so your reputation doesn’t come into question.

4. Utilize Technology
Physicians tend to be early adopters of new technologies. Healthcare is a
profession which requires people to continually update their ways of doing
business and their technology practices. Physicians were the first to use
PDAs when they came out many years ago then were the initial users of
smartphones and tablets. Pharmaceutical reps have always wanted to spend
time with physicians in person, but many have decided that with new
technology, there are other ways of interacting with doctors.

5. Have Quality Website Content

Make sure that the drug’s website has all of the content that a prescribing
physician or a patient would need. It should explain the benefits of the
drug, recommended dosages, clinical trial data, safety information, risks,
and more. The site should be easy to navigate, and you should also have a
system in place for capturing a person’s email address. The website is the
primary customer communication tool for the drug, so it should be a good
landing page for customers.

Having high-quality content on your pharmaceutical website not only helps

with user satisfaction, but it also drives Google rankings and traffic.

Bill Ross, Linchpin SEO, A Pharmaceutical Web Design Agency

6. Break The Rules With Guerrilla
Marketing
It always pays to think creatively when you are looking at your marketing
tactics. Guerrilla marketing happens in unexpected ways. Sometimes, a
pharma marketing expert might directly target their competitors in some
unexpected way. Many companies see this as a great method for being able
to stand out from the crowd. This is also one of the more risky forms of
pharma marketing because you are challenging the norms.

7. Connect With Customers

Emotionally
One idea for reaching new clients as a pharmaceutical marketing firm is to
create a meaningful experience that connects emotionally with customers.
If you are working on campaigns for an antidepressant drug, you may want
to think about using a mobile app campaign that encourages people to
share their feelings. This might require a little bit of B2C outreach, but the
truth is you will be able to reach more people.

Remember, when creating experiences to connect with customers

emotionally, it is vital that you do it with an ethical marketing baseline to
ensure you are being respectful and responsible with your messages.

8. Reach Physicians Through Online

Communities
One often-overlooked tactic is to reach physicians via online communities.
Because physicians are early adopters of technology, they are always
looking for new ways to connect with other professionals. These
communities are the perfect place to reach these physicians directly. You
can have conversations with physicians and patients alike to learn more
about what they are looking to hear.

9. Create Visual Aids For

Physicians
Remember that there is value in having visual aids for physicians to use in
their offices. If you have an attractive educational poster, you will be able
to have something of value that you can present to physicians’ offices.
Potential customers will see the value that you can provide and will want
to connect with you.

10. Participate in Conferences and

Events
Physicians always want to learn more about their field. One place where
you can reach these individuals is at a professional conference. This is a
great chance for you to interact with physicians directly and get feedback.
With feedback, you can tune your marketing message to be more desirable
by a wide audience of physicians.

If your drug isn’t getting the attention that it deserves, it would benefit you
to take a look at all of the various pharmaceutical marketing strategies
which are available to you. The reason why you might not be successful is
that you are using the wrong techniques.

Changing the mix of pharmaceutical marketing tactics is a wise idea from

time to time. You might be relying too heavily on meeting with the
physicians, but the physicians might be too busy to talk with reps. Instead,
you might want to reach out to those same people through less-intrusive
means such as with social media or an email newsletter.

11. Don’t Forget the Search Engines

With the majority of your users utilizing Google to find answers to their
questions, not doing pharmaceutical SEO can limit your reach online and
allow your competitors to earn the customers that are using Google.

Remember, at the core, SEO is about building a great experience and

providing quality, valuable content to help your users find your product or
service, solve their problems, and answer their questions.

Examine How Well Your

Pharmaceutical Marketing
Techniques Are Working
Remember that one part of all of the most successful pharmaceutical
marketing strategies is taking a very close look at numbers. Ultimately,
you should be creating as many prescribing physicians as possible.
Tracking your results ensures that you are aware of how well your
marketing strategy works or doesn’t work. Sometimes it doesn’t matter
what pharmaceutical marketing tactics you are using but how well you are
executing those tactics.

Always remember that there are many different pharmaceutical marketing

strategies that you can choose from. If at any time the pharmaceutical
marketing tactics you chose aren’t working, it may be time to move on to
something else. As always, the key to a successful pharmaceutical
marketing campaign is being consistent in your brand message and image.
With consistency, you are able to achieve more with your brand than you
could have without.

COMPANY PROFILE-
We, MITS Healthcare Pvt. Ltd, initiated our company in 2010 and are engaged
in manufacture, supply, distribute and trade Pharmaceutical Tablets and
Capsules. Our effective product range is inclusive of Antibiotics Tablets,
Pharmaceutical Tablets and Pharmaceutical Capsules. These medicines are
precisely processed from best quality ingredient, which is procured from well
known vendors. The compositional accuracy and optimum effectiveness makes
these tablets and capsules highly demanded in the market. Furthermore, we offer
franchises of the different pharmaceutical tablets and capsules. Our product
range is already been franchised in different cities of Uttar Pradesh, Arunachal
Pradesh, Assam, Goa, Orissa, Punjab, Rajasthan, Himachal Pradesh and in
many more stares. Invitations from different cities of unrepresented states are
invited for franchises of all our product range. We offer visual aid folders,
samples and all the available literatures as promotional inputs. Training and
multiple payment modes are essential components of our franchise.

For providing tablets and capsules of the highest quality, we have developed a
state-of-the infrastructure facility which is well- equipped with modern facilities.
We have segregated our infrastructural base into various departments in order to
ensure streamline and smooth operations. Our manufacturing unit is well-
equipped with different kinds of machinery, tool and equipment that are
necessary for large scale production. Furthermore, it is upgraded with
sophisticated technology on regular interval of time. Our infrastructure facility is
supervised by a team of expert professionals in order to ensure quality and
effectiveness of our product range in compliance with the FDA set norms and
regulations.

Established under the expert supervision of, Mr.M K Bhatia, we are growing
continuously and gaining a remarkable position in this domain. Our continued
focus on delivering optimum quality products has resulted in strengthening our
position in emerging markets.
COMPANY FACTSHEET-

Basic Information
 Nature of Business Manufacturer

 Wholesaler
 Trader
 Distributor
Additional Business

Company CEO MK Bhatia

Registered Address SCF 416 1St, 2nd Floor, Motor Market,, Chan

Industry Trading of a broad range of Pharmaceutical T

Total Number of Employees Upto 10 People

Year of Establishment 2010

Legal Status of Firm Private Limited Company

Promoter Mr. M.K. Bhatia

Annual Turnover Rs. 2 - 5 Crore

PRODUCTS
IROMITS-XT

REMIFOL TABLET-
CEFMITS-AZ

ZEOBA CAPSULE-
MUKTIMORE-G-

MARKETING COMPAIGN-
What Is a Marketing Campaign?
Marketing campaigns promote products through different types of media, such as
television, radio, print, and online platforms. Campaigns are not solely reliant on
advertising and can include demonstrations, video conferencing, and other
interactive techniques. Businesses operating in highly competitive markets may
initiate frequent marketing campaigns and devote significant resources to
generating brand awareness and sales.

Understanding Marketing Campaigns

Marketing campaigns can be designed with different goals in mind, including
building a brand image, introducing a new product, increasing sales of a product
already on the market, or even reducing the impact of negative news. Defining a
campaign's goal usually dictates how much marketing is needed and what media
are most effective for reaching a specific segment of the population.

Businesses operating in highly competitive markets may initiate frequent

marketing campaigns and devote significant resources to generating brand
awareness and sales.
Types of Marketing Campaign Activities
There are many ways to market products and services to customers, from
mailing brochures to coordinating a social media blitz. Small companies can
email invitations to a special sale and offer a free product to every customer who
brings the invitation. Larger companies can use paid advertising and professional
agencies to reach a wider audience.
Whatever the size of the company, it's important that someone is dedicated to
handling the influx of traffic a marketing campaign generates. If you are
prompting customers to sign up for your email list, you must make sure that the
list is managed well and that new customers receive welcoming messages. If
visits to your website increase, you must continually update your content to
convert this traffic to profitable sales.

Companies that lose sales due to major negative press often use marketing
campaigns to rehabilitate their image. One example is Chipotle Mexican Grill,
which was investigated by the Centers for Disease Control and Prevention after
dozens of customers became sick in 2015 from food safety issues related to E.
coli and norovirus. Chipotle's sales dropped 30%, and to regain customer
interest, the company offered coupons for free food via direct mail and texts.
Chipotle also used online video to announce a $10 million grant to support local
farmers