‘Amazonization’ of Healthcare

Whether Amazon succeeds in the healthcare market, or not, remains to be seen, but the reason I believe healthcare is about to get ‘Amazonized’ is because of what Chris Holt, Amazon’s leader of Global Healthcare said recently. 

“When we think about the healthcare space, our overall philosophy of obsessing around the customer has served us really well. So, we start with the customer and we work backwards.”

This thought process is so anti-healthcare, that it comes like a breath of fresh air. Incumbents might smirk at it, but customer obsession is the primary reason why Amazon and other tech companies have built giant corporations in unbelievable time-frames.

In India, Amazon recently announced their interest in buying stake in Medplus, India’s second largest organized pharmacy chain after Apollo. So, the question on everyone’s mind must be: will Amazon disrupt the Indian pharmacy space?

Amazon has always had a track record of creating fundamental changes to any industry that they enter. The distribution part of the pharma industry especially in India has always been ripe for disruption and as an industry observer, I was amazed about how the glaring inefficiencies in the distribution part of their business always escaped the attention of CEOs and put it down to the strong union that dominates it. And this is exactly what can make or break Amazon in this space.

Amazon has had bitter experience with Drugstore.com in the past, when its ambitions to sell prescription drugs got lost in a maze of regulations, logistical challenges, and pre-existing business alliances that effectively blocked it from huge segments of the market.

This time, Amazon has the scale and reach to pose a serious threat to the pharmacy sector, despite the challenging economics. Also, the retail pharma scenario in India is highly fragmented and no one store holds a bulk of customers like PBMs do in the US. Consolidation if at all, is rare and this likely explains why Amazon plans to buy stake in India’s second largest retail chain with close to 1500 pharmacy outlets.

“We are just trying to figure out what we learned in other industries and how we have architected our own infrastructure to figure out how we can bring that to healthcare and help healthcare migrate to simpler solutions. “ – Chris Holt

Amazon’s biggest advantage in the area is that it is comfortable operating at loss or on very low margins, something that Indian retailers abhor. With the entry of Walmart (through Flipkart) and now Amazon, the margins will see new lows. This augurs well for patients, but not for drug manufacturers who will see squeezed profits but cannot escape this business since it will be volume intensive.

I had expected Amazon to be more interested in recently established online pharmacies instead of brick and mortar ones, except that Amazon already has an established presence in the online space in India. They have a well-functioning logistics arm that serves their Prime customers. This can surely be used for drugs distribution also. What they didn’t have was a brick-and-mortar format presence. Considering the hazy regulations around online pharmacies and the continuing habit of customers purchasing from brick-and-mortar pharmacies than online, its possible that Amazon sees the brick-n-click model as more India-centric.

I also believe that Amazon understands Indian consumers better than most other pharma players including retailers due to their dependence on data and business intelligence. So, this move could be better thought out than we can possibly see at the moment.

About data privacy rules and other regulations in the healthcare space, I think that is a battle Amazon has already fought through its terrific presence in India. How data privacy rules shape up in India will be interesting to observe, but my personal belief is that it will by and large mimic the GDPR. Amazon understands GDPR and should therefore be comparatively better prepared. Policy makers however, must be wary of online giants trying to influence policy to their advantage.

It would quintessentially not be Indian if we didn’t protest anything and everything at first and then buckle down quietly later. ‘Dharna’ or protests from retail chemists or opposition from the government on a potential entry of Amazon in the pharmacy space is expected. Online pharmacies are being vehemently opposed by the traditional pharmacy owners, but their concerns are mostly unfounded leading govt to announce “policy papers” that are supportive to e-pharmacies. In my opinion, it would be quite stupid to expect Amazon to only stay in the online pharmacy space. If successful, it would not be too long before Amazon disrupts most of the current model – either alone or with the entry of other tech giants.

We aren’t trying to fit into any traditional definition of how things work in healthcare. We’re trying to bring our own capabilities to the market. We’ve seen a tremendous willingness among our customer base to try out new things even though they know that it might not be something that they’re used to.” – Chris Holt

In the past, Amazon has shown itself to have a ruthless, ‘winner-takes-all’ approach and it is that monopolistic approach to business that will worry the government more than anything else. But, if patients, caregivers and consumers are happy, the ‘Amazonization’ of Healthcare will be complete.

God to Guide; Patient to Participant – Lessons from TEDx Maastricht

The Future of Healthcare is a debate that can inflame the imagination. There is so much to be done, so much to be achieved in so little time! A topic about which everyone has an opinion also generates unlimited ideas. Ideas worth spreading. And spread TEDx did! In Maastricht, Netherlands, earlier this week on April 4th, 2011, TEDx had a gallery of thought-leaders who presented cutting edge ideas and work in all things healthcare.

Death – the greatest truth according to Hindu mythology – is a phenomenon that man fights endlessly in a mindless pursuit of immortality. He labors on in pain, in suffering and even when faced with debilitating diseases such as cancer. Yet, like David deBronkart, said, “when we fight cancer, we think we’re fighting death when in fact, we’re fighting life itself!”Dave deBronkart, known on the Internet as ePatientDave, is a cancer survivor himself. At the TEDx forum, his voice shook as he recounted his war against kidney cancer and how he lived threw the harrowing experience to be able to see his daughter get married. Although he “faced the grave”, Dave said he took it upon himself to search for information that was relevant to his medical condition. “Where does my body end and the problem start?” he asked himself, as he spent endless hours poring over raw data and information from all the resources he commanded. Finally, the effort paid off. As he learnt more about his medical condition, he worked harder with his doctor to create a treatment regimen that he knew he would follow down to the last detail. The result: Victory against cancer! His war cry: “Let patients help!” The story of deBronkart and many others captures the evolving relationship between the healthcare professional and the patient in the coming years. A relationship that promises to radically shake up delivery of healthcare as we know it.

It all begins with increasing access to information. When he knows so much, a patient is more likely to participate more actively than he presently does. Instead of being a passive object of treatment, he will begin to ask to stand on an equal footing with his doctor to develop care routines for his own health. Co-creation of value comes full circle in healthcare! According to neurologist Bas Bloem , healthcare professionals must accept this trend and descend from their ivory towers. The doctor can no longer pose as an omniscient god, but rather become a guide who works with and coaches the patient. This would be a great departure from the state of healthcare today where doctors and patients stand on different platforms – a phenomenon brilliantly depicted by Dr. Bloem in a skit at the TEDx. Ingenuity of such high order made TEDx Maastricht very special!

The future of healthcare is increasingly about patient empowerment. So much so that Frans Hiddema, CEO of the Rot­ter­dam Eye Hos­pi­tal, who also spoke at the TEDx calls the patient the least utilized resource in healthcare. “Its his body and therefore, his problem. Therefore its his choice”, he points out. And yet healthcare professionals work as if the patient doesn’t matter. Patients don’t ask much of their doctors too. They are either overawed or too scared to do so. “There is no need for you to be scared of your doctor” says Hiddema. According to him, scared patients run a higher risk of some­thing going wrong. The less afraid, the more sat­is­fied peo­ple are. This is an evidence-based result. And how do you overcome fear? Through knowledge. Through information. Information that is made accessible through technology such as the Internet that can be accessed conveniently through hand-held devices. Why is it important to know? Because knowledge empowers. In all things healthcare, patient empowerment is the trend and information technology is the enabler.

So, is it all as much a bed of roses as it sounds? Well almost! Something that constantly keeps payers (health insurance companies, employers etc.) up at night is the cost of healthcare. An empowered patient can create a steep rise in costs. “The more you know, the more is the need for treatment. And how would you deny the best treatment to a patient who asks for it?” asked Wouter Bous, a former Dutch politician who now works with KPMG. Healthcare costs rise partly due to the “undeniability” of technological advancement to patients. The more we know of ourselves, the more treatment we want. This creates potentially endless demand for treatment and thus high costs. Yet, the trick is to get doctors and hospitals to focus on giving it to those who “need it the most” and not just to those “who pay for it the most”.

The challenge is daunting. How do healthcare providers offer the best services en masse and still keep costs under control? There is potential for innovation here. What if you reduced the number of people who actually fell sick and needed healthcare services? The answer could lie in making healthcare:

  1. Predictive – forewarn people of susceptibility to diseases
  2. Preventative – empower them with information and resources to take preventive measures and to keep themselves healthy
  3. Personalized – provide information that is most relevant to them and what they want to know instead of generic and unimaginative information (n=1, R=G)
  4. Participative – make people a part of decisions made about their health. After all, its their lives. Enable them and trust them to hold themselves accountable

Hold on! Before you dismiss this off as idealistic, its good to remember that governments across the world work to ensure that people stay healthy. This, of course, does not mean that people won’t fall sick and never need a doctor or a hospital at all. But studies have shown that healthcare costs reduce dramatically when the overall population stays healthy. This is true empowerment. Empowering people with appropriate intervention to remain healthy. After all, health is not what we take care of when we fall ill. It is something we take of not to fall ill.

Is Pharma doing a Rip Van Winkle?

An environment of relentless challenge and change is the norm for pharmaceutical and healthcare companies. Despite critical need and high demand for its products, the industry remains under pressure from physicians, patients and regulators to deliver more effective treatments at lower cost. It is well known that the current business model, based on development and marketing of blockbuster drugs, is increasingly economically unsustainable and operationally unsuited to the kind of quick action needed to meet complex stakeholder demands.

To tackle this, strategic teams in most large biopharmaceutical companies have done the obvious – resorted to low priced generics as a growth driver. This may well prove to be a temporary strategy considering the large number of biotechnology (and other niche specialty therapy area) companies that have, either been acquired or their products in-licensed for later commercialization, by pharmaceutical companies.

To provide context lets consider PhRMA’s stated mission. The Pharmaceutical Research and Manufacturers of America (PhRMA) represents the United States’ leading pharmaceutical research and biotechnology companies, which are devoted to inventing medicines that allow patients to live longer, healthier, and more productive lives. PhRMA members (most BigPharma companies) invested an estimated $45.8 billion in 2009 in discovering and developing new medicines. Including low priced generic medicines as growth drivers into business models over the short to medium-term is hardly what PhRMA (and BigPharma) stands for. This was best captured by Mr. Severin Schwann, CEO, Roche in an interview with the Financial Times .Referring to the evolving business model based on diversification, he said, “A lot of people call it diversification. I call it giving up.”

This seems more like a knee-jerk reaction than a far-sighted, strategic approach. Is pharma doing a Rip Van Winkle like the Dutchman from the fable who went into the mountains and fell asleep for twenty years of his life to escape his wife’s constant nagging?

What gives me hope and holds my faith is that the pharmaceutical industry is a knowledge based one and innovation is its lifeblood. And through innovation the future holds promise.

1. The ramp-up of personalized medicine and increasing number of biologic products in development portend growth for the industry. Roche’s Schwann recently told an interviewer that he felt the importance of personalized medicine in short to medium-term plans should not be underestimated. “Personalized medicine is not a concept anymore,” he said, “it is reality”.

2. Delivery of targeted, specialty medicines to selected groups of patients should improve outcomes and boost profitability.

3. Rising populations and personal incomes in India and other emerging markets have the potential to broaden the customer base in untapped and underserved regions.

Pharma’s business model is changing. It must change. According to Andrew Witty, CEO of GlaxoSmithKline the pharma business model is transforming from being “blockbuster dependent” to becoming “blockbuster capable.” What he means is that as we wait for new blockbusters to arise, companies must become efficient at innovating and commercializing a steady stream of products within the $50-500 million range of annual global sales.

Growth opportunities are inherent in this change. To seize these opportunities, the industry must embrace a fundamentally new approach to doing business. Over the long-term the industry must adopt transformational business models that rely on collaboration with healthcare payers, providers (assuming that healthcare insurance will consolidate and grow in India) and nontraditional partners. The goal: to deliver bundled product-service packages of patient-centered, outcomes-based care.

The pharmaceutical industry may have done a Rip Van Winkle for decades now. It has often been accused of being a laggard while adopting marketing and technological innovation. But, a lazy Dutchman in a fairy tale is surely no role-model for an industry that can potentially provide healthy lives to billions around the world.

Open Source Model in Healthcare Can Create Shared Value

Salil Kallianpur, Pharmaceutical Marketing Professional, India

James Gillespie, President, Center for Healthcare Innovation

Last weekend, I [Salil] visited my parents who live in Hyderabad, a city in South India. During the trip, I initiated a conversation with an old lady in the neighborhood named Ghuraan Bi by simply asking how she was doing.  A slight lady in her 60s, the innocuous question seemed to trigger a barrage of emotions.  Ghuraan Bi settled down on the floor and unbundled a small bag in which she stored betel leaves (paan) and betel nuts (supari). This was an indication that she was preparing for a long conversation, and then, she said something that immediately caught my attention. She narrated a story about how she had to loan her home out as collateral to the local money-lender in order to pay for her husband’s medicines. Tears welled up into her eyes as she spoke about how expensive medicines took her home away from her. “Why do medicines have to cost so much?”, she asked! Why, indeed!

It is well known that sections of society are driven below the poverty line due to unbearable costs of healthcare and medicine in India. This is largely because millions of people pay out-of-pocket in the absence of social security guaranteeing health as a fundamental right. Some hold the pharmaceutical industry responsible for this “evil” despite knowing that the cost of medicines is only approximately 15% of overall healthcare costs. This is not to say that cost of medicines should not be reduced. The intention is just the opposite. It is to explore how healthcare can be made more accessible to the people through innovative partnerships, effectively leveraging technology and building innovative distribution models between different stakeholders. It is about thinking how to achieve this by getting the public and private sectors to work together to develop a wide range of innovative tools, partnerships, and approaches to improve healthcare delivery to the underprivileged.

Andrew Witty, Chief Executive Officer of GlaxoSmithKline, in the January 2011 issue of Health Affairs, wrote that pharmaceutical companies are driving crucial research into new medicines in a way that can benefit the life of the poor. The pharmaceutical industry and the public sector are thinking differently than before about how to improve access to medicines and advance research and development. Witty writes that diseases disproportionately affecting developing countries play a large role in stalling economic and social development. Pharmaceutical companies are driving crucial research into new vaccines and medicines; however, although there is an imperative for industry to research new therapies for diseases of the poor, the financial returns are often seen as limited.

What if financial returns do not become the constraining factor? Would companies be more open and willing to create innovative models? Take for instance a not-for-profit arm of the business. In a publicly held company, pressure from investors is likely to deter the Board of Directors and top management from considering any model that does not generate profit or financial return. Such innovation is likely to happen in smaller, privately held start-up companies such as the Institute for One World Health (iOWH), which became the first nonprofit pharmaceutical company in the United States. Since its inception, iOWH has received more than $200 million from the Bill & Melinda Gates Foundation, as well as funds from other philanthropic donors.

It’s a brilliant start! But, the ‘down-side’ is that excellent initiatives such as iOWH are simply not large enough to create an impact of the size that can simultaneously benefit the lives of the two billion people who do not have access to medicines and healthcare across the world. For such large-scale benefit one needs the scale of multinational companies that have both the resources and the capability to create world-wide impact. At the moment, this circle of not-for-profit and pressure for financial return is a vicious one!

In their recent Harvard Business Review article, Michael Porter and Mark Kramer introduce the concept of “shared value” that blurs the profit/non-profit boundary. Shared value, according the article, is defined as practices that enhance the competitiveness of a company while simultaneously advancing the economic and social conditions in the communities in which it operates.

Pharmaceutical companies like GlaxoSmithKline, Pfizer and AstraZeneca have begun tentatively pursuing an “open innovation” strategy, to share their collective pool of intellectual property, resources, and data. This is popularly known as “Open Source Drug Development” (OSDD) which opens research facilities to allow external researchers to work side by side with company scientists. This provides scientists and their institutions with access to compounds, technologies, and expertise that can help facilitate research on treatments for neglected diseases. OSDD also creates access to compound “libraries,” or collections of molecular entities, to support new and much-needed research leads. These compounds may have been cast aside by these companies for their lack of profitability.

Another important aspect in creating inexpensive medicines is transferring the technology for producing drugs and vaccines. This is one of the most innovative and sustainable ways to bridge both the research-and-development and access gaps and to increase the availability of medicines in the developing world. These transfers are at the cutting edge of business practices today. When iOWH, the not-for-profit company, did not have funds for manufacturing facilities to make and distribute a broad spectrum antibiotic that it could take through to commercialization, it partnered with a for-profit company in India, Gland Pharmaceuticals, which agreed to take on those roles for no profit, no loss. The key enabler here was that Gland Pharma is a family-run business with limited or no pressure from investors. However, a game-changer is iOWH’s semi-synthetic version of an antimalaria drug that has entered the commercial scale-up process and is on schedule to be manufactured by Sanofi-Aventis for no profit, no loss, by 2012. This would be a significant way forward for the pharmaceutical industry to emulate going forward.

Imagine the possibilities that would emerge if large pharmaceutical companies could be persuaded to consistently invest a part of their resources to create shared value. If only large companies, government bodies, NGOs, think-tanks and other players in the healthcare delivery chain put aside self-centeredness and got together to think of the larger good they could create for humanity. Now is the time for the healthcare community and the public and private sectors to come together and work together. For these efforts to be successful, it will be necessary to find tailor-made solutions to specific public health problems and to evolve our business practices and models in an effort to improve and do more. The need of the hour is for a body to work proactively to bring these players – both large and small – on a single platform to do just that.

Medicines do not have to be so expensive. That will make Ghuraan Bi and many others very happy!



Open Source Drug Development Manifesto?

James Gillespie, President, Center for Healthcare Innovation

Salil Kallianpur, Pharmaceutical Marketing Professional, India

The pharmaceutical industry of the future will require, at least in part, a robust, globally accessible informatics infrastructure available to industry, academic, regulators, and NGOs.  In some cases, accessibility may even be extended to patients.  The system will need to be flexible enough to permit rapid and accurate data sharing among disparate actors, systems, and institutions.  This innovation and collaborative thinking is already being applied in isolated cases.  For example, Pfizer, UK National Health Service trusts, Scottish Enterprise, and Scottish universities started a Translational Medicine Research Collaboration applying these principles to create a mini global network.  However, what is needed is a truly global network that includes multiple large bio-pharma companies, in addition to many other actors from the private, public, and NGO sectors.

One way to facilitate that would be for life sciences companies to make certain portions of their IT systems open source, which would facilitate development of best practice standards around annotation, compliance, and security.  In the context of the IT industry, in February of 2001, a small group of software developers met at a Utah ski resort in to discuss lightweight software development methods.  In the wake of their discussion, they signed and published the “Manifesto for Agile Software Development” to define the approach now famously known as agile software development. Some of the manifesto’s authors subsequently formed the Agile Alliance, a nonprofit organization promoting software development in line with the manifesto’s principles.  The life sciences industry might be well served to adopt something similar:  To wit, a select group of life sciences leaders, with a skew toward IT, come together to articulate, sign onto, and publish a set of principles to guide open source IT systems specific to the life sciences industry.

In an ideal world, the open source IT-oriented manifesto for the life sciences industry would be extended to cover basic drug discovery and development (i.e., the R&D side of the industry).  Thus, the eventual open source manifesto for the life sciences industry would encompass all major relevant aspects of developing drugs.

And even if these more programmatic steps never occur, the industry does need at least an informal “manifesto” to guide and inspire open source efforts in IT, R&D and other areas.

Will open source ever become the dominant modality in the life sciences industry?  For financial, logical, and liability reasons, that is highly unlikely, and it’s not even clear if that would be entirely socially beneficial if that did occur.  However, we are suggesting that a global modular open source network, encompassing dozens of major bio-pharma companies and other actors, should be created as one of the tools in the arsenal for helping improve humanity via pharmaceutical products.



Broadening Healthcare Delivery through Social Entrepreneurship

Health and wellbeing are not only of the highest importance to both the individual and to societies, they are also a fundamental human right. For as far as we can think, healthcare is a public good and therefore more a domain of the public sector than the private one. Governments and international institutions like the World Health Organization (WHO) have worked to integrate health and health care into their policies to ensure that health is regarded as a public good that must be achieved equitably and to the highest attainable level.

In achieving these goals that have become the basis for the alleviation of human  disease and suffering, pharmaceutical companies have a definitive albeit evolving role to play. The role here is more collaborative than competitive and is to bring together researchers, physicians, leading government officials and representatives from industry as well as from non-governmental organizations (NGOs) and health care systems with an aim to address the most pressing issues that medicine and health care delivery systems will face over time.


Medical progress and success in achieving equitable access to health care and preventive interventions are threatened by unsolved and newly emerging problems such as: the demographic shift to an ageing society; climate change and its health consequences; new types of epidemics, such as diabetes, hypertension, obesity and mental ill-health, in addition to the still raging epidemics of diseases such as HIV, TB, and malaria; the rising costs of health care; and the worldwide economic crisis and its serious threats to the health of population across India.

The rapid progress of medical science and technology opens up exciting possibilities for diagnosis, therapy, and prevention with the potential to improve health, security, and economic stability. In practice, though, the mechanisms to facilitate and evaluate the implementation of innovations in health care are largely absent. Consequently, the huge potential of medical progress is far from being sufficiently realized.

Social Solutions

The challenge for equitable healthcare delivery in India is to clearly define goals and responsibilities, and secure investments for the development and use of new technologies, medical advances, and healthcare delivery. The national health care systems of many developing countries are ill equipped to provide healthcare to their burgeoning populations thereby necessitating the use of novel and innovative health care delivery models. Stable public-private partnerships and renewed political engagement with the understanding of health as a public good will be the basis for harnessing innovative power and scientific development and will be crucial for translating new insights into advances for health. It is time to show leadership and ignite the entrepreneurial spirit. It is time to think of the solutions that social entrepreneurship can offer to this problem.

Exciting Times for the Pharmaceuticals Sector

The pharmaceutical industry is traditionally one of the most innovative of them all, developing better and more effective products – medicines, that alleviate disease, pain and suffering. Recently, though, the industry seems to have lost its traditionally innovative streak. Yet, instead of getting despondent, I would like to think that strategic planning in such an organization should be a very exciting time. A time when people, who are the best at what they do – at least in that organization – come together to collectively develop solutions to problems that hold it back from surpassing its expectations. It should be a time when cross-functional teams work with each other on a venture, learn from each other’s diverse capabilities and add value to both themselves and cumulatively to the organization. If that happened, it would be exciting indeed for that would make the organization a very progressive and forward looking one. And who wouldn’t want to be a part of such an organization?

Yet, sometimes, the excitement gets lost in the processes and SOPs. And this dogmatism is dangerous if it threatens to enforce boundaries in a place such as a meeting to plan strategy. These boundaries often define methodology – requiring someone to do something “this way and not that”. A golden rule to such planning sessions is to not start with the methodology, but with the problem. Many times, work on a venture tends to start with the methodology. And it is most likely, that’s where  most of the time gets wasted. It is quite rare that team members would agree upon methodology if it is discussed before the problem is analyzed threadbare.

When a team starts with a problem that’s of interest and applies whatever methodology is appropriate, the team members have quality time to focus on finding never-done-before, innovative solutions to the problem rather than focusing on how to do it. After all, the problems of greatest interest are those that you cannot explain with the current prevailing solutions – the so-called ‘benchmarks’.

If an organization aligns its growth plans with the problems currently prevailing in the environment in which it operates, it is best suited to find opportunities to develop solutions for those problems. And these are where it has the highest probability of finding not just new, but breakthrough growth opportunities.

The sad part is that teams that are tasked with developing breakthrough plans, barely recognize these opportunities even when they stare them straight in the face. The think-tank gathers in a plush hotel conference hall, listens patiently to the CEO and other senior leaders urge them to ‘think differently’ and then goes about working in the very same manner as it did in the preceding days and weeks, not realizing that it is that very style of functioning that necessitated the workshop they were in!

This has a lot to do with dealing with the pressure that the team faces to convince the company leadership of commercial viability of their ideas. A critical aspect that senior executives forget at this stage, is that the most powerful ideas – that could put the company on course to the next BIG thing – would not come out of multiple examples or ‘benchmarks’. They come out of intuition, business acumen and single case studies. Big impactful ideas are conceptual breakthroughs, not descriptions of common patterns.

Now this may sound contradictory since business acumen and intuition comes from loads of experience. And experience brings with it the need to fall back on best practices. Breakthrough ideas are – to borrow from C.K. Prahalad – “next practices” not best practices. You can’t define the “next practice” with lots of examples and benchmarks. Because, by definition, it is not yet happening.

If a pharmaceutical company looked for the ever-eluding growth opportunity, it wouldn’t have to look very far. Instead of focusing on the problems that the company faces such as an over-regulated environment, non-level playing field (domestic companies vs. MNC pricing & promotional practices), fragmented and complex healthcare delivery and distribution framework etc., what if it focused on the environment and on the customer instead?

The problems that the healthcare consumer faces are quite obvious. India is yet to measure up to international standards of domestic healthcare. A majority of citizens still struggle for access to primary healthcare, and diseases such as malaria and cholera continue to kill. Other challenges include inadequate affordable healthcare infrastructure, especially in rural areas. Also, in times of calamities, the protracted response time of emergency services drives up the number of fatalities. As I had written earlier, simply focusing on creating awareness, access, availability and applicability provides vast swathes of opportunities for companies to create meaningful value for society and economic value for themselves. When this balance is struck in strategic plans, they move from being capitalistic messes to becoming socially responsible and commercially viable.

With so much to do, especially when India is one of the two most promising ‘pharmerging markets’, strategy teams in pharmaceutical companies must be bursting with ideas. It is, but a matter of time, that mainstream pharmaceutical companies will find their lost streak of innovation. This time in services too, if not in products alone.