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Dissertation 1
An Exploratory Study on
The innovation, diffusion and adoption Processes of
the UK & Pakistan Pharmaceutical Industries, 2010
Hasan Muhammad Raihan
Submitted by:
Mr. David Shaw
Supervisor
Dissertation submitted in partial fulfillment for the degree of MSc. in Marketing,
University of Wales, 2010.
On 27th
September 2010:
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Declaration and Acknowledgements
I, Hasan Muhammad Raihan declare that no part of this dissertation
has been taken from existing published or unpublished materials
without due acknowledgement and attribution, and that all secondary
material contained therein has been fully and appropriately referenced.
There are several people without their assistance this work may never
have been completed and I would therefore like to acknowledge their
help and support.
First of all I would like to give thanks to Almighty Allah who gave me
the strength and made me eligible to complete this research and then I
would like to express my sincere gratitude to my dissertation supervisor
Mr. David Shaw for his kind guidance, time and all his support incompletion of this work.
I would like to say thanks to the medical community, who helped me
through their time, answers and responses in regard to my
questionnaires to complete my research work.
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Abstract
Pharmaceutical industry is one of the most dynamic and vital dissection of the
worldwide economy which is growing and progressive globally and expected
to touch global sales of $ 825 billion by the end of 2010. The industry however
is declining in its innovative performance and in converting the innovative
product into brands, in spite of that the industry is the sixth most effective
industry in generating innovation.
This work investigates the process of innovation, diffusion and adoption of UK
and Pakistan Pharmaceutical industry amongst physicians. Physicians are the
only and key customer in pharmaceutical if talk about drug prescription. The
failure and success of innovative drugs depends on their behavior to select
the drug on the perceived newness of the drug. This study explores the
physicians perspective of drug newness, their perceived characteristic of
innovative drug, its diffusion and adoption amongst the physicians.
A combination of qualitative and quantitative approaches of research is
employed to explore the whole process amongst physicians from UK and
Pakistan. The key results concern (1) the perceive innovativeness of the drug
amongst the physicians and its characteristics, explanation and extensions of
attributes of innovation in pharmaceutical context, (3) the diffusion processes
and their influence on the adoption of innovative drug, and (4) the back ground
of innovation adoption amongst the physicians. The study findings explore that
the adoption of innovation is highly dependent on the perceived newness of
the drug. Each physician may have his or her own interpretation that may be
based on meeting one characteristic of the innovative drug or more than one
characteristic.
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Contents
Chapter OneIntroduction 07
An Overview of global Pharmaceutical industry 07
Customers in Pharmaceutical Industry 09
Business Methodologies in the Industry 11
Business Focus in Pharmaceutical industry 12
The Concept of Disease 13
Types of Drugs & Treatment Employed by Industry 13Research Title 15
Research Objectives 15
Research Questions 15
Research Gap 16
Dissertation outline 16
Chapter Two
Literature Evaluation 18
Importance of Innovation 19
A Discussion & Definitions of Innovation 20
Innovation in pharmaceutical Industry 21
A Discussion & Definitions of Diffusion 23
Diffusion of Innovation in Pharmaceutical 26
Relative Advantage 27
Compatibility 27
Complexity 28
Trialability 28
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Observability 28
Communication Channels 28
Homophilous Group 28
Pace of innovation 29
Norm, rate & Social Network 29
Opinion Leaders 29
Infrastructure 29
A Discussion & Definitions of Adoption 29
Chapter ThreeResearch Methodology 33
Research Method 33
Data Collection 35
Data Analysis 38
Research Limitation 40
Chapter Four
Findings and Analysis 41
Innovation 41
Concept of Innovation among Physicians 42
Perception of Innovation by Physicians 44
Innovation Characteristic of Drug 44
Relative Advantage 45
Efficacy 45
Tolerability 46
Safety 46
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Complexity 46
Compatibility 47
Trialability 48
Observability 48
Process and Sources of Diffusion 48
Main Sources of Information 50
Additional Sources of Information 51
Best Source of Information 51
Qualitative findings of Drug diffusion 52
Drivers & Barriers in adoption process 53Drivers of innovative drug adoption 53
Qualitative findings 54
Barriers to innovative drug adoption 56
Chapter Five
Conclusion 58
Customer decision making process 64
Reflective Summary 68
References 69
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CHAPTER 1
Introduction
An Overview of the Global Pharmaceutical Industry
Pharmaceutical industry is one of the most dynamic and vital division of the
worldwide economy which is expecting to touch global sales of $ 825 billion by
the end of 2010 with a growth rate of 4 to 7% (IMS, 2009). Indeed in the UK
alone, market size during the year 2009 was valued at 28.4 billion dollars
(Prlog, 2010). On the other hand the rate of pharmaceutical innovation has
been declining since 1980s. As per Business wire 2006), cited by Holland
(2004), "Business as usual is no longer an option when it comes to developing
new prescription drugs. Pharmaceutical and biopharmaceutical companies are
spending more on Research & Development than ever before, yet the number
of new drug approvals have declined steadily. As a result, many drug firms are
focusing on ways to improve the efficiency and productivity of their R&D
programs". Since early 1990s, pharmaceutical industry has gone through a
process of significant consolidation through mergers and acquisitions. There
has been argument if this merger and acquisition activity may have harmed
innovation.
One of the purposes of research and development in pharmaceutical industry
has been to ensure that people have healthy and longer lives so that they
have no dependency and they do not require a care. Currently, many of the
people around the world may expect considerably longer and healthier lives in
comparison to their ancestors and hence with their healthier lives they are
contributing not only to their families, friends but also in the countries
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economy by reducing health burden. Pharmaceutical innovation and the
introduction of innovative drugs have positively played a key role in the
process of assuring healthier and happier lives. Pharmaceutical innovation isbased on improving, efficacy that represents the ability of the drug to control
or manage the disease, tolerabilitywhich is reduction in side effects profile of
the drug, evidence represent the supporting data of the drug on long term life
of the patients and compliance deals with the stickiness of patients with the
drug due to convenience in dosage and timing, Price reductionso that most
patients can afford the drug, as a whole or at individual attribute level.
Pharmaceutical organizations are striving hard in developing drugs that are
better than their existing drugs as well as better than competitive drugs. Thepositive perception of physicians about the drug newness and its superiority
over already available options is critical for the success of new drug
introduction.
Technological advancement and development of innovative drugs are
achieved on the basis of fundamental research carried out in universities and
research institutes, while virtually all end molecules and drugs are created and
manufactured by the pharmaceutical industries. Apart from continuousevolvement in the pharmaceutical industry, innovation remains the core focus
with the objective to resolve suffering of mankind and to be competitive within
the industry. Organizations that divert their focus from innovation are likely to
loose their ability to support their peoples as well as loose the competitiveness
and sustainability. Over the period of time a very few drugs have got the
acceptability among the physicians in the healthcare industry. The graph of
innovative drugs development in the industry has also gone down during the
last few years.
Huge developments have been made throughout the past decades in
understanding illness, mounting new diagnostic technologies and drugs that
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resulted in better treatment and prevention of diseases. Indeed, in the period
19521992, over one half of the gains in health were due to access to better
technology and application of new knowledge (WHO 1999). In modern healthcare, pharmaceutical drugs hold the promise to heal the mankind to protect
them from various serious and crippling diseases and its consequences. In
Pharmaceutical industry, business modus operandi is complex; sales of drugs
are dependent on the acceptability amongst physicians since they are the
gate keeper for the final adoption of the drugs amongst their patients for the
particular treatment so there is a need to have a satisfaction on levels,
physicians and patients. Physicians judge the drug on the basis of its efficacy,
tolerability, safety, convenience and the affordability by its patients based onevidence and their experience. While patients judgments are based on their
feelings and absence of side effects for the better quality of life.
Customers in the Pharmaceutical Industry
Physicians both at hospitals and community setting are the key customers of
pharmaceutical industry (Berbatis, Blackbourn & Smith, 1981). Hence having
the understanding about the decision making process and how they use
information, are the focal point in pharmaceutical marketing management,
planning and its implementation. In Pharmaceutical industry, decision making
is a complex process since both physicians and patients have to be satisfied
and their expectations should be met. The decision making in pharmaceutical
industry has been in the hands of physicians whereas patients have little
knowledge or influence (Holland & Batiz, 2004).
The complexity of the decision making in drug selection is well perceived
amongst the patients and hence there happens no hindrances from
consumers patients once a physician selects the drug for them. However,
patients do discuss with their treating physicians about their experience,
feelings and constrains with the prescribed drugs. The behavior of physicians
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is complex and is influence by multiple factors in the selection of drugs but
with a one main objective, improving patients live by controlling or managing
the disease. Over a period of time, very few innovative drugs however couldget acceptability amongst the physicians and are able to be converted into big
brands to become a benchmark for other innovation to come or replaced the
old available options. In other words not a good number of drugs had been
ranked as golden standard in the treatment and has been able to alter the
treatment protocol of the physicians. Prescription of innovative drug is based
on the perceived innovativeness and superiority amongst physicians.
Physicians in pharmaceutical industry are surrounded by organizations
communication based on Ps of marketing, Society, their own experience oftreating patients and up to some extend government too that reflect their
behavior. These external and internal actors are igniting the race to market
innovative drugs, because only the first to market would benefit. Resulting,
taking competition ferociously at the level of therapeutic class and being not
on time to market with an undifferentiated attribute in the product was a punch
of failure (Holland & Batiz, 2004).
In Pharmaceutical industry, physicians behavior could be observed on thebasis of the diagnosis of the disease and selection of the treatment regime
with a consideration of drugs benefits, patient types, concomitant disease,
long term consequences of disease and the future challenges from both
patients and physicians perspectives. However, physicians behavior in drug
selection is fundamentally based on considering efficacy, safety, tolerability,
cost, convenience and evidence of the drug.
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Business Methodologies of the Pharmaceutical Industry
During the previous few years, business situation for pharmaceutical
organizations have been changing rigorously, the model that was successful
in the past is not able to keep its pace and therefore making industry a
hostage of its past triumphs. The current strategies are only delaying the
inevitable and its is estimated that only one out of six innovative drugs shall be
able to deliver returns above their cost of capital which is an unpleasant view
for investors (Gilbert, Henske & Singh, 2003).
In pharmaceutical business, Sales force has been a fundamental tool for the
organizations to introduce a drug to physicians and delivering of the key
messages of the drug with conducting the activities to change the beliefs and
behaviors of physicians in favor of drug. Typically, a representative is
assigned to visit certain number of physician within his or her assign territories
and physicians are visited with a certain number of frequencies on a weekly,
monthly and yearly basis. Physicians behavior is observed through face to
face discussions and through pharmacies auditing about the prescription
pattern of the physicians. The progress of sales forces is measured on the
basis of the progress of doctors in the prescribing continuum (ladder of
adoption), which is generally comprises of five stages; Awareness, interested,
trying, broadened prescribing and full prescribing. Key Account Management
(KAM) in the pharmaceutical industry is concerning to create a strategic
rapport with customers so that to achieve long term profit, sales growth and
attain medium term goal by using the sales force.
Traditionally, frequency of calling model for drug introductions, delivering of
key messages to physicians had been supported by the industry. The model
includes the detail follow up as well as conducting activities and its analysis.
The model has been successful in moving the targeted physicians in the
prescribing continuum (Awareness, interested, trying, broadened prescribing
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and full prescribing). The model is also used to register the progress of the
organization internally to change their approach in meeting the needs of the
physicians especially when the physicians require additional support/servicesfrom the organizations.
Business Focus in Pharmaceuticals Industry
To manage this market, enormous amounts are spent on sales and marketing
to ensure diffusion and adoption of drugs whether it is innovative or me too is
the core amongst the strategies within the pharmaceutical organizations. The
companys Medical representatives are the key marketing tool in the bag
having at the back the marketing department that formulate the campaign to
be delivered to physicians as well as conducting the activities of developing
prescribers and building opinion leaders, arranging dinner debate, conducting
round table discussion meetings in shaping up the perception in favour of drug
by using both pull and push strategies depending on nature of disease and
type of innovation. Due to the nature of business, it shall not be unfair if the
adoption of drug can be explained in two levels; first level consists of the
acceptability of drug by the physicians and second level consists of
acceptability of drug by patients to comply the physicians prescription. In
order to ensure the complete adoption, pharmaceutical industry s
communication strategy is focused on utilizing both push and pull methods so
that to reach its target physicians and potential patients both physicians and
patients. Accordingly the push strategy is used to convince the prescribing
physicians of the drug, where as pull strategy is used to ensure patients have
the understanding about the disease and its management so that they must
comply the prescription of drug and visit the physicians.
Marketing problems associated with the introduction of new products are often
open to analysis and solution through the use of behavioural principles.
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The Concept of Disease
Physicians in pharmaceutical industry come across with two types of diseases
and that can be discussed as, the acute diseases and the chronic diseases.
Acute disease could be a disease with rapid onset and short duration of time
and usually may last for few days but may have the intense signs and
symptoms. Whereas the chronic diseases may persists for a longer duration
of time and produce symptoms for longer time as well and may take several
weeks or months in getting cure. According to AIHW (2002), CHRONIC
DISEASES ARE THOSE THAT OCCUR ACROSS THE WHOLE SPECTRUM OF ILLNESS,
MENTAL HEALTH PROBLEMS AND INJURIES. CHRONIC DISEASES TEND TO BE
COMPLEX CONDITION IN HOW THEY ARE CAUSED, ARE OFTEN LONG LASTING AND
PERSISTENT IN THEIR EFFECTS AND CAN PRODUCE A RANGE OF COMPLICATIONS.
Chronic diseases are likely to be difficult conditions in how they are rooted and
are frequently ongoing and continual in their effects with complications
(Thacker et al. 1995). Hence the drugs options for the doctors are based on
these diseases types accordingly. There has been a shift now in
pharmaceutical research and development and the efforts to create innovative
drugs are focused for the chronic and degenerative diseases instead of acute
diseases. Because these drugs are meant to be taken for a longer period of
time which is good for organizations since they always carry a sizeable pool of
patients on their drugs (CBO 2006).
Types of Drug and Treatment Employed in the Industry
Pharmaceutical products can also be divided into two group, namely the
Ethical products and OTC (over the counter) products. Ethical drugs are
those that can be sold only against the physicians prescription, but on the
other hand OTC drugs can be purchased with out any prescription. In ethical
pharmaceutical drugs, there are two therapeutic classes available on the basis
of disease types, one for acute diseases treatments and other for chronic
diseases treatments and or management.
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As marketing environment is getting changed because of cost challenges,
competitive pressures, changing needs and expectations of physicians and
frequent introduction of me too drugs. Thus organizations are demanded toimprove the way they develop and introduce drugs to the market that should
meet the changed needs of its physicians and remain profitable, competitive
ensure its sustainability in the industry competitive. It is an integrated process
through which organizations create value for physicians, deliver drugs to
physicians in exchange for some return. All marketing activities are used to
create and retain physicians by keeping them satisfied.
The demand of innovative drugs grow as the number of alternatives flourishthus identification and successful launch of innovative drugs become critical
for organizations success and is probably the most important activity for many
organizations. The development of innovative drugs in Pharmaceutical
industry is expensive, risky and time consuming as well. There is only about
one out of 60,000 compounds synthesized in laboratories can be regarded as
highly successful drug (Schweitzer 1997).
Over the period of time a very few drugs have got the acceptability in themarket. The graph of new product development in Pharmaceutical industry
has also gone down over the last few decades. Over the years, a growing
share of the industrys research and development outputs has consisted on
incremental betterment on previously available medications instead of creating
entirely new drugs. The new drugs launched during the period however could
not gain reputations that could make them a best available choice over the
available choices. However, pharmaceutical industry is the sixth most effective
industry in generating innovation (Business insight, 2010).
Diffusion of innovation and its adoption remains the core focus in the strategy
making process within the pharmaceutical organizations. To ensure the
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execution of drug diffusion and adoption, the companys Medical
representative has been used as a fundamental instrument with the other
synergistic tools.
Title of Research
An Exploratory Study on the Innovation, Diffusion and Adoption Processes of
the UK and Pakistan Pharmaceutical Industries 2010
Research Objectives (In Context of UK & Pakistan), areto:
Gain a deeper understanding of how customers (physicians) perceivedrug innovation.
Explore how perceived innovation affects the market success of drugintroduction.
Explore and understand the Adoption process of an innovative drugamongst its customers (physicians).
Understand the innovation diffusion process in the Pharmaceutical
industry.
Research Questions (In the Context of UK & Pakistan):
What is meant by the concept of innovation and how it is utilized in
Pharmaceutical industries?
What is diffusion and how does it happens in the pharmaceutical
industries?
What are the factors driving innovation and diffusion in the
pharmaceutical industries?
What are barriers and drivers of the adoption of innovative drugs
among physicians?
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This chapter will explore concept, definition of Innovation, Diffusion and
Adoption in the pharmaceutical industry. It shall further explore and establish
the concept each component of the topic. This chapter shall also explore thetype and structure of innovation, diffusion and source of information of the
innovative drug and consequently the adoption of the drug.
Chapter 3 shall explain the research methodology used for the research and
rational behind them. This chapter shall focus on the research philosophy, the
research approach adopted with the detail about the research strategy.
Chapter 4 shall present the anlysing and interpretation of the reviewedliterature in chapter two and the findings of qualitative and quantitative
research.
Chapter 5 shall be final chapter and hence present the researchers
conclusion in the light of research findings and interpretation.
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CHAPTER 2
Literature Review
Literature review demonstrates the thinking, explanation and relation of
Innovation, Diffusion and Adoption of innovation. Innovation, its diffusion and
adoption are the main focus of interest in this study. An increasing amount of
literature have discussed about the certain type of innovative models with
perceived innovativeness of the drug which are explained as the
characteristics of innovation. A number of authors and studies have connected
innovation with its diffusion and adoption when talk about the physicians and
patients perspectives.
Jaakkola, E. & Renko, M (2007) conducted research to investigate the critical
characters of innovation that influence the acceptability of new drug of
pharmaceutical. They termed physicians as surrogate adopter since they
select pharmaceutical drug for their patients. In their study, they discussed two
level adoptions in pharmaceutical product, firstly the surrogate physicians thatdecide to prescribe drugs to patients and patients are the second level
adopters since they need to stick with the prescribed drug. According to them,
the adoption at second level is critically important since without having drug
being adopted by the patients innovation would not be adopted. They further
discussed that patients have the influence on (physicians) surrogate adopters
in the evaluation of the satisfactoriness of an innovation in spite of the
professional powers of the physicians. Doctors keenness in adopting a new
drug is subjective to their judgments of distinctiveness of the drug from theviewpoint of their patients.
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Importance of Innovation
Innovation play an important and critical role in organization since it is
connected with the improvement in efficiency, quality, productivity, competitive
advantages, positioning so that to ensure growth, increase or maintain market
shares and adds values in the organizations and the portfolios it deals.
According to West midland observatory report (2009), INNOVATION IS ONE OF
THE KEY VARIABLES INFLUENCING PRODUCTIVITY GROWTH. INNOVATIVE FIRMS
GROW FASTER AND ARE MORE LIKELY TO SURVIVE DURING A RECESSION. THE
BENFITS OF INNOVATION ARE NOT ONLY LIMITED TO THE ORIGINAL INNOVATOR
THOGH; BY ITS OWN NATURE THE PRODUCTION OF INNOVATION CREATES
KNOWLEDGE SPILL-OVER THAT ALLOW OTHER FIRMS TO BENEFIT FROM THE INITIAL
INNOVATION IN TERMS OF INCREASING TOTAL FACTOR PRODUCTIVITY. IN TURN THIS
CAN CREATE THE CONDITION FOR A VIRTOUS CIRCLE OF ECONOMIC GROWTH FROM
WHICH THE WHOLE OF SOCIETY CAN BENEFIT.
Aggressive demands, price confronts, and increasing consumers expectations
are motivating organizations to get better the way they are developing and
introducing products to the marketplace. Whether the new product idea is
cultivated internally or in response to customer need and market requirement,
the new product launch method can facilitate the innovation. It mechanizes
everyday jobs, depictions performance bottleneck, and forces steady
implementation and unbroken upgrading. And, it gives management visibility
into the product development channels. Since new product introduction is so
linked with supplementary product development processes, its acceptance
and implementation considerably persuades potential for success (PTC,
2006).
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A Discussion & Definitions of Innovation
Luecke and Katz (2003) explain, INNOVATIONIS GENERALLY UNDERSTOOD AS
THE SUCCESSFUL INTRODUCTION OF NEW THING OR MEHOD INNOVATION IS THE
EMBODIMENT, COMBINATION, OR SYNTHESIS OF KNOWLEDGE IN ORIGINAL,
RELEVANT, VALUED NEW PRODUCT, PROCESS, OR SERVICES.
Rogers (1995) explains, INNOVATION IS AN IDEA, PRACTICE, OR OBJECT THAT IS
PERCEIVED AS NEW BY INDIVIDUAL OR SOME OTHER ENTITIY OF ADOPTION. There
is correlation amongst technology, newness, uniqueness, ergonomics, design,
market size, market growth rate, competition, relative price, customer loyalty,
customer familiarity with the product class and frequency of purchases
(Veryzer, 1998). Innovation can be evaluated on four characteristics, relative
advantage of the product, compatibility, its Trialability, Observability and
complexity (Rogers, 1962).
There could be many definition and classification of in innovation or new
product, however Robertson (1967) classified innovation between; a
continuous innovation that involve in alteration of a product rather than the
creation of entirely new product, a dynamically continuous innovation that
involved in creation of a new product on the alteration of an existing one and a
discontinuous innovation that involved in establishing a new product and new
related behavioural pattern.
Innovation can have several definitions; it could be the application of novel
ideas to the product, processes, or other portion of the activities of an
organization which results in increasing the value. The value can be
described in a wide manner to comprise more value added for the
organization and also benefits to customers. Two significant division of
innovation may be Product innovation that deals in introducing the new
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product, or a major qualitative modification within the current product. Process
innovationdeals in the application of a new process in producing the products.
Till et all (2005), cited by Bishop (n.d.), have supplemented the innovationtypes in the organization and describe innovation in four different ways
namely; product innovation, process innovation, positioning innovation and
paradigm innovation.
To market innovative pharmaceutical drug is a lengthy, time consuming and
complex process that requires significant amount of money and time to
establish and got accepted by physicians and require maximized market
admittance at the premium price to make return out of investment in the formof drug prescriptions. A large body of proof strongly associates innovation to
economic growth. According to Congressional Budget Office (2006), HEALTH
INNOVATION COVERS A WIDE RANGE OF SCIENTIFIC, MEDICAL, ECONOMIC AND
SOCIAL ISSUES. ON AVERAGE, IT TAKES ABOUT 10-15 YEARS AND MILLIONS OF
DOLLARS TO DEVELOP A NEW MEDICINE. AVERAGE PRICES OF NEW DRUG HAVE
BEEN RISING MUCH FASTER THAN THE RATE OF INFLATION, AND ANNUAL R&D
SPENDING HAS GROWN FASTER STILL NEVERTHELESS, INTRODUCTION OF
INNOVATIVE DRUGS HAVE SLOWED, THE AVERAGE COST OF DEVELOPING ANINNOVATIVE NEW DRUG AT MORE THAN $800 MILLION, INCLUDING EXPENDITURE ON
FAILED PROJECTS AND THE VALUE OF FORGONE ALTERNATIVE INVESTMENTS.
Innovation in Pharmaceutical Industry
According to Graham (2010)UNLEASHING INNOVATION IS AT THE CORE OF THE
PHARMACEUTICAL INDUSTRYS BUSINESS MODEL. THE PHARMACEUTICAL INDUSTRY
IS ALL ABOUT INNOVATION; INNOVATIVE SCIENCE, INNOVATIVE MANUFACTURING
PROCESSES, INNOVATION; INNOVATIVE SCIENCE, INNOVATIVE MANUFACTURING
PROCESSES, INNOVATIVE PEOPLE AND INNOVATIV PEOPLE AND INNOVATIVE
MEDICINES.
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According to freeman (1982), cited by Attridge (2006), innovation in
pharmaceutical industry can be classified as revolutionary, radical orincremental (table 1). Advancement in the concept such as detection of new
microbes and a new anti infective to cover that microbe is a revolutionary
innovation. Where as creating a drug with different mode of action which is
based on the identified disease mechanism is radical innovation which is
followed by the incremental innovation that are based on benchmarking
radical or revolutionary innovation by bringing improvement in different
attribute, which offer value in treating particular disease variation of segments
of specific segment of patients.
According to Landau (1999), cited by Attridge (2006), Pharmaceuticalorganizations simultaneously got engaged in race to compete on the bases of
different patterns that resulted in saturation and it became difficult to
differentiate the drug and hence using the term radical and incremental got
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difficult too. One after launch of similar kind of drugs that carry the similar
benefits, mode of action and side effects profile have created a competition
amongst different generic but in the same class. However the third and fourthor fifth launched drugs carry more balanced benefits for the patients and
physicians over the first launch. Therefore the first molecule launch in a new
class could fall in the radical innovation and the following molecules could be
the incremental innovation.
According to CBO (2006), ON AVERAGE, ONLY ABUOT ONE THIRD OF NEW DRUG
APPLICATION SUBMITTED TO THE (FDA) FOOD AND DRUG ADMINISTRATION ARE FOR
NEW MOLECULAR ENTITIES (NMEs),MOST OF THE REST ARE EITHERFOR
REFORMULATION OR INCREMENTAL MODIFICATIONS OF EXISTING DRUGS OR FOR
NEW ON LABEL USES.
According to Well (1998), cited by Attridge (2006), This incremental innovation
tends to be perceived as the best drug hence get more acknowledgments and
acceptance by the physicians as compare to the first introduction.
A Discussion & Definition of Diffusion
According to Arthur et al (1983) cited by Bronwyn (2003), THE STUDY OF
INNOVATION, THE WORD DIFFUSION IS COMMONLY USED TO DESCRIBE THE
PROCESS BY WHICH INDIVIDUALS AND FIRMS IN A SOCIETY/ECONOMY ADOPT A NEW
TECHNOLOGY, OR REPLACE AN OLDER TECHNOLOGY WITH A NEWER. BUT
DIFFUSION IS NOT ONLY THE MEANS BY WHICH INNOVATIONS BECOME USEFUL BY
BEING SPREAD THROUGHOUT A POPULATION, IT IS ALSO AN INTRINSIC PART OF THE
INNOVATION PART OF THE INNOVATION PROCESS, AS LEARNING, IMITATION, AND
FEEDBACK EFFECTS WHICH ARISE FROM ITS UNFOLDING ENHANCE THE ORIGINAL
INNOVATION.
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The adoption of a new drug or idea does not happen all at once in marketing
system. Ryan & Murray (1977) explain two ways of illustrating the process; the
generalized cumulative diffusion pattern and the generalized noncumulativediffusion pattern which both end up with the 100% adoption. A substantial
number of studies provide evidences that the timing of acceptance can be
represented by a normal distribution (Rogers, 1962). Robertson (1970)
suggested that the process of innovation diffusion can be conceptualized as;
the adoption of the new product overtime by consumers within a social system
that is encouraged by the marketing. The nature of product has affects on the
type of consumers that are adopting, the rate of adoption over the time and so
on.
Diffusion is a process by which things get dispersed (Robertson 1970). In
marketing the process of product, service or idea acceptability amongst the
consumer is known as diffusion. Since the acceptability of new product varies
amongst the consumers thus they can be classified because some consumers
accept the product immediately upon the launch of product where as some
are last to buy.
Rogers's (1983) explained the diffusion model which is based on the classical
"bell-shaped" normal distribution curve, the curve in the bell symbolizes the
consumers frequency for accepting the product over different intervals of
time. He classified consumers as innovators, early adopters, early majority,
large majority and laggard. His classification is based on demographic,
socioeconomic and personality characteristics. This approach suggest once
the target market for innovative product is set, companies must specifically
plan to approach innovators and early adopters that should follow the adoptionof innovation by early and late majority due to word of mouth (Hawkins, Best
and Coney 1989). Rogers (1995) has further explained diffusion as the
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process by which an innovation is communicated through certain channels
over time among the members of a social system.
A rising body of study discloses the importance of positive recognized
innovation characters as strong forecasters of the rate of adoption (Black et al,
2001). An innovation is an idea, practice, or object that is perceived as new by
individual or some other unit of adoption (Rogers, 1995). There is correlation
amongst technology, newness, uniqueness, ergonomics, design, market size,
market growth rate, competition, relative price, customer loyalty, customer
familiarity with the product class and frequency of purchase (Veryzer, 1998).
Rogers (1962), describe four distinctive attributes of innovation to beevaluated, relative advantage of the product, compatibility, its Trialability,
Observability and complexity.
Diffusion deals in the process of spreading of something (Robertson, 1970). It
is a concern amongst the marketers by which way adoption of the new
product or service spreads in the marketplace. Diffusion is the process by
which an innovation is communicated through certain channels over time
among the members of social system (Rogers, 1995). Mittman & Cain (2002)explained ten stages of the diffusion of innovation as, relative advantages,
Trialability, Observability, communication channels, homophilous group, Pace
of innovation, Social network, Opinion leaders, compatibility and infrastructure.
Once physicians decide to use a new device or a piece of technology, the
physician must often see the impact of product on the patient (Mittman & Cain,
2002).
Ryan & Murray (1977) explored that marketing controlled sources had lessinfluence than extent of their usage might suggest. The influence of
professional meetings, medical journals and peers in comparison to their
actual usage is noteworthy.
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The adoption of a new product or idea does not happen all at once in
marketing system. An impact of drug, technology or a new devices on patientsis prime consideration of clinicians once decides to use (Mittman & Cain,
2002). Ryan & Murray (1977) explain two ways of illustrating the process; the
generalized cumulative diffusion pattern and the generalized noncumulative
diffusion pattern and both end up with the 100% adoption. A substantial
number of studies provide evidence that the timing of acceptance can be
represented by a normal distribution (Rogers, 1962).
Diffusion of Innovation in the Pharmaceutical Industry
According to Rogers (1996), diffusion theory became more widely accepted
after James S. Coleman, Elihu Katz, and Herbert Menzel conducted a study
on the diffusion of tetracycline which is a drug developed by Pfizer laboratory
during 1966. Because of the success of drug, Pfizer initiated to investigate the
impact of advertisement on the adoption of drug. The company asked three
professors at Columbia University to find out how physicians adopted the new
innovation and how mass communication influenced this adoption process.
They conducted a survey to gather accurate and reliable data. Different with
previous diffusion research that relied on respondents recall of how they
adopted new technology, this study gathered data both from physicians'
responses and pharmacies' prescription.
In addition to this, Coleman et al. (1966) asked their respondents to list their
interpersonal connections in order to investigate the effect of interpersonal
network links with the new drug adoption. The result shows that the
percentage of adoption of the new drug followed an S-shaped curve, but that
the rate of tetracycline adoption was faster than the rate of other innovations
adoption. The researchers also found that doctors who are cosmopolite were
likely to adopt the new drug. One of the most important findings was that
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doctors who had more interpersonal networks adopted the new medical drug
more quickly than those that did not. This meant that interpersonal
communication channels with peers had a strong influence on the adoptionprocess.
According to Rogers (1996) The Columbia University study is one of the most
influential diffusion studies in showing that the diffusion of an innovation is
essentially a social process that occurs through interpersonal networks.
California Health Foundation (2002) in its health report has discussed in detail
of the ten different dynamics of innovation diffusion, according to themRelative Advantage:THE DECISION TO ADOPT A TECHNOLOGY IS INFLUENCED BY
FIRSTLY, THE ABILITY OF A POTENTIAL ADOPTER TO JUDGE WHETHER THE
BENEFITS OF USING THE INNOVATION WILL OUTWEIGHT THE RISKS OF USING IT,
SECONDLY, WHETHER THE INNOVATION IMPROVES UPON THE EXISTING
TECHNOLOGY. THE MORE BENEFIS PEOPLE ANTICIPATE FROM ADOPTING THE
INNOVATION RELATIVE TO WHAT THEY NOW DO, THE MORE RAPIDLY IT WILL
DIFFUSE.
Adoption of innovation is dependent on the characteristics of innovation. The
five characteristics of Rogers (1995) that are relative advantage, Compatibility,
Complexity, Trialability, and Observability have been explained by Fadi et al
(2010), as per them:
Relative advantage is the ability of a potential adopter to judge if the benefits
of the innovation outweigh the risks of using it, additionally in comparison to
the existing option whether the innovation provide more benefits.
Compatibility deals with the degree to which an innovative product is
perceived to be simple as compare to available option so that the behavior of
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adopter does not need to be modified. The compatibility of innovation has a
direct relationship in case if the practices, values, traditions and expectations
are established.
Complexity is the capability to seek out an innovation without total
commitment and with minimal investment. It deals with the partial agreement
from a customer to try the product in few of the cases so that to build a
confidence to move on. The more the innovation is complex in nature the
more it is difficult to be adopted.
Trialability is the characteristic of an innovation that provides opportunity toan adopter to evaluate if the innovation is experiment-able on a limited scale
to validate the promises of the innovation.
Observability deals with the observation of customers from other customers,
if the customers watch others using the product and the outcome of usage is
acknowledged for the safety and benefits of the product, the more likely it will
be adopted by new customers.
In addition to five characteristics of innovation, California Health Foundation
(2002) has explained five other dynamics of innovation diffusion, they are:
Communication Channels are critical for innovation to be diffuse since it is a
social process and depend on innovation to be communicated from the
customers they know it to the customers they dont know it.
Homophilous group play a vibrant role in innovation diffusion sinceinnovation diffusion is smooth and speedy in similar group of customers.
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Robertson (1970) suggested that the process of innovation diffusion can be
conceptualized as; the adoption of the new product overtime by consumers
within a social system that is encouraged by the marketing. The nature ofproduct has affects on the type of consumers that are adopting, the rate of
adoption over the time and so on.
Pace of innovation and its degree is also important in the adoption of
innovation since innovations are readily accepted by customers than others
depend on the nature of innovation.
The norms, roles, and social networks of medicine are very important to thediffusion of new technology.
Opinion leaders, role in diffusion is very important since their words and
behaviors influence the peers due to greater exposure of opinion leaders to
new ideas than others.
Infrastructure is important for an innovation to be diffused and adopted. The
relevant diagnostic facilities and techniques has a direct impact on theadoption of innovative drug since to asses the product profile and monitor
through clinical and laboratorial analysis.
A Discussion & Definitions of Adoption
Adopting an innovation needs time by the adopters since there is inherent
uncertainty involve with the new options (CHF, 2002). The satisfaction rather
the level of satisfaction with the available choices also matters in adopting the
innovation. More is the satisfaction with the available option more it create
barrier for innovative products by the adopters. It is important to evaluate the
actions required by the adopters as well as the choices available to them so
that to decide whether or not to put and innovation into practice (CHF, 2002).
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Kotler (1991) explains adoption process in five phases and according to
author the innovative product are adopted through Awareness amongst the
consumer, followed by developing interest amongst the consumer to use theproduct which leads to Evaluation of the product and agreeing to try the
product upon his or her evaluation and finally adopt or reject the product.
Rogers (1995) describe five step processes to explore innovation decision
process and they are knowledge, persuasion, decision, implementation and
confirmation (see appendix 1 for more detail). Allen (2009) has explained five
stages of adoption as awareness, increase understanding, positive attitude,
integration and adoption. Physician in the drug selection has the ultimateresponsibility and patients role is to comply with the prescription of the
physician (Gonul et al. 2001).
According to Turnbull and Parsons (1993) and cited by Jaakkola and Renko
(2007), A physician is not a customer in the sense of actually buying the
product, nor is he the consumer of the prescribe drug. There has been an
inherent hypothesis, as argued by Plouffe, Vandenbosch and Hullnad (2001)
and is cited by Jaakkola and Renko (2007) that there is only one groupresponsible for adopting the innovation and that is a consumer and th is
consumer has the decision power to adopt the innovation. In the scenario of
drugs selection, consumer or customer are neither single adopter or decider
but they both have to agree to adopt the product. Solomon (1986) describe
this kind of decision making that involve third party decision makers as a
surrogate consumer that has the influence on the end users.
In pharmaceutical drug adoption, two levels of adoption take place; firstly thedrug has to be adopted by the physician and secondly once a drug is
prescribed by physicians, the drug has to be adopted by the patient also, as
shown in (Fig 2). There for it requires pharmaceutical organization to target
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both treating physicians and patients with channelized marketing activities
accordingly (Wilkes et al, 2000). Additionally, opinion leaders are useful
external source that can speedup the adoption of innovative drug at both levelof adoption (Groves et al, 2002). According to Jones, Greenfield and Bradley
(2001), cited by Jaakkola and Renko (2007), opinion leaders have a strong
influence on GPs for adopting the innovative products because of their
experience and expertise at the treatment level and disease understanding.
There is a strong influence of opinion leaders on the consumption pattern of
drug at the second level of adopters. It is due to the nature of industry, there is
less or no influence of peers, friends or social circle on the end user (patients)
due to the involvement of treating physicians (Aggarwal and Cha 1997).
However first level adopters are strongly influenced by peers, social circle and
friends in adopting an innovative drugs.
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The adoption of innovative drug at first level is critically important but it is also
important the drug is purchased by second level of adopters and consume as
per the advice of the treating physician.
So adoption at the second level plays a vital role in the success of innovative
drug because a lacking in the compliance by second level adopters has a
serious consequence on adopters and on the society because of disease
burden. The adoption of innovative drug at physician level however is based
on considering the barrier in patients compliance but based on the benefits of
drug and hazard of the uncontrolled disease and point of view of their patients
(Jaakkola, Renko, 2007).
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Chapter 3
Research Methodology
The function of research design is to attach the questions to data. Design to
be seated amongst; firstly, presentation how the research questions are to be
connected to the data, secondly, the tools and measures are used in getting
them answered. Research design is to be followed from the questions and
match them with the data. The research design is the fundamental plan for a
piece of observational research, and includes the key thoughts like strategy,
sample, tools and measures to be used for collecting and analyzing the
gathered data (Punch, 2000).
Research Method
Exploratory method of research was adopted to carry out the conceive study
because exploratory research provides an opportunity to utilized both
qualitative and quantitative methods including a document review. Structured
online survey, face to face meetings and telephonic interviews were
conducted to collect the data. The use of multiple methodologies permitted
researcher in triangulation of the data to improve the validity of the findings,
and enabled greater inferences from the results.
The research method that was used is the mixed-model which combines
quantitative and qualitative data collection techniques and analysis
procedures. Additionally, qualitative and quantitative approaches were used
with the preparation of questionnaires. For the research, quantitative method
of research hold the dominance where as qualitative method used helped
research filling up the gap from the quantitative research as well as to have
deep understanding and explanation of certain perception and beliefs that
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were identified from the quantitative research and the answers that were not
possible from quantitative research or needed exploration.
Additionally qualitative method helped researcher to obtain feedback from
respondents to improve the questionnaire. The use of literature review,
quantitative and qualitative method of research helped researcher to establish
the understanding gain in close to the more accurate way by validating data
collected through cross verification from two or more sources. The use of
three sources however researcher believes has increase the research
credibility for the conclusions and findings.
The study presented here has investigated the process of innovation, diffusion
and adoption of innovative ethical pharmaceutical drug of two different
countries. The purpose of the study was three fold. Firstly to investigate that
how innovation is defined and discussed by the authors, how it is perceived by
physicians in pharmaceutical industry and exploring innovation practices in the
pharmaceutical industry. Secondly, how diffusion is define and discussed by
authors, how diffusion happened amongst the physicians of pharmaceutical
industry, what drive diffusion and what are constrains in the diffusion process.Thirdly, how adoption is define and discussed by authors and how innovative
drugs are adopted by physicians of pharmaceutical industry. This research
was conducted by applying qualitative and quantitative research method and
evaluated the collective responses of UK and Pakistan and relationship
between the primary and secondary findings.
Several studies have developed and used quantitative and qualitative
instruments to measure adopters perceptions on product diffusion. Ryan &Murray (1977) used quantitative methodology to investigate the diffusion of
ethical drug amongst the physician. Jaakkola & Renko (2007) used qualitative
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methodology of research to investigate the product related characteristic that
physicians evaluate while adopting the new pharmaceutical product
Data Collection
Data collection methods in this study had been divided into two groups;
quantitative that was covered the structured questionnaire surveys from
randomly selected customers from both countries. The selection of physicians
was not done on the basis of their specialty, type of practice, age, gender,
graduation year etc. An online survey software was subscribe for the purpose
to conduct the quantitative research which helped researcher to conduct the
survey in simplest framework and shortest time, additionally software helped
respondents to participate effectively and conveniently. On the other hand the
use of software helped researcher in analyzing the finding conveniently and
time efficient manner. For the quantitative research, two similar questionnaires
were designed and used for each country and send separately to the identified
list of physicians. The objective of separate but similar questionnaire was to
gather the responses separately so that to the dissimilarities if found, although
it was not an objective of the study.
The qualitative research from focus individual from random specialty was
based on an un-structured series of questions. The questionnaire for the
qualitative research was developed and finalized considering the knowledge
required from the responses out of quantitative findings as well as the
questions that need explanation on the topic which researcher believe would
be difficult in gaining from quantitative research and validating the responses
of both qualitative and quantitative research so both the methods had
complemented each others all the way.
Since the research was based on exploring the innovation, diffusion and
adoption processes of UK and Pakistan pharmaceutical industry so telephonic
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mode of qualitative research and Skype technology was used for Pakistan
since researcher was based in the UK. It is due to the experience of
researcher worked within the pharmaceutical industry of Pakistan, theappointments and timings for the telephonic interview and Skype were not a
problems and they were conveniently conducted and recorded on the
telephone and voice recorder. A series of questions in a draft version was sent
through email to the respondents of both countries so that they have a time
and preparedness to discuss on the topic and maximum information could be
gathered out of the interviews. Additionally it was also informed to the
respondents of both quantitative and qualitative research about the academic
purpose of study so that they are open in you point of view and theirresponses are not biased.
Qualitative research helped researcher in gaining an understanding of howor
why things are as they are. This discussion helped in uncovering how the
individual thinks and visualizes the scenario of the topic and what is their
understanding.
In qualitative research the discussion between the researcher and therespondent was largely determined by the respondents own thoughts and
feelings. The interviews were longer and in depth so the responses were also
in detail and were requiring clarification at some point so that researchers
interpretation was true and based on actual responses.
The data gathered from quantitative research was by the use of online
structured series of questions. Each question was connected with the next
question so that response of each question was double checked and validatedwhich helped researcher in gaining accurate information and at some point
with the example in the answers. Questionnaire for the quantitative research
was design by using multiple choice questions, descriptive questions with
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closed ended and open ended questioning technique. Since the questionnaire
was sent as a link through email so following up for the responses became
easier that help researcher in getting the maximum responses with a minimumefforts and follow ups. Additionally, it was also ensured that one respondent
can attempt the link to reply only once so that there are no repetition which
could otherwise have an impact on the findings. A consensus was taken from
the targeted respondents for quantitative research before sending them the
questionnaire link so that they could understand the urgency and importance
of the research.
Altogether 100 respondents were targeted to get response, 50 each from UKand Pakistan keeping in mind a time of 25 days. Altogether 82 responses
were received from both countries and were compiled accordingly. The
responses from both the countries were evaluated and analyzed collectively
and separately also so that to find the dissimilarities if any and explain. From
Pakistan 46 responses were received where as 36 responses were received
from the United Kingdom.
The qualitative data was collected by using semi structured questionnaireselecting respondents separately from Pakistan and UK having 5 respondents
from each country. Doctors were selected randomly without any consideration
of specialty, gender, age, year of experience etc. but it was mandatory for a
respondent to have active involvement in treating patients either in hospital or
at private clinic.
Both qualitative and quantitative researches were having the questionnaire
that was focus on non product base or disease based so that insight gain fromthe research is not product related or any disease related. So the research
provided researcher a general perception of medical community regardless of
any product specific and or disease related. At some stage in particular to
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qualitative research, doctors were requested to give examples to support the
answer so that insight gain is not subjective but have a logical meanings. At
some stages, an added questioning technique was also used in whichresearcher probe responded in further explaining their responses. This helped
researcher to be sure that the interviewee physicians have a clear
understanding on their replies. It was critical for researcher at the point to
have in depth perspective of respondents since they may not be aware of the
definition of innovation, its types and characteristics as explained by the
authors.
Researchers experience in the study had played an important role since anin-depth knowledge of drugs and diseases helped researcher conducted the
research in a focus and precise way without any deviation from the topic.
Knowing the drugs on researcher end had a significant importance for
researcher because to avoid the response about the me too and OTC drugs.
Obviously, the respondents feedback was consequently based on believes
and perceptions which were based on their experience in real life scenario
with innovative drugs.
Data Analysis
Data analysis started by writing down the tape recorded interviews. Firstly, the
transcripts were coded. Each countrys data was transcribed and send back to
the respondents of qualitative research so that there is no ambiguity once the
data is compiled and analyzed. The transcribed was based on the format of
question and under the question, the answer of the respondent in his own
word with example if applied.
The data from each country was compiled all together as well as separately so
that to compare and contrast the similarities and dissimilarities. This had a
significance to know if there are some differences in the point of view of any
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level so that it is explore in the study and open the opportunity for the next
level research on why.
Since the research was conducted separately for both UK and Pakistan. Each
response was compared from both countries so that to present any findings
those are dissimilar. The analysis process led to the identification of a set of
general themes that were subsequently compared to existing concept and
theories. The participants according to groups of physicians were contrasted
in order to find out if certain point of view and arguments were more prevalent
in from quantitative research had different from those of qualitative research
respondents. But this comparison was done on the basis of any specialtysince it was not the purpose of study
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Limitation of Research
Several issues in connection to this study were kept in the consideration. The
responses of quantitative hold potential success factors that contribute a
positive role in the reliability of the study. Respondents having dissimilar
knowledge, experiences, practices, education, qualification, specialty, their
attachment with government institutions were not considered during the study.
Further more, the answers of the respondents may be biased due to the
reasons mentioned above. Additionally, however the participants were
selected randomly but their responses might be based on their year of
practice, type of patients they see and the potential of patients since the
introduction of new drug to a low profile physicians are done at low pace from
business point of view. There may be chances if the same research is
conducted on the one specialty of physicians or one classified category of
physicians, the findings of the research could be different. Additionally the
scale of study is not as big as it is recommended by the authors which should
represent at least 7-10 % of the population. The researcher has acted just an
observer avoiding any possibility of influencing or biased the respondents
answers due to his previous knowledge and experience working within the
same industry. Even though the researcher is experienced and have
knowledge of the industry, he did not try to influence respondents to obtained
specific results or a specific behaviour from any of them. In order to reduce
the unreliability of the study, researcher has designed the format of questions
in a way that each response by the targeted physicians would be linked to the
next questions and so. Since the method used in this study is the mix of both
quantitative and qualitative so any ambiguity would be address and minimize
with the findings of each method.
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Chapter 4
Findings & Analysis
Innovation
Innovation was revealed as the most important and understood concept
amongst the respondents of both from quantitative and qualitative research.
However it is observed that at some level there is small degree of confusion
prevails in differentiating a new drug and innovative drug. However majority of
77.8% physicians believe that innovative and new products are different, but
the respondents that were believe innovative and new products are same had
mentioned the name of innovative drugs, so the interpretation of their
response was same.
There has been an overall satisfaction amongst 62.5% of physicians
responded that they are satisfied with the innovative drug introduced in the
market where as 12.5% physicians showed their dissatisfaction on the
innovative drugs introduced in the market and hence believing the innovations
in the drugs should be in the form or new molecule introduction instead of
brining insignificant incremental improvement over the available therapeutic
options.
Additionally, the satisfaction level amongst the physicians was 50% with
innovative drugs because majority 62.5% of them believes the innovative
drugs are not entirely new and are based on the improvement over the
existing available option. However 25% of the responded believe the
innovation in pharmaceutical are entirely new drugs.
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Moreover findings of research also revealed that Majority (60%) of the
physicians are not satisfy with the innovation in pharmaceutical drug, where
as (30%) of the respondents were satisfy with the innovative drugsintroduction within the industry.
Concept of Innovation among Physicians
Majority of the physicians 77.8% believe innovation in pharmaceutical drugs
should be a package of improvement in every aspect of drugs attribute that
include better efficacy, better safety margin, improve tolerability profile with a
convenience in dosage. Where as 11.1% of the respondents believe if any
significant improvement even in a single attribute of drug is innovation since
that gives the drug an advantage over the existing option and open the
opportunities for drug to be evaluated and prescribed. However this single
improvement should not be at the cost of patients compliance and safety.
Research explores, Innovation is highly linked with the improvement over the
available existing therapeutic options. Research findings of both quantitative
and qualitative research validating each other and exploring following
attributes carry importance while physicians evaluate the innovative drugs:
Efficacy
Safety
Tolerability
Compliance
Evidence of the product
Physicians rated the tolerability profile of the drug as the highest considered
attribute explaining reason that if a drug does not have the better tolerability
profile means their patients can not stay on the prescribed drug and hence it is
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not possible to gain the benefits of available evidences, prices and
convenience of dosage (graph 4.1). They explained, the efficacy is implicit
attribute of the drug and drug which does not provide the efficacy at-leastsimilar to the existing drug is not an innovative drug. If the innovative drugs
offer the desired improvement in the attributes than the price of the drug does
not matter.
Additionally, research explores that majority (60%) of the physicians were not
satisfy with the innovation in pharmaceutical drug because they find the drug
introduced are similar in offering the benefits and claims of the drugs are not
either inline or can not be measure due to insignificance difference. However,
(30%) of the physicians were satisfy with the innovative drugs introduction and
they find these introduction as another option for them to choose for their
patients since they comment that not every patient get response from single
drug.
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Perception of Innovation by Physicians
70% of the respondents believe that innovation in pharmaceutical industry is
all about bringing improvement over the existing options available; however
40% physicians from both UK and Pakistan were not satisfied with the
innovative drug introduced. Findings from literature review and qualitative and
quantitative explore that the innovation in pharmaceutical drugs are generally
incremental in nature and there is a radical innovation demanded by the
physicians.
Qualitative research explores that it is difficult for physicians to evaluate the
drug on the basis of five characteristics reliability, Trialability, Observability,
relative advantage, compatibility and complexity of innovative drug as
presented by Rogers 1965 since incremental innovation are not significantly
different from each others. Additionally, physicians find the incremental
innovation as another option to consider without adding value in their
treatment protocol. However, they explained if the innovative drug is entirely
new than they found it ideal to evaluate the drug in comparison to other
already available options on the basis of its efficacy, safety, tolerability,
compliance etc.
Innovation Characteristic of Drug
Research findings explores that all five characteristics of innovation that were
proposed by Rogers are found to be in practice during the diffusion and
adoption process at physicians level.
physicians have pre-define set of priorities of the drug attributes (graph1)
based on disease profile and patients types and those priorities are consist of
single, few or all attributes of the drug as shown (in graph 1) and hence the
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innovative drugs are evaluated to see the benefits accordingly by using the
characteristics of innovative product as explained by (Rogers 1965).
Relative Advantage
Interviewee discussed, they evaluate the drug on the relative advantages
basis which include the assessment of drug both on short and long term basis
against the claim attribute of the drug and against the available medications.
Physicians assess the drug not only with the widely prescribed drug but also
with the recent introduction of drugs both in same class and other therapeutic
options of other classes.
Three type of relative advantage emerged from the research that was
consistent with the reviewed literature. Physicians evaluate drug on the basis
of its effectiveness and the financial burden on the patients on both long term
and short term basis. However, in acute disease relative advantage
comparison is based on short term of the drug because patients need to take
acute disease treatment for short time. Usually for chronic disease drug
relative advantages are evaluated on more than short term benefits of the
drug.
Efficacyis prime attribute of the drug and considered mandatory amongst the
physician during drug selection regardless of the disease type. However, in
acute disease, efficacy is monitored and compared with available option within
short span of time which results in immediate perception building of the drug
in comparison to other or in isolation. Whereas in chronic disease treatment
and management, efficacy is one of the important attribute of the drug which is
connected with other attributes of the drug including tolerability, safety,
compliance and evidence to be evaluated as a relative advantages of the
drug. As per the research, efficacy is fundamental attribute of drug with no
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compromise and drug evaluation is based on a collection of attribute and their
relative advantages within the same class and with other classes also.
Compliance/tolerabilityof the innovative drug is another consideration while
evaluating the relative advantages because more the patients are compliant
with the drug more the benefits and claims of the drugs can be validated and
gain in both, acute diseases and chronic diseases. This is again and
important attribute since drugs are compared on this attribute immediately
even sometime followed by only one dose intake. Compliance according to
physicians deal in the number of pills to be taken, number of times to be taken
and timing of dose to be taken and the side effects related with the drugs.
Evidence of innovative drug/Safety is another feature that physicians used
to monitor or observed. This attribute has particular importance for drug of
chronic diseases. Innovative drugs that hold strong evidences are usually got
acceptance amongst the physicians due to safety of the drug. If the drug has
strong evidences it got preference and perceived better even the other
attributes of the drug evidence deals with the regression or controlling of
disease and prevention or positive effect of drug on vital organs of the body.
Complexity
Physicians evaluate the drug on the basis of its complexity. It is important for a
drug to be easy in dose titration, dosage adjustment as per the need of the
patients. They judge the complexity of the drug both from their own
perspective as well as from patients perspective. According to physicians, if
the innovative drug has similar usage pattern as of already available option for
patients and physicians make the drug easier to be adopted. It was also
explored that some drugs required some kind of special skill to screen out the
patients for the innovative drug. Some drugs need special adjustment in
dosage while prescribed with other medication. This complexity is important
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for both physicians and patients, because if the drug is complex for patients to
take, he or she might miss the dosage which means missing the benefits and
more complication in chronic disease.
Compatibility
Compatibility of the innovative drug with the prevailing environment and the
behavioural pattern of physicians buying process is another characteristic of
the drug adoption. In case of an innovative drug which is indicated in a
particular disease and that disease from physician point of view does not exist
or there is lacking in the diagnostic techniques for the physician. This
characteristic is also important for patients since there is a need to have
created awareness amongst the patients also to ensure their compliance due
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to perceive importance of disease management as well as its consequences
over long term.
Trialability
The interviewed physicians comments explores that Trialability of drug is one
of the important characteristic that establish the newness of the drug and
increase their confidence level in perceiving the drug in comparison as well as
in isolation. Trialability matters in innovative product since it helps physicians
in validating the evidence /claims of the drug and drug effects on the patients
and their feedback about the drug and their own observation on the key drug
attributes. It is also explored that organizations provide free samples to
physicians at the time of drug introduction so that physicians can evaluate the
drug in their patients.
Observability
As per the comments form interviewee physicians, innovative drugs benefits
must be observable; according to them the Observability of innovative drug is
three dimensional and they are patients own feelings with the drug, physicians
clinical assessment based on sign and symptoms of the disease and the
laboratorial findings of the drugs.
Process and Sources of Diffusion
The perception of Physicians on the drug influences, extent and rate of the
diffusion process, consequence the market positioning decisions of the
marketer and the product attributes they choose to emphasize are critically
connected to the diffusion process.
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The findings form qualitative research explores diffusion of innovative drugs is
based on the quality, frequency, quality and about the comprehensiveness of
the information. Diffusion of innovative drug need a comparative information
along with the drug related information. As per the comments from intervieweephysicians innovative drug information is reached to them from several
sources that include; company medical sales representative, scientific
meetings and symposia, advertisement in the medical journal, internet, dear
doctor letter from the specific organizations and some time from patients
visits. However in generally, innovative drug is introduced to them by the
medical representative of the organization but they believe the information
received from medical representative is not sufficient enough to take decision
to prescribe the drug. But they believe medical representative of anorganization is the best source in having the information both on product
related and also on the basis of product comparison.
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Qualitative and quantitative research explored the physicians seek more than
two sources to gain information. There response to predefine list for the
source of information, it is explored that the medical representative, internet,symposia/scientific meetings and medical association or community are the
first sources of information for innovative product. However 50% respondents
believe medical representative are the first source of information that is
followed by scientific meeting/symposium, internet and medical association.
Main Source of Information
Both, quantitative and qualitative research explore that more than one sources
of information are used by the physician to have quality knowledge about the
introduced drug and related supportive evidence. However 50% of physicians
believe the main source of drug information comes from the organizations
medical representative, whereas 25% of the physicians believe that scientific
meetings and symposia are the first source of innovative drug information
(graph 4.2).
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Additional Sources of Drug Information Used by Physicians
Research explores that for physicians Internet is best alternative source for
information followed by symposia/scientific are medical representative of the
organization. 37.5% physicians believe the best additional source of
information is internet due to comprehensiveness and quality of information.
However 25% physicians again look medical representative of the
organization for the additional information they seek. Similar percentage of
physicians believes that scientific meetings and symposia are the best
sources for additional information (Graph 4.3).
Best Source of Information
Research explores that the best source of information varies amongst the
group based on quality of information. There were 37.5% physicians that
believe that Medical Journal is the best source of information that provides
them comprehensive information of the drug and the studies/ evidence related
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to this. Where as 25% physicians believe medical representative of the
organization is the best source of information and similar 25% physicians
believe symposia and scientific meetings are the best sources or information
(Graph 4.4).
Physicians usage of information sources in this instance highlights the
importance of the medical representative of the organization. Additionally,
personal sources of information are more important than impersonal sources
that indicate the importance to the organization of the medical representative,
and access to the interpersonal network during the course of
seminar/symposia and scientific meetings.
The importance of medical journals as a best source of information has
implications for media expenditure at the drug introduction phase to ensurethe maximum reach and coverage in widely read journals. However this is
important to realize that medical journals are classified as autonomous source
of information that is not biased.
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Qualitative findings of drug diffusion
Qualitative research explores that interviewee physicians get exposed with the
drug well before the formal introduction of the drug but that information is not
usually comprehensive and neither comparative. They found internet is the
initial source of information for them since they get the drugs updates
regarding supportive clinical trials etc. However the get detail information of
the drug through the medical representative of the organization that is purely
related to drug attributes and its benefits supported with evidence of the drug.
For additional information they believe scientific forum and medical journals
are the best sources. Additionally, they believe medical representative of the
organization has vital importance since they get their precise queries
answered through them.
Drivers and Barriers in the Adoption Process
Drivers of innovative drug adoption
Interviewees comments explored that adoption of drug depend on successful
evaluation on the basis of innovative characteristics of the drug. However
apart from innovative characteristics of the drug, several factors influence the
adoption process including innovative drug itself, profile of drug, patients
dissatisfaction with the previous treatment, physicians own dissatisfaction,
organizationsrelationship with the physicians and organizations expertise in
the therapeutic class.
Furthermore amongst the factors, the most important factor that drives
adoption process is the profile of the drug which is followed by the expertise of
organization in that particular category. Physicians believe, if the drug is
introduced from an organization that already have expertise in the therapeutic
category is tend to facilitate the adoption of drug. Amongst the respondents
from quantitative research, 50% of the respondents give preference to the
profile of drug where as 25% respondents link it with the organizations
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expertise in the therapy area (graph 4.5). From the respondents, 62.5%
physician believe, they select few patients to be put on the innovative drug
once the drug is introduced to them with the sole objective of validating drugon innovative characteristics where as 37.5% physicians discuss the drug
amongst the peers before moving on.
Quantitative findings:
Once physicians are exposed with the innovative drug, they were found to
evaluate the drug on the basis of the profile of the drug, innovative drug itself,
relative advantage over available option and also the platform or the
organization that is launching the drug. Since believe there is a direct relation
for them to decide if they would potentially accept the drug. 50% of the
respondents believe in evaluating the profile of the drug on the basis of
efficacy, safety, tolerability and compliance. Whereas 25% thinks that for them
it is important to see which organization is launching the drug because some
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Research explores, adoption process of innovative drug is a conscious
process and is influenced by drugs own characteristics as well as external
efforts and influences. Interviewee physicians believe if drug is providing themthe opportunity to evaluate the drug for the comparison with the previously
available options make the adoption process quickly. The strongly believe in
evaluating the drug to see the relative advantages of the product, specially
from the patients perspective because it is physicians responsibility to select
the drug on the basis of its advantage and potential benefits to the patients
that also include the financial burden on him. However this relative advantage
does not actively apply on the drug for acute disease treatment since patient
pay for the drug for very shorter period of time in comparison to chronicdiseases.
According to the comments of interviewee, drug adoptability in the chronic
diseases management is highly based on Pharmacodynamics of the drug (the
effect of the drug to the bod