Hasan Dissertation Student ID a 4011515

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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has been taken from existing published or unpublished materials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

Hasan Dissertation Student ID a 4011515

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