The expanding healthcare research market in Asia
“To become aware of the possibility of the search is to be onto something” Walker Percy (author)
Pharmaceutical companies operate within a highly competitive and, in some cases, limited business arena. Always eager to expand patient bases and increase sales, pharmaceutical companies are now looking more to the Asia region as their next key target markets. The dominant focus on Western markets (such as the US and Europe) over the recent years has led to these markets reaching a saturation point – there are multiple therapies available for most conditions and very educated patient populations who are more likely to question and push back at both the physician and, ultimately, the pharmaceutical companies. The withdrawal of previously touted ‘wonder-drugs’ (such as Vioxx in 2004) and negative press coverage for pharmaceutical companies (such as that from a recent Panorama documentary in the UK suggesting a link between the prescription of the antidepressant Seroxat to teens and an increased suicide rate) have affected public perceptions of the companies which in some cases has a knock-on effect on public willingness to use their products. Pharmaceutical companies are looking to new markets where there is the demand for therapies and the obvious potential for profit.
The change in focus is becoming evident. Whereas previously Asian countries were usually ‘add-ons’ to international pharmaceutical studies, the first to be dropped when budgets were tightened or cuts needed, we now see a growing number of pan-Asian studies which focus solely on perceptions and attitudes within the region and extend beyond the ‘traditional’ countries (namely Japan, South Korea, China and Singapore). Instead of getting a taste of the region by sampling perceived ‘key’ countries and trying to overlay those findings onto the region as a whole, the desire now is to move beyond and look at each country on an individual level for their viability as a market. Also with many conditions in the West being addressed by multiple therapeutic possibilities, pharmaceutical companies are now targeting conditions which are only or predominantly seen in Asia (such as Dengue Fever) – untapped markets with unknown potential.
This realignment is, in some ways, driven by a change in attitudes within the countries they are looking to conduct the research in. ‘Western’ medications have become increasingly available and also used throughout the region. Physicians are more med-aware than before and, within some countries, there is an aura of efficacy and quality associated with ‘Western’ medicine over the local or generic alternatives.
The change is also driven by a realization of the potential population sizes in Asia who require treatment. Incidence rates of conditions such as diabetes, asthma (particularly in industrializing countries) and cardiac conditions are rising, sometime running level with or overtaking the counts seen in the West. According to the International Diabetes Institute (based in Victoria, Australia) 89 million Asians are thought to be diabetic with an estimated 32.7 million residing in India and a further 22.6 million in China. By 2025 the number of diabetics in Asia is predicted to hit 170 million – a huge potential market. Asian countries provide a new market places for pharmaceutical companies to move existing products to – where they may have multiple competitors in the US or European markets, in for example India they may only have one or two rivals in the therapy category.
Research made easier…
With the spotlight swinging towards Asia, market research companies are eagerly embracing the opportunities that this offers to them. Pharmaceutical research is more profitable for many than the traditional FMCG studies which have, to date, been the mainstay of research. With many international companies setting up R&D sites or sales hubs in Asia, there is a door being thrown open to local companies – more people on the ground for the pharmaceutical companies may lead to more locally decided investment and, in turn, more projects for the researcher.
Alongside this, market research is an increasing familiar concept to healthcare professionals in many markets. Physician confidence in participating in research is growing and they are now aware of what is expected of them which, to a large extent, removes their previous tendency to try and give the ‘correct’ or ‘desired’ answer. Now the discussions are much more frank and honest which ultimately produces more actionable and representative results for the end client, not to mention making the life of the interviewer a lot easier! Alongside this growing confidence, comes the increased availability of the medicine or therapy that the research is focused on. Although it may be somewhat limited in use due to price, it is at least being used and (thanks in part to the increase in disposable income being seen in some countries’ populations) usage is increasing. The project which five years ago may have seemed insurmountable is now possible and the results are meaningful.
Another area which makes conducting research less taxing is that physicians are often keen to participate. Many have either completed education overseas or have traveled for conferences and so they are more interested to learn what is new and coming onto the market, more willing to give feedback on what they like and dislike. This makes discussions with them entirely more productive as there is a genuine interest amongst some to share knowledge. Many are also heavily reliant on information gathered from bodies such as the FDA and American physician organizations so they may be able to comment on therapy developments which are not yet used within their countries (very useful if your client wants to do market entry work).
Further possibilities come in the change of perceptions amongst patients. Traditionally, in some countries, illness was kept hidden and not discussed outside the family home which made key target groups, especially the elderly patients, very difficult to find and successfully interview. However the views are shifting. Illnesses and conditions are becoming more openly discussed (although please note this is not the case with all illnesses and conditions) and with the presence of support groups and care structures within the community as opposed to just within the family home, patients are being brought into the open to share their experience and their views, making patient research a potential option.
… but not that easy
Despite the benefits that this increase in attention and business offer to the market research company, there are obvious challenges that need to be addressed and which can seem off-putting to the inexperienced.
Whilst use of ‘Western’ brands is increasing, awareness and brand recognition in some countries is not increasing in line buy accutane in mexico with this. This stands both in terms of physician awareness and patient awareness. There are still physicians who would rather give an inaccurate comment than admit a lack of knowledge and it requires a skilled interviewer to note this and probe beyond it. Alongside the potential lack of knowledge, there is the issue of locally produced therapeutic alternatives which can be overlooked as clients may not be aware of them. Some countries see a very high usage of generic products and, even if a drug patent has not expired, this does not mean that there are not generic alternatives available in Asia. The Thai government recently authorized the local production of a generic form of Kaletra, an HIV/AIDS antiretroviral, and the BMS cardiac therapeutic Plavix despite them still being on-patent, a highly controversial move. Generics run alongside the local therapies and ‘variations on a theme’ which may be produced by domestic companies – hidden competitors for the major brands, often at a more affordable price.
Patient research can still be challenging. In some European countries patient research into therapy satisfaction can be made complex due to low awareness and high patient reliance on their physicians’ recommendations. In some Asian countries the challenge can be ten-fold. The physician holds a high social standing and their word is, more often than not, seen as gold, meaning patients tend towards doing very little self-education. Also some patient populations may not know how to self-educate – leaflets may not be available in a physician clinic in the language that they read (in some countries literacy may also be an issue amongst patients), there is limited Rx advertising and there are far fewer ‘silver surfers’ using the internet in Asia than there are in the US, UK or similar countries. Having said this, the situation is changing and so this is an area which may increase in ease as Kevin Meyer, Managing Director of Opinion Research Taiwan highlights “Although the physician’s word is ‘gold’ and patients do little self-education, we are finding that the internet has opened up an increasingly important and relied on information source and forum on health care related issues in Taiwan. This has raised patient awareness and basic knowledge of disease symptoms and related therapies and this is especially true for chronic and more serious diseases”
Alongside a lack of informed patients within the population, the actual available universe of physicians in itself can be an issue. A client desire to talk to 50 neurologists can be a challenge if there are only 100 in the market. This is then made more troublesome if the physicians are over-researched, something often seen in Singapore and Australia. Instead of working the physicians around the research, there is a need to work the research around the physicians adopting a methodology that will be acceptable and successful for both the end client and the physicians.
The final challenge to any form of multi-country pharmaceutical research is the realization that there are almost as many healthcare systems in Asia as there are countries. From identifying the correct treating physician in each country, to dealing with the public versus the private systems and the issues surrounding reimbursement, the research requires a local team who can take all of this into account.
Traditionally healthcare research throughout Asia has been conducted by large research companies who have an established global presence – a network (sometimes in name only) of offices linked to the central research hub. This situation has changed considerably over the last five years with the growth of existing, and opening of new, independent companies based throughout the region.
Independent companies can often offer a more ‘local’ view on the pharmaceutical research front – their ears are closer to the ground and they have networks of physicians who know them personally. Understanding the market is considerably easier when you have a strong network to draw the information from. Ellen Cho, Project Manager of Hankook Research states “Hankook Research has been in this business for almost 30 years. Our clients assume that we have longevity and a large amount of market insight that we have accumulated over the years. Our clients value the close client service and on the ground knowledge we can offer”. This on the ground knowledge can also mean that independent companies are in the sometimes unenviable position of knowing what is and is not achievable and having to push back at the end client. Where this may initially appear to be a company being ‘difficult’, ultimately clients look for honesty and transparency in these matters and can soon see that the ‘one size fits all approach’ which others may state is achievable actually needs to be tailored and refined to get the results needed.
Another strength of the independent companies, is their flexibility in approach and method – they are less likely to try and fit the ‘square peg’ that is a research requirement into the ‘round hole’ that is their black box solution. Instead there is always room to move as, wherever possible, they are likely to accommodate your needs. Independent companies often operate in small teams with specialized hands-on senior staff guiding the research which can also be of appeal to the client. There is always a concern when research is being sent half way round the world that it might be given to the new staff member with three weeks ‘on-the-job’ experience. The operating mechanisms of independent companies make this much less likely – senior staff are involved in all projects and have more time to dedicate to individual projects and clients than if they were trying to manage a vast portfolio that spans numerous industries. As Aman Makkar, Managing Director of Kadence Research India confirms “The big Indian research factories who conduct pharma research do not normally have specialists to understand the client needs, they do everything, whereas we [independent companies] can compete with a small crew of specialists across the departments. It’s a trade-off between a big name or a research company with the needed specialization.”
Independent companies may not offer the massive cost savings that a client hopes for or even expects, but they can offer a wealth of knowledge, experienced senior staff and key market insights that may not be seen within larger companies. Ultimately one should look to the old adage ‘good things come in small packages’ – if you don’t try and open the package, how will you ever know?