Wednesday, September 25, 2013

We are all just prisoners here, of our own device!

Where does this notion that every mild ache or pain might be the harbinger of something particularly nasty, or even fatal, come from? asks drug baron in a recent post pondering on the Origins of Hypochondria

Since hypochondriacs too are prisoners of their own device**, I wondered in my comment if one can choose a device of well-being than of ill-health...
**Thank you Eagles, for penning such profound lyrics (and of course out-of-the-world music...) one can interpret in a zillion ways & still love.
My Comment
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A brave admission and a sound rationale...
Psychologically speaking…,
I'll try and link the three plausible reasons stated for being a hypochondriac to three personality types using the widely known MBTI system;

Domain Knowledge & (over)Exposure to Information - THE THINKER (INTP)
........applies knowledge & available information to connect the dots and map the domains - and at times create phantoms

(Supreme) Self-Confidence - THE SCIENTIST (INTJ)
.........pragmatic, believes in things that can be explained through well validated scientific rationale - at times negating viable but unsubstantiated dogmas

An Entrepreneurial Spirit - THE DOER (ESTP)
..........the risk-taker who's not always a conformer & who takes things into own hands with an intention of chasing the desired outcome - at times not reaching the goal

Probably being a hypochondriac is an outcome of the incremental edge the SCIENTIST has over the DOER in a quest set-out by the THINKER. What could probably change the equation is spooning-in a dollop of a few other personalities from the 14 others to choose from :-) (MBTI types again)
Physiologically speaking…,
I think though that one needs to believe in things for them to work for them - particularly so in matters of health & well-being! If the SCIENTIST questions how?, I'd try saying that since most disease conditions are manifestations of biochemical & ion-channel imbalances & brain plays a understandably important role, influencing the thought/ brain is perhaps important too as medicine is? Perhaps, there’s some rationale behind why placebo's routinely give new drug candidates a run for their money when it comes to efficacy?
Hippocrates did say... "Men ought to know that from nothing else but the brain come joys, delights, laughter and sports, and sorrows, griefs, despondency, and lamentations”
Just perhaps.... he also meant to include disease?

Thursday, September 12, 2013

Ambrosia for food, Palm-top engagement, Iterative decision making – A preview into evolving expectations of the healthcare consumer

Understanding consumer preferences has always been of paramount importance in most product segments. Within the pharmaceutical domain however even as there’s a constant ideation, speculation on future of healthcare; outlook on disease incidence, burden and pharmaceutical consumption patterns, this particular aspect has not been focused on, possibly owing to the prescriptive nature of the medicine where decision-making seldom lies with the patient & the power to influence product development lies more with the medical professionals & payers. To an extent this disengagement of consumer does justify the disinterest of Industry to understanding the consumer as against understanding the prescriber & the payer/ insurer.

Having said that, a number of disorders these days are getting close to being categorized as lifestyle-diseases & with early detection, diagnosis and routine monitoring getting simpler, it’s only imminent that the insurer will increasingly resort to rationalizing what treatment-regimens can be covered thus significantly shifting the onus of payment to consumer. Then again, owing to the abundance of open-source information and availability of validated healthcare gamification apps, the consumer is getting more knowledgeable & hence empowered. Seen together, these trends indicate that the average pharmaceutical consumer is well poised to be the key decision-maker on therapeutic choices, particularly on maintenance therapies that form a predominant portion (vis-à-vis’ the curative therapies) of all pharmaceutical revenues.

It also hence would not be overtly speculative to state that the hitherto quintessential practitioner-dependent healthcare consumer is evolving quick & is looking at an iterative role for her/ him-self rather than merely wanting to being ‘prescribed health’, literally & figuratively. Continued negligence of factoring-in consumer behaviour in the product development process can thus be a serious lapse of judgement in an industry that’s been groping around for the next paradigm shift for a few years now.

The Health 2025 survey I floated in early July is a token attempt to gain some basic perspective into the altering behaviour of an ‘aware pharmaceutical consumer’ which I hope either in its promise OR in its inadequacy will instigate more such studies in-depth and at a larger scale. While I can’t claim to have gotten a great number of responses, I fortunately received quality responses (& some incidental endorsement*) as indicated by consistency of the trend that was showing up right from early stages to till plateauing of response flow.

Even as I was compiling the final results I came across this rather well received fund raising pitch of Stefan Broda (Founder/CEO of BeforeWeDo) at the end of which one particular GP lauded the Consumer Iteration built into the business model which is worth emulating by other healthcare start-ups! – If not a sign from the heavens, a sweet coincidence nonetheless.

SAMPLE POPULATION, STATISTICAL ASSUMPTIONS & SURVEY DESIGN

I chose the sample population of pharmaceutical professionals who I believe are very representative of the above breed of ‘aware pharmaceutical consumers’ & to whom I have ready access through the Pharmaceutical Discussion Group I founded and manage on Linkedin & Groupsite.

Based on a guestimate of ~5million pharmaceutical professionals world-wide, I derived my target sample size as 350, using a Confidence level of 95%, which is the mostly used default level & a Confidence interval of 5, which again is the oft-employed default figure. By the time I chose to start the compilation (the survey is still active) I however had only 159 responses which translated amount to a confidence interval of 7.7 while the confidence level remains at 95% - That, I guess is my cue to you for taking the results with a pinch of salt :-)

Finally, I am neither a professional statistician nor a qualified analyst and it’s likely the design of survey may not fully please many out there. I however did consciously try and keep the questionnaire short, the questions specific & the choice of answers broad in order to minimize any chance of a bias setting-in – the trends indicated by the responses, as I see, justify some if not all questions.

PRESENTATION OF RESULTS, ANALYSIS

The survey is based on ten questions out of which the first three are essentially filters namely age, sex & nationality that enable some level of demographic segmentation of responses. While the charts of responses to individual questions looked very pretty on Surveymonkey dash-board, I agonized nonetheless quite a bit deciding on an ideal approach to presenting the results on my blog without sounding too pedagogic – I hence chose to weave the details around certain KEY OBSERVATIONS and then go about detailing on those further.

Since it may help put things in perspective, I have uploaded the primary results document* to file cabinet on Pharmaceutical Discussion Group – please note that this link opens the document only when you are logged in, (i.e. if not a member already, you will have to join the group)

**I’ll be happy to share the master data file too with anyone interested.

KEY OBSERVATIONS

In hindsight I realize some of the questions are pretty skewed & some fairly meaningful, but overall they seemed to fall in two broad categories, one set wherein the standalone overall response is itself strongly indicative of a trend & a second set wherein an interesting picture emerges only when the responses are separated out and compared across demographics. I however will spare the mundane trends and go straight to top observations based on the percentage response towards a trend-indicating response;

I.
Not just food, Ambrosia is what the consumer wants - a huge thumbs-up for Functional Foods!

Quite ironic that the top trend in a health survey is food & not medicine! - A whopping 87% of the respondents see/ want the food in 2025 to be more than nutrition, out of which 46% see a potential for food being a curative!








Women make up the majority of the ‘food as a curative’ advocates (60% as against 30% among men) – which simultaneously underscores & endorses the greater influence of women in the functional food promise.







More Indians (56%) believe in the promise of curative food than the North Americans (40%) or Europeans (44%) – a possible connection to the expectations influenced by prevailing, predominant ethno-cultural dietary practises?








II.
Consumers want to take things into their hands, literally – Mobile Health Tools all set to Rule

At 68%, a clear majority of the respondents are bullish on the role & significance of personal mobile apps in an individual’s health management. (25%, Indispensable & 43%, Very crucial)









Once again this is a trend driven primarily by women, the percentage of women who chose ‘Indispensable’ (40%) being significantly higher than the men, a majority of whom (67%) chose the mildly-tempered but still bullish, ‘Very crucial’ as their answer. This clearly establishes women as the ‘early adaptors of the health mobile tools & apps’ & possibly that mobile apps are more amenable to woman’s health management and finally that factoring-in gender into the development of a mobile healthcare app can be a key determiner of the success of the same.


When the Geography filter is applied, the trend expectedly peaks in North America with an overall bullish-ness at 76% - within which women once again stand-out strongly with 55% responding ‘Indispensable’. The dominant European response is however ‘Very crucial’ (60%) which probably indicates a currently lower penetration of mobile health apps within this geography – this holds good for India too.



III.

They seem to say, keep the Doctor away – Eating an apple isn't the only way

While the question has some unfortunate bias & choice of ‘You’ sounds like a given…, the responses still indicate an increasing role for non-physician health professionals. If the choice of ‘You’ (53%) is ignored, only 12% see the physician playing the single most crucial role towards an individual’s health much below the diagnostician at 18%.






There’s an interesting contrast in choice of physician v/s diagnostician among the female & male respondents’ viz., Female: 7% (P) v/s 21% (D) & Male: 14% (P) v/s 16% (D) – probably again owing to the essential nature of women’s health issues vis-à-vis’ male issues – nonetheless, a potentially important alert to the healthcare industry.

In-line with the number one trend above, the nutritionist polled 10% of the vote. Quite surprisingly, of all respondents who chose Nutritionist, 70% belong to the age group of 35-44 yrs. This read together with the first trend gives a great demographic insight into who could be the prime target demographic segment for promoting functional foods – Women between the age group of 35-44.






NOT-SO-KEY OBSERVATIONS

Apart from the above three observations, the rest of the observations though interesting aren’t necessarily great insights into the health consumer psyche - the same are listed below in no specific order;

  • 78% of the respondents feel medicines should target cure as against 22% that are okay with maintenance – expectedly, the 78% group is populated majorly with people under 55 years of age.
  • 87% of the respondents prefer oral medications to parenterals – Interestingly though, there’s a strong geographical variation with NA & EU preferring oral medications at 92%, while the Indian respondents still retain some of the cultural trust of ‘injections’ (26%) 
  • 89% of all respondents still believe the necessity of medicines per se’ in-spite or despite the preference of the ambrosial foods – if anything, this seems to showcase the omnipresence of the pills.


While the results may not qualify as astonishing findings, the unmistakable relevance of the trends thrown up by a mere seven-question survey still underscores the value of understanding the health consumer’s perspective and using the knowledge to build, refine the road-map of pharmaceutical product development.

Functional Food for thought! :-)

Wednesday, August 28, 2013

Isn't re-coding the organizational DNA viable only for smaller set-ups?

Bruce Booth makes some really radical suggestions to altering the way a big-pharma R&D set-up could work, primarily by way of re-coding the organizational DNA - the optimist in me loves the game-changing propositions, but the cynic in me fears a big-pharma is way too big to present itself to re-coding..... 


My comment:
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However long-term, I feel the inversion of periphery into core is something that sounds too Utopian for any block-buster-strapped-big-pharma-headed-by-a-recently-appointed-turnaround-artiste to consider doing - Laying off scientists & shutting down sites, though a lot messier, is much quicker and in corporate speak, efficient!

Having said that, I do believe this inversion is indeed happening in some fashion as the disruptive model of shutting down big-pharma R&D sites does release hell a lot of under-utilized scientific talent that in many cases ends-up getting far more productive by reinventing themselves as 'Out-sourced drug developer' and/ or 'Spin-off Biotech' each class of enterprise working in synergy with the other.

Just as genetically engineering a large mammal vis-a-vis' a single cell organism is a completely different devil, re-coding organizational DNA works only for smaller set-ups and hence the only way innovation has to change in big-pharma is through a disruptive shake-up that allows cloistered talent-islands to drift-apart and reassemble in mutually cohesive clusters.

Finally, it's surprising just how long its taking pharma to make that elusive paradigm shift in its approach to innovation.... here's a link wherein a lot of heated discussion happened way back in 2008 & nothing much is still different as on date.

Tuesday, July 30, 2013

Peak-Oil 2020 just got itself a mega top-up & the globe can look forward to balmier climes :-)

One of those small diversions from my routine - below's the comment I posted on a Linkedin article "OilBoom 2.0 – An American Dream Updated" by Christof Rühl, Chief Economist at BP. 

I was essentially answering the questions (in italics) raised by Christof in the closing paragraph of his article...


My comment:
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What triggered it?.... Accident? ....The North American resource base?.... Markets?

The trigger is a no-brainer really, the need for fuel independence & dominance (Markets?) in that order... in any order..........Accident? probably the technique of fracking was indeed one. Given the need & the refined technology to exploit the resource base, yet again we dreamed-in the improbably hypothetical terraforming into reality

What are the implications?

It sounds like;
  • Peak-Oil 2020 just got itself a mega top-up &
  • The globe can look forward to balmier climes :-)
And - will it happen elsewhere?

Considering the environmental precedents being set proactively by the USA, this trend of course will catch-up soon around the world, anti-fracking doomsayers notwithstanding.

Monday, July 22, 2013

The start-up investing winds, they are a-Changing OR are they?

In his latest, 'SuperLP' Chris Douvos  writes about the fears of an impending VC apocalypse....., okay to start with, in silicon valley primarily triggered by the capital deployment in start-ups far outpacing funds raised by venture capital firms, essentially affecting that someone else is gaming the system rather than VCs themselves..

Given they appear only once in a blue moon, I couldn't really let go a SuperLP article without a comment... here goes what I posted on his article 'Scents in the Air'

My comment
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Comments

Murali Apparaju

I am wondering if the issue with "capital raised by VC's increasingly falling short of capital invested into start-ups" is about true of all start-up hubs & not just Silicon-valley AND, that probably in general it’s true of all VC activity across the globe (tho' i do understand this data is of NVCA and for USA)

Out of the entities you mentioned, I see the following two as the key contributors to this skewed ratio;
1) CVC: The emerging aggression of CVCs whose enthusiasm to invest is in equal measure helped/ influenced by not having a limitation of capital to deploy AND by their necessity to shortening the product introduction cycle in face of an increasingly unproductive in-house innovation (think... a top-10 pharma major investing in start-up biotech with just one pre-clinical asset....)
2) Angel: The recent market regulatory changes indicate (JOBS et al) that the government is attempting to bring down the dependence of start-ups on the VC's - primarily by way of increasing the available angel base & encouraging HNWIs to risk their money a lot more freely than before.
Surely the above aspects do suggest why there's a scent of fear in the winds blowing through VC quarters.
I personally feel that these newer sources of capital need to establish their longevity & consistency before the start-ups can forget about serenading the VC for funds – particularly given that non-financial companies tend to be a lot more impatient with IRR cycle-times and HNWIs a lot more prone to gravitate towards less complex and shorter-term alternative investment options.
Essentially, IMHO what goes around comes around & VC as a source of start-up capital would remain a lot more relevant in the long-term

Friday, July 19, 2013

Coordinated rulings by SEBI & SEC - Winds of Market Regulatory Harmonization OR plain coincidence?

Viewed solely from the perspective of rationalizing regulatory framework to support creation & sustenance of new enterprise, a lot has indeed happened in the fortnight between 25th June and 10th July in India & USA.

While I’ll desist from repeating what many other bloggers, journalists & analysts have already written on, viz., the obvious v/s inferred derivations of the enactments & how they’d impact the start-up scene et al., my intention in putting together this piece is from my point of view to highlight certain clear similarities, interesting contrasts and some uncanny conjectures these two sets of reform throw up when seen together & what would this coincidence amount to.

Before getting there, below is a quick snap-shot of the regulatory changes (wherever possible, I used the official language of the regulator) that may be cross-referred down the line;

25 June 2013, when the SEBI (Securities & Exchange Board of India) board took, among others, the following three key decisions that impact the start-up investment scene;

      1.   Amendments to SEBI (Alternative Investment Funds)      Regulations, 2012 – thereby recognizing the angel          investors pools as category I venture capital funds

2.       Enabling Listing of Start-Ups and SMEs on Institutional Trading Platform (ITP) without having to make an IPO
3.       Acceptance of recommendations made by “Committee on Rationalization of Investment Routes and Monitoring of Foreign Portfolio Investments”

10 July 2013, when the SEC (US Securities & Exchange Commission) met to approve, among other things, adopting amendments to Rule 506 of Regulation D and Rule 144A under the Securities Act of 1933 to implement Section 201(a) of the JOBS (Jumpstart Our Business Startups) Act that essentially means enabling;

1.       Lifting the ban on general solicitation or general advertising for certain private securities offerings, thus improving the chance of a start-up raising requisite capital


Now coming back to the original story,

What is similar?

The Intent behind the reforms:  Enabling creation & sustenance of new enterprise within the respective countries

The primary approach of making funds available being by way of rationalizing  angel investment framework

Some level of similarity in enabling a regulator supported solicitation**;

o   Solicitation of investments by way of listing on ITP (Investor Trading Platforms) without having to make an IPO
o   Solicitation of investments by way of advertising on online & offline platforms after complying with filing of Form-D & submission of solicitation material with SEC et al

What is dissimilar?

While the intent is similar, it is interesting to note the subtle differences** of approach;

o   SEC comes across as more conservative in its approach of cautious provisions that simultaneously can OPEN-UP (owing to wider investment choices due to open solicitation) & CLAM-UP (some individual angels falling off the radar due to tightening the requirements of accrediting individual investors..) angel funding

o   SEBI on the other hand comes across as aggressive with its attempting sweeping changes to channelling & control of foreign investments while retaining FVCI as an independent investment class with benefits and simultaneously attempting to enhance access to domestic funds for the start-ups
**Just wondering, is this caution & aggression merely characteristics of a government that has just assumed power & one that is facing polls the coming year??

      While SEBI was at pains to formulate investor minimal requirements (min investment size, maximum angels in a particular scheme to be NMT 49 et al) – SEC seemed to have left the due-dil to the “issuer” by setting only some guidelines

      Finally, while the solicitation provisions are similar, the motivation/ rationale itself was pretty different with SEBI aiming to help improve exit-options of investors & SEC aiming to help raising of capital by the start-ups.

What are those uncanny conjectures?

Ponder this tango of “Accredited Investor” (SEC) ~ “Notified Investor” (SEBI);

-                  Portion of text from section 3.3ai of “Amendments to AIF Regulations” (SEBI):

Such investors shall also be required to have tangible net assets of at least Rs. 2 crore excluding the value of the investor's primary residence

                    Portion of text from text under Rule 506 of “New Rule Making” (SEC)

“An individual net worth or joint net worth with a spouse that exceeds $1 million at the time of the purchase, excluding the value (and any related indebtedness) of a primary residence

Contrasts apart, the similarities & conjectures make it appear like the market regulators in USA & India have been comparing notes, if not working in tandem, while formulating these acts, amendments – I wonder if this is some sort of market regulatory harmonization effort going on? – Surely not unlikely!

Food for thought!

Wednesday, July 17, 2013

There's some traction (in exits') for Indian VCs & that ain't bad!

Expectedly, there was some excitement & some skepticism over the recent acquisition of redBus by Ibibo. My comment on one such recent article "Is the redBus exit really good for the VC ecosystem inIndia?" on StartupCentral is as follows;

My comment:
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What you have said above sounds (to me) like;
If only the ‘sheer-return achieved on one exit’ by the VC is looked at in the broader context of ‘performance of the fund’ as such (disbursed funds?) rather than merely as a nX return on investment made into that particular company, only then will the overall picture emerge.
Now, just because you mentioned 200mio USD fund in your article, I wish to know if I can assume that one of the three VCs (or all three as an average) who disbursed funds of ~200Mio USD across past 7 years among multiple portfolio companies has hitherto managed only one attractive return of ~15-20X? (of RedBus) & this sheer return still doesn’t amount to being anything substantial to the LPs from whom the 200mio fund was raised?
If the answer is yes, I agree with you that for the Indian VC universe ‘Dilli abhi dhoor hain..’ (loosely translates as ~miles to go before resting on ones' laurels...)
Of course I’d also be cautiously optimistic when I say that if only the VCs that invested into RedBus used a similar good-sense & judgement while identifying, nurturing the other portfolio companies within this 200mio fund, then it is likely they’d still see some more good exists, including some from an IPO even.
Overall I guess there’s some traction & that aint bad.