Archive for May, 2012

Reflections on the doctor-patient interaction

Last week, I shared two interesting articles on this blog, one of which was the transcript of an interview with Dr. Eric Topol, author of the book, ‘The Creative Destruction of Medicine’. Buried in this article was a very interesting question posed by the interviewer :

Is there a possible irony that in using all this technology to “personalize” medicine you “depersonalize” it instead ?

A valid concern indeed! While the advances in science and technology make it possible to treat every individual’s physiology as unique and we now often have the means to tell apart conditions that are symptomatically similar but in fact are different diseases altogether, in all the exhilaration about the advances in medical science we tend to forget that there’s a person-to-person connect that we humans yearn for – especially when faced with bad news, and this seems to be slowly reducing.

A few years ago, a friend’s father developed an eye problem that needed surgery. It was complicated and he was referred to a surgeon well-known for his expertise in the field. The surgeon examined him, confirmed the diagnosis, scheduled the surgery and then – undoubtedly with the best intentions – blandly told him to be prepared for the worst as the operation had a high failure rate. As luck (and the surgeon’s skill) would have it, the operation was successful and the gentleman is fine now. However, his children still remember their father’s distress at hearing the news and wish it could have been presented in a gentler, more humane fashion; at that time I remember that they bubbled over in anger and resentment at the “cold, heartless” surgeon.

I’ve heard similar versions of this story from multiple people that met a thoroughly competent but not-empathetic-enough doctor/ surgeon/ other clinician. Not just those suffering from an ailment of some sort, even pregnant women that visit their gynaecologist voice a similar desire for time, information, and most of all, reassurance.

Partly, our frustration and distress stem from the fact that as patients or friends and relatives of patients, we want the Doctor to be everything, Superman almost. We hanker for the simple comforting relationship and degree of involvement of earlier times, but with all the benefits of better diagnoses and effective medicines that are available today; we want the caring demeanour, the reassurance, the generosity of time that an old-fashioned family doctor gave; yet we also want this person to have the skills and knowledge of a specialist, to have invested the time to be up-to-date with all technological and medical advances and to have the latest scientific facts at his fingertips. Occasionally, we meet such people, but they are rare. It’s a very fine line between doctors telling the patient as it is and being positive about the outcome to keep the patient cheerful and positive. Unfortunately our medical system does not train well for this ‘fuzzy’ part of medical care, and hence it is up to individual doctors how they deal with it.

One that does it very well is an orthopaedist called Dr. Niranjan Deshmukh at Lilavati Hospital in Mumbai. Multiple people that I know have been to see him for various back, shoulder and leg injuries and have given glowing reports of their experience. Apart from a calm reassuring manner, this Doctor also spends time with patients explaining to them why they are in pain, the cure needed, how long it will take etc. He uses 3-D images of our skeleton with the network of muscles and nerves over it to give detailed explanations of the reason for the pain, how it can be mitigated and means of preventing a recurrence.

I think it is time to acknowledge that such Doctors are the exceptions and build a system for the norm; one that is built around our needs as patients for more information to help us feel a bit more in control, for reassurance, and of course, for guidance and treatment. As Dr. Gawande says in his article, we need pit crews.

In some ways, hospitals are beginning to respond to these needs. Some hospitals address this through talk sessions that all their patients and their families can attend. Sometimes, for metabolic ailments, a doctor and a dietician work as a relay team for diagnosis and then ailment management. Additionally, one member of the pit crew could also be a trained medical counsellor, contributing the ‘time to care’ component of ‘quality of care’; someone who would help patients and their family members traverse from denial and anger to acceptance and solution-seeking, giving them all the information they need so that they can make sense of the situation – explain what’s happening, understand treatments available, sort through options etc.

Of course, one key question is that of the payer for these services and to what extent they can be rolled out in a country such as India where large swathes of underserved or un-served populace lack access to even basic medical care. Nevertheless, I think we need to push ahead on both fronts, improving quality of medical care and the overall experience and increasing access.

  • Zenobia Driver


May 28, 2012 at 6:19 am 20 comments

Is change afoot in the practice of medicine ?

Two articles that I came across recently got me thinking about the way medicine is practised currently and how it is going to change significantly during our lifetime.

The first is an article by noted physician, writer, and policy-maker Dr. Atul Gawande; titled ‘Cowboys and Pit Crews’, it is the text of Dr. Gawande’s commencement address at Harvard Medical School last year. In this speech he touched upon the way the practise of medicine evolved and the background to the way it is currently structured. Some fragments from the speech are reproduced below to whet your appetite, hope these encourage you to read the entire article :

‘The core structure of medicine—how health care is organized and practiced—emerged in an era when doctors could hold all the key information patients needed in their heads and manage everything required themselves…….The nature of the knowledge lent itself to prizing autonomy, independence, and self-sufficiency among our highest values, and to designing medicine accordingly. But you can’t hold all the information in your head any longer, and you can’t master all the skills. ……We’re all specialists now—even primary-care doctors. A structure that prioritizes the independence of all those specialists will have enormous difficulty achieving great care…..We train, hire, and pay doctors to be cowboys. But its pit crews people need………By a system I mean that the diverse people actually work together to direct their specialized capabilities toward common goals for patients. They are coordinated by design. They are pit crews.’

Dr. Gawande’s speech was about the systems and a process involved in healthcare delivery, and his prescriptions were practical, though complex to implement. The second article I’m pointing out to readers is a bit more far-out (or farsighted maybe), a bit like science-fiction-meets-medicine. This article is the transcript of an interview with Dr. Eric Topol, author of the book, ‘The Creative Destruction of Medicine’, a perspective on the changes in healthcare made possible by technology and digitisation. In this interview, Dr. Topol talks about the changes possible and the extent to which personalised medicine / treatment is now available and could benefit people, also about the prevailing system which (he feels) is resisting these changes.


  • Zenobia Driver



May 21, 2012 at 9:35 am 5 comments

Direct Selling

Although direct selling isn’t a very commonly discussed business model in India, it is a force to be reckoned with. It is now a Rs.4200 crore industry and about 3 million Indians are engaged in direct selling; of this, 2.1 million are women, mainly because it offers an additional income and flexible hours. Several brands sold through this model are now at par or beginning to overtake the more mainstream FMCG and OTC brands which are backed with aggressive marketing and extensive distribution networks.

Take for example Amway’s Nutrilite protein powder – It is now a Rs. 250 crore brand far ahead of its competitors like Wockhardt’s ProtineX. Amway’s supplement pill Nutrilite Daily is close on the heels of Ranbaxy’s heavily advertised Revital having grown 34% last year. Glister toothpaste from Amway is also a over Rs.100 crore brand now, and is fast closing in on Dabur Red Toothpaste which has been around in the market since decades.

As a company too, Amway has outgrown multinationals like L’Oreal, Nivea and Kellogg’s in India by reporting Rs.2130 crore in sales for calendar year 2010-11. The US-based company, which started operations in India 14 years ago, attributes its success to 5.5 lakh active distributors, aggressive pricing and advertising. It has ambitious plans for this year too – it plans to double its advertising spends this year from Rs.30 crore in 2011 to Rs.58 crore, as it targets double-digit growth to follow 19% rise in sales last year.

Tupperware India Pvt. Ltd., which sells food storage, preparation and serving dishes, is expanding its distribution by appointing more consultants in the 50 cities and towns it operates in. The company is also developing new product offerings to suit the need of Indians. Asha Gupta, MD-Tupperware India, points out that non-metros are seeing brisk member addition and sales, revenue contribution of non-tier I cities stood at 38% in 2009-10, against 14% in 2008-09.

Oriflame has now been in India for over 15 years and has been registering a CAGR of 40% over the past five years. Its key markets include East and North-East region – which contributes around 40% to its total sales in India. That said, they have been growing the fastest in the southern four states and plan to focus expansion efforts here. They already have a product basket of 650 products and plan to introduce 300-350 new ones this year to keep up with the latest trends. The company is targeting to appoint 1.25 lakh new sales consultants to take the figure to 3 lakh by the end of this year, and have 500 service points from the current 350.

Modicare, the first India-based direct selling company, which sells cosmetics, foods and beverages, health and wellness and agriculture, personal, home, fabric and automobile care products, has grown significantly in the last 4 years. It has a network of over 1 lakh consultants with 40 centers serving 2700 cities across India and targeting sales of Rs.200 crore this year.

The latest addition to the list of companies working on the direct selling method is Qi – but it does so on with a difference. One, it operates only on an e-commerce platform and two, in addition to products in the nutrition, health, home and personal care space, it sells a range of luxury products and services too – such as branded watches, gold and silver jewelry, holiday packages, e-learning packages. It has over 40 lakh members operating globally and has now made its entry into India.

While some companies like Amway, Tupperware and Eureka Forbes have been advertising on TV; Tupperware also has its products on display at several supermarkets for a touch and feel experience; others like Oriflame and Avon are targeting a higher sales consultant base before advertising or exploring alternate/ complimentary distribution channels. Modicare is also slowly and steadily expanding its sales consultant base along with product portfolio to attract the Tier-III and smaller town customers.

Whatever the approach may be, each one has set its growth goals and is striving to achieve them. Perhaps, it is the traditional FMCG and OTC companies that need to take notice and be prepared.

Sources: News articles, Company websites.



Roshni Jhaveri

May 14, 2012 at 8:40 am 10 comments

Organic – But Naturally!

Lately, I have noticed a sudden burst of organic stores on the scene. So far, I had been seeing small sections dedicated to organic products in supermarkets and other shops, offering a limited range of products. Earlier, buying organic vegetable and fruits was restricted to weekly Farmer’s Market in Bandra or smaller outfits and individual sellers which supplied fresh produce direct to home. Stores like FabIndia, Westside carried a range of packaged organics staples, spices and condiments while several large supermarkets as well specialty stores like Vinita Mathur’s Health Shop – had a small section stocking organic foods from Conscious Foods, 24 Letter Mantra and a few other certified brands.

But suddenly, there are entire stores dedicated to organic products mushrooming around Mumbai. I’d always thought of the category as being niche – premium and metro-centric – given the higher price of all products produced organically as well as the low awareness about its advantages over conventionally produced products. These dedicated organic stores got me very curious in terms of why this sudden spurt – whether the prices had gone down, whether the product offering had changed and whether the cost of a standalone store was really justified for such products. So, I paid a few of them a visit.

Organic Garden (located in Breach Candy and Prabhadevi, Mumbai) has a whole range of vegetables and fruits grown organically, certified by ECOCERT. It’s a small store, stocking only fresh and small quantities of different fruits and vegetables grown in the region.  Despite being higher priced than the regular vegetable seller, the price differential is no longer the 25-50% that it used to be, it was only about 10-15% higher.

Organic Haus (at Kemps Corner, Mumbai) is a premium shopping experience, stocking a whole range of organic products which are imported from Germany and Austria. Their range of products includes foods and beverages, nutritional supplements, cosmetics, baby and home care products. The store is supported by well trained and informed sales personnel who explain not only the advantages of going organic, but also the product ingredients, method of usage, etc. (especially critical since most of the packaging is in German), provide information and explain unfamiliar terms like “gluten-free”, etc. and recommend products according to consumer health conditions and dietary requirements. Such is the confidence in the success of the store and its products that during the launch of its flagship store in Ahmedabad (yes Ahmedabad! not Mumbai or Delhi as one would expect), Organic Haus Chairman Dilip Doshi said, “We are planning to open 8-10 company-owned stores and 10-20 on franchise route across the country. We are in talks with some retail stores for shop-in-shop segment”. Currently plans are underway for a store in New Delhi and Bangalore as well as an online store. The products in the store are definitely much higher priced, but the variety of products is huge as well as the type of products stocked are quite different from the regular organic fare (such as an organic slimming kit which is a rage in Germany, nutrition supplements, beauty cosmetics, etc.). Also, Organic Haus has been heavily marketing – with billboards all along Marine Drive as well as creating a buzz through Facebook.

Navdanya-The Organic Shop (in Andheri, Mumbai) has been started by Navdanya Organization, a network of seed keepers and organic producers spread across 16 states in India, which started out as a research initiative, led by renowned scientist and environmentalist Dr. Vandana Shiva. They sell a wide range of products ranging from fruits and vegetables, staples, spices, condiments, jams and spreads, dry fruits, tea and coffee to seeds for cultivation.

Not only stores, but dedicated restaurants and cafes are also spurring up. Lumiere is a chain of restaurants in Bangalore and Cochin using only organically grown products from their own farms. Navdanya restaurant at Dilli Haat in New Delhi serves delicious meals prepared with organic ingredients. is a chain of organic salad and juice bar with outlets in Bangalore and Pune.

A few years ago, this market was marred by inadequate retail presence, little to no certified branded produce, an incomplete range, uncompetitive price points, and government policies that were skewed towards exports. That said, this space has definitely seen a lot of activity in the past few years – not only in terms of more outlets, higher awareness, higher acceptance despite higher prices, but also in terms of regulations and certification of organic foods by government bodies. The organic food market is still a very niche market – under 5% of the total food market – and has huge scope for growth, some estimates pinning the growth numbers at 40% annually.

This sure has become a space to look out for.



Roshni Jhaveri

May 7, 2012 at 9:15 am 2 comments

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