Month: September 2021

by Rajkumar Natekar Rajkumar Natekar No Comments

MAXIMIZING INDIAN API OPPORTUNITIES

Corona virus disaster has turned out to be an eye-opening situation because of which many powerful nations have suffered and are still suffering. Number of small and big businesses are facing adverse impacts and Pharma industry is not an exception. China is the source of 40% of the global APIs & dominating 68.3% of chemical API market worldwide. In 2018, APIs exported from China accounted for 81% ($30 billion over $37 billion) of total value of exported Chinese pharmaceutical products. Indian pharmaceutical industry despite being a global market leader at generic drug formulations, largely depends on imported APIs from China. APIs which are used to manufacture at least 12 essential drugs such as paracetamol, ranitidine, ciprofloxacin, metformin, acetylsalicylic acid, ofloxacin, metronidazole, ampicillin, amoxicillin, ascorbic acid and some fermentation-based intermediates for which India solely depends on china.

I would not be wrong to say that the Covid-19 situation would not be so dire for Pharma industry if it was not China’s monopoly for major raw materials and chemical supplies. Domestic manufacturing potential was always neglected by Indians because of having 70% of imports from China for ages. Overdependency on imports always blocked our way toward Self-reliance. But I believe, every challenge comes with a solution. Although the Corona Virus crisis has turned the world upside down, many big nations including India are now trying to rise with new norms for life. In my opinion, our country has shown impressive moves during this period and is still blooming through this crisis.

The wise steps taken by Indian government for pharma during this crisis are one of the most important growth propelling factors. The government has now come up with two schemes for pharma; one is the PLI scheme which gives some financial incentives based on sales made by selected manufacturers for 41 products which covers around 53 APIs and the incentive ranges from 5-20% based on the incremental scales. That is going to help companies in terms of bridging the gap between the Chinese prices and India price to some extent. The second scheme which the government has come up with is the bulk drug park and this scheme is primarily to provide easy access to world class common infrastructure which will be located in these parks where companies can come, set up and make use of the common infrastructure. And this is again for a period of five years. As we need to build our strength, the government has come up with these schemes which should help in compensating price gap between China and India to some extent.

India is both competitor and customer of the Chinese API industry

We are currently the largest producers of generic medicines with a share of 20% of total global production, catering to over 60% of world’s demand. Third-largest medicine market in the Asia Pacific region with Well-established, strong local manufacturing capabilities, with an international export profile are the factors which are really highlighting our identity as ‘Pharmacy of the world’. India is by far the world’s champion of drug master files (DMFs). Drug master files (DMFs) are voluntary submissions to the import country authority, and contain confidential information about human drug products. APIs belongs to the Type II of DMFs, which is concerned with drug substance, material used in their preparation, or drug product. While China holds 12% of DMFs from the U.S., India holds almost half of them. Being the largest holder of DMSs gives India the edge to export higher-value APIs, enlarging the industry’s attractiveness. Indians generally speak better English than Chinese, which facilitates pharmaceutical trade with developed countries. Access to low cost vaccines, affordable generics & HIV treatment from India are some of the greatest success stories in Indian pharmaceutical industry. It is now widely accepted that without the likes of Sun Pharmaceutical, Ranbaxy, Dr Reddy’s Laboratories, Cipla and dozens of smaller Indian companies, many African countries would not have been able to cope with the public health challenges they face. No wonder India is called the “pharmacy to the world”.

Source: India Pharma 2020, Propelling access and
acceptance, realising true potential, McKinsey & Company India,
Pharmaceuticals & Healthcare Report Q2 2020, Fitch Solutions

Specialty areas to concentrate in future:

HPAPIs

Nowadays, there is an area of interest in API domain called as HPAPI- High-potency active pharmaceutical ingredient, gaining its identity in Pharmaceutical market worldwide. They are APIs that require special handling due to toxicity and used in extremely small doses in finished drugs. Traditional examples of HPAPIs are cytotoxic compounds and sex hormones such as estrogen. Deeper analysis says that, the generic side of the industry will drive meaningful growth in the HPAPI market. Generics is one of the strongest domains in Indian pharma sector. Having said that, there exist bundles of opportunities in HPAPI sector for India. As per the latest report published by Research Dive, the global HPAPI market is estimated to generate 42,491.7 million and rise at a CAGR of 10.5% during the forecast period from 2020 to 2027. Oncology-focused medicines are one of the leading molecules creating maximum growth due to innovative pipeline candidates and upcoming generic entries. The Asia Pacific region is estimated to witness the fastest growth.

We are now emerging as a 2nd highest supplier base for generics with HPAPIs. Main API producers are headquartered in 24 different countries/territories, though most are based in either India or mainland China (Fig.1). New product introductions are a core growth driver for the generic API industry, and many of the upcoming opportunities are oncology-focused, high-potency compounds. Accordingly, many manufacturers across many territories have been making investments in HPAPI capabilities. Thus, companies should anticipate similarly high levels of competition as product markets develop. Looking at our nation who is blessed with ancient history of medicines and generic portfolio, profitable growth is anticipated in this area in near future. Rather than representing a well-differentiated, more insulated market segment, trends in HPAPIs are still aligned closely with the underlying dynamics of the pharmaceutical industry. Investments in this part should be viewed as essential steps to keep pace with the market.

                                        Source: NewpotTM, a Cortellis solution

API & data security

Now looking into API security, the potential for insider theft exists at every level of the pharmaceutical production and distribution chain. Individuals employed at production sites, distribution centres, and pharmacies are all potential insiders. The API is stored in a secured vault until it is ready for use. It is then moved to the production area, where it is combined with inactive ingredients to make the final dosage form like pills. The pills are then packaged and sent out to distributors, leaving the control of the original facility that made them. In this whole process, there are chances that a small quantity of APIs can be lifted unofficially. Manufacturers can’t afford to overlook such malpractices as most of the APIs are highly expensive. Fortunately, at the pharmaceutical distribution sites, most employees are professionally licensed pharmacists and pharmacy technicians, bound by the ethical standards and keenly aware that a breach would result in the loss of their licenses. Quality assurance (QA) plays a central role in pharmaceutical production, and it is used as an element of theft prevention as well. At production sites, manufactured pills are pulled at random for QA checks. While these checks are primarily intended to ensure accurate formulation, they also provide a check against the diversion of API that would lead to detectable changes in pill formulation. Some more protective measures to avoid Insider theft which can be taken in terms of staff are mentioned in fig.2.

Everyone would agree with the statement that the pharma industry is one of the most resistance industry when it comes to adopt new technology. In the past, when cloud computing technology was installed, security was a major problem and was a primary reason why pharma companies would stay far from it. However, with time and recent technological advancements, security has become the biggest benefit of adopting the cloud technology.

Now, multiple layers of security are added to critical business data. Data such as contacts, sales tracking, patient information, content, and strategies are all heavily protected by the cloud, ensuring that your marketing operations remain safe and secure. The cloud is secured by encrypting data to be transmitted over networks and placed in specific databases. This encryption also prohibits access by internal team members who do not have authorized access to the data, which eventually shuts the idea of accessibility by cyber hackers. There is no way back when it come to adopting technology. In my opinion, getting familiar with such technologies and deriving highest benefits out of it is the topmost necessity in today’s world and pharma industry has to be ready for this.

Way forward in API Manufacturing……

While surfing through one of the Analysis created by PwC, some of the recommendations grabbed my attension. They might not be easy to demonstrate immediately at this point but also are not unrealistic while planning for future strategies.

Some long term recommendations were:

1.Develop large clusters and provide plug-and-play infrastructural support in dedicated zones for manufacturing APIs-

  • Construct 2–3 large-sized dedicated zones and lease them to private players for operating manufacturing plants.
  • Set up common utilities such as solvent recovery and distillation plants, power and steam units, effluent treatment plants, common logistics centres, regulatory infrastructure and warehousing to make smaller units economically viable in these zones.
  • The following support can be looked at to encourage investments in mega parks: – stamp duty waiver – 50% subsidy on water and electricity for 5 years – SGST reimbursement – 75% for 5 years – 50% subsidy on expenses incurred for quality certification/patent registration – waiver on development charges, which are currently at 9% of property cost.
  • Evaluate strategic locations for these mega parks, e.g. union territories, where the centre can play a larger role in controlling costs such as like cost of land and utilities.

 

  1. Industry–academia initiatives-
  • Facilitate collaborations with institutions like National Institute of Pharmaceutical Education and Research (NIPER), Council of Scientific and Industrial Research (CSIR) labs and universities to improve process technologies (e.g. yield improvement).

 

  1. Facilitate alternative sources of import-
  • For APIs and intermediates of high strategic importance that cannot be manufactured domestically, due to lack of either raw materials or concerns relating to environmental hazards, the government needs to adopt alternative sources.
  • Initiatives to promote imports of intermediates and APIs from multiple sources to reduce monopoly in imports. An additional 10% subsidy can be provided if the imports are from sources other than China.

 

Although we are one of the topmost players in the generic market, we still have struggled for a longer time because of high dependence on China. Our domestic API industry has been deeply affected because of policies such as stricter implementation of pollution control norms, implementation of DPCO, 2013, lower import duties, and complete collapse of the indigenous fermentation industry. However, favourable schemes from the government and a supportive financial ecosystem to boost private and foreign is a light at the end of tunnel and reviving our API manufacturing capabilities. MNCs like GSK, Pfizer, Novartis have been here for many years. We need to invite them to manufacture for exports in India. We have to look at setting up a kind of platform where we will use technology for consolidating sourcing, supply chain, regulatory, quality approvals and aggregate all the discreet capacities available from individual companies. This will enable collaboration and alliances with large global and domestic pharma companies.

In the slightly longer term, the government may look at the Chinese model and work on developing clusters for API and also can fuel our HPAPI manufacturing powers. API security and surveillance technologies at industry level is also one of the major factors which has to be taken care of. An emergency is inevitable and it always affects in a very unpleasant manner if we are not fully prepared to deal with it. Self-reliance is must and we have to get habituated to it. India for India and India for global is the strategy that we need to follow. Afterall we have to give justice to ‘Make in India’.

 

 

by Rajkumar Natekar Rajkumar Natekar No Comments

Four Changing Paradigms of Healthcare

2020, known as the year of uncertainties, was a rollercoaster for the healthcare industry as it was forced to adapt a number of new approaches which may turn out to be blessings in disguise. The sector is evolving at a greater pace and trying to future-proof itself to the extent possible.

The focus has drastically shifted towards advance research in medicines and vaccines to fight the ongoing pandemic. Moreover, the synergy between herbal and conventional medicines is now a trending practice.  

In addition to this, the approaches are patient-centric as personalisation of healthcare is on the rise. So, looking at the fruitful transition in actions, better healthcare can be expected in coming years even in the developing countries like India. 

Discussed ahead are four changing paradigms of healthcare- 

Paradigm 1- Easier and advanced access to healthcare through IT

Unequal access to the healthcare facilities is one of the major concerns when it comes to availability of these facilities to different groups in the society. People living in rural areas, where the healthcare services are inadequate and biased, are described as the unhealthy part of the population.

However, due to pandemic, telehealth practices in the healthcare are on the rise, barriers are decreasing and access to public health facilities is increasing. Rising digitalisation in healthcare is resulting in increased efficiency, patient engagement and personalisation of health solutions. Several interventions like tele-appointments, real-time interactions, telediagnosis, tele-patient monitoring, and much more, are possible due to virtual assistance.

Moreover, owing to this IT- based approaches, health professional who are based abroad, can efficiently guide surgical procedures and other interventions here virtually. Due to increasing acceptance of telehealth, rural population can enjoy better and advanced healthcare in the coming years.

Paradigm 2- Proactive patient care 

Due to late diagnosis of health condition, there was always a risk of highly advanced disease stage leading to unmanageable consequences. However, as the healthcare structure is evolving, proactive patient care gaining traction. 

Early diagnosis is essential for managing deadly diseases like cancer and other chronic health conditions. Early detection and preventive measures can lead to improved survival rate in the future. 

In recent scenario, the preventive healthcare approaches surging with the interventions of nutraceuticals, traditional medicines and herbal supplements. Along with classic nutraceuticals, one of the most in-demand nutraceutical formulations are ‘natural immunity boosters’ which have gained a good traction in pandemic.

Moreover, In India, Ministry of AYUSH has led down a platform for immunity boosting traditional medicines during COVID. Contesting the tested or untested formulation are going on and there are certain natural products like Bacopa monnieri, for which enough clinical trials are available. However, claiming them for immunity against Corona, they definitely need trials. 

Paradigm 3- Integrative approaches

The concept of holistic wellness is getting established among the people like never seen before. Government actions are also inclined towards increased acceptance of Ayurveda and other integrative medicines. In pharmaceuticals, Drs’ prescriptions have increased for plant-based nutrition products along with vitamins and minerals as supplementary prescription which is evident from IMS.org or IVAC reports. In comparison to overall growth of pharmaceutical industry, the nutritional products, vitamins and minerals as nutrients, are growing faster than the total market.

Due to the pandemic, the focus has shifted from cure to prevention. Role of spices, Ayurvedic ‘kadhas’ and other traditional medicines came up as precaution for every family. In addition, the pandemic, lockdowns and working from homes further fostered the use of such traditional remedies. As a result, though it is not a direct competition to modern medicines, the perception of Ayurvedic or traditional medicines shifted to prevention. This is the reason why acceptance of traditional medicine is increasing. Also, due to rising alertness about therapies like acupuncture, massage, meditation, etc., healthcare can adopt new ways of treatments which are much holistic in nature.

Patient’s rehabilitation is also one of the matters of concern as many a times, post-surgery care is important in order to return to  a healthy lifestyle. Looking at the better approaches towards today’s healthcare, rehabilitation centres can become prevalent in coming years. 

Paradigm 4- Technological headway

The days when surgeries were not so precise and unassured are fading away. Increasing technological advancements in healthcare at various levels are effectively future-proofing the entire sector and billions of lives. 

Artificial intelligence (AI), one of the highly trending topics today, is making great moves in healthcare industry. Several advanced interventions which are not only timesaving but also very promising are empowering the current healthcare sector. AI is highly useful in the space of genomics and gene editing which can give rise to the drugs and treatments for various life-threatening diseases.

While reshaping and reimagining healthcare, affordable healthcare cost should also be taken into consideration as this aspect of healthcare services is very important. As more healthcare organisations implement tech-driven initiatives, cost factors are need to be balanced in order to make the healthcare services approachable for the patients belonging to various strata of the society.

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Derma market overview – India

Discovered in ancient Egypt, dermatology practices in ancient times were primarily concentrated on treating skin cancers and major skin diseases. However, as these practices evolved, modern dermatology developed and hence the dermatology education in the medical schools. The products and treatments acquired regulatory boundaries under FDA which ensured the safety and efficacy of dermatological practices.

Dermatology, in today’s scenario, is no longer restricted in the boundaries of Dermatologists and their clinics. The practice has evolved and improved over the years, so has the process of skin care. Shift from chemical entities to more natural ones is one of the trends in skin care which has gained considerable attention in today’s scenario. Moreover, new generation consumers, having better penetration on social media platforms are now much aware about the ‘best’ skin care products. Discussing with general physicians, favorite ‘skin care blogger’, professionals at beauty salons is what the new scenario of skin care looks like. ‘Going to dermatologist and getting the skin treatments’ is
no longer the first choice for today’s consumers.

Moreover, as the dermatological products are increasingly going OTC, managing mild and moderate breakouts has become easy and convenient. The products essential for the basic needs of skin, improving texture and tone, managing sensitivity and maintaining blemish free skin are on the shelf of every drug store. Innovative products which are encompassing the market today are making the skin care products market highly lucrative and creating wonderful opportunities for future business.

Following is the overview of Indian skin care products market in 2021 and beyond-

Market overview-

  • The market value of the Indian skin care derma cosmetics products market in 2021 is $2,920.2 million.
  • It generated revenue of $750.3 million in 2019 and expected to account for $1,758.0 million in 2030, growing at a CAGR of 8.5% between 2020 and 2030.
  • Cream segment making excellent revenues in Indian skin care market.
  • Based on application/therapy, skin repair category is expected to grow at the highest CAGR during 2020-2030.

Brands and market players-
Based on brands, Avène accounted for largest share during 2014-2019 and is expected to witness fasted growth in Indian skin care derma cosmetic market in the years ahead. The brand offers a complete product range for all major skin concerns.

Major players in the Indian skin care derma cosmetic market- Unilever Group, The Procter & Gamble Company, Galderma S.A., Pierre Fabre S.A, Allergan plc, Shiseido Company Limited, Johnson & Johnson, The Estée Lauder Companies Inc., L’Oréal S.A., Beiersdorf AG, Clarins Group, Amorepacific Corporation, Avon Products Inc., NAOS, ZO Skin Health Inc., Oriflame Holding AG, Sebapharma
GmbH & Co. KG., Patanjali Ayurved Limited, Emami Limited, the Himalaya Drug Company, and Kao Corporation.

Regions and demographics

North India is the largest market for skincare derma cosmetics. The Garhwal hills of North India account for a high prevalence of dermatitis, skin appendages, acne, and eczema.

The highest Indian skincare derma cosmetics market CAGR is expected in the western part of the country in the near future.

Based on demographics, in India, female segment accounted for more than half of the in skin care products market in 2017. Female segment is expected to remain dominant in the future as well. However, the male segment in India is also expected to witness a significant CAGR, owing to rise in interest of men in maintaining their physical appearance.

Based on age group, the millennial segment will fetch highest revenue in skin care products. India has high millennial consumers.

Consumers shifting markets from synthetic to natural or organic skin care products would be interesting to watch as this trend is presenting potential opportunity for stockholders in Indian skin care products market.

Trending molecules-

  • CBD OIL (CANNABIDIOL)
  •  POLYHYDROXY ACIDS (PHAS)
  •  Glycolic acids
  •  Retinol
  •  Tea tree oil
  •  Bakuchiol
  •  Grapeseed oil
  •  hyaluronic acid
  •  Niacinamide
  •  Petroleum jelly
  •  Vitamin C
  •  squalene
  •  Castor oil
  • Salicylic acid
  •  Benzoyl peroxide
  •  Ceramides

Factors influencing growth of Indian skin care products market-

  • Presence of young demography
  • Increasing disposal income- Leading to higher investment in personal care products predominantly skin care.
  • Shift toward healthier lifestyle
  •  Increasing prioritization for Skin care – shift from a general idea of good-looking skin to the
    deeper concept of skin health
  • Influence of Korean skin care routine
  • Surging prevalence of skin diseases
  • Market players launching innovative and attractive products ranges in skin care
  • Rise in new product launches and approvals from regulatory bodies in India.
  • Market players are focusing on Mergers and Acquisitions to gain competitive edge

Trends to explore-

  • Microbiome- focused skin care
  • Celebrity skin influenced skin care
  • Products for blue-light (from tech screens) protection
  • Skin care products calming inflammation
  • Hand care (Pandemic- influenced)
  • Skin barrier repair-centric creams (to repair and strengthen skin barriers)
  • Refillable skin care products (Planet love)
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Role of Digital Transformation- Building Brands

A strong misconception I wish to shoot down at the beginning of this article is about digital transformation. You do not need a strong IT team with an army of coders and software engineers to execute your transformation journey, it’s 2021 and without writing a single line of code, you can create your website, landing pages, and even your app!

The world of SaaS scenarios will solve it all for you, with ease.

A broad definition is “Digital Transformation is the use of technology to change how a business operates and delivers experiences to its customers”.

Gartner’s digital transformation definition:

 “Anything from IT modernization, such as cloud computing or AI, to digital optimization, or the invention of new digital business models.”

Whichever definition you take, digital transformation has the same all-encompassing goal:

Improving business processes and using digital technology to help. Yet, digital transformation isn’t a one-size-fits-all concept.

Common digital transformation mistakes Brands make:

When it comes to how a Brand or Product needs to view a digital transformation, brands tend to make one or more of the following mistakes that prevent them from having a successful digital transformation:

  1. Viewed from the bottom up and not the top down

Brands often get confused with the term digital transformation – it doesn’t only mean digital. When organizations launch new websites, tools or processes, they may consider that as their digital transformation, but then it doesn’t work out as they intended.

Why is it so?

Digital transformation begins with the people. If new technology is implemented without considering the people, the organization as a whole and its internal processes, then the transformation will be a failure.

When viewing digital transformation from the C-Suite, it’s important to note that every business is unique, and there is no one size fits all solution.

Also, brands need to do away with old-school thinking that the digital business model has diverse rules compared to their regular business model. Online and in-store pricing may or may not vary in today’s scenario, yet both will still require investment for finding the right product mix, after-sales processes and customer support, most importantly the time spent on both these platforms are almost equal now.

  1. Digital transformation is a short-term concept

Numerous assumptions state that a transformation happens once and then you’re done. Digital transformation is an ongoing process, where brands need to adapt to new technologies, changes in consumer behaviour, and continuity.

Another problem with viewing digital transformation as a one-and-done thing is that some brands believe it would be too big of a project to undertake and end up costing lots of time and money.

If you plan well and understand your business constraints and reimagine them into different scenarios, then each problem can be tackled one by one. This makes it easier to view a digital transformation continually and as a benefit to the business rather than one “big bang” effort that customers end up ignoring.

  1. There is a lack of customer communication

Digital transformation does not mean build it and customer will come. Just because you add new technology doesn’t mean that your customers will immediately start using it. You need to communicate with both customers and employees and make sure that they are happy with the changes you are implementing.

Proper communication also helps to avoid friction between customers and the company and makes sure your digital transformation is tackling the right problems.

  1. It isn’t viewed holistically

When organizations don’t view digital transformation as part of one bigger movement, then they may believe that it won’t work for them.

In reality, every brand or product has at least one area that could improve with digital transformation. With proper cost-benefit analysis, brands will be able to determine where digital transformation will work best for their business and won’t just do it because it seems to be the latest trend.

Digital transformation doesn’t only impact customers but also employees and the overall company culture. Understanding this concept will help internal staff understand the benefits and lead to greater adoption across the business.

Also, real digital transformation needs to be embraced and executed by everyone and not just the Techno-Marketing team. Any technology that gets introduced as part of a digital transformation needs to be user-friendly or it won’t be effective.

How to get people on board with digital transformation?

Any process that changes the status quo will cause disruption. Consequently, there’s no such thing as “minimizing disruption” during the digital transformation process.

But people are the cornerstone of digital transformation so getting them on board is fundamental to success. Here are some steps you can take:

  1. Identity internal senior champions with the inclusion of the sales team (veterans of the organisation drive the transformation)

Establish a team of people across every aspect of the business. Digital transformation affects everyone so having key participants throughout the organization is critical to its success.

Starting with some of the major departments that digital transformation will affect and make sure everyone remains focused on the ultimate objective.

Key Take Away (KTA): “Determine who you can to be count on to help champion the digital transformation recommendations.”

  1. Undertake an inclusive planning process

Once you have your senior champions in place, gather all of them to begin the planning process. Including everyone in the planning process and hearing ideas from multiple places can provide a different perspective and lead to a better outcome.

The initial plans you had for a digital transformation could turn out to be more beneficial to some departments than to others. Hearing everyone’s views will help you to plan accordingly.

Key Take Away (KTA): “Capture all the ideas as a group and rate impact Vs effort.”

  1. Identity and chart high-impact vs effort

Categorize your ideas based on how much work they will require and the overall positive impact on the organization. High impact ideas that require a lot of effort would be classified as significant projects. 

However, you can’t forget about the thankless tasks that require high effort with little reward. Sooner or later, you will be happy that those tasks, such as digitizing client documentation or data collection, got done.

Any low impact and low effort work can always be filled in along the way where space allows.

Key Take Away (KTA): High impact ideas that need the least amount of effort are always a good starting point since they qualify as quick wins.”

  1. Select a cross-section for a phased approach

Make your digital transformation process an agile one and don’t try to implement everything at once. Do it to step by step, gradually introducing changes and seeing how your customers and employees react to changes before adding more.

Key Take Away (KTA): “A phased approach allows the flexibility to course correction without derailing the entire process.”

  1. Prioritize selection

Once you have selected which cross-section of the chart you’re going to begin working on, then you can start to prioritize the tasks within that section. 

Some of the factors to consider may include benefits, cost of implementation, and the overall strategic value of the initiative.

Key Take Away (KTA): “Identify any defining factors and weighted criteria you will use to help determine which job to tackle first.”

  1. Allocate owners to each initiative

Ownership allows stakeholders to feel like their contribution matters. Each initiative you have should be treated as an individual project, and one of your stakeholders should be designated as the project owner.

Owners will likely come from the departments where the project is primarily located.

Key Take Away (KTA): “As the project owner, it is that person’s responsibility to see the project to completion.”

  1. Have regular interactions (online and offline) to discuss progress

Digital transformation, like any important venture, isn’t a short-term project. Having regular meetings with stakeholders is essential to make sure that everything is on track.

When you meet, discuss any issues being faced, potential bottlenecks that are hindering progress and how far along you are on the project roadmap.

Key Take Away (KTA): “A talk solves a lot!”

  1. Inform stakeholders why you’re doing this (and the benefits associated with the journey)

When working with stakeholders and anyone within the organization who will be involved in the digital transformation process, it is essential to explain why you are undertaking the project in the first place.

Key Take Away (KTA): “One good way of doing this is to identify how they will benefit as individuals or as a department as a result of the digital transformation.”

  1. Over-communicate

Communicating the value of the digital transformation and with each other throughout the process is a recipe for success. 

Find ways to capture people’s imagination and align them with your vision for the organization. Make it easy to be found so that everyone can have clarity on what they’re working towards and make any content related to the digital transformation efforts easily consumable. This may include visuals, pics, video, gifs, etc. to boost interest and understanding.

Encourage discussion, not just among stakeholders but with others in the organization as well and avoid sending updates or resources related to the process that can be easily lost or ignored.

Key Take Away (KTA): “Some of the ways you can do this are by giving the transformation process a name, a good one.”

  1. Celebrate achievements

During any process, it’s important to celebrate achievements along the way. This reminds you and your team about how far you’ve come, even if you still have a way to go to complete your objectives.

Key Take Away (KTA): “Milestone every moment and scenario, drink it out or shout it loud!”

  1. Create visual signals of change for all (internal and external) stakeholders

Visual signals can create checkpoints internally among your employees and externally among your customers. Signals can help you determine how effective your transformation has been thus far and ensure that everyone has the digital transformation on their minds.

  1. Continuously seek feedback

Feedback is invaluable as it can determine if you’re on the right track or if you need to make sweeping changes to your approach. Don’t simply wait on your stakeholders to get back to you and tell you how you’re doing. Go directly to stakeholders and seek out feedback about your progress so far

 Key Take Away (KTA): “Be proactive and not reactive!”

  1. Make the process ongoing, don’t treat it as a one-off project

Digital transformation is a continuous process that needs updating as customer requirements change and new technologies emerge. For that reason, you shouldn’t treat it as a one-off project that is finished once you check the last task off of the to-do list.

Don’t let this deter you as it merely means that organizational goals and requirements will continue to change along the way, and you should always be ready to change with them if necessary.

Key Take Away (KTA): “Your digital transformation is, in some ways, never-ending.

Bonus content for the transformer in you!

Technology’s role in digital transformation

Since digital transformation begins with the people involved in the organization and the business processes, many begin to wonder what role technology plays in transformation. Following fig. 2 describes some of the things that technology does:

Fig. 1 Technology’s role in digital transformation

Source- Developed by author

 “Every journey starts with a single step!”

…………………………………………………………………………………………………………………………………………………………..

Reference

Gartner Study on Digital Transformation with CoreDNA data points

About Author

Mr. Anurag Dalal- He is a versatile corporate with strong track records across Marketing, BD and Digital streams for several International Pharmaceutical Organizations on B2B platforms in Egypt, Afghanistan and India. 

He has played a key role in establishing valuable marketing & communications strategy, novel revenue networks, increased productivity and cost efficiency. 

With more than 15 years of corporate experience, he is completely adept at Strategic Counsel & Planning for brands in diversified domains and single handedly managing the Product/ Brand.

Summary

In recent scenario, digital transformation is not just necessary, but essential. Various industries are increasingly shifting their business models and marketing strategies from traditional to modern and advanced ones. This shift is progressively driven by the advancing technologies owing to which various areas of business are transforming digitally. This article highlights certain aspects of digital transformation in building brand strategies in current scenario as companies are testing their efforts in the market in much creative and productive ways, which is interesting to know about…

 

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Nutraceuticals in Oral Mucositis

The term mucositis applies to the consequences of chemotherapy and radiation therapy in cancer treatment. It pertains to the mucosal damage occurring in the oral cavity, pharyngeal, laryngeal, oesophageal regions, and other gastrointestinal tract areas. About 20% to 40% of patients undergoing conventional chemotherapy and almost all patients who receive head and neck radiation therapy (H&NRT) develop mucositis.[1]

Oral mucositis (OM) results in painful ulcerative lesions that can negatively impact the overall quality of life by restricting essential activities, such as talking, eating, swallowing, and oral hygiene maintenance. OM can trigger an inability to tolerate food or fluids, which leads to malnutrition, dehydration, and weight loss. Immunocompromised patients have a much greater risk because these lesions can get secondarily infected, which may lead to systemic sepsis.

Depending on the severity [2], OM can be classified , as

  1. Tolerable mucositis (grade 1 and 2)
  2. Intolerable mucositis (grade 3 or higher).

A wide variety of molecules have been tried & tested for the OM management – prevention, severity reduction, and symptomatic relief. Naturally occurring compounds have attracted significant attention in this regard since they are perceived to have minimal side effects while helping the mucosa heal faster, which is a much-desired outcome since OM is already an adverse effect.

Zinc:

Zinc is an essential trace element, which is known for its action in tissue repair processes. Zinc induces metallothioneins (zinc-binding proteins) that protect against oxidative damage and inflammatory stress. Metallothionein reduced histological damage and neutrophil infiltration in methotrexate-induced intestinal mucositis in an animal model. [3]

Zinc in OM: [4,5]

Patients who received zinc displayed lower severity, delayed onset, and also had faster healing of OM. The best evidence for zinc comes from a randomized, double-blind, placebo-controlled trial in which zinc supplementation lowered the severity and delayed OM onset in oral cancer patients. Researchers have recommended zinc in oral cancer patients receiving radiation therapy or chemoradiation.

Honey: [6]

Due to its positive effects on wound healing, honey has been studied as a preventive modality in oral mucositis. Honey is recommended for the prevention of intolerable OM due to many of the properties that make it effective – its hygroscopic nature, viscosity, and its acidic pH that prevents bacterial growth on the mucosal surface. Also, honey contains vitamins – ascorbic acid, pantothenic acid, niacin, riboflavin, and minerals such as calcium, copper, iron, magnesium, manganese, phosphorus, potassium, and zinc – that help repair the tissue directly. Other advantages of honey include – being readily available, easy to gargle, non-irritating and sweet, and thus more acceptable to patients, especially children.

Curcumin: [6, 7]

Turmeric or curcumin (Curcuma longa) is a rhizomatous herb often used as a food spice. Curcumin is also traditionally used in oriental medicine to treat several illnesses. A wide range of pharmacological activities of curcumin such as anti-inflammatory, anti-oxidation, lipid-lowering, anti-viral, anti-bacterial, anti-cancer, anticoagulation, anti-fibrosis, anti-atherosclerosis effects, make it a commonly used therapeutic agent, which is further reinforced by low toxicity and minor adverse reactions.

Many studies have found a statistically significant effect of curcumin mouthwash in preventing intolerable OM in cancer patients. [6] However, we still need to determine the safe and tolerable concentration of curcumin mouthwash. Also, we need to determine the efficacy of different concentrations of curcumin mouthwash in oral mucositis prevention.

Chamomilla: [6]

Chamomilla is a commonly used ingredient in a wide variety of health products. It is one of the popular medicinal herbs best-known for its safety and therapeutic properties, such as anti-microbial, anti-inflammatory, antioxidant, and anti-cancer effects. A network analysis published in 2020 found Chamomile to be one of the most effective mouthwashes in the prevention of OM patients.

Glutamine: [8]

Glutamine, a precursor of glutathione, is the most abundant free amino acid in the body, known to play a regulatory role in several cellular processes involved in wound healing and tissue repair. Glutathione is a major intracellular antioxidant that protects cells from damage due to oxidative stress.

A double-blind, randomized, placebo-controlled trial showed that glutamine significantly decreases the severity of chemoradiotherapy-induced mucositis in head and neck cancer patients. [9]

A new study published in 2021 suggested that vitamin E, zinc, and glutamine could effectively prevent and treat OM.[10]

Let us take a look at two meta-analyses published in the year 2020 –

A network meta-analysis [6] published in 2020 compared the preventive effect of ten different types of mouthwashes in the clinical management of intolerable oral mucositis. A literature search was performed, and reports published from 1990 to 2019 focusing on mouthwashes in OM prevention were identified. The authors evaluated thirty-six randomized controlled trials that included a total of 2594 patients. The Bayesian network analysis showed that honey, chamomile, and curcumin-containing mouthwashes were superior to placebo, among the naturally available molecules. The study found that mouthwashes containing these molecules may be the most advantageous in preventing intolerable OM.

The authors of another meta-analysis [11] searched the databases for randomized control trials (RCTs) published from inception until January 2019 on the effects of different oral care solutions in preventing OM.

The network meta-analysis included a total of 28 randomized controlled trials involving 1861 patients. Among the oral care solutions containing natural molecules – honey and curcumin were more effective than placebo. The authors concluded that curcumin and honey might serve as the preferred options for preventing OM and form the basis for its clinical management.

 

References:

[1] Lalla RV, Bowen J, Barasch A, Elting L, Epstein J, Keefe DM, McGuire DB, Migliorati C, Nicolatou-Galitis O, Peterson DE, Raber-Durlacher JE, Sonis ST, Elad S; Mucositis Guidelines Leadership Group of the Multinational Association of Supportive Care in Cancer and International Society of Oral Oncology (MASCC/ISOO). MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy. Cancer. 2014 May 15;120(10):1453-61. doi: 10.1002/cncr.28592. Epub 2014 Feb 25. Erratum in: Cancer. 2015 Apr 15;121(8):1339. PMID: 24615748; PMCID: PMC4164022.

[2] Rao S, Hegde SK, Rao P, Dinkar C, Thilakchand KR, George T, Baliga-Rao MP, Palatty PL, Baliga MS. Honey Mitigates Radiation-Induced Oral Mucositis in Head and Neck Cancer Patients without Affecting the Tumor Response. Foods. 2017 Sep 6;6(9):77. doi: 10.3390/foods6090077. PMID: 28878156; PMCID: PMC5615289.

[3] Tran CD, Sundar S, Howarth GS. Dietary zinc supplementation and methotrexate-induced small intestinal mucositis in metallothionein-knockout and wild-type mice. Cancer Biol Ther. 2009 Sep;8(17):1662-7. doi: 10.4161/cbt.8.17.9293. Epub 2009 Sep 17. PMID: 19633421.

[4] Lin LC, Que J, Lin LK, Lin FC. Zinc supplementation to improve mucositis and dermatitis in patients after radiotherapy for head-and-neck cancers: a double-blind, randomized study. Int J Radiat Oncol Biol Phys. 2006 Jul 1;65(3):745-50. doi: 10.1016/j.ijrobp.2006.01.015. PMID: 16751063.

[5] Ertekin MV, Koç M, Karslioglu I, Sezen O. Zinc sulfate in the prevention of radiation-induced oropharyngeal mucositis: a prospective, placebo-controlled, randomized study. Int J Radiat Oncol Biol Phys. 2004 Jan 1;58(1):167-74. doi: 10.1016/s0360-3016(03)01562-1. PMID: 14697435.

[6] Zhang X, Sun D, Qin N, Liu M, Zhang J, Li X. Comparative prevention potential of 10 mouthwashes on intolerable oral mucositis in cancer patients: A Bayesian network analysis. Oral Oncol. 2020 Aug;107:104751. doi: 10.1016/j.oraloncology.2020.104751. Epub 2020 May 7. PMID: 32388411.

[7] Nagpal M, Sood S. Role of curcumin in systemic and oral health: An overview. J Nat Sci Biol Med 2013;4:3–7.

[8] Yarom, N., Ariyawardana, A., Hovan, A. et al. Systematic review of natural agents for the management of oral mucositis in cancer patients. Support Care Cancer 21, 3209–3221 (2013). https://doi.org/10.1007/s00520-013-1869-5

[9] Tsujimoto T, Yamamoto Y, Wasa M, Takenaka Y, Nakahara S, Takagi T, Tsugane M, Hayashi N, Maeda K, Inohara H, Uejima E, Ito T. L-glutamine decreases the severity of mucositis induced by chemoradiotherapy in patients with locally advanced head and neck cancer: a double-blind, randomized, placebo-controlled trial. Oncol Rep. 2015 Jan;33(1):33-9. doi: 10.3892/or.2014.3564. Epub 2014 Oct 23. PMID: 25351453; PMCID: PMC4254677.

[10] de Sousa Melo A, de Lima Dantas JB, Medrado ARAP, Lima HR, Martins GB, Carrera M. Nutritional supplements in the management of oral mucositis in patients with head and neck cancer: Narrative literary review. Clin Nutr ESPEN. 2021 Jun;43:31-38. doi: 10.1016/j.clnesp.2021.03.030. Epub 2021 Apr 15. PMID: 34024533.

[11] Yu YT, Deng JL, Jin XR, Zhang ZZ, Zhang XH, Zhou X. Effects of 9 oral care solutions on the prevention of oral mucositis: a network meta-analysis of randomized controlled trials. Medicine (Baltimore). 2020 Apr;99(16):e19661. doi: 10.1097/MD.0000000000019661. PMID: 32311938; PMCID: PMC7220734

The article is written by Dr. Chitguppi and is published by Interlink Insight_Vol 20_Issue 2

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