Schizoprenia: NAMI Interview: Mr. Dilip Sanghvi Chairman & M.D. - Sun Pharma

Interview:
Mr. Dilip Sanghvi
Chairman & M.D. -  Sun Pharma

Conducted By:
Akila Maheshwari
Convenor  NAMI-INDIA

Qus.1- Sun has been a forerunner in providing  cost-effective
medication in India for diseases of the central nervous  system. How has this come
about?

Ans - Sun  has been a forerunner in providing cost-effective
medication in India for  diseases of the central nervous system. How has this come
about? Essentially when we started the company in 1983, with 5 people and 5
products, psychiatry was still in its infancy as a speciality. The larger
companies at that point had only a marginal interest in this area, some  company
had a single product, some had two, but these were only marginal  products
that did not really get much attention as they did not contribute  to the
company's revenues. Hence we focused on this area for beginning the  business.

This focus helped us learn how the speciality customer  worked, what
his prescribing requirements were, what kind of products did  he choose
and how he handled and viewed different ailments in the spectrum  of psychiatry.
This single therapy area emphasis helped us to understand  the sector well. It
showed me how I could focus on solving problems, and  use this learning to my
advantage. As you know, in psychiatry treatment is  individualized and unlike
some other fields depending on the presenting  signs the doctor may use the
latest medicine, an older medication or any  from a bouquet of medicines
available. We were able to learn a great deal  from this interaction, specifically
understand the prescribing habits of  consultants and later we were able to
apply this learning to other therapy  areas. So in a sense, psychiatry market
was both a beginning point and a  learning school for us.

Qus.2- With the availability of quitpin (quetaipine)  consumers have
an added choice of medication? However what would be the  impact if new drugs
like ariprapazole (abilify) enter the  market?

Ans - We have introduced both these molecules-  quetiapine with the
brand name Qutipin and aripiprazole, with the brand  name Arpizol.
Schizophrenia is a complex and multifaceted illness, and as  you know the magnitude of
the presenting symptoms can vary from patient to  patient, and even the
symptoms can be different- auditory, visual,  hallucinatory etc. A particular drug
treats one set of symptoms better  than another set of symptoms. In order to
handle and treat this range of  symptoms, generally more than one drug is
prescribed.

Qus.3 - What kind of commitment does Sun Pharma have  towards
research in mental illness? In USA Companies like Eli-Lilly and  Jansenn-Cilag
have spent enormous amounts on the same.

Ans -  Over the years one problem area in psychiatry that has
remains inadequately addressed is that of compliance and maintaining blood
levels  of the drug over time, especially when patients are uncooperative or
violent. This is one area that we have extensively focused on, at Sun  Pharma. Several
of our products use a novel drug delivery system to  deliver the medication
predictably, avoid the need for repeat dosing and  ensure that
symptoms are controlled.

We've brought several products to  market, such as the bipolar mood
disorder treatment Lithosun SR, which was  amongst the first products we
launched. While many of the new molecules  have a long half life and are
intrinsically once a day, we have formulated  Oleanz rapitabs- olanzapine rapidly
dissolving, to deal with the  difficulty in swallowing that may be seen with
geriatric patients. We have  introduced Prodep LA, a once a week
antidepressant. We continue to look  for ways that dosage form delivery areas where modifications in the dosage  form would make a difference to the patient . I believe if we
help patients handle this issue of compliance better, we would be making
an  important contribution to the way mental illness is treated in the  country.

Qus.4 - Approximately 1% of the population suffers from  severe
mental illness like schizophrenia. This means in a country like  India the
number of sufferers is high. The level of awareness appears to  be low
especially in rural areas. What do you think should be the strategy  to reduce this?

Ans - Yes, awareness is an issue. But  possibly the stage when mental
illness was viewed as a taboo, has slowly  gone, possibly, atleast in city
areas.

Awareness about solutions in  any field- even in mental healthcare
are a function of education, literacy  levels, affluence, levels of
disposable income.

We are sure that  as these factors improve in our country, awareness
will also increase.

On their part several companies are working to increase awareness
using patient information booklets, posters and educational  material.

But even then its possible that it will take some time  for this
message to spread to the grassroots.

Qus.5 - You have adopted a marketing strategy focused on  doctors;
don't you think it should be a consumer driven approach focusing  on side-
effects comparative to other medication?

Ans - In  our opinion, psychiatry is a complex area, with coexisting
disorders and  overlapping symptoms. The treatment of choice depends
on the presenting  symptoms of a particular patient, and even with the extensive range
of medicines available for prescription, normally more than one drug is
prescribed in order to treat the range of symptoms. Hence the selection of  the
right medication is best left to the doctor, because he has had both  the
expertise and experience to decide the medicine and, how best the dose  is to be
titrated, for each patient. And this is true everywhere in the  world,
medications for mental illnesses are prescription only, and are  decided by the
medical professional. Otherwise there is a high risk of  self medication
which is certainly not in the patients best  interests.

As a pharma company, we shall work to ensure that the  latest
molecules are made available to patients in India at a sensible  cost and that
these products are of a dependable, standard  quality


Qus.6 - With the implementation of IPR regime in India  from 2005
what is Sun's strategy for growth?

Ans - Sun  Pharma is preparing to compete globally as a research
based speciality  pharma company.

We have over the years spent over Rs200cr in  research, and have
substantially increased these investments with Rs75cr  to be invested
in this year and in the next. This year alone we are  doubling our research staff and
adding 275,000 sq ft of floor area for  research.

International markets represent a tremendous opportunity  and we
expect this part of the business, which is 20% of sales to grow  very rapidly
over the next two years.
In the Indian market while we are  recognized as leaders in our core
speciality areas , we want to reach this  position of leadership in
all therapy areas including newer ones like  oncology and gynecology.

In my opinion, we've built a strong  platform so far, and this
enables us to make the most of growth for the  future.

Qus.7 - Do you think consumers will have a greater role  to play in
choice of drugs in the future?

Ans - In ensuring  the proper use of medication, yes perhaps not in
the choice of treatment  per se for that requires medical expertise and
experience.

Qus.8 - What should be the role of Patient Advocacy  Groups in this
regard?

Ans - You already said that awareness  was one area- we agree this is
one area where advocacy groups cd play a  major role.

We also see a very important role they could play for  emotional
bonding, forming sharing support systems - after all social  support, empathy
and understanding are as important an element of the  treatment
procedure, as medication is. Treatment non-compliance, is an  important issue which support
groups can help handle.

We also see a  role for patient advocacy groups in working with the
government bodies and  authorities at different levels in order to
modify the laws so that a fair  chance is given to people who are challenged, and that
their needs too are  looked after.

Qus.9 - As per your website psychiatry and neurology  account for 33%
of your turnover. What expectations do you have for sales  turnover in this
segment in the future?

Ans - We expect this  segment to account for a large part of our
turnover in the future too, and  grow at a brisk pace. Awareness itself is
increasing. If one applies  textbook incidences to the extent that the ailments are
reported in India,  then its obvious that these ailments are grossly under-
treated. As people  realize that treatment and medication can help improve the
quality of life  and help live a life that is as normal as possible, the number
of people  who reach out for treatment for these ailments will also  increase.

On the other hand, continuing life pressures and the pace  of living,
means that the need for medical treatments of ailments that  arise as a
consequence of high paced living will also increase.

Qus.10 - Thank You, and we wish that Sun Pharma becomes  one of the
world class global companies in the future. Do you have any  message for
consumers in India?

Ans - Expect the worldclass  - worldclass products, global level
quality and support services that  focus on serving the customer first.