Doctors' Perceptions towards Domestic and Multinational
An Investigation from Developing Country
Jashim Uddin Ahmed*, Md. Humayun Kabir Chowdhury**,
Ishrat Jahan Synthia***, and Ishrat Sultana****
This exploratory study focuses on doctors' perception towards domestic and multinational phar-
maceutical products. Doctors can heavily influence drug purchase decisions by performing the roles
of users (sometimes), influencer, gatekeepers and deciders, while patients perform the role of buyers
and users. The difference in perception was measured in terms of products, brand image and pricing.
Data were collected from a sample of 15 doctors (n=15) using a questionnaire comprised of 12 ques-
tions measured in Likert scales. The study reveals that brand image is the most influential factor for
price of medicines and brand image is highly related to quality and the level of promotion for the un-
derlying product. Furthermore, doctors perceive multinational products to be different and better than
domestic products due to their stronger brand image. This study highlights that doctors' preferences
are not fully unbiased and can be influenced by pharmaceutical companies. Due to its exploratory
nature, findings might need to be validated in a further study with a larger sample.
: Bangladesh, pharmaceutical industry, brand, products, medicine, price
Studi yang bersifat eksplorasi ini fokus pada persepsi dokter terhadap produk farmasi domes-
tik dan multinasional . Dokter dapat mempengaruhi keputusan pembelian obat dengan menjalankan
peran sebagai pengguna ( user ), pemberi pengaruh (influencer) , penjaga arus informasi (gatekeeper)
dan pembuat keputusan (deciders), sedangkan pasien melakukan peran sebagai pembeli (buyer) dan
pengguna (user). Perbedaan persepsi diukur dalam hal produk, citra merek dan harga. Data dikumpul-
kan dari sampel 15 dokter (n = 15) dengan menggunakan kuesioner yang terdiri dari 12 pertanyaan
yang diukur dalam skala Likert . Penelitian ini mengungkapkan bahwa citra merek merupakan faktor
yang paling mempengaruhi harga obat-obatan dan citra merek sangat berkaitan dengan kualitas dan
tingkat promosi untuk produk yang mendasarinya. Selain itu, dokter menganggap produk multinasi-
onal berbeda dan lebih baik dari produk dalam negeri karena citra merek yang lebih kuat . Penelitian
ini juga memberikan kesimpulan bahwa preferensi dokter tidak sepenuhnya bebas bias dan dapat di-
pengaruhi oleh perusahaan obat-obatan. Karena penelitian ini merupakan penelitian eksplorasi, maka
temuan penelitian ini perlu divalidasi dalam studi lanjutan dengan sampel yang lebih besar.
: Bangladesh, industri farmasi, merek, produk, obat-obatan, harga
"A generic drug is the same as a brand-name drug
in dosage, safety, strength, quality, the way it works,
* North South University, Bashundhara, Dhaka-1229,
the way it is taken and the way it should be used.
The FDA requires generic drugs have the same high
** Southeast University, Banani, Dhaka-1213, Bangla-
quality, strength, purity and stability as brand-name
desh. E-mail: [email protected]
***North South University, Bashundhara, Dha-
ka-1229, Bangladesh. E-mail: [email protected]
U.S. Food and Drug Administration (FDA)
**** United International University, Dhanmondi, Dha-
ka-1209, Bangladesh. E-mail: [email protected]
ASEAN MARKETING JOURNAL
Desember 2013 - Vol.V - No. 2 111
growth over the last 15-20 years and has be-
come a worth of BDT 30 billion (US$ 385 mil-
The pharmaceutical industry has recorded tre-
lion) industry. The industry has low volatility in
mendous achievements in the health sector and
terms of growth, profit, raw material and cost
contributed to the economic development of
of finished goods. Almost all the life saving im-
many countries (Al-Alak & Al-Ameri 2012).
ported products and new innovative molecules
In the last two decades, Bangladesh pharma-
are channeled into and marketed in Bangla-
ceutical industry has grown at a substantial rate
desh through these companies. The Drug Act
and has been one of the most profitable sectors
of 1940 and its rules formed the basis of the
with more than 245 pharmaceutical companies
country's drug legislation. A minimum quality
in Bangladesh (The Financial Express 2013).
standard is set by the Directorate of Drug Ad-
This sector has one of the highest growth rates
ministration and companies generally follow
(with a 15 percent rate) and as of 2011 it has a
Good Manufacturing Practices (GMP) which
total market size of US$1 billion. Bangladesh
includes rigorous quality control (Chowdhury
exports pharmaceutical products to 87 coun-
& Kabir 2009). A positive impact of the Drug
tries, including the US and a few European na-
(Control) Ordinance of 1982 was the limited
tions after meeting 97 percent of the domestic
availability of foreign currency which was ex-
demand and reducing the country's dependence
clusively utilized for importing pharmaceutical
on imported medicines, i.e. vaccines, insulin
raw materials and finished drugs. Since Drug
and anti-cancer products etc, which represent
(Control) Ordinance of 1982, a rapid devel-
three percent (Ahmed 2013; The Financial Ex-
opment of domestic manufacturing capability
helped contain the dependence on the import
Although multinationals (representing 13
of pharmaceutical products (raw material and
percent of the market) are increasingly shrink-
finished product) around pre-1982 level. Un-
ing the business of domestic companies in
der the Drug (Control) Ordinance, government
Bangladesh, domestic companies still capture
fixes the maximum retail prices (MRP) of 117
around 87 percent of the market, producing ap-
essential drug chemical substances and others
proximately 6,000 brands of medicines. Ban-
are priced through a system of indicative prices.
gladesh is a developing country with a popula-
This rule applies to domestic products only. In-
tion of 150 million. Many of them are unable to
terestingly, even with withdrawal of price con-
purchase high-priced medicines (Ahmed 2012).
trol from many products, prices have been set
It is a matter of concern that same generic med-
at affordable levels due to heavy competition
icines are selling at different prices, having dif-
in the market. The primary responsibility of
ferent brand names. Domestic firms, producing
drug quality control lies with the manufactur-
at lower cost, have been the principal suppli-
ers. Domestic companies were only taking part
ers of drugs to the Bangladesh health care sys-
in the distribution channel of MNCs. Millen-
tem (Oxfam Report 2001). The varying price
nium Development Goal 8 sets out the target
of medicine is very irrational. For instance,
for the international community in co-operation
Gliclazide BP 80mg 100 tablets are selling at
with pharmaceutical companies to provide ac-
BDT 750 (US$ 9.6) under a brand name Gli-
cess to affordable, essential drugs in developing
clid by a company, whereas the same Gliclazide
countries (The Millennium Development Goals
BP 60mg 100 tablets are selling at BDT 1,800
(US$ 23) under a brand name Diomicron by an-
other company. Lots of such examples could be
cited. Patients do not know the generic as well
as the brand name of the drugs. They depend
In the past decade, pharmaceutical compa-
on the prescriptions by the doctors. Most of the
nies have been involved in intense direct-to-
doctors prescribe high-priced medicine while
consumer advertising (DTCA) and promotion
the very same medicines with lower prices are
of prescription drugs. Spending on DTCA of
available in the market (Hossain 2011).
prescription drugs has been increased (Dono-
maceuticals sector has been enjoying a steady
hue et al.
2007; Parker & Delene 1999). DTCA
ASEAN MARKETING JOURNAL
112 Desember 2013 - Vol.V - No. 2
spending grew from US$2.5 billion in 2000 to
$3.3 billion in 2003, $4.2 billion in 2005, and
$4.5 billion in 2009. There was a 80 percent
Price perception is the process by which
increase in DTCA spending between 2000 and
consumers translate price into meaningful cog-
2009. As a result, the average American televi-
nitions and it has been the interest of research-
sion viewer spent more than 15 hours annually
ers for several years (Lichtenstein et al
watching prescription drug advertisements; that
Price conveys information to the consumer re-
was far more time than they spent with their
garding the product quality (Erickson & Johans-
family physicians (Brownfield et al
. 2004). In
son, 1985) and this issue has been extensively
developing countries pharmaceutical industry
studied more than any other factors in this do-
invests heavily in promotion, and it has used a
main (Dodds et al
. 1991; Swan 1974; Zeithaml
variety of promotional strategies to stimulate
1988). One of the most important findings in
sales of pharmaceutical drugs (Al-Areefi 2013).
the literature is that fair prices are related to ref-
Since the rapid growth in pharmaceutical drugs
erence prices (Kahneman et al
. 1986). The pri-
is a global phenomenon, it is essential for un-
mary rule is that the actual price should be equal
derstanding doctors' perception while prescrib-
to the price that a consumer expects. Doctors'
ing drugs and understanding patients' needs
price sensitivity of medicine is an important is-
and their preferences. The aim of this paper is
sue and it is the centre of interest for fair pricing
to examine doctors' preferences for source of
(Rice 2009). Price increases would be fairer if
information and understanding the context, as
they benefit poor people rather than rich people.
well as the reasons why they choose specific
This type of fairness in price is very important
branded medicine which they prescribe. Relat-
for developing countries. According to Perez-
ed constructs and literature are as follows:
Casas et al
. (2009: 960), "pricing policy of
pharmaceutical companies is not set according
Perceived Medicine Quality
to the purchasing power of the different coun-
tries, but follows a general strategy of maximiz-
Research reveals that perceived product
quality has been the subject of considerable in-
A worldwide increase in healthcare costs
terest to practitioners and researchers, mainly
poses a burden of affordability of medicines
in services marketing. This is due to the ben-
(Jamshed et al
. 2012). The prospect of better
eficial effects of marketing performance. The
health and a higher quality of life has led to in-
belief that high perceived quality leads to re-
crease in both the number of prescriptions and
peated purchases is at the heart of any business
the price of new medicines (Feldstein 2005).
(Kennedy et al
. 2001). Thus, when developing
Despite technical know-how and quality of
marketing strategies, marketers have to take
products, price plays an important role in deter-
into consideration perceived quality and every
mining the attitude towards purchase of medi-
factor associated with it.
cines. In terms of price versus volume, what
In the context of quality of medicine, it is
is not acceptable is a high-price: high-volume
little more than doctor perceptions as to "how
combination (Payers 2002). The cost of medi-
well a particular drug from a particular phar-
cines incorporates several added costs prior to
maceutical firm will perform for a particular
reaching patients (Perez-Casas et al
. 2009). In
patient's conditions" (Waheed et al
pharmaceutical sector, medicine prices are the
Quality of medicine comes first which is aimed
results of many different policy effects (Leop-
at building brand image and increasing market
old et al
. 2012). According to Olcay & Laing
share because its primary service is the patient's
recovery or the exchange of trust. Domestic and
multinational companies are competing with
"Price of medicines is determined by a combination
each other for their establishment and doctors
of variables, including national and individual in-
have different perceptions of each pharmaceu-
come, government policy, degree of competition in
tical product regarding quality (Borkowski &
the public and private markets, health system capac-
ity, public policies, intellectual property protection,
non-tariff barriers and import tariffs."
ASEAN MARKETING JOURNAL
Desember 2013 - Vol.V - No. 2 113
There are additional factors affecting phar-
commonly related to the repeated behavior of
maceutical products. For instance, price dis-
purchasing a specific brand over time (Iglesias
crimination by suppliers of patented products
. 2011). Brand loyalty can be described as
or the presence of a domestic pharmaceutical
consumer's conscious or unconscious decision,
industry with the capacity to produce generic
expressed through intention or behavior, to re-
substitutes. Perhaps this is why a group of cus-
purchase a brand continually and proclaim to
tomers could not afford to purchase medicines
be the ultimate goal of marketing (Yee & Sidek
beyond domestic pharmaceutical products.
2008). Moreover, brand loyalty exists when
customers have a high relative attitude toward
Brand Image, Perception and Loyalty
the brand, exhibited through repurchase behav-
ior. This can be an asset to the firm, especially
Brands create strategic positions and specif-
when a customer is willing to pay higher pric-
ic perceptual associations in the minds of con-
es, and allows the firm to spend less money to
sumers (Henderson et al
. 1998). Brand prefer-
serve and attract customers (Reichheld & Sass-
ence is strongly effective in medical products.
er 1990). Commitment and repeated purchase
Moss (2007: 318) strongly believes, "that good
behavior are considered as necessary conditions
product brand work exists, for example, Novar-
for brand loyalty followed by perceived value,
tis UK established Lamisil for fungal nail infec-
satisfaction and brand trust.
tion in the minds of the physician and patient
via clever healthcare professional and disease
awareness campaigns". Since consumers want
to buy the product of a company they trust,
Consumer perception is the factor that most-
previous experience and the reliability of the
ly influences the consumers buying process.
brand name obviously affect the buying deci-
When a consumer confronts with a new prod-
sion. Rice (2009) states that brand-name drugs
uct, s/he will consider salient attributes of the
that are considered close substitutes for a given
product and will form an opinion. In addition
medical condition are marketed simultaneous-
to this evaluation process, extrinsic cues might
ly, but sold at considerably lower prices. As a
influence consumers' perceptions of quality in a
result, the physician's prescribing decision is
more global manner by serving as an evaluative
often the choice between two or more brand-
context of liking or disliking the new product.
name drugs rather than between a brand-name
It is quite natural to surmise that a product that
and a generic drug.
maximizes perceived quality would certainly be
Brand perception is consumers' ability to
preferred to one that is perceived as low quality.
identify the brand under different conditions,
But the question becomes important when one
as reflected by their brand recognition (Keller
brand is preferred over another although they
& Kotler 2006). Consumer-based brand eq-
contain the same attributes. That's the reason
uity was described for four dimensions; brand
why the concept caused consumer behavior re-
awareness, brand association, perceived qual-
searchers to perceive the construct differently
ity, and brand loyalty (Pappu et al
from those of the economists. In consumer be-
Brand awareness was defined as consumers'
havior literature, taken altogether, it is argued
ability to identify the brand (Rossiter & Percy
that the quality of a good is not only inherently
1987). It refers to the strength of a brand pres-
related with the attributes in the good but also
ence in consumer's minds. Brand awareness
the psychological outcome a person or people
has several levels starting from less recognition
have for it.
of the brand to dominance (Aaker 1991).
Consumers often perceive price as an extrin-
Perceived quality is evaluated and decided
sic quality cue. Several studies have searched
by consumers and it is another valuation of
consumer perception of price as an indicator of
brand to push the customer. Brand is the image
quality, and many of these have shown price to
that consumers have in mind (Aaker 1991).
operate in this manner (Erickson & Johansson
Brand loyalty is one of the most-cited con-
1985). Although there are so many arguments
cepts in marketing literature and was most
in favor and against this rationale, in this study
ASEAN MARKETING JOURNAL
114 Desember 2013 - Vol.V - No. 2
the idea of positive relationship between price
understanding of pharmaceuticals' products
and perceived quality is adopted. The argu-
prescribing context. A short pretest took place
ments behind this assumption are: (a) produc-
before conducting the field survey using the
ing quality good needs sophisticated machinery
questionnaire. In our research, we also initially
that cost more and this increases the price, (b)
did one focus group discussion (FGD), a fact
manufacturers use high quality ingredients to
that is often ignored by researchers (
produce high quality products, and (c) it is un-
likely that a product with low quality will be
A sample of doctors' views was used in this
charged more in this competitive world.
study, a method widely used in pharmaceuti-
It is assumed that when a consumer initially
cal sector drug choices (Cockburn & Pit 1997;
encounters a new product, important informa-
Wulff et al
. 2007). There are many arguments
tion about the product is often missing. In this
in favor and against the convenience samples.
case, consumers may form inferences about
Several authors have enumerated the dangers
missing information by drawing a connection
of using convenient samples in research (Bel-
between available pieces of information, one of
tramini 1983; Oakes 1972). These authors
which is corporate image. Upon facing a brand,
have generally cited threats to external validity
consumers' cognitive responses will focus on
as their primary concern, arguing that conve-
question such as "Does the manufacturer have
nient samples have the threat to be atypical of
the necessary skills, expertise, and technology to
the ‘general population', and that any findings
produce quality drugs?" The positive responses
based on convenient samples may therefore
will develop into favorable evaluations toward
not be generalizable to other populations (Cun-
the brand. The opposite will be observed in case
ningham et al
. 1974). However, some scholars
of a negative response. Thus, corporate image
disagree on this issue. Oakes (1972) contends
that is relevant to the company's ability to pro-
that such arguments are unfounded because, re-
duce output, is one likely source of consum-
gardless of what population is sampled; gener-
ers' quality perceptions. Both the domestic and
alization can be made only with caution to other
multinational pharmaceuticals are producing
populations. In the same vein, Marshall (1996)
medicines for different disease in accordance to
argues that approach to ‘selection of a sample
patient's recovery and our research seeks to find
is usually justified'. Because the primary focus
out whether there is any difference and if there
of this study was to test theory and not effects
is any difference, what are the factors behind
generalization, considerations of internal valid-
higher or lower sale of their products.
ity were paramount and a convenient sample
was appropriate (Calder et al
. 1982; Cook &
Campbell 1975; Tybout 1982). Concerns about
external validity were secondary. A question-
This study is based on exploratory research
naire served as a data-gathering instrument.
with small sample size and non-representative.
In this exploratory research, doctors were
This type of research is used principally to gain
asked 12 questions (a sample of 15 doctors
a deeper understanding of something, which
was chosen from three different hospitals), af-
is carried out in the beginning of the research
ter reading the cover page of the questionnaire
process and initial activities carried out to refine
that only mentioned the purpose of the study.
the problem into a researchable one which need
The second page contained the scale items, the
not be precise (Robson 2002; Saunders et al.
measures needed to test the hypothesis. The last
page contained the demographic question. In
the questionnaire, the same question was asked
Questionnaire Method and Data Collection
to mark the evaluation on a 5-point Likert scale
for both domestic and multinational pharma-
ceutical regarding each factor. Most subjects
The questionnaires were designed and de-
spent between 20 and 25 minutes filling out the
veloped based on informal discussion with
entire questionnaire. By comparing the answers
some doctors and pharmacist to get insights and
to the questions, we checked whether the factor
ASEAN MARKETING JOURNAL
Desember 2013 - Vol.V - No. 2 115
Table 1. Items of the Study Questionnaires
Do pharmaceutical companies spend more on marketing and promotion than they do
on research and development?
Quality, Production, Price, Do all brand name medicines have generic equivalents?
and Brand evaluation
Does local production leads to lower prices because of low quality?
Technological advantage Do all the multinationals use more efficient and technologically advanced production
method than domestic firms?
Table 2. Independent Variables & Questions
Bangladesh pharmaceutical growth
"How would you rate the significance of each factor for the tremendous growth of the
pharmaceutical sector in Bangladesh?"
"How would you rate the significance of the following factors in determining the price of
Perception of Brand Image
"How would you rate significance of each option in how pharmaceutical companies promote
"How would you rate significance of each option which influences the Brand Loyalty in the
Bangladesh Pharmaceutical Market Factor "How would you rate the significance of each factor in advancing the performance of the
Bangladesh pharmaceutical market?"
Table 3. Descriptive Statistics
List of variables
Deviation Minimum Maximum
Bangladesh Pharmaceutical growth
Perception of Brand Image
Bangladesh Pharmaceutical Market Factor
that was asked influences the customer percep-
Survey Data Analysis
The data analysis involved planned compari-
Design of the Study
sons of the relevant variables. The Descriptive
Statistics (Table 3) is where SPSS has generated
Each question in the questionnaire was de-
descriptive and quartile statistics for the vari-
signed in order to investigate the understand-
ables. Due to small sample (n=15), instead of
ing of the related study of the elements to get
parametric test, non parametric statistical tool
was used. Here, Wilcoxon signed rank test was
The result was analyzed by descriptive na-
used where two related samples were compared
ture and generalizes the idea of different items
to assess whether their populations mean ranks
comparing domestic and multinational pharma-
differ. By examining the final Test Statistics ta-
ceutical companies. Questions were asked for
ble, we can discover whether these changes are
measuring all five independent variables.
significant. This is the p
value for the test.
We report the Wilcoxon signed-ranks test
using the Z statistic (-0.608) which is based on
positive ranking and Asymp. Sig. (2-tailed) is
The statistical package used is the SPSS 17,
0.534. We have seen in the analysis domestic
a most commonly used packages for quanti-
pharmaceutical products' has negative ranks (7)
tative research methods (Bryman & Cramer
and sum of ranks (44.00), multinational com-
2011). After data were collected, the data from
pany products' has positive ranks (5) and sum
questionnaires were tested using Wilcoxon
of ranks (16.00) and remaining 3 are ties.
ASEAN MARKETING JOURNAL
116 Desember 2013 - Vol.V - No. 2
Table 4a. Comparison of participants' score
a. Domestic Users < Multinational Users, b. Domestic UserS > Multinational Users, c. Domestic Users = Multinational Users
Table 4b: Test Statistics b
Domestic Users – Multinational Users
Asymp. Sig. (2-tailed)
Based on Positive ranks, b. Wilcoxon Signed Ranks Test.
Summary of Survey Data
medicine would correlate with this, as doctors
are likely to believe the two go hand in hand
We undertook numerous tests of robust-
with the patient's recovery.
ness including descriptive statistics, Wilcoxon
signed-ranks test using the Z
statistic. In this
Q3. Do all brand name medicines have generic
section, Q 1 to Q 7 presents the several issues
in this study, these being: (1) pharmaceutical
Doctors have a different perception about
companies' expenditure in more on marketing
the brand images while prescribing any phar-
activities than their research and development,
maceutical products. Results show that 9 out
(2) doctors influencing when prescribe a spe-
of 15 respondents disagreed with the same im-
cific medicine, (3) medicine brand issues, (4)
ages of brand pharmaceutical products. They
factor in enhancing the competitiveness of the
perceive pharmaceutical products depending
Bangladesh pharmaceutical market, (5) domes-
on their branding. Interestingly, 3 respondents
tic production lead to lower prices because of
remained neutral and 3 respondents strongly
low quality, (6) MNCs use more efficient and
disagreed with the statement.
technologically advanced production methods
than domestic firms, and (7) marketing directly
Q4. What do you believe is the most important
to doctors represent higher returns for Drug
factor in enhancing the competitiveness of the
Bangladesh pharmaceutical market?
Government regulation is the biggest fac-
Q1. Do you believe pharmaceutical companies
tor affecting domestic competitiveness. This is
spend more on marketing and promotion than
likely to be true, especially in light of compre-
they do on research and development (R&D)?
hensive TRIPS legislation that is affecting the
By far the strongest response received on
pharmaceutical landscape at present (The Daily
this survey is on this question which criticizes
Kalerkantho 2012). Drug manufacturers and
the companies. The lack of R&D infrastructure
how they adapt to such legislation as well as
seems evident from doctors' responses, under-
increasing competition also play a role in the
scoring the lack of investments in R&D. Mar-
sector competition. Interestingly, only one re-
keting and promotion, although important, do
spondent believed that either doctors or patients
not lead to the development of new and inno-
had any substantial affect on competition.
vative drugs which are critical for the develop-
ment of the sector in terms of global competi-
Q5. Does domestic production lead to lower
prices because of low quality?
Doctors' perception of the product's value
Q2. How would you rate the significance of the
sets the price of the product. Their perception
patient satisfaction factors in influencing doc-
toward the domestic pharmaceutical company's
tors to prescribe a specific medicine?
product quality determines favorable impact on
Patient satisfaction is very crucial factor in
their mind although domestic pharmaceuticals
the recommendation of a specific medicine.
are not as competitive as multinational compa-
Benefits of the drugs as well as the brand of the
ASEAN MARKETING JOURNAL
Desember 2013 - Vol.V - No. 2 117
Table 5. Factors for the growth of the pharmaceutical sector in Bangladesh
a) Latest manufacturing techniques
b) Government regulation
c) Intense competition
d) Marketing and promotional performance
e) Market demand
Table 6. Factors in determining the price of Medicines
Table 7. How pharmaceutical companies promote their brand
a) By introducing one new product
b) Profit maximizing
c) Exploitative practice
d) Strong brand recognition
nies in introducing latest technologically ad-
are also unaffected by the cost of the medicines
vanced production method. Surprisingly, none
they prescribe. The lack of doctors' knowledge
of the respondents strongly agreed with the
on prescription medicines, as well as their lack
lower pricing strategy of domestic pharmaceu-
of a financial incentive to be concerned with the
tical because of low quality.
cost of drugs, combined with insurance to cover
the patient's costs, have affected the structure of
Q6. Do all the multinationals use more effi-
this industry (see
for example, Feldstein 2005).
cient and technologically advanced production
methods than domestic firms?
The MNCs have advantages over domestic
companies in technologically advanced meth-
ods in production. Therefore, it is noteworthy
to point out that MNCs hold 15 percent share of
The findings of doctors' perception show
the market despite this advantage, which may
that introduction of latest manufacturing tech-
suggest the significance of government legisla-
of MNCs is greater than that of domes-
tion and advantages in domestic production.
tic companies and the difference is significant.
Similarly, doctors' perception show that Gov-
Q7. Does marketing directly to doctors repre-
is the most powerful fac-
sent higher returns for Drug Companies?
tor influencing tremendous growth of domestic
There is a strong perception that marketing
pharmaceutical companies compared to MNCs
drugs directly to doctors means greater returns
and the difference is quite significant.
for companies. A crucial factor that determines
Doctors' perception shows that the domestic
the demand for prescription drugs is the role
companies face significantly more competition
of the doctors as patient's agent in prescribing
than multinational pharmaceutical companies.
drugs. When treating a patient, doctors do not
The survey findings indicate of doctors' per-
have perfect information on the most appropri-
ception reveals that, domestic pharmaceutical
ate drug to prescribe, the possible substitute
companies are more successful in their market-
medicines that are available, their side effects,
ing and promotional performance
than the mul-
and their relative costs. Therefore, pharmaceu-
tinational companies and the difference is note-
tical companies devote a great deal of effort in
worthy. Doctors' perception of market demand
marketing their medicines to doctors. Doctors
for domestic pharmaceutical products is much
ASEAN MARKETING JOURNAL
118 Desember 2013 - Vol.V - No. 2
Table 8. Factors influencing the Brand Loyalty
c) Prescribed by doctors
d) Unethical practice
Table 9. Factors in advancing the performance of the Bangladesh pharmaceutical market
a) Government regulation
b) Drug manufacturers
higher than that for multinational pharmaceuti-
something to do with promoting the brand, but
promoting brand of a pharmaceutical product is
not varied by strong brand recognition.
Doctors' perception of multinational phar-
maceutical product's quality is significantly
The brand loyalty toward domestic and
stronger than that of domestic pharmaceutical
MNCs does not depend on price. Result shows
product's quality. Moreover, promotional activ-
that doctors do not perceive any significant dif-
ity was tested to determine the price of domestic
ference in pricing
of these two pharmaceutical
and multinational pharmaceuticals. This study
sectors that influences brand loyalty. The qual-
shows that doctors do not observe any differ-
ity of MNCs is greater than that of domestic
ence in the promotional activity of pharmaceu-
pharmaceutical companies respective to brand
tical sector in determining price of medicines.
loyalty and the difference is significant.
Doctors' perception shows that brand image
of MNC's is greater than that of domestic com-
Bangladesh Pharmaceutical Market Factors
panies and the difference is noteworthy. Most
interestingly, we have found that quality and
Analysis of perceptions shows that domestic
brand image for the MNC's product is higher
sector's advantage in Government regulation
than that of domestic products. Hence, doc-
is much higher than that of MNCs. Result of
tors feel that domestic pharmaceutical compa-
this hypothesis shows that progression of the
nies are competing more than the multinational
performance of the Bangladesh pharmaceuti-
cal market did not vary by drug manufacturers
More often than not, domestic pharmaceutical
products are prescribed by the doctors.
over, the patients
demand more of the domestic
The findings of doctors' perception show that
pharmaceutical products than that of Multina-
chance of introducing one new product
by a do-
tionals and the difference is noteworthy.
mestic company is greater than that of MNCs.
Similarly, doctors' perception of profit maximi-
of domestic pharmaceutical product is
much higher than that of multinational pharma-
In our research findings, we have seen that
doctors perceive domestic and multinational
The analysis reveals that doctors' perception
pharmaceutical products differently. In relation
about promoting a brand does not deal with ex-
to this, all the factors considered in this study
or unethical practice. Inter-
are different for domestic and multinational
estingly, both domestic and multinational com-
pharmaceutical products. Therefore, the market
panies believe that reinforcing brand image has
demand for drugs seems to be the single most
ASEAN MARKETING JOURNAL
Desember 2013 - Vol.V - No. 2 119
significant factor creating growth in the phar-
ferent pharmaceutical companies. Most of the
maceutical sector at present. It is not surprising
respondents agreed that marketing products di-
due to the growing number of elderly and the in-
rectly to them represents higher return for drug
troduction of more and better drugs to the pop-
companies. This might happen because several
ulation. Interestingly, government regulation is
medical representatives from different compa-
not considered to be highly effective relative to
nies try to attract the doctors through gifts and
other factors, which tends to diverge from re-
other facilities. Therefore, doctors prescribe the
sults indicating its impact. Therefore, it is clear
medicine of that company which attracts them
that market demand for domestic pharmaceuti-
the most. However, doctors should do what is
cal company products is very high, leading to
best for the patient and consider the financial
tremendous growth of domestic companies.
capability of the patient. Doctors should not
Brand image seems to be the single biggest
suggest expensive medicine to a poor patient.
factor affecting the price of medicines. Brand
So, it can be said that doctor's ethics is the pri-
image of medicine, however, can be affected by
mary factor while referring a medicine.
quality and promotion. As brand image comes
down to the effectiveness of the medication, it
is not surprising that this is the single biggest
factor affecting price.
From the research findings, we have seen
A brand promotion in pharmaceutical indus-
that instead of proper R&D, marketing of phar-
try can be successful if it can bring one new
maceutical products are given more emphasis.
product in the market followed by the reinforc-
An investigation should be conducted on the is-
ing of brand recognition. According to Moss
sue since healthy growth is likely to encourage
(2007:317) "brand image needs to be tracked
the pharmaceutical companies to introduce new
and monitored against the chosen identity and
drugs and maintain a healthy competitiveness
continually adjusted to maintain an ideal posi-
with respect to essential drugs.
tioning within the marketplace". Perhaps that
Due to lack of government's monitoring pol-
is because pharmaceutical companies are not
icy and practice, pharmaceutical products man-
inclined to admit exploitative practices. Inter-
ufactured locally cannot be ensured uniformly.
estingly, both domestic and multinational com-
Some of the leading pharmaceutical (domestic)
panies believe that reinforcing brand image has
manufacturers and the pharmaceutical export-
something to do with helping to promote the
ers of Bangladesh have started to export to for-
brand. The test of hypothesis shows that doc-
eign countries which are strategically important
tors' perception toward domestic pharmaceuti-
for global expansion. Here, government should
cal companies differs mostly by its introduction
encourage setting up of more domestic compa-
of a new product.
nies and provide them with financial assistance.
The test result shows that quality of medi-
In order to increase the LDCs export, phar-
cine associated with a brand plays a significant
maceutical companies need to ensure compli-
role affecting brand loyalty which highlights
ance of the policies and principles. Formation
why infrastructure and production are key de-
of alliance and contract for exchanging views,
terminants that must be enhanced in order to
information as well as technical know-how
ensure standards of quality. It can be concluded
with developed countries like India, Pakistan,
that customers perceive multinational phar-
Brazil and Argentina should enrich this sector.
maceutical company's medicine quality more
Many doctors are doing exploitative practice
positively, which influences the brand loyalty.
at present. An investigation is needed to empha-
Despite doctors play the critical role in pre-
size the doctors' suggestions in order to fulfill
scribing medications and in brand awareness
their expectations from the company. Finally,
with customers, they are looked at as the least
we can quote from statements of Moss (2007:
important factor influencing the performance of
the pharmaceutical market.
Doctors' preferences for a medicine are al-
The [pharmaceutical] industry needs to move from
most fully depended on the influences of dif-
tactical to strategic brand management, from a lim-
ASEAN MARKETING JOURNAL
120 Desember 2013 - Vol.V - No. 2
ited focus to a broad portfolio perspective, from a
activities of a traveler without a set of itiner-
largely sales-driven approach to one that also takes
ary in the sense that during the process traveler
into account brand identity and other sophisticated
can adapt the new changes in his/her way. Dur-
marketing concepts. At present, the pharmaceuti-
ing the research process especially when it is
cal industry is not ready for the major changes that
exploratory research, a researcher should be
have already occurred within the consumer world
but cost containment, diminishing pipelines and in-
ready to accommodate new changes and adjust
creasing governmental pressure on prices may well
according to new findings in the course of ac-
force its hand in the future.
tion (Robson 2002). This study is exploratory
research in order to get the deeper understand-
After analyzing all the data, facts and figures
ing of doctors' perceptions towards domestic
from the survey of fifteen doctors, a theory can
and multinational pharmaceutical products.
be developed that domestic and multinational
This study is limited with fifteen respondents
pharmaceutical companies in Bangladesh have
from a particular city of Bangladesh, which has
differences in their performance. The role phar-
been selected for the survey. In Bangladesh, al-
maceutical companies in a global economy is
though the current population is huge, the ratio
to carry-out research, develop and produce in-
of experienced and skilled doctors to popula-
novative medicines that improve quality of life
tion is very low, which keeps the doctors busy
and it is their duty to do so in a profitable way
treating the patients (Uzzal 2013). It was a dif-
(Leisinger et al
. 2012). The prevailing drug or-
ficult job to get the doctors to participate in the
dinance needs to be amended again to impose
study from their busy schedule and it was time
mandatory price approvals for all drugs from
consuming as well. Therefore, there was not
drug administration. To ensure quality medi-
enough data for getting valid and reliable con-
cine, the capacity of the drug testing laboratory
clusion and hence the effect of the perception
needs to be enhanced as well (Hossain 2011).
of doctors needs to be investigated further with
Finally, doctors should be fair while prescrib-
large sample size. The nature of this research
ing medicine to patients. Better treatment from
justifies the smaller sample size (n=15) and non
doctors should be expected based on ethical be-
parametric equivalent of t-test has been used
havior and morality.
as data analysis (Saunders et al.
2009), as the
focus is on in-depth interview of few doctors
Limitations and Future Research
instead of collecting large sample data. Moreo-
ver, this research should have included doctors
This study is based on exploratory research.
from all over Bangladesh. This is a shortcom-
Exploratory research is used principally to gain
ing of the research. Finally, the research find-
a deeper understanding of something, which is
ings based on developing countries may or may
carried out in the initial stages of the research
not be applicable to developed and underdevel-
process and initial activities carried out to re-
oped economies. Despite all these limitations,
fine the problem into a researchable one which
the research study indicates a promising direc-
need not be precise. Saunders et al.
tion for comprehending doctors' perceptions of
gue that exploratory research is just like the
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