Literature review: Marketing Medical Devices; An investigation into the value of continuous education when introducing a new innovation to the medical device market and using the stent as a product to provide the context.
Introduction
Continuing medical education (CME) is detailed and specific form of lifelong education that enables those in the medicine field to maintain competence and learn about new and developing areas of their field. Under the CME the learning activities usually takes various modes of application such as the live events, written publications, online programs other electronic media (Ahmed , 2009). The Contents for these programs are developed to fit into a specific organization, reviewed and revived so as to fit into current situation, and delivered by a faculty of specialists who are experts in their individual medical and clinical areas (Morris 2009). The CME applies the same procedure as any other learning institutions with any probable conflict in financial relationships for faculty members being disclosed and resolved as matter of having an important effect way, though detractors complain that drug and device manufacturers often use their financial sponsorship to bias CMEs towards marketing their own products (De La Lama, 2010).
An in-house learning centre differs from a training department in that it tends to be decentralized, reactive, and targeted primarily to instructing internal employees in job skills. It forms the centralized strategic umbrella for the education and development of employees and value chain members such as customers, suppliers, and dealers. Most outstandingly, an in-house institution learning centre is the chief vehicle for disseminating an organization’s culture and fostering the development of not only job skills, but also such core workplace skills as learning-to-learn, leadership, creative thinking, and problem solving (Galeon, 2006).
Evolution of continuing medical education (CME) from earlier times
Continuing medical education is not a new concept and has been in operation since the beginning of institutionalized medical instruction that is medical instruction affiliated with medical colleges and teaching hospitals where health practitioners conducted their learning by meeting with their peers Ashrafian H (2009). By then, grand rounds, case discussions, and meetings were held to discuss published medical papers comprising the continuing learning experience. CME was more and more funded by the pharmaceutical industry In the 1950s through to the 1980s. However it was marred by informational bias concerns, both intentionally and unintentionally, leading to an increase in the scrutiny of the CME funding sources (Ahmed , 2009).. Eventually this led to the establishment of certifying agencies such as the Society for Academic Continuing Medical Education which is an umbrella organization representing medical associations and bodies of academic medicine from the United States, Canada, Great Britain and Europe. The pharmaceutical industry has also developed guidelines regarding drug detailing and industry sponsorship of CME, such as the Pharmaceutical Advertising Advisory Board (PAAB) and Canada’s Research-Based Pharmaceutical Companies (R & D) (Ashrafian 2009).
In-house training centres help employees to become as valuable as possible, generates more loyal employees willing to go the extra mile and it also creates employees that have the skills necessary to continuously innovate. This innovation, in most cases, leads to new products being developed in the company that leads to increased sales volumes ones the product penetrates the intended market and customers are fully satisfied (Conroy, 2006).
In the medical professional, there are non-CME activities, which are generally called Promotional Medical Education which encompasses a variety of industry sponsored educational programs and are typically aimed at promotion of a given product or therapy (Ahmed , 2009)..
Continuing medical education is mainly carried out in such organizations as the: medical Education Agencies, Hospitals, Educational institutions, including universities, medical and nursing schools (Ashrafian 2009).
CME not only helps practitioners in an organization in Staying on top by virtue of technological changes but it also help Marketing Efforts through among other means: Reading professional literature and trade publications, meeting with colleagues, attending industry conferences, meeting with manufacturers’ reps, participating in certification courses and in-services, watching the news, and listening to your patients and their experiences. These traits are supposed to keep the practitioner abreast of other industry advances and bring those innovations to his her work practice (De La Lama, 2010).
In the medical science fraternity, in-house institution learning centre deems it necessary for practicing health care professionals to update themselves by taking continuous education courses after graduation more conveniently via Computer Assisted Learning and other available means of learning cum methods so as to address the effectively the ever changing and dynamic field of medicine. In addition, the continuous learning will as a matter of fact, effectively solve the changing face of the medical field and the problem associated with it particularly in addressing the challenge associated with the stent in cardiology (Galeon, 2006).
Among all these practices the easiest and most efficient is attending the conferences. Here a practitioner get a chance to mingle with other practitioners to learn about their experiences, to hear about what’s working and what’s not, listen to speakers from manufacturers, educators, and other professionals to see new products, talk to manufacturer representatives about their products and what might be on the horizon, pick up product literature, and absorb as much as he/she can in just a few days of an intensive educational experience (Ahmed, 2009).
When the practitioner returns from the show, he or she will have an outstanding marketing opportunity before his or her colleagues, sharing that newfound knowledge with the practitioner marketplace’s recommendation sources (Ashrafian 2009)… Most private physicians and nurses apply this unique technique where they Visit doctors, clinics, and therapists to tell them about the latest innovations. They then after gathering the information, bring referral sources by scheduling a special in-service session. They latter partner with a manufacturer and offer a demonstration of a particular prosthesis, orthosis, or fabrication technique. Lastly they develop and distribute a news release announcing new product or innovations grasping a rare opportunity to re-introduce their practice and the full range of services they offer (Ahmed K, 2009).
Conferences are held to help keep practitioners informed about the latest best practices and products to help your patients and adopting these keep you in business. The benefits outweigh the costs when practitioners consider the knowledge you will attain at the event. The possibilities of what practitioners will learn and bring back to his or her practice make attending a must. Not to mention the fact that practitioners’ competitors may be there, and if practitioners didn’t attend, the competitors always have the sole opportunity of reaching out to area referral sources when they return (Ashrafian 2009).
If practitioners cannot manage to attend the annual conferences, making regional events a priority and following them up individually with manufacturers that practitioners expect were participants can do. Reading the trade journals and the professional papers will help practitioners identify which companies are introducing new products and who to contact first (Ahmed , 2009).
Therefore, Continuous Medical education is not only crucial to an individual’s success but also to the success of an organization in general both in the short term and in the long run. It gives opportunities to grow and share knowledge.
In most companies, the formation of a prime in-house learning institution/centre forms the first step in responding to the need for continuous education for employees. Changing times requires changing tactics and hence the need for the education or learning to keep abreast of what is happening in and outside ones work place so as to offer lasting solutions to problems or to solve problems as adequately as they arise (Conroy, 2006). This in-hose learning institution is mandated with the task of looking into ways and means of lengthening the shelf life of knowledge and help in aligning training with strategic business goals. In most organizations the in-house learning institution offer more centralized training with education facility to address the shortened shelf life of knowledge and to align training and development with business strategies. School is a place where people should learn to learn…so they can get down to the business of really getting to know what they’re about after they are out in the real world.
(De La Lama, 2010).
Several motivating factors have been put forward in explaining the proliferation of institution learning centre. Notably, the shelf life of knowledge is becoming increasingly shorter, which necessitates continuous learning for workers. Basically knowledge changes quickly, and people have to keep up. Jim Moore, director of SunU, the corporate university of Sun Microsystems, says that the shelf life of knowledge at his firm is only one to two years. He estimates that more than 75 percent of Sun Microsystems’s revenue in 1996 was generated from products that had been in the market less than two years. Another reason for the rise of institution learning centre is the desire of many companies to be perceived as the “employer of choice” in their industries. This forms an investment in employee education and consequently yields competitive advantage for recruiting and retaining the best and brightest employees. In so doing the labour gap is eliminated (De La Lama, 2010).
Calls have been made by various labour organizations to companies to invest in training workers for new and emerging jobs. this call enhances that an organization will not at any time lack the desired labor force nor at any time will they lack to produce or fail carry out a specific task due lack of the necessary skills. Others have championed the need for corporate organizations to pay more attention to the training needs of shift workers, hourly employees, and others that toil in low-paying manual and service jobs with a high call to focus on computers, continuous education, networking, and career planning that emphasizes mobility across different industries-industries that are increasingly interrelated (such as communications and entertainment) and whose boundaries are increasingly becoming porous (De La Lama, 2010).
Over and again doctors, have been on record carrying test after another in an effort to finding lasting solutions to various ailments affecting the mankind. Abbott is not new in this experiments trade and had a laboratory set up purposely to test the working of heart stents (Conroy, 2006).
The first patient to get one of Abbott Laboratories’ experimental heart stents to treat chest pains was John Lamb who was a retired auto mechanic in New Zealand (Abbott website 2010).. In order to quest the curiosity of his new finding associated with results of continuous learning, Abbott used a stent which looked like a scaffold device the size of the spring in a ballpoint pen which was inserted into one of Lamb’s coronary arteries in March 2006 and inflated under pressure to prop open the passage, which had been clogged by fatty plaque. Unlike metal stents, Abbott’s stent was made of polylactic acid and designed to dissolve within two years after implant. According Lamb’s doctor, the stent left a healthy, unencumbered vessel.
It’s believed that if studies confirm the device helps arteries and disappears without causing clots or other risks linked to metal models, the product may take the lead in the $4 billion-a-year market for drug-coated stents, as it would be safer for patients. Similarly, Abbott’s new product may reach commercial channels in Europe within 18 months, putting it three years ahead of dissolving stents being developed by other competitors. However there wasn’t a surety on the promise that the dissolving stents would yield in that coronary stents have had an incredible premium on stent performance and that the bioresorbable stent are larger and bulkier. Likewise, the likelihood of it being a significant advance for patients and clinicians in coronary use was not massive (Abbott website 2010).
The dissolving stent was designed to confer the benefits of existing devices without leaving behind the “metal spider,” that is the image that appears during an X-ray of a patient whose coronary arteries are fully stented. Current stents don’t shrink and expand with the artery’s natural movement. The metal devices can trigger deadly clots, and may interfere with future tests and surgeries (Conroy, 2006).
As an indicator for the need of continuous learning coupled with the desire to win and conquer, Abbott redesigned his dissolving stent a year later after engineers found it didn’t keep arteries open so well as per expectations during studies in Europe. He noted that the stent would be difficult to hold open an artery well just as metal devices would do. In particular he observed that the devices have to withstand pressure, particularly when doctors insert them into severely blocked arteries (Abbott website 2010).
This being the first hurdle and a pointer towards achievement, there was a lot of enthusiasm in Europe that this would be a new breakthrough technology. It was argued that, the disappearing devices might solve one problem that had hampered sales of drug-coated stents since 2006, that is, the formation of blood clots years after implantation with studies showing clots develop in 0.2 percent to 3.1 percent of patients. In addition, the risk doesn’t decline over time, and the result is often fatal. Heart attacks occur in as many as 65 percent of patients with the clots, a 2008 study found (Galeon, 2006).
As an impetus for push-forward, there weren’t been any cases of clots in people getting Abbott’s bioresorbable stent. Data on 45 patients, who were followed for nine months after treatment, were being presented at the Transcatheter Cardiovascular Therapeutics meetings (Conroy, 2006).
The Abbott’s approach formed an evolution in technology. Prior to this development, Doctors would first clear clogged arteries with a balloon, inflating it inside a blockage to allow blood to flow. The arteries would often snap shut or reclog, leading researchers to craft metal tubes that were left behind to prop open the vessels. The devices attracted scar tissue, again narrowing the artery over time, and one in four patients needed retreatment. Makers of the stent finally coated them with drugs to prevent tissue from attaching on the metal. The artery never fully healed with a drug-coated device inside, and years after treatment some people developed blood clots that caused heart attacks and deaths. As a result, patients resolved to take blood thinners to prevent clots, putting them at risk of internal bleeding (Abbott website 2010)..
With Abbott’s dissolving stent, the treated arteries are able to bend, expand and contract with natural movement. Patients using the product don’t need years of treatment with drugs.
Meanwhile, Abbott’s main competitors in the stent market were in the early stages of evaluating dissolving devices. Most of their work was in places and parts such as the leg where the larger size of an absorbable stent isn’t a problem. a vice president and general manager of Minneapolis-based Medtronic’s coronary and peripheral division observed that stress and pressure on the legs can cause metal stents to fracture, making an absorbable device more attractive and the most appropriate one (Galeon, 2006).
Gaps in literature
While other research works are continuing on bioresorbable stents for leg and heart arteries, the emphasis in research is totally different in that metal devices with coatings that dissipate over time, rhythm and vascular group, very little evidence is available that the long-term presence of a metal scaffold is harmful. There are millions and millions of patients with metal scaffolds in their arteries and are in good health (De La Lama, 2010)..
The initial six-month results of the Absorb trial showed that Abbott’s dissolving device is as effective as Xience, the industry leader with $1.6 billion in 2009 sales. There were few complications, and the product performed as well as existing stents. The study may be enough to win approval in Europe, where companies must show only that medical devices are safe and similar to products that are already available. Patients have undergone tests, including intravascular ultrasound, induced vasodilation, and optical coherence tomography. In 1998, for example, the Reva Medical was founded, and is working on a stent that starts to resorb after 90 days. The company redesigned its prototype after patients who received it in a 2007 study needed repeat treatment. Reva, whose investors have included Boston Scientific and Medtronic, aimed to start another trial by the following year (De La Lama, 2010)..
Biotronik’s bioresorbable drug-coated metal stent made from magnesium and dubbed Dreams, was implanted in its first patient in August, in Germany. Biotronik which was founded in 1963 by the developers of a heart pacemaker was closely monitored. About half of all patients requiring stents had single, easy-to-treat blockages that would be perfect for the dissolving device. in his concluding remarks, Lamb then aged 69 years noted to have made the right choice and it appealed to him that it dissolved and I wouldn’t have a piece of hardware in his body (Galeon, 2006).
Before the procedure, Lamb had difficulty walking the 500 meters (1,640 feet) from his house in Tauranga, a city southwest of Auckland, to the road each day, to pick up mail, without taking a breather. The pain crept up his neck and arms, strangling his chest like a tourniquet.
Several calls and Critics have put forward for the entire elimination of commercial support for CME. The proponents of these critics argue that CME providers can easily pitch topics designed to attract commercial sponsorship and sponsors can award grants to programs that support their marketing strategies. However, the Institute of Medicine has collectively argued that CME has become too reliant on industry funding that tends to promote a narrow focus on the products and to neglect provisions of a broader education on alternative strategies such as communication and prevention despite ACCME’s requirements that program content be free of commercial interests (Ashrafian 2009)… For example, gabapentin (Neurontin) was approved by the U.S. Food and Drug Administration for adjunctive therapy in epilepsy, but Warner-Lambert sponsored CME activities that encouraged its use for off-label indications. The U.S. Department of Justice brought civil and criminal charges against Warner-Lambert, which Warner-Lambert settled for $430 million, alleging that Warner-Lambert paid kickbacks to doctors in the form of lavish trips to attend presentations about off-label uses. More recently, AstraZeneca PLC has been fined $520 million in the United States for off-label promotion to doctors for their anti-psychotic drug, Seroquel (Ahmed , 2009).
In the current modern medical situation, it’s common to find most of the medical device companies have invested money into new innovations and new product flow aimed at revolutionizing the standards of care. Besides, the new innovations and new product flows are creating an added value for their shareholders focused towards gaining sustainable competitive advantage over rivals. It is common to find that these medical device industry is continually trying to find a solution to meet the current needs or improving and modifying the existing devices to gain a competitive advantage (Lobuglio, 2007). for example, the state art innovation by Abbott Vascular of the Bioresorbable Vascular Scaffold (BVS) had invested millions of dollars in the past couple of years prior to his current and new innovation. Despite all this there was a shadow of doubt as to whether Abbott Corporation would be able to achieve market leadership with BVS. Similarly, many doubted whether Continuous Medical Education (CME) would help Abbott to gain sustainable competitive advantage over competitors with his new innovation (Goozner, 2004).
However, with several data references on the market of medical devices, the launch of the new innovations was a very serious activity principally when there was no clinical data available to support it. These references showed that creation of a real life example using animal replica to generate data was done in order to support marketable activities and launch products. This was made achievable by curiosity in trying to conquer and emerge as the market leader via the use of technology advancement in education. In other words, the need for comparing value of education and innovation particularly in the launching of new product into the market (Lobuglio, 2007).
In most consumer- related products, Marketing activities are generally customer-oriented activities primarily focusing on the needs of consumer. In the medical device market, the consumers are the physicians, the patients, the hospitals or the purchasing groups. The ultimate goal of any producer targeting these categories of people in the medical device should be base on how to adequately satisfy the consumers with the performance of their product. The teamwork of promoting and marketing of the products and sales teams is very essential for the progress and achievement of the firm. This is based on the view that the consumers’ needs and desires fluctuates and are unpredictable (Goozner, 2004).
Generally, where consumers do not know their needs hitherto the product being new due to a new innovation and technologies, the sales and marketing team should collectively carry out advertisement to make aware of the availability of the product and its benefits compared to the existing one.
However, with medical devices, physicians and nurses usually prefer to work with products they have experience with and most of them shy away of new technologies and innovations. References show that there are new ways of motivating health medical professionals and centers to use and new technologies. In U.S, for example, Hospitals can receive higher reimbursement from the Centers for Medicare & Medicaid Services (CMS) when they use certain new technologies like the InfraReDX’s LipiScan Coronary Imaging System to analyze the plaque material of the coronary artery. Using new technology and innovation can result in offering an improved clinical outcome and faster patient recuperation. Motivations such as, better reimbursement and education is essential for health care professionals to believe in and start to use new technologies and innovation (Lobuglio, 2007).
Medical professional like physicians and nurses, just like lawyers, should take continuing educational courses to stay up to date and uplift their professional career. By so doing, the medical professionals will practice high quality services and produce quality medicine when they continuously upgrade their knowledge about latest innovations and studies (Lobuglio, 2007).
In conclusion, Education is continuous. Every day presents its own problem and the only way to tackle the day –to-day problems is through learning new things as the world revolutionizes. The field of medical profession is faced with multifaceted problems which are and have being solved through technological and innovational advancements. The case of the healing using the stent through the Abbort’s effort is a wake up call for all those medical professionals, and any other career professions, who are aspiring to become a household name in solving today’s medical problems.
Continuous education not only does it add value to innovational products but it also ensures continuous production flow while maintaining the steady supply of the required labor. In marketing it offers an unprecedented upper hand in handling the obstacles in the modern market world bringing with it the expected market niche necessary to becoming a market leader in the specific area.
Nowadays, instructors are finding innovative ways to share up technical staff in the fight against the rising skills scarcity. The growing gap between technical skills needed by organizations and the skills available on the job market is becoming an advanced executive annoyance. In many organizations, the skills gap is enabling the trainers an unusual limelight as they seek to reduce its impact (Kreitner & Kinicki 2008). They’re rising to the challenge by molding technical workers out of promising technical talent, using training as an incentive to retain them and by using pre-employment assessments and testing tools to spot diamonds in the rough. Consequently, the utilization and allocation of resources has been optimal resulting to high production enabling organization to hit the market with the right quantity and quality of products. As a pointer to the influence of technological and innovational advancements in education, the level of market share for most companies has significantly improved with organization registering normal to supernormal profits since the marketing and the entire sales team is way ahead in the market.
In general, developing technical skills in-house is becoming a proven growth strategy as the job market becomes scarcer. Training is also being influenced effectively to keep top-flight technical talent from jumping ship in the face of aggressive recruiting tactics and lucrative signing bonuses, (Kreitner & Kinicki 2008). In others situations partnering is becoming a key strategy for many companies; specifically, collaborative arrangements with local community colleges to help provide baseline and higher-end skills to current employees and new recruits. Partly driven by state efforts to lure and retain businesses, high-tech companies in particularly are rolling out the red carpet by tailoring education programs for specific company needs. Some are even moving into the training arena by providing instructors to organizations to help with remedial and high-end technical training.
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