Rational Emotive Behavioral Therapy Essay

Abstract This is a case conceptualization of a client referred to a Residential Treatment Facility by Family Court for treatment and evaluation of intellectual, academic, and behavioral performance. The client presents with several issues. In the client interview, the counselor hypothesizes that client has difficulty with anger, aggression, and low frustration tolerance. The client’s current behaviors are affecting his home and educational environments. The client’s early experiences will be explored only as it relates to current behavior and beliefs. During the therapeutic process, the client and the counselor will explore his inability to respond appropriately when frustrations occur. Exploration would include disputing irrational thoughts and beliefs, and exercising more appropriate positive replacement behaviors. This case conceptualization will create a hypothesis of the client’s aggressive behavior. Using Rational Emotive Behavior Therapy framework, the counselor will explore the client’s issues and create a treatment plan with goals that pertain to the client’s presenting issues. This conceptualization will also include support that will show the benefits the client should gain with application of this theory. Rational Emotive Behavior Therapy Case Conceptualization of Michael Michael is a 14-year-old African American male. He has been referred to a Residential Treatment Facility (RTF) for an evaluation of intellectual, academic, and behavioral assessment. While in the treatment facility, Michael must undergo therapy to address his presenting problems. Michael presents himself as a very well dressed and engaged young man. Despite the fact that he is court-ordered to be in a treatment facility for an undetermined length of time, he was cooperative during the interview. During the interview, the counselor speaks with Michael and his adoptive family about the details of the court documents, the responsibility of the client (Michael) and the facility. The counselor, Michael, and the adoptive parents have completed the intake process and the time was scheduled for his first session. Biological and Environmental Factors Michael’s biological parents are reported to have been heavily addicted to drugs and alcohol. His mother reportedly abused multiple prescription drugs and cocaine during her pregnancies. It is also reported that the mother was Schizophrenic. Both parents have lengthy criminal records. Michael did not experience a nurturing environment. At age four, Michael and his younger brother were removed from the biological parents by child protective services. The brothers were placed in separate foster homes. Michael has had four foster care placements in two years prior to going to his adoptive parents. During his placements, it is suspected that Michael experienced neglect and sexual abuse. His maternal aunt and her husband adopted Michael. They also adopted his younger brother. They have two biological children. Michael did not adjust well to the new environment. He became more aggressive and exhibited hoarding behaviors. By age seven, he had been placed in a psychiatric hospital and other RTFs to receive treatment. Michael and his adoptive parents have sought counseling services through their church and local mental health agencies. Michael had been diagnosed with Reactive Attachment Disorder, ADHD, and ODD. He has poor sleep patterns and is on several medications that have little effect. Michael has self-harmed for attention, but denied suicidal thoughts. Michael has a history of violent and aggressive behaviors in school and home. Michael has very weak and superficial relationships with peers. Case Conceptualization Michael’s presenting issues and previous history is suitable for Rational Emotive Behavior (REBT). REBT focuses on environmental and biological factors that affect rational thought and emotional behavior (Murdock, 2009). Michael’s early history will offer insight in evaluating his current behavior, but otherwise have no relevant bearing on Michael’s treatment plan. Michael often experiences events that cause him to react in a negative manner toward his peers and relatives. The counselor theorizes that Michael’s early exposure to violence, unstable home environment, and inconsistent relationships may have contributed to his inability to rationalize his experiences. These outbursts have increasingly become more violent. One incident resulted in Michael choking another resident at a previous RTF placement. Michael states that he often felt agitated prior to his outburst. Later, he would be confused, sad, and even angrier that he lost control (secondary disturbance). In session, the counselor listens for the ABCs of the REBT therapy framework. Michael rehearses several events that occur prior to his outbursts and violent attacks (Consequence) (2009), the counselor notes that Michael often feels that â€Å"people are trying to get over on him† or â€Å"messin’ with him† (Antecedent behavior, irrational thought, faulty thinking) (2009). Michael voiced that people should just leave him alone† (faulty belief) (2009). Michael perceives his peers think he is â€Å"stupid† (irrational thought) (2009). When asked why he thinks this, Michael responds, â€Å"Maybe I am. I always get the questions wrong in class when the teacher calls on me† (faulty belief) (2009). Michael’s demands: self-demandingness, others demandingness and world demandingness (2009) are not being met, therefore creating a psychological and emotional disturbance for Michael (2010). The counselor also hypothesizes that Michael has low frust ration tolerance (LFT) (2010) with peers who he perceives do not treat him fairly or give in to his demands (other demandingness) (2009). Michael rehearsed that in the classroom the teacher never listens to him. She always tries to embarrass him in front of the class. Michael often stated that the teacher frequently called on him to prove he was â€Å"dumb† (awfulizing) (2009). Michael perceived the classroom environment was unfair and intolerable and hated going to school (maladaptive thought) (2009) because all the teachers hate him. Michael felt that he should be left alone, especially when he was not â€Å"bothering† anyone (world demandingness) (2009). The result was to defend himself through acting out, aggression, or defiance. Michael believed that he needed to be aggressive to prove his peers, teachers, and family members wrong, which led to further frustration. Michael explained that behavior made him feel like he was not â€Å"good enough† for people (self-demandingness) (2009). The counselor hypothesized that Michael is relying on irrational thinking to draw irrational conclusions (2009) which lead to irrational behavior. Michael’s negative thinking and behaviors influenced his home life. Michael describes that he upsets his adoptive mother when he fights (antecedent) (2009) and that he will never be able to make her happy (irrational thinking) (2009). Michael believes this makes him a bad person on the inside (faulty belief) (2009). This belief makes him angry and irritated (secondary disturbance) (2009), which causes him to become violent toward his younger siblings (consequence) (2009). Treatment Goals and Plan Michael’s goals toward survival and happiness (2009) are thwarted by his irrational thoughts and absolutions (Harrington, 2007) that life should be easy and painless (2007). Michael becomes frustrated with events at school and home frequently when he does not get what he wants. The counselor understands that frustration with particular events in itself is not the cause of the violent outburst, but is the result of wrong views of the event (2007). Michael has an additional belief: his reality must conform to his wishes. When this fails to occur, intolaration results (faulty belief). Hence, this creates the violent outburst (consequence). In other words, frustration intolerance arises, because the wish for a different reality collided with the demand for it (Harrington, 2011). Michael’s therapeutic goals will include teaching him the three unconditionals of acceptance (Barry, 2009): 1. Unconditional self-acceptance-I am not a bad person. I can make good choices, even if it does not always turn out right. 2. Unconditional acceptance of others- Everyone does not have to like my ideas or me, they can have each have our own opinion. People will not always treat me the way I want to be treated. This does not mean they want to harm me or do not care for me. 3. Unconditional life acceptance-Life is not fair. I can take the good with the bad. I can choose to enjoy the moment. I cannot control every circumstance, but I can control my reaction and thoughts toward it. Michael will also be taught to do a behavioral assessment (2009) of his thoughts and beliefs during the course of his treatment. This will include the use of a journal (between session homework) (2009) to track antecedent events, his emotional state prior to the event (calm, engaged) and immediately following (irritated, angry, and sad), and his beliefs toward the given circumstance. The counselor will actively model appropriate behaviors when frustrating moments occur in counseling. The counselor will use exaggerated behavior (2009) to demonstrate Michael’s behavior (sudden outbursts/aggression) when frustrating events occur. It is the hope of the counselor that Michael will see that his behavior can be considered extreme. Michael may even see some humor in the extremity of his outbursts in minor occurrences. The counselor will be direct with Michael in modeling (2009), an â€Å"it’s-not-about-you/me† stance in session. Michael will be consistently confronted during sessions with questions that will challenge him to consider when this attitude begins to surface (Shanahan, et. al. 2010). The counselor will model humor (2009) when appropriate to demonstrate when Michael’s irrational thoughts grow beyond reason. The use of coping skills can dispute irrational thoughts (self-talk, humor, relaxation techniques) (Harrington, 2011) and create a self-monitoring tool for Michael between sessions. The counselor will actively dispute irrational thoughts during the session using philosophical interpretation—demonstrating this is interrupting his goal to be happy, empirical evidence—asking for evidence that supports his belief or offering evidence that counteracts his belief, logic, and functional—helping him evaluate â€Å"always and never† statement (2009) relationships between the perceived disturbance and the reality of the unconditional. Behavior strategies can also be implemented. Michael should learn behavior (violence and outbursts) management through: 1. Reward (engaging in a pleasurable activity after enduring an uncomfortable/frustrating circumstance), and penalty (restriction of pleasurable activity) (2009). 2. The use of imagery of frustrating or uncomfortable situations, and unhealthy negative emotions (and behaviors) to reframe and rehearse rational beliefs and responses (Harrington, 2011). The counselor will use multiple resources (music, TV, and movies) and actual events for scenarios (Harrington, 2011). 3. Coping mechanisms (2011) will also be implemented when frustration arises. This will include relaxation techniques (2009) and removing Michael from the frustrating situation until he is able to respond appropriately. Eventually, Michael should be able to endure an uncomfortable circumstance (2011) without having to leave to regain composure. In summation, throughout the course of Michael’s sessions, he should be able to recognize irrational thoughts and dispute them immediately. Even when challenged with frustration, Michael should be able to evaluate the reality (reframing) (2009) of the circumstance and respond appropriately. Conclusion The counselor concluded that REBT is appropriate to use in this counseling scenario. REBT addresses thoughts and beliefs of an individual. These thoughts and beliefs create the behavior response. When an individual has irrational thoughts motivated by faulty beliefs, it is typically followed by a negative response. The counselor’s goal is to teach the client to evaluate irrational thoughts and faulty beliefs concerning the antecedent event in order to create a more appropriate consequence (response). Michael’s core faulty beliefs are found in the three unconditionals. Michael feels he is entitled (Fives, et al. 2010) to fair treatment and getting his way. Michael believed that when this entitlement was not fulfilled, it was appropriate to respond with aggression (2010). This response (consequence) created a cyclical event: antecedent event (fight/defiance)—irrational thought (my teacher is trying to embarrass me or he’s trying to intimidate me) — faulty belief (that teacher should leave me alone/ I will not be intimidated). After the fight/defiance, Michael often feels guilty, sad, or more frustrated (secondary disturbance) because he is a failure and cannot get it right (which disappoints his adoptive mother). As a result, Michael experiences more frustration and anger. Using REBT, the counselor hopes to effectively teach Michael to dispute his negative/irrational thoughts and faulty beliefs. Therefore, this will reduce frustration intolerance and create a more appropriate consequence to the antecedent event. REBT is logical, workable, and teaches the client realistic skills to cope with life’s circumstances (Minor, 2007). In cases like Michael’s, REBT is effective with including the family in the framework of the therapy (Bernard and DiGiuseppe, 2006). Michael’s adoptive parents will be taught to identify his (and even their own) irrational thoughts and faulty beliefs and the behavioral relationship. This equips them with knowledge needed to address the behavior. Most importantly, it helps with the long-term success of the child client in identification and appropriate response of frustrating circumstances (Fives, et al., 2010). REBT does not focus on the person, but the behaviors the person demonstrates (Levinson, 2006). This approach will be beneficial to Michael because his faulty thinking and irrational thoughts have been attached to his personhood. He perceives himself as â€Å"bad† and â€Å"inadequate† (Jones, et al, 2011). REBT should teach Michael it is not he or â€Å"the event, but the thoughts about the event† (Ellis) that cause his issues. This should encourage Michael to evaluate his thought and belief patterns frequently. REBT utilizes psychology, examining how thoughts cause emotional disturbance. Philosophically, REBT suggests that life views influence emotions. Lastly, REBT incorporates education that should provide Michael with the necessary tools to manage his thoughts, beliefs, and responses to frustrating events (Banks and Zionts, 2008). This will be an on-going process for Michael. Michael will experience success and failure throughout the application of REBT. The counselor will be diligent in explaining this reality to Michael. The counselor will reiterate this is a part of the three unconditionals. Michael will experience the reward of recognizing the ABCDE’s of REBT. Michael should understand the final stage of REBT is effectively (the â€Å"E†) (2010) disputing (the â€Å"D†) irrational thoughts toward the event, therefore, causing an appropriate response. Michael will learn when he is not successful, he can accept it and the consequences without becoming aggressive. References Banks, T., & Zionts, P. (2009). REBT Used with Children and Adolescents who have Emotional and Behavioral Disorders in Educational Settings: A Review of the Literature. Journal of Rational Emotive Cognitive-Behavior Therapy , 51-65. Bernard, M. E., & Diguiseppe, R. (2006). REBT assesstment and treatment with children. Rational Emotive Behaviors approaches to childhood disorders, theory, and practice , 85-113. Fives, C. J., Kong, G., Fuller, J. R., & DiGuiseppe, R. (2010). Anger, Aggression, and Irrational Beliefs in Adolescents. Cognitive Theory Research , 199-208. Harrington, ,. N. (2007). Frustration intolerance as a multidimentional concept. Journal of Rational-Emotive & Cognitive-Behavior Therapy , 191-211. Levinson, M. (2006). Anger management and violence prevention: A holistic solution. et Cetera 187-199. Minor, J. (2007). Why I use REBT in my private practice and personal life. et Cetera , 320-323. Murdock, N. (2009). Theories of Counseling and Psychotherapy. Upper Saddle River, NJ: Pearson. Shanahan, S., Jones, J., & Thomas-Peter, B. (2010). Are you looking at me, or am I? Anger, aggression, shame and self-worth in violent individuals. Journal of Rational Emotive Cognitive Behavior Therapy , 77-91.

Pharmaceutical Marketing

Pharmaceutical Marketing Merck â€Å"Merck has gone beyond developing and selling prescription pharmaceuticals. It formed joint ventures in 1989 with Johnson & Johnson to sell over the-counter pharmaceuticals; in 1991 with DuPont to expand basic research, and in 2000 with Scherigng-Plough to develop and market new prescriptions medicines. In 1997, Merck and Rhone-Poulenc S. A. (now Sanofi-Aventis S. A. ) combined animal health and poultry genetics business to form Merial Limited, a fully integrated animal health company.Finally, Merck purchased Medco, a mail –order pharmaceutical distributor, in 2003, and Sirna Therapeutics in 2006† (Kotler & Keller, 2012, p. 43-44). â€Å"For branding strategies to be successful and brand value to be created, consumers must be convinced there are meaningful differences among brands in the product or service category. Brand differences often related to attributes or benefits of the product itself . . Merck has lead (its) product catego ries for decades, due in part to continual innovation† (Kotler & Keller, 2012, p. 243).Merck has donated $100 million or more to charities in a year (Kotler & Keller, 2012, p. 632). Mission Statements Ex. Japan Both pharmaceutical and biotech companies are starting to make partnership a core competency (Kotler & Keller, 2012, p. 52). Intro: Michael Dawson, author of â€Å"The Consumer Trap,† states that the business of marketing, a trillion-dollar –a-year industry, is a social, economical, environmental, and unfriendly cost on Americans today as it â€Å"continues to soak up economic and environmental resources and dominate the personal lives of citizens† (Dawson, 2005, p. ). Dawson argues that corporate America is fueled by a continuous marketing race that manipulates people’s perceptions and actions of goods into thinking the economy is out to serve one’s pleasures and happiness, when in all reality, is only out to serve the demand of busin ess today (Dawson, 2005, p. 1). â€Å"It is critical that the U. S. government recognizes that intelligently focused nutrition-related efforts are important in helping lead Americans of all ages to lead healthier lifestyles.Marketing Nutrition shows how simple solutions can save lives. â€Å"–Congressman Timothy V. Johnson, United States House of Representatives (Wansink, 2007, p. 1). There are enormous economic dividends for health care providers, public health institutions, and commercial food companies if we are successful in doing this. â€Å"–Dr. David Mela, Expertise Group Leader, Unilever Health Institute(Wansink, 2007, p. 1). Marketing = A mechanism to help pharmacy develop, communicate, and sell future pharmaceutical services to consumers (Grauer, 1981, p. ). Pharmaceutical marketing is an â€Å"element of an information continuum, where research concepts are transformed into practical therapeutic tools and where information is progressively layered and ma de more useful to the health care system† (Levy, 1994, p. 1). Provides an informed choice of carefully characterized agents (Levy, 1994, p. 1). marketing assists physicians in matching drug therapy to individual patient needs (Levy, 1994, p. 1).Pharmaceutical marketing is presently the most organized and comprehensive information system for updating physicians about the availability, safety, efficacy, hazards, and techniques of using medicines (Levy, 1994, p. 1). pharmaceutical marketing strategies can negatively affect both- the end consumers or the patients and the health care profession (Need of New Pharmaceutical Marketing Strategies, 2010, p. 1). Also, the advertising strategies included in the marketing plan of any pharmaceutical company is not ‘direct to consumer' (Need of New Pharmaceutical Marketing Strategies, 2010, p. ). Any pharmaceutical marketing strategy targets the health care professionals or the Doctors who in turn prescribe the drugs to the patients (e nd consumers) liable to pay for the products (Need of New Pharmaceutical Marketing Strategies, 2010, p. 1). However, a few countries (till date two countries- New Zealand and United States) allow Direct-to-consumer advertising (DTC advertising) for pharmaceutical products (Need of New Pharmaceutical Marketing Strategies, 2010, p. 1). Pharmaceutical Market Trends 2010. Pharmaceutical & Drug Manufacturer Resources.Retrieved from: http://www. pharmaceutical-drug-manufacturers. com/articles/pharmaceutical-market-trends-2010. html The global pharmaceutical is forecasted to make a significant growth of about 4 – 6%, exceeding $975 billion, with global pharmaceutical market sales expecting to grow at a 4 – 7% compound annual growth rate (CAGR) through 2013, based upon global macroeconomy as well the â€Å"changing combination of innovative and mature products apart from the rising influence of healthcare access and funding on market demand† (Pharmaceutical Market Trend s 2010, p. ). pharmaceutical sales are growing at a fast rate in India, China, Malaysia, South Korea and Indonesia due to the rising disposable income, several health insurance schemes (that ensures the sales of branded drugs), and intense competition among top pharmaceutical companies in the region (that has boosted the availability of low cost drugs). India – 3rd Largest Producer of Pharmaceuticals Across the World- is already a US$ 8. 2 Billion pharmaceutical market.The Indian pharmaceutical industry is further expected to grow by 10% in the year 2010. (Pharmaceutical Market Trends 2010, p. 1). The development of infrastructure and rapidly changing regulations in the Middle East are being seen as the cause of its growth. Presently South Africa, Saudi Arabia and Israel dominate the region's pharmaceutical industry due to their better infrastructure and regulatory environment. However, The Middle East pharma market depends on imported pharmaceutical drugs and therapeutics.Th e governments of countries in this region are taking measures to raise their domestic production through heavy investments in the pharmaceutical industry (Pharmaceutical Market Trends 2010, p. 1). Pharmaceutical Drugs Trends of fastest expected growth consist of anti-Diabetic Drugs and those for cardiovascular diseases, due to the changes in demographics and lifestyle with anti-hypertensives drugs will dominate the global cardiovascular market with a market share of nearly 50% (Pharmaceutical Market Trends 2010, p. 1). Strategy:The pharmaceutical companies traditionally adopt four major marketing strategies for promoting their products: Giving drugs as free samples to doctors/ Gifts that hold the company logo or details of one or multiple drugs, providing details of their products through journal articles or opinion leaders; and Sponsoring continuing medical education (Need of New Pharmaceutical Marketing Strategies, 2010, p. 1). Pharmaceutical representatives, also popularly known as medical representatives, are the major pharma marketing strategy for marketing drugs directly to the physicians.Typically, the expense of this sales force of any pharmaceutical company comprises anything ranging from 15-20% of annual product revenues (Need of New Pharmaceutical Marketing Strategies, 2010, p. 1). â€Å"Marketing Nutrition offers a ‘win-win' proposition for all concerned. Insightful companies, health professionals, and policy makers can lead the way . . . in helping people eat better and enjoy food more. â€Å"–Dr. James O. Hill, Director of Human Nutrition, University of Colorado Medical School (Wansink, 2007, p. ). Take advantage of future growth opportunities. These growth opportunities will be realized from unmet health-care needs and changing consumer life style trends and values (Grauer, 1981, p. 1). Dispensing and drug-knowledge-distribution pharmaceutical services are reviewed by a product life cycle analysis of sales profits versus time (Gra uer, 1981, p. 1). A marketing mix for new pharmaceutical services is developed consisting of service, price, distribution, and promotion strategies.Marketing can encompass those key elements necessary to meet the organizational goals of pharmacy and provide a systematic, disciplined approach for presenting a new service to consumers (Grauer, 1981, p. 1). The costs of pharmaceutical marketing are substantial, but they are typical of high-technology industries that must communicate important and complex information to sophisticated users. These costs are offset by savings resulting from proper use of medicines and from lower drug costs owing to price competition (Levy, 1994, p. 1). oint to the Food and Drug Administration (FDA) and find comfort in the fact that this agency is tasked with regulating drug advertising. â€Å"only† 8% of advertisements are in violation of regulations. at least one of the 11 advertisements in the April issue of the ARCHIVES is likely to be misleadin g and, thus, provide potentially harmful information. In fact, the FDA, according to David A. Kessler, MD, commissioner, spends most of its time developing the package insert and not, as asserted by Levy, preapproving advertising. According to Kessler, â€Å"Except under very special circumstances, the agency does not eview or approve advertising and promotional materials before their dissemination by a drug firm† Furthermore, Kessler states that an â€Å"†¦ enormous potential exists for misleading adver ¬ tisements to reach the physician and influence prescribing decisions. † (Shaughnessy, Slawson, ; Bennett, 1994, p. 1). Gifts: Giving drugs as free samples to doctors/ Gifts that hold the company logo or details of one or multiple drugs, A study was done in 1995 to gauge the outcome of a patient’s perception of pharmacy marketing regarding physician’s accepting gifts from the pharmaceutical industry.The objective of this study was to â€Å"examin e patient perceptions of professional appropriateness and the potential impact on health care of physician acceptance of gifts from the pharmaceutical industry,† via a random telephone suvey of 649 adjults living in the state of Kentucky. Through the random sampling, the outcome of the survey was that Patient awareness of officeuse gifts (eg, pens, notepads) and personal gifts to physicians from the pharmaceutical industry, patient exposure to office-use gifts, and attitudes toward physician acceptance of both office-use and personal gifts. Mainous, Hueston, ; Rich, 1995, p. 1). Eightytwo percent of the respondents were aware that physicians received office-use gifts, while 32% were aware that physicians received personal gifts. Seventy-five percent reported receiving free samples of medication from their physicians. Compared with office-use gifts, more respondents believed that personal gifts to physicians have a negative effect on both health care cost (42% vs 26%) and quali ty (23% vs 13%). After controlling for demographic variables, as well as awareness and exposure to physician gifts, individuals with at least a high school education were 2. times as likely to believe that personal gifts have a negative effect on the cost of health care and 2. 3 times as likely to believe that personal gifts would have a negative effect on the quality of health care. (Mainous, Hueston, ; Rich, 1995, p. 1). Conclusions These results suggest that the public is generally uninformed about personal gifts from pharmaceutical companies to physicians. If public perception regarding the objectivity of the medical profession is to serve as a guide, these findings suggest a reevaluation may be in order for guidelines regarding physician acceptance of gifts from the harmaceutical industry (Mainous, Hueston, ; Rich, 1995, p. 1). The World Health Organization, the American Medical Association, the American College of Physicians, and the Pharmaceuticals Manufacturers' Association have also published guidelines on perks to physicians from the drug industry. The bottom line is that all these guidelines are voluntary, and physicians have continued to vote â€Å"with their feet. † (Shaughnessy, Slawson, & Bennett, 1994, p. 1). controversial 1962 FDA amendments.Just before 1962, congress studied and concluded that because of patent protection, heavy promotion by the drug companies, consumer ignorance, and minimal incentives for physicians to be concerned with cost, drugs of dubious quality and unnecessarily high expense were being prescribed by physicians, criticisms that sound remarkably familiar even today. Up to that point, the FDA had only required â€Å"proof of safety,† which dated back to the origins of the modern drug era and the 1938 Food, Drug, and Cosmetic Act (Shaughnessy, Slawson, & Bennett, 1994, p. 1).Discussions about the influence of pharmaceutical promotion on physicians often focus on gifts and payments of relatively large economi c value. This focus is also evident in ethics guidelines addressing pharmaceutical promotion among many professional medical societies. 1 The underlying assumption is that smaller gifts are unlikely to exert influence on prescribing decisions. (Grande, Frosch, Perkins, & Kahn, 2009, p. 1). In contrast, a substantial body of marketing and psychology literature suggests that even trivial items can exert influence irrespective of economic value.For example, adding a small gift such as personalized mailing labels to a solicitation for donations has been shown to significantly increase contributions. 2 In pharmaceutical promotion, small gifts are often tethered to branding efforts, as items such as pens and coffee mugs display logos. Aside from the intrinsic value of promotional items, branded materials strengthen brand awareness and build brand equity through a variety of largely unconscious but powerful mechanisms. 3 Nonverbal information about the brand, such as symbols or logos, is o ften more influential than verbal cues. Stronger brands have a memory encoding and storage advantage over unknown brands,5 which facilitates the formation of strong positive associations with the brand. Strong branded products are more often in a â€Å"top-of-mind† set of alternatives for consumers to consider. 6 Strong brand awareness provides a justifiable reason for choosing a particular brand. 7-8 This research suggests that small branded promotional items should increase favorable attitudes for the brand being promoted.We are unaware of studies that test these effects in a clinical context with health professionals, but many physicians, because they are medical experts, believe they are not susceptible to these influences. 5, 9-10 In one survey, just 8% of physicians believed they were susceptible to influence by marketing items such as branded pens, whereas 31% of patients felt these items could influence physicians. 9 The guidelines of the American Medical Association regarding gifts to physicians from industry reflect this belief of lack of susceptibility by permitting â€Å"gifts of minimal value. â€Å"1 (Grande, Frosch, Perkins, & Kahn, 2009, p. ). The study used a randomized experimental design. Participants were third- and fourth-year medical students at the University of Pennsylvania School of Medicine (Penn) and the University of Miami Miller School of Medicine (Miami). We selected these institutions because of their differing policies regarding interactions between trainees and pharmaceutical company representatives. The University of Pennsylvania has restrictive policies in place that prohibit most gifts, meals, and samples while Miami continues to permit such marketing practices. (Grande, Frosch, Perkins, & Kahn, 2009, p. 1). 007-2008. Study participants were assigned to a control or primed condition based on their day of enrollment. Participants assigned to the â€Å"primed† condition were exposed to Lipitor (atorvastatin) br anded promotional items immediately prior to completing a computer-based study instrument. These exposures included Lipitor logos on a clipboard (used when signing in to the study room) and notepaper (used to provide participants with their study identification number). Participants assigned to the control condition completed the same procedures but with a plain (nonbranded) clipboard and notepaper.Randomization was conducted by day in order to avoid contamination of conditions. (Grande, Frosch, Perkins, & Kahn, 2009, p. 1). Participants were told they were enrolling in a study about clinical decision making under varying conditions (Grande, Frosch, Perkins, & Kahn, 2009, p. 1). Our study was designed to measure the influence of exposure to branded promotional items on relative attitudes toward 2 lipid-lowering statins. We examined differences in attitudes toward Lipitor and Zocor (simvastatin) in our exposed (Lipitor promotional items) and control groups.Lipitor is among the most p romoted brand-name statins in the United States while simvastatin is available generically and considered to be nearly equally effective. The study outcomes included measures of implicit and self-reported (ie, explicit) attitudes. (Grande, Frosch, Perkins, & Kahn, 2009, p. 1). Implicit attitudes were evaluated with the Implicit Association Test,11-15 a widely used tool in marketing and psychology research that is thought to be resistant to social desirability bias among research participants.Initial applications of the IAT, for example, demonstrated the persistence of racial and gender stereotypes and prejudices, even in the face of strong conscious beliefs that such attitudes do not exist and strong social norms that dictate they should not exist. 16-17 Results from the IAT are a better predictor of intergroup discrimination (eg, biased behavior against people of other races/ethnicities, gender, and sexual orientation based on existing attitudes and stereotypes) compared with osten sibly similar self-report measures. 13 In recent years, the use of the IAT has been expanded to research focused on branding and marketing. 8-19 Further details regarding application and validity of the IAT have been published elsewhere13-15; a demonstration can be found at the Project Implicit Web site (https://implicit. harvard. edu/implicit). (Grande, Frosch, Perkins, & Kahn, 2009, p. 1). Explicit attitudes were assessed by self-report. Following the IAT, participants were asked to compare Lipitor and Zocor in 5 dimensions (superiority, preference, efficacy, safety, and convenience) a follow-up anonymous Internet-based survey that assessed their attitudes toward pharmaceutical marketing.The purpose was to measure differences in attitudes among students at the 2 schools given the differing institutional policies as a possible explanatory factor(Grande, Frosch, Perkins, & Kahn, 200 Then there is the pharmaceutical industry's holy grail of marketing — the relationship between their sales representatives and medical doctors. To maintain this relationship, often called â€Å"detailing,† pharmaceutical companies spend a whopping $8,290 per doctor.The average family doctor receives 28 visits each week from drug reps, who provide free samples, explain new findings from company-sponsored drug trials, and demonstrate the latest innovation in their company’s medical devices. Some doctors, reporters and public health advocates have long decried the pharmaceutical industry's seemingly endless attempts to buy goodwill among medical professionals. But insidious marketing campaigns seeking to rebrand medical conditions as lifestyle choices, and the patients who suffer from them as consumers, have received little scrutiny. (Ebeling, 2008, p. 1). 9, p. ). providing details of their products through journal articles or opinion leaders; Worse, the trend is seriously undermining the regulatory authority of the FDA. It's not surprising that profit-driven, cu tting-edge marketing techniques have outstripped the government agency established to guide them. What is surprising is that public health advocates haven't made pharmaceutical rebranding and off-label promotions of drugs and medical devices major issues. In December, the advocacy group Consumers Union sent a letter (PDF) to the FDA requesting tighter DTC advertising regulations on medical devices. Ebeling, 2008, p. 1). The December 2007 issues of the women’s fashion magazines Allure and Harper's Bazaar both featured multi-page spreads on non-surgical cosmetic procedures, including the array of injectable wrinkle fillers. The articles outlined the pros and cons of each filler, evaluating injection pain, cost per injection (most run between $500 and $800 per shot), and how long each lasts (Ebeling, 2008, p. 1). Dermatologist and anti-aging cream entrepreneur Dr. Patricia Wexler is featured prominently in the Bazaar story.Her remarks about each injectable reflect the marketing language of the brands themselves. When she is discussing Sculptra ®, for instance, she describes how the product acts as â€Å"a trellis on which the collagen can grow† — a line marketers use to describe how the device works. She also repeatedly suggests what are off-label, unregulated product applications, such as using injectable fillers in the eye area, in the temples, in the jawline, on the cheekbones, and in the fine lines surrounding the mouth. Dr. Wexler's injectable filler romotions are especially credible among the target audience. Wexler regularly discusses non-invasive, anti-aging procedures on the â€Å"Oprah Winfrey Show,† the â€Å"Today Show,† and â€Å"Good Morning America,† and in the pages of Vogue and Marie Claire. The big pharma companies that make the injectable fillers likely dream of doctors touting their products and suggesting off-label uses for them in popular women's magazines. As the saying goes, they couldn't buy suc h good press — but they probably did. (Ebeling, 2008, p. 1). Dr. David J.Triggle, a pharmacologist at the State University of New York at Buffalo who has written about drug advertising, says a doctor’s endorsement should be scrupulously honest (Saul, 2008, p. 2). Dr. Robert Jarvik, known for the artificial heart he pioneered more than a quarter-century ago. began appearing in television ads two years ago for the Pfizer cholesterol drug Lipitor (Saul, 2008, p. 1). Skip to next paragraph The ads have depicted him, among other outdoorsy pursuits, rowing a one-man racing shell swiftly across a mountain lake. When diet and exercise aren’t enough, adding Lipitor significantly lowers cholesterol,† Dr. Jarvik says in the ad. Celebrity advertising endorsements are nothing new, of course. But the Lipitor campaign is a rare instance of a well-known doctor’s endorsing a drug in advertising — and it has helped rekindle a smoldering debate over whether it is appropriate to aim ads for prescription drugs directly at consumers. A Congressional committee, concerned that the Lipitor ads could be misleading, has said it wants to interview Dr. Jarvik about his role as the drug’s pitchman.Some of the questions may involve his credentials. Even though Dr. Jarvik holds a medical degree, for example, he is not a cardiologist and is not licensed to practice medicine. So what, critics ask, qualifies him to recommend Lipitor on television — even if, as he says in some of the ads, he takes the drug himself? (Saul, 2008, p. 1). Skip to next paragraphThe House Committee on Energy and Commerce is looking into when and why Dr. Jarvik began taking Lipitor and whether the advertisements give the public a false impression, according to John D.Dingell, the Michigan Democrat who is the committee’s chairman. â€Å"It seems that Pfizer’s No. 1 priority is to sell lots of Lipitor, by whatever means necessary, including misleading the American people,† Mr. Dingell said. Lipitor, the world’s single best-selling drug, is Pfizer’s biggest product, generating sales of $12. 7 billion last year. But as it has come under competition from cheaper generic alternatives, Pfizer has used the Jarvik campaign, introduced in early 2006, to help protect its Lipitor franchise. Wherever the Congressional inquiry leads, the controversy risks damaging Dr.Jarvik’s credibility and undermining his real medical mission. The Jarvik campaign was rolled out the same year that Zocor, Lipitor’s chief competitor, became available as a generic drug that is widely considered about as effective as Lipitor but is sold at a fraction of the cost. (Saul, 2008, p. 1). Skip to next paragraph Criticism of consumer advertising of pharmaceuticals flared as an issue back in 2004, when Merck withdrew Vioxx, a heavily advertised painkiller, after a clinical trial showed that it sharply increased the risk of heart attack s and strokes.The pharmaceutical industry adopted voluntary guidelines the next year suggesting that companies delay advertising new products for an unspecified period after they first reach the market (Saul, 2008, p. 1). In early January, the U. S. House Committee on Energy and Commerce began investigating celebrity endorsements in television ads for brand-name drugs. These direct-to-consumer (DTC) ads have been controversial since the Food and Drug Administration (FDA) loosened the rules governing pharmaceutical marketing in 1997.Before Lipitor made headlines, there was Viagra. Pfizer's â€Å"Viva Viagra! † campaign was criticized by the FDA and organizations including the AIDS Healthcare Foundation, who said the DTC ads encouraged recreational use of the erectile dysfunction drug. One print ad suggested that Viagra be used to â€Å"celebrate† events such as the Super Bowl or New Year's Eve. (Ebeling, 2008, p. 1). While troubling, DTC ads represent only 14 percent of pharmaceutical companies' marketing budgets.By the time a 30-second drug commercial airs, the company has conducted months of segmentation studies, held dozens of meetings to define the â€Å"communication target† (typically a woman, usually a mother, and of a certain income), and spent millions of dollars to develop the drug's brand and its market. This strategic marketing, which represents the remaining 86 percent of drug promotion expenses, should receive at least as much attention from regulators and lawmakers as DTC ads. (Ebeling, 2008, p. 1).While DTC ads seek to change patients' behavior, pharmaceutical companies are more interested in changing doctors' behavior. Drug marketers work hard to persuade doctors to prescribe their branded drug over generics and other competitors, and to change other medical practices that limit company profits. To cultivate medical professionals, drug companies may retain a doctor as a spokesperson, position friendly medical â€Å"thought -leaders† in the media, or organize free events at posh resorts and expensive hotels to â€Å"educate† doctors about a new disease state (think Restless Leg Syndrome) or their latest drug.In 2000, the biggest 10 pharmaceutical companies spent $1. 9 billion on promotional events alone (Ebeling, 2008, p. 1). For example, the FDA found that Eli Lilly's television broadcast advertisement for Strattera (atomoxetine) was false or misleading because it inadequately communicated the indication for the drug (attention-deficit–hyperactivity disorder) by means of competing visuals, graphics, and music presented concurrently. Similarly, serious risk disclosures were minimized for Strattera, the FDA said, by the distracting visuals and graphics (e. . , erratic camera movement, quick scene changes, and visual changes in point of view). In another case, the FDA said Pfizer's print advertisement for Zoloft (sertraline) was false or misleading because it omitted important informa tion relating to the risk of suicidality in patients, a risk stated on the product's label at the time the advertisement ran. (Donohue, Cevasco, & Rosenthal, 2007, p. 1). Drugs that are advertised to consumers are predominantly new drugs used to treat chronic conditions.Ten of the top 20 drugs, as ranked by advertising spending, were introduced in 2000 or later. Advertising campaigns generally begin within a year after the introduction of a pharmaceutical product, which raises questions about the extent to which advertising increases the use of drugs with unknown safety profiles. At least one pharmaceutical manufacturer (Bristol-Myers Squibb) recently announced a voluntary moratorium on direct-to-consumer advertising for drugs in the first year after FDA approval.And PhRMA, the industry trade group, has recommended that manufacturers delay such campaigns for new drugs until after health professionals have been sufficiently educated, although no details have been provided on how long a period was deemed necessary. 20 Finally, in a recent study of drug safety, the Institute of Medicine recommended that the FDA restrict advertising for newer prescription drugs. 8 Our data show that a mandatory waiting period on advertising for new drugs would represent a dramatic departure from current industry practices.For example, the FDA found that Eli Lilly's television broadcast advertisement for Strattera (atomoxetine) was false or misleading because it inadequately communicated the indication for the drug (attention-deficit–hyperactivity disorder) by means of competing visuals, graphics, and music presented concurrently. Similarly, serious risk disclosures were minimized for Strattera, the FDA said, by the distracting visuals and graphics (e. g. , erratic camera movement, quick scene changes, and visual changes in point of view).In another case, the FDA said Pfizer's print advertisement for Zoloft (sertraline) was false or misleading because it omitted important in formation relating to the risk of suicidality in patients, a risk stated on the product's label at the time the advertisement ran. (Donohue, Cevasco, ; Rosenthal, 2007, p. 1). direct-to-consumer advertising of prescription drugs on television. Such advertising has been criticized for encouraging inappropriate use of medications and driving up drug spending. ,2 Concern that such advertising may lead to increased use of expensive medications was amplified by the introduction of a prescription-drug benefit in Medicare in 2006 (Part D). Studies of the effect of advertising on prescribing practices have shown that such advertising increases classwide sales, helps to avert underuse of medicines to treat chronic conditions, and leads to some overuse of prescription drugs. (Donohue, Cevasco, ; Rosenthal, 2007, p. 1). Direct-to-consumer advertising has also been controversial in light of postmarketing revelations regarding problems with drug safety.Specifically, clinical trials that are requ ired for drug approval are typically not designed to detect rare but significant adverse effects, and contemporary methods of postmarketing surveillance often fail to connect adverse events that have a high rate of background prevalence with the use of particular drugs. After the market withdrawal of Vioxx (rofecoxib), a drug heavily promoted to consumers,6 critics called for the FDA to place limits on direct-to-consumer advertising, particularly for new drugs,7 a view that was reiterated in a recent report by the Institute of Medicine on the safety of medicines. (Donohue, Cevasco, ; Rosenthal, 2007, p. 1). Sponsoring continuing medical education describes the influence of sponsoring on the results, protocol and quality of drugs studies (Deutsches Aerzteblatt International, 2010, p. 1). The authors conclude that pharmaceutical companies exploit a wide variety of possibilities of manipulating study results. Apart from financing the study, financial links to the authors, such as payme nts for lectures, may tend to make the results of the study more favourable for the company.Not only the results themselves, but also their interpretation, are significantly more often in accordance with the wishes of the sponsor. (Deutsches Aerzteblatt International, 2010, p. 1). In some publications, the authors detected evidence that sponsors from the pharmaceutical industry had influenced study protocols. For example, placebos were more frequently used in drug studies than was the case with independently financed studies. On the other hand, some favourable effects were linked to financial support from the pharmaceutical industry.The methodological quality of studies with industrial support tended to be better than with independent drug studies(Deutsches Aerzteblatt International, 2010, p. 1). Most physicians must complete accredited continuing medical education (CME) programs to maintain their medical licenses, hospital privileges, and specialty board certifications. Data from t he Accreditation Council for Continuing Medical Education (ACCME) show that CME is a $2 billion per year business in the United States that earns less than half its revenue from physician learners themselves. CME is increasingly underwritten by commercial sponsors — primarily manufacturers of drugs, biologic therapies, or medical devices — that spend more than $1 billion per year in educational grants and other funding to cover more than half the costs for CME activities (Morris ; Taitsman, 2009, p. 1). In recent years, a number of studies have shown that clinical drug trials financed by pharmaceutical companies yield favorable results for company products more often than independent trials do. Moreover, pharmaceutical companies have been found to influence drug trials in various ways. Schott, Pachl, Limbach, Gundert-Remy, Ludwig, ; Lieb, 2011, p. 1). Published drug trials that were financed by pharmaceutical companies, or whose authors declared a financial conflict of interest, were found to yield favorable results for the drug manufacturer more frequently than independently financed trials whose authors had no such conflicts. The results were also interpreted favorably more often than in independently financed trials. Furthermore, there was evidence that pharmaceutical companies influenced study protocols in a way that was favorable to themselves.The methodological quality of trials financed by pharmaceutical companies was not found to be any worse than that of trials financed in other ways. Conclusion: Published drug trials that are financed by pharmaceutical companies may present a distorted picture. This cannot be explained by any difference in methodological quality between such trials and trials financed in other ways. (Schott, Pachl, Limbach, Gundert-Remy, Ludwig, ; Lieb, 2011, p. 1). Clinical drug trials funded by pharmaceutical companies yield favorable results for the sponsor’s products more often than independent trials do.This has been demonstrated by a number of studies in recent years Various ways have been described in which pharmaceutical concerns exert influence on the protocol and conduct of drug trials, as well as on the interpretation and publication of their results. This systematic review showed widespread conflicts of interest in the shape of financial connections between scientists, academic institutions, and the pharmaceutical industry. Around one quarter of academic staff and two thirds of academic institutions had financial relationships with industry.Analysis of 8 review articles embracing a total of 1140 original articles (including randomized controlled trials [RCT], economic analyses, and retrospective cohort studies) revealed a statistically significant association between funding by biomedical companies and conclusions favorable to the pharmaceutical industry (summarized odds ratio [OR] 3. 6, 95% confidence interval [CI] 2. 6–4. 9). Industry financing was also connected with l imitations of publication rights and constraints on access to trial data. Schott, Pachl, Limbach, Gundert-Remy, Ludwig, ; Lieb, 2011, p. 1). In the second review, a systematic analysis of 30 publications, Lexchin et al. showed that drug trials financed by pharmaceutical companies are less likely to be published, but that those published more frequently yield positive results for the sponsors’ products than do independently funded studies (8). The quality of the methods employed (analyzed in 13 publications) in trials financed by pharmaceutical companies was not inferior to that in studies with other sources of funding. Schott, Pachl, Limbach, Gundert-Remy, Ludwig, ; Lieb, 2011, p. 1). The authors of the present systematic review set out to assess whether recently published studies reveal a connection between financing of drug trials by pharmaceutical companies and results favorable to these companies’ products. Part 1 investigates whether and, if so, how the type of fu nding affects study protocol and quality. Part 2 identifies and depicts the aspects of clinical drug trials that can be influenced by financial support from the pharmaceutical industry. Schott, Pachl, Limbach, Gundert-Remy, Ludwig, ; Lieb, 2011, p. 1). The publications included were primarily studies performed with the expressed goal of comparing clinical trials funded by pharmaceutical companies with clinical trials that had not received financial support from such companies, e. g. , with regard to the results or conclusions. These studies were accompanied by a number of publications that investigated the consequences of financing of a study by pharmaceutical companies.These included, for example, articles in which information from the files of the US licensing authority (Food and Drug Administration, FDA) was compared with data from publications in medical journals, and case studies on individual substances. (Schott, Pachl, Limbach, Gundert-Remy, Ludwig, ; Lieb, 2011, p. 1). Conne ction between type of funding and results of drug trials Twenty-six of the 57 publications analyzed sought to ascertain whether the results and/or conclusions of drug trials depended on the type of funding or on financial conflicts of interest on the part of the authors (eTable). Schott, Pachl, Limbach, Gundert-Remy, Ludwig, ; Lieb, 2011, p. 1). Altogether, 23 of these 26 studies came to the conclusion that there was a positive correlation between the financing of a study by pharmaceutical companies and/or conflicts of interest on the part of the authors and results or conclusions that were favorable to the sponsor. The statistical significance of this finding was investigated in 22 cases and confirmed in 20. (Schott, Pachl, Limbach, Gundert-Remy, Ludwig, ; Lieb, 2011, p. ). In 4 cases it was apparent that the findings were interpreted favorably towards the pharmaceutical concern that had funded the study, independent of the results (e5–e8). (Schott, Pachl, Limbach, Gundert-R emy, Ludwig, ; Lieb, 2011, p. 1). Another study investigated the connection between the conclusions and the source of financial support in clinical trials that had appeared in 5 influential medical journals over a period of 20 years (e10).Most trials yielded positive results for the drug in question regardless of the funding source, but this study also revealed a trend over the course of time towards more positive findings in industrially financed trials than in trials supported by non-profit organizations (e10). The third study compared the results (but not the interpretations or conclusions) of clinical trials of drugs used in pain management, some of them long available as generics (e9). (Schott, Pachl, Limbach, Gundert-Remy, Ludwig, ; Lieb, 2011, p. ). Five of the 57 studies analyzed investigated whether funding by pharmaceutical companies affected the design of the study protocol (Table 1 gif ppt). The use of placebos was shown to be significantly more common in RCTs of drugs f or psoriasis that were financed by such companies than in those with funding from other sources (e12). Moreover, several studies of treatment for premature ejaculation that were sponsored by a pharmaceutical company were found to have disregarded the relevant objective endpoint (e13).In an investigation of inhaled corticosteroids, significant differences in the frequency of adverse drug reactions (ADR) between the probands and the control group occurred only half as often when the study had been funded by the manufacturers (see also Part 2). The differences could be attributed wholly to the study design. For example, studies financed by pharmaceutical companies used lower dosages. (Schott, Pachl, Limbach, Gundert-Remy, Ludwig, ; Lieb, 2011, p. 1).The pharmaceutical company concerned investigated the marketing effect of the study, finding that participating physicians did indeed prescribe rofecoxib significantly more often than non-participants in its first 6 months on the market. (S chott, Pachl, Limbach, Gundert-Remy, Ludwig, ; Lieb, 2011, p. 1). The results of clinical drug trials that are funded by pharmaceutical companies or whose authors have financial conflicts of interest are favorable to the products of the sponsoring company far more frequently than studies whose funding comes from other sources.Furthermore, interpretation of the data in the conclusions of industrially financed trials more often favors the sponsor. This was shown by the present systematic review and analysis of investigations, published between 1 November 2002 and 16 December 2009, into various diseases, study types (e. g. , RCTs and observational studies), and drugs. The results confirm the conclusions of 2 systematic reviews, both published in 2003, conducted with similar intent (7, 8).The principle of equipoise, i. e. , uncertainty which of the alternative approaches benefits the patient most, forms the ethical foundation of clinical studies in which the probands receive various tre atments (14). This principle seems to be violated in many studies funded by pharmaceutical companies. (Schott, Pachl, Limbach, Gundert-Remy, Ludwig, ; Lieb, 2011, p. 1). There are numerous reasons why studies financed by pharmaceutical manufacturers more often yield positive results.Four investigations found evidence that pharmaceutical companies influence the study protocol to their advantage (e12–e14, e19), e. g. , by more frequent use of placebos in control groups than in independently funded studies (e12). Although the responsible authorities sometimes demand placebo-controlled trials as a condition of licensing, they also request active controls (15). Further factors leading to higher frequency of results favorable to the sponsor in trials funded by pharmaceutical companies are described in Part 2 of this review. Schott, Pachl, Limbach, Gundert-Remy, Ludwig, ; Lieb, 2011, p. 1). Trials financed by pharmaceutical concerns displayed no signs of poorer methodological qualit y. On the contrary, two studies showed superior quality (e16, e17). It must be taken into account, however, that some factors that serve to assess the quality of the instruments used in a study were not determined, among them the clinical relevance of the target parameters. In oncology, for instance, there are currently major defects in the protocols of industrially sponsored clinical trials, e. . , deficiencies in the definition of patient-relevant endpoints and in the selection of suitable substances for the control arm of RCTs (16–19). Moreover, clinical trials in oncology are often discontinued after preliminary analysis (20), with the result that only a short time after the licensing of a drug its additional benefits and the safety of new substances can frequently no longer be evaluated, preventing any benefit/risk analysis (21). (Schott, Pachl, Limbach, Gundert-Remy, Ludwig, ; Lieb, 2011, p. 1). Conclusion:Wansink argues that the true challenge in marketing nutrition li es in leveraging new tools of consumer psychology (which he specifically demonstrates) and by applying lessons from other products' failures and successes. The same tools and insights that have helped make less nutritious products popular also offer the best opportunity to reintroduce a nutritious lifestyle. The key problem with marketing nutrition remains, after all, marketing. (Wansink, 2007, p. 1). New services must therefore be oriented toward consumers (i. e. , patients, health professionals, and third-party agencies) to gain acceptance (Grauer, 1981, p. ). We encourage family physicians interested in providing the best care for their patients to become educated in the advertising techniques used by the pharmaceutical industry. (Shaughnessy, Slawson, & Bennett, 1994, p. 1). | | | | | | | | | | | new challenges as well as opportunities for increasing profitability. If the pharmaceutical companies want to improve their Return-On-Investment (ROI), they have to adopt new communicat ion technologies (digital media) along with their conventional sales force of medical representatives.They really need to adopt this multi channel marketing strategies for the following reasons: The concept of blockbuster drugs is dying out for big pharmaceutical companies where 2-3 drugs were good enough to pay back the whole investment for a larger number of manufactured drugs. Now the limited prospective for blockbuster drugs (thanks to low investment on R&D and patent expiry) makes it essential to focus on more specialized drugs sold in lower volumes. And when there is low volume products, sales driven marketing strategy (with high cost of sales force) is not feasible.As far as small pharma companies are concerned, they already have small sales force. However, with the use of digital media, having a lower investment cost (both for the company and its targeted customer) they can easily get return on investment. Customer behavior (doctors behavior) is rapidly changing. Doctors, wh o are getting more and more busy with increasing patients, can be hardly seen by the medical representatives. They are more inclined towards Internet for obtaining relevant information.It is the time for pharmaceutical companies to build their marketing strategies around this digital media. Website marketing, online marketing, blogs, social media, forums, chat rooms and any other such media is an influential means to present the company's products and offers through opinion leaders (Need of New Pharmaceutical Marketing Strategies, 2010, p. 1). The right marketing strategy for any pharmaceutical company would be to build on proven strategic marketing principles, along with a focus on changing customer behavior.Use of digital media through Internet marketing plan is the best marketing strategy that can provide the basis for a changed business model. However, there should be some planning for using digital media for marketing too. It should be a multi channel marketing strategy but sho uld identify the target audience. Every digital media used for all people can not be called the right marketing strategy. The focus should be on the high value customer segment for pharmaceutical products (Need of New Pharmaceutical Marketing Strategies, 2010, p. 1).

Investigatory Project Mosquito Repellent

I. IntroductionA. Background of the StudyMosquitoes are common pests in the tropics they have been known to cause many disease to most people. The real danger of mosquito lie their ability to transmit diseases like yellow fever, malaria, and dengue people have used various instruments control the mosquito problem in homes. The most commonly used chemical insecticides sprays. Most of these can destroy mosquitoes but they can also do serious damage to humans as well. So the researchers decide to make a new change into our lives researchers prefer a natural insecticide in is not only affordable but it is also a health caring not like in chemical it is toxic and it is not environmental friendly in this case our planet earth undergoes a global warming so instead using a chemicals we used a natural ones.B. Significance of the ProjectIt can prevent and use to kill mosquitoes in our house or anywhere it also prevent the insect borne disease like malaria, yellow fever, dengue and many more it is not hazard into our health because its ingredients is finely arranged to make this project in a good phase it has good basis to use for likewise chemical repellent is not good for our health because of the chemicals, chemical is toxic to our health. And it is environment friendly not like the chemical ones not only our health is affected when we use a chemical insect repellent but also our dear mother Earth its chemical release cfc gases (ChloroFluoroCarbon) that traps the heat in our planet and causes global warming.C. Statement of the ProblemIs a natural mosquito repellent as effective and safer to use, commercial mosquito repellents found in markets? Can it be used in long ranges?D. HypothesisThe natural mosquito repellent is more safe and effective than the commercial repellent found in markets because it doesn’t contain chemicals.E. Objectives1. To have an alternative for a chemical insecticides.2. To kill mosquitoes and to prevent diseases coming from mosquitoes tha t results in death.3. To protect your family in the real danger of mosquito like malaria and dengue.F. Scope and LimitationsThis product is not to be used in wide area because it cannot kill all mosquitoes for only one time spraying and of course it is not like the chemical ones in a trial it can kills some of those and the delimitations is it not harmful in our environment because it is an environmental friendly and it cannot affect our health because it is made up of natural ingredients made up of nature product so that it is not harmful.G. Definition of TermsMalaria- an intermittent and remittent fever caused by a protozoan parasite which invades the red blood cells and is transmitted by mosquitoes in many tropical and subtropical regions. Mosquito- a slender long-legged fly with aquatic larvae. The bite of the bloodsucking female can transmit a number of serious diseases including malaria and elephantiasis. Dengue- a debilitating viral disease of the tropics, transmitted by mosq uitoes, and causing sudden fever and acute pains in the joints. Insecticides- a substance used for killing insects.Chemicals- a distinct compound or substance, especially one which has been artificially prepared or purified. Toxic- substance means any chemical or mixture that may be harmful to the environment and to human health if inhaled, swallowed, or absorbed through the skin. Organic- Any member of a  large class of chemical compounds whose molecules compound carbon.II. Review of Related LiteratureA. Related LiteratureAccording to blogspot.com , an insect repellent is a substance applied to skin or clothing, other substance it may be in solid form or in liquid form which discourages insects from landing or climbing on that surface. Insect repellent help prevent and control the outbreak of insect borne diseases such as malaria, dengue fever, yellow fever and other diseases. Pest animals commonly serving as vectors for disease include the insects flea fly and mosquito. Mosquito es have complex methods of detecting hosts and different types of mosquitoes react to different stimuli.Most mosquitoes are active at dawn and dusk but there are also mosquitoes that seek hosts during the day. You can avoid being bitten by making sure you aren’t attracting mosquitoes, using attractants to lure mosquitoes else where, using a repellent, and avoiding actions that diminish the effectiveness of the repellent. It has been claimed that it can be used as a home remedy to help speed recovery from throat or other minor ailments because of it antibiotic properties. Treatment, health benefits & side effects with Science Investigatory Project Review Related Literature About Mosquito Repellent products.Many of the sources come from our Encyclopedia of Natural Health and include relevant health topics. Uses vary, but may include Fighting Bacterial and Viral Infections, and Boost Mental Focus Utilizing Phospholipids and are non-FDA reviewed or approved, natural alternatives, to use for Chemotherapy, and Weakened Immune System. Science Investigatory Project Review Related Literature About Mosquito Repellent products are reviewed below.

The Clouds as Mental Therapy Essay Example | Topics and Well Written Essays - 250 words

The Clouds as Mental Therapy - Essay Example The researcher will strive to bring the concept of aesthetic healing whereby the city residents can heal their disturbed mind through nature therapy. In this project, the researcher wishes people can look at the sky and engage their mind by thinking about the artwork that brings the shapes of the clouds. Actually, an installation made in clouds shape, and recap about their childhood which let them have a breath and break from their routine tasks. Unfortunately, modern people forget about their childhood where they had a dream and passion for the world. In the current world, people get obsessed with the new idea and they have a fixed mind that the new idea can change the world. In order to unburden ones with tired mind and body, the researcher is going to give them a break and mental relief within their imagination. The clouds are marveling; that nature and artwork so mysterious such that when one sees the installation done in a cloud shape, they can play around within their mind like what we did in our childhood. Finally, one would have a mental relief that most of the city dwellers desperately need.

Performance Appraisals Research Paper Example | Topics and Well Written Essays - 1250 words

Performance Appraisals - Research Paper Example Performance appraisal is also used in performance management where subordinates are given a chance to appraise their employer’s performance in meeting their expectations and relaying such expectations to employers (DeNisi & Pritchard, 2006). Performance management is used to manage and align organization’s resources so as to achieve the targeted goals. Therefore, the way performance appraisal is managed in an organization is a determinant of whether the organization will fail or succeed. DeNisi and Pritchard (2006) advise that every organization that plans to attain a competitive edge should put performance appraisal among its top priorities. This competitive advantage is highly depends on the way communication skills of the reviewer will guide that of the reviewed.McLean (2010) has outlined the way business communication should be fashioned when doing performance appraisal and other business undertakings. He analyzes that a business communicator should take the respons ibility of preparing several facets such as clarity, conciseness, punctuality and organization before the communication starts. In this case, if the business communicator is preparing for a performance appraisal exercise all these facets are significant so as to attain all set goals of the assessment. When all these facets are considered, the business communicator is said to be well prepared. This preparation involves selecting an appropriate topic to the goals and objectives of the appraisal, doing research on the needed information and covering the topic., putting the information in a logical sequence, and preparing for the best presentation of the interviews for appraisal. From the classical perspective, Mclean (2010) used the Aristotelian model of organization of a communicator. For Aristotle, the organization of a communicator is referred to as logos or logic. This involves making the communication and assessment logical so that it clearly leads to the intended end (Manasa & Re ddy, 2009). This process may involve filtering the needed and unwanted information based on the objectives of the whole exercise. This way, a logical performance appraisal assessment is understood by the reviewed, and they are able to offer their logical responses as well. The second part is that the message should be clear. Vague and wandering communication is not interesting listening or

Foundation of Marketing Essay Example | Topics and Well Written Essays - 1500 words

Foundation of Marketing - Essay Example The prospective markets for the household insurance products are also promising to the company. The company being the one that is specialized in auto insurance they have a very good market share and satisfied customers. Under internal audit concept, it is necessary to evaluate that whether PGI should have adequate resources for involving the new house hold insurance business. For the purpose of expanding the existing business, every business should require appropriate resources, like material, men, and money. Rather than these, effective marketing is also crucial. Market audit of the company throws light on the current market share of the company and the future opportunities for the company in the Market. Analysis of the case shows that PGI is the market leader in the Auto insurance sector. In 2006 the company had a total policy strength of 5, 66,000. And also the company had gained an annual growth rate of 6.2%. But even though the company has the best policy strength the growth rate of the company is lower when compared to its competitor. Blair Patterson has the highest growth rate which is 82.5% and Cherry Ash has a growth rate of 25% while the growth rate is only 6.2% for PGI. For the purpose of introducing house hold insurance, it is necessary for PGI to undertake various marketing strategies. Among them Porter's five force model is significant. supplier Power, rivalry, threat of substitutes, buyer power, barriers to entry. While introducing new house hold insurance by PGI, it is essential to concentrate about the competitors, substitute 's etc. Rather than this, it is also necessary to consider the macro environment factors like political, economic, social, technological, ecological and legal. Political Consist of legislation, regulation of transfer for capital and labour, and stability of political system. Economical consist of development of relevant economic indicators, business cycles, unemployment, and industry structures. Socio- Cultural consists of population and demographics and customer behaviour. Technological consist of life cycle phases of products and research and development expenses. Marketing Structure for Company Marketing is distinct in the Dictionary of modern English (1995:872) as the action to try to put up for sale a company's goods by advertising, by attractive packages. Consequently I can say advertising is a way companies sell their goods to the neighbourhood that needs them or customers. The following are a number of of the terms old in marketing covering, selling, advertising, endorsement of products and many additional, but these are the conditions I'm going to use a great deal on my essay. The paper will also be based on publicity, as it is fraction of advertising. According to the expert analysis advertising is merely an economic action that is used by advertisers for the reason of selling or hire customer's conscious of their military. To add on that I got a meaning of the word publicity from Dade (1989:1) and reads that "a paid statement future to provide information about a manufactured goods or service or to convince people to perform in a sure way." Some people too argued that

Aviation strategy- course assignment Essay Example | Topics and Well Written Essays - 4500 words

Aviation strategy- course assignment - Essay Example Making use of its point to point flights, the airlines gives regular direct flights for the short distances, for example from Los Angeles to Las Vegas, etc. In 2008, Southwest served 438 nonstop city pairs, in 64 cities in 32 states and carried over 101.9 million passengers, the most of any domestic carrier. As the low-fare leader, Southwest's average ticket price was $119.16 in 2008, up from $106.60 in 2007 compared to an average price of $139.40 in 2008 at its closest competitor, Jet Blue. The Southwest Airlines has a focused strategy, it has defined target market and does not scramble its efforts to gain benefits from all over. Instead, it has selected a niche segment, to cater their needs better. Target market - the market that the company focuses are the low cost and value conscious travellers, with no frills but a comfy journey. It focuses on customers that have to travel short haul, these include passengers that travel for their business, are time conscious as well and also include residential customers that prefer travelling for vacations and seeking best value for their spending. Product offering - With focused target market, Southwest has a differentiated product (service) offering, it describes its service offering as short haul, low fare, high frequency, and a point to point carrier in the United States' airline industry. The informal and casual but dignified journey experience is the whole package. It does not provide meals, a pack of peanuts would do, there are no assigned places, no transfer of luggage and no class differentiation either, in form of first class or the business class etc. Whilst the average cost of a meal serve per passenger in the airlines industry is approximately $5, the cost for Southwest airlines is around 20 cents (Rose, 1999)3. Pricing structure - since Southwest Airlines distinguishes itself as the low fare

Possible Recommendations for Drowling Mountain Essay

Possible Recommendations for Drowling Mountain - Essay Example Operating as a nonprofit resort meant that the organization did not have any income generating activity but after its lease to Ian MacArthur, things took a new turn. This specifically means than for the business to continue flourishing as the leading skiing resort, the management should encourage more privatization efforts. Owing to the numerous challenges that the Drowling Mountain faced in its operations, one can insinuate that it performed rather well in the 2009-2010 financial year, at least going by the financial statements recorded during the year. Perhaps the first major recommendation that would save Drowling Mountain from the previous downward trend and set it for a financial takeoff is the adoption of new marketing strategies. Keeping cognizant of the fact that the competition is very stiff, particularly when it comes to the skiing industry, Drowling Mountain can only embark on a robust marketing campaign to attract more tourists. This is majorly because despite the fact th at Drowling Mountain is strategically located at the highest ski mountain, it has won the love of the local Syracuse residents in the past. In addition, most lovers of skiing prefer Drowling Mountain especially the local population who perceive that the skiing resort is one of their own besides offering a host of other hospitality services apart from skiing. When it comes to the management of the organization, much more need to be done in order to ensure that all the departments are fully functional. This ought to start with the restructuring of the Board of Directors in order to eliminate any redundant positions while creating new and deserving managerial positions. This will actually lead to enhanced efficiency in service delivery that will translate to high customer satisfaction. Currently, there are only eight members in the board out of the required eleven, which means that there are lapses in concrete decision-making and overall management of the resort. Perhaps another recomm endation that would befit Drowling Mountain is the use of industry comparable to take the company to the next level. Although Cartier had done a good job in this perspective, it is important to advise that the resort needs to compare with other players within the industry in order to set a benchmark from which to operate. This will not only help in keeping track of their rivals’ profitability and strategies but it will also help the company come up with better strategies to gain a competitive advantage. This means that in addition to looking for outside and new sources to finance initiatives that could chip in, the company needs to find a lasting solution to the long-term debt that has always kept a toll on its working capital. Instead of digging into the market dynamics, Cartier should simply enhance the cash position of the company by expanding the services through active encouragement of the tourists to enjoy other services of the resort apart from skiing. Since a vast maj ority of the customers have complained of exorbitant pricing by Drowling Mountain, it would be appropriate to consider the pricing strategy. Taking into consideration the advanced ski hills owned by Drowling Mountain, more tourists should be encouraged by fair pricing that would give them value for their money. This way, the company would experience a tremendous rise in its yearly profits because, currently, it is the resort of choice for most tourists despite the fact that it is the most expensive resort in Syracuse. It is understandable that customers tend to remember the lower prices even if there is an increase and there will be a careful strategies to make the customers understand in case of any price increase in the future. Perhaps the section that needs a major overhaul in Drowling Mountain

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Visual Literacy Essay Example for Free

Visual Literacy Essay 1. Although Howling Wolf’s drawing is seen as naively executed by the standards of Western art, why do we conclude that his record of the treaty signing event is more honest than the illustration rendered by the other artist? * In Howling Wolf drawing he included the â€Å"Medicine Lodge Creek.† His drawing had Native American women with their backs turned away from the people while they watched the signing. This to me was drawn to make the women look as if they had played an important role in the signing. He included a red strip of paint in their hair to show they were married women. Artist John Taylor did not include â€Å"Medicine Lodge Creek† in his drawing. Taylor’s drawing only included one lady by the name of Mrs. Margaret Adams. She was supposed to be the interpreter for the Arapaho. I think that Taylor’s drawing is dishonest because he did not correctly draw Wolf’s drawing. Wolf’s drawing is more honest because he drew full ledge women and drew proof of the signing. I think that Taylor’s drawing was bias towards the black women. He did not include the Native women because he did not want to show that they played a big role in the treaty signing. 2. Why did the White artist ignore the many native women who were present at the treaty signing? Do you think this omission was deliberate or unintentional due to cultural bias? * He may have thought they weren’t as important as Mrs. Margaret Adams. Since she was the daughter of a French Canadian trapper she showed more importance in his drawing. I think he ignored them in his drawing to be bias because they were Native Americans. He could see that in Wolf’s drawing they played an important role witnessing the treaty signing. Taylor in my opponent didn’t want them to be of any importance in his drawing. By portraying only one woman he was trying to change the original picture. He made his drawing include the people he felt was of importance to the treaty signing. I think he left them out because he didn’t want the Native American to feel as if they were any more important than Mrs. Margaret Adams. Another reason I feel he left them out is because they may have had a great deal in what the treaty said and he did not want to portray that in his drawing.

Marks and Spencers Business Strategy

Marks and Spencers Business Strategy Introduction In section A of this report, we will analyse and assess Marks and Spencers (MS) food sector business strategy. In previous consultancy task we examined UK supermarket sector and business environment. That will be crucial in understanding current MS strategic position. Also, it will help us to identify sources of competitive advantage and at the same time opportunities for future strategic positioning. In addition, we have to be aware of companys non-financial performances as well as quantitative corporate objectives and key performance indicators. Analysing them using balanced scorecard and benchmarking method will show us, is our strategy sustainable, does it have long run perspective and direction we are currently moving. This will be covered in part B of this report Part A Strategy can be defined as â€Å"the direction and scope of an organization over the long term, which achieves advantage in a changing environment through its configuration of resources and competences with the aim of fulfilling stakeholder expectations† (Johnson et al. 2005, pp.9). According to Porter (1996) company can do better than other companies only â€Å"if it can establish a difference it can preserve† (Porter 1996, pp.63). Delivering additional value to customers, providing them with comparable products at lower cost or both is a good way to make a difference according to the author. Johnson et al. (2005) presented three Porters generic strategies which could be used by companies to achieve competitive advantage: cost leadership, differentiation and focus. It can be concluded that MS using focused differentiation strategy. According to the Bowmans strategy clock this strategy is seen as high price strategy which gives perceived high value to customers. They choose to differentiate themselves from other food retailers with: top quality own label food, ready prepared meals, fresh food and food for special occasions. They do not attract customers for full weekly groceries shopping but gives them additional value for their money with focus on freshness and quality. Their simply food stores contributed with high margins to overall sales in past few years. Also, they expanded abroad to 40 countries in order to attract new sales into the same niche. This is consistent with Johnson et al. (2005) who explained that growth may be achieved by targeting new sale at the same market niche abroad. In previous consultancy we analyse supermarket sector using Porters five forces framework. That helped us to better understand industry in which MS operates. We concluded that power of suppliers is high due to a lot of supermarkets and brands. Also the threat of substitutes is high because customers now want better value for money. MS is aware of that, especially because that was primary reason for a big decline in sales in 1990. The power of suppliers is low because of huge number of fragmented suppliers. Threat of new entries is on medium level and competition among industry is on high level. The four biggest food retailers in UK (Tesco, Asda, Sainsbury and Morrison) have almost 76% market share. Therefore, MS with 3.9% market share in 2009 cannot compete with lower price strategy. Their focus is more on product quality. The MS food offer ‘has largely focused on the upper end of the mass market, typically higher than its positioning for non-food.'[1] They are selling own brand labels only to their customers which giving them value for money. It helps them in promotion of overall MS brand. The good thing is introduction of some branded goods from 2008, because of higher targeted customers demand. MS food sector strategy lies on companys basic values: Quality, Freshness, and Value, Standards of innovation, Ethical Sourcing and Healthy eating.[2] MS is premium food retailer and food sector is very important to overall group business and performance. It brings over 50 percent of group revenues in UK with sales of  £4.25bn in 2009. Previous consultancy also shows that the most influential trends in broad environment related to food industry are: Food industry was relatively recession proof and these days UK is officially out of recession after six consecutive quarters.[3] High level of inflation in UK (CPI inflation=3 percent) is the reason which contributed to retailers profitability. In 2009, MS reported slightly decrease in margins and profitability. Previous year, they were moving in good direction with initiatives to cut costs (marketing, distribution, support) and reinvest that money in prices to provide better value to customers. The bad thing is reducing capital expenditures for almost 40% which have to create value in future. Increasing number of healthy conscious consumers is a second trend. As a premium food retailer who is selling top quality food, this trend is big strategic opportunity for MS future strategic positioning. In addition to this, survey show that only one in six customers switched to less expensive and frozen food.[4] Today we have environmentally aware consumers. MS is first food retailer who realizes that. Thus, they presented Plan A in 2007 with 100 environmentally commitments to complete within five years. Today, after two years they achieve 39 commitments. This strategy have aim to differentiate their food business from main competitors. Online shopping is also todays trend and opportunity for retailers. They launched MS direct and free wine delivery as a result of growing demand. In 2009 MS market share decline from 4.3% to 3.9% and this is opposite to what board of directors announced in 2008. They predicted growth in market share to 5%.[5] In formulating strategy for next year, they have to take into account few things which will have effect on customers disposable income. From January 2010, we have increase in Value added tax from 15 to 17.5%. Personal income tax will stay at the same level in 2011.This fiscal measure will affect 70,000 people across UK who are now in higher tax band. Additionally we have announced increase in sin taxes for alcoholic drinks. Customers are today spending  £36 per person per week on food in UK.[6] Previous mentioned changes will have certain impact on customers spending habits. Probably they will not cut food expenses, but some products coul be more affected. That is one reason more for MS to provide customers with additional value for money. Part B Balanced scorecard The Balanced scorecard is â€Å"an integrated set of performance measures derived from the companys strategy that gives top management a fast but comprehensive view of the organizational unit.† (Drury 2004, pp.1001). The main question behind the balanced scorecard concept according to Kaplan and Norton (2001) is how to measure future performance. The authors were aware that companies are only in 10 to 30 percent successful in executing its strategy. The main reasons are vision, people, resource and other barriers. For example non-understanding of strategy by employees or management fails to link budget with strategy objectives. Also they realize importance of intangible assets, not capital anymore in adding value to company. In this new business environment focus only on past financial measures (profit, cash flow) and not taking into account non-financial performances such as customer satisfaction could be fatal for organization. The authors presented framework and suggest eve ry company to be viewed from four perspectives: financial, customer, internal business process and learning and growth perspective. All financial and non-financial measures and objectives should be based on companys vision and strategy. That will help managers to have overview over whole processes in company and employees to better understand global firms strategy. We will use suggested framework to support formulation and implementation of Marks and Spencers current strategy. 1. Financial perspective Kaplan and Norton (2001) argue that non-financial perspectives are important but the same is with financial perspective. The reason is simple. Effects from other three perspectives will show their impact through companys financial performances. Marks and Spencer current financial objectives on group level and business unit level are to reduce costs and manage cash flow. In 2009, the effect of broad environment and recession in UK impacted direction of MS strategy. Because of decrease in UK food sector sales and decrease in market share from 4.3% to 3.9 % they choose to reduce costs with aim to keep profitability. Food gross margin was down 235 bps at 31.5%. We can continue to use gross margin as performance measure. Also, we could use profitability measures such as Operating profit, Return on equity, Return on capital employed and net margin which are already being used as MS key performance measures. The results of reducing costs are, reduced spending in support areas and marketing activities of 8.6% without threatening customer satisfaction (stayed at average high level of 84%) and increase of only 1.9% in staff costs. These activities will have impact on profitability in coming years. The target for next year should increase of 10% in mentioned profitability measures. On the other hand, significant cut in capital expenditures of  £450 million h ad immediate impact on companys cash flow from investing activities. MS also have to focus to on how to improve operating cash flow. They decreased cash conversion cycle for almost 6 days.[7] They should further monitor debtor payment period, creditor collection period and stock clearance period (decrease from 8.7 to 4.29 days in 2009).[8] In future, decrease of 10-20 % in stock clearance period and cash conversion cycle could help the company to have stronger cash flow. 2. Customer perspective Main objectives of MS in order to increase market share, acquire new customers and keep customer satisfaction on a high level are to provide customers on targeted market with additional innovation, improved on-shelf availability and to give them additional value for money. The last have roots to year 1935 slogan â€Å"Dont ask the price its a penny†[9]. They took numerous promotions like â€Å"Wise buys†, ‘Family favourites for  £4 and ‘Dine in for two for  £10 during the year. Despite this investing in prices across food range have impact on companys margins, it also provides customers with better value. In 2009 survey, MS is recognized as a leader in top quality food. In future, they should increase ‘wise buys products from existing 10% food range and set target measure to 15%. Also, innovation in products should be continued and monitored with comparing percent of new products in overall products. Relating to on-shelf availability, they already employ more people in stores, open new 75 and close 26 stores with underperforming performances. This trend should be continued because it gives customers more convenience shopping. Customer loyalty, satisfaction and quality customer service are important in future period especially when market share declined 0.4%. 3. Learning and Growth perspective Kaplan and Norton (1996) recognized importance of intangible assets and employees as most important resource company have. In order to keep customers satisfied and loyal, company need to invest in its employees, systems and organizational procedures according to Drury (2004). Therefore, employee satisfaction, investment in employee skill and training must not be overlooked. MS have good communication with employees via MS intranet and employee magazine. The results from employee satisfaction survey ‘Your Say show high response rate (90%) and consistent score with previous years of 70%. Another two measures could be applied to measure employee capabilities- employee retention and employee productivity. Last two derived from employee satisfaction, because only satisfied employee could be productive. Investment in employee skills is recognized as important for MS. Thus, organization of development programme for 2000 lines managers, leadership programme and food academy are vital for future growth and development. The aim to become most sustainable retailer by 2015 they converted into the Plan A. It is also in accordance with Food industry sustainability strategy presented by DEFRA in 2006. They already fulfilled 39 commitments in order to become energy efficient, send no waste to landfill and become carbon neutral. Target of accomplished 15 new commitments per year will keep them on right way to reach this strategic goal. 4. Internal business process perspective According to Drury (2004) internal business process perspective need to give answer on question what business processes will increase value to shareholders and customers and help company achieve its vision at the same time. MS recognizes that investment in innovation process and operation process (decrease distribution costs, maintain supplier satisfaction, increase efficiency in value chain and process quality) are vital to succeed. MS already presented innovation in food from national cuisines (Italian, Chinese etc.) and should monitor percentage of sales from these new products, also compare themselves with competitors (at first place Waitrose who is concentred on the same market niche- top quality food). To excel in innovation field, they should also focus on market products in which they are first or second in the market according to Drury (2004). Innovations in operation process has aim to make more efficient supply and value chain in a company. On one side we have suppliers and customers on other. Already half of 2000 suppliers were trained on MS ethical standards. Distribution costs will be managed with implementation of SAP software and building of domestic and international logistic and distribution centres. Once a build, they will significantly decrease distribution cost and time. Balanced scorecard method (BSC) will help organizations to translate vision into performance measures and improve communication within the company. Also we have to be aware of some limitations of BSC. Othman (2007) argues that BSC is static, ignores external environment and treat company as mechanical system. Drury (2004) describe that empirical study failed to provide evidence that link between non-financial data and financial performance in future exists- which is the assumption of BSC method. Benchmarking There are numerous definitions of benchmarking. One of the first books written about benchmarking providing definition of this method was in â€Å"The search for industry best practices that lead to superior performances† in 1989 by Camp. Until today many definitions emerged but still the most quoted one is from this book that says â€Å"Benchmarking is the search for the best industry practices which will lead to exceptional performance through the implementation of these best practices† (Ungen 2007,pp. 335). In this part, we are going to look at our internal strength and weaknesses, make comparison with our closest competitor in UK market- Waitrose, because both have almost the same market share of about 4% and the same market focus- top quality food. At the end, we will make comparison with Tesco and Sainsbury as a market leaders and see could we use knowledge to improve our operations. Here the aim is to learn from our competitors, not only to compare with them. First we have to understand our internal position- segments we are good at, possible opportunities and segments where improvement is needed. MS differentiate itself with high quality food and at the same time have perception among customers as a top food retailer. It has strong brand for last 125 years, strong internal financial sources and good communication with customers and suppliers. Almost 100% own label food is advantage but at same time could be weakness. So, they start selling branded premium food which they do not produce. Main opportunity is in further expansion to international market. Today, MS has 296 stores in 40 countries with significant 26% increase in international sales. In future, they should expand more as a wholly owned business, not as franchising business. Second, comparison with Waitrose we will start comparing their financial performances because they will show us how successful other perspectives from the balanced scorecard are. An MS food sector sale is down 0.1% at  £4.25bn with loss of market share of 0.4%. On the other hand, in the same period Waitrose increase its sale for 5% to  £4.2bn, market share 0.4% and decrease in operating margin 45 bps to 5.1%. Increase in Waitroses margins is at some part result of 13 Somerfield stores acquired in 2008. Waitrose is also focused on premium organic food brand. Comparing with Waitrose, MS opened 47 stores more and is selling 3600 products more with much more own label food selling. This store opening trend in previous years was primary reason for margin increase but now MS should closely monitor store performance (already close 26 underperformed stores in 2009) and different product lines and replace slow selling products. MS in terms of pricing is above Waitrose and selling almost 1 00% own brand food with products made in UK is major difference from competitor.[10] As a result their sales depends entirely on own label products. In addition to this in 2009 MS made a cut of  £127m in marketing activities which was important for him in food sector positioning.[11] In Corporate social responsibility section, MS is leader with presented 100 commitments plan A. Also partnership with Amazon will help them improve on-line shopping segment. On the other hand, Waitrose presented online food delivery service which could be next step for MS in satisfaction of customer needs. In UK food retail sector, major market share has Tesco and Sainsbury. They both have access to economies of scale and price promotions are fundamental part of their strategy. On the other hand, MS differentiate itself with providing additional value not cheaper price to customers. Despite different in size, MS could use good practice from leaders to achieve better results. Sainsbury launched these days promotion ‘buy now free next time.[12] MS could implement these on 500 wise buys products which are 10 % of range in a one month period and closely look at sales, profit margin and overall financial effect. Also, Tesco since last year increase 29% percent increase in marketing activities.[13] In year where we have 13.8% drop in organic food sale, cutting marketing activities as MS did should be re-examined. Tesco, for example offer double points in order to keep customer loyalty. MS has only 39 outlets out of 668 stores in UK. This number should be increased in future because of rising consumers demand for convenience shopping. Also, search for value and healthier eating will be still in customer focus.[14] Benchmarking can support BSC with recommendations from outside the company how internal, customer and learning and growth perspective could be improved. One of the main critics to benchmarking according to Johnson et al. (2005) it will not identify the reasons for companys good or poor performance. But Benchmarking as a tool have aim to improve companys performance and can support BSC. Therefore, synergy between benchmarking and BSC and implementation of current trends and best practice into organization will improve financial perspective of our company. Conclusion This report showed importance of understanding broad environment and market sector in strategy formulating and implementation. For example, mature supermarket sector in UK is one of the reasons for MSs decision to invest in developing countries in the same premium food market niche. In part B we showed changed focus from capital to intangible assets and from financial to non-financial measure. It is important for MS to monitor all four perspectives in order to have sustainable long- run strategy. Also it is vital for MS to understand what facors influence the financial and operational performance. Therefore, benchmarking and BSC should be used together in strategy formulation and implementation. References: Competition Commission (2000). Supermarkets: a report on the supply of groceries from multiple stores in the United Kingdom. Chapter 5. [online]. Last accessed on 24 April 2010 at www.competitioncommission.org.uk/rep_pub/reports/2000/fulltext/446c5.pdf Competition Commission (2008). The supply of groceries in the UK market investigation. [online]. Last accessed on 23 April 2010 at www.competitioncommission.org.uk/rep_pub/reports/2008/fulltext/538.pdf Department for Environment Food and Rural Affairs (DEFRA) (2009). Food Statistics Pocketbook. [online]. Last accessed on 24 April at www.defra.gov.uk Delpachitra, S. and Beal, D. (2002), Process benchmarking: an application to lending products, Benchmarking: An International Journal Vol. 9 No. 4, pp. 409-420. [online]. Last accessed on 24 April 2010 at www.emeraldinsight.com DEFRA (2010). Recovery, Growth and the Environment. 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