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Drug Delivery’s RISE CHALLENGES Big Pharma’s Dominance

Set to soar from just $2.4 billion to about $12 billion in just five years, the value of drug delivery technologies and the market clout of developers are making established pharmaceutical giants sit up and take notice, according to a study released today by Kalorama Information, a division of Market According to the study, delivery technologies themselves currently account for 16% of total rev enue in the oral delivery market, with the rest attributable to sales of the pharmaceutical being delivered. But by 2005, the technology component will soar to more than 40% of the total, in a market valued at almost $30 billion. This growing impor tance means more money for the delivery industry, but it also means that drug delivery companies will exert more influence over product design and development. The oral drugdelivery market is twofold, encompassing drug delivery technology and the revenue earned from licensing that technology and the sales of pharmaceuticals themselves. Because drug delivery technolo gy is an integral part of the pharmaceutical product and the drug delivery technology cannot exist without pharmaceuticals, rev enue has traditionally been reported as total sales. This is inclusive of the entire market for oral drug delivery. Kalorama believes inclusion of the pharma ceutical portion gives a distorted picture of the value of drug delivery technologies themselves.Therefore, the report, provides market data for the pharmaceu tical and drug delivery revenue in total and provides the percentage of revenue attributable solely to drug delivery sales. Data are presented for the entire forecast period from 1996 to 2006. Recent technical advances and market events have significantly raised the profile of drug delivery technologies. A spate of bigmarket patent expira tions is giving delivery innovators a chance to chal lenge big pharma for market share with new formu lations. In addition, splashy new products on the horizon (such as inhaled insulin) have given the sec tor high visibility. “It is no longer possible to turn a blind eye to the importance of delivery technology to the overall pharmaceutical industry,” says Steven Heffner, acquisitions editor for Kalorama. “Patent extension, product differentiation, and the promise of the drug discovery revo lution all depend on innovative delivery technology.” According to the study, this growing importance will cause some changes in the industry’s land scape;namely, large pharmaceutical companies may voraciously begin acquiring drug delivery companies to expand presence, deepen prod uct lines, extend product lifecycles, and forestall further incursions into their market share. The report released today is the first volume of a large, ongoing mar ket study of drug delivery technolo gies from Kalorama.Volume one,The Market for Oral Drug Delivery Sys tems, examines the market for mod ifiedrelease, fastdissolving, and tastemasked products and tech nologies,and is priced at $1,995. Pharma Sales Reps: LEARNING FROM THE LEADER Pharmaceutical sales forces have grown 85% in the past five years. As salesforces grow, revenue per sales rep tends to decrease. Due to this recent trend, leading pharmaceutical companies need to improve the effec tiveness and efficiency of their sales reps. Pharmaceutical sales rep resentatives operate in a highly competitive world where the most successful excel at weaving brief interactions with doctors into valuable longterm relationships. According to research from Best Practices LLC, sales managers can ensure that their sales representatives win favor among physicians by incorporating proven rela tionship management techniques as part of their training. “Pharmaceutical sales is very much a relation shipbuilding process,” says Chris Bogan, president and CEO of Best Practices. “Consequently, the prac tices used by leading sales reps to build those asso ciations are the companies’most valuable sales col lateral.” Consumers Want SEARCH ENGINES that Lead to Quality Health Websites In addition to significant consumer concerns about the quality and reliability of information on healthrelated Websites, survey results released by the Washington, D.C.based health organization, URAC, also known as the American Accreditation 68 S e p t e m b e r / O c t o b e r 2 00 1 PharmaVOICE PHARMA TRAX SALES, MARKETING, AND R&D TRENDS AFFECTING THE HEALTHCARE INDUSTRY Read clues that help discern the unique cultural and operating differences of each office Tailor detailing and sales messages in ways that achieve maximum impact Build rapport with physicians by openly discussing goals, office service needs, and personal needs TIPS FOR DEVELOPING WINNING RELATIONSHIPS URAC STANDARDSHAVE BEENDESIGNED FOR THE ACCREDITATION OF CONSUMER ONLINE HEALTH RESOURCES Health content editorial process Disclosure of financial relationships Links to other Websites Privacy and security Consumer complaint mechanisms HEALTHWEBSITE ACCREDITATION STANDARDSADDRESS: THE WORLDWIDE MARKET FOR ORAL DRUGDELIVERY SYSTEMS 19951996 1997 1998 1999 2000 2001 2002 2003 2004 2005 Calendar Year $30 $25 $20 $15 $10 $5 $0 Source:Kalorama Information FastDissolving/Tastemasked/Microemulsion ControlledRelease/SustainedRelease/DelayedRelease Note: $ are in billions EHEALTH PARADOX: It’s Harder to Reach Patients Online Than to Have an Effect on Them Although the Internet is increasing its influence on how patients approach their healthcare, strate gies borrowed from consumer sites fail to reach them,according to Harris Interactive andThe Boston Consulting Group.A recent study found that shifts in how people search for healthcare information pre sent industry players with new opportunities to engage and capture patients online. Deborah Lovich, a Boston Consulting Group VP and coleader of the BCG’s ehealth initiative notes PHARMA trax HealthCare/Commission, found that consumers want search engines that will help them locate high quality health information on the Web.More than75 millions consumers use search engines to find health information. The URAC study reports that more than 90% of consumers would prefer a search engine that indi cates whether health Websites are accredited according to rigorous standards.URAC suggests that such a system would help consumers find Websites more likely to provide the high quality, reliable infor mation they desire. A recent RAND Health study sponsored by the California HealthCare Foundation underscored the importance of this issue.The study found that search engines are usually inefficient and searches lead to irrelevant health information. Also, the study found that search engines are inconsistent and often pro vide very different results for similar searches. “As things now stand, search engines are some times an unreliable way to obtain healthrelated information,” says Garry Carneal,president and CEO of URAC.“Consumers are unable to determine from search engines which sites and information are rele vant and accurate. They want assurance that the search engines they use will lead them to sites that adhere to quality standards.” Healthrelated Website traffic is critically depen dent on search engines — only onequarter of the estimated 100 million people who seek health infor mation online go directly to a particular Website. “The challenge with online health information and search engines is one of quality and trust,” Mr. Carneal says. “Not only did we find that the majority of consumers want a quality `seal of approval’ on health Websites,but they also want to know there is a way to find those Websites through search engines.” 69 PharmaVOICE S e p t e m b e r / O c t o b e r 20 01 The application of genetics to biopharmaceutical R&D holds enormous potential,but is a highstakes game.An original research report issued byThe Boston Consulting Group (BCG) details the potential:savings, in the best case, of more than $500 million and up to two years in developing each new drug. In effect, that would more than halve the current cost of bringing a drug to market, and would transform pharmaceutical R&D and perhaps even the delivery of healthcare in general.But the report indicates that the application of genetics lags that of genomics technologies, and that there are many hur dles over which the approaches could stumble. “The potential rewards from applying genetics tools to R&D are enor mous,” says Peter Tollman,a BCG vice president in the Boston office and lead er of the firm’s biopharmaceutical R&D practice.“It’s possible that companies could, under certain plausible assumptions, cut the costs of drug develop ment by more than half.This promise should be tempered by the many asso ciated uncertainties however, significant scientific and technical problems that have yet to be solved, along with questions about market and regulato ry acceptance.” Mr.Tollman continues, “If companies ignore genetics, they could falter in the face of a truly transforming technology. On the other hand, to embrace genetics involves placing highrisk bets. The future of many firms may well depend on how successfully they navigate between these currents.” The report concentrates on two genetics approaches that are applicable to pharmaceutical R&D:Disease genetics, the search for diseasesusceptibility genes as potential drug targets, and pharmacogenetics, predicting patients’ drug responses by analyzing the genetic variations in their DNA. The two genetic approaches are applied at opposite ends of the phar maceutical R&D continuum.Disease genetics is invoked early in the drug dis covery process to help identify and validate key target genes for therapeutic intervention. By contrast, pharmacogenetics is used mainly to streamline the later stages of drug development by selecting for clinical trials those patients likely to respond favorably to the candidate drug. “Disease genetics holds the potential to change fundamentally the way drugs are discovered,whereas pharmacogenetics could radically change the way they are developed,” says Philippe Guy, senior VP, and leader of BCG’s worldwide healthcare practice. A targeted approach to drug development would make clinical trials more efficient and safer, but pharmacogenetics will not apply to all drugs. Pharmacogenetics will work only where the drug’s response and/or side effect profile is clearly linked with genetics, and where that relationship can be identified at the appropriate stage of development. Market implications will need to be considered as well: using Pharmaco genetics to exclude certain patients from clinical trials will shrink the poten tial market for the drug.Once again, pharmaceutical executives will confront the question of risk versus reward. The Impact of Disease Genetics Disease genetics should yield the larger share of cost savings, with the bulk being realized by improvements in the success rate of drug candi dates. But, these savings might be limited by the following: . Although culprit genes have been identified for numerous rare, single gene disorders, very few of the underlying genes have been pinpoint ed for common multigenic disorders. So it remains unclear whether a geneticsbased approach to drug discovery will really work, and if it does, for which diseases it will be relevant. . The cost of a comprehensive survey of diseaserelated genes is exorbi tant. However, this cost is expected to shrink in the next few years. . Original disease genetics studies are expected to identify only a small number of genes, and thus a small number of drug candidates, which then must struggle to progress all the way through clinical trials. The Potential of Pharmacogenetics Pharmacogenetics could fundamentally change the clinical develop ment of drugs in two ways: . Streamlining clinical trials — Clinical trials could be greatly reduced in size and cost by identifying and excluding in advance those patients unlikely to respond to the candidate drug. With a preselected patient population, the trials could assess a drug’s positive therapeutic effects far more effectively. . Salvaging compounds that would have otherwise failed — Genetic analyses could identify and exclude in advance those patients unlikely to respond to the drug, or who are likely to suffer from negative side effects. That might enable companies to continue developing drug compounds that would fail to secure regulatory approval for broad patient populations. DISCOVERY AND DEVELOPMENT Genetics in Drug R&D: HUGE REWARDS,HIGH RISK PHARMA trax that two contradictory findings have surfaced. “Patients who use the Internet to explore health issues report that the information they find online has a real impact on how they manage their overall care and comply with prescribed treatments,” she says.“This makes the Weban importantlever for com panies seeking to get patients more involved in care decisions.Yet, typical online trafficbuilding strategies don’t seem to work,since usage patterns in ehealth bear little resemblance to those in ecommerce.” Research shows that the more patients use the Web for health,the stronger their response to the call to action issued by healthcare companies. Indeed, those who use the Internet frequently are two to three times more likely than infrequent users to take action that affects their diagnosis and treatment. For example, the data patients find online result in their asking physicians more questions and in greater detail. But more importantly, when patients who frequently use the Internet for health consult with their doctors,about 36% suggest the specific ill nesses that they are suffering from and 45% request specific treatments. In comparison, among those who hardly ever venture online to find health infor mation, only 16% and 19% of patients respectively exhibit the same active involvement. Harnessing the power of the Internet will be daunting for healthcare companies, since reaching patients online is difficult. Recent research from Har ris and Boston Consulting Group reveals two key dis similarities between the searching behaviors of patients and consumers: First, unlike consumers seeking other informa tion online, patients don’t explore health topics on the Web at their leisure or for entertainment.The vast majority, 77%, use the Internet for health issues only when they have specific questions. Second, the same Internet users who might visit an automobile site to find information about cars or visit and return to Amazon to purchase books typi cally don’t turn to health sites directly when search ing for health information. To answer their health queries on the Web, 65% of patients usually start with general search engines such as Yahoo, Ask Jeeves, and Alta Vista. Only 24% make health portals such as WebMD and InteliHealth their first stop;11% start with diseasespecific Web sites such as Oncolo or MSWatch.And even those who favor spe cific healthrelated sites report that they initially found them through general search engines. These findings hold promise for all healthcare companies that benefit from influencing patient behavior, such as pharmaceutical companies pro 70 S e p t e m be r / O c t o b e r 2 00 1 PharmaVOICE PRIMARYWAYPATIENTS SEARCH FOR HEALTHRELATED INFORMATION ONTHEWEB % of patients accessing health information 65% Use search engines (includes banner ads) 24% Use general health portals 11% Use disease specific Websites PATIENT’S INTERNET BEHAVIOR MAKES THEM DIFFICULTTO REACH ONLINE Source: Harris Interactive and BCGAnalysis Note: Results for 14,278 respondents using the Internet for health related information; weighted to reflect the demographics of the entire online patient population. ADTCUPDATE PERCENTAGE OF RESPONDENTSCONTACTINGA DOCTOR ASADIRECTRESULTOFVIEWINGADTCAD 13% 10% 24% 7% 13% 20% 8% 12% 20% 9% 13% 21% 8% 10% 18% June 1998 June 1999 Dec.1999 Sept.2000 June 2001 Indirect Direct Total Source:DTC Monitor, Market Measures Interactive In 2001,DTC ads are not generating the direct doctor contact rates of nine months ago.However,more casual (indirect doctor contact) discussions with physicians have held steady for the last 2 years.This finding supports other consumer data from the 2001 DTC Monitor,which shows that consumers’discussions with physicians about DTC have become integrated into their ongoing healthcare behavior ADVERTISING AWARENESSOFDTC:ALLCONDITIONS JUNE 1996TO JUNE 2001 62% 71% 696 697 698 699 1299 900 601 Source:DTC Monitor, Market Measures Interactive While overall doctor contact rates have fallen off somewhat, general consumer awareness of DTC advertising has increased 3% points in the nine months. In fact consumer awareness of DTC has been trending up since 1996 — the first year of the DTC Monitor. 70% 72% 77% 71% 74% BCG SEGMENTED PATIENTS INTO FOUR PATIENT POPULATIONS BASEDONTHE SEVERITY OFTHEIR CONDITION AND THEIR ATTITUDETOWARDPHYSICIANS 55% Informed — Rely on doctors to make health decisions but typically go online after an office visit to learn more about a diagnosis or prescribed treatment without, in their view,wasting the doctor’s time with questions 28% Involved — View themselves as partners with their physicians in making care decisions and seek information online both before and after visits to discuss with their doctor; however,still rely on their clinician to make the ultimate decision regarding care 9% In control — Feel best suited to determine their care; use online information to diagnose themselves before visits to determine which treatments they want and to convince their doctor to treat them accordingly 8% Accepting — Rely entirely on doctors for health information and decisions THE IMPACT OF EHEALTH INFORMATION ON PATIENTS AND PHYSICIANS Source: Harris Interactive and BCGAnalysis PHARMA trax 72 S e p t e m b e r / O c t o b e r 20 01 PharmaVOICE moting new therapies and managedcare players promoting patient compliance with diseaseman agement initiatives. The struggle will be figuring out how to reach them. Tracking patients through search engines when logging on for answers to healthcare questions remains highly unpredictable. Emerging shifts in patient behavior, however, sug gest that healthcare companies can home in effec tively on the patient segments that they wish to tar get online. Research shows that while 46% of incontrol patients and 30% of involved patients often use the Web for health, only 14% of the informed and 3% of the accepting segments use the Internet in the same way. Because different segments of patients use e health differently and for different reasons, some patients are easier to find, and therefore easier to influenceonline. Two important behaviors of these groups have emerged: . Patients already have begun to migrate to more active segments in the past year.This suggests that greater patient access to online information is leading to greater patient involvement. Ultimately, if these shifts continue, the more active patients could well become the largest portion of the healthcare market. . Patients who take a more active role in their care are beginning to “stick” to sites.These patients are more likely than patients in other segments to visit health sitesand diseasespe cific sites in particular. Only 28% of patients in the accepting segment visit healthrelated por tals and diseasespecific Web sites, compared with 42% of the incontrol group.With roughly the same percentage — 23% to 27% of each segment visiting healthcare portals, the differ ences in behavior are fueled by visits to dis easespecific sites.This suggests that disease specific sites are an attractive pull for return visits among the most active and valuable seg ments in healthcare. “If, as the data suggest, patients continue to become more active and therefore more likely to visit diseasespecific sites, we can expect a shift to deep, narrow health sites,” Ms. Lovich says. “Conse quently,understanding the diseasespecific and seg mentspecific offerings that attract and retain patients will be an essential element for healthcare companies to build a future presence online.For the time being, however, search engines remain the most dominant vehicle for reaching patients on line.” Empowered Patients Are TAKING CHARGE and Getting Involved Healthcare is continuing to undergo fundamen tal changes as a result of new business models, developments in science and technology, and a growing emphasis on alternative or complementary therapies, according Euro RSCG Worldwide. “New technologies and genetic breakthroughs are further personalizing the healthcare process, whether by allowing patients to moni tor their medical conditions at home, providing broader access to information, or enabling doctors to tailor treatment via genetic testing,” says Mark Goldstone, director of development for Euro RSCG Healthcare. Among the key trends uncoveredby EuroRSCG’s S.T.A.R.: Strategic Trendspotting and Research, in homemonitoring is on the rise.A new generation of monitoring technology is allowing patients to take routine medical care out of the doctor’s office and into their own homes. The ability to monitor one’s owncondition at home becomes important not just in terms of cost savings, but also because of the greater sense of independence it affords. “Patients who play an active role in monitoring their chronic conditions are likely to feel greater `ownership’ of the problem — and, hence, may be more proactive in the pursuit of a solution,”Mr. Gold stone says. “Empowered consumers are, by defini tion, more involved in their own healthcare. The downside is that they will be expected to make diffi cult decisions and will need to have enough infor mation to make those decisions. The benefit is that they will be able to help shape moreindividual treatments with moreprecise and specific courses of action.” Web access has brought into consumers’homes notonly the kind of sophisticated health information once available only in medicalschool textbooks,but also increased access to information on physicians and medical facilities. Together, the thousands of healthrelated sites available enable people to approach their personal healthcare from a position of knowledge and increased power. “The passive healthcare consumer is becoming a relic of the past,” says Ann O’Reilly, author of the report and director of Euro RSCG’s S.T.A.R.“Technolo gy,particularly the Internet,is an enabler,but this shift is centered more on the overall attitudinal trend toward prosumerism. To an increasing degree, indi vidual consumers are becoming more demanding, more savvy, and less willing to accept massmarket solutions that don’t fit their individual needs. This applies regardless of whether the `product’ in ques tion is a pair of running shoes, kitchen cabinets, or a cancer treatment.” The trend toward patient empowerment, com bined with new technologies and scientific break throughs that permit such things as inhome mon itoring and geneticsbased prescriptions, ensures that traditional modes of patient care will be increasingly vulnerable to change. After a shift to sterile doctors’ offices and regimented hospitals, healthcare is once again becoming an integral part of everyday life. Treatments are taking place in the home,doctors are treating the “whole”patient rather than the disease, and patients are playing a larger role in determining how and where their conditions will be managed. CONSUMER PHARMACY Purchasing Patterns The second AmeriSource Index, a nationwide, quarterly survey released by AmeriSource Health Corp., polled 1,022 consumers about a range of top ics including the types of special services they would like to see in their local pharmacies, Internet buying, prescription purchasing patterns, and where they received the best service. ELECTRONIC DATA CAPTURE Market Cited for Growth There’s no mistaking the growth and the future potential of the electronic data capture (EDC) mar ket, according to Frost & Sullivan. For CB Technolo gies Inc. — a premier provider of technology tools and services, including MetaTrial EDC software to the lifesciences industry — the results of the U.S. Elec tronic Clinical Trials Market report, emphasize the strength of its market position. According to the report: . Hybrid EDC technology will be favored by the lifesciences industry . Alliances with electronic patient diary players are strongly encouraged to create integrated data capture solutions, enabling the collection of patient data directly into case report forms (CRFs) 56% Adjacent to doctor’s offices 19%Shopping malls 5% Internet 3% Office buildings 2% Health clubs and gyms 1% Restaurants WHERE SHOULDTHEDRUG STORE OF THE FUTURE BE LOCATED? Source: AmeriSourceHealth Corp. 39% Locally owned neighborhood drugs stores 36% Chain drug stores 15% Supermarkets 4 %Mass merchandisers WHICHTYPEOF PHARMACYOFFERS THE BEST SERVICE? Source: AmeriSourceHealth Corp. PHARMA trax 74 S e p t e m be r / O c t o b e r 20 01 PharmaVOICE . Consulting firms and other major technology players, such as Computer Sciences Corp.and Siebel Systems, are closely watching the EDC vendors for potential partnerships and affilia tions with the top players The Frost & Sullivan report states industry experts agree that regardless of technology, the type that will become most favored will be the hybrid model, because it offers the convenience of Internet upload ing while maintaining `on call’clean data at the inves tigator site. Hybrid EDC also allows for batch edits of patient records,a disadvantage of apureWeb system. CB Technologies pioneered hybrid EDC to offer phar maceutical, biotechnology, medical device compa nies and contract research organizations a consistent ly reliable, secure means to capture electronically the critical data collected during the clinical trials process. “We see this report as further affirmation that our innovative technology has become the industry gold standard,”says James L. Coyne,CEO of CBTech nologies. “We knew when we built our MetaTrial Hybrid EDC that Internet performance and speed were major concerns in adopting EDC technology. We worked to eliminate that as a barrier through MetaTrial’s design.” Primarycare Physicians Will Initially Remain LOYALTO PROZAC The U.S. patent expiry of Eli Lilly &Co.’s Prozac (flu oxetine) on Aug.2,2001,and the subsequent approval of several generic competitors are expected to dra matically alter the competitive landscape for selective serotonin reuptake inhibitors (SSRIs). In response to the question of whether and to what extent sales of other SSRIs will be adversely impacted by the release of generic fluoxetine, Decision Resources Inc., announced the results of a June 2001 survey of 72 U.S.based primary care physicians (PCPs) who are highvolume prescribers of antidepressants. The survey results indicate that 20% to 25% of the physicians in this influential group will initially retain their loyalty to branded Prozac rather than turning to the newly available generic fluoxetine for newly diagnosed depression patients. Preference for the branded product drops dramatically for existing patients, for whom weekly Prozac is another option. Prescribing patterns will be heavily influenced by potential formulary restrictions, as shown by physi cian responses when considering various managed caremandated treatment scenarios. The extent to which sales of other SSRIs — Pfizer Inc..’s Zoloft, GlaxoSmithKline’s Paxil, Solvay Pharma ceutical’s Luvox, and Forest Laboratories’ Celexa — will be adversely impacted by the availability of generic fluoxetine is highly dependent on the patient diagnosis and brand of SSRI.The survey finds that the remaining branded SSRIs will not be on a level playing field in terms of generic erosion.Survey results show the specific patient subgroupsand indi vidual brands that will be the most vulnerable. Formulary restrictions will influence significantly physicians’ generic fluoxetine prescribing patterns, particularly whenphysicians are considering switch ing patients’ medications. Results of interviews with seven pharmacydirectors of national HMOs showed them to be surprisingly consistent in their opinions of the future positioning of generic fluoxetine in their formularies and potential treatment directives that would be forthcoming. COX2 Inhibitors to Propel Pain Market to $30 BILLION BY 2007 The worldwide market for painmanagement therapeutics is expected to reach $30 billion by2007 from $22 billion in 2000, according to a report from Front Line Strategic Management Consulting Inc. The strong market growth that began in 1998,stem ming from the introduction of Celebrex ,marketed by PharmaciaCorp.and Pfizer Inc., andVioxx,market ed by Merck &Co., will stabilize at 4.4% during the next six years. This growth rate will be sustained by yearly world population increases and pain manage ment needs of a large population of seniors. Leading the pain category will beNSAIDs, includ ing top brands such as Celebrex and Vioxx. Analysts expect however that these brands’ sales will be effected by the imminent launch of the secondgen eration COX2 inhibitors that are in development. Analysts estimate that about 85 million people worldwide suffer from chronic pain and an addition al 193 million suffer from acute pain. Unlike chronic pain,acute pain is wellcontrolled through the use of NSAIDS and narcotics. Even so, a large portion of episodes of acute musculoskeletal, visceral, and intermittent pain are not treated by a physician. AMERISOURCE HEALTH CORP. is a dis tributor of pharmaceutical and related healthcare products and services,based in Valley Forge,Pa., and a provider of phar maceuticals to the acute care/health sys tems market. For more information,visit BEST PRACTICES LLC,based in Chapel Hill,N.C., conducts work based on the principle that organizations can chart a course to superior economic performance by studying the best business practices, operating tactics, and winning strategies of worldclass companies.For more infor mation,call 9194030251 or visit bestin THEBOSTONCONSULTING GROUP is a general management consulting firm based in Boston that works with compa nies in every major industry and global market to develop and implement strate gies for competitive success. For more information,visit CBTECHNOLOGIES INC.,Philadelphia, is a provider of electronic clinical intelligence tools and services for the lifescience indus tries.For more information,visit DECISION RESOURCES INC.,Waltham, Mass.,provides primary and secondary research publications,multiclient advisory services,and customized consulting. For more information,visit EURORSCGWORLDWIDE, is a global advertising network of 221 agencies located in 75 countries throughout Europe, North America, Latin America,Asia Pacific, and the Middle East.For more information, visit FRONT LINE STRATEGIC MANAGEMENT CONSULTING INC. is an international consulting company based in Foster City, Calif. For more information call Rob Ellis at 6505251500,ext. 123. FROST & SULLIVAN is an international strategic marketing consulting and train ing company based in San Jose,Calif.For more information, visit HARRIS INTERACTIVE is a worldwide market research, polling,and consulting firm based in Rochester,N.Y.For more information, visit KALORAMA INFORMATION,NewYork,is a division of that supplies the latest in market research for the lifescience industries.For more infor mation,visit NOPWORLD,UNITEDBUSINESSMEDIA, is a market research agency. For more information, visit URAC is a nonprofit,healthfocused organi zation and a leader in the accreditation of managedcare and specialty organizations based in Washington,D.C. For more infor mation,call 2022169010 or visit Follow up

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