Changing pharmacy for changing Germany

Germany is ageing, and fast – the UN puts the current average age at 46, second only to Japan, with the number of people over 60 set to reach 39% of the population by 2050. As younger Germans increasingly leave for the big cities, many small countryside towns are becoming depopulated, making it both hard for independent pharmacies to stay open and then to find replacements for them.

The small German town of Hüffenhardt – population 2,000 – is one such case, but luckily DocMorris has come up with an innovative solution to the problem – the telepharmacy, set to be opened as a pilot project in summer 2016. In the space of the old pharmacy, Hüffenhardt residents will be able to access a video screen linking them with a live pharmacist, with whom they can hold individual private discussions on health complaints, receive advice and product recommendations. At the end of the consultation, consumers can then choose to buy an OTC, or to hand in a GP prescription for checking, with the medicines then dispensed via a terminal controlled by the pharmacist. OTCs and Rx products which are not immediately needed can be delivered via DocMorris’ standard mail order service, or picked up at the neighbouring town at the next visit.

Hüffenhardt mayor Walter Neff commented: “The closure of our pharmacy affected our elderly and less mobile residents, who had to walk several kilometres to the next town to pick up medicines. Thanks to digital advances, Hüffenhardt residents can get personal face-to-face advice and pick up the most important medicines directly in the town”.

A longer version of this article will appear in the March 2016 issue of Nicholas Hall’s OTC INSIGHT Europe, a monthly publication reporting on OTC trends & developments throughout the region. For details on how to subscribe, contact


The Big Sleep

It is a common experience that a problem difficult at night is resolved in the morning, after the committee of sleep has worked on itJohn Steinbeck

With incidences of work-related stress picking up at an alarming rate around the globe, people constantly logging on and off the internet and electronic devices, and long-haul flights becoming longer and ever more frequent, so the quality of sleep from New York to London and Beijing has plummeted.  While the Centers for Disease Control & Prevention put the number of US citizens suffering from sleep disorders anywhere between 50-70mn, around a third of Europeans are said to suffer from sleep problems, rising to well over a half of all those over 65. Luckily the vast majority of these can be treated easily and safely with self-medication – the Chinese OTC sleep aids category is filled with TCMs, the US led by medicated ingredient diphenhydramine, while European markets are particularly fond of natural remedies with valerian, hops and melatonin.

It could even be that a good old glass of milk might be enough for some people. Scientists at the Sahmyook University in South Korea have shown that milk produced by cows at night – as opposed to during the day – can have a sedative effect, with their study published in the Journal of Medicinal Food. The study suggested that ‘nocturnal milk’ contains plenty of sleep-promoting ingredients, including the amino acid tryptophan and melatonin.

cow image

Your friendly sleep promoter

‘Night Milk’ is already on sale in pharmacies and drugstores in Germany in the form of Nachtmilchkristalle, a brand and company set up by farmer Tony Gnann. The cows are milked at night for the extra melatonin release – up to 100 times more than regular milk according to the company – with the animals also receiving a special regime of UV and long-wave red lights during the winter when they can’t be kept outside. Sales of the freeze-dried milk crystals, which can be stirred into other liquids, have not yet been enough to really test the leading sleep aid brands in Germany, but the recent South Korean study could provide a significant boost, and global interest is spreading. “In the past year we have seen increasing demand from England and soon it will be available in China”, said Kai Oppal, co-owner of Nachtmilchkristalle.

So maybe one last glass of the white stuff isn’t such a bad idea? Goodnight!

Brain Power for the Here and Now

It’s not for everyone and the rules are absurdly complicated, but cricket is a fascinating sport, not least for the monumental levels of concentration required by its players. Last week, two Australian cricketers spent over six straight hours batting together in the field. That’s six hours of trying to hit a red ball coming at you every 40 seconds, often in brutally hot conditions, and with the opposition doing and saying anything they can to distract you (known as “sledging”). Staying focused and in the moment is key. But that’s not possible for six hours straight. You have to know when to switch off … and switch right back on. It’s no surprise that vitamin marketers Swisse and Vitabiotics have recruited international cricketers Ricky Ponting and James Anderson respectively for their advertising campaigns in the past, even if the physical benefits have been more heavily emphasised than the mental.

ricky ponting swisse

Ricky Ponting for Swisse

Of course, extraordinary levels of concentration are required elsewhere: for airplane pilots, long-distance lorry drivers or even Cirque du Soleil dancers, a second’s lapse of concentration can put lives at risk! And in a digital age where we are constantly distracted by so many bleeps and flashing lights from phones and laptops, sticking with what’s in front of us also takes astonishing amounts of concentration, even for young people. Too often older consumers, or simply students, are flagged up in ads as needing to concentrate more and/or forget less. In fact we could all do with a little more brain power to deal with the here and now. An angle which VMS players should be much quicker to highlight.

Smoking cessation for Syrians?

The influx of Syrians to Germany has led many media sources to forecast a huge increase in cigarette sales. Around half of Syrian men smoke (according to the WHO), and with around 800,000 refugees entering the country in 2015, analysts reckon this will push cigarette sales up by 1% in an industry worth over €20bn.

Among discussions of how to physically accommodate the new refugees have been debates over state allowances afforded to them – they receive a monthly allowance of €143 for the first 3 months of entering the country and €300 thereafter. A pack of cigarettes costs well over €5 in Germany. A lot could therefore be gained by OTC marketers offering either free samples of smoking cessation options to Syrians, or starter packs at heavily reduced rates. Beyond saving money and improving respiratory health, even if only for a week or 2, it may also encourage refugees to seek out other health products in local pharmacies.

Some companies are admirably providing assistance to Syrian women and children by providing care packs containing body lotions, moisturising towels and underwear. While many may not consider a pack of nicotine gum or patches to be a truly necessary addition, they could go a long way to helping recipients stop for good, and ultimately save lives.

OTC experts on Germany, Austria and Poland will all be speaking at our 27th European Conference and Action Workshop in Krakow 13-15th April 2016. For more information on how to book at early bird rates, contact


Live life to the max… with OTCs

A recent CVS pharmacy survey has shown that over a quarter of Americans who get a flu shot every year or are planning to get one this year (60% of all respondents) cited the possibility of missing out on important life events such as birthdays and family gatherings as the reason for doing so.

While recent high unemployment in Southern Europe has led many cold & flu marketers to underline the importance of not skipping work through illness, not missing out on the good times and living life to the max is just as consistent a theme in European OTC ads as in the US.

Nicholas Hall’s Worldwide Marketing Award Winner way back in 2012 was Reckitt Benckiser, for its Don’t Lose A Day campaign backing Lemsip, Strepsils and Meltus brands, which highlighted the enjoyment of everyday activities unabated by cold & flu, from Tuesday dance classes to Friday night dates.

More recently, RB backed its Lemsip Cough Max entry with UK ads showing a mountain climber unable to make it to the summit owing cough, only to be boosted to the top with the aid of the Lemsip remedy.

Ricola used a slightly more surreal angle on the theme with its global Chrüterchraft (literally “the power of herbs”) campaign last year – also shown in the US – featuring naked ramblers and Nordic opera singers to emphasise Ricola’s ability to refresh, soothe, liberate and inspire.

Bayer’s more low-key TV ads for Aspirin Complex in 2014 leant on a Forsa survey showing that most Germans preferred to stay in bed when suffering from cold & flu, with the ads featuring a man miserably wandering around town in a duvet, featuring the tagline, “Live life to the full despite cold”.

Might CVS’ campaign prompt cold & flu marketers to focus their creativity more on individual “life events” rather than everyday ones? Or to further highlight the efficacy and relative convenience of tablets, syrups and lozenges as opposed to CVS syringes?

If you’ve launched an advertising campaign from 1st February 2015 or are planning to launch one before 31st January 2016, you could be up for a Nicholas Hall Marketing Award, which reward innovation and creativity throughout the consumer healthcare industry. For details on how to enter, contact

For a full review of recent A+P campaigns for cold & flu brands in leading markets, why not pick up a copy of our Cough, Cold & Allergy report? Contact for details on content & pricing.

The perfect birthday present

NicholasHallCo-AprilDreading the thought of traipsing up and down the high street failing to get an exciting birthday present for my sister, I was cheerfully reminded last week of personal genome test 23andMe, launched in the UK in December last year. While a breakdown of potential diseases waiting round the corner probably isn’t high on anyone’s Top 10 list of fun birthday things, the potential for better lifestyle management through this simple spit kit is quite extraordinary. Beyond being able to grade genetic traits ranging from smoking, taste perception and male pattern baldness – sis shouldn’t have to worry here – the test is also claimed to break down how your body is predisposed to react to drugs including PPIs, hepatitis C medications and a number of statins. So if healthcare professionals are willing to take on the information seriously, 23andMe could also help prevent thousands of cases of misdiagnosis and improve prescriptions. £125 a test sounds like a pretty fair price to me.

While I wait for her kit (and mine – 10% discount on multiple kits!), it is annoying, but unsurprising, to read a number of cynical online articles regarding privacy, following 23andMe’s second big deal with Pfizer in January 2015, which will focus on the genetics of lupus in 5,000 23andMe customers with the illness. All 5,000 individuals consented to the study and Pfizer will not be able to identify the anonymised patient data at individual level, a feature of 23andMe’s project made explicitly clear on the company website. All of which makes the genetics start-up a far cry from the cloak-and-dagger dealings of social media behemoths like Facebook.

Rather the cynics should look to the extraordinary potential for scientific innovation provided by such collaborations, as put by Pfizer’s Jose-Carlos Gutierrez-Ramos, Group Senior VP and Head of Bio-therapeutics R&D, “The expanding collaboration with 23andMe provides access to a wealth of data… The better we understand the genetic heterogeneity of complex diseases, the faster we may be able to accelerate the pace of development for potential new treatments for the right patient subpopulation.”

Find out more:

OTCs sum up the Greek Tragedy

NicholasHallCo-AprilOne of the many minor battles within the larger Greek crisis has been the free sale of OTCs. The Troika (European Commission, IMF and European Central Bank) has long advocated the release of OTCs from pharmacies as part of Greece’s economic reforms to boost competition and indeed the measure was passed by Parliament under the Antonis Samaras government in March last year, along with a lift on the ban on multiple-pharmacy ownership.

OTC free sale didn’t actually become a reality however and when Syriza came to power in January promising Greek pharmacists to back their “not one tablet in supermarkets” stand, it seemed that it was out of the question. But increasing Troika pressure has meant that Syriza has had to include OTC liberalisation as part of its latest reform proposals in negotiations, despite pharmacists closing stores in protest last month.

Sadly, it may be too little too late for Greece. As with so many of the government’s promises to its creditors over the past 5 years, it has come to nothing, owing to the wish to placate the plethora of Greek pharmacies – almost 1 to every 1,000 citizens, one of the highest rates in the EU. This is difficult to comprehend when hospital budgets for equipment and more serious medicines have been cut to so little for so long.

Perhaps one of the saddest aspects is that in the grander scheme of things, the free sale of OTCs was a relatively minor requirement from creditors, considering the grave situation Greece found itself in even 5 years ago, and quite possibly it may have had little to no effect on boosting trade. But the absence of effort from the Greek government in the eyes of the Troika, unlike Italy or Spain, to even give this modest policy a go has probably been simply yet another reason for creditors to refuse both more money or credit extensions.

German women enjoying new dawn after EHC switches

It has been just over two months since the first Rx-to-OTC switch of an emergency contraceptive in Germany, the first results are in and they should make happy reading for EHC marketers. Industry sources indicate that week-on-week EHC sales are around 40% higher than before the switch, a just reward for HRA Pharma’s 5+ year struggle with regulatory agencies to get the switch pushed through. The mid-May 2015 figures show volume sales for all EHCs sitting between 13,000 and 13,500, with around three-quarters of these generated OTC.

Following years of living in one of only three EU countries without OTC access to EHCs – along with Poland and Italy – German women now have a choice between ulipristal acetate, found in ellaOne only, and levonorgestrel, switched to OTC a few weeks later, found in HRA Pharma’s PiDaNa, Gedeon Richter’s Postinor and Hexal’s Unofem. While HCPs and GP associations have generally spoken out in favour of ulipristal given the longer time period it allows to prevent pregnancy, levonorgestrel is said to be a strong alternative for women breastfeeding as well as those who suffer from heavy asthma.

Price may also be a significant factor for female consumers, with ellaOne’s recommended retail price set at €29.96 (€35.72 before the switch) compared to €18.31 for PiDaNa, €16.99 for Unofem and €15.97 for Postinor. Breaking down the spring sales geographically, the growth has come primarily in the major cities of Hamburg (+50% compared to before switch) and Berlin, although sales have been below average in the less affluent east German regions.

With only a year’s patent on ulipristal acetate, HRA Pharma, award winner of Nicholas Hall’s Most Innovative European New Product of the Year, will have to make hay while it can, with pharmacist and HCP backing crucial given that no consumer advertising is allowed.

For a more complete look at the issue of EHCs in Western markets, why not enquire about our recently published report Women’s Health: Obstacles & Opportunities. Contact for more details.

Homeopathy: The debate rumbles on…

The publication of Prince Charles’ “Black Spider” letters last month again brings up the much-debated question of homeopathy, with the Prince’s Trust having lobbied Tony Blair both to retain NHS funding in the UK, as well as minimize criticism of alternative medicines. While critical evidence accumulates against the efficacy of homeopathy, from the UK’s House of Commons study in 2010 to an independent report from the Australian National Health and Medical Research Council in 2015, consumer support for the practice, even in countries with high levels of education and fast access to healthcare info, is as strong as ever.

Patient requests for homeopathic medicines on the NHS prevented Tony Blair’s government from cutting funding. In Germany, a 2014 study found 60% of Germans use homeopathics, a rise of 7% since 2009, with the vast majority of the 60 health funds offering OTC reimbursement doing so only for homeopathic and anthroposophic medicines. A recent study by the Dutch Office of Statistics revealed that homeopathy came second only to acupuncture as the favoured alternative medicine in the Netherlands, with women aged 30-65 with higher education the most frequent users. And this is before we touch on use in India, with its 100,000+ trained homeopaths…

Despite the recent efforts of regulatory authorities to make life hard for homeopathic manufacturers, in Germany (huge price rises for homeopathic registration), the Netherlands (no more indications on homeopathic packs) and the USA (see the FDA’s public hearing in April), the practice is unlikely to disappear any time soon. Nor should it. So long as marketers make no claims beyond soft indications, and HCPs ensure consumers return to them if symptoms have not cleared up, homeopathy can be a gentle and natural alternative to the often confusing world of medicated options. With the correct guidance, there’s enough space in OTC for everyone.

Online eating in-store sales in Germany?

Despite OTC growth in Germany remaining sluggish in 2014, online sales are starting to make serious advances. Online sales now account for a little over 10% of the country’s total OTC market, according to industry sources.

While market share is still relatively modest in traditional categories like cold & flu and GIs, online turnover for a variety of lifestyle and VMS brands – for which there is no desperate need for immediate face-to-face interaction with a pharmacist – is around 50% of that generated through pharmacies and drugstores. While convenience is, of course, a major factor, price is also significant, as consumers are often able to save €15 on premium supplements online, with savings growing further on jumbo packs. It is also noticeable that many of these double-digit sales increases are being made by products positioned for Germany’s older consumers, in particular eye vitamins with Age Macular Degeneration positioning, joint health products – now equivalent to two-thirds of pharmacy turnover – as well as herbal memory & brain health, with several premium ginkgo-based options chalking up huge increases in 2014. For the potentially less mobile consumer in the 65+ age bracket, a steadily growing demographic in Germany, the home delivery element is crucial.

So just who are the online retailers making headway? German marketing agency Dr Kaske completed a survey analysis of the 15 largest in April 2015, scoring them according to price on a select basket of common OTCs, search engine optimisation, customer service, user-friendliness and, of course, actual visitor numbers. Leader in all categories was Shop-Apotheke, a subsidiary of Netherlands-based Europa Apotheek Venlo, although the more widely known DocMorris – sold by Celesio to Swiss pharmacy retailer Zur Rose in 2012 – was a close contender, featuring the best SEO. Medikamente-per-klick and Sanicare are also noteworthy, with the latter investing heavily in TV advertising in 2014.

For more insight into trends and developments in Germany and elsewhere in Europe, why not enquire about our monthly OTC INSIGHT Europe publication? Contact