There is no question that free and easy access to information has transformed the world of the patient, and of the healthcare professional. Even so, there exists a health divide for those who do not have English as a second language.

In a DIA Clinical Forum meeting of the pharmaceutical industry last week, medical information directors and managers came together to share best practice and experience about how to provide the best quality information to patients and healthcare professionals in a world which is seeming to become smaller, as the Internet relentlessly presses on towards reaching all corners and people around the world.

One recurring theme in many of the presentations was the ‘globalization of information’. Each pharmaceutical company spokesperson showed their company approach or model for creating a master set of resources, which can then be regionalized or localized depending on the need. Various knowledge management systems were also introduced which were designed to address this requirement.

What struck me however, is that our current understanding of the ‘organization’ of pharmaceutical companies and indeed the organization of information within them, is largely influenced by historical context; including such factors as mergers and acquisitions, licensing and marketing authorization, drug development, sales and revenue, distribution chains, or even the location of the company headquarters. The result is predominantly large enterprise, the scale of which is somewhat unsustainable in the current financial climate.

This was evident as different session speakers described the varying acronyms representing the geographical regions that they are responsible for E.g. AMAC, ASIAPAC, EUCANZ, EMEA, AMERICAS, LATIN etc., reinforcing that our companies are so often organized by a geographic and historic way of thinking.

When we visualize the world, we also bring to mind centuries of history; wars, elections, exploration, migrations and calamities which have shaped the boundaries that we associate with countries on a map. Even this image in our mind is not a true picture of reality. For instance, the following image shows the world in what may appear to be somewhat different to that from school atlases; it is a map projection which shows the relative country size based on actual physical land area – rather than the stylized representation of it which we are usually accustomed to seeing.

A world cartograph showing geography according to actual land size Source: © Copyright SASI Group (University of Sheffield)

Of course in a modern world of Internet access, information passes across all of these arbitrary boundaries with no regard for geography. Nor does the passage of information have any regard for regulations which are intended to restrict the types of information available to different parts of the world.

This explains why when I perform search query in Google for “high blood pressure”, the results which are returned (and should provide me with localized support) are actually resources from the United States government – even though I am a resident of the United Kingdom.

Searching for 'Blood pressure' in Google returns results from outside the United Kingdom

In the results I might also see several prominent sponsored results which are commercial in nature (including a cholesterol-lowering margarine and a drinking awareness campaign). Perhaps most remarkable of all, is one particular advertisement for Amazon on the right-hand side:

Apparently if you have low blood pressure you can just ‘buy a little more’ at Amazon!

So these results have been provided to me by Google, who describe themselves as a ‘connector’ between people looking for something and those people who are providing something.

The accuracy of the information is always debatable – and the algorithm used by Google to provide results does not really consider appropriate medical advice for me as an individual, in my location. The reality is, I searched for something in the English language and Google presented me with the most popular results as determined by a worldwide crowd of English searches and links, and the most lucrative to Google in terms of advertising revenue. In this way, the language is the first filter through which results are considered and presented, not the country that I live in.

So when we think of the world, perhaps should really think in terms of language spread. Consider this cartograph of the world, which shows those people’s location that have English as their first language:

A world cartograph showing people with English as a first language, by location Source: © Copyright SASI Group (University of Sheffield)

Yet we know that English is not the most spoken language in the world by population; it is in fact Chinese (including Cantonese and Mandarin, and dialects). If we now consider a world projection through this lens, the cartograph looks like this:

A world cartograph showing people with Chinese as a first language, by location Source: Source: © Copyright SASI Group (University of Sheffield)

It is important to note that whilst the rest of the world appears not to have very many people who speak Chinese as a first language, this is really a distortion because the population of Chinese living in China is so vast in comparison to other countries. Here now is the world of ‘Chinese’ speakers – without those that live in China.

A world cartograph showing people with Chinese as a first language, by location and without those in China Source: © Copyright SASI Group (University of Sheffield)

One other aspect when considering our company business strategy and organizational structure, is the sheer population around the world. China and India has such a huge percentage of the global population, but do our evolving company organizational structures reflect this?

A cartograph of the world, showing the population size per country Source: © Copyright SASI Group (University of Sheffield)

Certainly, if I was going to start a new pharmaceutical company, based on population alone I would be inclined to be headquartered where the greatest area of population and economic growth is. Additionally, if I were to create information materials for patients in a master language I might be commissioning them in Chinese first and foremost, then thinking of English speaking countries like the United States, United Kingdom, and Australia as mere ‘territories’ in my global strategy for which localization was required.

We may well have a distorted view of the world, and our company structures, steeped in our historical perspective. To truly embrace the emerging markets, and the global world enabled by one single Internet, it may be time to radically rethink the way pharmaceutical organizations are structured.

What if the business was structured by language instead of geography? What if materials were created in the full knowledge that they will inevitably reach across government boundaries to all global citizens that use that language? What if we developed a truly global strategy and slowly moved away from our bias towards the country centricity of our company headquarters. Country centricity may well be at odds with the global opportunity for the pharmaceutical industry. It discriminates, not really against others, but against the full potential of our organizations.