Pharmaceutical Sales 101: Bagging Doctors (Part 2 of 4)

Pharmaceutical Sales 101: Me-Too Drugs (Part 3 of 4)

Pharmaceutical Sales 101: Inside Information (Part 4 of 4)

Despite his often pitiable work ethic, Jamie Reidy knew how to sell pharmaceuticals, and in July 1999, he reached his goal of becoming the number-one Pfizer salesman in the country. His 2005 book Hard Sell: The Evolution of a Viagra Salesman (Andrews McMeel Publishing) reveals shop-talk between pharmaceutical reps and doctors and chronicles his own sales career, which ended last March when he was fired from Eli Lilly & Co. after his book came out. A major film studio is currently in negotiations over the rights to this story published in the midst of pharmaceutical scandals such as those surrounding the drugs Vioxx and—as Reidy well knows—Trovan.

One afternoon in February of 1999 Jamie Reidy, a Pfizer pharmaceutical representative, made a sales call to “Brad,” a urologist with a practice in Modesto, California. Brad was one of Reidy’s favorite physicians to call on, not only because he was a friend with whom Reidy vacationed, but also because he was a doctor Reidy felt he could “push” when his sales needed a boost. Brad, Reidy knew, was malleable in the hands of a charming sales representative; he had admitted to Reidy that over the past four years he had prescribed “a ton” of Cardura (Pfizer’s drug for men who urinate frequently at night) in great part because Reidy’s attractive female predecessor asked him to.

The drug Reidy was selling that day was Trovan, a new antibiotic that was being hailed by industry analysts as a potential blockbuster because of its efficacy against a wide range of infections and its once-a-day dosage schedule—some analysts expected it to eventually top $2 billion in annual sales. In 1998, Trovan’s first year on the market, sales were $160 million, about what was expected for the new drug. Reidy’s numbers, however, couldn’t have been any worse. He had been dead last in the country his first year as a Trovan salesman. He was counting on Brad to help change that in 1999.

At 29, Reidy was a natural salesman. With pale blue eyes and an athletic build, he possessed all-American good looks and a commanding presence. He was also chatty, personable and polite to a fault—a trait honed during four years as an Army officer. His salient flaw was his work ethic, which, as he recounts in Hard Sell, led him to work a ‘T to T’ work schedule (Tuesday through Thursday, 10 a.m. to 2 p.m.) for much of his career. But Reidy was also fiercely competitive, and his last place finish in 1998 did not sit well with him. He was determined to not only crawl out of the basement in 1999, but to become a top representative.

Reidy’s friendship with the 42-year-old urologist had developed rapidly, in large part because he had easy access to him. Reidy, as well as two other representatives interviewed for this article, said a key to becoming a good drug salesperson was in gaining the good graces of the office staff, especially those of the receptionist, who is known in sales parlance as “the gatekeeper.” Reidy was an expert at this. He showered Brad’s nurses and staff members not only with the usual swag of pens and Post-Its and lunches, but also with boxes of expensive drug samples, such as the antibiotic Zithromax, even though it was M&Ms that Reidy found worked best with female staff members.

Once easy access to the physician had been obtained, Reidy would identify a common interest and use it to forge a bond. Eschewing the more technical pitches taught in Pfizer’s sales training and favored by many of his colleagues—Reidy described these as “going toe to toe with a doctor in the middle of his office”—he instead liked to build rapport with physicians, and to use the friendships he made with them, and the obligations that came along with those friendships, to induce doctors to prescribe his drugs.

In Brad’s case, sports was the connection. A Notre Dame graduate, Reidy shared Brad’s love of college football. They even had the same favorite baseball team, the New York Yankees. Baseball, in fact, played a large part in their relationship. Reidy took Brad to an Oakland A’s game; Brad invited Reidy along when he and his staff went to see the Modesto A’s (a minor league club)—the tickets paid for, incidentally, by a representative from a rival drug company.

It wasn’t sports, however, that Reidy had on his mind that afternoon in February 1999—it was Trovan.

Reidy was afraid of this, and had prepared a response. He called it his “buddy, you’re letting me down” routine.

“Jamie!” the nurse yelled enthusiastically as Reidy strolled across the waiting room. Reidy got straight to the point. He asked Brad how many Trovan prescriptions he had written that morning. After hesitant looks from both Brad and the nurse, Reidy confronted his friend. “You haven’t written any prescriptions for antibiotics today?” he asked. Brad ushered Reidy into his office and explained that he had trouble remembering Trovan when antibiotics were called for. It was a new medication, Brad said, and he “just couldn’t remember it.”

Reidy was afraid of this, and had prepared a response. He called it his “buddy, you’re letting me down” routine. Looking the physician squarely in the eye, Reidy insisted that he must be a lousy sales representative, since it was his job to make sure physicians not only remembered Pfizer’s drugs, but also prescribed them. Reidy then dragged their friendship to the fore, pointedly asking Brad how he could prescribe so much Cipro (a Bayer antibiotic) when he didn’t even like the Bayer saleswoman.

The technique worked. Brad apologized to Reidy, admitted he’d been “fucking up,” and promised to remember Trovan in the future. “I walked out of there and actually felt pretty terrible,” Reidy said of the encounter. “I didn’t want to insult my friend like that.” But, he added, from that point on Brad’s prescription writing of Trovan was “rockin.’”

In Hard Sell, Reidy sums up his job this way: “To get Docs to stop writing scripts for Drug X and to start writing them for Drug Y, thereby boosting the bottom line of the corporation that makes Drug Y.” The Pfizer-taught rationale for his profession—to provide busy physicians with important information about the latest medications—Reidy only half accepted. He agreed that most physicians were too busy to educate themselves about the latest drugs, and that many indeed relied on the information provided by drug representatives. But much of the information he and his colleagues provided to physicians, he said, was skewed to present the drug maker’s medications in only the best possible light. “There is no question that bias is involved,” he said. “For every negative trial that someone could show me about one of my drugs, or a positive one about a competitor, I could show the opposite.”

I would call on a young doctor, and I’d say to him, ‘Hey, do you know Dr. So-in-so across town? What’s he, like 80 years old? We’ve got a grandpa who’s Cutting Edge Guy and we’ve got you, who’s supposed to be Cool Guy, still using penicillin.

Another favorite Reidy sales technique, which he often used in pushing new drugs like Trovan, was to play on the innate competitiveness of many doctors, pitting one physician against another. He explained this method in a recent interview:

“A lot of doctors, especially orthopedic surgeons, are former athletes. There’s a competitiveness with them, especially among partners. So, say I would call on a young (doctor), and he was very slow to adopt whatever my new drug was. I’d say to him, ‘Hey, do you know Dr. So-in-so across town? What’s he, like 80 years old? Because he’s rockin’ with my drug. So we’ve got a grandpa who’s Cutting Edge Guy and we’ve got you, who’s supposed to be Cool Guy, still using penicillin. What’s going on here? I thought you were a Cool Guy.’ The young doctor would usually protest, saying that he was a cool guy, and so I’d say, ‘Well, why are you so far below Dr. So-in-so in writing my scripts?’”

While Reidy favored the personal touch in his selling, other drug reps clung to a more clinical approach, often mandated by management. Merck representatives, for example, were presented with excruciatingly detailed instructions on almost every aspect of physician interaction, and when Vioxx (a Merck anti-inflammatory medication) went under scrutiny because of related cardiovascular risks, so did those sales procedures.

The investigations came to a head this past May, when the Committee on Government Reform met to assess whether Merck had acted quickly enough in alerting physicians to the cardiovascular risks of Vioxx once the risks had been made known. They had been made known in March 2000, after Merck’s own study showed that patients who took Vioxx were five times more likely to have a heart attack than patients who took Naproxen, a generic anti-inflammatory.

But Merck didn’t withdraw Vioxx from the market until September 2004. The committee in May 2005 wanted to know why Vioxx stayed on the market so long and had more concrete evidence against Vioxx thanks to two studies published in January 2005: one in the British medical journal The Lancet estimated that between 88,000 and 140,000 people suffered heart attacks, strokes and other serious medical complications from taking Vioxx, and another published in Archives of Internal Medicine found that many, if not most, patients taking Vioxx would have done just as well on standard medications

In conducting their assessment, committee members obtained over 20,000 of Merck’s internal documents related to the selling of Vioxx. Rep. Henry Waxman (D-Calif.), the ranking minority member, made many of them available on his Web site.

Another document, entitled "Champion Selling," taught representatives to steel themselves against objections by paralleling their own drug selling challenges with the challenges faced by historic figures like George Washington, Martin Luther King, Jr. and Helen Keller.

What these documents show is that there was virtually no aspect of the interaction between drug representatives and physicians too small for instruction. Merck trained its representatives in everything from how to eat when dining with physicians ("Bread should be eaten one small bite size piece at a time…Break off and butter bread one single piece at a time…Bread dipped in olive oil should also be broken off and eaten one single piece at a time"), to navigating through complex hospital power struggles, to the execution of the perfect handshake ("should last three seconds”).

In one 45-page document entitled "Captivating the Consumer," Merck representatives were trained to use verbal and nonverbal communication—with the eyes, head, fingers, facial expressions, posture and tone of voice—to "mirror" the "customer." "Mirroring," the document said, "is…positioning yourself to match the person talking. It subconsciously raises his/her level of trust by building a bridge of similarity." Another document, entitled "Champion Selling," taught representatives to steel themselves against objections by paralleling their own drug selling challenges with the challenges faced by historic figures like George Washington, Martin Luther King, Jr. and Helen Keller. If a physician were too busy to talk, the document told its field staff, it was "those defining moments that distinguish all champions," and reminded them that "Helen Keller could have felt sorry for herself when she went blind and deaf."

The last step of any visit with a physician, the document "Selling Skills" told Merck field representatives, was the "close." The "close" involved summarizing the "point(s) you want the customer to remember," obtaining agreement, asking for a "specific, realistic, measurable action," and a "follow up to ensure action."

Reidy and the two other drug representatives interviewed for this article, said that the “close” was the most important part of the sales call. Each described a successful close as obtaining a verbal promise from the physician to prescribe the drug discussed a specific number of times. Occasionally this tactic can be more aggressive than some physicians are prepared for. One physician told me that the first time a drug representative tried to "close" him—he was asked to promise that he’d prescribe a certain brand of birth control pills for his next ten patients who needed them—he felt like "punching the guy in the nose."

And many other physicians aren’t swayed by sweet talk, athletic fraternity, and other sales tactics. Dr. Michael McCormick, a family practitioner with offices in Westchester County, N.Y., refrains from dispensing newly introduced drugs such as Trovan until they have been found safe in post-market trials. “I only write prescriptions for medications that have been on the market for years,” he said recently. “I find it the safest course for my patients. There are almost always alternatives to the newest drugs.” He pulled a black Bic pen from his jacket pocket to show that there were no drug company logos imprinted on it. “I don’t talk to drug representatives,” he added. “They’re salesman, pure and simple.”

Even if Brad had done his homework on Trovan and prescribed it strictly on its appropriateness for his patients instead of partially—or mostly—based on the urgings of his pharmaceutical representative friend, the fact remains that he still may have prescribed it frequently. According to pre-market studies conducted by Pfizer and presented to the FDA, Trovan was found to have no major side effects. According to the FDA’s Web site, “No reports of liver failure, liver transplant, or death due to liver problems were reported in the 7,000 patients studied in pre-marketing clinical trials for Trovan.”

But on June 9, 1999, four months after Reidy’s sales call to Brad, Trovan was pulled from pharmacy shelves after the FDA found it to have caused 140 cases of liver damage, including 14 instances of acute liver failure, six in which the patient died. In its 16 months on the market, Trovan was prescribed an estimated 2.5 million times.