Hard Sell: The Evolution of a Viagra Salesman (10 page)

Having decided to forgo the confrontational selling style preferred by Pfizer, I became the “anti-closer,” a sales rep who sought to increase sales through rapport and friendships rather than aggressive promotional tactics.
Accordingly, I searched for a way to connect with physicians on a personal level, hoping that such relationships would improve access and opportunities to discuss my drugs in a casual manner. My lifeboat arrived in the form of the
preceptorship,
an opportunity to learn more about a doctor’s specialty by tagging along for half a day while he made hospital rounds and saw patients in the office.

While such an experience was certainly educational, the key benefit lay in getting to know a doctor and, more important, his getting to know me. This personal relationship—and the $500 he’d receive from Pfizer—would hopefully nudge him toward writing more prescriptions for my products. Using this approach, I asked Dr. Fort Wayne, the second-highest prescription writer in my territory, if I could shadow him for an afternoon, and he agreed. Walking into his office, I was fairly nervous, primarily due to the fact that Bruce had reminded me a half-dozen times that as my number-two writer, this pediatrician could single-handedly determine whether or not I would make my Zithromax quota for the next year.

Thankfully, Dr. Fort Wayne turned out to be a laid-back guy who immediately put me at ease. He seemed to get a genuine kick out of explaining patient histories to the “medical student” assigned to him for the day. (In order to put parents at ease, I wore a white lab coat and played the role of a medical student trying to determine if I wanted to go into pediatrics.) For four hours I observed the standard bronchitis and ear infection cases, and he
let me listen to coughs with the stethoscope (amazingly phlegmy) and look into eardrums (amazingly red). More important, we found out we both were from New York—hello, rapport building. Having accomplished my goals, I was ready to call it a day at four-thirty and thank him for the unique experience. However, my hopes for an early exit were cut short when Dr. Fort Wayne asked, “You mean you’re not staying for the circumcision?”

At no point during my initial sixty-minute interview or subsequent six-week training session did anyone from Pfizer mention that there existed the slightest possibility that I would watch a physician sever a newborn’s foreskin. For me, this would have been a deal breaker. Unable to sit through half an episode of
ER
without covering my eyes, I knew O.J. had a better chance of hosting a show on Lifetime than I did of remaining conscious through an entire circumcision.

Scrambling for an excuse that would allow me to avoid revealing my phobia of needles, specifically, and all medical procedures, in general, I stood in embarrassing silence. This break provided his four female medical assistants the opportunity to hurl stinging barbs at me, calling me, among other equally clever names, “a girl.” Within three minutes I was scrubbed in.

Medically speaking, the procedure was a simple one, requiring only the doctor and a medical assistant. Parents—fathers, in particular—were not allowed to observe due to the increased likelihood that the physician
would emerge from the room with a black eye. From the moment patient Quentin was strapped down, we spent only twenty-five minutes on the procedure, fifteen of which amounted to waiting for the local anesthetic to take effect and the strategically placed clamps to slow the blood flow to an acceptable level.

Finally, Dr. Fort Wayne pulled out a stainless steel device that on first glance resembled a corkscrew. A plastic, disposable device was more commonly used, but this veteran physician preferred the old-school tool. Having seen the startled look on my face, he held up the instrument and said, “It’s called a Gomco clamp,” which I mistakenly heard as “Gumpco clamp,” sparking giggles over the idea of Forrest revealing the means by which he would touch the most lives: “Momma says it’s my magic clamp.”

Designed specifically for circumcisions, the Gomco clamp actually worked in a manner similar to the aforementioned corkscrew. After pulling back the surprisingly large amount of foreskin, the physician slid the clamp down over the penis and let the loose skin snap back over the device. Things then got a bit surreal as he began tightening the clamp by turning it, making a
scrr, scrr
sound like that of a ratchet. With the device secured, he grasped a scalpel and simply moved it along a ridge ingeniously placed in the Gomco clamp to guarantee a stable and accurate cutting path. When using sharp objects in the vicinity of the penis, accuracy was a nice feature.

Despite the apparent ease with which Dr. Fort Wayne performed the procedure, it was no breeze for the spectator. The evacuation of blood from my head coincided with the injecting of the local anesthetic, and if not for the industrial-strength doorknob that supported all of my 180 lightheaded pounds they surely would have been forced to call in medical assistance “stat!” Conversely, Quentin took it like the man I could only hope to be and
nodded off
for five minutes in the middle of the procedure.

Concerned that we had “lost” the patient, I asked why the baby, who just moments earlier been expressing his displeasure at high decibels, now looked as though he was not breathing. “Sometimes they fall asleep,” the fifteen-year veteran said, shrugging. I mentioned that if a boy could snooze during a circumcision, he probably wouldn’t make it to work on time very often as an adult. “I mean, if you don’t wake up when a scalpel tickles you
down there,
I doubt the buzzer on the clock radio is going to do much good.” Dr. Fort Wayne pulled his scalpel hand back from the patient. “Jamie, now’s not a good time to make me laugh.”

Poor comedic timing aside, the preceptorship had been extremely beneficial. All goals were met: Rapport had been established (the pediatrician asked if I wanted to start playing tennis with him), and he showed an interest in using my drug. “Hey, Jamie,” he yelled after me as I left the office, “make sure you leave me a bunch of those Zithromax samples; I want to try that stuff.”

Ah, samples. In the minds of most medical professionals, free drug samples were the raison d’être for the existence of pharmaceutical salespeople. Just as shoppers don’t buy a car without taking it for a test drive, doctors rarely prescribed a drug without trying it out a few times. Since patients might get angry about paying for a drug being test-driven by their physicians, pharmaceutical companies provide free samples. While it is possible for a rep to go a day or two without speaking to a doctor, making it through a day without dropping off samples is next to impossible. The ceaseless delivering of said items to offices without being allowed to speak to physicians—in
our
minds the raison d’être for our existence—prompted many self-effacing references to ourselves as “well-dressed UPS guys.” With samples being our lifeblood, we got a lot of them.

I learned quickly that having thousands of dollars’ worth of drugs lying around really warps your concept of health maintenance. Prior to working for Pfizer, I avoided taking antibiotics whenever possible, choosing instead to combat illnesses with heavy doses of vitamin C.
Really
heavy doses. I got this regimen from my father, whose morning ingestion of vitamin C met the recommended daily allowance for a grammar school. Coughing in front of my dad (“I don’t like the sound of that cough”) earned you an immediate overdose of the orange pills. Since we rarely got sick, my old man stood by his theory. In Pfizer training, however, I learned that
most adults
rarely got sick simply because they did not have the day-to-day, close personal contact kids experience in school. Every so often, though, when a cough or sore throat would not subside, I was forced to go to the doctor’s office.

Regardless of the city, state, or country in which I was examined, the physician invariably wrote me a prescription for amoxicillin. Three tablets a day for ten days? Please. There was no way I was finishing all that medication. As soon as I’d start feeling better—normally around day four or five—I’d forget I had ever been sick in the first place and stop taking the amoxicillin. Ask yourself, what do
you
do with your leftover medication?

As a drug rep, I learned that I was a “saver,” meaning I’d save the remaining medication for the next time I got sick. Pretty smart, I thought. Turned out that a lot of other people thought the same way. I met nurses who gave the leftover drugs to their dogs and doctors who kept the remainder for sick family members. Turned out that we were all members of a very stupid club.

There is a reason antibiotics are prescribed for a specific number of days, and, surprisingly, it has nothing to do with corporations trying to wring every last cent from the pharmaceutical stone. Simply put, doctors prescribe an antibiotic for the amount of time specified in the drug’s package insert. The FDA bases this time period on the dosing regimen used in the clinical trials that got the product approved in the first place. Finishing
a course of therapy, then, is crucial to combating an illness successfully. Alas, many people—like me—stop taking their medicine after the symptoms subside.

Feeling better didn’t guarantee that the bacteria inside my body were all dead. By day five, most were gone, but not all. Bacteria, like athletes suffering through grueling workouts, live by the credo “That which doesn’t kill me makes me stronger.” By surviving exposure to an antibiotic, pathogens can become, over time, resistant to that drug. Therefore, if a woman takes an antibiotic for only a few days, she can actually strengthen the very bugs she has been trying to destroy. Patient noncompliance is one of two major causes of the alarming spread of worldwide drug resistance.

If patients make up half the problem, doctors and mothers complete the equation. That’s right; in trying to heal the sick, physicians sometimes do more harm than good. Antibiotics cure only
bacterial
infections. Unfortunately, bacteria do not cause every illness.

Viruses are responsible for a large number of respiratory infections, but doctors don’t have any drugs in their arsenal to kill these organisms. Instead, someone suffering from a virus needs lots of rest and fluids as she simply lets the infection run its course. However, patients don’t want to hear that. More specifically,
mothers
of patients don’t want to hear that. “You’ve really got two patients when you treat a kid,” a pediatrician once told me. “The kid and the mom.”

Moms were the worst. I know. I have one. “Let me tell you something,” my mother began defensively after I asked her if she ever badgered our pediatrician for prescriptions. “Do you think I was going to bundle up three kids in their winter clothes, drive twenty minutes through the snow to the pediatrician’s office, where I would wait for another goddamned half hour, at least, to see the doctor for ten minutes,
maybe,
and have him charge me sixty bucks for that visit only to tell me your brother had a virus that couldn’t be treated with antibiotics? I don’t think so. I wasn’t leaving there without a prescription!”

This perspective was not rare. Seeing my mom get that riled up twelve years after last bundling anyone up in winter clothes was nothing compared to watching a real live mom scream at a pediatrician in the middle of the office. Amazingly, there was no difference in the content of the rants. Likewise, in both cases the doctors caved in and wrote out a prescription. For amoxicillin.

Are doctors in the wrong when they buckle under such pressure? The Centers for Disease Control (CDC) would say so. On the flip side, I wonder what Harvard Business School thinks. All other considerations aside, a physician runs a business. So, if the customer is always right, that puts the doctor somewhere between the proverbial rock and a hard place.

Suppose Dr. Smith puts his foot down and, citing the CDC’s guidelines, refuses to prescribe an antibiotic.
On the one hand, he has done his part to curb one of the biggest crises facing the medical community today. On the other hand, he has angered a customer who may very well go to the next neighborhood playgroup session and tell all the other mothers that Dr. Smith is a quack. Consequently, he may lose not one but five or ten other patients. In my experience, the short-term bottom line trumps the big picture view almost every time, and will continue to do so until American mothers start listening to their doctors. Their kids’ doctors, that is.

That being said, let me climb down from my sample box and admit that drug reps—especially those of us who sold Zithromax—were the worst offenders of all.
Wait a minute, Jamie; I thought you used antibiotics only as a last resort?
A little knowledge plus instant access added up to one big value change.

I have already explained that the one thing a rep learned in pharmaceutical training was that her drug(s) were the best. Period. I mean, would a company spend thousands of dollars on teaching its employees that their product is third best? Not surprisingly, I emerged from six weeks of training and brainwashing with the blind-faith belief that Zithromax was the best damn antibiotic under the sun, and I had $20,000 of the stuff sitting in my garage.

Suddenly, “staying drug free” had been replaced by “better living through pharmacology.” Within weeks, I had begun self-medicating. If I happened
to wake up in the morning with a scratchy throat, I’d start a Z-Pak. Even if the scratchiness had nothing to do with a bacterial infection and everything to do with having attended a rock concert the night before, I’d start a Z-Pak. Pretty soon, I began handing out samples to friends and family members who coughed in a way I didn’t like. Without the aid of throat cultures or even a stethoscope, I became a de facto doctor, replacing
expertise in
medicine with
access to
medicine. Emboldened by my early success (funny how concert-caused scratchy throats went away in two days), I branched out into antihistamine prescribing.

Unlike the other drugs in my sales portfolio, Pfizer did not discover and develop Zyrtec. Rather, we paid the Belgian company UCB Pharma for the right to help them sell this soon-to-be billion-dollar product. Co-marketing has become more commonplace throughout the industry as small companies with promising molecules but in need of bigger sales forces sought partners with larger sales forces needing promising molecules. Pfizer did this twice more during my tenure, with Parke-Davis (Lipitor) and G.D. Searle & Co. (Celebrex). Atarax was an older generation antihistamine that provided unparalleled allergy relief with also unparalleled somnolence. Due to the latter, most physicians stopped using it. However, a female researcher at UCB figured out how to maintain Atarax’s allergy-symptom relief while minimizing its sedation rate, thus prompting Pfizer’s interest. At the Zyrtec launch, the “Mother of Zyrtec” charmed the
general assembly by telling us, “Many men think they are the Father of Zyrtec, but only
I
know who the father is.”