Hard Sell: The Evolution of a Viagra Salesman (11 page)

In launching Zyrtec, Pfizer jumped into one of the more cutthroat arenas in pharmaceutical sales. In drug categories where no one agent had data demonstrating its superiority to its competitors, sales reps were forced to dig deep into the minutia to tout advantages. Such nitpicking often led to bad blood between salespeople. The antihistamine market was no exception.

Things got nasty in a hurry, especially with the Claritin reps. Weeks prior to the FDA’s approval of Zyrtec, the Schering-Plough people began warning doctors about “Atarax, Jr.,” which would still cause drowsiness in all of their patients. These aggressive efforts proved extremely successful, since my customers were asking me about Zyrtec’s sedation rate before hearing anything about its superior efficacy. Anticipating such tactics, Pfizer trained us on how to respond positively and forcefully. Despite those efforts, I found myself knocked back on my heels from the start. For the first time, I began to doubt the brainwashing that my drug was the best one in history. In desperate need of a success story proving Zyrtec’s merit, I found one in the most unexpected place: my living room. (Considering the amount of dust balls and moldy pizza crusts under the couch, perhaps this should not have been such a surprise.)

My roommates Steve and Michael and I sat around one Saturday afternoon, drinking beer and watching
college hoops. Aside from the occasional clapping for action on the court and the more frequent protesting of flatulence, the room’s main activity came from Michael’s chocolate Lab, Chauncey, and her endless pursuit of her blue racquetball. That is, until Ed showed up.

A fairly cantankerous guy, Ed trudged in and plopped down on the couch with a grunt. Following our grunted responses, the activity returned to its previous level and stayed there for approximately three minutes. Then Ed started sneezing as if he had just snorted a line of pepper. Uncontrollable eye watering followed. Steve thought the stream of snot pouring from Ed’s nose was faster than the riptide from his eyes, but Michael and I disagreed. Of course, the three of us mocked his incapacitation, and I got up to get us a round of beers in celebration of this exciting development.

As I headed to the kitchen, Ed managed to catch his breath and spit out, “It’s the dog! I’m freakin’ allergic to the dog!” It took a moment for the lightbulb to come on: Give Ed a Zyrtec.

One of Zyrtec’s advantages over other antihistamines was its rapid onset of action; 95 percent of patients who were going to respond to the drug would do so in fifty minutes, whereas Claritin often took close to two hours. This was the perfect opportunity to put my brainwashing to the test.

“Take a Zyrtec,” I sang, delirious from my brainstorm. “You’ll be good as new in fifty minutes.”

I quickly grabbed a sleeve of samples and, after popping out a tablet for myself, threw a packet to Ed, who missed it since he could no longer see. I didn’t need a Zyrtec at that point—my allergies wouldn’t start for another month—but I took one anyway. Hey, they were there.

“Can you drink and take Zyrtec at the same time, Jamie?” Ed asked worriedly. I could not answer right away, as my mouth was filled with Bud Light. Having swallowed, I answered, “Yep,” which was not the Pfizer approved response to this frequent question. Based on my personal experience, though, I found imbibing while medicating to be perfectly safe.

At one o’clock, Ed wiped his nose again and swallowed the tablet, and so began one of the longest hours of my life. It had not occurred to me that the drug might not work. I mean, I knew it didn’t help every allergy patient (“There’s no panacea, Doctor” was a common drug rep refrain), but the idea of failure had not entered my brain when I came up with this great idea. Ten minutes postdose, however, I began to get nervous.

“Hey, Jamo!” Ed barked, using a nickname for my nickname. “I’m still sneezing over here. This drug sucks.” The sneezing had gotten so bad that the guys stopped saying “Bless you.” His eyes continued to water, and the pile of snotty Kleenex grew to resemble a papier-mâché ottoman in front of which Chauncey, oblivious to her role in this commotion, had dropped her ball so Ed could throw it to her. He did not feel like playing.

At one-twenty, he mocked me again. “Does this shit work for anybody?” I wanted to laugh at his pathetic sniffling or make a crack about his red eyes, but I couldn’t. Instead, I sat frozen on the couch, struck dumb by the realization that I would hear about this for the rest of my life. Because that was what it really came down to. In the big picture, I didn’t care about Ed’s allergies; he could have simply gone home (locking Chauncey in the basement was
not
an option) and felt better in an hour. No, in the big picture I had made a personal guarantee, a declaration of belief. There was nothing guys liked better than to remind a friend about a failed declaration of belief.

“Hey, Ed,” Steve snapped, rushing to my defense. “He said it’d take fifty minutes. You’ve got another half an hour, dipshit.” Ed hocked a loogie in response.

Ten minutes later, Steve challenged him. “Eddie, I don’t hear so much sniffling over there anymore.” Ed barely acknowledged the comment. At the forty-minute mark, he conceded defeat.

“Okay, Jamo, you win. I’m all dried up.” Sure enough, Ed sat symptom free with dry eyes and a dry nose. He was crushed. “Man, I was really hoping that stuff wouldn’t work,” he admitted, revealing more about men in that one sentiment than any book about Venus and Mars ever did. “You would’ve heard about it forever.”

“Never a doubt, Eddie,” I said with a smile, hoping its radiance would compensate for the relief in my voice. “Never a doubt.” We sent Ed out for beers after that.

Instant access to samples didn’t end with Pfizer’s products, however. In fact, a drug rep’s options expanded infinitely upon arriving at an office. Sample closets were like receptionists; although they ranged in size and accessibility from practice to practice, every office had at least one, containing tens of thousands of dollars’ worth of samples of every product from Aricept to Zoloft. These closets served as a pharmaceutical filling station for salespeople in need.

Managers were notorious for grabbing samples while their reps, the people the managers were supposed to be evaluating, detailed doctors. It was straight out of a movie; one bad guy created a diversion while the other heisted the jewels. A rep really found out a lot about his boss’s extended family by watching what he lifted from a sample closet: Aunt Becky had acid reflux (Prilosec), Uncle Tony had herpes (Famvir), brother Phil wouldn’t leave the house (Paxil), sister Cindy couldn’t sleep (Ambien). Ten-year-olds gave their parents less detailed Christmas lists than some Pfizer managers brought on their field rides.

Not all offices had samples of the drugs that reps needed, so creativity increased at a rate directly proportional to desperation. A friend of mine called on a dermatologist late one afternoon. Nothing out of the ordinary there, except for the fact that she was a urology and ob-gyn rep. Seemed she had broken out in a near-fatal case of acne (three pimples for this beauty was a crisis)
and needed some dermatological products stat! So, this very ballsy Pfizer woman waltzed into the waiting room as if she had been there before (she hadn’t), smiled at the receptionist as if she knew her (she didn’t), and headed through the door leading to the back office, saying, “I just need to check samples.” The receptionist returned the smile and waved her back, just the way she did for the regular reps. With $100 of prescription drugs hidden in her detail bag, my friend sauntered out. “That was fast,” the receptionist said. Without missing a beat, our heroine replied, “Oh, you guys didn’t need anything of mine today. See you in two weeks.”

Having access and taking advantage of it, though, were two completely different things, at least for me.

In my defense, let me state (at the risk of being redundant) that I was a dumb guy. There was no doubt that a woman would have jumped on this gold mine immediately. As a possessor of the Y chromosome, however, it simply never occurred to me. As you can guess, I can only be speaking of birth control.

The birth control reps, most notably those from OrthoMcNeil, were a constant presence in ob-gyn offices, and they used their “Pill” samples to leverage their other products. Consequently, it was impossible to miss the cases upon cases of birth control boxes that spilled out of ob-gyn sample closets.

About six months into my Pfizer career, my girlfriend visited her gynecologist, and at dinner that weekend, she
complained about the cost of the Ortho Tricyclen the doctor had prescribed.

“I couldn’t believe it when the pharmacist told me the price went up again,” she said with disgust. “What a racket.”

“They cost money?” I asked.

“Of course they cost money, Jamie. How do you think I get them?”

And that cut right to the root of the issue. I didn’t think about how she got them. I had never thought about how she got them. Like most guys—and, believe me, I have checked with a lot of my equally challenged friends—I had let the woman worry about “that stuff.” Fortunately, I came back with a solid answer.

“Uh … you don’t get samples?”

Her anger receded a bit. “Well, yeah, you get samples when he first puts you on it and maybe once or twice more after that, but then he gives you a prescription.”

“That’s crazy!” I blurted, about to reveal my own insanity. “They have thousands of samples just sitting there. …” I trailed off as soon as I realized what I’d said, but the damage was done. I risked a glance to see if she had been paying attention. She had.

“You mean to tell me that for all these months you’ve been working for Pfizer, you could’ve been getting me the Pill for free?”

I nodded, wincing with the knowledge that the money she had (unnecessarily) spent on birth control would be wasted that weekend.

On a positive note, at least I had $20,000 worth of Zoloft in the trunk of the Lumina to help treat my impending depression.

“What exactly is it that you
do
?”

My mother’s question hung in the air a long time, possibly because I didn’t quite know how to answer it. I had just finished regaling family members with stories of circumcisions and drug samples (though I made sure to pawn off the birth control pill debacle on another guy), when my mom stumped me. Clearly, she was asking me to justify my existence. I wasn’t sure if I could. Mistaking my hesitation for confusion, she continued.

“I mean, why do they
need
drug reps?”

An official job description for a pharmaceutical salesperson would read: Provide health-care professionals with product information, answer their questions on the use of products, and deliver product samples. The general public could probably accept that as a useful role. An unofficial, and more accurate, description would have been: Change the prescribing habits of physicians.

And that is why drug reps exist: to get docs to stop writing scripts for Drug X and start writing them for Drug Y, thereby boosting the bottom line of the corporation that makes Drug Y. I didn’t give my mom the real deal, since patients rarely want to hear about their doctors making decisions based on what some sales guy tells
them, rather than scientific wisdom. Accordingly, I chose to share the official definition.

“But can’t they just get all that information themselves?” Uh, no, they can’t.

In a perfect world, there would be no need for drug reps. Physicians would receive sufficient pharmaceutical training in medical school and residency, and this training would last them indefinitely. Doctors would have sufficient time to update this training, if necessary, by reading the latest medical journals throughout their forty-year careers. Finally, pharmaceutical companies would bring to market only those drugs that provided marked benefits over products already in use.

Alas, the medical world is a few light-years from perfect. Physicians begin their careers with a solid foundation of pharmaceutical knowledge. Most medical schools require a second-year pharmacology class lasting one or two semesters, in which students are instructed on the mechanisms of action and pharmacokinetics of the products in the major drug classes. Microbiology classes cover some of the same area regarding infectious disease drugs, such as antibiotics, giving the majority of students a thorough review. In the third and fourth years of medical school, part of the internal medicine rotations again deal with the pharmacokinetics of drugs. Then, after selecting a particular field of medicine, the residents are educated about drugs specific to their field, so rheumatologists learn about pain medications while allergists
focus on antihistamines. Thus, it is fair to say that most doctors exit their residencies with a solid knowledge of pharmaceuticals. “The problem,” a pediatric ICU specialist and friend from Notre Dame explained to me, “is that most MDs in private practice lose their source of education about drugs and don’t have time to either refresh themselves with what they previously learned or, more important, educate themselves about new drugs.”

This is a familiar refrain among physicians: lack of time. Doctors have a tough gig. In addition to seeing thirty to fifty patients a day, physicians are expected to do dictations for each patient visit, make hospital rounds, explain treatment options to family members, call HMOs to fight for prescription coverage, and speak to pharmacists who like to double-check dosages on prescriptions. After all that in a day’s work, a doctor can choose to play with his three-year-old daughter or pick up the
New England Journal of Medicine.
What would you do? They won’t miss the earth-shattering breakthroughs like Viagra, but the subtler advances like modifications in dosing or the addition of a second agent do get past them. Without the time to do all of the professional reading necessary in order to stay current, physicians are forced to rely on drug reps for updates.

Of the three duties listed in the official job description, sales reps could be replaced for two of them: Free drug samples could be mailed to physicians, and specific product questions could be answered via twenty-four-hour
doctors-access-only Web sites. It is an unavoidable feature of the system, however, that physicians need reps to keep them up to speed. A salesperson has to provide helpful information only a few times before establishing himself as an asset. Once “in,” a rep can take advantage of his trusted position and begin influencing the decision-making process.