Hard Sell: The Evolution of a Viagra Salesman (21 page)

“I was told San Francisco was open,” I said. She shook her head. “We filled that spot yesterday with a woman who already lives there.” In response, I exhaled loudly, trying to look annoyed that she had wasted my valuable time by making me fly all the way to D.C. to interview for a position that was filled.

“I still have Fresno and Seattle open?” she asked more than stated. I didn’t know anything about the former,
but having spent a rainy summer of army training at Fort Lewis, Washington, forty minutes outside Seattle, I knew there was no way I’d be moving to the Pacific Northwest. Who needed a hopping mix of good music, good coffee, and plenty of young tech-millionaires anyway? As a guy originally from the East Coast with little knowledge of California, I presumed Fresno was twenty minutes from the beach. Recalling Bruce’s advice that a rep ranked in the bottom half of the nation should be happy to take a promotion anywhere, I gleefully bounced out of the room.

The pesky “sales numbers” question came up much earlier in the second interview with Don, the assistant regional manager, but my pat answer seemed to placate him. He asked a few other work-related questions, and then fixated on my having wrestled at Notre Dame. Turned out that he played basketball in college, which surprised me since his body resembled that of a middle linebacker more than a point guard.

“The wrestling room was located just off our gym,” he explained. “Every day we’d wonder what they
did
to you guys during practice, ’cause you’d always come out looking like total dog shit.” I laughed at the all-too-familiar image.

“Yeah, and I
walked on
the team. [Ru-dy! Ru-dy!] So, I just got
pounded
every day; guys used to fight over who got to wrestle me for the last match in practice when everybody was dead tired.”

Don laughed, shaking his head. “Why’d you keep doing it?”

I shrugged casually. “My freshman year I set a goal that I’d walk on and earn a monogram—that’s what we called a varsity letter at Notre Dame.”

He ate it up. “Guess you accomplished your goal,” Don said, smiling. I took that as a good sign and closed him immediately. He laughed again and said, “You get my vote, Jamie, but it’s the big guy you need to worry about.”

When Gary-the-big-guy opened the door to his suite, I breathed a sigh of relief. He looked exactly like every friend’s father I had ever seen at a Notre Dame tailgater: map of Ireland etched across his face, bright eyes, and a head of silvering hair. He smiled as he shook my hand firmly, putting his left hand on my shoulder to lead me inside. Suit jacket nowhere to be seen, his tie was loosened, and his sleeves were rolled up.

Without warning, he barked, “So why should I promote you, Jamie?”

His face had morphed from friend’s-fun-father to guy-responsible-for-a-$400-million-quota-who-can’t-believe-he-has-to-waste-time-interviewing-this-loser. He sat down with a
whoosh
on the sofa across from me, his two-hundred-plus pounds squeezing all the air out of the cushion. An uncomfortable stillness enveloped us; at least, it was uncomfortable for me. My throat tightened, and I envied Gary’s ability—as the big guy—to loosen his tie.

Having already told the story of reclaiming my competitiveness twice that day, I began confidently. He didn’t seem to listen and rifled through some papers on the coffee table. When I finished, a few seconds passed before his eyes locked onto mine, staring right through me. “You’re competitive, huh? Tell me how you’re competitive.”

I told him how my competitiveness had damaged my relationships with friends and their girlfriends and the relationships between my friends and their girlfriends. The weekend before the interview, my roommates and I were late for a dinner because I refused to quit playing two-on-two basketball in our driveway. The reason? My team hadn’t won a game yet. “Grow up, Jamie!” Steve yelled. “You’re twenty-seven years old, for Chrissake.” Finally, darkness prevailed. I got those guys back on the court the next day, hangovers notwithstanding, and I won.

I told Gary how my competitiveness had cost me untold dollars in Las Vegas. I took it personally when blackjack dealers beat me, and—despite the protests of friends and, occasionally, the dealers themselves—routinely continued gambling at cold tables much longer than advisable in order to show those dealers I could win.

I told Gary how my competitiveness had proven hazardous to my love life. Playing electronic trivia at a bar, I repeatedly ignored my better half’s answers in favor of my correct ones. After she expressed some dissatisfaction
with my behavior, I asked, “Do you want to break the record or not?” We did not date much longer after that.

Gary chuckled knowingly and began nodding his head, but he wasn’t ready to throw me the keys to the Pontiac Grand Prix just yet.

“Okay, now tell me how you’re competitive at work.”

I explained how in the spring of 1997 Bruce and the Managed Care supervisor met with Jack Howe, the PharmD (Doctor of Pharmacy) in charge of the formulary for Partners Health Plan, the largest HMO in northern Indiana, to discuss getting Zyrtec added to the list of drugs covered by his plan. “You guys need me a lot more than I need you,” Mr. Howe told them arrogantly. “I have Claritin, Claritin D, and now Claritin Syrup as antihistamines on my formulary. Zyrtec will
never
get added to my formulary! No way—”

“Some of these pharmacists are unbelievable,” Gary interrupted.

I nodded. “After hearing that story, Gary, it became
totally
personal for me. Who the hell did this guy think he was?
Zyrtec will never get on my formulary!
I’m sorry, Mr. Pharmacist, did you go to med school? What gives you the right to tell doctors what drugs their patients get? So, I made it my mission right then and there to get Zyrtec added to the Partners Health Plan formulary.”

Gary moved to the edge of the sofa seat. “What’d you do?”

I explained that over the next two weeks my Zyrtec colleagues and I called in favors and cajoled customers and achieved the impossible: We learned the identities of three members of the Partners Health Plan’s P&T Committee. Every health plan and insurance company had a Pharmacy and Therapeutics Committee that voted on which drugs to add to formularies, but the identities of its members were tightly guarded to prevent pharmaceutical reps whose drugs were not on formularies from trying to sway a member’s vote. On these three influential physicians we unleashed a barrage of letters and phone calls from some of the biggest allergy and dermatology specialists in northern Indiana (three of whom, I did not mention to Gary, were personal friends I had gone skiing with in Aspen) demanding the addition of Zyrtec to the formulary.

“A month later, Gary, just
three
months after the PharmD declared it would never be added, Partners Health Plan added Zyrtec to its formulary.” I left out the part about how it was the Zyrtec
syrup
used for children that got added, not the much more commonly used tablet. Apparently, the pediatrician on the P&T Committee assumed that it was
because
he was a pediatrician that my dermatologist friend had called him in the first place, so he only nominated the formulation he would use most often.

“That’s a great story, Jamie. Just the type of competitiveness we’re looking for.” I tried to close him, but he wouldn’t give me the commitment. “I’ll leave that up to Jackie and Don. We’ll be in touch.”

An agonizing three weeks later, Jackie called and offered me the job. Mediocre sales and poor work activity notwithstanding, I had managed to get promoted. Or, looking at it another way, even with an extra three weeks of interviews, they couldn’t find anybody else who didn’t know that Fresno wasn’t twenty minutes from the beach.

Fuck up, move up.

CHAPTER

Ten

VITAMIN V

H
ISTORY IS LITTERED WITH WONDERFUL MISTAKES.
Columbus thought he had sailed to Asia. An inventor at 3M discovered an adhesive that would not stick very strongly, and it became Post-it Notes. What if the guy with the chocolate bar hadn’t turned the corner and crashed into the girl carrying the open jar of peanut butter?

Medicine, too, has benefited from fortunate errors. Lifesaving developments such as the smallpox vaccine, penicillin, and the Pap smear were all discovered by accident or dumb luck. Viagra was also a mistake, although in terms of medical importance, it probably falls closer to the Reese’s Peanut Butter Cup than penicillin.

Dr. Ian Osterloh and his Pfizer research colleagues developed sildenafil citrate as a treatment for angina, a painful condition caused by the reduced supply of oxygenated blood to the heart. By inhibiting the enzyme phosphodiesterase 4 (PDE 4), the drug was supposed to
relax cardiac blood vessels and increase blood flow, thereby relieving angina-caused chest pain. Unfortunately, clinical trials failed to demonstrate pain relief, and, by the end of 1992, Pfizer was ready to cut its losses and discontinue research on the compound.

When several male patients refused to return leftover pills after completing their participation in the trials, however, Pfizer scientists reexamined their data. Researchers were surprised by the number of times “erections” had been mentioned as a common side effect. Patients enrolled in clinical trials were required to report
any
physical changes that occurred while taking an experimental drug, even one as innocuous as “itchy left ear.” Test subjects for any product normally listed headache, nausea, rash, or diarrhea;
erections
got Pfizer’s attention.

Viagra’s failure to relieve chest pain proved only that it failed to relax
cardiac
blood vessels and increase blood flow to the
heart;
increased erections indicated that the drug succeeded in relaxing nontargeted blood vessels, resulting in increased blood flow to a surprising and soon to be profitable area. Researchers quickly deduced that while Sildenafil had a weak affinity for PDE 4, it had a much stronger affinity for PDE 5, an enzyme in the penis that suppresses the flow of nitric oxide, the key ingredient in causing an erection. From heart to hard-on, Viagra was reborn.

Acknowledging the uniqueness of the drug, the FDA agreed to review Viagra under its fast track, six-month
process reserved for compounds that present a best-in-class therapeutic option. The agency’s subsequent approval of Viagra on March 27, 1998, set off an unprecedented media frenzy and left doctors and patients clamoring for the drug. They’d have to wait awhile.

Pfizer had not yet packaged any Viagra for sampling or sale. Had someone fallen asleep at the switch in a case of corporate carelessness? Not even close. Call it calculated caution. Pharmaceutical companies anticipating FDA approval of a product adopted either a conservative or aggressive approach to drug-launch preparedness, with the fear of looming competition normally the deciding factor.

In addition to determining whether a drug could be brought to market, the FDA retained final approval of the wording on the product’s label and package insert (PI). FDA committee members often asked for changes in wording in either document. For companies that took a conservative approach, these minor alterations were nothing more than a small annoyance, since the finalized product labeling and PI had yet to be printed and the product had not been packaged or shipped. On the other hand, a mistake of overaggression could cost millions of dollars, because every bit of the drug would have to be recalled and thrown out, and replaced by drug with the proper labeling. Under certain circumstances, for example if a similar, competing product would be launched only weeks after approval of Drug X, the latter’s company
might take the risk of labeling and packaging Drug X prior to FDA approval in order to maximize the amount of time it would be alone in the market. With no real competition to Viagra, Pfizer wisely waited for government approval before setting the wheels of production in motion.

The FDA approved Viagra on a Friday, and by Monday afternoon I had received thirteen phone calls from urology offices demanding samples. I don’t know what I found more surprising, that thirteen urology offices even knew who I
was
or that now I
was
being solicited as opposed to soliciting doctors. People were less than thrilled when I explained that I would not be delivering samples for at least a few weeks, since it was bad business for reps to distribute a drug about which they knew nothing.

On April 7, Pfizer flew the 120 members of its Urology Division to the Doral Golf Resort and Spa in Miami for a thirty-six-hour crash course on Viagra. We tore apart the hot-off-the-presses PI (the package insert contains every piece of information the FDA wants physicians and consumers to know about the drug), memorizing success rates and side-effect percentages. We rehearsed our sales pitches until we knew them cold. We were ready for war.

And nobody would listen to us. Not only had Viagra reversed the traditional doctor-rep relationship, it altered the way urologists approached new treatments.