Hard Sell: The Evolution of a Viagra Salesman (12 page)

Things would be a lot easier for doctors if the drugs in each class were radically different from one another. However, there are very few “Michael Jordans” in the pharmaceutical world, best-in-class products that have repeatedly proven far superior to their competition. Such drugs would be used first by every physician every time; if a new agent proved itself more effective than M.J. with an equal safety profile, everyone would obviously hear the news and change their treatments accordingly. Unfortunately, that scenario occurs about as often as an heir apparent to Air Jordan bursts onto the scene and continues flying high—Kobe Bryants are rare in the pharma market.

Instead, the industry has a glut of “me-too” drugs—products with similar efficacy rates but whose slight differences in insurance coverage, dosing, side effects, and cost only muddy a physician’s decision-making process. Is it Drug X or Drug Y that is covered by Blue Shield? I know Drug X has a warning against usage in diabetics and patients with liver problems, but does Drug Y have the same ones? In that European study where they
doubled the dose of Drug X, did they cut the number of days in half? Drug reps know
all
that information about their own drugs and the competing products because we get paid to know. For the physician fifteen years removed from residency who is running an hour behind schedule before lunchtime, a drug rep can be a beacon in a storm, the one person able to tell her if Drug Y is on the formulary and safe for use in a mid-fifties Hispanic female with high blood pressure. Helping out in that kind of a situation creates a bond between salesperson and physician, although such trust can lead to problems.

A pediatrician in western Michigan once accused me of lying to him, saying that Zithromax was not the least-expensive brand-name antibiotic on the market, as I had boasted, but the
most
expensive. Fully aware that a course of Zithromax cost under $40, while all of my competitors ran at least $50, I asked him where he got his information. He smiled victoriously as he reached into his desk drawer and pulled out a laminated color chart given to him by a competitor. Though initially panicked, I quickly recognized the problem.

“Doctor, this ranks drugs by cost
per day,
” I explained. He failed to see my point.

“Yeah, Jamie, and it says Zithromax costs eight dollars per day, whereas Vantin costs only six dollars per day! You lied to me.” The Upjohn Pharmaceuticals marketing guy who dreamed up that cost sheet deserved a promotion. I could not believe that this physician, a very smart
man, had been fooled. It was Enron math before anyone had even heard of Enron.

“Doctor, how many days is Vantin dosed for?” Ten, he answered. “And Zithromax?” Five. I looked at him, waiting. He still didn’t get it.

“Okay, so Vantin costs six dollars per day times ten days, which equals …” He finished my math. Sixty bucks.

“And Zithromax costs eight dollars per day times
five
days, which equals …” He didn’t finish my math this time. Instead, his face turned bright red. After a long pause, he turned toward me.
“Damn you, drug reps!”
he screamed before storming away. After a few steps, he stopped, walked back toward me, and tossed the laminated sheet back into the drawer. I didn’t envy the Vantin guy on his next call with that pediatrician.

I can hear it now:
Ban the pharmaceutical salespeople!
Without drug reps, though, who would bring free lunch to the receptionists and nurses every day?

CHAPTER

Five

WORKING FOR A LIVING

P
FIZER MANAGEMENT PROVIDED
us with numerous weapons to ensure sales success, and none was more important than the expense account. It was made very clear to us, however, that these funds were to be used
only
to build rapport and improve access into offices. Several pharmaceutical companies had gotten in trouble with the FDA, thanks to their reps’ attempts to use trips, dinners, and Super Bowl tickets to barter for sales with doctors.

Pfizer was extremely concerned about these violations regarding quid pro quo, a Latin phrase meaning “I will take you to play golf at Pebble Beach if you will then write five thousand prescriptions for Zyrtec.” It was absolutely, positively forbidden to enter into such agreements with medical professionals. Unfortunately, Monsieurs Quid, Pro, and Quo were old friends of mine, dating back
to my army days when I’d buy beers for soldiers who kept me out of the colonel’s doghouse. Some habits were hard to break.

I received a Travel and Entertainment (T&E) budget averaging $800 every two weeks. This money covered the basic day-to-day costs of doing business: gas for my company car, supplies, hotels and meals while on the road, and food for doctors and staff members.

The importance of food in pharmaceutical sales can
not
be overstated. The way to a man’s heart may be through his stomach, but the way to a doctor’s heart went straight through his office staff’s collective stomach. Whether morning (cinnamon rolls, Danishes, bagels, doughnuts) or afternoon (candy, cake, ice cream), medical office personnel ate as if winter hibernation was two days away and they had gotten a late start. Drug reps did everything they could to aid their cause. Some offices grew so accustomed to receiving free goodies they refused entry to reps arriving empty-handed, prompting salespeople to establish an identity by bringing the same treat every time.

One colleague from my training class handed out Blow Pops to every medical employee he saw, while another gave out cookies decorated with purple “Zithromax” stripes. Branding oneself was not limited to Pfizer personnel, however; my arch-nemesis the Biaxin guy
baked
cookies for all his pediatric offices. As much as I hate to admit it, homemade treats from a man in his
mid-forties proved to be a formidable obstacle to my efforts to buy the love of those women. Cattily, I’d tell nurses, “No matter how yummy they are, those cookies can’t get rid of Biaxin’s metallic taste!” My research found chocolate to be the best motivator for female office staff members. Consequently, I became the “M&M’s Guy.”

I brought M&M’s into every office I called on, every time I called on it. Averaging twenty bags per week, I quickly learned through informal polling that the peanut kind made way more friends than the plain, which just so happened to mirror my own preference. My dad had gotten me hooked on the former as a kid, when he showed me how it was possible to inhale an entire bag on the way home from the supermarket “without Mommy ever knowing.” Before assuming my role of chocolate candy sommelier, I did not know that Mars, Inc., produced M&M’s in colors appropriate for every holiday—the mint green, red, and white ones that came out only during Christmastime were a personal favorite—but it gradually became second nature to look for pink and red ones in early February and red, white, and blue in late June. (Unfortunately, I didn’t think of saving proofs of purchase until years later, when I would have accumulated more than three thousand.)

My M&M’s mania had its downside because it forced me to acknowledge a mania common among medical employees, aka “kleptos.” In selling antibiotics for young children, flavor played an important role, since no parent
wanted to fight with a squirming kid to get the medicine down. Consequently, if a company’s drug tasted good or just not too bad, its marketing team hyped that advantage nonstop. After the cherry-flavored Zithromax oral suspension won taste tests against every other
brand-name
antibiotic—nobody could touch amoxicillin, “the pink stuff”—Pfizer’s marketing geniuses wanted to drive home that point. To this end, we received cases of cherry-flavored tongue depressors and clear, plastic containers stamped with
ZITHROMAX
in—naturally—purple lettering to distribute to each office.

Well, like most ideas from the marketing teams, this one was only half successful. The tongue depressors came
separate
from the containers, meaning
somebody
had to assemble the package. Not bloody likely. I threw out an ark’s worth of cherry tongue depressors, as did most of my colleagues. However, the containers could hold two and a half pounds of M&M’s; left on the nurses’ counters, I could simply refill them every time I visited an office. That is, if they were still there.

Shortly after launching my container concept, I noticed they had vanished from the countertops in one of my bigger offices and in three other practices I called on that day. The mystery of the missing M&M’s containers gnawed at me until I finally asked the nearest staff member, “What happened to the M&M’s thingies?” I have yet to get over my shock at her answer.

“Oh,
those.
You know, they make great Q-tip holders.”

I was stunned by the thought of my beloved containers held captive in bathrooms throughout northern Indiana. It turned out that their worth was not limited to ear-cleaning products; they also made great cotton-ball holders. I began taping big
DO NOT REMOVE
labels onto the containers, but some still disappeared.

I considered ceasing my M&M’s purchases in protest, but that proved impossible. Unintentionally, I had created a confectionary conundrum for myself: These ladies equated me with the plain and peanut treats. They may not have known what drugs I sold, but they damn well knew I was the M&M’s guy.

“Hi,” I’d say pleasantly as I approached the check-in window.

“Where are they?” the receptionist would say, holding out one hand while unconsciously wiping away the saliva dribbling in Pavlovian fashion with the other. I became a literal sugar daddy. The rattle of a bag of my colorful little “office keys” brought women running. The M&M’s guy usually got back to see a doctor, making that money well spent.

The biggest chunk of my expense account was spent on office lunches. As a new Pfizer rep, I pictured myself aiding the fight against disease by providing doctors and nurses with important information that would help save lives. Little did I know that three months later I’d be running a de facto catering company and that one of my most well-received pearls would be that the
Olive Garden’s black-and-white cheesecake was available for takeout.

Lunches proved to be the most frustrating facet of pharmaceutical sales because they almost never turned out as planned. While colleagues in major cities utilized caterers, there were few of those in northern Indiana, so I had to pick up the food myself. This presented logistical problems since the restaurants rarely had the meals ready on time, and trays often spilled during transport. On more than one occasion, a woman with whom I was on a blind date glanced into my backseat, noticed the food stains, and remarked, “They didn’t mention that you had kids!” I also ruined suits when marinara sauce leaked from the tray I was carrying on two separate occasions, and one of my coworkers told me I was lucky the number wasn’t higher.

Inside the office, I’d often find the staff members knee-deep in yet-to-be completed paperwork and phone calls, unable to get the lunch area ready. Having finally schlepped the food in, I’d discover a lunch table covered with three feet of crap, including old Cheetos bags, issues of
People,
and patient charts. Since bigger offices worked through the lunch hour, the women would take their breaks in shifts, with the least-important personnel often eating first. Unfortunately, there seemed to be an inversely proportional ratio between a woman’s job importance and her appetite, so the food would occasionally be gone by the time the doctors rolled in.

Perhaps I shouldn’t throw stones, however, since I, too, once forced a physician to go hungry. For my first lunch ever, I wowed the staff with an impressive array from Subway. The rolled eyes and barely suppressed groans quickly alerted me to the preference for food that was hot and good, not necessarily in that order. Painfully aware of my brand-new status, the ladies gave me the benefit of the doubt, and things seemed to go smoothly after that. Except, of course, for the absence of either pediatrician, both of whom were “totally swamped.” Earlier, the first nurse on break told me, while less than enthusiastically choosing between a BMT or tuna on wheat, she hoped Dr. Blank would be able to pop in for a minute. After sitting down, she urged me to grab a sub. I politely declined, explaining that I had eaten a big breakfast and still wasn’t hungry. In truth, I was merely following a basic tenet of army leadership: Troops eat first. The last thing I wanted was to run out of food before the doctors arrived.

Twenty minutes later, the third nurse on break reported that there was no way Dr. Blank was going to have time to say hello, let alone eat. This prompted several more calls for me to dig in, but I continued to resist. Finally, at one o’clock the office manager pointed toward the lone remaining sub and said, “Really, Jamie, he isn’t going to stop back here. Go ahead and eat.” I relented and helped myself. No sooner had I shoved the six-inch Subway Club into my hasty mouth than a man in his early forties
wearing a Mickey Mouse tie—male pediatricians often sported cartoon ties in order to make little kids laugh—glided through the door. Rubbing his hands together with gusto, Dr. Blank headed straight to the table.