My interviewee has asked for her surname and current place of work not to appear here.
Louise is the perfect science pin-up girl: blonde, slim, and dressed in denim and boots when I meet her on campus. She works as a university teacher, facilitating medical students in “problem based learning” sessions. I have arranged to meet Louise to talk about the time she left medical research a few years ago to work as a “drug rep” with a major pharmaceutical company.
Prior to this, her specialty was in developmental and molecular biology. She had specialist interests but also a family, and wanted to stay in one place. “I was in a panic, and there were no research jobs. I mentioned to my GP that I was thinking about working as a rep – and he was positive about it.”
So what happened after she had signed up? Training – and there was no expense spared. “We were flown down to Heathrow, put up in a very nice hotel – I think at the time there was about 20 others – all in single rooms, £120 a night, three or four nights at a time. I would say about 2/3 of the training was on sales – the psychology of selling. Maybe one third was on the pharmacology, and physiology side – that was the bit I was most interested in.
“I started getting a bit irritated though – they would give out journal articles, the ones that you could show the GPs – about the drugs that were to be promoted. I would have questions – about say the sample size or methodology – but I never got straight answers. I would get answers like ‘oh, you don’t need to know that’.”
She was aware that she was unusual, with her biomedical background and PhD. “Most other people had a degree in marketing or years of sales experience. I thought you would really need extensive biomedical knowledge to do this job – but no. I then realised that the knowledge they really wanted you to have or acquire was how to sell. That is really where the emphasis lies.
“Even when presenting results of trials and the use of phrases like ‘relative risk reduction’ and ‘absolute risk reduction’ – well! I was thinking – this is misleading – they’re using relative risk here, because that’ll look better on a graph as its always a higher percentage than absolute risk, but its really the absolute risk reduction that counts. That use of statistics bothered me.” But her concern wasn’t shared. “Don’t you get questions about this, I asked – no, they said, GPs would hardly ever ask.”
Louise was also put out to shadow reps working between GP surgeries.
“What surprised me was that there was very little discussion of the product at all. It just had to be mentioned at some point before leaving. Discussions seemed to be based around maintaining ‘friendship’ – they knew the GPs by first name, they were very friendly with them. They would always bring goodies which were left on the desk (free gifts, like BP cuffs, clocks or notepads all with company branding) and have a chat about the family. They would show an interest in the GP, make them feel special. You’re taught that the GPs are busy and you have to make them feel important.”
Receptionists were seen as important too as they can make the decision as to whether you see a GP or not on a spec call. So it was important to bring along gifts such as appointment cards, pens or post-it pads. Often Louise would accompany reps, laden with food, on their way to a practice. The reason they would give was that they were “doing a lunch”.
“They were supposed to be doing a presentation about the products. The presentation however would be just putting cards on the table with product information and then feeding the receptionists, the practice nurses and the GPs – really, I think it was just to maintain contact. At some point you would have to say the drug name. The training was so thorough, but nowhere did it say that this is what it’s like. The key aim was to befriend GPs and to get invited back.”
While Louise had had contact with reps before, when she worked in a research lab, these had been much more informative visits with lots of technical information mainly about specialist equipment. But when mixing with the new pharma reps, she noticed that it wasn’t scientific knowledge, but confidence and image that counted. “I always felt rather dowdy next to them” she laughs “But another girl said to me – what are you worried about? You’re pretty, you’re blonde, and you’ve got a PhD.”
I tell Louise about the point put to me by some FT readers, that I should see reps because they are a good source of information about prescribing. Does she agree?
“That’s a load of nonsense. Many of the reps don’t have a science or medical background at all. They might be able to quote figures from a table, but that’s because they’ve memorised it. They don’t fully understand it, or the side effects of the drugs. After my 8 weeks training, I was out in circulation. During that time an article came out questioning the safety of one of the drugs I was promoting. That horrified me. I phoned head office – they said don’t worry about it – there wasn’t enough conclusive evidence to support the claims.”
But she was left with questions that she thought could only be answered by examining evidence from first principles. “During the training we were given the journal articles, and if you had a non science background, it would mean very little. But I had done research myself, published journal articles, so therefore had enough experience to critically analyse these papers.
“For example I would want to know about the ‘numbers needed to treat’ – they might need to treat a thousand in order to make a difference to one or two people. That made me wonder how beneficial the drug actually was and also how was efficacy affected when the patient was taking a cocktail of other drugs for various other ailments. This never seemed to be assessed in any of the clinical trials.” But the lack of this kind of information wasn’t obvious to someone without her level of training.
In fact, she says, the emphasis was never on how to understand the pharmacological data, but about how best to sell the product to doctors. Not only are doctors “personality-typed” in order to work out how best to make a sale, but science is used to provide a credible gloss.
On the training course, GPs helped the fledgling reps work out what to do. “They film you doing a mock interview with a GP, then analyse it later and discuss any failings they find. You have to do this really well as passing this part is an absolute requirement of the course. There is much emphasis on getting the whole approach correct – what they call the ‘triangle’. First, ‘identify a need’ with the GP – explain the benefits of the drug. Then you have to get them to think about a patient, and when they have identified someone who matches the criteria, you can then present your graphs.”
There were phrases she was to use to try convince the doctors of thebenefits of the drug, e.g. “are you aware” or “look at the relative risk reduction”. “You can show some fantastic graphs, and the marketing side can make data look ten times better than it actually is. I look back on those four months and it was a pretty black period in my career and gave me no job satisfaction whatsoever. But I’m glad I did it, as at least I can honestly say ‘I know what it’s like.’”
As a result, Louise has become quite “anti-drugs” in many ways. “Too many of them give more side effects than benefits, and you often need more drugs to combat the side effects of the first lot.” The trick has to be to sort out the genuinely useful product from the hyped and oversold one, and to work out how best to use if for the individual patient. But I agree with her. I can’t see any useful role for reps to do this.