A guide to drug reps

As a family physician, I have met hundreds of drug reps, and they are a different species entirely, about whom little has been written. So, to remedy this, and with tongue planted firmly in cheek, I have classified and tracked the behaviours and types of the more memorable ones I've seen.

By Shafiq Qaadri

THE JOB HOPPER
   Drug reps who have switched jobs to their competition face a challenging predicament. They must change their marketing tune without damaging their own credibility.
   "Doctor, I don't want to spin you, or at least I don't want you to realize it. I know I was in here a month ago talking about Perck's cholesterol medication. But that was before I knew about Mizer's medicines." (Which means, before he or she joined Mizer.)
   "I don't want to say anything negative about Perck's drugs, because I still stand by what I said to you for the past three years. But I've realized, in light of new information, especially since my trip to Maui is tied to my drug sales for this postal code, that Perck's drug is much better than Mizer's."
   Then I ask if they changed companies because they believe in the new company's medications. They nod in the affirmative, but what they're actually saying is, "Are you kidding? You should have seen the signing bonus."

THE NEWBIE
   The newbie is an overwhelmed beginner and speaks in the tentative tone of someone who's memorized what they have to say: "Well, doc, I just learned what a ventricle is, as I'm new to this therapeutic area, but I think this is just the drug you're looking for. I actually majored in English lit. and don't fully understand my own detail piece, but it's pretty isn't it?"
   Because their knowledge has just been acquired, they are easy to destabilize. They are completely alarmed when forced to speak off-script, and their confidence crumbles. I'll ask questions like: "Will that medication make teeth fall out, as Mr. Roberts has only two teeth left, and he's grown quite fond of them?"
   The newbie will reply: "That's actually a very good question. I have no idea how it even vaguely relates to my product, but I'm going to string a few words together if that's all right with you. I do know that my drug doesn't interfere with the cytochrome p450 system, whatever that is. And its half-life is only 12 hours, which must be good, because they keep mentioning it."
   Newbies tend to rely on their detail piece as a crutch, so you will be shown lots of graphs and bar charts. "This pretty graph shows a beautifully downward sloping curve," he'll say.
   To destabilize the newbie, say something bold like, "Well, with a skewed statistical representation like that, they can prove anything, don't you think?" Or keep it simple and ask: "What's the p-value?" No one actually knows what this means, but it shows you're in control, and nothing can be put over you.

THE EXPERT
   Some of my reps have been around for decades, and they dress and behave as if they were the CEOs of their companies. They have the high-energy tone of businessmen, and the leather briefcase and pinstripes seem out of place in my office. I know the fellow's tie alone is worth more than everything I'm wearing. Such reps don't feel as if they need data, or articles, or any outside information about their drugs—they feel their personal recommendation is enough.
   "My brother is head of gastroenterology at the Scripps Institute, and he was visiting the other day," this CEO-type says to me in an accent worthy of the House of Lords. "Over some port, I was discussing the use of my drug. And he agreed with my idea; it's not just an acid medicine, but could also have wide application for psoriasis."
   The fellow speaks as if he is sharing privileged information meant exclusively for me, and had I enough sense to understand, I would immediately prescribe his drug for the off-label indication he was touting.

THE BEAUTY
   Certain reps just happen to be unsettlingly attractive, surrounded by their own cloud of perfume and outrageously well-dressed. One can't really say too much in print here. But I do recall a rep who came in wearing a rather low-cut dress, with a sticker of her medication prominently displayed on the exposed skin of her left breast. Need I say more?

THE ENTHUSIAST
   Some reps are at a disadvantage as there's not much to distinguish their drug from its competitors. Yet they still enthusiastically promote another me-too product. Then you get to watch reps stretching to find any story to tell.
   "Doctor, I know there are lots of ACE inhibitors on the market. Probably you've already used benazepril, captopril, cilazapril, fosinopril, enalapril, lisinopril, quinapril, perindopril, ramipril and trandolapril. But MYpril really is more of a pril than the other prils. It's the only pril to cover hypertension 24 hours a day: in the early morning, the mid-afternoon, the late evening and the starry twilight. It also has multiple excretion pathways: It is excreted by the heart, lung, kidney and brain, as no organ wants anything to do with it. It'll save money too—it's 75 cents less per year than the others. And remember, our packaging is a pretty blue."

THE GIFT-GIVER
   Reps often leave reminders of their drugs. We all have huge collections of unused patient calendars, audio and video tapes, questionnaires, CDs and so on. They seem very helpful, but to match the patient with the leave-behind is difficult.
   The most amusing leave-behind was a talking picture-frame left by one of the reps. The young lady was selling an antibiotic; to help me remember her drug, she got one of those talking picture frames in which she put her photo and recorded a message. When I push the button, I heard: "Dr. Qaadri, please remember our antibiotic kills the bugs deader than our competitors."

THE MANAGER REVIEWED
   Reps will often bring in their manager for a field visit, and sometimes they even tell me the day before they're coming. The rep is always tense during such encounters, as this is something of a performance review. And even if I can barely recognize my rep—since he hasn't visited in the past nine months—it is understood I will be pleased with his impeccable service.
   "Please, doctor," he'll tell me the day before, "Just let me get through my detail. And for goodness' sake, say you use my drugs."
   With the manager in the room, I find my rep is suddenly more courteous, knowledgeable and obliging. I let the manager know my rep has established rapport, taken care of my needs, addressed my concerns and other worthy goals.
   This is also the best time to ask for anything, as the manager is watching the interaction. Whatever is needed is fair game: medication samples, CME dinner invitations, business loans, their first-born.

THE MBAer
   A rep with an MBA is grudgingly doing fieldwork—and desperately waiting to go back to head office. They will deny this, of course, and give a noble spin.
   "I've actually enjoyed my time out in the real world," they'll say. "I meet our customers and find out about their needs." This means: "Look, I'm in line to be associate product manager. I've got to do five more months of penance, and then I'll be rescued by head office!"
   Once their cover is blown, they relax and often share interesting insights into the pharmaceutical industry. "I sure am tired of lugging around all these samples," they'll say. "Boy, once your real rep is back from maternity leave, I'm outta here. The worst thing is that I'm so isolated. The higher-ups don't see me, and I'm missing all the corporate politics where all the real decisions are made, because out of sight means out of mind. You can't make marketing director like that. And our patent on this drug expires in three months, so there's no mileage left in it anyway."