Oct

23

Letter to a Drug Rep

October 23, 2007 | Leave a Comment

Dear Invanz Salesman,

While I appreciate the difficulty of being a salesman and wish you the best of luck peddling your product, don’t you think you are wasting your time in the Emergency Department?  I have no doubt that Invanz is a great drug.  In fact, we use a similar antibiotic in the same class for lots of things. But you are selling the wrong guys.  Most of us just use what’s recommended in the EMRA antibiotic guide (which is based on the Sanford guide).  We pick all of our antibiotics empirically, that is, without knowing the exact bugs with which we are dealing but only the reasonable likelihood of them being a particular species.  Once we get the cultures and sensitivities we can fine tune our selections but, and maybe they didn’t teach you this at your training seminar, these take a few days to cook and by that time the patient is out of the Department.   Although I sometimes have a nightmare that I have forgotten to check cultures or get the second set of cardiac enzymes, it’s only a nightmare.  I wake up, realize that I am in Emergency Medicine, roll over, and go back to sleep.

It’s kind of like those nightmares college students have.  You know, the one where you dream you have slept through an exam.

What you really need to do is suck up to the infectious disease guys because they’re the ones in the hospital who really get jiggy with antibiotic selection.  It’s their life.  They may care about the subtle nuances of this brand over that but we don’t, not really.  Sure, it’s a little bit cookbookish, thanks for pointing that out.  On the other hand I could pore over Sanford’s, the recent literature, and the internet and still end up with the same empiric therapy that I got from the EMRA guide.   If I have any doubts I can usually just speak with the pharmacist.  She knows her stuff and is happy to assist. 

And yes, I do know the mechanism of action of carbapenems.  Thanks for asking and stop trying to pretend you know more about infectious diseases than I do.  You’re a smart guy but you have a communications degree and four weeks of indoctrination by Merck.  You’re not a doctor.  You’re not a scientist.  It’s good to be enthusiastic about your product but only if the enthusiasm comes from a genuine interest.  Good salesmen have that kind of enthusiasm.  I worked with many of them in the Forest Products industry and when they talked about their company’s debarkers or lathes you could tell they knew the ins and outs of the engineering and sincerely believed in the superiority of their product.  It’s just a widget to you.  You have no more love for Invanz than you have for anything else.  You don’t use it yourself, you don’t know anyone who does, and once you make the sale you don’t care what happens.  It’s not like you’ll share any of the liability if I prescribe your drug over another one.

But isn’t that kind of the point?  Unlike other salesmen, you’re not really selling to your customer.  I’m not buying Invanz to sell later at a higher price nor do I use it myself.  Instead, you’re trying to hornswoggle me into forcing it on my customers, regardless of cost and regardless of efficacy.  Is it statistically better than the generic we use?  Who knows.  Maybe a little but then again, maybe not.  The glossy brochures which you brandish as though they were tablets from the Lord Jehovah Himself are not that convincing to anybody who understands a confidence interval, something that you clearly do not.  Not to mention that many of the new drugs coming on the market are either utter crap or the same drug with a new name to hang on to market share. Just add “XR” to the name and it should sell for a few more years.

I hardly ever prescribe anything other than generics.  I’m lucky that way because I don’t have to keep my patients happy to the extent that I cater to their whims.  Some of my patients, if you can believe it, eschew generic medications for the same reason they will not buy generic beer.   Beer is one thing but blood pressure pills?  It’s completely irrational, like obsessing over a brand of flour which, like most medications, is a commodity with very little to differentiate it in the market.  A beta-blocker is pretty much like any other and if I were poor, I’d rather pay ten bucks a month for a generic rather than $100 for a brand name or some fancy combination of two otherwise generic drugs. 

Now look, I am a conservative and a capitalist who is almost exclusively supportive of industry and big business on general principal.  If there’s one thing I can’t stand it’s whiney little pinkos who just want everything to be fair so they can have a cushy job in some useless socialistic government agency pushing papers and going to to seminars. I want to support free enterprise and competition and while I would love for Merck and Pfizer to have record sales and make their shareholders rich, this doesn’t mean that you get a free pass. Nor does it mean that you are entitled to the huge amounts of money in pharmaceuticals because you spend a lot on research and marketing.  Maybe the patent laws are stacked against you but we all operate in a restricted market.  You have your obstacles and I have mine. It’s just the ocean in which we swim.  The shark doesn’t rail against the abyss but instead finds more productive waters.  In other words, maybe we don’t need yet another permutation of the same drug but something original.

Another thing, I don’t like your crappy pens because, well, they are crappy.  Too big usually, and garishly colored.  As if I want to festoon myself with your brand logos anyways.  What am I?  A NASCAR driver?  Are you paying me to advertise your product?  I don’t think so.  Your crappy lunches?  Please.  I never liked them and as I eat for free at my hospital I have even less of an incentive to eat them now.  If I eat your lunch I have to listen to your cringe-inducing sales pitch which is almost as embarrassing as the time one of your colleagues tried to pimp our chief resident who politely handed him his ass in a bucket.  Hey, no doubt to be a resident is to feel stupid for most of the day but we’re really only stupid compared to our attendings and the experienced nurses, people with the qualifications and the credentials to either correct us or give us a little guidance.  You are not one of those people. 

Good luck.  Sales is a hard business.  I’d like to think your company knows what it’s doing by sending you around.  I rotated in a private physicians office and between the lunches and the free samples the doctors did write for a lot of your products so maybe you can sell medications.  I wonder if they felt obligated although I know for a fact they didn’t like you very much. 

Respectfully,

P. Bear, MD


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