The drug works. End of story

Of late I've witnessed plenty of angst amongst pharma marketers trying to discern the 'narrative' behind the product they sell.  

I've sat in too many workshops, the purpose of each is to apply The Hero's Journey to the fact that Drug A has an effect on Tumour Type B.  Invariably, inevitably the analogy collapses under the weight of the exercise.  Is it the drug that's the hero or is it the doctor?  If the drug is the hero then doesn't that relegate the doctor to the role of squire to some tumour-fighting knight-errant? Easier to agree that the doctor is hero, which makes our drug Excalibur.  But what about the competition?  Aren't they the ones we're really fighting against, even though it's poor form to describe them as the enemy?  Or is it the patient?  People with cancer can be pretty damn heroic y'know.  After a while the only thing that we can agree upon is that the tumour is the bad guy.

It's around this time that someone jokes that this exact exercise is probably being attempted by a dozen groups somewhere around the world at this exact moment.  So we take lunch.

Afterwards we agree that The Hero's Journey is a bit cliché and we cast around for other narratives and so arrive at Journey From Darkness to Light.  But the medical team shuts that one down immediately because it implies a promise that our trial data won't support.  We are talking about cancer after all.

There is only one successful narrative for pharma products: it works.  If you're lucky you might be able to say it works in a surprising way.  Say this in the right way and let the doctor see for himself (in the right patient).  After which we pretty much lose control of the situation.  The doctor either believes that it works or she doesn't.

Energy spent trying to reframe the customer's relationship with the disease in question is energy wasted.  Doctors know the condition better than we ever will because they live with it every day.  The more poetic amongst them will describe their jobs in terms of warfare ('battle') or travel ('journey') or vigilance ('watch'n'wait') or strategy ('chess game') or problem solving ('cracking the code', 'solving the puzzle') but that's them using metaphor to describe their world to us.  Medicine is all those things and many more and we do well to listen to the words used by the individual.

But it is a mistake for us to gather around a flipchart to concoct some grand narrative that suits our purpose.  In the sales situation it will add a layer of complexity, as metaphor often does, or oversimplify or distort our message in some other way.  Instead, speak plainly and let the facts do the rest.

18 hours in America

I am en route to the East Coast of the US to deliver a pitch presentation. All told I'll be on the ground about 18 hours. 

There are a number of strange things about this trip; firstly it's a competitive pitch, which is an unfamiliar situation for me as I'm usually in the room because of the unique nature of my offering.  The client doesn't quite know what it wants, except to say that the approach must be different, innovative and never tried in the sector before. 

Secondly, I'm presenting on behalf of a consortium that I was invited to join after the initial round of presentations so it isn't just my reputation on the line. Actually, given that almost all my business is 'non-US' I have less to lose reputationally than my would-be partners. However, that also means I'm presenting content not my own with the other partners joining down the phone line. This is never ideal. I have a long flight to internalise as much as I can and my ability to think on my feet will have to do the rest. 

Thirdly, (but related to the above) I have no prior relationship with anyone in tomorrow's room. I'm only there because the consortium reckons I can somehow add value. It will unusual for me to be so bereft of fans. 

I can't help thinking about the last time I flew the Atlantic to pitch at an American HQ. Years ago now it still stands alone as the least pleasant day of my professional career. I walked into an environment so immediately toxic that I found myself looking at the clock at 945am expecting it to say 11. The charitable explanation was that the company, long since taken over, was experiencing an intense bout of 'not invented here syndrome'. The truth was probably closer to being that I walked into a vicious turf war wherein being nasty to me was a handy surrogate for being nasty to someone else in the room. Never before or since have I been treated so rudely in a professional setting; and let's not forget that I work with the Germans, Austrians and Swiss. We called the daylong workshop off at lunchtime and I limped home to London. 

I suppose I'm about to find out what I've learned since then. 

I am paid well to remain sanguine as my ideas are diluted

I am deep in the planning and design process for a truly massive conference that will be held in Europe in a few months' time.  600 people will fly in from all over the world for a two day meeting.  When the idea was formed there seemed to be a burning commercial need: our product's market is changing and we need to energise ourselves against complacency in the face of new competition.  Six weeks later the whole thing is bogged down in a morrass of prohibitive deadlines (getting translations done over the European summer), rival agendas (India's needs are unsurprisingly different from Germany's) and sheer exhaustion.

It's hard to avoid the suspicion that the client is wasting a hell of a lot of money and making many people unhappy for little or no commercial return.  The product in question will continue to grow, albeit with a reduced market share but in a rapidly expanding market.

I've been here before.  Part of my role as an external vendor is to be unflappable, responsive and unfailingly upbeat, to play nicely with others and to do just a little bit more than is required because that's what is meant by 'exceeding expectations'.  I go into projects like these with no more than a faint hope that my work will shine because as the deadline gets closer absolutely every good idea and laudable intenton mutates, often twisting until the effect on the conference delegate is the exact opposite of what was planned.  By taking on the role of sage consultant and pointing this out, in the past I've been accused of prima donna-ish behaviour.  This is easy to level at an external supplier with a creative brief, which is not to say such accusations have been entirely unfounded in the past.

If I'm going to keep working on projects like this I have to let go of cleverness and adopt a new but unspoken standard for my work: -

Try not to add to the sum total of unhappiness in the world

I will try to do no more than have the delegates participate in simple yet creative tasks that have an immediately obvious commerical benefit.  No deep analogies that require decoding.  No fun for fun's sake.  And no endless PowerPoint plenaries where the one commands the time and attention of the many.

Be part of the solution not part of the problem and all that...

The Marketers' Dilemma

(what follows is an essay written for my consultancy business)

 

There is a tendency for marketers to see their roles as all-seeing strategists who, because they cannot direct the field force to specific action, abdicate responsibility for the nature of sales activity.  There is a direct correlation between the distance between the ‘flipchart and the field’ and the likelihood of such an abdication.  The negative consequences of this attitude range from the relatively trivial (e.g. time wasted on internal politicking) to the profound (e.g. a failed global product launch).  However, this is not all the fault of the marketers.  Many (most) pharma companies have imposed strict intra-company communications codes to govern the quality, quantity and access of marketing to sales.  The marketer who seeks to take more responsibility is often explicitly forbidden from doing so.

 

Marketers aren't respected because they have a not entirely unfair reputation for wasting salespeople’s time.  Organising time in front of a field force is very expensive prospect.  Getting a team off the road and into a room takes actual money from someone’s budget but this is dwarfed by the opportunity cost of time-off-road.

So why don't marketers always get the respect they should?

• It is perceived that they change their minds too often, both at a departmental and individual level
• A one-size-fits-all dictates of strategy do not gel with the quick-fire think-on-your-feet, at-the-coalface world of selling, especially when global strategy is soon to contradict local selling challenges
• From a field force perspective, marketers choose not to see the whole picture (e.g. P1 / P2 detailing) and tend to speak as if they're the only conversation going on in the room, wilfully ignoring the fact that theirs is only one of many voices that salespeople listen to
• They are sometimes accused of being victims of ‘agency capture’; being too enthusiastic about adopting the slick, overly clever marketing tricks that make doctors immediately suspicious

Furthermore, the context of the actual communication with the sales team is often wilfully ignored.  Sales teams are expensive, local resources (financed out of national budgets) that must first of all answer to local management priorities.  And Marketing is a multi-layered beast that rarely speaks with a single voice.  At every level (local, regional, global) it is staffed by clever, but not necessarily wise or smart, ambitious people looking to make a splash.  Such people aren't great at taking direction: who got into marketing to be a messenger for the regional / global office?

 

Marketing-sales communications are thus reduced to a few highly regulated interactions per year: the sales conference.  Even here every brand initiative is competing for ‘share of mind’ with other brands, marketing projects, training needs, team-building exercises, regulatory presentations, award ceremonies and so on.  The project is also competing with the pet project of the local marketer, which may or may not align with the global or regional initiative, and which may not be at all worthwhile anyway.

 

Global and regional marketers will always be accused of ‘not understanding the local situation’.  There is always a level of specificity you're accused of misreading.  If a local marketer based in Reading can be accused of ‘not getting it’ by a representative in Scotland then what chance the global marketer sitting in Japan or Switzerland?  And the challenges don't stop once marketing is in the room with the sales team.  Most of the more common objections given by salespeople for not following a marketing strategy can grouped under headings of ‘credibility’ and ‘practicality.

Objections over Credibility Issues

• Not relevant to my doctors
• Too complicated (I don't understand it and I'll lose credibility if I stumble)
• Obnoxiously simplistic (I will lose credibility if I take this approach)
• Too aggressive to the competitor (offends those doctors happy with the competitor product)

Objections over Practicality Issues

• The team doesn't the strategy as we’re successful enough (i.e. making budget) without it
• Conflicts with the ongoing expectations that the company has of the salesperson (complying with the sales model, call rate, strategies for other brands)
• Unrealistic in my selling environment (we work primarily in group selling / time-sensitive environments)

 

Similarly, there are a parallel set of objections that local marketers raise for not following a regional / global marketing strategy.  These include, but are not limited to the strategy not being 100% relevant in this market, being too complicated for ‘our reps’, clashing with a local initiative, been tried already, clashes with sales model, regulatory issues, translation issues, being unrealistic in our selling environment (groups, time sensitive), the imagery is racially wrong and insufficient time at sales meetings to explain it properly.

 

The Dramatic Change process can assist global, regional and local marketers in a number of ways…

1. At the very beginning of the process we co-opt sales training.  This removes all objections around sales models
2. Before meeting the sales representatives we co-opt sales management down to first-line level.  This allows issues around sales team priorities, time-off-road for meetings to be highlighted and positively resolved
3. Our baseline philosophy overcomes ‘credibility’ issues by fully aligning marketing strategy with doctor needs via Single Patient Focus®
4. We offer solutions for all selling environments including group and time sensitive selling
5. We set up a cogent and workable relationship between overarching strategy and local / individual sales tactics via Pre-Call Planning exercises.  A Dramatic Change programme can meet mulitple needs in a sales meeting context
6. We never focus on the competition
7. We don't require globally consistent sales materials to give the appearance that a recognisable global strategy is being enacted
8. Our programmes are fun.  Team-building is a given

For more information visit the company website: www.dramaticchange.com

Erasmus

As I was driving out to visit a brand new client last Thursday I was listening to Melvin Bragg's In Our Time programme on BBC Radio 4.  The topic of the day was the northern Rennaiscance philosopher Erasmus of Rotterdam (1466-1536) and much was made of the itinerant nature of his early career: -

"(Erasmus) is all over Europe, city after city...  He's always to be found around courts.  He's a great one for collecting patronage..."

And: -

"A lot of the writing is to please people because they are paying for his career..."

Perhaps it was because that morning's meeting was with a roomful of total strangers that the description so resonated.  Is there a better description of a consultant, or of any successful seller of financial services, than someone on and off airplanes, city after city, collecting the patronage of those who can pay for our careers?  Like Erasmus I am paid by the modern princes of Europe to be clever.  Nothing gives me greater confidence than knowing that the big boss wants the project to go ahead with my involvement.

But let's not stretch the comparison too far.  Erasmus fought a vicious, losing war of words with Martin Luther over the soul of the Catholic church and the fate of Europe whereas I help drug companies sell their drugs better.

Still, about halfway through that meeting someone described me as a 'thought leader', which was a nice thing for him to say.

Update on 2012-02-19 05:47 by Stewart

During the week a learned friend questioned the parallel with Erasmus and rightfully so.  With barely suppressed bemusement he pointed out that there aren't a great many points of comparison between the career of one of the foundation thinkers of Western thought and that of a jobbing management consultant circa 2012.

What I was trying to explore was that for those who think for a living the importance of patronage hasn't changed much in 500 years.  There's a stark difference in getting work out of an organisation where the big boss likes my way of thinking and one where he or she is indifferent.  For any project to proceed the very least we external suppliers need is the absence of a veto.  If the big boss dislikes what you do then any additional time and energy spent trying to change that is most likely a sunk cost.

Not saying 'no'

I'm sitting in Prague airport after yesterday's 1-dayer for a new client.  It will the last of 47 flights in 2011.

The job, a sort of six hour pitch to a pan-European mix of marketing and medical people, went well enough.  It was one of those situations where whilst the people who need to approve the project weren't in the room, there were plenty there who could kill it.  That gave me a very clear and not especially ambitious goal: to not have anyone say 'no'.

I had my usual mid-morning moment when it occurred to me that this may the last job I ever do; at the very least with this client and possibly ever.  This is my subconscience telling to relax, stop worrying about the next job and to simply concentrate on the people in front me.

By the time we decamped to the bar for too much Czech beer there was sufficient agreement that the project should go forward.  The clarity of a business model where you only attempt to be as good as your last job can be very liberating at times.

The last frontier

For my business the United States is the last frontier.  After almost seven years working out of London I'm relatively pleased as to how my presence has grown in Europe.  I am a known quantity here now and my clients seek me out as much as I seek out them.  In December I'm starting a new project with an old client.  Our third in ten years.  Every time he changes jobs I get a call.

I wonder if the experience would have been as successful if my wife and I had chosen instead to live in the US when we left Australia in 2005.  The challenge of getting visas notwithstanding the choice was ours to make as no company forced our hand by funding the relocation.  I suppose we just liked the idea of Europe more.

I've never felt as confident walking into an American Head Office as an Australian, British, Swiss or Asian one. Nowhere else in the world are foreign accents such a source of undisguised bemusement.  I don't respond especially well to the blank-eyed apathy that seems to say: -

Buddy, we're the richest pharmaceutical market in the world.  There are over 300 million of us here.  If your idea was that good don't you think we'd have thought of it by now already?

The only genuine traction I've had on American projects has been with European owned companies.  My theory is that there's a sense that ideas should be assessed on value not provenance.  Yet America beckons and yesterday I spent an hour on the phone with a Boston consultancy whose task would be to get me into the meeting where my ideas are heard louder than my accent.

One of the problems we discussed was that most Americans in bourgeois industries like pharma are just too damn polite.  Offering a London-based consultant a project in the Midwest might be asking a bit too much of him, what with all that inconvenient travel and time away from his family and whatnot.

Convincing a client that I'll travel anywhere on the planet for the right fee can be a surprisingly high hurdle when landing an overseas gig. This is why consultants never complain about jetlag.  Convincing my potential American clients that transatlantic travel is still just travel may be a step too far and I suspect the consultancy will recommend I relocate the business to somewhere in the corridor between Boston and Philadelphia.  Hopefully he'll also suggest less extreme alternatives but I've yet to see any evidence that you can succeed in America with anything less than a display of total commitment.

So cool

 I've only just found xkcd.

So, so cool...

Pesky verbs

Further to yesterday's thoughts on the descriptive noun (art v. science) this week I've been dealing with an even slipperier conundrum, the verb. To whit: -

What is an appropriate euphemism for 'selling'?

For some quite understandable reasons the client has decided that the guys on the road wot talk to doctors are hereon out to be referred to as 'health solutions managers'. Because nobody likes being 'sold to' right? But there sure as hell are plenty of health solutions out there that need managing: -

Beware of Greeks bearing gifts and solutions in search of problems.

I accept that in much of the world 'salesman' is a tainted word; derisively associated with sharp practices (double glazing in the UK, used cars elsewhere) but excising it from the corporate vocab leaves an glaring absence. Accountants account, researchers research and receptionists receive. Managers either run a team of people or have responsibility for a project or process or else they do... what?

We spent much of the week exploring what it might mean to manage a health solution when the behaviours we want to see exhibited in front of the customer looked consistently salesy.

If it walks like a duck and quacks like a duck then why are we struggling so hard to name the damn thing?

As I said, the client has understandable reasons for wanting this rebrand but as the behaviours (the verbs) aren't changing then was it any wonder that we spent the week wading through euphemisms?

The art of selling

The Schumpeter column in the October 22 Economist (no link available) explores the issue of variability amongst sales teams: -

the performance of salespeople within a single company typically varies by a factor of three.  And the difference between the best and worst companies when it comes to selling is far greater than the difference for functions such as supply-chain management, purchasing or finance.

I guess I'm so close to this issue (I spend so much time with sales teams, albeit only in health care) that the cross-departmental comparison surprised me.  An acceptance of such a broad spread in performance within a team undoubtedly leads to this greater variability between teams or companies.  Most of my clients implicitly employ me to improve the performance of the middle 70%; the thinking being that the top 15% are alchemists who we do well to leave undisturbed and the bottom 15% are heading out the door anyway.

The article speaks to the problem that it is so difficult to first standardise, then reproduce, the behaviours of the high performers that companies are left frustrated, reduced to describing selling as an 'art' as opposed to a 'science'.  I have no problem with this frustration (in fact it benefits me) because I don't see science and art as polar opposites.  Furthermore the better metrics that science requires are often fool's gold: -

Firms are starting to track reps much more closely, usually to their dismay.  Salesforce.com sells tools which allow sales managers to track on a daily basis what their minions are up to.

A number of clients of mine have been taken in by salesforce.com and similar tracking systems and after nine or so months the same 70-30 rule applies: 15% are unreplicably good, 15% aren't suited to the gig and then there's everyone else.  The problem with tracking that middle 70% and the rewarding them on measurable behaviours is that, as the old sales axiom has it, you should expect what you inspect and alas, the measurable behaviours of the alchemists aren't the ones responsible for their success.  Furthermore, systems like salesforce.com only work at all when the reps themselves enter the information about what they're doing into the system.

I like salespeople.  It's isn't hard to like people whose job it is to be likeable.  The immeasurable that I recognise in the good ones is the same as with high-performing actors, improvisers and stand-up comics, all of whom say words aloud for a living: when they are on the job they are present.   This translates into a wonderful ability to slow time such that the thing they say is the only thing that needs saying.

Part of my job is to encourage my clients to see their employees as artists of sorts (we're called Dramatic Change after all).  Too much salesforce.com has the effect of turning them into data entry clerks of their own behaviour, which isn't science so much as drudgery.

Chien noir. Perro negro. Cane nero...

At a dinner at a European pharma meeting last night the conversation couldn't escape the financial crisis. Budgets slashed. Health ministries paralysed by the turmoil. Every hospital, therapy area, patient group and drug company desperately seeking an ever-larger share of a shrinking pie just to keep up.

"My dog's blacker than yours" in twelve European languages

Not an elephant. Not in the room

I finished up in Seoul on Friday afternoon and will be back in London for dinner with friends on Saturday night. The programme, a 'how to coach' session for a sales team's first line managers (FLM's), went better than I dared expect.  The translation on slides and workbook wasn't risible and whilst interpreters unavoidably lessen my impact this one, despite an unedifying pre-game battle of wills, wasn't too bad.

The long-term efficacy of the session won't be determined by the guys in the room but by the one who wasn't.  The newly appointed National Sales Manager (NSM) didn't grace us with his presence for more than a few minutes over the two days.  The subliminal damage to the supposedly high priority given to my project is potentially fatal.  As engaged as the actual attendees were, some corner of their collective brain registered the absence as commentary of sorts.  When I ran into him in the corridor (the session was staged in the client's offices) he didn't look especially busy and his English was certainly on par with anyone's in the room.  He declined the offer to close the session on Friday afternoon even before the General Manager, a far more assured character, jumped on the opportunity.

I'd say that he's either totally contemptuous of my project or shit-scared of his FLM's.  Manipulating your new boss such that he's wary of you is a necessary skill in many organisations and low-ranking sales managers often hunt as a pack in this regard.  Korean sales teams have an uber-masculine sensibility and the NSM missed the perfect opportunity to assert the necessary alpha male status by either: -

1. Taking total ownership of my ideas, which is of course fine by me; or, 
2. Openly challenging the foreign 'expert' over how little he understood the local market. This would have been less fine but nothing I'm not paid to deal with

Instead he stayed in his office down the hall whilst his subordinates challenged me anyway.  He stayed away, seemingly unnoticed, as his boss loped in and claimed the last word.  To be fair, his is a lovely office.  He should enjoy it while he can.

Authoritative rapid Spanish

Some jobs lurch so far outside my control that any pressure to perform simply evaporates.

The other week I was booked to deliver an afternoon workshop for a Spanish sales team that was running two hours behind schedule after two hours.  I was due to follow the presentation of marketing plans for the rest of the year, which was essentially the centrepiece of the entire meeting.  As the morning dragged on it was obvious to everyone in the room that short of wrapping up around midnight something in the agenda would have to give.  And as often happens in such situations the client was forced to choose between delivering vital information (the marketing plans) and recouping a large sunk cost (my workshop).  The big boss chose me and instructed the marketing guys to 'just talk faster'.

Regular readers of this blog will know that I speak no language other than English.  Even under normal circumstances I find Spanish a daunting language to listen to; staccato and without the tonal range of French or Italian.  To my ears the demand that a Spanish speaker speed up was like putting a machine gun on fast forward.

For me at least, the effect was extremely compelling.  In the words of Elisa, Selma Hayek's wonderfully sexy nurse character on 30 Rock: -

I find that authoritative rapid Spanish subdues white people

Big bites in Big Pharma

As this next, even scarier phase of the Global Financial Crisis takes hold it appears that Big Pharma is much of its implicit losing political patronage.

The Spanish government is looking to cut its drug bill by €1.3B by demanding price reductions in both the off-patent and soon-to-be-off-patent medications.  By hitting branded drugs as well as generics (i.e. those already off-patent) a signal is being sent by the Minister for Health & Social Policy: -

The pharmaceutical bill rises to nearly €15 million annually and the government becomes the largest customer in this sector...  We demanded a lot to the industry and we believe enough is enough

In the UK the National Institute for Clinical Excellence (NICE) has decided that none of three leading treatments for metastatic colorectal cancer are good value at their current pricing.  This will effect Roche (Avastin), Amgen (Vectibix) and Merck Serono (Erbitux).  The NICE statement said that it was: -

Disappointed not to be able to recommend cetuximab (Erbitux), bevacizumab (Avastin) and panitunmumab (Vectibix) for this stage, but we have to be confident that the benefits justify the cost of the drugs

This is especially bad news for Roche as Avastin, the world's largest selling cancer medication, is under ongoing FDA scrutiny as a treatment for metastatic breast cancer in the US.

Boehringer-Lilly have been scared off launching diabetes medication in Germany due to legal-administrative changes that place a greater onus of the company to ensure that a new drug is value for money: -

Reorganisation of the Pharmaceutical Market (AMNOG), (which) was established in January this year to regulate the pricing of newly approved drugs within their first year.  This means that Germany's NICE equivalent IQWiG and a new Federal Joint Committee (G-BA) now assess a drug's cost-effectiveness against a suitable comparator and if the drug fails to demonstrate its cost-effectiveness, then its manufacturer may be liable to refund the government's Statutory Health Fund, which originally paid for the treatment.

It looks as if the German government called Boehringer-Lilly's bluff.

And all of this in the (somewhat) solvent north of Europe.  As I've mentioned previously, further south the picture is different.  In Greece the government is issuing zero-coupon bonds to pay its pharma bills.  Roche said that the conversion of their debt to a bond amounted to a loss of 26% when the bonds was converted to cash.

Of course as Greece racks up more debt a 26% 'haircut' might look like good value.  Assuming that Greek bonds of any value are still deemed to be assets in the months ahead.

Buying time, expecting attention

In the early 90's I once worked on a project to establish a sales/marketing culture for a mid-tier pharma company establishing it's own Australian operation for the first time. Their products were important, if a little mundane and somewhat limited in scope. The company had identified that as the size of the business meant that there was almost no scope for career advancement it was going to struggle to recruit effective salespeople.

Their solution was to staff the sales force with experienced women looking to reenter the industry after having children. Prima facie it was a good fit. The company needed solid experienced performers but who weren't interested in promotion and the women wanted to rejoin the workforce but on more sympathetic, less careerist terms. With the right HR attitude to flexible working hours it looked like a 'win-win'.

For a while it worked well enough. The new team was highly energised and quickly established a healthy, credible presence in the marketplace. Sure, the job-sharing and ongoing maternity leave coverage issues required additional Head Office and sales manager admin but no more than had been anticipated.

About nine months later, after the initial euphoria of launch had died down, the mood changed abruptly. Both management and the individual salespeople were suddenly, totally disenchanted. The company expected the women to still be grateful for the opportunity to rejoin the workforce on such sympathetic terms and that gratitude to manifest itself as greater attention to detail. The women couldn't see what the problem was: they were turning up and doing the job (sick kids who needed early collection from child care notwithstanding) weren't they?

The women were selling time only whereas the company thought that their (complete) attention came as part of the package. Within a year the complexion of the team had shifted back to the usual blend of unambitious old stagers, thrusting careerists and a few women with young children but decent family support to allay the early-pick-up-from-child-care-issue.

No pregnant person can give an employer his or her complete attention. Ditto for anyone with a new baby. It doesn't matter of that baby is real or metaphoric (i.e. a nascent IOS app, a comedy career or a that business you're starting up on the side) and it's no less true if both you and your employer buy into the fiction that selling only your time will be sufficient.

Something you love more than your job is always going to take attention away from that job. Because in part that's what love is.

Desperate times, desperate measures

The question of whether American drug reps are salespeople or robots is back to the Supreme Court.  If the suit is successful then the pharmaceutical industry will owe its (former) employees many millions of dollars in unpaid overtime.

This is a natural consequence of Big Pharma viciously downsizing its sales teams at the end of the blockbuster era.  The companies have no choice but to shed all these jobs but as the entire industry is contracting their laid-off employees can pursue this overtime claim with impunity.  There aren't enough new jobs emerging in the industry so there's no reward for not being labelled a troublemaker who went after this additional cash.  If you're not going to get another gig anyway you might as well try for whatever you can get?

Structural change.  Boy, I don't know...*

* With apologies to Aaron Sorkin

Do unto others...

Over the years and around the world I've worked with many of the major pharmaceutical companies but for whatever reason I haven't often crossed paths with Pfizer.  As such my impressions of the world's largest pharma company has usually been that of their competitors.

For over twenty years Pfizer has been the most ruthlessly single-minded marketing outfit in the industry.  By flooding doctors' offices with legions of undertrained reps, often as many as eight per territory for a single product, it sold good drugs (Lipitor, Viagra) in a bad way.  This successful focus on 'share of voice' triggered an arms race wherein every company selling a product in Primary Care had to proliferate sales reps or else be elbowed out of the doctor's mind.  This deluge of drug reps selling poorly differentiated products by parroting two or three key messages with scant regard for a prescriber's clinical needs has destroyed the industry's claim to be a partner in the fight against disease.  Most doctors now see the industry not as a partner but as an enemy and Pfizer's 'share of voice' strategy is a major cause of this shift.

As I said, I've not done much work for Pfizer but I've often been brought in to help prepare a defensive response to an upcoming Pfizer launch into a given market.  Even in specialty care fields like oncology there's a perception that Pfizer will enter the fray with a massive sales/marketing investment dispatched with a discipline that feels like violence.  All of those barroom laments at sales conferences about the underhanded things done by 'the other guy' are usually about the Pfizer rep.

This ruthlessness goes way beyond the hurly-burly of a couple of reps scrambling after a prescription in a suburban clinic somewhere in America.  Pfizer has effectively declared war on the government of New Zealand by demanding that Pharmac, the highly effective regulatory body charged with controlling the country's drug costs, be neutered in the name of an impending Free Trade Agreement.  Admittedly Pfizer isn't acting alone here and so far the NZ government has stood its ground but this story has a way to run yet.

You could argue that Pfizer really isn't any different from any of the other players (i.e. my clients); just a little more focused on the bottom line and a little more eager to adopt practices that will hurt the entire industry in the long term.

I disagree.  Lipitor, the largest selling drug of all time, is now off patent and in pursuit of this bottom line Pfizer is devouring the very people who drove that success.  I can just about stomach the job cuts because we could all see those coming; although this is cold comfort to the 16,300 employees losing their jobs in the coming weeks.  What I wasn't aware of was Pfizer's longer-term move to cap (American) retiree health benefits at $11,700 p.a. despite the cost of the policy being over $22,000 and rising.  The ex-employee pays the rest.  According to the Placebo Effect blog this will save the company about $534 million a year.  When Pfizer's sucked you dry it really does just discard the husk and move on.

The only justifiable stance the pharma industry has ever been able to take was set out by George Merck in 1950: -

We try never to forget that medicine is for the people.  It is not for the profits.  The profits follow, and if we have remembered that, they have never failed to appear.  The better we have remembered it, the larger they have been. 

In pursuit of profits Pfizer has thrown so much under the bus; the one-to-one relationship with the doctor, the collegiate nature of the industry, its world class research centres in Kent and Michigan and its own employees, past and present.  Its decline from industry dominance is not to be lamented.

Fixing pharma

Matthew Herper writes at Forbes about health care.  Last week he wrote a piece entitled Big Pharma: What Went Wrong?  Much of the article is a direct quote from Peter deVilbiss an ex-employee of Merck, who makes the obvious and off-stated point about pharma R&D: -

It takes a lot of profits from the few approved drugs that make it to market to pay for all the basic research and failed development candidates that lie beneath the surface and out of view of most people

Herper and many others are calling for two key reforms to 'save' Big Pharma: open source sharing of trial results and an end to direct-to-consumer (DTC) advertising.  I have no problem with either suggestion as either or both would improve the bottom line via a reduction in expenses and, in the case of DTC, improve the industry's American reputation.

As a consultant that works mainly outside the US (although regularly in Canada) and usually in more rarefied therapy areas like renal disease and oncology it strikes me that a lament on the evils of DTC is an analysis that is looking at the obvious rather than the important.  DTC is as much a symptom of the Blockbuster era as a cause.  I doubt that medical advances will ever again be as simple or as widely beneficial as the advent of the statins, COX-2 inhibitors and erectile dysfunction agents.  You won't see much DTC advertising of monoclonal antibodies because they're targeted therapies and the ROI on that sort of ad spend won't be there.

This is not to say that commercial medicine is about to get all classy: get ready for a massive increase and unedifying in TV ads for genetic screening: -

Did you know that you could be one of the millions of Americans who have cancer and don't even know it?  Call this number now...

Cold-calling a falling man

In these straitened times every client of mine is under pressure all the time.  The cultures of every pharma company pulse with implicit threat: -

Do more with less.  Do it sooner.  Do it right the first time or else...

Some days all of this makes self-employment feel a little better.  It feels as though I have more control over my destiny.  Arrant nonsense, of course, as there's nothing like a job scare to encourage a sales team to attempt a little DIY training.

This pressure on expenses is doubly felt by the pharmaceutical industry; not only is the sector going through the same GFC as everyone else but it faces a systemic threat in the number of hugely popular products that are coming off patent.  A branded medication can expect to lose as much as 80% of its sales within six months of patent expiry and by some calculations the big research companies (aka 'my clients') will lose a further $100 billion in sales to generic manufacturers in the next three years.

This is old news and the industry is responding.  Pfizer is closing research facilities in the UK and invest in sales teams in China.  Novartis has been positioning itself in the generics game with Sandoz since 2002.  Roche completed a takeover of Genentech in 2009 to try and dominate the biologics market.  This year Sanofi-Aventis has bought Genzyme and Takeda has bought Nycomed.  The M&A industry has plenty of reasons to love pharma.

This can make life a little tricky for a Headcount: 1 consultant trying a few cold calls but with one eye on his summer holidays.  Here's an ex-client's response to my friendly hi-how's-it-going email: -

Yes i do remember you.  It is probably not the right time to come in -- we have just been taken over by XXXX so things are a little unsettled at the moment.  Sorry can't help at this time

 Not my finest moment as a salesman.

White coats in far flung lands

No reader of this site would be unaware of the placebo effect (aka the 'white coat effect') which is usually defined as something like: -

The measurable, observable, or felt improvement in health or behavior not attributable to a medication or invasive treatment that has been administered

Your attitude to placebos is probably driven by your overall attitude to health care.  One side of the argument is that that anything that offers a sick person a respite from the effects of his disease has value.  People holding this view are renaming the phenomenon the placebo response; whatever it is that's going on is broadly on our side.  The opposing view is that what's being peddled is fraud and false hope; we're tricking the patient into believing that something substantial is being done and the fact that the patient's own brain is in on the ruse doesn't excuse anyone.

The placebo effect / response is the bete noir of pharmaceutical research.  If you've sunk upwards of half a billion dollars into developing a drug then 'no better than placebo' is not want you want to hear at the end of Phase III trials.  The brutal logic is that there's no point in subjecting the patient to an expensive treatment that is undoubtedly accompanied by a raft of side-effects when with a little encouragement the patient's own body can achieve the same response on its own.

And apparently we're seeing a strange increase in the placebo effect.  A few years ago Wired Magazine ran a great Steve Silbermen article entitled Placebos Are Getting More Effective.  Drugmakers Are Desperate To Know Why.  It tracks the work done by Dr William Potter, a researcher at Eli Lilly, who observed that new antidepressant and antianxiety medications were actually being overtaken by placebos in as many as nine out of ten trials.  Potter questioned two assumptions that are pivotal to clinical trials: -

1. If a trial is managed correctly, a medication will perform as well or badly anywhere in the world
2. The standard tests used to gauge volunteers' improvement in trials yield consistent results

It turns out that part of the problem stems from (surprise, surprise) the pharma industry's habit of scouring the globe for the cheapest option to undertake any necessary work; more and more clinical trials are using centres in Eastern Europe, Russia, China, India and Africa.  Something that's of great concern to the hand-wringing lefties of this week's Guardian: -

Places such as South Africa – where mostly vulnerable poor with low literacy levels are recruited and the culture is to accept authority without question – are fertile land for ethical misconduct

I accept that ethical misconduct of every kind is more likely in the less developed world (viz. Nestle infant formula) but I reject the knee-jerk implication that such exploitation is inevitable.  The irony is that the problem of the spreading placebo effect may be a result of exploitation in the opposite direction: -

A patient's hope of getting better and expectation of expert care—the primary placebo triggers in the brain—are particularly acute in societies where volunteers are clamoring to gain access to the most basic forms of medicine. "The quality of care that placebo patients get in trials is far superior to the best insurance you get in America," says psychiatrist Arif Khan, principal investigator in hundreds of trials for companies like Pfizer and Bristol-Myers Squibb. "It's basically luxury care."

Wired, ibid

When a Big Pharma company grandly states that its mission is to 'improve the lives of people across the world', I strongly doubt that the promotion of the placebo effect is what it has in mind.