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Road to nowhere

Despite pharmaceutical companies knowing that prescribing in the NHS has many barriers, does getting sales reps out on the road still boost the number of prescriptions?

Life is a battle. An up-hill struggle. A race against time. We go to work; nose to the grindstone, shoulder to the wheel, head down, putting our backs into our labours. At least it is for some of us. Not for the elegant barons of healthcare, resting in the boardroom, gathering their composure during the brief moments that lie between lunch and dinner.

However, for the road warrior, screaming up and down the motorways of Britain, juggling a scalding hot Latte in one hand and a mobile phone in the other, life is a bit different.

On days the heavens open and make the highways a death trap; on days the fog closes in and turns visibility into a game of roadway-roulette and on days some other poor soul puts his car into the back of a lorry and everything comes to a grinding halt - being a rep' ain't no joke.

Cruising in a brand new BMW has its compensations: air-con' for the hot days, heated seats for the cold days, GPS, ABS, EBS... a whole alphabet of extras and twiddly bits to make life interesting. A stereo-radio and CD-player with six speakers and base-woofer that could cause an earthquake in Peru has its own reward. Tinted screens, leather trim, alloy wheels; all benefits to die for.

Then there is private medical insurance. No pharma warrior need be troubled by waiting times, waiting lists or hanging around for treatment. Straight to the front of the queue. They know what a mess the NHS is in. No way do pharma bosses want their best producers to be worried by the shortcomings of their customer.

No road warrior needs to fret about using a bed-pan in a stifling ward with only a curtain for privacy. No sharing ablutions for these soldiers. No front line troops need concern themselves that they might be treated, or misdiagnosed, by an exhausted junior doctor, or be marooned on a trolley in a crumbling corridor.

It's not a bad life. It's not digging holes in the road and it's not a mind-numbing, repetitive, stuff-it-in-a-box job. Neither is it dealing with the great unwashed, the British public that seems to have, collectively, forgotten its manners, how to queue, or say please and thank you.

It is not sitting in front of a machine that goes 'blip', or punching a button that goes `beep'. Neither is it sitting in a call centre, following an on-screen algorithm, trying not to tell someone to bugger off and waiting to be relieved, for the relief of a toilet break.

Being a pharma rep is not a bad job - there are millions of worse occupations - but it's not easy. Despite the gloss, the cars, the computers, the smart suits and the hair gel, it is not an easy job. At the end of the day they have to sell things. The road warriors have to sell things to an indifferent customer who either knows much more about the topic than the rep', or who can't understand a word of the sales pitch.

Tough job
The road warriors have to flog stuff to a customer who can't make the decision about what they buy, use or prescribe. They have to try to inform prescribing committees that they'll never meet. Moreover, these committees are of course composed of such a diverse range of people; clinicians, managers, finance experts and Uncle Tom Cobley, that reps could never do a pitch that would interest or satisfy them all anyway.

Road warriors take on National Service Frameworks, NICE guidance, generic prescribing rules and arbitrary local formulary decisions that seem to be the result of a lottery. They try to build relationships with key NHS players, who get promoted, go on leave, or just disappear into the woodwork. Road warriors drive around with a car boot full of the products, adverts, handouts, giveaways and bric-‡-brac.

Somehow reps must inveigle their way, behind the lines, into the surgery using the simple tools of sticky jotters or cream cakes. Once in, they then have to promote the latest budget-busting wonder drug, or pills that are the mirror image of the latest me-too drug. It's a dog's job.

Why do they do it? Why do companies, which know that prescribing in the NHS has more barriers to choice than there are at a Taliban wedding, still try it on?

I was at a conference recently where I bumped into a new pharma-job-meister. He delighted in the title of head honcho of fieldforce effectiveness. He was a thoroughly nice man. Intelligent and calm. Incisive and insightful. Educated and interesting. The sort who could have got a proper job, anywhere!

Knowing what I know about the NHS, its rules, its policy shifts, its budgets, its guidance and its restrictions on prescribing and choice of drugs, I commented to him that he must have done something really bad in a previous life to have ended up with a job like that.

He smiled the sort of smile that is only smiled by people who 'know something' and asked me why I thought that firms with the resources big pharma have still spends millions developing their fieldforces?

As regular readers will know, for years I've been tipping BMW shares to crash when pharma fieldforces are slashed. Yet, my new friend in the business made me think. Good question. Why do they do it? We do it, he said, because it works. Put a fieldforce on the road and the scrips go up. So, forget all about the NHS house rules, regulations and policies - reps can still get their stuff written up.

Until the NHS learns to obey its own rules, the road warrior is the winner. Until the NHS gets some discipline in the workplace - the road warrior is still the champion. Forget everything I've said for 10 years - buy shares in BMW!

The Author
Roy Lilley is a healthcare author and broadcaster. He has written several books and is well known for his highly personal and sometimes controversial opinions.

2nd September 2008

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