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The blame game

What caused the rift in the GP–pharma rep relationship and how can it be cured?

David Impey is director of BigBear Communications Ltd 25 years ago, a young, fresh-faced rep who looked a lot like me hit the roads of Britain armed with a bootful of sales aids and branded goodies. His aim was to assail the 670 or so GPs on his patch, bolstered by a three-month intensive training programme that meant he could, more or less, hold his own with the customers he met.

The customers, in turn, were comfortable with setting aside 10-15 minutes for a reasonably intelligent diversion from ministering to the endless litany of coughs, colds, piles and other irritants. They could settle down with a cup of tea and a biscuit and – why not? – light up a well-deserved fag while jousting playfully with the rep's sales patter.

In those days, the Naprosyn rep, the Adalat rep and the Ventolin rep were ambassadors for the industry and were, on the whole, regarded well by their constituency. They were, if not openly welcomed, tolerated with good humour. At the end of the day, the doctors gained some new information about drugs that they could trust (even if it wasn't entirely impartial) and they could discuss their experience with someone who would act on the information as appropriate.

Fast-forward 25 years
A rep told me last week that Macclesfield Hospital is now closed to the industry as they "don't want to have anything to do with us". This is an extreme example (and not altogether true – you can still gain entry, it's just a lot more difficult), but when it's set against the numbers of GP practices that are closing their doors to us, more and more hospitals introducing rules for reps, and PCTs treating drugs as the blight in their budgets, it would be easy for us to fall into the trap of blaming everyone else.

Blame the government
The easy answer is to lay it all at the door of an increasingly controlling, target-obsessed and intellectually bankrupt government who see pharma as a soft target for pruning costs; damn near everything else is publicly funded (eg doctors). This wouldn't matter much if the medical profession truly cared for our industry.

Instead, we have Des Spence and his "no free lunch" mantra; a cause that is being espoused by the Royal College of Physicians (RCP), no less. It was reported that the RCP – as recently as February – sent out a circular to hospitals advising them to avoid accepting industry largesse (ironic, as it happens, as I had only just booked a meeting room at the RCP for an advisory board, but I digress).

As an industry, we can all froth in our beers and mutter darkly about how silly Des is going to look trying to treat his next patient with the power of his magnetic personality, but that isn't going to change things for us. Alternatively, we can knock back a stiff one and ask ourselves about how we got here in the first place.

Blame the CSOs
The rot, as many sanguine old GPs will tell you, really set in when the rent-a-reps appeared. Instead of a nice, cosy chat with the Feldene rep, a robot with an anxious frown would burst through the door, trot off the three key messages, demand the GP put the next five patients on his drug and then bugger off.

This was neatly captured by one GP friend I used to call on telling me bemusedly that some clean-shaven bloke in a suit had just thrust his head round the door and called him an Asilone.

The multiple salesforces were tolerable; you could still build a relationship with the Diflucan rep and the Istin rep irrespective of the fact that they both worked for the same company. But what really crippled the camel was four reps parading before you in quick succession, all touting the same product with a depth of understanding that even Paris Hilton would find superficial.

The nagging doubt started to creep in that setting time aside for reps was not as intellectually profitable as it had once been.

Blame the banks
This is a highly topical thing to do right now as they are the cause of all that's wrong in the world. As salesforces proliferated at literally logarithmic rates, every extra 500 reps trumpeted by big pharma would be accompanied by a 5 per cent rise in the share price. This was fuelled by some brain donor (you know who you are) going around the industry showing a graph demonstrating a linear relationship between sales and salesforce size.

The CEOs had been charged with making good on their perennial promise of double-digit growth and any and all means (usually short-termist) to expedite same were implemented. It rather ignored the natural rhythm of the industry where changes in marketing strategy can take 9-18 months to reap a bountiful harvest. The banks, on the other hand, needed something to report on a quarterly basis. So this was bound to create systemic stress.

It's fair to say that the bubble probably burst in around 2002-3 when Glaxo's share price practically halved and companies like Pfizer were not far behind. The majors all feverishly tried to do something to look busy and spent vast amounts of cash and time reorganising themselves with the self-conscious anxiety of a girl choosing the right outfit for her first date. But to no avail.

Blame the industry
The feeble afterglow of the double-digit growth manifesto has been companies cutting costs to maintain double-digit growth in profit, if not in sales. The first to fall were the massive, bloated salesforces; the second was R&D; the third was a swing towards specialist-healthcare (ie hospital-only) portfolios and the fourth is savings made through massive, asset-stripping mergers.

The death of the mega-salesforce will not be mourned. It brought us into disrepute and drove a wedge between us and our core customer base. It was an eloquent expression of our intention to milk our customer base ruthlessly.

The demise of R&D in favour of acquiring late-stage products from the biotech sector has yielded a few good introductions, but has distanced us yet further from the medical profession as all the exciting science is being done by someone else now.

The swing towards hospital-only products is a great idea on paper, if only it didn't mean turning our backs on primary care, which has the greatest concentration of the very people who would stand up for us if they thought we were worth the candle.

The mega-merger is the final act of desperation and does nobody any good – except perhaps Kleinwort Benson, whose idea it probably was in the first place. Think of all those lovely fees at a time when they are rarer than rocking-horse droppings.

Blame the doctors
They don't love us any more. Of course, how stupid! How do they expect to do their jobs if they don't see our reps and learn about our drugs? And then use them? (More spluttering in beer...)

Perhaps we should be nicer to them. Perhaps we should invest in our own people more. Graduates used to be able to join straight from university and undergo a careful, comprehensive training programme that would equip them with the knowledge and skills to meet the clinical and environmental needs of the doctors. Now, they have to join a CSO and try to earn the right to join a 'real' pharma company later on. It's like something out of The Apprentice and it's degrading.

Perhaps we should adopt a policy of market husbandry rather than overt exploitation and go back to developing meaningful partnerships with the medical profession at all levels. Perhaps then they will start to trust us again and uppity hospital apparatchiks who try to say we're no longer welcome can be put in their places.

Perhaps they will start to appreciate again that lunch was never free, but there was something to be gained professionally from their dalliance with the pharma industry. Perhaps a more liberal Code of Practice would make it easier to engage with doctors and remove another unnecessary wedge that has been driven into the relationship.

Perhaps doctors will learn to trust us again. As long as we can truly demonstrate that we are on their side.

Not everything in the garden was lovely 25 years ago and a lot has moved on. But the philosophy of looking after the medical profession and respecting and servicing their needs has been eroded over time.

I probably wouldn't advocate offering GPs a fag during the sales call now (although I used to get the price of a packet of JPS once a week to cover such an eventuality).

Once the doctors are on our side as a profession, the industry will garner more bouquets and less brick-bats.  

The Author
David Impey is director of BigBear Communications Ltd, a strategic marketing consultancy. He has 25 years' sales and marketing experience in the pharma industry both domestically and internationally and started out as one of the 64 reps who worked for Pfizer in 1983.
To comment on this article, email pm@pmlive.com

22nd April 2009

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