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A sparkling asshole

Discussion in 'AstraMerck' started by Anonymous, May 2, 2007 at 3:26 PM.

  1. Anonymous

    Anonymous Guest

    This is how AMI sold:

    The King of Happ y Hour Gene Carbona was almost a criminal. I know this
    because, thirty minutes into our first telephone conversation,
    he told me, “Carl, I was almost a criminal.”
    I have heard ex-drug reps speak bluntly about their former
    jobs, but never quite so cheerfully and openly. These days
    Carbona works for The Medical Letter, a highly respected
    nonprofit publication (Carbona stresses that he is speaking
    only for himself), but he was telling me about his twelve
    years working for Merck and then Astra Merck, a firm initially
    set up to market the Sweden-based Astra’s drugs in
    the United States. Carbona began training as a rep in 1988,
    when he was only eleven days out of college. He detailed two
    drugs for Astra Merck. One was a calcium-channel blocker
    he calls “a dog.” The other was the heartburn medication Prilosec,
    which at the time was available by prescription only.
    The Atlantic Monthly april 2006
    Prilosec is the kind of drug most reps can only dream
    about. The industry usually considers a drug to be a blockbuster
    if it reaches a billion dollars a year in sales. In 1998
    Prilosec became the first drug in America to reach $5 billion
    a year. In 2000 it made $6 billion. Prilosec’s success was not
    the result of a massive heartburn epidemic. It was based
    on the same principle that drove the success of many other
    1990s blockbusters, from Vioxx to Viagra: the restoration of
    an ordinary biological function that time and circumstance
    had eroded. In the case of Prilosec, the function was digestion.
    Many people discovered that the drug allowed them
    to eat the burritos and curries that their gastrointestinal
    systems had placed off-limits. So what if Prilosec was $4 a
    pill, compared with a quarter or so for a Tagamet? Patients
    still begged for it. Prilosec was their savior. Astra Merck marketed
    Prilosec as the “purple pill,” but, according to Carbona,
    many patients called it “purple Jesus.”
    How did Astra Merck do it? Prilosec was the first proton
    pump inhibitor (a drug that inhibits the production of stomach
    acid) approved by the Food and Drug Administration,
    and thus the first drug available in its class. By definition this
    gave it a considerable head start on the competition. In the
    late 1990s Astra Merck mounted a huge direct-to-consumer
    campaign; ads for the purple pill were ubiquitous. But consumer
    advertising can do only so much for a drug, because
    doctors, not patients, write the prescriptions. This is where
    reps become indispensable.
    Many reps can tell stories about occasions when, in order
    to move their product, they pushed the envelope of what is
    ethically permissible. I have heard reps talk about scoring
    sports tickets for their favorite doctors, buying televisions for
    waiting rooms, and arranging junkets to tropical resorts. One
    rep told me he set up a putting green in a hospital and gave
    a putter to any doctor who made a hole-in-one. A former
    rep told me about a colleague who somehow managed to
    persuade a pharmacist to let him secretly write the prescribing
    protocol for antibiotic use at a local hospital.
    But Carbona was in a class of his own. He had access to so
    much money for doctors that he had trouble spending it all.
    He took residents out to bars. He distributed “unrestricted
    educational grants.” He arranged to buy lunch for the staff of
    certain private practices every day for a year. Often he would
    invite a a group of doctors and their guests to a high-end restaurant,
    buy them drinks and a lavish meal, open up the club
    in back, and party until 4:00 a.m. “The more money I spent,”
    Carbona says, “the more money I made.” If he came back to
    the restaurant later that week with his wife, everything would
    be on the house. “My money was no good at restaurants,” he
    told me, “because I was the King of Happy Hour.”
    My favorite Carbona story, the one that left me shaking my
    head in admiration, took place in Tallahassee. One of the more
    important clinics Carbona called on was a practice there consisting
    of about fifty doctors. Although the practice had plenty
    of patients, it was struggling. This problem was not uncommon.
    When the movement toward corporate-style medicine
    got under way, in the 1980s and 1990s, many doctors found
    themselves ill-equipped to run a business; they didn’t know
    much about how to actually make money. (“That’s why doctors
    are such great targets for Ponzi schemes and real-estate
    scams,” Carbona helpfully points out.) Carbona was detailing
    this practice twice a week and had gotten to know some of the
    clinicians pretty well. At one point a group of them asked him
    for help. “Gene, you work for a successful business,” Carbona
    recalls them saying. “Is there any advice you could give us to
    help us turn the practice around?” At this point he knew he
    had stumbled upon an extraordinary opportunity.
    Carbona decided that the clinic needed a “practicemanagement
    consultant.” And he and his colleagues at Astra
    Merck knew just the man: a financial planner and accountant
    with whom they were very friendly. They wrote up a contract.
    They agreed to pay the consultant a flat fee of about $50,000
    to advise the clinic. But they also gave him another incentive.
    Carbona says, “We told him that if he was successful there
    would be more business for him in the future, and by ‘successful,’
    we meant a rise in prescriptions for our drugs.”
    The consultant did an extremely thorough job. He spent
    eleven or twelve hours a day at the clinic for months. He
    talked to every employee, from the secretaries to the nurses
    to the doctors. He thought carefully about every aspect of
    the practice, from the most mundane administrative details
    to big-picture matters such as bill collection and financial
    strategy. He turned the practice into a profitable, smoothly
    running financial machine. And prescriptions for Astra Merck
    drugs soared.
    When I asked Carbona how the consultant had increased
    Astra Merck’s market share within the clinic so dramatically,
    he said that the consultant never pressed the doctors
    directly. Instead, he talked up Carbona. “Gene has put
    his neck on the line for you guys,” he would tell them. “If
    this thing doesn’t work, he might get fired.” The consultant
    emphasized what a remarkable service the practice
    was getting, how valuable the financial advice was, how
    everything was going to turn around for them—all courtesy
    of Carbona. The strategy worked. “Those guys went
    Drug reps are easy to spot in a hospital or clinic. They are
    often young and strikingly good-looking. They are usually
    affable and sometimes very smart. And they are always,
    hands-down, the best-dressed people in the hospital.
    the drug pushers The Atlantic Monthly
    berserk for me,” Carbona says. Doctors at the newly vitalized
    practice prescribed so many Astra Merck drugs that
    he got a $140,000 bonus. The scheme was so successful
    that Carbona and his colleagues at Astra Merck decided
    to duplicate it in other practices.
    I got in touch with Carbona after I learned that he was
    giving talks on the American Medical Student Association
    lecture circuit about his experiences as a rep. At that point
    I had read a fair bit of pharmaceutical sales literature, and
    most of it had struck me as remarkably hokey and stilted.
    Merck’s official training materials, for example, instruct reps
    to say things like, “Doctor, based on the information we
    discussed today, will you prescribe Vioxx for your patients
    who need once-daily power to prevent pain due to osteoarthritis?”
    So I was unprepared for a man with Carbona’s
    charisma and forthright humor. I could see why he had
    been such an excellent rep: he came off as a cross between
    a genial con artist and a comedic character actor. After two
    hours on the phone with him I probably would have bought
    anything he was selling.
    Most media accounts of the pharmaceutical industry
    miss this side of drug reps. By focusing on scandals—the
    kickbacks and the fraud and the lavish gifts—they lose sight
    of the fact that many reps are genuinely likeable people. The
    better ones have little use for the canned scripts they are
    taught in training. For them, effective selling is all about
    developing a relationship with a doctor. If a doctor likes a
    rep, that doctor is going to feel bad about refusing to see
    the rep, or about taking his lunches and samples but never
    prescribing his drugs. As Jordan Katz, a rep for Schering-
    Plough until two years ago, says, “A lot of doctors just write
    for who they like.”
  2. Anonymous

    Anonymous Guest

    this was a great read...
  3. Anonymous

    Anonymous Guest

    Agree. Great read. As clinicians we are so busy it is impossible to keep up on every JAMA article. But I've learned reps are full of BS, so I took their countless wines & dines, & went pharma paid vacations for myself and family. But, I still did the ethical thing for my pts. too bad more MDs aren't like that. Never swayed me, but they did my colleagues.
  4. anonymous

    anonymous Guest

    I spent 3 x the time in the industry and can say if I paid for 10 lunches in 29 years I'll be surprised.

    There are always unethical people like this guy in any industry. I've heard of people with budgets in the 6 figures. I can say that was never my way of doing business, and we ended up owning AMI. Literally.

    And my old company had just as many unethical people, who seemed to skate along and never face the consequences of their actions.

    I'm glad I am now retired.

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