Lucy Randle of STAR Medical offers the following advice on making the move to Hospital Specialist Why do you want it? Have you really challenged your own thinking as to why you want that Hospital job? Are your reasons for moving into the role valid and robust, or do you just want to get away from selling to GP’s? If the latter is true, then you need to seriously reconsider. If, on the other hand you are looking to develop yourself and your career, moving into a more technical role where network selling is imperative, then this could be the right move for you. Do your research Is your understanding of the Hospital Specialist role based on preconceived ideas and beliefs? You must start by researching exactly what the role entails, and where better to start than with a real life bona fide Hospital Specialist? How about selling yourself and your enthusiasm to the point where you can secure a day field working? Of course, you will need to overcome barriers to make this happen, but this will only support your case and demonstrate that you have the right attitude to succeed in the secondary care environment. How about asking the customers too? What insights can you learn from them to best prepare yourself for the change in role? Sell yourself Whether you have some, little or no hospital selling experience you should be able to demonstrate how your current skills, experiences and successes can translate to successful selling in the hospital environment. To do this effectively you must have a solid understanding of the key skills and competencies required to excel in secondary care. Spend time reviewing your previous successes versus these criteria so that you can demonstrate how your transferable skills will generate results in a new environment. Politics When looking for any career move you must always consider the political environment in which you are operating. Are there any barriers which could prevent you moving into your dream Hospital job? Are there any advocates who can help make the move happen? Be sure to have a plan to work the internal political arena to your advantage.

There’s no doubt about it: Viagra® (sildenafil) is one of the most instantly recognisable brands in the pharmaceutical market. This month, Pf looks at how this brand has become so well established, and what it means to the Pfizer sales team to be part of what has become a blockbuster. PFIZER launched Viagra® in September 1998 in the UK, amidst a flood of news stories and publicity, following a thirteen-year development programme worked on by over 1500 Pfizer staff. The product revolutionised the treatment of erectile dysfunction (ED), immediately offering significant advantages over other medical approaches for treating ED both in terms of ease of administration and cost. An Award Winning Product In recognition of their ground-breaking research and success, Pfizer was awarded the prestigious Prix Galien 2000 award for scientific excellence and innovation. This award recognised Pfizer's pioneering discovery of the role phosphodiesterase- 5 (PDE-5) inhibitors play in the treatment of ED. The Prix Galien is considered within the industry as the most important award for innovation in the development of new drugs. Pfizer has also been recognised outside industry circles, gaining the Queen’s Award for Enterprise in April 2001. This award was made for the innovative discovery and development of Viagra® and was a tribute to Pfizer staff for their dedication to the continuing success of the company; and their commitment to those who benefit from the product. Standing up to the Competition with a Proven Safety Record In the past four years, three more oral preparations from other companies have been licensed in the UK for ED. Following reviews and published evidence on all of these products, sildenafil (Viagra®) still remains the first-line drug treatment for men with erectile dysfunction.¹ A four-year review of the safety of Viagra® concluded that it has a good safety profile and it has a low discontinuation rate due to sideeffects.² Doctors have confidence in this product that works for all types of patients with ED and is safe to use in those with stable cardiovascular disease and diabetes. Overcoming the Embarrassment of a Very Common Problem . . . ED is one of the most common male sexual health problems, particularly in men aged over 40 years, and its prevalence increases as men get older. Up to 52 percent of men aged between 40 and 70 years will experience some degree of ED in their lifetime.³ Embarrassed to discuss the matter with their GP and uncertain how it could possibly be treated, many men had suffered from ED in silence for years without seeking advice. That was until they began to hear about Viagra®, and some of the stigma around discussing the condition began to be removed. Pfizer has worked hard to build the profile of Viagra® and to help both patients and healthcare professionals overcome their reticence to discuss sexual health matters. Pfizer has sponsored a number of health care initiatives, including a campaign during the 2002 football World Cup featuring ED spokesperson Pelé, screening programmes for men during Men's Health Week, and a nurse education programme, accredited by the Royal College of Nursing called NEED (Nurse Education in Erectile Dysfunction). This programme aims to train nurses across the healthcare sector on the causes and diagnosis of ED. The programme also supports nurses in helping them to establish the most constructive way to talk about ED with men and their partners. Gavin Gandy, Marketing Manager for Viagra® says, "It has taken a long time to get people to overcome their embarrassment. On average it takes two years for a man to present his symptoms to his GP. Men are notoriously poor at accessing health care services; this is particularly true if the problem is of a sensitive nature." Pfizer’s strategy has obviously worked in making Viagra® a household name. Ultimately it has achieved superbrand status. Gavin Gandy gives us one definition of a superbrand: "One that has established the finest reputation in its field. It offers customers significant emotional and tangible advantages over the competition, be it consciously or unconsciously." The Role of the Representative Philip Watts, Sales Director at Pfizer told us: "It is particularly vital with a product like Viagra® that our representatives behave in a highly professional way, and with a real sense of pride in the therapy. We need to understand that erectile dysfunction is an embarrassing condition both for patients and in some cases even doctors. Right from the beginning we have encouraged our team to feel extremely proud of the difference that Viagra® can make to the lives of patients. Professionalism means "knowing your stuff" and presenting it to your customer in an appropriate, knowledgeable and confident manner. If you are able to do this, as well as showing pride for what you are doing, I am convinced that our brand will be the first choice of our customers." This notion of pride certainly seems to have filtered down through the sales force. We noticed a genuine feeling of passion when talking to anyone involved in the selling or marketing of Viagra®. It is clear that they recognise their personal contributions: making a real difference to peoples’ lives, not only for the patients but also for their partners and loved ones. We spoke to two representatives who told us what it is like to be part of the superbrand’s team:

Irene Stone

Irene Stone, a representative with the Becket Primary Care Team, was with Pfizer for the launch of Viagra®. Irene says the product does not necessarily open all doors, or sell itself, despite its fame. She told us, "Because Viagra® is so well known, a lot of doctors say they know all about it and that there is no need to give them any more information. This is my opportunity to bring the brand to life, for instance by discussing an emerging news story about the product, of which there are many, and/or the varied benefits of the product. This product is the market leader. I have 100% confidence in the brand and I am 100% committed to selling it."

Claire Das, who has sold Viagra® in hospitals for over four years, finds the fame of the product can really be a double-edged sword. "Obviously in the early days it was a fantastic opportunity to gain access to doctors as everyone wanted to talk about it. But there are misconceptions that people hold about Viagra®, often because the media coverage has been so extensive that customers think they already know all there is to know about it. Sometimes this is a smokescreen to avoid talking about ED, either because they are embarrassed, or possibly because they want to cover up their lack of knowledge about the subject. It is then very important to put them at ease and open them up to a frank discussion. It is hard to say whether it is Viagra®’s notoriety that makes it a motivating product to sell, or just the fact that it is such a life-changing product." Claire continues, "Despite new competition in the past two years, Viagra® is still commanding market leader position by some distance. The fact that there is now competition in the market has allowed the representatives to really focus on the benefits of Viagra®. We can explain why Viagra® is the standard by which ED treatments are judged; this is a source of great pride."

Claire Das

References 1 Drugs and Therapeutics Bulletin. Vol 42. No 7 July 2004. 2 Padma-Nathan H, Eardley I, Kloner RA et al. 4-year update on the safety of sildenafil citrate (Viagra®). Urology 2002(suppl2B); 67-90. 3 Feldman HA, Goldstein, I Hatzichristou DG, et al. Impotence and its medical and psychological correlates: results of the Massachusetts male ageing study. J Urol 1994;151:54-61.

‘Hate Something – Change Something’ – already recognisable as the catchy tune and lyric driving the most recent in a series of highly innovative advertising campaigns from Honda. “I hate diesels,” said Kenichi Nagahiro, Honda’s chief engineer. Indeed, he hated their dirty, smelly ways so much that his hate became the innovation to develop something much better. OFTEN TIMES it takes a grand passion to liberate thought and drive change. If you truly want to make a real and meaningful difference then you simply have to possess passion – or at the very least a high degree of positive motivation. It is in this spirit that I proclaim a personal passion: - ‘Hate Selling – Change Selling’. “Why, what’s to hate?” you ask. Picture the scene - it’s been one hell of a day in the field, you’ve brought home some work to fill your evening, you’re just about to sit down to dinner and the ‘phone rings. You know how it is…we’ve all been there. Perhaps you really didn’t need double-glazing but did you have to be so rude!? It’s understandable. We all dislike telephone sales calls because regardless of the gambits and ploys of the telephone salespeople we understand what they’re about, we know the rules of the game, and we don’t want to play thank you. Or, when you visit any one of those numerous chain-stores which now define our high-streets do you warmly welcome the attention of the instore salesman. Not one bit! Your radar picks him up at twenty yards and you halt his progress towards you with a well-aimed “just browsing”. So, why, when we ourselves hate this sort of treatment so much, do we routinely and systematically inflict it on our customers? Believe me we do! Don’t simply take my word for it. Go talk to any of the thousands of doctors who have closed their doors to industry representation over the past decade. Sure, the polite excuses usually suggest closure is due to pressure of work, increased administration . . . whatever. But let’s be honest with ourselves. If these thousands of customers truly saw some clear advantage in seeing representatives, obtained S H I F T I N G P A R A D I G M S Hate Selling - Change Selling ‘Hate Something – Change Something’ – already recognisable as the catchy tune and lyric driving the most recent in a series of highly innovative advertising campaigns from Honda. “I hate diesels,” said Kenichi Nagahiro, Honda’s chief engineer. Indeed, he hated their dirty, smelly ways so much that his hate became the innovation to develop something much better. 20 Pharmaceutical Field January 2005 some real and lasting value, then these surgeries would still be open to us and would welcome the representative visit. So, let us not criticise our lost customers – let us empathise with them. But you know what’s so surprising about this customer-drain? This is a relatively recent phenomenon. Things weren’t always this way. Something’s been happening out there in the marketplace to bring about this antipathy to sales people and selling. In pharmaceutical sales I would suggest that for some considerable time now our customers have been chanting, Honda-like, ‘Hate Being Sold To – Change Selling’ and we haven’t been listening. This is why they have closed their doors to us. They don’t like the way we sell and they don’t want to play our games anymore. The seeds of this demise were being sown back in the 1960’s with a growth of new selling processes and technologies – a growth which has been accelerating through until today. In the ‘60’s the ‘must-read’ book of the time was the eponymous work by Eric Berne M.D. – ‘Games People Play’. Attending my first ever sales training course back in the 80’s training consultants were still referring to some of the games, identified by Berne, which had gained a currency within pharmaceutical sales at that time. Games such as – ‘Let’s Pull a Fast One on Joey’ – ‘Look How Hard I’ve Tried’ and the infamous ‘Now I’ve Got You, You Son of A Bitch’. Games such as ‘Now I’ve Got You, You Son of A Bitch’ aptly illustrate the perverse nature of a selling environment in which the representative effectively harried the customer to a conclusion of the representative’s choosing. Whilst Berne was instrumental in the development and understanding of Transactional Analysis (TA) his work also contributed to that sea-change which has occurred in the ‘success literature’ over the past fifty years or so – a change identified by Stephen Covey, author of the Seven Habits of Highly Effective People. Covey draws attention to a significant shift from a character-based success literature, prevalent up until the latter half of the last century, to a more recent success literature steeped in technologies of the mind and one founded upon what he describes as the ‘personality ethic’. With the personality ethic has come a growth in mental technologies which have subsequently become ingrained into our culture and have spawned a publishing glut producing literally thousands of titles within the fields of Popular Psychology, Self- Help and Self-improvement. These works major heavily on technique and methods to lubricate the processes of human interaction so as to influence people, or oneself. Their claim is that they will help us be more effective with other people and this has driven a tendency towards seeking a quick fix - an instant win. For example, Positive Mental Attitude (PMA) is all you need. Unfortunately inappropriate use / over-use of these technologies has infiltrated sales training programmes. Such programmes invariably offer ever greater degrees of sophistication and ever greater promise of success. However, the evidence from our marketplace would suggest that successes won in this way are short-lived and that these programmes fail to deliver over time. Our customers have voted and withdrawn access. It is for us to respond to their concerns and offer a new way, a fresh approach. Covey offers suggestions as to why ‘quick fix’ solutions are eventually guaranteed to fail. He alerts us to the conclusion – the danger - that we have lost sight of those key human principles which underpin the character ethic. Core principles such as – industry, integrity, modesty, thoughtfulness, and service. Violate or disregard these principles and our communication will be compromised at its very heart. Just as we can instantly see through the ‘phone call inviting us to take part in a survey – “this is not a sales call” – so too do our customers see through our selling processes and behaviours. We are violating key principles when we choose to sell, employing techniques and processes to do so, when actually we should be communicating. We talk of building partnerships when our prime interest is our targets, our agenda, and our success. Little wonder then that we are losing our customers. So, what does all this mean for sales training and the selling process? Well, it seems we’ve come a long way over the past century but may not really have moved very far at all. Don’t despair, there is a solution. Our new mantra will be: ‘Hated Selling – Changed Selling – Love Communicating’ Consider. Despite the constriction in the customer base and the environmental changes in our marketplace over the past decades there remain a number of constants. Constants which suggest there is evidence for doing things another way, a better way. One such constant is that throughout this period certain individuals have out-performed their colleagues – and have done so consistently. Typically these top-performers also manage to retain access to customers from whom others are excluded. Undoubtedly, these ‘high-performers’ are routinely doing something that their colleagues are not. Research would suggest that they don’t actually sell at all, not in a conventional sense, but rather they successfully communicate. There is a difference here, a very real difference. For example, one key finding of our research suggests that people who truly communicate with their customers will routinely spend a much greater proportion of their time ‘listening’ to their customers. Not surprisingly, the converse holds true - those who don’t listen tend to do most of the talking and frequently singularly fail to communicate. This isn’t rocket-science – it’s actually much more subtle and complicated. Top performers act and behave differently to their colleagues and they do so because they think differently. How can this be? Well, Covey describes a paradigm as ‘the way you see yourself’ or the ‘way you see your role’. To change your paradigm you therefore have to change these pictures of yourself. Top performers start with a unique advantage in that they see their role differently to others – and consequently they behave differently with their customers. Peak performance mapping can offer you many further insights into why your best people are indeed the best. It’s time to re-model our collective industry behaviour. What it is we are, what it is we do, and what we are seeking to achieve. Kenichi Nagahiro got passionate and is making a difference. Let’s have some passion for what we are about and let’s make a difference for our customers. Clearly it can be so much better!

The pharmaceutical industry needs to jettison its historic ‘quantity over quality’ attitude to sales and marketing. With healthcare professionals harder to access by the day, and more sophisticated, cheaper ways of communicating with them becoming readily available, companies need to adopt smarter strategies based around achieving effectiveness over efficiency if they are to maintain and grow sales. GARETH THOMAS, managing director of pharmaceutical sales and marketing specialists, Cegedim UK, www.cegedim.co.uk reveals how the more agile mid-sized firms could seize the advantage in this regard and leap into the big league. It’s tough being a sales manager in the pharmaceutical world today. The pressure to retain and grow market share is huge even though the barriers to actually doing so are becoming ever more insurmountable. Mergers and acquisitions in the pharmaceutical industry are narrowing the gap between the leaders, while red tape is being tightened to lengthen the time it takes to get new drugs onto the market. Moreover, with the competition always at their heels, sales managers are faced with an increasingly elusive prey: doctors. The code on interactions with healthcare professionals calls for creative thought on how to attract the interest of prescribers, and beat the competition. The need for the prescribers to influence the formulary committees requires a more creative approach. The pharmaceutical industry has its traditional approaches to marketing which have served it well in the past. However, these have less value today when it comes to investing long-term in the future of the business. Established and conservative ways of operating are no longer strong enough weapons with which to fight off the midsized, upstart pharmaceutical firms. These new kids on the block are rising fast with their smarter, more agile, approaches to marketing, which rely less on numbers of sales reps and more on the strategic use of industry intelligence. More than ever before, sales reps and pharmaceutical marketeers need access to the right data at the right time in order to target their messages to prescribers and influencers effectively. This means pursuing effectiveness in marketing, relegating the pursuit of efficiency to yesterday’s strategy. It’s no longer enough to grow ever larger teams of sales reps and throw one-size-fits-all messages at doctors in the hope that some will stick. We need a smarter, more intelligent approach to match the increasingly individual needs of healthcare professionals. For example, multiple methods of permission-based specifically designed targeted communication, not just the rep with the bag. Quantity vs Quality Recent research by Cutting Edge Information has revealed that the pharmaceutical industry average for field force budgets is nearly $875 million, with top-spending organisations committing well over $1billion to sales. Yet, despite all this money being thrown into pharmaceutical sales, pity the sales rep carrying the bag. In many instances, they walk into a doctor’s surgery armed with last month’s data on interactions between the doctor and the pharmaceutical company. In the interim period, the doctor may have received direct mail from a product manager and taken up some points with a medical information service. The meeting agenda has changed, but the rep doesn’t know this. For this is the reality of selling in the pharmaceutical industry today; numbers of sales visits are valued over the quality of the interaction. Moreover, while historically very good at sending out incremental sales messages, pharmaceutical companies are not brilliant at matching these messages to the most appropriate communication medium, again favouring volume over efficacy. Integrating Data for Sales and Marketing Agility This attitude has been compounded by industry attitudes to message integration. More often than not, market intelligence is constrained by the use of non-integrated (disparate) data sources that provide out of date, inconsistent information, and rarely at the optimum time. Most vendors of pharmaceutical sales force automation (SFA) and data systems consider it acceptable to update their clients’ data at best once a month. This invariably leads to duplication, inaccuracies and missed sales opportunities. In many incidences, therefore, precious sales visits are a waste of time. Much of the time is taken up with going over old ground when the doctor has already moved forward in his or her thinking. Maybe if the sales rep had known all the most recent interactions between the doctor and the pharmaceutical company, he or she might have chosen to pitch a different sales message, or may even have replaced the visit with some other kind of interaction, for example, more direct mail or a sponsored lunch. In any case, the decision would have been made based on the very latest market and account intelligence, making use of tactical and intelligent targeting and profiling, and multiple and integrated communications channels. This message has particular relevance for midsized firms hungry for growth. While the giants struggle to overcome cultural barriers to change in their monolithic sales and marketing departments, mid-sized firms are becoming the rising pharmaceutical stars of tomorrow by injecting new agility into their sales and marketing strategies. Strategies which are beginning to enable these firms to compete on a level playing field with their much larger rivals, sharpening competition in a traditionally top-heavy market. Achieving Sales and Marketing Effectiveness Adopting effectiveness in selling means delivering the right message in the right way appropriate to each individual healthcare professional, and informing the sales force every step of the way. To do this you need up-to-date information delivered efficiently to all of the relevant areas ideally from one comprehensive source. Weekly sales data being one example. You then need to work out the next consistent message to give to each individual doctor, and whether this would be best delivered face-to-face, by direct mail, by e-detail or during a symposium, depending on the doctor’s previous interactions with the company. This way the sales message is built and supported from the ground up using the latest sales data and customer information with the most appropriate communications tool for the next interaction with the individual being identified. The returns from such a focused, analytical strategy will always be greater than those generated by a large number of standardised sales visits, planned weeks in advance, where the message to be delivered remains unchanged regardless of the doctor’s recent interactions with the company. Such a tactical approach, when combined with buying in weekly sales data, also makes it possible to develop the Holy Grail of pharmaceutical sales - a return on investment model which would give an indication of the impact of a particular campaign. It is possible to plot the current market share for a particular drug at a territory level, and then map weekly sales onto that to reveal any fluctuations. A simple calculation of marketing campaign costs against sales achieved would provide a good indication of how much your market share has increased. Conclusion The value of pursuing effectiveness over efficiency in sales and marketing has already been proven in the financial and retail sectors where pioneers have leapt into the big league. Even though the pharmaceutical sector has unique needs, adopting greater effectiveness in sales and marketing is already being proven by mid-sized firms to have an equivalent impact. Inevitably, the market dynamics in the pharmaceutical sector will force all firms to go down this route. While the giants struggle to change their ingrained sales cultures, mid-sized firms could act fast and establish a strong presence in the hearts and minds of those who make prescribing decisions. The time is ripe for pharmaceutical firms to jettison their old sales and marketing methods and adopt smarter tactics that exploit the latest market intelligence data and communication mediums. Only this way can they reasonably expect to make real headway in recouping the escalating cost of their sales and research and development programmes as well as retaining and growing their market share.