Cousin Stan the 'detail man'

My earliest memory of my cousin Stan was when, at age five, I was entrusted to his care on a Saturday afternoon for a matinee showing of Treasure Island at the Nortown theatre, near Bathurst and Eglinton in the northern reaches of Toronto. The year was 1950 and Stan had recently ascended to manhood, having reached the age of Bar Mitzvah, an anthropological “coming of age” in our faith. Twenty-two years later, cousin Stan, attired in a handsome brown-toned Tip Top Tailor suit, stood at the reception desk of my first medical office clutching an oversized “genuine alligator” sample bag. Stan had become a “detail man.” “Detail man” can be defined as a sales rep of a drug manufacturer who introduces new, or reinforces established drugs to physicians and pharmacists. The “man” designation references the fact that in the early years of the industry, women had not yet been welcomed into the sales force. There would evolve a reversal of fortune in the decades that followed. I recently sat down with cousin Stan at his dining-room table to reminisce about his career. Stan is now 85 and was enthusiastic to talk about his days in the field. I had introduced the idea of a story about his professional life and the evolution of the pharma industry a month earlier over bagels and coffee. Not surprisingly, he came to the table prepared with extensive notes and memorabilia, some dating back almost 60 years. Stan began as a Pharmacy student at University of Toronto but in 1961, after three years of tedious didactic academia, he decided that formal studies were not his forte. His interests in pharma having been established, he entered the industry in1961 as a sales rep for Boehringer Ingelheim, a division of Geigy Pharmaceuticals, where he first got the “detail man” moniker. In 1965, he began a highly successful 30-year career with Upjohn Pharmaceutical, head-quartered in Kalamazoo, Mich. His daily routines included calling on doctors, pharmacists, hospitals and dentists, at least initially. Expectations were to see five or six doctors and four or five pharmacists every day, both by appointment or “cold calls.” The worst aspect of his job was “the waiting.” I’m certain the origins of the office gathering space holds a special place for sales reps who learned patience, surrounded by patients every day. Stan’s time with Upjohn also included responsibilities as medical sciences liaison (MSL) for medical school researchers and introducing the generic Upjohn division, Kenral and its products to pharmacy head offices and retail. Every call was accompanied by the signature symbol of the industry: the sample bag. Besides samples of an extensive product line, the bag’s innards included clinical trial papers, detail aids and glossy brochures, all to be left behind at the conclusion of each encounter. Samples were signed off by the doctors in an inventory book, complete with carbon copy transaction tracking. In his day, the only parting gifts were notepads with the Upjohn name printed at the bottom. No pens, paper weights, preprinted prescriptions or articulated plastic joints. Stan never began his work day without a “pocket full of quarters.” Before cellphones, he’d call in orders from strategically located pay-phones. Stan’s menu of products included: Solu-Medrol, Solu-Cortef, Depo-Medrol, Provera and it’s “depo” formulation, Xanax, Motrin, Rogaine, and the lesser-known Lincomycin and AlbamycinT and who could ever forget Halcion, “the ultimate hypnotic,” an unfortunate tagline given its propensity for retrograde amnesia. These were manufactured locally, in North York, Ont., on York Mills Rd.—that is until generics upended the viability of Canadian manufacturing. Like so many other Pharma companies, Upjohn would transition with the mergers and acquisition trend to Pharmacia and ultimately Pfizer. Stan would similarly transition in 1995 with a legacy of excellence, a “package” and a pension. At that point, he was 58 years old and after auditing courses at York University and Ryerson, and volunteering in the community delivering Meals on Wheels, Stan was ready to enhance his personal productivity and relevance. He returned to pharma, doing part-time locums and contract work in sales for a medical devices company and then Bristol-Myers Squibb where he joined an all-female sales force providing maternity leave coverage, expanding beyond the comfortable territories of his past. In 2007, cousin Stan retired again, this time for good. In my years of formal association with him, Stan brought a kind and respectful approach to his work, always personable, easily engaged in conversation and consummately prepared professionally. There was no pressure to prescribe, no exhortations to consider his products for the “next 10 patients” that met his product line’s clinical indications, and never anything that approached the aggressive marketing ploys of his competitors. Stan was the quintessential pharmaceutical rep. It was always about the details. In time, he would become the exception. By the late innings of Stan’s tenure, the rules of the game were changing. Gender equity in the sales force became the norm, even trending towards more women than men. Creds included Bachelors of Arts and Sciences, Masters degrees, and MBAs. The academic focus extended beyond basic science and pharmacy to business and marketing. Youth supplanted the aged and well-travelled. Attractive became an understatement. The presentation became the message, a subtly aggressive “elevator pitch” designed to deliver ideas, product specificity, utility and benefits. Bottom line was no longer measured in millions. “Market share” was the goal in this new reality and was now measured in billions. Competition became fierce, primarily because most classes of drugs were overpopulated. And there was an inherent time sensitivity as licensing had “best before dates,” the result of genericization, now a multi-billion dollar industry worldwide. In our offices as doctors, we were facing temptation. Golf games and weekend getaways, always with an educational chaser and the requisite study credits included, CME dinners, details, and no dives, Pharma sports and entertainment, advisory boards and charcuterie boards. Expense accounts were expensive, often favouring the “whales” of product prescribing based on data accrued through mining the volume of prescriptions written in any particular territory. I suspect that one could drill down deeper for more specific individual prescribing profiles. This was all part of the “tradecraft” of the day in an industry where marketing was becoming a blood sport. There was so much riding on the endgame. In time, scrutiny by educational and regulatory bodies would determine, based on evidence, that pharma sponsorship of events designed to educate physicians in the therapeutic indications of new and/or reconfigured drugs carried the distinct odour of bias and influence for prospective prescribing physicians. Although disputed by many as ‘you can’t buy me off with steak au poivre or grilled lobster,’ there began a slow withdrawal from elegant dining towards moderately priced alternatives. The entertainment business went dark. Gone were the Mirvish nights, the Blue Jay afternoons and the Niagara-on-the-Lake mornings. Detailed marketing became increasingly complex and sophisticated as biological similars split hairs and chemical bonds in a quest for superiority. Equivalence was no longer adequate. In our physician offices, our time became more limited by the pervasive stressors of practicing with diminishing resources and escalating pressures from within and without—the “patient factor” and bureaucratic and operational constraints. Sales reps continued to drop in, see if we needed samples, just “passing by,, but always requesting a signature, justification and evidence that a call had been made, meeting performance objectives as expected by head office. Companies continued to pursue merger opportunities and with it, sales force attrition followed, often targeting the higher-paid, more experienced reps. There were many “goodbye visits” where reps thanked me for allowing them into my world while wondering what was in store for them in a world outside their expertise and long-established territory of comfort. And then, in March of 2020, our respective professional worlds were invaded by a pandemic of unprecedented proportions. As we locked our doors and scavenged for PPE, practices of all descriptions entered a remote and virtual and uncomfortable phase. However we individually accommodated, and with the imposed isolation from our patients, one of the collateral hits was the pharmaceutical sales rep. Literally overnight, their playing field was eliminated. They, too, were relegated to virtual and indirect contacts, emails, brochures left under locked doors, Zoom medical conferencing and meetings and phone calls, all in the interest of reinforcing the brand. On a quiet spring afternoon as I sat patiently awaiting the next phone call visit, I heard a knock on the waiting room door. I masked, shielded and released the deadbolt, slowly opening the door. A well-dressed young man introduced himself through the limited aperture as my “Pfizer rep.” I advised that the office was closed for all visitors, patients and pharma reps included, for the foreseeable future. He then asked if I needed any samples from his extensive product line, contained within the depths of his carry-on. “And whom would I provide these samples to?” He got points for chutzpah. We began seeing patients again in June, 2020 under controlled COVID protocols and in carefully scrutinized numbers. Pharma visits were never resumed. I sometimes wonder what happened to all those young, energetic and highly-educated reps. Where would they land when Covid restrictions were lifted? How would they adjust to the extended restrictions of hybrid practices? Would industry leaders have to reinvent the “detail man”, a term dating back to 1928? I had the unique privilege of practicing medicine for almost 50 years. What I experienced and observed with the available spectrum of modern therapeutics is nothing short of a miracle. And, the drugs we all prescribed to treat acute and chronic illness, to cure previously incurable disease and to prevent disease in children, adults and the elderly were all game-changers for those who entrusted their health and well-being to us. Pharmaceuticals have given us the power to heal and change the course of history, down to the final detail. With special thanks to cousin Stan.

Piece of Mind

Cousin Stan the 'detail man'

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