Hard Sell: The Evolution of a Viagra Salesman (23 page)

The deaths did serve as a powerful wake-up call. Pfizer sent a “Dear Doctor” letter to every physician in the United States, warning them of the danger of giving
Viagra to patients in poor physical condition and those with access to nitrates. Likewise, the company sent another letter to every hospital emergency room and every paramedic unit in America, urging them to ask heart attack victims if they had taken Viagra that day. (The standard treatment for heart attack victims is to place nitro under the tongue, which would be the
worst
thing to give a man who had already had a cardiac episode while on Viagra.) Additionally, Pfizer approached the FDA to change the package insert’s guidance from a “warning” that Viagra and nitrates are bad to a “contraindication,” a statement forbidding such concomitant usage. Having put the message out to all involved parties, Pfizer had to wait for the media to finish getting the word out to the public. And the word was not good for us: Viagra kills.

Still, guys kept pouring into offices telling docs, “Dying in the saddle; what a way to go.”

CHAPTER

Eleven

VIAGRA PLANET

A
PART FROM POSSIBLE DEATH
, the other side effects didn’t look too bad. Headache (16 percent), flushing (9 percent), and nausea (6 percent) were the most commonly reported adverse events, none of which interested anyone. The side effect all the urologists wanted to hear about was the blue-green visual haze that affected 3 percent of patients. Researchers deduced that Viagra had a weak affinity for PDE 6, an enzyme found in the retina. Once again, we anticipated a barrage of objections, mostly concerning drivers mistaking red traffic lights for green and causing accidents.

The urologists thought this was the coolest side effect ever. “Trippy,” exclaimed one doctor who attended college in the 1960s, and that word was repeated in urology offices throughout my territory. “It’ll be a big hit with your Grateful Dead fans,” I told a group of skeptical nurses, and their physician cracked up. Docs
never
wanted to hear from patients, but drug-related side effects often prompted such calls. So adverse events could be showstoppers because physicians would be more likely to prescribe a drug that made patient phone calls less likely. In the case of Viagra, however, all of the urologists wanted to
see
a patient who was seeing with a blue-green tint.

Three months after launch, I checked voice mail and heard, “Jamie! I got a guy! I got a guy who sees green. This is so gneat!” That had never happened with diarrhea.

The blue-green haze wasn’t the only side effect to spark a surprising conversation. On my first call one day, I pulled into my favorite practice. Offices generally prefer not to see reps first thing in the morning because such visits disrupt preparations for that day’s patients. (Given my previously stated aversion to waking prior to ten a.m., I normally respected such wishes. On this occasion, however, I had tickets to a San Francisco Giants day game and needed to make a few calls in order to get there in time for the 1:05 p.m. start.) That same absence of patients made the early morning an ideal time to drop by, since docs and nurses were not yet bogged down in exam rooms. Finding a handful of practices that allowed an unannounced visit was difficult, but this group gave me free rein. I knew they’d be happy to see me and chat.

As I opened the door, voices and laughter from the office bounced off the walls of the empty waiting room. The staff members stopped talking immediately upon
seeing me and began busying themselves with suddenly important paperwork. I tried to make eye contact with the receptionist, who avoided my gaze. The girls usually greeted me like I was Norm on
Cheers.
Something was going on.

In an overly suspicious voice I asked, “What are you ladies up to?” Unable to keep it in any longer, the three nurses and the receptionist burst into laughter. All of them turned red from giggling, but Carly in particular looked as though she had a Christmas stocking covering her face and neck. Strangely, her hue did not fade after several minutes of conversation. Confused, I finally inquired about the source of her newfound coloring. “You should know, Jamie!” one of them blurted, triggering an avalanche of hysteria. When I finally figured it out, the shock triggered my best Macaulay Culkin in
Home Alone
impersonation. Carly had taken Viagra.

Prompted by work frustrations, three of these medical professionals had decided to conduct their own little drug study. Purely for the sake of medical research, of course. During the previous days the nurses had refused numerous requests for Viagra prescriptions from female patients. Nurses become nurses because they have a natural desire to help people, and saying no over and over again didn’t fulfill that need. After a while, they got annoyed. “Why
can’t
women try it?” one of the RNs asked, echoing a frustration commonly heard across America. “It just increases blood flow. That could help
us,
too.” The staff
members shared a look, and a plan was quickly hatched. Each of them would go home, pop a Viagra obtained from the sample closet, and then seduce their husbands as guinea pigs. The following morning they would return to work and hopefully swap stories about the greatest orgasms of their lives. I happened to walk in just as story time concluded.

The results of this strictly regimented study? Nada. None of the three women experienced any heightened sensations, let alone memorable orgasms. In fact, Carly was the only one to notice any difference whatsoever—the modern-day equivalent of Hester Prynne’s scarlet “V” was the red flush on her face and neck, which occurred in 9 percent of patients.

The nurses’ curiosity about Viagra gave me some inspiration, since women were an untapped source of sales. Because the FDA had approved Viagra only for men, our sales quotas were based solely on male patients. Therefore, any female patients we picked up were gravy. Not surprisingly, every rep was scrambling to find a doctor or two who wanted to write prescriptions for women. On the other hand, Pfizer was not enthusiastic about this very real possibility.

The FDA had made it very clear to HQ that any—repeat,
any
—efforts by Pfizer salespeople to market Viagra for women would be met with a swift kick in the corporate pants. Understandably, the FDA was extremely nervous about the misuse and abuse of a novelty drug like
Viagra, and they were ready to knock Pfizer to pharmaceutical Pluto if they caught any of us doing anything but walking the straight and narrow. This was a smart move by the government agency, because the company, in turn, put the fear of God into its sales force regarding this no-no. Studies of Viagra in women had already begun, and Pfizer did not want to upset the FDA in any way. Companies that ticked off the agency, coincidentally, seemed to take a lot longer to bring their new drugs to market. The scare tactics worked. Common knowledge held that the government paid physicians to monitor the sales practices of pharmaceutical salespeople and report any illegal activity. I, for one, was scared shitless, certain that I would be the moron nabbed by FDA spies for promoting female usage of Viagra.

For the first two months postlaunch, I managed to avoid any illegal conversations. Whenever the topic was raised—approximately forty-seven times per day—I would simply shake my head and say, “Sorry, Doctor, Viagra is not FDA approved for women. But let me tell you what is FDA approved for your female patients: Diflucan for yeast infections!” Despite my best intentions, a seemingly harmless conversation with Dr. Charming would soon send me down the slippery slope.

A smooth-talking, well-dressed, and savvy businessman, this urologist always gave me at least five minutes of his time, thereby guaranteeing himself a visit whenever a manager spent the day with me. Upon meeting Jackie,
my first boss in the Urology Division, he ushered us into his private office where he dazzled her for fifteen minutes with self-deprecating humor and shameless compliments. Prior to our arrival, Jackie had expressed some displeasure with my sales performance, making me seem more Willy Loman than Donald Trump. After the call, however, she seemed ready to nominate me for the Sales Hall of Fame. Hearing my description of this surprising turnaround, one of my teammates said, “Thank you, Dr. Charming!” and the nickname was born.

A month later on a fateful day, he had some time to kill because one of his patients had canceled an appointment. A large Pfizer shareholder interested in the company’s bottom line, Dr. Charming asked if I knew how the Viagra studies in women were going. I explained that the company would never share that kind of information with us, fearing that reps like me would blab it in conversations like this.
However,
the evil voice inside my head reasoned,
no one ever said I wasn’t allowed to ask a physician about the biological processes that would result from vitamin V in this patient population.
“What would happen anyway, if a woman took Viagra?” I asked, my curiosity overriding the alarms going off in my head. His face took on a professorial look as he began to theorize.

“Well, the body parts are pretty much the same. I mean, the clitoris is basically a really small penis. They both contain hundreds of highly sensitive nerve endings and both fill with blood when the brain sends signals
that it is stimulated. So if a woman took Viagra, you might be looking at an increase in lubrication and some clitoral engorgement.” I thanked him for the biology lesson and headed to my next appointment, pleased to have learned this valuable information and certain I would not share it with any physicians. I managed to keep quiet for twenty minutes.

In addition to urologists, I called on ob-gyns. Predictably, it was this group of specialists who badgered me the most about Viagra’s use in women. The call following my discussion with Dr. Charming was no different.

“So when are you guys going to let me give Viagra to my patients?” Dr. OB asked immediately. A sharp, quick-witted African American woman, she regularly listened to my sales pitches, never hesitating to call bullshit on me. In fact, she liked to challenge salespeople. The threat of her posturing with hands set sternly on her hips intimidated a lot of reps, myself included.

I began to respond to her question, but Dr. OB was not about to suffer through my canned response again. “Oh, don’t even bother, Jamie,” she interrupted with her head shaking violently back and forth. “It’s a male-dominated world, and those boys that run Pfizer and the FDA and the insurance companies don’t care about keeping us girls happy.” To protest would have been futile. “How else can you explain that HMOs are starting to cover Viagra, but they have never paid for birth control pills?”

I could not explain it. I just wanted to crawl away. Surprisingly, she softened her tone and dropped her hands from her hips. “Theoretically, what would Viagra do for a woman, anyway?” Maybe her change in delivery caught me off guard, or maybe I was just happy she stopped yelling at me. Whatever the reason, I regurgitated the information Dr. Charming had just given me.

“Well, Dr. OB,” I began, trying to sound professorial, “what you are basically looking at is, uh, is, ahem …” That’s when it hit me: She was a
woman.
How the hell could I talk to a woman about woman parts?
My heart pounded as my face flushed and beads of sweat burst onto my forehead. She raised her eyebrows, signaling that she was waiting for me to continue. I took a deep breath and, avoiding eye contact, started talking as fast as I could. “What you are basically looking at, Doctor, is an increase in lubrication and some clitoral engorgement.”
There.
I had done it without too much embarrassment. However, I could not stop talking. Referring to the clitoral engorgement, I added, “And, you know, Doctor, ha-ha, anything that helps us guys find it has
gotta
be a good thing.”

Dr. OB stared at me for a long moment before she started to laugh. Shaking her finger at me knowingly, she told her nurse, “He’s cool. I’ll always see Jamie.” Dr. OB began writing prescriptions for Viagra.

And it worked. Not for most women she gave it to, but for some, mostly postmenopausal patients. I looked at it like a baseball player views hitting: three out of ten
is pretty damn good. Of course, some women hit grand slams with Viagra, and one of them happened to be married to a urologist.

A coworker in Sacramento called me several months later, laughing and screaming as though he had lost his mind. A veteran drug rep with a been there, done that nonchalance, Joe rarely worked himself into a lather over industry happenings. “You are not going to fucking believe this!” he exclaimed. He was right.

Earlier that day, he called on a urologist with whom he had no rapport whatsoever. Accordingly, he planned on scheduling a lunch appointment for the next month and, at best, speaking with a nurse. After handing the receptionist his card, she waved him in and led him straight back to Dr. Romeo’s private office, where she instructed him to make himself comfortable. Joe thought that odd. After a few minutes, the physician walked in and shook Joe’s hand as if they were old army buddies. Joe had entered the Twilight Zone.