Doctors can tell within 2 questions whether you understand the science or only memorised it. Reps who only learn the key messages are fine until the doctor asks one question outside the script. Then the conversation is over, and so is the credibility.
Knowing the science is what lets you stay in the room when the slide runs out. It's also what keeps you honest, because a rep who understands the data knows exactly where it ends.
Step 3 of the Pharma Career Ladder is knowing the science. Here's how I ask reps to build it.
Study in the right order
When I talk about learning the science properly, I mean an order. The disease first: the condition, the guidelines, the patients. Doctors think in patients, not molecules. Then the mechanism, in plain words. If you can't explain it simply, you don't know it yet. Then the key trials, limits included. Last, the hard questions: side effects, interactions, who shouldn't use it. Anything beyond the approved label goes to medical affairs.
Learn the disease, and the product will make sense. Before every cycle, ask yourself whether you could defend each claim if the doctor asked "how do you know?"
Most reps know the headline result of their key trial. Far fewer can say who was in it. Reading a clinical paper is a climb in 4 steps. The abstract is where you start, never where you stop. The methods tell you who was studied, against what, and for how long. The numbers give you the primary endpoint, the absolute difference and the confidence interval. The limitations are what the authors themselves admit, and doctors respect a rep who knows them. The methods change your calls most, because they tell you which of the doctor's patients the trial speaks to. If you only read the abstract, you're selling someone else's summary.
Get the numbers right
Relative and absolute risk are both true, and only one sounds exciting. Take a simple worked example, not from any trial: risk falls from 2 in 100 to 1 in 100. Relative, that's "50% lower". Absolute, it's 1 fewer patient in every 100. My rule: never show a relative reduction on its own, and show the absolute number first. The IFPMA Code of Practice says promotion must not mislead by distortion, exaggeration or undue emphasis. Give the doctor the absolute number before he has to ask for it.
"It's significant, Doctor" is one of the weakest sentences a rep can say. In 2016 the American Statistical Association published a statement on p-values because the misreadings had become so common. What p under 0.05 doesn't mean is worth learning. It says only that if the treatment had no real effect, a result this strong would be unlikely. It doesn't tell you the chance the drug works, or how big the effect is. Give the size of the effect, the confidence interval, and what it means for her patients.
Better still, give a number of patients. The number needed to treat was introduced in 1988 by Laupacis, Sackett and Roberts in the New England Journal of Medicine. It's 1 divided by the absolute risk reduction: how many patients he treats for 1 extra to benefit, over a stated time frame. Put it beside the number needed to harm, because the doctor weighs both. And never line up NNTs from different trials as if they came from one study.
Tell him the difficult part too
The fastest way to lose a doctor's trust is to pretend your drug has no side effects. He knows every drug does. When you talk about side effects, raise the most common ones yourself, say how they were managed in the trial, and show how many patients stopped and why. When a doctor reports a problem, thank him and report it to the safety team. The IFPMA Code asks for promotion that is balanced and complete. Handled well, this is often the moment the call turns.
Off-label questions have one correct answer: "That's outside the approved use, Doctor. Our medical team can answer you directly." Never guess or say "other doctors use it this way". Log his exact question as an unsolicited request, with his agreement, and let medical affairs reply to him. At the next visit, check only that he received the reply. An off-label question is a chance to show integrity.
Two numbers from 2 different trials only look like a comparison. Different patients, durations, endpoints and baseline severity make it head-to-head or nothing. Only a head-to-head trial, same patients and same endpoint, gives a comparison a doctor can rely on. If there's no head-to-head trial, say so. That sentence costs you less than a lost doctor.
Speak the doctor's language
Doctors prescribe from the guideline in their head. Guidelines are your ally if you read the current version for your therapy area, find your exact place in it, and speak its language: "For patients not at target on first-line treatment, Doctor..." Then link it to a patient type he sees every week. Never claim the guideline says more about your product than it does. He has read it too. Don't sell against the guideline. Sell inside it.
Reps feel safest on the mechanism slide, and that's the problem. It bores when you open with it or explain it to the specialist who teaches it. It helps in 1 sentence and 1 simple picture, when the doctor asks how it works or when it explains an outcome or a side effect. Mechanism explains the result. It never replaces it.
Follow through on every question
"I'll ask our medical team, Doctor" can be the strongest sentence in your call or the weakest. Answering a medical question properly means pausing instead of guessing, capturing his words exactly, and sending the question today, before the day ends. At the next visit, ask, "Did you receive the reply, Doctor?" Sending it the same day and making that check are where most reps fall down. You don't need to know every answer. You need to know who does, and follow through.
Your checklist for this week
- Write the disease, mechanism, key trials and hard questions for your main product on 1 page
- Read the methods section of your key trial and note who was in it
- Find the absolute risk reduction, NNT, time frame and NNH for that trial
- Practise the side effect conversation for your main product out loud
- Learn the exact sentence you'll use for an off-label question
- Read the current guideline for your therapy area and mark your product's place in it
- Send every open medical question to medical affairs on the day you hear it
That's Step 3. Next week Step 4 begins: preparing the visit, starting with the 2 minutes in the car park before you walk in.