Arthur Hailey - Strong Medicine

Aware that she was reaching rugged ground, Celia faced the audience squarely and chose her words with care. "As a result of my husband's experiences as a physician, he tells me he has mentally divided the detail men who call on him into three groups-first, those who give him honest information about their companies' drugs, including adverse side effects; second, those who are uninformed and fail to advise him properly about the drugs they are promoting; and third, those who will tell him anything, even lie, to have him prescribe what they are selling. "I would like to say that the first of those three groups-the detail people who are informed and honest-is the largest, and that the other two are small. Unfortunately that isn't true. The second and third groups are far larger than the first. What it adds up to is that the quality of detailing, in terms of full and accurate information, is poor, and that applies to all companies in the pharmaceutical business, including ours.”

Celia could now see signs of consternation, not only among executives at the front, but back beyond them. Amid a series of groans someone called out, "Hey, what is this?" She had anticipated the reaction and accepted it as part of a calculated risk. As she continued, her voice was strong and clear.

"I am sure you are asking yourself two questions. One: "How does she know all that stuff, and can she prove it” The second: "Why bring it up now, at a time when we're happy and cosy and don't want to hear unpleasant things " Again a voice from the audience.”You're damn right we're asking!" "So you should!" Celia shot back.”And you're entitled to an answer, which I'll give.”

"Better make it good!" Something else Celia had gambled on today was that whatever the reaction to her speech, she would be allowed to finish. It seemed to be happening. Despite frowns of displeasure in the executive rows, no one was rising to use authority and cut her off. "One reason I know what I'm talking about," Celia declared, "is that I used to be a member of that second group-the uninformed. That's because, when I went out selling drugs to doctors, I was inadequately trained. In fact, I was scarcely trained at all. Concerning that, let me tell you a story.”

She described the encounter-which she had related to Andrew on their honeymoon-with the North Platte physician who had accused her of having "inadequate knowledge" and ordered her brusquely from his office. Celia told the story well and there was a return to silence as the audience listened. Here and there she saw nods and heard murmurs of agreement. Celia suspected that many in the hall had had similar bruising experiences. "The doctor was right," she continued.”I didn't have the knowledge to discuss drugs with highly qualified physicians, even though I should have been given it before I went out selling.”

She reached behind her to a table and held up a file. "I mentioned reports from doctors about false information given by detail people. In the nearly four years I have been selling for Felding-Roth I have kept a record of those reports, and it is here. Let me quote examples.”

Celia pulled a sheet from the file.”As you know, we have a prescription product called Pernaltone. It is an excellent drug in the treatment of hypertension and one of Felding-Roth's good sellers. But it should never be used by patients with rheumatic disease or diabetes. To do so is dangerous; warnings to that effect are in the literature. And yet... four doctors in New Jersey, two others in Nebraska, were assured by detail men from this company that Pernaltone was safe for all patients, including those with the diseases mentioned. I have the doctors' names if you wish to see them. Of course, those are just the doctors I know about. Obviously there are more, perhaps many more. "Two of those doctors I spoke of, who were given that misinformation, checked it out and found it to be in error. Two others accepted it in good faith and prescribed Pernaltone for hypertensive patients who were also diabetic. Several of those patients became extremely ill, one of them close to death, though he eventually recovered.”

Celia whisked another paper from her file.”A competitor of ours has an antibiotic, Chloromycetin, again a first-rate drug, but for serious infections only, since its possible side effects include damaging, even fatal, blood disorders. Yet-and again I have dates, names, places-the other company's detail men have assured doctors the drug is harmless...”

Celia finished with Chloromycetin, then continued, "Now to comeback to Felding-Roth...”

As she talked, the damning evidence mounted. "I could go on," Celia said after a while, "but I won't because my file is here for anyone in this company to examine. I will answer that second question, though: Why did I bring this up today? "I brought it up because I could not get attention any other way. I have tried since last year to have someone at headquarters listen to me and go through my file. No one would. I had the strong impression that what I had accumulated was simply bad news that nobody wanted to hear.”

Now Celia looked down directly at the two executive rows.”It may be said that what I have done today is headstrong, even foolish. Perhaps it is. But I would like to say that I have done it out of deep conviction and caring-for this company, our industry, and the reputation of both. "That reputation is being tarnished, yet we are doing little or nothing about it. As most of us know, there are hearings being held at present in the U.S. Congress about the pharmaceutical industry. Those hearings are antagonistic to us, yet few in the industry appear to be taking them seriously. But they are serious. Already the press is giving prominence to criticisms; soon there will be a public outcry for reform. I believe that unless we do something ourselves to improve our sales practices and reputation we shall have it done for us by government-in a way that none of us will like and that will be harmful to us all. "Finally, for all these reasons I urge that our own company take the lead-first in establishing a detailing code of ethics, second in setting up a training and retraining program for us detail people. I have put together my own ideas for such a program.”

Celia paused and smiled.”If anyone is interested, they too are in my file.”

She concluded, "Thank you, and good afternoon.”

As Celia gathered up her papers and moved to leave the speakers' platform, there was some feeble handclapping, though it ceased almost at once, with few in the audience seeming inclined to join in. Clearly, most were taking their cue from the executive group at the front, from where there was no applause and facial expressions showed disapproval. The board chairman seemed angry-he was speaking in low tones, heatedly, to Eli Camperdown; the Felding-Roth president nodding as he listened. The vice president of sales, a New Yorker named Irving Gregson who had been recently promoted, approached her. A forceful man of athletic build, Gregson was normally genial and well liked- But now he was glowering, his face flushed.”Young woman," he declared, "you have been malicious, presumptuous and misguided; also your so-called facts are wrong. You are going to regret it. You will be dealt with later, but for now, I am ordering you to leave this sales convention and not to return.”

"Sir," Celia said, "won't you at least look at the material I have-"

"I'll look at nothing!" Gregson's raised voice was audible through the hall.”Get out of herel" "Good afternoon, Mr. Gregson," Celia said. She turned and walked away, heading for an exit. Her step was firm, head high. She thought, later there would be time for regrets, perhaps deep dejection; for now, she had no intention of leaving this male assemblage defeated, like a weakling. Just the same, she admitted to herself, she was defeated, and of course she had known this might happen but hoped that it would not. To Celia, the faults she had described were so obvious and glaring, the reforms so plainly needed, it was hard to see how others could disagree when facts were pointed out. But they had. And almost certainly her employment by FeldingRoth was ended, or would be shortly. A pity. Sam Hawthorne would probably say she had done what he cautioned her not to do -overreached in trying to achieve too much. Andrew, too, had warned her--on the way back from their honeymoon when she told him about building a file of doctors' reports. She remembered Andrew's words: "You're taking on something pretty big. Also some risks.” How right he had been! Yet, a principle was involved, and her own integrity, and Celia had decided long ago she would never temporize on that, What was that line from Hamlet she had teamed at school? "This above alk to thine own self be true You paid a price for it, though. Sometimes a stiff one. Moving through the hall, she was aware of sympathetic glances from a few of the men still seated. That was unexpected, after all her criticisms. Not that it made any difference now. "One moment, please!" Suddenly, startling her, coming from nowhere, a voice boomed strongly over the p.a. system.”Mrs. Jordan, will you wait?" Celia hesitated, then stopped as the voice repeated, "Mrs. Jordan, wait!" Turning, she saw with surprise that the voice was Sam Hawthome's. Sam had left his seat, ascended the speakers' platform, and was leaning over the microphone. Others were startled too. Irving Gregson could be heard exclaiming,