Ахмед Рушди - Quichotte - A Novel

But to begin at the beginning: a long time ago, when he was just starting out in the pharma business, he had gone to India to visit family and friends and in a Bombay street an urchin was distributing business cards. He took one. “Are you alcoholic?” it read. “We can help. Call this number for liquor home delivery.”

Excellent business model, he thought.

He had kept that card with him ever since. SPI had followed the excellent business model with great success, sending its products in impressively large quantities even to very small towns. When the indictments were handed down, some startling facts would emerge. For example, in the years 2013–18, SPI shipped five million highly addictive opioid doses every twelve months to a pharmacy in Kermit, West Virginia (pop. 400). Six million opioid doses were sent to a pharmacy in Mount Gay, West Virginia (pop. 1,800.) Call this number for liquor home delivery, indeed. A great many doctors and pharmacists made the call.

It was a unique characteristic of SPI’s sales force—a characteristic that set it apart from the rest of the pharmaceutical industry—that you could join it even if you didn’t have a background in pharma sales or even a college diploma or degree in science. Only two qualities were required. You had to be the driven and aggressive type, and you had to be extremely beautiful.

SPI boasted the most supremely attractive sales force in America. (One of their major competitors, Merck, went down a similar route, but SPI did so with much greater commitment and enthusiasm.) As was later revealed, SPI’s Eastern Region sales chief, based in Atlanta itself, was a certain Dawn Ho, previously a dancer at Jennifer’s, a strip club in West Palm Beach, Florida (pop. 108,161). At SPI she was in charge of selling InSmile™ to the whole highly populous Eastern Seaboard, a drug so dangerous that it required its own special prescription protocol. Dr. R. K. Smile’s national sales chief expressed one hundred percent confidence in her abilities. The national sales chief was called Ivan Jewel and had a background in aquarium sales, sleep apnea testing devices, and an online ticket-resale agency in New Jersey, whose company registration was revoked after it failed to file an annual report for two consecutive years. He was also quite a looker himself, the Clint Eastwood type, as he liked to say. “Anything for a few dollars more.” He agreed with Dr. Smile that a Florida strip club was not the kind of place where Big Pharma traditionally recruited staff, but insisted that Dawn Ho was a major asset. “She’s the warm, sympathetic, good-listener type,” he said. “You gots to picture these pain management physicians. All day, all night, they live around extreme agony and cancer. Then comes this beautiful woman, it’s a pleasant distraction, one, and then she wants to listen to all your sadness, she wants you to let out all your stress, maybe a little shoulder rub, whatever, that’s more than pleasant, two, and so she wants to sell you something, you buy it, boom, three, deal closed. To me she’s a closer. I use her (a) after a first contact by another salesperson and (b) when there’s a client who’s undecided, who says yes yesterday, no today, we need him to say yes tomorrow. A beautiful lady who cares for you is the best thing in such cases. She’s like a super gorgeous no-commitment version of their wives.”

The Little King, a.k.a. Little Big Hands, liked this explanation. “If there are more like her out there,” he told his sales chief, “just get them all.”

But the beauty of the sales force—gorgeous women sent to visit male pain management physicians, Clint Eastwood hunks of men sent to visit the female ones—wasn’t enough, by itself, to explain the huge numbers of the sales. Beauty allied to drive and aggression: still not enough. When you wanted to pitch a restricted drug to board-certified oncologists, you needed to add a raft of additional techniques. Incentives: that was a better word than techniques. A group of additional incentives.

It was Dr. R. K. Smile himself who thought up the speakers’ bureau. Actually, one part of the idea wasn’t original. The idea of recruiting big-name doctors to recommend a particular medication to other doctors was an old one. Word of mouth was always recognized as the most effective marketing device. But if you wanted to go off-label, hmm. That was borderline. Maybe across-the-borderline, because going off-label meant getting doctors to prescribe a drug for conditions other than the ones stated on the label, for which the drug was intended. Or, of course, for no conditions at all, turning a blind eye to recreational use, or, more seriously, to addiction. Another, more colloquial term for going off-label might be becoming a drug dealer. Or even becoming a narco lord.

“I’ve spent my life crossing borders,” said Dr. R. K. Smile, at the opening of the first session of SPEIK (Smile Pharmaceuticals Expanding Information and Knowledge) in Eureka, Montana (pop. 1,037), a smallish gathering which took place in the historic Community Hall, a single-story log building in the rustic style. “I read it in a book once: if you fly above the Earth and look down, you see no frontiers. That’s my attitude. I’m a no-frontier guy in favor of flying high.” That was the secret ethos of SPI. They were all high-flying no-frontier guys.

After the Eureka meeting Dr. Smile allocated a budget of three million dollars toward the speakers’ bureau project. Over time the project became even more sophisticated in its methods. Doctors were identified and booked, fees were paid, and then, more often than not, the events unfortunately could not take place owing to unforeseeable circumstances, but the terms of the agreements with the doctors stated that the speaking fees were nonreturnable. A budget of three million dollars a year, handed out in substantial dollops of, for example, $56,000 p.a., or $45,000 p.a., or $33,000 p.a., or $43,000 p.a., or even $67,000 p.a., in return for performing speaking engagements which did not actually have to be performed! Such a budget offered opportunities that were attractive to a lot of doctors. Such a budget bought—or to use a more polite term, booked—some very senior doctors. And these were tough doctors, ready to receive these substantial sums in return for prescribing InSmile™ off-label, willing to recommend doing so to other doctors, and able to take any heat that followed.

Yes, unfortunately, some of them got investigated by their state medical boards, but they just handled it! They paid the fines and carried on. Yes, unfortunately, in the worst cases there was disciplinary action when, unfortunately, some of the tough doctors went too far! When unfortunately they allegedly handed out multiple pre-signed prescriptions to patients and some of said patients died of drug overdoses from the drugs so prescribed! When unfortunately they allegedly prescribed InSmile™ to persons with zero cancer pain! When unfortunately they allegedly defrauded Medicare of multiple millions of dollars! When unfortunately they allegedly billed insurance companies for procedures they never performed! A pain management specialist from Rhode Island who was also a SPEIK speaker was reprimanded! A neurologist who was a SPEIK speaker was arrested! These matters were shocking to Dr. Smile and all the SPI team. They moved swiftly to rectify or terminate their relationships with such medical practitioners. They were a reputable company. They were running a speakers’ bureau on the side, that was all. They were not and could not be held responsible for what their speakers might be doing on their own time. SPEIK was a reputable and highly regarded program and if its speakers believed in InSmile™, that was because of the inherent quality of the product. It was ridiculous and even slanderous to impugn the ethics of SPI staff. Yes, it was true, some of the adult children of SPEIK speakers were employed by SPI as part of the sales force, but that was on account of their high levels of beauty, not their parentage. These were grown independent men and women and it would be insulting both to their level of beauty and to SPI to allege that their employment was a ruse to give SPI leverage over their parents. SPI had no need to twist people’s arms. The profession liked buying what SPI had to sell.