The Clinical Side: Turn up the science

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Clinical selling advice for specialty reps

Pharmaceutical Representative

Whether you are a specialty representative in a primary care field or you're in a niche specialty pharmaceutical field, you are probably focusing your time on the specialists in your area. Specialists are protocol-driven physicians; they are usually at the cutting edge of their therapeutic area and treat "niche" patient populations or rare diseases. At the specialist level, medicine has become as much an art as a science. Dr. Clarence Foster, the director of kidney and pancreas transplant surgery at the University of California in Irvine, is a surgeon who is interested in knowing "who is raising the bar in transplant." For Foster, this may mean steroid-sparing procedures or working with living donors or with kidneys from 60-year-old donors -- in other words, highly experimental approaches to treating a disease.

I asked Foster what he expects from his interactions with specialty representatives. "Product knowledge is the bare minimum," he says. The representative should know how the product is being used by specialists and "who's doing what in town." Because specialists often work with rare cases and challenging procedures, networking with their colleagues is especially important. Representatives have a unique opportunity to interact with other specialists and learn how the specialists are using their products as well as who the principal investigators are for novel treatment approaches with the products. This translates to information the representative may provide to specialists when they ask about current and novel applications of the product.

Skills to develop

Clinical skills. To interact with specialists like Foster, specialty representatives must have a strong command of clinical science, including clinical investigations (clinical trials). At the specialty representative level, clinical knowledge of your products includes knowledge of clinical study design ? why a particular design is chosen to study a particular effect, how the study design may influence the sample size and potential shortcomings of the study design.

Another aspect of clinical knowledge is the patient profile, which may be gleaned from the clinical study's inclusion and exclusion criteria -- why were certain patients or human subjects included or excluded from the study? How would these criteria translate into clinical practice and how physicians decide which patients may benefit most from the product?

Safety is a critical aspect of clinical knowledge that many reps avoid because they think it may reflect negatively on their product. Yet specialists deal with safety issues all the time and need information on side effect management. Balance efficacy information with safety information, and report all adverse events to the company.

Analytical skills. The selling cycle for specialty representatives is longer than that for primary care representatives; specialists usually work at academic institutions and teaching hospitals, and clinical science is at the forefront of their minds. Interacting with specialists also requires reps to exercise consultative skills and avoid data dumping or aggressive sales tactics. Specialists may respond to a rep's "hard close" with their own "hard close" of the door as the rep is leaving.

Knowing how to ask questions is as important as your ability to communicate clinical information. Specialists may not have time to answer general questions like "Tell me about your research." However, they will share what aspects of the research area they are interested in, so reps can tailor the information they provide accordingly.

Compliance skills. Specialty reps need to know where to draw the line and follow their companies' policies on exchanging information. Companies generally expect representatives to stay within approved product labeling and require sales representatives to leave off-label information to the medical information or medical affairs department. Communicating high-level clinical information may require as much skill to remain compliant as to deliver science. Specialists may expect representatives to know about the latest data from ongoing studies of a product, but they do not expect the representatives to overstep the boundaries of communicating on-label information. Foster says he does not mind at all if representatives tell him they will get back to him with answers to his questions or connect him with the company's medical science liaison. However, he also says he can tell whether the reps are following the rules of compliance or are clueless and don't understand the question. The knowledge level of a representative becomes apparent during the course of the interaction.

Reinforce your knowledge with self-study to keep up with the pace of therapeutic innovation. Complacency can make your knowledge obsolete to specialists and hurt your competitive advantage as an information provider. Your effectiveness as a specialty representative depends on your ability to "turn up" your clinical science dialogue.

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