Strong Medicine by Arthur Hailey
While Travellers Rest would not have qualified for the Michelin Guide, it served tasty food for the hungry, the fish freshly caught and prepared in an ancient skillet over a wood fire by their host, a wiry, wizened Bahamian named Cleophas Moss. He had seated Andrew and Celia at a table overlooking the sea. A candle stuck in a beer bottle was between them. Directly ahead were scattered clouds and a near-full moon. “In New Jersey,” Celia reminded Andrew, “it’s probably cold and rainy.”
“We’ll be there soon enough. Tell me some more about you and selling drugs.”
Her first assignment as a detail woman, Celia related, was to Nebraska where, until then, Felding-Roth had had no sales representation.
“In a way it was good for me. I knew exactly where I stood because I was starting from nothing. There was no organization, few records, no one to tell me whom to call on or where.”
“Did your friend Sam do that deliberately—as some kind of test?”
“He may have. I never asked him.”
Instead of asking, Celia got down to work. In Omaha she found a small apartment and with that as a base she drove through the state, city by city. In each place she tore out the “Physicians & Surgeons” section from the yellow pages of a phone book, then typed up record sheets and began making calls. There were 1,500 doctors, she discovered, in her territory; later she decided to concentrate on 200 whom she estimated were the biggest prescribers of drugs.
“You were a long way from home,” Andrew said. “Were you lonely?”
“Didn’t have time. I was too busy.”
One early discovery was how difficult it was to get to see doctors. “I’d spend hours sitting in waiting rooms. Then, when I’d finally get in, a doctor might give me five minutes, no more. Finally a doctor in North Platte threw me out of his office, but he did me a big favor at the same time.”
“How?”
Celia tasted some fried grouper and pronounced, “Loaded with fat! I shouldn’t eat it, but it’s too good to pass up.” She put down her fork and sat back, remembering.
“He was an internist, like you, Andrew. I’d say about forty, and I think he’d had a bad day. Anyway, I’d just started my sales talk and he stopped me. ‘Young lady,’ he said, ‘you’re trying to talk professional medicine with me, so let me tell you something. I spent four years in medical school, another five being an intern and resident, I’ve been in practice ten years, and while I don’t know everything, I know so much more than you it isn’t funny. What you’re trying to tell me, with your inadequate knowledge, I could read in twenty seconds on an advertising page of any medical magazine. So get out!’”
Andrew grimaced. “Cruel.”
“But good for me,” Celia said, “even though I went out feeling like something scraped off the floor. Because he was right.”
“Hadn’t the drug company—Felding-Roth—given you any training?”
“Oh, a little. But short and superficial, a series of sales spiels, mostly. My chemistry background helped, though not much. I simply wasn’t equipped to talk with busy, highly qualified doctors.”
“Since you mention it,” Andrew said, “that’s a reason why some doctors won’t see drug detail men. Apart from having to listen to a canned sales pitch, you can get incorrect information that is dangerous. Some detail men will tell you anything, even mislead you, to get you to prescribe their product.”
“Andrew dear, I want you to do something for me about that. I’ll tell you later.”
“Okay—if I can. So what happened after North Platte?”
“I realized two things. First, I must stop thinking like a salesman and not do any kind of pushy selling. Second, despite doctors knowing more than I did, I needed to find out specific things about drugs that they didn’t know, which might be helpful to them. In that way I’d become useful. Incidentally, while attempting all that, I discovered something else. Doctors learn a lot about disease, but they’re not well informed about drugs.”
“True,” Andrew agreed. “What you’re taught in medical school about drugs isn’t worth a damn, and in practice it’s hard enough to keep up with medical developments, never mind drugs. So where prescribing is concerned, it’s sometimes trial and error.”
“Then there was something else,” Celia said. “I realized I must always tell doctors the exact truth, and never exaggerate, never conceal. And if I was asked about a competitor’s product and it was better than ours, I’d say so.”
“How did you make this big change?”
“For quite a while I had four hours’ sleep a night.”
Celia described how, after a regular day’s work, she would spend evenings and weekends reading every drug manual she could get her hands on. She studied each in detail, making notes and memorizing. If there were unanswered questions, she sought answers in libraries. She made a trip back to Felding-Roth headquarters in New Jersey and badgered former colleagues on the scientific side to tell her more than the manuals did, also what was being developed and would be available soon. Before long her presentations to doctors improved; some doctors asked her to obtain specific information, which she did. After a while she saw that she was getting results. Orders for Felding-Roth drugs from her territory increased.
Andrew said admiringly, “Celia, you’re one of a kind. Unique.”
She laughed. “And you’re prejudiced, though I love it. Anyway, in just over a year the company tripled its business in Nebraska.”
“That’s when they brought you in from the outfield?”
“They gave someone else who was newer, a man, the Nebraska territory and me a more important one in New Jersey.”
“Just think,” Andrew said, “if they’d sent you to some other place like Illinois or California we’d never have met.”
“No,” she said confidently, “we’d have met. One way or another we were destined to. ‘Wedding is destiny.’”
He finished the quotation. “‘And hanging likewise.’”
They both laughed.
“Fancy that!” Celia said, delighted. “A stuffy head-in-textbook physician who can recite John Heywood.”
“The same Heywood, a sixteenth-century writer, who also sang and played music for Henry the Eighth,” Andrew boasted, equally pleased.
They got up from the table and their host called over from his woodburning stove, “Dat good fish, you young honeymooners? Erryting okay?”
“Everything’s very okay,” Celia assured him. “With the fish and the honeymoon.”
Andrew said, amused, “No secrets on a small island.” He paid for their meal with a ten-shilling Bahamian note—a modest sum when translated into dollars—and waved away change.
Outside, where it was cooler now, and with the sea breeze freshening, they happily linked arms and walked back up the quiet, winding road.
It was their last day.
As if in keeping with the sadness of departure, the Bahamas weather had turned gloomy. A stratocumulus overcast was accompanied by morning showers while a strong northeast wind whipped whitecaps on the sea and set waves beating heavily onshore.
Andrew and Celia were to leave at midday by Bahamas Airways from Rock Sound, connecting at Nassau with a northbound Pan Am flight which would get them to New York that night. They were due in Morristown the following day where, until they found a suitable house, Andrew’s apartment on South Street would be home. Celia, who had been living in furnished rooms in Boonton, had already moved out from there, putting some of her things in storage.
In the honeymoon bungalow which they would leave in less than an hour Celia was packing, her clothes spread out on the double bed. She called to Andrew, who was in the bathroom shaving, “It’s been so wonderful here. And this is just the beginning.”
Through the open doorway he answered, “A spectacular beginning! Even so, I’m ready to get back to work.”
“You know something, Andrew? I think you and I thrive on work. We have that in common, and we’re both ambitious. We’ll always be that way.??
“Uh-huh.” He emerged from the bathroom naked, wiping his face with a towel. “No reason not to stop work once in a while, though. Provided there’s a good reason.”
Celia started to say, “Do we have time?” but was unable to finish because Andrew was kissing her.
Moments later he murmured, “Could you please clear that bed?”
Reaching behind, without looking and with one arm around Andrew, Celia began to throw clothes on the floor.
“That’s better,” he said as they lay down where the clothes had been. “This is what beds are for.”
She giggled. “We could be late for our flight.”
“Who cares?”
Soon after, she said contentedly, “You’re right. Who cares?” And later, tenderly and happily, “I care …” and then, “Oh, Andrew, I love you so!”
4
Aboard Pan American Flight 206 to New York were copies of that day’s New York Times. Leafing through the newspaper, Celia observed, “Nothing much changed while we were away.”
A dispatch from Moscow quoted Nikita Khrushchev as challenging the United States to a “missile-shooting match.” A future world war, the Soviet leader boasted, would be fought on the American continent, and he predicted “the death of capitalism and the universal triumph of communism.”
President Eisenhower, on the other hand, assured Americans that U.S. defense spending would keep pace with Soviet challenges.
And an investigation into the gangland slaying of Mafia boss Albert Anastasia, gunned down while in a barber’s chair at New York’s Park-Sheraton Hotel, was continuing, so far without result.
Andrew, too, skimmed the newspaper, then put it away.
It would be a four-hour flight aboard the propeller-driven DC-7B and dinner was served soon after takeoff. After dinner Andrew reminded his wife, “You said there was something you wanted me to do. Something about drug company detail men.”
“Yes, there is.” Celia Jordan settled back comfortably in her seat, then reached for Andrew’s hand and held it. “It goes back to that talk we had the day after you used Lotromycin, and your patient recovered. You told me you were changing your mind about the drug industry, feeling more favorable, and I said don’t change it too much because there are things which are wrong and which I hope to alter. Remember?”
“How could I forget?” He laughed. “Every detail of that day is engraved on my soul.”
“Good! So let me fill in some background.”
Looking sideways at his wife, Andrew marveled again at how much drive and intelligence was contained in such a small, attractive package. In the years ahead, he reflected, he would need to stay alert and informed just to keep up with Celia mentally. Now, he concentrated on listening.
The pharmaceutical industry in 1957, Celia began, was in some ways still too close to its roots, its early origins.
“We started off, not all that long ago, selling snake oil at country fairs, and fertility potions, and a pill to cure everything from headache to cancer. The salesmen who sold those things didn’t care what they claimed or promised. All they wanted was sales. They’d guarantee any result to get them.”
Often, Celia went on, such nostrums and folk remedies were marketed by families. It was some of the same families who opened early drugstores. Later still, their descendants continued the family tradition and built drug manufacturing firms which, as years went by, became big, scientific and respectable. As it all happened, the crude early selling methods changed and became more respectable too.
“But sometimes not respectable enough. One reason was that family control persisted, and the old snake-oil, hard-sell tradition was in the blood.”
“Surely,” Andrew observed, “there can’t be many families left that control big drug companies.”
“Not many, though some of the original families control large blocks of stock. But what has persisted, even with paid executives running the companies, is the out-of-date, less-than-ethical hard sell. Much of it happens when some detail men call on doctors to tell them about new drugs.”
Celia continued, “As you know, some detail men—not all, but still too many—will say anything, even lie, to get doctors to prescribe the drugs they’re selling. And although drug companies will tell you officially they don’t condone it, they know it goes on.”
They were interrupted by a stewardess announcing they would land in New York in forty minutes, the bar would be closed soon, and meanwhile would they like drinks? Celia ordered her favorite, a daiquiri, Andrew scotch and soda.
When the drinks were served and they had settled down again Andrew said, “Sure, I’ve seen examples of what you were talking about. Also I’ve heard stories from other doctors—about patients being ill or even dying after taking drugs, all because detail men gave false information which the doctors believed.” He sipped his scotch, then went on, “Then there’s drug company advertising. Doctors are deluged with it, but a lot of the advertising doesn’t tell a physician what he ought to know—especially about side effects of drugs, including dangerous ones. The thing is, when you’re busy, with patients to see and a lot of other problems on your mind, it’s hard to believe that someone from a drug company, or the company itself, is deliberately deceiving you.”
“But it happens,” Celia said. “And afterward it’s swept under the rug and nobody will talk about it. I know, because I’ve tried to talk about it at Felding-Roth.”
“So what’s your plan?”
“To build a record. A record no one can argue with. Then, at the proper time, I’ll use it.”
She went on to explain.
“I won’t be calling on you any more, Andrew; that’s company policy, so someone else from Felding-Roth will be covering your office and Dr. Townsend’s. But whenever you have a detail man—or woman—visit you, from our company or any other, and you discover you’re being given wrong information, or not warned about side effects of a drug or anything else you should be told, I want you to write a report and give it to me. I have some other doctors doing the same thing, doctors who trust me, in Nebraska as well as New Jersey, and my file is getting thick.”
Andrew whistled softly. “You’re taking on something pretty big. Also some risks.”
“Someone has to take risks if it’s to improve a bad situation. And I’m not afraid.”
“No,” he said, “I don’t believe you ever would be.”
“I’ll tell you something, Andrew. If the big drug companies don’t clean house themselves, and soon, I believe the government will do it for them. There are rumblings in Congress now. If the drug industry waits for congressional hearings, and then new laws with tough restrictions, they’ll wish they’d acted first on their own.”
Andrew was silent, absorbing what he had just learned and mulling other thoughts. At length he said, “I haven’t asked you this before, Celia, but maybe now is a good time for me to understand something about you.”
His wife’s eyes were fixed on him, her expression serious. Andrew chose his words carefully.
“You’ve talked about having a career, which is fine by me, and I’m sure you wouldn’t be happy without it. But I’ve had the impression, while we’ve been together these past weeks, that you want more out of a career than what you’re doing now—being a saleswoman.”
Celia said quietly. “Yes, I do. I’m going to the top.”
“Right to the top?” Andrew was startled. “You mean head up a big drug company?”
“If I can. And even if I don’t get all the way to the top, I intend to be close enough to have real influence and power.”
He said doubtfully, “And that’s what you want? Power?”
“I know what you’re thinking, Andrew—that power can be obsessive and corrupting. I don’t intend to let it be either. I simply want a full life, with marriage and children, but also something more, some solid achievement.”
“That day in the cafeteria …” Andrew stopped, correcting himself. “That memorable day. Y
Celia smiled. “Horribly so.”
“Then is it ready yet—for someone like you? The reason I’m asking, Celia, is that I don’t want to watch, and see you hurt or unhappy, while you throw everything into the effort and then maybe it doesn’t work out.”
“I won’t be unhappy. I’ll promise you that.” She squeezed Andrew’s arm. “It’s new for me to have someone care as much as you do, darling, and I like it. And as for your question—no, the industry isn’t ready yet, for me or any other women with strong ambition. But I have a plan.”
“I should have known you’d have it all figured out.”
“First,” Celia told him, “I intend to make myself so good at my job that Felding-Roth will discover they can’t afford not to promote me.”
“I’d bet on that. But you said ‘first.’ Isn’t that enough?”
Celia shook her head. “I’ve studied other companies, their histories, the people who run them, and discovered one thing. Most of those who make it to the top get there on someone else’s coattails. Oh, don’t misunderstand me—they have to work hard, and be excellent. But early on they select some individual—a little higher up, usually a bit older—who they believe is en route to the top ahead of them. Then they make themselves useful to that person, give him their loyalty, and follow along behind. The point is: when a senior executive gets promoted, he likes someone he’s used to, who is capable and whom he can trust, coming up behind.”
“At this point,” Andrew asked, “have you picked someone to follow?”
“I decided some time ago,” Celia said. “It’s Sam Hawthorne.”