The relationship between the pharmaceutical sales representative and the physician has undergone a dramatic shift in recent years. In the past, the sales representative provided value to the physician, had an established and meaningful rela tionship, engaged in an interactive dialog, and acted as a company spokesperson. Today, according to industry executives, the role of the sales rep has been reduced to the most basic reminder contact. This disconnect comes despite a 14% increase in 2001 in pharmaceutical company detailing activity to physi cians, according to information from Health Products Research Inc., a division of Ventiv Health Inc. Informa tion was compiled from HPR’s Metropolitan Area Pro motional Audit, which monitors pharmaceutical compa ny fieldforce promotion across major metropolitan areas of the U.S. HPR estimates that pharmaceutical compa nies spent $8 billion supporting salesforce marketing activities during 2001 (see related box on page 52). 46 M a y / J u n e 2 0 0 2 PharmaVOICE SALES REPS What’sUpDoc? By Lynda Sears The industry is grappling with how to renew its relationship with the medical professional as the disconnect between the pharmaceutical sales representative and the prescribing physician continues to widen Photo: HealthStream R T SALES representatives According to physicians and market ing professionals, the disintegration of the physicianrep relationship can be attributed to factors on both sides of the equation — too many reps, too little time, and not enough detail in the call. Because access to highprescribing physicians is becoming increasingly more dif ficult, pharmaceutical sales reps must find ways to reconnect with the physician and establish a strong personal relationship. Reps, reps everywhere One of the biggest barriers to the physician rep relationship is the sheer quantity of “feet on the street.” The number of pharmaceutical sales representatives in the U.S. is unprece dented. Pharmaceutical salesforces have increased exponentially in the past several years, with as many as 80,000 reps in the field in 2002. “In many cases, share of voice, or having a large number of representatives, is how phar maceutical companies are staying competitive,” says Jim Foreman, executive VP of strategic marketing at Ted Thomas Associates. “The more representatives that are out there the higher the likelihood that one of them is going to be able to see the physician and make an impact on that physician’s decision making.” This makes sense for the industry, with data showing return on investment to be, on average, positive. However, some observers note that it is not efficient in terms of devel oping a rapport with the physician. In the past, one rep may have brought the physician information on specific products, but as companies move toward “franchise market ing,” multiple representatives are detailing the same products, or several products within a therapeutic category, to the same primarycare physician based on different priority levels. This can lead to confusion for the prescribing physician and an overload of information, which is then discounted by the prescriber. “Some people in the industry are concerned that no one will be heard through all the noise,” says Frederic Marshall, president of Quantum Learning Inc. “Others argue that the high reptodoctor ratio reduces the time doctors give to reps, and this seems to be happening in some cases, but the data are not always obvious. On the other hand, a company with a lot of reps calling on the same doctor results in more face toface time albeit spread across several reps.” As long as there is no product overlap, each rep has the opportunity to become an expert on his or her product, and create opportunities for their colleagues to detail the physician on other products. “If there are multiple reps selling the same product to the same physician, obviously there is an increase in the frequency of details,” says John Riggle, national sales trainer at Sankyo Pharma. “But there also can be a backlash from the physician depending on how many times per week the product is being detailed. A lot of physicians have requested that there be one point person per product to make it easier to request samples, additional information, etc. “The industry is nearly saturated with rep resentatives,” he says. “Our challenge is to dif ferentiate our reps as individuals while elevat ing our reputation as a whole. Almost every rep in the country can think of an office that no longer sees reps because of the inappropri ate behavior of one individual. The onus is on us to be consummate professionals at all times and provide valuable information to the physi cian that can benefit patients. In many cases, physicians have become accustomed to the lunches and dinner programs that have come to dominate our industry and are more inter ested in the meals than the representative’s message. We need to remember that we are, first and foremost, business professionals with great products that can benefit certain patients.” Some representatives get access to the physi cian every time they call and others don’t. Therefore, the belief is that the odds of getting in and detailing a product are increased if mul tiple reps call on the same physician. “From an organizational perspective, though, multiple reps selling the same prod uct to the same physician can create difficul ties in assessing individual performance,” Mr. Riggle says. Time is on nobody’s side According to Rob Sederman, executive VP of strategic business development at Market Measures/Cozint, “35% of the time, the repre sentative goes to the office and doesn’t see the physician; 85% of the time when they do get 47 PharmaVOICE M a y / J u n e 2 0 02 FREDERIC MARSHALL The successful representative will uncover a physician need,address that need through a discussion of the features and benefits of his or her product,and then close the deal with that physician by gaining a commitment to prescribe for a specific patient type. ROB SEDERMAN It’s about making the rep the hub for that information through a combination of interactions with the physician, and following up with emails or links to particular information.The one and twominute interactions can be supplemented with technology,whether the interaction is via the Internet, a Webcast,or CDRom. Q P SALES representatives in to see the doctor, the interaction is less than two minutes. These facetoface visits, essen tially reminders, have become increasingly expensive for pharmaceutical companies.” Some data suggest physicians only spend a minute or two with a rep per call. This is under standable. Physicians are under increasing pres sure to see more patients, and continue to face complex challenges created by managedcare organizations. Therefore the physician’s time time for inoffice education about a product or building a relationship with the pharmaceutical company representative is extremely limited. “Pharmaceutical companies find that send ing many sales reps out is effective since more reps mean more prescriptions,” Mr. Sederman says. “Physicians need the clinical informa tion, the samples, and other things the rep brings, but it’s very inconvenient for physi cians to interact with the sales reps in the mid dle of the day when they have patients to see. The challenge is to find ways to create more value in a shorter period of time.” “I have never really had a lot of time to spend with reps, and it has gotten worse — time constraints are even greater today,” says Nick Tsoulos, M.D. “I need to spend more time on the phone and doing paperwork in addition to seeing patients so it is even more difficult for me to sit down and talk to drug reps. I rarely spend more than a minute or so signing for samples or accepting a brochure.” Dr. Tsoulos’ experience is not exceptional. The physician community is squeezed for time on all sides, including the amount of time a doctor is able to spend with the patient. On average, according to statistics, a doctor spends between eight and 12 minutes with each patient. “When I’m talking with drug reps in the office, I feel the constraints of patients waiting,” Dr. Tsoulos says. “Often the reps see the nurse, who stocks our samples, and they catch me on the fly as I run down the hall. And even though the sales rep is available when I have questions, I can get the information elsewhere.” The changing dynamic within the physi cian’s office is forcing reps to develop a relation ship with the entire office, which means that it is essential that representatives are able to drive a message through to the physician’s staff. “The successful sales call is based on a rep’s ability to spend increased time with the physi cian, which today is increasingly dependent on the relationship with not only the physician but the staff,” Mr. Foreman says. In addition, the sales rep must be ready with a plan that builds on the relationship. “There needs to be ways that will supple ment the rep call and prepare the physician for the next time that the representative visits the office,” Mr. Foreman says. “I’m suggesting ini tiatives that can be implemented between rep calls.” Because the influence sphere is widening — the physician isn’t always the ultimate decision maker — reps need to be able to com municate with physician assistants and nurse practitioners as well as the office staff. “Ultimately the physician is not the only person in the office making the decision about a script,” Mr. Foreman says. “Many other influences are involved today.” Quality,not just quantity The proliferation of mergers within the pharmaceutical industry has led to an increase in rep numbers, which can mean less experi enced detailers. “Because of the expansion of the number of reps there isn’t the same experience base that there used to be,” Mr. Foreman says. “Today companies are realigning and people are mov ing around.” The future of pharmaceutical sales lies in the efficient dissemination of critical informa tion regarding therapeutic categories and medicines. The better the sales reps know their product, the better able they are to quickly and succinctly deliver meaningful messages. The challenge for pharmaceutical compa nies, Mr. Foreman says, is to motivate a sales force that has disparate abilities, and to ensure reps are at the top their game. “How do we customize training based on tenure, based on ability, based on therapeutic expertise so that the experience is motivating for all levels of expertise as opposed to the least common denominator?” Mr. Foreman asks. “This is the challenge, given the sheer volume of reps in any one organization, and it takes vision, planning, and a longterm commit ment.” Because pharmaceutical companies have several thousand reps, and because of the con stant realignment and movement within the sales organization there is less continuity. “The disruption within companies affects the physicianrep relationship,” Mr. Sederman says. “Training needs to meet this challenge, but training takes time. There is a fear that if reps aren’t making their 10, 11, 12 calls per day on doctors, then they are not going to be driving market share of the product.” Putting the detail back into the call Even for the successful sales reps, the ones who are continually exceeding quotas, the rela tionship with physicians is considerably differ ent than it used to be. Physicians want a repre sentative who can help their practice and demonstrate how a product can benefit certain patient types. There are a number of tech niques a representative can employ to increase their value to the physician, most of which 48 M a y / J u n e 2 0 0 2 PharmaVOICE AS PHARMACEUTICAL COMPANIES RELY MORE ON SALES REPRESENTATIVES, the reps say they need more training for the “real world,” according to a study conducted by Scott Levin, a Quintiles Transnational company,based in Newtown,Pa. More than80%of reps find their initial training effective,and75% say the same for advanced training,according ScottLevin’s Sales RepTraining:A Comparative Analysis — 2001. However, 40% of reps say their companies should invest more in training programs, and many also want more handson experience. Ninety percent say newrep training programs include field time with district managers and experienced reps, but 72% say most of their time is spent in the classroom.Sixtytwo percent say they would benefit from increased field training. In addition,60% of reps want more technologybased instruction, such as CDROMs and Webbased training. Other highlights from the study, which is based on responses from more than 900 reps from 20 companies, include: . Reps said the besttrained salesforces were from Pfizer and Merck . GlaxoSmithKline and Pfizer reps rated their training as above average;Aventis earned high erthanaverage marks for its advanced training . The topics most frequently covered for new reps include product knowledge, disease knowledge and management,professional selling skills, and anatomy and physiology . Advanced trainees rated professional selling skills as the most popular topic Pharmaceutical Sales RepTraining Programs — Room for Improvement SALES representatives largely depend on meeting the needs of the individual physi cian. “Often a valueadded pro gram exists that will meet the doctor’s needs, but the repre sentative isn’t using it because she or he hasn’t probed the doc tor to identify the problems he faces,” Mr. Marshall says. “The successful representative will uncover a physician need, address that need through a discussion of the features and benefits of his or her product, and then close the deal with that physician by gaining a commitment to pre scribe for a specific patient type.” From the physician’s perspective, he or she is seeing more representatives than ever before — in some cases up to five representatives from the same pharmaceutical company are calling on the same primarycare physician. “With physicians spending very little time with the representative during each visit, it’s even more important that the time is used to provide important information in a concise, easytounderstand format, which will lead to valuable interaction and discussion about our products,” says Michael Marquard, VP of phar maceutical sales at Wyeth Pharmaceuticals. Mr. Foreman concurs, “It is not uncommon to see two or three representa tives from different companies calling on the same doc at the same time. And due to copro motion agreements, there are representatives from different companies promoting the same product in the physician’s office on the same day.” With so many drugs — often from different classes — available to treat the same dis ease state, physicians have to prioritize their therapeutic options and reps have to know their business. “To increase the value of the relationship between a pharma ceutical representative and the physician, the focus of each call has to be on what’s important to the end user,” Mr. Riggle says. “This, in turn, will lead to increased visibility on subse quent calls.” “The primary benefit of the sales representative for me is samples — medicines that I can give my patients so that they can get started before they get to the pharmacy, or for patients who don’t have insurance,” Dr. Tsoulos says. “Drug representa tives are welltrained, bright, personable, and just nice people, and I don’t want to short change them. Unfortunately, they can interrupt the course of business.” The industry needs to develop alternative ways to communicate with the physician, including initiatives that support a rep visit but don’t necessarily require a rep to be in the office. “It’s not so important in terms of when a rep sees the physician, rather, it’s the ability to transfer knowledge and communicate informa tion,” Mr. Foreman says. “There are ways that a company can communicate with physicians and their staff that can be more valuable than a two minute detail. Supplementing the representa tive when they are not in the office is essential.” Dr. Tsoulos cites educational programs, subsidized by pharmaceutical companies, as one way to reach physicians outofoffice. “These are of enormous benefit to this prac tice,” Dr. Tsoulos says. “Most physicians want to get information not just from drug reps, but from educational programs or literature or the specialists who we refer to.” Any communication that reduces the doc tor’s risk or that makes the doctor’s life easier is invaluable. “If the representative can help the doctor use the right product with the right patient in the right way, the doctor will feel well served because most physicians are worried about using the wrong drug with the wrong 50 M a y / J u n e 2 0 0 2 PharmaVOICE The primary benefit of the sales representative for me in my practice as a pediatrician is samples — medicines that I can give my patients so that they can get started before they get to the pharmacy, or for patients who don’t have insurance.Drug representatives are welltrained, bright, personable,and just nice people,and I don’t want to short change them. Unfortunately, they can interrupt the course of business. DR.NICKTSOULOS JOHNVORIS To date, we have sent about 4.5 million messages to physicians, and about onethird of those have resulted in a physician request for additional information.We are able to deliver the same number of messages on a daily basis as a 2,500sales rep organization. R patient,” Mr. Marshall says. “Doctors are try ing to balance three forces: avoiding mistakes, simplifying the way they do things, and mak ing money even though they have to see more patients to do so.” “There is no shortage of great prescription medicines on the market, but a lot of physi cians are too busy to draw the connection between the product in the sample closet and the patient in the examining room,” Mr. Rig gle says. “Physicians prescribe products they are comfortable with.” Part of that comfort level is knowledge. “Despite how simple it may sound, the physi cian needs to hear a general overview of the product,” Mr. Riggle says. “Physicians see so many pharmaceutical reps that it often takes hearing a message six or eight times before they are comfortable prescribing the product. Key details that shouldn’t be overlooked on any call include the product name and indica tion, appropriate patient type, what those patients can expect in terms of results and side effects, and how the product is dosed.” Reps can increase their value to the physi cian and make the doctor’s life easier by reduc ing call backs, or helping them more quickly and correctly diagnose certain disease states. “The representative can help the doctor quickly identify which patients are not appro priate for their drug,” Mr. Marshall says. “The doctor can eliminate the risk of making a treat ment mistake. If a doctor doesn’t know who to exclude from treatment, he or she will simply avoid treatment. And that doesn’t help any body — the patient, the doctor, or the phar maceutical industry.” Role playing “Today, sales reps who have assumed the role of consultant are the ones who are suc cessful,” Mr. Riggle says. “Reps need to spend more of their time strategizing their call and developing a sound questioning plan to uncover physician needs. They should be more focused on openended probes, and be pre pared to tailor their message according to information the physician provides.” Providing tailored messages not only includes information about the specific prod uct, but data on formulary status. “One of the major changes for us is that our sales representatives have had to become insur ance consultants to the physicians,” says Rob Rindini, area sales manager at Novartis Oncolo gy. “Having information readily available, rather than having to get back to the doctor, puts that rep on a different level with the physician.” Physicians make prescribing decisions not only based on the safety, efficacy, and value of a product, but on formulary restrictions that are placed upon them by the pharmacy bene fit manager or the managedcare organization. “Many times a physician has to think not SALES representatives only about what may be, in their opinion, the best drug, but what is the best drug that is available to their patient based on formulary status,” Mr. Foreman says.“A significant majority of patients today have some type of pharmacy benefit plan. Not only do pharma ceutical companies have to convince physi cians that their product is a great one, offering advantages versus other products in their cate gory, but they also have to convince physicians that their product is worth the extra money for their patients if it’s not on formulary.” 52 M a y / J u n e 2 0 0 2 PharmaVOICE PHARMACEUTICALCOMPANYDETAILINGACTIVITY to physicians increased 14% in 2001, largely because of new product introduc tions, according to information from Health Products Research Inc., a division of Ventiv Health Inc. Informationwascompiled fromHPR’s Metropolitan Area Promotional Audit, or MPA, which monitors pharmaceutical company fieldforce promotion across major metropolitan areas of the U.S. There were more than 25 new product launches in 2001, which generated between 50,000 and 1 million details. HPR estimates that pharmaceutical com panies spent $8 billion supporting sales force marketing activities during 2001. Selected serotonin reuptake inhibitors (SSRIs),cholesterol reducers (statins),and COX II inhibitors received the great est amount of fieldforce attention.These three classes alone accounted for about 20% of all pharmaceutical company promotion to physi cians for theyear.Oralantihistaminesandproton pump inhibitors roundedout the top five thera peutic classes promoted tophysicians in theU.S. The therapeutic areas experiencing the greatest growth in detailing were diabetes related,including meglitinides — (up 500%) — and insulin — (up 155%). Growth in megli tinides detailing was led by the launch of Novartis’ Starlix, while insulin activity was driv enbyAventis’introduction of Lantus, indicated for the treatment of Type I diabetes in adults and pediatric patients, and adult Type 2 diabetes — patients who require basal insulin for the control of hyperglycemia. Activity for analeptics, indicated for ADHD,also increased signifi cantly (up 153%), driven by McNeil Consumer’s Concerta, as well as the launches of Adderall XR from Shire Richwood,and Metadate CD from Celltech Pharmaceuticals. Other therapeutic areas experiencing significant increases in fieldforce promotion for the year were:atypical antipsychotic agents (up 85%), which benefited from the introduction of Pfizer’s Geodon capsules;oral estrogens (up 65%), led by Pharmacia’s Activella and increased activity for Cenestin from Duramed Pharmaceuticals; bronchial steroids (up 62%), led by the launch of GlaxoSmithKline’s Advair Diskus and increased activity support for AstraZeneca’s Pul micort Respules; oral contraceptives (up 45%), driven by Ortho McNeil’s Ortho TriCyclen and the launch of Berlex’s Yasmin; and pro ton pump inhibitors (up 40%) were fueled by the launch of AstraZeneca’s Nexium. Alzheimer’s disease therapies received a new entrant with the launch of Janssen’s Reminyl,which also is being sup ported by the OrthoMcNeil’s neuroscience field force. The COX II inhibitor Celebrex,jointly marketed by Pharmacia and Pfizer,remained the top productpromoted to physicians in 2001,with more than 2.4 million details generated for the brand, followed close ly by its key competitorVioxx,which is marketed byMerck.Vioxx gen erated 2.1 million details for the year. Lipitor (Pfizer), Claritin tabs (Schering), Zocor (Merck), Celexa (Forest), Zoloft (Pfizer), Paxil (Glaxo SmithKline), and Zithromax Tabs (Pfizer) rounded out the remaining top 10 products detailed to physicians. Pfizer (12%), GlaxoSmithKline (10%), and Merck (7%) topped all companies in terms of the numberof contacts,or calls,made to physi cians in 2001 by sales representatives. AstraZeneca jumped to the 4th position in 2001 (up from 7th in 2000), driven by the launch of Nexium, and increased support for Pulmicort Respules, while BristolMyers Squibb slipped three spots to the 7th position. Novartis (8th) broke into the top 10, with increased support for its antihypertensive Dio van, as well as the launches of Starlix and Foradil Aerolizer, as did Pharmacia (9th), which benefited from increased support of Celebrex, Activella, Lunelle, and the launch of Detrol LA. Other companies ranking in the top 10, included: Eli Lilly (5th), which increased its sup port of its atypical antipsychotic Zyprexa, the introduction of Zyprexa Zydis and Zyprexa IM, as well as the launch of Prozac Weekly, and support for Humalog 75/25; Wyeth (6th) bene fited from increased support for the ACE inhibitor Altace (copromoted by Monarch Pharmaceuticals), in addition to increased support for Effexor XR; and Aventis Pharmaceu ticals (10th), which strongly sup ported its Allegraantihistamine line, Lovenox Injection, Nasacort AQ, and the launch of Lantus. These 10 companiesaccounted for 60%of total calls made to physicians in 2001. Promotion to Physicians Rise 14%AmidNew Product Introductions Top 5 therapeutic classes detailed to physicians Selected serotonin reuptake inhibitors (SSRIs) Cholesterol reducers (statins) COX II inhibitors Oral antihistamines Proton pump inhibitors Top 10 Companies Ranked by Detailing Activity 1 Pfizer Inc. 2 GlaxoSmithKline 3 Merck & Co. 4 AstraZeneca 5 Eli Lilly and Co. 6 Wyeth 7 BristolMyers Squibb Co. 8 Novartis Pharmaceuticals 9 Pharmacia Corp. 10 Aventis Pharmaceuticals NewProduct Introductions Top Detail List Nexium (AstraZeneca) Advair Diskus (GlaxoSmithKline) Prozac Weekly (Lilly) Geodon capsules (Pfizer) Detrol LA (Pharmacia) Starlix (Novartis) SALES representatives The sales rep also has to have the ability to pick up on nonverbal cues, which is just as important, if not more important, as deliver ing a boilerplate marketing message. “Often, a doctor’s facial expression or body language will signal what he or she is feeling,” Mr. Marshall says. “If the rep doesn’t probe and find out what the problem is, and instead continues with the predetermined speech about his or her product the doctor shuts down and the call is over.” The challenge is to identify any potential problem or objection the physician may have, and then work toward creating a solution. “With the level of advanced technology today, communication vehicles are being enhanced, but nothing will replace a faceto face meeting,” Mr. Foreman says. “This is why the sales representative remains at the core of pharmaceutical promotion.” The salesforce has to find ways to create tremendous value in a short period of time. Companies are trying combinations of person al interaction with different types of technolo gy to make it more convenient for the physi cian to get what she or he needs from the company at a convenient time and place. “The answer is not to have a completely separate edetailing or eCME initiative,” Mr. Sederman says. “It’s about putting these tools in the hands of the rep, making the rep the hub for that information through a combina tion of interactions with the physician, and following up with emails or links to particu lar information. The one and twominute interactions can be supplemented with tech nology, whether the interaction is via the Internet, a Webcast, or CDRom.” Leveraging different ways to make clinical and drugrelated information accessible to the physician requires changes in how the sales rep operates. Pharmaceutical representatives will need to be more technologically savvy and more comfortable in extending themselves in different ways — tactics that were not tradi tionally required as part of the job. By taking the message delivered by a trained pharmaceutical rep and coupling that with the focused message of a potentially lengthier edetail, healthcare professionals are sold on multiple levels — through peer edu cation, within the office setting, and through interactive ebusiness options. Edetailing can definitely be an asset to a sales organization, and surveys show that a majority of healthcare professionals are responding positively to this medium. “The nature of edetailing requires that physicians actively seek it out,” Mr. Riggle says. “Edetailing can effectively promote a product to a healthcare professional, but it doesn’t have the impact of professional sales reps who estab lish themselves as a resource to that office.” “There is some dabbling in edetailing and epromotions, but there also is a fear of disrupt ing what works,” Mr. Sederman says. “Compa nies are trying to get a feel for how edetailing works. Do physicians like it? Is the ROI posi tive? Is it effective? How does it compare to the sales rep?” Companies are testing software tools that can be used to supplement the office detail. One company that is providing critical information to physicians at the point of care is ePocrates. “In creating our tools, we looked at what the physician needs to practice better medicine, to keep track of all the pharmaceutical products that are out there, and something that they would really use when they are in the exam room,” says John Voris, CEO of ePocrates. According to the company, 235,000 physi cians have downloaded the ePocrates software. On average physicians are coming back week ly for clinical updates. Physicians use the ePocrates tool about twice a day to find infor mation that goes beyond the package insert. They want to know about the latest study, or how their colleagues are using certain drugs. “It’s a real art — delivering the most valu able information in an uncluttered way,” Mr. Voris says. “We measure each one of our mes sages for how many of them are read, opened, how many physicians request new informa tion. To date, we have sent about 4.5 million messages to physicians, and about onethird of those have resulted in a physician request for additional information. We are able to deliver the same number of messages on a daily basis as a 2,500sales rep organization.” By providing physicians with tools that they really use, ePocrates also is able to give compa nies the ability to target specialty interests. “We can deliver the same message on a handheld device that the rep would deliver via a brochure to the physician,” Mr. Voris says. “Delivering data in the handheld arena must be very solutions oriented. Physicians are not sitting at a desk. They are on the move — walk ing through the halls of the hospital or moving into the next exam room. We have to have the right data at the right time for the doctor. The additional content, such as clinical guidelines and dosage applications, which we can provide on behalf of a sponsor, is information that physi cians can use when they see the patient.” “I use the ePocrates software several times a day,” Dr. Tsoulos says. “I can literally type in the first few letters of either the brand name or the generic and the medicine is right there. The tool helps me treat the patient. I can check for drug interactions on more drugs than I have ever needed to, and patients are impressed that I have that information at my fingertips.” F PharmaVoice welcomes comments about this article. Email us at [email protected]. 53 PharmaVOICE M a y / J u n e 2 0 02 Experts on this topic JIM FOREMAN.Executive VP,Vox Medica, Philadelphia, Pa.;Vox Medica is a group of specialized communications services com panies, including Ted Thomas Associates Inc., CoMed Communications Inc., Galen HealthCom Inc., and Signova Inc. MICHAELMARQUARD.VP,pharmaceutical sales,Wyeth Pharmaceuticals, Radnor,Pa.; Wyeth Pharmaceuticals comprises prescription products,vaccines, and nutritionals with global operations consisting of 49 manufacturing facilities in 27 locations around the world, and export activities to another 60 nations FREDERIC MARSHALL.President, Quantum Learning Inc., Newtown,Pa.; Quantum Learning delivers advanced tools, skills, and strategies for changing physician prescribing behavior,and helps pharmaceutical companies achieve their sales and marketing goals JOHNRIGGLE. National sales trainer, Sankyo Pharma,Parsippany,N.J.; Sankyo Pharma is the U.S. subsidiary of Tokyo based Sankyo Co.Ltd., the secondlargest pharmaceutical company in Japan ROBRINDINI.Area sales manager,Novartis Oncology,East Hanover,N.J.; Novartis Oncology is a business unit within Novartis AG,a world leader in healthcare with core businesses in pharmaceuticals,consumer health,generics,eyecare,and animal health ROB SEDERMAN. Executive VP of strategic business development,Market Measures/Cozint,East Hanover,N.J.; Market Measures/Cozint,a unit of NOPWorld Health, is a suppler of indepth U.S. market and diseasestate analyses, and a leading provider of breakthrough speed and quality research solutions NICKTSOULOS,M.D.,F.A.A.P.Practicing pediatric physician, Poway,Calif. JOHNVORIS.CEO,ePocrates Inc., San Carlos, Calif.;ePocrates is the largest hand held physician network with more than 500,000 users