You've just given one of your key physicians what you thought was a clear and persuasive presentation using a new clinical reprint. You are confident that the results of the study should influence this doctor to change his prescribing pattern. As you check for agreement, his only comment to you is, "Your company funded this study. I know it's biased and I'm not going to base my treatment decisions on what you've just presented." You struggle to tell him that it's a randomized, double-blind, placebo-controlled trial, so it must be legitimate. He refuses to listen, and you walk away feeling disappointed and confused.

Does this scenario sound familiar? More and more physicians are questioning the results of the clinical studies that are presented to them by representatives. There are reasons for this behavior. Physicians are being trained in medical school and at conferences to be more critical of any research that is presented to them. This critical approach to medical literature is a result of the new practice paradigm in medicine called evidence-based medicine. Proponents of evidence-based medicine advocate basing clinical practice on a combination of available evidence and data from clinical studies, as well as patient values and preferences. Physicians are taught several key criteria to determine the validity of a study and its relevance to their clinical practice.

Understanding the criteria

If a representative presents an article to a physician without presenting the salient criteria he or she expects, the physician will most likely reject the study. To avoid this scenario, pharmaceutical representatives must understand these criteria and present them to the physician when selling with a clinical reprint. Reps must go beyond the traditional methods, and leverage this information to sell using reprints. This practice is called evidence-based selling.

Representatives must be able to do two things to sell in this new environment:

1. Learn to critically evaluate a study based on its validity and relevance using the criteria of evidence-based medicine.

2. Present a reprint using evidence-based medical findings so that the physician can apply the information to a specific patient need or concern.

When sales representatives receive a new study, it makes sense to begin by studying the abstract, learning the key points outlined by the marketing department and determining which physicians would benefit from the study. Reps who practice evidence-based selling take this approach further by critically appraising the study on its validity and relevance using the criteria of evidence-based medicine before presenting it to physicians.

How do we critically appraise a reprint? We need to go back and study the following terms: last observation carried forward, sufficient follow-up, blinding, randomization, number needed to treat, number needed to harm, median, mean measure of central tendency, statistical significance, clinical significance, absolute risk reduction, standard deviation, cohort study, crossover study design, meta-analysis, event rate, case control study, hypothesis, cross-sectional study, and intention to treat. You may remember some of these terms and need a little refresher to learn the others. It is important to understand these terms so that you can help the physician see the validity and relevance of the studies to his or her practice and patient outcomes.

Presenting the findings

How should a rep present a reprint using evidence-based medical findings? We know that all studies are imperfect. In fact, most are far from perfect because science is imperfect. Part of presenting our reprints is helping the physician determine whether the information in the study can be applied to his or her practice. In other words, translate statistical significance into clinical significance. Use the appropriate terms to talk with physicians about clinical significance. Our job is to use the information learned in the studies and to influence physician prescribing behavior.

Because physicians are learning a new method of analyzing studies, they are using this method to determine the value of our reprints. Sales representatives need to understand this new approach to learning and leverage it to sell with reprints. When we embrace the new trend in physician education, evidence-based medicine, then we can sell in a way that the physicians can use to determine their choice of products. Isn't that what being a pharmaceutical representative is all about? pr