As an ambitious college student, Cassie Napier had all the right moves - flips, tumbles, an ever-flashing America's sweetheart smile - to prepare for her job after graduation. She became a drug saleswoman.
Ms. Napier, 26, was a star cheerleader on the national-champion University of Kentucky squad, which has been a springboard for many careers in pharmaceutical sales. She now plies doctors' offices selling the antacid Prevacid for TAP Pharmaceutical Products.
Ms. Napier says the skills she honed performing for thousands of fans helped land her job. "I would think, essentially, that cheerleaders make good sales people," she said.
Anyone who has seen the parade of sales representatives through a doctor's waiting room has probably noticed that they are frequently female and invariably good looking. Less recognized is the fact that a good many are recruited from the cheerleading ranks.
Known for their athleticism, postage-stamp skirts and persuasive enthusiasm, cheerleaders have many qualities the drug industry looks for in its sales force. Some keep their pompoms active, like Onya, a sculptured former college cheerleader. On Sundays she works the sidelines for the Washington Redskins. But weekdays find her urging gynecologists to prescribe a treatment for vaginal yeast infection.
Some industry critics view wholesomely sexy drug representatives as a variation on the seductive inducements like dinners, golf outings and speaking fees that pharmaceutical companies have dangled to sway doctors to their brands.
But now that federal crackdowns and the industry's self-policing have curtailed those gifts, simple one-on-one human rapport, with all its potentially uncomfortable consequences, has become more important. And in a crowded field of 90,000 drug representatives, where individual clients wield vast prescription-writing influence over patients' medication, who better than cheerleaders to sway the hearts of the nation's doctors, still mostly men.
"There's a saying that you'll never meet an ugly drug rep," said Dr. Thomas Carli of the University of Michigan. He led efforts to limit access to the representatives who once trolled hospital hallways. But Dr. Carli, who notes that even male drug representatives are athletic and handsome, predicts that the drug industry, whose image has suffered from safety problems and aggressive marketing tactics, will soon come to realize that "the days of this sexual marketing are really quite limited."
But many cheerleaders, and their proponents, say they bring attributes besides good looks to the job - so much so that their success has led to a recruiting pipeline that fuels the country's pharmaceutical sales force. T. Lynn Williamson, Ms. Napier's cheering adviser at Kentucky, says he regularly gets calls from recruiters looking for talent, mainly from pharmaceutical companies. "They watch to see who's graduating," he said.
"They don't ask what the major is," Mr. Williamson said. Proven cheerleading skills suffice. "Exaggerated motions, exaggerated smiles, exaggerated enthusiasm - they learn those things, and they can get people to do what they want."
Approximately two dozen Kentucky cheerleaders, mostly women but a few men, have become drug reps in recent years.
While there are no statistics on how many drug representatives are former or current cheerleaders, demand for them led to the formation of an employment firm, Spirited Sales Leaders, in Memphis. It maintains a database of thousands of potential candidates.
"The cheerleaders now are the top people in universities; these are really capable and high-profile people," said Gregory C. Webb, who is also a principal in a company that runs cheerleading camps and employs former cheerleaders. He started Spirited Sales Leaders about 18 months ago because so many cheerleaders were going into drug sales. He said he knew several hundred former cheerleaders who had become drug representatives.
"There's a lot of sizzle in it," said Mr. Webb. "I've had people who are going right out, maybe they've been out of school for a year, and get a car and make up to $50,000, $60,000 with bonuses, if they do well." Compensation sometimes goes well into six figures.
The ranks include women like Cristin Duren, a former University of Alabama cheerleader. Ms. Duren, 24, recently took a leave from First Horizon Pharmaceuticals to fulfill her duties as the reigning Miss Florida U.S.A. and prepare for next year's Miss U.S.A. pageant.
Onya, the Redskins cheerer (who asked that her last name be withheld, citing team policy), has her picture on the team's Web site in her official bikinilike uniform and also reclining in an actual bikini. Onya, 27, who declined to identify the company she works for, is but one of several drug representatives who have cheered for the Redskins, according to a spokeswoman for the team, Melanie Treanor. Many doctors say they privately joke about the appearance of saleswomen who come to their offices. Currently making the e-mail rounds is an anonymous parody of an X-rated "diary" of a cheerleader-turned-drug-saleswoman.
"Saw Dr. Johnson recently," one entry reads. "After the 'episode' which occurred at our last dinner, I have purposely stayed away from him. The restraining order still remains."
Federal law bans employment discrimination based on factors like race and gender, but it omits appearance from the list.
"Generally, discriminating in favor of attractive people is not against the law in the United States," said James J. McDonald Jr., a lawyer with Fisher & Phillips. But that might be changing, he said, citing a recent ruling by the California Supreme Court, which agreed to hear an employment lawsuit brought by a former L'Oreal manager who ignored a supervisor's order to fire a cosmetics saleswoman and hire someone more attractive.
But pharmaceutical companies deny that sex appeal has any bearing on hiring. "Obviously, people hired for the work have to be extroverts, a good conversationalist, a pleasant person to talk to; but that has nothing to do with looks, it's the personality," said Lamberto Andreotti, the president of worldwide pharmaceuticals for Bristol-Myers Squibb.
But Dr. Carli, at the University of Michigan, said that seduction appeared to be a deliberate industry strategy. And with research showing that pharmaceutical sales representatives influence prescribing habits, the industry sales methods are drawing criticism.
Dr. Dan Foster, a West Virginia surgeon and lawmaker who said he was reacting to the attractive but sometimes ill-informed drug representatives who came to his office, introduced a bill to require them to have science degrees. Dr. Foster's legislation was not adopted, but it helped inspire a new state regulation to require disclosure of minimum hiring requirements.
Ms. Napier, the former Kentucky cheerleader, said she was so concerned about the cute-but-dumb stereotype when she got her job that she worked diligently to learn about her product, Prevacid.
"It's no secret that the women, and the people in general, hired in this industry are attractive people," she said. "But there so much more to it."
Still, women have an advantage with male doctors, according to Jamie Reidy, a drug representative who was fired by Eli Lilly this year after writing a book lampooning the industry, "Hard Sell: The Evolution of a Viagra Salesman."
In an interview, Mr. Reidy remembered a sales call with the "all-time most attractive, coolest woman in the history of drug repdom." At first, he said, the doctor "gave ten reasons not to use one of our drugs." But, Mr. Reidy added: "She gave a little hair toss and a tug on his sleeve and said, 'Come on, doctor, I need the scrips.' He said, 'O.K., how do I dose that thing?' I could never reach out and touch a female physician that way."
Stories abound about doctors who mistook a sales pitch as an invitation to more. A doctor in Washington pleaded guilty to assault last year and gave up his license after forcibly kissing a saleswoman on the lips.
One informal survey, conducted by a urologist in Pittsburgh, Dr. James J. McCague, found that 12 of 13 medical saleswomen said they had been sexually harassed by physicians. Dr. McCague published his findings in the trade magazine Medical Economics under the title "Why Was That Doctor Naked in His Office?"
Penny Ramsey Otwell, who cheered for the University of Maryland and now sells for Wyeth in the Dallas area, says she has managed to avoid such encounters.
"We have a few of those doctors in our territory," said Ms. Otwell, 30, who was a contestant on the CBS television show "Survivor." "They'll get called on by representatives who can handle that kind of talk, ones that can tolerate it and don't think anything about it."
But there have been accusations that a pharmaceutical company encouraged using sex to make drug sales. In a federal lawsuit against Novartis, one saleswoman said she had been encouraged to exploit a personal relationship with a doctor to increase sales in her Montgomery, Ala., territory. In court papers responding to the lawsuit, Novartis denied the accusation. The company has also said it is committed to hiring and promoting women.
For her part, Ms. Napier, the TAP Pharmaceutical saleswoman, says it is partly her local celebrity that gives her a professional edge. On the University of Kentucky cheering squad, Ms. Napier stood out for her long dark hair and tiny physique that landed her atop human pyramids.
"If I have a customer who is a real big U.K. fan, we'll have stories to tell each other," Ms. Napier said. "If they can remember me as the cheerleader - she has Prevacid - it just allows you do to so many things."
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