Name: Dr. Nova
Location: East coast
I’m a pharmacist by training. I have a Doctor of Pharmacy degree from an HBCU. My plan was to go work in the basement of a hospital somewhere until I’m 65 and retire. I graduated from college shortly after the economic crash in 2008 and like others in my generation, I went rushing for an advanced degree.
When I graduated from pharmacy school, that series of years from the early 2010s to the mid 2010s had the largest number of pharmacists who graduated. Every year across the country, the number of pharmacists just increased. It created a workforce that was easier to exploit because you’re more replaceable. So, Walgreens and CVS know that they can burn you out, kick you out of the door, and they’ll have another person come in. They know that people are going to be desperate for jobs. It got to the point where nobody wants to be at the large retail chains. We were all competing for the smaller pool of hospital clinical jobs, and a lot of the hospitals wanted more specialization or residency training, whereas, like, 20 years ago, you got your degree in pharmacy and you could go work anywhere. Long story short, I did not get a residency position, and I absolutely refused to go work at CVS and Walgreens, and I graduated, and I was just really at a loss.
I was about to graduate and I had no job offers, nothing. My mom was talking to one of my professors at my graduation — I don’t know how this conversation started — but he comes to me and he says, “Have you ever considered working in the pharmaceutical industry?” And I was like, “Not really”, because, on the one hand, it always seemed like something you do much further down when you’re more established in your career, if you do it at all. And then there’s also the stigma of Big Pharma. So it was just like, “Okay, I never really thought about that, but what the heck, I don’t have a job at all”.
Two weeks later, I’m on a plane to the Midwest, I interview for this job, then two days after that, I get offered the job, and I was like, “Well, I guess I’m moving from the east coast to the midwest.” So that’s how I got into the pharmaceutical industry.
I work in an area of pharma called Medical Affairs. It’s, like, all the scientific communications, all of the stuff that a pharma company puts out that’s not marketing, not advertisement, and essentially educational in nature. Medical Affairs sits in this place where we’re dealing with marketed products. Products that have been approved by the FDA. If we’re involved with pre-market products, it’s mostly towards the end of their development phases. Because we’re noncommercial representation, we talk with physicians and other health care providers. My role specifically is that I’m a Medical Science Liaison. In a nutshell, I am the scientific expert representing my company for a particular region of the country.
That first year was just learning the ropes. The biggest part of that was moving across the country. Like, I barely remember what work I did. I was just like, “I’m in a new place!”, so that was a challenge, and after I finished my first year fellowship, I didn’t really know if I wanted to stay in Medical Affairs or go focus on the Research and Development side of things. My second job at [Company A] was in pharmaceutical development project management. I was responsible for a number of assets, most of them early-phase diabetes projects. I was responsible for coordinating all of these different functions that play into getting a drug developed — engineering, chemistry, all the different scientists. And then you have manufacturing people, all these different groups that you have to herd, to get to a final goal of a drug that might come out 15 years from now.
Some of it got very complex. One project I was dealing with was about to go into phase one, where you just look at the basics of a medication in human beings. We were supposed to be ready to start the first human dose, and I remember the chemical engineering guy saying, “We can’t do this because the drug is not stable anymore”. The chemical engineers were like, “We cannot give it to people, it’s got to be redone”. And like, that’s it. The hard part about that was that it’s, you know, very long-term. The work that I was doing might have some effect on something in 10 years or more. So, if everything goes perfectly, according to all of these estimates, this drug might be submitted to the FDA in 2025. This was in 2015 or 2016.
That’s why it was hard for me, because I have… I like to organize things and I like to see projects happen. I mean, it’s very important work, but for me, it just didn’t have enough immediacy, and at the very same time, I had to get the hell out of the Midwest.
I started looking outside and successfully snagged my first Medical Science Liaison role at another company. Things were only normal for about one year, because I started in 2019 and then Covid happened in March 2020 and then, like everyone else, I had to stay home. Of course, being in the pharmaceutical industry, everybody’s efforts turn to, like, “What do we do about this?” Which was very cool, in a way. I remember we had a town hall meeting early in the pandemic, like, two weeks after things shut down. Our Chief Medical Officer was like, “Everybody, right now, open up the archives to look at every molecule we have to see if anything at all could be used against coronavirus.” At that time, we were just starting to try to figure out how the virus was even working, and what it was doing to people’s bodies. It was really heartening to hear, like, “We’re opening our library, we’re going to search every molecule that we have ever had in development, everything that we’ve ever even tried to make something out of and see if anything works”.
That’s how we had such a slew of random drugs at the very beginning of Covid, like, the remdesivir and baricitinib, a drug that they were using for people who were really sick with Covid, that all came from companies scrambling to figure out anything out.
I switched jobs towards the end. In 2021, I came over to [Company C], doing the same job that I was doing at [Company B], but outside again. I am in Dermatology. So that’s how I got to where I am and what I do.
If there’s a question about our medication, it comes to me. If there is a clinical trial ongoing with one of our medications currently or one that’s in the pipeline, I have to be aware of it. I am responsible for medical education. So, say, there’s a residency program, and they want a crash course through certain immunology topics, or something that’s specific to the drug that I represent. I’ll present that info to them as an educational program.
What I like most is that I don’t sell anything. If I walk into somebody’s office and they’re like, “This is the best drug ever!”, I’m like, “Cool.” If I walk in and they say, “This is the worst drug ever!” I’m like, “Cool.” We are a conduit back to the company for important insights. If you know, we have a bunch of people saying, “You know, this drug really sucks and you guys dropped the ball”, that’s valuable information, and we develop initiatives to address that. That’s the gist of it.
I’ll put it like this, a chill day is a day like today where I basically work from home. I spent some time answering questions from people in my territory, medical questions that they had. They’re never urgent because nobody’s dying in dermatology. There are some things that are better to explain to people face-to-face than trying to send an email, or, just, like a research paper or something. A very busy day is when I’m out in the field. Tomorrow is going to be a busy day. I’m going out to an office in the morning where I have to address some safety questions about our drug. A patient had a bit of a hypersensitivity, like, kind of like an allergic-type reaction after they started their first dose. I’m going down to talk to the doctors about how that came about and what to do if the patient has it again and if they feel more comfortable discontinuing the patient. Then I’m going to hit another office where I’m hoping to meet up with some physician assistants and go through one of our data sets with them. Then maybe I’ll hit a third. That’s just locally, like, driving around, hitting three offices.
Next week, I’m going to West Virginia for 3 days, and I’m essentially going to be doing the same thing that I do locally. When I travel, I tend to pack those days up with more things, like, I will have, like, a breakfast meeting, a lunch meeting, and then I’m going to go out to dinner with somebody. Another day I’ll hit 3 or 4 offices.
This can differ across therapeutic areas, even within my own. Within our company, Immunology is divided into Dermatology, Rheumatology, Gastroenterology. Neither Rheumatology nor Gastroenterology has even half the number of conferences that Dermatology does. I don’t know what dermatologists do, because they’re always at conferences [laughs]! Some of them are regional. Some of them are smaller. Some of them are big, national ones. I do 1 to 2 conferences a quarter. Because it’s a conference, it usually runs over a weekend, so when I do a conference, I’ll do Thursday, Friday, Saturday, sometimes Sunday, depending on the schedule. We often have booths, displays, things like that. It’s a lot of standing around and talking to people and socializing and smiling and all of that, and it can be very tiring, very busy.
I guess the best snapshot of what my days will look like depends heavily on where I’m located, what I’m supposed to be doing, but I like it, because I hate working in offices. That’s the main reason I became a pharmacist, I never wanted to work in an office. I always wanted to work in medicine, but I knew I didn’t want to work in an office. I had full intention of working as a pharmacist. I studied my ass off, I got great grades, I’m a licensed pharmacist. Like, I passed all the licensing exams and everything, I just don’t use it.
Sometimes, I wish I had done it. Where that hit me was when the pandemic started, because I just wanted to be more useful. Even though I don’t actively use my medical expertise, it’s still there, and early in the pandemic, I had a lot of friends from pharmacy school who were working in hospitals who were just as overwhelmed as everybody else. I did a course online, for ICU Pharmacy because I was like, if they open up jobs for something like that, I’m going to do it, because everyone’s burned out. It was awful. I did get hired by a local medical center for reserve pharmacy, and I did, like, a little bit of backup. I mostly worked on vaccination, so, I was glad I had that ability at a point where people were really, really in need.
The thing that keeps me away from turning my focus back into pharmacy is that everyone gets so burned out. I graduated, what, 8 years ago? I know people that quit, completely. Maybe if the field improves in some way, or if there’s really a great need again, I definitely would do it in a time of need. But you know, this is fine. If I had to go work in a regular retail pharmacy right after school, you know, you’ve got to do what you’ve got to do to survive. If I could go all the way back to college and choose again, I probably would have stuck to going to medical school. When I was trying to get out of the Midwest, I was very close to applying for medical school. I was like, “You already have so much debt, what’s a little more like, it doesn’t matter to you, you’re not paying it off!”
Nobody ever pressured me to be a doctor. I just genuinely fell in love with science as a kid. Always wanted to be some kind of scientist, and then, you know, gravitated towards medicine, it didn’t turn me off in the way that it turns others off. Like, other people get queasy when folks are ill. But I was very, very interested in it. And I wanted to know, like, why someone was sick and how they could get better? What could we do? and I became a very big chemistry nerd. I love chemistry. That pushed towards the drug part of things. I ended up deciding to do pharmacy school instead of medical school for some stupid 22-year old reason that made sense to me at 22.
If you have questions about how the sausage is made in pharma, like, how drugs come to life, I can answer them because, goodness, the internet is very confused about it. A lot of that is the industry’s fault because so much of the stuff that would answer people’s questions is proprietary information. I’ve actually seen the line items for drugs in development; it’s hard to grasp a real sense of the costs otherwise. They sit in front of Congress and they’re like, “Well, we need $1 billion to develop this drug.” I mean, they’re not lying about it, it’s true, but they don’t provide that evidence because it’s proprietary, trade secret information.
Sometimes, just being online, it’s like watching people is hard… because, I’m like, a left wing person. I watch people say things, and I’m like, “Oh that’s not how it works”. But I can’t prove it. The biggest [misconceptions] tend to be when people or news outlets are like, “This drug sells for $70,000, but it’s manufactured for $1 a pill” or something like that. And I’m like, no, it’s not. The raw materials cost might be really inexpensive, but that price, even if we were to strip out the profit motive — profit motive doesn’t matter to me, I don’t sell anything. I don’t care, I don’t care if the shareholders get another yacht. That has nothing to do with me. I’m part of the operating cost, but if you still just priced it for the people who have regular jobs and have to get paid to do the work that they do, it would still be expensive, right? Because people work to manufacture that drug for the 10 to 15 years it takes to develop. And then all of the other 50 drugs that they pulled the plug on, we’re paying, you’re paying for all of that at the end of the day. I would be totally fine if someone said like they’re not allowed to make profits anymore or whatever, but the fact that we need revenue to power our work, that has to be done and is really important. So that’s one thing.
The other thing, the one I hate the most, is importing drugs from Canada. When I was at [Company A], this was like 2017, after that election and a lot of people like Bernie Sanders were talking about importing drugs from Canada. And the thing that I felt like no one realized is that pharmaceutical companies are international corporations. They operate here in the United States, but they make their money all over the world.
If the same drug that is manufactured in Indianapolis, Indiana costs $100 for someone to get just over the border in Toronto, but here it costs, you know, $700, then the problem is not in Canada, it can’t be solved in Canada, it has to be solved here. Canada and the United States have completely separate, different health care systems. There’s different players involved. There are different people trying to make money at different steps in the chain that other countries don’t have. So, you know, maybe if we had some laws here that prevented people from trying to make a buck out of every transaction that has to happen along the supply chain, then maybe it wouldn’t cost, you know, $700 to get your prescription every month in Indiana when they make it next door versus somebody getting it for, you know, a fraction of the cost in a completely different country. If you end up importing it back from Canada, like, we’re literally paying for our own drug that we already made. That’s the problem. A lot of people don’t understand just how many different factions are involved in the American health care system and how murky and crazy and messed up it is.
I’m sorry to anybody who loves when someone in Congress holds up a little whiteboard and they’re like, well, “You make $300 billion a year!”. Then they ask “Why is this drug this much?” There’s never a straight answer because that dude doesn’t know anything. He does not know because nobody knows. You can question the CEO of a drug company or a health insurance company, you’ll keep questioning and the answers will be circular. That’s because it’s impossible to pinpoint one person that’s responsible. The whole thing needs to be upended.
I don’t blame anyone for being mad about this because, again, all of that info is proprietary and nobody is upfront about anything. Having seen it, you know, in front of my eyes, I get it. It costs $1.5 million to run a fertility study using rabbits. It sounds crazy but it does.
The most exciting thing I’m working on is actually happening right now. We have a new drug in our pipeline that’s launching, and, I’m not intimately involved with the development of it, but I get to see this trial come into fruition. The whole big deal right now in America is all this backlash against DEI, right? My company has made a genuine effort to diversify our clinical trial patient base. Over the last couple years, we did a trial that recruited self-identified patients of color. The drug is already on the market, so we already know that it works, but this was an attempt to make up for the racial gaps in the original study data. We’re not just saying, “Well, this study had 80% white patients, so it’s going to work for everybody”. We’re saying, “Okay, let’s try to make this group of patients more representative by doing this”. In trying to diversify our patient population for clinical trials, we actually diversified our investigator base.
Investigator is just another word for principal scientists. They’ll be, like, the lead doctor, at a clinical trial site. It’s really just a dermatologist who’s in charge of a clinical trial site in a particular area. We refer to them all as investigators.
I live in an area that is mostly people of color. We have a lot of minority representation here, but, my area, we had no clinical trial sites at all. We got 3 or 4 sites in my immediate territory that are now participating in the trial for this new drug that’s coming out. So we won’t have to go 8 years from now and be like, “Oops, let’s try to get people of color represented in our drug trial”.
I know there’s a lot of people that always say companies have just been doing this diversity stuff for, you know, capitalism’s sake and to get brownie points and everything, and while that might be true in some places, I’m very proud that where I work, that is not the case, that we’re doing something that really is going to have impact, we’re getting patients in the trials for the for this new drug that haven’t had the opportunity to be treated before. They’re getting treated for free, essentially. That’s probably the most rewarding thing that I have contributed to so far.
For a moment, I was afraid that my company, like other companies, would shrink away from it because the Chris Rufo’s of the world were coming for them or whatever. But it hasn’t happened. So now I feel like, you know, you can come for us if you want to, but look at what we’ve done, you know?
GOLIKEHELLMACHINE 