Most partner/presenters were tentative at the start. They began by asking the prospects what they wanted to get out of the meeting. Since the exercise was only ten minutes long, the prospects gave a 30-second overview of their needs and asked the sales person to, “Give us your pitch,” or said, “We use a lot of firms like yours. What makes you different.”

And that’s when the difficulty began. Few presenters were prepared with a brief, interesting headline focused on customer benefits. Most of them hemmed and hawed, drilled down into one particular feature of their services, or provided a summary statement that was fact-based and feature-based, not emotionally strong and benefit-driven.

For instance, the firm is proud of their process, their results, and their willingness to measure and publish those results. But all of those are internal and ambiguous to the prospect. Clients care most about results, and are more than likely indifferent to the process, as long as it gets the job done without too much disruption to their own work flow.

Furthermore, in this case, while my client firm could report their own success metrics, they could not report those of their competitors, so the information was meaningless.

And when they did mention their success metrics, they often quoted a number–”82% of our engagements are successfully completed,”–leaving the prospect to wonder if that number is good or bad, what happens with the other 18% of engagements, what does success mean, and what is the likelihood that I will be one of the 18% who get screwed?

The best guy in the whole exercise opened with three crisp points: we have a transparent process, we complete more assignments than our competitors, and we complete them faster. But he failed to stick to that outline during the subsequent role-play.

I liked what he was trying to do. He made three bold points, or claims, at the start, and he was going to describe how and why those claims were true. But he got derailed by the back and forth, and lost control of the meeting.

He would have done better if his points had been benefit statements–if they had been about what the client gets, rather than about his firm’s attributes. His message was seller-centric (all about him!) instead of customer-centric (all about them!)

Moving to a listener-centric message would have required that he understand why his clients buy services such as his, what they like about such services, and what they dislike.

I asked the group if they had any market research, or any well-founded opinions, that could guide us in the exercise. They did, and we were able to suggest another set of headlines that, if used broadly throughout the firm’s selling efforts, could provide new language, and a greater return on new client interactions.

The bottom line is this: language shapes reality! Some cognitive scientists say that language creates reality for us–that it is generative. Effective presentation of intangible professional services depends on a highly-skilled use of language capable of inducing clarity and trust in the prospect.

It’s worth the time to find the right combination of words.

That’s true and not true. I believe wholeheartedly in preparing, rehearsing, getting feedback, even scripting a speech or presentation. But then, once I have internalized the content, I boil my talk down into bullets and let myself wing it.

Rehearsal enables spontaneity. Jazz musicians work on their riffs, (their chops) in rehearsal so that they can improvise in performance. But much of that improvisation has been grooved into their muscles during hours of practice.

I don’t want to be married to a script, and I don’t think audiences want us to be married to scripts. They appreciate the fact that scripts can keep us on point, but they do not like the fact that scripts force us to read to them.

Ms. Korkki quotes Linda Blackman, founder of Executive Image in Chicago on the causes of stage fright. She says we get stage fright because:

1. We’re afraid we will look foolish
2. We’ll make a mistake (?)
3. We will disappoint the boss
4. Our expertise will be questioned
5. We may not have prepared properly

There are other reasons as well. We may have had a traumatic experience in childhood associated with humiliation, such as answering a question in class and hearing the entire room erupt in derisive laughter. Such an experience opens a pathway in the brain that makes it more likely we will experience the flight or fight syndrome.

The ancient Greeks called this dreadful sensation glossophobia. Glossa is Greek for tongue, and phobos means fear.

The Greeks also had another word that could describe stage fright: agoraphobia, which is the fear of crowds. Agora is the Greek word for marketplace.

According to some surveys, public speaking is the number one fear in America, followed by the fear of illness, heights, deep water, snakes and bugs, financial problems, and death.

Death is number seven, which means that most people would rather die than give a talk. Seinfeld once quoted this fact on his show and quipped, “That’s why, when you go to a funeral, you’d rather be in the box than deliver the eulogy.”

It has been shown that the blood chemistry of a soldier about to go into battle is the same as that of a speaker about to go on stage.

Overcoming stage fright is a multi-channel enterprise. Ms. Korkki’s article stresses the importance of preparing your script, but there are tens of thousands of well-prepared speakers who are terrified and ineffective.

Preparing your script is a brain function, but good speaking is not entirely cognitive. It also requires the heart and the body.

Dr. Charles Strobel of Yale University offered a more wholistic approach. His research indicated that there are two ways to alter a distressing inner state. One is to include positive self-talk and mental imagery as you prepare. The other is to use your body to impact your inner feelings.

For instance, Strobel proved that smiling blocks the enzyme in the brain that causes us to experience fear. He encouraged deep breathing, which can have the same effect, and showed that the best way to get a deep breath is to yawn–although not in front of the audience.

He also demonstrated that by simply manipulating your posture–by standing up straight and acting as if you were feeling comfortable, you change your blood chemistry.

The power of visualizing the results you hope to achieve is an established psychological technique. The power of using gesture and movement to alter inner states is less widely known, but it is another example of how emotion influences the body, and how the body can influence our emotions.

First of all, why is it important? It’s important because your hands speak quite loudly to the emotional radar of the audience. They can speak of your confidence and your delight in the topic, or of your anxiety and self-doubt.

A little anxiety is a good thing, because it tells your listeners that you care about doing a good job, and that you are a real person–like them.

But too much anxiety, demonstrated by wringing of hands, or fingernail cleaning, or spit-balling (rolling an imaginary spit ball between thumb and fore-finger), will undermine your credibility.

To do a good job, you need to let your hands talk, for two reasons. First, using your hands enables you to find the right word more efficiently, and second, your gestures enable the audience to better understand your meaning.

Please visit Science Daily to read more.

Here is a description of Vincent Scully, a Sterling Professor at Yale, giving a lecture on Classical Greek columns, insisting that “they rise like jets of water.” He is considered by many to be the best lecturer that Yale has ever seen.

“You can make that shape with a paddle in the water,” he says, of the scrolls on the capital. “It’s geometric. It’s hydraulic.”

…his hands reach out, turning and undulating, as if he means to conjure the image to life on the stage.

When he shows [a slide of] the huge choir window behind the altar at Chartres, he remarks that you have to climb uphill to the cathedral, and still seem to be climbing once inside.

“You get the feeling there’s a great tide coming. If you’ve ever rowed, and the tide changes…” Here he reaches out with both hands for imaginary oars and lays his back into it, as if toward the heavenly light behind the altar.

You may be thinking that your subject matter, your venue, or your temperament, prevent you from such theatricality. Doubtless there are moderating circumstances. But that does not negate the value of physical expression in front of an audience.

Hitler was a great speaker (not a great man.) He studied body language with some of the great actors of the German theater. He rehearsed, and had himself photographed. He made his passion and conviction visible and psychologically vivid for his audience. He used his gestures to help bring his message to life.

So my counsel to those who ask, “What should I do with my hands?” is, “Let them help you talk.”

And if they have trouble with that, I will ask them to do what Robert Lloyd, a great English actor, once asked me to do: wave them around while rehearsing. Don’t worry if they (your gestures) make sense. Break the habits of a lifetime with a sense of play. And, while playing, don’t allow your hands to touch your body. Keep them at arms length, making big gestures.

And then comes the final question. “What do I do with my hands when I’m not using them?”

If you’re the Prince of Wales, you hold them behind your back. If you’re Jesse Jackson, you press your fingertips together with isometric instensity. If you’re toasting at the country club, you may hold a glass of wine in one hand and have the other parked in the garage of your blazer’s pocket.

But ideally, I would like to see your body full of intention. You are there to get your point across. Your purpose is well-served if you bring yourself to life, not only intellectually, but emotionally, vocally, and physically as well.

And since your hands are such strong allies (and therefore, dangerous enemies if they go against you) I would keep them gainfully employed much of the time.

And when they need a rest from their labors, let them hang at your sides at the ends of your arms. They’re like bats–your hands. They like to sleep upside down. When their flying days are over, hang ‘em in the bat cave, down by your hips, at the side of your body, (and not in your pockets.)

Elizabeth Newton, a psychologist, conducted an experiment on the curse of knowledge while working on her doctorate at Stanford in 1990. She gave one set of people, called “tappers,” a list of commonly known songs from which to choose. Their task was to rap their knuckles on a tabletop to the rhythm of the chosen tune as they thought about it in their heads. A second set of people, called “listeners,” were asked to name the songs.

Before the experiment began, the tappers were asked how often they believed that the listeners would name the songs correctly. On average, the tappers expected listeners to get it right about half the time. In the end, however, listeners guessed only 3 of 120 songs tapped out, or 2.5 percent.

The tappers were astounded. The song was so clear in their minds; how could the listeners not “hear” it in their taps?

That’s a common reaction when experts set out to share their ideas in the business world, too, says Chip Heath, who with his brother, Dan, was a co-author of the 2007 book “Made to Stick: Why Some Ideas Survive and Others Die.” It’s why engineers design products ultimately useful only to other engineers. It’s why managers have trouble convincing the rank and file to adopt new processes. It’s why the advertising world struggles to convey commercial messages to consumers. And it’s why many presenters struggle to plant their ideas deeply in the soil of the listeners’ mind.

Part of the problem for expert speakers is their expert language, the terms that their specialized disciplines develop to speak in short hand. These highly specialized languages confer an identity on the speaker, and many of them are reluctant to relinquish this hard-won identity when speaking to the uninitiated.

Another problem is simple over-familiarity with the terrain. Researchers have been over and over their data and their findings in preparing for publication. It’s hard for them to see it through the eyes of a child, or the eyes of someone new to the terrain.

A parallel from my own experience: I find it difficult to give new friends directions to my home, even though I’ve lived there for 15 years. I’m on automatic pilot everyday as I drive away from and then back toward my house. I don’t pay attention to the names of little roads, or make note of landmarks. I know where I am, but my knowledge is tacit–I struggle to make it explicit.

I often ask scientists I’m working with to prepare a talk explaining their work to 5th Graders. It’s a difficult exercise for them–they make so many assumptions, the most obvious being, “Why are you studying the P54 and why does it have that name?”

They forget they have to start at the beginning. I.e., “Once upon a time, there was a Daddy who got very, very sick. He went to the doctor and….”

And suddenly they’re following the Golden Rule: “Speak to the audience, in the language of the audience, about what’s most important to the audience.”

What could have been an incomprehensible talk in a foreign language has become a story about a heroic effort to save somebody’s Daddy.

Everybody can understand that!

And while this may seem overly simple for expert speakers addressing sophisticated adults, the core truth remains valid. An audience needs to know why they should care about the information they are about to hear–they need to have their emotions (or at least their curiosity) engaged in order to listen.

And then they need clear outlines and headers as they’re led through the material. They need all extraneous information eliminated. And they need a good story line, as the speaker brings drama and suspense to the struggle to overcome obstacles and capitalize on the opportunity.

The word itself comes from the Greek word for tongue (glossa) combined, of course, with the more familiar root word for fear (phobos.)

For those of you who are Jackie Gleason/Ralph Cramden fans, it means, “Hummina, hummina, hummina,” accompanied by an urgent finger inserted between neck and shirt collar, with an audible “Gulp,” at the end.

Glossophobia is a disease to which all of us are susceptible, and is associated with several co-morbidities.

Hyper-Infoitis: The swelling of information in the body of a talk, usually caused by an insecure speaker trying to impress her audience with her expertise.

PowerPointitis: The proliferation of PowerPoint slides, caused by the mistaken belief that a presentation is what the speaker says, and not what the audience can take away.

Oldnewsatoid Syndrome: An illness that causes the speaker to tell the audience what it already knows (common in Medical Education.)

Laser Pointer Obsessive Disorder: The need to clutch, fondle, and wiggle a small, thin, pointed object with a magical little hole in the end from which comes a beam of intense light

Hyper Logorrhea: The tendency for speakers to speak so rapidly that the audience has to conclude that the speaker is brilliant but completely unintelligible.

Uhmatosis: The swelling and swarming of inarticulate groans and pre-verbal utterances that get stuck in the cracks between words and stink up the flow and impact of human speech.

Repetitive Uptalk Illness: Occurring primarily in young females, debilitating to their professionalism and credibility, it corrupts the intonation patterns of their speech so as to make them appear needy of approval, paradoxically earning them disdain.

These are just the first seven co-morbidities associated with glossophobia. Our speech scientists are hard at work diagnosing other illnesses that cascade from this terrible human scourge.

Stay tuned.

As a business speaker, if you are lucky enough to believe in your message, you have a better chance of making others believe—not guaranteed, but a better chance. If you don’t believe in your product, you’ve got to scratch and claw your way into belief. How? How do you hoist yourself into contagious belief? The simplest way is to rehearse.

Find the reasoning. Find the words. Find the attitude. Find the gestures that make you feel connected with yourself and the subject. If you’re not turning yourself on when you talk you’re turning the audience off. I know that when I’m excited about some domestic issue at home, I’m more engaging. If I feel connected to my thoughts and believe wholeheartedly in the power of my reasoning, my demeanor is (if I do say so myself) captivating. My wife and teenage daughter actually listen to me.

My domestic rant may not be the best template for a corporate or scientific presentation, but bear with me. Which is more convincing: a speaker’s conviction or her reasoning? Isn’t that the same as asking which blade in a pair of scissors does the cutting? You need both. Intelligent people will dismiss conviction without clear thinking. And reasoning without an emotional investment by the speaker is busywork—boring, pedantic, and inconsequential to all. You need both—reasoning and conviction.

Rehearsing aloud, you acquire both. And they feed each other. You find words that bring your thoughts to life, and when your thoughts are lively, you grasp them with greater conviction and infuse them with passion. Oliver Wendell Holmes said, “Eloquence is reason set on fire.” Rehearsal can help you find the reason and set it on fire.

So what are the standard excuses that the business presenter makes when she says she can’t or won’t rehearse?

No time! (He’s making slides five minutes before show time, making his performance slide.)
No need! (She’s done the same talk a thousand times; her suit could make it, and often does.)
No sense! (He thinks rehearsal makes him stale. Without it, he’s cooked.)
No standards! (Everybody in her company/industry is mediocre. Why should she be any different?)
No ego! (He doesn’t want to experience the awkwardness and vulnerability of finding his own voice, alone or in front of colleagues. Wimp!)
No show! (She thinks showmanship is unprofessional, which smacks of sour grapes. She’s probably afraid she doesn’t have the gene.)
No guts! (If he doesn’t rehearse, he’ll have an excuse when his talks flab out and fail.)

A good presentation can make a career. A bad one can leave you clinging to the suburbs of success for years to come. Actors get a month; we only get a few days. Let us remember that business without show business is no business. Rehearsal makes our thinking crisper, our language more vivid, and our passion a better ally. Without rehearsal, we have no show. If you have any sense, you’ll rehearse.

For more on what constitutes preparing for important presentations, see Ford Harding’s Blog.

One half is knowledgeable about your area of expertise, while the other half is green.  Or, one half is interested in the science, while the other half is preoccupied with its business application. Or one half of your audience is eager to hear your thoughts, while the other half is not only indifferent, but cynical and disengaged. Remarks you prepare all seem appropriate for one group, but not the other.

What’s the best solution?

First of all, an audience divided in two is probably overly simplistic.  There are those who care about the topic, those who couldn’t care less, and those who are neutral.

Furthermore, certain types of people are most interested in the speaker’s position on the topic and the reasoning supplied to support that position.  Others are more interested in how to execute the idea, and still others on the values and beliefs that are embedded in the stated position.

Generally, when making a proposal, a speaker can expect some listeners to be with him, some opposed, and some to be undecided. As in American politics, there are lefties, righties, and those who vote both ways.

Teachers often say, “Teach to the middle,” suggesting that you can reach the greatest number of students that way.  This also suggests that you are willing to lose the top performers as well as those at the bottom of the class.  It also implies that by appealing to the middle, you follow the Pareto Principle, which says you get 80% of your results from 20% of your effort. 

However, I think we can devise a better solution.  I have worked with many medical researchers who are presenting to venture capitalists and Wall Street analysts in order to raise money for their projects.  The audience in these situations is all over the map in terms of expertise. Some know a little, and some alot. 

In these situations, I have found that it is helpful to think of the problem of a split shot audience as a problem of attention, not comprehension .  And the way to keep attention is to tell a dramatic story and use all the tools available to a good storyteller.

The first step for the speaker is to set the stage.  The speaker needs to describe the current situation in the disease state, the current standard of care, and perhaps a dab of history to describe how the standard evolved.

Next, the speaker needs to describe the unmet medical need, and the suffering, or financial burden, that is the result.  This has to be emotional in tone.  The speaker needs to make the audience feel the suffering and demonstrate his real concern.

Then, the speaker needs to paint the picture of how patients, or providers, or payors would benefit if only this problem would go away. 

And only then, after he has helped the audience to understand the general situation, the terrible problem facing patients and the medical establishment, and painted a picture of what life could be like if only these problems could be overcome–only then does he introduce his new product and tell the story of how it works its wonders in the human body.

In other words, the speaker uses the basic tools of story-telling to make his presentation dramatic.  The basic tools of story-telling are setting, hero, problem, solution, climax, and resolution.

In this way, the skilled speaker engages everyone in the audience because the human mind is hard-wired to think in stories.  We tend to dismiss facts, but we are willing to suspend our disbelief when we hear stories, especially when they resonate with our previously held beliefs.

Furthermore, in my example, the scientific speaker can go into considerable detail if he has set up the story so that his molecule is the hero, riding into town, taking on the bad guys, and putting things right.  Listeners will stay focused because they’re interested in the drama.

And if he is careful to use analogies and metaphors to introduce and sum up complex information, then he will keep the attention of both the experts and the neophytes.  Humor sprinkled throughout can also keep people attentive during the denser parts of the talk.

For example, when I think of a particular cytokine that triggers the cascade of chronic inflamation that we know as rheumatoid arthritis, I often think of Osama bin Laden.  Both remain hidden, unharmed–manipulating levers to cause harm all over the world.  If only we could isolate both of them and knock them out! Then all the misguided minions–men and molecules–would stop inflicting pain on the world, and peace and ease would return to our lives.

Hardly scientific, I know.  But with a vivid and detailed description of how the disease works, it’s ultimately a story about a no-good cytokine–the ring-leader of a violent gang causing pain and suffering, and a heroic little drug who has a plan to get close enough to knock him out once and for all.

Who knows, it might inspire the venture capitalists to remember the pitch, and fund the effort to help the hero.

I asked if the boss knew what he wanted to say, and Derrick said yes, but the talk was not developed yet and he (the boss) wouldn’t have time to devote to it until the weekend.

I asked about the boss. Derrick said he was really smart but not all that experienced speaking to large groups and hard to pin down because he was so busy keeping his eye on the markets.

We set up two meetings. The first to hammer out what the message would be; the second to practice saying it. I asked for a general summary of what would be said. Derrick replied, “He’s going to talk about distressed securities.”

“Is he going to say something unusual about them, or is he going to say something predictable but try to say it well?” I asked.

“By that question, I can tell that you are going to be helpful,” said Derrick, assuring me that I would not see any drafts until I arrived.

When I walked in the door, the receptionist seemed to be expecting me. She jumped up and escorted me into a meeting room off the lobby.

Derrick arrived like clock-work. He handed me his business card, made from the thickest card stock I’ve ever felt. I enthused over the feel of his card. He seemed to enjoy that. It broke the ice.

He briefed me on the status of the script and slides (a work in progress) and then in came his boss, backing into the room as he spoke to an assistant down the hall.

Peter was small and intense, with long hair and granny glasses. If Derrick was natty and professional, Peter was rumpled and professorial. Derrick excused himself immediately and closed the door as he left.

Peter had a handful of wrinkled papers in his hand. They were his notes. He did not know how to connect his computer to the projector, or how to use PowerPoint well enough to re-sequence the slides.

However, his knowledge of distressed securities was encyclopedic and his speech was supersonic. He had so many thoughts stampeding from his mind to his mouth that they got stuck on his tongue and toppled over each other.

Hummingbirds beat their wings 15 to 80 times per second, depending on the species. If a hummingbird could speak, that’s how fast Peter talked.

When I asked questions about his meaning to help him clarify what he wanted to say and in what order, he was wonderfully patient with my modest understanding of his discipline, and used analogies and metaphors to explain his point—a sign, I think, of a good communicator.

In addition to speaking like a hummingbird, he did not look me in the eye, and did not relate what he said to the bar charts on the screen. But he spoke with visceral passion and emphatic verve about the coming crisis in corporate debt—and that made up for his other sins as a speaker. He could lift up his whole body and jump into a key word with both feet–giving it real meaning and significance.

When our rehearsal led him to a new thought, he leaned over the conference table, pawing through his wrinkled pages, and jotted  words on a spare corner of the paper.

He was trying to say that the imminent credit crunch would not be like past credit crunches, due to recent care-free lending practices. In fact, due to covenant-light loans, and CCC loans, he argued, we would not get early warning signs of trouble: we would be in the middle of the crisis all at once.

The challenge was to build the story so that the audience would think they were hearing a standard pitch about the potential attractive opportunities in distressed debt, and then yank the tablecloth out from under the meal spread before them to reveal something entirely new and terrifying.

After two meetings, we had cut the slides down to six and the timing down to less than ten minutes. He had no time to rehearse. He promised he would work on it in his hotel room when he arrived at the capital intro. I continued to e-mail suggestions to his Blackberry over the weekend.

I learned from Peter that he did not rehearse until he was on the plane, and then he stayed up most of the night in a panic working on it.

Two days after the event, he called to say it went well, and that my messages had helped. I called Derrick to get his assessment, who said it was a little short—much shorter than the presentations made by other speakers. I pointed out that’s not necessarily a bad thing.

As Mrs. Hubert Humphrey said to her husband after a particularly long stem-winder, “Hubert, for a speech to be immortal, it need not be interminable.”

The question will be whether Peter can:
1. Get attention at capital intros.
2. Keep attention
3. Make a clear point in a memorable way
4. Stand out in a crowded field
5. Move people to come talk with him.

That’s it. He doesn’t have to sell the fund, or close the deal. His job is to generate trust and curiosity.

I read of a double-blind study of hotel chambermaids in Paris who were trying to lose weight. One arm of the study was given a real weight-loss product; another arm received a placebo; and a third was told that the work they did in cleaning the rooms was strenuous and burned a lot of calories. The third group lost the most weight.

While medical science continues to debate its causes, there is wide agreement that the placebo effect can also be caused by the attention of doctors and nurses. It is thought that the touching, caring, attention, and other interpersonal communication that is part of the therapeutic setting, along with the hopefulness and encouragement provided by the medical professionals, affect the mood, expectations, and beliefs of the patient, which in turn trigger physical changes such as release of endorphins.

This leads to an interesting parallel with presenting. If we approach an audience as a doctor would a patient; if we diagnose the problem that the audience faces, and prescribe a solution to their difficulty, could we not stimulate the placebo effect?

This would mean that our message would have to be audience-centric. We might not be able to ask the audience questions then and there, but we could describe what we know of their situation, and then, if we gain their agreement that the description is fair and accurate, we could then ask a rhetorical question, such as, “Given that you face these difficulties, what would be the best solution?”

At that point, we are, in essence, thinking aloud about their problem. Of course, we have composed and rehearsed our thoughts. But all our attention is on them as we explore various avenues forward, and because of that, all their attention is on us–the speaker.

And if, like a good doctor or nurse, we lean forward, and express caring and concern in our demeanor and voice, might we be able to trigger the placebo effect?

Yes, yes, I think so. We could have neurochemical impact! Endorphins would flood their bloodstream.

We wouldn’t be talking about ourselves, our companies, our products, our plans. We wouldn’t be doing data dumps. We wouldn’t be talking at them about US! We would be talking with them about them.

And as a result, we would appeal to them, not only intellectually and emotionally, but ethically and chemically as well. They would walk out singing our praises–high on the placebo effect.

And here’s the paradox. Our self-interest is served when we’re more interested in them and their issues than we are in ourselves and our information.

Of course, the body of our presentation would contain all the information we have to impart, but if we frame it around their concerns, we are focused on them, not us.

That’s not bedside manner. That’s platform skill at its greatest.

Below, I have listed what I believe are the sentiments, concerns, and judgments of the average well-informed person who is concerned about the state of health care in the U.S.

I list these in no particular order for the purpose of helping all of us who work in pharma, and all who can help the industry, sort through what is true and false, what is relevant and what is not.

1. Pharma’s profits are too high. They hover around 3 times higher than the median for all other industries.

2. Despite these profits, which Pharma claims it needs for drug development, the number of new drugs approved by the FDA is less than half what it was ten years ago, and only 14% of the drugs approved between 1998 and 2003 were new molecular entities likely to be improvements over older drugs.

3. With the number of new drugs cut in half, sales and marketing budgets have grown to twice the budget for R&D.

4. During the 90s, when there were more new drugs, price increases were at one times the CPI. In 2003, they were 2.5 time the CPI.

5. To promote its me-too drugs in over-crowded therapeutic areas, it has tripled the number of reps in ten years. Genentech Chief Arthur Levinson says, “If you are developing novel drugs, you don’t need sales forces of tens of thousands.”

6. The credibility of the value/price ratio has been eroded. Is a cancer drug that extends life for four months worth $30 to $40 thousand dollars? Furthermore, consumers don’t understand the difference in cost between generics and brands, or between in-country and out of country prices.

7. Spending on Phase IV trials designed for marketing purposes is up 90% in four years. More spending designed to find some minor advantage for a me-too product.

8. Yet two-thirds of the post-marketing trials required by the FDA have yet to be initiated.

9. Pharma is disease mongering. Prescriptions for sleeping pills are up 45% in 5 years, yet there have been no reports of an epidemic of insomnia.

10. Respected journals hint that Pharma corrupts science. When pharma undertakes head to head trials with competitive compounds, more often than not the trials come out in favor of the sponsor’s drug.

11. Pharma corrupts Congress. Pharma has the largest lobby in Washington DC. There are more pharma lobbyists there than members of congress. And you know how voters feel about lobbyists.

12. Pharma is responsible for a large percentage of medical errors. There are an estimated 120,000 deaths per year in the U.S. due to adverse drug reactions.

13. Some see Pharma as heartless because it failed to provide assistance to Africa until it was forced to do so.

14. It is widely believed that doctors are influenced to put medicines in our bodies because Pharma supplies them with golf outings, dinners, honoraria, and meetings in resort locations.

As a result of all these charges, the top ten pharmaceutical companies have lost $30 billion in market value and the industry is rated as trustworthy as big Oil and big Tobacco.

Those of us who work in the industry, or who support it,  find ourselves trying to defend it. We would like to know the facts, and we would like to feel good about our industry.

I offer these charges as an opportunity for dialogue and education. I do not assume they are true. I have gathered them from public sources and look forward to gaining greater clarity from the discussion.