Most Big Pharma companies are functionally integrated. They have traditional hierarchies, with executive vice presidents in each main area -- R&D, sales, marketing, manufacturing, administration, and human resources. These same companies have been mostly responsible for the "blockbuster" drugs, products generating at least $1 billion in sales. The largest pharmaceutical company in the world, Pfizer, is currently organized by functional area.

The marketing in these companies is aggressive and increasingly directed at the consumer. An important component of marketing strategy is to expand the reach of a successful drug -- obtain approval for new indications, create combination formulas with other drugs to extend the patent protection period, or create new dosage and delivery mechanisms. The underlying purpose is to sell the product to as many patients as possible. Sales forces are aggressive, competitive, and highly polished. The culture of these marketing-driven organizations reflects their primary business model. Marketing people get involved early in product development teams and influence what products do come to market.

The crisis brought on by the near-demise of the Cox-2 inhibitors highlights the larger problem with mass-marketed drugs. In April 2005, Pfizer announced a major restructuring, which should yield savings in operations of several billion dollars over the next few years. Later in 2005, Pfizer announced it would not reduce its massive sales force, suggesting that the existing force will have to be re-deployed to create more value per rep. At mid-decade, traditional Big Pharma sales forces are being slowly transitioned into forces that promote drugs that are targeted at smaller patient populations and with a narrower profile of approved indications -- in other words, into specialty reps.

The specialty business unit organization

Many biotech companies and some Big Pharma ones (e.g., Johnson & Johnson, Novartis, Genzyme) have organized their pharmaceutical units around therapeutic specialty areas, each with their own sales forces and profit centers. Essentially the "Oncology Group" or the "Respiratory Therapy Group" are mini-businesses, and sales reps focus only on products in their group. In such cases, target patient groups are substantially smaller than for the mass-marketed drugs. Here, the group has the feel of a small business, and there is a greater chance to learn about all aspects of launching a drug faster than in a traditional company.

In rare diseases with small patient groups, the sales rep takes on a more nuanced role, serving more of a medical information consultant than as a sales agent. Over time, the rep becomes part of the extended team of caregivers and even gets to know patients themselves. Such a culture is more collaborative, less overtly aggressive, and places a greater premium on building and maintaining relationships. Make no mistake, the company will still set sales goals and expect its field force to meet them, but there is a more personal feel to the job.