Are Key Opinion Leaders Expensive Sales Reps?
35 CommentsBy Ed Silverman // June 20th, 2008 // 11:11 am
That’s the provocative question posed by BMJ, which examines some of the methods used to make use of high-profile academics who are billed as independent experts. BMJ’s answer: yes.
To make its point, there’s an interview with Kimberly Elliott, a former sales rep for 18 years for Novartis and others. “Key opinion leaders were salespeople for us, and we would routinely measure the return on our investment, by tracking prescriptions before and after their presentations,” she tells BMJ. “If that speaker didn’t make the impact the company was looking for, then you wouldn’t invite them back.” (Click here to watch the video).
Part of her job was developing relationships with local and national opinion leaders, and she would pay them $2,500 for a single lecture, which was largely based on slides supplied by her employer. Sometimes, the drugmaker would pay the fee to an academic center, which would then pay the doc. “These people are paid a lot of money to say what they say,” she tells BMJ. “I’m not saying the key opinion leaders are bad, but they are salespeople just like the sales representatives are.”
Meanwhile, Richard Tiner, the medical director at the Association of the British Pharmaceutical Industry, agrees that key opinion leaders play an important role. “Companies will employ consultants to help advise on marketing strategies…and present and speak at conferences,” he tells BMJ. “When these people are receiving a fee, they are in one sense in the employment of the company.”
So how do docs with long-term financial arrangements with drugmakers maintain independence? Tiner tells BMJ the key opinion leaders, or KOLs, are “free to speak about other medicines” and their presentations at influential medical meetings are “often quite balanced…I don’t think they are bribes. It’s payment for work done, rather than a bribe.” He agreed, however, that the work “might help to promote a particular medicine.”
Recent market research reports on how drugmakers identify, recruit, train, and pay their KOLs state that influential docs can earn up to $400 an hour, BMJ writes. A publicly available summary of one report shows that some docs can earn more than $25 000 a year in advisory fees. A press release from Cutting Edge, which sells the reports, suggests the average fee for a “scientific speech” is more than $3,000. Typically, these speeches are delivered at educational events sponsored by companies.
The BMA tells BMJ that,although it might have had agreed fees for its members to be paid as key opinion leaders in the past, it had not happened recently. The association’s fee guidance schedule, however, suggests members may charge drug companies more than $400 hour to participate in clinical trials. Although many docs keep the money, BMJ notes some donate fees to charities or research.
BMJ goes on to write that drugmakers keep KOL databases. One firm offers special web based software to measure the return on investment on KOLs. Why go to such lengths? Elliott offers her take: “There are a lot of physicians who don’t believe what we as drug representatives say. If we have a KOL (key opinion leader) stand in front of them and say the same thing, they believe it.”
Dan
Many doctors who choose to speak for a pharmaceutical company do so as a favor for the rep along with the honoraria they will receive for the presentation.
In my experience, the doctors who spoke for me at programs did not sell my product directly, but more spoke of the disease state and the class of medication for which my product belonged in such a class.
Typically, the rate was 1500 dollars for maybe a 10 or 15 minute presentation. And we as reps were coerced to conduct such speaker programs in order to exhaust our speaking budgets. So the reps, including myself, were quite apathetic on the whole process, as we believed such programs were largely ineffective as far as our business goes.
That’s my take on the subject, though.
Jack2
Isn’t there a distinction between a KOL and a speaker? I’m not certain, but it seems like the BMJ is saying KOL but means speaker.
JR
Sales reps are expensive sales reps.
Think about it for a minute.
Susan G
I am on the research side and they usually are in it for the money….sad but true. They want the notariety but are poor performers and need to be watched carefully since they think their status as KOL supercedes the federal regulations. It is about time that the public knew.
Sul
I’m glad her concience finally got to her after 18 years in the industry and winning numerous awards (and expensive trips I assume)…hypocrite.
KOLs are national thought leaders in a disease state, research, clinical practice and the majority of them are good physicians with the patient’s needs always in mind. They hold credibility and garner repsect for what they have to say. I don’t believe the vast majority would “sell” a product they didn’t believe had a legitimate place in their practice. This “lady” made me mad…
Sul
and you can talk about “there only in it for the money”…but many doc’s don’t make nearly what they used to years ago either…not that I’m crying for them that much. What would anyone else charge for leading a discussion or presentation within the realm of their expertise?
Doc
The current legal review of this situation is as follows.
MDs that are paid to speak at PROMOTIONAL programs are supposed to use promotional slide decks provided by the company. These are supposed to be on-label only. The speaker may respond to unsolicited off-label questions, but is then supposed to go back to the on-label deck. These are NOT CME programs, they fall under different legal considerations.
So if it is promotional program, the MD may very well sound like a rep- since they are using company provided decks.
Dr. Sal Giorgianni
There appears to be an underlying presumption that when a physician, pharmacist, nurse or other KOL speaks well of a product they are not telling the truth? That it is improper for them to provide positive information. And somehow taking money to spend the time and expertese to do so in “smarmy”.
Most products are good products and do provide benefit. True, some KOLs go a bit overboard but they are not presenting the information to dolts. They are presenting it to a peer group, usually doctorally educated and experienced in their own right.
So, in the not so rare occasion when a speker becomes a bit overentheusiastic about what they are speaking about the audience almost always (at least I do when I go to these things) can tell, just like we all can discern an over-the-top claim for any product or service.
Yes, I know the situation is a bit more complex than this. Yes, I fully understand the psychology of it all. Yes, I do understand that MDs, PharmDs, NPs, RNs PAs are all subject to influence. I simply want to remind folks here on Pharmalot that we who practice are not that gulable or dumb and we do like to keep the interests of the public at heart and we are not looking to use substandard products in inappropiate ways.
Former pharma Marketing Exec
Dr.Giorgianni,
Very well stated. It speaks to the point I was making on another post. There is nothing wrong with hiring a KOL to present these findings to their peers and using company provided slides in a non CME setting doesn’t harm anyone. It is always up to the KOL presenting to make sure they have all the facts straight and speaking from their own experience and expertise. If not, they run the risk of ruining their reputation by being seen as the “mouthpiece” for the company. It takes good skill and talent to walk the fine line.
Obviously ROI for these engagements is watched fairly closely, otherwise how would a budget for these functions be approved? So, yes, the KOL in this instance generates the same interest of measurable metrics as the rep does. It starts with who agrees to show up to the event, which hopefully gets translated into drug scripts in the near future.
Personally, when I was out in the field, I really didn’t want a KOL to be overly enthusiastic about my drug without the proprer data to back it because it harmed my credibility as much as their own. It gets time consuming to develop another KOL…..
CMC guy
Dr. Giorgianni thank you for your well expressed comments as there seems to be a prevalence of “guilty until proven innocent” relative to potential pharma conflicts of interest. To deal with issues there needs to interaction across many levels between MDs/Health providers, Industry, Academia and even Regulatory agencies. Rules and monitoring are required to prevent abuse but if place extreme barriers then progress and information exchange will be even harder.
BP MD
There are a number of different types of sessions that an MD outside of the company can get involved in. Promotional speakers are just that - using the company provided slide deck to promote the compound. They are “developed” by the company and “trained” on the deck. They are not to stray off-label, but unfortunately sometimes do and are even encouraged to do so. It is not a good thing if they are mcaught.They may be regional KOLs, but are not commonly national KOLs.
A CME event is usually run by an agency and features more prominet national KOLs presenting their own talks. These events are sponsored by the companies, but they are not to get involved at all in what is presented. Unfortunately, sometimes they just can’t help themselves and will stick their hands into it. Again, not a good thing if they get caught.
Doc
The bigger issue with promotional speakers is who is selected. The legal, correct way is to select MDs that have knowledge, experience that gives them insight into the product use. The companies are supposed to use this type of screening to select ‘KOLs’. The sad truth is that most companies choose their ‘KOLs’ based on product or class Rx volume. There is often an implied qid pro quo for payment and the continued use and high Rx share of said companies product. Sad but true.
Jack2
You make a great point Doc.
On the flip side you want to use a speaker who has substantial experience with your product. One of the biggest values they bring (from both a marketing perspective and a clinical education perspective) is there personal observation with the product outside of a clinical trial. That’s something, not just reps, but even the company’s docs/MSLs probably can’t offer. So it’s sort of a circle that you choose people who use your product.
I think the best control comes from ensuring a fair (but not excessive) compensation. Of course, that’s easier said then done, and the devils in the details.
Dr. Sal Giorgianni
Doc, with all due respects, who should the company select to speak: a) someone who uses and is satisfied with a product,b) someone who has never used the product or, c) someone who has used and hates the product? Surely, if I (our you) were selling the product you would select a)–and I bet every Dr. in the audience understands that. You can bet that the competition is likely to select one from item c)–and I bet every Dr. in the audience understands that.
As to quid pro quo…I believe you are putting the speaking cart before the prescribing horse, so to speak. And, besides, who would you like to take advice from or what type of neurosurgeon would you like to consult with; one who with a lot of experience or someone just out of training? In that regard Jack2’s point is one that I share.
Professionals are Learned Intermediaries…the system for all its good and bad points is set up that way. Your fellow professionals out there are not stupid and if they take presentations from ANY speaker, regardless of who is funding them or what the nature of their involvement with the subject matter is without careful thought and circumspection they are not being dilligent.
Justice in MI
I guess I am once again compelled to look at things from the other side of the looking glass.
In a field that has nothing to do with pharma, I happen to be the “guy who wrote the textbook.” That is, if this field had “KOLs,” I would be it.
But if I were approached by a publisher to endorse a book or related and paid for it, I would not begin to consider it. Yes, I write reviews - both positive and negative. I occasionally provide “blurbs” for back covers. But no money changes hands for any of this. If it did, it would be scuzzy on the face of it; not even a doubt by others in the field.
It is not about what this or that individual is or does. It is about what is considered appropriate practice.
My other field is not prudish or squeamish. It is pretty much the norm in academia that you just don’t pay for blurbs or good reviews of _whatever_ “product.”
So I continue to feel that the pharma/KOL system is in a world of its own. It may be that we all decide this is fine. But to consider it “normal” is to engage in delusion.
It at least deserves reflection.
Anon
If I am a patient presenting to one of these physicians after the KOL has done his thing in our area, I want the treatment that is best for my condition and situation. But academic research and sales metrics show that I am more likely to get the drug that the KOL pushed. How is that fair to me?!
C Phrms Res III
I have been working inside for big phrma for well over 15 years now. Doc and Jack2 have things just about correct and raise some really good issues. Dr. Sal and former big cheese marketing exec miss just about everything.
Fundamentally yes it is appropriate for physicians to speak on behalf of a company and a product, and yes they can get paid for it and yes it is fair to choose someone who understands the products. So the Phrma-can-do-no-wrong crowd throws those arguments around once again like someone is actually trying to undercut that. But I don’t see anyone trying to do that. It’s about the details. So let’s look at that.
While physicians should be able to get paid for promotional events, they and the companies they are speaking for should be more transparent about both (1) the nature of the program and (2) the speaker’s overall compensation. Let’s look at both issues:
(1) The Nature of the Program
When physicians get paid to speak for a company on a product, they are agents of the company for those purposes. Thus, as Doc stated correctly their presentation must stay consistent with the product labeling. But in addition the audience should understand that they are participating in a promotional event where all of the messaging is about a single product. All too often, companies including my own try very hard to dress it up to make it look like CME when it’s not. Speakers bureau’s have all sorts of fancy names and often the speaker decks are branded with logos and the like that make them look like CME programs. And that’s just inherently misleading because they might believe that they are hearing a broader presentation about a disease state where various options will be discussed.
(2) Overall Compensation
While I absolutely agree that a speaker can get paid to speak for a product and remain unbiased in his or her treatment decisions, when the physician does 35 programs a year and consults on top of that for a total of $200k or $300k or more etc etc, then I think people can fairly start to question it. I personally don’t believe that we should just assume a conflict. I certainly don’t. But at a minimum why aren’t the companies and their speakers more prepared to be transparent. Why do we need the Physician Sunshine Act from Congress to bring that transparency. If it is all so defensible (as Dr Sal and big cheese Pharma Exec argue) then why will it take the force of law before folks are prepared to be more transparent about the numbers. As Jack2 said, the devil really is in the details.
When the numbers get large, then people have a right to know that. If my mother had acute coronary syndrome and was going to see a cardiologist, then I think I would be interested to know if that cardiologist makes $250,000 a year in speaking fees for a stent maker and another $250,000 for a drug company. Would it change my decisions, I don’t know, but I think I’d like to have the information.
(3) Speaker Selection
There was another very interesting point addressed by some of the posts, so let’s look at speaker selection. As I agreed above, of course it is fair to select speakers who understand and even support the use of the product. Who on earth is going to want to hire someone who hates the product. That is just a silly and ridiculous conversation and it’s a red hering. The issue is the extent to which use of the product was relied on in making the selection. In other words, was the speaker’s familiarity with the product one of the many factors considered — in addition to his or her expertise, reputation and communication skills — or was it the sole factor. In the latter case, the speaker money is just used as a relationship builder and nothing more. The sad thing is that at most companies and on most large brands you end up with a few speakers who were selected because of their skills and expertise and many hundred others who were selected because of their prescribing. And that’s wrong. Again, the devil is in the details.
Conclusion
It’s easy to say things like “physicians should not be presumed guilty” and “companies have the right to promote their excellent products.” Of course those things are true. The question is: what would you find if there was complete transparency? What would it look like if everyone knew how many hundred and in some cases thousands of speakers companies pay to promote a single brand? What would it look like if patients could see what their own physicians were making from these promotional and consulting engagements in total? The fact is that the physicians are fighting the Sunshine Act more than phrma. They know they can’t defend the kind of money they make from these events in open light and they want to stay on the money train as long as possible.
It is sad because there are some great programs and excellent speakers — speakers who were selected because of both their expertise and their understanding of the product. And there are companies and speakers who work diligently to keep these relationships within fair financial limits that ultimately will be defensible. But there are companies and speakers whose actions cannot be defended. This includes speakers selected for one reason and one reason only — their prescribing. And it includes many companies which simply refuse to exercise restraint, hiring thousands of speakers who can make enormous amounts of money. These actions cannot be defended and these folks know it.
It is sad that in a country with so many issues, we are forced into a situation where the issue must be addressed by law. Phrma has a chance to step up and show some leadership here and it is failing once again. If promotional speaking engagements and consulting arrangements as presently employed can be defended then phrma should step up and adopt transparency on a voluntary basis. Maybe there is no devil in the details. Let’s see the data.
Matthew Holford
“When these people are receiving a fee, they are in one sense in the employment of the company.”
I wonder what sense he meant? The sense whereby the individual is beholden to the company; as in “whoever pays the piper”?
Anyway, this is about information laundering, unless I misunderstand the discussion. Good information, being disseminated by objective KOLs, is in everybody’s interests. However, shite information, being disseminated by charlatans is only in the interests of the Worshipful Company. Guess what the beef’s about?
Matt
Robyn
C Phrms Res III, some data was provided by MA Bowman and DL Pearle in J Contin Educ Health Prof 1988; 8(1):13-20. This from their abstract:
“In order to determine the impact of commercial company funding of continuing medical education (CME) courses, a survey was undertaken. Drug prescribing rates for drugs related to course content were determined by self-report survey of physician attendees (374 in number) for three different CME courses. The survey was performed immediately before and six months after the courses. A single, though different, drug company provided the majority of the funding for each course. Courses I and III were related to calcium channel blockers and Course II to beta blockers… While the rates for prescribing some of the related drugs increased after the courses, overall the sponsoring drug company’s products were favored.”
Jane
According to this article http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0040150&ct=1&SESSID=adc44b4a24ff8ba99ef4cc3935bf56c9 the only qualification for a doctor to be choosen as a speaker is “skeptical”. “Good details are dynamic; the best reps tailor their messages constantly according to their client’s reaction. A friendly physician makes the rep’s job easy, because the rep can use the “friendship” to request favors, in the form of prescriptions. Physicians who view the relationship as a straightforward goods-for-prescriptions exchange are dealt with in a businesslike manner. Skeptical doctors who favor evidence over charm are approached respectfully, supplied with reprints from the medical literature, and wooed as teachers. Physicians who refuse to see reps are detailed by proxy; their staff is dined and flattered in hopes that they will act as emissaries for a rep’s messages. (See Table 1 for specific tactics used to manipulate physicians.)”
truthman30
Of course they are “expensive sales reps” ..
They are glorified Sales reps under the guise of “independent opinion”..
Dr. Sal Giorgianni
When Justice suggested that the world of medical marketing may be a different world he is, I believe, correct. This view is based on the notion that in this conversation we are talking about peer-to-peer discourse.
I do take exception to the notion that I am an industry apologist. I did not say, nor have I in any of my blogs, suggested that PhARMA or BIO is pristine or at times wise or even plain old smart. I believe there are just as many poor judgments by the human beings in this industry as there are in the academic industry.
I have argued innumerable times in many venues for complete transparency.
In the matter of information dissemination I will not step away from what I firmly believe is true and a fundamental sound principle. Learned Intermediaries, regardless of who is presenting information, have an absolute obligation to review data and opinions critically.
I have spent a good time studying conflict of interest issues over my several decades in “The Biz”. I have seen many examples of fudged, inflated, poorly interrupted data and erroneous, self-edifying and self-promoting papers and presentations by academicians who are working in a way that is completely unaffiliated with any for-profit commercial supporter. Certainly anyone who has sat on or had dealings with university credentialing, IRB and promotion & tenure committees should understand this. There is a LOT of bad stuff out there. Academicians, government scientists and all manner of people can, and do, all manner of “bad” things. The pressures of funding, tenure, salary and, yes, plain old ego have the same potential to corrupt as PhARMA dollars. Yet, I have not heard anyone here, particularly those who have experience in biomedical research, suggest that there are any corrupting influences out there except corporate dollars.
I do not believe the world of science is a cesspool populated by charlatans. On the contrary, it is populated by earnest, honest and intelligent human beings. There are of course charlatans sporadically mixed in all sectors of the scientific community.
Learned Intermediaries have the obligation to view every presentation with healthy skepticism and with the idea that every paper, every platform presentation, every poster benefits someone or group in the for-profit or non-profit industries.
Jane
Sal,”I have spent a good time studying conflict of interest issues over my several decades in “The Biz”. I have seen many examples of fudged, inflated, poorly interrupted data and erroneous, self-edifying and self-promoting papers and presentations by academicians who are working in a way that is completely unaffiliated with any for-profit commercial supporter.” What exactly have you done about this?
Dr. Sal Giorgianni
Ms. Jane.
“What have I done about it?” that is a reasonable question which - within the limits of an informal, impersonal blog - deserves a reasonable, if not somewhat long and, what may sound to some here, to be a rather pompous answer. But here goes.
Please do not think it is a Holier-Than-Thou approach to my missive here; though I suppose it sounds that way. I do what I can, as forcefully and directly as I can whenever I can. I believe that is my professional ethical obligation as part of my duty to protect and serve the health of the public (and being a feisty, Italian, former-Columbia University grad and academician from NYC I suppose it is in my nature).
I would note at this juncture that I have long felt that earning a doctoral level degree gives you two things (no, not a better table in a restaurant-usually quite the opposite since most servers consider “doctors” poor tippers): a membership card into the Grand Debating Society of your profession and; two the privilege of being challenged, cut-to-ribbons (verbally of course) and second guessed by folks at least as smart as you (or in my cases much smarter) and at least as self-assured as you (or in my case, maybe). It is a privilege to be able to stand in a room full of learned women and men and have earned the courtesy of being heard and having your thoughts and questions given due consideration. It is a privilege to be able to present your work and to defend it. Yet, sadly, I believe in today’s environment few Learned Intermediaries exercise their membership privileges. It takes time and thought and sweat and a large amount of willingness to expose yourself to like criticism. For many new (last 20 years or so) health care professionals, that is not “their thing”. I believe part of the problem is professional education, which has become increasingly technical, partly the overall shift in American society, part the process of remuneration, patronage and promotion that exists in most organizations, in part just plain intellectual laziness.
Now, setting the stage, what responsibility have I taken on in the matter at hand? It depends on circumstances of course. In some cases nothing but a letter or question or my personal dismissal of the material was all that could be done or that I chose to do. In some cases, I was in a position to try (sometimes successfully, sometimes not) to rectify the matter. In some cases too, and this is one of the gray areas, my learned opinion was at variance with those of other equally or more learned individuals and I was quite quickly and summarily overruled and/or cut to ribbons. Sometimes I was a dope to bring it up and was rightfully put down, sometimes I prevailed – and hope that I was more-right than the others. (Yes, indeed, Virginia, experts do differ in opinions – and that is a great thing for the public).
I believe that by in large the professional communities have become intellectually lazy and apathetic to their obligation to “Read The Label” and the literature and to exercise their membership in their debating club and engage in active scientific thought and debate. More active participation by a larger part of the biomedical scientific communities will not stop all abuses but I do think that it will go a long way to make the persons who should be helping consumers make the best informed decisions about their care better informed.
I could write much more on this and related topics but it is Saturday. My dear family needs some attention, I promised myself I would paint something pretty today and, regrettably, I fear that I will not change too many minds on either side of this polarized argument. Have a pleasant weekend all.
Margaret
I had two children with manic depression (Gasp, a non-Phrma here!) Now I have one; the other having been killed by Zyprexa. How many of you know “shills” for Zyprexa of any sort? And my remaining child almost died from suicidality having been given a strongly-supported Lamictal promoted by her then-doctor who was on the “Glaxo Lamictal Board”.
There is a lot of talk within these comments of ethics, money-making, and lies. Next time you go to support hyper-drug promoters, just making ends meet by promoting whatever drug, keep my children in mind.
HorusCat
The current legal review of this situation is as follows.
MDs that are paid to speak at PROMOTIONAL programs are supposed to use promotional slide decks provided by the company. These are supposed to be on-label only. The speaker may respond to unsolicited off-label questions, but is then supposed to go back to the on-label deck. These are NOT CME programs, they fall under different legal considerations.
So if it is promotional program, the MD may very well sound like a rep- since they are using company provided decks.
Doc,
Of course the reason for using a company-provided deck is to avoid another Neurontin incident. The company decks have been vetted by lawyers–precisely to avoid over-the-top claims, off-label stuff and to ensure that fair-balance slides are covered (side effects, warnings, black box stuff). It is not ideal, since most docs have seen the material and it’s kind of boring.
I just had a KOL in for several talks–he was careful to point out that his experience over time with my product has led to his using it only as a last resort to having it be one of several he considers early in treatment. He didn’t make outlandish claims–he offered rationales for why he chooses different meds in different people, and he talked about my competitors. This was a win for me because most docs aren’t even considering my med as a last resort–they aren’t in the habit of thinking of it. For a respected academic and clinician to say that his experience has led him to CONSIDER it early in treatment is meaningful to my physicians.
I don’t think using a KOL in this way is wrong. This is not a me-too med in a disease state that is easily treated by generics. A significant population of patients remain refractory even to all the meds we have and non-medication interventions, and they are debilitated by the disease, not just inconvenienced. We can hope that successful sales of this drug and its competitors will lead to further R&D in the area. That is pharma and medicine working together to bring relief to a group of patients who before the advent of medication were considered possessed, wicked, retarded or worse.
HorusCat
Dr. Sal,
What are you painting? Enjoy it and your children. No, I fear not many minds will be changed. I enjoy the back and forth with you, Justice, Just a Thought, Nathan and a few others, but I am finding that often, I leave this site feeling like I need a shower to wash off the spit others have flung upon me.
I spend time here and I start to believe that the world hates us and no one benefits from pharma. Then I go out and do my job and live my life, and I remember that medicine is where it is in enormous part due to pharmaceuticals. I can think of few areas of medicine where physcians could do anything if they didn’t have pharmaceuticals at their disposal. Even surgeons have to have anesthetics and pain relievers. And I remind myself that the pharma-haters will turn to the industry if they get cancer or have a stroke or an MI–never thinking of their spiteful explosions on this site.
For this reason, I have decided to quit visiting. What I gain from the reasoned arguments from people like Justice and Jaynesday is not enough to outweigh the malevolence that predominates.
Take care, Sal, and feel free to email me at cathorus@yahoo.com. I suspect we have many experiences in common, since if I am not mistaken you used to work (and perhaps still do) for Big Blue.
God bless.
Doc
Dr. Sal et al,
After 30 years in pharma sales and mktg, I understand you want someone with experience doing your programs, however - there are WAY too many joe average FPs, IMs, etc that speak because of their RX share. These MDs on average know no more than the MDs that attend for the meal.
Promotional speakers are technically agents of the company they have signed a contract with, hence as has been pointed out, they must abide by what is essentially an “electronic detail aid”, called a slide deck.
Say what you want but the current system is heavily slanted to reward high prescribing MDs with honorariums.
Why not have true KOLs from academic centers that have a breadth of experience with many agents. Most, but no all of these speakers are somewhat concerned with their credibility and reputation. They will typically give a more balanced presentation.
As for the attendees to such programs being objective - no argument from me, but to think that these programs have no or little impact flys in the face of the millions of dollars pharma spends on them every year.
The current system is broken, it will be fixed after more credibility is lost, unfortunately.
Dr. Sal Giorgianni
Doc
You make an excellent point about the most dignified, experienced and unimpeachable researchers and speakers not being as active as they used to be.
But, truly, can you blame them? They are honorable women and men. They have feelings. And unfortunately much of the venom that has been spewed about in this blog thread many times gets directed at them and this gets to them. They do take this very personally. They are made to feel that they are bad people selling their souls to corporate greed, so more and more of THE BEST speakers decline in ever increasing numbers.
So unfortunately, the system was broken but the very people who are asking for opinions of the best speakers. These professors do not mind engaging peers in spirited scientific debate, they know how to engage this and it is in their blood. But they do not know how to deal with the types of accusations, condemnations and vilifications that heretofore have been reserved for only evil convicted wrongdoers in our society.
A fair question to ask at this juncture is, “Why don’t these Best Sources just go out and speak for free?” They do, at major national or international scientific meetings, but not every clinician can be there to hear, and most do not like to spend time reading the proceedings, for many reasons, and getting things published in the main-stream medical media is very difficult. So much good information goes by the boards and unheard on the Main-Streets-Of-Medical-Practice.
It is a dilemma that the cynical public, and ultra cynical health professionals, have brought upon themselves. I do not have the true answer but I do believe part of the answer lies in civility.
henry
Biederman of Harvard and Mass General was a KOL. he was involved in paxil studies and bipolar studies. Recently it was revealed he didn’t disclose important financial information.
He may be a brilliant MD and clinical researcher but his motives have to be questioned considering the amount of money he received from the drug companies.
Justice in MI
Dr. Sal writes: “Yet, I have not heard anyone here, particularly those who have experience in biomedical research, suggest that there are any corrupting influences out there except corporate dollars”
I think I’ve made this point a number of times, but there are a lot of posts, so I am not surprised if it was missed. Indeed, as I’ve also said, I don’t think the average level of integrity is different in academia than in pharma. Probably lower. The search for prestige, promotion, and a variety of perks not translated into dollars are certainly as potential “COIs” as moolah.
In the long run, it boils down to whether we draw the line somewhere in the sand or just get out of the desert. There have been many reasonable sounding ways to oversee the KOL biz - full transparency, some limit if the docs are also receiving an academic salary (Harvard model), etc..
I am willing to leave open the possibility that these sorts of requirements will preserve a worthwhile source of info for some number of docs. Particularly, if the program being presented has been preapproved by the AMA and the local state medical association.
Still, I cannot let go of the possibility that a doc’s obligations to science and to healing may not be consonant with his her being on the payroll of this or that company. It goes back to the survey discussed on another thread. If I learned (I would not have the wherewithal to ask) that a doc was rx’ing me a drug for which he/she was also a KOL, I probably would not take it. This is obviously too bad - it might be the absolutely ideal med for whatever condition. But I have learned too well and too often how things work in practice. Personally, I would take the risk of an independent opinion and choosing a different drug.
I am probably quite untypical. But to the degree I am not, this phenomenon can’t be good for anyone - the industry, medicine, or patients.
So I will let it be there. Except to say that I am sorry that HC has chosen to leave us. Not having her perspective, whether or not we concur, will be a loss for everyone here.
God speed, HC.
Bruce
In this setting, I am sad to have to report that KOLs are often just hired mouths used to communicate marketing’s message. They are often paid via contracts on a quarterly basis and the ransom often goes up as do the ramifications of their leaving your next for a newer more profitable nest. The companies will often go the extreme of providing a cell phone(corporate billed), hourly rates of $400-600 per hour, “assistance” offered for writing, and fly them to exotic locations.
KOLs are chosen for their placement of messages and are needed in the event a trial or outcome does not work out as epected. They are the first to chime in and say something like “its not conclusive” or “more data is required before we can reasonably assume…”.
These individuals often get flown around the US and into Europe and help steer the messaging of a pharma company and the drug companies utilize their positions on comittees and within society’s that write GUIDELINES about therapeutic treatments. You will find these guidelines often shift dramatically in the direction of the major drugs they “pimp”. Those classes of drug are often recommended earlier in algorithms than is reasonable and at doses outside of logic. Its all about the money.
Drug companies buy up these “faces” so they quiet the dissenters. They use them too if they sit on review panels or are peer reviewers for major journals in medicine. Some companies have gone so far as to help write editorials for medical journals and spoon feed the material to these KOLs to get their approval to have it published as if they wrote it personally.
The opinion of KOLs should often be viewed with concern. They are visited by the Medical Science folks who present false and misleading data as well. They spoon feed it to them. Many of these KOLs are in major academic areas. If they can successfully buy the opinion of the KOL with grants, then in return they can get a generation of new residents believing that the gospul is actually true. It pays off for the drug company. Sounds sick, huh?
Sadly very, very true.
Justice in MI
Bruce, when you say “in this setting,” can you give us an idea from where you are speaking? Is it within a company, med practice, acad. med. center, etc.?
Bruce
Justice,
“In this setting” is referring to the pharmaceutical arena. I speak from personal experience. This is not second hand or hearsay. The top 20 pharma companies operate in this way. It is a “cost of doing business” for them. They buy these people and churn out profits. KOL’s in academia, private practice, and within companies (PBMs) are all used (willingly, I might add) for these purposes.
Don’t be deceived about the intent, it is always about the money. Just stop paying them and see what happens! Reduce their honoraria to a reasonable amount and their eagerness to educate the masses suddenly dissipates. Its amazing to watch.
Former pharma Marketing Exec
Brilliant posts here, thanks to Doc, Dr. Giorgianni, Bruce and of course JIM.
Sorry HC has chosen to leave. I would have to say though that some people who I know who have worked for years in the pharma industry and are very well educated and have had very high profile careers have been stricken with illnesses and KNOW UNEQUIVICAlLY corrupted individuals in the system (not the entire system) interfere with patients rights and access to information. I am very close to a few of those individuals. Knowing what they are going through is the only reason I post here at Pharmalot.
I must say Ed is doing a fantastic job of keeping us up to date.
Thanks to all who continue to post here and share. I believe we can all make a difference in some way.