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.

“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.

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.

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.

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.

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.

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.

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.