Monsanto Roundup Lawsuit

Sunday, January 11, 2009

Key opinion leaders: independent experts or drug representatives in disguise?

Ray Moynihan, visiting editor, BMJ
1 University of Newcastle, Newcastle, New South Wales, Australia

Ray Moynihan examines the role of the influential experts paid by industry to help "educate" the profession and the public

In the world of medicine, "key opinion leader" is the somewhat Orwellian term used to describe the senior doctors who help drug companies sell drugs.1 These influential doctors are engaged by industry to advise on marketing and help boost sales of new medicines. Across all specialties, in hospitals and universities everywhere, many leading specialists are being paid generous fees to peddle influence on behalf of the world’s biggest drug companies.

Kimberly Elliott, who was a drug company sales representative for almost two decades in the United States, puts it directly. "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 said. "If that speaker didn’t make the impact the company was looking for, then you wouldn’t invite them back."

From the age of 23, Ms Elliott worked for several global drug companies, including Westwood Squibb, SmithKline Beecham, and Novartis, leaving the industry 18 years later, only last year. Many times a top national salesperson, part of her job was developing relationships with local and national opinion leaders, also described as "thought leaders." Ms Elliott says she would pay these respected doctors $2500 (£1280; 1610) for a single lecture, which was largely based on slides supplied by the company. Sometimes the company would pay the fee to an academic centre, which would then pay the doctor. "These people are paid a lot of money to say what they say," she said. "I’m not saying the key opinion leaders are bad, but they are salespeople just like the sales representatives are."

In a candid interview with the BMJ, the medical director at the Association of the British Pharmaceutical Industry, Richard Tiner, agreed key opinion leaders play an important role for drug companies. "Companies will employ consultants to help advise on marketing strategies . . . and present and speak at conferences," he said.

Generous earnings

Two recent business intelligence reports on how drug companies identify, recruit, train, and pay their opinion leaders state that influential doctors can earn up to $400 an hour.2 3 The reports were produced by a company called Cutting Edge, which works closely with drug company executives, and are available to purchase at around $8000. A publicly available summary of one report shows that some doctors can earn more than $25 000 a year in advisory fees. A press release promoting the other report suggests that the average fee paid to a doctor for a "scientific speech" is more than $3000.4 Typically these speeches are delivered at educational events sponsored by companies.

The BMA said 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 £200 an hour for participation in clinical trials. Although many doctors retain these earnings, it’s important to note that some donate their payments from drug companies to charities, or research.


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