Friday, January 07, 2011

Key Opinion Leader Services Companies: the Creation of Useful Idiots and Usefully Idiotic Organizations

In researching the conflicts of interest of the University of California "36," I stumbled upon a fascinating corner of the pharmaceutical/ biotechnology/ medical device marketing universe, the companies that find and manage key opinion leaders (KOLs), also known as "thought leaders."  Reviewing their own marketing materials reveals how KOLs truly are health care corporate marketing's useful idiots.

I found three companies which seem entirely devoted to the adoption, care and feeding of KOLs, plus numerous companies, including some medical education and communication companies (MECCs) that provide KOL-related products and services.  I will first describe the companies briefly, then draw upon their marketing materials to underline what KOLs are really about.

Leadership in Medicine Inc

This is the company I found first, because one of its directors is a member of the UC 36, the group of top university leaders who threatened to sue the university to increase their already generous pensions.

Leadership in Medicine Inc's web-site describes its reason for being thus:
IF YOU NEED TO KNOW who are the most prominent, admired, and influential actors in healthcare, how they are interconnected, and why, you need our expertise.

Given how vastly complex are the relationships among providers, researchers, and other significant actors in healthcare, it is vital to focus on key opinion leaders (KOLs) at local, regional, and global levels, and to understand the ties among them.

Its clients are:
Over 80 client companies
* All of the top 15 largest pharmaceuticals
* 8 of the 10 largest biotechs
* 5 of the 10 largest medical device companies

A graphic on its "experience" page listed the following companies: Baxter, Wyeth, Lilly, Roche, Gilead, GlaxoSmithKline, Pfizer, Abbott Laboratories, Genzyme, Bristol-Myers-Squibb, Medtronic, Johnson and Johnson, Genentech, and Covidien.

KOL LLC

Company description:
As our name implies, we are a company devoted to providing Key Opinion Leader software and Key Opinion Leader Management services for pharmaceutical, biotechnology and device companies.

The company's graphic client list included: Cephalon, Scios, Novartis, Schering-Plough King Pharmaceuticals, Pfizer, Genentech, Reliant Pharmaceuticals, McNeil (division of Johnson and Johnson, Jazz Pharmaceuticals, Endo Pharmaceuticals, Cytogen, Health Products Research, Shire, Reckitt Benckiser, Protein Design Labs, and Odyssey Pharmaceuticals.

Thought Leader Select

The relevant parts of the company description:
Thought Leader Select is a Chapel Hill, NC-based private research and consulting firm serving the biopharmaceutical and healthcare industries.
and
We serve these industries and the medical community at large by assessing medical experts (known as 'thought leaders' and 'key opinion leaders')....

Perusal of the materials used by these companies, and other companies which market KOL or thought leader related services makes the nature of the relationship between KOLs and commercial health care firms, and the purpose of employing KOLs clear.

KOLs are Employed by Marketing Departments to do Marketing

The best example comes from a description of a KOL information technology application sold by Nagarro:
A web-based application was developed by Nagarro to help the marketing department of a global pharmaceutical company exploit Key Opinion Leader (KOL) information in order to promote products and remain ahead of its competition.

Problem Description

In today s fast-paced competitive environment, pharmaceutical companies cannot solely rely on superior products to succeed. Well organized marketing departments help sales departments reach goals and give companies an edge over competition, but without access to valuable resources, like KOLs, they are ineffective. KOLs influence the medical community and ultimately the end users of pharmaceutical products.
Pharmaceutical companies that are able to identify and work with KOLs will be better positioned to compete....

Benefits

[include]
Creation of market intelligence from highly specialized and customizable reports containing previously unavailable aggregate data....

Ability to group KOLs by product knowledge and associations in order to better promote products

Ability to maximize ROI from KOL related events

Enhanced sales and marketing productivity through streamlining of complex multi-source information

That makes it crystal clear that marketers use KOLs to market, to sell products. While at times KOLs might actually be used to advise health care corporations about clinical or scientific issues, that is hardly their major point. KOLs are almost always hired to market by marketing departments.

In case someone might argue that this is only one example, let us look at materials from the other companies.

KOL LLC described the usefulness of KOLs thus:
Everyone recognizes the value of opinion leaders (OL), or thought leaders. While national level OLs may not write many prescriptions they influence thousands of prescribers and hence prescriptions through their research, lectures, publications and their participation on advisory boards, committees, editorial boards, professional societies and guidelines/consensus document development. Regional level OLs are often involved in state societies or legislative initiatives in addition to their speaking and publications. While local level OLs may not publish, they provide advice to local colleagues and may speak at grand rounds. And who are the ‘rising stars’ in your therapeutic area?

It is imperative that you know the OLs in your market at a national, regional and local influence level as well as those ‘rising stars’.

This is a bit more indirect, but it is clear that the goal is to "influence prescribers" to prescribe, not provide scientific or clinical advice to the company.

Leadership in Medicine Inc's materials also continually emphasized the point of KOLs is to influence, for example, they boasted of pioneering analyses "to assess paths of influence in healthcare," developed a particular tool called "Centrality Ranking" to "provide fine-grained ratings of KOLs' influence," and claimed to "have identified, profiled, and mapped the influence of tens of thousands of individual KOLs...." The clear implication is that KOLs' influence is the central consideration, and what else is this influence good for other than to sell products, and perhaps advocate for corporations in general?

When KOLs are Involved, Many Activities that Appear to be Educational or Scientific Really Are For Marketing

Strikingly, KOL LLC claimed its role in guideline development:
Guidelines produced by national societies are optimal, but often can be a slow, painful and expensive process to develop. KOL, L.L.C. can provide a faster alternative. We have experience convening a panel of experts in a therapeutic area. We serve a project management role to ensure the timelines and deliverables are met. We have access to a medical writing team of 25 healthcare professionals who can write the initial drafts, as our experience tells us it is easier for experts to edit, than to write from scratch.

There has been growing realization that guidelines may be biased by commercial sponsorship and by the participation by individuals with conflicts of interest. The KOL LLC marketing materials suggest, however, that guidelines have become purpose-built marketing vehicles through the participation of selected KOLs with allegiances to drug, device and biotechnology companies. As an aside, note that guideline-development services includes the participation of a team of ghost-writers who will write the first drafts, a function that naive academics might have thought should be that of clinical and scientific experts.

For another example, KOL LLC asserted it could manage "investigator meetings," :
We’ll help you better plan to maximize the communication of the trial results through targeted abstracts, posters, publications and lectures.
so
Due to the time constraints placed on Clinical Research Departments, many times ‘research mills’ are selected as the trial sites. This is fine, but who is going to publish the results and stand up and present the results at national, regional and local meetings. We can provide you advice and counsel about how to involve your KOLs effectively, while maintaining your aggressive timelines.

The goal of KOL management here is for the company to control how the research is disseminated. Note also the cynical view of "research mills," which likely refers to contract research organizations. Do we really think that CROs are used by commercial firms because they do better research?

Key Leading Organizations

A bonus from reading through the offerings on KOL management was to discover another related business that has not been subject of polite conversation before. Leadership in Medicine Inc put it this way:
Equally essential is recognizing the roles played by key leading organizations (KLOs) such as medical institutions, payers, professional organizations, patient groups, government entities, and journals in structuring KOL activities and relationships, since those are the stages on which KOLs perform.

Key Leading Organizations (KLOs) apparently include influential organizations, e.g., academic medical institutions, medical societies, and patient advocacy groups that can be deliberately turned into organizations of useful idiots for marketing purposes. Note that we and others have discussed how institutional conflicts of interest and conflicts of interest affecting leaders of of such organizations can lead to bias in favor of commercial interests. But what Leadership in Medicine Inc has written suggests that such organizations can be deliberately taken over to function as industry's fellow travelers.

Similarly, Thought Leader Select advertised services to manage organizations to support "thought leadership":
Through Centers, all of our research and assessment skills culminate in our evaluation of universities, influential clinics, and research foundations for a holistic approach to thought leadership in the medical community. With centers of excellence assessments we take a drill-down approach, starting at the academic medical centers, then moving into affiliated hospitals and clinics....

Summary

Industry spokespeople and key opinion leaders tout themselves as clinical, educational, and/or scientific experts chosen for their expertise to advance medicine, science and public health.  There are documented instances (e.g., see posts here and here) in which defectors from marketing departments of commercial health care corporations described KOLs as salespeople who could be more influential hidden within their professional or academic cloaks.  Even some physicians paid to be speakers on behalf of pharmaceutical corporations have acknowledged their role as salespeople in fancy dress (see post here).  There are cases of documents revealed by discovery in legal actions that show how companies planned organized stealth marketing efforts for drugs that included activities by KOLs (e.g., see post here about marketing of Lexapro, and here about Neurontin).

However, the marketing materials used by KOL service companies (for lack of a better name) show that KOLs are largely meant to be stealth marketers, and hired for that purpose, that KOLs participate as marketers in the sorts of activities that to the naive appear to be educational or scientific, and that marketers try to recruit whole organizations, such as medical schools, research organizations, medical societies, and patient advocacy groups as disguised sales organizations.

This goes beyond the problem of bias of physicians, or individual health professionals due to their financial relationships.  It goes beyond the problem of bias of organizations due to their sources of financial support or the financial relationships of their leaders.  It looks like there has been a massive campaign by health care corporate marketers to make useful idiots out of possibly a majority of medical academics and academic, professional, and supposedly patient-centered organizations.  This appears to be a massive, cynical effort to hollow out our once respected health care institutions and professionals in the service of marketing.

A final word to any individuals reading this who are paid by corporate marketers to be KOLs.  If you think that you are paid for educational or scientific purposes, you likely have been made into a chump.  The people who did this to you were likely not acting in your best interests, or those of society, but to cynically market their product and increase their own earnings.  If you doubt this, look at the materials cited above.  You really don't want to continue being chumps, do you?

10 comments:

Scot M Silverstein MD said...

IF YOU NEED TO KNOW who are the most prominent, admired, and influential actors in healthcare, how they are interconnected, and why, you need our expertise.

I am also intrigued by the possibility that these "KOL companies" might also be used to identify who the 'whistleblowers' and 'troublemakers' are, thus potentially interfering in a tortious manner in their employment opportunities...

-- SS

Anonymous said...

Thank you Roy, for providing additional insight on the machinery enabling the fraud and deception by the HIT vendors on America. The book title: Chumps and Booth Bunnies"...or
Pimps, Prix, and Prostitutes Wearing Suits".

Anonymous said...

Have you found any HIT vendors listed on any of these KOL websites?

Then again, the HIT industry set up its own KOL program, HIMSS, which then spawned CHIME and CCHIT.

CCHIT is particularly interesting. Its address in Chicago is a storefront, without any laboratory for testing the equipment it claims to be testing.

Take the tour of this influential (on Congress) vendor controlled non profit KOL on So. Wackers.

Anonymous said...

Hmmm, one would think that an opinion leader would not be able to be managed, otherwise how could they be a leader?

Anonymous said...

Apropos comment from here:

... In today's society, "experts" may not be at all what they appear to be. And their motivation may be strongly influenced by profit potential.

Sophists are in the business of selling knowledge. This is very different from true science or true wisdom, which seek (whatever the topic of inquiry)truth for the sake of truth.

Sadly, it is very true, as the history professor points out, that the young students today do not know how to inquire. Thus, they are easy led by whichever sophist has the flashiest message.

1boringoldman said...

Your restraint in this post is commendable. It's hard to make nice about the growing industry of Professional Pimps to find and manage Medical Prostitutes. Your comment that this is "a massive, cynical effort to hollow out our once respected health care institutions and professionals in the service of marketing" is dead on. The tragedy is that they seem to be able to find "once respected health care institutions and professionals" who will even talk to them.

Kristen Smithwick said...

While we are honored that you have identified us in your blog as a company dedicated to assessing the skills and experiences of Thought Leaders across the globe, we are also dismayed at your characterization of your fellow physicians as “useful idiots.”

Interestingly, the worst you could say about Thought Leader Select is that 1) we work with biopharmaceutical companies, and 2) we mention that some large medical clinics can be influential. You would be hard-pressed to find someone who would argue that clinics like the Mayo Clinic or the Cleveland Clinic do not have some influential impact in the medical community. We also disagree with assertions about the interactions between health care professionals and biopharmaceutical companies. There are many excellent and respected physicians who advise pharmaceutical companies in the area of clinical studies, determining unmet medical needs, or developing products that save millions of lives, yet you demean this level of interaction. It would be negligent for biopharmaceutical companies to develop new treatments and drugs in a vacuum, without the input of health care experts on the front lines. Just as technology companies engage outside technical experts when developing new technical products, biopharmaceutical companies engage outside healthcare experts to develop better medicines to treat some of the world’s most widespread and debilitating diseases.

We also disagree with your characterization of our company as the conduit for medical professionals to serve as extensions of the sales and marketing organizations within biopharmaceutical companies. Our primary mission is to connect health care professionals with biopharmaceutical companies for the right reasons – because they possess the requisite skills and experiences to provide input on new medicines and therapies, not because they will be veritable marketers. Your post seems to suggest that biopharmaceutical companies only seek to engage HCPs with high prescriber habits; however, Thought Leader Select advises the companies that we serve never to engage health care thought leaders for this reason. In fact, the OIG guidelines explicitly state that physicians should not be used in any consultative manner based on their prescribing habits, but based on their objectives skills and experiences suited for such consulting activities. We follow this principle very carefully, which you will see stated clearly in our website. We feel there is a right way and a wrong way to have physicians and the biopharmaceutical industry interact, and rather than dismiss everyone as being prostitutes, we believe by conducting objective assessments of the appropriate skills and experiences of physicians, we provide a valuable service to both parties.

We invite you to contact us directly to learn more about our company, a group of people who are trying to make a difference by advising our clients to approach their respective interactions with medical professionals with ethics and transparency that befit the core values of the medical profession itself.

Kristen Smithwick said...

While we are honored that you have identified us in your blog as a company dedicated to assessing the skills and experiences of Thought Leaders across the globe, we are also dismayed at your characterization of your fellow physicians as “useful idiots.”

Interestingly, the worst you could say about Thought Leader Select is that 1) we work with biopharmaceutical companies, and 2) we mention that some large medical clinics can be influential. You would be hard-pressed to find someone who would argue that clinics like the Mayo Clinic or the Cleveland Clinic do not have some influential impact in the medical community. We also disagree with assertions about the interactions between health care professionals and biopharmaceutical companies. There are many excellent and respected physicians who advise pharmaceutical companies in the area of clinical studies, determining unmet medical needs, or developing products that save millions of lives, yet you demean this level of interaction. It would be negligent for biopharmaceutical companies to develop new treatments and drugs in a vacuum, without the input of health care experts on the front lines. Just as technology companies engage outside technical experts when developing new technical products, biopharmaceutical companies engage outside healthcare experts to develop better medicines to treat some of the world’s most widespread and debilitating diseases.

We also disagree with your characterization of our company as the conduit for medical professionals to serve as extensions of the sales and marketing organizations within biopharmaceutical companies. Our primary mission is to connect health care professionals with biopharmaceutical companies for the right reasons – because they possess the requisite skills and experiences to provide input on new medicines and therapies, not because they will be veritable marketers. Your post seems to suggest that biopharmaceutical companies only seek to engage HCPs with high prescriber habits; however, Thought Leader Select advises the companies that we serve never to engage health care thought leaders for this reason. In fact, the OIG guidelines explicitly state that physicians should not be used in any consultative manner based on their prescribing habits, but based on their objectives skills and experiences suited for such consulting activities. We follow this principle very carefully, which you will see stated clearly in our website. We feel there is a right way and a wrong way to have physicians and the biopharmaceutical industry interact, and rather than dismiss everyone as being prostitutes, we believe by conducting objective assessments of the appropriate skills and experiences of physicians, we provide a valuable service to both parties.

We invite you to contact us directly to learn more about our company, a group of people who are trying to make a difference by advising our clients to approach their respective interactions with medical professionals with ethics and transparency that befit the core values of the medical profession itself.

Roy M. Poses MD said...

Kristen Smithwick,

(If that is really you....)

Of course academic physicians from prestigious medical centers are influential. The question is what is the point of the "influence" your web-site stresses? Influence may correlate with research or clinical expertise, but they are not the same. If you seek only people with research or clinical skills to provide research, technical or clinical advice, why does your web-site not make that explicit?

In fact, your web-site suggests that research is not the most important issue. For example:
"Our clients are always seeking the optimal ways to engage key opinion leaders in the medical community, and Thought Leader Select’s analysis and recommendations cover the most important brand development areas, including basic and clinical research, conference involvement, publications, media interactions, and patient advocacy." (http://www.thoughtleaderselect.com/kol-services/kol-engagement/)

Also, "Many medical experts interact with biopharmaceutical companies in an advisory capacity from time to time. Without these crucial collaborations—in clinical trial settings, advisory boards, and educational speaking and publishing– companies would be unable to bring to market medicines for better public health." (http://www.thoughtleaderselect.com/health-care-professionals/)

If you only seek to recruit opinion leaders for research, technical or clinical advice and consulting, your web-site's language does not make that at all clear.

I do not deny that drug, device and biotechnology companies do seek consulting and advice on research, technical and clinical issues. However, there is considerable evidence that key opinion leaders or thought leaders most often are meant to support marketing. (look here: http://hcrenewal.blogspot.com/search/label/key%20opinion%20leaders)

I did not mean to suggest that ALL key opinion leaders are picked because they are high prescribers or utilizers. However, there is evidence that some are. See for example: http://hcrenewal.blogspot.com/2010/11/of-drug-talks-deception-and-denial.html

XpyDDer said...

This is an excellent post followed by an excellent debate with the comments. I was once involved with commercializing a new medical device and I subsequently sought out KOLs in an effort to get my product to market. I believed very strongly in the medical device I was marketing and selling and believed it to be a life-saving imperative within the health care industry. I found that many prospective KOLs did not share my opinion and were not interested. On the other extreme I found a few MDs who agreed to be a KOL if they could receive significant amounts of ownership and sometimes other perks - I considered these MDs to be very unscrupulous and I chose not to work with them. My own experience clearly demonstrates that there are some KOLs who want to do a good service and some who are, as you say, completely useful idiots. I am currently preparing to help introduce another medical device and I am currently investigating some unique strategies to ensure that the KOL process is an ethical one. If I discover the "Holy Grail" of ethical KOL management I will come back and share it here on your blog. - wish me luck!