"Key Opinion Leaders Were Sales People for Us"

The role of key opinion leaders (KOLs) in marketing drugs and devices has been frequently discussed on this blog (see posts by Dr Bernard Carroll here and here), and on other blogs, such as the Carlat Psychiatry Blog and the Clinical Psychology and Psychiatry Blog.

The British Medical Journal just published an article providing further documentation about how such KOLs function. [Moynihan R. Key opinion leaders: independent experts or drug representatives in disguise? Brit Med J 2008; 336: 1402-3. Link here.] The article was based on a discussions with a long-term pharmaceutical representative who was several times "a top national salesperson," and articles in several business publications. Some key points were:

• Key opinion leaders are salespeople: "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....' Also, "Ms Elliott says drug companies desperately need key opinion leaders. '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.'"
• Key opinion leaders are expected to increase drug or device sales: Kimberly Elliott said "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." Also, "the industry’s Richard Tiner, accepts that drug companies often recruit senior specialists and evaluate the return on investment they may bring. They become an integral part of the company’s marketing, education, and research strategies. 'When these people are receiving a fee, they are in one sense in the employment of the company,' he says...."
• Key opinion leaders are meant to parrot their corporate patron's marketing message: "These people are paid a lot of money to say what they say. I’m not saying the key opinion leaders are bad, but they are salespeople just like the sales representatives are." Also, an industry publication said, "drug companies are then encouraged to evaluate the performance of their key opinion leaders continuously to avoid 'wasting money on the wrong people.'" Lectures were "largely based on slides supplied by the company."
• Key opinion leaders are well-paid: "Ms Elliott says she would pay these respected doctors $2500 (£1280; 1610) for a single lecture...." Also, "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."
• Physicians who show favor to particular products are groomed to be opinion leaders: "Importantly, marketing staff should find doctors who will endorse their products, 'who may be further down the influence ladder," and then help "raise their profile, and so develop them into opinion leaders.'"

Although pharmaceutical, biotechnology, and device company spokespeople, and some of the industries' cheer-leaders continue to insist that key opinion leaders are educators, this article underscores that they are merely high-priced marketers. What is most insidious about the use of KOLs, however, is that many of them do not acknowledge that they are even influenced by the money they are paid.

In my humble opinion, any physician or other health care professional paid as a key opinion leader should acknowledge that pay, its amount, its source, and its purpose in detail any time they express an opinion relevant to their corporate sponsor's products or services. If disclosing "I was paid $2,000 by company x to give this talk, using slides the company provided. Company x makes drug y. The purpose of this talk is to market drug y" might make some KOLs uncomfortable, then maybe they should reconsider the compromises they have made by accepting this role.

Any physician or health care professional, however, who does not make disclosures at least this detailed when speaking or writing on a topic relevant to the marketing of his or her corporate sponsor's products or services is being deceptive and dishonest.