Kissing goodbye to key opinion leaders

One of the hottest topics in the business of medicine is how the new sunshine of disclosure is affecting relations between drug companies and so-called key opinion leaders, or KOLs. In the United States, growing public scrutiny of company payments is now causing many doctors to shy away from corporate invitations to consult, speak or advise. As greater transparency comes to Australia, and previously hidden dealings are put on the table, industry here may also have to kiss goodbye to a key component of its marketing machinery.

Just last month, a US-based “business intelligence” firm produced a report called Engaging KOLs: new thinking on thought leader development.1 The promotional blurb promises valuable tips to companies on how to improve relations with influential doctors in this changing climate of increasing disclosure. Yet, with a price tag of $595 for individuals and $8925 for global corporates, its candid contents will likely remain hidden from view — like a lot of these regular intelligence reports for industry — depriving the public debate of a much-needed reality check about these controversial relationships.

One that has surfaced recently is a 180-page report on key opinion leader “management”, produced by the research house Cutting Edge Information. Based on a survey of more than 80 companies and frank interviews with many executives, the document offers a rare public window into industry’s thinking.2 A central message is that there’s a shrinking pool of “thought leaders” available. Along with new government oversight, the 2009 report finds “companies now must contend with a negative public image, a subsequent backlash from physicians worried that a pharmaceutical connection will tarnish their reputation, and increasingly restrictive rules in academia and at research institutions”.2 Strongly opposed to having financial dealings made public or being seen as industry salespersons, “many thought leaders have already begun to politely decline invitations to work with pharmaceutical companies on advisory boards, speeches, and other activities”, says the report.2

To address the crisis, companies are urged to meet the concerns of key opinion leaders and “develop strategies to utilize them properly”.2 The main strategy is reframing the relationship as being based on science, rather than on marketing. Citing comments from one executive, the report states that, “although it has become more difficult to justify having dinner with a thought leader, by focusing on the science, companies can still build relationships with physicians with little resistance”.2 Yet while the new rhetoric is about science, expanding markets remains the reality, with the report detailing “tactics for identifying thought leaders who align with company objectives”.2

Most tellingly, for the large drug companies, “promotional speeches” are still the biggest category of thought-leader expenditure, and “promotional” relationships outnumber “clinical” ones by three to one. And for any thought leader who thinks they’re primarily serving science rather than shareholders, the report reveals a “return on investment” mindset: one company executive explains how they use controlled trials to evaluate the impact of individual speakers on “prescription uplift”.

In the US, the Physician Payment Sunshine Act 2009 is forcing every payment to every health professional onto a public website, yet here in Australia darkness remains. Steve Hambleton, president of the Australian Medical Association (AMA), says he sees “beauty” in the Sunshine Act, but new AMA proposals for enhanced transparency come nowhere near the US law. Medicines Australia chief executive Brendan Shaw told me that it’s widely recognised there’s a “need for more transparency”, but, in my view, it looks unlikely that comprehensive disclosure will be embraced by industry any time soon. Asked about the desirability of a Sunshine Act in Australia, the federal health minister’s office sent me a bland response stressing that self-regulatory codes should ensure “professional and appropriate” relations between companies and doctors.

Jon Jureidini — clinical professor at the University of Adelaide and spokesperson for advocacy group Healthy Skepticism — says what saddens him most is seeing young doctors with academic aspirations becoming embroiled with industry, “without recognising how far they might compromise their independence”. He says the Cutting Edge report — which he recently purchased — shows key opinion leader relationships are still driven by marketing, reinforcing the need for full and mandatory disclosure.

Of course, companies want to financially engage with influential health professionals, and vice versa, and there’s little doubt some of those interactions serve the public interest. But when comprehensive disclosure finally comes Down Under, some among us may well choose to kiss goodbye to the corporate-funded key opinion leaders, no matter how much scientific rhetoric is used to try to disguise their promotional activities.