What on earth are key opinion leaders (KOLs)? In the world of medicine they are influential doctors who help pharmaceutical companies sell drugs (1,2). Drug companies realized that doctors don′t like to be ″educated″ by drug reps, but will listen to their medical colleagues. So they set out to recruit leading specialists to pitch their drugs — for a handsome fee of course. This seems to be a worldwide phenomenon.

″[Key opinion leaders] can influence thousands of prescribers and hence prescriptions through their research, lectures, publications and their participation on advisory boards, committees, educational boards, professional societies and guideline/consensus document development.″(2)

Typically KOLs lecture at company-sponsored events, using company-supplied material and saying what the companies want them to say. KOLs are also referred to as thought leaders; this presumably makes the medical doctors in their audience thought followers, not exactly reassuring if you are a patient.

How can pharmaceutical companies be sure that they′re getting their money′s worth from any given KOL? Drug companies actually have access to prescription records, incredible as it may sound. They routinely track prescriptions before and after every presentations, i.e. they can calculate their return on investment in their KOL to the Dollar; KOLs that don′t live up to expectations get dumped. Those that ″perform″ get paid quite handsomely. Typical fees might be $3000 per lecture, $200 per hour for participating in clinical trial, etc (2).

Sometimes a disgruntled drug rep quits and spills the beans. These former pharma employees make it very clear that drug companies consider KOLs sales people. But you don′t even have to listen to former sales reps; it all happens in broad daylight. In fact, the KOL practice has even spawned a niche business sector. Enter "key opinion leader management" in a search engine to see what I mean. There are actually central databases of opinion leaders, showing their return on investment (2).

What is wrong with all this?

Pharmaceutical companies will do anything to maximize profits, whether their drugs benefit patients or not. Their own pronouncements will be perceived as self-serving — drug companies have little credibility left. By persuading prominent doctors to front for them, their sales pitches appear to be objective presentations by independent experts. And this practice does seem to influence prescribing physicians, to the detriment of their patients.

It is bad enough that continuing medical education courses can be turned into pitch fests. At least the physicians in the audience know that these events are put on, and the speakers paid, by pharmaceutical companies. One would therefore hope that they take what they are told with a grain of salt.

But how are doctors to know which medical articles published by prominent physicians are trustworthy? The companies sponsoring the studies have the power to decide what gets published, and they are not above fudging results. Worse still, the supposed authors may not even have been involved in ″their″ studies, but were simply paid to put their names on publications (yes, this happens!).

It seems though that the ultimate use that pharmaceutical companies can make of KOLs is to get them on advisory boards and committees, where they can influence policies and standards of medical treatment that favour the firms they represent and the pharmaceutical industry in general.

What is the solution?

Medical doctors are now required to declare all sources of funding and potential conflicts of interest in their publications. This is of course a step in the right direction, but one wonders if one gets the whole truth. It is certainly not in Big Pharma′s interest to disclose their financial dealings, since it defeats the purpose of working with KOLs, whose principal asset is after all their perceived integrity.

I would think that patients′ best protection is to know as much as they can about health matters. Our health has to be our own concern, not something to be managed by doctors with pharmaceutical products.

Key opinion leaders — the best integrity money can rent!

Souces:

1. Doctors for pharma. Physician ″opinion leaders″ — helping or hurting medicine? The Scientist Community June 20, 2008
2. Key opinion leaders: independent experts or drug representatives in disguise? R. Moynihan. Brit Med J 2008;336:1402-1403.