BMJ article explores the cosy relationship that drug companies often have with doctors considered ‘key opinion leaders’

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Go to any medical educational meeting, and you’ll usually find individuals giving Powerpoint presentations that, when you boil down to it, sell the merits of a drug or device. Such presentations are usually delivered by doctors who are sometimes known as ‘key opinion leaders’ or ‘KOLs’. Being doctors, one might imagine that these doctors give their objective, independent view of the drug or device of which they speak. In reality, though, key opinion leaders are usually paid by pharmaceutical or medical device companies, and might just be viewed as ‘drug reps’ according to one industry insider.

The issue of Key opinion leaders and their payment came to light in this week’s British Medical Journal [1]. Attention to the practice of using key opinion leaders was drawn by Kimberly Elliott who had been a drug company sales rep for almost 20 years. Ms Elliott describes how doctors are initially approached by drug companies and ‘interviewed’ to gauge their opinion and attitude to relevant medical matters and their treatment. Those whose views match the drug company’s own objective are then ‘groomed’ by the company.

This process entails the drug company providing speaking opportunities for these doctors that helps raise their profile and help morph them into key opinion leaders and ‘product champions’. The drug company will often provide the very slides that are used for the basis of the presentations. And doctors tend to be well paid for their efforts too. Ms Elliott, for instance, paid doctors $2500 (�£1280) for a single lecture, and delivering more than one lecture in a day could allow doctors to earn several thousand dollars in a single day.

According to Elliott: These people are paid a lot of money to say what they say. I’m not saying they are bad, but they are salespeople just like the sales representatives are.�

The money paid to key opinion leaders is not for nothing though: the performance of these hired helps is monitored, and if their efforts do not lead to cost-effective increases in sales, they are dropped.

In the BMJ piece Richard Tiner of the Association of the British Pharmaceutical Industry is asked how doctors in the pay of drug companies can retain their independence. His reply referred to the fact that these doctors are free to speak about other drugs and that their presentations are often quite balanced.� His suggested cure for the malady of the sometimes cosy professional and financial relationship between doctors and drug companies is transparency: Doctors should be declaring their potential conflicts of interest whenever they speak.

The articles also cites Harvard University researcher David Blumenthal who has a special interest in the area and whose opinion is that the payment of doctors by drug companies to promote a particular message or product might not be in the best interests of the public, including the patients served by these doctors. He and others have called for the scaling back of influence that drug companies have over doctors and their education.

In the meantime, what are doctors to do? Ms Elliott advises doctors who attend KOL presentations to take them with a grain of salt and go back and do your own research.� However, it’s important to bear in mind that the messages propagated through key opinion leaders gets out into the mainstream too. This means that not just doctors but members of the public too may need to do their own research. My opinion is that the internet now allows unparalleled opportunity for this, and for the uncovering of information that isn’t the usual party line on a some drug or treatment.


1. Moynihan R. Key opinion leaders: Independent expert of drug representatives in disguise? BMJ 2008;336:1402-1403

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