To make its point, there's an interview with Kimberly Elliott, a former sales rep for 18 years for Novartis and others. "Key opinion leaders were salespeople for us, and we would routinely measure the return on our investment, by tracking prescriptions before and after their presentations," she tells BMJ. "If that speaker didn’t make the impact the company was looking for, then you wouldn’t invite them back." (Click here to watch the video).
Part of her job was developing relationships with local and national opinion leaders, and she would pay them $2,500 for a single lecture, which was largely based on slides supplied by her employer. Sometimes, the drugmaker would pay the fee to an academic center, which would then pay the doc. "These people are paid a lot of money to say what they say," she tells BMJ. "I’m not saying the key opinion leaders are bad, but they are salespeople just like the sales representatives are."
Meanwhile, Richard Tiner, the medical director at the Association of the British Pharmaceutical Industry, agrees that key opinion leaders play an important role. "Companies will employ consultants to help advise on marketing strategies...and present and speak at conferences," he tells BMJ. "When these people are receiving a fee, they are in one sense in the employment of the company."
So how do docs with long-term financial arrangements with drugmakers maintain independence? Tiner tells BMJ the key opinion leaders, or KOLs, are "free to speak about other medicines" and their presentations at influential medical meetings are "often quite balanced...I don’t think they are bribes. It’s payment for work done, rather than a bribe." He agreed, however, that the work "might help to promote a particular medicine."
Recent market research reports on how drugmakers identify, recruit, train, and pay their KOLs state that influential docs can earn up to $400 an hour, BMJ writes. A publicly available summary of one report shows that some docs can earn more than $25 000 a year in advisory fees. A press release from Cutting Edge, which sells the reports, suggests the average fee for a "scientific speech" is more than $3,000. Typically, these speeches are delivered at educational events sponsored by companies.
The BMA tells BMJ that,although it might have had agreed fees for its members to be paid as key opinion leaders in the past, it had not happened recently. The association’s fee guidance schedule, however, suggests members may charge drug companies more than $400 hour to participate in clinical trials. Although many docs keep the money, BMJ notes some donate fees to charities or research.
BMJ goes on to write that drugmakers keep KOL databases. One firm offers special web based software to measure the return on investment on KOLs. Why go to such lengths? Elliott offers her take: "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."