‘Key opinion leader’ (KOL) is a term sometimes used to describe doctors or researchers paid by pharmaceutical companies to talk about its products (favourably). The practice is widespread and has been broadly tolerated by the medical profession. However, in recent times, some have started to ask questions about the ethics surrounding the use of KOLs. See here for what I think is a good blog post that highlights the major issues and provides commentary from several people who believe KOLs have inappropriate and undue sway in the education of doctors and the way they go about their business.
Back in December, the British drug company GSK announced it was going to stop paying KOLs to speak on its behalf. This, I’d say, is a big step in the right direction.
However, this week, GSK has announced an addendum: while it will not employ ‘external speakers’, it plans to employ doctors to speak to other doctors about its products. I learnt of this through a news article that appears in today’s British Medical Journal [1].
Apparently, in an interview with the news agency Bloomberg, Deirdre Connelly – head of GSK’s US pharmaceuticals business – said that employing doctors and scientists to speak as in-house representatives of the company would provide more transparency, commenting:
We’ll continue to disseminate this very important information on drug benefits and risks, but we’re just not going to do that by hiring external speakers. We want to ensure that no one even perceives us to be doing anything wrong.
The article also tells us that a spokesperson for GS has said:
It’s important that we continue to provide important information to doctors about the benefits and risks of our medicines, but we want to do this in a modern way that removes any perception of conflict of interest.
Notice that both quotes refer to specifically to how practices are perceived.
I readily admit that if GSK employs a doctor to speak on its behalf to other doctors, then this is generally more transparent and, to me, more agreeable than having that doctor appear independent when they are anything of the sort. However, what is it about making a doctor an employee that suddenly nullifies any ‘conflict of interest’? The answer is: nothing.
Imagine being in a position where you are being paid a salary to ‘sell’ pharmaceutical drugs to doctors. Do you think the fact that your livelihood is derived this in this way might possibly influence your public opinion of a product? I would imagine it would. A conflict of interest clearly remains.
Making the paying of doctors more transparent may be a step in the right direction, but how this is perceived is largely irrelevant. It still does not get rid of the fundamental issues that individuals with clear conflicts of interest may hold undue sway and exert considerable influence over the prescribing practises of large numbers of doctors.
References:
1. Kmietowicz Z. GSK is to employ doctors to speak about its drugs BMJ 2014;348:g2241
Thanks Dr. Briffa for including a link to my post on The Ethical Nag about key opinion leaders.
You’re so right – swapping industry payments to independent physician for just hiring them straight out isn’t just a matter of transparency. Transparency isn’t enough – it’s the reality that trained health professionals who are on the take from Big Pharma (or medical device makers) consider taking the cash to be morally acceptable and NOT a conflict of interest.
The only reason industry pays physicians and academics to flog their products is to increase sales. As Dr. Daniel Carlat describes them, they’re merely “sales reps in white coats” no matter what their job title is.
regards,
C.
Caroyln
You are most welcome – thought your blog post was very accurate and fair.
Dr Carlat’s description is spot on, and I shall be poaching it and using it wherever relevant!
This article says a lot about GSK James Murdoch quits GlaxoSmithKline board.
Mr Murdoch, who joined Glaxo in 2009 as a non-executive director and sat on the company’s ethics committee, has told the board he has no plans to stand for re-election at May’s AGM.
Sir Christopher Gent, Glaxo chairman, said: “James has taken this decision to focus on his current duties as non-executive chairman of BSkyB, and following his decision to relocate to the United States” for News Corp. He thanked him for “the very strong contribution he has made”.
“following his decision to relocate to the United States” to avoid a stretch in choky?
You could not make it up !
Eddie
http://www.telegraph.co.uk/finance/newsbysector/mediatechnologyandtelecoms/9044015/James-Murdoch-quits-GlaxoSmithKline-board.html
The pursuit of science and monetary-systems are fundamentally at odds: One attempts to describe the natural world & take it into account – the other ignores it & distributes value/means around society ‘unevenly’ (to say the least).
A “pharmaceutical conflict of interest” is simply a very tangible example of such misaligned models of thinking/organizing colliding.