Abstract
Key opinion leaders (KOLs) are physicians and researchers engaged by pharmaceutical companies, most often to speak to audiences of other physicians. This article provides some background information on the structures of pharmaceutical company influence on and control over KOLs. The primary focus of this article, though, is on KOLs’ explanations and justifications of their paid work for the companies, on the basis of, among other sources, 13 interviews with high-earning KOLs. Among KOLs’ important justifications are ones in terms of the educational value of the talks they give and the benefits gained by patients; these are buttressed by claims about the integrity of the speakers. However, those justifications rarely address pharmaceutical companies’ use of KOLs, or larger issues to do with the general influence that pharmaceutical companies have on medical knowledge.
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Notes
The idea of a KOL stems most directly from the work of Paul Lazarsfeld. In his research on political views and voting behavior, Lazarsfeld (for example, 1944) coined the term ‘opinion leader’. The term was extended beyond politics and public affairs to other walks of life, including fashion, movies and marketing more generally (Katz and Lazarsfeld, 1955). The idea of opinion leaders, with its associated ‘two-step’ model of communication, was applied to medicine in the early 1950s, when Katz and co-workers, with a grant from Pfizer, studied the diffusion of the prescribing of tetracycline (Coleman et al, 1966).
For a short history of CME and an analysis of conflicts of interest, see Rodwin (2010).
The disclosure of such payments likely will change the companies’ and physicians’ behavior (Pham-Kanter, 2014). According to an article in the industry publication PMLive, the Act changed behavior before it was implemented, and the amount of money paid to doctors declined leading up to the first reporting deadline (Adams, 2014).
A number of governments are in the process of regulating payments to physicians, which tends to lower payments to the level of ‘fair market value’. Fair market value is a constant topic of discussion at industry conferences devoted to KOLs, and there are entire industry reports devoted to the topic (see, for example, Cutting Edge Information, 2013). The topic is important not because companies want to pay less, but because they want to avoid legally dubious payments that might be seen as inappropriate influence or even bribes.
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Acknowledgements
Research for this article was supported by grants from the Canadian Institutes of Health Research (Catalyst Grant #2009-11-02) and the Social Sciences and Humanities Research Council of Canada (#410-2010-1033). Earlier versions of it were presented at Harvard University, the Université de Montréal and the American Anthropological Association and benefited from discussion with those audiences. In particular, the authors would like to thank Marc Rodwin and the anonymous reviewers for this journal for their thoughtful and careful comments.
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Sismondo, S., Chloubova, Z. “You’re not just a paid monkey reading slides”: How key opinion leaders explain and justify their work. BioSocieties 11, 199–219 (2016). https://doi.org/10.1057/biosoc.2015.32
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DOI: https://doi.org/10.1057/biosoc.2015.32