5. Possession: Making and Managing Key Opinion Leaders

1 For example, Paul Lazarsfeld, ‘The Election is Over’, Public Opinion Quarterly 8 (1944): 317–330.

2 Elihu Katz and Paul Lazarsfeld, Personal Influence: The Part Played by People in the Flow of Mass Communications (Glencoe, IL: The Free Press, 1955).

3 James S. Coleman, Elihu Katz and Herbert Menzel, Medical Innovation: A Diffusion Study (Indianapolis, In: Bobbs-Merrill, 1966).

4 The industry had made use of opinion leaders prior to the 1950s, as shown by, for example, Nicolas Rasmussen, ‘The Drug Industry and Clinical Research in Interwar America: Three Types of Physician Collaborator’, Bulletin of the History of Medicine 79 (2005): 50–80. However, Katz and colleagues provided tools for thinking about how to use opinion leaders more systematically. An early effort at the concerted and systematic use of opinion leaders by the company Merck Sharp & Dohme, which may owe something to the Pfizer study, is discussed in Jeremy A. Greene, ‘Releasing the Flood Waters: Diuril and the Reshaping of Hypertension’, in Sergio Sismondo and Jeremy Greene, eds, The Pharmaceutical Studies Reader (Oxford: Wiley-Blackwell, 2015), 51–69.

5 Philip Topham, ‘Quantity Does Not Equal Quality in Evaluating a Scientist’s Real Importance as a Key Opinion Leader. lnx pharma whitepaper’, 2010 <http://lnxpharma.com/images/pages/Lnx_Whitepaper_6.pdf> [accessed 29 March 2011].

6 Watermeadow, ‘Rethinking the “KOL Culture”’, Next Generation Pharmaceutical 4 (2007) <http://www.ngpharma.com/> [accessed 29 March 2011].

7 Alice Fabbri, Quinn Grundy, Barbara Mintzes, Swestika Swandari, Ray Moynihan, Emily Walkom, and Lisa Bero, ‘A Cross-Sectional Analysis of Pharmaceutical Industry-Funded Events for Health Professionals in Australia’, BMJ Open 7, no. 6: e016701. For a general account of speaker bureaus, and issues about their conflicts with professional ethics, see Lynette Reid and Matthew Herder, ‘The Speakers’ Bureau System: A Form of Peer Selling’, Open Medicine 7, no. 2 (2013): e31.

8 Quoted in Ray Moynihan, ‘Key Opinion Leaders: Independent Experts or Drug Representatives in Disguise’, British Medical Journal 336 (2008): 1402–1403.

9 Daniel Carlat, ‘Dr. Drug Rep’, The New York Times, 25 November 2007.

10 Quoted in Ray Moynihan, ‘Key Opinion Leaders: Independent Experts or Drug Representatives in Disguise’, British Medical Journal 336 (2008): 1402–1403.

11 Wave Healthcare 2011

12 KnowledgePoint360, Promotional brochure, 2010.

13 Scott Hensley and Barbara Martinez, ‘New Treatment: To Sell Their Drugs, Companies Increasingly Rely on Doctors’, Wall Street Journal, 15 July 2005, p. A1.

14 It is interesting that in other contexts face-to-face communication is much more reliable than written texts at transmitting technical information. In the cases analysed in Science and Technology Studies, the reason for this is the transfer of tacit knowledge, rather than the modelling of behaviour. See, e.g. H.M. Collins, Changing Order: Replication and Induction in Scientific Practice, 2nd edn (Chicago: University of Chicago Press, 1990).

15 Scott Hensley and Barbara Martinez, ‘New Treatment: To Sell Their Drugs, Companies Increasingly Rely on Doctors’, Wall Street Journal, 15 July 2005, p. A1.

16 Adriane Fugh-Berman and Shahram Ahari, ‘Following the Script: How Drug Reps Make Friends and Influence Doctors’, PLoS Medicine 4, no. 4 (2007): e150.

17 Ed Silverman, ‘Novartis Loses Battle with the Feds over Documents for 80,000 “Sham” Events’ STATnews, 30 March 2017 <https://www.statnews.com/pharmalot/2017/03/30/novartis-feds-sham-events-doctors/> [accessed 11 May 2017]; Policy and Medicine, ‘Novartis Kickback Case Will Continue, Rules Federal Judge; What We Can Glean from the Ruling, Policy and Medicine, 29 October 2014 <http://www.policymed.com/2014/10/judge-allows-novartis-sham-speaker-programme-kickback-case-to-continue.html> [accessed 15 May 2017].

18 United States Department of Justice, ‘United States Files Complaint Against Novartis Pharmaceuticals Corp. for Allegedly Paying Kickbacks to Doctors in Exchange for Prescribing Its Drugs’, Justice News, 26 April 2013 <https://www.justice.gov/opa/pr/united-states-files-complaint-against-novartis-pharmaceuticals-corp-allegedly-paying>.

19 Evan Hughes, ‘The Pain Hustlers’, The New York Times, 2 May 2018.

20 Ioannis A. Giannakakis and John P.A. Ioannidis, ‘Arabian Nights—1001 Tales of How Pharmaceutical Companies Cater to the Material Needs of Doctors: Case Report’, British Medical Journal 321, no. 7276 (2000): 1563–1564.

21 Thought Leader Select, Promotional brochure, 2010. See also Thought Leader Select, ‘Our Services’ <http://www.thoughtleaderselect.com/services/> [accessed 4 February 2018].

22 Lnx pharma, ‘We Identify Truly Important Key Opinion Leaders and Undiscovered Connections’ <http://lnxpharma.com/products/key-opinion-leaders/> [accessed 31 March 2011].

23 This was in a personal communication. The joking tone of the statement shouldn’t be read as reducing its seriousness.

24 John Mack, ‘Thought Leader Management – A Challenge Met’, Pharma Marketing News, Physician Education Special Supplement (2006) 12–14.

25 Kimberly Cheryl, Escape from the Pharma Drug Cartel (Denver, CO: Outskirts Press, 2007), 71.

26 Ray Moynihan, ‘Key Opinion Leaders: Independent Experts or Drug Representatives in Disguise?’, British Medical Journal 336 (2008): 1402–1403.

27 Jim Zuffoletti and Otavio Freire, ‘Marketing to Professionals: Key Opinion Control’, Pharmaceutical Executive, 1 October 2006 <http://www.pharmexec.com> [accessed 28 March 2011].

28 Transparency laws differ widely from country to country, some building on industry self-regulation and some developing governmental structures. For a comparison of the transparency policies of nine European countries, see Alice Fabbri, Ancel.la Santos, Signe Mezinska, Shai Mulinari and Barbara Mintzes, ‘Sunshine Policies and Murky Shadows in Europe: Disclosure of Pharmaceutical Industry Payments to Health Professionals in Nine European Countries’, International Journal of Health Policy and Management (2018) <doi 10.15171/ijhpm.2018.20>.

29 Cutting Edge Information, Thought Leader Fair-Market Value: Compensation Benchmarks and Procedures (2009) <http://www.cuttingedgeinfo.com/thought-leader-fmv/> [accessed 3 October 2013]

30 InsiteResearch, ‘Can KOL Management Generate a Return on Investment?’ Next Generation Pharmaceutical 14 (2008) <http://www.ngpharma.com/> [accessed 28 March 2011].

31 Accreditation Council for Continuing Medical Education, ‘Annual Report’ (2012) <http://www.accme.org/sites/default/files/630_2012_Annual_Report_20130724_1.pdf > [accessed 3 October 2013].

32 Quoted in Howard Brody, Hooked: Ethics, the Medical Profession, and the Pharmaceutical Industry (Lanham, MD: Rowman & Littlefield Publishers, 2007), 208.

33 Quoted in Marcia Angell, The Truth About the Drug Companies: How They Deceive Us and What to Do About It (New York: Random House, 2005), 139.

34 Henryk Bohdanowicz, ‘The Synergy of Public Relations and Medical Education’ Communiqué 24 (2009): 14–16 <http://www.pmgrouplive.com/our_business/industry_sectors/pr/communique> [accessed 27 September 2009].

35 Jennifer Fishman, ‘Manufacturing Desire: The Commodification of Female Sexual Dysfunction’, Social Studies of Science 34, no. 2 (2004): 187–218.

36 InsiteResearch, ‘Can KOL Management Generate a Return on Investment?’ Next Generation Pharmaceutical 14 (2008) <http://www.ngpharma.com/> [accessed 28 March 2011].

37 We could read this claim in terms of an Actor-Network Theory account. See Bruno Latour, Science in Action: How to Follow Scientists and Engineers through Society (Cambridge, MA: Harvard University Press, 1987).

38 The term ‘key opinion leader’ (‘KOL’) remains the pharmaceutical industry’s most commonly used term to describe influential doctors, preferred in 62% of companies, followed by ‘thought leader’ in 14%. Cision PR Newswire, ‘Global Survey Reveals “Key Opinion Leader” (KOL) is the Most Commonly Used Term by Pharmaceutical Industry’, 19 September 2017, <http://www.prnewswire.com/news-releases/global-survey-reveals-key-opinion-leader-kol-is-the-most-commonly-used-term-by-pharmaceutical-industry-300521632.html>.

39 InsiteResearch, ‘The Prescription for KOL Management’, Next Generation Pharmaceutical 12 (2008), <http://www.ngpharma.com/> [accessed 28 March 2011].

40 David Healy, ‘Shaping the Intimate: Influences on the Experience of Everyday Nerves’, Social Studies of Science 34, no. 2 (2004): 219–245.

41 John Virapen, Side Effects: Death – Confessions of a Pharma-Insider (College Station, TX: virtualbookworm.com, 2010), 47.

42 Watermeadow Medical <http://www.watermeadowmedical.com/> [accessed 3 March 2009].

43 We might see a rough parallel to the supposed ‘hostile worlds’ of commerce and intimacy that, for example, Viviana Z. Zelizer describes in ‘The Purchase of Intimacy’, Law & Social Inquiry 25, no. 3 (2000): 817–848.

44 For a fuller account of these interviews, see Sergio Sismondo and Zdenka Chloubova, ‘“You’re Not Just a Paid Monkey Reading Slides”: How Key Opinion Leaders Explain and Justify Their Work’, BioSocieties 11, no. 2 (2016): 199–219.

45 Emily Martin, ‘Pharmaceutical Virtue’, Culture, Medicine and Psychiatry 30, no. 2 (2006): 157–174, at 167.

46 Carl Elliott, White Coat Black Hat: Adventures on the Dark Side of Medicine (Boston: Beacon Press, 2010): 108.

47 Dr F, ‘Comments on Dollars for Docs’ <http://www.propublica.org/article/profiles-of-the-top-earners-in-dollar-for-docs> [accessed 31 March 2011].

48 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, e.g., Cutting Edge Information ‘KOL fair-market value and aggregate spend’ <http://www.cuttingedgeinfo

.com/thought-leader-fmv/> [accessed 3 October 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.

49 Christophe Van den Bulte and Gary L. Lilien, ‘Medical Innovation Revisited: Social Contagion versus Marketing Effort’, American Journal of Sociology 106, no. 5 (2001): 1409–1435.

50 The phrase ‘self-fulfilling prophecy’ is owed to sociologist Robert K. Merton, ‘The Self-Fulfilling Prophecy’, The Antioch Review 8, no. 2 (1948): 193–210. Coincidentally, Merton worked closely with Paul Lazarsfeld, including on opinion leaders.

51 Besides Merton’s ‘self-fulfilling prophecy’, there are a number of other recent accounts of this kind of ‘performativity’ of models. At issue are such things as ‘looping effects’ in medicine and the social sciences and ‘bootstrapped induction’. See Ian Hacking, ‘The Looping Effects of Human Kinds’, in Dan Sperber, David Premack and Ann James Premack, eds, Causal Cognition: A Multidisciplinary Debate (New York: Oxford University Press, 1995), 351–394; Barry Barnes, ‘Social Life as Bootstrapped Induction’, Sociology 17, no. 4 (1983): 524–545. A prominent group of scholars has been examining how models in economics in general, and finance in particular, ‘perform’ themselves. See, e.g. Donald MacKenzie, Fabian Muniesa and Lucia Siu, eds, Do Economists Make Markets? On the Performativity of Economics (Princeton, NJ: Princeton University Press, 2007).