Last week, I wrote about the Allergan-sponsored “independent” Continuing Medical Education (CME) video lectures that dropped into my mailbox. The gossamer-disguised advertisement promoted Allergan’s Lap-Band bariatric surgery product.
The Lap-Band is Allergan’s fastest-growing money-spinner, with sales up 35.5% on last year, though their collagen and Juvederm dermal fillers and Botox are also putting in strong showings. Allergan is also testing Lumigan (bimatoprost), a prostaglandin eyedrop that makes women grow longer eyelashes, and has just purchased Inamed, a company that makes silicone breast implants.
Allergan are in hot competition with Johnson & Johnson in the gastric band market. J & J’s product is the Swedish Adjustable Gastric Band, branded “Realize” in the US. The direct-to-public marketing of the two companies, shiny and rich with testimonials, information seminar invitations, and Find-A-Surgeon widgets, can be found at weightlosssurgery.com.au and gastricbandingsurgery.com.au.
“HealthEd’s speakers are considered to be leading clinical and scientific authorities in their respective fields (“key opinion leaders”).”
“Key Opinion Leaders”? That’s NewSpeak, isn’t it?
Well, yes. KOLs are also known at “Thought Leaders” in the pharmaceutical industry, and they are exactly what you think they are – doctors who authoritatively present promotional material for particular products to other doctors, all in the name of “education”.
This week’s British Medical Journal has an article by Ray Moynihan on Big Pharma’s use of Key Opinion Leaders. Nick Miller from the Age sums up:
Pharmaceutical companies consider the doctors in their pay to be little more than salespeople spruiking their products, a drug industry whistleblower has admitted in a prestigious medical journal.
In response, the British Medical Journal has called for medical leaders to stop accepting personal payments for promoting a company’s drug or device. Companies pay “key opinion leader” doctors up to $6000 a day to deliver lectures to boost sales of new drugs. They give them slides for their presentations and train them in what to say and what not to say.
Ray Moynihan, co-author of “Selling Sickness: How Drug Companies Are Turning Us All Into Patients” and one of the few really good medical/scientific journalists out there, has long campaigned against industry “disease mongering” and pharmaceutical-company influence on medical education.
Moynihan’s BMJ article is titled: “Key opinion leaders: independent experts or drug representatives in disguise?”. An excerpt:
In the world of medicine, “key opinion leader” is the somewhat Orwellian term used to describe the senior doctors who help drug companies sell drugs. These influential doctors are engaged by industry to advise on marketing and help boost sales of new medicines. Across all specialties, in hospitals and universities everywhere, many leading specialists are being paid generous fees to peddle influence on behalf of the world’s biggest drug companies.
Kimberly Elliott, who was a drug company sales representative for almost two decades in the United States, puts it directly. “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 said. “If that speaker didn’t make the impact the company was looking for, then you wouldn’t invite them back.”
Moynihan specifically examined the HealthEd business several months ago, in feature article “Doctors’ education: the invisible influence of drug company sponsorship” .
In the case of one popular Australian provider of medical education, HealthEd, leaked documents and emails from a range of sources show drug company sponsors having input into the selection of some speakers at seminars held in recent years, despite the fact that these have been aggressively sold to general practitioners in brochures claiming that “all content is independent of industry influence.”
Another set of leaked emails features communications between the same educational provider and CSL, the company that markets the analgesic tramadol (Tramal) in Australia. While negotiating sponsorship arrangements with the provider, for a planned session on headache, a CSL representative writes that the company would like HealthEd to “determine the speaker’s opinion re: Tramal as I would like to ensure he positions it appropriately.” HealthEd replies that it “will reconfirm opinion of headache speaker re: Tramal to ensure balanced presentation.”
In another email the drug company Organon, now part of Schering-Plough, writes that “we would like to put forward the following two doctors for consideration” as speakers for a seminar on women’s health. The educational provider replies, “We will do our best to accommodate your request.” The drug company’s suggested speakers are ultimately accepted, provoking this grateful response to the educational provider: “I would like to again sincerely thank you for the political help . . . in respect of orchestrating the favourable consideration of the proposed topic and speaker.“
Around the time of the HealthEd exposé, Ray Moynihan conducted an episode of ABC’s “Background Briefing” featuring interviews with Ramesh Manocha (HealthEd Convenor) and a number of medical doctors and medical education professionals. In this episode, Paying the medical piper“, Moynihan reveals that the code used between HealthEd and its sponsors for the right to nominate speakers and dictate topics is “platinum sponsorship”. There is a lot of ground covered in the full transcript, but here’s a snippet:
Ramesh Manocha: The reason why our seminars are very popular, is because they feel that the information they are getting is independent, and if they didn’t think it was independent, they didn’t get that impression, they wouldn’t come back.
Ray Moynihan: Were GPs attending those seminars told that sponsors had an entitlement to suggest speakers?
Ramesh Manocha: No, but they were told that the topics were sponsored.
Ray Moynihan: Why weren’t they told that the sponsors had an influence, had the ability to suggest speakers? Do you think that would have been good thing to have told them?
Ramesh Manocha: Well, in hindsight, possibly, yes.
Ray Moynihan: That’s Dr Ramesh Manocha, the Director of Healthed, which he says educates more than 2000 Australian GPs every year.
Ramesh Manocha claimed to Moynihan that the leaked emails and documents were two years old, and that guidelines had been “tightened up” since then to ensure independence:
And as I said before, we have first of all ceased operating those seminars where we associated with sponsors that want us to influence the content in that way. Secondly, we came to recognise that this was an expectation from some sponsors but not others. And so we put into place specific guidelines and stricter and more stringent guidelines to prevent that.
I think it is also obvious from the advertising HealthEd sent me that they are still bathing in the big pharma faux-education  money-fountain. And their 2008 HealthEd prospectus still says:
“The sponsor can work with you to determine a topic that is on message for your product area.”
A minimalist, slapdash “disclosure” approach is simply not working to release the grip that the pharmaceutical (and nutritional) industries have on medical education and research. From lecture-orchestration to research ghost-writing, big business vets and massages a huge proportion of the information health professionals receive.
True disentanglement is the only viable solution. We’ve been through this all with Big Tobacco, we’ve gone dozens of rounds with the infant formula and pharmaceutical industries, and still we don’t seem to have learned our lesson yet.
 BMJ 2008;336:1402-1403 (21 June), doi:10.1136/bmj.39575.675787.651
 BMJ 2008;336:416-417 (23 February), doi:10.1136/bmj.39496.430336.DB
 Is “phauxducation” too awkward a portmanteau?