Friday, January 29, 2010

The New KOL: Your Local Community Doctor

Matthew Herper, contributor to Forbe's The Science of Business blog, suggests that an "unintended consequence" of regulating financial conflicts of interest in medicine -- eg, academics taking big speaking fees from drug companies -- is that the drug industry "can make experts out of community docs, then use those for speaking. Cutting them [drug companies] off from paying the academics just keeps the academics out of the system. It doesn't get rid of the system" (see "The Pharma Marketing Hydra").

I found this insight interesting because I just finished writing a Pharma Marketing News article related to this issue: "Corporate Reputation in the New Media World: Influencing the New Influencers" (PMN reprint #91-02). In that article, Gary Bartolacci, Senior Director, Kantar Health, cited research that questioned the traditional idea of thought leaders being perceived and defined by prestigious titles, number of publications, and speaking engagements. Other physicians may not fit that definition but are nevertheless quite influential, said Bartolacci, especially at the local and regional levels.

Influential physicians who are hired by pharmaceutical companies to speak about new therapies to other physicians are called "key opinion leaders" (KOLs). The problem with traditional KOLs is that many of them are usually so busy that they may not have the time to participate speaking programs.

But more and more KOLs are facing a more difficult choice: either stop moonlighting as a paid speaker for pharmaceutical companies or quit their jobs at top medical schools and teaching hospitals that restrict or ban participation in speakers’ bureaus.

Recently, the Boston Globe reported that Lawrence DuBuske, "an allergy and asthma specialist and a Harvard Medical School instructor [and Executive Editorial Board Member of the journal Allergy & Asthma Proceedings], will resign from Brigham and Women’s Hospital at the end of the month" (see article). As I reported in the article "Pharma Begins to Reveal Payments to Physicians" (PMN Reprint #91-03; also see this Pharma Marketing Blog post: "Why Does GSK Prefer New York Physicians & Will Governor Patterson Ruin It for Them?"), DuBuske received the highest total payment made by GSK for speakers in Q2 2009: $99,375.

Not many physicians on GSK's KOL payment list received nearly as much money as did DuBuske. Here's what GSK's distribution of payments looks like:

Key opinion leaders may also be found online using social media tools like Facebook and Sermo. “There may be newer doctors who are incredibly influential on social media sites who are not considered key opinion leaders in the real world or who are completely unknown to companies,” noted Bartolacci.

I find it interesting that the "unintended consequence" of physician payment sunshine laws may actually be helpful to the drug industry by encouraging it to break away from the academic KOL strategy to what may be a more effective strategy of using community doctors. And by "community," I also include online communities like Sermo (see "Pfizer has a Gold Mine in Sermo!").

See "Corporate Reputation in the New Media World: Influencing the New Influencers"


  1. I'm all for the Sunshine Act and transparency to know how deeply connected physicians are with pharma. And, while I can't imagine much change when it comes to using academically connected KOLs for clincial trials and the like, the impact on public relations could be least among traditional media.

    The lifeblood of public relations is media relations, which means getting a reporter to cover your story. In 20 years on this side of the business, reporters from top tier (USA Today, WSJ, NYT, Today Show and so on) to local outlets (ranging from the Miami Herald to The Times Herald Record) want a bonafide expert to comment on a disease or treatment. And, expert is not your family doctor in a private practice with privileges at the community hospital. An expert, in this case, has a university position or a significant hospital name/title to their credit.

    I trust my peers will find a meaningful path forward. But, I'm hard pressed to imagine a doc with limited affiliation finding themselves touted as an expert on Oprah or within the NYT.


  2. Marian,

    Thanks for your comments.

    Did you see last night's PBS News Hour? While it did feature experts, it also included videos that a couple of "ordinary" people submitted to its YouTube site. I see more and more news shows doing this.

    The more people (ie, consumers & physicians) hear about highly paid KOLs like DuBuske, the more they will distrust "experts."

    As for physicians, they like everyone else, are abandoning traditional media and being influenced by peers in other contexts, including social media.

    Also, the use of KOLs for media relations is one thing, but most of the pharma money goes to thousands of non-academic physicians who have local influence.

    I suspect the media KOLs you speak of are primarily useful for influencing analysts!

  3. Marian's comments seem salient if the aim is to influence patients via popular media but I wonder if the goal of developing KOLs within a social media context is (or ought to be) more about physicians influencing other physicians. With the many regulatory and messaging pitfalls of engaging with patients online, pharma has it's work cut out. In addition, within an online community of physicians, the primary measure of stature is how much you contribute to that community. As John points out, the physicians who have traditionally been tapped by pharma as KOLs are a busy bunch and so their at a disadvantage in an online community if they can't find the time to establish their thought leadership there. Talented docs who are otherwise unknown because they haven't published a lot or held prestigious academic or research positions can make a name for themselves in an online community where they eat what they kill, i.e., if their online peers find their contribution intelligent and helpful then they will become a key opinion leader even if they are not a KOL.

  4. As John points out, the physicians who have traditionally been tapped by pharma as KOLs are a busy bunch and so their at a disadvantage in an online community if they can't find the time to establish their thought leadership there.


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