Rapid Responses to:

HEAD TO HEAD: Giovanni A Fava Should the drug industry work with key opinion leaders? No BMJ 2008; 336: 1405 [Full text]

Rapid Responses: Submit a response to this article

Rapid Responses published:

Trust me, I'm a doctor.

Michael G Serpell   (30 June 2008)

Trick or Treat?

Christopher L. Manning   (7 July 2008)

Key opinion leaders or drug pushers?

Abid Jameel   (3 September 2008)

Trust me, I'm a doctor. 30 June 2008
Michael G Serpell, Consultant & Senior Lecturer in Anaesthesia University Dept. of Anaesthesia, Gartnavel General, Glasgow, G12 0YN Send response to journal: Re: Trust me, I'm a doctor.	I read with interest the head to head debate on whether opinion leaders should be involved with the drug industry. This is an increasingly emotive subject and one which often results in the propagation of extreme stories of doctors being bribed by lavish hospitality.1 I think opinion leaders are a different breed from normal prescribers, and I am more inclined to agree with the view of Buckwell in his defence of the relationship. He quotes that "...neither medicine nor industry can realise their true value independently of one another." However, we need "..to more precisely define that role to minimize suspicion and misunderstanding.”. The vast majority of opinion leaders do not have a "...a long term relationship..." which Fava defines as ".. a substantial conflict." of interest in his argument against the relationship. Evidence from NICE confirms that those "experts" involved in research are not biased in favour of industry sponsored treatments, but give a well balanced view.2 It is this critical eye which empowers researchers to analyse what is presented to them and interpret its relevance to their own patients, and to their colleagues. This is, after all what Kimberly Elliot (an ex sales drug rep who speaks against the relationship), urges doctors to do. She urges doctors to take presentations from opinion leaders "..with a grain of salt and go back and do your own research". That is precisely what opinion leaders seek. Clinicians need to foster an attitude of continual research and evidence collection. Pharma deliver the tools for us to use, but there are so many more issues we need to answer ourselves. In what order should we institute a therapy amongst the options available, and what regimen of therapy combinations (both drug and non drug) is most beneficial? Clinical research has reduced by 50% since the EU Clinical Trials Directive came into practice in 2004.3 The NHS needs to combine resources with industry and collaborate in a transparent and proper way if we are to stand any chance of answering these important questions. 1. Name and shame 'bribed' doctors. Tamara McLean. Heraldsun.com.au October 31, 2007 <http://www.news.com.au/heraldsun/story/0,21985,22679124- 5005961,00.html> accessed June 29, 2008 2. Lyratzopoulos G, Hoy AR, Veeramootoo D, Shanmuganathan NV, Campbell B. Influence of expert clinical adviser characteristics on opinions about interventional procedures. International Journal of Technology Assessment in Health Care 2008; 24: 166-169. 3. Clinical Trials Directive likely to turn Europe into the poor relation of clinical academic medicine. News-Medical.Net. Friday, 28 Sep 2007 <http://www.news-medical.net/print_article.asp?id=30493> accessed June 29, 2008 Competing interests: I have participated in both drug company sponsored and non commercial research. I have been a paid speaker at several educational events, but have always insisted and been allowed complete freedom to speak on content. A good scientific reputation is too important to throw away for a mere honorarium.
Trick or Treat? 7 July 2008
Christopher L. Manning, Director, Upstream Healthcare Twickenham TW11 9HG Send response to journal: Re: Trick or Treat?	Dear Editor, I have often wondered how many patients have to be treated with drug X to enable a single doctor to attend the usual pan-global multi-pharma giga-conference and suggest that such a number should be the real "Number Needed to Treat"? Yours Sincerely Dr Chris Manning Competing interests: I have many opinions and none of them are available for purchase or sale.
Key opinion leaders or drug pushers? 3 September 2008
Abid Jameel, Assistant Professor of Medical Oncology Postgraduate Medical Institute, Khyber Medical University, Peshawar (Pakistan) Send response to journal: Re: Key opinion leaders or drug pushers?	Having attended (and presented at) quite a few "Continuing Medical Education" programs in the past I have come to a strong conclusion that the ones that are solely sponsored by pharmaceutical companies are nothing more than "Continuing Advertisement of Specific Products." These pharmaceutical company sponsored CMEs are all focused on the drugs manufactured by that particular company. KOL invited by these companies will go all out to convince the audience (gathered for a free meal mainly) that a particular drug has done wonders. They will come up with all sorts of graphs and curves to prove that the drug being talked about has "significant" superiority over others. Even the slides that they present are all provided by the company. On occasions, they appear more like drug pushers rather than KOL. The main focus of KOL (who receive hefty honorarium for their loyalty) is not on the audience but on the company representatives sitting at the back of the hall. If they feel happy with the presentation and the convincing power of the speaker, that KOL will get another invitation to another exotic place and another fat cheque. A very shadowy relationship indeed. I doubt that any one paid by a company will talk against the drug of that particular company or say anything positive about the competitor even if the competitor drug is better. Conflict of interest definitely arises because of the money being spent on the speaker by the company. I have heard a KOL talk about the advantages of one particular drug in a particular indication on one occasion and about another drug for the same indication on another occasion. The only difference was that the two CMEs were sponsored by two different companies who happpened to invite the same speaker on the same topic. CMEs sponsored by neutral professional organizations or academic institutions that invite and sponsor the speakers themselves may be somewhat different. Since no drug company is directly involved in inviting the speaker, their presentations are neutral and more academic in nature as there is no conflicting interest in this situation. It is this type of pharmaceutical company free activity (with no direct link between the speakers and the companies) that needs to be encouraged. To be unbiased, I suggest attending CMEs that are not directly sponsored by drug companies and where speakers can present there own opinions without being influenced by anyone. Competing interests: Been a speaker at a few CMEs in the past.