Should the drug industry work with key opinion leaders? No

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.