Intended for healthcare professionals

Feature Christmas 2018: Look Before You Leap

Key opinion leaders’ guide to spinning a disappointing clinical trial result

BMJ 2018; 363 doi: (Published 13 December 2018) Cite this as: BMJ 2018;363:k5207
  1. Adam Hartley, academic clinical fellow1,
  2. Mit Shah, registrar2,
  3. Alexandra N Nowbar, clinical research fellow1,
  4. Christopher Rajkumar, academic clinical fellow1,
  5. James P Howard, clinical research fellow1,
  6. Darrel P Francis, professor1
  1. 1National Heart and Lung Institute, Imperial College London, London, UK
  2. 2Hammersmith Hospital, Imperial College NHS Healthcare Trust, London, UK
  1. Correspondence to: D P Francis darrel{at}

Adam Hartley and colleagues present a playbook for commenting on trials with disappointing results

The onward march of medical science is marred by a great deal of shuffling on the spot, since most wonderful ideas turn out to not work. To maintain a perception of an advancing tide of discovery and excitement, drug and device companies selectively promote specialty experts who can be relied on to provide an upbeat view in all situations. Internally, companies call them “key opinion leaders.”

When key opinion leaders are asked to comment on disappointing trial results in news reports or at conferences, we have observed that they seem curiously unable to recognise that the treatment doesn’t work. They prefer to argue that the trial design was wrong, drawing from a set of stereotyped criticisms. Using cardiology as an example, we have systematically analysed the excuses they provide to compose the Panellists’ Playbook, an anthropological classification that will be useful not only for readers but for key opinion leaders in need of inspiration (or backbone).

Compiling the playbook

We reviewed five years of reports from the world’s three largest cardiology annual scientific congresses—European Society of Cardiology, American Heart Association, and American College of Cardiology—examining remarks made to large news organisations that maintain a database: Medscape and MedPage Today.1 …

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