Key opinion leaders: independent experts or drug representatives in disguise?

We read with interest Ray Moynihan's piece about Key Opinion Leaders and would like to describe another "communication platform" the pharmaceutical industry use to influence the prescribing habits of doctors.

Whilst not strictly a condition of employment, many Deaneries promote doctors.net.uk and request that medical students and foundation programme doctors open email accounts with the company(1)(2)(3).

Accounts allow access to fora where doctors can discuss cases, resources including the Oxford Textbook of Medicine and CPD accredited online educational modules. But is it the service Deaneries should be promoting?

The company claims to be run "by doctors, for doctors". However, CEO Richard Adams "began his career as a medical representative for Wellcome" and Operations Director Paul Concannon has "22 years' experience in the pharmaceutical industry." The company receives funding from pharmaceutical companies who in return market their products to a selection of the 154,000 doctors who subscribe to the service.

The website describes their marketing methods (see doctors.net.uk/marketing). One campaign to "increase the depth of prescribing" utilised a "key opinion leader webcast". A "market development campaign" delivered "3,500 accredited disease education modules" to doctors. Colourful graphics demonstrate the significant effects their marketing campaigns have upon "knowledge", "prescribing" and "prescribing intentions".

It is known that contact with the pharmaceutical industry can adversely affect the prescribing habits of doctors. For example, three in four randomised controlled trials published in major journals are funded by pharmaceutical companies (BMJ 2003;326(7400): 1202-5) with sponsored trials four times more likely to find that therapies offer benefit (BMJ 2003; 326: 1167–1170). 80-95% of doctors regularly see drugs reps. Statements made by reps are often inaccurate, doctors do not pick up on these errors and errors almost always favour the product (JAMA 1995;273: 1296-1298). Physicians who rely on pharmaceutical companies for information are less likely to prescribe rationally (Soc Sci Med 1982; 16: 2017-23).

Whilst data needed to establish the magnitude of the effect online marketing has on prescribing practices is not freely available, pharmaceutical companies and doctors.net.uk apparently find this to be a profitable investment.

Deaneries are charged with turning graduates into competent doctors that prescribe drugs rationally on the basis of objective evidence.

It is therefore highly regrettable that they are encouraging medical students and doctors to have pharmaceutical company sponsored email addresses.

1. Doctors.net.uk official press release regarding deaneries www.doctors.org.uk/_datastore/pdf/deaneries.PDF

2. North Central Thames Foundation School registration form for final year medical students who have accepted foundation year posts has a doctors.net.uk email address as 'essential': http://www.ucl.ac.uk/medicalschool/nctfs/forms/Registration%20Form%20NCTFS%20 -%20entry%202008.pdf

This is reached through the page headed North Central Thames Foundation School NCTFS Requirements and Policies: http://www.ucl.ac.uk/medicalschool/nctfs/policies/

3. A Doctors.net.uk promotion sent to sucessful foundation programme applicants by the London deanery via NHS foundation application system website, a screeshot of the promotion is available online at http://i314.photobucket.com/albums/ll404/Sam_Jones_99/Doctorsnet.jpg

Competing interests: None declared