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

The infiltration of pharmaceutical marketing into the world of healthcare practitioners and medical science has been put front and centre by publications such as the British Medical Journal (BMJ). A number of recent articles in the BMJ have given well-deserved attention to the issue of medicine promotion and the controversial strategies employed by drug companies, and in particular, the use of key opinion leaders (KOLs).

The most damaging aspect of the KOL trend is the intrinsic conflict between the interests of pharmaceutical companies’ marketing departments and the interests of patients. As the middle men in this relationship, doctors and medical researchers hold a position of inviolable trust. Treading the fine line between duties to patient health and duties as a KOL for a pharmaceutical company will inevitably place a strain on a physician’s independence. It would be naïve to assume that success as a KOL for the pharmaceutical industry does not divide loyalties between profession and pay cheque. Pharmaceutical companies would not, and could not afford to continue employing experts who failed to achieve their marketing objectives.

As a minimum, more stringent transparency regulations for KOLs would provide a clearer picture of the conflicts of interest and allow other doctors and medical scientists to make informed judgments about the credibility of their message. However, transparency is no substitute for independence. Highly paid KOLs in a long-term relationship with a pharmaceutical company are more likely deliver information that has passed through the dubious filter of the company’s marketing department than they are to present reliable comparative data. Clearly, this represents a real obstacle to informed decision-making by patients and doctors alike.

The influence wielded by KOLs creates a distorted picture of therapeutic value and worse still, helps to extend the reach of that distortion to those responsible for public health and well-being. To counter the influence of KOLs and measure the real value of a medicine, we need more independent voices to discuss new medicines in context, side-by- side with other available treatments and with the fullest possible appreciation of its benefits and potential risks.

A return to independence and integrity must be championed and underpinned by unambiguous regulations to govern interaction between business and medicine. Drawing a line between the market and the research will ensure that the interests of public health trump the interests of the pharmaceutical industry.

Competing interests: None declared