Is your doctor a “thought leader”?

When a drug company’s sales rep needs to get a doctor to write more prescriptions for his company’s drug, there’s one almost foolproof way to get that task accomplished, according to a revealing National Public Radio report called Drug Company Flattery Wins Docs, Influences Prescriptions.

“To get a doctor to write more prescriptions, the drug rep asks the doctor to become a speaker on the company’s Speakers Bureau.”

For example, drug giant GlaxoSmithKline, like most other drug companies, hires doctors to speak to other doctors as part of their Speakers Bureau marketing efforts. The top GSK drug that their paid Speakers Bureau doctors talk about is called Avodart, a drug prescribed to treat enlarged prostates, and which has been locked in a heated sales battle with its main competition, Merck’s Proscar (now available as a generic).

But over the past five years of these Speakers Bureau presentations, Avodart has seen its sales more than quadruple and its market share double. Convincing a doctor to push your drug to his/her peers during a paid Speakers Bureau presentation really does seem to work.

According to this NPR report (in partnership with the Pulitzer prize-winning investigative journalists from ProPublica), drug companies train their sales reps to approach potential Speakers Bureau doctors in a very specific way. Drug reps use language that deliberately fosters the idea that the Speakers Bureau doctors they hire are educators, and not just educators, but the “smartest of the smart”.

For example, every Big Pharma drug representative interviewed for this report told of using the exact same phrase when approaching a doctor with a pitch to become a paid speaker. Each doctor approached to speak was told that he was being recruited to serve as a “thought leader”.

It feels good to be considered a thought leader (sometimes also called a KOL“key opinion leader”).  The title seems to have incredible psychological power, according to the report. But many drug representatives interviewed have a more cynical view of why drug companies choose the doctors they choose. It’s not about how well-respected the doctor is, they say, but it’s about how many prescriptions he/she writes. One rep reported:

“A ‘thought leader’ is defined as a physician with a large patient population who can write a lot of pharmaceutical drugs. Period.”

Drug companies in the U.S. buy doctors’ prescription data from firms like IMS Health that use pharmacy records to track the drug prescriptions of almost every doctor in the country. They know who prescribes which drug and how much.

And that is what brings us to another hard reality about doctors who are paid to speak about drugs to other doctors, says a drug rep interviewed in the NPR report:

“Although doctors believe that they are recruited to speak in order to persuade a room of their peers to consider a drug, one of the primary targets of speaking, if not the primary target, is the speaker himself.  That’s where reps look for a real increase in prescriptions — after a speech.

“So the way we could get to tell honestly if a speaker event was productive is to look at the hired doctor’s four-week data and see how many more prescriptions he wrote than he used to write. That’s how we knew.”

Drug companies often claim that these physician speaker/salespeople are chosen for their “expertise”.  GlaxoSmithKline, for example, says it selects “highly qualified experts in their field, well-respected by their peers and good presenters.”

But ProPublica found that some top speakers are experts mainly because the companies have deemed them such. Several doctors acknowledge that they are regularly called upon because they are willing to speak when, where and how the companies need them to. Most are required to use company-produced slides and presentation material – and not to veer from that product material. They are usually accompanied by drug company staff who monitor the speaker’s presentations.

New York City sociologist Dr. Susan Chimonas, who studies doctor-pharma relationships at the Institute on Medicine as a Profession, explains:

“It’s sort of like ‘American Idol’. Nobody will have necessarily heard of you before — but after you’ve been around the country speaking 100 times a year, people will begin to know your name and think: ‘This guy must be important!’  It creates an opinion leader who wasn’t necessarily even an expert before.”

The NPR/ProPublica report adds that critics of the industry practice of paying doctors for drug promotion say that when these paid Speakers Bureau presenters promote a company’s drugs, they’re not suggesting what the alternative options could be — whether it’s watchful waiting, physical therapy, or changes to diet and exercise.

Meanwhile, the drug industry’s trade group, PhRMA, claims that the current rules on hiring doctors to promote their drugs are “sufficient”.  A spokesman interviewed for the NPR report said the group was “unaware of any direct evidence that paying a doctor to speak influences his prescribing habits.”

Even so, a growing number of universities and hospitals no longer allow doctors who work on their staff to speak on behalf of drug companies. To find a revealing list of doctors whose organizations and non-profits do allow this, check out the Center for Science in the Public Interest and their Integrity In Science conflict-of-interest project.

And earlier this month, ProPublica published a searchable database of U.S. doctors who have taken money from seven major drug companies in the past two years. Their Dollars For Docs database features over 17,000 doctors, many of whom are paid substantial sums of money to act as speakers for drug companies. But because only these seven drug companies have publicly reported the payments they give to physicians, those doctors represent only a small fraction of the doctors who are actually paid to speak for pharmaceutical companies.

Some accuse doctors who agree to accept money from Big Pharma of being little more than paid sales reps themselves.  One such accusation comes from psychiatrist Dr. Daniel Carlat, who writes:

“There is another type of pharmaceutical representative whose actions remain completely unregulated. These reps have unfettered access to the top academics of all fields of medicine, are invited by medical societies to give keynote addresses, routinely publish articles in the best journals, and offer advice about medications that is accepted as gospel by doctors everywhere. These reps have medical degrees, and some have become millionaires by taking fat payments from drug companies. These are the hired guns of medicine.”

Dr. Carlat should know. His personal experience working on the Wyeth Pharmaceuticals Speakers Bureau is featured in Doctor’s Kiss and Tell Tale: “My One-Year Career as a Wyeth Drug Rep“.

See also:

Read the rest of the NPR/ProPublica report, Drug Company Flattery Wins Docs, Influences Prescriptions.

12 thoughts on “Is your doctor a “thought leader”?

  1. Dr. Carlat’s comments about the influence of drug companies are a welcome alarm to those concerned about the quality of health care. However, he inexplicably also has allied himself with the American Psychological Association’s political campaign to give psychologists the power of the prescription pad based on absurdly little medical education which would be obtained through online courses alone. Perhaps he is trying to shake up his colleagues with such a strange endorsement, but he is risking a cure that is far worse than the disease.

    One can only imagine the influence these brilliant and very well-financed drug representatives will have over psychologists whose medical training and collegial support in the medical field is minimal at best. The kind of legislation Dr. Carlat’s endorsement supports could result in hundreds of thousands of psychologists obtaining prescriptive authority through this less-than-adequate “back door” approach and then exposed to the full onslaught of the pharm industry. The fact that the specialists who have taken more benefits from the drug companies than all others are the psychiatrists shows the degree of risk in putting legions of under-trained psychologists in this position.

    Many of us in psychology hope that Dr. Carlat’s comments are contained to how to best influence psychiatry rather than participating in an extremely ill-advised political campaign by the American Psychological Association to increase the market share and political influence of the organization and its corporate partners.

    • Tim, my understanding is that only two U.S. states currently allow this expanded Rx practice and many PhDs do NOT support it, no matter what Big Pharma or Dr. Carlat promotes.

  2. This is embarrassing for those docs who have been swept up by flattering smooth-talking drug reps and recruited as a “thought leader”.

  3. “….It’s sort of like ‘American Idol‘. Nobody will have necessarily heard of you before — but after you’ve been around the country speaking 100 times a year, people will begin to know your name and think: ‘This guy must be important!’ …..”

    This would be hilarious if it weren’t so embarrassingly pathetic. And dangerous. We’ve already been hearing of drug companies paying billion$ fines for illegal marketing practices to push sales using these co-operative doctors, oops, I mean THOUGHT LEADERS!

  4. And here I thought that sitting in a jam-packed waiting room for OVER AN HOUR past my appointment time while listening to the sounds of chatty laughter coming from my doctor’s back office as he entertained a (pretty, young, blonde) drug rep was worth it because he was being “educated” by her…..

  5. Just saw this for the first time. About 10 years ago an orthopedist performed surgery on both my knees after a serious injury. Only, after some initial improvement each knee began to get worse, much worse. When he could imagine no cause (other than my own fault) I managed a diplomatic divorce.

    Another knee specialist looked at my file and solved the mystery within minutes. The first doc used a method that he himself had stopped using a few years before: Looks good at first, but actually kills the cartilage and leads to worse damage.

    And he reminded me that the first doc is actually an “educator” for the device manufacturer. Between surgeries he had gone on several tours of Europe and Asia to demonstrate the effectiveness of this device and method. My sister-in-law, a radiologist, went on a similar junket in China a couple years ago.

    And, of course, rep work changes their professional judgment in no way whatsoever.

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