by Dr.Harald Wiesendanger– Klartext
What the mainstream media is hiding
If you want to sell a product, you don’t have to address every single consumer. It’s enough to get a select few well-connected, hugely popular people, “influencers,” to tout it loudly. Then it’s only a matter of time before their recommendation spreads like wildfire. And this is what makes the opinion leaders of the medical profession so incredibly valuable for the pharmaceutical industry – and evidence-based to eminence-based medicine.
Have you always wanted to spend the night in a suite in a five-star hotel for free? Dine at Michelin level in posh restaurants without the waiter bothering you with a bill at the end? Get hold of free tickets for the Olympic Games or a football World Cup, box seat included? Want a free beach vacation in Florida or Hawaii? Fly there in business class without having to buy a ticket? Enjoy the eye candy of provocative girls in exclusive nightclubs whose uniforms look more like gift wrapping? Enjoy yourself in a boozy group of men for zero cents in a luxury brothel?
Would you like to be so important that you can give a much-appreciated speech in front of over a thousand colleagues – and receive around 5,000 euros for it? Would you like to pocket almost 7,000 euros for participating in a six-hour round of talks or nearly 16,000 euros for an essay? (1) Your sound advice, given for eight days, should be worth over 350,000 euros? (2)
Then become a doctor. And bring it to something. Run a larger hospital, preferably a university hospital. Fill a chair. Be a member of the board of your professional society. Publish a medical journal. Get elected in commissions. Either way, it’ll work for sure.
But who pays all the open bills? Who lets the fantastic fees jump? And why at all?
The power of the silverbacks
Among gorillas, things are rarely like in a grassroots democratic debating club. At their head is at least one older male with a silvery-gray back fur – an insignia of power that developed when its proud bearer reached full adulthood. The chief primates direct their group with showmanship and roaring. They block access to power for their peers. Sudden aggressive outbursts are to be expected at any time, as is the emission of scent marks in the event of anger and danger: if the silverback stinks, he has something to say.
In a figurative sense, medicine is teeming with “silverbacks” more than in almost any other area of life. Slightly older men are in charge, often with gray temples and always with an extremely dominant charisma. Listen to them; the herd will follow them. Anyone who resists them can experience something. In the ape kingdom, silverbacks are rewarded for their social position with the ready availability of females – often among humans as well, but above all, with money and prestige.
What behavioral scientists call “alpha animals,” social scientists refer to as opinion leaders or influencers: people who exert the greatest influence within a group as “opinion leaders.” They are held in high esteem. You listen carefully. Quite often, one agrees with their opinions, follows their recommendations, and bases one’s own decisions on them.
For anyone trying to sell a product, human “silverbacks” are of paramount importance. Why should advertising and marketing be limited to arousing the interest and desire to buy directly from the end consumer? Isn’t taking a detour much easier, cheaper, and more effective? Isn’t it enough to win over a few selected, well-connected, extremely popular people to praise the goods as enthusiastically and loudly as possible? Then it’s only a matter of time before their praise spreads like wildfire.
The celebrated propagandist of this approach, Canadian management consultant Malcolm Gladwell, raves in his bestseller Tipping Point (2001): “A declared dead shoe brand that overnight becomes the ultimate fashion item. A newly opened restaurant that immediately becomes an absolute hit. The novel by an unknown author that becomes a bestseller without advertising. There are numerous examples of the magic moment that can set off an avalanche and start a new trend. Like a virus, like an epidemic, the news spreads unstoppably across the board. Just as a single sick person can trigger a flu epidemic, a tiny, targeted push is enough to set a fashion trend, to establish a new product as a mass commodity (…) Little effort can lead to mega success.”
Pharmaceutical companies know this too.
However, marketing a medicine is much more delicate than with other products wherever there is a prescription requirement. If it is not the consumer himself who decides whether he needs it, but his doctor who issues the ration coupon, then it is essential to persuade him to prescribe it. On the one hand, its unrivaled social prestige makes it easier to convince because the patient trusts his doctor to a degree that he would never trust the advertising messages of a manufacturer. On the other hand, hiring doctors to promote sales is much more complicated than hiring a girlie who likes to show off as a YouTube “influencer” for clothes or make-up. After all, doctors are above-average intelligent, educated, critical contemporaries. Aren’t they likelier to see through despicable business interests than the average Joe? Don’t they keep a far greater inner distance from pushy pill sellers?
Eminence instead of evidence-based medicine
The opinion leaders in the medical industry are a great help out of this dilemma – the KOLs, from English “Key Opinion Leaders,” as the masterminds of pharmaceutical marketing call them. Because the practicing physician looks up to KOLs. You teach and research as a professor. During medical training, they stand at the podium. In university clinics, they sit in executive chairs and head professional medical organizations. You organize and lead large specialist congresses. They have distinguished themselves as authors of standard works, editors, or permanent authors of respected specialist journals. They advise and participate in decision-making in important committees and bodies. As experts, you will find open ears among political leaders.
For example, anesthetist J.B. He was a big number in Germany’s top medicine. At congresses and in his courses, the chief physician at the Ludwigshafen Clinic was considered a brilliant speaker. It was only clear that he was often deliberately serving up nonsense to his impressed audience after he was exposed as a brazen data forger in 2010. For years he had touted the drug hydroxyethyl starch (HES), a blood plasma substitute made from corn or potato starch, as a real miracle cure. As he claims to have found out in several of his own studies, HES infusions stabilize the patient’s circulatory system even in the event of immense blood loss and make transfusions superfluous.
J.B. lost his job, his professorship, and his reputation when it was discovered that he had been busily falsifying: In truth, HES not only didn’t help at all, it could cause considerable damage. (3)
Professor H.-J. M., from 1994 to 2012, was the Director of the Psychiatric Clinic at the Ludwig Maximilian University of Munich. He was a top man in his field: as the author or co-author of several textbooks and over 1100 scientific articles, as the editor of leading specialist journals, and as a member and President of numerous specialist societies. He eagerly “advised,” researched, and lectured for at least 14 pharmaceutical giants, from Astra Zeneca to Bristol-Myers Squibb, Eli Lilly, and GlaxoSmithKline to Janssen-Cilag, Lundbeck, Merck, Novartis, and Pfizer. He praised the slimming drug Acomplia in a promotional event by the manufacturer and in an article for the highly respected British Medical Journal for a “favorable risk-benefit profile” – even after the U.S. health authorities had already refused approval of the appetite suppressant because of severe side effects: Depression, suicidal thoughts, anxiety, memory problems, seizures, respiratory infections, nausea, diarrhea. M. also emphatically praised the antidepressant Valdoxan – active ingredient agomelatine – which the European Medicines Agency refused to recognize because it was ineffective. (4)
M. is in the best of company. Professor W. M., Director of the clinic and polyclinic for psychiatry and psychotherapy at the University Hospital Bonn, spokesman for two “competence networks” for dementia funded by the Federal Ministry of Research, chief editor of the leading specialist journal Dernervarzt; From 2012 to 2014 M. was President of the German Society for Psychiatry and Psychotherapy, Psychosomatics and Neurology (DGPPN), and he chaired their annual congresses several times. (5)
One of W.M.’s predecessors in the DGPPN chairmanship (2001/2002), Professor M.S., championed the controversial antidepressants Cymbalta, Solvex, and Cipralex and the neuroleptics Zeldox and Abilify at promotional events by Pfizer, Merz, Pharmacia, and Lundbeck. (6)
As a “consultant” and lecturer for around a dozen pharmaceutical giants, Professor S. K. from the Psychiatric University Clinic in Vienna worked hard. (7) From 2005 to 2009 he was President of one of the world’s three leading societies in his field, the World Federation of Societies of Biological Psychiatry; he chaired the Pharmacopsychiatry Section of the World Psychiatric Association (WPA); from 2012 to 2016 he was a member of the executive committee of the International College of Neuropsychopharmacology (CINP).
Prize question: What kind of treatment for the mentally stressed do such people ensure in their clinics?
Professional ethics mocked
The Austrian journalist Hans Weiss put this to the test. In 2007 and 2008, disguised as “Peter Merten, a freelance strategic consultant” for a Viennese pharmaceutical company, he approached five internationally renowned psychiatrists in leading positions at university clinics or large hospitals. (8) His company had developed an amazing new antidepressant, and he swindled – and made them a temptingly immoral offer. Would they be bought to conduct a clinical study that the World Medical Association classifies as unethical, or at least as ethically questionable: one on critically ill patients with severe depression? The necessary “placebo control” would have required every second person to be deprived of their tried and tested therapy for months, instead only administering an ineffective sham drug – and this even though medical students learn in their first semesters how horrific the psychological strain in severely depressed people is, how significant the risk of suicide is. Mertens offered a fee of 8,000 euros for the head of the study. Per participating patient, of course. With fifty test subjects, that would result in a whopping 400,000 euros.
The devastating result: all five of those baited declared that they were willing to get involved or at least “didn’t shut themselves off” from closer negotiations. Could they violate medical ethics more clearly? The World Medical Association’s Helsinki Declaration states, “the health of my patients shall be my foremost concern. In carrying out his work, the doctor should act exclusively in the patient’s interests. In medical research, considerations that affect the well-being of the subjects take precedence.” (9)
(Harald Wiesendanger)
Remarks
1 Calculated according to the usual average hourly rate and time required by which the pharmaceutical industry remunerated opinion leaders around 2007, see Cutting Edge: Pharmaceutical Opinion Leader Management – Cultivating Today’s Influential Physicians for Tomorrow (2007), quoted from Hans Weiss: Corrupt medicine – doctors as accomplices of corporations, 3rd edition Cologne 2008, pp. 84-86. There has certainly been a generous “inflation adjustment” since then.
2 R Abelson, “Whistle-blower suit says device maker generously rewards doctors,” New York Times, 1/24/2006.
3 Veronika Hackenbroch: “Too good to be true”, Spiegel Online of November 29, 2010: www.spiegel.de/spiegel/print/d-75376536.html.
4 According to Hans Weiss: Corrupt medicine – doctors as accomplices of corporations, loc.cit., p. 148 f., 259.
5 Based on Hans Weiss: Korrupte Medizin, loc.
6 According to Hans Weiss: Korrupte Medizin, loc.cit., p. 169 f., p. 261; Entry on M. S. at Wikipedia.de, retrieved on December 30, 2016.
7 Hans Weiss: Korrupte Medizin, loc.cit., p. 171 f. and 265; Entry on S. K. at Wikipedia.de, retrieved on December 30, 2016.
8 See Hans Weiss: Korrupte Medizin, loc.cit., pp. 141-191.
9 See “WMA Declaration of Helsinki”, www.bundesaerztekammer.de/fileadmin/user_upload/Deklaration_von_Helsinki_2013_DE.pdf, retrieved on December 30, 2016.
This text is part of a series of articles with the following additional contributions:
1) Trained demigods – How doctors become drug dealers
2) Visit from the Rep – Mendacious Friendship based on the script
4) Off label – crossing borders as routine
5) Purchased Observer – When the doctor becomes the “researcher.”
6) How easy – When doctors play “Kick-back.”
7) As you do to me, so do you” – reciprocity as the secret of success
8) Soft Rinsed – education and training as brainwashing
9) Insatiable Renters – The uncanny power of paid opinion leaders
10) Among Gorillas – Silverbacks call the shots
11) As KOL to the Golden Nose – Why “Key Opinion Leaders” have taken care of it
Evidence-Based Medicine, Eminence-Based Medicine, Opinion Leaders, KOLKey Opinion Leaders, Medical EthicsHelsinki Declaration, Influencers, Pharma Marketing, Harald Wiesendanger, Tipping Point, Malcolm Gladwell