by Dr.Harald Wiesendanger– Klartext
What the mainstream media is hiding
Harnessing the “opinion leaders” of the medical profession is of paramount importance for drug manufacturers. But how do pharmaceutical companies actually know how important and valuable a certain white coat is? Professional data collectors provide a clear perspective – for astronomically high compensation.
Influence is relative. The bigger, the more lucrative – for the “influencers” as well as for those who use them for their own purposes. “Cutting Edge Information” (CEI) in Durham, North Carolina, a consulting company specializing in the pharmaceutical industry and founded in 2002, helps to assess the business value of medical silverbacks and reward them appropriately. Of the 25 largest drug manufacturers worldwide, 22 use CEI services. (1) Their annual “Pharmaceutical Compliance” congresses each attract around 500 top managers. (2)
Thanks to CEI, we finally know that medical professionals have a “fair market value” (FMV) just like commodities, stocks, companies, and any other economic good – and that Big Pharma can calculate it razor-sharp for marketing purposes once they have bought CEI’s expertise. More than 140 CEI studies (3) illustrate how well thought-out the industry lures, cherishes, and nurtures coveted KOLs, “Key Opinion Leaders” – and uses them like a military commander. They explain how to “manage” such top people, give them appropriate “compensation,” – and measure the extent to which they are of business use (“return on investment”).
To the image above: Knows the market value of medical opinion leaders from the pharmaceutical service providers “Cutting Edge Information.” Right: Excerpt from the CEI customer list as of May 2019
The prices charged give an idea of the enormous value corporations attach to such information: A single customer pays USD 7,695 per CEI report (“single-user license”). An “unlimited license” for multiple readers costs a whopping $23,995. (4)
The “fair market value” of the Opinion Leader
What does Big Pharma get for it? For example, an elaboration entitled “Administration/Management of Pharmaceutical Opinion Leaders” is designed to “enable in-house teams to build relationships with opinion leaders and operate KOL databases.” It also highlights “which KOL activities are most useful to the organization” while avoiding “overusing” by individual opinion leaders. Another CEI report, “Promotional Speaker Programs,” offers “innovative, easy-to-implement strategies and best practices to make speaking events more effective and profitable” – one of which is that the speaker needs to answer all “questions about the products in one place.” answered positively.” The CEI report on continuing medical education states that its “success” depends “on recruiting the right speakers with a large sphere of influence.” Other CEI material helps measure “the fair market value of KOLs” and reward them appropriately – while of course avoiding the appearance of corruption. (5)
According to CEI data, pharmaceutical companies bribe up to 16,500 “leading” medical professionals worldwide to drum up publicity in various ways – an average of 259 per company. Opinion leader management is worth an average of US$ 61 million per year to a large pharmaceutical company, in some cases up to US$ 300 million.
The sales value of a KOL is measured according to ten characteristics: (6)
• years of professional experience
• Number of publications per year
• Number of speeches delivered per year
• Doctor category (provider category)
• Geographical reach (geographic influence)
• Clinical research background
• Rapid adoption of new products (early-adopter profile)
• Education level
• Level of annual advising fee funding
• Level of annual grant funding
No one knows better than CEI how to quantify all of this – no KOL should receive a penny too much, but also not too little. The scientific database Web of Science provides information about which authors have published how much on which disease. For example, one learns that in 2011, among the 100 most frequent authors of publications on multiple sclerosis, two luminaries from Italy performed top-performing: first and foremost a certain Massimo Filippi with no less than 606 articles, followed by Giancarlo Comi with 453. (7) It goes without saying that these two gentlemen are the first to be targeted by any corporation wanting to hype up a brand-new MS drug.
On several hundred document pages, CEI lists the fees that the world’s 46 largest drug manufacturers, from Bayer to Novartis, Roche, and Pfizer to Eli Lilly and Bristol-Myers Squibb, paid to opinion leaders – depending on their “fair market value” (FMV).
Between the Champions League and City Championship
When it comes to ranking, the specialist in pharmaceutical marketing and “medical opinion-making,” the sought-after market leader in this area, follows a five-level model (8) that is customary in the industry and is reminiscent of league structures in football.
Rank 1: The international stars of medicine play in the Champions League. You are considered highly influential among professional colleagues, enjoy a worldwide reputation, publish at least eight publications and eleven advertising lectures per year, have contributed to therapy guidelines, and helped to organize symposia. You studied at a well-reputed university and teach at one. You are eloquent and have strong business acumen. A third of the total “Opinion Leaders” budget goes to their accounts. Her usual hourly rate is $578, peaking at $3000.
Rank 2 and 3: Doctors who have made a name for themselves at the national level play in the first and second League. Second-rate earn an average of $385 per hour (maximum 2500), third-rate $244 (maximum 1000).
Rank 4: The regional league includes doctors who are highly regarded in the wider catchment area of their practice. Their work is worth an average of $205 an hour to the industry (maximum $300).
Rank 5: The leaders of city championships are doctors who are particularly well-known in their practice location. Your usual hourly rate in pharmaceutical services is 184 dollars, at most 300. However, like the regional league teams, you should not underestimate them, warns “Cutting Edge”; they could prove to be excellent “workhorses” and turn a therapeutically inferior remedy into a hit on the spot.
In addition, a cooperative doctor of any rank can snag substantial “extra perks.” (9) The average cost of speaking at a marketing event is $2,111; for a scientific lecture 3145; for a short review, i.e., a summary of already published studies 2725; $3,726 for writing a manuscript; to attend a meeting of the company’s “advisory board” 2940; for moderating them 3607; for its chairmanship 3664. Depending on the field, even more is possible: if the “advisor” is a well-known cancer specialist, he gets an average of 5388 dollars per assignment, a gastrointestinal expert, 7753 dollars.
Because outstanding “opinion leaders” don’t just work for one, but usually for several companies – the hardest working ones manage one to two dozen – they can definitely get annual pharmaceutical grants of over a quarter of a million dollars.
In Europe, the fee rates customary in the industry should not deviate too much from American conditions. The numbers given here are as of 2007; the medical journalist Hans Weiss came across them in CEI documents. They are unlikely to have dropped by now.
Are “monetary benefits of a reasonable amount” harmless?
Bribes often flow to silverbacks in the form of commissions, as the “Implant Files” showed at the end of 2018, the scandal surrounding the dirty business with inferior medical aids. A senior surgeon who has preferred the implants of a specific manufacturer for years can undoubtedly achieve six-figure sales bonuses.
Instead of firmly putting an end to the shady goings-on, the model professional code of conduct for doctors largely approves of it, with a half-hearted qualification: ”The acceptance of pecuniary benefits,” according to paragraph 33, paragraph 4, “is for participation in scientific further training events not illegal,” as long as it remains “at a reasonable level.” How about finally including a suggestion from US doctor Edwin Fuller Torrey? For each congress presentation, a notice should be placed in a visible place next to the podium, such as: “For this contribution, Dr. Smith $3,500, a business class airline ticket, and lodging at a four-star Eli Lilly & Co hotel.” (10)
With all these benefits, the focus is on the effort to build up the pressure of expectation of a return service and permanent, close contact, in the course of which the person being courted should lose the distance. And often enough, it obviously succeeds.
The fact that a professor’s proximity to industry, no matter how pronounced and extremely profitable, leaves completely unaffected how he trains his students, what he says in lectures, writes in his manuscripts, at congresses, and in specialist committees, is an extremely daring one, anything but evidence-based Hypothesis – but rather a pious wish.
The mischief of the KOLs is one of the excesses of a health system geared towards “pathological profit,” which “sets up so many scandalous false incentives that it is hardly possible to speak of medicine for people anymore.” At least the “Doctors for Enlightenment” find such clear words. When will such initiatives finally reach enough peers so that human medicine becomes more humane?
(Harald Wiesendanger)
Remarks
1 www.cuttingedgeinfo.com/, retrieved on 18.5.2019.
2 See www.cuttingedgeinfo.com/events.
3 www.cuttingedgeinfo.com. See the CEI papers Pharmaceutical Thought Leaders 2007, Thought Leader Compensation: Establishing Fair-Market Value Procedures; Pharmaceutical Opinion Leader Management – Cultivating Today’s Influential Physicians for Tomorrow 2007, and Pharmaceutical Thought Leaders – Determining Fair Market Value and Measuring ROI, quoted from Hans Weiss: Korrupte Medizin (2008), pp. 77-86. With his persistent undercover research, Weiss has made lasting contributions to more ethics in medicine.
4 According to Patients’ View, February 18, 2016: “The consulting company “Cutting Edge Information” and its reports on KOL and ROI”, https://patientensicht.ch/artikel/beratungsunternehmen-cutting-edge-information-its-reports-ueber-kol -roi, accessed 2019-05-18.
5 Quotation from the patient’s point of view, February 18, 2016, loc.
6 CEI report PH122: “Key Opinion Leaders” (2009), quoted from patient perspective, loc.cit.
7 According to patient perspective, October 7, 2012: “The most frequent multiple sclerosis publication authors,” https://patientensicht.ch/artikel/haufigsten-multiple-sklerose-publikationsautoren, retrieved on May 18, 2019.
8 Hans Weiss: Corrupt Medicine (2008), p. 80 ff.
9 According to Hans Weiss: Corrupt Medicine, loc.cit.
10 E F Torrey, “The going rate on shrinks,” American Prospect 13 (13) 2002.
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) Softened – 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” are taken care of
Opinion Leaders, Key Opinion Leader, KOLPharma-Marketing, Harald Wiesendanger