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Are you being duped?

How drug companies use opinion leaders

We all know that there is no such thing as a free drugs company lunch, but, what the hell, the food's good, those marketing people seem ever so nice, and, anyway, there doesn't really seem to be any catch. The catch, however, need no longer be a mystery. For the marketers have set out explicitly the methods they use to "educate" doctors into championing their products.

The May edition of Pharmaceutical Marketing magazine explains what it calls "the tricks of the trade." These include developing "opinion leaders" (key doctors or other health professionals or even patient group representatives who are likely to be able to influence many others); building successful relationships with them ("how you can best get them to know and like you and your products"); and skills training ("ensuring your product champions communicate effectively on your behalf").

These "tricks" appear in a 24 page supplementary guide under the heading "Effective medical education." The guide, written by people from the industry, describes medical education as "a potent weapon to be used by the marketer in supporting promotional activities."

This may at first not seem all that surprising, but Joe Collier, professor of medicines policy at St George's Hospital and Medical School, London, said, "Doctors are being cultivated because they are valued as promotional tools, and that is new. Are they being paid out of scientific funds or out of promotional funds?"

He said that what the marketers meant by "medical education" was effectively advertising and so should be covered by advertising regulations: "The use of opinion leaders hasn't previously been viewed as advertising, but now it has to be brought into that fold." He added, "The marketers are talking about educating people about their medicines, so `medical' and `medicines' are being used interchangeably, which is a trick." Professor Collier said that the guide set out "a detailed method of manipulation, a concept of using and duping that is very underhand." He added, "It's very blatant. Doctors are visibly being used as pawns."

So what exactly does this guide say? It advises marketers, in identifying opinion leaders, not to "risk wasting money" on doctors "who you eventually hear have no credibility with their peers." Instead, marketers should aim for those who are "on the editorial boards of key publications for ultimate target audiences," on scientific committees, members of key professional societies, representatives of national or international guideline committees, and key players on formulary committees. "The key aim," says the guide, "is to ensure that you are working with a mix of people who can ultimately be called upon to communicate on your behalf in different situations."

Marketers are advised not to overuse people: "If you front the same people to speak at your symposia, write publications etc, they will inevitably be seen as being in your pocket. No one wants to have a reputation for only having a handful of supporters."

Opinion leaders who are not prepared to overtly support a product are also worth cultivating. "Remember the halo effect," says the guide. "Being seen to merely work with you is good enough."

Marketers are advised to ask opinion leaders for their advice. "The advisory process is one of the most powerful means of getting close to people and of influencing them. Not only does it help shape medical education overall, it can help in the process of evaluating how individuals can best be used, motivate them to want to work with youand with subliminal selling of key messages ongoing all the while."

At one point, the guide starts referring to the opinion leader as a "trainee." Professor Collier said, "To call someone a trainee when we are talking about professor so-and-so is a bit rich."

Hugh Gosling, editor of Pharmaceutical Marketing, denied that there had been any departure in the way that the pharmaceutical industry dealt with opinion leaders. "I think it's exactly the same as it always has been. I don't feel that there has been a turning point in any way."

He said that the boundaries between what doctors and drug companies thought was meant by medical education had become more blurred in the past couple of years. "Medical education used to be seen as purely non-promotional. That is no longer the case," he said, adding that medical education and promotional activities worked well together.

But he denied that there was anything sinister or any duping taking place and felt strongly that the pharmaceutical industry acted ethically in its dealings with opinion leaders. "No one wants to be used," he said.

Trevor Jackson. 

BMJ