Pointy-Headed Drug Pushers

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Michael Morgenstern / www.mmorgenstern.com

Do you trust some medical professionals more than others? Most people do, including, it turns out, medical professionals themselves–a phenomenon that big pharmaceutical companies use to their advantage in researching and marketing drugs. These firms tap influential physicians, often academic researchers, who are highly trusted, well placed, and willing to receive compensation to endorse drugs. Actually, endorse might be too strong a term, University of Minnesota bioethicist Carl Elliot suggests in The Chronicle of Higher Education (Sept. 17, 2010).

These key opinion leaders, as they’re known, “do not exactly endorse drugs, at least not in ways that are too obvious, but their opinions can be used to market them–sometimes by word of mouth, but more often by quasi-academic activities,” such as lectures, symposia, and articles, writes Elliot. “The key opinion leader is a combination of celebrity spokesperson, neighborhood gossip, and the popular kid in high school.”

Some make more money from their sideline gig than from their school; the pharmaceutical industry spends fully one-third of its marketing budget on them. Companies drop big cash in anticipation of big rewards: Key opinion leaders are vital to shaping the discourse around their brands as they move them through trials and toward market.

“Equal parts scientific study, commercial hype, and academic buzz, this discourse will begin years before a drug or device is brought onto the market, and will usually continue at least until the patent expires,” Elliot writes. “If a company can manage the discourse effectively, it can establish the desperate need for its drug, spin clinical-trial results to its advantage, downplay the side effects of a drug, neutralize its critics, and play up the drug’s off-label uses,” meaning unapproved and potentially harmful–but highly lucrative–alternative uses.

These obvious conflicts of interest not only compromise good science and academic independence but also can put public health at risk from tainted trials and research. So what can be done? Elliot argues that disclosure laws, which are in place at some universities, are not enough, and that most universities don’t have the backbone to ban or cap industry payments to faculty members.

Until they take that step, it’s going to be hard to know whom to trust.

 This article first appeared in the January-February 2011 issue of Utne Reader.

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