• October 25, 2014

The Secret Lives of Big Pharma's 'Thought Leaders'

The Secret Lives of Big Pharma's 'Thought Leaders' 1

Michael Morgenstern for The Chronicle Review

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Michael Morgenstern for The Chronicle Review

In the early 1970s, a group of medical researchers decided to study an unusual question. How would a medical audience respond to a lecture that was completely devoid of content, yet delivered with authority by a convincing phony? To find out, the authors hired a distinguished-looking actor and gave him the name Dr. Myron L. Fox. They fabricated an impressive CV for Dr. Fox and billed him as an expert in mathematics and human behavior. Finally, they provided him with a fake lecture composed largely of impressive-sounding gibberish, and had him deliver the lecture wearing a white coat to three medical audiences under the title "Mathematical Game Theory as Applied to Physician Education." At the end of the lecture, the audience members filled out a questionnaire.

The responses were overwhelmingly positive. The audience members described Dr. Fox as "extremely articulate" and "captivating." One said he delivered "a very dramatic presentation." After one lecture, 90 percent of the audience members said they had found the lecture by Dr. Fox "stimulating." Over all, almost every member of every audience loved Dr. Fox's lecture, despite the fact that, as the authors write, it was delivered by an actor "programmed to teach charismatically and nonsubstantively on a topic about which he knew nothing."

It is tempting to imagine that the Dr. Fox study reveals a deep flaw in the structure of medicine—for example, that health-care workers are too trusting of authority, or that Continuing Medical Education (CME) lectures are a sham. But what the study actually reveals may be something closer to the opposite. If medicine were simple and transparent, pretending to be a medical expert would be very difficult. An audience could spot incompetence right away. Pretending to be a medical expert is possible precisely because medical knowledge is so specialized and opaque. These days an ordinary doctor can no more expect to understand the intricacies of specialized medical research than the driveway mechanic who tinkered with his Volkswagen in 1962 can expect to fully understand the complex, computerized automobiles on the road today. Those who have tried to sit through a medical lecture in a field other than their own will secretly admit that they could have been fooled by Dr. Fox as well.

Since the 1950s, marketers have been taken with the idea that when it comes to spreading the word about unfamiliar products or ideas, some people are far more important than others. The phrase "opinion leader" was made familiar by the sociologists Paul Lazarsfeld and Elihu Katz in their 1955 book, Personal Influence, where they used the term to explain the way that media messages were filtered and spread by personal, face-to-face contact with influential people. It is not hard to see why marketers liked this idea. Mass-media advertising can be expensive. What if there were a way to avoid the masses and simply concentrate on the special people? Today the pharmaceutical industry uses the terms "thought leader" or "key opinion leader"—KOL for short—to refer to influential physicians, often academic researchers, who are especially effective at transmitting messages to their peers. Pharmaceutical companies hire KOL's to consult for them, to give lectures, to conduct clinical trials, and occasionally to make presentations on their behalf at regulatory meetings or hearings.

The KOL is a combination of celebrity spokesperson, neighborhood gossip, and the popular kid in high school. KOL's 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 grand-rounds lectures, sponsored symposia, or articles in medical journals (which may be ghostwritten by hired medical writers). While pharmaceutical companies seek out high-status KOL's with impressive academic appointments, status is only one determinant of a KOL's influence. Just as important is the fact that a KOL is, at least in theory, independent. Medical audiences trusted Dr. Fox partly because he played the part of an expert so convincingly: white coat, gray hair, and a complicated lecture, delivered with authority. But they also trusted him because they had no reason not to trust him. Dr. Fox was not selling a product or pitching an idea. The very implausibility of his charade is part of what made it so persuasive. Dr. Fox appeared to be impartial.

It is not hard to see why pharmaceutical companies would like to have a Dr. Fox speaking on their behalf. Most marketers would like to have a convincing, influential, and apparently independent expert who will deliver the text that they give him. The more interesting question is: Why do so many academic physicians want to be Dr. Fox?

"It strokes your narcissism," says Erick Turner, a psychiatrist at the Oregon Health and Science University. There is the money, of course, which is no small matter. Some high-level KOL's make more money consulting for the pharmaceutical industry than they get from their academic institutions. But the real appeal of being a KOL is that of being acknowledged as important. That feeling of importance comes not so much from the pharmaceutical companies themselves, but from associating with other academic luminaries that the companies have recruited. Academic physicians talk about the experience of being a KOL the way others might talk about being admitted to a selective fraternity or an exclusive New York dance club. No longer are you standing outside the rope trying to catch the doorman's eye, waiting hungrily to be admitted. You are one of the chosen. "You get to hobnob with these mega-thought leaders and these aspiring thought leaders," Turner says. "They make you feel like you're special."

Turner is a former drug reviewer for the Food and Drug Administration. He worked at the FDA for three years, after six years as a fellow at the National Institute of Mental Health. In 2003, after taking an academic position at Oregon, he began giving talks on behalf of pharmaceutical companies—Eli Lilly, AstraZeneca, and Bristol-Myers Squibb. "I left the FDA, and I felt kind of frustrated that I had all this knowledge about how clinical trials work, and I felt there wasn't much of anything I could do with it," he says. "It felt like a demotion going from bossing big pharma around, where you tell them to jump and they ask how high, and then suddenly you are way on the other end of the food chain. You're begging to be a site investigator, and they say, 'Nah, I don't think so. You might have trouble recruiting,' or 'Your IRB is too slow.'"

Actually doing clinical trials for drug companies is often boring and mechanical, Turner says. But if you are involved with the rollout of a company's new drug, you are really in on the action. "The first thing they do is ferry you to a really nice hotel. And sometimes they pick you up in a limo, and you feel very important, and they have really, really good food. And they make you sign a confidentiality agreement and say you need to sign this if you want to get paid." The meetings Turner attended featured what he calls the "mega-thought leaders," the recognized leaders in the field, who gave presentations to a group of people like him—the second-tier "little thought leaders." ("It was kind of like the farm team," he says.) The companies will also offer these aspiring thought leaders media training and advice on public speaking. "They give you slides that you will probably be speaking from, and you'll be in a room with about a dozen other people," Turner says. "You get up there, and you have your pointer, and then you stand off to the side when you're done. And the facilitator will say, 'So what did you think of his voice? What did you think of his body language? Did he project well?'"

It is an article of faith among pharmaceutical executives that KOL's are a critical part of any marketing plan. According to a 2004 study of the 15 largest pharmaceutical companies, the industry spends just under a third of its total marketing expenditures on KOL's. So important are KOL's that new businesses have emerged solely to recruit, train, and manage them. The reason they are so important is their role in managing the discourse around a given product. 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. 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. (Drug companies are prohibited from promoting a drug for conditions other than the ones for which the FDA has approved it, but because these off-label uses are often highly profitable, many companies have found creative ways of getting around the prohibition.) Virtually all physicians are on the receiving end of this communication, but only a relatively few deliver it. If the industry can influence those few, then it can also influence the rest.

Naturally, some lower-level pharmaceutical employees resent the KOL's they are expected to flatter and serve. A medical writer I spoke with compares thought leadership to a cult, or maybe the priesthood. "At meetings they get big fancy badges, like generals with their medals," he says. Michael Oldani, an assistant professor of medical anthropology at the University of Wisconsin at Whitewater, worked for nine years as a drug rep for Pfizer before beginning his academic career. Once he flew in a surgeon KOL from Texas to talk about an antibiotic at a German restaurant in Milwaukee. Unfortunately, the restaurant seated them in the basement, which was sweltering hot. "It's a sweat pit down there!" Oldani said to the manager, but there was no other place for them to go. The evening was a disaster. "A lady passed out into her strudel, face down," says Oldani. "And it's an emergency, with an ambulance, and picture me: I'm like, 'Christ, just throw some water on her and get her outside! She's ruining this program!'" The surgeon's talk was fragmented and disorganized, and when it finally ended, at 10 p.m., Oldani was ready to go home and sleep. But to Oldani's astonishment, the surgeon was not finished. "He tells me he needs some kind of alcohol to clean his mouse pad. And I'm like, 'Really? I was just going to drop you off.' We drove around town for like an hour and a half until we finally found an all-night Walgreen's."

Perhaps the most remarkable recent exchange with a KOL emerged in an investigation of Joseph Biederman, a child psychiatrist at Harvard University. In a lawsuit against Johnson & Johnson, Biederman was accused of promising positive research results to the company in exchange for funding. A hint of Biederman's self-opinion emerged in a deposition, where a lawyer asked him about his academic ranking.

Biederman: "To move in the ranks from one rank, for example, at Harvard, there is instructor, from instructor you move to assistant professor, from assistant professor you move to associate professor, from associate professor you move to full professor."

Lawyer: "Full professor?"

Biederman: "Mm-hmm."

Lawyer: "What rank are you?"

Biederman: "Full professor."

Lawyer: "What's after that?"

Biederman: "God."

Lawyer: "Did you say God?"

Biederman: "Yeah."

The status of being a KOL carries a certain irony. It is a hunger for status that motivates many academic physicians to work for industry, yet in order to preserve their status, those physicians must also cultivate the perception of independence. If Dr. Fox were unmasked as an actor, merely reading his lines, nobody would pay any attention. And of course, most academics do not especially like to think of themselves as figures like Dr. Fox. As Erick Turner asks, "Is it worth it, feeling like you are a robot, just speaking from a prefab slide set?"

For the past several years, Sen. Charles E. Grassley of Iowa, the ranking minority member of the Senate Finance Committee, has made it his mission to investigate and expose the conflicts of interest generated when KOL's work for the pharmaceutical and medical-device industries. His investigations have targeted prominent academic physicians at Harvard, Stanford, Emory, Wisconsin, and Minnesota, among other universities. Last year, in a little-noticed section of the health-care-reform legislation, Congress passed the Physician Payments Sunshine Act, which will require drug and device companies to disclose payments to doctors and teaching hospitals to the Department of Health and Human Services. Disclosure of conflicts is widely seen as a "win-win" solution to the KOL problem. Doctors get to keep accepting industry money; the drug companies get to keep giving it; and anyone else who might be affected can be reassured by the knowledge that the transactions are no longer secret.

Mere disclosure is unlikely to fix the problem, however. Minnesota, where some of the most egregious offenses have occurred, has had a similar "sunshine law" since the mid-90s, to little effect. What is more, empirical research in psychology suggests that, contrary to conventional wisdom, people who disclose their conflicts of interest make judgments that are more biased, not less. If the aim of disclosure is to shame KOL's into giving up their industry relationships, it is based on a faulty premise; the most prominent KOL's often announce their industry relationships with something close to pride. And why shouldn't they? If the very reason scholars work with industry is the status confirmed by the relationship, then asking KOL's to reveal their industry ties is not much different from asking them to reveal their honors and prizes.

Universities could easily clean up the problem, simply by banning or capping industry payments to faculty members, but that is unlikely to happen. Not just because academic physicians would object, but also because many high-level university administrators have lucrative corporate relationships of their own. (For instance, the president of the University of Michigan sits on the Board of Directors of Johnson & Johnson, while the president of Brown University sat on the boards of Pfizer and Goldman Sachs.) As universities have come to look more like businesses, competing for funding and prestige in a consumer marketplace, industry relationships have become a lucrative perk of many university jobs.

David Healy, a psychiatrist at Cardiff University, in Wales, and a prominent industry critic, worked for many years as a KOL before his industry relationships began to go sour. Healy says he was never impressed with the intellectual accomplishments of KOL's: "If you look at the opinion leaders, the guys in the field are not stellar geniuses. The field moves forward by virtue of the fact that people cooperate. It's not that anybody has a particularly brilliant insight, or that these guys are really awfully bright, but the opinion leaders who work with pharma are actually the least bright. These guys get made by industry. They get money, they get status, and they knew they wouldn't be anything if it weren't for this."

My brother Hal, a psychiatrist at Wake Forest University, used to work as a KOL for GlaxoSmithKline. The event that drove him away from the business came one day when he was giving a lunch lecture at a local primary-care clinic. To his irritation, none of the doctors in attendance paid any attention to the lecture. They were answering pages, talking loudly with one another, helping themselves to the lunch that Glaxo had brought in—anything, it seemed, to avoid listening to him talk. Eventually Hal got so frustrated that he cut the lecture short. As he was packing up his laptop to leave, however, the Glaxo rep asked him a favor. The director of the clinic had been unable to attend the lecture. Would Hal mind sticking around a few more minutes to say hello? Reluctantly, Hal agreed, and the rep took him to a small room adjoining the clinic, where he said they would wait until the director appeared.

"There was a line on the floor," Hal says. He had never seen such a thing before. "The rep told me that we weren't supposed to step past that line unless a doctor said it was okay." They stood behind the line, waiting patiently. After a few minutes, the director walked down the hall toward them. "I sort of looked at him hoping to make eye contact and speak, but he wouldn't even look at us," Hal says. "This rep just stood there with a big smile on his face, and the doctor stopped in front of the treatment room five feet away from us, and stood there for several minutes reading a chart. Then he walked away into the treatment room like we were not even there."

Hal calls this his moment of understanding, after which he never gave another industry-funded talk. Up to that point, he had imagined himself as a high-powered academic physician bringing the latest university research to doctors out in the community. Standing next to the drug rep, however, Hal understood how the community of doctors saw him. To them, Hal was a drug-company shill. "I was literally standing in the drug-rep spot begging for a minute of this doctor's time, like a cocker spaniel begging for a leftover piece of meat from the table," he says. It was no wonder the doctors saw little difference between Hal and the rep. "It was like I had become a psychiatric call boy," he says. "I might as well have just said, 'Hi, I'm Hal. The company sent me to make sure you all have a good time.'"

Carl Elliott is a professor at the Center for Bioethics at the University of Minnesota. This essay is adapted from his book White Coat, Black Hat: Adventures on the Dark Side of Medicine, published this month by Beacon Press.

Comments

1. nurse_phd - September 13, 2010 at 01:06 pm

It never fails to amaze me how physicians are so attracted to ego-stroking and relentless in their assertions of superiority. No other group of human services professionals so assiduously defends their inflated salaries. No other group insists on being called "doctor" by laypersons, even in casual encounters. No other group sidelines all others who represent competition so effectively, although there is plenty of "market share" (sick people) to go around. There is something deeply sinister about the unbridled egotism of medicine that harms the health of Americans.

2. lauraw - September 13, 2010 at 01:25 pm

This is a smarmy, flip, irresponsible article. I know plenty of hardworking academic physicians who give talks for drug companies, advise them, work closely with them, and help them develop effective therapies. These are among the best and the brightest -- working long hours together to try to cure dreadful diseases. Should academic physicians just shun drug companies altogether? How virtuous they will feel. And all of us will be the worse for it. Be careful what you wish for. We can all die of cancer together, knowing we are pure of heart and deed, and will have nothing to do with those big bad drug companies.
Medicine has a lot of talented, knowledgeable, dedicated people. A lot of them are working with the private sector to improve medicine -- it isn't just all surface and PR. It's so easy to sneer and find fault. Once again, be careful what you wish for.

3. davi2665 - September 13, 2010 at 01:53 pm

The KOLs are the best marketing personnel money can buy. There is ample literature demonstrating that receipt of payments or other "gratuities" introduces bias into what should be objective assessment of the pharmaceuticals and devices that we count on for important treatments whose assessments we hope have not been a PR scam. Clinical trials supported by pharmaceutical companies show far more "positive" results (buzz, spin, etc) compared with similar clinical trials supported by NIH or other more objective sources of funding. Big pharma buys the results they need- only after more extensive market experience do the disasters from serious side effects show themselves. In other cases, the owners or investors talk up the wonders of a specific product/device (e.g. Atricure) without bothering to reveal their own investment or financial stake in the product.

And with some of the academic shills who not only collect millions for pushing products for their masters, but then lie to their own COI committees, deans, presidents, or even NIH funding agencies (e.g. the Emory psychiatry debacle) pretend to be "above" bias. Universities and hospitals that employ faculty members should simply shut down accepting "honoraria" and "consulting fees" for those who want to be marketing mouthpieces for profit.

4. drdrtsai - September 14, 2010 at 12:28 am

@lauraw: Read the article again. No one is arguing that doctors shouldn't work with drug companies. The terms of the arrangements are what are being called into question.

5. idoc007 - September 14, 2010 at 07:14 am

As usual the truth lies somewhere inbetween this very biased and sarcastic article and praises of the pharmaceutical industry. Yes, there have been egregious acts by pharmaceutic companies over the years but given the enormous scale of drug development, those are exceptions that often are blown out of proportion by the media. Your two feeble attempts to blame the pharmaceutical industry for personal actions are just that - feeble. The narcicissistic professor who thought he was close to God probably did so because he was a full professor at Harvard - not because he consulted for a drug company. The clinic director was just rude - he probably treated nurses and patients and the barrister at his local coffee shop and his auto mechanic the same way he treated the pharma reps. As an MD with 15 years experience in academic medicine and 3 years in private practice I've found that there are both buffoons and stuffed shirts as well as bright and sincere physicians who both worked with and shunned pharmaceutical companies. Everyone somehow assumes that if one makes it thorugh the academic ranks to the level of full professor that somehow, one must be pure and brilliant - that is a fallacy. While I have worked with many talented, hard working, and well-deserving of rank high ranking academic physicians I have also persoanlly worked with "full professors" who were listed among the best doctors in America that I wouldn't trust to take care of my dog because they were rude and grossly inept and had risen to their ranks by cronyism, nepotism, intimidation and bullying, or just by attrition of other faculty members - they just outlasted everyone else. I've served on peer review committees that sanctioned young physicians for the very behaviors that "full professor" committee members were guilty of. All of this was in a leading academic institution that strongly discouraged any pharmaceutical affiliations. I finally left, in part, because I found the place so hypocratical and stifling. I decided I would not want to be affiliated with a place that I would not feel comfortable being a patient because the institution projected such a self-absorbed and self-rightous image when it came to many issues, including pharmaceutical industry. In your very biased article you don't acknowledge that out that one source of academic bias against corporations is because universities have an inherent financial conflict of interest regarding corporate $$ vs federal $$ that no one ever wants to mention. It is well known that federal grants bring in an average of 50% "indirects" or facilties and administration (F&A) costs while pharmaceutical companies will rarely pay more than 20% F&A costs. So for every million federal dollars that an academic researcher brings in, ther university gets an additional $500,000 but for every million dollars of corporate money the research brings in their university gets only $200,000. Same researcher, same research, same research support - the university administrators just get less if the research is corporate funded than if it is federally funded. Those "facilicilities and administration costs" are only to cover the cost of "administering the study" - they have nothing to do with the cost of the actual research, the salaries of any members of the research team, the animal care (for animal studies) or patient evalation or testing (for human studies) or any of the laboratory supplies or equipment. Those costs are just to "administer" the grant. wink wink...Most be some very difficult accounting to cost half a million dollars. So university administrators have a huge conflict of interest that causes them to discorage corporate money and encourage federal money and therefore villify the pharmaceutical industry. Last time I checked, we live in a free society with a capitalist economy that is very competetive. Competition costs money, pure and simple. While such a system, of course, has its flaws, it has produced and continues to produce the most innovative technology in the world. While such technology, including medicine, might be cheaper in other countries it is because they are for the most part only copying and pirating what has been developed in the US. If you want to see what happens when the government puts stifling controls on capitalism - just do a google search to see how many drugs were developed in the USSR or China in the last 50 years. Then see how many were "copied" without regard to patents. If there is no financial incentive to develop or promote a drug, no new drugs will be developed. Each person is responsible for their own ethical behavior. My experience thus far is that when a "reformed pharmaceutical sinner MD or PhD" gets on the soapbox about the evils of Big Pharma, it is usually because they have a few skeletons in their closet and have to get out before they are exposed or they have been dumped by a company for lack of productivity and they want to take a few cheap shots at the new "golden boys" that took their place. It is rarely because they suddenly had an "epiphany" and want to repent and wear sackcloth. Insincere altruism is just as nauseating as arrogance.

6. mike1259 - September 14, 2010 at 10:21 am

A couple observations
1)In the "Dr. Fox" experiment, the presenter successfully duped the audience because he spoke on a topic the audience knew nothing about (mathmatics). This is quite different from what typically occurs in any sort of medical lecture, in which the audience has a baseline knowledge but is interested in recent advances. However, it IS similar to the everyday practice of journalists, who write convincingly about topic of which they are ignorant, swaying the opinion of a credulous audience.
2)I have long worked as a "Speakers Bureau" member, that is, a paid speaker for drug companies. Indeed, I am giving 2 talks in the next 2 months, neither of which will actually mention any particular drug. To extend Dr. Turner's analogy, I would be a semi-pro firehouse league player. The money is nice, but not much ($3000-4000 per anum). I actually make more money doing online surveys identifying other "thought leaders" and preparing marketing strategies. Although I've been a speaker for 10 years I have never had a class like that described above on how to present effectively. Pharma, in an act of pre-emptive self regulation, has become more strict concerning speakers. Oddly, this greatly limited speakers ability to offer honest opinions. Some companies (Pfizer is especially bad) limit the speakers' presentations to a preapproved slide show and force speakers to take an online training course and sign a lawyer sanctioned set of forms stating that if they deviate from the slides they will be fired from the speakers bureau. I was fired from Pfizer for making my own slides.
I think over all the article is misleading. The reason physicians give or attend these presentations is not for the meals or the money, but rather to get together as a group and ask each other how they handle particular medical problems, or difficult interactions with patients, or disallowals from insurance companies. That is, they get to gether to talk about common problems, just like any other group. I am sure the drug companies feel they get something out of it, but I personally have never understood what. For a 2 year period I was well compensated by a company whose drug I never prescribed, to give talks that had nothing nice to say about said drug. I have been to many similar talks as an audience member. So I would caution that just because Pharma spends a lot of money on something doesn't mean it is an effective investment. It just means they spend a lot of money.

7. machintruc - September 14, 2010 at 10:38 am

How would this go down?
http://pauillac.inria.fr/~xleroy/stuff/tomato/tomato.html

8. julioburmyte - September 14, 2010 at 12:23 pm

nurse_phd (comment #1), you've created an impressive array of straw people.

* "No other group of human services professionals so assiduously defends their inflated salaries." Are you sure about that? I'd agree that physicians (certainly when viewed through the A.M.A.) are guilty of this, but you've apparently never met any union electricians, teachers, etc. I've found it to be nearly universal behavior.

* "No other group insists on being called "doctor" by laypersons, even in casual encounters." I've met a few hundred physicians over the course of my life. Only a handful have committed that offense.

* "No other group sidelines all others who represent competition so effectively, although there is plenty of "market share" (sick people) to go around." That's a relatively fair shot. Health care could use some re-organization.

* "There is something deeply sinister about the unbridled egotism of medicine that harms the health of Americans." Sorry, that just sounds emotional.

9. jonleo001 - September 14, 2010 at 12:35 pm

It would be great if the two doctors who responded could elaborate on a couple of points. Letter five which could be titled: "Why I dont like Universities" seems to go far astray and touch on topics that have nothing to do with Carl Elliott's essay. For instance, I dont think Elliott is saying that pharm companies shouldnt make money. Saying that companies should be ethical does not equate to saying they shouldnt make money. Just out of curiosity in what way did his university discourage pharmaceutical affiliations? I doubt they banned grants? Or collaborations? I imagine that they did frown on professors getting paid to teach about a pharm product? Is that really so bad?
2) The author of letter number 6 writes that he or she did not talk about specific drugs in their presention. It might help the discussion if he or she could mention the disease that they did talk about.

10. nurse_phd - September 14, 2010 at 09:06 pm

@julioburmyte - I, too, was voicing an opinion based onmy 28 years of working alongside physicians as a nurse and advanced-practice nurse (now professor.) Absolutely, it is true that not all docs are pompous and overpaid. I'm saying that they seem to have a larger share of this type than other professions. I don't know what electricians make, but I don't think teachers' salaries are inflated. Physician salaries, on the other hand, far exceed those of other professionals with terminal degrees. And don't tell me they have more responsibility than anyone else - I have endless opportunities to kill people in my clinical practice in a Trauma ICU. Ditto airplane pilots (in fact, they can kill many more at once.)

11. nacrandell - September 14, 2010 at 09:50 pm

#1 nurse_phd - lol on the doctor comment.

My mother, while she was working as a 20 year old secretary at the University of Georgia saw Dean J. Alton Hosch and almost in tears said that she was sorry. He asked why she was sorry and why was she so upset. She told him that she had not called someone doctor. He put his hand on her shouler (Wouldn't be able to do that now) and replied, " Dottie, there are two sort of people you need to call doctor, recent Ph.D's and dentists."

I'd add chiropractor - obsessive about the title!

12. raghuvansh1 - September 14, 2010 at 11:34 pm

This happened everywhere.In literary world people blindly believed critics. Good review in Newyork Times increased the sale of book.Why advertising corporation place celebrities opinionon on advertisement.People worshiped to clebraties because they conquer the fear death customers think if we follow the celebrities we also overcome the fear of death

13. hedgehogca - September 15, 2010 at 02:47 am

As usual, things look different, North of the border. I've been working (in the field of health informatics) with literally hundreds of doctors across Canada over the past decade, and compared to other, similarly-remunerated professional groups I've had extensive contact with (lawyers, MBAs, oil-rig workers, bankers, CEOs, senior civil servants...), they provide society with by far the best value for money.

They'll also usually be the first to acknowledge that 90% of what they do can be (and routinely is) done every bit as well and at a fraction of the cost by the nurses; the "call me Doctor" thing, from what I've seen, is almost entirely for the patients' benefit, in both senses of the word. (However, idoc007 is dead on about Harvard graduates, MDs or otherwise.)

But to get back to the actual article: it may paint with rather broad strokes, and in rather garish colours, but it does add something valuable to the picture we're slowly building up of how medical research and practice interact with big business.

P.S.
Machintruc, loved the link, but disappointed not to find a single Pataphysical citation in a such a thoroughly researched paper.

14. btmaurer1 - September 15, 2010 at 05:34 am

Thank you, Dr. Elliott, for an academic parsing of what many of us working in the front lines of medical practice have come to realize over the course of our careers: the pharmaceutical industry uses medical experts to influence the prescribing habits of practicing clinicians.

Several years ago I published a piece on this same topic from a narrative perspective, which can be accessed here: http://www.dermanities.com/detail.asp?article=268

Keep up the good work.

15. cechulvick - September 15, 2010 at 09:12 am

It seems to me that this little charade can be used as support for those who see education moving to edutainment. What if the trained actor/presenter was presenting a well prepared and academically sound lecture instead of gibberish?

Would the skill of the presenter combined with somone else's scholarship provide a valuable teaching/learning experience,perhaps, as long as questions were not allowed.

16. gahnett - September 15, 2010 at 12:12 pm

Didn't any of the audience members/MDs who attended the faux lecture check any of the fake speakers' papers before going?

I bet they take attendance, too...

17. wbrought - September 16, 2010 at 02:14 am

I have spent 20 years as an academic physician - the so-called "dreaded professor". In years past, when speaking at medical meetings (especially when pharma sponsored) there was no requirement as to content. Usually the topic was a disease process that the company offerred a product for, but drug names were always presented as generics and all content was the speaker's own. After a time that began to change and the prospect of "commercial presentations" was repugnant to most. We viewed those that gave commercial presentations as "whores" and they were often called out as such during the post-presentation questions. I recall some ugly scenes.

Speaker's Boards were the next phase - meetings at posh resorts with real scientific content intermixed with obvious PR presentations intended to sell potential presenters on the current "product". Then the ready-made slides appeared.Good money too. As restrictions on slides/content began many of us stopped participating. We weren't being allowed to give "our talks" anymore. For some, our principles weren't for sale.

Currently, most commercial presentations occur after-hours, usually at fine restaurants. For a free meal one must tolerate 60 or so minutes of company prepared slides from a KOL (sorta). A few physicians attend (usually medical residents - after all, dinner is free). These events must still influence sales because the pharma companies keep paying for them. I, for one would prefer to read the journals and watch baseball at home in the evenings - I'll buy my own meals.

No longer (very rarely) does pharma sponsor purely educational presentations. Most universities now draw their Grand Rounds speakers from within. The quality of such talks varies but at least the content is the speaker's own - legitimate CME.

I must state that the idea that all pharma contact/support is evil, is incorrect. Pharma's involvement definitely influences drug sales, drives research direction and sadly sometimes influences research results. Still, their support for journal clubs and the occasional unrestricted educational grants (are there still such things?) often result in good educational experiences.

As in all things monetary: personal ethics, caution and a jaundiced eye are still necessary.

(oh yeah...and referencing your own writings in your comments only reinforces some of the uncomplimentary comments made in the article above)

18. hermadite - September 19, 2010 at 11:28 pm

The "Big Pharma's Secrets" with a phony Dr. Fox was most fascinating.
I say this because one of the most celebrated hoaxers is Alan Abel, who for the past fifty years has delivered over a thousand lectures posing as an expert. His satirical adventures were recently revealed in the award-winning documentary "Abel Raises Cain" that won film festival awards worldwide. He has bamboozled medical conventions, a meeting of 600 anthropologists at the American Museum of Natural History and on radio and television as well. Presently, he has the longest hoax ever perpetrated on the Internet....over three years...without discovery.

19. fcpiii - September 20, 2010 at 12:46 pm

As a former academic and now Private practice MD, I believe that if Pharma was prevented from providing lunch, dinner or resort accomadations ( latter very rare now) at these lectures, no one would show up. It is better than it used to be... A few years ago I could have eaten out every night of the week if I was willing to put up with a talk. While most MDs know these talks are bised, they provide the goal of advertising... exposure of the product.

The inflated salaries and egos that some of the above writers believe to be unique to MDs are certainly not rare on college nowdays... Most full professors make as much as a lot of MDs working nine months a year and only teaching three courses a year.. If you are looking for a profession where there is lifetime job security, great benefits, minimal hours, no nights or weekends and third party payors (parents) who accept 6% annual fee increases happily, it hard to beat higher education.

20. snavision - September 23, 2010 at 01:23 pm

I posted my comments at http://bit.ly/9M0s9a

21. polargrid - October 03, 2010 at 11:14 am

Fcpii: please don't overgeneralize with your comments about university professors. Those of us in the laboratory sciences (I am a tenure-track faculty in chemistry at a Research I university) work far more than 40 hours a week. Hours are certainly not "minimal" and we have 12-month appointments - no "summers off". There is no way to earn tenure in the hard sciences or engineering at a research-intensive university without working nights and weekends.

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