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"Key opinion leaders were salespeople for us, and we would routinely measure the return on our investment, by tracking prescriptions before and after their presentations," said Kimberly Elliot, who worked for 18 years as a sales representative for major drug companies. "If that speaker didn't make the impact the company was looking for, then you wouldn't invite them back." Elliot worked for companies including Novartis, SmithKline Beecham and Westwood Squibb from the age of 23, until deciding that she was disillusioned with the business in 2007. A major source of her dissatisfaction was the industry's increasingly aggressive marketing practices. Richard Tines, the medical director for the Association of the British Pharmaceutical Industry, also admitted to BMJ that so-called "key opinion leaders" (KOLs) are a major part of drug companies' marketing strategy. "Companies will employ consultants to help advise on marketing strategies ... and present and speak at conferences," he said. But the drug industry's strategy involves significantly more than the payment of consulting fees. There is an entire practice built up around cultivating KOLs and using them to greatest effectiveness. An article published in the industry magazine Pharmaceutical Marketing promises to reveal the "tricks of the trade" for making KOLs into "product champions." The first step is to "evaluate [the] views and influence potential" of doctors who might make good KOLs. The article stresses that companies should not target just senior doctors who are already influential, but also doctors "who may be further down the influence ladder." In the latter case, the company should then work to "raise their profile, and so develop them into opinion leaders." After developing relationships with current or potential KOLs, drug companies are advised to supply them with "appropriate communications platforms" to "communicate on your behalf" with patients, doctors and the public in general. As part of this practice, KOLs may be paid up to $400 per hour for giving presentations at conferences - presentations that have often been prepared ahead of time by the drug companies and take place at company or industry-sponsored "educational" events. A single "scientific speech" may net a doctor over $3,000, and some popular KOLs may make more than $25,000 per year from advisory fees alone. Elliot emphasized the importance of these practices to maintaining company profits. "There are a lot of physicians who don't believe what we as drug representatives say," she explained. "If we have a KOL stand in front of them and say the same thing, they believe it." Elliot regularly paid KOLs $2,500 per lecture. These payments were sometimes concealed by having the drug company pay an academic center, which would then make a separate payment to the doctor. Another key component of the drug industry's strategy is keeping track of KOLs and evaluating their performance. Failing to do so, the Pharmaceutical Marketing article warns, can lead the company to "[waste] money on the wrong people." A company called KOL actually specializes in helping drug companies with this function, even offering software custom-made for the purpose. The company's Web site highlights the degree of influence wielded by KOLs: although "thought leaders ... may not write many prescriptions, [they can] influence thousands of prescribers and hence prescriptions through their research, lectures, publications and their participation on advisory boards, committees, editorial boards, professional societies and guideline/consensus document development." Related CounterThink Cartoons:
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