{"id":63343,"date":"2016-02-06T12:29:34","date_gmt":"2016-02-06T17:29:34","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=63343"},"modified":"2016-02-06T18:30:55","modified_gmt":"2016-02-06T23:30:55","slug":"in-indelible-ink","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2016\/02\/06\/in-indelible-ink\/","title":{"rendered":"in indelible ink…"},"content":{"rendered":"\n
When I mentioned the sponsorship of the STAT Morning Rounds page [explanation?…<\/a>], George Dawson implied in a comment<\/a> that my radar was perhaps set too low:<\/div>\n
\n
What would you call it if I gave a lecture for CME, unrelated to prescribing but it was sponsored by Big Pharma – even though I had nothing to do with the business end of it? I would definitely get listed in Open Payments web site.<\/div>\n<\/blockquote>\n
And I had just written about the Annals of Internal Medicine editor going after Ben Goldacre’s COMPare for noting that the a priori<\/font> <\/em>outcome variables in one of their papers had changed in the published version [protest too much…<\/em><\/a>]. I don’t have anything to say more about either of those things because he’s right, I don’t really know where either boundary ought to be set – and perhaps that is my whole point.<\/div>\n

There was a time when pharmaceutical sponsorship of all kind of things was common, even desirable. I didn’t actually think much about it back then – seeing it as a service provided by one member of the medical community to another. They gave us an endless stream of pens, cheesy models if knees and brains, note pads, prescription pads. F. Netter’s drawings in C.I.B.A. pamphlet’s were the gold standard for anatomical illustration – much revered. But I honestly didn’t know which company made which drug. A friend once quipped that the only drug company we all really knew was SKF, because they made the diet pills we took as med students to cram for exams [embarrassingly true in the mythic 60s].<\/p>\n

I know that when I read the NYT article about the Senate investigation in 2008 [Top Psychiatrist Didn’t Report Drug Makers’ Pay<\/a>], that was the first time I’d ever heard of Speaker’s Bureaus<\/font><\/strong>. But by then, there were lots of things I’d never heard of – CROs<\/strong> <\/font>[Contract Research Organizations<\/font>] that actually did the Clinical Trials, KOLs<\/strong> <\/font>[Key Opinion Leaders<\/font>] and KOL Managers<\/font><\/strong>:<\/div>\n
\n
As pharmaceutical and life-sciences companies search for the most effective, efficient ways to manage collaboration with the physicians who conduct research, write articles, or speak on their behalf, relationship management of the interaction with these elite physicians, or key opinion leaders [KOLs], has ultimately emerged as an individual business discipline. Similar to CRM, KOL management is an essential component for marketers and medical staff throughout the life-cycle process of a specific drug or product.<\/div>\n
[NOTE: CRM stands for Customer Relationship Management]<\/font><\/strong><\/sup><\/div>\n

By sustaining a business process that creates and maintains meaningful and collaborative relationships between KOLs and business functions from marketing to medical affairs, pharmaceutical and life-sciences companies can experience increased share of voice and accelerated adoptions at the global, national, and regional levels. A CEO of a major pharmaceuticals company recently told a group of analysts that effectively managing KOL relationships was essential to companies’ future products and market expansion.<\/p>\n

As physicians strive to choose from a myriad of drug options for their patients, they often turn to fellow key opinion leading physicians for knowledge and advice on specific drugs. Key opinion leaders possess a unique credibility, as their validity often stems from years of industry experience and medical affiliations. As a result, pharmaceutical and life-sciences companies have begun relying heavily on key opinion leaders to help establish the knowledge base about their drugs and expand their markets throughout all stages of life-cycle management. <\/div>\n
[KOL Management in Pharma and Life Sciences:
The next wave of CRM applications<\/a> – 2006]
<\/sup><\/div>\n<\/blockquote>\n
And as we learned from first the Propublica Dollars for Docs<\/a> database and later from the Open Payments web site<\/a>, there are plenty of physicians on the PHARMA payroll to manage.<\/div>\n

So I take George’s point, and I don’t mean that sarcastically. My radar just doesn’t work anymore. When I think about it, Megan’s Morning Rounds<\/font><\/strong><\/em> Ph<\/em>RMA<\/font><\/strong> and Johnson & Johnson<\/font><\/strong><\/em> sponsorship is more along the lines of what I recall from the past. It’s open and I expect [hope] that her clarification is on the up and up [explanation?…<\/a>]. I’m sure that there are many hypotheticals that I wouldn’t have a clue how to classify, how to decide which side of the line they fall on. People like Dr. Nemeroff and the other ultra-KOLs on Senator Grassley’s list made that part easy. They were so far south of the border that the line drew itself. And there are plenty of others where that’s true.<\/p>\n

I come from an era when even the possibility or appearance of a Conflict of Interest was exclusionary. I did a lot of speaking during my years. And though it was to trainees, graduate students, and peer groups in my own and other mental health specialties, I didn’t ask for honoraria, and if it appeared, I donated it back to the sponsoring organization. I did accept room and board if it was out of town. That wouldn’t have worked had I been on the circuit<\/font><\/em>, but I wasn’t. Saying it now sounds kind of prissy, hyper-moral, maybe even pseudo-moral. But I was just following the lead of my own role models. I really liked talking about things I had learned, and I almost always came away from those talks having learned something myself. It was kind of like this blog – a way of collecting my thoughts. Nothing makes you think about things so much as the possibility of saying it out loud to others. I wouldn’t necessarily push that approach on anyone else. It just is what worked for me. <\/p>\n

So I expect that anything I said about drawing a line that marked the limits between acceptable and unacceptable COI policies would be idiosyncratic, anachronistic, or some other five dollar word. But I would stand behind the fact that that the line needs to be drawn – not in the sand, but in indelible ink. And I don’t much agree with the idea of exceptions<\/font><\/em>. I would much prefer the part that I think George objects to – 100% transparency. I’d rather they list all industry payments and connections publicly, and let the decision about whether they are benign or malignant come after the fact. And that’s based on how often people have found ways to use exceptions<\/font><\/em> to hide all kind of things. Admittedly, there are people who will indict any<\/font><\/em> industry involvement or payment, but we’re not all that way. And the people who push for transparency aren’t the cause of the problem – that blame falls on our colleagues who have abused the system, or allowed themselves to be used. I appreciate Megan’s quick, non-defensive clarification as what I was asking for. But I still think the editors response to COMPare was uncalled for. I know Megan of Morning Rounds<\/font><\/strong><\/em> and Ed Silverman of Pharmalot<\/font><\/strong><\/em> have to support themselves, and industry sponsorship is an obvious direction to look. But in a modern world, the burden of proof falls on their shoulders – proof that they’re not under the influence of some version of a KOL Manager<\/font><\/strong>. It’s just that kind of world now… <\/div>\n","protected":false},"excerpt":{"rendered":"

When I mentioned the sponsorship of the STAT Morning Rounds page [explanation?…], George Dawson implied in a comment that my radar was perhaps set too low: What would you call it if I gave a lecture for CME, unrelated to prescribing but it was sponsored by Big Pharma – even though I had nothing to […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[5],"tags":[],"class_list":["post-63343","post","type-post","status-publish","format-standard","hentry","category-opinion"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/63343","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/comments?post=63343"}],"version-history":[{"count":15,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/63343\/revisions"}],"predecessor-version":[{"id":63364,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/63343\/revisions\/63364"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=63343"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=63343"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=63343"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}