What makes an opinion leader?

Having heard from David Gillen and Sue Wright on behalf of the pharmaceutical industry and medical education agencies, Iain Macdougall, a consultant nephrologist at King's College Hospital presented a KOL perspective.

After a brief but diverting googling of the KOL acronym, Macdougall introduced the idea of opinion leaders, thought leaders and key experts. Are they all the same? Is there an identikit KOL? Macdougall draws some recognisable stereotypes - the 'extreme' KOL with strong links to pharma such as stocks and shares, regular consultancies, patents and so on. Much more common are the 'occasionals' who participate on an infrequent ad hoc basis, receive research grants and occasional consultancies for modest honoraria. At worst a KOL may be 'a company rep in disguise' says Macdougall, quoting Professor Spiers's recent letter to the BMJ 'easy to spot - his expenses and remunerations are shamelessly high and he uses proprietary names and drug company slides.'

Moving on, Macdougall went on to address four main areas - how he became a KOL, the advantages and drawbacks of a relationship with industry and the need for regulation. Speaking from his own experience, Macdougall cited his early research on erythropoietin (Macdougall et al., Lancet 1990; 335: 489-493) as the first step on his path to becoming a KOL. Despite such a high profile publication, Macdougall is disarmingly honest about the process 'It wasn't rocket science' he says 'it was a case of being in the right place at the right time'. Significantly, Macdougall was approached by the pharmaceutical industry rather than courting their involvement.

Macdougall sees several clear advantages of being a KOL. Firstly it brings kudos to the KOL's department, university and even the nation. This helps the department to recruit high quality, research-orientated staff and he was upfront enough to admit that it boosts the ego! There are financial benefits too, both personal (honoraria) and general (research support and event sponsorship).

The main drawback of being a KOL is maintaining scientific credibility. 'I regard myself first and foremost as a clinical scientist' says Macdougall 'I do not want to be known as a drug rep'. He stressed the need to do research in collaboration with industry.

In a frank assessment of agency writers, Macdougall felt that their role was unhelpful and too often too clearly linked to industrial sponsorship than the needs of the KOL and a potential conflict of interest. Although perhaps a personal viewpoint rather than the symptom of a general malaise, this clearly is an area in need of attention.

Macdougall also had concerns about the misrepresentation of data and gave examples such as rofecoxib, the use of SSRIs in children and alleged publication bias in antidepressant studies. He too has experienced difficulty agreeing manuscript contents with industrial sponsors and is sensitive to the need to avoid data selection for publication.

Finally, he posed the question of regulation. Is it necessary? The strongest case for regulation is protection of the KOL, of industry and, above all, Macdougall says, of the patient. In a clear illustration of the need for regulation he gave an example of a KOL who had spoken at two back to back satellite symposia, sponsored by rival pharmaceutical companies and gave two different messages. 'That just makes you lose credibility' says Macdougall 'as a clinical scientist, know what your message is and stick to it'. Sound advice.