martes, 15 de enero de 2019

The rise and fall and rise of paid speaking

In 2013, GlaxoSmithKline made a decision that stunned and baffled its peers. The industry had once again come under fire for its promotional tactics, with some generating more heat than others. One that topped the list, improbably, was paying physicians, academics, and other medical-world influencers to speak before audiences of HCPs.

Never mind that much of the industry considered the practice to be benign, especially when compared with decades-ago tactics. The thinking among critics came to be this: Anyone paid to shill on behalf of any organization, brand, or disease state was inherently slanted toward whoever was picking up the tab. GSK’s decision was to announce, with no small amount of fanfare, it would cease paying HCPs to speak about its products and therapeutic categories.


GLAXO "cierra puertas" a K.O.L.´s*

The company made this decision expecting, perhaps, the rest of the industry would follow its lead. Nobody did. “It kind of took a moral stand,” says Mike Luby, founder, president, and CEO of the Biopharma Alliance. “If you talk to people who were there at the time, the belief was it was going to science up its reps to the point it wouldn’t need to pay opinion leaders to speak. But the response from everyone else was, ‘Good luck with that.’”

Tara Grabowsky, M.D., chief medical officer at HVH Precision Analytics, agrees. “GSK shot itself in the foot by taking away one of its most powerful tools vis-à-vis its competitors. It’s a fantastic company, but it miscalculated. Maybe people back [in 2013] didn’t think of it as a voice to follow,” she says.

Not surprisingly, GSK doesn’t quite see it that way. “An industry shift to the standards we announced in 2013 has not materialized. HCP feedback has shown they prefer to learn about new data through peer-to-peer programs with global expert practitioners who have direct experience with our medicines,” wrote Evan Berland, director, U.S. corporate comms, and interim head, U.S. digital, in response to emailed questions, using verbiage lifted from the part of GSK’s website explaining the company’s recent history regarding its paid speaking guidelines. “The effect of this has been that our educational programs have not been as widely available, or seen as compelling to HCPs, compared to other company programs. We believe this has led to a reduced understanding of our products and is ultimately restricting patients’ access to innovative medicines and vaccines.

However, GSK does push back against the notion the no-paid-speaking policy placed it at a competitive disadvantage. “Under the previous policy, we developed medicines in HIV and respiratory that generated annual sales of more than $1.26 billion,” Berland noted.

Off-the-charts good

So here’s the thing about paid speaking programs: They work. Companies wouldn’t continue to spend so much money on them if they didn’t. Meanwhile, HCPs swear by their value, even when the klatches don’t come with the promise of an expertly tenderized prime rib.

This was as true in 2013 as it is today. Barring some complete reimagination of pharma marketing, it’ll be true in 2023, 2033, and beyond.

Mike Luby, Biopharma Alliance
The efficacy [of paid speaking] 
is off-the-charts good. 
In just about every case 
I can think of, 
it would be marketing negligence 
not to put huge dollars against this.
Mike Luby, Biopharma Alliance 

Even its critics acknowledge resources devoted to paid speakers are ones well spent. Adriane Fugh-Berman, M.D., is an associate professor in the department of pharmacology and physiology and in the department of family medicine at Georgetown University Medical Center, as well as the director of PharmedOut, described in her bio as “a GUMC research and education project that promotes rational prescribing and exposes the effect of pharma marketing on prescribing practices.”

Asked about the deployment of paid speakers, she responds, “It’s one of the most effective marketing strategies [pharma] has. Doctors trust their mentors and peers and most KOLs have the credibility that comes with being based in an academic institution.”

Which isn’t to say Fugh-Berman is a fan of the practice. “Unfortunately, it is not perceived as marketing by many people. It’s particularly effective because it isn’t perceived as marketing.” Nor is it regulated as such: Paid speaking is generally lumped under the CME umbrella, which spares it FDA oversight.

What gets lost in any discussion of these programs — and was especially absent in the schadenfreude-laden responses to GSK’s reversal a few months ago — is that paid speaking has evolved as an offering. Mary Manna Anderson, group president, medical education at Haymarket Media (the parent company of MM&M), recalls a time when speaking engagements underwritten by pharma were an entirely different animal.

The doctors weren’t the only ones getting paid in some cases. Attendees sometimes got a stipend in addition to their dinner,” she says. “Plus, speakers presented with decks that weren’t necessarily locked. They could mix and match slides depending on the occasion and the audience and whatever they were trying to get across.”

Compare this with her description of today’s klatches. “All the information has to be approved by medical and legal. Speakers can’t editorialize. There aren’t salespeople stalking around,” Anderson continues. “It’s what it should be, which is an opportunity for doctors to come and hear information from an expert in an appropriate and efficient manner.” 


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