The rise and fall and rise of paid speaking (cont)

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 The rise and fall and rise of paid speaking




An evolution in thinking

Grabowsky has experienced a similar evolution in her thinking about paid speaking programs. During her medical training, she and her peers took note of the faculty members who were “involved in getting the science out there,” as she puts it.

While she believed they were sincere in wanting to raise the level of care and expertise across all types of practices, she came away unimpressed by the speakers she encountered after finishing her residency. “I was happy to eat the steak because I was young and poor, but pharma companies were not selective enough in choosing their speakers. It always felt so sales-y,” Grabowsky explains.

The reality is physicians want to hear 

from people they respect 

and who they view as leaders 

in their own medical communities, 

not just the national opinion leaders

Mary Manna Anderson, Haymarket Media 

She believes that is no longer the case. “[Pharma companies] lost credibility by not choosing the right physicians or KOLs. They’ve gotten better at doing that, which makes all the difference.”

That’s one of the key changes the tactic of paid speaking has seen in the past decade or so: The industry no longer calls on the same individuals time and again. There’s a new degree of rigor in choosing speakers, one that relies as much upon ferreting out emerging voices via networking as it does hasty web searches for recently published articles in a given specialty. “There are lots of people who have opinions and expertise that are important to practicing physicians,”  
A positive effect

In a sense, then, maybe GSK’s decision to eliminate paid speaking had a positive effect on the practice after all. The industry appears to be far more upfront and transparent about the workings of these programs than it used to be. It has expanded the topical breadth of its offerings to include more real-world evidence. The presentations are medically and legally vetted within an inch of their lives.

Or maybe it’s just that speakers and attendees alike have arrived at the conclusion that paid speaking is, as a tactic, ethical and relatively impervious to abuse — and, as such, have made peace with it. “I think people realized there’s nothing dirty about this at all,” Luby says. “It’s a physician service and a public service [for companies] to put opinion leaders who understand the science out there.”

Adds Grabowsky, “Maybe it’s that the threshold of disgust has shifted. We don’t want to go back to the boondoggle of sending doctors on a cruise to write more Lipitor. Paying them to lecture seems more academically appropriate, and it’s obviously less ostentatious.”

Fugh-Berman gets where people who are OK with paid speaking are coming from, though she fundamentally disagrees with their reasoning.

“The role of the paid KOL is to never directly sell a drug — it’s to sell a disease or concept that supports marketing for a drug,” she says. “But if a drug is new or the market leader in a class [of drugs], promoting the disease is promoting the drug.”

She adds that HCPs, for all their intelligence, sometimes aren’t able to make these distinctions. “Physicians are more gullible than the average consumer. Apparently they’re a favored target for financial scams,” she says warily.

With paid speaking entrenched once again as a top-tier tactic, look for pharma to selectively increase its investments. While there’s little point in paying physicians, academics, or anyone else to speak on behalf of me-too brands, generics, or biosimilars, new drugs — or what Fugh-Berman dryly calls “drugs for invented conditions” — are ideal for the deployment of armies of A-list speakers.

“The one fear I have is that the pendulum swings back toward the cruise ships,” Grabowsky says. “But it all goes back to improving the quality of care delivered across the country. If you can get a true expert speaking about new science to educated communities of physicians who will listen, that can only be a good thing.” 
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Federico Relimpio "sale del armario": Ser K.O.L. / Key Opinion Leader.