A combination of conflict of interest concerns, public disclosure via the Sunshine Act and—particularly in GlaxoSmithKline’s (GSK) case—large settlements resulting from off-label promotion is causing a major shift in the way pharmaceutical companies interact with physicians. Not only did GSK announce it would discontinue paying doctors to speak about its drugs and the diseases its medicines treat (see my column Speaker Programs: RIP, in the February issue), but just recently Deirdre Connelly, head of GSK’s U.S. pharmaceuticals business, said the company will also begin to recruit doctors as in-house representatives to provide education about its medicines—instead of paying external speakers.1 Whether or not other companies will follow suit is unclear, but this is likely the beginning of a very different era of pharmaceutical promotions.
Eliminating “Kickback” Concerns
Advantages to industry use of in-house physicians to promote products include: Eliminating ethical concerns of “kickbacks” and the need for publicly reporting payment to speakers. Pharmaceutical companies will also likely reduce off-label promotion using employed physicians who they can fire versus external physicians who may not follow the rules. And assuming these physicians are full-time employees, certain efficiencies and cost savings in regard to program logistics would be gained.
How Can In-house Physicians Influence Peers?
The most likely concern: Whether or not a company-employed MD would be as influential as a well-known and trusted key opinion leader (KOL) with a lot of patient experience, or whether they would be seen as just another drug rep. Pharma companies can do several things to overcome this barrier:
1. Hire knowledgeable physicians with a lot of patient experience. Plenty of MDs possess a wealth of experience that would gain credibility among peers.
2. Stay local. Physicians are more likely to trust a peer from their own community.
3. Hire Primary Care Physicians (PCPs). The industry typically uses specialists as KOLs and speakers, but PCPs do not need to hear from a specialist about diseases they treat on a regular basis. PCPs prefer to hear from PCP colleagues who treat the same type of patients they do and who understand their issues and concerns.
4. Insist that MD researchers practice. Many in-house MD researchers in pharma companies are encouraged to keep up their clinical skills, often serving as voluntary faculty at nearby academic centers. Some may see this as a covert way to influence non-voluntary faculty peers, but it is important that the MD employees stay in clinical practice, as not doing so dramatically decreases credibility among peers. One possibility would be for companies to support free clinics where employed physicians can work, which could only help to improve public opinion.