The Secret Lives of Big Pharma’s ‘Thought Leaders’

By Carl Elliott

 The Secret Lives of Big Pharma's 'Thought Leaders' 1Michael Morgenstern for The Chronicle Review

In the early 1970s, a group of medical researchers decided to study an unusual question. How would a medical audience respond to a lecture that was completely devoid of content, yet delivered with authority by a convincing phony? To find out, the authors hired a distinguished-looking actor and gave him the name Dr. Myron L. Fox. They fabricated an impressive CV for Dr. Fox and billed him as an expert in mathematics and human behavior. Finally, they provided him with a fake lecture composed largely of impressive-sounding gibberish, and had him deliver the lecture wearing a white coat to three medical audiences under the title "Mathematical Game Theory as Applied to Physician Education." At the end of the lecture, the audience members filled out a questionnaire.

The responses were overwhelmingly positive. The audience members described Dr. Fox as "extremely articulate" and "captivating." One said he delivered "a very dramatic presentation." After one lecture, 90 percent of the audience members said they had found the lecture by Dr. Fox "stimulating." Over all, almost every member of every audience loved Dr. Fox’s lecture, despite the fact that, as the authors write, it was delivered by an actor "programmed to teach charismatically and nonsubstantively on a topic about which he knew nothing."

It is tempting to imagine that the Dr. Fox study reveals a deep flaw in the structure of medicine—for example, that health-care workers are too trusting of authority, or that Continuing Medical Education (CME) lectures are a sham. But what the study actually reveals may be something closer to the opposite. If medicine were simple and transparent, pretending to be a medical expert would be very difficult. An audience could spot incompetence right away. Pretending to be a medical expert is possible precisely because medical knowledge is so specialized and opaque. These days an ordinary doctor can no more expect to understand the intricacies of specialized medical research than the driveway mechanic who tinkered with his Volkswagen in 1962 can expect to fully understand the complex, computerized automobiles on the road today. Those who have tried to sit through a medical lecture in a field other than their own will secretly admit that they could have been fooled by Dr. Fox as well.

Since the 1950s, marketers have been taken with the idea that when it comes to spreading the word about unfamiliar products or ideas, some people are far more important than others. The phrase "opinion leader" was made familiar by the sociologists Paul Lazarsfeld and Elihu Katz in their 1955 book, Personal Influence, where they used the term to explain the way that media messages were filtered and spread by personal, face-to-face contact with influential people. It is not hard to see why marketers liked this idea. Mass-media advertising can be expensive. What if there were a way to avoid the masses and simply concentrate on the special people? Today the pharmaceutical industry uses the terms "thought leader" or "key opinion leader"—KOL for short—to refer to influential physicians, often academic researchers, who are especially effective at transmitting messages to their peers. Pharmaceutical companies hire KOL’s to consult for them, to give lectures, to conduct clinical trials, and occasionally to make presentations on their behalf at regulatory meetings or hearings.

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