Tuesday, March 11, 2008

"Not Much Money," KOLs, and Child Bipolar Disorder

Intro. A few months ago, I wrote about key opinion leaders (KOLs) in psychiatry arguing that we shouldn't be making such a big deal about their payments from drug companies. After all, they were just receiving chump change. At the time, my motivation was spurred by a great piece in the New York Times on the issue of physicians receiving payments from drug companies. Physicians are often paid to become "key opinion leaders," aka salespeople. Often possessing academic positions, these KOLs give speeches to fellow physicians in which they extol the virtues of a drug in exchange for cash. Of course, physicians might be leery if a sales representative was discussing the latest wonder drug, so using an "independent" physician uses a basic marketing trick, the third-party technique, in order to give the marketing message a veneer of credibility. For the past few years, KOLs have been lighting up the upscale restaurant scene across the nation, discussing the benefits of atypical antipsychotic (er, broad spectrum psychotropic) treatment for a wide variety of ills. From schizophrenia to bipolar disorder to anxiety to well, pretty much anything you can imagine, antipsychotics are the treatment du jour.

"I don't make much." One KOL in the wonderful world of atypicals has been Melissa DelBello. In particular, her specialty is children with bipolar disorder. I've previously stated my beef with the child bipolar paradigm and I'll discuss a couple of my contentions a bit later in the post. DelBello has been involved in research regarding the treatment of child bipolar disorder (not saying I necessarily agree with the term; just using it because she used it). As a KOL, DelBello has given talks supported by AstraZeneca, manufacturer of Seroquel. As for her reimbursement for such talks, she said "Trust me. I don't make much."

Here is what a little investigation from Senator Charles Grassley uncovered regarding DelBello's definition of "not much" money.
Here is where it gets interesting. After Dr. DelBello released her study, Astra Zeneca began hiring her to give several sponsored talks. Another doctor told The New York Times he was persuaded to start prescribing drugs [Page: S10722] such as Seroquel after listening to Dr. DelBello. But when the reporter from the New York Times asked Dr. DelBello how much money she got from Astra Zeneca, she told the paper: ``Trust me. I don't make much.''

Well, I decided to find out how much, and I went directly to the University of Cincinnati who, by the way, has been extremely cooperative, helpful, and responsive. Soon I figured out just how much ``not that much'' money is. Dr. DelBello's study, which helped put Seroquel on the map, was published in 2002. That next year, she got more money than she has ever received from the pharmaceutical companies--at least that is what the documents that I have say.

In 2003, Astra Zeneca alone paid her a little over $100,000 for lectures, consulting fees, travel expenses, and service on advisory boards. In 2004, Astra Zeneca paid her over $80,000 for the same services.
So, if I have this correct, $180k over two years is "not much money." Hey, this is quite similar to a response from another moonlighting entrepreneur with a license to practice medicine. To quote from the New York Times...

The psychiatrist receiving the most from drug companies was Dr. Annette M. Smick, who lives outside Rochester, Minn., and was paid more than $689,000 by drug makers from 1998 to 2004. At one point Dr. Smick was doing so many sponsored talks that “it was hard for me to find time to see patients in my clinical practice,” she said.

“I was providing an educational benefit, and I like teaching,” Dr. Smick said.

Right. The companies provide you with the slides and the key marketing points, and you call yourself an "educator." Um, doesn't that actually make you a marketer? And the clincher: Who has time for patients in clinical practice when you are off stumping for the hot drug of the week?

The KOL-Pharma Marriage: For all I know, Dr. DelBello is a great human being. I disagree with her a great deal on the child bipolar thing, but there are certainly many very bright and reasonable people who see things differently than myself. Personally, I have difficulty seeing the child bipolar bandwagon as anything other than a massive campaign to re-brand a broad spectrum of unruly behavior under one heading that can be used to call out for antipsychotic treatment. Researchers in the area of child bipolar perceive that scientific progress is being made because they have "discovered" a condition that affects millions of youth. Big Pharma loves it because, conveniently, they can treat this newfound condition with their cash cow atypical antipsychotics. And the marriage between child bipolar researchers and Big Pharma becomes even tighter through the well-paying speaking gigs in which KOLs pimp atypicals as the treatment for child bipolar, a condition that was considered quite rare until KOLs and Pharma "educated" us about this "neglected and undertreated serious medical condition."

Taking large payments then writing them off as "not much" just adds another brick to the wall of conflicted interests that dominates medicine these days. The physician-marketer (aka KOL) can perhaps take great pride in the rate of treatment for child bipolar expanding by perhaps 4000% of late. In fact, the spread of atypical antipsychotics for children, the elderly, and everyone else is such good news that I think KOLs should be up for some sort of marketing award. Go Team Seroquel! Viva Zyprexa! Rock on Geodon Crew! Gimme an I-N-V-E-G-A! Pimp that Abilify!

Believe it or not, I'm not against industry-academic collaboration. But I am against industry-academic corruption. When there are no checks and balances on a system, one should not be surprised when it is subverted by a combination of power and money. When academics turn into industry spokespeople, or become information launderers, or become medal winners in the conflict of interest department, why on Earth should we simply trust them as if they had no skin in the game?

6 comments:

Anonymous said...

I'm new to your blog. What does KOL stand for? You use it in the begining of the post without defining it. Thanks.

Pistol Pete said...

This is a very revealing article. I plan to cite and link it in my blog's (Necessary Therapy) next "Manic Monday" feature.

Stephany said...

Not to forget to mention that DelBello is on the bp kids dot org site, CABF, Child and Adolescent Bipolar Foundation, which has a successful parent forum that used to be free,and heavily promotes medicating children and has since my daughter was misdiagnosed in 1999.
Take a look there, Biederman and many KOL of the Childhood Bipolar disorder gang are there.

*I can't preview my comment, so I hope the link worked.

Marissa Miller said...

I had the hardest time posting on my comment on blogspot yesterday but I just wanted to say "Good post."

CL Psych said...

Thanks Marissa. Good to have you back -- haven't heard from you in a while.

Stephany, thanks for the additional information.

Anon -- I made a slight edit to address your point -- it's key opinion leader.

Pistol Pete -- thanks for the link.

Locum tenes said...

Not Much Money huh?
Great post.