Opinion Leaders in Medicine – Michael Herschel

This is a particularly interesting question, and one that we usually avoid because it is socially challenging. In his usual, direct manner, Herschel provokes a review of the definition of opinion leaders and departmentalises their value within clinical research and product promotion.

An Article of Faith?
What is an opinion leader?

Opinion leaders in medicine, and for the pharmaceutical industry in particular, are outstanding individuals – usually physicians who “lead the field”. By definition, an opinion leader is empowered by a group of “followers” to influence it. They are able to persuade others to accept his or her beliefs and to adopt his or her prescribing behaviour or other therapeutic methodologies that they favour. Opinion leaders can, in principle, be from all levels of medicine. In reality, however, they are usually very vocal individuals with high academic status or, at least, a high political and social status.

Concepts of opinion leadership
Political science suggests several models. There is a communication model, which is based on communication science and the dissemination of information and influence. This model is based on communication and cognitive function. It can be used to explain, among other things, the process by which medical information diffuses from its source to the parameters of the profession and how individuals can influence this process.

An alternative model is that of the “role model” as adopted by the opinion leader. From the opinion leader perspective, the role may appear functional; however, it is dependent on the acceptance of the individual within the underlying role to his or her function. In addition, the opinion leader role is one that the opinion leader enjoys and so achieves through personal attitudes and expectations as well as through action.

It is only more recently that measuring the effect of an opinion leader has started to become considered an experimental science. The results so far are disappointing; however, there are still several research projects in progress that are looking into how to convince opinion leaders, for instance.

Genesis of an opinion leader
While this may represent an entire research project, opinion leaders in medicine usually arise from leading academic institutions. As long as the cognitive model of medical science is valid, academic institutions will take this lead. However, it is not clear how strong the influence outside such institution really is if the individuals concerned are not outstanding national figures. Interestingly enough, the study of “fallen angels” ie opinion leaders that have lost their credibility and influence, shows, in most cases, that there was a point at which they “misbehaved” according to their “followers”.

What opinion leaders are good for?
According to common knowledge, opinion leaders do not necessarily have great recruitment rates on their own studies. However, if they are figures that are visible beyond their investigator circles, they can have a positive effect on patient recruitment through radio or TV appearances. They can generate great public relations, which enhances recruitment of patients onto trials. By writing favourable information about drugs in early development they can influence public opinion to bring about the desired affect.

An empirical approaches to opinion leadersIf opinion leaders can be defined by their influence on followers, questioning followers would be a logical choice. There is a difficulty though as many followers will not readily admit that they belong to the follower’s group, but like to maintain their illusion that all of their decisions relating to diagnoses and treatment are their own. Thus, more refined market research and opinion research has to be done. On the other hand, one could do so more easily by presenting a choice of potential opinion leaders to industry professions, or by them to volunteer spontaneous nominations.

Making use of opinion leaders
In general, there are four different types of situations in which you may work with opinion leaders. In the first of these “situations” your objective may be to convince an opinion leader to concede with a propagated opinion. Usually, opinion leaders are scientifically reasonable people who can be convinced by valid scientific data over (sometimes, considerable) time. It is almost impossible to influence opinion leaders without presenting appropriate evidence in support of the new opinion. Without sufficient evidence it is unlikely that the opinion leader will adhere to the opinion or its promotion.

Opinion leaders may be differentiated into two types. “Type 1” describes those more likely to actively speak in favour of a product, diagnostic tool, or therapy. “Type 2” refers to those who are more likely to remain sceptical, or even critical, towards new information. Further, Type 2 may endanger a positive image, or evidence, generated by a drug development programme. From a drug company’s perspective, the measures that are necessary to neutralise the potentially damaging effects of Type 2 opinion leaders, differ to those that are necessary to convince and persuade Type 1.

The association of an opinion leader or leaders with a trial is highly desirable, however, this role is usually one of a figurehead – as they are often too busy with other activities, such as lecturing and caring for real patients, to provide hands-on management of clinical trials.

Lastly, but mostly importantly, opinion leaders can be of tremendous value if deployed to support marketing activities. They have a wealth of experience and excellent clinical judgement in addition to usually having lived long enough not to be subject to fashion. Therefore, product support can be considered the main stay of an opinion leader’s usefulness. Needless to say, this is limited to products for which they can be “won over”.

Dangers of opinion leaders
Opinion leaders, especially conservative ones, can be extremely dangerous for the development of products. If their opposition is not addressed they can develop into enemies. On the other hand, even opinion leaders that are in favour of the product may actually use their power against the company that elected them. Therefore, it is wise to gain the support of more than one opinion leader in order to have an “insurance policy” to limit the potential damage that could result if one or other of the opinion leaders decides to support another product(s).

The right place of opinion leaders – is there one?
As discussed, the rightful place for opinion leaders is, except for the most progressive, not in the earliest stages of development but in the later stages of development or at product launch. As they are extremely vocal individuals and may have many followers, it is ideal to have them support a product in a given indication on the back of its scientific validity.

Marketing againt opinion leaders
There are examples whereby marketing against opinion leaders has not only succeeded but has actually changed the face of an indication. However, it requires that positive public opinion is courted and engaged at a level that can support a sustainable, public rebellion against opinion leaders – as can happen if extremely good scientific efficacy and/or safety evidence exists. In such cases, communication strategies will be different but should avoid irritating opinion leaders and should aim to keep them neutral, if possible.

There are several examples of communication breakdowns that occurred as a direct result of companies trying to work against opinion leaders. Communication is especially prone to breakdown when there is a significant change to paradigms as happened with the advent of the helicobacter pylori theory in peptic ulcers, for example. It took many years for this theory to emerge because most of the opinion leaders in the field at the time were not convinced by the concept and so avoided getting involved. Therefore, many attempts to market products that relied on the uptake of this theory failed because the opinion leaders were clearly supporting the incumbent products.

Having said all this, opinion leaders are very important but, in fact, we know very little about how they become opinion leaders, how they maintain their status and how to differentiate true opinion leaders from those whom we think are opinion leaders or those who think they are opinion leaders. A lot of research topics for social scientists are waiting to be tackled that should uncover some interesting results within this little known, but fascinating topic, that explores the science of personal influence.

Herschel’s Heresies

(C) 2008 – Alle Rechte vorbehalten

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