“The Key Opinion Leader is a combination of celebrity spokesperson, neighborhood gossip, and the popular kid in high school. KOL’s do not exactly endorse drugs, at least not in ways that are too obvious, but their opinions can be used to market them—sometimes by word of mouth, but more often by quasi-academic activities, such as grand-rounds lectures, sponsored symposia, or articles in medical journals (which may be ghostwritten by hired medical writers). While pharmaceutical companies seek out high-status KOL’s with impressive academic appointments, status is only one determinant of a KOL’s influence. Just as important is the fact that a KOL is, at least in theory, independent. Medical audiences trusted Dr. Fox partly because he played the part of an expert so convincingly: white coat, gray hair, and a complicated lecture, delivered with authority. But they also trusted him because they had no reason not to trust him. Dr. Fox was not selling a product or pitching an idea. The very implausibility of his charade is part of what made it so persuasive. Dr. Fox appeared to be impartial.” Un articolo su The Chronicle of Higher Education offre (puoi scaricarlo gratis su internet) la migliore analisi dei persuasori occulti utilizzati dall’industria farmaceutica per la promozione dei propri farmaci. Un’analisi ironica, spietata nella descrizione di fatti di disarmante banalità capaci però di mettere a nudo le debolezze del sistema che “regola” (?) la formazione continua del medico.
Ma perché un medico dovrebbe accettare di figurare come testimonial di medicinali di dubbia efficacia o, peggio ancora, potenzialmente dannosi? “It strokes your narcissism,” sostiene Erick Turner, psichiatra della Oregon Health and Science University. “There is the money, of course, which is no small matter. Some high-level KOL’s make more money consulting for the pharmaceutical industry than they get from their academic institutions. But the real appeal of being a KOL is that of being acknowledged as important. That feeling of importance comes not so much from the pharmaceutical companies themselves, but from associating with other academic luminaries that the companies have recruited. Academic physicians talk about the experience of being a KOL the way others might talk about being admitted to a selective fraternity or an exclusive New York dance club.
Storie di limousine in attesa agli aeroporti, di pranzi prelibati, di diapositive fornite dalle industrie e di … esami al cospetto di opinion leader di ancor più consumata esperienza (i “mega-thought leaders”): “They give you slides that you will probably be speaking from, and you’ll be in a room with about a dozen other people,” ricorda Turner. “You get up there, and you have your pointer, and then you stand off to the side when you’re done. And the facilitator will say, ‘So what did you think of his voice? What did you think of his body language? Did he project well?'”
Può cambiare qualcosa? Difficile, se è vero – com’è vero – che i legami tra università, centri ospedalieri e industrie sono così stretti che numerosi tra i presidi delle università statunitensi siedono nei consigli di amministrazione di industrie di primaria importanza (quello della Università del Michigan nel board della Johnson & Johnson, così come quello della Brown in quello di Pfizer e Goldmann Sachs).
Notizie migliori giungono da David Healy, psichiatra della Cardiff University: “If you look at the opinion leaders, the guys in the field are not stellar geniuses. (…) It’s not that anybody has a particularly brilliant insight, or that these guys are really awfully bright, but the opinion leaders who work with pharma are actually the least bright. These guys get made by industry. They get money, they get status, and they knew they wouldn’t be anything if it weren’t for this.” Chissà, un giorno, una risata li seppellirà?