Common healthcare PR practice may be about to change. Evidence given to the Health Select Committee during parliament's inquiry into 'The Influence of the Pharmaceutical Industry' has been the subject of much rumination in the healthcare PR sector over the winter months.
But it was the comments of two senior national newspaper health journalists in the sixth session of the inquiry that have intrigued many in the pharma comms sector.
Sunday Times medical editor Lois Rogers and Daily Mail medical correspondent Jenny Hope both made negative remarks regarding pharma companies' use of opinion leaders to support data and claims made in promotional campaigns.
Early in the inquiry, Hope said: 'The PR industry sets great store by opinion leaders, which mystifies me.'
And Rogers also said the suggestion by a PRO of an individual as a source would deter her from quoting that person because she would 'think they were in the pocket of a drug company' (PRWeek, 7 January).
While the final report on the outcomes of the select committee's inquiry is due to be published next month, voluntary or enforced changes in healthcare PR practice those changes are not expected for many months.
Nonetheless, the comments at the inquiry have led to concern in the healthcare PR industry that the practice of recruiting opinion leaders could be on the wane.
However, not all healthcare journalists are as sceptical of the credibility of opinion leaders as Hope and Rogers.
The Times health editor Nigel Hawkes says: 'I would probably quote (an opinion leader touted by a pharmaceutical company). I don't think it would invalidate the credibility of that person when they are put up in that way. It is usually a person involved in the trials of the drug. Anybody involved in a trial tends to be positive - that's human nature - so you would allow for that. But I wouldn't be too suspicious.'
The specialist healthcare media are not necessarily instantly dismissive of opinion leaders either. 'Just because they are put up by a big pharma firm doesn't mean you dismiss them out of hand,' says Chemist & Druggist editor Charles Gladwin.
'We assume they're fairly well informed and use their comments as the basis of our enquiries, but as healthcare professionals ourselves, we have our own views too,' he adds.
Hawkes sees some benefits in instant access to qualified opinion, particularly when it helps journalists with daily deadlines. 'In an ideal world, you would get someone else to quote too, but not all experts are aware of all of the research that has been done and we have not got enough time to quote every conceivable expert,' he says.
The use of opinion leaders to support healthcare PR campaigns is as old as healthcare PR itself. And in a highly regulated market with strict guidelines on the promotion of drugs, including a ban on direct-to-consumer advertising, the use of expert, independent support in PR campaigns has often proved invaluable.
Hawkes even sees the use of opinion leaders as an inevitable outcome given the regulatory environment under which drugs companies operate in the UK: 'It (the use of opinion leaders) is a reflection of the fact that drug companies are not allowed to advertise direct to consumers.
As a result, they depend heavily upon healthcare PR - you have to get at people in another way.
'Sometimes there is too much weight placed upon PR companies to achieve what would otherwise be achieved by advertising,' he adds.
But other more wide-ranging fears have also emerged from the inquiry, such as that it even calls into question the credibility of healthcare professionals - clinicians, academics, patient advocates and policy makers - who are employed to support the launch of drugs and products because of their expertise.
'We have to be clear about what's at stake here,' says Jeff Smith, managing director of healthcare PR firm Avenue HKM. 'We have to be careful in the context of comments made at the health select committee that this does not harm the integrity of these opinion leaders.'
Smith denies ever being involved in campaigns that offer fees, other than onorariums set at General Medical Council-agreed levels, to clinicians or any other expert for backing in a campaign.
Edelman executive vice-president and MD health, Europe Kate Triggs agrees that integrity has been a major concern for opinion leaders when considering supporting a drug launch: 'I have yet to come across an opinion leader who was not as keen on maintaining his or her independence and credibility as I was.'
Triggs continues: 'Aside from the regulations, there is a very simple natural order at work in the opinion-leader world. They are valued for their credibility.
'If they were seen to be in the pockets of pharma companies, that credibility would be diminished and, in turn, so would their standing with their peers and with their own institution.
'This would mean that their opinions would cease to be valued and, by definition, they would no longer be an opinion leader, and that is neither in their interests nor in those of the pharma companies,' she adds.
There is widespread rejection among healthcare PROs of the notion that opinion leaders are 'hired hands', as they were described in evidence to the select committee.
Smith argues: 'We don't recruit opinion leaders per se. These people are the ones driving research and knowledge in any given area. The term "recruitment" is not appropriate. If payment is a pre-requisite for a relationship (between an opinion leader and a pharmaceutical company) then there is a problem.'
However, Caroline Wright, chair of the Guild of Health Writers, says the influence of the pharmaceutical industry is pervasive, the situation is complex, and it is indeed something that should concern everyone.
'It is hard to find a leading expert who has not at some point taken money or had a trip supplied by a pharmaceutical company,' says Wright.
'The situation shouldn't be that we have to rely on the pharma industry to fund research - but that's the parlous state of the healthcare industry in the UK.'
On the future of third-party support through the use of clinicians and other health experts, Triggs says: 'I believe opinion leaders will always be key to campaigns since they see the patients, understand the gaps in treatment and participate in trials to see the difference treatments can make first hand.'
ADVICE ON HOW TO USE AN OPINION LEADER
1. As part of the process of defining an appropriate candidate, whether a top-level academic or someone involved in primary research, that person must be a recognised leader in the field, advises Avenue HKM managing director Jeff Smith. This usually means someone involved directly in drug trials in the case of a new therapy.
2. An effective opinion leader must meet the needs of the campaign itself. This is deceptively simple but feeds into the previous point, says Edelman executive vice-president and managing director, health, Europe Kate Triggs. 'For example, they (opinion leaders) need to be respected beyond the UK if the campaign is international and have real depth in the disease area,' she says.
3. Credibility is crucial. The best way to maintain the credibility of the opinion leader is through guaranteed independence, says Smith. Triggs argues this is one of the most sensitive and important areas, because if opinion leaders aren't seen to have independent views, then their credibility diminishes.
4. Expertise in the area is an indispensable criterion when selecting an effective opinion leader, but where would the campaign be without an effective communicator? So the fourth criterion is an ability to express ideas in language consumers will understand - especially important if they are expected to speak to the media.
5. Campaign managers must listen to what opinion leaders say, advises Smith. He points out that if the campaign manager begins telling the opinion leader what to say, then the expert is robbed of his or her independent expertise, damaging integrity for all involved.