The Sunshine Act and Working with Thought Leaders

Industry Insights from Paul Meade, M.Sc. MPH

With the Sunshine Act getting closer to implementation, every company that works with thought leaders is preparing for full disclosure and transparency in the way they work and compensate these physicians and other medical experts. So the big question at hand is this–just how many thought leaders should a healthcare manufacturer work with going forward? Some say just a few and others say many. What’s the right answer here?

If we take the argument that working with just a select few is better, one could surmise that it is best to cement a working relationship with a few key thought leaders rather than get to know a “cast of hundreds.” This way, companies may gain a better understanding of the respective key opinion leaders’ interests, preferences, beliefs, and skills. Companies can more effectively create a set of activities that most appropriately matches the skills and experiences of each physician and work with the strengths of each physician to bring new insights into new medical treatment options.

But the one factor working against the “less is more” option is the fact that many academic medical institutions are placing limits on how much remuneration a thought leader can accept from the industry in a given year. Whereas, not too long ago, managed care organizations were placing providers under a capitation system for their fees, several medical institutions are now implementing similar capitation systems for their physicians with regard to their consultative services to the biopharmaceutical industry.

Why? Well, perhaps they are concerned that by providing too many consultative services to too many companies, their physicians may lose some of their objectivity and adversely affect the institutions where they work. Or, maybe they are concerned that they are supplementing their income too much from these services. Perhaps these institutions dread the thought that one of their physicians will appear on the front page of the Wall Street Journal in an unfavorable light. Regardless of the reasons these institutions might have, capitation is certainly a major reason for not limiting the number of thought leaders a company might interact with on a regular basis.

And this brings us to the other argument, which supports working with many thought leaders. Every physician who is considered a thought leader among his or her peers has a unique set of skills and experiences, likes and dislikes, beliefs and perceptions, and personality styles that make that person ideally suited for various consultative activities. Some KOLs like the media and are comfortable in front of a camera or a probing reporter; others prefer to write about their scientific prowess in prestigious medical journals, and others still like to interact with patient advocacy groups and address lay audiences to help educate on health issues. By working with many thought leaders and having a sound understanding of their skills and experiences, a company stands a better chance of finding the right fit for having a physician provide consulting services.

You wouldn’t put a football team together of all quarterbacks, or a baseball team of all pitchers, or, heaven forbid, a hockey team of all goalies! So why would you only have a few thought leaders to help advise on key medical decisions about product development? Having a well-balanced team of physicians with a variety of skills and experiences that can address a multitude of complex issues facing many biopharmaceutical companies will always be a better course of action than having a handful of specialists with a narrow focus of interest. The advantages of this approach are one is less likely to bump up against a given thought leader’s capitation level, and, upon full disclosure and transparency as mandated in the Sunshine Act, one is not likely to draw undue attention to any single physician compensated fairly for consultative services.

The challenge, of course, is in gaining sufficient knowledge about the skills and experiences of a large number of physicians within a given therapeutic area. And remember, the battle is usually won by the side with the largest army!

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