Key Opinion Leaders

DOI: 10.1200/JCO.2015.63.1275 The first time I saw the term, I was mystified. “Hey, Dr S! We’re getting a few KOLs together to give us some advice about how to develop our new compound,” began the friendly e-mail from a pharmaceutical liaison, her return address reflecting her third employer in as many years. “Are you available to come to Atlanta next Saturday? We’ll give you an honorarium for your time.” KOL? What was that? Because “Google” had not yet become a verb, I pulled out my old college dictionary, but its sole suggestion seemed implausible: the Knights of Labor, a nineteenth century workingman’s organization. In response to my puzzled reply, the liaison patiently explained that KOL in this context meant “Key Opinion Leader,” a respected person who can influence others’ beliefs and actions. I was flattered: someone valued my opinions enough to pay real money for them? But I also found the term peculiar. Opinions seemed like a nebulous area in which to be a leader; much better to be recognized for expertise in scientific discovery, for development of new effective therapies, or for something else tangible and useful. I once had an uncle who was an opinion leader at family gatherings, always willing to share ill-informed viewpoints, half-baked ideas, and elaborate conspiracy theories with anyone polite or bored enough to listen. As Clint Eastwood crudely quipped in an early Dirty Harry film, “Opinions are like a**holes— everyone has one.” Later, I received other invitations that used a synonym for KOL, cribbed from public relations jargon: “thought leader.” This term, too, seemed strange when taken at face value, with its implied suggestion that if I could not lead in productivity, at least I might distinguish myself in thinking about being productive. In The Adventure of the Greek Interpreter, Sir Arthur Conan Doyle’s master sleuth Sherlock Holmes described his brother Mycroft as just such a leader: a brilliant deductionist who could have been a better detective than Sherlock, but who instead lived mostly in his own mind, rarely bothering to stir his ample backside from its familiar armchair in London’s stuffy Diogenes Club. Sherlock complained to his companion Dr Watson, “Mycroft has no ambition and no energy. He will not even go out of his way to verify his own solutions, and would rather be considered wrong than take the trouble to prove himself right.” Imagination without execution, like a hypothesis without supporting data, is vapor. I went to Atlanta and enjoyed the meeting with other KOLs, each of whom had far more experience than me. (At the time, I still had a six-figure medical school debt, so I also appreciated the honorarium.) Because all the advisory board involved was thinking and talking—not frantically washing dishes to keep up with a busy restaurant, mowing lawns on a muggy August afternoon, dodging punches from angry drunks while moonlighting in an emergency room, or any of the other jobs I have taken to earn a buck—it felt like the easiest day’s work ever. The company that had called that first advisory board was new to oncology, was planning a clinical trial to test a drug they had obtained in a merger, and needed some help from physicians who treated patients. I, in turn, appreciated hearing the perspectives of senior colleagues, especially views or interpretations of data that I had not considered before. It also felt good to be included in a “club” of active investigators in the area of diseases, even if only as a junior member—a tangible reward for long nights and weekends of work. The company asked us good questions and took our collective advice to heart. The advisory group’s recommendations largely coalesced, and the resulting clinical trial was successful, eventually leading to a US Food and Drug Administration approval. Over the years, I’ve participated in many other advisory committee meetings and, although many have been models of healthy and productive academic-industry collaboration, not all have been as enjoyable as that first one. In some cases, the panel seemed less a forum for exchange of opinion and instead just another way for a company to disseminate a marketing message—a chance to raise awareness of a drug’s profile or quell emerging fears on drug safety. Too often, a company’s representatives have already decided on a clinical trial design and drug development plan and seem to be simply going through the motions of soliciting external advice, JOURNAL OF CLINICAL ONCOLOGY A R T O F O N C O L O G Y VOLUME 33 NUMBER 28 OCTOBER 1 2015