Who the hell is a KOL? Our understanding of who has most clinical influence amongst their peers may need review

In pursuing my interest in things behavioural, I’ve been reviewing the area of social and professional networks with a view to assessing whether my personal preconception of what a Key Opinion Leader (KOL) looks like – in a pharma context – should be updated.

My working assumption had been that a KOL must have preeminent clinical or scientific expertise, a string of peer-reviewed publications and speaking engagements under their belt, and actively help to formulate treatment protocols and guidelines. Implied in that definition, is that any given therapy area will only have an ‘elite’ and highly coveted band of KOLs.

However, on revisiting social network theories I wondered if that definition was too exclusive, and a touch out of date. What about clinicians who don’t present and publish, but who are influential amongst their peers on an everyday basis by virtue of their relative expertise, accessibility, connectedness, and persuasiveness?

The literature on influence within social and professional networks says that genuine opinion leaders must possess all of the above traits, not just high expertise. And on review of current commercial offerings, it seems that some (but not all) companies in the business of hooking-up Pharma companies with KOLs are extending their sights to such people, no doubt prompted by insights from network theory as well as the established social media revolution.

Peer-reviewed studies have repeatedly shown that physician drug prescribing is more likely to be led by those who occupy a similar position in their professional network, rather than by an ‘elite’ KOL.

Opinion leaders are more precisely opinion brokers who carry information across the social boundaries between groups. They are not people at the top of things. (Burt, 1999)

The opinion leader translates an innovation for the rest of the community. This is their skill, they are admired by many and are good at scanning the environment because they are connected to lots of people. (Valente, 2010)

Such findings have gained credence as the ease with which we can network with each other has increased, and more is understood about the powerful ways in which influence travels through human networks. We might argue, in tandem, that ‘elite’ KOLs naturally have less influence these days, since the big decisions about which medicines are available to prescribers are increasingly in the hands of government agencies and purchasing specialists (e.g. in the UK: Nationally, NICE and, locally, “Medicines Managers” aka. “Payers”). Furthermore, in recent years it has come to light that those designated as KOLs, would actually prefer NOT to be called KOLs! In a study by System Analytic, as many as 62% said it was time for a name-change (or to go name-less) because the term had in their view become tainted, in large part due to its association with the pharma industry. They preferred the neutral term “external expert”.

Academic meta-analysis has identified no fewer than 10 different ways to identify opinion leaders. I won’t test your patience by listing them, but will say that self-identification emerges as a surprisingly reliable method, relative to most others. There are one or two better ways, but they are fiendishly expensive and very time-consuming! A 12-month study here at First Line Research successfully replicated academic outcomes, finding that ~8-10% of UK health professionals claim to possess all the characteristics of an influential opinion leader, i.e. expertise, accessibility, connectedness, and persuasiveness¹. These people self-select as opinion leaders within their networks, and have an innate ability to promote change amongst their peers. The messages they support travel further, and carry more weight than those supported by others. They are the medical profession’s equivalent of Seth Godin’s “Sneezers” in “IdeaVirus” and are also the sort of approachable ‘external expert’ from whom most people are happy to seek advice.

That is not to say that pronouncements from ‘elite’ KOLs do not sometimes cascade effectively down to prescribers, rather to suggest that to focus solely on them as agents of behaviour change would be to miss a rather large trick. Through understanding the beliefs and behaviours of these local, accessible, and influential “external experts”, organisations can formulate strategies that speak to them, in the knowledge that their views and preferences will transmit, naturally, through their network.

As a market researcher I am less interested in personally identifying, mapping, and directly communicating with these people, and more interested in reporting how their views differ from those of other clinicians. For example: Which clinical messages do they support? What are their future prescribing intentions? Which pipeline drugs most excite them? And so on…

If you are a research buyer interested in finding out more about our study findings, or research offerings in this area, please feel free to contact me:

John Aitchison, 01904 799550, john@firstlineresearch.com

¹ Asked indirectly, via a set of scale based based survey questions, adapted from the academic literature by First Line Research.


Leave a Reply

Your email address will not be published. Required fields are marked *