Globalization risks tracing the feudal system: today's "lords" are the ones who decide on information In recent years, "sponsored" disclosure has prevailed
In the June issue of the British Medical Journal (2008;336:1402-1403), Ray Moynihan addresses in the article "Key Opinion Leaders: independent experts or drug representatives in disguise?" the role of a particular category of doctors, the so-called "opinion leaders". Are the opinion leaders independent experts or drug representatives in disguise? The role of opinion leaders (see also Il Sole-24 Ore Sanità n. 29/2008) is a prevailing phenomenon of the last 15-20 years in which the pharmaceutical industries have intended to strengthen the work of their drug scientific representatives by associating them with information given by expert doctors in this or that sector. The investments of the pharmaceutical industry at marketing level (data from 2004, Nejm 2004;351:1185-1190) have achieved significant turnovers, about a third of the budget, which testifies that the industry trusts this type of pharmaceutical propaganda . In fact, it has been seen that in general, after sponsored meetings with the presence of opinion leaders, the turnover of the drug, which is the subject of the reports, has a growing trend. One of the areas of greatest intervention by opinion leaders is medical oncology, which as a specialty will reach a turnover of 41 billion dollars in 2008 against 24 billion in 2004. It is in fact realized that few medical oncologist specialists (both world and Italian level) are responsible for the greatest pharmaceutical expenditure by drug category and for this reason worthy of the utmost consideration and information addressed. The target of the Italian opinion leader, to remain in the oncology sector, is an expert (mind you, not a scientist) who enters well-established circuits both in congresses and in scientific publications. In general, the pharmaceutical industry actively collaborates in funding cooperative research groups which often report to opinion leaders. The role of scientific societies is extremely marginal in remedying this phenomenon with anti-conflict of interest rules, indeed being able to enter the governing councils of scientific societies is an element that strengthens the role of the opinion leader. Can a doctor who receives a certain fee for each individual presentation in commercial symposiums or satellite meetings of corporate congressional events maintain scientific independence? At first glance the answer is no. The writer has repeatedly stated that if the speaker, as the first slide of his speech, highlighted the "grant" he received for the report, the perception of his statements would be different on the part of the audience and, probably, he himself would try to be as aseptic as possible. Currently, world globalization, by analogy, could trace medieval feudalism with vassals (world opinion leaders), valvassori (continental opinion leaders) and valvassini (national/regional opinion leaders) who integrate with each other and are affected by a certain hierarchy. It appears evident that the role of the vassals is the most critical for correct information and independence. There is no doubt that ever more precise anti-conflict norms are being outlined at the level of the major scientific journals, and also in international congresses, however the old Latin saying Otto I meets Pope John XI (miniature) "Pecunia non olet" could catch on lose the scientific independence of the individual. Since independent research has now almost completely disappeared, it is evi
