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Pooling ideas

New research into doctors' behaviour could force a reappraisal of Key Opinion Leader management

Zebras at a watering holeWhen he invented the term 'paradigm shift', Thomas Kuhn recognised that science does not progress smoothly, but in occasional leaps separated by long periods of slow growth. Although it is an overused term in marketing, there are occasions when a paradigm shift happens in marketing science. Such a leap seems to be happening right now in the important area of new product acceptance.

Exactly how ideas like a new therapeutic approach spread through a market is of obvious interest to pharma marketers. Having an understanding of the mechanism enables accelerated acceptance and increases the area under the sales curve before genericisation steps in. For the last 40 years, the dominant theory used by marketers to manage uptake has been the diffusion of innovations curve, defined by Rogers in 1962, and the related idea of the Key Opinion Leader (KOL), coined by Katz and Lazarsfeld in the 1950s. The concept that a few prominent thought leaders strongly influence the choice of many followers is so engrained in marketing thinking that it is rarely questioned. Yet that is what new, collaborative research has set out to do. The results of this investigation could shape the future behaviour of pharma marketers.

The project, undertaken jointly by the Open University Business School and a leading customer information company, began by looking at the existing research underpinning KOL management. Remarkably, this was based mostly on consumer markets and was weak in technological, business-to-business markets like the pharmaceutical industry. This is an important weakness to highlight because, while consumers tend to make decisions alone and based largely on emotive criteria, it is known that clinical choices about which therapy to recommend are much more complex, involve groups and rely on scientific data. Of course this is especially true now that individual prescribers are ceding their decision-making power to payers and their drugs committees.

As management researchers love to investigate widely accepted theory with little supporting evidence, this research was spurred on further by another body of work that suggested an alternative model, known as Communities of Practice (CoP). That model suggested that new practice develops in professional environments when members of a group pool ideas within their team, which is relatively isolated from other work groups. There was evidence for CoP being important in some clinical settings, but none that supported the model in a pharma market setting. Two competing theories, neither with much evidence, were too much temptation for the management scientists to resist so the research question and methodology were set up.

KOL and CoP each suggest distinctive but very different patterns of connections between physicians. To greatly simplify something that is at the very edge of statistical thinking, KOL theory suggests a sparse, tree-like pattern of connections, while CoP suggests something more like islands of connectivity.

To test which theory was the best description of reality, the connectivity had to be drawn out to see what it looked like in practice. This was only possible because of a unique and huge set of data collected by the information company with its leading edge analytical capabilities. The picture that emerged, using a sample of many hundreds of oncologists, was more conclusive than expected (Figure 1).


Figure 1: A network of communities of practice

A diagram of a network of communities of practice


Pattern of connections
The pattern of connections revealed clearly supported the idea that CoP theory, rather than KOL, was the better description of how ideas flowed between physicians. However, as with any finding, it also threw up more questions.

What, if anything, could the data reveal about the nature of these 'islands' of connected clinicians? Further, what might that imply for the practice of pharmaceutical marketing?

Fortunately, the data set was extremely rich. Not only did it capture connectivity within this large group, but it also measured the participants' activity, their sources of information and their behaviour.  Again, sophisticated statistical techniques were needed to unravel the picture and again the results were remarkably clear. As exemplified in Figure 2, which compares just two of the CoP, each has a distinct profile, seeking information and behaving in different ways. The implication of this is, of course, that a market-wide marketing approach is unlikely to work on every CoP; something altogether more granular and refined is needed in such markets.


Figure 2: Behavioural and activity profiles of two typical communities of practice

Behavioural and activity profiles of two typical comunities of practice


There is much more to this research than can be described in this article and there is much more research still to be done, but some important conclusions can be drawn about the practical implications for pharmaceutical marketers.

First, the old fashioned KOL model is due for revision. Something like KOLs may exist, connecting communities, but they are not the handful of dominant figures previously thought. Second, relatively small CoP do seem to be the dominant structures and are highly likely to drive prescribing behaviour. These communities, however, are not all alike and differ in what they do and how they think.

So in practice, CoP management could offer those marketers who seize the idea first the chance to leap ahead of traditional KOL management. There are four key implications of this new thinking. First, fewer resources may be allocated to those physicians currently perceived as KOLs and those resources could be redirected to important CoP.

Second, the goal of marketing activity may shift away from KOL endorsement towards facilitating the diffusion of new practice between CoP, because it is likely to be at these interfaces where new product acceptance stalls. Third, this marketing activity may become more tailored to the needs of each individual CoP, reflecting the way in which sources of information, relationships and therapeutic concerns vary between different communities.

Finally, but perhaps most importantly, these changes would imply a significant change in what pharmaceutical marketers consider their most important assets. Rather than ranking professional relationships with KOLs as their primary intangible asset, they may consider their knowledge of CoP as their most important resource and critical to their competitive advantage. For the pharma marketer of the future, the database and the analytics may come to outweigh the handshakes and the KOL endorsement.

The Authors
Dr Brian D Smith
is a visiting research fellow at Open University Business School, the editor of the Journal of Medical Marketing and runs Pragmedic, a specialist consultancy. Marcus Bergler is vice president sales and marketing, Cegedim Customer Information, which provided the data and analytical capabilities needed to carry out this work. A more extensive research paper is available on request from:

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4th January 2011


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