Medical Science Liaisons (MSLs) are individuals with advanced scientific training (typically a PhD, PharmD, or MD) who are employed by pharmaceutical and medical device companies to forge relationships with physicians and other prescribers. Their main role, purportedly, is to educate clinicians, ensure the proper use of drugs and devices, and provide objective insights about scientific and clinical trial data regarding therapeutics manufactured by their employers. In reality, however, MSLs are an unacknowledged – and unregulated - part of the marketing team.
MSL positions are usually housed in the Medical Affairs department of a company rather than sales and marketing; however, MSLs are involved in training pharmaceutical sales representatives. MSLs can often get in the door to visit ‘no-see’ physicians, a term used by industry to describe physicians who refuse to see drug reps.
In fact, the primary function of MSLs is to foster relationships with physicians, especially key opinion leaders (KOLs), who are physicians or other health care providers considered to be thought leaders or influencers in their field or region. As industry puts it, relationships with KOLs are used to bring ‘maximum value’ and are ‘imperative to the success’ of a company. One of the ways in which MSLs forge relationships is by offering KOLs speaking opportunities, or recruiting them to participate in company sponsored trials. By participating in trials, KOLs, in turn, feel comfortable prescribing and recommending the products the MSL involved them in.
MSLs foster overdiagnosis by ‘educating’ prescribers about specific conditions, some of which have been invented or adopted in order to position targeted drugs; for example, the term gastroesophageal reflux disorder (GERD) was created to sell Prilosec (omeprazole) and Nexium (esomeprazole). MSLs have their hands on every part of the life cycle of a drug. Companies use them during pre-launch (before the drug is on the market) to raise awareness of specific diseases. They are also pivotal in the types of trials that are conducted on a drug and how or when a company publishes information on their product. After a drug is on the market, MSLs are used to promote off-label use, sales representatives, on the other hand are prohibited from such promotion. Pharmaceutical companies understand the importance of MSLs flying under regulatory radar, as the demand for MSLS has been steadily growing over the years.
Little attention has been paid to the promotion of diseases as an industry method to promote drugs. By selling diseases to physicians, MSLs foster both overdiagnosis and overtreatment. Regulation of MSLs is needed.
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