12 December 2010

Why you want to be a key opinion leader

Why does anyone do any one particular thing? Start where detectives do: greed, ambition, revenge, envy, conviction, and insanity. Set insanity aside, you're not on trial (yet). Set conviction aside as well since a prerequirement to being an opinion leader is the ability to convince yourself as well as your audience.

Detective, what next? "It's always money, unless it's a woman or drugs." Couldn't be; doctors make lots of money (though they wholeheartedly deny this). Here's a secret: the utility of money, after a certain point, no longer matters. It becomes a way of keeping score. Why do the assholes on Wall Street keep paying themselves hundreds of millions of dollars year after year? It isn't because their bank account doesn't have enough zeros, it's because it doesn't have enough zeros compared to someone else.
Obviously there's always a bigger house, or a nicer Mercedes to buy; that the money can be spent isn't the point. Getting the money is the point. Go play poker for an hour. The rush when you win is not because those tokens have utility, it's because you're playing a zero sum game (negative actually); your gain is someone else's loss. We don't like admitting this, so we borrowed the word for it: schadenfreude. (And you wonder why the Germans are always starting wars... The real question is how long the high lasts before they need another hit.)

If you're naive and you ask someone why they became a doctor, they will tell you that they did it to help people and a bunch of other happy horseshit. Fact: agricultural and sanitation advancements have saved more QALYs than every medical advancement in mankind's history. People whose primary goal is to help others are engineers or social workers. Altruism is the cloak that doctors are trained to hide beneath; most are so well trained it takes at least an hour of therapy to get them to admit this.

The truth is that medicine is the ultimate ego boost: you diagnose the patient, you do the surgery, you prescribe the meds. Not only is all that an ego boost, but it supplies you with constant, tangible reinforcement that you are the man. The engineer who drills a well in some Sudanese village? Sure he saves more lives than most physicians will in a career, but they are abstract lives. Sadly, evolution has trained us to view abstract rewards as less valuable than tangible ones.

Here's what happens when a doctor drops the cloak:
Biederman: "To move in the ranks from one rank, for example, at Harvard, there is instructor, from instructor you move to assistant professor, from assistant professor you move to associate professor, from associate professor you move to full professor."
Lawyer: "Full professor?"
Biederman: "Mm-hmm."
Lawyer: "What rank are you?"
Biederman: "Full professor."
Lawyer: "What's after that?"
Biederman: "God."
Lawyer: "Did you say God?"
Biederman: "Yeah."
Where were we? Oh right, it's not the money (it's what the money represents) and doctors are all above average on the NPI. Unfortunately for the scientific community, doctor compensation is a taboo topic. Why is this unfortunate? Remember those Wall Street assholes: they get to compare themselves based on the size of their (compensation) package; since doctors can't do that (it's hard to appear altruistic while bragging about your package), they have to measure themselves against each other some other way. Fortunately these measurements all maintain the veil of altruism.

In order to move up on these problematic metrics you need money (not the kind you pay your mortgage with, the kind you spend on lab equipment and gullible graduate students; i.e. other people's money). There are only two plentiful sources of OPM: government and pharma. Government offers you mountains of paperwork and the hassles of bureaucracy; pharma offers speaking honorarium, to sponsor grand rounds, and the well arranged cleavage of their reps. The only thing they both offer is opportunity. Wait, what opportunity? The opportunity to advance science.

You didn't really think these docs were spending their time shilling for drug companies because they need the extra dough did you? They are doing it because they're been convinced they're "advancing science," and they want to make sure they're included in the Next Big Thing. Syms Covington got a Wikipedia page out of being there, why not you?

"Hey, wait a second, you said that abstract rewards are inherently less valuable than real ones! Why are these docs giving up their real reward for this mirage?"

They aren't. Unlike poker this isn't a zero sum game. The doctors get to keep seeing patients and feel like they're advancing the greater good. The government grant winners have a built in justification for less clinic time: I'm doing work my country says is valuable. The trappings of pharmaceutical consultation are the nothing more than the cost of easing doctors away from patients and into the mindset that they are advancing science without them realizing it. Ask a clinician what they think pharma consultants accomplish. Then go ask the consultant.

That difference is what $57.5 billion buys.

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