title: Building legitimacy by criticising the pharmaceutical industry: a qualitative study among prescribers and local opinion leaders.
abstract: BACKGROUND
  The literature has described opinion leaders not only as marketing tools of the pharmaceutical industry, but also as educators promoting good clinical practice. This qualitative study addresses the distinction between the opinion-leader-as-marketing-tool and the opinion-leader-as-educator, as it is revealed in the discourses of physicians and experts, focusing on the prescription of antidepressants. We explore the relational dynamic between physicians, opinion leaders and the pharmaceutical industry in an area of French-speaking Switzerland.
  
  
  METHODS
  Qualitative content analysis of 24 semistructured interviews with physicians and local experts in psychopharmacology, complemented by direct observation of educational events led by the experts, which were all sponsored by various pharmaceutical companies.
  
  
  RESULTS
  Both physicians and experts were critical of the pharmaceutical industry and its use of opinion leaders. Local experts, in contrast, were perceived by the physicians as critical of the industry and, therefore, as a legitimate source of information. Local experts did not consider themselves opinion leaders and argued that they remained intellectually independent from the industry. Field observations confirmed that local experts criticised the industry at continuing medical education events.
  
  
  CONCLUSIONS
  Local experts were vocal critics of the industry, which nevertheless sponsor their continuing education. This critical attitude enhanced their credibility in the eyes of the prescribing physicians. We discuss how the experts, despite their critical attitude, might still be beneficial to the industry's interests.
authors.affiliation: University of Lausanne and Centre Hospitalier Universitaire Vaudois (CHUV), University Institute of the History of Medicine and Public Health (IUHMSP), Lausanne, Switzerland.
authors.forename: Anne-Laure
authors.initials: AL
authors.lastname: Pittet
authors.affiliation: McGill University, Faculty of Medicine, Centre for Medical Education, Montreal, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Saraga
authors.affiliation: University of Lausanne and Centre Hospitalier Universitaire Vaudois (CHUV), Service of Liaison Psychiatry, Lausanne, Switzerland.
authors.forename: Friedrich
authors.initials: F
authors.lastname: Stiefel
mesh_terms: D000928:Antidepressive Agents; D004345:Drug Industry / Q000592:standards*; D011307:Drug Prescriptions; D006801:Humans; D007407:Interviews as Topic; D040541:Marketing / Q000331:legislation & jurisprudence*; D010820:Physicians; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011639:Public Opinion; D036301:Qualitative Research; D013557:Switzerland
chemical_list: D000928:Antidepressive Agents