Conflict of interest & tobacco control

In a recent post ( Smoking, drugs & hypocrisy, May 24, 2008), I pointed out the self-serving hypocrisy of the anti-smoker brigade. On the one hand they routinely dismiss evidence from any individual or group with even the slightest hint of contamination by big tobacco; on the other hand, they rely heavily on funding, both directly and indirectly, from the pharmaceutical industry.

The big drug companies stand to make a lot of money from the “de-normalization” of smokers and the efforts of the tobacco control crazies to introduce outright tobacco prohibition.

The conflict of interest created by anti-smoker fanatics who receive huge sums of money from drug companies introduces an element of bias that tends to cast suspicion on all studies and reports funded by the pharmaceutical industry. This trend, which has been apparent for many years, is beginning to worry even those in the public health community.

Dr.Michael Siegel is an ardent anti-smoking activist and a professor in the Social and Behavioral Sciences Department, Boston University School of Public Health.

Recently, Dr. Siegel posted an article on his blog (The Rest of the Story, May 27, 2008) on one such particularly blatant conflict of interest. The chair of a panel of experts convened by the Agency for Healthcare Research and Quality (AHRQ) was found to have a substantial, undeclared conflict, and had received a good deal of money from “big pharma”. Eight other members of the panel also had conflicts which were apparently reported.

What made this particular conflict so galling was that the panel made a recommendation to physicians across the US that they recommend use of smoking cessation products such as Nicoderm, Nicorettes, etc. to all patients wanting to quit. That recommendation had a direct bearing on the financial bottom line of the drug companies, especially GlaxoSmithKline who manufacture most of the products recommended.

Dr. Michael Fiore, the chair of the panel, had done consulting work for the pharmaceutical industry, including ClaxoSmithKline, within the past five years. He also holds an endowed chair at the University of Wisconsin. In other words, GlaxoSmithKline was (is) providing direct support for both the professor's career and his academic endeavors to the tune of $50,000 per year.

Readers may judge for themselves whether the tens of thousands of dollars in consulting fees and the endowed chair at the University of Wisconsin may have swayed Dr. Fiore’s decision to recommend smoking cessation drugs to physicians across the country.

On a website called whyquit.com, I found the following: “The law of physiological addiction states that administration of a drug to an addict will cause reestablishment of the dependence on that substance”. The article also noted that according to some leading drug addiction experts, nicotine might be more addictive than either cocaine or heroin.

It is curious that Dr. Fiore and his panel of experts would recommend use of drugs that contain nicotine, if indeed it is addictive, since the addiction would continue. Patients would simply become dependent on the new delivery system (Nicorettes or the patch, for example) for their daily fix or return to smoking. The only beneficiary to such a recommendation would be the drug companies who market stop smoking aids.

Also of note is the fact that one of the drugs recommended by Dr. Fiore’s panel, Chantix, has been associated with severe and fatal side effects. The Federal Motor Carrier Safety Administration banned the use of Chantix by anyone seeking a commercial motor vehicle license. The Federal Aviation Administration (FAA) has also banned use of the drug by airline pilots.

The simple facts are that, in large measure, the drug companies have bought and paid for a substantial amount of the evidence used by the anti-smoker brigade in their march to tobacco prohibition. And their evidence is no more reliable than that provided by big tobacco.

Or, to put it another way, the public is being misled.