Monday, May 12, 2008

Press Release on Smoking Cessation Guidelines Fails to Disclose Financial Conflict of Interest of Expert Panelists

A press release issued by the Agency for Healthcare Research & Quality (AHRQ) to publicize the findings of a review by an expert panel of the role of clinicians in smoking cessation fails to disclose the significant financial conflicts of interests of the panelists.

The press release explains that: "The review found that there are now seven medications approved by the Food and Drug Administration as smoking cessation treatments that dramatically increase the success of quitting. The medications are: bupropion SR, nicotine gum, nicotine inhaler, nicotine lozenge, nicotine nasal spray, nicotine patch, and varenicline."

The press release fails to also mention that other research indicates that the overwhelming majority of smokers who quit successfully for the long-term do so via a cold turkey, and not a medication-based approach.

Nowhere, however, does the press release mention that 9 of the members of the expert panel, including its chair, have financial conflicts of interest by virtue of having received money from Big Pharma. Most of the companies from which funding was received are precisely those which manufacture or distribute smoking cessation medications, and which therefore stand to gain financially from the panel's recommendations.

A search of the other online materials regarding the Clinical Practice Guideline (not including the guideline itself) revealed that outside of the guideline itself, the financial conflicts of interest are not disclosed.

The Rest of the Story

I view it as being unethical for the Agency to report the results of the panel's recommendations without disclosing the fact that many of the expert panelists, including its chair, had financial conflicts of interest, namely, a history of funding by pharmaceutical companies that stand to gain from the recommendations contained in the report.

While allowing conflicted individuals to serve on the panel is itself questionable, the failure to disclose the conflict in reports of the findings of the panelists is indefensible.

In many cases, financial conflicts of interest are present but do not appear to have interfered with the objectivity of the research. In this case, it is quite clear to me that the conflicts did interfere with the integrity of this work. The panel largely ignored the population-based data demonstrating that the majority of smokers who quit long-term do so cold turkey, without the aid of pharmaceuticals. The panel also largely over-estimated the benefits of pharmaceutical aids, relying heavily upon clinical trials in which patients were not truly blinded to their treatment status. In addition, the panel relied too heavily upon studies conducted in a clinical setting and ignored studies conducted in real-life, population-based settings.

This is a great example of what can happen when we allow science to be prostituted by the potential for personal financial gain. One could argue that money always interferes in some way with the objectivity of scientific research; however, it usually doesn't interfere to this degree and there is no excuse for allowing conflicts of this magnitude to occur. It is even less excusable to fail to report such conflicts.

This is a very sad chapter in the history of tobacco control science.

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