Joint Commission Smoking Cessation Panel Chair's Disclosure in NEJM Article is Deceiving; History of Past Conflicts with Big Pharma are Not Revealed

Last week, I revealed that the Joint Commission's new tobacco treatment accreditation standard was created by a panel whose chair is financially conflicted by virtue of current and multiple past financial relationships with pharmaceutical companies that market or are developing smoking cessation drugs. As I noted, the standard requires hospitals to offer smoking cessation drugs to every smoking patient upon discharge. I also explained why such a requirement is inappropriate since it violates physician autonomy.

Today, I note that the financial disclosure statement submitted by the panel chair is deceiving, because it reports only the most recent conflicts, hiding from the reader the long history of the chair's financial relationships with multiple pharmaceutical companies.

As I reported:

In 2008, Dr. Fiore reported "that he has lectured and consulted for Pfizer and has served as an investigator on research studies at the University of Wisconsin (UW) that were supported by GlaxoSmithKline, Nabi, Pfizer, and sanofi-aventis."

According to Dr. Fiore's testimony in the Department of Justice tobacco lawsuit: "GlaxoSmithKline gave a grant to the University of Wisconsin that established a chair for the treatment of tobacco dependence. That donation by GlaxoSmithKline was to the University. Named chairs at the University of Wisconsin provide the person who sits in that chair to access to the revenue generated from the investment on the initial grant. So in this instance, I have access to up to $50,000 per year to support my University approved and sanctioned educational, research, and policy activities."

In his 2005 testimony, Dr. Fiore also admits that he did "consulting work for pharmaceutical companies over the years. Over the past five years, my outside consulting work on an annual basis has ranged between about $10,000 and $30,000 or $40,000 per year."

In 2000, Dr. Fiore reported that he "has served as a consultant for, given lectures sponsored by, or has conducted research sponsored by Ciba-Geigy, SmithKline Beecham, Lederle Laboratories, McNeil, Elan Pharmaceutical, and Glaxo Wellcome."

The Rest of the Story

In his disclosure statement in a recent article in the New England Journal of Medicine about the treatment of smokers in the health care setting, Dr. Fiore discloses only his current funding from Nabi Pharmaceuticals, not his prior funding by or consultancies/lectures for Ciba-Geigy, SmithKline Beecham, Lederle Laboratories, McNeil, Elan Pharmaceutical, and Glaxo Wellcome.

He discloses the existence of his endowed chair position (which he has resigned), but fails to explain that he had "access to up to $50,000 per year to support my University approved and sanctioned educational, research, and policy activities." Instead, he emphasizes that no funds from that endowment were ever paid "directly to him."

The disclosure is therefore deceiving to readers and does not reveal the full extent of his past financial relationships with pharmaceutical companies that manufacture smoking cessation medications.

Importantly, it is not that Dr. Fiore is being untruthful. The form instructs authors to report financial conflicts within the past 3 years, and Dr. Fiore does just that. The problem is that disclosing current conflicts may not paint an accurate picture of an investigator's potential biases when there is a long history of previous conflicts of interest, as there is in this case. Thus, I believe that investigators should voluntarily disclose significant past conflicts, even if the disclosure form does not require it. Otherwise, readers may not get an accurate picture of the potential biases that may be operating and could have the appearance of influencing the conduct or reporting of the research.