Published Review of Individual Smoking Cessation Treatments Fails to Mention Electronic Cigarettes; Another Example of the Results of Financial Conflict of Interest?

A review article which provides a comprehensive review of individual smoking cessation treatments appears in the March issue of Tobacco Control. The article reviews many forms of individual therapy for smoking cessation, including nicotine replacement therapy, varenicline (Chantix), buproprion, nicotine agonists and other drugs, behavioral support, telephonic counseling, brief intervention by doctors, and a nicotine vaccine. The article is entitled: "Improving smoking cessation approaches at the individual level." The article appears in a special 20th anniversary edition of the journal Tobacco Control, whose articles look back at the progress over the past 20 years.

See: Aveyard P, Raw M. Improving smoking cessation approaches at the individual level. Tobacco Control 2012; 21:252-257. doi:10.1136/tobaccocontrol-2011-050348.

The Rest of the Story

The remarkable thing about this article is that it does not so much as mention electronic cigarettes as a potential smoking cessation strategy, despite the fact that this approach is being used by more than 2.5 million smokers in the U.S. I wouldn't expect the article to sing the praises of electronic cigarettes, but the fact that it doesn't even mention these novel and promising devices I find quite telling. The article is biased towards pharmaceutical smoking cessation aids.

But all becomes clear when one finally gets to the end of the article and sees the financial disclosures. Both authors have or have had financial conflicts of interest with pharmaceutical companies that manufacture smoking cessation drugs: "PA has undertaken consultancy and/or research for McNeil, Pfizer and Xenova (now Celtic) Biotechnology. MR has in the last 5 years had conference expenses reimbursed, been paid an honorarium for a talk and received freelance fees from Pfizer, but has not accepted support from the manufacturers of stop smoking medications in the last 4 years."

More specifically, it turns out that: "the UK Centre for Tobacco Control Studies (UKCTCS) [the home institution of one of the study authors] has received payment from Pfizer for PA's role on the advisory board for varenicline, and a grant from McNeil for PA's work on trials of a new product, and that both PA and the UKCTCS received payment from Pfizer, McNeil and Xenova (now Celtic) for consultancy, and that PA received payment from Pfizer for talks and educational presentations." So at least part of the funding received was related to consultation on the drug varenicline. Electronic cigarettes are a direct competitor of varenicline, nicotine replacement therapy, and other smoking cessation strategies, even quitlines, behavioral support, and telephonic counseling.

Moreover, while MR states he has not accepted support from drug manufacturers of stop smoking medications for the last 4 years, he is the author of a paper published in 2009 that acknowledges funding from Pfizer: "We gratefully acknowledge ... Doreen McIntyre and the Global Treatment Partnership for financial support of the survey... The Global Treatment Partnership is a project funded by Pfizer and other organisations hosted by the International Non-Governmental Coalition Against Tobacco (INGCAT), whose director is Doreen McIntyre."

It is becoming clear to me, and should be to my readers, that these financial conflicts of interest with Big Pharma are associated with profound bias in the reporting of research and analysis of policy in the literature. Here is a great example. A 20-year review article on individual smoking cessation treatment and advances in the field and it doesn't even mention electronic cigarettes.