Thursday, August 30, 2012

Electronic Cigarette Opponents Fail to Disclose Relevant Conflicts of Interest to the Public

Yesterday, I pointed out a strong bias against electronic cigarettes in the response of Drs. Nathan Cobb and David Abrams to a commentary I co-authored with Drs. Ted Wagener and Belinda Borrelli in the September issue of Addiction. After pointing out the bias, I posed the question of whether there may be a potential explanation for this strong apparent bias against a potentially effective new smoking cessation product that might compete with the mainstays of current treatment: smoking cessation drugs and cessation quitlines and web sites.

The first thing that should cross the mind of regular readers of this blog is the possibility of a conflict of interest among the authors. 

However, in the published response, the authors deny having any conflict of interest. The declaration of interests statement reads: "Declarations of interest: None."

The Rest of the Story

Dr. Cobb is a paid consultant to a company that makes its profits based on an internet smoking cessation site which heavily promotes smoking cessation drugs: "Dr Cobb is a consultant to Healthways Inc, the current owner of the QuitNet system." Thus, he is conflicted because to the extent that the use of electronic cigarettes presents a different pathway to cessation than the traditional one - the use of a smoking cessation internet site, medication, online support, etc. - e-cigarettes may represent a threat to the profits of Healthways.

Dr. Abrams has received grant funding from multiple pharmaceutical companies that have investigated or manufactured smoking cessation drugs, including Eli Lilly, Dupont Merck, Glaxo-Wellcome, SmithKline Beecham, Sano Corporation, Bristol-Myers Squibb, Knoll Pharmaceuticals, and Pfizer. Dr. Abrams also reports having served as a senior scientific advisor for Johnson & Johnson. It is difficult to find a pharmaceutical company involved in smoking cessation drugs that Dr. Abrams has not had an association with over the years.

According to the guideline for authors on the Addiction web site: "Authors are also required to declare any financial conflict of interest arising from involvement with organisations that seek to provide help with or promote recovery from addiction."

It is difficult to see how Healthways, through its ownership of the QuitNet system, is not an organization that seeks to provide help with or promote recovery from addiction.

It is also difficult to see how the many pharmaceutical companies from which Dr. Abrams has received funding are not organizations that seek to provide help with or promote recovery from addiction.

Dr. Cobb's financial interest in Healthways appears to be current, since he disclosed that interest in a 2011 Archives of Internal Medicine paper.

Dr. Abrams' financial relationship with the pharmaceutical companies is in the past, as his most recent grant from Big Pharma appears to have been in 2003.

In my opinion, both of these conflicts of interest are relevant to readers' assessment of the validity of the opinions in the response and therefore they should have been disclosed.

One might ask the question of whether a financial interest dating back to 2003 is still relevant in 2012. In a previous post, I provided a detailed explanation of why I think past conflicts are relevant. I wrote that "past conflicts of interest are indeed critical for readers to know about. Just because Professor X and Professor Y had nothing to disclose during the past three years does not indicate that they have no financial conflicts of interest that need to be disclosed in their current publications, the journal's requirements notwithstanding. Furthermore, it would be hypocritical and inconsistent to argue that past conflicts are only relevant when it comes to tobacco. If past conflicts are relevant, then past conflicts are relevant. Therefore, it is my feeling that researchers do need to disclose their past conflicts (albeit briefly). A financial conflict of interest does not disappear simply because the conflict is no longer active. ... Clearly, past conflicts of interest are relevant and I believe that researchers have the obligation to disclose past conflicts that are related to the research in question."

It seems to me that Dr. Cobb's financial interest ought to have been disclosed both because of the journal's requirement for disclosure and because readers deserve to know about that conflict. While Dr. Abrams' conflicts of interest may not have needed to be disclosed under the journal's policies (it is unclear because no time frame is provided for conflicts), I nevertheless believe that it still should have been disclosed because readers deserve to know about these past conflicts in order to make informed judgments about the opinions expressed in the article.

The rest of the story is that this is yet another example of the failure of electronic cigarette opponents to disclose relevant conflicts of interest to readers and to the public.

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