Thursday, May 08, 2008

Financial Conflict of Interest Not Disclosed in Article on Smoking Cessation; Another Example of Failed Disclosure in Tobacco Control Research

In an article in this month's issue of the American Journal of Public Health, Dr. Michael Fiore of the Center for Tobacco Research and Intervention at the University of Wisconsin and co-authors examine the effect of smoking cessation media campaigns among socioeconomically advantaged and disadvantaged populations (see: Niederdeppe J., Fiore MC, Baker TB, Smith SS. Smoking-cessation media campaigns and their effectiveness among socioeconomically advantaged and disadvantaged populations. Am J Public Health 2008; 98:916-924).

In the paper, the authors make a push for increased access to pharmaceutical treatment for smoking cessation. They point out that access to these pharmaceuticals is a major barrier for less-educated populations: "Less-educated populations face more barriers in turning a quit attempt into smoking abstinence, including fewer smoking restrictions at work, greater nicotine dependence, and less access to evidence-based treatments. Future campaigns should keep these barriers in mind when developing campaigns to promote quitting among lower-SES populations."

The Rest of the Story

The paper's push for greater access to pharmaceuticals does not come from authors who are objective. In fact, Dr. Fiore has a history of very close financial connections to a number of pharmaceutical companies which manufacture smoking cessation products and thus stand to gain financially if his advice is heeded. However, these financial relationships are not disclosed anywhere in the paper.

The paper does acknowledge financial support from the Robert Wood Johnson Foundation and from the National Institutes of Health. However, it does not disclose the financial conflicts of interest of Dr. Fiore. It appears that there is really no way for article readers to know that Dr. Fiore has had severe conflicts of interest which could lead them to question his objectivity in making a recommendation for the greater use of pharmaceuticals. I find this to be quite unfortunate.

Whether Dr. Fiore has important conflicts of interest that ought to be disclosed does not seem to be at issue here. Because in an article published on almost the exact same day as the AJPH article, Dr. Fiore discloses in a JAMA article that he does indeed have important conflicts of interest. That article states: "In the past 5 years, Dr Fiore reports 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. In 1998, the UW appointed him to a named chair, made possible by an unrestricted gift to the UW from GlaxoWellcome."

Does it not seem mildly important for readers of his AJPH article to know that Dr. Fiore has lectured and consulted for companies which manufacture smoking cessation products and that his chair position was endowed by one such pharmaceutical company?

In my opinion, this is inappropriate. I believe it represents another failed disclosure of conflict of interest in tobacco control research.

While I do not necessarily think there is anything wrong with accepting money from pharmaceutical companies to examine the use and effectiveness of their products, I do think it is wrong when such conflicts of interest are not disclosed to the public. And I think these conflicts need to be disclosed in all relevant publications, not just some of them.

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