Today, I reveal that this was not a first-time mistake. In fact, I expose the presence of conflicts of interest among the majority of members of the first expert panel, which issued the initial clinical practice guideline for treating tobacco use and dependence in 2000.
I argue that while one might excuse the initial mistake in 2000, to have the panel repeat this mistake in 2008 is inexcusable and can really be viewed as an intentional decision to allow conflicts of interest to bias its recommendations.
The Rest of the Story
Treating Tobacco Use and Dependence is a Clinical Practice Guideline sponsored by the United States Public Health Service. The most recent update was published in 2008, but an earlier version was published in June 2000.
The original expert panel (for the 2000 version of the guideline) was chaired by Dr. Michael Fiore and consisted of a total of 18 members. The panel concluded that: "Numerous effective pharmacotherapies for smoking cessation now exist. Except in the presence of contraindications, these should be used with all patients attempting to quit smoking." In other words, the panel recommended to physicians throughout the nation that cold turkey smoking cessation should never be used (unless pharmaceuticals are specifically contraindicated).
Like the conclusion in the 2008 update, this recommendation goes against the evidence base, which documents that nicotine replacement therapy is dismal for the treatment of nicotine dependence and that long-term abstinence rates are extremely low. The research also shows that unplanned quit attempts are more successful than planned attempts, and that cold turkey quitting remains the most successful means of smoking cessation in the population.
Not surprisingly, the 2000 expert panel contained a chair and members with severe financial conflicts of interest by virtue of their financial relationships with Big Pharma. What is perhaps surprising is the magnitude of the conflicts. A total of 11 of the 18 panelists - the clear majority - had financial conflicts of interest with pharmaceutical companies.
Here is the listing of the panelists with conflicts of interest:
"Michael C. Fiore 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.
William C. Bailey has served as a consultant for, given lectures sponsored by, or has conducted research sponsored by Glaxo Wellcome, SmithKline Beecham, Schering-Plough, 3M Pharmaceuticals, Pfizer, and Sepracor.
Sally Faith Dorfman has served as a consultant for, given lectures sponsored by, or has conducted research sponsored by various pharmaceutical companies.
Michael G. Goldstein, in addition to being an employee of the Bayer Corporation, has served as a consultant for, given lectures sponsored by, or has conducted research sponsored by Glaxo Wellcome, McNeil, Ciba-Geigy, SmithKline Beecham, Boehringer Ingelheim, Sano Corporation, Dupont Pharmaceuticals, and Eli Lilly.
Ellen R. Gritz has served as a consultant for, given lectures sponsored by, or has conducted research sponsored by Bristol Myers Squibb, SmithKline Beecham, and Glaxo Wellcome.
Carlos Roberto Jaén has served as a consultant for, given lectures sponsored by, or has conducted research sponsored by Glaxo Wellcome Pharmaceuticals.
Thomas E. Kottke has served as a consultant for, given lectures sponsored by, or has conducted research sponsored by McNeil Consumer Healthcare.
Harry A. Lando has served as a consultant for, given lectures sponsored by, or has conducted research sponsored by Glaxo Wellcome and SmithKline Beecham.
Robert Mecklenburg has served as a consultant for, given lectures sponsored by, or has conducted research sponsored by SmithKline Beecham and Glaxo Wellcome.
Maxine L. Stitzer has served as a consultant for, given lectures sponsored by, or has conducted research sponsored by McNeil and SmithKline Beecham.
Louise Villejo has served as a consultant for, given lectures sponsored by, or has conducted research sponsored by Ortho Biotech."
To make matters even worse, 3 of the 5 consultants to the panel also had financial conflicts of interest with pharmaceutical companies:
"Timothy Baker has served as a consultant for, given lectures sponsored by, or has conducted research sponsored by Elan Pharmaceutical, SmithKline Beecham, Glaxo Wellcome, and Lederle.
Victor Hasselblad has served as a consultant for, given lectures sponsored by, or has conducted research sponsored by CorTheraputics, Skinceuticals, Merck, Novartis, AstraZeneca, AstraCharnwood, The Medicines, Pfizer, Daiichi, Hoffman-LaRoche, RhonePolenc Rorer, Alexion, SmithKline Beecham, Dade, Quad-C, and Centocor Lilly.
David L. Schriger has served as a consultant for, given lectures sponsored by, or has conducted research sponsored by Pfizer Corporation and the MedAmerica Corporation."
In other words, the panel and consultant list looks like a virtual directory of pharmaceutical company consultants.
It was ridiculous and irresponsible to have a panel of pharmaceutical company consultants put together national recommendations for the treatment of tobacco use.
However, if nothing else, this mistake should have taught a lesson to the panel and its members. It should have taught them that this type of prostitution of objective science to financial interests is wrong and should not be repeated.
What happened?
When the panel re-convened in 2008, its chair and eight other members had severe financial conflicts of interest with pharmaceutical companies.
While one might excuse the initial mistake in 2000, to have the panel repeat this mistake in 2008 is inexcusable and can really be viewed as an intentional decision to allow conflicts of interest to bias its recommendations.
This increasing practice in tobacco control of prostitution of objective science to financial interests must come to an end.(Note: For an extensive discussion of these issues, see John Polito's Why Quit site.)
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