Thursday, March 29, 2012

Glaxo Wellcome Chair at University of Wisconsin Was Created to Help Big Pharma Market Smoking Cessation Drugs

When I first heard of the endowed chair position created at the University of Wisconsin by Glaxo Wellcome to support the work of the University of Wisconsin's Center for Tobacco Research and Intervention, I assumed that the funding was intended to support a broad range of loosely defined research in the general area of tobacco control, consistent with the overall mission of the Center for Tobacco Research and Intervention.

John Polito, however, has brought it to my attention that the memorandum of agreement which established the endowed chair position defines a narrow range of supported activities that all focus on nationally marketing smoking cessation drugs. The four activities are specified as follows:

Each of these areas relates to the development or marketing of smoking cessation drugs:

1. Disseminating the AHCPR guidelines appears intended to make sure that all clinicians are aware that every smoking patient should be treated with pharmacotherapy.

2. Encouraging insurance companies to cover smoking cessation drugs appears intended to increase the use of these smoking cessation drugs by removing financial barriers to their use.

3. The development of innovative pharmacotherapies is of course directly related to the development of new or improved smoking cessation drugs.

4. Expanding public education about the availability of pharmacotherapy is of course intended to increase the national use of these drugs.

The Rest of the Story

Essentially, what Glaxo Wellcome has brilliantly done here is to establish what you might call a national marketing office disguised as an objective research center. Through this generous gift, the Center and its Chair are essentially made partners with Glaxo Wellcome in the effort to market smoking cessation drugs nationally by increasing awareness of specific guidelines that physicians must use these drugs to treat every smoking patient, trying to remove financial barriers to the use of these drugs, and educating the public about the option of pharmaceuticals to encourage them to increase their use of these drugs.

In other words, Glaxo effectively established a national "research" center for the encouragement of all smokers to use smoking cessation drugs and for the encouragement of all physicians to prescribe smoking cessation drugs to all their smoking patients.

It is striking to me how narrow the language is in this memorandum. Usually, I think of endowed chairs as non-specific documents which provide broad, general support for the work of a professor, certainly specifying a general area of research interest, but usually not proscribing an exact course of action and specific set of allowable activities under the research program.

For example, if Dr. Fiore became interested in cold turkey quitting, this memorandum does not appear broad enough to allow him to pursue research in the use of cold turkey quitting as a smoking cessation strategy. More importantly, it removes any incentive from he or others in the Center from doing so because it is clearly not in the financial interest of the sponsor.

Given the clear conflict created by the creation of this endowed position by a pharmaceutical company and the clearly narrow scope of allowable activities which all are focused on the marketing of smoking cessation drugs, it would appear to have been especially important to ensure that the endowed chair not have any other (that is, personal) financial conflicts of interest with pharmaceutical companies that manufacture smoking cessation drugs. The funding itself is one thing, but if the chair also had personal conflicts of interest with Big Pharma, such as consultancies, these would seem inappropriate under this new arrangement.

Unfortunately, it appears that Dr. Fiore, during at least the approximate years 1999 through 2005, did receive consulting income and honoraria from pharmaceutical companies and was therefore a conflicted investigator holding a Big Pharma-endowed chair.

To be clear, there is nothing wrong with the idea of educating the public or physicians about the availability of smoking cessation drugs and about recommendations for the use of these drugs. Glaxo was not asking the Center to do anything inappropriate. However, if that is going to be your mission, it is important to do so objectively. And that requires a non-conflicted investigator in the chair position.

In my view, there is nothing a priori wrong with a university accepting an endowed professorship from a pharmaceutical company. However, two things are essential.

First, the holder of that chair should be a non-conflicted individual.

Second, the scope of the work must be broadly defined, rather than defined specifically as activities which are tantamount to the national marketing of that company's products or potential products. Otherwise, the university must be willing to call a spade a spade and admit that the funded institution is basically serving as a marketing arm of the pharmaceutical company, helping it to do its bidding. This may not be a bad thing because the drugs do help some people quit smoking, but we need to be honest about what is going on.

There is harm, however, when this type of situation is handled wrongly and a conflicted investigator is put in the endowed chair position, funded by Big Pharma. while at the same time, the allowable activities are narrowly drawn to ensure a focus on the marketing of pharmaceutical products. What happens is that you now have a conflicted individual running a marketing program funded by a pharmaceutical company. The research activities now lose their scientific objectivity.

The harm comes when as a result of the exclusive focus on these smoking cessation drugs, the Center loses a broader perspective and fails to disseminate important research about the failings of smoking cessation drugs, their serious risks, and the research showing that cold turkey quitting is actually more effective than planned attempts with NRT.

I find it quite revealing, for example, that in the news archives of the UW-CTRI, I cannot find a single article about the dangers of Chantix. There is an article from 2009 highlighting a study which found no suicide increase due to Chantix, although it couldn't rule out a two-fold increase in suicide due to small sample size. But why no link to this 2011 article linking Chantix and suicide, or to this 2011 article reporting that there have been 272 suicides associated with Chantix, or to this 2010 study in the Annals of Pharmacology?

Buying an endowed chairmanship under these conditions buys you more than simply the opportunity to say that you've made a philanthropic contribution. In the case of the endowed chair at UW-CTRI, it gives you an opportunity to essentially control the agenda, the emphasis, and the presentation of the scientific information about pharmaceutical products to the public. Big Pharma has certainly got its money's worth.

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