Friday, August 10, 2012

North American Quitline Consortium Responds to My Criticism of Its Conference Sponsorship by Big Pharma by Lying About My Position and then Failing to Address the Argument

Yesterday, I published a commentary in which I criticized the North American Quitline Consortium for accepting as sponsors of its annual conference three pharmaceutical companies that have a vested financial interest in the advice given to smokers via these quitlines. I argued that the funding by Big Pharma destroys the scientific integrity of the conference by making it impossible for the conference to objectively address critical issues in smoking cessation practice, such as the debate between the reliance on pharmaceuticals versus cold turkey quitting and the safety profile of Chantix.

I concluded that "the acceptance of Big Pharma money to fund a quitline conference at which smoking cessation strategy is going to be discussed is not just a private matter. It represents a disservice to the public who we in tobacco control are supposed to serve. Thus, the rest of the story is that not only is the North American Quitline Consortium sacrificing its scientific integrity by accepting Big Pharma money, it is also betraying the clients who it is supposed to be serving."

The basis for my position is the following: "the 2012 NAQC annual conference is being sponsored by GlaxoSmithKline, Novartis, and Pfizer. GlaxoSmithKline markets Commit lozenges, Nicoderm CQ (the nicotine patch), Nicorette (nicotine gum), and a behavioral smoking cessation program called Committed Quitters. Novartis markets Nicotinell (nicotine patches and gum). Pfizer markets varenicline (Chantix). Thus, the conference is being sponsored by the very companies which stand to gain or lose most by the supposedly objective scientific discussions that are supposed to take place at the conference. There is simply no way that objective scientific discussions can take place when the conference is being sponsored by these very companies."

The Response - Part One

The North American Quitline Consortium responded to my commentary in two ways:

First, NAQC attacked me personally, trying to discredit me by lying about my position on smoking cessation medications. On its web site, NAQC wrote: "Earlier today, Dr. Michael Siegel posted a blog commentary suggesting that NAQC’s actions are destroying the scientific integrity of the global tobacco control movement. As many of you may know, Dr. Siegel is opposed to the use of medications in the treatment of tobacco dependence." (emphasis is mine)

The Rest of the Story

This statement is completely fallacious. I do not oppose the use of medications in the treatment of tobacco dependence and have never expressed such an opinion. I do believe that there has been an overemphasis on the role of medications compared to the role of cold-turkey quitting, but this is hardly the same as believing that medications should not be used in treating tobacco dependence. As a physician, I prescribed smoking cessation medications to many patients when I was working in the area of addiction medicine. Never have I opined that medications should not be used in the treatment of tobacco dependence.

The technique of responding to a criticism by lying about the individual critic's position is a common tactic used when groups find it difficult to argue the substance of an issue. The idea is to try to discredit the critic by misrepresenting their views to the public and to make the person appear to be a lunatic with outlandish views.

Here, by casting me as someone who opposes the use of medications in the treatment of tobacco dependence, NAQC has made me appear to its constituents and to the public as being a crazy radical who does not even believe that smoking cessation medications have any role in the treatment of nicotine addiction. 

There is no basis for such an attack since I have never suggested that smoking cessation medications should not be used. However, I can understand why the organization might level such an attack given its apparent reluctance to address the issue of its Big Pharma sponsorship head on. By diverting attention with its lie about me, the organization attempts to divert attention away from the issue at hand: namely, its decision to accept funding from companies whose products' efficacy and safety will be directly addressed at the conference.  

Incidentally, I wrote to NAQC asking the group to remove its inaccurate statement about my position. At this time, they have not yet removed the statement, but it has only been a few hours and I will certainly give them more time to respond and update my readers at that time.

The Response - Part Two

The response by NAQC was as follows:

"Thank you for the opportunity to respond to your commentary and to share NAQC’s position. I respectfully disagree with your opinion that "the acceptance of pharmaceutical industry sponsorship by a conference which aims to objectively discuss science and objectively consider policy strategies to promote smoking cessation destroys the scientific integrity of the global tobacco control movement.”

NAQC’s mission is to improve the quality of quitline services in North America and to make high quality cessation services more available to all tobacco users. We support cessation and encourage quitlines to adopt evidence-based practices. FDA-approved cessation medications are well-accepted evidence-based treatments for cessation. They are included as part of the U.S. Public Health Service’s Guideline on Tobacco Cessation Treatment. Currently, 75 percent of all U.S. quitlines provide medications along with counseling services. We hope to report 100 percent of quitlines are providing cessation medications to smokers in the near future. Providing medications as part of a quitline’s treatment protocol increases the likelihood that smokers will successfully quit.

NAQC Conference 2012 is supported by ClearWayMN, the American Cancer Society, the Canadian Cancer Society, the American Legacy Foundation, GlaxoSmithKline, Novartis and Pfizer. NAQC is grateful to all of the organizations that sponsor and support our programs, including those who support the upcoming conference. This is the first year pharmaceutical company contributions have helped support the NAQC conference and we are proud to have them on-board. We look forward to working with these partners in the pharmaceutical industry to advance NAQC’s mission and ensure that all tobacco users have access to evidence-based treatment services.

Thank you, again, for the opportunity to express NAQC’s opinion."

The Rest of the Story

This response, while quite courteous and much appreciated, does not actually address the specific arguments that I raised in my commentary. The response simply reiterates the fact that most quitlines provide smoking cessation medications. But I never took issue with the fact that quitlines provide smoking cessation medications. What I took issue with is the fact that the Consortium is accepting sponsorship for a scientific conference from companies whose products will be directly addressed at the meetings. This precludes any objective consideration of these important issues, as the companies have a vested financial interest in the outcome of the discussions. Subconsciously, the sponsorship of the conference by Big Pharma is going to have an effect on all aspects of the conference, including what topics are discussed, what papers are accepted for presentation, how results are presented, what conclusions are drawn, and what recommendations are made.

Even in this response, the issue is being diverted. The response is written as if my argument was that quitlines should not provide smoking cessation medications. I have never advanced such an argument, nor do I think that is a rational position. Of course quitlines should provide smoking cessation medications as part of their overall strategy. The issue is not whether quitlines should provide certain types of medications but whether an organization running what it hopes to be an objective scientific conference should accept sponsorship money from companies with a vested financial interest in the outcome of the discussions at the conference.

Let's suppose that a tobacco control conference was sponsored by a tobacco company. It is easy to see how that conference could not possibly offer an objective consideration of the issues, since the sponsoring tobacco company has a vested financial interest in the discussion and if the wrong things are said, the company could easily decide to withdraw its sponsorship. In fact, I imagine that most of the tobacco control groups in the nation would be protesting vigorously against acceptance of tobacco industry money for the conference.

But the issue is exactly the same with the sponsorship of this conference by Big Pharma, at least as far as the scientific objectivity of the conference is concerned. The financial conflict of interest created by the sponsorship precludes the possibility of objective consideration of scientific issues, just as the sponsorship of a tobacco control conference by Big Tobacco would preclude its scientific objectivity.

The rest of the story is that not only are tobacco control groups now solidly in the pocket of Big Pharma, but they appear unable to even engage in a discussion of the substantive scientific and ethical issues regarding the acceptance of conference sponsorships from companies with a vested financial interest in the proceedings.

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