Association for the Treatment of Tobacco Use and Dependence (ATTUD) Again Hides Financial Conflict of Interest of Author in Public Statement

Earlier this year, I discussed a study which casts doubt on the effectiveness of nicotine replacement therapy (NRT) in smoking cessation. The study, published in the journal Tobacco Control, challenges the prevailing wisdom in the tobacco control movement by arguing that NRT is ineffective for smoking cessation and that therefore, public expenditures for NRT provision to smokers is a waste of resources. The researchers found no difference in relapse rate among those who used NRT for more than six weeks, with or without professional counseling. No difference in quitting success with use of NRT was found for either heavy or light smokers. The authors concluded that: "using NRT is no more effective in helping people stop smoking cigarettes in the long-term than trying to quit on one's own."

In response, the president of the Association for the Treatment of Tobacco Use and Dependence (ATTUD) - Dr. Michael Steinberg - issued a public statement denouncing the study and defending NRT. According to the statement: "ATTUD does not believe this study shows that NRT doesn't help smokers to quit. This is not a groundbreaking study, but just one of 11 case-control studies on NRT, many of which have found efficacy, while others have not. Unfortunately many reputable news agencies ran the press-release of the article without examining the findings. We fear that the consequences may be that many people who very much need to quit smoking and would benefit significantly from NRT will not use it because they now believe that NRT does not work. We would encourage clinicians, the media, health administrators, etc. to read the article and compare our interpretation of the findings with those of the authors. Falsely concluding that a proven treatment is ineffective can be tragic, especially when the targeted disorder is the leading cause of preventable death in the world."

The Rest of the Story

What Dr. Steinberg does not reveal in ATTUD's public statement is that he has a financial conflict of interest by virtue of his financial relationship with a pharmaceutical company that manufactures a smoking cessation drug, and thus stands to lose financially if pharmacotherapy is found to be ineffective (or less effective than currently believed) for smoking cessation.

From an article published in 2010, we find out that Dr. Steinberg has had a financial relationship with Pfizer: "Dr. Steinberg’s institution received a grant from Pfizer for research support for a clinical trial, and he has received payment from Pfizer for the development of educational presentations."

And from a 2008 article, we find out that Dr. Steinberg has received grant support from Pfizer, has consulted for Big Pharma, and has received honoraria from Pfizer.

A Business Week article published in 2008 criticized Dr. Steinberg for failing to disclose his financial interest in Pfizer to patients that he treats with the drug and for failing to disclose this conflict on his university web site page. (The article incorrectly states that the financial conflict was not accessible from the journal's web site, but I found that was not the case: without purchasing the article, I was able to view the financial conflict of interest disclosure statement.)

I believe that this financial conflict of interest should have been revealed in the public statement responding to the Alpert and Biener study. Because of this conflict, ATTUD's interpretation of the study is inherently biased, and the public deserves to know about this conflict so that they can make an informed judgment about the validity of ATTUD's arguments.  

This is not the first time ATTUD has failed to disclose a personal financial conflict of interest in a public statement. In 2009, ATTUD wrote a letter to the FDA urging that the agency remove electronic cigarettes from the market. However, the letter failed to reveal the financial conflicts of interest of its two co-authors with Big Pharma. These authors had financial relationships with pharmaceutical companies that manufacture nicotine replacement products and stand to lose out in a major way if electronic cigarettes become popular.

I wrote at that time: "The rest of the story is that ATTUD appears more concerned with serving the interests of its own practitioners, who largely depend upon pharmaceutical money and traditional pharmaceutical-based smoking cessation programs for their livelihood than with serving the interests of smokers and of the public's health. This has the appearance of an organization which is sacrificing the public's health in order to protect Big Pharma profits, motivated by a bias created by a significant financial conflict of interest with the pharmaceutical companies. I believe it is unethical for a "health" organization like ATTUD to try to influence public policy with a press release and letter to the FDA without disclosing these significant financial conflicts of interest."

In a 2011 letter to the FDA, ATTUD again failed to disclose the financial conflicts of interest of its president at the time, who signed the letter. This letter was an attempt to influence public policy by lobbying the agency to give more favorable treatment to smoking cessation medications. The conflict of interest was therefore quite relevant to the petition and it should have been revealed.

ATTUD again failed to disclose the financial conflict of interest of its president at the time in a 2011 letter to the head of the Department of Public Welfare in Pennsylvania, urging him to give favorable treatment to smoking cessation drugs in terms of the state's decision on whether to include access to these medications as Medicaid benefits.

In yet another 2011 letter, this one to the Joint Commission, ATTUD hides the conflict of interest with Big Pharma of its president at the time, despite urging the Joint Commission to release standards that would require hospitals to prescribe a smoking cessation drug to every smoker, unless specifically contraindicated.

ATTUD also failed to reveal financial conflicts of interest of its leadership with Big Pharma in its 2010 citizen's petition to the FDA, which requested special favorable treatment in the review of smoking cessation medications -- treatment that is not given to other drugs reviewed by the agency.

To make matters worse, it appears that ATTUD is failing to disclose its own institutional conflict of interest with Big Pharma on its web site and in all of its public statements and letters attempting to influence public policy. In none of these statements or letters do I see it revealed that ATTUD has received financial support from Big Pharma. However, ATTUD has received financial support from GlaxoSmithKline.

Unfortunately, it does not look like ATTUD has learned its lesson. Sadly, it appears that the organization is still putting the financial interests of its own practitioners over the interests of smokers and the public's health. And it continues to hide the fact that its president has a financial relationship with a company that manufacturers smoking cessation drugs, thus undermining the organization's objectivity. Furthermore, it is also hiding from the public the fact that the organization itself has received money from Big Pharma. There is no way for readers to know the truth unless they search for the rest of the story.