American Legacy Foundation Gives Medical Advice to Smokers About Cessation Drugs, But Fails to Disclose Conflict of Interest with Makers of the Recommended Drugs

In a public statement of February 28, the American Legacy Foundation has this medical advice for smokers who are considering quitting using electronic cigarettes: Don't. Instead, use nicotine replacement therapy (NRT) or Chantix.

According to the statement: "Given the poor quality control of these products, consumers are taking unknown risks by using e-cigarettes, with few proven benefits. Until adequate research and regulation is in place, users should be wary of using e-cigarettes, and smokers who want to quit should pursue science-based effective cessation tools, such as nicotine replacement products, free counseling services available via telephone quit lines and Web-based cessation services, as well as non-nicotine pharmacotherapies."

One of these "non-nicotine pharmacotherapies" is of course Chantix, which has been associated with hundreds of deaths from suicide or other severe forms of violence. The number of lawsuits against Pfizer for deaths or severe injuries allegedly due to Chantix use exceeds 3,000.

Despite these severe adverse effects that have been associated with the use of Chantix, the American Legacy Foundation fails to give these effects so much as a mention in its statement.

While Legacy avoids making any mention of the known risks of Chantix, it does emphasize the unknown risks of electronic cigarettes, which the Foundation cannot articulate because so far, none have been clearly identified or documented.

While it is problematic that Legacy is presenting a biased picture of the health information regarding the known risks of various drugs used for smoking cessation by recommending Chantix - which has been associated with hundreds of deaths - while discouraging the use of electronic cigarettes - which have yet to be associated with a single death, that is not what this post is about.

The Rest of the Story

This post is about the ethical obligation of a body giving medical advice to the public about the use of various drugs to disclose any financial conflicts of interest related to funding received from makers of those drugs. It is because of the failure of the American Legacy Foundation to disclose its conflicts of interest with the very maker of the drug it is recommending for smokers over e-cigarettes (despite the vast difference in the currently known safety profiles of the two drugs) that I am writing.

The American Legacy Foundation has received substantial funding from Pfizer - the very company which manufactures Chantix, a smoking cessation drug which stands to lose severely if electronic cigarettes become more and more popular. Thus, the Foundation's receipt of funding from Pfizer is a conflict of interest that I believe should have been revealed in its statement providing medical advice to smokers, urging them to use a drug like Chantix rather than to try electronic cigarettes.

What is the evidence for a financial connection between Pfizer and the American Legacy Foundation? Although you apparently won't easily find any disclosure of this connection on the Legacy web site, Pfizer - unlike Legacy - is transparent, and readily reports its donations to the American Legacy Foundation on its web site:

• In the first quarter of 2011, Legacy received $150,000 from Pfizer for a "Quitting Smoking Public Opinion Initiative."


• In the third quarter of 2011, Legacy received $150,000 from Pfizer for a "Quitting Smoking Public Opinion Initiative."


• In the first quarter of 2009, Legacy received $260,500 from Pfizer for a "Smoking Cessation Awareness and Benefit Survey."


• In addition, Pfizer is listed as a contributor to the 2009 American Legacy Foundation Honors event.


• Pfizer is not the only pharmaceutical company from which Legacy has taken money. The Foundation also admits to receiving funding from GlaxoSmithKline, Novartis Consumer Health, and Schering-Plough between 2008 and 2010.

The rest of the story is that these substantial conflicts of interest were not revealed in the statement of medical advice to smokers, thus hiding from smokers the fact that this advice could potentially be affected by, influenced by, or biased due to the funding from multiple companies that manufacture smoking cessation drugs and stand to lose tremendously if electronic cigarettes become more popular. I think that smokers deserve to have this information and I therefore think these conflicts should have been disclosed.

Furthermore, I think that relevant financial conflicts of interest among Legacy senior staff members should also have been disclosed. Thus, the statement should have revealed that Dr. David Abrams - a Legacy senior staff member - has received grant funding from multiple pharmaceutical companies that have investigated or manufactured smoking cessation drugs, including Eli Lilly, Dupont Merck, Glaxo-Wellcome, SmithKline Beecham, Sano Corporation, Bristol-Myers Squibb, Knoll Pharmaceuticals, and Pfizer.

Lack of transparency in failing to disclose financial conflicts of interest has become a serious problem in tobacco control, but it is a particularly substantial problem when it involves a statement providing medical advice to smokers in which the financial relationships of the body making the statement and the drug companies making the recommended products are not disclosed.