The New York Times "Room for Debate" section Wednesday featured a debate about electronic cigarettes. I was one of six commentators who provided their perspectives on the issue. After reviewing the other commentaries, the first thing that struck me was the failure of one of the commentators to disclose an important financial conflict of interest: his receipt of funding from Big Pharma to study the effectiveness of a competitive product to electronic cigarettes.
The commentary was written by Dr. Andrew Strasser, an associate professor in the department of psychiatry at the University of
Pennsylvania's Perelman School of Medicine, where he is the director of
its Biobehavioral Smoking Laboratory. The commentary calls for more research and regulation of electronic cigarettes, a perspective with which I largely agree. It argues that electronic cigarettes are safer than tobacco cigarettes, a statement with which I completely agree. It calls for the FDA to set quality control standards for these products. I agree. However, the commentary goes on to assert that: "there is a paucity of research on how individuals actually use
electronic cigarettes. What about those who might have a chance of
quitting smoking altogether but instead end up replacing the tar and
nicotine from traditional cigarettes with e-cigarettes?"
There actually has been considerable research on how vapers are using e-cigarettes and from that research, it is quite clear that the smokers using these products are not people who would otherwise have "quit smoking altogether." Most of the e-cigarette users have tried and failed to quit using traditional "FDA-approved" therapies. In fact, the reason they are attracted to e-cigarettes in the first place is that these products provide an alternative to the products which do not work or have not worked for them. So it is simply not the case that e-cigarettes are hindering smokers from quitting. In fact, it is quite the opposite as these products are providing a ray of hope to smokers who otherwise would probably not even be making further quit attempts, or at least not serious ones.
There is one other point made in the commentary with which I disagree. The column expresses concern over "the perception that electronic cigarettes are less harmful ... than traditional cigarettes." I don't understand why we should be concerned about the public holding a perception that e-cigarettes are safer than tobacco cigarettes. In fact, this is the truth. Why wouldn't we want the public to understand the truth. It would be a tragedy, in fact, if smokers were under the mistaken impression that their "real" cigarettes were as safe as the electronic ones. So I just don't understand why the public perception that e-cigarettes are safer than tobacco cigarettes is concerning.
The main problem with this commentary, however, is not the opinions it expresses, but the fact that it hides from the public an important financial conflict of interest of the author that I believe should have been disclosed.
The Rest of the Story
It turns out that the author of the commentary has received funding from a company which manufactures a competitive product to electronic cigarettes. Specifically, he has received research funding from Pfizer, the manufacturer of Chantix, a smoking cessation drug that stands to lose substantial sales if electronic cigarettes become increasingly popular. Therefore, this is a significant financial conflict of interest and I think it ought to have been disclosed in the article.
This is not the only commentary which failed to disclose a significant financial conflict of interest. The American Lung Association offered a commentary which urged smokers not to use electronic cigarettes to quit smoking. This is a devastating recommendation that, if followed, will result in increased smoking, disease, and death as thousands of smokers who would otherwise have quit smoking using e-cigarettes will instead continue smoking.
But the larger problem with the commentary is that it fails to disclose a significant financial conflict of interest: the American Lung Association has received millions of dollars of support from Big Pharma; specifically, from Pfizer.
In the second quarter of 2009 alone, the American Lung Association received more than $1.5 million from Pfizer, manufacturer of Chantix and Nicotrol. Pfizer is a sponsor of the Lung Association's Freedom from Smoking program.
The financial connection is so strong that the American Lung Association goes so far as to promote Pfizer on its web site, boasting that: "Founded
in 1849, Pfizer is the world's premier biopharmaceutical company
taking new approaches to better health. We discover, develop,
manufacture and deliver quality, safe and effective prescription
medicines to treat and help prevent disease for both people and animals.
We also partner with healthcare providers, governments and local
communities around the world to expand access to our medicines and to
provide better quality health care and health system support. At Pfizer,
colleagues in more than 90 countries work every day to help people
stay happier and healthier longer and to reduce the human and economic
burden of disease worldwide."
In other words, the American Lung
Association is allowing Pfizer to gain a huge public relations benefit
out of its financial support. It is truly a partnership, not merely a
charitable contribution from Pfizer. Clearly, the ALA has become
beholden to Pfizer by virtue of the money it has received. No wonder the
ALA finds it such a threat that thousands of smokers are quitting by
virtue of a product that is not produced by Big Pharma. Electronic
cigarettes are a real threat to Pfizer's profits.
Clearly, New York Times readers have the right to know about this conflict of interest so that they can properly interpret the validity of the arguments being made by the American Lung Association.
It is valuable to engage in public debate about the complex regulatory, research, and policy issues involved with electronic cigarettes and the public's health. However, it is essential that this debate include appropriate disclosures of financial conflicts of interest that might bias the opinions or conclusions expressed in these debates. In particular, when a commentator has received financial support from a corporation that manufactures a competitive product to electronic cigarettes, that should be disclosed. Readers deserve this information so that they can properly evaluate and interpret the opinions expressed by the authors. Failure to disclose this information is effectively hiding important facts from the public.