This month's issue of JAMA features a commentary by Drs. Helene Cole (an associate editor) and Michael Fiore (from the University of Wisconsin School of Medicine and Public Health) which reviews the history of tobacco control in the 50 years since the release of the 1964 Surgeon General's report. The article makes recommendations for strategies to further reduce tobacco-related morbidity and mortality. One of these recommendations is that every patient who smokes be treated with medication. The article also argues that treatment with smoking cessation drugs is the "standard of care" for promoting cessation among smokers.
At the end of the article, the authors include their Conflict of Interest Disclosure, which reads: "The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported." Thus, Dr. Fiore is reporting having no conflicts of interest with regards to the subject matter of this commentary (which includes his recommendation that all smoking patients be treated with drugs, which he states is the standard of care).
The Rest of the Story
Readers who see that Dr. Fiore has declared no conflicts of interest might naturally assume that he has no conflicts of interest to report.
Might they not be surprised, then, to discover the truth:
1. According to his own 2008 JAMA article:
"In the past 5 years, Dr Fiore reports that he has lectured and
consulted for Pfizer and has served as an investigator on research
studies at the University of Wisconsin (UW) that were supported by
GlaxoSmithKline, Nabi, Pfizer, and sanofi-aventis."
2. According to his own sworn testimony, at the time of his chairing in 2008 of an expert NIH panel to make recommendations about the recommended clinical strategies for promoting smoking cessation, Dr. Fiore received up to $50,000 in annual resources from GlaxoSmithKline to
support his educational, research, and policy activities.
3. In 2006, Dr. Fiore acknowledged that "I have done some consulting work for pharmaceutical companies over the
years. Over the past five years, my outside consulting work on an annual
basis has ranged between about $10,000 and $30,000 or $40,000 per
4. In 1998, the University of Wisconsin appointed him to a named chair, made possible by an unrestricted gift to the University from GlaxoWellcome.
5. In the past, "Dr. Fiore has served as a consultant for, given lectures sponsored by,
or has conducted research sponsored by Ciba-Geigy, SmithKline Beecham,
Lederle Laboratories, McNeil Consumer Products, Elan Pharmaceutical,
Pharmacia, and Glaxo Wellcome."
6. Dr. Fiore directs a tobacco research
center that received nearly $1 million in funding from makers of
quit-smoking medicine in 2004 and $400,000 in 2005.
7. In a recent set of two articles on treatment for smoking cessation published in the Annals of Behavioral Medicine in April 2011 (article 1; article 2),
the conflict of interest statement regarding Dr. Fiore acknowledges that: "Over the last 3 years, Michael C. Fiore served as an investigator
on research studies at the University of Wisconsin that were funded by
8. In a December 2010 article on treatment for smoking cessation published in the Wisconsin Medical Journal,
the conflict of interest statement regarding Dr. Fiore acknowledges that: "Over the last 3 years, Dr Fiore has served as an investigator in
research studies at the University of Wisconsin that were funded by
Pfizer and Nabi Biopharmaceuticals."
Amazingly, none of these conflicts of interest are reported in the paper and the reader has no way of knowing this long history of financial conflicts of interest with Big Pharma. I imagine that most readers would be shocked to find out about this intense and long history of financial conflict with Big Pharma, given that Dr. Fiore reported no conflicts of interest.
In my opinion, the fact that there are significant conflicts of interest that should have been disclosed is undeniable. Moreover, it is undeniable that these conflicts are relevant to the subject matter of the paper. The article makes the bold and I believe incorrect statement that treatment with drugs is the "standard of care" for smoking cessation. In fact, I believe that there are many methods that physicians appropriate use to promote smoking cessation in their patients, and medication is only one of these methods. Many physicians recommend other approaches, including counseling, hyponosis, 12-step programs, and cold turkey quitting.
Given the controversial nature of the recommendation that treating every smoker with drugs is the "standard of care," I believe that the long and intense history of conflicts of interest with Big Pharma is absolutely relevant to the present article.
In my view, Dr. Fiore's failure to disclose these conflicts suggests that he really does have something to hide. If not, then what is the danger in not being honest and disclosing these conflicts?
For years, we in tobacco control have attacked tobacco industry-funded scientists or researchers who consulted for tobacco companies for not disclosing their conflicts of interest. It it therefore quite unfortunate, and ironic, that tobacco control researchers do not appear to take their own conflicts of interest seriously and that they, too, are hiding these conflicts from the public.