Friday, January 10, 2014

Why Fiore's Failure to Disclose Conflicts of Interest is So Important

Yesterday, I noted that this month's issue of JAMA features a commentary co-authored by Dr. 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. Although the article discloses no conflicts of interest, I revealed that Dr. Fiore has a long and intensive history of financial conflicts of interest with the very pharmaceutical companies that manufacture smoking cessation drugs, which he recommends, in the article, be prescribed to every patient who smokes.

Today,  I discuss the reasons why hiding a conflict of interest like this is problematic.

The Rest of the Story

There are four major reasons why hiding conflicts of interest are problematic:

1. It Violates Public Health Ethics and Could Be Damaging to the Entire Field of Tobacco Control

One of the basic ethical principles of public health is transparency. It is our responsibility to be forthright with the public about the basis of our opinions about public policy, not to merely express our support or opposition for those policies.

The core ethical principle of transparency was spelled out in a Tobacco Control article (see Fox BJ. Framing tobacco control efforts within an ethical context. Tobacco Control 2005;14[Suppl II]:ii38-ii44).

Fox writes: "The tobacco control community should strive for transparency in its dealings. If the tobacco control community fails to explain its dealings within an appropriate framework, it may be perceived as biased or hiding relationships, and it could lose its reputation for independence."

Thus, not only is hiding conflicts of interest an ethical violation, but it is potentially damaging as well. Once researchers in a field are viewed by the public as hiding relationships, the reputation of the entire field may be tarnished. Just look at what happened to the field of global climate change after it was revealed that merely one of hundreds of researchers in the field may have been biased in his approach.

In addition, hiding conflicts of interest deprives the public (and other researchers) to properly evaluate the validity of one's work. Certainly, one has a different view of the validity of the arguments in Fiore's piece once one becomes aware of his long history of financial relationships with Big Pharma. It is unfair to readers to deprive them of this relevant information. Plus, it is unfair to the journal, because the image of the journal itself could become tarnished if it becomes known that an author hid relevant financial conflicts from readers.

2. It Degrades the Research Integrity of Tobacco Control

One of the features that separates tobacco control research from research conducting historically by the tobacco companies is the integrity of our work. We want and need the public to view the integrity of tobacco control research as being higher than that of work which in the past was conducted by the tobacco companies. If it comes down to tobacco control researchers arguing that secondhand smoke is harmful and tobacco industry-funded studies suggesting that secondhand smoke is not harmful, we want the public to believe us. That requires that the public view our research integrity as being greater than that of the industry.

Previously, there was a significant history of tobacco-funded researchers failing to disclose their conflicts of interest. By now doing the same thing, we are blurring the distinction. Now, the public is going to question the integrity of our research, not just that conducted by or supported by the tobacco companies.

3. It Makes Us Hypocrites When We Criticize Failed Tobacco Industry Disclosures

Tobacco control advocates have often criticized scientists who were supported by the tobacco industry for failing to disclose their funding or other conflicts of interest, such as being paid to author commentaries critical of tobacco control policies. And rightly so. However, if we now engage in the very same tactics, then we become hypocrites, and our credibility in criticizing tobacco industry "hacks" is shot. We don't have any credibility in attacking "tobacco hacks" if we are "Big Pharma hacks."

4. It Hides the Influence of Big Pharma Money on the Field of Tobacco Control and Hinders Smoking Cessation Efforts

Ironically, in the long run, hiding the influence of Big Pharma on smoking cessation policy does not advance the cessation field, but brings it to a grinding halt. The public, and tobacco control practitioners themselves, need to understand the deeply ingrained roots of Big Pharma within the tobacco control movement, especially in the smoking cessation field. Failure to do so will lead to blind following of an industry-based agenda. This is precisely what has happened in tobacco control.

Thanks to deception like that we see here from Dr. Fiore, there is a perception that the use of smoking cessation drugs is the "standard of care." This is far from the truth. If the public, and tobacco practitioners themselves, understood the depth of the connection between those who crafted the "standard of care" (i.e., the Clinical Practice Guideline recommendations) and the industry that manufactures the drugs that are recommended in the Guideline, it would become apparent that these recommendations are heavily biased, not objective, and inappropriate.

Because of the importance of this issue, I have written to the editorial staff of JAMA, urging them to publish a corrective statement, requiring Dr. Fiore to disclose his long and intensive history of conflicts of interest with pharmaceutical companies that manufacture smoking cessation drugs.

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