Friday, 15 April 2011

Steer clear of Big Pharma, says... the WHO!

From the BMJ:

The World Health Organization has warned health professionals working in tobacco control not to become too closely involved with drug companies that produce smoking cessation products.

Well, well. This is a breath of fresh air. And it looks like the WHO picked a suitable audience for this message...

The warning came last month at a meeting on smoking prevention in Madrid that was hosted by the National Committee to Prevent Smoking, which represents most Spanish anti-tobacco organisations, and which was sponsored by Pfizer, GlaxoSmithKline, and McNeil—all of which make treatments to help smoking cessation.

Let's be clear on this. I have never had a problem with businesses lobbying or funding research, including pharmaceutical and tobacco companies. In fact, I would rather the government listens to people who have worked for a living than remain in the political echo chamber passing stupid and impractical laws.

Industry primarily represents its own self-interest, of course, but they represent the interests of their customers rather better than politicians represent the interests of the electorate. If we are being charitable, we might say that Big Pharma represents the interests of smokers who want state-funded pharmaceutical nicotine. Likewise—and I realise this is not a popular view these days—the tobacco industry's desire to sell cigarettes more closely matches the desire of the millions of people who want to buy cigarettes than does the desire of the WHO to ban them.

The problem with Big Pharma's role in tobacco control is two-fold. Firstly, it is blatantly hypocritical to ignore one industry while being hand in glove with another industry. Secondly, although the interests of Big Pharma are served by policies that have long since been decided on by tobacco control (smoking bans, higher tax on cigarettes, etc.), in several instances the influence of pharmaceutical companies results not just in damage to liberty but in damage to public health. For example, I do not believe that the ridiculous ban on snus would still be in place were it not for lobbying from Big Pharma at the EU and WHO level. At a national level, I doubt that ASH would be pushing Chantix quite so vigorously if Pfizer weren't a constant presence at every conference they attend.

But more to the point, where does the World Health Organisation get off telling other people not to be too chummy with the pharmaceutical industry? Isn't this the same organisation that welcomed Big Pharma as a partner in its tobacco control program with the barely ambiguous comment that "investing in health yields high returns"? This, from the Director-General of the WHO in 1999:

Three major pharmaceutical companies have joined this partnership: Glaxo Wellcome, Novartis, and Pharmacia & Upjohn. They all manufacture treatment products against tobacco dependence. Together, these companies will support a common goal that will have a significant impact on public health.

We are facing major health challenges. There is a real scope for meeting them. It is within our grasp to drastically reduce the global burden of disease. WHO is determined to do its part. And I am happy to welcome other stakeholders - and that includes industry - to join us - because investing in health yields high returns.

In the same year, Glaxo Wellcome's director of Global Commercial Strategy explained what they wanted in return (link should be here but is broken):

We want to support and be partners in tobacco control in a number of areas. We could use help in the area of reimbursement.

By 'reimbursement', he means using taxpayers' money to hand out free pharmaceutical nicotine products and that is exactly what the pharma-funded National Committee to Prevent Smoking has been lobbying for in Spain, as the BMJ notes:

In Spain public funding of drugs for smoking cessation is only provided in two autonomous communities: Navarra and La Rioja. Attempts by the National Committee to Prevent Smoking and some political parties—the conservative Popular Party and the Catalan nationalist Convergence and Union party—to get the public funding of such drugs put into Spain's new smoking law failed. 
Rodrigo Córdoba, spokesman for the National Committee to Prevent Smoking, denied that the committee had any conflict of interest, despite the fact that drug companies contributed to funding certain events. "We have tried by all means to maintain independence," he said, in the face of pressure from the drug industry "to persuade us to support public funding [of drug therapies] in a more aggressive way."

Some of the medical societies forming part of the committee had much "stronger links" to drug companies, he said. "There may be individual cases of conflict of interest. Clearly that has occurred and will still occur to some extent," he added."

No doubt it has and no doubt it will. It is good that the WHO is at least acknowledging this conflict of interest. Can we now expect the likes of ASH, the Roy Castle Lung Foundation and John Banbanbanzhaf—who are so quick to dismiss anything which has the slightest whiff of tobacco industry funding—to turn their back on pharmaceutical industry funding?

That was a rhetorical question, by the way.


(Thanks to Eric Crampton for sending me the full article.)

15 comments:

Anon said...

Sorry for posting here. Would not publish in previous thread, but still very relevant.

As I've said before, a public health movement that bans smoking in all 'public' places on the basis of 3,000 hypothetical deaths from secondhand smoke—based on much weaker epidemiological evidence that the study discussed here—is not going to think twice about hammering drinkers who are allegedly responsible for tens of thousands of deaths.

Sorry for O/T, but it’s a circumstance worth highlighting because your point can be made another way that points back to the medical establishment instead. (in 3 parts)

Consider iatrogenesis which refers to any detrimental outcome produced by medical conduct (e.g., adverse drug reactions, medical errors, poor care of the bed-ridden resulting in infected bed sores). In America, from the very few studies that have been done, iatrogenic deaths are estimated at 750,000-1,000,000 per annum. It dwarfs the so-called tobacco “death toll” (400,000) and is approaching half of the total annual death toll in America (2,500,000). The medical establishment is by far the leading cause of preventable death and disability and associated costs. The translation for Australia is that iatrogenic deaths are estimated at 55,000-74,000 per annum compared with the tobacco “death-toll” of 15,000. The translation for the UK would be 150,000-200,000 iatrogenic deaths per annum.

Further, the iatrogenic toll is far more plausible, causally, than the tobacco “toll”. The tobacco “toll” is based on lifetime use that also brings into play a veritable plethora of other factors over a lifetime. It is also argued from the population level that has very poor extrapolation to the individual level. Conversely, the iatrogenic toll is argued from the individual level and then estimated for the population level. For iatrogenesis, causation is typically demonstrable at the individual level. For example, with adverse drug reactions (these are properly prescribed, FDA approved drugs), it may take just one or a few pills to produce cardiac arrest in some patients that can be fatal or leave permanent injury. The patient is stable and within an hour of taking a pill goes into atypical catastrophic failure. The temporality of many of these associations is not over a lifetime, but involves hours or days. Of the two – the iatrogenic or tobacco tolls – it is the former that should attract very serious scrutiny. But, as will be seen, it has been the other way around, or upside-down.

DaveA said...

If you are not aware of the work of Freedom2Choose and The International Coalition Against Prohibition, you do now. As pro choice organisations on tobacco and alcohol we find the banning of smoking in bars and restaurants an abomination in a democracy. They are private property. The state and anti tobacco advocates have no rights to restrict consenting adults the freedom of assembly to consume a legal substance on private property.

The supposed "harm" of second hand smoke (SHS) I believe is one of the worst abuses in the history of science developed in the late 20th and early 21st Centuries (1) apart from if proven, man made global warming.

I was a speaker at the BMJ sponsored "..is smoking a disease or a habit" as you see above and was fully expensed by Pfizer. No doubt you can see from my style of writing and content I do not take prisoners. Believing that smoking is a habit I had to forward a copy of my speech and of course all the relevant papers and URLs to confirm my hypothesis. I would add apart from Dr. Reuben Dar's papers most of my evidence came from anti smoking advocates such as Dr. Martin Jarvis and Professor Simon Chapman.

It was as you might expect hard hitting. I compared the misinformation disseminated about SHS and compared it to misinformation about to be invented to portray smokers as pathetic addicts who need even more state and medical intervention. I even went on to accuse by implication that the heart attack "miracles" papers from Professors Jill Pell and Stanton Glantz and Dr. Anna Gilmore of publication bias.

You mentioned evidence based and that is a gold standard. At no time did Pfizer try to censor me, or persuade me to change my approach. In fact they felt most uncomfortable me criticising nicotine replacement therapy (NRT) such as patches and gum, who have "success" rates of 0.8%-11% after a year.(2) Pfizer of course do not produce NRT and could of seen of being biased against their competitors.

In conclusion, from my experience Pfizer seem to be playing a straight bat.

However I will say that I think it very wrong that tobacco companies are excluded from the process. It is very unfair and the WHO FCTC 5.3 is a disgrace, especially clause 11 "The measures recommended in these guidelines aim at protecting against interference not only by the tobacco industry but also, as appropriate, by organizations and individuals that work to further the interests of the tobacco industry."

So any dissent is to be silenced. Disgraceful. (3)

With tobacco control we are on a very slippery slope of misinformation, authoritarianism and misinformation, but with some honourable exceptions. Perhaps all parties need to get round the table and create our own framework of ethics.

1. http://www.bmj.com/content/326/7398/1057.full

2. http://tobaccocontrol.bmj.com/content/12/1/21.abstract

3. http://www.who.int/fctc/guidelines/article_5_3.pdf

Belinda said...

Nice one Chris: I wonder where this annual jamboree would get its funding from http://www.uknscc.org/uknscc2011_programme.php

Currently supported by http://www.uknscc.org/uknscc2011_exhibition_sponsors.php

Anonymous said...

As I always thought if tobacco control want to screech out their message they should pay for it themselves.
I find as a smoking taxpayer having to fund these cockroaches from my taxes tottaly unpalletable.

jredheadgirl said...

Nice one Chris. I almost choked on my breakfast when I came across the title of this latest piece..lol.

Dave- In thinking about clause 11 of the FCTC, I've come to wonder just what their intentions are when it comes to silencing individuals and organizations. Just how are they planning to do that without completely trashing the rights that we as individuals hold in democratic societies around the globe. I mean, I can see how they can achieve this objective when working in tandem with rogue and despotic regimes (which, is totally detestable, and says a lot about the WHO), but in the U.S., U.K., and other "free" nations?

Anon said...

(part 3)
Most are not aware that the Hippocratic Oath has all but been done away with in the contemporary medical establishment. It is not a requirement of medical graduation. A key tenet of the Hippocratic Oath is “first do no harm”. When the Hippocratic Oath is dispensed with, it opens the medical establishment to deranged ideology (eugenics) and greed: With the “first do no harm” precept done away with and open to deranged ideology, the medical establishment can then rationalize doing harm for the greater “good”, and where it defines all the factors. The same assault on the Hippocratic Oath occurred in the German medical establishment in the decade preceding the Nazi regime. Medically-pushed antismoking also began to appear in German society around this time.

The contemporary medical establishment has become a dangerous self-serving entity. While it incites arguments that particular social groups are “costly” to the system, they never ask what cost they pose to the system. Taxpayer-funding of the health system has become a black hole, sucking more and more funding into it. This is constantly blamed on everyone except the medical establishment. The medical industrial complex is wealthy, second only to the military industrial complex. Where is taxpayer funding going? Are medical services/products overpriced? Are there useless, costly products? Are there useless, costly procedures? Is there useless, costly equipment? Is there useless, costly screening and testing? Is there a useless, costly bureaucracy? etc, etc.

The argument can well be made that it is when the medical establishment is not properly looking after its affairs is also when it becomes additionally dangerous by venturing into havoc-producing social-engineering crusades.

DaveA said...

I should point out my scibblings on Pfizer were in a letter to the BMJ.

Dave Atherton

Anon said...

(part 2a)
Concerning smoking, there have been thousands upon thousands of antismoking “studies” conducted/funded. Many do not break new ground but simply reinforce the agenda. World Conferences on Smoking and Health have been occurring since the 1960s. In the last few decades there are National Conferences on Smoking and Health. There are now even Conferences for Nonsmokers. Then there are Smoking Cessation Conferences run by the Pharma cartel peddling their useless/dangerous wares. Additionally there are numerous antismoking lectures and colloquia and speeches and committees and campaigns. Specific institutes for the study of tobacco have been created as sub-centres of university Public Health Departments. There has been a frenzy of antismoking activity over the last three decades. A formidable, lucrative industry has been created that did not exist 30 years ago. And the bulk of it is all under medical direction. The medical establishment has wreaked havoc, again, to tackle the tobacco “death toll”, and peddled essentially on the basis of the far smaller tobacco “toll” in nonsmokers.

Anon said...

(part 2b)
So we could then ask that if this has been the reaction to the tobacco “death toll”, then there must be an even greater industry addressing/correcting institution-wide iatrogenesis? In fact, there’s not. Compared with the many thousands of antismoking studies, there are but a handful (less than 20) concerning institution-wide iatrogenesis, damning as they are. There are no conferences on iatrogenesis. There are no specifically-created institutes addressing the issue. In fact, it attracts almost zero attention within the medical establishment itself. The medical administration doesn’t like talking about it or the public knowing about it. This is the same medical establishment that now wants to “fix-up” the world. Scrutinizing the medical establishment would reveal how unstable its framework is. It would mean a loss of profits and trust. It avoids scrutiny like the plague. The medical establishment was out of control 30 years ago. It has since entered a sinister phase. And smokers are one of the first to notice the ugly side of the medical establishment in its world-fixing (eugenics) crusade.

Junican said...

If I can bring people's minds back to reality, I have just returned from a holiday in Mallorca.

The bars there have all fallen in line - smoking inside is banned. But what really, really upset me was the fact that the 'smoking area' in terminal A has been closed. This smoking area was a self-contained, glass enclosed, sliding doors controlled area with ventilation. It has been closed. PETS (People who Enjoy Tobacco) are trapped inside this building with no means of exercising their perfectly reasonable right to enjoy themselves reasonably as they wish without harming others. Also, there was a bar with an external terrace - that has also been closed.

It is clear from the above that there is a vicious and malignant intent in Mallorca to exterminate the enjoyment of tobacco at all costs.

(By the way, apart from two flights - one to Newcastle and one to Manchester - terminal A was deserted.)

The tourist industry in Mallorca has been in free-fall for some time, and yet the authorities there seem to be more and more inclined to damage that industry.

It seems to me that they would not be doing this unless there were actual bribes or promises of riches to come (unless they are crazy).

OR (and this is the important point, I suppose), it may be that the eugenicist healthists are totally in control, just as they are in the UK.

James Higham said...

in several instances the influence of pharmaceutical companies results not just in damage to liberty but in damage to public health

I'd be very wary of the pharmaceuticals - sounds like another bandwagon.

Anon said...

“not to become too closely involved”

What does that mean? I don’t think it means “steer clear of”.
It sounds more like a PR stunt.

Anonymous said...

Dave A, Pfizer manufactures Nicotrol and Nicorette.

Anonymous said...

Steer clear of Jackie Baillie as well, I would rather vote for a cabbage in the Scottish Election.


http://f2cscotland.blogspot.com/2011/03/scottish-labour-endorses-smoking-ban.html

karagiannis_dim said...

Here's another intersting link to check how sinful is Big Pharma

http://www.techdirt.com/articles/20110310/13141713432/is-fda-helping-hindering-medical-innovation.shtml