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.)