Vested interests

Dr. Theodore Dalrymple has written a typically incisive article about the Dutch government's decision to reduce the amount of taxpayers' money spent on anti-smoking groups. You might recall the squeals of discontent from various tobacco control employees in a recent letter to the Lancet. That the authors of that letter depend on draconian anti-smoking policies for their livelihoods has not gone unnoticed by Dalrymple.

It seems to be beyond the imagination of anti-smoking campaigners that someone might support the right to smoke on grounds of principle and not of narrow personal interest. The item, brief as it is, gives a flavor of the often bile-filled writing of anti-smoking campaigners:

It would be a matter of no little shame to a country that prides itself on a compassionate and inclusive ethos if its government were to abandon smokers to their fate. Every death that ensued would not just be the responsibility of the tobacco industry, which continues to promote its lethal product, but also of every politician in the Dutch Government who chose to look the other way and allow it to happen.

What of the responsibility of the smokers themselves?

Of this, not a word: they are putty in the hands of the tobacco companies and their government, scarcely human in fact. Apparently, Dutch smokers would stop if they knew about the effects of secondhand smoke, which are harmful additionally to first-hand smoke. A strange psychology indeed!

What if someone wrote a theoretical defense of the right to smoke, but put at the end that he had received money from the tobacco companies and indeed was employed by them? A cry of “vested interest!” would deafen.

Do go read the rest.

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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.)

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*Splutter*

[Warning: if you're drinking a cup of coffee, finish it before you read this. You may splurt it all over your keyboard]

From the New York Times:

“At one level, it’s true the pharmaceutical companies are competing with the tobacco companies. But this is not Coke versus Pepsi,” Professor Glantz said. “The tobacco companies are promoting products that kill half a million people a year. The pharmaceutical companies are trying to promote health.”

Professor Glantz added: “Those are two of the world’s experts, and we need to have people in there who are not going to get snookered by the industry, falling for a bunch of phony pseudoscience."

Stanton Glantz said that. 

Yes, that Stanton Glantz.

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Does advertising nicotine patches increase the smoking rate?

I'm currently reading The Logic of Life by Tim Harford. He mentions something about the advertising of nicotine replacement therapy (NRT) which I found interesting (p. 59).

Economists have also found that advertising for nicotine patches and gum seems to encourage non-smoking teenagers to smoke. That's easy to explain if teenagers are rational: the advertisements tell them that there are new ways to help them quit, so rationally it is less risky to start the habit.

It does make sense. If people are told there is an easy way to quit, they will be less tentative about starting. The study he refers to is this:

The Effect of Nicotine Replacement Therapy Advertising on Youth Smoking

The results indicate that NRT advertising has no effect on participation but increases smoking by youth who do smoke. The elasticity of smoking with respect to NRT advertising is about .10 and the elasticity of smoking with respect to price is about -1.03. Since average youth smoking is about 5.77 cigarettes per day, an increase of 10 percent in NRT advertising would increase this average to about 5.82 cigarettes per day. It is also estimated that a ban on NRT advertising would be equivalent to a 10 percent increase in cigarette prices.

You will notice that this study doesn't quite confirm what Harford is saying. NRT advertising makes smokers smoke more but "has no effect on participation" ie. it doesn't get non-smokers to start. 

This proposition was tentatively confirmed in an earlier study, which concluded:

...those exposed to NRT ads reported stronger perceptions about the ease of quitting, but non-susceptible non-smokers primarily drove this difference. This study suggests that exposure to NRT and Zyban® advertising in an experimental context does not reliably influence youth smoking-related beliefs, especially those vulnerable to becoming regular smokers.

But if NRT ads make people thing it is easy to quit, why wouldn't this perception affect those who are "vulnerable to becoming regular smokers"? You would expect them to be the most affected. How do we even work out who is "vulnerable" and who is "non-susceptible" any way?

The picture is clouded further by the fact that Melanie Wakefield was involved with both of these studies. Wakefield is Deputy Editor of the journal Tobacco Control, which has always been well-disposed to pharmaceutical nicotine. Indeed, one of her other studies on NRT was sponsored by GlaxoSmithKline.

The question of whether NRT advertising increases the smoking rate is, therefore, intriguing but unresolved. I dare say it will remain unresolved for as long as the pharmaceutical industry funds anti-smoking groups, conferences and research. At a time when ASH are calling for a 5% increase in cigarette taxes, it is interesting that research indicates that a ban on NRT ads would have the same effect as a 10% increase in cigarette taxes. But don't expect to hear pharmaceutically funded pressure groups like ASH calling for that any time soon.

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ASH Wales: still in the pay of Big Pharma

ASH Wales' financial accounts have finally come online. I have written previously about how the charity failed to send the Charity Commission the breakdown of where it's money was coming from. 

As expected, it transpires that—after the Welsh government—Pfizer is its biggest sponsor. Pfizer does, of course, sell the stop-smoking drugs Nicorette and Chantix/Champix. In addition, ASH Wales' Tobacco Control Conference will be sponsored by Pfizer, McNeil, Novartis and GlaxoSmithKline, all of whom manufacture or market nicotine drugs.

ASH Wales 2008/09 accounts run as follows:

Welsh Assembly Government: £115,800

Pfizer Foundation: £45,168

British Heart Foundation: £24,666

Donations: £2,697

Other: £351

Total: £188,682

Take note of the amount of voluntary donations: just £2,697. Less than 2% of this charity's income comes from the public. Meanwhile, Old Holborn has just announced that the blog-reading public has raised over £9,000 to free the Nick Hogan. Hogan should be released within hours, an extraordinary achievement all done in under a week with virtually no mainstream publicity. Perhaps the MSM will pick up on this story now?

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Where are ASH's accounts?

Strange goings on at the Charity Commission, who have just published ASH (England)'s financial accounts. Or so it seems at first glance. In fact, they've published ASH Wales' accounts, stamped ASH (England)'s charity number on them and filed them under 'Action on Smoking and Health: Charity number 262667).' 

This looks to be a cock-up by the Commission, rather than funny business on the part of the anti-tobacco industry. More puzzling are the ASH Wales accounts themselves, which are missing pages 9 to 14. As it says on page 8: "The notes on 9 to 14 form an integral part of these financial statements." They certainly do. They show where the money came from. What's happened to them?

Another cock-up, perhaps. I've contacted the Commission about this and should have some news in the near future. In the meantime, how much money ASH and ASH Wales received from the makers of Nicorette and Chantix last year remains a mystery. Our only clue is a 'key achievement' listed in ASH Wales' accounts:

2. Successful funding bid to the Pfizer Foundation for the delivery of youth worker training.

ASH Wales' links with Big Pharma are no secret. They acknowledged the "financial and/or kind support of" Pfizer, Novartis, McNeil and GlaxoSmithKline in their annual report. The question is whether their English big sister is taking the filthy lucre. We should have the answer any day now.

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