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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Nicotine wars: Latest

There can now be little doubt that the EU's ban on snus is being maintained at the behest of the pharmaceutical industry. It is not about health. It is not about science. As the Swedish press recently reported, the battle lines are drawn:

In the battle over snus the world's largest pharmaceutical company is in one corner of the ring and the world's largest tobacco company in the other. The battle is about the hundreds of millions of smokers who are trying to quit. Big time lobbying is clearly visible in the EU snus debate. The tobacco industry was most successful in mobilising support for petitions via YouTube and the Internet, while the pharmaceutical industry has achieved success by more selective actions.

“There is clear competition between us and the pharmaceutical industry,” says Swedish Match's Public Affairs Director Patrick Hildingsson. “In the EU there are 107 million smoking consumers both our industries want to reach. The pharmaceutical industry does not want see the success snus has had in helping people stop smoking to spread outside Sweden.”

But Pfizer's Medical Director John Brun does not see snus as competition: “Absolutely not. Tobacco is a major health risk regardless of how it is consumed, which is why we have committed ourselves to reaching out from a health perspective in public debate.”

Pfizer—maker of Nicorette and Champix—does not see snus as competition?! How strange that they should waste so much their time and money lobbying for it to remain illegal (almost as strange as them funding studies into the economic impact of smoking bans). You'd think they'd have better things to do that worry about a niche smokeless tobacco product, unless of course they're worried that it's a more effective smoking cessation aid than their own products.

Instead, they're keen to rush the European Commission into producing its new Tobacco Product Directive, which will address the question of whether the snus ban is justifiable. The following is a letter Pfizer put its name to (along with Anna Gilmore, Luke Clancy and other useful idiots):

Dear President Barroso,

We are writing to you as a group of NGOs, charities, researchers, industry representatives and MEPs representing a majority of Member States and every major major political group, to urge you to bring forward the proposal for a revision of the Tobacco Products Directive at the beginning of 2012, as promised.

... As a signatory of the Framework Convention on Tobacco Control the European Union has a responsibility to implement measures which reduce tobacco use across Europe, and the revision of the Tobacco Products Directive is central to that. As this report will be so important, and undoubtedly controversial, the Council and Parliament will need time to thoroughly scrutinise and negotiate an effective revision. If we do not begin work at the beginning of 2012 we could be in real danger of having to restart the whole process after the 2014 elections. Given our commitment to the Framework Convention on Tobacco Control this is simply not an option.

We are of the view that further delays are not acceptable, and would appreciate if the Commission could inform us of a definitive timetable for the revision of the Tobacco Directive.

The only problem is that the EU's public consultation didn't exactly go Big Pharma's way...

Of the citizens who submitted their opinions, more than eight out of ten, 84 percent, support lifting the export ban on snus. 86 percent of government representatives and 74 percent of industry representatives wish to lift the ban. Only among lobbyists and NGOs is there a slim majority, 56 percent, who want to keep the ban on snus.

The consultation was a disaster for Pfizer because the anti-tobacco extremists neglected to get their NGOs and fake charities to respond en masse. Worse still, tobacco retailers in two countries organised petitions which generated 82,000 responses.

Mind you, those 82,000 people were probably tobacco users so the EU won't be counting them...

The EU Commission, however, dismisses a significant portion of the responses from the 82,000 citizens on the grounds that two-thirds are from Italy and Poland, where tobacco merchants organised petitions.

Some people say the EU is anti-democratic, y'know.

But even if we exclude these two countries, the majority is still for lifting the export ban on snus, 10-6, when respondents are broken down by country.

Bit of a bugger. What if we exclude the public altogether?

DN's review of the 400 responses in this group shows that even among the responses from parliamentarians, municipalities, government agencies and ministries a large majority, 71 percent, support lifting the export ban. 

Ouch! Surely there must be some way to fiddle the figures?

Even when only EU governments and ministries are included, there is still no majority against snus, but rather 3-3.

Damn it! How is the EU supposed to justify its arbitrary, scientifically indefensible prohibition when even politicians won't lend their support?

Oh well, there's only one thing for it...

The European Commission's health directorate claims to have received responses from governments who in other ways support the ban on snus, but refuses to show them.

Bingo!

"You know that public consultation that went against us? You won't believe this, but I've just found a bunch of responses down the back of the sofa. Thousands of them, and all of them support the ban! 


Sorry, you want to what? Oh, you want to see them? Er, yes...erm...ah... Good Lord is that the time? I really must be going..."

Some people say the EU is corrupt as well, y'know.

However, there may yet be a glimmer of hope...

The European Commission has promised Sweden it will take another look at its ban of the tobacco product snus, which is allowed in Sweden but banned elsewhere in the European Union, the Swedish trade minister said on Wednesday.

Trade minister Ewa Bjorling said she had met EU Health Commissioner John Dalli and discussed the results of a survey of EU states about current tobacco laws.

“What I believe is most important is that you base your reasoning on scientific facts. That is what I try to tell Dalli, and I ask the question: Why do you still want to have a ban on Swedish wet snuff when there are other snuff products on the market in the EU, for example Pakistani snuff?,” Bjorling told Reuters.

This was the second time she raised the snus issue with Dalli.

“I think he was listening in a different way this time. The first time he dismissed it simply saying their goal is to get everything away for health reasons,” Bjorling said.

I suppose not dismissing the idea out of hand is some sort of step forward. Interesting to note that the real goal is total prohibition of all tobacco products, but I think we'd worked that out already.

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Snus and e-cigarettes work

Two studies have recently been published testing the efficacy of snus and e-cigarettes in smoking cessation.

In the Harm Reduction Journal, Joksic et al. report their results from a randomised, placebo-controlled, double-blind trial in which 158 smokers were given snus and 161 smokers were given a placebo. Smoking status was verified throughout with carbon monoxide tests and 81% of participants enrolled because they wanted to quit smoking.

The results show that the snus-users were three times more likely to reduce their cigarette consumption by more than 75% and were two to three times more likely to quit smoking entirely.

An interesting feature of the study is that it was conducted in Serbia, which has no history of snus use. It is sometimes said that snus is a quintessentially Swedish habit that could never take off in the rest of the world. This seems to me a rather odd and slightly xenophobic view (see Alan Blum's quote in The Art of Suppression!) but this success in Eastern Europe shows that the 'Swedish experience' can indeed be exported.

The e-cigarette trial had a smaller sample (of 40) and no control, but if its results are replicated elsewhere, things look very encouraging. At the end of the six months, 22.5% of participants had given up smoking entirely. Amongst all participants, average cigarette consumption fell from 25 a day to 5 a day. As Michael Siegel says, this compares very favourably with pharmaceutical nicotine products. The special point of interest in this study is that none of the participants expressed any particular desire to quit smoking at the outset.

You might think the anti-smoking movement would be jumping for joy at the prospect of having two effective smoking-cessation products to offer the public. As I write this, ASH Wales is holding a conference in Cardiff (with the temperance lobby, natch). It would be nice to think that they are celebrating the news that there are efficacious nicotine products to compete with Big Pharma's 'nicotine replacement therapies', but somehow I don't think they will be.

I wonder why?

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Does Champix cause heart attacks? Hmm, maybe.

The news that Champix/Chantix has been linked to heart disease has been widely reported in the last day or two, after a meta-analysis found that those who use the controversial stop-smoking drug had a 72% increased risk of adverse cardiovascular events.

The lead author, Sonal Singh, has been getting rather excited about the results.

"This is just like driving a car without brakes,” he said. “Going forward, I don’t know how we will convince our patients to take Champix for what, to increase your risk for heart attack?... People should be concerned. They don’t need Chantix to quit and this is another reason to avoid Chantix all together."

The days of the sober, disinterested academic may be over, but it would nice if researchers could release their results without sounding quite so much like campaigners. Especially when your results really aren't that impressive.

The meta-analysis took 14 studies and found a relative risk of 1.72. That sounds OK until you look at the results of the studies themselves (click to enlarge).

Of the 14 results, only one of them is statistically significant (just) and the rest of them are miles away from achieving significance. This is because the number of people suffering heart attacks is tiny—about one in a thousand overall. In only one of the studies was there more than seven cardiovascular events between the Champix users and the placebo group combined. In six of the studies, there was only one heart attack in the entire cohort. When all studies are combined you still only have 79 heart attacks from over 8,000 people (and 45 of these come from just one study, which clearly used a very different methodology). This, at the very least, indicates that if there is a risk here—and there may be—it is very small in absolute terms. It is simply impossible to take these studies as proof of anything.

This is not the (original) researchers' fault. The studies are too small for enough cases to emerge. If and when larger studies are conducted, it may become apparent that there is a real risk. The fact that 11 of the 14 studies show an increase in risk—albeit a very flimsy one—is suggestive of an effect, but I would put it no more strongly than that. Comparing it to driving a car without brakes is ludicrous and suggests a certain crusading zeal from the study's authors that may have biased their approach.

This is the problem with meta-analysing statistically nonsignificant relative risks. It's a fallacy to think that by combining different studies with different flaws and biases you are creating one good, robust study. You're not. If the original studies don't tell you anything, combining them usually doesn't make them any more informative. Meta-analyses are pretty good at estimating an accurate relative risk when there is strong evidence that a risk exists. When the risk is far from proven—and most of these studies aren't even suggestive—they generate more heat than light.

I realise that this view is far from universal in the debased world of modern epidemiology (not least by those who gather together a similar grab-bag of weak and conflicting secondhand smoke studies to 'prove' various outcomes), but achieving statistical significance by combining a bunch of near-useless studies is, in my view, tantamount to cheating. It is the equivalent of multiplying zero by ten and coming up with two. Consequently, the researchers have found a relative risk of 1.72 that is much higher or much lower than any of the risks found in the studies themselves. That should be a clue that something is wrong.

Lord knows, I hold no brief for the pharmaceutical industry and there are already good reasons not to take Champix without worrying about heart problems, but if the drug really does cause users to have heart attacks, this meta-analysis falls a long way short of proving it. It would be wrong and inconsistent to expect a lower burden of proof against Champix just because it is made by Big Pharma. This is one of those instances where more research really is needed.

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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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Give psychotic drug to the mentally ill, urges ASH

I returned from the International Harm Reduction Conference on Friday, a day late thanks to a cancelled flight. Carl Phillips—a more dedicated blogger than I—has written a series of posts about the conference at Ep-ology (eg. here, here and here) and I'll mention some themes in the next few posts.

As you may know, the harm reduction movement is focused on drug use, especially intravenous drug use, but is sympathetic to all forms of harm reduction. In the field of tobacco, that means snus, e-cigarettes, nicotine drugs and any other 99% less harmful nicotine delivery device.

Inevitably, there is a faction which tends towards Nuttism—defending illegal drugs as an means to condemn legal drugs (named after its greatest living exponent, David Nutt). Alarmingly, a representative of the WHO blamed drug use on smoking, using the post hoc ergo propter hoc logic that most people who take drugs have previously smoked cigarettes. Still more alarmingly, he suggested that it might be better to view smokers as criminals and drug users as victims.

Mercifully, he seemed to be in the minority. Most delegates work with—or are themselves—drug users and smokers, and they see neither as criminals nor addicts. Amongst harm reductionists, opinion varies from those who don't condone drug use but think it should be made as safe as possible, to those who think taking drugs is a human right. Certainly, there is an acceptance that people take drugs because (a) they like them and (b) they have psychological benefits.

If you suggested that people take drugs solely because of (a) peer-pressure and (b) addiction, they would laugh in your fatuous face. We tell school children that, of course, because if we told them the whole truth they would be more tempted to try drugs. And because they're children, it's okay to use a childish argument. But that's all it is—a simplistic half-truth to deter the kiddies from taking drugs. It has no place in the adult world. (I'm not saying that some drugs aren't addictive, BTW, but part of the addiction/habit comes from the enjoyment.)

When it comes to nicotine, however, simplistic half-truths persist even amongst many grown ups. And so when ASH Scotland asks why smoking prevalence is exceptionally high amongst people with mental disorders, they come up with every answer except the truth—ie. that nicotine helps alleviate the misery.

Most people start smoking in their mid to late teens before they realise how dangerous and addictive the stimulants in cigarettes are.

This is at least partly true. However, it doesn't explain why many people return to smoking years later, nor does it answer the question of why so many people with mental illness smoke, including 88% of schizophrenics.

Nicotine triggers the release of dopamine in the brain so smokers learn to associate cigarettes with pleasure and when they stop smoking they may experience withdrawal then associate relief with the next cigarette, and so begins the withdrawal/feedback loop.

Er, not really. Smokers don't learn to associate cigarettes with pleasure. Nicotine releases dopamine which provides pleasure. It's not a Pavlovian trick. It happens with each cigarette.

Some research appears to indicate that people with schizophrenia smoke as a kind of ‘self-medication’ to improve memory or reduce symptoms...

Here, the truth begins to sail into view...

...but the reasons for the higher rates of smoking amongst people with mental illness are complex and not yet clearly understood.

And sails away again, to be replaced with the standard line:

It should be remembered that people with mental illness are subject to the same peer pressure and inducements from the tobacco industry as the general population.

I'd love to know what inducements the tobacco industry have been using in Scotland in recent years (I guess it's those evil colours they use on the cigarette packs just above the massive health warning). But even if we accept this facile line of reasoning, it doesn't explain why people with mental illness smoke at three times the rate of the general population.

This being ASH, the purpose of the whole exercise is to call for total smoking bans in mental health units and to push pharmaceutical products. Not just any old pharmaceutical product either. They suggest...

Varenicline (trade name Champix)

You've got to be kidding. Champix (AKA Chantix), the drug that has been officially blamed for hundreds of deaths and many more psychotic episodes? From Michael Siegel's blog:

The FDA responded to the more than 100 reports of suicides, more than 400 reports of violence, and more than 11,000 other cases of severe side effects associated with Chantix by requiring Pfizer to place a "black box" warning label on the medication. The label warns physicians to monitor their patients for adverse psychiatric effects, such as severe depression, violent behavior, and suicidality.

According to the FDA:

Chantix has been linked to serious neuro-psychiatric problems including changes in behaviour, agitation, depressed moods, suicidal ideation and suicide. The drug can cause an existing psychiatric illness to worsen or an old psychiatric illness to recur and the symptoms can recur even after the drug is discontinued.

A recent study of 484 drugs found that Chantix made violent behaviour EIGHTEEN times more likely.

Varenicline has the largest number of reported violence cases, the highest proportion of violence cases (PRR = 18.0) ... of any of the 484 evaluable drugs.

Wow. That sounds like a great drug to be giving people who are already mentally ill and/or violent. Is there any limit to ASH's irresponsible stupidity?

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A dark day for satire

Do my eyes deceive me or is public health jumping the shark yet again?

This, from the Beeb:

'Give out statins with junk food'

Fast food outlets should consider handing out cholesterol-lowering drugs to combat the effects of fatty food, say UK researchers.

Taking a statin pill every day would offset the harm caused by a daily cheeseburger and milkshake, the Imperial College London team said.

It would only cost 5p a customer - similar to a sachet of ketchup.

Doesn't look good, does it? But before we over-react, we all know how the media can exaggerate research findings for dramatic effect. So let's have a look at what was written in the actual study...

Routine accessibility of statins in establishments providing unhealthy food might be a rational modern means to offset the cardiovascular risk. Fast food outlets already offer free condiments to supplement meals.

A free statin-containing accompaniment would offer cardiovascular benefits, opposite to the effects of equally available salt, sugar, and high-fat condiments.

Okay. Checked it, and that's what it says. WTF? Have these people have gone stark staring mad? Prescription drugs handed out in McDonalds to any random person that wanders in off the street?! Prescription drugs (made by GlaxoSmithKline) which have prescription-level side effects being equated with sachets of ketchup?! Hell, let's just pump the stuff into the water supply and be done with it.

It is now officially impossible—even in the depths of an absinthe-induced hallucination—to come up with a spoof that would out-parody the schemes of public health. These people are going to put The Onion and The Daily Mash out of business.


UPDATE: As if to prove my point, I see that my little joke about pumping statins into the water supply has indeed been seriously mooted, way back in 2004: Statin-fortified drinking water?

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Is the bank closing?

Apologies for the light blogging, dear reader. I'm very busy with other things, including a heated debate involving my latest book (see here, here, here and here for the tip of that iceberg).

I'll be back with more news and views from the dark side of prohibition at the weekend. Until then, I see that The New York Times is reporting that the Robert Wood Johnson Foundation (RWJF) is diverting its vast wealth away from tobacco control and towards obesity. (And yes, RWJF's primary funders Johnson & Johnson sell a number of weight-loss drugs, as well as making nicotine replacement drugs.)

Tobacco Funds Shrink as Obesity Fight Intensifies

When the Robert Wood Johnson Foundation decided in 1991 to take on Joe Camel, it became the nation’s largest private funding source for fighting smoking. The foundation spent $700 million to help knock the cartoon character out of advertisements, finance research and advocacy for higher cigarette taxes and smoke-free air laws and, ultimately, to aid in reducing the nation’s smoking rate almost by half.

But a few years ago, the Johnson foundation, based in Princeton, N.J., added another target to its mission, pledging to spend $500 million in five years to battle childhood obesity. As the antiobesity financing rose to $58 million last year, a new compilation from the foundation shows, the organization’s antismoking grants fell to $4 million.

And RWJF are not the only ones to be shifting focus.

The steep drop-off in private funds illustrates the competition under way for money as public health priorities shift. In the race for preventive health care dollars, from charities and from federal and state government sources, the tobacco warriors have become a big loser...

The 1998 Tobacco Master Settlement Agreement between 46 states and cigarette companies provided more than $200 billion through 2025. For a while it financed preventive programs like the “Truth” media campaign from the antismoking group American Legacy Foundation. But as states used money elsewhere, “Truth” spending declined, to a low of $35 million last year from $104 million in 2000.

Naturally, uber-zealot Stanton Glantz is not happy about being moved further down the trough.

Stanton A. Glantz, director of the Center for Tobacco Control Research and Education at the University of California, San Francisco, asked, “Given that tobacco kills four times as many people as obesity does, why is the government putting more money into obesity?”

From a European perspective, the funds allocated to tobacco control remain eye-wateringly huge. Whilst I would never condone the government giving money to lobby groups, the amounts received by ASH (England) and its wealthier little sister ASH (Scotland) are peanuts compared to the billions enjoyed by American groups. And yet the smoking rate in America is virtually identical to that of Britain. Does this mean that British anti-smoking groups are exceptionally effective or are American anti-smoking groups exceptionally useless? Or are they both simply irrelevant?

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Speak for yourself, National Obesity Forum

So the British government has decided to stop spending tens of millions of pounds of tax-payers' money on anti-obesity advertising campaigns and instead spend tens of millions of pounds of the food industry's money instead.

From The Guardian :

Beer companies, confectionary firms and crisp-makers will be asked to fund the government's advertising campaign to persuade people to switch to a healthier lifestyle and, in return, will not face new legislation outlawing excessively fatty, sugary and salty food, the health secretary, Andrew Lansley, announced today.

I do like the use of the word 'asked' there, like a bank robber 'asking' the cashier the open the safe.

I find it hard to care too much about this. We'll end up paying for it either way and an industry-funded campaign won't be any less effective than Labour's state-funded campaigns. If anything, the industry might end up being slightly less profligate with the money it is forced, I mean asked, to spend.

What did make me choke on my proverbial cornflakes, however, was this :

But Tam Fry, of the National Obesity Forum, said he was "horror-struck" about the thought of getting industry involved in funding Change4Life.

He said it was "nothing other than a bare-faced request to bail out a cash-starved Department of Health campaign".

"The quid pro quo is that the department gives industry an assurance that there will be no regulation or legislation over its activities."

I'm sorry, but isn't this the National Obesity Forum that is overwhelmingly funded by the pharmaceutical industry—specifically those pharmaceutical companies that make weight-loss drugs? The same National Obesity Forum that consistently defends its sponsors' weight-loss drugs long after everybody else has recognised their dangerous and highly unpleasant side-effects?

Weight-loss drugs like Alli (otherwise known as Orlistat), which has been found to have any number of nasty side-effects:

US authorities are investigating concerns an anti-obesity drug widely available over the counter at chemists may cause liver damage.

Orlistat went on sale under the brand name Alli without the need for a prescription in the UK in April.

The US Food and Drug Administration has received more than 30 reports linking the drug to serious liver injury.

This life-threatening side-effect goes alongside other known problems caused by the drug:

Diarrhoea and gas problems are to be expected if users persist in eating fat while taking the drug.

However, concerns have been raised over the medication's other possible side-effects. The FDA said the most commonly reported adverse reactions included the yellowing of skin or whites of the eyes, weakness and stomach pain.

Lovely stuff. Oh, and there's more...

It advised people who used orlistat [Alli] to seek medical advice if they experience possible symptoms of liver injury, in particular weakness or fatigue, fever, jaundice, or brown urine.

Other symptoms may include abdominal pain, nausea, vomiting, light-colored stools, itching, or loss of appetite.

Alli is made by GlaxoSmithKline, which is one of the National Obesity Forum's most generous donors/sponsors. So who has spent the last few years pushing for this dubious pharmaceutical remedy to be made available over the counter? Step forward the National Obesity Forum (NOF)...

NOF welcomes the decision to allow Orlistat, the weight-loss drug, to be sold over-the-counter and has been working closely with GlaxoSmithKline [GSK] to ensure that its introduction to the market in May runs as smoothly as possible. 

Or take Rimonabant, made by another of NOF's sponsors—Sanofi Aventis. Actually, don't take it. Just know that this drug was launched in 2006 and got a warm reception from—who else?—the NOF.

Dr David Haslam, clinical director of the National Obesity Forum, said the drug offered a real opportunity to get to grips with the obesity crisis.

"The launch of Rimonabant is important news for patients who are overweight, with type 2 diabetes, or low HDL cholesterol or high triglycerides."

But within a year, the Medicines and Healthcare Products Regulatory Agency had received 720 reports of unpleasant side-effects, including psychiatric discorders and suicidal thoughts.

Despite a growing body of evidence that Rimonabant was unsafe, it was approved for NHS use in June 2008, leading the BBC to report "Controversial diet drug approved":

An obesity drug has been approved for NHS use in England and Wales, despite links to an increased risk of depression and suicide.

Rimonabant is already used by thousands of Britons, and, coupled with exercise, could help patients lose up to 10% of their body weight.

Scotland and the US have not approved the drug amid safety concerns. However, an obesity specialist welcomed the National Institute for Health and Clinical Excellence (NICE) ruling.

This 'obesity specialist' was, of course, an NOF spokesman:

Dr David Haslam, the clinical director of the National Obesity Forum, said that he welcomed its approval for NHS use, and predicted that it would be prescribed to many patients.

He said: "We can be absolutely reassured that they have looked closely at the evidence and made an appropriate decision.

"This is a very good drug, and there are very many people who have tried everything else, including other drugs, with little success, who might benefit from it."

But within months of the NOF winning the campaign to have the drug approved, the European Medicines Agency said the risk of serious psychiatric problems and suicide were not worth the weight-loss benefits and recommended that use of the drug be suspended. By this stage even Sanofi-Aventis's own research had shown that use of Rimonabant doubled the risk of psychiatric disorders. The drug has never been approved by the FDA in America and it would go on to be banned in India. Still, the NOF defended it:

Dr Colin Waine, chairman of the National Obesity Forum, said: "My patients were doing very well on it, and they will now have to stop and come off it."

And then, as I mentioned earlier this year, there is Reductil, which was taken off the shelves after it was found to cause heart attacks. Reductil is made by Abbott Laboratories, who happened to pay for the National Obesity Forum's website, amongst other things. The ban was initiated by the European Medicines Agency and was supported by the UK Medicines and Healthcare Products Regulatory Agency. But, as usual, there was one dissenting voice:

David Haslam of the National Obesity Forum said he was surprised by the decision and knew of no study proving that Reductil had led to a death from a heart attack or stroke.

Now, as far as I'm concerned, the National Obesity Forum can go on shilling for Big Pharma all they like—they may even be right about some of these drugs—but it's a bit bloody rich for them to complain about industry being involved with the anti-obesity campaign and warning about conflicts of interests and qui pro quos. If I was Tam Fry's boss, I would strongly recommend he keeps his mouth shut and hopes no one asks too many questions about their own funding.

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