An increasing awareness of the harms of tobacco smoking has coincided with the growth of a new industry – smoking cessation campaigns – worldwide. With a high proportion of the world’s tobacco smokers, the Asia Pacific region is not an exception. A question of ethics now arises with regards to smoking cessation campaigns, which are being increasingly funded by pharmaceutical companies, in particular those with interests in nicotine replacement therapies (NRTs).
A key challenge faced by anti-smoking bodies is that there is a lack of funds for their campaigns. “There is still a lack of awareness of the risk factors associated with tobacco smoking, and smoking in general is often viewed as an issue of personal behavior, which is inaccurate,” said Dr. Carolyn Dresler, associate director for Medical and Health Sciences in the Office of Science at the US FDA Center for Tobacco Products Office. “It’s not just a behavioral problem we’re dealing with; it’s a chemical addiction – nicotine addiction – which is a serious disease.
“With regards to the relationship between the pharmaceutical industry and smoking cessation, to me it depends a little on the duplicity of the industries involved,” said Dresler. “In my opinion, the tobacco industry are convicted liars, but we cannot ignore that the pharmaceutical industry has had similar issues. However, the mission of pharmaceutical companies is ostensibly for good, whereas the product produced by the tobacco industry, when used as indicated, kills.”
Dresler noted that she was a former medical director of research and development for NRT products at a leading pharmaceutical company.
Market forces at play
“It is true that both smoking as well as smoking cessation are driven by market forces,” said Dresler, highlighting a recent case in which a US District Court in Washington D.C., ruled against the US FDA in favor of cigarette makers Lorillard Inc and Reynolds American Inc, who had sued the FDA in 2011, alleging conflicts of interest and bias by several members of the panel tasked with advising the FDA on tobacco-related issues. Their lawsuit specifically alleged that some committee members had conflicts of interest as they were paid expert witnesses, and possessed financial ties to pharmaceutical companies that manufactured smoking-cessation products.
In his ruling, which took place in July 2014, US District Judge Richard Leon said the FDA had erred in determining that the members did not have conflicts of interest and therefore, the agency’s appointment of those members was “arbitrary and capricious,” and tainted both the panel and its work. The FDA was ordered to reconstitute the tobacco panel and the use of its 2011 report on menthol cigarettes has been barred. [Available athttps://ecf.dcd.uscourts.gov/cgi-bin/show_public_doc?2011cv0440-82. Accessed on 13 November 2014]
“It is difficult to separate conflict of interests and biases from something like smoking cessation, especially when there’s funding involved,” Dresler admitted. “This is because, as I mentioned, there is already very little funding being allocated for smoking cessation campaigns,” said Dresler. “When you put it up against something as large as the tobacco industry, with their large resources, and their ability to influence government and political decisions, it’s an uphill battle.”
Is there an ideal source of funding?
“If you have sources of funding from non-pharmaceutical organizations, such as non-governmental organizations or the health ministry, that would be best,” said Associate Professor Dr. Mohamad Haniki Nik Mohamed, Deputy Dean at Kulliyyah of Pharmacy at the International Islamic University Malaysia. “However, given the limitations, sometimes we do have to consider accepting funding from pharmaceutical companies to facilitate certain events. In such cases, the funding company should not become involved in the planning of the advocacy program – it should be completely independent.”
The worst thing to do, he stressed, would be to accept funding from the tobacco industry, for whatever purpose. Dr. Zarihah Zain of the Disease Control Disease, Ministry of Health Malaysia, agrees. “According to Article 5.3 of the Framework Convention on Tobacco Control (FCTC), parties to the Convention should not partner with tobacco corporations to promote public health, nor accept the tobacco industry’s so-called corporate social responsibility schemes, which are really just marketing by another name,” she said.
The Article 5.3 Guidelines also outlined transparency measures including, “Disclosure of current or previous work with tobacco industry by applicants for government positions related to health policy, and of plans to work for tobacco industry by former public health officials.” Also, “disclosure of tobacco industry activities, including: production, manufacture, market share, revenues, marketing, expenditures, philanthropy – with penalties for providing false or misleading information.