New catalog of financial conflict of interest re anti-e-cig activism

For anyone who is not aware of pharmaceutical industry funding of the leading anti-THR activists, E Cigarette Direct recently produced this list. Anyone who understand the concept and implications of conflict of interest (i.e., does not just use accusations of COI when they lack the expertise to make substantive criticisms of an analysis they want to denigrate) will realize that any issue with worldly implications will unavoidably generate COI on all sides. It cannot be avoided so needs to be appropriately dealt with. In the case at hand, the obvious minimum step is for entities with ties to the pharmaceutical industry to disclose them and (until the public understands this) point out that pharma loses business when smokers adopt THR.

There is nothing inherently bad (or inherently good) about pharma giving grants. Some naive commentators argue that pharma grants must be better than other grants because those companies create good things. But, of course, the companies do many things. They (a) invent lifesaving drugs for serious diseases, which make huge net social contributions; (b) convince people that they should start treating some condition with drugs though it has been done not before, creating their own demand rather than meeting pent-up demand – i.e., they are akin to the fashion industry; and (c) create and heavily market drugs that are needlessly expensive or harmful, creating a profit but a net social loss – i.e., they are akin to the modern finance industry.

In other words, they are companies. If we substitute (a) creating hybrid and electric cars, (b) hyping minor design tweaks, and (c) pushing the sale of gas-guzzling trucks for commuters, then we have described the automobile industry. Indeed, if we substitute (a) developing and marketing smokeless products, (b) trying to entice brand switching, and (c) making cigarettes available to each new cohort, then we have described most of the major tobacco companies.

Lacking both saints and unrepentant demons in the world that controls the money that the rest of us need to do our work (I trust everyone understands that governments and foundations are as imperfect as corporations), it is up to researchers and advocates to be transparent about our relationships and to try to minimize their influences when we do science or engage in education/advocacy in the public interest. The lack of transparency is where ASH, ACS, and others clearly cross the line into unethical behavior – there is no excuse for them hiding relevant funding information from the public and journal readers. However, there is a good argument to be made that these organizations already have extremist positions that happen to coincide with the goals of pharma (and thus their politics could not be influenced by the funding). In particular, anyone whose worldly goal is the extreme position, elimination of all self-administered nicotine regardless of its costs and benefits, already have the incentive to discourage THR because they know they will fail in their goal if people learn that there are satisfying low-risk alternatives to smoking.

Thus the strongest COI is this goal, which therefore should be disclosed. Once that is done, knowing the goals of the funder offers no additional information – we know that the authors already supported that goal, so how could they be influenced by funding to support that goal? In keeping with this, my colleagues and I recognize that our concern about people’s freedom and welfare means that we want to encourage THR and resist the “quit or die” orthodoxy, and we try to disclose this information whenever it might not be obvious – i.e., when writing something that might tend to encourage THR, but is not a clear statement about why we support THR. I am not aware of any examples of the abstinence-only advocates meeting this ethical standard of disclosure. An interesting question is whether they know they are hiding something that they should be disclosing or are they simply so immersed in their insular political culture that they have convinced themselves that they have no COI, nor even any ethical duties.

–Carl V Phillips

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