HEALTH & SCIENCE

Old ties found between pharmaceutical, tobacco companies

Memos suggest drug firms "caved in" to tobacco money and pulled back on smoking cessation products.

By Susan J. Landers, AMNews staff. Sept. 9, 2002. Additional information

Washington -- A review of tobacco industry documents written in the 1980s and 1990s alleged that ties between that industry and pharmaceutical companies may have led to a scaling back of the marketing of such smoking cessation products as nicotine gum and patches,

"Financial ties between companies producing addictive tobacco products and companies producing drugs to treat or alleviate the addiction are a potential conflict of interest," wrote Bhavna Shamasunder and Lisa Bero, PhD, researchers at the Institute for Health Policy Studies at University of California, San Francisco.

Their findings, published in the Aug. 14 JAMA, did not astound Joel L. Nitzkin, MD, PhD, who chairs the Tobacco Control Task Force at the American Assn. of Public Health Physicians.

Dr. Nitzkin did express disappointment, however, in the pharmaceutical companies' response. "Had the pharmaceutical companies not caved in but taken a broader perspective on this issue, I think we could have used these nicotine replacement products much more liberally to help smokers to ease themselves in the direction of not smoking at all."

The researchers developed three case studies to illustrate the link between the pharmaceutical and tobacco industries. They drew from documents released by tobacco companies and posted on the Internet as a result of the Master Settlement Agreement reached in 1998 between major U.S. tobacco firms and most of the states.

One case study demonstrated how tobacco companies pressured drug companies to scale back the smoking cessation educational materials and resources that had accompanied the nicotine gum, Nicorette.

A second showed how they restricted to whom a drug firm could market its transdermal nicotine patch, and the third showed how subsidiary tobacco and drug companies collaborated in the production of a nicotine-release gum.

Stephen Hansen, MD, who coordinates the AMA's Tobacco Caucus, said he was not surprised by the collusion between the industries. "We've suspected that for years," he said. "But it's nice to have the 'smoking' documents."

Over the years, Dr. Hansen said, physicians had said they would help promote pharmaceutical products that were designed to help patients quit smoking and had asked for a little money to help "hit the tobacco companies hard."

"But the pharmaceutical companies didn't want to be a part of the vilification of the tobacco companies. Now we know why."

Dr. Hansen said he had found it useful, when counseling patients to quit smoking, to tell them about the "false research, lying, cheating, conspiring and covering up," in which tobacco companies engaged.

That information helped to counteract tobacco companies' claims that smoking was a personal choice. Smokers were all too willing to buy into the "it's all my fault" mind-set and then become depressed and believe nothing could help them quit, he said.

While there is certainly an element of personal responsibility involved in choosing to smoke, Dr. Hansen said, "if only they had understood how they had been manipulated and used all these years."

Focus on the enemy

The Pharmaceutical Research and Manufacturers of America, the trade group that represents many of the drug manufacturers, took strong exception to the researchers' findings.

Pharmaceutical companies successfully fended off efforts by tobacco companies to pressure them to back away from smoking cessation products, said John T. Kelly, MD, PhD, a senior vice president at PhRMA. And they have continued to develop and market aggressive smoking cessation products, he said, noting that the researchers based their conclusions on tobacco company memos that date back a decade or more.

"Pharmaceutical companies have developed five major types of smoking cessation products and 23 different smoking cessation products since 1984," Dr. Kelly said.

Michael Fiore, MD, professor of medicine and director of the University of Wisconsin's Center for Tobacco Research and Intervention, said he preferred to acknowledge more recent work by the pharmaceutical companies that demonstrates that the industry has been a good partner in the fight against the tobacco companies.

Not having personal knowledge of the drug companies' behavior much before the early to mid-1990s, he said, he would rather keep the blame firmly fixed on tobacco companies for the fact that 23% of adult Americans are smokers.

"I don't view anybody as equal to the tobacco industry in terms of the harm they impose upon residents of the United States and of the world," he said.

"What I think is more relevant is ... recognizing tobacco dependence as a chronic disease, developing counseling and medication strategies to treat it and getting those medications and counseling strategies into the hands of clinicians and smokers.

"The pharmaceutical industry, in contrast to the tobacco industry, has been working in concert to achieve that important public health goal in the time I have been involved in treating tobacco dependence," he added.

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Article, "Financial Ties and Conflicts of Interest Between Pharmaceutical and Tobacco Companies," JAMA, Aug. 14 (volume 288, issue 6) (http://jama.ama-assn.org/issues/v288n6/rfull/jsc20058.html)

AMA SmokeLess States, National Tobacco Policy Initiative (http://www.ama-assn.org/go/smokelessstates)

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Copyright 2002 American Medical Association. All rights reserved.