In April, four experts on smoking cessation published a paper in the Annals of Internal Medicine promoting an unconventional plan for helping hard-core nicotine addicts quit,BusinessWeek writes. And they proposed treating smokers as if they have a chronic disease, such as diabetes, instead of an addiction such as alcholism. Why? Insurance coverage for long-term med use.
Moreover, the authors, Michael Steinberg (pictured left) and Jonathan Foulds (pictured to the right), are paid for speaking and consulting by drugmakers with smoking-cessation products, such as Pfizer, the mag notes. And the paper appeared around the same time that Pfizer, at the urging of the FDA, added warnings to its Chantix label, fueling charges that paid experts are trying to protect a big-selling drug.
The researchers deny that. They say they follow only their independent judgment when recommending Chantix and other drugs, and emphasize they don't necessarily urge lifetime use of any drug. But they don't routinely reveal their Pfizer pay to hundreds of patients they've steered to Chantix, which has thrust them into the middle of a debate about proselytizing by medical researchers and how corporate relationships should be disclosed to patients, BusinessWeek writes.
"When (Chantix) goes wrong, it can go terribly wrong," Daniel Seidman, director of the smoking cessation clinic at Columbia University, tells the mag. "These guys may think (industry money) doesn't affect their opinions about the drug, but it does. When someone pays you, there's a bias."
Pfizer's Cathryn Clary, vp for external medical affairs, says she fears too much transparency will create confusion. "The more information that's out there, the more difficult it will be for patients to process," she says. Pfizer instructs the researchers it pays to disclose their compensation when speaking at professional conferences, and recently began disclosing grants for medical education on its Web site. [Our thought: Wait a minute. Withholding info is better? That's rather arrogant.]
The clinic at the University of Medicine & Dentistry of New Jersey run by Steinberg, an internist, and Foulds, a psychologist, is one of eight such centers in that state originally funded by the tobacco litigation settlements of the late 1990s. More than 500 smokers come through the clinic each year and it boasts a 30 percent success rate helping patients to quit for six months or more, the mag writes.
"The goal is to get more people not smoking," Steinberg tells the mag. "The medication is just a tool to increase their chances of being successful." And he's adamant that his work for Pfizer and other drug companies poses no problem: "We look at the data, and we look at our own clinical experience." Both of them stress that it's not standard practice to tell patients about potential conflicts.
Not that they make it easy to find out. The magazine tried and notes: There is no clearly labeled list of companies that pay Foulds and Steinberg that is directly accessible from the UMDNJ smoking clinic home page. There are links to journal articles, some of which reveal industry ties. But getting the info takes effort. The online version of the Annals article requires a viewer to have a paid subscription for full access. Their twice-a-year newsletter, The Nicotine Challenger, doesn't disclose their work for Pfizer, even in articles that speak highly of Chantix.
But back In 2006, Pfizer recruited Foulds to serve on its paid national advisory board for Chantix, and also selected Foulds and Steinberg to be "key opinion leaders," sending them to talk to docs about Chantix over dinners and paying them each $900 per presentation. Foulds and Steinberg say that between them they have made a total of about a dozen appearances.