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.
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.
Armando Peruga, programme manager of WHO’s Tobacco Free Initiative, advised health professionals “to be independent and guided by scientific evidence.”
“We have to keep a distance from the tobacco industry, but we also have to maintain some distance from any other industry that can have a commercial interest in this issue,” he said.
“Today the tobacco industry is starting to joke that we have been sold to the pharmaceutical industry, something we must be aware of,” he added.
Asked by the BMJ, Dr Peruga explained that the limits to collaboration should be clear. “WHO is working with the pharmaceutical industry in the implementation of policies, but only public health agencies are responsible for policy design. The issue of drugs [for smoking cessation] is [just] one more element [of tobacco cessation strategies] and we have to put it in perspective,” said the WHO representative.
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.
Some health professionals have advised against increased medicalisation of smoking cessation attempts. Mi vida sin ti is an independent internet based organisation launched in January 2011, which involves several professionals who want to avoid the usual messages like “see your doctor to help you stop smoking.”
Rafael Cofiño, one of its members, explained to the BMJ: “We must insist on measures that affect the whole population. That is why we consider the new law [in Spain] as very positive.”
The role of smoking cessation drugs in reducing smoking has been fiercely debated over the past few years. Simon Chapman and Ross MacKenzie pointed out, in a review of medical literature published in Plos Medicine in 2010, that two thirds to three quarters of former smokers stop unaided, even though stopping has been increasingly medicalised, with “obvious benefit of pharmaceutical companies”
The authors say most papers on smoking cessation interventions are studies of assisted cessation, most of which are funded by drug companies that are manufacturing those treatments. The authors refer to this as “the inverse impact law of smoking cessation,” meaning that the volume of research on medicalised cessation is in inverse proportion to that examining how most smokers actually quit.
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.
Though Dr Córdoba agrees that in Spain, probably up to 90% of the people quit unaided, he considers that by financing treatments “more people will achieve it.”
By Aser García Rada