On maternal smoking during pregnancy, from the Daily Mail and Pfizer

Rarely does one get to the nub of an issue so quickly. This research was reported in the Daily Mail under the heading 'Does smoking make you a bad parent?' two days ago, focussing on parenting behaviour. It was reported yesterday under the heading 'Mothers who smoke during pregnancy are more likely to have children with "bad behaviour or ADHD"', in the same paper, this time drawing a link between behaviour problems and maternal smoking. Both carry the paragraph:

The research was carried out by pharmaceutical company Pfizer as part of their Don't Go Cold Turkey Campaign and asked 6,271 smokers about how they funded smoking in tougher economic times.

In these tough economic times, indigent smokers are under scrutiny as a potential cash cow for Pfizer – which wants to sell a smoking cessation remedy. That is really all these appalling stories are about. Trying to persuade people not to give up smoking without help from pharmaceutical companies – it really is that cynical.

Time was when most parents in the UK smoked – the baby boom years of the fifties and sixties, before smoking was recognised as a major public health issue. There are still people around who remember those days. 

This study and associated surveys are in especially bad taste, as they seek to give the impression that only smoking parents ever deprive their children in order to fund treats for themselves. In the usual fashion of anti-smoking studies, the standards are rigorously unscientific, and no control is provided. (As for those stealing from their children's money boxes I suspect that many who admitted to doing this were in the grip of a stronger addiction than tobacco, but the survey wasn't about strong drugs.)

We should also not forget that behavioural problems have a huge number of factors to explain them –  an exponential increase in autistic spectrum disorders is just one of these. The most important factor is that they are a subjective issue – behaviour is a problem if it affects others and they perceive it to be a problem. Consider this paragraph, from the second report:

“Our findings suggest an association between pregnancy smoking and child conduct problems that is unlikely to be fully explained by postnatal environmental factors (i.e., parenting practices) even when the postnatal passive genotype-environment correlation has been removed.” The authors conclude, “The causal explanation for the association between smoking in pregnancy and offspring conduct problems is not known but may include genetic factors and other prenatal environmental hazards, including smoking itself.”

Trying to work out in such precise terms the factors for 'conduct problems' is a curious intellectual feat, precisely because conduct problems, like heart attacks and lung disease, are multi-factorial. The very word 'problem' has to be enormously problematic when making a scientific evaluation, because of its subjectivity. Behavioural problems might be any one of a number of issues of varying seriousness. They might exist only in the eyes of  monumentally selfish parents not prepared to give their children the time of day, or appear in an autistic child, without the power of speech, in physical pain and unable to explain his frustration – or a combination of anything in between.

That the study is clearly geared to promoting smoking cessation medications could not be clearer (as quoted above in the Daily Mail article: the press release also refers to 'funding disclosures' but I haven't been able to reach the study itself). It clearly fails to ask other pertinent questions, such as whether an austerity programme is really the best answer to our economic situation, with people experiencing unemployment and other cuts in the family budget. Or whether such high tobacco taxes can be avoided – because surely so much stress on families will make it harder for parents to make the decision to stop smoking until some of the chronic uncertainty in their lives is resolved.

But no, the pressure on smokers is set up specifically to the advantage of a pharmaceutical giant, and dressed up as public health in the interests of smokers and their children.

Novartis support for smoking bans spelled out

Hat tip to Dave Atherton for this link to Novartis's statement on public policy and advocacy.

Claiming an ethical basis for their activities they give the following on their involvement in smoking:

It is sometimes claimed that pharmaceutical companies exercise undue influence on governments and pursue commercial objectives without taking into consideration society's interests. We consider it our responsibility to provide decision-makers in government with the objective and fact-based information needed to formulate sound health policies. 

Our lobbying and advocacy efforts focus on increasing access to the best medicines and to health information globally, while preserving incentives for research and innovation through competitive pricing. In addition, we believe that it is in the interest of companies striving for a leadership role in corporate citizenship to campaign for policies and regulations which favor ethical business conduct. [emphasis added]

[...] 

An example of how Novartis is contributing proactively to the health policy and disease prevention debate in Europe is the question of smoking cessation. Tobacco is the single largest cause of avoidable death in the EU and over half a million people die each year in Europe as a direct or indirect result of smoking. It is estimated that 25% of all cancer deaths and 15% of all deaths in the EU could be attributed to smoking. 

Until recently, efforts by European regulators to reduce smoking were concentrated mainly on the introduction of 'smoke free' legislation which prohibits smoking in certain environments. Novartis believes that greater public health benefits could be achieved through a policy of smoking cessation, coupled with increased duty on tobacco. 

Novartis is campaigning to encourage policies to complement non-smoking environments with smoking cessation, with nicotine replacement therapy (NRT) as an important component of an EU strategy on tobacco control. 

Together with various NGOs, we helped to foster a 'Smoke Free Partnership.' Our aim is to foster a policy and legislative environment which leads to better public health through strong tobacco control measures and increased availability of NRT in line with the WHO Framework Convention on Tobacco Control.

It clearly acknowledges lobbying for conditions that favour its commercial objectives, namely NRT sales. Perhaps these well-meaning souls actually believe what they are saying, which is effectively that they are whiter than white, use only the best peer-reviewed evidence, care very much about citizens' health (and, of course only incidentally, can make a comfortable living into the bargain).

It is a favourite trick of the tobacco control industry to portray tobacco as 'big business' that is ruthlessly exploiting the little guy. But this company, and the entire pharmaceutical sector, is even bigger business. Somehow tobacco is unduly tarnished on the grounds that it is a big business, even though its rivals in the nicotine market are favoured and allowed to contribute to public policy. They have the ear of government, and can also engage in this kind of activity with the intelligentsia.

One result is that a whole lot of well meaning people with benevolent intentions can reduce people's capacity to make their own, usually faulty, choices about food, drink or smoking. The angle that is not acknowledged is the money that is made in the process. Not only does this benefit large corporations financially at the expense of smaller communities, but it also empowers them at the expense of these communities (probably on many issues beyond the lifestyle ones usually addressed here). Thanks to lobbying of this kind, we have the smoking ban and further restrictions, which have damaged pubs and recreational environments and will go on to damage shops. The whole fabric of economic society is at the mercy of those at the top.

I hesitate to call this kind of thing fascism (the collusion of corporations with the state?). But I still don't like it, because it looks to me as if the rightness of it is taken for granted by the whiter-than-white who engage in making decisions on behalf of everyone else, without apparently caring about the economic ramifications for the wider public – and failing to acknowledge their own dependence on the wider public for their survival.

Inappropriate influence at the Labour Conference?

The Telegraph reports that the Shadow Labour Secretary (and one of his team) took the huff because representatives of tobacco companies were invited to a business forum at the Labour Party Conference, and refused to turn up.

It's hard not to agree with the Labour Party leadership that the tobacco industry has received no favours from them. Politicians must take every precaution against being unduly influenced by corporations but the mere presence of industry representatives at conference events is no evidence of undue influence. The Shadow Health Secretary's gesture is petulant – it may reflect advice given in the Framework Convention on Tobacco Control by attempting to marginalise any tobacco industry presence in policy circles, but we should not attempt to exclude interested parties completely from the policy-making process.

It seems that another MP appeared to go on the run from a tobacco-sponsored fringe meeting at the Labour Party Conference but her non-appearance turned out to result from a misunderstanding about the arrangements. She did, however, express disquiet about the TMA sponsorship of the event, which came to her notice late.

Anyone would think that the tobacco companies were the only monstrous manifestations of capitalism that were accountable only to their shareholders and cared nothing for the welfare of consumers or the environment. It's actually refreshing to see the New Statesman's partnership with the TMA for this fringe meeting, since their relationship with Pfizer (clearly a rival to tobacco manufacturers in the market for nicotine) is entrenched.

But who's idea was the fringe meeting? I've no idea – but it does look like the Labour Party needs support to be renewed from all sectors. Perhaps it went begging?

Pharmaceutical sponsorship in smoking cessation: Toronto conference, November

Back in April, the World Health Organisation warned health professionals working in tobacco control not to become too involved with pharmaceutical companies. But the horse had already escaped. The creation of a global smoking cessation industry was already in its late stages, and continues to develop apace.

Michael Siegel blogs today on the 7th National Conference on Tobacco or Health being held in Toronto in June with Pfizer as a major sponsor. There is a significant conflict of interest (private v. public), since Pfizer manufactures Champix among other smoking cessation medications. Accepting sponsorship from Pfizer will compromise the integrity of the conference.

In March Siegel wrote a piece about ISPTID: the International Society for the Prevention of Tobacco Induced Diseases, in which he remarked that this society had renounced pharmaceutical funding and declared itself free of all industrial ties (before the advice from WHO had been published in the BMJ). He urges other organisations in this field to follow suit: but it will take a wholesale change for many years before I would have any confidence that the slate was clean of pharmaceutical influence. We know, in addition to the pharma-funded events that Siegel lists, that the major UK conference (UK National Smoking Cessation Conference) relies on pharmaceutical sponsorship.

Grants from the Robert Wood Johnson Foundation (a trust part-funded by profits from Johnson & Johnson) can be seen here. The list of grants (using 'tobacco' as a search term) contains some 1,650 entries with over $100,000 awarded for most of them.

It is probable that if all conference organisers wanted to find a willing source of funds for smoking cessation events and they were not permitted to take on pharmaceutical funding, they would find few people willing to come forward, and even fewer with a specific interest in coming forward, year after year in several different locations in any given period.

Champix off the approved list in France: risks outweigh benefits

They kept this one quiet. (Or have I been asleep for a week?) Hat tip Chris Holmes.

The pill, called Champix in Europe and Chantix in the U.S. but known generically as varenicline, has been tied to everything from violent rages to suicidal thoughts. Reported side effects of Chantix have led to hundreds of lawsuits nationwide, including one filed last month in Pennsylvania following a 2009 murder-suicide.

French health Minister Xavier Bertrand said Tuesday he decided to remove the drug from a list of approved treatments available for reimbursement through his country’s social security funds because of questions about its safety.

About bloody time. Well done the French Health Minister. Some recent history is also included in this report:

In another controversy surrounding the drug, the U.S. Food and Drug Administration announced late last week that Pfizer had been asked last year to resubmit thousands of reports on adverse events related to Chantix, a request that came after it was revealed the company had not sent the information through proper channels.

The adverse-event information had been sent as a periodic safety summary rather than as a report required within 15 days for unexpected or fatal events, the FDA said.

I could comment but time is short today. Chris has already said what had to be said (comment 5):

Medical authorities the world over CLAIM to have the best interests of patients at heart. They CLAIM to be approaching these problems logically and scientifically.

Therefore it should be standard practice everywhere to try all safe methods FIRST, and only proceed to methods that involve any risk at all if none of the safe methods work. It is an absolute no-brainer. Hypnotherapy, acupuncture and the Allen Carr approach (which is a mild form of hypnotherapy anyway) have all proven themselves to be more effective in the long term than any of the meds, and they all involve NO RISK.

Why are they not being used as a priority to avoid damage to patients? Because of the massive lobbying power of global drug giants and their immoral influence over politicians and medical authorities.

It’s corruption, and it is killing people. Think I’m exaggerating, calling this sort of thing corruption? Check this out: GlaxoSmithKline have just revealed how much cash they lavished on Australian doctors and other medical personnel last year alone: over two million dollars, of which $371,659 was just to go on merry junkets to conferences abroad. In the age of the internet, none of this is necessary but it certainly makes people feel important, doesn’t it? Would YOU like an all-expenses paid trip to Vienna? But that’s nothing: in the same period GSK spent a staggering $96,000,000 on doctors in the USA (link here). Why? Because money talks.

But so do smokers! Spread the word, don’t risk the slimy meds. Even Pfizer can’t force their drugs down your throat. Doctors, I keep telling you: you’ll miss your credibility when it’s finally gone forever. You are signing it away with your own prescriptions pads with dodgy drugs like Champix, every working day of your lives.

BUT HOORAY FOR THE FRENCH HEALTH MINISTER! Monsieur Xavier Bertrand, I salute you! Bravo!

He's right. Champix is a drug that is being used to treat something that is far from being universally recognised as a sickness: the desire to give up smoking. And it's not only not the safest option, it's got a known track record (and I don't mean in getting people off tobacco). So let's stop spending our 'health' money on it.

Calls for e-cigarettes to be banned while Champix remains on sale

Michael Siegel asks quite fairly why Champix, known to have links with psychotic, suicidal episodes and worse, is freely available, when certain anti-smoking groups have called for the banning of e-cigarettes, which have no documented safety record or pending lawsuits on behalf of users.

He shows links between the US anti-smoker groups and pharmaceutical giants including Pfizer, which manufactures Champix. He also addresses the ideology of anti-smokers (popularly tagged 'quit or die'). Your quitting aid mustn't even look like a cigarette or it doesn't count:

The ideology is simply this: nothing that looks like cigarette smoking can possibly be a good thing, even if it saves lives. People need to quit smoking the way we say they should quit smoking. There is a right way and a wrong way to quit smoking. The right way is our way and the wrong way is any other way. If it looks like smoking, it's still smoking, even if there are no adverse health effects and the individual has achieved smoking cessation. 

 His logic is persuasive:

If anti-smoking groups want to argue that any smoking cessation product on the market has to first be unequivocally proven safe, then fine. They can argue that e-cigarettes should be removed from the market but they must also call for Chantix to be pulled from the market for the same reason.

Alternatively, if they believe that the burden of proof is on others to demonstrate that Chantix is unsafe before pulling it from the market, then that's fine too. But then they must apply the same reasoning to electronic cigarettes and ask that these products remain on the market until such time as they are demonstrated to be unreasonably unsafe.

More on Champix here.

Introducing the NHS Centre for Smoking Cessation and Training. Your smoking cessation career starts here!

It's almost Pythonesque, the numbers of people who are being trained specifically to stop others from smoking with (or without) the use of drugs.

As mentioned at the beginning of the year the UK National Smoking Cessation Conference takes place in June, this year in London. I described in then as a trade conference, but it is even more serious than that. It's a training agency, aiming to train and give certification to people who want to develop competence in their role of smoking cessation advisers/practitioners.

Behind the UKNSCC however looms another organisation, National Centre for Smoking Cessation Training (NCSCT), created from a winning bid by a consortium led by University College London to provide an accreditation system for smoking cessation advisers. (Is this what Tony Blair meant all those years ago by 'Education, Education, Education'?)

The organisation does have an 'ethical policy', which shows its main players have 'interests which might have a bearing on the independence of their judgement in relation to their work for the NCSCT': namely that they have received hospitality from Pfizer (manufacturer of Champix), or the Department of Health.

Here is their quarterly report for April to June 2010, which includes the news that 'On the 27th May 2010 the NCSCT was officially informed that it is now an ISO 9001 certified organisation (certificate number: FS 559421)'. Well, that's also reassuring. As is the long list of links.

Transatlantic allies offer full accreditation for smoking cessation-related activities across the pond (supported by Pfizer). Isn't it nice that we'll soon have as many words for smoking cessation as the eskimos have for snow?

Book here for the conference in London. You'll probably get a refund from your employer, and maybe something for accommodation (it's only London after all!)

Contracts in Smoking Cessation and the Tobacco Display Ban: good money after bad?

An international public relations firm, Weber Shandwick, has won a double contract with the Scottish Government. In case you thought enough money had been spent on smoking cessation, this company, with offices in 77 countries, will 'signpost and motivate adult smokers wishing to quit to contact Smokeline'. An absolutely indispensable frontline service, wouldn't you agree?

The credentials of Weber Shandwick to do this kind of work are clear – they've been doing it for years. For example, two years ago they discovered that 9 out of 10 New Year's quitters in Australia were back on the fags by June, in a report for Pfizer.

The other contract is to educate the public about the tobacco display ban (Tobacco and Primary Medical Services Act), which was voted into law in January and will be enacted in October 2011. This Act is currently the subject of court action after a legal challenge from Imperial Tobacco: a verdict is awaited.

Employing PR companies seems an expensive way to convince the public to do something it doesn't want to do, or to sell unpopular government policy to the public. I look forward to Weber Shandwick winning a contract to sell a comprehensive hospital smoking ban package. I wonder how the people in the relevant Scottish Government departments feel about having their work of explaining policies and making them more publicly acceptable handed to an outside contractor. As a member of the public I find my confidence in the Scottish Government eroded a little, but my confidence in their tobacco policy is not high to start with.

Corporate Watch has a useful section on PR companies and the lobbying industry.

Afterthought: I've added to the sidebar our response to the Scottish Government's recent consultation on display and pricing in respect of the tobacco display ban legislation, submitted last month.