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June 27, 2008

Doctors Under the Influence -- BusinessWeek

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Doctors Under the Influence? In BusinessWeek a story of two New Jersey based physicians who have worked tirelessly for the last twenty years helping patients quit smoking and are now being questioned on their recent motives.

In a recent Annals of Internal Medicine Article around the long term use of drugs to facilitate smoking cessation, Dr. Michael B. Steinberg and Dr. Jonathan Foulds of UNDMJ disclosed that they are paid by manufacturers of smoking-cessation products for speaking and consulting. Among those companies is Pfizer (PFE), whose controversial drug Chantix the researchers mentioned favorably, along with other treatments.

No Good Deed Goes Unpunished.

These two researchers have for many years toiled in the unglamorous field of smoking cessation, with little personal compensation and continuous exposure to second hand smoke to help patients overcome their smoking habits and ultimately save lives.

Steinberg and Foulds encountered an obstacle that helped inspire their article advocating long-term drug use. They found many insurance companies wouldn't reimburse for Chantix, which costs about $100 a month, or for other less expensive antismoking products.

Steinberg and Foulds reasoned that if they compared nicotine use with diabetes, rather than with alcoholism or other addictions, they might help change insurers' thinking. Diabetes causes many of the long-term problems that nicotine addiction does. "We wanted to compare it to a disease that's well-covered," says Foulds, "and alcoholism isn't well-covered."

According to the article the two physicians gave a dozen or so lectures at $900/each to promote Chantix and received $30,000 for a study.   This does not sound like unreasonable compensation.

In the article BusinessWeek quotes:

Over the past decade, financial ties between doctors and companies have proliferated, prompting concern that treatment is distorted by industry money. The solution that has been widely embraced is disclosure of funding sources. But the rules are inconsistent and mostly voluntary. Moreover, disclosures typically are made in medical journals, conferences, and other venues that patients tend not to see.

Pfizer hasn't taken a formal position on whether doctors should disclose funding sources to patients. Cathryn M. Clary, vice-president 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. It also recently began disclosing grants for medical education on its Website.

Smoking is a serious problem. It is the main cause of the two most prolific killers, Heart Disease and Cancer. 

This type of fear mongering is likely to lead to significantly greater deaths than the small number of depressed people as a result of using drugs for smoking cessation.

I am not sure where it will all end but if the media and government wants to stop all clinical trials, speaking and consulting to ensure that the information is pure then perhaps all our clinical research will head east to China and India where the business environment is much more favorable.

In an Opt Ed, BusinessWeek published two opinions on this issue:

Halt the Pharma Freebies

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