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Thank You for Smoking

People have been smoking tobacco for over a thousand years. Even a generation ago smoking was considered the norm. Now we know of its link to a variety of cancers and diseases, and many laws have been introduced at all levels of government to try to protect nonsmokers and smokers alike. The numbers of U.S. smokers are declining, but cigarette smoking is the still the single most preventable cause of untimely death in this country – claiming 400,000 Americans each year – 1 in every 5 deaths. Treating cancer cost $219 billion in 2007.

Yet cigarettes are legal in almost all of the U.S. for anyone over age 18. Though they contain a drug nicotine and other products that are harmful to humans, they are not regulated by the FDA. Though they have been banned in public places and workplaces in most of the U.S., smoking is still largely seen as a matter of personal habit rather than public health.

That being said, many were horrified to learn that a pivotal study on lung cancer prevention, which the New England Journal of Medicine published in 2006, may be totally corrupt.

Since 1999, Dr. Claudia Henschke of Weill Cornell Medical Center had been advocating making CT scans of people’s lungs more commonplace in order to reduce lung cancer deaths by 80%. Two years later she had received a patent for such scanning and has 10 similar patents pending. After 15 years of research she concluded in the 2006 article that all that is needed to prevent most of the 160,000 annual deaths from lung cancer – the cancer that kills more people than any other – is more rigorous screening.

The NEJM article included the information that Dr. Henschke’s research had been funded by an obscure charity, the Foundation for Lung Cancer. It took an investigation by the New York Times to reveal that the foundation’s budget mostly consisted of $3.6 million from Vector, the parent company of Ligget – a cigarette manufacturer.
What is troubling about the publication of this article:

It is has been the norm since the 1990s for universities to refuse cigarette makers’ “research” grants. A 1998 landmark legal settlement also forced tobacco companies to admit that typically, cigarettes kill.

The links between drug companies and medical journals and associations have become clearer, and almost all of these organizations require full financial disclosure of their researchers.

So it is troubling to see well-respected institutions gloss over these realities as seemingly irrelevant:

  • The NEJM is one of the oldest medical journals in the world. Scientific researchers submit write-ups of their work for review by their peers in order to pass rigorous standards for publication. For this reason, medical research found in the NEJM’s pages is generally considered to be clinical evidence – the new foundation for further study in an area or the proof of certain treatments’ value.
  • Since 2000, Philip Morris has been funding scientific research on tobacco-related disease at places like Harvard and the Massachusetts Institute of Technology, two of the most highly rated and respected universities in the country. Worldwide this funding has fueled 470 research projects and more than 1,000 journal articles.
  • That a peddler of products that lead to lung cancer could have a hand in funding supposedly scientific, unbiased research to prevent that same disease struck the medical community as distasteful, if not outrageous.
  • The real shocker, however, was the lack of due diligence the NEJM showed by printing the study, knowing full well the prestige and influence their masthead would give the findings.

Conclusion:
Is it wrong for tobacco companies to fund the research that might heal millions from the impact of using their products?

And in a political climate where Federal funding for scientific research is hard to come by, what’s a scientist to do?

Can we trust esteemed universities to answer these questions by saying “Forego corporate dollars and their influence on your outcomes; protect our and your integrity”? Universities have put in place codes of ethics in response to study after study showing corporate funding does not make for objective research.

  • Perhaps for this reason, it is reportedly becoming more commonplace for academics to set up separate foundations to funnel corporate funding.
  • University administrators are more frequently on the boards of these organizations in order to patrol ethical boundaries, as they were in Henschke’s case.
  • But they still get a portion of whatever funds their staff researchers bring in, as well as the secondhand glow from their success.

The conflict of interest is clear.

What’s also now clear is that genes play a large role in why some people are more apt to become addicted to tobacco. Furthermore, these same genes also make it harder to quit and more often lead to lung cancer. In other words, CT scans may catch lung cancer when it’s a just a small tumor, but the folks they’re catching were probably doomed years ago, the minute they took up smoking.

So shouldn’t we be funding the real preventive research – how to keep people from starting to smoke in the first place and/or the best ways to get them to stop?

In the meanwhile, at least, there is federal legislation pending to force drug and device makers to post registries of payments to doctors – including doctors who conduct research.

P.S. Henschke and her co-authors had initially said that the study was only funded in small part by tobacco money, and that they no longer accepted such donations. Following the New York Times expose, Henschke printed a clarification of these claims in the NEJM.

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