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Concerns raised over doctors' ties to drug companies
Problem of pharmaceutical firms paying physicians 'swept under the rug
in Canada,' one researcher says
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Pfizer Canada, the maker of Nicorette, pays physicians to promote the
gum as a product that can help smokers quit by reducing nicotine
cravings.
Photograph by : Bruno Schlumberger, CanWest News Service
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 Font: * * * *  Carly Weeks, CanWest News Service
Published: Monday, January 22, 2007
OTTAWA -- To celebrate the launch of its new flavoured nicotine gum,
Pfizer Canada hired "brand ambassadors" dressed in ski suits to give
out free samples in Calgary and Toronto and published promotional
material that touted the benefits of the new product.

The company's press release declares: "using Nicorette ice mint coated
gum can help smokers quit by reducing nicotine cravings and withdrawal
symptoms and significantly improve their chances to quit smoking."

The promotional quote isn't attributed to a Pfizer staff member, but to
a Toronto-based general practitioner, who the company says was paid for
participating in the promotion.

Canadians expect doctors to provide sound, neutral advice about
treatment for health issues. But information is emerging that indicates
some are paid to publicize and promote smoking cessation medication,
possibly influencing the way smokers approach their battle to quit.

"There's enormous connections between what the drug companies do and
what and how doctors practice and what they say and what they write,"
said Dr. Jerome P. Kassirer, professor at the Tufts University School
of Medicine and editor-in-chief emeritus of the New England Journal of
Medicine.

Pfizer regularly pays physicians in Canada in exchange for testimonials
and research into its smoking-cessation aids without publicly
disclosing those ties.

In the last year, there have been growing calls within the medical
community for a change in rules to limit relationships with drug
companies that could impact a doctor's impartiality.

"These companies, who are very shrewd, are not doing all this out of
benevolence. They're doing it because they know that by using these
methods, they're increasing the sales of their product -- which is what
they want to do," said Dr. David Korn, senior vice-president for
biomedical and health sciences research at the Washington-based
Association of American Medical Colleges.

Korn is part of an expert task force examining new rules and
conflict-of-interest restrictions in the hopes of ending questionable
relationships between drug companies and the physicians they fund.

Although the issue doesn't receive the same level of attention in
Canada, the problem is alive and well here, according to medical
experts.

"I think it's been swept under the rug in Canada," said Kassirer, who
recently wrote a book on the subject called On the Take: How Medicine's
Complicity with Big Business Can Endanger Your Health. "I think it's a
problem in Canada."

The trouble with smoking cessation medication doesn't lie with product
safety -- most experts agree they can help some people quit smoking.
But there are growing concerns doctors funded by the drug industry may
overly promote the benefits to encourage more people to buy the
medication.

Doctors are featured repeatedly in Pfizer's promotional material and
often speak to the media about the benefits of nicotine replacement
therapy products, such as those produced by the company. Johnson &
Johnson recently purchased Pfizer Consumer Healthcare, a branch of the
parent company that is responsible for nicotine replacement therapy
products and other non-prescription medication.

The company uses doctors to speak about its products because hearing
from a credible member of the medical community reminds people about
the grave problems associated with smoking, said Johnson & Johnson
spokeswoman Krista Scaldwell.

"It's the seriousness of tobacco dependence," she said. "It is an
addiction, rather than a habit ... Using doctors can make that
differentiation."

But others see it as doctors bending the rules of their public contract
to be honest, clear and unbiased in order to do the bidding for drug
companies.

"I believe that when someone has a financial conflict of interest, that
they are influenced, even subconsciously, to think in terms of the gift
that they're getting from the company," Kassirer said.

There is evidence to suggest physicians funded by drug companies have a
favourable bias toward nicotine replacement therapy products and other
smoking cessation aids. A recent Canadian study found researchers who
receive money from pharmaceutical companies are more likely to conclude
nicotine replacement therapy has a better chance of helping people quit
than those without drug company funding.

"It's possible that because of the way science has been conducted that
some of the benefits have been overestimated somewhat," said Paul
McDonald, a health studies professor at the University of Waterloo, who
conducted the study.

The results, which will be made public at a conference in Texas next
month, illustrate the need for better disclosure and code of conduct
rules so Canadians are aware of any possible influences drug companies
may have over research and public statements by doctors, McDonald said.

"I think it's going to be essential for things like smoking cessation
treatment ... that the funders and program providers have very explicit
policies that enable them to ensure there's no conflict of interest
between whatever donations they might receive from any source, whether
it be a pharmaceutical source or a government or non-profit
organization," he said.

One doctor who has an ongoing relationship with Pfizer agrees Canada's
medical community should adopt improved codes of ethics, but said
receiving money from a drug company shouldn't suggest a lack of
professionalism.

"You've got to make sure as a researcher you don't get co-opted as the
spokesperson for that [medication]," said Dr. Peter Selby, clinical
director of addiction programs at Toronto's Centre for Addiction and
Mental Health. Selby was featured in a press release on a new smoking
cessation pill developed by Pfizer titled: "Magic pill to get you to
quit smoking!" It was distributed in June 2005 by the Ontario
government-funded Media Network for a Smoke-Free Ontario to highlight
Selby's research.

"It's as easy as open, pop, swig and swallow. Well, at least it will
be," reads the press release.

Selby, who is a vocal supporter of smoking cessation products, said his
relationship with Pfizer doesn't influence his research. Rather, he
stands behind the products because they provide options for people who
want to quit, including those who may not otherwise have access to
counsellors or other quitting methods.

"We've got to figure out how do we reach half-a-million smokers who
want to quit," he said.

Selby said the system isn't perfect, but that advertising medication
that's readily available to the general public is better than not
providing options to help people quit.

"There needs to be an ethical way of doing that, there needs to be
criteria as to who gets medication and who doesn't," he said.

McDonald said he's not surprised by his study's findings, since similar
ones done in other countries have indicated the same, but he's
disturbed by the level of research conducted with the help of
private-sector funding and the fact Canadians are none the wiser.

"What concerns me is an overwhelming majority of the studies that are
being conducted are being conducted in whole or in part with
private-sector funding or pharmaceutical funding," he said. "It's just
that we need to take that into account in trying to determine how much
confidence to have."

*****

TC