Pharma

The pharmaceutical interests supporting Tobacco Control

Pharmaceutical companies sponsor conferences of TC groups, studies that attempt to prove environmental tobacco smoke (ETS) is deadly and (financially) support the WHO/FCTC in their fight against smokers.

It is worth noting that during the last two decades, the pharmaceutical industry has donated hundreds of millions of dollars to organizations that lobby for smoking bans.

Was this an exercise in philanthropy on the part of the caring pharmaceutical industry?

Not exactly. Big Pharma is an industry every bit as profit-driven, cutthroat and devious as any other global industry. Smoking bans represent a lucrative market opportunity for Nicotine Replacement Therapy products (nicotine patches, nicotine gum etc.), to be maximized at all costs, collateral damage notwithstanding. The more bans there are, and the more draconian the penalties for transgression, the better the market penetration. In this instance, the costs of their drive for greater market penetration are borne by smokers around the world in the form of marginalization, restrictions as to where they are permitted to smoke, and demonization/denormalization. The theory behind this pogrom is that smokers will be driven to quit, and in doing so, will turn to nicotine replacement therapy (NRT), which is, of course, manufactured by those same pharmaceutical companies who are funding the Tobacco Control Industry. The hundreds of millions Big Pharma spends in funding Anti-Smoking and general smoking-ban initiatives is small beer when set against the profits from sales of NRT and smoking cessation products.

The prescription nicotine dependence market is set to grow strongly at a compound annual growth rate of 16% to reach $4.6 billion by 2016 ...

This perhaps would not be quite so cynical if the products had a proven success rate. However, the success rate is abysmal. Reports indicate a success rate of 19% at best, lower actually than completely unaided quitting:

According to the study, the three-month success rate with NRT is only 19% for light smokers, compared to 26% for unaided quitting. For heavy smokers, the three-month success rate is 9% for NRT compared to 15% for unaided quitting.

Belinda Cunnison, of pro-choice group Freedom2Choose, investigated the common claim that you are “four times more likely to quit with NHS,” which is used in most promotional materials for NRT products, and frequently in press releases on the subject of smoking cessation.

I traced this claim to a Department of Health web page, which also claimed a 15 per cent success rate at 12 months for NRT. The evidence that was supposed to demonstrate this 15 per cent success rate and the "four times more likely to quit" phenomenon was not listed in the footnotes, so I wrote to the Department to ask for it.

It took over three months to get the information

When that information was finally forthcoming, the figures showed a 6.5% quit rate for those using NRT, and a 6% quit rate for those going "cold turkey, i.e. without using NRT." So much for the "15% success rate" and "four times more likely" claims.

One study even found a quit rate using NRT as low as 0.8%! Hardly a ringing endorsement of NRT. In fact in most cases, the success rate was higher if no NRT was used.

Additionally, a study by Reuven Dar and Jean-Jacques Etter showed that commonly used placebo tests that test the effect of NRT products, carried out by the pharmaceutical nicotine producers, are defective and overestimate the effect of those products.

Gregory N. Connolly, professor of the Practice of Public Health, Director, Center for Global Tobacco Control recently published a study that he co-authored that came to the following conclusion:

This study finds that persons who have quit smoking relapsed at equivalent rates, whether or not they used NRT to help them in their quit attempts. Cessation medication policy should be made in the larger context of public health, and increasing individual treatment coverage should not be at the expense of population evidence-based programmes and policies.

Please note that letters disagreeing with this study were all submitted by researchers who had ties to the pharmaceutical industry. What is intriguing about this study is that it was completed in 2006 yet it was only published in January 2012. Could Professor Connolly's resignation from the FDA tobacco-advisory committee have anything to do with it? Could his support of a pharmaceutical smoked cigarette (that would most probably compete with nicotine replacement treatment) have anything to do with the delayed publication of this study? Whatever the reasons, it is quite strange that in the publish or perish world of epidemiology, research would be published after a 6-year delay

But when even the father of the universally known and utilized nicotine dependence test, Karl Fagerström, has a change of heart and now concedes that nicotine is not the only reason people smoke, is it any wonder nicotine replacement therapy is virtually useless?

The nicotine addiction fallacy, rather than helping science progress, creates barriers to further scientific research on tobacco. In Professor Robert Molimard's wise words:

(...) having arbitrarily decided that nicotine alone explains tobacco dependence and having it engrained in the minds of doctors, the authorities and the public, any research on the other possible factors of this dependency is now excluded in advance and a vast new market is made available for commercial exploitation by the pharmaceutical industry.

Patrick Basham and John C. Luik of the think tank Democracy Institute explain in a recently published paper why pharmaceutical assistance in quitting smoking is a prescription for failure:

A further important point is that NRT continues to dominate smoking cessation because of the pernicious effect of the addiction model of smoking. Because smokers are continually told that tobacco use is addictive, indeed, more

addictive than hard drugs such as heroin and cocaine, they are encouraged to believe that the only effective way in which to stop smoking is through a professionally administered pharmaceutical intervention. By convincing smokers that they are addicted (read powerless on their own to stop smoking),

the move to NRT as the only way to combat this addiction is seen as normative. Unassisted smoking cessation is seen as ineffective since smokers’ confidence in their ability to succeed is undermined by their belief that they are addicted.

Israeli studies conducted by Dr. Reuven Dar conclude that nicotine is not addictive as physiological addictions are usually defined. Nicotine does have a physiological role in increasing cognitive abilities but it's not an addictive substance -- like heroin for example -- which creates biological withdrawal symptoms. Dr. Dar believes that understanding smoking as a habit, as opposed to an addiction, will put the emphasis on psychological and behavioral aspects when helping smokers quit. This is less than likely to happen, because with the billions of profits Big Pharma risks to lose if the nicotine addiction theory is disproved by an ever increasing number of researchers, it will persistently defend it anyway: they will always find scientists and tobacco control advocates all too eager to perpetuate a fallacy for money. These findings might not be popular with advocates of the nicotine addiction theory, because they undermine the physiological role of nicotine and emphasize mind over matter when it comes to smoking Dr. Dar sharply opines.

Funding Tobacco Control organizations, astroturf groups and bans is not all the pharmaceutical industry does to boost its profits. It also practices a devious way to advertise cessation drugs (without even naming them) in the form of infomercials that mislead the viewer into thinking that they are public service messages. A typical example can be found here: New Advertising Trend: Fake "Public Service" Ads . The following quit campaign Quit Smoking Canada carries a tiny mention at the bottom This campaign is brought to you by one of canada’s leading research-based pharmaceutical companies without which the reader would have never known that it was Big Pharma funded.

Company Listing

Johnson & Johnson

Under the banner of its subsidiary, McNeil Consumer Products, J&J markets the Nicotrol nicotine patch and nicotine inhaler. The Robert Wood Johnson Foundation is a big shareholder in J&J and began its massive funding of tobacco control in the U.S. in 1991, the same year the FDA approved the nicotine patch as a prescription drug. Pharmacia reacquired the rights to market the Nicotrol Inhaler in North America from J&J's McNeil in July 2000.

GlaxoSmithKline

Pharmaceutical giants Glaxo Wellcome and SmithKline Beecham merged on December 27, 2000, making the new company the world's biggest drugs group by sales. Glaxo Wellcome markets Zyban (buproprion) and SKB markets Nicoderm CQ nicotine patch and Nicorette gum. One of the major holdups in getting FTC approval for the merger was that both companies sold smoking cessation products, but even though these cessation products accounted for less than 4% of SK's sales, neither company was willing for them to be sold to another pharmaceutical company to facilitate the merger. SK was also investigated by a congressional committee for overpricing of cancer treatments. SK infuriated the committee by refusing to hand over information about Kytril, its anti-nausea drug for chemotheraphy patients. ("Federal smoke delays merger," Andrew Clark, The Guardian, October 10, 2000).

In 1999, SmithKline Beecham Consumer Healthcare's combined U.S. sales of Nicorette and NicoDerm CQ reached $570 million. The company also markets its nicotine patch under the trade name "NiQuitin CQ" in Belgium, France, Denmark, Mexico and Brazil and under "Nicabate" in Australia and New Zealand, where it was the number one smoking cessation product in 1999 (Philippe Boucher's Rendez-vous with ... Leslie A. Ashburn, Communications Supervisor for GlaxoSmithKline, January 29, 2001).

Pharmacia

(Also Pharmacia & Upjohn).

• Makes Nicorette and Nicotrol, "a family of tobacco dependence therapies." ("About Pharmacia & Upjohn," company website, as of January 15, 2000). Pharmacia & Upjohn Consumer Healthcare "develops, manufactures and sells safe and efficacious OTC (Over the Counter) products …. A number of products are also sold globally. Among the company's largest and most well-known brands is a line of nicotine replacement products, including nicotine gum, transdermal patch, and nasal spray and inhaler."
• Pharmacia & Upjohn are one of three pharmaceutical "partners" in the WHO global anti-tobacco project. "Pharmacia & Upjohn announced a 17 percent increase in first-quarter earnings Thursday, as U.S. drug sales soared for its top three medicines …. Sales climbed 12 percent to $1.77 billion from $1.59 billion a year ago. Pharmacia, which makes Xanax anti-anxiety medication and Nicorette smoking cessation products, has completed a massive turnaround in the past two years" ("Pharmacia & Upjohn Profits Rise," AP, April 29, 1999).
• "Pharmacia & Upjohn Inc.'s Japanese unit saw sales of its Nicorette antismoking gum rise 50% in 1998 over a year earlier" ("Sales of Nicorette Gum Make Gains in Japan," Wall St. Journal, May 14, 1999).
• "Pharmacia Canada, Inc. and Aventis Pharma, Inc. today announced the closing of a transaction whereby Pharmacia acquires the Canadian Nicotine Replacement Therapy business of Aventis Pharma. Under the terms of the agreement, Pharmacia is acquiring the Nicoderm brand transdermal nicotine patch and reacquiring the sales and marketing rights to its Nicorette brand gum." Pharmacia Corporation is a global pharmaceutical company created through the merger of Pharmacia & Upjohn with Monsanto Company and its G.D. Searle unit. ("Pharmacia Consumer Healthcare acquires Nicotine Replacement Therapy (NRT) business of Aventis Pharma Inc," Company Press Release, January 26, 2001).
• Pharmacia merged with Pfizer in 2002.

ATP

[Advanced Tobacco Products, Inc./Advanced Therapeutic Products]

Sold their patented nicotine technology, which forms the basis of the Nicorette/Nicotrol Inhaler, to what once was Pharmacia Corporation, in exchange for product payments of 3% of Pharmacia's net sales. In July, Pharmacia announced it had reacquired the rights to market the Nicotrol Inhaler in North America from McNeil PPC, Inc., a unit of Johnson & Johnson. As a result of the Nicotrol takeback, Pharmacia said it has a renewed interest in consumer advertizing as well as the professional detailing of doctors and healthcare providers" ("ATP Announces Fiscal Year Results, Dividend Payments & British Medical Study of the Nicotine Inhaler," Company Press Release, November 28, 2000).

Hoechst Marion Roussel

(the pharmaceutical company of Hoechst)

Manufactures and markets Nicorette gum and Nicoderm patches in Canada. "NRT products have been available in Canada since 1979, and were cleared for non-prescription sale by Health Canada in 1993 (2mg Nicorette), 1997 (4mg Nicorette) and 1998 (Nicoderm and other patches ….'When these products became more easily available in the U.S. three years ago, the number of quit attempts doubled in one year,'" says Tony Ruta, Hoechst Marion Roussel spokesman. ("Nicotine therapies critical piece in Ontario tobacco strategy," Company Press Release, April 23, 1999).

Novartis

Maker of the Habitrol patch in Canada. Novartis Consumer Health Canada, Inc. ("Habitrol nicotine patch now available in Ontario without a prescription, Canada Newswire, April 23, 1999). Novartis is one of the three major pharmaceutical partners with WHO in the WHO global tobacco control program.

"Novartis Pharma To Launch Nicotine Patches in Japan," NewsEdge, May 11, 1999. "Although the patches are available over-the-counter in 29 countries, they will require a doctor's prescription in Japan and will not be covered by insurance."

Pfizer

Discovers, develops, manufactures and markets leading prescription medicines for humans and animals, and many of the world's best known consumer products. Pfizer had global revenues of $29.6 billion in 2000. In 2000 Pfizer took over Warner-Lambert. Pfizer is developing a new agent for smoking cessation, currently known as CP-526,555, "that relieves both cravings and withdrawal symptoms and blocks the reinforcing effect of smoking" ("Pfizer to Advance Industry Leadership Through the Best People, Products And Pipeline, Steere Tells Shareholders," Company Press Release, April 26, 2001).

Main sponsor for TC conferences and main supporter of the FCTC.