I'm afraid that this story illustrates how academic medicine's focus on finding more external funding has diluted its attention to its primary mission. We have discussed how academic medicine's financial entanglements with pharmaceutical, biotechnology, and medical device companies have too often lead to arrangements in which academics while cloaked in their academic regalia appeared to be helping these companies market their products.
Medical researchers at the University of Virginia believe they have identified an enormously promising way to stop kids from taking up smoking. So when a company was willing to pony up $20 million to finance the research, they seized the opportunity.
The fact that the company was Philip Morris USA, the largest cigarette manufacturer in the United States, has raised some eyebrows nationally, given the tobacco industry’s history of sponsoring research that suited its own commercial purposes.
'The historical record going back to the mid-’50s of the industry using funding to manipulate the scientific process is too strong,' says Stanton A. Glantz, a professor of medicine at the University of California at San Francisco, who has led the campaign at the UC system to ban such funds. 'To accept a gift like this, you have to completely suspend belief in the entire historical record, and assume that [the company has] suddenly decided to become the National Institutes of Health.'
Virginia officials bristle at such a characterization, which they say is an oversimplification. Administrators who crafted the agreement say that the university has complete control over the research that will be done and that Virginia had consulted with leaders across the medical school, including on the faculty, before deciding to accept the funds. 'It was potentially controversial enough that I went and discussed it with our entire leadership,' says Arthur Garson, dean of UVa’s School of Medicine and a professor of pediatrics. The bottom line for UVa, he says, was that 'a company has offered us $20 million to develop better ways so kids don’t smoke. Period.'
Rank and file faculty members at the university, including some who work on tobacco issues or specialize in ethics, tend to agree that the university is on solid ground in accepting the funds. But some also say they are made uncomfortable by the idea that the gift is likely to help Philip Morris’s image, at a time when the company has a continuing interest in the sale of cigarettes to kids, in the United States and, especially, abroad.
Garson says that Virginia officials had discussed the gift, which was more than a year in the making, with the 'entire leadership of the School of Medicine,' including all department chairs. They were assured, he says, that the university would be 'completely in charge of the science,' and that Philip Morris would play no role other than to be apprised of the 'broad outcomes' of the work.
Anti-smoking activists, however, cite several concerns. The most absolutist of them believe that tobacco industry money should be off-limit purely because of its source. 'We think it’s inherently wrong that the money, regardless of how much good it’s going to do, is coming from a source that is inherently tainted,' says Jerome Yates, national vice president for research at the American Cancer Society, explaining why the nonprofit group will not give its own research funds to individual scientists who have accepted grants from the tobacco industry.
'We believe the tobacco industry is a source of a lot of morbidity and mortality in the United States, and that promotion of cigarette smoking is inherently wrong.' Tobacco companies, even if they sponsor some anti-smoking research, still spend much more of their time and money promoting smoking and tobacco use, he notes.
The American Legacy Foundation, a nonprofit group created as part of the federal tobacco settlement, has an even tougher grants policy, barring its funds from flowing to any unit or school at which any researcher is receiving tobacco industry money. 'There is no such thing as a free lunch, and we believe that if you take money from a funder, you have a relationship with that funder,' says Ellen Vargyas, general counsel and corporate secretary for American Legacy. Secondly, a primary reason that tobacco companies like Philip Morris sponsor research like that at Virginia is 'to rehabilitate their corporate image,' Vargyas says. 'Universities should not be a party to that.'
The grant to Virginia is part of Philip Morris’s larger “external research program,” which materials on its Web site describe as “committed to continuously researching and developing new technologies with the potential to reduce the harm associated with our products. The company also finances a Center for Smoking Cessation Research at Duke University (which, like UVa, also resides in the heart of tobacco country), which has received two grants of $15 million, the Philip Morris spokesman says.
A 2006 study in the British Medical Journal’s Tobacco Control examined the first round of grants from the company’s external research program. The authors found that a majority of peer reviewers and of grant applicants had previous ties to the tobacco industry, and concluded that the program 'appears to exist less as a conduit for critical scientific inquiry than to fit into a corporate strategy intended to burnish PM’s public image.'
But at least these companies make products that are meant to improve health, and often have health benefits that outweigh their harms.
There is no doubt that smoking cigarettes leads to severe health risks, and has never been shown to provide any important health benefits. In my humble opinion, acceptance by a medical school or academic medical center of research money from a tobacco company is an affront to the academic medical mission. Academic medicine should not be a party to helping a tobacco company improve its image.
Maybe the university's Board of Visitors should awake from their "slumber" and put a stop to this example of mission-hostile management.
We have discussed before how academic medical centers have been willing to give up their faculties' control over research products to pharmaceutical, biotechnology, and device companies in exchange for financial support