Monday, March 31, 2008

Smoke Alarm: Tobacco Funding of Medical Research at Reputable Medical Schools May be Prevalent

We recently posted about a controversial study of using CT scans to screen for lung cancer that turned out to have been partially sponsored by a tobacco company. Even though we have written quite a bit about conflicts of interest, this surprised even me, since the conflicts of interest presented by financial relationships with tobacco companies seem so blatantly risky that I would have thought few physicians or medical researchers would dare contemplate them. It looks like even having blogged on Health Care Renewal for several years, I am still too naive.

For example, the Boston Globe just reported on funding of medical research in the Boston area just by tobacco company Philip Morris USA, just spun off from Altria Group Inc.

The nation's largest cigarette maker has paid for scientific research at four Massachusetts universities since 2000....

Philip Morris USA, which makes Marlboro and other top-selling cigarette lines, gave grants to scientists at Boston University, Harvard University, the Massachusetts Institute of Technology, and the University of Massachusetts, company spokesman David M. Sylvia said Friday.

The research supported by the company touched on conditions such as heart disease and cancer that are linked to smoking.

Funding went to Boston University.

BU's acceptance of research grants from Philip Morris was first disclosed Thursday in The Daily Free Press, a student newspaper at the university.

At BU, one recipient, Dr. Douglas Faller, is a longtime professor and director of the BU Cancer Center. According to a document detailing work at the university's Women's Health Interdisciplinary Research Center, Faller received $268,759 from Philip Morris to investigate a cancer drug.

Reached at his home late Friday, Faller deferred to university officials for comment.

Funding went to Harvard, although it has decreased since Harvard banned new tobacco funding of research in 2004.

At Harvard Medical School, researchers were ordered to stop pursuing tobacco-industry grants in July 2004. 'The policy did, however, allow those few researchers who had ongoing projects funded by those entities to complete them,' Margaret Dale, dean for faculty and research integrity at Harvard Medical School, said in a statement released Friday by a university spokesman.

Funding previously went to University of Massachusetts Medical Center, but the institution does not currently get tobacco funding.

A UMass Medical School spokeswoman said that the school does not currently have any research supported by tobacco companies and that it had accepted 'no more than' $2 million from the industry over the past decade.

No Philip Morris funding went to Tufts University School of Medicine, but the school did admit to receiving money from another tobacco company.

The Tufts University School of Medicine received no Philip Morris grants, but a school spokeswoman said that one laboratory there had received a grant in 2006 from a tobacco company.

The argument against funding of clinical research by pharmaceutical, biotechnology and medical device companies has been that such companies often try to exert influence, subtle or overt, that might bias the research to favor their products, or even suppress research that shows their products in a bad light. Such influence could adversely affect the advancement of science, and decision making by physicians and patients who accept the published research as unbiased. Such influence also breaks the trust of research subjects who were told that they were volunteering to advance science and health care.

But at least pharmaceutical, biotechnology, and device companies make products intended to help patients more than they harm them.

Tobacco products obviously pose serious health risks, and have no health benefits to counterbalance them. So the bias that could result from tobacco companies' sponsorship of research could be much worse for science, for medical decision making, and for research subjects than bias resulting from pharma, biotech, or device companies' research sponsorship.

Yet some medical schools seem to push their faculty so hard to get "external research support" that they do not mind if such support comes from tobacco companies.

Kudos to Harvard, though, for trying to cut back.

No medical school administrator nor researcher willing to be quoted by the Boston Globe reporter dealt directly with why tobacco company research support might not be a good idea. For example,

In a statement issued Friday evening, the provost of BU's medical campus, Dr. Karen Antman, said the school had received $3.99 million from Philip Morris during the past decade and devoted it to the study of tobacco-related diseases.

'We adhere to the highest ethical conduct in research and pursue funding from a variety of sources for unrestricted medical research,' Antman said in the statement. 'Our research is conducted and the results are assessed against the standard benchmarks that apply to any research.'

Again, the issue is that a researcher getting "unrestricted" research funding, funding that might be keeping his or her academic career alive, might naturally feel some gratitude for the funding, and consequently might unconsciously be less likely to criticize his or her funding source or its products than otherwise. Of course, the more the researcher might need future funding from this sponsor, the more likely would be a conscious sense of obligation to be nice to that sponsor. Furthermore, even "unrestricted" funding may open up some lines of communication between the sponsor and the researcher which the sponsor could use to further increase its influence.

Also, the tobacco companies surely are not spending money to support research out of pure altruism,

'Their interest now is to try to convince the public that they are truly concerned companies and that they care enough to fund important research at reputable institutions,' said Dr. Michael Siegel, a Boston University School of Public Health researcher who has extensively studied the tobacco industry. 'And, they're using the good name of these institutions to try to bolster their own scientific and public credibility.'

That seemed to be working, as demonstrated by this seemingly self-contradictory quote from a Massachusetts Institute of Technology researcher:

'As there were no strings attached in the application process I had no qualms in applying for this funding,' Rami Tzafriri, of MIT, said in an e-mail. 'In retrospect I can say that the whole process was very professional and friendly and that under similar circumstances I would apply for such funding again. Funding for research is essential, but unfortunately scarce. So any source that does not compromise my independence is welcome.'

On the other hand,

'Taking money from the tobacco industry to conduct scientific research is like the DA taking money from the Mafia to conduct investigations of crime,' said Gregory Connolly, a Harvard School of Public Health professor and former director of the Massachusetts Tobacco Control Program.

Indeed. It would strongly be in society's interest to find a way to wean academic medical institutions from their addiction to research dollars proffered by those with something to sell other than science and improving health care.

ADDENDUM (2 April, 2008) - See also comments on the Effect Measure blog.

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