Tobacco-funded studies are bad for us

Several journals will no longer publish research supported by the tobacco industry. Ginny Barbour, the chief editor of one PLoS Medicine, one of the journals to refuse tobacco-funded studies, explains why.

What made you decide to stop accepting papers reporting research funded by tobacco companies?

Last year PLoS Medicine decided to prioritise research about conditions and risk factors that cause the greatest burden of disease. Tobacco is certainly one: it directly kills over 4 million people a year worldwide, and more indirectly. We didn't want our policy to attract a flood of industry-funded tobacco research; we feel the tobacco industry has no reason to fund research aimed at improving public health. If they wanted to do that, they could just shut down. Its main reason for publishing research about tobacco is to downplay the harm it causes, in order to sell products: it has a long history of that. It also funds research unrelated to tobacco, but that is still a form of advertising.

Is it a medical journal's job to try and stop that?

Journals cannot just be passive conduits for papers. We have a duty to promote human health. Banning tobacco-funded papers can help researchers who are under pressure to accept funding: the next time a tobacco company offers them money, they can say "No thanks, that would limit where we can publish." Besides us and our colleagues at PLoS ONE and PLoS Biology, the British Journal of Cancer and the American Thoracic Society journals have also banned tobacco-funded research.

Tests of new drugs are usually funded by drug companies, and some studies have found that company-funded trials are more likely to get results favouring the company. Why single out tobacco?

There is a huge problem with all corporate funding of clinical trials: it's like asking the coach of the football team to referee the game. But unlike pharmaceuticals, the tobacco industry's products are never useful, they only harm human health. And there has been increasing evidence that the industry's research is problematic; one of our editors opposed banning research funded by tobacco companies as a restriction on free speech, but changed his mind because of that.

The industry is developing "safer cigarettes" and will need them to be tested in clinical trials. Shouldn't the results be published in peer-reviewed journals?

If tobacco companies fund these trials it will be hard to have confidence in the outcome. But in any case, even a so-called safer cigarette will not contribute to public health. The only reason the industry has for developing one is to promote smoking.

Wouldn't that reduce the harm caused by tobacco?

There is one simple way to reduce the harm caused by tobacco: stop it being sold. I don't accept that it will help even if you can make a slightly safer cigarette. That research is just advertising. Medical journals and the public health community must take a strong stand and say it isn't acceptable to publish research that only seeks to legitimise tobacco.
 

Source: NewScientist Opinion, 05 March 2010 
Link: http://bit.ly/cDBl40

Smoking prevents Alzheimer's? It depends who you ask

Papers by people with links to the tobacco industry play down the risks of Alzheimer's associated with smoking, notes Dr Ben Goldacre, Guardian Columnist.

If the media were actuarial about drawing our attention to the causes of avoidable death, newspapers would be filled with diarrhoea, Aids and cigarettes every day. In reality we know this is an absurd idea. For those interested in the scale of our fascination with rarity, one piece of research looked at a period in 2002 and found that 8,571 people had to die from smoking to generate one story on the subject from the BBC, while there were three stories for every death from vCJD.

So you've probably heard that smoking may prevent Alzheimer's. It comes up in the papers, sometimes to say it is true, sometimes to say it has been refuted. Maybe you think it's a mixed bag, that "experts are divided". Perhaps you smoke, and joke about how it will stop you losing your marbles.

This month, Janine Cataldo and colleagues publish a systematic review on the subject, but with a very interesting twist. First they found all the papers ever published on smoking and Alzheimer's, using an explicit search strategy which they describe properly in the paper – because they are scientists, not homeopaths – to make sure that they found all of the evidence, rather than just the studies they already knew about, or the ones which flattered their preconceptions.

They found 43 in total, and overall, smoking significantly increases your risk of Alzheimer's. But they went further. Eleven of the studies were written by people with affiliations to the tobacco industry. This wasn't always declared, so to double check, the researchers searched on the University of California's Legacy Tobacco Documents Library, a vast collection of scanned material which has been gathered over decades of legal action.

If you ever want to spend a chilling afternoon in the head of an industry whose product has been proven to kill a third of its customers, this is the place for you. "The importance of younger adults" uses financial modelling to explain the importance of recruiting teenage smokers to replace the dying older ones before it's too late, and explains that "repeated government studies have shown less than one third of smokers start after age 18 [and] only 5% of smokers start after age 24." "Youth cigarette – new concepts" from Marketing Innovations Inc takes these ideas further, into cola and apple flavour cigarettes, because "apples connote goodness and freshness".

How much did it matter if the researchers worked for the tobacco companies? A lot: the risks of Alzheimer's associated with smoking reported by these papers were on average about a third lower than those conducted by others, and they produced many papers showing cigarettes were protective. If you exclude these 11 papers, and look only at the remainder, your chances of getting Alzheimer's are vastly higher: comparing a smoker against a non-smoker, the odds are higher by 1.72 to 1.

So does that mean we can ignore all research that comes from people who disgust us? In Nazi Germany two researchers, Schairer and Schöniger, worked on biological theories of degenerate behaviour under Professor Karl Astel, who helped organise the operation that murdered 200,000 mentally and physically disabled people.

In 1943 the researchers published a well-conducted study demonstrating a relationship between smoking and lung cancer. Their paper wasn't mentioned in the classic Doll and Bradford Hill paper of 1950, it was referred to only four times in the 60s, once in the 70s, and then not again until 1988, despite providing a valuable early warning on a killer that would cause 100 million early deaths in the 20th century. It's not obvious what you do with evidence from untrustworthy sources, but it's always worth appraising its untrustworthiness with the best tools available.

Source: The Guardian, 05 March 2010
Link: http://bit.ly/bA6VFm

Call for 5% rise in tobacco tax 

An anti-smoking charity has called for a 5% increase on tobacco tax, saying it would lead to a drop in thousands of smokers and save millions in health costs.

A tax increase would discourage children from buying cigarettes and help adults quit the habit, according to a new report released by Action on Smoking and Health (ASH).

Raising tobacco prices through taxation by 5% above inflation would lead to a reduction in the number of smokers by 190,000 and save the NHS more than £20 million a year by cutting the cost of treating smoking-related diseases, the report says.

It would also reduce smoking-related absenteeism in the workplace, saving more than £10 million a year, increase government tax revenues by more than £500 million a year and result in wider economic benefits in the first five years of more than £270 million a year.

ASH is now calling on the Government to increase tobacco prices through taxation by 5% above inflation in its pre-Budget submission to the Treasury and by a minimum of the rate of inflation in subsequent years, with the support of organisations including the British Heart Foundation, Cancer Research UK and the Foundation for the Study of Infant Deaths (FSID).

Ash chief executive Deborah Arnott said: "Smoking is a childhood addiction and not an adult choice. By increasing tobacco taxation we help to discourage children from buying cigarettes. An above-inflation rise would also help adults stop smoking."

Howard Reed, who authored the report, said: "The economic analysis and forecasts in this report clearly show that an above-inflation rise in the price of tobacco is good for the health of the individual as well as for the health of the country."

Joy Townsend, emeritus professor of health economics and primary care at the London School of Hygiene and Tropical Medicine, said the Government should act on the report's recommendations.

She said: "This is an excellent and valuable report. It uses sound well-developed economic models which illustrate most effectively how great an impact raising taxes can have in reducing the demand for tobacco, and the clear and significant benefits for both public health and public finances."

FSID director Joyce Epstein said: "Scientific evidence shows that every year the lives of over 100 UK infants could be saved if no pregnant woman smoked. Smoking by fathers increases the risk of infant death as well. Our organisation supports increasing the price of tobacco because it will encourage smokers to consider quitting and so protect their children."

Links to further coverage:

BBC News:http://bit.ly/bnPZKM

ITN: http://bit.ly/9rzlkq

Reuters UK: http://bit.ly/ak7LcJ

Financial Times: http://bit.ly/bdkvqI
 

Source: The Daily Star, 06 March 2010
Link: http://bit.ly/9aR1EP

Smoking tied to lung cancer in women with HIV

Women infected with HIV or at risk of becoming infected with HIV, the virus that causes AIDS, appear more likely to develop lung cancer than women in the general population, possibly because they are much more likely to smoke cigarettes, study findings hint.

People with HIV have a much higher risk for many cancers. Still, it is unclear whether HIV infection plays a role in the development of lung cancer, Dr. Alexandra M. Levine, at City of Hope National Medical Center in Duarte, California, and colleagues note in the Journal of Clinical Oncology.

To investigate, they compared lung cancer cases in 2,651 HIV-infected and 898 at-risk but uninfected women, who were 35 years old on average, with lung cancer cases estimated to occur among similarly aged women in the general population.

"We found a substantially increased risk of lung cancer among both HIV-infected and at-risk uninfected women compared with population-based expectations," the team reports.

Specifically, population estimates suggested that the researchers would find between four and five lung cancer cases. Instead, over five years of follow up, they found 14 lung cancers - 12 in HIV-infected women and two in women at risk for HIV infection.

However, further analysis revealed that only smoking history and duration "were significantly associated with lung cancer" in the women with HIV or at risk for HIV infection.

Approximately two-thirds of women in the HIV group smoked. All of the women that developed lung cancer smoked, and over their lifetime smoked about double the amount of cigarettes as their lung cancer-free peers.

"As such, the development and implementation of smoking cessation programs aimed at HIV-infected persons will be of increasing importance," the investigators wrote.

There were no lung cancer cases among the women who were lifetime non-smokers.

Several studies, Levine and colleagues note, have shown a significant increase in lung cancer among HIV-infected patients since the introduction of highly active AIDS drugs. Yet, they found no difference in lung cancer development among women infected with HIV before or after the availability of powerful AIDS drugs, suggesting, they say, that lung cancer is not associated with the use of AIDS drugs.

"The precise role of HIV infection, per se, in terms of the development or progression of lung cancer" needs further study, the researchers conclude.

Source: Reuters, 05 March 2010
Link: http://bit.ly/aj7bxr

London Fire Brigade issues warning about cigarettes

Firefighters are reminding people to take extra care with cigarettes, ahead of National No Smoking Day on Wednesday. 

Figures released from London Fire Brigade show that smoking materials, including cigarettes, matches and cigars, are the greatest cause of fatal fires in London's homes.

About 40 per cent of fire deaths in the home are caused by smoking materials.

London Fire Brigade’s assistant commissioner for community safety, Andy Hickmott, said: “The health risks associated with smoking are well known but most people don’t realise that smoking also vastly increases the risk of having a fire in your home.

“It’s absolutely vital you ensure your cigarette is completely out when you’ve finished smoking it. If you don’t, you risk causing a fire which could destroy not only your home, but also your life."

Source: Guardian Series, 06 March 2010
Link: http://bit.ly/biJFzj