Nature Medicine | Spoonful of Medicine

Smoke and Mirrors

The tobacco industry produces a product that, used as intended, kills millions of people each year. So it seems a lot to ask the industry to assume ethical standards in another of its favorite endeavors—funding scientific research.

The tobacco industry is up to some of its usual antics, as reported by

The New York Times. It seems tobacco money helped fund one of the most controversial studies to recently emerge from The New England Journal of Medicine.

The study concluded that the widespread use of CT scans could prevent 80 percent of lung cancer deaths.

The primary author of the study, Claudia Henschke of Weill Cornell Medical College declared funding through a little-known group, the Foundation for Lung Cancer: Early Detection, Prevention and Treatment. It took an investigative

reporter checking tax records to discover that foundation is actually funded by the parent company of the Liggett group, which manufactures several cigarette brands. Henschke did not reveal the source of the foundation’s money to the journal—what’s more, she helped create the foundation and is its president; the dean of Weill Cornell is a director.

The study’s findings obviously are favorable to the tobacco industry. But they have been controversial in part because early screening can lead to unnecessary procedures for spots on a CT scan that are not an imminent threat to health. A $200 million follow-up trial is now under way at the NCI.

What the tobacco linkage will mean for the validity of the study in the minds of experts remains to be seen—although this quote, from Catherine D. DeAngelis, the editor of The Journal of the American Medical Association, is telling:

I would never publish a paper dealing with lung cancer from a person who had taken money from a tobacco company.

Why so much fuss?

As DeAngelis is undoubtedly aware, the industry’s influence in this study fits into an overall pattern.

Tobacco companies fund research that has the potential to minimize the severe effects of smoking, and they also underwrite unrelated, legitimate, research, to bolster their reputation. It’s also not unusual for tobacco companies to keep their fingerprints away from the research they fund.

Tobacco companies also have a well-documented history of trying to stir up ‘debate’ about the dangers of smoking and second-hand smoke. Their support of research to bolster their arguments helped, for many years,

create public uncertainty about the dangers of tobacco and staved off anti-tobacco legislation. Sowing doubt about generally-accepted science is a tactic that foes of global warming legislation successfully borrowed; indeed, the tobacco industry spawned some of the ‘think tanks’ that now fight against global-warming legislation by supporting industry-friendly scientists.

Manipulating science has been a core tactic of the tobacco industry for years. So it’s not surprising that some schools, such as Harvard’s School of Public Health, have banned tobacco money. The University of California system refused to follow suit, but they have implemented a system of extra scrutiny over research funded by the tobacco industry. Opponents of a ban in California argued that it would constrain ‘academic freedom.’

What do you think? Does the source of funding for the NEJM study throw its findings into doubt? Or is this all a bunch of fuss about nothing?

Finally, is it fair for the editor of the Journal of the American Medical Association to refuse lung cancer papers funded by the tobacco industry?


  1. Report this comment

    Alan Dove said:

    On the issue of the funding source clouding the findings, it’s important to emphasize that this is a special case. Not only was the PI funded by the tobacco industry, but both she and her Dean apparently conspired to hide that fact from the journal. If the funding source didn’t create a conflict of interest, why not disclose it fully?

    DeAngelis, meanwhile, seems to be taking a cheap shot at a competing publication that is widely considered more credible. In haughtily insisting that her journal would never publish a tobacco-funded study, she conveniently ignores that the NEJM was apparently more victim than co-conspirator in this case. We can’t honestly expect scientific journals to file FOIA requests and pore through the tax records of every funding organization cited by an author, can we?

  2. Report this comment

    Bo Yu said:

    The source of funding is a problem. So many trials are held in the world funded by companies. They won’t expect to see the result telling something bad against their products. Actually, at least in China, some of the trial are final products oriented. We won’t be surprised to see a famous prof. reading the “advertisement” result of an “important” trial. But we still have to keep in mind that most of the patients really get medical care.

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    Chris Muller said:

    I agree with Alan Dove that all sources of funding and any conflict of interest should be disclosed fully by all authors (for their own credibility). I also agree that DeAngelis is making an empty gesture by refusing to publish an article. It is not up to a journal to play games on ethical pretences unless you’re talking of an author or university or funding source being some anti-human agency such as active genocide promoters based on strong discriminatory factors such as race, sex etc. Tobacco manufacturers sell their product to anyone who will buy them. It’s also the buyers’ responsibility to decide what is good for them. Let the tobacco and potato chip and soft drink manufacturers all fund studies and let’s read what they have to say. Ultimately, we should exercise our own judgement and discretion in everything we do in life. That is not transferable.

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    Andrew Marvell said:

    I heard that some tobacco companies were required to sponsor research about the link between smoking and cancer as part of a settlement in court some time ago. Are we sure this instance of “hidden” funding doesn’t have to do with this settlement?

    In any case, I think the reaction of the JAMA and NEJM editors has been a bit melodramatic, but this is what’s expected from them, right? They have so bought into the idea of full disclosure of CFIs that, whenever a case like this crops up, they are supposed to intone some sort of cathartic “mea culpa”.

    It’s a little like the reaction you expect from the Pope when someone brings up the idea of, say, legalizing abortion. You expect him to pound on his chest and, if he could, spit fire.

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    Sergio Stagnaro MD said:

    Tobacco is notoriously a great business! But, on the base of 52 year-long-clinical experience, a scientific consideration is worthy here, in my opinion.

    One essential problem facing doctors treating patients affected by whatever disorder is certainly tobacco smoking, one of paramount risk factor. However, in all diseases, different in nature, we have to consider beside EBM also the Single Patient Based Medicine (see in internet).

    Actually, apart from the well-known negative influences of tobacco on biological systems and the importance of genetic predisposition , as Oncological Terrain and Inherited Oncological Real Risk, for instance(ibidem), as far as the onset of a lot of disorders is concerned, I should underline here tobacco smoking pathological powerful influence on tissue oxygen supply to all biological systems (Stagnaro Sergio, Stagnaro-Neri Marina. Introduzione alla Semeiotica Biofisica. Il Terreno oncologico”. Travel Factory SRL., Roma, 2004). This varies in intensity among individuals, in relation to a congenital mitochondrial cytopathology, termed Congenital Acidosic Enzyme-Metabolic Histangiopathy (ibidem). From the above brief remarks, although the biological influences of tobacco smoking results very different among individuals, in relation to their biophysical-semeiotic constitutions, it is necessary and urgent to regulate tobacco products by means of a nicotine regulation authority.

    In addition I think that every doctor, all over the world, has a moral obligation of informing their patients about the terrible dangers of this too silent killer.