By Danielle Jones
The vaping community has always identified Big Tobacco as Public Enemy #1 – and for good reason. Cigarettes are on track to kill 1 billion people by the end of this century, and vapor products were born from the desperate desire to escape that fate. No one disagrees that tobacco companies are responsible for untold premature deaths, but the question is: Are they really vaping’s biggest adversary?
Gums, patches, inhalers, and pills made by pharmaceutical giants like GlaxoSmithKline (GSK), Johnson & Johnson, and Pfizer are the only smoking cessation products recommended to people in the United States. But one of the little-known facts about these products is that they have an extremely low success rate. In 2011 researchers at The Harvard School of Medicine studied long term quit rates and found that nicotine replacement therapies (NRTs) were no more effective than quitting cold turkey. A more recent study, published this year in the New England Journal of Medicine, found that vapor products are nearly twice as effective as NRTs for quitting smoking. What, then, is the pharmaceutical industry’s motivation for continuing to sell ineffective products?
If pharmaceutical companies make money selling tools to help smokers quit, but they also make money off smokers continuing to smoke, that could be one explanation. In 2002 researchers from the University of California, San Francisco published their findings after reading through previously secret tobacco documents, now made public as a part of the Master Settlement Agreement (MSA). They discovered deep financial ties that exist between tobacco companies and pharmaceutical companies, specifically that cigarette manufacturers purchase many of their raw materials from chemical and pharmaceutical companies. In order to preserve these multi-million dollar deals, the pharmaceutical companies agreed not to include any anti-smoking messaging in the marketing campaigns for their quit-smoking products. Take a look at any patch, gum, or Chantix commercial, and you’ll notice the commercials never mention that smoking is bad for your health. Their message is very simple: “IF you want to quit, we have products to make it easier.”
The reality is that whether you buy cigarettes, or you buy quit-smoking products, and especially if you become ill from diseases attributed to smoking– you’re always a customer of Big Pharma. The only way they lose you is if you quit smoking with a product that doesn’t belong to them – like vaping – and dramatically reduce your risk of smoking-related diseases. Vaping is a disruptive technology that has thrown a wrench into the works of the Tobacco-Pharma merry-go-round.
Let’s follow the money and examine three ways the pharmaceutical industry works to preserve this carefully constructed profit machine.
Dr. Peter Rost, former Vice President of Pfizer and author of “The Whistleblower, Confessions of a Healthcare Hitman,” explains the relationship between pharmaceutical companies and the “science” they use in an interview for “One More Girl,” a KickStarter funded documentary which investigates malfeasance regarding the approval and marketing of Gardasil.
“Universities, health organizations – everybody that I’ve encountered in my former career as a pharmaceutical executive are out there with their hands out. Everybody is begging for money. Nobody has any money. The government doesn’t have any money; universities don’t have money – nobody has money. The only ones that have money are these big multinational corporations [pharma companies]. And they have lots of money. And they use that money to basically buy influence. And the way it’s done is #1 you give these organizations and institutions grants for various kinds of research, you develop research together with them, you establish friends, you make sure that they become beholden to you, and you also pay individual professors and doctors and researchers directly, you may pay them a speakers fee to travel around the country $1,000 or $2,000 per day, sometimes more. You give them money for educational programs where they can make a profit, and then they put on these programs, and they are supposed to be 3rd party, independent from the company, which is all fine, but as you and I can both imagine if you have a promotional budget at a corporation you’re probably going to give that money to the universities that do the programs that most support your drug. And the ones that don’t or are critical in any way, shape or form – they’re not going to get anything. And everybody obviously knows that this is how things work and that means that even if you can officially claim, ‘well this is arm’s length, we didn’t have anything to do with it, we just gave them a grant, they can do whatever they want with it’ the reality is they’re not going to continue to get money unless they’re saying what you want them to say. They know it, you know it, it’s only maybe the public that doesn’t know it. And that’s how you influence the medical establishment simply with money.”
Examples of following the money to illuminate these influences are plentiful. A seemingly above-board grant to a university tells a more covert tale. In 2015, The Robert Wood Johnson Foundation (RWJF) gave a $3 million grant to the UCSF School of Medicine. RWJF is a non-profit organization created by Johnson & Johnson, the pharmaceutical company that manufactures the majority of over-the-counter quit-smoking products. RWJF holds upwards of $1 billion worth of Johnson & Johnson stock, so it’s safe to say that the foundation has a vested interest in their success and the success of their products. The UCSF School of Medicine is the home of one of the most outspoken and ferocious vaping opponents in the scientific community, Stanton Glantz, Professor of Medicine. One of Glantz’s primary talking points is that he believes vaping is attracting
gigantic numbers of kids who probably would never pick up a cigarette, but are initiating nicotine use with e-cigarettes and then transitioning to cigarettes later."
One year after receiving the grant from RWJF, UCSF released a study claiming e-cigarettes don’t help smokers quit. Two years later, they released another study claiming adolescents who use e-cigarettes are more likely to start smoking tobacco cigarettes within one year.
Grants awarded under the guise of promoting objective research are plentiful. Johns Hopkins Bloomberg School of Public Health received $450,000 in grants from the RWJF in 2014 for the specific purpose of studying electronic cigarettes. The following year, Johns Hopkins released a study claiming e-cigarettes compromise the immune system in the lungs and have the same dangerous chemicals as regular cigarettes. Two years later, they published another study claiming e-liquid contains high levels of toxic metals.
The influence of pharmaceutical companies extends even further beyond individual university researchers into our government agencies. For example, the Centers for Disease Control and Prevention (CDC) has a track record of allowing pharmaceutical companies that donate to the CDC Foundation to influence their recommendations. In 2012, the CDC was investigated for conflicts of interest and ethics violations related to “conditional donations” from pharmaceutical companies that manufacture tests for hepatitis C. After receiving these donations, the CDC ran a major public campaign encouraging hepatitis C testing, even though there was serious debate about the accuracy of the tests. An article published in the British Medical Journal examined these funding conflicts and questioned how the CDC could be objective with the amount of funding it accepts from the pharmaceutical industry. Additionally, the CDC’s former Director, Dr. Brenda Fitzgerald, resigned in 2018 after evidence was found that she had personal financial ties to both the pharmaceutical and tobacco industries. These institutional conflicts of interest raise questions about the anti-vaping interpretations of the National Youth Tobacco Surveys the CDC has been releasing since 2011.
Another severe example of conflict of interest involves Jonathan Samet, Neal Benowitz, and Jack Henningfield. A federal lawsuit in 2014 found that all three men were being paid by pharmaceutical companies while they served as advisors to the Food and Drug Administration (FDA) on the Tobacco Products Scientific Advisory Committee (TPSAC), of which Samet was the President. TPSAC reviews and evaluates tobacco product marketing applications and advises the FDA on matters involving tobacco regulations.
Illustrations by Erik Deangelis
The federal judge in the case involving Samet, Benowitz, and Henningfield ruled that the conflicts of interest were so severe that the men had to be immediately removed from the advisory committee. Additionally, the FDA was prohibited from using one of their reports on menthol cigarettes. The judge stated, “The presence of conflicted members on [the FDA Tobacco Products Scientific Advisory Committee, TPSAC] irrevocably tainted its very composition and its work product” and “the committee’s findings and recommendations…are, at a minimum, suspect, and at worst, untrustworthy.”
Once the pharmaceutical industry has the science they want--whether it’s legitimate or not--the next thing they need is the support of widely trusted and allegedly objective organizations whose priority is public health. If those groups are on board, it legitimizes the science--regardless of how controversial it is. The pharmaceutical industry’s ability to infiltrate and influence health advocacy groups and government agencies is unprecedented. Many examples of these intertwined relationships exist if you know where to look.
In 1996 the American Cancer Society (ACS) signed an exclusive multi-million dollar deal with GSK, the U.S. sellers of Nicorette and NicoDermCQ. The deal was simple – ACS sold GSK the use of its logo on product packaging and in advertisements in exchange for millions of dollars. The American Lung Association (ALA) did the same thing with McNeil (owned by Johnson & Johnson), maker of the Nicotrol patch. These were not isolated incidents. This was a major source of funding for these groups. The ironic thing is, these trusted organizations insisted they did not actually endorse the products that their logos appeared on. Naturally, you can imagine how confusing that was for consumers, which is why there were numerous lawsuits against the pharma companies for this misleading advertising tactic. As a result, the logos have since been removed from their packaging.
Another advocacy group you might be familiar with is the Campaign for Tobacco-Free Kids (CTFK). This group is extremely vocal in its anti-vaping sentiments and is considered trustworthy by the general public, lawmakers, and regulators because their only goal is supposedly to protect the children. Surprisingly (or not, at this point) CTFK was created in 1995 by the Robert Wood Johnson Foundation, the American Cancer Society, and the American Heart Association. The RWJF has contributed over $100 million to CTFK, which if you recall, means that the advocacy organization is partially funded by sales of Johnson & Johnson’s NRT products.
The RWJF has also given over $100 million to the American Cancer Society, the American Heart Association, the American Lung Association, and others by way of grants. Coincidentally, these are the same organizations that always show up to legislative hearings testifying in support of anti-vaping legislation.
Pharmaceutical companies also garner support from larger institutions like, for example, the National Institutes of Health (NIH) – the primary agency of the U.S. government responsible for public health research. In 2008 an expert panel from within the NIH released guidelines recommending that every single smoker in the U.S. should be treated with pharmaceutical products ONLY – as in nicotine gums, patches, lozenges, inhalers, and prescription medication like Chantix – in order to quit smoking. The guidelines also advise against quitting “cold turkey,” or any other non-medical smoking cessation method. In yet another example of a brazen conflict of interest, nine members of the expert panel received money from the pharmaceutical companies that manufacture the same smoking cessation products being exclusively recommended by the NIH guidelines.
The FDA is also currently being accused of inappropriate relationships with the pharmaceutical industry. In February, CBS’s 60 Minutes aired a piece on the opioid epidemic in which it presented allegations and supporting evidence that the FDA illegally modified guidance to consumers and medical professionals. The changes that FDA made to the required warning label on prescription opioid pain medication allows manufacturers to market their drugs as approved for daily, long-term use in managing chronic pain. This change was made without any evidence that the pain medication is safe for long-term use. Pressured by the pharmaceutical industry, the FDA approved Oxycontin for long-term use in 2001 and expanded the use of opioids to anyone with any chronic pain. Years later, we are in the grips of an opioid epidemic that has killed more Americans than gun violence or breast cancer, and has contributed to a drop in U.S. life expectancy for the second year in a row.
Having examined how pharmaceutical companies influence the science they want, and the financial support they provide to legitimize it, let’s move on to how drug giants manipulate the law – the last piece of the puzzle that creates the change which impacts our everyday lives.
Since campaign contributions are a matter of public record, it’s easy to see that pharmaceutical companies have influence over politicians’ opinions about vaping that shapes laws and regulation. Take, for example, former Senator Frank Lautenberg of New Jersey, who received more than $460k in campaign contributions from pharma industry groups. He was one of the first politicians to publicly speak out against vaping in 2009. The previous year, Senator Lautenberg accepted the largest sum of contributions from pharma industry groups, totaling $141,000. Massachusetts Senator, Ed Markey, was quoted as saying that electronic cigarettes “should be put out of business.” He is also the senator responsible for urging the Department of Transportation to ban vapor products on airplanes in 2014. He has, so far, accepted a career total of more than $440,000 in campaign contributions from the pharmaceutical industry, the largest payments beginning in 2014. Other anti-vaping Senate Democrats, like Senator Sherrod Brown from Ohio and Senator Richard Blumenthal from Connecticut, have similar patterns of receiving hundreds of thousands of dollars from the pharmaceutical industry.
Since campaign contributions are regularly scrutinized, the pharmaceutical industry has another avenue for influencing public policy, one that they can easily dump millions of dollars into without anyone noticing.
The Robert Wood Johnson Foundation has paid out more than $22 million in grants to a company called ChangeLab Solutions, based in Oakland, California. California, if you recall, has been hit by some of the harshest anti-vaping legislation in the United States. A quick look at the ChangeLab Solutions website reveals an entire section dedicated to disinformation about vaping. The section also contains numerous documents and how-to guides for passing legislation that would regulate or ban vapor products, including pre-written draft bills for legislators to use. If you compare the drafts provided by ChangeLab to real bills being introduced and passed by cities and counties around California, you’ll find entire sections copied word for word from the ChangeLab Solutions documents.
One of the RWJF grants paid to ChangeLab Solutions, in the amount of $4 million, is titled “Supporting ChangeLab Solutions in developing law and policy tools to build healthy, equitable communities for children and families.” Strangely, 501(c)(3) organizations, like the RWJF, are prohibited from supporting attempts to influence legislation. It even says so on the foundation’s own website.
And let’s not forget about the CDC. The Affordable Care Act created a multi-billion dollar “slush fund” called the Prevention and Public Health Fund, which is controlled by the U.S. Department of Health and Human Services (HHS). Between 2010 - 2012, HHS used this money to give grants through the CDC by way of a program called Communities Putting Prevention to Work (CPPW). The CDC encouraged and allowed grant recipients to use this money to lobby for state and local policy changes, including tax increases on tobacco, smoke-free policies, and sugary beverage taxes. Why is that important? Primarily because lobbying using federal funds is illegal. But because it was a Democratic program, under a Democratic President, with a Democratic Attorney General, no action was taken against the CDC, other than a warning. One of these cases involved a CPPW advisory council at the Boston Public Health Commission advising the Mayor of Boston on the dangers of electronic cigarettes in 2011. That same year they passed a ban on using vapor products in public places.