Editorial
Time to Divest From Tobacco-Funded Research Fadlo R. Khuri, MD and Suresh S. Ramalingam, MD
A few months ago, the 2 of us were surprised to receive a thoughtful letter in response to a recent article in Cancer with a disclosure of ongoing support from tobacco companies. The author hailed from a mainstream academic institution and the arguments in the letter were critical and sound, but espoused a view held by the tobacco companies. This led us to examine our policy on publications from physicians and scientists whose work is funded by tobacco companies. As of this date, Cancer has not had a policy for editorially rejecting scientific work or correspondence directly funded by tobacco companies or their subsidiaries. That changes as of this issue, when we will no longer consider any work that is funded directly or indirectly from tobacco companies or their subsidiaries. This should be distinguished from organizations that sponsor research from funds won by the states and the federal government of the United States (and indeed from other countries) as part of tobacco settlements. The settlements were intended to begin the process of making (partial) amends for the devastating effects that tobacco products have unleashed on human health across the globe, and therefore are intended to promote research and care toward alleviating the suffering of affected individuals. This year alone, more than 5 million people will die of tobacco-related diseases globally,1 with even more tobaccorelated diseases recently annotated in a recent issue of The New England Journal of Medicine.2 At the present rate of growth, tobacco smoking is estimated to result in approximately 1 billion deaths in this century.3 These astounding figures should give everyone reason to pause and reflect on measures that each of us can undertake to promote research, educate the public, and, more importantly, prevent the spread of misinformation propagated by the tobacco companies. We are reminded of the consistently adversarial and deceptive positions taken by tobacco-producing companies toward the US Food and Drug Administration, the Surgeon General, and the academic community for trying to set the record straight on the harmful effects of smoking tobacco products. The tobacco companies have not only undermined research and educational efforts directed against smoking, but have often pursued unethical approaches to promote nicotine addiction.4,5 Unfortunately, although this has clearly profited their business, it has dealt a heavy blow to human health across the continents. To continue to accept work tainted by a close association with and sponsorship from these companies strikes us as morally indefensible and profoundly hypocritical. We have decided to take this stand to help clarify and bring to light the continued decisions of big tobacco to support research in the name of muddying the waters. Enough is enough. In recent years, journal editors have developed ways to promote disclosure and regulate research studies funded by pharmaceutical companies. We acknowledge that there is room for potential bias in research published by individuals who have received funding from pharmaceutical companies, and the academic community should continue rigorous efforts to address this issue. However, this cannot be considered in the same light as research funded by tobacco companies, whose overall goals are far removed from improving human health. Later this year, we will publish a special issue of Cancer focused on the devastating effects of tobacco-related diseases in China, as well as the research being performed to improve the health of individuals at risk. This issue features, among its guest editors and authors, some of the preeminent physicians, epidemiologists, and scientists who focus on tobaccorelated cancers in Earth’s most populous nation. More on that effort later, but suffice to say that, unconstrained by US and North American criteria for advertising and marketing their wares to young people, and not forced to reveal the full risks and true nature of the devastation caused by their life-threatening and life-shortening products, tobacco companies continue to wreak immeasurable havoc on the health of the global population.
Corresponding author: Fadlo R. Khuri, MD, Department of Hematology and Medical Oncology, Emory University School of Medicine, Winship Cancer Institute, 1365 Clifton Rd NE, Bldg C-3094, Atlanta, GA 30322; Fax: (404) 778-1267; [email protected] Department of Hematology and Medical Oncology, Emory University School of Medicine, Winship Cancer Institute, Atlanta, Georgia. DOI: 10.1002/cncr.29361, Received: February 25, 2015; Accepted: February 25, 2015, Published online March 26, 2015 in Wiley Online Library (wileyonlinelibrary.com)
2294
Cancer
July 15, 2015
Editorial/Khuri and Ramalingam
Smoking in the United States is “down” to 19% of the population, but there are over 90 million current and former smokers in the year 2015.6 Greater than 2 billion people smoke tobacco products worldwide and this is only poised to increase unless more effective tobacco control measures are implemented.7 Fifty-one years after the landmark Surgeon General’s report stewarded by the remarkable Luther Terry, a recent report from the Centers for Disease Control and Prevention found that electronic cigarette smokers were more than twice as likely to consider smoking a tobacco-burning cigarette.8 The portal of entry for smoking for the next generation is already here, and if the Food and Drug Administration does not carefully regulate electronic cigarettes, this Trojan horse for the next generation will slip seamlessly into the mainstream of youth and adolescents everywhere. Just in recent years, tainted research concerning the effects of vaccines against infections set us behind in the control of communicable diseases.9 This reminds us not to underestimate the potential of even one single publication to influence public opinion and behavior in today’s world. These are just some of the reasons that we, on behalf of the Journal, have decided that it is time to say “no more” to all tobacco industry-funded work. We acknowledge that some might criticize us for taking away a forum for the discussion of research funded by the tobacco companies. Some might say that we are late to take up this course. Regardless, we are proud to join the increasing list of journals that have taken this stance against the publication of tobacco industry-funded research.
Cancer
July 15, 2015
We urge the editors of other scientific and medical journals to join those who have led on this topic. It is well past time for a change in this unacceptable status quo. FUNDING SUPPORT No specific funding was disclosed.
CONFLICT OF INTEREST DISCLOSURES Dr. Ramalingam has acted as a paid member of the advisory boards of Amgen, AstraZeneca, Boehringer Ingelheim, Lilly, Genentech, Novartis, Gilead, Ariad, Celgene, and Bristol-Myers-Squibb.
REFERENCES 1. World Health Organization. WHO Report on the Global Tobacco Epidemic, 2011. Geneva, Switzerland: World Health Organization; 2011. 2. Carter BD, Abnet CC, Feskanich D, et al. Smoking and mortality– beyond established causes. N Engl J Med. 2015;372:631-640. 3. Jha P. Avoidable global cancer deaths and total deaths from smoking. Nat Rev Cancer. 2009;9:655-664. 4. Tong EK, Glantz SA. Tobacco industry efforts undermining evidence linking secondhand smoke with cardiovascular disease. Circulation. 2007;116:1845-1854. 5. Cummings KM, Brown A, O’Connor R. The cigarette controversy. Cancer Epidemiol Biomarkers Prev. 2007;16:1070-1076. 6. Agaku IT, King BA, Husten CG, et al; Centers for Disease Control and Prevention (CDC). Tobacco product use among adults–United States, 2012-2013. MMWR Morb Mortal Wkly Rep. 2014;63:542-547. 7. Ng M, Freeman MK, Fleming TD, et al. Smoking prevalence and cigarette consumption in 187 countries, 1980-2012. JAMA. 2014; 311:183-192. 8. Bunnell RE, Agaku IT, Arrazola RA, et al. Intentions to smoke cigarettes among never-smoking US middle and high school electronic cigarette users: National Youth Tobacco Survey, 2011-2013. Nicotine Tob Res. 2015;17:228-235. 9. Horton R. The lessons of MMR. Lancet. 2004;363:747-749.
2295
Time to Divest From Tobacco-Funded Research Fadlo R. Khuri, MD and Suresh S. Ramalingam, MD
A few months ago, the 2 of us were surprised to receive a thoughtful letter in response to a recent article in Cancer with a disclosure of ongoing support from tobacco companies. The author hailed from a mainstream academic institution and the arguments in the letter were critical and sound, but espoused a view held by the tobacco companies. This led us to examine our policy on publications from physicians and scientists whose work is funded by tobacco companies. As of this date, Cancer has not had a policy for editorially rejecting scientific work or correspondence directly funded by tobacco companies or their subsidiaries. That changes as of this issue, when we will no longer consider any work that is funded directly or indirectly from tobacco companies or their subsidiaries. This should be distinguished from organizations that sponsor research from funds won by the states and the federal government of the United States (and indeed from other countries) as part of tobacco settlements. The settlements were intended to begin the process of making (partial) amends for the devastating effects that tobacco products have unleashed on human health across the globe, and therefore are intended to promote research and care toward alleviating the suffering of affected individuals. This year alone, more than 5 million people will die of tobacco-related diseases globally,1 with even more tobaccorelated diseases recently annotated in a recent issue of The New England Journal of Medicine.2 At the present rate of growth, tobacco smoking is estimated to result in approximately 1 billion deaths in this century.3 These astounding figures should give everyone reason to pause and reflect on measures that each of us can undertake to promote research, educate the public, and, more importantly, prevent the spread of misinformation propagated by the tobacco companies. We are reminded of the consistently adversarial and deceptive positions taken by tobacco-producing companies toward the US Food and Drug Administration, the Surgeon General, and the academic community for trying to set the record straight on the harmful effects of smoking tobacco products. The tobacco companies have not only undermined research and educational efforts directed against smoking, but have often pursued unethical approaches to promote nicotine addiction.4,5 Unfortunately, although this has clearly profited their business, it has dealt a heavy blow to human health across the continents. To continue to accept work tainted by a close association with and sponsorship from these companies strikes us as morally indefensible and profoundly hypocritical. We have decided to take this stand to help clarify and bring to light the continued decisions of big tobacco to support research in the name of muddying the waters. Enough is enough. In recent years, journal editors have developed ways to promote disclosure and regulate research studies funded by pharmaceutical companies. We acknowledge that there is room for potential bias in research published by individuals who have received funding from pharmaceutical companies, and the academic community should continue rigorous efforts to address this issue. However, this cannot be considered in the same light as research funded by tobacco companies, whose overall goals are far removed from improving human health. Later this year, we will publish a special issue of Cancer focused on the devastating effects of tobacco-related diseases in China, as well as the research being performed to improve the health of individuals at risk. This issue features, among its guest editors and authors, some of the preeminent physicians, epidemiologists, and scientists who focus on tobaccorelated cancers in Earth’s most populous nation. More on that effort later, but suffice to say that, unconstrained by US and North American criteria for advertising and marketing their wares to young people, and not forced to reveal the full risks and true nature of the devastation caused by their life-threatening and life-shortening products, tobacco companies continue to wreak immeasurable havoc on the health of the global population.
Corresponding author: Fadlo R. Khuri, MD, Department of Hematology and Medical Oncology, Emory University School of Medicine, Winship Cancer Institute, 1365 Clifton Rd NE, Bldg C-3094, Atlanta, GA 30322; Fax: (404) 778-1267; [email protected] Department of Hematology and Medical Oncology, Emory University School of Medicine, Winship Cancer Institute, Atlanta, Georgia. DOI: 10.1002/cncr.29361, Received: February 25, 2015; Accepted: February 25, 2015, Published online March 26, 2015 in Wiley Online Library (wileyonlinelibrary.com)
2294
Cancer
July 15, 2015
Editorial/Khuri and Ramalingam
Smoking in the United States is “down” to 19% of the population, but there are over 90 million current and former smokers in the year 2015.6 Greater than 2 billion people smoke tobacco products worldwide and this is only poised to increase unless more effective tobacco control measures are implemented.7 Fifty-one years after the landmark Surgeon General’s report stewarded by the remarkable Luther Terry, a recent report from the Centers for Disease Control and Prevention found that electronic cigarette smokers were more than twice as likely to consider smoking a tobacco-burning cigarette.8 The portal of entry for smoking for the next generation is already here, and if the Food and Drug Administration does not carefully regulate electronic cigarettes, this Trojan horse for the next generation will slip seamlessly into the mainstream of youth and adolescents everywhere. Just in recent years, tainted research concerning the effects of vaccines against infections set us behind in the control of communicable diseases.9 This reminds us not to underestimate the potential of even one single publication to influence public opinion and behavior in today’s world. These are just some of the reasons that we, on behalf of the Journal, have decided that it is time to say “no more” to all tobacco industry-funded work. We acknowledge that some might criticize us for taking away a forum for the discussion of research funded by the tobacco companies. Some might say that we are late to take up this course. Regardless, we are proud to join the increasing list of journals that have taken this stance against the publication of tobacco industry-funded research.
Cancer
July 15, 2015
We urge the editors of other scientific and medical journals to join those who have led on this topic. It is well past time for a change in this unacceptable status quo. FUNDING SUPPORT No specific funding was disclosed.
CONFLICT OF INTEREST DISCLOSURES Dr. Ramalingam has acted as a paid member of the advisory boards of Amgen, AstraZeneca, Boehringer Ingelheim, Lilly, Genentech, Novartis, Gilead, Ariad, Celgene, and Bristol-Myers-Squibb.
REFERENCES 1. World Health Organization. WHO Report on the Global Tobacco Epidemic, 2011. Geneva, Switzerland: World Health Organization; 2011. 2. Carter BD, Abnet CC, Feskanich D, et al. Smoking and mortality– beyond established causes. N Engl J Med. 2015;372:631-640. 3. Jha P. Avoidable global cancer deaths and total deaths from smoking. Nat Rev Cancer. 2009;9:655-664. 4. Tong EK, Glantz SA. Tobacco industry efforts undermining evidence linking secondhand smoke with cardiovascular disease. Circulation. 2007;116:1845-1854. 5. Cummings KM, Brown A, O’Connor R. The cigarette controversy. Cancer Epidemiol Biomarkers Prev. 2007;16:1070-1076. 6. Agaku IT, King BA, Husten CG, et al; Centers for Disease Control and Prevention (CDC). Tobacco product use among adults–United States, 2012-2013. MMWR Morb Mortal Wkly Rep. 2014;63:542-547. 7. Ng M, Freeman MK, Fleming TD, et al. Smoking prevalence and cigarette consumption in 187 countries, 1980-2012. JAMA. 2014; 311:183-192. 8. Bunnell RE, Agaku IT, Arrazola RA, et al. Intentions to smoke cigarettes among never-smoking US middle and high school electronic cigarette users: National Youth Tobacco Survey, 2011-2013. Nicotine Tob Res. 2015;17:228-235. 9. Horton R. The lessons of MMR. Lancet. 2004;363:747-749.
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