International Scientific Forum on Alcohol Research (ISFAR) is Still Hiding Conflicts of Interest of Its Members

The International Scientific Forum on Alcohol Research (ISFAR) claims to be “an independent organization of scientists that prepares critiques of emerging research reports on alcohol and health.” The Forum describes itself as “an international group of invited physicians and scientists who are specialists in their fields and committed to balanced and well researched analysis regarding alcohol and health.” It is “a joint undertaking of Boston University School of Medicine in the United States and Alcohol in Moderation (AIM) of the United Kingdom. Its Co-Directors are R. Curtis Ellison, MD, Professor of Medicine & Public Health, Boston University School of Medicine, and Helena Conibear, Executive Director, Alcohol-in-Moderation (AIM), UK.”

The Rest of the Story

About a year and a half ago, I reported that ISFAR was hiding its conflicts of interest with Big Alcohol. At that time, ISFAR published a scathing review of a meta-analysis which concluded that moderate alcohol consumption does not reduce mortality as previously thought. The review contained statements from 14 members of ISFAR, and every one of the 14 blasted the study, with the review concluding that the study “markedly distorts the accumulated scientific evidence on alcohol and CVD [cardiovascular disease].”

It turns out that five of the Forum members who reviewed the article had conflicts of interest by virtue of either their having received research funding from the alcohol industry or serving on advisory boards of alcohol industry-funded organizations, yet none of these conflicts were disclosed.

Not only did ISFAR hide its conflicts of interest with alcohol companies on its web site, but it also hid these conflicts in a public interview.

More recently, one of the Forum members and reviewers was forced to publish a correction to a journal article because he failed to disclose that he is a beer industry consultant.

Has ISFAR reformed itself, and is it now disclosing the conflicts of interests of the reviewers who write its critiques?

The answer, unfortunately, is no.

Nowhere on its website does it list the specific conflicts of interest of its members/reviewers. Nowhere in its critiques does it disclose these conflicts of interest. And to top it all off, the biographies provided for its members do not disclose their conflicts of interest.

For example, Dr. de Gaetano’s bibliography fails to disclose that he consults for the beer industry — the precise conflict of interest for which he was forced to publish a correction in the Journal of the American College of Cardiology.

Dr. Estruth’s biography states that he is a member of the Advisory Board for “ERAB.” The reader is not told what ERAB stands for, hiding from the public the fact that ERAB is “supported by The Brewers of Europe, the voice of the brewing industry in Europe, whose members are the national brewing trade associations, representing more than 90% of European beer production.”

Ms. Stockley’s biography states that she works for the Australian Wine Research Institute, which it states is “an independent, not-for–profit research institution.” But it hides the fact that this Institute is funded by the alcohol industry. Far from being independent, the Australian Wine Research Institute is actually the “wine industry’s own research organisation.”

Dr. Teissedre’s biography fails to disclose that his research group received alcohol industry funding.

Dr. Waterhouse’s biography hides the fact that he has received alcohol industry research funding.

Dr. Skovenborg’s biography fails to disclose that he was on the Board of ERAB, which is funded by the alcohol industry.

Dr. Mattivi’s biography fails to disclose that he has received alcohol industry research funding.

Dr. Klatsky’s biography fails to disclose that in the past, he received alcohol industry funding.

Dr. Lanzmann-Petithory’s biography fails to disclose that in the past, she has received alcohol funding.

Dr. Gretkowsky’s biography fails to disclose that in the past, she has received alcohol funding.

So of the supposedly “independent” and “balanced” reviewers, at least 10 of them have conflicts of interest with the alcohol industry that are not disclosed on the web site, even in their own biographies.

Unfortunately, ISFAR continues to be essentially an industry front group that is providing highly biased reviews without readily disclosing the intricate details of the financial connections of many of its reviewers to the alcohol industry.

They should not fool anybody any longer. The time to end this scam operation is now. Especially in a period in which the federal government has basically tossed scientific objectivity out the window.

Sadly, what ISFAR is doing bears a strong resemblance to the fraudulent public relations activities of the tobacco industry many years ago. 

On a personal note, I feel somewhat ashamed that the Boston University School of Medicine has been playing a role in this scam, as ISFAR has been hosted, in part, by our medical center.

On a larger note, this story illustrates why the alcohol industry-funded NIAAA study of the potential cardiovascular benefits of moderate drinking is so problematic. The background research that informs the study is tainted by serious conflicts of interest. But the worst is yet to come — as I will reveal shortly, the research is not an objective attempt to get at the answer to this research question.

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CASAA Submits Comment to OMB Regarding CDC Campaign

Focus put on misleading “Tips From Smokers” campaign

In October 2017 the Centers for Disease Control and Prevention (CDC) submitted an information collection request titled “National Notifiable Diseases Surveillance System” to the Office of Management and Budget (OMB) for review and approval. The OMB subsequently requested comment from the public to determine whether or not the collection and evaluation of information generated from the CDC’s National Tobacco Prevention and Control Public Education Campaign (“The Campaign”) should continue to receive funding.

CASAA took this opportunity to make a strong statement condemning the misleading “Tips From Smokers” campaign, which included ads such as the ad pictured at the right. That particular ad included an accompanying story that stated “Months after using e-cigarettes, she ended up in the hospital with a collapsed lung…. Such wording was clearly an attempt to link her medical condition to the use of vapor products, rather than the fact that she continued to smoke up until her hospitalization.

In our comment to OMB, CASAA  noted:

  • The Campaign features misleading and inaccurate claims.
  • The Campaign is ineffective as designed and reported to date.
  • The Campaign does not adequately address the public health needs in that it promotes abstinence only, ignoring the lower opportunity costs along a continuum of risk reduction. 

CASAA recommended that The Campaign, “Tips from a Former Smoker,” be suspended and reworked to more adequately and truthfully educate the public. This will empower the smoking public to make a more informed choice about their tobacco use and health decisions.

CASAA strongly urged OMB to deny CDC’s request:

“It is time for the CDC to face the fact that The Campaign is inadequate to the task of promoting harm reduction in the smoking population. It is time that CDC change its focus from a nearly religious adherence to abstinence and align its mission with the core principle of public health – reduce the harm to the whole population, including smokers, through the promotion of harm reduction policies. It could do this best by recalling and retooling The Campaign towards promoting less harmful alternatives to combustible tobacco rather than presenting smokers with “Quit or Die” propaganda.”

The comment may be read here in its entirety:

Comment on CDC FR 2017-21122Comment on CDC FR 2017-21122.docx

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#VapesGiving – 2017!

CASAA is thrilled and honored to be a participating member of the inaugural fundraising event, #VapesGiving.

Hosted by the American Vaping Association (AVA), funds collected during #VapesGiving (December 13 – 19) will be distributed to more than twenty state and national associations working tirelessly to defend access to vapor products.

Because of a generous commitment from Naked 100, contributions through #VapesGiving will be matched dollar-for-dollar up to $190,000! Factoring in the matching commitment from Naked, #VapesGiving has already raised more than $10,000 in less than 24-hours!

Please help us make this inaugural event a resounding success by sharing this campaign with everyone you know who cares about access to low-risk, smoke-free vapor products.

Click here to contribute now!

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We are a united front!

Dear Members of the Vapor Community:

We write you today as a united front because the vapor industry is under attack and the future remains uncertain. We are all focused on the critical mission of making sure that Americans will continue to have access to the full range of vapor products that millions are using to quit smoking and improve our lives. We need your help to achieve this mission.

We all agree that there are short term and long term policy changes that must be made to ensure a robust vapor product industry in this country, but we are focused today on a near-term step — Changing the “Predicate Date” in Congress — which will allow all products on the market before 8/8/2016 to stay on the market and remain available to consumers.

The US House of Representatives has passed an appropriations bill which contains language that would modernize the 2007 predicate date for products newly deemed to be tobacco. But the Senate has not included similar language in its version of the bill. These two conflicting pieces of legislation will be negotiated in Congress in the near future, and we are going to need EVERYONE to weigh in!

In the coming days and weeks, we will be reaching out to our respective members with additional opportunities and guidance on how you can engage with your two Senators and your Representative and urge them to modernize the predicate date for vapor products. We hope that when we call on you, you will take a few minutes to ACT to save the vapor industry.

Thank you!


Related

  • Urge Congress to Support Cole-Bishop! (Click Here)
  • Say thank you to HR 1136 co-sponsors! (Click Here)

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First Major Action of Foundation for a "Smoke-Free World" Shows that It is Largely a Scam

I have already written about why I refused to participate in the activities of the Foundation for a Smoke-Free World, which I believe is essentially a front-group created by Philip Morris International (PMI) primarily to promote its business interests. I explained that if PMI were serious about creating a smoke-free world, it would stop aggressively marketing its deadly products throughout the world and stop opposing public health policies to reduce tobacco use.

The Foundation for a Smoke-Free World recently released a call for research proposals for preliminary projects that entail research to help the Foundation obtain the background information necessary for it to proceed effectively in its supposed mission to create a smoke-free world. By reviewing the call for proposals, we are now able to understand just how the Foundation is essentially a scam operation.

The Foundation calls for “scoping projects” to study strategies to reduce smoking. But nowhere in the five-page document does it mention anything about interventions to: (1) severely restrict or curtail cigarette advertising and marketing; (2) require plain packaging; (3) substantially increase cigarette taxes; (4) promote 100% smoke-free environments; and (5) heavily fund aggressive, state-of-the-art anti-smoking media campaigns.

In fact, the word “industry” appears only once, and it is not clear that marketing, taxation, clean indoor air, or counter-advertising are what the Foundation has in mind (especially since it groups “industry” with “farming”).

In contrast, the Foundation does want to support research on the role of genetics, physiology, individual choices and activities and environmental influences.

Frankly, this is all essentially a waste of time. We already know what interventions are most effective in reducing smoking rates. We don’t need more research to find out what works. What we need to do is to heavily fund programs to promote these tried and true policy strategies.

If the Foundation were serious about wanting to create a smoke-free world, then instead of wasting this money on research into topics like genetics and individual choices and activities, it would use its money to fund programs to implement – worldwide – policies and programs that we know are effective. These are: 1) severely restrict or curtail cigarette advertising and marketing; (2) require plain packaging; (3) substantially increase cigarette taxes; (4) promote 100% smoke-free environments; and (5) heavily fund aggressive, state-of-the-art anti-smoking media campaigns. It would also provide funding to create or supplement tobacco control infrastructure in countries throughout the world and to support the development of grassroots coalitions to promote policies to fight the tobacco industry.

In other words, these are all the programs that the Foundation fails to mention at all in its call for proposals.

Sometimes, what you don’t say is more important than what you do say. That is certainly the case here. The Foundation says nothing about the most effective interventions to reduce smoking, while focusing almost exclusively on areas that have little to no relevance.

You might argue that the Foundation can’t fund programs to promote bans on cigarette marketing, high cigarette taxes, plain packaging, and aggressive anti-smoking media campaigns that attack the industry because it is funded by the tobacco industry. Well … that’s exactly the point. A foundation funded by a large, multinational tobacco company is not in a position to carry out the types of initiatives that are most effective in reducing smoking. This is why I believe the Foundation is essentially a scam operation.

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Tobacco Control Researcher Calls for Boycott of Journal, Apparently Because the Editor Supports E-Cigarettes for Harm Reduction

In a comment posted on Dr. Stan Glantz’s blog yesterday, Dr. Thomas Eissenberg–a researcher studying electronic cigarettes at Virginia Commonwealth University–called for a boycott of the journal Addiction because of his claim that the editor of the journal exhibited bias in fast-tracking an article that reported low levels of aldehydes in e-cigarette aerosol.

Specifically, Dr. Eissenberg called for researchers to boycott the journal by not submitting articles to it and not reviewing for it “until it has published the means by which it will manage the apparent conflicts of conscience among its editorial staff…”. Presumably, Dr. Eissenberg is referring to what he views as a significant conflict of interest of the journal’s editor–Dr. Robert West–who he claims violated the peer review process in fast-tracking a 2015 article that defended e-cigarettes against the claim that they expose users to high levels of formaldehyde.

The situation is a bit complex, so let me try to summarize the background as best as I understand it:

In May 2015, Dr. Konstantinos Farsalinos and colleagues published an article in Addiction which reported the results of an experiment showing that e-cigarettes only produce aldehydes (such as formaldehyde, a carcinogen) under dry puff conditions. A dry puff occurs when a vaping device overheats the e-liquid, resulting in an unpleasant taste. Most vapers will discontinue vaping when they experience a dry puff. Therefore, if aldehydes are present only under dry puff conditions, then they do not present a major health concern for vapers.

In September 2015, Dr. Eissenberg–along with Dr. Alan Shihadeh and Soha Talih–published a letter to the editor of Addiction in which they accused him of having a “conflict of conscience” that led to a lack of rigorous peer review and inappropriate fast-tracking of the Farsalinos et al. article. The authors’ complaint was two-fold: (1) that the review period was only 11 days, which is uniquely brief for this journal; and (2) that the editor–Dr. West–has a significant conflict of interest because he was once quoted in a newspaper article as (according to Eissenberg et al.) stating that: “E-cigarettes are about as safe as you can get… E-cigarettes are probably about as safe as drinking coffee.”

Eissenberg et al. went on to accuse Dr. West of exhibiting bias in handling what they call a “flawed” manuscript: “These statements suggest a potential conflict of conscience in the handling of a flawed report that reinforces Dr West’s professed faith in e-cigarette safety…”.

Addiction published the extremely long letter by Eissenberg et al. (which itself is unusual), along with a response from Dr. West stating that the accusation is false because he didn’t even handle the paper: he designated the review to a different editor. Moreover, the paper went through the same peer review process as any other paper (although it was fast-tracked because of particular urgency of this topic). In fact, the authors went through not one, but two rounds of revisions before the manuscript was accepted for publication.

That is where the story stood until yesterday, when Dr. Eissenberg called for the boycott of the journal, apparently sticking to his accusation against Dr. West despite West’s response.

The Rest of the Story

Ironically, while Dr. Eissenberg is accusing Addiction of unscientific and biased actions that threaten scientific integrity, it is actually Dr. Eissenberg’s actions here that are inappropriate, biased, and a threat to scientific integrity.

First, Dr. Eissenberg makes a serious accusation against the editor of Addiction without sufficient evidence to justify the claim. He (and his co-authors) provide no substantial evidence that the peer review process was botched, that the Farsalinos et al. article was seriously flawed, or that a severe bias on the part of the editor led to a botched review and acceptance of an article that should not have been published.

As it turns out, Dr. West apparently had no role in the review of the manuscript, so Dr. Eissenberg’s accusation was incorrect. Moreover, the paper did go through the normal review process, although in expedited fashion. It is perfectly legitimate for journals to fast-track articles of particular interest, and many journals do that all the time. The article was peer reviewed and the authors were required to respond to reviewer comments twice. Thus, there was nothing qualitatively different about this peer review process from the review of any other paper submitted to the journal. No evidence is provided to support the accusation that the review process was flawed in any way.

Dr. West ended his response by stating: “I hope that this will give them (Eissenberg et al.) pause for thought before making serious accusations about colleagues.” I agree. The allegations against the editor and the journal were serious but no evidence was provided to support them. Making an unjustified accusation and then calling for a boycott of the journal based on that unsupported allegation is the threat to scientific integrity in this story.

Second, Eissenberg et al.’s claim that Dr. West has a “conflict of conscience” because he believes e-cigarettes are relatively safe is a perversion of the concept of conflict of interest. In fact, it would be impossible for any journal editor not to have a “conflict of conscience” according to the definition that Dr. Eissenberg and colleagues are asking us to accept. Everyone involved in tobacco control has some personal view on the relative safety of e-cigarettes. The idea that researchers should boycott the journal because the editor has expressed his personal views on the relative safety of e-cigarettes is ludicrous.

Interestingly, in making their accusation that Dr. West has some sort of unusual “conflict of conscience” that would make it inappropriate for the journal to consider papers on e-cigarettes, Eissenberg et al. only quoted a small portion of Dr. West’s comments in the newspaper article. I could just have easily accused Dr. West of having a strong personal bias against e-cigarettes by selectively quoting him from the newspaper article as stating:

“This is a danger. Regulators should monitor this.”

In fact, Dr. West’s views as expressed in the newspaper article appear to me to be balanced and evidence-based. His full comment to the paper explains the scientific reasoning behind his view, which I find quite reasonable:

“We have such a massive opportunity here. It would be a shame to let it slip away by being overly cautious. E-cigarettes are about as safe as you can get. We know about the health risks of nicotine from studies in Sweden into the use of “Snus”, a smokeless tobacco. Nicotine is not what kills you when you smoke tobacco. E-cigarettes are probably about as safe as drinking coffee. All they contain is water vapour, nicotine and propylene glycol [which is used to help vaporise the liquid nicotine].”

But more to the point, the entire concept of suggesting that researchers boycott a journal based on the scientific views of the journal editor is a dangerous one. It is basically setting up a system where the only journals that survive would be ones whose editors express opinions that are in line with the mainstream scientific opinion. In fact, the very idea that researchers should boycott journals based on the opinions of the journal editor is nonsensical. Should we boycott the journal Tobacco Control because the editor does not personally believe that e-cigarettes are orders of magnitude safer than real cigarettes? Once we start going down that path, we end up challenging the existence of scientific integrity in research reporting.

This is the reason why journals screen for financial conflicts of interest, rather than conduct a McCarthy-like witch hunt to determine whether a researcher may be biased because of opinions they have expressed. Believe me, we don’t want to go down that path.

There may be unusual situations in which an editor may have such a personal connection to an issue that it may be appropriate to recuse themselves from review and ask a deputy or assistant editor to handle the review, but that’s certainly not true in this case. Here, the review was apparently handed off to a different editor anyway, even though I don’t see any reason whatsoever why that would have been necessary.

What is perhaps most ironic about the letter to the editor by Eissenberg et al. is that although they accuse the editor and the journal of a serious conflict of interest, the letter itself fails to disclose an apparent financial conflict of interest of one of its authors. The letter fails to disclose any conflicts of interest among its authors (this link is to the PDF version of the letter which I checked to make sure a disclosure statement wasn’t just missing in the online version). Thus, one would assume that none of the authors has any connection to the tobacco industry, such as — for example — having received funding from an organization chaired by a tobacco industry executive.

But it appears that Dr. Shihadeh — the lead author of the letter to the editor — has failed to disclose that he has, in the past, received funding from an organization chaired by a tobacco industry executive. Dr. Shihadeh is the co-author of several papers that acknowledge funding from the International Development Research Centre, which — at the time — was chaired by Barbara McDougall, who was on the Board of Directors of the Imperial Tobacco Company.

In addition, Dr. Eissenberg — the senior author of the letter to the editor — also acknowledged having received funding from the same organization, which was at the time chaired by a tobacco company executive.

I find it ironic that the only real conflict of interest in this story is the fact that two of the authors of the letter to the editor have, in the past, received funding from an organization that was chaired by a tobacco industry executive. And that conflict of interest is not disclosed by the authors.

Now, to be very clear, I am not accusing Dr. Shihadeh or Dr. Eissenberg of voluntarily accepting tobacco industry-related funding. They stated that they were unaware, at the time of the funding, that the chair of the organization was a tobacco industry executive. So I’m not blaming them for accepting that funding. However, they were certainly aware in 2015 – when they wrote the letter to the editor – that they had been funded by an organization chaired by a tobacco industry executive. It seems to me that is a fact that should have been disclosed. That lack of disclosure, by the way, stands in contrast to Dr. West’s full disclosure of his industry-related funding from pharmaceutical companies and his clear statement that he has never been funded by the tobacco or e-cigarette industries.

The rest of the story is that in my view, Dr. Eissenberg is falsely accusing the journal Addiction of having violated scientific principles of peer review because of a personal bias on the part of the editor. Worse still, he has now called for a boycott of the journal based on these unsupported allegations.

It would truly be a shame if researchers followed this misguided recommendation.

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11.10.2017 – JBC: A harm reduction conversation with a Family Practice Physician

Yesterday, I started having conversations and asking questions of healthcare providers that I see almost daily about harm reduction and smoke-free alternatives. I will be posting each story as I organize my notes…I thought I would start with the difficult one first. A Physician who wanted only to be identified as a Family Practice Physician in the Sacramento, CA area for 20 years sat down with me, and this is the conversation we had:

I talked to him first about HIV/AIDS-related deaths now (around 12,000 per year) as opposed to the number of deaths at the height of the epidemic (over 50,000 per year), as well as the current all-time low new infection rates. My question to him was, “What strategies do you think got us here to the reduction in numbers”? His first answer was “abstinence” (I warned you this was a difficult conversation). I had to really go at him to get better answers out of him, and the abbreviated version is me asking how realistic that is, and finally asking that if someone is hell-bent on having sex, what do you tell them or prescribe to them so that they are as safe as they possibly can be? He said he gives people condoms and will prescribe either PrEP(Pre Exposure Prophylaxis) or PEP(Post Exposure Prophylaxis). I said, so harm reduction?. He said yes, harm reduction. I asked what he tells people who are IV drug users that come in and say that they have tried to stop using but can’t. He said, “I tell them to get off of whatever they are using.” I said again, what if they have tried and can’t quit? He said “needle exchanges”. So again I said harm reduction? He said yes, harm reduction.

Now the big question: I asked, “Do you think the same harm reduction strategies would be effective for people who smoke and can’t quit; ie, far less harmful alternatives like vapor products or Snus”? He said he would have a hard time telling someone it was ok because of the small percentage of risk. I asked why it was different for him with smoking, as opposed to sex, and furthermore the impact that lower risk products would have from a public health standpoint. He said he didn’t know why he felt different about harm reduction with smoking. He said he was going to go home and think about it for the weekend and try to figure out where his reservations are coming from. My final question to him was, “Do you tell your patients to wear seatbelts when they drive”? He said “Every day”. I asked if he wears his seatbelt. He said of course. Me: “Even though the CDC says that seat belts reduce fatalities and serious injuries by only around 50% and that it is by no means a guarantee that you won’t be killed in a car accident”? He smiled a big smile and said, “Yes, because harm reduction”.

The whole point of this story is that even though he didn’t emphatically agree with me, he did agree to go home and think about it and I saw the light go on. Sometimes, these conversations don’t end in huge, burning bush moments where people fall at our feet and proclaim their belief in what we propose. But changes can happen gradually. It’s better to start these conversations now, than scramble for support when it comes down to the wire. Go out and have conversations with people you know. If we all did it with just one person, we would have double the number of us during important election times. That’s how change usually starts. Slow and small. Don’t ever give up.

Jennifer Berger-Coleman

CASAA Director of Community Outreach

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