Islamset - Collaboration between the NGO Community and the Pharmaceutical Industry on Tobacco Issues: Advantages, Drawbacks and Challenges, Summary of Discussion: Summary, NGOs and Government Action, The 11th World Conference on Tobacco or Health.

Proceedings INGCAT International
NGO MObilisation Meeting
Geneva, 15-16 May, 1999.

Collaboration between the NGO Community
and the Pharmaceutical Industry on Tobacco Issues:
Advantages, Drawbacks and Challenges
Summary of a discussion

There are obvious advantages for both the NGO community and the pharmaceutical industry to the working together on tobacco issues, and yet collaboration could lead to undue influence on the agenda for action by the funders. The NGO community has chronically lacked resources for tobacco control activities, but can the challenges of collaboration with the pharmaceutical industry be overcome, so that both can see their won independent needs fulfilled? This was the subject of a hearty debate, which is summarised here.

Advantages to collaboration
From the point of view of the NGO community, the advantages of collaboration are not limited to funding for action and research, but also the very nature of a big, regulated industry competing with the tobacco industry for the attention of the same market, a big set forward for tobacco control. In addition, the pharmaceutical companies have developed scientifically proven aids to cessation, and can be a powerful source of information about addiction for the community at large. NGO community gives credibility to their messages about addiction, and about their products. Health providers are and important source of information about products, whether or nor they can be procured without prescription. And the more effort put into getting people to stop smoking and to be aware of the pharmaceutical products available and their known utility, the more likely smokers will be to attempt cessation and to buy these products.

Drawbacks to collaboration
The NGO community is wary of the influence that funders can have on the decisions and actions that are taken in relation to tobacco control. Some NGOs have documented unethical behavior concerning pharmaceutical products, and are distrustful of the industry as a whole. Areas of concern in the field of tobacco control include.

1. Excessive medicalisation of tobacco control, by portraying cessation as necessitating medicinal aids. This could desempower smokers from their own responsibilities in cessation, and could lead smokers to feel unable to stop when the medicine is not available, either because it has not been introduced on the market or because its cost is prohibitive.

2. Societal strategies for tobacco control, such as tax action, legislation and changing social norms losing ground to a more individual strategy for cessation, and this because of the pharmaceuticals influence rather than an evidence based decision to move in this direction.

3. Another point of unease is that the pharmaceuticals will not be willing to make direct assaults on the tobacco industry, leaving the hard work to the tobacco control advocates with the associated potential for attack, but nevertheless make profits from that work without acknowledging the necessary environmental support that has been provided.

4. Finally, many tobacco control advocates see that because the market for pharmaceutical aids to quitting are smokers in richer countries, the whole issue of tobacco control will be directed to those countries, and tobacco control efforts in low income countries will flounder.

The pharmaceutical industries are unwilling to spend money on initiatives that do not eventually influence sales. Because they are not interested in parts of the world where they do not see a market for their products, they are not willing to fund tobacco control in these countries. Generally, there is agreement that tobacco control activities that change the social climate towards non-smoking norms will create more dissonant smokers and thus a larger market for pharmaceutical aids to cessation. Nevertheless, while tobacco control and health groups look at the widest possible definition of activities for social change, pharmaceutical companies may not be interested in providing unrestricted funding, particularly from marketing divisions, unless it is clear that information about their own type of pharmaceutical aid for cessation will be presented.

Challenges to Collaboration
On one side, there is the potentially large impact of tobacco control activities from the NGO community through additional resources and the strength of the pharmaceutical industries, on the other there are the ethical issues posed by possible conflicts of interest. Both the NGO community and the pharmaceutical industry need to find suitable and acceptable standards of behavior to allow collaboration without conflict of interest or undue influence.

The NGO community can play an important role for the pharmaceutical companies and for tobacco control by leveling the regulatory playing fields: that is, change from the current situation of unregulated dirty nicotine delivery in the form of tobacco and heavily regulated nicotine delivery systems (nicotine replacement medications) that help people to stop using tobacco. The issue should be decided on the scientific evidence and the pharmaceuticals should probably not be involved in the decision making process.

On he other side, it is important for public health to act to move people towards wanting to quit, and this is an area that would ultimately be of great value to pharmaceuticals, and should be considered as legitimate for funding. Pharmaceuticals should also play a role insolating the tobacco industry, and involving other industries in the funding of tobacco control for "corporate credibility".

The issue of tobacco control in low-income areas is perhaps the most difficult for finding common ground. In many of these areas, very few people want to stop, so tobacco control efforts should go towards changing the environment and getting information to the public, not about how to quit, but why to quit, or not to start. Pharmaceutical aids to cessation are often prohibitively expensive for most of the small proportion of those who might think of trying to quit. Profitable outcomes for the pharmaceutical companies could only be in the long term, Nevertheless, the NGO community would expect and effort to be made to provide aid for tobacco control in these areas, i.e., in making the cessation aid products affordable, sponsoring education or lobbying activities to change the social climate, and funding research into the effects of their products in a hostile environment.

The pharmaceutical industries will always want to convey the following messages:
1. That their products do indeed help some smokers to stop more easily,
2. That this information can be relayed from a number of sources.
3. That health workers particularly can allay confusion about the toxicity of these products, particularly of nicotine delivery devices, and
4. That individuals can help themselves to successful quitting.

NGOs working in tobacco control will want to be sure that the actions they undertake and the information they convey are not different form what they would have been without funding from the pharmaceutical companies.

If NGOs pharmaceutical companies find common ground working towards the same goal, then collaboration is not only possible, it is essential. There is nevertheless a clear need for a set of ethical guidelines to be established to ensure the transparency of funding and the independence of decisions. Such guidelines should be created by NGOs themselves, and agreed to by the pharmaceutical companies.

The pharmaceutical companies have taken a big step forward in this regard by collaborating among themselves in funding. For example, the NGOs mobilization meeting was sponsored by Glaxo Wellcome and the World Self-Medication Industry, a trade organization, with funding from Pharmacia & Upjohn and SmithKline Beecham. Such a consortium gives much greater assurance to recipients that pressure for product endorsement will not be forthcoming. The next step on the part of these companies that would be very favorably received by the NGO community would be to establish an independent fund for tobacco control outside their marketing departments.

If NGOs and pharmaceutical companies find common ground working towards the same goals, then collaboration is not only possible, it is essential. There is nevertheless a clear need for as set of ethical guidelines to be established to ensure the transparency of funding and the independence of decisions.

Conclusions
There are number of goals of the NGO community concerning tobacco control shared by the pharmaceutical companies. These must be clearly identifies and agreed to, and rules and conditions of funding and collaboration should be established clearly through ethical guidelines. Such guidelines should be drawn up as quickly as possible.