For A Few Dollars More

In cowboy movies of old it was always easy to spot the baddie by what colour hat he wore. In real life, of course, nothing is so literally black and white.

Take tobacco companies, for example. They're widely regarded by the terminally bovine to be the only ruthless, gun-totin', black hatted, lucre-chasing evil in town. Lives can go hang from a rough and creaky noose for all they care as long as profits are protected via a system of lies, political manipulation and mendacity.

Whereas the pharmaceutical industry is perceived as riding in on a pristine white thoroughbred, their righteous eyes gleaming with probity and rigour.

Sadly, the script was written by PR experts for an industry which has more than a few skeletons hidden in its own saddlebags.

Hundreds of reports of suicides and violent reactions tied to the stop-smoking drug Chantix were left out of a crucial government safety review.

The reports were missing because the drug’s manufacturer Pfizer Inc. submitted years of data through 'improper channels', according to the Food and Drug Administration.

Serious problems — such as people killing themselves, trying to kill themselves, depression and unprovoked attacks on others — were mixed among 26,000 records of non-serious side effects such as nausea and rashes dating back to 2006, the year Chantix, or varenicline, was approved.

Hold on, does this mean that Pfizer were aware that their drug - when used as directed as is always the charge with 'big tobacco' - was killing people? And they hid the facts, again an accusation directed at the tobacco industry? That lives can go hang from a rough and creaky noose for all Pfizer care as long as profits are protected via a system of lies, political manipulation and mendacity?

Well, it certainly would appear so. Not that you'll read many froth-mouthed commenters angrily calling for Pfizer execs to have their assets seized, or be 'hung by their heels' - just a couple of the lurid lynching ideas suggested recently - for attempting to conceal a highly dangerous product (the deaths are only amongst smokers, after all).

No. Quite the opposite, in fact. Only last year, the Policy Exchange think tank exhorted for this drug to be made even more readily available.

Varenicline is the most cost-effective treatment option in the NHS Stop Smoking Service. Studies consistently demonstrate it to be superior to any other therapy, but it is only used in 20% of cases. Varenicline should be offered as first line drug treatment for all patients wishing to quit smoking

[...]

The NHS Stop Smoking Service should offer varenicline as first line drug treatment for all patients wishing to quit smoking.

[...]

the [NHS] only prescribes varenicline in 20% of cases, since it is often confined to patients who have failed with NRT. There is no good reason why all patients should not be offered it.

OK, it was written by PE's then resident ASH-influenced idiot, but it's also a view shared by NHS bodies up and down the country.

Champix, as it is known in the UK, may be killing people, but PCTs are being paid to liberally dish it out. Warwickshire is just one such trust.

GPs and Pharmacies are reimbursed for service delivery (inflation still to be applied for 09-10):

£10.50 for each client setting a quit date
£40 for each client still quit at 4-week follow-up
£10.50 for each client not quit at 4-week follow-up. No additional payment for those not followed up at 4 weeks.
Pharmacies only - £3 per supply of NRT

Contact 1: Plan strategy for quitting, including assessment for drug therapy including carbon monoxide test, access to nicotine replacement therapy, Zyban® or Champix®.

Contact 2: Possible quit date
Ensure access to NRT, Zyban® or Champix®. Carbon monoxide test

All heartily encouraged, and aggressively marketed, by the good guys in white hats who - we now understand - held sufficient evidence to expect people to die as a result.

Joint working with Pfizer around targeting of clinics/drop-ins

Joint working with Pfizer to develop more effective recruitment campaigns in N&B, also targeting health professionals to refer more and more effectively.

Because they're the goodies, you see. OK, they may have form for 'fraudulently marketing' their drugs, and for being forced to reveal hidden studies on products they knew to be toxic, but what's a few thousand dead people between public health friends, eh?

Unlike the tobacco industry, which is increasingly exhibiting a remarkable tendency to tell the truth however unpalatable it may be to their business, their competitors in the global nicotine delivery market - the pharmaceutical industry and their paid tobacco control stooges - are resorting to ever more devious, and arguably life-threatening, chicanery and deception.

Those who automatically sound off on tobacco debates from a starting position of 'big tobacco bad, big pharma good' are antiquated like a 1950s western B-movie, and about as knowledgeable on the subject as a rusty spitoon.