Who's buying off your doctor?

The smoky-smelling clinic at the University of Medicine & Dentistry of New Jersey (UMDNJ) run by Steinberg, an internist, and Foulds, a Ph.D. psychologist, is one of eight such centers in that state originally funded by the tobacco litigation settlements of the late 1990s. More than 500 smokers come through the clinic each year. It boasts a 30% success rate in helping patients quit for six months or more.

"The goal is to get more people not smoking," Steinberg says. "The medication is just a tool to increase their chances of being successful."

Adamant that his work for Pfizer and other drug companies poses no problem, he adds: "We look at the data, and we look at our own clinical experience." Both doctors stress that it's not standard practice to tell patients about potential conflicts.

Before Chantix's launch in August 2006, Steinberg and Foulds say they didn't work closely with the drug industry. They say they collected modest fees for occasional consulting for companies such as Novartis and GlaxoSmithKline, makers of over-the-counter nicotine patches, gum and lozenges.

Foulds is something of a celebrity in anti-smoking circles.

Before moving to UMDNJ in 2000, he worked with the World Health Organization and launched an extensive telephone hotline for smokers seeking to quit. He has written several journal articles on drug treatment for smokers and blogs for Healthline, a consumer Web site.

• Talk back: Do you trust your doctor to disclose corporate ties?

In 2006, Pfizer recruited Foulds to serve on its paid national advisory board for Chantix. The company also selected Foulds and Steinberg to be "key opinion leaders," sending them to talk to doctors about Chantix over fancy dinners and paying them each $900 per presentation. Foulds and Steinberg say that between them they have made a total of about a dozen appearances.

Pfizer's aggressive promotion of Chantix helped turn the drug into a sensation. The company has directed patients to a Chantix Web site via a ubiquitous TV ad campaign called "My Time to Quit." By the end of 2007, its first full year of sales, Chantix had nearly doubled the size of the U.S. market for smoking-cessation products, to $1.3 billion.

Meanwhile, Pfizer gave grants to physicians who wanted to study the drug in settings beyond those examined during the approval process. Such studies could expand the medicine's potential market.

Steinberg received a $30,000 grant from Pfizer in April 2007 to study the effects of Chantix on patients forced to forgo cigarettes while hospitalized for other illnesses. He says this was his first research grant from a drug company. (The Robert Wood Johnson Foundation separately provided $300,000 for the hospital study.)

As Chantix's popularity grew, Steinberg and Foulds encountered an obstacle that helped inspire their article advocating long-term drug use. They found many insurance companies wouldn't reimburse for Chantix, which costs about $100 a month, or for other less-expensive anti-smoking products.

Steinberg and Foulds reasoned that if they compared nicotine use with diabetes, rather than with alcoholism or other addictions, they might help change insurers' thinking.

Diabetes causes many of the same long-term problems that nicotine addiction does. "We wanted to compare it to a disease that's well-covered," says Foulds, "and alcoholism isn't well-covered."

Continued: Financial ties proliferate

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