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Although there are strict professional guidelines on Israeli medical research funded by pharmaceutical companies, neither the government nor the Israel Medical Association (IMA) has put any limitations on studies financed by tobacco companies.
The extent of foreign and Israeli tobacco companies' supply of research grants here is not known, but The Jerusalem Post has learned that $250,000 was invested by Philip Morris USA and Philip Morris International - the world's leading international cigarette business with products sold in 160 countries - in a study of the effects of genes, environment and psychological characteristics on smoking patterns in young Israeli women.
Lead researcher Prof. Bernard Lerer - head of the biological psychiatric laboratory at the Hadassah-University Hospital's psychiatry department in Ein Kerem, Jerusalem - told the Post on Monday that "we are not the only ones. There are at least four or five other Hadassah research teams currently conducting research on tobacco with funding from Philip Morris."
Lerer stressed that his study - just published in the on-line edition of the prestigious Molecular Psychiatry journal and due to be in the print edition in February - was his initiative, "completely objective and conducted according to scientific criteria." The supplier of the research funds "had no ability to intervene in the way the research was conducted, analysis of the results or their publication."
He said he initiated the study because he was "concerned about the worrisome rise in smoking rates among young Israeli women, especially when they complete military service." The Hadassah Medical Organization added that Philip Morris, while providing the money through an "independent research granting arm," did not set any conditions for the research.
The Hadassah Medical Organization - though its hospitals were the first in the country to voluntarily become smoke-free (the Hadassah Women's Zionist Organization of America's Hadassah Magazine was among the first to refuse tobacco advertising) - declined to provide any information about who else in its hospitals are currently conducting tobacco studies with Philip Morris or other tobacco company funding.
"We will provide such information only after the Post gets documentation on such research at all the country's other hospitals," said external relations director Ron Krumer.
The published study, conducted in cooperation with the department of molecular genetics of the Weizmann Institute of Science in Rehovot, studied 501 Israeli women students aged 20-30 and looked at their background, details of smoking (or non-smoking), psychological characteristics and life experiences. They then took blood samples and studied cholingeric receptor genes that bind with nicotine. Lerer and his team concluded that the "strongest influences on whether young women begin to smoke are psychological and background," (especially if their parents smoked and the women themselves suffered traumatic experiences); but if they are already hooked on tobacco, carrying such receptor genes is the "strongest determinant" of how long and how much they will smoke. In small print, at the end of his article, the authors acknowledge that the study was "partially funded" by Philip Morris.
Asked to comment, the Health Ministry spokesman said it was not aware of tobacco company funding of Israeli tobacco research in hospitals and did not know the extent of this phenomenon - whether it was just at Hadassah or in other hospitals as well - including government hospitals owned and supervised by the ministry.
"We will investigate this. The Health Ministry was not a signatory of the IMA document restricting pharmaceutical company funding of doctors' medical research, because we are ourselves the regulator. But if there is tobacco industry funding of research in the state hospitals, we will decide what action to take. Even if there is no such phenomenon in the government hospitals, we'll examine the implications of this matter," he said.
IMA chairman Dr. Yoram Blachar, informed of the Hadassah research, said, "this is the first time I hear that Philip Morris or other tobacco companies finance physicians' research on smoking. If companies want to give money, it should go to the state and to the health funds, which cover the costs of treating the diseases of smokers and those exposed to tobacco smoke, and not directly to hospital research institutes for researchers' work. It sounds absurd to me and a clear conflict of interest."
Blachar said he would discuss the matter with Hadassah-University Hospital neurology Prof. Avinoam Reches, head of the IMA's ethics bureau when he returns from abroad this week.
"I do not think that his working for Hadassah would affect his judgment in this case, but if he saw it as a problem, he could name a deputy to deal with it," he said.
Blachar added that $250,000 for a single research study of 500 subjects was "indeed a great deal of money" and an unusually large grant.
Prof. Gabi Barabash, director-general of Tel Aviv's Sourasky Medical Center and a former Health Ministry director-general, said that with the decline in government funding of medical research, doctors have no choice but to accept funding from commercial interests.
"I see no major difference between financing of research by pharmaceutical companies and tobacco companies. There must be supervision and care to keep the research objective, and I hope that Hadassah does this to prevent bias," he said.
He added that although his medical center does not have any research projects financed by tobacco companies, he would not rule them out if bias was eliminated. "Such research requires care and supervision, but we can't rule it out," he said.
Amos Hausner, chairman of the Israel Council for the Prevention of Smoking, maintained that Israel could have been specifically chosen by Philip Morris as the site of this research, apparently because it was a main defendant in several major Israeli lawsuits against tobacco companies. Hausner himself has since 1998 represented Clalit Health Services in a NIS 11.2 billion lawsuit against tobacco companies, including Philip Morris, for health costs paid for by Clalit.
"One of the main arguments in our case is that tobacco company advertising encourages people, including the young, and targeted women to start smoking and to keep on smoking. The Hadassah research, even though it involved psychiatrists, did not investigate whether advertising encourages Israeli women to start smoking," Hausner said.
"It is strange that although the study was carried out by psychiatrists, they did not investigate how cigarette advertising psychologically induces women to start smoking. Instead, the company is probably very pleased to be supplied with alleged proof that one's own genes, rather than tobacco ads, are largely responsible for why women continue to smoke and smoke more," he added.
When the companies decide which research proposals to finance, they are inherently selected what factors would be taken into account, while others are excluded, Hausner noted, thus the the way the studies are conducted are seriously flawed.
Another problem is that researchers who anticipate getting future tobacco money are likely to be careful not to upset the financiers with "whatever they research and the way they report it," he said.
Hausner added that the 1997-1998 US court settlement required tobacco companies there to pay $246 billion over 25 years to the states themselves, which may designate the money for treatment or genuine, independent research. "If tobacco companies do donate money for research, the money should not go to individual research teams in hospitals, but to the state and the health funds, which can objectively decide what research on smoking has to be conducted, especially on how to prevent young people from starting to smoke," Hausner said.
Prof. Shimon Glick, a senior medical ethics expert at Ben-Gurion University of the Negev and former dean of its health sciences faculty, commented: "It is very bad policy for medical researchers to take money from tobacco companies. They must be very careful. Tobacco companies' products spread death: Smoking is the leading preventible public health problem in the world. If taking their money is not absolutely forbidden, at least there should be strict limitations; if not, it may present a serious ethical problem."