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Abstract
The 2021 purchase of the respiratory pharmaceutical company Vectura by Phillip Morris International has been criticised by the public health and medical community, as a conflict of interest, with little input to date, from the patient community or the public. To address this gap, the COPD Foundation, along with global partners, surveyed 1196 people with chronic respiratory disease. 70% were bothered by a tobacco company making an inhaler to treat lung conditions and 48% reported that they would want to switch inhalers if they knew that a tobacco company made or sold their inhaler devices. Patients care about who makes the therapies used to treat their diseases.
- Asthma
- COPD epidemiology
- Tobacco and the lung
- Tobacco control
- Bronchiectasis
- Inhaler devices
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Introduction
In 2021, the tobacco company Phillip Morris International (PMI) purchased the UK-based pharmaceutical company Vectura.1 Based on its global market share of 12%, PMI tobacco sales may well be contributing to more than a million deaths annually, with many of those deaths from chronic obstructive pulmonary disease (COPD).2 Vectura has been part of the development of several widely used medication delivery devices that treat chronic respiratory diseases, including COPD and asthma.2 The purchase of Vectura by PMI has had repercussions in the medical community where, for example, medical societies prohibit the participation of the tobacco industry in conferences and publications, based on their prior history of misrepresenting the impact of smoking, spreading disinformation and other misbehaviours.3 This expansion of the tobacco industry into pharmaceutical companies follows their recent entry into non combusted tobacco products; all major international tobacco companies now have a presence in e-cigarettes.4
A group that has not been heard from, to date, is the patient community of people with COPD and other respiratory diseases, many of whom have tobacco-related disease. To address this gap, the COPD Foundation, supported by its partners the Global Allergy and Airways Patient Platform and the Lung Foundation of Australia, distributed a patient survey inquiring about patients’ attitudes regarding a tobacco company owning the company that makes their respiratory inhaler devices with the aim to inform global advocacy efforts.
Methods
This cross-sectional survey was developed by the COPD foundation with input from patient advocates. It was translated to Spanish and German by members of the Global Allergy and Airways Patient Platform. Respondents were eligible if they were adults above 18 years old. Analyses were limited to current or former uses of respiratory inhalers to treat chronic lung conditions, irrespective of their smoking status. The survey was administered anonymously between January 2022 and March 2022 and advertised using various social media and patient advocacy community support platforms; posts in English used an explainer video on the rationale for the survey and recruiting inhaler users. The survey consisted of 13 questions exploring respondent demographics, comorbidities and attitudes towards pharmaceutical industry acquisition by tobacco companies. All responses remained strictly confidential.
The survey was administered in three languages (English, Spanish and German) and reported using the Survey Monkey platform.
This report includes a composite of responses to the three survey versions analysed in Microsoft Excel. We graded responses to the question ‘In your own words, what is your opinion of tobacco companies owning companies that are earning money from inhalers and/or medications for lung conditions?’ as positive, neutral or negative; grading was reviewed by two raters. A third reviewer decided the grade when there was disagreement between the primary reviewers.
Results
The complete survey was only available to people who reported inhaler use, reducing the number of respondents from 1628 in the original sample to 1196 in the analysed sample. Of the 1196, 1033 (86.4%) responded in English, 136 (11.4%) responded in Spanish and 27 (2.2%) responded in German (table 1, online supplemental tables 1, 2 and 3). Current inhaler use was reported by 94%, with an additional 6% reporting former inhaler use (table 2).
Supplemental material
Details of survey respondents
Inhaler use
Among the respondents, most (68%) were from North America, although all regions of the world were represented (online supplemental figure 1). Thirty-four per cent were from cities with a population of 100 000 or higher. Most were former smokers (73%), with 11% reporting current smoking ad 15% never smoking. In contrast, current vaping was only reported by 2% with former vaping in an additional 12%. COPD was reported by 78% of respondents (table 1).
When asked ‘If you knew that a tobacco company owned the company that makes or sells your inhaler, would you want to switch to a different inhaler?’ 48% (n=571) responded ‘Yes’ and 17% (n=208) responded ‘No’, with the remainder either not sure (n=398, 33%) or not answering (n=19, 2%; figure 1A). This desire to switch was reported by 47% of 133 current smokers, 45% of 874 former smokers and 60% of 178 never smokers.
(A) Responses to ‘if you knew that a tobacco company owned the company that makes or sells your inhaler, would you want to switch to a different inhaler’; (B) Responses to ‘How do you feel about a tobacco company making money from an inhaler that treats lung conditions because they own part of the company that makes them’ (n=1196 survey participants provided a response; integrated dataset English Spanish and English surveys).
In response to the question ‘How do you feel about a tobacco company making money from an inhaler that treats lung conditions because they own part of the company that makes them?’ 43% responded ‘It really bothers me’ with an additional 27% responding ‘It bothers me’. Only 19% were not bothered by this scenario (figure 1B).
For analysis of the question ‘In your own words, what is your opinion of tobacco companies owning companies that are earning money from inhalers and/or medications for lung conditions?’ the overall patient sentiment was negative. A total of 655 of the 844 (78%) free-text responses were negative (‘greedy’, ‘disgusting’, shameful—they should be shut down), while 90 (11%) were neutral (‘I do not know’, ‘does not matter’) and 99 (12%) were positive (‘no problem if the inhaler works’, ‘good for them’).
Discussion
This survey reports patients’ opinions on how they view tobacco industry ownership of companies that develop formulations or devices for inhaled therapies and sell therapies that are used to treat chronic respiratory disease. The majority (70%) of patients using inhalers in this survey were bothered by this scenario and 48% said they would want to change inhalers if they knew that a tobacco industry company was making or selling their inhaler.
In this survey, the most important factor to patients in choosing their inhaler was ‘It makes me feel better’ (table 2). Discussions between patients and providers should now include a frank discussion about involvement of the tobacco industry in these therapies as this may also affect what therapies a patient may want to be on.5
There are several limitations of this study. Participants were volunteers recruited via the outreach efforts of the study sponsors and may not reflect the views of the broader population of patients with lung disease. Since patient use of medications, including inhalers, is influenced by several factors, including insurance coverage, structure of the healthcare system, ability to properly use the device, convenience and other factors,6–9 the willingness to switch medications that was expressed in this survey may not actually occur.
To conclude, these results highlight that patients are interested in how their medications are developed and who profits from their sales and that the concern expressed by professional societies and the medical community is reflected in the patient community.
Ethics statements
Patient consent for publication
Ethics approval
No personal identifiable information was collected or retrieved, and Institutional Review Board Exemption was attained in advance from WCG IRB Connexus.
Supplementary materials
Supplementary Data
This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.
Footnotes
Twitter @rtalsinger1, @MachinaVictor
Contributors RT-S, TD, LW, DMM, KFH, BT and AS designed the survey. VG and SH translated the survey and TW, NH and LM supported dissemination within patient community networks. RT-S, TD and AS analysed the survey. DMM and RT-S drafted the manuscripts and all authors reviewed and commented on the final version. Survey was funded by the COPD foundation.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests RT-S is a retiree and shareholder of GlaxoSmithKline. She is a non-executive board member of ENA Respiratory and reports holding share options. She also reports personal fees from Vocalis Health, ENA Respiratory, Teva, and Immunomet. TW is President & CEO of Allergy & Asthma Network in the USA. She serves as President of GAAPP. Both AAN and GAAPP receive funding for unbranded disease awareness, education and advocacy from Aimmune, ALK, Amgen, AZ, DBV, GSK, Novartis, Sanofi/Regeneron, Viatris, TEVA. TW personally reports speaker & advisor fees from Aimmune, ALK, Amgen, AZ, DBV, Novartis and Sanofi/Regeneron. BT reports consultancy to GlaxosmithKline and participation at an advisory board for Boehringer Ingelheim. DMM is a former employee and current shareholder of GlaxoSmithKline and receives royalties from Up to Date. He is also a consultant to GlaxoSmithKline, Medical Director of the COPD Foundation, and an expert witness for people suing the Tobacco Industry. LW, TD, AS, KFH, VG, SH, NH and LM report no conflicts.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.