To the editor:
I read with interest the supplement on chronic obstructive pulmonary disease (COPD) by Doherty et al (J Fam Pract 2006; 55[11]:S1–S8). In particular I appreciated the authors’ discussion of smoking cessation as the cornerstone of COPD prevention and treatment, pulmonary function testing as a more sensitive tool in the diagnosis of suspected COPD than chest radiographs, and the role of pulmonary rehabilitation as a valuable referral resource for patient education and conditioning. The authors note that other than smoking cessation and oxygen therapy (for severe COPD), none of the presented treatments have been shown to “modify” COPD. I look forward to the publication and discussion of related clinical studies that the authors report are in progress.
I would, however, call upon JFP to be more transparent in making disclosures of potential conflicts of interest between a manuscript’s authors and the medications they discuss, as well as avoiding related advertisements elsewhere in the journal. For example, the supplement is made possible by an educational grant from Boehringer Ingelheim Pharmaceuticals, the US affiliate of a multinational firm that produces one of the medications prominently (and favorably) featured in the supplement and later advertised in the journal—the long-acting inhaled anticholinergic tiotropium (Spiriva). Of note, and not disclosed in the supplement but featured in the related ads, is that Spiriva is co-marketed in the US by another prominent pharmaceutical company—Pfizer.
This disclosure in the supplement is relevant in that all of the supplement’s authors have financial ties to Boehringer Ingelheim or Pfizer. The marketing of Spiriva by these companies should be explicitly acknowledged. With such information, family physicians can then more critically examine the authors’ claims pertaining to tiotropium in the treatment of COPD and seek out separate and independent analysis. A simple way for the editorial board to enforce this precept would be to refuse advertisements from the sponsor(s) of the supplement in the issue in which the supplement is published.
Peter R. Lewis, MD
Department of Family and Community Medicine, Penn
State College of Medicine, Hershey, Pa; plewis@psu.edu