TSANZ backs inhaler boycott over Big Tobacco links


By Geir O'Rourke

10 Jul 2024

TSANZ says it will reject any sponsorship with drug company Mundipharma and support appropriate deprescribing of its Flutiform inhalers after the pharma giant entered a “bizarre and destructive” commercial arrangement with an inhaler developer acquired by Big Tobacco.

The announcement marks a major escalation in the stand-off between respiratory physicians and tobacco giant Philip Morris International over its $2.1 billion takeover of a UK inhaler technology firm called Vectura.

Part of a long-term plan by Philip Morris to develop smoke-free products and transition to a “broader healthcare and wellness company”, the September 2021 acquisition move prompted a storm of criticism from groups including TSANZ, not least because Vectura technology was used under licence in a number of asthma devices sold in Australia and elsewhere.

All inked pre-buyout, these arrangements included products such as Flutiform, GSK Ellipta devices, some Novartis Breezhalers (Seebri, Ultibro and Enerzair), and certain inhalers sold by Sandoz and Bayer.

But in April, Mundipharma said it had launched a new partnership with the company to reformulate Flutiform’s active ingredients, fluticasone propionate/formoterol fumarate, with the aim of reducing its environmental impact.

TSANZ CEO Vincent So said this deal had crossed an ethical red line, prompting the society’s board to send a communique to members on Tuesday night.

“Philip Morris International (PMI)’s acquisition of Vectura means that profits from Vectura’s involvement in the development and production of respiratory medications lead patients and governments to unknowingly support a tobacco giant,” he said.

“This is a perverse outcome: PMI profits from cigarettes and e-cigarettes which contribute to respiratory illnesses, then PMI profits again from medications used to treat the very conditions its cigarettes and e-cigarettes caused and exacerbated. This ownership means that PMI can then use these extra profits to market and sell more cigarettes and e-cigarettes, a bizarre and destructive self-reinforcing cycle.”

Pre-takeover deals exempt

Mundipharma was part of the network of privately-owned companies associated with Purdue Pharma, which filed for bankruptcy in 2019 in the wake of a series of civil and criminal lawsuits related to its role in the US opioid crisis, Mr So noted.

He said that TSANZ, together with the Lung Health Alliance, had released a position statement in the wake of the Vectura takeover declaring the company would face sanctions from health professionals, researchers, research organisations and respiratory societies. These would include avoidance of collaborations, commercial contracts and restrictions on publications and involvement in medical and scientific conferences.

At the time, the society stressed the boycott should not extend to a blanket ban on the use of inhalers that were developed by Vectura prior to the takeover, in view both of the practical difficulties involved and the fact these arrangements had been made prior to any link with Big Tobacco.

However, the TSANZ board considered that Mundipharma’s Vectura deal had changed the ethical equation, Mr So said.

“Reinforcing TSANZ’s commitment to ethical healthcare, the TSANZ Board has decided to cease all future sponsorship from Mundipharma,” he said.

“Although we currently have no current sponsorship agreements with Mundipharma, this decision upholds our standards.”

TSANZ was developing a support document to assist clinicans in discussing prescribing options and alternative with patients, although it remained clear that prescribing decisions remained a matter for individual patients and their doctors, he added.

“This resource will be sensitive to varying levels of health literacy and the need to avoid undue pressure on clinicians to change prescriptions if it could impact patient care and wellbeing,” he said.

“Expressed in private conversations with me, clinicians across Australia and New Zealand have strongly expressed their intention to deprescribe Mundipharma’s products for existing patients and to refrain from prescribing its products to new patients – provided there is no impact on patient health.”

Mundipharma was approached for comment.

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