To the Editor:

As clinician-investigators with an interest in the impact of legalized cannabis on pulmonary diseases, we read the results of a clinical trial of vaporized cannabis for advanced chronic obstructive pulmonary disease with enthusiasm (1). We commend the researchers for conducting a well-designed study focused on use of noncombusted cannabis for pulmonary conditions. However, publication of this study by AnnalsATS raises an important point. Together with acknowledging support of the study’s authors by numerous funding sources, including the Canadian Institutes of Health Research, the senior author also received an investigator-initiated study grant from Tilray. Per the company’s website, (www.tilray.com), “Tilray is a global leader in medical cannabis research, cultivation, processing and distribution [that aspires] to lead, legitimize and define the future of our industry by building the world’s most trusted cannabis company.… [W]e are the first GMP-certified medical cannabis producer to supply cannabis flower and extract products to tens of thousands of patients, physicians, pharmacies, hospitals, governments and researchers.…” Tilray was listed on the Nasdaq Stock Market (NASDAQ:TLRY) in July 2018 with a market value reportedly worth $5 billion (2), making it relatively smaller than Philip Morris International or Coca-Cola, each valued at over $100 billion. However, Tilray’s involvement in the study begs the question: Is it ethical to accept a study for publication that has been supported by for-profit cannabis corporations whose products have an unknown and potentially negative impact on human health?

All three journals under the aegis of the American Thoracic Society (ATS) provide clearly stated policies for authors regarding work supported by the tobacco industry, namely that authors must certify that no part of the research presented has been funded by tobacco industry sources, similar to many other medical journals. Importantly, for none of the ATS-affiliated journals, nor for any other major medical journals, is cannabis industry funding for research queried specifically in the authors’ instructions, despite the fact that consuming cannabis by combustion remains most common among regular users (3).

Accepting funding from commercial sources to conduct research has the potential to bias scientific investigations and may also undermine trust in research results. Tobacco industry research funding is the most obvious example in which strategies used by the industry to shape evidence on risk have been identified, including funding and publishing research that supports the interest group’s position (4). Earlier this year, alcohol industry support of federal research regarding alcohol use also came under similar scrutiny when the National Institutes of Health (NIH) stopped a $100 million study of the putative benefits of alcohol on human health that was revealed to be largely supported by the alcohol industry, which may have had input during the trial’s design in 2013 and 2014 (5).

Although conducting clinical trials related to cannabis in the United States remains challenging, options do exist for performing this type of work that do not require direct funding from industry. Methods that investigators have used include purchasing cannabis from a commercial supplier using investigator funding (including suppliers in Good Manufacturing Practice–certified facilities [6]) or using cannabis supplied for research purposes free of charge (less optimal). The National Institute on Drug Abuse also has a drug supply program that can provide both NIH-sponsored and non–NIH-sponsored investigators with cannabis products for research after an Investigational New Drug Application is filed and reviewed and a Drug Enforcement Administration registration for cannabis (a schedule I controlled substance) is obtained by the investigator. We hope that editors of ATS journals will urgently clarify instructions with respect to investigators accepting funding from for-profit cannabis companies with the same level of concern as tobacco industry–funded investigations until sufficient evidence can be provided regarding its safety for human health.

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