The tobacco industry has long sponsored medical research as part of its strategy to undermine existing (and damning) evidence about the health effects of smoking, and to foster the illusion that there is still some debate about smoking -- that the jury is still out and that there is a need for further research.(177,178) There is also strong evidence that the tobacco industry has suppressed adverse research findings about the effects of smoking.(177,179,180) In the United States, the tobacco industry funded Council for Tobacco Research has been described as an 'industry insurance policy', in that its major function has been to create the illusion of controversy about the health effects of smoking. Ostensibly an independent research body, the Council for Tobacco Research apparently became the creature of tobacco company lawyers and public relations staff. The Council has been accused of advancing sympathetic science, and discontinuing, ignoring, suppressing or distorting detrimental research findings. Its activities are currently under legal investigation on the grounds that the tobacco industry may have used the Council as a vehicle for defrauding the public.(178) In-house tobacco industry research has also been investigated by a subcommittee of the US Congress, on the grounds that crucial but damning scientific findings have been suppressed.(181)
Internationally and in Australia, it has been tobacco industry policy to sow the seeds of doubt in the public mind about whether smoking is harmful. According to Mr John Dollisson, former Chief Executive Officer of the Tobacco Institute of Australia, (and at the time of his comments, Corporate Affairs Manager for Philip Morris Australia):
The facts about smoking are: no-one knows the cause of cancer, no-one knows the cause of heart disease ... what we do know is that there is a relationship between those people who smoke and the risks of certain diseases, and the appropriate answer to that is more research, and that is what we're doing about it.(182)
In Dollisson's view, there could be no proven causal link between smoking and disease 'until someone can demonstrate the biological pathways or mechanisms by which smoking causes disease'.(182) In the light of the vast body of medical evidence which has accumulated against smoking, Dr Peter Wilenski (former chairman of the Public Service Board) has observed that 'If the tobacco lobby were marketing sex, they would say that its connection with pregnancy was a random statistical correlation'.(183)
In seeking incontrovertible evidence of the 'causal link', the tobacco industry is deliberately demanding the impossible. According to the US Surgeon General:
The ability to totally control the experimental environment, to randomise exposure, and to measure discrete outcomes allows a clear experimental demonstration of causality. However, the application of these rigid laboratory techniques for establishing causality to the study of cancer in humans is clearly impossible. The idea of exposing human subjects to potentially cancer-producing agents in order to establish causality is morally and ethically unacceptable. Therefore, other criteria have been developed to establish causality with a very high degree of scientific probability.(184)
(The 1982 Report of the US Surgeon General subsequently re-evaluates the medical evidence and finds that smoking is a cause of cancer at a number of sites. The criteria developed to establish causality are discussed in the introductory section to Chapter 3 of this book).
In Australia, the three major tobacco companies provide around $500,000 a year to support medical research, through the Smoking and Health Research Foundation of Australia (formerly known as the Australian Tobacco Research Foundation).(185) The Foundation distributes this money in the form of grants 'to conduct research into the relationship in Australia between smoking and health and disease in its widest context. Support may be given to projects which aim to elucidate the mechanisms by which tobacco smoking is thought to be linked to human disease.' Grant applications are invited through open advertisements and reviewed by the Scientific Advisory Committee of the Foundation.(186) The tobacco industry also views all applications, but according to the Scientific Advisory Committee, has not attempted to, nor has the power to, influence decisions or individual projects or determine the direction of research or publication of results.(185)
In response to criticism about the appropriateness of the tobacco industry supporting medical research, the Scientific Advisory Committee has made the following public statement:(185)
The members of the Scientific Advisory Committee are unanimous in believing that smoking is an important causative factor in several major diseases. We recognise the link between smoking and lung cancer which generally is attributed to the presence of known carcinogens in tobacco-smoke. We are also aware of the increased risk of coronary heart disease, stroke and emphysema in persons who smoke cigarettes. For these reasons, we strongly endorse the view that the public should be fully informed about the risk in smokers, and we fully support any measures, which are consistent with the liberty of the individual, that are designed to reduce smoking ...
... The members of the Scientific Advisory Committee devote time to this activity in the belief that increasing the knowledge of the relationship between smoking and health can only be of benefit to society. It is not our task to advise the tobacco industry on any matters other than those that relate directly to the funding of research projects, or to discuss other matters that are related to industry and society. In particular, we do not, in any sense, act as spokesmen for the tobacco industry, nor do we have any financial relationships with the tobacco industry except to advise on the disbursement of research funds.
It is interesting to note that the tobacco industry prefers not to believe the views of the very scientists whose advice it otherwise values in the disbursement of its research funding. It is also interesting that none of the standard publicity material distributed by the Smoking and Health Research Foundation of Australia appears to make any mention of their source of funding; the name change from Australian Tobacco Research Foundation also possibly serving to obscure an obvious connection.
A study into tobacco industry funded research in the United States has shown that only one in six projects actually focussed on the health effects of tobacco, and that the majority of tobacco funded scientists who responded to a questionnaire strongly agreed with the statements: 'The smoke from someone else's cigarette is harmful to a non-smoker', 'Most deaths from lung cancer are caused by cigarette smoking', 'Cigarette smoking is addictive'. The authors of this study concluded that industry funded research was undertaken for public relations purposes only.(187)
Other researchers and health workers have opposed tobacco industry support for medical research for the following reasons:(187,188,189,190,191)
ð It is unethical that profits earned by the companies manufacturing and marketing tobacco, the cause of many of the conditions against which medical and health workers are fighting, should be used for medical research. Even in an environment of limited funding for research, scientists must ask whether the value of their research outweighs its utility in furthering the corporate interests of the tobacco industry.
ð It lends credibility to industry claims that there is insufficient evidence to conclude that smoking causes disease.
ð It improves the corporate image of the industry to be seen to be involved in apparently altruistic activities and associated with respected scientists.
ð Researchers in receipt of tobacco money may feel constrained about what they say publicly about health and smoking -- not wishing to bite the hand that feeds them. Tobacco funding may therefore silence a potentially influential and articulate opponent.
ð Accepting money from a source with so clear a vested interest may lead to a biased research programme, biased results and biased reporting.
The Australian Cancer Society and the National Heart Foundation of Australia agreed in 1984 that they would not sponsor or co-sponsor work which received any funding from the Australian Tobacco Research Foundation.(188) The Australian Medical Association, the Thoracic Society of Australia and the Royal Australasian College of Physicians have stated that it is inappropriate for medical research to be funded by the tobacco industry (see Appendix II). The health promotion foundations in Victoria,(192) Western Australia(193) and South Australia(194) will not fund bodies in receipt of research funding from the Smoking and Health Research Foundation of Australia or the tobacco industry, and several Australian universities, including the University of Western Australia, Deakin University,(195) the University of Sydney,(196) the University of New South Wales(197) and Murdoch University(198) have moved to disassociate themselves from tobacco industry funded research. Curtin, Flinders, Edith Cowan and the University of Tasmania are said to have informal anti-tobacco funding policies, while the issue is under review at Griffith, Wollongong, Adelaide, Charles Sturt and UTS.(195)
For further discussion of the Australian tobacco industry's public denials of the health consequences of smoking, see Chapter 5, Section 4.