10.12 The tobacco industry's revised stance on health issues

Corporate admission that smoking causes ill-health and death is at the heart of the tobacco industry's metamorphosis into socially responsible corporate citizens. From the earliest days, the tobacco industry robustly countered any claims that smoking caused disease. Discovery of internal tobacco industry documents in the wake of several US court cases in the late 1990s (discussed in Chapter 10, Section 10.10) proved what health advocates had long suspected—that the tobacco industry was indeed aware that its product was a major cause of death and disease, and that several decades had been spent deliberately colluding in covering up, denying, confusing and questioning the issues of smoking and health.¹ Even well into the 1990s, spokespeople for the tobacco industry in Australia denied that tobacco use was a cause of disease, citing, for example, a perceived lack of causal proof, and the vagaries of genetics², and that other risks cause cancer too. For example, “So are potatoes. Cancer-causing that is. Tobacco is in the same family. You inhale the fumes of potatoes when you’re cooking them.”(R Berryman, Tobacco Institute, Australia, 1989).ⁱ It is highly probable that this legacy of denial, maintained consistently and persuasively for more than half a century, still has residual effects on smokers today.³

10.12.1 Smoking, health and addiction

Historically, the industry denied that smoking was addictive, despite conducting research and developing products that enhanced and increased the uptake of nicotine.^{4, 5} Today, a visit to any one of the websites of Philip Morris International,⁶ British American Tobacco Australia⁷ and Imperial Brands PLC⁸ provides the reader with a number of carefully crafted statements about the effects of tobacco on health. As of 2017 all three of these major tobacco companies have issued statements that acknowledge that smoking is addictive and harmful to health. Philip Morris International states its acceptance of the views of major health authorities with the statement: 'Cigarette smoking causes serious disease and is addictive. When a cigarette is lit, the tobacco burns and creates smoke. In cigarette smoke more than 8,000 chemicals or ‘smoke constituents’ have been identified. Public-health authorities have classified approximately 100 of them as causes or potential causes of smoking-related diseases such as lung cancer, cardiovascular disease, and emphysema. These constituents include among others arsenic, benzene, benzo[a]pyrene, carbon monoxide, heavy metals (such as lead and cadmium), hydrogen cyanide, and tobacco-specific nitrosamines.'⁶ British American Tobacco Australia states that, 'Along with the pleasures of smoking there are real risks of serious diseases such as lung cancer, respiratory disease and heart disease, and for many people, smoking is difficult to quit.'⁷ Imperial Brands PLC makes very similar statements on the health risks and addiction, ‘Smoking is a cause of serious diseases in smokers, including lung cancer, heart disease and emphysema. Cigarette smoking is addictive and it can be very difficult to stop.'⁸

It can safely be assumed that all of the above statements have been thoroughly vetted by industry lawyers to ensure that they will adequately serve the companies' needs in the event of litigation. Meanwhile, it has been observed by some commentators that in reality, the tobacco companies have not made substantial strides towards a consensus with public health interests on smoking and health. In her 2007 analysis of the evolving language on tobacco, health and addictiveness on Philip Morris's website, Friedman comments that Philip Morris's wording in fact concedes little and is deliberately leaves open options for Philip Morris's defence in the event of litigation.⁹ A 2008 study on the use of language on Philip Morris's website found many contradictions and omissions that may undermine public health messages, including confusing information about addiction, tar and nicotine, a lack of motivational messages to quit smoking, and silence about tobacco-related mortality.¹⁰

Henningfield et al have studied courtroom testimony and other related statements made by tobacco companies regarding the addictiveness of tobacco.¹¹ This report concluded that industry strategy has evolved to redefine and trivialise the term 'addiction', likening nicotine to substances such as caffeine and chocolate but distinguishing it from hard drugs like cocaine and heroin. The World Health Organization has published an extensive report, Evolution of the Tobacco Industry Positions on Addiction to Nicotine, that provides a detailed outline of the tobacco industry's public and internal views on addiction.¹² It concludes that, 'the industry's current position on addiction as a complex of social, behavioural and pharmacological factors potentially allows the company to develop a so-called "safer" cigarette that manipulates behavioural and chemical properties related to addiction, but without necessarily changing the potential for addiction at all'.¹²

10.12.2 Secondhand smoke

As with active smoking, each of the tobacco companies operating in Australia addresses secondhand smoke (SHS) on its website in different, but equally meticulously constructed, statements. Philip Morris International's website offers a list of health consequences declared by 'public health authorities' to be caused by SHS, and recommends that the public should be guided by these conclusions (Philip Morris International itself neither confirming nor denying any connection between SHS and disease).⁶ Philip Morris International has described its approach to any regulation as 'common sense' and is pushing 'smoke-free' alternative products as the primary solution.⁶ The British American Tobacco Australia website does not include reference to SHS in the health risks section of its site,⁷ nor does it mention SHS laws under the regulation section of the site. This is perhaps reflects the fact that smokefree laws are hugely successful and comprehensive in Australia, so there is little point in pushing against them. In low and middle income countries however, British American Tobacco website describe support for ‘regulation that accommodates the interests of both non-smokers and smokers and limits non-smokers’ involuntary exposure to [environmental tobacco smoke]...such as the creation of smoke-free areas, combined with adequate provision for smokers’.^{13, 14}   

Similarly to British American Tobacco Australia, Imperial Brands PLC is notable in that it does not include any information or position on SHS or smokefree laws in its 'our views' summary on health risks and regulations.⁸

In Australia and internationally, the tobacco industry has had a long history of lobbying against measures to protect non-smokers from tobacco smoke, to dispute and undermine findings by medical and health bodies^15-17 and to fund, directly and indirectly,^18-21 research that supports its position on the health effects of secondhand smoke.

References

1. Francey N and Chapman S. 'Operation berkshire' - the international tobacco companies' conspiracy. British Medical Journal, 2000; 321(7257):371-4. Available from: http://www.bmj.com/cgi/reprint/321/7257/371.pdf

2. Gundle K, Dingel M, and Koenig B. 'To prove this is the industry's best hope': Big tobacco's support of research on the genetics of nicotine addiction. Addiction, 2010; 105(6):974–83. Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2010.02940.x/full

3. Carter S and Chapman S. Smoking, disease, and obdurate denial: The australian tobacco industry in the 1980s. Tobacco Control, 2003; 12(suppl. 3):23iii-30. Available from: http://tc.bmjjournals.com/cgi/content/abstract/12/suppl_3/iii23

4. Stevenson T and Proctor RN. The secret and soul of marlboro: Phillip morris and the origins, spread, and denial of nicotine freebasing. American Journal of Public Health, 2008; 98(7):1184–94. Available from: http://www.ajph.org/cgi/content/abstract/98/7/1184

5. Wayne GF and Carpenter CM. Tobacco industry manipulation of nicotine dosing. Handbook of Experimental Pharmacology, 2009; (192):457–85. Available from: http://www.springerlink.com/content/p620645230641214/

6. Philip Morris International. Smoking and health New York: Philip Morris International, 2017. Last update: Viewed 19 June 2017. Available from: http://www.pmi.com/eng/tobacco_regulation/smoking_and_health/pages/smoking_and_health.aspx.

7. British American Tobacco Australia. The health risks of smoking. Potts Point, New South Wales: British American Tobacco Australia, 2017. Last update: Viewed 19 June 2017. Available from: http://www.bata.com.au/group/sites/BAT_9RNFLH.nsf/vwPagesWebLive/DO9RNMSS.

8. Imperial Brands PLC. Our views: Important issues in the tobacco industry. Bristol: Imperial Brands PLC, 2017. Last update: Viewed 19 June 2017. Available from: http://www.imperialbrandsplc.com/content/dam/imperial-brands/corporate/responsibility/responsible-with-products/Our Views.pdf.

9. Friedman LC. Philip morris's website and television commercials use new language to mislead the public into believing it has changed its stance on smoking and disease. Tobacco Control, 2007; 16(6):e9. Available from: http://tobaccocontrol.bmj.com/cgi/content/abstract/16/6/e9 

10. Smith E and Malone R. Philip morris's health information web site appears responsible but undermines public health. Public Health Nursing, 2008; 25(6):554–64. Available from: http://www3.interscience.wiley.com/journal/121473560/abstract

11. Henningfield J, Rose C, and Zeller M. Tobacco industry litigation position on addiction: Continued dependence on past views. Tobacco Control, 2006; 15(suppl. 4):iv27-36. Available from: http://tobaccocontrol.bmj.com/cgi/reprint/15/suppl_4/iv27

12. Hirschhorn N. Evolution of the tobacco industry positions on addiction to nicotine. Tobacco Free Initiative, Geneva: World Health Organization, 2008. Available from: http://www.who.int/tobacco/publications/evolution_tob_ind_pos_add_nicotine/en/index.html.

13. British American Tobacco Malaysia. Who framework convention on tobacco control. Selangor Darul Ehsan: British American Tobacco Malaysia, 2014. Last update: 17 September 2014; Viewed 19 June 2017. Available from: http://www.batmalaysia.com/group/sites/bat_7ryj8n.nsf/vwPagesWebLive/DO7SUKPX?opendocument.

14. British American Tobacco Nigeria. Second-hand smoke. Lagos: British American Tobacco Nigeria, 2014. Last update: 03 April 2017; Viewed 19 June 2017. Available from: http://www.batnigeria.com/group/sites/BAT_7YKM7R.nsf/vwPagesWebLive/DO7YLG2B?opendocument.

15. Trotter L and Chapman S. 'Conclusions about exposure to ets and health that will be unhelpful to us: How the tobacco industry attempted to delay and discredit the 1997 australian national health and medical research council report on passive smoking. Tobacco Control, 2003; 12(suppl. 3):iii102-6. Available from: http://tobaccocontrol.bmj.com/cgi/content/abstract/12/suppl_3/iii102 

16. Muggli ME, Hurt R, and Repace J. The tobacco industry's political efforts to derail the epa report on ets. American Journal of Preventive Medicine, 2004; 26(2):166-77. Available from: http://www.ncbi.nlm.nih.gov/pubmed/14751332

17. Ong E and Glantz S. Tobacco industry efforts subverting international agency for research on cancer's second-hand smoke study. Lancet, 2000; 355(9211):1253–9. Available from: http://www.thelancet.com/journals/lancet/article/PIIS0140673600020985/abstract

18. Tong EK, England L, and Glantz S. Changing conclusions on secondhand smoke in a sudden infant death syndrome review funded by the tobacco industry. Pediatrics, 2005; 115(3):e356-e66. Available from: http://pediatrics.aappublications.org/cgi/reprint/115/3/e356.pdf

19. Tong EK and Glantz SA. Tobacco industry efforts undermining evidence linking secondhand smoke with cardiovascular disease. Circulation, 2007; 116(16):1845-54. Available from: http://circ.ahajournals.org/cgi/reprint/116/16/1845.pdf

20. Bero LA, Glantz S, and Hong M-K. The limits of competing interest disclosures. Tobacco Control, 2005; 14(2):118-26. Available from: http://tobaccocontrol.bmj.com/cgi/content/full/14/2/118

21. Kummerfeldt CE, Barnoya J, and Bero LA. Philip morris involvement in the development of an air quality laboratory in el salvador. Tobacco Control, 2009; 18(3):241–4. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2679184/