Manufacturers researching risks associated with their own or competitor products experience a conflict of interest that can bias findings and interpretations.1, 2 Nonetheless, the tobacco industry has a long history of conducting and funding research on tobacco use and exposure, as well as on the effectiveness of tobacco control policies. For example, early research on secondhand smoke that was affiliated with the tobacco industry overwhelmingly concluded that secondhand smoke is not harmful to health.3 In response to plain packaging legislation in Australia, the tobacco industry funded research (heavily criticised by public health experts)4-6 that concluded the measure has had no impact on smoking prevalence in Australia.7, 8 Such research serves to promote public uncertainty about the health risks of smoking and to undermine the legitimacy of public health measures that regulate tobacco use and products.
The peer-reviewed journals Critical Reviews in Toxicology and Regulatory Toxicology and Pharmacology have been criticised for their ties to the tobacco industry.9 They have been labelled as “junk science” that primarily aim to create doubt, delay regulatory efforts, and interfere with independent scientific literature. In 2017, a review of tobacco related papers published in Regulatory Toxicology found that the majority (76%) of the papers with authors affiliated with the tobacco industry drew self-serving conclusions and none drew unfavourable conclusions.10
These issues have led to a number of journals refusing to publish work that is partly or wholly funded by the industry, including since 2013 BMJ, Thorax, Heart, BMJ Open,11 as well as The American Thoracic Society (since 1995), PLOS Medicine (since 2010), Tobacco Control (since 2013) and the European Journal of Public Health (since 2014).12
10A.3.1 Industry conducted research
The tobacco industry has conducted extensive research into its own products; however there is evidence that the release/promotion of its findings largely depends on whether the results serve its own interests. For example, despite a promise made in 1954 to investigate the health effects of secondhand smoke and make all findings public,13 the tobacco industry failed to disclose the results and continues to deny the extent of the health effects caused by exposure to secondhand smoke.14 In response to growing concerns about the health effects of smoking, tobacco companies added “low-tar” cigarettes to the market in 1971.15 A former research director at Philip Morris testified in 2016 that its own studies decades earlier showed switching to “light” or “low tar” cigarettes led to compensatory smoking (and therefore had no health benefits; see Section 12.4);16 however, these findings were again not released.
More recently, much of the research conducted by tobacco companies is focused on developing “safer” products that are heat-not-burn and smoke-free. Philip Morris International claims to have invested millions in employing over 400 “world-class scientists, engineers, and technicians.”17 British American Tobacco similarly claims to employ over 400 “highly skilled specialists in areas such as biochemistry, genetics, toxicology, biotechnology and electronics.”18 The industry’s own studies have consistently concluded that compared with cigarettes, heated tobacco products are substantially less harmful to users and bystanders; however as with earlier industry research on cigarettes, the methods and conclusions of such studies have been criticised by public health experts (see InDepth 18C),19-21 and an investigation by Reuters into Philip Morris found shortfalls in training and professionalism among some lead researchers.22, 23
10A.3.2 Industry affiliated research institutions
On several occasions up until the mid-1990s, the tobacco industry established pseudo-scientific research foundations designed to give credibility to the notion that there remains controversy about the medical evidence on the health risks of smoking. Funding research organisations has also allowed the tobacco industry to:24-27
- reap a public relations advantage from financing (apparently) independent research on smoking
- demonstrate its disagreement that smoking causes disease while appearing committed to finding ‘solutions’
- support research likely to produce outcomes advantageous to industry objectives, (including ‘inconclusive’ research showing that yet more research is needed)
- suppress unfavourable research
- create delays in regulation or legislation
- locate and foster credible public spokespeople with the appearance of independence
- offer smokers reassurance
- keep in the public eye ‘distraction’ or ‘diversionary’ research (which, for example, places emphasis on air pollution or sick buildings) to deflect attention from tobacco.
Generally research foundations of this nature were given official sounding names that did not indicate the connection between the organisation and its financial backers. The organisations funded in-house research, and acted as funding agencies that provided grants to other groups, with or without obvious tobacco connections.
10A.3.2.1 – International Industry affiliated research institutions
The first industry research group, established in the US in 1954, was the Tobacco Industry Research Council (later the Council for Tobacco Research), which promoted the industry’s ends for more than 40 years until its closure under the terms of the Master Settlement Agreement in 1998.25 As an antidote to concerns regarding secondhand smoke, the industry established the Center for Indoor Air Research to fund projects that would support industry resistance to smokefree regulations.27
The Master Settlement Agreement-mandated closure of multi-company co-operative research and lobbying organisations resulted in a new crop of organisations post-settlement, including the Institute for Science and Health (funded by British American Tobacco and Brown & Williamson), the Philip Morris-connected Life Sciences Research Office,28 and the Philip Morris External Research Program. A critical analysis of the first round of projects funded by the Philip Morris External Research Program shows that foci of the program’s interest were projects that would deliver findings likely to support Philip Morris’ corporate aims. The program was also used as a vehicle for identifying co-operative scientists, as well as gaining credibility and goodwill.25
Other groups have been established to divert attention and trivialise smoking in ways appealing to the popular media. In the early 1990s the Advancement of Sound Science Coalition, funded by Philip Morris, purported to be a grassroots coalition of people fed up with health scares and ‘junk science’.29 Associates for Research into the Science of Enjoyment (ARISE) claimed to be an affiliation of independent scientists but was actually substantially funded by several tobacco companies. ARISE’s brief was to show how ‘everyday pleasures, such as eating chocolate, smoking, drinking tea, coffee and alcohol, contribute to the quality of life’.30 The Institute for Biological Research (INBIFO), a research laboratory in Germany, was secretly acquired by PMI in the 1970’s.31, 32 INBIFO would go onto publish research suggesting an association between lung cancer and green tea.33
Internal tobacco industry document research continues to expose global examples of tobacco industry funding of research institutes to refute secondhand smoke concerns,34, 35 question the evidence and legality of tobacco control reforms, and build alliances.36
10A.3.2.2 – Australian industry affiliated research institutions
The Australian Tobacco Research Foundation (ATRF) opened for business in 1970, the joint creation of the three major tobacco companies operating at the time (WD & HO Wills, Rothmans and Philip Morris), which shared its funding and oversaw its governance. Although criticised from the start for its overt mission of forestalling tobacco regulation and widespread cynicism that it would contribute to robust, impartial research, the ATRF fulfilled a useful PR function for the following two decades, chiefly by providing evidence that the Australian tobacco companies supported independent medical research.24 The ATRF entered terminal decline in 1988, when, in response to mounting criticism from health interests about the shared interests of and blurred organisational boundaries between the ATRF and the tobacco companies, the entire scientific advisory committee of the ATRF wrote to the Medical Journal of Australia declaring its unanimous agreement that smoking caused disease.37 Negative publicity, compounded by increasing rejection of tobacco research money by the medico-scientific community, led to the scaling down and eventual closure of the ATRF in 1994.24
Meanwhile the industry was engaged against secondhand smoke through the offices of another seemingly independent organisation. In 1987 the Tobacco Institute of Australia facilitated the establishment of a local offshoot of the US-based Air Conditioning and Ventilation Associates Atlantic, which came to be known as Healthy Buildings International.38 Its brief was to promote the tobacco industry view that the evidence about secondhand smoke was inconclusive; that secondhand smoke is a minor issue in the context of overall indoor air quality; and concerns about smoking indoors could be adequately met with appropriate ventilation and by providing smoking areas (Sick building syndrome is discussed further in Chapter 3, Section 25). Healthy Buildings International gained a high public profile, achieving extensive media coverage and a wide professional audience for its views, while always asserting its status as an independent organisation.38 During the 1990s Healthy Buildings International gained membership on an advisory committee charged with revising Australian Standards for indoor air, a position which allowed it to influence the committee’s recommendations, as well as keep Philip Morris abreast of developments, until Healthy Buildings International was exposed and its position on the committee terminated in 2002.24
In 2002, the Institute of Public Affairs admitted to receiving tobacco industry funding. In 2010, during interviews following the Federal Government’s plain packaging legislation announcement, Tim Wilson (an Institute of Public Affairs employee) refused to clarify if the Institute of Public Affairs currently received tobacco industry funding, simply stating that ‘any funding has no impact on the policy positions we take whatsoever’. The official Institute of Public Affairs response to the funding question was that, ‘the IPA does not disclose its membership list. However, members are welcome to disclose their membership of the IPA’. When ABC Media Watch approached the three Australian tobacco companies, Imperial Tobacco responded stating it did not currently nor had it in the past provided funding to the Institute of Public Affairs. British American Tobacco Australia responding by stating that, ‘any such arrangements are commercial in confidence’ and Philip Morris International gave a similar reply: ‘we do not disclose the details of these relationships’.39
10A.3.3 Industry-funded research in academic institutions
As discussed in Section 10A.3.2 above, the industry has used its own funding bodies, their connection with the industry often obscured, as a conduit for distributing money into mainstream universities and other research institutes.
Over the years, acceptance of tobacco industry funding has been widespread in Australia40 and globally,26 generating rafts of studies with findings beneficial to the tobacco industry. In turn, this research has permeated the peer-reviewed medical press. For example, in 2005 Philip Morris provided the funding for an Israeli study into the determinants of uptake of smoking in young women,41 which examined the influences of genetics, environment and psychological characteristics. Critics pointed out that the study neglected to include the possible impact of tobacco advertising.42 The successful infiltration by the tobacco industry of reporting of published research in Germany has been credited with serving the industry’s interests of increasing the social acceptability of smoking and undermining tobacco control initiatives in that country.43 Prominent researchers at Weill Cornell Medical College caused controversy in 2008 when it became public that they had earlier accepted grants channelled through a tobacco-funded organisation called the Foundation for Lung Cancer: Early Detection, Prevention and Treatment, and that findings from this research44 had been published in mainstream medical press without disclosure of tobacco funding.45
As well as providing funding to individual scientists or departments, in some cases tobacco companies have established entire programs within universities. For example, Philip Morris has funded the Center for Nicotine and Smoking Cessation Research within Duke University’s Nicotine Research Project (in Richmond, Virginia).46 In 2002, the University of Nottingham accepted funding from British American Tobacco to establish the International Centre for Corporate Social Responsibility,47 invoking, according to one observer, ‘the ethics of the cash register’48 (see Section 10.11 for more discussion on the tobacco industry and corporate social responsibility).
To accept or refuse tobacco funding clearly raises important ethical questions. Arguments against accepting tobacco grants include that:26, 49, 50
- 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
- it lends credibility to industry claims that there is insufficient evidence to conclude that smoking (or secondhand smoke) is a cause of disease, and bolsters the industry claim that ‘more research is needed’
- it improves the corporate image of the industry to be involved in apparently altruistic activities and associated with respected scientists and institutions, and can provide leverage in wider policy-setting scenarios
- those in receipt of tobacco money may feel constrained about what they say publicly about health and smoking; tobacco funding may therefore silence a potentially influential and articulate opponent
- accepting money from a source with so clear a vested interest may lead to a biased research program, biased results and biased reporting
- even the requirement for researchers to divulge the sources of their funding may not expose underlying tobacco finance, which is often well concealed
- reliance on funds of tobacco origin leads to ‘institutional addiction’, in which organisations dependent on tobacco money become unwilling to bite the hand that feeds them.
On the other hand, those who argue in favour of accepting research funding from tobacco companies contend that:26, 51
- what is at issue is the quality of the work, not the origins of the funding
- appropriate firewalls and safeguards will ensure the research is conducted without bias
- any benefits the tobacco industry might gain in corporate image are minor compared to the potential public health benefits that may accrue from the research
- the peer review process ensures validity
- requirements for disclosure alerts the reader to any conflict of interest and makes the findings even more subject to scrutiny
- funding research is a useful purpose for industry profits.
In June 2004, Cancer Research UK and Universities UK agreed to a protocol that contains guidelines for institutions considering accepting tobacco funding.52 Cancer Research UK is the leading provider of research funding into cancer in the UK, and has a strict policy of avoiding any direct or indirect links with the tobacco industry.53 Cancer Research UK has stated that it will not fund research in a university where there is the possibility that there could be any association with work funded by a tobacco company. The cancer charity also states that it considers it has a duty to publicly criticise a university that accepts tobacco donations. For its part, Universities UK has stated that while it is up to individual universities to decide which funding they should accept, they ‘should normally reveal the source of funds for research and should satisfy themselves that their reputation for impartiality, integrity and disinterested inquiry will not be compromised by any particular source of funds’ (p6). 53 In the US, several schools of public health and of medicine (including Harvard University, Emory University, the University of California and Johns Hopkins University) have policies prohibiting acceptance of tobacco funding.54 In Australia, there is no over-arching agreement between universities but many have adopted policies governing or prohibiting the acceptance of tobacco money (Further information regarding the policies of Australian universities are in the article supplement; see: http://jech.bmj.com/cgi/data/58/5/361/DC1/3.55
Given the scarcity of research dollars, some researchers have proposed assessment criteria and models that could be used to potentially illuminate the criticisms and problems associated with accepting tobacco industry funding for research.56 They propose the following eight criteria to evaluate four funding models:
1. Transparency and independence
2. Competitive funding process
3. Ownership of data and freedom to publish
4. Independent research agenda
5. Governance
6. Protection against conflict of interest
7. Industry public relations gains that counteract public health
8. Feasibility.
The four models assessed were: 1) a dedicated tobacco tax or manufacturer licence fee (legislation), 2) legally mandated contributions from tobacco companies (court ordered), 3) voluntary tobacco company contributions administered through an independent third party, and 4) voluntary tobacco company contributions direct to academic institutions. In their evaluation of the four funding models they conclude that there is no perfect model that scores well in every area. Overall, the most feasible models (3 and 4) were the ones deemed least acceptable to the public health and tobacco control communities. 56
10A.3.4 Industry-sponsored consultants
The tobacco industry has long seen the advantage in financing and helping promote publicity for outspoken, media-savvy scientists who are prepared to challenge accepted views on smoking and health or various aspects of tobacco control, while appearing to be independent. Co-operation between the tobacco companies on a global scale has ensured that competent tobacco industry spokespeople have been shared.57-59 In Australia, it has been documented that at least nine visiting industry-sponsored scientists gained substantial publicity between 1969 and 1979, promoting a range of industry-friendly views debunking the health evidence about smoking. Over the years the views of these individuals were widely reported, often uncritically, by the news media. It is probable, given the timing and content of some of these publicity initiatives, that tobacco industry consultants adversely influenced the course of tobacco control initiatives in those early days.57
In the late 1970s and into the 1980s, the Australian tobacco industry cultivated a home-grown dissenter, Sydney general practitioner Dr William Whitby, who self-published two books (Smoking is Good for You and The Smoking Scare De-Bunked). Although there is evidence that the industry recognised that Dr Whitby’s particular brand of pro-smoking fanaticism might pose a liability, it provided the means for his views to be widely disseminated and Whitby’s works were retained in the armoury of international tobacco circles well into the 1990s.58
The tobacco industry adopted similar techniques in efforts to subvert the accumulating medical evidence on secondhand smoke, as well as deflecting attempts to introduce bans on tobacco advertising and other forms of regulation of tobacco products in Australia and internationally. For example, Philip Morris and other international companies collaborated to promote the views of scientists holding views on secondhand smoke counter to those of mainstream health authorities throughout Asia, Europe and the US during the 1980s and 1990s.27, 59-62 During the 1980s British American Tobacco ‘ghost-wrote’ reports for JJ Boddewyn, which were published by the International Advertising Association, designed to counter bans on tobacco advertising.63 The Boddewyn reports on advertising were widely circulated internationally (including in Australia64) and formed the basis of industry campaigns to oppose advertising bans.
More recent examples of high-profile tobacco industry-funded consultants include Patrick Basham and John Luik of the Democracy Institute. Basham directs the Washington and London-based Democracy Institute65 and is a Cato Institute66 adjunct scholar (The Cato Institute has a history of accepting funds from tobacco industry donors including Altria and RJ Reynolds67). Basham and Luik have published reports68 and newspaper editorial critiques69 of plain packaging legislation. In June 2011, Luik and Basham made a submission to Australia’s public consultation on plain packaging, primarily arguing that there is little evidence the legislation will reduce smoking and that it is a violation of intellectual property laws.70 Basham was funded by Philip Morris in August 2011 to visit New Zealand in order to discourage the government from following Australia’s lead in developing plain packaging legislation.
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