A new report in BMJ Global Health explores the links between unhealthy commodity industries (UCIs) such as tobacco, alcohol, unhealthy food, and gambling; analyzes the extent of alignment across their corporate political strategies, and proposes a cohesive systems approach to research across UCIs. The authors conclude that UCIs employ shared strategies to shape public health policy, protecting business interests, and thereby contributing to the perpetuation of non-communicable diseases. A cohesive systems approach to research across UCIs is required to deepen shared understanding of this complex and interconnected area and to inform a more effective and coherent response.Continue reading Developing a cohesive systems approach to research across unhealthy commodity industries
Donald J. Cohn of Webster & Sheffield, a cigarette manufacturer’s counsel, is shown speaking to the jury in Cipollone v. Liggett Group, Inc., 683 F.Supp. 1487 (1988), in U.S. District Court D in New Jersey by Marilyn Church. Source.
The language used by attorneys in tobacco litigation reveals key elements of the strategies deployed by cigarette makers and their courtroom opponents. In a new article in Tobacco Control, Risi and Proctor use methods from computational linguistics to identify differences in the rhetorical strategies deployed by defense versus plaintiffs’ lawyers in cigarette litigation.
More than 100 free-market thinktanks from North America to Europe and south Asia took positions helpful to the tobacco industry or donations, an investigation by The Guardian shows. These thinktanks have provided a powerful voice of support to cigarette manufacturers in battles against tougher regulations. At least 106 thinktanks in two dozen countries have accepted donations from tobacco companies, argued against tobacco control policies called for by the World Health Organization (WHO), or both, according to The Guardian analysis.
These groups have opposed plain cigarette packaging, written to regulators in support of new tobacco products, or promoted industry-funded research. In one extreme case, an Africa-based thinktank questioned whether the link between cancer and smoking “was yet to be empirically established”, before backing away from the claim.
Patricio Marquez, lead specialist on health global practice at the World Bank, said such activity could impact public health efforts. The thinktanks “have created an arsenal of evidence in order to influence policy-making and decision-making,” he said.
The Guardian examined one of the largest networks of independent free-market thinktanks in the world, organized by Atlas Network, a not-for-profit based near Washington DC in Arlington, Virginia, which it says “connects a global network of more than 475 independent, civil society organizations in over 90 countries to the ideas needed to advance freedom.” The Guardian coverage for this report was supported by Vital Strategies.
Read The Guardian’s Free-market groups and the tobacco industry database
Earlier this month, the U.S. Food and Drug Administration proposed new rulesthat would restrict flavored e-cigarettes and tobacco products that have lured young people into vaping and smoking.Fast Company, a media outlet that “chronicles how changing companies create and compete”, recently published a profileof Juul, a company founded in 2017 to make and sell e-cigarettes. Juul is now valued at more than $16 billion and controls 72% of the U.S. e-cigarette market. It’s also hooking teens on nicotine and drawing scrutiny from the FDA. Can the company innovate its way out of a crisis it helped create, asks Fast Company?
Another story last week, this one in The New York Times, describes how Matt Murphy, a high school senior then 17 years old in Reading , Massachusetts, become addicted to Juul. “It was love at first puff,” said Matt, now 19. As the United States debates what rules will govern the marketing of e-cigarettes, public health researchers and advocates will have to digest and synthesize a growing body of literature — and misleading claims. Two recent reviews, cited below, can help readers to begin to sort through this evidence.
Breitbarth AK, Morgan J, Jones AL. E-cigarettes-An unintended illicit drug delivery system. Drug and alcohol dependence. 2019(88): 144-149.
Unger M, Unger DW. E-cigarettes/electronic nicotine delivery systems: a word of caution on health and new product development. Journal of thoracic disease. 2018;10(Suppl 22):S2588.
A Juul in the hand…(credit)
When a San Diego-based mother posted an emergency alert on Nextdoor, a community discussion app, she hoped a Good Samaritan could help, according to court filings, reports The Washington Post. Her son was hysterical after losing a flash drive with his homework near the local McDonald’s, she wrote, uploading a photo along with the message. A neighbor quickly replied, explaining that the chewing-gum-sized object in the picture was not a flash drive: It was a Juul vaping device. “That’s just an indication of how quickly Juuls became prevalent,” recounted Esfand Nafisi, a lawyer who is handling two of three lawsuits initiated against Juul Labs last month. “You blinked your eye, and suddenly they were all over the place.”
“I think Juul has been insincere from the very beginning in saying it’s only for adult smokers,” said Robert Jackler, principal investigator at a Stanford University School of Medicine program that studies the impact of tobacco advertising. He noted that Juul Labs executives have boasted that they run “the most educated company, the most diligent, the most well-researched.”
Two recent court cases challenge Juul’s practices.
Read the complaintfiled against Juul in United States District Court Southern District of New York in June 2018.
Read the complaintfiled in United States District Court District of Northern California in April 2018.
The rapid growth of a new brand of e-cigarette known as Juul has attracted media and public health advocates’ attention. According to The New York Times, school officials, struggling to control an explosion of vaping among high school and middle school students across the country, fear that the devices are creating a new generation of nicotine addicts.
Since launching about two years ago, reports BuzzFeed News, Juul has become one of the hottest e-cigarettes on the market. It’s been called “the iPhone of e-cigs” and it has gained somewhat of a cult following among young adults. Shaped like a USB device and easy to conceal, Juul is made by a San Francisco-based company that has received venture capital money.
Following the playbook of cigarette and alcohol manufacturers, who long ago learned that the best way to market their products to children and young people was to claim they were only for adults, Ashley Gould, the chief administrative officer of Juul, told the Times that the company’s products are intended solely for adults who want to quit smoking. Among the flavors Juul markets are fruit medley and crème brulee.
A new study published in PLOS One assesses the net gains and losses from the spread of vaping. The authors calculated the expected years of life gained or lost from the impact of e-cigarette use on smoking cessation among current smokers and transition to long-term cigarette smoking among never smokers for the 2014 US population cohort. Their conclusion: “e-cigarette use currently represents more population-level harm than benefit. Effective national, state, and local efforts are needed to reduce e-cigarette use among youth and young adults if e-cigarettes are to confer a net population-level benefit in the future.”
To counteract the rapid spread of e-cigarettes, seven public health and medical groups, and several individual pediatricians, filed suit in federal court in Maryland challenging a U.S. Food and Drug Administration (FDA) decision that allows electronic cigarettes and cigars – including candy-flavored products that appeal to kids – to stay on the market for years without being reviewed by the agency. According to Industrial Safety and Hygiene News, The lawsuit was filed by the American Academy of Pediatrics and its Maryland chapter, American Cancer Society Cancer Action Network, American Heart Association, American Lung Association, Campaign for Tobacco-Free Kids, Truth Initiative and five individual pediatricians.
Although the groups strongly support the FDA’s new efforts to reduce nicotine levels in cigarettes to minimally or non-addictive levels, they also believe that the FDA’s August 2017 decision to exempt e-cigarettes and cigars from agency review for years to come is unlawful and harms public health.
Dr. Derek Yach at the launch of the Foundation for a Tobacco Free World credit
Last September, Phillip Morris International , which calls itself the “world’s most successful cigarette company”, announced that beginning in 2018, it would contribute about US$80 million annually over the next 12 years to create the Foundation for a Smoke-Free World with the goal of accelerating “progress in reducing harm and deaths from smoking worldwide.” Derek Yach, whose credits include serving as a key architect of the WHO’s Framework Convention on Tobacco Control and a stint as Senior Vice President for Global Health and Agriculture Policy at PepsiCo, was hired to serve as President of the new foundation.
Within the public health and tobacco control community reaction to the new foundation has been divided—mostly negative.
Writing in The Wire, an independent news platform based in India, Anoo Bhuyan summarized some of the reactions:
Philip Morris International is attempting to distribute nearly $1 billion for research on reducing smoking. But the grant is being called a “billion dollar bribe” of “blood money,” a “wolf in sheep’s clothing,” a “smokescreen,” a “public relations stunt” and the “height of hypocrisy.” The American Cancer Society has even called it a “new twist out of the tobacco industry’s deadly playbook”, while the World Heart Federation says it is a “vehicle for the tobacco industry.” One anti-smoking group said “the tobacco epidemic will never be ended by its perpetrators.” Another found it so unbelievable they said it “truly sounds like fake news.”
A number of top universities in the US and UK have said they will not be accepting this research funding as it clashes with their ethics policies. Columbia University remained non-committal on the issue. However, one scholar at Harvard’s prestigious T.H. Chan School of Public Health told The Wire that they are “discussing” if it violates their 15-year-old policy of rejecting funding from the tobacco industry. He added, however, that the university’s ban on tobacco industry funds remained firmly in place.
In a blog for the British Medical Journal, Richard Smith, who served as editor of that journal until 2004, offered a different opinion:
There is a logic to Yach’s move. It will probably never be possible to achieve a nicotine-free world, not least because people with severe mental health problems find benefit from nicotine…. But with the arrival of e-cigarettes it may be possible to achieve a tobacco-free world. E-cigarettes might be harmful, but even the most ardent anti-tobacco campaigner would agree that it’s the smoke not the nicotine that kills. The appearance of e-cigarettes is changing the world of tobacco as railways changed canals and digital images changed film. How should tobacco companies react? …Philip Morris International seems to have bet that e-cigarettes will be the future, and so there is business logic to funding a Foundation for a Smoke-Free world. Unfortunately, there is also a business logic to continuing to block attempts to reduce cigarette consumption in markets where e-cigarettes have yet to make inroads.
This two-faced attitude will seem unacceptable to many, but if the foundation can achieve real independence from the company then much can be achieved with $1 billion. Many foundations have little or no independence from their companies, but I believe that it is possible to achieve true independence with the right governance—at least if the money is committed for 12 years.
The debate about BMI’s billion dollar investment mirrors a larger dispute about e-cigarettes and the future of the tobacco/nicotine industry and of tobacco/nicotine control. A few recent reports illustrate the scope of the conflict.
In a special report on Philip Morris research on e-cigarettes, Reuters questioned the quality of the research PMI has sponsored to justify its new smoking devices to the US Food and Drug Administration and other regulatory agencies.
Tamara Koval, who worked at the company from 2012 to 2014 and helped coordinate clinical trials for the device, questioned the quality of some of the researchers and sites contracted to carry out those experiments. Koval was a co-author of the company’s protocol used to run the studies globally. When she highlighted an irregularity in one of the studies, Koval said, Philip Morris excluded her from meetings.
Reuters also found irregularities during interviews with some of the principal investigators contracted to conduct the trials for the company. One principal investigator said he knew nothing about tobacco. Philip Morris had to jettison the experiment that investigator performed after it emerged he hadn’t followed a basic procedure for obtaining informed consent from participants during clinical trials.
The allegations raise questions as to whether despite its new foundation, PMI is following its old strategy of distorting science to achieve its business goals. David Kessler, a former FDA commissioner told Reuters, “taken as a whole, it’s clear they do not have the sophistication to carry out adequate and well-controlled clinical trials.”
The conflicts about PMI and e-cigarettes also raise larger questions for the public health community:
- What might be the consequences of creating corporate sponsored research foundations at the same time as the federal government is cutting public health regulations and the agencies that support them?
- How will private corporate-sponsored philanthropy influence government decisions about public research funding?
- What effect will corporate -sponsored research foundations—however rigorous and independent their research—have on public trust of science and scientists?
As tobacco control activists debate the specific questions of how to respond to PMI’s new Foundation for a Smoke-Free World, it is important to also pay attention to the longer-term consequences of corporate funding for public health research.
Corporations and Health Watch
Eleven years ago, writes historian Robert Proctor in The New York Times, a Federal District Court judge in Washington concluded after a nine-month trial that cigarette makers had committed fraud and violated racketeering statutes in a decades-long conspiracy to deceive the public about the dangers of smoking. Judge Gladys Kessler didn’t mince words, ruling that Philip Morris and other tobacco companies had “marketed and sold their lethal product with zeal, with deception, with a single-minded focus on their financial success, and without regard for the human tragedy or social costs that success exacted.” This week, newspapers and television networks will begin carrying five “corrective statements” ordered by the court, shown above as printed in The Times. Altria, R. J. Reynolds, Lorillard and Philip Morris will be required to run statements five times a week on weekdays for one year on CBS, NBC and ABC; the statements will also appear in full-page ads on five Sundays between now and March in more than 50 leading newspapers.
Despite the corrective statements, tobacco companies still spend far more money persuading people to smoke than warning of the dangers. And, as Wall Street Journal columnist Jo Craven McGinty noted, “the nation’s 92 million millennials and teenagers may not get the message because the ads will run primarily on network television and newspapers. ‘That’s not where young people’s eyeballs are’, said Robin Koval, CEO and President of Truth Initiative, a nonprofit organization that campaigns against youth smoking.”
In its annual Good Governance report, writes Fair Observer, the Institute of Directors assesses the United Kingdom’s largest listed companies against indicators that include board effectiveness, audit and risk accountability, remuneration, shareholder relations and stakeholder relations. Ironically, the IoD index’s top performers often come from the alcohol and tobacco industries. This year’s report gave pride of place to the distiller Diageo and the 2016 winner was British American Tobacco (BAT). The IoD’s standards may be appropriate for how these companies behave in London. In Kinshasa, Kampala and Juba, though, the praise of BAT surely raises eyebrows. As the rest of the world has learned over the intervening months, above-board corporate behavior in the UK does not guarantee ethical conduct elsewhere. Over the summer, The Guardian revealed in a series of explosive investigative pieces that BAT (as well as other multinational tobacco firms) has been ruthless in staking out market share and seeing off health regulations in African markets. BAT and its allies have threatened governments in some eight African countries to counteract policies that have underpinned public health initiatives in Western markets.
Image from Youth Food Educators of East Harlem
Countermarketing campaigns use health communications to reduce the demand for unhealthy products by exposing motives and undermining marketing practices of producers. These campaigns can contribute to the prevention of noncommunicable diseases by denormalizing the marketing of tobacco, alcohol, and unhealthy food. By portraying these activities as outside the boundaries of civilized corporate behavior, countermarketing can reduce the demand for unhealthy products and lead to changes in industry marketing practices. Countermarketing blends consumer protection, media advocacy, and health education with the demand for corporate accountability. Countermarketing campaigns have been demonstrated to be an effective component of comprehensive tobacco control. This review describes common elements of tobacco countermarketing such as describing adverse health consequences, appealing to negative emotions, highlighting industry manipulation of consumers, and engaging users in the design or implementation of campaigns. It then assesses the potential for using these elements to reduce consumption of alcohol and unhealthy foods.
Full citation: Palmedo PC, Dorfman L, Garza S, Murphy E, Freudenberg N. Countermarketing Alcohol and Unhealthy Food: An Effective Strategy for Preventing Noncommunicable Diseases? Lessons from Tobacco. Annu Rev Public Health. 2017;38:119-144.