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TheLancet publishes damning evidence of tobacco companymanipulation of passive smoking science

New documentary evidence published in The Lancet[1] shows international tobacco companies mounted a dirty-tricks campaign todiscredit a major passive smoking and cancer research study [2]. The PRcampaign cost far more than the research itself.  The evidence shows a sophisticated world-wide public-relationscampaign was created prior to publication in 1998 to mislead the public aboutthe significance of the research [3] - a campaign in which Britain's Sunday Telegraph newspaper wasmanipulated into playing a pivotal role.

ASH Director Clive Bates said: "it was clear from thestart that the news stories about the research had tobacco company fingerprintsall over them."

"Companies like BAT and Philip Morris are trying toturn on the charm to convince us they have broken with the deceit and sophistryof the past - so let them come clean about passive smoking and lung cancer andadmit the risk which is now clearly established beyond any reasonable doubt[4]."

ASH called on governments and WHO to cease alldialogue with the tobacco companies regarding science and regulatory matters:"all they want to do is to confuse, delay and obstruct - so why talk to them?"said Bates.

On March 8, 1998, the Sunday Telegraph published its story headlined "Passive smokingdoesn't cause cancer - Official" and suggested it may even have a protectiveeffect against cancer.  This is acomplete misrepresentation, dismissed as false and misleading by WHO and thestudy authors.   After persuasionfailed, ASH reluctantly went to the Press Complaints Commission.  After months of wrangling the PCC concludedthat the Sunday Telegraph had addressedASH's concerns in subsequent coverage - a point we still dispute. The articlesand details are on the ASH web site [5].

Notes

[1] Elisa K Ong, Stanton AGlantz,  Tobacco industry effortssubverting International Agency for Research on Cancer's second-hand smokestudy: THE LANCET: Vol 355; April 8,2000 (abstract below)

[2] Boffetta P,Agudo A, Ahrens W, et al. Multicenter case-control study of exposure toenvironmental tobacco smoke and lung cancer in Europe. J Natl Cancer Inst 1998; 90:1440-50.

[3] Editorial: Resisting smokeand spin, THE LANCET • Vol 355 • 8April, 2000 - see below.

[4] A K Hackshaw, M RLaw, and N J Wald The accumulated evidence on lung cancer and environmentaltobacco smoke BMJ 1997; 315: 980-988. www.bmj.com/cgi/content/full/315/7114/980

[5] See: www.ash.org.uk/papers/pcc.htmlfor the articles, complaint and correspondence.

Press release from Stanton Glantz

Press release from the International Agency for Research on Cancer

The Lancetarticle and editorial are available at www.ash.org.uk/papers/lancet080400.pdf

Scientificreports on second-hand smoke have stimulated legislation on clean indoor air inthe USA, but less so in Europe. Recently, the largest European study, by theInternational Agency for Research on Cancer (IARC), demonstrated a 16% increasein the point estimate of risk in lung cancer for nonsmokers, a resultconsistent with earlier studies. However, the study was described by newspapersand the tobacco industry as demonstrating no increase in risk. To understandthe tobacco industry's strategy on the IARC study we analysed industrydocuments released in US litigation and interviewed IARC investigators. ThePhilip Morris tobacco company feared that the study (and a possible IARCmonograph on second-hand smoke) would lead to increased restrictions in Europeso they spearheaded an inter-industry, three-prong strategy to subvert IARC'swork. The scientific strategy attempted to undercut IARC's research and todevelop industry-directed research to counter the anticipated findings. Thecommunications strategy planned to shape opinion by manipulating the media andthe public. The government strategy sought to prevent increased smokingrestrictions. The IARC study cost $2 million over ten years; Philip Morrisplanned to spend $2 million in one year alone and up to $4 million on research.The documents and interviews suggest that the tobacco industry continues toconduct a sophisticated campaign against conclusions that second-hand smokecauses lung cancer and other diseases, subverting normal scientific processes.

Lancet editorial: Resisting smoke and spin [2]

The Lancet endured anunwelcome shock in 1998 when legal documents placed on the internet revealedthat a letter about environmental tobacco smoke, published in The Lancet during the 1990s, was part ofa project sponsored by the tobacco industry to blur the issues surroundingrisks of passive smoking. Unknown to the editors of the time, there was acampaign to seed the medical literature with pro-tobacco misinformation. Onlynow has the extent of that campaign become clear. Elisa Ong and Stanton Glantz(see p 1253) describe how the tobacco industry worked to undermine theconclusions of an International Agency for Research on Cancer (IARC) report onpassive smoking. The IARC found an increased relative risk of both spousal lungcancer and lung cancer among those exposed to smoke in the workplace. ThisEuropean study was too small to show statistically significant differences butthe results were in line with previously published reports. When the existenceof this research became known, Philip Morris established a multidisciplinarytask force across the tobacco industry to explore, in conjunction with a publicrelations company and a firm of lawyers, the potential impact of the IARCreport and ways to "stimulate controversy" around it.  Philip Morris alone devoted US$2 million to this work.Consultants sympathetic to the tobacco industry were recruited to find out moreabout the IARC report, often by hiding their industry links while seekinginformation from IARC investigators. One aim of the task force was to criticiseIARC's epidemiological methods by promoting the notion of "Good EpidemiologicalPractice". Another was to commission new research that might be more favourableto the tobacco companies' position. In sum, Ong and Glantz conclude that"Scientists and policy makers need to understand that they function  in an environment that is heavily influencedby covert tobacco industry efforts to subvert normal decision makingprocesses".

All Ong and Glantz say may be true. But a curiousdownside of the industry's strategy was that it made it harder for faircriticism to be made of the IARC study by truly independent scientists. Yet theIARC study was underpowered to detect reliably relative risks smaller than 1.3,and the tobacco industry was quick to exploit this methodological weakness.Moreover, good epidemiological practice is a sensible goal. The fact that ithas partly originated from tobacco manufacturers may taint and therefore slowits successful attainment. This week's Lancetreport comes at a time when tobacco control has received a furtherimportant setback in the USA. Last month, the US Supreme Court ruled, in a 5-4decision, that the Food and Drug Administration lacked authority to regulatetobacco products. Not surprisingly, tobacco companies were delighted, callingthe FDA's attempt to protect public health "politically expedient". As industrystock prices rose, a programme of random checks to prevent retailers sellingcigarettes to teenagers came to an end. The Supreme Court has recklessly andshamefully harmed efforts to stop smoking behaviour from creeping intoever-younger age groups. It is not without perverse irony that Mark Smith, aspokesman for the tobacco company Brown and Williamson, noted how US businesses"ought to breathe a sigh of relief " at the Court's decision. While the USCongress now contemplates tougher restrictions on tobacco manufacturers, thedirty war of misinformation in academic and more public settings is likely tocontinue. Journal editors are especially vulnerable to being duped since wehave limited powers to discover sources of funding support other than merelyinviting disclosure from authors. And, as Ong and Glantz observe, even EuropeanUnion officials were drawn into the web. Tobacco is not the only aspect ofmedicine open to twisted corporate communications strategies. A 1998 studyreported that published opinions on safety of calcium-channel blockers wererelated to the financial rewards bestowed by pharmaceutical companies on thosegiving such opinions. All policymakers must be vigilant to the possibility ofresearch data being manipulated by corporate bodies and of scientificcolleagues being seduced by the material charms of industry. Trust is no defenceagainst an aggressively deceptive corporate sector. Meanwhile, IARC should nowadd passive smoking to its respected monograph series on substancecarcinogenicity.

The Lancet

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