The interference of the tobacco industry on the scientific debate. From harm reduction to SARS-CoV-2 pandemic| Tabaccologia

Article

To reassure smokers about the health effects of smoking itself, the tobacco industry has always sought to play an active role in the scientific debate. Their objective was to counterbalance the growing empirical evidence from independent research that was strongly unfavourable for tobacco use [1,2]. Tobacco companies’ strategy was to subsidise doctors, researchers, and scientists who were willing to propagate pro-industry messages [1,3].

Tobacco harm reduction has long been a popular topic among these messages [4,5]. In the past, the tobacco industry has spent money on developing research-supporting products such as low-tar cigarettes (branded as “light cigarettes”) or smokeless tobacco, such as Swedish snus [4]. Nonetheless, a few decades ago, the rising understanding of the negative effects of all kinds of tobacco [6] was increasingly at odds with the favourable findings of the aforementioned research - disclosing conflicts of interest with industry. So much so, that the World Health Organisation (WHO) began to recommend that only evidence from independent research should be seen as trustable. Several scientific journals declined to publish the results of studies related to tobacco companies [3,7], causing the tobacco industry to struggle in recruiting new advocates among researchers. Collaborating with the tobacco industry was increasingly becoming a disreputable practice.

That was until a decade ago, when electronic cigarettes entered the market in most high-income countries. This provided the tobacco industry the opportunity to re-emerge in the scientific community again, advocating for the same cause together with the e-cigarette companies. Within a few years, in fact, tobacco companies were ready to launch their electronic devices promoted as safer than traditional cigarettes: the so-called heated tobacco products, first and foremost Philip Morris International Inc.’s (PMI) IQOS [8].

PMI has earmarked nearly $1 billion for the Foundation for a Smoke-Free World (FSFW), an organisation established to support research to demonstrate that IQOS is a safe product, and that can be considered a valuable tobacco harm reduction tool [9]. Other companies, including British American Tobacco (BAT) and Japan Tobacco International (JTI), are also investing huge amounts of money in research to support these new products.

Given the magnitude of these figures, and the total lack of national or international independent funds allocated to prevention, it is only partially surprising to see (more or less) experienced tobacco control researchers agreeing to work with tobacco companies, forgetting how the industry has used scientists in the past [10]. As a result, new organisations promoting tobacco harm reduction have emerged and continue to emerge, going against not only the WHO and the vast majority of independent international tobacco associations, but also more importantly against independent scientific evidence warning against these new products [8]. Although the source of funding is not always clear, these organisations seem to have an expanding number of affiliates, who are ready to get their snout in the trough. It is difficult to imagine that these organisations are not subsidised by the FSFW or directly by the tobacco companies, yet many affiliates do not disclose any conflict of interest. Some of these may be unaware of the tobacco companies’ involvement, but it is more likely that they pretend or prefer not to know.

What is certain is that on tobacco harm reduction the scientific literature is already heavily ‘contaminated’ with potentially biased data, funded and controlled by the e-cigarette industry and, above all, the tobacco industry [11]. Some systematic reviews, conducted on e-cigarettes or harm reduction strategies, have found that all independent studies are not supportive of the tobacco harm reduction strategy, while only a negligible proportion of those funded by the industry reached the same conclusion [4,11-13]. It is interesting to note how authors with different points of view can come to opposite conclusions even when interpreting the same data. For example, with reference to data from the Eurobarometer survey conducted in 2014, harm reduction advocates, presumably linked to the tobacco industry, concluded in favour of e-cigarettes by claiming that “more than one third of current e-cigarette users polled reported smoking cessation and reduction” [14]. In contrast, researchers without conflicts of interest, analysing the same data spoke out against e-cigarettes, concluding that they “are associated with inhibiting rather than assisting in smoking cessation” [15]. If one assumes that independent researchers have a free and unconditional view, the conclusions of those with conflicts of interest can only appear biased and misleading.

Even during the COVID-19 health crisis the tobacco industry attempted to manipulate scientific information to put tobacco products and the spread of nicotine in a favourable light. This is what emerged from an article recently published in the influential British Medical Journal (BMJ) by French journalist Stéphane Horel of the popular newspaper Le Monde and the Dutch journalist Ties Keyzer from The Investigative Desk [16].

In the midst of the pandemic, some articles suggested that there might be more protection for SARS-CoV-2 infection for smokers than for those who had never smoked. The authors of these articles went so far as to recommend nicotine consumption through the use of new products, such as electronic cigarettes. Unsurprisingly, these articles generated headlines all over the world. Even in Italy, as highlighted by an article on the web site of Tobacco endgame () [17], the Libero newspaper headlined: “Smokers don’t get Covid”. Unfortunately, it was later revealed that the authors of these scientific articles had undeclared financial ties to the e-cigarette industry and/or the tobacco industry. These authors also included members of organisations that, according to Tobacco Tactics, received subsidies from the FSFW, such as the Lega Italiana Antifumo (LIAF). LIAF is a partner of Center of Excellence for the acceleration of HArm Reduction (CoEHAR) and Eclat S.r.l., organisations that, according to Tobacco Tactics, have received millions of US dollars from FSFW [18].

It is unfortunate that we have to be so explicit, but it is vital in order to safeguard scientific evidence. For decades, the tobacco industry has been trying to fund conniving researchers who are eager to promote misleading messages that are solely conducive to the marketing of their tobacco products. Until a decade ago, these efforts were thwarted by the response of independent research. Today, without significant public funds for prevention, and due to the enormous amount of money allocated by the tobacco companies, the few remaining independent researchers will find it difficult to counter those who collaborate with the tobacco industry, whether or not they declare conflicts of interest. And, unless anything changes, there is the risk that scientific truth might be jeopardized.

References

1. Fields N, Chapman S. Chasing Ernst L Wynder: 40 years of Philip Morris’ efforts to influence a leading scientist. J Epidemiol Community Health. 2003; 57:571-8. DOI
2. Francey N, Chapman S. “Operation Berkshire”: the international tobacco companies’ conspiracy. BMJ. 2000; 321:371-4. DOI
3. Legg T, Legendre M, Gilmore AB. Paying lip service to publication ethics: scientific publishing practices and the Foundation for a Smoke-Free World. Tob Control. 2021; 30:e65-72. DOI
4. Hendlin YH, Vora M, Elias J, Ling PM. Financial conflicts of interest and stance on tobacco harm reduction: a systematic review. Am J Public Health. 2019; 109:e1-8. DOI
5. Shields PG. Tobacco smoking, harm reduction, and biomarkers. J Natl Cancer Inst. 2002; 94:1435-44. DOI
6. IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Personal habits and indoor combustions. Volume 100 E. A review of human carcinogens. IARC Monogr Eval Carcinog Risks Hum. 2012; 100:1-538.
7. Shaw DM, Etter JF, Elger BS. Should academic journals publish e-cigarette research linked to tobacco companies?. Addiction. 2016; 111:1328-32. DOI
8. World Health Organization (WHO). World Health Organization: Geneva; 2021.
9. van der Eijk Y, Bero LA, Malone RE. Philip Morris International-funded ‘Foundation for a Smoke-Free World’: analysing its claims of independence. Tob Control. 2019; 28:712-8. DOI
10. McKee M. The tobacco industry: the pioneer of fake news. J Public Health Res. 2017; 6:878. DOI
11. Pisinger C, Godtfredsen N, Bender AM. A conflict of interest is strongly associated with tobacco industry-favourable results, indicating no harm of e-cigarettes. Prev Med. 2019; 119:124-31. DOI
12. Baena García A, Córdoba García R, González-Galarza RD, Fernández Olmo R, del Carmen González Carreño M, López Nicolás A. Comité Nacional para la Prevención del Tabaquismo: Madrid; 2020.
13. Martínez C, Fu M, Galán I, Pérez-Rios M, Martínez-Sánchez JM, López Conflicts of interest in research on electronic cigarettes. Tob Induc Dis. 2018; 16:28. DOI
14. Farsalinos KE, Poulas K, Voudris V, Le Houezec J. Electronic cigarette use in the European Union: analysis of a representative sample of 27 460 Europeans from 28 countries. Addiction. 2016; 111:2032-40. DOI
15. Kulik MC, Lisha NE, Glantz SA. E-cigarettes associated with depressed smoking cessation: a cross-sectional study of 28 European Union countries. Am J Prev Med. 2018; 54:603-9. DOI
16. Horel S, Keyzer T. Covid 19: how harm reduction advocates and the tobacco industry capitalised on the pandemic to promote nicotine. BMJ. 2021; 373:n1303. DOI
17. Tobacco endgame. COVID-19: i sostenitori della riduzione del danno e l’industria del tabacco hanno approfittato della pandemia per promuovere la nicotina. 2022.
18. Tobacco Tactics - University of Bath. Centre of Excellence for the Acceleration of Harm Reduction (CoEHAR). 2021.