Commentary
Lessons from private statements of the tobacco industry
Judith Mackay1
Strategies and tactics used by transnational tobacco companies are revealed in the article y Yussuf Saloojee & Elif Dagli included in this issue of the Bulletin (1). The article draws heavily upon once-secret documents intended for internal circulation within the industry. Saloojee & Dagli show that documents dating back to the mid-1950s prove beyond doubt that the industry had known for decades that tobacco causes death, that it is addictive and has been manipulated to make it more addictive, that getting more teenagers and women to smoke and expanding into new markets is crucial to company profits,and that this knowledge had been covered up (2). The revelations are clear the tobacco industry has consistently obscured the truth about smoking from governments, the media and smokers them-selves.
The 1998 Minnesota lawsuit in the United States against the tobacco industry was settled on terms highly favourable to the plaintiffs. The lawsuits most significant result was not the large financial settlement or the banning of all advertising and promotion within Minnesota but the disclosure of millions of pages of previously confidential tobacco industry documents exposing decades of subterfuge regarding the health risks of smoking,the addictive nature of nicotine and its manipulation by the industry,and marketing to children (3).
The documents are available in warehouses in Minnesota, USA, Guildford, England,and at the Brown & Williamson Collection at the University of California in San Francisco.2 Some of the material has been published in a book (4) and the documents are also available on tobacco industry web sites and several health sites dedicated to making the documents more user-friendly.3
The documents are a collection of letters, memos, studies, reviews of studies, marketing plans, statements of policy, article reprints and news clippings, on a wide range of topics such as smuggling, science, youth, denigration of tobacco control personnel, infiltration of the World Health Organization and the International Agency for Research on Cancer, addiction, tobacco-industry front groups, lo ying tactics, women, tobacco industry lawyers, public relations and advertising companies, and tactics to encourage voluntary agreements in preference to tobacco control legislation. Millions of pages remain unexamined and more revelations will be forthcoming.
Obstacles to tobacco control that were once puzzling may now e understood. Government employees who resisted pro-health measures have been shown to have acted in liaison with the industry. The industry infiltrated some of the most respected scientific institutions, and scientists who argued against the scientific evidence on the damaging effects of tobacco are now known to have been paid to do so. The authors describe how the industry singled out scientists whom they believed could be persuaded to work with, and for, the tobacco industry (5). They would then pay them well to criticize the scientific methods used by others, to dispute findings of studies performed on secondhand tobacco smoke, to concoct contrary articles and appear as expert witnesses for their side against clean indoor air measures at government hearings.
Not only did the tobacco industry subvert science, ut the authors point out that it also presented distorted economic arguments, attempted to hijack the moral high ground on freedom issues, and used its corporate muscle to convince governments not to take strong measures against tobacco.
These tactics of the industry have, in general, been highly successful. In spite of decades of knowl-edge, World Health Assembly resolutions, World Health Organization plans for action,conferences and declarations, the number of smokers is increasing, more smokers are dying, children are still taking up the habit, more girls and women are smoking, and the economic costs are escalating (6) (Table 1).
By 2020, the World Health Organization predicts that tobacco will be the leading single cause of death and disability in the world (7). In addition, the epidemic is being transferred to developing countries and by 2030 only 15% of the worlds smokers will live in developed countries (Alan Lopez, personal communication, 1997). New and innovative ways of prevention and cessation must be introduced. However, this is a global health emergency that many governments have yet to confront.
In the past, occasional lapses, leaks, and statements from people who once worked for tobacco companies have given tantalizing glimpses of the industry. But looking at the millions of pages of the Minnesota documents is like penetrating the thought process of the industry and evokes a sense of outrage. The examination of the industrys public and private statements on just one issue the addictiveness of nicotine provides a good example.
On April 14, 1994, the Chief Executive Officers of Americas seven biggest tobacco companies stood side by side and took an oath to tell the truth to a committee of the US House of Representatives (8). They were asked, for the record, whether they believed nicotine was addictive. One by one, they said no.
The documents, however, reveal that for decades, the industry knew and internally acknowledged that nicotine is an addictive drug and cigarettes are the ultimate nicotine delivery device. The industry also new that nicotine addiction may be perpetuated and even enhanced through cigarette design alterations and manipulations (4). A memo from Brown & Williamson Tobacco Corporations General Counsel Addison Yeaman states (9) :
Moreover, nicotine is addictive. We are, then, in the business of selling nicotine, an addictive drug effective in the release of stress mechanisms.
It is clear from the paper y Saloojee & Dagli that analysis of tobacco industry strategies over the past decades is essential to formulate an appropriate legislative and public policy response. Industry documents discovered in the Minnesota trial have already provided key information to countries and activists around the world, and have been used as an advocacy tool in places as diverse as Guatemala, Hong Kong Special Administrative Region of China, and South Africa. Each nation needs to access its own countrys documents so that governments may fully understand the behaviour and tactics of the tobacco industry in their own country. Only in this way will they be better prepared to introduce public health policies to improve the health of their citizens and, in particular, to protect their children.
Dr Gro Harlem Brundtland summarized the World Health Organizations sentiment at the WHO workshop that officially launched the Tobacco Free Initiative on October 20 1998: There is every reason to elieve that through these [industry] documents we will find information that will add power to the ability of countries all over the world to press for comprehensive tobacco control measures (10).
Having reviewed these documents, the WHO guidelines state that it is still too premature to consider involving or consulting with the tobacco industry on policy issues, a position equally applicable to ministries of health and other health agencies.§
References
1. Saloojee Y, Dagli E. Tobacco industry tactics for resisting public policy on health. Bulletin of the World Health Organization, 2000, 78: 902910.
2. Hurt RD, Robertson CR. Health law and ethics. Prying open the door to the tobacco industrys secrets about nicotine: the Minnesota tobacco trial. Journal of the American Medical Association, 1998, 280 (13):11731181.
3. Ciresi MV et al. Decades of deceit: document discovery in the Minnesota tobacco litigation. William Mitchell Law Review, 1999, 25: 477566.
4. Glantz SA et al. The cigarette papers. Berkeley, Los Angeles, London, University of California Press, 1996.
5. Hirschhorn N. Shameful science: four decades of the tobacco industrys hidden research on smoking and health. Tobacco Control, 2000, 9 (3), in press.
6. World Bank. Development in practice. Curbing the epidemic: governments and the economics of tobacco control. Washington, DC, The World Bank, USA, May 1999.
7. Murray CJ, Lopez AD, eds. The global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries and risk factors in 1990 and projected to 2020. Cambridge, MA, Harvard School of Public Health on behalf of the World Health Organization and the World Bank, 1996 (Global Burden of Disease and Injury Series, Vol. I).
8. Lewan T. Dark secrets of tobacco company exposed. Associated Press, 12 September 1998.
9. Yeaman A. BAT speaks out on nicotine. The Associated Press online, 12 September 1998 (available on the Internet at http://www.bmjpg.com/data/tobarch/autumn98/indwatch.htm).
10. Tobacco Free Initiative. Media Advocacy Workshop, Geneva, World Health Organization, 20 October 1998.
1 Senior Policy Adviser of the WHO Tobacco Free Initiative; Director, Asian Consultancy on Tobacco Control, Riftswood, 9th milestone, DD 229, Lot 147, Clearwater Bay Road, Kowloon, Hong Kong Special Administrative Region of China (email: jmackay@pacific.net.hk).
2 http://www.library.ucsf.edu/tobacco
3 http://www.cdc.gov/tobacco/industrydocs/docsites.htm; http://www.ash.org.uk; http://www.mnbluecrosstobacco.com; http://www.tobacco.org; http://www.health.usyd.edu.au/tobacco; http://www.tobaccodocuments.com; http://www.house.gov/commerce/TobaccoDocs/documents.html; http://www.smokescreen.org
Ref. No. 00-0690