• June 16, 2024

The Credibility Gap

 The Credibility Gap
Photo: ia_64

What tobacco industry scientists wish they could say to physicians and public health researchers about their work

Cheryl K. Olson

“I was an ardent antismoker who believed that the tobacco industry was a bunch of evil scientists just working out how they could addict children,” said Justine Shaw Jackson, who is also known as Justine Williamson. Her grandfather, a smoker, died of COPD; her father’s smoking was likely linked to his heart attack and cancer.

She simply didn’t believe anything that tobacco industry scientists said. “I thought they wanted to make their products even more harmful,” she added.

So, how did she end up working for Big Tobacco?

Scientists employed by most industries face predictable concerns about the independence and credibility of their work and even whether they’re “real” scientists. After all, we have a pretty good idea what the Egg Board will be recommending we eat for breakfast. This problem is particularly acute for scientists who work in the tobacco industry.

Despite their detailed and sophisticated knowledge about harm reduction for smokers, they’re sometimes excluded from professional interactions with nonindustry researchers in which that expertise would be of benefit. The history of Big Tobacco from decades ago has stripped them of their credibility.

Current employees of tobacco companies are constrained by a combination of government regulations and corporate nondisclosure rules. I spoke with several scientists who had recently left positions at tobacco companies about what they wished they could say to physicians and public health researchers about the work they’d been doing. Some agreed to speak on the record; others agreed to provide background information.

Twenty years ago, Jackson was finishing her doctorate in genetic technology at Swansea University. British American Tobacco was funding a project in a professor’s laboratory. She met some of their scientists. “These guys were working incredibly hard on understanding what in smoke was causing problems and on reducing the harm of tobacco products,” she added.

Across the pond in the U.S., Willie McKinney, a toxicologist, had a similar start to his career at Philip Morris USA. He had finished his doctorate in toxicology at the University of North Carolina, met with industry scientists and was impressed with their honest assessment of tobacco’s health effects.

“They told me that they were out of alignment with society and that their products cause harm,” he said. “That alignment with society means modifying products to be less harmful or selling products that do not cause harm. They can’t make money if they’re shut down. So for 20 years, that was my focus: testing and evaluating potentially reduced-risk products.”

They both became experts in harm reduction for smokers. Yet because of their association with Big Tobacco, they were frustrated that public health practitioners, medical professionals and government policymakers left researchers like them out of the conversation when it came to helping smokers stay healthier or quit smoking.

Both recently left industry positions. Jackson is now an executive coach; McKinney formed his own consulting company. (Full disclosure: I’ve worked and written articles with McKinney.)

One of the concerns I heard from them and others was being unable to respond to the rampant misinformation on the relative risks of nicotine products, especially when that misinformation comes from well-intended government sources or nonprofit organizations. Like epidemiologists facing anti-vax propaganda, industry scientists watch in frustration as facts lose ground to uninformed beliefs and outright lies—information that could interfere with smokers quitting combustible cigarettes.

I asked them to imagine a long plane flight. Their seatmate, whom they had never met before, is a public health researcher. Upon discovering that they work in the tobacco industry, the public health person starts peppering them with questions. If they could have spoken freely, how would they have responded?

Why can’t you just stop selling cigarettes? That would solve the problem!

Unfortunately, it wouldn’t. In an ideal world, there would be no cigarettes. There would be no nicotine. But the world we inhabit includes 1.14 billion smokers.

This number may startle the seatmate, who probably doesn’t know many current smokers. Smoking is not evenly distributed among the population nowadays. In North America, it’s relatively rare among the highly educated and well-to-do, for example. It’s banned in most workplaces. Anti-smoking ad campaigns have waned. But the deaths continue—nearly 8 million a year. Yet many smokers cannot or will not quit, even with all the available information on how smoking kills. That’s an incredible challenge that won’t respond to simplistic solutions.

“We know from past experience with prohibition of alcohol and opioids that simply banning something doesn’t work,” noted Jackson.

In fact, one of the predictable consequences of prohibiting the sale of combustible cigarettes at the commissaries of state and federal prisons has been the growth of a resilient black market. That’s a reflection of how powerful the addiction to nicotine is.

But combustible cigarettes, the most dangerous of nicotine products, are not the only option for people who are addicted. There’s growing evidence that e-cigarettes work better than nicotine gums or patches at helping people quit smoking.

But isn’t vaping just as bad?

Public service campaigns in the U.S. that are meant to keep youth from vaping have stoked fears. National surveys show that more and more people incorrectly view vaping as equal in harm to smoking. Reports of potential benefits get scant attention.

It’s another example of a moral panic—a widespread and irrational feeling of fear that’s not supported by scientific data. (A moral panic in the 1920s was that motion pictures about gangsters would turn millions of innocent teenagers into hoodlums. We now refer to those films as “classics.”)

By contrast, health authorities in Europe, such as Public Health England, the Royal College of Physicians and Cancer Research U.K. are taking a different approach than their North American counterparts. They’re educating adult smokers about the relative risks of smoking versus vaping and encouraging them to switch, ideally as a first step toward quitting nicotine altogether. Their experts say that e-cigarettes are about 95 percent less harmful than combustible cigarettes and doubt that vaping leads youth to take up smoking.

But what about the flavors?

Some e-cigarette flavors, unfortunately, are attractive to teens. That’s a legitimate concern. We need to have a combination of effective youth vaping prevention programs, buyer age verification protocols, responsible marketing and nicotine addiction treatment programs for those who get hooked.

But this concern about flavors seems inappropriately focused on vaping. My local grocery store sells stacks of mango-flavored and watermelon-flavored White Claw fizzy alcohol drinks with no visible protest. Yet these types of “alcopops” are highly attractive to underage drinkers and have been linked to dangerously high blood alcohol concentrations.

Also, banning flavored vapes may do more harm than good when it comes to public health. Grown-ups prefer flavors too. “Evidence shows that flavors are incredibly important for adult smokers to use e-cigarettes to switch with,” Jackson added. “So how do you responsibly market those flavors with age-appropriate adult names? In the U.K. and in Europe, we worry whether the levels of nicotine in these products are high enough for smokers to be able to switch satisfactorily.”

In other words, adequate nicotine levels may be a critical variable in getting addicted smokers to switch to reduced-harm vaping.

Can’t we just get rid of the nicotine?

Not only does the proverbial “man on the street” wrongly point to nicotine as the health danger in smoking; new studies show that most physicians “strongly agree” (also incorrectly) that nicotine directly contributes to cancer and heart disease.

“Yes, nicotine does have addictive properties; that’s beyond question,” said Jackson. “But it’s all the other stuff. There are 10,000 components in cigarette smoke, and a chunk of them contain the carcinogens and toxicants that do the damage.”

That’s where harm reduction comes in. If nicotine is not the health danger, how can you improve the health of addicted smokers who don’t (or don’t yet) want to quit? We now have a variety of delivery systems, such as e-cigarettes, heat-not-burn products, pouches and snus that can give smokers the nicotine their brains crave “without all the nasties in the smoke,” as Jackson put it. Ideally, they’ll use those reduced-harm products as a bridge to quitting tobacco and then nicotine completely.

How can you work for Big Tobacco?

“I was hired to focus on harm reduction because the people at the company knew that their product caused harm,” said McKinney.

Today’s industry scientists work under different assumptions than past generations and toward different goals. We know and can openly say that smoking is addictive, dangerous and deadly. From inside, we can work to save lives without being dependent on the vagaries of grant support.

The flight is coming to an end. The seatbelt light is on. Your seatmate has one final question.

What can we agree on?

The development of Covid-19 vaccines has shown what can happen when industry, academia and government work together on solving a critical public health problem. The ongoing threat and lives lost from smoking is similar to that of the pandemic. Imagine what could be achieved with that same level of cooperation and transparency.