Fighting The Wrong War

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    The automatic criticism of everything associated with tobacco is not merely misguided; it has the potential to do real harm.

    By Clive Bates

    Yes, the tobacco companies worked hard to acquire a terrible reputation over many decades. With the publication of authoritative reports on smoking and health in the early 1960s, the tobacco companies entered a prolonged existential battle with reality. Emerging science threatened one of the most lucrative cash cows ever milked. What became known as the tobacco wars were fought over doubt, the marshy no-man’s land between ignorance and certainty, and it was ugly. That war essentially ended around the turn of the century with ignominious defeats in the courts and at the hands of the U.S. states’ attorneys general. It became clear that the costs of deceit and obfuscation were just too high. With advancing scientific knowledge, the companies would be left clinging to indefensible positions, and their executives would look increasingly absurd.

    But where are we today? Let us consider six recent developments.

    First, in March 2022, the World Health Organization blocked approval of a new SARS-CoV-2 vaccine even though Canada’s regulator had approved it and despite the Canadian government investing in its development. The WHO’s reason? The vaccine is made by a biotech company, Medicago, in which the tobacco company Philip Morris International holds a minority stake. The WHO argues that this would be to protect health policy from “tobacco industry interference.” The global health agency seemed to care little about suppressing the expanded supply of a new vaccine with possibly innovative benefits to a world that will need Covid-19 vaccines for the foreseeable future. And it didn’t explain how a company could conceivably exert any influence through this implausible route or why it might try.

    Second, in September 2021, tobacco control activists tried to stop a tobacco company, again PMI, from acquiring a pharmaceutical company, Vectura, that specializes in inhalation technologies. When they failed to stop the acquisition, they resorted to bullying directed against the scientists at Vectura, threatening to isolate and marginalize them from the scientific community. The activists argue that such investments “legitimize tobacco industry participation within health debates.” But they did not explain why PMI’s clearly stated strategy of diversification to facilitate its transition out of the cigarette trade would be a bad thing or something that they should try to prevent.

    Third, in July 2021, the board of the scholarly Society for Research on Nicotine and Tobacco (SRNT) voted to ban tobacco industry employees from attending the SRNT’s annual conference. Employees of the tobacco industry were already prohibited from SRNT membership. The SRNT defines the tobacco industry as any company owned (in part or whole) by a commercial tobacco manufacturer, implicitly tainting any effort at pro-health diversification or innovation. Yet, the society’s January 2020 guiding principles declared, “SRNT supports, without bias, the generation, dissemination and facilitates debate of rigorous science to address challenging public health questions regardless of the direction the evidence leads.” The tobacco companies now produce some of the highest-quality science in the field in connection with products that can significantly improve health. The SRNT’s words about open-mindedness and freedom from bias are undoubtedly noble, but they failed in their first collision with reality.

    Fourth, in May 2021, the specialist journal Nicotine & Tobacco Research produced a reasoned argument for accepting the occasional paper from an industry source. “Some feel that the tobacco industry’s history, motives and current activities should exclude them from publishing in the journal. Others feel equally strongly that science should be judged on its merits, irrespective of its origins. […] Our current position requires us to sit with this tension and trust that our editorial and review process, and our policies, will ensure that work can be judged on its merits whilst also allowing reviewers and readers to form a view based on its origins.” But in October 2021, the journal issued an “update,” which was little more than an abject reversal of the reasoned policy it had set out six months earlier. The journal felt compelled to follow the direction set by the board of the SRNT. The quality of the science or contemporary evidence of manipulation of scientific discourse was not offered as a justification. However, racial equity and the diversification of the industry were among the stated reasons.

    Fifth, in May 2021, the leading vape company, Juul, published a series of papers summarizing the behavioral science behind its premarket tobacco product application to the U.S. Food and Drug Administration. A special issue of the American Journal of Health Behavior brought together 13 papers covering everything from switching behaviors to retailer compliance. It was all collected in a single publication and free to read. But such brazen openness provoked fury in the tobacco control establishment. The British Medical Journal quoted Matthew L. Myers, president of the Campaign for Tobacco-Free Kids, saying, “… one thing should be abundantly clear: Research funded by tobacco companies cannot be treated as a credible source of science or evidence. No credible scientific journal should allow a tobacco company to use it for this purpose.” Even United States senators took time off from running the country to protest to the FDA at the impertinence of a company publishing its science in an accessible format. Some of the attacks focused on Juul paying fees to the journal for open publication, though that is a standard publishing model. Perhaps critics believed it would somehow serve the public interest if the 13 papers were paywalled, spread over multiple subscription-only journals and published on different dates? So far, no one has found any material fault with the actual science. So far, none of Juul’s critics has shown any curiosity about the findings and what they mean for public health policy.

    Sixth, since 2017, there have been intense and ongoing attacks on the nonprofit Foundation for a Smoke-Free World. The foundation’s stated mission is “to end smoking in this generation.” But because it was set up with a billion-dollar, 12-year commitment from a tobacco company, it has been the subject of intense hostility. Did anyone stop to ask whether research on ending smoking in this generation might be a good idea? Instead, the WHO and tobacco control mainstream would rather the research was never done and that the money was kept by the company. Why?

    What is Going on Here?

    First, this hostility has nothing to do with bad science or inappropriate influence. The tobacco companies, the larger vaping companies and industry consultants produce very high-quality science. Much of it captures the harms caused by cigarettes and shows how such harms could be reduced. Their regulatory science must convince skeptical regulators and withstand public, professional and legal scrutiny for signs of manipulation. Today, tobacco industry science must be and generally is credible.

    Second, several companies are indeed trying to influence the debate about the evolution of the tobacco and nicotine market. But this is in a direction that would be good for public health. With varying assertiveness, the companies want to diversify from combustible products to much safer noncombustible nicotine products and from nicotine businesses to non-nicotine businesses. They would like to discuss the policy frameworks that would cause this to happen more quickly. Tobacco control activists do not like this argument. It implies a future for their nemesis, Big Tobacco, and a diversion from their path to the “nicotine-free society,” a Utopian ideal typical of the War on Drugs. Rather than confront the science head-on, they would prefer the arguments not to be made or not to be heard.

    Third, their cause is served by framing the tobacco and nicotine issue in the simplifying Manichean certainties of good and evil. This makes for more straightforward stories. It supports a well-worn narrative that describes a predatory industry hooking teenagers into lifelong possession by an addictive drug. That sells well, even though it is a grotesque simplification and misunderstanding of how nicotine use works in reality. It also means tobacco control benefits from “white hat bias,” in which embarrassingly poor science escapes scrutiny and challenge. The result has been a steady debasement of the currency of tobacco control sciences.

    Fourth, the most profound reason is that tobacco control activists really need an enemy. They frame their work in war-like language, and the leaders had their formative experiences in the tobacco wars of the last century. The Campaign for Tobacco-Free Kids now uses the slogan “Taking on the Toughest Fights for 25 Years.” Fighting wars is what they do, even if this is increasingly at the expense of public health. It is why the WHO and others cling to the principle that there is an irreconcilable conflict between the interests of tobacco companies and public health. That way, there will always be a battle, they always have the prestige of war heroes, and there will always be money, conferences and entire institutions devoted to the struggle. But permanent belligerence will leave us in a slow-moving stalemate. If there is to be a war, can we please make it a common front against disease and death and not a rerun of the battles of the last century?