Are there manipulations of research in the tobacco industry

The manipulation of the tobacco industry is legendary

Red. The National Council debates a tobacco product law in the winter session. Large tobacco companies that have set up their headquarters in Switzerland continue to count on special treatment. Rainer M. Kaelin, FMH specialist in pulmonology and internal medicine and former Vice President of the Swiss Lung League, shows the methods the industry uses to assert its interests. With success, as the evaluated consultation shows. (Second part)

Trade and advertising on the part of the tobacco companies
The Tobacco Products Act proposed by the Federal Council becomes an "alibi law" because it largely corresponds to the wishes of the tobacco industry and ignores the requirements of the WHO Framework Convention on Tobacco Control (FCTC). Switzerland has signed this convention, but is one of the very few countries that has never ratified it.

The state and politics have favored the tobacco industry in our country since the Second World War. The big multinational Philip Morris (PM), British American Tobacco (BAT) and Japan Tobacco International (JTI) have become an important and influential part of the economy.

These companies rarely appear in public. For years they have relied on the organizations GastroSuisse, WerbungSchweiz and the Swiss Trade Association (SGV). The media, more and more dependent on the diminishing income from advertising, largely adopt the arguments of this strong lobby (see Part I: “Switzerland as the headquarters of the cigarette manufacturers”).
The influence of the tobacco lobby manifested itself this summer: the majority of the Council of States rejected the draft of the Tobacco Products Act to the Federal Council, with the mandate to remove the - already fragmentary - advertising bans. The WHO FCTC Framework Convention was not mentioned at all. Even so, the commission claimed to want to protect the youth.

It could only have come to this point because massive PR campaigns have succeeded in preventing or delaying structural measures for tobacco prevention in recent years. In accordance with the behavior of the state and many politicians, with the media as accomplices, such actions explain the benevolence towards tobacco in civil society and in the academic institutions of our country.
From the non-smoking tables to the passive smoking initiative

Since 1987, PM and the agency Burson Marsteller (1) contacted the Association of Cafés and Restaurants (today GastroSuisse) with the following message: The agreement between smokers and non-smokers is a question of tolerance, politeness and ... room ventilation. A convention between the cigarette industry (Swiss Association of Cigarette Manufacturers, today SwissCigarette) and the innkeepers enabled PR campaigns in the inns (2).

And with obvious success. In the canton of Lucerne, for example, in 1990 the Grand Council refused to introduce non-smoking tables in restaurants by law. In an internal note, PM commented: «This positive result is due to the considerable efforts of the President of the Café and Restaurant Association and the Director of the cantonal SGV ... These two allies, members of the cantonal parliament, had been briefed on our arguments (tolerance, courtesy and Indoor air quality) (3). »

Successful campaign against the "twin initiative"
The aim of the "twin initiative" of 1993 was to generalize the ban on advertising alcohol and tobacco on radio and television that had existed since 1965. Before the voting campaign, the tobacco advertisements disappeared completely from the advertising space. Instead, one saw "Advertising ban" posters drawn by WerbungSchweiz with the request to vote "No". This spread the idea that the people would not have to decide on a ban on advertising for alcohol and tobacco, but that the vote was about a general ban on advertising. The initiative was rejected with 75 percent votes against.

The arguments of the public debate at that time reveal the strategy of the PR agencies, that is:

  • to present the proposed specific structural measures as an attack on a fundamental right;
  • to describe the prevention professionals as extremists;
  • to keep the information of the population on prevention issues generally incomplete.

One recognizes the same strategy during the voting campaign of the people's initiative «Protection against passive smoking». It was assumed that the initiative wanted to ban smoking. This line of argument can currently also be found in the statements of the cantons and some political parties in response to the consultation on the Tobacco Products Act. (see 1st part)

Internal industry documents outline the PR methodology to prevent or impede advertising bans. Three lines of focus are mapped out:

  • emphasize the protection of minors;
  • strengthen the self-regulation of advertising by creating a fairness commission, and
  • create a link between alcohol and tobacco (4).

This line of communication proved successful. The claim that cigarette advertising is aimed at adult smokers as legitimate information and not aimed at young people obscures the fact that tobacco advertising has the primary function of making a product that is toxic and addictive as a consumer product appear like another to let.

Its regular mention in connection with alcohol meant that the discussion about preventive measures yielded nothing concrete. The inclusion of alcohol was easy to create confusion. In fact, however, the two substances require fundamentally different prevention approaches: moderate consumption is decisive for alcohol and passive exposure is not up for discussion, while smoking should avoid any exposure, even by passively affected persons.

With the parliamentary initiative of the then FDP Council of States and prevention doctor Felix Gutzwillers in 2004, the debate about protecting the population from passive smoking began. The report of the Health Commission of the National Council was based on a solid scientific basis in order to introduce the smoke-free workplace for everyone in Switzerland.

However, Parliament also had the prevention law on its agenda. It became important for the industry to discredit both prevention as such and its official “lawyer”, the Federal Office of Public Health (BAG). This was the goal of a campaign against its director, Professor Thomas Zeltner. In 2008, the newspaper of the trade association apostrophized Zeltner as the “Ayatollah of prevention”.

The term was widespread in the TV show 10vor10 and repeated with a few variations when it came to prevention.

Beda Stadler: «Inventions by extremists»
Medical colleagues like Professor Beda Stadler are also responsible for the bad reputation of prevention. In his columns in the NZZ and Weltwoche, the former immunologist at the University of Bern mixed healthy nutrition, health promotion and protection against secondhand smoke in an entertaining but intellectually dishonest way, and all of them condemned them as moralizing interventions by the state in individual freedom. Scientific findings on the decrease in acute coronary syndromes after the introduction of passive smoke regulations disqualified Stadler as inventions by extremists.

In this way it became “politically correct” to claim that prevention is an attack on individual freedom. This view is reflected in the media debate about the Tobacco Products Act. It largely falls under the table, which is why the freedom of advertising cannot be absolute in a liberal constitutional state. Firearms, antibiotics, concentrated hydrochloric acid, anti-personnel mines and the like are legally available. However, advertising for them is prohibited or subject to precisely defined regulations, simply because these products are dangerous.

Tobacco is also undoubtedly a dangerous product. Its “legal status” can only be explained by historical developments. It is inconceivable today that a product that kills half of its users in normal use would be allowed for sale. And it would certainly not be allowed to advertise it.

This happens in a society that by law prescribes product liability, wearing seat belts, warning notices on all technical devices and much more. A comprehensive ban on tobacco advertising does not mean a ban on sales, but pursues the legitimate goal of preventing the banalization of tobacco consumption. It is therefore the minimum requirement for youth protection.

The electronic cigarette
Your promoters and free market advocates play down the role and influence of advertising especially when it comes to e-cigarettes. The commercial reality is different:

The tobacco companies have invested heavily in the electronic cigarette. It supplies nicotine-dependent consumers with its drug cheaply and “without the harmful effects of tobacco”.

It is implausible that the industry intends to free its tobacco dependent customers from their dependence. Rather, it can be assumed that this industry aims to popularize the use of nicotine among boys with the help of the new e-cigarette gadget and to keep them dependent on nicotine. Sooner or later, these consumers will turn from the electronic cigarette to the far more effective administration method, the original tobacco cigarette, on which they will remain dependent for many years.

This is a great danger if e-cigarettes are allowed to be advertised. No advertising is needed so that they can help heavy smokers to avoid harmful substances such as tar in the usual cigarettes and, if necessary, to gradually get rid of their addiction.

However, electronic cigarettes have already reached the school playgrounds as multi-colored toys (5), and they are proving to be suitable for preparing young people to pick up their first tobacco cigarette (6). The gadget is also a marketing tool that creates confusion among smokers, politicians, educators, and doctors.

Quite a few allow themselves to be instrumentalized. The discussion about the "damage reduction" through the electronic cigarette is very similar to the previously known sales argument of the "mild" cigarette, the undiminished toxicity of which was unmasked in the 1980s (7).

There is little doubt that the electronic cigarette controversy is being promoted and used by the industry to portray nicotine as a mundane stimulant.

The disinformed civil society

The empty phrases “individual freedom”, “personal responsibility instead of state prevention”, “prevention is paternalism”, “advertising is information for adult consumers”, “tobacco, historical luxury food, is part of our culture” obey a communication strategy that tries to cover up that the industry is causing and sustaining a worldwide tobacco epidemic based on the addictive drug nicotine.

This strategy is showing success, as the responses to the consultation on the Tobacco Products Act show. In its statement, the KF Consumer Forum only accepts the introduction of the ban on sales to minors and the continuation of the ban on advertising aimed at young people. "The rest of the Tobacco Products Act is vehemently rejected."

Consumers, who are also parents, taxpayers and health insurance premiums, know about the cost of tobacco consumption. Nevertheless, the consumer forum, co-financed by the economy, claims that "from the consumer forum's point of view, demonizing tobacco products is not a strategy that will bring further success ... Maturity ... is not reinforced ... because there is no differentiation between enjoyment and addiction."

The draft for the Tobacco Products Act is also judged surprisingly uncritically by health organizations. The 52,000 members in 14 associations of the “Swiss Association of Professional Organizations in Health Care” welcome “the proposed elements to further restrict advertising, sales promotion and sponsorship, as well as a ban on the sale of tobacco products to and by minors”, without however, to address the loopholes in the ban.

The “Association of Leading Hospital Doctors” also says: “Although the general provisions on advertising and sponsoring events are still not restrictive enough, we can live with this legislation. We hope, however, that the bill will no longer be watered down by Parliament. "

Unfortunately, the detailed, critical opinion of the FMH was drawn up very late, on November 26, 2015, more than a year after the start of the consultation, and published in the Swiss medical journal SAeZ (8). It largely coincides with the alliance's position for an effective tobacco product law. This statement could have served as a template for other organizations and more emphatically underlined the obvious gaps in the preliminary draft to the BAG.

One would have expected the same from “Swiss Public Health”, the organization that unites the university institutes for social and preventive medicine. Surprisingly, this has never made a public statement on the Tobacco Products Act or on tobacco prevention in general. The silence of medical experts as active help to the disinformation orchestrated by opponents of prevention has been pointed out elsewhere (9).

The most paradoxical statement on the preliminary draft of the Tobacco Products Act comes from Professor Jean-François Etter from the "Institut de santé global" of the medical faculty of the University of Geneva, co-signed by European colleagues (10). The commentator welcomes the envisaged approval of the nicotine-containing e-cigarette, but he is concerned that these devices fall under the Tobacco Products Act and are therefore subject to the same restrictions as the far more harmful tobacco products: «Advertising for electronic cigarettes should be less restricted than for tobacco products ... this would ensure that smokers are informed about these products and are encouraged to switch from combustion cigarettes to safer products ... The application of legislation primarily intended for combustion tobacco to electronic cigarettes will produce effects which meet the objectives (limit toxic effects tobacco consumption) are contrary ... Excessive restrictions on advertising and high taxes will hinder the development of the electronic cigarette market. "

These statements repeat, often verbatim, the statements of the cantons of Neuchâtel and Vaud, which want to promote the local economy with the Tobacco Products Act (Part I). Jean-François Etter has repeated his reasoning many times in professional (11) and amateur (12) publications. He claims that the free market game will increase the demand for e-cigarettes among quit smokers and that they will switch from tobacco cigarettes to "less toxic products". This would "automatically" reduce tobacco consumption and set barriers to the tobacco epidemic worldwide. Therefore, the e-cigarette should be allowed to advertise freely.

In these considerations one finds inconsistencies: If the electronic cigarette were a real competitor to the tobacco cigarette, it should be an effective smoking cessation aid, which is not the case. The widespread distribution and promotion of e-cigarettes trivializes smoking and does not stop the tobacco epidemic. Most e-cigarette smokers become double consumers, which means they “vape” e-cigarettes and smoke tobacco cigarettes - just as the tobacco companies want. The corporations certainly do not want to endanger their cigarette sales.
Corporations do not want to endanger their cigarette sales

It is implausible that tobacco companies are investing massive sums in the e-cigarette market to help their customers break free from their tobacco addiction. In other words, why would they want to sabotage their own primary market?

Obviously, the Geneva professor Etter ignores the strong potential of nicotine to create and maintain addiction. The business with industrially manufactured tobacco cigarettes is based on this dependency.

It would be in the public interest for Professor Jean-François Etter to disclose whether he receives benefits in kind from circles of the tobacco industry.

Instrumentalization of academic institutions
The question is not out of thin air. The Swiss Association of Cigarette Manufacturers SVZ (now Swiss Cigarette) invested several hundred thousand francs annually between 1962 and 1994 in basic research and research on respiratory physiology in all university institutions in Switzerland.From 1962 to 1977, Professor Etienne Grandjean and his group at ETH were paid to study passive smoking exposure. The funding was interrupted because his colleague published the health effects of the exposed test persons, which did not correspond to the SVZ's research plan.
From 1964 to 1994, Professor Karl Baettig from the ETH Zurich was in charge of research on the psychopharmacology of nicotine, financed by the SVZ. Professor Dauwalder from the University of Lausanne has received funding for his work on behavioral psychology for many years. He was a member of a group of sociologists, psychologists, ethicists and scientists, called ARISE, who had been financially supported by PM since 1988 to investigate the effect of the "little daily joys" (such as chocolate, coffee, wine, sweets and the pleasure cigarette) on the explore mental balance.
Professor Ragnar Rylander from the Institut de médecine sociale et préventive of the University of Geneva (today Institut de médecine global), at the same time professor at the University of Gothenburg, turned out to be an "independent" scientist in 2003, who secretly reports to Philip Morris International PMI between 80-100 annually 'Pay $ 000. He held on to the "scientific doubt" about the toxicity of secondhand smoke, although this contradicted his own research results.
Rylander's science fraud was the subject of a lengthy lawsuit (13) sparked by his libel suit. Nevertheless, the University of Geneva condemned his behavior, albeit very hesitantly.

As early as 2001, the University of Geneva recommended to its members not to accept any funding from the tobacco industry. Nevertheless, Professor Andreas Auer wrote a legal opinion for JTI in 2005, which was published during the cantonal campaign for passive smoke legislation. He concluded that “it has not been proven that passive smoking is harmful to health” and that the proposed legislation violates the constitution, since it disproportionately restricts individual freedom.

Without considering the recommendations of the WHO, he relied on studies that JTI had made available to him. These had examined an older population, which had long been recognized by epidemiologists as inadequate to answer the question asked.

The current studies by Professors Kaul and Wolf from the Universities of Zurich and Saarland on “plain packaging” (neutral cigarette packs with neither a logo nor specific lettering) are of dubious quality. They were financed by PMI, which had stipulated in the contract the right to have a say in the formulation of the conclusions (16).

These were rightly criticized because the statistical method used is inadequate to conclude that the “plain packaging” in Australia has not contributed to a reduction in the number of smokers. This statement is misleading. The rector of the university was asked to withdraw the study, which he refused, although a re-analysis of the data using a different statistical method came to the opposite conclusion (17).
The tobacco companies sneak into the academic world and systematically pursue their goals. It is found that the institutions are belatedly reacting to sanction the attacks on their integrity. The public is hardly informed about these conflicts of interest within the university, as the media rarely and mostly incomplete information about them.

Repeatedly misled and manipulated
The tobacco industry has established itself in Switzerland because it was able to benefit from the advantages of a liberal state located in the geographic center of Europe. It has taken root in Switzerland, especially since the USA increasingly restricted its business by law.

Although the proposed Tobacco Products Act still takes prevention too little seriously, it combats the industry. The parliamentary debate and the majority decisions in this pulling rope will show to what extent our representatives are aware of the manipulations of which they are the subject. They are called upon to position themselves and to prove that they are willing to give preference to the greater interest in the health of their voters over the pressure tests and dubious maneuvers of the industry.

References to this second part:

1. An accommodation strategy in EEMA. A strategic brief. 1990-05-07. Bates No 201 181862_1887
2. Document «Switzerland 1987 Objectives Philip Morris (…) articles on the subject of passive smoking are regularly published in the journal of the hotel / restaurants association, without mentioning the tobacco industry. A convention was signed between SVZ and the Hotel / Restaurant Association, which enables a PR campaign in 1,800 restaurants ». BatesNumber 2501240585_0599URL
3. Raymond Pantet, director of public affairs. Philip Morris, July 12th 1990 (Bates Number 2024195742).
4. R.J. Reynolds A.G. Switzerland: Swiss Advertising Ban. Case study. November 28.1993.
5. Barben J .: The e-cigarette: a new danger for our children. Pediatrics. vol 25, no 3. 2014.
6. Leventhal A.M., Strong D.R., Kirkpatrick M.G., et al .: Association of Electronic Cigarette Use With Initiation of Combustible Tobacco Smoking in Early Adolescence. JAMA; 314 (7): 700-707.
7. Department of Health and Human Services; The health consequences of smoking. The Changing Cigarette. Report of the Surgeon General. 1981.
8. Because B .: Prize de position: Interdiction de la publicité pour le tabac. Bulletin des médecins suisses. 2015; 96 (48), 1750-1751
9. Kaelin R.M .: Le silence des experts médicaux (3). La responsabilité publique des médecins au sujet de l initiative “Protection against the fumée passive”. Bioethica Forum: 2015 / Vol 8 No.4 / ISSN 1662-6001.
10. Clive Bates, London; Dr Konstantinos Farsalinos M.D Athens; Prof. Peter Hayek PhD, London; Prof. Riccardo Polosa M.D Catania.
11. Etter J.F .: Should electronic cigarettes be as freely available as Tobacco? Yes. BMJ 2013; 346: 3845 doi.
12. Etter J.F .: La vérité sur la cigarette electronique. Fayard. Paris 2013.
13. Malka S, Gregori M .: Infiltration. Une taupe à la solde de Philip Morris. Médecine et Hygiène éd. Genève 2005. German edition: How the tobacco industry buys science. Orell Füssli, Zurich 2008.
14. Auer Andreas: “Le droit face à la political correctness: la constitutionalité de l initiative populaire genevoise‹ fumée passive et santé ›”. octobre 2005.
15. Working paper no 149. March 31, 2014. Department of Economics at the University of Zürich, and June 30, 2014. Working paper no 165.
16. Angeli Th .: University of Zurich: Tobacco multinational may «review» explosive study. Observer 26/2014.
17. Laverty A.A., Diethelm P., Hopkinson N.S .: Use and abuse of statistics in tobacco-funded research on standardized packaging. Tob.Control, 2015.

Additional information

Subject-related interests of the author

Rainer M. Kaelin is an FMH specialist in pneumology and internal medicine. He was Vice President of the Swiss Lung League and the Vaud Lung League and is Vice President of Oxyromandie.