Philip Morris
Tobacco Industry Efforts Subverting the International Agency for Research on Cancer's Secondhand Smoke Study
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- Hlatky, M.A.
- Ong, E.K.
- Hlatky, M.A.
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I certify that I have read this thesis and in my opinion it
is fully adequate, in scope and quality, as a dissertation
for the degree of Master of Science
Stanton A. Glantz, PhD
Advisor, Department of Medicine
University of California, San Francisco
I certify that I have read this thesis and in my opinion it
is fully adequate, in scope and quality, as a dissertation
for the degrce of Master of Science
Mark A. Hiatky, M.D.
Chairman, Department of Health Research and Policy
CONFIDENTIAL DRAFT - Do Not Distribute ~
r 4
Tobacco Industry Efforts Subverting the International
Agency for Research on Cancer's Secondhand Smoke Study
.f
A thesis submitted to the Department of Health Research and Policy
and the Committee on Graduate Studies of Stanford University
in partial fulfillment of the requirements
for the degree of Master of Science
By
Elisa K Ong, BA
November 1999
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Introduction.---°
....................................................................................................
... . ..... 67
Traditional Lobbying Activities
............................................................................°. - . 67
The "Good Epidemiology Practice" Program
................................................................... 69
Industry Use of the IARC Study in Regulatory Settings
................................................... 79
Summary .......
....................................................................................................
.. ..............---................................. 81
CHAPTER 8: CONCLUSION......... --------------------- -..............
......................................................... 82
REFERENCES
....................................................................................................
.......................... --.------------° °................................. 85
CONFIDENTIAL DP?.FT - Do Not Distribute 4
APPENDICES ................................................................
Figure 1 - Philip Morris' IARC Task Force Structure
Figure 2 - 1989 PM Public Opinion Survey
Table A-1 - IARC Study Authors and Investigators
Table A-2 - Tobacco Industry Members and Allies
Table A-3 - Names from a "Partial Listing of Selected International Involvement of
TASSC Scientists"
Table A-4 - Covington & Burling's List of "B2" and "B3" Epidemiologists
Table A-5 - The "London Panel" of experts on Good Epidemiology Practices convened
by
Federal Focus, Inc.
CONFIDENTIAL DRAFT - Do Not Distribute 5
Information on or i" zations like EuropeanVScience Environment Forum, Federal Focus, and the
International Epide}egistsAssociation were obtained from their websites. The series of
international studies assessing secondhand smoke exposure with personal monitors were listed
on the publishing company website www.elsevier.coni. In addition, key IARC investigators were
contacted by electronic mail to describe their experience with the industry and to confirm
information described about themselves in certain documents.
CONFIDENTIAL DRAhT - Do Not Distribute 13
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~Table 1: Health Effects Associated with Exposure to Environmental Tobacco Smoke''z
ffects Causally Associated with ETS Exposure
evelo mental Effects
etal Growth: Low birthweight or small for gestational age
udden Infant Death Syndrome (SIDS)
1 es irato Effects
cute lower respiratory tract infections in children (e.g., bronchitis and pneumonia)
thma induction and exacerbation in children
hronic respiratory symptoms in children
ye and nasal irritation in adults
ddle ear infections in children
arcino enic Effects
ung Cancer
1 asal Sinus Cancer
(Lardiovascular Effects
T eart disease mortality
cute and chronic-coronary heart disease morbidity
#ffects with Suggestive Evidence of a Causal Association with ETS Exposure
IDeveloomental Effects
~pontaneous abortion
dverse impact on cognition and behavior
es irato Effects
xacerbation of cystic fibrosis
ecreased pulmonary function
Qarcinoeenic Effects
(rervical cancer
CONb'IDENr1AL DRAFT - Do Not Distribute 7
effect29 British American Tobacco (BAT), which had held private media briefmgs30 to ensure
"balanced" coverage of the forthcoming study, was suspected to have fueled the story.31 BAT
responded that it knew of IARC's preliminary results from earlier public conferences and IARC's
mandated Biennial Report.3z Despite press releases from WHO33 and IARC34 noting that the
study still awaited its peer-review publication and calling the Sunday Telegraph interpretation of
statistical significance "false and misleading,sJ4 the allegations quickly spread around the world
from Australia35 to Zimbabwe.36
The confusion in the media represented only the first public manifestation of the
industry's interest with the IARC study; the industry had been developing a proactive strategy
against the IARC study starting five years before the study's publication. Our analysis of internal
industry documents reveals that industry leader Philip Morris (PM) spearheaded an extensive
effort to "stop," "mitigate," "delay," and "counteract"37 IARC's activities. The IARC study was
seen by the industry as the first step toward an increase in international smoking restrictions, and
PM organized both multinational companies and national monopolies around its plan.
We describe the scientific, communications, and government relations components of the
industry's resulting comprehensive strategy against IARC. The industry programs implemented
include intelligence gathering, research designed to counter IARC's results internationally,
"sound science" coalitions, and the Good Epidemiology Practice (GEP) project. The outcome of
these plans demonstrate a sophisticated effort to shape the scientific perception of secondhand
smoke issues for the IARC investigators, general scientific community, public opinion, and
policymakers at large_ An ironic twist is that these same target audiences were at times
integrated into participating in the industry's programs against the forthcoming IARC study,
lending a credibility that has helped mask the industry's primary involvement.
The industry's planning processes and implementation has important implications for the
conduct of science and health policy. Effective health policy needs to be based on good science.
The industry not only continues to argue against unfavorable scientific findings and produce
contradictory evidence, but is attempting to shape the definition of good science on a greater
scale to serve its economic self-interest rather than the public health.
CONFIDENTIAL DRt1F I' - Do Not Distribute I 1
TABLE OF CONTENTS
CHAPTER I : INTRODUCTION
.................................................................................... 5
Policy Implications .............................................. ...........
.................................................... 7
Tobacco Industry Response ......................................................... .....
-................................. 7
Industry Strategy Change with IARC Smdy
.......................................---.........-................... 9
CHAPTER 2: METHODS
................................------------------................---...-----.............
........... 11
CHAPTER 3: THE INTERNATIONAL AGENCY FOR RESEARCH ON CANCER STUDY
AND ITS MEDIA COVERAGE..°.....................................................
..............--------....... 13
Introduction ....................
.....................................................................
.................................. 13
Background on IARC ............................................ -........
-.................................................. 13
IARC Study on Passive Smoking and Lung Cancer Summary......................................... 14
Media Coverage ...........................................................................
......°--................................... 15
Discussion on the IARC Study's Statistics
......................---...--,,,,_.,._-,.-_______............. 23
Summary .....................................
----------- ............... ----........................................................ 25
CHAPTER 4: PHILIP MORRIS TOBACCO COMPANY PLANS AND ORGANIZATION
REGARDING IARC ................ _......................
............................................... -................. 27
Introduction ..........................................
................................................ ............................. 27
[nitial Fears .............................. ................................ ...................
....................................... 28
-
Philip Morris' LARC Task Foice ........................... .......................... ..............
-.................. 30
International Allies in the Tobacco Industry..........
.............................................. ............. 31
International Consultancy Program ------------------- -..........................
:.................................... 33
Summary .......................................................... ---._.-
......................................................... 34
CHAPTER 5: SCIENTIFIC STRATEGY
..................--....................................-------------------...36
In trod ucti on
....................................................................................................
................... 36
Intelligence Gathering and Analysis................
.............................°--°....................-.......... 36
Reaching Out to IARC investigators .................................................
.------------------------------- 42
Preparations for the potential IARC monograph
................................................:.............43
Personal Exposure Sampling Studies
.................................................................:.............. 46
Confounding Factors for Cancer Studies
.......................................................................... 47
Summary ............................. ............................................... ......
--........................................ 48
CHAPTER 6: COMMUNICATIONS STRATEGY
.........................................................----......51
Introduction .......................... --............ ...-------------------
........................................................ 51
Objectives ........................................................................................
... ............................. 51
"Sound Science" Groups
.................................................................°-----....----------..-........--
52
Internal communication preparations
................................................................................ 57
Using the med ia
....................................................................................................
............. 58
Summary ............................ ..................... -----------------------------
---------....................---.......... 65
CHAPTER 7: GOVERNMENT RELATIONS STRATEGY AND THE GOOD
EPIDEMIOLOGY PROGRAM
.................................................................°----................ 67
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The Roper report recommended that the industry's long-term strategy should be to conduct
research that would discredit the growing scientific evidence of secondhand smoke's detrimental
health effects:
The strategic and long run antidote to the passive smoking issue is, as we see it, developing and
widely publicizing clear-cut, credible, medical evidence that passive smoking is not harmful to the
non-smoker's healnt'2
The production of research concluding that passive smoking is not harmful would continue the
precedent set by the industry's prior strategy for active smoking research. Through the industry's
CTR and the establishment of the industry's Center for Indoor Air Research (CIAR), certain
scientific research projects on secondhand smoke were sent through a"special review" by
industry lawyers, as opposed to research undergoing the traditional scientific peer review process.
Such CIAR "special reviewed" projects generally conclude that secondhand smoke is not
harmful 23 The industry has also sponsored and promoted review articles'" and symposium
publicationsu'26 on secondhand smoke that generally conclude that secondhand smoke is not
harmful. Again, as seen previously with active smoking, this industry-sponsored rescarch was in
contrast to the industry's in-house research, which has supported the conclusion that secondhand
smoke is dangerous to health.'x
Industry Strategy Change with IARC Study
Our analysis of recently released industry documents demonstrate that the industry's
defensively reactive approach to secondhand smoke changed to a systematically proactive
strategy in the 1990s This change was in response to a scientific study in Europe that the
industry perceived as threatening to stimulate smoking restrictions worldwide. Few studies
evaluating the health effects of secondhand smoke had been conducted in Europe z' and
European countries have been relatively slow to implement smoke-free measures.3 This
European situation was poised for change when the International Agency for Research on Cancer
(IARC), a research branch of the World Health Organization (WHO), undertook from 1988-1998
the largest European epidemiological study on lung cancer in non-smokers exposed to
secondhand smoke.V Because IARC is internationally regarded as an authoritative source on
cancer research, the possible ramifications of global clean indoor air laws presented a grim
scenario for an industry seeking to expand its business intemationally.
The IARC study was published in October 1998 and its results were consistent with
earlier major studies (Table 1).l'S-10 IARCn observed a 16% increase in the risk of lung cancer
for non-smoking spouses of smokers (95% CI = 0.93-1.44), and a 17% increase in the risk of
lung cancer for non-smokers' exposure to passive smoking at the workplace (95% CI = 0.94-
1.45).z' The October 1998 Jountal of the National Cancer Institute published the study with an
accompanying editorial concluding that the new study plus previous scientific evidence presented
an "inescapable scientific conclusion" that secondhand smoke causes lung cancer.Z$
This publication in the scientific literature, however, was preceded by numerous media
reports that spread confusion about the study's llndings. Seven months earlier, on March 8,
1998, the London Sunday Telegraph reported that WHO was withholding a study that not only
failed to show that passive smoking caused lung cancer, but might even demonstrate a protective
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9
"instead of (the lARC study] being released with a fanfare, they were summarised
in three short paragraphs and buried in a bulky WHO internal document."s3
* Radio show programs in Australia and Arizona had guests from the Australian
Hotel Association54 and an opponent of a proposed local Arizona ordinancess
stating the IARC study did not demonstrate a link between passive smoking and
lung cancer_
* The television program "NewsHour with Jim Lehrer" had Charles Blixt,
Executive Vice President and General Counsel of R.J. Reynolds tobacco
company, stating in a debate over the U.S. EPA report that "the preliminary
[lARC] report...says that the risk of cancer from second-hand smoke has not been
established" ss
* The National Smokers Alliance,57 a"smokers' rights" front group created and
funded by Philip Morris; 8 and Jacob Sullum of Reason Magazine59 (with
financial ties to the tobacco industry)'$ criticized the WHO and tobacco control
advocates for putting "spiti " on the IARC study results.
* The medical demographer for the European Science and Environment
Foundation, a Cambridge-based organization of scientists advocating "sound
science" likely initiated by the industry (described below), wrote an opinion-
editorial in the Wall Street Journal stating that the lARC study's "true risk ratio
could be trivial or nonexistent" and demonstrated the poor scientific basis for
countries"`antismoking policies in the name of public health.^so
* Restaurant owners fighting a smoke-free restaurant law in Rockland, New York
cited the WHO study as demonstrating "no correlation" between lung cancer and
nonsmokers and supporting their position.67
* Conservative radio talk show host Rush Limbaugh discusses the Sunday
Telegraph article on his nationally syndicated show, over a year from the article's
first publication.62
* One person from Canada wrote a letter to the editor in a Chicago newspaper
with the letter's title "no proven risk" summarizing the letter's description of the
JARC study.s'
The voices promoting the viewpoint that the IARC study did not demonstrate an increase of risk
for lung cancer came mostly from industry representatives and organizations allied with the
tobacco industry, such as the National Smokers' Alliance and hoteUrestaurant associations.
Others did not disclose any obvious industry affiliations, although the European Science and
Environment Forum links with the industry is described in Chapter G.
In response to the Sunday Telegraph's original articles, the UK Action on Smoking and
Health, a London-based charity that campaigns for tobacco control, requested a withdrawal and
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