Philip Morris
Tobacco Industry Efforts Subverting the International Agency for Research on Cancer's Secondhand Smoke Study
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PM utilized the media successfully with journalists communicating the industry's
perspective. The industry lacked credibility as an objective source of information. This
acknowledgment is reflected in PM's contemplation of creating a scientific journal that disregards
conflict of interest disclosures, and the severe reaction against PM's advertising campaign against
secondhand smoke research. Philip Morris sought to market the personal exposure and
confounder studies to influential regulatory bodies and the media, even bypassing the study's
author and the industry's CIAR, the study's nominal funding agency, when the study was not
marketed to PM's satisfaction. Through receptive newspapers like the Sunday Telegraph, the
industry could communicate directly the industry's interpretation of scientific research statistics
and results.
.}
The communication programs allowed the industry the means of exercising control over
how the IARC study would be perceived upon its publication. The "sound science" coalitions and
media coverage created the appearance of an independent consensus, composed of scientists,
policymakers, and media, about secondhand smoke independent of the industry_ Maintaining a
low profile with the implementation of the programs helped promote credibility for these
initiatives. The industry tightly coordinated and implemented these plans years before the
publication of the IARC study.
CONFIDENTIAL DRAFT - Do Not Distribute 67
But reputable scientists say that weak associations arent necessarily meaningful.
So there's no big campaign to persuade you to give up your daily biscuit.
Nor is there any sound justification for a campaign against second-hand tobacco smoke z31
A table in the advertisement listed 10 different studies with the relative risk ratio of getting a
disease (e.g., lung cancer) from performing various activities (e.g., frequently cooking with
rapeseed oil). This industry advertising campaign, which misrepresented the studies by
y inappropriately comparing statistical results, was a bold public move by the industry.
The openly industry-sponsored ads drew a rapid and severe response. The campaign was
publicly criticized by the European Union social affairs commissioner,Z3Z and formed the basis for
a successful legal action by a French biscuit manufacturer to halt publication of the advertisement
and a separate lawsuit by the French National Anti-Tobacco Committee 233 In October 1996, the
UK Advertising Standards Authority upheld a complaint that the studies were misrepresented and
asked the advertisers to withdraw the advertisements.23
The heightened polarity created when the industry produces a public campaign under its own
name is also the result of the lack of industry credibility.
The most successful use of the media seemed to be briefing journalists about the industry's
perspective. Having articles written was a tactic used for promoting the IEMC-funded Hazleton
studies, and then repeated for BAT's promotion of the IARC study. In fact, the same newspaper
and journalists were utilized, the Sunday Telegraph and writers Victoria Macdonald and Robert
Matthews (Matthews is an ESEF member).
PM looked for media coverage and means to market the confounder and exposure studies
for their IARC plan, consistent with the International Consultancy Program philosophy of
producing research and controversy for public affairs persons to market. Joanna Sullivan of
PMCS Brussels commented to David Greenberg:
You solicited my thoughts on how we can effectively progress certain of the IARC plan elements.
Confounders and Exposure studies
Obiectives:
1.-Ensure studies progress in such a way to provide maximum CA [PM Courtesy and Accommodation
oroeraml benefit. '
-> monthly updates on progress and key findings for potential CA/scientist use and if
necessary to adapt study protocol (for maximum scientific impact)
-> thorough analysis of site selection to maximise use of results with national/EU target
groups
-> agreement from study investigator/university to publicise ongoing developments through
scientific conference and media opportunities
-> assess feasibility of obtaining Europe Against Cancer budget for confounders studies or
other endorsement by DG V [European Union's Directorate General for Employment, Industrial
Relations and Social Affairsl.
2. Marketine the confounder study results- elements could include:
* pre-publication exclusive by study investigator
* investigator/university to seek study endorsement by independent cancer body (EPIC?)(European
Prospective Investigation of Cancer]
* investigator/university to send published study direct to target groups (Annex I)
* promote study results via contacts of investigator .
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and whose quotes in the news release are used verbatim in the Sunday Telegraph
article)
* "The Complete Body of Statistical Evidence on Environmental Smoke" listed the
statistical significance of secondhand smoke studies and stated "Relative risks are
not statistically significant if the 95% confidence interval includes 1.0. When this
is the case, the study has failed to reject the "null hypothesis." In the case of
environmental tobacco smoke and lung cancer, it means that the study has not
identified that ETS is associated with lung cancer."
* "What is the International Agency for Research on Cancer"
* "New opinion research on the public's views of irritating behavior" describing a
BAT-sponsored survey revealing smoking in pubs and restaurants ranked lower
than dog fouling in public places and bad language.104
BAT's elaborate press packet and international promotion misrepresenting the study was the
primary source generating the conflicting news stories around the globe about the IARC study.
The study which the industry had feared for years would lead to increased consumption
restrictions now was transformed into a tool with which the industry could cast doubt upon major
secondhand smoke scientific reports, like the U.K. SCOTH report.
Sunmary
The industry's communications strategy for the IARC study served as an adjunct to the
scientific strategy. With its efforts to reach out to the IARC investigators and scientific research
program, the industry could only influence IARC and the scientific community to an unknown
certain extent. Just as the target goal was to ensure IARC's study would not stimulate more
smoke-free legislation or rea lations, the industry broadened their communication efforts to create
an environment in which policymakers would not be compelled to take action.
The creation of "sound science" coalitions was PM's means of generating a critical mass
of reputable voices advocating how science should be used in policymaking. TASSC in the U.S.
was most likely replicated as ESEF in Europe. Although these third-party coalitions publicly
appeared to be independent, public relation firms developed and managed the coalitions with the
purpose of helping PM in its "legislative battles-" As the public relation firms' research
demonstrated that corporate sponsorship, especially by PM, proved controversial to European
scientists, PM's role in these coalitions may have been downplayed, as with TASSC, or not
revealed. Although TASSC is defunct and seems to have been transformed into its former
executive director's "junk science" web page, ESEF has continued to serve as a critical voice
about the IARC study and secondhand smoke scientific research.
The industry did not leave much to chance in managing the announcement of IARC's
results. The organization of "crisis" teams across the industry ensured a well-coordinated
response in case the study's results were announced unexpectedly. Such precautions were
undertaken for an international basis as well.
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CHAPTER 7: GOVERNMENT RELATIONS STRATEGY AND THE GOOD
EPIDEMIOLOGY PROGRAM
Introduction
PM's ultimate goal for the industry's IARC study plans was to impact policymakers The
policymakers would be the ones deciding how to use the IARC study for any secondhand smoke
-=legislation or regulation. While theindustry has had a long history of lobbying policymakers
directly, such as through the industry's Tobacco Institute lobbying organization, the industry's
government relations strategy expanded the typical lobbying activities into a sophisticated
communication program directly targeting policymakers. The govemment relations program was
designed to influence the policymakers' evaluation processes about the risks of secondhand
smoke.
In keeping with its traditional lobbying activities, PM tracked public sentiment about
smoking restrictions, and developed comprehensive "briefing book" materials about secondhand
smoke for its own representatives and policymakers. A 1989 PM survey of 10 European countries
demonstrated that "both smokers and non-smokers in Europe desire more rules in the future
against smokingin public places," and that Europeans are less opposed to government
involvement with smoking than Americans (Figure 2).239 Citizens of Europe actually wanted
more smoking restrictions than their U.S. counterparts, even though progress has been more rapid
in the U.S.
To communicate indirectly with policymakers, PM developed the Good Epidemiology
Practice (GEP) program. The GEP program sought to establish procedural standards for
epidemiology, and subsequent seminars on GEP and good risk assessment practice were
conducted throughout the world. As with the scientific and communication strategies, the
government relations strategy sought to establish credibility by maintaining a low profile and
incorporating the participation of third-parties. Through the GEP program, policymakers could
learn from "experts," pre-screened for their participation by the industry, about how to analyze
scientific risks in creating policy.
Traditional Lobbying Activities
With the IARC study, PM concluded "[a] European initiative to regulate exposure to ETS,
be it at the Union level, national level, or both, appears not only inevitable, but also
imminent."24O
In September 1993, PM planned to develop a lobbying plan before and after the IARC study's
release. PM sought "key national government influence points" in the IARC donor countries to
"generate pressure for reorientation/reprioritization of IARC priorities/budget allocations," and
planned to lobby regulatory bodies and secure preemptive legislation against smoking
restrictions.90 Re-directing IARC's priorities and budget proved difficult, as described in the
scientific strategy section. Targeting regulators and legislators thus comprised the heart of the
industry's resulting government relations strategy.
In 1994, PM developed a "ETS & IARC Briefing Book" in preparation for the IARC
study. The structure of the book sections would be "written in a narrative style which can be
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0
* generate letters to editors (scientific/general media) promoting study and highlighting EPA/other
weak ETS methodology inc. IARC .
* encourage libertarian policy groups to promote study and criticise the weakness of epidemiology,
especially on ETS
* independent scientists to push feature articles promoting confounders arguments
* promote perspective argument: confounders, especially poor diet (dairy fat) and other relative
risks vs. ETS, no significant risk- possibly through VNR featuring study investigator, and third
party advocates of confounders arguments.
3. Marketing the exposure study results
* study investigator to publicise to scientific peers via scientific journals, conference
opportunities
and direct to government (EU/national) scientific advisory bodies
* CA use not reconunended....
Anne
Targets
EU: DGV [European Union's Directorate General for Employment, Industrial Relations and Social
Affairs]
DG XII (European Union's Directorate General on Science, Research, and Development]
STOA [European Union's Science and Technology Office of Assessment]
Public Health Research Deparunents (CEC/EP)
EP Environment Committee Members/Secretariat _
CEC H-ealth and Safety Advisory Committee
ECOSOC Health Committee/Secretariat
CEC Public Health Advisory Committee
CEC European Committee of Cancer Experts
CEC Consultative Cornmittee on Cancer
Consumer Policy Service (?)
European Health and Safety Agency (?)
Advisory Committee on Health Promotion (not yet established)
EU Influencers -
European Prospective Investigation of Cancer (EPIC) (nutrition bias)
European Cancer Prevention Organisation
European Public Health Alliance
European Public Health Association (NGOs)
. European Institute of Oncology
Standing Committee of European Doctors .
European Medical Association of Smoking and Health
European Organisation for Research and Treaunent of Cancer (has a databse of 60,000
cancer patients "Euro-Code" which could be used for confounders study?)
Intern ati on al In fluen cers
IARC staff and country collaborators
International Union for Health Promotion and Education
International Union against Cancer
International Union against Tuberculosis and Lung diseases
WHO Regional Adviser for Cancer
Member States
Health Ministers, Ministrics, Government Committees ~--
HealthlScientific Advisory bodies
National Cancer Institutes
W
*CEC = European Commission'3s O
Cyr
p)
_ 4~h
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PM's objective was to place articles that seemed to independently support the industry's position.
PM took this objective a step further by contemplating the development of an independent
journal. In April 1995, the head of PM's IARC Task Force proposed PM produce "Science
Forum: An International Journal of Science and Critique." The precedent for a third-party forum,
which the industry could criticize scientific research, had already been established with PM's
"sound science" coalitions. The production of a scientific journal could complement the
coalitions' objectives to promote appropriate use of science for policymaking:
PURPOSE
To provide a forum where the objective validity of statements claimed to be scientific - and
therefore their technological or policy usefulness is evaluated according to the objective criteria
of
the scientific method.
EDITORIAL POLICY
Communications in all fields of science are invited, as original experimental reports, reviews,
critiques, or seminal speculations. Communications are also invited in the philosophy and methods
of science and the interactions of science with public interest policies. Submissions will be
considered only if data presentations, evaluations, and associated critiques adhere to scientific
principles of validation, according Co standard criteria of the scientific method.._.
The Journal stands by the principle that what counts is-the message and not the messenger.
Accordingly, the Journal does not consider submissions that include ad hominem arguments, is not
concerned with personal or institutional conJlicts of interest of authors, but only with possible
conflicts of their statements in relation to the above principles of the scientific method.
Anonymous
submissions are considered according to the same principles and provisions.230 [emphasis added]
PM sought a seemingly independent journal in which it could credibly critique scientific studies
and policymaking. Of note is the proposal's recommendation that the journal not be concerned
with personal or institutional conflicts of interest of the authors, which would bypass a standard
protocol for journals and allow the industry greater rein to promote its messages. Among other
things, such a joutnal would provide another avenue for critiquing the IARC study. Discussion of
these plans was scheduled on an agenda that included other IARC plans, such as a review of the
IARC monograph participant selection process and a Covington and Burling's draft of a Good
Epidemiology Practice Resolution for the European Union (described below in this chapter). It is
not known if such a journal evolved or exists.
Communication efforts using PM's name openly resulted in harsh criticisms. In 1996, PM
ran a°Secondhand Tobacco Smoke in Perspective" advertising campaign across European
newspapers, claiming that studies demonstrated the risks of passive smoking were trivial
compared to other everyday activities_ The "evidence" that secondhand smoke did not present a
meaningful health risk read in one advertisement:
The United States Environmental Protection Agency recently conducted a major review of studies
on the risks of second-hand tobacco smoke to non-smokers. These studies typically involve non-
smokers living with smokers over a long period, such as 20 years.
And this review put the risk of lung cancer from second-hand tobacco smoke,at a level well below
the risk reported by other studies for many everyday items and activities.
And below, in fact, the risk to health that one other study reported for eating one biscuit a day.
As the table below shows. many everyday activities have been statistically associated at one tiine
or
another with apparent risks to health. .
CONFIDENTIAL DRAFT - Do Not Distribute 60
dismiss [the study] by arguing that our research receives support from...the tobacco industry. Our
findings are completely independent of any influence from the industry."227 However, not only did
the Hazleton study have extensive industry involvement, but the article was probably a result of
PM's public relations effort.
Generating media coverage of the industry's perspective was repeated for BAT's
interpretation of the IARC results, obtained from the abstract in IARC's Biennial Report_ The
~ March 1998 Sunday Telegraph story and subsequent media coverage were acknowledged by the
first head of PM's IARC Task Force, Winokur, as the "publicity generated by BAT":
BAT decided to publicize the information in the Biennial Report and on March 8 issued a press
release highlighting what it believed were the limits of IARC's research. BAT concluded "the risk
of lung cancer from environmental tobacco smoke to be either non-existent or too small to be
measured at a meaningful level." The timing of BAT's initiative may have been influenced by the
U.K. SCOTH report which was scheduled jor and was released March 11. SCOTH concluded that
"long term exposure to environmental tobacco smoke is a cause of lung cancer" and recommended
restrictions on smoking in public places, including workplace bans.
On March 8 The Sunday Tele¢ranh broke the story accompanied by an editorial. On March 9 Tie
Guardian and The Times also covered the story as did other U.K. newspapers and radio talk shows.
The story ran in other EU markets. Also on March 9 BAT issued press releases via Brown &
Williamson and W.D. & H.O. Wills. There were only small mentions in U.S. media but the story
appeared in Ausrralia. On March 11 BAT held a press conference in Brazil which generated
stories. BAThas indicated it will continue to promote the story in other markets....
During the week there were two significant stories. On March f I the Wall Street Journal Europe
published [European Science Environment Forum's] "Smoking Out Bad Science" and the March
14 The Economist published "Smokescreens" criticizing the W.H.O. and concluding "Although
passive smoking is unpleasant and irritating for non-smokers, that alone cannot justiJy banning it
in public places. "
Additional stories appeared in the U.K. over the March 14-15 weekend.''s'[emphasis addedl
The document demonstrates BAT's primary role in the March media blitz, and unfolding of the
international plan implemented by the industry. BAT even sent the Sunday Telegraph articles to a
Bangladesh newspaper that refused to publish cigarette advertisements238 The Sunday Telegraph
continued to be the medium for the industry's messages to the public about secondhand smoke.
Of note is that Winokur regards ESEF's opinion-editorial in the Wall Street.7ournal Europe as
one of the "two significant stories" of the week.
The industry documents include BAT's press packet to the media about the IARC study.
This press packet included:
* a March 5 news release entitled "Europe's largest ever passive smoking study
has failed to establish a meaningful risk of lung cancer to non-smokers" with the
statement "In short, the study failed to find any statistically valid increase in lung
cancer risk in non-smokers who have lived, worked or grew up with smokers."
* an invitation to interview BAT spokespeople or obtain a videotape with a pre-
recorded interview with.BAT's Head of Science (Chris Proctor, IEMC member
CONFIDENTIAL DRAFT - Do Not Distribute 65
The entire industry was made aware of GEP's potential benefits. If an international standard for
the conduct of epidemiologic studies was adopted , the results from the IARC study and
anticipated monograph could potentially be criticized.
PM's initially attempted to have a body of scientists adopt a PM version of GEP. The
scientists would either be pre-screened by the industry or belong to a"sotmd science" coalition.
The scientists' conclusions would then be communicated to policymakers. Public relations firm
Burson-Marsteller first described this concept, in conjunction with other proposals to demonstrate
the "misuse of science" and "ETS in perspective," in the December 1993 "Preparedness plan for
the announcement of the IARC study:"
A. Misuse of science survey.... B. Overview of other low level workplace risks and safety
standards...
* to put ETS in.perspective
* to gain the support of companies by scaring them of the impact of ETS on regulation of other tow
level workplace risks
C. ET.S.reminnr._.
._.with the stakeholders in the ETS debate (unions, employers organisations, horeca organisations,
human resources managers, etc.).... The real allies would be asked to speak at this meeting....
Objective of the meetings is _
* to have participants understand how the [sic] science is sometimes misused by activists. Philip
Morris should be perceived as asupplier of credible information.
* to scare the allies about the impact of hysterical legislation on smoking (and on other low level
risks)200.
Burson-Marsteller proposed putting the risks of secondhand smoke in perspective by holding a
seminar to demonstrate the "misuse of science," and recruiting the involvement of other industries
facing similar regulatory challenges. PMCS Brussels developed this concept further by proposing
a European Union-endorsed seminar on GEP with selected epidemiologists:
GEP Seminar
Objectives:
-extract an agreed set of criteria on GEP for use as a lobby tool -based on criteria developed
during
seminar
-incite participants to lobby DG V [European Union's Directorate General for Employment, Industrial
Relations and Social Affairs] to establish need for and push GEP Resolution
* encourage other supportiveivulnerable industries to support seminar and promote the need for GEP
criteria
to be legislated -
* have STOA host conference [European Union's Science and Technology Office of Assessment]
* have small number of MEPs [Members of the European Parliament] endorse conference and through
involvement encourage them to lobby Commission on need for GEP Resolution, possibly have EP
own-initiative report on GEP
* CIAR vs tobacco industry funding
* ensure scientific epidemiologist participants have clear philosophy of criteria sought via careful
pre-
selection, pre-briefings
* possibly invite DG XII? fEuropean Union's Directorate General on Science, Research, and
Development]
* STOA/CIAR/epidemiologists to publicise "agreed GEP criteria" to key targets and follow up with
lobby efforts. '
GEP Lobby
* focus seminar participants on DG V. and supplementary focus by epidemiologists on national Health
Ministersz35
CONFTDENCIAL DRAFT - Do Not Distribute 72
allow Keith to participate in the brieHngs, and the lateness of the decision to go ahead, meant that
no independent third party was available to provide the necessary perspective.
* Covance.following itsflotation, seems determined to say as little as possible of any significance
about the studies for fear of drawing attention to their involvement with the tobacco industry
(though this is not KP's [author Keith Phillips) attitude).
* The net result is not only a tortuous process of trying to get the studies reported at all, bur
also
briefing material which is neutral,and bland to the point of being devoid of media interest....
Conclusions
* The abstracts should be more comprehensive and also better structured to make clearkey points
which enhance understanding of air quality measurements.
* A communications strategy which essentially leaves journalists to find their own way around the
figures and put their own interpretation on them is counter-productive. It is essential to be much
more direct and up front with what the studies could mean, offering a commentator who can give
this necessary perspective on the figures- an environmental scientist or toxicologist, for example.
* There is little hope of changing this situation, given the attitude of Covance/its PR advisors,
and
the artn's length dialogue, while certainly above reproach. makes the process management
exceedingly difficult. _
* If CIAR is unable/unwilling to take a more active part in presenting the findings, the industry
should brief journalisrs on the studies once they have been published in scientifec journals. There
would be some loss of credibility but Covance could not dispute the information- since it would be
based entirely on their research- and a third parry could be on hand to give an independent view.
* In the case of Barcelona, I recommend that a follow-up briefing is given by industry scientists to
Spanish journalists. "Ibis could be linked to the additional information which the Harris poll
provides on perceptions of ETS.
* There is an argument for waiting until all studies are published, but this will miss the
opportunity
to prepare the ground for lARC.
There is much more to discuss, but my basic thrust is that there is no longer any point in waiting
for
other parties, notably Covance in this instance, to transmit a clear message about exposure- the
indusrry must tackle the issue head on. "` [emphasis added]
Hazleton author Philips' "emphasizing upper decile not median figures - so they are 'exaggerated"'
is actually a standard environmental measurement approach, but stating the highest levels of
secondhand smoke exposure would not help demonstrate that secondhand smoke exposure was
minimal. As the author and organizations primarily behind the study were not marketing the
study sufficiently for PM's objectives in "prepar[ing) the ground for IARC," PM wanted to take
the lead in promoting an interpretation of the exposure studies.
The recommendation that "the industry should brief journalists on the [exposure] studies"
did seem to bear fruit. In August 1998, Robert Matthews and Victoria Macdonald of the Sunday
Telegraph, who wrote the series of articles stating the IARC study did not link passive smoking
and lung cancer, reported that the Hazleton studies demonstrated that "Passive smokers inhale six
cigarettes a year" and that "real-life levels" of secondhand smoke probably do not cause fatal
diseases.'Zl In the article, the study's author Phillips is quoted as stating "[Some scientists] try
to
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PM viewed GEP as a lobbying tool, a means to communicate their view with policymakers.
European Union legislators and regulatory bodies could be recruited to participate and endorse.
The seminar participants would help lobby for implementation of GEP across the European Union.
Continuing the lobbying concept of GEP, PM drafted versions of a GEP European Union
resolution with the help of its legal resources and internal scientific departments. The provisions
of the resolution were designed to specifically cover the LARC study. Sullivan of PMCS Brussels
~ asked Winokur to make preparatiot5s before their next meeting:
GEP Resolution
Obtain the scientific input on the draft C&B [Covington & Burling law firm] Resolution, from S&T
[PM Science & Technology], and SI-IB [Shook, Hardy and Bacon law firm] as well as Tony
[Andrade] and Tom Borelli to ensure that the Resolution contains the necessary language to catch
the IARC study. As we discussed the crucial elements need to be identifiable to PMCS as distinct to
the padding (which is important to make the Resolution politically viable). Once the changes have
been agreed and incorporated, you will send around the amended version to the full IARC Task
Force for final comments. Once this process is complete we will have a final text to act on here; we
should aim to complete this exercise by end of June.
Next meeting
...The key elements that need to be covered off at this meeting are -1 endorsement of language of
Resolution -2 discussion and agreement on the feasibility, objectives, and timing of the GEP
conference: you will have BM10" and APCO [Associates public relations firm] attend to present their
refined plan...-3 discussion and agreement on the potential use of scientists known to C&B and SHB
to promote GEP concept and Resolution wording to DGV, DGXI and their Scientific advisory cttees
[slc], and same for national level. You will ask them to come prepared having identified individuals
for this specific purpose, and the degree where known of their access points within EU and national
government scientific/public health circles. ~a [emphasis added]
PM intended for scientists selected by the industry's law firms to promote the GEP concept and
resolution with European Union regulatory bodies and legislators. In the different GEP resolutions
drafted,2t5.249 the "Executive Committee of the Sound Science Coalition" was listed as the author
of the resolution. While The Advancement for Sound Science Coalition in the U.S., described in
the scientific strategy section, had been established to help PM in its "legislative battles", a
European body of scientists may have better suited PM's need to address the Europe-oriented
IARC study. Unfortunately, in June 1994 Burson-Marsteller was still researching the development
of a European sound science coa]ition.217 Perhaps as a substitute or a potential roster for a
European coalition, in August 1994 Covington and Burling law firm created a list (Appendix Table
A-4) of potential epidemiologists to invite that were screened out for anfl-tobacco views:
....[Category] B2 lists non-German candidates who appear from our research to date to be reasonably
balanced on the tobacco issue and [category] B3 lists influential epidemiologists known to have
strongly anti-tobacco views. There appears to be general agreement that all those on the latter list
should be excluded from the seminar. We have excluded from our B2 Gst a number of the
candidates suggested by Stig Albinus 20°, either because their area of expertise,appeared to be
outside
the boundaries of epidemiology, or because they, or their institution, or some of their close
collaborators, appeared from our knowledge or research to be euremely hostile to tobacco 'S°
[emphasis added]
The `B3" list of anti-tobacco epidemiologists included Rodolfo Saracci, senior co-head
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