Tobacco company’s understanding of addiction revealed by internal documents

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While Philip Morris’s public statements reinforce the idea that nicotine’s pharmacology principally drives smoking addiction, company scientists frame addiction as the result of interconnected biological, social, psychological, and environmental determinants, with nicotine as but one component, found a University of California study.

After decades denying the role of nicotine dependence in smoking addiction, tobacco company Philip Morris (PM) publicly embraced nicotine as the main driver of smoking behaviour in 2000. However, their internal understanding of smoking addiction was more complex, and the company simultaneously promoted nicotine reduction products alongside advertising and policy campaigns to promote smoking behaviour, according to a study.

The research, by Jesse Elias, Yogi Hendlin, and Pamela Ling of the Centre for Tobacco Control Research and Education at the University of California – San Francisco, analysed previously secret, internal PM documents made available as a result of litigation against the tobacco industry to explore the company’s understanding of addiction before and after publicly admitting nicotine’s addictiveness.

The researchers found that PM continued studying addiction through the 2000s to develop successful and potentially safer nicotine products, and that from the mid-1990s to at least 2006, PM’s internal models of addiction regarded psychological, social, and environmental factors as comparable in important to nicotine in driving cigarette use.

Elias and colleagues argue that PM’s outward support for nicotine’s role in driving smoking allowed the company to redirect policy away from proven social and environmental interventions and toward the promotion of potentially reduced harm industry products.

The researchers note that due to the fragmented and incomplete nature of the tobacco industry documents archive, some relevant documents may have been missed. Nevertheless, the authors emphasize that reducing smoking prevalence requires policies that address all of the factors driving smoking addiction (advertising restrictions, plain packaging, tobacco taxes, and widespread smoke-free restrictions).

The authors say: “As PM’s internal research indicates, positive health outcomes are more likely to be achieved by complementing NRT and behavioural counselling with ever-stronger society-level interventions addressing the psychological, social, and environmental components of addiction.”

Abstract
Background: Tobacco addiction is a complex, multicomponent phenomenon stemming from nicotine’s pharmacology and the user’s biology, psychology, sociology, and environment. After decades of public denial, the tobacco industry now agrees with public health authorities that nicotine is addictive. In 2000, Philip Morris became the first major tobacco company to admit nicotine’s addictiveness. Evolving definitions of addiction have historically affected subsequent policymaking. This article examines how Philip Morris internally conceptualized addiction immediately before and after this announcement.
Methods and findings: We analyzed previously secret, internal Philip Morris documents made available as a result of litigation against the tobacco industry. We compared these documents to public company statements and found that Philip Morris’s move from public denial to public affirmation of nicotine’s addictiveness coincided with pressure on the industry from poor public approval ratings, the Master Settlement Agreement (MSA), the United States government’s filing of the Racketeer Influenced and Corrupt Organizations (RICO) suit, and the Institute of Medicine’s (IoM’s) endorsement of potentially reduced risk products. Philip Morris continued to research the causes of addiction through the 2000s in order to create successful potentially reduced exposure products (PREPs). While Philip Morris’s public statements reinforce the idea that nicotine’s pharmacology principally drives smoking addiction, company scientists framed addiction as the result of interconnected biological, social, psychological, and environmental determinants, with nicotine as but one component. Due to the fragmentary nature of the industry document database, we may have missed relevant information that could have affected our analysis.
Conclusions: Philip Morris’s research suggests that tobacco industry activity influences addiction treatment outcomes. Beyond nicotine’s pharmacology, the industry’s continued aggressive advertising, lobbying, and litigation against effective tobacco control policies promotes various nonpharmacological determinants of addiction. To help tobacco users quit, policy makers should increase attention on the social and environmental dimensions of addiction alongside traditional cessation efforts.

Authors
Jesse Elias, Yogi Hale Hendlin, Pamela M Ling

PLOS Medicine abstract

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