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Big Tobacco and the controversy over research and influencing policy

News that the South African universities accepted tobacco industry sourced funding has reignited the controversy over the industry's attempts to influence public debate on health issues.

The University of Cape Town’s department of psychiatry and mental health agreed to take more than R1m from a foundation funded by tobacco giant Philip Morris International, causing outrage among the broader university, including its health sciences department, Bhekisisa reports. The school says it never signed off on the deal.

UCT is one of at least two South African universities to have taken Big Tobacco money in the last year, the report says. The UCT department’s decision sparked outrage among the broader university, including its health sciences department. The contract has since been cancelled, but in the deal’s wake, other donors have refused to work with the university’s internationally-recognised tobacco control unit. Experts worry the now-cancelled contract could make them untouchable for public health funders.

The report says Philip Morris International is the sole funder of the non-profit organisation Foundation for a Smoke-Free World. The tobacco giant has committed to paying R1bn annually to the foundation over the next 12 years.

The university only became aware of the donation after the tobacco-funded foundation’s 2018 tax returns were made public, says Leslie London, the head of UCT’s public health medicine division at its School of Public Health and Family Medicine. By the time UCT learned of the grant, R300,000 had already been paid to its psychiatry department. At the time, the university was drafting guidelines that London says are eventually expected to largely ban university entities from accepting money from tobacco firms.

Meanwhile, the report says, University of Stellenbosch Business School also accepted about R1.2m for a project called “An ethical framework for a smoke-free world”, tax returns show. The university did not respond to questions about the programme.

Scientists have good reason to be concerned about the Foundation for a Smoke-Free World’s motives, the report says. The tobacco industry has long used third-party “research units” to back industry claims.

A study on tobacco industry influence, “The Crooked Nine” report, released by the international watchdog group Stopping Tobacco Organisations and Products (STOP), has outlined the dirty tricks the tobacco industry has used to oppose health policies around the world, write Dr Catherine Egbe a specialist scientist at the Alcohol, Tobacco and Other Drug Research Unit of the South African Medical Research Council and Savera Kalideen, the executive director of the National Council Against Smoking, South Africa in a Health-e News report.

They write: “These tactics include building alliances and front groups, trying to weaken the public health community, disputing public health facts, producing and promoting misleading research, lobbying, influencing high-level policies, litigation, facilitating smuggling, and seeking to improve its reputation. Nearly all of these tactics have been used in South Africa to fight previous regulations and to try and defeat the Control of Tobacco Products and Electronic Delivery Systems Bill.

“A little more than a year ago, the National Department of Health proposed to significantly improve how it regulates tobacco in South Africa. If passed into law, this Bill will help us reduce the number of smokers in the country and the related diseases that it causes or exacerbates – such as cancers, diabetes and tuberculosis. It will also bring South Africa more closely in line with the standards set by the world’s first-ever global health treaty, the World Health Organisation’s Framework Convention on Tobacco Control which South Africa signed on to in 2005.

“The tobacco industry tried to hijack South Africa’s socio-economic impact assessment process on the bill by raising superficial arguments against the Economics of Tobacco Control Project at the University of Cape Town, and ultimately delayed the process. South Africa’s earlier efforts to tackle tobacco smuggling placed it in the cross-hairs of tobacco industry interference who, true to form, objected to the draft bill with the misleading claim that evidence-based measures to protect the public will increase cigarette smuggling.

“Another tactic of the Tobacco Institute of South Africa (Tisa) against the Bill was the commissioning of its own study that presented smaller, local tobacco companies as being wholly responsible for the sale of illegal cigarettes. According to Tisa, if the government curbed illicit trade, there would be no need for the draft bill nor would tobacco taxes have to be raised.

“The industry does not mention the evidence from around the world, which shows that the proposed changes in the bill will reduce tobacco consumption, and therefore health harm, nor that increasing the tax on tobacco reduces its use. Less health harm from tobacco use, and a reduction in tobacco consumption in South Africa, will benefit individuals and society as demands on the National Health Insurance (NHI) for healthcare will be reduced too.

“Even beyond these self-serving arguments is evidence of tobacco companies being actively involved in smuggling globally. When governments attempt to address this, the tobacco industry promotes its own track and trace “solution” – Codentify – through the use of front groups.

“The WHO FCTC Illicit Trade Protocol requires a global track and trace system in which cigarette packs will be marked with unique, secure identifiers, to reduce tobacco smuggling. The protocol stipulates that track and trace “shall not be performed by or delegated to the tobacco industry.” Yet leaked documents show that the major tobacco companies have been working collaboratively through an increasingly complex set of front groups and third parties to promote Codentify to governments.

“The industry also has a long history of producing and disseminating misleading information, as it did in Hong Kong, working with a consulting firm to cook up statistics that failed to show the economic benefits of smoke-free restaurants and bars. In reality, two years after the ban, restaurant revenue increased by more than 30% in that country.

“It used the same tactics here with the new Bill. The draft Bill will ban smoking in all public places, introduce plain packaging of cigarette packs with graphic health warnings and stop cigarette sales from vending machines. The new Bill will also regulate e-cigarettes or vape products. While these are being advertised as safer alternatives to cigarettes, research shows they are already causing serious health harm, with the recent deaths of 18 in the US and more than 1,000 seeking medical help for a range of lung and other respiratory conditions. The Bill’s proposed measures would provide much-needed safeguards for those who vape or use e-cigarettes and prevent these products from being marketed to kids.

“With profits to lose, the tobacco industry wasted no time in opposing these public health policy proposals through various groups. The Free Market Foundation and National African Federated Chamber of Commerce and Industry, two organisations with a history of funding from tobacco interests, have advocated against the Bill. Among the litany of complaints from the two groups were how the Bill would, in protecting the health of non-smokers and smokers alike, be an infringement on personal freedom and hurt the competitiveness of legal businesses. According to the new STOP report, this is a typical trick: a few years ago, Philip Morris International, Imperial Tobacco and British American Tobacco financed a group called the Australian Retailers Alliance to oppose the government’s introduction of plain packaging in Australia.

“Such attempts to influence can also be less overt, taking the form of perceived partnerships and donations. It is probably not a coincidence that the same month that the new Bill was introduced, British American Tobacco South Africa (BATSA) announced a partnership with the Eastern Cape Development Corporation (ECDC), a government agency. Under their agreement, BAT would collaborate on training for farmers and BATSA would commit to buying their tobacco leaves.

“This dirty tactic not only seeks to recruit farmers; it also inadvertently involves the government in public relations that burnishes tobacco’s reputation while undermining public health efforts.

“With the goal of the NHI Bill to make quality healthcare accessible to all South Africans, we must pass the new tobacco Bill with urgency as any delay continues to subject the population to immediate health harm from tobacco use, and also hampers efforts to control communicable diseases such as tuberculosis and HIV, and non-communicable diseases such as diabetes, cancers and heart disease.

“Tobacco use increases the population’s health burden and the government’s health expenses. The draft tobacco bill is exactly the kind of prevention policy that will ensure the success of the NHI. The tobacco industry has seen success from its dirty tactics in many other countries. We must be vigilant to ensure that it does not succeed here.”

Meanwhile, tobacco companies have been accused of undermining plain packaging laws by introducing gimmicks that ensure their cigarettes stand out from rival products but do not breach regulations, reports The Guardian. A report found that global tobacco companies adopted subtle marketing techniques to replace traditional cigarette branding, which was banned in the UK in 2016.

One of the MPs who pioneered the legislation said ministers should consider tightening up the law to eliminate loopholes detailed in the report, written by academics at the University of Bath. Researchers found that tobacco companies initially ramped up production before a one-year “sell-through” period, during which retailers were allowed to keep selling their remaining branded packs. This had the effect of keeping the older packs on sale for as as long as possible, maximising brand exposure in the run-up to May 2017, when they could no longer be sold.

According to The Guardian, the report also pointed to the terms introduced by tobacco companies to describe the filters on their cigarettes, such as “advanced” or “firm”. The researchers said previous studies suggested that such differentiating features “perpetuate the perceptions that some tobacco brand variants are less harmful than others”.

The report’s lead author, Dr Karen Evans-Reeves, said the tobacco industry was “engaged in activities that undermined and continue to undermine the legislation”. “Major tobacco companies will always try to find a way to market their products,” she said. “Based on the number of innovations we found in this study, we would encourage all governments considering implementing plain packaging legislation to consider how tobacco companies have adapted to the legislation in other countries and where possible, close any remaining loopholes.”

The report says Philip Morris International, which owns Marlboro, did not respond to requests for comment.

Objectives: UK standardised packaging legislation was introduced alongside pack size and product descriptor restrictions of the European Union Tobacco Products Directive to end tobacco marketing and misinformation via the pack. This paper aims to assess compliance with the restrictions and identify attempts to continue to market tobacco products and perpetuate misperceptions of harm post legislation.
Design, setting and intervention: A prospective study of the introduction of standardised packaging of tobacco products to the UK.

Participants and outcomes: We analysed commercial sales data to assess whether the legally required changes in pack branding, size and name were implemented. To explore any adaptations to products and packaging we analysed sales data, monthly pack purchases of factory-made (FM) cigarettes and roll-your-own (RYO) tobacco, tobacco advertisements from retail trade magazines and articles on tobacco from commercial literature (retail trade, market analyst and tobacco company publications).
Results: One month after full implementation of the UK and European Union policies, 97% FM and 98% RYO was sold in compliant packaging. Nevertheless, tobacco companies made adaptations to tobacco products which enabled continued brand differentiation after the legislation came into force. For example, flavour names previously associated with low tar were systematically changed to colour names arguably facilitating continued misperceptions about the relative harms of products. Tobacco companies used the 1-year sell-through to their advantage by communicating brand name changes and providing financial incentives for retailers to buy large volumes of branded packs. In addition, tobacco companies continued to market their products to retailers and customers by innovating exemptions to the legislation, namely, filters, packaging edges, seals, multipack outers, RYO accessories, cigars and pipe tobacco. Conclusions: Tobacco companies adapted to packaging restrictions by innovating their tobacco products and marketing activities. These findings should enable policy makers globally to close loopholes and increase the potential efficacy of standardised packaging policies.

Karen A Evans-Reeves, Rosemary Hiscock, Kathrin Lauber, Anna B Gilmore

[link url=""]Bhekisisa report[/link]

[link url=""]Health-e News report[/link]

[link url=""]The Crooked Nine report[/link]

[link url=""]The Guardian report[/link]

[link url=""]BMJ Open abstract[/link]

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