An ambitious deal between a leading global medical education provider and Philip Morris International (PMI) collapsed this week, with Medscape acknowledging its “misjudgment” and saying it will not accept funding from any organisation affiliated with the tobacco industry in the future.
This followed an intensive investigation – by the respected British Medical Journal (BMJ) and The Examination – into the planned collaboration.
The probe also linked South Africa to the scandal, finding that the Alliance of South Africa Independent Practitioners Associations (ASAIPA), a coalition of health practitioner associations and a medical education provider, has already hosted seminars sponsored by Philip Morris South Africa.
This had triggered a complaint from the National Council Against Smoking to the Health Professions Council of South Africa (HPCSA), expressing “deep concerns”, and saying that funding of CPD (continuing professional development) from a tobacco company was “unethical and stands contrary to . . . the WHO’s Framework Convention on Tobacco Control”, said the HPCSA complaint
In Medscape’s case, the medical education provider bowed to pressure and agreed to permanently remove a series of accredited medical education courses on smoking cessation funded by tobacco industry giant Philip Morris International, after The BMJ and The Examination investigation uncovered the PMI deal which had resulted in widespread protests among doctors and academics in reaction to the partnership.
Critics said the content tended to portray non-cigarette nicotine products as relatively harmless, therefore aligning with the commercial interests of PMI, which also sells e-cigarettes, nicotine pouches and snus.
An internal Medscape document seen by The BMJ and The Examination also hints at the true scale of the multimillion dollar deal between PMI and Medscape.
Medscape had planned to deliver 13 programmes under the deal – called the PMI Curriculum, according to the internal document. It had also planned podcasts and a “TV-like series”.
Other PMI funded programmes with different continuing medical education (CME) providers have also emerged, not just in South Africa, where a former World Medical Association president featured as a speaker, but also in Saudi Arabia.
This apparent global push by the tobacco giant into certified medical education has been met with alarm and calls for certification bodies to issue a ban.
In response to the criticism, a spokesperson for PMI told The BMJ: “Health agencies around the world have recognised the beneficial role smoke-free products can play to improve public health. We are concerned that known special interest groups are actively blocking medical education that the US FDA and medical community have determined are needed.
“These actions stand to prolong use and possibly increase consumption of combustible cigarettes – the most harmful form of nicotine use.”
But Tim McAfee, professor (adjunct) at the Department of Social and Behavioural Sciences at the University of California-San Francisco, and former director of the Centres for Disease Control and Prevention’s Office on Smoking and Health, called PMI’s partnership with Medscape “the ultimate example of the fox not only signing up to guard the hen house but offering to sit on the eggs”.
“It is a perversion of ethics surrounding continuing medical education to allow the very companies that caused and profit from the continuing epidemic of tobacco related death and disease to be involved in any way.”
Pamela Ling, director of the Centre for Tobacco Control Research and Education at the University of California-San Francisco, applauded Medscape for its U-turn, adding that tobacco companies had a long history of using social scientists and other expert voices to normalise tobacco and nicotine use and to downplay the harms.
“However, the entry into the world of medical education is particularly audacious,” said Ling. “In the past, medical education sponsored by the manufacturers of the leading preventable cause of death would have been ridiculous. As tobacco companies remake their image into pharmaceutical-like nicotine purveyors, it appears they have been emboldened to enter this arena.”
The BMJ contacted three Medscape employees, who reported widespread internal disappointment with the company’s decision to produce the courses.
“The programmes, and the way they were developed, distort scientific knowledge, crossing an ethical line made worse by the common knowledge of the tobacco industry’s role in hiding the dangers of its toxic products in the pursuit of profit,” said one.
“It’s also a departure from Medscape’s practice of presenting balanced, accurate, vetted content conveyed by expert faculty without ties to any related industry.”
Robert Jackler, Sewall professor emeritus at the Stanford University School of Medicine, added: “Medscape’s subtitle for the series – ‘Towards a Smoke-Free Future’ – is a heavily promoted PMI corporate slogan. As there are many accredited CME providers who may be tempted by PMI’s financially generous proposals, accreditation bodies which oversee providers need to join Medscape and send a clear message that the tobacco industry has no business funding this.
“PMI’s engagement of Medscape was not an isolated occurrence but rather is part of a global campaign.”
Medscape’s backpedalling was welcomed, but critics demanded that tobacco industry-funded medical education should not be accredited by the responsible bodies in the first place.
Philip Morris in South Africa
In SA, warning flags had been raised and a complaint lodged with the HPCSA after the Alliance of South Africa Independent Practitioners Associations (ASAIPA) – a coalition of health practitioner associations and a medical education provider – hosted seminars sponsored by Philip Morris SA.
The first, in November 2023, was held around the same time as parliamentary hearings were taking place countrywide on the Bill to regulate electronic nicotine delivery systems (ENDS) as tobacco products, the complaint noted.
“Accepting funding of CPD from a tobacco company is unethical and stands contrary to . . . the WHO’s Framework Convention on Tobacco Control,” said the HPCSA complaint. The seminar was delivered by an advocate for ENDS, the National Council Against Smoking noted.
The speaker, Vivian Manyeki, had not published any peer-reviewed research on the topics of harm reduction or tobacco cessation, it said, noting that “she is allied with the African Harm Reduction Alliance, which is openly promoting ENDS (electronic nicotine delivery systems) as a public health measure”.
Shortly after the National Council Against Smoking issued its complaint to HPCSA, it noticed the announcement of a second seminar for April 2024, this time with Kgosi Letlape as speaker.
Letlape, a past president of HPCSA, and an influential ophthalmologist who was also president of the World Medical Association and chair of the South African Medical Association (SAMA), also has tobacco industry ties, demonstrated by speaking at tobacco industry events. He is also a co-founder of the African Harm Reduction Alliance.
‘I did not even know who Philip Morris was’
An ASAIPA spokesperson forwarded a general statement saying: “At ASAIPA, our mission is clear: to serve as a tireless advocate for the public good.”
ASAIPA’s chair, George Aldrich, responded in an email apparently not meant to be seen by The BMJ that, although he “did not attend this …to know what was presented,” it was “by a doctor for doctors” and “did not promote or advertise any tobacco products”.
Aldrich added: “We did not know the speaker, but our doctors are professional and will not be influenced that easily. Nothing in the invite was related to smoking or vaping and was a totally independent subject. The only issue is the sponsor, but I did not even know who Philip Morris is.”
HPCSA, Manyeki and Letlape did not reply to The BMJ’s request for comment.
Emerging Market Healthcare, which describes itself as “a provider and patient initiative within the base of 200 black doctors from disadvantaged areas of the Western Cape”, had already announced similar courses in 2022, which had also prompted a complaint by the National Council Against Smoking to the company.
The complaint said: “We are gravely concerned that the facilitator for the EMC (Emerging Market Healthcare) master-class course is Professor Praneet Valodia, who serves as a consultant to Philip Morris South Africa (PMSA), a subsidiary of Philip Morris International (PMI).
“PMI has a history of funding researchers, medical professionals and setting up front groups in ways meant to intentionally confuse the public and advance their own interests.”
The National Council Against Smoking urged Emerging Market Healthcare to reconsider its decision to affiliate or collaborate with Valodia and to discontinue the second leg of the master-class course.
The second course of the series was then cancelled, said Olalekan Ayo-Yusuf, president of the National Council Against Smoking and head of the School of Health Systems and Public Health at the University of Pretoria.
But apparently PMI quickly found another supplier, he told The BMJ. “I was surprised that they’ve become so emboldened,” Ayo-Yusuf said of PMI’s move into medical education.
“Tobacco control was so strong in South Africa for many years.”
Leslie London, chair of public health medicine at the University of Cape Town, said: “Industry should be held accountable and should put money into health promotion, but it should be put into an independent foundation which they do not control.”
Valodia replied: “I am an academic and scientist and deliver presentations on independent, evidence-based science. I only respond to scientific discussions and am not involved in debates relating to funding by tobacco companies or anything else unrelated to the science and innovation. My only interest is to assist smokers and hence, I do not think that it is appropriate for me to respond.”
Emerging Market Healthcare did not reply to The BMJ’s request for comment.
And in the Middle East …
The long tentacles of PMI also extended into Gulf countries. In Saudi Arabia, the educational provider Middle East Medical Portal was providing courses until last year on harm reduction in healthcare and the impact of smoking on public health.
The course was advertised as a “CME webinar for healthcare/research professionals in the Gulf Council Countries”– Saudi Arabia, Kuwait, Bahrain, the United Arab Emirates, Oman, and Qatar.
The website stated, “This educational CME is sponsored by Philip Morris Management Services (Middle East) Limited.”
The course consisted of a webinar led by the speaker Tara Rampal, “a consultant anaesthetist and public health expert in the NHS and CEO of Quest Prehabilitation”, the announcement said.
An earlier version of the course from 2022 said that it was sponsored by “PMI Science” and featured a prominent PMI logo.
The mention of the course was deleted after The BMJ reached out. Nathan Nagel, chief executive of Middle East Medical Portal, told The BMJ, “We are a tiny, two-person company, and we missed deleting old material that shouldn’t have been on the site. We are overwhelmed with just trying to stay afloat in business. We stopped working with PMI in 2023.”
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Big Tobacco link sees high-profile delegates pull out of SA TB conference
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