Case study one: FSFW special issue in the ‘International Journal of Environmental Research and Public Health’

This first case study outlines the Foundation’s attempts to publish its research in the International Journal of Environmental Research and Public Health (IJERPH). The Foundation used a public relations (PR) firm to coordinate publication of its science; sought (and was granted) high levels of editorial control over a special issue despite clear COIs; and presented itself as independent from industry, which was important as the journal has a restriction on publishing tobacco industry research.

In November 2018, the IJERPH, an open-access journal (published by MDPI, with an impact factor of 2.849 in 2019),16 announced a policy banning tobacco industry-funded science, saying it:

will not consider for publication papers reporting work funded, in whole or in part, by a tobacco company or tobacco industry organization or affiliate. Nor will the journal consider papers by authors who accept tobacco industry or affiliate funding, including funding for research costs and for all or part of any author’s salary, or other forms of personal remuneration.17

Yet in October 2019, a special issue was announced with Derek Yach, FSFW’s president, as guest editor, entitled ‘15 years after the Framework Convention on Tobacco Control’s (FCTC) Adoption: Time for Greater Urgency and Focus’.18 The COI here is clear: not only is the Foundation fully funded by PMI, but PMI’s intense opposition to the development of, and ongoing attempts to undermine, the FCTC are well-documented.19 20

We contacted the journal editors on 28 October 2019 to inform them the special issue contravened their policy and they withdrew the announcement and call for papers. As part of this correspondence, the journal provided us with emails explaining the circumstances (some between the Foundation’s Vice President (VP) of Communications and the journal, and one between PR company, Ruder Finn, and the journal).

These suggest the Foundation used PR company Ruder Finn21 to negotiate the publication of its research. In an email dated September 2019 between the PR company and the journal, Ruder Finn requested Yach be permitted to select ‘a majority of the contributors’, ‘and specifically our grantees’. The journal agreed Yach could collect the papers he wished to, and added ‘but kindly note that IJERPH does not publish studies funded by the tobacco industry.’

PMI has used PR firms for decades as part of its efforts to create and disseminate research refuting the harms of tobacco.22 As far back as 1968, Ruder Finn provided services to Philip Morris, advising ‘you must take positive steps to neutralise the great reservoir of ill will that has been built up against you’, ‘you must also convince the public that you are interested in research’ and ‘that you are not ‘peddling a deadly weapon.’’23 In subsequent years, Ruder Finn facilitated Philip Morris’ sponsorship of scientific symposiums, co-option of scientists and funding of scientific facilities; all in attempts to create doubt about health harms of smoking and bolster the corporation’s credibility.21 In the 1990s, Ruder Finn was contracted again by Philip Morris, to fight advertising restrictions, and again proposed using third parties as a ‘discrete, credible and effective voice…without being visible as Philip Morris’.21

The Foundation’s most recent tax return reveals that it paid Ruder Finn over $2 million in 2019 for PR work.24 The Foundation’s decision to work with a seemingly ever-expanding group of PR firms with previous links to PMI25 is inconsistent with its supposed independence from the tobacco industry.

In another email exchange from September 2019 between the Foundation’s VP of Communications and the IJERPH, the VP disclosed the Foundation is funded by PMI, but appears to have attempted to sidestep the journal’s policy of not publishing tobacco industry-funded science, by failing to acknowledge that PMI is a tobacco company, sowing confusion about FSFW’s independence—describing FSFW as ‘an independent, non-profit organisation’.

The VP also caused further confusion by making fundamentally flawed comparisons between the Foundation and two other bodies: the US Food and Drug Administration (FDA) (the agency within the US Department of Health and Human Services funded through the federal budget and industry user fees to regulate food, medical products and tobacco)26 and the Legacy Foundation, now the Truth Initiative27 (which was established through the same legal action that led to the forced dissolution of tobacco industry third parties), saying:

I know you have communicated with our PR agency Ruder Finn about this and I am hoping to get clarity on one key issue… we are interested to know how you determine what falls under this tobacco industry funded umbrella since many studies funded by the FDA are in effect funded by industry, as are projects supported by Legacy F[oundation] (through the MSA).

Yet these payments received from the tobacco industry, as part of legally binding agreements, are fundamentally different from PMI’s voluntary payment to an organisation it chose to establish for specific purposes, and over which there is no external oversight. This difference between voluntary industry contributions and mandatory payments—‘compensations due to legal settlements or mandated by law or legally binding and enforceable agreements’ is clearly outlined in the guidelines for implementation of Article 5.3 of the World Health Organization's (WHO) FCTC which calls for the former to be rejected.28 Further, the reductio ad absurdum argument here is that any programme funded by a government department is ultimately tobacco industry funded because the state receives tobacco taxes and user fees.

In terms of independence, the Foundation states29 that it meets Cohen et al’s criteria30 for ensuring research funding programmes are free from tobacco industry interference. This is despite the authors stating that their criteria are not met and that the Foundation ‘does not represent a funding model that should be acceptable to the research community’.31 Further, two independent deep dive analyses32 33 of the Foundation’s constitutive documents indicate it should not be considered independent from its funder, with one concluding that:

Putting all this together, it would not be unreasonable to form a picture […] in which Yach’s ‘independent foundation’ is more akin to a program of Philip Morris, with Yach and the foundation’s directors […] having a degree of day-to-day autonomy in their operations (just how much autonomy is unknowable), but with the fundamental settings put in place by, and enforced, by Philip Morris’s USD 960 million.32

In line with this, the FSFW has been rejected by nearly 300 leading academic and public health institutions and individuals globally34 and the WHO, which denounced the Foundation, stating:

There are a number of clear conflicts of interest involved with a tobacco company funding a purported health foundation…WHO will not partner with the Foundation. Governments should not partner with the Foundation and the public health community should follow this lead.20

Despite this widespread condemnation of the Foundation, the Managing Editor of the IJERPH, a health journal which has published over 700 papers on tobacco,35 stated they were not aware of the Foundation’s tobacco industry connections since the Foundation had called itself an ‘independent non-profit organisation’; and that they ‘didn't realize' PMI was a tobacco corporation.

Case study two: the Center of Excellence for the Acceleration of Harm Reduction special issue in the IJERPH

This second case study reveals further issues about the publishing practices of researchers in a FSFW-funded centre; despite the IJERPH’s COI policy precluding publication of tobacco industry-linked research (whether funded by the tobacco industry or authored by those receiving its funds), researchers from one of the Foundation’s two ‘centres of excellence’ have published in and undertaken editorial roles at the journal; and are often failing to adequately disclose their links to the tobacco industry.

Despite the IJERPH’s decision to cancel Yach’s planned special issue, 6 months later, in April 2020, the journal began publishing another special series linked to the Foundation, entitled ‘Cyber Health Psychology and Psychotherapy: The Use of New Technologies in the Service of Mental Health’.36 Two of the three guest editors of this issue are researchers at the Center of Excellence for the Acceleration of Harm Reduction (CoEHAR) based at the University of Catania, Italy.37 CoEHAR, one of just two existing so-called ‘centres of excellence’ funded by FSFW to conduct tobacco harm reduction research, received over US$8 million between 2018 and 2019 (through grantee Eclat Srl, an ‘academic spin off’ of the Department of Clinical and Experimental Medicine at the University of Catania)24 38 39 with a further US$22.9 million committed, according to FSFW’s 2019 tax return.24

The first paper published within this special issue, an investigation of smoking cessation technology, was authored by CoEHAR researchers, including Pasquale Caponnetto and Riccardo Polosa.40 In addition to his link to FSFW via CoEHAR,41 in 2020, Caponnetto was the first author of both a journal article detailing a trial funded by Philip Morris Products S.A.,42 and a preprint article detailing a trial on which he is listed as principal investigator funded by Juul Labs43 (which is part-owned by Altria, owner of Philip Morris USA).44 Riccardo Polosa, founder of CoEHAR, who has long-standing tobacco industry links,45 co-authored both these papers. Despite the fact that Caponnetto's tobacco industry funding would seemingly mean his research being published in the IJERPH would contravene the journal's COI policy, he is not only an author but is also listed as the editor-in-chief of the IJERPH's section on mental health.46

Caponnetto is also listed as editor-in-chief of the journal ‘Health Psychology Research’ (HPR),47 an open-access journal published by Page Press Publishers.48 HPR states that authors are “responsible for disclosing all financial and personal relationships that might bias their work. To prevent ambiguity, authors must state explicitly whether potential conflicts do or do not exist.”49 In 2020, Caponnetto published three tobacco-related papers50–52 in this journal within which he declared no COI (in two of these, coauthor Polosa declares funding from FSFW, but none of his previous funding from tobacco corporations).53 54

In May 2020, we again contacted the IJERPH to flag the COIs with this second special issue. In relation to the CoEHAR-funded paper, IJERPH responded:

We very much appreciate your bringing this paper to our attention and we concur that it is contrary to the Journal policy concerning publishing research funded by tobacco companies and their proxies.…Because the authors did acknowledge the funding source and because the journal policy was not communicated as prominently as it could have been in the instructions to authors, we do not feel withdrawing the paper is appropriate.

The journal did not cancel CoEHAR’s special issue, and in August 2020 published another paper55 written by CoEHAR researchers. Although this paper declared it received no external funding and was on a subject separate from tobacco, it still contravened the journal’s policy of not publishing papers from authors who accept tobacco industry or affiliate funding.

When tobacco industry third parties such as FSFW disperse their funds through grantees, it becomes increasingly difficult to trace the industry connections. For instance, Riccardo Polosa has often and variously failed to disclose the research funds he has received from PMI, his consultancy fees from British American Tobacco, CoEHAR’s link to FSFW and FSFW’s link to PMI.45 For example, CoEHAR’s website has no funding statement, and on several papers where Polosa declares CoEHAR as an affiliation, no mention is made of FSFW or PMI in the funding or COI declarations.37 In another instance, one of his papers56 declared no external funding, despite being listed on the Foundation’s own website as an ‘FSFW-sponsored publication’.57

CoEHAR itself now lists 17 organisations as ‘international partners’ on its website (including several of FSFW’s other grantees).41 Complex relationships such as these further limit stakeholders’ (including journal editors, peer-reviewers, and consumers of science such as researchers and health professionals) ability to distinguish industry-linked from independent science.

While the conduct of FSFW staff and the researchers it funds is questionable, so too is that of the IJERPH. Despite its public statement that it will not publish tobacco industry-linked science,17 these case studies illustrate it is repeatedly failing to effectively implement this policy.

Case study three: FSFW special issue in ‘Drugs and Alcohol Today’

This third case study details the subsequent publication of Derek Yach’s proposed special issue (as detailed in case study one) in journal ‘Drugs and Alcohol Today’ (DAT). The Foundation here appears to have chosen a journal which lacked a robust COI policy, and whose editor-in-chief had links to the Foundation; and FSFW-funded researchers once again failed to adequately declare their industry links.

Between May and July 2020, the proposed special issue on the WHO FCTC (cancelled by the IJERPH), was subsequently published in DAT in serialised form.58 DAT is a hybrid journal (using both open access and subscription-based publishing models) published by Emerald Group Publishing, with an impact factor of 0.58 in 2018 (the most recent data available).59 The publisher states that ‘authors, reviewers and editors all have a duty to report possible COIs’60 yet does not expressly preclude the publication of research funded by the tobacco (or any other) industry.

Arguments made within the papers included in this special issue often align with traditional industry arguments including critiques that: FCTC implementation has been poor and neglects low-income and middle-income countries; ‘traditional’ tobacco control is regressive and does not serve subsections of society adequately; deliberate misinformation about the relative risks of nicotine products abounds; greater collaboration between governments, the tobacco control community and the private sector is necessary; and weakening tobacco control measures in areas including taxation of next generation products and restrictions on flavourings (both of which PMI is known to oppose),19 61 may be warranted.58As such, much of the content appears to align with PMI’s interests, while PMI’s indirect funding of the papers is often not declared.

All nine papers in the special issue have Foundation grantees or staff members as authors. At the time of their publication, seven of the nine mention some affiliation with FSFW. Of the two papers that did not mention FSFW, one is written by authors from CoEHAR62 and the other63 by authors from two FSFW-funded institutions (its other ‘centre of excellence’ in New Zealand),64 and UK grantee the Centre for Health Research and Education.65 Between them, these three grantees received US$10.9 million over 2018 and 2019,24 38 and have US$30.9 million more approved.24 Only one of the nine papers, Derek Yach’s overview article, identifies PMI as the Foundation’s funder.66

Sudhanshu Patwardhan, co-founder of FSFW grantee CHRE, a medical doctor who worked for British American Tobacco (BAT) between 2005 and 201965 was both guest editor of the special issue58 and first author of a paper in it.67 Despite the publisher’s policy that authors, reviewers and editors must all report possible conflicts of interest,60 Patwardhan’s paper did not mention his previous employment with BAT (though it does disclose FSFW funding of CHRE). Nor is there a public statement of the conflicts of interest in relation to his editorial role – his funding from FSFW, recent history of employment with BAT, and that his business partner and co-founder of CHRE authored one of the papers63 in the special issue.

In another link between DAT and FSFW, the journal’s editor-in-chief Axel Klein’s consultancy company, ACK Consultants, received US$100 000 in grant funds from FSFW in May 2018,24 38 and as of December 2020 remains listed on the Foundation’s website as a current grantee.68 There is no disclosure on DAT’s website of this connection between FSFW and Klein in relation to his editorial role (although the one paper co-authored by Klein in the special issue does disclose funding from FSFW).69 This is not the first time Klein has been involved in the publication of FSFW science. In January 2019, a paper authored by FSFW staff was published on the open research publishing platform F1000 Research.70 On this platform, once an article is published, its authors are responsible for identifying suitable reviewers, who should not be ‘close collaborators of the authors or in other ways personally, financially or professionally associated with them’.71 Despite his consultancy receiving grant funds from FSFW only 7 months earlier,38 one of the two ‘invited reviewers’ was Klein, who gave a positive review of the piece and declared no COI. By contrast, the other reviewer was somewhat more negative, flagging the lack of ethical approval, an ‘untrue and misleading’ statement on tobacco products, and lack of clarity in the write up of analysis.70

DAT is a member of the Committee on Publication Ethics (COPE),72 stating its editors and employees work hard to ensure its content is ‘ethically sound’ and ‘closely follow the advice laid out’ by COPE, which includes requirements that ‘readers should be informed about who has funded research’ and that policies should be in place to ensure unbiased review.73 The fact that several links between the tobacco industry and the authors of the papers in this special issue, the guest editor of the issue, and the editor-in-chief of the journal are not immediately apparent, highlights that operationalising such standards is difficult.

Governance of tobacco industry COIs in scientific publishing

Grundy et al advocate for standardised reporting of COI and funding declarations across journals.75 We recommend that as part of this, journals explicitly ask authors and editors (including those of special editions) whether they have any COI relating to the tobacco industry, and whether research has been funded (either directly or indirectly) by the tobacco industry. In the meanwhile, journals must be on high alert for science funded by tobacco industry third parties such as the Foundation. Their COI policies should preclude from publication not only science directly funded by the industry, but also—based on the tobacco industry’s historical use of scientific third parties to manufacture doubt about its products4 5 —that funded through third parties, with clear sanctions (ie, withdrawal of the paper) when authors breach this policy. The University of Bath’s knowledge exchange platform, tobaccotactics.org, provides details of organisations and individuals with financial links to the tobacco industry, including through FSFW. Editors and reviewers could be encouraged to use this resource to identify COI in this area.

However, these case studies of the Foundation’s dealings with IJERPH and DAT illustrate that for COI to be effectively governed, solutions cannot be left solely to journal staff. Grundy et al have also recently argued in the BMJ for a ‘public, comprehensive, structured, author-centric database of…[researchers’]…financial interests’,75 which would aid journal editors in identifying and excluding research funded by the tobacco industry and its affiliates.

We suggest this include details not only of direct research funding to authors, but also any funding received for non-research activities (speaking engagements, consulting services, travel to meetings and so on); any authorship of papers funded by the tobacco industry; and any affiliation with centres that receive tobacco industry funding—all of this pertaining to both tobacco corporations directly and their affiliates. This database should also include information on the financial interests of journal editors (if not already included due to their role as authors), since currently, although recommended by the Council of Science Editors,76 editors are often not required to disclose their own COIs.77 The IJERPH and DAT do not list information on their editors’ competing interests, unlike The BMJ78 and Tobacco Control,79 for instance. Such a repository would require both independent oversight (Grundy et al suggest using the current ORCID system which identifies researchers using a persistent digital identifier) and mechanisms through which authors’ undisclosed COIs could be reported (and independently verified).

Eliminating tobacco industry COIs in science

Beyond issues of transparency in scientific publishing however, and based on the history of scientific misconduct by the tobacco industry and those it funds,9 10 the ultimate goal must be to ensure the research community has scientific and financial independence from the industry and its third parties.

This will entail both enhancing researcher awareness of the continued dangers of partnering with the industry and implementing institutional policies to prohibit such relationships. Indeed, it has recently been argued that a civil society version of the WHO FCTC’s Article 5.3 (which prohibits governments from collaborating with the tobacco industry) is needed, in order to protect ‘organisations from associating with or lending support and credibility to the tobacco industry.’80 Any conceptualisation of this should stipulate, at a minimum, that non-government organisations such as foundations, academic institutions and scientific journals should not work with tobacco corporations, and should also prohibit indirect relationships with the industry, such as those created through FSFW and its grantees.

In recent years, PMI has invested heavily in its new heated tobacco products, but as yet, there is no independent evidence that they are any safer than cigarettes.81 The robustness of PMI’s own science on its ‘next generation products’ has recently been questioned,82 83 and overall, there are growing concerns that the tobacco industry’s long history of research misconduct to hide the harms of cigarettes is now being repeated with its latest products.84 This underlines the urgent need for high quality, independent research on new tobacco and nicotine products, which must be facilitated through a mechanism completely distinct from PMI’s funding arrangement with the Foundation.

Cohen et al have explored such mechanisms, and proposed that legally mandated industry financial contributions (taxes or tobacco manufacturer licensing fees) overseen by a government body could eliminate both the COI associated with working with the tobacco industry, and the risk of PR gains for the industry.30 PMI’s ability to fund the Foundation shows this is affordable. In the meanwhile, the case for the dismantlement of the FSFW, just as the TIRC, CIAR and Tobacco Institute were dismantled, is increasingly clear.