The ethics of the cash register: taking tobacco research dollars

SIMON CHAPMAN; STAN SHATENSTEIN

doi:10.1136/tc.10.1.1

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The ethics of the cash register: taking tobacco research dollars

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Is Tobacco Control "objective?"
Dennis P Quinn
Published on: 13 May 2016
Is it possible to pay the piper and not dictate the tune?
Niyi Awofeso
Published on: 13 May 2016
Response from Sir Colin Campbell, Nottingham University
Colin Campbell
Published on: 13 May 2016

Published on: 13 May 2016
Is Tobacco Control "objective?"
- Dennis P Quinn
A flap is going on over at the British Medical Journal about whether Nottingham University should accept BAT (tobacco) money to fund an International Centre for Corporate Social Responsibility. Some critics not only call for the university to refuse the money but also clamor for the resignation of BMJ’s editor, Richard Smith, because of his point of view on the matter. For the tempest raging in that teapot see http://www.bmj.com/...
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A flap is going on over at the British Medical Journal about whether Nottingham University should accept BAT (tobacco) money to fund an International Centre for Corporate Social Responsibility. Some critics not only call for the university to refuse the money but also clamor for the resignation of BMJ’s editor, Richard Smith, because of his point of view on the matter. For the tempest raging in that teapot see http://www.bmj.com/cgi/eletters/322/7294/DC1 On May 6, 2001, I contributed a letter to the BMJ forum called “Magical Money.” I suggested that anti- tobacco activists and researchers seem to have a sort of schizoid view of industry money: If it comes from Big Pharmaceutical, it’s good money no matter what it’s used for; if it comes from Big Tobacco, it’s bad no matter what. In a private email challenge (May 9), Tobacco Control editor Professor Simon Chapman has asked me to write to this forum to justify why the following sentence appears in my letter: “Anti-tobacco warriors don’t consider BMJ to be ‘tainted’ by that money, and even support the objectivity of editor Smith who, with a straight face, quotes from Tobacco Control as if that publication were objective and scholarly.” Mr. Chapman asks me to explain what I mean by the term “objective,” and he says the term “for years has been regarded as a fairly complicated issue.” I’ll try. In common parlance, a primary adjectival sense of “objective” is “uninfluenced by emotion, surmise, or personal prejudice; based on observable phenomena; presented factually” (American Heritage Dictionary, 2nd College Edition) or perhaps, “expressing or involving the use of facts without distortion by personal feelings or prejudices” (Merriam Webster’s New Collegiate Dictionary, 9th Edition). These are the senses I intended. Rather than attempting a painstaking review of scores of articles published in TC over the years, I offer the following five items to support my suggestion that TC is no objective forum. First, the very name of the journal makes clear its aim: to control tobacco. One does not need to be a veteran on the front lines of the worldwide war against tobacco to know that “tobacco control” is a euphemism for “taxing and segregating smokers with the ultimate aim of prohibiting tobacco altogether.” That’s a fine plan if Mr. Chapman wants to follow it, but he cannot claim his journal is objective. Second, every truly objective study of the effects of ETS has shown either no negative effect on non-smokers or a barely significant one. Some studies have even produced statistically significant protective effects. The 1992/93 U.S. EPA report on ETS is null and void in most of its conclusions for the very reason that non-objective bias led to cherry picked data and false statistical conclusions. One would never learn that by reading anything about ETS in TC which continues to parrot blatant statistical untruths about ETS and its relationship to coronary heart disease and lung cancer. Third, on the March 2001 TC Online Top Ten Articles, we see an interesting phenomenon regarding the authors of these pieces. Ten of the authors are members of the TC editorial board: Sargent, Pierce, Gilpin, Choi, Jacobson, Warner, Henningfield, Benowitz, Slade, and Davis. So much for objective peer review: TC seems clearly to be one of those journals that thrives due only to self-referential publication. Not very objective. Fourth, the Associated Press (April 20, 1997) reported that “Australia’s principle medical advisory board massaged research results to suit recommendations to ban smoking in public places.” The article states in part: “In a letter to members of the working party, [Chapman] expressed concern that tables in the draft report did not show a high death rate from passive smoking.” It then quotes Editor Chapman as follows: “Journalists looking at that table (or being directed to it by the industry) will be hard pressed to write anything other than ‘Official: passive smoking cleared – no lung cancer.’” So here we have a study of ETS that does not lead to the conclusion that Professor Chapman wants, so it is altered. According to the Australian AP, the panel’s final report did not contain either Mr. Chapman’s concerns that the evidence was not in the direction he wanted, “nor did the final report contain the contentious table of data.” This report, therefore, is no more objective than is the one from the U.S. EPA. http://193.78.190.200/who/2308.htm Finally, as regards money being good or bad depending on where it comes from, we have this June 1, 2000 report by Victoria Button, medical reporter for The Age, “Tobacco study funding attacked.” Ms. Button writes, “Advance photocopies of the report were distributed to journalists without any acknowledgement that it was funded by the drug company SmithKline Beecham.” She goes on, “One of the authors of the report, Simon Chapman . . . defended industry funding as standard academic practice. . . .” But Mr. Chapman’s hands were spanked anyway by Meredith Carter, executive director of the Health Issues Centre: “’If the cigarette companies funded research that wasn’t acknowledged we would be hopping mad, wouldn’t we?’ she said.” http://theage.com.au/news/20000601/A30178- 2000May31.html Yes, you sure would. The close relationships among TC contributors and its editorial board plus its commitment to tobacco eradication plus its cozy ties to BMJ mean that all research published in TC must be considered suspect as respects its objectivity. Too many of the articles in TC use tortured statistics to make their points and too many of its contributors are indeed warriors on the front lines of the war on smokers. Bias not science rules at Tobacco Control. I stand by my original statement. Editor's reply: Thank you Dr Quinn for the obvious trouble you went to in replying. I have some further bad news for you about the lack of objectivity in medical publishing. There are so-called scholarly "journals" with names like Preventive Medicine and Injury Prevention, which, like Tobacco Control, have taken up the radical position that reducing preventable disease and injury is a good thing and that there is little point in feigning some sort of "objectivity" that we might not want to control AIDS, malaria, motor vehicle deaths or those caused by smoking, to name a few. Turning to his specific accusations: 1. We want to tax tobacco. Guilty! It is a very effective way of reducing tobacco use. 2. We want to "prohibit tobacco altogether". Can he point to even one sentence published in any part of Tobacco Control since it began over 10 years ago, that shows prohibition of tobacco use by adults being advocated by any author or editorially endorsed? Indeed, I recently contributed to a debate in the journal (Banning smoking outdoors is seldom ethically justifiable 2000;9:95-7) where I explicitly argued against prohibitionism. Only yesterday I wrote an article for the Sydney Morning Herald advocating dedicated smoking rooms in hotels (http://www.smh.com.au/news/0105/11/features/features5.html) 3. We do not deal objectively with ETS: Could Dr Quinn name one review of the evidence on ETS not commissioned by the tobacco industry which does not conclude that ETS causes disease and should be controlled through public policy? 4. Our Top 10 Online articles for March are stacked with members of the editorial board ... we therefore "thrive on self-referential publication". "Ten of the authors are members of the editorial board". Sorry, Dr Quinn, but Sargent Gilpin, Choi, Jacobson and Davis (5/10 of the people you named) are not members of the journal's editorial board. That's not a very good "objective" start to your criticism. And, as stated plainly on the page, the Top 10 Online refers to those papers that have had most "hits" from online readers. It has nothing to do with "self-referential publicaton" Again, your case is looking decidedly threadbare. 5. Dr Quinn cites a newspaper article from 1997 that he believes shows evidence that I was party to a process that eliminated unfavourable evidence from an Australian government report on ETS. The remarks I made in the letter he cites concerned suggestions I made to the committee about ways of expressing data that would make them more understandable. A table in a draft report of a working party of which I was a member showed estimates of annual ETS caused lung cancer deaths in Australia, broken down by age and sex. As Australia has a relatively small population, this resulted in some cells having "fractional" annual death rates. I warned my colleagues that journalists would have no idea what a "fractional death" meant and may question that the report's estimate of annual lung cancer deaths from passive smoking in Australia consisted of adding up "fractions" of deaths. However, an annual fraction such as 0.5 simply means we can expect one death every two years from a cause. If we were to construct tables of deaths broken down by age groups and sex for deaths in Australia from a huge number of relatively uncommon deaths, the same concern would have it that there were "no deaths" in Australia in the average year from measles, whooping cough or lightening strikes to name three because for most age groups, only annual "fractional" deaths occur. My crime here, was to advise my colleagues that it would be sensible to express the estimated number of deaths from ETS in a way that would be more intelligible to the ordinary reader. The final report did that, but did not somehow "alter" the original estimate as Dr Quinn's offensive comments imply. 6. Dr Quinn's final effort at implying I accept support from the pharmaceutical industry and do not acknowledge it is also incorrect. The newspaper report to which he refers arose when a report I authored on trends and influences on smoking cessation in Australia was faxed to a journalist. Acknowledgement of SmithKlineBeecham sponsorship of the report was clearly printed on the report. The colour contrast of the lettering of the acknowledgement with the colour of the page on which it appeared did not carry when it was faxed. The journalist called me asking why there was no acknowledgement. I explained that there indeed was; and that the contrast problem was probably responsible for this misperception. A copy was immediately couriered to the journalist, who nonethless ran her muck raking story as planned, gathering condemning quotes from people who had not been told that acknowledgement indeed had been given. A formal complaint about this incident was lodged with the editor of the newspaper. 7. Tobacco Control has a "cozy" relationship with the BMJ. In fact the BMJ publishes Tobacco Control. Your point? 8. Our contributors are "warriors on the front lines of the war on smokers". The war is on smoking, not on smokers.
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Conflict of Interest:
None declared.
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Published on: 13 May 2016
Is it possible to pay the piper and not dictate the tune?
- Niyi Awofeso
I read your recent apt editorial with great interest. The views presented represent some of the more seminal in contemporary ethics vis-a-vis the ivory tower. As you are well aware, it is unfortunate to note that many academic institutions in developing countries collaborate (in the literal sense of the word!) with the major domos mentioned in your five scenarios. Less than 5% of academic research are carried out citize...
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I read your recent apt editorial with great interest. The views presented represent some of the more seminal in contemporary ethics vis-a-vis the ivory tower. As you are well aware, it is unfortunate to note that many academic institutions in developing countries collaborate (in the literal sense of the word!) with the major domos mentioned in your five scenarios. Less than 5% of academic research are carried out citizens of developing countries. Money, or lack of it, is the usual obstacle. Thus, 'fortunate' African academics like myself, with two dozen peer-reviewed publications, are rare in the developing world. Your editorial raises three issues, which I would like to address from the lenses of a developing country academic:
1) The editorial starts on the premise that the five senarios are totally unacceptable to any university. Not quite. Mariam Babangida and Maryam Abacha were wives of two dictators who collectively ruled Nigeria for 14 years. Mariam established a Better life for Rural Women Program while Maryam established the Family Support Program. Both programs were affiliated to Nigerian universities, and funded from Nigeria's petrol dollars. It is on record that Maryam Abacha, who with her late husband plundered about $US5 billion from Nigeria's treasury, was awarded a PhD from The University of Maiduguri, Nigeria. As an 'academic' she joined Idi Amin, Uganda's former dictator, who was awarded a PhD from Uganda's Makerere University. The military-dictator husbands of these powerful women collectively damaged the very fabric that would facilitate improved quality of life for Nigerian women and Nigerian families. On another note, the atrocities perpetrated by Cecil Rhodes in Southern Africa are well known to students of African history. Yet, many brilliant students world-wide (but excluding Southern African countries, where the ill-gotten wealth was obtained) continue to benefit from Rhodes scholarship. I suspect that Sydney University offers its students Rhodes scholarships. Furthermore, Shell Nigeria provides funding to six Nigerian universities, part of which is allocated to ecological research. Thus, although I agree that these suggestions are in poor taste, but when poor States have to deal with such ethical dillemas, I am pretty certain they would not adopt your moral high ground - the recent acceptance of a space tourist by the cash-strapped Russian space mission is a case in point. The point I'm making is that it is difficult to discuss ethics and morality on an empty stomach.
2) You suggested that the funding of universities by the tobacco industry merits greater condemnation than their funding of other agencies such as sports and schools. I disagree. Such a perspective is akin to the front-page headlines the fall of the Australian dollar below the 50 US cents 'psychological barrier' made in Australian newspapers about six weeks ago. The fact, as you rightly pointed out, is that the tobacco industry has been poaching venal and naive academics, and using them to sow doubt among the public. With funding going directly to a university, ethical approval processes should reduce the propensity for a few academics to become the tobacco industries' mouthpiece after taking the proverbial thirty pieces of silver. If properly managed, the tobacco industry could end up funding their nemesis. Should the tobacco industry withdraw funding from universities that dare speak the truth, editorials such as yours would take on a superior ethical flavour.
3) Is the tobacco industry alone in influence peddling in universities? Not quite. The adverse effects of the atrocities of the pharmaceutical and information technology industries on the quality of research in our universities, and indeed on the quality of health care is currently a subject of intense intrest, attracting a recent editorial in the New England Journal of Medicine. I was particularly exasperated by their antics at the 14 International AIDS conference in Durban, South Africa, in July 2000[1]. It is tempting to excuse their lobbying on the premise that pharmaceuticals potentially save lives while tobacco certainly costs lives. However, in the final analysis, the primary concern of pharmaceutical industries is the bottom line. Their recently withdrawn court case, apparently to compel the South African government to buy their more expensive drugs is a case in point.
In conclusion, the ethics of tobacco funding need to be placed in context. While it is ridiculous the the tobacco industry should continue to exist at all, given the plethora of evidence on the adverse effects of their products, we have all had to contend with the reality that it would continue to exists for many more decades in spite of our best efforts. A consensus also apparently exists that the fight against the tobacco industry would have to be conducted at many points, to be successful. Rejecting, outright, tobacco industries' funding for research in universities is a rational approach to isolating them. Accepting the funding, and subjecting the projects undertaken with such funds to utmost ethical approval is another. While the former is the more appropriate response in wealthy nations, it would be unfair to blame poor nations for adopting the latter strategy.
1. Awofeso N, Degeling P, Ritchie J, Winters M. Thabo Mbeki and the AIDS 'jury'. School of Health Services Management, Faculty of Medicine, University of New South Wales, Sydney 2052, Australia.
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Conflict of Interest:
None declared.
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Published on: 13 May 2016
Response from Sir Colin Campbell, Nottingham University
- Colin Campbell
This letter was received from Sir Colin Campbell on 20 December 2000. Thank you for your comments about the University's decision to accept funding for a new Business School Centre from British American Tobacco. From comments I have seen and heard since the announcement was made I know that people hold widely differing views in this area. The University has made a judgement, which it holds to be the right one, but I recognise...
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This letter was received from Sir Colin Campbell on 20 December 2000. Thank you for your comments about the University's decision to accept funding for a new Business School Centre from British American Tobacco. From comments I have seen and heard since the announcement was made I know that people hold widely differing views in this area. The University has made a judgement, which it holds to be the right one, but I recognise that the debate will continue. Thank you for taking the time to let the University know your point of view. Colin Campbell Colin.Campbell@nottingham.ac.uk
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Conflict of Interest:
None declared.
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