As the health toll from tobacco use mounts worldwide,1 ,2 policy makers, programme personnel, and researchers are focusing more on the tobacco industry as the “underlying cause” of the tobacco epidemic.3 ,4 To mitigate growing public opposition, the tobacco industry attempts to buy respectability and social legitimacy.5-8 In the process, not only does it addict consumers to its lethal product, but it addicts institutions to a portion of its profits. Outcomes of institutional addiction to tobacco may include delayed decision making, distortion of the research agenda, and silence or inaction on tobacco control issues.9-11

Institutional addiction to tobacco is widespread. In Canada and the United States, individual legislators and political parties have benefited from tobacco industry campaign contributions.12 ,13 Many governments garner tax revenues generated from the sale of tobacco—for example, refs14 ,15. In addition, the organisers of major sporting and cultural events on both sides of the Atlantic have come to depend on tobacco funds, and are now fighting along with the industry against restrictions on sponsorship.16 ,17

Universities and healthcare institutions also may be dependent on tobacco industry funding and connections. Their relationships with the industry pose a direct conflict of interest, particularly for those with health mandates, since these institutions are implicitly entrusted with researching and publicising the harmful effects of tobacco and the role of the tobacco industry. In this commentary, we examine the ways in which these institutions become dependent on the tobacco industry, that is, “institutionally addicted to tobacco”, and discuss what can be done to break this addiction.