THE AUSTRALIAN CTR: THE ATRF

As a well informed outpost of the US and UK dominated transnational tobacco industry, the benefits of funding external research scientists were not lost on the Australian tobacco industry and the formation of the Australian equivalent of the CTR, the ATRF, was announced in 1969 and inaugurated in 1970.⁷ With a commencing annual budget of $A1 million, the public were informed:“This would be by far the industry’s biggest contribution to Australian research on smoking.”⁸ The ATRF was fully funded by Australia’s three main tobacco companies (Wills providing 40%, Rothmans and Philip Morris 30% each). Eight trustees were appointed, with four representing the manufacturing companies, joining four university based scientists selected by the industry. A scientific advisory committee comprising the four scientists allocated research grants.⁹

The announcement of the ATRF immediately drew cynical and critical responses from both the press and some in the medical profession.^10–12 Dr Cotter Harvey of the Australian Council on Smoking and Health said:“Their proposition was that until they had finished all their research nobody must do anything about the smoking problem out here. ...These people in the tobacco industry would like to believe that Australians are hillbillies who don’t know what is happening in other countries...” and that the Foundation was “just another move to keep health authorities from doing anything about warning people on the dangers of smoking.”¹³ Commentary in the Australian Financial Review described the ATRF as an “inversion” strategy:““the industry” is establishing itself in the forefront of research and condemning its opponents (discreetly) for their poor research effort... Presiding over this complicated structure is Dr CR Bickerton Blackburn, Professor of Medicine at the University of Sydney. He is the only man authorised to talk about the Foundation—and he isn’t talking. Says Blackburn “We will soon be advertising our grants and I would not want any controversy that might give the foundation a bad reputation and turn away good researchers”.”¹⁴

The journalist continued:“there is a troubling lack of information ... The aims of the foundations could also be clarified...the manufacturers are using it as a key point in their contention that cigarette legislation must wait until further research establishes a causal link between lung cancer and cigarette smoking. Or as one of their handouts cries:‘There should be no political repression of smoking until all the medical facts are established beyond doubt’.”¹⁴

PROFESSOR MIKE RAND (1927–2002)

In other publicity at the time, ATRF member Professor Mike Rand of the University of Melbourne was photographed smoking, with the article suggesting “To any self-conscious smoker counting the minutes from his lifespan every time he lights up, the professor is delightful”. Rand commented:“One can’t deny the association between smoking and a number of diseases, but people are not smoking to make themselves ill so they can die of lung cancer or something like that. ...I think it is terribly important to find out what this desirable effect is, check the efficacy of what they want, and make the equation between beneficial and deleterious effects ...”¹⁵

Rand was a key member of the ATRF, serving throughout its 24 year history (1970–1994), chairing its successor the Smoking and Health Research Foundation, and personally being awarded large grants.¹⁶ Industry documents describe him as being “industry positive”,¹⁷ note that he had “very favorable views on smoking”,¹⁸ describe how he colluded with the industry’s concerns to keep their sponsorship of international visiting scientists hidden by issuing letters of invitation from his university,¹⁹ and then arranging for them to be awarded honorary titles.²⁰ He was described by the industry as one of “a selected group of imminent [sic] scientists whose potential contribution lies in their creative power and breadth of vision” who was to be included on an industry junket on a “cruise ship steaming among the fjords of Norway”.²¹ One industry insider’s report on Rand’s presentation at the industry hand picked 1994 Quebec International Symposium on Nicotine noted:“His closing remarks at the symposium were very much in agreement with the views of the tobacco industry. He does not believe that smoking causes lung cancer or cardiovascular diseases. He said that it was ludicrous to equate heroin and cocaine with nicotine. He said that prohibiting something that people enjoy is encouragement for the Mafia. He is opposed to limiting the nicotine content of cigarettes. Unfortunately, he also lives far away.”¹⁸

The ATRF awarded “over 100 grants” between 1970–1986, for a total of $A4 808 055.²² A later document reports funding from 1970–1994 totalled $A9.1 million, suggesting that $A4 291 945 was awarded in its last eight years.²³ Altogether, 272 projects were supported, and 346 rejected.²³ A 44% funding rate compares very favourably with the rate typically awarded by Australia’s principal source of medical research funding, the National Health and Medical Research Council (circa 25%). Throughout the 24 years of the scheme’s existence, only two reports were issued,^22–24 suggesting an extremely low level of transparency. The ATRF also served as an important tax deduction for the tobacco industry. In 1993, Philip Morris’s (PM’s) contribution to the ATRF of $US197 851 represented 61.4% of its total charitable and other tax deductible donations for the year.²⁵

DISCREDITING “ADDICTION”

A relatively large seam of documents on the ATRF’s support for an international meeting on nicotine pharmacology provides a case study of the way the local industry used the ATRF to further its policy objectives. In 1985, the Australian tobacco industry succeeded in its efforts to prevent the warning “smoking is addictive” appearing on Australian packs.²⁶ In the same year, the ATRF began arrangements to support an international symposium on nicotine. Documents reveal extensive industry vetting of proposed attendees, resulting in an attendance heavily weighted by industry employees and consultants and a symposium programme structured to feature presentations on the benefits of nicotine.

In November 1985, minutes of the ATRF noted a recent visit to Australia of the head of the West German Tobacco Research Foundation, Professor K Thurau. Thurau had suggested that the International Pharmacological Society hold a meeting in Sydney on nicotine, to be chaired by Rand.²⁷ It was agreed that the ATRF and the West German Tobacco Research Council should support the meeting and members would draw up lists of potential speakers.^27,28

Notwithstanding claims about the ATRF’s supposed independence from the tobacco industry, local PM executives were nonetheless concerned about those who might attend the meeting. In 1985 and 1986, documents show several episodes of correspondence between Australian and US PM officials and industry lawyers Shook, Hardy & Bacon (SHB) in Kansas about the meeting. Australian PM staff sent lists of those to be invited to SHB asking to “know what stance [proposed Symposium participants] take regarding smoking”.²⁹ Another note summarised for each whether they supported the view that nicotine produced any of the classic symptoms of drug dependence.³⁰ Other correspondence concluded:“Clearly they are not all anti-smokers, and that’s probably the best we can expect. The problem is that the antis among them will be fully exploited by our local opponents.”³¹

PM Australia’s Phil Francis later wrote to his New York office:“It is our intention...to speak with Rand shortly about the attitudes of these speakers but I now feel it would be more appropriate to leave that discussion until we have received input from yourself and Don Hoel [from SHB] in respect of Industry positive additional or alternative speakers. Right now I am not aware if Rand has drawn up a final list of presenters, in any event it would be wise if we were to move reasonably quickly.”¹⁷

The next month, Francis wrote to SHB:“We are particularly concerned that some speakers may be more than willing to co-operate with anti-smokers in gaining media coverage.” Citing the ATRF’s minutes, he noted that “After a wide ranging discussion on the need for balanced papers to be presented at the symposium, the part the media may play during the symposium and its likely outcome, it was agreed that before any plans were finalised the Foundation members on the symposium organising committee should meet with the industry members of the Foundation”,³² presumably so that their concerns could be passed on. SHB’s comments on the proposed speakers included:

Dietrich Hoffmann: “Well known anti-smoking researcher...[who has] expressed view that smoking causes disease...”

Ovide Pomerleau: “...his approach is adverse because it posits a primary role of nicotine in smoking and often relates action of nicotine to opiate-like effects.”

John A Rosecrans: “...[despite] his use of phrase ‘dependency’ to describe smoking, his views are nevertheless probably reasonably moderate in that he does not emphasize withdrawal relief or avoidance as the main source of nicotine’s importance in smoking.”³³

Still concerned, Francis wrote again to SHB:“At this stage we need a clear impression of where each speaker stands with regard to smoking. Specifically, who among them is likely to cooperate with antismoking organisations and possibly attack smoking and/or the tobacco industry in the course of media interviews.”³⁰ PM Australia divided the speakers into three groups:

“Those who appear to be neutral or moderate in the views on smoking (Fuxe, Nedergaard, Ginzel, Kellar, Rosencrans, Benowitz, Holmstedt, Jarvik, Bassenge, Kuschinsky, Wennmalm.

Apparently pro-smoking: Warburton

Apparently anti-smoking: Hoffman[n], Russell, Pomerlau.

With regard to Hoffman[n] and Russell, we believe there is a definite danger of their co-operating with local anti-smoking leaders such as Simon Chapman in arranging media interviews. I would appreciate your views on this listing before we have further discussions with Professor Michael Rand.”³⁰

SHB replied that Benowitz “should be listed with the ‘antis’ and Warburton should be listed with the ‘moderates’”.³⁴ Warburton was later to become a prominent consultant for the industry, heading ARISE (Association for Research into the Science of Enjoyment)³⁵ and serving as a model consultant for what the industry named “Warburton clones”.³⁶

Mirroring PM’s concern about the potential of participants to speak to the media in ways not welcomed by the industry, the minutes of an ATRF meeting in October 1986 record that a wide ranging discussion took place “on the need for balanced papers to be presented at the Symposium, the part the media may play during the Symposium and its likely outcome”.²⁸“Balanced papers” was presumably industry code for speakers who would not draw attention to the harms of smoking or state that nicotine was addictive. The letter inviting keynote lecturers to participate in the symposium had no mention of tobacco industry sponsorship.³⁷

The symposium was held on Queensland’s Gold Coast, 4–6 September 1987, with 84 attending. Of these, one in six were tobacco industry employees or their lawyers.³⁸ One session chair, consultant Dr Frank Roe, later wrote a candid report of the meeting for his industry employers noting that of the 84 attendees “a dozen or so were overtly associated with the tobacco or nicotine chewing gum industries. Rather more were current or past recipients of grants from the tobacco industry... These...gave the symposium a deep fragrance of academia”.³⁹

Roe’s report is remarkable for its revelations about the extent to which the final programme appears to have been structured to give prominence to speakers extolling the benefits and safety of nicotine. He notes of one speaker “unfortunately I had to cut him short just as he was waxing poetic about the benefits of nicotine in relation to Parkinson’s disease and inflammatory bowel disease” and that “D.M. Warburton spoke clearly and persuasively on certain aspects of the benefits of smoking” and concluded “certainly no bad news for the industry emerged”.³⁹

RISING CRITICISM OF THE ATRF

From its launch, the ATRF had attracted controversy which accelerated in the late 1980s with the publication of a scathing editorial in the Medical Journal of Australia.⁴⁰ A physician wrote to the ATRF expressing concern that the industry had “used its association with scientific bodies to maintain their argument that they are actively involved in trying to sort out the ‘controversy’ that exists in the question of whether or not smoking causes ill health”.⁴¹ The ATRF chair, Professor Austin Doyle, responded:“I regard your statement that the Australian Tobacco Research Foundation does not deserve to be seen as an impartial organisation with an interest in improving scientific knowledge as impertinent and ill informed”.⁴²

Following publication of another attack on tobacco industry funding of health research⁴³ Doyle and the paper’s author (Simon Chapman) were interviewed on radio:

“Chapman: ... the US Surgeon General has said unequivocally...that it believes that the consistency of the association and the volume of evidence about smoking and health, justifies the use of the verb “cause”, about the relationship between smoking and cancer... The [Tobacco] Institute repeatedly denies this and yet spokespeople for the Tobacco Research Foundation and I would have to, I think, include yourself [Doyle] in that—have been conspicuously absent from making any public statements to that effect ... Where do you stand?”

Doyle: I am not personally in the public policy area. It seems to me that it’s the Surgeon General’s duty to make a guess: that he has to look at all the data and he has to come up with what he thinks is the most probable explanation.

Interviewer: Do you agree with his guess?

Doyle: No, I don’t disagree, because he’s doing what his job demands him to do. I think the fact of the matter, of course, is that you cannot say that one thing causes cancer.”⁴⁴

This professional and public criticism concerned the ATRF and shortly after Doyle’s evasiveness on radio (above) he wrote to the industry appointed secretary to the ATRF, enclosing a letter drafted by all members of the ATRF firmly stating that they believed smoking played a causative role in disease (see below), and writing:“We were concerned by recent events which seem to indicate a deterioration in the public image of the A.T.R.F., particularly among the medical and scientific community. These events include the recent attack by Dr. Chapman, and the refusal of a number of referees to assist in evaluating applications... The major problem seems to be a mistaken perception that the A.T.R.F. is an organisation which represents the views of the tobacco industry, which is, of course, factually incorrect. Members thought it likely that there was confusion in the media and among anti-smoking lobbyists between the A.T.R.F. and the Tobacco Institute. The effect, whether unintended or deliberate, has been to depreciate the purely scientific goals of the A.T.R.F. and to denigrate the action of the industry in providing funds for research.⁴⁵

Doyle could have hardly imagined that his private letter to the ATRF secretary would later become public, so his private insistence that the ATRF was indeed not being used as a public relations tool by the tobacco industry provides an interesting insight into either his naivety or ability to rationalize.⁴⁶

In 1988 the Medical Journal of Australia published a significant letter signed by all members of the scientific advisory committee of the ATRF stating:“the members of the scientific advisory committee are unanimous in believing that smoking is an important causative factor in several major diseases. We recognize the link between smoking and lung cancer which generally is attributed to the presence of known carcinogens in tobacco smoke. We are also aware of the increased risk of coronary heart disease, stroke and emphysema in persons who smoke cigarettes. ...While members of the tobacco industry see all applications, the industry has not attempted—and indeed has no power—to influence decisions on individual projects, or to determine the direction of research or to influence the publication of results. Research workers have no direct contact with the industry.”⁴⁶ This was followed by a letter to a newspaper emphasizing “the fact that the A.T.R.F., although funded by the Tobacco Industry, is entirely independent of it”.⁴⁷

“MANY APPLICANTS TREAT US A LAST RESORT”

The continuing controversy over the ATRF, together with its public declaration that tobacco “caused” disease, plainly annoyed the local tobacco industry, and by the early 1990s it was re-considering its support for the ATRF. Momentum had built among Australian medical research groups against tobacco industry sponsorship such that by 1994, 7/10 medical faculties in Australian universities had policies refusing to administer tobacco industry research grants, with two universities having institution-wide policies refusing industry money.⁴⁸ PM’s Australian chief advised his next-in-line:“I have taken the opportunity to investigate the research being supported. Frankly, the current applications are second rate. At first sight, I cannot see that we are getting much value from this expenditure. I have discussed the matter with two professors in the last few days. They have indicated that most talented young scientists would be concerned that accepting ATRF funding would damage their careers.”⁴⁹ PM Australia informed its New York office:“For some time now we have been reviewing the focus and future of the ATRF with the lawyers in New York.”^50–52 In 1994 the ATRF changed its name to the Smoking and Health Foundation.²³ It is not clear from the documents or other sources what this change hoped to achieve. Two years later, minutes record discussion about winding up the Foundation at the end of 1997.⁵³ By 1997, Philip Morris Australia was actively reviewing the viability of the ATRF. One applicant requested his university to delete the ATRF as a source of funding:“It seems to me, however, that having obtained funding from The Tobacco Research Foundation places my integrity, and that of my research, in some doubt. I have no concerns about this, but I have been surprised by the strength of the response to this source of funding by some members of the academic community for the past year. It is important to me that my work is considered exclusively on the basis of scientific merit, and it seems clear to me that this is unlikely if I am seen to be providing support (either scientific or public relations) to a particular group.”⁵⁴

PM Australia’s CEO wrote to head office:“It is quite clear that pressure has been exerted on both potential applicants and existing and potential members of the Advisory Committee. Two former members have been forced to resign by their employers... The effect on the organisation is quite dramatic. Firstly there are few, if any, projects related to tobacco. When I was supported by this body in 1971–73, only projects which in some way related to tobacco were considered—now these are more of an exception. Furthermore, as several Universities have banned the acceptance of these funds, the overall standard of applications has dropped. Quite obviously, many applicants treat us a last resort...funding has shrunk to quite a modest level—I think some A$150–$200,000 per year...half of the members on the Advisory Committee are my personal friends. ...New recruits will be difficult, if not impossible, to find; we get no credit or positive publicity; we can argue that we sponsored research and have now been prevented from doing so.”⁵⁵ By this stage, the Foundation did not even have an office.⁵⁶

Goldberg suggested one option would be to replace the programme “with targeted, specific support. I have already moved in that direction with some excellent results” naming the Mental Health Research Institute (“despite Health Department objections”), multiple sclerosis research, juvenile diabetes research, education programs for gifted children and disadvantaged communities. “These are well-publicised—within the limitations of the current law. They are very well known to the relevant Minister and to the Premier. Since they are based largely on my personal contacts, these ventures are almost all in the state of Victoria but I would see this developing into an even more focussed program with events in every State.”⁵⁵

Little is known about the criteria used by the ATRF to award grants. A statement issued at its formation stressed that studies seeking corroboration of known findings on smoking and health would not be supported,¹⁴ and although many of the grants funded reported further “bad news” for the tobacco industry²² this was almost invariably buried away in often obscure scientific publications and did not influence public debate about smoking. A small number of studies examining beneficial effects of nicotine⁵⁷ were funded, as was a study examining ventilation and reduction of exposure caused by environmental tobacco smoke⁵⁸—a research direction that was consistent with the tobacco industry’s policy that ventilation was a solution to the problem of environmental tobacco smoke pollution.

In 1976, an ATRF grant recipient received press coverage about his work predicting susceptibility to lung cancer.^59–62 In contrast to repeated statements about the separation and independence of the scientific activities of the ATRF from its industry members, this application was sent by an Australian tobacco industry representative to a Brown & Williamson colleague in Kentucky with the comment:“I should be glad if you would maintain the confidentiality of these papers... It does appear...that he has talked unwisely and none too well to the press.”⁶³

In 1987, the Wills representative on the ATRF contacted Philip Morris to discuss limiting funding:“He would like the Industry contribution to ATRF to be limited to $500,000 plus a further $95,000 to Professor Spradbrow’s project at Queensland University.”⁶⁴ While it is unclear why Wills would have wanted to see Spradbrow’s project funded (papilloma virus and sun associated skin tumours in animals and man),⁶⁵ Wills’ intervention in the allocation of grants indicates that decision-making in at least one instance was subjected to representations by the tobacco industry.

In 1975, in notes marked “for conversations with State politicians. NB: not to be left with contact”, industry lobbyists were advised to argue that:“the industry is vitally concerned and funds a great deal of scientific research by independent scientists. The Australian Tobacco Research Foundation...has so far underwritten research to the tune of one million dollars. Internationally, the cigarette manufacturing industry has funded independent research well in excess of thirty million dollars.”⁶⁶ Ten years later, they were still replaying the same mantra: John Dollisson, chief executive of the Tobacco Institute of Australia, told the Hong Kong Legislative Council:“over the last decade, the tobacco industry in the US, UK and Australia alone has contributed in excess of US$130 million into ‘hands off’ research into smoking and health. This research, as with the majority of research in this area, is inconclusive and shows the need for more research. The sooner the causes of the diseases that affect mankind can be identified the better for us all. It may well be that there is some component in tobacco that is harmful; we just don’t know if this is the case - but, should it be so, we have the technology to remove the component.”⁶⁷

In 1993, Mike Rand was interviewed at length by TCN 9’s Sunday television programme.⁶⁸ Journalist Helen Dalley questioned him about the ATRF’s procedures and independence from industry influence:

“Rand: Tobacco companies don’t get a say in...there is a scientific advisory committee which...err...which sets out a priority list for funding. And I’ve never heard any hesitation expressed on the part of the tobacco companies about what might be the outcome.

Dalley: As well as being a recipient of tobacco funds, you also sit on the board of trustees, alongside executives of each tobacco company. How independent or unaffected by their views can you really be?

Rand: They don’t ask for any oath of allegiance and I do my very best as a member of the ATRF to act without prejudice in regard to my personal ideas.”⁶⁸

Despite his public protestations to the contrary, it would appear that Rand was seen by the industry as a “friend in court” in the ATRF’s scientific advisory committee. Philip Morris executives felt they could approach him to express their concerns on occasions when any of the science threatened industry concerns.

DISCUSSION

The international tobacco industry has always had a clear and consistent understanding of why it supported scientific research. Helmut Wakeham, head of research for Philip Morris USA, told his CEO in 1970:“It has been stated that CTR is a program to find out ‘the truth about smoking and health’. What is truth to one is false to another. CTR and the Industry have publicly and frequently denied what others find as ‘truth’. Let’s face it. We are interested in evidence which we believe denies the allegations that cigaret smoking causes disease.”⁶⁹

In 1974, Alexander Spears, head of research at Lorillard, summarised the purpose of industry research:“programs have not been selected against specific scientific goals, but rather for various purposes such as public relations, political relations, position on litigation etc... In general, these programs have provided some buffer to public and political attack of the industry, as well as background for litigious strategy”.⁷⁰ In 1978, PM’s Robert Seligman said of the CTR:“It was set up as an industry ‘shield’ in 1954... It is extremely important that the industry continue to spend their dollars on research to show that we don’t agree that the case against smoking is closed... There is a ‘CTR basket’ which must be maintained for ‘PR’ purposes.”⁷¹

And most succinct of all, Addison Yeaman, Brown & Williamson’s lawyer, said of the CTR that it was the “best & cheapest insurance the tobacco industry can buy, and without it, the industry would have to invent CTR or would be dead”.⁷²

Aside from the behind-the-scenes efforts of the industry representatives on the ATRF to load the 1987 nicotine symposium audience with industry positive scientists, there appears little evidence other than the seemingly minor instances described that they ever sought to overtly steer or interfere with the ATRF’s scientific committee’s deliberations in the ways that occurred in the USA. This made the ATRF a far less overt tool of the industry than the US CTR. As a 1986 legal report described:“Far from being independent, the activities of the CTR [Council for Tobacco Research] and SAB [Scientific Advisory Board] activities were monitored and controlled by industry representatives, including tobacco company lawyers and public relations consultants. Indeed, the lawyers stopped central nervous system research proposals, screen out ‘dangerous project proposals’, and funded ‘special projects’ designed for litigation purposes. ...Although the industry funded a number of other ‘outside’ research projects, it did so only when it received clear advance assurances of a ‘favorable’ outcome. For example, Dr. Gary Huber, then of Harvard, solicited industry funds with his view that ‘the number of people at potential risk from tobacco consumption is extremely small relative to the very large number of people who now smoke’.”⁷³

The value of the ATRF to the industry was far more covert. Few ATRF grant recipients were ever active in tobacco control advocacy in any significant way, perhaps reflecting the “don’t bite the hand that feeds you” effect warned by critics of industry funding. The main benefit to the Australian industry lay with the ATRF being an elaborate symbol of the “more research is needed” argument designed to prevent tobacco control policy being enacted.

The internal correspondence reviewed in this paper points to the ATRF being something of a clone of the US CTR, established and funded by the industry for the explicit purpose of delaying progress in tobacco control. For as long as “more research was needed” the industry could argue that policy interventions designed to reduce tobacco use were premature. Projects funded by the ATRF throughout its history seldom posed any threat to the tobacco industry by addressing topics that held any obvious potential to further public concern or invited policy responses from governments. With only two reports issued in 24 years on the actual research it had funded, there was plainly little interest in the ATRF or its industry backers to publicise any of the results obtained.

The scientists involved in the ATRF were not people who were involved in tobacco control but in scientific and medical research which was predominantly curiosity driven rather than addressing policy relevant questions. They were plainly sensitive to criticism that they were being used by the tobacco industry in the ways described, but sought to defend their involvement through arguments about the independence and integrity of the grant awarding process, selecting some of Australia’s most experienced and senior medical researchers to administer the scheme.

The demise of the ATRF was achieved by sustained criticism from its critics made both to grant recipients and in public. This eroded the academic community’s willingness to embrace the relationship with the industry as a routine and unproblematic source of funding. In Australia today, the tobacco industry maintains only private consultancy relationships with a small number of individuals in universities. Tobacco control efforts in other nations would do well to note the potential of such sustained criticism designed to challenge the notion that tobacco industry research funding can somehow be divorced from the industry’s intent to use it as a brake on effective tobacco control policy.