• Denormalization
• Global Health
• Public Policy
• Tobacco Industry
• Tobacco Industry Documents

The report published here on Japan’s Smoking Research Foundation (JSRF)1— an entity funded in substantial part by Japan Tobacco—yields not only history but crucial lessons for tobacco control today. For decades, the JSRF has funded scientific research ostensibly independent from the tobacco industry, yet as the authors note, tobacco industry documents show that ‘it was never meant to be an independent research funding body’, but rather ‘was created to generate and publicize cigarette-friendly science through a seemingly neutral third party front’. This provides valuable insight at a moment when the world has just been introduced to a brand-new organisation, the ‘Foundation for a Smoke-Free World’ (PMI_FSW), backed by enormous funding support from Philip Morris International (PMI). PMI_FSW claims to have ‘an independent research agenda, independent governance, ownership of its data, freedom to publish, and protection against conflict of interest’.2 Iida and Proctor’s analysis of formerly secret documents revealing a deliberate masking of tobacco industry influence in Japan illustrates some of the risks of such a funding model for public health worldwide.

Tobacco policy in Japan is driven by a triangular power structure of governmental finance officials, politicians (primarily from the leading Liberal Democratic Party) and the tobacco industry itself (including agriculture, foreign and domestic cigarette producers, and numerous partners throughout the economy in media, retail and the like). But this vast enterprise has been largely hidden from public view in the JSRF’s work. The public, and agencies and courts that rely on the JSRF’s research output, have seen instead a different triangle of famous and respected academics, leaders in medical societies and the Japanese Foundation for Cancer Research, which appears both benign and reliable. An intentional sleight of hand has obscured these connections. Documents uncovered by Iida and Proctor show comments that ‘the industry must be inconspicuous. Otherwise…the public will suspect the authenticity of the information’.1

According to officials from the Japan Society for Tobacco Control (JSTC), JSRF award recipients have led or served on the boards of the nation’s foremost medical societies, and then with those prestigious titles, received appointments to key government panels relating to the Ministry of Finance and the Ministry of Health, Labour and Welfare. While the report published in this issue documents such connections going back to the 1980s, JSTC officials inform us that famous JSRF recipients remain in leadership positions where they continue to impede policy changes that could reduce tobacco consumption and protect the Japanese public from exposures to harmful second-hand tobacco smoke.

JSRF research has also had a detrimental effect with regard to expert testimony presented in litigation in Japan. As reported in this article, in litigation filed in 2005 on behalf of lead plaintiff Masanobu Mizuno and two others, the Yokohama District Court rejected the plaintiffs’ claims outright with the decision in part relying on a 1989 Tobacco Business Council Report that had been developed with JSRF grantees’ academic fire power.1

Perhaps the most pernicious lessons from Japan are evidenced through a long-term perspective. After the work of a research operation that had been inside Japan’s tobacco monopoly enterprise since 1973, the JSRF was founded in 1986 and has been operating for over 30 years to subtly extend the industry’s reach.3 Investments decades ago in the work of promising young scholars in Japan’s most distinguished universities are now reaping fine dividends, as these individuals have progressed in their careers into the highest echelon of Japan’s famously hierarchical academic research communities. These scholars, with years of tobacco industry funding underwriting their work, can extend industry interests into their research topic areas and through the ability to cast a chill on the work of junior scholars today who might otherwise engage in more aggressive tobacco control research or present more critical views on important public health topics.

The JSRF remains active in Japan and still distributes substantial sums towards research relating to tobacco and disease. Its latest annual report indicates plans for 375 million yen (roughly US$3.3 million) to be spent in 2017 on 211 research awards, including 35 awards especially designated towards younger scholars, continuing the industry’s engagement with future leaders.4 Meanwhile, as recent as 2008, tobacco industry executives still claimed in court testimony that the JSRF operates with ‘independence and neutrality.’1 The JSTC has criticised the JSRF for many years and in many fora. In recent years, some progress has been made, such as in requiring/promoting more explicit declarations regarding conflicts of interest within academic organisations and at academic society gatherings. But disclosure is not a panacea for the often-hidden influences of funders with a financial stake in the outcomes of research and policy decisions.

The PMI_FSW was launched in September 2017 with a slick video, a futuristic-looking website and predetermined research directions. The name of the foundation follows the tobacco industry’s long-standing engagement with semantic mischief. While the warm and appealing notion of a ‘Smoke-Free World’ seems to align with the vision of global tobacco control advocates, the foundation’s leader violated a key tenet of global tobacco control by unilaterally accepting tobacco company funding, although with caveats.

Similar to how JSRF made long-term investments in promising young scholars, it appears that the PMI_FSW will be looking to support ‘Centers of Excellence’ around the world, including in low-income and middle-income countries. We question the likely effectiveness of the purported safeguards from tobacco industry’s potent, though indirect, effects on research outcomes that may accomplish its goals just as well as direct interference would. And as we have seen in Japan, such a strategy is well-poised to reap large dividends in tobacco companies’ favour.

We are told once again that this is a new day, that PMI is committed to phasing out its cigarette business and that its ultimate goals are in harmony with global tobacco control priorities. But we are not in harmony as long as PMI and other tobacco companies fight against and work to undermine the evidence-based tobacco control policies of the Framework Convention on Tobacco Control (FCTC) and the interventions that build on the floor that the FCTC provides. We cannot ignore how tobacco companies have worked covertly to corrupt science, create doubt and thereby delay the implementation of effective tobacco control interventions. Iida and Proctor demonstrate that this continues to the present day in Japan. The influence of tobacco industry money on science and policy is insidious and has never been proven to be beneficial to public health. Ignoring the past will only condemn us to repeating our mistakes, at the cost of millions of lives.