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Under the influence
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  1. Raglan Maddox1,
  2. Pamela M. Ling2,
  3. Billie-Jo Hardy3,
  4. Mike Daube4
  1. 1 National Centre for Epidemiology and Public Health, Australian National University, Canberra, Australian Capital Territory, Australia
  2. 2 Center for Tobacco Control Research and Education, School of Medicine, University of California San Francisco, San Francisco, California, USA
  3. 3 Well Living House, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
  4. 4 Health Sciences, Curtin University, Perth, Western Australia, Australia
  1. Correspondence to Dr Raglan Maddox, National Centre for Epidemiology and Public Health, Australian National University, Canberra, ACT 0200, Australia; raglan.maddox{at}anu.edu.au

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The tobacco industry has a long and well-documented history of influencing, exploiting and misleading public health and research communities.1–4 Starting with the 1953 ‘Tobacco Industry Research Committee’5, stakeholders affiliated with the tobacco industry have strategically promoted industry interests through the funding of research programmes and public health initiatives, in order to influence research agendas, manipulate the design, methods and conduct of research, affect interpretation of findings and selectively disseminate information through publications, conferences, forums and panels.1–4 These activities have enabled the tobacco industry to promote its versions of ‘sound science’ and ‘good epidemiology’ which have been designed to weaken consensus about the harms of tobacco use and second-hand smoke exposure.6 Academics and public health communities have sought to raise awareness about and challenge industry interference and manipulation,7–9 and some industry-funded research organisations such as the Council for Tobacco Research and the Center for Indoor Air Research were disbanded as part of the 1998 Master Settlement Agreement in the USA due to their extensively documented role in industry efforts to defraud the public.7 8 However, as Legg et al 10 highlight, the approach has intensified and become more sophisticated over time.

A central tenet of the World Health Organization’s Framework Convention on Tobacco Control (FCTC),11 Article 5.3, states: ‘In setting and implementing their public health policies with respect to tobacco control, Parties shall act to protect these policies from commercial and other vested interests of the tobacco industry in accordance with national law’.11 There is now increasing evidence on the ways in which tobacco companies seek to position the industry as a strategic partner to public health, presenting themselves as scientific authorities who are promoting new products as solutions to concerns about commercial tobacco and as legitimate commentators on science and health research and policy.4 6 9 12 For example, Philip Morris International (PMI) recently sponsored a series of articles published on The Australian newspaper website promoting the company’s views on both the scientific evidence and public policy on vaping,13 an action that may arguably breach national tobacco advertising and promotion laws,13 14 while highlighting the use of any available opportunity to present the industry as ‘part of the solution’. Such activities frequently fail to acknowledge clear conflicts of interest (COIs)4 and may be interpreted as attempts to actively undermine FCTC Article 5.3 implementation.11 15

The most lavishly funded new face of the tobacco industry was the 2017 establishment of the Foundation for a Smoke-Free World with an original ‘pledge agreement’ of almost $1 billion over 12 years from PMI, although a more recent version of the ‘pledge agreement’ seems to indicate reduced funding commitments.16 17 The PMI-funded Foundation and multinational tobacco companies promote the use of alternative tobacco products as ‘tobacco harm reduction’, a phrase co-opted from the illicit drugs arena, seeking to use the term exclusively to promote use of novel tobacco products and to renormalise the use of nicotine, helping to ensure the industry’s long-term profitability as smoking rates drop.18 19 Tobacco companies adopted the term ‘harm reduction’ to enhance public relations,20 ignoring many tobacco control approaches, such as eliminating flavoured or menthol cigarettes,21 that reduce tobacco harm without promoting uptake of new tobacco products—actions that, like so many other evidence-based measures to reduce smoking, tobacco companies have fiercely opposed.22

Some researchers have sought to discount the importance of full financial COI disclosure,4 23 24 attempting to generate a false equivalence between receiving industry funding and receiving public health funding,24 while tobacco company executives and those who support their position have equated tobacco industry funding with mandated government settlements, taxes and fees and philanthropic support.10 25 Of especial note, there has been a recent surge in publications funded by the tobacco industry and associated groups.

We comment further on journals ignoring or weakening their policies prohibiting industry-funded articles and ignoring failures by tobacco industry stakeholders and their affiliates to disclose COI practices that can undermine the integrity and trustworthiness of public health research and initiatives.10 23

The PMI-funded Foundation for a Smoke-Free World’s President, Derek Yach, recently published a letter in Nicotine and Tobacco Research entitled Tobacco Use Patterns in Five Countries During the COVID-19 Lockdown.26 While Yach reported that ‘this survey was funded by the Foundation for a Smoke-Free World’, the letter was silent about the Foundation’s PMI funding, and the statement on ‘Declaration of Interests’ reads ‘none declared’. Yet, this journal’s Declaration of Interest policy clearly specifies that ‘Science needs to be beyond reproach, particularly when financial vested interests operate, such as in nicotine and tobacco research’ and ‘The presence of undeclared sources of support and financial interests has the potential to undermine the credibility of published work regardless of whether or not the financial factors are linked to tobacco or non-tobacco industries’.27 Yach’s failure to disclose that the Foundation is funded by a tobacco company is in our view inconsistent with the journal’s policy, which is to ‘disclose any financial or other substantive COI that might be suspected of influencing the outcomes reported’.27 Further, evidence suggests that the Foundation may function operationally to advance and amplify tobacco industry messaging and may continue to potentially influence research and public health.4 28 Although COI disclosure is not a failsafe,29 it is a minimum standard for scientific integrity.

As discussed by Legg et al,10 a special issue of Drugs and Alcohol Today is reported by the Foundation as aiming ‘to explore progress towards the goals outlined’ in the FCTC.12 As Legg et al 10 outlined in this journal and also detailed on the Tobacco Tactics website,25 the PMI-funded Foundation reported that a number of articles by ‘Foundation’s staff, grantees and other prominent experts’ describe strategies for ‘improving’ the FCTC and its implementation,12 without acknowledging that government partnership with the Foundation would be prohibited by Article 5.3 of the FCTC. The articles list the affiliations of authors who are Foundation employees and grantees, but some fail to disclose PMI financial support or interest in the research.12 30 31 Articles written by O'Leary and Polosa30 and Glover et al31 list affiliations with their research centres of ‘Excellence’ and that they have received funding from the Foundation. However, they did not disclose PMI's funding of the Foundation or that Polosa25 has also received further tobacco industry funding.25 32 There is an absence of such detail in the respective COI statements among most of the articles listed.12 30 31 The lack of disclosure seems to us to be inconsistent with the Drugs and Alcohol Today statement of its research and publishing ethics. While noting that the research published should have been conducted with the highest standards of rigour and integrity, this statement emphasises that there is a duty to report possible COIs. These possible COIs are specified as including undisclosed financial support for the research by an interested third party and further emphasises the need to provide ‘the background to any financial support for the research from third parties and highlight any other possible COI’.33 The result of the approach taken in these articles is a quiet whitewashing of PMI’s influence using Foundation grant making. Further, the irony is not lost that the leader of the PMI-funded Foundation was previously involved in development of the FCTC; as a result, PMI is now uniquely positioned to influence the FCTC through its established relationships, knowledge and experience.

Finally, the journal Tobacco Regulatory Science recently changed its policy to allow consideration of publications that are funded by the tobacco industry.34 The new Tobacco Regulatory Science policy states: ‘Effective immediately, articles that have received funding from a tobacco company can be submitted for review and consideration for publication in Tobacco Regulatory Science’.34 The change in policy is described as being linked to a Society for Research on Nicotine and Tobacco (SRNT) policy,34 which may confer even more legitimacy to publishing tobacco industry research. However, in our view, this is inconsistent with the SRNT position on membership which details that individuals employed by a ‘company that is part of the tobacco industry or a company that is partially or wholly owned by a company that is part of the tobacco industry are not eligible for membership’.35 COI disclosure is necessary, but not sufficient to identify and manage scientific COI.29 36 More concerning is that in some instances, merely relying on disclosure may worsen bias37 further emboldening organisations like PMI and highlighting the need for stronger mechanisms to address COI. For example, reliance on disclosure alone can leave the actual COI unaddressed. While disclosure shifts the COI to ‘open bias’, as opposed to undisclosed or ‘secret bias’, it may also be perceived as absolving a person from their responsibility of managing their COI. Further, voluminous or self-styled disclosure sometimes generates ‘white noise’ which can obscure conflicts.23 38

Together, and complementing the discussion by Legg et al,10 these examples highlight the role of scientific journals in enabling tobacco industry stakeholders to influence production of research and public health policy to further industry interests, as well as structural failures to hold them to account in a transparent manner. Some affiliated with the industry claim that journal policies against acceptance of industry-funded research constitute ‘censorship’, an argument reminiscent of similar claims made in countries where tobacco advertising bans have been mooted and implemented. Rather, these policies recognise the fundamental, irreconcilable conflict between the tobacco industry’s interests and public health, as set out in the FCTC and its guidelines.11 39 The tobacco industry continues to reinvent itself and to reshape research and public health debates, prioritising profits over people. This is of concern not only for ethical reasons,5 9 11 40 but also because these efforts appear to be a well-coordinated initiative to promote the tobacco industry’s interests by presenting tobacco companies as part of the solution to the tobacco problem.19

While efforts to exploit relationships with scientific journals are not new,41 the continuing steady drip of industry-funded articles in scientific journals should raise concern. Journals such as Tobacco Control, BMJ and PLoS Medicine have taken a principled stance against the acceptance of tobacco industry-funded research.42–45 As scientists and members of the public health community, it is our responsibility to expose when and in what manner tobacco industry interests intersect with and influence research and public health.40 We strongly support policies prohibiting tobacco industry-funded articles and agree that practices such as fully declaring interests in peer-reviewed journals must be clearly set out, consistently monitored and enforced. Where these policies are lacking, they should be introduced.

Analogous to FCTC Article 5.3 and the 2020 World No Tobacco Day theme, ‘Protecting youth from industry manipulation and preventing them from tobacco and nicotine use’, we must insulate both scientific publishing and policy-making from tobacco industry influence.11 As work to strengthen the implementation of the FCTC continues, both governments and scientists need support and encouragement to end, not embrace, tobacco industry influence.15 46 The ‘merchants of doubt’1 and the actors who work with them should not be permitted to claim legitimacy or credibility in the scientific arena.3

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Footnotes

  • Twitter @RaglanMaddox, @BillieJ_Hardy

  • Contributors All authors have contributed substantially to conception, drafting and finalisation of this manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.

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