Elsevier

The Lancet

Volume 363, Issue 9423, 29 May 2004, Pages 1820-1824
The Lancet

Public Health
Learning from Philip Morris: Japan Tobacco's strategies regarding evidence of tobacco health harms as revealed in internal documents from the American tobacco industry

https://doi.org/10.1016/S0140-6736(04)16310-1Get rights and content

Summary

Japan is in the midst of a rapid increase in tobacco-related disease mortality, following the rapid growth of smoking after WWII. Stomach cancer was the country's leading cause of cancer death for most of the 20th century, until lung cancer took over this position in 1993. Cigarettes are the major cause of lung cancer in Japan, but the country's leading manufacturer, Japan Tobacco, two thirds of which is owned by the Japanese government, continues to question whether tobacco is a major cause of disease and death. Japanese courts do not have the power to subpoena a company's internal records, which has made it difficult to document Japan Tobacco's strategies concerning tobacco and health. Our interpretation of online archives of internal documents from American tobacco companies, however, is that Japan Tobacco has long known about the potential health risks involved in smoking and has sought to obstruct effective tobacco control. Beginning in the mid-1980s, these efforts were often co-ordinated with American tobacco manufacturers. The documentary evidence shows that cigarette manufacturer Philip Morris in particular assisted with and sometimes also supervised Japan Tobacco's actions and statements on smoking and health. In one instance, data gathered for an article published by the Japan Public Monopoly Corporation (Japan Tobacco's predecessor) were deliberately altered to lower the reported value of a hazard indicator (nicotine concentration in the air). International collaboration has made it easier for companies such as Japan Tobacco to develop effective anti-antismoking strategies. Evidence of such global industry collaborations might grow as lawsuits begin to be filed in other nations.

Section snippets

629 000 cigarette vending machines

In 2002, according to figures compiled by Japan Tobacco, 49% of all Japanese men and 14% of all Japanese women were smokers.1 In 1998, according to the US Centers for Disease Control and Prevention (CDC), Japan had the highest per-capita consumption of cigarettes among all industrial countries (2403 cigarettes per person per year among people aged 15 years and older).3 The underage smoking rate is also high: surveys done in 1996 and 2000 showed that 25% of high school seniors (males) were daily

Championing the cause of cigarettes

Japan Tobacco continues to question whether tobacco is a major cause of disease and death. On Jan 29, 2002, for example, in legal proceedings of the first major lawsuit by Japanese smokers against the industry (the Tobacco Disease Lawsuit), Yoshihiko Ohkawa, a Japan Tobacco representative, claimed that “since not all smokers suffer from a disease, we cannot conclude that smoking itself is harmful” and that “lung cancer has many causes other than smoking.”9 In an oral proceeding for the same

Coordinating anti-antismoking efforts

Japan's collaboration with international tobacco companies was weak before the mid-1980s. There is some evidence of friendly correspondence: in 1978, for example, Philip Morris offered JPMC “assistance in briefing them on PM's [Philip Morris's] experience” with legal aspects of smoking and health issues.18 Then again in January of 1981, when Japanese anti-smoking groups filed a lawsuit against JPMC, asking for the establishment of non-smoking cars in Japanese trains, the chief manager of JPMC's

Keeping “our good relationship”

Philip Morris has been helping supervise Japan Tobacco's smoking and health stance since the Japanese company was semi-privatised in the 1980s. For nearly 20 years, details of many public statements by Japan Tobacco on matters of smoking and health have been routinely shown to Philip Morris authorities for approval. In July 1993, for example, the Tobacco Institute of Japan's “final draft” of an “ETS Leaflet” explaining environmental tobacco smoke to the Japanese public was sent to Philip Morris

“We eliminated this data”

Although the Japanese-American collaboration is best documented from 1987 onward, this does not mean that the JPMC was previously naive about smoking and health issues. In 1981, Peter N Lee, Philip Morris' research consultant, visited JPMC and reported back to Philip Morris that JPMC was already spending a lot of time exploring psychological approaches of how to show the Japanese people “that smoking can have beneficial effects”.44 Another document shows that JPMC planned to fund a research

Winning “the sympathy of minors”

Japanese tobacco manufacturers have used other strategies to resist tobacco control efforts. A 1996 e-mail from Shin-ichiro Imai at Philip Morris Japan to Matthew Winokur and others reveals that the Tobacco Institute of Japan, Japan Tobacco, and Philip Morris Japan, ran a “Smoking Manners Campaign” in order to “secure smoking areas and consumer freedom of smoking” in outdoor public spaces.53 According to the Tobacco Institute of Japan's internal strategy plan ("A Charter for the 1990's”), the

Conclusion

Japanese tobacco control advocates are unfortunately hampered to some extent by not being able to obtain internal industry documents to examine the broader extent to which the industry may have manipulated public opinion and distorted scientific facts. Subpoena power is much more restricted in Japan than in the USA.

A few internal documents from American legal proceedings give us hints of what has gone on in Japan, however, as glimpses through a keyhole. Japan Tobacco has long known about

Search strategy

Industry websites offer a convenient way to research tobacco industry activities. We used the Philip Morris Document Site (http://www.pmdocs.com/) and other industry documents released in the course of American tobacco litigation. “Japan”, “JT”, “JTI”, or “JTS” were used first as keywords to look for documents related to Japan Tobacco; once we established key individuals and dates, we used the names, documents' date range, a related institute's name (eg, “TIOJ” [Tobacco Institute of Japan]),

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