The tobacco industry's worldwide ETS consultants project: European and Asian components

Abstract

Background: The tobacco industry has formed regional environmental tobacco smoke (ETS) consultants programs in order to generate controversy on the issue of secondhand smoke (SHS) in Europe, Asia and Latin America. Only those countries in which the industry foresaw SHS restrictions were included. This paper describes the European and Asian components of the tobacco industry's worldwide ETS consultants program. Methods: A systematic search was carried out of tobacco industry documents available on the Internet between October 2002 and February 2004. Results: Beginning in 1987, Philip Morris assembled an international ETS consultants program in collaboration with other tobacco companies based on their market shares in different regions of the world. The law firm Covington & Burling contacted and hired consultants with a wide range of expertise, usually affiliated with an academic institution, in order to avoid direct contact with the industry. The objective of the program was to influence policy makers, media and the public by providing, through their consultants, ‘accurate’ (pro-industry) information concerning smoking regulations in public places and workplaces, indoor air quality and ventilation standards, and scientific claims regarding SHS. Consultants also conducted research related to SHS and organized and attended regional and international symposiums related to SHS without acknowledging industry funding. Conclusions: Despite evidence that the issue of smoke-free environments was close to emerging within the general public throughout the world in the late 1980s, the tobacco industry used its well-organized network of consultants to avoid SHS regulations in most of the world.

The tobacco industry has long known that smoke-free workplaces reduce cigarette consumption;^1–5 later research showed the magnitude of this reduction to be ∼29%.⁶ To slow the spread of the movement for smoke-free policies outside the United States, beginning in 1987 the tobacco industry, led by Philip Morris (PM), developed its ‘International ETS (Environmental Tobacco Smoke) Consultants Program’⁷ ‘to develop an international network of independent scientists who can publicly and credibly address inaccurate claims of the health effects of ETS’.⁸ As already reported,⁹ the goal of the program was to identify, develop and promote scientists, physicians and engineers who were not publicly identified with the industry who would ‘go beyond the establishment of a controversy concerning an alleged ETS health risk but to disperse the suspicion of risk’.¹⁰ The consultants were paid and managed by the industry's Washington, DC-based law firm, Covington and Burling (C&B).^7,11,12 By 1988 the Program included 81 scientists in the ‘major international markets of concern to PMI (Philip Morris International)’.^7,8 As of early 2004, no document has been located indicating that the program has been terminated.^7,11

Consultants would publish research supporting the industry's position that secondhand smoke (SHS) was not dangerous, that ventilation provided a ‘solution’ to the problem of SHS, or ‘to weigh its contribution to indoor air quality against the plethora of other substances that abound indoors’.¹³ The consultants carried out these activities through publication of scientific papers and reports, attendance at conferences and symposia (some organized and funded by the tobacco industry), and lobbying.^7,11 The industry's role was not disclosed to the public or, when it was mentioned, was minimized or obscured.^7,11,14 The first element of the project was the recruitment of consultants (sometimes referred to as ‘whitecoats’^7,15) in Europe, which was already underway by 1987,^9,14,16–20 followed by Asia, then Latin America²¹ (table 1). In 1991, the budget for the European Program was $3.3 million, for Asia, $160 000 (with $100 000 in reserve) and for Latin America, $135 000.²² Two years later the budget for the program was cut back to $3 million, ‘which represents a substantial decrease from the 1992 investment’.^7,23

The general structure of the project has been described,⁷ as well as one element, the Latin Project;¹¹ this paper extends our understanding of this important industry project by describing the European and Asian components.

Methods

Between October 2002 and February 2004 we searched tobacco industry documents on the Internet (Legacy Tobacco Document Library, http://legacy.library.ucsf.edu; Philip Morris, www.pmdocs.com; Tobacco Documents Online, www.tobaccodocuments.org). In addition, we obtained documents by visiting the British American Tobacco (BAT) Guildford Depository in England. We initially searched under ‘consultants’ and ‘international’. After identifying key players and countries, we searched using names, locations, dates and reference (bates) numbers.

PM was the main source of documents; they led the International ETS Consultants Project.⁷

Results

The European ETS Consultants Program

The Program began in Europe in 1987,⁷ and by 1989 included consultants from Belgium, Canada, France, Germany, Italy, Nordic region (Finland and Sweden) and the UK.^17,24–26 Australia is also mentioned as part of the Program.^17,24–26 According to the PM 1988 action plan for 1989–1992, Europe and ‘adjacent areas’ were divided in two tiers ‘moving from the most to least critical: (1) France, Italy, the Nordic countries (particularly Sweden and Finland), Switzerland, the UK, West Germany; (2) Austria, Belgium, Egypt, Greece, the Gulf Cooperation Council countries, the Iberian countries, Ireland, The Netherlands, Turkey’.³ By 1992, the goals of the European program were well formulated (table 2), mirroring the overall goals of the International ETS Consultants Program⁷ and the Latin Project.¹¹

The level of concern over secrecy and control of the project is reflected in the indirect recruitment strategy that the industry's lawyers used: ‘In the initial contact, the scientists are asked only concerning their availability as consultants and for a copy of their most recent curriculum vitae. Second, we now have for all of the major European countries an extensive list of additional consultant candidates, and I would like Myron [Myron Weinberg, from the Washington, DC-based Weinberg Group] to use his visits actually to get clearance to make a second contact in which he discloses that the consultancy would relate to ETS and would be on behalf of the industry’.¹⁸

In 1987 PM asked the Center for Environmental Health and Human Toxicology, a consulting firm based in Washington, DC, to ‘identify scientists in the Scandinavian region who, based on their expertise in toxicology and/or indoor air pollution, might serve as consultants to the tobacco industry in Scandinavia on the subject of health effects of environmental tobacco smoke (ETS), and the role of ETS as an indoor air pollutant’.²⁷ The Center identified eight scientists, none of whom were actively involved in research in SHS, through ‘a review of the medical and toxicological literature published in Scandinavian journals’.²⁷

The Center also recommended that the industry retained ‘at least’ one Scandinavian scientist to coordinate the local efforts, because some of the published medical and toxicological literature on ETS is not in English and some prospective consultant scientists might not publish in the academic literature, and a local scientist would be able to identify these candidates. In addition, a local scientist would have knowledge of the ‘sociopolitical [sic] aspects of science in the Scandinavian countries’,²⁷ which would also facilitate identifying institutions or scientists that would make good consultants. The Center identified Torbjorn Malmfors, MD, PhD, who at the time held an appointment as Adjunct Professor of Pharmacology at the Karolinska Institute and owned a consulting firm, to identify and coordinate the consultants' activities in the Nordic region.^28,29 Malmfors showed interest in doing so.²⁷

By 1988 the ‘mobilization’ of consultants was more advanced in the Nordic region and the UK than in the rest of Europe. The industry was motivated ‘by the deteriorating ETS trend, the industry has organized for the first time a Nordic NMA [national (tobacco) manufacturers’ association] Working Group to address the ETS issue'.¹⁶ Malmfors had agreed to be the director of the corps of consultants in the Nordic region.^18,30–32 (He also served as author for an industry study, which concluded that SHS was not a problem in airliner cabins.³³) Dr Francis Roe (Consultant in Pathology for the Tobacco Research Committee, an organization created by the tobacco industry in England³⁴), and Dr George Leslie of London (coordinator of the industry-organized Association for Research on Indoor Air, ARIA^9,35) would serve as directors of the corps of consultants in the UK.^20,30 Germany was handled by Gunter Wille from the Association of Cigarette Industries of Germany (Verband der Cigarettenindustrie, VdC) and Franz Adlkofer (Research Director of VdC).^19,32 In addition, by 1987 C&B had recruited Dr George Neurath in West Germany.³⁶ Consultants in Europe would seek individuals ‘affiliated with institutions such as the Hannover Medical School, University of Dusseldorf and Fraunhofer Institute’.³⁶

Working with the Weinberg Consulting Group, which describes itself as ‘an international scientific and regulatory consulting firm that helps companies protect their product at every stage of its life’ (www.weinberggroup.com, accessed 4 June 2003), C&B worked to approach several potential European consultants. (Interestingly, the website does not mention the tobacco industry among the Group's many clients.) Names mentioned as possible consultants included Dr Terracini, Dr Veneis, Dr Vu Duc,^37,38 Dr E. Guberan,^37,38 Dr Claude Bieva^28,37–40 and Dr Lovertfroid.^37,38,41 While we do not have a complete list of the individuals who joined the Consultant Program, table 3 includes a list of names noted as ‘consultants’ in several documents.

A Europe ETS Coordination Meeting was held in Lausanne on 29 February 1988.⁴² The first topic to be discussed was an overview of the ETS/IAQ Programme, including the selection and deployment of scientific consultants throughout European Economic Community (EEC) and Eastern Europe Middle East and Asia (EEMA) regions. In the meeting, John Rupp (C&B lawyer) and Helmut W. Gaisch (Science and Technology, PM Europe) would describe the modus operandi of the consultants (‘whitecoats’) project.⁴² According to the presentation made by Gaisch at Lausanne, consultants fall into one of three categories: (i) university staff (professor, reader, docent, etc.); (ii) professional consultants (many university professors have a consultancy firm⁴³); and (iii) members of a chartered research institution [e.g. Netherlands Organization for Applied Scientific Research (TNO)].

The PM 1988 action plan for 1989–1992 outlines what the industry hoped consultants would accomplish: they ‘should be appropriately encouraged to prepare papers, participate in scientific societies with relevant areas of interest, and take active roles in scientific conferences. Where possible, without compromising a scientist's effectiveness, they should be encouraged to provide statements or testimony for use before government commissions and information to the media. The industry should encourage and/or indirectly support scientific conferences, such as the recent ‘Perry Conference’ in London [emphasis added].'³

The Perry Conference was held at the Imperial College of London between June 13 and 15, 1988. Presentations at the conference were later written into chapters for the book Indoor and Ambient Air Quality, edited by Dr Roger Perry (UK consultant¹³) and Peter W. Kirk (Imperial College of London).^44,45 Chapter authors include tobacco industry consultants such as Peter Lee (Statistics and Computing Ltd, UK), Adlkofer (Germany) and Christopher Proctor (BAT, UK). The conclusion of the chapter on ETS in indoor air written by Kirk agrees with the industry rhetoric that SHS is just another indoor air pollutant: ‘Results from non-smoking environments showed that there are sources of particulate matter and carbon monoxide other than ETS’.⁴⁵ Similar to other industry-funded symposia,⁴⁶ the Perry Conference made the industry argument that SHS is not a major contributor to indoor air pollution.

As described by Muggli et al.,⁷ consultants would attend, organize and monitor scientific meetings. In Europe we found three examples of scientific meetings. First, a meeting sponsored by industry-formed Indoor Air International (IAI).⁷ The 1992 overview of the European program notes that a major meeting was held in Athens in April. ‘The meeting offered more than 100 papers, including many of value to us. There was widespread radio, TV and press coverage, and contacts with governmental officials. A book and a special journal issue resulted’.¹⁵ The meeting was titled ‘Quality of the Indoor Environment’.^47–49

A second conference, ‘Present and Future of Indoor Air Quality’, held in Brussels, Belgium, in February 1989 was sponsored by PM.^50,51 Industry consultant Claude Bieva was part of the scientific and organizing committee and edited the proceedings from the conference.^52,53

Bieva was the Conference Director and Local Coordinator of the International Conference ‘Building Design, Technology & Occupant Well-Being in Temperate Climates’, held in Brussels in February 1993.^54–56 PM support of this conference was through the American Society of Heating, Refrigerating and Air-Conditioning Engineers, Inc. (ASHRAE), whose support was acknowledged in the brochure.^57,58 (The tobacco industry has devoted considerable effort to influencing ASHRAE, which writes ventilation standards.⁵⁹)

According to a 1988 memo from Andrew Whist (PMI Senior Vice-President of External Affairs, 1986) to R. William Murray (PMI President and Chief Operating Officer, 1987–1989), at first consultants would serve as editors and contributors of three books. The first, Clearing the Air, which at the time was already published in the US, dealt with health effects of ETS, policy and freedom related to ETS, and ‘contains the first anthology of medical statements on ETS’.⁸ The second book was expected to be published by Cambridge Press in the UK and would deal with health issues and ETS only. The third, to be published in France or Germany, would deal with indoor air quality.⁸

Noteworthy is the ability of the industry to orchestrate a worldwide program, in which consultants from different countries will serve not only their own countries, but overseas as well. As noted the 1992 ‘Overview of the Strategies and Goals of the European Consultant Program’: ‘The European program has long offered major support to the consultant programs in Asia and Latin America. European consultants are frequent participants in Asia and Latin America programs, and offer suitable opportunities for Asians and Latins to appear in Europe.’¹⁵

Despite the ability of the industry to organize the European ETS Consultants Project, a 1997 memo from Ted Sanders (Scientific Affairs EU/EEMA Region) to Richard Carcham (Scientific Affairs Director) and Helmut Reif (Director of Science & Technology, Fabriques de Tabac Reunies, Philip Morris Research and Development facility in Nuechatel, Switzerland), noted: ‘we [scientific affairs] are not getting our money's worth from our consultants. Again, there are many reasons—historical and otherwise—to account for this. Perhaps the most important reason is that it is extremely difficult to obtain good consultants for the tobacco industry.’⁶⁰

The Asia ETS Consultants Program

In Asia, the project was active in 1989, supervised by C&B's Rupp.^13,61,62 Supporting companies were PM, R. J. Reynolds (RJR), BAT/Brown & Williamson (B&W) and Japan Tobacco Incorporated (JTI) (table 1).^12,13,23,63 Four initial target markets were selected: Hong Kong, Philippines, Taiwan and Korea. During the last 2 months of 1989 recruitment efforts were expanded to China, Malaysia, Singapore, Indonesia and Japan. The proposed 1990 budget for Asia was $800 000.⁶⁴ Recruitment costs (budgeted) were $135 000, an additional $60 000 were allocated for ‘regional meetings, informal training sessions and consultants fees for reviewing pertinent literature’.⁶⁵ By February 1990 the project had already recruited 13 consultants (table 4).^65,66

Developing a close relationship with academic and health associations is a strategy used by the tobacco industry to gain credibility through third party spokespersons.¹¹ In Asia, the industry developed a close relationship with the Asian Association of Occupational Health (AAOH), which is described by Rupp as formed by scientists from Asian countries as well as from New Zealand, Australia, India and several Middle Eastern countries. The relationship was through consultants Dr Benito Reverente (Philippines, past AAOH president), Dr Malinee Wongphanich (Thailand, president of AAOH in 1990) and Dr Fengsheng He (China, who would succeed Wongphanich in 1991). In addition, Reverente would chair a new committee on indoor air, with Dr Sarah Liao (Hong Kong) and Dr Yoon Shin Kim (Korea) in the committee, which will also organize a ‘one-day satellite symposium on indoor air pollution at the association's [AAOH] next regional meeting’.⁶⁵ In 2002, at the same time that the government was considering expanding regulations on indoor smoking, consultant Liao was appointed Secretary of the Environment, Transport and Works Bureau in Hong Kong.⁶⁷ The Bureau is responsible for policy matters on environmental protection and conservation.

As in Latin America, Asia consultants would make a list for distribution of the ‘McGill monograph’.^64,65 This book, Environmental tobacco smoke: Proceedings of the International Symposium at McGill University,⁶⁸ is a result of a 1989 industry- sponsored symposium on SHS at McGill University in Montreal.^7,9,11 Asian consultants Liao, Bacon-Shone, Reverente and Kim attended and participated in McGill symposium.^13,65 Conclusions of the monograph are typical of the industry's rhetoric: it concluded that available data when ‘critically examined and evaluated, are inconsistent with the notion that ETS is a health hazard’. Just as in Latin America, where the monograph was translated to Spanish,¹¹ translation in Asia would be done by Kim and then submitted to scientific journals.⁶⁵

Consultants were also active in publishing articles, as well as reaching the media. The editorial board of the journal of IAI included Asian consultants Bacon-Shone, Ferrer, He, Kim, Liao, Liu and Reverente.⁶⁵ In 1991, consultants Liao, Bacon-Shone and Kim published a paper titled Factors Influencing Indoor Air Quality in Hong Kong: Measurements in Offices and Shops.⁶⁹ The paper, published in the journal Environmental Technology, concludes that ‘tobacco smoking indoors seems to be relatively rare in these environments and does not play a significant role in indoor air quality’.⁷⁰ In 1996, Koo published a paper⁷¹ in the journal Lung Cancer related to the role of diet as a confounder between air pollution and female lung cancer in Hong Kong. This critique of previous published studies on the topic found that ‘it is unlikely that ETS exposure would explain the unusually high lung cancer incidence among nonsmoking Chinese women in Hong Kong’. Regarding media outreach, in Korea consultant Kim appeared on ‘television and radio as an expert on air pollution issues, both ambient and indoors’. Dr Kim, in 1990, would also be appointed to the Korean Air Pollution Research Association.⁶⁵ Consultant Koo also received considerable media attention.^72,73 Quoted in the Hong Kong Sunday Morning Post, she claimed that lung cancer among Chinese people is due to ‘the food they ate rather than smoking or passive smoking’.⁷²

Asian consultants were also involved in lobbying. In Malaysia a letter by C&B's Philip Tamussino to Malaysian tobacco industry representatives notes that project: ‘implementation for 1994 is, of course, to be coordinated with local industry lobbying efforts. In particular, this concerns the current legislative position after the passage of the Control of Tobacco Regulations’;⁷⁴ and that this legislative situation was: ‘expected to remain stable for the next several years. This stability is seen to depend, however, on the understanding reached between the industry and the Malaysian government’.⁷⁴ In addition, the consultants would focus on ‘deepening the scientific understanding of ETS/IAQ issues’ and ‘strengthening contacts with government officials’.⁷⁴

The strategy of using consultants to organize, monitor and attend scientific meetings used in Europe and Latin America was also used in Asia. A 1989 fax from C&B lists all conferences attended or scheduled to attend by consultants. It included 34 conferences from December 1988 to November 1990, mostly related to indoor air and health, such as the meeting of the British Aerosol Society and the American Heart Association.⁷⁵ Korean consultant Kim hosted in Seoul an international symposium on ‘Environmental Health and Protection in the 1990's’, which ‘may provide us with a further opportunity to convey our basic message on ETS’.⁶⁵ In 1991, through IAI, the ‘International Conference on Indoor Air Quality in Asia’ was held in Bangkok, Thailand. Every member of the organizing committee was a tobacco industry consultant. Reverente was the Chairman, and the rest of the committee were He, Kim, Liao, Wongphanich and George Leslie (UK consultant).⁷⁶ In addition, Reverente, Weetman and Wongphanich edited the proceedings of the conference, which were published by IAI in 1993.^77–79 As noted by Rupp, ‘the report documents the wide range of problems with which Asian governments must contend having nothing to do with ETS’.⁷⁸ In the preface they acknowledge that the conference was organized by IAI and that this is the first book published by IAI; there is no mention of any financial support by the tobacco industry.

In 1995, Roe (UK consultant⁸⁰) monitored the ‘Asia-Pacific Conference on the Built Environment’. This conference was held in Singapore in June 1995 and jointly organized by the Singapore Association of ASHRAE members and the Institute of Environmental Epidemiology, Ministry of the Environment, Singapore.⁸¹ In his report on the meeting, Roe wrote summaries of each of the key note speakers presentations, regardless of their anti-tobacco message.⁸²

The conference ‘Healthy Buildings’ was a 4-day international conference focused on ‘systems, materials and policies relating to the improvement of indoor air quality and included a major section planning on ‘healthy’ buildings’,^83–85 another tobacco industry theme.

As in Europe and Latin America, Asian consultants would conduct indoor air research. The 1990 budget proposal includes the ‘Asia Cities Monitoring Project’ that would: ‘focus first on Hong Kong and then move to Manila, Seoul, and possibly Tokyo, in essentially that order. The purpose of the project is to collect baseline data on indoor air pollution at three site categories (office buildings, street level retail establishments and public transport facilities) and to compare those baseline data with ambient air pollution levels in the same general locations. We expect the project to show that ambient air pollution (particularly pollution from motor vehicles) is a serious problem in the target Asian cities and that the much less serious indoor air pollution problems that exist in those cities are, in turn, caused largely by pollutants generated outdoors. Such data would be of substantial value in discussing with Asian officials sensible priorities on air pollution and other environmental issues.’⁶⁵

Dr Chris Proctor (BAT) was to assist on the project with Dr Roger Perry (Imperial College). The initial budget (1990) for the project was $125 000, with the project conducted by Liao, Bacon-Shone and Koo.⁶⁵

In a memo from Tamussino four projects are described for Malaysia in 1994. These projects are: (i) a British Council seminar; (ii) a limited volatile organic compounds testing project; (iii) follow-up meetings by Professors Perry and Leslie with Malaysian government officials; and (iv) the continued distribution of indoor air/ETS-related materials.⁷⁴

Funding for the projects would be from the ‘central budget of the ETS Consultants Program’.⁷⁴

Discussion

These results from tobacco industry documents indicate in detail, beyond that already described,⁷ how the tobacco industry organized a network of consultants on ETS in Europe and Asia, just as they did later in Latin America.¹¹ Through the Washington-based law firm, C&B, the tobacco industry, led by PM, identified and recruited scientists in various fields in order to gain access to credible spokespersons to argue against smoking restrictions. The aim was that scientists would conduct, publish and distribute research that agrees with the industry's position that SHS does not pose a health risk. Europe was the first region where PM began organizing the worldwide program in 1987.

The fact that consultants would be involved in lobbying activities deserves further research in each country where the ETS program was active. As shown in Argentina, where President Menem vetoed an anti-tobacco law after lobbying by consultant Carlos Alvarez,¹¹ industry consultants can play a vital role in obstructing tobacco control legislation. The industry consultants' involvement in the editorial board of the journal of IAI is similar to situations in Latin America, where they recruited Maria del Rosario Alfaro (Costa Rica), who at that time was the editor of the journal Ciencias Ambientales (Environmental Sciences; journal of the School of Environmental Sciences at the National University of Costa Rica).¹¹ These strategically placed editors allow the industry to influence the academic literature. These publications complement industry-funded symposia⁴⁶ and scientific meetings around the world. Two of these meetings have been documented in Latin America, one in Ecuador and one in Argentina.^7,11 As our results show, these meetings also happened in Europe and Asia. As previously documented, the industry uses these meetings as a venue to publicize their consultants and get the media educated on the indoor air quality issue.¹¹

Co-opting academic organizations is also a strategy used by the industry to gain a credible third party spokesperson. In Latin America they did so through the National Academy of Sciences of Buenos Aires.¹¹ In Asia it was through the AAOH. In both cases, tobacco industry consultants held high ranking positions, gaining another venue to make a case in favour of the industry.

Of particular relevance is the fact that the International ETS Consultants Project was organized in the late 1980s in response to serious concern by the tobacco industry that the issue of smoke-free environments was about to start moving in these countries. A PM 1988 draft of ‘an action plan for ETS in Europe and adjacent areas, 1989–1992’ notes: ‘erroneous perceptions of the issue [ETS] increase the social pressure against smoking, encourage non-smokers to become anti-smokers, and foster an atmosphere conducive to both governmental and private restrictions upon smoking’.³ In addition, it notes that the ETS issues ‘are not localized within any country or region’.³

ETS questions cut across national and marketing boundaries. Accordingly, ETS issues can be most effectively addressed by a coherent and well-coordinated program (coordinated both within PM and with other elements of the industry) that mobilizes all the international resources of the entire industry.³

As summarized by Keith Ware (PM EEMA) in a 1988 letter to Gaisch, the project had two goals: to ‘resist and roll back smoking restrictions’ and ‘restore smoker confidence’.^86,87 In short, the industry believed that the ground was fertile for substantial progress in smoking restrictions throughout the world. The industry's efforts succeeded in forestalling this progress; as of the end of 2003 none of these countries had realized the relevance of smoke-free laws to halt the tobacco epidemic.⁸⁸

The tobacco industry has been a major player in the delay of the adoption of key tobacco control measures, in this case, smoke-free environments. Its worldwide consultants program was successfully orchestrated to avoid industry exposure. Health-care professionals around the world should be aware of and denounce such tactics. Failing to do so will only delay even more the adoption of smoke-free environments, contributing to depriving the general population of a clean air environment.

This work was supported by the American Legacy Foundation and National Cancer Institute Grant CA-87472. S.A.G. is a Cahan Distinguished Professor of the Flight Attendants Medical Research Institute. This work was presented at the American Public Health Association meeting in November 2003.

References