Accepting tobacco industry money for research: has anything changed now that harm reduction is on the agenda?

The tobacco industry has a long track record of attempting to distort research, while continuing meanwhile to profit from a business which destroys lives on a large scale. Because of this, several major grant-giving bodies (including the major supporter of cancer research in the United Kingdom, Cancer Research UK) will not provide funding to those in receipt of tobacco industry money. This editorial examines the rationale for this policy in the context of what appear to be efforts by the tobacco industry to rehabilitate itself through harm reduction initiatives and generous ‘no strings’ research grants and Corporate Social Responsibility programmes. Cambridge University’s announcement in 1996 that it was setting up the Sheehy Chair of International Relations [named after the retired Chairman of British American Tobacco (BAT)] was greeted with dismay by academics and public health practitioners alike. A predecessor to Cancer Research UK, the Cancer Research Campaign (CRC), felt the need to examine how its funds could be protected from contact with tobacco industry funding. It circulated a consultation document to all UK universities entitled ‘Breaking Addiction to Tobacco Industry Funding’. The CRC received extensive support for its proposed policy to refuse funding to any research team in receipt of, or sharing resources with those in receipt of, tobacco industry funding. This policy was endorsed by the governing body of UK universities. Then, in 1999, Nottingham University announced it was setting up an International Centre for Corporate Social Responsibility (CSR), with £3.8 million from BAT. Once again academics and the public health community expressed their strong disapproval. The editor of the BMJ, Dr Richard Smith, organized a poll on the BMJ website and of 1075 votes cast, 84% said that Nottingham University should return the tobacco industry money. Dr Smith also resigned his visiting professorship at Nottingham University. A CRC research team chose to relocate, and local CRC volunteers decided not to fund-raise for a proposed research building at the University [1–2]. The policy was reviewed in 2002. There was, by then, a growing body of evidence from internal tobacco industry documents, released on the internet as a result of litigation in the United States, of the industry’s attempts to interfere with legitimate research processes. Claims to have changed appeared little more than an attempt to gain credibility and respectability [3]. Since the second report was produced, studies have continued to show how the industry has sought systematically to distort the scientific evidence on the harmful effects of tobacco, especially in relation to second-hand smoke (SHS). Scientists have been recruited and paid to speak at scientific and political forums, and to write letters and papers disputing the evidence on the harm caused by tobacco and by second-hand smoking [4–10]. Attempts have been made to infiltrate scientific institutions such as the International Agency for Research into Cancer (IARC) [leading to a top-level World Health Organization (WHO) investigation][8]. Studies have been commissioned with the aim of casting doubt on the evidence of the harmful effects of SHS either by producing findings counter to major influential studies [9] or by proposing other confounding factors, such as diet, as being the harmful factors [8]. Attempts have been made to cast doubt on accepted scientific methods, e.g. putting forward the notion of ‘good epidemiological practice’ in order to question agreed findings on SHS [4,11,12]. Various bodies have been funded to publish studies, hold symposia, etc. that criticize the accepted evidence on SHS, e.g. the European Science and Environment Forum, the Centre for Indoor Air Research [6–8]. Misleading press statements have been sent out, e.g. on the WHO passive smoking study [8]. In many cases, tobacco industry funding has not been disclosed [8,10,13]. Studies on SHS funded by the tobacco industry have been criticized, by epidemiologists not in their pay, on the grounds of: selective use of the existing literature; selective use of potentially biasing factors; failure to consider overall plausibility; and drawing conclusions unwarranted by the evidence [14,15]. A review of 106 published reviews of SHS studies found that 37% had concluded that SHS was not harmful to health, of which 74% were authored by scientists affiliated with the tobacco industry. Controlling for a number of factors relevant to the scope and overall quality of the reviews (whether or not they were systematic reviews, whether they were subject to peer review, relevance of specific review topic and year of publication), the only factor found to be associated with showing no harm was having an author with a tobacco industry affiliation [16]. Similarly, a review of 97 studies that made statements on the economic impact of SHS legislation found that 32% (31) were funded by the tobacco industry or an industry-linked group. Four quality criteria were applied (use of objective data, use of all available data points both before and after legislation and whether or not secular and overall economic trends were controlled for). Of the industry-supported studies, 26/31 met none of these criteria, whereas 21/60 clearly non-industry-supported papers met all four. All the studies that found a negative economic impact were funded by the tobacco industry or a linked source. Finally, 94% of industry-supported studies compared to none of non-industry-supported studies concluded a negative economic impact [17]. The American Lung Association has made a further assessment of the methodological biases seen in tobacco industry-funded studies on the economic impact of SHS regulation [18]. Using evidence from internal industry documents available on the internet, a recent review of the papers on indoor air quality and SHS published in the journal Indoor and Built Environment has revealed extensive links to the tobacco industry [19]. During the period January 1992–February 2004, a time of considerable growth in evidence on the harmful effects of SHS, two-thirds of the editorial board of the journal had histories of financial associations with the tobacco industry. Of 484 papers on the topic of SHS published in the journal over that period, 61% reached conclusions that could be judged to be positive to the industry. Of these, 90% had at least one author with a history of association with the tobacco industry. More recently still, tobacco-industry funding of a key paper, that questions the evidence on SHS and sudden infant death syndrome, has been uncovered [20]. Research into tobacco industry interest in the p53 tumour suppressor gene is also revealing [10]. In a review published in 2005, Bitton and colleagues showed from internal documents how the industry sought to confuse evidence linking a carcinogen in tobacco smoke with gene mutations found in human lung tumours. Research published in 1996 by Denissenko and colleagues had shown that the mutagenic effects of benzo[a]pyrene on p53 in vitro correlated strongly with the p53 mutations found in human lung cancers. The internal documents show that executives and scientists at the highest level of the tobacco industry anticipated and carefully monitored p53 research. The tobacco industry’s own scientists conducted research which appeared to cast doubt on the link between smoking and p53 mutations. Researchers and a journal editor with tobacco industry ties participated in the publication of this research in a peer-reviewed journal, without clear disclosure of their tobacco industry links. Perhaps more important than all this, colleagues in Central and Eastern Europe, Africa, Asia and South America are still struggling against an industry that continues to engage in promotional activities that would simply not be allowed in countries with good tobacco control policies. Some would suggest that there are common interests between tobacco control researchers and the tobacco industry, as suggested by a workshop held in 2003 [21] and a recent Science commentary [22]. However, it is important to remember that the imperative for the tobacco industry is to generate maximum profits for its shareholders and the main way it can do this is by selling more of its product, and continually recruiting new smokers to replace those it kills. Until the tobacco industry was found out, it appeared to manifest no concern over the scale of the harm it was doing to the world’s population. There is no reason to believe that without the pressure it is currently under it would have changed that attitude. It has been proposed that it is acceptable to take funds from the tobacco industry. However, to believe that it will not seek to manipulate the research and public relations agendas flies in the face of evidence from its track record and is counter to its own interests. Unrestricted grants sound attractive but researchers need to remember that they are dealing with hard-headed businessmen. If they are giving £4 million in an unrestricted grant they expect to receive at least that much back in terms of selling tobacco products. One way they can do this is by parading alliances with reputable institutions as some kind of endorsement that they are not so bad after all. There are those who feel that a ‘mutually beneficial’ harm reduction research agenda can be funded directly by the tobacco industry; but such links give the industry a credibility and respectability it does not merit. The very same industry that is pursuing the harm reduction agenda in countries with strong tobacco control measures is aggressively promoting its addictive, lethal products elsewhere in the world. So far as when it will be acceptable to deal directly with the tobacco industry, this cannot be until the abuses stop. It has taken decades to find out about the tobacco industry’s bad practices and, even if it were to embrace genuine change now, it would take many years, and a system of transparency and independent regulation, before the public health community could trust it. The global tobacco pandemic can be likened to a bush fire raging out of control. The arsonists claim they want to help put it out and even to be admitted into the fire control operations room. Yet they are still fanning the flames and starting new fires around the world. That tobacco industry resources and scientific knowledge are both required for harm reduction research is not in dispute. How these should be accessed is, however. Given the evidence of manipulation of scientific processes and findings by that industry, it cannot be allowed to have any control over, or gain any credibility or respectability through association with, that research. Thanks go to David Simpson, Claira Bannon, Rosanna Roughley and Elspeth Lee for commenting on this manuscript. Vice Chair of ASH, employee of Cancer Research UK.