Can we trust Big Tobacco to promote public health?

There’s a new catchcry in public health: people working in tobacco control should join with Big Tobacco to promote “safer” tobacco products.

It runs like this: before starting work each morning, tobacco company employees sing with gusto the company song “Thank you, thank you, addictive nicotine”. But they really hate the small problem that smoking kills around two in three of its long-term users early. Just think of all the lost revenue from those collective millions of smokers who die an early death.

So for decades tobacco companies have been busy trying to get their chemists and engineers to develop “safer” (ie less dangerous) products, e-cigarettes being the latest kid on the block.

The public health community has always seen the tobacco industry as the largest vector for lung cancer and all the other diseases caused and exacerbated by smoking. This is why the World Health Organization’s Framework Convention on Tobacco Control – now ratified by every country in the world except Cuba, Haiti, Argentina, Mozambique, Switzerland (headquarters to Philip Morris International) and the US – has a whole section (Article 5.3) detailing how governments should work to combat tobacco industry interference in tobacco control. I contributed to a background document on the many ways the tobacco industry tries to gut tobacco control at every turn.

Shifting the focus

The new catchcry proposes Big Tobacco really, really wants to stop selling its deadly products and have all its smokers, in time, switch over to its we-are-not-yet-sure-how-much-but-probably-less-deadly products.

It emphasises the only real goal tobacco control should have is to reduce disease caused by using tobacco products. And guess what? This now turns out to be a shared goal: Big Tobacco and public health both want the same thing so they should forget all the mistrust and animosity of the past, welcome the industry to the table, invite them to conferences, share data and embrace them as partners.

Unfortunately, the catchcry is profoundly myopic. No, let’s not muck around. It displays weapons-grade naivety and ignorance in those promoting it, as this opinion piece shows.

Has Big Tobacco really changed?

Here is why the “they’ve changed” argument about Big Tobacco hits the rocks.

Can anyone name a single example of any Big Tobacco company taking its foot off the accelerator of aggressive opposition to any policy that promises to effectively reduce its core mission: selling more cigarettes?

Philip Morris tried and failed recently in a legal case to gut Uruguay’s tough, comprehensive tobacco control program. The company was doubtless attempting to bully a minnow nation into submission, to send a loud message to any other small nation silly enough to get ahead of itself with such policies.

All tobacco companies fight with all they have to stop tax rises. Just go to British American Tobacco (BAT) Australia’s twitter feed, where tweets about illicit tobacco feature heavily. Here’s an example:

But why is BAT so obsessed with illicit tobacco? The company is trying to get public brownie points by showing it’s concerned about tax lost to illicit trade. Its main agenda is it wants the government to stop raising tobacco tax. It knows that a tax-reduced lower prices will increase tobacco sales like nothing else, particularly to low income groups like the poor and kids. Tax is the single most effective policy in reducing use, which is why Big Tobacco gives such priority in its lobbying to trying to defeat tax rises.

All the main transnationals poured millions into trying (and failing) to stop Australia’s pioneering plain packaging legislation. Go figure why they tried that.

And as recently as December 2016, BAT wrote this appalling letter to the Hong Kong administration trying to stop graphic health warnings going ahead. This was from a company which, published in its 2016 financial results statement a call to “champion informed consumer choice”.

Informed, yes, but please we don’t want smokers to see pictures of what smoking does to you and be THAT informed.

Big Tobacco would love its new generation products to sell well. But down the corridor from its harm reduction division are its cigarettes, financial and executive divisions that know which side the corporate butter is spread thickest. The only possible conclusion is Big Tobacco’s goal with reduced risk products is not to cannibalise its own core product, but to try and promote dual use (cigarettes and e-cigarettes): “smoke when you can, and vape when you can’t”.

Cigarettes still core business

Three of the world’s biggest tobacco transnational companies have very recently affirmed that cigarettes will remain their “core” business.

Philip Morris says:

…cigarettes, our core product.

Imperial says:

Our core business is built around a tobacco portfolio…

BAT says:

Tobacco will be a core part of our business for many years.

BAT chief executive officer, Nicandro Durante said recently the company expects to continue to boost sales of traditional cigarettes in several key markets, pointing to (paywall) the fastest growing areas:

Places like Vietnam, the Philippines, and Indonesia — there are many opportunities out there.

He added that BAT derives more than half of its total revenues from emerging markets.

No firewall between ‘good’ and ‘bad’

The Royal College of Physicians of London wrote recently (p188):

There is no firewall between a “good” tobacco industry that is marketing harm-reduction products in the UK and a “bad” one that promotes smoking, or undermines tobacco control activities, in low- and middle-income countries.

It’s report continued:

Tobacco companies make their money by selling tobacco, and the industry’s recent programme of investment and acquisitions in e-cigarettes perhaps indicates recognition that these products represent a disruptive technology that should be harnessed to protect the core business of selling tobacco, exploited to expand tobacco markets or developed as an opportunity to make nicotine products attractive to non-smokers. There is little likelihood that the industry sees e-cigarettes as a route out of the tobacco business, but it is highly likely that e-cigarettes will be exploited to enhance claims of corporate social responsibility, and to undermine implementation of Article 5.3 of the World Health Organization Framework Convention on Tobacco Control.

Those who believe the tobacco companies are born-again public health angels with the advent of e-cigarettes have little to say about Big Tobacco’s business as usual with cigarettes. It’s a bit like arguing that we should pat a mafia boss on the back for donating a few hundred thousand dollars to a drug rehabilitation clinic while it’s business as usual during the rest of his week.