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New York–based Philip Morris International (PMI), which sells cigarettes and other tobacco products in 180 countries outside the United States, announced in September that it would contribute a total of $960 million over the next 12 years to the Foundation for a Smoke-Free World. The money is supposed to fund research “that advances the field of tobacco harm reduction and reduces the public health burden of smoking-related diseases,” as set forth in the foundation’s bylaws.
Criticism of the new foundation and its funding source was swift, with skeptics from leading health organizations and research institutions questioning PMI’s motives as well as the ethics of using profits from a product responsible for about 1 in every 5 US deaths to fund health research.
“There are a number of clear conflicts of interest involved with a tobacco company funding a purported health foundation, particularly if it promotes sale of tobacco and other products found in that company’s brand portfolio,” the World Health Organization (WHO) said in a statement. “WHO will not partner with the Foundation. Governments should not partner with the Foundation, and the public health community should follow this lead.”
The International Union Against Tuberculosis and Lung Disease called the foundation “a billion-dollar bribe the tobacco company hopes will secure it a seat at the table with the public health policymakers around the world.”
In late January, the deans of 16 US and 1 Canadian schools of public health similarly issued a statement saying their institutions would not work with the foundation. “Our schools of public health consider funding from the Foundation for a Smoke-Free World to be equivalent to funding from the tobacco industry and, as a result, we are not collaborating with the Foundation,” they wrote.
But the 17 deans that have signed the statement so far represent only a minority of accredited public health schools and programs.
“Will people take their money? Yes,” said Cheryl Healton, DPH, dean of the New York University College of Global Health.
Healton has not yet signed the statement because it is still under review by an ad hoc faculty committee at her institution. “Will the best and the brightest take their money? I don’t think so. Will the ethical take their money? I don’t think so.”
The new foundation is not the tobacco industry’s first foray into funding researchers who aren’t on its payroll.
“When the announcement came out about the formation and funding of this foundation, it drew our attention because of the long, long sordid history of the tobacco industry [undermining] research and policies,” said Ellen MacKenzie, PhD, dean of the Johns Hopkins Bloomberg School of Public Health, who instigated the statement from the public health school deans.
That history dates back more than half a century. In 1954—around the time that the first scientific studies of smoking’s health effects began to appear—the tobacco industry, led by Philip Morris, created the Tobacco Industry Research Committee to investigate reasons other than smoking that could explain why lung cancer is common among smokers.
“It operated mainly as a propaganda generator, giving grants to friendly scientists who knew which side of the bread was to be buttered,” according to an article on the Center for Media and Democracy’s tobacco portal, funded from 2006 to 2009 by the American Legacy Foundation (now called the Truth Initiative), established as part of the 1998 Master Settlement Agreement (MSA) between the major US tobacco companies and virtually all state and territory attorneys general. In 1964, the Tobacco Industry Research Committee was renamed the Council for Tobacco Research, which continued to fund scientists until the MSA shut it down in 1999.
“I think the historical context is really critical here,” said Jonathan Samet, MD, pulmonary specialist and epidemiologist who serves as dean of the Colorado School of Public Health and signed the public health school deans’ statement. According to Samet, the tobacco industry has never funded research “that did not turn out to be misleading or dedicated to the industry’s purpose and goals.”
“Philip Morris, they have skin in the game here,” MacKenzie added. “I think Philip Morris has seen the writing on the wall with regard to cigarettes.”
Indeed, the company’s website states repeatedly that it aims to stop selling cigarettes. “We’re building PMI’s future on smoke-free products that are a much better choice than cigarette smoking,” according to an article on the PMI website.
Already, the company markets IQOS, which heats instead of burns tobacco, in about 3 dozen countries outside the United States. Citing a lack of evidence, though, a US Food and Drug Administration (FDA) advisory panel in January voted unanimously, with 1 abstention, against approving PMI’s request to claim that IQOS is less risky than cigarettes. Even if the FDA follows the panel’s advice, it could still approve PMI’s application to market IQOS in the United States.
However, PMI and the foundation it supports have failed to demonstrate that they truly want to reduce the use of cigarettes, said Mike Daube, professor of health policy at Curtin University in Perth, Western Australia, who has long been involved in tobacco control.
Daube noted that the foundation’s recent global survey of smokers asked about heat-not-burn tobacco products and e-cigarettes but not about cigarette taxes and advertising bans, both of which have helped drive down smoking rates. Meanwhile, he said, PMI has a history of suing governments to block public health efforts to reduce smoking, such as graphic warnings on cigarette packages.
Foundation president Derek Yach, MBChB, MPH, says he conceived of the nonprofit when he was invited to meet with PMI Chief Executive Officer Andre Calantzopoulos and tour the company’s research facility, staffed by hundreds of former pharmaceutical company scientists, on the shores of Lake Neuchatel in Switzerland.
“I was deeply shocked at what I saw. I was deeply shocked at my own ignorance,” recalled Yach, a former executive director for noncommunicable diseases and mental health at WHO. “They really want to accelerate an end to smoking.”
Yach said Calantzopoulos asked: “What would it take for people in public health to truly believe that we are going to make combustibles history?” Yach suggested that PMI invest in an independent foundation. “From then on, it was just a question of how much [to invest],” he said, acknowledging that “when I first started these discussions, I was as queasy as many of my colleagues are today.”
So, Yach said, he anticipated skepticism toward the foundation but not what he describes as “bullying and scientific harassment.”
In March, the 17th World Conference on Tobacco or Health, held in Yach’s hometown of Cape Town, South Africa, banned him and anyone else from his foundation from attending. The conference’s admission policy bans individuals with tobacco affiliations, either currently or in the previous 5 years. The policy aligns with WHO’s Framework Convention on Tobacco Control, which states that “there is a fundamental and irreconcilable conflict between the tobacco industry’s interest and public health policy interests,” according to a statement from the conference.
“We now have folks with the best intentions in the world running ad hominem attacks,” Yach said of foundation critics. “The tragedy, of course, is that you’ve got people inside all of these institutions saying, ‘We want to work with you.’”
According to Shawnmarie Mayrand-Chung, PhD, public health institutions have overreacted to PMI’s funding of the foundation. “Clearly, there is a fair amount of skepticism about the motives of the tobacco industry, but changing perceptions takes time,” said Mayrand-Chung, who previously worked at the National Institutes of Health and the FDA. “Very few organizations have the interest and monies to fund this type of research, other than the big tobacco companies.”
Mayrand-Chung, who now works as a consultant based in Lausanne, Switzerland, home of PMI’s worldwide operations center, recently helped a client develop a grant application that was turned down in late April by Yach’s foundation. Her client was seeking funds to do more research on a new vaping product he had developed.
She said she knows of many others who would like to apply for grants from the foundation but can’t because their institutions won’t let them. “You can easily get tainted in this field,” Mayrand-Chung said. “There are people who stand to lose more than others.”
Jed Rose, PhD, coinventor of the nicotine patch, called the criticism of the foundation “unfair and misguided.”
“The suspicions are born of a forgone era,” said Rose, director of the Duke University Center for Smoking Cessation, who has received funding over the years from PMI and Philip Morris USA. “The real enemy is death and disease caused by smoking,” not the tobacco industry.
Today, Rose said, his center is funded exclusively by National Institutes of Health grants. Still, he said, “I would not hesitate to apply for funding from the foundation. The merits of accepting funding to do public health [research] outweigh the risks.”
However, recent reports suggest that long-held suspicions may still be well-founded. Shortly before the foundation was formally launched, Reuters News Agency published an investigation, based on internal PMI documents, that concluded the company has been trying to weaken Framework Convention on Tobacco Control provisions curbing tobacco use. Ironically, Yach helped develop the tobacco control convention, which coordinates global efforts to combat tobacco use.
In a recent JAMAViewpoint, published a few months before the formal launch of Yach’s foundation, Sandro Galea, MD, DrPH, dean of the Boston University School of Public Health, and his coauthor wrote: “Schools of public health should not accept money if doing so pushes them to be something that is not consistent with their mission to promote the health of the public.”
However, Galea says he needs more information about the smoke-free foundation before deciding whether to sign a statement that his school will not accept its money. “I think all money comes with conflicts,” he said. “Should we take money from large conglomerates where part of their manufacturing goes to building parts of weapons?” To help inform him and his faculty and students, Galea said, he has invited Yach and Daube to speak at a symposium on campus in the fall.
As of mid-June, the foundation had not yet announced the recipients of its first round of grants. “My guess is that they’re going to fund some of the zealous supporters of e-cigarettes and people who haven’t really worked intensely on tobacco,” said Matthew Myers, president of the Washington, DC–based Campaign for Tobacco-Free Kids, which works in about 25 countries around the world.
While PMI may be developing smoke-free alternatives, Myers said, he has never seen the company market combustible cigarettes as aggressively as it is now.
“One of my strongest criticisms of the foundation is they did not demand, as a condition of accepting the money, a real change in Philip Morris’s business practices,” Myers said. “In the absence of Philip Morris agreeing to do that, it is obvious that this grant is a diversion to make it appear that they are part of the solution, not the problem itself.”
Note: Source references are available through embedded hyperlinks in the article text online.
Rubin R. New Foundation Revives Debate About Health Research Funded by Big Tobacco. JAMA. 2018;320(2):123–125. doi:10.1001/jama.2018.6975