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Hendlin YH, Han EL, Ling PM. Pharmaceuticalisation as the tobacco industry's endgame. BMJ Glob Health 2024; 9:e013866. [PMID: 38316465 PMCID: PMC10859997 DOI: 10.1136/bmjgh-2023-013866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 11/27/2023] [Indexed: 02/07/2024] Open
Abstract
CONTEXT Declining smoking prevalence and denormalisation of tobacco in developed countries reduced transnational tobacco company (TTC) profit during 1990s and 2000s. As these companies faced increasingly restrictive policies and lawsuits, they planned to shift their business to socially acceptable reduced-harm products. We describe the internal motivations and strategies to achieve this goal. METHODS We analysed previously secret tobacco industry documents available through the Truth Tobacco Documents Library. These documents were triangulated with TTCs' investor and other professional reports, websites and public statements. FINDINGS Mimicking pharmaceutical business models, tobacco companies sought to refurbish their image and ensure long-term profitability by creating and selling pharmaceutical-like products as smoking declined. These products included snus, heated tobacco products, e-cigarettes, nicotine gums and inhalers. Tobacco companies created separate divisions to develop and roll out these products, and the majority developed medical research programmes to steer these products through regulatory agencies, seeking certification as reduced-harm or pharmaceutical products. These products were regarded as key to the survival of the tobacco industry in an unfriendly political and social climate. CONCLUSIONS Pharmaceuticalisation was pursued to perpetuate the profitability of tobacco and nicotine for tobacco companies, not as a sincere search to mitigate the harms of smoking in society. Promotion of new pharmaceuticalised products has split the tobacco control community, with some public health professionals and institutions advocating for the use of 'clean' reduced-harm nicotine and tobacco products, essentially carrying out tobacco industry objectives.
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Affiliation(s)
- Yogi Hale Hendlin
- Erasmus University Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
- Center for Tobacco Control Research and Education, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Elieen Le Han
- Center for Tobacco Control Research and Education, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Pamela M Ling
- Center for Tobacco Control Research and Education, University of California San Francisco School of Medicine, San Francisco, California, USA
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McDonald A, McCausland K, Thomas L, Daube M, Jancey J. Smoke and mirrors? Conflict of interest declarations in tobacco and e-cigarette-related academic publications. Aust N Z J Public Health 2023:100055. [PMID: 37230897 DOI: 10.1016/j.anzjph.2023.100055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 03/26/2023] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVE This research explored international tobacco control experts' level of satisfaction with conflict of interest (COI) declaration processes; and the transparency of COI declarations of identified authors publishing in the tobacco, e-cigarette, and related novel products academic literature. METHODS This case study profiled 10 authors' (identified by expert panel) COIs pertaining to the tobacco industry; identified the 10 authors' publications (2010-2021); and assessed the transparency of the COI declarations within the publications. RESULTS All authors received indirect or direct funding from the tobacco industry. On review of the authors' 553 publications, 61% of COI and funding declarations were accessible, 33% were partially accessible and 6% were inaccessible. Overall, 33% of authors provided complete COI declarations, 51% provided incomplete declarations, and 16% provided no declaration. CONCLUSION This research demonstrates existing guidelines and recommendations for reporting COI declarations are not sufficiently robust to ensure transparency in reporting of COI declarations within the field. IMPLICATIONS FOR PUBLIC HEALTH Research outcomes have the potential to define public health discourse and influence public opinion, practices, and policy. It is critical that research remains independent and protected from the influence of the tobacco industry. Processes for monitoring and enforcing accurate reporting of COI declarations are needed.
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Affiliation(s)
- Amy McDonald
- School of Population Health, Curtin University, Bentley, WA, 6102, Australia.
| | - Kahlia McCausland
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Bentley, WA, 6102, Australia
| | - Laura Thomas
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Bentley, WA, 6102, Australia
| | - Mike Daube
- Faculty of Health Sciences, Curtin University, Bentley, WA, 6102, Australia
| | - Jonine Jancey
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Bentley, WA, 6102, Australia
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Jun J, Kim SH, Thrasher J, Cho YJ, Heo YJ. Heated debates on regulations of heated tobacco products in South Korea: the news valence, source and framing of relative risk/benefit. Tob Control 2022; 31:e57-e63. [PMID: 33542068 DOI: 10.1136/tobaccocontrol-2020-056131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 12/22/2020] [Accepted: 01/11/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND We analyse news representations of the regulation of heated tobacco products (HTPs) in South Korea, the country where HTP use is among the highest in the world despite conflicts between the government and the HTP manufacturers. METHODS We analysed a total of 571 print and TV news covering HTP regulations, published between 2017 and 2018, the time period when HTPs were introduced to the country and various regulations of HTPs were proposed and implemented. We assessed the prevalence and associations among specific types of HTP regulations that were discussed, valence towards regulation, sources, framing of the relative health risks/benefits of HTPs compared with conventional cigarettes. RESULTS Taxation (55.2%) and warning labels (25.7%) were two regulation topics covered the most. Almost equal proportions of pro-regulation (2.5%) and anti-regulation valence (2.2%) were found in taxation-related news, while pro-regulation valence appeared more frequently for other restrictions, including warning labels (pro=9.5% vs anti=1.4%), marketing restrictions (pro=6.9% vs anti=0%) and integration of HTPs into smoke-free policies for cigarettes (pro=8.7% vs anti=0%). The government (59%), followed by the tobacco industry (39.4%), was the source cited most often across news stories while the presence of tobacco control advocates was low (4.9%). As for framing, there was no significant difference in the prevalence of stories mentioning reduced harm (31.7%) and equal or more harm (33.6%) of HTPs compared with cigarettes. CONCLUSIONS We provide implications for governments and tobacco control advocates on building consensus for applying cigarette equivalent taxes and pictorial warning labels to HTPs.
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Affiliation(s)
- Jungmi Jun
- School of Journalism & Mass Communications, College of Information and Communications, University of South Carolina, Columbia, South Carolina, USA
| | - Sei-Hill Kim
- School of Journalism & Mass Communications, College of Information and Communications, University of South Carolina, Columbia, South Carolina, USA
| | - James Thrasher
- Department of Health Promotion, Educaiton, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Yoo Jin Cho
- Department of Health Promotion, Educaiton, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Yu-Jin Heo
- School of Journalism & Mass Communications, College of Information and Communications, University of South Carolina, Columbia, South Carolina, USA
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Hoek J, Edwards R, Waa A. From social accessory to societal disapproval: smoking, social norms and tobacco endgames. Tob Control 2022; 31:358-364. [PMID: 35241613 DOI: 10.1136/tobaccocontrol-2021-056574] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Janet Hoek
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Richard Edwards
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Andrew Waa
- Department of Public Health, University of Otago, Wellington, New Zealand
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Jun J, Zhang N, Zain A, Mohammadi E. Social Media Discussions on the FDA's Modified Risk Tobacco Product Authorization of IQOS. Subst Use Misuse 2022; 57:472-480. [PMID: 34986075 DOI: 10.1080/10826084.2021.2019777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background: The U.S. Food and Drug Administration (FDA) authorized the marketing of the IQOS tobacco heating system as a modified risk tobacco product (MRTP) in July 2020, permitting its 'reduced exposure' marketing. This decision is accompanied by much controversy among the global health community. We provide a preliminary analysis of Twitter conversations regarding the MRTP authorization of IQOS by identifying the authors, valence towards the policy decision, source of cited link, and focused topic. Methods: We analyzed 548 tweets mentioning MRTP posted between July 2016 (when PMI submitted the proposal) and October 2020. Results: We found a higher proportion of pro-MRTP valence (25.4%) than anti-MRTP (16.2%). Nearly half of the tweets (47.2%) expressing personal opinions presented pro-MRTP valence (vs. anti-MRTP = 23.9%). The FDA website was more frequently cited in pro-MRTP tweets (30.8% vs. anti = 4.8%), while tobacco control advocates' websites were cited only in anti-MRTP tweets (77.4% vs. pro = 0). Pro-MRTP valence appeared more frequently in tweets mentioning health (53.1% vs. anti =38.5%) and cessation (100% vs. anti = 0). Nearly 42% of tweets showed a bot score greater than .43, indicating a possibility of automation. Conclusion: Continuous efforts are needed to surveil the industry's attempts to create a climate of false consensus and circulate misinformation regarding MRTP on social media, as well as to assist non-scientific audiences' understanding of MRTP.
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Affiliation(s)
- Jungmi Jun
- School of Journalism and Mass Communications, College of Information and Communications, University of South Carolina, Columbia, South Carolina, USA
| | - Nanlan Zhang
- School of Journalism and Mass Communications, College of Information and Communications, University of South Carolina, Columbia, South Carolina, USA
| | - Ali Zain
- School of Journalism and Mass Communications, College of Information and Communications, University of South Carolina, Columbia, South Carolina, USA
| | - Ehsan Mohammadi
- School of Information Science, College of Information and Communications, University of South Carolina, Columbia, South Carolina, USA
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Chido-Amajuoyi OG, Agaku I, Onwuliri C, Shete S. Industry-sponsored antismoking advertisements in low-income countries. Lancet Glob Health 2020; 8:e485-e486. [PMID: 32199119 DOI: 10.1016/s2214-109x(20)30043-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 02/03/2020] [Indexed: 02/03/2023]
Affiliation(s)
| | - Israel Agaku
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA
| | - Chinemerem Onwuliri
- Department of Community Medicine, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Sanjay Shete
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
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Abstract
The smoking of tobacco cigarettes by millions of people over the past 100 or more years has had devastating public health consequences around the world. In some countries, this has been mitigated by the introduction of multiple regulatory strategies that have taken decades to implement. But even in the countries with most success at tobacco cigarette regulation, some smokers find it very hard to quit and need better treatment. Electronic cigarettes and other electronic nicotine delivery systems (ENDS) have emerged in the last decade or so. Initially designed to help smokers quit and produced by small independent entities, ENDS have become big business, with major transnational tobacco companies competing hard for market share where, for example, in the United States, a single device came to dominate the market within a couple of years and where soaring uptake by adolescents reached levels high enough to alarm the FDA. No doubts remain about the damaging health consequences of tobacco cigarettes. Controversies persist about e-cigarettes-their efficacy, health impacts, development of addiction and whether or not they provide a "gateway" to tobacco cigarette smoking. The regulation of tobacco cigarettes falls under a global WHO treaty, the Framework Convention on Tobacco Control (FCTC); over 180 countries are party to the FCTC. The regulation of ENDS has no such treaty, varies considerably around the world and in many countries remains completely untrammelled by specific directives. This paper will not discuss the evidence for or against the of e-cigarettes in smoking cessation (effectively discussed in this issue by Dr. Wallace) but aims to review the current state of tobacco regulation around the world, identify key differences in ENDS regulation, examine the impact of industry influence on public health policy and determine how the lessons of tobacco control should apply to ENDS.
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Affiliation(s)
- Emily Stone
- Department of Thoracic Medicine and Kinghorn Cancer Centre, St Vincent's Hospital Sydney, University of New South Wales, Sydney, Australia
| | - Henry Marshall
- Department of Thoracic Medicine, University of Queensland Thoracic Research Centre, The Prince Charles Hospital, Brisbane, Australia
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Hall W. Finding acceptable ways to fund research on e-cigarettes. Addiction 2019; 114:375-376. [PMID: 30324643 DOI: 10.1111/add.14465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 10/03/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Wayne Hall
- The Centre for Youth Substance Abuse Research, The University of Queensland and the National Addiction Centre, King's College London, London, UK
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