204 � Public Health Chronicles
Public Health Reports / March–April 2005 / Volume 120
effects of secondhand smoke.47 Two colleagues and I con- ducted a preliminary study of publication bias; we found that approximately 20% of published peer-reviewed articles on passive smoking presented statistically nonsignificant find- ings.48 Then, by interviewing investigators studying second- hand smoke and health effects, Misakian and I determined that studies with statistically nonsignificant results take about two years longer to be published than those with statistically significant results.49 Thus, the tobacco industry’s argument that statistically non-significant results are not published is invalid. Since statistically nonsignificant results are published, but take longer to be published than statistically significant results, reviews of research should attempt to include un- published data and should be periodically updated. The Cochrane Collaboration, for example, attempts to identify unpublished studies and include them in reviews if they meet quality standards. Cochrane reviews, which are pub- lished online, are regularly updated.50
STRATEGY 3: SUPPRESS RESEARCH THAT DOES NOT SUPPORT THE INTEREST GROUP POSITION
While interest groups are eager to fund research and the publication of research that supports their position, they are hesitant to publicize research that does not support their position. Tobacco industry lawyers and executives have ed- ited their externally funded scientific research publications and, in some cases, prevented publication of research.21,35,51
Editing has included attempts to obscure evidence on ad- verse health effects by using the code word “zephyr” for “cancer” in internal memos about health effects research.17
Another example of research suppression is shown in the contrast between what a tobacco company knew in 1963 and what it stated publicly in 1994. In 1963, Addison Yeaman, Vice President and General Counsel at Brown and William- son, attended a meeting of tobacco industry researchers, executives, and lawyers, where he summarized the findings of some recent tobacco industry research: “[N]icotine is addictive. We are, then, in the business of selling nicotine, an addictive drug. . . .”52 Yet Yeaman’s summary and other findings from tobacco industry research on nicotine were not released to the public. In 1994, Thomas Sandefur, Chair- man and CEO of Brown and Williamson, testifying before Congress about whether the Food and Drug Administration should regulate nicotine products, stated, “I do not believe that nicotine is addictive. . . . [It is] a very important con- stituent in the cigarette smoke for taste.”52
For years, tobacco industry executives suppressed the dis- semination of its internal research findings to the public and regulatory decision makers.
STRATEGY 4: CRITICIZE RESEARCH THAT DOES NOT SUPPORT THE INTEREST GROUP POSITION
To criticize research that is not favorable to its position, the tobacco industry has misused legitimate means of scientific debate, such as letters to the editor in scientific journals and editorials. The industry has also used less legitimate meth- ods to criticize research, including attacking the integrity of
researchers or using lawsuits to obtain data that are then reanalyzed.53
To get its views into public commentary on risk assess- ments38,40 or into the lay press,39 the tobacco industry has cited letters to the editor as if they were peer-reviewed jour- nal articles. Tobacco industry–affiliated authors of letters often fail to disclose this affiliation.54
The tobacco industry maintains large international teams of scientific consultants.20,21,35 A major goal of the industry’s scientific consultancy program from the 1970s on has been to refute data about the harmful effects of tobacco. Industry consultants were paid to criticize independent research on tobacco and secondhand smoke in a variety of forums; these industry consultant programs were international and were used to discredit research conducted by non-industry scien- tists around the world.20,21,35
STRATEGY 5: DISSEMINATE INTEREST GROUP DATA OR INTERPRETATION OF RISK IN THE LAY PRESS
The important role of the media in risk communication has been extensively studied.2,55 The tobacco industry has been active in stimulating controversy in the lay print media about the health effects of secondhand smoke. In a cross-sectional sample of 180 North American newspaper and 95 magazine articles reporting on secondhand smoke research from 1981 to 1995, 66% of newspaper articles and 55% of magazine articles left readers with the impression that there was con- tinuing controversy about secondhand smoke research.56 As scientific studies showing an association of secondhand smoke and adverse effects accumulated, the proportion of articles concluding that the research was controversial remained relatively constant.56 Although tobacco industry–sponsored research studies were not widely cited in the lay press ar- ticles, tobacco industry–affiliated individuals were often cited.56,57 Among 180 newspaper articles examined,56 52% cited tobacco industry officials, whereas 56% cited govern- ment officials and 46% cited independent scientists.
STRATEGY 6: PRESENT INTEREST GROUP DATA OR INTERPRETATION OF RISK DIRECTLY TO POLICY MAKERS
The last strategy in the tobacco industry’s effort to stimulate controversy about data demonstrating risk is to get its funded research directly into the hands of individuals who are likely to influence policy. My colleagues and I conducted a series of in-depth case studies examining the role of research evi- dence in the development of two risk assessments of second- hand smoke, two state indoor air regulations, and two fed- eral tobacco regulations.38,58–60 In the United States, the processes for developing these risk assessments and regula- tions involves review of the relevant scientific literature by the appropriate government agency, preparation of a draft report, collection of written and oral public commentary, and revision of the report based on that public commen- tary.8,61,62 Public participation in the process is important for shaping the findings of the final risk assessment or regula- tion as well as for public acceptability of the findings.61
