Public Health Chronicles
200 � Public Health Reports / March–April 2005 / Volume 120
TOBACCO INDUSTRY MANIPULATION OF RESEARCH
Lisa A. Bero, PhD
Research findings provide the basis for estimates of risk. However, research findings or “facts” are subject to interpre- tation and to the social construction of the evidence.1 Re- search evidence has a context. The roles of framing, problem definition, and choice of language influence risk communi- cation.2 Since data do not “speak for themselves,” interest groups can play a critical role in creating and communicat- ing the research evidence on risk.
An interest group is an organized group with a narrowly defined viewpoint, which protects its position or profits.3
These groups are not exclusively business groups, but can include all kinds of organizations that may attempt to influ- ence government.4,5 Interest groups can be expected to con- struct the evidence about a health risk to support their predefined policy position.6 For example, public health in- terest groups are likely to communicate risks in a way that emphasizes harm and, therefore, encourages regulation or mitigation of a risk.7 Industry groups are likely to communi- cate risks in a way that minimizes harm and reduces the chance that their products are regulated or restricted in any way. Disputes about whether a risk should be regulated are sometimes taken to the legal system for resolution.8 Thus, interest groups often have two major goals: to influence policy making and to influence litigation.
CREATING CONTROVERSY
Policy making is facilitated by consensus.9–11 However, scien- tific research is characterized by uncertainty, which poses problems when decision-making moves to a public forum. It is often to the benefit of interest groups to generate contro- versy about data because the controversy is likely to slow or prevent regulation of a given product. For example, scien- tific debate over the data and methods used in a risk assess- ment can hinder the development of the risk assessment.12
The tobacco industry has devoted enormous resources to attacking and refuting individual scientific studies. In addi- tion, the industry has attempted to manipulate scientific methods and regulatory procedures to its benefit. The to- bacco industry has played a role in influencing the debate around “sound science,”13 standards for risk assessment,14
and international standards for tobacco and tobacco prod- ucts.15 In the early 1990s, the tobacco industry launched a public relations campaign about “junk science” and “good epidemiological practices” and used this rhetoric to criticize government reports, particularly risk assessments of envi- ronmental tobacco smoke.13 The industry also developed a campaign to criticize the technique of risk assessment of low doses of a variety of toxins,14 working with the chemical, petroleum, plastics, and chlorine industries.
In this article, I describe the strategies used by the to-
bacco industry to manipulate information on the risks of tobacco (Figure). These strategies have remained remark- ably constant since the early 1950s. During the 1950s and 1960s, the tobacco industry focused on refuting data on the adverse effects of active smoking. The industry applied the tools it had developed during this time to refute data on the adverse effects of secondhand smoke exposure from the 1970s through the 1990s.
The release of previously secret internal tobacco industry documents as a result of the Master Settlement Agreement in 1998 has given the public health community insight into the tobacco industry’s motives, strategies, tactics, and data.16
These documents show that for decades the industry has tried to generate controversy about the health risks of its products. The internal documents also reveal how the in- dustry has been concerned about maintaining its credibility as it has manipulated research on tobacco.16
The tobacco industry has explicitly stated its goal of gen- erating controversy about the health risks of tobacco. In 1969, Brown and Williamson executives prepared a docu- ment for their employees to aid them in responding to new research about the adverse effects of tobacco, which stated: “Doubt is our product since it is the best means of compet- ing with the ‘body of fact’ that exists in the mind of the general public. It is also the means of establishing a controvery. . . . If we are successful in establishing a contro- versy at the public health level, then there is an opportunity to put across the real facts about smoking and health.”17
Eleven years later, the tobacco industry expressed the same goal regarding evidence on the risks of secondhand smoke. A report prepared by the Roper Organization for the To- bacco Institute in 1978 noted that the industry’s best strat- egy for countering public concern about passive smoking was to fund and disseminate scientific research that coun- tered research produced by other sources: “The strategic and long-run antidote to the passive smoking issue is, as we see it, developing and widely publicizing clear-cut, credible, medical evidence that passive smoking is not harmful to the non-smoker’s health.”18
Philip Morris promoted international research related to passive smoking in order to stimulate controversy, as
Figure. Tobacco industry strategies to manipulate data on risk
1. Fund research that supports the interest group position. 2. Publish research that supports the interest group position. 3. Suppress research that does not support the interest group
position. 4. Criticize research that does not support the interest group
position. 5. Disseminate interest group data or interpretation of risk in
the lay press. 6. Disseminate interest group data or interpretation of risk
directly to policy makers.
Public Health Chronicles � 201
Public Health Reports / March–April 2005 / Volume 120
described in the notes of a meeting of the UK [Tobacco] Industry on Environmental Tobacco Smoke, London, Feb- ruary 17, 1988: “[W]e are proposing, in key countries, to set up a team of scientists organized by one national coordinat- ing scientist and American lawyers, to review scientific litera- ture or carry out work . . . to keep the controversy alive.”17
The tobacco industry organized teams of scientific consult- ants all over the world with the main goal of stimulating controversy about the adverse health effects of secondhand smoke.19–21
Studies show that industry sponsorship of research is associated with outcomes that are favorable for the spon- sor.22–24 One possible explanation is that industry-sponsored research is poorly designed or of worse methodological qual- ity than non-industry-sponsored research. However, no con- sistent association has been found between industry spon- sorship and methodological quality.22 Factors other than study design can affect the outcome of research, including (1) the framing or social construction of the research question, (2) the conduct of the study, and (3) the publication (or not) of the study findings. In the following sections, I de- scribe how the strategies that the tobacco industry uses to stimulate controversy about tobacco involve manipulating research at multiple stages. The tobacco industry, through its funding mechanisms, has attempted to control the re- search agenda and types of questions asked about tobacco. The industry’s lawyers and executives have been involved in the design and conduct of industry-supported research as well as the suppression of research that has not been favor- able to the industry.
STRATEGY 1: FUND RESEARCH THAT SUPPORTS THE INTEREST GROUP POSITION
The first prong in the tobacco industry’s strategy to influ- ence data on risk has been sponsorship of research designed to produce findings that are favorable to the industry. Direct funding of research serves several purposes for the tobacco industry. Industry-supported research can be disseminated directly to policy makers and the lay press. Support for research can provide good public relations for the tobacco industry by portraying it as philanthropic. Last, funding of research can increase the credibility of the industry. One of the criteria that Philip Morris’ Worldwide Scientific Affairs Program considered during the 1990s when deciding whether to approve a given research application was whether the research would enhance the credibility of the company.25
The tobacco industry funded research through its trade association, the Tobacco Institute,26,27 internally (e.g., inter- nal company research), externally (e.g., by supporting the research of scientific consultants), and through sponsored research organizations. Tobacco industry lawyers and execu- tives were involved in the selection of the research that was funded. Most of this research did not undergo any form of scientific peer review, but was funded on the basis of its potential to protect the interests of the companies.26,27
Lawyer involvement in research Much of what is known about corporate interest group ac- tivities has been pieced together by studying internal indus-
try documents that have been made available through the legal “discovery” process. In the mid-1990s, internal tobacco industry documents were circulated by industry whistle- blowers. By 1998, availability of tobacco industry documents increased exponentially as a result of the settlement of a suit by the state of Minnesota and Blue Cross/Blue Shield against the major tobacco companies. The Master Settlement Agree- ment between the attorneys general of 46 states and Brown & Williamson/British American Tobacco, Lorillard, Philip Morris, R.J. Reynolds, the Council for Tobacco Research, and the Tobacco Institute released millions of additional documents to the public. These documents provided an unprecedented look at how tobacco industry lawyers were involved in the design, conduct, and dissemination of to- bacco industry–sponsored research.16
The internal tobacco industry documents include de- scriptions of research that was funded directly by law firms. For example, the law firms of Covington and Burling, and Jacob and Medinger, both of which represent a number of tobacco company clients, funded research on tobacco in the late 1970’s through the early 1990’s.26 Lawyers selected which projects would be funded; including reviews of the scientific literature on topics ranging from addiction to lung reten- tion of particulate matter. These law firms also funded re- search on potential confounding factors for the adverse health effects associated with smoking. For example, projects were funded that examined genetic factors associated with lung disease or the influence of stress and low-protein diets on health.26 These deflected attention from tobacco as a health hazard and protecting tobacco companies from litigation.
In other research funded directly by the tobacco compa- nies, lawyers were involved in the selection of projects and dissemination of findings. For example, tobacco companies funded individuals to serve as consultants to prepare expert testimony for Congressional hearings, attend scientific meet- ings, review the scientific literature, or conduct research on the health effects of tobacco or secondhand smoke.27 At one tobacco company, Brown and Williamson, the legal depart- ment controlled the dissemination of internal scientific re- ports.27 The lawyers at Brown and Williamson developed methods for screening scientific reports from affiliated com- panies to ensure that scientific information related to to- bacco and health would be protected from the legal discov- ery process. In a memo dated February, 17, 1986, J. K. Wells, the Brown and Williamson corporate counsel, outlined one method for protecting industry-produced research data: “The only way BAT [British American Tobacco, parent company of Brown and Williamson] can avoid having information useful to plaintiff found at B&W is to obtain good legal counsel and cease producing information in Canada, Ger- many, Brazil and other places that is helpful to plaintiffs.”27
Research organizations The tobacco industry also formed research funding organi- zations that gave the appearance that the research they sup- ported was independent of influence from the industry.
Council for Tobacco Research. The Council for Tobacco Re- search (CTR) was formed by U.S. tobacco companies in 1954 as the Tobacco Industry Research Committee (TIRC).
