Tobacco Industry, Governmental and Non-governmental Organisations

Because฀of฀its฀huge฀proits,฀the฀tobacco฀industry฀is฀able฀to฀support฀a฀wide฀range฀of฀sport- ing฀and฀cultural฀activities฀of฀the฀state.฀It฀remains฀questionable฀whether฀the฀state฀or฀other฀ bodies฀should฀accept฀such฀money,฀for฀which฀a฀“return”฀is฀naturally฀expected฀from฀politi- cians฀and฀state฀institutions.฀In฀2002฀the฀German฀government฀reached฀an฀agreement฀with฀the฀ tobacco฀industry,฀under฀the฀terms฀of฀which฀the฀latter฀is฀to฀make฀a฀“no฀strings”฀payment฀of฀ 12.6฀million฀to฀the฀government฀over฀a฀period฀of฀3฀years฀for฀the฀implementation฀of฀preven- tion฀programmes฀among฀children฀to฀discourage฀them฀from฀taking฀up฀smoking฀at฀an฀early฀ age.฀This฀form฀of฀collaboration฀is฀always฀suspect:฀the฀scientists฀engaged฀in฀future฀work฀of฀ this฀kind฀are฀free฀only฀to฀a฀limited฀extent฀because฀they฀are฀“taking฀tobacco฀research฀Euros.”฀ An฀analogous฀situation฀existed฀when฀BAT฀announced฀that฀it฀would฀fund฀an฀International฀ Centre฀for฀Corporate฀Social฀Responsibility฀at฀Nottingham฀University฀in฀the฀UK฀for฀the฀ sobering฀sum฀of฀£3.8฀million฀ [9,฀10] ฀see฀Sect.฀ 14.3 . A฀few฀years฀ago,฀a฀very฀far-reaching฀law,฀the฀so-called฀“Tobacco฀Deal,”฀was฀planned฀in฀ the฀USA.฀This฀law฀proposed฀to฀increase฀tobacco฀duty฀from฀1฀to฀10฀per฀pack฀over฀a฀ period฀of฀5฀years,฀to฀impose฀sharp฀restrictions฀on฀tobacco฀advertising,฀and฀to฀set฀up฀a฀ special฀fund฀for฀the฀treatment฀of฀smoking-related฀diseases฀20฀billion฀per฀year.฀In฀return,฀ the฀ tobacco฀ industry฀ would฀ be฀ “sheltered”฀ by฀ the฀ state฀ from฀ individual฀ legal฀ actions.฀ However,฀in฀connection฀with฀elections฀in฀the฀year฀1998,฀the฀tobacco฀industry฀gave฀50฀ million฀in฀campaign฀donations฀to฀the฀Republicans,฀who฀at฀that฀time฀held฀a฀majority฀in฀ Congress,฀and฀at฀the฀same฀time฀ran฀an฀advertising฀campaign฀on฀television,฀all฀of฀which฀had฀ the฀desired฀effect.฀The฀law฀was฀brought฀down฀by฀the฀votes฀of฀the฀Republicans฀ [11] . According฀to฀internal฀discussions฀of฀the฀German฀Cigarette฀Industry฀Association฀VdC,฀ the฀tobacco฀industry฀is฀pursuing฀several฀strategic฀goals฀to฀secure฀its฀sales฀markets฀ [12] .฀One฀ of฀its฀primary฀goals฀is฀to฀prevent฀a฀ban฀on฀tobacco฀advertising฀worldwide,฀in฀the฀EU฀and฀ Germany฀by,฀for฀instance,฀obstructing฀the฀discussion฀and฀passage฀of฀bills฀in฀the฀European฀ Parliament฀andor฀preventing฀laws฀from฀coming฀into฀force฀through฀court฀action.฀To฀do฀this,฀ the฀tobacco฀industry฀conducts฀talks฀with฀politicians฀of฀all฀parties฀and฀also฀seeks฀to฀exert฀ pressure,฀ through฀ business฀ and฀ trade฀ union฀ representatives,฀ on฀ the฀ members฀ of฀ the฀ EU฀ Parliament,฀with฀the฀aim฀of฀bringing฀314฀members฀of฀the฀European฀Parliament฀“onto฀the฀ tobacco฀industry’s฀side.”฀The฀ostensible฀argument฀used฀against฀a฀ban฀on฀advertising฀was฀the฀ “freedom฀ of฀ advertising฀ information,”฀ backed฀ by฀ large-scale฀ placard฀ and฀ advertising฀ activities฀prior฀to฀the฀vote฀ [13] . In฀a฀recently฀published฀comprehensive฀report฀ [14] ,฀the฀WHO฀has฀documented฀in฀detail฀ that฀the฀tobacco฀industry • ฀ Is฀seeking฀to฀distract฀attention฀from฀tobacco฀abuse฀through฀sidetracking฀activities • ฀ Has฀tried฀to฀reduce฀the฀WHO’s฀tobacco-related฀budgets฀and฀mobilise฀other฀UN฀organi- sations฀against฀the฀WHO • ฀ Has฀sought฀to฀convince฀developing฀countries฀that฀the฀WHO’s฀anti-tobacco฀programme฀ would฀be฀at฀their฀expense • ฀ Has฀misrepresented฀the฀results฀of฀important฀scientific฀studies฀ [14] The฀tobacco฀industry฀has฀also฀laid฀down฀a฀strategy฀in฀a฀conidential฀document฀position฀ paper฀–฀though฀this฀has฀now฀been฀published฀on฀the฀Internet฀–฀on฀ways฀of฀inluencing฀the฀ activities฀of฀the฀WHO฀ [15] .

14.2 Politicians and Their Attitude to Smoking

Smoking฀is฀seen฀by฀many฀people฀as฀a฀demonstration฀of฀strength฀and฀superiority,฀and฀cigars฀ even฀as฀a฀symbol฀of฀power฀as฀evidenced฀by฀caricatures฀of฀capitalists.฀Some฀typical฀exam- ples฀of฀cigar฀smokers฀are฀Churchill,฀Clinton,฀Erhard฀and฀Schröder.฀Politicians฀are฀supposed฀ to฀be฀independent฀people฀who฀decide฀solely฀according฀to฀their฀conscience;฀in฀fact,฀however,฀ they฀are฀usually฀embedded฀in฀social฀lobby฀groups,฀who฀also฀generate฀the฀voter฀potential฀for฀ future฀elections฀ [16,฀17] .฀Most฀studies฀on฀smoking,฀and฀the฀statements฀made฀in฀them฀on฀the฀ “more฀or฀less฀signiicant฀risks”฀caused฀by฀smoking,฀come฀from฀the฀laboratories฀and฀adver- tising฀agencies฀of฀the฀cigarette฀industry,฀which฀in฀terms฀of฀inluence฀on฀public฀opinion฀have฀ even฀more฀importance฀in฀the฀USA฀than฀in฀Germany฀ [18–20] .฀Despite฀an฀appeal฀by฀the฀ Medical฀Advisory฀Board฀of฀the฀Bonn฀organisations฀to฀the฀German฀chancellor฀to฀abandon฀ the฀government’s฀opposition฀to฀the฀EU฀directive฀banning฀cigarette฀advertising,฀the฀govern- ment฀felt฀it฀necessary฀to฀ight฀the฀“resolutions฀of฀the฀EU฀Commission฀as฀they฀would฀put฀ jobs฀at฀risk”฀and฀to฀put฀a฀brake฀on฀the฀“witch฀hunt”฀against฀advertising฀by฀the฀tobacco฀ industry฀ [21] . In฀1998,฀the฀British฀government฀launched฀a฀nationwide฀“Smoking฀kills”฀campaign,฀ with฀the฀aim฀of฀reducing฀smoking฀among฀juveniles฀from฀13฀to฀9,฀among฀adults฀from฀ 28฀to฀24,฀and฀especially฀among฀women฀from฀23฀to฀15,฀within฀a฀period฀of฀10฀years฀ [22] .฀For฀the฀irst฀3฀years฀of฀this฀campaign,฀the฀British฀government฀has฀made฀£60฀million฀ available฀ [22] . In฀Germany,฀as฀in฀many฀other฀EU฀countries,฀there฀is฀still฀a฀kind฀of฀“stalemate”฀situation,฀ with฀“powerless”฀politicians฀and฀journalists฀–฀a฀lot฀of฀whom฀smoke฀–฀on฀the฀one฀side,฀and฀ the฀ social฀ security฀ contributors,฀ who฀ ultimately฀ have฀ to฀ pay฀ for-the฀ costs฀ of฀ smoking- related฀disease,฀on฀the฀other฀side,฀including฀a฀potential฀majority฀of฀the฀population฀who฀ would฀vote฀in฀favour฀of฀tough฀measures฀to฀protect฀non-smokers฀and฀for฀a฀complete฀ban฀on฀ cigarette฀advertising.฀This฀scenario฀indicates฀failure฀on฀the฀part฀of฀many฀politicians฀ [23] .฀ Depending฀on฀whether฀they฀decide฀“for”฀or฀“against”฀a฀ban฀on฀advertising฀and฀the฀protec- tion฀ of฀ non-smokers,฀ politicians฀ stand฀ to฀ lose฀ credibility฀ among฀ their฀ respective฀ voter฀ groups.฀The฀refusal฀of฀politicians฀to฀take฀a฀clear฀stand฀on฀these฀issues฀is฀a฀misrepresenta- tion฀of฀the฀will฀of฀the฀people฀ [24] .฀The฀politicians฀prefer฀to฀accept฀the฀proven฀damage฀to฀ health฀caused฀by฀smoking,฀which฀can฀add฀up฀to฀billions฀in฀only฀a฀few฀years,฀rather฀than฀ make฀a฀clear฀decision.฀Also,฀the฀politicians฀in฀Germany฀have฀so฀far฀adopted฀no฀effective฀ measures฀to฀protect฀children฀at฀home.฀At฀present,฀there฀might฀exist฀some฀improvement฀ concerning฀public฀protection฀for฀non-smokers,฀but฀research฀into฀this฀ield฀still฀receives฀ hardly฀any฀support. Where฀specialist฀advice฀is฀called฀in฀prior฀to฀taking฀legislative฀decisions,฀the฀cigarette฀ industry฀is฀always฀able฀to฀present฀“experts”฀from฀a฀range฀of฀disciplines฀who฀cast฀doubt฀on฀ the฀indings฀of฀studies,฀generating฀a฀general฀atmosphere฀of฀uncertainty฀and฀in฀this฀way฀ ultimately฀exercising฀an฀inhibiting฀effect฀on฀the฀intended฀legislative฀measures฀ [25–27] .฀ The฀tobacco฀industry฀is฀also฀able,฀by฀threatening฀to฀claim฀for฀damages฀–฀including฀court฀ costs฀running฀into฀millions฀–฀to฀paralyse฀any฀activity,฀as฀happened฀in฀the฀case฀of฀CBS,฀the฀ radio฀and฀TV฀broadcaster,฀in฀the฀USA฀ [28] .

14.3 Scientists and the Tobacco Industry

One฀perennial฀important฀issue฀is฀whether฀scientists฀should฀accept฀money฀from฀the฀tobacco฀ industry฀for฀their฀work.฀Ignaz฀Semmelweis,฀director฀of฀the฀Gynaecology฀Clinic฀in฀Budapest฀ in฀the฀mid-nineteenth฀century,฀once฀made฀the฀famous฀statement,฀on฀being฀asked฀whether฀ he฀had฀accepted฀money฀from฀a฀condom฀irm,฀which฀was฀after฀all฀immoral:฀“This฀is฀no฀ cause฀for฀reproach:฀I฀have฀a฀machine฀into฀which฀I฀put฀dirty฀money฀at฀the฀top฀and฀take฀out฀ clean฀money฀at฀the฀bottom.”฀But฀it฀is฀surely฀evident฀that฀a฀scientist฀cannot฀take฀the฀view฀ that฀it฀is฀not฀where฀money฀comes฀from฀that฀counts,฀but฀only฀what฀it฀is฀used฀for. In฀1954,฀the฀US฀tobacco฀industry฀founded฀the฀Council฀for฀Tobacco฀Research฀CTR,฀ which฀provides฀large฀sums฀of฀money฀for฀research฀work:฀US฀83฀million฀for฀865฀research฀ projects฀ in฀ 279฀ medical฀ facilities฀ at฀ universities,฀ hospitals฀ and฀ research฀ institutes฀ [29] .฀ While฀initially฀the฀funding฀was฀given฀for฀work฀on฀the฀subject฀of฀“smoking฀and฀health,”฀a฀ research฀group฀was฀formed฀which฀was฀devoted฀to฀biomedical฀research฀without฀any฀refer- ence฀ to฀ smoking.฀ The฀ inluence฀ of฀ the฀ CTR฀ on฀ research฀ projects฀ has฀ been฀ variously฀ assessed,฀with฀no฀bias฀being฀found฀in฀many฀instances.฀In฀these฀cases,฀the฀aim฀of฀the฀CTR฀ was฀to฀appear฀as฀a฀donor฀of฀equal฀standing฀with฀the฀American฀Cancer฀Society,฀the฀National฀ Science฀Foundation,฀the฀National฀Institutes฀of฀Health฀and฀other฀leading฀research฀bodies฀ [29] ,฀and฀in฀this฀way฀to฀acquire฀equal฀status฀with฀them฀by฀riding฀“piggy-back,”฀as฀it฀were.฀ It฀is฀ultimately฀a฀question฀of฀conscience฀whether฀money฀can฀be฀accepted฀from฀an฀industry฀ which฀is฀responsible฀for฀1,000฀smoking-related฀deaths฀a฀day฀in฀the฀USA฀alone. In฀Germany,฀the฀“Smoking฀and฀Health”฀research฀council,฀the฀“Rauchen฀und฀Gesundheit฀ mbH”฀ research฀ company฀ in฀ Hamburg฀ and฀ the฀ “Verum”฀ Behaviour฀ and฀ Environment฀ foundation฀in฀Munich,฀advised฀by฀the฀physiologist฀K.฀Thurau฀andor฀the฀clinical฀medical฀ specialist฀F.฀Adlkofer,฀have฀sought฀to฀do฀scientiic฀work฀in฀this฀ield฀ [30,฀31] .฀Their฀results฀ have฀been฀the฀subject฀of฀very฀severe฀criticism฀ [30] .฀The฀Danish฀physician฀T.฀Voss฀was฀paid฀ US฀3,500–6,500฀a฀month฀by฀Philip฀Morris฀for฀speaking฀publicly฀against฀anti-smoking฀ groups.฀The฀Swedish฀physician฀T.฀Malmfors฀of฀the฀Karolinska฀Institute฀also฀worked฀for฀ Philip฀Morris,฀presenting฀the฀risks฀of฀passive฀smoking฀as฀unproven,฀for฀which฀they฀received฀ the฀equivalent฀of฀DEM฀60,000฀ [32] . Around฀the฀year฀1990,฀INFOTAB,฀a฀think฀tank฀supported฀by฀the฀tobacco฀industry,฀pub- lished฀“A฀guide฀for฀dealing฀with฀anti-tobacco฀pressure฀groups”฀ [33] ,฀in฀which฀an฀early฀ warning฀system฀was฀established฀for฀setting฀up฀WHO฀bureaux฀and฀for฀holding฀regional฀ workshops฀of฀anti-smoking฀groups฀and฀non-smoker฀organisations฀and฀coalitions.฀These฀ initiatives฀were฀accompanied฀by฀activities฀aimed฀at฀delaying฀the฀establishment฀of฀anti- tobacco฀programmes.฀After฀BATCo฀had฀studied฀the฀WHO฀programmes,฀scientists฀were฀ enlisted฀and฀paid฀by฀BATCo฀who,฀acting฀as฀private฀persons,฀cast฀doubt฀on฀the฀WHO฀pro- grammes.฀These฀scientists฀included,฀for฀instance,฀Paul฀Dietrich,฀at฀that฀time฀president฀of฀ the฀Institute฀for฀International฀Health฀and฀Development,฀and฀Bob฀Tollison฀from฀the฀Centre฀ for฀Study฀of฀Public฀Choice.฀The฀former฀played฀down฀the฀tobacco฀issues฀in฀a฀publication฀ planned฀for฀the฀New฀York฀Academy฀of฀Sciences,฀and฀the฀latter฀wrote฀similar฀articles฀for฀ the฀International฀Herald฀Tribune.฀The฀essence฀of฀these฀articles฀was฀that฀the฀WHO฀should฀ concern฀itself฀more฀with฀combating฀infectious฀diseases฀malaria฀and฀cholera฀in฀the฀Third฀