The Foundation for Tobacco-Free World is unlikely to win hearts and minds in the tobacco control community, said Matt Myers, president of the Campaign for Tobacco-Free Kids.
The new foundation, which received an $80 million-a-year funding commitment from Philip Morris International, has the support of John Seffrin, former CEO of the American Cancer Society.
If it is to gain credibility, the group would now need to recruit a board of directors who would be willing to stake their reputations on a venture funded by the makers of Marlboro cigarettes.
“I personally do not think anybody actually interested in reducing the death and disease from tobacco should give Philip Morris International any credibility as long as they continue to market the product the way they do,” Myers said to The Cancer Letter. “As long as they continue to introduce highly flavored new forms of Marlboro to attract kids. As long as they oppose high cigarette taxes, oppose effective warning labels, oppose paid mass media campaigns. Otherwise, it’s simply a get-out-of-jail-free card.”
Myers spoke with Paul Goldberg, editor and publisher of The Cancer Letter.
Paul Goldberg: I’m working on a story about the Foundation for Tobacco-Free World, and people have been telling me that the world has changed, that kids aren’t smoking as much anymore. That this generation of tobacco smokers could be the last generation of smokers, and that e-cigarettes are the wave of the future. I am also told that no one’s paying attention to existing smokers, old folks who still need the drag. Is this a time to engage companies like Philip Morris differently?
Matt Myers: First of all, many of those statements don’t truly reflect the full situation. I think that’s very important to understand. There’s also myopia over what goes on in a country like the United States versus what’s going on throughout the rest of the world. The problem with cigarette smoking is a long way from being solved. The problem with youth tobacco use is a very long way from being solved. It is true that in the United States, that smoking rates among high school students are now below 10%.
If you look at low-income countries across the globe, you continue to see high levels of smoking among young people, but even more importantly, you continue to see companies like Philip Morris aggressively marketing to those young people.
In some respects, the issue of whether we should be looking for new alternative ways to help adults quit is a very different question from looking at the behavior of Philip Morris International. That’s a fundamentally important distinction with what’s going on with this foundation.
Philip Morris International has a long history of funding what it calls independent research by previously credible researchers. In the past, they’ve always funneled that research to try and set an agenda, to divert attention away from what they’re doing.
They’re doing the same thing here. They want us all to be talking about harm reduction and ignoring the fact that they continue to market aggressively. That they continue to introduce new versions of Marlboro, whose primary appeal is to children and young women. They continue to sell their products … Johns Hopkins School of Public Health is in the process of finishing up a series of studies looking at marketing to kids, elementary school kids, in low income countries. They’ve found example after example, after example of kiosks, literally outside the front door of elementary schools, in low-income countries, supported by Philip Morris International.
You got to start from a slightly different premise, that there has been great progress made in countries like the United States, but the problem isn’t solved. There has been progress made in low-income countries, but it is despite what Philip Morris International has been doing.
So, they haven’t changed?
MM: They haven’t changed at all. Now, they have a new product that may or may not be significantly less harmful.
We don’t know that, do we?
MM: We don’t know that for sure. What we do know, is that while their website has wonderful statements about a world that is smoke-free, their marketing behavior, their opposition to government policy that will actually reduce tobacco use, and their introduction of new forms of Marlboro, is totally inconsistent with that goal.
Somebody who wants to buy into the foundation as proof that the company has changed, ignores the history of how similar this behavior is to their behavior over the last 60 years.
Right. Reporting the story, I actually heard people say, “Oh, that Matt Myers, who rides around Washington on his white horse…”
MM: Actually, my organization is one of the organizations that actually works in the low-income countries, where we see what Philip Morris does every single day.
Let me just move you to another question….
MM: I’m not uncomfortable with my white horse, by the way.
I’m sure. It’s a good horse. It’s a really good horse. Gets you through the swamp.
MM: A number of my staff just came back from South America. Marlboro has introduced a host of new flavors there. Fusion blast. You can buy every flavor of Marlboro you want. Tell me this is a reformed company.
It’s not my argument.
MM: This is the same company who told us in 1954 that they were going to be part of the solution. They promised to tell us the answer. Every time we get close to an answer, they want to fund somebody to say the real problem is, we need more research. What we really need is less opposition from Philip Morris.
How do you deal with the older smokers, the existing smokers, the old guys who go behind the cancer center where they’re treated to take a drag?
MM: The quick answer to that is that our organization as well as a number of the other major organizations has done, in recent years a great deal. We have petitioned the FDA, on multiple occasions now, to urge that CDER reconsider how it reviews smoking cessation products, and that CDER actually convene people in order to pose the question about what it needs to do to promote tobacco cessation innovation.
Our organization supports the legislation giving FDA jurisdiction over tobacco products, including setting up a structure for FDA, not the tobacco companies, for scientifically reviewing which products, if any actually help smokers reduce their risk of disease, so that we don’t have to continue to rely on the unsubstantiated statements of tobacco companies who first told us, filtered cigarettes were safer, then told us light and low tar cigarettes were safer.
They have a long track record of making claims that are not substantiated by the science and have resulted in more people continuing to smoke.
In fact, if you believe in science, our organization as well as others have said, FDA is a tried and true method for independent, objective scientific review. It is what we use for drugs. It is what we use for safety for foods. It only makes sense to say we should do the same thing for tobacco.
So, you’re focused on kids…
MM: We’re not just focused on kids. The campaign does a great deal of work to prevent youths from starting because long-term, that’s the best way to reduce tobacco use. The campaign has always worked on policies that impact individuals of all ages. That’s why if you look, you’ll see, no organization has petitioned the FDA more to encourage it to take tobacco cessation seriously than us.
Do you see danger to kids from e-cigarettes and other alternative products?
MM: In the absence of meaningful government regulation, we absolutely do.
How?
MM: If you look and see today, you see that more kids are experimenting with e-cigarettes than experimenting with cigarettes. While more kids use cigarettes regularly, a significant number of children continue to use e-cigarettes with a good deal of frequency, as well.
What we also see is that is in the absence of regulations, the thousands of flavored e-cigarette products that the industry has introduced with no testing, without any consideration as to whether they either help people quit smoking, or entice kids, has resulted in the fact that over 80% of the kids who say they use e-cigarettes, say they use flavored e-cigarettes. They use these e-cigarettes because they’re flavored.
We don’t know, because e-cigarettes are so new on the marketplace, what the long-term impact of this experimentation is. It may be that virtually all of those kids end up using e-cigarettes and never use any other tobacco product.
But there’s one statistic that ought to be a cause for concern for anybody who cares. That is, in the second wave of FDA’s PATH study, what they found was of the kids that were exclusively using e-cigarettes in wave one, 24 percent were using cigarettes in wave two. [The PATH study doesn’t provide conclusive evidence of gateway effect, experts say. Discussion of available evidence is published online by CA: Drope et al., “Key Issues Surrounding the Health Impacts of Electronic Nicotine Delivery Systems (ENDS) and Other Sources of Nicotine.”]
Do you see any rationale for reduction of risk from tobacco versus complete elimination of tobacco? Should the latter still be the goal?
MM: Complete elimination needs to be the long-term goal. We are comfortable with the concept of FDA reviewing products that can be used to assist smokers who can’t or won’t quit to switch completely to those less harmful products, ideally as a pathway to quitting.
The key, though, is we think that the evidence shows that in the absence of meaningful regulation that e-cigarettes on the market all too often, are being used to sustain smoking through dual use. That we’re seeing far too little good science to assist a smoker who wants to use an e-cigarette to quit or switch, to know which ones to do so.
You have to differentiate the concept. Our organization is very clearly on record. If e-cigarettes assist smokers to quit completely, under a regulated situation, that’s something we would support.
What’s really interesting is this argument that it’s kids versus adults. The kids aren’t smoking—
MM: It’s a false dichotomy.
It’s specious; no?
MM: It is a totally specious dichotomy. It sounds good until you actually look at the facts.
Which is what I’m doing.
MM: The same public health public policy to reduce smoking among adults reduces smoking among kids, it’s not an either/or at all. If e-cigarettes have a public health benefit, it is to assist smokers to switch completely or quit.
The introduction of thousands of flavors without any research whatsoever as to whether any of them, or which of them actually helps smokers to quit, and under what circumstances, neither serves adults nor kids.
What would serve them both, is good science. In the absence of regulation, we have not seen good science. It may or may not be possible to do some nontraditional flavors may assist adult smokers to quit. The answer is we don’t know that, because the e-cigarettes companies haven’t done the research to identify which of them do that, if any.
Have you seen any reason at all to believe that this Foundation for a Smoke-Free World will be a real hands-off research funding agency, or will this be another way to provide tobacco companies with a way to advance their agenda?
MM: It already is serving as a way to advance their agenda. Philip Morris would like the world to think that the problem is that we need more research as a way to divert attention from the fact that in many of the countries in which my organization works, Philip Morris is actively opposing the adoption of tobacco control policies that work.
Philip Morris, in addition, wants to control the research agenda.
This is something that they have always done. By focusing the research agenda for this new foundation and quote, “harm reduction,” what they’re doing is steering the debate on a topic they want to talk about.
The history of Philip Morris as well is they always find somebody who has public health credibility to give their research dollars to, as a way to divert attention away from their own behavior. In the 1960’s, they gave massive grants to the American Medical Association, for allegedly independent research. Subsequent to that, if you’ll read … I don’t know if you’ve ever read Robert Proctor’s book. [Proctor, Robert N. (2012). Golden Holocaust: Origins of the Cigarette Catastrophe and the Case for Abolition. Berkeley: University of California Press.]
Yes, I have.
MM: Okay. You’ve got whole chapters of major American universities, the most credible ones, who were given so called independent research dollars, with regard to it.
Whatever role harm reduction may play in speeding up the process of eliminating the death and disease caused by tobacco, this foundation, there’s all the hallmarks of a game plan that Philip Morris has executed time and time again.
Were you surprised to see John Seffrin endorsing this Foundation?
MM: You know, Paul, John’s an old friend of mine. I will stay away from the comment about it.
He did endorse it.
MM: He had a very positive comment about it. He said I think it’s—
Well, I mean friends talk to friends. Have you spoken to him?
MM: Yes, they do. They do. I will say this. It’s inconsistent with the policy of today’s American Cancer Society.
Hey, which he put together. He put together probably the absolutely strongest conflict policy that any organization anywhere has.
MM: That’s exactly right.
I have tested it probably more than any other reporter, over the years.
MM: People who work in the tobacco control field are passionate, and are constantly looking for the magic bullet. It’s easier than the day-to-day hard work, on it. This is a case where I hope that there will be introduced a host of products that are far more effective at helping smokers quit or switch.
But to date, the major tobacco companies have not been a force for positive change. The products they have introduced by and large, including Philip Morris’s vapor products, appear to be the least effective in helping smokers quit. Whether or not Philip Morris International’s new product is or is not significantly safer… I’ll wait to see what FDA says about that. It doesn’t detract from the fact that they continue to market Marlboros as aggressively as possible around the world.
You would not join this Foundation for a Smoke-Free World?
MM: No. I personally do not think anybody actually interested in reducing the death and disease from tobacco should give Philip Morris International any credibility as long as they continue to market the product the way they do.
As long as they continue to introduce highly flavored new forms of Marlboro to attract kids. As long as they oppose high cigarette taxes, oppose effective warning labels, oppose paid mass media campaigns. Otherwise, it’s simply a get-out-of-jail-free card.
I was actually looking at this statement by a bunch of anti-tobacco people, basically outlining the characteristics respectively, of the circumstances where you can take money from a tobacco company to fund research. You know the paper, right?
MM: Yeah.
Do you accept that? It seems to be just another paper.
MM: It is just another paper, but more importantly, the paper in my view, didn’t contemplate that giving a lot of money that argues that our major problem, tobacco problem is research. It’s truly nothing more than a PR campaign and diversion, from Philip Morris’s actual practices.
My organization just got through working with the government of Uruguay who spent six years defending itself against a lawsuit from this very same company, when it simply tried to increase the size of its warning labels.
We worked closely with the government of Australia who is still facing a lawsuit that was prompted by Philip Morris International when they adopted plain packaging, to reduce tobacco use. We have worked with a number of governments in Africa that have received threatening letters from Philip Morris International, when it sought to adopt strong tobacco control measures.
I don’t know if you saw the Reuters story just earlier this year, that documented Philip Morris International’s effort to undermine implementation of the framework convention on tobacco control.
The notion that Philip Morris is anything other than even slicker than it used to be, is undermined by their other behaviors.
Looking at that paper that there was referencing, with the characteristics of all that credible effort by a tobacco company to fund research.
One of the aspects of it is having an independent board. I don’t see the board yet.
I see their bylaws. That seemed to be tailored to that paper. I don’t see anybody on their board. Can you imagine anybody credible joining that board? What would you say to somebody that would?
MM: I would think that anybody who knows the history of this industry who would join that board without first requiring that Philip Morris International change its behavior. That would be inconsistent with everything we know.
Which of course, would never happen.
MM: Well, we’ll see.
It’s really fascinating. Thank you so much.
MM: Philip Morris has long since had a goal to find ways to divide the tobacco control community. This fits that playbill completely. It’s interesting, because as I’ve watched the reaction of people who actually work on tobacco control, on the ground in countries across the globe.
The response has been uniform. It’s not people who care more about adult cessation versus youth. It’s people who day in and day out have been working to get adopted the kind of tobacco control policies that we know work.
Thank you so much.
