Philip Morris International, the tobacco company, is spending $1 billion over 12 years on “cancer research,” which will be funded through something called the Foundation for a Smoke-Free World.
Here at The Cancer Letter, a news item of this sort might have been easily chalked up to crafty PR tactics and thrown the heck out.
And it would have been, were it not for this tidbit: the press release included a gushing quote from a gentleman named John Seffrin.
The John Seffrin?
Until two-and-a-half years ago, Seffrin was the CEO of the American Cancer Society, where he engineered one of the toughest no-tobacco-funding policies anywhere. It’s one strict policy: if you take money from tobacco companies, don’t bother asking your American Cancer Society for a grant or a contract.
When he was at ACS, Seffrin was known for saying that tobacco companies “behave very much like terrorists and have been more successful than al-Qaeda.”
Would the John Seffrin we remember allow his name to be associated with these words of praise for a group funded by Philip Morris?
“The world needs to act with greater urgency and more creativity to cut the adult smoking rate and prevent cancer, heart disease and lung diseases. The Foundation for a Smoke-Free World will bring new energy, needed resources and significant expertise to the fight. The Foundation will fund critical research to help eliminate gaps in science, and help the global community pick up the pace of progress in providing science-based solutions for the world’s one billion smokers, most of whom seek to quit cigarettes.”
Here, things started to match. The title of the former ACS CEO John Seffrin matched the title of the Philip Morris-endorsing John Seffrin: professor of practice at Indiana University–Bloomington School of Public Health.
The bottom line is that technologies/ alternatives exist today that can help people quit smoking or at least reduce significantly their consumption of burned tobacco, which is what kills them.
John Seffrin
I spent several years pursuing a story on a far-reaching ACS action called the National Dialogue on Cancer, which, I learned, was designed by a PR firm that also represented tobacco companies. (see story here)
PR companies are known to cultivate conflicts, and I found a lot of conflicts—PR firms working for two masters who were at war with each other: i.e. tobacco companies and ACS. Yet, every time I brought these conflicts to the attention of ACS, the society and the dialogue fired the conflicted PR firms.
And now this: Seffrin’s name is associated with a Philip Morris action. Something akin to a seismic change would be required for the John Seffrin I remember to allow this.
Perhaps more ominously, the press release mentioned sparking a “dialogue” that would set the foundation’s research priorities.
With questions swirling in my head, I banged out an email to Seffrin:
“I hope this finds you well. I wanted to ask you whether you are playing a role in the Foundation for a Smoke-Free World. Do you support their strategy? If so, I would love to state how your thinking has changed. I think of you as the architect of one of the strongest policies barring tobacco money from ACS.
“Do you have a formal role with this organization, either as a staff member, a consultant, a volunteer, or a fiduciary? Is this a paid role?”
It would have been nice to discuss this—especially if mistaken identity, evolution of thought, or money is involved—so it made sense to ask whether Seffrin would be willing to have a chat.
He responded via email, confirming that I had the right John Seffrin.
“Sorry, I can’t talk. Even though I’ve been retired from the ACS for about 2 1/2 years, I’m still too darn busy! My current professional role is as a professor of practice at Indiana University–Bloomington School of Public Health.
“In that role, over the last two years I have worked with other “senior” tobacco control advocates on The NTRI (National Tobacco Reform Initiative). One of its purposes has been to develop and encourage innovative ways to reduce the population risks to tobacco smoke. A.k.a. harm reduction. The bottom line is that technologies/alternatives exist today that can help people quit smoking or at least reduce significantly their consumption of burned tobacco, which is what kills them. Please see JAMA viewpoint by Warner and Schroeder published online Sept. 8, 2017.
“Among others, Dr. Derek Yach has been one of the public health professionals and tobacco control advocates participating in the NTRI. BTW he was the senior executive at the WHO that lead the effort to develop and pass the FCTC (framework convention on tobacco control), now ratified by 180 countries. The first-ever public health treaty.
“As I think you know, Derek is the founder of the Foundation for a Smoke-Free World. As I understand it, it is incorporated in Delaware as a 501(c)(3) nonprofit expressly and legally independent from PMI and the tobacco industry, even though it’s initial funding comes from PMI.
“I have no formal role with the foundation. I’m not a fiduciary, not a staff person, not a paid consultant.”
Had Seffrin agreed to talk, it would have been nice to ask him what it’s like to have so many of your former friends say you are taking a step that is at odds with your entire career. Or has the world changed? Do public health experts still note that tobacco companies often employ the strategy of infiltrating the cancer research circles and creating schisms in the anti-tobacco movement in order to promote their agenda?
Since Seffrin’s email to me cited a JAMA viewpoint piece by Steven Schroeder, director of the Smoking Cessation Leadership Center and distinguished professor in health and healthcare at the University California San Francisco, I decided to start by emailing him.
It turns out Schroeder is not awestruck by the promise of the Philip Morris-backed foundation.
“While the goal of ending smoking worldwide is laudable, the past history of Philip Morris is so disreputable that it will be a challenge for this new foundation to be perceived as credible,” Schroeder said to me in an email.
Experts in the field seem to agree that it’s reasonable to advocate for harm reduction and to study e-cigarettes and other new generation products. However, they are troubled by seeing tobacco money back science and public policy initiatives.
The American Cancer Society’s comment on the Philip Morris action didn’t mention Seffrin by name, but had a great deal to say about the new foundation:
“This attempt by Philip Morris International to paint itself as a public health partner is manipulative and dangerous. It is a new twist out of the tobacco industry’s deadly playbook, but nobody should be fooled. It’s a continuation of a decades-long effort to paint over tobacco’s role in spreading death and misery around the globe.
If Philip Morris International is serious about ending the epidemic of smoking-caused illness, it has the power to do it: Stop selling cigarettes. Stop spending billions to market cigarettes. Stop suing governments around the world. And stop fighting every meaningful, evidencebased tobacco control effort.
The American Cancer Society
“Their pledged support of $80 million per year over 12 years may sound sizable, but it is a drop in the bucket compared to the health costs of tobacco. In fact, it is a tiny fraction of the $300 billion in annual health and related costs due to tobacco in the United States.
“American Cancer Society policy prohibits partnering with any research or public health effort that takes tobacco industry support. It is unethical to take money earned off the top cause of preventable deaths in the world.
“If Philip Morris International is serious about ending the epidemic of smoking-caused illness, it has the power to do it: Stop selling cigarettes. Stop spending billions to market cigarettes. Stop suing governments around the world. And stop fighting every meaningful, evidence-based tobacco control effort.”
The World Health Organization Framework Convention on Tobacco Control Secretariat isn’t applauding the Philip Morris venture, either:
“There is extensive experience of tobacco-industry-funded research that was later used to prevent effective tobacco control policies,” the secretariat said in a lengthy statement that merits a click.
“It is clear that the industry aims to follow the same path in the area of non-traditional tobacco products, which are unregulated in many countries.”
The secretariat doesn’t mention Seffrin’s name, but has a bit to say about his compadre Yach:
“Although the president of the Foundation was part of the WHO Secretariat during the negotiation of the WHO FCTC, the treaty had no single architect. It resulted from the work of hundreds of committed government representatives, individuals and organizations, and that is its greatest strength—teamwork.”
In a similarly click-worthy post, a group of tobacco control cognoscenti writing on the BMJ blog slam Yach—and puts the entire matter in historical perspective:
“PMI, which has been working for decades to rebrand itself as a ‘socially responsible’ company while continuing to promote sales of its top-branded Marlboro cigarettes and oppose policies that would genuinely reduce their use, clearly believes this investment will further its ‘harm reduction’ agenda, led by its new heat-not-burn product, IQOS. But don’t worry, the Foundation assures everyone that ‘PMI and the tobacco industry are precluded from having any influence over how the Foundation spends its funds or focuses its activities.’
“Except that is what a broad range of industry front groups, sometimes headed by respected and even well-intentioned leaders, have been saying since the ‘Frank Statement‘ of 1954. The long and sordid history of the industry’s funding of ‘research,’ a major part of the mission of this new foundation, is replete with exactly this sort of blithe reassurance, as Yach himself pointed out in an earlier time. In reality, nothing has changed. The ‘research’ really isn’t the point anyway. The mere fact of having landed Yach is a major public relations coup for PMI that will be used to do more of what the industry always does: create doubt, contribute further to existing disputes within the global tobacco control movement, shore up its own competitive position, and go on pushing its cigarettes as long as it possibly can.”
Unlike many of his colleagues in the anti-tobacco movement, Kenneth Cummings, co-leader of the Tobacco Research Program at the Medical University of South Carolina Department of Psychiatry and Behavioral Sciences, said Seffrin’s and Yach’s action is worth the risk.
His rationale:
Though still profitable, tobacco companies have to adjust to new market realities. Thanks to six decades of work, young people aren’t taking up smoking cigarettes at a high rate. Meanwhile, quit ratios among adults haven’t budged in years.
“We see them at our hospital every day,” Cummings said. “If you have somebody pulling their chemo bag and they are going to sneak a cigarette out behind the cancer center, which we see, it’s pretty sad. It ain’t a choice. It’s a true addiction.”
Meanwhile, e-cigarettes have been growing rapidly in popularity, and Cummings says it’s worthwhile to explore these new products as a harm mitigation measure for current smokers.
“There are alternative nicotine delivery products that don’t have to send you to your local cancer center,” Cummings said. “Those products may or may not help you stop smoking. There are still debates about that. I’d say the evidence is suggestive rather than affirmative, and part of the reason that hasn’t been done is that we haven’t had randomized trials.”
Seeing that burning tobacco isn’t a recipe for economic survival, tobacco companies are moving in the direction of developing these alternative products. “Cigarette companies are going to get left in the dust unless they get into that business,” said Cummings. “The winners in the process are going to be the companies that capture that marketplace and the losers are going to go off the track.”
Cummings, who often testifies as an expert in lawsuits against tobacco companies, sees a historic opportunity to do something to help current smokers. Opponents say that taking advantage of this opportunity will require downgrading the goal from elimination of tobacco to mitigation of risk—and potentially opening new doors for abuse of tobacco.
“It’s a big risk. I give kudos to John Seffrin. He didn’t just stick his neck out. He put his reputation on the line, because if anybody is committed to smoking control, it would be John Seffrin—and Derek,” Cummings said.
Public health advocates have been considering a methodology for making it acceptable to take money from tobacco companies. A set of principles is published in a 2009 paper by J.E. Cohen et al in Tobacco Control. This is, of course, just another paper, but it can be used as a gauge for assessing the bylaws of the Foundation for Tobacco-Free World, which are posted here.
The foundation has yet to identify its directors. Finding credible people to fill these positions will likely be a challenge. And while $80 million a year is a considerable sum in the business of funding public health research, anyone who takes money from this group would be precluded from receiving ACS research grants or doing business with the society. The foundation’s officers may face a similar sort of excommunication.
“Do I trust Philip Morris? No,” Cummings said. “Do I have trust in Derek Yach and John Seffrin? I sure do. I think they have high integrity and they see a need to change.”
I decided to check whether Matt Myers, president of the Campaign for Tobacco-Free Kids, agrees with the view that new technologies open new opportunities which require new tactics. He did not.
We see them at our hospital every day. If you have somebody pulling their chemo bag and they are going to sneak a cigarette out behind the cancer center, which we see, it’s pretty sad. It ain’t a choice. It’s a true addiction.
Kenneth Cummings
Even the notion that the interests of adult smokers are somehow distinct from those of young smokers is false and “specious,” Myers said to The Cancer Letter. And so far, he has seen nothing that would justify taking money from Philip Morris.
“The same public health public policy to reduce smoking among adults reduces smoking among kids, it’s not an either/or at all,” he said. “If e-cigarettes have a public health benefit, it is to assist smokers to switch completely or quit.”
These new products could also reel in new smokers and expose them to new forms of harm, Myers said.
“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,” he said.
Our conversation appears here.
The presumption that tobacco money comes with strings attached formed the intellectual foundation of the policy Seffrin instituted at ACS. The policy was strict, but, alas, it was also porous.
The John Seffrin of yore sponsored the National Dialogue on Cancer, which ran into significant conflicts of interest involving tobacco. I would argue that it was the most important story in oncology from 2000 to 2005.
The dialogue was designed as a massive effort that had the potential to propel ACS to the top role in setting the cancer agenda, mandating the rewriting of the National Cancer Act to install a “cancer czar.”
Conflicts created by the dialogue reached into the ACS headquarters in Atlanta and all the way to the top of the National Cancer Institute when it was run by dialogue governing board member Andrew von Eschenbach. As NCI director, von Eschenbach pledged to end “suffering and death due to cancer” by 2015.
The initiative later ceased to be one of the top ACS and NCI priorities, and it continues under the new name—C-Change.
When he launched the dialogue, Seffrin relied on former ACS official Allan Erickson to run it. Does Erickson play a role in the Philip Morris matter as well?
I learned that Erickson now runs the National Tobacco Reform Initiative, a small group that includes Seffrin and Yach. Recently, the group published a report calling for tobacco reform.
One recommendation: “Establish a more rational tobacco, nicotine, and alternative products regulatory framework based on their relative risks, and that is adaptable to the increased speed of innovation in new technology development.” But this is, of course, not the same as saying go take research funds from Philip Morris.
Digging deeper, I found that last year, in the context of the Moonshot, the NTRI folks made an intriguing proposal to then-Vice President Joe Biden.
They wanted to tell Biden how a change of course in tobacco control could score a big victory in the “War on Cancer”:
“In our view, we have outgrown the original National Cancer Act, and we need a new one, including a new organizational structure, and possibly even a ‘cancer czar.’ Now is as good a time as any to launch a concerted effort to conquer this dread disease. We know the new War on Cancer is winnable, and we know how to get there, which absolutely must include an all-out effort to expedite the demise of cigarette smoking as soon as possible.
“Core Team leaders, Michael Terry [identified on the NTRI website as “son of former U.S. Surgeon General Luther Terry”] and John Seffrin, immediate past CEO of the American Cancer Society (1992-2015), would very much like to meet with you and your team at the earliest possible time. Such a meeting would give you a better understanding of the weaknesses and strengths of the current tobacco control effort in the U.S., as well as our perspective on what programming changes are needed in order to bring the tobacco-related cancer epidemic under control.
“We are confident that our ‘neutral position’ and unbiased approach to this will serve you, the War on Cancer team and panel of distinguished public health leaders far better than if you were to rely exclusively on what each of the competing organizations and agencies would tell you.”
Of course, I called Erickson.
Erickson said he has no role in the Philip Morris venture, but he does support it.
“I have been a soldier for ACS for half my life,” he said. “I think a lot of people have hidden their heads in the sand. They are just so totally opposed to e-cigarettes, it drives them nuts.”
Our conversation appears here.
