Big Tobacco’s Pandora’s box| Tabaccologia

Abstract

It has been nearly 30 years since the ending of the tobacco trial in Minnesota and the signing of the Master Settlement Agreement (MSA) by 46 general attorneys from the United States and the U.S. tobacco industry. The Minnesota agreement exposed the tobacco industry’s long history of misleading marketing, advertising, and research and ultimately imposed the industry to change its business practices. The provisions for disclosure of public documents that were included in the Minnesota Agreement led to the disclosure of approximately 70 million pages of documents and nearly 20,000 other multimedia materials. In fact, other document archive is comparable to it as far as dynamicity, voluminosity and mis à jour is concerned. Only a few individual events in public health history have had such a dramatic effect on tobacco control as the public disclosure of previously secret internal tobacco industry documents. With the deposition of Jeffrey Wigand of B&W Co. in front of a US Court, a Pandora’s box, full of lies, scams and deceptions perpetrated by the tobacco industry (Big Tobacco) for over 50 years, was opened. It became an authentic gold mine for researchers, full of confidential and top-secret news on cigarettes. They discovered for instance that Big Tobacco was aware since the early 60’s that nicotine was addictive and then, not content with that, they invented a way to make it totally penetrating the blood, treating tobacco with ammonia. Big Tobacco’s guiding rule was to spread misinformation to create and feed doubt. There are numerous deceptions that come to the surface: light cigarettes, second hand smoking, air quality, enlistment of deep throats in all sectors and testimonials especially in the film field, up to the concealment of the presence of Polonium 210 in tobacco.

Introduction

In 1994, the CEOs of the seven largest tobacco companies testified under oath before the U.S. Congress that nicotine was not addictive. Joseph Taddeo, then president of the US Tobacco Company, told Congress: “I don’t believe that nicotine or our products are addictive”, and so did the other six CEOs who all agreed; “No sir, nicotine is not additive”.

This perjury cost them dearly when Jeffrey Wigand took the leap as an insider on 11/29/1995 by resigning from the Brown & Willianson Tobacco Company and testifying before the Mississippi Court: “Yes, nicotine is a drug that we treated with ammonia to allow 100% absorption”.

Following these affirmations from Wigand, the State of Minnesota, along with the insurance companies Blue Cross and Blue Schield, seeking compensation for money spent on medical treatment by smokers, filed a lawsuit against Philip Morris International Inc. (PMI) and the other U.S. tobacco companies. The trial (Minnesota Attorney General litigation, no. C1-84-8565, 2d Dist. Minn.) ended with a compensation of 6.1 billion dollars for the State of Minnesota and 469 million dollars for the two insurance companies, with the prohibition for multinationals to direct marketing actions to minors and with the posting online of all the documents collected during the preliminary phase of this and other proceedings concerning the compensation of the damages caused from cigarette smoke. But the most important injunction of the Court, for us researchers, was the obligation to declassify and publish confidential and top-secret documents to be published open access on the respective websites of the tobacco companies until 2010, thus uncovering for the first time a veritable Pandora’s box with a quantity of documents of the tobacco industry equivalent to 32 million pages [1].

The most consulted site, as it was richer in information, was that of PMI [2]. Once inside, it was possible to consult all the strictly confidential documents of the largest tobacco multinational. With a sort of deferred espionage, it was possible to analyse the reports, view the spending programs, reconstruct the activity plans of the various structures belonging to the company. It was possible to investigate the contacts that the industry had established at the political, medical-scientific and mass-media levels, what strategies it had implemented on the media side, what scientific research it had conducted and for what purposes. This archive, like that of the other cigarette manufacturers, was accessible to everyone from 1998 to 2010.

Obviously after 2010 the sites were thoroughly cleaned, but fortunately before that happened, they were all saved and collected in a single site by the University of California San Francisco [3].

The conspiracy and false communication

In the early 1950s, the tobacco industry, concerned about the scientific studies that pointed out tobacco smoking as responsible for lung cancer as well as respiratory and cardiovascular diseases, decided to quit hostility between each other and to make a common front against the rising tide of resentment towards smoking.

So, on December 14, 1953, they met at the Plaza Hotel in New York and agreed to form a “cartel” steeped in lies, deception and misinformation. The high point of this intrigue was the publication of the “Frank Statement to Cigarette Smokers”. It is a press release of the main U.S. tobacco industries, which appeared full-page in over 400 American newspapers and magazines on January 4, 1954, reaching about 43 million people. With this communiqué, the tobacco companies wanted to counter the scientific evidence that had been produced up to that point and which showed that cigarette smoking caused cancer and other respiratory diseases [4].

The text was drafted on December 26, 1953, and corrected two days later in New York, at the Plaza Hotel, by delegates from all the tobacco companies. The original draft of the Frank Statement, preserved in the historical archives of the State of Wisconsin (USA), is very interesting because it contains the corrections noted in the margins of the document. It is an excellent example of disinformation, in which it can be seen that the changes have been carefully designed to protect the tobacco industry, to reassure public opinion and to “cover up” the truth [4]. For example, the sentences that said:

1. that science had no evidence that tobacco was dangerous to health were deleted;
2. who would never manufacture and sell a product that is dangerous to human health.

These removals were obviously made unwillingly because:

1. the scientific evidence began to be more and more numerous and could not be disproved;
2. it was not possible to say that tobacco products were not dangerous.

By deleting these phrases, the tobacco industries have thus shown that their main interest was only profit; in fact, from then on, they have continued to produce and sell a product harmful to health in spite of scientific evidence and the protection of human health. Moreover, with these erasures, they have also proven their falsehood; in fact, a few lines earlier they declared that they considered the protection of human health a basic responsibility of their work, superior to economic interests. Instead, it is clear that they did not consider people’s health and that what they declared was only for the purpose of reassuring public opinion and taking legal precautions. Finally, they claimed to have always cooperated and continue to do so, with those who have the task of protecting public health. Instead, history reveals that the actions taken by tobacco industries have:

1. criticized scientific studies conducted by researchers independent of their industries with a regular action of scientific/mass media counter-marketing and disinformation;
2. generated controversy about the health effects of their products;
3. created the impression of a lack of scientific consensus that cigarettes cause lung cancer and are associated with the onset of many other diseases;
4. falsely presented their products as safe and harmless through advertising;
5. advertised cigarettes to children through cartoon characters;
6. exploited, through advertising on young smokers, the adolescent phenomenon of following the same behaviours to belong to the group, in order to “capture” new smokers;
7. chemically modified the content of cigarettes to promote nicotine addiction (increased the “impact and satisfaction” caused by nicotine) and to mask the negative properties of smoking (addition of sweeteners).

This press release was the first of a long disinformation campaign aimed at discrediting the results of scientific research that has been accumulating evidence and which has shown that cigarette smoking is not only the cause of lung cancer but is also implicated in many other diseases [4].

Disinformation or the “factory of doubt”

In order to understand the intention of the whole operation, it is necessary to keep in mind that the big industry (not only the tobacco industry) has always used public relations agencies to convey a good image of itself. Teams of specialists ensure “intelligent monitoring” of market trends and consumer expectations; develop strategies to prepare public opinion to welcome corporate choices; they follow the evolution of the regulations governing production and marketing; They teach managers to deal with emergencies in case flaws in the company’s operations or some unwanted feature in the products are discovered. All with the declared aim of defending its market share, its business. Among the beneficiaries are the public relations agencies Burson-Marsteller and the Italian SCR Associati, among the newspapers the Sunday Telegraph of London and a myriad of Italian and foreign researchers.

The Ammonia Nicotine Deception

Since at least the early 1960s, the tobacco industry has been aware of the additive nature of nicotine. On PMI website alone, there were something like 49,722 standards, confidential and top-secret documents.

An executive of Brown and Williamson, a subsidiary of British American Tobacco (BAT), Addison Yearman, wrote on July 17, 1963: “Nicotine is addictive. Our business, therefore, is the sale of nicotine, an addictive drug”. A 1967 BAT paper stated, “Smoking is an addictive habit attributable to nicotine, and the form of nicotine influences the rate of absorption by the smoker.”

Aware that it was nicotine that hooked experimenters to make them habitual smokers and, as if that were not enough, to overcome the medium-poor ability of nicotine to cross the respiratory mucous membranes (about 50-60%), at the end of the ‘60s they began to “dope” nicotine, ammoniating it, in order to make it 100% absorbable, as later revealed by Wigand in the ‘90s [5,6]. Nicotine ammonisation was first secretly devised by Philip Morris, and then adopted by other tobacco companies once this treatment was discovered [7,8].

The unbearable lightness of the... Light Cigarettes

Another deception of Big Tobacco was that of light cigarettes. The annual expenses of tobacco companies to advertise the unsustainable lightness of light cigarettes amounted to 10.1 billion $US / year, worldwide, but for misinformation on the alleged and false safety of light cigarettes.

On the SME’s website there were 49,722 documents that revealed that they were designed to expand the market to women and to those smokers who wanted to continue smoking while getting less harm... A precursor of “risk reduction strategy”, but unfortunately the light cigarettes were no less toxic for smokers. Indeed, according to an official report of the US government, published in 2001 by the National Cancer Institute, since cigarettes had entered the market, in versions of “light” or “superlight”, smoking-related diseases have even been on the rise. Among the female population, lung cancer deaths rose from 44 per 100,000 in the mid-1960s to 119 per 100,000 in the mid-1980s. A similar trend was also recorded for men [9-11].

In the National Cancer Institute (NCI) monograph, entitled “Risk associated with smoking low-tar and nicotine cigarettes”, the authors conclude that the evidence does not indicate a public health benefit from changes in the design and production of low-tar and nicotine cigarettes over the past 50 years [11].

Scott Leischow, director of the NCI-Tobacco Control Research Branch, stated that “the monograph clearly demonstrates that those who switch from ‘regular’ cigarettes to “light” cigarettes, inhale substantially the same amount of carcinogenic toxins and remain at the same level of risk of developing cancer and other smoking-related diseases”. In addition, smokers who switch from “normal” cigarettes to Light cigarettes compensate for the lower level of nicotine inhaled, inhaling more deeply, with more and faster puffs or increasing the number of cigarettes smoked per day. As a result, smokers cancel out all the potential benefits of LTC, due to the lower concentration of nicotine and tar.

And so it was that the sanctions and the withdrawal from the market began. PMI was sentenced to pay a fine of 10 million $US by an Illinois court: “it is not true that they hurt less”. The European Union also banned all cigarettes advertised with mild, light, light or low tar words from 1 September 2003 [12].

From a scientific point of view, the verdict of conviction is all there as by now all the research agreed that light cigarettes do not limit the damage of tobacco smoking.

The International Agency for Research on Cancer (IARC) based in Lyon was also under the attention of the tobacco industry. Also, on the SME’s website there were 23,049 documents. And it was no coincidence, because Philip Morris, and the other tobacco companies, were very concerned about the multicenter study of the IARC conducted in Europe (1988-98) on the carcinogenicity of passive smoking, which in 1993 began to enter the operational phase, and which could have led the various national governments to launch restrictive regulations regarding tobacco smoking.

Philip Morris and the other tobacco companies feared the developments of this multicentre study by the IARC (International Agency for Research on Cancer) on second-hand smoke and lung cancer conducted in Europe. The results of this study (and a possible IARC monograph on passive smoking) could have led to the issuance of restrictive regulations in Europe as well. This study was perceived as a serious threat to their business by tobacco companies. For this reason, it has committed, together with other tobacco companies, to undermine the IARC results through the manipulation of the media, the public, and the scientific world, trying to politically oppose the approval of any legislation that places limits on smoking freedom, leading a cross-sectoral strategy on three fronts to subvert the work of the IARC.

Therefore, for Big Tobacco, in view of the results, it was necessary to “influence the formulation of the conclusions and the official communication of the results; publish the conclusions of the study as late as possible; counteract the potential impact of the study on government policies, public opinion, the actions of private entrepreneurs and the owners of public premises”. In this scenario, a 360° strategy was planned. The scientific strategy attempted to weaken IARC’s research and develop industry-led research to counter the expected results. The communication strategy involved shaping opinion by manipulating the media and the public. The political strategy tried to prevent an increase in smoking restrictions and tried to prevent the approval of any legislation that placed limits on the freedom to smoke”. On the communication side, Big Tobacco aimed at manipulating the media and public opinion. And to do this, Philip Morris spared no expense. The enormous effort launched by the tobacco industry against this scientific study was remarkable. While it is estimated that over ten years (1988-98) the IARC study cost $1.5-3.0 million, the PMI alone allocated at least $2 million for the IARC plans for a single year (1994), investing $4 million to fund the IARC study’s enforcement and discrediting actions, producing counter-information research, stimulating controversy, misinforming with pseudo-scientific literature, creating shadow organizations and fake “pro-tobacco” social movements that minimized the problem of passive smoking and emphasized that of environmental pollution [1]. And the tobacco industry had every reason to worry, because the IARC multicentre, published in 1998, showed a 16% increase in the point estimate of lung cancer risk for nonsmokers subjected to passive smoking, a result, moreover, consistent with previous studies. However, the study was described by newspapers and the tobacco industry as demonstrating no increased risk [1,13]. The results of this IARC study, however, over the years, have motivated many national governments, especially in the West, to pass anti-smoking laws to protect non-smokers.

Given that it is not just any industry that wants to promote its image, but a multinational manufacturing whose main product is the primary cause of avoidable deaths in the countries where it is marketed, one can imagine how articulated and aggressive these strategies must be. In order to continue to sell these goods without restrictions, it is necessary, now as then, to also have legal assistance and above all great expertise in the scientific field because it is there that the evidence of the danger of smoking accumulates, and it is therefore at that level that the battle must be waged. Of course, the tobacco industry, with its staggering turnover, has never had difficulty in “producing research and stimulating controversy” and in “disseminating the scientific literature with pro-tobacco disinformation” [1].

So, when IARC starts the study, Philip Morris already has a vast network of scientists and consultants in Europe, willing to provide their expertise at the service of the tobacco industry. On the other hand, much scientific work on second-hand smoking had already been manipulated by the influence of the tobacco multinationals [14]. And the strategy of doubt (“We are the factory of doubt”) was the mantra of the confidential relationships of the tobacco industries “[...] one of the fundamental strategies of the tobacco industry has been to insinuate doubt and contradiction about the scientific knowledge acquired on the effects of tobacco on health” [14]. And as Lojacono himself recommended, the important thing is that the news is... “well publicised and disseminated” (Doc. 2501356124/6) [15].

Deep throats or the Whitecoat project

One of the most devious and dangerous actions of Big Tobacco was to influence a part of the scientific world to its advantage by enlisting at least one deep throat in each country; thus, the Whitecoat project was born. The core and purpose of the Whitecoat project (the temptation to rename a dirty operation with a clean name is irresistible) was to know in advance the results that were emerging and then insinuate doubts about scientific correctness. If for Switzerland, for example, Professor Rylander was Professor Rylander (18,684 documents out of ), for Italy Professor Giuseppe Lojacono (58 documents). And it is at this point that the Italian side of this story opens up. Ong and Glantz report that the most detailed information on the IARC study came to Philip Morris through SCR Associati, which had among its consultants the “late Giuseppe Lojacono, former professor of health economics at the University of Perugia”. Lojacono had visited the IARC several times, from 1977 to 1999, in his role as Editor-in-Chief of the Journal Epidemiology & Prevention (E&P), an organ of the Italian Association of Epidemiology and Epidemiology [16,17]. And it was the same E&P magazine that courageously and professionally revealed the Lojacono-Philip Morris affair [16-18].

Querying the [2], cleaned up after 2010, with the entry Lojacono (with the “i” in the search) 58 documents were obtained.

It thus turned out that Prof. Lojacono had been for 10 years, from 1988 to 1998, scientific consultant to the SCR Agency which took care of the public relations of the tobacco industry in Italy. On behalf of this Agency, he participated in conferences, kept an eye on Italian scientific production, collected information and reported. A diligent official described him as “active in journalism, with good contacts with the WHO and the then Director Nakashima, knows Tomatis, Director of the IARC, personally, and disagrees with what the Surgeon General has said about passive smoking and nicotine addiction” (doc. 2501152054/64).

So, delegations of experts in the pay of the tobacco task force left for Lyon proposing meetings with those responsible for research and reporting to the parent company, ready in turn to churn out press releases of the opposite sign. Real Trojan horses to steal in advance the secrets and moves of IARC researchers. Every European nation had at least one deep throat in the medical-scientific field. Lojacono also reported on the inclinations of the Italian scientific community and the attitude of public opinion on smoking. The reports underline the propensity of Italian epidemiologists to deal with risk factors present in the workplace, in the urban environment and in food, concluding that by virtue of this vocation “the Italian scientific community, or at least a part of it (...) has already made and can continue to make significant contributions to the reduction of the problem of passive smoking on the national conscience” (doc. 2501356124) [15].

Indoor air quality

The catch phrase was: recontextualize second-hand smoking as one of the many factors of indoor air quality.

Lojacono, therefore, suggested strategies to be used to divert the attention of researchers and the public from the harmfulness of second-hand smoke. “To resize the role and weight of passive smoking as a risk factor”, is the proposal relaunched in several documents, placing it in the more general cauldron of indoor air quality: “this remains our primary objective in Italy” (so in October 1990. Doc. 2028350107-13) [15].

With this strategy, round tables (Naples 1992), conferences (Anacapri, 1994) were organized with a myriad of patronages and sponsorships (WHO, Ministry of the Environment, University of Naples, Healthy Cities of Milan, E&P, Glaxo, etc.) with “the aim of generating a discussion on pollutants other than passive smoking” trying to demonstrate that “in the scientific field we can talk about IAQ (Indoor Air Quality) without the intrusion of passive smoking and that many researchers in Italy are interested in the topic” (doc. 2501341966/8)[15]. Thus, NGOs and Glantz [1] continue together with the “network of informants, mostly made up of journalists, the exchange with the tobacco industry was transversal and continuous” and it was possible to heavily influence public opinion with continuous disinformation campaigns, sometimes sensational and other times minimal. Attempts have been made to direct the attention of researchers and the public to harmful factors other than tobacco. Research has been conducted, on its own by Philip Morris, and studies by researchers have been funded, hoping for results that can be used in the implementation of one of the most effective tactics: opposing data to data, study to study, to trigger and fuel endless controversies in order to disorient public and political opinion on the smoking problem.

Polonium-210

Alpha radioactivity in tobacco has always been a problem feared by Big Tobacco. Although the first studies on the radioactivity of tobacco date back to the early 60s, and then continued with important conclusions, unfortunately they never had the impact on the health and legislative world that the problem deserved. The importance of these studies can be understood from the attention that the counterpart, PMI in the first place, has reserved for them. Among the millions of documents declassified and made public until 2010 on the website, due to the famous sentence of the State of Minnesota (USA), there were 462 confidential documents-memoranda on the alpha radioactivity from Po-210 of tobacco smoke. One of these, dated 1980, reveals that the PMI was already aware that the cigarettes contained lead and radioactive polonium and that this was largely due to the fertilizers used, and in particular calcium phosphates, used in tobacco cultivation (“210- Pb, radioactive lead, and 210- Po, radioactive Polonium, are present in tobacco and smoke...”).

It is no coincidence that the Polonio dossier bore the inscription: “Do not wake up the sleeping giant”.

Tobacco producers were also perfectly aware of the studies of Martell and others [19-22] on the possibility of being able to reduce the levels of radioactivity in tobacco and smoke, reducing that of fertilizers by transforming calcium phosphate into ammonium phosphate... a procedure that is too expensive (“using ammonium phosphate instead of calcium phosphate as fertilizer is probably a valid but expensive point...”) (Newscript: Radioactive cigarettes, PMI, Apr 2, 1980, doc. 2012611337/1138) [23].

Pro-tobacco testimonials

To conquer more and more markets and increase its business, Big Tobacco’s marketing has wildly and shamelessly enlisted pro-tobacco testimonials at various levels [24,3].

Various doctors have lent themselves to advertising in favour of tobacco consumption. In the entertainment sphere, Hollywood has represented a promotional goldmine. And then we learn of pharaonic fees to actors to give visibility to various cigarette brands: a) Silvester Stallone: $500,000 fee for smoking in 5 films, including those of Rambo; b) Sean Connery: $12,000 worth of jewellery for a couple of cigarette scenes; c) Paul Newman: $42,000 car fee for smoking scenes in some of his films; d) up to the title of a film “I love you Philip Morris”

Incredible news emerges from the drafting of the Marshal Plan (Paris 1947) in which a senator from Virginia manages to include in the aid plan to Europe devastated by the Second World War, 1 dollar in cigarettes for every 2 dollars of food aid [24].

Conclusion

Thanks to the rulings of the American courts, Pandora’s box has been opened on the strategies, interference and deceptions of the tobacco industries.

Big Tobacco had an easy time thanks to the complicity of some journalists, politicians and operators in the medical-scientific world who were part of the tobacco lobby. And the results are there for all to see. It has thus been possible to heavily affect public opinion with striking or sometimes minimal, but continuous, disinformation campaigns, so that we find ourselves with smoking patients and a large part of public opinion who regularly underestimate the damage of exposure to smoke.

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