Two days ago it was announced to much fanfare that the international tobacco giant, Philip Morris International (PMI) pledged $1bn over the next 12 years to the Foundation for a Smoke-Free World (FSFW) to fund scientific research designed to eliminate the use of smoked tobacco around the globe. The Lancet editor, Richard Horton tweeted a challenge to the health community: how should we respond? My tweeted response is shown below, but the challenge drew a range of (usually negative) responses, and the whole announcement is worthy of further unpacking and analysis.
First, it is worth pondering PMI’s motivation. Would turkeys vote for Christmas? Would tobacco companies vote for a world without tobacco? And the answer is no, they wouldn’t.
The announcement of the funding was picked up by, among other media outlets, Bloomberg, the Guardian, the Financial Times, Fortune, and CNBC. Most of the headlines start with two words, “Philip Morris”, which means the corporate social responsibility team at PMI can expect a big elephant stamp on their performance appraisals and an end-of-year bonus. This kind of positive publicity for a tobacco company is extraordinary and under other circumstances I would have said they couldn’t buy it, but apparently they can.
If you visit the PMI corporate web-site you will be presented with a glossy video of talking heads with overlaid text that PMI is “Designing a smoke-free future”. Some time in the future PMI will be out of (less reliant on) their cigarette business — not their tobacco business, but their cigarette business.
We’re dedicated to doing something very dramatic – replacing cigarettes with the smoke-free products that we’re developing and selling. That’s why we have a total of over 400 dedicated scientists, engineers, and technicians developing less harmful alternatives to cigarettes at our two Research & Development sites in Switzerland and Singapore. It’s the biggest shift in our history. And it’s the right one for our consumers, our company, our shareholders, and society.
That is clearer. PMI is still deeply committed to the manufacture and sale of an addictive, harmful substance, but in the future they hope it will be less harmful. The level of PMI’s commitment to the shift away from smoked tobacco can be gauged by the allocation of 400 of their 80,000 staff to the innovation of smoke-free products, or about 0.5% of their workforce. It should also be noted that when countries have attempted to interfere with PMI’s capacity to trade in a lethal product, it has fought those measures vigorously. This means that PMI will fight extremely hard (as is required by its fiduciary duty to investors) to maintain its profitability even at the expense of the life and health of its consumers. If PMI can develop a range of successful proprietary tobaccos products/technology that are smoke free, it is entirely in PMI’s interest to throw its weight behind anti-smoking initiatives, because competitors will be forced to use PMI technology under license.
Having got a sense of PMI, I will shift focus, more directly to the funding for FSFW. In the light of the PMI pro-tobacco, smoke free agenda, ponder the name of FSFW. This is a foundation dedicated to a smoke-free, but not a tobacco-free world. This is consistent with the commercial goals of PMI. For some, the argument is one of harm reduction. If the world moves to smoke free products, harm will be reduced. The fact that PMI is funding it, is proof of the excellence of public-private-partnership models.
Would it reduce harms? Yes. The harms, however, may not be reduced to the extent that might be hoped. There are some indications that the use of smoke-free products carry an increased risk of mortality over non-smoking, non-use of smoke-free products. Nonetheless, for those who would have become smokers, or switch from smoke to smoke-free products, harm will be reduced over being a smoker.
Does FSFW have a conflict of interest? They say, no.
Importantly, as established in the Foundation’s bylaws, PMI and the tobacco industry are precluded from having any influence over how the Foundation spends its funds or focuses its activities. Independence and transparency are core principles of the Foundation and all activities will be conducted with full transparency, free of tobacco industry influence. The Foundation has, constituted in its bylaws, an independent research agenda, independent governance, ownership of its data, freedom to publish, and protection against conflict of interest. Furthermore, strict rules of engagement will be put into place to ensure any interactions with the tobacco industry are fully transparent and publicly reported.
This is naive.
PMI has pledged about $80 Million per year over 12 years. this represents about 0.11% of of PMIs annual net revenue. The money is not paid up-front or held in an escrow-type account, and the continued payment will be decided up by PMI — presumably factoring in PMI’s satisfaction with FSFW’s activities. And $80 Million buys a lot of loyalty.
The loyalty that funding from corporate giants garners was well illustrated recently by the New America Foundation (NAF). “New America is a think tank and civic enterprise committed to renewing American politics, prosperity, and purpose in the Digital Age. We generate big ideas, bridge the gap between technology and policy, and curate broad public conversation.” Like FSFW they also boldly proclaim their independence from funders, stating under their Gift Guidelines:
New America steadfastly adheres to its mission of developing independent, non-partisan analysis and recommendations reflective of rigorous scholarship and promoting those ideas through broad public discourse. New America maintains full authority regarding project agendas, events, budgets, editorial content, and personnel decisions.
NAF receives substantial funding from Google. One of the NAF Fellows commented (as part of his work) positively about a decision by a European Union antitrust regulator that went against Google. The employee was subsequently fired by NAF, after Eric Schmidt the Executive Chairman of Alphabet, Google’s parent company, spoke with the head of NAF and made his displeasure known. This is instructive for two reasons, first Google was famous for its internal corporate motto “Don’t be evil” and later in Alphabet, “Do the right thing”. If a company that had “do the right thing” as an explicit part of its self image can’t leave independent foundations to be independent, what hope does a tobacco company have? Second, companies react negatively to things that they perceive as a threat to profit, without regard to the legitimacy or moral rectitude of the threat.
One would have to be foolish or naive to believe that one could be independent of the hand that feeds them. Even if someone at FSFW felt truly unshackled and unconstrained, the invisible thread of funding would moderate the independence of judgment.
Mitch Zeller the director of the Center for Tobacco Products at the US Federal Drug Administration regards this approach to harm reduction as a positive step forward, because Public Health has been “stunningly unsuccessful“, at selling harm reduction thus far. Unfortunately, government and industry are often tightly bound, ensuring that harm reduction does not work unless, as in this case, the industry can continue to make money from a (less) harmful addiction.
If government wants harm reduction to be successful, then government needs to get serious about tobacco control. Ban all forms of tobacco advertising. Ban the sale of cigarettes in locations frequented by children. Enforce uniform, plain packaging. Ban smoking in public places. Tax the product heavily. Place all taxation revenue from tobacco products into health promotion, quit campaigns, interventions, and tobacco related research.
Within a minute I swung from apoplectic to flummoxed. My erudition had been called into question with an unkind gibe. A friend — truth be told, an impious ragamuffin — started this small, mental kerfuffle by suggesting I would not be able to use a set of 21 words in a single blog post. Was this louse, this piebald swiller serious, or was it waggish humour? Apparently, he was serious. There was no playfulness here.
A busy McDonalds is like a well-greased machine. A coordinated team of short-order cooks; staff behind the counter ready to take your order. Queues of people waiting impatiently to pick up their triple burger, hold the onions, no cheese and a flurry of fries. A Manager hovers. Joel, someone’s vomited in the toilets. Sarah, supersize the “meal”. Dinesh, where’s the lady’s McMac?
