Public Health Chronicles TOBACCO INDUSTRY bacco industry to manipulate information on the risks of MANIPULATION OF RESEARCH tobacco (Figure). These strategies have remained remark- ably constant since the early 1950s. During the 1950s and Lisa A. Bero, PhD 1960s, the tobacco industry focused on refuting data on the adverse effects of active smoking. The industry applied the Research findings provide the basis for estimates of risk. tools it had developed during this time to refute data on However, research findings or “facts” are subject to interpre- the adverse effects of secondhand smoke exposure from the tation and to the social construction of the evidence.1 Re- 1970s through the 1990s. search evidence has a context. The roles of framing, problem The release of previously secret internal tobacco industry definition, and choice of language influence risk communi- documents as a result of the Master Settlement Agreement cation.2 Since data do not “speak for themselves,” interest in 1998 has given the public health community insight into groups can play a critical role in creating and communicat- the tobacco industry’s motives, strategies, tactics, and data.16 ing the research evidence on risk. These documents show that for decades the industry has An interest group is an organized group with a narrowly tried to generate controversy about the health risks of its defined viewpoint, which protects its position or profits.3 products. The internal documents also reveal how the in- These groups are not exclusively business groups, but can dustry has been concerned about maintaining its credibility include all kinds of organizations that may attempt to influ- as it has manipulated research on tobacco.16 ence government.4,5 Interest groups can be expected to con- The tobacco industry has explicitly stated its goal of gen- struct the evidence about a health risk to support their erating controversy about the health risks of tobacco. In predefined policy position.6 For example, public health in- 1969, Brown and Williamson executives prepared a docu- terest groups are likely to communicate risks in a way that ment for their employees to aid them in responding to new emphasizes harm and, therefore, encourages regulation or research about the adverse effects of tobacco, which stated: mitigation of a risk.7 Industry groups are likely to communi- “Doubt is our product since it is the best means of compet- cate risks in a way that minimizes harm and reduces the ing with the ‘body of fact’ that exists in the mind of the chance that their products are regulated or restricted in any general public. It is also the means of establishing a way. Disputes about whether a risk should be regulated are controvery. If we are successful in establishing a contro- sometimes taken to the legal system for resolution.8 Thus, versy at the public health level, then there is an opportunity interest groups often have two major goals: to influence to put across the real facts about smoking and health.”17 policy making and to influence litigation. Eleven years later, the tobacco industry expressed the same goal regarding evidence on the risks of secondhand smoke. CREATING CONTROVERSY A report prepared by the Roper Organization for the To- bacco Institute in 1978 noted that the industry’s best strat- Policy making is facilitated by consensus.9–11 However, scien- egy for countering public concern about passive smoking tific research is characterized by uncertainty, which poses was to fund and disseminate scientific research that coun- problems when decision-making moves to a public forum. It tered research produced by other sources: “The strategic is often to the benefit of interest groups to generate contro- and long-run antidote to the passive smoking issue is, as we versy about data because the controversy is likely to slow or see it, developing and widely publicizing clear-cut, credible, prevent regulation of a given product. For example, scien- medical evidence that passive smoking is not harmful to the tific debate over the data and methods used in a risk assess- non-smoker’s health.”18 ment can hinder the development of the risk assessment.12 Philip Morris promoted international research related to The tobacco industry has devoted enormous resources to passive smoking in order to stimulate controversy, as attacking and refuting individual scientific studies. In addi- tion, the industry has attempted to manipulate scientific methods and regulatory procedures to its benefit. The to- Figure. Tobacco industry strategies to bacco industry has played a role in influencing the debate manipulate data on risk around “sound science,”13 standards for risk assessment,14 and international standards for tobacco and tobacco prod- 1. Fund research that supports the interest group position. ucts.15 In the early 1990s, the tobacco industry launched a 2. Publish research that supports the interest group position. public relations campaign about “junk science” and “good 3. Suppress research that does not support the interest group epidemiological practices” and used this rhetoric to criticize position. government reports, particularly risk assessments of envi- 4. Criticize research that does not support the interest group position. ronmental tobacco smoke.13 The industry also developed a 5. Disseminate interest group data or interpretation of risk in campaign to criticize the technique of risk assessment of low the lay press. doses of a variety of toxins,14 working with the chemical, 6. Disseminate interest group data or interpretation of risk petroleum, plastics, and chlorine industries. directly to policy makers. In this article, I describe the strategies used by the to- 200 ᭛ Public Health Reports / March–April 2005 /Volume 120 Public Health Chronicles ᭛ 201 described in the notes of a meeting of the UK [Tobacco] try documents that have been made available through the Industry on Environmental Tobacco Smoke, London, Feb- legal “discovery” process. In the mid-1990s, internal tobacco ruary 17, 1988: “[W]e are proposing, in key countries, to set industry documents were circulated by industry whistle- up a team of scientists organized by one national coordinat- blowers. By 1998, availability of tobacco industry documents ing scientist and American lawyers, to review scientific litera- increased exponentially as a result of the settlement of a suit ture or carry out work . to keep the controversy alive.”17 by the state of Minnesota and Blue Cross/Blue Shield against The tobacco industry organized teams of scientific consult- the major tobacco companies. The Master Settlement Agree- ants all over the world with the main goal of stimulating ment between the attorneys general of 46 states and Brown controversy about the adverse health effects of secondhand & Williamson/British American Tobacco, Lorillard, Philip smoke.19–21 Morris, R.J. Reynolds, the Council for Tobacco Research, Studies show that industry sponsorship of research is and the Tobacco Institute released millions of additional associated with outcomes that are favorable for the spon- documents to the public. These documents provided an sor.22–24 One possible explanation is that industry-sponsored unprecedented look at how tobacco industry lawyers were research is poorly designed or of worse methodological qual- involved in the design, conduct, and dissemination of to- ity than non-industry-sponsored research. However, no con- bacco industry–sponsored research.16 sistent association has been found between industry spon- The internal tobacco industry documents include de- sorship and methodological quality.22 Factors other than study scriptions of research that was funded directly by law firms. design can affect the outcome of research, including (1) the For example, the law firms of Covington and Burling, and framing or social construction of the research question, Jacob and Medinger, both of which represent a number of (2) the conduct of the study, and (3) the publication (or tobacco company clients, funded research on tobacco in the not) of the study findings. In the following sections, I de- late 1970’s through the early 1990’s.26 Lawyers selected which scribe how the strategies that the tobacco industry uses to projects would be funded; including reviews of the scientific stimulate controversy about tobacco involve manipulating literature on topics ranging from addiction to lung reten- research at multiple stages. The tobacco industry, through tion of particulate matter. These law firms also funded re- its funding mechanisms, has attempted to control the re- search on potential confounding factors for the adverse search agenda and types of questions asked about tobacco. health effects associated with smoking. For example, projects The industry’s lawyers and executives have been involved in were funded that examined genetic factors associated with the design and conduct of industry-supported research as lung disease or the influence of stress and low-protein diets well as the suppression of research that has not been favor- on health.26 These deflected attention from tobacco as a able to the industry. health hazard and protecting tobacco companies from litigation. STRATEGY 1: FUND RESEARCH THAT SUPPORTS In other research funded directly by the tobacco compa- nies, lawyers were involved in the selection of projects and THE INTEREST GROUP POSITION dissemination of findings. For example, tobacco companies funded individuals to serve as consultants to prepare expert The first prong in the tobacco industry’s strategy to influ- testimony for Congressional hearings, attend scientific meet- ence data on risk has been sponsorship of research designed ings, review the scientific literature, or conduct research on to produce findings that are favorable to the industry. Direct the health effects of tobacco or secondhand smoke.27 At one funding of research serves several purposes for the tobacco tobacco company, Brown and Williamson, the legal depart- industry. Industry-supported research can be disseminated ment controlled the dissemination of internal scientific re- directly to policy makers and the lay press.