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Third-Party Endorsement and the Resurrection of Heat-Not-Burn Tobacco Products Jesse Elias,1 Pamela M Ling1,2

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Third-Party Endorsement and the Resurrection of Heat-Not-Burn Tobacco Products Jesse Elias,1 Pamela M Ling1,2 Tob Control: first published as 10.1136/tobaccocontrol-2018-054433 on 6 June 2018. Downloaded from Research paper Invisible smoke: third-party endorsement and the resurrection of heat-not-burn tobacco products Jesse Elias,1 Pamela M Ling1,2 1Center for Tobacco Control ABStract internally hoped Premier would ‘address the Research and Education, Background Tobacco companies are introducing growing pressures cigarette smokers face on the University of California, San subjects of smoking and health, environmental Francisco, California, USA new ’heat-not-burn’ cigarettes in dozens of countries. 2UCSF Department of Medicine, Historically, these products failed commercially, and tobacco smoke, and other issues related to the social Division of General Internal independent researchers contested their health claims. acceptability of smoking’.5 In an internal memo Medicine, San Francisco, The most prominent early heat-not-burn cigarette was to employees, RJR’s President of Development California, USA RJ Reynolds’s (RJR’s) Premier, introduced in the USA in Richard Kempe described Premier as ‘one of the 1988. Curiously, The Lancet endorsed Premier as a ’near- most important projects any of us will be involved in Correspondence to during our professional lives…because the success Dr Pamela M Ling, Department perfect low tar cigarette’ in a 1991 editorial, 2 years of Medicine, University of after Premier had been removed from the market. We of this project could easily result in a tremendous California San Francisco School examined the context of this endorsement. long-term competitive advantage to RJR and would of Medicine, San Francisco, CA Methods To ascertain what RJR knew about this clearly have a substantial impact on the industry as 94143, USA; endorsement, we systematically searched and analysed we know it’.6 Smokers nonetheless widely rejected Pamela. Ling@ ucsf. edu previously secret RJR documents in public archives and the product’s taste, smell and difficulty of use. Received 11 April 2018 triangulated the industry document data with other Having invested $300 million ($635 million infla- Revised 23 May 2018 published work. tion-adjusted to 2018), RJR removed Premier from Accepted 27 May 2018 Results RJR had a long-standing interest in test markets after only 6 months. Published Online First In 1991, 2 years after Premier’s failure, The Lancet 6 June 2018 collaborating with outside scientists to endorse potentially reduced harm cigarettes. The author of The published an editorial praising Premier’s ability to Lancet editorial had previously corresponded with RJR deliver nicotine with fewer carcinogens.7 The edito- regarding Premier’s health effects and market potential. rial called for health authorities, particularly in the Internally, RJR regarded The Lancet’s editorial, its stance UK, to promote cigarettes that delivered nicotine on novel tobacco products, and its endorsement of with as little accompanying tar as possible. As one Premier as major successes. While the editorial came of the earliest examples of an influential journal too late to save Premier, RJR saw future business promoting a novel tobacco product, The Lancet’s opportunities for novel products if endorsed by health endorsement of Premier provides important context authorities. for the tobacco industry’s current pursuit of health 8 Conclusions Endorsement by high-impact medical authority endorsements for its new products. http://tobaccocontrol.bmj.com/ journals and health authorities may be critical in helping Though the 1991 editorial appeared after Premier’s heat-not-burn’ products succeed where previous demise, RJR viewed The Lancet’s position as prom- attempts have failed. Conflicts of interest influenced ising evidence that some health authorities would these endorsements in the past. Health leaders and support novel tobacco products, and that with academic journals should consider both conflicts of such endorsements, consumers might accept future interest and the ethics of endorsing tobacco product products. substitution, as tobacco companies simultaneously work to promote cigarette smoking and undermine tobacco METHODS control globally. We analysed previously secret internal tobacco industry documents available through the Truth Tobacco Industry Document Library (https:// indus- on October 1, 2021 by guest. Protected copyright. trydocuments. library. ucsf. edu/ tobacco/) between BACKGROUND January 2016 and February 2017. In seeking to iden- Since the 1960s, the tobacco industry has developed tify why The Lancet endorsed Premier in 1991, we ‘safer’ products to attract health-conscious smokers combined qualitative analytical methods with iter- and improve its public image.1 Major tobacco ative search strategies.9–11 Initial keyword searches companies have recently expanded their product included: ‘Lancet’ AND ‘Premier’; ‘Nicotine use portfolios to include alternative nicotine products, after the year 2000’; ‘editorial’ AND ‘Premier’ and such as electronic cigarettes (e-cigarettes) and ‘heat- ‘Chemical and Biological Studies of a Cigarette that not-burn’ cigarettes.2 In 2015, Philip Morris Inter- Heats Rather than Burns Tobacco’. On learning that national (PMI), British American Tobacco (BAT), two historians attributed the anonymous editorial to RJ Reynolds (RJR; now owned by BAT) and Japan Michael Russell,2 12 we conducted further searches Tobacco International (JTI) all launched heat-not- with keywords including: ‘Michael Russell’, ‘MAH burn products in dozens of countries. Russell’ and ‘Russell’ AND ‘Premier’. We conducted Heat-not-burn cigarettes have a near 30-year snowball searches to locate related documents using 3 4 To cite: Elias J, Ling PM. record of dismal market performance. RJR intro- reference (Bates) numbers, file locations, dates and Tob Control duced the first heat-not-burn product—Premier individuals mentioned in pertinent documents. 2018;27:s96–s101. ‘smokeless’ cigarettes—in the USA in 1988. RJR Triangulation with online search engines and s96 Elias J, Ling PM. Tob Control 2018;27:s96–s101. doi:10.1136/tobaccocontrol-2018-054433 Tob Control: first published as 10.1136/tobaccocontrol-2018-054433 on 6 June 2018. Downloaded from Research paper news coverage (eg, Google News) generated data that helped Great Britain for reduced “tar” to nicotine ratio cigarettes’16 resolve and contextualise questions raised by the documents. The Froggatt Committee was, since Peter Froggatt’s appoint- We repeated iterative searches until keywords and documents ment as chair, the informal name of the Independent Scientific yielded only previously viewed documents, suggesting satura- Committee on Smoking and Health (ISCSH; earlier known as tion. This analysis is based on a final set of 196 documents. the Hunter Committee). The ISCSH served as the UK govern- ment’s chief scientific advisory body on the issue of smoking and RESULTS health through the 1970s and 1980s and was openly advised 22 In a 1988 internal memo, RJR insisted that in its marketing of by major British tobacco manufacturers. Effectively, deBethizy, Premier, the company was: an RJR scientist, used the authority of the ISCSH, which was under industry influence, to stress to The Lancet the importance [N]ot claim[ing] that the cigarette is ‘safe’ or ‘safer’… [instead] of RJR-funded findings on Premier (an RJR product). In his we have used the word ‘cleaner’… This is not a therapeutic letter, deBethizy set Premier in a framework promoting tobacco claim… Premier’s tobacco-heating technology is a breakthrough product substitution: that ‘changes the very composition of the smoke – substantially reducing many of the controversial compounds found in smoke The public health community in the US has not been receptive to 13 of tobacco-burning cigarettes.' these prototypes, taking the position that prohibition of smoking is the only avenue that should be pursued. We believe that this is a RJR President and CEO for West Germany, Peter Fischer, short-sighted approach which ignores the projections that by the stressed that, when meeting with policy makers, RJR’s scientific year 2000, forty million Americans and an even greater number representatives should ‘concentrate on “tar”/condensate related worldwide will choose to smoke…. We feel that cigarettes that scientific aspects of [Premier] thereby avoiding to address [sic] heat tobacco will provide an alternative to smokers who choose the remaining nicotine and CO issues’14 which, if independently to smoke despite warnings that adverse health effects may arise interrogated, might lead scientists to refute Premier’s implicit from smoking.16 health claims as ‘cleaner’. Legally restricted from making health claims, RJR depended While we found no return correspondence from The Lancet, the journal published the editorial 6 months later.7 Historians on the scientific community and media to make those claims 2 12 on its behalf. Proctor notes that Premier’s marketing campaign Virginia Berridge and Mark Elam attribute this editorial’s included ‘one-on-one briefings with university presidents, authorship to Michael Russell, one of Britain’s most prominent medical school deans, science writers, and medical organiza- tobacco scientists during the second half of the 20th century . We tions, along with politicians and “opinion leaders” throughout found no evidence of collaboration between RJR and Michael the world’.1In a confidential 1987 planning document, Fischer Russell regarding the content of this editorial. discussed strategy to ‘insure [sic] a successful product
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