A ten-year study conducted by the International Agency for Research in Cancer (IARC) examining the links between second-hand smoke and cancer was subverted by an unprecedented misinformation campaign coordinated by the tobacco industry and resulting in misleading media reports of the European scientific study even before it was published.
These are the findings of two UC San Francisco scholars whose analysis of the fierce tobacco industry information campaign is published in the April 8 issue of the medical journal Lancet. Authors are Elisa K. Ong, BA, and Stanton Glantz, PhD, both researchers at the Institute for Health Policy Studies in UCSF's Department of Medicine.
"The extent of tobacco industry money and effort spent to discredit a single study is unprecedented," said Glantz, professor of medicine at UCSF and long-time scholar and critic of tobacco industry strategies. Ong is a medical student at Stanford University.
The reason the industry was so concerned about the paper, he suggests, is that while scientific reports on second-hand smoke had already stimulated legislation on clean indoor air in the U.S., European countries have been slower to change.
"Tobacco industry strategists were apparently trying to head off the possibility of sentiment growing for similar restrictions in their European markets, so they hit this report with all they had," Glantz says. "There seems to be little regard for the truth in the information they tried to spread."
In their paper, Ong and Glantz describe how the tobacco industry worked to undermine the conclusions and potential impact of the largest European study of passive smoking, conducted by IARC, the research arm of the World Health Organization (WHO).
Fearing that the IARC study (and a possible IARC monograph summarizing all scientific evidence linking second-hand smoke to disease) would lead to increased European smoking restrictions, the Phillip Morris tobacco company spearheaded an inter-industry, three-pronged strategy in the mid 1990s to subvert IARC's work, write Glantz and Ong. The scientific strategy attempted to undercut IARC's research and to develop industry-directed research to counter the anticipated findings; the communications strategy planned to shape opinion by manipulating the media and the public; the government strategy sought to prevent increased smoking restrictions.
The IARC scientific study cost roughly $2 million over ten years; Philip Morris planned to spend $2 million in one year alone and up to $4 million on research, the authors report. Part of Philip Morris' strategy was to use consultants sympathetic to the tobacco industry who were asked to find out more about the IARC report, and did not always disclose their industry links while seeking information from IARC investigators. The documents and interviews suggest that the tobacco industry continues to conduct a sophisticated campaign against conclusions that second-hand smoke causes lung cancer and other diseases, "subverting normal scientific processes," the authors conclude.
The IARC study demonstrated a 16% increase in risk in lung cancer to nonsmokers from second-hand smoke, a result consistent with earlier studies. Although the results were clear and comparable to those found by others, the number of people in the study was too small to reach statistical significance (at the 95 percent level).
As Ong and Glantz document, the tobacco industry exploited the degree of statistical uncertainty by providing selected newspapers with the misinformation that the study had demonstrated "no risk" of cancer from second-hand smoking - clearly not the study's finding. These incorrect conclusions were published in the British press before the scientific study was published, and as an official British report reviewing second-hand smoke's health effects was released.
To understand the tobacco industry's strategy regarding the IARC study, Ong and Glantz interviewed IARC investigators and analyzed tobacco industry documents among 32 million pages released in 1998 as part of the settlement of the legal case, State of Minnesota and Blue Cross/Blue Shield of Minnesota vs Phillip Morris, Inc. The documents are archived in Minneapolis.
The study by Ong and Glantz was supported by a grant from the National Cancer Institute.