A guest post by Sophie Petterlin, health promotion student at Curtin University (2021)
The tobacco industry is the world’s most lethal industry which causes over 8 million deaths worldwide each year, in addition to tens of millions of other preventable illnesses (World Health Organization [WHO], 2021). Despite tobacco being the leading cause of preventable death in Australia, responsible for over 20,000 deaths each year (Australian Institute of Health and Welfare [AIHW], 2019), tobacco companies are still yet to publicly recognise or admit that their products cause death and disease. Instead, the tobacco industry continues to conduct a relentless campaign to undermine Australia’s tobacco control programs and policies through large-scale PR and lobbying investments disguised as ‘harm reduction’ initiatives (WHO, 2021).
Smoking as a cause of lung cancer was first revealed by Sir Richard Doll and Sir Austin Bradford Hill in a study published in the British Medical Journal in 1950 (Doll & Hill, 1950). Results indicated the majority of those with lung cancer had been smokers at some point within their lives. As a result of their findings, Doll and Hill concluded that, “smoking is a factor, and an important factor for the production of a carcinoma of the lung”. In 1962, the UK Royal College of Physicians published its landmark report Smoking and Health which drew on the initial findings from Doll and Hill (Royal College of Physicians, 1962). The report explicitly outlined the link between smoking and lung cancer, in addition to various other diseases. The report was released with the hope of raising public awareness of the detrimental health effects of smoking and was instrumental in building the evidence-base for action on tobacco control (Royal College of Physicians, 1962).
In 1964, the US Surgeon General Report on Smoking and Health further exposed the hazards of smoking (US Department of Health Education and Welfare, 1964). The report was prepared by an expert committee of health affiliates which reviewed over 7000 articles to conclude smoking was a key factor in the development of lung cancer, and that smokers were 9 to 10 times more likely to develop lung cancer in comparison to non-smokers (US Department of Health Education and Welfare, 1964). This figure increased significantly for heavy smokers, who were identified to be 20 times more likely to develop lung cancer (US Department of Health Education and Welfare, 1964). Furthermore, the evidence confirmed smoking to be the most significant cause of chronic bronchitis, as well as an overwhelming correlation between smoking, emphysema, and coronary heart disease (US Department of Health Education and Welfare, 1964). The report played an integral role in societal shifts against smoking and was a catalyst to tobacco regulation globally (National Centre for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health, 2014).
Despite these landmark reports documenting the many health effects caused by smoking, the tobacco industry robustly countered any claims that smoking caused disease (WHO, 2012). In 1981, over 30 years since smoking was confirmed to cause lung cancer, Dr L Blackman, Director of R&D, British American Tobacco said “despite a never-ending stream of research on the possible health hazards of smoking, there is no proof of a cause-and-effect relationship between cigarette smoking and various alleged smoking diseases” (Action on smoking and health, 1997). Even well into the 1990s, spokespeople for the tobacco industry in Australia denied that tobacco use was a cause of disease. Internal industry documents show that tobacco companies knew smoking was a cause of cancer by the late 1950s, but deliberately funded scientific research intended to manufacture controversy and prolong the public debate about smoking and health (Cummings et al., 2007).
From the early 1950s, tobacco companies deliberately downplayed the health effects of smoking, by marketing cigarettes with a ‘lower’ tar or nicotine yield (King et al, 2003). Cigarettes were marketed with brand descriptors such as “mild” or “light” to mislead smokers to believe that by consuming cigarettes with a lower nicotine or tar content they were reducing the harm caused by inhaling tobacco smoke. (King et al., 2003). There has been considerable research on the fraud of ‘low tar’ cigarettes in Australia leading the Australian Competition and Consumer Commission (ACCC) to require tobacco companies to cease these marketing claims and conduct corrective advertising (Liberman, 2011). It is probable this legacy of denial, maintained consistently and persuasively for more than half a century, still has residual effects on smokers today.
Philip Morris International (PMI) is the largest multinational tobacco company in terms of overall global market share (Freeman et al., 2019). A study on the use of language on PMI’s website from 1999 – 2008 found many contradictions and omissions that undermined public health messages, including confusing information about addiction, tar and nicotine, a lack of motivational messages to quit smoking, and silence about tobacco-caused mortality (Smith & Malone, 2008).
The major tobacco companies operating in Australia, including PMI and British American Tobacco Australia (BATA), have continuously opposed all effective tobacco control policies to reduce the impact of smoking such as plain packaging, increases in tobacco tax and restrictions on advertising and promotion (Freeman et al., 2018). The tobacco industry continues to use its financial and political power to try and undermine tobacco control strategies in Australia and prevent the introduction of further measures which would reduce the consumption of tobacco products (WHO, 2012). In attempt to reframe their image, tobacco companies are moving away from traditional marketing techniques as they become bound by stricter policies and legislation that control the advertising of tobacco products (Chapman et al., 2003). Instead, they are aiming to influence politicians and the community by portraying themselves as a ‘transformed’ industry which plays an integral role in ‘tobacco harm reduction’ (WHO, 2012). As cigarette sales begin to decline, all major tobacco companies are diversifying their product from traditional cigarettes to potentially ‘reduced-risk’ alternatives such as e-cigarettes and heated tobacco products. These products are being heavily promoted on their websites. However, cigarettes remain the industry’s core business and major source of profit (National Centre for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health, 2014).
Tobacco companies continue to mislead consumers as they heavily promote their new so-called ‘reduced-risk’ products (WHO, 2021). While these products are being marketed as attractive and potentially reduced-risk to the consumer, the long-term health effects remain unknown (National Academies of Sciences, Engineering and Medicine, 2018). Leaked 2014 PMI documents outline the company’s 10- Year Corporate Affairs Strategy including its plan to expand its business and attract new customers using ‘harm reduction’ claims (Evan-Reeves, n.d.). The so-called ‘reduced risk products’ are a strategy to ensure long-term sustainability of the tobacco industry (Banks et al., 2015), while the tobacco companies continue to produce and widely market and promote cigarettes, causing the death of up to two out of three long term users (Banks et al., 2015).
To date, limited studies have identified the extent to which tobacco companies acknowledge the death and disease caused by their products on their websites, annual reports, and media releases. This study will identify the key messages promoted online by the four major Tobacco companies from 2018 – 2021 and any admission that their products cause death and disease.
In August 2021 the author examined the websites, media releases and reports of the four major Tobacco companies between 2018 and 2020 – Philip Morris International (PMI), British America Tobacco (BAT), Japan Tobacco International (JTI), and Imperial Tobacco, for the following key words: harm, harmful, risk, death, kill, disease, mortality, morbidity, and health. Statements that mentioned the keywords were recorded for each company using an excel spreadsheet, documenting the quote, source, and year of publication. The statements were only included if they mentioned the keyword in direct relation to harm caused by smoking. The study did not include statements referring to ‘reduced-risk products’ or novel nicotine delivery devices unless they specifically referred to health impacts of smoking traditional cigarettes. Once all appropriate sources had been examined, they were analysed to compare statements for each keyword across PMI, BAT, JTI and Imperial Tobacco.
Across the four tobacco companies, there was a total of 56 mentions of tobacco related harms in line within the key words. Table 1 shows the total number of mentions for the key words across each tobacco company.
Table 1: Number of mentions of key words by each tobacco company in media releases, websites, and annual reports, 2018 – 2020
Themes in the language used by Big Tobacco
This study identified consistent themes across the statements by the major tobacco companies in which they acknowledge that there are several harms associated with smoking tobacco. All four tobacco companies made an admission in relation to the harms caused by tobacco, however, the language used to communicate the effects to consumers is selective and indirect. The strongest admission of the health effects caused by smoking were statements that include the word disease, which was mentioned 11 times across the four tobacco companies. PMI, BAT, JTI and Imperial tobacco all publicly recognise that smoking causes several diseases such as lung cancer, emphysema, and heart disease, yet no company promoted the fact these conditions contribute to 8 million deaths each year globally. JTI states directly on their webpage that “smoking is a cause of serious disease including lung cancer, coronary heart disease, emphysema, and chronic bronchitis”, however, there is no mention on the website of the word death, or the number of deaths caused by smoking. Among the total of 56 statements identified, there is only one mention of death, which did not refer to smoking caused deaths. Imperial Tobacco stated in its 2019 annual report “it’s distressing to see reports of death and ill-health being linked to vapour products” (Imperial Tobacco, 2019). All four tobacco companies failed to acknowledge on their website that their tobacco products are responsible for millions of deaths each year.
A study conducted in 2008 which examined the health information on the PMI website also noted that while the company does admit that use of their products leads to numerous negative long term health effects, admissions of these harms are nothing but a marketing ploy to enhance their image (Smith & Malone, 2008). Findings from Smith & Malone (2008) demonstrate PMI’s choice of selective messaging about tobacco related harms and its lack of ability to deliver messages which are consistent with public health information. The authors note that while the overall information is fairly accurate, PMI chose to make no recognition of the evidence that cigarettes are a significant contributor to mortality among smokers globally each year (Smith & Malone, 2008). Furthermore, an internal document on their website illustrates their lack of public acceptance towards smoking related mortality. In an interview PMI representatives were asked “So do you now accept that smoking kills 400,000 people in the US, and millions more round the world?” and their response was “We don’t know” (Philip Morris Records, 2000). The company goes no further in the interview than to subtly acknowledge that over the years “smokers have at least died in part because of their smoking” (Philip Morris Records, 2000).
Across the four companies, the terms ‘harm’ and ‘harmful’ were mentioned in combination a total of 22 times when used in the context of smoking related harms. It was consistent across all companies that use of tobacco was harmful to its users. For example, the 2020 Annual Report from Imperial Tobacco stated “I also want us to make a meaningful contribution to harm reduction and reduce the public health impact of smoking” (Imperial Tobacco, 2020). Despite harm being a common term mentioned throughout the sources searched, not one company explicitly named the harms caused by their products. Harm is discussed numerous times in relation to harm minimisation frameworks or approaches, which again illustrates further that tobacco companies are aware of the harm caused by tobacco products; however, they continue to be the perpetrators responsible for all such harms. An analysis of internal tobacco documents by Friedman (2007) showed deliberate and evolving use of language on the Philip Morris website to portray the company as a ‘responsible’ consumer-focused organisation. Friedman notes that PMI changed its stance on its website in 1999 and acknowledged cigarette smoking causes disease to “inform people about the risks”. However, internal documents revealed this admission was purely to protect their public image, avoid litigation, and promote themselves as a transparent company to gain trust among consumers (Smith & Malone, 2015). The findings from Friedman are consistent with those reported in this study which found that in 2021, PMI continues to have minimal recognition on their website that smoking is responsible for death and disease.
Risk is the most common term mentioned across the four companies with 15 mentions in total. The term is mentioned numerous times throughout each website; however, the mention of risk goes no further than admitting that there are risks involved with smoking, with no explicit mention of what is actually meant by risk. There is an overarching theme across all four companies which state that the risks of smoking are clear and well-defined, yet there is not one single mention of what the smoking caused risks are, contrary to their argument.
Discussion of tobacco related risk is shallow, and majority of the results which match the word search of risk are in relation to promotion of their “reduced-risk products”. Messaging identified on risk and harm is consistent with the tactics employed by the tobacco industry over the years, as they attempt to undermine and lessen the influence published evidence which confirms the detrimental health effects of smoking, in the hope of keeping existing smokers and recruiting new smokers (Friedman, 2007). This is documented in detail as part of the Tobacco Industry Inference report by the World Health (WHO, 2012). This comprehensive report examines the relentless tactics which have been employed by the tobacco industry over the years as they continuously sidestep the scientific evidence which establishes smoking as a cause of cancer (WHO, 2012). This failure by Big Tobacco to explicitly accept the harms of their products is outlined in an article by Carter et al (2008). The report includes a quote made by a representative of BAT:
“… A vague statement such as ‘Cigarette Smoking may be harmful to health’ is a lot easier to live with than something more specific, such as “Excessive cigarette smoking is associated with an increased risk of death from lung cancer.”
This statement was made in 1969 in relation to the introduction of warning labels on cigarette packaging. This same indirect messaging has carried through to the websites of the tobacco companies today in the 21st century and is consistent with the findings documented throughout this report (Carter et al., 2008).
The harms caused by smoking have been a key focus of public health programs and activities since the 1950s. For decades tobacco companies have been reluctant to explicitly accept the evidence of the health effects caused by smoking, in an effort to minimise the effects that such negative publicity would have on existing smokers and maximise the profits generated by their business. This report demonstrates that tobacco companies continue to omit information about the death and disease caused by smoking in published reports, media releases and websites. Tobacco companies use their websites and other communication platforms to portray their business as part of the ‘solution’, promoting ‘reduced-risk’ products; however, they continue to cause a huge burden of disease, downplay the health effects of smoking, and continue to manufacture and market the world’s most lethal consumer product.
Action on smoking and health. (1997). Public versus private statements by tobacco companies. https://ash.org.uk/media-and-news/press-releases-media-and-news/public-versus-private-statements-by-tobacco-companies/
Australian Institute of Health and Welfare. (2019). Burden of tobacco use in Australia: Australian burden of disease study 2015. (Cat. no. BOD 20). https://www.aihw.gov.au/reports/burden-of-disease/burden-of-tobacco-use-in-australia/summary
Banks, E., Joshy, G., Weber, M., Liu, B., Grenfell, R., & Egger, S. et al. (2015). Tobacco smoking and all-cause mortality in a large Australian cohort study: Findings from a mature epidemic with current low smoking prevalence. BMC Medicine, 13(1). https://doi.org/10.1186/s12916-015-0281-z
Chapman, S., Bryne, F., & Carter, S. (2003). “Australia is one of the darkest markets in the world”: The global importance of Australian tobacco control. Tobacco Control, 12(90003), 1iii-3. https://doi.org/10.1136/tc.12.suppl_3.iii1
Cummings, K., Brown, A., & O’Connor, R. (2007). The cigarette controversy. Cancer Epidemiology Biomarkers & Prevention, 16(6), 1070-1076. https://doi.org/10.1158/1055-9965.epi-06-0912
Doll, R., & Hill, A. (1950). Smoking and Carcinoma of the Lung. BMJ, 2(4682), 739-748. https://doi.org/10.1136/bmj.2.4682.739
Evan-Reeves, K. (n.d). Addiction at any cost: Philip Morris International uncovered. https://exposetobacco.org/wp-content/uploads/STOP_Report_Addiction-At-Any-Cost.pdf
Freeman, B., Winstanley, M., & Bay, M. (2019). The global tobacco manufacturing industry. Tobacco in Australia: Facts and issues. http://www.tobaccoinaustralia.org.au/chapter-10-tobacco-industry/10-2-the-global-tobacco-manufacturing-industry
Friedman L. C. (2007). Philip Morris’s website and television commercials use new language to mislead the public into believing it has changed its stance on smoking and disease. Tobacco control. 16(6). https://doi.org/10.1136/tc.2007.024026
Imperial Tobacco. (2019). Annual report and accounts 2019. https://www.imperialbrandsplc.com/investors/annual-report-accounts-2020/annual-report-archive.html
King, W., Carter, S., Borland, R., Chapman, S., & Gray, N. (2003). The Australian tar derby: The origins and fate of a low tar harm reduction programme. Tobacco Control. 61-70. https://tobaccocontrol.bmj.com/content/12/suppl_3/iii61.info
Liberman, J. (2011). Litigation brought by Australian consumer and regulatory groups against the tobacco industry. Tobacco in Australia: Facts and issues. https://www.tobaccoinaustralia.org.au/chapter-16-litigation/16-2-litigation-brought-by-australian-consumer-and-regulatory-groups-against-the-tobacco-industry
National Academy of Sciences, Engineering and Medicine. (2018). Public health consequences of e-cigarettes. https://doi:10.17226/24952
National Centre for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health. (2014). The health consequences of smoking: 50 years of progress. https://www.ncbi.nlm.nih.gov/books/NBK294303/
Royal College of Physicians. (1962). Smoking and Health: Summary of a report of the Royal College of Physicians of London on smoking in relation to cancer of the lung and other diseases. https://www.rcplondon.ac.uk/projects/outputs/smoking-and-health-1962
Smith, E., & Malone, R. (2008). Philip Morris’s health information web site appears responsible but undermines public health. Public Health Nursing, 25(6), 554-564. https://doi.org/10.1111/j.1525-1446.2008.00743.x
Truth tobacco industry document. (2000). Smoking and disease in smokers. Philip Morris Records; Master Settlement Agreement. https://www.industrydocuments.ucsf.edu/docs/fymn0075
US Department of Health, Education, and Welfare. (1964). Smoking and Health: Report of the advisory committee to the surgeon general of the public health service. https://profiles.nlm.nih.gov/101584932X814
World Health Organization. (2021). WHO report on the global tobacco epidemic, 2021: Addressing new and emerging products. https://www.who.int/health-topics/tobacco#tab=tab_1
World Health Organization. (2012). Tobacco industry inference: A global brief. https://www.euro.who.int/__data/assets/pdf_file/0005/165254/Tobacco-Industry-Interference-A-Global-Brief.pdf