[Al THE TOBACCO INDUSTRY AND ITS IMPACT ON
SCIENTIFIC AND MEDrCAL ATTITUDES AND OPINION
Despite the almost unprecedented amount of worldwide research
on many aspects of smoking and health - both by the tobacco
industry and by scientific laboratories, universities and
hospitals - the overall picture remains inconclusive.
The research findings continue to raise further questions,
and to maintain the 'general controversy'. It is not simply
a question of the precise definition of causation - as stated,
for example, in the Sth Edition of the Van Norstrand Scientific
Encyclopedia:
'Causality is the hypothesis that a
precisely determined set of conditions
will always produce precisely the -same
effects at a later time.'
but it is the direct result of the conflicting nature of the
evidence.
Over the past twenty years, the Tobacco Industry has successfully
defended more than 100 law suits in the US&. An important
aspect has been the lack of proof of causation.
But throughout this period, the tobacco industry has remained
essentially quiet on the basic issue - and this attitude has
been widely interpreted by the external world as a sign or
an admission of guilt. In reality, however, as indicated
above, much of the publicized evidence produced in this period
has been and still is inconsistent and inconclusive. In
raising, as it does, further questions, the research to date
serves to continue the general controversy on the smoking and
health issue.
Notwithstanding the contradictory nature of the evidence,
certain views have been advanced that there is a risk to
health that is related to the number of cigarettes smoked
per day. As a result of these views (albeit challenged in
certain medical/scientif ic circles), many Government and
health authorities have recommended that cigarettes should
be modified to give lower deliveries of tar, nicotine and
other smoke components.
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The public have heard these views, and a substantial number
of consumers have also shown an interest in products with
lower smoke deliveries.
Accordingly, the industry has developed and marketed an
expanding range of products, including those of low delivery,
to serve the evolving markets.
Now, after some 10-20 years of increasing use of lower delivery
products, many Governments and health authorities believe
that there is evidence from epidemiological studies that such
products are indeed associated with reduced risk. [Fig 11
if this Is in fact so, one should note that only future studies
can give evidence about present day products. (Pigs 2 & 33
At complete variance with the hypothesis that lower delivery
products are associated with lower risk, is the view of some
medical authorities that there are reasons to expect the
reverse, ie that lower delivery products might carry a higher
risk.
Such attitudes might partly be motivated by an overwhelming
desire to discredit smoking: but over-compensation by the
smoker for the lower smoke content, and the inability of
filters without ventilation to reduce carbon monoxide, have
been cited in support of the view.
i While on the subject of carbon monoxide, it is pertinent to
,.not that with the advent of ventilation - which started more
than 10 years ago in the USA, but rather more recently in the
UK - the carbon monoxide land indeed all other gaseous
components of cigarette smoke] falls directly in line with
the reduced tar content [Fig 4). One may also note the
autharative conclusions of both the UK Hunter Committee 1979
(Fig 51 and the US Surgeon General 1981 EFig 6].
Returning now to the epidemiological studies, it is a fact
that neither the statistical evidence, nor the alleged link
,between smoking and health, Is universally accepted. Thus,
a number of eminent scientists, past and present, believe
that the association may be explained by, for example:
- genetic predisposition] [Fig 71
- personality type. I
- environment/nationality EWHO Europe Study Fig 81 co
- Vitamin A [Fig 91
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Moreover, some US and UK researchers, who in the 1950 1 and
1960 Is noted that in some age groups of white males the lung
cancer rates had already started to decline, predicted that
the lung cancer rate of other age groups would start to fall
in the 1970 1 a - irrespective of any change in smoking habit.
[Notably Dr G Gilliam in the US, and Dr T W Lees and
Dr J R Belcher in the UK.]
other examples of the confounding evidence relate to the
fact that incidence of lung cancer and heart disease does
not show a simple relationship with smoking incidence. Thus
comparisons may be made of, for example:
Continent to continent - heart disease vs smoking
incidence [Fig 101
Country to country -WHO study ot lung cancer
in European countries [Fig 8 - repeat]
State to state in USA -heart disease and lung
cancer vs smoking incidence.
Notwithstanding such examples of genuine confounding evidence,
the critics of smoking often compound the situation with
statements or claims that are either unsubstantiated or - in
some cases - blatantly false. Some relevant exampi6es are
given below:
1) A medical A-Z Encyclopedia that is currently being
published in weekly issues in the UK by Marshall
Cavendish Ltd states - apropos cholesterol and heart
disease - "that there is no point in doing anything
[(about diet)] until a person stops smoking, as this
will counter the good effects of any other measures'.
This seemingly authorative recommendation to the
public is certainly at variance with the results
of the recent Norwegian study repeated in a The
Lancet*, P 1503, Dec 12th 1981, which showed that
while the risk of heart disease decreased when serum
cholesterol was reduced, there was no such pronounced
decline as a result of reduction of cigarette
consumption.
2) The same Medical Encyclopedia specifically indicts
nicotine as the cause of arterosclarosis and heart
disease. But in another recent article in "The Lancet'
[page 775, October loth 19811 Dr Nicholas Wald et al
reported findings under the title "Serum Cotinine Levels
in pipe smokers: evidence against nicotine as cause of
coronary heart disease."
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'The Times' report of the article on 13th October
completely changed the emphasis, however, by
using two sub-headings purporting. that carbon
monoxide was the cause. [Pig 111
3) Finally, for truly outrageous reporting, we may refer to
the Editorial article from the 'Sunday Observer" of 6 tb
December 1981. [Fig 121
And then contrast this statement with the
real-life measurements of Hinds and First
taken in typical smoking environments. [Fig 131
With this background of controversial evidence, and increasingly
unsubstantiated or misrepresented claims,-what should be the
approach of the Tobacco Industry? Is there now a need to try
to get a better balance in the debate on smoking issues?
Certainly the statement on page 117 of the 1980 EJICC document
'Guidelines for Smoking Control' is definite on the subject
of the credibility of the tobacco industry.
0..... this refusal to admit candidly to the
health hazards of its products may be cited as
proof of the tobacco industry's lack of credibility
on all topics'.
BAT has given very serious thought to the above questions.
The subject is complex, and it has involved very close working
of top management with the Legal (both millbank and Brown &
Williamson) Public Affairs and R&D Departments.
The conclusions have been:
(1) Yes - the tobacco industry should try to create
a better climate for its legitimate commercial
operations.
(2) The approach should be based on a more open
dialogue with Governments, MP's, doctors,
employees and shareholders.
In stressing that Industry actions have been influenced both
by the demands of consumers, and by the views of Governments,
care must be taken not to be selective as to any evidence or
third-party views that are discussed.
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it is particularly vital that the tobacco industry should not
adopt any third-party view as its own. Nor should there be
Sony attempt to form an Industry judgement on the health
implications of the scientific and medical evidence.
The key points in any dialogue should be:
(1) the changing interests/demands of consumers
(2) the views of Governments (which are primarily
influenced by published scientific and medical
findings).
(3) the opinions of independent third-parties as
to product modifications
(4) the detailed way in which product designs
have changed over the past 20 years.
The legal constraints in the USA continue to be the major
concern. But BAT bole ives it is possible to discuss the
various isues, to the longer term good of both consumers and
industry, without jeopardizing the sensitive position of
Industry.
many of our detractors claim that we are non-caring. Our
activities, however, prove that the accusation is false. BAT
is a socially responsible Company - proud of its reputation
and concerned about the wellfare of its consumers. it provides
products that meet the changing consumer demands, and the
stipulations of authorities where these are expressed.
BAT be I that progress can come only from continued
research - and from reasonable and open discussions about all
the highly-complex issues. It believes that the tobacco
industry should now attempt to generate a more balanced debate
of the issues.
January 1982
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