Tobacco Industry approaches to harm reduction science: a help or hinderance to public health?
: (Alternative Format Thesis)

Student thesis: Doctoral ThesisPhD

Abstract

Background: Smoking kills over 8 million people globally each year. Public health policies and interventions have subsequently been developed which seek to reduce the harms caused by smoking – often referred to as tobacco harm reduction. As smoking prevalence and cigarette sales have subsequently fallen, the tobacco industry has begun selling new nicotine and tobacco products, including e-cigarettes and heated tobacco products (HTPs), which it claims are less harmful than cigarettes. To substantiate this claim, the industry conducts and promotes its own scientific research on these products. However, the industry has a documented history of scientific misconduct, which raises concern over the integrity of its current science. The largest transnational tobacco company, Philip Morris International (PMI), has positioned itself, its flagship new product, a HTP called IQOS, and its science at the forefront of the harm reduction debate. Through five papers, this thesis explores PMI’s approach to harm reduction science, as well as that of the wider industry, through examination of the harm reduction claims made about HTPs and the scientific research underpinning them. Further, I discuss the impact of the industry’s science on public health and the implications for policy and practice.

Methods and Findings: 
First, I identified and assessed the harm reduction claims made by PMI about its HTPs. In Paper I, analysis of claims made to potential consumers through live, one-to-one webchat conversations from the IQOS website, found that a range of harm reduction claims were used to promote IQOS, some of which differed between countries and were sometimes contradictory to one another. In Paper II, the scale and nature of PMI’s science on its HTPs was examined and used to assess the veracity of the harm reduction claims it made about its HTPs on its science website (pmiscience.com). This study revealed the PMI’s scientific assessment largely comprises non-epidemiological research, and that many of its harm reduction claims about its HTPs are not adequately substantiated by its own scientific research. Most of the claims identified in Papers I and II focused on the harm of HTPs relative to cigarettes.

Second, I conducted more detailed examinations of the scientific evidence, critically appraising the design, conduct and reporting of clinical trials on HTPs. In Paper III, a systematic review of industry and independent interventional clinical trials on HTPs showed most trials were of short duration and at high risk of bias and could not be relied on to adequately establish the impact of HTPs on public health. The industry’s trials focused on demonstrating users’ reduced exposure to toxicants compared to cigarettes (rather than reduced harm) and, unlike independent trials, made few comparisons to other purportedly less harmful products. In Paper IV, evaluation of the biomarkers of exposure and potential harm measured in these clinical trials suggested that much of the industry’s existing biomarker data are inappropriate for determining the risk posed by HTPs of developing lung cancer – one of the most common and deadly tobacco-related diseases. Further, the limited appropriate data indicated HTPs do not reduce the risk of lung cancer. Both Paper III and IV suggested the industry’s clinical research fails to adequately assess the harms of HTPs and whether they are beneficial to public health.

Third, I used leaked PMI documents to further explore PMI’s scientific activities and whether these bore any similarity to its previously documented problematic scientific practices. In Paper V, hermeneutic-based and thematic analyses of these documents revealed PMI attempts to use and influence science to advance its interests and continues to employ the problematic practices of its past.

Conclusions: 
Altogether, these findings suggest PMI, and to an extent the wider tobacco industry, uses harm reduction science to promote its new, purportedly less harmful, products, like HTPs, and ultimately to protect its economic interests. The nature and quality of the industry’s science is constrained. It appears to largely be designed to substantiate harm reduction claims and meet market entry requirements, rather than to assess the full extent of harm posed by HTPs. The tobacco industry’s potential bias and covert activities undermine the integrity of its science, limiting its value to those trying to establish the impact of HTPs on public health. The industry’s approach to conducting, using and communicating science exacerbates challenges faced by policymakers to develop appropriate tobacco control strategies. It is clear urgent reform in the governance of tobacco research is needed to protect public health from the industry’s vested interests and maximise the value of the industry’s science to public health.
Date of Award28 Jun 2023
Original languageEnglish
Awarding Institution
  • University of Bath
SupervisorJohn Campbell (Supervisor) & Anna Gilmore (Supervisor)

Keywords

  • tobacco control
  • tobacco
  • harm reduction

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