COMMIJNITY HEALTH STUDIES VOLUME X I , NUMBER 2, 1987

COMMElNTARY: TOBACCO INDUSTRY HEALTH RESEARCH ‘BLOOD MONEY’: THE BRITISH HEALTH PROMOTION RESEARCH TRUST

Simon Chapman, Health Promotion Branch. South Australian Health Commission

“The industry is certainly not sitting back and ignoring these allegations [about smoking and health]. In fact, over the last decade, the tobacco industry in the US, the U K and Australia alone has contributed in excess of US130 million into ‘hands off research into smoking and health. This research, as with the majority of research in this area, is inconclusive and shows the need for more research.” (emphasis added).

These words were contained in a 1985 submission by John Dollisson, then head of the Tobacco Institute of Australia, to the Hong Kong Broadcasting Review Board enquiry into a ban on tobacco advertising on television. Dollisson’s summary of his industry’s contribution to smoking and health research is noteworthy as the tobacco industry’s program of funding medical and other research has caused widespread debate in the scientific community. Neither the Australian Cancer Society and its member bodies nor the National Heart Foundation of Australia award their research funds to projects or individuals in receipt of tobacco industry money. Two recent editorials have condemned the industry and its motive:; for funding health research.”’ In reply, the Chairman of the Australian Tobacco Research Foundation (TRF), the tobacco industry-funded grants body in Australia, defended the Foundation in terms of a ‘no strings attached’ argument.-’

This paper argues that the ‘no strings attached’ argument represents a very narrow interpretation of what a ‘string’ might be said to consist, and also ignores several other major criticisms of financial involvement with the industry. This paper describes the case of the British Health Promotion Research Trust (HPRT) and what occurred when I wrote asking questions of those in receipt of its grants.

Background In October 1982, the British government

announced the formation of the HPRT, a body funded exclusively by the British tobacco industry. The Trust had 1 1 million pounds to award to health promotion research projects over 3 and a half years, provided they did not include ‘studies designed

directly or indirectly to examine the use and effects of tobacco products”, unless information on smoking was “necessary to achieve the purposes of the research programme” in such areas as coronary risk factor research.

Reaction to the Trust was overwhelmingly condemnatory, with its only written public defence coming from its Chairman.4 Editorials in the Lancet’ and the British Medical Journal6 were sharply critical. A British Medical Association conference voted by a large majority that “no doctor or health authority associate themselves with the Trust”.’ Other boycotts followed from the Society of Health Educationists, the Association of District Medical Officers, Alcohol Concern and the Faculty of Community Medicine of the Royal College of Physicians. The then Director of ASH (UK), Mike Daube, said that the industry’s concern with health promotion made it “rather like Jack the Ripper wanting to take up health visiting’% and a writer to the Lancet speculated ‘Imagine the mafia funding research into the promotion of law and order but ruling out the topic of organized crime”.g Later, Professor Hilary Rose returned 30,000 pounds to the Trust after reconsidering its implications. In a letter to the Trust, she urged its head, Sir John Butterfield, Vice Chancellor of Cambridge University, to dissociate himself from the industry.10

A number of people approached tojoin theTrust had refused on principle and the composition of the Board took some nine months to announce.11 Besides its Chairman, the only two medically qualified members of the board, Jonathan Miller and Eva Alberman, later resigned, Miller saying he had not been told of the Trust’s connection with the industry when he accepted his post.12

Arguments against tobacco money for research There are two principles at the heart ot these

criticisms, as well as the practical question of whether recipients of tobacco industry money are influenced to shelve their interests in smoking. People tend not to bite the hand that feeds them. By offering generous financial grants to researchers in times of economic stringency, the industry might hope to ‘quieten’ any critics or smoking control

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advocates within its grant-receiving ranks. Another effect might be that researchers who work in several different health fields, including smoking, may move away from their concerns with smoking, seeinggrant sanctioned subject areas as ‘safer’ and more secure. This effect would be less likely to be seen with senior academics and major well-funded institutions, than with junior researchers and less financially secure institutions, where substantial grants may mean the difference between employment and the dole or closure.

In Australia, T R F money is directed exclusively into research on smoking and health. Can this latent ‘quietening’ effect be said to operate in those administering the T R F or receiving its funds? Having been closely involved with smoking control policy and programs over the past seven years, I can recall no instance of any scientist in receipt of a T R F grant ever publicizing their findings in any arena that might influence health policy, nor taking any role in public criticism of the industry’s marketing efforts. But this is a comment that might be made of the work of most researchers in this field, regardless of the source of their funding. Perhaps a more pertinent question would be: how have T R F administrators and recipients responded to the industry’s repeated public assertion that there is no causal relationship between smoking and various diseases, in view of the published research produced under T R F grants? The U S Surgeon General has argued at length that ‘cause’ is a justifiable verb to summarize the relationship of smoking to lung cancer.13Nigel Gray, chairman of the UICC’s smoking control program, believes that the administration of the T R F should publicly advise the industry that smoking causes lung cancer and actively protest in unison with other health agencies whenever its representatives seek to deny this.

Collusion with tobacco industry S public relarions efforts

The tobacco industry is in the business of selling cigarettes and all its ‘public spirited’activities such as sporting and cultural sponsorship are essentially public relations activities which must be seen in light of its commercial ambitions.14 Being so often maligned for marketing a product which kills, it is understandable that the industry is concerned to nurture associations that will distract from this criticism. Sponsoring research into health promotion through the HPRT is as cynical an attempt as imaginable to portray their industry as a group concerned with people’s health. It is scarcely credible that the Chairman of the HPRTcould write on behalf on the Trustees that “Neither should they [the Trustees] put themselves in the position of

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attacking those [the tobacco industry] whom they recognised were moved by a conscientious desire to promote health.”I5

In the Australian case, T R F grant recipients are colluding with the rhetoric of the industry, that it is genuinely interested in learning more precisely the relationship between smoking and illness. A reasonable corollary to draw from this rhetoric is that the industry is suggesting that, if only there was more definite evidence, it would be prepared to agree that its product killed. Such collusion is naive and serves the industry’s position ~- that the issue of smoking and disease is still wide open and that therefore it can remain blameless and unrestricted in promoting smoking.

The ethical principle involved here is that one should not collude to assist the ambitions of those whose primary interests are judged to be against the public interest. Accepting Trust research money is collusion with the industry’s desire to appear to be concerned about health, which is no more than a public relations strategy designed to court public and political favour.

Means versus ends The second principle is that of means versus

ends. The HPRT and the T R F have funded many important projects, and have enabled some researchers to remain employed, with spin-off benefits to their colleagues and dependents. But the worthiness of research and the desirability of employment ought not to be evaluated apart from the means by which they are achieved. Tobacco grant money derives directly from the sale of tobacco. Researchers with industry grants thus cannot avoid the fact that they are benefitting directly from the sale and promotion of tobacco, with its associated death and disease.

There are several defenses that might be run against these criticisms. One of base expediency runs “there is money on the table, and someone is going to pick it up, so it might as well be me”. Another says that researchers have a moral duty to apply their knowledge and skills, and that in such cases, a balance must be struck between the implications of accepting the money and a neglect of important health and medical research. This would elicit some sympathy if it were the case that other funding sources were simply unavailable. There are seldom times when it is not said that research funding is scarce.

I believe there is a parallel with the case for cultural, sporting and scientific boycotts with the present regime in South Africa. Those who oppose such boycotts often argue that the benefits oftaking, for example, socially critical theatre to play before

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multi-racial audiences in South Africa, will be to chip away at the attitudes that sup;>ort apartheid within the country. Supporters of boycotts say this is rubbish, and that such thinking plays into the hands of the South African Government, who wish to give the impression of reform when there is still no recognition of fundamental human rights. Likewise with taking money for worthy eff’nrts from the tobacco industry: the view that smoking and health is still an open question is perpetuated, and the industry basks in the public relations glory of apparent concern and open-mindedness.

A more complex defense suggests I hat there is no such thing as clean money. For example, anyone who is paid by government gets their salary partly from government tobacco excise receipts, thereby putting them (so this argument would want to have it) in the same ethical boat that critics are wanting to hole. To this, the response is that the two are not the same at all. One might .just as well argue that anyone who drives on a public road is in the r.ame position, because the State pays for roads. People who might not want to derive benefit from tobacco money in such indirect ways have no choice but to d o so. The practice o f governments of placing all forms of tax and excise into consolidated revenue prevents individuals exercising such choice. Bul in the case of tobacco grants, recipients actively choose to obtain the money and so must bear responsibility for what it entails.

What tho recipients surd Despite al! this, the HPRT has not I’oundered. Its

first Report states that i t received 280 applications, of which 41 were funded for a total of 3.5 million pounds.’< T o date, those taking the ‘blood money’, as it was called by the Director General of the Health Education Counci1,Io have remained publicly silent on the issues of principle at the heart of the widespread criticism. In June 1985, I wrote to all Trust grant holders, asking them to respond to a set of frankly worded critical statements and questions. I stated that I shared the criticisms, seeing no point in feigning neutrality. I asked whether they would be prepared to accept similarly conditicmal research money from sources like a consortium of arms manufacturers, a publisher of pornography, the fascist National Front. the research bureau of a foreign military dictatorship and a philanthropist with a reputation and /o r criminal record as a narcotics trafficker. These analogies had been proposed, by critics of the Trust, to involve parallel questions of principle. If people objected to the morality of engaging financially with a perfectly legal group like the National Front, but embraced

the tobacco industry, I was curious to have the difference explained.

Fifteen written replies and two phone calls were received from a total of 43 letters. Only three attempted any detailed response. Several others confined themselves to emphasising that there was complete freedom from any industry influence in their project and did not address any other issues. Two wrote ‘arms length’ replies suggesting they might be willing to discuss things with me, but certainly not in writing.

The remainder, to varying degrees. were contemptuous of my enquiry and in refusing, tended to suggest that I was ‘biased’, not‘objective’or, in the case of one reply from a renowned epidemiologist. that I was “a remarkably naive individual.” The same person however. did write that “If I believe a job of research needs to be done for the sake of the public health, I will if necessary accept even unsavoury funding provided that there are no constraints on publication.” Another said bluntly that he would take money from the devil himself or the Great Train robbers. Such strident assertions may be interesting, but d o little to illuminate the principles that justify their positions.

The refusal of most recipients to respond was not entirely unexpected. The forthrightness of my questions allowed little room for meandering replies and, judging from those who wrote refusing, probably most took shelter behind inappropriate terms like ‘lack of objectivity’. This issue turns on matters of principle where one cannot finally evade taking a moral position. Objectivity is not at issue here. Those who take tobacco money are either indifferent to the criticisms raised, disagree with them or hold to mitigating criteria which may or may not satisfy critics. This is an issue where bloodless neutrality is an ethical stance in itself: one of avoidance.

Aftermaih The industry clearly would have liked nothing

more than for the H P R T exercise to have been summarized by “well, what was all the fuss about? Some excellent research was done”. Most importantly, the industry hoped the government would be grateful for a ‘worthy’ deed and a distraction from the government’s failure to more severely restrict tobacco advertising (the Trust was announced in parliament in the same speech that introduced a highly criticised new voluntary code of tobacco advertising restraint).

My action in writing the letters succeeded in

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generating quite a storm. Several people complained bitterly to senior people in the Civil Service and to a Minister in the British government that 1 had written on Health Education Council (HEC) stationery, implying that 1 wrote with its imprimatur (1 was a visiting researcher there at the time). In fact the Director General of the HEC, David Player, whose opposition to the Trust was well known, urged me to use the stationery. He said plainly that the absence of the country’s foremost health education institution from those seen to condemn the Trust was not a situation over which he wished to preside. Some in

the governing Council of the HEC, all of whom appointed by the Thatcher government, tried, unsuccessfully, to have Player carpeted. At the 1986 Council retreat, the Council agreed not to fund projects or researchers who were in receipt of Trust money.” The HEC was disbanded by the Thatcher government on April 1, 1987 and Player’s stand against the Trust and against several other politically sensitive industries implicated in health promotion is thought to have been instrumental in its downfall.

Can we hear from tobacco grant recipients themselves?

References

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Shaw J. He who sups with the devil. Med J Ausr 1986; 144:617. Anon. Taking money from the devil. Br Med J 1985; 291(651 ]):I7434 Castaldi P. On supping with the devil. MedJ Aust 1986145:360-61. Butterfield J. Health promotion research aims (letter). The Times 30 Oct 1982. Anon. Heal th Promot ion Research Trust:Salving the Government’s conscience. Lancet 18 Feb 1984. Anon. Smoking still kills. Br Med J 6 Nov 1982. Anon. Ban on ‘tobacco-tarred’ research cash is urged. The Times 4 Jul 1984. Milmo S. Trust causes anti-smoking lobby to fume. Doctor 25 Nov 1982. Coleman MP. (letter). Lancet 13 Nov 1982. Hencke D. Academic returns tobaccocash for

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research. The Guardian Nov 4 1985. 1 I . Proboscis. Inside the elephant: smoke screen.

Times Health Supplement 12 Aug 1983. 12. Anon. Miller quits research Trust. The

Guardian 20 Mar 1984. 13. US S u r g e o n G e n e r a l . The heal th

consequences of smoking: cancer. A report of the Surgeon General. US Department of Health and Human Services 1982; 13-169.13.

14. C h a p m a n S. Great expectorations: advertising and the tobacco industry. London:Comedia, 1986.

15. The Health Promotion Research Trust. Annual Report 1984. Addenbrooke’s Hospital Cambridge, 1984. Lovesey J. Doctors face ‘tainted’ dilemma. Sunday Times 7 Oct 1984. Ferriman A. Tobacco industry snubbed over cash. Observer 19 Jan 1986.

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