Manufacturing and Marketing Tobacco: An Inquiry Into the Relevance of Integrity

Manufacturing and Marketing Tobacco: An Inquiry Into the Relevance of Integrity

How has tobacco usage gained and maintained such a deadly strangle hold? Is it simply a commentary on the weakness of human beings and the power of the almighty dollar? The knowledge that professional integrity and codes of ethics have been abandoned with regard to the manufacturing and promotion of tobacco products is deeply sobering. This article illustrates how scientists, advertisers, lobbyists, legislators, and lawyers in their collaboration with tobacco manufacturers have forsaken social responsibility and deceived themselves and their constituencies despite significant data concerning the health consequences of nicotine addiction.

Tobacco Nicotine addiction Social responsibility Integrity

Our question is why are scientists willing to forfeit their integrity in support of an industry selling a deadly product -- tobacco -- that maims and kills thousands of people annually. Neither the thirty-pieces-of-gold theory nor the fact that advertisers, lobbyists, legislators, and lawyers participate in the protection game is an adequate answer. Before answering the question, however, we provide evidence of the problem. The fact that "the leading preventable cause of premature death in the United States is cigarette smoking" has become a truism. Any literate person must know that cigarette smoking causes cancer, and respiratory and circulatory diseases that contribute to death, disability, and financial catastrophe in the public and private health care systems ( 24). Tobacco use is responsible for more than 415,000 deaths annually ( 17). One-third of the United States population is addicted to tobacco ( 17) and only 3% of nearly 15 million smokers who attempt to stop smoking every year have lasting success ( 8). The total annual cost to society of tobacco-related morbidity and mortality has been estimated at 72 billion dollars ( 11), and because more than 37 million Americans are uninsured, much of the cost is absorbed by public insurance programs ( 10).

Why is it that tobacco usage has gained and maintained such a deadly strangle hold in a society whose citizens are both intelligent and educated? Is it simply a commentary on the weakness of human beings and the power of the desire for money? Our subject, however, is not the people at large, but small groups of professionals whose background, education, and training give them a privileged status that enables them to influence the conduct of others. Indeed, the roles these professionals play in society is so dominant that they themselves adopt codes of ethical conduct to ensure integrity in their efforts, but these codes have been abandoned with regard to the manufacturing and promotion of tobacco products, a deeply sobering fact. The purpose of this article is to demonstrate how scientists, advertisers, lobbyists, legislators, and lawyers have rejected the restraints of their codes and -- in collaboration with tobacco manufacturers -- have forsaken their social responsibility. Either they have deceived themselves and their constituencies, despite significant data concerning the health consequences associated with nicotine addiction, or they have acted with full knowledge. In short, they are either fools or knaves.

We start with advertisers whose disregard for the public welfare is manifested by the "Virginia Slims" and "Joe Camel" ads designed to dupe consumers into believing that sophistication and success is only a puff away. Then there are the lobbyists, whose fees for touting the right of individuals to choose to kill themselves -- while providing the tobacco companies with a healthy profit -- must be substantial. Next there are the legislators whose campaign coffers prove to be ideal places for the tobacco industry to plant influence in the form of campaign contributions. Then, of course, there are the lawyers who use their skills -- and misuse the law -- to control the use of the results of scientific research. And, finally, there are the scientists whose misguided research efforts have supported the tobacco industry's campaign of misinformation.

Advertisers

The advertisers' profit from the tobacco industry is suggested by the fact that cigarette advertising grew from $47 million in 1939 to $5 billion in 1992 ( 22), even though some activities related to tobacco advertising are subject to regulation. The regulated ad campaigns, however, do not deter the advertisers from designing ads with the intended effect of selling indiscriminately to adults and children. Glitzy commercials are targeted to make consumers believe that ruggedness, femininity, youthfulness, worldliness, affluence, or whatever the aspiration, are available if only they use tobacco.

One recent empirical study sought to determine whether tobacco advertising encouraged smoking in children under 18. The study found the "Joe Camel" campaign, a cartoon character approach appealing to youthful audiences, very successful, with that brand's market share increasing among young smokers. The researchers concluded, what the tobacco and ad industries must have known, that cigarette advertising encourages children to smoke and should be prohibited ( 19). A study sponsored by the Coalition on Smoking or Health, which concluded advertising to be the most significant inducement for children to smoke even ahead of peer pressure ( 6), confirmed the finding.

Point of sale advertising and placement of tobacco products in relation to other merchandise have been the focus of several studies. One finding indicated that 24% of tobacco product displays were located adjacent to candy and snack displays, areas appealing to youths ( 5).

Lobbyists

Lobbyists for tobacco interests continue to be present in force at public forums from the local council chambers to the halls of the U.S. Congress. Recently, Victor Crawford, a retired Maryland legislator, and former lobbyist for the Tobacco Institute, gave a number of their tactics a public airing. In the July 19, 1995 Journal of the American Medical Association, Crawford, a former smoker terminally ill with cancer, described by his physician as "a textbook case of cancer caused by smoking" ( 21), characterized his work as a tobacco lobbyist as "helping the tobacco industry fight public health efforts to restrict smoking" ( 21). He revealed that the Tobacco Institute used its computerized data bases to identify smokers by name, race, and even by the brand smoked, information that permitted lobbyists to mobilize smokers' rights advocates on a moment's notice. Crawford concluded that when dealing with tobacco lobbyists "you're in the big leagues and you've got to expect to get beaned and spiked....It's one of the most sophisticated, well organized lobbying machines in the world" ( 21).

Legislators

No inquiry into the relevance of integrity and the abandonment of ethics and the public trust would be complete without reference to the public solon -- the legislator. Recent documentary news reports have suggested that the tobacco industry is most comfortable in casting its lot with antiregulatory, probusiness Republicans. And it has been reported that overwhelming percentages of tobacco industry contributions are being -- or have been -- diverted from Democratic to Republican coffers. Money flows to the power. Victor Crawford's account asserts that gross profits of 100 billion dollars a year cause the tobacco industry to pursue a "take no prisoners" approach to winning at any cost. He avers that tobacco interests effectively control Congress' tobacco agenda and pointedly comments, "you're not going to see any anti-smoking legislation come out of Congress as long as the Republicans have control..."( 21).

Lawyers

Lawyers representing tobacco companies provide another view into the unethical practices of the purveyors of tobacco products. Victor Crawford noted, in the above-mentioned interview, that tobacco companies often hire lawyers as lobbyists so that the lawyer-client privilege will be available as part of their campaign to control information and shape the "truth" to their benefit.

Research by Glantz documents how attorneys for the tobacco industry moved from a representative role to a more active one in which they not only gave legal advice but also served as managers who selected research projects, determined which investigators received funding, and devised public relations efforts ( 12). Two articles in the July 1995 Journal of the American Medical Association focus exclusively on the role of lawyers for the tobacco industry in controlling scientific research. In the first, the authors concluded that lawyers took a number of steps to avoid tobacco company legal liability, including: a) efforts to control the language of scientific discourse; b) efforts to bring potentially dangerous scientific documents under lawyer-client confidentially to prevent litigation discovery; and c) efforts to insulate one client from damaging knowledge possessed by other client companies ( 15). The second article summarizes tobacco industry documents that reveal that decisions concerning which research was to be funded were based on legal stratagem rather than scientific merit. The authors concluded that memoranda between tobacco industry lawyers reflected that the scientific research agenda was dictated by the desire to generate positive publicity, to create distractions from health risks, and to influence policy makers ( 2).

There can be little doubt that tobacco industry lawyers understand the real dangers of cigarette smoking. And the more embattled the tobacco industry becomes, the more prominent the role of their lawyers. The controversy over the multimillion dollar lawsuit against ABC -- reportedly settled for $15,000,000 in attorneys' fees -- the "Sixty Minutes" interview with Dr. Jeffrey Wigard, first cancelled, shown finally on February 4, 1996, after the Wall Street Journal's report of Dr. Wigard's testimony before a grand jury, and the release of a 500-page dossier on Dr. Wigard in an effort to discredit him all attest to the role of lawyers. But it should be noted that even as some lawyers defend the tobacco industry, other lawyers are fighting it. Arguably, then, the problem is not that lawyers defend the tobacco industry, but that they misuse the law and corrupt the system as they do so.

Scientists

The Center for Tobacco Research and the Tobacco Institute -- presumably funded by the tobacco industry -- support scientists who use "research" to obscure obvious scientific conclusions that implicate tobacco as addictive and deadly. The recently revealed Brown and Williamson Tobacco Corporation documents provide an understanding of the corporate mentality of tobacco manufacturers toward the use and control of scientific research to obfuscate the facts. First available in 1994, these materials were obtained from Congress, the private papers of a deceased British American tobacco officer, and an anonymous source, a tobacco industry whistleblower, who obtained additional papers from a Louisville, Kentucky law firm that represented Brown and Williamson. These raw documents have been scanned into a computer data base at the University of California at San Francisco and are reviewable on the Internet at http://www.library.ucsf.edu/tobacco.

A summary of these documents for the Journal of the American Medical Association noted that the tobacco industry has misused or withheld scientific data in three primary approaches to thwarting public knowledge (and therefore public regulation): a) claims that evidence of tobacco as a cause of cancer or heart disease are inconclusive; b) claims that nicotine is not addictive; and c) claims that the tobacco industry is committed to determining the effect on health by internally and externally funded research ( 12).

Glantz and his coauthors assert that these documents demonstrate that the Brown and Williamson Tobacco Corporation, British American Tobacco Company, and their researchers had reason to know, as early as the 1960s, that cigarette tar caused cancer and that nicotine was addictive, but their public statements and efforts continued to belie this knowledge. One such instance was before the House Energy Subcommittee of the U.S. Congress in April, 1994 when the heads of the nation's largest cigarette companies testified under oath that they did not believe nicotine to be addictive.

A new foray into the private files of industry giant, Philip Morris, may soon reveal whether there is evidence to support ABC-TV's earlier assertion that nicotine levels have been controlled by the manufacturer to addict smokers ( 18). These Philip Morris files are being sought by a congressman and attorneys in a smokers' class action lawsuit pending in the federal court in Louisiana. Even though the tobacco industry denies that it increases the nicotine levels in cigarettes, the Wall Street Journal cited two confidential reports, which indicate that most tobacco manufacturers are adding chemicals to increase the potency of nicotine. One of the documents, a 54-page booklet, explains the fundamentals of ammonia chemistry and how the nicotine in ammonia-enhanced tobacco is capable of more quickly entering the smoker's bloodstream ( 16).

An earlier example of scientific subterfuge is found in a 1991 piece describing the Scientific Advisory Board, a group of 13 scientists utilized by the tobacco industry for grant review and selection. It is reported that "knowledgeable observers" believed this advisory board to be part of the tobacco industry's scheme to reinforce doubt in the public's mind about the hazards of smoking. Because the members of this board had never taken a public position regarding the industry claim of no causal relation between smoking and disease, the author polled the scientists. Despite repeated follow-up in asking whether they believed smoking was linked to cancer, only four responded, and they responded affirmatively. A review of published works found two others who had stated that smoking was a cause of cancer. Of the 13 members of this scientific body, six were on record in opposition to the industry's position -- over half the board did not make any public response ( 25).

Codes of Ethics

In spite of mounting data available since the 1960s demonstrating the morbidity and mortality associated with the use of tobacco products and the resultant addiction to nicotine, many professions have been willing to forego their ethical and social obligations. Today, the ethical codes of scientists, advertisers, lawyers, and corporations make general, if not specific, reference to the notions of social accountability.

Advertisers' Ethics

The American Association of Advertising Agencies (AAAA) includes in its statement of activities and goals of the organization the following objective: "The mission of the AAAA is...encouraging the highest creative and business standards. It works with federal, state, and local governments to help achieve desirable social and civic goals..." ( 13). Under the section titled "Implementation and Enforcement of Code" it is stated, "Pursuant to the Qualifications for Membership, only an advertising agency that can give `reasonable assurance' of its `readiness and ability to uphold the highest ethical standards' may join the organization" ( 13).

Lawyers' Ethics

The preamble to the American Bar Association's (ABA) Model Rules of Professional Conduct states, in part, "A lawyer's responsibilities as a representative of clients, and officer of the legal system and a public citizen are usually harmonious....So also, a lawyer can be sure that preserving client confidences ordinarily serves the public interest....In the nature of law practice, however, conflicting responsibilities are encountered. Virtually all difficult problems arise from conflict between a lawyer's responsibilities to clients, to the legal system and to the lawyer's own interest in remaining an upright person while earning a satisfactory living" [( 13), p. 472]. Rule 1:2(d) of the ABA Model Rules provides: "A lawyer shall not counsel a client to engage, or assist a client, in conduct the lawyer knows is criminal or fraudulent..." [( 13), p. 476]. The comments to this section give further guidance: "A lawyer is required to give an honest opinion about the actual consequences that appear likely to result from a client's conduct. The fact that a client uses advice in a course of action that is criminal or fraudulent does not, of itself, make a lawyer party to the course of action. However, a lawyer may not knowingly assist a client in criminal or fraudulent conduct. There is a critical distinction between presenting an analysis of legal aspects of questionable conduct and recommending the means by which a crime or fraud might be committed with impunity" [( 13), pp. 477-478].

Corporations' Ethics

The 1992 report of Corporate Ethics Practices notes that in the 5 years since its first report, company programs designed to articulate basic ethical principles have become more prevalent and more sophisticated. This report, based on responses to a detailed survey of corporate executives in the United States, Canada, Mexico, and Europe, found that the three subjects most often included in corporate ethics statements relating to corporate social accountability were environmental, marketing, and product safety responsibility. The fact that the increasingly popular Total Quality Management approach was more likely to be successful when the company defines relationships of trust with employees, customers, suppliers, and local communities was also mentioned. This report concludes that whereas corporate ethics codes once were the reactive result to public distrust, today they are routinely adopted by companies. Further, the increasing involvement by corporate attorneys in their development suggests a greater recognition of these codes as legal documents that establish the accountability of the company and its employees to, among others, the general public ( 1).

Scientists' Ethics

Joseph Rotblat, 1995 Nobel Peace Prize winner, issued a manifesto 40 years ago in which he and other scientists declared that they must take responsibility for their inventions and actions. Although the manifesto's focus was the atomic bomb, it has broader implications. Rotblat stated, "Nowadays science plays a very important role in the world: it can almost decide the destiny of mankind...and, therefore, it is particularly important for scientists to realize what is the impact of their work, and to do something if they feel this impact could be detrimental to the community" ( 20).

Although physicians have subscribed to the Hippocratic Oath since the 4th century B.C., many other branches of science have only recently begun to consider the need for professional oaths because scientists have frequently perceived their research objectives as amoral and incapable of being confined within morally based codes of ethics ( 4). Professor M. W. Thring of Great Britain has been a strong proponent of a general scientific oath. In 1987, the Institute for Social Inventions supported Thring's objective by drafting a proposed Hippocratic Oath for Scientists, Engineers, and Executives. It is a very general piece, and its drafters anticipated that each branch of specialization would complement it with a more issue-specific code of ethics. That oath reads:

I vow to practise my profession with conscience and dignity; I will strive to apply my skills only with the utmost respect for the well-being of humanity, the earth and all its species; I will not permit considerations of nationality, politics, prejudice or material advancement to intervene between my work and this duty to present and future generations; I make this Oath solemnly, freely and upon my honour. [( 4), p. 28]

Lobbyists' Ethics

Lobbyists come from many backgrounds and, of course, whereas many may be subject to codes of ethics from their particular profession (i.e., lawyer-lobbyists, physician-lobbyists, etc.), many are not covered by any professional promulgations. Many states have specific laws governing lobbying activities and reporting requirements, and the U.S. Congress is again tinkering with regulations in this area.

In 1991, the Council on Governmental Ethics Laws prepared a model law to provide for ethics in and regulation of lobbying ( 7). Section 314 of the Model Act lists conduct specifically prohibited including gifts or favorable loans by a lobbyist to a legislator, legislative candidate, or executive official during a legislative session or during the time an executive action is pending. Further, the act prohibits a gift by a lobbyist to such individuals in excess of $50 dollars in a calendar year. The act also prohibits a lobbyist from knowingly or willfully making a false statement or misrepresentation to a legislative or executive official.

The drafters of the Model Act in their commentary recognize that the Constitution affords citizens the right to petition their government but also recognizes that to preserve and maintain the integrity of the governmental decision-making process it is necessary to regulate and publicly disclose the identity, expenditures, and activities of persons hired to influence that process ( 7).

Conclusion

Although codes of ethics do not generally have the effect of law, they establish, at a minimum, the aspirations and ideals of the promulgating group. If each of the professional organizations associated with the promotion and selling of tobacco would take to heart their proclamations of social accountability, doubtless the dialogue could shift to a higher plane and eventually much human suffering could be averted. But until we become more ethically correct and integrity is restored, various other approaches remain necessary. Such approaches to the smoking problem include the Food and Drug Administration's (FDA) and President Clinton's recently proposed regulations aimed primarily at the child smoker. These will be an important piece of the puzzle in gaining some control over an industry that has behaved rather badly under a laissez faire approach.

Perhaps the ultimate manner of addressing the problem is through the broader use of product liability litigation. The tobacco industry has successfully externalized the health costs associated with smoking. The most direct way to internalize these costs is through taxation and/or imposition of legal liability. The idea of governmental entities seeking recovery of outlays of public funds used to treat smoking-related illness is becoming a popular device ( 9). Although, to date, litigants have been generally unsuccessful in actions against tobacco manufacturers, change may be at hand. With the new awareness of tobacco industry subterfuge, as evidenced in the Brown and Williamson documents, and with new found attention being given to the addictive nature of nicotine, plaintiffs have new theories to pursue.

Two very important class action lawsuits are pending in the federal district courts in Louisiana and Kansas. The Louisiana suit is a class action filed on behalf of all U.S. citizens who have used and been addicted to tobacco products produced by the largest manufacturers ( 3). The Kansas action is a similar class action suit filed against the manufacturers of smokeless tobacco ( 14).

Only when the tobacco industry is forced to include the costs of human disease and suffering will this industry be forced to confront reality in the market place. When the tobacco product is forced to bear the cost of the human toll it is taking, then the price to the consumer would be very nearly prohibitive. As reported in a recent British study, whereas persons in lower socioeconomic groups are more responsive to price increases in tobacco products than are high socioeconomic groups, real price increases in cigarettes could more fully achieve government goals of reducing the incidence of smoking and its related health consequences in all socioeconomic categories ( 23). Most importantly, the costs that are now borne by individuals, private insurance programs, and public financing mechanisms will be placed where they rightfully belong -- on the back of the tobacco industry.

The tobacco companies' claims that every American should have the right to choose to smoke or not, made with full knowledge that cigarettes are both physically destructive and addictive, calls to mind the comment that behind every great fortune there is a great crime. And behind the very great fortunes of the cigarette companies, we can assume that there are some very great crimes. But what are the crimes? They can best be summed up as information control, a seemingly minor infraction until one realizes what it entails. And what it entails is public lies orchestrated by a group that can best be characterized as an intellectual Mafia whose target is the truth. And of which, sad to say, some scientists have become members.

But there are other participants, and one may ask if the scientists are more culpable than advertisers, lobbyists, legislators, and lawyers. The answer is yes. We know, for example, that the occupational hazard of advertisers, lobbyists, legislators, and lawyers, by the nature of their professions, is intellectual dishonesty. But of all the groups in our society, scientists are persons of whom we would expect complete and absolute intellectual honesty, for we view them as being consistent in their reasoning, logical in their thought, and demanding in their proofs.

What, then, are we to think of scientists who stray so far from the reservation of intellectual integrity? Two thoughts come to mind. One is that scientists, too, are human; and the other is that some scientists suffer from character defects. For given their experience, training, education, and culture, only a character defect can explain scientists who support the tobacco industry.

Perhaps this is part of the price we pay for a free society, for the truth of the matter is that democracy codifies the law of self-interest. Thus, rights reign supreme and responsibilities are for someone else, not me. But in the end, freedom requires order and order requires a recognition of responsibilities.

References
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(23.) Townsend, J. Cigarette smoking by socioeconomic group, sex and age: Effects of price, income and health publicity. Br. Med. J. 309:923-927; 1994.

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Cognizant Communication Corporation.

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By Gary R. Smith and L. Ray Patterson

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