A new policy on tobacco papers.

Abstract

This past month PLoS Medicine pub-lished two original analyses on smoking,the single greatest preventable risk forpoor health and death in the developedworld, and an increasingly important riskfactor in the developing world. The firststudy, using internal tobacco companydocuments unsealed through litigation,provides further evidence of the alreadywell-documented strategy of deceptionused by the tobacco industry to furtherits commercial activities. The second studyshows the ways in which the tobaccocontrol agenda is distorted by the increas-ing medicalization of smoking cessation.In the first paper, Katherine Smith andcolleagues report how British AmericanTobacco (BAT), the world’s second largesttobacco transnational, strategically influ-enced the European Union’s frameworkfor evaluating policy options, leading to theacceptance of an agenda that emphasizesbusiness interests over public health [1].The researchers examined over 700 inter-nal BAT documents that contain informa-tion on the company’s attempts to influenceEuropean regulatory reform and conductedinterviews with European policymakers andlobbyists. Their analyses show that BATcreated a policy network of representativesfrom many corporations involved in mar-keting products that are damaging to publichealth and the environment, which thensuccessfully campaigned to have specificchanges made to the EU Treaty thatallowed policymakers to reduce the regula-tory burden on businesses. These changestherefore set up conditions that may allowfuture European policy to favor businessesrather than the health of citizens.In the second paper, Simon Chapmanand Ross MacKenzie critique the domi-nant messages about smoking cessationcontained in most tobacco control cam-paigns, which emphasize that seriousattempts at quitting smoking must bepharmacologically or professionally medi-ated [2]. This has led to the medicalizationof smoking cessation. In fact, argue theauthors, there is good evidence that themost successful methods used by most ex-smokers are quitting ‘‘cold turkey’’ orreducing then quitting. The medicaliza-tion of smoking cessation is propped up bythe extent and influence of pharmaceuticalsupport for cessation intervention studies,say the authors. They cite a recent reviewof randomized controlled trials of nicotinereplacement therapy that found that 51%of industry-funded trials reported signifi-cant cessation effects, while only 22% ofnon-industry trials did [3].This month also marks the implemen-tation of a new policy on tobacco papers atPLoS Medicine.Whilewecontinuetobeinterestedinanalyses of ways of reducing tobacco use,we will no longer be considering paperswhere support, in whole or in part, for thestudy or the researchers comes from atobacco company. As a medical journal wedo this for two reasons. First, tobacco isindisputably bad for health. Half of allsmokers will die of tobacco use [4]. Unlikethe food and pharmaceutical industries, thebusiness of tobacco involves selling aproduct for which there is no possiblehealth benefit. Tobacco interests in researchcannot have a health aim—if they did,tobacco companies would be better offshutting down business—and thereforehealth research sponsored by tobaccocompanies is essentially advertising. Publi-cation is part of tobacco company market-ing, and we believe it would be irrespon-sible to act as part of the machinery thatenhances the reputation of an industryproducing health-harming products.Second, we remain concerned about theindustry’s long-standing attempts to distortthe science of and deflect attention awayfrom the harmful effects of smoking. Thatthe tobacco industry has behaved disrep-utably—denying the harms of its products,campaigning against smoking bans, mar-keting to young people, and hiring publicrelations firms, consultants, and frontgroups to enhance the public credibilityof their work—is well documented. Thereis no reason to believe that these directassaults on human health will not contin-ue, and we do not wish to provide a forumfor companies’ attempts to manipulate thescience on tobacco’s harms.Furthermore, the business model usedto support our open access publishing (theresearch funder covers publication costs,unless the author requests a waiver) meanswe would essentially be accepting moneyfrom the tobacco industry by publishingtheir papers. This is unacceptable to theeditorial team of PLoS Medicine.Our new policy may be criticized asmoralistic, unscientific, and against trans-parency. Indeed, the leading tobaccocontrol journal (Tobacco Control) does notban tobacco industry–funded research, fortwo reasons: it wishes to avoid beinglabeled as biased by the industry, and itdoes not think it sensible to single outtobacco when the food and drug industriesalso have deeply vested and conflictedinterests in the research supporting theircorporate agendas [5]. Journals such asBMJ have also rejected a ban on researchpapers from authors funded by thetobacco industry, citing such a move as aform of unacceptable censorship andinstead managing the potential competinginterests as it would all papers [6]. Tenyears ago, one of us (GY) argued for theBMJ position [7], but has changed hisview over the last decade in the face of