Understanding corporations to inform public health policy: the example of tobacco industry interests in harm reduction and reduced risk products

Abstract

BackgroundCorporations selling products that are damaging to health should be researched as vectors of disease, but how can such research inform public health policy? On the basis of findings of increasing transnational tobacco company (TTC) investments in reduced risk products, we aimed to examine companies' interests in harm reduction, including smokeless tobacco and nicotine-containing products in Europe. Methods416 TTC documents released via litigation and dating from 1971 to 2009 were obtained via searching the online Legacy Tobacco Documents Library and analysed by hermeneutic and sociohistorical archival methods. Various materials were used to triangulate documentary findings, including media, relevant tobacco industry journal, and Euromonitor reports. We also systematically examined contemporary industry materials, including all TTC annual reports accessible online and via the British Library in October, 2012, all British American Tobacco (BAT; n=42) and Philip Morris International (PMI; n=47) investor presentations available online in September, 2012, and all BAT sustainability reports from 2001–02 (the first year of publication) onwards. FindingsFrom 1971, prompted by fear of declining cigarette sales, BAT began to explore opportunities in smokeless tobacco in Europe and the potential to create a new form of tobacco use for those no longer interested in taking up smoking. Young people were therefore a key target. Despite awareness of smokeless tobacco's substantially lower health risks from the 1970s, TTCs did not invest in the product until 2002, when European Union cigarette volumes started decreasing and the public health community began actively exploring smokefree legislation and harm reduction. All TTCs have now invested in snus (a form of smokeless tobacco) such that no major European snus companies remain independent of cigarette interests; yet snus test markets seem to have failed and we identified no evidence that snus is central to TTCs' business strategy. This finding suggests that TTC snus investments might have been intended to eliminate competition between snus and highly profitable cigarettes. Recently, TTCs have invested in nicotine-containing products, including e-cigarettes. The scarce corporate information on this issue suggests that concerns identified in relation to smokeless tobacco might apply to such products; for example, a BAT investor presentation (2011) stated that “new ‘would be smokers’ begin with and stay with low risk product categories”. Documents suggest TTCs adopted the term “harm reduction” from the US Institute of Medicine, which published a report on the topic in 2001. Thereafter, TTCs increasingly used the term. For example, BAT's use of the term “harm reduction” in its social reports increased from two in 2001–02 to 247 in 2010. Documents and interviews suggest harm reduction offered TTCs two main benefits: reputation enhancement and an opportunity to establish or re-establish dialogue with and access to policy makers, scientists, and public health groups. InterpretationThe main study limitation is that the document collections might not fully represent TTC interests in Europe because they mainly cover BAT and PMI. Nevertheless, the findings suggest that TTCs' harm reduction discourse signals a tactical adaptation to policy change rather than a genuine commitment to reducing harm. Public health must, therefore, continue to protect policies from TTC influence. TTCs' historic interest in smokeless tobacco might apply to nicotine-containing products. Furthermore, having eliminated any competitive threat from snus, TTCs are now investing in e-cigarettes, which needs careful monitoring because TTC control of this market would serve to maintain the dominance of the cigarette. FundingThe internal industry document work was supported by the Pricing Policies and Control of Tobacco in Europe project EC FP7 Grant AgreementHEALTH-F2-2009-223323; the collection and analysis of contemporary industry materials was supported by the National Cancer Institute, US National Institutes of Health (grant RO1CA160695).