The examination of financial ties and conflicts of interest revealed that the parent company of one tobacco manufacturer also owned a firm that made nicotine gum, so the company profited both from selling tobacco products and drugs to break the tobacco addiction.

Such financial ties and conflicts of interest should be made public, researchers argue in the August 14 issue of The Journal of the American Medical Association (JAMA).

Their analysis stems from a study of 187 internal tobacco industry documents dating from the mid-1980s to the mid-1990s accessed on the web sites of Philip Morris, RJ Reynolds, Lorillard and the Tobacco Institute. The researchers don't know if the conflicts of interest they uncovered still exist, since neither tobacco nor pharmaceutical companies publicly disclose such ties.

"This study shows how the tobacco industry has used its financial might to thwart public health," said Lisa Bero, PhD, UCSF professor of clinical pharmacy and health policy "In today's business climate, the ethics of financial ties should be discussed more openly. We should ask if a company should be able to profit both from selling an addictive product and a drug to treat the addiction." Bero is senior author on the JAMA paper.

Lead author is Bhavna Shamasunder, who holds a masters degree in environmental studies. She was a research associate with Bero during the study. A Philip Morris internal document dealing with the nicotine gum Nicorette summarizes a tobacco industry strategy found in a number of documents: "As a customer (of agricultural chemicals and pesticides) we have an ameliorating influence on Nicorette promotions. We would lose this impact as a non-customer."

Some of the documents focus on Marion Merrell Dow, then a subsidiary of Dow Chemical Company, which released Nicorette gum in 1980. The company's marketing of the gum included a Smoking Cessation Newsletter to help doctors advise their patients to quit smoking. The first - and only - newsletter issue contained an interview with an expert discussing how smoking addiction develops and is maintained. The newsletter also included statistics on deaths from smoking and an article encouraging physicians to urge their patients to quit smoking.

Philip Morris bought about $8 million of chemicals from Dow Chemical in 1982 to help make cigarettes. The tobacco company quickly attacked what it called the "anti-cigarette" Nicorette marketing campaign. Dow claimed it was not taking an anti-cigarette approach, but it stopped publication of the newsletter, and by 1984, its educational material was limited to the single sentence, "If you want to quit smoking for good, see your doctor."

Philip Morris continued to pressure Dow. Internal documents stress that future purchases of Dow products would be "predicated on Dow's performance as a supplier as well as the course of the Nicorette program."

"The tobacco company pressured Dow to cut out the aspect of their marketing approach that stressed the health hazards of smoking," Bero says. "The result was to reduce the number of people who would be encouraged to try the product to quit smoking."

In another case, Philip Morris took action once they concluded that sales of transdermal nicotine patches would have a damaging effect on cigarette sales in the early 1990s. CIBA-Geigy, manufacturer of the nicotine patch Habitrol, had a long-term financial relationship with Philip Morris. Soon after the release of Habitrol an internal Philip Morris memo stated that "marketing of this product included a 'smoke-busters' campaign which bordered on being anti-tobacco...Since CIBA-Geigy also markets a number of agri-chemicals used in tobacco production, our concern on this advertising program was funneled through their Ag Chemicals Division. Members of the Ag Chemicals Division of CIBA-Geigy have met with the Pharmaceutical Division (which manufactured Habitrol) to express concerns over the 'smoke-busters' campaign and to help devise more appropriate advertising for this product in the future."

Under pressure from the tobacco company, the Habitrol manufacturer agreed to "groundrules" for advertising their product which met with Philip Morris's approval.

A third case reveals that a Swedish-owned holding company, Procordia AB, held controlling financial interest in both a pharmaceutical company that manufactured nicotine gum to quit smoking and a tobacco company that sold a tobacco chewing gum designed to keep the habit going. The researchers point out that by collaborating and sharing technology among its holdings, "Procordia AB had the potential to benefit financially from creating an addiction through tobacco sales that could then be treated with their nicotine replacement therapies."

"The study shows that, once again, the tobacco industry is putting profit above anything - even when this means pressuring companies to reduce sales of products that can help people stop using deadly tobacco," Bero said. "Maybe greater public scrutiny can force greater corporate responsibility."

All documents used in the study are now online at UCSF's Legacy Foundation site: Legacy.library.ucsf.edu Documents can be accessed by typing in the "Bates number" cited in the references of the JAMA paper. The study was supported by the California Tobacco-Related Diseases Research Program.

Source: UCSF News Service Wallace Ravven