• conflict of interest
• history
• research ethics
• tobacco industry

Concern over commercial sponsorship of medical research is at an all time high these days. As academic medical schools become increasingly dependent on financial relationships with the pharmaceutical industry, for example, there have been calls for more stringent standards for research contracts and public disclosure of potential conflicts of interest.¹ But, so far, severing industry ties completely has not been considered as a serious option.

The case with tobacco, however, is different. A small but growing number of academic institutions (most recently the Harvard School of Public Health and the Arizona College of Public Health) have approved official policies prohibiting their faculty from receiving financial support from tobacco companies and their affiliates. Some prominent funding agencies have also taken a stand. The Wellcome Trust, the American Legacy Foundation, the Public Health Association of Australia, and the National Cancer Institute of Canada will not fund researchers who concurrently receive tobacco industry funding or support. Cancer Research UK is currently considering adopting a similar policy.

Indeed, the tobacco industry is fundamentally different from, say, the chemical or pharmaceutical industries. While Big Tobacco does not have a monopoly on impure science, it is the undeniable leader in organised subterfuge and manipulation of the scientific process. Over half a century, the industry has used quasi-scientific organisations, such as the Council for Tobacco Research, to promote controversy and uncertainty rather than generate knowledge about the effects of tobacco smoke. Secondly, the tobacco industry has succeeded in evading the kind of comprehensive regulatory structure that exists for chemicals and drugs, which would require manufacturers to meet particular safety and performance standards and allow for close scrutiny of marketing claims. Thirdly, among the enterprises of modern society, tobacco is unparalleled in its toll on human health. And unlike other risky products, the negative effects of tobacco result from the intended use of the product, not from recklessness, misuse, or manufacturing defects.

Given these facts, some insist that there are no circumstances under which it is appropriate to collaborate with or take money from tobacco companies. The Arizona policy states: “Any association between the College of Public Health and the tobacco industry taints the reputation of our College.”² Tobacco companies gain public credibility through relationships with prestigious academic institutions, and Cancer Research UK insists that “when a tobacco company benefits, the results are almost certainly negative. Tobacco companies and human well-being are simply incompatible.”³

Now Fields and Chapman reveal that one of the most revered figures in the history of smoking and health himself received generous industry support and, moreover, kept quiet about it.⁴ Wynder was coauthor of one of the landmark 1950 lung cancer case-control studies that first brought attention to the hazards of smoking and, throughout the ensuing decades, was an incessant voice for public health action to reduce the morbidity and mortality associated with tobacco use. But, between 1973 and 1995, Wynder’s American Health Foundation received over $5.7 million in building fund gifts and research support from Philip Morris. In fact, his dealings with the industry began even earlier than Fields and Chapman suggest. In the late 1950s, Wynder began a longtime working relationship with Lorillard scientists that included the evaluation of experimental filters and chemically treated tobacco.^5–7

But we should be cautious in judging Wynder’s conduct from our 21st century perspective. Firstly, while Wynder was among the first to advocate for harm reduction, he was not alone in his belief that cigarettes could be made substantially less harmful. When testifying before the US Congress in 1957, he urged the passage of regulations to reduce the overall tar and nicotine content of cigarettes by 40%, so that “we can give our public a safer smoking product, and, above all, we can save lives.”⁸ By the mid-1960s, the Surgeon General, the American Cancer Society, and other leading public health scientists were also voicing support for research into “less hazardous cigarettes”.¹⁰ And between 1968 and 1980, the National Cancer Institute’s (NCI) Smoking and Health Program spent $50 million supporting such research.

Secondly, attitudes towards scientific collaboration with industry, particularly the tobacco industry, have evolved significantly over the past 30 years.¹⁰ The NCI’s “less hazardous cigarette” research programme, for example, included industry scientists on its advisory board. At the time, of course, scientists and public health officials did not have the inside knowledge of the tobacco industry’s tactics that we have today thanks to whistleblowers and litigation.

Finally, Wynder was fighting an almost single handed battle to promote the fledgling discipline of preventive medicine. In 1969, when the American Health Foundation was created, the NCI did not have any organised programme to fund cancer control activities (that only came later with the 1971 National Cancer Act). Moreover, it was much easier to generate private financial support and political clout for finding a cure for polio than for, say, educating the public about healthy eating habits. Thus, Wynder, who was a pragmatist as well as a visionary, sought aid from those industries that did have an economic stake in the problem.

So what did the cigarette makers stand to gain from courting Wynder? In part, they encouraged Wynder to believe that their interest in “safer” cigarettes was genuine. In turn, Wynder’s public statements provided fuel for industry-wide claims that regulation was unnecessary because manufacturers were voluntarily doing what the public health community recommended. For example, in 1957 media reports highlighted the fact that some products on the market already met the recommendations of the authoritative Dr Wynder, including Lorillard’s “improved” Kent filter cigarette (with the infamous asbestos laden Micronite filter).¹¹

Wynder was a sophisticated and politically astute advocate for public health, and he could not have been oblivious to the risks of collaborating with the tobacco industry. Presumably, he believed that doing so would yield a net benefit for public health through harm reduction. But on this point the documents Fields and Chapman have uncovered, fragmented, and incomplete, raise more questions than they answer. Why did Wynder fail to acknowledge his financial ties to Lorillard and Philip Morris when making claims about reduced harm products? Would he have accepted industry funding today? We will never know for sure.

Science, as the saying goes, is not carried out in a vacuum. Therefore, scientists and academic institutions have an obligation to be aware of what a sponsor stands to gain from supporting their work and whether that relationship could be used in a way that is detrimental to public health. In today’s environment, where the tobacco industry is desperate to redeem its image to stave off government regulation and jury verdicts, the stakes are higher than ever. Perhaps research grants coming from tobacco companies should carry their own Surgeon General’s warning. Caution: Tobacco industry sponsorship may be hazardous to the public’s health.