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Tough on drugs -- weak on tobacco

Compared with funding for other public health issues, funding for tobacco control in Australia is appallingly neglected

Simon Chapman

MJA 2000; 172: 612-614

  "Tobacco smoking is the single largest preventable cause of premature death and disease in Australia."1 This is the first line of a document distributed recently with the Ministerial Council on Drug Strategy's National Tobacco Strategy 1999 to 2002-03.2 The World Health Organization, in recognition of the unabating global rise in tobacco-caused deaths -- forecast to reach 10 million a year in the decade 2020-2030 -- has elevated tobacco control to one of its priority projects,3 alongside malaria control and the essential drugs program.

So, how is tobacco control faring in Australia? It is popular for Australian governments to be tough on illicit drugs, but of late they have been decidedly weak on tobacco. They have allowed smoking prevalence to languish unchanged in the 1990s, after having successfully driven it down during the preceding three decades.4 A small gain has been that several State governments have announced or have implemented bans on smoking in restaurants, but, relative to government funding of other public health issues, funding for tobacco control is appallingly neglected. Moreover, for some of the other public health issues, such as illicit drug use prevention, little evidence for policy or program effectiveness exists (Box 1).

Further progress with tobacco control appears to be shackled by:

  • ideological recoil at regulating a "legitimate product";

  • concern for short term political industry patronage; and

  • ill-informed views that robust tobacco control will rapidly strangle the goose that lays the annual $5 billion golden egg of tobacco excise.

In April this year, in the face of huge criticism, the Liberal Party accepted sponsorship from Philip Morris for a lunch at its annual conference, with the Federal Director, Lynton Crosby, and the Prime Minister, John Howard, shrugging off criticism, claiming that tobacco products are legal,13 just as politicians of 150 years ago might have said of opium or even slavery. The Labor Party's record is little better, having received many donations from tobacco companies over the years.14 Only the Democrats refuse tobacco sponsorship. In 1999, Prime Minister Howard said on radio "the only way you could further reduce smoking in this country is probably by making it illegal".15 Borrowing Thatcherite vernacular, he has previously declared tobacco control to be a "nanny State" activity.16 Federal Health Minister Michael Wooldridge has championed the national tobacco campaign, although he has failed to make it a priority within his portfolio.

Funding for the national tobacco campaign is now at a historic low, with the National Tobacco Strategy brimming with promises, but remaining woefully underfunded.2 In 1999, after seven years of lobbying by the Australian Cancer Society, the tobacco tax system was changed, but not a cent of the $400 million windfall expected from the changed basis of excise (from per weight to per cigarette stick) has been committed to smoking prevention. For all its occasional rhetoric on the importance of tobacco control, the Federal Government, over the coming two years, is likely to derive at least a thousand times more ($10.25 billion) from tobacco excise17 than it committed to "tobacco harm minimisation" in its 1998-99 Budget ($3.8 million -- additional small allocations come from other public health programs).18

Australia and New Zealand's nine Attorneys General agreed in March this year to investigate whether to emulate their US counterparts and sue the tobacco industry. International precedents suggest that they could choose from charges ranging from conspiracy, misleading and deceptive conduct, or common law negligence. Criminal charges against individuals are allegedly also receiving active consideration.19 In the United States case, the tobacco industry hoisted the white flag in November 1998 and settled, agreeing to pay the US States $US206 billion over 25 years.20 (Population adjusted, at today's exchange rates, this would translate into $A25.7 billion.) The money from this case -- the largest settlement in world history -- will compensate the US States for the public costs of caring for uninsured, dying smokers and fund massive education programs to redress decades of industry misinformation.

Since the settlement, four US civil cases have seen juries return verdicts in favour of plaintiffs.21 The latest, the Florida Engle class action, may result in an award of punitive damages totalling hundreds of billions of dollars.22 Some analysts believe it could bankrupt the industry,23 ushering in a new era of fully regulated tobacco sales with tobacco classified as a toxic substance.

What has brought about these successes? Everything changed overnight for the tobacco companies when, on 8 May 1998, the Minnesota District Court ordered US tobacco companies to place on the World Wide Web what has now run to over 30 million pages of internal documents.24 Among this Niagara of revelations are thousands that are highly incriminating, including a great many authored by Australian industry operatives. The decades-long industry claims that lung cancer was only "statistically associated" rather than caused by smoking, that nicotine was not addictive, and that tobacco companies did not want children to smoke, have been confirmed as carefully orchestrated positions designed to avoid litigation. These views contrast with the industry's private admissions and its elaborate efforts to deny evidence, delay government action and deceive smokers. As a Philip Morris executive wrote in 1978:

". . . an admission by the industry that excessive cigarette smoking is bad for you is tantamount to an admission of guilt with regard to the lung cancer problem. This could open the door to legal suits in which the industry would have no defence."25

The internal documents detail a massive international conspiracy designed to muddle public thinking about tobacco and stall government action26 (Box 2).

After the documents were revealed, the Australian tobacco companies have been attempting to deny that the arguments that sustained the US settlement are relevant to Australia. They are amassing a collection of press cuttings about smoking, presumably in an effort to argue that, even if the tobacco companies were determined to promote public doubt about tobacco's harms, this counted for little against what the public could read in the press. The centrepiece of this argument is that, because Australian tobacco tax more than covers the public costs of treating diseased smokers, smokers pay their way -- government claims for recompense are therefore unsupportable.38 This argument has all the moral force of a company polluting the environment, attempting to cover it up with commissioned and carefully managed science and then pleading -- but our customers pay taxes . . . use that to pay for the damage you claim, but that we dispute, occurs.

A lobbying document has been circulated by Philip Morris threatening that, if the Australian and NZ Attorneys General proceed with legal action, governments risk huge legal costs and closure of Australian tobacco manufacturing with attendant job losses.38 Predictably, it fails to mention any of the recent legal decisions against the tobacco industry, nor the seachange in evidence provided by the availability of the internal documents. If the Attorneys General take courage, the industry will walk naked into court, with its manifest vulnerabilities illuminated by thousands of its own documents.

If the Attorneys General proceed and succeed, we are entitled to wonder whether the money they extract will be used for the intended purpose. One year on from the settlement in the United States only three cents in the dollar were being used for tobacco control.39 Cynics might well ask if the present momentum is motivated solely by revenue raising.

References

  1. Ministerial Council on Drug Strategy. Background paper. A companion document to the National Tobacco Strategy 1999 to 2002-03. A framework for action. Canberra: Commonwealth of Australia, 1999: 1.
  2. Ministerial Council on Drug Strategy. National Tobacco Strategy 1999 to 2002-03. A framework for action. Canberra: Commonwealth of Australia, 1999.
  3. Brundtland GH. WHO's International Conference on Global Tobacco Control Law: Towards a WHO Framework Convention on Tobacco Control. Speech text. January 7, 2000. <http://www.who.int/director-general/speeches/2000/ 20000107_new_delhi.html> (accessed 18 May 2000).
  4. Hill DJ, White VM, Scollo MM. Smoking behaviours of Australian adults in 1995: trends and concerns. Med J Aust 1998; 168: 209-213.
  5. Anderson J. Black spot road safety a national priority in federal budget. Media release. <http://www.dotrs.gov.au/budget/anders/ABudget12_99.htm> (accessed 22 May 2000).
  6. Lawrence C. Human Services and Health Portfolio Budget Statement 1995-96, Budget Related Paper No. 4.9. Canberra: AGPS, 1995: 31-52.
  7. Willis R. Budget Statements 1994-95. Budget Paper No. 1. Canberra: AGPS, 1994: 3.63.
  8. Wooldridge M. Health and Family Service Portfolio Budget Statement, Paper No. 1.8. Canberra: AGPS, 1997.
  9. Costello P. Budget measures 1998-99. Budget paper No. 2. Canberra: AGPS, 1998, 1-42. (Also: Commonwealth Department of Health and Family Services. Fact Sheet 1. Investment in preventive public health measures, Budget 1998-99.)
  10. Costello P. Budget measures 1999-00. Budget paper No. 2. Canberra: AGPS, 1999. (Also: Department of Health and Aged Care. Fact Sheet 4. Tough on drugs, Budget 1999-2000, May 1999.)
  11. Australian Bureau of Statistics. Causes of death, 1998. Canberra: ABS, November 1999. (Catalogue No. 3303.0.)
  12. English DR, Holman SDJ, Milne E, et al. The quantification of drug-caused morbidity and mortality in Australia, 1995 edition. Canberra: Commonwealth Department of Human Services and Health, 1995.
  13. Hardaker D. 7.30 Report, ABC Televison, 2000; 13 April. <http://www.abc.net.au/ 7.30/730subjectidx_Politics.htm> (accessed 18 May 2000).
  14. Chapman S. Tobacco Control Supersite. <http://www.health.usyd.edu.au/ tobacco/worddocs/political_donations.txt> (accessed 18 May 2000).
  15. Howard J. Comments on Jeremy Cordeaux radio program 5DN. 1999; July 22.
  16. Brough J. Minister tips tobacco sponsorship to stay. Sydney Morning Herald 1997; 3 Sept: 1.
  17. Costello P. Australian Budget, 2000-01; Budget paper No. 1. Budget strategy and outlook, Statement 5 revenue: Part II. Budget estimates of revenue, Table 6. Indirect tax. Canberra: Ausinfo. <http://www.ausinfo.gov.au/budget/papers/ bpl/html/bs5-01.htm#P57_5844> (accessed 18 May 2000).
  18. Costello P. Budget measures 1998-99, Budget paper No 2. Canberra: AGPS, 1998, 1-42. (Also: Commonwealth Department of Health and Family Services. Fact Sheet 1. Investment in preventive public health measures. Budget 1998-99.)
  19. Griffin T (South Australian Attorney General). ABC-TV. Lateline 23 March [transcript]. <http://www.abc.net.au/lateline/archives/S113020.htm> (accessed 22 May 2000).
  20. Kelder G, Davidson P, editors. The multistate Master Settlement Agreement and the future of state and local tobacco control; 1999 March 24. <http://tobacco.neu.edu/msa/index.html Executive Summary> (accessed 18 May 2000).
  21. Levin M, Menn J. $33m award to smoker who knew risks. Sydney Morning Herald 2000; March 29: 11.
  22. Williams B. Smokers win case in Fla. News and Observer (Raleigh, Va) 2000, April 8. <http://www.news-observer.com/daily/2000/04/08/nc00.html> (accessed 18 May 2000).
  23. Tobacco Control Resource Center Inc., and the Tobacco Products Liability Project, Northeastern University. <http://tobacco.neu.edu/> (accessed 18 May 2000).
  24. The Tobacco Archives. <http://www.tobaccoarchives.com> (accessed 18 May 2000).
  25. Osdene TS. Roper study proposal to Tobacco Institute, 1978, 16 February. <http://www.tobaccoinstitute.com/getallimg.asp?DOCID=TIOK0034601/4602> (accessed 18 May 2000).
  26. Cullman H. (Philip Morris) Memorandum to the files (Confidential). Interoffice correspondence. 1976; December 3. Search for -- Did:2025025286 at <http://www.pmdocs.com/default1.asp> (accessed 23 May 2000).
  27. Proposal for the organisation of the Whitecoat Project. <http://www.ash.org.uk/ papers/2501474262.pdf> (accessed 18 May 2000).
  28. Project Down Under. 1987; June 26. Search for -- Did:2021502671/2678 at <http://www.pmdocs/com/default1.asp> (accessed 23 May 2000).
  29. Boyse S (British American Tobacco). Minutes of a special meeting of the UK industry on environmental tobacco smoke. 1988, February 17. <http://www.ash.org.uk/papers/401247331.pdf> (accessed 18 May 2000).
  30. Headden S. Papers you weren't ever supposed to see. How Big Tobacco fought an all-fronts war. US News 1998; May 4. <http://www.usnews.com./ usnews/issue/980504/4toba.htm> (accessed 22 May 2000).
  31. Marlboro marketing strategy (Australia) 1990. Search for -- Did:2048571302/1384 at <http://www.pmdocs.com/default1.asp> (accessed 23 May 2000).
  32. Philip Morris (Australia) Corporate Affairs Plan 1992. Search for -- Did:2023240608/0627 at <http://www.pmdocs.com/default1.asp> (accessed 23 May 2000).
  33. Health aspects of environmental tobacco smoke: an evaluation of the scientific literature. Submission to the Health Care Committee of the National Health and Medical research Council. Sydney: November 1994, 156 pp.
  34. Staunton D (Tobacco Institute of Australia) Memorandum 1994; 7 April. Search for -- Did:2504088601/8606 at <http://www.pmdocs.com/default1.asp> (accessed 23 May 2000).
  35. Knopick P. Memorandum to William Kloepfer: TI, USA; 1980. <http://www. tobaccoinstitute.com/getallimg.asp?DOCID=TIMN0107822/7823> (accessed 18 May 2000).
  36. Francis P (Philip Morris Australia). Telex to Don Hoel (Shook, Hardy and Bacon, lawyers, Kansas). 1998; 11 December. Search for -- Did:2021588889 at <http://www.pmdocs.com/default1.asp> (accessed 23 May 2000).
  37. Chapman S. Tobacco Control Supersite. <http://www.health.usyd.edu.au/ tobacco/ozdocs.html#Plainpackaging> (accessed 18 May 2000).
  38. Philip Morris (Australia). Why US style medical cost recovery litigation is not right for Australia. Melbourne: Philip Morris, 2000; March 16: 7pp.
  39. Rees D. Tobacco money scattered by states. Richmond Times-Dispatch. Richmond, Va, 1999; 19 Nov.

Authors' details

Department of Public Health and Community Medicine, University of Sydney, Sydney, NSW.
Simon Chapman, Associate Professor; and Associate Director, VicHealth Centre for Tobacco Control, Drummond Street, Cartlton, VIC.

Reprints will not be available from the author.
Correspondence: Associate Professor S Chapman, Department of Public Health and Community Medicine, University of Sydney, NSW 2006.
simonc@health.usyd.edu.au

©MJA 2000
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1: Recent federal budget commitments to major public health programs (average annual commitments for 1994-95 to 2002-03), compared with deaths from associated causes, 1998
Average committed
per year ($ million)
No. of deaths
in 1998
11,12
Amount ($)
committed per death

Black-spot road safety program5
AIDS control6
Breast cancer7
Cervical cancer program6
38.1
49.5
51.6
10.5
1942
187
2558
302
19619
264706
20172
34603
Illicit drugs
National Drug Strategy7
National Illicit Drug Strategy8-10
36.6
74.7
630
630
58095
118571
Asthma management103.16854525
Preventing falls101.711821438
Tobacco (Health Australia)
Tobacco Harm Minimisation 1995-19986
6.118224337
National Tobacco Campaign
Tobacco Harm Minimisation 1999-20029
2.018224112
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2: What the tobacco companies' internal documents revealed
In 1977, after years of individually denying tobacco-caused disease, the tobacco companies came together at a stately manor in Berkshire and gave birth to an international conspiracy. In the decades that followed, the companies

  • Gagged their own scientists and signed up a phalanx of external consultants. These consultants agreed to be "managed" by industry lawyers via programs with pulp fiction titles like the Whitecoat Project27 and Project Down Under.28
  • Spent what a 1988 meeting described as "vast sums of money to keep the [passive smoking] controversy alive".29
  • Funded teenage education gestures calculated to gain political "Brownie points", while privately noting that they would not support programs that actually reduced tobacco use30 and assiduously noting the brand preferences of "new smokers" (industry-speak for teenagers).31

In Australia, the tobacco companies pumped hundreds of thousands of dollars into community concerns about the government's misplaced priorities on tobacco, arguing that it should instead be addressing illicit drugs.32 Members of a group commissioned by the Tobacco Institute in 1994 to review the literature on passive smoking33 were said to be "known to us, as are their views".34 Most crucially, the word "addiction" has been the industry's bête noire. A letter between two senior US industry officials noted

"[industry lawyers] remind us that the entire matter of addiction is the most potent weapon a prosecuting attorney can have in a lung cancer/cigarette case. We can't defend 'free choice' if the person was 'addicted'".35

So they invested millions in public relations efforts at denying that nicotine was addictive. There are dozens of memos between the Australian tobacco industry and the same lawyers, approving strategy, vetting scientists who might utter the profane "a" word in industry-sponsored meetings, and sanitising public documents.36 A fascinating series of memos documents the delight of Philip Morris over lobbying by the then Victorian Premier Jeff Kennett in 1992-93, designed to keep "addiction" off Australian packs by promoting instead comparatively tepid and tiny European-style warnings.37

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