Karen Evans-Reeves

Tobacco industry manipulation of data on and press coverage of the illicit tobacco trade in the UK

Background In the UK, transnational tobacco companies (TTCs) have been arguing that levels of illicit trade are high and increasing and will rise further if standardised packaging is implemented. This paper examines trends in and accuracy of media reporting of, and industry data on, illicit tobacco in the UK. Methods Quantification of the volume, nature and quality of press articles citing industry data on illicit tobacco in UK newspapers from March 2008 to March 2013. Examination of published TTC data on illicit, including a comparison with independent data and of TTC reporting of Her Majestys Revenue and Customs data on illicit. Results Media stories citing industry data on illicit tobacco began in June 2011, 2 months after the Tobacco Control Plan for England, which heralded standardised packaging, was published. The majority of data cited are based on industry Empty Pack Surveys for which no methodology is available. For almost all parts of the country where repeat data were cited in press stories, they indicated an increase, often substantial, in non-domestic/illicit cigarettes that is not supported by independent data. Similarly, national data from two published industry sources show a sudden large increase in non-domestic product between 2011 and 2012. Yet the methodology of one report changes over this period and the other provides no published methodology. In contrast, independent data show steady declines in non-domestic and illicit cigarette penetration from 2006 to 2012 and either a continued decline or small increase to 2013. Conclusions Industry claims that use of Non-UK Duty Paid/illicit cigarettes in the UK is sharply increasing are inconsistent with historical trends and recent independent data. TTCs are exaggerating the threat of illicit tobacco by commissioning surveys whose methodology and validity remain uncertain, planting misleading stories and misquoting government data. Industry data on levels of illicit should be treated with extreme caution.

‘It will harm business and increase illicit trade’: an evaluation of the relevance, quality and transparency of evidence submitted by transnational tobacco companies to the UK consultation on standardised packaging 2012

Introduction Transnational tobacco companies (TTCs) submitted evidence to the 2012 UK Consultation on standardised packaging (SP) to argue the policy will have detrimental economic impacts and increase illicit tobacco trade. Methods A content analysis of the four TTC submissions to the consultation assessed the relevance and quality of evidence TTCs cited to support their arguments. Investigative research was used to determine whether the cited evidence was industry connected. Fishers exact tests were used to compare the relevance and quality of industry-connected and independent from the industry evidence. The extent to which TTCs disclosed financial conflicts of interest (COI) when citing evidence was examined. Results We obtained 74 pieces of TTC-cited evidence. The quality of the evidence was poor. TTCs cited no independent, peer-reviewed evidence that supported their arguments. Nearly half of the evidence was industry-connected (47%, 35/74). None of this industry-connected evidence was published in peer-reviewed journals (0/35) and 66% (23/35) of it was opinion only. Industry-connected evidence was of significantly poorer quality than independent evidence (p<0.001). COIs were not disclosed by TTCs in 91% (32/35) of cases. Conclusions In the absence of peer-reviewed research to support their arguments, TTCs relied on evidence they commissioned and the opinions of TTC-connected third-parties. Such connections were not disclosed by TTCs when citing this evidence and were time consuming to uncover. In line with Article 5.3 of the Framework Convention on Tobacco Control and broader transparency initiatives, TTCs should be required to disclose their funding of all third-parties and any COIs when citing evidence.

Illicit trade, tobacco industry-funded studies and policy influence in the EU and UK

In the course of the last decade, the tobacco industry has attempted to increase the political salience of the illicit trade in tobacco products (illicit trade) (box 1).1 ,2 Tobacco companies have claimed that sharp rises in tobacco taxation and innovative regulation, such as standardised packaging and product display bans, are drivers of the illicit trade, and have advocated programmes of engagement with policymakers and other social actors in an effort to ensure that the issue is given greater consideration in health policymaking.2–5 Box 1 ### Major activities comprising the illicit trade in tobacco products.6–8 Transcrime adopts the definition of illicit trade outlined in the World Health Organisation, Framework Convention of Tobacco Control, namely, ‘any practice or conduct prohibited by law and which relates to production, shipment, receipt, possession, distribution, sale or purchase including any practice or conduct intended to facilitate such activity’.6 ,9 This covers:

Digital phenotyping and the development and delivery of health guidelines and behaviour change interventions

Lovatt and colleagues make the case that drinking guidelines informed by the experiences and behaviours of drinkers are likely to have increased relevance, credibility and efficacy. There is reason to believe that digital technologies such as crowdsourcing, social media, mobile digital devices and biosensing devices measure behaviours such as drinking with a level of detail and on a scale that has not been possible previously. The intensive measurement of behaviours enabled by these approaches, combined with appropriate modelling techniques, can reveal patterns of behaviours that, together with knowledge of the resultant negative or harmful consequences, can inform the development of improved guidelines.

How do corporations use evidence in public health policy making? The case of standardised tobacco packaging

Abstract Background In 2012, the UK Government consulted on standardised packaging (SP) of tobacco products. Four transnational tobacco companies (TTCs) submitted large responses opposing SP, criticising evidence cited and citing alternative evidence to support their case. We examine the problems faced by policy makers assessing large volumes of diverse evidence submitted by well-resourced corporate interests to public consultations, and discuss potential strategies for evidence management in public health policy making. Methods We synthesise the results of three UK-based studies. Data were identified from four TTC submissions (available online). Assessment criteria for content analyses were developed by literature review. Independent second coding of data was used to validate findings (studies 1 and 2: 100%; study 3: 13%), examine convergence, and resolve interpretation differences. Study 1 was a comparative content analysis of quality (independence, peer-review) and relevance (subject matter) of 77 research documents cited by TTCs to argue that SP will not work, and 37 research documents from a systematic review (SR) of SP. Two-tailed Fishers tests were used to compare datasets. Study 2 was a content analysis of quality, relevance, and type (eg, research, opinion, policy) of 92 documents and quotations cited by TTCs to argue that SP will have negative, unintended consequences for the UK economy and illicit trade. Study 3 was a qualitative interpretive analysis of techniques used by two TTCs to undermine evidence of SPs effect on smoking behaviour. 120 purposively selected pages (of 1037) were analysed using a verification-oriented cross-documentary analysis, comparing use of research with originals, and a thematic analysis, informed by principles and techniques of constructivist grounded theory—conceptual coding for a-priori and emergent themes, constant comparison, discourse sensitivity, and attention to divergent data. Findings In 1521 pages, the four TTCs cited 143 formal research documents to underpin their opposition to SP and made extensive reference to policy documents, quotations, and media coverage. In study 1, 12% of TTC research evidence that SP will not work was both relevant (addressed SP or tobacco packaging) and fulfilled one or more quality criteria (independent of TTCs, published in a peer-reviewed journal, or both), compared with 100% of SR evidence. In study 2, 16% of data were both independent and relevant. TTCs offset the scarcity of outcome-based evidence on the consequences of SP with industry-commissioned research and used independent and industry-connected opinion to inflate the risk of unintended consequences. In study 3, TTCs misused published evidence through inaccurate reporting, attempted methodological deconstruction through mimicked scientific critique, and sought to promote a parallel evidence base to reduce the power and credibility of evidence supportive of SP. Interpretation TTCs used sophisticated, complex, and mutually reinforcing evidential presentation strategies to oppose SP. Assessment of submissions and associated evidence represents a substantial challenge and cost, causing delay or even abandonment of policies. Two strategies could address this. First, implement evidential management processes at submission (eg, requiring respondents to record evidential funding sources, conflicts of interests, and accuracy of evidential representation). Second, introduce a formal post-submission evidence assessment framework. Such strategies could reduce costs imposed on policy makers by the present requirement to invite and assess evidence from stakeholders. They might also reduce the ability of corporate interests to use evidence misrepresentation to oppose policy change. The resource advantage of TTCs is a substantial challenge to potential reforms. Funding JLH and KAE-R are supported by Cancer Research UK (CR-UK; grants C38058/A15664, C27260/A12294). SU, GJF, and ABG are supported by the US National Cancer Institute (R01CA160695). All authors are members of the UK Centre for Tobacco and Alcohol Studies, a UK Centre for Public Health Excellence (MR/K023195/1) funded by the BHF, CR-UK, ESRC, MRC, and NIHR, under the auspices of the UK Clinical Research Collaboration. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funders.

Assessing the evidence base of tobacco industry submissions to public consultations: The case of ‘plain packaging’ of tobacco products in the UK

Background The UK’s public consultation on ‘plain packaging’ of tobacco products generated an unprecedented volume of responses. Given the track record of the tobacco industry’s misuse of science to oppose policy change, and the fact that plain packaging has only recently been introduced in a single jurisdiction – Australia, December 2012 – how can policymakers weigh up evidence submitted to them? In this paper, the authors deliver an analysis of the relevance and quality of evidence on ‘plain packaging’ submitted to the UK Department of Health by the UK’s four largest tobacco companies to support their argument that plain packaging will not meet associated public health objectives for disease prevention. Methods We conducted a case-study based comparative analysis of the quality of evidence cited in tobacco industry submissions consultation with that presented in favour of ‘plain packaging’ in a ‘Systematic Review’ of the literature. We coded each piece of evidence for relevance of subject matter and three quality criteria - funding source, primary or secondary research and peer-review status – and compared the relevance and quality of the two bodies of evidence. Results We identified 112 pieces of evidence which present arguments about whether or not plain packaging will influence smoking behaviour – 65 from industry submissions, and 37 from the ‘Systematic Review’. Our preliminary findings are that the tobacco industry cited 10 sources of evidence which critique the evidence for ‘plain packaging’. These were funded by the tobacco companies and were not peer-reviewed. The tobacco companies cited a further 55 sources of new evidence, 34 presenting primary research. Of these 34, 2 related directly to ‘plain packaging’, one of which was funded by the tobacco industry and 14 of the 34 appeared in peer-reviewed journals. In contrast, all of the 37 ‘Systematic Review’ papers were funded independently of the tobacco industry and presented primary research directly related to plain packaging. 22 of these reports appeared in peer-reviewed journals. Conclusion Our preliminary findings suggest that evidence cited by the tobacco industry to oppose ‘plain packaging’ is, overall, not as relevant or robust as the growing body of evidence in favour of this regulatory proposal. We propose that an evidence assessment framework, based on four criteria – relevance of research, independence of funding, nature of research and peer-review may offer a structure by which policy-makers can make an assessment of the evidence base of submissions to public consultations, especially where response volumes are high.

Tobacco industry data on illicit tobacco trade: a systematic review of existing assessments

Objective To examine the quality of tobacco industry-funded data on the illicit tobacco trade (ITT) through a systematic review of existing assessments of industry-funded data on ITT. Data sources Papers and reports assessing tobacco industry-funded data on ITT were obtained via searches of 8 academic databases, Google searches and correspondence with ITT experts. Study selection Inclusion criteria identified 35 English-language papers containing an original assessment of tobacco industry-funded data. Data extraction Using a coding framework, information was extracted from the assessments regarding the quality of tobacco industry data. Documents were second-coded, achieving 94% intercoder reliability with all disagreements resolved. Data synthesis Of the 35 assessments reviewed, 31 argued that tobacco industry estimates were higher than independent estimates. Criticisms identified problems with data collection (29), analytical methods (22) and presentation of results (21), which resulted in inflated ITT estimates or data on ITT that were presented in a misleading manner. Lack of transparency from data collection right through to presentation of findings was a key issue with insufficient information to allow replication of the findings frequently cited. Conclusions Tobacco industry data on ITT are not reliable. At present, the tobacco industry continues to fund and disseminate ITT research through initiatives such as PMI IMPACT. If industry data on ITT cannot meet the standards of accuracy and transparency set by high-quality research publications, a solution may be to tax tobacco companies and administer the resulting funds to experts, independent of the tobacco industry, who use previously developed reliable models for measuring ITT.

Worldwide news and comment:Europe: BAT and European Union policy influence- another third party?

MAURITIUS: FIGHT AGAINST TOBACCO MANUFACTURING PLANT After ratifying the WHO Framework Convention on Tobacco Control (FCTC) in 2004, Mauritius put in place effective tobacco control measures, supported by strong political will. Legislation was adopted to ban tobacco advertising, promotion and sponsorship and smoking in most public places, and the first pictorial health warnings on cigarette packs in Africa were introduced in 2008. More than 70% of the retail price of the most popular tobacco products is tax, although they are still easily affordable to the average-income smoker. In 2007, British American Tobacco closed its manufacturing plant on the island. In 2012 it stopped the purchase of tobacco leaves from tobacco growers in Mauritius, bringing an abrupt end to domestic cultivation. Data compiled from the customs office indicate that the import of cigarettes is going down. However, the shadow of big tobacco is looming again in the Mauritian landscape. An undisclosed international tobacco company based in Dubai is seeking authorisation from the government to set up a tobacco manufacturing plant for products to be exported to other African countries. Although officially the company will be manufacturing cigarettes, information indicates that the company will also be producing chewing tobacco. According to the existing law in Mauritius, the company will be allowed to sell up to 50% of its production on the local market. The proposal has been strongly opposed by VISA, a Mauritian tobacco control NGO, on the basis that it violates the WHO FCTC as well as the United Nations Political Declaration of the High-Level Meeting of the General Assembly on the Prevention and Control of NonCommunicable Diseases. The proposed manufacturing plant will support the tobacco industry to increase consumption in Africa, leading to further tobacco-related suffering and deaths in a continent already faced with the double burden of communicable and non-communicable diseases. VISA and other organisations argue that Mauritius has a moral responsibility not to allow the tobacco industry to use its territory to manufacture a deadly product which will harm the populations of other African countries. According to the World Customs Organization, the free zones in the United Arab Emirates, including Dubai, are known sources of considerable counterfeit cigarette production which targets predominantly West African markets. There is concern that the Dubai-based tobacco manufacturing plant may use the free port of Mauritius to engage in illicit trade of tobacco products. Action led by VISA to dissuade the government of Mauritius from authorising the tobacco plant, including official protests to the prime minister and other key government ministers, and advocacy by international organisations such as the Framework Convention Alliance and African Tobacco Control Alliance appears to have fallen on deaf ears. The official response received from the Ministry of Agro-Industry is that the “cigarette is a legal product worldwide and smokers will purchase the product whether manufactured in Mauritius or in any other country”. This stance ignores the health, social, economic and environmental consequences of tobacco use and the normalising effect of welcoming a manufacturing plant, thereby signalling societal approval of its products. Mauritius is regarded as a model and leader in tobacco control by the WHO and other international bodies. Establishing a tobacco manufacturing plant risks tarnishing this image, as it indicates a lack of regional and global responsibility in the face of the harms caused by the tobacco epidemic. The issue is a reminder that the tobacco industry is always looking for opportunities to expand its commercial activities, even (and perhaps especially) in countries that have put in place strong tobacco control measures. The national and international response by non-government organisations and other agencies shows that civil society remains a major force to counteract the power and influence of the tobacco industry.

TobaccoTactics.org:A resource for industry monitoring

AUSTRALIA: HIGH COURT UPHOLDS PLAIN PACKAGING In response to Australia’s introduction of tobacco plain packaging laws in 2011, Japan Tobacco International and British American Tobacco brought legal action in the High Court of Australia, complaining that the legislation amounted to an acquisition of property on less than just terms under the Australian constitution. Philip Morris Ltd and Imperial Tobacco intervened in the case, and supported their fellow tobacco companies. The Australian government defended the constitutionality of the Act, with the solicitor-general for the Commonwealth Stephen Gageler arguing: “This legislation is no different in principle from any other specification of a product standard or an information standard for products or, indeed, services that are to become the subject of trade in the future”. The Australian government was supported by the governments of the Australian Capital Territory, the Northern Territory, and Queensland; and the Cancer Council of Australia. On 15 August 2012, the high court rejected the challenges by tobacco companies, and awarded costs against them. The orders noted: “At least a majority of the court is of the opinion that the act is not contrary to the Australian constitution”. The court will published its reasons on 5 October (link available on the Tobacco Control blog). The High Court of Australia is a well-respected superior court, with great expertise in intellectual property. The ruling will be an important and influential precedent throughout the world. The trade minister, Craig Emerson, stressed that the victory will strengthen Australia’s defence of the plain packaging of tobacco products in international forums. He emphasised that the Australian government would vigorously defend a challenge against it by Ukraine, Honduras, and the Dominican Republic through the World Trade Organization. Emerson maintained: “Australia will strongly defend its right to regulate to protect public health through the plain packaging of tobacco products”. MATTHEW RIMMER Australian National University Matthew.Rimmer@anu.edu.au