Commentary on Adams et al. (2010): Learning from history


Working with industries that promote addictions? When will we ever learn? In the early 1970s a senior figure in Imperial Tobacco took me to lunch to discuss ‘common ground’: he was the first of many. Shortly afterwards the chairman of Rothmans generously offered me the option of choosing another campaign on which we could both work together. (This may have been connected with tobacco industry AGMs at which I asked how many deaths the companies' products had caused in the previous year). While I never saw cooperation with tobacco companies as an option, I was naïve or optimistic enough to try that route with alcohol two decades ago, only to be disillusioned by an industry unwilling to give ground on anything that might adversely affect its interests. The final straw was when the most progressive drinks industry CEO brought me a carton of Duff beer, assuring me that the association with the Simpsons was purely accidental.

For three decades after we had overwhelming evidence about the dangers of smoking [1,2], scientists, governments, even some campaigners tried working with tobacco companies, despite increasing evidence that the industry was using them as part of a deliberate strategy. Millions of confidential tobacco industry documents available following the US Master Settlement Agreement demonstrate beyond doubt that while these evil companies talked the language of partnership and cooperation, they were knowingly doing everything possible to promote a lethal product to adults, children and vulnerable populations, to deny the evidence, to undermine the efforts of governments and health authorities, to buy the support of scientists, and to exploit and manipulate even well-intentioned researchers [3].

It is now widely accepted in the tobacco control community that there is no scope to work with the tobacco industry.

Why should alcohol and gambling be different, especially when all three industries have long been closely associated? Indeed, tobacco and alcohol companies have at times not only been under the same ownership, but have learned from each other, and have sung from the same songbook [4].

Even the possible benefits of collaboration identified by Adams et al.[5] are unconvincing. From standard drink labelling to protecting non-smokers the companies and their allies oppose the recommendations of health authorities, and seek (usually successfully) to achieve weaker alternatives. Far from providing ‘desirable outcomes for health’, tobacco industry youth education programs are known to be ineffective and possibly counter-productive [6,7]. The chimera of ‘improvements to the product’ has been used by tobacco companies for decades as a means of distraction, keeping people smoking, playing down the dangers and avoiding constraints.

While there are obvious differences, the objectives of the alcohol and gambling industry are, like tobacco, to maintain and increase sales of their products to anybody, anywhere. The alcohol industry has developed products and an extraordinary range of promotional activities that appeal to young people, while resisting any measures that might constrain its activities or sales. The gambling industry promotes increasingly in ways that will reach young and vulnerable audiences. Repeated professions of corporate social responsibility bring an irresistible reminder of Emerson's line: ‘the louder he talked of his honour, the faster we counted the spoons’[8].

All three industries want to develop partnerships and relationships because these provide access, influence and innocence by association. ‘Cooperation’ is code for voluntary self-regulation that does nothing to prevent them promoting their products exactly as they wish; for front organisations that carry their messages; for funding research that will not adversely affect their interests; for phoney ‘education’ activities; and for seeking maximum involvement in the policy process. Their public rationales have been refined to suit changing circumstances—thus in 2009 British American Tobacco seek ‘constructive’ involvement to help the Australian Government avoid policies that might have ‘unintended consequences’—but the desired outcome remains the same [9].

While governments know and understand this only too well, they are also often amenable to commercial pressures, siren songs and soft options. Action on tobacco has been all too slow, but after continuing pressure from health organisations over several decades, tobacco companies are widely recognised in developed countries as disease vectors with whom any contact should be avoided. Alcohol companies are at risk of heading in the same direction. A drinks industry CEO recently told me, ‘we hate being compared with tobacco companies’—but this is inevitable while the industry adopts near-identical strategies.

Adams et al.[5] rightly conclude that for addictive consumption industries the ‘non-association model’ is the only approach that meets the interests of public health. It is hard therefore to understand why they feel a need to propose a ‘managed association’ model, even for some time in the future. Offering the prospect of ‘joint activities’ at some stage implies some sort of magical transformation into responsible, cooperative industries. It just won't happen. The companies will continue to use every opportunity to exploit such a model while promoting their own aims. The history of tobacco again shows us—from the low-tar fraud [10] through ‘safer cigarettes’[10] to the industry's more recent interest in snus [11]—that only the most naïve observer could even conceive of industries such as this as being responsible partners.

Researchers should be aware of and recognise industry objectives and strategies, playing an exemplar role through avoiding any form of support for or association with tobacco and alcohol and gambling companies. They should press governments to act firmly and unilaterally rather than encourage a disingenuous dream of partnerships in which the industries somehow fail in their duty to their shareholders by working against their own interests.

There is much scope for researchers to focus further on the policies most strongly opposed by tobacco and alcohol interests: this is where, following what one might call the Cynicism Model of Public Health, action is likely to have most impact. Similarly, it needs only a modicum of pragmatism to work out why calls for cooperation with governments and health interests are always at the top of industry shopping lists. Those who argue for any form of partnerships or associations with alcohol, tobacco and gambling companies have learned nothing from the history of the past 60 years.

Declaration of interest