tag:theconversation.com,2011:/au/topics/tobacco-industry-32229/articlestobacco industry – The Conversation2024-03-01T03:45:31Ztag:theconversation.com,2011:article/2246212024-03-01T03:45:31Z2024-03-01T03:45:31ZCould messages from social media influencers stop young people vaping? A look at the government’s new campaign<figure><img src="https://images.theconversation.com/files/579070/original/file-20240301-18-gh27cc.jpg?ixlib=rb-1.1.0&rect=4%2C4%2C2991%2C1985&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-man-smoking-electronic-cigarette-looking-579690556">Alexandru Chiriac/Shutterstock</a></span></figcaption></figure><p>Vaping is on the rise among young Australians. Recent figures from the <a href="https://www.aihw.gov.au/reports/illicit-use-of-drugs/national-drug-strategy-household-survey/contents/tobacco-and-e-cigarettes-vapes">National Drug Strategy Household Survey</a> show current use of e‑cigarettes among teenagers aged 14–17 increased five-fold from 1.8% in 2019 to 9.7% in 2022–2023. For young adults aged 18–24, use quadrupled from 5.3% to 21% over the same time period. </p>
<p>If these young Australians were using e-cigarettes to quit smoking, perhaps we would have slightly less to worry about. But many young Australians using e-cigarettes do so recreationally and haven’t previously been exposed to nicotine. Although we’re still learning about how vaping will affect health in the long term, we know e-cigarettes <a href="https://onlinelibrary.wiley.com/doi/full/10.5694/mja2.51890">are harmful</a>.</p>
<p>Reforms <a href="https://theconversation.com/from-today-new-regulations-make-it-harder-to-access-vapes-heres-whats-changing-218816">introduced this year</a> by the federal government will be key to reducing rates of e-cigarette use among young Australians, while ensuring those who are genuinely using e-cigarettes to quit smoking have a pathway to do so. </p>
<p>It will take some time to see a reduction in e-cigarette use as a result of these reforms. We need to be patient, and give the laws time to work. Enforcement will be key. But if there’s anything we’ve learnt from decades of tobacco control, it’s that we need a comprehensive approach.</p>
<p>This is where the federal government’s <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/next-steps-of-vaping-reform-and-launch-of-influencer-led-youth-vaping-campaign?language=en">latest initiative</a> – a social media campaign targeting youth vaping – comes in.</p>
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<em>
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Read more:
<a href="https://theconversation.com/young-non-smokers-in-nz-are-taking-up-vaping-more-than-ever-before-here-are-5-reasons-why-185400">Young non-smokers in NZ are taking up vaping more than ever before. Here are 5 reasons why</a>
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<h2>From television to TikTok</h2>
<p>Many will be familiar with the anti-smoking TV ads that have aired over the past several decades. Who could forget the “<a href="https://www.cancer.nsw.gov.au/prevention-and-screening/preventing-cancer/campaigns/quit-smoking-campaigns/sponge">Sponge</a>” campaign featuring tar being squeezed out of a sponge into a jar to represent the tar in the lungs of those who smoke.</p>
<p>Or the <a href="https://www.cancer.nsw.gov.au/prevention-and-screening/preventing-cancer/campaigns/quit-smoking-campaigns/terrie-anti-smoking-campaign">hard-hitting testimonial</a> featuring a former smoker named Terrie diagnosed with oral and throat cancer, who had her larynx removed. </p>
<p>But times have changed. Tobacco smoking <a href="https://pp.aihw.gov.au/reports/smoking/tobacco-smoking-ndshs">continues to decline</a> and young Australians spend a lot of their time on social media. For better or worse, platforms such as Snapchat, TikTok, YouTube and Instagram have <a href="https://doi.org/10.1177/2056305119886025">become a source of information</a> for youth. </p>
<p>And so we need to be creative with our campaigns. We need to present information in a fresh way.</p>
<p>The government’s new <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/next-steps-of-vaping-reform-and-launch-of-influencer-led-youth-vaping-campaign?language=en">influencer-led youth vaping campaign</a> aims “to spark a conversation with the next generation of Australians about the harms of vaping and nicotine addiction”.</p>
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<p>This campaign will feature a range of influencers seeking to combat the large amount of pro-vaping content on social media platforms. These influencers – people like Ella Watkins (a writer and actor), Ellyse Perry (a cricketer), Zahlia and Shyla Short (surfers), the Fairbairn Brothers (comedians), and JackBuzza (a gamer) – span multiple areas to ensure young Australians with diverse interests are reached. Some have vaped in the past and subsequently quit. </p>
<p>The government hopes these influencers will engage young people using their own unique style and tone, and communicate authentically about the harms associated with e-cigarette use. </p>
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Read more:
<a href="https://theconversation.com/tiktok-promotes-vaping-as-a-fun-safe-and-socially-accepted-pastime-and-omits-the-harms-203423">TikTok promotes vaping as a fun, safe and socially accepted pastime – and omits the harms</a>
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<h2>The influence of influencers</h2>
<p>The campaign capitalises on what can be powerful <a href="https://www.verywellmind.com/what-is-a-parasocial-relationship-5210770">parasocial relationships</a>: one-sided relationships where a person becomes emotionally connected to a public figure such as a celebrity or influencer. Social media influencers are in our children’s bedrooms, bathrooms, and classrooms. Why not use them to promote healthy attitudes and behaviours?</p>
<p>Emerging <a href="https://journals.sagepub.com/doi/full/10.1177/2056305120912475">research</a> suggests the use of social media influencers in anti-vaping campaigns could be a promising strategy for improving the reach of public health messaging and engagement with the target audience. </p>
<p>In the context of vaccination, the use of social influencers in a campaign promoting the flu vaccine in the United States led to <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0240828">significant increases</a> in positive beliefs about the vaccine and marked decreases in negative attitudes toward it.</p>
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<img alt="A young woman vaping indoors." src="https://images.theconversation.com/files/579073/original/file-20240301-28-wxfoog.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/579073/original/file-20240301-28-wxfoog.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/579073/original/file-20240301-28-wxfoog.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/579073/original/file-20240301-28-wxfoog.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/579073/original/file-20240301-28-wxfoog.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/579073/original/file-20240301-28-wxfoog.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/579073/original/file-20240301-28-wxfoog.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Data shows vaping is on the rise among young Australians.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/portrait-cute-young-vaping-girl-vapor-1024757749">Lifestyle and Wedding ph/Shutterstock</a></span>
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<h2>Will this campaign be effective?</h2>
<p>The use of social influencers to promote a healthy lifestyle is still a relatively new frontier in health communication, and whether this campaign will be effective is a tricky question to answer. </p>
<p>There are several <a href="https://www.tandfonline.com/doi/full/10.1080/17538068.2023.2249714">benefits to this approach</a>, such as leveraging the relationships influencers have built with their audience, enhanced authenticity, and meaningful communication of health information. </p>
<p>It also provides an opportunity to shift social norms. In the context of tobacco and vaping control specifically, public health has far fewer resources compared to the tobacco and vaping industries. The strategic use of social influencers can help organisations involved in health promotion to <a href="https://journals.sagepub.com/doi/full/10.1177/2056305120912475">overcome this commercial imbalance</a>.</p>
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<p>
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<strong>
Read more:
<a href="https://theconversation.com/how-can-i-help-my-teen-quit-vaping-201558">How can I help my teen quit vaping?</a>
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</em>
</p>
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<p>But there could also be risks associated with this campaign, such as the lack of control over the content an influencer may choose to share, and their actions and opinions on other topics, which may affect their credibility. Vetting influencers and implementing <a href="https://www.fda.gov/media/165158/download">risk mitigation plans</a> will be crucial steps for the government to take. </p>
<p>Specific details of the campaign are yet to be released, so we don’t know exactly how the influencers will be engaged to combat increasing rates of e-cigarette use among youth. But we will be closely watching this innovative approach.</p><img src="https://counter.theconversation.com/content/224621/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michelle Jongenelis currently receives funding from the National Health and Medical Research Council and the WA Health Promotion Foundation (Healthway). She is affiliated with the Australian Council on Smoking and Health and the World Federation of Public Health Associations' Tobacco Control Working Group.
Michelle has never received services, assistance, or support (whether monetary or non-monetary in nature) from the tobacco industry and/or e-cigarette industry. Michelle has never provided services, assistance, or support (whether monetary or non-monetary in nature) to the tobacco and/or e-cigarette industry.
</span></em></p>Times have changed. While in decades past we watched anti-smoking campaigns on TV, we now need anti-vaping messages on TikTok.Michelle Jongenelis, Associate Professor, Melbourne Centre for Behaviour Change, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2168352023-11-12T19:14:24Z2023-11-12T19:14:24ZWho’s lobbying whom? When it comes to alcohol, tobacco, food and gambling firms, we’re in the dark<figure><img src="https://images.theconversation.com/files/558269/original/file-20231108-23-hhpw6i.jpg?ixlib=rb-1.1.0&rect=0%2C7%2C1000%2C658&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/business-people-shaking-hands-finishing-meeting-420967090">Shutterstock</a></span></figcaption></figure><p>Alcohol, tobacco, food and gambling industries are among those that lobby government ministers and their advisors to help shape public policy.</p>
<p>But when we looked for details of who’s lobbying whom in Australia, we found government lobbyist registers largely left us in the dark.</p>
<p>In our recently <a href="https://academic.oup.com/heapro/article/38/5/daad134/7326506">published research</a>, we found these registers were time-consuming to navigate and not detailed enough. The registers couldn’t give us a comprehensive picture of who’s lobbying whom, and how often. Most registers weren’t set up to do so.</p>
<p>We’re concerned about this lack of transparency and the potential for business interests to have undue influence over health policies. This has the potential to <a href="https://transparency.org.au/wp-content/uploads/2020/11/NIS_FULL_REPORT_Web.pdf">diminish trust in government</a>, a risk to democracy.</p>
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Read more:
<a href="https://theconversation.com/its-not-just-tax-how-pwc-kpmg-and-other-consultants-risk-influencing-public-health-too-209687">It's not just tax. How PwC, KPMG and other consultants risk influencing public health too</a>
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<h2>Why are we concerned about lobbying?</h2>
<p>In Australia, anyone can lobby governments and has a right to represent their views. It’s an important part of the democratic process. Yet not everyone has fair access to decision makers. </p>
<p>Some <a href="https://theconversation.com/paying-the-piper-and-calling-the-tune-following-clubsnsws-political-donations-60639">individuals and businesses</a> have outsized and <a href="https://theconversation.com/influence-in-australian-politics-needs-an-urgent-overhaul-heres-how-to-do-it-103535">undue influence</a> on government decision making. Lobbying is one form of such influence.</p>
<p>For instance, in the past ten years or so, the <a href="https://movendi.ngo/news/2021/12/06/australia-alcohol-lobby-pushes-to-weaken-public-health-again/">alcohol industry</a> has lobbied to <a href="https://academic.oup.com/heapro/article/38/3/daac022/6573372">delay implementation</a> of pregnancy warning labels.</p>
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<p>The gambling industry, which has funnelled <a href="https://www.abc.net.au/news/2021-10-14/how-the-gambling-industry-cashed-in-on-political-donations/100509026">millions of dollars</a> into both major political parties, has <a href="https://www.theguardian.com/australia-news/2023/sep/24/gambling-companies-accused-of-using-big-tobaccos-tactics-in-push-for-weaker-regulations">lobbied to weaken gambling regulations</a>.</p>
<p>The <a href="https://theconversation.com/when-even-winning-is-losing-the-surprising-cost-of-defeating-philip-morris-over-plain-packaging-114279">tobacco industry</a> sued the Australian government for its plain packaging laws, <a href="https://tobaccotactics.org/article/alliance-of-australian-retailers/">after concerted lobbying</a> had failed to derail plans to introduce them. While the lawsuit was unsuccessful, this has <a href="https://theconversation.com/big-tobaccos-decisive-defeat-on-plain-packaging-laws-wont-stop-its-war-against-public-health-140439">deterred</a> other governments from implementing similar laws. </p>
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<em>
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Read more:
<a href="https://theconversation.com/why-businesses-want-the-ear-of-government-and-are-willing-to-pay-for-it-90688">Why businesses want the ear of government and are willing to pay for it</a>
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</p>
<hr>
<h2>A deep dive into lobbyist registers</h2>
<p>Understanding who is seeing which government ministers or their advisors and what they are meeting about is the first step towards protecting against undue political influence and fostering political integrity.</p>
<p>So we decided to look at lobbyist registers to see what they tell us. These registers are like <a href="https://lobbyists.ag.gov.au/register">digital phone books</a>, with information about lobbyists. The aim of these registers is to guard against undue or unethical political influence. </p>
<p>Last year, we systematically extracted information from all lobbyist registers in Australia. All jurisdictions, except for the Northern Territory, have one. We: </p>
<ul>
<li><p>compared the disclosure requirements of Australian with international registers</p></li>
<li><p>mapped the population of lobby firms, lobbyists and clients that were active in each jurisdiction</p></li>
<li><p>identified which lobby firms represented tobacco, alcohol, gambling and ultra-processed food organisations.</p></li>
</ul>
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<h2>Here’s what we found</h2>
<p>Compared to international lobbying registers, Australian registers provided little information. In the United States, for instance, companies must disclose <a href="https://www.opensecrets.org/federal-lobbying">how much money</a> they spend on lobbying.</p>
<p>Only four jurisdictions (federal, Australian Capital Territory, Victoria and Queensland) provided information about whether a lobbyist had previously worked in government. We need to know this to gauge whether there are any conflicts of interest.</p>
<p>Of the registers that provided this information, few provided enough detail to identify the specific position or the exact date a lobbyist left government. Of particular concern, 96 lobbyists said they both <em>had</em> and <em>had not</em> worked in government, raising questions about oversight of these registers.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/politicians-who-become-lobbyists-can-be-bad-for-australians-health-124078">Politicians who become lobbyists can be bad for Australians' health</a>
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</p>
<hr>
<h2>Which industry hired the most lobby firms?</h2>
<p>Of the four industries we explored, gambling organisations hired the most lobby firms, followed by food, alcohol and tobacco. </p>
<p>Tobacco companies hired lobby firms in six jurisdictions, potentially contravening Article 5.3 of the World Health Organization Framework Convention on Tobacco Control, which <a href="https://www.tobaccoinaustralia.org.au/chapter-19-ftct/19-3-who-fctc-guiding-principles-and-general-obligations-">warns against</a> the tobacco industry lobbying governments.</p>
<p>Most registers are a directory of lobbyists rather than their activities. So, as most registers did not require disclosure of lobbying activities, it is unclear what service the firms provided for the tobacco industry.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/we-worked-out-how-many-tobacco-lobbyists-end-up-in-government-and-vice-versa-its-a-lot-205382">We worked out how many tobacco lobbyists end up in government, and vice versa. It's a lot</a>
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<h2>What’s missing?</h2>
<p>Registers only provide information about “<a href="https://www.ag.gov.au/integrity/australian-government-register-lobbyists">third party</a>” lobbyists that work for professional lobby firms. This excludes many lobbyists working in Australia, such as those working directly for tobacco or alcohol companies or industry associations. In practice, this means a great deal of lobbying is hidden from the public.</p>
<p>Except for Queensland, registers did not provide a record of lobbyist meetings or contact with government officials. This information is important to understand who meets whom, and why. </p>
<p>The lobbyist registers hold no information about how much money is spent on, or received for, lobbying activities. </p>
<p>Lastly, we cannot see which individual lobbyists worked for which client. For firms that represent organisations with different interests, this raises questions about potential conflicts of interest.</p>
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<h2>Greater transparency and oversight needed</h2>
<p>In the past year, Australia has created the <a href="https://www.nacc.gov.au">National Anti-Corruption Commission</a> and <a href="https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Political_Influence_of_Donations/PoliticalDonations/Report_1">recommendations</a> about reforming political donations. Lobbying reform is the next logical step to ensure an integrated and coherent approach to political integrity. </p>
<p>The Australian government, like others, has a <a href="https://www.ag.gov.au/integrity/publications/lobbying-code-conduct">lobbying code of conduct</a> with rules about ethical behaviour. It also stipulates that former members of government are not allowed to work as lobbyists for a “cooling off period” of 12 or 18 months (depending on where someone worked in government).</p>
<p>However, in the lobbying code, “lobbyist” is only understood as those working for third-party firms (such as the ones we analysed). It places no restrictions on ministers or government officials taking jobs with companies they used to regulate, or the consulting sector. Expanding the definition to include all forms of lobbying would help close this loophole. </p>
<p>We also need better enforcement of the rules around lobbying with sanctions and fines imposed to improve compliance.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-revolving-door-why-politicians-become-lobbyists-and-lobbyists-become-politicians-64237">The revolving door: why politicians become lobbyists, and lobbyists become politicians</a>
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<img src="https://counter.theconversation.com/content/216835/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jennifer Lacy-Nichols receives funding from the Victorian Health Promotion Foundation. She is a member of the People's Health Movement, Healthy Food Systems Australia and the expert advisory group on commercial determinants of health for the World Health Organization. The findings of the research reported in this article, and the views expressed, are hers alone and not necessarily those of the above organisations.</span></em></p><p class="fine-print"><em><span>Katherine Cullerton receives funding from the NHMRC and the Children's Health Foundation. She is on the executive of the Food and Nutrition Special Interest Group for the Public Health Association of Australia. </span></em></p>We found lobbying registers were hard to navigate and not detailed enough.Jennifer Lacy-Nichols, Research fellow, The University of MelbourneKatherine Cullerton, Research Fellow, Food and Nutrition Policy, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2166982023-11-03T13:01:00Z2023-11-03T13:01:00ZWhen science showed in the 1970s that gas stoves produced harmful indoor air pollution, the industry reached for tobacco’s PR playbook<figure><img src="https://images.theconversation.com/files/556930/original/file-20231031-23-i7kn8d.jpg?ixlib=rb-1.1.0&rect=29%2C7%2C4855%2C3763&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Gas stoves without adequate ventilation can produce harmful concentrations of nitrogen dioxide.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/photo-illustration-of-a-gas-stove-burner-in-a-kitchen-on-news-photo/1346128905">Sjoerd van der Wal/Getty Images</a></span></figcaption></figure><p>In 1976, beloved chef, cookbook author and television personality Julia Child returned to WGBH-TV’s studios in Boston for <a href="https://juliachildfoundation.org/timeline/#">a new cooking show, “Julia Child & Company</a>,” following her hit series “The French Chef.” Viewers probably didn’t know that Child’s new and improved kitchen studio, outfitted with gas stoves, was <a href="https://drive.google.com/file/d/1asSgPpVbTEwC5DzzUglnxxnvnr17Qsn7/view?usp=sharing">paid for by the American Gas Association</a>.</p>
<p>While this may seem like any corporate sponsorship, we now know it was a part of a calculated campaign by gas industry executives to <a href="https://s3.documentcloud.org/documents/23812229/aga-monthly-196901.pdf">increase use of gas stoves across the United States</a>. And stoves weren’t the only objective. The gas industry wanted to grow its residential market, and homes that used gas for cooking were likely also to use it for <a href="https://theconversation.com/why-gas-stoves-matter-to-the-climate-and-the-gas-industry-keeping-them-means-homes-will-use-gas-for-heating-too-197866">heat and hot water</a>.</p>
<p>The industry’s efforts went well beyond careful product placement, according to <a href="https://climateinvestigations.org/report-gas-industry-campaign-to-manufacture-controversy-health-risks-of-gas-stove-emissions/">new research</a> from <a href="https://climateinvestigations.org/who_we_are/">the nonprofit Climate Investigations Center</a>, which analyzes corporate efforts to undermine climate science and slow the ongoing transition away from fossil fuels. As the center’s study and <a href="https://www.npr.org/2023/10/17/1183551603/gas-stove-utility-tobacco">a National Public Radio investigation</a> show, when evidence emerged in the early 1970s about the health effects of indoor nitrogen dioxide exposure from gas stove use, the American Gas Association launched a campaign designed to manufacture doubt about the existing science. </p>
<p>As a researcher who has <a href="https://scholar.google.com/citations?user=iR82G3IAAAAJ&hl=en">studied air pollution for many years</a> – including gas stoves’ contribution to indoor air pollution and health effects – I am not naïve about the strategies that some industries use to <a href="https://global.oup.com/academic/product/doubt-is-their-product-9780195300673?cc=us&lang=en&">avoid or delay regulations</a>. But I was surprised to learn that the multipronged strategy related to gas stoves directly mirrored tactics that the tobacco industry used to <a href="https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2011.300292">undermine and distort scientific evidence</a> of health risks associated with smoking starting in the 1950s. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/LgnIR18Te5Y?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">The gas industry is defending natural gas stoves, which are under fire for their health effects and their contribution to climate change.</span></figcaption>
</figure>
<h2>Manufacturing controversy</h2>
<p>The gas industry relied on Hill & Knowlton, the same public relations company that <a href="https://www.latimes.com/archives/la-xpm-1994-09-18-tm-40179-story.html">masterminded the tobacco industry’s playbook</a>
for responding to research linking smoking to lung cancer. Hill & Knowlton’s <a href="https://climateinvestigations.org/report-gas-industry-campaign-to-manufacture-controversy-health-risks-of-gas-stove-emissions/">tactics included</a> sponsoring research that would counter findings about gas stoves published in the scientific literature, emphasizing uncertainty in these findings to construct artificial controversy and engaging in aggressive public relations efforts.</p>
<p>For example, the gas industry obtained and reanalyzed the data from <a href="https://s3.documentcloud.org/documents/23684646/air-pollution-abstracts-vol-6-issues-5-8.pdf">an EPA study on Long Island</a> that showed more respiratory problems in homes with gas stoves. <a href="https://s3.documentcloud.org/documents/23785753/mitchell-et-al-1974-survey-of-the-incidence-of-respiratory-disease-in-households-using-gas-and-electric-cookery-session-v-paper-4.pdf">Their reanalysis</a> concluded that there were no significant differences in respiratory outcomes. </p>
<p>The industry also funded its own health studies in the early 1970s, which confirmed large differences in nitrogen dioxide exposures but did not show significant differences in respiratory outcomes. These findings were documented <a href="https://doi.org/10.1016/0013-9351(79)90074-4">in publications where industry funding was not disclosed</a>. These conclusions were amplified in numerous meetings and conferences and ultimately influenced major governmental reports summarizing the state of the literature. </p>
<p>This campaign was remarkable, since the basics of how gas stoves affected indoor air pollution and respiratory health were straightforward and well established at the time. Burning fuel, including natural gas, generates nitrogen oxides: The air in Earth’s atmosphere is <a href="https://education.nationalgeographic.org/resource/atmosphere/">about 78% nitrogen and 21% oxygen</a>, and these gases react at high temperatures. </p>
<p>Nitrogen dioxide is known to <a href="https://www.epa.gov/no2-pollution/basic-information-about-no2">adversely affect respiratory health</a>. Inhaling it causes respiratory irritation and can worsen diseases such as asthma. This is a key reason why the U.S. Environmental Protection Agency established an outdoor air quality <a href="https://www.epa.gov/sites/default/files/2020-07/documents/fr-1971-04-30-co_phchemoxids_hcs_no2finaldecision_0.pdf">standard for nitrogen dioxide in 1971</a>. </p>
<p>No such standards exist for indoor air, but as the EPA now acknowledges, <a href="https://www.epa.gov/indoor-air-quality-iaq/nitrogen-dioxides-impact-indoor-air-quality">nitrogen dioxide exposure indoors also is harmful</a>. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/556944/original/file-20231031-27-khx5m4.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Infographic about nitrogen dioxide as an asthma trigger" src="https://images.theconversation.com/files/556944/original/file-20231031-27-khx5m4.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/556944/original/file-20231031-27-khx5m4.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=305&fit=crop&dpr=1 600w, https://images.theconversation.com/files/556944/original/file-20231031-27-khx5m4.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=305&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/556944/original/file-20231031-27-khx5m4.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=305&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/556944/original/file-20231031-27-khx5m4.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=384&fit=crop&dpr=1 754w, https://images.theconversation.com/files/556944/original/file-20231031-27-khx5m4.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=384&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/556944/original/file-20231031-27-khx5m4.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=384&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">More than 27 million people in the U.S. have asthma, including about 4.5 million children under age 18. Non-Hispanic Black children are two times more likely to have asthma compared with non-Hispanic white children.</span>
<span class="attribution"><a class="source" href="https://www.epa.gov/asthma/asthma-awareness-month">EPA</a></span>
</figcaption>
</figure>
<h2>How harmful is indoor exposure?</h2>
<p>The key question is whether nitrogen dioxide exposure related to gas stoves is large enough to lead to health concerns. While levels vary across homes, scientific research shows that the simple answer is yes – especially in smaller homes and when ventilation is inadequate. </p>
<p>This has been known for a long time. For example, <a href="https://doi.org/10.1080/10473289.1998.10463704">a 1998 study that I co-authored</a> showed that the presence of gas stoves was the strongest predictor of personal exposure to nitrogen dioxide. And work dating back to the 1970s showed that indoor nitrogen dioxide levels in the presence of gas stoves <a href="https://doi.org/10.1021/es60158a013">could be far higher than outdoor levels</a>. Depending on ventilation levels, concentrations could reach <a href="https://doi.org/10.1289/ehp.1306673">levels known to contribute to health risks</a>. </p>
<p>Despite this evidence, the gas industry’s campaign was largely successful. Industry-funded studies successfully muddied the waters, as I have seen over the course of my research career, and stalled further federal investigations or regulations addressing gas stove safety. </p>
<p>This issue took on new life at the end of 2022, when researchers published a new study estimating that 12.7% of U.S. cases of childhood asthma – about one case in eight – <a href="https://doi.org/10.3390/ijerph20010075">were attributable to gas stoves</a>. The industry continues to <a href="https://www.nytimes.com/2023/01/29/climate/gas-stove-health.html">cast doubt on gas stoves’ contribution to health effects</a> and <a href="https://www.motherjones.com/environment/2020/06/gas-industry-influencers-stoves/">fund pro-gas stove media campaigns</a>.</p>
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<h2>A concern for climate and health</h2>
<p>Residential gas use is also controversial today because it slows the ongoing shift toward renewable energy, at a time when the impacts of climate change are <a href="https://theconversation.com/climate-damage-is-worsening-faster-than-expected-but-theres-still-reason-for-optimism-4-essential-reads-on-the-ipcc-report-202116">becoming alarmingly clear</a>. Some cities have already moved or are considering steps to <a href="https://www.boston.com/real-estate/real-estate-news/2023/07/25/mass-bill-would-ban-gas-stoves-new-construction/">ban gas stoves in new construction</a> and <a href="https://chicago.suntimes.com/2023/10/3/23896185/electrification-chicago-new-buildings-gas-stoves-heat-transition-ordinance-hall-knudsen-op-ed">shift toward electrifying buildings</a>. </p>
<p>As communities wrestle with these questions, regulators, politicians and consumers need accurate information about the risks of gas stoves and other products in homes. There is room for vigorous debate that considers a range of evidence, but I believe that everyone has a right to know where that evidence comes from. </p>
<p>The commercial interests of many industries, including alcohol, tobacco and fossil fuels, <a href="https://doi.org/10.1016/S2214-109X(16)30217-0">aren’t always compatible with the public interest or human health</a>. In my view, exposing the tactics that vested interests use to manipulate the public can make consumers and regulators savvier and <a href="https://applications.emro.who.int/docs/FS-TFI-198-2019-EN.pdf?ua=1">help deter other industries from using their playbook</a>.</p><img src="https://counter.theconversation.com/content/216698/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jonathan Levy has received funding from the National Institutes of Health, the U.S. Environmental Protection Agency, the U.S. Department of Housing and Urban Development, and the Health Effects Institute for studies on the contribution of outdoor and indoor sources to air pollution levels in homes.</span></em></p>The natural gas industry has spent years trying to undermine scientific findings about gas stoves and health. If this sounds familiar, that’s no accident.Jonathan Levy, Professor and Chair, Department of Environmental Health, Boston UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1935292022-11-08T18:03:33Z2022-11-08T18:03:33ZForget tobacco industry arguments about choice. Here’s what young people think about NZ’s smokefree generation policy<figure><img src="https://images.theconversation.com/files/493964/original/file-20221107-3609-3b8npk.jpg?ixlib=rb-1.1.0&rect=110%2C330%2C7238%2C4517&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Getty Images</span></span></figcaption></figure><p>Aotearoa New Zealand’s <a href="https://legislation.govt.nz/bill/government/2022/0143/latest/LMS708154.html">bold plan</a> to introduce a <a href="https://pubmed.ncbi.nlm.nih.gov/23591500/">smokefree generation</a> by <a href="https://www.parliament.nz/en/pb/bills-and-laws/bills-proposed-laws/document/BILL_125245/smokefree-environments-and-regulated-products-smoked-tobacco">prohibiting the sale of smoked tobacco products</a> to anyone born after January 1 2009, has attracted <a href="https://tobaccocontrol.bmj.com/content/tobaccocontrol/30/4/361.full.pdf">international acclaim</a>. </p>
<p>However, tobacco companies, rehearsing their well-worn arguments, have claimed this measure will <a href="https://www.health.govt.nz/publication/proposals-smokefree-aotearoa-2025-action-plan">deprive young people of important freedoms</a>. Having spent decades refining tobacco products to enhance their addictiveness, these companies appear to believe that protecting young people from addiction would deprive them of personal autonomy.</p>
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<p>While it is predictable that health researchers would <a href="https://tobaccocontrol.bmj.com/content/27/3/278?casa_token=0t1OtNdOOx4AAAAA:nDh-5cECiLGTSeTlWLyTPDa3a1bFMCsn8jb68XisciLVLkah3BYh-ut4kpbtXzWPF7VTDmF8TLkn">support effective</a> measures and tobacco companies would oppose them, we know much less about how young people, those targeted by the policy, view these measures. </p>
<p>We <a href="https://tobaccocontrol.bmj.com/content/tobaccocontrol/early/2022/10/25/tc-2022-057658.full.pdf">explored this question</a> through in-depth interviews with 20 young people aged 17 or 18, and probed in detail how they viewed the smokefree generation policy. </p>
<p>Five of our participants reported currently smoking, one had formerly smoked and 14 did not smoke. Most supported the policy and believed introducing a smokefree generation would protect their freedoms. </p>
<p>Several had seen addiction within their whānau (extended family) and knew the <a href="https://journal.nzma.org.nz/journal-articles/ethnic-inequities-in-life-expectancy-attributable-to-smoking">health inequities smoking causes</a>. Some struggled with addiction personally and thought the smokefree generation policy would address and protect young people’s right to healthy futures.</p>
<hr>
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Read more:
<a href="https://theconversation.com/new-zealand-is-introducing-law-to-create-a-smokefree-generation-here-are-6-reasons-to-support-this-policy-186283">New Zealand is introducing law to create a smokefree generation. Here are 6 reasons to support this policy</a>
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<p>Their life experiences led these participants to favour longer-term outcomes and societal wellbeing over choices they viewed as illusory. They felt protecting young people from smoking uptake and addiction was crucial, and saw a society that protected young people from these pressures as more important than the so-called freedom to choose.</p>
<h2>The right to protection trumps absolute freedom</h2>
<p>Participants who supported the smokefree generation policy held a nuanced view of freedom and did not see it as absolute; instead, they recognised regulation could enhance positive freedoms and well-being.</p>
<p>They rejected the <a href="https://pubmed.ncbi.nlm.nih.gov/27292838/">negative view of freedom</a> tobacco companies propose, which presents regulation as limiting or removing choices. Many outlined a positive view of freedom that prioritised protection from addiction and the negative health consequences that follow, and endorsed the smokefree generation policy.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/smoke-and-mirrors-why-claims-that-nzs-smokefree-policy-could-fuel-an-illicit-tobacco-trade-dont-stack-up-191753">Smoke and mirrors: why claims that NZ’s smokefree policy could fuel an illicit tobacco trade don’t stack up</a>
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<p>For these participants, it followed that the government had a responsibility to protect them, including limiting access to harmful products. As one young woman observed: </p>
<blockquote>
<p>The government essentially is supposed to keep you safe, and they’re not supposed to […] make things readily available that are gonna actively harm you.</p>
</blockquote>
<h2>Addiction not a choice</h2>
<p>Participants did not see smoking as an “<a href="https://pubmed.ncbi.nlm.nih.gov/25192770/">informed choice</a>” they were entitled to make. Most young people who reported smoking supported the smokefree generation policy because it might have protected them from losing the freedoms addiction had taken from them.</p>
<p>One participant presented the options bluntly: </p>
<blockquote>
<p>Whether it’s the government taking the choice or you being addicted to smokes, you’ve got no choice either way. If you’re addicted to smoking it’s not like you are choosing to go buy smokes. You’re going, ‘Oh, I needed a packet of smokes this week’.</p>
</blockquote>
<p>A small minority did not support the smokefree generation measure, either because they felt less restrictive measures could prevent smoking uptake (such as raising age restrictions) or because they disagreed philosophically and believed people should not “be protected from yourself”. </p>
<p>In contrast to the societal perspective that supporters of the policy had adopted, these participants took an individualistic approach and felt people could and should make informed personal choices.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/new-zealands-tobacco-endgame-law-will-be-a-world-first-for-health-heres-what-the-modelling-shows-us-187075">New Zealand’s ‘tobacco endgame’ law will be a world first for health – here’s what the modelling shows us</a>
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<h2>Industry rhetoric</h2>
<p>Most young people we interviewed did not share the tobacco companies’ view that the policy will reduce their autonomy or limit their freedoms. Their deep reflections suggest a sharp divide between industry “<a href="https://www.pmi.com/our-transformation">transformation</a>” rhetoric and young people’s values.</p>
<p>Our findings add to earlier <a href="https://itcproject.s3.amazonaws.com/uploads/documents/ITC_Data_Briefing_SF2025__ASAP_support__final.pdf">research</a> documenting wide support for the smokefree generation policy. Such evidence indicates its acceptance and likely effectiveness. </p>
<p>Introducing a smokefree generation policy will promote freedom from lifelong addiction and the harms smoking causes, and safeguard the wellbeing of future generations.</p><img src="https://counter.theconversation.com/content/193529/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Janet Hoek is a co-director of ASPIRE 2025, a University of Otago Research Centre whose members undertake research to inform the Government's Smokefree 2025 goal. She has received or currently receives funding from the Royal Society Marsden Fund, the Health Research Council of New Zealand and the Cancer Society of New Zealand.</span></em></p><p class="fine-print"><em><span>Richard Edwards receives funding from various Government- and NGO-funded research funders such as the Health Research Council of New Zealand, National Institute for Health (USA) and the Cancer Society of New Zealand. He is a member of several expert advisory groups including for Hāpai te hauora - Māori Public Health, The New Zealand Cancer Society, Health Coalition Aotearoa and the Public Health Communication Centre.</span></em></p><p class="fine-print"><em><span>Elizabeth Fenton, Jude Ball, and Lani Teddy do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Whether or not they smoke, most young people don’t share the tobacco companies’ view that New Zealand’s new smokefree measures will reduce their autonomy or limit their freedoms.Janet Hoek, Professor of Public Health, University of OtagoElizabeth Fenton, Lecturer in Bioethics, University of OtagoJude Ball, Research Fellow in Public Health, University of OtagoLani Teddy, Research Fellow, University of OtagoRichard Edwards, Professor of Public Health, University of OtagoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1917532022-10-18T23:59:43Z2022-10-18T23:59:43ZSmoke and mirrors: why claims that NZ’s smokefree policy could fuel an illicit tobacco trade don’t stack up<figure><img src="https://images.theconversation.com/files/490213/original/file-20221017-15431-y4hu8g.jpg?ixlib=rb-1.1.0&rect=0%2C234%2C6016%2C3773&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock/ Nopphon</span></span></figcaption></figure><p>The New Zealand parliament is currently considering a <a href="https://www.parliament.nz/en/pb/bills-and-laws/bills-proposed-laws/document/BILL_125245/smokefree-environments-and-regulated-products-smoked-tobacco">new smokefree law</a> to implement key components of the <a href="https://www.health.govt.nz/publication/proposals-smokefree-aotearoa-2025-action-plan">Smokefree Aotearoa 2025 Action Plan</a>. </p>
<p>This plan includes the removal of nicotine from tobacco and a reduction of the number of tobacco retail outlets to ensure a smokefree generation. </p>
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<p>Some submissions to the select committee considering the legislation, notably from the tobacco industry, oppose key measures, claiming they would fuel illicit trade in tobacco. </p>
<p>However, findings from our <a href="https://pubmed.ncbi.nlm.nih.gov/36028304/">recently published study</a> suggest the level of tobacco smuggling in New Zealand is relatively low. It remained so even after a steep rise in the tobacco excise tax and the introduction of plain packs – both measures the tobacco industry also claimed would increase illicit trade.</p>
<p>For the study, we collected littered tobacco packaging around New Zealand between May 2021 and April 2022. Usually these studies risk over-estimating tobacco smuggling as it is difficult to distinguish whether foreign packs are illicit or brought in legally by visitors. </p>
<p>But we were able to conduct a “natural experiment” during a period when littered foreign packs were very likely to be smuggled because no international tourists and relatively few New Zealand travellers arrived while COVID border restrictions were in place.</p>
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Read more:
<a href="https://theconversation.com/new-zealand-is-introducing-law-to-create-a-smokefree-generation-here-are-6-reasons-to-support-this-policy-186283">New Zealand is introducing law to create a smokefree generation. Here are 6 reasons to support this policy</a>
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<p>Of 1,590 littered packs and pouches, 36 were foreign (2.3%). Most foreign packs were from China (1.6% of all packs) and South Korea (0.6%), and were found mainly in Auckland and Wellington. When adjusted by population distribution, the estimated national prevalence of foreign packs was 5.4%. </p>
<p>There may also be some use and trade in homegrown tobacco but we suspect this is likely to be modest given its typically rough and unpalatable nature (due to the lack of processing and lack of additives). </p>
<h2>Little change over time</h2>
<p>The observed level of foreign packs was similar to earlier pack collection studies in New Zealand: <a href="https://tobaccocontrol.bmj.com/content/18/5/416.long">3.2% in 2008/2009</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/24317006/">5.8% in 2012/2013</a>. </p>
<p>This suggests the size of the illicit market in Aotearoa changed little over a period when tobacco excise tax increased very substantially and plain packaging was introduced. </p>
<figure class="align-center ">
<img alt="A plain cigarette pack with a warning about the harms of smoking" src="https://images.theconversation.com/files/490215/original/file-20221017-19-q8r4vc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/490215/original/file-20221017-19-q8r4vc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=366&fit=crop&dpr=1 600w, https://images.theconversation.com/files/490215/original/file-20221017-19-q8r4vc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=366&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/490215/original/file-20221017-19-q8r4vc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=366&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/490215/original/file-20221017-19-q8r4vc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=460&fit=crop&dpr=1 754w, https://images.theconversation.com/files/490215/original/file-20221017-19-q8r4vc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=460&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/490215/original/file-20221017-19-q8r4vc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=460&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The tobacco industry also claimed the introduction of plain packaging would increase illicit trade, but it remained low.</span>
<span class="attribution"><span class="source">Shutterstock/Denis Junker</span></span>
</figcaption>
</figure>
<p>The New Zealand findings also contrast with a 2010 <a href="https://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2010.03018.x">global estimate</a> for illicit trade in high-income countries of 9.8%. They are also much lower than <a href="https://www.scoop.co.nz/stories/BU2206/S00326/homegrown-and-imported-roll-your-owns-now-part-of-nzs-growing-tobacco-black-market.htm">claims by the tobacco industry</a>. </p>
<h2>Will denicotinisation make a difference?</h2>
<p>Greatly <a href="https://blogs.otago.ac.nz/pubhealthexpert/removing-the-nicotine-from-tobacco-the-key-component-of-the-current-smokefree-bill/">reduced nicotine levels</a> are a key measure in the proposed smokefree legislation to make cigarettes and other tobacco products non-addictive. This should markedly reduce smoking uptake and encourage quitting or reduced consumption, as people who smoke find these cigarettes and tobacco less satisfying. </p>
<p>The law could temporarily increase illicit tobacco use among some people who don’t quit smoking. However, people who smoke are more likely to switch to vaping (widely and legally available in New Zealand) than turn to the illicit market. </p>
<p>Even if the price of illicit tobacco is only half the current legal price, vaping would still typically be a much cheaper way to obtain daily nicotine.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/young-non-smokers-in-nz-are-taking-up-vaping-more-than-ever-before-here-are-5-reasons-why-185400">Young non-smokers in NZ are taking up vaping more than ever before. Here are 5 reasons why</a>
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<p>The evidence from <a href="https://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2012.03906.x">randomised trials</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/35728131/">modelling</a> <a href="https://www.medrxiv.org/content/10.1101/2022.07.17.22277571v1">studies</a> for New Zealand suggests denicotinisation will substantially and equitably reduce smoking prevalence. </p>
<p>Combined with other measures in the <a href="https://www.health.govt.nz/publication/proposals-smokefree-aotearoa-2025-action-plan">Smokefree Action Plan</a>, it should result in a greatly reduced demand for tobacco products, shrinking both the legal and illicit markets. </p>
<h2>Tobacco smuggling in context</h2>
<p>It is worth considering how society and governments respond to other illicit markets such as the sale of stolen goods, illegal firearms and illicit drugs.</p>
<p>Governments generally don’t abandon control measures like gun registers and sales restrictions or laws that make dealing in stolen goods or hard drugs illegal. Rather, they typically implement measures such as border controls and enforcement directed at dealers to minimise these illicit markets. </p>
<p>Given the potentially dramatic health benefits of smokefree measures such as denicotinisation, opposition on the grounds of illicit trade from the highly conflicted tobacco industry makes a very weak case for abandoning smokefree policies. </p>
<p>A much more logical approach is to strengthen efforts to prevent illicit trade and implement robust monitoring and evaluation of intended (reduced smoking uptake, increased quitting) and possible unintended (increase in illicit tobacco market) outcomes of smokefree policies. That way we can refine policies as necessary. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/new-zealands-tobacco-endgame-law-will-be-a-world-first-for-health-heres-what-the-modelling-shows-us-187075">New Zealand’s ‘tobacco endgame’ law will be a world first for health – here’s what the modelling shows us</a>
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<h2>New Zealand is well-placed to control smuggling</h2>
<p>Due to its relative geographical isolation and strong border controls, New Zealand is particularly well-placed to minimise illicit markets. </p>
<p>A recent <a href="https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-021-00783-4">international study</a> of 160 countries ranked New Zealand the world’s first, equal with Sweden, for controlling tobacco smuggling. </p>
<p>To prevent any potential increase in illicit trade, shipping containers from China and South Korea could be screened at higher levels, with “drug dogs” trained to detect tobacco. </p>
<p>Exaggerated and discredited tobacco industry concerns about illicit trade should not mean key public health measures are abandoned. The appropriate response is to introduce additional enforcement efforts and enhanced monitoring with the full implementation of the <a href="https://www.health.govt.nz/publication/proposals-smokefree-aotearoa-2025-action-plan">Smokefree Aotearoa Action Plan</a>.</p><img src="https://counter.theconversation.com/content/191753/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Richard Edwards receives funding from government and health NGO funders such as the Health Research Council of New Zealand, the US National Institute of Health and the Cancer Society of New Zealand. </span></em></p><p class="fine-print"><em><span>Nick Wilson does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Even if the new smokefree legislation did cause some temporary extra illegal trade in tobacco, the best response would still be better law enforcement and border control.Nick Wilson, Professor of Public Health, University of OtagoRichard Edwards, Professor of Public Health, University of OtagoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1846742022-06-10T14:39:03Z2022-06-10T14:39:03ZPlan to slash smoking in England is backed by the evidence – but it could go even further<figure><img src="https://images.theconversation.com/files/468211/original/file-20220610-26-ppvb1l.jpg?ixlib=rb-1.1.0&rect=90%2C126%2C5916%2C3881&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/world-no-tobacco-day-concept-stop-1381443422">Shutterstock/chayanuphol</a></span></figcaption></figure><p>If smoking tobacco was invented today, there is little doubt it would be made illegal. The harm it does is simply too great. </p>
<p>It is still the biggest cause of preventable illness and death in England, with an annual cost to society of <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1081366/khan-review-making-smoking-obsolete.pdf">around £17 billion</a>. Persuading 6 million smokers to quit is not an easy task, but a new <a href="https://www.gov.uk/government/publications/the-khan-review-making-smoking-obsolete">independent review</a> commissioned by the government has come up with some sensible recommendations, as well as crucially highlighting that smoking is a key driver of inequality, and far more common among the poorest in society.</p>
<p>One of the most eye-catching recommendations is to gradually raise the minimum age for buying tobacco, to ensure future generations never smoke. New Zealand has already committed to this, by banning the sale of tobacco to anyone born <a href="https://www.bbc.co.uk/news/world-asia-59589775">after 2008</a>. </p>
<p>Other suggestions in the review include banning cigarette sales in supermarkets, “freezing” the tobacco industry to make it unable to launch new products/brands, and more funding for support services and mass media campaigns which help people quit smoking. </p>
<p>The review’s author, former charity executive Dr Javed Khan, also recommends making tobacco less affordable, mainly by increasing the amount of tax. This idea is backed up by extensive research which demonstrates that this is one of the <a href="http://dx.doi.org/10.1136/tc.2010.039982">most effective</a> tobacco control measures available, and one that successfully <a href="https://tobaccocontrol.bmj.com/content/20/3/235">addresses social inequalities</a>.</p>
<p>While the UK already has relatively high prices (a pack of 20 factory-made cigarettes now <a href="https://www.ons.gov.uk/economy/inflationandpriceindices/timeseries/czmp">costs £12.64</a> on average), they are still much cheaper than places like <a href="https://www.numbeo.com/cost-of-living/country_price_rankings?itemId=17">Australia and New Zealand</a> where the charge may be double. </p>
<p>The review’s recommendation for a sudden increase in taxation of all tobacco products by 30% is in line with <a href="http://dx.doi.org/10.1136/tobaccocontrol-2019-054969">our research</a> which suggests that large one-off increases are more effective than incremental ones. The reasonable expectation is that this would generate a significant fall in tobacco use in both the short and long term. </p>
<p>Khan also highlights another conclusion of our research, which is that tax on hand rolling tobacco <a href="https://doi.org/10.1016/j.drugalcdep.2018.07.047">needs to be increased</a> to match that of factory-made cigarettes so that it is not seen as a cheaper option for smokers. </p>
<p>Tobacco industry supporters often argue that higher taxes will push smokers into the black market. But Khan rightly acknowledges that the primary reason people buy illicit tobacco is because they can, and instead proposes more funding for legal enforcement. </p>
<p>The reality is that the tobacco industry has a long history of <a href="https://tobaccocontrol.bmj.com/content/28/2/127.info">involvement in smuggling</a>. Over two thirds of illicit cigarettes in the UK have been found to be the tobacco industry’s own brands, suggesting, at best, a failure to control its supply chain.</p>
<h2>Smoke and mirrors</h2>
<p>As well as encouraging smokers to quit, one of the advantages of increased tobacco taxes is increased government revenues. This money would help the government pay for the additional funding requested, but Khan is clear he would favour making the industry pay in line with the “polluter pays” principle. </p>
<p>Our research shows they can certainly afford it. Manufacturing tobacco products – which are highly addictive and cost little to make – is still inordinately profitable. </p>
<p>In 2018 (the most recent year for reported figures) the world’s six largest cigarette manufacturers made profits (before income taxes) of more than <a href="https://doi.org/10.18332/tpc/138232">US$55 billion</a> (£44 billion). That is more than the combined profits (US$51 billion) of Coca-Cola, Pepsico, Nestle, Fedex, Starbucks, Mondelez, General Mills, Heineken and Carlsberg who collectively own many household brand names. </p>
<figure class="align-center ">
<img alt="No smoking sign." src="https://images.theconversation.com/files/468214/original/file-20220610-22251-5fcrtg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/468214/original/file-20220610-22251-5fcrtg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/468214/original/file-20220610-22251-5fcrtg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/468214/original/file-20220610-22251-5fcrtg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/468214/original/file-20220610-22251-5fcrtg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/468214/original/file-20220610-22251-5fcrtg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/468214/original/file-20220610-22251-5fcrtg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">By 2030?</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/no-smoking-warning-sign-6472006">Shutterstock/Mark William Richardson</a></span>
</figcaption>
</figure>
<p>Khan suggests several ways in which the industry could be made to pay directly, including a surcharge on corporation tax, or a new “polluter pays” levy on cigarette profits. Both of these ideas are supported by <a href="https://doi.org/10.1093/pubmed/fdz004">our research</a>. </p>
<p>Ideally, we would encourage the government to go even further by introducing <a href="http://dx.doi.org/10.1136/tobaccocontrol-2021-056554">price regulation</a>, whereby a regulator would fix the price of each tobacco product, giving the industry lower returns and the government maximum tax potential. </p>
<p>If done carefully, this could transfer current large industry profits into higher government revenue. And it would also put a stop to the <a href="http://dx.doi.org/10.1136/tobaccocontrol-2021-056630">clever pricing tactics</a> the tobacco industry has been using to undermine taxation. </p>
<p>Such direct control of prices might seem radical. But it already happens with water and energy in the UK. So why not with an addictive product that kills tens of thousands in the country every year? </p>
<p>The Khan review shows that a radical approach is what is needed to help save lives and achieve plans for England to be smoke free by 2030. The key question is whether the government will be brave enough to do battle with such a rich and powerful industry in order to do what is necessary.</p><img src="https://counter.theconversation.com/content/184674/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>J. Robert Branston owns 10 shares in Imperial Brands for research purposes. The shares were a gift from a public health campaigner and are not held for financial gain or benefit. All dividends received are donated to health related charities, and proceeds from any future share sale or takeover will be similarly donated. He has received funding from Bloomberg Philanthropies Stopping Tobacco Organizations and Products project funding (<a href="http://www.bloomberg.org">www.bloomberg.org</a>), Cancer Research UK, and several other health related charitable organisations. </span></em></p><p class="fine-print"><em><span>Anna Gilmore currently receives funding from Bloomberg Philanthropies and the Medical Research Council as part of the UK Prevention Research Partnership of the SPECTRUM Consortium. Full details of funding are available here: <a href="https://researchportal.bath.ac.uk/en/persons/anna-gilmore">https://researchportal.bath.ac.uk/en/persons/anna-gilmore</a> and here <a href="https://www.bath.ac.uk/corporate-information/tobacco-control-research-group-statement-on-funding-sources/">https://www.bath.ac.uk/corporate-information/tobacco-control-research-group-statement-on-funding-sources/</a>. She provided expert input to the Khan review (see "experts" listed in the report: <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1081366/khan-review-making-smoking-obsolete.pdf">https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1081366/khan-review-making-smoking-obsolete.pdf</a>). She is a Council member of ASH. </span></em></p>Water and energy prices are fixed, so why not do the same with cigarettes?J. Robert Branston, Senior Lecturer (Associate Professor) in Business Economics, University of BathAnna Gilmore, Professor of Public Health/Director, Tobacco Control Research Group, University of BathLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1732052022-02-04T13:08:31Z2022-02-04T13:08:31ZNew forms of advertising raise questions about journalism integrity<figure><img src="https://images.theconversation.com/files/444123/original/file-20220202-17-dvum8z.png?ixlib=rb-1.1.0&rect=12%2C8%2C2659%2C1350&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Is this a paid ad or a news story? Can you tell?</span> <span class="attribution"><a class="source" href="https://www.washingtonpost.com/brand-studio/wellsfargo/investing-in-a-cleaner-future/">Screenshot from washingtonpost.com</a>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span></figcaption></figure><p>Mainstream news media outlets have, in recent years, begun to <a href="https://www.orbooks.com/catalog/black-ops-advertising-by-mara-einstein/">create advertisements that look like news articles</a> on their websites and on social media. <a href="https://ijoc.org/index.php/ijoc/article/view/17824">My research</a> raises questions about whether this modern form of advertising might influence those outlets’ real journalism. </p>
<p>These specific advertisements are called “native advertising,” but are also tagged as “<a href="https://www.orbooks.com/catalog/black-ops-advertising-by-mara-einstein/">sponsored content</a>,” “partner post” or other labels <a href="https://doi.org/10.1177/1464884918754829">consumers don’t understand</a>. They look like news articles, with headlines, photos with captions and polished text. But really they are ads created by, or on behalf of, a paying advertiser.</p>
<p>With declining revenue from traditional display advertising and classified ads, news outlets are <a href="https://www.orbooks.com/catalog/black-ops-advertising-by-mara-einstein/">increasingly relying on</a> native advertising – a sector in which U.S. spending was expected to reach <a href="https://www.outbrain.com/blog/21-native-advertising-statistics-for-2021/">$57 billion by the end of 2021</a>.</p>
<p><a href="https://www.nytimes.com/paidpost/cole-haan/grit-and-grace.html">Fashion</a> and <a href="https://www.nytimes.com/paidpost/netflix/women-inmates-separate-but-not-equal.html">entertainment</a> companies buy native advertising. So do corporations that produce products with potentially significant environmental or health connections, such as <a href="https://www.thenation.com/article/environment/media-fossil-fuel-ads/">fossil fuels</a>, <a href="https://www.statnews.com/sponsor/2019/02/07/leveraging-technology-to-help-address-the-opioid-crisis/">opioid medications</a> and <a href="https://www.washingtonpost.com/brand-studio/wp/2021/05/25/lost-amid-misinformation-real-people-real-science-real-progress/">cigarettes</a> – including in attempts to <a href="https://doi.org/10.1080/02650487.2021.1914445">counter negative news coverage</a>.</p>
<h2>Deceiving audiences</h2>
<p>In one example from spring 2021, Philip Morris International – the tobacco company – ran a native advertising campaign across many media outlets, including <a href="http://sponsored.bostonglobe.com/pmi/science-leading-to-a-smoke-free-future/?s_campaign=bg:article:tease">The Boston Globe</a>, <a href="https://www.nytimes.com/paidpost/philip-morris-international/embracing-science-for-better-if-not-now-when.html">The New York Times</a>, <a href="https://www.reuters.com/article/sponsored/we-cannot-let-misinformation-get-in-the-way-of-progress">Reuters</a> and <a href="https://www.washingtonpost.com/brand-studio/wp/2021/05/25/lost-amid-misinformation-real-people-real-science-real-progress/">The Washington Post</a>. </p>
<p>The ads complained about the “<a href="https://www.washingtonpost.com/brand-studio/wp/2021/05/25/lost-amid-misinformation-real-people-real-science-real-progress/">disinformation campaigns that muddy the truth</a>” regarding the benefits of vaping products while themselves muddying the truth. </p>
<p>In the past, the tobacco industry sought to <a href="https://global.oup.com/academic/product/doubt-is-their-product-9780195300673?cc=us&lang=en&">manufacture public uncertainty</a> about the harms of its products. This time, Philip Morris is using a practice that <a href="https://www.theguardian.com/commentisfree/2014/feb/25/yahoo-opens-gemini-native-advertising">media critics</a> say is deceptive and media scholar Victor Pickard calls “<a href="https://archives.cjr.org/behind_the_news/qa_victor_pickard.php">subterfuge … creating confusion between editorial and advertising content</a>,” to make claims about the benefits of its products.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/439374/original/file-20220104-23-aobs3m.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/439374/original/file-20220104-23-aobs3m.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=283&fit=crop&dpr=1 600w, https://images.theconversation.com/files/439374/original/file-20220104-23-aobs3m.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=283&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/439374/original/file-20220104-23-aobs3m.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=283&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/439374/original/file-20220104-23-aobs3m.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=355&fit=crop&dpr=1 754w, https://images.theconversation.com/files/439374/original/file-20220104-23-aobs3m.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=355&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/439374/original/file-20220104-23-aobs3m.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=355&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Screenshot of a native advertisement appearing in The Washington Post from Philip Morris International.</span>
<span class="attribution"><a class="source" href="https://www.washingtonpost.com/brand-studio/wp/2021/05/25/lost-amid-misinformation-real-people-real-science-real-progress/">Washington Post</a>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>These advertisements that look like real news are <a href="https://www.ftc.gov/tips-advice/business-center/guidance/com-disclosures-how-make-effective-disclosures-digital">labeled as ads</a>, as required by the Federal Trade Commission. But <a href="https://www.doi.org/10.1080/00913367.2015.1115380">research studies</a> have <a href="https://www.doi.org/10.1080/21670811.2017.1293488">repeatedly</a> <a href="https://doi.org/10.1177/1464884918754829">shown</a> that those labels are largely ineffective at helping readers distinguish between the two types of content.</p>
<h2>Made by journalists</h2>
<p>Many media companies have created <a href="https://thetrust.wsjbarrons.com/">content</a> <a href="https://www.tbrandstudio.com/">studios</a>, separate from their newsrooms, to <a href="http://mediashift.org/2017/10/advertisers-underwrite-new-york-times-content/">create native advertising</a> on behalf of corporate and special interest groups. While newspapers traditionally had ad departments that designed and mocked up advertisements for their clients, today’s native ads are in the form of a “story” that often does not focus on – and sometimes <a href="https://doi.org/10.1080/10496491.2017.1323264">does not even mention</a> – its sponsor in order to resemble the seemingly objective journalism it imitates.</p>
<p>Sometimes those efforts have the help of intermediaries such as so-called “product marketing” teams that work between the newsroom and studios. A former “creative strategist” at The New York Times says that arrangement allows publishers “<a href="https://www.cjr.org/tow_center_reports/native-ads.php">to skirt the implication that news staff work directly with brands to craft commercial content</a>.” In other cases, journalists write for <a href="https://thebaffler.com/salvos/rest-advertising">both the newsroom</a> <a href="https://www.opendemocracy.net/en/blurred-lines-and-black-ops-disappearing-divide-between-uk-news-and-adverti/">and their publisher’s content studio</a>.</p>
<p>Because native advertising typically has <a href="https://www.cjr.org/tow_center_reports/native-ads.php">no bylines</a>, most people are unaware that advertisements may be created in such close connection with mainstream newsrooms. <a href="https://www.cjr.org/special_report/digital-age-the-new-york-times-slippery-path-news-advertising.php">Former</a> <a href="https://www.cjr.org/tow_center_reports/native-ads.php">employees</a>, including a <a href="https://nymag.com/intelligencer/2019/01/jill-abramson-merchants-of-truth-book-excerpt.html">former executive editor of The New York Times</a>, say most publishers are not transparent about it with their audiences. One digital journalist told researchers, “Some people will say the ad is labeled so it’s not bad. That’s crap … the unsophisticated won’t get it and then <a href="https://doi.org/10.1177/0002764216660135">they’ll click on something meant to look exactly like a story</a>. That’s a problem.”</p>
<h2>Disappearing disclosures</h2>
<p>When native ads are <a href="https://www.cjr.org/tow_center_reports/native-ads.php">shared on social media</a>, they’re often distributed in ways that further confuse or deceive audiences.</p>
<p>The Wall Street Journal, for instance, has <a href="https://twitter.com/WSJ/status/890327274062577664">retweeted posts from its Custom Content studio</a> from the same Twitter account that promotes its news content. While this particular retweet disclosed the commercial nature of the original tweet, this is not always the case.</p>
<p>More than half the time, the FTC-required advertising disclosures disappear when the content leaves the publisher’s website and is shared on <a href="https://doi.org/10.1111/joca.12212">Facebook</a> and <a href="https://doi.org/10.1080/1461670X.2021.1906298">Twitter</a>. For example, when I recently shared an <a href="https://www.washingtonpost.com/brand-studio/api-can-natural-gas-be-the-key-to-lowering-emissions/">American Petroleum Institute native ad</a> on Twitter, the disclosure disappeared – a violation of the FTC’s labeling mandate. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/440939/original/file-20220115-19-1q3i1qz.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/440939/original/file-20220115-19-1q3i1qz.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=434&fit=crop&dpr=1 600w, https://images.theconversation.com/files/440939/original/file-20220115-19-1q3i1qz.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=434&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/440939/original/file-20220115-19-1q3i1qz.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=434&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/440939/original/file-20220115-19-1q3i1qz.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=545&fit=crop&dpr=1 754w, https://images.theconversation.com/files/440939/original/file-20220115-19-1q3i1qz.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=545&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/440939/original/file-20220115-19-1q3i1qz.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=545&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">When retweeted, native advertising appearing in The Washington Post from the American Petroleum Institute was no longer labeled as a paid ad.</span>
<span class="attribution"><span class="source">Michelle Amazeen</span></span>
</figcaption>
</figure>
<p>I believe it is the <a href="https://doi.org/10.1080/1461670X.2021.1906298">responsibility of publishers, not consumers</a>, to ensure that sponsored content is accurately labeled when shared online. Otherwise, <a href="https://hal.inria.fr/hal-01281190">people will amplify</a> undisclosed commercial content <a href="https://doi.org/10.1111/jcom.12232">they think is genuine news</a>.</p>
<h2>Suppressing news coverage?</h2>
<p>I have another concern about this type of potentially deceptive advertising. <a href="https://doi.org/10.1080/08821127.2005.10677638">Since as early as 1869</a>, <a href="https://doi.org/10.1177/1464884917725162">anecdotal</a> <a href="https://doi.org/10.1080/1461670X.2017.1397531">evidence</a> has indicated that reporters are hesitant to write about advertisers that are lucrative to their news outlet. My <a href="https://ijoc.org/index.php/ijoc/article/view/17824">recent research</a> with <a href="https://www.colorado.edu/business/leeds-directory/faculty/chris-vargo">digital advertising scholar Chris Vargo</a> signals that similar concerns may occur with this new form of advertising.</p>
<p>We counted all the native advertisements between 2014 and 2019 we could find from The New York Times, The Washington Post and The Wall Street Journal, by looking at native ads those news outlets posted on Twitter and with a custom search process we built on top of Bing. We noted what dates the native ads were published and what company sponsored them. </p>
<p>We also used the <a href="https://github.com/chrisjvargo/gdelt/blob/master/GDELT%20sources.ipynb">GDELT database</a>, which collects online news stories from those three outlets and many other mainstream, partisan, and emerging news sites across the U.S. In that data, we noted the number and dates of news stories naming major companies. </p>
<p>We found 27 companies for which there was enough information in both data sets to make a meaningful connection. For each of those 27 companies, we charted how many mentions they had in news stories over time, and compared those time periods with the timing of that company’s releases of native advertising. </p>
<p>We found that for 16 of the companies, news coverage noticeably decreased after a native advertisement was published. For just three companies, news coverage noticeably increased after a native ad was published.</p>
<p>These results suggest that advertiser-driven “news” stories – <a href="https://www.thenation.com/article/environment/media-fossil-fuel-ads/">written and approved by paying sponsors</a> – often go unchallenged. </p>
<p>For example, Wells Fargo – a multinational financial services company plagued by a <a href="https://en.wikipedia.org/wiki/Wells_Fargo#Lawsuits,_fines_and_controversies">litany of scandals</a>, such as <a href="https://www.nytimes.com/2019/03/09/business/wells-fargo-sales-culture.html">deceiving customers with fake bank accounts</a> – engaged the content studios of The New York Times, The Washington Post and The Wall Street Journal to create nearly a dozen native ads. One, created by The Washington Post’s BrandStudio, touted how Wells Fargo was <a href="https://www.washingtonpost.com/brand-studio/wellsfargo/investing-in-a-cleaner-future/">investing in a cleaner environmental future</a>. If it had been a real news article, it would have reported that the company was also financing <a href="https://www.yesmagazine.org/democracy/2016/09/29/how-to-contact-the-17-banks-funding-the-dakota-access-pipeline">the controversial underground oil transport system, the Dakota Access Pipeline</a>.</p>
<p>Our study found statistically less reporting on Wells Fargo not only within those three elite news organizations but across all U.S. online media following the native advertising campaigns.</p>
<p>[<em>Over 140,000 readers rely on The Conversation’s newsletters to understand the world.</em> <a href="https://memberservices.theconversation.com/newsletters/?source=inline-140ksignup">Sign up today</a>.]</p>
<p>Native ads are potentially very deceptive to consumers, in their content, their presentation and how they are shared on social media. Our research does not prove a direct connection, but when we add it to the anecdotes that <a href="https://global.oup.com/academic/product/democracy-without-journalism-9780190946760?cc=us&lang=en&">news management discourages stories critical of important advertisers</a>, we also wonder about the power of native ads over journalists’ supposedly independent decisions regarding what to cover and when.</p><img src="https://counter.theconversation.com/content/173205/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michelle A. Amazeen has received funding from The American Press Institute, the Democracy Fund, and The Rita Allen Foundation. </span></em></p>When news outlets also publish so-called ‘native advertising,’ their journalistic reputations suffer – and their news coverage shies away from the companies that paid for the ads.Michelle A. Amazeen, Associate Professor of Mass Communication, Boston UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1735782022-01-03T15:58:40Z2022-01-03T15:58:40ZScientific certainty survival kit: How to push back against skeptics who exploit uncertainty for political gain<figure><img src="https://images.theconversation.com/files/438254/original/file-20211217-13309-zl5c72.jpg?ixlib=rb-1.1.0&rect=9%2C0%2C6025%2C3999&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">It can be difficult to distinguish between the calls of sincere scientists for more research to reach greater certainty, and the politically motivated criticisms of science skeptics. </span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 175px; border: none; position: relative; z-index: 1;" allowtransparency="" src="https://narrations.ad-auris.com/widget/the-conversation-canada/scientific-certainty-survival-kit--how-to-push-back-against-skeptics-who-exploit-uncertainty-for-political-gain" width="100%" height="400"></iframe>
<p>The mathematician Kurt Gödel was obsessed by the fear that he would die by poisoning. He refused to eat a meal unless it was prepared by his wife, the only person he trusted. When she fell ill and was sent to hospital, <a href="https://www.ias.edu/kurt-g%C3%B6del-life-work-and-legacy">Gödel died of starvation</a>.</p>
<p>His death is sad, but also ironic: The man who discovered that even logical systems are incomplete — that some truths are unprovable — died because he demanded complete proof that his food was safe. He demanded more of his lasagne than he did of logic. </p>
<p>“Don’t eat unless you are 100 per cent certain your food is safe” is a principle that will kill a person as certainly as any poison. So, in the face of uncertainty about our food we take precautions and then we eat — knowing there remains the slimmest chance an unknown enemy has laced our meal with arsenic.</p>
<p>The example of Gödel teaches us a lesson: sometimes the demand for absolute certainty can be dangerous and even deadly. Despite this, demands for absolute or near certainty are a common way for those with a political agenda to undermine science and to delay action. Through our combined experience in science, philosophy and cultural theory, we are acquainted with these attempts to undermine science. We want to help readers figure out how to evaluate their merits or lack thereof. </p>
<h2>A brief history of certainty</h2>
<p>Scientists have amassed abundant evidence that <a href="https://www.cdc.gov/cancer/lung/basic_info/risk_factors.htm">smoking causes cancer</a>, that the <a href="https://climate.nasa.gov/causes/">climate is changing because of humans</a> and that <a href="https://hub.jhu.edu/2017/01/11/vaccines-autism-public-health-expert/">vaccines are safe and effective</a>. But scientists have not proven these results definitively, nor will they ever do so. </p>
<p>Oncology, climate science and epidemiology are not branches of pure mathematics, defined by absolute certainty. Yet it has become something of an industry to disparage the scientific results because they fail to provide certainty equal to 2+2=4. </p>
<p>Some science skeptics say that findings about smoking, global warming and vaccines <a href="https://oxford.universitypressscholarship.com/view/10.1093/acprof:oso/9780199356102.001.0001/acprof-9780199356102-chapter-10">lack certainty</a> and <a href="https://www.vox.com/the-highlight/22291183/skeptic-covid-vaccine-climate-change-denial-election-fraud">are therefore unreliable</a>. “What if the science is wrong?” they ask. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/climate-change-denial-2-0-was-on-full-display-at-cop26-but-there-was-also-pushback-171639">Climate change denial 2.0 was on full display at COP26, but there was also pushback</a>
</strong>
</em>
</p>
<hr>
<p>This concern can be valid; scientists themselves worry about it. But carried to excess, such criticism often serves political agendas by <a href="https://global.oup.com/academic/product/doubt-is-their-product-9780195300673?cc=ca&lang=en&">persuading people to lose trust in science</a> and <a href="https://www.pewtrusts.org/en/trend/archive/winter-2021/why-we-must-rebuild-trust-in-science">avoid taking action</a>.</p>
<p>Over 2,000 years ago Aristotle wrote that “<a href="http://classics.mit.edu/Aristotle/nicomachaen.1.i.html">it is the mark of an educated person to look for precision in each class of things just so far as the nature of the subject admits</a>.” Scientists have agreed for centuries that it is inappropriate to seek absolute certainty from the empirical sciences. </p>
<p>For example, one of the fathers of modern science, Francis Bacon, wrote in 1620 that his “<em>Novum Organum</em>” — a new method or logic for studying and understanding natural phenomenon — would <a href="https://oll.libertyfund.org/title/bacon-novum-organum#Bacon_0415_82">chart a middle path between the excess of dogmatic certainty and the excess of skeptical doubt</a>. This middle path is marked by increasing degrees of probability achieved by careful observation, skilfully executed tests and the collection of evidence. </p>
<p>To demand perfect certainty from scientists now is to be 400 years behind on one’s reading on scientific methodology.</p>
<h2>A certainty survival kit</h2>
<p>It can be difficult to distinguish between the calls of sincere scientists for more research to reach greater certainty, on the one hand, and the politically motivated criticisms of science skeptics, on the other. But there are some ways to tell the difference: First, we highlight some common tactics employed by science skeptics and, second, we provide questions readers might ask when they encounter doubt about scientific certainty.</p>
<p>One common tactic is the old “correlation does not equal causation” chestnut. This one was <a href="https://dx.doi.org/10.2105%2FAJPH.2011.300292">used by the tobacco industry to challenge the link between smoking and cancer in the 1950s and ‘60s</a>.</p>
<figure class="align-center ">
<img alt="A package of cigarettes on a table with one cigarette beside it. The box shows a photograph of a tongue covered in white spots, a form of oral cancer caused primarily by smoking." src="https://images.theconversation.com/files/438253/original/file-20211217-25-sngx0j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/438253/original/file-20211217-25-sngx0j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/438253/original/file-20211217-25-sngx0j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/438253/original/file-20211217-25-sngx0j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/438253/original/file-20211217-25-sngx0j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/438253/original/file-20211217-25-sngx0j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/438253/original/file-20211217-25-sngx0j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">In 2001, Canada became the first country to introduce photographic warnings on cigarette packages, which often focus on cancer.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Denis Savard</span></span>
</figcaption>
</figure>
<p>Smoking is merely correlated with cancer, the tobacco industry and their representatives argued, it didn’t necessarily cause cancer. But these critics left out the fact that the correlation is very strong, smoking precedes cancer and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1898525/pdf/procrsmed00196-0010.pdf">other potential causes are unable to account for this correlation</a>. </p>
<p>In fact, <a href="https://www.ncbi.nlm.nih.gov/books/NBK53010/">the science linking smoking and lung cancer is now quite clear given the decades of research that produced volumes of supporting evidence</a>. This tactic continues to be a mainstay of many science skeptics even though scientists have well-tested abilities to separate simple correlation from cause and effect relationships.</p>
<p>Another tactic argues that science is unable to prove anything positive, that science only tests and ultimately falsifies theories, conjectures and hypotheses. And so, skeptics say, the real work of science is not to establish truths definitively, but to refute falsehoods definitively. If this were true, <a href="https://plato.stanford.edu/entries/scientific-underdetermination/">scientific claims would always be “underdetermined”</a> — the idea that whatever evidence is available may not be sufficient to determine whether we believe something to be true.</p>
<p>For example, science could never prove true the claim that humans are warming the planet. While science may fall short of complete proof, scientists nevertheless amass <a href="https://agupubs.onlinelibrary.wiley.com/doi/full/10.1029/2021GL096644">such great evidence that they render their conclusions the most rational among the alternatives</a>. </p>
<p>Science has moved past this criticism of underdetermination, which rests on an outdated philosophy of science made popular by Karl Popper early last century, according to which <a href="https://plato.stanford.edu/entries/popper/#BasiStatFalsConv">science merely falsifies, but never proves</a>. Larry Laudan, a philosopher of science, wrote an influential 1990 essay, “<a href="https://conservancy.umn.edu/bitstream/handle/11299/185722/14_12Laudan.pdf">Demystifying underdetermination</a>,” that shows that this objection to scientific methodology is sloppy and exaggerated. </p>
<p>Scientists can reach conclusions that one explanation is more rational than competing claims, even if scientists cannot prove their conclusions through demonstration. These extensive and varied lines of evidence can collectively lead to positive conclusions and allow us to <a href="https://www.ipcc.ch/report/ar6/wg1/downloads/report/IPCC_AR6_WGI_SPM_final.pdf">know with a high level of certainty that humans are indeed warming the planet</a>.</p>
<h2>Scientists can be the target too</h2>
<p>Another way to drum up uncertainty about what we know is through attacks on scientists. <a href="https://doi.org/10.1038/d41586-021-02741-x">Personal attacks on public health officials during the ongoing pandemic are a prime example</a>. These attacks are often <a href="https://doi.org/10.1080/17524032.2020.1741420">framed more broadly to implicate scientists as untrustworthy, profit-seeking or politically motivated</a>.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/438248/original/file-20211217-13309-c7f4x4.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Wegener's original black and white schematic showing the Earth's continents locked together like a jigsaw puzzle in the first panel, and spread out into their current configuration in the last." src="https://images.theconversation.com/files/438248/original/file-20211217-13309-c7f4x4.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/438248/original/file-20211217-13309-c7f4x4.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=1011&fit=crop&dpr=1 600w, https://images.theconversation.com/files/438248/original/file-20211217-13309-c7f4x4.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=1011&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/438248/original/file-20211217-13309-c7f4x4.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=1011&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/438248/original/file-20211217-13309-c7f4x4.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1271&fit=crop&dpr=1 754w, https://images.theconversation.com/files/438248/original/file-20211217-13309-c7f4x4.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1271&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/438248/original/file-20211217-13309-c7f4x4.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1271&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Alfred Wegener proposed in 1912 that the continents were once joined together into a single landmass and had drifted apart.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:De_Wegener_Kontinente_018.jpg">(Alfred Wegener/Wikimedia)</a></span>
</figcaption>
</figure>
<p>For example, consensus among scientists is sometimes touted as no guarantee of truth or, in other words, scientists are sometimes wrong. One well-known example involves the theory of plate tectonics, where the scientific community for several decades largely dismissed the idea proposed by geophysicist Alfred Wegener. This consensus rapidly shifted in the 1960s as <a href="https://www.nationalgeographic.org/encyclopedia/plate-tectonics/">evidence mounted in support of continental drift</a>. </p>
<p>While scientists may be using <a href="https://www.sciencenews.org/article/science-top-10-erroneous-results-mistakes">flawed data, suffer from a lack of data or sometimes misinterpret the data that they have</a>, the scientific approach allows for the reconsideration and rethinking of what is known when new evidence arises. While highlighting the occasional scientific mistake can create sensational headlines and reduce trust in scientists, the reality is that science is transparent about its mistakes and generally self-correcting when these issues arise. This is a <a href="https://www.theatlantic.com/technology/archive/2012/12/how-science-changes/266145/">feature of science, not a bug</a>.</p>
<h2>Being mindful about certainty</h2>
<p>When reading critiques that inflate the uncertainty of science, we suggest asking the following questions to determine whether the critique is being made in the interest of advancing science or procuring public health, or whether it is being made by someone with a hidden agenda:</p>
<ol>
<li> Who is making the argument? What are their credentials?</li>
<li> Whose interests are served by the argument?</li>
<li> Is the critique of science selective or focused only on science that runs against the interests represented by the speaker? </li>
<li> Does the argument involve any self-critique?</li>
<li> Is the speaker doubting the existence of the problem? Or asking for delay in action until certainty is obtained? Who stands to benefit from this delay?</li>
<li> Does the speaker require a high level of certainty on the one hand, but not on the other? For instance, if the argument is that the safety of a vaccine is not sufficiently certain, what makes the argument against its safety sufficient? </li>
<li> Has the argument made clear how much uncertainty there is? Has the speaker specified a threshold at which point they would feel certain enough to act?</li>
</ol>
<p>A friend of ours recently encountered a vaccine skeptic who articulated their problem this way: “I don’t know what’s in it.” In fact, we do know what is in vaccines, as much as we can know for certain what is in anything else we put in our bodies. The same question can be fruitfully asked of any argument we put in our minds: “Am I sure I know what’s in it?”</p><img src="https://counter.theconversation.com/content/173578/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Paul Frost receives funding from the Natural Sciences and Engineering Research Council of Canada.</span></em></p><p class="fine-print"><em><span>Marguerite Xenopoulos receives funding from Canada Research Chairs and the Natural Sciences and Engineering Research Council. She is Editor-in-Chief of JGR: Biogeosciences.</span></em></p><p class="fine-print"><em><span>Michael Epp is affiliated with the NDP as a member and volunteer</span></em></p><p class="fine-print"><em><span>Michael Hickson does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Skeptics may make demands for absolute certainty to undermine science and delay action. Critiques may not be in the interest of advancing science and public health, but by someone with an agenda.Paul Frost, David Schindler Professor of Aquatic Science, Trent UniversityMarguerite Xenopoulos, Professor and Canada Research Chair in Global Change of Freshwater Ecosystems, Trent UniversityMichael Epp, Associate Professor of Cultural Studies, Trent UniversityMichael Hickson, Associate Professor, Department of Philosophy, Trent UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1411132020-06-29T05:23:19Z2020-06-29T05:23:19ZReforming cannabis laws is a complex challenge, but New Zealand’s history of drug reform holds important lessons<figure><img src="https://images.theconversation.com/files/343926/original/file-20200625-33533-1t6nsqi.jpg?ixlib=rb-1.1.0&rect=0%2C163%2C5200%2C3292&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Soru Epotok/Shutterstock</span></span></figcaption></figure><p>In less than three months, New Zealanders will vote in the world’s first <a href="https://www.referendums.govt.nz/cannabis/index.html?gclid=EAIaIQobChMIiIDKqNib6gIViH4rCh2PRwtvEAAYASAAEgKCpfD_BwE">national referendum</a> on a comprehensive proposal to legalise the recreational use of cannabis.</p>
<p>Unlike cannabis ballots in several US states in which the public only voted on the general proposition of whether cannabis should be legalised or not, New Zealanders have access to the detailed <a href="https://www.referendums.govt.nz/materials/Cannabis-Legalisation-and-Control-Bill-Exposure-Draft-for-Referendum.pdf">Cannabis Legalisation and Control Bill</a>. It outlines how the government <a href="https://www.referendums.govt.nz/materials/Cabinet-paper-Summary-of-policies-Cabinet-minutes-Exposure-draft-Cannabis-Legalisation-and-Control-Bill.pdf">proposes to establish</a> a “controlled and tightly regulated” legal cannabis market. </p>
<p>The approach is not like the Brexit referendum, which had no detailed plan of action for a yes vote. Neither is it like New Zealand’s <a href="https://www.theguardian.com/world/2016/mar/25/new-zealand-referendum-same-flag-what-was-that-about">much maligned 2016 flag referendum</a>, in which people <a href="https://nzhistory.govt.nz/media/interactive/2016-flag-referendum-long-list">knew exactly what they were voting for</a>. In this case, New Zealanders are voting on a proposed law reform, but even following a yes vote, the cannabis regime will have to go through select committees and public consultation. And a legal cannabis market will require monitoring and enforcement. </p>
<p>Our <a href="https://www.tandfonline.com/doi/full/10.1080/09687637.2017.1282422?scroll=top&needAccess=true">research</a> on an earlier law reform, aiming to regulate the manufacture of “<a href="https://www.health.govt.nz/our-work/regulation-health-and-disability-system/psychoactive-substances-regulation">low risk</a>” psychoactive products, shows New Zealand has a history of ambitious ideas that ultimately suffer from poor execution. </p>
<h2>Even the best law does not guarantee compliance</h2>
<p>The cannabis legislation bill sets out how the government would control and regulate a legal cannabis market, including the following measures: </p>
<ul>
<li><p>licensing of cannabis industry operators</p></li>
<li><p>limits on the maximum potency of different cannabis products</p></li>
<li><p>a ban on advertising</p></li>
<li><p>sales via licensed specialised premises only (no online sales)</p></li>
<li><p>a minimum buyer’s age of 20 or older</p></li>
<li><p>the government’s ability to control both the price (via excise taxes on the psychoactive ingredient THC and weight) and limit on the total amount in the market (via annual production caps). </p></li>
</ul>
<p>The bill envisions a commercial industry that will manufacture and sell cannabis. But there are provisions for not-for-profit and community-oriented operators. </p>
<p>Some <a href="https://www.nzma.org.nz/journal-articles/the-governments-proposal-to-legalise-cannabis-in-new-zealand-10-key-questions">key issues remain unresolved</a> (price, tax rate, role of local governments), but these could be addressed through further legislation and public consultation following the referendum.</p>
<p>But executing the plan for a tightly regulated legal cannabis regime is another story. </p>
<p>First, the referendum is not binding. Even if New Zealanders vote yes, the incoming government can decide not to proceed or make significant changes.</p>
<p>Second, how the law looks on paper is rarely how it is in practice. Some laws, by design, are difficult to enforce. For example, the ban on all advertising sounds good, but it is not clear how covert promotion, celebrity endorsements and other sophisticated social media promotion techniques (product reviews, blog posts) would be controlled. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-nzs-cannabis-bill-needs-to-stop-industry-from-influencing-policy-128530">Why NZ's cannabis bill needs to stop industry from influencing policy</a>
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<p>Similarly, it sounds reasonable to limit the maximum daily purchase to 14 grams, but it is hard to imagine effective enforcement without a real-time tracking system of purchases by individual customers. The same questions arise when considering the stated maximum limit of growing two plants at home or the ban on “dangerous” production methods to produce extracts at home.</p>
<p>It is reasonable to assume some New Zealanders will be growing more than the legal cannabis plant limit (as they already do) and will be able to purchase more than 14 grams a day (if they wish to). We can also be certain the cannabis industry will develop creative ways of online promotion (<a href="https://onlinelibrary.wiley.com/doi/full/10.1111/add.12835">as alcohol and tobacco industries have done</a>) and will actively lobby behind the scenes against public health measures and regulatory restrictions.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/potential-cost-to-patient-safety-as-nz-debates-access-to-medicinal-cannabis-120750">Potential cost to patient safety as NZ debates access to medicinal cannabis</a>
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<h2>Preparing for challenges</h2>
<p>The success of a legal cannabis regime under the proposed law will depend on who oversees the implementation and regulation plans. This task will primarily be up to a new cannabis regulatory authority, but it remains unclear whether this will sit within the portfolio of health, justice or business (with their respective cultures and values). </p>
<p>The new authority will have a lot on its plate. Licensing producers and retailers, developing production standards, regulating labelling, approving products, administering cannabis taxes, revising maximum potency limits, and developing local licensed premises policies for all 67 local councils are just some of the tasks. The sheer volume of work required before a legal cannabis market can operate creates risks. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/teen-use-of-cannabis-has-dropped-in-new-zealand-but-legalisation-could-make-access-easier-132165">Teen use of cannabis has dropped in New Zealand, but legalisation could make access easier</a>
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<p>New Zealand has recent history of poorly implementing drug policy reform. Agencies were overwhelmed by the immense regulatory workload when New Zealand attempted to establish a regulated legal market for “low risk” <a href="https://www.health.govt.nz/our-work/regulation-health-and-disability-system/psychoactive-substances-regulation">psychoactive products</a> under the <a href="http://www.legislation.govt.nz/act/public/2013/0053/latest/DLM5042921.html">Psychoactive Substances Act</a> in 2013.</p>
<p>There were significant gaps in the law, including regulating opening hours, lack of excise tax and poor engagement with key stakeholders. As one key official interviewed in our <a href="https://www.tandfonline.com/doi/full/10.1080/09687637.2017.1282422?scroll=top&needAccess=true">research on that reform</a> said: the law “got lost in translation”. As a result, political and community support for the reforms evaporated and the regime remains unused. </p>
<p>We need to learn from that experience.</p>
<p>This is not to say a vote against cannabis legalisation will result in better outcomes. But it is important to have realistic expectations, accept the complexity of implemention, know the risks (including lobbying from the commercial industry) and develop plans to best mitigate those. </p>
<p>In the cannabis referendum, New Zealanders will be voting on a new idea and a draft plan on how to get there. There is no guarantee the lofty vision will match reality.</p><img src="https://counter.theconversation.com/content/141113/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Marta Rychert receives funding from Marsden Royal Society of New Zealand and Health Research Council of New Zealand. </span></em></p><p class="fine-print"><em><span>Chris Wilkins currently receives research funding from the New Zealand Royal Society Marsden Fund and Health Research Council of New Zealand. He has previously received research funding from the New Zealand Ministry of Health, New Zealand Police and New Zealand Customs Service.</span></em></p>New Zealand will hold the world’s first national referendum on legalising recreational use of cannabis in September. It must learn from mistakes in implementing earlier drug law reforms.Marta Rychert, Senior Researcher in Drug Policy, Massey UniversityChris Wilkins, Associate Professor of illegal drug research, Massey UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1209612019-08-11T12:19:04Z2019-08-11T12:19:04ZChina’s tobacco industry is building schools and no one is watching<figure><img src="https://images.theconversation.com/files/287207/original/file-20190807-144883-r5d1h4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Reports suggest there are more than 100 tobacco-sponsored schools in China, a country with more than 300 million smokers.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Would you send your child to a school named after a cigarette brand? What if it was one of only two schools in your area and boasting far better infrastructure? What if the school also had an inspirational slogan such as “<a href="https://observers.france24.com/en/20100126-china-tobacco-sponsored-schools">genius is from hard work</a>, <a href="https://www.huffingtonpost.ca/2011/09/26/chinese-cigarettes-sponsor-schools_n_981849.html">tobacco helps you</a> excel” on a sign or its walls, and a tobacco company’s logo on its building? Would you care if the school was built by a tobacco company?</p>
<p>For me, as a person involved in tobacco control research, this is nothing less than a horror story. What is more terrifying, however, is that what I describe above is not conjecture, but reality to many residents of rural China.</p>
<p>The shock and disbelief I experienced when I first found out about these so-called “tobacco schools” drove me to research this issue. I worked with some Chinese colleagues from the Peking Medical Union College to document Chinese <a href="https://www.ncbi.nlm.nih.gov/pubmed/31302606">public perception of these schools for the very first time</a>.</p>
<p>We visited a small village in Yunnan province and interviewed a government official, school principals, teachers, students and parents of three local schools, one of which was sponsored by a local tobacco company. In addition, we also interviewed tobacco control advocates in Beijing. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/287212/original/file-20190807-144873-7ywwdo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/287212/original/file-20190807-144873-7ywwdo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/287212/original/file-20190807-144873-7ywwdo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/287212/original/file-20190807-144873-7ywwdo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/287212/original/file-20190807-144873-7ywwdo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/287212/original/file-20190807-144873-7ywwdo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/287212/original/file-20190807-144873-7ywwdo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Future generations’ health is at risk when indirect marketing of tobacco in schools is permitted.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<h2>Why schools?</h2>
<p>The Chinese tobacco industry is a powerful state-owned enterprise. The commercial arm called the China National Tobacco Corporation (CNTC) is managed by the government arm, the State Tobacco Monopoly Administration. CNTC is <a href="https://doi.org/10.1080/17441692.2016.1241293">the largest tobacco company in the world, producing 40 per cent of the global cigarette supply</a>. The company has a monopoly in China to supply <a href="https://www.who.int/tobacco/about/partners/bloomberg/chn/en/">more than 300 million Chinese smokers</a>, but is virtually unheard of outside of China. All facts combined, CNTC wields significant financial and political power.</p>
<p>As a state-owned enterprise, CNTC is expected to closely follow the government’s policy leads, and to support particular priorities, such as reducing poverty. </p>
<p>The Chinese government’s Project Hope targets rural development and provides education through what it designates as Hope elementary schools. To actively support this government initiative through its corporate social responsibility projects, CNTC has built numerous schools. We find that what tobacco companies such as Hongta promote as <a href="http://www.hongta.com/language/en/duty/back/support/">corporate social responsibility</a> acts as a form of indirect marketing. </p>
<p>It is difficult to predict exact numbers, but reports suggest there are <a href="http://news.ifeng.com/society/2/detail_2011_05/30/6712976_0.shtml">more than 100 such tobacco-sponsored schools</a>, named after tobacco companies or cigarette brands — such as <a href="http://china.zjol.com.cn/05china/system/2009/12/13/016146988.shtml">Sichuan Tobacco Hope primary school</a> or <a href="http://www.huaxia.com/ah-tw/ahyw/2006/00458088.html">Yingkesong Hope primary school</a>. </p>
<p>In particular, many such tobacco schools were built following the devastating <a href="https://www.theatlantic.com/photo/2018/05/10-years-since-the-devastating-2008-sichuan-earthquake/560066/">Sichuan earthquake in 2008</a>. The tobacco industry does not stop here, however. The sponsoring company will often donate school supplies, equipment, stock school libraries and even provide <a href="http://www.nj.yn.gov.cn/nj/72340168526266368/20081023/186491.html">student bursaries and teacher bonuses</a> in some instances.</p>
<h2>Charity vs. propaganda</h2>
<p>We found public perception of locals in the Yunnan village to be overwhelmingly in favour of tobacco corporate social responsibility exercised through projects such as school sponsorships. An education bureau official denied that the tobacco sponsorships constituted tobacco marketing, stating that “this is a company giving back to the community.” </p>
<p>A school principal of one such tobacco Hope elementary school we visited stated that school sponsorship is “to show they are kind and care about the community … Contributing to a public cause is the best way to show kindness and repay locals.” The impact on students was swiftly dismissed by another principal, who said: </p>
<blockquote>
<p>“Sponsorship if purely financial, and not teaching students about tobacco.”</p>
</blockquote>
<p>Teachers employed by the school felt “gratitude to the tobacco company for improvements to our learning and teaching environment,” and have repeatedly mentioned the benefactor to their students. Students as young as Grade 5 expressed a wish “to study hard to repay” the company, and many thought “the tobacco company is kind.”</p>
<p>Some parents, however, were less enthusiastic, having reservations about the school’s name change following tobacco sponsorship. One parent called it “propaganda in disguise.” </p>
<p>While the Chinese tobacco control community agrees such corporate social responsibility projects constitute tobacco promotion, some were more lenient, citing local Chinese context of the tobacco industry’s status and pointing out financial needs the local government may not be ready to meet. </p>
<p>The situation is best summed up by a parent, who pointed out that “tobacco is bad, but money is money.”</p>
<h2>Going global</h2>
<p>Tobacco schools are not unique to China, and the industry’s support for education is present in at least two other countries. </p>
<p>CNTC has been operating a subsidiary in Zimbabwe since 2005. Tian Ze Tobacco Co specializes in tobacco leaf procurement <a href="http://www.chinaembassy.org.zw/chn/xwdt/t1419434.htm">and built an elementary school in 2010</a> in the farming community of Beatrice, and periodically donates school supplies and sports equipment. While referred to as <a href="https://www.herald.co.zw/zim-china-growing-a-forest-of-relations/">Dunnolly Primary School</a> in Zimbabwean media, Chinese sources call the school China Tobacco Ma Bo Hope Primary School, reportedly <a href="http://www.sohu.com/a/199385435_201960">named after a former Tian Ze Tobacco employee, Ma Bo</a>. </p>
<p>While CNTC’s Cambodian subsidiary Viniton Group has not built any schools, it is said to be an <a href="http://www.viniton.com/a/cn/news/20150929/73.html">active supporter of education</a>. In 2013, in the name of friendship, Viniton Group <a href="http://www.viniton.com/a/en/news/20130705/70.html">donated school supplies, desks and chairs to Hun Sen Primary School</a>. Viniton Group also <a href="http://www.viniton.com/a/cn/news/20150929/73.html">supported another school in 2015</a>, located near its new production plant.</p>
<p>CNTC has been <a href="https://blogs.bmj.com/tc/2019/08/01/china-tobacco-and-belt-and-road-initiative-the-new-go-global/">increasingly active on the international market</a> through implementing various strategies. The aim is to further expand global markets and establish more off-shore production facilities. </p>
<p>As CNTC aggressively expands its international presence, will the world be ready for the increasingly global reach of what it frames as its corporate social responsibility?</p>
<p>[ <em>Like what you’ve read? Want more?</em> <a href="https://theconversation.com/ca/newsletters?utm_source=TCCA&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=likethis">Sign up for The Conversation’s daily newsletter</a>. ]</p><img src="https://counter.theconversation.com/content/120961/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jennifer Fang receives funding from the National Cancer Institute, US National Institutes of Health grant R01-CA091021 and the Social Sciences and Humanities Research Council grant 430-2018-00736.</span></em></p>The Chinese National Tobacco Corporation is expanding its international markets through subsidiaries. Is the world ready for tobacco companies sponsoring or supporting schools?Jennifer Fang, Research fellow, Faculty of Health Sciences, Simon Fraser UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1198312019-07-04T12:24:15Z2019-07-04T12:24:15ZE-cigarettes: why I’m optimistic they will stub smoking out for good<figure><img src="https://images.theconversation.com/files/282659/original/file-20190704-51262-rrign9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/vape-cigarettes-585182902?src=0MkwCLbW4CEwEX3hxNGtMw-3-20&studio=1">Shutterstock/Lumen Photos</a></span></figcaption></figure><p>There are over a billion smokers across the world – a habit which causes more than <a href="https://www.who.int/news-room/fact-sheets/detail/tobacco">7m deaths per year</a>. We have known that <a href="https://tobaccocontrol.bmj.com/content/21/2/87">smoking kills for decades</a>, but this simple fact has not been enough to persuade every smoker to quit. </p>
<p>Even more surprising is that the vast amount of evidence about the risks of smoking hasn’t been enough to put people off starting to smoke in the first place. If knowing smoking kills doesn’t stop people from taking up the habit, what will? </p>
<p>I believe e-cigarettes provide real hope. Available since 2007, these devices often contain nicotine, the addictive substance in cigarettes, but without <a href="https://tobaccocontrol.bmj.com/content/23/2/133">many of the harmful toxicants</a>. Consequently, they are proving to be a seriously disruptive technology which is striking fear into the traditional tobacco industry.</p>
<p>Using <a href="https://www.gov.uk/government/publications/e-cigarettes-an-evidence-update">less harmful</a> ways of delivering nicotine to help people quit smoking is a tried and tested method for quitting smoking. Products like nicotine patches, gums and lozenges have been used <a href="https://tobaccocontrol.bmj.com/content/9/suppl_2/ii60#ref-1">since the 1980s</a> with some success. </p>
<p>E-cigarettes differ from these other products by providing a more similar feel to smoking. Users have to inhale a vapour which provides a throat “hit” similar to smoking. They also have to use the familiar motion of putting the product to their mouth, as they would with a cigarette. </p>
<p>Importantly, these products can provide <a href="https://truthinitiative.org/research-resources/emerging-tobacco-products/e-cigarettes-facts-stats-and-regulations">similar amounts of nicotine</a> to cigarettes, meaning they hold great potential for helping people to quit smoking.</p>
<h2>Do they actually help people quit smoking?</h2>
<p>E-cigarettes were originally designed to help people quit smoking, but until recently there has been little evidence to show that they work in this regard. This year, a <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa1808779">study was published</a> which explored how effective e-cigarettes are at helping people to quit smoking. </p>
<p>Participants in the study were assigned to one of two groups in which they either used nicotine replacement products of their choice or e-cigarettes. The findings not only showed that e-cigarettes were effective in helping people quit, but that e-cigarettes were more effective than nicotine replacement therapies. Nearly twice as many people in the study were still smoke free one year after quitting if they had used an e-cigarette compared to using nicotine replacement therapies. </p>
<p>Similarly in my own research, I have found that young people who use e-cigarettes to help them quit smoking are more likely to continue using them than continuing to smoke. Using e-cigarettes to quit smoking was the second most common reason the young people gave for why they had used an e-cigarette. </p>
<p>The most common reason was that they were curious. I think this says a lot about the popularity of the products. People are curious because there are so many users around, making smokers wonder whether e-cigarettes could help them too.</p>
<p>Indeed, e-cigarettes have generally proved to be extremely popular, with an estimated <a href="http://ash.org.uk/media-and-news/press-releases-media-and-news/large-national-survey-finds-2-9-million-people-now-vape-in-britain-for-the-first-time-over-half-no-longer-smoke/">2.9m users in the UK</a>, and around <a href="https://uk.reuters.com/article/us-health-ecigs-us-adults/almost-one-in-20-u-s-adults-now-use-e-cigarettes-idUKKCN1LC2DN">10.8m in the US</a>. Since they were introduced, the use of nicotine patches, gums and lozenges has <a href="http://www.smokinginengland.info/latest-statistics/">significantly decreased</a>. </p>
<p>This combination of effectiveness and popularity could spell the end for cigarettes by tempting more smokers to use e-cigarettes and quit smoking. There are still some users who haven’t tried them though, and this could be due to <a href="http://ash.org.uk/wp-content/uploads/2017/05/ASH-Adult-e-cig-factsheet-2018-corrected.pdf">misconceptions</a> that e-cigarettes are more harmful than cigarettes for users. </p>
<p>By dispelling these misconceptions, we could see an even bigger increase in the popularity of e-cigarettes and consequently a reduction in the amount of people smoking.</p>
<h2>An industry up in smoke?</h2>
<p>Even the tobacco industry seems to feel threatened by e-cigarettes, effectively responding to their popularity by trying to jump on the bandwagon. They have been developing their <a href="https://www.bat.com/ecigarettes">own rival products</a>, and buying shares in popular e-cigarette brands as a reaction to losing so much of their traditional customer base. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/282667/original/file-20190704-51288-1xiy4kt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/282667/original/file-20190704-51288-1xiy4kt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/282667/original/file-20190704-51288-1xiy4kt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/282667/original/file-20190704-51288-1xiy4kt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/282667/original/file-20190704-51288-1xiy4kt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/282667/original/file-20190704-51288-1xiy4kt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/282667/original/file-20190704-51288-1xiy4kt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Over and stubbed out?</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/cigarette-stub-quitting-smoking-180744572?src=rntt7zOHxYbWkzjvnFpDRA-1-19&studio=1">Shutterstock/phildaint</a></span>
</figcaption>
</figure>
<p>Some big tobacco companies have even made this part of their sustainability plan. To me, this reiterates that the industry cannot be sustained by the sale of tobacco cigarettes. Less harmful devices are eventually likely to eradicate sales.</p>
<p>I see great potential in e-cigarettes in the fight against tobacco. The evidence suggests that they are less harmful than cigarettes, more effective at helping people quit smoking than traditional nicotine replacement options, and popular. </p>
<p>All of this has the tobacco industry scared enough to invest in e-cigarettes because they fear for the sustainability of their traditional market. This makes me confident that e-cigarettes will be the disruptive technology which sees smoking stubbed out for good.</p><img src="https://counter.theconversation.com/content/119831/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jasmine Khouja does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>They’re effective – and popular.Jasmine Khouja, PhD Candidate, University of BristolLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1167612019-05-10T11:40:08Z2019-05-10T11:40:08ZWhat should British universities do about benefits received from past wrongs?<figure><img src="https://images.theconversation.com/files/273533/original/file-20190509-183083-12zgrgb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/panorama-cambridge-beautiful-sunset-sky-uk-501120658?src=mDEAUH0mLrUhWCI1V5H2Og-2-30">Shutterstock/Pajor Pawel</a></span></figcaption></figure><p>The University of Cambridge has <a href="https://www.bbc.co.uk/news/education-48097051">embarked on a project</a> to discover how it may have contributed to, and benefited financially from, slavery. This venture follows hot on the heels of a similar investigation at University College London, and a decision by the <a href="https://www.theguardian.com/world/2018/sep/22/glasgow-university-wealth-from-transatlantic-slave-trade-reparations">University of Glasgow to launch</a> a “reparative justice programme” after having discovered it made the equivalent of £200m from the transatlantic slave trade.</p>
<p>Not everyone has welcomed these developments however. Trevor Phillips, former head of the Equality and Human Rights Commission, <a href="https://www.telegraph.co.uk/news/2019/04/30/cambridge-university-inquiry-slave-trade-connections-virtue/">described the Cambridge inquiry</a> as “virtue signalling on steroids”, unlikely to reveal anything we don’t already know. He argues that the money might be better spent attempting to find solutions to some of the current challenges facing non-white people in Britain. </p>
<p>These inquiries form part of the growing debate in British and other universities about how their connections with various historic wrongs, especially those connected with slavery and colonialism, should be addressed. And superficially, there are two possible responses: either they should do nothing at all, or they should recognise the tainted benefit, raise awareness about it, make a full public apology, and provide appropriate recompense to the descendants of direct victims. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/should-a-nation-apologise-for-the-crimes-of-its-past-66525">Should a nation apologise for the crimes of its past?</a>
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</em>
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<p>But the histories of these institutions and the injustices themselves are extremely complex. So even if the first response is rejected, tricky issues arise with the alternative. </p>
<p>Let’s look first at the case for doing nothing. To begin with, distinctions need to be drawn between different kinds of historic wrongs, the benefits received, and degrees of culpability on the part of various institutions. </p>
<p>For example, by contrast with some of the cities in which they were established, British universities founded long after the formal abolition of slavery in most of the empire in 1833, are unlikely to have benefited directly from it. And any benefit derived from colonialism will probably have been shared by many other public and private institutions. </p>
<p>UK universities are, typically, also the beneficiaries of a range of other historic wrongs, with varying degrees of moral culpability. For example, construction of the University of Bristol’s iconic <a href="http://www.bristol.ac.uk/university/visit/tower-tours/">Wills Memorial Building</a> was financed largely by the Wills tobacco fortune. Other historic sources of morally suspect income might include those derived from industries that were harmful to workers, the general public, and the environment. </p>
<p>All of this may suggest that singling out certain kinds of morally contaminated funds is less than honest about the full historical record. Yet to start apologising for the full range could be regarded as a vacuous exercise in tokenism, virtue signalling, gesture politics and moral grandstanding. </p>
<h2>Healing wounds</h2>
<p>But even if we reject the “do nothing” position, questions remain about how we should rise to the challenge of making suitable amends. Should we, for example, tear down statues of enthusiastic <a href="https://www.theguardian.com/education/2016/jan/28/cecil-rhodes-statue-will-not-be-removed--oxford-university">imperialists like Cecil Rhodes</a>? </p>
<p>Or would it be better to keep them where they are, but add explanatory plaques exposing their hidden histories? Should we erect physical and virtual memorials to the victims, acknowledge the wrongs of the past, rename facilities which currently honour discredited historical figures, issue apologies, and find other ways of seeking to atone for the sins of our forebears? </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/273537/original/file-20190509-183083-1kabj8x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/273537/original/file-20190509-183083-1kabj8x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=411&fit=crop&dpr=1 600w, https://images.theconversation.com/files/273537/original/file-20190509-183083-1kabj8x.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=411&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/273537/original/file-20190509-183083-1kabj8x.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=411&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/273537/original/file-20190509-183083-1kabj8x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=516&fit=crop&dpr=1 754w, https://images.theconversation.com/files/273537/original/file-20190509-183083-1kabj8x.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=516&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/273537/original/file-20190509-183083-1kabj8x.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=516&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Bristol’s Wills Memorial Building.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/wills-memorial-building-landmark-university-bristol-30128479?src=38FwbSQo7VurZ0X22VNWPw-1-4">Shutterstock/Tupungato</a></span>
</figcaption>
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<p>Several things need to be considered if we proceed down this path. First, while history matters, the wrongs of the present more urgently require attention than those of the past. And although there is almost universal consensus on what many of these are – human trafficking, child abuse, racism – there is much less agreement on how others, including excessive private wealth, chronic poverty, and limited access to higher education on the part of disadvantaged groups, should be tackled. </p>
<p>We should certainly seek to learn from the past. But the temptation to see it only as a series of heroic struggles between the good guys and the bad guys should be resisted. </p>
<p>The uncomfortable fact is that, in reality, history was typically much more complex and multidimensional. Two eminent late 18th-century Cambridge alumni, <a href="http://www.bbc.co.uk/history/historic_figures/clarkson_thomas.shtml">Thomas Clarkson</a> and <a href="http://www.bbc.co.uk/history/historic_figures/wilberforce_william.shtml">William Wilberforce</a>, were for example, leading lights in the movement to abolish slavery. And the Wills family tobacco business pioneered canteens, free medical care, sports facilities and paid holidays for its workers.</p>
<p>The moral imperative to apologise for the behaviour of distant ancestors, far removed from responsibility or control, is difficult to determine. That said, in certain contexts, it may contribute to healing deep wounds. </p>
<p>Finally, where they can be identified, the descendants of the direct victims of past wrongs need to be consulted about what should be done now. The city of Bristol was, for example, not only directly involved in slavery and colonialism – it was also one of the first English cities where freed and escaped slaves established their own communities. </p>
<p>There are two main reasons why excluded voices, particularly those of their descendants, should be heard: first, they do not always chime with those which echo round the ivory towers; and second, unless inclusive consultations take place with such parties, subtle forms of elite domination are likely to remain.</p><img src="https://counter.theconversation.com/content/116761/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Steven Greer does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>History is complex and multi-dimensional. Any response to what happened in the past should reflect this.Steven Greer, Professor of Human Rights, University of BristolLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1123272019-03-13T09:44:21Z2019-03-13T09:44:21ZSmoking costs society dear – so why isn’t Big Tobacco paying its way?<figure><img src="https://images.theconversation.com/files/262428/original/file-20190306-100781-qpqbvq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/566174944?size=medium_jpg">Shutterstock</a></span></figcaption></figure><p>It is well known that some of the world’s biggest technical companies pay pitiful amounts of corporate tax. Now <a href="https://academic.oup.com/jpubhealth/advance-article-abstract/doi/10.1093/pubmed/fdz004/5307071?redirectedFrom=fulltext">our new research</a> has placed the tax returns of tobacco firms <a href="https://www.independent.co.uk/news/business/news/tobacco-companies-uk-corporation-tax-profits-university-bath-study-a8764841.html">under the spotlight</a>. </p>
<p>Despite the enormous harm they cause, and the massive profits they earn, it turns out that multinational tobacco companies pay almost no corporation tax in the UK. Given the <a href="https://www.theguardian.com/society/2018/may/28/nhs-deficit-last-year-twice-as-high-as-expected-say-sources">deficit in NHS funding</a>, this should spur the government into action. </p>
<p>Our work, supported by <a href="https://www.cancerresearchuk.org">Cancer Research UK</a>, drew on publicly available data from 2009 to 2016, a period when corporation tax rates varied between 20% and 28%. It showed that the four tobacco multinationals operating in the UK – two of which have British headquarters – are not paying corporation tax at anything like this rate. </p>
<p>For example, for four of these years British American Tobacco (BAT) paid absolutely no corporation tax and negligible amounts in the other years. Imperial Brands paid, at most, an effective rate of 13% – often much lower – and even received tax credits of up to £112m in some years. </p>
<p>In 2016, Imperial, BAT and Gallagher (Japan Tobacco International’s UK subsidiary) together made UK operating profits in excess of £1 billion – yet paid only £83.6m in corporation tax, a fraction of what might be expected. </p>
<p>No doubt they ensure this is legal, but it cannot be right. These are some of the world’s most profitable companies. They sell a highly addictive product that <a href="https://www.bbc.co.uk/news/health-31600118">kills two out of three</a> long-term users, imposing enormous suffering and costs on smokers, their families and society as a whole. </p>
<p>According to <a href="https://www.gov.uk/government/publications/towards-a-smoke-free-generation-tobacco-control-plan-for-england">recent government analysis</a>, the cost of smoking to the economy was £11bn in 2017 in England alone. Tobacco excise duties generated £9.5bn in the UK that year, leaving a deficit of at least £1.5bn – a deficit barely touched by the negligible corporation taxes paid.</p>
<p>Our research highlights some underpinning problems. First, the whole reporting system for corporation tax and company accounts in the UK is inadequate. It’s almost impossible to know exactly how much corporation tax is due because companies don’t have to report the profits they earn in the UK, nor offer full details of how their corporation tax payments have been calculated. </p>
<p>Second, like many other businesses, tobacco companies have clearly reorganised corporate structures to enable profits to be shifted overseas. </p>
<p>The bigger picture – the market failure causing the rot at the heart of our public health system and our NHS funding crisis – is more alarming still. It is the products of major corporations – not just tobacco, but highly processed foods, sugary drinks, and alcohol – that are the <a href="https://www.northumbria.ac.uk/about-us/news-events/news/2015/09/smoking-and-drinking-are-in-top-10-causes-of-death-in-uk/">major causes of death and illness</a> in the UK, and indeed globally. </p>
<p>Yet the profit-seeking companies producing these products remain incentivised to cause great harm, because the costs of that harm are offloaded on to others. Until the real costs of selling those products are factored into those companies’ bottom lines, the rot will continue and tax payers will pick up the tab. </p>
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<img alt="" src="https://images.theconversation.com/files/262431/original/file-20190306-100778-1haf5ue.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/262431/original/file-20190306-100778-1haf5ue.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/262431/original/file-20190306-100778-1haf5ue.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/262431/original/file-20190306-100778-1haf5ue.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/262431/original/file-20190306-100778-1haf5ue.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/262431/original/file-20190306-100778-1haf5ue.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/262431/original/file-20190306-100778-1haf5ue.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Money to burn?</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/burning-cigarette-smoke-on-black-background-173384390">Shutterstock</a></span>
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<p>Instead, corporations must be made to bear the costs of the harm they cause. A first step is to mandate more robust country by country reporting of tax and profits so that companies can no longer draw on their vast resources to play the system. </p>
<p>A simple second step would be to impose a corporation tax surcharge on companies whose products are damaging to health, to ensure they start to pay for the harm they cause. An 8% corporation tax surcharge is <a href="https://www.gov.uk/government/publications/bank-corporation-tax-surcharge">currently imposed on banks</a> in the UK. This could simply be extended to other companies. </p>
<h2>Increase tax, reduce consumption</h2>
<p>Increasing taxes on harmful products such as tobacco and alcohol excise duties, and the recent tax on sugary drinks, also plays a vital role in reducing consumption of those products while raising government revenues – a win-win situation. The fact that tobacco duties in the UK (among the highest in the world) only partially meet the true costs of tobacco shows how far we may need to go. </p>
<p>A <a href="https://www.theguardian.com/society/2019/mar/02/raise-legal-smoking-age-to-21-say-mps">new proposal</a> to force tobacco firms to pay a levy which will fund efforts to help smokers quit is to be welcomed. While this is unlikely to change the industry’s profit making – as it will be passed on to smokers in the form of higher prices – it would deter smoking while raising much needed revenue.</p>
<p><a href="https://tobaccocontrol.bmj.com/content/19/5/423">Price cap systems</a> have also been proposed and have the advantage that they would reduce the perverse profit incentives these companies have while also <a href="https://tobaccocontrol.bmj.com/content/23/1/45.short">raising government revenue</a>. In these systems the prices companies can charge on potentially health-damaging products is capped, reducing the profits from those products, but the cost the consumer faces does not drop because a higher excise duty would replace the foregone profits.</p>
<p>The public must make it clear it no longer wants to pay for the harms that these companies cause, and the government must urgently grasp this issue. This will require them to reject the self-interested overtures of the think-tanks promoting tax cuts and <a href="https://iea.org.uk/in-the-media/media-coverage/excessive-tobacco-duty-has-fostered-growing-black-market">claims</a> about their impacts, including that high excise duties are the primary driver of tobacco smuggling. </p>
<p>It is entirely unacceptable that enormously profitable companies are not paying for the harm they cause. Until they are, they remain incentivised to keep selling and promoting their health damaging products to the detriment of individual and global health.</p><img src="https://counter.theconversation.com/content/112327/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The research prompting this article was supported by Cancer Research UK (<a href="https://www.cancerresearchuk.org/">https://www.cancerresearchuk.org/</a>) and Gilmore’s contribution to the World Bank report detailed was supported by the World Bank. Anna Gilmore also currently receives funding from Bloomberg Philanthropies (<a href="http://www.bloomberg.org">www.bloomberg.org</a>) and the National Institute of Health Research. The Tobacco Control Research Group which she directs is part of the UK Centre for Tobacco and Alcohol Studies (UKCTAS), a UK Centre for Public Health Excellence funded by the UK Clinical Research Collaboration, and the Tobacco Control Capacity Programme funded by Research Councils UK as part of the Global Challenges Research Fund. She is a Council member of Action on Smoking and Health.</span></em></p><p class="fine-print"><em><span>J. Robert Branston currently receives funding from the National Institute for Health Research (NIHR), Cancer Research UK, and Bloomberg Philanthropies.</span></em></p>It is time governments made corporations pay for the harm they cause.Anna Gilmore, Professor of Public Health/Director, Tobacco Control Research Group, University of BathJ. Robert Branston, Senior Lecturer (Associate Professor) in Business Economics, University of BathLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1099902019-01-22T13:56:38Z2019-01-22T13:56:38ZWhy Nigeria needs a huge tobacco tax hike to curb smoking<figure><img src="https://images.theconversation.com/files/254726/original/file-20190121-100267-4wpb41.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Smoking is a major public health threat.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p><a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0202467">Cigarette sales</a> in most African countries are going up all the time. But smoking rates are much <a href="https://www.cancer.org/content/dam/cancer-org/cancer-control/en/reports/tobacco-use-in-africa-tobacco-control-through=prevention.pdf">lower</a> than in high-income countries. Because of these comparatively lower smoking prevalence rates – combined with the urgent need to address infectious diseases – tobacco control policies have largely not been prioritised. </p>
<p>Nigeria is a case in point. Preventing smoking rates from increasing requires a proactive response, including strong excise taxation policy change. The country has been slow to act. Last year it increased tobacco excise tax rates. But the increase was small and still falls well below the <a href="http://apps.who.int/iris/bitstream/handle/10665/44316/9789241563994_eng.pdf;jsessionid=729229D19644C225C765116071B04D54?sequence=1">World Health Organisation (WHO) recommended</a> excise tax burden of 70% – that’s the percentage that the excise tax should make up of the average retail price. </p>
<p>Sufficiently increasing tobacco excise tax in Nigeria is crucial to bring about meaningful change. But to how much? To answer this question the <a href="http://cseaafrica.org/">Centre for the study of the Economies of Africa</a>, with our support at the WHO Framework Convention on Tobacco Control <a href="https://untobaccocontrol.org/kh/taxation/">Knowledge Hub on Tobacco Taxation</a>, used a tobacco excise tax simulation model to evaluate the impact of various changes in the tobacco excise tax structure on government revenue and smoking prevalence. </p>
<p>The <a href="http://www.tobaccoinduceddiseases.org/The-economics-of-tobacco-control-in-Nigeria-modelling-the-fiscal-and-health-effects,84729,0,2.html">initial results</a> show that targeting an excise tax burden of 75% – taking into account different economic growth rates and industry pricing response – would result in an approximately 20% drop in cigarette consumption. As tobacco is an addictive substance, consumers will continue to spend on cigarettes, but less so. The simulation also showed that once the higher tax burden is reached, government revenue from tobacco excise taxes would increase by more than 100%. </p>
<p>It’s reasonable to assume that this level of change would need to be phased in over a couple of years. For instance, in 1994 South Africa announced that it wanted to reach an excise tax burden of <a href="http://www.tobaccoecon.uct.ac.za/sites/default/files/image_tool/images/405/People/Staff_research/Corne/van-walbeekcp-the-economics-of-tobacco-control-in-south-africa1.pdf">50%</a> by the late 1990s. This resulted in more than 100% increase in <a href="http://www.tobaccoecon.uct.ac.za/sites/default/files/image_tool/images/405/People/Staff_research/Corne/van-walbeekcp-the-economics-of-tobacco-control-in-south-africa1.pdf">government revenue</a> and 30% drop in aggregate smoking rates in 10 years.</p>
<h2>Nigeria’s challenges</h2>
<p>The WHO <a href="https://www.who.int/fctc/text_download/en/">Framework Convention on Tobacco Control</a> is the first global health treaty created to address the tobacco epidemic and the burden of death and disease associated with it. One of the convention’s key articles to reduce demand is the use of excise taxation on tobacco products. But it remains <a href="https://afro.who.int/sites/default/files/2017-06/who-fctc-10-year_report_web.pdf">underused</a> in most African countries. </p>
<p>Nigeria ratified the convention in 2005, but only enacted comprehensive tobacco control policies in 2015 with the <a href="https://www.tobaccocontrollaws.org/files/live/Nigeria/Nigeria%20-%20TCA%20-%20national.pdf">National Tobacco Control Act</a>, after years of strong industry opposition. Researchers have <a href="https://tobaccocontrol.bmj.com/content/early/2018/07/25/tobaccocontrol-2018-054344">emphasised</a> the role of civil society organisations in Nigeria in culminating this change. </p>
<p>But the act is limited in the provisions it makes for the use of price and tax measures. These are brief and not explicit.</p>
<p>Last year Nigeria increased the excise tax on cigarettes. Although a step in the right direction, the tax change fell short of bringing meaningful change: it fell way below the excise tax burden of 70% recommended by the <a href="http://apps.who.int/iris/bitstream/handle/10665/44316/9789241563994_eng.pdf;jsessionid=729229D19644C225C765116071B04D54?sequence=1">WHO</a>. </p>
<p>The Nigerian Tobacco Control Alliance – a tobacco control advocacy group consisting of several civil society organisations – argues that, even after the increase, the tobacco excise taxes are still too low. And it’s called for an <a href="https://www.premiumtimesng.com/news/more-news/286450-group-wants-more-increase-in-nigerias-tobacco-excise-duty.html">increase in rates</a> that amount to the WHO’s recommendation.</p>
<p>Nigeria should also consider a proposal put forward in the International Monetary Fund <a href="https://www.imf.org/en/Publications/CR/Issues/2018/03/07/Nigeria-Selected-Issues-45700">country report</a>. It has suggested a move from ad-valorem tax (levied in proportion to the estimated value of goods) to specific excise taxes (levied on the quantity of goods). This, it argues, is necessary to improve tax administration and revenue collection. It also suggests that real tobacco excise taxes be more than doubled over a three-year period. </p>
<h2>Why Nigeria matters</h2>
<p>A significant tax change in Nigeria is not only important for the health of Nigerians. It’s important for the continent because Nigeria is politically and economically important in Africa – and a strategically important <a href="https://www.ncbi.nlm.nih.gov/pubmed/28199720">policy trendsetter</a> within the West African region. </p>
<p>It’s also been a magnet for investment by tobacco companies. Both British American Tobacco and Japan Tobacco International have <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0202467">production facilities</a> in Nigeria. The British American Tobacco <a href="https://www.ncbi.nlm.nih.gov/pubmed/29137678">facility</a> in Nigeria is the regional headquarters. </p>
<p>The importance of Nigeria strengthening its tobacco excise tax policy is further increased by its strategic position within the Economic Community of West African States (ECOWAS), a West African regional economic bloc. </p>
<p>In December 2017 the ECOWAS Council of Ministries adopted a new tobacco tax directive. It requires members to apply a minimum ad valorem tax of 50% on the factory price as well as specific tax on clearly defined quantities of tobacco products. </p>
<p>The next step for this directive is country-level implementation, of which Nigeria could set an example for the region.</p>
<h2>What’s next</h2>
<p>So what’s next? To bring about meaningful change, it’s crucial that tobacco excise tax be increased even further in Nigeria, something more in line with the levels proposed by the International Monetary Fund and the Centre for the study of the Economies of Africa.</p><img src="https://counter.theconversation.com/content/109990/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Laura Rossouw previously received funding through a National Research Foundation chair. </span></em></p>Research shows that a higher excise tax rate on tobacco would result in a decrease in the number of people who smoke.Laura Rossouw, Senior Research Officer, Economics of Tobacco Control Project, University of Cape TownLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1043562018-11-08T10:17:52Z2018-11-08T10:17:52ZThe tobacco industry plays price games to make it even tougher to quit smoking<figure><img src="https://images.theconversation.com/files/244307/original/file-20181107-74783-17v4lab.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Cash tray.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/cigarette-british-pound-coins-ashtray-1070797088?src=b2IkyybXxLIEsSoLo6jZSg-1-0">Shutterstock</a></span></figcaption></figure><p>It is thought about <a href="https://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/index.htm">two in three smokers</a> want to kick their deadly habit, and with good reason – the same proportion of them <a href="https://www.bbc.co.uk/news/health-31600118">are believed to die prematurely</a> because of smoking. Around the world, the habit <a href="http://www.who.int/news-room/fact-sheets/detail/tobacco">kills more than 6m</a> people a year. </p>
<p>Yet quitting is notoriously difficult. Smoking tobacco is an <a href="https://www.nhs.uk/common-health-questions/lifestyle/why-is-smoking-addictive/">addictive habit</a> that the UK Royal College of Physicians <a href="https://www.theguardian.com/uk/2000/feb/08/smoking1">has likened</a> to heroin and cocaine addiction.</p>
<p>But this doesn’t mean there is nothing we can do. The <a href="https://tobaccocontrol.bmj.com/content/20/3/235">evidence suggests</a> that increases in tobacco taxation are the most effective means of reducing tobacco use. These taxes, <a href="https://www.who.int/tobacco/mpower/raise_taxes/en/">recommended by the World Health Organization</a> and the <a href="https://www.worldbank.org/en/topic/tobacco">World Bank</a>, increase the price of tobacco products in shops, reducing their affordability – a situation which encourages smokers to quit, and deters others from starting in the first place. </p>
<p>Taxation is particularly important because <a href="https://tobaccocontrol.bmj.com/content/23/e2/e89">lower income smokers are less likely to respond</a> to many other anti-tobacco campaigns and regulations intended to encourage quitting. Yet such smokers, including many young people, are the most sensitive to price increases. </p>
<p>If addiction alone wasn’t enough, an added challenge for kicking the habit is that tobacco companies simply don’t want smokers to quit. They don’t want to lose their customers and the substantial profits they provide. </p>
<p>It is therefore unsurprising that the tobacco industry has a <a href="http://www.who.int/tobacco/publications/industry/who_inquiry/en/">well-documented history</a> of undermining regulations that seek to control the use and sale of tobacco for the benefit of public health. For instance, the largest tobacco companies have continued to <a href="https://www.theguardian.com/world/2018/mar/09/how-children-around-the-world-are-exposed-to-cigarette-advertising">market cigarettes to children across the globe </a> despite claiming not to do so, and often in places where <a href="https://www.takeapart.org/tiny-targets/">advertising is banned</a>. In the UK, where tobacco advertising is banned, Philip Morris International has effectively circumvented the ban with its <a href="https://www.bbc.co.uk/news/business-45932048">recently launched “stop smoking” campaign</a> which actually still promotes its tobacco products. </p>
<h2>Paying a heavy price</h2>
<p>While many of these tactics are obvious, some are harder to detect. Our <a href="https://doi.org/10.1136/tobaccocontrol-2017-053891">latest research</a> exposes another – how the tobacco industry’s pricing tactics in the UK minimise the intended public health impact of tobacco tax increases. </p>
<p>Tobacco companies offer a range of cheaper products to help keep people smoking (and entice new consumers to start) while also offering a suite of higher priced brands to really cash in on those unable or unwilling to quit. </p>
<p>When tobacco taxes are increased, they play with their pricing to undermine the impacts of the tax increases on smoking. They absorb the tax increases, particularly on the cheapest brands, delaying and staggering the intended tobacco price rises. In this way, price increases are applied gradually to their portfolio of brands to ensure smokers never face a sudden quit-inducing price jump when the government increases taxes.</p>
<p>Further tactics adopted by the industry include <a href="https://www.bbc.co.uk/news/uk-42864685">shrinkflation</a> – cutting the number of cigarettes in a pack to disguise price rises and prevent the cost of a packet of tobacco being tipped over certain psychological levels. </p>
<p>Reducing the number of cigarettes in a pack from 20 to 19, 18 or even 17, while keeping the price stable means the higher cost per cigarette isn’t immediately obvious to most smokers – and the producer can make greater profits. </p>
<p>The industry also used price marked packaging to limit the ability of retailers to increase their small mark-up on tobacco sales as a further way of keeping tobacco cheap. Sales of ten-cigarette packs increased and very small packs of loose tobacco (10g or less) were introduced. These small packets appeal to the most price sensitive smokers as they cost less to buy. </p>
<p>Such tactics and small packs <a href="https://www.bbc.co.uk/news/uk-39984887">have recently been banned in the UK</a> with the <a href="https://www.gov.uk/government/publications/packaging-of-tobacco-products">introduction of standardised packaging</a> (where tobacco has to be sold in a standardised format with drab packaging) but are still available elsewhere. The <a href="http://www.cityam.com/260508/budget-2017-new-cigarette-tax-based-pack-price-735">UK has also introduced</a> a new minimum excise tax which puts the average price at
<a href="https://www.ons.gov.uk/economy/inflationandpriceindices/timeseries/czmp">over £10 for a packet of 20 cigarettes</a>)
stopping the sale of ultra cheap mainstream tobacco products.</p>
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<p>Ultimately the tobacco industry wouldn’t be manipulating price if it wasn’t so effective in ensuring young people take up smoking and in preventing existing smokers from quitting. So what more can we do?</p>
<h2>Stubbing it out</h2>
<p>Further restricting industry use of pricing tactics would be a good option. Companies could be limited in the number of brands and brands variants they sell to cut down on the range of prices on offer, and in the number of times they can change prices in order to remove their ability to smooth prices and directly undermine the public health benefits of tax increases. </p>
<p>There is even a <a href="https://researchportal.bath.ac.uk/en/publications/the-case-for-ofsmoke-how-tobacco-price-regulation-is-needed-to-pr">case for directly regulating</a> tobacco prices in the same way that prices for public utility services, <a href="https://www.ofwat.gov.uk/">such as water</a> and electricity are often determined by independent government agencies. Public utilities are important services, which is why the government looks to protect the public from company pricing choices – but then tobacco is a very addictive and deadly product where price matters too.</p>
<p>Meanwhile, Bloomberg Philanthropies <a href="https://www.bath.ac.uk/announcements/major-funding-announcement-puts-bath-tcrg-at-centre-of-new-20-million-global-industry-watchdog/">recently announced</a> a US$20m investment to create <a href="https://www.bloomberg.org/program/public-health/stoptobacco/">STOP</a> (Stopping Tobacco Organisations and Products) – a global tobacco industry watchdog to help expose more of these practices. The <a href="http://www.bath.ac.uk/health/research/tobacco-control/">Tobacco Control Research Group</a> at the University of Bath is one of three partners funded to lead this initiative. </p>
<p>The public can cannot afford to let the industry operate under the radar when the product they make kills two out of three long-term users. This new partnership will serve as a necessary watchdog to expose their deadly tactics.</p><img src="https://counter.theconversation.com/content/104356/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>J. Robert Branston receives funding from the National Institute for Health Research (NIHR), Cancer Research UK, and Bloomberg Philanthropies.</span></em></p><p class="fine-print"><em><span>Anna Gilmore receives funding via the Tobacco Control Research Group from Bloomberg Philanthropies, Cancer Research UK and the National Institute of Health Research. The TCRG is part of the UK Centre for Tobacco and Alcohol Studies (UKCTAS), a UK Centre for Public Health Excellence funded by the UK Clinical Research Collaboration, and the Tobacco Control Capacity Programme funded by Research Councils UK as part of the Global Challenges Research Fund.</span></em></p><p class="fine-print"><em><span>Rosemary Hiscock receives funding from Cancer Research UK and the National Institute for Health Research. She has previously received funding from the US National Institute for Health, EU FP7 and Horizon 2020, ESRC, UKCTCS and the Joseph Rowntree Foundation. She is a member of and volunteers for the Liberal Democrat Party. </span></em></p>Economic tactics play a big part in a habit that’s hard to break.J. Robert Branston, Senior Lecturer (Associate Professor) in Business Economics, University of BathAnna Gilmore, Professor of Public Health/Director, Tobacco Control Research Group, University of BathRosemary Hiscock, Research Associate, University of BathLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/868722017-11-22T11:21:42Z2017-11-22T11:21:42ZTobacco hurts more than just your lungs – it damages the communities that grow it<figure><img src="https://images.theconversation.com/files/194058/original/file-20171109-13329-1mgnx98.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Eleanor Jew</span>, <span class="license">Author provided</span></span></figcaption></figure><p>The Kipembawe Division is hidden in the southern highlands of south-west Tanzania, a long seven-hour drive north from the city of Mbeya. The scenery is stunning, yet when you look closer you can see that tobacco plants dominate agricultural areas, and the sound of trees being felled is a constant background noise.</p>
<p>Just the word “tobacco” conjures up vivid imagery of death and disease, as depicted on graphic cigarette packets and through hard-hitting anti-smoking campaigns. But tobacco’s impact starts long before it is found wrapped in a cigarette, and affects many more people than the estimated <a href="http://www.who.int/mediacentre/factsheets/fs339/en/">one billion smokers</a> worldwide.</p>
<p>Tobacco also impacts the health and well-being of the people who grow it and the environment where it is grown, often with devastating consequences. My colleagues and I have recently published research demonstrating just how damaging it can be <a href="http://onlinelibrary.wiley.com/doi/10.1002/ldr.2827/full">to the environment</a> <a href="http://etheses.whiterose.ac.uk/12380/">and communities</a> in rural Tanzania.</p>
<p>Most villages in Kipembawe don’t have electricity or mobile phone coverage. There are minimal healthcare facilities, and water is obtained from wells and rivers. There are few crops people can grow to make money and the dominant one is tobacco, farmed by 86% of the 196 households we surveyed. In Tanzania, 47% of the population lives below the <a href="http://www.worldbank.org/en/country/tanzania/overview">international poverty line</a> and rural poverty rates are even higher, where most people are reliant on agriculture.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/194061/original/file-20171109-13329-166lnkt.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/194061/original/file-20171109-13329-166lnkt.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/194061/original/file-20171109-13329-166lnkt.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/194061/original/file-20171109-13329-166lnkt.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/194061/original/file-20171109-13329-166lnkt.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/194061/original/file-20171109-13329-166lnkt.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/194061/original/file-20171109-13329-166lnkt.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Nutrient-hungry crop.</span>
<span class="attribution"><span class="source">Eleanor Jew</span></span>
</figcaption>
</figure>
<p>In Africa, tobacco cultivation is often associated with the presence of a dry tropical woodland called “miombo”, which dominates Kipembawe. Miombo woodland covers over <a href="http://wwf.panda.org/what_we_do/where_we_work/miombo_woodlands/">2.4m km²</a> in Africa, but is undergoing rapid deforestation and degradation throughout its range. Both tobacco and miombo trees like sandy, slightly acidic soils.</p>
<p>Unfortunately, these soils don’t contain many nutrients, and tobacco is one of the most <a href="http://tobaccocontrol.bmj.com/content/9/2/217">nutrient-hungry</a> crops there is. This means farmers must clear more woodland almost every year to create new fields, because the land can only support one or two cropping cycles.</p>
<p>For tobacco leaves to be preserved for transportation and further processing they must be dried or cured. This places another burden on the trees, which are used for fuel. In total, approximately <a href="http://onlinelibrary.wiley.com/doi/10.1002/ldr.2827/full">4,134 hectares</a> of woodland are cleared annually within Kipembawe. This <a href="http://www.sciencedirect.com/science/article/pii/S0006320715301336">reduces biodiversity</a> and the benefits the local environment can provide people, including <a href="http://www.sciencedirect.com/science/article/pii/S0378112715006179">carbon storage</a>, firewood, building materials and fresh water.</p>
<h2>Risks to farmers</h2>
<p>But woodland clearance is just the start of the process. Throughout the growing season, farmers apply several rounds of fertiliser and pesticides to the crop, yet few farmers understand the <a href="http://tobaccocontrol.bmj.com/content/21/2/191?utm_source=TrendMD&utm_medium=cpc&utm_campaign=TC_TrendMD-0">risks associated</a> with their use. During our time in Kipembawe, we didn’t see anyone using protective clothing or equipment, exposing farmers, families and labourers to harmful chemicals.</p>
<p>What’s more, despite regulations that aim to reduce the impact of fertilisers on water sources, the crops are often initially grown close to rivers so that the distance to carry water is shorter. This means the only source of drinking water for livestock can become contaminated, causing conflict between livestock keepers and tobacco farmers.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/194060/original/file-20171109-13337-1un6fbo.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/194060/original/file-20171109-13337-1un6fbo.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/194060/original/file-20171109-13337-1un6fbo.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/194060/original/file-20171109-13337-1un6fbo.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/194060/original/file-20171109-13337-1un6fbo.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/194060/original/file-20171109-13337-1un6fbo.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/194060/original/file-20171109-13337-1un6fbo.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Young farmers.</span>
<span class="attribution"><span class="source">Eleanor Jew</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Child labour within tobacco growing is a also well-known issue, and the main tobacco organisations have joined the <a href="http://www.eclt.org/">Eliminating Child Labour in Tobacco Growing Foundation</a>. But we saw children working in the fields, and evidence from primary schools indicates that children are likely to start working on their parents’ fields from around the age of 13.</p>
<p>While this has obvious consequences for their education, there are also severe health impacts. <a href="https://www.cdc.gov/niosh/topics/greentobaccosickness/default.html">Green tobacco sickness</a> is a form of nicotine poisoning that occurs when the tobacco leaves are wet and contact the skin. Nicotine is absorbed through the skin, and leads to fever, vomiting and dizziness. While it rarely results in death it can be extremely frightening to children, who are <a href="https://www.theguardian.com/world/2009/aug/24/malawi-child-tobacco-pickers-poisoned">more susceptible</a> to severe symptoms due to a lack of nicotine tolerance and smaller body size.</p>
<h2>Little other choice</h2>
<p>So why do farmers grow tobacco? Many people have few alternative ways to make a living and farmers can get a good price for top quality tobacco. This money can <a href="http://etheses.whiterose.ac.uk/12380/">significantly improve</a> the lives of the farmers, enabling them to pay school fees, invest in other businesses, and afford bicycles and solar electricity.</p>
<p>Some men spend their money during the weeks after harvest drinking in the local pubs and pop-up bars which emerge. Canny women brew home beer from maize, and make a roaring trade. But prostitutes also flock to the area around this time, raising the risk of STI transmission. HIV rates in Mbeya are the third highest in the country, with <a href="https://dhsprogram.com/pubs/pdf/AIS11/AIS11.pdf">nine per cent of 15-49 year olds</a> testing positive for HIV – four per cent higher than the national average. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/194062/original/file-20171109-13303-z318o8.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/194062/original/file-20171109-13303-z318o8.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/194062/original/file-20171109-13303-z318o8.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/194062/original/file-20171109-13303-z318o8.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/194062/original/file-20171109-13303-z318o8.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/194062/original/file-20171109-13303-z318o8.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/194062/original/file-20171109-13303-z318o8.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Crop collectors.</span>
<span class="attribution"><span class="source">Eleanor Jew</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Despite the <a href="http://www.who.int/fctc/en/">2005 World Health Organisation’s Framework Convention on Tobacco Control</a> and falling smoking rates, global population growth means total tobacco use looks <a href="http://www.healthdata.org/news-release/despite-declines-smoking-rates-number-smokers-and-cigarettes-rises">likely to keep rising</a> in the foreseeable future. But in Kipembawe, the deforestation associated with tobacco cultivation will ultimately make production unviable because there will be no fuel left to cure the crop. This will leave the community without a significant source of income and a degraded environment.</p>
<p>If people had other ways to make their living, it would help reduce the social and environmental burdens of tobacco production, but opportunities are limited. Tobacco production could be made more sustainable using alternative drying methods, reforestation, more efficient use of fertilisers and pesticides and land use management plans. But extensive training and support is needed, and child labour must be eliminated. </p>
<p>All of this will be difficult while there is such great demand for tobacco. So next time you think about lighting up, remember it’s not just your health at risk. Kicking the habit could save both trees and children’s chances.</p><img src="https://counter.theconversation.com/content/86872/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Eleanor Jew receives funding from the Natural Environment Research Council.</span></em></p>New research shows just how bad tobacco farming can be for the environment and for farmers.Eleanor Jew, Researcher in Conservation and Agriculture, University of LeedsLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/772342017-05-05T02:14:58Z2017-05-05T02:14:58ZWorld Trade Organisation gives Australia’s plain tobacco packs the (draft) thumbs up<p>The World Trade Organisation (WTO) has <a href="https://www.bloomberg.com/news/articles/2017-05-04/wto-said-to-uphold-australia-s-ban-on-cigarette-logos">reportedly</a> backed Australia’s laws on plain tobacco packaging implemented from December 2012.</p>
<p>The apparent decision marks the end of the last of three cases brought against Australia’s plain packaging; it will almost certainly open the floodgates and see other nations implementing the measure.</p>
<p>However, the report quoted two unnamed sources and no details of the final decision, which will be formally available in July. It is also not clear which precise stage of the dispute we’re at. Depending on the accuracy of the media report, there may well be <a href="https://www.wto.org/english/thewto_e/whatis_e/tif_e/disp1_e.htm">three of four more stages</a> before the report is finalised, outlined here:</p>
<ul>
<li><p>first draft: the panel submits the descriptive (factual and argument) sections of its report to the two sides, giving them two weeks to comment. This report does not include findings and conclusions.</p></li>
<li><p>interim report: the panel then submits an interim report, including its findings and conclusions, to the two sides, giving them one week to ask for a review.</p></li>
<li><p>review: the period of review must not exceed two weeks. During that time, the panel may hold additional meetings with the two sides.</p></li>
<li><p>final report: a final report is submitted to the two sides and three weeks later, it is circulated to all WTO members. If the panel decides the disputed trade measure does break a WTO agreement or an obligation, it recommends the measure be made to conform with WTO rules. The panel may suggest how this could be done.</p></li>
<li><p>ruling: the report becomes the ruling or recommendation within 60 days unless a consensus rejects it. Both sides can appeal the report (and in some cases both sides do).</p></li>
</ul>
<h2>What is the WTO dispute?</h2>
<p>Several minnow nations in global tobacco trade (Cuba, the Dominican Republic, Honduras) joined by a major tobacco grower and consumer, Indonesia, brought the case to the WTO. Ukraine had earlier been part of the action, but withdrew.</p>
<p>The applicants argued that Australia’s plain packs breach the WTO’s General Agreement on Tariffs and Trade, Agreement on Technical Barriers to Trade, and Agreement on Trade-related Aspects of Intellectual Property Rights, in that they are discriminatory, more trade restrictive than necessary, and unjustifiably infringe upon trademark rights. The WTO has been working on the dispute for the past five years.</p>
<p>The final decision will be open to appeal from July, which may excite the tobacco industry with the prospects of further delaying the will of other nations to introduce their own plain packaging legislation.</p>
<p>Nations, not companies, must bring disputes to the WTO. But <a href="http://www.mccabecentre.org/focus-areas/tobacco/dispute-in-the-world-trade-organization">British American Tobacco and Philip Morris</a> have ploughed support into the case. The companies spent many millions fighting plain packs in Australia and the UK.</p>
<h2>The long fight against plain packaging</h2>
<p>The WTO case is the third failed attempt by Big Tobacco and its national supporters to wreck plain packaging using laws and treaties.</p>
<p>In October 2012, the full bench of Australia’s <a href="http://www.hcourt.gov.au/cases/case-s389/2011">High Court</a> upheld plain packaging law in a humiliating 6-1 judgement. But there was worse to come for the tobacco companies and their vast, deep pockets. </p>
<p>In June 2011, Philip Morris Asia took Australia to the <a href="https://pca-cpa.org/en/home/">Permanent Court of Arbitration</a> in an investor-state dispute.</p>
<p>There were three arbitrators: Australia appointed Professor Don McRae of the University of Ottawa; Philip Morris Asia appointed Professor Gabrielle Kaufmann-Kohler; and the Permanent Court of Arbitration appointed Professor Dr Karl-Heinz Böckstiegel as the presiding arbitrator. </p>
<p>In the final judgement in <a href="http://www.abc.net.au/news/2016-05-17/philip-morris-loses-legal-battle-against-plain-packaging-laws/7420356">May 2016</a> all three arbitrators – including the Philip Morris Asia appointed arbitrator – supported the Australian government’s law.</p>
<p>Today’s news should be three strikes and out for any legal fantasies that Big Tobacco has about legally strangling nations’ rights to legislate plain packaging.</p>
<p>But past form will almost guarantee these companies will continue to intimidate particularly small, impoverished nations. Big Tobacco will continue to launch domestic law cases against plain packaging where the costs of defending laws against wealthy transnationals may be daunting. </p>
<p>Big Tobacco has been implicated in <a href="http://www.bbc.com/news/av/uk-34970163/panorama-the-secret-bribes-of-big-tobacco">bribery allegations</a>, and tobacco companies may pay special attention to nations with <a href="http://www.transparency.org/research/cpi/overview">high corruption indexes</a> where nascent efforts to introduce plain packaging might be easily distracted.</p>
<h2>Eyes on Australia</h2>
<p>There has been immense international interest in what has happened in Australia with plain packs. Some 54 months after Australia implemented standardised plain tobacco packaging, here’s the state of play in 18 nations:</p>
<ul>
<li>six nations have legislated for and have implemented or will shortly be implementing plain packaging (Australia, France, UK, Norway, Ireland and Georgia)</li>
<li>three nations have legislated but not yet implemented (Hungary, New Zealand, Slovenia)</li>
<li>seven nations have legislation in early stages or under formal consideration (Belgium, Canada, Finland, Mauritius, Singapore, South Africa, Sweden, Uruguay)</li>
<li>two nations have signs of early political momentum (Brazil, Chile). While Chile does not have what is officially described as plain packaging, it has graphic warnings that take up the front and back of packs.</li>
</ul>
<h2>Why is the WTO case important?</h2>
<p>The essence of the WTO case is whether nations have a right to introduce laws intended to protect and promote the health of their citizens. </p>
<p>In all this, we need to reflect that there are many examples of governments introducing strong restrictions, bans or penalties on the sale or promotion of commercial products for cultural or health reasons. </p>
<p>Many nations, including Australia, severely restrict civilian access to firearms; asbestos products are banned in several nations; pharmaceutical products are subject to stringent formulation, dosage, access, packaging and sales controls, with direct-to-consumer advertising of prescribed products allowed in only two nations (the USA and New Zealand); several Islamic nations prohibit the sale of alcohol; food safety regulations have been accepted as the norm for many decades; many nations impose strict quarantine regulations on importing exotic animals, insects and biological material.</p>
<p>We have not seen, for example, firearms manufacturers lobbying nations to bring cases to the WTO or other global tribunals to force such nations to relax their gun control laws. This is because of the principle of nations being able to have sovereignty over their own internal laws and regulations.</p>
<p>Restrictions and regulations on tobacco packaging need to be seen against this background and against the exceptionally deadly and addictive status of tobacco – a product which sees <a href="https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-015-0281-z">two in three of its long-term</a> users die prematurely. </p>
<p>In this, tobacco is unique among all consumer goods. It is one of the reasons why tobacco was also the subject of the world’s first global health treaty, the <a href="http://www.who.int/fctc/en/">World Health Organisation’s Framework Convention on Tobacco Control</a>, now ratified by 180 nations, representing 89% of the world’s population.</p>
<p>Take a giant global bow, <a href="https://en.wikipedia.org/wiki/Nicola_Roxon">Nicola Roxon</a>, the former Labor health minister and attorney general who championed plain tobacco packaging in Australia during the Rudd and Gillard governments against trenchant opposition from the global tobacco industry.</p>
<hr>
<p><em><a href="https://ses.library.usyd.edu.au/bitstream/2123/12257/7/9781743324295_Chapman_RemovingtheEmperorsClothes_FT.pdf">Removing the emperor’s clothes: Australia and tobacco plain packaging</a> by Simon Chapman and Becky Freeman, is freely available to download.</em></p><img src="https://counter.theconversation.com/content/77234/count.gif" alt="The Conversation" width="1" height="1" />
The World Trade Organisation (WTO) has reportedly backed Australia’s laws on plain tobacco packaging implemented from December 2012. The apparent decision marks the end of the last of three cases brought…Simon Chapman, Emeritus Professor in Public Health, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/752112017-04-11T01:10:35Z2017-04-11T01:10:35ZTobacco tax hikes are great, so long as you’re not a poor smoker<figure><img src="https://images.theconversation.com/files/163780/original/image-20170404-21933-o1dsau.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Increases in tobacco taxes hurt low-income smokers, who are already stigmatised.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/309470237?src=cIbb4_3uNegpuucjyRleCA-1-2&size=medium_jpg">from www.shutterstock.com</a></span></figcaption></figure><p>Tobacco tax increases in Australia that will see a packet of cigarettes costing A$40 may discourage smoking, but will end up having unintended consequences for poorer smokers, new research shows.</p>
<p>According to our recently published <a href="http://tobaccocontrol.bmj.com/content/early/2017/04/07/tobaccocontrol-2016-053608">paper</a>, low-income smokers who continue to smoke will have to spend more of their limited incomes on tobacco, potentially foregoing other household expenses, like food. Poorer smokers will also be further stigmatised by continuing to smoke.</p>
<p>We argue that equity issues need to be considered when implementing tobacco tax increases, and revenue raised by tax hikes need to be earmarked for helping low-income communities where smoking rates remain high.</p>
<h2>Tax increases blow household budgets, maintain stigma</h2>
<p>Last year’s federal budget included an <a href="http://budget.gov.au/2016-17/content/glossies/tax_super/html/tax_super-05.htm">increase in tobacco excise</a> of 12.5% per year. The increase was approved for four years, meaning that by 2020, the cost of a pack of cigarettes will be A$40, <a href="http://www.dailymail.co.uk/news/article-3572856/The-expensive-cigarettes-world-Aussies-pay-23-pack-25-huge-tax-hike.html">one of the most expensive</a> in the world.</p>
<p>The Australian government policy to increase tobacco tax is in keeping with overwhelming support from public health experts. This includes the <a href="http://www.who.int/tobacco/mpower/raise_taxes/en/">World Health Organisation</a>, which describes tobacco taxation as:</p>
<blockquote>
<p>the single most effective way to encourage tobacco users to quit.</p>
</blockquote>
<p>But support for tobacco tax increases among public health experts is not universal. <a href="http://www.instituteofhealthequity.org/projects/fair-society-healthy-lives-the-marmot-review/fair-society-healthy-lives-full-report">A UK review</a> of health inequalities research, led by <a href="http://www.who.int/social_determinants/thecommission/marmot/en/">Sir Michael Marmot</a>, concluded that governments should not increase tobacco taxes as this potentially can increase health inequalities.</p>
<p>While increased tobacco prices may <a href="http://www.iarc.fr/en/publications/pdfs-online/prev/handbook14/handbook14-6.pdf">prevent many people from starting smoking</a> and encourage <a href="https://www.mja.com.au/journal/2011/195/8/impact-2010-tobacco-tax-increase-australia-short-term-smoking-cessation">current smokers to quit</a>, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1448232/">not all smokers</a> will cut back or stop smoking.</p>
<p>For instance, low-income smokers tend to find it <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2948137/">harder to quit</a> than higher-income smokers. This is particularly relevant as <a href="http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129549848">nearly one in four</a> of the poorest people smoke. </p>
<p>The increased cost of cigarettes for these smokers may mean they have <a href="https://www.ncbi.nlm.nih.gov/pubmed/26116583">less income</a> for individual or family expenses. In New Zealand, for instance, low-income smokers who continued smoking after a tax increase faced <a href="http://europepmc.org/abstract/med/27639173">considerable financial difficulties</a>. The same study found participants viewed tobacco tax increases as:</p>
<blockquote>
<p>evidence of an uncaring state that punished its most disadvantaged citizens. </p>
</blockquote>
<p>Efforts to decrease tobacco use at a population level can unintentionally stigmatise communities (typically poor or marginalised ones) in which smoking remains high. In the UK, for instance, smokers are often characterised as being poor or low class, which has led to <a href="https://www.cambridge.org/core/journals/journal-of-social-policy/article/smoking-stigma-and-social-class/591A7937A4EBE3D610E94882F6A424D8">stigmatisation</a> for smoking <em>and</em> for being poor. </p>
<h2>Could tax hikes boost illegal trade?</h2>
<p>When the latest round of tobacco tax increases was announced, some said higher prices could lead to <a href="http://www.news.com.au/finance/economy/australian-economy/illegal-tobacco-industry-flourishing-in-australia-as-government-hikes-taxes/news-story/c1d28c0a1919d0fbcc499579a2386b28">increases in illegal tobacco trade</a>, as smokers would be tempted to buy cheaper tobacco from unofficial sources.</p>
<p>While tax increases <a href="http://tobaccocontrol.bmj.com/content/7/1/66">are not usually the driver</a> of illicit trade, they can play a role in <a href="https://www.ncbi.nlm.nih.gov/pubmed/11473911">stimulating demand</a> for cheaper products, particularly in poor communities.</p>
<p>The tobacco industry has <a href="http://tobaccocontrol.bmj.com/content/22/2/e1">pushed back</a> against tax hikes, arguing tobacco taxes will lead to increased smuggling and divert enforcement efforts away from other crimes.</p>
<p>This, and the industry’s argument that tax hikes <a href="http://www.tobaccoinaustralia.org.au/13-10-a-regressive-tax-">harm the poor</a>, have
led to the tobacco industry gaining <a href="http://tobaccocontrol.bmj.com/content/22/2/e1">non-traditional allies</a> such as labour trade unions and police to campaign against tax increases. </p>
<p>In Canada, for instance, the tobacco industry joined forces with unions, the retail sales sector and journalists to lobby against tobacco tax hikes, leading to a <a href="https://www.ncbi.nlm.nih.gov/pubmed/16681189">reversal</a> of a tobacco tax increase in the early 1990s. This was at a time when the tobacco industry was directly involved in <a href="https://www.ncbi.nlm.nih.gov/pubmed/18724578">tobacco smuggling</a>.</p>
<h2>Avoiding unnecessary harms</h2>
<p>While tobacco tax increases are <a href="https://www.iarc.fr/en/publications/pdfs-online/prev/handbook14/handbook14-0.pdf">good for the majority</a>, we need to ensure poor smokers don’t bear the negative impacts.</p>
<p>First, we need better data to understand how tobacco tax increases affect low-income and other disadvantaged communities. We could use existing population surveys to collect this information or conduct new research. Before any future tobacco tax increases, researchers could <a href="http://hiaconnect.edu.au/old/files/EFHIA_Framework.pdf">analyse policies</a> before they are implemented to identify potential harms and offer recommendations, particularly for low-income or disadvantaged smokers.</p>
<p>Secondly, we could use revenue from the tax increase to support health and well-being in lower income communities, including tobacco control programs. Currently, revenue from the tobacco tax increase is not ring-fenced for tobacco control programs. But it could be easily appropriated to health programs, particularly for low-income communities, or other novel approaches that don’t just reduce consumption but aim for a completely <a href="http://tobaccocontrol.bmj.com/content/25/5/594">tobacco-free population</a> (known as <a href="https://theconversation.com/its-time-to-focus-on-an-endgame-for-tobacco-regulation-72084">end game strategies</a>). </p>
<p>We also need to work with communities to determine viable tobacco control strategies, including talking to them about tobacco taxes and <a href="https://pbnetwork.org.uk/category/geographic/england/">how revenue is used</a>.</p>
<p>Finally, the Australian government needs to stay vigilant on tobacco industry activities, particularly those using “equity” or smuggling arguments (as <a href="https://www.ncbi.nlm.nih.gov/pubmed/16681189">Canada’s experience</a> showed), and to continue to monitor illicit trade.</p>
<p>Through considering the potential unintended consequences of the tobacco tax increase, policymakers can ensure that they’re contributing to a decline in overall tobacco use, while making sure disadvantaged smokers aren’t harmed in the process.</p><img src="https://counter.theconversation.com/content/75211/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Katherine Smith has previously received funding from the Economic and Social Research Council in the UK, the Medical Research Council in the UK, Cancer Research UK, the Wellcome Trust and the Leverhulme Trust. </span></em></p><p class="fine-print"><em><span>Katie Hirono does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Tobacco tax increases in Australia that will see a packet of cigarettes costing A$40 may discourage smoking, but will end up having unintended consequences for poorer smokers, new research shows.Katie Hirono, Research Associate, Centre for Health Equity Training, Research and Evaluation, UNSW SydneyKatherine Smith, Reader, Global Public Health Unit, The University of EdinburghLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/684282016-11-30T19:18:29Z2016-11-30T19:18:29ZHow e-cigarettes could ‘health wash’ the tobacco industry<figure><img src="https://images.theconversation.com/files/146181/original/image-20161116-13555-1ac2es0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Classifying e-cigarettes as a nicotine replacement therapy could help the tobacco industry influence health policy.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/237371161?src=sql-LWcr4laxp9REXUUEgA-1-22&id=237371161&size=medium_jpg">from www.shutterstock.com</a></span></figcaption></figure><p>The evidence that e-cigarettes help people quit smoking was described in the World Health Organisation’s (WHO) recent <a href="http://www.who.int/fctc/cop/cop7/FCTC_COP_7_11_EN.pdf">report</a> as “scant and of low certainty”. Predictably, this triggered the latest <a href="https://www.theguardian.com/society/2016/nov/04/vaping-does-not-help-people-stop-smoking-says-who-report">round</a> of claims and counterclaims in an ongoing, and often acrimonious, dispute about the potential of e-cigarettes.</p>
<p>This lack of definitive evidence about either their efficacy or their long term health effects, outlined by the WHO, is echoed by <a href="http://www.thelancet.com/journals/lanres/article/PIIS2213-2600(15)00521-4/abstract">others</a>, including Australia’s <a href="https://www.nhmrc.gov.au/guidelines-publications/ds13">National Health and Medical Research Council</a>.</p>
<p>Regulatory authorities outside Australia have classified e-cigarettes as medical devices or smoking cessation aids, similar to nicotine replacement therapy, like patches or gums. So far tobacco companies are the only actors to successfully gain medical licences for such products, although none have yet come to market.</p>
<p>But the decision to seek medical approval for their products may have serious consequences.</p>
<p>It may allow the industry to reclaim a role in health policy, part of a wider strategy by tobacco companies to rebrand themselves as nicotine companies with a key role in the fight against smoking.</p>
<p>By positioning themselves as “part of the solution”, rather than the essence of the problem, the tobacco industry is seeking to claw back from its pariah status and to re-engage in the policy process.</p>
<p>Policy makers who would shun overtures from Big Tobacco may nonetheless be prepared to meet with “nicotine companies” and producers of smoking cessation devices. This offers tobacco companies a significant opportunity to shape regulatory debates surrounding their core cigarette businesses, potentially undermining effective tobacco control policies which have driven declining smoking rates in Australia and elsewhere.</p>
<h2>How are e-cigarettes regulated?</h2>
<p>The lack of definitive evidence about either e-cigarettes’ efficacy or long term health effects underlies the Australian government’s decision to implement a near-complete ban.</p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/145692/original/image-20161114-9081-8kyo63.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/145692/original/image-20161114-9081-8kyo63.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=776&fit=crop&dpr=1 600w, https://images.theconversation.com/files/145692/original/image-20161114-9081-8kyo63.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=776&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/145692/original/image-20161114-9081-8kyo63.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=776&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/145692/original/image-20161114-9081-8kyo63.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=975&fit=crop&dpr=1 754w, https://images.theconversation.com/files/145692/original/image-20161114-9081-8kyo63.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=975&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/145692/original/image-20161114-9081-8kyo63.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=975&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">E-cigarette shop, Paris (supplied).</span>
</figcaption>
</figure>
<p>Current <a href="http://www.racgp.org.au/afp/2015/june/e-cigarettes-and-the-law-in-australia/">regulations</a> prohibit the sale, supply and possession of e-cigarettes containing nicotine. Regulation of the use of e-cigarettes in public places, their marketing and promotion varies by state, adding a further level of legal uncertainty.</p>
<p>People can import e-cigarettes as an unapproved therapeutic good with a prescription. However, most vapers (e-cigarette users), are unlikely to visit doctors to access products readily available over the internet. Many vapers also reject the idea they are sick and need to be cured.</p>
<p>Australia’s position differs from that of other jurisdictions. The European Union, for example, allows e-cigarettes to be sold as licensed medical devices or as non-medical products if they meet certain criteria set out in the 2014 <a href="http://ec.europa.eu/health/tobacco/products/revision/index_en.htm">Tobacco Products Directive</a>.</p>
<p>In the UK, British American Tobacco is the only company so far to have obtained a medical licence for an electronic nicotine delivery device, although its Voke brand is not yet on the market. This opens the possibility that UK patients could be prescribed tobacco industry products on the National Health Service.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/145689/original/image-20161114-9077-f8nh9u.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/145689/original/image-20161114-9077-f8nh9u.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=660&fit=crop&dpr=1 600w, https://images.theconversation.com/files/145689/original/image-20161114-9077-f8nh9u.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=660&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/145689/original/image-20161114-9077-f8nh9u.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=660&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/145689/original/image-20161114-9077-f8nh9u.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=829&fit=crop&dpr=1 754w, https://images.theconversation.com/files/145689/original/image-20161114-9077-f8nh9u.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=829&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/145689/original/image-20161114-9077-f8nh9u.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=829&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Vype advert, UK (supplied).</span>
</figcaption>
</figure>
<p>In 2013, British American Tobacco subsidiary Nicovations applied to the Australian Therapeutic Goods Administration (TGA) to have Voke licensed as part of its “<a href="http://www.abc.net.au/news/2014-10-02/tobacco-giant-wants-e-cigarettes-classed-as-medicine/5786508">medicines-based approach</a>” to reduce the harms from smoking. When the TGA refused to evaluate its application, Nicovations successfully took the issue to the <a href="http://www.judgments.fedcourt.gov.au/judgments/Judgments/fca/single/2016/2016fca0394">Federal Court</a>, which in April 2016 <a href="http://www.smh.com.au/federal-politics/political-news/federal-court-forces-drug-regulator-to-consider-nicotine-inhaler-case-20160421-goc3kx.html">ruled</a> the TGA was required to consider the company’s submission.</p>
<p>Another British American Tobacco brand, Vype, which is not regulated as a medical device, is sold in UK pharmacies alongside nicotine replacement products. It is being positioned – both physically and symbolically – as a smoking cessation tool.</p>
<h2>Do we need products to help us stop smoking?</h2>
<p>Current debates on e-cigarettes occur in a context in which quitting smoking has become defined as a treatable medical condition and the best way to stop smoking is to buy a manufactured remedy. This situation is the result of aggressive promotion by pharmaceutical companies that manufacture nicotine replacement therapies and other pharmacotherapy. </p>
<p>Despite the <a href="http://jamanetwork.com/journals/jama/article-abstract/1812969">reality</a> that the overwhelming majority of ex-smokers quit without using pharmaceutical products, the manufacturers of nicotine replacement therapy have successfully shaped perceptions around how smokers quit, both in Australia and internationally.</p>
<p>Tobacco companies’ investment in e-cigarettes builds on the medicalisation of smoking cessation. While some companies have invested in developing medical devices, the vast majority of tobacco companies’ “next generation” products, including e-cigarettes, are carefully differentiated from existing nicotine replacement therapies. They are positioned as smoking substitutes rather than overtly medical treatments. </p>
<p>Indeed, the development of medical products may be intended to draw attention to the availability of non-medical substitutes, which are targeted at smokers who do not see themselves as unwell or in need of treatment but may be attracted by substitute products.</p>
<p>Niconovum USA, Inc, a subsidiary of Reynolds American, provides a particularly explicit example through production of Zonnic nicotine gum and other products. As Niconovum’s president <a href="http://ajph.aphapublications.org/doi/full/10.2105/AJPH.2016.303456">said</a> recently:</p>
<blockquote>
<p>Many smokers do not see smoking as a medical condition and, thus, have not been reached by traditional nicotine replacement therapy marketing and channels of distribution.</p>
</blockquote>
<p>The current developments in smoking cessation and the evolving corporate strategy of Big Tobacco means we need to be clear about the key issues and participants in current smoking cessation debates. </p>
<p>The marketing of e-cigarettes as smoking cessation products will reinforce misconceptions among policy makers and the wider public that some form of medical or non-medical replacement product is required to quit smoking. It will also reinforce the idea that to drive quit rates, it is both necessary and legitimate to engage with the producers of these products.</p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/145694/original/image-20161114-9048-1ebr979.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/145694/original/image-20161114-9048-1ebr979.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=799&fit=crop&dpr=1 600w, https://images.theconversation.com/files/145694/original/image-20161114-9048-1ebr979.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=799&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/145694/original/image-20161114-9048-1ebr979.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=799&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/145694/original/image-20161114-9048-1ebr979.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1004&fit=crop&dpr=1 754w, https://images.theconversation.com/files/145694/original/image-20161114-9048-1ebr979.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1004&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/145694/original/image-20161114-9048-1ebr979.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1004&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Smoking cessation products display, UK (suppplied).</span>
</figcaption>
</figure>
<p>Investment by tobacco companies in e-cigarettes raises important concerns regarding the renormalisation of the industry, and the impact on tobacco control policies. It, may, for instance, allow tobacco companies to reposition themselves as key partners in the health policy process in ways <a href="https://responsibilitydeal.dh.gov.uk/">similar</a> to the alcohol and food industries.</p>
<p>While meetings between governments and the tobacco industry are precluded by <a href="http://www.who.int/tobacco/wntd/2012/article_5_3_fctc/en/">Article 5.3</a> of the <a href="http://www.who.int/fctc/text_download/en/">Framework Convention on Tobacco Control</a>, tobacco companies will be able to argue such restrictions do not extend to their e-cigarette subsidiaries. </p>
<p>Despite strategies to rebrand themselves as nicotine companies and technological innovators, the core business of the tobacco industry, and its sources of profit, remains firmly focused on conventional tobacco products.</p>
<p>As such, governments should approach e-cigarettes and their producers with caution. Tobacco companies, including their subsidiaries, must be viewed as tobacco companies in all contexts, and governments should adhere to internationally accepted norms of non-engagement.</p><img src="https://counter.theconversation.com/content/68428/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ross MacKenzie receives funding from the National Institutes of Health. He he has previously worked on research projects funded by the Rockefeller Foundation, and Cancer Council NSW.</span></em></p><p class="fine-print"><em><span>Benjamin Hawkins receives funding from the US National Institute of Health (Grant No. R01-CA091021).</span></em></p>Classing e-cigarettes as quit smoking aids could help rebrand the tobacco industry as a legitimate player in health policy. Here’s why we should be concerned.Ross MacKenzie, Lecturer in Health Studies, Macquarie UniversityBenjamin Hawkins, Lecturer in Global Health Policy, London School of Hygiene & Tropical MedicineLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/658732016-11-01T19:07:35Z2016-11-01T19:07:35ZEssays on health: how food companies can sneak bias into scientific research<figure><img src="https://images.theconversation.com/files/141182/original/image-20161011-3903-1rt4e5s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Proper nutrition is critical to combatting the costly and deadly epidemics of obesity, diabetes and cardiovascular disease. </span> <span class="attribution"><span class="source">from www.shutterstock.com</span></span></figcaption></figure><p><em>This is the first in our occasional series of longer reads titled, Essays on health. Enjoy!</em></p>
<hr>
<p>Should we eat breakfast every day? How much dairy should we have? Should we use artificial sweeteners to replace sugar? If we had the answers to these questions, we could address some of today’s biggest public health problems such as <a href="https://theconversation.com/how-australians-die-cause-1-heart-diseases-and-stroke-57423">heart disease</a>, <a href="https://theconversation.com/how-australians-die-cause-2-cancers-58063">cancer</a>, <a href="https://theconversation.com/how-australians-die-cause-5-diabetes-57874">diabetes</a> and <a href="http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4338.0%7E2011-13%7EMain%20Features%7EOverweight%20and%20obesity%7E10007">obesity</a>.</p>
<p>Consumer choice is often guided by recommendations about what we should eat, and these recommendations also play a role in the food that’s available for us. Recommendations take the form of dietary guidelines, food companies’ health claims, and clinical advice.</p>
<p>But there’s a problem. Recommendations are often conflicting and the source of advice not always transparent.</p>
<p>In September, a <a href="http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2548255">JAMA Internal Medicine</a> study revealed that in the 1960s, the sugar industry paid scientists at Harvard University to minimise the link between sugar and heart disease. The historical papers the study was based on showed researchers were paid to shift the blame from sugar to fat as responsible for the heart disease epidemic. </p>
<p>The paper’s authors suggested many of today’s dietary recommendations may have been largely shaped by the sugar industry. And some experts have since questioned whether such misinformation can have <a href="http://www.nytimes.com/2016/09/13/well/eat/how-the-sugar-industry-shifted-blame-to-fat.html?_r=0">led to today’s obesity crisis</a>. </p>
<p>We’d like to think industry influence of this scale won’t happen again. We’d like to have enough systems in place to shine a spotlight on any potential bias, or risk of it, as soon as it happens. But the reason it took so long to expose the sugar industry’s tactics is bias can be well hidden. To avoid the potentially huge ramifications, we need much better systems in place when it comes to nutrition research.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/143856/original/image-20161031-15783-1nr46d7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/143856/original/image-20161031-15783-1nr46d7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/143856/original/image-20161031-15783-1nr46d7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/143856/original/image-20161031-15783-1nr46d7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/143856/original/image-20161031-15783-1nr46d7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/143856/original/image-20161031-15783-1nr46d7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/143856/original/image-20161031-15783-1nr46d7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/143856/original/image-20161031-15783-1nr46d7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Partnerships between industry and research institutions aren’t uncommon.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<h2>How are national guidelines put together?</h2>
<p>Governments issue national dietary guidelines to inform people’s food choices and the nation’s food policies. To be credible and scientifically sound, they should obviously be built on rigorous evidence.</p>
<p>Best practice for creating guidelines includes beginning the process with a systematic review, which is a study that identifies all the available evidence on a particular research question. This ensures studies favourable to a particular party can’t be cherry-picked. But systematic reviews are only as valid as the studies out there. </p>
<p>An important part of any systematic review is to evaluate the biases in the studies included. Public health dietary guidelines and policies are influenced by <a href="http://www.oxfordscholarship.com/view/10.1093/acprof:oso/9780199691975.001.0001/acprof-9780199691975">political</a>, <a href="https://theconversation.com/food-industry-digs-in-heels-over-traffic-light-labels-311">economic</a> and social factors. That’s inescapable. But if the evidence on which these decisions are based is flawed, the entire foundation for systematic reviews, guidelines and policy, crumbles.</p>
<p>So <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3726025/">identifying and minimising bias</a> in <a href="https://www.questia.com/library/journal/1G1-236332510/corporate-manipulation-of-research-strategies-are">each part of the research process</a> – from the researcher’s decision on which question to answer in the study, to the publication of the results – is essential to having a strong evidence base. </p>
<p>Bias in research is the systematic error or deviation from true results or inferences of a study. Pharmaceutical, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1497700/">tobacco</a> or chemical industry funding of research <a href="https://www.ncbi.nlm.nih.gov/pubmed/23235689">biases human studies</a> towards outcomes favourable to the sponsor. </p>
<p>Even when studies use similar rigorous methods – such as keeping study information away from participants (blinding) or removing selection bias between groups of patients (randomisation) – studies sponsored by a drug’s manufacturer are more likely to find the drug is more effective or less harmful than a placebo or other drugs. </p>
<p>This bias in pharmaceutical industry sponsored studies is just like the sugar industry sponsored studies that downplayed sugar’s link to heart disease while putting the blame on fat.</p>
<p>Financial conflicts of interest between <a href="http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0050217">researchers and industry</a> have also been associated with research outcomes that favour companies researchers are affiliated with.</p>
<p>So how does this happen? How can industry-funded studies use methods similar to non-industry funded studies but have different results? Because bias can be <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3726025/">introduced in several ways</a>, such as in the research agenda itself, the way research questions are asked, how the studies are conducted behind the scenes, and the publication of the studies. </p>
<p>Industry influences on these <em>other</em> sources of bias in research often remains hidden for decades.</p>
<h2>Types of hidden bias</h2>
<p>It took over 40 years to show how the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1497700/">tobacco industry undermined the research agenda</a> on the health effects of secondhand smoke. </p>
<p>It did this by <a href="https://www.ncbi.nlm.nih.gov/pubmed/8784687">funding “distracting” research </a> through The Center for Indoor Air Research, which three tobacco companies created and funded. Throughout the 1990s, this centre funded dozens of research projects that suggested components of indoor air, such as carpet off-gases or dirty air filters, were more harmful than tobacco. The centre did not fund research on secondhand smoke. </p>
<p>There is a high risk of bias when the methodology of the study (how the study is designed) leads to an error when assessing the magnitude or direction of results. Clinical trials with a high risk of methodological bias (such as those lacking randomisation or blinding) are more likely to <a href="https://www.ncbi.nlm.nih.gov/pubmed/7823387">exaggerate the efficacy</a> of drugs and underestimate their harms. </p>
<p>A 2007 <a href="https://www.ncbi.nlm.nih.gov/pubmed/17954797">paper that compared over 500 studies</a> found those funded by pharmaceutical companies were half as likely to report negative effects of corticosteroid drugs (used to treat allergies and asthma) as those not funded by pharmaceutical companies.</p>
<p>Many <a href="https://www.ncbi.nlm.nih.gov/pubmed/23235689">industry-sponsored studies</a> of drugs are conducted for regulatory approval and the regulators require certain methodological standards. So often, the design of industry-sponsored studies is pretty good and the bias is elsewhere. It can be in how the questions are framed or another common form: publication bias.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/143857/original/image-20161031-15728-19a0mmj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/143857/original/image-20161031-15728-19a0mmj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/143857/original/image-20161031-15728-19a0mmj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=470&fit=crop&dpr=1 600w, https://images.theconversation.com/files/143857/original/image-20161031-15728-19a0mmj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=470&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/143857/original/image-20161031-15728-19a0mmj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=470&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/143857/original/image-20161031-15728-19a0mmj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=591&fit=crop&dpr=1 754w, https://images.theconversation.com/files/143857/original/image-20161031-15728-19a0mmj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=591&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/143857/original/image-20161031-15728-19a0mmj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=591&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Clinical trials with a high risk of methodological bias are more likely to exaggerate the efficacy of drugs and underestimate their harms.</span>
<span class="attribution"><span class="source">shutterstock.com</span></span>
</figcaption>
</figure>
<p>Publication bias occurs when entire research studies are not published, or only selected results from the studies are published. It is a common myth <a href="https://www.ncbi.nlm.nih.gov/pubmed/2406472">publication bias</a> comes about because scientific journal editors reject studies that don’t support the hypothesis or question the studies were asking. These are called negative or statistically non-significant studies. But <a href="https://abstracts.cochrane.org/2004-ottawa/methodological-quality-accepted-and-rejected-papers-submitted-three-leading-biomedical">negative research is as likely to get published</a> as positive research. So it’s not that.</p>
<p>Analysis of <a href="https://www.ncbi.nlm.nih.gov/pubmed/16908919">internal pharmaceutical industry documents</a> from 1994 to 1998 shows the pharmaceutical industry had a deliberate strategy to suppress publication of sponsored research unfavourable to its products. Industry-funded investigators were not allowed to publish negative research that did not support the efficacy or safety of the drugs being tested.</p>
<p>This has contributed to a clinical literature dominated by studies demonstrating the efficacy or safety of drugs. The tobacco industry also has a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1497700/">history of stopping the publication of research</a> it funded if the findings didn’t lean in favour of tobacco products.</p>
<p>Previous research on bias in tobacco, pharmaceutical, and other industry-sponsored research is relevant here because the biases that affect research outcomes are the same, regardless of the exposure or intervention being studied. When it comes to nutrition research, we actually know little about how corporate sponsorship or conflicts of interest might bias the research agenda, design, outcomes and reporting. </p>
<h2>Industry influence on nutrition research</h2>
<p>The credibility of nutrition research has <a href="https://www.washingtonpost.com/news/wonk/wp/2016/02/04/what-this-scathing-exchange-between-top-scientists-reveals-about-what-nutritionists-actually-know/">come under attack</a> because the funding source is often not transparent and <a href="https://www.ncbi.nlm.nih.gov/pubmed/26595855">industry-funded research</a> affects food policy. But we actually know very little about how sponsorship biases nutrition research.</p>
<p>Our systematic review, published this week in <a href="http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/jamainternmed.2016.6721">JAMA Internal Medicine</a>, identified and evaluated all studies that assessed the association between food industry sponsorship and published outcomes of nutrition studies.</p>
<p>We were surprised to find few studies examining the effects of industry sponsorship on the actual, numerical findings of the studies. Only two of 12 studies assessed the association between food-industry sponsorship and the statistical significance of research results, and neither found a link.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/143858/original/image-20161031-15728-1qg5nml.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/143858/original/image-20161031-15728-1qg5nml.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/143858/original/image-20161031-15728-1qg5nml.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/143858/original/image-20161031-15728-1qg5nml.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/143858/original/image-20161031-15728-1qg5nml.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/143858/original/image-20161031-15728-1qg5nml.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/143858/original/image-20161031-15728-1qg5nml.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/143858/original/image-20161031-15728-1qg5nml.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">We know very little about the association between industry sponsorship or authors’ conflicts of interest and the results of nutrition research.</span>
<span class="attribution"><a class="source" href="https://images.unsplash.com/photo-1473360526459-100c8e8ec8d8?ixlib=rb-0.3.5&q=80&fm=jpg&crop=entropy&cs=tinysrgb&s=7049742c2ff3515292f2ed87d6edc07f">Jordan Whitfield/Unsplash</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Only one paper found studies sponsored by the food industry reported significantly smaller harmful effects of consuming soft drinks than those without industry sponsorship. Overall, our review showed we know very little about the association between industry sponsorship or authors’ conflicts of interest and the actual results of nutrition research.</p>
<p>More studies assessed the association of industry sponsorship with authors’ conclusions or interpretations of their findings (not the results). Eight reports, when taken together, found industry sponsored studies had a 31% increase in risk, compared to non-industry sponsored studies, of having a conclusion favouring the sponsor’s product.</p>
<p>So what we know is that food industry sponsorship is associated with researchers interpreting their findings to favour the sponsor’s products. Conclusions don’t always agree with results but can be spun to make readers’ interpretations more favourable.</p>
<p>For example, a study might find that a particular diet leads to weight loss and an increase in heart disease but the harmful effects of heart disease are omitted from the conclusion. Only the weight loss is mentioned. This <a href="https://www.ncbi.nlm.nih.gov/pubmed/20501928">spin on conclusions</a> is a tactic <a href="https://www.ncbi.nlm.nih.gov/pubmed/18024482">in other industries</a> and can influence how research is interpreted.</p>
<p>But it is the results (the research data) that really matters. From the standpoint of developing systematic reviews and evidence-based recommendations, the results are more important than conclusions because only the data, and not a researchers interpretation of them, are included in the reviews.</p>
<p>We need more rigorous investigation of the effects of industry sponsorship on the results of both primary nutrition studies and reviews. For example, <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0162198">our recent study</a> examined 31 reviews of the effects of artificial sweeteners on weight loss. We found reviews funded by artificial sweetener companies were about 17 times as likely to have statistically significant results showing artificial sweeteners use is associated with weight loss, compared to reviews with other sponsors.</p>
<h2>Nutrition research agenda</h2>
<p>Our studies mentioned above didn’t identify any differences in the quality of industry-sponsored and non-industry sponsored nutrition research. But, similar to research sponsored by the pharmaceutical or tobacco industries, sponsors could affect outcomes by setting the research agenda, framing the questions or influencing publication.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/143859/original/image-20161031-15810-5l72oq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/143859/original/image-20161031-15810-5l72oq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/143859/original/image-20161031-15810-5l72oq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/143859/original/image-20161031-15810-5l72oq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/143859/original/image-20161031-15810-5l72oq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/143859/original/image-20161031-15810-5l72oq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/143859/original/image-20161031-15810-5l72oq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/143859/original/image-20161031-15810-5l72oq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">There is a lack of transparency about funding sources and conflicts of interest in the area of nutrition research.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>A <a href="https://cup.columbia.edu/book/nutritionism/9780231156561">research agenda</a> focused on single ingredients (such as sugar) or foods (such as nuts) rather than their interactions or dietary patterns may favour food-industry interests. This is because it may provide a platform to market a certain type of food or processed foods containing or lacking specific ingredients, such as sugar-free drinks.</p>
<p>Most data sources used to study publication bias in other research areas are not available for nutrition research, which make it more difficult to detect.</p>
<p>Researchers have identified publication bias in pharmaceutical and tobacco research by <a href="http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0050217">comparing the full reports</a> of drug studies submitted to regulatory agencies with publications in the scientific literature. Researchers have also <a href="https://www.ncbi.nlm.nih.gov/pubmed/16908919">compared data released</a> in legal settlements with published research articles. There are no similar regulatory databases for foods or dietary products.</p>
<p>It is possible to use statistical methods to estimate publication bias in large samples of nutrition research, as in other <a href="https://www.ncbi.nlm.nih.gov/pubmed/25880564">research areas</a>. Interviewing industry-funded researchers could be another way to <a href="https://www.ncbi.nlm.nih.gov/pubmed/9676672">identify publication bias</a>.</p>
<p>Another obstacle to rigorously assessing bias in nutrition research is the lack of transparency about funding sources and conflicts of interest. Our review of artificial-sweetener studies found authors of 42% of them had conflicts of interest not disclosed in the published article.</p>
<p>Also, about one third of the reviews didn’t disclose their funding sources. Although disclosure in journals is improving over time, not all journals enforce disclosure guidelines for author conflicts of interest and research funding sources.</p>
<h2>Reducing bias in nutrition research</h2>
<p>Studies on research bias related to pharmaceutical and tobacco industry sponsorship and conflicts of interest has <a href="http://www.cochrane.org/about-us/our-governance-and-policies/cochrane-policies/access-data-alltrials">led to international reforms</a>. These have been in the area of government requirements for research transparency and data accessibility, stricter journal and university standards for managing conflicts of interest, and methodological standards for critiquing and reporting evidence (and conducting systematic reviews). Similar reforms are needed in nutrition research.</p>
<p>Further studies will determine which mechanisms to reduce bias should be urgently implemented for nutrition research. Options include:</p>
<ul>
<li><p>refined methods for evaluating studies used in systematic reviews</p></li>
<li><p>enforced policies for disclosing, managing or eliminating financial conflicts of interest across all nutrition-related journals and professional associations</p></li>
<li><p>mechanisms to reduce publication bias, such as study registries that describe the methods of ongoing studies, or providing open access data</p></li>
<li><p>revised research agendas to address neglected topics and to produce studies relevant to population health, without corporate sponsors driving the agenda</p></li>
<li><p>independent sources of funding for nutrition research, or, at a minimum, industry sources pooling their funding with research funds administered by an independent party.</p></li>
</ul>
<p>In the current economic climate, in which industry funding is encouraged by universities, studying bias is important and contentious research. </p>
<p>Research institutions should implement strategies that reduce the risk of bias when industry sponsors research. They could do this by a risk-benefit assessment for accepting industry sponsorship of research. This would evaluate the sponsor’s control of the design, conduct and publication of the research, as well as any risk to the institution’s reputation.</p>
<p>The full effects of industry sponsorship and financial conflicts of interest on nutrition research remain hidden. An evidence base as rigorous and extensive as the the one on bias in pharmaceutical and tobacco research is needed to illuminate how nutrition research is at risk of bias.</p><img src="https://counter.theconversation.com/content/65873/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>In the last 5 years, Lisa Bero has received research funding from the California Breast Cancer Research Program, The Cochrane Collaboration Methods Innovation Fund, US Office of Research Integrity, and the US National Institute of Environmental Health Sciences.
She is Co-Chair, Cochrane Governing Board since 2013 and receives remuneration that is paid to the University of Sydney.</span></em></p>Food, drug and other companies often sponsor research in the hope it might produce results favourable to their products. How can we ensure such research remains independent?Lisa Bero, Chair professor, University of SydneyLicensed as Creative Commons – attribution, no derivatives.