Despite ‘evidence’ from tobacco companies, review pushes towards plain packs

Not the full story. Srpskohrvatski, CC BY-SA

Public health ministers have said they will push ahead with standardised packaging for cigarettes in England after the publication of a much-anticipated independent review. Paediatrician Cyril Chandler, who led the government-commissioned review, said it was “highly likely” that the policy will discourage people from smoking and public health minister Jane Ellison said it made “a compelling case” and would draw up draft regulations by next spring following a brief final consultation.

It will certainly come as a blow to tobacco companies which have promoted unreliable evidence that it will increase the illicit trade in cigarettes and support organised crime, while criticising evidence that it will reduce smoking.

Take the claims made in a 2012 campaign advert from Japan Tobacco International (JTI), which produces the Camel, Benson & Hedges and Silk Cut brands. The advert, which was taken down by the Advertising Standards Agency in 2013, stated:

The black market in tobacco is booming. Last year it cost the Treasury £3bn in unpaid duty. Standardising cigarette packs will make them easier to fake, more profitable for organised crime, and so cost the country millions more in lost duty. There is no evidence whatsoever that standardising packs would reduce smoking rates, but plenty of evidence to suggest that low-priced fakes increase demand among the very people the proposal is intended to protect. So, smoking rates rise whilst tax revenues fall. Where’s the sense in a policy like that?

This is just one example of a global tobacco company making evidence-based claims to oppose policy on plain packs.

However, after scrutiny of the evidence for this ad, the ASA held that JTI’s claims about the scale and cost of the illicit trade were misleading, and ordered that the ads be removed. Another set of ads were also removed by the ASA last year for claiming that the government had rejected the policy in 2008 on the grounds of lack of evidence when the policy was still open to review.

Positive signs

Standardised packaging has so far only been implemented in Australia, but independent reports have indicated an increased desire to quit and a sustained increase in calls to Quitline, a reduction in pack appeal and a reduction in display of cigarette packs by smokers. Independent figures show no impact on tobacco smuggling since the policy’s introduction.

JTI is not a lone voice opposing standardised packaging and despite the emerging evidence, similar arguments have also been made in the media and in submissions to government by British American Tobacco (BAT), Imperial Tobacco and Philip Morris (PMI). On the basis of leaked documents, a letter from 17 leading health experts published in The Lancet suggested that PMI had also attempted to use third parties with undeclared links to the tobacco industry as “media messengers” to promote its position.

But what is the “evidence” that tobacco companies rely on and how credible is it? Recent research by our team at the Tobacco Control Research Group at the University of Bath and published in articles in Tobacco Control, BMJ Open and PLOS Medicine, has exposed the ways four global companies have used evidence as a tool to influence the UK policy debate. By both contesting evidence and citing additional unreliable evidence from self-commissioned studies, they have promoted the idea that standardised packaging risks a rise in illicit trade, with no benefit for public health.

A question of timing

In one recent paper we revealed how global tobacco companies solicited press coverage of illicit cigarettes during 2011 and 2012. These reports only began to appear after the Department of Health announced it intended to consult on standardised packaging. At the same time, industry-commissioned illicit tobacco reports – such as PMI’s Project Star report – showed a sudden large increase in non-domestic/illicit cigarettes between 2011 and 2012.

This reported increase in the illicit trade was wholly inconsistent with independent data from HM Revenue & Customs and an EU research project called Pricing Policies and Control of Tobacco in Europe (PPACTE), which showed continued declines or stabilisation over the same period.

The press reports cited tobacco industry empty pack surveys (a system of collecting littered cigarette packs) as evidence. But in previous and new research, we’ve detailed how tobacco companies tend to commission empty pack surveys in locations and venues such as large cities and sporting events, where illicit and non-domestic cigarette packs are also more likely to be present in higher numbers. A change in the methodology used in the 2012 Project Star report also made it impossible to compare with earlier data.

Tobacco company claims on illicit trade appear to be part of a deliberate industry strategy to derail standardised packaging. In Australia, the tobacco industry’s claims have been similarly unfounded; in March 2014 a BAT claim that illicit tobacco was up by 30% was subsequently contradicted by government data showing no increase.

Distorting the evidence

Submissions made by four global tobacco companies to the UK government’s consultation relied primarily on 14 non-peer-reviewed reports funded by or linked to themselves, to make their case that standardised packaging would not have public health benefits.

In a subsequent paper, published in PLOS Medicine, we revealed how BAT and JTI commissioned research to critique a systematic review of standardised packaging commissioned by the Department of Health.

Our study demonstrated how these tobacco industry-funded reports fundamentally misreported papers included in the systematic review. Papers were mis-quoted, distorting their main messages, and each paper dismissed as flawed even though they had been published in peer reviewed journals.

Within their submissions the tobacco companies cited a large volume of independent research that did not consider the health impacts of standardised packaging. This evidence drew attention to other issues, while giving the impression of evidential quality. We showed that industry evidence relevant to standardised packaging that would have undermined their case was withheld.

In contrast, the Department of Health’s peer-reviewed systematic review found “strong evidence” that removing all branding and design from cigarette packs would make them less attractive for both adults and children.

Why evidence matters

In the UK, the political will to follow Australia and implement standardised packaging is in place – MPs voted overwhelmingly by 453 to 24 in favour of the measure earlier this year. But implementation will be dependent upon ministers deciding to proceed. And this decision hinges on evidence.

Evidence has been central to the whole policy process. In line with what’s known as “better regulation”, standardised packaging has had to undergo an evidence-based impact assessment and public consultation. Evidence was cited as the reason for the coalition government’s “wait and see” position in July 2013. The last hurdle before implementation is the review, and it is expected that a ministerial decision, or more likely further consultation, will follow its publication.

By exploiting the importance of evidence in the policy process, well-resourced tobacco companies have used the media and the government’s consultation as an opportunity to misrepresent and manufacture evidence on both illicit tobacco and the health benefits of standardised packaging in order to attract popular and political support to their campaign. And they have not only targeted their evidence at the UK, but also other countries with an interest in standardising packs, including Australia, New Zealand and Ireland.

Despite these efforts, the vast majority of the UK’s elected representatives have supported standardised packaging and acknowledge the significant harm to health caused by smoking. Much now depends on what steps the government takes to act on Chantler’s report.