10A.4Mechanisms of influence—undermining public health organisations

Last updated: May 2018     

Suggested citation: Freeman, B., & Winstanley, M. 10A.4 Mechanisms of influence—undermining public health organisations. In Scollo, MM and Winstanley, MH [editors]. Tobacco in Australia: Facts and issues. Melbourne: Cancer Council Victoria; 2018. Available from http://www.tobaccoinaustralia.org.au/chapter-10-tobacco-industry/10a-4-the-mechanisms-of-influence-undermining-publ  

10A.4.1 Influence on major public health organisations

Co-operative efforts within the industry to keep abreast of developments in tobacco control go back at least as far as the World Conference on Smoking and Health in the late 1970s.1  

One of the most detailed accounts of how the tobacco industry has responded to tobacco control initiatives is contained in the 260-page report published by the WHO in 2000.2 This report examined internal tobacco industry documents that were made public as a result of the Master Settlement Agreement of 1998 with a view to determining how the industry had sought to counter the objectives of the WHO. The documents revealed that multiple strategies had been used, including:


  • establishing connections with WHO employees, consultants and advisors, and infiltrating the organisation with its own consultants in order to influence policy issues
  • attempting to shift financial priority away from tobacco control activities
  • engaging with other UN agencies (such as the Food and Agriculture Organization and the World Bank) to undermine WHO policy
  • using ‘independent’ individuals and organisations to discredit the WHO’s policies and officers
  • using apparently unrelated organisations to lobby on its behalf against WHO policies
  • discrediting or distorting WHO research 
  • monitoring, at times secretly, WHO meetings and other activities.


The industry was especially keen to place a wedge between developing and developed countries by characterising the WHO as an organisation with ‘first world’ priorities, unfairly endangering the economic opportunities provided by tobacco industry in developing countries. The report concludes:

‘At the most fundamental level, this inquiry confirms that tobacco use is unlike other threats to global health. Infectious diseases do not employ multinational public relations firms. There are no front groups to promote the spread of cholera. Mosquitoes have no lobbyists. The evidence presented here suggests that tobacco is a case unto itself, and that reversing its burden on global health will be not only about understanding addiction and curing disease, but, just as importantly, about overcoming a determined and powerful industry.’ (p 244)2 

In the US during the 1990s, the tobacco industry countered major National Cancer Institute initiatives promoting community-based tobacco cessation projects. The program, American Stop Smoking Intervention Study (ASSIST), was the largest and most comprehensive tobacco control program launched in the US, and was strongly oriented to interventions and activities at a local level.3 The tobacco industry response was thorough. It monitored the projects; attempted to infiltrate them, and obstructed them in some communities; and seeded negative media stories. A network of allies to assist in lobbying was organised. The industry attempted to have pre-emptive legislation introduced to protect tobacco advertising. It also attacked the basis of the project as a misuse of taxpayers’ money to unfairly target the tobacco industry and launched a number of law suits, which disrupted and delayed program implementation.3, 4 Litigation has also been used by the industry as a tool against other tobacco control campaigns in the media, such as those run by the American Legacy Foundation and the California Tobacco Education Media Campaign.5

As well as targeting interventions, the tobacco industry paid attention to the organisations that worked against its interests. Evidence from internal tobacco industry documents in the US shows that tobacco companies attempted to infiltrate at least two organisations. STAT (Stop Teenage Addiction to Tobacco) and INFACT (the Infant Formula Action Coalition) were active and effective during the 1990s and pursued agendas antithetical to industry interests.6 In their efforts to gain intelligence on the activities of these groups, the tobacco industry used intermediaries to access materials on their behalf and to attend conferences, planted public relations consultants as spies to attend and report on meetings, and illegally tape recorded meetings.6 The industry has also made it its business to publicly discredit key individuals working in tobacco control.7, 8  

The evidence of tobacco industry infiltration of health interests in Australia is sparse; however, according to a former CEO of the Tobacco Institute of Australia (as stated during court testimony in 2005), in the early 1990s the Tobacco Institute of Australia engaged a private investigations agency to arrange for rubbish bins belonging to certain health organisations, such as the NSW Cancer Council and the National Heart Foundation, to be searched in an effort to discover the health lobby’s forward planning and funding details.9

Philip Morris USA took a different tack in 1995, undermining public health initiatives by appearing to offer them its support.7 As part of ‘Project Sunrise’, Philip Morris identified and then actively sought dialogue with public health advocates that it deemed to be ‘moderate’ in view and likely to be persuaded to see advantages in forming co-operative policies on tobacco control (such as concentrating on harm reduction strategies rather than on policies that would impact more negatively on industry profitability and survival). The benefits of any alliances would be multiple: they would buy Philip Morris social credibility; they could act as a conduit for Philip Morris’ views; and they might help ensure that any programs supported or regulation developed was acceptable to Philip Morris. But above all, Philip Morris could argue that people who did not wish to associate with them were ‘prohibitionists’ or ‘extremists’, establishing useful schisms between tobacco control advocates and diluting their effectiveness.7

10A.4.2 Influence on major scientific reviews 

The findings published in authoritative scientific reviews about smoking and health, the publicity they generate, and the impetus they give to governments to introduce tobacco control policies inflict huge damage to the tobacco industry. Consequently the industry engages vigorously with scientific process using many of the tools described in the preceding sections, such as countering mainstream science with its own research (see Section 10A.3) and employing third parties to argue on its behalf. One of the earliest examples of the industry interfering with the content of an essential scientific review is when it successfully influenced the definition of addiction that led to the classification of tobacco as an ‘habituation’ in the 1964 US Surgeon General’s Advisory Committee report. Tobacco was later clearly defined as addictive in the 1988 US Surgeon General's report.10

In the 1990s, the industry directly engaged in several attempts to disrupt the scientific review process. For example, in Australia, the industry mounted a concerted effort to undermine and derail the National Health and Medical Research Council’s review on passive smoking, which was finally published in 1997.11 The Tobacco Institute of Australia launched legal challenges regarding the procedure of the review, attempted to discredit individuals on the council’s working party, and commissioned several consultants to make submissions to the working party expressing pro-industry views. The industry also primed allies to speak to the media in its support. The Tobacco Institute of Australia had a fair measure of success, in that publication of the recommendations of the final report was prevented on purely procedural grounds. (There was no problem with the science or the recommendations themselves. Nonetheless this provided enough ammunition for the industry to dismiss the report and its findings widely in the media.)11 

In the US, the tobacco industry launched a similar offensive12 against California’s Environmental Protection Agency, which issued a report on the health effects of environmental tobacco smoke in 1992.13 The industry exerted pressure on the Environmental Protection Agency and related instrumentalities, attacked procedural issues and directly lobbied politicians. As in Australia, the tobacco industry was successful in delaying the process and eventual release of the report, and took every opportunity along the way to gain positive publicity by discrediting the report and the procedures followed in its development.14 The International Agency for Research on Cancer was also targeted by Philip Morris with strategies intended to undermine its work on secondhand smoke by disputing the research, influencing media coverage and countering government attempts to introduce smoking restrictions.15

The tobacco industry also tried to prevent agencies outside of the health sector from publishing damaging tobacco control reports. In 1999 the World Bank published a landmark report on the economics of tobacco control, Curbing the Epidemic: Governments and the Economics of Tobacco Control,16 which concluded that tobacco control brings unprecedented health benefits without harming economies. This threatened the tobacco companies' ability to use economic arguments to dissuade governments from enacting tobacco control policies and supporting the WHO Framework Convention on Tobacco Control (WHO FCTC), the first international treaty to be negotiated under the auspices of the World Health Organization. The industry hired public relations firms, had academics critique the Curbing the Epidemic report, hired consultants to produce estimates of the importance of tobacco to the economy, and worked through front groups, particularly the International Tobacco Growers’ Association, to question the report’s findings. These efforts were a near total failure, and the report remains an authoritative economic analysis of global tobacco control.17 



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2. Committee of Experts on Tobacco Industry Documents. Tobacco company strategies to undermine tobacco control activities at the World Health Organization. Geneva: WHO, 2000. Available from: http://www.who.int/tobacco/media/en/who_inquiry.pdf.

3. White J and Bero L. Public health under attack: The American stop smoking intervention study (ASSIST) and the tobacco industry. American Journal of Public Health, 2004; 94(2):240–50. Available from: http://www.ajph.org/cgi/content/full/94/2/240

4. Carlini B, Patrick D, Halperin A, and Santos V. The tobacco industry's response to the commit trial: An analysis of legacy tobacco documents. Public Health Reports, 2006; 121(5):501–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16972502

5. Ibrahim JK and Glantz SA. Tobacco industry litigation strategies to oppose tobacco control media campaigns. Tobacco Control, 2006; 15(1):50–8. Available from: http://tc.bmjjournals.com/cgi/content/abstract/15/1/50  

6. Malone RE. Tobacco industry surveillance of public health groups: The case of STAT and INFACT. American Journal of Public Health, 2002; 92(6):955–60. Available from: http://www.ajph.org/cgi/reprint/92/6/955.pdf

7. McDaniel PA, Smith EA, and Malone RE. Philip Morris's project sunrise: Weakening tobacco control by working with it. Tobacco Control, 2006; 15(3):215–23. Available from: http://tc.bmjjournals.com/cgi/content/abstract/15/3/215  

8. Carter SM. Mongoven, Biscoe & Duchin: Destroying tobacco control activism from the inside. Tobacco Control, 2002; 11(2):112–18. Available from: http://tobaccocontrol.bmj.com/cgi/reprint/11/2/112  

9. Simpson D. Australia: Epidemiology classes, shredding, and calls to 'the garbageman': A day in the life of tobacco folk. Tobacco Control, 2005; 14(2):75–6. Available from: http://tobaccocontrol.bmj.com/cgi/reprint/14/2/75

10. Mars S and Ling P. Meanings & motives: Experts debating tobacco addiction. American Journal of Public Health, 2008; 98(10):1–11. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2636463/

11. Trotter L and Chapman S. 'Conclusions about exposure to ETS and health that will be unhelpful to us: How the tobacco industry attempted to delay and discredit the 1997 Australian National Health and medical research council report on passive smoking. Tobacco Control, 2003; 12(suppl. 3):iii102–6. Available from: http://tobaccocontrol.bmj.com/cgi/content/abstract/12/suppl_3/iii102  

12. Muggli ME, Hurt R, and Repace J. The tobacco industry's political efforts to derail the EPA report on ETS. American Journal of Preventive Medicine, 2004; 26(2):166–77. Available from: http://www.ncbi.nlm.nih.gov/pubmed/14751332

13. U.S. EPA. Respiratory health effects of passive smoking (also known as exposure to secondhand smoke or environmental tobacco smoke - ETS). U.S. Environmental Protection Agency, Office of Research and Development, Office of Health and Environmental Assessment, Washington, DC, EPA/600/6-90/006F,  1992. Available from: http://cfpub.epa.gov/ncea/risk/recordisplay.cfm?deid=2835.

14. Muggli ME, Hurt RD, and Becker L. Turning free speech into corporate speech:  Philip Morris' efforts to influence US and European journalists regarding the US EPA report on secondhand smoke. Preventive Medicine, 2004; 39(3):568–80. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15313097

15. Ong E and Glantz S. Tobacco industry efforts subverting international agency for research on cancer's second-hand smoke study. Lancet, 2000; 355(9211):1253–9. Available from: http://www.thelancet.com/journals/lancet/article/PIIS0140673600020985/abstract

16. Jha P and Chaloupka F. Curbing the epidemic: Governments and the economics of tobacco control. Washington DC: The World Bank, 1999. Available from: http://siteresources.worldbank.org/INTETC/Resources/375990-1113853423731/chapter5.asp.

17. Mamudu H, Hammond R, and Glantz S. Tobacco industry attempts to counter the world bank report curbing the epidemic and obstruct the WHO Framework Convention on Tobacco Control. Social Science and Medicine, 2008; 67(11):1690–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18950924

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