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WHO Statement on Philip Morris funded Foundation for a Smoke-Free World

WHO statement http://www.who.int/mediacentre/news/statements/2017/philip-morris-foundation/en/

28 September 2017

On 13 September 2017, tobacco company Philip Morris International (PMI) announced its support for the establishment of a new entity – the Foundation for a Smoke-Free World. PMI indicated that it expects to support the Foundation by contributing approximately USD 80 million annually over the next 12 years.

The UN General Assembly has recognized a “fundamental conflict of interest between the tobacco industry and public health.” (1) WHO Member States have stated that “WHO does not engage with the tobacco industry or non-State actors that work to further the interests of the tobacco industry”, (2) the Organization will therefore not engage with this new Foundation.

Article 5.3 of the WHO Framework Convention on Tobacco Control (WHO FCTC) obliges Parties to act to protect public health policies from commercial and other vested interests of the tobacco industry in accordance with national law. Guidelines for implementation of Article 5.3 state clearly that governments should limit interactions with the tobacco industry and avoid partnership. These Guidelines are also explicit that Governments should not accept financial or other contributions from the tobacco industry or those working to further its interests, such as this Foundation.

Strengthening implementation of the WHO FCTC for all tobacco products remains the most effective approach to tobacco control. Policies such as tobacco taxes, graphic warning labels, comprehensive bans on advertising, promotion and sponsorship, and offering help to quit tobacco use have been proven to reduce demand for tobacco products. These policies focus not just on helping existing users to quit, but on preventing initiation.

If PMI were truly committed to a smoke-free world, the company would support these policies. Instead, PMI opposes them. PMI engages in large scale lobbying and prolonged and expensive litigation against evidence-based tobacco control policies such as those found in the WHO FCTC and WHO’s MPOWER tobacco control, which assists in implementation of the WHO FCTC. For example, just last year PMI lost a six year investment treaty arbitration with Uruguay, in which the company spent approximately US$ 24 million to oppose large graphic health warnings and a ban on misleading packaging in a country with fewer than four million inhabitants.

There are many unanswered questions about tobacco harm reduction (3), but the research needed to answer these questions should not be funded by tobacco companies.

The tobacco industry and its front groups have misled the public about the risks associated with other tobacco products. This includes promoting so-called light and mild tobacco products as an alternative to quitting, while being fully aware that those products were not less harmful to health. Such misleading conduct continues today with companies, including PMI, marketing tobacco products in ways that misleadingly suggest that some tobacco products are less harmful than others.

This decades-long history means that research and advocacy funded by tobacco companies and their front groups cannot be accepted at face value. When it comes to the Foundation for a Smoke-Free World, there are a number of clear conflicts of interest involved with a tobacco company funding a purported health foundation, particularly if it promotes sale of tobacco and other products found in that company’s brand portfolio. WHO will not partner with the Foundation. Governments should not partner with the Foundation and the public health community should follow this lead.

WHO tells governments to reject Philip Morris-funded smoking foundation

The World Health Organization told governments on Thursday not to get involved in a foundation funded by tobacco firm Philip Morris International to look at ways of reducing the harm from smoking.

http://www.reuters.com/article/us-health-tobacco/who-tells-governments-to-reject-philip-morris-funded-smoking-foundation-idUSKCN1C31X4

The U.N. health body said there was a conflict of interest in a tobacco firm funding such research – drawing a sharp rebuke from the Foundation’s head who said his work was independent.

Philip Morris International said this month it wanted to help set up a body called the Foundation for a Smoke-Free World and planned to give it about $80 million a year for 12 years to keep it running.

The company did not immediately respond to a request for a comment on the WHO’s statement.

The U.N. body said on Thursday there were already proven techniques to tackle smoking – including tobacco taxes, graphic warning labels and advertising bans – which the tobacco industry had opposed in the past.

“WHO will not partner with the Foundation. Governments should not partner with the Foundation and the public health community should follow this lead,” it said.

The foundation’s founder and president-designate, Derek Yach, a former senior official at the WHO, said more collaboration, not less, was needed to win the war on smoking.

“I am deeply disappointed, therefore, by WHO’s complete mischaracterisation of the nature, structure and intent of the Foundation in its recent statements – and especially by its admonition to others not to work together.”

He said the foundation was a non-profit organization with strict rules to insulate it from the influence of the tobacco industry, and its research agenda would be subject to peer review.

Reporting by Tom Miles; Editing by Toby Chopra and Andrew Heavens

A Billion Dollar Lie: We must not take our eyes off Big Tobacco

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The Union denounces PMI launch of a ‘Foundation for a Smoke-free World’

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Tobacco Consumption: Going Up in Smoke

In a reassuring move, the Delhi government has warned of legal action against tobacco companies if they violate laws and advertise at outlets selling their products

http://www.indialegallive.com/health-updates/tobacco-consumption-going-up-in-smoke-34241

We all know how tobacco companies sneak in surrogate advertising as they are not allowed to advertise their products. But Philip Morris International (PMI) Inc., the 160-year-old tobacco giant, pushed its top cigarette brands like Marlboro blatantly. It approached small shops and kiosks selling cigarettes and gave them free attractive boards with its advertisement to adorn the front of their shops and paid shopkeepers around Rs 500 as an incentive to break the law. The tobacco major roped in smart, young executives, mainly girls, to gift cigarette packs to youngsters in bars, discos and at parties.

However, after the Cigarettes and other Tobacco Products Act of 2003, which allowed tobacco companies to advertise in shops, was amended, these ads were prohibited. And in mid-August, the Delhi government’s Directorate General of Health Services shot off a stern warning to Philips Morris threatening legal action if it did not remove advertisements from kiosks and other point of sale outlets. The letter asked the company why appropriate punitive action could not be initiated against it and its directors. The letter was sent when the health ministry realised that the tobacco company was violating India’s tobacco control law by advertising at outlets where it was selling its products. It also sent these notices to two other tobacco companies, Indian Tobacco Company Ltd., and Godfrey Philips.

But this was after a series of earlier warnings which were ignored by these tobacco companies. On March 24 this year, the government had told them to get the ads removed. This was largely ignored. Their stand was that the law only stipulated that the ads should not be outside the outlets and did not mention that these could not be carried within the establishments or shops. Last month, the government shot of another letter reiterating the same, but this too was ignored. An internal document of Philip Morris said that the India market had high potential.

Dr SK Arora, additional director, health, Delhi, and also the state tobacco control officer, told India Legal: “In the last three years, we have been constantly writing to tobacco companies like Philips Morris, Indian Tobacco Company and Godfrey Phillips that their ads on posters and billboards were not allowed as they were violating Section 5 of the Cigarettes and other Tobacco Products Act (COTPA-2003). Our teams used to challan vendors who displayed these ads. But they would again put up the ads after we left as they were paid by the tobacco companies.”

Though the government told the companies that they would be held responsible and legal action could be initiated against them, it made no difference as they said it was not being done by them, but by distributors and vendors. When the Act was amended in 2005, it clearly said that there would be no such ads outside shops.

Though the government told the companies that they would be held responsible and legal action could be initiated against them, it made no difference as they said it was not being done by them, but by distributors and vendors. When the Act was amended in 2005, it clearly said that there would be no such ads outside shops.

Arora added: “So the tobacco companies removed the ads outside the shops, but started putting them inside, arguing that the Act did not mention that they should not be within shops or point of sale counters. Recently, the government clarified there should be no such ads both outside and inside. The tobacco companies are now pleading that they be allowed to advertise within the shop or on counters. We have no fight with these companies as long as cigarettes can be sold legally. But they have to sell them within the legal provisions.”

A source from the health ministry said that as far as Delhi was concerned, most of the ads had now been taken off and if they spotted any new ones, legal action would be initiated. Till the Delhi government carries out its threat of cracking down on violators, it is unlikely they will ever comply with the rules.

This is not the first controversy that PMI has faced. In 2010, the tobacco giant admitted to using child labour at its production facility in Kazakhstan. Human Rights Watch documented 72 cases of children used as forced labour.

India alone has some 100 million smokers. Government data says that tobacco use annually kills over 9,00,000 people. WHO estimates that tobacco-related diseases annually cost India $16 billion. Arora warned: “Tobacco is a leading cause of 40 percent of all cancers, 90 percent of oral cancer, 30 percent of tuberculosis, and 20 percent of diseases like heart attack, diabetes and hypertension apart from other respiratory diseases. While we are rapidly developing curative strategies like setting up huge cancer, diabetics and hypertension clinics, we are not doing enough to work on a preventive strategy to ensure that these diseases do not happen.”

The reach and marketing power of tobacco companies is huge. According to a 2002 study in the American Journal of Public Health, the tobacco industry in the 1990s increasingly sponsored entertainment events in bars and nightclubs where it displayed cigarette brand paraphernalia and advertisements.

Globally, anti-tobacco campaigners have accused PMI of breaking an ethical code when it deliberately targeted new young smokers. Often, cigarettes were given free to those who had just entered the legal age to smoke. The company had earlier aggressively run an advertising campaign in about 50 countries, cleverly targeting the young. Internal documents of the company indicated that those between 18 and 24 years had to be zeroed in. Company executives were specifically told that they must never use the word “promotion or advertising” when they were interacting with sellers or potential users.

In 2013, Germany banned promotional images of Marlboro, saying it encouraged children as young as 14 to start smoking. But other countries did not do so despite the fact that seven anti-tobacco organisations in a report charged that Philip Morris was trying to get a new generation hooked to tobacco. The ads of PMI appealed to teenagers as they used attractive models partying, falling in love, travelling, exploring, being cool and even confused. PMI violated its own ethical code which stated that it would not use images and content that would appeal to minors.

India enacted the national tobacco control law in 2004 before being one of the first countries to ratify WHO’s Framework Convention on Tobacco Control treaty. It contains a raft of anti-smoking provisions, including tobacco taxes, warning labels on cigarette packs and advertising bans. India, thereafter, strengthened the law in line with the provisions of the treaty. It was ultimately signed by 181 countries.

A group of cigarette distributors challenged the law. But in 2013, the Supreme Court ordered that the law be implemented. It said advertisement of tobacco products would attract the younger generation and innocent minds who were not aware of the grave and adverse consequences of consuming it.

Delhi has acted strongly, but what about other states? The central government is supposed to monitor and supervise implementation of the Act all over India. Had it done that, all states would have cracked down on tobacco companies the way Delhi has done.

The Tobacco Control Programme has the infrastructure and manpower, but lacks commitment to crack down on the tobacco lobby. An anti-tobacco activist said these companies used to set aside a budget to ensure that monitoring officials were well-inclined towards them.

It is time to act before matters go up in smoke.

Tobacco companies interfere with health regulations, WHO reports

Tobacco industry is interfering with government attempts to regulate products and aggressively pursuing new markets in Africa, World Health Organization says

https://www.theguardian.com/world/2017/jul/19/tobacco-industry-government-policy-interference-regulations

Cigarette manufacturers are attempting to thwart government tobacco controls wherever possible, even as governments make progress regulating the products, a new World Health Organization report has found.

World health officials also warn that tobacco companies have moved their fight to the developing world, such as Africa, where smoking rates are predicted to rise by double digits in the coming decades.

“Tobacco industry interference in government policymaking represents a deadly barrier to advancing health and development in many countries,” said Douglas Bettcher, director of the WHO’s department for the prevention of noncommunicable diseases. “But by monitoring and blocking such activities, we can save lives and sow the seeds for a sustainable future for all.”

Tobacco-related diseases are the leading preventable cause of death worldwide. The products kill more than 7 million people each year – more than HIV and Aids, tuberculosis and malaria combined. The effects of the substance are also costly. Researchers believe that tobacco-related harm costs the world $1.4tn in healthcare costs and lost productivity.

A recent investigation by the Guardian found that tobacco companies, including British American Tobacco, threatened African countries with domestic and trade lawsuits if certain anti-smoking measures were put in place. BAT says it is not against all regulations but needs to take action from “time to time”.

A Reuters investigation found that BAT’s arch-rival, Philip Morris International, developed a vast lobbying campaign to delay and prevent tobacco controls. PMI says there is nothing improper about its executives engaging with government officials.

Wednesday’s WHO report, which was funded by Bloomberg Philanthropies, comes on the same day as a shareholder vote on a $49bn merger between BAT and Reynolds American Incorporated, a deal that would make BAT the largest listed tobacco company in the world.

“The epicentre of this epidemic has moved to the developing world,” said Dr Vera Luiza da Costa e Silva, head of WHO’s convention secretariat. “Low- and middle-income countries struggle to combat a tobacco industry seeking to pursue new markets, often through shameless interference with public health policymaking.”

Currently, the World Health Organization recommends countries put in place six regulations health officials see as critical to reducing smoking: systems to monitor smoking rates; laws to protect people from secondhand smoke; tools to help people quit; warnings about the dangers of tobacco use; enforcement of advertising bans, and increased taxes on tobacco products.

Six in 10 countries have implemented at least one of the six protections, officials said, four times the population that was protected in 2007.

However, progress is lopsided. Some recommendations have been far more widely accepted than others. For example, 3.5 billion people in 78 countries are protected by graphic warnings on cigarette packs, but only 15% of the world’s population is protected by a comprehensive advertising ban, and high tobacco taxes, while very effective, are one of the least-implemented measures.

Even some wealthier nations have had trouble getting tobacco control measures in effect. In the United States, for example, there are no graphic warnings on cigarette packs because of industry lawsuits and regulatory delay, and tobacco taxes remain low.

Anti-tobacco lawmakers and campaigners in the US blame the slow progress on “pervasive” tobacco industry influence, which reaches all the way to top officials in the Trump White House.

“Working together, countries can prevent millions of people from dying each year from preventable tobacco-related illness,” said Tedros Adhanom Ghebreyesus, the WHO director-general. “Governments around the world must waste no time”.

Bloomberg Philanthropies funds Vital Strategies, which part funds the Guardian’s Tobacco: a deadly business series, the content of which is editorially independent.

UN Reports More People Warned Against Tobacco Use

Despite measures protecting a majority of people from tobacco-related illness and death, the tobacco industry continues to hamper Government efforts to fully implement life and cost-saving interventions, the United Nations health agency reported.

http://www.womenofchina.cn/womenofchina/html1/features/health/1707/4690-1.htm

“One-third of countries have comprehensive systems to monitor tobacco use. While this is up from one-quarter of countries monitoring tobacco use at recommended levels in 2007, Governments still need to do more to prioritize or finance this area of work,” according to the UN World Health Organization’s WHO report on the global tobacco epidemic, which was launched today on side-lines of the UN High-level political forum on sustainable development in New York.

The report shows that some 4.7 billion people – more than 60 per cent of the population – are protected by at least one “best practice” tobacco control measure from the WHO’s Framework Convention on Tobacco Control (WHO FCTC). These measures include no smoking areas and bans on advertising tobacco products, for example.

In the foreword to the report, the head of WHO urged Governments to incorporate all the provisions of the WHO FCTC into their national tobacco control programmes and policies, and to fight against the illicit tobacco trade.

“Working together, countries can prevent millions of people from dying each year from preventable tobacco-related illness, and save billions of dollars a year in avoidable health-care expenditures and productivity losses,” said Tedros Adhanom Ghebreyesus, WHO Director-General.

The report, funded by Bloomberg Philanthropies, noted that systematic monitoring of tobacco industry interference in government policymaking protects public health by shedding light on tobacco industry tactics.

Such tactics include “exaggerating the economic importance of the tobacco industry, discrediting proven science and using litigation to intimidate governments.”

Douglas Bettcher, director of WHO’s Department for the Prevention of Noncommunicable Diseases (NCDs), said tobacco industry interference in government policy making represents “a deadly barrier to advancing health and development in many countries.

Controlling tobacco use is a key part of the 2030 Agenda for Sustainable Development. The Agenda includes targets to strengthen national implementation of the WHO FCTC and a one-third reduction in premature deaths from NCDs, including heart and lung diseases, cancer and diabetes, according to a press release launching the report.

“The progress that’s been made worldwide – and documented throughout this report – shows that it is possible for countries to turn the tide,” said Michael R. Bloomberg, WHO Global Ambassador for Noncommunicable Diseases and founder of Bloomberg Philanthropies.

The Guardian view on big tobacco: stop the spread

Companies like British American Tobacco are using the same tactics they used in the global north to delay legislation in the global south

https://www.theguardian.com/commentisfree/2017/jul/12/the-guardian-view-on-big-tobacco-stop-the-spread

Global corporations work hard to persuade the public of their commitment to corporate social responsibility. British American Tobacco, for example, declares on its website that “as the world’s most international tobacco group, we are in a position to take the lead in defining and demonstrating what a socially responsible tobacco company should be”. It goes on to set out five core beliefs that underpin its “high standards of behaviour and integrity”. The evidence that the Guardian is publishing this week – at the start of a two-year project intended to show just how the global tobacco industry works – suggests that the distance between the words and the deeds of this huge and powerful company is about the size of the distance from the developed to the developing world.

A generation of campaigners in western Europe and north America are familiar with the devious tactics that are now in play in Africa and Asia. The wickedly slow pace of change from 1949, when the link between smoking and cancer was first established, to the introduction of plain packaging in the UK nearly 70 years later, owes everything to the sustained campaign the industry fought against regulation that would limit the harm of smoking. It was fought in the public domain, in carefully placed reports that undermined medical research or questioned the impact of proposals like plain packaging. And it was fought privately, in privileged access to politicians, sometimes indirectly by other interested parties. The most notorious example was the Ecclestone affair in 1997, when a Labour pledge to ban tobacco advertising at all sports events was suddenly and inexplicably withdrawn. It soon emerged that the Formula One boss, Bernie Ecclestone, had donated £1m to Labour, and that there were hopes of more to come.

In the course of those 70 years of delay, millions of people will have taken up smoking and a significant number will have suffered and died because of it. Now the tobacco companies are fast exporting the insidious tactics that worked for so long in the markets of the global north to new ones in the global south. More than half of BAT’s sales are now in emerging markets.

Take the increasingly prosperous East African country of Kenya: its government signed the World Health Organisation’s Framework Convention on Tobacco Control in 2004, before it was officially adopted. Yet nearly 15 years later, multinational tobacco firms are still fighting to delay the introduction of anti-smoking laws. As one recent study found, the slower the process of legislation, the greater the scope for tobacco company influence. The WHO reports how companies sponsor sporting events for children, for example, and hand out cigarettes in shopping centres regardless of people’s age. Already, proportionately more Kenyan children are smoking than adults.

It’s not all about the companies. Part of the story is the low priority given to public health: in a country of 45 million people like Kenya, the anti-smoking budget is $45,000. But these are places where tobacco can do business. Tobacco taxes are vital revenue, so the tobacco companies claim that regulation will erode the tax base and provide new opportunities for the black market. And part of it is corruption, the purchase of influence.

As Bath University’s Tobacco Tactics website details, big tobacco’s attempts to delay the introduction of laws to limit the harm of tobacco across Africa follow a familiar pattern: the companies influence politicians, they intimidate tobacco farmers, and they use unrestrained advertising to promote smoking. The companies insist they are only ensuring that legislation is proportionate. These are weasel words. Their tactics are well-funded, well-rehearsed and slick. They worked for years in the old markets. But if tactics can be exported, so can campaigns. BAT is about to become one of the FTSE 100’s top three companies. Reputation matters. Shareholders have leverage – and they should prepare to use it.

Nairobi’s smoking culture – in pictures

In east Africa, the tobacco industry, including British American Tobacco, has been putting pressure on local governments over some of the regulations attempting to curb smoking.

https://www.theguardian.com/world/gallery/2017/jul/12/on-the-tobacco-road-david-levene-in-kenya

BAT says it is not against all regulation, but from ‘time to time’ needs to challenge it. BAT Kenya is currently taking a legal case to the country’s supreme court over some regulations.

Every year, more than 6,000 Kenyans are killed by tobacco-linked diseases, part of what the WHO calls the ‘biggest public health threats the world has ever faced’.

Campaigners say the industry is developing its African market and sees new potential customers as populations and prosperity grow there.

David Levene spent some time documenting the country’s smoking culture in Nairobi, noticing the prevalence of cigarette brands in daily life. This collection is gathered from his walks through the city

Facts from Tobacco Atlas

Smoking in public areas in highly restricted in Kenya. These two men sit back in one of central Nairobi’s smoking zones, as designated by the country’s ministry of health. Photograph: David Levene for the Guardian

Smoking in public areas in highly restricted in Kenya. These two men sit back in one of central Nairobi’s smoking zones, as designated by the country’s ministry of health.
Photograph: David Levene for the Guardian

Meru, Kenya - Over the past 50 years, Africa has seen a significant increase in tobacco farming. Many farmers suffer from green tobacco sickness, which shares symptoms with nicotine addiction and withdrawal. It’s simply caused by being in consistent contact with the plant, as nicotine can be absorbed through the skin especially when wet. Tanzania, Kenya’s southern neighbor, earns $50 million per year from tobacco but spends $40 million for tobacco- related cancers alone. Photograph: David Levene for the Guardian

Meru, Kenya – Over the past 50 years, Africa has seen a significant increase in tobacco farming. Many farmers suffer from green tobacco sickness, which shares symptoms with nicotine addiction and withdrawal. It’s simply caused by being in consistent contact with the plant, as nicotine can be absorbed through the skin especially when wet. Tanzania, Kenya’s southern neighbor, earns $50 million per year from tobacco but spends $40 million for tobacco- related cancers alone.
Photograph: David Levene for the Guardian

Approximately 176 million adult women worldwide are daily smokers and 37 women die every week in Kenya due to tobacco related complications. Photograph: David Levene for the Guardian

Approximately 176 million adult women worldwide are daily smokers and 37 women die every week in Kenya due to tobacco related complications.
Photograph: David Levene for the Guardian

A vendor sells single sticks in central Nairobi’s Uhuru Park. Most Kenyan smokers prefer this to buying whole packs, given the cost.Manufacturers are not allowed to produce cigarettes in packs of less than 10, and they say they want customers to purchase full packs, and that they work with vendors to encourage them to sell them this way.The World Health Organization estimates that people in low-income countries can spend as much as 10% of household income on tobacco products.Uhuru Park is also a key spot for Nairobi’s bourgeoning skate scene. Photograph: David Levene for the Guardian

A vendor sells single sticks in central Nairobi’s Uhuru Park. Most Kenyan smokers prefer this to buying whole packs, given the cost.Manufacturers are not allowed to produce cigarettes in packs of less than 10, and they say they want customers to purchase full packs, and that they work with vendors to encourage them to sell them this way.The World Health Organization estimates that people in low-income countries can spend as much as 10% of household income on tobacco products.Uhuru Park is also a key spot for Nairobi’s bourgeoning skate scene.
Photograph: David Levene for the Guardian

Excises taxes are still the most effective controls against tobacco. In Kenya, they make up 35% of retail price, similar to the US’s 38%. One of the elements of government plans that BAT Kenya is fighting in the court is a new tobacco industry tax.Clear adverts may be outlawed, but still, Kenyans know what is being sold. These red boxes are instantly recognizable. Photograph: David Levene for the Guardian

Excises taxes are still the most effective controls against tobacco. In Kenya, they make up 35% of retail price, similar to the US’s 38%. One of the elements of government plans that BAT Kenya is fighting in the court is a new tobacco industry tax.Clear adverts may be outlawed, but still, Kenyans know what is being sold. These red boxes are instantly recognizable.
Photograph: David Levene for the Guardian

The afternoon sets on Enterprise Road in Nairobi’s industrial zone. Photograph: David Levene for the Guardian

The afternoon sets on Enterprise Road in Nairobi’s industrial zone.
Photograph: David Levene for the Guardian

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A smoker in a Nairobi smoking zone Photograph: David Levene for the Guardian

A Nairobi smoking zone Photograph: David Levene for the Guardian

A Nairobi smoking zone
Photograph: David Levene for the Guardian

Nairobi, Kenya Photograph: David Levene for the Guardian

Nairobi, Kenya
Photograph: David Levene for the Guardian

The combined revenues of the world’s 6 largest tobacco companies in 2013 was USD342 Billion, 85% larger than the Gross National Income of Kenya Photograph: David Levene for the Guardian

The combined revenues of the world’s 6 largest tobacco companies in 2013 was USD342 Billion, 85% larger than the Gross National Income of Kenya
Photograph: David Levene for the Guardian

Tobacco companies tighten hold on Washington under Trump

Top White House figures – including the vice-president and health secretary – have deep ties to an industry whose donations began pouring in on day one

https://www.theguardian.com/world/2017/jul/13/tobacco-industry-trump-administration-ties

Tobacco companies have moved swiftly to strengthen their grip on Washington politics, ramping up lobbying efforts and securing significant regulatory wins in the first six months of the Trump era.

Day one of Donald Trump’s presidency started with tobacco donations, senior figures have been put in place within the Trump administration who have deep ties to tobacco, and lobbying activity has increased significantly.

“As in so many areas, the promise to drain the swamp has been an extraordinary hypocrisy,” said Senator Richard Blumenthal, who supported anti-tobacco legislation and was one of the US attorneys general to broker a hundred-billion-dollar settlement with tobacco companies in the 1990s. “Many of his appointees have deep commitments to the tobacco industry,” he said.

“Tobacco industry influence in Washington is pervasive, in many different ways,” Blumenthal said. “They have an active presence on the Hill, they meet frequently with administrative agencies, on hugely significant issues such as regulation of e-cigarettes, tobacco packaging and warnings.”

America’s largest cigarette manufacturers, Reynolds American and Altria Group, donated $1.5m to help the new president celebrate his inauguration. The donations allowed executives to dine and mingle with top administration officials and their families.

Not long after Trump promised to transfer power from Washington to the American people, a wave of spending in pursuit of influence was unleashed. In the first quarter of 2017, tobacco companies and trade associations spent $4.7m lobbying federal officials. Altria, the company behind Marlboro, hired 17 lobbying firms. Reynolds, makers of the Camel brand, hired 13, according to the Campaign for Tobacco Free Kids.

Since then, tobacco companies have been putting points on the scoreboard. Politicians and officials with deep ties to the tobacco industry now head the US health department, the top attorney’s office and the Senate, even as tobacco use remains the leading preventable cause of death.

Agencies in charge of reviewing large mergers let a window slip by in which they might have requested information about a $49bn merger between Reynolds and British American Tobacco (BAT). That merger, expected to be voted through by shareholders next week, will make BAT the biggest listed tobacco company in the world, and puts proceeds from eight out of 10 cigarettes sold in the US into the pockets of two companies: Altria and BAT.

Advocates and opposition politicians fear public health wins in curbing smoking could be vulnerable to a more emboldened industry.

There are also concerns that most at risk are poorer and more vulnerable citizens whose health insurance coverage could be weakened by Republican reforms.

“With the new Trump administration and Congress trying to roll back health and safety regulations, generally the tobacco industry is seizing the opportunity to mount its own assault on the programs and policies that have reduced smoking in this country,” said Vince Willmore, a spokesperson for the Campaign for Tobacco-Free Kids.

The Food and Drug Administration has twice delayed legal briefs to defend regulations of e-cigarettes, products cigarette makers say are the future. Summer deadlines for cigar and e-cigarette makers to file applications with the FDA, which regulates the products, have all been delayed by the Trump administration.

And the high-profile attorney Noel Francisco, who once argued for Reynolds that including a quit-line phone number on cigarette packs amounted to government advocacy against smoking, has been nominated for the post of solicitor general, the government’s top attorney.

In the past two decades, the tobacco industry has increasingly steered donations to Republicans. The past two election cycles, 2014 and 2016, were the most partisan ever. Tobacco companies made 84% of their donations each cycle to Republican candidates, according to the Center for Responsive Politics. Since 1990, $57m has been donated exclusively to Republicans, 74% of the industry’s total donations.

Proposals from Republican lawmakers for health reform, which the president has attempted to broker, have threatened to cut $126m that the Centers for Disease Control uses to educate Americans about the harms of tobacco use. Cuts Republicans proposed to Medicaid, a public health program for the poor, could imperil smoking cessation coverage for people already far more likely to smoke than middle- and upper-class Americans.

Trump himself, notoriously secretive about his personal wealth, has revealed that he had investments in tobacco companies, including Philip Morris International, its American spinoff Altria Group, and Reynolds American Inc.

In the past three years, Trump’s financial disclosures show he earned up to $2.1m from tobacco holdings in diversified portfolios. Trump said he sold his stocks this spring (although he did not provide proof).

For Trump’s inaugural celebration, Reynolds American gave $1m. Altria Group gave $500,000. The US Chamber of Commerce, which has been fiercely pro-tobacco in recent years, gave $25,000.

Vice-President Mike Pence was already well acquainted with the tobacco lobby. In 2001, Pence argued that “smoking doesn’t kill”. Two months later, Pence met with tobacco lobbyists who steered donations his way.

Tobacco lobbyists discussed donating to Mike Pence in a 2001 email. Photograph: University of California San Francisco Truth Tobacco Industry Documents

Tobacco lobbyists discussed donating to Mike Pence in a 2001 email. Photograph: University of California San Francisco Truth Tobacco Industry Documents

Over his career, Pence received $39,000 in donations from RJ Reynolds, a Reynolds American subsidiary, and more than $60,000 from the tobacco company-aligned National Association of Convenience Stores, both among his top donors. Pence owned up to $250,000 in stock in a family business, a chain of 210 convenience stores doing business as Tobacco Road. The company later went bankrupt.

The Senate majority leader, Mitch McConnell, who has had a high-profile role in developing health reform proposals, has long cast votes that favor tobacco interests. McConnell once threatened to derail negotiations on the Trans-Pacific Partnership trade deal in support of tobacco. McConnell is from Kentucky, one of the top tobacco-growing states in the country. In January, his former chief of staff was hired by Altria.

Trump’s health appointments also have deep links to tobacco companies. The health secretary, Tom Price, in 2009 voted against a 62-cent cigarette tax hike that would have helped pay for public health insurance for poor children. He called the law a blow to “hard-working Americans” meant “to feed [Obama’s] reckless agenda”. Until 2012, Price owned at least $37,000 in shares in Philip Morris International and Altria, Mother Jones reported, and during his career as a state legislator and Georgia congressman he received more than $37,000 in donations from tobacco companies and related political action committees. In March, Price’s former deputy chief of staff was hired as a lobbyist for Reynolds.

In addition to his vote against the cigarette tax, Price also voted against allowing the FDA to regulate tobacco, a vote that would have a large impact on e-cigarettes. Price now leads the department in charge of enforcing those regulations.

Reporting to Price, as the head of the FDA, is Scott Gottlieb. Before he headed the FDA, Gottlieb worked primarily for the investment bank Winston & Company, which helped raise $4.7m for the e-cigarette company Kure in 2016, according to Bloomberg News.

Gottlieb then became a director at Kure the same year. Writing about the FDA, he argued in Forbes that anti-tobacco “activists have managed to infiltrate the middle ranks of the agency’s center”, and suggested e-cigarettes could be an alternative for smokers.

Attorneys appointed to defend the FDA’s authority to regulate tobacco products have, in some cases, come directly from the law firm that once fought them – Jones Day. The firm’s attorneys represented Trump during the campaign as well as RJ Reynolds in suits against the US government. Now, 11 lawyers from the firm have been appointed to various government agencies, American Lawyer reported.

Until Francisco’s nomination for solicitor general, he represented both RJ Reynolds and its parent company, Reynolds American Inc. The companies were two of just 16 sources of income, including his law firm Jones Day, from whom Francisco reported earning more than $5,000 a year.

Francisco has had “a profoundly important involvement with the tobacco industry”, said Blumenthal.

Francisco argued on behalf of Reynolds in a continuing case. In one instance, he successfully argued against a graphic warning design on cigarette packs, which are common in other developed nations, because the warnings included a phone number where people could seek help to quit.

Francisco argued the message veered into advocacy because it told people to “live a certain way”, according to the Seattle Times.

“The government is trying to send a powerful message: quit smoking now,” Francisco reportedly said.

Even the dark “American carnage” speech Trump gave at his inauguration was written by a one-time tobacco advocate: his speechwriter Stephen Miller argued against a cigarette sales ban while he attended Duke University in 2007.

“Smoking, while risky and potentially lethal, is not nearly as dangerous as special interest groups and their cohorts in government have made it out to be,” Miller wrote. “The real risks are the fascistic tendencies that prohibit smoking in even private establishments.”