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Tobacco Company Downplayed Risks in China, Report Says

RONI CARYN RABIN, The New York Times – December 29, 2008

An international tobacco company vying for the huge Chinese cigarette market took steps to stall public smoking bans in that country by sowing doubt about the known risks of second-hand smoke and diverting attention to other public health issues, a new report claims.

Beginning in the mid ’90s through at least 2002, British American Tobacco downplayed smoking-related disease in China by suggesting air pollution was a greater public health threat than smoking and arguing that the focus should be on what it characterized as China’s top killer, liver disease, the paper said.

The paper’s researchers based their report on an analysis of internal documents obtained from the London-based company in response to litigation. The paper, published in the December issue of the online journal PLoS Medicine, is sprinkled liberally with damning statements drawn from those documents.

In an e-mail, British American Tobacco officials denied they worked to undermine any laws and issued a statement saying that the company “welcomes sensible regulation” and consistently seeks “to engage with regulators to work towards balanced legal frameworks.”

British American Tobacco is very clear about the risks to health associated with smoking,” the statement said.

But researchers said the company’s own documents revealed a complex strategy that used several approaches to make sure smoking-related health issues were put on the back burner of China’s public health agenda.

“Everyone and their mother wants a piece of the Chinese market,” said Monique E. Muggli, the first author of the paper and a nicotine researcher at the Mayo Clinic in Minnesota. “What was unique about China was BAT’s efforts to train the local industry in China on their playbook, causing controversy and doubt around second-hand smoke where none really existed, and targeting the local tobacco industry, which is government owned.”

As recently as 2006, despite two decades of research into the harms of second-hand smoke, China’s State Tobacco Monopoly Association was issuing statements that more research was needed to determine the effects of smoke exposure, she noted.

One of British American Tobacco’s initiatives was to fund the Beijing Liver Foundation, which operated under the auspices of an established charitable organization that BAT considered had an “anti”-smoking agenda. BAT used the liver foundation “to reprioritize the agenda of the Ministry of Public Health” and to “divert the public attention from smoking and health issues to liver diseases,” according to company documents. The foundation was also used as a platform to promote BAT’s message that liver disease, rampant in China, “is the number one killer” there.

In 2000 and 2001, BAT used the liver foundation’s Web site to disseminate the message that second-hand smoke is not harmful, the documents indicate. The foundation funded research on second-hand smoke that dismissed the risks of environmental smoke exposure and convened expert panels to report the findings to the media.

Awareness of the risks of smoking to nonsmokers is particularly low in China, with only about one-third of Chinese citizens aware of the health risks of second-hand smoke, according to Chinese Ministry of Health estimates.

Even though the consensus among most public health experts is that there is no safe level of second-hand smoke exposure, Ms. Muggli said, BAT promoted the use of air filtration and ventilation systems in restaurants, hotels and other public spaces as a “route to avoid smoking bans,” the paper said. The company also pushed for “resocialisation” of smoking, industry code for accommodating smoking and avoiding public smoking bans, according to the report.

Although many cities in China have public smoking bans on the books, the restrictions are not usually enforced, the paper said.

In other presentations to the media, BAT sought to “present the message that tobacco smoke is just one of the sources of air pollution and a very insignificant one compared with other pollutants,” the paper said, quoting from company documents.

The company held “smoking and health seminars” for representatives of China’s state tobacco monopoly, in which it trained them how to convey the message that there is insufficient data to prove that second-hand smoke is harmful to children or other adults, and hence no need for government regulations.

The Chinese cigarette market is dominated by the state tobacco monopoly, but foreign cigarette companies will have more access to China’s 350 million smokers when the country eliminates tariffs on foreign cigarettes and opens up the market in accordance with international trade agreements, according to Teh-wei Hu, a professor at the school of public health at the University of California, Berkeley and an expert on China’s tobacco policy.

About 540 million Chinese are exposed to second-hand smoke each year, resulting in more than 100,000 deaths, experts say.

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