Like salivating foxes outside a henhouse, Big Tobacco companies like Philip Morris International and British American Tobacco are deep in global charm offensives, trying to convince the public, the corporate world, governments and public health leaders that they have changed. They want to be embraced as health promoters!

Overnight, Moira Gilchrist, Vice President at Philip Morris International, tweeted this

Here’s some news for you Moira, we’re doing very, very well in helping  smokers “who would otherwise continue smoking” to stop doing just that. It’s been going on for decades, despite your industry’s best efforts to thwart what we’ve been doing. And look at the harm we’re been able to reduce, in spite of your industry’s opposition.

Despite decades of abject failures in producing reduced harm products, they are still at it, this time with ecigarettes and heat-not-burn nicotine delivery systems.

The development of cigarette filters from the 1930s was the daddy of all harm reduction false assurances. While anyone looking at the brown gunk discolouring a cigarette filter gets it that this nasty stuff is caught in the filter and not inhaled, few appreciate that filters do not stop a lot of toxic material being inhaled.

And few are likely to appreciate that what gets inhaled deep into the lungs does not all come out when a smoker exhales, as this elegantly simple video demonstration makes very clear.

Throughout my career, journalists have often asked me for sets of questions I might suggest that they could ask visiting spin doctors from tobacco companies at conferences, press conference or during interviews.

Here’s one I put together in 2005 for David Davies, then vice president for corporate affairs for Philip Morris, when he spoke about harm reduction at Australia’s National Press Club in Canberra.

So, journalists, here are 10 questions you might like to be impertinent enough to ask a tobacco company wanting to explain to you their latest vision. And Moira, you are very welcome to answer these here. I will publish your responses, and will give you up to 2000 words to do so.

10 Questions for Philip Morris International

1. You say you want smokers to switch to IQOS, but  Philip Morris USA (a separate company to Philip Morris International which just happens to share the words “Philip Morris” in its title) is on record recently as saying on its website that cigarettes are “our core product” and that they are working hard to keep their smokers happy with “best quality” cigarette products. Are cigarettes also PMI’s “core product’? Or asking another way, how much global revenue does PMI make from tobacco today, and how much from IQOS and what are your forecasts for these numbers in the next 10 years? Are your shareholders happy with you purposefully trying to drive south (by far) your biggest income stream?
2. What are the KPIs (key performance indicators) for the sales, marketing and public affairs staff in your cigarette division today? Are they being asked to try and sell less cigarettes or to keep on trying to sell more? Could we all see copies of some of those please?
3. In Indonesia, Philip Morris International owns the Sampoerna tobacco company. In 2016, Reuters reported that you were trying to get “wider reach” there via “stronger cigarettes” What do you say to those who say you are being duplicitous with all this reduced harm talk when this is what you are doing when you calculate that people in the west might not notice? Similarly, when the city of Balanga, Luzon in the Philippines wanted to implement a smokefree campus and surrounding environs, you supported the Philippine Tobacco Institute in its (successful) legal case against the proposal. So you say you want people to quit smoking, but only if they switch to IQoS, is that it? And if not you will continue fight effective tobacco control as usual?
4. In recent years, your company has aggressively opposed tobacco control policies like graphic health warnings, plain packs, and increasing tobacco tax, all known to reduce smoking. When you do this, can you understand that many people think you are flagrantly lying when you say you want to help tobacco control?
5. What do you say to critics who say that your business model is surely all about smoking AND vaping, not smoking OR vaping?
6. I don’t think I’ve ever met a smoker who wanted their kids to grow up and start smoking. Do you feel the same way? Would you also hope that children would not take up vaping? If you really believe ecigs are of minimal risk, why not openly encourage kids to vape?
7. Smoking by Australian teens is at a record low (1.9% of 15-17 year olds currently smoke) I find it hard to believe if your company had not modeled the impact of such a dire situation on your bottom line into the future if this was to continue. So what does that modelling show? And am I wrong in thinking that if your IQOS product does not attract a significant number of kids into regularly using it, then your company will wither and die within a few decades because if only smokers switch, many of those will quit and die, with no cohort of young people moving through to replace them.
8.  The  parent company of Philip Morris USA, Altria, just invested $US12.8billon in Juul, the vaping product that has spearheaded 20% of US teens using ecigs in the last 30 days.  Are you going to tell me that this teen use of ecigs “concerns” you or that there were a lot of champagne corks popping at work when you all saw that data?
9. The average daily vaper inhales 200 times a day and up to 600. The average daily smoker inhales about 95 times a day. Does that comparison suggest that nicotine delivered via vaping might be very, very addictive? Does that bother you?
10. I’ve heard people very unkindly quip that it would be a good idea if all tobacco company employees were obliged to smoke or vape (in the obverse way that no cancer control agency would hire a smoker). It would be hard to imagine a senior executive in a car company who chose to not drive or own a car, but to always cycle or walk and openly declare that; or the head of a meat marketing board who was an open vegetarian, or a skin cancer prevention advocate who was deeply tanned. So why do you think your company is comfortable with some of its employees choosing not to smoke or vape? Do you smoke or vape yourself?

Follow-up (1 March 2019)

After I posted this piece a week ago, and tweeted a link to Moira Gilchrist from PMI, the following exchanges occurred (see thread here)

So. Thank you Moira, for partially answering the first bit of question 1 above (“Or asking another way, how much global revenue does PMI make from tobacco today, and how much from IQOS and what are your forecasts for these numbers in the next 10 years?”) and this below

Moira, this is clear as far as it goes, but it sits very awkwardly with all the unanswered questions I posed above about your company’s continuing efforts to attack tobacco control policies designed to get non-smokers (mostly kids) to “don’t start” (eg: high tobacco taxes, graphic health warnings, plain packs) and to motivate smokers to “quit now” (again, high taxes, graphic warnings, plain packs, plus smoke free policies like the one you helped stop recently in Balanga, Philippines).

So, no fudging please. When can we expect your answers to the questions you  publicly invited on Twitter from people like me who are (profoundly) skeptical of what we read as yet another wolf in sheep’s clothing exercise from your industry?

21 March 2019: update. Moira has posted this reply on the PMI website. Here‘s my reply

Late last month, Philip Morris International tweeted one of its daily attempts to convince the world that it is now a health promotion company, firmly aligned with global public health to try and reduce the disease and death caused by tobacco use. Its mainstay, cigarettes, kill two out of every three long term users.

The company is aggressively marketing its heat-not-burn product IQOS (see footnote below) in several markets and  Altria, which owns Philip Morris USA, recently invested $US12.8 billion in the tearaway e-cigarette market leader, Juul. PMI has bankrolled the establishment of the fully “independent” Foundation for a Smokefree World with a grant of $US960 million dollars over 12 years in a classic exercise in astroturfing its messages to also come from a third party.

The Foundation has attracted incendiary criticism since it was first announced. See here, here, here, here, here and here, as just a few examples.

Last month a PMI tweet stated “If we stopped selling cigarettes tomorrow, someone else would take our place”.

This was clearly a response to what any review of how its “we’ve changed” message is traveling would have undoubtedly identified as its most hobbling Achilles’ heels: its long-standing track record in both attacking tobacco control policies that threaten to actually reduce smoking (high cigarette tax, plain packs, graphic health warnings, smoking restrictions), and its on-going aggressive global marketing and promotion of its cigarettes.

For example, in Indonesia, the world’s fourth most populous nation where it is almost compulsory for men to smoke, the tobacco industry exploits this smokers’ paradise. A pack of cigarettes can sell for less than a small bottled water, tobacco advertising virtually wallpapers the entire country and non-smoking areas are uncommon and mostly ignored. Philip Morris owns the local manufacturer Sampoerna, which controls about one-third of the massive market there. In 2011, a Sampoerna advertisement proposed “Dying is better than leaving a friend. Sampoerna is a cool friend”. In 2015, the company began aggressively promoting its U-bold brand, a “stronger flavoured” brand, often code for higher yielding tar and nicotine brands.

In July, 2018, a legal action brought by the Philippine Tobacco Institute (PTI), representing Philip Morris and other tobacco manufacturers,  succeeded in preventing an ordinance being implemented in Balanga City, Luzon which would have banned smoking and the sale, distribution and promotion of cigarettes within the 80-hectare University Town and its kilometer radius. A press report stated that “PTI had argued that Philip Morris Philippines Manufacturing Inc. would lose P15 million in sales due to the city’s ban.”

In 2018, the company opened a new $30m cigarette factory in Tanzania

These are  hardly actions compatible with ad nauseum statements from company that it wants smokers to quit.

The tweeted admission “If we stopped selling cigarettes tomorrow, someone else would take our place” disrobes the entire charade. The “we’ve changed” emperor now quite clearly has no clothes.

Let’s pick the statement apart, one ethically bankrupt sub-text at a time.

Like a wolf outside a henhouse, Philip Morris has gushed an incontinent deluge of claims that it really, really wants smokers to switch to its alleged low risk products. But never once in all this has it set any target dates. Nowhere can we find when the company plans to actively take steps to end its own role in encouraging and promoting smoking and attacking policies known to reduce smoking. Will this happen in 5 years? 10 years? 30 years? Never?

All we know now is that it won’t happen “tomorrow”. And the great beauty of it never being tomorrow, is that tomorrow never comes.

We might think they were serious if they were to, for example, voluntarily move their cigarette products to dull plain packaging and add large pictorial warnings, or declare that they wre going to voluntarily stop all cigarette advertising in nations where it is still allowed, or axe their “Mission Winnow” sponsorship of Ferrari in the F1 Grand Prix and Ducati in the Moto GP  when Mission Winnow’s advertising livery is red and white, coincidentally we can be certain, the same colours as Marlboro.

But hell might freeze over before they did any of these things.

The company is not simply going to passively sit by and watch smoking prevalence continue to head south by taking its feet off its marketing accelerators or slamming them hard in concert with public health on the tobacco control policy brakes. It has said and done nothing to indicate that it won’t continue to do what it can to preserve and expand its cigarette sales.

PMI’s statement requires those reading it to understand that the company has been called out by critics to show that they are being serious about wanting to actively  end smoking. But by invoking the  “someone else will do bad things if we stopped” they seek to make a virtue out of knowingly and purposefully continuing to do the wrong thing.

Their pitch here is like a brazenly misbehaving 5 year old who knows he is doing something wrong, but says to the teacher “why should I stop? Why pick on me? Everyone else is doing it too!” Or a drug dealer saying to the court “yes, I was cutting my heroin with cheap adulterants that put all who used it at extra risk, but that’s what my competitors are all doing too, and I just needed to keep up with them price-wise or go under. Please sympathise with my situation!”

As I wrote in 2014:

“My wife is a primary school teacher with 35 years experience. She has often described incidents where 5-9 year olds with poorly developed moral compasses have been caught red-handed bullying, stealing, cheating or lying but unblinkingly deny it regardless of the evidence in front of them.  More than once, she’s suggested that such a child might one day make an ideal applicant for a job in a tobacco company.

Globally, different legal, moral and religious codes tend to share basic principles when it comes to how to deal with those who have done serious wrong. Sentencing often takes note of evidence of contrition and civilized societies and judiciaries tend look for five broad pre-conditions in considering punishment”

• Full public acknowledgement of the misdeeds and harms caused
• apologising for these harms
• promising never to repeat them
• making good the damage done, and
• undertaking some form of public penance to symbolise your changed moral status.

Like many caught-out five year olds and recidivist adult sociopaths, the tobacco industry has done none of these things. Its corrective advertising is being done reluctantly after 15 years of legal kicking and screaming, while schmoozing with the global corporate social responsibility movement, publicizing its donations to carefully selected charities and just getting on with trying to sell as much tobacco as possible, regardless of the misery it causes.

They have all the ethics of a cash register.”

At least cash registers don’t pretend to be something they are not.

Footnote: a just published report comparing the impact of  IQOS with cigarette smoke on human lung cells  concluded “IQOS exposure is as detrimental as cigarette smoking and vaping to human lung cells. Persistent allergic, smoke or environmental-triggered inflammation leads to airway remodelling/scarring through re-organisation of ECM and airway cell proliferation, and mitochondrial dysfunction plays a pivotal role in this process. These are the principal causes for airflow limitation in asthma and COPD.”

[updated 24 Jan 2020]

In a recent Medical Journal of Australia Insight blog on e-cigarette regulation, vaping promoter Colin Mendelsohn responded to a comment, writing “ecigs are consumer products. Medicines regulation is not appropriate. Why should they be regulated more strictly than cigarettes which can be bought at every corner shop?”

Then, without pausing for breath, in his very next sentence he goes on to tell us about how effective in smoking cessation they are, compared to nicotine replacement therapy (NRT), as one recent study reported them to be.  In case you missed it, NRT is a medicine regulated by the  Therapeutic Goods Administration, not a “consumer product” , whatever that might mean.  (see my previous blog and here for comments on the major limitations of the evidence that Mendelsohn cited)

Excitable News Corp journalist Joe Hildebrand puts it this way “How come it’s legal for me to walk into a convenience store and buy something that’s going to kill me but it’s illegal to buy the one thing that could save me?”

The one thing, eh Joe. Tell that to the 30% of Australia’s adult population who are ex-smokers who somehow managed to quit smoking without using an e-cigarette. About 5,440,800 of them, according to 2017-18 ABS data on smoking.

One problem with this trite comparison is that tobacco products are regulated in Australia in many ways that  Mendelsohn strongly opposes for ecigarettes.

• All advertising and promotion for tobacco products has been banned since 1994. Mendelsohn wants advertising for ecigarettes allowed
• the sale of fruit and confectionary flavoured cigarettes is prohibited in South Australia, New South Wales and Tasmania. He is strongly in favour of allowing many flavours, including those that may have high appeal to both adults and teens
• smoking is banned in all enclosed and several crowded outdoor areas like stadiums. He wants vapers to be allowed to smoke in areas where smoking is banned because he says this will add to the appeal of vaping and cause smokers to quit. The rest of us can just put up with clouds of vape like this is bars, restaurants and cinemas, apparently. When many vapers are present (and that would never happen of course), particulate matter levels can reach and exceed those that used to be recorded when smoking was allowed in crowded bars.
• Tobacco products are heavily taxed, depressing demand particularly among low income group and children. Mendelsohn supports reducing tax on ecigs, a policy that would make them more accessible to Australian children, of who only 1.9% smoke daily today.
• Retail display of tobacco products is banned nationally. Ecigarettes are on open display in retailers, something he fully supports
• All products are plain packaged, with large health warnings while packaging for ejuice is a cornucopia of beguiling images

Let’s repeat the same mistakes we made in allowing open slather sales and promotions with cigarettes

But more fundamentally, the galactic dangers of smoking were not fully understood for at least 40-50 years after mass consumption and the commerce that facilitated it had commenced in the first decades of the twentieth century. After mechanisation of cigarette production made them cheap as chips, it then took us 40 -50 years between the 1960s and today to fight for all the policies and campaign funding that have together taken smoking down to its lowest ever levels.

Out of ignorance and under sustained pressure from the tobacco industry, we began by making every regulatory mistake possible when cheap, mass produced cigarettes appeared. Our understanding of the health risks that may be posed by ecigarettes is in its early infancy, given the latency periods that apply with the development of chronic disease.

It is often said that if cigarettes were invented tomorrow, and we knew now what we didn’t know when they entered the market, no government in the world would permit their sale, let alone allow them to be sold in every convenience store.

With pharmaceutical products that save lives, treat illness and reduce severe pain, we allow only those with a 4 year pharmacy degree to sell them. And only to those with a temporary license issued by a doctor (a prescription) to use them. With cigarettes, we foolishly allow them to be sold everywhere.

Very few people (me included) are saying we should ban ecigarettes. But nearly every health and medical agency in Australia and many internationally, including the WHO, are saying that they should be strongly regulated through the TGA so that over time, as knowledge increases we could review whether looser or stronger regulation (perhaps including bans) was appropriate when that knowledge is available.

That’s the way nearly every country regulates pharmaceutical products. Strict, prescription-only regulation at first,  followed by evidence-driven loosening or tightening down the track.

Vaping advocates seem to have understood little from where we went so wrong in unleashing cigarettes and allowing them to be sold everywhere from the get-go. Today they are trying to walk on both sides of the street by insisting ecigs are not therapeutic goods, but in the next breath megaphoning claims about how good they allegedly are in helping smokers quit compared to other therapeutic goods.

Make up your minds?

This 2016  Lancet meta-analysis of smoking cessation and ecigarettes concluded that  ecigs were associated with less quitting among smokers. The 2018 report of the US National Academies of Science, Engineering and Medicine on ecigarettes concluded “Conclusion 17.1 Overall, there is limited evidence that e-cigarettes may be effective aids to promote smoking cessation.” NASEM rated limited evidence four rungs below “conclusive” evidence and just two above “no available evidence”.