LONDON The World Health Organisation has been the target of a long-running, elaborate and secret campaign by the tobacco industry to subvert its anti-tobacco initiatives, according to a report published today. The independent report, commissioned by WHO after last year's publication of confidential tobacco industry documents, concludes: "That tobacco companies resist proposals for tobacco control comes as no surprise, but what is now visible is the scale, intensity and, importantly, the tactics of their campaign." The report calls for stronger rules on conflict of interest to protect the integrity of international decision making.
The committee of four independent experts reviewed some of the 35 million pages of tobacco industry documents released last year as a result of US litigation. It found evidence that may explain the poor impact of WHO's efforts to control tobacco use over the past 20 years, particularly in the developing world. Tactics used by the industry included secretly paying individuals to attack WHO in the media; using paid contacts to infiltrate WHO committees and divert funds away from tobacco control; financing institutions to lobby developing countries and international organisations, including the Food and Agricultural Organisation and the World Bank, to stress the economic importance of tobacco growing; and using paid scientists and journalists to manipulate research findings.
According to the report, Paul Dietrich, an American lawyer, enjoyed a long-term financial relationship with tobacco companies, during which he wrote prominent articles in major US newspapers questioning WHO's mandate and budgetary priorities. His main theme was that too much money was spent on first world diseases and too little on controlling infectious diseases in developing countries. In 1990, he was appointed to the Development Committee of the Pan American Health Organisation (PAHO), which also serves as WHO's regional office for the Americas. Documents from British American Tobacco give him credit for PAHO's decision that year to strike tobacco control from its budgetary priorities, in favour of immunisation and cholera campaigns. At no time did he declare his links with the tobacco industry.
In 1992, Dietrich was also instrumental in negotiating funding of $1.5 million from PAHO for a major teleconference promoting childhood immunisation throughout Latin America, arranged with the intention of distracting attention from the 8th World Conference on Tobacco or Health. This was just part of what the report concluded was an orchestrated strategy to undermine the conference, which included plans for a soccer match to coincide with Jimmy Carter's arrival at the conference, a campaign to stress the need for AIDS prevention and treatment in Latin America, a programme to train local journalists to dominate press conferences with questions about why tobacco control should be funded when children were dying of preventable diseases, and a recruitment drive for "independent" top-level scientists who would generate controversy on the effects of passive smoking.
A large multicentre study on passive smoking, run by the International Agency for Research on Cancer (IARC) during the 1990s, was a key target of the industry campaign. Concerned that the study would prompt further restrictions on smoking in public places, the industry used a wide range of tactics to undermine the study and misrepresent the results. Industry contacts gained confidential information about the study's methods and preliminary results; scientists were paid to discredit the methods and to reduce confidence among policy makers in epidemiological methods in general; and journalists were paid to misrepresent the study as having found no link between passive smoking and lung cancer.
The report concludes that there is a need for better awareness and understanding of the way the tobacco industry can influence decision making. "The evidence shows that tobacco companies have operated for many years with the deliberate purpose of subverting the efforts of the World Health Organisation to address tobacco issues. The attempted subversion has been elaborate, well financed, sophisticated and usually invisible."
The report recommends that WHO should clarify and strengthen its rules on conflict of interest. All staff should be required to declare their financial affiliations and should be barred from having links with tobacco companies. Staff should also commit not to work for tobacco companies for at least two years after leaving WHO, and to declare any links with tobacco companies when approaching WHO. WHO should also avoid using the services of any organisation that is working simultaneously for a tobacco company.
WHO has released the report directly onto its website, without accompanying comment, showing its commitment to transparency, and will await the public's response before deciding how to proceed.