摘要：Despite the tobacco industry's claims that it has changed its practices, the toll of tobacco-related disease and death continues to grow worldwide, and the industry continues to use a vast array of strategies to promote its products and increase profits. This commentary discusses the ways the tobacco industry has created controversy about risk assessment and about the scientific evidence of the health hazards of secondhand smoke. The authors recommend that policymakers be more vigilant and that they demand transparency about affiliations and linkages between allegedly independent scientists and tobacco companies. They also urge policymakers to be prepared for new and continuing challenges posed by the tobacco industry, because, despite the industry's claims, there is little evidence of fundamental change in its objectives. TOBACCO COMPANIES CLAIM that they have changed. They assert that their efforts to undermine global tobacco control policy are a product of a past era and that now they seek to engage in constructive dialogue with the World Health Organization (WHO) and national governments. 1 Unfortunately, the reality is that the consequences of their actions continue. Four million deaths per year, 1.2 billion smokers in the world today, and high rates of youth smoking are in part the result of the failure of governments to implement tobacco control policies that are known to work. And governments' inaction is largely a result of decades of tobacco companies' untoward influence. Among the lingering effects of tobacco companies' actions are the insidious ways in which the public health policy agenda and the media debate about tobacco have been influenced. In this issue of the Journal, Ong and Glantz highlight one aspect of industry influence with respect to epidemiologic standards of causality. 2 The authors show that tobacco companies carefully planned to undermine accepted epidemiologic practices and hoped that by partnering with a broad range of academic and private commercial interests, they could create confusion about the role of epidemiology and risk assessment in public policy development. The ultimate goal of the industry was to promote the trivialization of the risk of tobacco use, stating that nearly everything from eating Twinkies to crossing the street was harmful, and that tobacco was just one more “risky pleasure.” Ong and Glantz's work needs to be considered within the broader concerted efforts of the tobacco companies to influence public policy in a manner detrimental to public health. The release of tobacco industry documents following US litigation provides us with access to a snapshot of the truth. These documents show a nearly 50-year effort to improve public relations, rather than public health. One example, from 1977, is Operation Berkshire, 3 which shows how 7 of the world's largest tobacco companies colluded to promote doubt about tobacco and health. These companies created the International Committee on Smoking Issues (later the International Tobacco Information Center) to internationally coordinate a network of national manufacturers' associations to block tobacco control measures. In another example, Philip Morris convened a meeting of its top executives in 1988 in Boca Raton, Fla, to develop an action plan aimed at attacking WHO's tobacco control programs at the national level and targeting the structure, management, and resources of the WHO. 4 These documents show the lengths the tobacco industry went to in its attempt to thwart the International Agency for Research on Cancer's epidemiologic research on secondhand smoke and lung cancer in Europe. 5 They show how linkages were created between tobacco companies and the chemical, food, pesticide, and utility industries, as well as how the tobacco industry developed its “scientific” strategy. The industry documents, described in The Cigarette Papers 6 and most recently summarized in A Question of Intent: A Great American Battle With a Deadly Industry, 7 tell about the scope and depth of the tobacco companies' ability to recruit scientists from the ranks of the most prestigious academic institutions. Tobacco companies sought to create doubt where scientific consensus existed. To do so, they enlisted scientists in their cause. This way, the industry voice would be heard but the industry would not be directly involved, as tobacco industry funding often remained undisclosed in publications and participation in public forums. The consultants, grantees, and speakers who were willing to work for the industry came from some of the best academic centers in the United States and abroad. For example, the US Tobacco Institute had a team of academics and scientists, “faculty members of prestigious universities and medical schools,” to assist in responding to the US Environmental Protection Agency's risk assessment methodologies, among other things. 8 Although the US Tobacco Institute was forced to close as a condition of the 1998 Master Settlement Agreement, 9 equivalent agencies still operate in major tobacco markets around the world, where the degree of intimacy between certain scientists and tobacco companies is not widely known. As discussed by Ong and Glantz, the use of front groups and consultants is a wellestablished tobacco industry practice to avoid dealing with its lack of public credibility. Scientists were constantly at hand to assist in maintaining the industry-created controversy on the tobacco and health issue.
