Big Tobacco spends billions to expand its influence on healthcare and research – Follow the Money
Tobacco giants have invested billions of dollars into remedies for smoking-related diseases, including by funding scientific research into medicine and treatment. This spending blurs the line between the tobacco industry and the pharmaceutical sector – raising ethical concerns among many healthcare professionals and experts. One pulmonary doctor was shocked to discover that his PhD research into children with asthma was suddenly affiliated by cigarette manufacturer Philip Morris International.
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- The world’s four largest tobacco companies have between them invested more than 21 billion dollars this century in at least 33 companies making products for the health and wellness market.
- Such spending is part of a strategy by which tobacco companies are securing their future in what the industry is calling “a smoke-free world”.
- Remarkably, Big Tobacco invests in treatments for smoking-related illnesses and conditions. But a lot of industry money is also being poured into replacements for traditional cigarettes, such as e-cigarettes. Known as vapes, they are increasingly popular among young people and may pose huge health risks, as they expose users to toxic metals, research has found.
- Through the pharmaceutical sector, the tobacco industry also funds scientific research into smoking disorders, medicines, therapies and aids for people who want to quit their smoking addiction or who have already become ill because of their habit.
- Dutch media partner The Investigative Desk and The British Medical Journal found almost 900 medical-science studies involving one or more scientists who received some form of indirect funding from a tobacco company.
- Scientists are not always aware of the source of the money funding their work. For example, during his PhD research, a Dutch doctor and researcher was caught off guard by the news that the original funder of his study – a manufacturer of inhalers for asthma sufferers – had been taken over by tobacco giant Philip Morris International.
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One moment, Dutch doctor and researcher Wytse van den Bosch was working with a pharmaceutical company striving to treat lung disease; the next, with a subsidiary of a tobacco giant.
“Suddenly, I was linked to a company whose sole purpose is to sell cigarettes,” said Van den Bosch, who specialises in paediatric lung diseases at the children’s hospital Erasmus MC Sophia in Rotterdam. “That was really troubling.”
This was the uncomfortable situation facing Van den Bosch in September 2021 when Philip Morris International acquired Vectura, a British manufacturer of asthma inhalers.
As a result, the funding he had received from Vectura in 2018 – for his PhD research into the small airways of children with severe asthma – was now affiliated with the tobacco industry.
Major tobacco companies have for years been investing billions of dollars in treating conditions caused or exacerbated by smoking, such as asthma and chronic obstructive pulmonary disease (COPD), diabetes, heart disease and addiction.
This spending has put doctors, researchers and scientists in a quandary. The line between the pharmaceutical industry and the tobacco sector is blurring, making it difficult sometimes for health professionals and experts to escape the influence of cigarette manufacturers.
A doctor’s dilemma
Take Van den Bosch’s PhD research, for example. That was a result of a four-year unconditional grant from Vectura, a manufacturer of inhalers for drugs to treat lung diseases.
Van den Bosch had approached Vectura for funding because he wanted to use the company’s Akita inhaler in his clinical trial. “With that nebuliser, you can target an inhaled drug to a certain target area in the lungs in a very efficient and controlled way,” he said.
He was shocked to learn in the summer of 2021, three years into his research, that Philip Morris International had acquired Vectura. Van den Bosch’s PhD research was still in full swing, leaving him with a dilemma: should he quit or take money from a tobacco manufacturer’s subsidiary?
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“Your gut feeling says: just quit. As a pulmonologist, I would never get involved with a tobacco company,” he said in an interview.
Van den Bosch said he discussed the dilemma with colleagues, supervisors and medical ethicists at Erasmus MC, and ultimately decided to put the patients’ interests ahead of his own principles.
“We looked at whether stopping was actually more harmful to the patients’ well-being than continuing,” he said.
Van den Bosch and his team decided to continue with their study, but to publish an article in the British Medical Journal (BMJ) about “the unfortunate course of events”, he said. They did this partly to help other researchers avoid experiencing a similar situation, he explained.
Claims of “a smoke-free future”
Purchasing pharmaceutical companies is part of a strategy by which so-called Big Tobacco – the four largest tobacco companies in the world – is trying to ensure its survival as more and more countries restrict cigarette sales.
Philip Morris International (PMI), producer of Marlboro, L&M and Chesterfield, refers to that tactic as “Transforming Beyond Nicotine” and Altria, the US arm of Philip Morris, labels its approach as “Moving Beyond Smoking”.
Other major tobacco companies are running similar campaigns.
British American Tobacco (BAT), known for Lucky Strike and Dunhill, talks about “Building A Better Tomorrow”, British Imperial Brands, manufacturer of Gauloises, West and Davidoff, about “Beyond Smoke” and Japan Tobacco International (JTI), which makes Camel and Winston, about “Creating A Better Future”.
Such slogans coincide with the promotion of e-cigarettes (or vapes), heated tobacco, and nicotine pouches – alternatives that are gaining popularity among young people.
But the so-called alternatives to cigarettes are not nearly as harmless as the tobacco industry claims, research shows. For example, a study published by US researchers in the BMJ in April found that vaping at a young age could increase the risk of exposure to toxic metals – such as lead and even uranium – potentially harming brain and organ development.
The use of e-cigarettes is now more prevalent among children aged 13-15 than for adults globally, a May 2024 report by the World Health Organization (WHO) found. Young people who vape are almost three times more likely to use traditional cigarettes later in life, it said.
And despite brands’ pledges about harnessing their knowledge and resources to work towards a world without smoke, the industry is ever-growing and tobacco sales are still rising, mainly due to growth markets in Asia and Africa, according to various forecasts.
Expanding and profiting
Focusing on medical products and treatment is also part of the tobacco industry’s new strategy.
Last year, The Investigative Desk uncovered that tobacco companies are pumping big money into the pharmaceutical and healthcare industries, seeking to make money by selling medical products to treat conditions exacerbated or caused by smoking.
Philip Morris International, for example, not only invests in inhalers for lung patients through Vectura, but also in nicotine gum – an aid to quit smoking – via its Danish subsidiary Fertin Pharma.
Japan Tobacco International, through its pharmaceutical arm, produces medicines for lung cancer, heart disease and skin conditions. And Imperial Brands is betting heavily on medicinal cannabis, which is used as pain relief during radiotherapy and chemotherapy.
Yet these examples are just the tip of the iceberg.
In a new investigation, The Investigative Desk found that, since 1996, the four largest tobacco companies combined have invested more than 21 billion dollars in at least 33 firms offering products for the health and wellness market. This means industry giants can cash in on their consumers several times: first when someone buys a packet of cigarettes, then to get rid of their addiction, and again when they need treatment or drugs due to smoking-related illness.
Many doctors are at a loss over how to deal with this. Should they continue to prescribe drugs that make money for tobacco companies? Some think not. Others see no alternative.
Methodology
To investigate the investments of the “Big Four” (Philip Morris International/Altria, British American Tobacco, Imperial Brands and Japan Tobacco International), The Investigative Desk analysed public information in annual reports and press releases, and in the company databases Pitchbook and Company.info, among others.
The journalists recorded data on these investments in pharmaceutical and medical companies in a spreadsheet, which included the type of investment, the size and the amount of shares acquired. They then identified what type of products each company makes, and for which medical condition(s) they are intended to treat.
To investigate links to medical science, the journalists searched for the names of the medical companies in which the tobacco giants have invested in the medical-scientific database PubMed.They collected all results dating from after the tobacco company invested in that medical company.
This data was also recorded in a spreadsheet: titles of the scientific studies, the names of the scientists and universities involved, publication dates, the scientific journals in which the research was published, and the type of collaboration. This yielded 876 results.
In cases of doubt, the journalists tried to contact the scientist(s) concerned to avoid someone being wrongly included in the database. Unfortunately, they could not reach all the scientists.
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Some scientists such as Van Den Bosch have to consider whether or not to accept money from the tobacco industry. Those who decide against it reduce their chances of obtaining a research grant.
Using PubMed – an online archive of medical-scientific research – Dutch media outlet The Investigative Desk found 876 studies involving one or more scientists who received money indirectly from one of the “Big Four” tobacco companies. In some cases, the research was entirely funded by a subsidiary company in which the tobacco industry invests, while in others, the scientists received compensation from such a firm for consultancy work or a speech, for example.
Big Tobacco’s influence on research
Ruth Malone, professor of social behavioural sciences at the University of California and former editor-in-chief of the scientific journal Tobacco Control, warned of the pitfalls of the tobacco industry’s new tactics.
The sector uses science by “stoking division around the endlessly proliferating array of new tobacco and nicotine products and their potential to be less harmful for users”, Malone said.
“Anyone who understands the history, extent and nature of the epidemic and the tobacco industry’s strategic efforts to divide the public health community knows that industry money should be rejected,” she said.
Big Tobacco is known to fund “distracting research” that can divert attention from findings it does not like, and to use its influence to design studies in a way that can obscure unfavourable evidence, according to Malone.
“People may not realise how their work will be deployed to advance industry strategic goals,” she said.
Even if there is no obvious direct link between the cigarette industry and scientific research, Big Tobacco’s influence can be dangerous, medical experts have warned.
“The tobacco industry has a very well documented, very long-standing history of dishonesty and subverting science”
Medical-scientific research on asthma inhalers, for example, is valuable for manufacturers of cigarettes and vapes, according to Harm Tiddens, emeritus professor of paediatric pulmonology at Erasmus MC.
Tiddens, who was also Van den Bosch’s PhD supervisor, explained: “It’s very difficult to get drugs you inhale exactly to the right place in the lungs. That’s what Van den Bosch’s research was about. This could be interesting for a tobacco manufacturer … Philip Morris International is obviously keen to get its products to the right place in the lungs.”
For this reason, Nicholas Hopkinson, professor of respiratory medicine at Imperial College London, said scientists should immediately sever ties with pharmaceutical companies the moment they receive any money from the tobacco industry.
“That is very straightforward,” Hopkinson said. “And if they don’t, they are working with the tobacco industry.”
“The tobacco industry has a very well documented, very long-standing history of dishonesty and subverting science,” he added.
No interference, no problem?
However, not all academics agree with Hopkinson. Take, for example, Alexander Sack, professor of brain stimulation and applied cognitive neuroscience at Maastricht University in the Netherlands.
Sack sometimes works with Danish neuroscience company PlatoScience, which receives money from British American Tobacco via an investment fund. That fund holds an estimated 20-25 per cent of PlatoScience’s shares. Sack occasionally publishes scientific papers in collaboration with PlatoScience staff.
He also acts as “chief science advisor” to the company, which produces neurostimulation devices that help to deal with conditions such as depression and addiction.
In response to questions from The Investigative Desk, Sack did not disclose the fee he receives from PlatoScience for his occasional work, and said that he did not know the specific details about the connection between the company and British American Tobacco.
“As long as British American Tobacco does not interfere with my scientific work, I see no immediate problem,” he said via email.
Sack said that the tobacco giant had already invested in PlatoScience before he became involved with the company. “I have always considered British American Tobacco as a kind of ‘holdover’ from that time,” he wrote.
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He also believes that his work has no value to the tobacco company. “I am of no interest to that industry because I am not doing research that fits in with them,” Sack added.
At the same time, Sack’s employer, Maastricht University, declared, when applying for a grant from the World Health Organization (WHO) in 2023, that the university does not collaborate with the tobacco industry: according to Pamela Habibović, the university’s rector magnificus. She said that the university, at the time of the application, had indicated it hadn’t had “any relations with the tobacco industry in the past four years, including investment interests (other than general investment funds or complex arrangements), impossible business interests or the provision of financial and/or other support.”
Habibović does not take issue with the fact that British American Tobacco, through its investment fund, is a shareholder in PlatoScience. “The articles [that Sack co-authored in collaboration with PlatoScience] did not concern the tobacco industry in the broadest sense of the word,” she said in an email.
Since PlatoScience operates in a completely different field, Habibović said that there is no question of “collaboration with the tobacco industry.”
Habibović also dismissed the risk of a conflict of interest.
“The mere fact that British American Tobacco has acquired a minority stake in PlatoScience does not imply that PlatoScience influences research results, publications, or that there is automatically a potential conflict of interest,” she said.
Ancillary activities
Although Maastricht University declared to the WHO that it does not collaborate with the tobacco industry, it does not have a special policy for employees who perform ancillary work for tobacco manufacturers or for companies in which they invest.
“Permission should be sought for each ancillary activity,” Habibović said, explaining that an assessment is carried out before any such permission is given. “Permission will not be granted for an ancillary activity at Philip Morris International or British American Tobacco.”
When asked about ancillary activities for companies that have a tobacco manufacturer as a shareholder, Habibović said it was not possible to deduce this from public records.
“After all, this is not public information,” she said.
Yet this is incorrect: that information can be obtained online via press releases, annual reports and the Dutch Chamber of Commerce.
Publishing policies
Academic publishers should have measures in place to keep out tobacco funding by ensuring that scientists and researchers who do receive such money are barred from publishing, working with their institutions, and taking part in conferences, according to Hopkinson from Imperial College London.
Scientific journals often operate with a code of ethics that requires authors to disclose links to companies in conflicts of interest. Some also have a separate tobacco policy, by which they vow not to publish research that was facilitated with money from tobacco companies.
“The first thing they ask is: ‘Are you related to a tobacco company?’ If I am then very honest, I have to say yes”
But this system is by no means foolproof.
For example, Swiss publisher Multidisciplinary Digital Publishing Institute (MDPI), declares that it “does not publish studies funded partially or fully by the tobacco industry”.
Yet 12 of its journals appear to contain studies in which one or more researchers have a financial link to a company affiliated with the tobacco industry, The Investigative Desk found.
“We were not aware of the ‘Beyond Nicotine’ strategy of tobacco companies,” said Ana Stankovic, the publisher’s ethics specialist. “We have always trusted scientists themselves to disclose any links with the tobacco industry.” MDPI said it would investigate the issue.
Similarly, the European Respiratory Society (ERS), a global membership organisation for those working in respiratory medicine, says its publications and editors do accept articles by authors who have had any connection with the tobacco industry since 2000.
But in practice, the ERS is less strict. For example, it published Van den Bosch’s asthma study in January this year despite the fact that Philip Morris International acquired Vectura while the research was still being carried out.
Van den Bosch said: “We stated at the time that we received a researcher-initiated grant from Vectura in 2018, and that we are not involved in any way in the production, sale or promotion of tobacco. This was enough for the editor to go ahead with publishing the piece.”
It made no difference that Van den Bosch and his colleagues continued to receive funding for their research in 2022, the year after Philip Morris International took over Vectura.
Since Van den Bosch’s grant had already been approved in 2018, there was no violation of the ERS policy on tobacco, according to publisher Elin Reeves. The fact that Vectura is not a tobacco company but a pharmaceutical is of no consequence, Reeves explained.
“Our tobacco policy also applies to companies owned by the tobacco industry,” she added.
Bypassing lobbying and funding ban
The tobacco industry can also use investments in medical science to circumvent the WHO Framework Convention on Tobacco Control.
The treaty, signed by 182 countries, requires governments to protect their health policies from the commercial interests of the tobacco sector. For example, it states that policymakers and officials are not allowed to have contact with industry lobbyists.
The convention defines the tobacco industry as “manufacturers, wholesalers and importers of tobacco products”. As such, the lobbying ban does not apply to pharmaceutical companies in which the tobacco industry invests. Therefore, employees of those companies have access to meetings prohibited to the tobacco industry.
For instance, an e-mail exchange that was obtained following a Freedom of Information request to the EU’s Directorate-General for Health and Food Safety revealed that Philip Morris International subsidiary Vectura Fertin Pharma was able to participate in a conference last year to which EU representatives were also invited.
The WHO treaty also bans financial sponsorship of the tobacco industry. Yet this applies only to the parent companies, not the medical companies in which investments have been made by the sector. In 2019, for example, the European Commission awarded a grant worth 50,000 euros to Danish company PlatoScience to develop a headset for ‘neurostimulation’ against depression. This funding was provided before British American Tobacco invested in PlatoScience in 2020, but the tobacco manufacturer ultimately benefited from the grant.
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Van den Bosch said he has mixed feelings about the decision to continue his research into the small airways of young asthma patients after Philip Morris International acquired Vectura.
He is now in a position where his name is associated with the tobacco industry. “If you want to go to a conference, present an abstract or submit a paper, the first thing they ask is: ‘Are you related to a tobacco company?’ If I am then very honest, I have to say yes,” Van den Bosch explained.
“I am at the beginning of my career, becoming a paediatrician, I very much want to stay active in the research world. My name is now linked to Vectura, and Vectura to Philip Morris,” he added. “So then you become affiliated with the tobacco industry yourself.”
Right to reply
A spokesperson for British American Tobacco (BAT) said the following about its corporate venture capital company BTomorrow Ventures (BTV): “While BTV does have a minority investment in PlatoScience, neither BTV nor BAT work commercially or scientifically with PlatoScience and have no working relationship with the person in question [Professor Alexander Sack]. BTV invests in consumer brands, digital transformation, new technologies and future sciences, but not medical investments. When BTV invested in PlatoScience, the company’s focus was on cognitive enhancement, not medical applications.”
Japan Tobacco International, Altria and Imperial Brands did not respond to a request for comment. Philip Morris International declined to comment.
The World Health Organisation (WHO) did not respond to a request for comment.
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This research was produced in collaboration with Hristio Boytchev of The British Medical Journal and John Hansen of the Danish newspaper Politiken, with support from Journalismfund Europe.
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