World Cancer Day
4 February 2021
The tobacco industry hides the truth about tobacco and cancer
The truth is that all tobacco use causes cancer – and even one cigarette a day can harm you. Smoking during childhood or adolescence may lead to lasting or even permanent genetic damage in the lungs that increases the risk of lung cancer, even after the smoker quits. Husband’s smoking can cause cancer in their wives.
This has all been established for many decades, yet the industry has spent much of the last 50 years denying the harmfulness of smoking and of second-hand smoke. Even the newer forms of tobacco such as heated tobacco products and e-cigarettes contain carcinogens. There is no safe level of tobacco smoke.
Often, when people think about smoking and cancer, they think of lung cancer alone. But it is much worse than that. Tobacco use is also linked to cancer of the mouth, oesophagus, colon, kidney, bladder, liver, pancreas, stomach, cervix, and some leukaemias.
Smokers inhale much higher doses of harmful substances than is stated on their cigarette packages, according to a study by Dutch public health institute RIVM (the Dutch National Institute for Public Health and the Environment). The researchers found that the amount of (cancer-causing) tar, nicotine and carbon monoxide is at least twice as high as manufacturers claim.
For decades the industry has denied the cancer link.
Exposed in the Lancet “The whole truth and nothing but the truth? The research that Philip Morris did not want you to see,” the tobacco industry maintained, for many years, that it was unaware of research about the toxic effects of smoking. There were even attempts to skewer the science: in the 1970s, internal industry documents exposed that Philip Morris acquired a research facility, INBIFO, in Germany and created a complex mechanism to ensure that the work done in the facility could not be linked to Philip Morris. INBIFO appears to have published only a small amount of its research and what was published appears to differ considerably from what was not.
In particular, the unpublished reports provided evidence of the greater toxicity of sidestream than mainstream smoke, a finding of particular relevance given the industry’s continuing denial of the harmful effects of passive smoking, and its opposition to laws and regulations creating smoke-free areas. By contrast, much of its published work comprises papers that convey a message that could be considered useful to the industry, in particular casting doubt on methods used to assess the effects of passive smoking.
The pioneer cohort study in 1981 by Japanese investigator Takeshi Hirayama examined the association of passive smoking and lung cancer among non-smoking wives of smokers in Japan. The study concluded that wives of heavy smokers had up to twice the risk of developing lung cancer as wives of non-smokers and that the risk was dose related. The Hirayama study was influential because it launched an extraordinary amount of critical debate and has been one of the most frequently cited studies in regulatory proceedings, risk assessments, and the media. It paved the way for smoke-free legislation as we know it today.
But the tobacco industry immediately generated its own study, the “Japanese spousal study,” in an attempt to refute the findings of Hirayama’s study, at the same time trying to hide industry involvement. Internal tobacco industry documents describe how the tobacco industry considered multiple strategies to conceal its involvement in the Japanese spousal study. Those involved in conducting the study included a tobacco industry scientist, a tobacco industry consultant, an industry law firm, and two Japanese investigators. The consultant was the sole author of the final publication.
Nearly 40 years ago, I left a career in hospital medicine in Hong Kong because our medical wards were full of smoking-induced cancers, many only arriving at the hospital too late for any cure, and I realised prevention was the only sustainable route forward.
I had to battle with denial from the industry. In 1982 in Hong Kong, British American Tobacco published a brochure, which was leaked to me, asserting “it has not been proven that these illnesses are actually caused by smoking.”
BAT went on to state “The anti-smoking lobby in Hong Kong is largely anonymous, unidentifiable, entirely unrepresentative and unaccountable.” It urged governments and the public to instead consult the industry as a more reliable source of information, claiming “The tobacco industry comprises identifiable, legal, accountable, commercial organisations.” This last statement was a tipping point in my life. I was so outraged that it caused me to change forever from curative to preventive medicine.
While the cancer cases continue to pile up across the globe, the tobacco industry has neither admitted liability nor paid any compensation to the disease and death its product has caused over the decades. Instead, it continues to oppose tobacco control legislation and even sue governments for enacting measures to protect public health. This industry must be made to pay for the devastation it causes.
Prof. Judith Mackay
Special Advisor on Article 5.3 Implementation
 British American Tobacco. 1982. CIGARETTE SMOKING AND HEALTH RESEARCH.