Richard Smith: A public health witch hunt—bad for everybody

richard_smith_2014At the end of last week I received this email:

“Greetings from India, and I hope this finds you well!

My name is Anoo. I’m a journalist based in Delhi, at The Wire.

I broke the story on 13 December, about Derek Yach’s email-list, targeting health professionals with grant money:

Exclusive: Philip Morris Funded Anti-Smoking Foundation Targeting Public Health Leaders With Grants

The World Health Organisation has issued two public statements, asking governments not to associate with Yach’s foundation due to the fact that it is funded by Philip Morris International:

19 Sep 2017 http://www.who.int/fctc/mediacentre/statement/secretariat-statement-launch-foundation-for-a-smoke-free-world/en/   

28 Sep 2017 http://www.who.int/mediacentre/news/statements/2017/philip-morris-foundation/en/  

Your name and contact details were on Yach’s email.

So I am writing to you for comment:

1- Have you received Yach’s email? Please check your spam box and trash folders for this.

2- Why do you think Yach has personally emailed you to apply for his foundation’s grants/ to recommend others for it?

3- What are the reasons you would apply or not apply for these grants?

4- Which are the other names on his personal mailing list, that stand out to you, and for what reasons?

5- A number of people have been asking Yach and his foundation to remove their email IDs from his communication list. Have you done/ not done the same? What are your reasons?

I hope to hear from you soon, as this is a matter of public interest. Please let me know if I can further clarify anything on this for you.

Best wishes,

Anoo

If you’re a well-known tobacco researcher you would probably shudder to receive such an email, but I’m an old dog with nothing to lose. So I responded to Bhuyan:

“Dear Anoo,

I was emailed by Derek because I’ve known him for some 25 years and have always admired him as the leading strategic thinker in countering non-communicable diseases.

I used to be the editor of The BMJ.

I won’t be applying for research funds from the foundation as I’m not an active researcher.

I think that the public health sector is showing a knee-jerk reaction in objecting to the foundation Derek is leading.

The appearance of e-cigarettes has changed the picture radically. As I explain in this piece, I don’t think that it will be possible to achieve a nicotine-free world—because people with severe mental health problems are given relief from nicotine. But it may be possible to achieve a tobacco-free world by moving from tobacco to e-cigarettes. Philip Morris seems to think that this will happen, and so there is business logic in funding a foundation to promote a tobacco-free world.

I think too that it is possible for the foundation to achieve a form of governance that will guarantee its freedom—at least until more funding is needed.

I think that WHO and other public health bodies should think more deeply before reacting so quickly and negatively.

Finally, I hope that you are not being used to conduct a witch hunt when there are no witches. Or perhaps I’m one.

Best wishes

Richard”

Let me explain the background to this interchange. Derek Yach, one of the leading campaigners against tobacco, is a figure who profoundly confuses public health people. I’ve known him for 25 years and see him as the leading strategic thinker in countering NCD globally, whereas others see him as a money-and-fame-hungry opportunist.

When an assistant director at WHO he was one of the main architects of the Framework Convention on Tobacco Control, which many regard as the second greatest achievement of WHO after smallpox eradication. It is probably the biggest ever development in global tobacco control.

But after working at the Rockefeller Foundation and at Yale, Yach moved to be chief medical officer at Pepsico. This was too much for the many public health people who regard “Big Food” as little better than “Big Tobacco.” Public health people concluded simply that Yach had sold his soul to the devil.

But there was a logic: Indra Nui, the chief executive, recognised that increasing health consciousness among consumers meant that there was money to be made from healthy products and that the future of unhealthy products—like sugary drinks—might be short. Yach could have impact on a huge scale by facilitating the move to healthier products. It’s also the case that once a publicly-listed business commits itself to something it has to deliver. This is in contrast to many public organisations, including governments and UN organisations, that make commitments and then fail to deliver on them. It’s much harder to deliver than to promise.

Yach left Pepsico, and, after a relatively short time at the Vitality Institute, made the move that the public health world cannot grasp at all—as head of a Foundation for a Smoke-Free World funded by Philip Morris International, one of the world’s largest tobacco companies. The foundation will receive $1 billion in funding over 12 years. WHO refuses to have anything to do with the foundation and urges governments and other bodies to follow its lead.

It’s easy to see why public health people would react in this way. The tobacco industry sells products that kill and has an appalling record of opposing measures to reduce tobacco consumption and of corrupting the scientific process. But, argues David Sweanor, a Canadian lawyer who has many times successfully sued the tobacco industry, it’s a mistake to regard the industry as a monolithic empire of evilDifferent companies and people within the companies have different views. He argues that it’s important for public health people to engage with the industry, and the Lancet recently argued the same.

Again there is a logic to Yach’s move. It will probably never be possible to achieve a nicotine-free world, not least because people with severe mental health problems find benefit from nicotine. People with severe mental health problems account for around 10% of sales of tobacco in the US. But with the arrival of e-cigarettes it may be possible to achieve a tobacco-free world. E-cigarettes might be harmful, but even the most ardent anti-tobacco campaigner would agree that it’s the smoke not the nicotine that kills.

The appearance of e-cigarettes is changing the world of tobacco as railways changed canals and digital images changed film. How should tobacco companies react? If they react wrongly they may follow Kodak, who failed to respond correctly to the appearance of digital images, into oblivion. Philip Morris International seems to have bet that e-cigarettes will be the future, and so there is business logic to funding a Foundation for a Smoke-Free world. Unfortunately there is also a business logic to continuing to block attempts to reduce cigarette consumption in markets where e-cigarettes have yet to make inroads.

This two-faced attitude will seem unacceptable to many, but if the foundation can achieve real independence from the company then much can be achieved with $1 billion. Many foundations have little or no independence from their companies, but I believe that it is possible to achieve true independence with the right governance—at least if the money is committed for 12 years. True independence is impossible if money is drip fed into the foundation.

The foundation hired McKinsey to try and achieve guaranteed independence, and I spoke to the consultants. I wasn’t paid, and I won’t be applying for research funds from the foundation because I’m an old dog and not an active researcher.

Somebody in Yach’s office made the mistake when reminding people of the closing date for applications for grants of pressing the CC rather than BCC button—so all the names of the over 300 recipients are visible to anybody who received the email. In the highly charged atmosphere surrounding the foundation and with WHO having urged everybody not to engage with the foundation there is immediately a suspicion that the people named are willing to sell their integrity for research funds or, worse, are lackeys of the tobacco companies or even “double agents.”

It was inevitable that somebody would pass the email to the media, and, as my name is on the list, I received the email from Anoo Bhuyan.

I hope that Bhuyan will write a well-balanced article, but her questions have a McCarthyite feel to them.

Since I wrote the first draft of this Anoo has published a piece making the point that several people have asked to be removed from Yach’s email list. She hasn’t yet included anybody speaking up for the foundation, but I hope that she might include some of my comments; and perhaps there will be others who see something positive in the foundation.

Nobody will benefit from creating further division among public health people and organisations. People, I believe, should not only be talking to the tobacco industry, but to each other with mutual respect.

Richard Smith was the editor of The BMJ until 2004.

Competing interest: As the blog makes clear, RS has known Derek Yach for 25 years. He spoke to the consultants advising on the governance of the new Foundation but has not received any money from the Foundation or Yach and will not be applying for funds. He has also experienced denigration on moving from the BMJ to United Health, a private company. Although widely praised for giving up his professorship at Nottingham University when the university took money from British American Tobacco to found a centre for corporate social responsibility, he also received a torrent of abuse when editor of the BMJ for publishing a paper that suggested that passive smoking might not be as harmful as commonly supposed.

  • I would be most interested in seeing a comment on this blog from the current editor, thank you.

  • Franklin Apfel

    Read the interchange of Richard and @AnooBhu on Twitter! She definitely teaching the old dog new tricks! Very surprised BMJ ran this unbalanced article which normalises the “unfortunate” deadly business case of Tobacco industry esp PFI, fails to note anything about their ongoing marketing and efforts to undermine public health (https://www.reuters.com/investigates/special-report/pmi-who-fctc/) and promotes dialogue and collaboration.