Farmer's Voice

Lifting the Lid

Despite its perceived amateurishness and actual divisions of interest, the antitobacco movement may have proved to be a better strategist than the tobacco industry.

By Jeannie Cameron

person.png When I first joined the tobacco industry in 2001 in a corporate and regulatory affairs role, I researched to find out what I could about the status of tobacco regulatory policy development. I soon discovered that there were some significant individuals who were globally connected and had a strategic vision. One of these individuals was Judith Mackay, a medical doctor and international anti-tobacco advocate who led a campaign against tobacco in Asia from 1984 onward, campaigning for tax increases to discourage youth smoking and for the creation of smoke-free areas, and challenging tobacco companies.

In 1988 she was awarded the World Health Organization Commemorative Medal, in 1989 the U.S. Surgeon General's medallion and in 1992 the APACT Presidential Award. In 2006 she was awarded an Asian Heroes Award by Time magazine. In 1997 she had published at the World Conference on Tobacco or Health (WCTOH) a document making her predictions for tobacco-control policy and the tobacco industry. She outlined that within 25 years, certain tobacco-control policies would be implemented if tobacco-control activists remained committed and focused. Her predictions at the global level were that the FCTC, at that point just a germ of an idea, would be signed and ratified and the WHO would have a major tobacco department. She also predicted there would be a supranational advertising policy; a global policy on tar, nicotine yields and additives; a global policy on tax; and a global policy on smuggling. At the national tobaccocontrol level, she predicted national offices to control tobacco would be established; that the licensing of nicotine as an addictive drug would be achieved; and that the manufacturing, promotion and sale of tobacco products would be regulated by an authority such as the Food and Drug Administration. She predicted there would be smoke-free areas in the workplace, bans on promotion, generic packaging and tar levels below 15 mg. As we know, much of it has been achieved.

Predictive value

I discovered that the World Conference on Tobacco or Health took place approximately every three years and had done so since the 1960s. At the end of each WCTOH, there would be "conclusions" or "resolutions" to map out future activism. I studied these conclusions and discovered that the 1994 WCTOH in Paris had made a resolution to approach the WHO to encourage it to exercise its constitutional right to create a treaty. We all now know what happened-the Framework Convention on Tobacco Control (FCTC) was negotiated between 2001 and 2003 by 193 governments and entered into force as the world's first health treaty in 2005. I noticed the resolution of the 2000 WCTOH was to embark on a global process of stigmatizing the tobacco industry and to make smokers become socially unacceptable. I noticed that a 1990 conclusion was to establish a global tobacco-control, information-sharing framework known as Global Link. I realized there was a direct correlation between the resolutionsm of the WCTOH and regulatory policy and outcomes after a period of approximately five years. That is-a resolution to have an FCTC in 1994, and the process begins in 1999. I decided I needed to go to the next WCTOH in Helsinki in 2003 to gain an understanding of what was of major concern in the tobacco-control debate and to hear firsthand the issues being discussed. Colleagues were puzzled as to why attending an anti-smoking event had any value, but two of us set off for Helsinki with one consultant. Each of us separated to attend several of the more than 30 concurrent daily sessions that were on offer, and I don't think I have ever attended a betterorganized or more informative conference.

Anti-tobacco and anti-corporation

As we had been transparent in registering as coming from the tobacco industry, it was soon apparent that we were there and the word spread. I recall sitting in a session being hosted by the WHO when someone spotted me, and I saw a note being passed to the front and lots of people turning around to look at me. I wondered what might happen, but nothing did and the session continued. It turned out to be a kind of beauty parade between different tobacco control entities making claims for WHO funding to carry out their activities. It was a hot debate between what seemed to be two major tobacco-control factions. It was my first realization that the two opposing sides had very different perspectives-and although tarred with the same "anti-tobacco" brush, one seemed genuinely interested in public health, yet the other was clearly anti-corporation and tobacco was a multinational. In the same way that many in the tobacco-control movement assume the tobacco industry is one homogenous entity, so too does the tobacco industry assume tobacco control is one-it is not, and various events throughout the years have proven this point. While I seemed to sail through the entire week without any issues at Helsinki, my two colleagues were not so lucky. One was required to stand up in a session of more than 100 delegates and explain why she was there. Eventually it was the WHO representatives on the session panel who "saved" her by saying that as a paying delegate who registered transparently she had a right not to be harassed. But from then on at the start of sessions an announcement was made: "Just so you are all aware, the tobacco industry is among us. They are here in the form of Jeannie Cameron and Chloe Campen of BAT, but they have come in their own clothes and we applaud them for that-but just be aware that they are among us." It was at this WCTOH where I learned more than I ever did about the tobacco-control movement and a lot about tobacco in general-the different uses for tobacco, some of its benefits to mental health, the pros and cons of tobacco harm reduction, the issues in nicotine policy, litigation of the future, as well as an understanding of the drivers behind the actions of the tobaccocontrol movement. Rather than being, as I had been led to believe, a bunch of politically motivated, single-issue crusaders who had nothing else to do, I discovered that in fact the majority were well-educated and very keen on reducing the harm to public health from the use of tobacco, and, in my view, the sessions and the discussions reflected that.

The pharmaceutical factor

I came away thinking that if one was to think the tobacco-control lobby was one homogenous group focused only on the vilification of the tobacco industry and tobacco products, one would be wrong. There were very different drivers at play, in the same way as the tobacco industry is made up of various companies, each with its own structure, philosophy, strategic vision and modus operandi. Yet, within the tobacco industry, the "antis," as they were most often referred to as, were seen as one entity, with one objective. However, while the two factions fought their battles for funding, it became apparent that it was not just the WHO that was providing it-there was another dimension. At the WCTOH was a 5,060-foot advertising billboard of the Marlboro Man across the back of the room-the man, the horse, the cowboy hat-identical in every way except one: instead of reading "Welcome to Marlboro Country," it read "Welcome to Nicorette Country." At first I was stunned that it was allowed, but it became clear why it was there, especially when one took a look at the conference delegate list, which had been printed showing who funded each delegate to attend-and there were long lists of pharmaceutical-paid tobacco-control delegates. In fact, Pfizer was the main conference sponsor. Each had a large stand and lots of gimmicks. The GlaxoSmithKline (GSK) stand had a huge placard of a tobacco-control wheel outlining in a most strategic fashion all the regulation that was needed to put the tobacco industry in its place. GSK had also produced a CD-ROM for delegates called the "Tobacco Trap," which contained more than 200 slides in 12 chapters outlining more about tobacco science than I had ever seen. There were plenty of materials on offer to enable one to carry out the most effective of tobaccocontrol advocacy-it seemed like no expense had been spared. Did this largesse have anything to do with Zyban, Nicorette patches or other pharmaceutical drugs? What better way to ensure a market for tobacco-cessation drugs than by sponsoring those that would carry out tobacco-control activity. I also attended the 2006 WCTOH in Washington. Almost 4,000 global tobacco-control delegates gathered, and the opening left no one with any doubt who had funded it. The lights fell and the pumping music started. Around the massive conference room flew the logos of Pfizer, GSK and Novartis. It was time to take off the rosy-tinted glasses-tobacco control is the pharmaceutical industry and the activists merely puppets. All that funding in the early 2000s bought the pharmaceutical industry something very valuable: Article 14 in the FCTC treaty on the cessation of tobacco use, which states, "Each Party shall endeavour to collaborate with other Parties to facilitate accessibility and affordability for treatment of tobacco dependence including pharmaceutical products pursuant to Article 22. (Cessation and treatment of nicotine dependence). Such products and their constituents may include medicines, products used to administer medicines and diagnostics when appropriate." How very clever to have thought through a strategy that would ensure in perpetuity the use of your product in an international law and a requirement for 193 governments to implement it in national policy. While the public-health-focused tobaccocontrol activists were busy building a global regulatory framework to bring effect to their long-held desire to improve public health, and the anti-corporate activists were building in their anti-industry elements, the pharmaceutical industry had cleverly built in its own little nugget by providing the funding both to the tobacco-control movement and to the WHO budget. The 11th WCTOH in 2000 spelled it out in a resolution: "The alliance between the traditional anti-tobacco movement and the WHO, and between the WHO and the World Bank, pharmaceutical companies and international and local NGOs, serves the purpose of expanding the anti-tobacco movement worldwide." Unfortunately, the tobacco industry seemed to have little interest in any of this intelligence or to understand how strategically the pharmaceutical industry was

"What better way to ensure a market for tobaccocessation drugs than by sponsoring those that would carry out tobacco-control activity?"

operating-after all, the antis were just a bunch of radicals, and no one really paid attention. But the pharmaceutical industry did pay attention, and they were going to reap the rewards. Not long after, in 2006, Pfizer launched Chantix.

Lollipops

During the FCTC INB negotiations between 2001 and 2003, there were always interesting activities to observe. The Framework Convention Alliance (FCA) and Corporate Accountability would compete for government officials to read their interpretation of the daily news-the Alliance Bulletin and the Marlboro Man Awards, in which governments were named and shamed for what they said or did not say during negotiations. Corporate Accountability's Marlboro Man Awards were always far more aggressive than the FCA's Orchid and Ashtray Awards, and so were their antics. Being ostensibly anti-corporate rather than pro-public health, their focus would be vehemently against the tobacco industry, and we would arrive at the conference center to find body bags showing how many people had died of tobacco use over a given period, a Grim Reaper on stilts depicting those of us who worked for the tobacco industry, or "Big Tobacco Sucks" lollipops being handed out. There were also posters that would appear from time to time handed out to government officials-one showed a photo of my face and some of my colleagues in a criminal-type fashion with the words: "Beware-the Merchants of Death are here." The FCA on the whole did notcarry out these types of stunts; in fact at the same time that Corporate Accountability was handing out those posters, the FCA was warning me. It was Corporate Accountability that managed to achieve the exclusion of the public, including the tobacco industry, from the public gallery of the FCTC Protocol negotiations. The tobacco industry had always carried out a policy of complete transparency in terms of registering for access to the public gallery-it was always clear who was from the tobacco industry, and we were always careful not to engage government officials in these forums. Despite this, one Brian Hirsh, representing Corporate Accountability, although claiming to be a journalist doing some research on who was interested in observing international treaty making, moved from person to person in the public gallery asking their identity and why they were present. Of course we all told the truth, and he had his evidence that the tobacco industry was "undermining the conference." That sitting in the public gallery observing discussions on developing public policy on how to tackle the illicit trade in tobacco products could be construed as "industry interference" was a stretch, but the outcome was observation of a public policy discussion that had been open to the public for many years before was now closed to all-even the guests of the FCA had difficulty in trying to accredit their own tobacco-control speakers to enter the conference.

Strategic thinking

Regardless of the differences between the tobacco-control groups, what has always been abundantly clear to me is the tobacco-control activists have always been very well-informed and very strategic in their application of what they know. At the 2006 WCTOH, Gerard Hastings and a colleague made a presentation titled "BAT out of Hell," where Hastings pretended to be Paul Adams, then CEO of BAT. He gave the Annual Report to Shareholders in which he outlined the BAT company plan from 2006 to 2011. He went through internal policy, company investments in China and Asia, profit and loss forecasts, and areas of corporate focus-anyone watching it had to say it was brilliantly executed. Another presentation given by someonefrom the Harvard Business School outlined the benefits in the PMI business strategy over its competitors. There were also the Tobacco Industry Academy Awards on the final day, which were second only to the Oscars themselves in polish and presentation and provided about two hours of entertainment on the global tobacco industry activities in various award categories. Whether these presentations were right or wrong, accurate or inaccurate, they showed the tobacco-control movement was thinking strategically about its "enemy" and how to implement its long-term tobacco-control plans. When an army prepares for war, one of the tasks it does is gain intelligence on the enemy, to know what motivates it, who leads it, how many troops it has, its strategic strengths and weaknesses, to try to understand its battle plan. If one were to say the activities carried out by the "antis" against the tobacco industry were in any way similar to a war, then it could be assumed that the tobacco industry might think it relevant to know all that was possible about those executing tobaccocontrol activities. This was not the case and perhaps is still not the case. Either due to historical arrogance that assumed there was nothing or no one that could really harm the tobacco industry, or due to lack of rigour, it has not been an area of any real focus, strategic planning or even interest. It is an odd situation given that most of the tough tobacco-control regulations we see today have been driven by global tobacco-control activism. Anyone looking historically over the regulatory stepping-stones of the past 10 to 15 years of tobacco-control activism can see the patterns and long-term strategic planning of a well-orchestrated and well-funded global tobacco-control movement, with clear wins for the pharmaceutical industry. However, another observer may argue that in 2002, the BAT share price was around £2 ($3.21) per share, and now, 10 years on, it is about £33 per share-the tougher the tobacco regulation, the better the company performance!