Philippe Boucher's Rendez Vous: Elisa Ong
Rendez-vous with Elisa Ong
Institute for Health Policy Studies, University of California San Francisco; San Francisco, USA
By Philippe Boucher
RENDEZ-VOUS 65
Friday, April 28 2000
PB : Thank you Elisa for accepting our rendez-vous.
May I ask you to introduce yourself?
Elisa Ong : I have been a full-time tobacco control researcher working with Stan Glantz for almost 2 years at the University of California, San Francisco. Besides being at UCSF, my secret identity is really being a medical student at Stanford University, from which I am graduating this June and finishing a master's in health services research. I will be starting a residency program in primary care/internal medicine at Santa Clara Valley Medical Center shortly.
My interest in tobacco control started in early 1996 when I helped to organize a workshop for Stan Glantz to talk about tobacco control and the U.S. Food and Drug Administration at our student health policy forum. That's when my eyes were first opened to the various misdeeds of the tobacco industry, as revealed by the Brown & Williamson tobacco documents (aka The Cigarette Papers). Besides the medical implications of active and passive smoking, I am also interested in the impact of tobacco internationally, especially in Asia, and within the Asian American Pacific Islander community.
When Stan advertised a research position a couple years later, I jumped at the chance!
Q1 First question : You just co-authored with Stan Glantz an article published in the Lancet about the way the tobacco industry (mostly Philip Morris?) developed a complex misinformation strategy to counter the influence of a report on ETS prepared by IARC. Most of your research was mined from industry documents stored in Minnesota. Can you tell us about the origin of this research (there are so many possible issues to tackle), how practically you worked and -if it is not indiscreet- what was your share and Stan's share and what type of co-worker Stan is? I mean he seems to have so much energy, isn't that overwhelming?
EO : Finding the tobacco industry's strategies against IARC was really an amazing experience. When I started my research position, the industry had just posted their documents on-line for a few months, and Stan encouraged me to surf the web and explore my interests. I started off by searching "Asia" on the Philip Morris website, and stumbled into a Philip Morris Asia management document that listed IARC on its agenda. I did not know at the time that IARC was the International Agency for Research on Cancer, nor that only a few months earlier, British American Tobacco had fueled an international disinformation campaign through the press before the study was even published. Even though the IARC study analyzed only European countries, the fact that I came across the IARC documents with a search on "Asia" underscores how the industry (led by Philip Morris) was making preparations against the study's anticipated international impact. I ran a search on "IARC" and came across one fascinating document after another.
There were a ton of documents about IARC to print out and sift through. Luckily, Philip Morris' management and its public relations firm Burson-Marsteller created very clear presentations, memos, and summaries. I also had some great resources in Stan, Clive Bates (UK ASH's director), and Stella Aguinaga-Bialous (WHO fellow) to talk with and start putting the big picture together. Document searching can be so engrossing that it can be difficult to stop just to synthesize the material, especially since the industry keeps updating their sites every few weeks with documents from other lawsuits. The Lancet article is a condensed summary of the documents highlighting the industry's strategy to prevent IARC's work from leading to smoking restrictions worldwide. I encourage everyone to look at the Philip Morris source documents, which Lancet references on the on-line version of the article (www.thelancet.com).
As for what working with Stan is like? I'm saving that for my kiss-and-tell memoirs. Seriously, though, not only does he have tremendous energy and intellect, he has a wonderful heart filled with integrity. I have really appreciated how he has encouraged me to develop my interests in tobacco control. As for how we worked, Stan was crucial in tightening the whole IARC story, which was very difficult to do since every detail seemed important, and bringing out the story's meaning and broader perspective.
Q2. You mention the creation by Philip Morris of an International ETS Management Committee (IEMC) and you said the French Seita contributed. Was this misinformation enterprise mostly a Philip Morris effort or were other companies significantly involved? I remember very well the full page ads Philip Morris placed in the main French dailies in 95 and 96 at a tune of about $ 2 millions each year to claim that smoke-free regulations were fascist like or that ETS was no more or less dangerous than cookies, pepper or water. Did you consider those ads as part of the strategy you studied?
EO : Philip Morris was the first tobacco company to raise the alarm about the IARC study and create a plan for the industry. The existence of the International ETS Management Committee (IEMC) predated Philip Morris' IARC plans, and was the means for Philip Morris to begin coordinating the industry with its plans. The IEMC members included scientific heads for Philip Morris, British American Tobacco, RJ Reynolds, Rothmans, Imperial, and Reemtsma. The industry has collaborated before the 1991 establishment of the IEMC, such as with the inter-industry International Committee on Smoking Issues (ICOSI) which later became INFOTAB, to ensure that the major company players are all on the same page about smoking and preventing restrictions on their operations. IEMC was also a way for Philip Morris to have the industry pool its funds for its expensive IARC strategy: Philip Morris budgeted $2 million for its first year of IARC plans and anticipated $4 million on counteractive research (personal monitoring of secondhand smoke exposure; analyzing nonsmoking populations characteristics for confounders in developing cancer). France's Seita contributed for research to be done in France. Other companies like Japan Tobacco were brought in too, as Philip Morris warned that IARC's work could lead to smoking restrictions in everyone's market.
The Philip Morris ads stating that exposure to secondhand smoke was not as dangerous as other things, like eating a biscuit, certainly fits in with the communications plan to shape public opinion about secondhand smoke. It is a good example of how the industry continues to misrepresent statistics in scientific studies to support its position. Unfortunately, we really had to trim the IARC story to the bare essentials for the Lancet article.
Q3. It is very true that ETS has been much less a health issue in Europe (in general) than in the US. The industry propaganda is certainly responsible for this lack of interest but the big health organizations have also been very timid, as well as the health research institutes: what type of research do you think is eventually the most appropriate to raise the ETS issue, if any? is it enough to translate in the various national languages the studies published in english?
For instance I cannot tell you now how the Lancet's article is going to be covered by the media in France but it is possible that it is much less than in the States, even with IARC based in Lyon...
EO : Researching the industry documents can be a very powerful tool. Once people realize how the tobacco industry has targeted and manipulated them specifically, it can be a big wake-up call. I think once IARC saw all the Philip Morris documents trying to subvert their work, they began to regard the tobacco industry with much greater reservation. Before this, the tobacco industry's activities and goals did not seem to have much direct bearing on IARC's own work. The WHO's Tobacco-Free Initiative and Director-General, Dr. Gro Harlem Brundtland, have also taken a great interest in this work, as IARC is affiliated with the WHO.
There have to be reasons why secondhand smoke is not yet as big an issue in Europe besides being a "cultural" phenomenon. In our Lancet article, there is a graph of a 1989 Philip Morris survey that demonstrated 7 European countries had higher percentages than the U.S. in believing that government should pass laws restricting cigarette smoking in public places. We need more research about how tobacco control policy is shaped and implemented that is specific to countries and organizations to help make the issue relevant for people and their political representatives. Translation of scientific articles about secondhand smoke is not enough. Some may worry this kind of research is too "political", but science and public health do not exist in an objective vacuum; we need to examine the vector of disease with tobacco just as with any other disease.
Q4. You work with the Institute for Health Policy Studies within the University of California in San Francisco. Can you explain to us the way it works? how many people, what budget? Do you know of any similar structures in other Universities in the US or elsewhere? If not... what does it take?
EO : The Institute for Health Policy Studies is an inter-disciplinary department for many UCSF faculty, fellows, and researchers. Research varies from Stan's research group analyzing tobacco control policies to the cost-effectiveness of medical interventions. There are most certainly similar structures in other universities.
Q5. When I interviewed Ichiro Kawachi I asked him the "so what" question and I am tempted to do the same. The Lancet in its editorial sort of warns researchers and the media to be cautious, and hope new IARC studies on ETS. What about the political lessons? what about obliging Philip Morris to dismantle all its pr offices like the tobacco industry was obliged to close down the Tobacco Institute? Philip Morris seems very defiant about the whole affair basically saying this was then but now were are a newborn company, we cleant our acts, etc... What demands do you think would be appropriate? How to ensure this will stop? I bet the Philip Morris Institute for Policy Affairs is still alive in Brussels with all its top notch journalists, former EU commissionners and Ministers on the board...
EO: Our Lancet article is one step in waking the scientific and policymaking communities out of complacency. One theme I have observed in my work is that people can be confident about their scientific and political integrity, but may not realize how they can be manipulated in the tobacco industry's bigger global picture. I find Philip Morris' explanations that their IARC strategies were "in the past" to be ridiculous. Their plans started in 1993 and carried through to the IARC study publication in 1998; now every time the WHO announces progress with the Framework Convention on Tobacco Control, somehow a misrepresentative news story appears stating the IARC study does not show a link between passive smoking and lung cancer. The industry continues to deny secondhand smoke's health effects and to work against smoking restrictions to protect their profits; the public means of saying this may just be different or obscured. Also, I found it amusing that Philip Morris stated in a recent news article that their campaign against IARC was "not unusual." If this is the case, we had all better watch out!
The Lancet editorial made a strong call for one way to stem the industry's misdeeds. At the end of the editorial, the Lancet called upon IARC to "now add passive smoking to its respected monograph series on substance carcinogenicity." The IARC monograph would be an authoritative review of secondhand smoke's health effects. This is what Philip Morris feared most, more so than the IARC study itself. Countries all over the world might implement strong smoking restrictions with the scientific basis of IARC's work, just as the tobacco industry had seen in the U.S. with the 1992 U.S. Environmental Protection Agency report. This is the next crucial, concrete step for IARC to settle the scientific "controversy" created by the tobacco industry, and it would be good for the scientific community to encourage IARC to follow through.
Q6. Do you have anything else you would like to add ?
EO : I am a great fan of the Rendezvous series, and it has really helped introduce me to the fascinating people who work in tobacco control. Thank you so much for inviting me to participate!
PB : Thank you Elisa for taking the time to be with us today.
This document's URL is: http://www.tobacco.org/News/rendezvous/ong.html
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