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The Power Of Paperwork: How Philip Morris Neutralized The Medical Code For Secondhand Smoke  

A new medical diagnostic code for secondhand smoke exposure became available in 1994, but as of 2004 it remained an invalid entry on a common medical form. Soon after the code appeared, Philip Morris hired a Washington consultant to influence the governmental process for creating and using medical codes. Tobacco industry documents reveal that Philip Morris budgeted more than $2 million for this "ICD-9 Project." Tactics to prevent adoption of the new code included third-party lobbying, Paperwork Reduction Act challenges, and backing an alternative coding arrangement. Philip Morris's reaction reveals the importance of policy decisions related to data collection and paperwork.

Recently, the Bush administration has been subject to charges of "abuse of science."1 Science is vulnerable to pressure from politicians and from private industry.2 For example, decisions about data collection policy are often contested in the political arena by various interests.3 According to a Los Angeles Times story in 1995, one controversial case has been the tobacco industry's response to the collection of data on secondhand smoke.4 In December 1993 the U.S. government adopted a medical code for secondhand smoke as an external cause of illness or injury, in response to requests from coders and also in light of the Environmental Protection Agency's (EPA's) 1992 risk assessment of secondhand smoke.5 The tobacco industry responded swiftly.

To better understand the tobacco industry's involvement with the code, we conducted a search of once-private internal tobacco industry documents. . . .

The CMS form 1500 expires 31 march 2006 and will need OMB reapproval; this presents an opportunity to readdress the issue by allowing all E-codes, including secondhand smoke, back on the form.62 Successful lobbying by MBS has had a wide impact for different industries in which chemical exposures or occupational hazards are not documented. The agency will presumably solicit public comment on any changes to the form. The public health sector should be prepared to respond and to be attentive to any challenge to the form from private industry. Meanwhile, the ICD-10-CM, when it comes into use, contains some major changes in medical coding.63 The secondhand smoke exposure code will be found under Z58.83.64

The tobacco industry has thus far undermined the collection of data on secondhand smoke's relationship to illness. These findings exemplify the use of politics to influence science. The medical and public health communities need to be made aware of these different codes and the potential for tobacco industry interests to undermine their use.

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