June 11, 2018

Stanton A. Glantz, PhD

Michael Russell, the father of tobacco harm reduction, had ties with BAT

Proponents of tobacco harm reduction, including the FDA, take British psychologist’s Michael Russell's idea that, " It's not the nicotine that kills half of all long-term smokers, it’s the delivery mechanism” advanced in his 1991 paper "The future of nicotine replacement" as an article of faith, despite the fact that he simply presented it as a “hypothesis.”    In addition, as I noted before, this view was promulgated long before we knew that nicotine has many direct adverse health effects, particularly related to cardiovascular and lung disease (including, perhaps, a causative role in COPD) as well as cancer promoter.

Now Jesse Elias and Pam Ling have published a paper showing direct collaboration between Russell and the tobacco industry in their paper “Invisible smoke: third-party endorsement and the resurrection of heat-not-burn tobacco products.”

Here is the introduction to their discussion of Russell:

Michael Russell is oft-quoted as stating, ‘people smoke for nicotine but they die from the tar’. A psychiatrist by training, Russell is today widely regarded as influential in British health organisations’ and authorities’ promotion of e-cigarettes for long-term nicotine maintenance and cessation purposes. One of the first researchers to identify nicotine as the primary reason for which smokers became addicted, Russell was an early developer of and advocate for nicotine replacement therapy. Among other proposals, Russell promoted medium and high nicotine, low tar cigarettes so as to avoid smokers’ ‘compensation’, a phenomenon in which low-tar cigarette smokers inhale more deeply to obtain nicotine, thereby ingesting as much, if not more tar and negating any ‘health’ benefits of low-tar cigarettes.

In the late 1970s, Russell collaborated with BAT on two ‘safer’ cigarette studies and received £55,000 (£300,850 inflation adjusted to 2018) in funding to conduct a third joint study, testing medium nicotine, low tar cigarettes. Russell acknowledged this ‘strong relationship with BAT’ and their ‘help with some funding’ in a 2004 interview with Addiction, commenting that maintaining relationships with tobacco companies was common practice among researchers at the time.  Russell also engaged extensively with RJR about Premier’s ‘positive aspects’, both prior to the product’s release and following its failure. [citations removed]

There are a lot more details in their paper, which you can read for free here.

Here is the abstract of their paper:

Background Tobacco companies are introducing new ‘heat-not-burn’ cigarettes in dozens of countries. Historically, these products failed commercially, and independent researchers contested their health claims. The most prominent early heat-not-burn cigarette was RJ Reynolds’s (RJR’s) Premier, introduced in the USA in 1988. Curiously, The Lancet endorsed Premier as a ‘near-perfect low tar cigarette’ in a 1991 editorial, 2 years after Premier had been removed from the market. We examined the context of this endorsement.

Methods To ascertain what RJR knew about this endorsement, we systematically searched and analysed previously secret RJR documents in public archives and triangulated the industry document data with other published work.

Results RJR had a long-standing interest in collaborating with outside scientists to endorse potentially reduced harm cigarettes. The author of The Lancet editorial had previously corresponded with RJR regarding Premier’s health effects and market potential. Internally, RJR regarded The Lancet’s editorial, its stance on novel tobacco products, and its endorsement of Premier as major successes. While the editorial came too late to save Premier, RJR saw future business opportunities for novel products if endorsed by health authorities.

Conclusions Endorsement by high-impact medical journals and health authorities may be critical in helping heat-not-burn’ products succeed where previous attempts have failed. Conflicts of interest influenced these endorsements in the past. Health leaders and academic journals should consider both conflicts of interest and the ethics of endorsing tobacco product substitution, as tobacco companies simultaneously work to promote cigarette smoking and undermine tobacco control globally.

It is time for the FDA and others to stop starting every talk on nicotine policy with a quote from Michael Russell and recognize that, like much of the harm reduction agenda, the tobacco companies were hiding in the shadows working to manipulate the debate.

The full citation to the paper is Elias J, Ling PM.  Invisible smoke: third-party endorsement and the resurrection of heat-not-burn tobacco products.  Tobacco Control Published Online First: 06 June 2018. doi: 10.1136/tobaccocontrol-2018-054433.  It available here.

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