Where there s smoke there s money Campaign contributions and

Where there’s smoke there’s money: Campaign contributions and U. S. government efforts to derail the Global Tobacco Treaty Martin Donohoe

Tobacco – Weapon of Mass Destruction 1. 3 billion smokers (32% of men, 7% of women) n 80% in developing countries n 42 million (18% of adults) in U. S. (15% of women, 21% of men) Almost 6 trillion cigarettes smoked/yr worldwide

Tobacco – Weapon of Mass Destruction 6 million deaths/yr worldwide (11% of male deaths; 6% of female deaths) – 600, 000 from passive smoking n More deaths than from malaria, TB, and AIDS combined n Tobacco industry makes $7, 000 for each of the direct deaths n Estimated 8 -10 million by 2030 25% prevalence of ETS exposure among non-smokers n 2/5 children

Tobacco – Weapon of Mass Destruction Leading cause of death in U. S. n 443, 000 deaths/yr from smoking n 42, 000 from environmental tobacco smoke (ETS) Sum exceeds number of US soldiers who died on the battlefields of WWI, WWII, Korea, and Vietnam combined n Smokers die 10 years earlier than nonsmokers

Tobacco – Weapon of Mass Destruction Numerous health consequences (21 diseases n Heart disease, cancer (12 types; 25% of all cancers), stroke, COPD, suicide, etc. Tobacco smoke contains over 7, 000 chemicals, including numerous toxins, carcinogens, air pollutants, chemicals classified as hazardous waste, and radioactive pollonium

Tobacco – Weapon of Mass Destruction Grown in more than 100 countries on over 5 million hectares of arable land n Which could otherwise feed 10 -20 million people 20 -50 million trees cut down/yr to cure tobacco Heavily pesticide-dependent crop n Tobacco industry has lobbied to weaken environmental regulations

Cigarette Litter The most littered item in the world n 4. 5 trillion butts (1. 7 billion lbs)/yr n 38% of all street litter n Most common trash item on world’s shorelines n Comprised largely of filters made from cellulose acetate, a non-biodegradable plastic n Filters trap toxins, heavy metals which can leach into environment

Tobacco – Weapon of Mass Destruction Direct medical costs = $100 billion/yr Lost productivity = $97 billion/yr Combined total would require tobacco tax of $10. 47 per pack (actual total tax = $1. 18 to $5. 36 per pack) Medical care and lost productivity due to tobacco use costs each U. S. citizen approximately $600/yr

Tobacco – Weapon of Mass Destruction Smoking costs the average smoker at least $1. 1 million over a lifetime n Includes cost of tobacco, health care costs, income loss, and other costs (e. g. , homeowner’s insurance, etc. )

Smoking and the Military 34% of active US military smoke n Cigarettes tax-free Costs $346 million annually for lost productivity and $584 million in direct medical care Veteran smoking rates/health care costs high n Federal law requires smoking facilities at VA hospitals

Smoking Prevention and Cessation Over the last 10 years, only 3. 2% of state revenues from tobacco taxes and settlement money spent on prevention and cessation Financial institutions convinced many state governments to divert settlement funds into capital appreciation bonds, in order to borrow money for routine expenses n Bankers, consultants, and lawyers have pocketed over $500 million in fees

Smoke-Free Legislation 1975: Minnesota passes first clean indoor air law 1999: All 50 states and D. C. have some public smoking restrictions n n Health benefits for smokers and non-smokers Do not hurt economic bottom line of bars or restaurants 2013: ALA gives 40 states “F” for tobacco control

Tobacco Control Measures Associated with avoidance of estimated 8 million deaths and estimated extended mean life span of 19 -20 years since first surgeon general’s report in 1964 Ever $1. 00 a state spends on smoking cessation treatments saves an average of $1. 26 Additional savings from other tobacco control measures

Tobacco Control Measures Only 16% of the world’s population lives in jurisdictions with comprehensive smoke-free laws 10% live in areas with comprehensive bans on advertising, promotion, and sponsorship

Smokescreen Cigarettes most marketed products in the world n $8. 6 billion/year profit in the U. S. n $50 billion/year profit worldwide $7, 000 for each direct tobaccoattributable death Tobacco industry profits over $44 billion in 2013

Smokescreen U. S. leading exporter of cigarettes U. S. tax money used to assist corporations in their marketing efforts overseas n Top 3 tobacco companies received almost $19 million in government subsidies in 2012

Smokescreen Tobacco manufacturers pay governments U. S. $133 billion/yr, but less than $1 billion/yr spent on tobacco control (and only 3% of this spent on low- and middle-income countries) Tobacco companies spend $23 on marketing for every $1 that states spend to fight tobacco use n States spend less than 2% of tobacco revenue to fight tobacco use n Recent state funding cuts

Smokescreen Reynolds American and Phillip Morris International are the 2 largest donors to the American Council on Science and Health (a corporate front group promoting e-cigarettes) n See slide show and article on ACSH on “Science and Pseudoscience” page of phsj website

WHO Framework Convention on Tobacco Control Treaty Finalized 2/27/05 Ratified by 175 nations n Including Russia, Canada, Australia, Mexico, and the UK n Another 8 have signed but not yet ratified/approved

WHO Framework Convention on Tobacco Control Treaty Exempts tobacco control from free trade challenges Limits tobacco advertising Cracks down on tobacco smuggling Bans tobacco sales to and by minors

WHO Framework Convention on Tobacco Control Treaty Promotes agricultural diversification and alternative livelihoods for tobacco farmers Standardizes packaging n Bans deceptive terms such as “light” and “mild” n Improves warning labels

Tobacco Advertising Worldwide 24 countries with 694 million people have introduced complete bans n Banned in European Union, China, etc. 100 more countries are close to a complete ban 67 countries currently do not ban any tobacco advertising

U. S. Efforts to Undermine the Treaty Despite overwhelming U. S. and international public support for the goals of the treaty… U. S. government attempted to scuttle the treaty in the name of free trade and free speech Tobacco industry documents show attempt to create alternative through Project Cerberus

U. S. Efforts to Undermine the Treaty Original U. S. negotiator Thomas Novotny resigned after the Bush administration pressured him to lobby for the deletion of 10 of 11 treaty provisions, as outlined in a Phillip Morris memo

Phillip Morris and Altria Phillip Morris = world’s largest tobacco company Parent company = Altria (also owns 85% of Kraft Foods and 28 % of Miller Brewing) n 2008: Phillip Morris International becomes independent company, separates from Phillip Morris USA and Altria n

U. S. Efforts to Undermine the Treaty U. S. Belatedly signed on 5/3/05 Senate must ratify AND President must sign n Administration has not submitted treaty to Congress – “studying it”

Bush Administration Ties to the Tobacco Industry Karl Rove (Deputy Chief of Staff and Senior Advisor) – lobbyist/strategist for PM Kirk Blalock (White House liaison to the business community) – PM public relations official

Bush Administration Ties to the Tobacco Industry Charles Black (informal advisor to Bush during 2000 campaign) – PM lobbyist Daniel Troy (former FDA Chief Counsel) – represented tobacco industry when it sued the FDA over tobacco ad regulation

Bush Administration Ties to the Tobacco Industry Tommy Thompson (HHS Secretary) n n n received $72, 000 in campaign contributions from PM executives when he was governor of Wisconsin advisor for the primary tobacco lobbying firm in D. C. Rejected his own advisory panel’s recommendation to increase federal tobacco tax

Bush Administration Ties to the Tobacco Industry British American Tobacco PLC’s Brown and Williamson unit and RJ Reynolds Tobacco Holdings, Inc. represented by Barbour, Griffith and Rogers n Lobbying firm stocked with Republican operatives, including: Haley Barbour – former GOP Chairman, MS governor Lanny Griffith – White House aide to GHW Bush

Obama Administration and Tobacco Has called for $0. 94 increase in federal tobacco tax US Trade Representative Ronald Kirk n Former PM lobbyist n Opposed smoking ban at Dallas airport when mayor of Dallas in early 1990 s n Opposed federal excise tax on tobacco Opposes special rules for tobacco in international trade agreements

Campaign Contributions $3. 5 million (through individual contributions and PACs) in 2004 n 74% to Republicans $20 million to Republican candidates for federal office since 1997 PM – leading overall campaign contributor to Republicans since 1989

U. S. Non-Cooperation on International Treaties Failure to sign or approve: n n n Kyoto Protocol on Climate Change Convention on the Prohibition of Anti. Personnel Land Mines Cluster Bomb Ban Comprehensive Nuclear Test Ban Treaty Convention on the Rights of the Child

U. S. Non-Cooperation on International Treaties Failure to sign or approve: n n n Convention on the Elimination of Discrimination Against Women Convention on Economic, Social and Cultural Rights Convention for the Suppression of Traffic in Persons Failure to pay full U. N. dues Opposition to International Criminal Court

Health Care Organizations and Medical Schools As of 2009: insurers (including some of the largest owners of HMOs) and mutual funds heavily invested in tobacco stocks n n Prudential - $1. 4 billion; Sun Life - $1 billion; Standard Life - $950 million TIAA-CREF (whose mutual funds are owned by many health professionals) owns over $700 million in Phillip Morris stock.

Health Care Organizations and Medical Schools 1996 -1998: PM and Cigna collaborated to censor accurate information on the harms of smoking and ETS from health newsletters Tobacco companies sponsored “research” to refute links between tobacco and disease

Health Care Organizations and Medical Schools Tobacco industry has “whitecoated” itself since the 1940 s n Borrowing from medicine’s prestige and public esteem in ads featuring smoking doctors

Tobacco Company Harassment of Academics Threatened litigation against historians who have testified on behalf of plaintiffs Hired graduate students to do “research” n Some unwittingly

Health Care Organizations and Medical Schools As of late 2004, despite a decade’s old plea from the AMA for medical schools to divest their tobacco holdings, some of the nation’s leading medical schools had failed to do so: n n Cornell, Duke, Washington University, Yale, and possibly Penn (refused to answer requests) Columbia is said to have divested, but could not provide details to confirm

Smoke-free Hospitals 1993: JCAHO mandates that all hospitals seeking accreditation adopt smoke-free indoor work policies 60% of US hospitals have smokefree policies by the end 2012 Cleveland Clinic, U Penn Health System, others no longer hire smokers

Smoke-free Hospitals Higher quit rates, faster quitting, less second hand smoke exposure at smoke-free hospitals Yet 1/5 smokers lights up while hospitalized

Smoke-free College Campuses ¼ to 1/3 of college students smoke Estimated 1/3 to ½ of U. S. colleges have gone or are considering going smoke-free n CA state colleges ban tobacco use in 2013; CUNY 2014

Tobacco in Correctional Facilities 70%-80% of inmates use tobacco 2012: 30 state departments of corrections have indoor tobacco-free policies (15 of which also cover outdoor areas) Federal prisons 100% smoke-free since 1994

Tobacco in Drug Treatment Programs 77%-93% of clients in substanceabuse treatment programs use tobacco n Few drug treatment facilities offer tobacco treatment, even though dual treatment is more successful

Smoking Bans and Penalties 21 states allow bans on hiring smokers Insurers can charge higher premiums if smokers do not commit to cessation programs (70% of smokers want to quit, 625% = average one year successful quitting rate)

Conclusions U. S. resistance to / attempts to scuttle global tobacco treaty squanders opportunity for U. S. to take lead on important international public health issue Represents callous disregard for human health and world economy

Conclusions Some health care organizations and medical schools have failed to provide ethical and moral leadership in antitobacco crusade Government / health care community’s obstructionism and failure to lead likely due to influence of campaign contributions / research funding

Recommendations President should send Treaty to U. S. Senate, which should immediately ratify, and President sign Campaign finance reform Strengthen smoke-free legislation, enact truly comprehensive tobacco reform laws

Recommendations Medical schools and health care organizations should immediately divest all tobacco holdings Health care professionals should lobby their institutions and legislators to take the lead in the war on tobacco n Increase tobacco taxes, spend more on prevention and cessation programs

Recommendations Media should more aggressively expose tobacco industry machinations Ban public smoking n Majority of public supports n 28 states + D. C. currently prohibit smoking in all indoor areas (worksites, restaurants, bars)

Recommendations Ban tobacco sales in pharmacies Increase access to counseling and nicotine replacement therapies

Family Smoking Prevention and Tobacco Control Act of 2009 Tobacco companies must provide ingredients to govt. ; govt. will regulate harmful ingredients Govt. cannot ban cigarettes, reduce nicotine content to zero Age limit of 18 to purchase cigarettes and smokeless tobacco

Family Smoking Prevention and Tobacco Control Act of 2009 Minimum cigarette pack size of 20 Bans “light” and “low tar” labels, fruitand candy- flavored cigarettes; menthol flavoring still allowed n Menthol cigarettes (1/4 of those sold in U. S. ) more addictive

Family Smoking Prevention and Tobacco Control Act of 2009 New, larger set of warning labels (50% of pack / 20% of ads by 2012; quit line number also included) n As in at least 43 other countries n Canada – covers 75% of pack; EU – 65% by 2016

Family Smoking Prevention and Tobacco Control Act of 2009 Limits on public advertising in publications with high numbers of young readers Bans sponsorships of sports and entertainment events Restricts vending machines to adult-only venues Bans free samples

Family Smoking Prevention and Tobacco Control Act of 2009 Supported by Phillip Morris n Possibly to solidify its dominant market position May mitigate the legal liabilities of tobacco companies

Family Smoking Prevention and Tobacco Control Act of 2009 WTO has ruled against measures designed to decrease teen smoking n Ban on clove, candy, and colaflavored cigarettes n U. S. unlikely to abide by ruling

The Future Late 2010: EPA proposes new, larger, more visual warning labels (required by 2010 under FSPTCA 2016: EU advertising ban takes effect, graphic warning labels and childproof packages mandated

Cigars and Cigarillos US cigar consumption doubled from 2000 – 2011, continues to rise n 1/20 US adults Health consequences

e-cigarettes 2011: FDA plans to regulate electronic nicotine delivery devices (ENDS, aka e-cigarettes) as tobacco products (contain nicotine, respiratory toxins, formaldehyde, and up to 10 X as the amount of carcinogens in regular cigarettes) n Some contain diethylene glycol [ingredient in antifreeze] n 3 ml/day “vaping” can increase cancer risk more than cigarettes (due to formaldehyde)

e-cigarettes n 2013: e-cigarette ads on television and in print 2014: Nicotine poisonings from e-cigarette liquid refills increasing 2014: OMB waters down FDA’s proposed regulations Tobacco companies initially pushed for ecigarette controls, now backing off since control majority of e-cigarette market

e-cigarettes Data suggest e-cigarettes prompt kids to smoke (some brands appeal directly to kids and young adults); probably not beneficial in smoking cessation Many cities have banned

Tobacco Taxes Federal tax = $1. 01 per pack Average state excise tax = $1. 53 per pack n $0. 17 (MO) to $4. 35 (NY) 10% price increase cuts consumption in young adults by about 4%; 50% by 20% n WHO recommends increased taxes to curb demand

For references, see: Donohoe MT. Cigarettes: The other weapons of mass destruction. Medscape Ob/Gyn and Women’s Health 2005; 10(1): posted 4/5/05. Available at http: //www. medscape. com/viewarticle /501586

Contact Information Public Health and Social Justice Website http: //www. phsj. org martindonohoe@phsj. org