We're engaged in an epic battle with the tobacco industry over plain packaging.

The government has an open mind on the matter, and has extended its consultation until 10 August (i.e. this Friday).

But despite Big Tobacco claiming the policy will have no effect, Japan International Tobacco has launched a £2m advertising offensive to try to convince the British public to let Big Tobacco cling on to its last marketing outpost - the pack.

So we wanted to highlight three studies published in June that, taken together, reinforce the urgent need to stop cigarette companies marketing their deadly wares.

The first two studies show how tobacco companies manipulated national and international policy - first in the early days of the Czech Republic, then as the World Health Organisation tried to draw up its landmark Framework Convention on Tobacco Control.

The third looks at the change in lung cancer death rates over time, in different US states, where different degrees of tobacco control were in operation.
Individually, each paints a depressing picture. Collectively, they show why we must act urgently to put limits on tobacco marketing - there's a link to our petition at the bottom of this post.

Cunning tactics
The first two studies appeared in the June edition of PLoS Medicine. Both drew on the Legacy Tobacco Documents Library - a vast, searchable, online repository of internal tobacco company memos and documents, spanning from 1989 to 2005.
We'll summarise their findings below, but both papers are freely and accessibly written - we recommend you download and digest them for the full picture (here and here).

Czech-ered history

"I support the fight against restrictions on smoking. ... This is something other than the promotion of smoking... This is stupid; it is unreasonable and something that politicians should not do."-

In 1989 communism collapsed. Four years later in 1993, Czechoslovakia split into Slovakia and the Czech Republic. The new Republic inherited a large, state-owned tobacco industry, which made several home-grown brands of cigarettes.

Over the next few years, this was privatised and sold off to multinational tobacco companies. By the time the Czech Republic joined the European Union in 2004, the country was awash with imported brands like Marlboro and Silk Cut, and many domestic cigarette factories had closed.

By this time, the Czech Republic had one of the highest rates of lung cancer in the developed world, and one of the poorest tobacco control records in Europe. In recent years, its senior politicians have frequently challenged international tobacco regulation in public.
But to what extend did Big Tobacco have a hand in this state of affairs?

To find out, a team of international researchers searched the Legacy Tobacco Documents Library for relevant references, interviewed key stakeholders and participants, and cast their net wider for newspaper articles, market reports and other sources that might help them piece together what had gone on.

Their collected evidence painted a shocking picture, showing how tobacco companies systematically:

• ignored, weakened and ultimately overturned attempts to restrict tobacco advertising;
  


• lobbied, with some success, for favourable tax structures (e.g. on import duties);
  


• conspired to keep tobacco prices low, to stave off possible tax rises; and,
  


• donated large sums of money to political parties to attempt to influence policy.

Perhaps as a result, the proportion of Czechs who smoke has changed little since 2000, and tobacco sales actually increased between 2000-2007 (although they've declined in recent years, "largely due to market conditions", i.e. the recession, say the papers authors).

This isn't a 'scientific' study in the traditional sense - but it's a thoroughly researched historical and social analysis, drawing on thousands of archived sources and documented experiences, many of which were never intended for public consumption.

As such it represents a rare window into how these organisations operate outside North America.

But tobacco companies are multinational organisations. Do they operate in a similar way to try to manipulate international efforts to control tobacco use?

Globalised hypocrisy
The World Health Organisation's Framework Convention on Tobacco Control is a landmark international treaty between 175 countries, who have all agreed to implement coordinated national policies on tobacco control. It took six years to negotiate: discussions kicked off in 1999 and the treaty came into force in February 2005.

It was the first international treaty specifically focused on improving global health.

Naturally, multinational tobacco companies campaigned heavily against the treaty which, in their own words, represented an "unprecedented challenge to the tobacco industry's freedom to continue doing business". But no-one had ever carried out a comprehensive analysis of the methods they used.

Again relying on the Legacy Tobacco Documents Library, the researchers (who were part-funded by Cancer Research UK) examined how the same multinational tobacco companies behaved on the international stage, during the negotiations over the Framework.

The documents show how industry insiders developed and promoted several lines of argument, or 'frames', to try to block or water down the treaty. These included claims that:

• The treaty would damage the world economy - despite it having the backing of free-market institutions such as the World Bank.
• The treaty would "disrespect the poor" because tobacco-related diseases were a rich country's issue (despite the fact that tobacco-related diseases are on the rise in most developing nations).
• The treaty allegedly conflicted with international obligations on free trade (contrary to the opinion of the World Trade Organisation itself).
• The treaty would interfere with nations' sovereign rights.
• It would be a 'slippery slope' leading to tighter regulation on other issues.

• commissioning scientists to produce and disseminate reports supporting these arguments,
• using the consultation process to try to slow the treaty's progress,
• mobilising other agencies and organisations (notably the International Tobacco Growers Association) to represent them,
• and creating conflict between delegations from different nations.

But is this really so surprising? In the world of political campaigning and lobbying, none of these issues or actions is illegal, or even unusual. And it could be argued that, as global corporations, tobacco companies have a legal duty to their shareholders to maximise their profit margins.

In this light, tobacco companies are behaving no differently than any other globalised industry.

But tobacco companies market an addictive product that sends an estimated 5 million people to an early grave every year - a number that's predicted to grow to more than 8 million in 2030. By 2015, tobacco is projected to kill 50 per cent more people than HIV/AIDS, and to be responsible for one death in ten.

No other global industry can claim such a lethal degree of brand loyalty.

Let's look at a third piece of research, which rams home why we at Cancer Research UK are desperate to see an end to tobacco marketing.

A sad state of affairs
The final piece in our jigsaw puzzle is a study of the lung cancer death rates changed in different US states between 1973 and 2007.
Since there there's been considerable migration in the US over this period, and because Hispanic and black people have different risks of lung cancer to white people (for a variety of reasons), the researchers restricted their analysis to white women. This allowed them to exclude any effects that were due to changes in the balance of ethnic populations. Using SEER - a large, population-level database of health records, they looked at what happened to women who were born in different years, tracking the death rates in the elderly, middle aged and young, state by state.

Publishing their findings in the June 2012 edition of Journal of Clinical Oncology, the researchers elegantly show how, in the state with the strictest tobacco control policy - California - lung cancer death rates continued to fall (in most age groups), while rates tended to plateau in states with less stringent regimes.

But in states with lax tobacco policy - for example, tobacco-growing Alabama (which had a tobacco tax of 42 cents per pack, under half that of New York's $1/pack) lung cancer death rates continued to climb - especially in younger women, born since 1950.
Because of the statistical rigour of the study, the researchers are convinced that the effects they're seeing are due to changes in smoking rates. As they argue:

Factors in addition to smoking that may contribute to differences in lung cancer mortality trends [include] occupational and environmental exposures. However, the contributions from these are likely to be modest or minimal, since cigarette smoking in the United States accounts for more than 70% of lung cancer deaths in women.

Further, cigarette smoking and subsequent lung cancer mortality patterns by birth cohorts have shown parallel trends in the United States.

In other words, taking action against tobacco saves lives.

Take action now
And yet tobacco companies stubbornly resist these policies. As we've seen, they take advantage of globalised markets, yet cry foul when policy makers draw up globalised health policies. They say they want to work with policy makers, yet fund groups to oppose them. They say international policy is a breach of nations' sovereign rights, yet spend hundreds of thousands of pounds to influence politicians.

And they say plain packaging won't work, but spend £2 million on advertising to campaign against it.

We want the government to force these companies to sell their addictive, deadly products in plain packaging, to make them less attractive to children. There's solid evidence it will work, which you can read here.

You need to ask yourself, right now, are you going to sign our petition? The answer is plain.
Together we can end the packet racket.

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