Date Published: May 1, 2018
Publisher: Public Library of Science
Author(s): Jesse Elias, Yogi Hale Hendlin, Pamela M. Ling, Louisa Degenhardt
Abstract: BackgroundTobacco addiction is a complex, multicomponent phenomenon stemming from nicotine’s pharmacology and the user’s biology, psychology, sociology, and environment. After decades of public denial, the tobacco industry now agrees with public health authorities that nicotine is addictive. In 2000, Philip Morris became the first major tobacco company to admit nicotine’s addictiveness. Evolving definitions of addiction have historically affected subsequent policymaking. This article examines how Philip Morris internally conceptualized addiction immediately before and after this announcement.Methods and findingsWe analyzed previously secret, internal Philip Morris documents made available as a result of litigation against the tobacco industry. We compared these documents to public company statements and found that Philip Morris’s move from public denial to public affirmation of nicotine’s addictiveness coincided with pressure on the industry from poor public approval ratings, the Master Settlement Agreement (MSA), the United States government’s filing of the Racketeer Influenced and Corrupt Organizations (RICO) suit, and the Institute of Medicine’s (IoM’s) endorsement of potentially reduced risk products. Philip Morris continued to research the causes of addiction through the 2000s in order to create successful potentially reduced exposure products (PREPs). While Philip Morris’s public statements reinforce the idea that nicotine’s pharmacology principally drives smoking addiction, company scientists framed addiction as the result of interconnected biological, social, psychological, and environmental determinants, with nicotine as but one component. Due to the fragmentary nature of the industry document database, we may have missed relevant information that could have affected our analysis.ConclusionsPhilip Morris’s research suggests that tobacco industry activity influences addiction treatment outcomes. Beyond nicotine’s pharmacology, the industry’s continued aggressive advertising, lobbying, and litigation against effective tobacco control policies promotes various nonpharmacological determinants of addiction. To help tobacco users quit, policy makers should increase attention on the social and environmental dimensions of addiction alongside traditional cessation efforts.
Partial Text: While the tobacco industry has believed since the 1960s that nicotine is addictive , it publicly denied this until the early 2000s . Although nicotine is today widely considered addictive , this designation is not fixed. The classification of a given substance as addictive depends as much on the contexts in which substances are used as on robust scientific findings regarding these substances’ neurochemical properties [4–8]. Definitions and connotations of “addiction” continually change. Due to this changeability, addiction is best viewed not as a “universal scientific trut[h] to be unveiled or denied” but a “malleable concept situated in specific social, political and scientific contexts” .
This study is based on qualitative analysis of previously secret internal tobacco industry documents available through the Truth (formerly Legacy) Tobacco Industry Document Library (https://industrydocuments.library.ucsf.edu/tobacco/). Documents were retrieved between December 2016 and April 2018. These searches combined traditional qualitative methods of textual analysis with iterative search strategies, analyzing documents chiefly on the basis of relevance to the research question and novelty of information. We excluded documents irrelevant to the analysis on grounds of repeated information, or unverifiable content without supporting documentation.
Our analysis suggests that PM’s (now Altria’s and PMI’s) shift from denying to embracing nicotine’s addictiveness is an opportunistic attempt to maintain future profit and capitalize on tobacco harm reduction. As PM’s internal research indicates, positive health outcomes are more likely to be achieved by complementing NRT and behavioral counseling with ever-stronger environmental interventions addressing the psychological, social, and environmental components of addiction. To date, these broader policies have prevented and treated addiction and disease more effectively than individualized solutions, including pharmacotherapy [13, 24, 25, 40]. Such interventions are especially important given smoking’s increasing concentration among the most marginalized members of society, who are least likely to have access to pharmacotherapy, potentially reduced harm products, or effective cessation assistance services [118–120]. A biopsychosocial model recognizing the broader, industry-driven determinants of tobacco use is more likely to support a comprehensive approach to address tobacco disparities.