Cigarettes are the only legal consumer product that kill up to half of their users when consumed exactly as the manufacturer intended. The diseases they cause cost Australia's health system A$136.9 billion a year.
Authors
Kristin Carson-Chahhoud
Associate Research Professor, University of South Australia
Bruce Thompson
Professor and Dean of the School of Health Sciences, Swinburne University of Technology
John Upham
Professor of Respiratory Medicine, The University of Queensland
Philip Morris International (PMI) is one of the global leaders in the cigarette supply chain. But with steady declines in cigarette sales over the past 20 years, tobacco companies such as Philip Morris are now attempting to market themselves as health-care companies with visions for a "smoke-free future".
One of the industry's first moves was to manufacture non-cigarette nicotine products, such as nicotine replacement therapy to help people quit smoking.
In the latest move to diversify its portfolio, Philip Morris has acquired British health-care company Vectura Group Plc, at a cost of more than £1 billion (A$1.9 billion).
Vectura specialises in manufacturing inhalation products such as commonly used inhalers (or puffers) and nebulisers that help people with asthma and lung disease to breathe.
On August 12, the Vectura board announced it "unanimously recommended the PMI offer" to shareholders, with the decision based on price and access to resources.
The Vectura board noted:
[…] wider stakeholders could benefit from PMI's significant financial resources and its intentions to increase research and development investment and to operate Vectura as an autonomous business unit that will form the backbone of its inhaled therapeutics business.
On September 15, the deal became official. And so the problems begin.
Why Vectura?
In acquiring Vectura, Philip Morris will profit from treating the very illnesses its products cause, as nebulisers are commonly prescribed for patients with tobacco-related lung disease.
Philip Morris's interest in the company is to help it generate "[…] at least $1 billion in annual net revenues from Beyond Nicotine sources in 2025". In other words, Philip Morris plans to expand development of electronic cigarettes and start profiting from other inhaled devices.
This is despite there being limited evidence to support electronic cigarettes to help people quit smoking, but mounting evidence showing damaging health effects.
If Philip Morris really wants to move "beyond nicotine", it should stop its aggressive promotion and sale of all tobacco products.
Why does it matter?
The consequences of Philip Morris's acquisition of Vectura are far reaching, especially for the medical and research workforce fighting against respiratory disease. The Philip Morris takeover will have significant implications for the sector.
Many public health organisations, medical professional bodies, universities, individual health professionals and researchers cannot and will not work with tobacco companies or their affiliates. This is in line with the World Health Organization's Framework Convention on Tobacco Control.
This means researchers who would have received support from Vectura, or used their products to pioneer the next generation of inhaler therapies, will no longer be able to do this.
There will be conflicts of interest prohibiting them from publishing their findings, collaborating on grants for new research, and presenting their work at conferences.
This has already begun to happen, with pharmaceutical industry conferences such as the Drug Delivery to the Lungs Conference terminating Vectura's sponsorship, forcing the company's representative to stand down from its committee, and barring them from participation.
Going forward, companies, health professionals and researchers now inadvertently linked to big tobacco through Vectura may be restricted from fully participating in the medical and scientific community. The European Respiratory Society, for example, excludes participation from anyone with links to the tobacco industry in the past ten years.
The Pharmaceutical Benefits Scheme (PBS) will need to consider if it's appropriate for Australian taxpayers to subsidise inhaler devices licensed to Vectura or, more truthfully, to big tobacco.
Many doctors will be looking for alternative devices to prescribe for their patients that do not contribute to Philip Morris's or Vectura's profits.
Meanwhile, people with lung disease are also likely to be reluctant to use devices linked to big tobacco.
But switching from one inhaler to another comes with consequences, such as lower adherence and new side effects, causing poorer clinical outcomes.
There are also concerns Philip Morris's takeover of Vectura could be used to buy "a seat at the table" with health care policymakers and professionals, meaning they could have a say in the development of government policies.
The tobacco industry hasn't changed
The tobacco industry remains one of the world's most lethal. And Philip Morris continues to undermine public health messages, while trying to disguise itself as a health brand.
Yet Philip Morris's company statutory regulations, which are the standards by which they undertake business, list evidence-based actions to reduce smoking rates - such as strong health warnings on packets and smoking bans in public places - as "risk factors" for its business.
Philip Morris's move into the health sector, reinforced with the latest acquisition of Vectura, should be met with equal measures of disgust and contempt.
Kristin Carson-Chahhoud receives funding from The National Health and Medical Research Council, Channel 7 Children's Research Foundation, Cancer Australia, Ministry of Health, The Sax Institute, New South Wales Government, Thoracic Society of Australia and New Zealand, University of South Australia, Australian Association of Gerontology, Cancer Council Victoria, Asthma Australia, The University of Adelaide and the Australian and New Zealand School of Government. She has received honorariums and travel reimbursement from Pfizer Australia to present her research findings at the Pfizer annual general meeting and at the Ogilvy Smoking Exchange Summit. Kristin is a Board Director for the Thoracic Society of Australia and New Zealand (TSANZ), Chair of the TSANZ Research Subcommittee and Executive Director of the SA/NT Branch of the TSANZ. She is also a member of the Australian Association of Gerontology.
Bruce Thompson is immediate past president of the Thoracic Society of Australia and New Zealand. He has received research funding from the NHMRC, and historically speaker fees from Chiesi, Mundipharma, GSK and AstraZenca.
John Upham has received funding from the National Health & Medical Research Council. He is currently President of the Thoracic Society of Australia and New Zealand.
