Historians' testimony on "common knowledge" of the risks of tobacco use: a review and analysis of experts testifying on behalf of cigarette manufacturers in civil litigation

Food as harm reduction during a drinking session: reducing the harm or normalising harmful use of alcohol? A qualitative comparative analysis of alcohol industry and non-alcohol industry-funded guidance

BACKGROUND

The aim of this study was to critically analyse information concerning the relationship between alcohol and food consumption provided via alcohol industry (AI) funded and non-AI-funded health-oriented websites, to determine the role it plays within the alcohol information space, and how this serves the interests of the disseminating organisations.

METHODS

Information on food as a harm reduction measure while drinking alcohol was extracted from 15 AI websites and websites of AI-funded corporate social responsibility (CSR) organisations. As a comparison group, non-AI-funded health websites were also searched (n = 16 websites with food and alcohol-related content). Information was included from webpage content and associated downloadable documents. Critical discourse analysis (CDA) was adopted to allow the texts analysed to be situated within the broader political and social context. Analysis was carried out iteratively, involving continuous comparison within and between websites. Discursive themes were identified by three researchers. Identified discursive elements were discussed to reach a consensus, and a final coding framework was then developed. "Tone" analysis was used to assess whether the overall tone within individual websites was considered to be pro-alcohol consumption, neutral or discouraging of alcohol consumption.

RESULTS

There were some commonalities across AI and non-AI-funded websites, whereby both appeared to normalise alcohol consumption and to encourage use of food as a measure to enable sustained drinking, to avoid drinking in a way that results in short-term harms, and to prevent or "cure" a hangover. The fact that both AI-funded and non-AI-funded organisations shared many of these narratives is particularly concerning. However, a discourse of food and alcohol that served to promote "moderate" drinking as beneficial to health was used exclusively by AI-funded organisations, focusing on special occasions and individual-blaming.

CONCLUSIONS

Alcohol consumption, including heavy and harmful consumption, is frequently normalised within the online information space. Emphasising food consumption with alcohol may have the effect of supporting consumers to drink for longer periods of time. Health professionals and independent health organisations should review the information they provide in light of our findings and challenge why AI-funded organisations, with a major conflict of interest, and a history of health misinformation, are often given the responsibility for disseminating health information to the public.

Big tobacco focuses on the facts to hide the truth: an algorithmic exploration of courtroom tropes and taboos

OBJECTIVE

To use methods from computational linguistics to identify differences in the rhetorical strategies deployed by defence versus plaintiffs' lawyers in cigarette litigation.

METHODS

From 318 closing arguments in 159 Engle progeny trials (2008-2016) archived in the Truth Tobacco Industry Documents, we calculated frequency scores and Mann-Whitney Rho scores of plaintiffs versus defence corpora to discover 'tropes' (terms used disproportionately by one side) and 'taboos' (terms scrupulously avoided by one side or the other).

RESULTS

Defence attorneys seek to place the smoker on trial, using his or her friends and family members to demonstrate that he or she must have been fully aware of the harms caused by smoking. We show that 'free choice,' 'common knowledge' and 'personal responsibility' remain key strategies in cigarette litigation, but algorithmic analysis allows us to understand how such strategies can be deployed without actually using these expressions. Industry attorneys rarely mention personal responsibility, for example, but invoke that concept indirectly, by talking about 'decisions' made by the individual smoker and 'risks' they assumed.

CONCLUSIONS

Quantitative analysis can reveal heretofore hidden patterns in courtroom rhetoric, including the weaponisation of pronouns and the systematic avoidance of certain terms, such as 'profits' or 'customer.' While cigarette makers use words that focus on the individual smoker, attorneys for the plaintiffs refocus agency onto the industry. We show how even seemingly trivial parts of speech-like pronouns-along with references to family members or words like 'truth' and 'facts' have been weaponised for use in litigation.

Waterpipe tobacco package warning exposure's impact on risk perceptions and use among young adults in the USA: a longitudinal analysis of the population assessment of tobacco and health study

BACKGROUND

Although Food and Drug Administration (FDA)-mandated waterpipe tobacco warnings were not required until August 2018, some waterpipe tobacco packaging (WTP) sold in the USA, contained warnings prior to this date. We examined the prevalence of WTP warning exposure and whether exposure influenced risk perceptions or use among young adult (aged 18-24 years) current waterpipe users.

METHODS

We used data from waves 1 (2013-2014) and 2 (2014-2015) of the Population Assessment of Tobacco and Health Study, a nationally representative longitudinal study of US adults and youth. We conducted logistic regression analyses to identify factors associated with wave 1 warning exposure, and whether wave 1 WTP warning exposure predicted wave 2 relative risk perceptions and waterpipe use.

RESULTS

More than one-third of our sample (35.9%, 95% CI 33.5 to 38.4) reported past-month WTP warning exposure. Exposure was higher among males (adjusted OR (AOR)=1.34, 95% CI 1.04 to 1.72), those who usually do not share the waterpipe (AOR=3.10, 95% CI 1.45 to 6.60), those who purchased waterpipe tobacco (AOR=1.73, 95% CI 1.28 to 2.34), and those with a regular brand (AOR=1.84, 95% CI 1.26 to 2.68). Those exposed to WTP warnings at wave 1 were more likely than those not exposed to perceive waterpipe tobacco to be as or more harmful than cigarettes at wave 2 (AOR=1.35, 95% CI 1.02 to 1.78). There was no association between wave 1 WTP exposure and wave 2 waterpipe use.

CONCLUSIONS

More than one-third of US young adult current waterpipe users reported WTP warning exposure prior to FDA-mandated warning implementation. Findings suggest the mandated warning may result in high exposure among users; it will be critical to assess exposure's impact on risk perceptions and behaviour after FDA-mandated warnings are implemented.

Tobacco industry use of personal responsibility rhetoric in public relations and litigation: disguising freedom to blame as freedom of choice

We examined the tobacco industry's rhetoric to frame personal responsibility arguments. The industry rarely uses the phrase "personal responsibility" explicitly, but rather "freedom of choice." When freedom of choice is used in the context of litigation, the industry means that those who choose to smoke are solely to blame for their injuries. When used in the industry's public relations messages, it grounds its meaning in the concept of liberty and the right to smoke. The courtroom "blame rhetoric" has influenced the industry's larger public relations message to shift responsibility away from the tobacco companies and onto their customers. Understanding the rhetoric and framing that the industry employs is essential to combating this tactic, and we apply this comprehension to other industries that act as disease vectors.

Inventing conflicts of interest: a history of tobacco industry tactics

Confronted by compelling peer-reviewed scientific evidence of the harms of smoking, the tobacco industry, beginning in the 1950s, used sophisticated public relations approaches to undermine and distort the emerging science. The industry campaign worked to create a scientific controversy through a program that depended on the creation of industry-academic conflicts of interest. This strategy of producing scientific uncertainty undercut public health efforts and regulatory interventions designed to reduce the harms of smoking. A number of industries have subsequently followed this approach to disrupting normative science. Claims of scientific uncertainty and lack of proof also lead to the assertion of individual responsibility for industrially produced health risks.

Rauchen und Lungenkrebs

Sir Ronald Aylmer Fisher, der wohl berühmteste und produktivste Statistiker des 20. Jahrhunderts, hat zeit seines Lebens den kausalen Zusammenhang zwischen dem Tabakrauchen und der Entstehung von Lungenkrebs angezweifelt. Er zog stattdessen einen genetischen „Confounder“ als Erklärung für die zwischen beiden Faktoren bestehende statistische Assoziation in Betracht, d. h. er konstatierte ein Gen, das sowohl das Rauchverhalten als auch die Krebsätiologie beeinflusst. Es gab viele Versuche, Fishers Starrsinn in dieser Angelegenheit zu erklären. Neben außerwissenschaftlichen Gründen (Fisher war selbst leidenschaftlicher Raucher) spielte wohl auch Fishers Sorge um den Stellenwert valider statistischer Methoden in der medizinischen Forschung eine entscheidende Rolle. Genomweite Assoziationsanalysen (GWAS) zum Rauchverhalten und zum Lungenkrebs haben in jüngster Vergangenheit Hinweise dafür geliefert, dass Fishers Überlegungen vielleicht doch ein Fünkchen Wahrheit enthielten und dass sich sein Confounder in Form des Gens für die Nikotinrezeptor-Untereinheit α5 auf Chromosom 15q25 wiederfinden könnte.

Tobacco manufacturers' defence against plaintiffs' claims of cancer causation: throwing mud at the wall and hoping some of it will stick

BACKGROUND

In the late 1990s and the early part of this decade, the major US cigarette manufacturers admitted, to varying degrees, that smoking causes cancer and other diseases.

OBJECTIVE

To examine how tobacco manufacturers have defended themselves against charges that their products caused cancer in plaintiffs in 34 personal injury lawsuits, all but one of which were litigated between the years 1986 and 2003.

METHODS

Defence opening and closing statements, trial testimony, and depositions for these cases were obtained from the Tobacco Deposition and Trial Testimony Archive (http://tobaccodocuments.org/datta/). All available defence-related transcripts from these cases were reviewed and a content analysis was conducted to identify common themes in the defendants' arguments.

RESULTS

After review of the transcripts, defendants' arguments were grouped into seven categories: (1) there is no scientific proof that cigarette smoking causes lung cancer; (2) the plaintiff did not have lung cancer as claimed; (3) the plaintiff had a type of lung cancer not associated with cigarette smoking; (4) the plaintiff had cancer that may have been associated with cigarette smoking or smokeless tobacco use, but tobacco products were not to blame in this particular case; (5) the plaintiff had cancer that may have been associated with cigarette smoking, but the defendant's cigarette brands were not to blame; (6) the defendant's cigarettes (or smokeless tobacco) may have played a role in the plaintiff's illness/death, but other risk factors were present that negate or mitigate the defendant's responsibility; and (7) the defendant's cigarettes may have been a factor in the plaintiff's illness/death, but the plaintiff knew of the health risks and exercised free will in choosing to smoke and declining to quit. Use of the argument that smoking is not a proven cause of lung cancer declined in frequency during and after the period when tobacco companies began to publicly admit that smoking causes disease. Corresponding increases occurred over time in the use of other arguments (namely, presence of other risk factors and "free will").

CONCLUSIONS

Despite the vast body of literature showing that cigarette smoking causes cancer, and despite tobacco companies' recent admissions that smoking causes cancer, defendants used numerous arguments in these cases to deny that their products had caused cancer in plaintiffs. The cigarette companies, through their public admissions and courtroom arguments, seem to be saying, "Yes, smoking causes lung cancer, but not in people who sue us".

Tobacco industry litigation position on addiction: continued dependence on past views

This paper reviews the tobacco industry's litigation strategy for addressing the addiction issue through trial testimony by its experts, and opening and closing statements by its lawyers. Despite the fact that several companies now claim to accept, in varying degrees, the conclusions of the Surgeon General concerning tobacco addiction, the tobacco industry litigation strategy pertaining to addiction is essentially unchanged since that of the early 1980s when the issue emerged as crucial. The industry uses its experts and the process of cross-examination of plaintiff's experts to imply that the addictiveness of tobacco and nicotine are more comparable to substances such as caffeine, chocolate, and even milk, than to heroin, cocaine and alcohol. Furthermore, the tobacco industry contends that the definition of addiction has now become so broadened as to include carrots and caffeine and hence that any concurrence that smoking is addictive, does not imply that cigarettes are addictive to the standards that drugs such as heroin and cocaine are addictive. Finally, the industry has continuously asserted that tobacco users assumed the risks of tobacco since they understood that quitting could be difficult when they began to use, and moreover, that the main barrier to cessation is lack of desire or motivation to quit and not physical addiction. These positions have been maintained through the 2004-2005 US Government litigation that was ongoing as the time of this writing.