How anti-tobacco researchers cook the evidence

It’s called ‘research’, but investigations into Big Tobacco are increasingly a moral activity.

In a study recently published in the journal Tobacco Control, researchers asked a sample of young smokers about their views on the design of a range of cigarette packets (Borland et al, 2013). The researchers were interested in such things as how attractive the young smokers thought the different packs were, their views on the likely quality of the cigarettes the packs contained, and whether the physical design of the packs impacted in any way on the visibility of the now standard health warnings. Among other things, the researchers identified that the young smokers liked the ‘flip top’ opening on the packs and that this type of opening, in contrast to the various other type of openings used, detracted least from the health warnings on each packet.

On the basis of that précis, this sounds like standard market research – indeed, it sounds like research which the tobacco industry itself might have undertaken, keen to know what its consumers thought of the packaging of its products. But these were tobacco-control researchers, so their interpretation of their findings was nothing like anything a tobacco company might have come up with.

The researchers noted that, ‘While on the surface one might conclude that even though the standard flip-top opening was the least likely to distract from the health warning, it was also rated as the most desirable and thus should be considered for removal’.  The thinking here could be paraphrased along the lines of: ‘Find out what smokers like most, and don’t give it to them.’

Interestingly, removing the cigarette pack design feature that the researchers were most concerned about (flip-top opening) would, on the basis of their own analysis, run the risk of weakening rather than strengthening the very health warnings that public-health advocates had previously sought to have placed on cigarette packs. However, when it comes to tobacco control research, there is no greater priority than that of reducing the appeal of smoking and the number of people smoking, even if that means reducing the salience of the health warning.

The tobacco-control mindset evident in the suggestion of removing the flip-top opening can on occasion lead to a highly selective presentation of the available evidence. Take Public Health England as an example. In its contribution to the Independent Review into Standardised Packaging of Tobacco (the so-called Chantler Review), Public Health England emphasised the result of a recent survey of directors of public health. The executive summary to their submission notes that an impressive ‘100 per cent of directors recommend standardised packaging’ (PHE, 2014:4). Further on in the submission, the 100 per cent figure seems a lot less impressive when it is explained that out of the 131 directors of public health surveyed, only 57 per cent (75) responded to the survey (PHE, 2014:16). On the basis of that response rate, it would be more accurate to say that 57 per cent of directors of public health agreed with the plain-packaging policy.

The use of simple percentages to give a misleading impression of near universal support for a policy is repeated later on in the same document, when it is noted that 94 per cent of directors of public health suggested that standardised packaging ‘would have a positive impact on reducing health inequalities, particularly in relation to children and young people, those from deprived communities, people with health needs, such as mental health and long-term conditions, and respiratory illness’ (PHE, 201417).

Again, the reference to 94 per cent support for the policy is misleading, since it can only refer to just over half of the directors, the ones who completed the questionnaire.  It is also significant that Public Health England chose to report the directors’ belief that the policy would reduce health inequalities, improve mental health, and reduce the impact of long-term (though unspecified) chronic conditions without citing a single piece of evidence as to why those beliefs should be taken seriously. It is evidence that should drive policy here, not belief.

But why does such a respected body as Public Health England choose to present statistics in this misleading way? The answer, perhaps, is in its commitment to the public-health goal of reducing smoking and the political goal of tackling Big Tobacco. As social policy researchers Michael Mair and Ciaran Kierans recently noted, ‘Tobacco research has come to represent as much a moral activity as an investigative one, a weapon used by the “researcher-activist” in the “fight against tobacco”’ (Mair and Kierans, 2007:104).

If truth is the first casualty of war, then dispassionate discussion of the evidence may be the first casualty in the battle against Big Tobacco. The goal of reducing tobacco-related harm is too important to be subjected to such a casual use of the evidence. Plain packaging may turn out to be a stellar policy, but to know whether that is the case we need to conduct the right studies in the best way. In other words, we need more evidence and less spin.

Neil McKeganey works at the Centre for Drug Misuse Research in Glasgow.

References:

Borland, R; Savvas, S; Sharkie, F; Moore, K (2014); ‘The impact of structural packaging design on young adult smokers perceptions of tobacco products’, Tobacco Control, 2013 22 97-102

Mair, M; Kierans, C (2007); ‘Critical reflections on the field of tobacco research: the role of tobacco control in defining the tobacco research agenda’, Critical Public Health, Vol 17 No 2 103-112.

Public Health England (2014), ‘Submission to the Independent Review into Standardised Packaging of Tobacco’.

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