On July 9, Philip Morris International Inc. (PMI) issued a statement of intent to purchase Vectura Group plc (Vectura), a provider of inhaled drug delivery solutions. According to the statement, the acquisition contributes to the PMI goal to move “beyond nicotine” by leveraging Vectura’s expertise in inhalation and aerosolization into adjacent areas.
Given PMI’s strong ties to tobacco, the acquisition raises concerns across the medical field. D. Robert McCaffree, MD, Master FCCP, shares his thoughts on the prospective acquisition in the following guest feature.
August 2021: D. Robert McCaffree, MD, Master FCCP
In 2018, Dr. Neeraj Desai and I published an editorial in the journal CHEST®. The title was, in part, “Is Big Tobacco Still Trying to Deceive the Public? ... ”1 Before I give an opinion about the answer, I should give some background on events eliciting the editorial.
In 1999, the U.S. Department of Justice (DOJ) sued major tobacco companies (Philip Morris, USA; Altria; RJ Reynolds; and Lorillard) for being in violation of the Racketeer Influenced Corrupt Organization Act (RICO) in that they colluded for decades to mislead the public about the risks of smoking and risks of secondhand smoke, downplayed the addictiveness of nicotine, manipulated nicotine levels, marketed cigarettes as “low tar” or “light” when they knew these were no less hazardous than full-flavored cigarettes, purposefully targeted youth, and failed to produce a safer cigarette.
In 2006, Judge Gladys Kessler of the D.C. District Court issued a1 700-page opinion finding the defendants had violated RICO. In her words,
• “[This case] is about an industry, and in particular these defendants, that survives, and profits, from selling a highly addictive product which causes diseases that lead to ... [an] immeasurable amount of human suffering ... they have consistently, repeatedly and with enormous skill and sophistication, denied these facts to the public, the Government, and to the public health community.”
“Defendants have marketed and sold their lethal products with zeal, with deception, with a single-minded focus on their financial success, and without regard for the human tragedy ... exacted.”
• “Over the course of more than 50 years, defendants lied, misrepresented, and deceived the American public, including ... the young people they avidly sought as ‘replacement’ smokers.”
• “The evidence in this case clearly establishes that defendants have not ceased engaging in unlawful activity ... ”
Since, under RICO, the government could not recover monetary damages but only require corrective actions going forward, the court ordered them to publish “corrective statements” (five different ones in total) in major publications and on television during prime time over the course of several months, as well as at the point of sale. (They are still appealing the point-of-sale display.)
Of course, the defendants appealed, but those appeals were largely thwarted until the (almost) final order in 2017, which then led to our editorial in 2018.
While this is a rather long introduction, I thought it necessary to depict the long-standing nature and behavioral patterns of deception, distortion, and destructive behavior of this industry – all designed to maintain their incredible profits - before trying to answer the question posed in our editorial.
Since all of the above, is there evidence the industry’s behaviors have changed? On the negative side, there is a recent study published on the Tobacco Free Kids website documenting the past and continued marketing to women and girls, with all the adverse consequences to women’s health.2 The industry continues to produce and market cigarettes to everyone, including youths and focused markets such as Blacks and LGBTQ populations. However, they are quite aware that the future of combustible tobacco, the major source of their incredible profits, is threatened.
Currently, most of the profits from Philip Morris International (PMI), as well as the other major players, come from combustible products. But, the CEO of PMI has stated that he thinks combustible tobacco products will be gone in 10 to 15 years and PMI will be selling only smoke-free products by 2025. So, to preserve similar profits as their combustible products diminish, they have made major investments in vaping products, such as Juul, and development of other noncombustible tobacco products. But these are still addictive, and any reduction in health consequences is still being evaluated. A prime example of trying to change their image is Philip Morris’ Beyond Nicotine campaign. However, currently all the companies continue to produce combustible products in large amounts, both locally and internationally.
One way of assessing the vision of any company is to see where it is putting its money. Currently, all major tobacco companies are investing in marijuana companies. For example, Philip Morris has invested $2.4 billion into Cosmos, a Canadian marijuana company.
They also recently purchased Vectura, Fertin, and Kraft Foods. I know, it’s hard to see where Kraft Foods fits in here, but Vectura, an inhalational device manufacturer, and Fertin, which makes nicotine gum, as well as vehicles such as powders, pouches that dissolve in the mouth, and lozenges, certainly do fit in.
My take on these recent acquisitions is that tobacco companies realize combustibles are dying. However, they continue to develop and market nicotine in noncombustible forms. They are likely looking to move into marijuana, at least as an investment. It’s not a huge leap to consider the possibility that the purchase of Vectura will help develop delivery systems for nicotine, marijuana, and possibly medications. It’s unclear whether PMI intends to get further into inhaled pharmaceuticals.
Bottom line is that, as pulmonary physicians, we need to be aware of all developments in inhaled substances and delivery methods. On the upside, everything the industry is currently doing is apparently more transparent than they have been in the past. They are not yet, however, ceasing production and marketing of cigarettes.
It’s also important that we remind ourselves of their past actions because, personally, that past still bothers me, and I’m not quite ready to trust them. When it comes to “Big Tobacco,” it is appropriate that we always keep in mind the immortal words, often repeated in various forms, of Edgar Allen Poe, master teller of horror stories, “Believe nothing you hear and only half that you see.”3
References
1. McCaffree DR and Desai NR. Is big tobacco still trying to deceive the public? This is no time to rest on our laurels. Chest. 2018 May;153(5):1085-6. doi: 10.1016/j.chest.2018.01.012.
2. A lifetime of damage: How Big Tobacco’s predatory marketing practices harms the health of women and girls. Tobacco-Free Kids. May 2021.
3. Quote Investigator. 2017 Jun 23. “The system of Dr. Tarr and Prof. Fether,” from Graham’s Magazine, November 1845.