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http://www.nytimes.com/2002/08/14/health/14TOBA.html

Tobacco Industry Fought Drugs' Marketing

By KENNETH CHANG

obacco companies in the 1980's and 1990's put pressure on drug companies to limit their marketing of nicotine gum and skin patches that help people quit smoking, according to a new study of tobacco industry documents.

The study, published in today's issue of The Journal of the American Medical Association, describes how Philip Morris, the maker of Marlboro, Virginia Slims and other cigarettes, exerted financial leverage over the pharmaceutical divisions of giant chemical companies by threatening to cut off purchases from the companies' agricultural divisions.

The drug companies then toned down their marketing strategies, the study says, focusing on smokers who had already decided to quit rather than making broader appeals based on the health benefits of quitting.

What might otherwise be considered merely hardball business tactics was unethical in this case because the tobacco companies knew the health risks of smoking, said Dr. Lisa Bero, a professor of clinical pharmacy and health policy at the University of California at San Francisco and the senior author of the study.

"There was another product on the market designed to keep people from using their deadly product," Dr. Bero said. "They were attempting to keep people from using it."

Because of mergers and reorganizations in the chemical and pharmaceutical industries, the makers of the quit-smoking products say their marketing is now free of tobacco industry influence.

For its part, Philip Morris says the incidents described in the paper are ancient history. "Basically, the actions that are described in the study do not reflect the actions we are taking on issues like this today," said Brendan McCormick, a spokesman. "Certainly we acknowledge smoking causes serious disease in smokers and is addictive."

The nicotine gum and skin patches curb cravings, increasing the chances of kicking the habit.

Dr. Bero and her colleague Bhavna Shamasunder sifted through the trove of internal tobacco industry documents released in 1998 as part of the settlement of the states' lawsuit against the tobacco industry.

According to memorandums, when Merrell Dow, a subsidiary of Dow Chemical, introduced Nicorette nicotine gum in 1980, executives at Philip Morris wanted Dow to limit marketing to only people who needed to quit for health reasons. Dow canceled an antismoking newsletter to doctors after one issue.

Philip Morris executives were not satisfied and on May 7, 1984, canceled purchases of Dow chemicals that help moisten tobacco, an $8-million-a-year account.

"Dow was informed that the recent spate of activity can only be interpreted as a conscious corporate decision that Nicorette is more important than the Philip Morris (and other tobacco) business," an internal Philip Morris memorandum said.

Philip Morris soon resumed purchases. According to notes of a meeting in October 1984, David Sharrock, president of Merrell Dow, assured Philip Morris executives that he was screening advertising and education materials to eliminate antitobacco statements.

Philip Morris also pressured Dow to discontinue support for an antismoking alliance of public health organizations.

The episode was first reported in 1998 and 1999 by The Washington Post and The Los Angeles Times, whose articles were based on many of the same documents studied by the medical researchers.

The new study expands on those earlier reports, showing that Philip Morris's tactics continued into the early 1990's, when the first nicotine skin patches were approved. After Ciba-Geigy introduced its patch, Habitrol, Philip Morris started pressuring Ciba-Geigy's agricultural division about what it saw as an antitobacco bias in the Habitrol advertising.

"Boom, this financial sanction comes, and boom, the advertising changes," Dr. Bero said. "They're very sequential."

The Ciba-Geigy divisions negotiated "ground rules" for the marketing of Habitrol that specify "no antismoking theme" and "we do not endorse positions which would take away the freedom of choice for smokers."

While the study focused on Philip Morris, other tobacco companies were also involved in pressuring the drug companies, Dr. Bero said. The Ciba-Geigy guidelines were widely distributed to other tobacco companies and even tobacco growers.

Stephen Gillers, a professor of legal ethics at the New York University School of Law, called Philip Morris's behavior understandable, given that it was trying to protect its market.

"A company that sees a supplier trying to take away its customers might quite reasonably choose not to deal with that supplier," Mr. Gillers said. "That's rational economic behavior. Why should we enrich you when you're trying to hurt us?"

But he said he was surprised how quickly Dow and Ciba-Geigy acceded to Philip Morris's demands. As they were not in the tobacco business, Dow and Ciba-Geigy "have an obligation to question the ethics of withdrawing a profitable product that can help smokers stop in order to appease tobacco," Mr. Gillers said, adding: "The word that occurs to me is `cowardly.' Why didn't they stand up to Philip Morris?"

John Musser, a spokesman for Dow Chemical, said the actions were part of the usual give-and-take between large companies.

"That business was never affected by any changes in our accommodations to Philip Morris," Mr. Musser said. "That product thrived a lot of years before, during and after all that."

Dow sold its pharmaceutical business in 1995, and Nicorette is now marketed by GlaxoSmithKline, which does not have ties to the tobacco industry.

"We have absolutely no conflicts of interest," said Steve Burton, the company's vice president for smoking control. "Our commitment is unconditional."

Marketing still focuses on smokers who have already decided to quit, but that is because the products work best in those who are motivated, Mr. Burton said.

Worldwide sales of Nicorette and NicoDerm, GlaxoSmithKline's nicotine skin patch, totaled $513 million last year, he said.

Ciba-Geigy merged with Sandoz in 1996 to form Novartis. It has since spun off its agricultural divisions, and Novartis officials says they, too, are free out of outside pressures. Habitrol is no longer marketed directly, but sold under the private label of drugstore chains.

Dr. Bero said she did not know if tobacco companies continued to pressure drug companies.

"We can't go beyond the limits of our data," she said.

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