Experts condemn US tobacco firm's sponsorship of doctor training as 'grotesque'

A common condition

The human toll of non-communicable diseases (NCDs) is huge and rising. These illnesses end the lives of approximately 41 million of the 56 million people who die every year - and three quarters of them are in the developing world.

NCDs are simply that; unlike, say, a virus, you can't catch them. Instead, they are caused by a combination of genetic, physiological, environmental and behavioural factors. The main types are cancers, chronic respiratory illnesses, diabetes and cardiovascular disease - heart attacks and stroke. Approximately 80% are preventable, and all are on the rise, spreading inexorably around the world as ageing populations and lifestyles pushed by economic growth and urbanisation make being unhealthy a global phenomenon.

NCDs, once seen as illnesses of the wealthy, now have a grip on the poor. Disease, disability and death are perfectly designed to create and widen inequality - and being poor makes it less likely you will be diagnosed accurately or treated.

Investment in tackling these common and chronic conditions that kill 71% of us is incredibly low, while the cost to families, economies and communities is staggeringly high.

In low-income countries NCDs - typically slow and debilitating illnesses - are seeing a fraction of the money needed being invested or donated. Attention remains focused on the threats from communicable diseases, yet cancer death rates have long sped past the death toll from malaria, TB and HIV/Aids combined.

'A common condition' is a Guardian series reporting on NCDs in the developing world: their prevalence, the solutions, the causes and consequences, telling the stories of people living with these illnesses.

Tracy McVeigh, editor

Dr Tess Legg, of the Tobacco Control Research Group at the University of Bath, said sponsoring medical education was part of a "strategy to influence how science is used in medical practice and an attempt to rebuild the industry's credibility among health professionals".

Nicholas Hopkinson, a professor of respiratory medicine at Imperial College London, said: "Based on its market share (around 15%), and the global death toll from smoking (more than 8 million annually), Philip Morris kills at least a million people every year. The idea that it should have any role in medical education is grotesque."

The sponsored courses allow participants to collect credits showing they are engaging in post-qualification learning. Typically, doctors must collect a certain number of these "continuing medical education" (CME) or "continuing professional development" (CPD) points annually to continue practising.

Hopkinson called for bodies that provide or regulate medical education to "produce explicit statements and policies that tobacco industry involvement is completely forbidden".

Dr Rüdiger Krech, the director of health promotion at the WHO, called on certification authorities to ban partnerships with tobacco and related industries in medical education. "There's a clear commercial interest that could spread misinformation undermining public health efforts," he said.

"Health workers should be supported by education that is evidence-based, transparent and held to the highest ethical standards."

One doctors' organisation in South Africa, the Alliance of South African Independent Practitioners Associations (Asaipa), has offered webinars on harm reduction in public health "sponsored by Philip Morris South Africa".

Sharon Nyatsanza, the deputy director of South Africa's National Council Against Smoking, said the sponsorship may breach local laws designed to reduce the influence of the tobacco industry.

She said: "We hope public health professionals know who PMI really is. PMI - which is the largest [global] cigarette manufacturer - has a history of funding research, medical professionals and setting up front groups in ways meant to advance its own interests and in conflict with public health."

Along with many South African public health organisations and professionals, she has written to the Health Professions Council of South Africa urging it to set out a clear policy that tobacco industry funding and sponsorship would not be allowed. They have also asked that CPD credits for events sponsored by a tobacco company be withdrawn.

In a statement, Asaipa said the content of all CPD webinars was reviewed "to ensure that no products of any partner are being promoted during the educational sessions, and all statements made during these sessions are based on clinical data and evidence".

The statement added that Asaipa was "committed to upholding the highest standards of integrity, transparency and ethical conduct in all our endeavours" and would "conduct a thorough review of our sponsorship and involvement with PMI to ensure our actions align with our mission and values".

A number of online courses run by the training provider Middle East Medical have received Philip Morris sponsorship, including a seminar for healthcare workers and researchers in the region on 26 April last year "sponsored by Philip Morris Management Services (Middle East) Ltd". Content included "obstacles to implementing harm reduction" and "what is the evidence base for harm reduction in smoking". A spokesperson said the company "stopped working with PMI in 2023".

PMI has also sponsored sessions and speakers at conferences in countries including Jordan and Egypt.

Dr Ahmad Abbadi, the regional coordinator for the eastern Mediterranean at the Global Alliance for Tobacco Control, said he feared tobacco companies were targeting countries with weaker laws and regulations, particularly around conflicts of interest.

"It's a great opportunity to advocate […] in favour of the industry," Abbadi said, adding that many of his contemporaries as a Jordanian medical student had gone to work overseas. "I am in Sweden, many of my classmates are in the US, in Canada and the UK, across the world," he said. "You affect the region itself, but also the whole globe because the world is more connected."

Abbadi said the idea of harm reduction was crucial in public health, citing examples such as car seatbelts, but that the term had been co-opted as a marketing tool for tobacco companies pushing new products, including heated tobacco.

The WHO has highlighted a lack of independent research to back claims they are less harmful than cigarettes.

Medscape, a US website for health professionals, has withdrawn a planned series of educational courses around smoking cessation "supported by an independent educational grant from Philip Morris International" after criticism from doctors and academics. It said use of PMI funding "was a misjudgment that was out of character" and that it would not accept tobacco industry funding in the future.

A spokesperson for Philip Morris International said the company "believed science-based education on the topic of tobacco harm reduction was vital to improve public health.

PMI provides educational grants for science-based programmes that are run independently from PMI and follow accredited standards, including a further independent third-party academic review, he said.

"Funding is clearly labelled and attributes support from PMI. We do not control the content and it is unfounded to claim the programmes are to promote PMI products. Our activities comply with all applicable laws."