Medical researchers at the University of Virginia believe they have identified an enormously promising way to stop kids from taking up smoking. Virginia officials say their effort, which builds on a method they've patented for delivering highly targeted forms of health information to people based on their backgrounds and preferences, has the potential to help protect huge numbers of young people from the enormous health risks that tobacco poses. So when a company was willing to pony up $20 million to finance the research, they seized the opportunity.
The fact that the company was Philip Morris USA, the largest cigarette manufacturer in the United States, has raised some eyebrows nationally, given the tobacco industry's history of sponsoring research that suited its own commercial purposes. The UVa gift comes at a time when debate is intensifying over a proposal at the University of California, for instance, to ban researchers there from taking any tobacco industry funds, and several national grant-making groups refuse to give money to researchers or schools that accept tobacco industry funds. Given those trends, some national experts characterize Virginia as being out of step in accepting such a donation.
"The historical record going back to the mid-'50s of the industry using funding to manipulate the scientific process is too strong," says Stanton A. Glantz, a professor of medicine at the University of California at San Francisco, who has led the campaign at the UC system to ban such funds. "To accept a gift like this, you have to completely suspend belief in the entire historical record, and assume that [the company has] suddenly decided to become the National Institutes of Health."
Virginia officials bristle at such a characterization, which they say is an oversimplification. Administrators who crafted the agreement say that the university has complete control over the research that will be done and that Virginia had consulted with leaders across the medical school, including on the faculty, before deciding to accept the funds. "It was potentially controversial enough that I went and discussed it with our entire leadership," says Arthur Garson, dean of UVa's School of Medicine and a professor of pediatrics. The bottom line for UVa, he says, was that "a company has offered us $20 million to develop better ways so kids don’t smoke. Period."
Rank and file faculty members at the university, including some who work on tobacco issues or specialize in ethics, tend to agree that the university is on solid ground in accepting the funds. But some also say they are made uncomfortable by the idea that the gift is likely to help Philip Morris's image, at a time when the company has a continuing interest in the sale of cigarettes to kids, in the United States and, especially, abroad. Philip Morris's Marlboro brand is the favorite of young Americans, the lifelong smokers of tomorrow.
"One way to look at this is that Satan is handing us tools to combat Satan," says John D. Arras, the Porterfield Professor of Biomedical Ethics and Professor of Philosophy at Virginia. "But there's also the question of whether the fact that Philip Morris has burnished its public image is a reason not to accept the gift and do this kind of research." (Arras adds that it may be "excessively ethically fussy to fret about this kind of thing.")
Genesis of the Gift
Under the gift that Virginia and Philip Morris officials announced last Friday, the company is giving the university a total of $25 million -- $20 million to the medical school for research and another $5 million to UVA's commerce school for leadership development and other programs. In announcing the gift, and in interviews since then, Virginia officials portrayed the gift as a logical partnership between a university trying to do important scientific work and a company that has portrayed itself as a leader (at least within the confines of its own industry) in efforts to prevent youth smoking, sincethe 46-state tobacco settlement in 1998.
“We believe this partnership has the potential to make significant progress on reducing the harm associated with cigarettes and could yield great benefits to society," Mike Szymanczyk, chairman and chief executive officer of Philip Morris USA, said at the news conference announcing the gift. “We are proud to be able to play a constructive role in this campaign, and to expand our longstanding relationship with this great university.”
The university's announcement said that the $20 million for Virginia's School of Medicine would be used for research and projects to "help prevent youth smoking, improve the effectiveness of smoking-cessation efforts and reduce the harm caused by smoking." Garson, the medical school's dean, says the main project the university will pursue with the Philip Morris funds seeks to merge the company's "huge program with the intent of preventing childhood smoking" with a system the university has developed to provide personalized health information to individuals. "That's the real impetus behind what we’re doing -- trying to marry something we already know we have with what we think is a tremendously important issue: not to have kids ever start smoking."
Garson says that Virginia officials had discussed the gift, which was more than a year in the making, with the "entire leadership of the School of Medicine," including all department chairs. They were assured, he says, that the university would be "completely in charge of the science," and that Philip Morris would play no role other than to be apprised of the "broad outcomes" of the work. (Garson noted that the initial arrangement could lead down the road to the university taking over Philip Morris's entire smoking prevention program.)
Richard J. Bonnie, the John S. Battle Professor of Law and a professor of psychiatric medicine at Virginia, is no friend of the tobacco companies; he has been actively involved in Institute of Medicine studies of youth smoking and tobacco policy. Based on what Bonnie has read in news reports about the gift's purposes -- studying nicotine addiction, tobacco-related disease and methods of preventing both -- "these are laudable scientific goals and will advance knowledge on one of the nation's biggest public health problems," he says. "I'm confident that the university would not have accepted this money if there were any strings attached” to the Philip Morris money that would compromise the independence and integrity of the research. “Assuming there’s nothing beneath the surface, I don’t see any reason in the world why the university should not have accepted this money.”
Anti-smoking activists, however, cite several concerns. The most absolutist of them believe that tobacco industry money should be off-limit purely because of its source. "We think it's inherently wrong that the money, regardless of how much good it's going to do, is coming from a source that is inherently tainted," says Jerome Yates, national vice president for research at the American Cancer Society, explaining why the nonprofit group will not give its own research funds to individual scientists who have accepted grants from the tobacco industry.
"We believe the tobacco industry is a source of a lot of morbidity and mortality in the United States, and that promotion of cigarette smoking is inherently wrong." Tobacco companies, even if they sponsor some anti-smoking research, still spend much more of their time and money promoting smoking and tobacco use, he notes.
The American Legacy Foundation, a nonprofit group created as part of the federal tobacco settlement, has an even tougher grants policy, barring its funds from flowing to any unit or school at which any researcher is receiving tobacco industry money. Under its policy, the foundation, which awards about $30 million a year in research grants, would not provide any funds to any researcher in the UVa medical school.
The foundation has that policy in part to avoid conflicts of interest. "There is no such thing as a free lunch, and we believe that if you take money from a funder, you have a relationship with that funder," says Ellen Vargyas, general counsel and corporate secretary for American Legacy. Secondly, a primary reason that tobacco companies like Philip Morris sponsor research like that at Virginia is "to rehabilitate their corporate image," Vargyas says. "Universities should not be a party to that."
The grant to Virginia is part of Philip Morris's larger "external research program," which materials on its Web site describe as "committed to continuously researching and developing new technologies with the potential to reduce the harm associated with our products. We provide grants to support the highest quality independent research, both in the U.S. and abroad, that contributes to fundamental scientific knowledge and helps to address the concerns of the public health community and society regarding cigarette smoking." A spokesman for Philip Morris says the UVa is "among the largest" donations Philip Morris had made to a university for research. The company also finances a Center for Smoking Cessation Research at Duke University (which, like UVa, also resides in the heart of tobacco country), which has received two grants of $15 million, the Philip Morris spokesman says.
A 2006 study in the British Medical Journal's Tobacco Control examined the first round of grants from the company's external research program. The authors found that a majority of peer reviewers and of grant applicants had previous ties to the tobacco industry, and concluded that the program "appears to exist less as a conduit for critical scientific inquiry than to fit into a corporate strategy intended to burnish PM’s public image."
Garson, Virginia's medical school dean, returns again and again to the underlying purpose of the gift. "The job is to do something really important -- it's about stopping children from smoking, or not even letting them start," he says. "If we can stop kids from starting to smoke, I don't care whether Philip Morris gets PR for it or we get PR for it. If on the basis of this program, children don't smoke, then we have succeeded, period."
He adds: "Come back in five years and see if we did it right."