Research evidence
Australia’s post implementation evidenceBig tobacco strongly argues that there is no reliable evidence to show that plain packaging will reduce smoking rates. The tobacco companies have used this argument in their advertising campaigns in Australia, the UK, France and elsewhere. It is part of the opposition in each jurisdiction that considers the policy.
Advertisements run by BAT in Australia and JTI in the UK.
These industry campaigns make bold but simple assertions that are often then picked up and repeated in the media. The tobacco company submissions to the governments go into more detail. Their arguments fall into four broad categories:
- Undermining or criticizing the supporting research evidence, by asserting it is all seriously flawed;
- Misquoting or distorting the main messages of the supporting evidence;
- Arguing that smoking prevalence rates in Australia have not decreased (or that plain packaging has not affected the existing downward trend); and
- Relying on industry-funded, non-peer-reviewed studies as evidence.
Undermining the research evidence
The four big tobacco companies have criticized the systematic evidence reviews — such as the Stirling Review, the Chantler Review, and the Hammond Review, detailed on the RESEARCH EVIDENCE page of the Tools and Resources.
For instance, in its response to the UK 2014 consultation, Imperial Tobacco commented on the Chantler Review:
“At its heart the Report relies on a selection of theoretical studies, including those in the ‘Systematic Review’ commissioned by the Department of Health from Public Health Research Consortium (“PHRC”), none of which have been able to show that standardised packaging would reduce smoking prevalence and which themselves have had to acknowledge their very significant limitations.” [p. 9]
In its written response to the Oireachtas Joint Committee on Health and Children in Ireland, JTI stated that:
“The Systematic Reviews, which were written by a small number of tobacco control advocates, are not reliable or convincing. The methodology is flawed. Not a single study can be pointed to in the Systematic Reviews which demonstrates that plain packaging is likely to achieve actual public health benefits. Furthermore, the individual surveys underlying the ‘systematic’ reviews test what people say they will do rather than what they actually do.”[p. 5]
Claims that data from Australia show no impact from plain packaging
In their responses to consultations on plain packaging, tobacco companies have consistently stated that the real life evidence from Australia’s statistics on prevalence and consumption do not show any decline attributable to plain packaging and that countries should wait until the outcome of real life evidence from Australia.
For instance, in its submission to the UK 2014 consultation, Imperial Tobacco stated:
“The Australian Government is planning to conduct a review on the plain packaging implementation in December 2014 and we would expect other governments to wait until this review has been completed before making any policy decisions.”[p. 21]
And the JTI submission to the Canadian 2016 consultation stated:
“The empirical evidence does not show that plain packaging has accelerated the rate of decline in smoking, or has had any public health impact at all.”[p. 71]
(The Post-Implementation Review by the Australian Government was published in February 2016 and is discussed on the Australia’s Post-Implementation Evidence page of the Tools and Resources.)
In its submission to Australia’s post implementation review of plain packaging, Philip Morris stated that:
“The vast majority of the data available from the first two years of plain packaging show consistently that there is no sound basis today for concluding that plain packaging has been effective in achieving its original objectives of reducing smoking prevalence or consumption.”[p. 12]
The tobacco company consultation submissions also highlight other statistics from Australia to seek to show that prevalence and consumption have not been affected by the introduction of plain packaging.
Philip Morris, in its submission to the Australian Post-Implementation Review, cited the surveys from a number of Australian state governments and organizations.
“. . . four of five states, Victoria, Queensland, Western Australia and South Australia reported increases in smoking prevalence after the implementation of plain packaging. Specifically, smoking prevalence in South Australia increased from 16.7% to 19.4% between 2012 and 2013. During the same period, smoking prevalence in Queensland and Western Australia went from 14.3% to 15.8% and 12.7% to 13%, respectively.” [p. 9]
However, these state surveys use small sample sizes and, therefore, year on year, the changes in prevalence are not statistically significant. This issue was addressed in the PIR (see the Australia’s Post-Implementation Evidence page on Tools and Resources).
Relying on industry-funded, non-peer-reviewed studies
The tobacco companies rely on academic studies both to criticize the supporting research evidence and to analyze the prevalence and consumption data from Australia. It is important to note that almost all of these have been directly funded by the tobacco companies, none of them has been subject to peer review, and their authors were never provided access to tobacco company internal research or sales data to assist or verify their conclusions.
It is also important for government officials to recognize the experts that the industry repeatedly use around the world and the criticisms that have been made of them. Reports by the following experts are considered below:
In relation to smoking prevalence and sales data from Australia -
- 1. Ashok Karl and Michael Wolf, University of Zurich (funded by BAT)
- 2. London Economics (funded by PMI)
- 3. Sinclair Davidson and Ashton de Silva,RMIT University (a member of the Institute of Economic Affairs which receives funding from tobacco companies)
In relation to the international research evidence on plain packaging:
- 4. Professor Kip Viscusi (funded by BAT)
- 5. Professor Mitchell (funded by BAT)
- 6. Professor Steinberg (funded by JTI)
- 7. Professor Devinney (funded by JTI)
Tobacco industry experts on smoking prevalence and sales data
In its response to the Norwegian consultation JTI stated:
“Studies by the Universities of Zurich and Saarland [by Kaul and Wolf] have found that plain packaging has had no effect on smoking prevalence, either among minors or adults.1
A study by London Economics found that: “the data does not demonstrate that there has been a change in smoking prevalence following the introduction of plain packaging and larger health warnings, despite an increase in the notice ability of the new health warnings” 2.
Contrary to misleading claims by the tobacco control lobby, Australian government data further reinforces the fact that plain packaging has not had a positive impact. The overall decline in smoking prevalence between 2010 and 2013 is consistent with the continuation of the pre-existing trend, despite the introduction of plain packaging.” [pp. 11–12]
These two studies have been referred to extensively by all the tobacco companies, in particular those by professors Kaul and Wolf from the Universities of Zurich and Saarland. In their response to the 2014 UK consultation, BAT relied on a Kaul and Wolf study to state:
“The evidence to date from Australia shows that more than 18 months after its introduction, Plain Packaging has not had any effect on smoking behaviours beneficial to public health.3”
The Kaul and Wolf studies are relied on by BAT, JTI, PMI, and Imperial Tobacco in all their consultation submissions.
These (and other industry-commissioned studies) claim that there was an existing downward trend in tobacco prevalence rates in Australia that would have continued even without plain packaging being introduced. A number of tobacco-control measures were introduced in Australia at a similar time to plain packaging, such as larger graphic health warnings and increases in excise tax. The analysis from these studies is that plain packaging did not increase the predicted trend in the rate of decrease in prevalence and, therefore, cannot be shown to have had any impact.
Sinclair Davidson of RMIT University in Australia has been vocal in claiming that consumption rates and sales have not fallen. Philip Morris relies on his reports to claim that there is no evidence to show that plain packaging has had any impact on the declines that have occurred.
“Researchers from RMIT University in Australia who analyzed this data could find no evidence of a plain packaging effect. When holding price constant and controlling for long-term declines in spending on tobacco, the researchers found: ‘Any evidence to suggest that the plain packaging policy has reduced household expenditure on tobacco is simply lacking.’”4
Tobacco industry experts used to analyze the research evidence
BAT has consistently relied on reports by Professor Kip Viscusi. Following his critical review of the studies supporting the conclusion that plain packaging increases the effectiveness of health warnings, Prof.Viscusi claims there is:
no evidence from these studies that plain packaging will increase the effectiveness of warnings … The public is overwhelmingly aware of the dangers of smoking. In this environment, there is no beneficial role of plain packs for increasing the effectiveness of warnings or discouraging smoking initiation. 5
A report by Professor Mitchell of the University of Virginia is also used by different tobacco companies. His report concludes that:
“Factors associated with the initiation, continuation, and cessation of underage smoking have been the subject of a large amount of empirical research. Two propositions relevant to the question of the effects of standardized packaging regulations on underage smoking are apparent from this body of research: (a) many variables are now known to be associated with underage decisions to initiate and continue smoking; (b) features of cigarette packaging have been relatively little studied as a cause or correlate of underage smoking, with no published field studies demonstrating an association between standardized cigarette packaging characteristics and reduced smoking initiation or continuation by underage persons.”6
The reports by Mitchell and Viscusi were annexed to the BAT submission to the UK 2014 consultation.
JTI relies on a report by Professor Steinberg from 2010 7 that analyzes the research evidence on plain packaging and his letter to the Chantler Review process in 2013, which stated that he was aware of:
no scientific evidence that suggests, nor would [his] understanding of the current research on adolescent decision-making suggest, that cigarette packaging is relevant to adolescents’ decisions to experiment with or continue smoking.
JTI also commissioned reports by Professor Devinney who has undertaken ‘in-depth analysis of a large number of publicly available consumer studies’ on plain packaging. His 2014 report was submitted by JTI to the Chantler review and concluded that:
The current evidence base is insufficient to justify the conclusion that plain packaging is likely to have any impact on actual smoking behaviours. 8
Criticisms and court judgments on the industry reports
The studies by Kaul and Wolf (which did not receive a peer-review scrutiny before publication) have been the subject of significant academic criticism. A paper by Anthony Laverty and others commented on:
…the low statistical significance of the analytical methods used and the assumption that Standardised Packaging should have an immediate large impact on smoking prevalence
And concluded
“Both of [the Kaul et al papers] are flawed in conception as well as design but have nonetheless been widely publicised as cautionary tales against standardised pack legislation.”
A study by Diethelm and Farley sought to assess the effect of plain packaging on smoking prevalence among adults in Australia based on the same data as Kaul and Wolf but using a more appropriate statistical method and accounting for the potential effect of other key tobacco-control measures. They concluded that:
A significant decline in smoking prevalence in Australia followed the introduction of plain packaging, after adjusting for the impact of other tobacco control measures. This conclusion is in marked contrast to that of the industry-funded analysis. 10
Cancer Council Victoria have also produced critiques of Karl and Wolf’s reports 11; the London Economics report 12; and the Davidson and de Silva report. 13
(See also Australia’s Post-Implementation Evidence for the Australian government’s information on consumption rates in Australia since implementation.)
Evidence in the High Court challenge to the UK regulations
Reports by Viscusi, Mitchel, Devinney and Steinberg were used as expert evidence by the four tobacco companies in their legal challenge to the UK plain packaging regulations.The judge was highly critical of the evidence put forward by the tobacco companies in general stating that they “not accord with internationally recognised best practice” or international norms. The judge also highlighted flaws in the reports of specific experts including Viscusi [at paragraph 385], Mitchell [at paragraph 384], Devinney at [at paragraph 388] and Steinberg [at paragraph 353]. 14
The criticisms included that:
- Viscusi, Mitchell, Devinney and Steinberg have never had a peer reviewed study published in relation to tobacco use and non of their reports used in the court proceedings were peer reviewed.
- None of the above mentioned reports refer even once to the role of addiction in perceptions of risk.
- None of them refer to any internal tobacco company research on tobacco marketing and packaging.
- These experts entirely ignored or airily dismissed volumes of relevant research literature.
- In their respective reviews of the literature, none of these experts accepted a single research study as relevant and reliable.
- Viscusi was highly selective in the evidence he used, ignoring contrary evidence even within the same studies he relied upon.
- They gave views and opinions that were frequently unverifiable and made without a single citation or reference in support of them. Where references were made, they were to non-peer-reviewed studies.
Similar criticisms can be made of all the academic experts relied on by the tobacco industry. More detail on the High Court legal challenge against the UK regulations is provided in Legal issues and case summaries.
The Counter Arguments
The Evidence pages of the Tools and Resources contain detailed information about the evidence that supports the introduction of plain packaging of tobacco products.
- There have been five independent comprehensive evidence reviews, and there is now over four years post-implementation data from Australia — all of which point towards the measure being effective. The evidence reviews considered over seventy peer-reviewed scientific studies.
- The tobacco companies have not disclosed any of their own consumer research or internal material into plain packaging and have failed to effectively deny if they have undertaken any such research. 15 “To date, no empirical studies conducted by, or on behalf of, tobacco companies have been published.” “To date, no empirical studies conducted by, or on behalf of, tobacco companies have been published.”16
-
None of the studies used by the tobacco industry to support their arguments
have been subject to peer review.
The evidence the tobacco companies submitted to the UK’s 2012 consultation on
standardized packaging has been analyzed in a study by the University of Bath, which
found that they misrepresented the supporting evidence base for by misquoting and using
a “mimicked” form of scientific critique. 17
Researchers also analyzed 77 items of evidence submitted by four tobacco companies intended to prove that standardized packaging wouldn’t work. Their analysis found that only seventeen out of the 77 items actually addressed the impact of standardized packaging. Of these seventeen, fourteen were directly industry-funded, and none had been published in peer-reviewed journals.18 - The Chantler Review from the UK stated that all the evidence “points in a single direction, and I am not aware of any convincing evidence pointing the other way.” 19
- The official statistical evidence from Australia shows an increase in the rate of decline of both smoking prevalence and tobacco consumption after implementation. Implementation Review attributes a 0.55 percentage point reduction in smoking rates to plain packaging, equivalent to 118,000 fewer smokers over the 34 months after implementation.20
- The High Court challenge against the UK Regulations was the first (and as yet only) legal challenge that addressed the evidence on both sides in detail (see 4.2.1). The 400-page judgment of Mr Justice Green goes to considerable length to assess this evidence. 21
The judge’s conclusion was that the “qualitative evidence relied upon by the [Government] is cogent, substantial and overwhelmingly one-directional in its conclusion.” [para 492].
He was then scathing in his criticism of the evidence put forward by the tobacco companies because it was not peer reviewed, either ignored or airily dismissed the worldwide research and literature base, and was frequently unverifiable. He made detailed critiques of each of the expert reports put forward by the tobacco companies and concluded that this “body of expert evidence does not accord with internationally recognised best practice.” [para 374].
1The (Possible) Effect of Plain Packaging on the Smoking Prevalence of Minors in Australia: A Trend Analysis,” University of Zurich, Department of Economics, Working Paper No. 149, May 2014. Available from: http://www.papers.ssrn.com/sol3/papers.cfm?abstract_id=2414430,and “The (Possible) Effect of Plain Packaging on Smoking Prevalence in Australia: A Trend Analysis,”Working Paper No. 165, June 2014. Available from: http://www.papers.ssrn.com/sol3/papers.cfm?abstract_id=2460704.
2 See “An analysis of smoking prevalence in Australia,” London Economics, November 2013, page 1 (for PMI). Available from: http://londoneconomics.co.uk/wp-content/uploads/2013/11/London-Economics-Report-Australian-Prevalence-Final-Report-25-11-2013.pdf.
3 The BAT submission refers to the Kaul and Wolf studies and uses a further non-peer-reviewed study by Stephen Gibson, an economist, consultant at SLG Economics Ltd, which essentially mirrors the analysis by Kaul and Wolf.
4 S. Davidson and A. de Silva, “The Plain Truth about Plain Packaging: An Econometric Analysis of the Australian 2011 Tobacco Plain Packaging Act,” Australia National University Press, November 2014, available from: http://press.anu.edu.au/apps/bookworm/view/Volume+21,+Number+1,+2014/11311/davidson.xhtml.
5 An Assessmentofthe Likely Effectof Plain Packagingon Warnings Efficacy June 5, 2015. Available from: https://www.regjeringen.no/no/dokument/dep/hod/hoeringer/hoeringsdok/2015/horing-av-forslag-til-innforing-av-standardiserte-tobakkspakninger-og-gjennomforing-av-tobakkskonvensjonen-artikkel-5.3-i-norge/Download/?vedleggId=b84be9bd-0c56-4f97-a995-646f18bf768f.
6 G. Mitchell, “A Psychological Analysisofthe Potential Impactof Standardized Cigarette Packagingon Underage Smoking. Available from:http://www.academia.edu/8883995/Plain_Packaging_and_the_Interpretation_of_the_TRIPS_Agreement.
7Letter from L Steinberg to Chantler Review, January 2013. Available from:http://www.kcl.ac.uk/health/Packaging-review/packaging-review-docs/submittedevidence/Steinberg,-Professor-L-Submission.doc.
8
T. M. Devinney, “Analysis of Consumer Research Evidence on the Impact of Plain Packaging
for Tobacco Products” (Updated to 2014). January 2014. Available from:
http://webarchive.nationalarchives.gov.uk/20140911094224
http://www.kcl.ac.uk/health/Packaging-review/packaging-review-docs/submittedevidence/Devinney,-Professor-Timothy-Submission-(2).pdf.
9 A. A.Laverty, P. Diethelm, N. S.Hopkinson, et al. “Use and Abuse of Statistics in Tobacco Industry-Funded Research on Standardised Packaging.”Tobacco Control 2015;24:422–424. Available from: http://tobaccocontrol.bmj.com/content/24/5/422.long.
10 P. Diethelm et al. “Refuting Tobacco Industry Funded Research. Tobacco Prevention Cessation, November 6, 2015. Available from:http://www.tobaccopreventioncessation.com/Refuting-tobacco-industry-funded-research-empirical-data-shows-decline-in-smoking-prevalence-following-introduction-of-plain-packaging-in-Australia,60650,0,2.html
11 Available from: http://www.cancervic.org.au/downloads/tobacco_control/2013/Cancer_Council_Victoria_comments_on_Kaul_Wolf.pdf.
12 Available from: http://www.cancervic.org.au/downloads/tobacco_control/2013/Critique_by_Cancer_Council_Victoria_on_report_by_PMI_26.11.13.pdf.
13 Available from: http://www.cancervic.org.au/downloads/plainfacts/Davidson_working_paper_comments_3_June_2016.pdf.
14 The full judgment is available from: https://www.judiciary.gov.uk/wp-content/uploads/2016/05/bat-v-doh.judgment.pdf
15 This was queried by Mr Justice Green, the judge presiding over the UK High Court challenge to the Standardised Packaging of Tobacco. JTI was the only tobacco company to respond, and its response in denying research had been conducted was carefully limited to a very narrow set of parameters.
16 David Hammond, “Standardised Packaging of Tobacco Products Evidence Review,” March 2014, p. 23. Available from: http://health.gov.ie/wp-content/uploads/2014/06/2014-Ireland-Plain-Pack-Main-Report-Final-Report-July-26.pdf.
17 Selda Ulucanlar.“Representation and Misrepresentation of Scientific Evidence in Contemporary Tobacco Regulation: A Review of Tobacco Industry Submissions to the UK Government Consultation on Standardised Packaging.” Available from: http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001629.
18 A Gilmore. “Standardised Tobacco Packaging Myths.” Available here:http://www.bath.ac.uk/research/case-studies/standardised-tobacco-packaging-myths.
19 At paragraph 6.2 Available from:http://www.kcl.ac.uk/health/10035-TSO-2901853-Chantler-Review-ACCESSIBLE.PDF.
20 The Post-Implementation Review is available from:https://ris.govspace.gov.au/2016/02/26/tobacco-plain-packaging/.
21 R (British American Tobacco & Ors) v. Secretary of State for Health [2016] EWHC 1169 (Admin). Available from: https://www.judiciary.gov.uk/wp-content/uploads/2016/05/bat-v-doh.judgment.pdf paragraphs 592 and 374.