Countering Industry Arguments Against Plain Packaging: No Evidence Plain Packaging Will Work

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Plain tobacco packaging was extended to the UK and Ireland in May 2016,[1][2] three and a half years after it was first introduced in Australia in December 2012.[3] France is due to follow suit in January 2017[4] and Bulgaria, Canada, Finland, Hungary, New Zealand, Norway, Singapore, South Africa, Sweden and Turkey are also formally considering the measure.[5]

As with other tobacco control measures, the tobacco industry have consistently argued that there is no evidence to show that plain packaging works; have sought to raise the required standard of evidence to include ‘real-world’ evidence pre-implementation; and have used public consultations as an opportunity to present their own commissioned evidence to governments.[6]

This page recounts the tobacco industry’s historical tactic of using evidence to oppose tobacco control policy and the importance they place on branding and packaging as marketing tools. It then describes the shortcomings of tobacco industry evidence on plain packaging and describes the growing body of public health evidence prior to and following the policy’s implementation in Australia.

Tobacco Industry Use of Evidence to Oppose Policy

The tobacco industry’s attempts to deny the evidence, even when evidence exists, is a tactic aimed at influencing public opinion. Placing this argument in the public domain creates a level of doubt which permeates even when credible evidence is presented to the contrary. This tactic has been used to oppose earlier policies (such as advertising bans and smoke-free legislation) which were strongly associated with positive health outcomes and reductions in health inequalities.[7][8][9][10][11][12][13][14] [15][16]

Insisting on real world evidence before regulating, as the tobacco industry has argued in the case of plain packaging,[6] would effectively place a block on all new laws likely to promote public health and welfare, irrespective of advances in scientific knowledge.

In opposing plain packaging, the tobacco industry has used the principles and processes (public consultations and impact assessments) of Better Regulation to support its argument that there is insufficient evidence to support the implementation of the policy.[17] Better Regulation was lobbied for by the industry and requires risks, costs and benefits to be weighed against one another before new regulatory burdens are placed on businesses. [18][19][20]

Flawed Tobacco Industry Evidence

Australia – Critique of Tobacco Industry Graphic Health Warnings Research

A report by Deloitte (2011), commissioned by BAT, suggested that health warnings on cigarette packets had not been successful in reducing cigarette consumption and therefore plain packaging was unlikely to be effective.[21] However, Cancer Council Victoria (Australia) reviewed the analyses forming the basis of this conclusion and found the methodology weak in several respects.[22] For instance, Deloitte made an error in their analysis by starting it in 1990, whereas health warnings were introduced in 1987. In addition to this error, the data used were not actually consumption data but rather duty paid shipment volumes. It has been reported that duty paid does not necessarily amount to consumption because in some years cigarettes are over-produced and surplus is often kept in storage until needed.[23] Looking only at BAT brands, Deloitte concluded that volumes did not decline any more steeply than normal. However, when data on all duty paid tobacco products was assessed, Cancer Council Victoria reported that excise and customs duty declined more than would be predicted following the introduction of health warnings.[22]

UK – Critiques of Industry Evidence that Plain Packaging Will Not Work

Peer-reviewed research has shown how global tobacco companies commissioned, cited and critiqued evidence as part of a campaign to prevent the introduction of plain packaging for their products in the UK.[6][24][25][26]

Tobacco companies used this strategy to argue that plain packaging “won’t work”. Evidence to support this claim was promoted through the media and in submissions to government.

This strategy was examined in a series of peer-reviewed research papers, which highlighted the misleading nature of tobacco companies’ evidence on plain packaging, emphasising that:

  • Tobacco companies cited evidence that did not directly consider plain packaging to argue that regulation “won’t work”;[6]
  • Evidential critiques commissioned by tobacco companies used misleading techniques to discredit public health research on plain packaging;[24]
  • Quoted statistics on illicit tobacco were over-estimated to exaggerate the risks of the policy.[25][26]

The Importance of Branding and Packaging to the Tobacco Industry

Despite the tobacco industry’s claims that plain packaging will not work because packaging is not important to marketing, internal industry documents show how important tobacco branding is, with innovations (packaging and product) leading to a 10% increase in market share for BAT in 2011.[27] Internal industry documents reveal a long held understanding by the tobacco industry that cigarette packets and tobacco pouches represent mobile advertisements. One Rothmans document from 1982, for example, stated that the company was:

"very aware that every customer carries the Rothmans logo, on the package, with him or her all the time. That package comes out many times a day, and every time it is seen makes a personal comment about the person who carries and shows it."[28]

In 1994, Philip Morris said:

“In the absence of any other marketing messages, our packaging -- comprised of [sic] the trademark, our design, color [sic] and information -- is the sole communicator of our brand essence. Put another way -- when you don't have anything else -- our packaging is our marketing."[29]

The tobacco industry claims that cigarette packaging has no bearing on people’s smoking behaviour, however advertising works for every other industry. The tobacco industry has long argued that tobacco advertising is aimed at building brand loyalty, not trying to persuade young people to smoke or smokers to continue and not quit. However, others within the advertising industry have disputed this categorically.

Advertising executive Emerson Foote, former Chairman of the Board of McCann-Erickson, which handled $20 million in tobacco account sales, argued that:

"The cigarette industry has been artfully maintaining that cigarette advertising has nothing to do with total sales. This is complete and utter nonsense. I am always amused by the suggestion that advertising, a function that has been shown to increase consumption of virtually every other product, somehow miraculously fails to work for tobacco products."[30]

In 2004, BAT acknowledged packaging innovations as the reason for the increased success of their Dunhill brand: “In Australia and Taiwan, the continued success of the new packaging led to increased volumes of 7 per cent and 20 per cent respectively”.[31]

Global – Pre-Implementation Evidence For Plain Packaging

Prior to the implementation of plain packaging in Australia a large volume of peer-reviewed research supported the measure. The research showed that when branding is removed from tobacco packaging, health warnings are more salient[32][33] packs appear less attractive and of a lower quality, and there is less confusion about the relative harm from different brands, e.g. Marlboro gold packs are viewed as less harmful than Marlboro red packs.[32][22] Furthermore, a number of studies evaluated in a systematic review for the UK Department of Health found that cigarette packaging influences children and is an important consideration in children’s smoking behaviour.[32] A few examples of studies included in the systematic review are:

  • A study of school children in Canada and the US found that the majority of children, when asked, would prefer to take home a branded rather than a plain cigarette pack as the plain pack was "ugly" and "boring".[34][35][36]
  • A Scottish study found that amongst 10-17 year olds, plain cigarette packs were seen by the majority as "unattractive", "uncool" and "a pack you would not like to be seen with".[37]

Prior to the implementation of the policy in the UK and Ireland, two plain packaging evidence reviews by both the UK (the Chantler Review), and Irish Governments (the Hammond Review) concluded that that this population-scale measure is likely to be effective in reducing youth uptake of smoking. For example, in the UK, Sir Cyril Chantler’s review concluded that:

“Having reviewed the evidence it is in my view highly likely that standardised [plain] packaging would serve to reduce the rate of children taking up smoking and implausible that it would increase the consumption of tobacco. I am persuaded that branded packaging plays an important role in encouraging young people to smoke and in consolidating the habit irrespective of the intentions of the industry. Although I have not seen evidence that allows me to quantify the size of the likely impact of standardised packaging, I am satisfied that the body of evidence shows that standardised packaging, in conjunction with the current tobacco control regime, is very likely to lead to a modest but important reduction over time on the uptake and prevalence of smoking and thus have a positive impact on public health.”[38]

While the Hammond Review, commissioned by the Irish Government, concluded:

“The evidence indicates that tobacco packaging is a critically important form of tobacco promotion, particularly in jurisdictions with comprehensive advertising and marketing restrictions, such as Ireland. The evidence indicates that plain packaging reduces false beliefs about the risks of smoking, increases the efficacy of health warnings, reduces consumer appeal among youth and young adults, and may promote smoking cessation among established smokers.

Overall, there is very strong evidence that plain packaging would be effective in regards to four of Ireland’s specific policy objectives:

  • Prevent non-smokers including children and young people from starting to smoke;
  • Encourage, motivate and support current smokers to quit;
  • Reduce recidivism rates among those who have quit;
  • Limit the societal impacts of smoking and protect society, especially those under 18 years, from the marketing practices of the tobacco industry.”[39]

Australia – Early Evidence that Plain Packaging Works

Following the introduction of plain packaging in Australia in December 2012, calls to Quitline increased,[40] individual pack display decreased,[41] cigarette sales fell 3.4%,[42] there was no increase in transaction times, no defection to larger stores to make tobacco purchases, and no impact on the illicit trade.[43][44][45]

These early policy outcomes contradicted the claims made by tobacco companies in the UK, and complement the Tobacco Control Research Group’s research, which has raised serious questions about the trustworthiness and scientific value of tobacco companies’ arguments that plain packaging “won’t work”.

Australia – Evidence from the Post-Implementation Tobacco Plain Packaging Evaluation

In order to monitor the outcomes of the 2011 Tobacco Plain Packaging Act, in 2012 the Australian Department of Health commissioned a National Monthly Tobacco Plain Packaging Tracking Survey of the early effects of plain packaging on adolescents. Findings were reported in several studies published in a special issue of Tobacco Control. A Post-Implementation Review of Tobacco Plain Packaging was also published in 2016.

Results of Australia’s National Monthly Tobacco Plain Packaging Tracking Survey

Four hundred smokers and recent quitters were surveyed every four weeks between April 2012 and March 2014, with a follow up survey in May 2014. Post-implementation plain packaging legislation:

  • Reduced appeal of packs[46];
  • Increased health warning effectiveness;[46]
  • Corrected some misperceptions of harms;[46]
  • Increased rates of quitting cognitions and quit attempts.[47]

Evaluation of the Effects of Plain Packaging on Australian Adolescents

A 2013 evaluation survey examined the impact of plain tobacco packaging and enhanced graphic health warnings on adolescents’ perceptions of pack images, brand differences and on their cognitive processing. Comparisons of results from 2011 and 2013 showed that:

  • The appeal of cigarette packs and brands to Australian adolescents decreased significantly;[48];
  • Acknowledgement of negative health effects of smoking among Australian adolescents remained high; but, apart from bladder cancer, new requirements for packaging and health warnings did not increase adolescents cognitive processing of warning information;[49].

Post-Implementation Review of Tobacco Plain Packaging in Australia

In 2016, in the Post-Implementation Review of Tobacco Plain Packaging, the Australian Department of Health linked the introduction of tobacco plain packaging with a reduction in daily smoking prevalence:

“The 2013 NDSHS collected data from nearly 24,000 people across Australia from 31 July to 1 December 2013, (notably, after the introduction of the tobacco plain packaging measure and mostly before the first of a series of four 12.5% tobacco excise increases on 1 December 2013). The results of the 2013 NDSHS show that daily smoking prevalence among Australians aged 14 years and over has fallen significantly from 15.1% in 2010 to 12.8% in 2013, a drop of 15%. This included declines in all Australian states and territories (except Tasmania).”[50]

Tobacco Industry Response to the Australian Post-Implementation Review (PIR)

Philip Morris Limited (PMI) made a submission to the PIR[50] consultation which raised concerns about the PIR process.[51] The submission sought to widen the scope of the Review beyond the impacts on smoking prevalence and the denormalising effects of plain packaging. It asserted that a ‘compliant’ PIR would need to include a ‘cost-benefit analysis’ of the policy which includes consideration of any impact on the illicit tobacco trade and on the structure of the tobacco market. The PMI submission cited a KPMG report on illicit tobacco in Australia.[52] Earlier reports from this source has previously been rejected by the Australian Borders and Customs Agency and per-reviewed research, which maintains there has been no impact on the illicit trade.[53][44] [45]

Similarly replicating previous tactics, Japan Tobacco International (JTI)’s press release following the release of Australia’s PIR[54] questioned the credibility of the analysis.[55]

Countering Industry Arguments Against Plain Packaging

TobaccoTactics Resources

TCRG Research

Notes

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