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      Public versus internal conceptions of addiction: An analysis of internal Philip Morris documents

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          Abstract

          Background

          Tobacco addiction is a complex, multicomponent phenomenon stemming from nicotine’s pharmacology and the user’s biology, psychology, sociology, and environment. After decades of public denial, the tobacco industry now agrees with public health authorities that nicotine is addictive. In 2000, Philip Morris became the first major tobacco company to admit nicotine’s addictiveness. Evolving definitions of addiction have historically affected subsequent policymaking. This article examines how Philip Morris internally conceptualized addiction immediately before and after this announcement.

          Methods and findings

          We analyzed previously secret, internal Philip Morris documents made available as a result of litigation against the tobacco industry. We compared these documents to public company statements and found that Philip Morris’s move from public denial to public affirmation of nicotine’s addictiveness coincided with pressure on the industry from poor public approval ratings, the Master Settlement Agreement (MSA), the United States government’s filing of the Racketeer Influenced and Corrupt Organizations (RICO) suit, and the Institute of Medicine’s (IoM’s) endorsement of potentially reduced risk products. Philip Morris continued to research the causes of addiction through the 2000s in order to create successful potentially reduced exposure products (PREPs). While Philip Morris’s public statements reinforce the idea that nicotine’s pharmacology principally drives smoking addiction, company scientists framed addiction as the result of interconnected biological, social, psychological, and environmental determinants, with nicotine as but one component. Due to the fragmentary nature of the industry document database, we may have missed relevant information that could have affected our analysis.

          Conclusions

          Philip Morris’s research suggests that tobacco industry activity influences addiction treatment outcomes. Beyond nicotine’s pharmacology, the industry’s continued aggressive advertising, lobbying, and litigation against effective tobacco control policies promotes various nonpharmacological determinants of addiction. To help tobacco users quit, policy makers should increase attention on the social and environmental dimensions of addiction alongside traditional cessation efforts.

          Abstract

          Using previously secret, internal Philip Morris documents from the early 2000s, Pamela M. Ling and colleagues find that the company's public statements on nicotine as the sole cause of smoking addiction were made in parallel with internal research characterizing addiction's interconnected biological, social, psychological, and environmental determinants.

          Author summary

          Why was this study done?
          • Tobacco companies publicly denied for decades that nicotine was addictive.

          • In 2000, Philip Morris became the first tobacco company to publicly state that nicotine is addictive.

          • Today, addiction is understood as a complex phenomenon resulting from both the pharmacology of the addictive substance and the user’s biology, psychology, social milieu, and environment.

          • The tobacco industry avidly promotes new nicotine products, emphasizing that nicotine addiction is the key driver of smoking.

          • Little is known about how tobacco companies internally understood addiction as they changed their public position.

          What did the researchers do and find?
          • We examined previously secret internal Philip Morris documents and public company statements and traced Philip Morris’s internal understanding of addiction from the mid-1990s until 2006.

          • We found that Philip Morris’s shift from denying to affirming nicotine’s addictiveness was driven by public, regulatory, and legal pressures, not by a substantive change in scientific understanding.

          • Philip Morris continued studying addiction through the 2000s to develop successful and potentially safer nicotine products.

          • From the mid-1990s to at least 2006, Philip Morris’s internal models of addiction positioned psychological, social, and environmental factors as equally important to nicotine in driving cigarette use.

          What do these findings mean?
          • Philip Morris’s public embrace of nicotine as the main driver of addiction bolsters the case for tobacco harm reduction but likely does not accurately reflect the company’s internal understanding of addiction.

          • Philip Morris has internally understood since at least 2006 that its actions (e.g., advertising, lobbying, and litigation) influence addiction by shaping users’ psychology, social milieu, and environment.

          • Philip Morris’s public embrace of nicotine’s addictiveness currently works to redirect policy away from proven social and environmental interventions and toward the promotion of the industry’s potentially reduced harm products.

          • To improve addiction outcomes, public health authorities should continue expanding and strengthening social and environmental restrictions on cigarette smoking.

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          Most cited references69

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          Neurobiologic Advances from the Brain Disease Model of Addiction.

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            Addiction Is a Brain Disease, and It Matters

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              • Article: not found

              Addiction is a brain disease, and it matters.

              Scientific advances over the past 20 years have shown that drug addiction is a chronic, relapsing disease that results from the prolonged effects of drugs on the brain. As with many other brain diseases, addiction has embedded behavioral and social-context aspects that are important parts of the disorder itself. Therefore, the most effective treatment approaches will include biological, behavioral, and social-context components. Recognizing addiction as a chronic, relapsing brain disorder characterized by compulsive drug seeking and use can impact society's overall health and social policy strategies and help diminish the health and social costs associated with drug abuse and addiction.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Writing – review & editing
                Role: Formal analysisRole: Funding acquisitionRole: MethodologyRole: ResourcesRole: SupervisionRole: ValidationRole: Writing – review & editing
                Role: Academic Editor
                Journal
                PLoS Med
                PLoS Med
                plos
                plosmed
                PLoS Medicine
                Public Library of Science (San Francisco, CA USA )
                1549-1277
                1549-1676
                1 May 2018
                May 2018
                : 15
                : 5
                : e1002562
                Affiliations
                [1 ] Center for Tobacco Control Research and Education, University of California, San Francisco, San Francisco, California, United States of America
                [2 ] UCSF Department of Medicine, Division of General Internal Medicine, San Francisco, California, United States of America
                University of New South Wales, AUSTRALIA
                Author notes

                The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0002-3250-3329
                http://orcid.org/0000-0002-1714-6132
                http://orcid.org/0000-0001-6166-9347
                Article
                PMEDICINE-D-17-03958
                10.1371/journal.pmed.1002562
                5929514
                29715300
                d02c85fd-2496-45ac-9520-b3ec27926a7e
                © 2018 Elias et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 6 November 2017
                : 28 March 2018
                Page count
                Figures: 2, Tables: 0, Pages: 18
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/100000054, National Cancer Institute;
                Award ID: R01 CA 87472
                Funded by: funder-id http://dx.doi.org/10.13039/100000054, National Cancer Institute;
                Award ID: R01-CA-141661
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/100000054, National Cancer Institute;
                Award ID: CA 113710
                Award Recipient :
                This research was supported by the National Cancer Institute Grants R01-CA-087472, R01-CA-141661, and T32-CA-113710. The funder website is: https://www.cancer.gov/. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Biology and Life Sciences
                Psychology
                Addiction
                Nicotine Addiction
                Social Sciences
                Psychology
                Addiction
                Nicotine Addiction
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Substance-Related Disorders
                Nicotine Addiction
                Medicine and Health Sciences
                Public and Occupational Health
                Substance-Related Disorders
                Nicotine Addiction
                Biology and Life Sciences
                Behavior
                Habits
                Smoking Habits
                Biology and Life Sciences
                Psychology
                Addiction
                Social Sciences
                Psychology
                Addiction
                Physical Sciences
                Chemistry
                Chemical Compounds
                Alkaloids
                Nicotine
                Medicine and Health Sciences
                Pharmaceutics
                Drug Therapy
                Neurological Drug Therapy
                Anti-Addiction Drug Therapy
                Nicotine Replacement Therapy
                Biology and Life Sciences
                Psychology
                Addiction
                Behavioral Addiction
                Social Sciences
                Psychology
                Addiction
                Behavioral Addiction
                Biology and Life Sciences
                Agriculture
                Agronomy
                Plant Products
                Tobacco
                Biology and Life Sciences
                Agriculture
                Crop Science
                Plant Products
                Tobacco
                Medicine and Health Sciences
                Public and Occupational Health
                Custom metadata
                All the documents are freely publicly available on the UCSF Truth Industry Documents website: https://www.industrydocumentslibrary.ucsf.edu/tobacco.

                Medicine
                Medicine

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