Historically, lung cancer was a fairly rare disease. However, towards the end of the 19th century, widespread mechanisation and mass marketing of cigarettes caused a global lung cancer epidemic (Proctor, 2012). Now, Lung cancer is the third most common type of cancer in England, with 37237 new cases in 2020–totalling 12.9% of all new cases–and accounting for 20% of all cancer deaths (Broggio, 2022).

The relationship between big tobacco and lung cancer

The main cause of lung cancer is tobacco smoking and about 80-90% of lung cancers can be attributed to it. ‘300 UK deaths a day related to tobacco ‘ said Alison Cox, director of intelligence and clinical engagement at Cancer Research UK (Simpson, 2020). According to Professor Proctor, cigarette makers make about a penny for every cigarette they sell, meaning the life of a lung cancer patient is worth about $10,000 to cigarette makers (Proctor and Proctor, 2011). In this way, Imperial Tobacco and Japan Tobacco International, which control 80% of the UK cigarette and tobacco market, can earn more than 1 billion annually.

Big Tobacco is seeking to polish its image and diversify as countries clamp down on smoking | Money Sharma/AFP via Getty Images

The UK government has taken some actions

But lung cancer is also one of the most preventable cancers, and the best way to prevent lung cancer is to stop smoking as soon as possible (Parsons et al., 2010). In this context, the British government adopted the smoking ban and the Standardized Packaging of Tobacco Products Regulations in 2007 and 2015 respectively to control tobacco and protect public health. Furthermore, the UK government also set a goal in 2019 for England to be smokefree by 2030, which would mean that only 5% of the population will be smoking by then (Hopkinson, 2020).

Big tobacco’s retaliation

These measures have inevitably affected the interests of big tobacco companies. To mitigate the impact of these moves, these tobacco companies have also taken a variety of measures.

One of the strategies used by tobacco companies to weaken or prevent progress in tobacco control is to send gifts to those who may influence the passage of tobacco control laws to build positive relationships with policymakers, and finally modify advertising regulations (Olivia Maynard, 2015). Another common measure is investing a large amount of money in third-party front groups, such as foundations, to publish research that supports deceptive tobacco industry arguments (Legg et al., 2021). For example, Tobacco companies funded sceptics and ran advertisements in medical journals to alternate explanations for lung cancer, such as pollution, asbestos and even the keeping of birds (McGarity and Wagner, 2010). They are also working on developing new products, such as e-cigarettes, which they claim are extremely low risk to lung health. But in fact, this claim is quite controversial. Brown states that this product does not actually reduce nicotine addiction and can still deeply hurt lung health for people who never smoked (Brown et al., 2021).

One of the report authors, Prof Ann McNeill from King’s College London, said e-cigarettes could be a “game-changer” in public health.

Most ironically, these tobacco companies have invested in companies that work on lung health to improve their reputation. Philip Morris International (PMI), the maker of Marlboro cigarettes, bought a British respiratory drugs company, which has worked on treatments for lung cancer and some other diseases, for £1.04 billion in 2021 (Sweney, 2021). “It’s ironic that a tobacco company wants to invest in the lung health industry when their products are the biggest preventable cause of cancer, including lung cancer. If PMI wanted to help, they could stop aggressively promoting and selling their products altogether. ” said Michelle Mitchell, Cancer Research UK’s chief executive (Sweney, 2021).

There is still more we can do

The struggle between lung health and the tobacco industry is a continuing war. According to the World Health Organization Framework Convention on Tobacco Control, the UK’s tobacco control ranking declined from first to fourth last year (Simpson, 2020). In an independent report on tobacco control in England, Dr Javed concluded that without further action, England will miss the smoke-free 2030 target by at least 7 years (Khan, 2022).

To mitigate the effects of big tobacco on lung cancer and reach the goal of being smoke-free by 2030, there are two main types of steps that can be taken:

1. Strengthen measures to prevent and treat lung cancer

  • Increase awareness of the link between smoking and lung cancer, and encourage young people to avoid tobacco use.
  • Offer face-to-face smoking cessation counseling and checks, such as the Stop Smoking Service provided by National Health Service (NHS).
  • Invest in lung cancer research and alternative tobacco products while weighing the pros and cons of e-cigarettes.
  • Increase tobacco company taxes to reduce smoking rates and fund lung health and anti-smoking campaigns.

2. Protect health policy from interference by the tobacco industry

  • The UK and devolved governments must reaffirm their commitment to the International Framework Convention on Tobacco Control. Prohibit private interactions between government officials and the tobacco industry, strictly enforce advertising laws and the smoking ban, etc.
  • Scrutinize foundations, and researchers’ relationships with the tobacco companies, and indicate whether their published research is funded by the tobacco industry.



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