Abstract

Background: It is well known that the tobacco industry has placed articles in scientific literature to maintain controversy over the dangers of tobacco use, while claiming that smokers are well-informed about risk. This study illuminates an industry attempt to directly undermine popular understanding of the hazards of smoking using an industry-created organization called Associates for Research in the Science of Enjoyment (ARISE). Methods: Searches of tobacco industry documents contained in the Legacy Tobacco Documents Library, British American Tobacco Documents Library, and British Columbia's Tobacco Industry documents were performed as well as searches of the LexisNexis database for news articles on ARISE published between 1989 and 2005. Qualitative analysis focused on industry motives, media strategies, and rhetorical tactics; quantitative content analysis focused on media coverage. Results: Between 1989 and 2005, at least 846 articles appeared in the European, Australian, and US press mentioning ARISE, its members, or its activities. Many of these articles presented two themes: smoking was a healthful ‘pleasure’, and health promotion practices, including cessation, were stressful and unhealthy. Few articles included responses from health advocates, questioned ARISE's claims, or mentioned its funding. Conclusions: ARISE successfully planted stories in the press, designed to allay the health concerns of smokers and to discredit health promotion information and practices. ARISE's later interest in food suggests that counterfactual ‘health’ messages on almost any topic could be promoted similarly, regardless of their implausibility.

Tobacco use causes millions of deaths worldwide.1 Previous research has demonstrated how, in its effort to encourage smoking, the tobacco industry has attempted to inject ‘doubt’ about the harms of tobacco use into the scientific literature.2–10 Less has been written about similar efforts directed towards the popular press.11 This study examines the industry front group ARISE, Associates for Research in the Science of Enjoyment, which used mass media to promote the healthfulness of tobacco use throughout the 1990s. Although ARISE was recently criticized in the press,12 no in-depth analysis of the organization has been done.

Risk perception and media influence

While acknowledging that smokers are at greater risk than non-smokers for certain diseases, adult13 and adolescent14 smokers frequently minimize their personal risk. Smokers also regard smoking as less risky than do non-smokers.15 Those who believe that the harm of smoking has been exaggerated and underestimate their personal risk are less likely to make quit attempts16 or identify cessation as a way to reduce cancer risk.17 Mass media contributes to the tobacco disease epidemic by minimizing the harms of tobacco use, glamorizing smoking, and supporting tobacco industry political arguments.18–25 News coverage about smoking and health issues correlates with cessation rates: when news coverage emphasizes scientific consensus about smoking hazards, smoking cessation rates increase; when smoking hazards are presented as ‘controversial’, they decline.26

The tobacco industry and ‘informed’ smokers

The tobacco industry claims that it should not be held responsible for tobacco-related diseases, as smokers are well informed about the risks of smoking through warning labels27,28 and common knowledge.29–31 Health advocates have questioned how informed smokers are.32 This study illuminates an industry attempt to place false information in the news media about the hazards of smoking.

Methods

Millions of internal tobacco industry documents have been made public as a result of litigation.33 These documents were accessed online via the Legacy Tobacco Documents Library (), the British American Tobacco Documents Library (), and British Columbia's Tobacco Industry documents (), with searches ending in May 2006. Documents were selected using a ‘snowball’ sampling method, beginning with broad search terms (‘ARISE’, names of ARISE members) and then using more specific search terms (such as file names and reference numbers) found in retrieved documents. Approximately 400 documents, dated between 1976 and 1999, were retrieved and assembled into a chronologically constructed case study.34,35

The LexisNexis US, European, and Asian/Pacific news databases were searched, using the terms ‘science of enjoyment’ and names of known ARISE spokespeople; 279 articles were found. An additional 567 unique newspaper articles were retrieved from the tobacco documents databases, collected by industry clipping services. (A single ‘document’ in the industry databases can contain multiple clippings; thus, the number of documents found is smaller than the number of articles.) All articles were coded by the author for year, country, context of ARISE mention (e.g. ARISE research or event, ARISE member focus, Christmas/New Year, other research), funding source mentioned (tobacco, alcohol, food, other industry, or none), specific harms of smoking mentioned (cancer, heart disease, lung disease, general unfitness), and characterizations of tobacco (pleasure, indulgence, risky, harmful, safe) and of health promotion (puritan, anti-democratic, helpful/healthy, contradictory, misinformed); results were analysed with descriptive statistics.

The coding system was developed inductively; perusal of some items suggested recurring themes, which were then added to the coding schema. Because of the multiplicity of languages, the system was concrete, e.g. counting the appearance of words and phrases. English translations and summaries of some of the articles, automatic translation available on the Internet, repetition across articles of paragraphs and quotations, and duplication of entire articles by different newspapers facilitated coding. No attempt was made to determine conceptual framing or overall position of articles.

This study has limitations. The sheer size and poor indexing of the document databases means that some relevant documents may not have been retrieved. Some documents may have been destroyed or concealed by the tobacco companies;36 others may have never been obtained in the legal discovery process. ARISE was active primarily in the UK, Europe, and Australia, and supported by some companies not involved in litigation (e.g. Rothmans). The document collections were obtained in response to US-based litigation; thus, it is likely that some relevant documents are not available. Methodological issues pertaining to tobacco documents research have been explored in other work.33,37,38 The tobacco industry archives revealed that ARISE activities were covered by Spanish, Italian, French, Belgian, German, Dutch, and Scandinavian media. LexisNexis has a limited collection of sources in these languages, so data from media in languages other than English may be less comprehensive.

Some of the clippings counted here were in languages unreadable to the author (e.g. Chinese and Greek; N = 44); frequently English summaries or translated headlines were provided by industry clipping services, but much about these articles is unknown. Translated articles and articles from Hong Kong and Greece originally in English do not suggest any substantive variations. A few items were illegible reproductions. Thus all statistics represent the minimum number of possible occurrences.

Results

ARISE origins

The specifics of the origins of ARISE are unknown. Tobacco industry documents referring retrospectively to ARISE report that it was a response39 to the 1988 US Surgeon General's report declaring nicotine to be addictive.40 The stated organizational goal was to ‘separate nicotine’ from substances of addiction and abuse.39 A 1994 Philip Morris (PM) document identified the organization's objectives as developing ‘scientific research into the enjoyment of products that give pleasure’(e.g. coffee, tea, alcohol, and chocolate), presenting such research ‘objectively’, contributing ‘to the social acceptability debate’, and disseminating findings to ‘a wide audience, including the public’.39 ARISE originally stood for ‘Associates for Research in Substance Enjoyment’41,42; however, ‘substance’ evoked associations with ‘substance abuse’, placing tobacco ‘dangerously close to heroine [sic]’,43 a PM employee noted. The 1994 name change to ‘Science of Enjoyment’ was considered ‘a positive step’ by ARISE spokesman David Warburton and by a Rothmans public affairs manager.44

Warburton is identified in industry documents and news reports as the ‘founding’ member of ARISE.45 A professor of human psychopharmacology at the University of Reading, Warburton was a long-time industry consultant,46–48 wrote scientific reports on the (positive) effects of nicotine49 for the industry and for publication,50–53 and is named as a contributor in the 1988 US Surgeon General's report 40 (though he denied nicotine's addictiveness).54 Warburton and another ARISE member published a paper on smokers' optimism regarding their health risks.55 Some ARISE members, such as Ian Hindmarch56 were industry consultants prior to ARISE's formation, while others joined later (Table 1).57,58

Table 1

ARISE participants named in tobacco industry documents or news accounts

Participant Affiliation 
Vittorino Andreolia Psychiatry, Ospedale Civile de Soave (Italy) 
Digby Anderson Social Affairs Unit, London (UK) 
Dale Atrensa Psychology, University of Sydney (Australia) 
Gary Beauchamp Monell Chemical Sense Center (US) 
David Benton Psychology, University of Wales (UK) 
Keith Botsford Journalism, Boston University (US) 
Michael Bozarth Psychology, State University of New York (US) 
Michel Cabanac Physiology, Laval University (Canada) 
Bruce Charlton Epidemiology, University of Newcastle (UK) 
Anthony J. Cleare Kings College School of Medicine (UK) 
Angela Clow Psychophysiology, University of Westminster (UK) 
Jean-Pierre Dauwalder Psychology, University of Lausanne (Switzerland) 
J. Christie Davies Sociology, University of Reading (UK) 
John Davis Psychology, University of Strathclyde (UK) 
Philip D. Evans Psychophysiology, University of Westminster (UK) 
Timothy Evans Political Sociology, Adam Smith Institute (UK) 
Sherwin Feinhandler Social Systems Analyst (US) 
Claude Fischler École des Hautes Études en Sciences Sociales, (France) 
Faith Fitzgeralda Medicine, University of California, Davis, (US) 
Marianne Frankenhaeuser Psychology, University of Stockholm 
Chris Gratton Economics, Sheffield Hallam University (UK) 
Ian Hindmarcha Psychopharmacology, University of Surrey (UK) 
Simon Holliday Economics, Sheffield Hallam University (UK) 
Frank Hucklebridge Psychophysiology, University of Westminster (UK) 
Claude Javeau Sociology, University Libre du Bruxelle (Belgium) 
Klaus Jung Internal & Sports Medicine, University of Mainz (Germany) 
Verner Knott Alcohol & Drug Dependence Unit, Ottawa (Canada) 
Gerd Kobal Physiology, University of Erlangen (Germany) 
Brian Leonard Psychopharmacology, University College Galway (Ireland) 
Harvey Levenstein History, McMaster University (Canada) 
Geoff Lowea Psychology, University of Hull, (UK) 
John Luika Philosophy, Niagara Institute (Canada) 
Jean-François Malherbe Philosophy, Sherwood University (Canada) 
Bob McBridea Sensometrics, Mosman (Australia) 
James McCormicka Community Medicine, Trinity College (Ireland) 
Frank McKenna Psychology, University of Reading (UK) 
Petra Nettera Psychology, University of Geissen (Germany) 
Philip Norrie Writer/Physician 
Alberto Oliverioa Psychology & Pharmacology, National Research Center, Italy 
Michael Robbins Anthropology, University of Missouri—Columbia 
Peter Rogers Institute of Food Research (UK) 
Paul Rozin Psychology, University of Pennsylvania (US) 
Neil Sherwooda Psychopharmacology, University of Surrey (UK) 
Andy Smith Health Psychology, University of Bristol (UK) 
Philip Snaith Psychiatry, University of Leeds (UK) 
Jan Snel Psychology, University of Amsterdam (The Netherlands) 
Hera Tsimara-Papastamatiou Pathology, University of Athens (Greece) 
Frank van Dun Philosophy of Law, University of Ghent (The Netherlands) and University of Maastricht (Belgium) 
Steve Van Toller Psychology, University of Warwick (UK) 
David Warburtona Psychology, University of Reading (UK) 
Simon C. Wessely Kings College School of Medicine (UK) 
Participant Affiliation 
Vittorino Andreolia Psychiatry, Ospedale Civile de Soave (Italy) 
Digby Anderson Social Affairs Unit, London (UK) 
Dale Atrensa Psychology, University of Sydney (Australia) 
Gary Beauchamp Monell Chemical Sense Center (US) 
David Benton Psychology, University of Wales (UK) 
Keith Botsford Journalism, Boston University (US) 
Michael Bozarth Psychology, State University of New York (US) 
Michel Cabanac Physiology, Laval University (Canada) 
Bruce Charlton Epidemiology, University of Newcastle (UK) 
Anthony J. Cleare Kings College School of Medicine (UK) 
Angela Clow Psychophysiology, University of Westminster (UK) 
Jean-Pierre Dauwalder Psychology, University of Lausanne (Switzerland) 
J. Christie Davies Sociology, University of Reading (UK) 
John Davis Psychology, University of Strathclyde (UK) 
Philip D. Evans Psychophysiology, University of Westminster (UK) 
Timothy Evans Political Sociology, Adam Smith Institute (UK) 
Sherwin Feinhandler Social Systems Analyst (US) 
Claude Fischler École des Hautes Études en Sciences Sociales, (France) 
Faith Fitzgeralda Medicine, University of California, Davis, (US) 
Marianne Frankenhaeuser Psychology, University of Stockholm 
Chris Gratton Economics, Sheffield Hallam University (UK) 
Ian Hindmarcha Psychopharmacology, University of Surrey (UK) 
Simon Holliday Economics, Sheffield Hallam University (UK) 
Frank Hucklebridge Psychophysiology, University of Westminster (UK) 
Claude Javeau Sociology, University Libre du Bruxelle (Belgium) 
Klaus Jung Internal & Sports Medicine, University of Mainz (Germany) 
Verner Knott Alcohol & Drug Dependence Unit, Ottawa (Canada) 
Gerd Kobal Physiology, University of Erlangen (Germany) 
Brian Leonard Psychopharmacology, University College Galway (Ireland) 
Harvey Levenstein History, McMaster University (Canada) 
Geoff Lowea Psychology, University of Hull, (UK) 
John Luika Philosophy, Niagara Institute (Canada) 
Jean-François Malherbe Philosophy, Sherwood University (Canada) 
Bob McBridea Sensometrics, Mosman (Australia) 
James McCormicka Community Medicine, Trinity College (Ireland) 
Frank McKenna Psychology, University of Reading (UK) 
Petra Nettera Psychology, University of Geissen (Germany) 
Philip Norrie Writer/Physician 
Alberto Oliverioa Psychology & Pharmacology, National Research Center, Italy 
Michael Robbins Anthropology, University of Missouri—Columbia 
Peter Rogers Institute of Food Research (UK) 
Paul Rozin Psychology, University of Pennsylvania (US) 
Neil Sherwooda Psychopharmacology, University of Surrey (UK) 
Andy Smith Health Psychology, University of Bristol (UK) 
Philip Snaith Psychiatry, University of Leeds (UK) 
Jan Snel Psychology, University of Amsterdam (The Netherlands) 
Hera Tsimara-Papastamatiou Pathology, University of Athens (Greece) 
Frank van Dun Philosophy of Law, University of Ghent (The Netherlands) and University of Maastricht (Belgium) 
Steve Van Toller Psychology, University of Warwick (UK) 
David Warburtona Psychology, University of Reading (UK) 
Simon C. Wessely Kings College School of Medicine (UK) 

a: ARISE spokesperson

Organizational control

Although ARISE was putatively funded by multiple industries,59,60 it apparently received primarily tobacco industry support. ARISE financial supporters for the budget year 1993–1994 included tobacco companies British American Tobacco (BAT), Gallaher, Philip Morris International (PMI), Rothmans, and R.J. Reynolds (RJR).61 Coca-Cola, International HORECA (Hotel, Restaurant & Café Association—a frequent tobacco industry collaborator)62 and a coffee industry organization were also listed. However, tobacco company contributions for that year accounted for >99% of the $300 400 budget.61 The 1994–1995 budget, over $770 000, also appears to have been 99% tobacco money.61

The tobacco companies also solicited contributions from such alcohol and food-related companies and organizations as Miller Beer and Kraft Jacobs Suchard (subsidiaries of Philip Morris), ‘a consortium of European alcohol manufacturers’,39,63 the UK Chocolate Society,58 the European Advertising Agencies Association, and Nestle.39 It is unknown what amounts these organizations gave.

PM and Rothmans controlled the ARISE budget. Any changes to ARISE budget plans were to be referred to a Rothmans employee,64 and ‘[m]ajor spending authorization and approval’ were to come from a ‘Budget Committee involving PM, Rothmans and possibly RJR and BAT’. 61

Activities

Between 1989 and 1999, ARISE's primary activities were conferences and opinion poll research.64 ARISE conferences were held in Florence (1989),39 Venice (1991),65 Brussels (1993),66 Amsterdam (1995),67 Rome (1997),68 and Kyoto (1999).69 Opinion polls on relaxation and pleasure (1993),39 workplace stress (1994),70 pleasure and guilt (1996),71 and the ‘pleasure quotient’ (1998),72 were conducted in Europe, the US, and Australia. Polls asked respondents about their means of relaxation, including smoking, consuming other substances, and activities such as exercise, reading, and bathing. ARISE performed an analysis of international dietary guidelines in1997.73 The conferences and reports were extensively publicized in mainstream news.74 In addition, ‘opportunistic’ publicity efforts took place at Christmas and/or New Year.75

Message

ARISE's message was that ‘a little of what you fancy can do you good’.76–78 This message had three components. First, ‘a little’—or moderation—was emphasized, although when asked to define ‘moderation’, Warburton replied that ‘each individual determines for themselves what is best for them … [so] they can enjoy the benefits without causing problems for themselves.’79 The second concept was ‘what you fancy’. In this locution, people did not smoke because they were addicted, but rather as a ‘treat’80 or ‘indulgence’.81

Finally, ‘can do you good’ declared that smoking was not just safe but beneficial. The primary explanation for this claim was that ‘moderate enjoyment’82 gave people a ‘higher quality of life’, which in turn ‘actually promotes a longer life’.79 Warburton asserted in at least 59 news stories between 1993 and 1998 that ‘There is clear scientific evidence that spoiling ourselves with, say, a glass of wine, a cup of coffee, a cigarette or a few pieces of chocolate makes people calmer, more relaxed and generally happier’.83,84

ARISE expanded this technique in 1997 with its study of international nutritional guidelines.73 Warburton concluded that they were so variable ‘as to appear arbitrary’.73 Rather than attempting to strictly adhere to such guidelines, Warburton, like many nutritionists,85 suggested ‘moderate consumption of a variety of foods’.86 However, he included ‘a cigarette’ in his description of this balanced but varied diet.87

An additional message was that health promotion advice or practices could result in ill health.45 Because pleasure ‘increased immune competence’, denying oneself pleasure—through dieting or cessation—could render one more susceptible to disease.76,88 One ARISE member endorsed the idea that ‘the stress associated with health fads is likely to bring on cancer’.65

ARISE also claimed that the guilt invoked by health campaigns was unhealthy. Numerous articles suggested that it was unwise to ‘deprive yourself of your favourite treat in a New Year's resolution’, as the guilt resulting from broken resolutions would do ‘more harm than good’.89 More explicitly, Warburton claimed in this context that ‘Any research scientist will tell you that if you load yourself down with shame and stress, you are more likely to die young. It is a scientific fact.’ He further asserted that the stress of keeping resolutions had the same effect.60

When directly challenged about the health hazards of tobacco, Warburton remarked, ‘It's interesting how few people die from smoking. Most smokers live to a ripe old age. Don't forget, the death rate for smokers and non-smokers is the same in the end—100 percent’ [emphasis in original].88 Fatalism was another ARISE rhetorical strategy. ARISE spokespeople recommended that ‘people should live a life of moderate hedonism, so that they can live to the full the only life they are ever likely to have’.90 An ARISE representative claimed that ‘Two-thirds of those people that die from smoking-related disorders … die over the age of 70’.79 Thus death due to ‘pleasure’ came ‘at the end of a life that has been, for the most part, pleasurable’.79

Referencing ‘science’ gave ARISE's claims ‘added credibility,’91 according to an internal PM presentation. Though Warburton and other ARISE representatives used phrases such as ‘statistics’,79 ‘scientific evidence’,78,92 and ‘scientific fact’,60 the only supporting studies ever identified were the ARISE public opinion polls. The organization also attempted to affiliate itself with other respected institutions. For example, the 1995 ARISE meeting was introduced by a Director at the World Health Organization.90

One attempt to borrow credibility was contested. In the Italian press, the 1993 poll was frequently presented as being a joint effort of ARISE and the CNR (National Research Council). However, the CNR's president objected to the results, saying that ‘a cigarette is not like a coffee’. ‘The pleasure of smoking a cigarette is not enough to justify smoking’, he went on, calling Warburton's contrary conclusion ‘a mistake’. 76 The majority of stories in the Italian press failed to mention this dispute. An Italian radio broadcast referred vaguely to the ‘reaction’ from Italian scientists but concluded, ‘it's all in the measure. Enjoy the small pleasures, but use judgment.’79 This was precisely the ARISE message.

PM believed the ARISE message had several advantages. First, it was easy for the media to understand and disseminate.91 Unlike the results of actual scientific research, which are often equivocal or complex, the ARISE message—that ‘products of enjoyment’ could improve health—was simple. The ARISE message also ‘gives customers reassurance’91—e.g. health concerns did not require them to quit smoking. The academic membership of ARISE (Table 1) gave the story ‘a recognised scientific base’.91 And finally, PM noted, ‘the message has universal appeal’,91 as it promised effortless health. In addition, the fact that ARISE statements contradicted all other scientific research regarding smoking made it ‘as tempting as a cream cake for news media’, a Canadian journalist noted.74 Multiple articles suggested excitement or relief over the apparent reversal in health advice, featuring headlines such as ‘Smoking and drinking do you good, claims expert’,93 and ‘Quando l'alcol e il tobacco fanno bene [When alcohol and tobacco do good]’.94

Media coverage of ARISE

ARISE surveys and meetings received extensive media coverage worldwide. Of 846 articles from 20 countries published between 1989 and 2005 (Table 2), 483 mentioned tobacco.

Table 2

Country of origin of articles about ARISE

 Articles mentioning tobacco All articles 
 N % N % 
Australia/NZ 80 16.6 146 17.3 
Belgium 25 5.2 33 3.9 
Canada 25 5.2 31 3.7 
France 15 3.1 17 2.0 
Greece 0.8 35 4.1 
Hong Kong 1.0 33 3.9 
Italy 64 13.3 73 8.6 
Netherlands 12 2.5 15 1.8 
Scandinavia 1.4 13 1.5 
Spain 36 7.5 48 5.7 
Switzerland 1.0 16 1.9 
UK 109 22.6 250 29.6 
US 81 16.8 108 12.8 
Wire service 1.4 13 1.5 
Other 1.6 14 1.7 
Unknown 0.1 
Total 483 100 846 100.1a 
 Articles mentioning tobacco All articles 
 N % N % 
Australia/NZ 80 16.6 146 17.3 
Belgium 25 5.2 33 3.9 
Canada 25 5.2 31 3.7 
France 15 3.1 17 2.0 
Greece 0.8 35 4.1 
Hong Kong 1.0 33 3.9 
Italy 64 13.3 73 8.6 
Netherlands 12 2.5 15 1.8 
Scandinavia 1.4 13 1.5 
Spain 36 7.5 48 5.7 
Switzerland 1.0 16 1.9 
UK 109 22.6 250 29.6 
US 81 16.8 108 12.8 
Wire service 1.4 13 1.5 
Other 1.6 14 1.7 
Unknown 0.1 
Total 483 100 846 100.1a 

a: Does not equal 100 owing to rounding

Most articles focused on ARISE activities (survey results, conferences, and member interviews) (N = 785; 92.8%). Articles focusing on Christmas (and the importance of enjoying it) or New Year (and the harmful effects of self-depriving resolutions) (N = 54; 6.4%) ranked next as vehicles for ARISE's message. Most articles (N = 691; 81.7%) did not identify any source of funding for the group; only 57 (6.7%) mentioned the tobacco industry as a sponsor.

Reported benefits of tobacco

ARISE articles that mentioned tobacco (N = 483) frequently characterized it as relaxing or beneficial (N = 403; 83.4%), a ‘pleasure’ (N = 330; 68.3%), or as an ‘indulgence’ (N = 179; 37.1%). (Multiple characterizations per article were common.) It was also frequently stated or strongly implied that tobacco was safe to use ‘in moderation’ (N = 230; 47.6%). Tobacco was often listed—and thus equated with—chocolate, coffee, tea, and alcohol (N = 455; 94.6%). In only 28 articles (5.8%) was tobacco differentiated from other substances.

Reported harms of tobacco

Specific negative characterizations of tobacco use were rare: 71 (14.7%) articles mentioned that it was generally harmful, and 44 (9.1%) described it as risky. (Multiple characterizations were common.) Conditions such as cancer, heart disease, and emphysema were largely ignored; 31 (6.4%) articles made 51 specific references to smoking causing physical ailments (Table 3). Guilt and stress were mentioned as a consequence of smoking 44 times. In total only 67 (13.9%) articles referenced any harm of smoking. The vast majority of tobacco articles (N = 437; 90.5%) made no statement about tobacco and addiction; tobacco was labelled addictive 30 (6.2%) times, not addictive 10 (2.1%) times (both statements were present in some articles; in addition, 11 articles mentioned tobacco, but whether they referenced addiction is unknown).

Table 3

Attribution of harms to health mentioned in articles about ARISEa

  Articles mentioning tobacco (N = 483) All articles (N = 846) 
 Harms attributed to smoking (N) Harms attributed to health promotion (N) Harms attributed to health promotion (N) 
Articles mentioning any harms 67 221 246 
Anxiety/guilt 44 173 189 
Brain damage 
Cancer/tumours 14 38 38 
Death 10 
Eating disorders 12 
Gastric disorders 30 31 
Heart disease 10 35 37 
Immunosuppression 144 153 
Infection 26 27 
Lung disease 
Unfitness 10 
Other 
Total harms 95 475 511 
  Articles mentioning tobacco (N = 483) All articles (N = 846) 
 Harms attributed to smoking (N) Harms attributed to health promotion (N) Harms attributed to health promotion (N) 
Articles mentioning any harms 67 221 246 
Anxiety/guilt 44 173 189 
Brain damage 
Cancer/tumours 14 38 38 
Death 10 
Eating disorders 12 
Gastric disorders 30 31 
Heart disease 10 35 37 
Immunosuppression 144 153 
Infection 26 27 
Lung disease 
Unfitness 10 
Other 
Total harms 95 475 511 

a: Multiple harms possible per article

Health promotion

Reporters usually failed to provide health experts with the opportunity to respond to ARISE claims. Only 42 out of 846 articles (5.0%) sought health advocates' opinions; another 18 (2.1%) actively challenged the organization or exposed it as an industry front. The remainder (786; 92.6%) reported solely what ARISE told them.

Both in articles that mentioned tobacco and in those that did not health promotion experts were frequently criticized. Health promotion campaigns were characterized as misinformed (N = 103; 12.2%), ‘fascist’ or otherwise undemocratic (100; 11.8%), or puritanical (N = 70; 8.3%). These campaigns were blamed for causing various maladies (Table 3). This, ARISE claimed, happened in two ways. First, abstinence from tobacco and other substances deprived people of stress relief. Excess stress ‘will lead to heart disease and ulcers’, and speed the progression of cancer.95 Second, health campaigns could induce guilt about indulging; the guilt caused ‘stress and depression which could lead to eating disorders and contribute to infection, ulcers, heart problems and even brain damage’.96 Overall, the articles attributed health problems to health promotion five times as often as they did to tobacco. Tumours or cancer were attributed to health promotion more than twice as often as they were attributed to smoking, and heart disease was attributed to health promotion more than three times as often.

Later ARISE interests

In the late 1990s ARISE interests changed. In addition to continued work on ‘pleasure’, it performed a poll for an ice cream manufacturer demonstrating that eating ice cream made people happy.97 By 2001, Warburton, still occasionally mentioned as the founder of ARISE, was promoting a survey he had done for a wine company. This revealed a malady called ‘Kitchen Performance Anxiety’ (KPA),98 reportedly triggered by unrealistic expectations of replicating the elaborate meals featured on cooking shows, and responsible for a decline in home entertaining. None of these stories mentioned tobacco.

Warburton may have broken with the tobacco industry. In 2001 he complained that his research on nicotine and Alzheimer's disease was not being supported by the medical/scientific establishment or by the tobacco companies, who, he said, ‘are not interested in addressing the elderly, who are not going to become smokers’.99 There is no evidence that ARISE continues to function, but its reputation lives on. In 2005 the Guardian (London) referred to it as ‘a wonderful group of scientists’ which had ‘proved … that the experience of pleasure can … . improve your immune response’.100

Discussion

It has been well-established that the tobacco industry has attempted to create ‘controversy’ over the harms of smoking in scientific literature since the 1950s.4,101 Industry attempts to manipulate popular press accounts of the hazards of tobacco use are less well documented. The ARISE campaign successfully disseminated a message designed to reassure people about the safety of smoking. ARISE promulgated pro-tobacco statements in the mainstream press, which usually accepted ARISE's statements uncritically, thus abetting industry efforts to sow doubts about the dangers of tobacco. The absurdity of the claim that smoking was good for you may have made reporters feel that counterbalance was unnecessary. On the rare occasions that ARISE was contradicted, it still benefited; ‘controversy’ in the lay press worked exactly as it did in the scientific press. Perhaps the only articles not to have this effect would be those that debunked the enterprise, exposing ARISE as an industry front; only 18 of 846 articles did so.

ARISE made several linked, but distinct arguments about tobacco use. First, it claimed that smoking was not unhealthy or not as unhealthy as was reported. Since smokers who believe that the risks of smoking have been exaggerated are less likely to quit,16 this claim may have helped smokers rationalize continuing their habit. Asserting that smoking was ‘safe in moderation’ may also have assisted smokers in this psychological task. Smokers tend to believe that their personal risk is lower than that of other smokers;13 defining their own tobacco consumption as ‘moderate’ provides support for this belief.

Warburton's litany of ‘pleasures’ underscores the effectiveness of placing tobacco along with other ‘substances of enjoyment’. The other items on the list are foods that are considered harmless except in excess. ARISE's advice regarding chocolate, wine, and coffee is sensible; regarding tobacco, it is not. But Warburton's false analogy between tobacco and the other items rhetorically preserved the plausibility of the argument that smoking could be good for you.

A denial of the addictiveness of nicotine was embedded in the ‘moderation’ message, as it presupposed that smokers could easily control their habit. Occasionally, ARISE spokespeople explicitly asserted that tobacco was not addictive; more often they implied it by equating cigarettes with other, non-addictive products, such as chocolate or wine. ARISE promulgated this message although the industry had known for nearly 30 years about the addictive properties of nicotine.102

Second, ARISE actively discouraged smokers from quitting, claiming that smoking relieved stress and improved health, quality of life, and longevity. Fatalistic messages underscored this, asserting that since one has to die of something, at least smoking, unlike overwork and anxiety, is a pleasure.

Third, ARISE claimed that quitting smoking could be as unhealthy as continuing to smoke. It attributed numerous diseases, including several frequently caused by tobacco use, to abstention from ‘products of pleasure’ or attending to health promotion advice.

The tobacco industry has claimed that smokers make an informed choice to smoke and that the necessary information is common knowledge.31 However, it used ARISE to clandestinely promote false information that would reinforce smokers' tendency to minimize the harms of smoking and their personal risk.13,15,17 The presence of these messages in the media may help explain why, after decades of publicity about the consequences of smoking, many ‘informed’ smokers continue to underestimate its harm.

The ARISE message was not confined to tobacco; the group attempted to discredit all health promotion. Scientists reached consensus on the hazards of tobacco use decades ago. ARISE simply ignored it. Healthy food guidelines are also well known and agreed upon by nutritionists (e.g. recommended intake of calories, vitamins, and other nutrients). However, powerful economic interests, including both the food103 and diet104 industries, work to persuade consumers otherwise. The ARISE campaign on dietary guidelines adroitly took advantage of this situation to normalize tobacco use, to sow more confusion and doubt about dietary principles, and to dismiss all health information as contradictory, useless, and actively threatening to physical health and emotional well-being.

ARISE's later shift in focus to food issues, and the close ties between big tobacco and big food (most prominently seen in Altria's ownership of Philip Morris and Kraft, and tobacco industry ties to the hospitality sector),62 suggests that this strategy could have wider application. For example, the Guest Choice Network, originally funded by Philip Morris to promote ventilation over clean indoor air laws,62 has changed into the Center for Consumer Freedom (CCF).105 In its new identity, CCF criticizes efforts to control the food industry (e.g. getting soda out of schools) or hold it responsible (e.g. lawsuits against fast food chains for causing obesity).106

ARISE's message about health promotion should put all health advocates on their guard. Attributions of disease to health advice were more frequent in articles mentioning tobacco, but not exclusive to them. ARISE succeeded in planting its messages in the press, long after tobacco's dangers had been proven. Counterfactual ‘health’ messages on almost any topic might be promoted similarly, regardless of their implausibility.

Thanks to Teresa Scherzer, Irene Yen, Ruth Malone, Naphtali Offen, and Patricia McDaniel for comments on earlier drafts of this paper. Funding for this study was provided by State of California Tobacco-Related Diseases Research Program #13KT-0081. The author has no competing interests to declare. Funding for this study was provided by State of California Tobacco-Related Diseases Research Program #13KT-0081. The sponsor had no input into the content of this study.

Key points

  • The tobacco industry used the front group ARISE to successfully promulgate the message that smoking was healthy and cessation harmful as late as the 1990s.

  • The ARISE message, by using a false analogy between tobacco and food products such as coffee and alcohol, also attempted to discredit health promotion messages about diet and nutrition.

  • Tobacco control and other health advocates should be aware of the economic and political links between tobacco and food companies and work together to counter similar attempts in the future.

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