Lessons from the 'Diamond Princess' COVID response
Five years after the COVID-19 outbreak on the Diamond Princess cruise ship, we look back at Japan's response in the early days of the pandemic.
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Japan Times
7 hours ago
- Japan Times
Smoke and mirrors: How big tobacco manipulates science in Japan
In April 2019, I joined Philip Morris Japan as director of medical and scientific affairs. I'm a doctor — and a smoker — and after 25 years working in global health for the Foreign Ministry, I was attracted by the smoke-free vision of Philip Morris International, the world's largest tobacco company. Philip Morris, headquartered in Stamford, Connecticut, states that it is building its future on 'smoke-free products that — while not risk-free — are a far better choice than cigarette smoking.' Products such as its Iqos 'heat-not-burn' device, which heats tobacco without setting it alight, offer a better alternative for adults 'who would otherwise continue smoking cigarettes,' the company says, claiming that this amounts to 'tobacco harm reduction.' Yet while working at Philip Morris Japan, I came to view this as an illusion, a vision used to mislead customers around the world, including in Japan. It was here that Iqos was first launched in 2014 and the country remains the most successful market for the device — with Iqos' global revenue now surpassing that of Marlboro, the world's bestselling cigarette brand, also owned by Philip Morris. I decided to come clean after witnessing how the company used what I believe amounts to bribery to manipulate scientific research at some of Japan's leading universities to show that heated tobacco products are less harmful than cigarettes — despite this not being backed by independent science. After raising my concerns within Philip Morris Japan to little effect and my firing in October 2019, I decided to share my story with government authorities and the media. I am now advocating for an end to improper and potentially illegal practices in this industry and for Japan's tobacco policy to change. I became one of only a handful of whistleblowers in the history of the global tobacco industry to help break the spell that so many are under. Dubious harm reduction claims Philip Morris International says that it has 'dedicated more than 1,460 scientists, engineers and technicians, and invested over USD 14 billion in the research and development of innovative smoke-free products.' It also claims that, according to 'laboratory tests,' the aerosol (smoke) from Iqos and similar products 'has an average of 95% lower levels of harmful and potentially harmful constituents (HPHCs) and is less toxic than cigarette smoke.' Without directly stating that Iqos are less harmful than cigarettes, Philip Morris' message is a smart combination of four talking points: Heated tobacco's aerosol has less HPHC, tobacco harm is reduced, Iqos is a better alternative to cigarettes and therefore better for public health, and the company is committed to a smoke-free future. In April 2019, the United States Food and Drug Administration (FDA) authorized the marketing of Iqos, a decision 'largely predicated on scientific research provided by PMI (Philip Morris International) in its application, including its clinical and post-market studies from Japan,' as stated in a paper by the Tobacco Control Research Group of the University of Bath in the United Kingdom. In July 2020, the FDA went on to approve Iqos as a modified risk tobacco product, namely one that reduces the risk or harm of tobacco-related disease — a profoundly disappointing decision and one based on the lower levels of HPHC detected in heated tobacco smoke. However, in an earlier deliberation, the FDA's own Tobacco Products Scientific Advisory Committee denied that such reduced exposure was likely to lead to a 'measurable and substantial reduction in morbidity and mortality.' In addition, in a study published last year, a group of researchers from Yokohama City University found that the cigarette smoke extract of heated tobacco products and combustible cigarettes both induce cytotoxicity, i.e., cell damage. Yet many view heated tobacco products as reducing the risk of tobacco-related diseases, especially in Japan, the country with the highest use of these products globally. Such beliefs are 'in defiance of independent research evidence,' according to The BMJ medical journal. Regardless of how many harmful constituents are present in Iqos and similar devices' smoke, what really counts is how much actual harm they cause the human body. Where there's smoke, there's fire When I joined Philip Morris Japan, I inherited two cooperation projects with the University of Tokyo and Kyoto University. In the former case, the company was paying ¥36 million ($250,000) annually to a private consultancy firm owned by a University of Tokyo professor. As I told my superiors at the time, the firm didn't provide Philip Morris Japan with deliverables that justified such a high fee: These amounted to some low-quality academic articles and a medical industry forum at the university on innovation in and public acceptance of heat-not-burn tobacco products (and vaccines). The real purpose of the ¥36 million, I learned through company documents and colleagues, was to facilitate the hiring of an economist employed by Philip Morris International as a visiting scholar within the professor's university department and then to publish research under the university's name. I raised my concerns internally: Given the substantial size of the payments and the lack of due diligence when it came to the relationship with the consultancy firm, I pointed out that this arrangement posed reputational risks for Philip Morris. I feared that the payments could amount to bribery. Ultimately, the economist wasn't hired as a visiting scholar and — while the professor didn't disclose the payments his company was receiving from Philip Morris Japan to the university — a university investigation was conducted in 2020, five years after the consultancy had started receiving ¥36 million a year from my former employer. The university found no conflicts of interest or breaches of its code of conduct. This is despite its ethics guidelines stating that its employees cannot use their position 'to advance private interests for their own benefit or for the benefit of organizations to which they belong.' Visitors of a tobacco products store in Tokyo are only allowed to use heated tobacco products like Philip Morris' Iqos. If Japan is to make its indoor smoking ban effective, it must extend it to smoking rooms for heated tobacco products. | REUTERS In the Kyoto University case, Philip Morris Japan paid ¥18 million a year to research contractor CMIC, which in turn paid ¥16.5 million to a professor from the university. Kyoto University's ethics committee approved a CMIC-sponsored research project to be conducted by the professor, but no mention of Philip Morris was made in the contract between the firm and the institution or in the university's official records. The research — which focused on Japanese smokers undergoing smoking cessation treatment and was also provided to the FDA — was supervised by CMIC. In my view, the professor did not provide a labor input equivalent to the ¥16.5 million he was receiving, therefore also raising my suspicions that this amounted to bribery. While it is standard practice for companies, including in the tobacco industry, to sponsor scientific research, what also worried me was that in this case, this was not out in the open. Philip Morris Japan's compliance office investigated my allegations of wrongful conduct, but these were found to be without merit. I was given a negative performance evaluation and told I had failed my probation period at the company. Eventually, I was dismissed. I believe this was a form of retaliation for having raised my concerns, though my former employer denies my termination was unlawful. However rigorously Japanese scientific research standards are applied, they cannot fully prevent wrongdoing by people committed to working for both research and industry in unethical and potentially corrupt ways. After all, a vision founded on deliberate scientific fraud is an illusion. Fighting back Once I was fired, I could start to truly fight back. Where raising the alarm internally hadn't worked, the only option was to look outside. 'Sunlight is said to be the best of disinfectants,' late U.S. Supreme Court Justice Louis Brendeis once wrote. I approached the Japanese health and finance ministries, with the latter exercising significant authority over tobacco policy, from price and tax approval to regulating marketing and health warnings. No serious action came of this. In May 2020, I also received a subpoena from the U.S. Securities and Exchange Commission (SEC), who I had contacted on suspicion that Philip Morris' actions may have breached the U.S. Foreign Corrupt Practices Act. Under it, a publicly traded American company is prohibited from bribing foreign officials — including employees at state-funded universities. While I am not aware of an ongoing SEC case, it is not standard practice for the commission to divulge such information — not even to whistleblowers — so as to preserve the integrity of investigations. What I do know is that not long after my interview, Philip Morris International hired a new general counsel, Suzanne Rich Folsom, a corporate governance expert with rich experience in investigations and compliance. As well as talking to government officials, I also turned to the media. I was in touch with a reporter from a major Japanese newspaper and, despite their initial interest in my case, nothing came of it. Later, I found that Philip Morris International was sponsoring a conference organized by the same media outlet and that the tobacco conglomerate's CEO, Jacek Olczak, was due to speak at the event. But the sponsorship was cancelled just a few days before the forum, after several speakers had withdrawn their attendance in protest. Yet as recently as this March, two other Japanese outlets published interviews with Olczak, including statements that heated tobacco products substantially decrease exposure to cigarettes' harmful substances and that they present fewer health harms compared to their combustible counterparts. Perhaps I can't blame these newspapers for publicizing misleading tobacco industry talking points. After all, I myself had once believed in the positive health effects of heated tobacco products and Philip Morris' smoke-free vision. After my revelations failed to spark much attention in Japan, I turned to academics and journalists in the U.K. The University of Bath's Tobacco Control Research Group published articles detailing how Philip Morris Japan tried to 'exploit science' at Japanese universities. In Nicotine & Tobacco Research, it wrote that 'some of PMI's most significant clinical and post-market studies were conducted in Japan ... However, our findings raise concerns about the integrity of this evidence base and, by extension, the true harms of PMI's products.' Still in the U.K., The Bureau of Investigative Journalism published an expose and several stories as a result of my whistleblowing. In them, Japan is described as a 'tobacco state' because of the close relationship between tobacco companies and government agencies. For example, Japan Tobacco International, one of the world's largest tobacco manufacturers, is one-third owned by the finance ministry. Yet these revelations were largely ignored by the Japanese media. Moving forward My message is simple. Japan should address and properly regulate the entire spectrum of nicotine delivery products, from the most to the least harmful. If heated tobacco products are allowed, Japan should be consistent in its policy and also permit e-cigarettes: These contain nicotine but not tobacco and are classified as medicinal rather than tobacco products under Japanese law, which bans their sale. E-cigarettes are not risk-free and many health authorities express concern about their use, especially among young people. Yet these devices have been found to be less harmful than smoking conventional cigarettes, as detailed by sources such as National Health Service in the U.K. and John Hopkins University in the U.S. 'For people who smoke, legal e-cigarettes are an option to help them stop,' according to Cancer Research U.K., the world's largest independent cancer nonprofit. Also, Japanese regulators should ban heated tobacco smoking rooms, which it approved when the country adopted its indoor smoking ban in 2020: An outcome that Philip Morris Japan lobbied for, targeting select politicians with — guess what — favorable scientific research. When I was dismissed from the company, I faced turmoil and financial concerns. I was initially afraid to have my name out in public, but I was inspired to speak out by those who revealed the sexual abuse they had faced in the Japanese entertainment sector. Every time I pass an Iqos store, I cannot help but feel that I did the right thing in making my voice heard to protect public health. Awareness of hypocrisy and malpractice in the tobacco industry is the first, concrete step toward a truly smoke-free world. Shiro Konuma is the director of an elderly care home in Hokkaido. A former director of the Ministry of Foreign Affairs' Global Health Policy Division, in 2019 he was briefly director of medical and scientific affairs at Philip Morris Japan.
NHK
7 hours ago
- NHK
Averting tragedy when dementia patients go missing
Most people with dementia or suspected dementia who died after going missing in Japan were found less than 5km away. What can communities do to prevent such tragic deaths?
NHK
9 hours ago
- NHK
UN report: Lack of US funding will cause 4 milion additional AIDS deaths by 2029
The United Nations has warned that a permanent halt in US funding is expected to result in 4 million additional deaths from AIDS-related causes by 2029. The General Assembly met on Thursday to study a UN progress report on the fight against HIV/AIDS. The report says the US has been a leader in the global response to HIV for more than two decades, contributing more than 70 percent of donor funding. But it notes that the administration of US President Donald Trump has paused the contributions since the end of January. UN Deputy Secretary-General Amina Mohammed told the meeting that the cost of the reduction is stark. She said closures of clinics and other disruptions to HIV services are putting adolescent girls and young women at especially greater risk, and that more babies are being born with HIV. Mohammed said if US funding is permanently halted, the UN projects 4 million additional deaths and over 6 million new HIV infections by 2029. She called on countries to reverse the funding declines, saying they must not allow themselves to "shatter the possibility of achieving the 2030 goal to end AIDS as a public health threat." The UN report says nearly a quarter of the 39.9 million people living with HIV globally are not receiving life-saving treatment. It says one person is dying from HIV-related causes every minute.
