Is Big Tobacco's move into medical devices all bad?

In their splendid 1200-page book (no kidding!) on ethics and the law for the health professions, Professor Ian Kerridge, a Sydney haematologist and academic ethicist and colleagues, begin with a definition of ethics – ethics is deliberation about what we ought to do.

And that ought takes a thousand pages to determine; as what it means it is not always, or even often, easy to understand.

Ethics penetrates just about everything that doctors do.

Take the matter of tobacco companies now seeking to diversify into health technology.

The move everyone’s talking about is Marlboro-maker Philip Morris’s multimillion dollar deal to buy UK inhaler group Vectura that produces dry powder inhalers.

One strongly suspects its interest in inhalers has something to do with vaping device development. And profitability is likely the principal driver.

So, what ought we, as doctors, do?

For many medics, especially those who’s patients have severe tobacco-induced injury, Big Tobacco’s move into vaping for profit is indefensible.

Their view is, that the fact we’ve learned to live with tobacco is a global folly, and anything that can be done to make the life of Big Tobacco less pleasant and profitable ought to be done.

Some medical organisations, like the Thoracic Society of Australia and New Zealand, say doctors should boycott all inhaler devices produced by companies owned by Big Tobacco.

They argue that if doctors continue to prescribe them, they’re inadvertently supporting the very industry that brought about the tobacco pandemic in the first place.

"How can we in good conscience give a treatment to a patient where the funding from that treatment will be going to the company that caused the disease to begin with?" the society’s CEO, Dr Graham Hall (PhD), told ABC News in response to the Philip Morris-Vectura deal.

The aim of such a boycott would be to hit revenues, contributing to an overall decline in profitability and the availability of cigarettes.

Read more AusDoc:

• Philip Morris attempts to buy company making inhalers to treat lung disease
• After killing millions, Big Tobacco moves into healthcare

However, others have a different view. They believe the business acumen of Big Tobacco is truly brilliant.

We may not like what they do but as an example of a ‘successful’, agile (think e-cigarettes) business enterprise it is almost without peer.

So, why not encourage Big Tobacco to turn its capacity to produce stuff that is health-enhancing – rather than health damaging – like medical equipment?

This would provide them with the chance to continue to thrive, even if they had to switch to become BMI – Big Medical Infrastructure.

With medicine on the cusp of truly disruptive technological change and IT transformation – think gene science, telehealth and more – this is a good time for reimagining its future with massive profits waiting to be made.

BMI could become the Bitcoin of the next two decades.

The risk of this second viewpoint – that we ought to encourage Big Tobacco to diversify into health – is that the principles at work in big business do not include self-sacrifice.

They cannot. The business of business is to return a profit to shareholders.

And the way this is achieved is complex. For even when big business conforms to commercial law, benevolence is constrained, meaning any investment in medical research by Big Tobacco would come with a price tag.

Read more: Doctors alarmed by Big Tobacco's push to legalise 'smoke-free' devices

But let’s change tack for a moment.

There are interesting parallels between Big Tobacco and the industries that produce copious greenhouse emissions.

To mark the month’s COP26 climate change conference in the UK, McKinsey & Company questioned whether it should be advising and assisting polluters.

It argued it should, because the transition to net zero was so colossal that even big industry needed help.

“Hard-to-abate sectors represent 81% of the global economy’s carbon footprint. Like it or not, there is no way to deliver emissions reductions without working with these industries to rapidly transition,” the management consultancy wrote in its newsletter.

Similarly, Big Tobacco is subject to international constraints on tobacco production and promotion under the UN Framework Convention on Tobacco Control.

Good progress has been achieved to reduce tobacco consumption in many countries following these protocols.

But there is a long way to go.

What if encouraging tobacco companies to change their principal product, even little by little, was actually a more effective approach to stubbing out tobacco-use for good?

It’s a tricky ethical question.

What do you think we ought to do?

References

1.       Ethics and Law for the Health Professions, 4th ed. (Sydney: Federation Press, 2013).

Published in Medical Observer OPINION
8th November 2021