London School of Hygiene & Tropical Medicine

New report asks why, with up to 140,000 Germans dying from tobacco-related illness each year, the German scientific and medical establishment is still in bed with the tobacco industry

The tobacco industry in Germany enjoys a staggering amount of influence among leading scientists and clinicians and has, for decades and with virtual impunity, sought to manipulate and distort scientific evidence linking smoking to fatal diseases.

These are the findings of a new study, published online today in the American Journal of Public Health, which names some of the most eminent professors from Germany's leading universities as being hand-in-hand with the tobacco industry.

The release of internal tobacco industry documents through litigation in the USA has allowed researchers to gain unique insights into the conduct of the tobacco industry. Today's study, was based on close examination of these previously secret documents, reviewing German language documents for the first time. With Germany having some of the weakest tobacco control policies and the highest rates of smoking in Europe1, the study sought to explain Germany's resistance to implementing policies that would help reduce the harm from tobacco. It highlights some of the sinister tactics employed by the industry, and presents a five-point plan to enable Germany to gain control of its health agenda and reverse its appalling reputation on tobacco control.

The study shows that the extent of the tobacco industry's influence over science in Germany is profound. The industry spends millions recruiting large numbers of clinicians and scientists, including many eminent professors based at some of Germany's leading universities. These include, for example, Professor Helgo Magnussen, until last year president of the German Association of Pulmonology, Professor Jürgen von Troschke, until recently executive director of the German Association for Public Health, Professor Schievelbein, former Director of the Institute for Clinical Chemistry of the German Heart Centre in Munich, and Professor Karl Überla then President of the Federal Health Office. Others received significant consulting fees from the tobacco industry, for example Professor Fritz Kemper, former Director of the Institute for Pharmacology and Toxicology at the University of Münster, who then was appointed as expert by the European Commission to its scientific committees.2

In the 1960s and 70s it was far more acceptable, not only in Germany but internationally, to accept tobacco industry funding. But times have changed and the scientific community elsewhere has rejected tobacco industry funding and sought to mitigate its influence on science. Germany, however, has failed to do so.

Thilo Grüning, of the London School of Hygiene & Tropical Medicine, who is lead author of the study, comments: 'In Germany, tobacco is the single most important cause of illness and premature death, accounting for between 110,000 and 140,000 deaths a year. These documents reveal how the tobacco industry has, for decades and with huge success, sought to manipulate and distort the evidence for a link between smoking and fatal disease.

'We see evidence that, as early as the 1950s, scientists were being courted and that by the 1970s, a huge network of scientists and institutions existed who were 'on side'. Unfavourable research results were suppressed, while the publication of favourable findings, on the other hand, was encouraged, and such findings were often, in order to make them more credible, presented by a 'third party', often by a university professor whose connection with the industry could be concealed.

'The industry selectively recruited scientists who had doubts about the adverse health effects of smoking, and funded research projects designed to find no association between smoking and disease, introducing severe bias into the evidence base. Articles and presentations were vetted by the industry - one university professor funded by RJ Reynolds had his World No Smoking Day keynote address changed by the tobacco industry!'

Martina Pötschke-Langer, head of the WHO Collaborating Centre on Tobacco Control at the German Cancer Research Center in Heidelberg adds: 'There can be no doubt that the close relationship between the tobacco industry and leading German clinicians and scientists has blocked efforts to curb smoking in Germany and in Europe. It is shocking that so many high level scientists were involved'.

Jean King, Cancer Research UK's Director of Tobacco Control says:
'Tobacco companies have attempted to distort scientific research for many years. It is deeply regrettable that there are still scientists prepared to take their money. In spite of this disreputable behaviour some may even undertake biased research that aims to cast doubt on the proven association between smoking and disease. It's essential that research institutes have controls in place to stop this happening and to protect their own reputation.

Germany's record on tobacco control is not good. We are delighted that the German Cancer Research Center recently followed other international organisations and adopted an ethical code to reject financial support from the tobacco industry. We urge other German organisations to do the same and funding bodies to only fund academics who also reject tobacco industry funds.'

The authors have set out a five-point plan which will enable the scientific and health community in Germany to take back control of the nation's health, and reverse its poor record on tobacco regulation:

Research funding organisations such as the VERUM, a foundation established by the tobacco industry, must be added to the growing list of known industry front groups so that editors and peer reviewers are aware of the true source of funding.

Universities and academics in Germany should be encouraged to review their approach to tobacco industry funding and adopt a code similar to that produced in the UK3 or recently adopted by the German Cancer Research Center (Deutsches Krebsforschungszentrum, DKFZ).4

German funding bodies should consider refusing to co-fund those also in receipt of tobacco industry funds.

The Federal Medical Chamber should include a policy on tobacco industry support in its Professional Code of Practice.

German and international academic journals should review their policies on accepting tobacco-funded research and the need for disclosure statements.