A large medical-information platform that reaches hundreds of thousands of American physicians and millions more worldwide, Medscape is popular for its broad array of quality educational videos. The company allows doctors at no cost to obtain credits toward renewing their medical licenses by viewing modules and passing a corresponding test.

As a medical professional, I’ve watched many of these videos over the years. So I was excited when Medscape invited me to participate as an instructor in two planned videos on the topic of tobacco harm reduction (THR), the practice of delivering nicotine in safer ways through lower-risk products such as e-cigarettes and smokeless tobacco.

Most physicians know little about THR, including the options tailored for people unable or unwilling to quit smoking using FDA-approved cessation tools, such as nicotine patch or gum. The videos, on which I was to be paired with professors of medicine, would present a wonderful opportunity to inform colleagues why THR is the answer to using combustible tobacco (aka cigarettes), still the leading contributor to needless illness and death in the developed world. On April 1, our two 30-minute videos went live as part of a five-module series.

Four days later, tobacco-control advocates erupted in protest, persuading Medscape to remove the videos. “Outcry as Philip Morris International funds smoking cessation courses on Medscape,” read an April 9 headline in the British Medical Journal. “The idea that the lethal and immoral tobacco industry has a role in medical education is absurd,” a professor of respiratory medicine at Imperial College London told BMJ reporter Hristio Boytchev. If Medscape were to put the courses back up, the professor warned, there “would be a rapid global boycott by healthcare professionals disgusted by their behavior.”

While Philip Morris International (PMI) funded my colleagues’ and my Medscape videos, we had full control of the content, observing the firewall between funder and faculty that is now standard in continuing-medical-education programs. My partner on one video, Brad Rodu of the University of Louisville, is a THR expert, whose work was funded by unrestricted industry grants to his institutions from 1999 to 2018. “My grants were immediately disclosed publicly,” he told me, “and the universities’ agreements assured complete independence to publish results without informing the sponsors, regardless of the results’ impact on them.”

Our presentations were dense with facts. We showed that e-cigarettes, the most popular quit-smoking aid, are far less hazardous than smoking in terms of toxin emission—95 percent less, according to the Royal College of Physicians. We discussed improvements in asthmaCOPDvascular function, and hypertension in smokers who had switched to vaping, and reported on vaping’s demonstrated superiority as a cessation method in randomized controlled trials and a large review study. We showed that e-cigarette use has not led to smoking among youth, and further explained why the claim that nicotine impairs teen brain development is speculative at best. Throughout, we insisted on the importance of continued epidemiological follow-up to detect the latent complications, if any, associated with long-term use of reduced-risk products.

Our fact-driven efforts were not enough. In opposing tobacco-harm-reduction research and communication, the playbook is clear: blame the funder, evoke outrage, suppress the content.

At one time, of course, the tobacco industry was brazen. In the 1950s, for example, major cigarette manufacturers launched a campaign to refute the robust evidence that their products caused lung cancer. The companies hired a few skeptical scientists to raise doubt about smoking-related harm, and they buried their own internal research if unfavorable to their interests. Many remember the 1994 congressional hearing where top executives of seven major tobacco companies asserted, one after the other, that nicotine was not addictive.

But times have changed, and the tobacco industry is now held accountable for its research by the Food and Drug Administration; responsible university researchers, like Rodu, keep themselves independent of company funders by a strict partition (though most universities won’t take any grants at all).

Despite these changes, the Medscape fiasco reflects widespread efforts to shut down all scholarship in tobacco-harm reduction. Scientific journals, for example, often refuse to publish scholars whose work is funded by tobacco companies. The American Thoracic Society publishes a family of journals that will not accept “any research that has been funded by tobacco entities.” The BMJ and other journals of the British Medical Association, such as Tobacco Control, and the Public Library of Science (PLOS) journals, including PLOS Medicine, PLOS Global Public Health, and the European Journal of Public Health impose similar restrictions. This policy extends to the Society for Research on Nicotine and Tobacco, which hosts the largest international tobacco and nicotine conference annually and bars tobacco-industry scientists from attending its annual meeting or submitting research abstracts for publication in the meeting handbook. The Society says that it needs to maintain the forum as a “safe space.”

Excluding this research keeps doctors in the dark about innovations in tobacco alternatives. Indeed, companies like PMI conduct some of the best research, since they have the resources to support more ambitious studies than would be approved by government agencies. According to Ondrej Koumal, director of external relations for PMI, “our longer-term clinical studies would almost certainly never be underwritten by government grants or non-profits due to cost.” “Industry researchers must study their products,” Koumal told me, “and when we do those studies, we should be able to subject them to scrutiny by publishing them and presenting them at public fora.” 

The same forces opposed to industry researchers’ inclusion have sought to cancel a global grant-making entity called the Foundation for a Smoke-Free World. Established and funded in 2017 by PMI, the foundation offered $1 billion over 12 years to “fund scientific research designed to eliminate the use of smoked tobacco around the globe,” according to the Financial Times. The deans of 17 schools of public health in the United States and Canada, along with the World Health Organization, greeted the news by refusing to collaborate with the foundation. In 2023, the foundation severed ties with the tobacco industry and reduced the grant money it makes available because of this image problem.

Science, ideally, should be immune to guilt-by-association charges. As six world-renowned researchers noted in a 2018 article, “the level of accountability and transparency by the FDA is similar to or greater than that for pharmaceuticals and exceeds that expected of academic scientists.” And, critically, PMI and other companies are seeking to make use safer by inventing and promoting non-combustibles.  “If the tobacco industry seeks to make money by marketing reduced risk products instead of more risky products,” the authors note, “we fail to see this as a menace to public health.”

On April 22, I learned from the BMJ reporter that Medscape had capitulated and permanently removed the educational videos. Four days later, his story carried the company’s cringing apology: “Upon reflection, we acknowledge that the use of this funder was a misjudgment that was out of character for Medscape Education and that doing so may have disappointed our members.”

Among the disappointed are those who care about smokers’ safety. After all, erecting barriers to creating and sharing data on low-risk nicotine products only helps cigarette makers worldwide, keeping millions of people smoking—and dying.

Photo: Martina Paraninfi/Moment via Getty Images


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