Thursday, October 29, 2009

Interference: ICD-9 Project Big Tobacco's strategy to prevent attributing illnes to secondhand smoke

The International Classification of Diseases (ICD) in its 9th revision is a code book for every ailment, treatment, procedure, and cause. Back in 1994 Big Tobacco, specifically Phillip Morris, planned a project (with $2 million financial backing) to prevent secondhand smoke (SHS) from being included in ICD-9. The ICD has three types of codes: diagnosis, treatment, and e-code or causal code. If the causal classification of SHS was included it would mean death and disease caused by SHS would be directly attributable to Big Tobacco. It would make it much easier to determine the direct costs of secondhand smoke on the government. Naturally, Big Tobacco was going to fight this, interference style (pictured left).

Their plan to fight this inclusion of a causal classification code would mean that even if a doctor knew a particular ailment was caused by SHS, it would be impossible to record the causal code. A review of tobacco industry documents  shows that Big Tobacco used a fake lobbying group, Multinational Business Services, Inc.(MBS), to avoid any causal link being made to secondhand smoke exposure. On behalf of Phillip Morris, MBS submitted documents questioning the science behind secondhand smoke.

This was in 1994! 
The science was clear then and the science is clear now.

The industry also argued that the costs associated with the inclusion of this code would be huge for both the public and private sectors. One doesn't need scientific proof to know that Phillip Morris would be made vulnerable to additional law suits, workers compensation claims due to workplace exposure, and so forth if this code was included. Moreover the financial toll of death and disease from direct and indirect inhalation of tobacco smoke is already costing us millions of dollars every year, regardless of a classification code. Perhaps pushing paper is more important to Phillip Morris then they would like to admit.

A 2005 article from Health Affairs says, "The tobacco industry has thus far undermined the collection of data on secondhand smoke’s relationship to illness.These findings exemplify the use of politics to influence science. The medical and public health communities need to be made aware of these different codes and the potential for tobacco industry interests to undermine their use."

For Wisconsin, as well as the rest of the nation, this means that even though we know secondhand smoke is dangerous and causes disease, tobacco industry interference has prevented us from gathering accurate data. The question remains, what would tobacco control look like, if there was no tobacco industry interference? What would Wisconsin's tobacco control efforts look like if Phillip Morris did not employ front groups to block and stall a comprehensive statewide smoke-free air law?

The most infuriating tobacco industry document related to this issue. The full journal article is available here.

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