26 May 2023

Podcast "Let's Talk Cancer": Tobacco and alcohol – manipulative marketing and how to counter it

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Fake science, front groups and the promise of happiness: uncover the tactics used by the tobacco and alcohol industries to market their products, particularly to vulnerable populations, as well as ways to counter them.

Nearly half of all cancer deaths are caused by known preventable risk factors such as smoking and alcohol consumption.

They are called “preventable” because unlike genetic predispositions, for instance, a person can lower their risk of cancer by limiting their exposure to these factors. However, it can often be difficult for individuals to make informed choices about their health, as strong commercial interests can promote the availability, accessibility, affordability, and desirability of harmful products such as tobacco and alcohol.

In this podcast, Cary Adams, CEO of UICC, is joined by Dr Adriana Blanco Marquizo, Head of the Secretariat of the WHO Framework Convention on Tobacco Control, and Maik Dunnbier, Director of Strategy and Advocacy at Movendi International, to discuss the commercial determinants of health related to tobacco and alcohol, the tactics used by these industries to market their products, and ways to counter this. 

"When you see an advertisement for tobacco, and I think the same applies to alcohol, they don't put a cigarette in front of you and explain the quality of the tobacco. What they show you is nice, young, beautiful people with a high standard of living. So they are selling a concept: the concept of happiness, of being friendly, being attractive. And that totally obscures the reality of the product."
Dr Adriana Blanco Marquizo, Head of the Secretariat of the WHO Framework Convention on Tobacco Control

"We always say that Big Tobacco and Big Alcohol are Big Buddies."
– Maik Dunnbier, Director of Strategy and Advocacy at Movendi International

See podcast transcript below

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Podcast transcript

Cary Adams: Welcome to Let's Talk Cancer. My name is Carey Adams and I'm the CEO of the Union for International Cancer Control. Nearly half of all cancer deaths are caused by known preventable risk factors with smoking, alcohol consumption and high body mass index, BMI among the top three. They're called preventable because unlike genetic predispositions, for instance, a person can lower their risk of cancer by limiting their exposure to these risk factors. However, it can often be difficult for individuals to make informed choices about their health, as there are strong commercial interests that influence the availability, accessibility, affordability and desirability of products such as tobacco and alcohol, which cause cancer. In our previous podcast, we looked at these commercial determinants of health and their relation to poor diet, physical activity and high body mass index. But in this podcast we will discuss the similarities and differences between the tactics used by the tobacco and alcohol industries to market their products. I'm delighted to welcome Dr Adriana Blanco Marquizo, Head of the Secretariat of the WHO Framework Convention on Tobacco Control, and Maik Dünnbier, Director of Strategy and Advocacy at Movendi International, an organisation that calls for civil society to address alcohol as a serious obstacle to development. Welcome to you both. So while the health risks associated with tobacco are well known, alcohol, I feel, is often trivialised or normalised. Why do you think that is, Maik?

Maik Dünnbier: You know, it's like this we know or the WHO, Special Agency for Cancer Research, knows since 1988 that alcohol, the ethanol in beer, wine and liquor is carcinogenic. It's in the same group as tobacco and asbestos. Today, we know that alcohol causes seven types of cancer. And we also know that already low doses of alcohol consumption increase the cancer risk. So the more human beings consume alcohol, the greater their risk becomes. And we know that there is no safe amount, there is no healthy no no safe threshold for for alcohol consumption. The public, even, you know, doctors, journalists, they are not aware they're not recognising the cancer risk that comes from ethanol and beer, wine and liquor. I think that has to do with the activities of the alcohol industry. Very early on, they identified the threat to their profits, to their sales from public recognition that their products cause cancer. And so they invested in science that shows that alcohol is healthy. For example, the myth that alcohol is good for the heart.

Cary Adams: We've known for many decades the the issues that tobacco use causes, not just for cancer but for other non-communicable diseases. So despite all the health risks, they continue to use the same tactics or maybe their slightly different tactics, Adriana, in terms of looking at the way in which they can continue to sell their products around the world and in fact sell their new products. So how would you summarise the current situation with regard to the tobacco industry?

Adriana Blanco Marquizo: The tobacco industry has been, let's say, the teacher for all other industries because we have seen that the strategies used by the tobacco industry are now used by other industry and not only alcohol. Even other industries that produce, for example, sugary sweetened beverages are trying to get the same kind of strategies. I think that one of the main strategies of this industry is they are not selling the product. They are selling a concept. Okay? So when you see an advertisement for tobacco and I think the same thing is for alcohol, you don't see that they put a cigarette in front of you and they explain the quality of the tobacco. You will see that what they show you is nice people, young people, beautiful women, people with a very high standard of living, in very nice places. So they are selling you a concept, the concept of happiness, of having friends, being attractive, and that totally obscures the reality of the product. That is exactly the opposite. Because what you are going to have if you are a smoker, the probability is you are going to  have diseases, less money. So you are going to be in less affluent situation. Then they have another strategy, and Mike already mentioned part of that, which is trying to create their own science. You can say, okay, how can someone have their own science? Okay, because science is science. But well, unfortunately, there are scientists that  don't have problem to carry out bias research and then present sometime their results without  people knowing that the research has been funded by an industry that has an economical interest in the results. The other thing that this industry does is to use front groups. We know that now there is a widespread knowledge of what are the real intentions of these companies, they try to be presented by someone else. So it's not the tobacco industry that is so bad saying that. But this group of citizens who they are trying to show you how good they are. And there is even a last one that we are seeing now, that is the tobacco industry acquiring pharmaceutical industry. And we see that in that way they are again trying to buy a seat into the, let's say, the respectable group of public health where they try to portray themselves as part of the solution.

Cary Adams: How would you summarise the current situation with regard to e-cigarettes, vaping and things like that?

Adriana Blanco Marquizo: The tobacco industry is trying to be part of the solution of the problem they created. It's kind of like you break someone's legs and then you sell the crutches to to them to  walk. No. So how are you creating a problem and then portraying yourself as the saviour of the world? But come on, let's remember who created the problem in the first place. And of course their solution is a solution that is a solution also for their own problem. That is the decrease of  profits because people are quitting smoking.

Cary Adams: Mike I remember attending a Congress some years ago when there was a wonderful presentation done by a researcher who had identified the crossover between the non-exec directors that were sitting on on tobacco companies as advisors and were also sitting on alcohol companies as advisors. And and in part that sort of shows the handshake between these these two industries. What do you see from your perspective? Are there similarities and are there any differences?

Maik Dünnbier: We always say that big tobacco and big alcohol are big bodies. Tobacco companies are major shareholders in alcohol companies, so they share the profit-making interest from selling these health harmful products. The new CEO of Diageo – Diageo is one of the biggest alcohol companies in the world – the new CEO hails from big tobacco, so they sit on each other's boards. They use the same think tanks, PR agencies, law firms, all these things. It's just the same network. And Adriana made this important point about the front groups. It's increasingly the case that the alcohol companies also want to be represented by front groups that disguise who this really is. And even here, even in the WTO context, when WHO was working on the Global Alcohol Action Plan, the alcohol industry deployed a network of think tanks that are connected to the tobacco industry. So even for political interference in lobbying, they work together very much. We talk about the dubious five. So the alcohol industry is using five strategies to shape everything: our values, our concepts of a good life, as Adriana explained, the tobacco industry is doing it for us. The dubious five are lobbying, promotion, manipulation, deception and sabotage.

Cary Adams: Adriana, you mentioned earlier about the industry, the tobacco industry moving into the solutions for global health problems. Is this credible? Is this really credible? Do you feel that this is just whitewashing their position with regard to the harm they cause to their their classic tobacco products? Or do you think they actually believe it?

Adriana Blanco Marquizo: I will think about that saying that says you fool me once, shame on you, you fool me twice, shame on me. And I think that the tobacco industry has fooled us not twice, many, many times, because this, let's say, strategy of trying to portray products as less harmful is not new. And the first attempt to do this was the filter. The filter, even though the name suggests that they filter things, at the end of the day does not make a difference because filter cigarettes and unfiltered cigarettes have more or less the same amount of health problems. It's really something that from the health perspective, is not helping at all. So that was the first time that the tobacco industry said, okay, we are going to put this so you can smoke. You don't need to quit. You just use these ones that are less harmful. The second intention was when they launched the concept of the mild, an ultralight and this kind of concept. Even doctors were fooled with that. And in many countries doctors say to the people, well change to this okay. And what is the difference between the between a light product and a regular product? The number of holes in the filter.

Adriana Blanco Marquizo: Okay. That is the only thing. So even though the tobacco industry knew at that moment that it will be a compensatory behaviour in the smoker to try to get the same amount of nicotine, because the smoker smokes because of the nicotine. So they need to have the doses, let's say the profile of the lung cancer totally changed after the introduction of this of this product because people inhale more deeply, keep more the the smoke in their lungs. This is not new. I will ask to anybody with with some sense how a company will produce a product that will kill the main income, that is the regular cigarettes. And also this product is not for general consumption according to them, is just for those smokers that wanted to to quit and couldn't quit with something else or wanted to have a better option. Okay. So is is signing the death certificate for themselves. So how can you really trust this?

Cary Adams: The young, ethnic minorities, women, low income communities. What are you seeing, Mike, from an alcohol perspective, What is the what are the tactics of the alcohol industry at the moment.

Maik Dünnbier: When it comes to young people, we always talk about training wheels for alcohol consumption. It's these ultra sweetened, rather high alcoholic content beverages, alcopops. They are very often called this, is what the alcohol industry is doing, because they know that from the beginning we have to acquire the taste for beer, wine and liquor. It's not pleasurable from the beginning. So they put lots of sugar, you know, they make alcohol taste like candy for kids and for women. It's very similar to what Adriana has said. They put low calorie on it or gluten free vodka you can get. And so women start thinking it's healthy, of course, and they forget that the ethanol in beer, wine and liquor is carcinogenic. Women have been using much less alcohol compared to men. But in countries like the UK, the US, women have caught up and we can see an epidemic of liver cirrhosis in young, well-educated women in Great Britain, for example. So we can see directly the effect of marketing. There are all these myths that mothers need to get through the day and use wine to to cope with everything. And maybe the last thing that is really important to say, the alcohol industry is targeting low income, vulnerable communities. The alcohol industry is dependent on heavy alcohol users for major parts of their profits. You can think of Hispanic communities or black and brown communities in the United States. They have a much higher density of alcohol outlets because they cannot protect themselves against the alcohol industry. So in marketing and availability, the alcohol industry really goes after these more vulnerable communities.

Cary Adams: There is a bit of a backlash in high income countries. You know, there is more understanding, more knowledge, but that doesn't seem to be stopping the industry in terms of exploiting other markets around the world. So what are you seeing?

Maik Dünnbier: We see, for example, that in high income countries, in Western countries, young people want to stay alcohol free longer. So their debut is later and they have reduced consumption compared to previous generations if they begin alcohol consumption. And so, of course, the alcohol industry needs to do something with this. But in Western countries, the market has been saturated, which means that the alcohol industry has turned their attention to low and middle income countries where the majority of the adult population is and has been alcohol abstainers. They are very often showing white people in Kenya or in Sri Lanka on these huge billboards, on on these commercials with this super successful lifestyle where the alcohol product is the main facilitator of the social success, of the happiness of the sexual appeal, all these things. So that is going on and that is, of course, a major risk for impeding development in those countries because alcohol consumption is projected to rise and with it harms like cancer and other problems.

Cary Adams: I know that in many parts of, for example, Africa, the smoking rates, Adriana, for women are about 2%. They're very low. And of course we applaud that. That's great news. But I can imagine there are some executives in the tobacco industry thinking, great, it's only 2% a market opportunity. So what's the experience of you and your team in terms of observing the tobacco industry's tactics to approach and to make the most of those vulnerable populations?

Adriana Blanco Marquizo: When we say 2% of smoking is a good news, it's also a good news for them because that means that there is a niche of market that they will exploit. It's not by chance that women smoke more or less. It's because there are strategies that are specifically focused on them. And if you see in more developed countries, the gap between the cigarette consumption in men and women is narrower. And in young people in some countries, we are seeing even girls smoking more than than the boys. Okay. The same has been with the African American communities in the United States. And the use of menthol. They they was much more advertisement in menthol with black characters that it was for other products. So there is an intention, obviously, and again, I always think that when you have this kind of advertisement of a standard of living and you are a poor person, what is the only thing that you can have like these people? You cannot buy the car, you cannot buy the house. Okay, You don't have this beautiful hair and thing because you cannot take care of yourself, but you can smoke or probably you can get a drink. That is the other thing. So  then obviously the industries also provide cheap products. So you can because there no one is coming to look at which cigarette are you smoking, is it the high end brand or the low end. So they provide cheap ones. So you feel that at least you are sharing part of this glamorous life of the people with more means and all of this is pervasive and is not by chance, it is done by design, by these industries.

Cary Adams: Obviously, as the Head of the Framework Convention for Tobacco Control Secretariat, which is the only international legal treaty, you've got a framework which is recommendations, policy interventions for governments to pursue to reduce the smoking levels in their own country. So how effective is that?

Adriana Blanco Marquizo: I need to disclose my conflict of interest. I think that the convention is really effective. Obviously, I have been working my whole life on this. We have 182 parties in this moment that represent more than 90% of the population of the world. And for those parties, these are mandates. Okay? So they need to abide from what is said, even though they need to domesticate, let's say, the convention, because it's a framework. It tells more or less what needs to be done. But every country need to put their own legislation in place for doing so, what to set as the best environment for people not using tobacco. And there is nothing in the convention that say we are going to ban smoking. Okay? This is not about banning smoking because we know that this is not a solution for an addictive behaviour. Okay? The main part of the convention ensures that people are not smoking everywhere. So in a way, you are reducing the possibilities of people smoking that help the smoker to quit, but also help the non smoker not to be exposed to second hand smoke that we know is is really a danger. Then you have the ban on advertising because it has been really proved that the advertising has an impact in the initiation of the tobacco. Then we have the health warning. And the health warning is something that is the minimum thing that any ministry of Health can do is to warn the people who use the product about the risk.

Adriana Blanco Marquizo: So that is something that is very clear and it has not cost for the government because it's the tobacco industry who need to pay for for the printing of that. Of course, we need also to raise taxes and that is the most effective individual measure because it really affects the population that are more prone to consume. That is the young, the poor. The other thing is  offering cessation. But we know the majority of the people just quit by themselves when these other measures in the environment are put into place. The main objective of the of the treaty is to protect present and future generation of the devastating effect economic, social, health, environmental of tobacco use and the environment. When you are thinking about tobacco, it is one of the of the contributors to all the environmental problems that we have, especially the plastic contamination that is something like looks obscure. But we are seeing more and more than in our own bodies. We are incorporating the microplastic when we eat  common food. So we need to be aware that every plastic we put outside is coming back to us. in a microcosmic way, but with effect on our health.

Cary Adams: Well, I guess we we we've always talked about the the risks and the issues of secondhand smoke and maybe we should start talking about the risks and the issue of secondhand plastic.

Adriana Blanco Marquizo: Secondhand plastic. Yes.

Cary Adams: I recently attended another conference and colleagues from the World Health Organization did an incredibly presentation about the environmental impacts of those very same filters that you mentioned, that not only are they the most prevalent waste on beaches around the world and in seas, but also all of the chemicals which they are capturing from the process of smoking are now infiltrating the soil and the sand and creating a really quite terrible situation for many of us who don't smoke, who like to go to a beach and just not see all the stubs from cigarettes.

Adriana Blanco Marquizo: This year is the 20th anniversary of the adoption of the convention in the World Health Assembly. But at the same time, we are 18 years into the implementation of the treaty, and still there is a lot that need to be done because the treaty is as strong as the implementation at country level. Just being party to the to the treaty does not protect the public, the people. The only protection is passing legislation.

Cary Adams: Adriana. There is a movement from many countries to get to a generational end game where people born after a certain date cannot actually purchase or use tobacco. What are your thoughts on that approach that seems to be being reflected on by a number of countries at the moment?

Adriana Blanco Marquizo: That is true. The countries that are more advanced in tobacco control and they have basically implemented many of the actions in the CTC already, they are looking for going beyond and trying to well, begin to think about solving this problem for once. Just saying that for a future generation it will not be in any moment allowed for them to consume cigarettes. The parties to the convention are interested. And in this new conference of the parties, we are going to have a discussion on the Article 2.1 of the convention, that is, measures beyond what we have, because we always said the FCTC is the floor, not the ceiling. So now the countries will begin to elaborate on what is the concept of the how we can go beyond.

Cary Adams: I am looking forward to the outcome from that discussion because I think a lot of countries will be reflecting on, you know, how it's been implemented and the legal challenges that they face in getting it through. Maik, you don't have a FCTC for alcohol, but what do you have in terms of no getting commitments from countries around the world to address alcohol in a similar way as potentially we have through the CTC and tobacco.

Maik Dünnbier: As you said? Cary we don't have a framework convention on alcohol control. I would say we have momentum towards something similar. Many countries are talking about a global binding treaty, I think. Exactly because they're experiencing the benefits of the FCTC. We have the Global Alcohol Strategy from 2010. That is the foundation for alcohol being included in the Sustainable Development Goals and in the NCDs Global Action Plan. So we have the alcohol policy best buys for us, it's taxation advertising ban and common sense limits on alcohol availability. So we have also increasing knowledge about the return on investment from these alcohol policies. Best Buys governments have now clearly said that action on alcohol as a public health priority needs to be accelerated. They want more support from WHO for country work, for country impact. So I think we have things in place that alcohol will also be more often on the agenda of the WTO governing bodies. There are incredible success stories in alcohol policy implementation, Cary. I think all this will inspire more and more action at the country level.

Cary Adams: What can we do to support the great work that you're doing, Maik, and the great work that you're doing, Adriana. What is your call out to the cancer community?

Adriana Blanco Marquizo: If someone who is listening to us is in a position  of taking decisions in the country, of course what they need is to really try to strengthen the implementation of the FCTC because the FCTC is science based. Everything that is in the CFTC, there is no doubt about the effectiveness of that measure for the common people. I will say, okay, hold your governments accountable, okay? And request your right to not to be exposed. For example, the right of having a smoke free environments in public places and workplaces, your right of your kids not being bombarded by marketing of  this industry. Your right if you are a smoker to have some help to to quit smoking. So I think that these are right of the population based on the fact that this is to ensure the higher level of quality of life for people.

Cary Adams: Maik, what about yourself? What can the cancer community do for you and your great organisation.

Maik Dünnbier: Awareness raising about the link between alcohol and cancer. That is very important and looking for the possibility of local partnerships. I think, secondly, carry support for alcohol policy solutions. It's amazing how effective raising alcohol taxes is for preventing and reducing the cancer burden in a country. So alcohol policy is a really good catalyst for cancer prevention. So, you know, identifying corporate social responsibility, deployments of the alcohol industry in local communities, exposing the alcohol industry and protecting cancer prevention, cancer control activities from co-option by the alcohol industry is really important at the local level. Sometimes that means to ditch funding. I think that's a reality that we just face in different countries. And last but not least, working together, I think towards the health care system, informing cancer patients about the link between alcohol and cancer. One and a half years ago, my uncle passed away from cancer and he never got the information that both tobacco and alcohol he should stop using. So until his last days, he was smoking and having beer. And I mean, it just broke the heart of my mom, as everyone can imagine. And so there is so much to be gained also in informing patients. As Adriana said, people have a right to know about these things, that they are carcinogenic and then they have a chance to protect themselves and I think improve their healing process.

Cary Adams: Maik, Adriana, thank you very much. It's been very, very interesting.

Maik Dünnbier: Thank you. Adriana. Thank you, Carrie. This was really fantastic.

Adriana Blanco Marquizo: It was really and we feel reinforced because we see that we are not alone in this. So I think it's very interesting to have this chat.

Cary Adams: I hope you enjoyed this episode of Let's Talk Cancer. If you're interested in the barriers to accessing healthier lifestyles, I'd highly recommend listening to our previous episode on nutrition, physical activity and obesity. And if you want to hear more on the topic of alcohol, why not check out Maik's podcast, Alcohol Issues. As always, if you have questions, comments and suggestions, please get in touch with us at or send us a message on social media. And if you want to know when we've released a new episode, why not sign up to our newsletter through our website


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Thursday 31 August 2023

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