In early April 2021, a report funded by alcohol interests, led by what was described as an independent data expert and two academic statisticians, was released. The report, “A deep dive into the relationship between trauma admissions and lockdown measures during the Covid-19 pandemic in South Africa: A high-level overview”, has as its aim (although it is not explicitly stated) an attempt to “establish with certainty whether there actually does exist a clear causal link between alcohol bans during lockdown and trauma admissions”.
The news organisation BusinessTech made it clear that it had little doubt about the conclusions of the report as evidenced by their headline “New research highlights major flaws in South Africa’s lockdown alcohol bans”.
The authors of the report have cleverly situated their report in a vast grey space between a rigorously peer-reviewed academic paper and an opinion piece that targets the public. Were this a peer-reviewed journal article it would be immediately rejected based on insufficient description of statistical assumptions and statistical methods, poor referencing and insufficient detail about data being used. Of course, the authors of the report might respond that their target is not a journal but government and the public. Here too, however, there is a problem – the paper is littered with terms and figures that require a level of statistical understanding that most members of the public simply do not have. Is this positioning in this vast grey space an accident or is it by design?
In the early 1950s the tobacco industry was facing a massive crisis. The first conclusive evidence of the toxicity of smoking, the link between smoking and lung cancer, and even the dangers of passive smoking were beginning to emerge. In 1953, the CEOs of all the major rival USA tobacco companies met in the Plaza Hotel in New York to hatch a plan to deal with this emerging evidence, and the sensitive issue of reports such as the front cover of Reader’s Digest at the time, that ran with the title “Cancer by the Carton”. Their response was multipronged, but the major component was enlisting the services of John Hill, the founder of the public relations firm Hill+Knowlton.
In a stroke of genius, Hill suggested a focus not on discounting or trying to directly counter the evidence, but rather developed a strategy to slowly and systematically sow doubt, to manufacture uncertainty and hesitancy in the minds of policy makers and the general public about any link between smoking and lung cancer. This has become known as the “tobacco playbook” – recently powerfully described in a 10-part BBC Radio 4 podcast series “How They Made Us Doubt Everything” (Also, see: “Merchants of Doubt: How a Handful of Scientists Obscured the Truth on Issues from Tobacco Smoke to Global Warming” by Naomi Oreskes and Erik M Conway; and “Doubt is Their Product” by David Michaels.)
The playbook was so successful that it delayed any meaningful legislative control of the tobacco industry in the USA for 40 years. But what does the playbook suggest, and how does the report draw heavily on it?
Manufacture and create doubt at every opportunity
Do not worry too much about facts. Your task is to sow doubt about the scientists, the science, their data and by doing this you will achieve the same aim. The metaphoric page 1 of the original tobacco playbook was the explicit instruction to use the word “theory” at every opportunity. Always state that the link between smoking and lung cancer, or the link between burning fossil fuels and global warming “is a theory”.
In the 21st-century adaptation of the playbook being used in the report, the word ‘theory’ has been replaced by the word ‘causal’. In the report the word theory is not mentioned once, but the word causal appears no less than 12 times – even underlined the first time it appears. “State firmly that causality has not been established and in so doing you will ‘create doubt, and doubt is your friend’”, as the BBC programme notes.
This is particularly clever. Showing causality, at population level – even conceded by the authors of the report – in the midst of a pandemic is of course impossible. What the authors of the report do not tell us is that there are other ways of determining causality (using for example the Bradford Hill criteria). But the way the report so cleverly positions itself in that grey space of semi-respectability – who cares about the Bradford Hill criteria, and in fact who truly even knows the difference between correlation and causation? No problem, because the issue is not really proof – only doubt.
Do not fear facts – even if they make you look bad
Do not push back too hard against the science and the data as there will always be new data about the damage that tobacco, sugar or alcohol inflicts. Avoid the outright public rejection of negative statistics. So in response to statistics that show how the direct and indirect harms of alcohol to South Africa is approximately R277-billion, or between 10% and 12% of Gross Domestic Product each year, the alcohol lobby selectively quotes data with qualifiers such as “total percentage of cases where alcohol has been confirmed”. Of course, nobody is going to actually ask what is meant by “confirmed” or what it takes to confirm the link.
Ingeniously this subtly muddies the data and understanding. Also, make sure through the money you spend conducting media training that your spokespeople litter their speeches with words such as ‘choice’. “Alcohol is not the problem, instead it is people who abuse alcohol and drive drunk who are the problem.”
This echoes other similar scripts from the playbook such as “we live in a free world, if people want to smoke they should be free to choose”, and even in the oft-quoted proclamation in the USA about how “guns are not the problem, but rather bad people with guns are”.
Use friendly ‘white coats’ and scientists as your allies
The tobacco playbook strategy entails enlisting doctors and scientists (“white coats”) to argue their case. They knew implicitly that people would question the “objectivity” of a tobacco company executive. But people will believe a doctor or a scientist. Make sure to enlist a doctor or scientist to be your allies and to be the “credible front of the campaign”.
In the tobacco playbook the tobacco industry could always rely on the services of Dr Frederick Seitz, a prominent physicist from Rockefeller University who also led the National Academy of Sciences in the USA. Dr Seitz not only consistently cast aspersions on the science underlying the link between smoking and lung cancer but went on to bigger things and became one of the most prominent climate change sceptics.
The best thing about the playbook is its extraordinary versatility. It can be used for smoking, sugar, fossil fuel, alcohol and will soon, I predict, be used by gambling advertisers to manufacture doubt about the harm that gambling advertising and gambling wreaks on children and adolescents globally. Watch this space.
Avoid declaring interests
Make sure that you frame your publications as “independent” and make sure the media describes your reports as “objective”. The fact that alcohol interests are paying for this report, and that according to the Mail & Guardian one of the authors is a prominent member of a lobby group that is against lockdowns, makes the notion of “objectivity” in this report utterly oxymoronic.
Of course, accepting payment for writing a report or even being part of a lobby group is not by definition a conflict of interest, but without a declaration of interests on the part of the authors of the report, it is impossible to even begin to assess this. On this issue alone, the report should be treated with a large pinch of disdain coupled with a massive dose of scepticism.
The tobacco playbook is ubiquitous, and its key worth is that it can be easily (and dangerously) marshalled against any global cause or issue. It is inspired in how it uses the very strengths of science – curiosity, scepticism, doubt – against science itself.
But it does this without holding itself to the concomitant rigours of science such as transparent peer review, declarations of interests, or clarity and a willingness to embrace uncertainty in order to advance knowledge. It says to commercial interests marketing harmful substances “go wild, sow doubt, manufacture scepticism about science and scientists, and continue to sell your toxic product unencumbered by pithy concepts such as facts, truth, regulations, public health or community safety”. DM