The development of scientific consultants: how the tobacco industry creates controversy on the carcinogenicity of tobacco-specific nitrosamines.

BACKGROUND: Tobacco-specific nitrosamines (TSNAs) are a group of carcinogens, which originate from nicotine and other tobacco alkaloids during fermentation and burning of tobacco. Between 1990 and 2010, the tobacco industry-funded extensive academic research on TSNAs in Germany. The objective was to gain better knowledge of how industry aims and strategies correlate with contents of publications by German toxicologists accepting tobacco industry funding by focusing on one prominent such toxicologist. METHODS AND FINDINGS: The authors analysed previously secret tobacco industry documents that were disclosed following a series of litigation cases in the USA and compared them with peer-reviewed published results of tobacco industry-funded toxicologists. The tobacco industry, in particular Philip Morris, developed sophisticated strategies to downplay TSNA's carcinogenic potential. Over 2 decades, German toxicologist Elmar Richter, faculty member of the renowned Ludwig-Maximilians-University, Munich, received substantial financial support from the tobacco industry. Numerous publications show that his research findings supported the aims of the tobacco industry. In his commissioned work, he suggested that TSNA burden can be explained by misclassification of smokers or assay background levels caused by TSNA-like molecules from food. Other publications cast doubt on the relevance of animal testing for TSNAs to humans claiming a detoxifying effect of nicotine on the metabolism of TSNAs or suggesting that adducts of TSNAs are unsuitable as biomarkers of exposure to tobacco smoke. CONCLUSIONS: Economic interests of the tobacco industry have strongly influenced the research activity of Richter and his group. The publications of his working group about carcinogenic effects of TSNAs published between 1992 and 2009 should therefore not be regarded as independent. Scientists and policy makers should consider the long-standing and intensive inter-relation between certain toxicologists and the tobacco industry when assessing the research results and consider ignoring them.

Tobacco use and cessation among medical students in Croatia--results of the Global Health Professionals Pilot Survey (GHPS) in Croatia, 2005.

OBJECTIVES: To collect information from third year medical students attending Croatian medical schools on prevalence of cigarette smoking and other tobacco use, exposure to second-hand smoke, desire to quit using tobacco, attitudes and training concerning counselling patients on tobacco cessation. METHODS: Global Health Professionals Survey (GHPS) was conducted in 2005 in all four Croatian medical schools with a census of third year medical students (404 out of 409, response rate 98.5%) using an anonymous, confidential and self-reported questionnaire. RESULTS: More than two thirds (67.4%) of medical students in Croatia have ever smoked cigarettes, and over one third (36.6%) are smoking cigarettes currently. Half of the medical students (50.4%) report exposure to second hand smoke at home. Less than a third of current smokers (30.9%) have received cessation assistance when they tried to quit. CONCLUSIONS: Our findings indicate significant tobacco use among medical students in Croatia. There is an urgent need to reduce this harmful behaviour through more comprehensive public health initiatives, provision of support for cessation among health professionals who smoke and provision of training to health professionals to assist their patients with cessation.