Big Tobacco: Role Model or Pariah for the Pharmaceutical Industry?

This article was written by Nicholas Freudenberg for the Symposium of the Geneesmiddelenbulletin on June 30th 2016 in Leiden ’Science and Economy’. It was also translated and published in the Symposium-issue and in the July-issue of the bulletin.

Nicholas Freudenberg is Distinguished Professor of Public Health at the City University of New York School of Public Health. E-mail:

In the last two decades, the public health community has generally agreed that the tobacco industry has no role in setting health policy or sponsoring research on tobacco. The Framework Convention on Tobacco Control bans industry participation in policy deliberations on Tobacco1, most major global public health organizations and national health departments have sharply limited their interactions with representatives of the tobacco industry, 2 and many universities and some journals no longer accept or publish research supported by the tobacco industry. 3

However, no such agreement has been reached on the appropriate role for corporations and trade associations in other sectors such as pharmaceuticals, food and beverages, and alcohol. Some health and business analysts emphasize that the different roles that the products of the tobacco, medicines, food and alcohol industries play in patterns of health and disease make any judgements inappropriate and misguided, especially in the case of the drug industry.4 5 ’Such comparisons (between the tobacco and pharmaceutical industries) are not just absurd, they are irresponsible as they contribute to patients not taking prescribed medicines that can clearly benefit them’, wrote one former drug industry executive.6

Other health researchers make the case that while the products may differ, the practices of the tobacco industry that led public health officials and researchers to disassociate themselves from this sector (e.g., deception on health harms, aggressive marketing, and political interference with health regulations) are also followed by food and beverage, alcohol and pharmaceutical corporations.7-9 In this view, the tobacco industry has served more as a role model to emulate than a pariah to be avoided and the corporate playbook this industry created in the decades after World War II has guided Big Pharma, Big Food, and Big Alcohol in their interactions with governments, consumers, and health and regulatory agencies.

In this review, I examine the evidence for these two positions by comparing the business and political practices of tobacco industry and the pharmaceutical industry, two sectors that play very different roles in contributing to global patterns of health and disease. The goal of this comparison is to gain insights that can guide the development of appropriate government and corporate roles for protecting population health from harmful corporate practices.

Clearly, the products of the tobacco and pharmaceutical industries are different. The former produces and sells tobacco in various forms that are the world’s leading cause of premature death and preventable illnesses, associated with 100 million deaths in the 20th century and an estimated one billion deaths in this century if current smoking patterns continue.10 Pharmaceutical companies, on the other hand, produce essential medicines that save millions of lives each year and reduce the burden of suffering for tens or hundreds of millions.11 Both industries, however, follow practices such as a trend towards market concentration12 and tax evasion13 that are no different than the practices of other transnational corporations.

Box 1. Business and Political Practices.

Business Practices Political Practices
Practices that contribute to profitability, return on investment and increased market share Practices that create economic and political environments that allow companies to advance their business goals and minimize threats to profitability
Product design
Retail distribution
Campaign contribution
Sponsored scientific research
Public relations and media advocacy


  • Prof dr N. Freudenberg