Taylor ConradA UCSF researcher presented his study to Mills students on the lobbying tactics of tobacco companies to ensure Medicaid and Medicare coding procedures that would be favorable to the company.
In “The Power of Paperwork: How Philip Morris Neutralized the Medical Code for Secondhand Smoke,” published in the Journal of Health Affairs in August, Daniel Cook and co-authors trace Philip Morris’ efforts to prevent the creation of a medical tracking code for secondhand smoke in the early ’90s.
Cook said to Mills students on Oct. 11 that the U.S. government uses modified forms of the World Health Organization’s ICD-9 codes, used by physicians on common medical forms, to document the external cause of a patient’s injury or illness. This tracking system enables public health researchers to estimate the national costs associated with each injury or illness as well as identify prevention strategies.
“As we have seen with the census, how we gather statistics is very political,” Cook said.
Cook and co-authors used online documents made public under the 1998 Masters Settlement Agreement, in which the nation’s top five tobacco companies were forced to hand over their internal documents, make compensatory payments to states and potentially face greater accountability for their actions.
The UCSF research reveals that when the secondhand smoke code was ultimately adopted in 1994, Philip Morris spent at least $2 million to protect the company from the potentially damaging consequences of a national medical record documenting the connection between illness and secondhand smoke.
Documents turned over to Cook and his colleagues by Philip Morris indicate that the tobacco company was troubled by the power of physicians to attribute patient death or illness to secondhand smoke and likewise feared that the new code would create an associative link between secondhand smoke and national health costs.
Secretly adding retired bureaucrat James Tozzi to their payroll, Philip Morris campaigned to challenge the code’s validity on a Medicare billing document in 1994 and 1995 Cook said. In 1996, Philip Morris began advocating for an alternative system that would be more favorable to the company.
What the UCSF research team uncovered was not unusual. Such lobbying is more the rule than the exception, said Mills Health Economics professor Eirik Evenhouse. “This is a great example of how vested interest impacts policy,” he said.
The research was funded by the American Legacy Foundation, which was founded in 1999 with funds generated from the Masters Settlement Agreement. The Legacy Foundation chose to allocate $15 million to UCSF because the university has played a decisive role in the nation’s struggles against big tobacco companies, dedicating much of their resources to anti-tobacco research.
Under the settlement, tobacco companies are required to release any documents arising from ensuing litigation, which UCSF will continue to add to their online library.
“This is a great example of how vested interest impacts policy,” Cook said.
The archives publicized under the Masters Settlement Agreement, can be viewed at www.library.ucsf.edu/tobacco/.
