Kill or cure—confused messages from Japan Tobacco

Kill or cure—confused messages from Japan Tobacco colony stimulating factor. n Oct 18 the US company The Corixa deal gives Japan Genzyme announced had it had Tobacco the exclusive right to formalised an agreement to acquire develop vaccine products containing Cell Genesys for approximately Corixa’s lung-cancer antigens. Jim US$350 million. This move follows Denike, director of corporate coman agreement by the pharmaceutical division of Japan Tobacco, the world’s third-largest tobacco company, to purchase the rights to therapeutic and preventive lungcancer vaccines under development by Cell Genesys and another American biotechnology company, Corixa. If the vaccines are approved, Japan Tobacco will find itself in the unusual position of marketing products that cause, prevent, and treat the same disease. Last week, the largest cigarette Source of revenue for vaccine development manufacturer in the USA, Philip munications for Corixa, confirmed Morris, for the first time acknowlparts of a COMLINE wire report edged the evidence that smoking is stating that the agreement includes the cause of several diseases includthe development of preventive vacing lung cancer. On a new internet cines for lung cancer. The preventasite, Philip Morris said there is an tive vaccine is being developed “overwhelming medical and scienaccording to the theory that one can tific consensus that cigarette smokstimulate the production of complex ing causes lung cancer, heart disease, protein antigens that hinder the penemphysema and other serious disetration of external substances that eases in smokers”. The company also foster the development of cancerous admitted that cigarette smoking is cells in the lung. addictive. Until now the company Japan Tobacco seems to be pursuhas strongly contested that cigarette ing a strategy of creating a high level smoking is an unhealthy and addicof synergy between its product divitive behaviour. sions. The company sells more than By contrast, Japan Tobacco 250 billion cigarettes a year, and continues to deny a causal link hundreds of thousands of smokers between smoking and lung cancer. (many of whom are Japan Tobacco’s Hironori Mizuguchi, a spokesperson customers) contract lung cancer each for Japan Tobacco, said that “it is year; Japan Tobacco then stands to quite difficult to identify something profit from the treatment of patients as the sole cause of lung cancer with lung cancer (the pharmaceutical because it is associated with many division of the company is also develfactors. Cause and effect between oping treatments for diabetes and smoking and lung cancer has not cardiovascular disease). been proved pathologically but we Mizuguchi, said that “JT’s phardo not deny the risk that smoking maceutical division has its own busimay affect physical health”. ness mission, which is to develop Nevertheless, the the company is innovative drugs. The focus of the investing millions of dollars in lungcollaboration with Corixa was on the cancer research. innovation of Corixa’s technology. During the past year, Japan The focus of that medicine happened Tobacco has signed agreements with to be lung cancer”. Cell Genesys and Corixa to develop Japan Tobacco’s pharmaceutical cancer vaccines. Payments and loans division was created as part of a for the deals could surpass US$170 diversification plan instituted when million during the next few years. the company was privatised in the The Cell Genesys deals are for the mid-1980s. Japanese law requires the company’s GVAX vaccines (curMinistry of Finance to maintain a rently in phase II clinical trials for controlling interest (now about 67%) prostate cancer and phase I/II trials in the company. The pharmaceutical for lung cancer) which are comprised division is small by international of tumour cells that have been irradistandards—sales for the year ending ated and genetically modified to March 31, 1999, were $534 million secrete granulocyte macrophage

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between Japan Tobacco and recently acquired Torii Pharmaceuticals. Nevertheless, Japan Tobacco is investing heavily in the division’s future, having constructed a $300million research facility in Osaka in 1993. With annual revenues, mostly from cigarette sales, in excess of $32 billion dollars a year, Japan Tobacco can afford to spend what it takes to become a major player in pharmaceutical development. The company plans on losing money on the pharmaceutical division until 2005. The company is pursuing a bold yet dangerous strategy. Japan Tobacco has, throughout most of its history, operated as a protected monopoly. This year, they bought the non-US business of R J Reynolds, which makes the Camel and Winston cigarette brands, instantly becoming a major international player. Although Japan Tobacco acquired a significant share of the worldwide cigarette market through the acquisition, the company also inherited some liabilities. Global tobacco companies have low credibility with the public and little credibility with the scientific community because of the years of denial regarding the health effects of smoking. Japan Tobacco seems to be planning to continue that tradition of denial while having the cooperation of the medical community to test, approve, and prescribe its drugs. This year’s acquisition of Torii, a Japanese pharmaceutical company, shifts Torii’s research and development activities to Japan Tobacco and assigns the marketing of all of Japan Tobacco’s products to Torii in Japan. This effectively creates a marketing subsidiary through which Japan Tobacco can sell its products under another name. Japan Tobacco’s best-selling product, the protease inhibitor Viracept (nelfinavir, co-developed with Agouron), is marketed by other pharmaceutical companies, even in Japan. As Japan Tobacco’s investment in its pharmaceutical division reaps benefits in new products, clinicians may be faced with some troubling ethical issues, especially since WHO estimates that smoking will soon be the number one cause of death worldwide. Sean Murray

THE LANCET • Vol 354 • January 00, 1999