Dear Editor,

The detrimental effects of tobacco use on health are a major concern, with an estimated 1.14 billion smokers worldwide as of 2019 and 7.69 million deaths annually¹. One aspect of the tobacco industry that raises concerns is the possibility of covert marketing to the healthcare sector², although the extent of this practice is not fully understood, particularly in Japan.

In 1986, the Smoking Research Foundation (SRF) was created when Japan Tobacco Inc. (JT) was established through the privatization of the Japan Tobacco and Salt Public Corporation. The research grants by the SRF may potentially play a role in preserving JT’s influence over the medical community through the distribution of research grants to medical professionals and researchers³. To shed light on this issue, we investigated the extent and distribution of the research grants paid by the SRF to medical professionals and researchers in 2018.

The data used for our analysis was sourced from the Annual Report of the SRF for fiscal year 2019, which was the only relevant document available to us. The Annual Report lists the names and affiliations of each project, which are categorized as either young or standard research projects.

The foundation provides funding up to 0.5 million Japanese Yen (JPY) (about 3111 sterling pound or GBP) annually for young researcher grants and up to 2 million JPY for general research projects. The exact monetary values of individual grants were not specified. Therefore, we assumed a full grant allocation of 0.5 million JPY for young researchers and 2 million JPY for general research for the sake of simplicity. When a grant covered multiple researchers, the amount was divided equally among all, including the primary investigators and other researchers.

We initially gathered all available data from the Annual Report, which included the names and affiliations of each project, along with the classification as either young or standard research. We then formatted this information into a database to facilitate further data collection on the Internet. Subsequently, the first and second authors conducted supplementary Internet searches to determine each researcher’s gender, specialty, qualifications, types of affiliations, and positions. We adhered to the classification of specialties as outlined in a previous article⁴. Regarding qualifications, individuals whose credentials did not clearly identify them as healthcare professionals based on their educational institutions or degrees were grouped together. In cases where any data were ambiguous, they consulted with the sixth author to clarify and finalize the details.

With regard to the analysis, we first calculated the total amount of research grants and average monetary value per recipient. Subsequently, we repeated this analysis for subgroups of each characteristic. The monetary value was converted from JPY into sterling pound (GBP) with an exchange rate of 160.7 JPY per 1 GBP. All the analyses were conducted using Microsoft Office Excel (Microsoft Corporation, Seattle, the United States).

Table 1 shows the distribution of research funding among the grant recipients. In total, 633 individuals received grants with a total amount of 2229148 GBP with a mean value of 3522 GBP (SD=2174.1). Of the recipients, 546 (86.3%) were male, and the most common characteristics were internal medicine (n=188; 29.7%) for medical specialty, medical doctor (n=332; 52.4%), and for qualification, national and public university (n=417; 65.9%) for affiliation, and professor (n=193; 30.5%) for position.

The study shows that in 2018, a research grant of more than 2 million GBP was allocated by the SRF, a JT-backed research organization. The funding was primarily allocated to health professionals and researchers who are considered authoritative, such as male medical doctors, national university professors, and those from prestigious institutions. These results, which have also been observed in previous studies on pharmaceutical industry payments in Japan⁵, are consistent with the hidden but original motivation behind establishing the SRF.

Given the substantial relationship between healthcare professional and researchers and the SRF, several proposals have been made to establish a system that enables researchers to conduct studies independently of such organizations. First, there is a need to secure sufficient private or public research funding. Secondly, it is necessary to educate healthcare professionals and researchers not to accept grants from tobacco-related organizations. Furthermore, grants related to smoking should be excluded from research grant introduction sites. Lastly, journals should not publish studies conducted with funding from sources associated with smoking.

Limitations of this survey include the fact that it is a single-year study and the specific monetary value of each grant is unknown. However, we believe that the methodology incorporated in this study is justifiable since the total monetary value of the research grant in 2021, which was reportedly 2.32 million JPY⁶, is similar to the speculated total amount of the grant in 2018. This indicates that a comparable amount of grant money was distributed from the SRF between 2018 and 2021.