The main strength of this study is that it is the first independent assessment of the effectiveness of industry misinformation, with direct comparisons across a range of industries which affect public health. The study also shows that the effects of industry misinformation on uncertainty have now been shown directly and experimentally, as opposed to inferred (e.g. from industry documents).


N. Maani (E-mail:, M.C.I. van Schalkwyk, F.T. Filippidis, C. Knai, M. Petticrew


N. Maani, M.C.I. van Schalkwyk, F.T. Filippidis, C. Knai, M. Petticrew, Manufacturing doubt: Assessing the effects of independent vs industry-sponsored messaging about the harms of fossil fuels, smoking, alcohol, and sugar sweetened beverages, SSM - Population Health, Volume 17, 2022, 101009, ISSN 2352-8273,

SSM - Population Health Volume 17, March 2022, 101009
Release date

Manufacturing doubt: Assessing the effects of independent vs industry-sponsored messaging about the harms of fossil fuels, smoking, alcohol, and sugar sweetened beverages

Research article



Manufacturers of harmful products engage in misinformation tactics long employed by the tobacco industry to emphasize uncertainty about scientific evidence and deflect negative attention from their products. This study assessed the effects of one type of tactic, the use of “alternative causation” arguments, on public understanding.


In five trials (one for each industry) anonymized Qualtrics panel respondents were randomized to receive a message on the risk in question from one of four industry sponsored organizations (exposure), or from one of four independent organizations (control), on risks related to alcohol, tobacco, fossil fuel and sugar sweetened beverages.

Logistic regression models were used to evaluate the effect of industry arguments about uncertainty on the primary outcome of public certainty about product risk, adjusting for age, gender and education.

The results from all five trials were pooled in a random-effects meta-analysis.


In total, n=3284 respondents were exposed to industry-sponsored messaging about product-related risks, compared to n=3297 exposed to non-industry messages.

Across all industries, exposure to industry-sponsored messages led to greater reported uncertainty or false certainty about risk, compared to non-industry messages.

The effect was greater among those who self-rated as not/slightly knowledgeable, or moderately knowledgeable compared to those very/extremely knowledgeable.


This study demonstrates that exposure to industry sponsored messages which appear intended to downplay risk significantly increases uncertainty or false certainty, with the effect being greater in less knowledgeable participants.


  • Alternative causation (AC) arguments are used by harmful product manufacturers to dispute product-harm relationships.
  • Such arguments are used to present alternative, misleading explanations for product harms.
  • Survey panellists were randomized to read industry AC arguments or a factually correct statement about product risks.
  • AC arguments generated significantly greater uncertainty about harms of tobacco, alcohol, sugar sweetened beverages and fossil fuel harms.
  • The ubiqitous nature and effects of industry AC arguments pose a significant challenge to public health.

Examples of how health harmful industries manufacture doubt

TopicIndustry-sponsored textsNon-industry-sponsored texts
Smoking and lung cancer“Cancer is a very complex disease. Many factors have been associated with this disease besides smoking, including occupational and environmental exposures, diet, viruses, heredity and stress. Clearly there are many gaps in knowledge about lung cancer that only further research will resolve.”  

Source: BAT ‘Claims and Responses’ document (1992)
“Smoking cigarettes is the single biggest risk factor for lung cancer. It’s responsible for more than 70% of cases.
Tobacco smoke contains more than 60 different toxic substances, which are known to be carcinogenic (cancer-producing). If you smoke more than 25 cigarettes a day, you are 25 times more likely to get lung cancer than a non-smoker.”
Source: NHS UK
Alcohol and breast cancer“It’s important to put the risks from drinking alcohol into context. There are many other factors that increase the risk of developing breast cancer, some of which we can’t control, like:
– Age: you’re more likely to develop it as you get older
– A family history of breast cancer 
– Being tall 
– A previous benign breast lump
However, in addition to alcohol, other lifestyle factors such as being overweight and smoking are thought to increase your risk of developing breast cancer.”

Source: Petticrew et al, 2017 (Drinkaware, UK)
“Alcohol is a Group 1 Carcinogen.
Like Tobacco.”

Source: Balance North East
“Some studies show a link between alcohol and breast cancer among both pre-menopausal and post-menopausal women. However, no causal relationship has been shown between moderate drinking and breast cancer.”

Source: Source: Petticrew et al, 2017 (EducAlcool, Canada) – has been removed from their website now
“The Chief Medical Officers advise: 
Alcohol can cause cancer, including breast and colon cancers”

Source: Warning message from Hobin et al, 2020
“Breast cancer is the leading cancer among women, and is associated with a large number of individual risk factors. Research has shown that breast cancer risk is associated with family history and hormonal and reproductive factors. Increased risk has been reported with hormone replacement therapy, but varies by the type of breast cancer (ductal, lobular, or mixed). Similarly, risk associated with other reproductive factors, such as age at menarche or breastfeeding, have been shown to differ by cancer subtypes. According to IARC, cancer of the female breast is causally associated with the consumption of alcohol beverages.”

Source: Petticrew et al, 2017 (International Alliance for Responsible Drinking (IARD), global)
“For some cancers, any amount of alcohol increases the risk. For other types of cancer, the risk only increases after drinking two or three drinks per day – around 26 to 35 units per week.
Any amount of alcohol increases the risk of:
– Mouth cancer
– Upper throat and voice box cancer
– Food pipe (oesophagus) cancer
– Breast cancer”

Source: Alcohol Concern information on alcohol and cancer (now Alcohol Change)
Risk of Foetal Alcohol Syndrome from alcohol consumption“Some studies have shown that among pregnant women who drink heavily, smaller women are more likely to give birth to a child diagnosed with FASD, although other studies report an association with higher BMI … there is not necessarily a causal relationship between all potential risk factors and FASD. For example, other maternal risk factors include drinking alone, family members who abuse alcohol, having less stable domestic partnerships, and being at risk for domestic violence.… FASD births are more common in women with low socioeconomic status and educational level” 
Source: Lim et al, 2019 (International Alliance on Responsible Drinking (IARD), global)
“Foetal alcohol syndrome is completely avoidable if you don’t drink alcohol while you’re pregnant.  The risk is higher the more you drink, although there’s no proven “safe” level of alcohol in pregnancy. Not drinking at all is the safest approach.”
Source: Source: Lim et al, 2019 (NHS Choices, UK)
“There is confusion about how much
one can safely drink during pregnancy.
We know very clearly that excessive
amounts, either in isolated binge drinking or in prolonged drinking, are very harmful.
What we don’t know for sure is the lowest possible level that you can drink safely. We therefore say, for that reason, the safest possible thing that you can do is to not drink at all during pregnancy or while you’re breastfeeding.”
Source: Lim et al, 2019 (Drinkwise, Australia)
“If you are pregnant or planning a pregnancy, the safest approach is not to drink alcohol at all, to keep risks to your baby to a minimum.”
Source: UK Chief Medical Officer Guidelines
Sugar-sweetened beverages and obesity“Obesity is a complex phenomenon. If there were a simple, direct connection between the consumption of sugary refreshment drinks and obesity, it should be in the statistics. But, according to the data of the World Health Organization (WHO), this assumption is not true. One example: In countries like Finland, where young people consume very few soft drinks, there is a high rate of overweightness. In the Netherlands it is the exact opposite.”

Source: Coca-Cola public statement
“Recent evidence suggests that sugar sweetened beverages consumption is positively associated with or has an effect on obesity indices in children and adults.”

Source: Luger et al, 2017
Supplementary table 1: Industry-sponsored and non-industry-sponsored statements used in Qualtrics panels (all statements were anonymized) by topic and funding source

Study conclusion and solutions

This study shows that industry-sponsored information leads to significantly greater uncertainty – or false certainty – about the risks posed by harmful products compared to independent information. This difference is largest where participants’ prior knowledge is moderate or low. The misinformation effects are greatest in relation to the links between alcohol and breast cancer, and between fossil fuels and climate change. The overall effect of industry misinformation is large, increasing the odds of an inaccurate perception of the risk by around 60%.”

Among those who self-reported low knowledge in the topic beforehand, the effects of manufacturing doubt were greater.

The findings on level of prior knowledge are relevant in the context of existing inequalities. Tobacco, processed-food and alcohol companies have been found to target their marketing at those ethnic and socio-economic minority groups who already consume at more harmful levels, or have a lower level of knowledge about the harms. The same groups are more likely to be affected by the health impacts of industry products and practices, including tobacco, alcohol, SSBs and climate change.

The forms of misleading misinformation, and the observations that the impact is greatest among those who are moderately or slightly knowledgeable, suggested that information campaigns that include a counter-marketing component that expose the strategies adopted by industries to undermine public knowledge may be particularly important.

The potency of this misinformation is of concern in part because exposure to it is widespread. Compared to the tobacco industry, which has now been prevented from many forms of public engagement, the fossil fuel, alcohol, and sugar sweetened beverage industries have far wider access to the public as conveyors of misinformation, including by funding charities with the express purpose of communicating on product harms to the general public, as well as to children and young people through schools.

By way of example, Drinkaware, an alcohol-industry-sponsored group in the UK, whose misinformation is used in two of the study’s examples, is named on most alcohol-related advertising labels, posters and adverts, and its website, from which the information used in this study was obtained, received over 10 million unique visitors in 2018 (DrinkAware. Impact Report, 2018).

The impact of these messages is a function of both their potency, and their breadth of exposure.

Source Website: Science Direct