Being in the business of driving up your own health care costs --
is a tough place to be. But Philip Morris was up to the challenge. According to the August 2004 issue of American Journal of Public Health (I have access to a departmental subscription at work), from 1996 to 1998, Philip Morris collaborated with its health care provider, CIGNA, to "censor accurate information on the harm of smoking and on environmental tobacco smoke exposure from CIGNA health newsletters sent to employees of Philip Morris and its affiliates." The agreement came to light after Blue Cross/Blue Shield and the state of Minnesota sued the tobacco industry and won access to business documents in the settlement. "The arrangement between Philip Morris and CIGNA involved the active participation of employees from both the tobacco company and the health insurer," the authors write. Employees of the Philip Morris benefits department would review each issue of CIGNA's Well-Being newsletter for "objectionable" material. If a "problem" was discovered, the tobacco company had a choice of (1) blocking delivery of the newsletter altogether or (2) replacing the article with alternate content. Sometimes CIGNA employees alerted Philip Morris employees to potentially objectionable content, as in this quoted communication: "Please take a look at page 7, the asthma piece. It mentions cigarette smoking as a possible trigger for an attack, I thought I should bring that to your attention." Other times, Philip Morris employees would raise the objection: "It contains some objectionable content referencing smoking. Specifically, the article lists 'cigarette smoking' as one of the irritants in the environment which can trigger an asthma attack. The article goes on to say 'Do not allow smoking in your home or any other environment that you can control.'... It is my recommendation that we forego the winter edition due to content..." The astonishing agreement to censor smoking-related content apparently ended in 1999, as a result of the aforementioned settlement. I am not at all surprised that Philip Morris did this, but for their health insurance carrier to collaborate! -- boggles the mind. As the authors note:

While this arrangement no longer exists, the potential for similar arrangements involving other industries is a matter of concern. Have paint manufacturers asked for censorship on the hazards of lead paint? Have gun makers asked that their employees not read about statistics on gun-related violence?

Obviously this list could be extended... pesticide manufacturers, HRT manufacturers, etc. The authors' wise recommendation is that those agencies that accredit managed care companies "mandate that health plans not censor employee-directed health information at the request of employers."