Word wars and tobacco control

UPDATE: A short-list of the best have now been selected – place your vote now!  Congratulations to the nominees and good luck!

Ruth Malone, Editor

To help officially launch the Tobacco Control Blog, this month’s Editorial has also been posted to the blog and is ready for your comments. The aim of this blog is to stimulate debate, generate ideas and explore new and, at times, controversial ideas. Increasing the opportunities for interaction between readers, authors, and editors is essential to ensuring that the journal remains on the leading edge in today’s world of instant and constant digital communication. In keeping with this theme, editor Ruth Malone raises the issue of how important language is in defining and framing the tobacco pandemic and challenges readers to share their own creative ideas for “language weapons.” To entice you to join the conversation and make a suggestion, the best idea will win a one-year online subscription to Tobacco Control.

Tobacco Control Editorial Team


Ruth Malone writes

Some of the most impressive work in the global tobacco wars is never noticed within the battlefields of city councils, legislatures, regulatory agencies or courtrooms. Instead, it is carried out much more subtly, on the front lines of everyday word wars. Words not only represent and describe, they also reflect and constitute our very understanding of what the issues are: they ‘make reality’. Smoking denormalisation and tobacco industry delegitimisation, so critical to 21st century tobacco control efforts, did not just naturally extend from an earlier focus on telling individuals not to smoke and helping individuals quit one by one. Rather, a few thought leaders began to put into language fundamentally new ways of talking about tobacco as a societal problem. For example, the brilliant ‘vector’ analytic of LeGresley(1) changed forever the way public health views the tobacco industry.

Contemporary philosopher Charles Taylor identified three important aspects of language(2): first, in language we formulate things, bringing to full awareness what we may have previously understood only implicitly. Taylor shows how, when we can’t articulate something, we are also unable to decide how to focus on it, how different aspects of it may be related, how it figures amidst other things. When we finally break through and find the words for it, this new language allows us to better understand its boundaries and grapple with it in new ways. Thus, when LeGresley and others pointed out in fresh language the parallels between tobacco companies and the mosquitoes that transmit malaria, they brought to the forefront of public attention the need to address the supply side of the tobacco disease epidemic.

Second, language puts things into a public space where we can share understandings—but beyond that, Taylor says, it actually creates that public space or shared vantage point. This is not merely a matter of communicating ‘information’; it also creates an ‘us’. Taylor gives an example of two people riding in a hot train car. One turns to the other and says, ‘Whew, it’s hot’. Each person already knows this; the language is not conveying anything new. What it is doing is putting into words their shared experience, and in so doing, creating a new shared space. The laughing recognition of a then-common experience that followed comedian George Carlin’s quip that ‘a smoking section in a restaurant is like a peeing section in a swimming pool’ created a new space quickly shared by advocates in many places, who used it effectively to argue for 100% smokefree policies.

Finally, Taylor points out that language grounds our moral sense as human beings, enables us to draw distinctions about meaning based on understandings about what we value most. Language is ‘constitutive’: it shapes common understandings about our social relationships with one another, our practices, our aspirations and goals. Helping people understand that lung cancer was not always so common a disease, that we face an industrially produced epidemic, calls attention to the moral problem of corporations and individuals promoting and profiting from deadly products.

In too many places even today, tobacco use is still taken for granted and if problematised at all, is understood primarily as an individual ‘bad habit’ rather than an ongoing failure by governments to provide adequate public health-based constraints on the disease-promoting practices of powerful corporate interests.(3–5) This is why it is important for all of us to attend to how our language serves or undermines tobacco companies’ preferred framing of ‘smoking and health’ issues, of cigarettes as a ‘risky product’ and of ‘responsibility’ as comprised primarily of providing ‘information’ in a decontextualised way.(6)

Instead, we should insist on talking about ‘smoking and disease’, ‘deadly products’ and corporate responsibility as acting in a way that is consistent with being fully accountable for the effects of the products one sells when they are used as intended. We should also discontinue discussion of ‘giving up’ smoking, a construction that makes becoming free of tobacco addiction a loss rather than a gain; we should stop calling our new pack labels ‘graphic health warnings’ and instead call them ‘graphic disease warnings’. We also ought to stop calling tobacco addiction a ‘habit’, as though it were comparable to the habits of brushing one’s teeth, eating cereal each morning for breakfast, or staying up late at night reading in bed.

As Chapman argues, ‘epidemiologists’ currency in debate is probabilistic data on risk, but this is not how communities define problems, nor why they can become outraged about low-risk issues, remain indifferent to some high-risk exposures or support some policy responses and not others.’(7) Instead, new problems come to be defined through new definitions and arguments advanced by advocates using fresh language—or using old language in new ways. Tobacco Control’s readers are always seeking innovation in how we talk about what we do and the tobacco industry is continually adapting itself to new circumstances, while reframing doing the same old thing as ‘responsible’.

Do you have other ideas for new language weapons in the word wars? A free online one-year subscription to the journal awaits the best suggestion received. Please share your idea (or ideas) by clicking on “post a comment” at the TC Blog. We eagerly await your insightful, inspiring ideas. The contest closes for submission on 1 October 2010. The editorial team will compile all the suggestions, choose a set of finalists, and put the final decision to a vote by TC Blog readers.

Competing interests: Ruth Malone owns one share each of Philip Morris/Altria, Philip Morris International and Reynolds American tobacco company stock for research and advocacy purposes. She served as a tobacco industry documents consultant for the US Department of Jutice in USA vs Philip Morris et al.

1. Legresley E. A ‘vector analysis’ of the tobacco epidemic. Bulletin von Medicus Mundi Schweiz No 72.1999.
2. Taylor C. Theories of meaning. In: Philosophical papers I, Human agency and language. Cambridge, UK: Cambridge University Press, 1985:248–62.
3. McDaniel PA, Malone RE. The role of corporate credibility in legitimizing disease promotion. Am J Public Health 2009;99:452–61.
4. Wiist WH. Public health and the anticorporate movement: rationale and recommendations. Am J Public Health 2006;96:1370–5.
5. Freudenberg N. Public health advocacy to change corporate practices: implications for health education practice and research. Health Educ Behav 2005;32:298–319.
6. Balbach ED, Smith EA, Malone RE. How the health belief model helps the tobacco industry: individuals, choice, and “information”. Tob Control 2006;15(Suppl 4):iv37–43.
7. Chapman S. Public health advocacy and tobacco control: making smoking history. Oxford, UK: Blackwell, 2007.

  • Farzad

    Hi everybody, I have some ideas and pictures for anti tobocco programs, where can I send and upload them?

  • Jim Bogden

    I love the use of the disgust-invoking term “spit tobacco” to replace “smokeless tobacco.” The latter was introduced by the industry to suggest that tobacco isn’t as harmful if it is not smoked. I first heard “spit tobacco” used by Dr. Antonia Novello when she was Surgeon General some years ago.

  • Stewart Brock

    I was reading a report just yesterday on BAT’s financial results and annual report, with lots of talk about growing markets in developing countries etc. I thought it would be good to produce an alternative article, changing the focus from financial issues to disease ones, while maintaining the style of a city story. So instead of the article reading:
    “The company reported that Africa and Asia delivered the best performance, with strong volume growth in Pakistan, Bangladesh, South Korea, Nigeria and the Gulf. ”

    it might read:
    “Strong volume growth in Pakistan, Bangladesh, South Korea, Nigeria and the Gulf should lead to increased levels of addiction with excellent prospects for lung cancer growth in future decades”

  • Robbin

    So often people talk about smoking in terms of rights and individual freedom. I believe we need to counter those assertions with strong, no nonsense language. An individual’s rights end the moment they infringe on another person’s rights. An individual’s “right” to smoke tobacco ends when it infringes on other people’s right to breathe without inhaling disease-causing secondhand smoke.

  • jwatso

    Quite right, Robbin, Stewart, Jim and Farzad. But I think that Becky is hoping that we will think of better ways to PUT INTO WORDS the devastation caused by smoking. It is not easy.
    I am not sure, but I have recently seen some ideas on – where was it? – maybe the daily mail or the mirror where some people have said that tobacco is a ‘natural substance’ and so there is nothing wrong with it. I know this sounds daft, but it does have some merit if you are religious. After all, everything is made by God and God would not ‘make’ a bad thing. (Sorry to be so simplistic, but that is the way some people think, isn’t it?)

    Well, what they say is OK, but is it not true that the ancient philosophers said ‘all things in moderation’? So, yes, the tobacco plant has its uses – as a medicine – literally. (But I am not quite sure precisely what!) It makes no sense to say that one can therefore dry the leaves (or whatever), crush them and burn them and draw the smoke into one’s lungs! That is not medicinal!

    I think that the MBJ should describe precisely how nicotine can be medicinal and at the same time point out that the SUBSTANCE, nicotine, is, ethically, a good thing. But that does not mean that burning tobacco plant leaves and inhaling the smoke is a good thing! After all, the substance ‘chlorine’ is a good thing for killing bugs, but that does not mean that ‘mustard gas’ (mostly chlorine) is a good thing, does it? This would be a good reason for banning ecigs – the only good use for nicotine is ‘medicinal’, therefore only people with the knowledge of the chemistry should allowed to ‘use’ nicotine, just as chemists are the only people who are allowed to ‘use’ heroin to produce effective pain killers.

    I would like to see the BMJ produce an article or two describing the good things about the tobacco plant – the medicinal value – in order to counteract the claims of the tobacco companies (hidden agenda!) that tobacco is a ‘natural substance’ and is therefore OK.

    I think that there could be some benefit in ensuring that religious folk understand that God’s gifts should not be misused.

    It is difficult to think of words and phrases which might be good. Possibly one might think of the phrase, “The misuse of God’s gifts is evil!” Not very good, I must admit, but on the right lines. How about, “It is not God’s will that people should use a natural beneficial substance like nicotine to poison others”. Still not very good. But you get the idea.

  • jwatso

    Perhaps some other ideas might be interesting. Comedy? Many rather good TV adverts have used just a little comedy in order to amuse us while drawing our attention to some pretty serious matters. We could take the well known funny ad by Jimmy Saville – ‘clunck click’ – re seat belts as a good example. It seems to me that very many people view all groups of health activists as misanthropic or nannyish and rather dull. Perhaps a little bit of fun will drive public interest and make very good public relations as well. Must be worth a thought.

  • db

    Jwatso – you must have a weird sense of humour, there’s nothing remotely funny about the clunk-click campaign.

  • jwatso

    Personally, I have a problem. I am not a health professional, but I have read many online BMJ articles, and indeed commented on them, occasionally. I find it really difficult to understand why health professionals are not making their views known on this site. I find this hard to understand – unless it is purely a matter of the ‘newness’ of the site.

    Rather than think of the physical harm of smoking, might it not be a good idea to think of the psychological harm of smoking? New words and phrases would not be difficult to imagine – “When you smoke tobacco leaves, you disorientate your mind as well as damaging your body”. New words and phrases should be about the effect of tobacco upon the mind.

    Only if we stop emphasising the PHYSICAL can we understand the ADDICTION. The addiction impinges upon THE BRAIN. The fact that people who smoke, and those around them, may possibly PHYSICALLY suffer in some way is not important. What is important is THE ADDICTION. The ADDICTION to tobacco alters your mind and costs you.

    Perhaps the ‘new words and phrases’ need not to be about smoking as such. Maybe the abhorrence of smoking could be part of a new way of thinking. Essentially, the new way of thinking would be that mere physical pleasures are not very important. Physical pleasures are OK, but not THE BEST pleasures.

    Also, we must be aware that people who smoke tobacco know very little about the damage that they are doing to their bodies. Despite the efforts made over several decades, few people really understand how damaging smoking is. Only when they get lung cancer, or similar, do they realise how much damage smoking can do.

    Genetically, speaking, there is very little doubt that some people are more inclined than others to suffer from smoking related diseases. If we are thinking about finding words and phrases which encourage people to stop smoking, ought we not to be emphasising the fact that ONE DOES NOT KNOW WHETHER OR NOT ONE HAS THE GENETIC PROPENSITY OF SMOKING HARM? Since smoking related disease are almost always fatal, ought we not to be more circumspect in our thinking about how to persuade people not to smoke tobacco?

    Anyone with any sense can see that not everyone who smokes tobacco will suffer smoking related diseases. Most do not, but the statistical evidence is that there are many, many who do. What is the percentage of the population who do? Difficult to say since the harm can be greater or lesser. What we know for certain is some people will suffer badly and that there are many of them.

    Nevertheless, it is true that THE CORRECT words and phrases are important. These words and phrases need not necessarily be ‘alarming’. It is quite possible for these words and phrases to convey reality. Assuming that most people are sensible, the statement, “If you smoke tobacco, you MAY not suffer adverse effect, but there is a real possibility that YOU MAY DIE if you do!” could be more effective than a blanket statement that ‘smoking kills’, when almost everyone is aware that this is not true in general.

    Drastic action is not necessarily the best way forward. Indeed, in my opinion, a more subtle approach is required. As I said in my first post, published above, the BMA needs to be more PERSUASIVE than COERSIVE.

    Actually, it would make sense to understand that smokers are not fools. They know that smoking is a bad habit. Better to gently persuade than to coerce.

  • jwatso

    “Do you have other ideas for new language weapons in the word wars?”

    Ruth Malone asks for new words in order to engage in the ‘word wars’.

    Tobacco companies have massive funds to employ the best wordsmiths. We do not. The question then arises: Is it better to be pro-active than retro-active? If we are retro-active, then that means that we must wait for the Tobacco companies to speak, in which case, we must wait. That cannot be the best way forward.

    We might think of the recent oil catastrophe in the Gulf of Mexico. Did Obama wait until the oil was cleared up before condemning BP? No, he did not! He said straight away that they were to blame. We need to be pro-active.

    New words to describe the irresponsibility of the Tobacco companies are required now!

    We must understand that the multinational Tobacco companies are not really interested in the UK and Europe any more. Their markets are in India, Pakistan and China, etc. The new words need to be projected to the rulers of these nations, possibly via the UN.

    I am no wordsmith, but I can easily understand the following:

    1. If people purchase cigarettes from foreign multinationals, THE PROFITS are leaving the country.
    2. However, the COSTS, in terms of health consequences remain the country.

    Someone with greater acumen than me would have to actually translate this into words.

  • You are absolutely right. If the public knew what kind of language healthcare professionals use, they’d have different perspectives. As a respiratory therapist, we have a little language of our own. We call cigarettes, “death sticks”. I believe that is a fairly popular description among healthcare people and when I use it around my non-healthcare family members, they giggle when they hear it. Then it hits them, “oh yeah”, they say, “they ARE death sticks”.

    Between lung cancer and COPD alone, these little death sticks do quite a job. You’re right, it’s not a “nasty habit”, it’s a death habit.

    Very good point.

  • Jim Bogden’s suggestion brings to mind the concept of “Newspeak”. We must come up with more and better ways to hide the truth from the public. We must not, under any circumstances, allow the public to learn that some smokeless products are actually up to 99% less harmful than inhaling smoke. Perhaps we could get the Lancet to purge all copies of the article that reported “There was little difference in health-adjusted life expectancy between smokers who quit all tobacco and smokers who switch to snus.” http://www.ncbi.nlm.nih.gov/pubmed/17498798

    There are many more articles that report on the reduction in a variety of smoking-related diseases. All these would need to be purged. A regular Fahrenheit 451 party! Furthermore, the medical journals will have to ensure that all future published research compares the health of smokeless tobacco users to never-users of tobacco, not to the health of continuing smokers or former smokers. That way, the lie can be kept alive.

    Perhaps the slogan, “Smokeless is smoking”? Or if using more disgusting language is preferable, we could start referring to “snus” as “snot.” Would that work?

    It is better for those who cannot give up nicotine to continue inhaling smoke than to switch to a product that provides measurable health improvements. If their wheezing and coughing disappears once they switch to something like snus or an electronic cigarette, those former smokers might get the wrong idea and continue using the product—especially if they are using nicotine as self-medication.

    We know that a sizable percentage of nicotine users who cannot quit are self-medicating problems of depression, anxiety, attention deficit disorder, and memory impairments. We need some strong ad campaigns to reach these folks before they learn that their dysfunctions can be effectively controlled by switching to snus or nicotine vapor. How about, “Feeling depressed? Pop a Prozac instead of lighting up.” Or, “Feeling confused and fuzzy-headed? Light up with Ritalin instead of a cigarette.”

    Since nicotine is the only known substance that can prevent the build-up of alpha-synuclein protein deposits in the brain, we will need to convince the older population that is beginning to feel the effects of early dementia that memory lapses can be fun and entertaining. Why fight it?

    Yes, folks, all of the above observations and suggestions are made with tongue firmly in cheek. But this is no laughing matter. The Tobacco Control Community needs to wake up to the fact that the dream of being able to wipe out all nicotine use is just that—a dream. The Tobacco Control Community needs to take a step back and ask why they began this war against smokers in the first place. Wasn’t the goal to improve health? If this war is successful, forcing those who are medically dependent on nicotine to live with cognitive dysfunctions, mood impairment, or mounting dementia is not in keeping with preserving public health. If, as I suspect, the war fails, how many lives can be made healthier and longer by offering acceptable options to smokers that preserve their ability to remain functional members of society?

  • jwatso

    To Elaine Keller.

    When you say ‘snus’, do you mean ‘snuff’? I do not know what ‘snus’ is, unless it is another word for ‘weed’.

    Can I just say that I am really pleased that others have started to comment? I was beginning to feel a bit lonely!

    Oh, by the way, db, what was wrong with the ‘clunk click’ campaign? Unless you are referring to my mis-spelling of the word ‘clunk’. “Clunk click – every trip” – beautifully unrhythmical.

  • Kristina Zachry

    As a Tobacco Prevention Specialist, I work not only with youth to show them that they are manipulated by the tobacco industry but also with adults to help them with tobacco cessation. I think that, in using words to achieve these goals, it is all about how you frame the issue. The students think hard when I tell them that “tobacco is the only product that, when used as intended, will kill you” or that “inhaling smoke is not biological – a primate won't do it, they will only hold the smoke in their mouths – humans are the only ones who will inhale.” Similarly, telling people who are trying to quit smoking to “think about it as if you are breaking up with your best friend who has been deceiving you for X amount of years.” This helps them understand the emotional struggle they will face with quitting. Framing the issue properly helps break down the mechanics of quitting or fighting the industry into its basic form, which makes it easier to generalize to other things in life, which helps us understand what we are up against. Similarly, in using statistics or rates it is much better to frame the issue as, for example, “80 percent of adults do not use tobacco” rather than “20 percent of adults use tobacco” – it helps capture the social norm that most people do not use tobacco when you frame the issue in a positive way.

  • Terence A. Gerace

    Cost-free Countermarketing: “Big Tobacco” versus “toxic-tobacco companies”

    Terence A. Gerace, Ed.M., M.A., Ph.D.
    National Coordinator, Toxic-Tobacco Law Coalition

    As long as tobacco companies are permitted to market their products to each new generation of youths, tobacco control advocates will require low cost or cost-free countermarketing to discredit the companies' fraudulent advertisements and to highlight the harm caused by their products. This paper describes a cost-free countermarketing proposal that urges tobacco control advocates to substitute the words “toxic-tobacco” for tobacco and “toxic-tobacco companies” for Big Tobacco in all press releases, speeches; radio, television and newspaper interviews, counteradvertisements and proposed legislation. Then, the mass media (e.g., newspapers) will have to use the substitutions in order to properly quote advocates. These replacements will both (a) reinforce the message that tobacco is a dangerous, poisonous product for those who know this, and (b) educate those who do not know this fact. These verbal substitutions will also challenge the credibility and acceptability of toxic-tobacco companies in civilized society.

    Tobacco companies spend billions of dollars in the United States each year (1) to successfully market their addictive, lethal products. For example, the most heavily advertised cigarettes are the ones that are consumed most often by underage smokers (2). In addition to using print advertisements and point-of-purchase promotions, the tobacco industry markets its products by sponsoring sporting events, concerts, and special nights at bars (3). Even Philip Morris' current “anti-smoking” campaign in the United States appears to promote smoking by appealing to the rebelliousness of youths and by casting smoking as an attractive route into adulthood and independence (4).

    Efforts to restrict advertisements of tobacco products in the United States have been thwarted by the current Supreme Court's interpretation of the First Amendment to the U.S. Constitution (5). Resigned to this judicial environment, Bayer and colleagues have suggested that a countermarketing campaign, similar to the effective television and radio campaigns of the late 1960s and early 1970s, might be a better strategy than trying to restrict the tobacco industry's advertisements (6). They recommend funding the campaign by adding a federal tax to each pack of cigarettes that would raise about $2 billion each year, or about 20% of what the top six cigarette companies in the United States spend on advertisements and promotions (1).

    Although recent counteradvertisements appear to reduce smoking initiation rates in youths (7), they are in great danger of being inadequately funded in the future (8). Nevertheless, each new generation of youngsters needs to be exposed to countermarketing campaigns that challenge the well-funded efforts by the tobacco industry to entice it into using tobacco products.

    Furthermore, counteradvertisements that expose the predatory behavior of the tobacco industry are also needed to persuade the public to support legislation that will end the harm caused by the industry (9). Therefore, I propose to tobacco control advocates for their consideration the following simple, cost-free method of countermarketing.

    First, the term “toxic-tobacco” should be substituted for the word tobacco in all anti-tobacco advertisements, press releases from governmental and non-governmental organizations (e.g., voluntary health organizations, professional health societies), remarks at press conferences, telephone and in person interviews, speeches, appearances on television, radio and the World Wide Web, and proposed local, state and federal legislation (e.g., Toxic-Tobacco Law, 10,11). Then, the mass media (e.g., newspapers) will be required to include the prefix “toxic-” with the word “tobacco” in order to properly quote tobacco control leaders. For example, The Glendale News-Press, a California daily newspaper, used this headline,

    A solution to toxic tobacco dilemma (12),

    certainly a catchier, edgier and more descriptive headline than “A solution to tobacco dilemma”. In addition, television and radio broadcasters would also have no choice but to air “toxic-tobacco” when tobacco control advocates speak this term.

    The prefix “toxic-” will reinforce the message that tobacco is a poisonous product for those who know this, and educate those who do not know this fact. If tobacco control advocates substitute “toxic-tobacco” whenever they refer to tobacco, their audiences, both adults (e.g., legislators) and children, will hear an attention-getting, novel message; a more descriptive message, and an important public health education message.

    Second, the terms Big Tobacco, tobacco industry, and major tobacco companies should be eliminated in favor of “toxic-tobacco companies” or “toxic-tobacco industry”. None of the former terms provides the true negative denotation that “toxic-tobacco companies” and “toxic-tobacco industry” do. Rather, the word “Big” in Big Tobacco helps perpetuate the image that the industry has “considerable authority . . . or influence”, is “[c]onspicuous in . . . importance”, and is “[b]ountiful; generous”(13). Placing “Big” in front of Tobacco blunts tobacco's negative associations. “Big” has a positive connotation as evidenced by McDonalds Corporation's using “Big” in front of “Mac” and Frito-Lay placing “Big” before “Grab” to designate its large bag of snacks for individuals. Likewise, “Big” combined with “Blue” is used synonymously for IBM, while golden oldies radio station WBIG is “Big 100” in Washington, D.C. Another example is the 1988 international feel-good hit film “Big”, starring Tom Hanks.

    The proposed terms (e.g., Toxic-tobacco companies) can be combined with tag lines to create slogans for countermarketing like the following:

    Toxic-tobacco companies: Assisted suicides are us.

    Other possible tag lines include: Body bags and bucks; No pain, no profit; Peddling poison for profits, Poisons is us, and We care — about profits. Further extensions to the proposed plan might include substituting “cancer causing-cigarettes” and “coronary disease causing-cigarettes” for cigarettes, and “cancer causing-chew” for chew in all public statements made by tobacco control advocates. Perhaps, advocates should also reintroduce the apt, terse terms “cancer sticks” and “coffin nails” which will be new to younger generations.

    Lastly, unlike many movements (14), the tobacco control movement and its many organizations do not have a unifying theme, especially one to counter the industry's ability to consistently frame regulatory debates in the context of “free speech/legal product” or “positive economic force, moralizing/hostility/prohibition”(15). By adopting the proposed verbal substitutions, activists can begin to speak with a common voice that clearly communicates (a) the nature of the unacceptable products (i.e., toxic) and (b) who is responsible for their production, aggressive and misleading promotion, and resistance to all regulations (i.e., tobacco companies).

    Could this cost-free countermarketing proposal prove to be counterproductive? Will the public be confused if some tobacco advocates adopt this plan and others do not? For example, will some members of the public then assume that there must be a non-toxic-tobacco? Controversies that may arise if there is confusion may in fact prove enlightening if they broaden the discussion about the dangers of tobacco. Debates may also increase the chances that tobacco will remain an active news item before the public.


    Countermarketing will be necessary for the foreseeable future. Given the extreme unlikelihood that tobacco control advocates could ever match the enormous wealth that the tobacco industry uses for marketing, advocates need to seek more cost-effective and cost-free countermarketing techniques. The proposed plan to use the term “toxic-tobacco” to replace tobacco and “toxic-tobacco companies” to substitute for Big Tobacco might be one easy and cost-free way to reinforce the fact that tobacco is poisonous for those who know this, and educate those who do not know this fact. Also, these substitutions will challenge the credibility and acceptability of the tobacco industry in civilized society.

    Acknowledgements: I thank M. Holly Gerace for her unwavering support, Pam Catanzano, R.N., M.S., for her research assistance and Lora Fleming, M.D., Ph.D., and Valerie George, Ph.D., for their helpful comments on earlier versions of this paper.

    1. Federal Trade Commission Cigarette Report for 2000. Available at: http:www.ftc.gov/os/2002/05/2002cigrpt.pdf. Accessed April 17, 2003.
    2. USDHHS. Preventing Tobacco Use Among Young People: A Report of the Surgeon General. Atlanta, Georgia: U.S. Department of Health and Human Services, 1994, 194.
    3. Sepe, E., Ling, P.M., and Glantz, S.A. “Smooth Moves: Bar and Nightclub Tobacco Promotions that Target Young Adults,” Am. J. Public Health. 92 (2002): 414-9.
    4. Farrelly, M.C., Healton, C.G., Davis, K.C., Messeri, P., Hersey, J.C., and Haviland, M.L. “Getting to the Truth: Evaluating National Tobacco Countermarketing Campaigns,” Am. J. Public Health. 92 (2002): 901-7.
    5. Bayer, R. “Tobacco, Commercial Speech, and Libertarian Values: The End of the Line for Restrictions on Advertising,” Am. J. Public Health. 92 (2002): 356-9.
    6. Bayer, R., Gostin, L.O., Javitt, G.H., and Brandt, A. “Tobacco Advertising in the United States: A Proposal for a Constitutionally Acceptable Form of Regulation,” JAMA. 287 (2002): 2990-5.
    7. Sly, D.F., Hopkins, R.S., Trapido, E., and Ray, S. “Influence of a Counteradvertising Media Campaign on Initiation of Smoking: The Florida “Truth” Campaign,” Am. J. Public Health. 91 (2001): 233-8.
    8. Editorial. “Sleeping on smoking,” The Washington Post, March 23, 2002:A20.
    9. Dorfman, L., and Wallack, L. “Advertising Health: The Case for Counterads,” Public Health Rep. 108 (1993): 716-26.
    10. Gerace, T.A. “The Toxic-Tobacco Law: 'Appropriate Remedial Action,'” J. Public Health Policy. 20 (1999): 394-407.
    11. Gerace, T.A. “Tobacco Advertising and Freedom of Speech,” Letter to the Editor. JAMA. 288 (2002): 1586.
    12. Seeley, D. “A Solution to Toxic Tobacco Dilemma,” The Glendale-News-Press, July 15, 1999:A7.
    13. The American Heritage Dictionary of the English Language, Third Edition. Boston, MA: Houghton Mifflin Company, 1992.
    14. Stewart, C.J., Smith, C.A., and Denton, R.E., Jr. Persuasion and Social Movements, 3rd Edition. Prospect Heights, IL: Waveland Press, Inc, 1994.
    15. Menashe, C.L., and Siegel, M. “The Power of a Frame: An Analysis of Newspaper Coverage of Tobacco Issues—United States, 1985-1996,” J. Health Communications. 3 (1998): 307-25.

  • Patnurse

    As a lifelong and cultural smoker, I am in the 25% of people in this country that chooses not to quit. We all know the health risks of starting to smoke but the only study I have seen on lifelong active smokers suggest they have a 60% greater chance of getting lung cancer if they quit and this has, indeed, been backed up by their own anecdotal and life experiences.
    Lifelong smokers started in childhood – some as young as 7 or 8 – and they are now in the older and pension age group. Some fear quitting because they fear the adverse effects of quitting after a lifetime of smoking, having grown and evolved around tobacco use. Others enjoy smoking, knowing the risks, and as hard as that might be for health professionals to comprehend, it is an inconvenient truth. I personally smoke for the taste of (light) tobacco and not the nicotine which I could get elsewhere. Neither would I choose an electric cigarette but I believe those lifelong smokers who would move over to their use should be allowed to do so. Smoking is a bit like whether you prefer Cadbury's or Galaxy, insant or granulated coffee etc…. Purely personal taste.
    Public health encourages among the general public to promote the “pathetic addict” syndrome when studies also show that smoking is a habit. If it is so addictive, then how come so many active smokers quit so easily?. I've known many who have done it without anti-smoking products. I have worked around heroin, cocaine, amphetamine and alcohol addicts and absolutely refute that tobacco is harder to quit than any of the above. Lifelong smokers find that offensive as they do the constant barrage of insults about their personal appearance. The teeth on the graphic health warnings are clearly those of a Meth addict, for example. I have to ask, if smoking is so addictive, and passive smoking is so harmful, then please explain why everyone is not addicted to tobacco? Tobacco is not “a friend” either and it is quite patronising to suggest it.
    As for “Death Stick”, mentioned further down, I have to say that as a child in the playground, I recall the abuse of the bullies who shouted across at me – ” Cancer stick.” The only difference today is that the bullies are now part-funded by my own taxes .
    Lifelong smokers have not quit at earlier times in their lives because of the abusive nature of the propaganda and the methods employed to coerce them into quitting. They have seen around them more harmful substances and products being ignored by public health. They now feel alienated for no other reason that they began to smoke when they were children in a different age and they will not quit now for all of the reasons above. Already branded suicidal serial killers, they now have to endure being branded child abusers which many of us find galling when we are the children of parents, of parents, of parents, of parents who smoked.
    After July 2007, when no provisions were made for us, and we were excluded from society, and in some cases criminalised because of our desire to meet as a group, many of us began to research tobacco and the culture of users. I was personally amazed to find that there is even a sexual culture around smoking fetttishm. I believe this is an example of how the culture of smoking is deeply embedded into a minority – many of them poor and vulnerable – and that to further isolate them through negative propaganda and oppressive restrictions is simply the wrong approach to take.
    I do believe that smoking should not be encouraged among today's children and teenagers, but I also think that tobacco control has got to learn to live with lifelong smokers, the consequences of a previous age, without fear or prejudice and with tolerance.

  • jwatso

    Well, I have just read Terence's post and Pat's post, and I must admit that I am totally confused!
    I thought that I had it about right when I said that the general population of this country are really rather intelligent and that they are a bit fed up with doom and gloom, and that they regard health activists as a bit misanthropic and dull. I thought that it would be a good idea to lighten things up a bit. But I see that Terence wants to exacerbate the matter even further!

    Who am I to argue with an Ed. M., M.A., Ph. D.? I am only a ASBI (retired).

    However, it has to be recognised that Terence has introduced an NEW WORD – 'toxic'. It certainly sounds nasty, but is it nasty enough? But Pat says that she chooses not to quit, whatever words might be used, and that is her choice, isn't it?

    So we have a catch twenty two situation – the more horrible the words used to describe smoking, the more people like Pat resist, and rightly so. Ultimately, the human condition demands that the horrible words become attractive!

    The way to stop people smoking is not through horrible words and greater taxes. All these 'ploys' are self-defeating.

    The battle against tobacco is going to be a long,drawn-out one. It is more like a war than a battle. More like the Afghanistan situation than World War 2.

    I think that the schools are the key. Children need to be taught from a young age that their health is absolutely the most important thing. Not much else matters – including Climate Change.

  • rothenbj

    I had intended to just review this blog item to understand the direction. However, after reading the last few comments, I felt the need to add my input. Yesterday, I responded to an abstract on a study on whether smokeless tobacco would benefit the stop smoking initiative. It gives you my background and a feel as to where I am coming from so I'll re-post it here before getting to my point.

    “After 25 Years of Misinformation, What Would You Expect

    Joel L Nitzkin and Elaine Keller did an excellent job of identifying problems with this study so I shall not endeavor to duplicate their suggestions. Instead I wish to speak as a 43 year, at the end 2 to 3 pack, smoker who used Swedish snus 6 months ago to completely stop smoking.

    I attempted smoking cessation for over 30 years using just about every NRT product except Chantix. I tried hypnosis twice, group and individual, and herbal remedies. Nothing worked. I was persuaded by my girlfriend to purchase an electronic cigarette over a year ago. That immediately got me down to a half dozen cigarettes a day plus the ecig. However, I was unable to stop smoking completely.

    If it had not been for an electronic cigarette forum, I would never have tried any smokeless tobacco product. I was told decades ago that these were no better than smoking. In addition, the only vision I had of smokeless tobacco was the type that you had to spit the juices which I still would not do. That being said, I'm sure that there are many that would even consider that form of smokeless if they didn't feel it was just as dangerous as smoking.

    Even after being directed to Swedish snus, I had serious doubts ingrained from bad science and worse publicity. It wasn't until I started investigating on my own that I realized what most of the 44 million smokers in the US don't know. Smokeless is anywhere between 90 and 99% safer than smoking. I was shocked and angry that I might have quit a quarter century ago if this information was provided by those that were supposedly trying to get people to stop smoking.

    In her response, Elaine Keller wrote, “What if the government changed the warning labels to read “THIS PRODUCT IS NOT A 100% SAFE ALTERNATIVE TO SMOKING”? See what a difference one tiny change can make? This would lead folks to ask, “Well if it's not 100% safe, how much safer is it?” “

    I shall take her thought one step further. How about a warning 25 years ago that read “THIS PRODUCT IS ONLY 95% SAFER THAN SMOKING”, or whatever the right percentage is. Six months ago I had my first portion of Swedish snus. Six months ago I had my last cigarette with absolutely no desire to smoke since. For me, the electronic cigarette is still useful in certain circumstances, but it currently sits mostly unused as about four portions of Swedish snus have replaced cigarette smoking entirely.

    Now you produce a modeling study using parameters that draw a conclusion that selling the idea of smokeless won't make a difference in the smoking rate. Had the industry been honest 25 years ago, your study wouldn't have needed to be done. We'd have the answer. My guess is that the number of smokers would have seriously been reduced. Of course that would not have aligned well with the goal of Big Pharma in providing the answer and that makes me angry.

    How the industry and the “health” associations could continue to push products that have a success rate only a couple percent better than cold turkey after a year is beyond my comprehension. I know that 25 years less smoking would have improved my odds health wise in the future and that does not make me happy.

    My last point is that the only snus mentioned was the American versions that have come out over the last year or so. These are not Swedish snus. I have difficulty even accepting that they can be considered snus. Whether it's nicotine content or the other tobacco alkaloids that are missing, I'm not sure. The product has to be adequate to fulfill the needs of the smoker.

    Conflict of Interest:

    I hold quite a few shares of Pharmaceutical shares, many with companies that sell NRT products. “

    I also should have added that I retired from decades of employment in that industry.

    I've watched anti-smoking become anti-nicotine and anti-tobacco. The further you move from the target, the more difficult to hit the mark. anti-smoking has separated the weak from the herd. As Pat expressed, the reluctance to quit is founded on some medical evidence but more on the fight instinct. I believe with the right approach, the smoking numbers could be further reduced. However, more wordsmithing with derogatory content will only harden already resistant opposition.

    Toxic tobacco? Isn't it the smoke that causes the diseases. Yes we know that there is limited risk in nicotine and smokeless, but there is limited risk in many aspects of life and you can't try to eliminate everything. I can imagine the tobacco resistance movement then using expressions such as Nazi inspired tobacco temperance movement for those opposed to tobacco control. Quite frankly , tobacco control itself is quite offensive to the tobacco customer.

    If temperance is truly what TC wants as their goal, resistance is what it will get.The all out war that we've seen in alcohol temperance and the continuing war on drugs should be enough evidence that the movement has hit the wall. Why? Some will never quit and many are looking for the right approach.

    Had the anti-smoking initiative moved properly into establishing and advertising the continuum of risk in various tobacco products over the last quarter century, the overall number of current smokers would have been reduced. If the anti-smoking industry would embrace rather than try to ban the new e-cigarette product more people could be converted from the consumption of combustible tobacco products. There are quite a few tobacco products now on the market that don't involve smoking, but they are also resisted in the name of killing the tobacco industry. It's not going to happen.

    Sometimes it's hard to believe that this whole anti-smoking campaign hasn't degenerated to a money grab scheme. The way things work now, this process is good for big tobacco and pharma, it's good for the governments, it's good for the researchers, it's good for the “health” associations, it's good for the news industry. The only people it appears to hurt are the people who smoke and the children it claims to try to try to protect.

    I'm sure there are smokers out there that don't care if our youth smoke. However, from my experience, the vast majority are TC's best anti-smoking messengers. Most will send the message “Don't make the mistake I made, don't start” or “Quit while it's still rather easy”.

    One last thought. Rather than putting up the legal and legislative battles against the sales of electronic cigarettes, some of this wasted money should be directed toward its research. Rather than wasting untold millions on third hand smoke junk science and poorly modeled studies of whether smokeless tobacco might have a benefit in preventing smoking, study and advertise relative risk between different products.

    We really don't need another war which this topic continues to lead us closer to.

  • Luka Solmajer

    I applaud many posters, especially Terence A. Gerace, toxic tobacco – is simple and brilliant and other excellent points. The poster Patnurse just proves that the semi-annonimity of blogging and posting is a fruitful humus for the toxic industry – they have exploited it very well because we have allowed it. I''ll try to stay on the subect of owrds, but also broaden the issue. The importance of words can not be overstated. For instance there should not be an anti-smoking law, but law to protect from second hand smoke or environmental smoke. There are excellent examples of reactions to tobacco sponsored events – the Davideath swiss Indoors tennis tournament (which won the argument in the word war recently – because – Using tennis to sell death – was simply brilliant and should be used for all such sponsorships, eg F1!), but I haven’t seen this ‘’ironic promotion’’ done for all products. there are fantastic public education campaigns: Truth, Recall, TV ads in NY: ‘’There is nothing sexy about a filthy habit’’, ‘’The lost child’’ etc. but it has not seen all over the world and that is where the problem lies. The toxic-tobacco industry ruthlessly exploits the ‘’facts’’: tobacco production is legal, selling is legal, promotion is limited at times but still present (on the packs, in the majority of countries at points of sale, etc. ), tobacco is a natural product, tobacco tax brings some money to the governments – (but only a fraction of the actual cost of tobacco, not to speak about the loss of life). To this they use to their aims many manipulations – they still sell ‘’light’’ cigarettes, ‘’slims’’, ‘’gold’’, ''soft'' or different colors that are identified as lights, in reports on counterfeit cigarettes we often read that these are harmful for user’s health (implying that regularly and controlled produced are not!?), how many times have we seen celebrities shown smoking, advocate and promote smoking, … etc. Additionally they have also exploited the forbidden-ness of smoking as an adulthood initiation, the added attraction of doing something naughty at that age is well known. Another key manipulation the t.i. uses is their rhetoric that we need a liberal society, tolerance to smoking, they promote ‘’freedom’’, (this also escalates to the shocking insults of tobacco controllers as fascists, nazis, etc.)… There is absolutely nothing liberal about smoking, there is no freedom at all in being addicted, but unfortunately they do to some degree successfully promote these ideas (even connected to their products) in some segments of the population. Worst of all the toxic tobacco industry was relatively successful in manipulating smokers into their advocates by heavily promoting smoker's fiendly environments web-pages, speaking about their ''human rights'', etc. and defaming anyabody concerned with smoker's health. The goal we would want to achieve in tobacco control would be to get the public, smokers included to share our views on tobacco, which are based on scientific facts. This seems very hard to achieve as the tobacco control community receives a fraction of the money the tobacco industry makes (we have seen many highly successful campaigns when they were well funded), simply because their business is still far too profitable. To change this, (we have read some encouraging news that their profits will have to be returned in lawsuits in the US) the status of tobacco production, tobacco sales and perception of tobacco use need to change. Foremost the No. 1 goal of tobacco control should be: to make tobacco production and sales unprofitable, because the tobacco industry would be forced to pay all the health costs of toxic tobacco victims (I propose the use of this word instead of smokers). With this goal, all the other problems will be minimized and there would far less of any opposition to e.g. pictorial warnings or standardized packaging and other necessary measures. I believe it is a grave mistake to let t.i. companies collaborate with EU institutions to prevent toxic tobacco smuggling, I thought these lessons were learned in the past that they only work for their interest and their goals are completely non-compatible with public health goals. Do we trust the FCTC to be the turtle and get to the finishing line in next 2-3 decades? Do we not expect too much if toxic tobacco will continue to be so profitable? How can it stay unquestioned that such a toxic product is allowed by most states in the world to make such profits and the expenses are paid by citizens and the states? Why does the state not snap up and seize their bloody money? Of course we need to win the words arguments first.

  • Zach

    “Tobacco is not “a friend” either and it is quite patronising to suggest it.”

    As a lifelong smoker, have you not spent happy and sad times with your smokes? Have you not turned to them in times of boredom, exasperation, or confusion – just as you would a friend? They have been there for you through thick and thin and they have yet to turn you down when you need them, just like a friend. I am not being patronizing, I am merely suggesting an analogy. I have been there – a committed smoker for 8 years, I quit without NRT, so when you also decide to quit you will see that you can liken it emotionally to breaking up with your best friend.

  • I smoked for 45 years. I used to lie in my bed, kept awake by my wheezing, praying that God would send me a way to stop inhaling smoke without being forced to pay for improved physical health with my cognitive and emotional health. I am one of those who self-medicates underlying disorders with nicotine.

    With the help of bupropion and as many pieces of nicotine gum as my digestive system can handle, I was able to reduce my smoking to 10 per day, but not to quit. My prayer was answered in the form of the electronic cigarette. The electronic cigarette supplied sufficient nicotine to replace those last 10 daily cigarettes. As of today (8/13/2010) I have been smoke-free for 1 year, 4 months, and 17 days.

    Similar to the experiences reported by 90% of electronic cigarette consumers, my lung health has improved tremendously: No more wheezing, no more productive morning cough, and best of all, I am able to laugh out loud without going into a fit of coughing.

    When I write about my experiences, I find it especially galling to be accused of being an industry shill. You can insist that there is no such thing as a satisfied customer until you are blue in the face, but that does not change reality.

    If I'm not mistaken, you have just accused Patnurse of being an undercover PR person for the tobacco industry. Stuff and nonsense! In my “missionary work” to convert smokers to vaping, I have run across many folks just like her. They like smoking and want to stick with it. I accept reality: No matter what words I select, what clever arguments I use, I will not be able to change their opinion. I wish them well and go on about my business.

    I take exception to a portion of the following statement: “The goal we would want to achieve in tobacco control would be to get the public, smokers included to share our views on tobacco, which are based on scientific facts.”

    The prevailing views on tobacco that I see repeated over and over again by governments and so-called health organization is “all tobacco products are equally deadly.” These views fly in the face of scientific facts. Smoking accounts for 80% of all tobacco use and 98% (or more) of tobacco-related disease.

    If I had known 20 years ago that switching from smoking to Swedish snus would reduce my risks of smoking-related disease to that of former smokers who quit all forms of nicotine, I could have saved my lungs and cardiovascular system years of damage.

    When the American Cancer Society and the Surgeon General told us smokers back in the 80s that if we couldn't quit, we should switch to low-tar, low-nicotine products, we believed them. http://rodutobaccotruth.blogspot.com/2010/07/wh

    Unfortunately, they were mistaken. Following their advice made many a pack-a-day smoker double or triple their daily intake. The problem lies in the fact that the recommendation was made based on an untested theory. Tar is what causes the damage, so reducing the tar content should reduce the damage. Sounds logical, but the fly in the ointment is that droplets of tar are the mechanism by which smoke delivers nicotine. Lowering the tar automatically lowers the nicotine. Smokers want a sufficient level of nicotine, so they smoke more (or inhale more deeply.)

    Unlike the “lower the tar” theory, we actually have scientific research to back up the assertion that switching completely to smokeless forms of tobacco reduces health risks for smokers. Why are those scientific facts being ignored?

    Here, from deep within the “enemy camp” I offer you some intelligence that could greatly increase your odds of winning this war, if indeed the purpose of this war is to reduce the burden of disease and death caused by tobacco.

    1. Stop trying to skew the science to match your preconceived notions of “how things are supposed to be.” Compare continuing smokers' health outcomes to those of former smokers, not to never-smokers. The latter comparison only tells us that we never should have started smoking in the first place. Lacking a time machine, we can't fix that. A smoker can only stay remain a continuing smoker or become a former smoker. It is impossible to become a never-smoker.
    2. Face reality: Some people cannot stop using nicotine, and some don't want to stop and never will.
    3. Offer acceptable nicotine alternatives that will reduce the mortality and morbidity rates caused by inhaling smoke.
    4. Stick to the truth: Provide accurate information about the continuum of harm caused by the spectrum of products that deliver nicotine.

    If you keep doing what you have been doing, you are going to keep getting the same results. “U.S. Adult Smoking Rates Remain Stalled” http://www.cdc.gov/media/pressrel/2009/r091112.htm

    The AAPHP estimates that encouraging smokers to switch to electronic cigarettes could save the lives of 4 million of the 8 million smokers who will die of smoking-related disease over the next 20 years. What if we offered and promoted a full spectrum of safer nicotine alternatives? Think of the lives that could be saved!

  • jwatso

    There is something going wrong. People are not obeying orders. On the DT site today, people are still talking about stinks and stuff. Where are the BMJ professors expounding the science behind the smoking ban?
    I am becoming very disturbed and worried. No one seems to be backing me up! All I can think of is 'stinks' and 'toxics'.
    PLEASE! Help me out! I am becoming desperate!

  • Craig Mosbaek

    I also prefer the term “spit tobacco” over “smokeless tobacco.” However, some of the new tobacco products do not require spitting. A term that could encompass all these products is “oral suppository tobacco.”

  • Lezak Shallat

    Unfortunately for tobacco control advocacy — and especially efforts to reach out to women – another battlefield in the war of words is the one that currently occupies the terrainwe should be sharing with the feminist health movement.

    In my experience, there is a real clash of discourses between the language we use in tobacco control and the language we should be using to reach out to potential (and much needed) allies in the women’s movement.

    This raises a linguistic and ideological barrier that impedes greater collaboration.

    A case in point is the concept of tobacco “control”. For the TC movement, the word “control” encompasses a strategy to focus on a product and not its users (smokers) by setting limits that protect the rights of non-users. Within the TC movement, there is little talk of “anti-tobacco” measures or policies. This abbreviated terminology is reserved for headlines and journalists.

    Among feminists, however, the word “control” raises hives. It is located at the opposite end of the spectrum from autonomy over one’s body and the right to decide for oneself about work, education, reproductive life and more. This idea is central to feminism, and has been successfully exploited by the tobacco industry as a concept to sell cigarettes.

    The discourses clash. Control vs. protection; freedom to chose vs. informed choice; promoting vs. exploiting aspirations of “autonomy.”

    These words carry ideological subtexts that hinder greater dialogue with the feminists about how to address smoking as a women’s health issue.

    Lezak Shallat (Santiago, Chile)

  • Mark

    In any other sphere this language would be considered bullying or harassment –
    do you feel that you are immune from that charge?

  • Abigail

    As a corollary to Robbin's comment, the freedom to smoke also ends when smokers (who think they freely 'chose' to smoke) become addicted…at that point, smoking is no longer a choice (at least for the 95% who try to quit and are unable to do so). Unfortunately, people blame themselves for this 'failure' rather than the tobacco industry, which has spent billions of dollars seducing them to try smoking in the first place, engineering the product to be maximally addictive, and discouraging them from quitting (with ploys like 'light' cigarettes), all the while championing their 'freedom' to smoke.

  • Patnurse

    “….a committed smoker for 8 years…” Hardly the same. I suggest you were a person who smokes. I have been a committed and lifelong smoker from the age of 8 to 50 – 42 years. Cigarettes may have been your friend, they are not mine. My friends are human.

    I repeat “…the culture of smoking is deeply embedded into a minority – many of them poor and vulnerable – and that to further isolate them through negative propaganda and oppressive restrictions is simply the wrong approach to take.”

  • db

    I don't understand it. If tobacco is the single biggest cause of premature death and illness, why isn't your slogan 'Ban all sales and use of tobacco immediately'?

  • Andrea Portenier

    Yesterday was the 47th anniversary of Martin Luther King Jr.'s “I Have a Dream” speech. A speech that through the power of its words helped change history for the better. For us to shape a future free from tobacco use it is incumbent upon us to choose our words carefully so that the picture we paint is one that the public wants to become part of.

    Quantum physics is also suggesting that while we know our present shapes our future, our future may also be able to shape out past. If we consider that our dreams of the future cause us to act in ways now to bring it about, the importance of dreaming is clear. If we want to realize our dreams we will need to articulate them clearly so that the dream can be shared.

    To that end there are several language changes that have the power to accelerate our movement in the direction of a healthier world.

    First, there is no such thing as a “smoker”. No one is born with a pack of Marlboros in their hands. Smoking is not innate. Breathing is. Using the word “smoker” creates the impression of an innate characteristic which is to be accorded certain rights. If we want to get rid of the impression that smoking is a right, it only makes sense, doesn't it, to use language that dissolves the impression that it is. The inculcation through language that smoking is a state of being, rather than an activity, also can make it harder for someone to free themselves of their addiction. It is after all harder to quit being something than doing something. If every journal would make an editorial decision to not print this word, other than as a quote, we would go a long way towards reducing tobacco use.

    This also helps undo the “Us vs. Them” dichotomy upon which the tobacco industry plays. The tobacco industry isn't just out to recruit “smokers”, they are out to recruit everybody they can, including your children your brothers and sisters, the people you care about, not some hapless, nameless “label” who can then be discounted because fault will be attributed to them anyway. Let's make smoking the issue not the individual or group of individuals who at some point, likely quit early in their lives, made a judgment error and got stuck with an addiction.

    This brings us to the second language shift that can make a difference. The tobacco industry has been quite successful in co-opting the concept of freedom. Their use of archetypes to do this has been a tremendous aid in that effort. The cowboy is a quintessential male archetype, master of his domain and many of the female figures used in the ads for Virginia Slims, Misty and other female directed brands have strong feminine archetype symbology. Archetypes are owned however, so we can create our own. How about ads that portray people in athletic pursuits sky diving, windsurfing, snow boarding, scuba diving etc that are either doing it to get away fro the secondhand smoke “Out here I'm free to be me- away from the secondhand smoke” or “Once I cut the shackles of cigarettes, I was able to embrace life to it's fullest”.

    Third: An earlier post suggested we find a different way to talk about “quitting smoking”. Absolutely! Why not talk about freeing oneself from the oppressive chains of tobacco addiction? Bring the freedom ball back on our court where it belongs so the tobacco companies can't score with it any more?

    Fourth: When talking about rights, we can be talking about how we are helping to restore the right to breathe which was stolen by tobacco companies trying to create the impression that choking, wheezing, lung cancer, impotence (insert audience appropriate debilitating disgusting disease here) were somehow desirable.
    Fifth: Let us also celebrate each success any colleague has in creating a culture conducive to health. It is terrific that Australia has been able to cut off another avenue or the tobacco industry to brand death as attractive. Why not view this as a hostage rescue that does not have a clock? Everything we do that helps free someone whether it is done singularly or in combination, is a reason to rejoice. We can still evaluate the methods being deployed and refine all we do to come up with greater success in each country where we are working to free people from tobacco.

    Sixth: We can hold the press accountable. When they use the term “smoker”, ask why they are using the label as opposed to seeing a human being.
    When they state that a fire was caused by “careless smoking” explain that smoking is inherently careless, there is no such thing as “careful smoking” as inhaling carbon monoxide does not improve the thought process. The fire was caused by smoking. Period. Bring people to the understanding that smoking is a careless act that causes every sort of misery possible.

    Seventh: Smoking is also not a “personal behavior”. As soon as a cigarette or cigar is lit, it becomes a public behavior and the public has a right to have a say in it. That includes if it is in a park, a restaurant or an apartment. Secondhand smoke does not know that it not supposed to drift. So it does, often into the lungs of people who would rather not breathe it and also into those who have significant health problems when they do.

    For those who think that to ban smoking in a park, excludes anyone who happens to smoke consider that banning sexual activity in a park does not mean that it is for virgins only. All it means is that we behave publicly in ways that do not interfere with others enjoyment of the space. We certainly do not engage in activities that can harm others in public spaces. Why is smoking the only activity that somehow has become exempt from this principle? To use Dr. King's words:

    “But we must go on to say that while it may be true that morality cannot be legislated, behavior can be regulated. It may be true that the law cannot change the heart but it can restrain the heartless. It may be true that the law cannot make a man love me but it can keep him from lynching me and I think that is pretty important, also. So there is a need for executive orders. There is a need for judicial decrees.”

    Eighth: Let's be impeccable with our word. We must walk out talk. Always. What do we own in our retirement funds? What do we drive? How big is our environmental footprint? Do we eat at least some fruits and vegetables and get some exercise? /this doesn't mean not having a good time or not enjoying some really decadent food and wine. It does mean being responsible in ll that we do and showing that it is fun to make healthy choices. People do not listen if they find hypocrisy between what we say and how we live.

    Ninth: Consider the connotations of the words being used and apply those with negative connotations to tobacco and those with positive connotations to what we are doing. We are not banning smoking we are restoring the right to breathe freely. We don't advocate “quitting” smoking we offer the option and ability to free yourself from its controlling grip.

    Tenth: I'll close with some quotes from Dr King's speech as he said everything so much better than I ever could. While he was speaking to the social injustice of racism and poverty, tobacco is tied to many social justice issues and his words have meaning for us:

    “All I'm saying is simply this, that all life is interrelated, that somehow we're caught in an inescapable network of mutuality tied in a single garment of destiny. Whatever affects one directly affects all indirectly. For some strange reason, I can never be what I ought to be until you are what you ought to be. You can never be what you ought to be until I am what I ought to be. This is the interrelated structure of reality.” MLK
    Sweet dreams to all.

    Andrea Portenier

  • Satoshi Hirota

    Satoshi Hirota, M.D., Ph.D.

    I would like to propose a new concept about tobacco.

    “The tobacco plant (Nicotiana tabacum) is an infectious disease. The plant infects human brains, affects human intelligence and causes defects in human behavior.”

    In 1999, the concept of “communicated disease” was advanced by Dr. Harlem Brundtland who once said that “Tobacco is a communicated disease. It is communicated through advertising and sponsorships.”

    Seven years later, in 2006, Dr. Ron Aspinall described the addiction of tobacco described as “a chemical infection of the brain.”

    Five years after Dr. Aspinall’s description, in 2010, I would like to posit another concept about tobacco. I advocate that tobacco is “a plant infection disease.”

    Let us explore five sets of evidence as to why I believe the tobacco plant (Nicotiana tabacum) is an infectious disease.

    First, typically, we tend to imagine only microorganisms as infectious diseases. But for example a tapeworm is defined as an infectious disease as well. So I think that by definition, infectious diseases should not be limited to microorganisms and that the definition of all living things which are harmful and spread to us (human-beings) should be defined as infectious diseases. I think that the tobacco plant (Nicotiana tabacum) should be included in this broadened definition as well.

    Let us examine the concept of “infection” a little further in our second point. The concept of the “infection” shouldn’t be limited solely to “internal multiplication” of a pathogen but should also include “external multiplication.” For example Staphylococcus aureus produce enterotoxin outside of the body, and the toxin invades into the body. Indeed the word “infection” has broad meanings. According to the dictionary, the definition of the word “infect” is “to make a disease or an illness spread to a person, an animal or a plant” or “affect a person etc. with a disease-causing organism.”

    Looking beyond the concept of “infection” to our third point, the effect (phenomenon) of infection is not limited only to inflammation but also to extended actions as well. For example the infectious agent in Bovine spongiform encephalopathy (BSE) is believed to be a specific type of misfolded protein called a prion. The deformation of native cellular prions is not an inflammatory response, yet BSE is categorized as an infectious disease. Like prion diseases, BSE is caused by the infection of prion to the brain. As a result of this infection, non-inflammation illness appears. Likewise the tobacco plant also infects the brain by the toxin of nicotine. Moreover the tobacco plant is similar to prions from the point of view that they both infect the brain and cause damage to normal brain function.

    So I recommend that we put the tobacco plant (Nicotiana tabacum) into the category of infectious disease and add it to the textbooks of internal medicine as the field of infectious disease.

    Fourth, in addition to shortening the lives of up to half of those who smoke, the tobacco plant is known to cause many severe diseases, for example lung cancer, many other cancers, COPD, acute myocardial infarction, brain infarction and other diseases. Though the many diseases caused by smoking are currently categorized into many fields according to which the parts of body affected, for example, I propose that these be categorized under the singular broad field of “tobacco plant infectious disease.”

    Fifth, there is the matter of social behavior. Why is it that human-beings build tobacco factories all over the world, knowing full well the harmful effects of tobacco? I’d like to explain the question as a form of peer-interaction between human-beings. For example in Japan, the action of mind control caused devotees of a well-known cult to make a sarin factory. I think this is an example of peer-interaction gone awry. I’m not an expert on interaction mechanisms but I do know that social behavior such as yawning, depression and suicide have the capacity to infect others. These interactions are usually observed among various animals, for example, the movements of sheep, fish and flocks of birds. In a similar manner, I think the abnormal activity of building tobacco factories stems from the interaction and influence of tobacco plant-infected individuals and groups.

    If an intelligent alien race were to approach our planet and observe the earth from space by telescope, they would see human-beings weakened and broken down by their adherence to the leaf of the tobacco plant and would easily recognize the tobacco plant as an infectious disease. When we human-beings also step back and observe ourselves in a detached manner, we would soon notice that it is the most popular harmful and devilish thing that adheres to us.

    Why haven’t any countries (except Bhutan having religious reason) resist making tobacco illegal by implementing laws about health, food sanitation, pharmaceutical business, surroundings, product liability, etc., in spite of the developments of civilization, science, politics, economics and judicature in recent years? The “avoiding tendency” is strange and mysterious. My answer is that the tobacco plant has deeply infected the human brain and thereby controls human intelligence and distorts human behavior. Now tobacco plants breed all over the world by controlling human intelligence, using them as vectors and killing a large number of them.

    In fact, the huge number of deaths caused by the tobacco plant is more than the top 3 infectious diseases combined. In 2005, total deaths were published by the WHO: AIDS 2.2 million, TB 2 million, malaria 1 million, the total of three disease 5.2 million while deaths caused by tobacco number 5.4 million. For human-beings, HIV/AIDS is a very serious disease because it confuses the human-immuno-system. But the tobacco plant is more serious than HIV/AIDS because it confuses the human-thinking-system. So we haven’t recognized tobacco plant as infectious disease for a long time. We can easily stop the spread of tobacco if we choose to do so, but have no intention of doing so. Why haven’t we done so? Because human thinking has been distorted by tobacco “infection.”

    I want to evolve the concept of tobacco all over the world. When using this concept, we are able to explain the contradiction that tobacco has nevertheless been sold legally although it kills huge numbers of the people all over the world every year.

    And by spreading this concept, we human-beings should regain the “captives held hostage by Nicotiana tabacum.” By “captives” I mean not only smokers, but the people who have an affirmative image of tobacco and the people involved in the tobacco industry. And we should call them back to our tobacco-free-world with warmth and compassion, because they are really miserable and poor; especially tobacco industry workers who are bound by the tobacco plants and forced to work under them.

    I hope making tobacco selling illegal will start from the very advanced nations involved in the tobacco-free-initiative such as New Zealand and Australia.

    Let's expand the knowledge of this new concept all over the world with a strong message by impressive methods, from fine art to artistic expression through music, rivaling that which is currently used to promote and spread the infectious disease that is Nicotiana tabacum.

  • Th60802

    tobacco killed my father Jerry Harper on September 14 2010!!!!!!!!!

  • Satoshi Hirota

    Satoshi Hirota, M.D., Ph.D.

    I would like to add some comments to my opinion and to enhance my concept.

    I have only shown an obscure idea about the “environment condition” of three main factors of infectious disease in my previous comments. I’d like to clarify some of these concepts.

    In the age of European voyages of discovery, tobacco plant infection was already spread among native Americans. Columbus and his party were also infected by it and brought the disease back to their country. Since then the disease has been spread all over the world. The period in which it was spread was pre-industrial times but nevertheless it had been transmitted by means of lighting a cigar (a rolling leaf).

    One hundred and fifty years ago, the cigarette was invented and the process of mass-producing it was manufactured. Furthermore tobacco industries have added addictive agents artificially and intentionally to enhance dependence. The invention and the addiction cause the pandemic of the disease.

    Of course I think it is sufficent to explain the “environment condition” via the concept advanced by Dr. Brundtland

    that “it is communicated through advertising and sponsorships.”

    Today, conversely, it is difficult to understand that the tobacco plant is an infectious disease for the modification by the tobacco industry.

    The second factor is the necessity of a “host”, as well as host sensitivity. For example, it is well documented that younger people are more susceptible to infection than older.

  • Becky Freeman

    We have now short listed the top 6 entries for voting – congratulations and good luck!


    Becky Freeman
    Assistant Editor, New Media
    Tobacco Control

  • Becky Freeman

    Congratulations! Your entry to “Limit using the word control and embrace “anti-tobacco” to describe measures” has been short-listed as one of the top 6 ideas. Be sure to vote here:

    Becky Freeman
    Assistant Editor, New Media
    Tobacco Control

  • Becky Freeman

    Congratulations! Your entry to “reframe quitting as “breaking up” with a deceitful best friend ” has been short-listed as one of the top 6 ideas. Be sure to vote here:

    Becky Freeman
    Assistant Editor, New Media
    Tobacco Control

  • Becky Freeman

    Congratulations! Your entry to “change tobacco industry financial reports to disease reports” has been short-listed as one of the top 6 ideas. Be sure to vote here: http://blogs.bmj.com/tc/2010/10/27/word-wars-and-tobacco-control-choose-the-winner/ Becky Freeman Assistant Editor, New Media Tobacco Control

  • Becky Freeman

    Congratulations! Your entry to “get rid of the word “smoker” – stop labelling users” has been short-listed as one of the top 6 ideas. Be sure to vote here: http://blogs.bmj.com/tc/2010/10/27/word-wars-and-tobacco-control-choose-the-winner/
    Becky Freeman Assistant Editor, New Media Tobacco Control

  • Becky Freeman

    Congratulations! Your entry to “focus on how multinational profits vs health costs are globally distributed” has been short-listed as one of the top 6 ideas. Be sure to vote here: http://blogs.bmj.com/tc/2010/10/27/word-wars-and-tobacco-control-choose-the-winner/
    Becky Freeman Assistant Editor, New Media Tobacco Control

  • Becky Freeman

    Congratulations! Your entry to “stop using “Big Tobacco” and call the industry “toxic tobacco industry”” has been short-listed as one of the top 6 ideas. Be sure to vote here: http://blogs.bmj.com/tc/2010/10/27/word-wars-and-tobacco-control-choose-the-winner/ Becky Freeman Assistant Editor, New Media Tobacco Control

  • BLF

    The BLF has been set up a Web Community as a place for people affected by a lung condition, including partners, other family members and friends, to find support from others and to share information. Our aim is to provide a community that is friendly, supportive and informative; where people can share experiences and find help in coping with the everyday challenges of living with a lung condition.

    You can visit the site;


  • Follow the money. Who do you think benefits financially from the sale of products to avert premature death and treat illness?  Hint: Not tobacco companies.

  • Johnny Savage

    Would making the sale of tobacco illegal also apply to the pharmaceutical companies? Where would they obtain the nicotine for their practically useless NRT products? (Would you buy a condom with up to a 98.6% failure rate?)

    Are these very same companies performing research into nicotine-based drugs to treat a spectrum of conditions from obesity to Parkinson's Disease?

    Are these the very same companies who sponsor and fund Tobacco Control and make considerable financial gains from their 'investments'?

    Follow the money!

    P.S. I have absolutely no connection s with the tobacco industry, apart from enjoying their products.

  • Crithomas

    Alcohol and
    tobacco industries insist their products are aimed at adults, but beverages
    like Sparks and bright colored tobacco products seem tailored and fit for the
    youth. There are fruit flavored cigars and energy drinks that are not only high
    in caffeine, but now have up to 9 percent in alcohol. “Alcohol and caffeine are
    really double trouble when they’re marketed to kids and when they create the
    illusion of alertrness combined with the impairment of alcohol,” Connecticut
    attorney general Richard Blumenthal said. It is not only the content that
    worries critics, it’s the marketing strategies. Randall Pinkston reports from
    CBS news the concerns of prosecutors of the 27 states and the District of
    Columbia are accusing breweries of promoting products that are “highly”
    attractive to underage youth.  If
    the breweries do not comply, the attorneys general will be threatening
    lawsuits. Mean-while, anti-smoking organizations are pushing for tighter
    regulated tobacco advertising industry. 

  • ruthmalone

    I am out of the office until January 8. I will be unable to check email consistently during this time. I will respond to your message as soon as possible or on my return–thanks for your patience.
    Should you need immediate assistance with UCSF matters, please contact Regina Gudelunas, 415-476-9302. If this is a Tobacco Control journal matter, contact journal staff at tobaccocontrol@bmj.com. For our military research projects, contact Libby Smith at libby.smith@ucsf.edu. For other research, contact Patricia McDaniel at patricia.mcdaniel@ucsf.edu.
    If this is concerning Knowland Park, please contact Tom DeBoni: tomdeboni@mac.com

    Ruth Malone

  • Bernard

    It is great that you have launche a tobacco control blog. Recently I read an article where was written that in Russia and China things with tobacco control go bad. What do you think about this?