Faculty of Health Sciences, Simon Fraser University
JTI-MacDonald recently launched a multimedia campaign, Both Sides of the Argument, to sway public opinion against proposed plain packaging legislation in Canada. The campaign includes advertisements on popular radio stations, a website, posters in restaurant and bar bathrooms, advertisements in national newspapers and sponsored posts on Facebook. The advertisements and website state that they are “A JTI-Macdonald Corporation Initiative”, however JTI-Macdonald is not a household name in Canada. It is therefore unlikely the viewers/listeners will recognize that the campaign is funded by a tobacco company.
The arguments, presentation and even name of the campaign is remarkably similar to one implemented by British American Tobacco New Zealand, titled ‘Agree–Disagree’, which coincided with the NZ government’s standardized packaging consultations. Analysis of the New Zealand campaign found that messaging misrepresented the intent of the proposed legislation, claimed standardized packaging would harm all brands, and used vague premises as a basis for claiming negative outcomes. The commonalities between the campaigns suggest similar strategies might be used elsewhere, and also creates opportunities for public health advocates to counter industry opposition to plain packaging.
While the Canadian campaign purports to present ‘Both Sides of the Argument’, it quite clearly represents only one perspective. A section of the website, subtitled Has Plain Packaging worked in Australia?, first presents “The evidence for why plain packaging worked in Australia”, appearing to represent the pro-plain packaging camp. However, the text underneath states that there is no evidence plain packaging contributed to declines in smoking, linking to an Australian government site that documents smoking prevalence, but does not mention plain packaging. Underneath this “the evidence for why plain packaging did not work in Australia” is presented. The claim that plain packaging is ineffective is repeated, this time supported by links to JTI-funded research and press releases. ‘Both sides of the argument’ conveniently supports the same conclusion by linking only to JTI funded ‘research’ and spin.Campaign messages are continually buttressed by weak evidence from organizations with known links to the tobacco industry. For example the site refers to an Institute of Economic Affairs (IEA) report that “demonstrates plain packaging policy is destined to fail.” Not only does the IEA have a long and well documented history of producing research to counter tobacco control initiatives while receiving funding from the industry, the “report” is in fact a brief blog, which in turn links to an even shorter news report that cites statistics without reference or explanation.
JTI-MacDonald did commission an independent firm, Forum Research, to poll 2000 Canadians on their views about plain packaging. A quick scan of the research report reveals numerous weaknesses. Many of the questions are clearly leading. Take, for example, the following: “Some people say that a change to ‘plain’ packaging from multiple different brand designs will make it easier to produce fake cigarette packaging and increase the amount of illegal cigarettes sold in Canada. Do you think this is unlikely or likely?” In response to a question asking if respondents could explain plain packaging to someone else only 17% answered positively. Considering these results, the survey essentially documents the opinions of uninformed individuals. The sampling method in general is unclear, with the only details provided being that 2301 regionally and demographically representative Canadians completed an online survey during a week in August. How the participants were selected to ensure the sample was ‘demographically representative’ is not stated.
Encouragingly, for tobacco control advocates, comments on the campaigns Facebook posts reveal that not everyone is falling for the spin. Of the 50 most recent comments (as of 24 October 2016) under a Both Sides of the Argument post from 4 October 2016, 19 point out the weaknesses in the campaign, identify it as astroturfing, and call out the tobacco industry for promoting junk science.
Tobacco companies want to sell you cigarettes – today, tomorrow and for the foreseeable future. Whether you’re at the tobacco counter or out with friends, glitzy cigarette packaging is a really important part of their sales pitch. Tobacco companies are aware of this. It’s why they are so opposed to their cigarettes being put in plain packaging.
But why would these organisations lobby against plain packaging? On looking into these opposition groups, our recent research gives a clear answer. Opponents of plain packaging tend to have links to the tobacco industry. So much so that three-quarters of organisations identified in our study had financial links to tobacco companies.
Perhaps we shouldn’t be surprised. Decades of research into political activity by the tobacco industry has shown that “third parties” are used to campaign against tobacco-control policies. Health advocates are aware of this. In 2005, the World Health Organisation’s Framework Convention on Tobacco Control committed the countries that signed the convention to protect tobacco policy from interference by the tobacco industry and, crucially, groups linked to them. In response, in 2011, the UK government committed to publishing details of any policy meetings with tobacco companies and the Department of Health routinely requests disclosure of tobacco industry links. So far so good. In doing so, the UK sets a strong example.
Third party interference
But our research shows how “third party” opposition to tobacco control policies extends tobacco industry interference beyond this realm of government. In a three-year period which included the 2012 government consultation on plain packaging, 88% of research and 78% of public communications opposing plain packaging were carried out by organisations with financial links to tobacco companies (see figure 1). And public and retailer campaigns funded by tobacco companies to mobilise opposition to plain packaging generated 98% of the more than 420,000 negative postcard and petition submissions to the consultation.
In this way, ideas and arguments that come from tobacco companies and their research spill into public spaces. Once there, they can influence the public and political mood on life-saving tobacco control policies and create a misleading impression of diverse and widespread opposition. This is known in the world of political science as “conflict expansion”. And the potential effects are significant. When widespread, these “third party” activities can work to delay and even prevent policies: it took four years to get from consultation to implementation in the UK.
This wouldn’t be so serious if organisations and tobacco companies were open about their relationships. But, in many cases, links were not easy for the research team to detect. Of 150 examples of public communications, less than 20% explicitly acknowledged tobacco industry connections. And, while academics and research consultants tended to clearly report funding sources, “third parties” promoting their research in press releases, news stories and letters to government, frequently did not.
If they were open about their financial relationships with tobacco firms, business and civil society organisations would give the public, politicians and officials the opportunity to scrutinise their arguments and evidence in context. In the case of plain packaging, a lack of openness masked these links and lent credibility to claims that the policy lacked evidence and would increase the trade in illicit cigarettes – claims which have been shown to be unfounded by both peer-reviewed research and by the High Court in Britain. Now, as more countries move to introduce plain packaging, “third party” transparency remains an issue.
In order to help countries guard against tobacco industry interference, awareness can be raised of the effects of their activities on public and political debates. And steps could be taken to make their relationships with tobacco companies clearer. A compulsory register of tobacco companies’ memberships, political activities and associated spending would be a strong first move.
There is strong global commitment to addressing the problem of tobacco industry interference. Parties to the framework convention meet in India in November amid concerns about this issue, and the message to the tobacco industry from the WHO is clear: “The world understands who you are and what you do, and is determined to stamp out the global plague which you do so much to spread.”
Indonesia has once again emerged as a clear laggard in curbing tobacco industry interference in policy-making, according to a report ranking countries in the Southeast Asia region based on their level of implementation of Article 5.3 of the WHO Framework Convention on Tobacco Control (FCTC). It is the third annual report on tobacco industry interference prepared by the Southeast Asia Tobacco Control Alliance (SEATCA).
Indonesia is the only country whose score increased in both the 2015 and 2016 reports among the seven surveyed in all three years (Brunei, Philippines, Cambodia, Malaysia, Thailand, Lao PDR, Vietnam and Indonesia). Its 2014 score of 78 (the first year of the survey) reflected a very high level of interference, and exceeds the scores of all other countries in any year of the survey. Indonesia’s score has continued to worsen, and stands at 84 in the 2016 report. The maximum possible score is 100; a higher score reflects a greater level of interference.
Ranking of countries in the Southeast Asia region by tobacco industry interference, as calculated by SEATCA. Source: 2015 ASEAN report on implementation of WHO Framework Convention on Tobacco Control Article 5.3.
The dismal result is a stark illustration of why Indonesia, one of only a handful of countries that has not signed the FCTC, is a tobacco control ‘rogue state’. The country achieved worldwide infamy in 2010 when a video of a smoking toddler went viral. The video prompted increased media coverage of the striking absence of effective tobacco control policies and regulation in Indonesia, a situation which tobacco companies have taken full advantage of to saturate the country in cigarette advertising.
The Global Adults Tobacco Survey (GATS) of 15 low and middle income countries with high tobacco use published in 2012 found that Indonesia was among the countries with the highest adult male smoking prevalence at 67%. The lax regulations extend to failure to protect Indonesians from secondhand smoke; the GATS also found that 85% of people who visited restaurants were exposed to tobacco smoked and 82% reported seeing cigarette advertising within the last month – exposure far higher than any other country surveyed. Unsurprisingly, Indonesia’s (male) youth smoking prevalence is among the highest in the world; according to the 2014 Global Youth Tobacco Survey, 35% of boys aged 13-15 are current smokers.
At the other end of the scale, the standout countries in the 2016 report were Brunei and the Philippines. Brunei was ranked first for the third year in a row with a score of 29, unchanged from 2014 and 2015. The Philippines has seen a dramatic improvement from a score of 71 in 2014 down to 38 in 2016. Cambodia and Malaysia have also shown consistent improvement from their 2014 scores to be ranked equal fourth at a score of 49 in 2016.
On 8 September, New Zealand joined a growing international move to outlaw the tobacco industry’s ‘silent salesman’ when it became the latest country to introduce cigarette plain packaging.
The legislation – the Smoke-Free Environments (Tobacco Standardised Packaging) Amendment Bill was passed on its third and final reading in the New Zealand parliament with 108 votes in favour, 13 against.
The move has been welcomed by health experts as a an important measure towards achieving the goal of Smokefree 2025. Professor Janet Hoek, co-director of research group Aspire 2025 said: “Standardised packaging is a pivotal measure in the road to Smokefree 2025. It transforms tobacco packaging from a highly effective marketing tool, particularly for youth and young adults, to a plain and unattractive object. For decades, tobacco companies have used skilfully designed packaging to help attract the next generation of smokers and the government has rightly ended this practice.”
Professor Hoek has led several studies on cigarette plain packaging, as well as an innovative study on the potential for dissuasive cigarette sticks.
The Public Health Amendment (Tobaccofree Generation) Bill 2014 was tabled in the Tasmanian Parliament in November 2014 by an Independent MP Hon. Ivan Dean. The Bill proposes to phase out the sale of tobacco products to any person born after the year 2000. The Bill is a measure to curtail supply; smoking would not be criminalised and there would be no penalties for using or possessing tobacco. The Bill was referred to a Parliamentary Committee in March 2015. It has been debated and scrutinised for well over a year. The committee was asked to look at the workability and practicality of the Bill.
The Committee, brought down its report in July 2016, making the following key findings:
There does not appear to be any significant legal impediment to the operation of the Bill in delivering the policy intent.
The Parliament should take a measured and cautious approach in considering a Bill which could limit or ‘extinguish’ fundamental rights relating to age, equality and liberty.
The Bill raises some practical legal issues in relation to online sales and the impact of the Bill on tourism/tourists. The proposer of the Bill may wish to give consideration to amendment of the Bill to avoid negative impacts on tourism.
Should the Bill be supported, appropriate education programs would be required to effectively implement the Bill. This would incur a cost and would be a matter for the Government of the day.”
A number of submissions were made including one from Lois Ireland, a retailer, who said:
“I made a conscious decision to stop gaining a profit from sales of a product that I knew to be highly addictive and that was causing long term health issues with those who I knew personally as members of my community. I knew they would go elsewhere to purchase their cigarettes but I did not wish to be further implicated in their poor health choices.
As a result, I fully endorse any moves that make it more difficult for young people to take up/continue smoking, despite any effects such measures may have on businesses. To be honest I’d be happy to see a ban on all sales – think how much lower our hospital costs would be!”
Other submissions were made by the tobacco industry and their front organisations including the Alliance of Australian retailers (AAR) which was set up to lobby against plain packaging – but seems to have extended its reach. The UK University of Bath website has exposed AAR as a tobacco industry front organisation.
The Cancer Council of Tasmania (CCT) carried out two surveys of public opinion on smoking matters including questions on TFG. The CCT survey shows that 75% of Tasmanians support the idea of a tobacco free generation, an increase on previous surveys.
A number of lawyers and an international human rights expert also provided reports and advice to the Committee. Dr. Gogarty from the University of Tasmania said there was no legal impediment to the Bill, but expressed concerns about age discrimination and liberty. A comprehensive response and rebuttal to Dr. Gogarty’s advice was provided by Barrister Neil Francey, who says that Dr. Gogarty abandons a strict legal approach and adopts an “extreme libertarian” approach.
Ethicist Dr van der Eijk added, relating to the absence of a right to smoke. “It is highly unlikely that, given the toxic and addictive nature of smoking, it can be defended as liberty right……and children’s rights.” Also, “Smoking can also not be defended as a privacy right.”
Eminent international Professor of Law, and Professor of Public Policy and Urban Affairs in Boston USA, Professor W. Parmet also commented,
“Critically there is no fundamental right to exercise all of one’s choices without any, even indirect, legal hurdles. If that were the case, cigarette taxes, which also make It harder for some people to exercise their choice to smoke by raising the cost of cigarettes would also violate individual’s fundamental rights. Indeed, all public health laws would violate someone’s fundamental right, as all impose some road blocks on individual choice. ….In debating the wisdom of any particular public health law, it is important not to confuse the question of whether the benefits conferred by the law outweigh the inconveniences and hurdles It imposes, with the question of whether it violates recognized fundamental rights, such as the right to bodily integrity or free speech.”
The current conservative Liberal Tasmanian government has said that it might raise the “smoking age” to 21 or 25 years instead of proceeding with the TFG. This proposal has been met with a deluge of criticism in Tasmania, as all major local health groups support the TFG proposal and there is immense community support. Professor Simon Chapman criticised the raising of smoking age to 21 proposal as a “symbolic political gesture”.
The decision on 19 May 2016 by the High Court of Justice of England and Wales to dismiss the legal challenges brought by the four multinational tobacco companies against the UK’s tobacco plain packaging legislation was a major blow to the industry. The 386 page ruling addresses a wide range of legal claims and evidence; together with lessons learned from the industry’s failed attempts to overturn Australia’s 2012 plain packaging legislation, it provides an important resource for countries planning to introduce similar laws.
The McCabe Centre for Law and Cancer, a joint initiative of Cancer Council Victoria and the Union for International Cancer Control, has prepared a paper on the UK decision which draws out eight key aspects likely to be of widest relevance to litigation and policy development in other jurisidictions. Included in the aspects of the ruling which are explored and analysed are: the intent and limits of the laws, the conflicting interests of the tobacco industry and public health, the complementary nature of comprehensive tobacco control measures, and the relevance of the World Health Organisation Framework Convention on Tobacco Control.
Some notheworthy points in the analysis:
“…the Court points out that tobacco companies overstate the restrictive effects and implications of standardised packaging legislation” (page 4)
“The Court noted that the interests at stake ‘collide in the most irreconcilable of ways” (page 4)
“The Court notes that not all rights and interests are of equal value or worth. The protection of public health is one of the highest of all public interests. Health is a fundamental right” (page 5)
“…the Court notes that effective tobacco control requires the implementation of a number of complementary, mutually reinforcing measures, and that it can be difficult (if not impossible) to evaluate the contribution of individual measures in isolation to the reduction of tobacco use” (page 6)
“…the Court recognises that tobacco control does not and cannot stand still if it is to be effective (page 7)
“…the Court recognises the fundamental reality of intellectual property rights – they are created and protected to serve public purposes and interests, and are not absolute. Their exercise can be limited or restricted to serve other public purposes and interests. Public health is universally recognised as a public purpose and interest which justifies limitations and restrictions on the exercise of intellectual property rights” (pages 10 and 11)
“…the Court explains why, even if standardized packaging laws did constitute an expropriation of property, standardized packaging would fall within the category of ‘exceptional’ circumstances in which it would not be appropriate to require the payment of compensation” (page 13)
Chris Bostic, Richard Daynard and Tamar Lawrence-Samuel
The history of the Framework Convention on Tobacco Control (FCTC) is filled with one unprecedented victory after another (see page 21). The next milestone for the treaty can—and should— tap the potential of Article 19 to hold the industry liable. Though the implementation of measures in line with Articles 5.3 and 13 has dramatically shifted the way the tobacco industry can operate globally, Article 19 has similar—if not greater—potential to curb the operations of the industry, and therefore the tobacco epidemic. As we look to the next Conference of the Parties (COP) in November, Parties should be looking to make sure that Article 19 achieves its potential.
For many who participated in the drafting of the FCTC, Article 5.3 (protecting public health policies from the tobacco industry) and Article 13 (banning tobacco advertising, promotion and sponsorship) seemed too visionary. Many thought these articles would be politically and technically impossible to implement. But a decade later, Parties are prioritizing these articles— and the effects are startling. Today, tobacco industry marketing is being rolled back across the globe. And dozens of countries have barred the industry from the policymaking table, creating space for effective policies to take hold.
But still the industry continues to be enormously profitable, with the top six corporations raking in $44 billion of profits in 2013. This, in part, because it breaks national laws and is not held accountable for what its products cost society. Governments pay billions of dollars in healthcare costs due to the tobacco epidemic. And evidence continues to mount of the tobacco industry’s illegal activities, which it currently appears to engage in with relative impunity—from illicit trade to widespread and systematic bribery.
To take the next big step in reducing the industry-driven tobacco epidemic, we must be able to hold the industry civilly and criminally liable. We must appreciate the visionary potential in Article 19. And we must take bold, courageous action to realize the world that Article 19 can make possible.
A vast ocean of possibility
Successful civil liability litigation in the U.S. and Canada has proven this tactic has great, global potential. It can provide an avenue for governments to hold the industry accountable for breaking laws, whether it be illegal marketing practices or illicit trade. Financially, it can shift the cost of the tobacco epidemic to the industry, where it belongs, raise the price of tobacco products (which reduces consumption), and provide funds for tobacco control campaigns. And finally, civil liability suits can expose internal industry documents, which provide invaluable insight into the industry’s tactics and help pave the way for even more effective legislation and litigation.
Holding the tobacco industry criminally liable, on the other hand, is admittedly venturing into less tested waters. But the ocean of possibility is vast.
Research on criminal liability provides cause for hope. A successful criminal prosecution would dramatically change the landscape for the tobacco industry. Tobacco executives could face potential prison time for violating tobacco control laws or for misleading people about the lethality of their products. The negative publicity generated with such charges would go far in denormalizing the tobacco industry and would chill the recruitment of talent.
Moral and financial imperative
To be sure, successful implementation of liability measures will prove to be challenging. And it will look different in each country given the range of legal systems across Parties. But the moral and financial imperatives are clear. Parties in the Global South, such as those recently targeted by British American Tobacco’s bribery, are now calling for tools to advance Article 19. These are some of the same Parties who championed Articles 5.3 and 13 during the FCTC negotiations.
We can and must follow these Parties’ visionary lead once again. During COP7, Parties should adopt strong guiding principles to advance implementation of Article 19. These include principles for developing and reforming legislation, and best practices for litigating in civil and criminal liability regimes in both civil and common law jurisdictions and systems.
Without a doubt, litigating against the tobacco industry is costly and intimidating. But many governments are already locked in defensive legal battles with the industry as it turns to litigation more and more to undermine strong tobacco control policies around the world. If governments are going to be in court with the industry, they should be doing it on their terms, proactively holding the industry liable for its myriad of abuses. And to do so, they need tools and guidance for implementation of Article 19 from the treaty, the Secretariat, and the COP. We have the ability to bring the untapped potential of Article 19 into fruition and to rein in the tobacco industry as we have never seen before. We have no time to lose. We must act, as a global community, now.
Across forty years I’ve come to recognise many factoid-driven myths about smoking that just won’t die. If I asked for a dollar each time I had to refute these statements, I’d have accumulated a small fortune.
Their persistence owes much to their being a vehicle for those who utter them to express unvoiced but clear sub-texts that reflect deeply held beliefs about women, the disadvantaged, mental illness, government health campaigns and the “natural”.
Let’s drive a stake through the heart of ten of the most common myths.
1. Women and girls smoke more than men and boys
Women have never smoked more than men. Occasionally, a survey will show one age band where it’s the other way around, but from the earliest mass uptake of smoking in the first decades of last century, men streaked out way ahead of women.
In 1945 in Australia, 72% of men and 26% of women smoked. By 1976, men had fallen to 43% and women had risen to 33%.
As a result, men’s tobacco-caused death rates have always been much higher than those of women. Women’s lung cancer rates, for example, seem unlikely to reach even half the peak rates that we saw among men in the 1970s.
But what about all the “young girls” you can see smoking, I’m always being told. In 2014, 13% of 17-year-old male high school students and 11% of females smoked. In two younger age bands, girls smoked more (by a single percentage point).
Those who keep on insisting girls smoke more are probably just letting their sexist outrage show about noticing girls’ smoking than their ignorance about the data.
2. Quit campaigns don’t work on low socioeconomic smokers
In Australia, 11% of those in the highest quintile of economic advantage smoke, compared with 27.6% in the lowest quintile. More than double.
So does this mean that our quit campaigns “don’t work” on the least well-off?
Smoking prevalence data reflect two things: the proportion of people who ever smoked, and the proportion who quit.
If we look at the most disadvantaged group, we find that a far higher proportion take up smoking than in their more well-to-do counterparts. Only 39.5% have never smoked compared with 50.4% of the most advantaged – see table 9.2.6).
When it comes to quitting, 46% of the most disadvantaged have quit compared to 66% of the least disadvantaged (see table 9.2.9).
There is a higher percentage of the disadvantaged who smoke mainly because more take it up, not because disadvantaged smokers can’t or won’t quit. With 27.6% of the most disadvantaged smoking today, the good news is that nearly three-quarters don’t. Smoking and disadvantage are hardly inseparable.
3. Scare campaigns ‘don’t work’
Countless studies have asked ex-smokers why they stopped and current smokers about why they are trying to stop. I have never seen such a study when there was not daylight between the first reason cited (worry about health consequences) and the second most nominated reason (usually cost).
For example, this national US study covering 13 years showed “concern for your own current or future health” was nominated by 91.6% of ex-smokers as the main reason they quit, compared with 58.7% naming expense and 55.7% being concerned about the impact of their smoking on others.
If information and warnings about the dire consequences of smoking “don’t work”, then from where do all these ex-smokers ever get these top-of-mind concerns? They don’t pop into their heads by magic. They encounter them via anti-smoking campaigns, pack warnings, news stories about research and personal experiences with dying family and friends. The scare campaigns work.
4. Roll-your-own tobacco is more ‘natural’ than factory made
People who smoke rollies often look you in the eye and tell you that factory made cigarettes are full of chemical additives, while roll-your-own tobacco is “natural” – it’s just tobacco. The reasoning here that we are supposed to understand is that it’s these chemicals that are the problem, while the tobacco, being “natural”, is somehow OK.
This myth was first turned very unceremoniously on its head when New Zealand authorities ordered the tobacco companies to provide them with data on the total weight of additives in factory made cigarettes, roll-your-own and pipe tobacco.
For example, data from 1991 supplied by WD & HO Wills showed that in 879,219kg of cigarettes, there was 1,803kg of additives (0.2%). While in 366,036kg of roll-your-own tobacco, there was 82,456kg of additives (22.5%)!
Roll-your-own tobacco is pickled in flavouring and humectant chemicals, the latter being used to keep the tobacco from drying out when smokers expose the tobacco to the air 20 or more times a day when they remove tobacco to roll up a cigarette.
5. Nearly all people with schizophrenia smoke
It’s true that people with mental health problems are much more likely to smoke than those without diagnosed mental health conditions. A meta-analysis of 42 studies on tobacco smoking by those with schizophrenia found an average 62% smoking prevalence (range 14%-88%). But guess which study in these 42 gets cited and quoted far more than any of the others?
If you said the one reporting 88% smoking prevalence you’d be correct. This small 1986 US study of just 277 outpatients with schizophrenia has today been cited a remarkable 1,135 times. With colleagues, I investigated this flagrant example of citation bias (where startling but atypical results stand out in literature searches and get high citations – “wow! This one’s got a high number, let’s quote that one!”).
By googling “How many schizophrenics smoke”, we showed how this percolates into the community via media reports where figures are rounded up in statements such as, “As many as 90% of schizophrenic patients smoke.”
Endlessly repeating that “90%” of those with schizophrenia smoke does these people a real disservice. We would not tolerate such inaccuracy about any other group.
6. Everyone knows the risks of smoking
Knowledge about the risks of smoking can exist at four levels:
Level 1: having heard that smoking increases health risks.
Level 2: being aware that specific diseases are caused by smoking.
Level 3: accurately appreciating the meaning, severity, and probabilities of developing tobacco related diseases.
Level 4: personally accepting that the risks inherent in levels 1–3 apply to one’s own risk of contracting such diseases.
Level 1 knowledge is very high, but as you move up the levels, knowledge and understanding greatly diminish. Very few people, for example, are likely to know that two in three long term smokers will die of a smoking caused disease, nor the average number of years that smokers lose off normal life expectancy.
7. You can reduce the health risks of smoking by just cutting down
It’s true that if you smoke five cigarettes a day rather than 20, your lifetime risk of early death is less (although check the risks for one to four cigarettes a day here).
But trying to “reverse engineer” the risk by just cutting down rather than quitting has been shown in at least four large cohort studies such as this one to confer no harm reduction.
If you want to reduce risk, quitting altogether should be your goal.
8. Air pollution is the real cause of lung cancer
Air pollution is unequivocally a major health risk. By “pollution”, those who make this argument don’t mean natural particulate matter such as pollen and soil dusts, they mean nasty industrial and vehicle pollution.
The most polluted areas of Australia are cities where pollution from industry and motor vehicle emissions are most concentrated. Remote regions of the country are the least polluted, so if we wanted to consider the relative contributions of air pollution and smoking to smoking-caused diseases, an obvious question to ask would be “does the incidence of lung cancer differ between heavily polluted cities and very unpolluted remote areas?”
Yes it does. Lung cancer incidence is highest in Australia in (wait for this …) in the least polluted very remote regions of the country, where smoking prevalence happens also to be highest.
9. Smokers should not try to quit without professional help or drugs
If you ask 100 ex-smokers how they quit, between two-thirds and three-quarters will tell you they quit unaided: on their final successful quit attempt, they did not use nicotine replacement therapy, prescribed drugs, or go to some dedicated smoking cessation clinic or experience the laying on of hands from some alternative medicine therapist. They quit unaided.
So if you ask the question: “What method is used by most successful quitters when they quit?” The answer is cold turkey.
Fine print on this English National Health Service poster states a bald-faced lie by saying that “There are some people who can go cold turkey and stop. But there aren’t many of them.” In the years before nicotine-replacement threapy and other drugs were available, many millions – including heavy smokers – quit smoking without any assistance. That’s a message that the pharmaceutical industry was rather not megaphoned.
Not true. NHS poster.
10. Many smokers live into very old age: so it can’t be that harmful
In just the way that five out of six participants in a round of deadly Russian roulette might proclaim that putting a loaded gun to their head and pulling the trigger caused no harm, those who use this argument are just ignorant of risks and probability.
Many probably buy lottery tickets with the same deep knowing that they have a good chance of winning.
Ten more myths about smoking that will not die
There’s plainly a big appetite for smoking myth busting, so here are 10 more.
1. Today’s smokers are all hard core, addicted smokers who can’t or won’t give up
This claim is the essence of what is known as the “hardening hypothesis”: the idea that decades of effort to motivate smokers to quit has seen all the low-hanging fruit fall from the tree, leaving only deeply addicted, heavy smokers today.
The key index of addicted smoking is the number of cigarettes smoked per day. This creates a small problem for the hardening hypothesis: in nations and states where smoking has reduced most, the average number of cigarettes smoked daily by continuing smokers has gone down, not up. This is exactly the opposite of what the hardening hypothesis would predict if remaining smokers were mostly hard core.
2. Smoking is pleasurable
Repeated studies have found that around 90% of smokers regret having started, and some 40% make an attempt to quit each year. There’s no other product with even a fraction of such customer disloyalty.
But I’m always amused at some die-hard smokers’ efforts explain that they smoke for pleasure and so efforts to persuade them to stop are essentially just anti-hedonistic tirades. Many studies have documented that the “pleasure” of smoking centres around the relief smokers get when they have not smoked for a while. The next nicotine hit takes away the discomfort and craving they have been experiencing.
This argument is a bit like saying that being beaten up every day is something you want to continue with, because hey, it feels so good when the beating stops for a while.
3. Light and mild cigarettes deliver far less tar and nicotine to the smoker than standard varieties
Several nations have outlawed cigarette descriptors such as “light” and “mild” because of evidence that such products do not deliver lower amounts of tar and nicotine to smokers, and so are deceptive.
The allegedly lower yields from cigarettes labelled this way resulted from a massive consumer fraud.
Cigarette manufacturers obtained these low readings by laboratory smoking machine protocols which took a standardized number of puffs, at a standardized puff velocity. The smoke inhaled by the machine was then collected in glass “lungs” behind the machine and the tar and nicotine weighed to give the readings per cigarette.
But the companies didn’t tell smokers two things. So-called light or mild cigarettes had tiny, near-invisible pin-prick perforations just on the filter (see picture). These holes are not covered by the “lips” or “fingers” of the laboratory smoking machine, allowing extra air to be inhaled and thus diluting the dose of tar and nicotine being collected.
But when smokers use these products, two things happen. Their lips and fingers partially occlude the tiny ventilation holes, thus allowing more smoke to be inhaled. Smokers unconsciously “titrate” their smoking to obtain the dose of nicotine that their brain’s addiction centres demand: they can take more puffs, inhale more deeply, leave shorter butt lengths or smoke more cigarettes.
Today, where use of these descriptors has been stopped, the consumer deception continues with the companies using pack colours to loudly hint to smokers about which varieties are “safer”.
Magnification and location of filter ventilation holes. Author collection
4. Filters on cigarettes remove most of the nasty stuff from cigarettes
We’ve all seen the brown stain in a discarded cigarette butt. But what few have seen is how much of that same muck enters the lungs and how much stays there.
This utterly compelling video demonstration shows how ineffective filters are in removing this deadly sludge. A smoker demonstrates holding the smoke in his mouth and then exhales it through a tissue paper, leaving a tell-tale brown stain. He then inhales a drag deep into his lungs, and exhales it into a tissue. The residue is still there, but in a much reduced amount. So where has the remainder gone? It’s still in the lungs!
5. Governments don’t want smoking to fall because they are addicted to tobacco tax and don’t want to kill a goose that lays golden eggs
This is perhaps the silliest and most fiscally illiterate argument we hear about smoking. If governments really want to maximise smoking and tax receipts, they are doing a shockingly bad job of it. Smoking in Australia has fallen almost continuously since the early 1960s. In five of the 11 years to 2011, the Australian government received less tobacco tax receipts than it did the year before (see Table 13.6.6).
Plainly, as smoking continues to decline, diminishing tax returns will occur, although this will be cushioned by the rising population which will include some smokers.
In the meantime, tobacco tax is a win-win for governments and the community. It reduces smoking like nothing else, and it provides substantial transfer of funds from smokers to government for public expenditure.
Those of us who don’t smoke do not squirrel away what we would have otherwise spent on smoking in a jam jar under the bed. We spend it on other goods and services, benefiting the economy too.
6. Most smokers die from smoking caused diseases late in life, and we’ve all got to die from something
Smoking increases the risk of many different diseases, and collectively these take about ten years off normal life expectancy from those who get them.
Smoking is by far the greatest risk factor for lung cancer. In Australia, the average age of death for people with lung cancer is 71.4 (see Table 4.2), while life expectancy is currently 80.1 for men and 84.3 for women.
This means that, on average, men diagnosed with lung cancer lose 8.7 years and women 12.9 years (mean 10.8 years). Of course, some lose many more (Beatle George Harrison died at just 58, Nat King Cole at 45).
If a 20-a-day smoker starts at 17 and dies at 71, 54 years of smoking would see 394,470 cigarettes smoked. At ten puffs per cigarette, that’s some 3.94 million point-blank lung bastings.
It takes about six minutes to smoke a cigarette. So at 20 a day, smokers smoke for two hours each day. Across 54 years, that’s a cumulative 1,644 days of smoking (4.5 years of continual smoking if you put it all together).
So by losing ten years off life expectancy, each cigarette smoked takes about 2.2 times the time it takes to smoke it off the life expectancy that might otherwise have been enjoyed.
7. Smokers cost the health system far more than the government receives from tobacco tax
In June 2015, a senior staff member of Australian libertarian Senator David Leyonhjelm, Helen Dale tweeted:
In Australia, a now old report looking at 2004/05 data estimated the gross health care costs attributable to smoking “before adjustment for savings due to premature death” were $A1.836 billion. In that financial year, the government received $A7,816.35 billion in customs and excise duty and GST on tobacco.
Someone who thought that the fiscal ledger was all that mattered in good government might conclude from this that smokers easily pay their way and perhaps we should even encourage smoking as a citizen’s patriotic duty.
With smokers being considerate enough to die early, these noble citizens lay down their lives early and thus contribute “savings due to premature death” like failing to draw a state pension or needing aged care services late in life. Philip Morris notoriously gave this advice to the new Czech government in 1999.
Other assessments, though, might well point to the values inherent in such assessments. History’s worst regimes have often seen economically non-productive people as human detritus deserving death. Primo Levi’s unforgettable witnessing of this mentality in Auschwitz comes to mind.
8. Big Tobacco is starting to invade low-income nations, now that smoking is on the wane in the wealthiest nations
Sorry, but US and British manufacturers have been aggressively marketing cigarettes in places such as China since the early years of last century. These collectable posters show many featuring Chinese women.
The large populations, the often lax tobacco-control policies and the higher corruption indexes of many low- and middle-income nations makes many of these nirvanas for Big Tobacco.
There are fewer more nauseating experiences than reading the corporate social responsibility reports of tobacco transnationals and then seeing how they operate in smokers’ paradises such as Indonesia. This documentary says it all.
9. Millions of cigarette butts on the world’s beaches leach lots of toxic chemicals into oceans
Cigarette butts are the most discarded items in all litter. Every year uncounted millions if not billions are washed down gutters in storm water and find their way into rivers, harbours and oceans. Cigarette filters and butts contain toxic residue and experiments have shown that placing laboratory fish in containers for 48 hours with leachate extracted from used cigarette butts, 50% of the fish die. From this, we sometimes hear people exclaim that cigarette butts are not just unsightly, but they “poison the oceans”.
But a confined laboratory container does not remotely mirror real life exposures in oceans or rivers. There are some 1,338,000,000 cubic kilometers of water in the world oceans, so the contribution of cigarette butts to the toxification of all this could only excite a homeopath.
If we want to reduce tobacco litter, we need not wander into such dubious justifications. The best way by far is to keep reducing smoking. Industry attempts at portraying themselves as corporately responsible by running dinky little clean-up campaigns or distributing personal butt disposal canisters avoids their efforts to keep as many smoking as possible.
10. Tobacco companies care deeply about their best customers dying early
Naturally, all businesses would rather their customers lived as long as possible so that the cash registers can keep ringing out long and loud. Tobacco companies wish their products didn’t kill so many, but worship the god nicotine for its iron grip on so many.
Visit any tobacco transnational’s website and you will find lots of earnest and caring talk about the companies’ dedication to doing all they can to reduce the terrible harm caused by their products. All the major companies have now invested heavily in electronic cigarettes, so isn’t this a sign that they taking harm reduction seriously?
It might be if the same companies were showing any sign of taking their feet off the turbo-drive accelerator of opposing effective tobacco control policies. But they are doing nothing of the sort. All continue to aggressively attack and delay any policy like tax hikes, graphic health warnings, plain packaging and advertising bans wherever in the world these are planned for introduction.
For all their unctuous hand-wringing about their mission to reduce harm, they are all utterly determined to keep as many smoking as possible. Big Tobacco’s business plan is not smoking or ecigarettes. It’s smoking and ecigarettes. Smoke when you are able to, vape when you can’t. It’s called dual use and some 70% of vapers are doing just that. The tragedy now playing out in some nations is that too many gormless tobacco control experts are blind to this big picture.
The tobacco industry lost the health argument 50 years ago, and in the past decade the WHO Framework Convention on Tobacco Control (FCTC) developed the antidote to reverse the smoking epidemic. However the tobacco industry is stepping up direct attacks, particularly at WHO. Recently the industry took pot shots yet again at WHO and the FCTC Conference of the Parties (COP) in its mouthpiece, Tobacco Reporter. The article, (Snail Mail, Jan 2016) makes several ludicrous accusations against both WHO and the COP but ends up only incriminating itself. We pull quotes from the article and provide our response.
TR: “Most of the besuited classes that turn up at COP7 will have few insights into the lives of the financially impoverished people who tend to make up the world’s smokers.”
SEATCA: In reality the tobacco industry has been making billions in profits from selling cigarettes to financially impoverished people all over the world. Eighty percent of the world’s 1.2 billion smokers are in developing countries http://www.who.int/mediacentre/factsheets/fs339/en/. Studies have shown that in the poorest households in many low-income countries, spending on tobacco products often represents more than 10% of total household expenditure http://www.who.int/tobacco/research/economics/rationale/poverty/en/. Don’t forget the famous response from the R.J. Reynolds executive when asked why he didn’t smoke: “We don’t smoke that shit! We just sell it. We reserve the right to smoke for the young, the poor, the black and the stupid.”
TR: “People who turn up at COP7 will almost certainly be well-fed and cossetted”
SEATCA: Government officials make up the bulk of the delegates who attend the COP and it seems the industry has no qualms insulting them.
TR: “Wonder whether these smokers really want to trade in what is possibly one of the few enjoyments they have for the few extra years of poverty and struggle …”
SEATCA: Most smokers started smoking when they were still minors and did not know any better. Most smokers (70%) want to quit. What the industry refers to flippantly as “few enjoyments” actually leads to illness for many million smokers. Worldwide, about 6 million people die each year , often painfully, because of smoking. This not only affects smokers – it devastates families, emotionally and financially.
TR: “There are far too many people demonizing smokers…”
SEATCA: The FCTC does not demonise smokers. It does the reverse to help smokers quit. Smokers are addicted to nicotine and exposed to the thousands of harmful chemical compounds in the product. Two out three of the tobacco industry’s long term customers die prematurely because of their smoking, however the industry continues to push this harmful product. FCTC measures are aimed squarely at the industry, protecting non-smokers and supporting smokers to quit.
TR: “… making decisions about cigarette smoking without understanding it.”
SEATCA: There is no misunderstanding because the evidence is in – cigarette smoke contains 7,000 chemical compounds, many of which are carcinogenic.
TR: “People choose to smoke.”
SEATCA: Nicotine addiction is not a choice. Most smokers want to quit but find it hard – the addiction is potent displaying similarities to hard drugs such as cocaine and heroin. For decades, the tobacco industry denied or downplayed the harms of tobacco, and it has engineered its products to enhance their addictiveness. It has fought regulations to protect non-smokers from cigarette smoke, restrictions on advertising, and health warnings to inform the public about the danger of smoking.
The WHO is fulfilling its responsibility to support 180 governments’ obligation to implement the FCTC to reduce tobacco use and reverse the smoking epidemic to save lives. An industry that continues to peddle a product that kills has lost the basic concept of humanity.
Shame on the tobacco industry for exploiting the poor and taking pot shots at the WHO and the COP.