By K. H. Ginzel
Edited by Ashlee Dunston
Posted: Monday, October 1, 2001
ARTICLES
Publication Date: October 1, 2001
"In a time of universal deceit, telling the truth is a revolutionary act."
—George Orwell
To attempt an answer to this question, we must first assess the current situation. As I see it, it is bleak to the extreme.
After more than 20 years of intense efforts in helping fight the unparalleled human tragedy of disease and death caused by tobacco use, I feel utterly frustrated, angry, defeated, hopeless, and cynical. More so, I am inescapably losing respect for a society and a culture that has permitted this state of affairs not only to materialize, but also to persist essentially unabated.
The admirable, untiring work of a dedicated tobacco control community has in no way been matched by the actions that would be necessary on the part of those individuals and institutions who alone have the power and responsibility to stop the victimization of the people of this nation and of the rest of the world. Governments have largely remained aloof, while the tobacco cartel has been riding out crisis after crisis—especially the one of the last decade—by practicing and perfecting their well-seasoned deployment of cunning, craftiness, and deceit. That Big Tobacco managed to survive the most recent turmoil virtually unscathed is primarily reflected in its success in securing the next generation of its customers. Despite all the adverse media publicity that tobacco received during the 1990s, teen smoking in America rose during that period, and overseas expansion of tobacco trade has also been progressing at an ever increasing pace. "Business as usual" continues to thrive, prompting leading epidemiologists to predict worldwide tobacco-related mortality to reach 150 million in the first quarter, 300 million in the second, and a grand total of one billion (!) during the 21st century—figures that dwarf any statistics from other known causes.
Not only is tobacco killing its direct users, at an annual toll of over 400,000 in the United States alone: it also claims the lives of an estimated 60,000 nonsmokers who die from a similar range of diseases as smokers, but in their case caused by exposure to environmental tobacco smoke. It has now been 15 years since Harvard epidemiologist John Bailar stated in The New England Journal of Medicine that the "sharp and continuing rise in deaths from lung cancer, nearly all from cigarette smoking, is now widely recognized as a medical, social, and political scandal."
Who are the players in this gruesome drama? Foremost, they are the purveyors of the deadly merchandise. They also include the nation's youth— targeted, tricked, and manipulated into lifelong dependency; an army of biomedical scientists who dispassionately measure, count, and transform human suffering into impersonal numbers; and, at the other end of the spectrum, us—the tobacco control advocates and activists, emerging from every part of society and trying desperately to contain the mayhem. Sprawling across the entire scene is finally the government—federal, state, and local officials who duplicitously cater to both the sellers of death and their frustrated opponents. All in all, we are witnessing an arrangement of remarkable stability and continuity that, barring radical change, offers little prospect for a resolution in the foreseeable future.
To grasp the enormity of it all and put a human face on the abstract numbers, we only have to pause and envisage, however feebly, the dying and death of some of the estimated 100 million victims that smoking has claimed thus far. The unspeakable agonies of dying from cancer of the lungs or larynx, the slow suffocation of those afflicted with emphysema, and the fatal heart attacks in the prime of life conjure up visions of bodies lined up in endless rows, bodies fallen victim to violence turned inward, ravaged by a product whose dangers have been known but insidiously concealed by its manufacturers for almost five decades. These images are fundamentally no different from those of the death camps and mass graves the last century has witnessed in Nazi Germany, the Soviet Union, Cambodia, Rwanda, and Bosnia.
Although our pro-health advocacy has steadily gained in membership and momentum, the tobacco industry has been able repeatedly to boast record profits and exports, matched only by the rising toll of tobacco-related disease, disability, and death encircling the globe. The industry has skillfully absorbed what, at first glance, may have appeared a major setback, such as the 1998 Attorney Generals' settlement, which amounted to some $240 billion to be paid to the states over a period of 25 years. However, it simply enticed the recipient governments to spend the windfall moneys for anything they like except tobacco prevention, because reducing smoking would contractually also reduce industry payments. The most recent analysis attests to the industry's success: only a miniscule 5 percent of the settlement has been used for the originally stated purpose.
What Are the Antecedents to the Present Dilemma?
FIRST, it is the unceasing, undiminished pursuit of the youth market by tobacco corporations, which employ ever changing strategies of attack, aided by our stubborn persistence in the irrational (I will explain later) belief that common ground and mutual trust can eventually be found. During the past half-century, public health groups as well as government officials have repeatedly tried to seek some sort of accommodation with the manufacturers of tobacco products. A case in point is the industry's voluntary code of advertising, launched some 20 years ago, which promised not to prey on the vulnerabilities of the young. Yet precisely the opposite has happened, as thousands of secret company documents summoned during recent court trials have chillingly revealed. Flying in the face of such unabashed lies as "We don't want children to smoke" or "Smoking is an adult custom," or "It is an adult choice"—all craftily phrased to lure kids into lighting up—the industry mounted a monumental marketing scheme bluntly directed at teens and even preteens. Several other empty commitments were voiced over time, each of them designed to rekindle confidence and stir fresh, unrealistic expectations among tobacco control advocates who were still hoping for change.
The tobacco industry has resisted true change throughout its long history. The first opportunity for change offered itself most forcefully when in 1942 Lennox Johnston's landmark report in the British medical journal The Lancet identified nicotine as the active agent in tobacco responsible for the pleasant sensations experienced by the smoker. Johnston proposed that smoking tobacco was essentially a means of administering nicotine, just as smoking opium was a means of administering morphine. In 35 volunteers he found that nicotine injections not only simulated cigarette smoke inhalation but were also actually preferred to a cigarette. The second major opportunity for change followed only eight years later, when the first solid evidence surfaced that incriminated cigarette smoking as a cause of lung cancer. At that juncture, the tobacco industry could have followed the example of the pharmaceutical industry, which had already scored remarkable breakthroughs by identifying, isolating, and purifying active ingredients from natural products—such as morphine from poppies, salicylic acid from the bark of willows, reserpine from Rauwolfia (an ancient herb in India with medicinal properties), curare alkaloids from South American arrow poison, penicillin from mold, and many more. All of these can now be used safely in specified dose ranges to treat a variety of medical conditions.
The tobacco industry could then have concentrated on developing nicotine preparations free of the unnecessary burden of thousands of toxicants and carcinogens contained in the smoke of ordinary cigarettes. Fifty years ago, the tobacco industry might even have had a chance to obtain FDA approval, since the addictiveness of nicotine, though alluded to by Johnston, was then far from being generally recognized or experimentally confirmed. That the industry failed to do what modern medical research in other areas had been doing all along, suggests that addiction liability and FDA regulation must have raised a red flag even then.
Rather than focusing on nicotine and removing the toxic contaminants, the cigarette makers took the opposite course and actually added several hundred chemicals as tobacco additives. These additives served various purposes, but they especially helped to smooth and aromatize the rough smoke of natural tobacco so that kids and women would be able to tolerate it and become hooked more rapidly as nicotine was made available to the huge surface area of the lungs upon inhalation. The rest of the story is one of unprecedented lies and deceit, denying and obscuring the truth about the carnage wreaked upon this country and much of the world by the cigarette makers.
This is the same industry that several lawmakers, during the tumultuous congressional negotiations in 1997, considered worthy of protection from legal liability in return for $350 billion and certain concessions, whose effectiveness in reducing tobacco use was still largely in doubt. Fortunately, the concerted effort of our nationwide coalition "Save Lives Not Tobacco" averted the passage of any such bill. It would be truly unthinkable that the U.S. Constitution should ever be so subverted as to fit the schemes of an industry that wants to continue selling death with impunity. In a letter printed in The Washington Post on September 21, 1997, I wrote in the closing paragraph: "If this type of mind-set had prevailed at the end of World War II, we probably would have stopped our advance on the beachhead at Normandy, made peace with Hitler and argued about the least offensive way to keep the concentration camps operating."
In its most recent PR ploy, the tobacco industry, faced with a mountain of undeniable revelations about its conduct, tried to portray itself as a reformed industry. Because it has reformed, so the industry implied, it should not be judged by its past actions. In June 2001, the Campaign for Tobacco-Free Kids and Action On Smoking and Health in London released a report, entitled "Trust Us: We're The Tobacco Industry." It contains over 250 quotes from internal tobacco industry documents on topics from addiction and advertising to women and youth smoking, and indexes the dozens of countries mentioned in the documents.
The evidence is overwhelming that the tobacco industry has not changed.
While they claim they have reformed and are now "nice" and "responsible," their own documents tell a different story.
All this is just a repeat performance. The few allegedly corrective actions the industry and its allies have taken over the years were either evasive or merely feigned changes in attitude. Noisy ostentations of tobacco company CEOs vowing to keep kids from using tobacco, have repeatedly misled naive observers who were willing to detect a trait of responsibility in the industry's actions and even entertain variations on the theme "Can the tobacco industry be trusted to protect our children?"
Industry efforts to emasculate public health initiatives are now being aimed at the current WHO agenda—the Framework Convention on Tobacco Control—which is seeking worldwide consensus to stem the tide of the tobacco pandemic. Here the industry found an unexpectedly new ally in the U.S. delegation, which was lately directed to relax its earlier stance of firmly supporting a global treaty with teeth in it. Representative Waxman accused administration negotiators of doing everything they could to prevent the creation of strong global standards. During the third round of negotiations in November 2001, the United States continued to take positions on tobacco advertising, consumer protection, trade, and other issues that would protect the interests of the tobacco industry rather than public health. Philip Morris had this to say on its web site: "We do not agree . . . that tobacco use is an 'epidemic.' And we are concerned that certain proposals by WHO fail to recognize tobacco consumption as a legitimate choice that adults should be free to make." Tobacco giants admitted in Geneva in 2000 that smoking cigarettes was dangerous and addictive, but defended their right to sell and advertise them freely.
That year, after reviewing all of the new postures adopted by Philip Morris, BAT, Japan Tobacco, Imperial Tobacco, and Gallaher, the U.K. House of Commons Health Committee concluded that the tobacco industry had not really changed, but rather had only enhanced its public relations machinery. The industry continues to aggressively promote tobacco use in every corner of the globe, often in ways most effective at reaching youth. In the U.S., tobacco industry marketing expenditures have achieved a new annual high of over $8 billion, according to the latest report.
The SECOND most important factor leading up to the present situation is the failure to achieve FDA regulation of tobacco products. The push for such regulation as envisaged by Dr. David Kessler, then Commissioner of the FDA, and widely supported by the health community, President Clinton and some members of Congress, was unfortunate. It contained the seeds of failure from the start.
In a letter to Dr. Kessler of May 3, 1994, which I also sent to the President, I stressed that the shape that such regulation would take seemed to be highly problematic. Then I asked: "How would a tobacco product that contains nicotine and is used for the sole purpose of satisfying a craving prone to lead to serious health consequences qualify as a 'drug,' defined 'to include all medicines and preparations recognized in the U.S. Pharmacopoeia or National Formulary for internal or external use, or any substance intended for the cure, mitigation, or prevention of disease in man or animals' (Arthur H. Hayes, MD, Commissioner of FDA: Food and Drug Regulation After 75 Years, JAMA: 246, 1223, Sept 11, 1981)? How would a tobacco product comply with the 1962 Amendment requiring manufacturers to prove on the basis of substantial evidence that the drug is safe and effective, when such a product is in fact unsafe, and effective only in killing more than 400,000 Americans each year?"
In an invited presentation, entitled "Science-Based Tobacco Use Control: The Future Is Now," at the Dixy Lee Ray Memorial Symposium on Science-Based Environmental Management, in Seattle, August 30 to September 2, 1994, I again took issue with the proposed FDA regulation of tobacco in conjunction with two 1994 bills, HR 2147 and S 672, seeking to amend the Federal Food, Drug, and Cosmetic Act to include tobacco products. I reasoned that such an amendment "would totally subvert the well-defined, time-honored charge of the FDA to provide the American consumer with safe and effective therapeutic agents and non-harmful food and cosmetic products. The regulation by the FDA of a prodigious mixture of a few thousand chemicals, replete with potent poisons and powerful carcinogens, which are smoked or ingested for no purpose other than to satisfy a craving for nicotine, would seriously undermine the credibility of a federal agency known and respected for its health-oriented mission."
A year or two later, an almost identical argument was raised by attorneys for the tobacco industry who filed a lawsuit trying to prevent an FDA rule. If the court says the FDA has jurisdiction over tobacco, the industry argued, the FDA must ban tobacco, because the law insists that products under the FDA's purview must be "safe and effective"—a standard no tobacco product can meet. The case finally reached the U.S. Supreme Court, which, on March 21, 2000, rejected FDA jurisdiction over tobacco, stating that the government lacks authority to regulate tobacco as an addictive drug. Ruling 5 to 4, the justices said the FDA overreached when it reversed a decades-old policy in 1996 and sought to crack down on cigarette sales to minors. During their deliberations, some justices were skeptical that an agency charged with monitoring "safe and effective'' products could bring cancer-causing tobacco products into its domain. "It just doesn't fit,'' said Justice Sandra Day O'Connor. "It strains credibility to see how these products can be safe,'' she added.
O'Connor and other moderate and conservative justices suggested that the FDA would have no choice but to ban cigarettes and smokeless tobacco if it did begin to regulate them.
In the same May 3, 1994, letter to Dr. Kessler, in which I questioned the appropriateness of proposing FDA jurisdiction over tobacco, I pleaded for the placement of nicotine—an agent with proven addictive potential—under Schedule II of the Controlled Substances Act of 1970, along with morphine and other opioids of clinical usefulness, thus permitting the continued use of nicotine in the treatment of nicotine addiction. As a consequence, nicotine-free cigarettes and other tobacco products would quickly fall out of favor and bring an end to the 20th century nightmare of self-inflicted disease and death.
The THIRD integral factor in this analysis is the failure of the federal government and the majority of state legislatures to protect summarily the nonsmoking majority of this country from exposure to environmental tobacco smoke (ETS). Next to keeping its foothold on the youth market, the tobacco industry's major concern has been to preserve "smokers' rights" to smoke in the workplace, in the public arena, and especially in restaurants and in bars. This is why Big Tobacco viewed the nonsmokers' rights movement as "the most dangerous development to the viability of the tobacco industry that has yet occurred" (1978 Roper Report).
It is imperative that the Occupational Safety and Health Administration (OSHA) finally live up to its charge to protect employees from harmful exposures, which include those to tobacco smoke. The general duty clause of the Occupational Safety and Health Act of 1970 states in Section 5 (a): "Each employer shall furnish to each of his employees employment and a place of employment which are free from recognized hazards that are causing or are likely to cause death or serious physical harm to his employees." In the past, OSHA has consistently dodged its responsibility. Despite persistent efforts and repeated lawsuits against OSHA by the Action on Smoking and Health (ASH), OSHA continues to procrastinate and delay action on a nationwide workplace smoking ban.
In a written testimony submitted to the Senate Hearing on ETS on April 1, 1998, I tried to spell out the multifaceted aspects of lacking or providing a smoke-free environment. The physical harm inflicted by many of the more than 4,700 chemicals and 60 carcinogens in ETS has its greatest impact during pregnancy. This is when nicotine, a neuroteratogen, can interfere with fetal brain development, and when potent carcinogens, such as nicotine-derived NNK, invade growing organs not yet protected by mature DNA repair mechanisms. Impeccable research defining ETS-related morbidity and mortality, conducted by reputable scientists at prestigious institutions, has been maliciously attacked by tobacco interests, including industry front groups, with no letdown at a time when the industry pretended to reform. The industry vigorously and viciously opposes a smoke-free environment most probably because the absence of smoking in the public domain, which could eventually spill over into private residences and family automobiles, would eliminate a crucial incentive for children to experiment with and start smoking cigarettes themselves. It would also help smokers quit. The exposure of children to ETS has inflicted widespread physical and psychological harm, prompting Dr. William G. Cahan of Memorial Sloan-Kettering Cancer Center to call it, in a March 1985 New York Times editorial, the most prevalent form of child abuse.
Although smoking in enclosed air spaces has diminished, as more and more local clean-indoor-air laws have been enacted—often requiring an undue amount of time, energy, dedication, and nerves to implement their passage—smoking on the television and movie screen has recently taken off, obviously to keep smoking behavior well in the public eye.
The need to provide a smoke-free environment is not less important than the need to help smokers quit and to keep children from starting to smoke. All are integral parts of the same problem and should not be separated from one another. The disappointing outcomes of our past and present programs in prevention and cessation are no doubt a consequence of the fragmented and restrained approach that varying circumstances beyond our control have forced upon us.
So, Finally, What Are We Going to Do Now?
As a general guideline: We need a total turnaround from the manner in which we have been dealing with the tobacco issue in the past. We need uncompromising honesty. We need to recognize and end the reassuring self-delusion we have so comfortably indulged in. We need to acknowledge once and for all not just the obvious—that the tobacco industry has never kept its commitments—but also the hidden fact that it actually CANNOT be expected to behave differently.
The reality is simply this: The tobacco industry makes and markets a product that is highly addictive and maims or kills when used as intended. No other product officially traded on world markets shares this unique notoriety with tobacco. The continued prosperity of the industry depends on three basic requirements: Most importantly, it depends on the successful recruitment of children and adolescents into the ranks of smokers. Statistics have compellingly shown that very few people ever start to smoke after age 21. This is why the industry has vehemently opposed any legislation that would have raised the legal age for buying tobacco products above the age of 18. Since many high school seniors are 18 years or older, they can legally buy cigarettes and sell them to their younger classmates. Secondly, the cigarette business depends on the pervasive visibility and the continued social acceptance of smoking as part of normal human behavior. And thirdly, the industry depends on the calculated presence of nicotine in tobacco in amounts sufficient to produce and/or maintain addiction and thus to assure customer loyalty in the face of alarming news from the health front.
To expect that one of the most powerful industries—and probably the most lucrative enterprise on the planet—would voluntarily compromise or make serious concessions in any one of these vital preconditions for its survival is totally unrealistic; in fact, it would be tantamount to expecting the industry to commit suicide.
Finally, we need to admit that, by deluding ourselves, we have all been playing an unending game—call it "enabling" or call it "co-dependency"—whose outcome is counted in millions of children starting, and millions of smokers dying from, tobacco use. The perennial question asked in this game of life and death has been this: How do you plan to stop the tobacco companies from targeting kids? The fact that we have asked this very question unremittingly over the past half century is the root of our failure. It is a no-brainer! But it surely has helped retain the status quo.
This question is, in fact, as absurd as to ask whether the tubercle bacillus can be persuaded not to cause tuberculosis, or HIV not to cause AIDS. The "business," so to speak, of the tubercle bacillus is to cause tuberculosis; the "business" of HIV is to cause AIDS; the business of the tobacco industry is to market a product that inadvertently kills. To be sure, the manufacturers would be pleased if it wouldn't, but it does. At the least, the delayed onset of disease guarantees many years of profitable consumption.
Recognizing these self-evident facts calls for a fundamental revision of our approach. We must stop treating the tobacco industry as a partner in negotiation, as an organization run by people like ourselves with whom we can talk and reason. We must confront them as a quasi-nonhuman entity, as a carrier or vector of disease, a pathogen like the tubercle bacillus or HIV. We don't make a "deal" with the germs that produce disease and death—we try to eradicate them.
In the case of an epidemic in the conventional sense, we turn to the Centers for Disease Control and Prevention (CDC), which swiftly mobilizes a concerted effort to stop the outbreak. The CDC and several other institutions under the umbrella of the U.S. Department of Health and Human Services (U.S. DHHS) are also involved in fighting the epidemic of tobacco-related illnesses, but here their options to act are severely limited. For one thing, this epidemic is not caused by a simple microbe, but rather by a product legally manufactured and sold by American industry. The major constraint the U.S. DHHS faces, however, is imposed by the same government of which it is a constituent. A quote from a court opinion in the Cippolone lung cancer trial refers to the intention of the U.S. Congress as "seeking a carefully drawn balance between the purposes of warning the public of the hazards of cigarette smoking and protecting the interests of the national economy." Obviously, the carrier of tobacco-related diseases has infiltrated the very institution elected by public vote, whose sworn charge and duty it is to uphold the tenets of the Constitution, mindful of the Unalienable Rights to Life, Liberty and the Pursuit of Happiness that the founding fathers have proclaimed for the people of this nation. A recent commentary from Downing Street, with respect to a proposed workplace smoking ban in Britain, also invokes the concept of "balance" that has to be "achieved between desirable health objectives and being sensitive to the problems of restricting business practice."
There is still another economic perspective: Tobacco business allegedly saves the treasury billions by killing people before they deplete social security and pension funds. Calculations of this kind, however flawed, have been attempted not only by industry but also by governments.
Here are a few examples from the industry: Philip Morris vs. Czech economy analysis that made headlines in 2001, stating that the premature deaths of smokers saved the country millions in health care costs; a 1993 report commissioned by Imperial Tobacco stating that tobacco-related deaths are an economic advantage to Canadians because cigarettes kill people before they become a burden to the healthcare system; and a November 1978 secret document from the British American Tobacco Company, talking about what they call the "social cost" issue in rather chilling language: ". . . with a general lengthening of the expectation of life we really need something for people to die of. . . . In substitution for the effects of war, poverty and starvation, cancer, as the disease of the rich, developed countries, may have some predestined part to play."
According to Milton and Rose Friedman, corporate officials have only one "social responsibility," i.e., to make as much money for their shareholders as possible. The best guarantors of maximum profitability in the long run are product quality and product safety. In the case of tobacco, however, these market forces are suspended by the addictiveness of the products. Here, governmental intervention is necessary to protect the consumer. In their wisdom, the Framers of the Constitution granted Congress the right to regulate commerce, empowering the U.S. government by the "Commerce Clause" of Article 1, Section 8, of the Constitution to stop the interstate trade of dangerous merchandise. If this authority would be exercised in the case of tobacco, it could usher in the beginning of the end of tobacco marketing. Such action must clearly be distinguished from prohibition, since individuals would still be able to grow tobacco strictly for personal use.
It would, indeed, be a bold move. Yet extraordinary challenges require extraordinary responses, whose feasibility and whose legal and legislative ramifications must be seriously explored. The inescapable truth, sadly affirmed by past experience, is that no intervention of any kind can be expected to protect children fully from being targeted by Big Tobacco. Recruitment of children as future consumers is the sine qua non of the survival of the tobacco industry.
Therefore, if government and society honestly want kids not to smoke, the logically compelling choice is to shut down the commercial marketing of tobacco products. The task would be monumental, but it is the only practical, social, and ethical alternative to allowing the killing to continue. Although only trade within the U.S. would initially be affected, other countries, assisted by WHO's worldwide tobacco control initiative, might soon follow our lead. Indeed, final success would depend on full international cooperation. There are positive indicators that the time is right for comprehensive action. U.S.-based tobacco corporations are already widely diversified in areas other than tobacco and should be given reasonable time to phase out the manufacture of tobacco products and expand their share in non-tobacco commodities.
Tobacco farmers should be encouraged and assisted to shift, at least in part, from conventional tobacco farming to the cultivation of tobacco plants for the extraction of tobacco protein, which has been shown to be superior to all other plant proteins tested and deserves full-scale development and utilization for food and a variety of medicinal purposes. What an intriguing prospect that the same plant that has killed millions of people should also possess the potential and capacity of feeding a protein-starved world and stimulating novel biotechnological research. Neither tobacco nor anything that human ingenuity has brought forth is inherently evil. It just depends on what we, collectively and individually, make of it.
Preparing for Action
The tools are at hand, but the will to use them is still lacking. In order to initiate the process of phasing out conventional tobacco commerce, all sectors of society must become actively involved. While the process of phasing out conventional tobacco commerce is unfolding, education will have to play a major role. Surprisingly, the population at large is still remarkably ignorant about the depth and magnitude of the global public health tragedy caused by tobacco use. Very few people can even guess some of the mind-boggling statistics. The Journal of the American Medical Association recently reported that even smokers are only marginally aware of the risks they incur. However, the much needed social and political support by the public, especially the voters, will depend on their being fully informed.
So far we have done poorly in educating the people vis-a-vis the overriding impact and indoctrination by Big Tobacco. The perennial reference to "drugs and alcohol" has effectively eclipsed the much greater risks associated with tobacco use. Therefore, it is not surprising, yet still quite disconcerting, that recent headline revelations about contemptible tobacco industry conduct, instead of inciting outrage, were largely met with indifference and apathy by the public. On the other hand, the proverbial person on the street, responding to community campaigns for smoke-free places, often asks why cigarettes are not banned altogether.
The first steps toward ending conventional tobacco commerce would be a comprehensive advertising ban and the protection of nonsmokers from tobacco smoke exposure. Both objectives are vigorously pursued by WHO but opposed by the U.S. delegation. Regrettably, the U.S. position will aid efforts by the tobacco industry and its allies to fight enactment of clean-indoor-air measures across the globe.
A totally different approach to stop tobacco trade, promotion, and ETS pollution lies in the hands of the next generation. If children and young people under the age of 21 did not start smoking cigarettes or using any other tobacco products, the conventional tobacco business would eventually be doomed. According to the CDC, less than 10 percent start smoking after 21.
Based on my own experience, I submit that a consistent, nationwide educational effort could take us a long way toward this goal. It is crucial that we tell kids the truth! Tell them that the tobacco companies are tricking them with lies, deceit, and fraud into smoking or chewing as if it were their own informed "adult choice" or an act of rebelliousness, independence, and "doing their own thing." The overused "Just say no" formula is largely ineffective, be-cause youngsters feel invulnerable to the risks of future illness.
During the 2001 spring and fall terms, assisted by a group of nursing students from New Mexico State University, I conducted over 100 demonstrations of a graphic smoking experiment combined with media literacy training. We addressed almost 4,000 children from the 3rd to the 8th grade in the Las Cruces school district. It was an uplifting experience that instilled new hope in the human potential for change.
It turned out that neither the children nor the teachers had been aware of the insidious ways the tobacco industry is manipulating the mind of kids. Their comprehension of what adults may view a difficult subject to convey was immediate and impressive and prompted the children to compose letters and make drawings, reflecting their grasp of the subject.
We routinely summarized our presentation by facing the facts:
1. More than 90 percent of all adult smokers start smoking before age 21.
2. To stay in business, the tobacco industry must recruit youth.
3. Governments have allowed the industry to do precisely that.
4. So, who is going to help and protect YOU??? Only YOU YOURSELVES!
We scroll down point by point but stop before revealing the answer in number four, asking: "So who is going to protect you?" Invariably, students raise up their hands and call out loud and clear: "Us! We ourselves!" Pointing to the inscription on the cap I am wearing—"It is time we made smoking history"—I ask "So WHO will be making smoking history?" Again I hear a chorus of voices, pledging "It is us. We will do it !!"
This, indeed, gives us confidence that our message has gotten through and that these youngsters feel it is in their power to change the world for the better. We also designed a flyer that reinforces our message and is discussed and distributed by the teacher in a followup session.
A second flyer is directed to the parents who smoke and expose their children to secondhand smoke in their homes. As many as one to two thirds of the children complained that they suffer such exposure, causing them a variety of respiratory problems. Children whose parents smoke are also more likely to become smokers themselves.
K.H. Ginzel, M.D. (jdunaway@nmsu.edu), is Professor Emeritus of Pharmacology and Toxicology at the University of Arkansas for Medical Sciences.
(From Priorities, Vol. 13, No. 4)
