This article is related to Anthony Biglan’s forthcoming book “Rebooting Capitalism: Forging a Society that Works For Everyone.”
All of my work over the past three years had come down to this moment. David Bernick, the wiry little high-paid lawyer for Brown and Williamson Tobacco Company, was cross-examining me with the air of a skilled hunter about to eviscerate his prey. Others told me he was nasty and clever, that his law firm billed $1,000 an hour for his time, and that he had won many high-profile cases. I, on the other hand, had never even testified in federal court. He was going to skewer me like a piece of meat.
Using the PowerPoint I had prepared, which detailed how tobacco companies make their brands attractive to youth, Bernick had created icons for each of the key concepts in my testimony. At first, I had no idea where he was going. That was what I found most distressing. During my thirty-three hours of depositions over two years, the tobacco company lawyers had taught me to fear surprises that might embarrass me or destroy my credibility.
In more than 400 pages of written testimony, I had described how the tobacco companies enticed vulnerable adolescents into smoking by associating their brands with all the things teens craved: excitement, fun, independence, sex, adulthood, and — most importantly — social acceptance. After reviewing thousands of cigarette ads, I had come to appreciate how cleverly the brands, especially Marlboro, could make little sticks of cancer-causing tobacco seem like the key to a teen’s social success.
The tobacco companies denied that they marketed to teens. In recent years, as the tobacco control movement had begun to accuse them of doing so, they stopped gathering data on teens. They sanctimoniously questioned me and other experts about whether we had any evidence that they had done market research with teens. Their subpoenaed documents indicated that they had not for many years.
Now Bernick was questioning me about each of the adolescent needs the tobacco companies used to make their brands appealing. As he put each one up on a large magnetic board, he would ask me whether the need was also important to those over twenty-one. After all, weren’t things like autonomy, social acceptance, excitement, and appeal to the opposite sex just as important to young adults? As he methodically proceeded, it became clear that he was going to try to show that the companies were simply targeting people over twenty-one. For anyone convinced of the harm of smoking, it might seem like a criminal thing to do, but under existing law, it was not. The court could hold the tobacco companies accountable only if we could prove they knowingly marketed to youth, despite their public denials. That would be fraud.
It all started four years earlier in 2001, when Russell Kinner of the U.S. Department of Justice asked me to be an expert witness in their lawsuit against the tobacco companies. I had been doing research on adolescent smoking prevention for twenty years, but had never been involved in litigation. I pointed out a number of other tobacco researchers with experience in these cases. Mike Cummings of Roswell Park Cancer Center in Buffalo had been involved in numerous cases. He had written scathing critiques of the tobacco companies. I couldn’t imagine a better witness. Cheryl Perry, a good friend of mine for many years, had been the expert witness on youth marketing in Minnesota’s suit against the tobacco companies. Why would he want me?
Russell explained that Mike had been in so many cases that all of his prior testimony and depositions would be available to the tobacco company lawyers and that they would use it to make it seem like Michael had biases against the tobacco companies. Cheryl had refused to do another case. But she was willing to assist in preparing me.
I spoke with Cheryl. She said that serving as an expert witness had taken her about two days a month. The fact that she would help me prepare made it more appealing. But, most importantly, I volunteered because I knew just how outrageously harmful tobacco marketing was.
How many people does cigarette smoking kill in the United States? More than 400,000 a year. Tobacco control advocates illustrate this by saying if two Boeing 747s crashed, killing everyone on board, every day of the year, it would kill the same amount of people. If two such planes went down today and two tomorrow, wouldn’t the F.A. A. ground all 747s until the NTSB determined and rectified the cause. Yet we have continued to proceed as thousands have died from smoking, acting as if nothing was happening.
The smoking prevention programs I’d been evaluating over the previous two decades had shown some benefit, but the positive effects were small. It had become clear to me that the tobacco companies’ youth marketing was much more powerful than the prevention programs we were able to put in schools. Tobacco companies were spending hundreds of millions and using some of the world’s most sophisticated marketing techniques. We simply could not compete.
The perfidy of the tobacco companies was inconceivable. Here was a product that, when used as intended, killed people. Recently released secret company documents showed that the companies had conducted their own studies of the carcinogenic effects of cigarettes in the 1950s. For fifty years, they had known that cigarettes caused cancer and they denied it.
Tobacco control researchers had thus far focused on getting people to quit or not ever start. Research in the 1990s began to show specifically how tobacco marketing got teens to start smoking and smokers to continue smoking. Cheryl had led a team that wrote the 1994 Surgeon General report on youth smoking. For the first time, the evidence that the companies’ marketing was motivating youth to smoke was available to everyone.
So here was a chance to really make a difference. After all the years that I had talked about the problem, how could I refuse to do something that could have a far greater impact on public health than anything else I might ever do? It was the opportunity of a lifetime to have a real impact.
A federal lawsuit is a grueling affair and this was the biggest suit in U.S. history. The Justice Department first asked me to write a report summarizing my understanding of the role of tobacco marketing in youth use. My report was sixty-nine pages, including copies of cigarette ads. In it, I stated my opinion that the tobacco companies were intentionally and very effectively marketing to teens.
Then the tobacco company lawyers were able to question me under oath in a deposition: for nineteen hours over two days! They came to Eugene, Oregon, where I live. There were about ten of them. Russell was the only DOJ lawyer in the room. They put me at one end of a long table with a videographer at the other end and the lawyers arrayed along the sides. Any misstep, inconsistency, or faltering on my part would be recorded and could be shown in court when it came my turn to testify. They recorded and transcribed every word I uttered. Excerpts of my testimony could be (and were) presented in court in an effort to show inconsistencies in what I was saying.
The companies’ lawyers are some of the highest-paid in the land. They scrutinize your evidence, theories, career, and scientific work in more detail than any promotion or tenure committee ever will. They try to find anything that will impugn your knowledge or integrity and to intimidate you. They will do it with formal politeness. (“Are you comfortable Dr. Biglan? Any time you need to take a break, just let us know.”) But they will ask questions whose premise is clearly demeaning and then will sneer, grimace, roll their eyes, and smirk at your answers. Only I was on camera; they would not be visible.
I did two more depositions before I testified in the trial. Slowly, I learned to steel myself against emotional reactions to their attacking style. In the movie Dirty Rotten Scoundrels, Steve Martin portrays a con man who pretends that he is paralyzed and has no feeling in his legs. He and another scoundrel, played by Michael Caine, are competing to see which of them can bilk the lovely heiress to a soap fortune. Martin has told her that he needs treatment from Dr. Sheffhausen. Caine finds that out and pretends to be Dr. Sheffhausen. He proceeds to examine the patient. He rolls up Martin’s pants, pinches his legs, sticks pins in them, and beats them with a switch. Each time Martin has a look that only Martin can do. He pauses with a pained look on his face as he struggles to detect the slightest feeling! A tear appears in his eye. He shakes his head sadly. He can feel nothing!
After two depositions and much input from Justice Department lawyers, I began to understand that it was not my job to argue with the tobacco company lawyers, nor to get angry or feel hurt. My main job was to remain unemotional, no matter what they asked or threw at me, and to state the facts. I thank Steve Martin for his help.
Bernick had already taken me and other experts through testimony showing that, in recent years the companies had conducted marketing research only on those over eighteen and in some cases had even limited their research to those over twenty-one. He was out to show that it was perfectly understandable that the companies would use themes of sex appeal, popularity, and excitement…simply to appeal to their entirely adult customers!
Now he was slowly taking me through each psychological motivation and asking me whether people over twenty-one had each of these needs. I couldn’t deny that most adults also wanted these things. Most of my answers were to the effect that they were certainly needs among many people over twenty-one, but they were stronger among adolescents.
My Justice Department keepers had told me that it is important not to be argumentative, but that from time to time you have to rise up and fight back, without seeming to be hostile, uptight, or argumentative. Bernick was getting to the end of the list and would soon close off this line of questioning with some kind of summary question meant to make it seem as if the companies were just marketing to adults. (“And so, Dr. Biglan, isn’t it true that every one of these needs is something that those over twenty-one desire? And isn’t it true that all marketing research simply helps us learn how to reach these young adult consumers?”) So after he asked about one of the motivations that one could reasonably argue is important to many adults, I had to take a chance and see if I could cut the legs out from under his argument. I said that it is precisely because those under and those over twenty-one shared these needs that they could be confident that what is effective advertising with adults will be effective with those under eighteen.
The look of shock and dismay on his face was priceless. There in front of the judge, it was clear that my answer destroyed the point he was trying to make. Bernick had not been to the Steve Martin School of Emotional Responding.
U.S. vs. Philip Morris et al. was one battle in the Tobacco Wars. It was a clear victory for antismoking forces. Judge Gladys Kessler ruled in favor of the government on almost every count. She found that the tobacco companies (a) had “falsely denied, distorted, and minimized the significant health consequences of smoking,” (b) were well aware of the addictive property of nicotine but continued to deny it, (c) falsely denied they could control the level of nicotine that their cigarettes delivered, and (d) knew their low-tar and low-nicotine cigarettes are not safer but continued to market them as such. (It wasn’t hard for me to make my case. So many documents in the tobacco company files did it for me. For example, Philip Morris economist Myron Johnston wrote in a memo, “Today’s teenager is tomorrow’s potential regular customer, and the overwhelming majority of smokers first begin to smoke while still in their teens.”)
I was particularly pleased that Judge Kessler accepted each of my opinions. For years, the tobacco companies had marketed cigarettes to young people because it is much harder to get adults to start smoking. They had conspired to hide this fact from the public. Despite their settlement of lawsuits with forty-eight states, in which they stipulated that they would stop marketing to teens, they had continued to do so. (They also pretended to make efforts to prevent youth smoking through bogus prevention programs they promoted with much fanfare but never really implemented or evaluated.)
It is fair to say that the tobacco control movement has made significant gains. In 1965, more than half of men and one-third of women smoked. By 2015, only 15.1 percent of adults were smoking.1 The Institute of Medicine, the nation’s source for unbiased summaries of the state of science in public health and medicine, cited the reduction of smoking as one of the most important achievements of public health in the twentieth century.
The tobacco war is not over. Cigarette smoking in the United States is continuing to cause about 480,000 deaths a year, according to the Centers for Disease Control. More than 36 million Americans smoke. And 16 million Americans have chronic illnesses due to smoking.2
The tobacco industry continues to be highly lucrative. Jennifer Maloney and Saabira Chaudhuri of The Wall Street Journal reported that, despite the fact that the rate of smoking has declined in the United States, tobacco companies’ profits are soaring.3 One reason is that the tobacco companies have been increasing the price of cigarettes so that every pack they sell is more profitable than it used to be.
And tobacco companies continue to innovate. Perhaps the most important innovation has been electronic cigarettes. E-cigarettes vaporize nicotine so that the users can inhale it. They came on the market with the idea that they would be safer than cigarettes because they would reduce people’s exposure to the carcinogens in cigarette smoke. Clear evidence on this point is lacking. Although e-cigarettes expose people to less tobacco smoke, the vapor contains chemicals such as propylene glycol and flavorings that may well be harmful. Moreover, the tobacco industry is marketing e-cigarettes to teenagers using the same strategies they used to market traditional cigarettes. Recent research by my colleague Erika Westling has conducted shows that young people who start using e-cigarettes are more likely to smoke regular cigarettes. Unfortunately, there is currently virtually no regulation on the marketing of e-cigarettes.4
In addition, the United States has fallen behind other countries in its efforts to reduce cigarette smoking. I became aware of how far we were lagging in 2015 when the Australian government asked me to review the evidence on graphic health warnings on cigarette packages. Australia had begun requiring manufacturers to package all cigarettes in plain brown boxes covered with graphic health warnings, such as gory pictures of people’s cancers. Australia’s policy was under attack through a complaint to the World Trade Organization and a lawsuit filed by Philip Morris Asia.
One of the primary allegations in these disputes was that graphic health warnings on plain packages had no benefit in reducing young people’s attraction to cigarettes and that it was an illegal interference in the companies’ use of their intellectual property; namely, their logos. I had not been involved in these issues since my testimony in 2005. I was surprised to learn that considerable research had studied the impact of traditional packs versus the type of packaging Australia had adopted. The evidence shows very clearly that the traditional cigarette packs conveyed to young people that cigarettes were popular, attractive, and safe — impressions that are well-established influences on youth starting to smoke.
In reviewing the evidence, including the declining rate of smoking in Australia, it became clear to me that visually striking health warnings on otherwise basic packages were highly useful in reducing youth smoking.
In short, it will require much further work to reduce the carnage associated with cigarette smoking. To make further progress on this and every other way in which corporations are doing harm, we need to understand how industries evolve and maintain harmful practices.
The Evolution of the Tobacco Industry
More than 20 million people died from smoking-related illnesses in the United States between 1965 and 2014.5 Yet in 2015, the American tobacco industry reported soaring profits.2 How is it possible that a product with no discernible benefit and that has killed so many people is still making so much money for the industry?
To understand that, we need to understand how the practices of the tobacco industry evolved. It is a story about how profits can select practices that produce those profits, even when the practices prove to be harmful. It is perhaps the clearest example of how an industry will fight to maintain its profits, even as the evidence mounts that those profits result from selling a product that harms its customers.
Consumers smoked cigarettes in very small numbers until the 1880s when James Bonsack invented a machine that could mass-produce them. Until then, people used tobacco by chewing it or by smoking pipes or cigars. For the most part, people did not inhale the smoke in cigars and pipes; as a result, the health consequences were less deadly. Once cigarettes could be mass-produced, there was a tremendous opportunity for cigarette sales to take off, and marketing made that happen
In many ways, the story of the development of marketing in the twentieth century is the story of cigarette marketing. The tobacco industry made some of the most successful innovations in marketing.
The first milestone in cigarette marketing occurred during the First World War when the demand for cigarettes by the troops undermined opposition to smoking in the military. When a reporter asked General Pershing, the head of the American Expeditionary Force, what we needed to win the war, he replied, “You ask me what we need to win this war. I answer tobacco, as much as bullets.”6 The tobacco industry provided cigarettes in the rations for every soldier, thus encouraging them to think of cigarettes as an essential item. Smoking became a basis for camaraderie, a form of social acceptance and bonding that is essential to military life. The beauty of the cigarette is that, if you can get a person to smoke 100 of them, it will almost surely addict them to smoking. In fact, the generation of young men who fought in the First World War was the first generation to smoke in significant numbers.7
However, men were only half the potential market, and providing cigarettes to soldiers did not get women to smoke. In the 1920s, society considered smoking undignified and inappropriate for women. There were several failed attempts to make smoking more compatible with femininity. Finally, the American Tobacco Company came up with a surefire way to convince women to smoke: their “Reach for a lucky instead of a sweet!” campaign linked smoking to weight loss – a motivating consequence if there ever was one. For the first time, significant numbers of women began smoking.
The most significant success in cigarette marketing history, however, was creating the Marlboro man. Philip Morris originally targeted Marlboro at women. But in the 1950s, the company began a campaign to associate the brand with virile, independent, rugged men. Over time, the advertising increasingly featured cowboys. The campaign convinced millions of young men that they could have these qualities by smoking Marlboro.
In preparation of my testimony in U.S. vs Philip Morris et al., I read hundreds of pages of Philip Morris documents concerning Marlboro. The company’s advertising was extraordinarily successful in convincing young men that they wanted to be the Marlboro Man. A focus group conducted for Philip Morris in the early 1990s found that the Marlboro Man elicited these images:
All-American; hardworking/trustworthy; rugged individual, man’s man (experienced, sure of self, confident, in charge, self-sufficient, down to earth, cool/calm, get the job done); admire his strength. …2045060177-0203 at 0186 (U.S. Exhibit 20,459).8
As I studied the impact of the Marlboro advertising, I realized that the campaigns worked in several ways. First, thanks to the image of a Marlboro smoker established through marketing, an adolescent boy can feel rugged and masculine simply by smoking Marlboro. A boost in self-esteem is an effective reinforcer of smoking behavior. Second, because his peers also have seen these images, they will see him as rugged and masculine if he smokes Marlboro. Improved social status is another great reinforcer. Similarly, if girls see him as rugged and masculine because of Marlboro’s masculine brand image, they are more likely to find him appealing. The possibility or promise of sex is yet another rewarding consequence. In short, by dangling several tantalizing consequences, the masculine Marlboro image shapes the values and beliefs of both the individual adolescent male and of his peers.
Closely related to the masculinity theme were the themes of independence and autonomy. Marlboro cigarettes became a symbol of freedom, autonomy, and independence. As Philip Morris made clear in a 1993 document, “Marlboro Worldwide Creative Issues and Guidelines,” Marlboro Country is just such a place of freedom:
“From an image standpoint, Marlboro stands for self-confidence, freedom of choice, leadership, strength, independence. The advertising proposition is: ‘Come to Where the Flavor Is…Come to Marlboro Country.’
Marlboro country is about fantasy and escape — a mythical place and state of mind where you are who you choose to be, command your own destiny and do what others only dream about.” 2501174579-4584 at 4583 (U.S. Exhibit 45,906).9
An adolescent can come to this wonderful country simply by smoking Marlboro. In a strange way, I became an admirer of the Marlboro advertising. The photographs they used to associate the brand with tough, independent, and admirable men were stunning, and they were quite successful.
Over more than three decades, Philip Morris persuaded generations of young men that, by smoking Marlboros, they could achieve the ideals of masculinity and the admiration of others. But it was a Faustian bargain. Naïve boys, striving to be admired young men, could feel as if they had achieved that status by buying Marlboros, while the company got an addicted smoker. Myron Johnston, the Philip Morris economist, put it this way:
“At least part of the success of Marlboro Red during its most rapid growth period was because it was the brand of choice among teenagers who then stuck with it as they grew older.”10
Men continued to smoke at higher rates than women, thanks in large part to the Marlboro success. However, the 1970s brought a new round of marketing to women. It took its lead from the women’s liberation movement that was encouraging women to assert their rights. The tobacco industry saw this as an excellent opportunity to associate smoking with women’s independence and success.
The first and most successful campaign was for Virginia Slims. This was another Philip Morris product. Here is how their advertising agency Leo Burnett described the campaign:
The original advertising campaign, “You’ve Come a Long Way Baby,” was in perfect sync with the times. It reflected the emotional independence of women, the freedom of their spirit and their newfound confidence. The brand quickly became synonymous with the style, wit, and self-confident nature of women’s new attitude. LB0131021-1040 at 1023 (U.S. Exhibit 33,402).11
This is a typical ad from Cosmopolitan magazine in 1976. This campaign and similar ones by other companies were quite successful. They had their greatest impact on fourteen- to seventeen-year-old girls, who increased their smoking even though smoking was declining among women over eighteen and among men,12 thanks to the first large-scale antismoking campaign, which was occurring around the time that the Virginia Slims campaign began.
The major competitor of Philip Morris during the second half of the twentieth century was R. J. Reynolds, makers of Camel cigarettes, among others. They too realized that if they did not get teens to smoke their brands, they would lose market share. Here is how R. J. Reynolds employee Diane Burrows put it in a memo to her superiors in 1984:13
Younger adult smokers have been the critical factor in the growth and decline of every major brand and company over the last 50 years. They will continue to be just as important to brands/companies in the future for two simple reasons: The renewal of the market stems almost entirely from 18-year-old smokers. No more than 5% of smokers start after age 24. The brand loyalty of 18-year-old smokers far outweighs any tendency to switch with age. . . . ‘First Brand’ strategies appeal to 18-year-old smokers rather than switchers ages 19-24.14
I found it amusing to read the R.J. Reynolds documents about their effort to wrest market share from Marlboro. Over the course of twenty years, they were tearing their hair out. They had a campaign between 1971 and 1974 called “They’re not for everybody,” implying that you had to be real man to smoke Camels. It didn’t put a dent in Marlboro’s market share. Then there was the “Meet the Turk” campaign featuring studly, mustachioed guys with attractive blondes staring admiringly at them. Another dud. After that, they ran the Bob Beck campaign from 1981 to 1987. Like its predecessor, it showed Camel smokers as independent, rugged outdoorsmen in dangerous, exciting situations. But it was no match for the Marlboro man. Finally, Reynolds struck pay dirt. They created the cartoon character Joe Camel. In contrast to the Marlboro cowboy, Joe Camel had a distinctly urban vibe. At last, Reynolds began to wrest market share from Marlboro.
“He‘s what guys really want to be–a Man’s man but not super macho. . . . He’s a natural leader–not pushy, but people just sort of follow his lead . . .never gets stressed out—always real relaxed and easygoing . . . Best of all—he only does what he enjoys doing—the ultimate.”
. . .
“He’s someone you can hang out with—He makes you feel comfortable . . .That’s a real knack . . . I wish I could be so easy to talk to . . . I guess it’s ’cause he’s done and seen everything—He’s got nothing to prove, so he never puts people off.”
. . .
“Never gets stressed out He can deal with whatever comes his way . . . If something doesn’t work out—he just does something else—goes with the flow . . . No big deal to someone real flexible like he is.” 509045372-5416 at 5392, 5393, 5394, 5395 (U.S. Exhibit 22,441).15
Notice how they seem to think that Joe is a real person. Imagine how appealing this image would be to a boy who is struggling with his identity, who is worried about his looks, his ability to succeed, and his appeal to girls. You might not be doing well in school, you might be short and unattractive, but you can have everything Joe has just by smoking Camels. Sound familiar?
For the first time in thirty years, Camel began to take market share away from Marlboro. John Pierce and colleagues did an analysis of the success of the Marlboro and Joe Camel campaigns in getting teenagers to smoke those brands. They estimated that, between 1988 and 1998, 7.9 million teenagers would begin to experiment with cigarettes due to their exposure to tobacco advertising and promotion. This would result in 4.7 million young people becoming regular smokers. Based on the evidence about the effectiveness of the Marlboro and Camel campaigns, they estimated that 2.1 million would begin smoking Camels and 1.2 million would begin smoking Marlboros. Finally, based on the evidence about the number of smokers who eventually die of smoking-related illness, Pierce and his colleagues estimated that the Camel campaign during those 10 years would eventually lead to the deaths of 520,000 people, while the success of the Marlboro campaign would be responsible for killing 300,00.16
In essence, the story of the tobacco industry is an evolutionary story. Humans evolved physiological processes that made them susceptible to becoming addicted to nicotine. Because humans also had to be highly social, they found social approval highly reinforcing. It thus became possible to market cigarettes by associating cigarette brands with social acceptance. This encouraged groups of young people to smoke together until the aversive effects of inhaling cigarette smoke faded and their addiction was established. Once that happened, they would find it very difficult to stop smoking, and the tobacco company that addicted them gained a profitable customer, often as long as the customer lived.
To be fair to the pioneers in the tobacco industry, they did not realize at the outset that cigarette smoking could be harmful to health. As the evidence began to emerge, their attachment to the profits produced by this business led them to deny the evidence – an example of selection at work. In the end, it has been the economic consequences to the tobacco companies that have shaped and maintained this industry.
The Tobacco Control Movement
As the harm of cigarette smoking became clear, a movement arose to try to reduce it. The history of the tobacco control movement shows us some important things about how to successfully counter harmful corporate practices.
It has taken many years, but the tobacco control movement has had a remarkable impact on the problem of smoking. Indeed, a report issued by the National Academy of Medicine deemed this movement one of the most successful efforts to advance public health in history.17 This figure shows the change in the prevalence of smoking by men and women in the U.S. between 1965 and 2016.18,19
The success of the tobacco control movement provides important lessons for other efforts to improve people’s well-being. Its first critical component was a solid body of evidence about the harm of cigarettes. Following the publication of initial research showing that cigarette smoking causes lung cancer, the public health community begin to assess other ways in which cigarettes caused illness and death. The evidence grew and grew. We now know that smoking causes most types of cancer, contributes to about one third of deaths due to cardiovascular disease, results in low birth weight babies, and causes chronic obstructive pulmonary disease, strokes, diabetes, tooth loss, rheumatoid arthritis, and cataracts.20
But it was not just the accumulation of this evidence that made a difference; it was the extensive and clever ways in which this information was disseminated. Surgeon General reports documented the harm that smoking causes, as did monographs the National Cancer Institute issued. These documents generated considerable publicity and armed national, state, and local organizations with information that increased support for controls on smoking.
A number of Surgeon General reports were carefully calculated to influence public policymaking. For example, a report on the effect of non-smokers’ exposure to cigarette smoke helped advance clean indoor air policies. The 1994 Surgeon General Report on adolescent smoking inspired efforts to document the impact of cigarette marketing on youth smoking and the adoption of policies to restrict marketing to young people.
Mounting evidence about the harm of cigarettes and the fact that hundreds of thousands of people were losing loved ones each year to smoking-related illness fostered the development of numerous advocacy organizations. These developments led to research on programs and policies that could affect smoking and, as they began to identify effective programs and policies, the governmental and advocacy organizations pushed for their wider adoption.
Initially, the emphasis was on getting people to quit smoking. My colleague Ed Lichtenstein developed the first effective intervention to help people quit smoking. It was called Rapid Smoking, which is just what it involved. Smokers were instructed to take a puff of the cigarette every seven seconds until they could simply no longer stand it. It worked for many smokers, but people weren’t exactly lining up to receive this treatment. Indeed it turned out that most people prefer to try to quit on their own. So despite the fact that researchers had developed some good programs, it became clear that we needed strategies that would reach a much larger proportion of the population of smokers. Ed Lichtenstein was one of the first people to advocate taking a public health approach to the problem. He is in fact the person who got me started thinking in terms of public health.
Eventually, it became clear that reaching many more people would require policy changes. The tobacco control movement began to advance policies such as increasing the cost of cigarettes through taxation, restricting the marketing of cigarettes, and prohibiting smoking in workplaces, restaurants, bars, and other public places.
Another critical component of the tobacco control movement was the careful monitoring of smoking. For many years, the government has had in place systems for tracking the prevalence of smoking among adults and the initiation of smoking among adolescents. This monitoring system was essential for two reasons. First, it kept reminding citizens and policymakers about the extent of the smoking problem. Second, it provided feedback about what was working and what was not. As evidence accumulated that restrictions on smoking and workplaces motivated some people to quit, more resources were put into advocating for smoke-free policies. When the monitoring system showed that adolescent smoking was increasing in the 1990s, it influenced the government to take action to restrict marketing to youth; as a result, the rates of kids starting to smoke declined.
All of these activities changed the culture with respect to smoking. If you are under forty, you might be surprised at how much it has changed. When I give talks I often say that if the talk had been given forty years ago, the room would’ve been full of cigarette smoke and I would’ve been one of the people smoking. Thanks to the relentless and sophisticated marketing of the cigarette industry, smoking and reminders to smoke were ubiquitous in the 60s. Now, fewer people smoke, cigarette advertising is limited, and it would be unthinkable to light up in a lecture hall.
In sum, we have made considerable progress in reducing smoking, and we have learned very much about how to improve public health. However, the tobacco industry has learned quite a bit too. As the tobacco control movement evolved efforts to reduce smoking, the tobacco industry spent lavishly on developing new ways to market its product, and to conduct lobbying and public relations to prevent the regulation of smoking and the company’s marketing practices.
Indeed, as you’ll see when I discuss other harmful industries, the efforts of the tobacco industry to spread misinformation and doubt about the harmfulness of cigarettes has become a model for any industry that wants to prevent its harmful practices from being restricted.
Lessons from the Tobacco Industry
The generic features of the evolution of the tobacco industry and efforts to counter its ill effects are echoed in every industry that does harm. First, an industry innovates and its successful innovations spread and become refined as a function of their impact on profits. Second, the harms of the industry’s practices become apparent only after the industry has become prosperous and well-organized. Third, the industry unsurprisingly does what it can to prevent erosion of its profits. It will do this by trying to convince the public that it is not responsible for the damage that occurs. Industry representatives lobby and fund politicians to prevent them from enacting laws and regulations that would harm their business. They innovate in marketing to get around problematic regulations (e.g., shifting to magazine advertising when regulations prohibit billboard advertising). They develop new products such as so-called low-tar and low-nicotine cigarettes and e-cigarettes. In profitable industries, the companies spend lavishly in an effort to preserve their profitable, albeit harmful, practices.
These features appear in the stories of the other industries that are causing harm. In every case, a network of people and organizations attempts to counter the harmful practices of an industry by trying to educate the public and to advocate for effective regulation.
However, efforts to stop a particular harm are played out in the context of the acceptance of the capitalist system as it has evolved in the twentieth century. Although those who oppose practices such as marketing cigarettes or fossil fuels recognize that the underlying reason for continuing the harmful practices is their profit to the company that engages in it, that seldom reaches the root of the problem. In a sense, the problem is not the practice; the problem is that the practice results in profits and profits are currently seen as the only relevant outcome.
For example, when the attorneys general of forty-eight states sued the tobacco industry over the deaths of hundreds of thousands of people, the industry and the states attempted to negotiate a settlement. One of the things the attorneys general proposed was that the industry would pay a fine for every percent of the youth population that begin smoking. For example, if Marlboro influenced three percent of the under-eighteen population to begin smoking in a particular year, they would pay a fine for each percent. The industry strongly resisted this proposal, and the attorneys general abandoned it.
Yet it was the perfect contingency. The agreement that was eventually reached prohibited billboard advertising and the use of cartoon characters, among other things, as ways to reduce youth smoking. However, the problem wasn’t those methods of marketing to young people. The problem was that the industry profited from getting youth to smoke. As soon as these methods of marketing were cut off, the industry immediately increased its magazine advertising, and subsequent research showed that the industry was still reaching and influencing large numbers of youth. Getting young folks to smoke continued to be vital and lucrative to the industry, and that was because the fundamental consequence – profit – remained the same.
Opponents of harmful practices faced almost knee-jerk hostility toward regulation per se. The public now considers the idea of regulating corporate practices so antithetical to economic well-being that we must go to extraordinary lengths to convince it that a particular practice is detrimental. The default assumption is that most corporate practices are beneficial and most regulation is harmful.
So we come to the fundamental contingency to consider in any analysis of corporate harm: the profits of the industry. In every instance of corporate harm, the practices of the corporations have evolved because they were profitable. I am referring not just to the development and marketing of a harmful product, but also to the lobbying and public relations that prevent our legislators from enacting effective regulations.
Our progress in evolving a form of capitalism that minimizes harm and benefits most people will be impossible to achieve if we continue to fight separate battles in each of the industries that are doing harm. Once we see the generic features that select harmful practices, we can move the society away from its current default assumption that regulation is bad and toward a framework in which all corporate practices are measured in terms of their harms and benefits and so that practices that are proven harmful are no longer profitable.
Thus, I propose a general framework for preventing harmful corporate practices. The standard should be that experts assess a specific practice, such as marketing cigarettes to teenagers, in terms of the harm that it does and if, as in this case, the evidence so clearly shows harm is resulting, the practice would face regulation. In every case, it would be possible to assess the costs to society of that harm and to ensure that the company would have to pay more to engage in the practice than it could profit from that practice. With that contingency in place, it simply wouldn’t make financial sense for a corporation to do something that hurt people.
I should mention an additional aspect of these contingencies. The benefits to a company of engaging in a harmful practice are clear and direct to the company. However, the harm is often less obvious, and may be relatively small or far in the future for any one individual. This means that people may not be motivated to take effective collective action.
Twenty million people died of smoking-related illness between 1965 and 2014.5 Yet it took at least forty years to mobilize enough people and organizations to begin to put a dent in the impact of cigarette marketing. The tobacco industry knew from the first report of smoking-related lung cancer that it needed to mobilize all its resources to prevent any reduction in its profits. Meanwhile, millions of Americans who would eventually die of cigarette smoking not only did not organize to stop the harm that was being done to them, many of them were convinced by the tobacco industry to rail against any suggestion that government should tell them what to do.
The tobacco industry provides a lesson about the harm that can be done in the name of profit. No other industry has contributed as much to promote illness and death. Yet, as I illustrate in the next five essays, numerous other industries are harming large segments of the population.
- If you are a smoker, start working on quitting. I once smoked, have counseled many smokers on quitting, and even made videos to help smokers quit. Many smokers hesitate to try quitting because they are afraid they will fail. But the only way you can really fail is not to try at all. You may not be completely successful the first time you try. However, every time you try to quit you’ll pick up some new skills that will eventually help you succeed. Here are some resources for quitting:
- one of the most helpful leads to quitting is the app, 2MorrowQuit [https://itunes.apple.com/us/app/2morrowquit-was-smartquit/id913032892?mt=8]
- Nicotine patches and nicotine gum are also helpful.
- If you have friends or family members who smoke, you can help them quit. To do that, you need to be warm and supportive. Most smokers know the risks of smoking. But many fear that if they try they will fail and that if other people know they tried and they will be embarrassed at their failure. See if you can listen to them about their hesitation and agree with them that it can be quite a challenge. Tell them how pleased you would be if they quit and how you will support them if they try. Remind them of what I said above, that it often takes more than one try, but every time you try, you learn new skills. Tell them about the resources I mentioned above.
- Support laws and regulations that have proven benefit in reducing smoking. Increasing the tax on cigarettes reduces the number of young people who start smoking and motivates smokers to quit.
- Your state and local public health offices should be offering support for people quitting. There should be a quit line people can call for support in quitting and nicotine replacement therapy should be subsidized.
- Restrictions on sales to young people should be strictly enforced.
- The U.S. has fallen behind Australia and England in its efforts to reduce smoking. A court ruling initially blocked the Food and Drug Administration from implementing graphic health warnings. An appeals court overturned that ruling, but tobacco control advocates had to go to court to get the FDA to move forward on implementing the warnings.
- The website https://tobacco.publichealth.gsu.edu/solutions/
organizations/organizations/ provides a list of organizations that are working on reducing tobacco use. You can advance their work by giving money or volunteering to work with them.
Read the Full “Cultural Evolution of Social Pathologies” Series by Anthony Biglan:
1. Introduction by David Sloan Wilson
- Centers for Disease Control and Prevention. Cigarette smoking among adults–United States, 2006. Mortality and Morbidity Weekly Report. 2007;56(44):1157-1161.
- Center for Disease Control and Prevention. Current Cigarette Smoking Among Adults in the United States. Smoking and Tobacco Use 2018; https://www.cdc.gov/tobacco/data_statistics/fact_sheets/adult_data/cig_smoking/index.htm. Accessed August 8, 2018, 2018.
- Maloney J, Chaudhuri S. Against all odds, the U.S. tobacco industry is rolling in money. 2017. https://www.wsj.com/articles/u-s-tobacco-industry-rebounds-from-its-near-death-experience-1492968698.
- Westling E, Rusby JC, Crowley R, Light JM. Electronic Cigarette Use by Youth: Prevalence, Correlates, and Use Trajectories From Middle to High School. Journal of Adolescent Health. 2017;60(6):660-666.
- U.S. Department of Health and Human Services. The health consequences of smoking: 50 years of progress. A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and HumanServices, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2014.
- Brandt AM. The cigarette century: The rise, fall and deadly persistence of the product that defined America. New York, NY: Basic Books; 2007.
- Harris JE. Patterns of cigarette smoking. U.S. Department of Health and Human Services;1980.
- Biglan A. U.S. Exhibit 20,459 as cited in Direct written testimony in U.S. vs. Phillip Morris et al. In: U.S. Department of Justice; 2005:121.
- Biglan A. U.S. Exhibit 45,906 as cited in Direct written testimony in U.S. vs. Phillip Morris et al. In: U.S. Department of Justice; 2005:136.
- Biglan A. U.S. Exhibit 22,334 as cited in Direct written testimony in U.S. vs. Phillip Morris et al. In: U.S. Department of Justice; 2005:151.
- Biglan A. U.S. Exhibit 33,402 as cited in Direct written testimony in U.S. vs. Phillip Morris et al. In: U.S. Department of Justice; 2005:187-188.
- Pierce JP, Lee L, Gilpin EA. Smoking initiation by adolescent girls, 1944 through 1988: An association with targeted advertising. Journal of the American Medical Association. 1994;271(8):608-611.
- Burrows D. Younger adult smoker: strategies and opportunities. Memo February 29, 1984. In. Vol Bates No. 501928462-501929550: R. J. Reynolds Tobacco Company; 1984.
- Biglan A. U.S. Exhibit 52,223 as cited in Direct written testimony in U.S. vs. Phillip Morris et al. In: U.S. Department of Justice; 2005:338-339.
- Biglan A. U.S. Exhibit 22,441 as cited in Direct written testimony in U.S. vs. Phillip Morris et al. In: U.S. Department of Justice; 2005:338-339.
- Pierce J, Gilpin E, Choi W. Sharing the blame: smoking experimentation and future smoking-attributable mortality due to Joe Camel and Marlboro advertising and promotions. Tobacco Control. 1999;8(1):37-44.
- Institute of Medicine. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press; 2007.
- U.S. Department of Health and Human Services. Health United States 1980. Hyattsville, MD: U.S. Department of Health and Human Services, Public Health Service, National Center for Health Statistics; 1980.
- Center for Disease Control and Prevention. Smoking is down, but almost 38 million American adults still smoke. 2018; https://www.cdc.gov/media/releases/2018/p0118-smoking-rates-declining.html. Accessed August 9, 2018, 2018.
- Center for Disease Control and Prevention. Health Effects of Cigarette Smoking. 2017; https://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/effects_cig_smoking/index.htm. Accessed August 8, 2018, 2018.