Views And Reviews

Tobacco wars

BMJ 1994; 308 doi: (Published 28 May 1994) Cite this as: BMJ 1994;308:1444
  1. G Dunea

    America's tobacco industry has long provided countless jobs for tobacco farmers, factory workers, corporate executives, takeover specialists, stockbrokers and market analysts, advertising companies, government officials and regulators, primary care doctors, nurses, pulmonary specialists, chest surgeons, radiotherapists, ashtray makers, waste management companies, consumer activists, and funeral directors. It also derives substantial profits from abroad, helping to balance the trade budget by exporting its products to friendly nations. At home, however, the industry is running into trouble.

    Business so far had not been too bad. An estimated 46 million Americans continue to smoke. Each year over 400000 die from cigarettes - from cancer and from diseases of the lung and vascular system. None the less, in the 30 years since the surgeon general published the first report on the dangers of smoking (and 23 reports later) the proportion of smokers has declined from 42% to 25%. Such decline has been more noticeable among men than among women, who now smoke almost as much as men (especially younger women) and who correspondingly are developing more complications, particularly lung cancer. But then there has also been increased emphasis on the hazards of passive smoking, especially for people with respiratory ailments and for children, of whom an estimated nine million live with a smoker. Not surprisingly, the efforts to reduce smoking have long been opposed by the tobacco lobby, and in fact one of the first of the “wars on smoking,” in 1978 cost the then minister of health his job.

    In the ensuing years, none the less, local government and private organisations have done much to try to restrict smoking. Many buildings are now entirely smoke free or limit smoking to special areas. Smoking is outlawed on domestic airline flights, and McDonald's has recently banned it in its 1400 restaurants. Recently the American Medical Association has also launched a big antismoking campaign, and a team of liability lawyers has filed a $5 billion class action suit claiming that smoking has killed thousands of people.

    Now the activist Democrat administration has declared war on the tobacco industry as well. There had been rumbles of this, with the surgeon general's 23rd report asserting that smoking was a teenagers' addiction, that tobacco firms were luring the young, and that advertisements aimed at them should be banned. Then Congress, trying to raise money for health reform, announced that it was considering raising the tax on a packet of cigarettes from 24 cents to $1.49 - hoping thereby to raise $16 billion a year - and subsequently held public hearings on the subject. Not to be outdone, the Food and Drug Administration's activist commissioner said that cigarettes should be regulated as drugs because nicotine is added during the manufacturing process. Finally, in April, the Labor Department proposed extensive new regulations that within five years would ban smoking in bars, restaurants, hotel rooms, sports arenas, and casinos as well as in government buildings and six million workplaces. Regulations would require employers to monitor air quality and ventilation, make in some cases considerable renovations, and maintain extensive records to show that they are in compliance.

    Already the powerful tobacco lobby is readying itself to fight back, in the courts and in the political arena. There are also many people who continue to believe that, whereas the efforts of local government and private enterprise are commendable, an intrusive federal Big Brother is once again going too far in protecting us from ourselves. It remains to be seen if an administration recently characterised as breaking into every garden but running away when the dog barks will stick to its guns.

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