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Do Anti-Smoking Campaigns Work?

 6 min read / 

It’s been a bad half-century for Big Tobacco, starting with the US surgeon general’s report on smoking in 1964, the Federal Cigarette Labeling and Advertising Act of 1965, and the Public Health Cigarette Smoking Act of 1969. Together these led to mandating the US Surgeon General’s warning be placed on cigarette packages and broadcast ads be banned.

Big Tobacco weathered that storm, and the initial lawsuits by smokers who claimed their cancer was caused by the tobacco companies. True, Big Tobacco had claimed that their product did not cause cancer, but the surgeon general’s label gave them a fig leaf of protection.

Then the tide turned. In November 1998, the four largest tobacco companies agreed to a Master Settlement Agreement (MSA), settling lawsuits with 46 state attorneys general for more than $200bn over 25 years. (In February 2000, a smoker even got one past the goalie with a jury award of more than $50m.)

War on Smoking

One of the results of that MSA was a massive anti-smoking campaign to convince smokers to quit and dissuade young people from starting. Just last year a judge ordered tobacco’s big four to run a new set of “corrective statements” also acknowledging (among other things) that they deliberately designed cigarettes to be addictive (though the ads also say that “A Federal Court has ordered [them] to make this statement”.)

The overall aim of these campaigns has been to stop smoking—which can cause cancer, emphysema, and other health problem—and stop addiction to nicotine. How effective these campaigns have been is not clear.

While the number of smokers overall has fallen, in the US, from 24.7% of the adult population in 1997 to 15.5% in 2016, the profits of Big Tobacco have increased. In 2016 US tobacco companies alone earned $117bn, a one-third increase over 2001, with operating profits of $18.4bn.

France still has a reputation as a nation of smokers, but even its smoking rates have gone down. More alarming is Austria, known as the “ashtray of Europe” among anti-smoking activists, where Deutsche Welle reported in March that the Parliament voted to rescind a ban on smoking in bars and restaurants. Both, though, are far behind Russia, China, and other Eastern European and Asian nations for smoking levels.

Addiction Vs. Disease

New alternatives to classic smoking may prolong nicotine addiction, but be safer than smoking. While that is not the final result that was hoped for, it might not be the worst thing that could happen.

Cancer, largely, is a consequence of tobacco as a whole, particularly when burned for smoking (though smokeless tobacco such as chewing tobacco or snuff are not risk-free in this regard), while addiction is caused by the nicotine in tobacco. The act of smoking causes most of the harm.

Addiction, in general, is bad, but most studies find that nicotine addiction might be more harmful than caffeine addiction, but it is much less harmful than alcohol addiction or prescription pills addiction. Smoking cessation programs do not often require the level of drug addiction help or therapy of the kind offered for heroin, cocaine, or methamphetamine.

Vaporisers, E-Cigarettes, and Other Devices

Big Tobacco seems to have discerned which way the wind is blowing and is moving towards a smokeless future using vaporisers and similar devices such as Juuls and iQOS. The e-cigarette industry grew to $4.1bn in 2017 and could reach 30bn by 2023.

Juul, an e-cigarette device the size and basic shape of a thumb drive, accounted for more than half of all e-cigarette retail market sales in the US as of March, a $1.16bn market in 2017. Philip Morris International spent $3bn to develop new products such as iQOS, a proprietary device similar to a vaping pen but using tobacco, not liquid.

iQOS is on hold in the United States, pending negotiations for approval with the US Food and Drug Administration, but is extremely popular in Japan, and is said to have already secured more than 10% of the tobacco market there, and also is sold in about another 30 countries, including Canada and the United Kingdom.

British American Tobacco also is spending at least $1bn developing its own heat-not-burn products and the Vype vapouriser.

Safety Concerns

These smokeless alternatives work by heating the tobacco or liquid, allowing the user to inhale a vapour that is less irritating, more discreet, and probably less harmful than cigarette smoke, though it does contain nicotine.

What worries many smoking opponents is that long-term use of vaporisers may have consequences of which researchers are not yet aware. The device, or its heating coils, might be cancerous themselves. Some argue that nicotine itself may cause, or stimulate the growth of, cancer, but most say there is no evidence or little danger compared to smoking. Better nicotine gums and patches may also replace smoking for people who want to quit but have not proven very effective.

Arguments that vaping might lead to smoking cessation seem to have been disproven, too. If anything, by making tobacco use less harsh and less socially unacceptable, vapers have less incentive to quit.

Another concern is that young people might take up vaping or “Juuling” because they believe it is safer than smoking, or easier to hide, or even “cool”. Some accuse the manufacturers of marketing to children.

Unintended Consequences

A current FDA plan to drastically cut nicotine levels in cigarettes so that they are “essentially non-addictive” could prevent an estimated 8 million smoking-related deaths but also could have the opposite effect. Remember, the most harmful part of cigarettes is the smoking, not the nicotine.

By making cigarettes so low in nicotine that they no longer satisfy smokers’ nicotine addiction, the FDA rules could entice smokers to try e-cigarettes, maintaining their nicotine habit. They also might continue to smoke the weak cigarettes because they are used to the habit. Some studies suggest that even after they start vaping, tobacco users continue to smoke cigarettes, compounding the known risks of smoking tobacco with the unknown risks of vaping.

Another unintended consequence might be saving tobacco. Philip Morris and the rest already are investing heavily in smokeless alternatives. Weaker or plummeting cigarette sales could give them time and incentive to shift over completely to smokeless e-cigarettes.

Persuading smokers to switch to smokeless nicotine delivery systems probably will not end nicotine addiction, but it appears to be safer than smoking. Activists might prefer that every tobacco field is salted, the crop destroyed (though not burned), but harm reduction demands campaigners try what works, not what is futilely desire.

In the absense of substantial evidence of harm, vaporisers and other smoking alternatives should be allowed.

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