To western observers interested in tobacco control policy, Japan is a fascinating anomaly. Despite its extraordinary achievements in manufacturing and technology, coupled with its high levels of education and research, and an economy that until a recent blip, probably only temporary, has been a world leader, its smoking rates have been sky high, with subsequent disease levels to match. In many ways, to a westerner it is rather like a Germany of the East.

Two decades ago, Japan had the highest male smoking prevalence of any industrialised country, at around 80%, but an almost negligible prevalence among women. Then came the invasion of American tobacco companies led by the US Trade Representative in 1985. Along with Thailand, Taiwan, and South Korea, Japan rolled over and modern tobacco promotion began. Until then, the Japanese tobacco monopoly (ironically, in view of Japan’s high incidence of hypertension and stroke, it was called the Japan Tobacco and Salt Public Corporation) had been supplying a large and eager male market but had desisted from what must have so attracted the foreign invaders—the almost totally non-smoking female half of the population. A wind of change was in any case blowing through Japanese society, with increasing numbers of young women not only having significant disposable incomes—it is still quite common for young working women to live with their parents until marriage, usually later than their western counterparts—but traditionally strict attitudes to women’s behaviour were softening. What better way for tobacco companies to recruit them than by somehow exploiting this new mood of liberation? Just as in many emerging, fast growing developing countries, the potential to nearly double the market by recruiting women to smoking must have been the western tobacco companies’ dream come true.

Within a decade, smoking rates among young Japanese women had shot up, well …