Statistics from Altmetric.com
I didn’t expect to find Clive Turner in this book, but there he was, starring on page 278. Turner, long-time spokesman for the British tobacco industry, was the first tobacco industry person I ever met. I found him a curiosity: completely calm, very rational, and utterly at ease with himself.
Turner was representing the industry in London in the mid-1980s, when passive smoking had become a particularly important issue. Although it fundamentally re-defined smoking as a “public” health issue rather than just a private one, public health advocates certainly took no pleasure from the mounting evidence that one person’s smoking could damage someone else (particularly an infant)—it was simply the latest indication that, whatever we knew about tobacco use, the truth was going to turn out to be worse.
It was enlightening, therefore, to learn from Cunningham’s account of Turner’s remarks at the 1994 tabexpo conference in Vienna, that what annoyed Turner was not passive smoking or its implications for his industry. What concerned him were the “self-righteous anti-smoking lobbyists” who have “a sort of missionary glint in the eye”. Turner went on to inform his audience that “anytime the words ‘passive smoking’ are said, I think they have an orgasm. I really do. They get all hot and flush and quite excited by it all.” I have been unable to identify to whom, among the sedate and unfrenzied health advocates I knew, Turner might have been referring.
This is an important book, not just for the wealth of anecdotes and inside information. The book is an astounding achievement, given that it was completed in 1996, after the release of the Brown and Williamson documents and the Liggett Group settlement, but before the release of documents in relation to the legal action against the industry taken by US state attorneys general. Those who cannot read a book without a highlighter pen in hand will not be disappointed: there are gems to be savoured on nearly every page.
The book is valuable for its revelations and accompanying narrative, which weave together fascinating chapters from tobacco industry archives, such as this, from an Imperial Tobacco Ltd Company document from about 1987: “Smoking restrictions have moved from abstract discussion to practice. This increasing social isolation of the smoker will not only increase his ill-ease with smoking, but will also have a measurable effect on daily usage rates resulting in overall industry losses.” (page 116) We have read similar things much more recently from health researchers, but the tobacco companies said it—and knew it—first.
Cunningham gives us (page 163) a BAT document from 1974 which shows that the company knew that smoking machines do not accurately reflect the nicotine that the smoker receives. We are also given an idea of how much research the industry was doing that health groups were unable to do because of a lack of resources. For example, in 1982, a market research company conducted a number of focus groups for Imperial Tobacco to examine why young people smoke; to learn how smokers feel about non-smokers, ex-smokers, and the health issue; to explore youth perceptions of light brands, including as “potential substitutes for quitting”; and to probe the issue of quitting among both smokers and former smokers. The study reported on the top motivations for quitting among young people, as well as insights into the relationship between peer behaviour and brand selection.
After the first 150 pages of this book, the conclusion is inescapable: “The knowledge inside the industry was decades ahead of what was known by the scientific community generally. The industry concealed this knowledge, thus delaying progress in research vital to public health” (page 156). What is commendable is how Cunningham’s research so thoroughly documents this claim, without the benefit of the tobacco industry documents released as a result of litigation in the United States in 1997 and 1998.
This book is Canada’s story—the story of its tobacco industry, its politicians, and most of all, the story of Canadian public health advocacy. At a time when many health advocates (and bureaucrats) in other countries had difficulty gaining access to an international fax line, Canadian advocates had formed effective coalitions and were finding ways to do what needed to be done. Cunningham has to be right when he reports that, “Health groups recognize that there is strength in numbers and have been most effective when advocating as coalitions . . .. A key factor to successful lobbying has been hiring professional full-time staff and placing them in Ottawa to work close to government” (page 199).
As Cunningham says, “Despite its small population, Canada makes a tremendous contribution to tobacco control internationally. By taking the lead in implementing tobacco control measures and setting important precedents, Canada opens the way up for other countries to do likewise” (page 233). Not only was Canada the first country in the world to require its domestic and international flights to be smoke-free (in 1994), but the Canadian Health Minister’s 1995 tobacco control blueprint was amazing for its foresight and inclusion of advertising and product display measures that are only now being adopted in some jurisdictions.
There is a lot of information in this book about initiatives, proposals, and ideas, many of which were strikingly before their time. In 1894, Reverend Albert Sims of Ontario produced a 173-page book which included charts showing how much money would be wasted yearly on smoking, with amounts compounded over time by forgone interest. In 1914, during a hearing conducted by the Canadian House of Commons Select Committee on Cigarette Evils, Dr LJ Lemieux, administrator of the Montreal juvenile court, suggested that the following measures be implemented: placing nicotine levels on cigarette packages, prohibiting anyone but tobacconists from selling tobacco, enforcing laws against selling tobacco to minors, setting higher fines and revoking licences of those stores that do sell to minors, increasing the national minimum age to 18, and ending incentives, such as getting a free umbrella in exchange for empty cigarette packs (page 38).
Cunningham has a knack for presenting information and summing up a situation very neatly. He has important words (his and the industry’s) on tobacco sponsorship, tobacco advertising and consumption, women, young people, and passive smoking. Discussions of these subjects are sensible and accessible to a wide audience, from students to public health advocates to policy makers.
In a classic model of insight and brevity, Cunningham provides a two-page discussion of nine ways in which tobacco advertising can increase consumption (pages 66–67). And in the heat of the current debate over tobacco industry involvement in the Formula One Grand Prix, we find the helpful statement from a tobacco advertising executive that, “basically, sponsorship is part and parcel with the marketing of your product. It is one of a range of tools. No one hands over big cheques just to give themselves a warm fuzzy feeling” (pages 95–96).
The most disconcerting aspect of this book is that it is overly ambitious and about 100 pages too long. There are really three books here: Canada’s story; a discussion of the global war, with a detailed discussion of eastern Europe; and the author’s prescriptions for change. The first 200 pages are all that are needed to make a significant contribution to the tobacco control literature.
Those in the policy trenches, particularly in other countries, may not always find the prescriptions in the final section to be sufficiently grounded in reality. However, it is difficult to argue with the author’s general thrust: “Canada has recognised that a comprehensive strategy is necessary to minimise tobacco use . . .. It has taken a long time for some government and some health groups to come around to the view that legislation should be used to control tobacco . . .. A focus on curbing the industry is the most effective, and cheapest, component of a comprehensive strategy. Indeed, failing to address the industry is like trying to prevent malaria while ignoring the mosquito” (page 194).
Occasionally, the author’s eagerness to prove a point leads him to let the reader down. Cunningham tells us that, in 1994, Canadian provinces began to require health messages in retail stores selling tobacco. “This is”, he asserts, “a very cost-effective way to get a health message out to the public.” It may be cheap, but is iteffective? How do we know?
It is impossible to choose a favourite quote from this book. However, there are two that refer to “harm”, and probably deserve to be read together. First, a tobacco industry executive gives his point of view: “I’ll tell you what I like about the business. First, there are no surprises. There is nothing more to be said or discovered about the cigarette business or the industry. And there’s no way to write an article that could do us any more harm than what has already been written . . .. [No] matter how you look at the cigarette business, it’s incredibly predictable, it’s extremely secure as an investment vehicle and, therefore, it’s a great business to be in—if you can deal with the fact that some people are not going to like you” (page 19).
Then we have Cunningham’s view: “Enough is enough. The global harm caused by tobacco use is the leading health issue of our day. The case for tobacco control is overwhelming. The excuses used to justify inaction or delay are simply unacceptable. Decisive and comprehensive measures are needed now. The future health of a generation of youngsters hangs in the balance” (page 283).
Ms Goodin performed the work in her private capacity. The views expressed here are her own and no official support or endorsement by the Department of Health and Family Services is intended or implied.
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.