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By W Kip Viscusi, University of Chicago Press, 2002, $27.50, 263 pp, ISBN 0-226-85747-6
SMOKE AND MIRRORS
Cigarettes are a major cause of premature death. Cigarettes are addictive. Secondhand smoke can be annoying, but is really not enough of a health risk to justify banning smoking in indoor environments. Payments to states in the Master Settlement Agreement were unjustified since cigarettes are self financing. States actually save money because smokers die young. Lawsuits against the tobacco industry are without merit, since smokers have long known about the health risks. Continuing efforts to warn the public about the health risks of smoking are unwarranted since public awareness of these risks are now universal. Filters and low tar technology have made cigarette smoking safer, but more could be done to encourage cigarette manufacturers to produce a less toxic cigarette. The government should focus on giving smokers information about the risks posed by different types of cigarettes, which would foster market competition in the development of safer cigarettes while at the same time preserving individual choice.
Such are the views expressed by Harvard Law Professor W Kip Viscusi in his new book entitled Smoked-filled rooms. If cigarette smoking hasn’t already caused one to become short of breath, reading this book surely will. Viscusi’s selective presentation of data on what consumers do and don’t know about the risks of smoking, the dangers of secondhand smoke, the benefits of filtered and low tar cigarettes, and ultimately who should be held accountable for the massive death toll caused by smoking cigarettes is breathtaking. This book leaves one with the impression that the cigarette industry and not the American public has been the victim in what has been a massive money grab by greedy trial lawyers and media starved state attorneys general. It appears that Dr Viscusi has spent a few too many hours in smoked filled rooms to be able to reasonably separate fact from fiction. However, one fact is crystal clear—Viscusi is not the unbiased observer of the tobacco industry. He acknowledges that he has served as an expert witness for the cigarette industry. Thus, his diatribe against plaintiff lawyers, some of whom have risked their own personal fortunes to shed light on the lies and deceit of the cigarette industry, seem misplaced. Viscusi ought to take a look in the mirror.
Reading this book leaves one with the impression that the cigarette industry bears no responsibility for marketing what is admittedly a lethal and addictive product that results in the premature death of one out of every two users. Viscusi dismisses the evidence revealing how cigarette manufacturers knowingly misrepresented the dangers of smoking to the American public on the grounds that smokers knew everything they needed to know about smoking in order to make an informed choice. However, one needs to question whether this assumption is correct. The evidence presented in chapter 7 to support the claim that smokers are fully informed is far from compelling. Viscusi misrepresents polling data showing that the public has long been aware of medical reports linking smoking and cancer as evidence that smokers were fully informed of health risks. He must surely recognise that having a general awareness that smoking causes cancer does not necessarily translate into a belief that one is personally at higher risk of developing cancer.1 In fact studies conducted by Viscusi himself demonstrate that smokers as a group are less likely to perceive health risks from smoking compared to non-smokers. He also fails to mention the knowledge deficits that many smokers have regarding compensatory smoking, the lack of benefits from smoking filtered and low tar cigarettes, and product defects.2,3 Viscusi ignores evidence revealing how cigarette manufacturers have designed their cigarettes to induce dependency on nicotine.4 He also conveniently ignores the data showing that most people begin their smoking careers during their teenage years when health concerns about smoking and addiction are not in the realm of consciousness.5
Viscusi’s chapter on the factors involved in youth smoking behaviour represents an exercise in selective recall, laying the blame for youth smoking mainly on parents. Hardly a mention is made of the billions of dollars spent annually by cigarette companies to advertise and promote cigarettes. Viscusi also ignores the mountains of internal industry documents that openly discussed the importance of the youth smoking market to the economic viability of the cigarette industry.6 Instead he accepts at face value the industry’s line that they don’t want kids to smoke. Viscusi’s remedy for the youth smoking problem is to get parents do more to keep their kids from smoking and to enact policies to prohibit the sale of unconventional cigarettes like bidis. The discussion of bidis is especially odd since hardly any teenagers smoke these products; instead teenagers smoke Marlboro, Newport, and Camel. Thus, while one can hardly argue with Viscusi’s plea for better parenting, his failure to recommend stronger measures to curb how tobacco companies market their cigarettes to attract the attention of youthful smokers makes the sincerity of his recommendations suspect.
Viscusi’s chapter on the health risks associated with secondhand tobacco smoke is grossly uninformed. Much of this chapter reads like it was drawn from industry sponsored websites that have been designed to spread misinformation, downplaying the well documented scientific evidence linking secondhand smoke exposure to a wide array of health risk. Remarkably, Viscusi suggests that limits on indoor smoking are unjustified and bad for the economy because such restrictions cause smokers to consume fewer cigarettes, and, therefore, “losses accrue to society in terms of foregone taxes”.
Viscusi’s sharp criticism of current public health campaigns to warn the public about the health risks of smoking defies common sense. According to Viscusi, since public awareness of the health risks of smoking are nearly universal, there is no need to keep repeating these messages. In fact he argues that such efforts are counterproductive because people are likely to form unrealistic risk perceptions about smoking. Such reasoning is illogical. By analogy, if one were to accept Viscusi’s premise that once the public recognises the health risks of smoking there is no need to reinforce health messages, then one would also have to accept the idea that there is no need to spend a dime advertising Marlboro cigarettes since the Marlboro Man is nearly universally recognised. Apparently, cigarette manufacturers don’t accept Viscusi’s logic and nor should the public health community. Declining cigarette consumption in the USA since the 1960s corresponds directly to increased efforts to inform the public of the dangers of tobacco use.7 Viscusi’s criticism of the current wave of edgy in your face counter-advertising campaigns ignores the evidence that these programmes are actually reducing cigarette consumption.8 Instead of continuing these effective public health campaigns, Viscusi recommends that the government refocus its efforts towards giving smokers information about the risks posed by different types of cigarettes in the hope that this would move smokers to use less toxic cigarettes.
Viscusi is correct in noting an important deficiency of the Master Settlement Agreement that has made it difficult for new tobacco companies to enter the market, thus dampening competition for the development of potentially safer tobacco products. However, his credibility on this subject is diminished by his acceptance of the view that filtered and low tar cigarettes have actually benefited the publics’ health. Convincing evidence to demonstrate a measurable public health benefit gained from lowering the machine measured tar yield of cigarettes has proven elusive.9 Moreover, on a population wide basis, a strong argument can be made that the marketing of lower tar cigarette brands had an adverse impact on the public’s health by convincing a segment of smokers who might have otherwise stopped smoking to maintain their smoking behaviour under the illusion that their disease risk would be reduced by switching to a filtered low tar cigarette.10
In summary, Smoked-filled rooms reads more like a legal brief written by a team of tobacco industry lawyers instead of a thoughtful commentary on the legal, financial, and social consequences of smoking. As such this book is a must read for plaintiffs’ attorneys, but for the rest of us we should stick with “smoke-free rooms”.
K Michael Cummings is not an unbiased observer of Dr Viscusi’s research and writings. He has served as a paid expert witness on behalf of plaintiffs counsel in several of the same cases in which Dr Viscusi also served as an expert for the cigarette industry. Dr Cummings is currently employed as a senior research scientist and is chairman of the Department of Health Behavior in the Division of Cancer Prevention and Population Sciences at the Roswell Park Cancer Institute in Buffalo, New York, USA. His salary support comes primarily from Roswell Park Cancer Institute and from research funding provided by the National Cancer Institute, the Robert Wood Johnson Foundation, the American Legacy Foundation, and New York State Department of Health. Dr Cummings serves on the medical advisory board for the Flight Attendant Medical Research Institute (FAMRI) and has served on various scientific advisory boards and grant review committees for National Institutes of Health, Centres for Disease Control and Prevention, American Cancer Society, Canadian National Cancer Institute, Robert Wood Johnson Foundation, and state and local health agencies for which he has received honoraria. Dr Cummings has also received honoraria and has accepted hospitality and on a few occasions, travel costs, from pharmaceutical companies making tobacco dependence treatment products.
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