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This book review was originally published in the 10 May 1998 issue of the “Washington Post”. It is reprinted here by permission. Readers may take issue with some of the statements contained in this review—for example, that research on cigarette advertising “proves very little”, that the notion of smoking as an addiction is “simplistic”, and that the Food and Drug Administration “could well ban cigarettes entirely” (theoretically possible but as unlikely as the Galapagos Islands winning the World Cup). Nevertheless, we reprint it here because it offers insight into how developments in tobacco control are perceived and interpreted by those outside the field of tobacco control.—ED
Cornered: Big Tobacco at the bar of justice. Peter Pringle. New York, New York, USA: Henry Holt, 1998. ISBN 0-805-04292-X, pp 352, US$27.50.
The people vs. Big Tobacco: how the states took on the cigarette giants. Carrick Mollenkamp, Adam Levy, Joseph Menn, Jeffrey Rothfeder. Princeton, New Jersey, USA: Bloomberg Press, 1998. ISBN 1-576-60057-2 , pp 334, US$23.95.
For your own good: the anti-smoking crusade and the tyranny of public health. Jacob Sullum. New York, New York, USA: Free Press, 1998. ISBN 0-684-82736-0 , pp 338, US$25.
Perhaps the worst luck in recent publishing history befell Gene Lyons in 1996. His book subtitled How the Media Invented Whitewater arrived on reviewers’ desks just days after a jury convicted Arkansas governor Jim Guy Tucker for his role in that affair. Peter Pringle and the four writers of The People vs. Big Tobacco suffer from similarly unfortunate timing. These books painstakingly trace the fascinating—but now largely irrelevant—legal maneuverings that led to a bargain among the tobacco companies, attorneys general, and private litigators last June. A deal that seemed historic is now only a footnote to history. Just last month, tobacco executives announced that they would no longer negotiate with Congress over tobacco-control legislation and resumed their familiar position of defiance.
That’s not to say the legal attack achieved nothing. Tobacco giants will still pay billions to Florida and Mississippi for costs of treating smokers through Medicaid. And it was the lawyers’ prodding that led to tobacco executives’ long-awaited concession that their products are addictive and cause disease. (Under the agreement, cigarette packs would have carried blunt warnings such as “Smoking can kill you” and “Cigarettes cause cancer”.)
Still, with the deal dead, books about the legal wranglings miss the more important story, which is a political one: how the tobacco industry went from power broker to pariah. When Thomas Bliley (Republican from Virginia), scorned by tobacco opponents as the “Congressman from Philip Morris,” took over the House Commerce Committee in 1995, he immediately quashed the high-profile tobacco investigations pushed by his predecessor, Henry Waxman (Democrat from California). What a difference three years can make. After threatening tobacco companies with contempt charges, Bliley on April 22 published 39,000 once-privileged industry documents on the Internet, proclaiming himself “very concerned about teenage smoking.”
How did the tobacco companies fall so far so quickly? Part of the credit belongs to Bill Clinton and his erstwhile political advisor Dick Morris. When then-FDA (Food and Drug Administration) commissioner David Kessler approached the White House in 1995 with plans to regulate cigarettes, Clinton worried about the reaction of the five main tobacco-growing states. Then Morris came to the president with polls showing regulation popular even in tobacco country, particularly if it was aimed at protecting children. “It is time to free our teenagers from addiction and dependency”, Clinton said at a news conference shortly thereafter. After (Republican Presidential nominee) Bob Dole wondered aloud whether cigarettes were worse for some people than milk—and got trounced for it—Republicans began to distance themselves from the industry.
The reversal is surprising, but it shouldn’t be. The cry of “protect the children” is hard to resist, and even Republicans who claim to be diehard protectors of liberty have proven flexible when the object of that liberty is sufficiently unpopular. For a cogent and thorough explanation of this contradiction, Jacob Sullum’s bookFor Your Own Good is a must-read. Sullum, a libertarian and longtime contributor to Reason magazine, lays out his philosophy early on with a quote from John Stuart Mill: “The only purpose for which power can rightfully be exercised over any member of a civilized community, against his will, is to prevent harm to others. His own good, either physical or moral, is not a sufficient warrant.”
The prevailing view of public health is grounded in the opposite assumption—one that has been eagerly taken up by journalists as well as politicians. “What’s a government for if it doesn’t step in and say, ‘You can’t commit suicide’?” asks NPR (National Public Radio) correspondent Susan Stamberg. The lies and obfuscations of the tobacco industry provide the second justification for anti-smoking activists. If these companies are “merchants of death”, compared by leading figures to “guards and doctors at Nazi death camps” and other villainous figures, there is a clear need for government intervention.
Rather than defend the tobacco industry, Sullum devotes considerable space to chronicling its misdeeds and its “preposterous” attempts to deny that smoking leads to disease. Nevertheless, he argues that criticisms of Big Tobacco are a ruse. “The crusade for a smoke-free society”, he writes, “is aimed at the behavior of individuals, not the behavior of corporations.”
Tobacco critics have made this clear. “I think that the government has a perfect right to influence personal behavior if it is for the welfare of the individual and the community”, former surgeon general C Everett Koop has written. Koop and his fellows in the movement make two arguments: the first is that smoking is patently irrational, a foul habit that could be continued only by someone who is deluded or addicted and thus deprived of free will. The second is that society, bearing directly or indirectly the costs of treating smokers’ diseases, can justly take whatever means necessary to reduce smoking.
Sullum’s response to the second point is that “a government empowered to maximize health”—defined by the World Health Organisation as “complete physical, mental and social well-being and not merely the absence of disease or infirmity”—“is a totalitarian government.” By the logic of tobacco opponents, any behavior could be defined as injurious to the common pool of societal resources and thus subject to control via taxation or legal restriction. (Never mind the fact that smokers probably actually save society money by dying early—macabre but true.)
Some tobacco opponents would also like to see taxes on fatty foods to help enforce healthier lifestyles. The example is illustrative because most Americans recognize that diet is a matter of individual choice. A Big Mac certainly isn’t good for you, but it tastes good—and this is a tradeoff that citizens are trusted to make. Sullum, a non-smoker, nevertheless believes that the decision to smoke deserves the same respect, that people have the right to trade “longevity for pleasure”. He notes that the refrain that “tobacco kills 425,000 people a year” is technically incorrect: that many lives are cut short by the decision to smoke. Of course, none of us wants the people we love to have their lives cut short. But the question is whether the government should make, or even heavily influence, that decision.
Sullum’s view is an unequivocal “no”, but there are complications. The first is advertising: does it “seduce” people to make decisions against their best interests? Most research on this question actually proves very little: yes, many 6-year-olds can identify Joe Camel as a cigarette icon. But that doesn’t mean they’ll smoke any more than recognizing Saddam Hussein means they will grow up to be genocidal dictators. On the other hand, anecdotal evidence—that African Americans, for example, prefer Newport, which features blacks in its ads—leads me to believe that such advertising should be limited where such limits are legal, and accompanied by full, blunt disclosure of tobacco’s risks. There is a clear line between consumer protection and Big Brotherish interference.
In the same vein, I’m more troubled than Sullum by the fact that so many regular smokers take up the habit before they are 18. Judging from the record, high prices and adult discouragement don’t seem to accomplish much except, in the latter case, to enhance cigarettes’ forbidden appeal. Nevertheless, trying to limit kids’ access to tobacco seems a worthy goal.
But the real reason David Kessler calls smoking a “pediatric disease” is that he objects to adults making a decision he thinks is foolish. This attitude dates back centuries, to King James I’s 1603 cry that tobacco is “in the blacke stinking fume . . . neerest resembling the horrible Stygian smoke of the pit that is bottomless”. To timeworn hostility is now added scientific principle, in the argument that, since tobacco is addictive, smokers must be rescued from a pharmacological slavery.
But this view of addiction is simplistic. As Sullum notes, “addiction is a pattern of behavior, not a chemical reaction.” Certainly, for many people, to stop smoking—or to stop using heroin or alcohol—is difficult. Calling these people slaves to the substance, however, ignores the large element of human choice. Most smokers who try to give up the habit but relapse do so because, on some level, they enjoy it, even while understanding the consequences. As David Carr, editor of Washington’s City Paper, once told me, “I would do anything to be an ex-smoker, except quit.”
The stakes of this debate would be much lower if the only question was how high tobacco taxes ought to be. But if the FDA gets control over tobacco—as it seems certain to—the agency could well ban cigarettes entirely or order such low nicotine levels that the country’s 50 million smokers could be driven to the black market to satisfy their cravings. Kessler himself has said that “a strict application” of FDA rules could lead to a ban, and such a move has historical precedent. (Massachusetts banned the sale of tobacco in the 1630s, and 14 states outlawed tobacco between 1893 and 1909.)
It’s ironic that Philip Morris, a generous contributor to drug-war propaganda via the Partnership for a Drug Free America, now finds itself the victim of the same absolutism that motivates policy on illegal drugs. Practical considerations—namely, the millions of smokers—may keep cigarettes legal, but this is hardly a certainty. At least 18.4 million Americans used marijuana in 1996, a drug never reliably blamed for even a single death but nevertheless subject to an increasingly strict prohibition. Americans who prefer unpopular intoxicants should always be wary.