Informed choice and the nanny state: learning from the tobacco industry

Objectives: To examine the 'nanny state' arguments used by tobacco companies, explore the cognitive biases that impede smokers' ability to make fully informed choices, and analyse the implications for those working to limit the harmful effects of other risk products.

Study design: A critical analysis of the practices engaged in by the tobacco industry, the logic on which they relied, and the extent to which their work has informed approaches used by other industries.

Results: The tobacco industry's deliberate strategy of challenging scientific evidence undermines smokers' ability to understand the harms smoking poses and questions arguments that smoking is an informed choice. Cognitive biases predispose smokers to discount risk information, particularly when this evidence is disputed and framed as uncertain. Only state intervention has held the tobacco industry to account and begun ameliorating the effects of their sustained duplicity. Evidence other industries are now adopting similar tactics, particularly use of 'nanny state' claims to oppose proportionate interventions, is concerning.

Conclusions: Some marketing strategies have deliberately mis-informed consumers thus directly contributing to many public health problems. Far from removing free choice, government policies that restrain commercial communications and stimuli are prerequisites necessary to promote free choice.