08/12/97
18:00BST
Warning: Anti-tobacco crusades can damage your lifeWhether or not the anti-tobacco measures proposed by Bill Clinton and Tony Blair would succeed in reducing smoking remains uncertain. The dangers of the moral crusade against tobacco are, however, already apparent, writes Dr Michael FitzpatrickSmoking is set to become an election issue on both sides of the Atlantic. In August, Bill Clinton declared his intention to label tobacco a 'drug of addiction' and to subject the industry to stricter regulation through the Food and Drug Administration. After saying that he was not convinced that nicotine was addictive, Bob Dole, Clinton's Republican opponent in the forthcoming presidential contest, was harassed by anti-smoking campaigners at every rally, led by the provocatively costumed 'Buttman'.In June, the call for a ban on cigarette advertising was one of the few specific policy proposals in Tony Blair's five-point draft manifesto plan for the health service. Though John Major has so far kept out of the smoking wars, it is well known that his predecessor Margaret Thatcher received a handsome consultancy fee for services rendered to tobacco giant Philip Morris. However, before rushing to take sides in this familiar left-right pre-election ding-dong, it is worth asking what has given rise to the sudden clamour for a clampdown on the tobacco industry? The link between smoking and lung cancer and other diseases is not a new discovery. It was first clearly demonstrated in the early 1950s and became widely known to the public in the 1960s. Indeed overall smoking rates have fallen by about 40 per cent over the past 20 years, largely as a result of the recognition of the health dangers. Medical authorities have been demanding stricter controls on the tobacco industry for more than 30 years. In 1962, for example, the Royal College of Physicians proposed restrictions on advertising, the printing of information on tar and nicotine content on packs, and a publicity campaign to discourage smoking: the government agreed to only a watered down public information campaign (see British Medical Journal, 16 January 1993). For the past decade, the British Medical Association has been campaigning for the sort of measures now endorsed by Clinton and Blair. They made me Yet smoking did not become an issue in the last two elections. It is particularly striking that Clinton and Blair, two politicians well known for their pragmatism in adjusting their policies in accordance with the popular mood, should now take what might appear to be a high-risk stand against tobacco. After all, around a quarter of the US electorate still smoke and among supporters of the Democratic Party the proportion is even higher. A similar trend is apparent in Britain, where the overall level of smoking is slighter higher. The anti-tobacco campaign also obviously antagonises a powerful industry with considerable political clout employing thousands of workers, especially in the USA. So why tobacco and why now? The political significance of the anti-tobacco crusade is that it resonates with some of the most influential themes in Western society today. It projects an image of the general public as helpless dupes of tobacco propaganda and as pathetic victims of chemical dependency on nicotine. The campaign against tobacco assumes a society of feeble individuals who need to be protected against cigarette adverts and against their own addictive personalities. A recent high-profile court case in Florida reveals the changing climate of opinion around smoking. Grady Carter, a 66-year old retired air traffic controller, who developed lung cancer after smoking Lucky Strike cigarettes for 44 years, won $750 000 in compensation from Brown & Williamson, a subsidiary of the British tobacco firm BAT. In past cases the tobacco companies had successfully argued that an individual's free choice to smoke implied acceptance of the known risk to health. This time, however, the jury upheld the view that the company rather than the individual was responsible for the consequences of the decision to smoke. While the tobacco company lawyers immediately lodged an appeal, US medical authorities and anti-smoking lobbies celebrated a historic victory--and many more litigants prepared their cases. No doubt the Florida judgement was a blow to the tobacco industry. But, though it might have brought some comfort to Grady Carter and his family, the award was no victory for the people. The implication that people are incapable of deciding for themselves what is good or bad for them, and that some external public agency has a greater responsibility for an individual's behaviour than the individual himself, simply degrades the individual in relation to society. The instinct to blame somebody else for misfortunes resulting from your own decisions or actions is characteristic of young children: indeed this judgement implicitly reduces the citizen to the status of a child in the eyes of the law. The campaign against cigarette advertising is based on the presumption of a gullible public being manipulated by the fiendish tobacco barons and their slick publicity agents. In fact, so great are the restrictions on cigarette advertising already that an advanced grasp of semiotics is required to interpret many current adverts. A visitor from Mars would certainly be at low risk of being lured into cigarette smoking by the latest Silk Cut posters. Lady killers It is striking that the anti-advertising campaign began by emphasising the danger to children and to women, and has now expanded to include the entire population, implicitly reducing everybody to the level of children. Back in the eighties, one of Esther Rantzen's first television campaigns was against the promotion of cigarettes to children. Feminists took up the menace of cigarettes to women focusing particularly on the marketing of Virginia Slims (see B Jacobson, The Ladykillers: Why Cigarette Smoking is a Feminist Issue, 1981 and Beating the Ladykillers: Women and Smoking, 1986). Emphasising the peculiar vulnerability of women to advertising which suggested that smoking was cool and sophisticated or which linked cigarettes with slimness and beauty, the feminists persuaded women's magazines to restrict cigarette adverts. It is remarkable that so few feminists objected to a campaign which implicitly reinforced the conventional patriarchal prejudice that women are feckless creatures easily swayed by a flatterer's guile and, in the terms used by one campaigner, 'seduced into smoking' (see L Doyal, What Makes Women Sick: Gender and the Political Economy of Health, 1995, p191). For the crusaders against the tobacco industry, the fact that it spends millions every year on promoting its seductive images is proof enough of their effectiveness in selling cigarettes. But, if manufacturers of cigarettes can so easily connect with the people's desires and aspirations, then banning the adverts is unlikely to have much effect on overall levels of smoking, though it might affect sales of particular brands. More importantly, the message that emerges from this crusade is that our society is made up of people who are so susceptible to advertising that it is necessary for the state to step in to protect them from it. If that is true then any project of collective political activity that goes against the conventional tide must be a non-starter. The mirror image of the omnipotent manipulator of public behaviour is the impotent individual destined to obey the dictates of the media, even if they result in self-destruction. A crusade proclaiming a commitment to better public health ends up inducing a life-denying fatalism. Therapeutic The new emphasis on nicotine as an addictive drug, a key theme in the current US controversy, reinforces the notion of the vulnerable individual and further undermines the idea of individual responsibility for behaviour. It is a commonplace observation that it is difficult to quit smoking. Yet, it is equally apparent that over recent decades millions have managed to give up, the vast majority without admission to specialist detoxification units, or being subjected to behaviour modification programmes or other therapeutic regimes designed to redeem the hapless addict from the ravages of drug dependency. The drive to relabel smoking as a form of drug dependency is part of a wider expansion of the category of addiction that is symptomatic of our times. Until recently the concept of addiction was limited to alcohol and heroin; now it has been widened to include other forms of behaviour of a compulsive, self-destructive, character, including gambling, shopping, sex--and smoking. The self-help model of Alcoholics Anonymous and other therapeutic procedures have been extended to cover this ever-widening range of behaviour. The common theme is the damaged individual, the helpless victim of uncontrollable urges. Whether these compulsions originate in genes, or hormones, or in deep-rooted psychic trauma is controversial; what is certain is that they are beyond individual control and can only be contained through external intervention (in the form of state regulations and professional therapy). A key link in the development of the anti-smoking crusade was the construction of the category of 'passive smoking' in the early 1980s. Whereas the early campaigns declared that smoking was a threat to the smoker's own health, the emphasis has now shifted to the argument that the smoker is a threat to the health of others. By branding smoking as an anti-social as well as a self-destructive activity, this shift effectively raised the moral stakes and legitimised more repressive measures, such as bans on smoking in workplaces and in public spaces. According to a recent Guardian editorial, 'mention of "passive smoking" now attracts groans and ridicule only from a small minority of those refusing to believe the overwhelming weight of opinion' (11 April 1996). It proceeds to invoke a consensus that embraces 'everyone else from the Department of Health to independent researchers' who accept that passive smoking damages health. Such a smug and rhetorical statement, typical of much public health propaganda, should immediately raise suspicion. In fact, much of the case against passive smoking is based on a statistical fallacy: the confusion of relative and absolute risk. For example, a survey may be reported as revealing a 33 per cent increase in the incidence (relative risk) of some disease among the non-smoking spouses of smokers compared with spouses of non-smokers. This sounds dramatic and impressive evidence of the dangers of smoking to others. Yet closer inspection reveals that the actual increase in the incidence (absolute risk) of the (relatively rare) disease in question was from 10 cases per 100 000 to 13 cases per 100 000, a 33 per cent increase all right, but one of dubious statistical significance. (For a rigorous critique see JR Johnstone, 'Scientific fact or scientific self-delusion: passive smoking, exercise and the new puritanism' in Health, Lifestyle and the Environment: countering the Panic, Social Affairs Unit/Manhattan Institute, 1991.) But the 'passive smoker' has become such an emblematic figure of our times that nobody questions her scientific credentials. The January 1993 award of £15 000 damages by Stockport Council to Veronica Bland, who claimed that her chronic bronchitis resulted from 11 years of exposure to smoking workmates, marked the public affirmation of the status of the passive smoker. Many commentators wondered why the council agreed to this out-of-court settlement rather than contest a case in which there appeared to be an impossible burden of proof on the litigant. A cynic might argue that £15 000 was a cheap price to pay for a decision which enabled employers throughout the country to tighten the regulation of their workforces through bans or restrictions on smoking at work. Whatever the motivations in this particular case, the passive smoker was ready to take her place in the pantheon of victims of the 1990s. Pie in the sky The proposed curbs on cigarette advertising, sports sponsorship, promotion and sales may succeed in reducing smoking. There is some evidence that such measures in the past and in other countries--particularly increases in price--may curtail demand. On the other hand, there is a clear danger that Prohibition will encourage illicit tobacco consumption and indeed that the puritanical proscription of smoking may provoke a backlash, particularly among the young, who tend to savour indulgence in activities deemed sinful by their elders. While reducing smoking may prolong some lives in the distant future, the measures introduced to achieve this objective diminish the quality of all our lives now. One fact that emerges from all the smoking surveys receives remarkably little attention in the great anti-smoking debate. This is that the highest levels of smoking are to be found among the most disadvantaged in modern society--the unemployed, low income families, single mothers, the widowed, divorced and separated (see J Townsend, 'The burden of smoking' in Tackling Inequalities in Health: An Agenda for Action, Kings Fund, 1995). The greatest danger of the crusade against tobacco is that by reinforcing fatalism and notions of individual inadequacy it undermines the possibility of collective action against the social circumstances in which cigarette smoking induces its greatest damage to health. Reproduced from Living Marxism issue 94, October 1996 |
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