What Nurses Need To Know (And Share With The Public) About The Tobacco Industry

1. The epidemic of tobacco-caused disease is a product of the rise of Big Tobacco.
Prior to the industrialization of cigarette production and marketing, rates of tobacco use were lower, most tobacco use involved cigars or spit tobacco, and lung cancer was such a rare disease that most clinicians never saw a case of it in their lifetimes. In 1914, per capita tobacco consumption was less than one pound per year and the death rate from lung cancer was 0.6 per 100,000 persons. In 1986, death rates from lung cancer ranged from 24.3 to more than 70 per 100,000 persons—as high as 116 times the rate in 1914. Today, tobacco consumption is approximately four times higher than it was in 1914 and lung cancer is the number one cause of cancer deaths, killing more women than breast cancer, virtually all of it linked to cigarette smoking. This is an industrially produced epidemic. ^1-3

2. The tobacco industry has known for decades that its products are addictive and deadly.
The tobacco companies’ own internal documents show that they have been well aware of the effects of their products. Addison Yeaman, general counsel for the Brown and Williamson tobacco company, wrote in 1963: “…Nicotine is addictive. We are, then, in the business of selling nicotine, an addictive drug…” The tobacco industry has also manipulated the chemical composition of cigarettes to enhance the uptake of free-base nicotine. See http://tobaccowall.ucsf.edu/ and http://ark.cdlib.org/ark:/13030/ft8489p25j/

3. Tobacco companies engaged in massive, coordinated efforts to obscure the truth about their products through public relations.
The so-called “Frank Statement” of 1954 announced the creation of a multi-company funded Tobacco Industry Research Committee “to meet the public’s concern” about recently reported research that linked cigarette smoking to lung cancer. This was just the beginning of a long-term plan to obscure the truth about the disease effects of their products, both from smoking and secondhand smoke. Their objective, as the documents reveal, was to “maintain doubt on the scientific front.” See http://legacy.library.ucsf.edu/tid/cjj24e00

“Emphasize controversy,” was the approach they determined to take, rather than pulling these deadly products from the market. “If we can reach the stage where the general public recognizes that there is a genuine controversy over smoking and health, we shall have achieved our target. Our job is…to sow seeds of doubt…”

Repeatedly, they tried to reassure the public that the science was still in question. See http://legacy.library.ucsf.edu/tid/upv92f00, in which plans for a tobacco industry publication are discussed: “The most important type of story is that which casts doubt on the cause and effect theory of disease and smoking,” they wrote.

Nightingales at GE general meeting to speak about smoking in the movies

4. The tobacco industry has engaged in manipulation of science for public relations purposes. The industry-funded research organizations established by tobacco companies funded “special projects” reviewed by lawyers to ensure they would provide research results favorable to industry.
The tobacco industry also has paid for and arranged “ghost” authors of scientific papers, distorted the evidence, and tried to discredit scientists. A recent study showed that—after controlling for study quality and other factors—the primary determinant of whether a review article concluded that secondhand smoke was not harmful was tobacco industry funding of the work. ^{4, 5}

5. The tobacco industry has targeted children, youth and young adults.
Because an estimated 80% of smokers take up the habit before they are 18 years old, the industry focuses heavily on identifying and recruiting these “replacement smokers.” Studies have shown that Joe Camel was a more recognized figure among children than Mickey Mouse. ⁶

See http://legacy.library.ucsf.edu/tid/eyn18c00 for a document that discusses “replacement smokers.” The tobacco industry now claims it does not want children to smoke and has developed aggressive “youth non-smoking campaigns.” However, their messages have repeatedly been shown to be ineffective, as they focus on smoking as an “adult choice” –tapping effectively into adolescent desires to rebel and be adult. ⁷

6. The tobacco industry targets vulnerable/marginalized groups:
The tobacco industry has over the years made special efforts to target groups including racial/ethnic minorities, lower income people, gay people, and others who are already at increased health risk due to poverty, prejudice, and lack of access to health services and resources.
^{8, 9 10 11 12}

7. The tobacco industry regards health authorities—the Surgeon General, the World Health Organization, and major organizations like the American Lung Association—as their “opponents” and has engaged in spying and attempts to discredit, disrupt the work and obscure their messages. ¹³
See the WHO report about these efforts at http://www.who.int/genevahearings/inquiry.html

The tobacco industry also regards nurses as “formidable opponents.” See “An overview of anti-smoking organizations” at http://legacy.library.ucsf.edu/tid/dkf24d00

8. The tobacco industry knows firsthand that its products cause suffering and death: its customers and their families have been telling them so for years.
The tobacco companies’ previously-secret files contain hundreds, possibly thousands of letters written by dying customers and their grieving families, sharing their anguish and asking to be removed from the mailing lists companies use to send customers birthday cards with coupons for free or discounted cigarettes: “discount coupons to death.” See letters

In some cases, their response was to deny that cigarettes were in any way responsible and send misinformation to consumers. Just one example found in the secret documents.

9. The tobacco industry is now targeting developing countries where smoking rates have been historically low, especially among women.

China is regarded as a “prize” for tobacco companies, with its huge population. The industry is also making efforts to increase cigarette smoking in developing countries in Africa, Latin America, and elsewhere. The poverty of these countries makes offers from the tobacco industry difficult to refuse. As tobacco companies establish a presence, the use of tobacco becomes normalized. The World Health Organization estimates that if present trends continue, tobacco will kill 10 million people a year by 2025, and seven million deaths will occur in developing countries.

10. Tobacco is an environmentally destructive industry.
In addition to the problems of cigarette butt litter, tobacco is a very pesticide-intensive crop. Also, the deforestation of developing countries for wood used in tobacco curing is becoming a significant concern. ¹⁴

11. Philip Morris (now Altria) is engaged in a major makeover aimed at downplaying their tobacco ties and proving that they can be “good corporate citizens.” ¹⁵
Perhaps you’ve seen the ads touting Altria’s contributions toward helping battered women, poor senior citizens, arts groups, social organizations, and virtually anyone who will take their money. However, that money comes at a cost: Altria continues to make almost all its money from the sale of products that addict and kill. The real reason for the makeover is to continue to find ways to protect their massive profits: the “blood money” of the hundreds of thousands of people their products kill each year. Don’t let them get away with it!
See www.altriameanstobacco.com

REFERENCES

1. Kluger R. Ashes to ashes: America’s hundred-year cigarette war, the public health, and the unabashed triumph of Philip Morris. New York: Vintage Books; 1997.
2. Stotts C, Shopland DR. Overview and summary. In: Smokeless tobacco or health: An international perspective. Smoking and Tobacco Control Monograph No. 2. Bethesda, MD: US Department of Health and Human Services, National Institutes of Health, National Cancer Institute, NIH Publication No 92-3461; 1992.
3. MMWR. Chronic disease reports: Deaths from lung cancer—United States 1986. Morbidity and Mortality Weekly Report, Centers for Disease Control and Prevention 1989;38(29):501-505.
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9. Hackbarth DP, Silvestri B, Cosper W. Tobacco and alcohol billboards in 50 Chicago neighborhoods: Market segementation to sell dangerous products to the poor. Journal of Public Health Policy 1995;16(2):213-230.
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11. Offen N, Smith EA, Malone RE. From adversary to target market: The ACT-UP boycott of Philip Morris. Tobacco Control 2003;12:203-207.
12. Smith NC, Cooper-Martin E. Ethics and target marketing: The role of product harm and consumer vulnerability. Journal of Marketing 1997;61(3):1.
13. Malone RE. Tobacco industry surveillance of public health groups: The case of STAT and INFACT. American Journal of Public Health 2002;92(6):955-960.
14. Geist HJ. Global assessment of deforestation related to tobacco farming. Tobacco Control 1999;8(1):18-28.
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