Sunday, November 21, 2010

Big Tobacco - The Government's Favorite Scapegoat

Smokers of the world unite! It’s strange for a physician to be sympathizing with the tobacco companies, purveyors of the opium of the people. Am I a stealth nicotine addict, an apologist for Big Tobacco who supplies me with my daily fix? This scurrilous allegation can be vaporized in a one-question quiz.


Identify which two of the three individuals listed below are cigarette smokers.

John Boehner, newly elected Speaker of the House , 3rd in line to the presidency

Barack Obama, Commander-in-Chief and leader of the free world

Michael Kirsch, Hemorrhoid examiner

I’ve never smoked and I detest the habit. It kills people and separates lower income Americans from money that could likely be devoted to more worthwhile endeavors. I remember caring for folks with end stage emphysema as a medical resident and thinking that this disease was worse than cancer. I haven’t changed my mind.

Yet, I have felt for years that Big Tobacco is demonized by the press and the government as Big Scapegoat, and this blame shift has always troubled me. I am well aware that the tobacco companies are guilty of many offenses. They have lied about their corporate practices, advertising strategies and manipulation of nicotine content. These companies – like any individual or business – should be held accountable with available legal remedies. If crimes were committed, then I’m sure this nation has a few idle and altruistic attorneys who can fight them in the courts.

My quarrel is blaming these companies for the decisions that individual smokers have made. Assuming that every nefarious allegation against the tobacco companies is true, and throw in a few more, it doesn’t change the fact that smokers for several decades knew (or should have known, a favorite lawyers’ phrase) that cigarettes steal life and breath. This was common knowledge even before cigarette warnings appeared on cigarette packages. I think it an abuse of the justice system and an assault on morality when an individual who is suffering a horrible consequence of a habit that he freely began, blames the manufacturer for his misery.

We all remember the billion dollar settlements that the tobacco companies paid to the states, ostensibly to be used to reduce cigarette use, but were largely devoted to general operating expenses. The phrase ‘up in smoke’ applies here.

While I personally oppose the habit, and counsel my smoking patients to cease and desist, this is a free society. Folks can choose to engage in a variety of activities that span the risk spectrum.

In my state of Ohio, it is legal to
  • Ride your motorcycle in the rain without a helmet
  • Become an alcoholic
  • Flush your life saving medicines down the toilet
  • Hunt
  • Ski on a Black Diamond path when you should be on the Bunny Hill
  • Gorge yourself on a diet of crème brulee, cheesecake and assorted deep fried delicacies
The federal government has issued new regulations that will require cigarette manufacturers to incorporate new labels that will cover half of the cigarette pack or carton. These 36 color photos will be graphic and ghastly portrayals of the ravages of nicotine addiction. The labeling will be a veritable slide show of horror, including a corpse with a toe tag, a man blowing smoke out of a tracheostomy hole in his neck and a wasted and cadaverous individual who looks too weak to lift his last cigarette.

Cigarettes must not be entirely evil, or else the government would outlaw them. Here are some pesky realities that anti-tobacco company zealots must overcome.

  • The product is legal
  • Tobacco directly and indirectly creates jobs and income in all 50 states
  • Smokers pay a fortune in taxes to the states and to the federal government
  • Many smokers enjoy the habit
Don’t misunderstand this post. I will never smoke and hope that no person I care about will pursue this habit. I encourage all inhalers to exchange their habit for a more salubrious addiction. What I do oppose is blaming tobacco companies for the woes of their customers. I also am uncomfortable with the government slowly suffocating these companies who are entitled to advertise and sell their legal wares. If, as a matter of public policy, cigarettes’ adverse health consequences outweigh their economic benefits and the rights of smokers, then have the guts to outlaw them outright, rather than incrementally bleed the companies.

If you support the government’s strategy of pursuing the demise of Big Tobacco by a thousand cuts, then who will be the next targets? Should every product that is not on an approved health and wellness list be attacked? Who decides which companies and activities should be on the list?

Beware! We may soon see similar scenes of ghoulish horror on Hershey bars, Frosted Flakes and even Twinkies. Ronald McDonald will be behind bars, wearing a different set of stripes. Sesame Street's Cookie Monster will be in shackles.  When you pop a champagne cork at your next family celebration, the label won’t be a pastoral scene of a vineyard, but will be a jaundiced alcoholic vomiting blood.

I’m not scared of the government’s new cigarette horror show. I’m scared it won’t end.



9 comments:

A. Bailey said...

None of the indiscretions you mention above are habit-forming/highly addictive except for tobacco products.

I see people younger than I by considerable dying miserable deaths from tobacco usage.

I also cringe when I see young women take up the habit for weight-control issues, knowing that they're shortening their lives for silly vanity.

Yes, there is always a slippery slope involved when we give government power over any facet of our lives. But I reject as a false dichotomy that our only choices are an Oppressive Nanny State and libertarian-inspired anarchy.

We have a moral imperative to eliminate tobacco usage in the most practicable manner we can.

Now if you'll excuse me, I'm going to take a bong hit or two. It will soon be legal, don't you know, by the same people who are trying to make tobacco illegal.

We live in a highly conflicted world I suppose.

Toni Brayer, MD said...

Sorry, Dr. Kirsch but I disagree with you on this one. Tobacco companies have been vilified because of their egregious practices and tampering with pure tobacco to make it more addictive. I believe in personal responsibility but I do think there is a role for government to step in when big business is taking advantage. The market place is not self regulating and I am not as afraid as you are about the domino effect for other business. More labels? Big deal. I don't see that as a slippery slope. I wish there would be a $10 tax on every pack to be allocated toward the Medicare fund.

Michael Kirsch, M.D. said...

Thanks for the comments. No apology ever needed for a disagreement. There are many layers to this issue. I wanted to state plainly that with regard to A. Bailey's sad experience, which we all share, of witnessing "... people younger than I by considerable dying miserable deaths from tobacco usage", who's responsible? As a physician and a person, I am pained by the misery that folks endure. I am not willing, however, to transfer responsbility for personal decisions elsewhere. As I stated in the post, assuming that the tobacca companies have committed illegalities and obfuscations, this does not, in my mind, mean that smokers were somehow duped. If you decide to smoke, hang glide, bunjee jump or dirt bike across the country, then I wish you well, but accept the risks. Smokers have known for decades that cigarettes can destroy them. They knew this even if the cigarette companies were not exactly Eagle Scounts.

Elaine Schattner, M.D. said...

Michael,
While I agree with your emphasis on personal responsibility for most health care choices, I see the smoking blame as shared: people, and especially educated people who are not self-destructive, choose to smoke, or not; tobacco companies suppressed relevant data for decades and, still, market their addictive, cancer-causing products in parts of the world where it's legal to do so.

Michael Kirsch, M.D. said...

Thanks, Elaine. We all agree that the tobacco companies have not been model corporate citizens. Folks have the right to make their own choices and receive the benefits and the consequences of their choices. My point is, especially in the developing world, that the risks of smoking are well known, despite the obfuscations and chicanery of the cigarrette manufacturers.

Carolyn Thomas said...

Hello Dr. K,

I suspect it may be far more than garden variety "obfuscations and chicanery" we're worried about with the tobacco industry.

Except for smoking, your list of allowed Ohio freedoms don't involve paid medical experts on the payrolls of industry marketing machines.

Consider the physicians that the drug industry hired decades ago to undertake research “proving” that cigarettes were not dangerous to our health.

In 1969, Post-Keyes-Gardner, the ad agency for tobacco giant Brown & Williamson, relied on the testimony of their hired gun physicians for a new campaign “to set aside in the minds of millions the false accusations that cigarette smoking causes lung cancer or other diseases.” (Handbook of Public Relations, Heath & Vasquez, 2004).

And back then, it was also a social norm to be a smoker. When my own father quit smoking at the age of 30, he says that his friends suspected he must be "sickly". Why else would any red-blooded manly man decide to give up his smokes? There was no talk of addiction back then!

Ironically, it was the very same Brown & Williamson whose Director of Research (the now-famous whistleblower Dr. Jeffrey Wigand) eventually led to the tobacco industry’s $246 billion litigation settlement in 1998 to help pay for smoking-related health care bills in the U.S.

I'm going to go now to find myself some crème brulee, cheesecake and assorted deep fried delicacies.... :-)

Michael Kirsch, M.D. said...

Carolyn, thanks for your comment. Of course, I recall Wigand. We 'whistleblowers' are a close community. By the way, how much of the $246 billion was actually devoted smoking issues? My father smoked in the 50's, when it was 'the norm', although he told me a few decades ago that it was known then that cigarettes promoted illness. Don't misundertand me, I carry no water for the tobacco companies and I treat patients who are suffering from the ravages of their addictions. However, I don't hold the cigarette companies responsible for their freely made choices. While it was true in the remote past that folks were not fully informed when they chose to smoke, this has not been the case since the 1960s. Some folks transfer their anger against 'Big Tobacco' to dilute personal responsibility of smokers. This strategy is also present in other spheres of society.

Michael Kirsch, M.D. said...

I will post Andrew Barovick's comment. Andy tried hard but technical snafus interfered.


Michael,
This is why it is difficult to read your post while remaining calm. http://www.sourcewatch.org/index.php?title=Tort_reform The folks who manufacture cigarettes not only enjoy the large profits they reap, but have funded the propaganda campaign known as tort "reform," to make certain that they are not held accountable for pushing their poisonous products, on kids and adults.
I discussed this in a recent blog post: http://www.thenewyorkmedicalmalpracticelawblog.com/2010/11/do-tort-reformers-want-smoke-to-get-in-your-eyes/
And the hypocrisy in the way they conduct their "business" is outrageous. They have recently sued two South American countries over their insistence on accurate, graphic warning labels. So you'll forgive me if I don't respect the Big Tobacco's right to involve itself in American free enterprise. What they do is despicable, irresponsible and driven by a profit-at-all-cost mentality to the detriment of consumers.
Finally, "personal responsiblilty" may be a valid point with regard to adults, but as you probably know, most tobacco companies, though they're loathe to admit it, market to children as well.

Carolyn Thomas said...

Hello again,

Although your Dad may have been aware of the health dangers of smoking (smokers' cough?) back in the 1950s, consumer behaviour was heavily (and successfully) influenced by Big Tobacco ads like "More Doctors Smoke Camels Than Any Other Cigarette!" throughout the 50s and 60s:
http://www.youtube.com/watch?v=cKMn-_aQoPk&NR=1

Let's face it, if your own doctor does it, how bad for you can smoking really be? When I was a little girl, my family doc (a smoker, too) had ashtrays in the waiting room and in his office!

In North America, about 5% of physicians smoke - a big drop from 20% of doctors in the 1970s. In China, 32% of male doctors smoke (but 0% of females docs smoke), in Italy 28% of doctors smoke (32% among men), and in Turkey or Bosnia & Herzegovina, around 40% of doctors smoke. (BioMed Central, 2007, 7:115)

While these vintage TV and print ads feature actors pretending to be doctors, there were and are doctors who not only smoke, but continue to do "research" on behalf of their Big Tobacco funders. Every signficant lawsuit against tobacco companies includes expert defense testimony arguing against the known dangers of smoking coming from physicians who are bought and paid for by industry.

An intriguing idea, especially for a self-described "whistleblower", might be to have you look into the members of your own profession who have colluded with their Big Tobacco employers to help sell cigarettes - the so-called "white coat sales force".

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