On January 11, 1964—50 years ago—Surgeon General Luther Terry released his landmark report on smoking and health, concluding that smoking causes lung cancer and chronic bronchitis and may also cause heart disease and other forms of cancer. Since that time, smoking prevalence among adults has dropped from 42 percent to 19 percent, tobacco companies have been found guilty of fraud and racketeering, and the Food and Drug Administration has assumed jurisdiction over tobacco products, all contributing towards the public perception that the tobacco problem has largely been solved.
While most of the national tobacco control organizations are boasting about the amazing progress since the 1964 Surgeon General’s report on smoking—progress that they claim has continued to this day—there is another side to this story, one that the public doesn’t readily see.
In recent years, the tobacco control movement has squandered the opportunity to reduce smoking-related disease and death. Instead of continued progress, the tobacco control movement has largely been co-opted by a bureaucracy of national organizations that seem more concerned about bolstering their funding streams than fighting the tobacco industry. Both the government and the national tobacco control organizations have largely abandoned the fight against the tobacco industry and smoking, and instead have dedicated themselves to seeking funding for research or policy that makes little or no further contribution to the protection of the public’s health.
How has the tobacco control movement squandered opportunities to reduce smoking-related morbidity and mortality?
- In 1998, the state attorneys general abandoned their lawsuits against Big Tobacco, essentially being bought off by the tobacco companies. The signing of the Master Settlement Agreement was motivated by the desire for political gain for the attorneys general and money for the states. Furthermore, between 1998 and 2013, the states have squandered the money, spending only 4 percent on smoking prevention and cessation. The Master Settlement Agreement made the states partners with Big Tobacco by tying state revenues to the continued sale of cigarettes and removing any incentive for states to pass laws or establish programs that would make a serious dent in cigarette consumption. As a result, state-level tobacco control programs are largely dead.
- In 2009, Congress enacted legislation that gave the FDA limited regulatory authority over cigarettes. However, the FDA is ill-equipped to regulate a deadly product and has limited ability to do anything that would actually make a dent in cigarette consumption. Adding insult to injury, the tobacco companies can now claim that they are concerned, socially responsible companies that are contributing to the protection of the public’s health. They can say, with honesty, that their products are approved by the FDA and that they comply with “stringent” federal regulations intended to protect the public’s health. However, the FDA has yet to take a single action that either makes cigarettes safer or reduces youth smoking. In fact, by trying to ban electronic cigarettes, the FDA actually protected cigarette profits at the expense of smokers who desired to quit. It was Philip Morris who wanted the FDA legislation—to institutionalize their products, protect their market share by stifling competition from potentially safer products, and give the public the perception that cigarettes are now safer because they are federally regulated.
- In 2014, antismoking organizations are spending more time trying to prevent smokers from quitting (by trying to prohibit or discourage the use of electronic cigarettes) than they are attempting to enhance the options available to smokers who are unsuccessful with available drug treatments. Financially tied to Big Pharma, they are trying to force drugs down the throats of every smoker, even though research has demonstrated that cold turkey unassisted quitting is far more effective than reliance on drugs.
Tobacco control organizations have become addicted to money and the movement’s actions are designed to promote funding streams to these groups rather than to attempt to end the tobacco epidemic. Moreover, the grassroots nature of the tobacco control movement has largely disappeared, having been replaced by a few large national organizations that tell the local groups what to do.
On the 50th anniversary of the 1964 report, Alan Blum, director of the Center for the Study of Tobacco and Society at the University of Alabama, released a documentary that highlights what he calls “the persistent foot-dragging, fear, and squandering of funds by public health agencies, universities, and medical associations alike in ending the smoking pandemic.” This is the real story of the modern-day tobacco control movement. It demonstrates that the tobacco problem is far from over, and that today’s leading antismoking groups have squandered the opportunity to continue Terry’s legacy.
While the tremendous decline in smoking since the 1964 Surgeon General’s report is worthy of celebration, the actual number of smokers has declined only from 53 million to 45 million. Clearly, the problem of cigarette smoking remains one of the most critical public health issues of our time. But to succeed, we need to rebuild a tobacco control movement that, unlike the current one, cares more about saving lives than gaining dollars.
Michael Siegel, a School of Public Health professor of community health sciences, can be reached at firstname.lastname@example.org.
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