The Medical Profession's Fight With the Tobacco Industry: Strategies for Winning the War

by Thomas F. Heston

When former Surgeon C. Everett Koop called for a smoke-free society by the year 2000, he challenged us to engage in an all out war. To win this war we need a unified strategy. It can be helpful to study the origins of smoking, and realize that smoking has only been with us for a short period of history. Most importantly, we need to engage the enemy where he can be hurt the most--in the political arena. Only through tough legislation will nonsmoker's rights be protected. Only by demanding truth in advertising will we be able to save our teenagers from the immoral brainwashing done by the tobacco industry.

Cigarette smoking is historically a new phenomenon, only about a century old. Before the New World was discovered in the 15th century, most of the world's population did not smoke or consume tobacco in any form. Unfortunately, the Indian ritual of restricting tobacco smoking to the peace pipe (to signify the end of a war) was not adapted by the French settlers. When they introduced pipe smoking to Europe, the practice became rampant in spite of vigorous opposition by various governments. Even the wives of Andrew Jackson and Zachary Taylor smoked pipes while in the White House. By the end of the 19th century, smoking tobacco in the form of cigarettes was introduced. The cigarette has since become the tobacco industry's most addictive weapon in their deadly assault on society (1,2).

Medical activism is an essential part of the fight against the tobacco industry. There are many opportunities for physicians of all personality types to get involved in this area. One popular and highly effective group is "Doctor's Ought to Care" (DOC). Founder Alan Blum, a Family Physician, has used humor, satire, and an undeniably offbeat approach to the problem. Started in 1977, DOC currently has over 5000 members. The group's approach to community medicine has proven so effective that some family practice residencies have incorporated DOC activities as required rotations (e.g. the Cedar Rapids Family Medicine Residency). It's activities include sponsoring antismoking athletic tournaments such as the Emphysema Slims Tennis Tournament, which was first held one week after the well know Virginia Slims Tournament. The tournament's slogan was "you've coughed up long enough, baby." The tournament was a huge publicity success with newspapers all over the country carrying articles about it. The Journal of the American Medical Association also reported the activity (3).

Other physicians may prefer to engage in different methods of activism. One way is to make it a habit to write your political representative a weekly postcard urging him or her to introduce stronger anti-tobacco legislation. Another way is to simply have your secretary call the politician's office on a regular basis, urging action in the anti-tobacco war. Some may want to periodically write letters to their city newspaper editor and urge grassroot efforts to protect our teenagers from tobacco. Let them know that conservative estimates indicate that a 10% increase in the price of cigarettes will lead to a 10% decrease in the number of teenage smokers (4). Thus, increasing tobacco excise taxes is likely to be an effective way to limit teenage smoking. Workplace smoking bans also have been shown to effectively reduce overall cigarette consumption. In one study, a statistically significant mean decrease of 5.2 cigarettes per day was observed after workplace smoking bans were implemented. However, the authors also noted that if such bans were extrapolated to the entire Australian Public Service, about 52 million less cigarettes would be smoked per year in Australia. If 1 cigarette costs 8› this means a loss of $4,000,000 in retail cigarette sales (5). No wonder the tobacco companies so vigorously lobby congress.

The fight the medical profession has waged against tobacco smoking has gone on for centuries. In spite of the limited success of previous efforts, the accumulation of scientific evidence and sobering statistics has made the time ripe for a societal change. Even a partial victory is worth the effort.

REFERENCES

1. Garrett N. Smoking now and then. Canad Nurse 1973;69(11):22-6.

2. McCusker K. Landmarks of tobacco use in the United States. Chest 1988;93(2 supp):34S-36S.

3. Gunby P. Medical news. JAMA 1985;253(20):2943.

4. Shikles JL, Ratner J, Schwalenstocker M. Teenage smoking: higher excise tax should significantly reduce the number of smokers. Washington, D.C.: Government Accounting Office, Human Resources Division, 1989; publication no. GAO/HRD-89-119.

5. Borland R, Chapman S, Owen N, Hill D. Effects of workplace smoking bans on cigarette consumption. Am J Public Health 1990;80(2):178-80.