Where There’s Smoke, There’s Death

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Recently, one of the medical journals that I read published a book review. The book is The Cigarette: A Political History by Sarah Milov. The book was published last year. According to the review, the book contains some startling revelations and is a must-read. For starters, cigarettes remain the leading preventable cause of death, a morbid fact that is easily lost in our current COVID-19 frenzy. Even if this virus kills 200,000 Americans, that death rate pales in comparison to the half a million Americans killed every year by cigarettes.

The genius of the nicotine industry in getting people to use their products is mind-boggling. For example, in 1999, Philip Morris launched a campaign urging young women to “Find your voice” by smoking Virginia Slims cigarettes that was part of a larger effort to turn smoking into a form of speech. Opponents of smoking were therefore trying to stifle free speech. In the decades after World War II, the cigarette industry was able to addict state governments, mostly in the American South, to the cash flow that was generated by cigarette sales. In 2003, the president of R.J. Reynolds commented on the dynamic by admitting that “the largest financial stakeholder in the industry is our state governments.”

The author explores the political muscle of the industry by utilizing unparalleled historical treasure – 85 million pages of online archives maintained by the University of California San Francisco, including documents and detailed plans to market to young people euphemized as rookies, novices, or replacement smokers. There are thousands of pages outlining plans for ethnic marketing, nicotine manipulation, and schemes on how to refute any kind of science that might implicate cigarettes in causing harm. A Philip Morris engineer named Ronald Tamol kept notebooks on the company’s need to determine “the minimum amount of nicotine required to keep normal smokers hooked.” Most of the documents were revealed before ever passing through the redacting hands of lawyers.

Sadly, American smokers today smoke about 230 billion cigarettes annually, more than three times the number smoked in 1940. And this is despite the overwhelming, irrefutable evidence that cigarette use shortens a user’s lifespan and causes a myriad of diseases. Cigarette makers still prosper financially. Credit Suisse in 2015 pointed out that cigarettes have been the leading financial investment in American history. Altria, the parent company of Philip Morris USA, still has a market cap of $76 billion, and Philip Morris International is worth $112 billion. Milov writes that smoking has become a “shameful private vice” – but people can still smoke freely in most public places, unlike public urination (although our current mayor does not enforce it). Smoking remains common in many Hollywood films and TV shows. It is clear that the cigarette industry has won the “war” against those who oppose it.

Scholars need to pay more attention to cigarettes, even during the current plague. Any focus on disease that ignores the cigarette, or the cigarette industry, is like pretending an interest in malaria while ignoring mosquitoes and swamps. Nicotine addiction will outlive this virus, shackling millions in chains that lead to suffering and death. The havoc wreaked on human health is worse than any virus, and Milov is right to insist that the catastrophe is not just preventable, but it is also political.

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 By Peter Galvin, MD

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