The End of the Illusion That Smoking Is a Choice
By Sarah Milov
"Dr. Milov is an associate professor of history at the University of Virginia and the author of “The Cigarette: A Political History.”
The Food and Drug Administration recently proposed lowering the nicotine content in cigarettes to less addictive levels. If adopted, this regulation would finally test one of the tobacco industry’s favorite claims: that smoking is a choice. Portraying smoking as a willful, personal decision has long allowed tobacco companies to promote cigarettes even while acknowledging their deadly risks. But the paradigm of individual choice has also guided cigarette regulation, ironically strengthening the industry’s key talking point — until now.
Nicotine is the addictive element in a cigarette. By reducing nicotine levels in cigarettes, federal regulations will, for the first time, address the key driver of cigarette consumption, which claims 480,000 American lives each year. Nicotine’s effects are particularly acute in adolescence, which is when most smokers start.
Tobacco companies have long understood that physiological dependence on nicotine — or what executives preferred to call nicotine satisfaction — was central to their business. Since the 1960s, the tobacco industry has manipulated ammonia levels in cigarettes to enhance nicotine’s effects. As one cigarette company research director commented in 1954, “It’s fortunate for us that cigarettes are a habit they can’t break.”
Publicly, tobacco’s advocates have argued that smoking is a choice of free, responsible adults. As early as 1929, the United States Patent Office granted patents to engineers who had devised processes for denicotinizing tobacco. But as one 1935 American Tobacco Company pamphlet reassured its readers, “The makers of Lucky Strike cigarettes deliberately refrain” from these techniques because “such removal of nicotine produces an emasculated product, shorn of the very qualities which give a cigarette character and appeal.” Selling the cigarette has always involved selling both the illusion of choice and a product designed to preclude it.
Ironically, the argument for individual consent was even bolstered by the earliest federal regulations on cigarettes — some of which the industry quietly lauded. After the surgeon general released the landmark 1964 report on smoking and health, policymakers debated how they would heed its call for “appropriate remedial action” to respond to the deadly health threat posed by cigarettes. The Federal Trade Commission’s proposal for cigarette warning labels that explicitly linked cigarette smoking to cancer and death was pre-empted by the warning label proposed by a tobacco-friendly Congress: “Caution: Cigarette smoking may be hazardous to your health.” These labels, which have intensified in urgency with each revision since 1966, appear to put the responsibility for smoking squarely on the shoulders of the smoker. Having been duly warned, it is the smoker’s decision to smoke and bear the consequences.
While publicly the industry howled that a warning label was unfair, privately lawyers breathed a sigh of relief. The surgeon general’s report and the warning label could bolster the industry’s defense in the courtroom in any future product liability suits. Indeed, when a wave of product liability suits brought by dying smokers or their families hit the industry in the 1980s, industry lawyers could gloat that “no tobacco company has ever paid one penny in damages” to a plaintiff. The warning label shielded companies as much as it informed smokers.
To circumvent the power that the tobacco industry held in Congress and at courthouses, anti-tobacco activists in the 1970s and ’80s pioneered a different strategy. Laws and workplace rules aimed at reducing public smoking — such as the creation of nonsmoking sections and smoking sections, indoor bans and even outdoor bans — were enacted on behalf of nonsmokers. Whatever a smoker may have decided, nonsmokers never agreed to smoke secondhand. One antismoking bumper sticker from the late 1970s playfully satirized the assumption-of-risk paradigm: “Caution: Your smoking may be hazardous to my health.”
The nonsmokers’ rights movement catalyzed a sharp decline in smoking rates. But it left the paradigm of individual consent untouched — or even strengthened. For nonsmokers’ rights activists, the smoker can pursue his choice with full knowledge of the deadly consequences as long as his choices don’t affect others. “I would not mind a smoker killing himself privately,” one nonsmoker explained in support of public smoking restrictions in 1978. “I greatly object to his infecting my air.”
In more recent decades, age restrictions on smoking have reinforced the idea that smoking is the choice of fully consenting adults. After fighting such laws for decades, cigarette manufacturers supported 2019 legislation that raised the minimum purchase age from 18 to 21. Whereas the industry once feared that such laws would “gut our key young adult market,” in the words of a Philip Morris strategy document, it now embraces them as a way to preserve “adult choice.”
“We can’t defend continued smoking as a ‘free choice’ if the person was ‘addicted,’” a tobacco lobbyist observed more than four decades ago. And yet this is precisely what the industry has done — with the unintended blessing of even anti-tobacco lawmakers, whose rules have granted the validity of the cigarette’s engineering while making it ever more difficult, expensive and stigmatized to be a smoker.
The F.D.A.’s nicotine proposal is, at long last, an opportunity to test one of the industry’s core propositions. Only then will we truly see if smoking is a free adult choice rather than the consequence of addiction and skillful product design.
The fact is that most smokers want to quit. For all the industry’s insistence that cigarettes are an emblem of individuality, nearly 70 percent of adult smokerswould prefer not to. More than half of the nation’s 31 million adult smokersattempt to quit each year, and only 7.5 percent succeed.
One study found that lowering nicotine levels could save an estimated 8.5 million lives in the next 80 years — lives of current smokers who will find it easier to quit, as well as lives of would-be smokers who never get hooked. It will save many millions more from tobacco-related heart and lung disease and from the unquantifiable grief that attends watching loved ones suffer prolonged and preventable illness. Such a stunning victory for public health is possible only with the kind of regulation that rightfully targets not individual smokers but the cigarette itself."
Post a Comment