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Kaplan J. Don’t blame the smoker. Harvard Public Health Review. Fall 2018;15. DOI:10.54111/0001/O3
“More people die each year from smoking than from murder, AIDS, suicide, drugs, car crashes, and alcohol, combined.”
A callous, robotic voice delivered statements like the one above in complete monotony. As this Siri-esque narrator read off these disturbing smoking facts, plain black text crawled across a boring white backdrop. Before I could even rationalize what I had watched, the pathetic PSA was over. These were the advertisements it took Big Tobacco 11 years to create?
In 2006, a Federal court ruled that nine major tobacco companies, found guilty of racketeering, must release a series of “corrective statements,” intended to rectify decades of misinformation they fed to the American public.1 The reparative ads, to be paid for entirely by the tobacco industry, were required to utilize “the same vehicles […] historically used to promulgate false smoking and health messages,” including television commercials and printed newspaper ads.2 While a victory for the health organizations who filed the suit, the court orders ultimately came with a caveat: the industry itself had a say in the design of the ads.
For over a decade, Big Tobacco’s powerful attorneys appealed and stalled the mandated advertisements, whittling away their impact through content negotiations and strategic delays. The ads finally aired in November 2017 and ran during primetime on ABC, CBS, and NBC—as well as in newspapers like The New York Times—for one year. Unlike the powerful cigarette campaigns that enticed millions in the 20th century, these ads were dull, decidedly misplaced, and designed to fail.
In the painstaking fight against tobacco, any progress deserves to be celebrated. But justice has not been served for the millions of people who were, and continue to be, manipulated by this insidious industry. People guilty of nothing more than turning on a TV, reading a newspaper, or visiting a convenience store. People who have been targeted, misled, and deceived.
People like my Aunt Nancy.
"All cigarettes cause cancer, lung disease, heart attacks, and premature death —lights, low tar, ultra lights, and naturals. There is no safe cigarette.”
Nancy was born in September 1958 and grew up in a time when the risks of smoking were systematically disputed and downplayed by Big Tobacco.
Beginning in the 1930s, researchers reported strong links between smoking and lung cancer in animal models, biochemical assays of cigarettes smoke, and even observational studies of smokers. By the early 1950s, scientists at the American Cancer Association were confident they had proven the lethal association ‘beyond a reasonable doubt.’ In 1960, 48 percent of US doctors still smoked cigarettes, and only one-third considered smoking to be a ‘major cause of lung cancer.’3 Unalarmed and unconvinced, Nancy’s parents, my grandparents, smoked cigarettes and pipe tobacco inside the house.
But why were our nation’s healthcare providers—and accordingly, the people who trust them—so unfazed by the well-documented risks of smoking? The answer lies in cunning industry advertising.
In 1954, a Big Tobacco conglomerate, covertly calling themselves the Tobacco Industry Research Committee, unleashed a full-page newspaper ad disputing the “inconclusive” health effects of cigarettes.4 Called “A Frank Statement to Cigarette Smokers,” the ad ran in nearly 450 US newspapers, and is projected to have reached over 43 million Americans with its message “that there is no proof that cigarette smoking is one of the causes [of lung cancer].” 5 This very cancer denialism was maintained by industry public relations until at least the 1970s.6 With Big Tobacco strategically muddying the waters, children like Nancy had no way to know that cigarettes were dangerous.
“Altria, R.J. Reynolds Tobacco, Lorillard, and Philip Morris USA intentionally designed cigarettes to make them more addictive.”
Nancy tried her first cigarette as a teenager in the early 1970’s. It was an era defined by experimentation, non-conformism, and flourishing feminism. Not to mention opportunistic marketing by the U.S. tobacco industry.
Just a few years earlier, industry giant Phillip Morris had introduced Virginia Slims, a cigarette brand unapologetically targeting a promising new demographic: the liberated woman. With catchy commercials that championed smoking cigarettes as a hard-earned freedom like voting rights in the 1920s,7 Virginia Slims aimed to hook the groovy and empowered generation.
“You’ve come a long way, baby
To get where you’ve got to today
You’ve got your own cigarette now, baby
You’ve come a long, long way.”
The brand’s bold jingle saturated the airwaves, even featuring in the last cigarette commercial ever aired on TV in America, which ran in the final minutes before tobacco advertising was banned from television by the Public Health Cigarette Smoking Act in 1971.89 But the damage had already been done. Thanks to the Virginia Slims campaign and other female-focused rivals, the smoking initiation rate for 15-year-girls swelled by 75 percent between 1967 and 1973.10 Nancy and millions of young women like her succumbed to the vicious profiling.
As the industry spent billions of dollars keeping cigarettes cool in the public eye, Phillip Morris, RJ Reynolds, and fellow tobacco cronies were privately developing methods to increase the addictiveness of their products. By adding ammonia—a chemical commonly found in cleaning supplies like Lysol—the industry amplified their cigarettes, increasing the nicotine kick and improving flavor, all while keeping tar “low.”11 By the 1970s, major brands like Marlboro had perfected their addictive blend of additives and adulterants. Nancy went on to become a lifelong smoker.
“There is no safe level of exposure to secondhand smoke.”
Growing up, I never knew Nancy the smoker—she never lit up in front of us kids. I knew Nancy the animal lover, who fostered and trained Capuchin monkeys, adorable little primates often seen wearing costumes in movies. For nearly fifteen years, Nancy prepared hundreds of Capuchins not for the silver screen, but for careers at Helping Hands, a Boston-based non-profit that matches people with spinal cord injuries and mobility-limiting conditions to intelligent and dexterous monkey assistants.
Whenever my brothers and I visited Nancy, we would play with the helpers, who lived in the maze of cages that filled her modest house. We could barely hear each other over their clanging and howling. And that house—oof, it reeked. I’ll never forget the smell: feces, ammonia, and the lingering tinge of smoke.
“When you smoke, the nicotine actually changes the brain — that’s why quitting is so hard.”
They first found cancer in Nancy’s brain. By the time she fell ill, she had smoked on-and-off for three decades and racked up more than 20 pack-years. Every time she quit, sometimes for weeks, sometimes for years at a time, cigarettes always drew her back. A product engineered for lifelong dependence—and more addictive than heroin.12
After her diagnosis was updated to metastatic lung cancer, Nancy seemed to give up on giving up and indulged in nicotine regularly. Why not? At that point, nothing could save her. As she told my Mom during a family visit while smoking outside, “This isn’t the cigarette that’s going to kill me.”
Nancy smoked until she no longer could when she was moved to hospice care and attached to an oxygen tank. Even in her final week, as she struggled to breathe through a nasal cannula, cigarettes were never far away. Her boyfriend, a fellow smoker, tried to light up in her room. My empowered, sarcastic, and compassionate aunt died from complications of lung and brain cancer on September 25, 2005, two days after celebrating her birthday in a hospice bed. She was 47. I was 12.
“Smoking kills, on average, 1,200 Americans. Every day.”
After Nancy passed, I got to keep her blanket. Originally a gift from my mom, it was meant to keep Nancy comfortable as she recovered from her grueling radiation therapy. Brown and fuzzy, the blanket is almost as soft as Nancy’s capuchins. It took ten washes to get the smell of smoke out of it.
And there is a lingering imperfection: a hole, with charred, melted edges — a burn hole, undoubtedly from a cigarette.
In the thirteen years since my aunt’s untimely death, I often wondered why Nancy puffed her life away, why she started smoking in the first place. Why she never quit for good. For thirteen years, I blamed her.
Only as I watched the disgraceful, court-mandated PSAs that Big Tobacco fought so hard to contain, did I realize: the fault lies with the industry. No one should blame the smoker.
At 26, I still sleep with Nancy’s blanket—I’ll never sew up that hole.
Justin Kaplan currently is an MPH candidate, in social and behavioral sciences and health communication, at the Harvard T.H. Chan School of Public Health.
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