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Vol. LVII, No. 25
December 16, 2005

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Consumer Misperceptions About Tobacco Still Abound, Says Cummings

On the front page...

Okay, you're at NIH, and the learned professor comes to town to deliver the lecture titled, "Does the Government Really Need to Do More to Educate the Public About the Risks of Smoking?" It's not simply that Dr. K. Michael Cummings' answer was obvious before he spoke a word, but the manner in which he skewered the tobacco-use habit that also proved entertaining. Even a committed nonsmoker had to ask, following his hour-long talk at Executive Plaza North on Nov. 30, "How do smokers continue to do such a disgusting thing to themselves?"


Granted, Cummings was preaching to the choir — a group of NCI cancer prevention and control fellows, not one of whom looked familiar with a nic fit. And maybe humor is the only sane response to the baldness of the pseudoscientific balderdash issued by tobacco industry propagandists in the past few decades.

Owing largely to extensive federal litigation against the tobacco industry, we now know that its campaign to sidestep or discredit decades of scientific findings damning tobacco use has been deliberate and shrewd.

Only two weeks after then Surgeon General Dr. Luther Terry issued the landmark 1964 report linking smoking to a variety of health ills including lung cancer, a memo circulated at the top of one of the largest cigarette manufacturers, declaring: "We must give smokers.a psychological crutch and self-rationale to continue smoking."

Cummings, who is chair of the department of health behavior in the division of cancer prevention and population sciences at Roswell Park Comprehensive Cancer Center in Buffalo, spent much of his lecture illuminating how Big Tobacco has cleverly offered a variety of crutches to succeeding generations of potential smokers.

The first crutch was filters; adding them to popular brands gave the illusion of a safer smoke. Next came so-called "light" cigarettes promising less tar, in the early 1970's, which initially were not embraced by consumers, but gradually grew in popularity, especially with female smokers, whom the ads targeted. Cummings paused to decry the recent "celebration" of the 50th anniversary of the Marlboro cigarette brand: "How can you legitimately celebrate the anniversary of a product — Marlboro — that alone has caused an estimated 2.3 million American deaths over the past 50 years — more than the number of Americans killed in all wars combined? Marlboro is the only product I know of where the flavor outlasts the customer."

Cummings does not fault the mass media campaigns of the past 30 years with failing to acquaint Americans with the dangers of smoking. To the contrary, they have been highly effective, he said, and the overwhelming majority of people know that smoking is risky behavior. The problem today is that smoking's true dangers have been soft-pedaled by industry and largely unexplored by major ad campaigns.

For example, how many people know that smoking damages small blood vessels in the eye, and is the leading cause of preventable blindness in the U.S.? Smoking raises risk of heart attack, stroke, lung cancer and other cancers and impotence, yet one survey showed that 40 percent of smokers believed they were at no greater risk of these ailments than someone their age who doesn't smoke. Fifty to 60 percent of survey respondents thought that modern cigarettes are less dangerous than they used to be, which Cummings said is not true.

One of the three major studies Cummings cited sought to learn what smokers know about the ingredients in their smokes. Most were aware of nicotine and carbon monoxide, but few were aware that cigarettes contain lead, ammonia, urea ("a pee in every pack" said one wag), arsenic, cyanide and radioactive material. "Once smokers learn the truth about their smokes, they can begin to make an informed decision about smoking and most will choose to quit," Cummings said. "Of course, quitting smoking isn't easy because smokers get hooked on nicotine, but knowing and appreciating the risks of smoking is the first step towards helping smokers beat their nicotine addiction.We're talking about the most lethal consumer product ever marketed."

Many cigarettes today are contaminated with plastic (the cellulose acetate used in filter production often finds its way into smokers' lungs, a condition known as "filter-fiber fallout"), shoe polish (used to paint the normally clear cellulose acetate white) and fake tobacco (studies have shown that 20-30 percent of a typical cigarette is actually "reconstituted" material containing random ingredients ranging from whatever's been shoveled off the tobacco barn floor to stale tobacco recycled from unsold packs of cigarettes.) Adding insult to injury is the fact that a pack of cigarettes costs only a nickel to manufacture; compare that with whatever you paid for your last pack.

Another tobacco industry ruse is that cigarette filters are "vented," allowing fresh air to mix with each inhaled puff. Problem is, the vents are not only invisible but also are almost microscopically small. And because they are located near the filter's end, they are normally blocked by the holder's fingertips, Cummings showed.

In the main, people know smoking is bad for you (though many are unaware, for example, that nicotine is not the cancer-causing aspect of a cigarette). And most who smoke (more than 56 percent, in one international study) intend to quit sooner or later. But the industry gives them just enough optimism to believe they are doing less harm to themselves than they actually are, and continues to tout the canard that smoking is not addictive and can be set aside painlessly at any time.

So, to answer his lecture's title, Cummings gives a resounding "No!" It's not enough to communicate smoking's risk in scanty detail, especially when it is countered by massively opposing messages issued by the tobacco industry (there is an entire science of measuring advertising impact, based on such arcana as GRPs, or gross rating points, which both sides in the battle employ).

His solution? Yes to more ads — they work. Yes to graphic warnings on cigarette packages — studies show that the more frankly the damage is presented, the more the product repels potential users. Yes to more harm-reduction efforts, more extensive use of NRT (nicotine replacement therapy, usually by gum, patch or lozenge), more clever advertising (especially educational kits that mimic the artwork of popular cigarette brands) and laws banning indoor smoking.

Concluded Cummings, "You can't make someone quit smoking, but educating people so they can make an informed choice is where we should start. Requiring cigarette companies to limit the nicotine in their cigarettes to non-addictive levels would help, too, since it would make it easier for addicted smokers to be able to exercise their choice to quit." According to Cummings, most smokers would try to quit if they knew the truth about their cigarettes.

Little League Activism Launches Educational Crusade

It was not as a firebrand that Dr. K. Michael Cummings began his anti-tobacco message at EPN recently, but as a dad who, while coaching his son's Little League baseball team, became alarmed at the number of anxious parents puffing away in the bleachers. "One third of the patients at our cancer center are there because of smoking. Running our local Little League got me involved in trying to do something about smoking," he said. "I believe in the adage, 'Think globally, act locally.' I managed to convince some of the parents to stop, we made our baseball park smoke-free and we put anti-tobacco billboards along the outfield fence."

His lecture included a timeline of the past 55 years of grappling between the multinational tobacco industry and the medical research community, a classic sort of David versus Goliath scenario.

In 1950, the British Medical Journal published a landmark paper by Doll and Hill showing that smoking was an important risk factor in lung cancer. By January 1954, the industry pledged its "aid" to the research effort and created its own Tobacco Industry Research Committee.

"This is where the conspiracy begins," noted Cummings.

The TIRC's first job was to retain public relations firm Hill & Knowlton, he explained. Their advice was to declare that the link between smoking and health was unproven, but to support a research program to study the question.

TIRC hired an eminent scientist as its scientific director, Dr. Clarence Cook Little, former president of the University of Michigan and past president of the American Cancer Society. He was to serve in that post from 1954 to 1971, declaring all the while that cigarettes were safe. Much of the research funded by TIRC, which in 1964 was renamed the Council for Tobacco Research, had little if nothing to do with smoking and health, and the organization never officially conceded that smoking caused cancer in its entire 45-year history.

In 1958, the tobacco industry created the Tobacco Institute (TI), essentially a PR and lobbying arm for the business, Cummings said. Both the TIRC and TI were run by the same management group of industry lawyers who helped keep the myth alive that smoking was an unproven cause of cancer, heart disease and chronic obstructive pulmonary disease.

The next major volley in the battle was the Surgeon General's Smoking and Health report issued Jan. 11, 1964, to which the industry responded with a disinformation campaign that extended for 50 years. "It would be nice if tobacco companies would keep the promise they made to smokers in 1954 when they declared that they would stop selling cigarettes if they were ever found harmful to human health," Cummings said. "Today the cigarette industry says there is no such thing as a safe cigarette, so I guess it is time that they keep their promise and find something else to sell."

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