By Alan Blum, Eric Solberg and Howard Wolinsky
Los Angeles Times, January 13, 2004
http://www.latimes.com/[...]m13jan13,1,4001482.story



Forty years ago this month, the U.S. surgeon general delivered a bombshell. Cigarettes, he said, represented "a health hazard of sufficient importance ... to warrant remedial action." He issued a call to arms against a modern plague, and in doing so, launched the contemporary war on smoking. 

Too bad that the war against smoking has been a complete flop, the worst public health failure in U.S. history. Lung cancer, despite its 14% decline in California over the last decade, is as deadly as ever nationally and has even surpassed breast cancer as the leading cancer killer among women. Though the proportion of people who smoke has declined in the United States, the number of those who smoke - 46.2 million people - has remained virtually the same. Smoking claims more than 400,000 lives a year in this country. And today, Marlboro smokers are younger than ever. Even the recent four-year decline in smoking among adolescents has yet to offset the dramatic increase in smoking among this age group over the last decade.

Progress has come slowly because of a combination of things. Topping the list is that the tobacco industry has political clout and made lucrative payoffs to the very forces that should have been in the vanguard to end the tobacco pandemic - members of Congress from both parties, the media, medical
organizations and academia have all been chronic recipients of tobacco industry largess and have not been prepared to bite the hand that feeds them.

Meanwhile, the health community has bounced from one failed multimillion-dollar public relations crusade to another, only to settle each time for voluntary agreements crafted by the tobacco industry. And the anti-smoking movement is still wandering in the desert, unfocused and splintered.

Sure, there have been some advances, most notably the smoking ban on aircraft and the ban of TV, radio and billboard ads. But overall, the tobacco industry has remained in the driver's seat during the last 40 years and has always managed to turn potential adversity to its advantage.

For example, when Congress banned cigarette ads from broadcast media in 1971, it did so at the request of the tobacco companies, whose sales had flattened because of anti-smoking commercials between 1967 and 1970 from the American Cancer Society. The ban meant the end of free air time in
prime-time for the anti-smoking forces. But then the tobacco companies launched a new strategy: sponsoring sporting events that made cigarette logos a fixture at televised auto races as well as cultural events such as concerts and art exhibitions.

California has marched to its own drummer and, as a result, smoking rates and cigarette sales have fallen in the state more than nationally, according to the American Lung Assn. That success can be attributed in large measure to a uniquely persistent grass-roots movement responsible for smoking bans in government and private workplaces, retail stores, child-care centers, recreational and cultural centers, restaurants and bars.

 In 1987, a small coalition of health organizations persuaded California voters to pass Proposition 99, a cigarette tax aimed at raising hundreds of millions of dollars earmarked for medical research, anti-smoking education and related programs. It was a great idea, but problems surfaced over how the money should be spent. The fight against the public health problem of smoking became a fight among umbrella health organizations trying to get their hands on the money. Funds from Proposition 99 were, among other things, supposed to pay for the best minds in advertising to conceive and produce anti-smoking ads. Though the ad campaigns won awards, they lacked the frequency needed to have a more significant effect. Ironically, some of the best ads were not designed to counteract smoking but were developed to challenge politicians, medical organizations and others who wanted to dip into the pot of money. During the 1990s, health organizations accustomed to affluent new lifestyles with funds from Proposition 99 spent much of their time and energy preserving their entitlements. 

Now this experience is being repeated across the country as a result of the 1998 Master Settlement Agreement - a $206-billion, 25-year agreement between tobacco companies and 46 states, including California, to settle state lawsuits. The American Lung Assn. found that state legislatures were using the money from the windfall settlement to pay for programs other than anti-smoking efforts. 

The reality is that states are hooked on the cash flow and are using it to close budget deficits. Besides nicotine, perhaps the most addictive thing about tobacco is money. The contemporary public health
model to counteract tobacco use relies on money from state governments, which in turn rely on the tobacco industry for funding. 

It's time to return to the original grass-roots movement pioneered in California. Activists in California and elsewhere need to be weaned from their addiction to government money. They should use their creativity to tackle this issue in new ways. Without breakthroughs in leadership, the anti-smoking movement may be condemned to another 40 years in the desert and the public no closer to the promised land of a smoke-free America.

Forty years after tobacco was first officially linked with cancer, a leading public health expert warns that thousands will continue to die unless the Government remedies its "scandalously low" spending on the problem.

This week marks the 40th anniversary of the US surgeon- general's 1964 report on cigarettes, the first official recognition that tobacco causes cancer and other serious diseases.

In the years since, Australia has banned tobacco advertising, banished smoking from indoor public spaces and forced the industry to put anti-smoking messages on cigarette packets.

The links between smoking and cancer, lung disease, heart disease, osteoporosis, thyroid problems, diabetes and more have been backed by an avalanche of scientific evidence. Yet a fifth of Australian adults continue to smoke.

The nation's tobacco-related death toll stands at about 19,000 a year - a higher toll than from murder, suicide, car accidents, breast cancer, skin cancer, AIDS and diabetes combined.

Professor Simon Chapman, head of the University of Sydney's School of Public Health, said the Federal Government was not doing enough to remedy Australia's "tobacco epidemic".

"I think the pace and commitment at which the epidemic's being addressed is pretty poor compared with the size of it," he said.

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