WHY THE WAR ON TOBACCO WILL FAIL
Jul 20, 1998, Vol. 3, No. 43 • By JOHN E. CALFEE
The war on tobacco has turned upside down. For decades, as new information emerged about the health effects of smoking, public policy relentlessly emphasized individual decision-making. This brought real achievements -- notably, a 40 percent reduction in U.S. per capita cigarette consumption between 1975 and 1993.
Some half dozen years ago, however, the battle over tobacco entered a new phase. The focus shifted from smoking to the tobacco industry. A new view took hold. In this view, smoking is caused primarily by deceptive advertising targeted at young people, the manipulation of nicotine to maintain addiction, and the suppression of information on the harm caused by smoking. Smokers should be seen as victims of these forces. And the solution is drastic reform of the industry itself.
This new vision rapidly coalesced into policy. Several states raised tobacco taxes in order to protect smokers from their own preferences and to fund anti-smoking campaigns and research. Federal action followed, notably the attempt of the Food and Drug Administration to regulate cigarettes as nicotine-delivery devices. At the same time came an astonishing barrage of litigation, generating multi-billion-dollar settlements in Mississippi, Texas, Florida, and most recently Minnesota. A June 1997 agreement among plaintiff attorneys, state attorneys general, and the tobacco industry provided a model for comprehensive federal legislative proposals, over which debate continues to this day.
All of this activity tends to focus on a concrete goal and a specific set of tools. The goal is to reduce teen smoking rapidly by half or more, with a corresponding reduction in adult smoking as the teens get older. The tools: elimination of advertising seen by teens, price increases of up to $ 2 per pack, anti-smoking campaigns, litigation to penalize the industry financially, "look-back" penalties on the industry if teen smoking does not decrease, and FDA jurisdiction over the development of safer cigarettes.
The new approach will almost certainly fail. In fact, disturbing symptoms of failure have already begun to appear. Teen smoking has increased substantially since 1991. That has caught people's attention, but probably more alarming is a little-noticed change in the trend of overall consumption. After 15 years of sharp annual declines, per-capita cigarette consumption has hardly dropped since 1993.
Quite aside from these numbers, there are compelling reasons to believe that the central elements of the new plan cannot do what they are supposed to do. Consider prices, the single most important tool in the new thinking. Current proposals would raise federal taxes by a dollar or two -- former surgeon general C. Everett Koop and former FDA commissioner David Kessler have proposed $ 1.50. This is expected to cut teenage smoking by a third or more. The logic is that teens don't realize they will get hooked on nicotine if they smoke, but they will react strongly to higher prices. This seems most unlikely. With teen smokers consuming an average of eight cigarettes a day, there is little reason to expect an extra five or ten cents per cigarette to stop them from smoking. And in fact, the biggest drop in teenage smoking -- a nearly one-third decline in the late 1970s -- occurred when cigarette prices were also going down (by about 15 percent). On the other hand, prices have been stable or slightly rising since 1991, even as teen smoking increased. In the United Kingdom, where cigarettes already cost twice as much as in the United States, teenagers smoke at about the same rate as they do here.
What about advertising? Tell a teenager that advertising is the reason he smokes, and you will probably convince a teenager that you are out of touch with reality. Repeated statistical analyses have failed to detect a substantial effect on consumption from advertising. One may quibble about the details of individual studies, but the overall results are unmistakable. If advertising's effect on cigarette consumption were substantial, it would have been detected by now.
FDA regulation, if it comes to pass, will be institutionalized frustration. The new rules on advertising cannot reduce teen smoking, because advertising restrictions can hardly prevent what advertising never caused. Safer cigarettes (with less tar and nicotine) will be stymied, as the FDA vigorously implements policies reflecting the public-health community's hostility to safer smoking and new types of cigarettes.