The tobacco industry, graphic labels, and the “nanny state”

The CDC calls tobacco use “the single most preventable  cause of disease, disability, and death in the United States” with an estimated 443,000 smoking related premature deaths and 8.6 million living with serious illnesses caused by smoking. In addition, according to the CDC, tobacco use is responsible for more than $96 billion a year in medical costs and another $97 billion a year from lost productivity. So there’s no question that tobacco plays a major role when it comes to our country’s (and the world’s) health, health care, and medical costs.

One of the most infuriating aspects of the tobacco saga is the role of the tobacco industry and its unlawful and deceptive practices, for which companies have been repeatedly called out and in the U.S. government’s landmark lawsuit, successfully sued. As U.S. District Judge Gladys Kessler stated in the final opinion of this lawsuit: “Despite [the] knowledge [of the harmful effects of tobacco], [the Defendants] have consistently, repeatedly, and with enormous skill and sophistication, denied these facts to the public, to the Government, and to the public health community… In short, Defendants have marketed and sold their lethal products with zeal, with deception, with a single-minded focus on their financial success, and without regard for the human tragedy or social costs that success exacted.”

The stories of deception continue to this day, with a new analysis from UCSF, published just a couple weeks ago in PLoS Medicine, showing that tobacco scientists altered their study protocols to obscure the increased toxicity of additives in cigarettes.

Despite the seemingly never ceasing stories of deception and defrauding the public, U.S. tobacco companies had the audacity to sue the federal government this past summer over proposed graphic cigarette warning labels, saying the warnings violate their free speech rights and will cost millions of dollars to print (the latter point elicits a very bitter laugh, given we’re talking about an industry that rakes in billions and billions in profit).

The case was decided in favor of the tobacco companies in district court, but is currently being appealed (and I was happy to see that 24 attorney generals filed a friend of the court brief a couple weeks ago, saying the First Amendment doesn’t prevent the government from requiring “lethal and addictive products carry warning labels that effectively inform consumers of the risks those products entail”).

But what I’d like to turn to is public reaction to the graphic labels fight. Certainly, there are those that support the use of graphic labels on cigarette packages as a way to discourage tobacco use (there is in fact quite a bit of scientific evidence supporting this). But there are also those clamoring about the “nanny state”.

Public health professionals are pretty used to such “nanny” claims, and I think Yale University’s Dr. David Katz captured it perfectly in his Huffington Post article, “Public Health and the Illusion of Your Autonomy”, a few days ago:

“You may think you are defending your autonomy by opposing a ban on toys in Happy Meals. But while you are resisting the tyranny of public health, you are playing right into the hands of a large and rich corporatio­n that is far more concerned with its profits than the health of your child.”

EXACTLY. Why are some people so much more willing to be dictated by for profit corporatio­ns (whether in the fast food industry, tobacco industry, or otherwise)  than the recommenda­tions of public health and medical professionals?

They are infuriated by the idea of government placing graphic warning labels on cigarette packets, but seemingly unfazed by the continued deceptive practices of tobacco companies  (including supposed public service announcements about the harmful effects of cigarettes, which have been shown to be ineffective and sometimes even cause youth to start smoking or have more favorable beliefs about tobacco companies – which is exactly what they have worked to achieve).

They are infuriated by the idea of curtailing the freedom of McDonald’s to put toys to Happy Meals, never mind that it was most likely a decision made after “highly-paid marketing executives told them how to manipulate you by manipulating your children,” as David Katz puts it.

What can we do on this front? My advice today is not so much specific action steps, but more about thinking critically. First, let’s look into the “illusion of our autonomy” in a variety of different arenas – who really controls our behaviors and choices, and what are their motives? Then let’s ask, what can we do – on the ground in our communities and in the policy sphere – to limit the sometimes manipulating and deceptive influence of those with their bottom line in mind instead of what’s best for our health and well being? If you have any thoughts about these questions or related topics, please sound off in the comments!

(This post is cross-posted at

Vinu Ilakkuvan received her Masters of Science degree in Society, Human Development, and Health from the Harvard School of Public Health in May 2011. She currently works in youth violence prevention in Richmond, Virginia, and blogs about public health at

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Posted in healthcare, Innovation, public health
  • HurricaneRita

    Woah, wait a second. The premise of this artile is slightly flawed at its basis. It is not tobacco that causes health problems. It is the USE of tobacco that can. It is the action and decision of an individual to consume the carcinogen that may (or may not) lead to health complications for that particular person. Let’s make sure we start our arguments with the right foundation, putting the responsibility where it lies: in the free choice of the individual.

    We are confusing two separate things here. The reason the government regulates communications concerning tobacco is NOT because it is “bad.” It is because it is misleading. The media communications do not fully exposure the possible health risks associated with the consumption of the tobacco. But whether or not you “should” or “shouldn’t” consume tobacco…is up to the individual! And God forbid that our government ever tell us what we can and cannot eat because they deem it isn’t good for us on a purely personal level (although there are certainly many theocratic nations you can live in if you like that kind of rule). You may think you are doing a favor by telling adult human being what is good and not good for their lives, what is right and wrong as it effective only the individual, but that is not the purview of GOVERNMENT. Social taboos, cultural norms do the job not only much better, but without physical or punitive forces, which are inherent in government rule.

    We have instutitions of learning, we have schooling, we have family units, peer groups, that teach the value of “good decision-making.” It is not your faceless federal government–overwhich you have no individual say in its run and direction–that should be doing that. And fortunately for us, our court system is not founded the premise that government dictates the right and the wrong except in cases where social consequences to the group exist. The government has successfully sued the tobacco industry for false and misleading information–and for targeting ads towards minors…not because tobacco is “bad”. And good for them, because we need to ensure that accurate information is at the top of our social responsibilities. But good for the corporations, too, for standing up for freedom of speech. You may not like smoking…but evidently there are millions of people that do like it. The industry exists because people buy it. And please, let’s not be naive here. I don’t know of a single smoker (adult) who doesn’t realize it’s not good for them. They do it anyway. Do you think it matters to them what the label says?

  • pursuitofPH

    Thank you so much for your comment.

    I appreciate the point about tobacco use (as opposed to tobacco) causing health problems – I actually tried to be pretty careful about that, and referred to tobacco use in introducing the article in the first paragraph, but I’m really sorry if I slipped up elsewhere!

    While it is the actions and decisions of individuals to consume carcinogens, those actions and decisions are heavily influenced by an array of factors, including marketing, cost of products, availability of products, policies and systems in their community, etc. To focus on the free choice of the individual without considering all the factors that impact this choice leads us to miss many opportunities to impact health without curtailing free choice.

    I appreciate your opinion that it is not the purview of the government to tell its citizens what is good/not good, but one of the points of this article (and Dr. Katz’s post, which I referred to) is that for-profit industries – through marketing, their products, and more – give citizens their opinion of what is good/not good for them all the time.

    You mention that social taboos and cultural norms play a role in this – and I agree completely. But those taboos and norms are influenced by a number of things, including policy (a prime example being shift in public opinion and norms about smoking after laws were passed across the country and the world prohibiting smoking in certain indoor places).

    I think we do have say in the run and direction of government through voting and advocacy, and that saying government should not impede on our right to choice and liberty – which I agree with – is different from saying government should not play a role in influencing the things that influence our choices (after all, companies do this all the time; and actually, so does government, whether directly/indirectly, intentionally/unintentionally – for instance, influencing our choice about what to eat by influencing the price of foods through agricultural subsidies).

    You are likely right that there is not a single adult smoker who doesn’t realize it’s not good for them, but that doesn’t mean these labels are useless. The key is to look to the evidence – the Discovery News article I linked to provides the following information:

    “Perhaps the strongest evidence for the new labels comes from the International Tobacco Control Evaluation Project, which has examined tobacco-control policies around the world.
    After Thailand switched to graphic labels in 2005, for example, the project found that the percentage of smokers who reported thinking about health risks because of the warnings went up from about 35 percent to 55 percent. The percentage of smokers who said that the warnings made them more likely to quit rose from 31 percent to 46 percent.

    During the same period in Malaysia, which retained its small text-box labels, there was no change in the effect of warnings on attitudes about health risks, which hovered around nine percent. The likelihood that warning labels might induce people to quit there actually went down slightly from 14 percent to nine percent.

    In Mauritius, likewise, the percentage of smokers who said they frequently noticed warnings on packages rose from 56 to 83 percent after a switch to graphic labels.

    “We have found this in virtually every country in which graphic labels have been introduced,” said Fong, who is principal investigator for the ITC project. “Graphic labels work, and the reason why they work is the same reason why advertisers use vivid images in their pro-tobacco communication to consumers. What the FDA is doing now is trying to level the playing field a little bit.””

  • HurricaneRita

    Thank you for the clarification. I definitely know where you are coming from and why it may be frustrating to see convincing advertising being used for such a “regrettable purpose.” Indeed, we know smoking is terrible for our bodies.

    The question, though, about government’s involvement in deciding whether and to what level citizens of this country are allowed to persuade fellow citizens…is in fact a question of freedom of speech. It is not illegal to persuade. Whether the purpose of the rhetoric is good or bad….is not something the government gets to decide. Thank goodness.

    Whether or not the government gets to use a graphic ad instead of just a text label…. The government is known for issuing symbols in many other countries around the globe to indicate warnings or direction, and these are relatively effective. I think you make a good point to reference Fong on how this will level the playing field. Seems a minor point that will probably have some positive effect on warning consumers of the risk.

    The Tobacco Prohibition that recently occurred in this country did make a drastic change in usage. Just like the prohibition did of alcohol a century ago (of course reversed now). But keep in mind, it was relatively unconstitutional to force private property owners to prohibit people from smoking on their premise. The fight still continues on this issue. Do I personally like the fact that people don’t smoke when I’m eating now? Absolutely. And I think most people like it too. But you start tumbling down a very slippery slope to have the government force your hand instead of the individual, the business owner, making the deicion. It must be up to the citizen to determine his/her own free acts as it pertains to their property. We are slowly–and so “harmlessly”–stripping ourselves of crucial individual rights in this country. You may enjoy it now because you are on the same side of the issue as your federal government…but the day that you are not, you will wonder where all of this started.

    Make no mistake, too, that the same level of money that is used in selling tobacco, is also used in political elections. To even hint that we have decision-making power on the individual level in federal policy is comical. Your argument against tobacco and the persuasive power of those investors could also be applied to the lobbyists of our governmental leaders. Shall we level the playing field there too? That may be a more important cause than getting people to stop smoking. In the end, they know it’s bad for them, and they like it anyway.

  • pursuitofPH

    Sorry for the late response, but I wanted to thank you for the comments! I see where you are coming from, and the danger of slippery slopes is always good food for thought…

    Also, you make an incredibly important point re: money in political elections. Campaign finance reform is so critical to leveling the playing field and giving everyone a fighting chance when it comes to having a voice. I have no idea how to make it happen, but I agree that it is an absolutely imperative cause that would have repercussions across pretty much everything, public health and healthcare or otherwise. As a side note, I’ve been pretty impressed with Stephen Colbert’s satirical (but real!) Super PAC experiment and commentary…it’s all pretty scary.