Doubt is Their Product

Chris Mooney reviews a new book about the war on science

Doubt is Their Product: How Industry's Assault on Science Threatens Your Health by David Michaels (Oxford University Press, 359 pages, $27.95) ...

Tobacco companies perfected the ruse, which was later copycatted by other polluting or health-endangering industries. One tobacco executive was even dumb enough to write it down in 1969. "Doubt is our product," reads the infamous memo, "since it is the best means of competing with the 'body of fact' that exists in the minds of the general public. It is also the means of establishing a controversy."

In his important new book, David Michaels calls the strategy "manufacturing uncertainty." A former Clinton administration Energy Department official and now associate chair of the Department of Environmental and Occupational Health at George Washington University, Michaels is a comprehensive and thorough chronicler -- indeed, almost too thorough a chronicler, at times overwhelming the reader with information.

But there's a lot to be learned here. Even most of us who have gone swimming in the litigation-generated stew of tobacco documents (you can never get the stink off of you again) don't have a clue about the extent of the abuses. For the war on science described in Doubt is Their Product is so sweeping and fundamental as to make you question why we ever had the Enlightenment. There aren't just a few scientists for hire -- there are law firms, public-relations firms, think tanks, and entire product-defense companies that specialize in rejiggering epidemiological studies to make findings of endangerment to human health disappear.

In a post about Roger Bate and the Tobacco Documents John Quiggin suggests:

The fact that so many people could be fooled by industry propaganda on issues where the scientific evidence is clear requires some explanation, and two obvious explanations are available. First, the majority of those who have been fooled are on the political right, and are being told what they want to believe. This is usually an easy sell, enhanced by the more general insulation from reality that prevails on the US right in particular. Second, the tobacco industry is selling a product that has been known for decades to kill a large proportion of its consumers. This takes real expertise, and this expertise is transferrable to other fields. If you can persuade someone to ignore scientists warnings of a long and painful death from smoking, persuading them to ignore climate scientists worries about future generations is child's play.

More like this

Reminds me of a Jack in the Box (fast food) commercial, which opens with a sciency-looking guy pontificating on how Jack's fatty burgers and fries are super healthy, then cuts to reveal that Jack and one of his underlings are watching the guy on TV. Jack says incredulously, "Where did you find this guy?" and the underling says matter of factly, "Tobacco company."

For all their blather, did anyone ever actually fall for the baloney put out by the tobacco companies? Everyone I've ever known has known from the age of 4 that smoking will probably kill you dead one day. Lying about tobacco use is about as pointless as lying about the color of the sky. Why does anyone give a crap?

For all their blather, did anyone ever actually fall for the baloney put out by the tobacco companies? Everyone I've ever known has known from the age of 4 that smoking will probably kill you dead one day. Lying about tobacco use is about as pointless as lying about the color of the sky. Why does anyone give a crap?

ben, you did not understand the article or their tactic.

they do NOT wnat to convince someone. they just want to cast MINOR DOUBT on the scientific consensus. that stops and slows the process and is ammunition for those who disagree with the consensus for other reasons. (mainly profit)

The doubt in that case is quite insignificantly minor. Have you known anyone who doubted that tobacco use causes all sorts of death? The only thing they accomplished was to make themselves look like fools.

Tobacco is safe, One in every three smokers will become only slightly dead! - or is that death-lite?


Rather reminds me of Monty Python Crunchy frog - lightly killed.

Praline: Superintendent Parrot and I are from the hygiene squad. We want to have a word with you about your box of chocolates entified The Whizzo Quality Assortment.

Milton: Ah, yes.

Praline: (producing box of chocolates) If I may begin at the beginning. First there is the cherry fondue. This is extremely nasty, but we can't prosecute you for that.

Milton: Agreed.

Praline: Next we have number four, 'crunchy frog'.

Milton: Ah, yes.

Praline: Am I right in thinking there's a real frog in here?

Milton: Yes. A little one.

Praline: What sort of frog?

Milton: A dead frog.

Praline: Is it cooked?

Milton: No.

Praline: What, a raw frog?

(Superintendent Parrot looks increasingly queasy.)

Milton: We use only the finest baby frogs, dew picked and flown from Iraq, cleansed in finest quality spring water, lightly killed, and then sealed in a succulent Swiss quintuple smooth treble cream milk chocolate envelope and lovingly frosted with glucose.

Praline: That's as maybe, it's still a frog.

By ScaredAmoeba (not verified) on 29 May 2008 #permalink

'be' or 'ben' is posting one of the standard talking points. Look it up in the tobacco papers.
The tactic was indeed sufficient doubt, by keeping their own research secret, having a lawyer's eyes pass over every sensitive document, and moving files overseas, to hold off regulation.

By Hank Roberts (not verified) on 29 May 2008 #permalink

Ben, minor doubt is all they need. "Yeah, but some scientists disagree" is a very powerful statement when you're catering to people who are, themselves, inclined to disagree, no matter what they're disagreeing on.

Look up any of the editorials in conservative newspapers on second-hand smoke and you'll see the power a "minor" amount of doubt can have, if it's applied in a sensitive spot.

Picture Joe Smoker who doesn't like th' guv'mint tellin' him anythin'. A government agency says that cigarettes cause cancer and that the government should regulate their sale or tax them for health costs or similar. Joe is going to disagree with this. Now comes along Mr. PR, who is saying that there's a lot of guys in white coats who don't think cigarettes cause cancer, or that these white-coated guys are hotly debating the government over this, or that the agency is corrupt and making a tax grab, or that there's a government conspiracy to control tobacco. This is exactly what Joe wants to hear -- a credible-sounding source lending credence to his pre-existing biases, giving him ammunition to use against all those damn nanny-government liberals -- and for very well-understood reasons will trust this source, no matter how much it reeks of tobacco.

The scary part about this is that it doesn't only work on Joe Smoker. It also works on anyone with related biases... and you'll notice that several of them overlap with free-market fundamentalism, which has had (at least since the Cold War, possibly earlier) a strong political presence.

By spending a few thousand dollars on advocacy in the right places, they can forestall government action on issues like this by spreading 'quite insignificantly minor' doubt in the right spots. Talk about a bargain.

Praline: What's this one, 'spring surprise'?

Milton: Ah - now, that's our speciality - covered with darkest creamy chocolate. When you pop it in your mouth steel bolts spring out and plunge straight through-both cheeks.

"The Surgeon general has determined..." was in 1964. 44 years later (roughly 2 generations) it is still legal to sell cigarettes, cigarette usage continues to grow (developing countries are ripe markets), and we see Philip Morris Intl has a $1009B market cap, and is doing just fine.

The PR guys who managed accomplished this are *awesome heroes* in the annals of PR-dom. $23.5B (for just one company) for a product known to be life-threatening for ~two generations.

By John Mashey (not verified) on 29 May 2008 #permalink

Good point from Mooney at the end:

"The manufacturing-uncertainty strategy works because it buries you in the facts, loses you in the woods of science. [But] Sometimes, arguing back within that arena only makes it worse.
... I worry that the defenders of science sometimes delude themselves into thinking rational criticism is enough. It isn't, however, because scientifically grounded argument will only persuade those inclined to defend science in the first place.

Solutions to this?

It amazes me that I find examples of popular culture's awareness of tobacco's danger that go pretty far back. I saw a comedy film from 1933, where one set was called the Coffin Nail Cafe, with a glowing cigar butt as part of the neon sign. I had also seen speculation of tobacco's danger in publications of the 1800s, when tobacco first became widely popular. The problem with this of course is that nobody thought of second-hand smoke as having significant dangers of its own for quite some time, and even then there were tobacco company employed rent-a-scientists who would dismiss the risk even when there was significant evidence that it was dangerous. Sowing doubt is a profitable enterprise.

Anna Haynes:

There's science (as in stuff done by people donning white garb in labs filled with weird gizmos), and then there's science (good old traditional values such as evidence, proof, and falsifiability). I think Mooney's talking about the former, but there's no reason why one can't focus on the latter.

I think there's two things going on with the tobacco companies' lying. All the lying and manipulation of science was done mostly to affect public policy, to prevent tobacco from being banned. But as a former smoker, I tend to agree with Ben... I never assumed, nor did I ever, ever meet another smoker who didn't know that we were killing ourselves. We just didn't care. It can be hard for non-smokers to understand, but it's as simple as that: we knew, and didn't care.

By former smoker (not verified) on 29 May 2008 #permalink

A new book seems to answer the question as to why the tobacco industry and their PR flacks have been so successful over the years. 'Mistakes were made, but not by me' by Tavris and Aronson point up the role of cognitive dissonance in how we look at the world.

If you are a smoker, you know its bad for you, but if the tobacco companies wheel out some guy in a white coat saying 'perhaps ciggies don't cause cancer after all', thats exactly the sort of reassurance you need to carry on buying the things. Its not that you dont care about the harm they cause to you, its that you can explain that harm away as 'possible', or 'who knows', etc.

Once this sort of campaign works in one area, then you can fire it up to nix all sorts of other legislation. Dont want curbs on carbon emissions? Then play the same game. A lot of us dont even understand exactly what climate change is anyway, so anything you say about 'uncertainty' will play well, and with the media's desire for 'balance' (no matter how unbalanced this actually is), anyone who sounds or even calls themselves an expert will get invited to argue their case against actual, real scientists.

And of course, no one actually wants to hurt the planet, so its far easier to listen to some PR hack telling you its not your fault, while carrying on with your daily life - you cant see climate change, so why should you make life difficult for yourself on something that might not be happening anyway?

And the band played on as the deckchairs started to slide overboard...

A government agency says that cigarettes cause cancer and that the government should regulate their sale or tax them for health costs or similar. Joe is going to disagree with this. Now comes along Mr. PR, who is saying that there's a lot of guys in white coats who don't think cigarettes cause cancer, or that...

The bold part is where the rubber meets the road. If we didn't have socialized medicine of a sort, in which the government incurred costs associated with smoking, then it would be tough bananas for the smokers, and they might just have more incentive to quit. They have quite a lot now... life and health insurance premiums that are higher, among other things.

I'm in agreement with Former Smoker. That is exactly how I've known smokers to be on the subject.


THANK YOU for being honest. I applaud your clarity and honesty here -- it's not about medicine, or about climate, or even about the future. To you, it's about the government leaving you alone, and you'll fight tooth and nail to keep it that way. Most denialists are too cowardly to admit that their argument is about the role of government and mask it behind a science-sounding argument. (And yes, I'm calling you a denialist, just not the traditional type -- you deny that the tobacco lobby's doubt-spreading had any effect.)

You see, I chose that example of regulation deliberately. The difference is that the damage isn't just done to the smoker, but to those around him. If it only harmed the smoker, you might have a point. (This is partly why second-hand smoke was such a violent debate in the tobacco denial lobby.)

The minimalist role of government espoused by free-market libertarians (the people who spout the same position you just did) is to protect your rights from my liberties, and vice versa. One of those rights is the right to life. Smoking has a tendency to threaten the lives of those around the smoker -- that's the whole second-hand smoke ("passive smoking") thing. Even if medical systems aren't socialized, the tax is still implemented -- you pay a cost, a fine if you will, for violating the rights of others.

The final result is that, even for the free-market libertarian, the government has an obligation to step in. The libertarian just doesn't like this, and will act to forestall it, likely by spreading doubt in the voters... which brings us full-circle to the denialist PR machine described here.

You may notice the parallel to climate change quite readily, by the way. Not only is the setup the same (the biggest difference is in scale -- passive smoking in America today doesn't harm people in Bangladesh in 10 years, for instance), but the tactics used by those who don't like it are identical, and in fact several of the same players are shared by both tobacco and climate inactivism. Steve Milloy is perhaps the best example.

Just to be clear: I'm not a libertarian, and I'm not saying tobacco companies are blameless. What I am saying is that the effect of propaganda on smoker's minds is nil when compared to the effect of the product itself.

One other thing: I'm all for tobacco taxes, and was, even when I smoked. Fair is fair, and smokers do cost society more in sundry ways; I didn't mind paying my share. I treated it like any other social responsibility, like paying for garbage pickup, taxes, etc. I don't think they should be banned, though it's likely to happen in the next 20 years or so. Cigarettes are becoming more and more lower-class, and that's a big part of why they're being targeted. Alcohol has kept its grip on the affluent and that's why it's not going away any time soon.

By former smoker (not verified) on 30 May 2008 #permalink

Ben et al, those who think people have "always known" smoking is dangerous... Today in the Guardian there is an article about the deliberations of the British cabinet on public health warnings on smoking, in 1956. It was 2 years after the first smoking study proved that it was dangerous, and a year before the British Medical Research Council decided their first smoking policy. Macmillan and the other cabinet members decided that the risk of smoking was minor and the benefits of public health warnings did not outweigh the revenue benefits of smoking. At that time the risks weren't well established by public research, so Macmillan said

"Expectation of life 73 for smoker and 74 for non-smoker. Treasury think revenue interest outweighs this. Negligible compared with risk of crossing a street

Obviously, this is a decision based on competing risks. The job of tobacco company apologists is not to make people doubt that smoking is dangerous, but to muddy this analysis of competing risks for as long as possible. These kinds of decisions are subject to democratic approval, so people like Macmillan have to consider what the public want. And if the public think like Macmillan did, enlightened public health policy is going to be pissing in the wind.

The tobacco companies never had to convince ordinary consumers that smoking wasn't harmful. They just needed to keep us thinking, as Macmillan did, that you are "more likely to be run over by a bus", as the saying goes, and that the benefits of public health warnings don't outweigh the costs.

Not that I expect libertarians to understand this level of sophistication in public policy...

"The bold part is where the rubber meets the road. If we didn't have socialized medicine of a sort, in which the government incurred costs associated with smoking, then it would be tough bananas for the smokers, and they might just have more incentive to quit."

- Ben

Take a look at the figures for smoking in the developing world - its growing rapidly and somehow I doubt it has much to do with "socialised medicine" in countries like India or Thailand.

By Ian Gould (not verified) on 30 May 2008 #permalink

For some reason, all the science blogs are all messed up on Firefox. But not so on IE. Anyone else see what I'm seeing?

I'm on Firefox and not experiencing any problems.

By Ian Gould (not verified) on 30 May 2008 #permalink

I have a nephew who smokes, and who knows that cigarettes cause cancer, and who is passionate about life. Why doesn't he quit?

Because he's positive that, by the time HE gets lung cancer, there will be a cure.

Sure, it's an idiotic rationalization, but he's young, and I can't seriously claim it's much more idiotic than many of my views at the same age.

Weirdly enough, I actually agree with "former smoker" mostly.
Nicotine is powerfully addictive, especially if people start with it while their brains are developing.
a) That shows up in statistics of cessation versus when they started, i.e., people who started in their early teens have a tough time stopping.
b) It shows up in rats ... the relevant lab experiments on humans of course being not possible.

See 2005 New Scientist article on teenagers and rats. it says that in US, 88% of smokers had started before they were 18.

My mother was certainly not libertarian, and desperately wanted to stop smoking, but she started too early, and never could (for very long), and died of lung cancer. My father never smoked ... and died of lung cancer, later. I've had several close friends who were smart, well-educated [graduate degrees], strong-willed people, and could never quite stop, for the same reason. If they get you early enough, it takes incredible* will power to stop.

As for secondhand smoke, I've had friends who were asthmatic, and their lives are a lot better now. Even back at Bell Labs in the 1970s, a relatively non-smoking place, there was enough smoking that I've seen people start to enter a conference room, get hit by a little leftover smoke, and have to excuse themselves from the meeting (or we would have been taking them to the hospital.)

Personally, I think if someone chooses to start smoking at age 22 [most people's brains are developed by then], and if they keep away from others enough, that's their choice, although I certainly wish tobacco would go away from the deforestration/energy reasons.

But, as I pointed out in Discussion over at John Quiggin, post #2:

From an 1980s RJR document:
There is much discussion of the importance of the 18-24-year-old market segment. Of course, the game is given away early:

- 31% of smokers start after 18
- less than 5% start after 24

Let's see: does anyone think RJR was under the illusion that the 69% of smokers that didn't start after 18 started *at* 18â³? Recall that RJR is the purveyor of candy-flavored tobacco cigarettes like Twista Lime.

These numbers are a little different than the 88% pre-18 numbers above. Why? In the 1980s, there were more smokers who'd started after 18. As smoking restrictions caught on, and there were more anti-smoking campaigns, anyone who could stop easily did, leaving a much higher percentage of smokers as having started before 18.

Libertarians like minimal government, a legitimate political viewpoint. Cigarette companies play to that wish ... but the goal is to keep enough cigarettes around to make sure teens get addicted.

I suggest spending a few hours with the Tobacco Archives doing searches like "libertarian smokers rights". Unlike libertarian thinktanks, many libertarian groups actually support the (very profitable) cigarette companies *for free*. Need I say more about the evidence of intelligence thus displayed and accurately assessed by the tobacco industry?

RJR, PM, etc *really* care for people's rights vs big government. Oh, they really do, and they're right there in spirit with libertarians. Trust them, they really care.

ONE MORE TIME: tobacco companies' business *totally* depends on getting kids addicted in the teens and the companies have known this for a long time. After they're addicted, *nothing* else is very relevant.

By John Mashey (not verified) on 30 May 2008 #permalink

It's worth bearing in mind that the actual epidemiological evidence against smoking came quite late. The 1954 paper I mentioned above was revolutionary and it showed (according to macmillan) a 1-year difference in life expectancy. The strong results didn't come out till later. So even in the 80s teenagers were being exposed to cigarette advertising in the rather fragile circumstances of having parents and grandparents who grew up smoking with no serious evidence of its harm. Until the 50s, the idea that smoking was dangerous was about, but it had no strong scientific basis (though it was believed to be biologically plausible) and was often based in the prohibitionist public health activism of that time, rather than sound policy debate. So teenagers in the '80s were very vulnerable to the kind of "manufactured doubt" that the tobacco companies were after, especially when it was packaged with all the fashion and sex-appeal symbolism of smoking at that time.

It's worth noting as well that for all the libertarian conspiracy theories to the contrary, governments have been very careful about stamping on peoples' individual liberties in this area. They didn't even outlaw advertising at sports events until the late 80s, and even when the epidemiological evidence was all in they were simply discussing increasing taxes and warnings. This is a product people have known is deadly for 50 years, and have known conclusively is extremely deadly for 20 years at least, and yet it is still legal. Compared with pharmaceutical drugs, heroin or even alcohol it has been treated with kid gloves. All this anti-big-government posturing is, in this regard, exactly that: posturing. If the government really wanted to nanny-state people ferociously, or if it cared about the socialised costs of smoking that it has to bear in the way Ben thinks, it would have stomped on this habit 20 years ago. It's hardly evidence for the conspiratorial nanny state the libertarians are so fond of laying into.


> If we didn't have socialized medicine of a sort [...] they might just have more incentive to quit.

"Look, there's Socialized Medicine here? Great! I'll eat fries everyday and watch TV like a couch potato and smoke a lot! And you imperialistic Americanos full of _personal responsibility_ will have to learn about the Okinawan Diet Plan, and do lots of exercise everyday, and _stop smoking!_ Victory Will Be Ours! Bwahahahahahaha!"

Yeah Ben, can you explain to me why, since you live in a society you claim has socialised medicine, you are not smoking but they are? Are you better than everyone else? This same logic works with the "clean needles cause people to use drugs", "condoms cause people to have sex" and "welfare makes people dependent" arguments. They are all based on the idea that the person making them is better than everyone else. Otherwise the person making them would be doing the thing they say the system encourages.

So how is it that socialised medicine encourages everyone else to smoke and not you? Or me?

And aren't smoking rates in Canada (where private healthcare is illegal, don't you know!) lower than in the US? Or at least similar...

Brian D, you are right about second hand smoke and the regulation required to keep it out of non-smokers faces in public. On the other hand, the free market is figuring that out too. Us non-smokers simply avoid establishments that allow smoking. When we're in the majority we win.

SG, you are right about all those things except welfare. Nobody needs a condom to have sex, people don't need clean needles to do drugs, and folks don't need socialized medicine to smoke. Those things just help a little. People do need a handout from someone if they are to live without working... it's either that or die, or turn to crime, which is sortof like having a job.

Are you better than everyone else?

Define "better than everyone else" please. I made a better decision to not smoke, if that's what you mean. I've made my share of dumb decisions though, and nobody bears responsibility for those but me.

Ben: you are right about second hand smoke and the regulation required to keep it out of non-smokers faces in public. On the other hand, the free market is figuring that out too. Us non-smokers simply avoid establishments that allow smoking. When we're in the majority we win.

Let's assume you leave it completely to market forces. Let's also assume, for simplicity's sake, that the only establishments that allow smoking are bars (a gross oversimplification, but for a simulated case study, it'll work).

How many waitresses, cooks, bartenders, bouncers, and similar, just trying to earn a living, will be exposed against their will to carcinogens before the business goes belly-up? And how long will that take until you're "in the majority" given the aggressive marketing behind tobacco hooking new smokers? (See also John Mashey's reply, #24).

Note that under purely market forces, there are still only so many jobs available in non-smoking venues, and given the choice between working in a smoking bar, living without working, turning to crime ("which is sort of like having a job" except insofar as the victims are concerned!), or dying, which would you naturally take? (Remember, purely free-market here, so no welfare.)

This says nothing about market forces pushing for *more* tobacco, or for pollution of free spaces -- I wouldn't want my kids to avoid every park, simply because there are no non-smoking parks, for instance.

Under all of these scenarios, government action, not the free market, does the greatest good for the greatest number with the minimum loss of quality of life.

In all honesty, if your argument were financial in nature, it would be akin to "We're very poor. We should print more money to be wealthier." It's not only extremely naiive, but shows a profound lack of understanding in *every* nuance of the discussion.

But, if you'll pardon the elitist statement, that's pretty much par for libertarianism.

> Nobody needs a condom to have sex, people don't need clean needles to do drugs, and folks don't need socialized medicine to smoke. Those things just help a little.

A little? Like... how much?

I can imagine that, every time ben travels to a new country, he'll check out whether that country has Socialized Medicine™ before he decides whether to go eat at that McDonalds instead of so-and-so bistro.

For me, the question of Socialized Medicine doesn't even begin to figure in this decision. (Well, it'll still be a factor for me in deciding whether to migrate to the country _in the first place_, but after that, I'll choose what to eat based on, um, other factors.)

ben's ideology assumes that everyone else is just as ideologically obsessed as he is.


> Define "better than everyone else" please. I made a better decision to not smoke, if that's what you mean.

To put it simply, what exactly made you decide not to smoke, and what makes you think other people can't figure out the same things you did to decide not to smoke?

That's right Ben. Why is it that person A decided to smoke because the socialized medical system would socialise their costs, but person B (B for Ben) decided not to? How come it's a factor in the decisions of everyone else but you?

The other example I gave is a common one. You find conservative commentators (and religious folk) regularly decrying the dispensation of free clean needle/syringes. "It will encourage people to use drugs!" they cry. But the conservative commentator doesn't use drugs even though they (seem to) know that doing so is safe due to free needles. Why don't they? How come the seductive lure of these things always effects everyone except the commentator.

You should always be careful of arguments based on the silly idea that your own decision-making processes are better than everyone else's, particulary if your entire political ideology rests on the assumption that everyone is a rational consumer.

Historical Perspective
There is a silent Agfa colour cine film of Adolph Hitler circa 1936 in one of his mountain hideouts. It has been lip-read and had English subtitles added. In it Hitler tells-off a young woman who is smoking. He says to her: "You know that the doctors think smoking causes cancer".

While this isn't science, but it is suggestive that while the smoking-cancer link had not been established, that the medical profession in Germany had their suspicions. It is of course feasible that with the techniques available at the time, that proof of a causative link could not be established conclusively.

By ScaredAmoeba (not verified) on 31 May 2008 #permalink

former smoker wrote, What I am saying is that the effect of propaganda on smoker's minds is nil when compared to the effect of the product itself.

Depends on which propaganda you're talking about.

There's plenty of pro-smoking propaganda---you see it in movies all the time. There was a study once that propaganda directed at young people, to make smoking seem uncool, etc, was pretty effective, hence the tobacco industry was vehemently against it.

It's true that once you're hooked, anti-smoking propaganda might have little effect. But before you've started is another matter entirely.

re: socialized medicine, propaganda

Smoking in Canada (2003) is a useful overview.

As usual, averages can be misleading, as regional differences matter: B.C. was low at 16%, Quebec high at 25% at that point.

US: slightly newer is: State-specific prevalence of cigarette smoking, in which US states range from:

11.5% UT

15.2% CA


26.8% TN

28.7% KY

UT is low due to Mormon influence.
CA is CA, but also for years ran a brutally-effective ad campaign aimed at discouraging teenagers from starting.

In one commercial, a group of young men in tuxes light their cigarettes as a beautiful woman walks in. Voiceover mentions cigarettes-imp*tence connection, and the cigarettes all go limp. Woman walks away. Voiceover: "Cigarettes? Still think they're s*xy?"

The fiercest was probably the one with a woman who'd been smoking since she was a teen, had had throat cancer, but was still smoking through a hole in her throat, because she couldn't stop.

On the other hand, cleverly-done commercials to urge parents to tell their kids not to smoke have the desired effect, i.e., as in Philip Morris' "Talk: They'll Listen" campaign... Like I said in #9, *awesome PR heroes*; I'm sure they were proud of that one.

By John Mashey (not verified) on 31 May 2008 #permalink

Perhaps it wasn't clear about the cine film of Adolph Hitler circa 1936 post #33. I have seen this film on British TV [many years ago]. While I don't speak German, Hitler's finger-wagging and facial expressions were to me, entirely consistent with the subtitles. It looked like a friendy warning, it wasn't the ranting of a megalomaniac.

PS: No, I am not a fan of AH or his politics!
PPS: I am not suggesting that AH wasn't a megalomaniac.

By ScaredAmoeba (not verified) on 31 May 2008 #permalink

ScaredAmoeba, Hitler is a good example of the kind of people who believed smoking was bad before the 50s. He was a health nut, an ascetic, and a lunatic. Until the epidemiological evidence was in and the health professionals jumped on the bandwagon, the anti-smoking movement was primarily made-up of this kind of wowserist fringe. This made it easier for the tobacco companies to cast doubt on the post-50s smoking movement.

SG, I'd need to check the details but my understanding is that by the mid-30's most of the German medical establishment had concluded smoking was linked ot cancer and this conclusion wasn't based solely on the moralistic concerns you mention.

Germany actually had a fairly large and successful anti-smoking campaign by the late 30's which was dropped during the war (when rationing made it largely redundant in any case).

Post-war the general and understandable revulsion at anything that smacked of "Mazi science" especially in the field of human health led to a delay in the German pre-war work being accepted.

Again, that's what I remember from the few articles I've read.

By Ian Gould (not verified) on 01 Jun 2008 #permalink

I'd also read about the anti-smoking campaigns undertaken in Nazi Germany, and a quick check on Google brings up a very interesting article in the BMJ from 1996 by Robert Proctor, who wrote a book some years ago on the same topic, called 'The Nazi War on Cancer'.

I think that the title of the book is perhaps closer to what we should be thinking about, rather than the 'Anti-smoking = Nazi' mindset which seems to be pretty popular, judging by the sort of hits I got from my Google search!

The protection of the 'volk' was the twisted rationale behind the anti-tobacco campaigns, and the attempt to reduce tobacco comsumption was only part of the 'War on Cancer', which included preventative chest screenings, colon checks, restrictions on envionmental factors, etc.

These measures were evidence based, with 'German tobacco epidemiology by this time was the most advanced in the world. Franz H Muller in 1939 and Eberhard Schairer and Erich Schoniger in 1943 were the first to use case-control epidemiological methods to document the lung cancer hazard from cigarettes. Muller concluded that the "extraordinary rise in tobacco use" was "the single most important cause of the rising incidence of lung cancer" (Proctor 1996).

Unfortunately, the moral of the story is that science can be used and abused by any individual, any industry or any regime. In the case of the Nazis, pretty much all of science got abused, and even the good stuff was terribly, tragically, tainted.

SG: You may be right that the only people who thought smoking was bad for you were the "wowsers", health fanatics etc. But doesn't this vindicate them somewhat? Maybe they weren't so crazy as you think.

"How come the seductive lure of these things always effects everyone except the commentator." I think that is a bad argument. It's known that demand follows supply, and if condoms are viewed as a prerequisite for sex, and clean needles as a prerequisite for drugs, then they DO increase effective supply in this context. But there are two issues here:

1. They aren't really a prerequisite, so the increase in effective supply is very small (but present, I think)

2. You have to measure this against the other benefits (less spread of disease, fewer unwanted pregnancies etc.)

What I worry about, not so much about free condoms but "shooting galleries" and similar, is that the acceptance implied in such schemes has negative long-term effects. The biggest restriction on effective supply may still be lack of acceptance.

I am not the marginal smoker. If tobacco taxes were removed, I would still not be inclined to start. But the marginal smoker, the one who does not smoke today but would if tobacco was cheaper, exists. Exactly who he is doesn't matter from a societal perspective.

Harald K:

> It's known that demand follows supply, and if condoms are viewed as a prerequisite for sex, and clean needles as a prerequisite for drugs, then they DO increase effective supply in this context.

Using this "demand"/"supply" frame, ben's argument is that the existence (supply) of universal healthcare causes people to want to make use of universal healthcare (demand), and this means that people will choose to live more unhealthily, and smoke more tobacco.

OK, while I may agree that universal healthcare causes people to demand for healthcare services in certain ways -- e.g. more people may decide to call in sick for no reason -- it's not exactly the kind of thing that anyone factors in when deciding whether to smoke.

Anyway, my (and SG's) question to ben still stands:

What exactly made you decide not to smoke, and what makes you think other people can't figure out the same things you did to decide not to smoke?

Re 41, yea access to universal healthcare makes people go out and get sick like access to jails makes them go out and commit crimes.

By Ian Gould (not verified) on 03 Jun 2008 #permalink

Harald, my argument is not with whether the condoms=sex argument is true, but with its foundation in the minds of the arguer. It's always someone else who is the marginal consumer of the good. Why aren't you? Why assume that everyone else can be influenced by that cost but not you? I don't think in his free healthcare=smoking argument that Ben was really subscribing to a model of all individuals as rational consumers, because Ben is supposedly himself a rational consumer and the chain of logic doesn't work for him - he didn't start smoking when he lived in Canada even though he knew the state would protect him. So why should he assume, if the argument didn't work on him, that it would work on others?

The reason of course is that Ben is a (drum roll...) libertarian! So he is smarter and more independent than us. Which is why he doesn't smoke, and holds only extremely intelligent and rational and independent views.

Ian Gould, I was at the 17th Bradford Hill Memorial lecture tonight, kind of coincidental with this discussion, and it struck me again how recent this epidemiology is. Even the Nazis doing it in 1943 is very close to the start of the Dole and Hill study (1950?1948?) and until Bradford Hill came up with his 9 criteria for causation, people didn't really even have a framework for putting the epidemiology and the biological science together. So though the Nazis may have had some ideas, I don't think it can be said that they were well accepted even in the medical community at that time, and until they had both the framework for linking causation and epidemiological results, the biological results and the cohort studies, they just didn't have a story to take the anti-smoking position beyond the health spa fringe. And as I understand it, it was the discussion of these epidemiological results which inspired Hill to develop the 9 criteria.

In that context, it's pretty easy to see why the early results were easily dismissed by the tobacco companies - they even had a curmudgeon, RA Fisher, who they could quote as evidence of a "lack of concensus"...

This is a must-read: Matt Nisbet has an interesting post up on a study of the "skeptic" think tanks. The conclusion:

"Our analyses of the sceptical literature and CTTs indicate an unambiguous linkage between the two. Over 92 per cent of environmentally sceptical books are linked to conservative think tanks, and 90 per cent of conservative think tanks interested in environmental issues espouse scepticism. Environmental scepticism began in the US, is strongest in the US, and exploded after the end of the Cold War and the emergence of global environmental concern stimulated by the 1992 Earth Summit. Environmental scepticism is an elite-driven reaction to global environmentalism, organised by core actors within the conservative movement. Promoting scepticism is a key tactic of the anti-environmental counter-movement coordinated by CTTs, designed specifically to undermine the environmental movement's efforts to legitimise its claims via science. Thus, the notion that environmental sceptics are unbiased analysts exposing the myths and scare tactics employed by those they label as practitioners of 'junk science' lacks credibility. Similarly, the self-portrayal of sceptics as marginalised 'Davids' battling the powerful 'Goliath' of environmentalists and environmental scientists is a charade, as sceptics are supported by politically powerful CTTs funded by wealthy foundations and corporations."

By Steve Bloom (not verified) on 04 Jun 2008 #permalink

RE: 41 Why people smoke -

I would be amazed if there was any evidence to suggest that people smoke because 'the state will take care of them'. In fact the idea that people do risky or unhealthy things because the state would look after them is manifestly false when you look at the real world.

If the cost of healthcare to the individual (such as in the US) played a part in decision-making over lifestyle (smoking, unprotected sex, drinking, drug-taking, etc), then the US should be the healthiest country on Earth. Anyone who risks their health through smoking will certainly pay more for it in the form of higher insurance premiums. Yet Americans continue to smoke in large numbers (some 21% in 2006), as do the British (c.23% in 2005). The US has a large and growing problem with obesity (with the UK and other western countries following behind), which again should be something which a rational person would avoid in order to save insurance costs.

The reality is that smokers smoke for all sorts of reasons (mine were particularly spurious, I seem to remember), but none of them include the notion that if you get sick, then you'll get a new lung free, or something. If you smoke, your mindset simply don't accept that there is a problem, or that you'll be someone who gets ill - you know some who knows someone who smoked a 150 a day and got hit by a bus when they were 115; which proves that smoking is fine. Smokers live in denial.