This week, we’re talking about the changing landscape of the tobacco industry and its impact on health.
When you look at smoking in a historical context, the aggressive anti-smoke campaigns of the early aughts are a massive departure from the way smoking tobacco was first perceived in this country.
Smoking used to be such a ubiquitous part of life as an American that tobacco and rolling papers were deemed an item necessary for soldier rations in World War I.
During the second world war, tobacco production was seen as so integral to the U.S. economy that the government began buying the supplies of cigarettes that the English had stopped purchasing in their effort to fund the war.
Once the war ended, a marketing board known as the Tobacco Associates was formed with the goal of promoting cigarettes in foreign markets, in order to sell off the excess stock.
Marketing and public relations were the reason that the tobacco industry maintained its stronghold on the American public for so long.
In the 1930s, people had already begun to notice a dramatic increase in the rates of cancer, particularly lung cancers, and had started to suspect cigarettes as a cause.
By the 1950s, a link between smoking and lung cancer had been pretty solidly established by a number of well-designed and repeatable studies.
The research at the time was enough to convince the American Medical Association (AMA) to stop including ads for cigarettes in their publications by 1954.
The AMA had its own standard that required pharmaceutical companies to prove the claims they wanted to make before their ads would be published, but they did not hold cigarette manufacturers to the same standard.
Why would there be cigarette ads in a major medical publication to begin with? The answer comes back to the magic of marketing.
Before there was evidence that smoking was actually extremely damaging to your health, everyone was doing it! Even doctors. And if doctors are doing it then it can’t be bad for you, right?
That’s the conclusion ad agencies were at least hoping you’d draw.
Ads used to make health claims about cigarettes, saying they’d improve digestion, or that menthol cigarettes should be prescribed to patients to soothe a sore throat.
Camel cigarettes once famously claimed that it was the brand smoked by more doctors, which might have been because Camel would send free cigarettes to doctors and then later call them and ask what kind of cigarettes they were smoking.
Once the studies linking smoking to disease began to appear in the mid-1950s, the tobacco industry quickly realized that they would need to take a new approach to keep their consumer base.
By 1955, over half of all men in the U.S. (and nearly a quarter of women) were smokers.
Realizing that making false claims about the benefits of cigarettes would likely draw questions, the various heads of Big Tobacco met up to conspire to obscure the truth.
The traditionally competitive tobacco CEOs came together in December of 1953 and agreed to hire a prominent New York public relations firm, Hill and Knowlton, to come up with a solution to the dire threat of…the truth.
And so, the Tobacco Research Industry Committee was formed.
By forming the Tobacco Research Industry Committee to “investigate” the “health concerns,” cigarette makers were signaling that they really cared about the health of their consumers.
In reality, by saying that they were committed to discovering the truth, they were attempting to cast doubt that the truth had already been discovered.
The committee set up their headquarters in the offices of the PR firm they’d hired and got to work.
Their tactics involved denying the link between cigarettes and cancer, discrediting the research that was being done by others, and appearing to care by investing in technologies they presented as “less harmful.”
They also kept up the appearance of concern by funding research into cancer, which distracted people from the fact they should have been investigating the potential link between cigarettes and cancer, not just cancer in general.
They even created a Scientific Advisory Board of seemingly independent doctors to review applications and research.
However all these doctors were prescreened to make sure they were already skeptical of the link between smoking and cancer and were, preferably, smokers themselves.
Things got a bit harder to deny when, in 1964, the U.S. Surgeon General released the report “Smoking and Health.”
This report found that smoking caused premature death from lung cancer, emphysema, bronchitis, and coronary heart disease.
In 1965, following the publication of the report, companies were required to add the first iteration of the Surgeon General’s warning to all packs of cigarettes—"Caution: Cigarette smoking may be hazardous to your health.”
More interventions followed, like banning cigarette ads from TV and radio in 1971.
The industry continued to pivot in the face of these limitations.
Print ads in the 70s and 80s began to try to convince users of “improved,” “less harmful” tobacco products by using terms like “smooth” or “lite.”
Eventually, the health and safety of cigarettes was simply implied by using models engaging in healthy activities in ads.
But the tides were turning.
The increasing understanding of the risks of secondhand smoke began influencing “smoke-free spaces” laws by the late 80s. From the 90s through the early 2000s, more and more states began to mandate smoke-free bars, restaurants, and other spaces.
By 1988, it had become clear that smoking cigarettes wasn’t just a lifestyle choice, it was actually an addiction, a fact that tobacco companies knew for years. They also knew it was nicotine in particular that caused dependency.
Nicotine is so addictive that some studies show it may be harder to quit smoking than to stop using cocaine or opiates like heroin.
The biggest blow to Big Tobacco came in the 90s. In 1994, litigation between tobacco companies and the Department of Justice found that the companies were guilty of violating racketeering laws, lying to the public about the dangers of tobacco, and marketing to children.
The long battle against the deception of the tobacco industry eventually began to pay off.
The Tobacco Research Industry Committee was formally disbanded in 1998, and much of the scientific community does not appreciate their decades of deceit.
The American Journal of Public Health continues to refuse to publish any research funded by the tobacco industry. They just lied too much and for too long to regain trust.
Currently, cigarette smoking in the U.S. is at an all-time low, with 11% of the population reporting smoking, and 6% of people under 30 saying they smoke cigarettes.
A new form of smoking seems to be creeping up to take the place of cigarettes: e-cigarettes and vapes.
If you want to get technical, the device is an e-cigarette and the act of inhaling the vapor from it is vaping, but most people just refer to the products as vapes now.
First developed in 2006, e-cigarettes are often presented as a “less harmful” alternative to cigarettes. But what does that really mean?
First, vapes don’t contain tobacco, which is an ingredient in cigarettes that contributes to a lot of disease.
Inhaling tobacco smoke creates a buildup of tar in the lungs which can cause cancer and increase your risk of lung disease.
Tobacco smoke also contains carbon monoxide, a poisonous gas that is released as a byproduct of burning tobacco. Carbon monoxide stops the blood from getting enough oxygen, which can increase the risk of stroke and heart disease.
And this is in addition to the, at least, 70 other chemicals in cigarettes that are known to cause cancer.
Does the fact that vapes don’t contain tobacco make them safer?
The true safety of vapes isn’t clear, simply because they haven’t been around that long. It took decades of widespread cigarette use before we began to see cancer trends emerge, and vapes haven’t even existed for 20 years.
One thing vapes have that we do know to be harmful, particularly to kids and young adults, is nicotine.
Nicotine is the substance that makes cigarettes so addictive, and many vape products use nicotine salts instead of freebase nicotine.
Freebase nicotine is a liquified form of nicotine that allows for higher potency without changing the dose, but as a result can cause throat irritation.
Nicotine salts have a lower pH, which makes them less irritating to the throat. As a result, many vape products are designed so that users can inhale higher doses of nicotine more comfortably.
Nicotine can cause such side effects as dizziness, shortness of breath, increased blood pressure, and increased risk of blood clots, among others.
In children, nicotine can impact brain development, impairing areas of the brain that control attention, mood, and impulse control.
Research has shown that kids who vape are more likely to go on to smoke regular cigarettes in the future.
That is pretty concerning when you consider that many tobacco companies are now investing in, or starting, vape products.
Many vape products seem to be targeting youth consumers for a highly addictive substance.
Take the former vape giant JUUL for example. Just this week they’ve begun distributing the nearly $440 million settlement they agreed to in order to resolve numerous lawsuits that stated they intentionally targeted their product to underaged youth.
Which brings us to another potential hazard of vapes: the flavors.
Much of the appeal of vapes is that they come in a variety of flavors, but there’s concern that some of the additives, while studied and found safe to ingest, don’t have data in regard to how safe they are to inhale.
Speaking of inhaling, there’s also concerns of other potentially harmful things being inhaled, such as metal components from the battery heating the device, formaldehyde that can form when the liquid is heated, and other volatile organic compounds that are bad for your health.
One of the biggest safety issues with vapes is just how many of them are out there.
The FDA was only granted regulatory authority over vapes in 2016.
Since then, they have approved 23 e-cigarettes, yet some estimates say there are over 9,000 unregulated products for sale in stores across the country.
