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If Obama quits ... smoking

February 26, 2007|Allan M. Brandt | ALLAN M. BRANDT is a professor of medical history at Harvard University. His new book, "The Cigarette Century," will be published next month.

PRESIDENTIAL hopeful Barack Obama is trying to quit smoking. There are, of course, many good reasons to. He will significantly reduce his own risk of serious disease and that of those around him by not smoking. But clearly, one of the reasons Obama wants to quit now -- beyond pressure from his wife -- is that it would be widely perceived as unseemly and inappropriate to have a smoker in the White House.

Smoking has become a marginalized and often stigmatized behavior, a sign of personal weakness -- which just won't do in a presidential candidate these days. A once-social behavior has become largely solitary; the fragrant has turned foul. Indeed, we've had a revolution in the meanings associated with cigarettes that has coincided with a remarkable decline in smoking.

At the time of the first U.S. surgeon general's report issued in 1964, nearly half of all adult Americans were smokers. Today, the number stands at about one in five. Nonetheless, smoking continues to exact an enormous health toll. Nearly 450,000 deaths each year in the U.S. are attributed to cigarette use.

As Obama must know, quitting is no easy matter. Most individuals attempting it have tried and failed. Even those who get the best counseling and pharmacologic treatments are likely (at a rate of about 80%) to be smoking still, or again, at the end of a year.

And it may well be getting even more difficult to quit. A recent study shows that the average dose of nicotine in a pack of cigarettes has increased by more than 10% just since 1995, a result of explicitly engineered modifications.

Yet tobacco giant Philip Morris claims that it is eager to help smokers quit. It says so on its website and in much-touted "Quit Assist" ads and booklets that offer cessation strategies to smokers. This is the brilliant contemporary formulation of an old tobacco industry yarn: any smoker can quit if they are motivated and persevere.

So, even as tobacco companies admit that smoking is harmful -- a fact they denied for 40 years -- they continue to assert that consenting adults assume the risks (though they don't like to get specific about what those risks are, like lung cancer and stroke). As we now know from the millions of pages of internal tobacco documents available on the Web, the industry blows smoke out of both sides of its mouth. Philip Morris has been especially eager to complete its makeover into a "responsible corporate citizen." The company gave $25 million to the University of Virginia this month to support research on, yes, smoking cessation. Meanwhile, the five major U.S. tobacco companies, including Philip Morris, spent more than $15 billion last year promoting cigarettes here.

For every American like Obama who may successfully quit, there are "replacement smokers" in foreign lands. When Americans and others in Western developed nations began quitting in greater numbers in the 1970s and 1980s, the industry ramped up its efforts abroad, often with the assistance of the U.S. trade representative. Philip Morris International now sells more than four times as many cigarettes as its American sister company.

This dramatic rise in global consumption will prove disastrous in the future, especially in poorer countries. While 100 million people worldwide died of tobacco-induced diseases in the 20th century, the World Health Organization now predicts that nearly 1 billion such deaths will occur in this century.

Yet the ability to regulate tobacco is severely limited both here and abroad. Despite a Supreme Court ruling Tuesday tossing out a $79.5-million punitive damages judgment against Philip Morris, litigation remains a critical approach to holding the companies accountable. (In this case, the award may still be reinstated or reduced.)

One new strategy is the Framework Convention for Tobacco Control, an international treaty developed by the World Health Organization to restrict tobacco use. Participating countries agree to formulate pricing, taxation, labeling and controls on advertising to promote public health.

Philip Morris worked concertedly behind the scenes during the drafting of the pact to undermine the treaty's key provisions. The chief U.S. treaty negotiator, a career public health officer, even quit in protest when the Bush administration assisted in trying to water down the final version.

The treaty has been ratified by 144 nations, with the notable exception of the U.S. The Bush administration has yet to forward it to Obama and his colleagues in the Senate.

If Obama quits, no doubt Philip Morris will be the first to congratulate him. After all, won't that prove that anyone can stop anytime he wants to? If only that were true. Then the global epidemic of tobacco deaths would be coming to a precipitous end instead of spiraling upward. As the tobacco executives know all too well, a new smoker is born every minute -- and they are ready with a pack of Marlboros.

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