For American smokers, her portrait is a glimpse of a future frightening to ponder and, for U.S. health officials, perhaps too powerful to foist on the public: an unsparing photograph of a person scarcely recognizable as a woman, her body wasted by cancer, her hair gone, her blue eyes fixed in a thousand-mile stare.
She was Barb Tarbox, and she died on May 18, 2003, of lung cancer at the age of 42. From October 2002, two months after she was diagnosed, to the moment of her death, the Edmonton, Canada, homemaker set about making her ordeal a lesson to others about the dangers of smoking.
Photos: Barb Tarbox
In her final months, she maintained a punishing schedule of public speeches to schoolchildren and teen groups and allowed a newspaper to chronicle her slide toward death.
The photograph, taken five days before Tarbox died, was one of 36 images the Food and Drug Administration considered in the run-up to last week's unveiling of nine graphic messages that must be on the cover of every cigarette pack sold in the United States starting in the fall of 2012.
The fine print of the FDA's final ruling notes that, among the images considered, the photograph that regulators blandly dubbed "deathly ill woman" was among the most widely recalled by adults and high school students in tests. But it was not among the nine that made the cut.
Some scientists who study how public health messages work — and don't work — to make people change their behavior were disappointed by the FDA's decision. Others professed relief. Both camps, however, agreed that such emotionally laden images will be a powerful weapon going forward in moving smokers to give up the habit and swaying others not to start.
For all the power of facts, people do not react to health messages with cold, hard reason. They respond to them emotionally, said Paul Slovic, a pioneer in the field of health communications at the University of Oregon. When smokers are confronted with an image that makes them feel unlovable, unhealthy, unappealing or ashamed — and they link those feelings to their cigarette habit — they will, he said, be primed to quit.
He said the "ugly, disturbing image" of a cancer patient at death's door is a perfect counter to tobacco advertising, which for decades has depicted attractive people engaged in fun activities with cigarettes in hand — sitting around a bonfire on the beach, sharing a laugh with a friend over coffee, strolling through a meadow in bloom.
Tarbox could have been a model in one of those ads. Six feet tall and willowy, with a head of honey hair and fierce blue eyes, she picked up gigs as a runway model while living in Ireland in her early 20s, and then back in Canada when she returned to help care for her mother, who died of smoking-induced lung cancer at 46.
Tarbox was quick with a laugh and even quicker with a cigarette. She started smoking at age 11 and didn't stop when doctors warned she faced a higher-than-normal risk because of her family history. At the time of her diagnosis, she was a two-pack-a-day smoker, said her husband, Pat Tarbox, a 53-year old restaurateur in Calgary who has since remarried.
She was a devoted mother of three, including a baby, Patrick, who died two weeks after his premature birth and his twin, Michael, who was diagnosed with autism and died suddenly of a heart defect at 8. Her daughter Mackenzie was 9 when Barb Tarbox died, and has just graduated from high school. Pat Tarbox says his wife was racked with guilt for allowing cigarettes to leave Mackenzie motherless.
Within a month of learning that the cancer had spread to her brain and neck and was inoperable, she took her shame and grief on the road. Crisscrossing Canada, she warned any group that would invite her about the health consequences of smoking. She was particularly keen to confront young teens with her story, knowing that many had already been — or would soon be — tempted to start smoking. And confront them she did.
"Her message was hard. It was, 'Look at me: This is what can happen to you,' " said Bruce Buruma, executive director of an educational foundation that organized Tarbox's most well-attended speech, which packed 5,000 kids into a hockey arena in the Alberta city of Red Deer. "She had a gift for talking to kids."
The stay-at-home mom, it turned out, was a performer. She would saunter across the stage — when she still could saunter — with an unlit cigarette and a big hat and tell kids they were looking at "the biggest idiot in the world." Always vain about her shoulder-length mane, she would draw listeners in with tales of the life and looks she had before her diagnosis. Then with a flourish, she'd snatch off her hat or wig and stand bald and gaunt before a stunned audience.
"She would throw herself in front of a bus to help a kid," Pat Tarbox said in an interview last week. "But she did not varnish the truth."