Four Types of Killjoy: #1 Anti-smoking

Tobacco control: the daddy of them all

In this series, the IEA’s Dr Christopher Snowdon explains the background and beliefs of the anti-smoking, anti-alcohol, anti-obesity and anti-gambling movements in the UK.

This is Part 1, on tobacco.

Part 2 on alcohol, is here.

Part 3 on food will be available next week, but paid subscribers can access Part 3 immediately here.

Anti-smoking pressure groups existed in Britain before the 1970s, but they never amounted to much more than platforms for their evangelistic leaders. Grassroots agitation against tobacco has always been negligible in the UK and remained so even after the dangers of smoking were proven.

By the mid-1960s, following reports from the UK’s Royal College of Physicians (1962) and the US Surgeon General (1964), the association between smoking and lung cancer was so strong and consistent that there was no plausible explanation other than that smoking cigarettes greatly increased the risk of lung cancer. Other evidence, including animal experiments and ecological studies, would later add to the evidence-base and it was soon shown that smoking caused other conditions such as chronic obstructive pulmonary disease, heart disease and laryngeal cancer.

The tobacco industry infamously sought to undermine this evidence even as their own private research confirmed it. Advised by lawyers in the 1950s to neither confirm nor deny that smoking caused cancer, industry executives took no official position on what they called the ‘smoking controversy’ but paid many sceptical scientists and spokespeople to cast doubt on the evidence. This has been extensively documented elsewhere and the following summary by Coraiola and Derry will suffice.

‘First, the industry realised it was commercialising a routinely fatal product and did not stop in spite of the blatant evidence. When scientific research showed that cigarettes cause cancer, the industry responded with a public relations program to dissuade public opinion about the harms of tobacco. Second, they created a machine of public deception to disconfirm, silence, and discredit contrary voices. When evidence against tobacco began to mount the industry promoted a campaign of disinformation to obliterate the knowledge of the harms and attack the science behind the evidence. Third, they systematically concealed, edited, and destroyed records of their wrongdoing while propagating a different history of the tobacco controversy and their involvement in acts of irresponsibility.’

This all became public knowledge in the late 1990s when a large archive of hitherto private industry documents was sent to the American anti-smoking campaigner and academic Stanton Glantz by an anonymous source. The US tobacco industry, already faced with mounting class action lawsuits, signed the Master Settlement Agreement with 46 states, in which it agreed to pay billions of dollars of compensation to state governments in return for immunity from further personal injury claims.

By the end of the twentieth century, the industry’s reputation was tarnished beyond repair and its story of ‘doubt and delay’ became the textbook example of corporate malfeasance. This naturally benefited anti-smoking campaigners who portrayed themselves as being on the side of the angels in a battle between good and evil. Scientific research funded by tobacco companies was treated with extreme scepticism and industry opposition to anti-smoking policies became almost a commendation.

(Dismissing arguments on the basis of who is making them is an ad hominem argument known as the genetic fallacy, but public scepticism of the industry was understandable and activists exploited it to bolster support for a string of anti-smoking policies. Evidence shows that ad hominem arguments are effective. In a series of experiments, Barnes et al. (2018) found that ‘some strictly ad hominem attacks (specifically the conflict of interest and past misconduct attacks) are just as effective as attacks on the empirical foundation of a claim.’)

In Britain, cigarette advertising was banned on television in 1965 and health warnings were applied to cigarette packs in 1971 (the latter as a result of a voluntary agreement with industry). Until the 1990s, the government’s anti-smoking strategy revolved around education and incremental tax rises. That began to change in 1997 when Tony Blair’s Labour Party was elected with a manifesto commitment to ban all tobacco advertising and sponsorship, the last of which was abolished in 2003.

By this time, Action on Smoking and Health (ASH), a small charity funded by the Department of Health and founded in 1971, had become the UK’s primary anti-smoking pressure group. The British Medical Association became more vocal on the issue in the 1980s and two of the country’s biggest charities, Cancer Research UK and the British Heart Foundation, adopted a more activist approach in the 2000s.

ASH scored its biggest win in 2006 when Parliament voted to ban smoking in virtually all indoor premises that are open to the public. This was far from inevitable. Ireland had gone ‘smoke-free’ only two years earlier but very few countries had followed suit. The Labour Party’s 2005 manifesto had explicitly promised to exclude private member’s clubs and pubs which did not sell food. ASH succeeded by forming the Smoke-Free Action Coalition, an alliance of organisations which created a ‘swarm effect’ by drip-feeding reports, studies, comments and opinion polls into the media from 2003 until the final parliamentary vote in February 2006. The proposed exemption for ‘wet pubs’ (in which no food is sold) and private member’s clubs was a threat to the rest of the pub estate and so ASH was able to ‘split the hospitality trade from the tobacco industry’ and pull them towards demanding a ‘level playing field’ (i.e. a total ban) . Interestingly, those who led the campaign recall that it was not the tobacco industry but the government who were their ‘major opponents’ in this campaign. Victory was only possible once politicians were persuaded that the ban would be popular.

K. E. Smith argues that tobacco control proponents were able to convince governments to take a more coercive approach to the smoking issue because they changed the framing in three ways. Firstly, they emphasised the putative economic costs of smoking, particularly to the health service. Secondly, they focused on the ‘harm to others’ aspect of passive smoking, thereby de-emphasising their fundamentally paternalistic agenda. Thirdly, and more recently, they made arguments about health inequalities which became increasingly important in health policy during the Blair years.

As the historian Virginia Berridge notes, the concept of addiction benefited anti-smoking groups from the 1990s onwards despite having ‘never been central to tobacco discourse’ previously. Bolstered by previously unseen tobacco industry documents showing that cigarette firms had been aware of nicotine’s addictive potential for decades, traditional framing that focused on self-control and free choice were undermined and cognitive biases such as bounded rationality and time-inconsistency came to be used as justifications for paternalistic interventions such as ‘sin taxes’, both to discourage people from taking up a habit which, it was supposed, they would regret and to ‘help’ smokers who wished to quit but needed a commitment device.

As Smith notes, much of the literature on tobacco policy succumbs to the ‘seductive framing’ of a ‘heroes and villains’ narrative. Instead, she sees loose and flexible coalitions of interest groups aligning around specific issues. At the centre are the anti-smoking pressure groups and activist-academics, but they are most effective when they find allies on certain policy proposals. At times, they may find their position supported by surprising allies, including elements of tobacco industry. At others, they are opposed by natural supporters. On tobacco taxes, for example, some tobacco companies support specific tax rises while some in public health oppose higher taxes because of concerns about inequality. The issue of e-cigarettes as smoking cessation devices has been particularly divisive, with both the ‘pro’ and ‘anti’ sides able to wield evidence to support their diametrically opposed viewpoints.

On the core issue of cigarette smoking, however, the tobacco control movement is united and the tobacco control literature is unusually homogenous. There is very little disagreement about the need for policies such as smoking bans, plain packaging, graphic warnings, etc. Ethical questions are occasionally raised, but the unintended consequences of anti-smoking policies are typically dismissed, denied or treated as a price worth paying for the greater prize of a ‘tobacco-free world’.

This unity of purpose stems from the perception that the issue is, at heart, a simple one; that smoking is an unhealthy addiction with no redeeming features and that there is no safe level of tobacco use; that the optimum amount of smoking in society is zero, and any demand-side or supply-side policies that reduce smoking prevalence is to be welcomed. The logical conclusion to the tobacco control campaign is prohibition. That aim began to stated explicitly in the 2010s as smoking rates dropped and the possibility of a full ban on tobacco or cigarette sales became more realistic. Public health academics now openly talk about ‘endgame strategies’ and ‘phasing out cigarette sales’. ASH, who once made a point of stating ‘ASH don’t want to get tobacco banned’ on the homepage of their website are now keen supporters of the British government’s generational tobacco ban.

More than in most academic fields, tobacco control merges activism with research. Several senior figures in tobacco control, such as Stanton Glantz in the USA and Simon Chapman in Australia, were members of anti-smoking groups before they worked in public health academia. Campaigners, such as ASH’s Deborah Arnott and Martin Dockrell (now both retired), have published in public health journals while academics, such as Anna Gilmore and Linda Bauld, have sat on the board of ASH. Gilmore is a Professor at the University of Bath’s Department for Health, but also leads a self-appointed ‘watchdog’ funded by Michael Bloomberg called Stopping Tobacco Organizations and Products.

To criticise a public health academic today for having an anti-smoking bias would be almost meaningless. The health community is anti-smoking, and for obvious reasons. Professional activism is not considered a conflict of interest. In the ‘financial & competing interests disclosure’ at the bottom of an article attacking media criticism of a secondhand smoke study, Martin Dockrell of ASH wrote:

‘The author considers that his employment with Action on Smoking & Health does not constitute a conflict of interest as their goal of minimising the harm from smoking is served best by even-handedly assessing the effectiveness of public health interventions.’

The result is that advocacy and academia sit together in tobacco control to an unusual degree. Evidence for policies is often built and evaluated by the people who campaign for them.

In his discussion of the historiography of drug policy, David T. Courtright divided writers into ‘policy hots’ and ‘historical cools’. Policy hots write indignant articles criticising current policy and attack policy entrepreneurs on the other side of the debate. They openly endorse particular framings and specific policies, often using emotional language. By contrast, historical cools, such as the aforementioned Virginia Berridge, set out the facts without giving the reader any sense of their own opinion. The field of tobacco control academia is dominated by policy hots.

Can’t wait for Part 2? Read here now