Monday, October 31, 2005

CHALLENGING DOGMA (Post #6): Cigarette Companies Have a Responsibility to Produce a Safer Product

One of the most well-established and long-standing dogmatic principles in the tobacco control movement, it seems to me, is that cigarette companies have a responsibility to produce and sell a safer product if one is technologically feasible (which presumably it is, according to internal company research).

This premise seems to me to be one of the most basic ones that inform the actions and proposed policies of tobacco control practitioners.

For example, it plays a key role in the DOJ tobacco lawsuit. According to the government's complaint against the cigarette companies: "Even though they have long understood the hazards caused by smoking and could have developed and marketed less hazardous cigarette products, defendants chose and conspired not to do so. ... At least since the early 1960's, the Cigarette Companies have been able to remove potential carcinogens and to independently alter the delivery of tar and nicotine respectively. Many alternative designs are possible, some of which are less hazardous than the cigarettes that the Cigarette Companies actually manufactured and sold. ... Despite their demonstrated ability to design cigarettes that they believed were less hazardous, defendants have refused to test and/or actively promote such products."

It is also a basic premise outlined in The Cigarette Papers: "In 1994, R.J. Reynolds announced a novel product called Eclipse, which, according to newspaper accounts, delivers a nicotine aerosol to the smoker together with lower levels of other toxins than cigarettes deliver in their smoke. ... Does R.J. Reynolds plan to withdraw Camel, Winston, and Salem cigarettes and replace them with Eclipse? Not at all. If the industry can make a substantially less dangerous product, why does it not cease marketing the more dangerous ones that are presently being sold?" (Glantz SA, Slade J, Bero LA, Hanauer P, Barnes DE. The Cigarette Papers. Berkeley, CA: University of California Press, 1996, p. 440-441)

It seems to me that anti-smoking organizations and advocates often criticize the tobacco companies for not producing and selling less hazardous cigarettes and for failing to pursue to completion the research and development of less hazardous products that has already occurred.

The Rest of the Story

This may come as a surprise to many, but I do not feel that cigarette companies have any responsibility to develop, produce, and sell a less hazardous cigarette product. And I don't think that it is appropriate for public health practitioners to criticize the companies and to try to hold them accountable on this score.

Why? Because if cigarette companies have a responsibility to produce a less hazardous product, then they have a responsibility to the health of the public. And if they have a responsibility to the health of the public, then they certainly have a responsibility not to produce, market, and sell a product that is going to result in the deaths of thousands of consumers. Thus, they would have to be viewed as bearing the responsibility for removing this hazardous product from the market. Producing a marginally (or even greatly) safer product would just not cut it under that reasoning.

This is a fatal flaw into which I believe the anti-smoking movement has fallen. The flaw is that if the cigarette companies truly have a responsibility to protect the health of the public, then they have a responsibility to withdraw these deadly products from the market. It seems ludicrous to me to argue that the companies should produce a safer product instead of arguing that they should simply phase the existing products out.

Am I arguing that cigarettes should be withdrawn from the market? No. What I am suggesting is that the rationale behind criticizing the companies for not developing, producing, and selling a safer cigarette is absurd. How can a public health practitioner possibly attack the companies for not producing a safer cigarette but not attack them for failing to phase out the products entirely? If cigarette companies bear a responsibility to the health of their consumers, then what possible public health rationale is there for the companies to merely remove or reduce the levels of a few of the carcinogens and toxins, rather than all of them?

I do not believe that the cigarette companies are responsible for the health of the public (including their consumers). I believe that as a society, we have made a decision (at least for now) that cigarettes are a legal product and that despite the deadly nature of the product, we are going to tolerate and allow this product to be produced and sold. Given that decision, the responsibility to safeguard the health of the public has been lifted from the tobacco companies.

Clearly, I believe the companies do have a responsibility to be truthful in their marketing, including all of their advertising, public relations, public statements, etc. And I believe they have a responsibility to inform consumers about the health risks of their products. And they have a responsibility not to deceive consumers in any way, including misleading them about the health effects of smoking, the potential benefits of low-tar or "light" cigarettes, the addictiveness of nicotine, etc.

But I don't believe their responsibility extends to the development of safer cigarettes.

In as many tobacco cases as I've testified (at least 7, including Engle, which resulted in a $145 billion punitive damage verdict against the companies), and with as many criticisms as I have leveled against the companies in those cases (misleading advertising, targeting youths in advertising, undermining public understanding of the health effects and addictiveness of smoking, etc.), I do not believe I have ever criticized the companies for failing to pursue to completion a reduced risk product.

I am not necessarily suggesting that as a public health strategy, establishing incentives for the companies to develop and market such products would be a bad thing. It's a complex issue and I don't think it's yet clear exactly what the tradeoffs would be in pursuing that type of a harm reduction approach in tobacco control.

But I think it greatly undermines the public health definition and framing of the problem of tobacco products in our society when practitioners attack the companies for failing to pursue less hazardous cigarettes. Because the problem, in my mind, is not that cigarettes are more harmful than they have to be. The problem is, simply, that they are substantially harmful. Period.

I think the movement is harmed, not helped, when we emphasize the failure of cigarette companies to pursue reduced risk cigarettes as if they are neglecting some health responsibility that they have to the public's interest.

They are companies which are in the business of selling an inherently dangerous product. Nonetheless, it is a product that we as a society have decided to retain as a legal one. We shouldn't pretend that decision has not been made. We shouldn't pretend that tobacco companies should be held to the same standards as other companies which manufacture consumer products.

Ultimately, this is one aspect of the Department of Justice's complaint that I do not agree with. I do not follow the logic of this aspect of the complaint and I do not believe that the companies' failure to produce a safer cigarette violates, in any way, any United States law that I am aware of. It is the clear intent of our society (including our government and even our public health establishment) to allow the product to remain on the market. There is simply no rationale for expecting companies to produce a safer cigarette when society has already accepted the high level of risk that existing cigarettes pose.

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