A recent Jerusalem conference seeks ways to stymie tobacco pushers and help addicts quit.
By JUDY SIEGEL-ITZKOVICHpublic smoking 224 88(photo credit: Channel 10)
Sigmund Freud's nephew Edward Bernays was a public relations genius - described in a biography as "The Father of Spin." Born in Vienna in 1891, he was taken to New York by his family. Eventually, he served as an adviser to the famous and powerful, from industrialist Henry Ford and inventor Thomas Edison to singer Enrico Caruso and US presidents Wilson, Coolidge, Hoover and Eisenhower. He died of bladder cancer at the age of 103.
He was so clever that when the American Booksellers Association asked him to help get people to buy books instead of just borrowing them from libraries, he persuaded the Homebuilders Association to install bookshelves next to fireplaces so people would have to fill them.
But to those who shudder at the devastating toll of tobacco, he was no hero: Bernays was hired 80 years ago by the American Tobacco Company to promote smoking among women - which was then considered absolutely unacceptable - and invested great efforts in getting women addicted.
ON MARCH 31, 1929, less than nine years after US women got the right to vote and when they still suffered from abysmal inequality compared to men, the Easter Parade was held in Manhattan. A woman named Bertha Hunt led a group of women wearing their Sunday best who lit cigarettes while journalists watched. Miss Hunt told them she had recently been told to put out a cigarette, and had decided to demonstrate her "plight" by lighting up in protest with her friends. The cigarettes, she declared, were "torches of freedom" - a next step in the march toward equality.
But she did not reveal that she worked as a secretary for Bernays; what was called a "feminist promotion of the emancipation of women" was in fact a publicity gimmick.
Since then, Bernay's ideological successors have continued to aggressively target women, men and young people to replace customers killed by their products over the years. By processing tobacco with lots of dangerous and addictive additives - cyanide, formaldehyde, DDT, nicotine, acetone, arsenic, carbon monoxide and many other substances - the tobacco companies and their public relations men have turned lung cancer from an unknown disease into one of the world's most common, and vastly increased deaths from cardiovascular and many other ailments.
THIS LITTLE-KNOWN piece of history was disclosed by Prof. Michael Eriksen at the National Conference on Smoking Prevention and Cessation organized recently by the government, the health funds, the Israel Defense Forces and other bodies in an effort to bring Israel's adult smoking rate down from the current 22 percent. Eriksen, an anti-tobacco expert at Georgia State University's Institute of Public Health and a former head of the US Centers for Disease Control's Office on Smoking and Health, made his first visit to Israel to participate in the conference.
He presented slides showing ads from the tobacco companies - ads with false claims that smoking is "good" for health, prevents weight gain; contemporary American ads for Virginia Slims and many other brands and French ads for Gaulois cigarettes show thin, beautiful women of all races and sexy, virile men.
"Imagery," said Eriksen, "is hugely important in attracting new customers for cigarettes, and it must be terminated."
The lecturer also showed an X-ray of a 72-year-old man with lung cancer and emphysema published in the New England Journal of Medicine: Take a look at the upper right-hand side of the X-ray and see the cause of the diseases that killed him - a packet of cigarettes in his shirt pocket.
Eriksen was personally involved in banning the image of "Joe Camel," the popular dromedary with a cigarette in his mouth. "It targeted white American boys who had psychosocial deficits, didn't get along with parents, have friends or do well in school. Joe Camel, in a bow tie and fancy suit who wanted to make you his friend, was a source of identification for these kids. RJ Reynolds was pressured to stop using cartoon characters to push Camels, but they were replaced by ads showing a sexy woman with a short skirt and a cigarette in her mouth."
DURING THE Jerusalem conference, the World Health Organization has urged governments to protect the world's 1.8 billion young people by imposing a ban on all tobacco advertising, promotion and sponsorship.
"In order to survive, the tobacco industry needs to replace those who quit or die," said WHO director-general Margaret Chan. "It does this by creating a complex 'tobacco marketing net' that ensnares millions of young people worldwide, with potentially devastating health consequences. A ban on all tobacco advertising, promotion and sponsorship is a powerful tool we can use to protect the world's youth," she added.
"Since most people start smoking before the age of 18, and almost a quarter of those before the age of 10, tobacco companies market their products wherever youth can be easily accessed - in the movies, on the Internet, in fashion magazines and at music and sports venues. In a WHO worldwide school-based study of 13 to 15-year-olds, more than 55% reported seeing ads for cigarettes on billboards in the previous month, while 20% owned an item with a cigarette logo on it. But it is the developing world, home to more than 80% of the world's youth, which is most aggressively targeted. Young women and girls are particularly at risk, with tobacco companies seeking to weaken cultural opposition to their products in countries where women have traditionally not used tobacco, Chan said.
In Israel, tobacco ads may not be placed on radio or TV, in cinemas or youth magazines, but they do appear in the rest of the print media and billboards. Unlike the US, Israel does not allow people to appear in them. However, the Health Ministry has not demanded that disgusting images (such as black lungs or yellowed teeth) be mandatory on all cigarette packs; there are only text messages that are virtually ignored. Any attempt to implement the WHO's recommendation in Israel would be met with huge opposition from Israel's powerful tobacco lobby.
While a century ago lung cancer was so rare that medical residents were called into the operating room to "see a condition you'll probably never see again," thanks to tobacco companies it has reached epidemic proportions, said Eriksen. The famous 1964 US Surgeon General's report commissioned by President John F. Kennedy - which concluded that smoking is a serious health hazard and requires urgent remedial action - was released on a Saturday because the government feared the news would crash the stock market due to the power of tobacco companies.
"WE IN the US still have not taken appropriate action," Eriksen declared, "and neither have you in Israel." In the US alone, over 160,000 deaths from lung cancer occur each year - more than the next four leading cancers (colon, breast, pancreas and prostate) combined. "This is unacceptable. It is a man-made form of cancer and preventible. "
Eriksen offered governments and voluntary organizations tips on how to fight smoking: monitor tobacco use and prevention strategy; offer help to quit; ban imagery in the marketing of tobacco products; increase tobacco taxes; prohibit smoking in all indoor areas; and regulate the sale and manufacture of tobacco products (Under US law, tobacco sales are unregulated because a cigarette is neither a food nor a drug, but defined as 'a device of pleasure' "); help smokers to permanently quit ("I was struck by the very low rate of 25% or so of Israeli smokers who want to quit, as in the US it is 70%,"); invest in evidence-based tobacco control strategies; hold the tobacco industry accountable for the harm it has caused; and set clear objectives for the reduction of tobacco use and monitor success.
Present at Health Minister Ya'acov Ben-Yizri's annual No-Smoking Day press conference, Eriksen was disappointed that the minister has no current plans for additional legislation to minimize the smoking rate, which has dropped to 14% in California, or even regulations to ban duty-free tobacco sales and vending machines, bar smoking in vehicles containing children or prohibit teachers from smoking in school staff rooms.
Dr. Leah Rosen, who two years ago launched the ministry's Healthy Israel 2020 program, said it hopes to bring the smoking rate down to 15.1% in 12 years, but wasn't certain this could be achieved. Rosen, also a health promotion expert at Tel Aviv University's School for Public Health, said her group aims to reduce passive smoking as well, as "there is no reason why anybody should be exposed against their will to tobacco smoke... The more you reduce smoking by adults, the more you prevent it among kids, because they learn from adults."
But the government is not unanimous on reducing tobacco use. "With annual government revenues of NIS 3.3 billion from tobacco," said Rosen, "the Treasury doesn't fight for smoking reduction. And only 14 agorot per person are spent on fighting tobacco."
We should be spending $6 to $16 dollars per person, according to recommendations of the US Centers for Disease Control."
Haim Geva-Haspil of the ministry's department for health promotion noted that places of entertainment argued they would lose customers and income from the more stringent no-smoking laws that significantly raised fines to violators and fine proprietors who don't enforce the laws. "Although 30% of smokers say they go out less for entertainment because of the law and 8.9% of nonsmokers go out more," there is a net benefit since non-smokers are more than 75% of the population.
Dr. Yossi Azuri of Maccabi Health Services spoke about ways to get smokers to kick the habit. Smoking cessation groups, along with phone help lines, are very helpful. There are nicotine-replacement patches, gums, lozenges and inhalers, but the nicotine is absorbed by the mouth, not the lungs, so it takes 15 or 20 minutes to reach the brain, instead of the 15 seconds from smoke. There is a variety of new prescription medications, but they can cause side effects, even anxiety, depression, headache, insomnia - and seizures on rare occasions, Azuri said. The future could bring nicotine drops or filled straws for introducing nicotine into beverages or food. But as this could result in nicotine addiction, it would probably not be passed.
Teams are working on passive-immunity vaccines to prevent nicotine from reaching the brain, or active ones to stop youths from starting to smoke. But these, he said, involve ethical quandaries. As many smokers like the taste and smell of products that have a 50% chance of killing them, the possibility of supplying synthetic smells or taste and the visual effect of smoke is being studied.
The cumulative number of deaths by smoking around the world has reached 70 million. This figure is projected to reach 520 million by 2050 if nothing significant is done, Eriksen concluded.
A short time before New York senator Robert Kennedy was assassinated in 1968, the former US attorney-general stated: "The cigarette industry is peddling a deadly weapon. It is dealing in people's lives for financial gain. The industry we seek to regulate is powerful and resourceful. Each new effort to regulate will bring new ways to evade. Still, we must be equal to the task, for the stakes involved are nothing less than the lives and health of millions all over the world.
"But this is a battle [that] can be won. I know it is a battle [that] must be won."
Indeed, 40 years later, it still must.
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