While idling away the hours last New Year’s Eve, I was watching a documentary about Brazil on public TV. During the intervals when most other stations run commercials, this one paid its moment of homage to the oil companies, then cut to a strange aquatic scene. A team of trained dolphins was swimming around in a tank. On signal, they leaped up, one after another, and plucked burning cigarettes from the mouth of a trainer suspended over the water. My initial shock—of apprehension, that the dolphins would burn their bottle-noses—soon gave way to a shock of nostalgic recognition. So this was one of the old anti-smoking commercials! This was where they had gone. A little ditty was playing in the background, urging citizens to say “You Mind Very Much If They Smoke.” The ad ended in a freeze-frame sequence as a dolphin, with an uncharacteristically vicious expression on its face, ripped a cigarette from the lips of its startled trainer.
What memories the ad called up! I sat for a moment in reveries about the anti-smoking spots that used to run on television before the Federal Trade Commission took both pro- and anticigarette commercials off the air in 1971. Cowboys had been laid low by racking coughs; withered old crones had rasped out “Smoking Is Sexy,” between drags on a cigarette. The cancer experts thought that the genius of Madison Avenue was beginning to help them make headway against the habit.
The reflection turned sour a moment later, as I recalled some of the news I had been reading more recently in the paper. Just a few weeks earlier, doctors had started using words like “epidemic” to describe the worst cancer reports in years. The government announced in November that the death rate from cancer was going up five times faster than usual in 1975, largely because of a big boom in lung cancer. As Time put it in describing the report, “lung cancer must take a large share of the blame. The American Cancer Society reports that lung cancer next year will kill an estimated 65,200 men and 18,600 women2,800 more victims than last year. Ironically, unlike other forms of the disease, lung cancer is largely preventable. At least 80 per cent of the cases appear to be the direct result of cigarette smoking.”
A touch of the grotesque was added a few pages later, when, on its back cover, Time bade its readers adieu with a full-page ad for Tareytons—only one of several four-color spreads from the tobacco industry spaced throughout that issue. What, in the name of God, was going on here? Had the campaign against smoking really reached the silly level of leaping dolphins, while lung cancer was making people drop like flies? By what marvels of self-justifying sophistry was Time warning its readers about cancer on one page and turning its ad space over to the hucksters who proclaimed that L&D was “The Proud Smoke”? Was there some hidden explanation for all this that I had somehow missed?
Spurred by a perverse fascination, I looked further into the world of the cigarette and discovered that its ironies were even more ghoulish than they initially seemed. Quite a lot has happened in the five years since the FTC took the ads off television and the press stopped paying attention to the hazards of smoking. The high points are these:
First, more people are dying from lung cancer than ever before, and medical science keeps discovering new and more appalling ways in which cigarettes can be fatal. Second, cigarette sales are booming—up 30 per cent since 1969—and more youngsters are acquiring the habit than ever before. Third, public policy about smoking, which once tried to help smokers stop and keep kids from starting, has taken a different tack. All the clamor about smoke-free zones and protection for the non-smoker has, in effect, told those who do smoke, “Go ahead and kill yourself, you dumb asshole, but don’t do it on the elevator.” And fourth, the magazines and newspapers, prominent moralizers that they were about getting cigarette ads off the airwaves, have picked up virtually all the advertising money that used to go to television.
Since the perils of cigarettes have been a boring topic for the press in the last few years, the recent scientific data comes as a surprise. To begin with, there have been two epidemiological developments of particularly ugly significance. The first, connected with the trend reported in Time, is the epidemic of lung cancer which has apparently just begun. Even though many thousands of people have quit smoking in the last ten years, more and more die of lung cancer each year. This is a perfectly predictable, statistical result of previous trends.
At the beginning of this century, when cigarettes were still an esoteric taste, the mortality rates from lung cancer were about one or two people per 100,000. Most of those who died were elderly, having developed the disease at the end of a long life; few were in their forties or even fifties. Then, around the time of World War I, more men began smoking, both in America and elsewhere in the world. For a while, there was no dramatic difference in the mortality rates. That was because lung cancer, like most other forms of the disease, requires a certain “latency period” between exposure to the carcinogen and active growth of the malignancy.
The latency period for lung cancer seems to be something like 20 years. In 1934, roughly 20 years after the smoking boom, the mortality rate from lung cancer among men was 5.3 per 100,000. By 1940 it had nearly doubled, to 9.4, and ten years later had nearly doubled again, to 19.5. Ten years after that, in 1960, the mortality rate had risen by another 90 per cent, to 36 per 100,000; by 1969, it had increased by yet another 80 per cent, to 63.
As the cancer boom picks up steam, women will play a prominent part. The authors of an article called “The Changing Epidemiology of Lung Cancer—Increasing Incidence in Women” reported in Medical Clinics of North America last March, “Mortality rates for men with lung cancer began rising sharply in the 1930s, approximately 20 years after significant numbers of men began smoking cigarettes. The mortality rate for women is now similar to that of men in 1930.” Women smokers protect themselves, relatively speaking, by smoking fewer cigarettes each day than men, inhaling less deeply and choosing brands with less “tar”; nonetheless they are catching up. The New York Times reported, in its article on the cancer boom, that scientists feel it represents the “mushrooming of a long-forecasted epidemic of lung cancer among women.” (Not far from that story, the Times, too, ran a number of enormous cigarette ads.) “Most of the increase we’re seeing now is from women who took up smoking after World War II,” says Donald Schopland of the government’s anti-smoking organization, the National Clearinghouse for Smoking and Health.
So few people ever recover from the disease that the statisticians’ debates—about whether the survival rate is one per cent or four per cent—seem more grotesque than significant. “It’s a quite quick death, but it is expensive and can be very painful,” says Schopland. “The cancer may spread to the pancreas or brain.” The damage does not stop with the victim himself. “Eighty per cent of the families which have a premature cancer victim of this sort have severe emotional problems,” says Dr. Ronald Glasser, the author of 365 Days and a recent book about cancer. “The family’s finances are ruined. The kids develop psychological problems, obesity, truant behavior, anger at their parents—you name it.”
Callous as it may seem to consider it, there is even a cost that extends beyond the family. During the year it may take a victim to die of lung cancer, his medical expenses may exceed $10,000; the annual cost for treating victims of lung cancer is by some estimates as much as $7 billion. The family pays, until it can pay no more, but the expenses still go on. “Somebody has to pay for all of this, and it is you and me,” Dr. Glasser says. “We pay through our insurance rates, we pay through our taxes.”
This sort of epidemic, to repeat, will continue for at least another generation, no matter what we do about smoking. But the second piece of news from the statisticians, even less cheering in its implications, is that yet another generation of cancer victims may be on the rise. Last September the American Journal of Public Health published an article called “The Growing Epidemic: A survey of smoking habits and attitudes toward smoking among students in grades 7-12. . . .” The subtitle conveyed its gist: “The increased smoking among boys and particularly girls in a recent seven-year period is of epidemic proportions.” In the region selected for study, the researchers found that the percentage of boys who smoked had risen from 21 to 30 between 1964 and 1971. Among teenage girls, the increase was even greater, from 12.8 per cent in 1964 to 25.7 per cent in 1971.
“It looks neat. . .”
A broader national study, conducted by the National Clearinghouse, differed somewhat in the details but concurred about the trend. According to this study, 18 per cent of the boys aged 15 and 16 smoked in 1974, while 31 per cent of the slightly older boys, aged 17-18, were also regular smokers. Both of these percentages were slightly higher than in 1968. Among girls, the increase had been phenomenal. In 1968, less than one per cent of the girls aged 12-14 were regular smokers; in 1974, it was nearly five per cent. For those aged 17-18, the rate rose from 18.6 per cent to 25.9.
“Nobody really knows what is going on,” says Donald Schopland. “Since so much of the increase has been among girls, there is some speculation that it has something to do with the women’s liberation movement. We hope to find some of the keys when we do another attitudinal study.” The attitudinal studies which the government has already conducted do not provide clear-cut answers about this new epidemic of smoking, but they contain several pieces of provocative information. One is that a good many of the young smokers count on quitting later on. The vast majority of the teenagers-90 per cent, in some studies, both smokers and non-smokers—believe that smoking is harmful. Of the children who smoke, about half say they will not be smoking five years from now. These findings accord perfectly with every common-sense notion of why teenagers smoke. In that painful period of maximum awkwardness and minimum security, youngsters grab whatever mask they can in hopes of acquiring a suave, or at least not humiliating, identity before their friends. The mask may be organizational, it may consist of the right circle of friends, it may be a passion for a hobby or a sport. Often it is smoking.
In January, The Washington Post carried this report on students who smoke at one local high school: “They say they started to smoke cigarettes in junior high school at age 11 or 12. ‘It just used to look nice,’ says Bonnie, 16. ‘Now it’s just a bad habit.’ `It looks neat the way it comes out of the corner of your mouth,’ says Peggy, 16. . . . ‘I don’t carry cigarettes,’ says Linda, 16. ‘But I go outside after lunch and somebody offers me one and it just looks so leisurely and nice.’ “
Most teenagers don’t intend to acquire a lifelong addiction, any more than they intend to spend the rest of their lives as football players or cheerleaders. They are looking for a temporary prop and are surprised to find themselves with a permanent burden.
The attitudinal surveys reveal one other surprising fact—a class division between smokers and non-smokers. Since the release of the Surgeon General’s report there has been a clear correlation between education and smoking for adults. The more education a person has, the more likely he is to have quit smoking, if he ever smoked to begin with. The same stratification is now visible in high school. Twice as many of the teenagers who held jobs smoked as those who confined themselves to schoolwork. Among boys aged 17-18, 40 per cent of those who took vocational courses smoked, compared to 20 per cent of the boys taking a “college preparatory” curriculum. In a way, it is surprising that smoking among children of the middle classes has not picked up more than it already has. For years their parents have been so terrified of losing their children to marijuana or the sirens of sexual promiscuity that they regard cigarettes almost with a sigh of relief. In terms of demonstrable physical danger, of course, cigarettes are by far the most hazardous of the group.
|October 19: Medical progress note. Diagnosis: Lung cancer. Biopsy diagnosis: Bronchial biopsy, squamous cell carcinoma; metastatic spread to bone and liver. |
“It was just a routine physical, the doctor took a chest X-ray and saw this shadow near the top of his lung. He sent us to a thoracic surgeon who tried to be nice, but we knew. He said that Herb needed a biopsy and so we had him admitted to the hospital the next day, and they did a biopsy. It was lung cancer.”
October 20: Due to severe unrelenting bone pain, have increased Demerol. . . new bony lesions of the spine, lumbar vertebrae Ll and L2, visual on X-ray bone survey.
“Herb took it very well. Dr. Brown said that if things went well, Herb would have six to eight months.. . . We talked and Herb said how lucky he really was to have time to put all his things in order.. . that. . . that many men don’t have that. He talked of a few people he knew, businessmen, who had had heart attacks without… without . . . ”
November 9: Erosion of lumbar spines have continued with neurological involvement of spinal cord. Patient now has loss of rectal and bladder function; neurosurgeons consulted. Their recommendation due to patient’s terminal condition is to do nothing. Patient becoming hostile; have changed pain medication from Demerol to morphine.
“It’s difficult to know now what was really the hardest. I think if it would have lasted much longer, we would have really had trouble with our oldest boy; towards the end, he stopped studying and would just sit in his room. Our youngest child was first bewildered and I think angry that I was spending so much time at the hospital.”
November 16: The patient is unable to keep down any food. Have begun IV therapy, patient is becoming very withdrawn.
“And to tell you the horrible truth, at the end I could barely bring myself to even walk into his room; don’t think poorly of me, please don’t, but once, just once, I didn’t go. . . . I stayed home. . . he looked so terrible and tried so hard to show how it didn’t hurt. . . I just stayed home and cried. . . “
—from The Body As Hero by Ronald Glasser, to be published by Random House in April.
Apart from these statistical developments, there have been several recent additions to the canon of medical horrors caused by smoking. The general catalog of diseases caused or aggravated by smoking is too long and familiar to bear repeating, but too important not to mention briefly. For at least ten years, most doctors have agreed that smokers are about ten times as likely to die of lung cancer as non-smokers; nine times as likely to die of cancer of the mouth and pharynx; six times as likely to die of emphysema and cancer of the larynx; four times as likely to die of cancer of the esophagus; and they are much more likely to die of coronary heart disease. In 1965, when only 40,000 people died of lung cancer, the Surgeon General, Dr. Luther Terry, estimated that 240,000 people would die prematurely of disorders related to smoking. If the same proportions hold today, more than half a million people will die this year because of cigarettes. This is ten times as many Americans as were killed during the entire course of the Vietnam war.
Two other items might be added. In the wave of concern about environmental and occupational carcinogens, bladder cancer has played .a prominent role. It was bladder cancer which workers in dye and pesticide plants contracted and which caused the government to shut down the plants; and it was because cyclamate sweeteners, when fed in enormous doses to experimental animals, produced bladder cancers that they were removed from the market in 1969. But according to recent medical articles, the primary cause of bladder cancer these days is not pollutants or occupational hazards, but cigarette smoking. The assorted carcinogens present in cigarette smoke do not act solely on the lungs, but are also absorbed into the blood stream and eventually pass through the kidneys. While contained in the urine, they are stored for several hours at a time in the bladder, where they may eventually produce tumors.
The second item concerns the effects of smoking on the smoker’s own offspring. Doctors have long understood that if a mother smokes while pregnant, her baby is more likely to be aborted or stillborn, and if it does survive it is likely to be smaller and weaker than if she had not smoked. Cancer is a surprisingly frequent cause of death in children—between the ages of one and 15 it kills more children than any other disease. Some doctors have speculated that the carcinogens in cigarette smoke may enter the mother’s bloodstream, pass through the placenta into the infant’s system, and leave the baby predisposed to cancer from the moment it is born.
Thirty years ago, popular culture presented a distinct and quite flattering picture of the aura of a cigarette smoker. Anyone could look at the silver screen and see Bogie standing there with a cigarette dangling from his lip, the very embodiment of rough, tough worldly wisdom. When Edward R. Murrow began appearing on “See It Now,” he was constantly at work with his cigarette, a cool, debonair chain-smoker. For those of a different taste, Albert Camus was hardly photographed without a Gauloise planted in the corner of his mouth. GI Joes smoked in the ranks; somewhat earlier, George Orwell had written in Homage to Catalonia about the camaraderie of a cigarette in the trenches. With the brilliant slogan, “Reach for a Lucky Instead of a Sweet,” the advertisers equated cigarettes with attractiveness. The effect was so widespread and persuasive that the cigarette companies have been trying to recreate it ever since, with the Marlboro cowboys and the suave smokers of Benson and Hedges.
Now the members of this generation are in their late forties and upwards. If experience and logical self-interest were all it took to change behavior, they would have stopped smoking in droves, for the changes they have seen have been chilling. The two heroes most clearly identified with cigarettes, Bogart and Murrow, died one after the other, both of lung cancer. The Surgeon General’s report came out in the early sixties, and soon afterwards the prevailing popular attitude began to change. Instead of thinking that smokers were chic, people began to think that smokers were stupid. When the smokers have visited their doctor, he has told them to stop for the sake of their heart, or their lungs, or their pharynx. Apart from the handful of cigarettes they savor with their morning or evening coffee, the two or three dozen others they consume each day do not even confer any real pleasure. They don’t need to ask their doctor when they first see blood in the sputum, because they already know what it means. But still they have not been able to stop.
Some have, of course. The first identifiable group to do so was the doctors, whose percentage of smokers dropped from 60 to 20 per cent during the 1960s alone. But millions of other people still feel themselves imprisoned; according to some studies conducted during the late sixties, 80 to 90 per cent of the adults who smoke wish they could stop. By now, some of these people have died or developed cancers. Others may already be doomed. But a substantial number could still be helped, if only they could break the habit. Within a few weeks of the time a smoker stops, the extra risk of coronary disease decreases. Because of the years of exposure, his prospects for cancer are harder to determine, but if a smoker makes it through ten years after quitting the habit, his chances from that point on are statistically the same as if he had never smoked.
While these smokers have been desperate to quit, the government has been fighting its gigantic “War on Cancer.” Grants are granted, research conducted; viruses are hunted down in their lairs. On cancer research of this kind the government spent hundreds of millions last year. As a result of this research, a smoker who gets lung cancer has the comfort of knowing that he may survive for 18 months instead of a year. Meanwhile, a handful of small change is devoted to the two steps that could keep people alive for an extra ten years instead of an extra six months—helping smokers quit and preventing children from starting. In the whole cancer budget, there is virtually nothing set aside for these purposes. From a humanitarian point of view this is brutal; from a practical point of view it is wasteful. If the war on cancer is really intended to save lives, then the focus should change toward helping smokers quit and keeping children from starting.
So that there will be no mistake, I am not talking here about denying cigarettes to adults who want them, or engineering another burst of Prohibition. I am speaking only of people who do want to quit, and of what might be done to help them. Specific prescription is difficult in this area, since people smoke for so many different reasons and since cures have had such limited success. Hypnosis may work wonders for some people; for others, little habit-breaking tricks may ease the way from slow cut-back to total abstention. Some smokers may break the habit through sheer force of will. Still others, with exactly the same amount of moral rectitude, may find that when they do go cold-turkey they think of nothing else but the next cigarette they must resist. Far better, they may feel, to go on smoking than to live in that zombie state.
There may be answers to be found, however. As an initial step, we might take some of the money now spent on cancer research and use it for a serious examination of the various quitting techniques. Is there a better drug to ease the physiological addiction than those which are now prescribed? Should aversion therapy—for example, putting a person in a telephone booth and letting him smoke himself sick– play a larger part? Or hypnosis? With a clearer idea of what works and what doesn’t, we might then concentrate on making this knowledge available to the people who can use it: the smokers, their doctors, both public and private anti-smoking clinics. Some of these private organizations, most notably the Schick clinics, have run up an impressive record of cures, and a public campaign against cancer should welcome their efforts rather than undercut them. But Schick now charges $450 for a cure and has little incentive either to find simpler ways to help the smoker or to treat everyone who wants to quit. The government has the money to do the research, and it has a reason to cast its net wide.
The Need for Paternalism
While a campaign against cancer is helping people quit, it should also keep youngsters from starting. Just as it makes more sense to stop people from getting cancer than to blast them with radiation once they are dying, it also makes more sense to keep people from becoming addicted than to put them through the agony of a cure. This, it will be noted, is a paternalistic notion: the state is telling people what is good or bad for them. There will be more to say about paternalism in a moment, but here we are speaking of children, and when dealing with children paternalism may be a very good thing. Parents do not let their children learn from experience in the case of electric sockets, or railroad crossings, or household poisons, and they should not do so with cigarettes. The forces that draw children toward smoking in those awkward teenage years may be only temporary, but the consequences are not. People who start smoking at age 15 are five times more likely to die of lung cancer than those who start at 25.
The burden of paternalism falls first on the parents. Of all the influences affecting a child’s decision to smoke, the example of his parents is the most important. But even if parents try to dissuade their children, there are many other influences that remain beyond their control. The chic ladies of the Virginia Slims advertisements, the rugged cowboys smoking Marlboros—these and other creations of the advertising world lure their children toward the romance of the cigarette. There are other pressures as well, from school, friends, and elsewhere.
The boundaries of parental influence suggest where the state might take a hand. One step would be to get a clearer idea of why children decide to smoke, and what incentives are most effective in stopping them. The next would be to launch campaigns— paid for, once again, out of the current anti-cancer budget—to play on the most sensitive juvenile emotions. Television may be the most influential medium for this audience, and the anti-smoking spots of the sixties, though mainly aimed at adults, illustrate the approach to be taken. Antismoking commercials, of course, are not only paternalism but also propaganda, and in some minds they call up visions of a mind-controlling government at work. Today cigarettes are denounced on TV; tomorrow, the Jews. This is alarming only to those who overlook the most obvious distinctions between the realm of free discussion and that of addictive poisons.
The two steps considered so far would pass muster under most schemes of individual freedoms and proper functions of the state. By helping people quit and steering children from an immature choice that could prove fatal, the public is only finding a more practical way, at no cost in individual liberties, toward reducing the toll from cancer. Beyond that, any public efforts against smoking run smack into debates about First Premises and theories of the state, the same debates that have cropped up elsewhere in the last few years. In San Francisco, a proposal has been debated which would require extra-high fencing along the Golden Gate Bridge. Its supporters argued that the unfenced bridge was an invitation to suicide. Prevention of accidental falls was not the issue, since the existing fence was adequate for that. Rather, the question was whether those who decided to commit suicide by leaping from the bridge should be prevented from carrying out that decision. In less dramatic fashion, the same issue lies behind the “buzzer” legislation, designed to protect drivers from any foolhardy desire not to wear their seatbelts. It lies as well behind efforts to stamp out smoking. The issue is whether the government should prevent its citizens from consciously doing themselves harm.
I believe that a distinction between public and private efforts is essential. To take an extreme conception of public powers, one might argue that the state has an absolute power to keep its citizens from harming themselves. It would outlaw smoking, forbid all drinking (as we did during Prohibition), and take steps to see that no one jumped off the bridges. Such a policy would be based on the notion that the citizen owed a special kind of loyalty to the state. Besides just paying his taxes and obeying the laws, he would be expected to deliver his productive labor—which depends on his health—for the good of the community. As Michael Walzer has phrased it, this is the duty to live for the state, as opposed to the more familiar duty to die for it. Such a duty might be right for a tightly knit guerrilla band or a young ideological state, but it has never been part of our public philosophy. That is why I think that the state should have no quarrel with any adult who wants to smoke, just as it should have no quarrel with those who attempt suicide.
The only quarrel the state might have with the smoker is when he violates the rights of others. This has been the battle cry of the non-smokers on their fights for smoke-free havens within airplanes and elevators, but it means something else as well. Over the course of their lives, most smokers will spend more days in the hospital, off the job, and at the doctor’s than non-smokers will. Their total medical bills will be higher, and, of course, they will die sooner. The companies that insure their lives and sell them medical insurance stand to lose money on smokers. As things work out, however, it is not companies that lose but those who do not smoke. Only a handful of insurance companies offer any discount at all for non-smokers, and these are so trivial as to hardly be worth the bother. If you are 30 years old and a non-smoker, for example, Mutual of New York will knock a full 66 cents off your annual premium for each thousand dollars of your life insurance policy. By the time you’re 60, the discount soars to $2.14. It’s easier for the companies to jack rates up acrossthe-board, and the effect of that is to make those who do not smoke subsidize those who do. Smokers who cannot afford insurance rely on the public for their medical care. They draw on these facilities more heavily than people who do not smoke, so they, too, are subsidized by nonsmokers. Our public services are riddled with hundreds of indirect subsidies, but none of them can make less sense than this one.
Here we leave public duties at an end. Private responsibilities are quite a different matter. As a friend or a member of a family, I have an interest in the well-being of my friends. Though I don’t want the state to prevent them from committing suicide, I will try to prevent them myself, as I might try to persuade them against smoking. Private individuals and organizations are held to a standard of conscience not expected of the government, and that is why we return now to the question of advertising. 1970 was the last year in which cigarette companies could vend their product over the airwaves. During that year the makers of the top 20 cigarette brands spent $241 million advertising their products, more than two thirds of that total going to TV. Then came the ban, and for three years the ad totals were depressed. In 1973, they had only combed to $196 million, 20 per cent below their previous high. But by 1974 the ad total for the top 20 brands had reached $243 million, and expectations for 1975 are higher still. When inflation is taken into account, this is clearly a smaller total than before the ban; but when you consider that not a penny of it is going to TV, it means that newspapers, magazines, and the owners of outdoor billboards are having a field day. Open a copy of Time or Newsweek, Harper’s or Atlantic, New York or Esquire, Penthouse or Playboy, and you will see the bright ads for Winston, Saratoga, More, and Virginia Slims. According to Advertising Age, newspapers and magazines have increased their take from the cigarette companies by more than 300 per cent since 1970. During that period, outlays for cigarette ads in magazines have risen from $49.5 million to $114.6 million, and in newspapers from $14.7 million to $80.5 million.
There are gradations within these advertisements, with different levels of culpability. The tobacco men claim that their ads are aimed at people who already smoke and attempt nothing more than to make them switch their brands. True enough, one sort of ad does serve that purpose. Most of the “healthy” cigarettes—the low-tar varieties like Doral, More, Vantage—make their pitch to the smoker who is getting cold feet. “With all the talk about smoking I decided I’d either quit or smoke True,” says an executive type in one of the current campaigns. “I smoke True.” But on the other side of the great divide are the many ads clearly designed to resurrect the shades of Bogie and Murrow and restore to smoking the romantic appeal it once had. Benson and Hedges show their smokers stubbing their extra-long cigarettes on the rear end of a girl in a bikini; Advertising Age calls this the “skin flick ad,” and, whatever its name, its purpose is to equate smoking and sex. Winston, apparently choosing Charles Bronson as its modern Bogie, depicts bullnecked young men announcing, “I don’t smoke to be like everybody else.” Salem has a pair of “smoker’s pride” ads. In one, a man says, “People ask me if I really enjoy smoking”; in the other, a chipper young woman asks, “Do you enjoy smoking as much as I do?” Perhaps the most obscene of them all, in view of the epidemic of cancer among women, is Virginia Slims and its well-established slogan, “You’ve Come A Long Way Baby.” While a feeble case might be made for the first sort of advertisement as a way of luring smokers to brands which will kill them more slowly, there is no defense at all for the second.
Both kinds of ads continue to run in our finest journals, in settings which are increasingly grotesque. The New York Times worries solemnly about the cancer rate and beats the drum for Winston; Newsweek reports on the declining public health and invites readers to meet “The Long One, Max.” Under one conceivable circumstance the ads would be justified: if the papers, like Hugo Black, believed in absolute freedom of speech. This is simply not the case. Nearly every newspaper and magazine in the country reserves—and exercises—the right to censor the material advertisers place in its pages. Last fall The Washington Post deleted the phrase “a dirty movie that really delivers the goods” from an ad on its amusements page. (The delicious touch in this case was that the quote had come from the Post’s own movie reviewer.) In his book, Legal Control of the Press, Frank Thayer describes the censorship policies of various newspapers:
“The general principles guiding the [St. Louis] Post-Dispatch are to deny space for any advertisement. . . which might cause an injury to health. . . Illustrations of the type of Post-Dispatch rejections of advertising. . . . An eyelash and eyebrow darkener consisting of silver nitrate and pyrogallol rejected because of the possible injury to the eyes that might result to the user. . . .
“The New York Times policies in regard to censorship of advertising are as follows: . . . The chief purpose of the Times‘ censorship is to protect the reader.’ … [the Times forbids] objectionable medical advertising of products containing habit-forming or dangerous drugs. . . . Any other advertising that may cause money loss to the reader, or injury to health or morals, or loss of confidence in reputable advertising and honorable business, or which is regarded by The New York Times as unworthy.'”
The New Yorker also has its censorship rules. It accepts no advertising from the government of South Africa, it rejects patent medicines, and, according to one of its spokesmen, it frowns on products whose price level is out of keeping with the readership’s assets. But The New Yorker is different in one other way, which is that it, along with Reader’s Digest, is the only major publication to place a flat ban on advertisement from cigarette companies. “It happened right after the first Surgeon General’s report,” says Hoyt Spellman, the magazine’s public relations man. “We decided in January 1964 that we would take no new business pending the final report. We continued the business we already had. One year later we banned it all—new and old. We felt there was no redeeming social value in cigarettes— unlike liquor, cars, and the other death-dealing instruments The New Yorker advertises. Even one is bad for you.”
Spellman continued: “On a conservative basis, it’s been estimated that we could probably have a couple of pages of cigarette ads in every issue. That would amount to about a million dollars of revenue per year.”
Considering the competition, The New Yorker and Reader’s Digest do deserve praise for putting their money where their mouths are, even though their performance is nothing more than the literal execution of the advertising policies of all our greater publications. One hears the noble soughing of Sulzbergers and Ochses behind The New York Times‘ ideal of “protecting the reader”; “this is not just a business, my son, it is a public trust.” Unlike some other businesses, newspapers like the Times and the Post, and magazines like Time and Newsweek, have some underlying sense of moral purpose and public responsibility. They would never accept the notion that they are simply in business to make money. But for organizations so concerned about “protecting the reader,” for publishers so intent on steering the public away from corruption and injustice, and for editorialists who have moralized so often about the government’s perfidy in threatening the life of one man, Fidel Castro, it is grotesque, to say the least, that they are devoting so much space to the cause which kills 500,000 people every year.
Unless one assumes that the advertisers are lunatics, the reason they are advertising is that it pays off. They convince smokers to continue, and they entice new victims to start. If there are merchants of death these days, they are not the men of Honeywell but of the great tobacco industrial complex that runs from the green fields of Piedmont to the publishing offices of New York.
At this point the inevitable rejoinder is heard: but what about free speech? To begin with, this is utter hypocrisy as it applies to most publishers, since they will censor for esthetic or moral objections no matter how trivial. But there is something even more perverse about it than that. When the man in the publisher’s office decides to accept a cigarette ad, deep in his mind there lurks a strange conception of his obligation to evenhandedness and fair play. It shows up most clearly whenever people talk about the ban on televised ads. That was a terrible mistake, the antismoking forces say, because it removed the stop-smoking spots along with the industry’s own ads. A Justice Department official named B. C. Wilson, to choose one example of many, has proposed that we let the cigarette ads back on TV so that we can regain the beneficial effect of the antismoking spots.
Broadcasting is a different business than publishing; since a network is little more than a franchised moneymaking machine, using public airwaves, the public can set stricter terms for what does and does not appear than it can for the press. But the logic of Wilson’s proposal lies close to our publishers’ hearts. You have to give everyone a chance, they tell themselves; I may disagree with what you say, but I will defend to the death your right to buy my space to say it. So if you’re giving cigarettes a hard time in your news columns, then it is only fair to let them reply in the ads.
Now, there is certainly a place in this world for free speech, equal time, and letting all sides be heard. It would be wrong to give the Democrats ads, but deny them to the Republicans; to let Ford advertise without GM; or even to run news reports about oil spills without letting Mobil or Exxon buy their minute’s worth of rebuttal. But somewhere there is a line which separates these political disagreements from unequivocal menaces to the public health and safety. No serious student of free speech has claimed that anything besides political speech has an absolute privilege; similarly, no serious student has claimed that anyone has a right falsely to yell “Fire!” in a crowded theater—which is the kind of threat we are discussing here.
The papers offer no free speech or equal time to white slavers, for example, nor to dope pushers or contract murderers. Granted, these services are illegal, but the problem with finding proper analogies for cigarette advertising is that no other legal product comes close to matching the danger of cigarettes. They cause more cancer than radiation, pollution, or any other known cause; they kill more people than criminals, wars, auto accidents, and domestic quarrels put together. I do not deny any smoker his right to smoke, but I challenge anyone to deny that cigarettes are the major public health menace in this country—indeed in all of the, Western world.
When [More] ran a full-page ad for Marlboros in its December 1975 issue, it demeaned itself as certainly as if it had sold that space to a gang rape club or a Mafia recruiter. No one is forcing [More], or anyone else, to take these ads; they will not offend any serious notion of fair play if they turn them down. Publications are not public utilities, bound to serve any random client off the street. When a publisher decides to present a product to his readers, he puts his name behind that product, at least to the extent of saying that it is worthy of his readers’ consideration. And when the publishers decide to put their names behind cigarettes, how can anyone believe their protestations of prudence and public responsibility? They have sold out. And, seriously, their employees have not bothered to complain. In the past decade, an important idea has grown up about the relationship between organizations and the individuals they employ. When the company is doing something bad, the employees complain. If it is bad enough, they back up the complaint with the threat to quit. This might not work at the local car dealership or the Manchester Union-Leader, but publishers like Katharine Graham and Punch Sulzberger, who place high price on the appearance of public responsibility, would be least able to resist serious pressure from their staff on a moral point such as this. Yet the idea seems not to occur to anyone involved.
The sad thing is that the publications are selling themselves so cheap. Certainly there are some groups who could not survive if the cigarette industry folded. The tobacco growers are the most obvious case, and if a successful war on cancer means hard times for the farmers, then the public has a responsibility to find new ways for them to use their skills. A few publications rely so heavily on cigarette ads that they might not survive a boycott. Of the major national magazines, New Times seems the main entrant in this category. By my count, 45 per cent of its four-color advertising in the last half of 1975 came from the tobacco industry. (It’s “my count” instead of their figures because New Times was not eager to discuss this question.) For the majority of the publications, this is hardly a question of economic survival. The Times and the Post, Time and Newsweek, could get along for years without cigarette ads, as they did for years before the TV ban created the current bonanza. For most of them, taking cigarette ads is not a matter of making a profit, but only of maximizing it. The extra five or ten per cent this adds to their revenues comes at an enormous cost in hypocrisy, and, let us say it outright, contempt for human life. Everything else they say will be cheapened until they stop.