Acknowledging The Tobacco Epidemic: A New Phenomenon?

First of all, what is an epidemic? We all heard it during the COVID-19 pandemic but what does it truly mean? What is the relation with tobacco as an epidemic and why is it important?

An epidemic, as defined by the Miriam Webster dictionary ¹ , is an eruption of disease that escalates rapidly and affects many people simultaneously. Many might think that it does not apply to tobacco since it is not a spreading disease, such as the COVID-19 virus.

While tobacco use may not be a disease itself but might become a substance use disorder ² , addiction occurs very quickly and smoking, even “lightly” or non-daily may leads to severe disease, disability and harms nearly every organ of the body ³ . Another recurring statistic indicates that cigarette smoking remains the leading cause of preventable disease, disability, and death in the United States. Worldwide, tobacco use causes more than 7 million deaths per year. If the pattern of smoking all over the globe doesn’t change, more than 8 million people a year will die from diseases related to tobacco use by 2030 ³ . Tobacco is consequently the source of multiple diseases leading to millions of deaths each year.

It wasn’t until the launch of the first article in the ‘Tobacco Control’ peer reviewed journal ⁴ and the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) that radical measures were put in place in order to stop the spread of tobacco smoking. Those measures include reductions in prevalence, cost-effective measures to reduce the demand for tobacco, the increase of clinical studies and political focus to regulate the tobacco industry as it is the source of an epidemic ⁵ .

For example, according to Mackay et al. ⁵ , several high- and middle-income countries like Australia, Turkey, and Uruguay achieved great reductions in tobacco prevalence rates due to the development and implementation of targeted tobacco control strategies. Since 2004, the FCTC has been signed by 168 countries and came into effect in 2005 ⁶ . It actively moved those countries and nations to create smoke-free public places, restricted tobacco advertising and promotion, and raised tobacco product taxes to unheard-of levels.

In 2008, WHO suggested six policies (MPOWER) to stop the tobacco epidemic, as described below: ⁷

• Monitoring tobacco use and prevention policies
• Protecting people from tobacco smoke
• Offering help to quit tobacco use
• Warning about the dangers of tobacco
• Enforce bans on tobacco advertising, promotion and sponsorship
• Raising taxes on tobacco.

Despite the implementation of tobacco control measures, a WHO report showed that the tobacco industry has employed numerous practices to avoid the regulations and erode public health measures. These practices are regularly documented by tobacco control authorities, particularly in countries where tobacco measures are still at the beginning process ⁵ .

The origins of tobacco control

Dating back to the 1940s and 1950s, with the progress of studies from epidemiology, animal experiments, cellular pathology and chemical analytics, cigarettes were scientifically recognized as a link to the epidemic of lung cancer ⁸ . Nevertheless, does the phenomenon of acknowledgment only dates to that far in the past? The answer is no.

As a matter of fact, the history of tobacco control goes back to the 16th Century when Pope Urban VII threatened to excommunicate anyone who consumed tobacco in the porchway or inside a church regardless of the consumption method⁸. Other oppositions to tobacco later came, for example with King James I who wrote ‘A Counterblaste to Tobacco’⁹, which is a formal written discourse describing smoking as "a custom loathsome to the eye, hateful to the nose, harmful to the brain, dangerous to the lungs, and in the black stinking fume thereof, nearest resembling the horrible Stigian smoke of the pit that is bottomless".

The earliest forms of citywide smoking restrictions were implemented in some parts of Europe such as, Germany and Austria around the end of the 17th Century along with the ban of smoking in the 1720s and 1740s until the revolutions of 1848 in Berlin, Königsberg and Szczecin¹⁰. It wasn’t until the 1930s that tobacco control became supported by scientific research revealing the connection between lung cancer and smoking¹¹. Later came administrative actions with reports to initiate a concrete position against the tobacco industry spending billions of dollars on marketing cigarettes.

Surprisingly, the Nazi party was the first government authority in modern times to ban tobacco use. Hitler and Nazi researchers considered tobacco as a genetic poison, cause of infertility, cancer, and therefore a threat to national resources. Since tobacco was considered as an enemy to the nation, they implemented aggressive policies. After World War II, most of the leading scientists in the anti-tobacco campaign committed suicide and tobacco bans were no longer effective years after. For instance, it is estimated that U.S manufactures illegally imported more than 400 million packages of cigarettes each month in 1949¹¹.

Where does this leave us?

The interest of the tobacco industry leaves us and the tobacco control authorities with various ethical questions. What is a human life worth to a cigarette manufacturer? In a classic “people over profit” case, the tobacco industry wouldn’t consider reducing the amount of nicotine in their products to a non-addictive level. Yet, laws are still being applied to this industry, shaping odd marketing behaviors comprehensively to specific countries and their policies.

According to a study from McDaniel and Malone¹², many retailers in California frequently cited tobacco’s negative health effects as an impetus to discontinue tobacco sales. As awareness was raised by teaching individuals that smoking was bad for their health and preventing children from starting smoking, the focus is now on the implementation of new restrictive measures and the protection of those that are already in place.

Image source: Steve Heap, Oleg Golovnev - Shutterstock

However, with the notorious vape company Juul now being a part of the tobacco industry, challenges also extend to e-cigarettes as they attract youth and remain a product delivering nicotine. Our current analysis of the market motivates the team of Ditch Labs to pursue its clinical studies and aim for a medical solution instead of another e-cigarette contributing to the complication of smoking cessation.

References

¹ Definition of EPIDEMIC. (n.d.). Dictionary by Merriam-Webster: America’s Most-Trusted Online Dictionary. Retrieved June 28, 2021, from https://www.merriam-webster.com/dictionary/epidemic.

² Crocq, M.-A., Crocq, M.-A., Guelfi, J. D., American Psychiatric Association, Guelfi, J. D., & American Psychiatric Association. (2015). Dsm-5 : manuel diagnostique et statistique des troubles mentaux (5e édition). Elsevier Masson.

³ Centers for Disease Control and Prevention. (2020, December 10). Fast Facts and Fact Sheets. Centers for Disease Control and Prevention. https://www.cdc.gov/tobacco/data_statistics/fact_sheets/index.htm.

⁴ Davis, R. M. (1992). The slow growth of a movement. Tobacco Control, 1(1), 1–2.

⁵ Mackay, J. M., Bettcher, D. W., Minhas, R., & Schotte, K. (2012). Successes and new emerging challenges in tobacco control: Addressing the vector. Tobacco Control, 21(2), 77–79. https://doi.org/10.1136/tobaccocontrol-2012-050433.

⁶ WHO | WHO Framework Convention on Tobacco Control. (2005). WHO; World Health Organization. Retreived June 28, 2021, from: ttp://www.who.int/fctc/text_download/en/.

⁷ World Health Organization. The MPOWER Package. Geneva, Switzerland: World Health Organization; 2008. Available at https://apps.who.int/iris/bitstream/handle/10665/43888/9789241596633_eng.pdf.

⁸ Proctor, R. N. (2012). The history of the discovery of the cigarette-lung cancer link: Evidentiary traditions, corporate denial, global toll. Tobacco Control, 21(2), 87–91. https://doi.org/10.1136/tobaccocontrol-2011-050338.

⁹ James. (1954). A counter-blaste to tobacco (Ser. Miniature books). Rodale Press.

¹⁰ Proctor, R. (1997). The Nazi War on Tobacco: Ideology, Evidence, and Possible Cancer Consequences. Bulletin of the History of Medicine, 71(3), 435–488. https://doi.org/10.1353/bhm.1997.0139.

¹¹ Proctor, R. N. (2001). Commentary: Schairer and Schöniger’s forgotten tobacco epidemiology and the Nazi quest for racial purity. International Journal of Epidemiology, 30(1), 31–34. https://doi.org/10.1093/ije/30.1.31.

¹² McDaniel, P. A., & Malone, R. E. (2014). “People over profits”: Retailers who voluntarily ended tobacco sales. PloS One, 9(1), e85751. https://doi.org/10.1371/journal.pone.0085751.