Professionalism/British American Tobacco and the Promotion of Smoking

British American Tobacco (BAT) has been one of the front runners in cigarette sales since the inception of the United States tobacco market in the early 20th century. This multi-billion dollar industry has been subject of much criticism over the years due to the health risks associated with smoking cigarettes, such as increased cancer, coronary heart disease, stroke, and birth defect rates. BAT and other industry leaders have made some questionable ethical choices in their promotion of cigarettes. Throughout the industries history, many of the policies and regulations regarding cigarette sales have been influenced by BAT.

History of the Tobacco Industry
The use of tobacco products in the United States has been around since the 16th and 17th centuries. Native Americans engaged in tobacco consumption during ceremonies, prayers, and rituals. Tobacco was also used for medical treatment for a variety of ailments including asthma, skin diseases, convulsions, and fevers

The Rise and Fall of US Sales
It wasn't until the 1900's that the US cigarette and tobacco industries experienced a rapid growth in popularity. The yearly consumption of cigarettes per capita in the US can be seen here. The sale trends from 1900-present can be broken down into three distinct periods.

[1917 - 1945] The Industry Boom
The ~2500% increase in cigarette sales during this period can be attributed to a few key factors, giving birth to the cigarette age in America. The first factor was the USA's involvement in both World War I and II. Both soldiers, and housewives alike were targeted by the cigarette industry. Tobacco companies such as BAT marketed their brands towards the female population at home, advertising their new cigarettes with slogans like "Mild as May" to attract females wanting a less harsh smoke. Between 1925-1935, the number of teenage female smokers in the US increased by upwards of 300%. During this time, cigarettes also became a staple item included in the G.I. military C-Rations, and millions of free cigarettes were sent overseas, supplying the industry with a steady stream of loyal customers as the troops returned home

[1950 - 1980] Sales Stagnation
Studies linking cigarette smoking and cancer rates became more and more prevalent during this time, starting with the "Cancer by the Carton" which appeared in Reader's Digest in December of 1952 Other studies such as the "Smoking and Health", published in 1964 by the Surgeon General, helped increase awareness even further of the prevalent health diseases that may be associated with smoking. These early documents didn't have a huge affect in reducing the cigarette consumption rates in the US, but were the stepping stones for changes in Tobacco control legislation and restrictions. In 1967, the Fairness Doctrine was deemed applicable to the cigarette industry by the Federal Communications Commission (FCC). This ruling required equal broadcasting time for anti-smoking campaigns, which lead to a surge in awareness about the risks of cigarettes via radio and TV ads.

[1980 - Present] The Decline in Smoking
In 1985, lung cancer becomes the #1 killer of women in the United States, even surpassing the mortality rate of women's breast cancer. Rattled with a steady stream of lawsuits and the US general public's disapproval of cigarettes, Tobacco companies such as BAT experience a drastic decrease in cigarette sales. Due to this bleeding of profits in the US, Tobacco industry leaders like BAT shift their marketing towards countries that lack government regulations and supervision. Recently, there has been an upsurge in aggressive marketing campaigns towards the developing world, primarily in areas like Africa and Asia.

Tobacco Industry Research Committee
By late 1953 various publications claimed an establishing relationship between smoking and health problems such as lung cancer. The tobacco industry and its leaders needed to to join together to combat these growing concerns and thus they formed the Tobacco Industry Research Committee (TIRC) in December of 1953.

A Frank Statement
The first course of action of the TIRC was to the release A Frank Statement to Cigarette Smokers. On January 4, 1954 a full-page promotion in more than 400 newspaper with an estimated reach of over 43 million Americans went out across the country. It was the industries first campaign strategy to dispute growing reports that claimed smoking cigarettes could cause lung cancer or other serious health defects.

Claims
The advertisement claimed:


 * 1) That medical research of recent years indicates many possible causes of lung cancer.
 * 2) That there is no agreement among the authorities regarding what the cause is.
 * 3) That there is no proof that cigarette smoking is one of the causes.
 * 4) That statistics purporting to link cigarette smoking with the disease could apply with equal force to any one of many other aspects of modern life. Indeed the validity of the statistics themselves is questioned by numerous scientists.

A Scientific Perspective...
Part of TIRC's next steps to further the controversy whether smoking cigarettes has detrimental effects on health was to collaborate an 18-page brochure to challenge current claims, A Scientific Perspective on the Cigarette Controversy. The industry-sponsored group cherry-picked scientific studies that denied evidence of smoking and its potential to cause health problems and employed other techniques to stir confusion among the public. This booklet had 205,000 copies printed. It was sent to 176,800 doctors, members of congress, and 15,000 members of the of the press.

Key Points

 * The evidence is still inconclusive. "A Scientific Perspective" quoted a British scientist who said that "many correlations of a comparable nature ... have in the end proved false. ... Let us be sure of our evidence before we scare the public."
 * Something other than smoking may be responsible. Doctors were quoted who speculated that the rise in lung cancer might be due to "air pollution," "vehicle exhaust fumes," "the increased aging of the population" and "improved diagnosis." One doctor speculated that "infectious diseases" might be responsible for lung cancer; another speculated that lung cancer might be increasing because of fewer infectious diseases: "The widespread use of antibiotics has resulted in fewer hospital admissions and fewer deaths from infectious diseases, and proportionately, more from malignancy."
 * Statistical evidence can't be trusted. "This whole question of cause and effect deducted on a statistical basis is subject to the greatest fallacies," argued Chicago cancer surgeon Max Cutler. "One way I like to emphasize it is to say that simply because one finds bullfrogs after a rain does not mean that it rained bullfrogs."
 * It's all a scare campaign. "Is it wise to scare the public and create widespread anxiety among millions of people on the flimsy evidence that has been presented?" Cutler asked. Another authority complained, "the moment the word cancer is mentioned to the public ... emotion is aroused and any calm objective view of the value of evidence presented becomes most difficult. It is important that the medical profession ... not make matters worse by merely joining in a cry and increasing the alarm." Another doctor decried "the loose, unscientific and irresponsible statements that are continuously appearing in newspapers and magazines."
 * The issue is too complicated, even for scientists. "If smoke in the lungs were a sure-fire cause of cancer, we'd all have it by now. The cause is much more complicated than that," said Clarence Cook Little.
 * Nit-picking at irrelevant details. One scientist complained about "the failure to separate data referable to these tumors in the white and Negro patient."
 * More research is necessary. "A great deal more research must be done before one can establish the etiology of lung cancer or, as a matter of fact, all cancer," said New York doctor Milton Rosenblatt.
 * Tests on animals don't apply to humans. "Pathologically lung cancer in mice resembles only remotely bronchogenic carcinoma in the human," Robenblatt said. "A Scientific Perspective" also quoted Dr. Jonathan Hartwell of the National Cancer Institute, who objected to "the attempt to carry over, without reservation, to man, conclusions based on animal experiments." Hartwell went so far as to say it would be "dangerous" to rely on animal tests as a guide to human carcinogenicity.

Agnotology
Agnotology is the study of willful acts to spread confusion and deceit, usually to sell a product or win favor. The neologism was coined by Robert Proctor, a professor of the history of science and technology at Stanford University. His pursuit to study the deceitful tactics of businesses and industry stem from a released memo from the tobacco industry which revealed how cigarettes are marketed to the public: "“Doubt is our product since it is the best means of competing with the ‘body of fact’ that exists in the mind of the general public. It is also the means of establishing a controversy.”" His research first began with the tobacco industry, but it by no means ends there. Agnotology is a dangerous tool used by politicians and others in effort to control the thoughts of the public.

Harm Reduction
After decades of denying the health risks of smoking, BAT has begun to operate under a policy of harm reduction. From their website :

"“We know tobacco products pose real and serious health risks and the only way to avoid these risks is not to use them. But many adults choose to smoke, so we are committed to researching, developing and commercializing less risky alternatives to regular cigarettes. And our ambition is to lead the Next Generation Products category worldwide.”" Among these next generation products are E-cigarettes. BAT cites a study that says: “E-cigarettes are around 95% less harmful than tobacco estimates landmark review."

"Taking Advantage of Africa"
BAT's involvement in Africa has been controversial. Realizing that that the demand for tobacco has been in steady decline in the West, it has been argued that BAT has been attempting to export the vice over to countries that aren't as aware of its potential problems and health risks. In 1990, BAT Chairman Barry Bramley spoke about the growing market in Africa and the need to take advantage of it:

"'As you can see, the North American market is expected to continue to decline at a faster rate than elsewhere. Latin America is volatile, but further growth is projected over the next five years. Europe and the Fart East (excluding Kreteks) are expected to decline slowly.  Following a big decline in India due to changes in excise levels, the sub-continent is now growing and further growth is anticipated. Africa is also projected to continue growing.... BAT is strongly placed to take advantage of the growth in these markets.'"

In a 1990 article entitled "Africa: Ashtray of the World" the Sunday Times featured a story of Francis Kabui, who  "started smoking because everyone in the adverts wore shoes.  Today he is dying of cancer. BAT showed him the advert but didn’t warn him that smoking could harm his health ."

BAT has also been accused of acting on two separate standards, one for the west, where people know the health risks of smoking, and one for the third world.

Conclusion
Many of the ethical obstacles that BAT faced can be generalized to other industries. Cigarettes are not the only addictive and abusable substance being offered to the general public. For example, the fast food industry doesn't put warning labels on their "happy meals" showing side effects of overeating, such as heart failure, type two diabetes, and coronary artery disease, and yet these are all linked to obesity rates. Two main ethical questions can be extracted from the BAT case study are as follows:


 * 1. Can companies ethically justify the intentional misleading and confusion created by PR campaigns?


 * 2. Can a company place profits over public health when growth of a product is dependent on the health and well-being of their consumers?

While there will be much debate over where along the spectrum of answers to these questions is correct, it's important to consider the possibilities and the effects they have on the general public as well as the minorities. To a person educated on the subject, the answers might seem trivial, but less than 100 years ago that cigarettes were considered benign. Future discoveries might pull the carpet out from under us on other such products considered harmless today, much like it did to the average American citizen around 1964. Those without the same education programs must also be protected from companies trying to profit off their ignorance. With the onset of the technological age, information is becoming more and more readily available to all, and so exploration becomes harder and harder. BAT might have made some un-ethical choices during their peak of sales, but the lessons learned from their mistakes will help prevent future epidemics, such as the cigarette age, from occurring again.