Tobacco companies forced to tell the truth

It’s about time.

That’s what many people are saying about corrective statements that cigarette manufacturers have been ordered by a U.S. federal court to print in newspapers and magazines and air on television over the next year. That includes Michael Cummings, Ph.D., a member of the Hollings Cancer Center’s Cancer Control Program and co-leader of tobacco control research at the Medical University of South Carolina.

The corrective statement ad campaign is the result a 2006 Department of Justice (DOJ) lawsuit that found that U.S. cigarette companies had conspired intentionally to mislead the public about the risks of cigarette smoking. One of the statements featured in the campaign captures the scope of harm: More people die every year from smoking than from murder, AIDS, suicide, drugs, car crashes, and alcohol combined.
 
Cummings, who helped uncover many of the secret documents that led to the cigarette companies’ guilty verdict in the DOJ case, testifies as an expert witness in litigation against cigarette companies. “The corrective statements are exactly what I speak to juries about in court cases, explaining how the companies lied about nicotine addiction and how they engineer their cigarettes in ways that make them hard to quit.”

The ad campaign has received some criticism, mainly because it has taken so long for the ads to appear and that the ads themselves are so bland that no one will notice them. Cummings has a different take, though.
   
“Forcing people who don’t tell the truth to tell the truth is a good thing. Facts do matter. If we didn’t have facts, we wouldn’t have science driving new cancer treatments. Science cannot tolerate fiction. The truth about smoking certainly matters to our patients and their families,” he said.

Cummings said the corrective statements finally are being published after 11 years of legal wrangling, and it simply reminds him that the cigarette companies are experts at the art of non-confession. “When I see the corrective statements I’m angry. I’m sad it has taken so long. And when I hear tobacco company representatives refer to them as ‘alleged’ factual statements, it makes my blood boil. They knew back in the ’50s their products killed people, and they lied about it. It is time for them to fess up to their actions.”

He’s glad to see smoking rates are decreasing rapidly, especially among teenagers. Reductions in adult smoking are less robust, because once someone gets addicted, it is hard to stop. One of the corrective statements explains why: Cigarette companies intentionally designed cigarettes with enough nicotine to create and sustain addiction. When you smoke, the nicotine actually changes the brain – that’s why quitting is so hard.

The evidence linking cigarette use to lung cancer started to accumulate in the1950s as scientists began to notice the rising rate of lung cancer deaths in the United States closely paralleled the rapid rise in cigarette use. Cigarette smoking increased dramatically in the U.S. in the beginning of the 20th century, largely due to advances in mass production and the introduction of the modern American cigarette blend, which made it easier to inhale nicotine-laced smoke deep into the airways and resulted in millions of addicted smokers, he said.

Nicotine is the addictive drug in tobacco, but its addictiveness is mediated by the delivery system. A patch with nicotine applied to the skin, such as a nicotine patch, is not particularly addictive, because the nicotine is absorbed slowly into the bloodstream. However, nicotine in an aerosol that is inhaled deep into the airways can be highly addictive, as the drug reaches the brain in less than10 seconds, he said. Engineering cigarettes so smokers could easily inhale the nicotine into their lungs resulted in generations of smokers becoming addicted to cigarettes, which in turn led to the rapid rise in lung cancer deaths.

“By the late 50s, there was no debate – cigarette smoking caused lung cancer. The reason people smoke is nicotine addiction.”

Cigarette sales are declining, and companies are looking to potentially safer ways for people to get nicotine, such as vaping products, like e-cigarettes, which research is showing might be a viable substitute for someone who smokes. Citing recently published research like that of MUSC colleague Matt Carpenter, who specializes in nicotine dependence and tobacco control, Cummings said MUSC has a wide range of researchers who are dedicated to unraveling the mysteries of addiction.

There are policy lessons to be learned from the history of the cigarette-lung cancer epidemic as well as the corrective statements, particularly as marijuana becomes legalized in more states, he said. 

“We ought to pay attention to product regulation and harm reduction, not just for tobacco, but also for marijuana. Any time you burn any organic material, it generates carbon monoxide and polycyclic hydrocarbons that could pose health risks to users and healthy bystanders. With legalization, and the opportunities for profits to be made, one can assume companies are going to find ways to sell more and more marijuana, just like they did cigarettes,” he said.

His advice: Treat marijuana as a public health issue.

“In South Carolina, marijuana use is going up, and smoking is going down. Just like tobacco, we should tax marijuana and think about ways to package and control distribution, making sure kids don’t have access to it. Products themselves need to be regulated to ensure they are not made to be highly addictive and more dangerous than they should be. Manufacturers who make defective products and fail to warn their consumers should be held accountable for their actions.”

That highlights another benefit of the corrective statements, in that they put blame on the manufacturers for the addictiveness of the product. Getting this message out helps people avoid blaming themselves for being addicted, he said. “Drug addiction is defined as a chronic, relapsing brain disorder, characterized by compulsive behaviors, despite knowledge of harm. With cigarettes, people have heard it is bad for their health. Nearly all smokers say they regret their decision to start smoking, most wish they could quit. Over half try to quit every year, but of those who try to stop, the vast majority end up relapsing back to smoking.    

MUSC Health offers a hospital-based smoking cessation program for patients who choose to receive assessment and counseling. As standard of care, every patient is asked about his or her smoking status; visited by a bedside counselor for assessment, if the patient opts in; and offered a “quit” plan before being discharged. They also receive follow-up care.

Cummings is proud that every patient has this resource available to them, especially given the fact that this kind of treatment can more than double patients’ odds of success in stopping smoking, he said. Research shows smokers benefit when they are supported through behavioral counseling and offered medication to help them combat nicotine withdrawal. 

“We offer free medication to eligible patients and their family members. We know we are likely to have better outcomes when our patients are supported by their families and friends, so we established a community tobacco control fund that provides smoking cessation medications to patients and family members who cannot afford them,” said Cummings.  

“Addiction is not like a light switch that can be turned on and off. Overcoming addiction can be a lifelong journey for many people. When patients come to receive health care at MUSC, it provides a teachable moment to educate them about nicotine addiction and offer treatment services to help them overcome their addiction to cigarettes,” he said, emphasizing it’s not just a matter of willpower.

“We need to stop stigmatizing those who struggle with cigarette addiction and treat it for what it is – a physiological medical problem that benefits from treatment. We need to develop better treatments for nicotine addiction, which is what much of our research is all about. If someone is struggling with nicotine addiction, we’re here to help you. We will hold your hand.”