Gruesome Images, Smoking, and Australia

Back in 2011, we wrote about proposed legislation that would have required US tobacco companies to put graphic warning labels on cigarettes, similar to what is now done in Canada. The suggested labels featured gruesome images, such as corpses with diseased chests, lungs blackened by cigarette smoke juxtaposed with pictures of healthy lungs, or tumors afflicting various body parts. Under the photos, the text would have read something like, “Warning: Cigarettes are Addictive.” The legislation called for nine variations on the theme and would have required the boxes to feature the images on half of the front surface, still allowing some space for branding.

Three years later, the best-selling Marlboro brand still sports a slick red-and-white package featuring the slogan, “20 Class A Cigarettes” on the front. There are no corpses, no diseased lungs, no cancer-riddled body parts to scare preteens from taking up the habit. In fact, the only image on the box is a coat of arms that makes the package look, somehow, connected to royalty.

What happened to the scary-box campaign? It turns out, not surprisingly, that R.J. Reynolds and other tobacco companies banded together and sued to block the graphic labels from ever seeing the light of day. ¹ “F.D.A.’s graphic cigarette rule goes up in smoke after U.S. abandons appeal.” 19 March 2013. CBS News. 12 June 2014. http://www.cbsnews.com/news/fdas-graphic-cigarette-labels-rule-goes-up-in-smoke-after-us-abandons-appeal/ Also not surprisingly, they won their case in a federal appeals court on the grounds that the labels violated their free speech rights and that there was no good evidence to prove that the labels would reduce rates of smoking. In the end, the FDA decided to drop the proposal rather than appeal to the Supreme Court. Supposedly, the Agency went back to the drawing board to come up with some new, less provocative labels.

A few months after the dust from the case had settled, the journal Tobacco Control published a study concluding that the data provided by the FDA to the courts-the data that inspired the courts to shoot down the graphic labeling proposal-was flawed, but not in the way you might think. ² “New Study: FDA Vastly Underestimated How Much Graphic Cigarette Warnings Would Reduce Smoking in U.S.” 25 November 2013. PR Newswire. http://news.yahoo.com/study-fda-vastly-underestimated-much-graphic-cigarette-warnings-154900064.html   In fact, the study found that the FDA had grossly underestimated the impact graphic labeling was having in the Canadian market.

According to study director Matthew L. Myers, “The graphic warnings reduced smoking rates in Canada by 12 to 20 percent from 2000 to 2009.  Based on these findings, the study concluded that the impact of graphic warnings on smoking rates in the U.S. would have been 33 to 53 times larger than the FDA estimated.” The upshot, says Myers, is that the labels would have resulted in up to 8.6 million fewer smokers.

On closer inspection, the blunder made by the Agency seems remarkable. It turns out that in analyzing the Canadian data, the FDA concluded that price, rather than graphic packaging, played the greatest role in controlling smoking. Smoking rates did decline in Canada after graphic labels were introduced, but the FDA attributed that change largely to the rising expense of cigarettes. It turns out, though, that cigarette prices actually declined by four percent during the duration of the study. The FDA used cigarette excise tax rates rather than actual prices paid by smokers to calculate the changes in smoking rates attributable to cigarette prices, and so the results were quite skewed. This mistake led the FDA to overestimate the impact of price increases and underestimate the efficacy of the graphic warnings.

Again, the data from the Canadian study was one of the chief determinants the US courts used to rule against graphic labels. Suspicious minds might wonder what influenced the FDA to make so obvious a mistake. In any event, other studies have found that graphic labeling definitely works, leading 60 countries worldwide to now require such labels on cigarette packages.

Meanwhile, Australia has transcended the American version of graphic labeling and gone to the next level. Australian law calls for “plain packaging,” which means that cigarettes come in dull brown packages that sport no logos or taglines at all.³ Bosely, Sarah. “Government urged to act quickly on plain cigarette packaging.” 10 June 2014. The Guardian. 12 June 2014. http://www.theguardian.com/society/2014/jun/10/government-plain-cigarette-packaging-delay-tobacco The packages instead show grizzly images and warnings that take up the entire surface.  In practice, this means that cigarettes in Australia come wrapped with such unmistakable and vulgar death warnings that it’s a wonder anyone would touch the box, much less partake of its contents. For instance, one box says “Smoking Causes Mouth Cancer” in bold caps across the top. Below the text, the image shows a close-up of a diseased open mouth with a huge tumor in it. Other packages show gangrened limbs and cancerous eyeballs, all very horror-show and gross. Samples of the labels were published in The Guardian.⁴ Sarah Boseley. “Government urged to act quickly on plain cigarette packaging.” The Guardian, 10 June 2014. (Accessed 12 June 2014.) http://www.theguardian.com/society/2014/jun/10/government-plain-cigarette-packaging-delay-tobacco

An article in the New York Times says the Australian plan is working. In the 15 months since plain packaging with graphics was introduced, cigarette consumption has steadily declined.⁵ Innis, Michelle. “Australia’s Graphic Cigarette Pack Warnings Appear to Work.” 11 June 2014. New York Times. 12 June 2014. http://www.nytimes.com/2014/06/12/business/international/australias-graphic-cigarette-pack-warnings-appear-to-work.html In the first quarter of this year, tobacco consumption fell by 7.6 percent. Last year, the decline was 4.9 percent. While these are impressive changes, the more extraordinary fact is, again, that anyone in Australia would smoke at all given the dire appearance of the packaging. Also, Australia has introduced higher cigarette taxes, which might also influence smoking rates.

Other countries are edging toward following the Australian example. In Great Britain, for one, 600 physicians and medical experts signed a petition urging the government to hurry up and implement plain packaging as a deterrent to young people who might otherwise be tempted to start smoking. Ireland already has introduced plain packaging legislation. The tobacco companies intend to fight the proposed labeling changes, of course.

By the way, the tobacco companies dispute Australia’s claims that smoking is on the decline. Scott McIntyre, a spokesman for the British Tobacco Company-which supplies 45 percent of Australia’s cigarettes-says, “A year after plain packaging was introduced, industry volumes had actually grown for the first time in over a decade,” and the decline in the number of people smoking “has slowed by more than half to 1.4 percent.”

What isn’t clear is if the increase McIntyre refers to includes worldwide statistics, or just Australian; and it isn’t possible to verify his remarks because the company refuses to release its data. Sounds like yet more smoke and mirrors intended to keep the graphic labels in the closet.