Tobacco and Public Health - TCSC Indonesia

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PREFACE
from legal recourse, and possesses enormous political influence and economic power
that it is willing to use to undermine public health efforts (Orey 1999; Kessler 2000).
In addition, it sells a highly addictive product that, ironically, makes many of its
most debilitated consumers its strongest supporters (Taylor 1984; Kluger 1996;
Givel and Glantz 2001). By way of contrast, there are probably few malaria-afflicted
persons who would fight for their ‘right’ to continue to be exposed to the mosquitoes
spreading this disease, nor are HIV-afflicted persons lobbying for the right of
other persons to willfully afflict others with the disease, but there is a ‘smokers rights’
movement, which must be appropriately addressed and hopefully recruited to the side
of public health.
The enormity and complexity of the public health assault demands a broad and
sophisticated public health response. I would like to take this opportunity to comment
briefly on what I believe should be our vision for health, and how we can achieve it.
I will begin with a few additional comments on how we got to this place in the epidemic,
because an understanding of these issues is crucial in addressing the problem.
Historical perspective
Tobacco use and addiction have existed for centuries, and there surely was resultant
death and disease (Corti 1931; US DHHS 1989). However, tobacco-based mass destruction
of life on a global scale was only possible with the emergence of multinational
companies capable of the daily production and distribution of billions of units of the
most destructive of all forms of tobacco—the cigarette. Further, the modern cigarette
has extraordinarily toxic and addictive capability: its increasingly smooth and alkaline
smoke both enable, and require, inhalation of the toxins deep into the lungs to maximize
nicotine absorption. James Albert Bonsack, who invented the modern cigarette
machine, also deserves some discredit; however, if he hadn’t invented it, someone else
would have done so soon enough.
In the early days of the industry’s growth, tobacco manufacturing and selling might
have appeared to be a legitimate form of consumer product development and marketing.
However, there were two important distinctions between legitimate consumer marketing
and the tobacco industry that were not generally recognized until decades after the
industry was well entrenched in the economic and political framework of many countries,
and the fabric of their cultures. The first distinction was clearly appreciated by
the first modern cigarette marketers, i.e. following a few occasions of smoking, many
cigarette smokers would come to be as addicted to their daily fix of tobacco as other
drug addicts become to their form of narcotic. The industry discovered that nicotine
was critical to this process (US DHHS 1988; Slade et al. 1995; Hurt and Robertson
1998; Kessler 2000). The second distinction was that cigarette smoking carried a substantial
risk of lung cancer, as discovered in the pioneering studies of Richard Doll,
Alton Ochsner, Ernst Wynder, and others in the 1950s (Wynder 1997).