Tell people that smoking is one of the major problems of the modern world and you’ll get quite a few surprised reactions: 

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“Wait – wasn’t that a battle we fought and won? Tobacco is heavily regulated now. And anyway, isn’t smoking way down?”

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But take a look at the figures and you’ll see the reality is not so rosy. In the Netherlands, smoking is by far the biggest risk factor for preventable death. Globally, the problem is even bigger, with tobacco killing 8 million people a year; a number that is only going up. 

Our image of smoking as a problem that will solve itself is an illusion: a tall tale that the tobacco industry keeps telling us. For although the percentage of people who smoke is steadily waning (in wealthy countries), this is more than “compensated” by global population growth and the increasing popularity of smoking in poorer countries. Overall, the number of tobacco industry victims – and industry profits – have only grown. 

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And here’s the thing: the mass addiction to cigarettes is not some natural phenomenon, but the result of deliberate and concerted efforts by a whole industry. An industry with an annual turnover of almost 900 billion dollars and decades of experience dodging laws and regulations. An industry that we need our best lawyers, lobbyists and activists to take on, because it will never stop trying to hook people on its own.

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“If we ban cigarettes, what’s next?”

Which brings us to the second misconception about smoking: that it’s a “free choice”. 

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Only mention restrictions on smoking and you’ll be pummeled with accusations of “paternalism”. Because, if we go after the tobacco industry, what’s next? If people want to consume cigarettes, beer, wine, candy and other stuff that’s bad for them, it’s their choice to make, isn’t it? 

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The problem with this “free choice” argument is that, for most smokers, it’s not: 80 percent say they want to quit and one-third have made a serious attempt to quit in the past year. The comparison often made with alcohol consumption also doesn’t wash for this reason: only 3 to 4 percent of people who drink alcohol are addicted, and most consider it an enjoyable part of their lives.

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What about the decision to start smoking? Isn’t that a free choice? This idea doesn’t hold up either, because the vast majority of smokers start lighting up in their teens.

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Research by the Trimbos Institute found that the average age at which people in the Netherlands take up smoking is 17, and that two-thirds start before reaching 18 (and almost all smokers start before the age of 26). Plus, the younger smokers are when they start, the more cigarettes they smoke and the harder it is for them to quit.

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When you lay out the facts, we’re dealing with a product that hooks people at a young age, right when their brains are most susceptible to nicotine. So, just how is that a “free choice”?

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Engineered for addiction

It’s no accident that modern cigarettes are so powerfully addictive. They were deliberately made to be as addictive as possible. 

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“[W]e’re talking about one of the most carefully (and craftily) designed objects on the planet,” the historian Robert N. Proctor writes in his authoritative book on the tobacco industry. “Billions of dollars have been poured into the black arts of cigarette science.”

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It starts with the actual “tobacco” in cigarettes, which is only two-thirds pure tobacco. Inhaling tobacco pure is rough, so manufacturers put in additives to suppress coughing and flavor enhancers like sugar, cocoa powder and licorice that make smoking less unpleasant and also significantly more carcinogenic.

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Then there is the process known as freebasing, which is the use of ammonia to speed nicotine absorption by the brain. Freebasing is a technique invented by researchers at Philip Morris in the 1960s and 70s to get around rules limiting nicotine levels in cigarettes. It enabled the company to use smaller amounts of nicotine to get people hooked as fast or even faster and, according to some historians, is the real secret behind Marlboro’s success (long the world’s biggest cigarette brand, owned by Philip Morris).

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There are plenty more things Big Tobacco does to dodge the rules. Cigarette filters were ostensibly introduced to block harmful particles, yet in internal documents Philip Morris itself described the idea of “selective filtration” as a “thermodynamic impossibility.” The same goes for “ventilation holes” in filters. In the smoking machines used to test cigarettes, these perforations dilute the smoke with clean air to give readings suggesting ventilated cigarettes are less harmful. But manufacturers know full well that smokers cover the holes with their fingers and lips, and in practice the product is no less harmful or habit-forming.

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A final way the tobacco industry is dodging the rules is with e-cigarettes, or “vapes.” Using marketing that illegally targets children, they peddle vapes as a “safer” way to smoke. This tactic has proved alarmingly successful. Dutch pediatricians recently warned that one in five young people has taken up vaping, pointing to research that shows that kids who vape are three times more likely to start smoking and that vaping itself is extremely harmful to health.

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A smoke-free future

It seems the many-headed monster of Big Tobacco has never really been defeated. With each new restriction that is imposed, manufacturers slyly open two more side doors. 

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Such as when the World Health Organization adopted the Framework Convention on Tobacco Control (FCTC) in 2003, prohibiting contacts between health policymakers and the tobacco industry. It marked an important step, yet in practice ties between government and tobacco companies were never severed at all, and these companies regularly recruit senior health ministry officials to work in the industry.

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Or take industry messaging around one of the most effective measures to reduce smoking. Higher taxation has repeatedly proven an effective way to tackle tobacco use, particularly among youth and poorer populations. In response, the industry is fighting tooth and nail to convince policymakers that raising excise taxes would intensify illicit trade, even though the evidence shows otherwise.

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These are but a few tactics from the tobacco industry’s playbook for opposing anti-tobacco policies, running the gamut from promoting harm reduction to promising a “smoke-free future.”

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If we are to defeat this many-headed monster once and for all, we need individuals with the courage and the tenacity to confront it head-on. Individuals like lung specialist and activist Wanda de Kanter, who are unafraid to challenge powerful people about tobacco industry ties. But also lobbyists, lawyers, tax experts and consultants – of which there are many in the ranks of Big Tobacco but too few on the side of public health.

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What all of these individuals must share in common is a refusal to settle for half-measures. And a clear objective: the complete phase-out of the sale and production of cigarettes. 

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We have cause to be optimistic. The United Kingdom has shown that a smoke-free future is within political reach. But as long as there is an industry that deliberately sets out to fool and hook us, that future is far from certain. 

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Translation by Elizabeth Manton

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