A ruling Monday by federal Judge Richard J. Leon is not friendly to public health. Leon sided with tobacco companies to block, at least for now, a Food and Drug Administration requirement that cigarette packages include images that illustrate the risks of smoking, along with a phone number (1-800-QUIT-NOW) where people can get help. In effect, the ruling will contribute in some way to the deaths of 443,000 Americans annually in the name of corporate free speech.
As with many free-speech issues, the ruling has generated a flurry of public debate. My colleague Rob Field, blogging today on Check Up, weighs in on the government's role. Here is my take, and the supporting research, on why a few of the main arguments against the warnings are bunk:
Claim 1: People already know that smoking is bad. To an extent, but not completely. Sure, people generally know that smoking is not good for them. But research has shown that those with lower socioeconomic status have lower levels of awareness about the harms of smoking. Low-income adults, it turns out, were also nearly three times as likely to smoke in 2010 than were those earning over $50,000 a year. Studies suggest that this might have something to do with low literacy levels (which happen to apply to about 20% of American adults). The addition of images to written warnings has the potential to reduce this disparity.
Claim 2: The images are overly graphic and disturbing. I disagree, and you should take a look at the images and decide for yourself. Of the 9 FDA-approved images, 4 are not the slightest bit disturbing to me (a woman crying, for example, and a burly man wearing a shirt stating that he quit smoking). The remainder, which you can click through in a slide show, are no more graphic or disturbing than what routinely appears in prime time on network television.
Claim 3: The images won't have an impact. The research, while limited, suggests otherwise. An international survey of 14 countries that require graphic warnings to be displayed on cigarette packages found that most smokers noticed the warnings. In six of the countries, more than 50 percent of those smokers reported wanting to quit as a result. More than 25 percent had the same reaction in all the other countries surveyed except one (smokers in Poland weren't particularly moved by the images).
While solid research on the effectiveness of graphic warnings on cigarette packages is still lacking, the research on the harms of smoking is air-tight. Smoking is indisputably bad for you. From a public health perspective, the fewer people who smoke the better. End of story. While the warnings' potential impact on smoking rates in the U.S. has not been proven, there is plenty of evidence that they are a step in the right direction.
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