Three weeks ago, I commented on the Physicians for a Smoke-Free Canada (PSC) proposal for a government buyout of Canadian tobacco manufacturers, with the government to run the country's tobacco business or see to its administration by a non-profit entity. At that time, I was analyzing the PSC summary of the proposal, but had not read the entire book that describes and defends the proposal.
I have now read the book and will comment on it (see: Callard C, Thompson D, Collishaw N. Curing the Addiction to Profits: A Supply-Side Approach to Phasing Out Tobacco. Ottawa: Canadian Centre for Policy Alternatives and physicians for a Smoke-Free Canada, 2005).
The basic premise of the book is that the chief problem with tobacco products in our society is that the tobacco industry which produces, sells, and markets them is a for-profit industry that has no inherent interest in doing anything but making a profit, and therefore it opposes and undermines any public health efforts (e.g., laws, policies, and programs) to attempt to reduce tobacco consumption.
The proposed solution is to have the government buy out the tobacco industry and place it in the hands of a non-profit corporation (such as a public interest enterprise, non-profit business, or publicly-owned enterprise), which would produce and sell tobacco products, but without huge marketing expenditures and without opposing public health efforts to reduce tobacco consumption.
The premise, succinctly put, is that "we can be more effective by transforming big tobacco into a public health ally." ... "There is no reason that tobacco 'has to' be sold by business corporations. There are many other institutional forms to whom the business of providing tobacco could be entrusted." ... We need to "move on to an era of a cooperative tobacco industry that helps us to reduce tobacco consumption." ... The goal is "to remove the corporate behavior that impedes reducing the problems that tobacco causes. ... We can choose a tobacco industry that works to support and promote health protection measures instead of one which undermines them."
The proposal will "point the way forward for a tobacco manufacturer that could help promote public health, instead of promoting tobacco consumption." ... It would "help create a corporate culture of commitment to public health improvement. All employees would become part of an exciting new public health enterprise. Instead of selling more and more cigarettes, the corporation would actually give customers what the vast majority of them want - help with quitting smoking."
"Our proposal," the book argues, "provides users with the substance they want, while offering assistance in quitting to the vast majority who do want to quit."
The legislated mission of the non-profit corporation would be "to take all steps within its power to reduce tobacco consumption...".
The estimated cost of buying out the tobacco industry in Canada is $15 billion. How would this money be re-captured? According to the book: "A portion of the purchase cost debt could be repaid by future revenues from the sale of tobacco products. ... After the debt is paid off, the profits from the industry, once they paid off the debt, could contribute significantly to government coffers."
The Rest of the Story
After reading the book, I think this has got to be one of the most absurd public health ideas I have ever heard.
Right off the bat, putting the government in a $15 billion hole (that's the estimated cost to buy out the tobacco industry in Canada), with the only way out of that hole being to sell cigarettes that are going to kill thousands of Canadians, seems crazy to me. What it would do is to make the government dependent on killing people, essentially, in order to remain solvent. That is insane to me.
Not only that, but once the debt is paid off, the government will be filling its coffers with tobacco revenues, as admitted in the book, and this money will certainly be used to fund government programs and services. Thus, the government will become addicted to tobacco money; it will be heavily dependent on sustained tobacco consumption for its own sustenance.
These are certainly not the conditions under which tobacco consumption could reasonably be expected to drop drastically, as the book posits it will. It will destroy any incentive whatsoever for the government (at both the national and provincial levels - since tobacco revenues would fill coffers of both) to enact effective policies to reduce tobacco use. Doing so would result in economic harm.
We have already witnessed, here in the U.S., what the Master Settlement Agreement has done in terms of protecting the tobacco industry's interests by creating a partnership with the states, who are now dependent upon tobacco revenues to fund critical programs and services.
It is difficult enough to get policy makers to take appropriate actions that are necessary to effectively address the public health problem of tobacco use. The last thing in the world I would recommend is making the government irretrievably dependent upon tobacco revenues for its own solvency.
Perhaps even more absurd than the plan itself is the reasoning behind it. The premise is essentially that tobacco is a public health problem because the cigarette companies are making profits off of it and the profit incentive causes the tobacco industry to oppose and undermine public health programs to reduce tobacco use.
That's not how I define tobacco as a public health problem. To me, tobacco is a public health problem because it kills large numbers of people. I don't care who is making profit off of it, if anyone. It is the fact that tobacco is killing people that makes this a problem, not who is selling it and who is profiting from it and what incentive particular groups have to take particular actions. Taking away the profit motive doesn't take away the fundamental problem: tobacco products are deadly. Period.
A fundamental flaw in the argument presented in "Curing the Addiction to Profits" is that it is even possible for a tobacco industry to be a "public health ally." How can a corporation that is producing a product that is killing thousands of citizens be a public health ally? It's just a ludicrous concept.
Taking away the profit motive does not suddenly make a tobacco manufacturer a public health ally. If you are producing a product that kills thousands of people, you are no friend to public health in my book. I don't care how much you might work to try to dissuade people from smoking. The fact is - you're producing a product that is killing people - and that precludes you, in my view, from being a friend to the public's health.
And you can't with a straight face legislate the goal of the non-profit entity as being "to take all steps within its power to reduce tobacco consumption" because one step that would certainly be within the power of the corporation would be to stop producing the product and therefore to stop killing people. By definition, the legislative mandate of the corporation would be to produce the product and continue to kill people.
Another fundamental flaw in the argument presented is the fantasy-like assertion that the elimination of the profit motive and the concomitant elimination of massive advertising and promotion expenditures to market cigarettes is going to result in the virtual elimination of demand for cigarettes.
I won't quibble with the claim that cigarette consumption would be reduced if cigarette marketing were eliminated, but I certainly don't find any reasonable evidence that it would end the demand for cigarettes.
What the proponents of this idea don't seem to realize is that the greatest marketing for cigarette use is the product itself. It is seeing other people smoking that is the greatest and most effective advertisement for cigarettes. You can take cigarette ads off all the billboards and out of all the magazines and you can stop paying retailers to stock certain brands and offer price discounts, but as long as people are smoking the product, it is going to market itself.
Producing a product that people can use and making the product easily available to them are perhaps the top two marketing tools available, and those marketing tools would most certainly be used by the non-profit corporation to "promote" its products, even in the absence of traditional advertising.
The book suggests that cigarette consumption in Canada will drop to zero by 2030 based on an linear extrapolation of smoking prevalence trends over the past five years. That is scientifically fallacious in my opinion. To begin with, it's cherry-picking. One could choose any period in which consumption is falling and conclude that the trend will continue. But if you look at the overall trends in smoking in Canada (or in the U.S), you will see that the rate of decline in smoking has greatly slowed down. One would not expect the rates to continue to decline at this pace, especially since the remaining smokers will represent a much more heavily addicted and more resilient group over time.
In fact, I don't see any convincing argument in the book for why tobacco consumption will decline rapidly in Canada after "de-profitization" of the tobacco industry.
In many ways, the book is suggesting that the solution to the problem is to structure the tobacco industry in a way similar to that in a country like China, where the tobacco industry is a state-run enterprise: a state monopoly. But arguably, the problem of tobacco use in China is the world's greatest public health problem: it is killing nearly 1 million people each year. Clearly, it's not the competitive market and profit motive that's killing people - it's the cigarettes!
On top of all of this, the book proposes to deny Canadian citizens of their legal rights to hold the tobacco industry accountable for damages caused by their products: "there would be no more need for tobacco litigation. ... The member/shareholders, directors and managers in the new organizations would need to be legislatively protected from lawsuits for the past wrongs of the for-profit tobacco industry."
Canadian citizens would be stripped of their legal rights and the non-profit entity would be essentially non-accountable to citizens through the legal system. I think this represents an intrusion into the civil justice system and an interference with individual rights that would be highly questionable even if the proposal were tenable, but it is unthinkable in a situation were the proposal is this absurd.
In all fairness to Physicians for a Smoke-Free Canada, they are not the first to propose such an absurd idea. The first I heard of this idea was from none other than former FDA Commissioner Dr. David Kessler, who in his book "A Question of Intent: A Great American Battle with a Deadly Industry," proposes a very similar "solution" to the tobacco problem.
I think it is a shame that the book, after pages and pages of data about how terrible it is that people are smoking such a deadly product, concludes by suggesting that the solution is simply to have the government buy out the industry and transfer it to a non-profit entity, who would now be the ones to produce, sell, and reap in revenues from this deadly product.
The rest of the story suggests to me that the problem of tobacco is not going to be solved until first, public health practitioners are able to define the problem of tobacco. Tobacco is not a public health problem because an industry makes profits off of it or because the incentives to decrease tobacco use are non-existent in the industry or because the industry opposes and undermines public health measures. Tobacco is a public health problem because it kills a lot of people. Until we can define the problem properly, we're not going to solve anything.