Forty years after the Surgeon General’s report, we are still wandering in the desert, almost as far away from the Promised Land as we were when we began the journey. Progress has come about so slowly because of a combination of political clout and lucrative payoffs to the very forces that should have been in the vanguard to end the tobacco pandemic. Congress (Democrat and Republican representatives alike), the mass media, medical organizations, and academia have all been chronic recipients of largess from the tobacco industry, and have not been prepared to bite the hand that fed them.
Meanwhile the health community has carried on, bouncing from one failed multimillion dollar public-relations crusade after another only to settle each time for voluntary agreements crafted by the tobacco industry.
The U.S. public health community has also put its faith in mirages: safer cigarettes that promise to reduce death and disease, policy coalitions that propose prohibitionist legislation, personal injury lawsuits against the tobacco companies, and state attorneys-general who worship the golden calf of tobacco cash settlements. Medical school curricula remain devoid of comprehensive interdisciplinary instruction to address and tackle tobacco problems.
The flow of Big Money from Big Tobacco—hundreds of millions of dollars handed over to the states under the Master Settlement Agreement negotiated by the tobacco companies with the attorneys-general in 1998—has fooled anti-smoking groups into thinking that they would at long last be able to buy the best minds in the advertising game for major campaigns in the mass media. It did not happen.