1. You are known worldwide as an expert on, and public advocate against, the use and promotion of tobacco products. How did you first become interested in this widespread health issue?
My father, a family doctor in Rockaway Beach, New York, was my inspiration. He recognized the devastating impact of smoking when he himself—a physician in his 40s who had smoked two packs of Chesterfield cigarettes a day since medical school—suffered a heart attack. Even though he was athletic and physically active, he knew that smoking had had a devastating impact on his life.
But consider that in the 1950s, two-thirds of doctors still smoked. Cigarette ads continued to be published in the Journal of the American Medical Association until 1954 (and tobacco companies continued to give out cartons of cigarettes at some state medical association meetings until the 1980s!). One popular commercial of the early-1950s claimed that “more doctors smoke Camels than any other cigarette.” One day when my father and I were watching a Brooklyn Dodgers game on TV, sponsored by Lucky Strike, he urged me to tape-record the between-innings ads. That’s when I started tracking the tobacco industry like a parasitic disease. My father predicted that future generations would never believe that sports and smoking could have been promoted together. Yet this association continued in the US for another 50 years, by means of cigarette billboards in baseball and football stadiums and in sponsorships of televised sports such as Winston Cup Racing and the Marlboro Grand Prix.[2,3]
2. What do you feel is the most important historic milestone elevating public awareness of, or protection against, the harms of tobacco use?
In my opinion, the landmark medical publication of the 20th century in the US was the 1964 report on smoking and health by the Advisory Committee to the Surgeon General of the US Public Health Service. The major conclusion was blunt, sobering, and unequivocal: “cigarette smoking is causally related to lung cancer in men, far outweighing all other factors.” Moreover, noted Surgeon General Dr. Luther Terry at the press conference at which he released the report, smoking is “a health hazard of sufficient importance to warrant appropriate remedial action.”
But the American Medical Association (AMA) did not immediately join most of the world’s health organizations in endorsing the report, choosing instead to collaborate with the tobacco industry for the next 14 years on more research. The AMA would accept over $18 million from the tobacco companies for this effort, only to conclude in 1978 that the Surgeon General’s report had been right all along. Not until the mid-1980s, by which time Surgeon General Dr. C. Everett Koop had gained popularity for using the office of Surgeon General as a bully pulpit to campaign against smoking, did the AMA jump on the bandwagon. I believe that the three theme issues on tobacco problems that I edited for the New York State Journal of Medicine and the Medical Journal of Australia—the first issues of any medical journal ever devoted entirely to a consideration of ending the world cigarette pandemic—also helped galvanize the involvement of the medical and public health communities into taking a more active role in standing up to the tobacco industry and its allies.[5-8]
3. In 1977, you founded Doctors Ought to Care (DOC), which you have described as the first medical organization dedicated to ending the tobacco pandemic. Can you share some of its public awareness activities?
DOC was the first dues-paying physicians’ group devoted entirely to health promotion. As a resident in family medicine at the University of Miami, I began recruiting residents and medical students through the American Academy of Family Physicians. We started chapters in over 100 medical schools and family medicine residency programs. One hundred percent of our budget was devoted to countering the promotion of unhealthy products by means of paid advertising space in the mass media.
Joined by my colleague Dr. Rick Richards, we began buying ads on bus benches in Miami, Florida and Spartanburg, South Carolina with satirical slogans such as “Country Fresh Arsenic” (instead of Philip Morris’ “Marlboro Country”), “Arctic Lungs” (instead of the actual brand, Brown & Williamson’s “Arctic Lights”), and “Emphysema: The Disease That Takes a Decade to Make” (instead of Liggett & Myers’ “Decade: The Taste That Took 10 Years to Make”). We had to turn to bus benches because billboard companies would not sell us space once they realized we would be employing Mad magazine–style parodies to ridicule tobacco companies—their top customers. Our goal was to shift the focus away from smokers, nicotine addiction, and lung cancer and instead onto the pushers, their products, and their promotions.
We also created mock sports events at arenas and university campuses such as the Emphysema Slims Tennis Tournament and the Deadman Chew Softball League; sponsored the US Boomerang Team and a variety of professional motor racing vehicles; and led satirical protests (we called them “housecalls”) at dozens of tobacco-sponsored cultural and sports events throughout the US.
Our modus operandi was to use laughter and ridicule to get people to think differently about cigarettes and the tobacco industry. Thomas More famously said, “The devil can’t stand to be mocked.” In other words, the tobacco industry relished fending off claims that smoking was dangerous to health by giving money to universities and medical organizations to do more research aimed at identifying and removing any constituents of tobacco smoke that caused cancer. But the industry didn’t like to see ad campaigns by doctors that debunked cigarette filters, menthol brands, “light” and “ultra-light” cigarettes, and the very notion that smoking could be made safer. DOC spent thousands of dollars every year on such advertising in various media, including newspaper and magazine ads and TV and radio commercials, hoping to inspire the major health organizations, foundations, and government health agencies to do the same.[10,11] Although the federal government has long spent millions of dollars a year on paid advertising, such as to recruit teenagers into the military, it wasn’t until 2012 that any significant amount of federal funds was spent on anti-smoking ads in the mass media. That was the year the the Centers for Disease Control and Prevention launched its $48 million national campaign “Tips From Former Smokers™”, which the agency claims was both successful and cost-effective in reducing the prevalence of cigarette smoking.
I believe the most glaring failure of the public health and medical communities in the 20th century—and, for that matter, of the pharmaceutical, hospital, and insurance industries—was not putting their money where their mouth is to counteract the leading preventable cause of cancer.
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6. The world cigarette pandemic, part II. New York State J Med. 1985;85:279-477.
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18. Blum A. Ethical investors failed to spread the word. Financial Times. October 25, 2013, p 8.
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20. Wilson D. Philip Morris’s support casts shadow over a bill to limit tobacco. New York Times. March 31, 2009. http://www.nytimes.com/2009/04/01/business/01tobacco.html. Accessed December 28, 2016.
21. Barker KG. Thank you for regulating: why Philip Morris’ embrace of FDA regulation helps the company but harms the agency. Admin Law Rev. 2009;61:197-224.
22. National Institutes of Health: Office of Disease Prevention. Centers Research Portfolio. https://prevention.nih.gov/tobacco-regulatory-science-program/research-portfolio/centers. Accessed on December 19, 2016.
23. Blum A. Ethics of tobacco funded research in US medical schools. Tobacco Control. 1992;1:244-5
24. Blum A. Alchemy, the safer cigarette, and Philip Morris. Lancet. 2008;371:1644-6.
25. Blum A. Big tobacco has surprising friends. Tuscaloosa News. March 27, 2015, p 6A.
26. Ong MBHO. Tobacco interests contribute a portion of the $109 million raised by SU2C. Cancer Letter. Sep 12, 2014. http://cancerletter.com/articles/20140912_2/. Accessed December 19, 2016.