The other report cited an astonishing decline in advertising by U.S. tobacco companies, with advertising spending down from $932 million in 1985 to just $56 million in 2005. Thus, 2005 advertising spending was just 6% of what tobacco firms had spent two decades earlier. The report added that tobacco firms still spent $13.1 billion total on advertising and promotions in 2005, with in-store promotions such as price discounting programs accounting for much of that figure.

While some would say they feel sorry for imperiled tobacco workers, others would stress that good people can always find good jobs. Picture farm workers in Colombia losing jobs when their cocaine and marijuana crops are dusted with insecticides. Landowners who hire such workers choose to make money from lethal products instead of making a living growing crops that would feed people.

Building momentum

Lest you think I'm being too harsh, pharmacologically nicotine is a highly toxic chemical sometimes used in animal tranquilizers and insecticides. Just because the world has a tradition of smoking tobacco doesn't mean we have to put up with dangerous second-hand cigarette smoke and fetal effects resulting from pregnant women's smoking. All indications are that nicotine has the highest risk of producing dependence of all abused chemicals.1 Non-smoking policies in workplaces and public areas suggest most everyone is getting tired of the products.

We must remain aware that tobacco companies will focus toward other countries where their products are still used. Europe is one destination, although it is only a matter of time until sales there fall dramatically as well (Great Britain, for example, has just become smoke-free indoors). And of course, tobacco companies are still selling a legal product. If the U.S. should ever prohibit cigarettes, black-market cigarettes undoubtedly will turn up, probably at very high prices and with accompanying crime scenarios perhaps as bad as what was seen during Prohibition.

The current period offers the best chance the U.S. ever has had to ditch a legal but lethal drug through public outcry. It is important that the public keep up the pressure—not against tobacco companies, but against the product itself. Companies are highly resilient—if their products decline in popularity, they will find another way to make money. In the case of tobacco products, which have no public health value but cause great public health harm, it should be easy to maintain pressure.

What about alcohol?

Could this approach also work with alcohol? Even though alcohol has a huge public health downside, it is so established in the fabric of American society (weddings, religious ceremonies, sporting events, meals, etc.) that we are unlikely ever to see a consensus attack against alcohol, especially with the lessons learned from Prohibition long ago.

Continuing to educate children about tobacco's harms is critical. Smoking rates are declining, fewer new smokers are lighting up, and addiction treatment centers are finding that most patients can stop smoking and using other substances at the same time, enhancing treatment's long-term outcomes. Past columns have cited the emergence of important medications such as bupropion and varenicline, along with nicotine replacement therapies and counseling. These tools are allowing the field to help many more people than in the past.

This is a classic case of winning by demand reduction, not supply reduction, and we can expect to see even more pressure against tobacco in the future. Someday, history lessons will begin like this: “In the old days, tobacco products were used in U.S. society. The sticks and chaws of tobacco were too harmful, however, so today such products are no longer available.”