Vol. 4 No. 7 (July, 1994) pp. 91-92
SMOKING POLICY: LAW, POLITICS, & CULTURE by Robert L. Rabin
and Stephen D. Sugarman (Editors). New York: Oxford University
Press, 1993. 243 pp.
Reviewed by A. Lee Fritschler, President, Dickinson College,
Carlisle, Pennsylvania.
The ill effects of smoking on health is an issue which will not
die; it is an area of public policy which seems to have achieved
a life of its own. Starting with the Surgeon General's report in
1964, the smoking and health controversy has attracted the
attention of scientists, both soft and hard, lawyers, media
specialists and to a surprisingly large extent, the general
public. When things seem to quiet down, new revelations appear.
The latest round includes indications that nicotine is allegedly
addictive, and that cigarette manufacturing executives knew from
the beginning that their product was unsafe and habit forming.
According to recently released internal memoranda, they did a
great deal to discourage the release of the unfavorable, even
damning information they had before them in the 1960s.
SMOKING POLICY is the flowering of the social science perspective
on the smoking and health issue. The authors use social science
approaches to the subject to illustrate the wide range of
implications, social, political and legal, which are associated
with the issue. All of its contributors are Californians. They
deserve our congratulations for producing very thorough and
interesting studies of this important public policy area.
Although the book is dense with facts and theories, it is
engrossing and rewarding. Robert Kagan and David Vogel examine
smoking regulations in three countries, Canada, France and the
United States. Their socio-political findings relating to the
nature of those societies explain the various approaches to
regulations those three countries have taken over the past
several years. Accordingly, their conclusions about the
reluctance to regulate smoking or consumption head-on in this
country, rests on our positive views of individualism and
negative views on paternalism.
The Canadian and French governments have gone further than the
U.S. in regulating tobacco consumption. The U.S. government's
response to the smoking threat was hortatory compared to the
responses of the other two. Although one could conclude that our
approach has been successful, it is noteworthy that our success
has been achieved in a peculiarly non-directive way. Further, the
three nations have moved in the same direction but the United
States has moved faster to protect the health of non-smokers than
smokers themselves. Kagan and Vogel conclude that in ten years
the United States will probably institute more paternalistic
controls because this is the direction government policy is
moving generally. The essay is an interesting analysis of how the
structure of governments and political cultures affect the extent
of government intervention and the nature of regulatory
processes.
Two chapters by sociologists and political scientists, Joseph
Gusfield, Jerome Skolnik and Kagan once again, deal in very
interesting ways with the symbolism of smoking and the problems
and prospects of gaining compliance with regulations without
enforcement. As other essays in this volume, these rise in terms
of their interest and sophistication well beyond the particular
case in point. Gusfield points out that cigarette smoking gained
popular acceptance in the early part of this century as a symbol
of moral looseness and a rebellion against authority. He sees the
release of the Surgeon General's report riding on a turn of
popular sentiment toward more healthful life styles. In a similar
vein, Kagan and Skolnik claim that self- enforcement of
anti-smoking regulations conform evermore clearly to current
definitions of civility. To support this claim, they present
interesting data from questionnaires dealing with reactions to
secondhand smoke. The study was done for McDonald's franchises
located in communities across the country which have either
considered banning or have actually banned smoking in their
restaurants.
Franklin E. Zimring has contributed a very useful essay to the
volume on the relationship between our approach to diminishing
the consump-
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tion of cigarettes and control of illicit drugs and alcohol. He
credits the Surgeon General's report of 1964 with most of the
social change that has resulted in the intervening thirty years.
Conveying the scientific findings with some forcefulness has led
to the reduction in smoking. On the other hand, outright
prohibition would probably have had the opposite result. He
writes, "Crediting the criminal law for the low usage levels
of prohibited substances is a bit like congratulating children
for the fine job they did of raising their parents." (100)
The future for cigarette consumption will probably be one of
gradual decline. Zimring notes the frustration which could arise
from that slow pace because of the enormous costs of health care
generated by smoking behavior. But he concludes that the
achievement of an almost smoke-free country will be more
remarkable and more solid if it is done in an environment of
governmental restraint. On this point, most of the disciplines
represented in this volume agree: a regulatory process
characterized by low levels of government intervention and high
levels of education seem to be most effective in our society.
Two chapters on the reaction of the court system to the cigarette
smoking and health controversy written by Robert L. Rabin and
Gary T. Schwartz are comprehensive. They are the best brief legal
analysis of the fate of the cigarette companies in court I have
seen. It is remarkable that in a period of more than thirty-five
years, cigarette manufacturers have not lost a case in court. The
combination of U.S. traditions of tort liability law, the health
warning itself and the difficulty of pinning down with accuracy
the specific causes of any disease, have led to these victories.
Schwartz writes, "...it is difficult to see how liability
doctrines could be expanded (or the uncertainties in current
doctrines resolved) in ways that would contribute to the
development of an intelligent public policy." (157)
Recent developments suggest a new avenue for judicial activism,
however. If nicotine finds its way onto the list of drugs
regulated by the Food and Drug Administration there are some
interesting possibilities for suit. For example, if cigarette
manufacturers manipulated nicotine levels to make their product
more addictive, their liability could increase. Hearings were
held in Congress last month (June 1994) to determine what role
the FDA might have in this area of regulation. One could predict
a number of suits arising out of the possibility that nicotine,
and hence tobacco, might be treated similarly to other
pharmaceuticals.
Stephen D. Sugarman and Helen Halpin Schauffler write about the
problems, legal and otherwise, arising out of the fact that
smokers and non-smokers are treated differently in employment
insurance. As of mid-1992, about half of the states had passed
laws protecting the rights of smokers in employment. The
contentious juxtaposition of smokers' rights to employment,
insurance and related benefits versus the employers' interest in
maintaining a healthy workplace and low insurance premiums is one
which will not be resolved for years. These essays are
particularly interesting in the way that many of the others in
this volume are...the implications of the analysis go far beyond
cigarettes and health. Fringe benefits as we now know them will
change dramatically in the next few years, thanks to changes in
the economy and in the way gay and non-married heterosexual
demands will be treated. Smokers and their health insurance
coverage are a harbinger of those changes.
Michael Schudson concludes the volume with a fascinating
discussion of cigarette advertising and the health messages they
contain. He reaffirms the position of the cigarette manufacturers
that cigarette smoking probably does not induce non-smokers to
smoke. Cigarette advertising is a less powerful marketing tool
than many people believe and, banning it is not likely to have a
dramatic impact on the prevalence of smoking. As in the other
chapters, there is no suggestion in this essay that government
regulatory efforts be extended to further reduce consumption.
Rabin and Sugarman have come up with a good volume of essays. It
is a book which will interest scholars from a variety of academic
fields and those with interests beyond smoking and health. They
have made a fine contribution to public policy scholarship as
well as to the discussion of this particular issue.
Copyright 1994