Read the Warning, Light a Cigarette?

To the Editor:

Re “Inhaling Fear” (Op-Ed, Dec. 12):

Martin Lindstrom tries to convince us that the only effect of warning labels on cigarettes is increased craving to smoke. His source of evidence is a brain-imaging study he conducted on 32 smokers.

These smokers reported reduced craving when exposed to the warning labels, but Mr. Lindstrom dismissed those reports because the smokers’ brain activity “told a different story.” He cautions the coming Obama administration against the use of these antismoking warnings.

Mr. Lindstrom doesn’t acknowledge evidence from numerous national and international studies indicating that graphic warnings are an inexpensive and effective component of comprehensive tobacco control.

The evidence shows that exposure to graphic warning labels increases smokers’ knowledge of the health risks of smoking, and their intentions to quit, the likelihood that they attempt to quit and, most important, successful quitting. Smokers who react to the labels with the most fear and disgust are also most likely to quit in response to them.

Should Mr. Lindstrom’s brain images dictate our public health policy? The evidence tells a different story.

Suzanne Colby

Providence, R.I., Dec. 12, 2008

The writer is an associate professor of psychiatry and human behavior at the Center for Alcohol and Addiction Studies, Brown University.

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To the Editor:

I know why cigarette warning labels stimulate the desire to smoke.

We are the only animals who labor under the awful knowledge of our own inevitable deaths. No matter how cautious we are, how lucky we are or how splendid our genetic endowments, we, too, will die, decay and be quickly forgotten by all save our closest friends and relatives.

There is something fundamental to the human spirit that is infuriated by this. If the world will kill us no matter what we do, why not assume godlike powers and claim a role in the process?

I have long thought that one of the explanations for many types of self-destructive behavior is this basic need to play a direct part in our tragic fate. There is a sad nobility in this.

David Hayden

Wilton, Conn., Dec. 12, 2008

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To the Editor:

Martin Lindstrom reports the results of a study in which all subjects were smokers. It is no surprise that seeing an image of tobacco products, even in the context of attendant health problems, caused activity in the so-called craving spot in the brains of smokers. That is the nature of addiction — knowledge of negative effects doesn’t reduce the desire for the addictive substance.

A more useful study would include an equal number of nonsmokers. If viewing health warnings caused activity in the parts of the brain that register alarm or disapproval in nonsmokers, we could conclude that such information is useful in preventing people from starting smoking.

For addiction, as for all health problems, prevention is easier and more effective than treatment. David Bacon

Photo

Aspen, Colo., Dec. 12, 2008

The writer is a medical doctor.

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To the Editor:

There is big difference between the verbal warning labels used on packs of cigarettes in the United States and the more graphic pictures used in Canada.

We and our colleagues have published research on the effectiveness of Canadian warning labels in the United States. The Canadian labels have been linked to quitting in far larger studies than Martin Lindstrom’s study of 32 subjects. When tested in the United States, the Canadian warnings appear to be far more effective for both smokers and nonsmokers than the bland statements we now use.

What little we know about the brain’s addiction center indicates that it responds not only to potentially addictive cues but also to any that signal uncertainty about rewards and penalties. Could those labels actually be effective in creating doubt in smokers regarding their dangerous habit?

Our understanding of brain imaging does not permit us to draw any firm conclusions about Mr. Lindstrom’s findings. But in the context of considerable evidence to the contrary, they should hardly be the basis for health policy in the United States. Dan Romer

Kathleen Hall Jamieson

Philadelphia, Dec. 13, 2008

The writers are, respectively, associate director and director of the Annenberg Public Policy Center, University of Pennsylvania.

To the Editor:

As someone who has no intention of quitting smoking, I must say that Martin Lindstrom’s article doesn’t surprise me in the least. It doesn’t take a scientific study to tell us that campaigns to bully people out of their pleasures only work up to a point — especially when you’re trying to bully taxpaying adults out of enjoying a legal product.

The discrimination and stigmatization that smokers have to deal with on a daily basis may well push some into quitting, but they make others increasingly angry and defiant.

It’s one thing to be antismoking, but it’s quite another to deny that tobacco gives pleasure and comfort to millions, to deny that many of us are deeply skeptical of the antismoking movement and, ultimately, to deny human nature.

Antitobacco scaremongering is indeed at, or beyond, the point of being counterproductive.

I suggest an alternative, though it may strike some as radical. How about just leaving us alone? Joe Jackson

New York, Dec. 12, 2008

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To the Editor:

A two- or three-pack-a-day smoker, I desperately tried numerous schemes to quit. First I tried not carrying cigarettes, bumming them from friends. That worked for only a short time.

Then I used a toothpick to poke holes in cigarettes to dilute the smoke entering my lungs. Then I tried simply holding unlighted cigarettes, continually rejecting offers by well-meaning friends to light me up. Nothing worked.

One day my father died of lung cancer and emphysema. Even in the hospital, dying, he managed to mooch cigarettes from my mother. That day I taped my last cigarette on my office wall and told my office mate that this was the last cigarette I would ever smoke.

For more than 50 years, I have easily kept my word, suffering hardly any withdrawal pains and after-meal temptations. What worked: sheer fear.

Benjamin Bederson

New York, Dec. 12, 2008