340 Tobacco Control 1998;7:340–344 Tob Control: first published as 10.1136/tc.7.4.340 on 1 December 1998. Downloaded from NEWS ANALYSIS

Clinton and his entourage, includ- All articles written by David Simp- ing 250 journalists, saw none of the son unless otherwise attributed. starred and striped tobacco hype. Per- Ideas and items for News Analysis haps fearful that the president, on a should be sent to David Simpson at rare step outside Air Force One, the address given on the inside would catch a glimpse of his cowboy front cover. kinsman and cry “Foul play!”, Philip Morris had taken acute pains to cover the “evidence”, strategically banishing all their advertising: radio, posters, and billboards. Philip Morris had good reason to Senegal: now you be afraid. Proposed tobacco legisla- see it, now you tion in the United States at the time A young Senegalese mother holding her was calling for strict international Marlboro-bedecked son (not quite two years old). don’t—PM’s April tobacco control measures which would bar government funds from Fool’s joke on being used to promote American tobacco overseas; further, it called for Clinton increased funding for overseas When President Clinton arrived in tobacco control via international Dakar, Senegal on 31 March 1998, on agencies such as the World Health an exuberant tour to promote trade Organisation, UNICEF and through

and goodwill in West Africa, he prob- an American-sponsored technical http://tobaccocontrol.bmj.com/ ably didn’t realise that another Ameri- assistance body, and a code of can icon had already beaten him to conduct for American tobacco the sale. companies abroad comparable to The “Marlboro Man” had long domestic anti-tobacco laws; and a since established himself as the crack down on tobacco smuggling. number one American businessman Furthermore, the US State Depart- in town (see ment had issued a new directive on Tobacco Control A young boy getting the feel of a Marlboro pack. 1997;6:243–5). Months before Clin- international tobacco policy less than ton’s arrival, Philip Morris had no two months earlier, encouraging qualms about cashing in on American embassies to “assist and was again as strong as ever. Sexily Senegalese youth’s fascination with promote tobacco-control eVorts in clad Marlboro women hand out free

the United States. “Come to host countries”. cigarettes in popular nightclubs. Tod- on September 24, 2021 by guest. Protected copyright. Marlboro Country”, invited large According to one local radio dlers in rural villages sport “Marl- billboards at every turn. “America, station technician with a friend work- boro” outfits. And Dakar schoolchil- here I come!”, exclaimed a poster for ing for Marlboro, Philip Morris dren were spotted carrying their L & M, Marlboro’s sister brand, pulled all their radio advertisements books in red and white “Marlboro” sporting a trendy, young, white during the week coinciding with the backpacks. Philip Morris’ great April couple sharing a smoke beside a pay president’s and first lady’s visit. Local Fool’s Joke in Senegal was over. ’phone before they zip oV to New store owners in the Grand Dakar “If Americans know cigarettes kill York City on their shiny new neighbourhood confirmed that Philip people, how come they let ‘Marlboro’ motorcycle. “Win a trip to the US Morris representatives had paid a promote them in Africa?” a young withL&M”,itenticingly announced visit to remove posters before the Senegalese man, sharing a smoke to passers by. Clintons’ arrival. The explanation with his buddies, asked in genuine Philip Morris even employed given to one store owner was that wonder. Good question. It is at the Senegal’s best loved wrestler, Mo- the “mayor of Dakar has put a very heart of the international hamed “Tyson” Ndao (namesake of tax on posters”. Funny timing, and the American boxer Mike), often seen since when has Marlboro been so tobacco hypocrisy that Philip Morris wearing an American flag during his “poor”? wishes to cover up. trademark victory dance, to plug their With Clinton gone, Philip Morris ANNA WHITE addictive sticks. Last autumn, a began repainting whole storefronts in Federation des ONG et OCB television advertisement showed a red and white, a strategy often used Luttant Contre le Tabagisme (FLCT), close up of Tyson giving the “thumbs by other products to dominate and c/o 103 RadcliVeDrive, up” sign as the camera panned eliminate competing advertising. And Newark, Delaware 19711, USA; “M-A-R-L-B-O-R-O”. the Western cowboy’s omnipresence [email protected] News analysis 341 Tob Control: first published as 10.1136/tc.7.4.340 on 1 December 1998. Downloaded from How to make the Development (USAID), but USAID’s Although the ambassador could not five-year plan focuses on family endorse any specific organisation, he US State planning, child and maternal health, agreed to issue a public statement on and AIDS prevention—and not the occasion of World No-Tobacco Department’s tobacco control. Day: “Growing up Tobacco Free” (31 There is little evidence so far that May 1998). This statement ran in at tobacco directive local anti-tobacco movements have least one local paper and served as benefited from the measure—except important foreign political support for work for you: in Senegal. Perhaps the Senegalese the local anti-tobacco activists’ cause. Senegal’s case example can give tobacco control After World No-Tobacco Day, the groups elsewhere ideas on how best to new anti-tobacco federation wrote a It is laudable that the State approach their local American letter of introduction to Ambassador Department issued a directive on embassy and make the directive work Smith, also thanking him for issuing American international policy on for them. the public statement, and inquiring as tobacco in February 1998. At the The key for tobacco control groups to whether the embassy had any old same time it represents no real change is to think of ways American computers available for donation. The in policy. embassies can lend support without response was favourable and two Old fair trade rhetoric and a new using American funds or compromis- months later a shiny new-looking pro-health agenda aren’t easily ing their integrity as a front for official computer found a new home at the squared, as the directive clearly United States policy. Perhaps the folks federation. This generous donation indicates. Wrought with the old will allow the federation to establish misguided logic of the “legal” in Senegal have a good deal: Ambassador Dane F Smith is a mem- itself much more rapidly, by making product, its policy objective of everything from letter writing to elec- ber of Action on Smoking and Health ensuring American companies “equal tronic communication much more (USA) and confesses to “biting his access to a shrinking global market for eYcient. tobacco” echoes the old USTR tongue” when forced to deal with (United States trade representative) American tobacco companies. In a ANNA WHITE brief meeting with the ambassador, he mentality: “We know cigarettes are Federation des ONG et OCB bad, but hey, we’ve got to help ‘poor’ acknowledged having read a New York Luttant Contre le Tabagisme (FLCT), American companies get their ‘fair’ Times article on American corpora- c/o 103 RadcliVeDrive, share of the pie!” This ignores the fact tions selling cigarettes in Senegal Newark , Delaware 19711, USA; that these companies’ marketing tech- through liberal use of American [email protected] niques are often more aggressive. The imagery. Familiar with the State result? American companies end up, Department’s directive, he was openly EU/UK: ad ban not only hogging the pie, but also receptive to the idea of lending support to Senegal’s anti-tobacco increasing its size. busting plan http://tobaccocontrol.bmj.com/ Furthermore the policy suVers movement. Tobacco control advocates in the from a lack of “teeth”. Although the United Kingdom and other western first guideline of the directive European countries which have not explicitly states: “Posts [embassy oY- yet banned tobacco promotion are cials] are encouraged to assist and busy trying to ensure the eVectiveness promote tobacco-control eVorts in of legislation being drafted under the host countries,” there is no mention of European Union’s ad ban directive. how exactly posts might do so. Ameri- Of greatest concern is some can embassies are not in the business governments’ apparent weakness of of providing financial assistance to resolve. The cause of this is unclear, local non-governmental organisa- but may be presumed to be tions. That’s the job of the United exacerbated by budgetary restrictions on September 24, 2021 by guest. Protected copyright. States Agency for International and the near certainty of the industry’s now routine twin proce- dures of (a) legal challenges and (b) deliberate “breach-and-see” tactics to test out the government’s commit- ment to its new law. The big loophole in the EU ad ban is on branding of non-tobacco products. However, the wording does not give an unqualified exemption as a right. The relevant article in the direc- tive (98/43/EC, 3, para 2) says that the ad ban “shall not prevent the member states from allowing a brand name already used in good faith for both tobacco products and for other goods and services traded or oVered . . . prior to July 1998 to be used for the advertising of those other goods and services.” This wording does not L&M hats, Lucky Strike shorts, Marlboro baby clothes: ways in which American companies increase require member states to exempt brand the size of the market pie in Senegal. stretching, but merely allows them the 342 News analysis Tob Control: first published as 10.1136/tc.7.4.340 on 1 December 1998. Downloaded from choice to exempt it. It can still be world) contains nothing but grainy banned, and the exact wording pictures, often without the products suggests that member states can do it clearly in view, in an attempt to on a case-by-case basis. convey a truly tough and independent Although the directive says that the image, like we are supposed to have of advertising in question must be the Wild West. Presumably, the distinct in appearance from that of grainy, out-of-focus look is similar to tobacco brands, the brand names will the way the world appears through the be retained and the positive associa- eyes of, say, a patient suVering from tions generated through advertising macular degeneration caused by items such as boots (Camel), coVee smoking, or simply by a lung cancer (Benson & Hedges), and clothing patient heavily sedated with post- (Marlboro), will strengthen the operative drugs. tobacco branding. Health advocates note that one of the terms of the Min- nesota settlement agreed in May 1998 Alaska: Trampling deals with this type of advertising and does not allow the tobacco brand tobacco name to be used. The parties to the The Trampling Tobacco Project aims Minnesota settlement include compa- to reduce tobacco use and related nies that market tobacco-branded death and disease in Alaska, United boots and clothing in Europe (see the States. The Alaska Native Health article on “Marlboro Classics” Board (ANHB) implemented the clothing in Tobacco Control A postcard ad for the new-look Camel boots Trampling Tobacco Project on behalf 1996;5:340–341). In addition, recent brand, a handout in a British shoeshop. of the Alaska Tobacco Control legislation in both Tasmania and Que- Alliance (ATCA), a statewide coali- bec, which have obvious similarities to ourful Camel boots, the sort of move- tion, and the project is funded by a western Europe, has unequivocally ment that many older people could Robert Wood Johnson Foundation banned brand stretching. not even attempt, and which would be SmokeLess States grant. The key Meanwhile, two developments in impossible for a peripheral vascular components include policy, technical London in recent months indicate disease patient, just to pick a random assistance, and youth education, what tobacco companies may expect example. which the staV provides through to get away with unless the British A Marlboro Classics shop has training, materials, and mini-grants to government is prepared to be appeared in Covent Garden, home to local organisations and communities. courageous. Camel introduced pub- numerous fashionable clothes shops, The programme title “Trampling licity materials in shoe shops selling its with a massive supporting ad Tobacco” was based on an Iditarod http://tobaccocontrol.bmj.com/ Camel boots, sporting a new version campaign on the side of London’s theme–the Iditarod is a sled dog race of its cigarette logo using a diVerent famous red buses. Marlboro has also from Anchorage to Nome, Alaska, a typeface, though still set in an used a diVerent typeface, but the distance of approximately 1100 miles upturned crescent. True to form, it theme is as tough and rugged as ever. (1770 kilometres) over treacherous shows a person who is unquestionably In fact, the 40-page A3 colour terrain. In keeping with the purpose of far too young to appear in the regular brochure distributed free in the shops the first Iditarod, which brought cigarette ads still permitted in the UK. (and no doubt throughout Marlboro’s life-saving diphtheria serum to Nome, He is skipping energetically in his col- growing chain of shops around the the race in recent years has been used on September 24, 2021 by guest. Protected copyright.

The Marlboro Classics brochure and an ad for the brand in the United Kingdom. News analysis 343 Tob Control: first published as 10.1136/tc.7.4.340 on 1 December 1998. Downloaded from

MARGARET LANIER The Alaska Tobacco Free Iditarod Project, Alaska Native Health Board, 4201 Tudor Centre Drive, Suite 105, Anchorage, Alaska 99508, USA; [email protected] Seizing the microphone on Capitol Hill In September, I attended a “March on Cancer” in Washington, DC, together with a conference sponsored by the Alliance for Lung Cancer Advocacy, Support and Education (ALCASE). Before leaving my home in Michigan for the nation’s capital, I was informed that, although the march was well-intentioned on the Alaska’s Ramy Brooks an accomplished “dog musher”, is the spokesperson for the Iditarod tobacco part of the grassroots organisers, it free project. would focus entirely on generating funding for research into the to raise public awareness about While the Marlboro Man’s goal is to treatment and cure of cancer. It had modern health plagues including lure young people into smoking, Ramy also become a promotional vehicle for alcohol abuse, AIDS, and now is the real-life hero who models good a number of major pharmaceutical tobacco use. health by being tobacco-free and and medical products companies. Smoking and smokeless tobacco use finishing among the top mushers in the There would be no focus at all on pre- rates in Alaska are among the highest in Iditarod Race. vention, since there is no money in the United States. The problem is par- Ramy and his lead dog, Bruce, have that, even though prevention is an ticularly severe among Alaska Natives visited many schools statewide and essential component of the fight (indigenous peoples), as detailed in the talked with young people about the against cancer. This is especially true 1998 report of the United States dangers of tobacco. In his presenta- of cigarette smoking, since it is Surgeon General (see Tobacco Control tions, he emphasised that to be a top responsible for more cancer than any 1998;7:198–209). Nearly half of athlete you must be tobacco-free. other cause. http://tobaccocontrol.bmj.com/ Alaska Native adults use tobacco. It is After all, as Ramy points out, his dogs Following the conference, I went not uncommon for pre-school age chil- don’t use tobacco! As a result of the with a group of ALCASE staV and dren to become addicted to smokeless publicity, Ramy has received posters, volunteers to the Friday night tobacco, which is sometimes given to cards, and letters from youngsters “candlelight vigil” that served as the big kick-o to the next day’s march. teething babies. across the country showing their V The educational component of One of the volunteers, my friend appreciation and excitement. Trampling Tobacco was the Iditarod Susan Soloway Levine, lost her The primary component of the Tobacco Free Project. The target daughter at the age of 28 to cigarette- Iditarod Tobacco-Free Project is a population was young people, particu- caused lung cancer earlier in the year. tobacco prevention curriculum for fifth larly in rural Alaska, including There were several thousand people Eskimos, Indians, and Aleuts. and sixth graders (10–12 years old) attending the event by the Lincoln that has been continually modified and

Ramy Brooks, a promising young Memorial and the Reflecting Pool, on September 24, 2021 by guest. Protected copyright. dog musher (as the driver of a dog expanded. In 1997, a board game was and an enormous stage was set up, team is known in Alaska), was chosen developed to use in conjunction with along with large screens, spotlights, to act as a spokesperson and role the curriculum. Nearly 700 schools and a large, elevated platform in front model for the project. Brooks is the statewide were notified by mail of the of the stage for dozens of reporters son, grandson, and great-grandson of Iditarod Tobacco-Free Curriculum. and cameras. A number of prominent famous Athabascan and Eskimo dog Teachers who requested it were sent people spoke—the Reverend Jesse mushers, who continues a family the packet to implement during the Jackson, Olympic skater Scott Hamil- legacy each time he races. His motto Iditarod. ton, former “junk bond king” and is, “The 1100 mile race to Nome takes Based on feedback from teachers prostate cancer survivor Michael everything the dogs and I have got. who implemented the curriculum and Milken, and professional tennis player I’m glad to be tobacco free!” Brooks community members who partici- Andrea Jaeger, among others—some has finished the Iditarod in the top 20 pated in the Iditarod project, the quite movingly. positions during each year of the impact was positive. This was The Reverand Jackson preached Iditarod Tobacco Free Project. especially true for the young people well, as always, but like the others, he During the 1994–1998 races, who live in the villages and towns that never once mentioned cigarette smok- Brooks spoke with reporters about the serve as checkpoints along the ing, tobacco, or lung cancer (which, in project and recorded radio and Iditarod trail. In each of the the anti-cancer community, is known television advertisements for statewide checkpoint locations, youngsters be- as the “invisible cancer,” getting broadcast. His image has also appeared came involved in direct tobacco relatively little attention because of on anti-tobacco posters and trading prevention activities and supported the low survival rate and the general cards. Brooks is Alaska’s healthy Ramy as he competed tobacco-free in disinterest of the pharmaceutical and counter-image to the Marlboro Man. the Iditarod Race. corporate medical community), al- 344 News analysis Tob Control: first published as 10.1136/tc.7.4.340 on 1 December 1998. Downloaded from though he chose to mention diet as a “I am here with my friend Susan to prostate cancer, and which accepts a particularly serious problem for the say that it is shocking that not a single portion of the proceeds from “Big African American community. These speaker has had the presence of mind Smoke” parties sponsored by the speeches went on for a full hour. With or the courage to talk about cigarette magazine Cigar Aficionado.) only half an hour remaining, literally smoking, until now. Cigarette smok- The next day, at the march itself, not one word had been said about ing is the leading cause of cancer in Jesse Jackson gave a modified speech. tobacco. America. Lung cancer, most of which This time, he railed against the Like others in our group, Susan and is caused by cigarette smoking, is the tobacco industry. I saw him backstage I became increasingly incensed. leading cause of cancer deaths in afterwards (Susan, former Winston Finally, without saying a word to one America, and lung cancer has cigarette model and lung cancer another, we split from our group and surpassed breast cancer as the leading victim Alan Landers, and I had gradually made our way together from cancer killer of women in the past few sneaked through some barricades the very back of the crowd, up years. Reverand Jackson mentioned again), and he gave me a warm hand- through the throngs of people diet. He should have mentioned ciga- shake. Some time later, Alan and I cramming the area around the stage. rette smoking too.” talked to singers David Crosby and The speeches continued, the lights It was then that a cheer went up, Graham Nash, whom we spied were blinding, and the scene struck possibly one of relief on the part of waiting under a tent, about the impor- me as having an air of Orwellian unre- those who, like the two of us, had been tance of focusing on tobacco. When ality about it. frustrated by what had been they finished their second set near the Susan Soloway Levine is a fighter. happening. Standing in that place, end of the day, Graham Nash’s final She is neither tall nor physically near the spot where Martin Luther words, made at our request, were imposing, but when something King, Jr once changed history, was about the need to fight tobacco and matters to her, she never backs down one of the most extraordinary keep kids from smoking. and she never gives up. Susan and her moments of my life. Finally, I ran into General Schwarz- family watched her daughter, Deanna Then Susan and I stepped back, lit kopf and introduced myself. He Soloway, suVer an agonising death, our candles, and stood beside the grinned, looked at me knowingly and and she and her husband, who was others. Retired General Norman said, “How’d you like what I said last also at the vigil, wanted something Schwarzkopf, the honorary chairman night!” Much as I wasn’t a supporter said about what killed her, an of the March on Cancer, took his turn of the Persian Gulf war (that involved addiction to cigarettes that started at the microphone, said a few prepared another protest, and another story), I when she was 15 years old. words, then pointedly added, “And I thanked him sincerely for what he had We finally made our way around to also light this candle for my mother done on Friday night. the side of the stage, which was who died of lung cancer caused by So, in the end, perhaps we made crowded with people, and managed to cigarette smoking”. He looked over at some small progress. As Jesse Jackson sneak through the first barrier. When us, and Susan went over and hugged often says: keep hope alive. we reached the second barrier, Susan the man. He told her that he had http://tobaccocontrol.bmj.com/ worked her persuasive magic on the followed our example. (Michael CLIFF DOUGLAS woman guarding the entrance, and we Milken, standing behind me, looked a 3189 Rumsey Drive, found ourselves on the stage with a little abashed. He has formed an Ann Arbor, Michigan 48105–3437, USA; group of the next speakers— organisation which funds research on [email protected] individuals, each of whom was holding a candle, who had been invited by the sponsors to step up to the microphone and say a few words of remembrance for a relative who had died of cancer. This was to be the emotional climax of the vigil. Susan

and I, suddenly part of this group, on September 24, 2021 by guest. Protected copyright. were handed candles. Barely a minute later, Susan said “Come on,” and together we walked into the bright lights at the front edge of the stage. We stood there alone. No one seemed to be aware that we were gatecrashers. Maybe some of the organisers knew it, but what could they do? At the microphone, Susan’s voice rang out over the Mall and in the direction of the Capitol. She said, “I am Susan Soloway Levine,” then bravely told the audience that she was lighting her candle for her daughter Deanna, whom cigarette smoking had Smoke-free on the roof of Africa. Raul Uranga, United Nations Focal Point on Tobacco, and killed with lung cancer. colleagues pictured at the summit of Mount Kilimanjaro, east Africa, after another climb to highlight It was the first time such words had the benefits of non-smoking (see “Tobacco Control” 1992;6:172). Thirty-three participants, 17 from been uttered all night. With my arm Latin America and 16 from Europe, climbing in three groups, reached the summit during the six-day climb last September. Among the Tanzanian oYcials who lent their support and encouragement to the still around Susan, I moved up to the participants was Ambassador Gertrude Mongella, herself a veteran of the climb, who proposed the microphone and said: organisation of another, even bigger ascent in the year 2000.