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Critical Condition

NRO’s health-care blog.

Warnings That Don’t Work



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Diseased lungs. Corpses. Rotting teeth. A man smoking from a tracheotomy hole. These are some of the shocking images featured in the Food and Drug Administration’s recently unveiled series of cigarette package warnings. The FDA asserts that these graphic warnings will serve public health by terrifying smokers into quitting. Commissioner Margaret Hamburg boasts that “the FDA [is taking] a crucial step toward reducing the tremendous toll of illness and death caused by tobacco.” But will these labels work? Will the lurid imagery scare smokers into quitting?

Probably not.

First, the shock value of such warnings is likely to cause smokers to reject, not absorb, the message that smoking causes disease and premature death. Instead, they will tune out the message and do their best to ignore the images. Those in favor of the new labels insist that, now, tuning out such warnings will be difficult because the color images take up more than half the cigarette pack. However, when similar ads were introduced in Canada, smokers found them so disturbing that they purchased covers for their cigarette packs to block out the images — and then kept right on smoking.

Second, for habitual smokers, the decision to light up is not a rational, well-considered one: The nicotine in cigarettes is highly addictive, and smokers simply need that physical “hit.” In truth, the urge to have a smoke involves many behavioral and situational cues not at all addressed by the graphic warnings. These warnings will not address the power of that addiction; at best, they may prove a minor annoyance to the smoker.

Third, while shock value can, in some circumstances, help modify behavior, its impact is very short-lived. “The point of putting these pictures on is shock value — and [that] wears off very quickly,” notes Dr. Timothy Edgar, associate director of health communication at Emerson College.

If the federal government is going to be effective in discouraging cigarette smoking, it should focus on interventions that work, not those with no proven efficacy. For instance, instead of spending time on graphic warnings, the feds could help prevent tens of thousands of premature deaths by informing smokers that there are less harmful ways to use tobacco — ways that can be a valid step toward cessation. Specifically, smokeless tobacco products like snus, because they are not lit and inhaled, do not generate the products of combustion that greatly increase the risk of disease and death to cigarette smokers.

Yet the federal government continues to ignore such possibilities. Not only does the government not have a program to urge smokers to switch to smokeless products, they forbid the smokeless manufacturers to advertise the unambiguous truth: using smokeless products is far less hazardous than smoking cigarettes.

Cigarette smoking remains the leading cause of preventable death in America. We should be doing everything we can to help smokers to quit — and to prevent people from starting in the first place. But the efforts of our federal agencies to pursue such a goal are pathetically ineffective. The new series of gross-out warning labels is just another example.

— Dr. Elizabeth Whelan is the president of the New York–based American Council on Science and Health.



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