Blogs & Comment

Do disgusting tobacco warnings encourage smokers?

Following Canada's lead, the U.S. will introduce new tobacco packaging next year warning of the health impacts of smoking. Research supporting such initiatives may not tell the whole story, however.

(Photo: FDA)

American smokers will soon have disgusting pictures accompanying their disagreeable habit. The U.S. government has released nine graphic tobacco warnings that will begin appearing on all cigarette packaging in September 2012, and also on advertisements. One shows a set of diseased lungs. (There’s also a healthy set nearby for handy comparison.) Another shows a cancerous lesion on someone’s lower lip. And there’s some poor fellow expelling smoke through a hole drilled conspicuously in his throat.

These may come as a bit of a shock for American smokers, who are accustomed only to discreet, small written warnings. The gory images are intended to discourage people from smoking. It may seem self-evident that rotting teeth and gangrenous toes would achieve precisely that. But then, tobacco is materially different from toothpaste, frozen orange juice and other consumer products, in that it’s addictive. And if the scent of a burning cigarette doesn’t turn people off, will visual aids do any better?

Authorities insist they do. In supporting that contention, the U.S. Food and Drug Administration cites a 2007 study by the Institute of Medicine, which the FDA says “concluded that the available scientific evidence indicates that larger graphic health warnings would promote greater public knowledge of the health risks of using tobacco and would help reduce consumption.” The Institute’s 700-page study is actually less equivocal than advertised. “Although few studies have been able to parse out the effects of warnings on smoking behavior,” its report observed, “the available data suggest a beneficial effect on consumption and cessation.”

This “available data” seemingly is confined to consumer surveys. Looking more closely, the Institute’s study specifically cites Canada, the first country to introduce grotesque pictorial labeling. Beginning in 2001, cigarette packages sold here contained one of 16 warnings on the upper half of each main panel, each bearing a large (and not infrequently disgusting) image and a short declarative statement such as “cigarettes leave you breathless.” The Institute cited a 2001 survey of Canadian smokers, in which more than half of respondents “reported that the pictorial warnings have made them more likely to think about the health risks of smoking.”  It mentioned also two 2005 Health Canada surveys that suggested 95% of youth smokers and 75% of adult smokers thought the warnings provided them “important health information.”

More recently, the World Health Organization surveyed smokers in 14 countries that have signed on to the WHO Framework Convention on Tobacco Control, which requires conspicuous warnings on tobacco packaging. The WHO survey found that more than a quarter of respondents in 13 of the countries said they were considering quitting after seeing the disturbing warnings. (The lone exception was Poland; apparently its citizens are particularly resistant to suggestion).

But such studies may not tell the whole story. The most interesting and counterintuitive submission I’ve read on this question comes from a branding consultant named Martin Lindstrom. His ideas have the attraction of novelty. He’s an exponent of “neuromarketing,” which borrows techniques from neuroscience to study why consumers behave the way they do. As far as Lindstrom is concerned, asking people about their buying habits is often a futile exercise because people often aren’t aware of the real forces driving their actions. Getting the real answers requires delving inside the human brain.

In his 2008 book Buyology: Truth and Lies About Why We Buy, Lindstrom recounts what he calls “the largest neuromarketing study ever conducted.” He executed part of it on 32 smokers at the Centre for NeuroImaging Sciences in London, England.  Subjects were interviewed about how graphic warnings affected their thinking about smoking. Then they were placed in an fMRI (functional magnetic resonance imaging) scanner and shown images of actual labels. An fMRI scanner can be used to identify which parts of the brain are receiving oxygenated blood—and thus what notable regions are active at a given moment. Fans of House and other medical dramas will be intimately familiar with this noisy device.

And the results? Subjects’ oral responses were similar to those results from government studies described above: Most smokers said warning labels worked. But the fMRI scanner told a different story altogether. Lindstrom reports the team leader of the research, one Dr. Gemma Calvert, concluded that warning labels did not suppress smokers’ cravings at all. More surprisingly, the images “had in fact stimulated an area of the smokers’ brains called the nucleus accumbens, otherwise known as ‘the craving spot.’” In other words, the images actually encouraged smokers to light up. Lindstrom concluded that such labels were “a big waste of money.”

U.S. officials have high expectations for their new warnings. The FDA predicts they’ll convince 213,000 Americans to quit smoking in 2013. That, in turn, is expected to reduce the number of smoking-related deaths and medical expenses. However, presumably authorities had similar expectations and motivations when they introduced the first tobacco warnings in the 1960s. The Institute of Medicine claimed the text warnings that prevailed in the U.S. for decades didn’t work. “Evidence regarding the ineffectiveness of the prescribed warnings has continued to accumulate,” it reported. “The U.S. package warnings have served the tobacco industry well by reducing their liability exposure while communicating ineffectively with smokers and potential smokers. The basic problems with the U.S. warnings are that they are unnoticed and stale, and they fail to convey relevant information in an effective way.” If Lindstrom is right, authorities may be disappointed again.