Game Over, the Tobacco Industry has Won

[written spring 2025, but not accepted for publication by any of my usual newspapers, unfortunately further strengthening my opinion...]

This past January, right around the time when Canada’s tobacco settlement was being finalized, our country held its sadly necessary 49th annual aspirationally-named National Non-Smoking Week. Back in 1964, when the US Surgeon General, Luther Terry, released his report making crystal-clear the immense dangers of smoking, his intent was that the findings would lead to the end of the tobacco industry. Unfortunately, now, nearly three generations later, smoking remains the leading preventable cause of death worldwide, including in Canada. Why has this horror-show of addicting children to their ultimate dooms been allowed to continue?

As a young doctor in 1998, when the American lawsuits against the tobacco companies were settled for an announced $206 billion USD, I thought it would mean the end. How naive I was! What I had missed, and the congratulatory news stories largely omitted, was that it wasn't $206 billion to be paid now, but instead over 25 years. So, for the government to receive its money, the tobacco companies needed to be alive and well 25 years later, ensuring the two parties would functionally become long-term partners in crime.

That same year Canadian anti-tobacco lawsuits began. As the Canadian cases dragged out over decades, advocacy groups outlined better ways to structure the settlement here in order to achieve real health goals. After a Quebec win, our provinces, with claims totalling ~$500 billion, forced the companies into bankruptcy protection in 2019. After further dragging, a final settlement was recently reached. So did Canada learn from the American experience? Unfortunately, not at all. Financially, it totals only a paltry $32B. Much worse, non-monetary components are not even up to American standards. No wrong-doing is being admitted, and disease outcome-only research funds prohibit use towards tobacco control. Far from trying to restructure the deadly, but momentarily insolvent, cigarette business, the text of the settlement actually requires that the industry resume business as usual, and ensures no harm is done to alternative products [vaping].

In a recent blistering editorial, a former industry counsel mused: "who actually is the tobacco industry?"; pointing out that the government takes most of the profits, and significantly controls price, sales, marketing, manufacture and consumption of the product. However, blaming the government, albeit accurate, sits too easily with us. Canada is not a dictatorship- we are, and will continue to be, our own government. Federal governments of recent generations, and, even more so, the current provincial governments who together negotiated and accepted this terrible settlement, span Canada's full left-right political spectrum. They represent us, and respond to our public outcry, or the lack of such. If resuming business as usual was really as odious to the public as I think it should be, then it wouldn't have been on the table.

Looking back to the big picture, attempts at imposing transformational change on the industry have been few. Properly-structured Canadian lawsuits [which would then have been copied elsewhere] were one of the more hopeful avenues of finally achieving such. That hope is now gone. In another huge loss, New Zealand recently abandoned its smoke-free generation legislation. The tobacco industry has kept its opponents fighting on the margins of its business and continues to thrive sixty years later. Dedicated visionary anti-tobacco advocates and groups are fewer and smaller than the public may realize, have very limited power, and are aging rapidly, without apparent heirs. Health ministries don't quite view their mandates as transformational, to which the lawsuit settlement attests.

Ending tobacco/ nicotine use is achievable via a combination of supply-side policies including performance-based regulation, retail reform, and licensing. A generational phase-out of combustible cigarettes could at least avoid a dual-use future, the industry's dream outcome. All this requires only bold legislation, however it seems clear neither the government nor the greater public has the necessary interest in doing much other than providing lip-service to these strategies.

Dr Stuart Kreisman

Director, Physicians for a Smoke-Free Canada