From Dysfonction érectile - Tobacco Info No. 9 - April 2012
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Winner of the 2012 Luther L. Terry Award for Community Service

Stan Shatenstein on advocacy and the banality of death

By Geoffrey Lansdell

Montreal-native and freelance journalist Stan Shatenstein has been one of the world’s leading voices in tobacco control for more than 15 years. In 1995, Shatenstein was hired by the Quebec Ministry of Health and Social Services to research second-hand smoke legislation around the world. His research contributed to the 1998 Tobacco Act, Quebec’s first tobacco control law. Since then, Shatenstein’s eloquent editorials and online news bulletins have been hugely influential in keeping the public apprised of the latest tobacco-related developments.

Shatenstein’s first electronic bulletin was La revue de presse. This was followed by Tobacco News Online, and today he works for two of the world’s leading journalistic services in tobacco control as a contributor to Tobacco Control and the coordinator of GLOBALink News and Information Monitoring Service. He has also co-authored two books: the Pan American Health Organization’s Profits over People (2002) and Cancer: My Story (2006), based on writings co-authored with his friend, the late Daniel Feist.

In honour of his tireless commitment to tobacco control, Shatenstein will be presented with the Luther L. Terry Award for Community Service on March 21, 2012, at the 15th World Conference on Tobacco or Health in Singapore. We sat down with Mr. Shatenstein to discuss his work as a freelance journalist and his views on a variety of tobacco-related issues.

Tobacco Info: First of all, congratulations on receiving the Luther Terry Award for Community Service. Who nominated you?

Stan Shatenstein: I was nominated by Simon Chapman, who is a well-known professor, and he also won the Terry medal for Outstanding Leadership. We know each other well and I was very flattered that he nominated me.

TI: I’ve gotten the impression that you’re one of the more militant spokesmen for tobacco control. Would you characterize yourself that way?

SS: Well, I don’t know if I would use the word ‘militant’. You can bring your own judgment to bear and others can as well. I’m forceful in my opinions, and I’ve written a lot of op-eds and hundreds of letters to the editor over the years, many published, many not, but that’s been one of my signature things. If you want to call that militancy...

TI: It’s more the extreme dedication, so maybe ‘militant’ is the wrong word...

SS: OK. But why I hesitate on it, because it’s an important question for me, is that I came to tobacco control as a freelance writer, and I always felt that in writing I wanted to be impartial. So when you say ‘militant,’ that’s the element of advocacy and arguing forcefully for a point, and I don’t reject that idea because, to a certain extent, that is what I do; but on the other hand, I still have a ‘just-the-facts-ma’am’ approach. So when you’re well-based in the science and the facts, you can make a forceful argument without necessarily feeling like you’re being a militant.

TI: In a recent Medical Journal Update, you quoted a study headed by John Pierce called “Quitlines and Nicotine Replacement for Smoking Cessation: Do We Need to Change Policy?” Do we need to change policy? Has there been too great an importance placed on nicotine replacement therapies (NRT) as a cessation method?

SS: There’s a polemic in the field of tobacco control over this issue, and it has to be discussed. Both sides are right, in a certain way. That’s not me sitting on the fence. It’s that cessation rates are higher with NRT, and given the number of people who are smokers and need to quit, any method that increases your chances of cessation is worthwhile. However, the vast majority of people — as Simon Chapman and others have argued — have quit cold turkey, or unassisted. And therefore the medicalization of cessation and the point of view that people won’t be able to quit without a cessation tool creates a distortion. I feel that assisted cessation is right for some people, and I don’t think that people who promote it are in the pockets of Big Pharma. I think there’s a legitimate reason to seek assistance because tobacco use is a pharmacological addiction, but it’s also a behavioural addiction.

TI: And all smokers fall on different points along that continuum, right?  

SS: Precisely. And so I feel that the whole panoply of measures should be available, but I think it’s a healthy debate to be having because there’s always a limited amount of money. So if a great deal of money is being spent on assisted cessation, then you have to look at it very carefully, and that’s what some people are doing now, and I think that’s correct.

TI: After a few decades of steady declines in smoking rates, the numbers seem to have plateaued over the past few years. According to the Canadian Tobacco Use Monitoring Survey, after dropping from 25 per cent in 1999 to 19 per cent in 2005, the next five-year period dropped by only 2 per cent, from 19 per cent in 2005 to 17 per cent in 2010. Have governments, the media, and the public become complacent in fighting the tobacco epidemic? 

SS: Absolutely, and it’s one of my main arguments. A large part of my work is to keep people well-informed so they can keep pressure on the government and the media. But having worked as a journalist, I can tell you there’s a great deal of laziness, and there’s a great sense of ‘What’s new?’ You know, ‘What’s the novelty? Why do you want to do a story on this now? We know that already.’ Well, if you scratch past the initial level of knowledge that people can easily associate smoking with lung cancer, the number of conditions with which smoking is associated that people don’t fully comprehend is vast and extensive. Now, I would ask, ‘When was the last major federal campaign that we’ve seen on television or in the media highlighting the dangers of smoking?’ We haven’t. It took us ten years, but we’re finally going to get new warning labels. And the size went up from 50 to 75 per cent, but many countries leap-frogged Canada in the interim and Australia has taken the lead with plain packaging, which is being challenged there, but there’s a good chance that we’ll see Australia mandating the first plain packs in the world, which I think is tremendous development.

TI: Do you see that having a snowball effect throughout the rest of the world?

SS: Well I think there’s no doubt. We saw it with Canada’s example of the first graphic warnings. That was highly contested at the time, and it succeeded. You know, the issue of intellectual property rights has been well-resolved because, in essence, the governments are not taking away companies’ trademarks, they’re just dictating a fair use warning. And when it comes to tobacco products, any size warning is fair use, given the magnitude of the problem.

TI: On a few occasions, you have used the term ‘the banality of death’ to describe the relative difficulty of getting tobacco-related horror stories on the front pages of newspapers because it’s not exactly ‘news’ that tobacco is constantly killing people. Can you describe the phenomenon as you see it?

SS: I think I quoted Stalin once that ‘One death is a tragedy; a million is a statistic’. There’s also the cliché in journalism that ‘If it bleeds, it leads’, and we don’t see the bleeding in tobacco deaths. Of course, the banality of tobacco deaths comes from Hannah Arendt’s phrase ‘the banality of evil’, which states that evil takes a whole industry of people doing banal, everyday actions. In the realm of smoking, there’s the banality of people consuming a product that’s available everywhere and getting sick. And they get sick years after they start their consumption, and it often takes many years to die. Some smokers die quite abruptly from heart attacks — an under-appreciated risk of smoking in the general public — but it’s a slow process in general, and slow processes don’t make for good journalism, and don’t make for good headlines, and they become the banal background to our everyday world. People lose battles one smoker at a time, but the cumulative effect is massive and dwarfs any other cause of mortality.

TI: On March 12, a $27 billion class-action lawsuit began at the Montreal Courthouse filed by the many victims of the tobacco industry against Imperial Tobacco, Rothmans / Benson & Hedges, and JTI-Macdonald. What’s your take on the trial and the potential outcome?

SS: I think the salient fact is that these things can go either way. There’s a very realistic chance that the case could be won, but it’s only my assessment of what’s happened in other trials in other countries. Knowing how long it’s taken and knowing how deep the pockets of the industry are, I put nothing past them in their ability to continue delaying action. I think it would obviously be a tremendous outcome, but even if you get a tremendous verdict, you don’t necessarily get change. Consumption rates are gradually coming down as we’ve said about Canada. Nothing is happening in a revolutionary fashion. Things are improving in an evolutionary fashion, and a lot of people are dying in the interim. So I never get too giddy about any outcome of any particular legislation or lawsuit.