Bringing Everyone to the Tobacco Table

Good Business: The Talk, Fight, Win Way to Change the World Book Review

Cancel culture is not unique to the age of Twitter. After all, we cancelled the tobacco industry decades ago. As such, the treatment of the sector may hold important lessons for navigating a world of wokeness and the potential pitfalls of absolute cancellation. In his new book, Good Business: The Talk, Fight, Win Way to Change the World, Bill Novelli describes, among other things, opportunities that may arise from working with a cancelled industry. Ultimately, however, Novelli’s inconsistency on this stance reveals the power of cancel culture to stifle dialogue and impede clearheaded action.

Of Courage and Cancellation

An alumnus of the advertising world, Bill Novelli has devoted the bulk of his career to social impact marketing. The firm he built, Porter Novelli, spearheaded myriad high-profile campaigns, including the National High Blood Pressure Education Program for the National Institutes of Health. Novelli’s accomplishments also include the successful rebranding of the Peace Corps, a tenure as CEO of AARP, and founding the Campaign for Tobacco-Free Kids (CTFK) — the context in which I first encountered him.

When I met Novelli in the mid-1990s, we were both privy to conversations in Washington that would reorient US tobacco control efforts to focus on the prevention of youth smoking. This positioning was initially considered strategic in that it sidestepped libertarian critiques of regulation and generated political interest in a health issue for which progress had been slow. I recall with great clarity that the decision to address kids was not an effort to negate the importance of tackling adult smokers, but rather a strategy for attracting attention to an urgent cause.

In his book, Novelli describes his experience working with and against the industry during this era. He notes that when he started this work, even meeting with tobacco representatives could taint one’s reputation by proxy. Put another way: the industry had been cancelled. Nonetheless, Novelli repeatedly negotiated with representatives in his capacity as President of CTFK, then a young but well-funded anti-smoking nonprofit.

The goal of these negotiations was to arrive at a productive compromise: the tobacco industry would pay billions of dollars in damages and, in return, would have some protection against further liability. Such an arrangement, Novelli explains, was necessary if regulators had any hope of arriving at legislation that might hold the industry accountable for past misdeeds and minimize future ones. Yet, Novelli and his colleagues faced substantial backlash for their apparent collaboration with Big Tobacco, receiving loud critiques from the media, leading academics, and public health officials.

The ugliness of this period is also recounted in Michael Pertschuk’s Smoke in Their Eyes. Therein, Matthew Myers — another CTFK founder and its current president — recalls his own experience of the post-negotiation fallout. He describes:

All of my instincts told me that we would face a firestorm among some advocates. But I didn’t anticipate the ferocity, the nastiness, the viciousness, nor did I anticipate fully its impact on the large organizations that I believed supported what we were trying to do…It was not our opponents who surprised me, it was the people and organizations whom I assumed were allies.

As a result of engaging with industry, Myers and Novelli faced personal attacks and professional frustration. On top of that, the process failed to generate a successful bill. Yet, in Good Business Novelli asserts that he was “right to negotiate with industry.” He adds: “We need everyone at the table including adversaries.” This view coheres with the book’s larger theme, which emphasizes “creating economic value by creating social value.” He goes on to provide several examples of this type of work, such as Nestlé’s plans to fight the obesity epidemic via programs that emphasize nutritional balance.

In sectors needing modest change, executives can implement a shared value model with relative ease. Yet, the biggest gains to health and the environment will come from applying these ideas to more challenging industries — dirty legacy sectors where disruptive technologies can ameliorate historic harms while maintaining profitability. These sectors — including transportation, oil and gas, and tobacco — require extra effort not just because they call for truly transformational change, but because engaging with “cancelled” industries demands courage.

In many ways, Novelli’s early tobacco negotiations exemplify such courage: he bravely endured ad hominem attacks in the name of multisectoral problem-solving. Yet, the author fails to demonstrate such mettle in the book’s discussion of tobacco harm reduction (THR).

Harm Reduction

Harm reduction products (HRPs), including e-cigarettes, have the potential to dramatically reduce death and disease caused by tobacco. Because these solutions appear to arrive from a cancelled industry, however, organizations like CTFK do not acknowledge their benefits. To the contrary, CTFK has called for boycotts and bans of the tobacco and e-cigarette industry, even promoting nasty attacks on harm reduction researchers. These actions are as ironic as they are disappointing, given that CTFK’s current president, Matthew Myers, has been on the other side of cancellation. Yet, while Myers bemoaned the “ferocity” and “viciousness” hurled upon him in the nineties, he now leads an organization that regularly exhibits these features.

Similarly, In the case of harm reduction, Novelli’s strong support of purposeful engagement with industry evaporates. This turn is surprising in light of the fact that, unlike the tobacco industry of the 1990s, the THR sector emerges from significant investment in technology aimed at reducing health risks associated with nicotine products. Indeed, there now exists a substantial body of toxicological, clinical, and epidemiological studies demonstrating the benefits of switching to this new genre of products.

Yet, due to the wholesale cancellation of industry, this research may not reach those who most desperately need to see it. A sharp division now separates industry research and public health research, each sphere with its own conferences and publications. While Novelli once positioned himself as a vital interlocuter between such domains, he now appears to have abandoned his post. As such, he fails to recognize new opportunities for productive engagement.

In an apparent effort to justify this shift in stance, Novelli cites the dangers of youth vaping, as well as the 2019 EVALI outbreak. While said outbreak was ultimately attributed a vitamin E acetate additive in THC-containing products, perceived links between EVALI and HRPs continue to impact public policy. Across the world, e-cigarettes (or their flavors) are being banned, while deadly combustible cigarettes remain on the market. This type of irrational legislation is a hallmark of cancellation politics — a breed of decision-making that prioritizes ideological purity over reason.

Indeed, while Novelli applauds CTFK’s new vision of “a future free of death and disease caused by tobacco,” he fails to recognize the steps needed to actualize this vision. To combat the devastation caused by smoking in the medium-term, the public health community must: (1) improve cessation and harm reduction solutions; and (2) enhance early diagnosis and treatment of diseases caused by tobacco. None of these actions are currently a priority for CTFK, which remains narrowly focused on children, often at the cost of their parents.

To achieve CTFK’s purported goals, we must learn to prevent youth uptake while also recognizing the needs of current tobacco users. A sound approach for doing was identified in 2017 by Scott Gottlieb and Mitchell Zeller, who proposed a “nicotine-focus” framework. Proceeding from science, rather than ideology or politics, such a framework would: reduce the addictiveness of cigarettes, thus curbing youth uptake; and carve out a role for nicotine products that help users quit.

Though CTFK remains stubbornly resistant to such ideas, that is not to say that the entirety of the public health community rejects evidence-backed strategies. In fact, thinkers with whom Novelli has collaborated — including John Seffrin, Steve Schroeder, and Tom Miller — now strongly support a role for THR. Yet, where these experts have updated their views to cohere with science, CTFK remains ideologically opposed to THR in any form.

Getting the Message Right

A self-professed “marketing guy,” Novelli treated CTFK as a kind of public relations firm for tobacco control . While this approach has its perks, good marketing does not always cohere with good science. Unfortunately, the broader tobacco control movement is dense with marketers and lawyers whose vision often takes priority over doctors and scientists. As a result, the field repeatedly fails to grasp the importance of research, innovation, and intellectual property; and policy often reflects not what’s best for public health, but rather what sells.

In the nineties, Novelli focused his efforts on youth smoking because he knew it had the emotional charge necessary to generate political attention. Yet, the use of emotion also has the potential to drown out sound science. This is particularly true in the context of the current social media ecosystem in which rage and rancor promote virality. If QAnon teaches us anything, it’s that a “save-the-children” angle can be quite persuasive, particularly in online channels. Yet, this type of emotional messaging also holds the potential to obscure logic — often, with devastating consequences.

The “kiddification” of US tobacco control has yielded many positive developments, including the recent ban on sales to youth under 21. In the process however, the country has ignored the needs of smokers currently at risk of dying from their habit. This trend is particularly disappointing in light of mounting evidence regarding the potential of HRPs to help smokers quit. Yet, unlike anti-vaping hysteria, scientific evidence does not generate clicks and retweets.

Due to online misinformation — sometimes perpetuated by nonprofits like CTFK — harm reduction research now suffers from an image problem. The whole of THR has been reduced to a debate about children vaping; and the e-cigarette industry has been inaccurately conflated with Big Tobacco. In reality, these products were developed not to prop up the combustible cigarette industry, but to displace it. They emerged not from greedy tobacco executives, but from Stanford academics and, independently, from a Chinese pharmacist seeking a way to quit cigarettes — details that anti-vaping crusaders tend to omit.

From a marketing perspective, the depiction of all nicotine products as evil is a relatively easy sell: it’s simple and emotional, with the perk of conferring moral superiority. The problem is, it’s just not true. Certainly, we should do everything in our power to ensure that kids do not use e-cigarettes and other HRPs; at the same time, however, we must recognize that these products offer a feasible strategy by which to save the lives of individuals who use combustible cigarettes and other toxic tobacco products. Put another way: progress in tobacco control requires nuance, not cancellation.

Novelli’s failure to again recognize the need for “everyone at the table” is disappointing, but it may also be instructive for a society grappling with cancel culture. Bad actors must be punished for their misdeeds. However, absolute cancellation for the sake of moral superiority may obstruct truly moral aims. In the field of tobacco control, and society at large, we must develop better tools for correcting misinformation and communicating nuance. Millions of lives hang in the balance.

President of the Foundation for a Smoke-Free World and former World Health Organization (WHO) cabinet director for noncommunicable diseases and mental health.

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