FDA goes for gruesome on proposed tobacco warnings

Is fear a legitimate motivator?

November 13, 2010

Taking a clue from Stephen Colbert's recent march on Washington, the Food and Drug Administration seems to be tapping the keep-fear-alive theme in its proposed new warning labels for cigarettes.

Gruesome images of diseased lungs, a decaying mouthful of teeth and a corpse in a coffin with a toe tag are among the graphic images that could be placed on cigarette packages as part of a strengthened campaign to warn consumers of the dangers of smoking. According to government statistics, about 440,000 people die a year from smoking-related health problems.

An array of 36 graphic images, including one showing a man exhaling smoke through a hole in his neck, were unveiled this week. These will be winnowed to nine images in June, after public comments, a review of scientific literature and a study of somehow the labels affect smokers. If all goes according to schedule — and if a lawsuit by R.J. Reynolds Tobacco Company challenging the beefed-up regulations goes away — the new images will appear next October, taking up half of the front of cigarette packages.

This raises several questions. Is fear a proper weapon to use in a public health campaign?

Effective advertisements can exaggerate facts and fudge data. For example, e-mails from a behind-the-scenes debate in the New York City health department over how to frame its campaign against sugary soda consumption show that the simplicity stressed by the ad writers — soda makes you fat — trumped the worries of the scientists, who noted that mitigating factors such as exercise, age and gender are involved in weight gain. Ideological zeal, even for a good cause, should not outweigh science.

There may be less concern in this case — after all, there's no question about how bad cigarettes are — but officials need to be careful not to overdo it, lest they compromise the authority of their message.

Then there is the question of effectiveness. Can smokers be scared straight, terrified into quitting? A notable experiment in fear, the 1978 documentary "Scared Straight," in which convicts tried to intimidate juvenile delinquents into changing their ways, seems to have shown mixed results. The tough teens in the film went on to lead happy, felony-free lives. However an analysis of seven similar scared straight programs found that the fear tactics failed to deter criminal behavior and in some cases encouraged it.

Can scary images stop people from smoking? Looks like we will find out next fall.

—Rob Kasper

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