Frakit Vatee-Satokit's fight against U.S. tobacco companies is that of a conscientious physician striving mightily to protect the health of people in his country. He was in Washington last month as part of a 12-member delegation from Thailand for a series of negotiations with officials of the U.S. Trade Representative. But the issue isn't only trade, he argued in several days of meetings, it's also health.
"You should be helping us, not hurting us," says Vatee-Satokit, chairman of the department of medicine at Ramathibodi Hospital in Bangkok. As a lung specialist, trained at Bellevue Hospital in New York City, he is concerned about the nonsmoking citizens of Thailand who may be harmed by U.S.-made tobacco products.
American companies recently won rights to sell cigarettes in Thailand, after pressures by the U.S. Trade Representative. Now that the market is open, companies such as R.J. Reynolds, Philip Morris and Brown & Williamson are planning to exploit it through advertising. One immediate obstacle is the Thai government's ban on cigarette advertising, both for domestic and imported brands.
The issue of Thailand and cigarettes has international visibility because it marks the first time that health groups have joined with foreign organizations to block expansion into their markets by American tobacco makers. Small anti-smoking groups in three other countries -- Japan, South Korea and Taiwan -- were no match for the well-heeled, sophisticated tobacco firms in the 1980s. U.S.-style advertising and promotion, previously prohibited, was permitted. As a result, local health officials say, dramatic and lethal rises in cigarette consumption occurred in each country among women and minors -- two groups that rarely smoked before because of cultural reasons.
As U.S. cigarette companies move into Thailand, such groups as the American Heart Association, the American Lung Association and the American Cancer Society are joining forces with the Thai Anti-Smoking Campaign Project. Thailand has no surgeon general to require health warnings on cigarette packages, no organized heart or lung associations and has only minimal public funds for health-education programs that could focus on the dangers of smoking.
The country's public health physicians and nurses are overwhelmed with caring for an impoverished population where a good salary for construction workers is $3.50 a day. Nearly one out of three Thais who becomes sick lacks the money for medical care. Lung cancer is already the leading form of cancer among Thai males, two thirds of whom smoke. And now health officials worry that more Thai women and children will take up the habit.
With help from U.S. anti-smoking groups, Thailand promises to be the country where tobacco products will be met with the same sort of resistance they experienced in the U.S. throughout the '80s, when public health campaigns about the risks of nicotine use achieved a reduction in the number of smokers. An estimated 1.3 million Americans a year successfully quit smoking.
In a recent article in the Journal of the American Medical Association, Vatee-Satokit wrote: "In Thailand, there is much prestige attached to products from the glamorous West, especially among younger, style-conscious Thais. Many who would not otherwise think of smoking will do so because the cigarettes are made in the hills of North Carolina, not on Rama Four Road . . . If we are pressured into changing our advertising, we will endure torrents of Madison Avenue promotions and inducements to enlist new smokers."
If the U.S. Trade Representative, at the behest of American tobacco interests, continues to press for elimination of the current ad bans, how credible will be the Bush administration's war against drugs? While it is vocal about stopping the river of cocaine flowing in from the Colombian cartel, it is willing to support export of the lethal nicotine drug to developing countries. Last year, sales abroad were a record $3.4 billion. Is the message going to be: "Your drugs are bad for us, but our drugs are good for you?"