Death was much on American minds when the Gulf War produced the first 11 deaths from ground combat. How many Americans noticed the reports from the federal Centers for Disease Control that in 1988, 434,000 deaths -- nearly eight Vietnams -- were the result of tobacco?
Most of these deaths -- up 11 percent over 1985 -- were from self-inflicted wounds, inflicted during 10, 20 or more years, the time it usually takes for smoking to result in cancer. But for some thousands of adults and children, death came from the second-hand smoke of others, and because women smoked during pregnancy and parents smoked around their infants. (Second-hand smoke increases the risk of sudden infant death syndrome.)
Fathers who smoke increase the risk that their children will have brain cancer or leukemia, which suggests that smoking can damage sperm. Recent research also suggests that smoking accelerates development of AIDS in infected people, and that there is a dangerous synergism between depression and nicotine addiction.
Most of those 1988 tobacco fatalities resulted from addictions acquired before or not long after the 1964 Surgeon General's report insisting on the connection between smoking and cancer. Today, grimly realistic social policy counts on these utterly predictable casualties of foolish behavior: the Social Security system counts on millions of smokers dying before receiving many, if any, benefits.
Today's tobacco-related mortality rates reflect a lag of about a generation in changed behavior. Today's many behavior-changing policies constitute reasonable attempts to deal with the conundrum of a legally merchandised product that is invariably harmful. Consider these:
Eight California chain stores and some tobacco manufacturers have paid a $750,000 fine for not warning customers (California law requires "clear and reasonable warning") that cigars and pipe tobacco can cause cancer and birth defects. Massachusetts' Supreme Court has allowed plaintiffs in a liability case against Phillip Morris to name as a defendant a store that sold the company's cigarettes to minors.
New Jersey's Supreme Court has held that warning labels on cigarette packs and advertisements do not immunize manufacturers against damage claims by smokers or their relatives. A New Yorkjudge has ruled that parents' smoking habit is a legitimate consideration when determining which parent in a divorce proceeding should get custody of children.
(One in six cases of lung cancer in non-smokers is caused by protracted exposure of children to second-hand smoke at home. Twenty-five "smoker-years" -- two parents smoking 12 1/2 years -- doubles a child's lung-cancer risk.)
California's state health director wants state universities and major pension funds to divest themselves of their $525 million of stocks in tobacco companies. Smoking will soon be banned on all regularly scheduled bus trips in the United States, affecting 300 companies carrying 94 million passengers a year.
San Francisco is restricting tobacco (and alcohol) advertising on such public places as buses, cable cars and streetcars, as Seattle's and Denver's transportation systems have done. Congress soon will consider sharply curtailing all cigarette advertising, banning the use of cigarette brand names in sponsorship of sporting events and restricting cigarette vending machines to adult locations such as nightclubs or restaurants where hard liquor is served.
The vendor's lot is not a happy one these days. To purchase a $2.50 pack, a customer needs 10 quarters, so vendors are pushing to replace the dollar bill with a dollar coin. And while many cigarette machines are being reduced to scrap, some visionary vendors are working on ways to sell french fries from machines.
Last summer, Laguna Beach, Calif., raised the minimum requirement for non-smoking seating in restaurants from 25 percent to 60 percent of capacity. San Luis Obispo has passed the nation's strictest anti-smoking law, banning smoking in any indoor public space -- shops, restaurants and bars.
The University of Wisconsin, Madison, is extending its smoking ban from 18 buildings to almost all its 900 buildings, a policy comparable to that of Temple University in Philadelphia. Some campuses are considering giving staff who smoke paid hours of leave to attend classes to help them quit.
California seems to have doubled the rate at which smokers quit, using an extremely aggressive advertising campaign that stigmatizes smoking as de'classe' as well as dangerous and depicting tobacco companies as loathsome. In one radio ad, a man tells his girlfriend that her yellow teeth are disgusting.
As a result of these and many other measures, comprising a comprehensive campaign against millions of premature deaths, 20 years from now the ashtray may have gone the way of the spittoon. This happy result would mean victory in a war that already has killed many times more people than have died in all of America's wars combined.