Reflections on 50 years as an anti-smoking activist: the danger of the single narrative
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University of Alabama, Center from the Study of Tobacco and Society, United States of America
Publication date: 2018-03-01
Tob. Induc. Dis. 2018;16(Suppl 1):A646
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Background and challenges to implementation:
Since writing his first article on smoking as a high school newspaper editor in 1964, Dr. Blum has presented over 2000 invited lectures on tobacco in all 50 US states and 18 other countries, including 45 presentations at 11 world conferences. In 1977, he founded the first physicians' anti-smoking activist organization DOC (Doctors Ought to Care), which pioneered in purchasing counteradvertising space in the mass media that ridiculed tobacco companies and cigarette brands. In the 1980s as editor of the New York State Journal of Medicine and the Medical Journal of Australia, he produced the first three theme issues on the world tobacco pandemic at any journal.

Intervention or response:
Although DOC closed its national office in 2002, several of its 80 chapters remain at medical schools as an extracurricular activity. At its peak, DOC had 5000 physician and medical student members, many of whom have become leaders in tobacco control. Entirely dues-supported, DOC was not dependent on government or foundation funding. This independence enabled DOC to confront the tobacco industry and its allies in ways that government and voluntary health agencies alike were fearful of doing.

Results and lessons learnt:
Tobacco control has become formulaic and increasingly reliant on government-led efforts that tend to be overly cautious. Even half a century after the landmark scientific reports confirming cigarette smoking's irredeemable harmfulness, the bulk of funding for tobacco control is devoted to research on the health consequences of smoking. There is insufficient prioritization, division of responsibilities, and accountability. Above all, there is a static herd mentality in tobacco control in contrast to the dynamic of the tobacco industry.

Conclusions and key recommendations:
The single narrative of tobacco control, wherein research-based policy leading to legislation and regulation, contrasts with the grassroots activist approach that laid the foundation for today's generation of tobacco control professionals. Such activism needs to be studied and revived.