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Clouding the Web

Tobacco 2.0

The Internet will help achieve “friction free capitalism.”

BILL GATES

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Cigarettes are one of the most carefully designed small objects on the planet. But it was not an easy thing to get people to smoke. To make smoking as ordinary as, say, eating carrots or drinking orange juice, you needed an elaborate marketing and promoting apparatus, the likes of which the world had never seen. People also had to learn how to smoke. And while this is easy enough in a world of ubiquitous smoking peers and visual models (just look at today’s Hollywood films), there was a time when people had to be taught how to smoke. In the 1930s the American Tobacco Company organized classes for such purposes, directed principally at women. Company reps used dolls to demonstrate the proper way of holding, lighting, and smoking a cigarette, and some of these manikins can be found on display in tobacco museums. The saturation of film and virtually every other medium with smoking has to be seen in this light: smoking had to be made socially acceptable, and huge budgets were devoted to this cause.

Anthropologists like to talk about “material culture,” meaning the diverse ways physical objects are built into the daily life of a people. The material culture of smoking has a long and complex history, appreciated best perhaps by the collectors of tobacciana, comprising the endless variety of pipes, cards, silks, lighters, humidors, matchbooks and cigar boxes, wooden Indians, tobacco tins, posters, advertisements, and other paraphernalia that now fill the world’s (mostly industry-run) tobacco museums. Collectors prize the well-made meerschaum pipe, the lighter carved in a World War I trench, the agate snuff box cut for the European aristocrat, the minstrel-era matchbox or tobacco tin.1

But cigarettes have been built into life in many other ways. The front shirt pocket that now adorns the dress of virtually every American male, for example, was born from an effort to make a place to park your cigarette pack.2 Alternate uses of course have become common—just as we now plug electronic devices into holes once meant for lighters—but the fossil function testifies to the intrusive power of the cigarette and to how easily we overlook the origins of everyday objects. There are many other examples. Germans still talk about male formal wear as a “Smoking” (jacket), and in many parts of Europe you get your newspaper from “Le Tabac.” My vote for the creepiest goes to the U.S. military, which in the wake of the Korean War outfitted war-wounded veterans with artificial arms housing built-in cigarette lighters.

VENDING MACHINES AND ASHTRAYS

Vending machines may already seem like an anachronism, but for more than sixty years they were a prime source of cigarettes in the United States, especially for young people, who could get their fix of sticks in perfect anonymity by simply dropping in a few coins (see Figure 21). Early vending machines dispensed gum and other novelties—the Oxford English Dictionary (OED) gives 1895 as the first known use of the expression—but prior even to its breakup in 1911 American Tobacco owned a controlling share in the Garson Vending Machine Company, part of its effort to control all links in the cigar and cigarette supply chain. Patents for the automatic dispensing of cigarettes and cigars date from the 1880s,3 but serious exploitation of such devices doesn’t really begin until after the First World War, when skyrocketing consumption and standardization of packaging led to new commercial opportunities. An American by the name of William Rowe invented an improved cigarette vending machine in 1926, and by 1938 the Rowe Cigarette Service Company of New York was operating 14,000 dispensers in twenty-two U.S. cities.4 Coin-operated sales grew steadily up through the late 1970s, when 875,000 machines in the United States were bringing in $2.7 billion in annual cigarette business.5 This was an effective way to move product, and companies paid a premium to place their brands in favored spots inside the machines (center column was best) and in high-traffic areas of a store or a city. Nothing was left to chance; the industry’s archives preserve detailed calculations of how placement or on-the-machine advertising would affect sales.6 Cigarette companies also paid for lobbyists to defend such machines when efforts arose to have them banned.

Vending machines were often criticized for making it too easy for children to get cigarettes, and in 1988 Surgeon General C. Everett Koop urged a ban on all such devices. Trade associations fought back, with the Amusement and Music Operators Association distributing brochures with titles like “A Responsible Program for Cigarette Vending Machines,” recommending ways to block youth access. The whole point of these machines was to automate sales, however, which is why kids were so easily enticed. A number of U.S. states enacted bans in the 1990s, though automated cigarette dispensers remain legal in many parts of the world. Japan may have more than any other nation and has come up with some high-tech—and ridiculous—ways to bar access from underaged smokers, such as optical scans and software for detecting facial wrinkles. Clever teens can apparently game the system by simply making a contorted face.

Ashtrays are another example of the insinuation of cigarettes into everyday life. It is hard to imagine a world without, but ashtrays were not a common part of life until about a century ago. The word we most often use (and spell) did not even exist: until the twentieth century ash-tray was typically spelled as either two separate words or a hyphenated compound, and the OED records the first single-word spelling (with no hyphen) in 1926.

Louis Kyriakoudes, director of the Oral History Project at the University of Southern Mississippi, has shown that cigarette makers spent a great deal of time and effort getting ashtrays into American consumer products. Automakers were cajoled into putting one into every car, and anyone who flew in a commercial plane in the 1960s, 1970s, or 1980s will remember ashtrays in the armrests of their seats—later stuffed with trash or gum after the smoking bans of the 1990s. Ashtrays were ubiquitous in offices and restaurants, hospitals and doctors’ offices, trains and taxis, and for a time it was hard to get very far from one without hiking into the woods. Movie theaters and university lecture halls had ashtrays built into the seats, and ashtrays were built into barber chairs. I have seen (Japanese-made) slot machines with built-in ashtrays and “smokeless” ashtrays powered by batteries or USB cables. Bridge tables had clip-on ashtrays, and Kyriakoudes tells how Edward Bernays, the marketing genius for American Tobacco, approached furniture makers in the 1930s to get them to build ashtrays into kitchen cabinets. Designers threw themselves into the art, fashioning ashtrays in the shapes of pianos, shoes, turtles, toilets, tires, and naked ladies. I have seen ashtrays celebrating Walt Disney World, Penn Central Station, the 1980 Olympics, and every state in the Union.

My all-time favorite, though, is the ashtray built into the U.S. military’s SAGE computer, a digital brain behemoth designed in the 1950s to protect U.S. airspace against a Soviet nuclear attack. SAGE—Semi-Automatic Ground Environment—was the world’s most advanced electronic brain, linking hundreds of radar stations in the United States as “the first large-scale computer communications network.”7 The charming part of this doomsday machine, now on display at the Computer History Museum in Mountain View, California, is the cigarette lighter and ashtray built into the console, just to the left of the radar screen intended to reveal enemy aircraft or missiles penetrating our airspace. One can imagine these guardians of our national security, stoic in their morbid duties, carefully extinguishing their cigarettes as the world descends into Armageddon . . .

Kyriakoudes has also shown that for decades, teachers in American schools taught industrious young kids how to make ashtrays. Ashtray making was part of the curriculum in many public schools, and teachers were encouraged to assign such projects as a useful pedagogic activity. Well into the 1970s American schoolboardissue textbooks encouraged middle- and even grade-school teachers to instruct children in how to craft an ashtray out of clay, glass, ceramic, stone, or metal. (I have even seen precious stones—even agates—turned into receptacles of this sort.) Many kids from my generation and even later were taught how to make such objects—and there may be parts of the world where children are still being taught such skills.

Ashtrays have always been important for cigarette makers; they realize the danger of smoking becoming inconvenient and for many years worked hard to place receptacles wherever possible. The document trail is not what it should be (because subpoenas have not targeted this realm), but the industry has fought to keep ashtrays in public parks, hospitals, planes, trains, and automobiles. Ashtrays became a kind of de rigueur furniture for several generations of Americans, as they remain in many parts of the world today. With the gradual extinction of smoking, however, we can expect these to glide into antiquity. Readers of these pages in the not too distant future will probably find the ashtray as much of a curiosity as public urination or the spittoon.

(Spittoons were ubiquitous in nineteenth-century America because of the widespread use of chewing tobacco. The chaw in the cheek generated spittle, which admen sometimes offered as proof that tobacco “aided digestion.” Oscar Wilde in 1882 described the nation as “one long expectoration”; other visitors were astonished to find Americans spitting inside theaters, streetcars, and seemingly every other public place. Spittoons were introduced to prevent the spread of germs, and some states barred spitting anywhere but into a spittoon. In courtrooms a lawyer might have his own brass pot, as would the judge and jury. Spittoons bit the dust with the broader triumph of the germ theory of disease and fears of spreading microbes, though not without some protest. The governor of Pennsylvania in 1905 characterized spitting as “a gentleman’s constitutional right” and its banishment “an infringement of liberty.”8 Ashtrays will eventually suffer the same fate; they are already an anachronism in richer parts of the world.)

Ashtrays may not seem like rocket science, but readers might be surprised to learn how many patents have been awarded for innovative designs. A search of Google Patents turns up thousands of claims for ashtrays, from the “Snuf A Rette” of 1937 to the battery-powered “smokeless” receptacle (with USB port) of our own millennium. Ashtrays have been designed to protect against fires, to stand up steady in an office, and to attach to the dash of your car. There are patents for windproof ashtrays and safety ashtrays and illuminated ashtrays; also for ashtrays that are self-cleaning or attached to thermometers or double as coasters or containers for napkins, coins, poker chips, or food. Patents describe ashtrays that can be folded for carrying or are stackable, portable, or disposable. There are ashtrays that sound an alarm (to prevent fires) or look like human lungs (to help you stop smoking). Others are specially made for urinals, sportsmen, the female smoker, or the disabled. Cigarette makers have even researched the cigarette-ashtray “fit”: Brown & Williamson in the 1980s, for example, asked test panels of smokers to evaluate how easy a particular brand was to handle “with respect to placement in an ashtray.”9

The tobacco industry has also tried to design ashtrays that will absorb secondhand smoke or allow a smoker to dispose of ashes when under way. Philip Morris in the 1990s, for example, worked with Royal Philips Electronics to create an ashtray that would absorb smoke; “active ashtrays” of this sort had a little fan inside and an electrostatic filter to scrub the smoke from a fuming cigarette.10 The industry had already spent a great deal of time designing cigarettes that would emit less or less visible smoke along with a whiter, firmer ash, and these newfangled ashtrays were part of this push to shore up the “social acceptability” of smoking, a high priority since the late 1970s. Portable ashtrays were developed for similar reasons: the idea was that smokers would carry around little boxes or pouches into which ashes could be discreetly tapped. A Google Patents search for “ashtray” and “portable” in 2010 returned more than two hundred items.

SYRINGES FOR KIDS?

There are other ways, of course, that cigarettes have been insinuated into everyday life. I’ve mentioned candy cigarettes, but we also find smoking toys and dolls of various sorts, including toy cigarette packs, spring-loaded cigarette pranks, smoking toy animals, even miniature cigarettes and ashtrays for your child’s dollhouse or toy soldier (Figure 22). Rarely were such toys produced as generic brands; most are faithful renderings of commercially popular cigarettes. It is not yet clear whether the makers of such playthings obtained permission from cigarette manufacturers to make them; it could well be that, as with candy cigarettes, the industry turned a blind eye or even welcomed such infringements as nice advertising for the novice.

What is remarkable, though, is how many different kinds of infringements can be found. Apart from those already mentioned, a short list would include gag or trick packs for use in magic shows, exploding cigarettes in name-brand packs, and battery-powered cigarette pack “smokey amps” (“the world’s smallest and least expensive guitar amplifier”) used supposedly by “artists like The Rolling Stones, The Foo Fighters, Mike Watt, The Red Hot Chili Peppers, and many, many others!” I have seen novelty prank packs that deliver an electric shock, wind-up packs that jump around on the table, cigarette trick (magic) books, cigarette-pack squirt guns, cigarette-pack spy cameras, cigarette-pack radios, cigarette-pack peep shows, and cigarette-pack measuring tapes—all in popular name-brand packaging. I myself own a Kent cigarette solar-powered calculator, a Marlboro disappearing cigarette pack for use in magic acts, a Basic (Philip Morris brand) tape measure, and a set of artfully crafted buttons (from the 1930s) made to look like Camel, Lucky Strike, and Old Gold cigarette packs—only smaller. The phenomenon is not purely American: miniature lighters, ashtrays, and cigarettes were made in England in the 1960s by a company called Kiddicraft, which sold reduced-size packs of brands like Players Navy Cut for use as toys. Novelty shops in the United States still sell toy cigarettes of various sorts—some of which emit puffs of pretend smoke (“not recommended for children under the age of 8 years”). One might wonder why we don’t have toy syringes for kids to pretend to shoot up heroin, or toy hash or crack pipes.

So much for Tobacco 1.0. What is new, tobacco-wise, in the virtual world?

INTERNET SAVVY

Cigarette makers have always been technically adroit and by the 1960s had computerized many of their operations. British American Tobacco had established a kind of Internet by the early 1980s: the INTERBAT linked seven leading European tobacco makers via an early version of email, and by the end of that decade every major cigarette company was Internet savvy. BAT held its first INTERBAT Workshop in 1982, by which time it had already developed a series of computerized databases containing product information, direct mail addresses of customers, and so forth. By 1966 Britain’s Tobacco Documentation Centre was compiling annotated reviews of dozens of Internet tobacco sites—both pro and con. In one such compilation, “Anti Tobacco” websites included those put out by the World Health Organization and the American Cancer Society.11 BAT by this time was effusing over the Internet, pointing out that while 95 percent was “rubbish, puerile, imitative, self-indulgent, irksome, tedious,” or even “ranting commercial rubbish,” the remaining 5 percent was “innovative, fascinating, quirky, profound, enlightening, mischievous, anarchic and stimulating,” and above all else a great opportunity, a place where you could advocate the need for “tolerance and harmony between smokers and nonsmokers, and all of this theoretically without censorship (commercial or moral) or vast expense.”12

Early tobacco websites were mostly directed at the investment community, but it wasn’t long before advertising opportunities were exploited. By the mid-1990s Rothmans in Canada had a Rothmans Williams Renault Formula One site, BAT had a site selling T-shirts and toasters sporting its Lucky Strike logo, Reynolds had a site for Camels, and Burrus in Switzerland had a site for its brands. Reemtsma in Germany had one of the most ambitious sites, communicating the virtues of its West brand in a manner consistent with its avant garde self-image: “We were the first to integrate gays into our brand, to have a dominatrix, the first to show naked breasts on a billboard, and we’ve always addressed sexist issues. Not just to point out focal points but to be provocative.”13 Reemtsma’s Westcyte, launched in October 1995, offered flashing brand graphics, techno-friendly music, competitions to win a trip to Russia’s “space city” for training to be an astronaut, and other freebies. “Image gain” by means of brand exposure has been the most common goal, but companies have also used the Internet to discredit evidence of health harms and to forestall regulation. By the mid-1990s pro-smoking “astroturf” groups like the American Smokers Alliance, FORCES (Fight Ordinances and Restrictions to Control and Eliminate Smoking), and the Fair Cigarette Tax Campaign (funded by Philip Morris) had their own websites, as did a number of tobacco prevention organizations—notably Globalink, organized and operated by the International Union Against Cancer.

Since this time, despite some success in curtailing web-based advertising, the Internet has become a major source for cigarette sales. A Prudential Securities report cited by the Campaign for Tobacco-Free Kids in 2005 estimated that in the United States alone cigarettes were available from more than five hundred different websites. Internet transactions accounted for an estimated 14 percent of all cigarette sales, with the percentage steadily growing.14 For the industry this is like manna from heaven: smokers can order cigarettes and have them delivered by mail, and there is the added (and substantial) allure of avoiding sales tax—which for instate traffic is illegal but quite hard to police. A 2002 U.S. General Accounting Office study found three quarters of all Internet sales avoiding sales tax.15 Online buyers also don’t have to face the shame of a public display of their addiction. And shoddy age verification systems make it easy for computer-savvy minors to get cigarettes online: a 2003 study published in JAMA found that children as young as eleven were able to get cigarettes 90 percent of the times they tried.16

Cigarette manufacturers have responded with a number of technical fixes to try to catch such “cheaters.” (Recall those Japanese efforts to verify age by means of optical scanners programmed to detect facial wrinkles.) State governments in the United States are trying to recoup revenues lost to Internet sales: New York State loses an estimated $75 million annually down this drain and has started billing people found to be evading taxes, sometimes to the tune of several thousand dollars.17 Many states ban Internet tobacco purchases, but enforcement is lax and difficult, especially for small-scale buyers and sellers. Credit card companies have pledged to help curtail online sales,18 though it remains to be seen how effective this will be. Flying below the radar, the clever and persistent buyer can usually get through.

DRAGGIN LADY AND SMOKINGBABE

Internet sales are only one of several ways tobacco circulates in the virtual world. The companies have their own websites, but smoking is also promoted through auction sites, cigarette rating clubs, “smokers’ rights” organizations, and clubs with specialty interests in cigars, smokeless tobacco, hookah, or even cigarette pack art.19 Tobacco manufacturers have started seeking input from users to design tobacco ads: Playboy magazine in 2008, for example, launched its “Skoal Builds Playboy” promotion in which Skoal fans were invited to help design the content of a twelve-page Skoal-themed spread for the January 2009 issue of the magazine.20

Pornography sites catering to smoking fetishists have also become popular. A 2008 Google search returned 1,950,000 hits for “smoking fetish” and 139,000 for “smoking porn.” There are tens of thousands of such sites, with names like “MSInhale” and “Dirty Smokers,” featuring artists such as “Draggin Lady” or “Smoking-Babe” and others with names less fit to print. There are even websites to help you rank and evaluate such sites, rating ease of navigation and image and video quality (of course) but also models, locations, frequency of image updates, number of brands displayed, inclusion of “subfetishes,” and originality. One such site (www.smokingfetishsites.com) asks, “Are the photos & videos completely original and shot specifically for the site, or are they bought from a broker as non-exclusive content, which means they could be on any number of other sites out there? Was the content shot by a smoking fetishist or is the site run by a faceless company who buy the content in and have it shot by a photographer who doesn’t understand the ins and outs of the fetish?”21 Cigarettes also figure in various forms of online role-playing games. There are several dozen smoking groups in “Second Life,” for example, which also has “smoke shops” that offer virtual cigarettes for sale for Linden dollars. Ashtrays and smoking gear can be purchased at Second Life Classifieds sites, where you can also find ads for virtual cigarettes, cigars, and ashtrays. It is not yet clear how much of this—if any—has been organized by the industry.

More politicized are the “smokers’ rights” groups coordinated through websites such as CLASH (Citizens Lobbying Against Smoker Harassment), which features prominent links to groups like FORCES, FOREST (U.K.), Smokers of the World Unite, Minnesotans Against Smoking Bans, and several dozen others. CLASH also directs smokers to several sites where discount cigarettes can be purchased online and to OLTRA (Online Tobacco Rights Association), a trade association formed to defend the sale of cigarettes online.22 CLASH also links to numerous online pro-smoking newsletters and political contact sites like Congress.com, where users are instructed in how to create pro-smoking “Video Advocacy Messages” for uploading on YouTube.

Facebook and MySpace are also sites where smoking is being promoted. As of March 2008 there were 311 groups for “smokeless tobacco” on Facebook, with one or two new sites being added every week. Some of these groups are quite large: one called “Actually, IDID know that cigarettes are bad for me! NOW SHUT THE F**K UP” had more than 12,000 members and 124 discussion boards, with hundreds of people contributing opinions on topics such as “most annoying time that someone bitched about smoking.” This site is linked to others with equally heartwarming titles, such as “I Secretly Want to Punch Slow Walking People in the Back of the Head.” Some tobacco companies also have Facebook sites: British American Tobacco has several closed sites (membership by invitation only), the largest of which has nearly seven hundred members.

Yahoo as of 2008 had 1,200 “smoker” groups and 5,300 “smoking” groups; My-Space also has lots of people with smoking network friends. “I image Smoking” as of June 2008 had 487 friends, virtually all of which were smoke-themed. Many of these MySpace sites post smoking video clips, and many are linked to smoking fetish sites. It is hard to monitor or even get an overview of such sites, however, given how rapidly they change. Already by September 2006 YouTube had 65,000 new videos uploaded daily and by March 2008 was growing by more than 150,000 per day. A YouTube search of “tobacco” gets over 30,000 hits, with “smoking” returning 177,000 separate videos, split roughly equal pro and con. And hundreds of ads from cigarette manufacturers. A Ruyan ad for its electric cigarette had been viewed over 320,000 times as of November 2008, and many of the larger companies have widely watched YouTube ads. MySpace also has lots of smoking-themed uploads: my search in June 2008 using the search term “smoking” yielded over a thousand MySpace videos, from smoking chimps (and dogs) to smoking kids (as young as eight), a lot of sensual/seductive smoking (with females way outnumbering males), smoking comedians, a rock group called Smoking Presidents, and Fred Flintstone’s famous smoking cartoon from 1960 in which he and Barney sneak out (!) behind a rock to savor a Winston, hiding from their wives.

SMOKING PASSIONS, CIGARETTE GEAR

Internet dating services for smokers are a relatively new phenomenon; sites like www.smokerdatelink.com and www.smokingpassions.com have thousands of smoker profiles online, with hundreds added daily. Simon Chapman of the University of Sydney documents a growing trend to indicate a preference for nonsmoking partners on Internet dating sites, signaling in Australia at least an increasing denormalization of smoking. These sites may be somewhat upscale, but people everywhere are starting to demand smoke-free hotel rooms, apartments, rental cars, and roommates. The stigma attached to smoking is growing in many parts of the world, though it is easy to exaggerate the extent to which we have already transcended the habit.

Readers may find it surprising, for example, that at any given moment on eBay there are upwards of a thousand items plugging the Marlboro brand. A March 2008 search returned Marlboro-branded Swiss army knives, toy trucks, lighters, canteens, jogging suits, cookbooks, sweatpants, jeans, jackets, playing cards, photo frames, suitcases, belt buckles, money clips, and dozens of other items. Similar returns are obtained by searching “Camel,” “Silk Cut,” and other leading cigarette brands. Judging by availability on eBay, it would seem that much of the world is awash in cigarette gear. A search of “cigarette” returns tens of thousands of items, with pro smoking offerings outnumbering antis by more than fifty to one. Most of these are things like cigarette cards (or silks), lighters, magazine ads, or antique cigarette packs and cases, but many are items designed originally to spread the name of a particular brand of cigarette. A search of “tobacco” yields this same material asymmetry. “Ashtray” returns about 10,000 items on eBay—which could well be an index of their disappearance. Smoking rates are falling in many parts of the world, though even in a state like California, with its aggressive smoke-free laws, there are still about eight hundred cigarettes smoked per person per year—which is not much lower than average for the earth as a whole.

There are of course other kinds of tricks being used to penetrate web and networking culture. One has been to collaborate with manufacturers of nontobacco products to create cigarette synergies. Food and clothing are often involved, but electronic communications have recently joined these ranks. British American Tobacco, for example, has been bragging about its use of a Neverfail BlackBerry network to keep its global workforce in touch (“Neverfail keeps that heart beating”). BlackBerry and BAT have both been celebrating their newfound alliance, but why such a fuss about a system that presumably all large corporations have in place? The company’s repeated “announcements,” press releases, videos, and so on, about its use of global communications seem designed to keep the BAT name in view. YouTube even has a puff piece on BAT’s BlackBerry network (at http://www.youtube.com/watch?v=MOTaTQ8-dbc), which is hard to see as anything but an ad for both companies. The clip does not allow any commentary, presumably to keep up the illusion of honest communication. A BlackBerry newsletter on the web reveals that the devices were supplied to top BAT personnel as part of a plan to “seduce your users.” BAT’s Information Technology director, David Sampson, explains that use of such devices “is really a matter of personal choice,”23 like cigarettes, presumably.

Another trick has been to buy up potentially embarrassing web domains, making it harder for critics to organize advocacy. In 2010 Lorillard, makers of America’s most widely smoked menthol brand (Newport), bought up over fifty different web domain names, including MentholKillsMinorities.com, KillerMenthol.com, MentholAddictsYouth.com, and FDAMustBanMenthol.com. Lorillard here followed a path blazed by Philip Morris in 2001, when the Marlboro giant bought up dozens of domains with names like AltriaSucks, AltriaLies, AltriaKills, AltriaEquals Death, and AltriaStinks, each in suffixed variations of .com, .net, and .org, anticipating its rebirth as “Altria.” The company even bought up misspellings of its new moniker: Altreea.com, Alltreya.com, and so forth.

A very different kind of web presence has emerged in the form of chat groups and message boards, which let us hear the protest voices of a few courageous former smokers. The “WhyQuit” site, for example, allows former smokers dying from their addiction to share stories and forge alliances: “I’m Deborah and Smoking Has Smoked this Body.”24 This lived, and dying, cancer presence is more often invisible, though, until it is too late. Most people who contract lung cancer regret ever having smoked; and the sad reality is that when people start smoking at age thirteen or fourteen they have no idea what lies in store for them. Physical suffering is not an image conveyed through tobacco advertising, which is one reason health advocates call for graphic pictures of diseased bodies on all packs of cigarettes.25

No image, though, can convey the real terminal horror of smoking, with all its bodily torment and social aftershocks. How do you capture the smell of a gangrenous foot, or the torture of a sleepless wheezing night rent by cough? How do you convey the lost years of life, or the indignities of medical impoverishment, or the intangibles of familial loss and dependence? Marketing effaces all this, giving a false front to suffering that, in the end, leaves no living memory.