There are powerful cultural values that account for the resilience of the cigarette. Tobacco use continues to be widely viewed as the responsibility of the individual smoker. Even as the tobacco-control movement has worked to contest this view—by emphasizing the addictiveness of nicotine and the aggressive pitch to children—common cultural logic continues to assert that smoking is a matter of individual control. This view takes tobacco regulation off any list of political priorities. At the same time, efforts to bring Big Tobacco under regulatory mandates are viewed with considerable skepticism in a polity hostile to big government, big taxes, and Big Brother. Cigarette use, in this view, is an area where government pursuit of social goals must yield to the individual’s right to disregard health and well-being. The stigmatization of the smoker, which occurred in the last decades of the twentieth century had the effect of further eroding the political will to regulate tobacco. Because they are attributed to individuals, large and concrete risks, like smoking, are perceived far more benignly than are smaller but more dramatic risks. Because the effects of tobacco are slow—and iterative—and produce diseases that have other causes and explanations, often later in life, they seldom arouse fear commensurate with their impact. If, for example, we were to identify an infectious organism that caused lung cancer, heart disease, and emphysema in a substantial number of people who were exposed, one can only imagine the level of concern and political action that would result. But we have an industry that produces such an “agent” with a warning label printed on the side of every package. As a culture, we seek to insist—despite much powerful evidence to the contrary—that smoking remains a simple question of individual agency, personal fortitude, and the exercise of free will. Certainly, if it involves imposing risks on others, its public use should be legally curtailed. As a result, there has been much support for restrictions, increasingly universal, prohibiting smoking in public places. But at the same time, there has been an ongoing insistence that smoking remains an aspect of personal agency, beyond the ken of regulatory interest. This view is widely held because it protects our larger sense of individual control and agency. Smokers, who are easy to stigmatize and condemn, assure our sense of a world in which individuals do make decisions, exercise agency, and control their destinies. Keeping smoking essentially unregulated assists us in a larger cultural denial of forces over which we may have little control. In this sense, we need the cigarette and the smoker to make sense of our world. And the tobacco industry is willing and eager to assist in the assertion of the logic of individual responsibility. Take, for example, the recent major advertising campaign sponsored by Philip Morris known as “Quit Assist.” These widely viewed television spots and pamphlets—often perceived as counterintuitive—contend that Philip Morris, the nation’s biggest producer of cigarettes, is eager to support efforts to restrict youth smoking and aid those who wish to quit. Not only do such public relations efforts attempt to demonstrate that the company now is a “responsible corporate citizen,” the campaign also seeks to underscore the claim that smoking is simply a matter of adult “choice.” These ads have been shown to have little or no effect on quitting, but they are quite effective in shoring up the industry’s principal defense of cigarette smoking as an individual responsibility. If Philip Morris is offering to help you quit—and you don’t—who should be held accountable?

Resisting the blandishments of the companies and the addictiveness of nicotine is one cultural test of our discipline, independence, and individualism. This cultural idiom—central to the way we think about vulnerability, health, and disease—continues to shape the history of the cigarette in our time. But as the last century has shown, this orientation to the cigarette is a product of time and culture, subject to change. That said, it is powerful and resilient, and vast corporate interests seek to reify these values.

Our insistence on personal responsibility may be a double-edged sword. It may encourage a heightened sense of individual control over health but also alienate and distance those who become ill. I cite a common scenario: “I have a friend in the hospital with lung cancer.” First question: “Did he smoke?” “Two packs a day—tried to quit and failed.” A shrug of the shoulders: “What did he expect?” This quick and commonplace response reveals the nearly instantaneous mechanism by which we identify the smoker as the one responsible for his sorry fate. By doing so, we dissociate ourselves from the complex forces—economic, corporate, cultural, and biological—that have brought such smokers to their plight. Shall we consider smokers ignorant and stupid for maintaining an “unnecessary behavior” that has clearly been defined as highly dangerous, or shall we recognize the power of advertising and cultural conventions, as well as the biological and psychological qualities of addiction that constrain individual choice?

Calls for public responsibility need not erode our expectations of individual responsibility. It would be far easier and more appropriate to consider smoking truly an individual choice if, for example, cigarettes were subject to a serious and effective regulation. Setting individual versus social responsibility creates a false dichotomy that has served the tobacco industry’s interests.

This is not to suggest that smokers are absolved of accountability. To the contrary, most investigators of addictive behaviors confirm that individual motivation and acceptance of responsibility are critical to cessation and recovery. But we should not allow the industry to use calls for individual responsibility to secure a free ride at the expense of smokers and society. Indeed, the very notion that responsibility can be allocated either to smokers or the industry misrepresents a deep historical reality about the interconnectedness of culture, behavior, and commerce in the last century.

By the early years of the new century, the legal assault on Big Tobacco that once looked so promising had been all but repelled. The industry had secured new allies by providing a steady flow of state revenues. Now state governors and attorneys general would help the companies fight off litigation. In the last decade of the twentieth century, many tobacco-control advocates had dared to envision a broken and bankrupt industry, with jail terms for executives whose perjuries were the least of their crimes. To the contrary, the industry emerged on the other side of the decade decidedly intact, ready to do business profitably at home and abroad.

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