Threat Of Impotence Becomes A New Weapon Against Smoking
November 09, 1998 11:09 PM
By Suein L. Hwang and Nick Cumming-Bruce, Staff Reporters of The
Wall Street Journal
A potent new weapon is surfacing in the battle against smoking:
impotence.
Scientists have known about links between smoking and sexual
problems for several years. But doctors and health-advocacy groups -- in
some cases emboldened by the global publicity for the drug Viagra -- are
just now beginning to trumpet the warnings.
The state of California has been been running a $21 million antismoking
campaign featuring a TV commercial in which a man's efforts at flirtation
fail when his cigarette goes limp. "Cigarettes," says the tagline. "Still
think they're sexy?"
Last week in Thailand, where 90% of all smokers are male, cigarette
packs were required to start carrying this warning: "Cigarette smoking
causes sexual impotence." That message, one of a series of tough
warnings to be printed in rotation, must be plastered in white letters on a
black background covering one-third of each pack.
Last night, CBS television's "60 Minutes" dedicated a segment to the
problem, featuring prominent doctors warning that smokers have a
greater likelihood of suffering impotence.
The spate of attention has caused a buzz among public health groups.
After being away from his office in Washington for two weeks, one
leading activist, Matthew Myers, returned to find roughly 20 e-mails sent
by various activists interested in the approach. As executive vice
president of the Campaign for Tobacco-Free Kids, he says, "It could have
a powerful impact."
Tobacco's role in cancer and cardiovascular disease has been the
antismoking message of choice for years. To the extent the impotence
warning surfaced, it has mostly been in urologists' offices, where patients
have been warned to avoid cigarettes for nearly two decades.
Now publicity for Pfizer Inc.'s Viagra, the prescription drug for impotence,
has transformed male sexual dysfunction from a taboo topic to a publicly
discussed health concern. "Absent the Viagra debate, impotence wasn't
a commonly discussed topic," says Carla Agar, deputy director of the
California Department of Health Services in Sacramento. "I think the
discussion surrounding Viagra has allowed us to take the issue of
impotence into the public domain." Ms. Agar says her department has
heard little criticism of the ad since its launch last summer.
For decades, doctors have believed smoking can harm a man's sexual
function because it constricts blood vessels, compromising blood flow.
Over the years, studies have strengthened those beliefs, most recently in
1994, when a study published in the American Journal of Epidemiology
surveyed Vietnam veterans and found that while 2.2% of nonsmokers
suffered persistent impotence, 3.7% of current smokers did. Many
researchers also believe that smoking may lower sperm count as well.
"Smoking is a significant cause of impotence, there's no question about
that," said a spokesman for Pfizer, who adds that 75% of the men in
Viagra's clinical trials were current or former smokers.
Cigarette makers, who have devoted huge sums to strengthen smoking's
macho, sexy image, are mum on the subject. "We don't have anybody
who has done any work in that area," a spokesman for RJR Nabisco
Holdings Corp.'s Reynolds tobacco unit says. "That's about all we've got
to say about it." A spokesman for Philip Morris Cos. declined to
comment.
In the past, some public health advocates were concerned about the
approach. "The focus has always been on the big killers, so there may
be some feeling this is a distraction," says antitobacco activist Michael
Pertschuk, former head of the Federal Trade Commission. "The only time
we've talked about it is half in jest, and that's part of the problem. Sexual
impotence can quickly degenerate into parody."
But with the decline in the nation's cigarette consumption leveling off,
health groups have been searching for new ways to convince smokers to
quit. This message could be particularly compelling to adolescent boys,
who are concerned about sexuality and not necessarily worried about
their mortality decades down the road.
There is anecdotal evidence that the method has worked in Thailand.
Adulvit Kitchakarn, deputy secretary general of the Thai Tobacco
Monopoly, traveled to northern Thailand 30 years ago to investigate
rumors that menthol cigarettes caused penile shrinkage. The locals were
suffering from nothing worse than chilly winter weather, he concluded, but
menthol cigarette sales dropped for months.
"If men are not concerned about their heart or their lungs, maybe they will
be concerned about their sex life," chuckles Prakit Vathirsathojkit,
secretary-general of the National Committee for Control of Tobacco Use,
who provided the impetus for the Thai package warning, believed to the
first in the world.
Other Asian countries -- which have half the world's smokers -- are
watching the Thai program closely, according to Dr. Judith MacKay of the
Hong-Kong based Asian Consultancy on Tobacco Control. "I only have to
mention impotence to an audience and everyone sits up," she says.
"We're saying maybe the Marlboro cowboy isn't so virile after all."
Drawing heavily on a post-lunch cigarette outside a central Bangkok
McDonald's, 62-year-old Chalerm Am-prasit is wholly unimpressed. A
veteran smoker of 43 years, he limits himself to a pack a day for financial
reasons only. "I won't stop smoking for any doctor," he says, brushing
aside any talk of impotence.
Bodin Sanarin, a 25-year-old bartender in Bangkok's notorious Patpong
red-light zone, is similarly nonchalant. "I read the cautions on every
single packet. I believe they're true," he says. But he says he hasn't
noticed any sexual problem personally, so his early fears have subsided.
That is a major hurdle for public-health groups trying to use the
impotence message: Only a small percentage of smokers ultimately
wind up with a serious problem, says Kenneth Laughery, a psychology
professor at Rice University who has conducted research on the
effectiveness of warning labels. "There's an 'It won't happen to me' kind of
phenomenon," he says.
That's the message Massachusetts health officials got when they
showed California's sagging-cigarette ad to focus groups. "It was
humorous, but it wasn't believable," says Gregory Connelly, director of
the Massachusetts Department of Public Health. "They think of personal
examples where it's not true." Instead, Massachusetts runs highly
personal ads of ailing smokers, including a series focusing on the travails
of a young mother with emphysema.
It can even be difficult to convince smokers actually suffering from
impotence to quit. Harris M. Nagler, chairman of the urology department
at Beth Israel Medical Center in New York, says he has been advising
impotent patients to quit smoking since the early 1980s -- with little
success. "The younger ones who are just beginning to have problems
tend to be more inclined to stop, but I haven't been impressed by the
numbers who have walked away from smoking because of it," he says.
"This is truly an addiction."
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