Philip and Me
Motivated by the effects smoking has on patients, a group of nurses invest time, money, and effort to confront Big Tobacco

By Lisette Hilton
July 19, 2004

Twelve nurses from around the United States paid their way and each bought a share of stock in the Philip Morris USA company to attend the cigarette maker’s annual shareholders meeting in April in East Hanover, N.J. Their quest was not to hear about the company’s financial progress; rather, it was to pressure the industry to voluntarily stop promoting tobacco products.

Ruth Malone, RN, PhD, associate professor of nursing at the University of California, San Francisco, spearheaded the effort. “Nurses have always been against smoking, but we’ve never taken on the industry as a group,” she said.

Malone helped form the Nightingales, a group of nurses whose mission is to highlight the tobacco industry’s behavior and its contributions to the suffering that nurses witness in their jobs, and to call on the industry to voluntarily end active promotion of tobacco products.

In her research into tobacco industry documents, Malone found a “critics,” or “enemies,” list, in which people working for the industry had assessed organizations that could be critical of the industry and their potential power against tobacco. The American Nurses Association was listed, according to Malone, but the comment in the document was that while nurses are staunchly antitobacco, they have never become active on the issue.

If they would become active, the document went on to say, they would be formidable opponents.

“I thought, ‘We need to be formidable opponents. We are the ones who see what this does to people day in and day out,’” Malone said.

The meeting

The Nightingales decided that the Philip Morris shareholders meeting would be a good starting point to make their feelings known. The meeting was for the Altria Group Inc., the parent company of Philip Morris USA, Philip Morris International, and Kraft Foods.

The nurses went armed with a 37-foot banner of letters from cigarette smokers and their families. Malone found the letters in tobacco industry files while doing her research. They weren’t allowed to bring the banner into the meeting, but displayed it outside. They attended the meeting in their white lab coats and came prepared with questions that each would pose during the shareholders’ question-and-answer session.

Malone admits that it was “scary” walking into the meeting, “but we also have the power of being nurses. I think that nurses are coming of age in terms of being able to speak out on issues beyond what had been traditionally seen as nursing practice at the bedside.”

She was the first among the nurses attending to speak. She read a few excerpts from letters about people dying from cigarette smoking and asked Atria Group Inc. chairman and CEO Louis Camilleri how the company responds to letters like these.

Sharon Brown, MN, MPH, FNP, PhD(c), a family nurse practitioner and doctoral student at the University of California, Irvine, talked about the loss of a loved one to cigarettes during her allotted two minutes for questioning. Brown requested that for 30 seconds everyone observe a moment of silence for her father, whose 78th birthday would have been the day of the meeting. She said her father “could have been here today had he not become so addicted to tobacco and died at the very young age of 60 years.”She asked what the company was doing not only to inform consumers about the addictive nature of the products, but also to diminish the addictiveness of cigarettes.

Camilleri said, according to Brown, “I’m sorry about your father.” He mentioned that there were some cessation statements on the company website.

“It was a very rehearsed and generic response, I felt,” Brown says.

Tamara Moore, manager of media relations at Manhattan-based Altria Corporate Services Inc., a services division of Altria Group, said Camilleri already had addressed the nurses’ concerns in his presentation. “So, the impression might have been that he was not responding to their questions. I think he had felt that he had answered many of the questions,” she said.

According to Moore, “I think our chairman welcomes the comments that he gets from people in attendance who may share a different perspective than his own, but in order for us to align with society’s expectations, basically, we have to hear what those expectations are. The nurses have one perspective on our businesses, while other stakeholders might have another. We certainly welcome their perspective, not just as shareholders but also as stakeholders — people who have a vested interest in our business.”

Moore, who attended the meeting, says she was “glad” to see the nurses there and hear them share their perspectives. “Obviously, as the chairman said and I would say to anybody talking about a loved one that they’ve lost, my first reaction is that, ‘I’m sorry to hear about your loss.’”

The nurses also used the opportunity to garner media attention. They mingled with the press, talking with reporters from Reuters, Dow Jones, and others, and were involved in a press conference with other protesters, including the American Cancer Society and a group of youth.

Shareholder resolutions

In addition to raising awareness for their cause, the nurses tried, as shareholders, to have an effect on health-related shareholder resolutions. One of them had to do with whether to improve warnings for women of childbearing age about the effects of smoking on pregnancy and infants. Another addressed the use of the terms “lights” and “ultra lights,” which are deceptive, according to Malone. “One had to do with filters and the fact that the industry has known for 40 years that fibers from the filters fall out during smoking and get sucked into users’ lungs, where they lodge and cause problems. The change would be to address this in terms of a warning.

“And the fourth [resolution] was whether to use Canadian-style health warnings on packages, here and elsewhere. Canadian health warnings take up about 40% of the cigarette package’s front and back and they have graphics, including pictures of diseased lungs and other things that spell out much more clearly what happens when you use this product.”

Is smoking a choice?

Moore said she doesn’t know if the Nightingales’ goal of an all-out ban on cigarette advertising is a reality. “I know that Philip Morris USA and Philip Morris International are both working to market their products in the most responsible way that they can. After the tobacco settlement agreement here in the United States, they’ve gone above and beyond what the marketing restrictions were that were dictated by the settlement,” Moore said.

One example, according to Moore, is that the cigarette maker could advertise on the backs of certain magazines but chooses not to because the ads would be so accessible to children’s eyes. Philip Morris, she said, is the only tobacco company to actively support federal regulation of the tobacco industry.

“We also supply ample information on our website about the very real public health risks associated with smoking,” she said. “Tobacco is a legal product in this country, and we want adults who choose to smoke (and again, the key word is for adults to make the most informed decision).”

Malone, though, questions the industry’s motives.

“The fact is that we know most people take it up as teenagers or very young adults, before they’re really aware of what sort of choice they’re making,” she said. “The industry’s marketing materials consistently portray people as young, healthy, dynamic, and having fun. They don’t portray people sitting hunched on the edge of a bed trying to grab for the slightest bit of breath. Now that’s truth in advertising.”

Using Federal Trade Commission figures, Malone says the five largest tobacco companies spent more than $11.22 billion in 2001, or $1.2 million dollars an hour, 24 hours a day, on the advertising and promotion of cigarettes.

Malone says she would like to have 500 nurses on the next trip to a tobacco industry shareholders meeting.

Looking back, she says the trip was well worth the expense and effort. “I think what we accomplished was we planted the seed for nurses to take on Big Tobacco,” Malone says. “And I think if anyone in this country could make a difference, it would be nurses.”

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