What can we learn about the current debate over guns from earlier public health crises? (Photo illustration: Yahoo News; photos: Getty Images (2); background from top left: Nam Y. Huh/AP, MediaPunch/IPX/AP, Alex Brandon/AP, Joe Skipper/AP, MediaPunch/IPX/AP, Nam Y. Huh/AP, Hoo-me.com / MediaPunch/AP (2), Manuel Valdes/AP)

Survivors of the mass shooting at Marjory Stoneman Douglas High School in Parkland, Fla., joined the chorus of Americans denouncing the National Rifle Association’s (NRA) influence on elected officials over the gun control issue. But will this moment lead to substantive change in the nation’s gun laws, or will it be subsumed into Washington’s larger gridlock — forgotten until the next school shooting, as has happened repeatedly in the past?

There may be a clue in the history of the regulation of another dangerous product, cigarettes. Gun-control groups say the firearms industry is using some of the same tactics the tobacco lobby used to forestall regulations for most of the 20th century, including the suppression of potentially damaging research and casting the issue in terms of “rights” and “freedom.” But the record shows that over the course of several decades, and over the well-funded opposition of a powerful industry, public-health advocates (mostly) prevailed in the battle against smoking.

“The tobacco industry is built on profiting from a product that kills and causes disease for hundreds of thousands of Americans. Unfortunately, the same is true for the gun industry. While there are legitimate uses for firearms — for example in the military — for the most part firearms, particularly assault weapons, are marketed to civilians in a way which increases and continues a legacy of death and injury,” Mark Pertschuk, former president of Americans for Nonsmokers’ Rights and former legislative director of the Coalition to Stop Gun Violence, said to Yahoo News.

A study published in the American Journal of Medicine in February 2016 found that Americans are 10 times more likely than citizens of other developed countries to be shot and killed. Researchers from Harvard T.H. Chan School of Public Health and the University of Nevada at Reno analyzed World Health Organization mortality data for 23 high-income nations. Though the U.S. only had half the population of the other 22 nations combined, Americans accounted for 82 percent of all gun deaths. Gun-murder rates are 25 times higher in the U.S. than in similar wealthy nations. The U.S. also accounted for 90 percent of all women, young adults (under 25) and children killed with a gun.

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The analogy isn’t only to the tobacco industry. Trade groups have clear missions to support the interests of their industries they represent. But public health advocates take issue when misinformation is knowingly propagated and, from their perspective, profits are privileged over people. For instance, Coca-Cola and other soda companies long promoted the notion that exercise rather than healthful nutrition choices could solve the obesity epidemic. They still challenge soda taxes and other initiatives intended to reduce consumption.

Barron Lerner, a professor of medicine and public health at NYU Langone Health, said the tobacco industry’s mission for many years was to obfuscate the data that shows cigarette smoking causes lung cancer. Although the tobacco industry lobbied in Washington, he said, its greatest accomplishment wasn’t buying the cooperation of members of Congress or finding advocates from tobacco-growing states so much as it was complicating the issue — creating enough doubt in the public to delay the implementation of antismoking measures.

“There are historical moments where things get so bad, the carnage is so much and the rhetoric is so absurd that there’s finally movement,” Lerner told Yahoo News. “I think we’re ready for some type of a similar movement in the world of guns.”

In the mid-20th century, nearly half of all adult Americans smoked cigarettes, which were considered cool and glamorous. Smoking rates have steadily declined — from 42.4 percent of American adults in 1965 to 16.8 percent in 2014 — and many now consider cigarettes disgusting and socially distasteful. What changed? In short, the health hazards became widely known.

A major turning point for cigarettes came in January 1964, when the Surgeon General’s Advisory Committee on Smoking and Health released its landmark report, which definitively linked cigarettes and lung cancer — discrediting the tobacco companies’ attempts to cast doubt on the link. The science on cigarette smoking led directly to public health measures to mitigate harm: higher taxes, public service announcements, warning labels on the packages, smoke-free areas, etc. The cigarette companies eventually had to publicly apologize after published correspondence clearly showed that they had lied to and misled the American people.

Cliff Douglas, vice president for tobacco control at the American Cancer Society and an attorney, was involved in landmark litigation against the tobacco industry in the ’90s. He said the tobacco industry’s lobbyists and attorneys, with whom he dealt directly, are experts at changing the subject, just like the character Nick Naylor from “Thank You for Smoking.” They would much rather discuss “freedom” and “rights” than cigarettes or guns, he said.

“They are masterful at spinning the web and distracting from the key issues, which is that their products are killing people and that the industry actually has the ability to change the whole dynamic. You can make the products safer or not market them the way you do. There are so many decision points for them, but instead they shift the burden to us to defend restricting people’s freedom.”

Back in December 1953, Douglas said, the CEOs for the major cigarette companies initiated a half-century long conspiracy to cover up the dangers of smoking. These companies were found guilty of racketeering in federal court in 2006. They created false science, misled the public about the health impact of their products, delayed policy change by influencing the political process and distracted from “the reality of the epidemic of death that their business was responsible for.”

“That’s very dramatic sounding but it’s factual,” Douglas said. “What I see is a direct line of comparison between that political and public relations strategy and that of the gun industry.”

In the mid-’90s, Douglas was responsible for an exposé on ABC News about the tobacco industry’s manipulation of nicotine levels in cigarettes to get consumers addicted. The story prompted tobacco company Philip Morris to sue for libel. Facing the possibility of $10 billion in damages, ABC News publicly apologized. Fast-forward to today: Thanks to the 2006 ruling, tobacco companies are legally obligated to run prime-time TV ads with corrective messages — such as “cigarette companies intentionally designed cigarettes with enough nicotine to create and sustain addiction” — that effectively corroborate Douglas’s thesis.

In the early ‘90s, there was a push for a similar, public health approach to reducing the high rate of gun deaths. Physician Arthur Kellermann published several articles in the New England Journal of Medicine arguing that if a product is killing and injuring Americans, then public health officials should find science-based approaches to reduce the harm. Perhaps waiting periods, gun registration, locking up guns in homes and other steps could reduce deaths, he suggested. His intent was to depoliticize the issue. But, as you might have noticed, guns have not been depoliticized at all.

There are several important distinctions between tobacco and guns. Cigarette use was prevalent across virtually all demographics in the U.S. during the industry’s golden years. But gun ownership diverges strongly along rural and urban lines — a divide that’s been exploited in the culture war.

“There’s probably a small percentage of people giving away their guns because they’re disgusted. Most people who have guns and use them properly love their guns. That’s another cultural difference,” Lerner said. “That makes it harder to stigmatize guns. Cigarettes became stigmatized. People who didn’t smoke hated them. People who did smoke wished they didn’t.”

There’s also the issue of research. Whereas there are reams of government studies about tobacco, lung cancer and heart disease, the Dickey Amendment of 1996, which mandates that no government funding “may be used to advocate or promote gun control,” effectively prevents the Centers for Disease Control and Prevention (CDC) from even studying gun violence. There have been numerous efforts to repeal it and former Rep. Jay Dickey, R-Ark., now regrets introducing the legislation.

“There’s less science available to prove what sort of strategies might be effective for gun control” as a result of the law, Lerner said. “That cuts out one of the legs of the stool of a public health approach.”

Lerner’s book “One for the Road” recounts the national debate over another public-health menace, drunk driving, pitting those who campaigned for education and legislation against those who thought the problem was overregulated and exaggerated. The book explores the reasons drunk driving deaths remained stubbornly high for decades — the alcohol lobby, backlash against Prohibition, insufficient public transit — and the public’s beliefs about individualism, civil liberties and civic responsibility. In meaningful ways, the drunk driving debates foreshadowed the cigarette and gun issues.

“The word ‘freedom’ is often used. People called the car ‘the freedom machine.’ The idea in the United States is that since we celebrate our independence and frontier spirit means you should be allowed to do all these things,” Lerner said. “The word ‘freedom’ with guns is constantly used.” An illustrative headline emblazoned across the NRA’s registration page reads, “It’s not just about guns. It’s about freedom.”

The rates of drunk-driving deaths in the ’60s were enormously high because there were no regulations and poorly enforced laws. But in the early ’80s, there was a massive anti-drunk driving movement, led by groups like Mothers Against Drunk Driving (MADD). Armed with data about fatalities, they fought for tougher laws and stigmatized drunk driving.

“In the vast majority of cases, when scientists and researchers made a good case for a public health approach to a problem, things really changed. Tobacco, drunk driving, absolutely. There was data. These were respected scientists and to some degree the issues became de-politicized,” Lerner said.

The Pew Research Center found that despite sharp divisions over concealed carry and other issues, Republicans and Democrats largely agree on several modest gun safety measures, such as conducting background checks for private gun sales and prohibiting people with mental illness or on no-fly lists from purchasing guns.

One problem that has stymied grassroots efforts to effect change at the local level is state preemption of local laws. In the ’80s, the cigarette industry started fighting to establish statewide smoking laws that would supersede local jurisdictions — making it impossible for local governments to pass tougher smoking laws. They were opposed by antismoking activists, who overturned state preemption laws, so that today only 12 states preempt local governments from passing ordinances related to smoking.

In stark contrast, nearly all states preempt local governments from passing local gun laws. (Hawaii, California, Illinois, New York, New Jersey, Connecticut and Massachusetts do not preempt local governments. The rest do.) The NRA borrowed this strategy of promoting state preemption of local laws from the cigarette industry back in the ’80s, when grassroots movements for gun control were strong.

Yahoo News contacted the NRA to get its perspective on these comparisons. We asked what the organization thinks of the claim that the gun industry — like the cigarette industry before it — has suppressed information about the dangers of its product and prevented necessary measures to protect the public.

NRA spokesman Lars Dalseide responded, “I realize it’s a constant misconception and often misreported in the press, but the NRA represents individual gun owners, while the National Shooting Sports Foundation (NSSF) represents the gun industry. Our members are people, while their members are the Smith & Wessons, Bass Pro Shops and the average AAA Gun Stores of the world.”

The NRA presents itself as a voice for 5 million gun owners. But a report from the Violence Policy Center, called “Blood Money: How the Gun Industry Bankrolls the NRA,” revealed that the NRA received between $14.7 million and $38.9 million from all “corporate partners” between 2005 and 2011. The majority of this money (74 percent) came from the gun industry.

Josh Sugarmann, executive director of the Violence Policy Center, told Yahoo News, “Today’s NRA is a gun industry trade association masquerading as a shooting sports foundation. Through direct payments and sponsorship deals, tens of millions of dollars flow to the NRA from its financial patrons in the firearms industry. To argue otherwise is to deny reality.”

The NSSF did not respond to requests for comment.

Alan Gottlieb, founder of the Second Amendment Foundation and a conservative activist, said guns and cigarettes are a completely different story. He said people conflate these topics to demonize guns because they would like to prohibit guns or pass more regulations.

“The difference is the cigarette industry suppressed information that really affected public health because ingestion of the cigarette smoke, tar and nicotine obviously had a public health consequence to people’s bodies. People don’t eat or digest guns. People don’t eat or digest bullets,” Gottlieb told Yahoo News. “Guns don’t cause diseases. Cigarettes cause cancer. That’s a significant difference.”

He endorsed the position that cigarettes kill people when they are used properly, whereas guns, when used properly, do not kill anyone. According to Gottlieb, the gun industry — unlike the cigarette industry — has gone out of its way to explain safety and how particular guns function.

“Yes, there are innocent people who are murdered by guns. But there are also lots of innocent people who are alive today because they had a gun to defend themselves,” Gottlieb said. “They want to ignore that side of the equation.”

The Tobacco Atlas, recently published by the American Cancer Society and Vital Strategies, found that the tobacco industry is increasingly targeting emerging markets in Africa, Asia and the Middle East, where regulations aren’t as strong.

“At a broad strokes level, what both industries do is prey on vulnerability and ignorance,” Douglas said. “They manipulate the information environment to steer those who know less to actually believe in falsehoods. In other words, they traffic in fake news, and people buy it.”

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