Tarbox images shortlisted for U.S. cigarette warnings

The U.S. Food and Drug Administration has shortlisted deathbed images of Canadian anti-smoking crusader Barb Tarbox for its news cigarette package warnings.

The image shows an emaciated and dazed Tarbox in bed during her last days in palliative care at Edmonton’s Grey Nuns Hospital. “Cigarettes cause cancer,” the warning reads.

“Today, FDA takes a crucial step toward reducing the tremendous toll of illness and death caused by tobacco use by proposing to dramatically change how cigarette packages and advertising look in this country,” said FDA Commissioner Dr. Margaret A. Hamburg on Wednesday. “When the rule takes effect, the health consequences of smoking will be obvious every time someone picks up a pack of cigarettes.”

The Tarbox image is the main one featured on the FDA’s website announcing the new warnings and is one of 36 shortlisted. Nine will be chosen for the cigarette packs.

By Oct. 22, 2012, American manufacturers can no longer distribute for sale cigarettes packs without the new warnings.

Tarbox died at age 42 on May 18, 2003, after 30 years of smoking and after waging one of the most successful anti-smoking campaigns in Canadian history, where she spoke to more than 50,000 schoolchildren in the last eight months of her life.

The FDA-shortlisted photograph was taken by the Edmonton Journal’s Greg Southam, who won a National Newspaper Award for the revealing and graphic images he took of Tarbox during her crusade and last days palliative care.

Southam remembers being with Tarbox and her close friend Tracy Mueller and taking the FDA-shortlisted picture. He thought little of it at the time, as he had shot thousands of images of Tarbox. But this photograph proved to be unlike any of the others, as Southam quickly realized. When he got back to the office, and went through his pictures on his computer, he could not bear to look at this particular one.

“I had to shut it off,” he says of his computer. “It was so hard to look at, so stark, so real, so powerful that I couldn’t look at. It’s a stark reminder of what can happen when you smoke.”

The same deathbed image had been slated to go on cigarette packages in Canada, but the Harper government is dragging its heals on bringing in a new series of health warnings on cigarette packages. “If Barb were here, she would be saying, “˜This is phenomenal,’” Southam says of the FDA announcement. “Then I think she would be rolling over in her grave when she realizes this was happening in the U.S. and not happening in Canada. She would be embarrassed by what’s happening here.”

“This is U.S. using Barb Tarbox, which is terrific, but it also points out what our own government is not doing to protect its people,” says Geoffrey Fong, a psychology professor at the University of Waterloo and an international expert on smoking cessation laws and media campaigns. “I’m both overjoyed that the U.S. is taking this courageous step at the same time as being extraordinarily upset, even more so, that our own government here in Canada is not taking that same courageous step.”

Earlier this week, the Canadian Medical Association criticized Health Canada for its “senseless policy” on tobacco warnings. “We should all be outraged about the suspension of efforts to renew tobacco warning labels,” read an editorial in the Canadian Medical Association Journal.

U.S. Department of Health and Human Services unveiled the shortlisted Tarbox cigarette warning on Wednesday, part of a new comprehensive tobacco control strategy that includes bolder health warnings on cigarette packages and advertisements. The Americans haven’t updated their health warnings on cigarette packs for 25 years, having only the same small print warnings on the side of packs.

While a number of countries, such as Brazil and Venezuela, now update their cigarette warnings every two years, Canada hasn’t done so in 10 years, says Rob Cunningham of the Canadian Cancer Society. Research had found the old warnings are increasingly stale and ineffective.

Health Canada started a process to bring in new warnings five years ago. Two years ago, federal health official tested 49 new health warnings, including two palliative care images of Tarbox. The new Canadians warnings were to be more disturbing and much larger, taking up 75 per cent of the cigarette package.

Sixty focus groups of smokers in Toronto, Calgary and Montreal rated the Tarbox deathbed image as having the highest impact on them, saying it was far more clear and powerful than most anti-smoking warnings. The prospect of early death struck a chord with smokers of all ages, Decima reported: “In both Montreal and Toronto, people questioned whether people looked really that horrible when dying of cancer and whether this was exaggerated or a worst-case scenario. When this was disputed by other participants who had seen the effects of cancer first-hand, the credibility was no longer questioned.”

But in late September 2010, federal officials privately told their provincial counterparts the plan for new health warnings was off. Health Minister Leona Aglukkaq had no new comment on Wednesday, but her department recently issued a statement on the matter, saying: “Health Canada continues to examine the renewal of health warning messages on tobacco packaging but is not ready to move forward at this time. … The impact and possible effectiveness of any new messages on the smoking behaviour of Canadians needs to be determined before new messages are considered.”

Critics of the Harper government suggest Health Canada has given in to the lobbying of big tobacco companies. “I can’t think of any other answer,” New Democrat health critic Megan Leslie has said. “We have so much evidence that this (warnings on packages) works.

“This is putting shareholders above the health of Canadians … It’s not in the best interest of the public.”