OCTOBER 9, 2000 VOL. 156 NO. 14

Stuart Isett/Corbis Sygma for TIME. Cigarettes are given out for free at old-age homes in Japan.

No Warning
On the eve of a major international meeting on smoking, Japan's lonely anti-cigarette activists wonder why the nation is still tobacco's best friend
By DONALD MACINTYRE Tokyo

ALSO
Taking on Tobacco: Asia starts kicking some butts

Shuhei Tatsuoka lost an eye to cancer as a child. At school he once saw a video of someone who had lost his toes to a smoking-related disease. But when he was 16, friends offered him a cigarette and he thought: "I'll just try one." Now 24, he is fighting a daily battle to stay away from the nicotine he craves. With help from a doctor, Tatsuoka quit in April. But every day he has to tell himself he won't smoke for just one more day, leaving the door open a crack—the thought of a future without a smoke is too overpowering. Tatsuoka never imagined quitting could be such hell: "I don't know if I've succeeded. They should treat tobacco like a drug and arrest you for using it."

In Japan, they could start by treating it as something to be wary of. While countries in North America, Europe and the rest of Asia are cracking down on tobacco, Japan is still puffing happily away. Far from taking a stand against smoking, the government is the biggest investor in Japan Tobacco, the world's third-largest tobacco multinational. The last time Japan passed a law to curb the practice was in 1900 (it banned underage smoking). Tobacco companies, facing few advertising restrictions, use squared-jawed cowboys, youthful mountain bikers and chic young women to tout their product from giant billboards and subway posters. Manufacturers still hand out samples in the street, and Japan Tobacco donated 15 million cigarettes to old folks' homes on Respect for the Aged Day last month (a contribution to the community, the company says).

The result of this laxity? More than half of Japanese men smoke, a far higher percentage than in the U.S and Europe. Deaths from lung cancer are soaring: two years ago, it overtook stomach cancer as the country's deadliest form of cancer. Tobacco will kill some 95,000 Japanese this year, making it the biggest cause of premature death. Just as alarming, smoking is rising among minors and women in their 20s and 30s. Since there is a long lead time before health problems kick in, the numbers spell trouble ahead. Says Dr. Mayumi Abe, an expert on health and lung disease at Tokyo Women's Medical University: "This is an epidemic that Japan just can't ignore anymore."

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As the death toll mounts, there are indications that ordinary Japanese are finally waking up to the threat. The legal assault on the tobacco industry in the U.S. is breathing new life into Japan's fledgling anti-smoking movement. Former smokers suffering from emphysema and cancer have filed an unprecedented lawsuit against the government and Japan Tobacco, while non-smokers are growing bolder about defending their rights. What's needed, anti-tobacco advocates say, is pressure from the outside. Next week the World Health Organization will start public hearings in Geneva on a global convention on tobacco control. The first international legal effort to tackle an epidemic that, according to the who, kills 4 million people a year, it will probably leave wiggle room for pro-tobacco countries. But by articulating the growing international consensus on the need to rein in Big Tobacco, the convention is expected to boost Japan's anti-smoking forces. "It will be a powerful tool," says Yoshio Isayama, lead lawyer in the recent tobacco suit. "It could be decisive in the courts as well."

The power of the tobacco lobby became clear earlier this year after the Health Ministry published a report on ways to improve health. A draft initially called for a 50% reduction in adult smoking by 2010. But alarmed tobacco farmers approached supporters in the dominant Liberal Democratic Party for help. The so-called Tobacco Tribe, a group of LDP lawmakers sympathetic to cigarette makers, obligingly drew up a toughly worded resolution opposing the Health Ministry target and, for good measure, any who-imposed restrictions on the industry. Adults are free to choose whether to smoke or not, the resolution argued, adding: "the impact of smoking on health isn't clear yet." When the final ministry report appeared in March, it included detailed numerical goals for everything from reducing stress to swelling the ranks of 80-year-olds with more than 20 teeth. But the target for smoking had vanished. (So had a public-health expert who had pushed hard for the target—she was asked to leave her job at the ministry.)

The Health Ministry has a history of being out of step with the times. It officially noted the connection between smoking and cancer in 1987—more than two decades behind the U.S. Surgeon General—in a densely worded, user-unfriendly study. Since then, the ministry has produced more studies but no laws or regulations. It hasn't even banned smoking in its own offices. The head of the ministry's Tobacco Control Program, Etsuro Kashiwagi, points to his paltry $430,000 budget: "We're doing the best we can." Another problem: the Minister of Health is a Tobacco Tribe member.

Expanding the budget would require the approval of the Finance Ministry, which has a huge stake in the tobacco industry. Japan Tobacco was privatized 15 years ago, but the ministry still owns two-thirds of the shares and sends its retired officials to help run the company. Under the Tobacco Business Law, the ministry is obliged to promote the health of the industry, which generates $22 billion a year in tax revenue—almost 3% of the government's total intake. The same law, which is virtually silent on the subject of health, puts the ministry in charge of writing the warning labels on cigarette packages. The ministry says it isn't in the business of trying to promote smoking, or discourage it. But while Western countries commonly demand warnings like tobacco kills, Japan opts for a gentler formula: there's a risk of damage to your health, so let's be careful not to smoke too much. Says Finance Ministry official Keita Fukui: "People don't decide on the health risk just by looking at the package. They should ask their doctors."

It's that kind of attitude that has turned taxi driver Matao Yamamoto into one of the tobacco industry's most determined foes. Seven years ago, Yamamoto started having difficulty breathing whenever he was waxing his cab. It never crossed his mind that it could have anything to do with the 50 cigarettes he was smoking a day—his doctors hadn't said a thing during three decades of twice-yearly checkups. At first, they blamed his breathing difficulties on acute bronchitis. But in 1995, they changed their tune. Holding up an X ray of a healthy lung in one hand and one of Yamamoto's blackened lung in the other, his doctor told him he had pulmonary emphysema, a condition that progressively destroys the lung's ability to take in oxygen. Stunned and angry, he threw away his cigarettes that same day. "In Japan, there is absolutely no education about the damage tobacco can do," he says.

So in 1998, Yamamoto and six other men suffering from tobacco-related diseases filed suit against Japan Tobacco and the government. The first suit in Japan to pit smokers suffering from tobacco-related diseases against the industry and its bureaucratic backers, it charged both with deliberately hiding the dangers of tobacco. The plaintiffs are demanding $667,000 in damages, a ban on all tobacco advertising, an end to sales from automatic vending machines and much tougher warning labels. Says lawyer Isayama: "Since there is no proper warning label, they have deceived the public."

Still, it will be an uphill battle: Japan's legal system is far less plaintiff-friendly than America's (Japan Tobacco and the government don't comment on cases before the courts). But Yamamoto hopes the case will at least make the industry squirm. A small wiry man who looks older than his 66 years, Yamamoto attends the hearings with a tube in his nose delivering oxygen from a kit he pulls behind him. Barely able to walk up the slightest incline without losing breath, he says the legal battle is worth the effort: "I'm doing it for the kids." Indeed, children are particularly at risk, health experts say. Smoking among 18-year-old male high school students jumped from 27% in 1991 to 37% in 1996, according to the Health Ministry's most recent figures. Girls and younger children are smoking more, too. "The ministry isn't even tracking the problem properly," says activist Bungaku Watanabe. "Regional studies by doctors show the smoking rate is as high as 70% in some high schools," he claims. He calculates that minors bought 51 billion cigarettes last year, 40% more than in 1990.

Besides minors, young women are puffing more as well. In the mid-1980s, just over 10% of women in their 20s smoked—today 20% do. Taboos against females smoking in public are disappearing, especially among the young. At the clinic where she helps people kick the habit, Dr. Abe says the number of female patients keeps growing. Why? "American companies are targeting young women, putting out ads that make smoking look stylish," she says, adding that Japan Tobacco, too, lures kids with ads that make smoking look sporty. "It's just wrong and it's not fair."

The Tobacco Institute of Japan, a lobby group, denies culpability and points to its twice-yearly campaign to prevent smoking by minors. New posters feature young women playing volleyball above the slogan: "You can have fun because there are rules. The rule for tobacco is don't smoke until you're 20." Critics charge that the posters actually promote tobacco, reinforcing the idea that it's an enjoyable passage to adulthood. Offering a visitor a cigarette, the association's managing director Katsushi Ono defends the campaign: "There is no message here that tobacco is fun. We're saying you shouldn't smoke." Tatsuoka, who is struggling to beat his addiction for just one more day, offers a different view: "A picture of a black lung would be more effective."

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