Stanford physician Robert Jackler ’72 works to expose the dangers of nicotine marketing
Robert Jackler ’72 knows all too well how readily teens can succumb to the influence of their peers. He experienced it himself at Williston, where, as his yearbook portrait shows, he wore his hair to his shoulders and dressed in the biggest bell bottoms he could find, just like his friends. “That’s how teens rebel,” he explains. “You rebel by conforming.”
And so today, as a renowned professor at Stanford University School of Medicine and a leading scholar of tobacco marketing, he wants us all to understand how the nicotine industry is leveraging that same dynamic, amplified by social media and the novel technology of e-cigarettes, to hook a new generation of young people on its products—with consequences in later life far more dire than an out-of-fashion hairstyle.
Jackler, a specialist in complex diseases of the ear, broadened his medical career 15 years ago to launch Stanford Research Into the Impact of Tobacco Advertising (SRITA), an interdisciplinary research group that catalogs and analyzes the promotional tactics of the tobacco industry. The organization, which he founded with his artist wife, Laurie, curates an extensive online archive of tobacco advertisements for use by researchers, develops educational exhibits for museums, issues reports and white papers, and advocates with legislators and federal agencies for more stringent nicotine regulation. Jackler’s work, particularly his research on the recent surge in adolescent use of e-cigarettes and nicotine vaping devices such as Juul and Puff Bar, has been featured extensively in the press, and Jackler has appeared frequently before Congress as an authority on the topic.
What led a successful ear doctor to take on what he calls “the tobacco apocalypse”? “It’s an interesting transition,” he acknowledges. “Mid-career, I continue to be a surgeon, continue to care for patients, teach residents and students, and to support research in hearing science, but I developed an entirely different interest that I saw as impactful,” he says. “If you can make a difference in the leading cause of preventable death and serious disease, you can make a real public health impact.”
Inspiration also came from the legacies of both his parents. His father, a cardiologist in Waterville, Maine, would let Robert accompany him on his weekend rounds at the town’s Catholic hospital, where as a young Jewish boy he was intrigued by the nuns in their formal habits. His father’s sudden death from leukemia, when Jackler was just nine, upended his life, forcing his mother to eventually move the family to her parents’ hometown of Holyoke. But it was there that his aunts decided to send young Robert to Williston, a decision that would prove transformative.
“It was wonderful to find a home at Williston,” says Jackler, who competed on the chess club, played goalie for the hockey team, learned to write persuasively, and was deeply inspired by science teacher Jack “Doc” Gow, who was then just beginning his career. “Williston gave me stability and purpose. It helped to mature me. I didn’t know how to study when I arrived at Williston, but I learned there.” While he did not consider a career in medicine until college, he says, “as I look back, there’s an element in my career of me wanting to finish what my dad never could do.”
Later in life, after he earned his undergraduate degree at Brandeis, graduated from Boston University Medical School, and established himself as a physician and researcher at the University of California San Francisco, his mother’s death from lung cancer would again shift his life’s work. “Before she passed away, I remember asking, ‘Why was it that everybody smoked when you were young?’ And she said, ‘It was the sophisticated thing to do. Everybody did it,’” he recalls. “I started thinking about that, and it occurred to me that this was not a cultural spontaneity. It was engineered, designed, absolute genius. How do you take shredded leaf, wrapped in paper, and make it an essential part of daily life?”
Now, after 15 years with SRITA, Jackler has a scholar’s understanding of how the industry accomplished that, and how it continues to manipulate behavior today. The death toll from tobacco in the United States, while declining, still amounts to the equivalent of four 747s crashing every day, he notes. Globally, tobacco use kills 8 million people annually, and its associated illnesses diminish the lives of millions more. The rise of e-cigarettes and other alternative delivery systems for nicotine, while often marketed as a healthier alternative to cigarettes, has not stopped the carnage, and in many ways, says Jackler, they have abetted it.
While cigarette alternatives may be an off-ramp for a small number of smokers, Jackler argues they more often serve to deepen a smoker’s habit, allowing nicotine users to vape or use a nicotine pouch in places where conventional smoking is prohibited. And far more pernicious is the appeal they have to those who have never smoked before, he says: Their ease of use, greater nicotine potency, and appealing flavors are engaging a new generation of teenagers, the prized demographic of the tobacco industry. “They’re making this cool again,” Jackler argues. “It’s the renormalization of smoking behavior.”
The case of Juul was particularly troubling to Jackler, and not merely because the company’s two founders happen to be Stanford graduates. Launched in 2015, Juul set off what Jackler describes as a nicotine arms race, building on the company’s chemical innovation that allowed their devices to deliver high doses of nicotine along with sweet and fruity flavors. Savvily promoted through social-media marketing and online influencers, the fashionably sleek devices soon became the rage among teenagers and made the founders rich. Jackler and his SRITA colleagues responded with a white paper in 2019 that eventually led to new government restrictions, a dramatic loss in Juul’s market share, and numerous ongoing state lawsuits against the company, for which Jackler often serves as an expert witness.
The new laws, however, had a loophole: They did not outlaw disposable nicotine devices that use an unregulated synthetic form of nicotine. “So suddenly, you have disposables in every flavor you can imagine,” Jackler notes, citing Puff Bar as one example. “It just shows you that the industry can manipulate the lawmakers. They have the best people money can buy.”
Which has only made Jackler more determined to present his research and to educate the public and lawmakers about the industry’s long and unflattering history. “I am not a radical saying all of these things should be outlawed,” he says, noting that taxing nicotine heavily would be a better approach. “I spend a lot of time thinking about a practical, implementable, and sensible set of regulations that protects young people from getting hooked on nicotine, but helps adult smokers transition to something less consequential to their health.”
And even half a century later, lessons from Williston are informing that work. “What I took from Williston was a passion and a love for science, and I give Doc Gow and other teachers credit for that,” he says. “But even more important was to learn how to write and speak in public. You can have brilliant ideas, but if you can’t articulate them and write, you will not influence and persuade people.”