Moving tobacco control beyond “the tipping point”

Next week over 4000 people from about 120 countries will attend the 11th world conference on tobacco or health in Chicago. To mark the occasion, the BMJ, JAMA, and the Bulletin of the World Health Organization are publishing theme issues. At a time of steadily increasing death and disease caused by tobacco and alarming trends in smoking in both developed and developing regions, conference delegates will discuss how to wipe out the “brown plague.”

Malcolm Gladwell, author of the best selling book The Tipping Point,1 believes he has the answer. He argues that ideas, messages, products, and behaviours spread like viruses. Fashion trends, crime waves, Pokémon, and many other phenomena that characterise everyday life are examples of “epidemics in action.” New ideas, products, or behaviours will cross the threshold into epidemic transmission—that is, move beyond “the tipping point”—if three rules are met. Firstly, people with a “rare set of social gifts,” who are capable of starting epidemics, are involved. Secondly, the “contagion” …