Blog Verité

In Jan., the now-former U.S. Surgeon General Vivek Murthy called for new cancer warning labels on alcohol-containing beverages. It’s an important and potentially life-saving step, since the current warning labels haven’t been updated since their introduction in 1988 and only half of Americans know alcohol is associated with cancer.

However, the history of tobacco policy suggests the need for caution. Indeed, when Congress decided to first label cigarette packages in 1965, it was seen as a triumph for public health. But the law, which required the warning, “Caution: Cigarette Smoking May Be Hazardous to Your Health,” was so vague and watered down that it did not significantly reduce smoking rates. Instead, it shut the door on more meaningful regulations and, in the name of compromise, consolidated industry power. In fact, the greatest beneficiary of the Federal Cigarette Labeling and Advertising Act of 1965 ended up being Big Tobacco.

[time-brightcove not-tgx=”true”]

During the early 1960s, roughly 40% of Americans smoked—with limited awareness that tobacco was cancerous. However, in 1964, the Surgeon General released a landmark report, definitively linking smoking to lung cancer and helping convince between 70% and 80% of Americans about these health risks. In an interview, Allan Brandt professor of the history of science at Harvard University said that the report also led to a range of regulatory action, from the Federal Trade Commission (FTC) going after tobacco companies’ “unfair or deceptive” practices to 20 states targeting the promotion of cigarettes.

Read More: Products Can Harm People for Decades Before Companies Change. Here’s How to Stop Them

Vocal opponents of the tobacco industry, such as Sens. Maurine Neuberger (D-Oreg.) and Warren Magnuson (D-Wash.), took up the mantle in Congress. But the industry ultimately pushed the 1965 law through, seeing it could no longer avoid government action but recognizing the legislature was the friendliest, most compliant arena. “What tobacco wanted, tobacco got,” wrote Michael Pertschuk, a Senate staffer who shepherded this bill through Congress, in his 1986 book Giant Killers. “That first labeling bill ended up a sorry piece of tobacco knavery.”

Indeed, by 1966, cigarette sales actually reached an all-time high, with the FTC reporting that there was “virtually no evidence that the warning statement on cigarette packages has had any significant effect.”

Rather, this law precluded state and local governments from instituting their own more damning labels, while affording the tobacco industry protection against future litigation. Indeed, the industry would later claim that, with these labels, the public had been forewarned about the risks of smoking—and thus assumed these risks themselves.

An editorial in The New York Times called the law “a shocking piece of special-interest legislation… a bill to protect the economic health of the tobacco industry by freeing it of proper regulation.” Similarly, an article in the Atlantic Monthly emphasized: “The Quiet Victory of the Cigarette Lobby: How It Found the Best Filter Yet—Congress.”

This pattern of the industry hijacking public health measures, offering minor concessions to entrench their own interests, continued with other tobacco policies. For example, in 1969, Congress introduced legislation banning cigarette advertising over TV and radio. Under the Fairness Doctrine at the time, the Federal Communications Commission required broadcasters to present both sides of controversial issues. So, as tobacco companies filled the airways with advertisements, anti-smoking advocates received millions of dollars of free time to respond. They proved incredibly effective at getting people to quit cigarettes, and the tobacco companies were powerless to stop it. They couldn’t collectively stop advertising, lest they trigger anti-trust lawsuits, or withdraw individually, lest they forego market share without really changing the information landscape.

Getting Congress to ban broadcast cigarette advertising was thus the most promising path forward, so the tobacco industry “acceded” to this law and allowed Congress another moral victory. Smoking rates decreased by 7.2% in the three years before the ban, but according to an empirical analysis from University of Michigan economist Kenneth Warner, they increased by 4.5% over the three years that followed.

Over time, cigarette package warning labels were strengthened, both in terms of wording and the diversity of messages. In 1984, for example, Congress passed a set of four new labels, given growing awareness that the old ones were not impacting public knowledge or attitudes. These more stringent labels appeared to symbolize the demise of Big Tobacco’s influence on Capitol Hill, said Brandt, but the fundamental issue over efficacy remained. The Institute of Medicine called them “woefully deficient,” and more recently, the Food and Drug Administration described how these labels have become “virtually invisible.”

From Big Tobacco’s perspective, conceding to this bill might have helped the industry stave off more pernicious tax hikes. Evidence shows, for instance, that taxes are more effective at helping people quit smoking than labeling. In the 1980s and 1990s, tobacco taxes actually declined in real terms, even as congressional advocates repeatedly pushed for increases, according to Brandt.

Read More: The FDA Wants to Make Cigarettes Nonaddictive

Ultimately, the lesson from tobacco policy isn’t that public health legislation is always doomed to backfire, but that reform requires caution and vigilance as to not inadvertently serve the industry. The lesson is about standing firm so that special interests cannot co-opt public health language and push for “compromises” tilted toward their own benefit.

When done correctly, warning labels are important—not necessarily as a transformative public health intervention but as public recognition of a product’s harms and catalyst for further action. For a society confused by conflicting messages but largely sensitive to cancer risk, even calling for updated labels offers a useful spotlight, regardless of whether it alters drinking habits.

Changing behaviors demands much more. It wasn’t warning labels that helped Americans smoke less. Higher taxes, legal action, and comprehensive anti-smoking campaigns did that. So, if the U.S. is serious about reducing alcohol-related harms, Murthy’s cancer warning labels are only a first step. These warnings, alongside a larger suite of regulations, such as higher alcohol taxes, will likely be the most evidence-based, cost-effective way to save lives.

Simar Bajaj studies epidemiology at the University of Oxford and is an award-winning journalist who has previously written for Washington Post, The Guardian, National Geographic, NPR, and The Atlantic.

Made by History takes readers beyond the headlines with articles written and edited by professional historians. Learn more about Made by History at TIME here. Opinions expressed do not necessarily reflect the views of TIME editors.