After smoking Camel cigarettes for twenty-four (24) years, my lungs are as clean as a whistle.
SYLVIA SINDELAR TO REYNOLDS, APRIL 28, 1958
Take old George Burns for example; he’s been smoking for (probably) 60 years now, and is probably healthier than average for a man of his age. You might say that old George is living proof that tobacco smoke is not harmful to health.
M. WHITE TO REYNOLDS, OCTOBER 30, 1985
We’ve seen some of the techniques used by the smoke folk to manufacture and disseminate ignorance. How, though, do we measure the success of such efforts? After all, maybe the companies are right when they say that smokers have always known that tobacco is bad for you, that knowledge of hazards is “common” or nearly universal. If that is true, then perhaps the companies are innocent, or guilty only of puffery: if everyone is fully informed when they begin smoking, why should anyone be upset when disease sets in? The manufacturers may well have lied in denying harms, but is it really fraud if no one believes you? What can we say about the extent to which people have or have not known about the hazards of smoking?
Agnometrics may be a new word, but it is a well-developed field of inquiry. Since the 1950s, in fact, polling agencies such as Roper and Gallup have been paid substantial sums to explore what people know and don’t know about specific topics, including the dangers of smoking. Polls can be used to test the industry’s claim that such harms have long been “common knowledge,” but there are other sources for gauging popular understanding. There is the testimony of smokers themselves, as revealed in letters written to the companies and telephone logs preserved in corporate archives. We also have the industry’s own assessments of the extent to which people appreciate the dangers.
Here I want to explore these different ways of measuring ignorance, recognizing that there are difficulties in how we define some of the crucial terms. How do we gauge what is common or uncommon knowledge? The tobacco industry in staking its claim for “universal awareness” likes to confuse knowledge and awareness, ignoring the crucial difference between knowing that cigarettes are dangerous and simply having heard this to be the case. The error is so blatant that one marvels at its bravado: it would be hard, after all, to find someone who hasn’t “heard” that cigarettes may be hazardous—and the warning is right on the pack. But there are obvious differences between awareness and belief. Many of us will have heard that some people think there are alien spacecraft being held at Area 51 in southern Nevada—but does that mean we actually believe it?
The industry seeks to perpetuate a similar confusion in its effort to prove that the dangers of smoking have long been common knowledge. A body of knowledge is common, they say, if large numbers of people have heard about it or have heard someone putting it forward as true—which is convenient in the cigarette context. Cigarettes in the United States have had cautions on the packs since 1966 and warnings since 1970; most smokers have seen such labels or at least are “aware” of them, so surely anyone with even half a brain must have been fairly forewarned. (The industry started making this argument when warnings were first proposed: people didn’t need a warning since they already knew.) Common knowledge is also supposed to be evident from the broad dissemination of writings by health authorities, including discussions in textbooks or news media to which anyone but an ostrich or a hermit must have been “exposed.”
But is this really evidence of public understanding? What, in fact, do people believe about the nature of harms from cigarettes? How seriously do they take such threats, and how have such views changed over time? These are questions that cannot be answered simply by looking at, say, high school textbooks or articles in magazines and newspapers, as the industry wants us to believe. If convictions could be measured simply by exposure to authoritative texts, then teachers would have no need to assign grades; we could just grade the textbooks. The industry’s claim is sort of like saying that everyone in the 1930s must have been a communist, because communist literature was widely disseminated. Exposure is not a measure of belief; what people know about a topic and what has been written (by others) are two very different things—which the companies want us to conflate. They would rather we not distinguish between “having heard that” cigarettes may kill you and believing this to be true. But surely people may have heard that tobacco may be harmful without actually believing this is the case.
In court, the tobacco industry’s “common knowledge” experts go to great lengths to confuse knowledge and awareness. Called to testify on what was known about the risks of smoking at some point in time, these experts produce countless examples of what people might have been exposed to—typically newspaper and magazine articles and the like—inferring from this that smokers must have known what they were doing. Media reporting on such topics is taken as evidence of “common knowledge”: so if newspapers reported on, say, smoking as a cause of Buerger’s disease or bladder cancer, then ordinary people must have understood such dangers. They were properly forewarned.
Surveys of actual attitudes and opinions tell quite a different story, however. They make it clear that knowledge of smoking’s hazards has varied widely over time and space but also by age, class, and sex—and (especially) by whether or not one smokes. It turns out that smokers are significantly less likely to recognize hazards than nonsmokers and less likely to see themselves as vulnerable. Many smokers find it hard to apply whatever knowledge they have to their own situation; they often feel that they personally don’t smoke enough to pose a real danger, or that their brands are not the really bad ones. Many people who smoke only a few cigarettes per day do not even regard themselves as smokers. And a surprising number do not think there is anything wrong with moderate smoking. The answers people give in such surveys depend very much on how the questions are asked: virtually everyone will agree that smoking might cause lung cancer, for example, while far fewer will realize it as the major cause or that the evidence constitutes irrefutable proof.
There are several different ways to get at this changing history of ignorance. Here we explore three different sources: public opinion polls, including qualitative assessments based on interviews; consumer letters and logs of phone calls to and from the industry; and statements by the industry itself about the nature or extent of popular knowledge. Sources such as these shed light on what people have or have not known, and in a more reliable way than looking only at the media to which people have been “exposed.” Exposure does not guarantee belief, any more than propaganda guarantees patriotism. We have to look at what people actually believe, as revealed by surveys, interviews, and testimonials in people’s own words.
So first the polls.
In the United States polling agencies have been interested in what people know and don’t know about tobacco since the 1940s. The first Gallup poll to address this question dates from 1949, when 52 percent of American smokers were found to agree that cigarettes were “harmful,” though the question was vague and didn’t distinguish different kinds of harm—as in cancer versus cough. And no effort was made to gauge strength of conviction or degree of concern.
More sophisticated polling techniques were developed in the 1950s. In 1958, for example, a Gallup poll reported that “among cigaret smokers, the sentiment still is that cigaret smoking is not one of the causes of lung cancer.” George Gallup found that when asked, “do you think that smoking is or is not one of the causes of cancer of the lung?” smokers answered as follows:
Yes, is a cause |
33 percent |
No, is not |
43 percent |
Undecided |
24 percent |
The report also showed that smokers of filter-tipped cigarettes were more likely to believe in cancer causation (38 percent vs. 28 percent). And that nearly three quarters of the smokers of unfiltered cigarettes said “no” or were undecided.1
Polling agencies hired by tobacco manufacturers came up with similar results. Elmo Roper and Associates at Williams College in 1958, for example, was hired by Philip Morris to conduct a study of smokers’ attitudes for the company. Five thousand smokers from all across the country were asked several dozen questions about the dangers of cigarettes and how these compared with other kinds of hazards. While most of these people had heard that smoking had been linked to cancer—were aware of a controversy—nearly 70 percent agreed that “as long as you are careful not to smoke too much, cigarettes won’t do you any real harm.” And unprompted recall of cancer was quite low. When asked to complete the sentence, “The trouble with cigarettes is that they . . . ,” only one percent volunteered “could cause cancer.” And only 3 percent offered that cigarettes could be “harmful to your lungs, wind, breath.” A “Highlights” section of the report concluded that while cigarettes were regarded as “bad for you to a greater extent than the other products we asked about” (air pollution, climbing out of a bathtub, etc.) there was “surprisingly little concern” about cigarettes. What little concern there was seemed “largely directed at the avoidance of throat irritation and the consequent search for mildness” in the form of filters. The survey found “fertile ground for promoting cigarettes as a good friend—a friend that relieves tension, permits one to relax, and is comforting when alone or idle.” The good news (for the industry) was that while fear of cancer was “certainly present,” smokers seemed to be “more preoccupied with the fact that cigarettes make them cough and cause sore throats.”2
Polls can of course be misleading, especially when a clear distinction is not drawn between “awareness” and “belief.” A 1954 Gallup poll, for example, revealed that 90 percent of those surveyed had “heard or read about” the connection between smoking and lung cancer, and this is often cited by the industry’s polling experts in court. But when this same survey asked whether people believed what they had read—that cigarettes could cause cancer—less than half of those polled answered “yes.” And smokers were even less convinced. A 1965 Louis Harris poll found that when 1,250 Americans were asked whether smoking was a “major” or a “minor” cause of lung cancer, only 20 percent of the heavy smokers said “major cause.” Twenty-four percent said “minor” cause of the disease, and 56 percent answered “can’t yet tell.” Surveys conducted in 1966 for the U.S. Public Health Service found only 46 percent of the adult population answering “yes” when asked, “Is there any way at all to prevent a person from getting lung cancer?” Only 21 percent said “yes” in response to the same question about emphysema and chronic bronchitis.3
Surveys have sometimes looked at the extent to which people are worried about what they’ve heard. A 1956 series of interviews conducted by Lorillard Tobacco found that most smokers had been unaffected by the recent cancer publicity and that since many smokers’ friends and physicians still smoked there was little pressure to change habits. Here, as in all such studies, smokers were found to be less knowledgeable and less worried than non-smokers.4 That makes sense, given that many non-smokers are former users who have quit, fearing for their lives. The ranks of smokers get depleted of people savvy in such matters, pushing their average knowledge downward.
We should also not be surprised that people with different educational backgrounds have learned about health harms at different rates. Prior to the 1964 Surgeon General’s report even doctors were slow to accept the reality of tobacco mortality. The scientific consensus of major health harms emerges in the 1950s, but a 1960 poll conducted for the American Cancer Society by Chicago’s National Opinion Research Center found that only a third of all physicians in the United States were convinced that smoking was “a major cause” of lung cancer. Doctors were asked, “Is cigaret smoking a major cause of lung cancer?” Only 33 percent said “definitely,” with another 31 percent saying “probably.” Thirteen percent said “probably not,” 9 percent said “definitely not,” and 14 percent expressed no opinion. This same poll revealed an astonishing 43 percent of all American physicians still smoking cigarettes on a regular basis, with occasional users accounting for another 5 percent. Of the 52 percent who didn’t smoke, more than three quarters were former smokers who had quit when the cancer connection started generating publicity.5
There are many graphic examples of ignorance in this realm—even among physicians. Dr. Kenneth M. Colby in his 1951 Primer for Psychotherapists asked and answered, “Should the therapist smoke during the interview? Why not?” Morris Fishbein, the former JAMA editor, in 1954 boasted to Lorillard’s chief of research, “I offer on my desk nothing but Kents.” Some doctors scoffed at the 1964 Surgeon General’s report: as recently as 1984 one Virginia physician recalled it as “the opinion of a bunch of eggheads” and “just another attempt by the d__ yankees to destroy the tobacco industry.” The industry’s pollsters found results similar to those of the American Cancer Society: a 1959 poll of American doctors conducted for Hill & Knowlton and the TIRC found only 14 percent of physicians willing to say that the cigarette-cancer link had been “conclusively proven”—with nearly as many (about 10 percent) admitting to having advised their patients to smoke.6
Lung cancer of course is only one of smoking’s many maladies, each of which has its own distinctive ignorance microclimate. A 1966 report on Philip Morris’s secret Project 6900 concluded that while medical authorities had recognized a heart disease threat from cigarettes, the general public was still “not fully aware of the relationship.” A 1970 survey conducted by Roper for the Tobacco Institute showed that most Americans considered smoking “only one of many causes” of smokers being sicker—with only 24 percent recognizing it as “the major cause.” Most Americans by this time regarded cigarettes as “bad for you” in the abstract, but fully a third thought that only heavy smoking (defined as 1.5 packs or more per day) was dangerous.7 That is massive ignorance. If there were 60 million smokers in the United States in 1970, this means that 20 million American smokers believed that only heavy smoking was dangerous.
This same Roper poll also looked at quitting expectations. Fifty-nine percent of those surveyed had tried to quit at some point, and among those who had managed to quit only 12 percent said they had been advised to do so by a doctor. Few, though, said they had no intention of quitting. One of the most striking findings was that two-thirds of those interviewed said they didn’t even enjoy cigarettes but rather smoked them just from habit. Only 32 percent said they enjoyed “most things about smoking.” Enjoyment was even rarer for smokers of menthols (26 percent) and filtered cigarettes (28 percent). Answers differed significantly by brand: 42 percent of all Benson & Hedges smokers said they enjoyed smoking, for example, as compared with only 29 percent of Marlboro smokers. Not even a quarter of all Kent smokers enjoyed their habit and only one in five smokers of Kools.
Does this mean that the makers of Marlboro, Kent, and Kool were doing something that made people smoke while also making them not like it? Or just that people who didn’t much care for cigarettes smoked Kools, Marlboros, and Kents? Several companies by this time were beginning to juice up their cigarettes, making them more potent by means of ammonia chemistry (see below on “crack nicotine”); Kent cigarettes also seem to have appealed more to what the industry called “guilty” smokers, people who disliked smoking but thought that low-delivery cigarettes would be less likely to cause them harm. A surprisingly large fraction of Kent smokers (over 20 percent) said there was “nothing good about smoking.” Light smokers were less likely than heavy smokers to enjoy smoking, and women were less likely than men. Only about one in three female smokers said they enjoyed the habit. African Americans were less likely to enjoy smoking than whites, and for the entire sample enjoyment was so rare that when people did like smoking they were called “enjoyers” and considered “rather unique.”8
This is an insufficiently recognized but crucial fact: most smokers dislike smoking and don’t like the fact they smoke—which has become increasingly true over time. A 2007 Gallup poll found an astonishing 81 percent of smokers in the United States saying they would like to quit, with a comparable percentage considering themselves addicted. These pollsters concluded, “Current smokers widely agree on two things—they are addicted to cigarettes and they would like to quit.”9 It could well be that the very survival of the industry depends on the perpetuation of this myth, that people who smoke do so because they “like” it. The reality is that few smokers like the fact they smoke.
Surveys conducted in the 1960s and 1970s reveal an increase in public appreciation of hazards, though opinions did not change as fast as one might imagine. A 1964 poll conducted just prior to the release of the Surgeon General’s report found only 25 percent of smokers believing that smoking was “a major cause” of lung cancer. An industry survey later pointed out that the Surgeon General’s report caused this to jump to 46 percent, a substantially higher figure but not yet even a majority. Doubters also remained dominant in Britain, where a 1964 survey of five thousand people found 60 percent skeptical of any connection between smoking and cancer. Twenty years later, in 1984, another British poll found about half of all adults disbelieving that smokers were more likely to suffer from heart disease. And only one in four realized that smoking fewer than twenty cigarettes per day conferred an increased risk of lung cancer.10
Interpreting such surveys, we should keep in mind that the answers people give will depend on how the questions are asked. Virtually everyone will answer “yes” when asked, “Have you heard that smoking may cause cancer?” But fewer will give the same answer when asked, “Are you convinced that smoking is the leading cause of lung cancer?” Asking about proof will also reduce the number answering in the affirmative. In 1967 a telephone poll conducted by C. E. Hooper for the Tobacco Institute found that when 1,996 people were asked whether the U.S. government had “proof” that smoking causes serious health problems, only 48 percent of heavy smokers answered “yes.” One goal of this poll was to find out whom people were willing to blame for ill effects from smoking, with the remarkable result that over 90 percent of those polled agreed that “the smoker has himself to blame.” Only about 10 percent said that cigarette manufacturers should shoulder any of the blame. Wide variance was found by age and level of education, however, and in ways we today might find surprising. Very few young people (only 8 percent) were willing to say that cigarette manufacturers should be blamed, whereas people aged fifty-five and older were far more likely to attribute fault in this manner (21 percent)—perhaps because they were more familiar with the grip of addiction. Nearly 30 percent of those with only an elementary school education blamed the manufacturers, compared with only 7 percent of those with a college degree. For reasons that are not entirely clear to me, educated people were far less willing to hold the industry responsible for health harms from smoking.11 It would be interesting to see if this has changed in the intervening years.
Understanding this reluctance to blame the industry may help explain why juries have so often sided with defendants in tobacco litigation. For many years it was virtually impossible to win a lawsuit against the industry. A 1964 Florida jury, for example, refused to award damages to the family of Edwin M. Green, who in 1958 had died from lung cancer after several decades of smoking. The jurors, many of whom were smokers, found cigarettes to be “reasonably safe and wholesome for human consumption.”12 A later judgment found that while Mr. Green’s cancer may well have been caused by his smoking of Lucky Strikes, the American Tobacco Company could not have known that smokers were increasing their risk (at least not as of 1956 when his cancer was diagnosed). Of course neither the jury nor the judge nor the attorneys bringing the case had access to the incriminating documents we have today.
Polling has also revealed unrealistic expectations of how easy (or hard) it is to quit. The U.S. Department of Health, Education, and Welfare (HEW) in a series of polls conducted in 1968 and 1970 showed that teenagers had unrealistic expectations of whether they would ever take up smoking and how easy it would be to quit. Close to 90 percent of those interviewed (smokers and non-smokers alike) didn’t think they would be smoking five years hence, when the reality was that about 35 percent would be. Personal expectations diverged radically from statistical facts, and what these and other surveys show is that young smokers have been poorly informed about their capacity to quit. The HEW researchers also concluded that the high fraction of those answering “yes” when asked whether smoking is harmful was misleading, given that “there seems to be a feeling among young people who smoke that cigarette smoking is detrimental to health at some time in the far distant future, perhaps at middle age, but that they can smoke for a few years while they are young and quit later as they approach the age when cigarettes might hurt them.”13 Young smokers seem to regard the dangers of smoking as distant but also as transient—like a bullet they may dodge if they are lucky and don’t indulge too much. Otherwise put: they don’t appreciate the cumulative nature of the threat, which is different from, say, driving too fast on the highway. Driving’s dangers are not cumulative: the risk resets to zero each time you make it home. With smoking, however, each cigarette does its own little bit of damage, which is never fully undone. This incremental nature of the risk makes it easy to imagine that “just one more” can do no harm, especially if one thinks that the body somehow cleanses itself between each cigarette. In reality the lungs are an excellent filter, which is why smoking changes them from a healthy pink into a speckled necrotic black.
This same study reported that the number of American teens using cigarettes was growing at a rapid pace: from three million in 1968 to four million only two years later—with significant geographic and cultural variations. Teenagers in the east were more likely to smoke than teenagers in the west, but smoking was also more common in cities than on farms and in blue-collar than in white-collar homes. And in homes with only one live-in parent. Children in homes where both parents smoked were twice as likely to smoke as those from homes where neither parent indulged. Sibling smoking was an even stronger predictor: girls with an older brother or sister smoking, for example, were more than four times as likely to smoke as girls with smoke-free older siblings. A curious fact about the 1960s, though, is that most Americans still trusted the industry to tell the truth. A 1966 U.S. Public Health Service survey found well over half of all smokers agreeing that people would not be convinced smoking was harmful until “the tobacco industry itself” made this admission. This same survey found over 60 percent of all smokers agreeing that the cancer link was “not yet proved” because it was “only based on statistics.”14
The turning point for when a majority of smokers in the United States realized that cigarettes are a major cause of death does not come until the 1970s and 1980s, though most people still ranked smoking lower on the scale of hazards than the reality as recognized by medical authorities. A 1972 Roper poll found only one in three smokers realizing that a pack a day made “a great deal of difference” in how long a person lived. Remarkable also is that not even one in ten ranked smoking among the two or three things they considered most threatening to health—with far more worrying about water pollution, food additives, and the safety of prescription medicines. Most were aware that smoking was “bad for you,” but few took this very seriously. That may be one reason smoking and cancer was so often the butt of comedic humor: it just wasn’t taken very seriously. We don’t find a lot of people making jokes about polio or malaria, because these were recognized as being rather horrific. Today, though, we no longer hear so many jokes about smokers’ cancers—perhaps because people finally realize that the diseases caused by tobacco are pretty serious.
Roper conducted another poll for the Tobacco Institute in 1982—their eighth such survey—and found smoking still “low on the list of things people are concerned about.” Asked whether smoking a pack a day made “a great deal of difference in longevity,” for example, only about half of those polled answered “yes.” (Living under “a lot of tension and stress” was more often listed as something that was likely to curtail one’s life, interestingly.) Many people were also poorly informed about secondhand smoke, with only about two-thirds believing it was “probably hazardous to be around people who smoke.” Non-smokers ranked secondhand smoke lower on their list of concerns than drivers who don’t dim their headlights, parents who fail to control an unruly child, and sitting near someone in a restaurant who hasn’t used deodorant. Smoking was also ranked second to the last in a list of fourteen potential hazards considered appropriate for governmental intervention, behind crime, chemical waste, narcotics, nuclear radiation, air and water pollution, food additives, and a number of others. The survey concluded that both smoking and secondhand smoke “have always ranked low” on the list of things people worry about.15
Louis Harris and Associates did a similar poll in 1983, comparing the views of ordinary American smokers to those of 103 health professionals. Deans of medical schools and schools of public health and other scholars were asked to rank a list of twenty-four steps people could take to improve their health, from most to least effective. As readers of this book will appreciate, “quitting smoking” was ranked number one by the overwhelming majority of medical scholars. When the same task was assigned to a group of randomly sampled adults, however, quitting smoking was ranked in tenth place, below “taking steps to control stress” and “getting enough vitamins and minerals” and “having smoke detectors in the home.”16
This business of how much people know (or don’t know) has also been addressed by regulators trying to find out whether the public has been adequately informed. In 1981, as part of an inquiry into whether warning labels should be strengthened, the Federal Trade Commission completed a five-year study of popular attitudes toward smoking. More than a dozen carefully designed polls were consulted, including surveys by Gallup, Roper, and Yankelovich, along with polls contracted privately by the Tobacco Institute. The conclusion of this detailed synthesis, summarized in a 330-page report to the U.S. Congress, was that despite more than a decade of warnings “a great many Americans” still did not know much about the health risks of smoking. Thirty percent were unaware of the relationship between smoking and heart disease, for example, and nearly half of all women didn’t know that smoking during pregnancy increased the risk of stillbirth and miscarriage. Twenty percent didn’t even know that smoking could cause cancer. The situation had improved somewhat by 1989, when Surgeon General Koop cited studies showing that about 15 percent of adults in the United States still held smoking not to be a major cause of death or injury.17 Fifteen percent may not sound like much, but that was still around 30 million Americans.
Global data are not so abundant, but we do have some interesting figures from Britain. In March 1999 a MORI poll conducted for Britain’s Action on Smoking and Health showed that 88 percent of British smokers didn’t know that smoking could cause impotence. The British Medical Association used this to push for new warning labels on U.K. and E.U. cigarettes reading, “Smoking causes male sexual impotence.” Scholars have also shown that many Canadians don’t realize that “light” cigarettes are no less deadly than regulars. In 2008 researchers from the University of Waterloo looked at how people thought of cigarettes labeled “light,” “mild,” “smooth,” and “silver” and found that cigarettes with such labels were consistently judged as having a lower health risk than regular “full flavor” brands.18
Chinese surveys reveal similar gaps. In 1996 a study of Chinese smokers found 61 percent agreeing that tobacco did them “little or no harm.” And in 2009 Yang Gonghuan from China’s Center for Disease Control and Prevention reported that 67 percent of Chinese did not know that secondhand smoke could cause lung cancer. Many Chinese smokers seem to believe that foreign cigarettes are more dangerous than domestics and that herbal brands are significantly safer. In a country where nearly half of all physicians still smoke, we should probably not be surprised that accurate medical information is not widespread.19
Even today it is probably fair to say that the full range of harms from smoking is not well known. Public understanding of tobacco has never been sophisticated, and few people even today know there is cyanide in cigarette smoke—or insect excrement or radioactive isotopes or “impact boosters” and “ameliorants” of various sorts. Tar and nicotine are often misunderstood, as when people write to the companies asking why tobacco cannot be “de-tarred” just as coffee is decaffeinated. Few seem to know even the rudiments of cigarette design.20 There is a diversity even of expert opinion when it comes to questions like whether smoking causes breast cancer—so it is hardly surprising to find nonexperts in the dark. The more salient fact, though, is that decades of industry propaganda have left their mark.
Indeed, we have some instances in which the industry set out to quantify the impact of its propaganda, measuring the ignorance thereby created. In the late 1960s, for example, Brown & Williamson conducted before-and-after tests of an advertising message crafted to weaken public acceptance of smoking-disease links. Separate groups of smokers and non-smokers were asked, Do you regard the smoking-health relationship as “proven,” “maybe proven,” or “not proven”? The goal was to see whether an editorial attached to a Kool cigarette ad could weaken the confidence people had that smoking was a proven cause of disease. As hoped, the fraction of those answering “proven” dropped by more than 10 percent after being shown the denialist ad. Smokers were more easily persuaded than non-smokers, with the “proven cause” fraction dropping from 73 to only 60 percent. Those already in the “not proven” camp were little affected, but the fraction answering “maybe proven” doubled following exposure to the denialist message, from 7 to 15 percent among non-smokers and from 14 to 28 percent among smokers.21 This was clearly the opportunity the industry was looking for, these fence sitters vulnerable to the denialist message. Cigarette companies after all don’t need to convince everyone; all they need is enough converts to keep the enterprise going—meaning cigarette sales—via whatever slivers of doubt can be insinuated.
We have other, equally blatant, examples of the industry charting its power to create doubt. In the summer of 1973, for example, Tobacco Institute VP Anne Duffin wrote to her superior, William Kloepfer, informing him that test showings of the Institute’s propaganda film, Smoking & Health: The Need to Know, had generated “large and statistically significant shifts in attitudes favorable to the Tobacco Industry.” A survey commissioned by the Institute showed that watching the film had reduced by 17.8 percent the number of people agreeing that “Cigarette smoking cause[s] lung cancer.” Duffin reported that the film had also caused more people to agree that “the Surgeon General could be wrong about the dangers of smoking cigarettes” and that “reports have overemphasized the dangers of smoking.” These successful results encouraged additional showings, and by October 1973 the film had been viewed by “37,000 in community audiences . . . including 18,000 men, 9,600 women, 5,400 boys and 3,200 girls.” Four years later the film’s distributor, the Modern Talking Picture Service, reported that the movie had been shown to 318,724 people, including 38,851 boys and 27,429 girls. And that was just for one of several industry-distributed films. An equally misleading propaganda piece, titled The Answers We Seek, had been shown to 324,512 viewers by 1982, including tens of thousands of children.22
Public opinion polls show that millions of Americans still do not appreciate many of the dangers of tobacco use.23 That is perhaps not surprising in a nation where huge swaths of the population don’t know that humans share a common ancestor with apes, or cling to the preposterous notion that Iraq—or the CIA or Israel—conspired to blow up the Twin Towers of the World Trade Center or that Barack Obama is a secret Muslim. H. L. Mencken once observed that no one ever went broke underestimating the intelligence of the American public; of course the real issue is not lack of intelligence but rather the lingering effects from one of history’s most powerful disinformation campaigns. What can we say about knowledge, beyond what we’ve already learned from polls?
The letters written to the tobacco companies are useful in this regard, since here we have the unfiltered testimony of consumers, or at least of those going to the trouble of writing and mailing a letter. Tens of thousands of letters by people from all walks of life are preserved in the industry’s archives, most of which are to or from R. J. Reynolds, maker of Camel, Salem, and Winston cigarettes. People wrote to offer suggestions or to lodge a complaint, or even to ask for help with medical bills or to find out where they might buy their favorite brand of smoke. Still others wrote to brag about their health, despite having smoked for thirty, forty, or even fifty years. Much can be learned from such letters, as from the phone and email logs kept by the companies recording comments or complaints.24
One thing we learn is that people have had lots of ideas about how the industry should be running its business. “Suggestion” letters are preserved going back to the 1930s; people wrote to propose cigarettes that would make colored smoke or new ideas for tobacco substitutes or filters. Financial and marketing advice was offered, along with advice on how to win a legal case.
Many of these letters recommend ways to make cigarettes safer—by adding certain chemicals or modifying some aspect of cigarette design. In 1954, for example, two women from Pine Bluff, Arkansas, wrote to Reynolds suggesting that the company incorporate penicillin into its cigarettes, to help people ward off colds in the winter. Other correspondents suggested packing cigarettes with the filter end up, so workers with dirty hands could nab a fag using only their lips. Still others proposed ways to fight anti-tobacco “hysteria” or “zealots,” or offered themselves as guinea pigs to test claims useful to the industry—that smoking cures allergies, for example. Smokers volunteered to serve as witnesses in litigation and asked for advice on how one might sue for discrimination. A Vanderbilt engineer wrote to propose stuffing wildflower seeds into the filter ends of cigarettes, so that butts tossed from cars would end up germinating flowers, adding “beauty to our roadside berms.”25
We also learn that many people have been profoundly ignorant about cigarettes. One commonly encountered view is that simply having survived smoking is proof it is safe. In 1985, for example, a Pocatello, Idaho, woman wrote to say she’d been smoking for sixty years and found it “neither addictive, habit forming or fattening.” A fifty-year Camel smoker from Granite Falls, Minnesota, reported that same year, “This idea of smoking being bad for one’s health to me is a lot of malarky. . . . I don’t think smoking is bad at all.” A Newcastle, Wyoming, man wrote of his view that “drunk driving kills more people than smoking ever did,” and a man from Quebec wrote to emphasize “how many lives have probably been saved, and most likely prolonged due to smoking when under stress . . . most likely many more than lost due to lung disease!” (Reality check: in 2005, according to the U.S. Department of Transportation, 16,885 Americans died from alcohol-related traffic accidents, compared with 440,000 deaths from smoking.) Smokers characterized the cancer claim as bogus, bunkum, balderdash, and baloney—and often jumped from this to complain about people suing the companies. A woman in Casco, Maine, ruminated (in 1985):
I think the case of the woman suing for her husband’s death is full of baloney. I know people who have died of Lung Cancer that never smoked.
Also no way can they pin point this is caused by cigarettes. When I put my white lawn umbrella on the lawn in the summer and it is black in the fall—like soot—I am sure it is not caused by cigarette smoke. In fact I don’t believe the lung association can prove anything either. With so many other things in the air, where you work etc! I love to smoke—why don’t people mind their own business. . . . This country is getting just like Russia. No rights!
Reynolds was more than happy to agree, responding that “medical science” had not shown that “any element in cigarettes, tobacco, or tobacco smoke causes human disease.” The true causes of human disease were to be determined “by scientific research, not by statistics.”26
Many of these letters follow a kind of testimonial format: smokers claim to have indulged for years without adverse effects, and the industry is urged to defend itself against charges from medical authorities or anti-tobacco fanatics. The cancer evidence is often simply dismissed, as in 1970, when an Oklahoma City woman wrote to inform Reynolds of her view that “all the hooy about cancer is all a big nothing as far as I am concerned.” A Hartford, Connecticut, man in 1984 characterized the cancer consensus as a bunch of “hysterical propaganda, shoddy science, and bully tactics.” Many such letters are clearly from people with little formal education, but some are from professionals with advanced degrees. The director of the “National Institute of Inventors” wrote to say he had proof that “Smoking does not create cancer”—and offered to share his secret for $5 million. A retired mathematician formerly employed by the National Institutes of Health wrote that the war on tobacco had been “a scam—the danger of smoking is vastly exaggerated.” And many “alternate causes” are proposed for the lung cancer epidemic. Another man from Hartford wrote to express his view that “cancer is caused by your emotions, not cigarettes.” A retired navy man from Brooklyn protested all this talk about cancer as “a lot of bunk . . . you don’t get cancer from cigarettes, you get it from treated foods.” Some of these skeptics linked the fingering of tobacco to other unwarranted ideas, as when a Rialto, California, man compared the cigarette theory to Darwin’s theory of evolution. Public health authorities were trying to “brainwash the country”: “That smoking causes cancer is a theory just like Darwin’s theory of evolution. It’s someone’s idea of how things might be, but is by no means proven fact.”27
Ignorance of this sort is not surprising, given how hard the industry worked to spread its denialist message. In 1958, for example, a Bloomington, Illinois, man wrote to Reynolds asking about a rumor he had heard that Salem, “among a few other brands, is conducive to lung cancer.” William S. Koenig from the company’s public relations department wrote back to reassure him that despite all the “confusing publicity,” the reality was that cancer claims were based “almost completely on statistics” and disputed by “doctors and scientists of high professional standing.” A similar exchange took place in 1959, when a Boston woman wrote to ask why the companies didn’t “refute some of these allegations about cancer.” She was convinced that “a great many doctors do not believe it” and that many people contract lung cancer “who never smoked.” Reynolds wrote back, assuring her that many distinguished medical scientists had “failed to verify the charges of a causal relationship” between cigarettes and lung cancer. Indeed the ongoing rise in cigarette consumption had led the company to believe that “a vast number of consumers are of the same opinion as you are.”28
Many other kinds of letters were sent to the companies. Parents complained about free cigarettes being sent to their kids (some as young as twenty months) and protested infomercials disputing a hazard from secondhand smoke. Physicians wrote to express their support for the companies, with some confiding in their belief that moderate smoking was fine and problems arose only from overindulgence.29 People wrote to ask about tobacco ingredients, or to protest finding foreign matter in their cigarette. (From Honolulu: “This letter is a complaint letter. I can’t smoked this cigarettes. Because worm in cigarettes so dirty and gross! Reexamine this cigarettes. Please send new cigarettes to me.”)30 And while most of these letters sympathized with the industry, many are more open-ended, asking whether cigarettes really were as bad as people were saying. To which the industry invariably responded with its denialist routine.
The volume of such letters increased dramatically in the 1950s, and by the 1960s R. J. Reynolds alone had more than a dozen people working in its public relations department responding full-time, with the rhetoric in each case quite tightly scripted. To a woman in Grapeview, Washington, Reynolds wrote, “notwithstanding all the theories bandied about, actually the real cause of cancer in human beings is still unknown.” And to a man in Cottage Grove, Oregon: “the truth is that in spite of what the Surgeon General’s Committee had to say on January 11, the cause of cancer in human beings is still unknown.” T. A. Porter from Reynolds’s Department of Public Relations was a frequent author of such letters, which often included his calming balm, “The fact still remains that the cause of cancer in human beings is unknown. Research must go on to determine the real cause.”31
Reynolds employed skilled writers to draft such letters, and though each had his or her own distinctive style, the common thread was reassurance. Thomas Dixon concluded one such letter by emphasizing “the plain fact” that “notwithstanding all the theories bandied about, actually the real cause of cancer in human beings is still unknown. Condemnation by association has never managed to get very far with the American people.” William S. Koenig from the same office characterized the 1964 Surgeon General’s report as having “nothing new in it, nothing that had not been heard before. The fact still remains that the cause of cancer in human beings is unknown. Research must go on and is still going on to determine the real cause.” Thousands of letters offered this same basic message. Here is a version sent to a man in Secaucus, New Jersey, reaffirming that “the case” against tobacco had “by no means been proven”:
In spite of all the excitement stirred up, the cold hard fact is that no one knows the cause of cancer in human beings.
And another, sent to a woman in the Ideal Trailer Park in Ontario, California:
Now with regard to the present controversy relating to smoking and health, one inescapable fact stands out. No one yet knows the real cause of cancer in human beings. The Surgeon General of the United States in releasing his committee’s report himself indicated that there was a great deal yet to be known and rejected out of hand the suggestion that no further research was needed.
And to a man in Punxsutawney, Pennsylvania:
I earnestly hope you have not lost sight of the fact that after all no one knows the real cause of cancer in human beings. This statement can be made with positiveness, notwithstanding all the statistical fireworks with which the anti-tobacco forces have tried to dazzle and befuse the American public. All of us know that cancer was an affliction of the human race long before tobacco was introduced by the Indians to European explorers in the Seventeenth Century.32
Reassurances of this sort continued into the 1970s, 1980s, and 1990s. Tim K. Cahill in 1973, for example, wrote to assure a biology teacher from Drake University there was “no conclusive evidence that the ingredients in tobacco are causative of any disease.” To a teacher in Wellesley, Massachusetts, Cahill characterized recent work on tobacco as full of “a great deal of misinformation” and “faulty statistical interpretations.” Cahill et al. were especially fond of saying that the “cold fact” or “cold hard fact” was that “no one knows the real cause” of cancer; and from 1964 through the 1970s there are more than a hundred letters to the public using this morbid turn of phrase.33 Reynolds’s PR department generated a seemingly endless stream of such letters, always with this same basic message: “cold hard facts,” which in reality were cold-hearted lies.
One thing we learn from this correspondence is that many ordinary smokers trusted the industry and distrusted “the government,” the Surgeon General, and doctors generally. The industry’s archives are full of letters from people ridiculing medical authority, deriding all the cancer talk as “nonsense,” “hooey,” “hoopla,” “hysteria,” “bunk,” “balderdash,” or “brainwashing.” Many of these letters warn about infringements on smokers’ liberty, as when a South Carolina man in 1991 cautioned that caffeine could be “the next to go”: “You could be arrested for having a second cup of coffee and be hauled off to jail in your housecoat, with curlers still in your hair.”34
How widespread, though, were such sentiments? It turns out there is a fairly simple way to find out.
What is wonderful about the seventy million pages of documents now online at http://legacy.library.ucsf.edu is that they are full-text searchable by optical character recognition—which means you can search a term, or string of terms, and obtain (theoretically) every document in which that term or string appears. Google’s search engine works on essentially the same principle: you enter a phrase, and Google will find and display that phrase wherever it appears. The same can now be done with the tobacco archives. The archives can be combed for hot button expressions such as “cold hard fact” or “please destroy” or “no conclusive proof,” and every document containing such a phrase will be displayed—theoretically. I say “theoretically” because the system is not perfect: documents that are handwritten, for example, don’t generally show up, and not every odd font can be read, or old fuzzy carbon copies or texts that are smudged or otherwise illegible. But the system is fairly robust, and the possibilities virtually endless. The novelty (and utility) is ultimately in the form of search speed: rhetorical diamonds can be sifted from archival dunes, and searches that might well have taken five hundred years if done manually can now be done in a matter of seconds. Scholars are going to have to think much more about search theory, about new ways to comb and navigate through massive online digital archives.
So how can this be applied to the consumer letters? One thing we can do is search the archives for terms like propaganda or brainwash to see how or how often people writing to the industry used them. We can then ask, when people used such terms, were they using them against the tobacco industry or against public health authorities? Whom did these people trust or distrust?
A search of “dt:consumer letter propaganda,” for example, returns 140 documents, each of which is a consumer letter (dt: means “document type”) written either to or from the industry containing at least one use of the word propaganda. Typical is this 1989 letter from an eighty-year-old Camel smoker in Pine Beach, New Jersey:
It is obviously impossible for government propagandists to state that smoking shortens life since only God . . . and certainly not the government . . . knows how long each of us will live and therefore cannot reasonably predict how many years will ultimately be lost to smoking. . . .
Contrary to those who state, as if it were a scientific fact, that smoking causes illness and shortens life, it has enabled me to live healthily into my eighties because stress is the root of most illness. . . .
I expect you to defend your customers, not bow to governmental blackmail and propaganda intended to fill Treasury’s coffers.35
Not everyone who used the term propaganda was referring to the government, however. Some people denounced the industry’s propaganda, as illustrated in this 1991 letter from “a concerned parent” in Vincennes, Indiana:
Gentlemen,
I am disappointed that a company can send propaganda to a boy that is only 17 years of age. Will you please stop sending CRAP through the mail to him. He is not legally even able to buy your products.36
So the question is, when the term propaganda is used in such letters, how often is it used to characterize actions or opinions of the industry versus actions or opinions of the public health community?
For those letters that have been preserved, it turns out that people have been more likely to apply the label “propaganda” to public health authorities than to the tobacco industry. Among the 140 letters using the term, 7 are from the industry (all of which talk about public health propaganda) and 8 others are duplicates. Among the remaining 125 letters, 70 are pro-industry, meaning that the reference is to public health or governmental propaganda. And only 51 are anti-tobacco, complaining about the industry’s propaganda—typically promotional materials or denialist advertising. So people writing to the industry were more likely to worry about medical than about tobacco industry propaganda.
Similar results are obtained when one searches for uses of the term brainwash and related cognates (brainwashed, brainwashing, etc.). A search of “dt:consumer letter brainwash*” yields 53 letters, more than three quarters of which reveal consumers placing their trust in the industry. Here is a typical letter from a Hillsboro, Texas, citizen worried about “brainwashing”:
I am appalled and angry at the misleading and erroneous information which is bombarding and brainwashing the public by the news media with so-called health hazzards [sic] as determined by “doctors.”
The facts are that people are living longer even to 100 years and over. These are the people who were born at home with a mid-wife or other family member, smoked, dipped and chewed tobacco and in their earlier years knew nothing of “doctors” and their toxic drugs and medicine. . . . It is absurd that anyone would attribute any problem to only one cause when every day the very air we breath [sic] is contaminated with toxic fumes from factories, carbon monoxide from cars, buses, trucks, etc., dangerous chemicals in drinking water and toxic chemicals used by “doctors” in lab tests. . . . I can easily see where it would be to the advantage of “doctors” to brainwash the public through whatever means, into believing that all Americans problems are caused by cigarettes.37
Or consider this 1968 letter from a woman in Bel Air, Maryland:
Gentlemen,
Operation Brainwash has got me scared. . . . I have an excellent doctor who has vanquished my depressive state . . . and who assures me that a pack a day and twenty or thirty cups of coffee will do me no harm. He is far more competent in internal medicine than the Public Health Service, which has strained “statistics” in its cigarette attack. I’d be much interested in knowing how much lung cancer has increased incidence as a result of their subtle scare psychology.38
Reading this entire set of “brainwash” letters, what we find is that correspondents have been more likely to trust the industry than the public health community. Some people clearly believed the companies when they offered their reassurances. Of course we don’t really know how representative such people were of the general population; it could well be that industry supporters were more likely than their opponents to write, for example. We don’t find a pro-industry bias among correspondents in general, however, since those who wrote to the industry about advertisements were critical of the industry by a ratio of about two to one.39 Notable also is the fact that people who wrote to the companies were more likely to say they were “addicted” than “not addicted.”40 All we can really say is that a significant fraction of the American public seems to have taken the industry at its word, or at least felt that “doctors” and “the government” were no more trustworthy than the manufacturers.
Of course there are other kinds of letters that don’t mention health at all. A number of teenage girls seem to have fallen for the dark-haired mustachioed Winston Man, for example, and wrote to request copies of his poster for their personal use. Girls wrote on behalf of their (female) teachers, and mothers asked for such posters for their daughters (to put up in their bedrooms). Anyone who doubts that such ads appealed to teenagers should consider letters such as the following, sent to Reynolds in 1976 from a girl in Wayne, New Jersey.
Dear Winston-Salem Co.,
During the last few months, I have greatly admired your Winston Box billboard. It is the one with the man with dark hair and moustache.
I was wondering if you could possibly send me a copy. I would be glad to pay a reasonable price for it. Please let me know if this could be worked out.
By the way, I have been smoking Winston cigarettes for nearly 3 years. And that’s a lot considering I am only 15 years old.41
We also find letters of protest, many of which are heartwrenching. The companies often sent out promotional offers, and though some effort was made to weed out the dead or underaged the volume was such—millions of mailings—that mistakes were sometimes made. In June of 1990, for example, a disgruntled parent wrote to Reynolds:
I would appreciate it if you would stop sending my son your unhealthy literature to try and sell him cigarettes.
Please take him off your filthy mailing list. He is only fifteen years old and we as parents resent your corporation trying to brainwash our youth for your own greedy purposes.42
Sharon Marvin of Mesquite, Texas, responded to a 1999 offer mailed to her home:
Please remove [my husband] from your mailing list—
I buried my daddy because of cigarettes. I’m not going to bury my husband because of them.43
Not everyone, though, was so polite or so well spoken. Many people returned promotional items, as did Jana Clyne of Clive, Iowa, accompanied by a note saying that the recipient “has been DEAD for 31 months” as a result of smoking. Clyne scrawled “DEAD” in large capital letters all over the offer-insert and returned it to the company.44 Others expressed anger in a form so harsh I cannot even print it here. The word “filthy” often appears in such letters, as in, “How dare you name a filthy cigarette after a noble Indian tribe and my home state?” (The reference is to Reynolds’s Dakota brand.) Or: “Our only daughter died because of your filthy tobacco products.” Absent or invisible, of course, are the thoughts of those too disheartened or angry to write to the companies—or the laments of those already dead.
Viewed in the aggregate, we can also find certain patterns in the letters written by the companies. In 1986, for example, Miriam G. Adams, manager of consumer correspondence at R. J. Reynolds, responded as follows to a certain Annette Rodrigues from Cupertino, California, who had asked for information on smoking.
Despite all the research going on, the simple and unfortunate fact is that scientists do not know the cause or causes of the chronic diseases reported to be associated with smoking. The answers to the many unanswered smoking and health questions—and the fundamental causes of the diseases often statistically associated with smoking—we believe can only be determined through much more scientific research. Our company intends, therefore, to continue to support such research in a continuing search for answers.45
This exact same paragraph appears in hundreds of Reynolds letters to the public: a search for the phrase “unfortunate fact” returns 660 separate documents, almost all of which are letters from the company denying evidence of harms from smoking. Indeed the archives preserve the original form letter instructing the firm’s PR agents to use this terminology when answering questions about smoking and health. A stamp on this document indicates that this phraseology was to be used for inquiries concerning “S & H” (smoking and health) in correspondence “Primarily for Children.”46
Reynolds prepared hundreds of different form letters for such purposes. Form letters were drafted for children, for “high school & below,” for people inquiring about teen smoking or cancer or secondhand smoke or warning labels or tar and nicotine yields—and so forth. Letters of this sort were usually handled by public relations departments, but higher-level executives sometimes got involved. In 1977 William D. Hobbs, Reynolds’s chairman and CEO, reassured one angry woman from Richmond, California, that “no element as found in cigarette smoke has ever been shown to be the cause of any disease.” Hobbs assured her that “the questions of smoking and health are indeed still open” and that “the answers will be found through careful research, not anti-smoking propaganda.”47
Not every letter, though, was judged deserving of a reply. Angry letters were often simply ignored. In 1996 an exasperated woman from Charlotte, North Carolina, wrote to Reynolds about her son:
I have a 16 year-old son who is addicted to cigarettes—he is very open about it and wants to quit, but the addiction is so strong that thus far, he has been unable to stop. My husband and I are both non-smokers—my father died of a smoking related cancer at the age of 57. I also lost an aunt and a cousin to lung cancer—both were heavy smokers. My son knows all of this, but he is as addicted to nicotine as were my three now-deceased relatives. I find it totally ludicrous that you continue to deny the addictive power of nicotine, and I am outraged that my young son is now hooked to such a deadly product. He has no trouble buying cigarettes, even though he is under-age. I want you to tell me what I can do—I am angry yet I feel totally powerless to help my son, short of sending him at great expense to a drug rehabilitation center. You tell me why 3,000 teenagers a day start smoking, and why they cannot stop until, like my father, they are dead and buried way before their time.48
The policy seems to have been not to reply to such letters, which were numerous. In 1996, for example, a man from Metuchen, New Jersey, wrote to protest the company’s call for people to speak out against tobacco regulation, accusing Reynolds of being “nothing but organized thugs and criminals.” The company did not bother to answer. Nor was any answer given to Meghan E. Colasanti of Denver, who in 1990 wrote to ask, “Do you guys find it pleasing to kill people?” Colasanti’s letter, preserved in Reynolds’s files, is stamped “Pub. Concerns—Unfav. NO RESPONSE” and filed as part of a large collection of “unfavorable” correspondence, including missives comparing smoking to slavery or asking questions like, “Why are you still killing people with your lousy cigarettes? You should be in jail for attempted murder.”49
Opinion polls and letters sent to tobacco manufacturers reveal many smokers poorly informed about cancer, heart disease, and other cigarette-linked maladies. Addiction also falls into this class, though many smokers do develop an intimate grasp of this excruciating fact, as a result of trying and failing to quit. Most smokers want to quit and eventually do try; smokers can even become “experts” in a sense, experiencing addiction in ways quite foreign to non-smokers or to thirteen- or fourteen-year-olds just starting to smoke. The sixty-year-old repeat quitter is understandably different from the novice in this respect. Letters documenting this desperate “awareness” have been preserved, as when a woman from Lakewood, Colorado, sent Reynolds a 1994 letter she had published in Time magazine:
Your report [i.e., Time’s] on scientific experiments involving nicotine . . . quotes a researcher as saying, “There’s an overwhelming body of evidence that it does produce an addiction in humans.” No kidding! There is also an “overwhelming body of evidence” when my rear end hangs out of our fireplace as I rummage through six-month-old butts trying to find one long enough to light up again. This is after I “quit” for the 173rd time in three years. And I consider myself to be somewhat dignified! There’s your proof of addiction. No kidding!50
Smokers prior to this time, however, don’t seem to have liked using the term addiction to describe their relationship to cigarettes. A 1982 Roper poll conducted for the Tobacco Institute found 52 percent of smokers considering smoking “a habit,” while only 25 percent considered it “an addiction.” An additional 19 percent volunteered that it was “both”—a habit and an addiction. Roper’s conclusion: “smokers consider smoking to be only a habit (52%) rather than an addiction (44%).”51
Of course when smokers try to quit, most learn fairly quickly how difficult that can be. Quit attempts increased following the 1964 Surgeon General’s report, which is when millions of smokers discovered the strength of their addiction. Thousands of consumer letters in the industry’s archives incorporate the word addiction, and by the 1980s the writers of such letters—judging from those that have been preserved—were more likely than not to recognize they are addicted. People do seem to differ in how easily or deeply they become addicted, but for most smokers we cannot really say that smoking, as the industry wants us to believe, is a “free choice.” Smokers may well “choose” to smoke when they are first trying cigarettes at the age of thirteen or fourteen, but the reasons people start are quite different from why they continue. New smokers are not yet addicted and haven’t yet learned how hard it is to quit. The industry has known about this for decades, and more recent studies provide confirmation.
In 2001, for example, the Annenberg Public Policy Center of the University of Pennsylvania published a sophisticated study—based on four thousand interviews—showing that young people underestimate how hard it can be to quit. Ninety-five percent of the adult smokers interviewed reported cravings stronger than they had expected, and few were happy they had ever begun smoking. Over 80 percent expressed regret at having ever started. The survey also found that young smokers had profoundly unrealistic expectations for how long they would be smoking: only 5 percent expected to be smoking five years down the road, when in reality most would still be smoking.52
This was old news for the companies, of course, who had long realized that most smokers—even young smokers—want to quit. Imperial Tobacco’s Project 16 had come to this conclusion in 1977, based on their study of English-speaking kids in Canada, where it was found that teenagers once hooked “cannot quit any easier than adults” and that most likely “few will.”53 Cigarette makers realized that while smokers start smoking for one set of reasons (advertising, peer pressure, etc.), they continue for very different reasons—with the most important being physiological addiction. Trying to quit gives you basically a crash course in what it means—what it feels like—to try to loosen this addictive grip. The letters written to the industry, and especially those from after the 1970s, make it clear that most longtime smokers are painfully familiar with the realities of addiction. But this is a lesson most often learned after trying to quit and failing, by which time for most it is already too late—or at least too late without a painful struggle.
For decades the mainstay of the industry’s legal position has been that the public has long been “well informed” about the hazards of tobacco. Defense attorneys want us to believe that people make an informed choice when they decide to take up smoking or fail to quit—and therefore have only themselves to blame for whatever illnesses they contract. Smoking by this logic is a calculated risk, a “risky decision,” as one well-paid expert likes to put it.54
We have already seen from opinion polls and customer correspondence, however, that lots of people have what charitably might be called “gaps” in their knowledge. That is also the assessment of polling professionals, appalled by the tobacco industry’s misuse of polls in litigation. In 1999 Lydia Saad and Steve O’Brien of the Gallup Organization commented on how
Time and again, the tobacco companies have successfully convinced juries that the connection between smoking and diseases such as lung cancer has been common knowledge in the American culture for at least a century and, therefore, plaintiffs are responsible for the results of their voluntary decision to smoke. . . .
[A] review of historical Gallup surveys suggests that there was, in fact, a high degree of public doubt and confusion about the dangers of smoking in the 1950s and 60s. There may have been widespread awareness of the controversy over smoking, but public belief that smoking was linked to lung cancer trailed far behind this general awareness of the controversy.
The legal question at the core of these cases is whether average Americans (or average teenagers) understood the risks they were taking when they began smoking thirty or forty years ago. Looking at Gallup data in the public domain, it is difficult to conclude that they did.55
This poor state of understanding is hardly surprising, given how hard the industry has worked to obscure such hazards. The basic script never varied much, despite some variance in the rhetoric used to belittle or ridicule the evidence. I’ve listed below some of the terms used by the industry to denigrate the science implicating tobacco in health harms; such terms were used in correspondence with the public but also in Tobacco Institute brochures, press releases and “white papers” and the like:56
Such attacks were widely distributed. Addison Yeaman, vice president and general counsel of Brown & Williamson, managed to have one especially vituperative tirade printed in the Congressional Record (December 4, 1967), launched with a quote from North Carolina governor Dan Moore characterizing the recent U.S. Surgeon General’s report as “unwarranted harassment and unnecessary confusion created by headline seekers using biased information.” Yeaman then mocked Surgeon General William Stewart as basically a scientific fraud, warning that the nation’s top medical cop either had “lost the quality of objectivity” or was “misinterpreting the information available to him.” Yeaman went on to denounce the “vicious attack” on the industry organized by
a formidable coalition of government agencies, legislators, fund-raising organizations, propagandists, and do-gooders—all engaged in a crusade against tobacco . . . disregarding and even stifling the truth . . . doing slight [sic] of hand manipulations with statistics . . . weaving a tangled web of propaganda and deceit . . . blind to all but their own position . . . outright statistical nonsense . . . devoid of ascertained facts . . . a shabby piece of propaganda . . . bamboozled . . . arrogance of bureaucracy . . . the dangers of demagoguery and arbitrary government actions [etc.].57
Yeaman’s bottom line: “no one—and I mean no one—knows whether cigarette smoking causes any human disease.”
Yeaman’s vitriol in the Congressional Record was prefaced by an equally dismissive rant by Samuel Ervin, the U.S. senator from North Carolina best remembered today for his feisty role in the Watergate hearings. Ervin attacked Senator Robert F. Kennedy’s reproach of the industry and had seventeen denialist screeds read into the record. In Ervin’s view the arguments advanced in favor of the causal hypothesis contained “little more than old platitudes, new hyperbole, and blatant nonsequiturs,” all based on statistics either “erroneous, irrelevant, or statistically meaningless.” Ervin ridiculed the idea of requiring a health warning as an “absurdity” and declared that Americans had “a right to know that there is no proof that smoking causes lung cancer and heart disease.” Indeed it was “far easier to show statistically that smoking cigarettes prolongs life.” The senator mostly followed the Tobacco Institute’s playbook—he had obviously been well briefed—but also felt it worth noting that the Encyclopedia Britannica (he doesn’t say what edition) defined cancer as “an autonomous new growth of tissues of an unknown basic cause.”58 As if archaic definitions could resolve matters of fact.
Ervin may have been just plain ignorant in this realm; lots of people were, after all, and the senator may have been thinking only of the financial well-being of tobacco farmers in his native North Carolina. Such was still his view in 1972, when he objected to a proposal for federal limits on tar and nicotine from cigarettes as requiring “a police state far beyond that envisioned by Hitler.”59 It is unclear whether his opinion changed after being diagnosed with emphysema, following a lifetime of smoking.
One thing we can say is that the industry’s assessment of popular understanding has been opportunistic. In the 1950s and 1960s, for example, it was common to hear them say that no one took such hazards seriously. By the mid-1960s, however, we start to hear that everyone was “aware of the issue,” a theory first advanced as part of a tactic to forestall warnings and to protect against lawsuits. Congressional hearings on whether to require a warning label of some sort began shortly after the 1964 Surgeon General’s report, and the industry responded by claiming that people were already aware of the “alleged health harms” caused by smoking—and therefore didn’t need to be warned. The strategy was outlined at a secret meeting in May of 1964, where the industry’s powerful Committee of Counsel decided to finance a survey to help buttress the point: “At our meeting in Washington on May 7, 1964, a decision was reached to proceed, on a preliminary basis, with a public opinion survey which we hoped would establish that there is a very high level of public awareness concerning the health issue involving cigarette smoking. It was contemplated that the results of this survey would be used as a basis for testimony at a Congressional hearing.”60 The survey had actually been proposed by two scholars of marketing and communications—Gary Steiner from the University of Chicago and David Berlo from Michigan State—who suggested to the committee that a public opinion survey might help to provide “strong support” for the industry’s position that warnings were unnecessary. As recorded by an attorney working for Arnold, Fortas & Porter, the goal would be to try to establish six “basic propositions”:
1. That there is greater public awareness of the charges against smoking than there is of numerous other important public issues;
2. That a very high percentage of the American public believes there are risks to health involved in habitual smoking of cigarettes;
3. That the risk to health is overestimated (accepting as a basis for comparison the statistics in the Surgeon General’s report and the Royal College report);
4. That there is substantially greater public awareness of the possible risks of cigarette smoking than there is of such other health issues as the cholestorol [sic] question, drinking and obesity;
5. That persons who do not know of the health issues probably would not be reached by warnings in any event;
6. That advertising does not have as much to do with the social acceptability of smoking as do numerous other personal and psychological factors.61
Projects of this sort were always carefully lawyered, and in this instance the Committee of Counsel sequestered polling results to make sure “unfavorable data” would never see the light of day. All interviews, analyses, and statistical results were to be forwarded to the committee; the goal was to reduce the danger of a successful subpoena and to make sure inconvenient findings “could be destroyed and there would be no record in any office of the nature of the returns.”62
Similar arguments—about the universality of awareness—would be revived in the 1980s, to counter calls to strengthen warnings but also to buttress the industry’s “common knowledge” defense in court. Typical is the testimony of Reynolds CEO Edward A. Horrigan on March 16, 1982, at congressional hearings on the adequacy of warnings:
The evidence shows that over 90 percent of the American public is aware of the claim that smoking is harmful. . . . This awareness level is virtually, if not totally, unprecedented in comparison to the awareness of the major issues facing this nation. The facts demonstrate that the Federal Cigarette Labeling Act is working, that the public has been made aware of the claimed health hazards of smoking, and that people are in a position to make a free and informed choice of whether or not to smoke.63
Opposition to warnings and legal defense were the two main reasons industry lawyers emphasized “universal awareness.” Indeed, this was precisely how the industry kept winning all its lawsuits: the argument was that people had long known about the hazards, or at least had known enough to make a free and informed choice.
The oddity, of course, is that the companies themselves throughout this time were refusing to admit such hazards, a disjoint finessed by radically separating expert from popular knowledge. Expertise demanded caution and “more research”; popular knowledge—spun as “awareness”—was supposed to be universal. And so by the 1990s the industry’s public stance on smoking and health had crystallized into “We believe the general public has long been aware of the contention that smoking may be injurious to health”64—but we ourselves, the experts, don’t believe there is any proven harm from smoking. Such confessions were always carefully worded, since the intent was not to admit that smoking was injurious but rather only that some people had made this “contention.”
One last legal fact is relevant here. Historians of the law often point to the importance of a 1963–64 treatise known as the “Second Restatement of Torts,” edited by William Prosser and his colleagues at the American Law Institute and a bible of sorts for American liability doctrine. Prosser et al. here state, in a famous passage in Section 402A, that whereas a manufacturer might be held liable for selling “bad whiskey” (containing, say, a poisonous contaminant), a maker of “good whiskey” cannot. And the same is claimed for tobacco. A maker of “bad tobacco” might be held liable, but makers of the good stuff cannot. The theory again was that people were supposed to know that whiskey or tobacco can cause harm and that a product to be defective would have to be unreasonably dangerous:
The article sold must be dangerous to an extent beyond that which would be contemplated by the ordinary consumer who purchases it, with the ordinary knowledge common to the community as to its characteristics. Good whiskey is not unreasonably dangerous merely because it will make some people drunk, and is especially dangerous to alcoholics; but bad whiskey, containing a dangerous amount of fusel oil, is unreasonably dangerous. Good tobacco is not unreasonably dangerous merely because the effects of smoking may be harmful; but tobacco containing something like marijuana may be unreasonably dangerous.65
What is remarkable, however—and not discovered until recently—is that the Restatement (Second) of Torts (as it is also known) is partly a tobacco artifact. It turns out that lawyers working for Big Tobacco—including H. Thomas Austern from Covington & Burling, chairman of the Tobacco Institute’s Committee on Legal Affairs—were deeply involved in drafting this document, notably the tobacco-friendly Section 402A, the founding text of strict liability. Elizabeth Laposata discovered the intrigue in documents preserved in the archives of the American Law Institute, where she found a record of tobacco industry attorneys trying to influence early drafts of the Restatement, including the crucial passage about what can be considered “unreasonably dangerous.” Similar efforts were undertaken to influence the Third Restatement, issued in 1997. We should perhaps not be surprised that Tobacco tried to have its voice heard in such a crucial legal arena; what is surprising is how successful that effort has been. If American law exempts “good tobacco” from liability, that is partly because Tobacco helped draft the law.66
In court, the claim that the dangers of smoking have long been “common knowledge” is deployed to suggest that smokers make a free and informed choice when they light up. In private, however, the industry has been perfectly willing to admit there is much that people don’t understand about cigarettes. Tar and nicotine numbers for many years were printed on packs, but few smokers knew the levels for their preferred brands or (more important) the deception behind such numbers. And few today know about the many poisonous gases in cigarette smoke—such as carbon monoxide and hydrogen cyanide. “Gas” became an area of intense industry research in the 1960s, with the goal of reducing some of the more noxious ciliastats. Several companies thought about educating smokers on this topic but quickly realized this could backfire, stirring up fears of yet another tobacco menace. Smokers didn’t seem to know or care about “gas,” so why raise the issue? Gas turned out to be one of those many areas where the companies decided to “let sleeping dogs lie.” American Tobacco had already decided this for carbon monoxide in the 1930s, and forty four years later Brown & Williamson was still satisfied that “The subject of ‘harmful’ gases in cigarette smoke is an issue of which the general public is presently unaware.”67 And thankfully, from their point of view.
Radioactivity was treated in a similar manner. Harvard scholars had found radioactive polonium 210 isotopes in cigarette smoke in 1964, and the industry quickly verified this fact, as we shall see in Chapter 26. Despite having several different techniques to remove this isotope from cigarettes, however, the companies never took such steps and never warned consumers. Public ignorance was clearly the industry’s bliss—and Philip Morris made a conscious decision not to wake this “sleeping giant.”68 Here, too, the industry preferred its customers ignorant.
There are other examples where the industry knew many people were in the dark about specific aspects of smoking. Philip Morris research chief Helmut Wakeham in a 1979 memo noted that people take up smoking long before they become aware of its addictive grip, and Brown & Williamson about this same time remarked that “Very few consumers are aware of the effects of nicotine, i.e., its addictive nature and that nicotine is a poison.” The U.S. Federal Trade Commission in 1999 expressed its concern that millions of Americans were wrongly interpreting the tar levels marked on cigarette packs, imagining that a “5 mg” cigarette would deliver only one-third the tar of a “15 mg” cigarette. The companies have long known that smokers who switch to low-tar brands often end up smoking these more intensively, but smokers have been poorly informed on this point.69
We should also keep in mind that there are many different kinds of tobacco use, each of which has its own ignorance micro-environment. Water pipes have recently become quite popular on college campuses, for example, and many students smoke “hookah” without even realizing this is tobacco—and no less hazardous. Most hookah smokers believe water pipes are less harmful and less addictive than cigarettes and that quitting will not be difficult.70 The industry appreciates such naïveté, and depends on it to a certain extent. New tobacco fads often have health effects that might not become manifest until twenty or thirty years down the road—which means that a nimble industry can profit by changing fashions from time to time. Think of people shifting from pipes or cigars to cigarettes, thence to long-stemmed holders, king-sized, filters, menthols, “hi-fis,” slims, hookah, oral snuff, snus or “e-cigarettes,” and so forth, apparently ad infinitum. Plus ça change . . .
Of course the industry itself is part of the public, and their long-standing refusal to admit any evidence of harms has always created certain difficulties in the realm of logic. How could knowledge of hazards be “common,” for example, if the manufacturer wouldn’t even admit it? This is perhaps the biggest contradiction in the industry’s “common knowledge” defense: if everyone always knew, why were manufacturers so adamant in denying proof? The industry for many years denied the reality of harms but also any knowledge of harms even among its own research staff. Milton E. Harrington, Liggett’s former president and CEO (1964–72), in 1985 responded to questions along these lines by insisting that “Nobody in the company thought smoking was harmful.”71
The example of Sam Ervin shows that politicians have also been ignorant in this realm—which is hardly surprising. Politicians have often ignored tobacco hazards, perhaps for fear of offending a powerful source of jobs and potential donations. U.S. presidents have been required by Congress to issue an annual proclamation on cancer control ever since 1938, for example, recognizing April as “Cancer Control Month,” and the remarkable fact is that neither smoking nor tobacco was even mentioned in any such proclamation until 1977, when President Jimmy Carter stated that the fight against cancer depended on the willingness of Americans “to alter their eating, drinking, and smoking habits and to seek early and appropriate medical care.” (Carter in 1978 irritated health officials in his own cabinet when he claimed that cigarette manufacturers were striving to make smoking “even more safe than it is today”—implying it was already safe.) Smoking was not mentioned in any of the next four presidential Cancer Control Month proclamations, and Ronald Reagan did not issue a strong statement until 1984, when he announced that avoiding smoking was the “single most important step which can be taken” to decrease one’s risk of cancer. Smoking has figured in most subsequent presidential statements but not in Bill Clinton’s from 1998 or 1999 or in George W. Bush’s from 2004. President Obama—himself a smoker until 2010—in his 2009 proclamation noted only that smoking “accounts for thousands of cancer deaths every year” and that quitting “can greatly reduce the risk of cancer.”72
Pundits and presidential contenders have sometimes denied even the reality of harms. Senator Robert Dole of Kansas, while campaigning for the presidency in 1994, denied the addictiveness of smoking, comparing it to drinking milk. The conservative syndicated columnist James J. Kilpatrick as recently as 1985 was still publishing widely read articles with titles like “We Still Don’t Know if Cigarettes Really Do Cause Cancer.” And Rush Limbaugh—the notorious disinfotainer—gained further notoriety for this 1994 pontification: “It has not been proven that nicotine is addictive, the same with cigarettes causing emphysema.”73
I should mention one final way to assess public understanding, using the records kept of phone calls and emails to the various companies. The companies sometimes kept logs of such calls, and these, too, reveal the persistence of ignorance even in the face of long-established medical wisdom.
The background here is that like many other large corporations, tobacco manufacturers often receive thousands of calls per day from consumers. In 1997, for example, R. J. Reynolds received 260,000 calls to its consumer relations department, plus an additional 400,000 calls via its outside telemarketing contractors.74 Philip Morris fields an even larger volume, which can increase dramatically during periods of special promotions. At the turn of the millennium the company was receiving three to four million consumer-initiated calls per year, most of which were responses to promotions.75
Calls are handled in a number of different ways, according to what the company hopes to gain from such communications. In the late 1980s, for example, Philip Morris launched a “Bill of Rights” campaign essentially to identify smoking as a form of free speech. Toll-free numbers were created for people to call to obtain a free copy of the Bill of Rights, and by 1990 the company had received over three million requests for the document. An even bigger response followed the company’s 1993–94 Marlboro Adventure Team promotion, during which smokers were invited to call 1–800 MARLBORO to obtain free brand-linked merchandise after accumulating “Marlboro Miles” (for smoking that brand). The response was one of the largest in the history of telemarketing, generating 900,000 calls in the first forty-five minutes and 2.5 million during the first four hours. Nearly 10 million smokers participated in the frenzy, which Philip Morris marketers characterized as “the largest promotion in consumer products history.” Some 4 million orders were placed and 11 million items shipped.76
Telemarketing on such a scale requires complex and coordinated management. In 1993, for example, just to receive calls and process orders for its Marlboro Adventure Team promotion, Philip Morris established a new 450,000-square-foot “fulfillment facility” in Lafayette, Indiana, staffed by 350 employees, and a new Customer Service Telemarketing Facility in Kankakee, Illinois, with a staff of 25 to handle phone orders. Philip Morris in the year 2000 expanded its call-receiving capabilities, implementing natural-language speech recognition, standby promotional and apology mail packages, and a “new attitude” tailoring personal service to the individual smoker. Callers were given a personalized consumer ID and PIN to allow personal logins, and email and fax programs were installed to reach consumers more quickly. For a time the industry hoped to replace its telephonic contacts with fax, email, and web-based interactions, though phone calls apparently still remain important, with texting and interactive web 2.0 advertising close on their heels.77
Philip Morris is not the only tobacco company to engage outside firms for such purposes. R. J. Reynolds in 1997, for example, contracted with the Young American Corporation (YAC) in Young America, Minnesota, to handle its promotions fulfillment at a cost of $11 million. YAC responded to over 400,000 phone calls to the company that year, handling also certain aspects of computer security. YAC was the largest fulfillment vendor in the country at the time, with 250 separate packaged goods accounts. Three of YAC’s facilities in 1997 had operators constantly standing by, with up to 350 staffers taking calls for the Camel maker. Brown & Williamson’s operations were on a smaller scale, but in the 1990s the company contracted with the Cognos Corporation to handle its telemarketing and data processing, including help with assembling logs of calls to the company.
Though tobacco companies may receive millions of calls and emails in any given year, only a tiny fraction are recorded and preserved in the online archives. Phone logs are generally low on the industry’s priorities for retention, which is why they don’t usually survive for very long. Phone and mail logs are typically held for only a year prior to destruction,78 and those few that have survived are probably just the result of either bureaucratic accident or the chance timing of a subpoena. I stumbled onto one such log while searching for references to one of my books: a caller had recommended my Nazi War on Cancer and two of my other publications to Brown & Williamson’s PR department, a recommendation buried in a set of logged calls to the company from 1999 treating “Smoking and Health.”79
Brown & Williamson’s phone log from 1999 summarizes 129 recent calls to the company in which “smoking and health” was the principal focus. We usually have only a sentence or two summary for each, but callers reveal a wide range of views on cigarettes and their makers, from fawning sycophancy to derisive contempt (see Figure 30).80 Accidents involving cigarettes are reported by a number of callers, as are various kinds of contaminants in tobacco. A father called because his ten-month-old daughter had swallowed some filters, for example, and a Japanese man called because he had found a “glass fiber-like substance” in his cigarette and was “anxious and worried about its harmfulness.” Some callers were looking for health information: one wanted to know if the company had data about harms based on cigarettes smoked per day; another asked whether smoking was addictive. Several were clearly irate: one said that the company “lied to our customers” about addiction; another effused, “You are killing people with KOOL cigarettes. I hope you are happy.”81
Many of these callers reveal substantial ignorance. One had heard that whereas filtered cigarettes cause cancer, nonfilters cause emphysema. Another expressed his view that it was not cigarettes but rather cigarette lighters that cause cancer. Another asserted that “petroleum products cause more health problems than cigts.” And another had heard Rush Limbaugh on the radio and endorsed his view that “smoking is not addictive.” One was upset that people “blame every disease on cigarettes,” and another revealed his own personal cure for lung cancer—caused, as he imagined, by a virus.
As in the written correspondence, many of these callers reported being in good health despite having smoked for many years. This is a common refrain in the consumer letters: a search for expressions such as “forty years” and “fifty years” returns hundreds of documents, most of which are people bragging about having smoked for decades without apparent harm. George Burns, the cigar-smoking comedian who lived to the ripe old age of one hundred, is mentioned dozens of times in such letters. A search for “George Burns” returns ninety-seven documents, most of which are either contractual negotiations for the actor’s appearance in industry-sponsored shows (such as Hollywood Palace) or letters from ordinary smokers extolling his longevity.
One interesting aspect of Brown & Williamson’s phone log is that only six of the 129 callers were clearly angry with the company. One accused the company of having “lied about cigt addiction,” another “ranted and raved” about how smoking “kills people,” adding “You guys are worse than Hitler.” A much larger number, however, were apparently unconvinced of smoking’s hazards. The sample size is not enormous, but in these 129 calls touching on “Smoking and Health” callers were more likely to say smoking did not cause disease than to say that it did. Email logs tell a similar story: a 121-page Reynolds log kept by CEO Andrew Schindler snapshots more than 1,400 emails from the year 2000, with correspondents (still) offering that cancer is caused “by your emotions, not cigarettes,” or that people exposed to high levels of radon “are prevented from lung cancer.” A Tyler, Texas, man in 1997 took the trouble to fax a letter to Charles A. Blixt, Reynolds’s general counsel, assuring him that “Microscopic Mites Cause Cancer Not Tobacco.”82
Perusing such correspondence, we learn that the techniques used by the industry to respond to inquiries have changed dramatically over time. In 1958, for example, the Tobacco Institute acquired its first electric typewriters—two sixteen-inch Royals—at a cost of about $470 each. The IBM machines acquired in 1962 were even more expensive ($535) and typically the costliest equipment in such an office. Typewriters with storable memory meant that letters could be generated by changing only the address and salutation, and in 1967 use of the IBM Magnetic Tape Selectric was credited with allowing Reynolds’s public relations department to operate with eleven fewer people processing correspondence. Form letters were in wide use by this time, as were computers by the 1970s and email by the 1990s. Automation of correspondence allowed the industry to ramp up volume and to save on costs while preventing potentially dangerous deviations from the syndicate’s PR and legal lines.83
New clerical technologies (and media) are often easier to use and cheaper, but they can also be used to target more consumers—in this instance smokers—more directly. Highly focused communications also render marketing and promotions essentially invisible to the non-smoking world. People who don’t smoke are often shocked to learn that the tobacco industry still spends about $13 billion annually on marketing and promotion just in the United States—mostly via discounts and direct mail—since much of this is unseen by non-smokers. This is precisely how the industry wants it: a fungus always grows best in the dark.
Public opinion polls, consumer letters, and internal industry assessments make it clear that the hazards of smoking were anything but “common knowledge” in the 1950s and 1960s—or even later in many respects. Smokers in particular seem to have had a hard time grasping the breadth of the threat, which encompasses not just lung cancer and heart disease but also emphysema, chronic bronchitis, cancers of the lip, mouth, and tongue, blackening gangrene of the feet, injuries to the developing fetus, and myriad other maladies. Not to mention corruption of academia and the legal profession.
Much of that difficulty can be traced to the industry’s coordinated campaign of reassurance. The hucksterism of the 1930s and 1940s was followed by the “Frank Statement” of 1954 and the barrage of distracting research, misleading ads, manipulation of governmental and professional organizations, and false marketing of filters, “lights,” and low-tars. The companies said they would find and fix whatever might be wrong with cigarettes and on occasion even promised they would “stop business tomorrow” if genuine evidence of harms was ever uncovered. Such promises were never kept; indeed, the industry abandoned this responsibility while also doing everything it could to prevent the public from learning the truth.
Tobacco use has now spread into other parts of the world, propelled by many of the same strategies perfected in the United States. The golden weed already kills about six million people every year, and that number will grow before it begins to decline. Smoking rates are the ultimate proof of “common knowledge,” and while total consumption peaked in the United States in the early 1980s there are many places where cigarette use is still on the rise. And even in health-conscious California we still have about eight hundred cigarettes smoked per person per year, a figure not much lower than the global average. Each of these cigarettes is a measure of the industry’s morbid campaign of disinformation, combined with the lasting grip of addiction. Ignorance is the seed, death the harvest.
It would be wrong, though, to place too much emphasis on knowledge or its absence. The “consumer sovereignty” so often sanctified by economists places all responsibility for tobacco death—or quitting—on consumer choice, giving the industry a free pass. We tend to forget that cigarette makers also have choices, that they are the ones keeping nicotine in tobacco, fomenting addiction, robbing smokers of their ability to make a free choice. So “full disclosure” is not enough; we should not be satisfied with a highly addicted, even if highly informed, citizenry. And we don’t have to grant unlimited freedom to manufacturers. The manufacture or sale of cigarettes is not an inalienable right or the sine qua non of freedom; the opposite is actually closer to the mark.