“The cigarette permeates twentieth-century America as smoke fills an enclosed room. This book centers attention on how the cigarette deeply penetrated American culture.” After decades of warnings that tobacco smoking was dangerous, the Surgeon General officially reported in 1964 that smoking caused lung cancer. The industry’s emphasis on freedom of choice and its disputing of the science sustained domestic business for another three decades. Opponents began to focus on secondhand smoke and on suing the tobacco companies. By the 1990s, only a quarter of Americans were smoking, the lowest number since the 1920s.
The modern cigarette was invented in the late nineteenth century, and its growth was propelled by a machine that replaced hand rollers. Buck Duke was the man who organized mass production and sophisticated marketing to sell cigarettes and create a new industry. He formed the American Tobacco Company, a trust with 90 percent market share. American Tobacco, along with U.S. Steel and Standard Oil, was eventually targeted in the Progressive Era. The ensuing oligopoly—American Tobacco, Liggett and Myers, P. Lorillard, and R.J. Reynolds—dominated a still noncompetitive environment. The era also saw the rise of an anti-tobacco crusade that equated smoking with drinking as pathways to lives of immorality. “The movement marked the intensification of a fundamental conflict in values between the Victorian and the modern.” The affection of the men of the U.S. Army during the First World War for cigarettes effectively ended the crusade against tobacco use. In the 1920s, three marketed and promoted national brands came to dominate the American market: Camel, Chesterfield, and Lucky Strike. “The cigarette century had arrived.”
The interwar years saw increasing sophistication in advertising to sell and identify brands aimed at specific segments of the population. Philip Morris joined the Big Three in 1933 by advertising cigarettes that were lighter and healthier. Lorillard promoted Old Gold, thus assuring that for half a century the market would be shared by five firms. By 1950, Americans were smoking 350 billion cigarettes per year.
The postwar years saw heightened concern about tobacco’s ill effects on health. The simple fact that lung cancer deaths had increased threefold was deftly ignored by an industry countering with claims of the health benefits of smoking. Many opponents emphasized issues tangential to health risks, such as smoking worsening study habits, fostering delinquency, inhibiting lactation, or simply not being congenial to femininity. The deleterious effects of smoking did not come to the fore because it took decades for smoking to manifest its consequences and, most importantly, because people were living much longer than their ancestors. Nonetheless, the proofs were beginning to mount. “By the early 1950s, it was abundantly clear that the evidence implicating cigarette smoking as a risk to health was now of a different order.” The industry’s response was to “produce and sustain scientific skepticism and controversy.” It retained Hill and Knowlton in 1953 to launch a major public relations counter to the emerging medical consensus. Hill set up the Tobacco Industry Research Committee to offer controlled advice that appeared objective. The TIRC attacked causation theories and argued that heredity was the compelling factor in cancer deaths. “The TIRC was designed to direct the attention away from the questions of immediate concern to the American public: the health effects of smoking.” Even when the industry’s internal scientists concluded that the link between smoking and cancer was accurate, management “continued to offer blanket assurances to consumers and stockholders.” The public was content; by 1961, Americans were smoking 488 billion cigarettes per year. “By making science fair game in the battle of public relations, the tobacco industry set a destructive precedent that would affect future debate on subjects ranging from global warming to intelligent design.”
In 1962, Surgeon General Luther Terry began a study of the risks of smoking. “What Terry sought—and ultimately got—was a political document that was scientifically unimpeachable.” The January 1964 Surgeon General’s Report stated unequivocally that smoking caused lung cancer. The industry’s “denial and distortion” strategy would no longer succeed. The battle shifted to the political arena, which remained supportive of Big Tobacco. The 1965 Federal Cigarette Labeling and Advertising Act was written by the industry and watered down the warning label to “may be hazardous to your health.” An application to the FCC in 1967 to apply the fairness doctrine to television ads gave opponents hours of airtime to counter cigarette advertising. Cigarette consumption dropped one percent per year for the next four years. Before advertising could be banished from the airwaves, the industry stopped television ads voluntarily, shifting dollars to print media. For all intents and purposes, attempts to regulate the industry failed. It remained free to sell its lethal products to the public.
The concept that smoking was an individual’s choice prevailed in the marketplace of ideas. “But what if the risks were not purely individual?” Smoke as an “environmental toxin” would change the debate. It was not the threat to the individual but to society that turned the tide. In 1975, Minnesota became the first state to ban smoking in public spaces. By 1981, thirty-six states had some restrictions on smoking. Boeing was the first company to ban smoking in the workplace. Smoking was banned on all airplane flights in the U.S. in 1990.
The first lawsuits against Big Tobacco began in the 1950s. The 1983 Cipollone case in New Jersey ran for almost a decade and achieved the first jury award. The industry’s Achilles’ heel—its cover-up of knowledge of the risks—was exposed during discovery. The award was reversed on appeal, dealing a blow to the plaintiffs’ bar, but several issues discussed in the appellate opinion gave lawyers hope.
The mounting exposure of the industry’s knowledge of nicotine addiction meant that “the firewall surrounding the tobacco industry’s intricate scientific, legal, and trade secrets was about to come down.” A television report featuring an industry insider revealed that companies sometimes added nicotine to specific brands to increase addictiveness. This was the smoking gun that would punish the industry in America. In 1994, the spectacle of five tobacco company CEOs telling the Waxman Committee that cigarettes were safe was an unmitigated public relations nightmare. Tobacco was now “a rogue industry.” A whistleblower copied and released 4,000 internal Brown and Williamson documents going back three decades, proving the company knew tobacco was addictive and harmful and took steps to hide that information.
Litigation would undo the industry. Broin v. Philip Morris was a class action on behalf of 60,000 flight attendants. The usual defense assumption-of-risk arguments would not work in a case involving nonsmokers. The defendants’ scorched-earth legal tactics consumed six years of pretrial maneuvering before a five-month trial in 1997. The industry settled for the first time, for $300 million. Class action suits proliferated. One particularly creative case involved suing on behalf of the state of Mississippi to recover Medicaid costs for treating smoking-related illnesses. Thirty more states joined the litigation. Around the country, individual plaintiffs began receiving jury awards that were upheld on appeal. In 1997, the companies settled with most of the states for the astounding sum of $365.5 billion, to be paid over twenty-five years. One irony was that the states now needed Big Tobacco to remain profitable enough to keep paying. As the century closed, tobacco consumption dropped by 20 percent. Although smoking has been stigmatized, millions still smoke, and lung cancer remains the nation’s leading killer. As for the tobacco companies who appeared on the verge of collapse, the new century saw “the industry emerge decidedly intact, ready to do business profitably at home and abroad.”
“One of the most disturbing ironies of twentieth-century public health is that it was the relative success in reducing tobacco use in the developed world that spurred the sharp increase in cigarette use in developing nations.” There will be more deaths from cigarette smoking in this century—an estimated one billion—than in the last century’s 100 million. By 2030, “developing nations will claim 70 percent of the world’s overall tobacco mortality.” The industry playbook that expanded American consumption is now being repeated overseas, in countries with limited oversight and regulation, and with the assistance of U.S. government encouragement of free trade.
This Pulitzer Prize–winning book is almost twenty years old. Since smoking slipped from its place of prominence in our lives to its current place of ignominy, I paid zero attention to it and had no awareness of its international spread. It appears that Big Tobacco is alive and well. For those with a cynical view of the world, this book affirms the primacy of money, the drive to make money, and our society’s addiction to profit regardless of human cost.
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