by Allan Brandt
In 1978, the whole enterprise collapsed when Gio Gori, the director of the TWG and the deputy director of the NCI’s Smoking and Health Program, claimed in the Journal of the American Medical Association and the public media that one could avoid a critical threshold of risk of disease by choosing several low-tar brands. The Washington Post, for example, reported, “Some Cigarettes Now ‘Tolerable,’ Doctor Says.” But the data for Gori’s claim was sketchy at best, and there remained no certain way to determine how cigarettes were smoked in practice.137 Soon Secretary of Health, Education, and Welfare Joseph Califano and Surgeon General Julius Richmond would move to close down the TWG. Richmond would note in his massive 1979 surgeon general’s report, which reviewed the “overwhelming” data on the harms of smoking that had been generated in the fifteen years since the first report, that “there can be no final assessment of the public health benefits of our present search for less hazardous cigarettes.”138 And Califano explained that “there is no such thing as a safe cigarette.” Gori eventually decamped to become a paid consultant for the industry.139
During the two decades following the publication of the 1964 surgeon general’s report, the “remedial measures” forecast by Luther Terry never did materialize. The Tobacco Institute, on behalf of the companies, assembled an impressive record of derailing attempts to bring tobacco under any regulatory mandates whatsoever. As the Wall Street Journal noted in 1972, the Tobacco Institute had developed a unique reputation for “turning a series of imminent disasters into near victories.”140 As William Kloepfer, senior vice president of Tobacco Institute, explained, the “tobacco industry believes in informed consumer response as opposed to government consumer coercion.”141
The defeat of regulatory initiatives reflected the many ways in which tobacco money fueled the American economy. The industry had many friends to call upon to help it fight off public health legislation. Its strong base of tobacco-state congressmen and senators, often vested with important committee assignments and chairmanships, were only the beginning. Lobbyists for the advertising industry, antitaxation coalitions, and even civil liberties groups were among the strange bedfellows generated by tobacco politics.142 Within this matrix of allies, the industry quickly learned how best to exert power in a sympathetic Congress.
The notion that regulation serves the needs of the regulated is often identified as “paradoxical,” but it has deep historical roots.143 It was anything but a paradox to those who meticulously mapped and executed the tobacco industry’s strategy in the gradual accumulation of battles that was coming to be known as the tobacco wars. Just as the cigarette both illuminated and shaped major transformations in culture and science, so now it marked critical shifts in the nature of American politics. Although special interests and their influence had a long history in shaping the legislative process, the tobacco industry broke new ground in its ability to upend regulatory efforts. The Tobacco Institute, in concert with elite corporate law firms, ran circles around the poorly financed and weakly organized public health advocates.
The two most significant acts of federal tobacco regulation promulgated by Congress in the second half of the twentieth century—labeling and the ad ban—had, upon inspection, proven to be little more than special interest legislation protecting the very actions they were meant to inhibit. Moreover, through the Tobacco Institute, the industry had a mechanism to ensure that its strategy was implemented systematically. Thus, the industry could score repeated victories in spite of an overwhelming scientific judgment justifying new restrictions on the promotion and marketing of its product.144
Wars typically feature combat between at least two opposing forces, though they may be wholly unequal in strength, skill, or resources. In these early years of the tobacco wars, however, it was sometimes difficult even to identify any coherent public health force to resist Big Tobacco. While the tobacco industry plotted a centralized strategy in their corporate board rooms, legal conference rooms, and in the offices of the Tobacco Institute, public health advocates were poorly organized and diverse. They lacked the capacity for an integrated strategy and commanded few resources to counter the industry’s planning and implementation. As a result, the tobacco industry was often able to determine on what terrain it would seek engagement. Congress was an especially congenial venue in which to do battle. Spending liberally in support of political campaigns, the Tobacco Institute had easy access to the levers of congressional power and authority.145
The legislation that emerged from Congress during this period testifies to the masterful preparation and strategic command of the tobacco industry. Given the disparity in resources between the companies and public health interests, these outcomes are not surprising. But even in these early decades of the war, the industry showed vulnerabilities that a gathering force of public health advocates would later exploit. Even as tobacco scored wins in specific conflicts, it was growing apparent that antitobacco forces would not leave the field uncontested for long.
Do you mind if I smoke?
Why, no . . . Do you mind if I fart?
It’s one of my bad habits. I quit once for a year, you
know, but I gained a lot of weight. It’s hard to quit. You
know, after sex I really have the urge to light one up.1
STEVE MARTIN, 1977
If children don’t like to be in a smoky room, they’ll leave.2
CHARLES HARPER, 1996
CEO, R.J. REYNOLDS
CHAPTER 9
Your Cigarette Is Killing Me
BY THE MID-TWENTIETH century, smoking had become almost a required practice, and the norms of etiquette reflected its prominence. Emily Post, the doyenne of manners experts, turned her attention in 1940 to those who continued to object to cigarette use: “those who do not smoke cannot live apart, and when they come in contact with smokers, it is scarcely fair that the few should be allowed to prohibit the many from the pursuit of their comforts and their pleasure.”3 Although making exceptions for visitors to a sickroom or a bride with a veil on, Post felt that smoking was appropriate in almost all settings, something to be not only tolerated by nonsmokers, but accommodated and admired.
As Post’s advice made clear, the cigarette’s triumph rested fundamentally on its public nature. By the middle of the century, cigarettes had become a ubiquitous prop in a full set of highly ritualized social interactions. From coffee breaks to the college seminar room, from bars and restaurants to boardrooms and bedrooms, the cigarette was a constant presence. With the able guidance of the growing tobacco industry, the early twentieth-century prohibitions on public smoking had been dismantled. The industry had well understood that the commercial success of the cigarette depended on its public associations with leisure and pleasure, for men and women alike, across all socioeconomic and ethnic groups.
Beginning in the 1960s and 1970s, the acceptability of smoking would come under increasingly aggressive attack from public health activists and grassroots groups. This new front in the tobacco wars would reveal how a popular product, along with a behavior with positive meanings and associations, could be quickly and radically transformed. If the meanings of smoking were, as we have seen, elastic, they were by definition vulnerable to change. In the decades following the first surgeon general’s report, the tobacco industry would lose control of the very meaning-making processes that they had all but perfected early in the century.
There was a powerful irony in this transformation, since by the early 1970s it appeared that the tobacco industry had emerged from two decades of catastrophic news in remarkably good shape. Despite the emergence of conclusive scientific evidence that cigarette use caused serious disease, debility, and death, cigarettes remained remarkably popular and virtually free of public regulation. Even with warning labels on the packaging and a ban on broadcast advertising—both measures initially opposed by the industry—cigarette sales and profits remained impressively robust. Per capita consumption in 1974 was virtually the same as it had been a decade earlier
, approximately 4,100 cigarettes per year.4 And it appeared that the regulatory initiatives of the previous decade had reached their limits. Through an impressive combination of public relations, product modification (filters), political hardball, and outright misrepresentation, the industry had managed to fight off regulation and litigation, invent new approaches to promoting its product, and generally secure its ongoing success and stability.
Widely shared libertarian attitudes about both the role of the state and the behavior of individuals constrained the future of campaigns against tobacco. The American individualist credo, “It’s my body and I’ll do what I please,” cast a net over further antismoking initiatives. Unlike other industrial nations, most of which had developed national health insurance systems, the United States retained a strong disposition to hold individuals strictly accountable for their behaviors.5 American culture held that citizens must take responsibility for their own health, including making sensible decisions about risk and behavior based on the available information. Now that every cigarette package had a warning label, it was assumed that smokers were fully capable of taking responsibility for their own behavior.6 Moreover, there existed a deep and abiding skepticism, if not overt hostility, to paternalistic interventions on behalf of health.
The tobacco companies and the Tobacco Institute had aggressively and effectively presented the case for smoking as a voluntary risk.7 According to this view, there was a “debate” about the risks of smoking, and Americans had been fully informed of the arguments on both sides. They should now be permitted to make up their own minds about whether to smoke or not. This line of reasoning raised the question of whether cigarette smoking any longer constituted a risk to public health at all. Since the risks incurred were entirely to the individual, the authority to regulate and restrict smoking should rest there, too.
The industry and its political allies frequently invoked Big Brother or the Prohibition debacle to point out how paternalistic government interventions offended the basic American values of independence, autonomy, and the right to take risks. Dictating other people’s behavior, even in the name of health, was portrayed as un-American. It was one thing, for example, to educate the public about seat-belt use, and quite another to require Americans to buckle up. Once Big Brother entered your car, he would inevitably follow you into your home. These ominous themes began to characterize the discussions of further regulation of cigarettes in the early 1970s. Consenting adults, the argument went, had been informed of the cigarette “debate” and should now be left alone. Spurred by the well-oiled tobacco interests, critics proudly decried the “health and safety fascists” telling Americans how to live and sapping their sense of individual responsibility.8 Cigarette smoking had become the quintessential voluntary health risk.
But what if the risks were not purely individual? What if smoke from cigarettes harmed nonsmokers? If this were true, the very same arguments in defense of smoking could be turned on their head. Beginning in the 1970s, a new set of grassroots antismoking groups would begin to explore this assumption. Cigarette smoke as an environmental toxin would become the basis for a radical shift in the tobacco wars. Risks to nonsmokers would emerge as a critical problem for the companies and lead to a more stringent regulatory environment.
Nothing spurred the effectiveness of this new anticigarette movement so powerfully as the recognition of the so-called “innocent victim” of “secondhand smoke.” The old ambivalence about preaching to smokers about their individual behavior disappeared; now one could talk about the impact their self-destructiveness had on others. The identification of “innocent victims”—typically nonsmoking women married to smokers, or children with smoking mothers—radically reconfigured the moral calculus of cigarette smoking in the United States.9
If Americans have been highly tolerant of risks assumed by individuals, they have been aggressively intolerant of risks imposed on others. If there were innocent victims of cigarette smoke, then smokers became guilty of imposing risk, disease, and even death on unsuspecting women and children. 10 As a New York Times editor explained in 1978:Non-smokers who breathe the air in smoke-filled rooms are in a sense engaging in ‘involuntary smoking’ . . . much of this out pouring also lands in the lungs of innocent bystanders.11
It is ironic that the impact of smoking on nonsmokers, rather than on smokers themselves, is what finally transformed the regulation and cultural perception of the cigarette. Even as the industry asserted in the aftermath of labeling that smokers were now well-informed of the “alleged” risks of smoking and thus could make their own decisions, nonsmokers were seen as being subjected to the smoke of those decision makers. These innocent victims heightened the state’s interest in controlling behaviors previously viewed as outside its purview.12
The first efforts to address the harm smoking caused to nonsmokers had a simple logic. If, as the surgeon general had concluded in 1964, smoking causes serious disease, how could ambient smoke, both from the burning cigarette and from the lungs of the smoker, not do the same? Though the industry would try mightily to reassure the nonsmoking public on this point, it would never manage to disrupt this commonsense view, which rested squarely on the authoritative assessment of the first surgeon general’s report.13 Nonetheless, the precise nature and severity of the harms of secondhand smoke were not so easily determined.
The smoke produced by cigarettes was labeled with a range of terms, each with different social and cultural implications. Environmental tobacco smoke (ETS) invited public concern about cigarette use as promoting an environmental hazard.14 Passive smoking contrasted with active smoking; secondhand smoke contained the ominous implication that someone else had used it first; involuntary smoking assumed that the practice of smoking was indeed a voluntary act. These terms reinforced each other in mobilizing this new campaign against public smoking.15
The growing concerns about air pollution from factories and automobiles soon extended to tobacco smoke as well. As early as 1967, Philip H. Abelson, the editor of Science, implicated cigarette smoke as an important and potentially dangerous element in air pollution, especially in combination with other pollutants. Abelson noted that while the diseases incurred by smokers might be considered their personal responsibility, the impact of smoking on the environment also endangered nonsmokers, who had accepted no such responsibility:The principal effects of smoking are borne by the smokers themselves. They pay for their habit with chronic disease and shortened life. Involved are the individual’s decision and his life. However, when the individual smokes in a poorly ventilated space in the presence of others, he infringes on the rights of others and becomes a serious contributor to air pollution.16
His editorial marks an early instance of how the rise of rights-based arguments in the context of scientific analysis would begin to reframe the smoking debate.
The following year, Frederic Speer, an allergist writing in Archives of Environmental Health, noted that “the effect of tobacco smoke on nonsmokers has received very little attention.”17 It was not surprising that an allergist would be interested in this question. For the better part of the twentieth century, people who had bad reactions to cigarette smoke were deemed to be suffering an allergic reaction. Calling sensitivity to cigarette smoke an allergy defined these reactions as idiosyncratic to a small group of affected individuals. Speer investigated the responses of exposure to smoke in both “allergic” and “nonallergic” subjects and found that smoke caused reactions in both groups, suggesting that the irritation many experienced might not be allergic at all. Noting how common exposure to smoke was and how intense it might be, he raised
the possibility that heavy exposure of the nonsmoker may lead to the serious diseases which afflict smokers. It cannot be denied that such exposure might have such grave results, but the answer to this question must await studies similar in complexity to those used in studying the effect of tobacco smokers.18
But the scientific investigation of secondhand smoke would prove no si
mple matter. Although the new research would employ the same epidemiological and statistical techniques, honed in the 1950s, that demonstrated the risks of smoking for smokers, investigators faced a new set of research obstacles. With any environmental toxin, measuring a small exposure or a small effect is more difficult than measuring a large one. It was already known that cigarette smoke could cause lung cancer in smokers, but little research had been done on the harms smoke might cause at lower doses. Symptoms among nonsmokers exposed to smoke ranged from eye, nose, and throat irritation to coughing, sore throats, and sneezing to the potential for cancers and serious respiratory and heart disorders. There was no unexposed population to serve as a basis for comparison, as nonsmokers had done for smokers, and no clear way to reliably identify groups with differing exposures. Given the widespread use of cigarettes, almost everyone breathed in some smoke, some inhaled significant amounts, and many people’s exposures could change unpredictably. As they had done when determining the risks to smokers a generation earlier, epidemiologists would assess the harms of smoke for nonsmokers by a range of different methods.