The Cigarette Century
Page 36
Surgeon General Koop’s report confirmed the findings of the NAS and went on to suggest that simply segregating smokers in the same workplace might reduce, but not eliminate, the risks to nonsmokers. “The right of the smoker to smoke stops at the point where his or her smoking increases the disease risk in those occupying the same environment,” explained the surgeon general. “The data contained in this report lead me to conclude that the simplest, least expensive and most effective way to accomplish this protection is to establish a smoke-free work-site.”52 Koop clearly intended to spur new regulatory efforts at the local and the federal levels.
These reports distinguished between the two sources of environmental tobacco smoke. “Mainstream smoke” was the aerosol mixture inhaled from the cigarette by the smoker, filtered in the lungs, and exhaled into the environment. This smoke mixed with the “sidestream smoke” released directly from the burning end of the cigarette. Both types of smoke were found to contain oxides of nitrogen, nicotine, carbon monoxide, and a number of known carcinogens. “Sidestream smoke” had a higher concentration of carbon monoxide and constituted approximately 85 percent of the nonsmoker’s intake.53 By this time, smoke inhaled by nonsmokers had become a familiar enough concept to acquire an acronym: ETS.
Determining the number of deaths attributable to ETS was critical to the impact of these reports at the policy level. The National Academy of Sciences study estimated that ETS caused between 2,500 and 8,400 lung cancer deaths per year in the United States. Surgeon General Koop placed the number at approximately 3,000.54 These numbers, seized by the media, transformed complex statistical calculations—odds ratios, relative risks, issues of statistical significance, and complex debates about validity and inference—into a basic social truth: passive smoking causes cancer and, ultimately, deaths. Secondhand smoke posed risks not only to vulnerable individuals—those with respiratory and other diseases—but to healthy adults and children as well. The NAS and Koop reports had converted the nuisance of secondhand smoke into a validated risk.
The tobacco companies now updated and intensified their well-tested methods of attacking both scientific procedures and the findings. The industry eagerly sought to link scientific assessments of secondhand smoke to other environmental toxins, especially those about which there was considerable scientific uncertainty. In December 1987, the Executive Committee of the Tobacco Institute discussed a proposal for an industry-based Center for Indoor Air Research, with the understanding that a primary goal would be “to expand interest beyond the misplaced emphasis solely on environmental smoke.” Again, this “expansion” was a familiar strategy to industry executives, who had long insisted that the Tobacco Industry Research Committee maintain a broad focus on disease instead of investigating the risks of smoking.55 As one planning memo suggested:Strategy:1. Mobilize all scientific studies of indoor air quality (i.e., radon, wood stoves, gas stoves, formaldehyde, asbestos, etc.) into a general indictment of the air we breathe indoors. Use a scientific front—especially some liberal Nader group.
2. Use this material to fuel PR offensive on poor indoor air quality.56
This type of diversionary science would be an essential tool in combating the reports of secondhand risk.
The companies reasoned that since few scientists wished to be associated with the industry, they should establish a grant-making institute like the Council for Tobacco Research.57 Founded in March 1988 by Philip Morris, R.J. Reynolds, and Lorillard, the Center for Indoor Air Research (CIAR) was designed to provide counterarguments against the emerging regulatory efforts. The bulk of its peer-reviewed science was unrelated to environmental tobacco smoke and served to divert attention from smoking as a pollutant by centering attention on other indoor air toxins. “To date,” explained William Murray, vice chairman of the board of Philip Morris, “our principal defense has been the position . . . that there are many other things to blame for poor indoor air quality, and tobacco smoke is only a small part of the problem.” He urged that “we must find stronger arguments to support our position on ETS.”58 The research on ETS that CIAR did sponsor, usually funded through a “special review” process, typically confirmed industry positions. In a review of more than one hundred scientific review articles about ETS that appeared between 1980 and 1995, researchers found that 37 percent concluded that ETS was not a risk to human health. Three-quarters of these articles were authored by scientists with ties to the tobacco industry, many through CIAR.59
Many epidemiologists, statisticians, tobacco company publicists, and antitobacco activists vigorously debated the quality and significance of the findings regarding the health impact of passive smoking. Arguing from what they called a perspective of objective science, some pro-tobacco forces suggested that the process of determining the risks of passive smoking had been perverted by an aggressive antitobacco movement offering rhetoric rather than research.60 Dr. Philip Witorsch, a lung specialist at George Washington University Medical School, told a Washington Post reporter that the contribution of ETS to air pollution was “minimal” and “insufficient to produce a pathophysiological effect.” Witorsch’s work had been sponsored by the industry-funded Indoor Air Pollution Advisory Group. Such conflicts of interest eroded the authority of these claims.61 The industry would continue to assert—as it had done for the harms of direct smoking—that passive smoke posed “no proven harm or risk whatsoever.”62 In a press release, the Tobacco Institute protested the Koop report, noting that “the continued propagation of unfounded claims that tobacco compromises—even slightly—the health of nonsmokers will only intensify the current climate of emotionalism and impede the progress of scientific integrity. . . . Most alarmingly, scientific integrity and academic freedom face a serious threat from political pressures being applied by government health officials and otherwise principled scientists.”63 Such statements now only confirmed how profoundly out of touch the tobacco industry had become. By the mid-1980s, as Roper had indicated, few people looked to the tobacco industry as a crusader for scientific integrity.
Changes in the broader culture worked against the companies’ efforts. First, it was no longer possible, as it had been in the 1950s, to denigrate epidemiology and statistics. These elements of medical science had grown to be trusted influences on both public opinion and policy making. Second, the industry’s own loss of credibility—a product of its “skepticism” of scientific findings about the harms of smoking—made the media and the public unwilling to accept industry attacks as scientifically legitimate. The industry would increasingly have to seek third parties and front groups to represent its position even though this, too, was already a familiar gambit. Finally, American society had become far more health-conscious since the 1960s—and more risk averse. The 1980s and 1990s were simply not a good time to urge consumers to tolerate low-dose risks.64 To the contrary, American society became committed both culturally and politically to the identification and removal of even small risks.
The relationship of the epidemiologic and toxicologic data to regulatory politics is best understood as a complex dialectical process. Given that no scientific study is ever final—there is always some uncertainty—the question always comes down to what level of risk merits what level of intervention. Thus, the social process of identifying and regulating risk, though ultimately resting on scientific discourse, was powerfully influenced by a range of social and moral factors that mobilized the public health and antitobacco movement. Determining the risks of secondhand smoke was not like evaluating the causal relationship between smoking and disease for smokers themselves. In a society deeply concerned about imposed risks, how conclusive did the data about ETS need to be? In an atmosphere of rising concern about environmental contaminants and especially carcinogens, how long would local governments and businesses wait to regulate public smoking, especially in instances where they might possess liability?65 How good did the data need to be when many businesses perceived that regulating smoking could bring significant cost savings, and when
social conventions were already moving quickly to stigmatize smokers as irrational, dirty, and self-destructive? How persuasive did the data on passive smoking need to be, when the harms that were identified were typically inflicted on “nonconsenting, innocent victims”? Early regulatory initiatives drove the research agenda. In turn, research results—though preliminary—drove the regulatory process. The surgeon general’s 1986 report and the NAS report added legitimacy to a social movement and regulatory agenda that already possessed considerable momentum.
In the case of passive smoke, risk and nuisance were deeply entangled. Even those who questioned the scientific data indicating the measurable risks of secondhand smoke found it hard to assert that smoking could not be restricted simply because nonsmokers found it to be irritating and bothersome. As the tobacco industry and its patrons came to learn, there was no inalienable right to smoke in public. The very practice of public smoking. which the industry had worked so assiduously to secure in the early part of the twentieth century, was a contingent cultural norm that was now decidedly reversed by a combination of cultural, scientific, and political factors. The public did not need “proof ” that passive smoke could cause lung cancer to decide that it wanted smoke-free workplaces, restaurants, and transportation. The cigarette had little standing in a health-conscious culture, increasingly skeptical of an industry whose self-interest had long since been exposed.
By the late 1980s, the tobacco companies recognized that secondhand smoke posed a potentially life-threatening risk—to the industry. As John Rupp, a lawyer at Covington & Burling working on tobacco accounts, put it, “we are in deep shit.” Rupp was speaking at a 1987 conference for Philip Morris’s Project Down Under, organized to devise new strategies to address the threat.66 Attendees continued to hope for ways to upend the research implicating secondhand smoke as a serious health risk. Minutes from the meeting reported, “A scientific battle was lost with the Surgeon General’s ’86 Report. Is there any way of showing the Surgeon General is wrong?”67 Even as the gathered executives recognized that they were losing the battle of public perceptions, they understood that they still had considerable advantages in resources and power. One theme discussed at the conference was “Make It Hurt.” “Let pols know down side of anti activity,” noted the conference minutes. “To do this, we take on vulnerable candidate, beat him/her, let people know we did it.”68
At a brainstorming session, the Philip Morris executives came up with more than one hundred “solutions to the problem.” These ranged from “create a bigger monster (AIDS)” to “undermine Koop et al.”69 Even as they agreed to attack the science of passive risk, those gathered understood the essential dilemma in constructing their defense: “We’ve got to get people on the street, but we are constrained because we can’t say it’s ‘safe.’”70 Notes from the meeting concluded, “ETS issue will have devastating effect on sales” and predicted that “we are just at the beginning of impact of ETS issue.”71
Industry executives and lawyers at the meeting, aware that their adversaries in the tobacco wars had again successfully seized the science, complained that “what created [negative] perceptions is their science.”72 Nonetheless, the industry sought to regain control of this aspect of the debate. Regarding risks to smokers, the industry had come to rely on proclamations of “not proven.” With ETS, they understood that promoting scientific uncertainty was unlikely to stem the growing demand for regulatory action. Individual smokers might well decide to continue if the risks were “not proven.” But such a stance was a weak and meaningless promise to nonsmokers, on whom such risks (even if small and uncertain) were imposed. Even internal industry reviews apparently confirmed the risks.73 At the same time, throughout the debates about ETS, the industry continued to deny that direct smoking had been proven harmful to smokers, while carefully avoiding any definitive assurances to the contrary. Locked into this position by ongoing fears of litigation, the industry had lost much of its scientific credibility. Now, executives worried that contesting the harms of secondhand smoke too strongly could be perceived as an acknowledgment that smoking was dangerous for smokers. “Pervasive fear,” noted the conference minutes, “that if you fight too hard on ETS, it means conceding the primary issue.”74
In the fight against public restrictions on smoking, the companies worked to initiate and support grassroots campaigns on behalf of “smokers’ rights.”75 The tobacco industry was quick to point to such restrictions as “an intrusion into the businessman’s and the individual’s rights.”76 “Our concern,” explained Walker Merryman of the Tobacco Institute, “is what this portends for society and business, for governmental bodies to be regulating public behavior.” He explicitly evoked images of the civil rights movement. “It is dangerous when you try to paint our members as social pariahs and to make 60 to 80 million smoking Americans second class citizens. We already sit in the back of the plane and the bus.”77
In an effort to recruit smokers to defend their rights, the industry eagerly sought to portray restrictions on smoking as the beginning of a massive government intrusion into citizens’ personal behavior. Stanley S. Scott, vice president and director of corporate affairs for Philip Morris, offered an ominous vision of the slippery slope ahead:The basic freedoms of more than 50 million American smokers are at risk today. Tomorrow, who knows what personal behavior will become socially unacceptable, subject to restrictive laws and public ridicule? . . . Could travel by private car make the social engineers’ hot list because it is less safe than public transit? Could ice cream, cake and cookies become socially unacceptable because their consumption causes obesity? What about sky-diving, mountain climbing, skiing and contact sports? How far will we allow this to spread?
Scott sought to place smokers’ rights in the hallowed tradition of American social movements to secure basic freedoms:The question all Americans must ask themselves is: can a nation that has struggled so valiantly to eliminate bias based on race, religion and sex afford to allow a fresh set of categories to encourage new forms of hostility between large groups of citizens? . . . After all, discrimination is discrimination, no matter what it is based on.78
Cigarettes now came wrapped in the First Amendment. Philip Morris sponsored a nationwide essay contest on free speech, publishing the winning entries in a volume called American Voices.79 This contest did not go unnoticed by the other side in the tobacco wars. In a striking example of antitobacco guerilla tactics, a small group known as Doctors Ought to Care, founded by activist physician Alan Blum, sponsored a competing contest on the question “Are tobacco company executives criminally liable for the deaths, diseases, and fires that their products cause?” Although Blum could not match the industry’s resources to advertise his contest, he nonetheless drew media attention for spoofing the companies’ campaign.80
In the tobacco wars, it was now hand-to-hand combat. Each new incursion was met with a counteroffensive. Philip Morris decided, for example, to mount a campaign in response to the American Cancer Society’s Great American Smokeout, an annual educational effort in which smokers were encouraged to quit. So the company offered a Great American Smoker’s Kit, complete with a lapel pin and a sign to hang on a doorknob announcing, “Great American Smoker at work.” “We hope you will find the Great American Smoker’s Kit useful and enjoyable,” explained the accompanying pamphlet. “We understand the kinds of pressures you may face from friends and coworkers. Their efforts are well-meaning, but they can be intrusive and some may even be aggressive.” The pamphlet concluded, “Above all, if you’ve chosen to smoke, help them understand it is your right to choose.”81 Philip Morris also offered a Bill of Rights for smoking:As a smoker, I am entitled to certain inalienable rights, among them:The right to the pursuit of happiness;
The right to choose to smoke;
The right to enjoy a traditional American custom;
The right to be treated courteously;
The right to accommodation in the workplace;
The right to acc
ommodation in public places;
The right to unrestricted access to commercial information about products;
The right to purchase products without excessive taxation;
The right to freedom from unnecessary government intrusion.82
Along with other companies, Philip Morris helped fund the National Smokers’ Alliance (NSA), a “grassroots” organization created with the assistance of the PR firm Burson-Marsteller to advocate smokers’ rights and oppose smoking restrictions. Claiming some three million members, NSA sought to promote a pro-smoking agenda “unlinked” to the industry. But it soon became clear that NSA was a front for industry interests.83
Although the industry never generated a true popular coalition of smokers eager to come to its defense, it did successfully exploit themes of personal freedoms in its efforts to fight more restrictive state and local legislation. For example, civil liberties groups and labor unions—hardly traditional allies—supported antidiscrimination provisions to protect workers who smoked during nonbusiness hours.84 Generating enthusiasm for smokers’ rights proved difficult when the vast majority of smokers were already deeply ambivalent about their own habit. Most polls indicated that most smokers wanted to quit.85 “Smokers are not easily allied. They are defensive, and many would like to quit,” noted an industry assessment.86 They were hardly likely to insist on smoking as an “inalienable” right.