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Confidential Prepared for Litigation Draft I December Ii, 1989 CIGARETTE SMOKING AND HEALTH RISKS: FOUR CENTURIES OF INFORMATION AND PUBLIC AWARENESS Everyone has heard about the alleged risks of smoking. Indeed, no consumer product ever marketed has been surrounded by more information regarding its potential health hazards. The public has received this information through every conceivable medium including radio, television, movies, newspapers, magazines, books, sermons, pamphlets, lectures and brochures, as well as through advice and word-of-mouth communications from physicians, teachers, coaches, parents and others. Smoking and health issues have been part of health education programs in virtually every state since the early 1900s and the subject of a wide variety of programs conducted by various educational, social, medical, political and other groups. Early Warnings The dissemination of anti-smoking information is anything but a recent phenomenon. Indeed, claims of health risks associated with smoking date back more than 350 years. As long ago as 1604, England's King James I issued his Counterblaste to Tobacco, denouncing smoking as "a custom loathsome to the eye, hateful to the nose, harmful to the brain, dangerous to the lungs . . ." (more)

-2- From the late 1800's to the present, the United States has witnessed a vocal revival of King James' opinion on smoking. Numerous well-organized groups -- armed with pamphlets, school programs, films, demonstrations, posters, no-smoking pledge cards and the like -- orchestrated zealous campaigns against the use of tobacco in general and cigarettes in particular. Organizations such as the Women's Christian Temperance Union, the Anti-Cigarette League, the International Boys & Girls Anti-Cigarette League, the Life Extension Institute, the Non-Smokers Protective League, the Clean Life Army, and the No-Tobacco Army were formed for the express purpose of combating tobacco use. Such diverse religious organizations as the American Society of Friends (Quakers), the Methodist Church, Baptists, Mormons, YMCA, Salvation Army, Seventh Day Adventists, and the Presbyterian Board of Temperance waged vigorous anti-smoking campaigns as part of their overall mission. Their efforts were complemented by anti-smoking crusades undertaken by a host of civic and education groups including PTA's, the National Education Association, the Boy Scouts and the Girl Scouts. In addition to the many anti-smoking groups who campaigned against the use of tobacco, a variety of colorful and prominent individuals participated in the movement. For example, Lucy Page Gaston, a former Illinois school teacher and founder of the International Anti-Cigarette League, sought the Republican nomination for President in 1920 on an anti-tobacco platform. Dr. John Harvey Kellog of Battle Creek, publisher of Good Health magazine, utilized his publication as a vehicle for spreading his fervent anti-smoking message. Other well-known individuals who campaigned vigorously against smoking included automobile (more)

-3- magnate Henry Ford, baseball great Ty Cobb, boxers Jack Dempsey and Gene Tunney, and inventor Thomas Edison. The Warnings Continue In more recent times, the anti-smoking message has been spread primarily through the popular press. The Reader's Divest, one of the most widely-read magazines in the world, has been front and center in this movement. As long ago as 1924, the editors of that publication embarked on a campaign to alert the public to the presumed dangers of smoking with an article entitled "Does Tobacco Injure the Human Body?" During the 1950's the campaign intensified. For example, "Cancer by the Carton," an article published in 1952, linked the reported increase in the incidence of lung cancer to an increase in cigarette consumption. An article published in August 1957, "Wanted - And Available - Filter-Tips That Really Filter," has been credited with the tremendous growth in the sales of filter tip cigarettes. The six-decade old Reader's Digest campaign, which both urges smoking cessation and provides advice on how to quit, continues to this day. In addition to the Reader's Digest, other widely-circulated magazines -- including Time, Newsweek, Good Housekeeping, and Consumer Reports -- closely tracked new events in the smoking and health controversy. For example, the February 26, 1954 issue of U.S. News and World Report ran as its cover story an article entitled, "Is There Proof Smoking Causes Cancer?" This 10-page article contained an in-depth interview with Dr. E. Cuyler Hammond, then Director of Research for the American Cancer Society, and outlined the (more)

-4- steps the ACS was taking to determine if smoking was causally-related to lung cancer. In the decade following publication of that interview, U.S. News ran at least 18 follow-up articles. During the past two decades, the publicity attending claims of chronic disease hazards said to be associated with smoking has intensified. For example, there was widespread publicity -- not only in the national media, but also in "hometown" newspapers and magazines -- concerning the 1964 Report of The Advisory Committee to the Surgeon General and subsequent, similar reports about smoking. In addition, for more than 20 years smokers have been constantly and repeatedly informed of the health risks attributed to smoking through the warnings required on cigarette packages and in cigarette advertising by federal law. The Message Was Heard The numerous activities undertaken by anti-smoking groups, with the attendant widespread publicity, have not gone unnoticed. To the contrary, the message has been recognized and accepted by the American public. For example, in response to intense lobbying efforts by anti-smoking organizations, 15 states banned the sale of cigarettes for various periods between 1895 and 1927. While these prohibitions were eventually repealed, virtually every state retained some legislative restrictions on the sale of tobacco, especially to minors. In addition, many states have required instruction on tobacco use as part of the standard elementary and/or high school curriculum since the early 1900's. (more)

-5- Awareness of the risks of smoking is also reflected in the many epithets which have been coined to describe cigarettes. The term "coffin nails," for example, can be traced back to 1886. Terms such as "cancer stick," "poison sausage," "little white slaver," "smoker's cough," and "nicotine fit" are also firmly established in the folklore of this country. Perhaps the most direct evidence that the message has been heard is found in the results of public opinion polls on smoking and health issues. The earliest scientifically- designed polls were conducted during the late 1940s and showed that the public was well aware of the alleged hazards of smoking. According to a 1949 Gallup poll, for instance, more than half of all cigarette smokers believed that smoking was harmful to their health. In 1954 -- the year in which the American Cancer Society for the first time "cautiously" voiced its "suspicion" that cigarette smoking had something to do with lung cancer "to a degree as yet undetermined" -- a poll showed that almost 90 percent of the public had recently heard that cigarette smoking causes lung cancer. This high level of awareness continues into the present day. For example, a 1987 Gallup poll sponsored by the American Lung Association found that 94 percent of the public agreed that smoking is harmful to one's health. In 1986, the Roper Organization issued a report that found 99 percent of the public think that smoking cigarettes presents a risk to a person's health. These and other surveys confirm the blunt observation of a close neighbor of a smoker involved in a tobacco liability case who testified that "you would have to live in a cave" to avoid hearing claims of health risks associated with smoking. That statement applies to anyone living in the civilized world during the last 400 years. To believe otherwise is quite simply a denial of historical fact. To be sure, many people may have disagreed with various health risk allegations or have chosen to continue smoking, but no one could have escaped them.