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A SMOKING GUN: HOW THE TOBACCO INDUSTRY GETS AWAY WITH MURDER Elizabeth M. Whelan, Sc.D., M.P.H. Executive Director American Council on Science and Health A People's Health Library Book Edited by Stephen Barrett, M.D. George E Stickley Co. 210 West Washington Square Philadelphia, PA 19106

I OTHER BOOKS BY ELIZABETH M. WHELAN The 100% Natural, Purely Organic, Cholesterol-Free, Megavitamin, Low-Carbohydrate Nutrition Hoax (with EJ. Stare, M.D.) 1983 Nutrition During Pregnancy • 1982 The Expectant Parents" Survival Guide 1982 The Pregnancy Experience 1978 Eat OK J Feel OK (with EJ. Stare, M.D.) 1978 Preventing Cancer. What You Can Do to Reduce Your Risks by Up to 50% 1978 Boy or Gift? 1977 A Baby?... Maybe 1975 Panic in the Pantry: Food Facts, Fads and Fallacies (with EJ. Stare, M.D.) 1975 Making Sense Out of Sex (with S.T. Whelan, M.D.) 1975 Sex and Sensibility 1974 I

The People's Health Library is a series of easy-to-read books written by experts who explain health and health care concepts for the general public. For a complete list of titles, send a self-addressed, stamped envelope to the George E Stickley Company, 210 West Washington Square, Philadelphia, PA 19106. Fore,~ Prefa, Copyright © 1984 by Elizabeth Whelan ISBN-0-89313-039-7 Library of Congress Card 84-050685 All Rights reserved. No part of this book may be reProduced or used in any form or by any means--graph.ic,~lectronie, or mechanical, including photocopying, recording, taping, or information storage and retrieval systems--without permission from the publisher. Manufactured in the United States of America; Published by the George E Stickley Company, 210 W. Washington Square, Philadelphia, PA'I9106 APP APP APP IND

Contents Foreword by Luther L. Terry, M.D. Preface PART I: AN AMERICAN TRAGEDY 1. The paradox of cigarettes in the health-conscious '80s 2. Tobacco or health: the risks of smoking 3. Fourteen ploys that can kill you PART u: A BACKWARD GLANCE 4. In the beginning, there were no cigarettes 5. A triumph of American ingenuity 6. When Camels became kings 7. The cigarette hit parade: 1920-1940 8. Luckies go to war 9. The evidence mounts I0. The saga of the '60s 11. Showdown in Marlboro country 12. ,lop Califano and the politics of smoking in the '70s 13. Is there a safe tobacco product? PART Ill: MANDATES FOR ACTION 14. Reflections on a burning issue 15. Smokers should carry their load 16. "Sue the bastards!" 17. Exploitation of de~;eloping countries should be ended 18. Cigarette advertising shonld be stopped 19. Nonsmokers should be protected 20. The smokescreen must be lifted 21. Smoking cessation: an overview APPENDIX A. Tobacco's industrial network APPENDIX B. Helpful organizations APPENDIX C. Recommended reading INDEX ix Xlll 1 9 15 28 40 47 56 72 81 97 109 120 133 141 146 154 166 177 191 201 212 225 228 230 234

About the Author Dr. Elizabeth M. Whelan is co-founder and Executive Director of the American Council on Science and Health, a New York-based not-for- profit, tax exempt consumer education group directed by a panel of some 100 American physicians and other scientists. Dr. Whelan is a graduate of Connecticut College, received a Master's degree from the Yale School of Medicine, and Master's and Doctoral degrees from the Harvard School of Public Health. She is a frequent contributor to both popular and profes- sional publications and one of the nation's leading proponents of the question "smoking or healthT" She is married to attorney Stephen T. Whelan; they and their daughter, Christine, live in Manhattan. About the Editor Stephen Barrett, M.D.~ a practicing psychiatrist and lecturer on con- sumer health, is author/editor of 16 books, including The Health Robbers (a comprehensive expos~ of quackery~ Vitamins and "Health" Foodsm The Great American Hustle, and the college textbook Consumer Health--A Guide to Intelligent Decisions. An expert in medical com- munications, he is Editor of Nutrition Forum newsletter and is a scientific and editorial advisor to the American Council on Science and Health. vi I As en0 of ab, Ar im W~ an

Acknowledgments First and foremost, I would like to thank Dr. Paul Magnus, Medical Associate at the National Office of Heart Research in Australia, for his encouragement and cdticismmand for providing access to his extensive research materials on smoking and health. Dr, Magnus is one of a very small number of individuals who have focused in depth on the magnitude of the health chaos caused by cigarettes and are dedicated to speaking out • about it. Thanks are due to Cathy Becker Popescu, Research Associate at the American Council on Science and Health, for the sometimes tedious library research for this work and for her major contribution to the chap- ters of this book dealing with litigation, nonsmokers' fights, the economic impact of cigarette smoking, and the tragedy of cigarettes in the Third World. Lee Francis and Cheryl Martin helped greatly with their research and typing efforts. And Dr. Stephen Barrett did a superb job of editing the manuscript on his legendary IBM word processor. I am also indebted to Federal Trade Commissioner Michael Pertshuk; William Rothbard, FTC Attorney Advisor;, John M. Pinney, President of John M. Pinney Associates and former Director of the U.S. Office of Smoking and Health; Donald Shopland, Technical Information Officer for the U.S. Office of Smoking and Health; John Banzhaf, Executive Director of Action on Smoking and Health; Elizabeth Fayad, Associate Director of the Coalition for Smoking or Health; Matt Myers, StaffDirec- tot of the Coalition for Smoking or Health; Dr. Marvin Kristein, Con- maltant in Health Economies at the American Health Foundation; Steve Wieckert, Legislative Aide to Congressman Thomas Petri; Dr. Mike Daub, Department of Community Medicine, Edinburgh University;, and A. Lee Fritschler, Director of the Advanced Study Program at the Brook- ings Institution and author of Smoking and Politics. , A special acknowledgment is due to Martha Lindsey, who typed the many drafts of this book and became committed to the need to alert Americans to the health disaster called the cigarette. Finally, I heap thanks and praise on my husband Steve Whelan who read each draft of this book, and to my 6-year-old daughter Christine who patiently awaited my emergence from the "writing room" during the

viii Acknowledgments summers of 1982 and 1983. I knew that she too was immersed in the subject matter when, in the course of my research, my great aunt died in her mid-80s and Christine asked, "Did Aunt Mary smoke?" When I told her Aunt Mary did not smoke, her puzzled response was "Well, then, why did she die7" ho Ot of OV p~ fo

Foreword When I was appointed U.S. Surgeon General in 1961, like some 50 percent of American men, I was a smoker. Unlike most Americans, however, I was aware of the dangers of smoking even before I took it up. One of my professors in medical school had been Dr. Alton Ochsner, one of the first scientists to investigate the relationship between cigarette smoking and lung cancer. Nevertheless, during my residency training, I somehow slipped into the smoking habit. Despite my knowledge, I continued to smoke for many years without making a serious attempt to quit, Like many other smokers, I was phys- ically and psychologically dependent upon cigarettes and found it easier to suppress my knowledge rather than give them up. As Surgeon General, however, I felt that continuing to smoke would do more than endanger my own health. Since I was a "role model," my smoking would jeopardize the health of millions of other Americans. It was difficult, but I finally gave up cigarettes around the time that President Kennedy asked me to appoint an expert advisory committee to resolve the "smoking and health question." I tried switching to a pipe, but soon found that I was smoking it in much the same manner as ciga- rettes-so I stopped altogether- The advisory committee met for the first time in November, 1962. They met in secret, but there was no doubt about the conelusion they would reach.because the scientific evidence against cigarettes was by that time overwhelming. Their verdict was announced on Januat3, 11, 1964. On that day, the committee members and I sat on a platform in the State Depart- ment auditorium and confronted reporters with the grim news ihat smok- ing was a primary cause of lung cancer, was overwhelmingly associated with emphysema, chronic bronchitis and cardiovascular disease, and was a major factor in premature death. That evening there was camera coverage of our report on every televi- sion outlet, and the next morning, there was front page coverage in every newspaper in the country. During the next several weeks, millions of people gave up smoking. Sales dropped. And we were jubilant! As sensible physicians, public health officers, educators and scientists, we imagined for a moment that we had "conquered" cigarette smoking.

We were wrong. Not altogether wrong, but mostly wrong. Within a few months, millions of those who quit began to smoke again. During the 20 years which have passed, the prevalence of smoking has edged ~lownward, and we can be thankful for that. But some 56 million Americans still smoke over 600 billion cigarettes every year. And morn than 350,000 Americans die prematurely each year as a result. We were unduly hopeful in 1964 for several reasons. • We vastly underestimated the dependency factor involved in cigarette smoking. Our 1964 report called smoking a "habit" and said that smokng is compulsive with some smokers. Today, we know that cigarette smoking is compulsive for many if not most smokers. Smoking is unquestionably a form of drug addiction just like heroin use. YeL while possession and selling of heroin is a felony, we allow cigarettes to be passed out on the street and advertised in newspapers, magazine.s and billboards. • We also underestimated the capacity which humans have for ignoring and denying unpleasant information. Although surveys.indicate that 90 percent of Americans know that cigarette smoking is hazardous, many are only vaguely aware of the magnitude and spe.~ifics of the risks involved. Every day, smokers are inundated with cigarette ads which suggest that lots of healthy, young, good-looking people smoke. Rarely do they come across information on smoking's dangers. Thus, it is relatively easy for most smokers to ignore the truth. • We overlooked another thing in our innocence in 1964: the economic cIout of the tobacco industry. Our earlier battle to eliminate polio had been extremely successful, and we expected similar success with cigarette smoking. But there had been no mighty industry nurturing and promot- ing the polio virus! Tobacco is grown in 22 states and is our sixth largest cash crop. Moreover, a complex network extends the chain of economic dependence to a broad spectrum of other industries. The tobacco industry carries a great deal of weight in business and legislative circles. • Finally, we overlooked our greatest ally in combatting the cigarette industry: the large numbers of Americans who didn't smoke. In 1964, there were 115 million adults--and 68 million (59 percent) of them did not smoke cigarettes. The percentage of nonsmokers has grown so that today, 67 percent of American adults--108 million people--are nonsmokers. It never occurred to the authors of the 1964 report to consider the discomfort, annoyance and the actual physical harm which smoking causes nonsmokers. The 1972 Surgeon General's report was th~ first to review the health effects of "involuntary smoking," but the subject has still not been studied sufficiently. In recent years, there has been increasing awareness of the problems caused by "second-hand smoke." We are finally beginning to get responsi- ble and sensible no-smoking policies for public areas and places of em- ploy into ~CO0 tinui L¢ Alth who now victc W~ do tl Sma "bin econ powe It indu: will e the c Dr. 7 sity ~ Pubh

ployment. Aside from protecting nonsmokers, perhaps the greatest value of these policies is their message that smoking should no longer be socially acceptable. As smokers are increasingly asked to refrain or are segregated into smoking sections, young people will be less likely to think smoking is "cool:' Smokers, too, may be forced to re-evaluate the wisdom of con- tinuing their habit. Looking back over the past two decades, there is much good news. Although 55 million Americans continue to smoke, 34 million others who used to smoke have given it up. Per capita cigarette consumption is now at its lowest level in over 30 years. We can also cheer at some recent victories in establishing reasonable no-smoking policies. We must now devise ways to continue and accelerate this progress. To do this, we must first know what we are up against. This is where A Smoking Gun comes in. Examining the history of the cigarette from its "birth" in 1884 to the present time, Dr. Whelan explores the political, economic and social forces which have made the tobacco industry so powerful--and smoking our leading cause of premature death. I hope this book makes you angry as it describes how the tobacco industry has been hurting you--whether or not you are a smoker. I hopeit will also inspire you to take action against our number one health enemy: the cigarette. Luther L. Terry, M.D. Dr. Terry, who is Emeritus Professor of Research Medicine at the Univer- sity of Pennsylvania School of Medicine, was Surgeon General of the U.S. Public Health Service from 1961 to 1965.