The Cigarette Century Read online

  Table of Contents

  Praise

  Title Page

  Dedication

  Introduction

  I - CULTURE

  CHAPTER 1 - Pro Bono Publico

  CHAPTER 2 - Tobacco as Much as Bullets

  CHAPTER 3 - Engineering Consent

  II - SCIENCE

  CHAPTER 4 - More Doctors Smoke Camels

  CHAPTER 5 - The Causal Conundrum

  CHAPTER 6 - Constructing Controversy

  III - POLITICS

  CHAPTER 7 - The Surgeon General Has Determined

  CHAPTER 8 - Congress: The Best Filter Yet

  CHAPTER 9 - Your Cigarette Is Killing Me

  IV - LAW

  CHAPTER 10 - Nicotine Is the Product

  CHAPTER 11 - Mr. Butts Goes to Washington

  CHAPTER 12 - The Trials of Big Tobacco

  V - GLOBALIZATION

  CHAPTER 13 - Exporting an Epidemic

  Epilogue

  REFERENCES

  NOTE ON SOURCES

  Acknowledgements

  INDEX

  Copyright Page

  Praise for The Cigarette Century

  “Brandt the historian shines in this tome. The research is thorough; his assertions are meticulously documented.”

  —Charlotte Observer

  “Brandt’s admirable skills as a researcher and analyst are in full flower here.”

  —New York Times Book Review

  “I can’t remember the last time I read a more scathing indictment of corporate malfeasance.”

  —Washington Post

  “The most comprehensive account [of tobacco historiography] to date.”

  —Science

  “[A] superb book. . . . Brandt took his time to get it right, and the end result is a masterful account of what he calls the cigarette century.”

  —New England Journal of Medicine

  “Brandt has an acute eye for the larger cultural and institutional dimensions of the tobacco narrative. . . . The Cigarette Century is thus a thought-provoking account of tobacco as a key defining constituent of life in America over the course of the 20th century.”

  —American Scientist

  “Brandt is a Harvard professor of medical history with a long title, a hawk eye for detail and an avenging spirit.”

  —Bloomberg News Wire

  “[A] detailed, illuminating book . . . But if the companies sometimes seemed to be getting away with murder in the courts, they don’t get away with it in Brandt’s book, which painstakingly documents this depressing sideshow in American corporate history.”

  —New York Review of Books

  “Highly readable, exhaustively researched . . . fascinating (and shocking).”

  —Publishers Weekly

  “In this smoke-filled room of a book, full of secrets and closed files, medical historian and expert witness Brandt reveals just what Big Tobacco has wrought in the last 125 years.”

  —Kirkus

  “[T]he revelations come thick and fast . . . an exhaustive and highly entertaining take.”

  —The New York Post

  “Brandt makes an important contribution to the field of public history as well as to medical and scientific debates.”

  —American Historical Review

  “Brandt makes it maddeningly clear that the industry knew that its products might be dangerous from about 1950 on, but did a bang-up job of obfuscating the risks.”

  —The Week

  “At 600 pages, it’s an academically rigorous indictment of the industry, its deceptive practices and its devastating impact on public health. But the book is also, in parts, surprisingly fun.”

  —Newsweek.com

  “[A] meticulously researched and passionately argued history of smoking in America . . . impressive command of the vast tobacco archive . . . Brandt is massively persuasive in representing the risks that cigarettes and tobacco pose to public health.”

  —Slate

  “Allan Brandt’s long-awaited history of the cigarette in America uncovers the extraordinary lengths to which the tobacco industry has gone to hide the health consequences of smoking. Thoroughly researched and engagingly written, The Cigarette Century is destined to become a classic.”

  —Randall M. Packard, William H. Welch Professor of the History of Medicine, Johns Hopkins University

  “A thought-provoking, unbelievable story about the long and arduous road to the truth: Tobacco is a dire threat to humanity.”

  —Gro Harlem Brundtland, Former Director-General of the World Health Organization and Former Prime Minister of Norway

  “This is the story of how greed and self-interest perverted industry, science, and politics to create and prolong an enormous man-made epidemic. It is a fascinating piece of American history, prodigious in its research and a pleasure to read. Like all good history books, it has resonance today.”

  —Tracy Kidder, author of Mountains Beyond Mountains and a recipient of the Pulitzer Prize and the National Book Award

  “The Cigarette Century is a brilliant history of America’s struggle with cigarettes and with the tobacco industry. It should help to prepare the next generation of public health leaders to deal not only with tobacco but with other threats to human health as well.”

  —Dr. David Satcher, 16th U. S. Surgeon General

  “A masterful analysis of the rise and fall of Joe Camel’s industry by

  America’s leading historian of public health. Brandt has produced another

  classic, illuminating an iconic piece of US history in a gripping narrative.

  The Cigarette Century is a story about corporate power, health citizenship

  and institutions of governance but ultimately it is a tale of lost innocence

  about what it meant to be cool in American culture.”

  —Dorothy Porter PhD, Chair,

  Department of Anthropology, History and Social Medicine,

  University of California at San Francisco

  “Allan Brandt has vividly illustrated how the interaction of culture, biology and disease brought about a pandemic that will result in one billion smoking-related deaths the world over during the 21st century. A must read.”

  —Michael Merson, MD, Director, Global Health Institute, Duke University

  “For decades tobacco companies have killed more Americans than all the armies, terrorists, and criminals combined. In this morally revolting story, Allan Brandt exposes the biggest public-health scandal of the past century. His passionate though evenhanded history is destined to become a classic.”

  —Ronald L. Numbers, Hilldale Professor of the History of Science and Medicine at the University of Wisconsin

  “The Cigarette Century presents a sordid history of the most duplicitous industry of our time. Allan Brandt documents a consistent pattern of deception, intimidation, and fraud extending over a five decade span. If you don’t feel outraged after reading this important book, you are an even cooler customer than Joe Camel.”

  —Dr. Steve Schroeder, Professor UCSF School of Medicine and former President of the Robert Wood Johnson Foundation

  “A well-written exposé of the reality that cigarette companies and their executives neither die, nor fade away. Only their customers do.”

  —Joseph A. Califano, Jr., Chairman and President of

  The National Center on Addiction and Substance Abuse (CASA)

  at Columbia University and former Secretary of Health,

  Education and Welfare

  “A brave book . . . The reader is in the hands of a master.”

  —Jordan Goodman, Welcome Trust Centre for the History of Medicine at University College London

  For Shelly,

  Daniel and Jacob


  To the Princess, it was an enigma why anyone would smoke, yet the answer seems simple enough when we station ourselves at that profound interface of nature and culture formed when people take something from the natural world and incorporate it into their bodies.

  Three of the four elements are shared by all creatures, but fire was a gift to humans alone. Smoking cigarettes is as intimate as we can become with fire without immediate excruciation. Every smoker is an embodiment of Prometheus, stealing fire from the gods and bringing it on back home. We smoke to capture the power of the sun, to pacify Hell, to identify with the primordial spark, to feed on the marrow of the volcano. It’s not the tobacco we’re after but the fire. When we smoke, we are performing a version of the fire dance, a ritual as ancient as lightning.

  Does that mean that chain smokers are religious fanatics? You must admit there’s a similarity.

  The lung of the smoker is a naked virgin thrown as a sacrifice into the godfire.

  TOM ROBBINS, STILL LIFE WITH

  WOODPECKER, 1980

  Introduction

  The Camel Man and Me

  IN 1961, WHEN I was seven years old, my parents took me to New York City for the first time. In this, my introduction to the city’s many sights and attractions, nothing elicited my attention and fascination more than the famous Camel billboard looming above Times Square. The Camel Man blew endless perfect smoke rings into the neon-lit night sky. I was quite simply amazed. The sheer size of the display, the wafting of the smoke, and the commercial tumult left me in a state of awe. Certainly, I was already aware from my parents’ warnings that smoking was “bad for you.” Perhaps this threat was yet another reason why the Camel sign held my attention in ways that the art at the Metropolitan Museum could not. Someday maybe I would blow giant smoke rings. Not.

  The Camel Man had gone into operation to great fanfare just days after Pearl Harbor, on December 11, 1941. The brainchild of billboard designer extraordinaire Douglas Leigh, the sign was located above the Hotel Claridge at Forty-Fourth Street and Broadway. At the time of its construction, the billboard cost some $35,000, and Reynolds paid nearly $10,000 a month to rent the space from Leigh. He designed the sign and invented the steam machine that would metronomically expel fifteen rings per minute, each two feet in diameter. Among other accomplishments, Leigh would also design in Times Square a steaming coffee cup for an A&P billboard and a block-long waterfall on a Pepsi-Cola billboard, as well as the lights that topped the Empire State Building. Widely recognized as the greatest billboard impresario of the twentieth century, Leigh rejected the common term billboard; he was constructing spectaculars.1 At seven, I could attest to Leigh’s success.

  Here, at the crossroads of the world, the Camel billboard signified the triumph of the cigarette in the mid-twentieth century as well as the success of modern American marketing and commerce. In 1941, cigarette use was on a steeply rising trajectory, a behavior with almost universal acceptance and appeal. The Camel Man, confidently blowing his perfect rings into the Great White Way, marked just how far the cigarette had come in a relatively short span of time. At this American center of sales, shows, and sex, the Camel Man performed for the multitudes below. During the war, he was typically found in uniform (Navy, Army, Marines). Even when the Times Square lights went down in a blackout during the war, he continued to smoke.2 He returned to civilian life following the war, often appearing in boating garb. During my visit in 1961, he appeared in uniform again, this time as a football player. No doubt, such powerful male icons had particular appeal to seven-year-old boys.

  The Camel Man had earned his dominating view of Times Square through determination, hard work, and brilliant innovation in marketing and promotion. As recently as 1900, the cigarette had been a stigmatized and little-used product constituting a small minority of the tobacco consumed in the United States. Its rise to cultural dominance by mid-century marked a remarkable historical shift that brought together developments in business organization and consumer behavior as well as deeper changes in the morals and mores of American society. The movement of the cigarette from the periphery of cultural practice to its center encompassed critical innovations in production technologies, advertising, design, and social behaviors. The tobacco industry both utilized and helped to foment deeper changes in the culture that served to promote cigarette use. The ability of the industry to both read and shape the emergence of these new cultural forces was striking, and it distinguishes the cigarette as the prototypical—indeed emblematic—product of the century. The cigarette came to be a central symbol of attractiveness, beauty, and power. This transformation engaged social values about pleasure, leisure, sexuality, and gender.

  But the cigarette’s iconic position in the consumer culture represents only one prong of its historical significance. Indeed, there are few elements of American life in the last century that examining the cigarette leaves unexposed. It seems striking that a product of such little utility, ephemeral in its very nature, could be such an encompassing vehicle for understanding the past. But the cigarette permeates twentieth-century America as smoke fills an enclosed room. There are few, if any, central aspects of American society that are truly smoke-free in the last century. This book centers attention on how the cigarette deeply penetrated American culture. We have witnessed the remarkable success of smoking as a social convention, as well as its ignominious demise. These shifts in cultural meanings and practices have profoundly altered patterns of human health and disease through the twentieth century. As a result, this book attempts to link meaning to materiality. The cigarette fundamentally demonstrates the historical interplay of culture, biology, and disease. As we now know, the rise of the cigarette was sustained not only by convention and personal psychology, but by the powerfully addictive properties of the nicotine in tobacco. The Camel Man was the ultimate chain-smoker.

  As I followed his circular exhalations into the night sky, medical science had only recently, in the previous decades, attained a fundamental determination of the often deadly harms smoking posed for health. The cigarette had drawn fire from critics ever since its popular introduction in the nineteenth century, with many of those opposed to smoking having voiced important health concerns. The medical literature of the late nineteenth and early twentieth centuries is replete with testimony to the multiple perils of tobacco. Nonetheless, the cigarette had largely trumped these objections by the 1930s as it became ubiquitous. Smoking came to be considered a behavior of medical discretion, an issue requiring the clinical judgment of physicians treating patients who might exhibit the telltale symptoms of immoderate use, smoker’s cough, or smoker’s heart.

  A steep rise in lung cancer—a disease virtually unknown at the turn of the twentieth century—had, however, ominously followed in the wake of the rise of the cigarette. In the early 1950s, the relationship of these two trends would be explicitly and scientifically linked. When I visited with the Camel Man in 1961, substantial scientific investigations had concluded that smoking caused lung cancer and other serious disease. Although medical concerns had percolated as the cigarette rose to prominence, it had been difficult to achieve this scientific knowledge. Physicians and public health officials had long debated the impact of smoking on health and the best methods to assess its risks. Even though the relationship of cigarettes to disease is today perhaps the epiphenomenal fact of modern medicine, demonstrating this connection required a fundamental transformation in medical ways of knowing in the mid-twentieth century.

  Research into the harms of cigarette smoking in the 1940s and 1950s generated breakthroughs in modern epidemiological thought, as well as technical innovations upon which subsequent medical knowledge would firmly rest. Although many clinicians had concluded that smoking could cause disease and death based on their experiences with patients, individual doctors lacked the capacity to demonstrate conclusively this connection in the 1940s. The historical application of innovative methods of causal inference is inextricably tied to proving the harms of smok
ing. At the core of this narrative are critical questions about the processes by which new scientific knowledge is ultimately achieved. All the while, the tobacco industry worked diligently to disrupt the course of this scientific investigation. The industry’s strategic campaign to obscure and confuse the ongoing scientific enterprise would significantly impede public acceptance and understanding of these important findings. Fundamental questions about knowing, and about how we know, are illuminated by examining the obstacles that medical science and the public confronted as cigarettes came to be indicted as a powerful cause of serious disease and death.

  In January 1966, two years after the historic news conference held by Surgeon General Luther Terry announcing—unequivocally and with the government’s seal of approval—that cigarette smoking in fact causes lung cancer, the Camel Man quit smoking; the billboard came down. When R.J. Reynolds announced that “the longest running hit on Broadway” would be dismantled, its advertising agency, the William Esty Company, denied any connection to the rising public concerns about the impact of cigarettes on health.3 Yet another example of a disingenuous industry denial; at that time, the industry continued to insist vigorously that there was “no proof ” that cigarettes were harmful. Despite the pathbreaking scientific research demonstrating the hazards of smoking, the industry continued to argue for the next three decades that the evidence indicting smoking was neither scientific nor convincing.