Authors: Richard Kluger
But there had come a sea change by the 1970s, as a new breed of doctors, reflecting the idealism and revulsion with materialism of the previous decade, emerged from medical school. A number were even prepared to practice within health maintenance organizations rather than as individuals. Smoking had by then dropped sharply within the profession to perhaps as low as 10 percent, and those who chose to join the AMA were bringing to it a fresh sense of social awareness.
A shining example of the new AMA breed was Ronald M. Davis, trained in medicine at the University of Chicago and devoted to improving society by working within its established power centers. Elected at the age of twenty-four to the House of Delegates, the AMA’s version of representative democracy, Davis served on the governing councils of first the medical student and then the resident physician sections, speaking out on policy issues like smoking, about which he felt the AMA had been grievously backward. In 1984, he became the first resident physician with full voting authority to serve on the AMA’s ruling sixteen-member board of trustees, where he spoke up spiritedly but respectfully to his elders. Among his suggestions was that the AMA get out in front on the smoking issue, and in 1985 the association sent a spokesman to testify before Congress—in favor of making the higher federal cigarette sales tax permanent.
Later that year, the AMA board weighed a proposal from its membership to endorse an extension of the ban on broadcast advertising of cigarettes to inelude
all forms of advertising of the product. Davis forcefully pushed the idea and successfully expanded it to include a ban on all forms of promotion, including cultural and sports events that carried the name of cigarette brands. When U.S. Representative Mike Synar of Oklahoma introduced a House bill to impose the sweeping ban, it was young Ronald Davis who was sent to testify in its favor in 1986. The nation could no longer afford to allow cigarettes to be “the heaviest advertised consumer product in our society,” he asserted. “In terms of health costs alone it is unjustifiable; but, more importantly, in terms of human suffering and loss it is unconscionable … .”
After his residency AMA trustee Davis joined the preventive medicine training program at the Public Health Service’s Centers for Disease Control, and during a stint in the Dominican Republic to oversee government immunization efforts, he was struck by the saturation advertising of cigarettes, including street signs that bore the Marlboro design, colors, and logo. More than ever he was convinced of the predatory nature of the tobacco manufacturers. Soon thereafter, the director’s job at the Office on Smoking and Health had to be filled. Many around the country in the antismoking cause favored the appointment of Donald Shopland, its acting director and the executive editor of the Surgeon General’s reports, who was unmatched in his dedication to the tobacco control movement. But the Public Health Service required the OSH director to hold academic credentials that Shopland had never acquired. The job went instead, with the full endorsement of the AMA, to its rising star, Ronald Davis, who in 1987, at the age of thirty, found himself in the forefront of the new generation of antismoking advocates now beginning to bring the tobacco industry down, if hardly to its knees.
Another young activist in the public-health field, Joe B. Tye III, an Iowan trained as a hospital administrator, put his mark on the antismoking movement in two distinctive ways. In 1985, while completing his MBA training at Stanford, he established a program to nip the smoking problem in the bud; Tye called it Stop Teenage Addiction to Tobacco, or STAT. Its principal vehicle was a highly graphic quarterly newsletter in the form of a tabloid paper which went after the cigarette makers for what he saw as their transparent advertising pitch to young people and lamented the widespread indifference to enforcing state laws against the sale of cigarettes to underage buyers.
As a communicator, Tye was more a broad-axed propagandist than a neat dart-thrower. But he was also capable of excoriating the tobacco lords in a more philosophical vein, as in an article he contributed to the special June 1985 issue of Alan Blum’s
New York State Journal of Medicine
, placing the cigarette industry against the broader backdrop of business conduct and trying to define its particular brand of roguery. The ultimate consequences of the way cigarettes were sold, Tye argued, were “so pernicious” as to constitute corporate violence, which he defined as behavior producing “an unreasonable risk of
physical harm to consumers, employees, or other persons as a result of deliberate decision-making by corporate executives or culpable negligence on their part.” Such violence was distinguishable from more familiar forms “by the absence of malevolent intent … [or] a deliberate conspiracy to cause injury, but results from subordination of concern for human safety to monetary considerations.”
But if, as Tye charged, the cigarette companies were committing corporate violence, how exactly was their behavior different from or worse than the bottom-line ethic that came naturally to so many aggressive businessmen? Or were their crimes simply variants of the malfeasance of, say, General Motors in marketing its Corvair and Ford its Pinto, each with known design defects that the carmakers could have eliminated at small cost but instead denied and delayed fixing, thereby causing deaths and injuries? The cigarette makers, though, did not design in a defect that made their product more dangerous—it just turned out that way because of the toxic properties of the cured leaf when burned and could be made safe only by altering the very essence of the product. The tobacco companies in fact had acted—too slowly and too little, to be sure—to try to modify the toxicity of cigarettes by offering smokers a wide range of nicotine and tar potency, thereby feeding the scientifically plausible inference that the weaker yields were, to some undemonstrable degree, less hazardous. The cigarette manufacturers, furthermore, could not fairly be accused of the sort of gross managerial negligence involved in Union Carbide’s failure to safeguard equipment used to manufacture highly toxic pesticides, resulting in a heavy human toll in Bhopal, India, or in Metropolitan Edison’s faulty monitoring of the nuclear reactors at Three Mile Island in Pennsylvania, where the consequences could have been catastrophic. Nor had the tobacco companies shown a flagrant disregard for the health of their own employees by failing to safeguard them from the toxic ingredients that went into their products, as a number of leading chemical manufacturers had habitually done. Nor had the tobacco companies knowingly and wantonly dumped the residue of their manufacturing process and fouled the environment, like General Electric, which for twenty years had poured PCBs, recognized as a dangerous toxin, into the Hudson River and badly polluted it. Nor had the tobacco people doctored their research as the A. H. Robins Company did by fudging the data presented to the FDA on the efficacy of its Dalkon Shield as a contraceptive device and then, despite warnings by its own scientists, withholding information from the public on the pain and disease the device could and did inflict. The perils of smoking, by contrast, had been long and well documented by outside investigators.
The violence committed by the cigarette companies was to be found, rather, as Tye and others saw it, in their continuously disappointing the expectation by society “that when significant evidence suggests that a product is dangerous,
those engaged in selling it should adhere to a standard of conservatism, whether they believed the evidence or not.” The potential health risks from smoking did not need to imply the inevitability of harm; the duty to alert the public fully of it “arises as soon as there is credible evidence, not when the last shred of doubt in the manufacturer’s mind is resolved,” Tye wrote. Instead, the cigarette industry had steadfastly declined to warn about the risk of its own accord, and, worse still, Tye added, through its advertising, promotions, and pseudo-scientific publications, “the industry has conducted major publicity campaigns to create doubt in the public mind” about the relationship between smoking and disease—no mere passive negligence in the form of omitted disclosures but overt acts of calculated deception. By insisting on an unobtainable level of knowledge of human pathology as a requisite for dealing forthrightly with the public, Tye contended, the cigarette companies could reasonably be said to have behaved both violently and fraudulently, even if out of fear that to have acted otherwise might well have put them out of business.
XI
A
s their enemies grew in number, resolve, skills, and effectiveness, the cigarette companies resisted all the more fiercely, sometimes with new weapons.
Nothing better illustrates the industry’s unrelenting tactics than its response in the form of booklets, issued by the Tobacco Institute, that challenged each emerging Surgeon General’s report, no matter how authoritatively and carefully wrought or what the weight of evidence against smoking. The TPs rebuttal to the 1982 report on cancer, for example, regurgitated the same discredited arguments that the industry and its apologists had been dispensing for almost thirty years, starting with the suggestion that there really might not have been an upsurge in lung cancer—or if so, it had been greatly exaggerated. And although the TPs reply pamphlet to the 1983 Surgeon General’s report argued that “the mechanisms by which smoking may relate to heart disease are not known” and the TI reply to the 1984 report contended that the causes of chronic obstructive lung disease were “multiple and poorly understood,” the truth was that the causes and the mechanisms in both cases had become far better understood.
A yet more heinous instance of the Tobacco Institute’s deception could be found in a 1983 pamphlet seizing upon the findings of the Public Health Service’s lately reported “Mister Fit” study (after the acronym for its full name, the Multiple Risk Factor Intervention Trial). A twenty-year investigation undertaken by the government at a cost of more than $100 million, MRFIT monitored 12,000 subjects between thirty-five and fifty-seven who were divided
into two groups, one receiving its usual health care and the other given special counseling with regard to the three leading risk factors in heart disease (smoking, high blood pressure, and fatty diet). The prime purpose was to learn if those given the added attention would correct their destructive habits—that is, quit smoking, reduce their stress levels, and eat more healthful foods—and thus suffer less heart disease.
As it turned out, the smokers among those receiving special health counseling did quit at almost twice the rate of those in the regular-care group, but, as the Tobacco Institute crowed, “there was no significant difference in the mortality rate between the two groups” (meaning the special-care and regular-care cohorts), and indeed, the death rate for all causes, not just heart disease, was slightly lower among those receiving the usual health care. The TPs implication was that there was no correlation between smoking, quitting, and the rate of heart disease. In fact, while MRFIT showed that the care intervention did not have any notable effect on overall death rates, it also confirmed what earlier studies had shown—that smokers, whether receiving regular or special health-care treatment, suffered about a 70 percent heightened risk of heart disease and that those who quit substantially reduced their risk over time. The TI revealed neither point.
The industry was also displaying fresh skill at enlisting accomplices and exploiting their reputable names. In 1984, for example, the National Association of State Boards of Education put its imprimatur on a pair of slick pamphlets entitled
Helping Youth Decide
and
Helping Youth Say No: A Parents’ Guide to Helping Teenagers Cope with Peer Pressure
. The Tobacco Institute paid for the publications because, according to its spokesman, “the industry does not want youngsters smoking cigarettes”—he did not say why. The booklets themselves were hardly more instructive. The one intended to guide parents contained no substantive discussion of, or any reference to, the specific health hazards of smoking or the reasons why youngsters should refrain other than to urge on them the “need for patience” before taking up customs reserved for adults. Such a characterization of smoking served, of course, to glorify it as forbidden fruit, placing the custom alongside drinking and sexual activity among the normal, acceptable forms of adult conduct. The closest
Helping Youth Say No
came to noting the health risks of smoking was a case scenario that began, “Bill’s best friends start smoking and encourage him to join them. What are his alternatives?” By year’s end, the Tobacco Institute bragged that 100,000 copies of the booklets had been distributed—evidence, presumably, of the industry’s purity of heart against juvenile smoking.
At the Tobacco Institute’s executive committee meetings, where the rotating chairmanship was held for several years in the early ’Eighties by Reynolds Tobacco chief Edward Horrigan, concern grew that smokers were fast becoming second-class citizens and social outcasts. Although RJR had lost the industry’s
lead in market share, the feisty Horrigan was no quitter and, if anything, grew more determined to display his company’s clout within tobacco councils. Arguing that antismoking sentiment had “clearly reached a point beyond reason,” Horrigan called on his fellow executives to undertake an institutional advertising campaign, based loosely on the sort of “advertorials” that Mobil Oil had done so well on newspaper op-ed pages—a set of running rebuttals to their enemies that would support and reassure smokers and defuse the growing impact of the secondhand smoke issue. Some of his fellow tobacco chieftains agreed with Horrigan’s view that “You can’t be intimidated and stay in this business,” and were willing to join in his proposed united-front campaign—until, as Horrigan recounted it, they got back to their headquarters and were talked out of the idea by their lawyers. His own two superiors, Reynolds Industries chairman Paul Sticht and president Tylee Wilson, were not enthusiastic about the concept, either, but Horrigan bulled it through as an RJR-only venture, poured himself into the effort (budgeted at $7 million) and made sure that every word was fine-combed by a battery of admen, marketers, and lawyers.