America Lights Up
The first cigarette entrepreneur, James Buchanan “Buck” Duke, “almost single-handedly invented the modern cigarette.” He began manufacturing cigarettes in 1879. By 1885, he employed more than 700 cigarette rollers in North Carolina and New York. Duke remade the industry with a technological breakthrough: James Bonsack’s cigarette roller. With it, Duke could make 200 cigarettes a minute – 60 times more than a skilled hand roller could create. He negotiated a quick, secret contract with Bonsack. To raise demand to equal production, Duke invested heavily in ads and promotions, using coupons, premiums and collectable cards, and targeting teens.
“The centrality of tobacco within American culture is remarkable both for its longevity and for the elasticity of its products and meanings.”
Since cigarettes have few differentiations and are vulnerable to price competition, he focused on consolidation. Duke manipulated his competitors into joining his American Tobacco consortium. He established vertical integration of tobacco growing, and cigarette manufacturing and distribution. By the 1900s, American Tobacco was one of the U.S.’s top three companies. The government disbanded the monopoly in 1911, creating four firms: American Tobacco, Liggett & Myers, R.J. Reynolds and P. Lorillard. Philip Morris became the industry’s fifth primary player.
“The consumer culture in which the cigarette became so prominent and popular marked the construction of the first truly national, secular culture in American history.”
In the early 1900s, society saw the new smoking fad as dirty, lazy and indulgent. Cigarettes’ popularity among WWI soldiers helped change that view. General John Pershing famously said, “You ask me what we need to win this war. I answer tobacco, as much as bullets.” In response, the YMCA, an ardent opponent of smoking, sent cigarettes to the front.
“From its inception, the cigarette targeted the uninitiated; young people...were the primary constituency.”
The concept of “brand differentiation,” arose during the 1920s and quickly became embedded in the culture. Brand choice, based on differences among products and their consumers, became an extension of each customer’s personality, status, discernment and individuality. R.J. Reynolds president George Washington Hill collaborated with Albert Lasker, Edward Bernays and Raymond Loewy, pioneers in advertising, public relations and product design, respectively. Lasker created the “Reach for a Lucky” campaign, one of modern advertising’s most successful promotions. Bernays attempted nothing less than shaping societal behavior and values through brilliant, media-friendly “created events.” Loewy redesigned the Lucky package with its famous red target. By the early 1930s, all the tobacco companies hired marketing pros and spent lavishly on advertising. Their campaigns changed how society felt about women smokers, who were frowned upon until the late 1930s, when big tobacco PR made the cigarette a symbol of equality and independence, and women responded. This was not just cultural influence; the industry orchestrated a deliberate shift in society’s perceptions of cigarettes.
Dying for a Cigarette
R.J. Reynolds’s advertising slogan – “More Doctors Smoke Camels than Any Other Cigarette” – marked its strategic response to growing health concerns. U.S. lung cancer cases tripled between the early 1900s and 1946. Clinicians documented smoking’s health risks, but their observations were not seen as scientific “proof.” Several issues made it hard to prove that smoking undermined health. Some people never suffered its purported harms. In others, decades passed before the ill effects surfaced. Medical research methods created to identify communicable diseases, such as cholera and typhoid, didn’t apply to smoking.
“For some late nineteenth-century reformers, the cigarette represented many of the evils already associated with alcohol: wastefulness, indulgence, a poison harmful to self and others.”
The full impact of smoking didn’t become statistically visible in the U.S. until the late 1940s when Dr. Evarts Graham and Ernst Wynder compared 604 lung cancer patients to cancer-free people, and reported, “The enormous increase in the sale of cigarettes in this country approximately parallels the increase in bronchogenic carcinoma.” British medical statisticians A. Bradford Hill and Richard Doll found that cigarettes were the central cause of the rise in lung cancer. By the mid-’50s, researchers used “clinical observations, population studies and laboratory experiments” to establish the relationship between smoking and lung cancer. Experts began to agree that a link existed, and urged doctors and public health officials to warn the public.
The Great Debate
When revelations of smoking’s health risks threatened big tobacco, it responded with an innovative, unprecedented PR effort to create uncertainty and controversy. It cried that the question of whether smoking causes cancer has “two sides” and needed more “proof.” This doubt gave smokers a justification and let new smokers start. The manufactured controversy gave the industry a way to work against regulation and legal liability.
“The cigarette revealed the power of the technique of investing a commodity with cultural meaning...to motivate consumption.”
John W. Hill, of the PR firm Hill & Knowlton, masterminded the industry’s strategy of insisting that different opinions existed about smoking’s risks, the cornerstone of the industry’s efforts to obfuscate the scientific process. Hill invented the Tobacco Industry Research Committee (TIRC), a supposedly independent think tank, to make the industry seem committed to research. An American Cancer Society official told The New York Times, “When the tobacco companies say they’re eager to find out the truth, they want you to think the truth isn’t known...They want to...call it a controversy.” Hill got biologist Clarence Cook Little to head the TIRC. Vocal and charismatic, Cook was the perfect front man and scientific skeptic to perpetuate the debate.
The Rise of Antismoke
This state of affairs, with powerful corporations hampering the spread of vital scientific information, required a response from the U.S. Public Health Service. John F. Kennedy’s Surgeon General, Luther Terry, formed an investigative committee that reported smoking’s health risks in 1964, though Terry’s office lacked the resources for an antismoking initiative. Big tobacco demanded more proof but began saying that smokers must assume smoking’s “alleged” risks. The Food, Drug and Cosmetic (FTC) agency proposed new rules requiring warnings on cigarette packs and ads. The industry put its powerful Tobacco Institute lobby to work in Congress, the forum where it wielded the most influence. It acceded to warning labels law in order to place any risks on the smoker’s back. The bill pre-empted big tobacco’s biggest fear: tort litigation.
“From December 1953...tobacco companies would present a unified front on smoking and health; more than five decades of strategic and explicit collusion would follow.”
Antitobacco advocate John F. Banzhaf III turned the industry’s methods against it, asking the Federal Communications Commission (FCC) to use the “fairness doctrine” to give antismoking organizations equal broadcast time to counteract cigarette ads. The FCC granted one antismoking announcement for every three ads. For three years, health agencies aired millions of dollars worth of public service announcements on the dangers of smoking. But when the FCC banned broadcast cigarette ads, with the industry’s cooperation, that effectively ended the antismoking campaign.
“Cigarette smoke as an environmental toxin would become the basis for a radical shift in the tobacco wars.”
The tobacco industry entered the 1970s relatively unscathed and unregulated. Antitobacco groups advocated for laws against smoking in public places. In 1973, Arizona became the first state to limit smoking in museums, libraries and buses. By the 1980s, most employers had antismoking policies. The industry aggressively reputed evidence of the harm of secondhand smoke, but the public did not require “proof” to prefer smoke-free environments. Big tobacco pushed smokers’ “rights,” but most smokers were already ambivalent about the habit; many said they wanted to quit. As health consciousness emerged, the smoker’s image declined. By 1985, only 30% of U.S. adults said they smoked. Their demographics reflected lower education and economic status.
I’ll See You in Court
By the 1980s, tort law held U.S. companies to greater responsibility, but no one had yet successfully sued cigarette manufacturers. Tobacco thwarted all such attempts by presenting TIRC experts who questioned research saying cigarettes caused lung cancer and arguing that no absolute scientific proof linked smoking to the disease. They asserted that the very debate on smoking’s health risks alerted people to its potential dangers.
“Smoking is – by far – the most significant preventable cause of death in the United States, resulting in more than 430,000 deaths each year from heart disease, emphysema, stroke and lung cancer, among other causes.”
Attorney Marc Edell brought a landmark case on behalf of dying lung cancer patient Rose Cipollone. He gained historical impact by using the courts’ evidence-discovery process to get access to more than 300,000 internal tobacco industry documents – the first significant crack in the industry’s armor. The jury held Cipollone responsible for her behavior, in spite of compelling evidence about the cigarettes’ addictive properties and the companies’ behavior. This recognition of individual choice and responsibility is deeply entrenched in U.S. culture. Yet, the court gave Rose’s husband Antonio $400,000, the first verdict against the industry in more than 300 suits.
“As a culture, we seek to insist – despite much powerful evidence to the contrary – that smoking remains a simple question of individual agency, personal fortitude, and the exercise of free will.”
In 1994, a powerful combination of investigative journalists, Congress and the Food and Drug Administration (FDA) began to assert that big tobacco had deliberately manipulated its product to maintain its addictive nature. The Cipollone trial revealed a Phillip Morris document proving that the company understood nicotine’s addictive properties. It read, “Think of the cigarette pack as a storage container for a day’s supply of nicotine. Think of the cigarette as a dispenser for a dose unit of nicotine. Think of a puff of smoke as the vehicle of nicotine.” An ABC TV exposé by Pulitzer Prize-winner Walt Bogdanich sparked an intense legal battle between the industry and ABC, which ultimately backed down. But, the media floodgates were open. In 1994, seven tobacco CEOs claimed ignorance and denied health risks before an outraged Congressional subcommittee. Within a year of this media disaster, each of the companies replaced its CEO.
Blow Your Whistle
As a former employee of an industry law firm, Merrell Williams had reviewed thousands of the tobacco industry’s internal documents, gathering more than 4,000 pages of incriminating evidence. Eventually the press, Congress and various universities received leaked copies of these “Cigarette Papers.” They proved the industry had understood smoking’s carcinogenic effects and nicotine’s addictive properties since the 1960s. This blew the smoke away from the debate about tobacco. The antitobacco forces now had ample data for liability litigation. Class actions suits became the new battlefield in the tobacco wars. In the early 1990s, more lawyers filed antitobacco suits than in the previous three decades. Broin v. Philip Morris, the first case to get to trial, sought $5 billion for 60,000 flight attendants who suffered the ill effects of secondhand smoke. At trial, tobacco CEOs finally conceded that smoking might cause health risks. They settled before the verdict, also a first, agreeing to invest $300 million in a research institute.
“We stand on the threshold of a global pandemic of tobacco-related diseases.”
Lawyers filed a class action suit for addicted smokers in Florida. Another group sued the tobacco companies to recover state Medicaid expenses for smoking-related diseases. By 1990, treating such diseases cost more than $2 billion every year. Individuals began winning cases. Brown & Williamson had to pay lung cancer victim Grady Carter $750,000. Marlboro smoker and cancer patient Patricia Henley won $51 million. In 1997, state cases fell under the private negotiations of a “global settlement agreement” between the industry and the states. Acceptance required an act of Congress, so the industry brought its powerful lobby to bear. In 1998, it won the “Master Settlement Agreement,” a “pale reflection” of the original agreement. Big tobacco would pay “$206 billion to 46 states over 25 years.”
Cancer Knows No Borders
U.S. cigarette smoking has declined steadily, so the tobacco industry is seeking new global markets aggressively, using its same old ads, marketing and PR strategies, such as “establishing ties to agricultural and finance ministers in developing nations,” “emphasizing the economic significance of tobacco,” “creating resentment about the ‘imposition of controls’,” and “attempting to shift authority over tobacco from the World Health Organization (WHO) to more sympathetic agencies.” Cigarettes have long-term health implications for these countries, but distinguishing public health concerns from restraints on trade has proven difficult. In the mid-’90s, the WHO started creating a “international treaty on tobacco control.” By 1999, the formal process began to set up a Framework Convention on Tobacco Control (FCTC). In 2003, 192 WHO nations accepted the FCTC, the WHO’s first multilateral treaty. Whether history will view this as a landmark victory for public health or a feeble attempt to rein in big tobacco is yet to be seen.