Fortunately for tobacco companies, American consumers have relatively short memories. Why else would their claims that they knew nothing of the hazards of cigarette smoking play so well among jurors today? But, as Harvard professor Allan Brandt demonstrated during this year's Harvey Young Lecture on April 9, tobacco companies were attempting to allay the health fears of smokers through advertising as early as the 1930s. They enlisted physicians, real and imagined, to attest to the "mildness" of certain brands, many of which were said to reduce "smoker's cough" or other maladies.
Still, the evidence is there. Consumers smoked an average of 50 cigarettes per capita, per year in 1900 to over 4,000 in the late '60s and early '70s. The rise in cigarette smoking corresponded to a rise in the incidence of lung cancer, said Brandt. "As recently as 1964 almost half of all Americans smoked," he noted. Today the number is just over 25 percent.
"Cigarettes-one of the most popular products of the century-turns out to be among the most dangerous," said Brandt, who wrote the book No Silver Bullet: A History of Venereal Disease in the United States Since 1880 and whose work in progress is titled The Rise and Fall of the Cigarette. "And one of the most dangerous products ever produced turns out to be the least regulated-defined as neither food nor drug in the major legislative landmarks in the 20th century."
Ironically, it was an agricultural fluke that created the cigarette's popularity. "Almost no one smoked cigarettes before 1900," said Brandt. But changes associated with curing tobacco modified the product's taste. Once dried over an open flame that produced a more alkaline, bitter flavor, tobacco farmers began using flues to pipe warm air over leaves, which produced "a slightly acidic tobacco that was far milder and easier to inhale," said Brandt. The 1880s saw the invention of the cigarette machine, which made the manufacture of millions of cigarettes a year possible.
"But it was the significance of advertising that created a mass national market in the 20th century," said Brandt. "Before then, cigarettes were a relatively undifferentiated, utility product." As the advertising industry grew in prominence, marketers increasingly defined patrons of products rather than the products themselves, said Brandt. They used the "testimonials" of society matrons or sports and movie stars to foster a democratic image for the cigarette, said Brandt, to tell consumers: "You can smoke the same cigarette that even the most wealthy Americans smoke."
Cigarette smoking's popularity also paralleled larger, sweeping changes in American culture-a rise in consumerism and the emergence of the youth culture of the 1920s. "About the worst thing that you could say about somebody in 1875 was that they were indulgent and pleasure-seeking," said Brandt. In 1925, ads proclaimed: "Indulge in a Lucky, the most pleasurable cigarette."
"It took a fundamental change in the culture," said Brandt, "from one that emphasized discipline, deferred gratification and production to one that emphasized spending, consumption, pleasure and leisure as a major element of the construction of this consumer culture."
But while advertisers promoted the pleasures of smoking, medical researchers and epidemiologists were methodically documenting its dangers, culminating in the Surgeon General's report in 1964 and mandatory labeling in 1966. Tobacco advertisers were responding to the increasing drumbeat of population-based data on the hazards of smoking by sowing seeds of doubt. "As people began to think statistically, what the manufacturers of cigarettes began to suggest is 'don't believe published results, make your own determination,'" said Brandt. It was a "subtle process of subverting new forms of knowledge in the '30s and '40s," he said.
Even as medical evidence linking cigarette smoking and cancer became firmly entrenched, consumers still had problem finding fault with tobacco companies, said Brandt. It stems from our cultural mindset about risk and disease, he said. "We want to believe that we actually can control our health. If people get sick, it's their own personal failure."
That mindset may be changing. The dangers of second-hand smoke, new revelations that nicotine levels in cigarettes have risen by 10 percent in the last decade, the apparent efforts of tobacco companies to target children and black consumers, the knowledge that almost 90 percent of people begin to smoke before the age of 18, and the recent Liggett company settlement may all serve to undercut the notion that smokers bear sole responsibility for their health problems.
Still, said Brandt, "it would be premature to celebrate the demise of the cigarette." For every one person convinced to quit here, two to three are recruited in the developing world. Not surprisingly, those countries' rates of lung cancer are now rising as well.
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