The Cigarette Papers.

• Author: LeBel, Paul A.

by Stanton A. Glantz, John Slade, Lisa A. Bero, Peter Hanauer, and Deborah E. Barnes. University of California Press, Berkeley, Cal., 1996. Pp. 539. $29.95.

Immediately after the death of Hamlet, confronted by demands from Fortinbras and the English ambassadors for an explanation of what has occurred, Horatio responds:

And let me speak to the yet unknowing world

How these things came about: so shall you hear

Of carnal, bloody, and unnatural acts,

Of accidental judgements, casual slaughters,

Of deaths put on by cunning and forced cause,

And, in this upshot, purposes mistook

Fall'n on the inventors' heads: all this can I

Truly deliver.(1)

It is a telling measure of the profound moral ambivalence evoked by the history recounted in these recent books about the tobacco industry that one seeks an allusion in the works of Shakespeare rather than in the Nuremberg trials for crimes against humanity.(2) Nevertheless, Richard Kluger, Philip Hilts, and Stanton Glantz and his colleagues do "Truly deliver" a powerful indictment of the behavior of the tobacco industry over the last forty years, with much of the most damning evidence coming from the industry's own files.

What will ultimately turn out to have "Fall'n on the inventors' heads" is still very much an open question in the context of how this society and its legal system deal with the health effects of smoking. The Food and Drug Administration (FDA) has promulgated the jurisdictional predicate for regulating cigarettes as a medical device for the delivery of the drug nicotine.(3) On a different legal front, an August 9, 1996, verdict by a Florida jury in Carter v. Brown & Williamson Tobacco Corp.(4) awarding three-quarters of a million dollars in damages to a lung cancer victim and his wife offers more than a little encouragement to those who are committed to pursuing a litigation strategy against the industry.(5) From the perspective of the ordinary citizen observing the power exerted by the tobacco industry, the gap between realism and pessimism may have shrunk to the point where it is difficult to shake the belief that raw emotion and political power struggles will affect the resolution of the tobacco and health issues as much as will reason and scientific inquiry. What is considerably clearer after an encounter with the story told in the sixteen hundred pages of these three books is that we can no longer plausibly be said to inhabit a "yet unknowing world" with regard to these "deaths put on by cunning and forced cause."

These books lay out the background against which the current round of litigation and regulatory measures needs to be evaluated and the future courses of conduct planned. Richard Kluger's Ashes to Ashes(6) is a detailed social history of cigarettes in the United States. Kluger is probably best known as the author of Simple Justice,(7)' a justifiably acclaimed history of the legal battle for school desegregation. Just as that book gave the reader an exposure to the development of the strategy that culminated in a declaration of the unconstitutionality of school segregation in Brown v. Board of Education,(8) Ashes to Ashes takes the reader into the operations of the various parties--tobacco companies, scientific researchers, public interest groups, the public health community, the smoking public, antismoking advocates, state and federal legislators, and government administrative officials in a variety of agencies--with an interest in the role that cigarettes play in this society.(9)

Kluger's book is comprehensive in its attention to the product development, marketing, scientific research, lobbying, and legal maneuvers that have encircled cigarettes since their serious introduction into American commerce more than a century ago. As the book's subtitle suggests, the progress made by Philip Morris from minor player to industry leader plays a prominent role in Kluger's history.(10)

The other two books are more narrowly focused than Ashes to Ashes, which surveys the entire history of cigarette production and smoking, seeming to devote at least some attention to every imaginable aspect of that history. Both New York Times reporter Philip Hilts, in Smokescreen,(11) and the collaborators on The Cigarette Papers(12) concentrate on a much more narrow and disturbing feature of that landscape--the decades-long deception about the health effects of smoking that the tobacco companies perpetrated on public health authorities and the consuming public.

The eponymous papers of the book by University of California Medical School professor Stanton Glantz and his colleagues are internal industry memoranda from the files of Brown & Williamson Tobacco Corporation,(13) and their availability to litigators, regulators and legislators is changing the nature of the debate about the tobacco industry's accountability for the health of its consumers. Excerpts from twenty-one of these documents were introduced into evidence in the Carter trial,(14) and are likely to have been at least partly responsible for the plaintiffs verdict in that case. The FDA's assertion of jurisdiction over tobacco rests to a degree on the analysis of key internal documents from the industry.(15) Furthermore, the most dramatic scenes to date in the history of the tobacco industry--the 1995 appearance by executives of seven tobacco companies to testify under oath before a Congressional subcommittee chaired by Representative Henry J. Waxman of California(16) and the subsequent solo appearance by the CEO of Brown & Williamson--were prompted in large part by the legislators' access to the information in these documents.(17)

The Cigarette Papers is an expansion of an influential set of articles published in the Journal of the American Medical Association in 1995 analyzing the contents of those memoranda.(18) Hilts was an early recipient of much of that same material, and he broke the story of the industry's knowledge in his reports for the New York Times.(19) Smokescreen goes beyond the Brown & Williamson memoranda, however, and incorporates Hilts's analysis of a good deal of the material developed in the Cipollone(20) litigation as well as some material to which he had exclusive access.(21)

The most striking feature of the Brown & Williamson papers is the stark contrast between the candor and scientific sophistication displayed within the industry and the denials and obfuscation presented to the public by the industry. Presentations and research proposals discussed at research conferences held by Brown & Williamson's parent corporation, BAT Industries, formerly British American Tobacco, dealt with nicotine's addictive properties, the carcinogenic and cardiopulmonary effects of cigarette smoke, and the risks from environmental tobacco smoke, or "passive smoking," well in advance of nonindustry parties' initial publication of concerns and research findings about those matters.(22) Internal industry communications wholly contravene the denials made throughout those periods to the public and to the government agencies that had expressed concern about the product's negative health effects.(23)

Were we ever as blind to the link between cigarette smoking and health as the tobacco industry spokespeople would have had us believe we should have been, at least until their legal self-interest caused them to switch their position and assert that everyone knew precisely what risky behavior they chose to adopt? The term "coffin nails" appeared in American popular literature at least three-quarters of a century prior to the 1964 report of the United States Surgeon General that articulated the health effects of smoking.(24) In Raymond Chandler's 1939 novel The Big Sleep, detective Philip Marlowe, needing to pass time on a stakeout, tells the reader that he "sat there and poisoned myself with cigarette smoke.(25) Common sense undoubtedly made the vast majority of smokers, as well as their family members, aware of the connection between the impaired state of their health and their indulgence in cigarette smoking.

Likely to have been missing throughout the relevant period, however, was a smoker's appreciation of the extent of the harm attributable to smoking and of smoking's addictive nature. A smoker's lack of understanding, when combined with the industry's knowledge of the full import of those facts, results in a state of affairs that falls well short of any truly informed consent by the average smoker to continue being exposed to the hazards of smoking. For much of the time that the government and individual smokers' own experiences were announcing that there was a problem, the industry strongly resisted the existence of any such link as more than speculative. This position adopted by the industry further undermined the consuming population's appreciation of the nature and the extent of associated health risks.

The Cigarette Paper's analysis of the Brown & Williamson memoranda accuses the tobacco industry of "trying to have it both ways: maintaining that there are no health dangers in smoking but providing `healthier' cigarettes to those people who are worried about possible dangers."(26) Recent litigation postures assumed by the tobacco industry reveal that the convoluted illogic of its position involves even more grotesque contortions. If the tobacco industry is to be believed, smoking has not been conclusively proven to be harmful; nicotine is not addictive; and cigarette advertising is directed only at adults to influence their brand preference. Because the dangers of cigarettes have been known so well for so long, however, a person's decision to begin or continue to smoke reflects a fully informed choice to indulge in this nonaddictive, not-dangerous product.

In the words of H. Lee Sarokin, the federal district judge who, by virtue of presiding over tobacco litigation for ten years, acquired the clearest insight into the behavior of the tobacco industry:

All too often in the choice between the...