Was Science Sidelined in Cigarette Debate?

02/13/2012 02:18 pm ET | Updated Apr 14, 2012
  • Barron H. Lerner Professor of medicine, New York University School of Medicine; Author, 'The Good Doctor'

It was instructive to be reading Golden Holocaust, Robert N. Proctor's new history of the tobacco industry, during the recent debates over Mitt Romney's leadership of Bain Capital.

Bain made some of its money by closing unprofitable companies that it had bought, often firing hundreds of people along the way. During his 15 years at Bain, Romney became a multimillionaire.

To many observers, the Bain story was a yawn. Those who have studied the history of capitalism, dating back to the days of John D. Rockefeller and Andrew Carnegie, have shown that it is generally a dirty business, in which more ruthless practitioners generally get ahead and deftly use science and statistics to support their causes.

But perhaps due to the current economic downturn and high unemployment rate, others asked whether someone who had made his fortune as Romney did was an appropriate person to lead our country. It was, of course, only a momentary pause, but one that may have actually forced people to rethink something that they have long taken for granted.

This type of dramatically new perspective, "making the familiar seem strange and the strange familiar," is what Proctor is trying to achieve in Golden Holocaust. Is the tobacco industry so inherently duplicitous that it does not deserve to exist, even if it is a great capitalist success? Proctor challenges his readers to conceptualize a much happier and healthier world in which the manufacture and sale of cigarettes is prohibited.

Proctor is hardly the first accomplished author to mine this topic. Books by Richard Kluger, Stanton Glantz and Allan Brandt have savaged the cigarette industry, relying in part on internal tobacco company documents that were released as a result of a series of lawsuits.

Proctor builds not only on this earlier work but on the continued release of documents in an easily searchable online database, now containing 70 million pages. As the author notes, being able to search for specific terms -- like candy cigarettes, cyanide and the famous 1964 surgeon general's Report -- made it easy for him to document the industry's perfidies. Through such searches Proctor learned, for example, that cigarette filters don't filter and that light and low tar cigarettes are especially deadly. He also learned that, remarkably, the tobacco industry was given the power to veto membership on the surgeon general's committee, leading to a report that did not condemn smoking nearly as forcefully as it might have.

Indeed, Golden Holocaust is like a 700-page how-to manual of how to sell a dangerous product that no one needs and make lots of money as a result. Here is the full story of the December 1953 meeting of tobacco company CEOs that engineered several public strategies for obfuscating the growing proof -- privately well-known to these executives -- that smoking was both addictive and almost surely linked to lung cancer. The main plan, engineered by the public relations firm Hill and Knowlton, was to repetitively insist that no definitive proof of harm existed and that "more research was needed." It was a masterful example of what we now call "plausible deniability." Proctor calls it an "oncologic Ponzi scheme."

Proctor's charges gain authority by his willingness to name the names of extremely respected historians and other academicians who have received compensation for providing either written support or court testimony on behalf of the tobacco industry -- blood money, according to Proctor. One such individual, Yale University epidemiologist and smoker Alvan R. Feinstein, placed his influential theory of detection bias in service to tobacco, calling into question the association of smoking and lung cancer even as other scientists were nailing it down. In another instance, Proctor discovers a script developed by the tobacco industry's lawyers for a historian to recite during his testimony.

Proctor makes no attempt to interview Feinstein (now deceased) or others who he criticizes, some of whom have tried to justify their actions elsewhere. But this is not surprising. Although Proctor, a superb historian, readily admits that science is inherently messy, it is the use of scientific data to obfuscate that he identifies as the most venal and successful strategy of the tobacco industry. There are times, he believes, that science is black and white.

So what of Proctor's challenge to his readers that they think outside the box? If an industry creates a product that is both dangerous and addictive and, ultimately, so unpleasurable that 85% of its customers want to quit, shouldn't society ban it? Maybe the tobacco industry's longtime claim that choosing to smoke is an "exercise in freedom" is a farce.

Even those who applaud Proctor in general might balk here. "Tobacco is not like wine but is rather more like smallpox or heroin," he writes, but as someone who has researched the history of drunk driving, I wonder how much pleasure binge drinkers and alcoholics really derive from downing beer after beer. I also suspect that if historians could somehow gain access to confidential memos from the alcohol and hospitality industries, there would be similar outrage to that generated by the tobacco lawsuits. But no one would want to try Prohibition again.

Still, Proctor's study, like the Bain controversy, should encourage every one of us to scrutinize "business as usual." Six trillion cigarettes are smoked annually, enough to make a chain from the earth to the sun and back as well as a couple of trips to Mars. One billion people will die far too young during the 21st century as a result. The cigarette cannot disappear quickly enough.