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The fight to control smoking

Yale Medicine Magazine, 2014 - Autumn


How anti-smoking efforts pushed back against the tobacco industry

A photograph of Harvey W. Cushing, M.D., lies flat in one of the glass cases that ring the rotunda in the Cushing/Whitney Medical Library. In the picture, the pioneering neurosurgeon leans against a stone barrier along the Axenstrasse roadway in Switzerland, his face pensive as he peers at unseen landscapes, a cigarette balanced easily in his left hand. Next to the photo sits an advertisement: “More doctors smoke Camels than any other cigarette.”

The photo and ad are part of a library exhibit highlighting the dueling campaigns of the tobacco industry and the anti-smoking movement. “Selling Smoke: Tobacco Advertising and Anti-smoking Campaigns” ran from May 15 through Sept. 12.

The tobacco industry is notorious for shamelessly persuasive advertising, using everything from sex to Santa to sell its products. They hired celebrity spokespeople (“Smoke [Philip Morris] for pleasure today,” says Lucille Ball, of I Love Lucy, in an ad. “No cigarette hangover tomorrow,” adds her husband and co-star Desi Arnaz); advertised promotions and giveaways (“1,000 gifts you can get for free with B&W Raleigh Coupons …”); and even touted supposed health benefits (“Smoking Camels has been found to have a marked beneficial effect on digestive action. … Camels set you right!”). The industry aimed to integrate smoking into everyday life and largely succeeded. Appliance companies gave away lighters with refrigerators; restaurants and businesses advertised on matchbooks; and tobacco ads regularly appeared on primetime television. Americans spent much of the 20th century cloaked in clouds of cigarette smoke.

By 1964, the year of the first U.S. Surgeon General’s Report on Smoking and Health, 70 million Americans were smokers. Nearly half of all adults smoked, fueling an $8 billion industry. Smoking’s negative health effects were well known, but tobacco sales remained unregulated even as the famed Marlboro men began to die of smoking-related diseases like chronic obstructive pulmonary disease.

“The funny thing is the Food and Drug Administra-tion didn’t step in to try to extensively regulate tobacco until 1996,” said Melissa Grafe, Ph.D., the John R. Bumstead Librarian for Medical History and a curator of the exhibit. “But the Federal Communications Commission and the Federal Trade Commission engaged early in the fight against the tobacco industry, especially concerning false advertising.” The FTC brought lawsuits against cigarette companies as early as the 1930s for misleading advertisements. The American Cancer Society and the American Lung Association took up the fight against Big Tobacco, but what really launched the anti-smoking movement was secondhand smoke.

All told, cigarettes caused 100 million deaths in the 20th century, and many of the dead were nonsmokers. “I remember getting on a plane and asking for a nonsmoking seat,” recalled Jocelyn Malkin, M.D. ’52, who identified smoking as a risk factor for cancer in her medical school thesis. “I was in a nonsmoking seat, but the seat next to me was a smoking seat. That’s what was going on and it wasn’t so long ago.” Smoking wasn’t banned on domestic flights in the United States until 1998.

Lawsuits against the tobacco industry by innocent victims of tobacco—such as flight attendants stuck for hours in airliner cabins with smoking passengers—were critical to the success of the anti-smoking movement. (Other innocent victims included children and unborn babies.) “The estimate is that 8 million lives have been saved because of anti-smoking efforts,” said Grafe.

Today only 18 percent of adults are smokers, and 26 states and the District of Columbia have banned smoking indoors. Alas, history may already be repeating itself. The use of traditional cigarettes may be declining, but e-cigarettes—battery-operated devices that deliver nicotine, flavor, and other chemicals—are growing in popularity. And e-cigarettes are not yet regulated by the FDA.

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