Unit 3Text ATracing the Cigarettes Path From Sexy to Deadly HOWARD MARKEL, M.D.For many Americans, the tobacco industrys disingenuousness became a matter of public record during a Congressional hearing on April 14, 1994. There, under the withering glare of Representative Henry A.Waxman, Democrat of California, appeared the chief executives of the seven largest American tobacco companies.Each executive raised his right hand and solemnly swore to tell the whole truth about his business. In sequential testimony, each one stated that he did not believe tobacco was a health risk and that his company had taken no steps to manipulate the levels of nicotine in its cigarettes.Thirty years after the famous surgeon generals report declaring cigarette smoking believed otherwise.But it was not always that way. Allan M. Brandt, a medical historian at Harvard, insists that recognizing the dangers of cigarettes resulted from an intellectual process that took the better part of the 20th century. He describes this fascinating story in his new book, “The Cigarette Century: The Rise, Fall and Deadly Persistence of the Product that Defined America” (Basic Books).In contrast to the symbol of death and disease it is today, from the early 1900s to the 1960s the cigarette was a cultural icon of sophistication, glamour and sexual allure a highly prized commodity for one out of two Americans. Many advertising campaigns from the 1930s through the 1950s extolled the healthy virtues of cigarettes. Full-color magazine ads depicted kindly doctors clad in white coats proudly lighting up or puffing away, with slogans like “More doctors smoke Camels than any other cigarette.”Early in the 20th century, opposition to cigarettes took a moral rather than a health-conscious tone, especially for women who wanted to smoke, although even then many doctors were concerned that smoking was a health risk. The 1930s were a period when many Americans began smoking and the most significant health effects had not yet developed. As a result, the scientific studies of the era often failed to find clear evidence of serious pathology and had the perverse effect of exonerating the cigarette. The years after World War II, however, were a time of major breakthroughs in epidemiological thought. In 1947, Richard Doll and A. Bradford Hill of the British Medical Research Council created a sophisticated statistical technique to document the association between rising rates of lung cancer and increasing numbers of smokers. The prominent surgeon Evarts A. Graham and a medical student, Ernst L. Wynder, published a landmark article in 1950 comparing the incidence of lung cancer in their nonsmoking and smoking patients at BarnesHospital in St. Louis. They concluded that “cigarette smoking, over a long period, is at least one important factor in the striking increase in bronchogenic cancer.” Predictably, the tobacco companies and their expert surrogates derided these and other studies as mere statistical arguments or anecdotes rather than definitions of causality. Dr. Brandt, who has exhaustively combed through the tobacco companies internal memorandums and research documents, amply demonstrates that Big Tobacco understood many of the health risks of their products long before the 1964 surgeon generals report. He also describes the concerted disinformation campaigns these companies waged for more than half a century simultaneously obfuscating scientific evidence and spreading the belief that since everyone knew cigarettes were dangerous at some level, smoking was essentially an issue of personal choice and responsibility rather than a corporate one. In the 1980s, scientists established the revolutionary concept that nicotine is extremely addictive. The tobacco companies publicly rejected such claims, even as they took advantage of cigarettes addictive potential by routinely spiking them with extra nicotine to make it harder to quit smoking. And their marketing memorandums document advertising campaigns aimed at youngsters to hook whole new generations of smokers. In 2004, Dr. Brandt was recruited by the Department of Justice to serve as its star expert witness in the federal racketeering case against Big Tobacco and to counter the gaggle of witnesses recruited by the industry. According to their own testimony, most of the 29 historians testifying on behalf of Big Tobacco did not even consult the industrys internal research or communications. Instead, these experts focused primarily on a small group of skeptics of the dangers of cigarettes during the 1950s, many of whom had or would eventually have ties to the tobacco industry. “I was appalled by what the tobacco expert witnesses had written,” Dr. Brandt said in a recent interview. “By asking narrow questions and responding to them with narrow research, they provided precisely the cover the industry sought.” Apparen