2124/2014 E-cigarettes: Healthy tool or gate\'rclydelJice? - CNN.com

E-cigarettes: Healthy tool or gateway device?By Jen Christensen; CNN Q~t~.~" d.-- J. y -}-~. mupdated 12:46 PM EST, ThuFebruary6,2014 l\ \f\ vl ....I.....vV

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E-cigarettes: Healthy tool or gateway device? Council FHeNoj~Item No... I .

Are e-cigarettes bad for your health? Q.~.tv:~ui~L(CNN) --If the tiny sample of smokers in a new study in the BritishjournaJ Lancet are anyindication, electronic cigarettes might be slightly more effective than nicotine patches in helpingpeople quit smoking.

Great, right? Except another new study from the Centers for Disease Control and Preventionsuggests more children and teens are trying them.

The implications of both these studies means electronic cigarettes have been getting a lot ofattention lately. Just what e-cigarettes are and what role they should play in helping people quitsmoking depends very much on who you speak with about this topic.

Thetopic,though,

Smoking is still the leading cause of avoidable death in the United States. The devices are notone of the FDA-approved methods to help people quit, but many people are using them this way.A growing number of scientists are studying them to see whether they may be a way to end anepidemic.

New cigarette trend 'smokeless' E-cigarette sales on the rise

remains as polarizing a health issue as sex education or diet sodas.

An e-what?

The e-cigarette was actually developed by a pharmacist in China.

The pharmacist, Han Lik, was a three-pack-a-day smoker. That was nothing unusual-- more than300 million people in China are regular smokers. But when Llk's father, who was also a heavysmoker, died of lung cancer, Lik decided he had to come up with an alternative that wouldn't killhim.

Most scientists believe nicotine itself, while highly addictive, is not what causes cancer forsmokers or for the people around them who breathe their second-hand smoke. Instead, it's thetoxic chemicals that are created when tobacco and filler products burn that are dangerous.

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212412014 E·cigarettes: Healthy tool or gatewaydelAce?· CNN.com

If there was a way to get nicotine addicts their fix without the burn, you just might avoid the healthproblems. Nicotine then becomes as harmless as any other addictive substance, such ascaffeine, some experts say.

So Uk developed an e-cigarette -- a device that uses a small battery to atomize a pure liquidsolution of nicotine. Nothing is burned. There is no ash. There is no smoke. There is nicotine, andthen there is flavoring added for taste.

Essentially the person using these inhales a kind of vapor that looks like fog from a fog machine.A recent review of all the scientific research done on e-cigarettes by Drexel University professorIgor Burstyn concludes "current data do not indicate that exposures to vapors from contaminantsin electronic cigarettes warrant a concern."

In plain language, Burstyn concludes: "lt's about as harmless as you can get."

"I wouldn't worry at all if someone was smoking one of these by my kids," Burstyn said. "From apure health perspective, these are not as bad as a cigarette."

E-cigarettes came to the U.S. market around 2009. The CDC now estimates about one in fiveAmerican smokers have tried an e-cigarette -- that's about 6% of all adults.

There are e-cigarette stores, but now you can also buy them online or in convenience stores.Some look like regular cigarettes; some look like pens or thumb drives.

First you buy a starter kit, which costs between $40 and $130. In the kit is the e-cigarette, acharger and a few cartridges. The cartridges typically last as long as a 20-pack of cigarettes andsell for around $10. You can also buy a bottle of e-liquid to refile the cartridge yourself.

But as far as risky behavior goes, it's still a tiny fraction of students. The survey showed about 3% .of these kids said they had used one in the last 30 days. By contrast, 39% of students said they

The anti-e-cigarette camp

Critics point out e-cigarettes come in kid-friendly flavors such as gummy bear, atomic fireballcandy and cookies and cream. tt makes them worry that e-cigarettes will become a gateway toencourage kids to develop a lifelong nicotine addiction -- or worse, try the real thing.

Only about 20 states specifically forbid the sale of e-cigarettes to children.

Tobacco use has been on the decline with kids; it's about half what it was in the mid-1990s. Butthe latest CDC study shows a growing number of middle and high school students have tried e-cigarettes.

One in 10 high school students surveyed said they had tried e-cigarettes last year. That's doublethe number from 2011. One high school in Connecticut banned them after the principal saidadministrators dealt with at least one incident involving e-cigarettes every day.

CDC director Tom Frieden characterized this trend as "deeply troubling."

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212412014 E-cigarettes: Healthy tool or gateooyde\.ice? - CNN.com

drank some amount of alcohol in the past 30 days, 22% binge drank and 24% rode with a driverwho had been drinking.

The real problem is that 88% of adult smokers who smoke daily said they started when they werekids, according to the CDC. Kids who start down the path to using e-cigarettes may stick withthem for life.

"So much is unknown about them and what the long-term complications could be with their use,"said the American Lung Association's Erika Sward. "Bottom line, we don't know what theconsequences of using them are, and we are very troubled that kids would find them attractive."

E-cigarettes are unregulated in the United States; no laws make manufacturers tell you what you'are actually inhaling. The unknown is one of the many qualities of e-cigarettes that the AmericanLung Association doesn't like.

It's "a complete unregulated Wild West," Sward said. She wants the FDA to move quickly withregulatory oversight, which she says would make manufacturers disclose what the actualingredients are in each of the 250 or so brands available.

In 2009, a FDA test on a small number of e-cigarette samples found "detectable levels of knowncarcinogens and toxic chemicals to which users could potentially be exposed." They founddiethylene glycol in one cartridge at a 1% level; this is an ingredient used in antifreeze and canbe toxic to humans in large quantities. Diethylene glycol is also found in some dental productsand in some pharmaceuticals.

After that study, the FDA banned the sale of e-cigarettes. They warned e-cigarette smokers thatthey were inhaling "toxic" and "harmful" chemicals. However, in 2010, a court ruled that "the FDAhad cited no evidence to show that electronic cigarettes harmed anyone," and stores could goon selling them.

The early e-adopters

Florida resident Craig Lashley says they've changed his life.

On the other side of the debate are the passionate supporters of e-cigarettes. Many who usethem say it is the first thing that has helped them stop using cigarettes -- something more than90% of smokers fail to do with any of the existing FDA-approved methods. There are blogs andmessage boards dedicated to them. And there are countless impassioned testimonials from thepeople who use them.

"I got tired of being like that little kid in 'Peanuts' who had the cloud of smoke following him all thetime," Lashley said. "I didn't like the way I smelled when I smoked, and I didn't like what smokingsaid about me, especially to kids."

He discovered the e-cigarette about a year ago and hasn't smoked a regular cigarette since.

He says he smells better, feels better and spends a lot less -- about $1 0 a week on e-cigarettes.He used to spend about $45 a week on regular cigarettes.

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2124/2014 E-cigarettes: Healthy tool or gatewayde'vice? - CNN.com

III like the feel of blowing smoke," Lashley said. lilt seems to me like (e-cigarettes are) a healthieralternative,"

A growing number of respected physicians and scientists agree, and they say these productscould end a major health problem.

"Electronic cigarettes and other nicotine-containing devices offer massive potential to improvepublic health, by providing smokers with a much safer alternative to tobacco," the Royal Collegeof Physicians says. "They need to be widely available and affordable to smokers."

The latest study, published in the British journal the Lancet, examined whether people who usedthem as an alternative to smoking would abstain from using regular cigarettes.

The New Zealand authors studied the behavior of 657 people who were trying to quit. One groupgot nicotine patches, another got nicotine e-cigarettes and others got placebo e-cigaretteswithout the nicoti ne.

Over a period of six months, only a tiny fraction of the people in the study actually quit smoking.

People using the nicotine e-cigarettes quit at a slightly better rate compared with those using thepatch, though. Some 7.3% using the e-cigarettes abstained from smoking traditional cigarettescompared with the 5.8% who stopped with the patch. About 4.1 % stopped with just the placeboe-cigarettes.

It was such a small number of people who quit that the authors concluded "more research isurgently needed to clearly establish their overall benefits and harms at both individual andpopulation levels."

Siegel theorizes the e-cigarettes might look too much like smoking.

Dr. Michael Siegel, a physician who has spent the past couple decades working on tobaccocontrol initiatives, has been surprised by the negative reaction to e-ciqarettes from so manypeople in the public health sector. Siegel says the studies he's done have shown e-cigarettesare a help.

"True we don't know the long-term health effect of e-cigarettes, but there's a very good likelihoodthat smokers are going to get lung cancer if they don't quit smoklnq," he said. "If they can switchto these and quit smoking traditional cigarettes, why condemn them?"

Ray Story, founder of the Tobacco Vapor Electronic Cigarette Association, agrees. He says hisassociation has also pushed for age verification legislation.

lilt's ironic the very thing that makes them so effective ... drives the anti-smoking groups crazy.But what makes them so effective is it mimics the physical behaviors smokers have, which issomething the patch can't dO.1I

Siegel does believe there is an urgent need for more regulations.

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2124/2014 E-cigarettes: Healthy tool or gatewayde\Ace?- CNN.com

"When you have these companies trying to promote these as something they are not, and youhave stores that sell them in the candy aisle, you are going to have a problem," Story said. "Ifthey are officially categorized as a tobacco product, you get an automatic age verification put inplace.

"Nicotine is addictive, and we want the federal government to create guidelines and a structurethat will confine these to being sold as adult products."

Lashley says no matter what the debate, he will continue to spread the e-cigarette gospel to hisfellow adults.

So far, his co-workers have been receptive to the idea. He used to be the only one with an e-cigarette on smoke breaks. Now he says he's got more than a dozen colleagues doinq thesame.

One colleague, though, complained about it.

"He said 'I'm sick of all these people smoking electronic cigarettes," Lashley said. "When Iasked him why he said. 'Simple, now I can't bum any off of them.' "

© 2014 Cable News Network. Turner Broadcasting System, Inc. All Rights Reserved.

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2!24f2CH CDC - History of the Surgeon General's Report - Sm:>l<ing& Tobacco Use

Centers for Disease Control and PreventionCDC 2417~Sdving Lives. Protecnng Poopfe.1'M

History of the Surgeon General's Reports on Smoking andHealth

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On January 11,1964, Luther L.Terry, M.D.,Surgeon General of the U.S. Public HealthService, released the first report of the SurgeonGeneral's Advisory Committee on Smoking andHealth.

On the basis of more than 7,000 articles relatingto smoking and disease already available at thattime in the biomedical literature, the AdvisoryCommittee concluded that cigarette smoking is

The most important cause of chronic bronchitis

A cause of lung cancer and laryngeal cancer inmen

A probable cause of lung cancer in women

The release of the report was the first ina series of steps, still being taken more than 40 yearslater, to diminish the impact of tobacco use on the health of the American people.

For several days, the report furnished newspaper headlines across the country and lead stories ontelevision newscasts. Later it was ranked among the top news stories of 1964.

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2/24/2014 CDC ~ His!oryofthe Surgeon General's Report- Smol<ing & Tobacco Use

During the more than 40 years that have elapsed since that report, individual citizens, privateorganizations, public agencies, and elected officialshave pursued the Advisory Committee's call for"appropriate remedial action."

Early on, the U.S. Congress adopted the Federal Cigarette Labeling and Advertising Act of 1965and the Public Health Cigarette Smoking Act of 1969. These laws-

Required a health warning on cigarette packages

Banned cigarette advertising in the broadcasting media

Called for an annual report on the health consequences of smoking

In September 1965, the Public Health Service established a small unit called the NationalClearinghouse for Smoking and Health.

Supported successful state and community programs to reduce tobacco use

Through the years, the Clearinghouse and its successor organization, the Centers for DiseaseControl and Prevention's Office on Smoking and Health, have been responsible for 29 reports onthe health consequences of smoking.

In close cooperation with voluntary health organizations, the Public Health Service has-

Disseminated research findings related to tobacco use

Ensured the continued public visibility of antismoking messages

Within this evolving social milieu, the population has given up smoking in increasing numbers.Nearly half of all living adults who ever smoked have quit.

However, more than 45 million American adults still smoke, more than 8 million are living with aserious illness caused by smoking, and about 438,000 Americans die prematurely each year as aresult of tobacco use .

The antismoking campaign is a major public health success with few parallels in the history ofpublic health. It is being accomplished despite the addictive nature of tobacco and the powerfuleconomic forces promoting its use.

.Efforts to implement proven interventions must be continued and expanded.

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2ff4(20;14 CDC - Historyofthe Surgeon General's Report- Srrol<ing & Tobacco Use

Page last rev iew ed: July 26, 2013

Page last updated: July 6,2009

Content source: Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion

Centers for Disease Control and Prevention 1600 Clifton Rd. Atlanta, GA30333, USA800-CDC-INFO (800-232-4636) TIT: (888) 232-6348 - Contact CDC-INFO

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Failed promises of the cigarette industry and its effect onconsumer misperceptions about the health risks ofsmoking .K M Cummings, C P MorleYI A Hyland

See end of artide forauthor,' affiliations

Correspondence to:Michael Cummings, ~hD,MPH, Department ofCancer Prevention,Epidemiology &Biostatistics, Roswell PorkCancer Institute, Elm andCarlton Streets, Buffalo,New York 14263, USA;MichaeLCummings@Roswellpark.org

Tobacco ConfroI2002;11ISupp! II:i 11 O-i 117

BQ<:kground: In January 1954, US tobacco manufacturers jointly sponsored on advocacy advertise-ment entitled "A Frank Statement to Cigarette Smokers" which appeared in 448 newspapers in 258cities reaching an estimated 43 245 000 Americans, The advertisement questioned research findingsimplicating smoking as a cause of cancer, promised consumers that their cigarettes were safe, andpledged to support impartial research to investigate allegations that smoking was harmFul to humanhealth.Objective: To examine [1) the extent to which cigarette companies FulFilled the promises made to con-sumers in the 1954 "Frank Statement", and [2) the efFect of these promises on consumer knowledge,beliefs, and smoking practices.Methods: This study reviews statements made since 1954 by the tobacco companies individually andcollectively through the Tobacco Institute and Tobacco Industry Research Committee/Council ForTobacco Research on the subject of smoking as a cause disease, and the industry's pledge to supportand disclose the results of impartial research on smoking and health. Many of the industry documentsevaluated in this study were obtained from a collection consisting of 116 documents entitled the "State-ment of Defendants' Misrepresentations" prepared by attorneys representing the state of Connecticut inthe Medicaid litigation against the tobacco industry in 1998. In addition, we searched for corroborat-ing material from tobacco industry documents collected from the tobacco industry's document websites.In order to contrast industry statements on smoking and health with what smokers' actually believedabout smoking we reviewed reports of public polling data on smokers' knowledge and beliefs aboutsmoking and disease gathered from tobacco industry sources and from surveys conducted by publichealth researchers.Results: Anolysis of public statements issued by the tobacco industry sources over the past five decadesshows that the companies maintained the stance that smoking had not been proven to be injurious tohealth through 1999. The public statements of the tobacco industry are in sharp contrast to the privateviews expressed by many of their own scientists. The tobacco documents reveal that many scientistswithin the tobacco industry acknowledged as early as the 1950s that cigarette smoking was unsafe.The sincerity of the industry's promise to support research to find out if smoking was harmful to healthand to disclose information about the health effects of smoking can also be questioned based upon theindustry's own documents which reveal: P) scepticism about the scientific value of the smoking andhealth research program established by the industry; and [2) evidence that research findings implicat-ing smoking as a health problem were often not published or disclosed outside the industry. Industrydocuments also show that the companies knew that their own customers were misinformed about smok-ing and health issues.Condusion: It is clear that the cigarette companies failed to fulfill the promises made to consumers inthe 1954 "Frank Statement" advertisement. The failure of cigarette manufacturers to honour thesepromises has resulted in a public that even today.remains misinformed about the health risks ofsmoking.

Cigarette manufacturers have only recently acknowl-edged the medical and scientific consensus that smok-ing causes serious diseases such as lung cancer, respira-

tory disease and heart diseasc.!" For most of the past 100years, cigarette manufacturers have told smokers that theirproducts were not injurious to health.":" In fact, cigarettecompanies frequently promised consumers that their brandswere better for them than their competitor's brands becausethe smoke was less irritating, smoother, and milder." In 1935,RJ Reynolds told consumers that Camel cigarettes were somild that "they don't get your wind" and that you could"smoke all you want". In 1943, Philip Morris told smokers"you're safer smoking Philip Morris ... this cigarette has beenscientifically proved less irritating to the nose andthroat ... eminent doctors report that every case of irritation ofthe nose and throat due to smoking cleared completely ordefinitely improved:' In 1943, Lorillard promoted its Old Goldbrand by claiming it was "lowest in nicotine, lowest in

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throat-irritating tars and resins:' In 1946, Brown andWilliamson used baseball legend Babe Ruth to pitch Raleighcigarettes, with the claim that "Medical science offers proofpositive, .. No other leading cigarette is safer to smoke!" Ironi-cally, Babe Ruth later died of throat cancer.

As publicity about the health risks of smoking increased inthe 19505 the industry recognised tha t the design of productsthat were perceived by consumers to be safer could be profit-able. For example, in 1953 one unnamed tobacco companyresearch director was quoted as saying: "Boy, wouldn't it bewonderful if our company was the first to produce acancer-free cigarette? What we could do to competition.'?' In

Abbrevj<lIions: CTR, Council for Tobacco Research; FDA, Food andDrug Administration; RfP, request for production; SAB, scientiFic advisoryboard; TIRC, Tobacco Industry Research Committee

Consumer misperceptions about health risks

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illl

the 1950s and 1960s, in response to information linking ciga-rette smoking with cancer, the tobacco industry propagatedmassive amounts of advertising that helped position filtersand lower tar cigarettes as technological fixes." su

Product claims of less throat irritation, milder tastingsmoke, and low tar and low nicotine were good selling pointsfor cigarette brands as demonstrated by the increasing marketshare of filtered cigarettes in the 19505 and 1960s and later bythe growth of low tar/low nicotine brands in the 1960s."Ironically, medical science has shown that making cigarettesmoke milder, less irritating, and lower in nicotine increasedsmokers' ability to inhale the smoke into their lungs therebynegating any health benefit that might have been gained byaltering the product. ll-)4 The question of when cigarettemanufacturers should have known about the serious healthconsequences of smoking their products and what they toldconsumers about these risks is the crux of current litigation.

Evidence now indicates that senior scientists and executiveswithin the cigarette industry knew about the cancer risks ofsmoking as early as the 19405" and were aware that smokingcould cause lung cancer by the mid 19505." By 1961, cigarettecompanies had access to dozens of published scientific studieswarning that cigarette smoking and chemical agents found intobacco smoke might cause cancer." Despite growing knowl-edge of the serious health risks associated with cigarettesmoking, cigarette companies continued to reassure smokersthat their products were safe. InJanuary 1954, Philip Morris,RJ Reynolds, Brown & Williamson, Lorillard, and AmericanTobacco jointly placed an advertisement entitled "A FrankStatement to Cigarette Smokers" which appeared in 448newspapers in 258 cities, reaching an estimated 43 245 000people.'" The "Frank Statement" advertisement questionedresearch findings implicating smoking as a cause of cancer,promised consumers that their cigarettes were safe, andpledged to support impartial research to investigate allega-tions that smoking was harmful to human health. This paperexamines the extent to which cigarette companies fulfilled thepromises made to consumers in the 1954 "Frank Statement"advertisement and the effect of these promises on consumerknowledge, beliefs, and smoking practices.

METHODSThis study reviews statements made since 1954 by the tobaccocompanies individually and collectively through the 'IobaccoInstitute and Tobacco Industry Research Committee/Councilfor Tobacco Research on the subject of smoking as a cause dis-ease and the industry's pledge to support and disclose the'results of impartial research on smoking and health. Many ofthe industry documents evaluated in this study were obtainedfrom a collection consisting of 116 documents entitled the"Statement of Defendants' Misrepresentations" prepared byattorneys representing the state of Connecticut in the Medic-aid litigation against the tobacco industry in 1998." Inaddition, we searched for corroborating material from tobaccoindustry documents collected from the tobacco industry'sdocument websites. The websites were searched using"request for production" (RFP) codes, specified keywordsearches, and serendipitous terms identiIied in documentcitations found with RFP and keyword searches.

In order to contrast industry statements on smoking andhealth with what smokers' actually believed about smokingwe reviewed reports of public polling data on smokers' knowl-edge and beliefs about smoking and disease gathered fromtobacco industry sources and by surveys conducted by publichealth researchers.":"

RESULTSPromise 1: "We believe the products we make are notinjurieus to beolth"In October 1999, Philip Morris Tobacco Company announcedto the public on its web site that "[t]here is an overwhelming

medical and scientific consensus that cigarette smokingcauses lung cancer, heart disease, emphysema and other seri-ous disease in smokers," While some people may have Inter-preted this message to mean that Philip Morris had changedits long held position that smoking was not a cause of disease,in fact the message only acknowledged that there was medi-cal and scientific consensus that smoking caused disease, notthat Philip Morris accepted this consensus. A response fromthe Philip Morris board of directors to a shareholders' resolu-tion on this subject revealed that the company had notchanged it position about smoking and health." Theshareholders' resolution asked the company to produce areport on how it intended to correct the defects that resultedin its products causing disease. A letter sent to the Securitiesand Exchange Commission, dated 10 Pebruary 2000, on behalfof Philip Morris responding to the proposed shareholdersresolution noted that: "Mr Neuhauser's letter mischaracter-izes the Company's web site as constituting a public admissionthat cigarettes causes illness. It does nOL""

The reality is that cigarette manufacturers have onlyrecently-and in a very general way-acknowledged thatsmoking is a cause of lung cancer and other serious diseases.For example, in a recent interview, world scientific managerfor Philip Morris, Bruce Davies, stated: "[Philip Morris J is notproud of the fact that our products cause disease," Othercigarette manufacturers have followed Philip Morris' lead inproviding information to consumers about the risks of smok-ing and acknowledging that there is "no such thing as a safecigarette,"?" However, for the most of the past century,cigarette manufacturers have assured the public that the useof their products was safe.

The 1954 "Frank Statement" advertisement assured consum-ers that research into tobacco use and human health did notsubstantiate generalised charges against smoking as a cause ofcancer.' ,. Tohelp support the claim that their cigarette productswere not injurious to health the Frank Statement advertisementinformed the public that "distinguished authorities point outthat there is no proof that cigarette smoking is one of thecauses",'" However, this statement is misleading since some ofthe medical au rhorities identified as questioning the evidencethat smoking was a cause of cancer did acknowledge that theremight be some merit to the hypothesis, only that more researchwas needed.""

According to Edwin Jacobs, a lawyer who represented thetobacco industry, many industry officials in 1953felt that daimsabout smoking and lung cancer were unsubstantiated andwould eventually be proven false." Such beliefs may account forsome of the bold promises and statements made by cigarettemanufacturers around the time of the Frank Statement adver-tisement. For example, in a 1953 interview, Paul Hahn,president of the American Iobacco Company, stated: "It [here isno proof of lung cancer in any person traceable to tobacco or anyform of tobacco product:" In two 1954 speeches made by PhilipMorris vice president George Weissman, he promised: "[I]f wehad any thought or knowledge that in any way we were sellinga product harmful to consumers, we would stop businesstomorrow" The 1953 annual report from Lorillard TobaccoCompany told stockholders: "[w]e believe Lorillard products arenot injurious to anyone's health, but that we accept as an inher-ent responsibility of our corporate citizenship the obligation tomake the public's health our business?"

Whether or not the top cigarette executives believed theirown statements that smoking was safe, at least some of theirscientists clearly thought otherwise. In 1953, a young chemistat RJ Reynolds', Dr Claude Teague, conducted a comprehen-sive literature survey on smoking and cancer in which hereferenced 78 scientific papers on the topic of smoking andcancer." Based on. this comprehensive literature review,Teague concluded: "studies of clinical data tend to confirm therelationship between heavy and prolonged tobacco smokingand incidence of cancer of the lung. Extensive though incon-clusive testing of tobacco substances on animals indicates the

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Cummings, Morley, Hyland

probable presence of carcinogenic agents in thosesubstances."" Teague was employed at RJ for Reynolds' for 35years ( 1952-1987) and held various executive level positions atthe company including that of director of research and devel-opment.

In 1956, a chemist who later also became the director ofresearch at RJ Reynolds, Dr Alan Rodgrnan, commented onthe implications of his research studies that had set out to iso-late and/or identify several polycyclic aromatic hydrocarbonspresent in the cigarette smoke of Camel cigarettes." Rodgmanstated in 1956 that: "[s [ince it is now well established thatcigarette smoke does contain several polycyclic aromatichydrocarbons and considering the potential and actual carci-nogenic activity of a number of these compounds, a method ofeither complete removal or almost complete removal of thesecompounds from cigarette smoke is required?" In a 1959memo Rodgman noted that: "there is a distinct possibility thatthese substances [polycylic hydrocarbons] would have a carci-nogenic effect on the human respiratory system?" Scientistsat R1 Reynolds were not the only ones acknowledging theprobable association between smoking and cancer. A 1958report authored by a British American Tobacco scientist whovisited with leading industry and non-industry scientists inthe USA and Canada, noted that: "with one exception theindividuals whom we met believe that smoking causes lungcancer.?" A 1961 Liggett and Myers memorandum stated thatthere are "biologically active materials present in cigarettetobacco. These are: a) cancer causing; b) cancer promoting;and c) poisonous:';' By 1978, a scientist at Lorillard acknowl-edged that: "[tjhc [smoking] habit can never be safe."?"

However, while internally acknowledging the mountingevidence showing a link between smoking and disease,cigarette manufacturers continued to deny the validity of thehealth charges against smoking externally. In 1957 speech tomembers of the Burley Auction Association, Philip Morrisexecutive, George Weissman declared: "there is not one shredof conclusive evidence to support the link between cigarettesmoking and lung cancer," In the 1959 annual report fromLorillard Ibbacco, company chairman Lewis Gruber com-mented on new evidence pertaining to health in relation totobacco by assuring stockholders that: "I believe in the inno-cence of om products as well as their future." A 1963 letter toan elementary school teacher from RJ Reynolds 'lobacco Com-pany assured the teacher that: "medical science has beenunable to establish that smoking has a direct causal link withany human disease."

Even after the Surgeon General issued his report on smoking'and health in 1964,cigarette companies continued to cast doubton the link between smoking and cancer. A 1968 Tobacco Insti-tute publication entitled "The Cigarette Controversy" stated "noscientific proof, then, has been found to convict smoking as ahazard to health." A 1969 advertisement published in the NewYork Times by the American 1bbacco Company proclaimed:"[w]e believe the anticigarette theory is a bum rap':"

In 1971, the chairman of Philip Morris, Joseph Cullman,appeared on the TVnews show, Face the Nation, and declared:"we do not believe that cigarettes are hazardous; we don'taccept that.?" In 1972 interview with the Wall Street Journal,Philip Morris vice president James Bowling repeated the com-pany's promise to consumers two decades earlier that "if ourproduct is harmful, we'll stop making it."'· Bowling repeatedthe company's position on smoking and health in a 1976interview when he noted: "from our standpoint, if anyone everidentified any ingredient in tobacco smoke as being hazardousto human health or being something that shouldn't be there,we could eliminate it. But no one ever has.?" In a 19761e[1ersent to an individual who had written a letter to the R1 Rey-nolds Tobacco Company after his father had been diagnosedwith lung cancer, the company responded that: "this Companydoes not regard itself as being in any way responsible. Wefirmly believe that cigarettes have been unfairly blamed as a

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cause of human dlscase.?" In a 1978 magazine interview Wil-liam Dwyer, vice president of the Tobacco Institute, stated: "wetake the view that the best science can say is that cigarettesmoking may be hazardous. And then it may not be.:" A 1978Philip Morris publication entitled "Facts About the SmokingControversy" stated: "scientists have not determined whatcauses cancer ... cigarettes have never been proven unsafe.':"

Throughout the 19805 and 1990s the cigarette industry heldfast to the view that scientists had not proven conclusively·that smoke or any of the thousands of its constituents asfound in cigarette smoke causes human disease. A 1990 lettersent by RJ Reynolds to the principal of an elementary schoolin upstate New Yorkdeclared: "[d]espite all the research goingon, the simple and unfortunate fact is that scientists do notknow the cause or causes of the chronic diseases reported tobe associated with smoklng.:" The letter encouraged theschool principal to share this information with his fifth gradestudents. In the 1994 Congressional hearing before theSubcommittee on Health and the Enviromnent, industryexecutives again expressed their belief that smoking had notbeen proven to be a cause of cancer." As recently as 1998, asenior research scientist at RJ Reynolds testified that: "[l]t'snot scientifically established that smoking by itself causesdiscase.?" In 1998, Philip Morris chairman Geoffrey Bibleresponded to the question "has anyone died from smokingcigarettes?" in the following manner: "I don't know if anyonedies from smoking tobacco, I just don't know?"

Promise 2: "We are pledging aid and assistance to theresearch effort into all phases of tobacco use andhealth"The 1954 "Frank Statement" advertisement promised the pub-lic that the tobacco industry would support research into allphases of tobacco use and health.'" Towards this end, thetobacco industry announced the establishment of the TobaccoIndustry Research Committee (TIRC), which later becameknown as the Council for Tobacco Research (CTR,. The statedgoal of the TIRC was "to investigate and make known to thepublic facts about tobacco use in relation to human well-being.:" According to a 1957 TIRC press release: "[o]ur solepurpose is to encourage and support qualified researchscientists in their efforts to learn more about these complexproblems [cancer and heart disease],"?' However, many TIRCand CTRfunded research projects were only remotely related tosmoking and health, as acknowledged in a 1960 court case (theLartiquc trial) by the first scientific advisory board (SAB) chair-man ofTIRC, Dr Clarence Cook Little." Little "testified that TIRChad conducted no studies of tobacco smoke because it had neverbeen proven to be carcinogenic. He viewed such a study a wasteof time. Similarly Little refused to conduct animal experimen-tation because he believed that it was only relevant to animals,not human beings. Finally, TIRC did not sponsor epidemiologi-cal studies.'?' Evidence that CTR funded research projects hadlittle to do with smoking and health was Iurther confirmed in a1989 survey of CTRfunded scientists, which asked grantees iftheir research had anything to do with understanding the rela-tionship between smoking and health. Only one of six scientis tsresponded affirmatively to this question:'

While the tobacco industry touted the SAB"independence"to determine what research was deemed worthy of support-ing, the SAB was selected by the tobacco companies. It isnoteworthy that no person known to favour the cigarette/disease hypothesis was selected to serve on the originalSAB." The independence of the TIRC/CTR can also bequestioned by the amount of money disbursed either directlyto the chair of the SAB and to SABmembers themselves or tothe institutions with which they were affiliated." Two boardmembers, Dr Richard Bing and Dr Hans Meier, received grantsfrom the TIRC/CTR each of the years they served on theSAB,'" The independence of the TIRC/CTR was even ques-tioned by the president of American Tobacco Company (RK

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Heiman) who in 1977 wrote: "Another side result of our newdirection is that we seem to be combining in one person, aScientific Director and a quasi-grantee, a combination whichis hardly compatible with the administration of an objectiveand independent grant program."!

Internal industry documents also reveal that industry scien-tists questioned the scientific value of research produced by theTIRC/CTR.For example, the director of research for Philip Mor-ris said in 1970 that: "[Ijt has been stated that CTRis a programto find out the truth about smoking and health. What is truth toone is false to another. CTRand the Industry have publicly andfrequently denied what others find as truth. Let's face it. We areinterested in' evidence which we believe denies the allegationthat cigarette smoking causes dlsease.:" Nates from a 1978meeting of the officials of the major tobacco companies to dis-cuss the future role of the CTRreveals that CTRwas consideredvaluable primarily for public relations purposes."

Despite the fact that much of the research supported by thetobacco industry had little to do with understanding thehealth effects of smoking, cigarette companies publicised theirsupport of scientific research as a way to reassure the publicthat an answer to the question of whether smoking causeddisease would be forthcoming. For example. a 1958 pressrelease from the Iobacco Institute declared that: "[tjhe indus-try itself is contributing millions through unbiased scientificresearch facilities to find the truth.":" In a 1957 magazine arti-cle authored by Clarence little, director of the TIRC, he wrotethat: "[tjhe industry intends to support research until thesecharges can be proved or disproved by direct experimentalevidence.":" A 1962 press release from the Tobacco Institutereassured the public that: "[w]e in the tobacco Industryrecognize a special responsibility to help science determine thef'acts.?" In a 1966 speech by Philip Morris president JosephCullman to members of the South Carolina Tobacco Ware-house Association, he stated: "We feel a deep sense of respon-sibility to our cigarette smokers ... We intend to leave noresearch question unanswered in our quest for the truth?" Ina 1976 letter from RJ Reynolds to the family member of a lungcancer patient, Reynolds noted: "[y]ou may be interested inknowing that we and others in our industry have for manyyears supported scientific research to learn the true factsabout smoking and health?" In 1985, RJ Reynolds took outadvertisements in major newspapers and magazines whichstated: "We believe in science. That is why we continue to pro-vide funding for independent research into smoking andhealth ... Science is science. Proof is proof. That is why thecontroversy over smoking and health remains an open one.?"A 1990 letter from the RJ Reynolds Tobacco Company to anelementary school principal stated that: "the tobacco industryin a sincere attempt to determine what harmful effects, if any,smoking might have on human health, established the Coun-cil for Tobacco Research - USA:'"

During its four decade history the TIRC/CTRnever acknowl-edged that smoking had been proven to be a cause of cancer orather serious diseases in smokers, even though the vast major-ity of CTR funded scientists themselves believed that cigarettesmoking was responsible for a wide range of serious, and often,fatal diseases," It appears that the cigarette companies wereunwilling to accept the opinions of the scientists it had deemedworthy to support. More striking is the fact that during thesame period when cigarette companies expended billions ofdollars to design and market cigarette brands that ostensiblylowered a smoker's exposure to the harrnlul constituents intobacco smoke, research on the health benefits of theseredesigned products was virtually nonexistent." rs

Promise 3: "We always have and always will cooperateclosely with those whose task it is to safeguard thepublic health"The 1954 "Frank Statement" advertisement told the publicthat the tobacco industry "will cooperate closely with those

whose task it is to safeguard the public health:' , ,. However,rather than cooperate, there is abundant evidence that thetobacco industry went to great lengths to undermine tobaccocontrol efforts of the public health community. The formerdirector of the US Food and Drug Administration (FDM, DrDavid Kessler, has recently described the efforts of the indus-try to avoid regulation by the FDA.74Other recent publicationshave also documented how Philip Morris, RJ Reynolds, andBrown & Williamson attempted to thwart public health effortsto curb tobacco use.":" Additionally, it is clear that the tobaccoindustry has endeavoured to influence or undermine specifictobacco control efforts and credibility of public healthofficials."" A 1972 Tobacco Institute memorandum from vicepresident Fred Panzer to Tobacco Institute president Horace.Kornegay describes the industry's strategy "for nearly twentyyears" consisted of "creating doubt about the health chargewithout actually denying it"; "advocating the public's right tosmoke, without actually urging them to take up the practice";and "encouraging objective scientific research as the only wayto resolve the question of the health hazard.'?" The documentdescribes that although this strategy had been effective in liti-gatlon and "on the political front" it was rapidly becoming apublic relations failure. Panzer stressed: "the public ... mustperceive, understand, and believe in evidence to sustain theiropinions that smoking may not be the causal factor in lungcancer. As things stand, we supply them with too little in theway ofready made credible alternatives.:" He then points out"two such credible alternatives exist": the "constitutionalhypothesis" that smokers differ in substantive ways fromnon- smokers; and the "multifactoral hypothesis" that "as sci-ence advances, more and more factors come under suspicionas contributing to the illnesses for which smoking isblamed ... "'. Panzer goes an to outline a plan to disseminatesuch information in a believable manner to the public. Otherdocuments indicate that such research was supported by thetobacco indus try."

The 1954 "Frank Statement" advertisement also told thepublic that the tobacco industry had" an interest in people'shealth as a basic responsibility, paramount to every other con-sideration in our business."'" The goal of supporting researchon smoking and health was, the companies claimed, to findout if their products posed a health hazard and then to sharethis information with consumers. In 1955, the director of theTIRC, Dr Clarence Cookdid a TVan interview with Edward RMurrow in which he was asked the following question: "Sup"pose the tremendous amount of research going on were toreveal that there is a cancer-causing agent in cigarettes, whatthen?" Little replied: "[I]t would be made public immediatelyand just as broadly as we could make it, and then effortswould be taken to attempt to remove that substance orsubstances:" A 1968 press release from Philip Morrisdeclared: "[w]e would like the public to be fully informed,'?" A1970 advertisement from the Tobacco Institute said: "[t]he'Iobacco Institute believes the American public is entitled tocomplete, authenticated information about cigarette smokingand heal th:"

Despite the promise made to disclose information aboutsmoking and health issues to the public, internal industrydocuments reveal that cigarette companies failed to keep thispromise. A 1953 document from the files of the publicrelations firm of Hill and Knowlton which helped create theTIRC, suggests that the purpose of the "Frank Statement"advertisement was to assure smokers that it was safe to smokerather than to share what was known about the healthdangers of smoking: "There is only one problem---confidence,and how to establish it; public assurance, and how to createit ... And, most important, how to free millions of Americansfrom the guilty fear that is going to arise deep in their biologi-cal depths-regardless of any pooh-poohing logic-every limethey light a cigarette":" A 1962 internal report an the "smok-ing and health problem", written by RJ Reynolds scientist Dr

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Alan Rodgman, reveals that: "Members of this [Reynolds]Research Department have studied in detail cigarette smokecomposition. Some of the findings have been published. How-ever, much data remain unpublished because they areconcerned with carcinogenic or co-carcinogenic compounds orpatentable ruaterial.?"

Given the cigarette industry's promise to investigate thesmoking and health question, one would expect to findnumerous references to scientific papers authored by industryscientists in the medical and public literature. However, thisturns out not to be the case. We performed an author queryusing the Center for Disease Control's Smoking and Healthdatabase using the names of 29 tobacco company executives,senior industry scientists, and scientific leaders affiliated withthe TIRC/CTRmentioned in the documents reviewed for thisstudy (see footnote for the names of individuals included inthis analysis). The Smoking and Health database containsover 63 120 citations to scientific papers published on thesmoking and health question." This analysis yielded fewerthan 100 citations to papers authored by these individuals.Many of the citations for papers authored by these individualsappeared in non-peer reviewed journals or are from confer-'ence proceedings. Few of the citation from papers authored byindustry executives/scientists relate to active smoking andhealth concerns and most of the papers that do are based uponstudies with animals not humans.

It seems dear that if cigarette company scientists were seri-ously working on finding answers to the questions of smokingand health, they were not sharing their results with thebroader scientific community. The promise to discloseevidence about the health risks of smoking is also not reflectedin cigarette adver tising and promotions use d to sell cigarettes.While federal legislation began requiring cigarette companiesto place a mandated warning on cigarette packs in 1965, ciga-rette companies themselves never used their advertisements

Author queries were performed on the following tobacco industryscientists and spokespeople: PhiJlip Morris: TS Osden, H Wakeman, FEResnik, A Bavley, G Weissman, H Cullman. J Morgan; R.) Reynolds: ARodgman, K Hoover, C Teague, FG Colby, M Senkus, DE Townsend;Lorillard: AW Spears, RD Carpenter, DM Conning, CRE Coggins {alsoworked lor RJ Reynolds); Brown and Williamson/BAT: RB Griffith, CDEllis, J Wigand; American Tobacco: PM Hahn, HSN Green, RKHeimann;Ligge! and Myers: JD Mold; TJRC/CTR: CC little, JF Glenn, GH Sere, SCSommers, HC McAllister.

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to inform consumers about what they knew about the serioushealth risks related to smoking, the presence of cancer causingagents in cigarette smoke, and the problem of compensatorysmoking. On the contrary, cigarette brand marketing duringthe past half century was designed primarily to reassuresmokers that they could get good taste by smoking a low tar,filtered cigarette.

Consumer beliefs about the health risks of smokingIn litigation, cigarette companies have argued that they arenot responsible for any health problems that might arise fromsmoking because smokers have always been aware of thehealth risks involved with smoking cigarettes." Even if smok-ers have known of the health risks of smoking, which it is notthe case, the fact remains that many smokers optimisticallyassume that their personal risk of illness is no greater thanaverage!' This belief is due in part to the misperception thatmany smokers have that they will be able to stop smokingbefore health problems occur:" " This optimistic perception ofone's ability to stop smoking ignores evidence showing thatthe majority of smokers are dependent on nicotine, whichinhibits their ability to stop smoking easily.'?"

While population surveys do show that smokers today gen-erally recognise some health risks from smoking, this has notalways been the case. Beliefs about smoking as a cause of lungcancer have changed over time. According to the GallupOrganization, in January 1954,41 % of people answered, "yes"to the question "Do you think cigarette smoking is one of thecauses of lung cancer, or not?"" In September 1999, 92% ofpeople answered "yes" to this same question." Polling datacollected by cigarette companies reveal that the companiesthemselves recognised that smokers were misinformed aboutthe health risks of smoking. For example, a 1959 Elmo Roperand Associates poll conducted for Philip Morris found thatwhile many smokers perceived cigarettes as "bad for you",there was "surprising little concern about the health aspectsof cigarettes.?" According to the poll, concern about health"seems directed at the avoidance of throat irritation and theconsequent search for mildness which seems to be a majorasset of til ters."" A 1970 study sponsored by RJ Reynolds todetermine consumer attitudes toward the idea 01' a "substi-tute" product for cigarettes reported that 68% of smokersanswered either "true" or "don't know" to the statement:"Cigarette smoking in moderation is safe."

In 1977, Dr Martin Fishbein reported to the Federal TradeCommission that "almost 50% of all current smokers had not

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fully accepted the proposition that smoking cigarettes is dan-gerous to health" and that "the American public is presentlyuninformed [about smoking] by almost any definition ofInformed.':" Evidence from recent surveys of smokers' knowl-edge and beliefs, as summarised in table L suggests thatsmokers continue to be misinformed about smoking."'""'"" "Cohen reported results of a national probability telephonesurvey, in which he found that few smokers knew the tar lev-els of their own cigarettes and most did not know how tointerpret the tar ratings." Filter vents are key to reducing thestandard tar and nicotine yields of cigarettes. All Ultra Light(1-5 mg tar) and Light brands (6-15 mg tar) of cigaretteshave ventilated filter tips. Vent blocking during smoking willincrease the amount of tar the smoker will be exposed to.Thus, it is important for smokers to be aware of the filter ventsin their cigarettes so they are not blocked during smoking.Kozlowski and colleagues found that few Massachusetts ciga-rette smokers were aware of the filter vents in theircigarettes." Hastrup and colleagues recently reported theresults of a convenience survey of 52 current and 24 formersmokers, which found that 53% incorrectly believed that theaddition of a filter would make the cigarette safer," Cummingsfound a similar result from a nationwide sample of 1046smokers who were asked whether the addition of filters Of thereduction of tar levels in cigarettes has made smoking safer."Finally, Ayanian and Cleary reported the results of a 1995nationwide survey, which found that 30-40% of smokersfailed to acknowledge their higher average risk of heartdisease and cancer caused by smoking:" Previous reviews ofindustry documents related to the marketing of low tar ciga-rettes have demonstrated an awareness on the part of thecigarette companies that smokers did not appreciate thatswitching to a low tar cigarettes was no safer than smoking aregular cigarette because of compensatory smoking (that is,puffing harder, smoking more of each cigarette, smoking morecigarettes per day)." '"

DISCUSSIONThe cigarette companies that signed the 1954 "FrankStatement" did not fulfill the promises made to the public inthat advertisement. Cigarette smoking is clearly injurious tohealth, a fact that cigarette companies have only very recentlybegun to acknowledge to the public.' However, the questionremains as to when the cigarette companies could have knownthat their products posed a serious risk to their consumers.

The tobacco documents show that the cigarette companieswere carefully monitoring the scientific literature on smokingand health before 1950, and that at least some of their scien-tists recognised that cigarette smoking was unsafe by the mid1950s. The conclusion reached by Reynolds' scientist ClaudeTeague in 1953, that long term heavy smoking was a healthrisk, is retlectcd in the writings of other industry scientistsduring the later part of the 1950s and subsequently. Forexample, a decade following Teague's 1953 report, RJ Reynoldsscientist Dr Alan Rodgman characterised the amount ofevidence accumulated to indict cigarette smoking as a healthrisk as "overwhelming" while the evidence challenging suchan indictment was "scant","

The failure of cigarette manufacturers to honour the prom-ises made in the "Frank Statement" has contributed to a pub-lic that even today remains misinformed about the tobaccoproducts that they consume.":" 7l or Notwithstanding thecigarette companies' demonstrated expertise in advertisingand marketing, and the extraordinary financial resources attheir disposal, the companies have not even been successful incommunicating to consumers their newfound belief that ciga-rette smoking is hazardous. Nearly 60% of smokers in a recent(2001) nationwide poll agreed with the statement: "[c]iga-rette companies still do not believe that smoking can causecancer"." Misperceptions about the relative health risks of

What this paper: adds . <. , "

..::::..:::.':.:'::.::::.:::.... ....::····16Uhich\H~··

Y{hlChhdvelnV~I~rt!J~~~~ct;:~P9~Sq~irg:~f~~:ht~cigarettes, smokeless tobacco products, and nicotine medica"tions may prevent smokers from switching from cigarettes toless dangerous forms of nicotine delivery." Cigarette cornpa-nies should be held accountable for making sure that personsusing their products are adequately informed about the healthrisks involved.

ACKNOWLEDGEMENTSThe research described in this paper was supported by grants [rom theNational Cancer Institute CA7702l-03, CA87696-01, and by CoreGrant CM6056-26.

Authors' affiliationsK M Cummings, C P Morley, VA Hyland, Department of CancerPrevention, Epidem io!ogy & Biostatistics, Roswell Park Cancer Institute,Elm and Carlton Streets, Buffalo, New York 14263, USA

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72 RJ Reynolds. of cigarettes and science. 25 March 1985. Bates No.513960251.

73 Stralton K. el al. Clearing the smoke: assessing Ihe science base rertobacco harm reduction. Washington DC: National Academy Press,2001.

74 Kessler O. A question "f inlenl: a greal American baHia with a deadlyindustry. New York: Public Affairs, 200 I.

75 Kluger R:Ashes to ashes: America's hundred.year cigareHe war, thepubric hearth, and Ihe unabashed triumph of Philip Morris. New York:Alfred A Knopf, 1996. .

76 Tursi F, White SE, McQuilkins S. The ax foils Surgeon General's'experts' find a smoking-cancer link and the FTC sets up hearings onrequiring warning labels; stunned cigareue.makers rally together inself-defense. Winston-Salem Journar. 7 November 1999.

77 Glanl~ SA, Slade J, aero LA, et al. The cigarette papers. Berkeley,California: Univer5ity of California Press, 1996.

78 Morley C, Cummings KM, Hyland A, ., al. Tobacco Institute lobbying atthe state and local levels of government in the 1990s. Tobacco Conlrol2002;11Isupplll:iI02-9.

79 See hltp:llwww.library.ucsf.edu/tobacco/5tate.htmlfor reports byGlantz el alan the activities of the tobacco Industry to influence andundermine tobacco control.

80 Panzer F. Subjed: the Roper proposal. Philip MOlfjs Incorporated. TheTobacco Institute. 1 May 1972. Bates No. Range:2024274199·2024274202. hltp:! /www.pmdoc5.com.

81 lincoln JE. Subject: additional thoughts on the constitulionaFtheory.Philip Morris Incorporated. 31 July 1972. Bates No.1003035041·1003035042. hup:! /www.pmdocs.com.

82 Murrow ER, Hueper WC. Selected excerpts from Edward R. Murrow's1V Program on cigarettes and iung cancer.·31 May 1955. WIH0000 1485.0000 1500.

83 Ruder & Finn Incorporated for Philip Morris. Press release: Mojortobacco company executive says that "cere, cooperation andconfidence" will provide acceptable answers to smoking andhealth controversy. 28 October 1968. Bates No.1002367358·1 002367362.

84 The Toba ceo Institute. The Tobacco Institute believes the Americanpublic is entitled to complete, authenticated information about cigarettesmoking and health. The American Cancer Society does not Seem to

. agree. 1970. Bates No. 2023038910.85 htlp:/ /outside,cdc.gav: 80B5/BASIS/.hd/ shdview/5moking/Sf.86 Spen ce r T. Engle: Doctor lcrqets tobacco company's claims.

Sur-Sentinel.com 3 November 1999 [see quote from ottcrney Dan Webb·representing Philip Morris: 'To say he [Frank Amodeo j was not aware ofthe dangers of ciqorelts smoking since that time 11964j is silly"); alsosee: Spencer T. Another Big Tobacco CEO admits cigarelles addictive,cause cancer. Sun-Sentinel.com 14 June 2000 Isee '1uote From Nicholas

Consumer misperceplions aboul heolth risks

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G Brookes, chairman and CEO of Brown and Williamson: "We believethat the risks are known fa smokers"]; also see: Herzog B, l.clts M.Anderson trial verdict. Credit Suissee/First Boston, 27 June 2000 I"Thedefendants argued that M, Anderson was well awara of the dangers ofsmoking. "J. .

87 Kessler DA. Statement on nlcotine-contoinlnq dgor-eHes. Testimonybefore House Subcom mitte" on Health and the Environment, March 25,1994. Tobacco Control 1994;3: 148-58.

B8 US Department or Health and Human S.......ices, The healthconseouances of smoking: nicoline addiclion. A report of the SurgeonGeneral, 1988. Rockville. Maryland: Publk Health Service, Centers for

Disease Control, Office on Smoking and Health, 1988. IDHHSPublication No {CDC] 88.B406.J

89 US Food and Drug Administralion. 21 CFR Pari B01, et ol.Regulations restricting sale distribution of ciqcreftes and smokelesstobacco product. to protect children and adolescents; Final Rule.Federa! Register 1995 III August); 6011551:41314-41375,41453·41787.

90 Leavell NR. Low tor lie, Tobocco ControJ 1999;8:433-6.91 Schoenbaum M. Do smokers understand the mortality effects of

smoking? Evidence from the Health and Retirement Survey. Am J PublicHealth 1997;87:755-9.

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TC Failed promises of the cigarette industry andits effect on consumer misperceptions aboutthe health risks of smokingK M Cummings, C P Morley and A Hyland

Tab Cantrol2002 11: i11 OMi117doi: 10.1136/tc.11.suppL 1.i11 0

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• Economics of TobaccoThe U.S. has a capitalist economic system Under thissystem, one or more people get together and formacompany to make and sell something. They do this tomake money. The money that they make after payingoff their bills or expenses is called profit. Inotherwords, a profit is the money they have for themselvesafter paying rent, salaries, utility bills (electricity, gas,telephone) and buying machines/computers and anyother equipment they need to make their product andrun their business.

2124f2014

It's lime wemade smukingbistory.

Title Page

Introductio n

Unit 1• What is Tobacco?

• History of Tobacco

• Reading & WritingActivities: FindingImportant FactslDetails

Unit 2

Unit 3

Unit 4

UnitS

Unit 6

Bibliography

Economics of Tobacco

From the First lathe Last Ash:The History, Etonomics & Hazards of Tobo(co

Unit 1:istory & Economics of

Tobacco

Economics of Tobacco

Economics deals with the making and selling ofproducts and services to consumers. Products arethings like chewing tobacco, cigarettes, televisions,houses, and cars. Services include medical care,education, and insurance, Consumers are the peoplelike ourselves who buy or receive the products andservices,

When companies sell more than they spend, they makea profit. Selling their products to other countries iscalled exporting. The product that is sold is called anexport. Buying from other countries is called importing,and what U.S. companies buy is called an import. Forexample, if Ford Motor Company buys steel fromJapan to make a car, it is importing a product. Steel isthe import. When Ford sells its cars to Brazil, it isexporting. Cars are the exports.

When companies or governments export more thanthey import, they have a trade surplus. A trade surplusis another way of saying a profit. On the other hand,when they import more than they export, they have atrade deficit. A deficit means a debt or money owed tosomeone else.

http://heal thliteracy.'MJrlded.org/docs/lobacco/U nit1/3economics _ of.hlml

Read More:

The GregLouganis StOlY

When RonaldReagan wascampaigning forPresident in 1980.he wrote thefollowing letter:

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Tlrroughout history, tobacco companies have had atrade surplus, That is one big reason why they havebeen important to the economy of the U.S. In 1992 thetobacco industry reported a $5.65 billion dollar tradesurplus, In the first half of 1992, tobacco exports were$2 billion more than imports. The taxes that the tobaccocompanies pay provide a lot of money for theU.S.government. In 1992, Philip Monis alone paid $4.5billion in taxes. This makes it the largest tax payer in theU.S.

"We have the 'bu-st partl'ler.tl inthe 'WorM: IhegO\"eITunents. lna lot of

coonmes, it'sincredihiy important to the\iih:ofe \"relfarestate: !ha.t 'Wf::$ell our

products to CXlI!ct:t taxa ",-_£:.11.0- ....."'Iil ....... "" • .wm."

Ii'i:~.~ ""-"",<I

Credit: Copyright © 1994 by The N ew York TimesCompany. Reprinted by permission. 'How Do TheyLive With Themselves?" Roger Rosenblatt, The NewYork Times Magazine, 3/20/94

Tobacco companies export their products (cigarettes,cigars, chewing tobacco) to at least 146 countriesaround the world. They sell to Hong Kong, SaudiArabia, United Arab Emigrates, Turkey, South Korea,Singapore, China, Russia, and many more countries, In1992 Philip Monis sold 11 billion cigarettes to Russiaalone. '

One of the reasons tobacco growing is so profitable is

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212412014 Economi cs of Tobacco

because its costs are so low. There are only about800;000 people working in the tobacco industry. Thereare 136,000 tobacco farms in more than 16 states.

Tobacco Acres Harvested byState in 1991

State 1991 AcresConnecticut 1,750Florida 6,700Georgia 40,000Indiana 7,200Kentucky 223,150Maryland 7.400Massachusetts 480Montana 3.000North Carolina 274,000Ohio 1,0,500Pennsylvania 10,500South Carolina 51,000Tennessee 61,700Virginia 53,600

West Virginia 1,800Wisconsin 7,400United States 761,080Credit: Dr. Joel Dunnington,Tobacco Almanac, Revised,May 1993

The making or manufucturing of cigarettes is ahnostcompletely automated. It is done by machines withoutpeople. Machines crush and cleantobacco leaves andadd chemicals like nicotine. They also roll cigarettes,put on filters, cut them to length, and then packagethem

All of the six U.S. companies producing cigarettes arelarge and powerful They are so strong that not even anthe medical reports of the health dangers of smokingand all the laws restricting smoking and advertising havebeen able to weaken them They are still able to makebig profits by buying up other non- tobacco companiesin the U.S. and by selling and making cigarettes outsidethe country, For example, Philip Morris bought Miller

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. 2124/2014 Economics of Tobacco

Beer and Kraft General Foods, and R.J. Reynoldsbought the Nabisco Food Group and GeneralEntertainment Corporation

Tobacco Companies: The Companies They Own &The Products They Make

PhilipMoms

Bird's Eye Louis Kemp JelloSeafood

Louis RichLight 'nLively Kool-Aid

Meats

Crystal LightLender's

KraftBagels

Minute Rice Oscar Mayer Tang

Post Cereals ClaussenLowenbrau

Pickles

Stove-Top Log CabinCountryTime

Millers Beers M . Coffe Maxwellaxnn 0 e HouseShake and

Baboli Bread Seven SeasBakeMiracle Whip Louis Rich Cool Whip

Milwaukee'sSharp's Beer

Bulls EyeBest Beer Sauce

KnudsonMeister Brau ParkayBeer . Margarine

Capri SunDiGiomo

Food ClubPasta

EntenmannsSealtest Ice BakersCream Chocolate

ChiffonRichmix Breyer'sCandy IceCream

Brooke Group (formerly Liggett &Myers)

MAl (computers, NBA Hoopsinformation systems) (baseball cards)

LineDrive Pre-rookie(base ballcards)

Basic F 01.U'

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, 2124/2014 Economi cs of Tobacco

D:istnbutor of football Marvel superhero& hockey cards cards

W orId ChampionshipWrestling cards

GI Joe cards

Terminator II moviecards

Disney cards

NFL Proline Portraits 1992 Olympic cardsStar Trek X-menFull House Perfect Strangers

DC comic bookcharacters

Farnily Matters

LorillardLoews TheatreManagement Corp.

CNA I CBulova Corp. (watches,

nsurance o. 1 k)c oc sDiamond M. Majestic ShippingOffshore Drilling Corp,Regency Hotel, Sunmrit Hotel, NewNew York York

Loews Hotels

R. J. ReynoldsRJR Nabisco Products (non tobacco)

Annual Report 1991cookies -Almost HomeFamily StyleCookies

Bakers Bonus LornaOatmeal Cookies Doone

Barnum'sBugs Bunny Cookie

AnimalCrackers

Graham Crackers Break

Biscos CameoChipsAhoy

Cookies 'NHeyday IdealFudge

Made 'emMallomars MysticMyself

NationalN ilia Wafers

NutterArrowroot Butter

Social TeaTeddy

Suddenly S'mores

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212412014 Economics of Tobacco

CheddarBetter Cheddars

WedgesDip inaChipNipsRitz BitsSwissCheeseVegetableThins

Wheat Thins ZingsGraham Cracker: Oat ThinsTrfficurr Waver~

Newtonscrackers -AmericanClassicChicken in aBiskit Crown Pilot

Harvest Crisps Honey MaidOysterettes Premium

Oreo

Royal Lunch Sociables

Twigs Uneeda

WheatsworthTid-BitRitzcereals -

Nbabisco 100% Shredded Wheatran

other products -

Comet Cups Doo Dads

Mister SaltyPretzels

NAB Packs

Mr. PhippsPretzel Chips

Cracker Meal

specialty products -Al SteakSauceCream ofWheat

grahamPinwheels

Team

EasyCheese

Mr. PhippsDips

Brer Rabbit Syrup College Inn

Davis BakingPowder

Grey Poupon Ortega MexicanMustard Food

Millebone

ReginaWines &Vinegars

Fleischmann's EggRoyal Gelatins Beaters and My T Fine

MargarinesBlue Bonnet

Cream of RiceMargarineCanada Products -

Aylmer Christie

Dad's cookies Del Monte

Ideal Canned Magic Baking

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CoronationcondimentsHarnoisCookies

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Vegetables Powder Milk bone

Nabisco RoyalCereals Peek Red Oval Farm RoseFreans VegetablesNabisco Int. -Anselmi

Aurora GelatinsBubble

Cookies YumChips Ahoy DelMonte Famosa

Gloria MilkHoney

FleischmannProducts

BranCracker

Konitos Lifesavers MartinsonCookies

o C ki Pepito Bubble Plantersreo 00 ies Gum Snacks

PortenasPremitun RitzCrackers Crackers

Royalina Saroma SnukiUniversal Cameo FiestaKraker Bran Omega Bun PommyRoyal Gelatins TrakinasPlanters Div. -Planters Nutsand snacksLifesavers Div. -

Lifesavers Gurmni SaversBreathSaversMintsBeechnutGum

Breath Savers CarefreeMints Sugarless Gum

Bubble Yum F . S' GGum nut tnpe um

American BrandsFranklin Lite British Navy Pussersmsurance RumJim Beam Kamchatka VodkaRon Rico Rum The ClaymoreW olfschmidt Vodka CrawfordsGilbey's Gin Tornintoul-GlenlivetDeKuypen Schnapps Old FettercaimWindsor Canadian Vladivar Vodka

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ScotchLord CalvertWhiskeyLeRoux Brandy Chicago SpecialtyKessler Whiskey Dearborn BrassThe Dalmore Scotch Hoov-R-LineGilbeys Vodka Anchor BrassOld Grand Dad AristoKraft CabinetsKamora DecoraACTUA Soft-Joys ShoesMasterlocks STA-SO F GlovesWaterloo Toolboxes Weather SOF GlovesCraftsman Doland and AitchinsonToolboxes Optics (UK)

Acushnet RubberProductsAll American

Swingline Staplers

Pocket Day-timer

ACCO Staples

ACCO paperclips

Perma Products

Vogel PetersonEastlight (UK)Sasco (UK)ValRex (France)Office ProductsInternational(Australia)

Hetzel (Germany)

Touch Control

Golden Belt-Cigarette FiltersPrestige PressurecookersDexter LocksWilson Jones Pads andbindersKensingtonMicrowave Computer'Access.

ACCO dataRexel(UK)Twinlock(UK)King- Mec (Italy)

Marbig- Rexel(Australia)

Titleist Go1fBalls andAccessories

Foot-Joy Golf Titleist IronsPro Trajectory Clubs Classics Golf Shoes

Brown & WilliamsonAppleton Papers Inc.

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2/24/2014 Economi cs of Tobacco

Saks Fifth Ave.Marshall Field'sIvey'sBrewersFanners Group Inc.

Credit: Dr. Joel Dunnington, Tobacco Ahmnac, 1993

We can see the power of the tobacco companies byreading about what happened to Greg Louganis, anolympic diver.

The Greg Louganis Story

The U.S. government and the tobacco companies helpeach other. Since 1964 all the Surgeon Generals of theU.S. have talked and written about the health dangersof cigarettes. Still, cigarettes are made, advertised, andsold. The tobacco industry gives thousands of dollars tohelp cover the costs of political campaigns ofpeoplerunning for political office. These are people who wantto be elected or reelected as Senators, Representatives,Vice- President, and President. In turn the politicianshelp the tobacco industry.

One way politicians help is continuing the tobacco pricesupport system Under the price support system,tobacco can only be grown on a certain number ofgovernment-approved farms, The government givesfarms special, low interest loans to help cover the costsof growing tobacco. The U.S. Department of

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2124/2014 Economics of Tobacco

Agriculture allows a certain amount of tobacco to begrown each year. This is called a quota. It also sets aminirmm price for tobacco. When the farmer takeshislher tobacco to the market, any tobacco not sold onecent above the government price is bought by growercooperatives and stored to be sold another year.

next section »

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