Allan Brandt, a leading US historian of medicine, provides a superb history of the century of the cigarette in the USA. He explains the technological and social reasons for the victory of the cigarette over all other methods of tobacco use; the key role played by the first world war in legitimating cigarette smoking; and the success of advertising and public relations in the 1920s and 1930s in making smoking such a pervasive habit that by 1950 over half of all men and a fifth of all women in the United States smoked cigarettes.
Brandt also provides a detailed excellent account of the discovery of the health harms of cigarette smoking. He describes the clinical observations in the 1920s, actuarial analyses of smokers' life expectancies in 1930s, and the epidemiological research of Doll and Hill in Britain, and Wynder and Graham in the United States in the early 1950s. The subsequent debate within the medical profession about the probative value of epidemiological evidence is well covered, as is the industry's PR strategy of maintaining a spurious controversy by amplifying the views of sceptics like Berkson and Fisher.
The 1964 US Surgeon General's report is justifiably given a central role in convincing the medical community that cigarette smoking was a contributory cause of lung cancer, heart disease, and obstructive pulmonary disease. Brandt makes good use of industry documents in describing the industry's response to the report, reassuring anxious smokers by promoting cigarette filters and “low tar” cigarettes without explicitly acknowledging that smoking was harmful.
The most depressing aspect of the history is the success of the tobacco industry over 40 years in delaying and subverting attempts to regulate their product. In the 1960s they bought Congressional votes and used corporate lawyers to write legislation that allowed them to evade legal liability for the health consequences of smoking. They also appear to have survived the “killer blow” of suits for damages brought by US state attorneys general in the 1990s as well as a suit for racketeering brought by the US Department of Justice in the 1990s and 2000s.
Success for tobacco control efforts comes later in the story with the use of evidence on environmental tobacco smoke in the 1980s to justify restrictions on smoking that undermined the idea that it was permissible to smoke anywhere, anytime. The release of incriminating internal industry documents in the 1990s (a byproduct of tort suits and whistle‐blowers) eliminated any residual credibility of the industry by exposing the amorality and duplicity of its executives.
This book should be read by anyone who is interested in understanding the extraordinary rise of the tobacco cigarette in the United States in the first half of the 20th century and the reasons for its more gradual cultural retreat since the early 1980s.