The Fight Against Big Tobacco

A Matter of Life and Death

(Continued)

Your university houses the Legacy Tobacco Documents Library, a collection of about 80 million pages of previously secret internal tobacco industry documents. What did we learn from this incredible cache of documents?

The thing that we learned overall is that the tobacco companies are even worse than we thought, and more cynical than we thought. The tobacco companies have been on top of the science, and probably 20 or 30 years ahead of the general public and the general scientific community, since the forties or the fifties, and have exhibited just a mind-boggling level of cynicism.

Can you give us an example of that cynicism?

Probably the single most quoted line in the documents was from 1963, from the vice president of Brown & Williamson Tobacco, who said, “We are in the business of selling nicotine, an addictive drug.” And they were still denying that nicotine was addictive when they testified in front of Congress in 1994. They’re talking about freedom when in fact they were taking people’s freedom away; talking about autonomy when they were keeping people under their thumbs; denying that nicotine was addictive when they were redesigning cigarettes to optimize their effectiveness as nicotine delivery devices — to maximize the addictive potential of nicotine; denying that smoking causes heart disease and cancer when their internal research accepted it; manipulating the way they designed scientific studies so they could avoid unpleasant results. The list just goes on indefinitely.

How did you get these documents?

The original documents were leaked to me; the bulk of the current collection was released as a result of litigation. The Minnesota attorney general insisted these documents be made public as part of the settlement of litigation with the tobacco companies, and not destroyed, which is what usually happens when a case is settled. He said the important thing to come out of the litigation was going to be the truth, not the money. And he was absolutely right. There were some minor limits put on the tobacco companies’ marketing, which are also important, but the truth is the thing that really mattered.

What was the impact of the truth becoming known?

It changed the politics. It forced a lot of politicians away from the industry; it forced a lot of these groups that were taking their money to stop taking the money. Not all of them — some still take the money. It led to a lawsuit under the federal racketeering act brought by the Clinton Administration, where the tobacco companies were found to be racketeers that are still under court-ordered monitoring. Those things all contributed to major changes in the culture.

When it comes to the individual smoker, are there quitting strategies that are more effective than others, or does it depend on the person?

The strongest predictor of success in quitting is the number of times you’ve tried. So the most important advice I give people is, whatever you think will work for you, do it — and don’t be discouraged and keep doing it. We do know that if health professionals — dentists, doctors, nurses, people like that — actively intervene and encourage their patients to quit smoking and provide them with active support, it dramatically increases success rates. There are drugs out there that will help handle the addicted smokers if they’re used properly, supervised properly. For people who are lighter smokers, which is the great bulk of people, behavioral support and education about second-hand smoke is important. But it takes time. What you need to do is give people help regularly for the first month or two. And then, once you get them over the hump, you give them ongoing support. There was just a paper published a month or two ago out of Harvard that showed an aggressive full-court press among hospitalized patients got a 30% quit rate, which is quite excellent — way better than the unassisted rate, which is a couple percent. So active intervention by health providers to help people quit smoking does work.

When you say they need behavioral support at the beginning, what specifically do you mean?

Counseling, encouragement, advice to make their home smoke-free, advice to not let people smoke around them when they’re getting cravings. This is not rocket science, and I can say that as a rocket scientist. Protocols have been very well worked out and very well tested — it’s just that they’re not widely used.

Are electronic cigarettes any safer? What should consumers know about them?

The most dangerous thing about electronic cigarettes is that they keep people smoking. A lot of people look at electronic cigarettes as alternatives to conventional cigarettes but the great bulk of people continue to do both at the same time. It’s not surprising, since the electronic cigarette market has been taken over by the big cigarette companies.

When will you know your work on this issue is done?

If we got tobacco use down to a few percent, to where it was essentially gone as an acceptable health behavior, and I think that’s eminently reachable. Like everything else around tobacco, it’s a question of political will. And tobacco companies know how to buy friends. Public opinion is on the right side of the issue. There’s just a lot of very wealthy, unscrupulous forces aligned on the other side. But despite all of that, we’ve made enormous progress. Despite all their money and PR and lawyers, we’re beating them: In California and many other places around the country and the world, you can go about your life and not have to breathe any second-hand smoke.