I decided they were critical questions i wanted to get into about what was the meaning of smoking, its impact, as an american historian, i began to realize there was almost no aspect of 20thcentury american ,ife from advertising to film medicine and science, regulation politics, that in some way could not be encapsulated by investigating the history of smoking the cigarette century. The problem again how best to do that. I added a fifth question as i was getting near the end. So did smoking come to be popular in the course of the 20th century . Almost no one smokes cigarettes as recently as 1900. Cigarette consumption was 50 per capita per adult. In 1970, it was 4000. Its really a modern behavior although tobacco use would go into the earliest days of native in the americas. Those interested in how do you create a modern behavior around major industry and this became the focus of my early work. How do you go from no one smoking in 1900 to a majority of men smoking by mid century and , a significant minority of women become smokers by mid century as well. Hello to explain what are the engines, the forces behind this remarkable rise of smoking . We know part of the answer but if we understood this in a more sophisticated, historical way, we would understand more about how to address the problem of smoking and contemporary culture. It was obviously cultural, social, relating to advertising promotion buts of what both the behavior . Some very brilliant early 20th century business then businessmen built the tobacco trust. There are very much concerned with how do you move products. On the left is the bonds at machine, which duke begin committed to. He became committed to. He overproduced. He had millions of cigarettes to sell and becomes oriented to that part of the business to motivate sales in the context of overproduction. The industry innovative time and time again the motivation of consumer behaviors. This industry convicted that invented invented card collecting. People become crucially oriented to collecting cards. What ones are missing, how to get the ones you dont have. This industry was built into tapping into that psychological behavioral than mx. Today we talk about pokemon. Bored, collecting you could doers, woman actors. This is how do you initiate and obtain the clientele. This is the industry that really withed National Brands ofnd identity. Camel is one the first National Brands. Clever slogans. It starts on the golf course when r. J. Reynolds executives are playing golf and one of them ran out of cigarettes and said walk aother one, id mile for camel. It was one of the largest running slogans in the history of tobacco. Questions in this time of building behavior was what about women smokers. Even though many men came back from the First World War very serious and they get smokers, there was a question about the propriety of advertising directly to women. This ad was an early industry advertisingout directly to women to bring them into it. Arehe late 1920s, many ads directed at women. Brides are smoking. Campaign do you nail . Inhale . Some of my students think these ads are sexually suggestive. These were drawn by a wellknown pinup artist. Racier. Them are even it. Ybodys doing another Popular Series of ads from the 30s. Said instead of a weet. Integrating. Ime of the head of tobacco in 1928 was concerned women warned smoking lucky strikes because of the green package. One of the things was should we change the color of the package and a hired the father of American Public relations and he said it change the color of the package, lets change fashion so fashion turns green. He goes to france and hires the french designers to focus on green and holds conferences about the meaning of the color green and hires academics to come and soon, green is the highfashion color. I think that story captures something about the social engineering of the cigarette during this time. We understand much more about how it was incredibly sharply articulated. Bets has a theory about the engineering of consent and that individuals needed to believe they were making individual choices in the marketplace but it was the job of the corporation to engineer those decisions perceived as individual choice. I will come back to this but this remains at the core of even contemporary arguments about the sale of tobacco today. It was not unusual to see physicians in tobacco else. Concerna good deal of about the character of the risks that were potential around these of tobacco going back to the earliest times. These ads were meant to reassure smokers who might have concerns about the impact of their smoking on health. Pitched with a therapeutic effects. Ethos. Celebrities were used in ads. Identifythat you could smokers across social boundaries, economic status was a key element. The utilization of smoking and film. The group he has done work on Product Placement but from an early time, the people in the Tobacco Industry knew that smoking in film would be beneficial. Articles about how methodically,tes all of which directors began to use in their films. Voyager with betty davis. Clyde. Eft, bonnie and beyond aht, resaonable doubt. The sexual attraction, questions of glamour. Captured in are these films. Of1950, weve gone from 2 the how did this happen . How did this happen . Aboutw a good deal more u. S. A smoking country. Is how do weestion know smoking is dangerous. Thing mostngle within, best understood modern Public Health. In 1950, this was a complex question in modern science. Has thenique we use basis of evidencebased medicine. Heres what the industry said. Medical ads from journals. Couldid everything they so the ad on your left arguing here is there a doing everything they could to divert attention away from the categorical knowledge that smoking caused disease. A number of researchers began to try to discern. You can say clearly its obvious the relationship. 1935ld invite you back to or 1951 the incidence of lung cancers beginning to rise steeply but there could be any number of hypotheses about why those cases were rising. The automobile, paving roads. The ability to determine the rise of smoking with lung cancer with a lag of 20 years was a complicated and important problem. Today we see although is often perceived that cancer has increased cancer deaths have increased, it lung cancer that stands out as the only cancer that arose so dramatically during the course of this time. This is the same chart for women. This got a lot of attention in the mid1980s when the incidents of lung cancer began to exceed the incidence of Breast Cancer among american women as a cause of death. Principaltwo of the american epidemiologists. They were crucial to the development of the epidemiological knowledge that smoking causes lung cancer. They worked with one of the great figures of medical statistics of the 20th century. Ad windsor worked with surging all you was a medical student. They demonstrated that by doing very meticulous epidemiological work demonstrating that smoking caused lung cancer. This is the way the industry responded. More doctors smoke camel than any other brand. I try to show how the industry tried to encourage the idea that the question of smoking and health should remain an aspect of independent, individual, clinical judgment as opposed to a categorical finding. Every doctor should decide for him herself whether smoking was a probe. For their pay was appropriate for their patients. In this ad on the left, the little gross says i will grow 100 years old. This is a similar ad. This one appeared in the journal of the american medical association. Theyre telling smokers to take their own judgment. This is about unseating medical and scientific knowledge. The use of euphemisms like a mild were about suggesting the problems with the product had been solved. Industry begins starting in december 1953 one of the first major campaigns of scientific disinformation, saying we need more research. They said we will commit ourselves to developing new knowledge about smoking and health. Now we know so much from the documents that this was a Public Relations effort in which one of the documents you find on the legacy collection says. Industries have used these types of campaigns, sowing the seeds of uncertainty, in order to do business in the face of new knowledge. These are the four filters. Reassured and anxious public. Arthur godfree later died of lung cancer. Frederick march. What the doctor ordered. Byound the document online rj reynolds in my 253. He says weve been doing experiments on filters and we a few very the ph, the color of the filter will change and in groups of tests with consumers we thought if we change the color to yellow or brown, consumers believe these are the most effective. At the same time, he knew these filters were not effective for removing any of the carcinogens but he said i think we should get a patent on this because it could be beneficial to marketing. This is in your collection. 1953. Molboro maybe dramatic shift from being a womans cigarette to being a filtered cigarette directed at men. This idea of the independent cowboy was one who would do things against the grain. This campaign had an encouragement of independence in the face of knowledge. Living alone on the range, the cowboy image, the image of independence from knowledge. Mid1950s, there was categorical knowledge that smoking caused lung cancer and it has been confirmed the range of carcinogens and risk in labs but it became about what is the role of this state. This is one of the sorriest stories in the history of tobacco. The question of how would Tobacco Products in the industry be regulated. On your left is a Tobacco Industry research council. One of their people on the far left is holding a cigarette. Is lutherur right terry announcing the findings of the first Surgeon Generals report. First report was an important innovation and the government taking responsibility for resolving a controversy that have been generated by an andstry for the public good now we do think of these types of consensual reports as one important mechanism for attempts to end controversies that are often generated by industries and this becomes the model for that kind of work in which they assembled a group of scientists. It would come up with a categorical conclusion. Not much good evidence regulatory initiative. Even theow that legislation requiring packages wasabeled with a warning strongly supported by the Tobacco Industry whose lawyers were warning themit would protect against possible suits. Turningegulation and it. Question isabout the responsibility for the harms of smoking. Focused on questions of the law and litigation. You are familiar with the emergence of tobacco litigation. Started suing as early as almost always without success. It was incredibly expensive to sure, e. In the book, i knew it a lot of the story of rose chipp alone. She eventually developed lung cancer and a young lawyer her out. Sought she agrees to sue five of the. Ig Tobacco Companies a the Tobacco Industry said we are not sure smoking caused lung cancer. The plaintiffs have presented evidence to suggest it did but weve resented evidence that causets smoking did not her particular type of cancer. This was a classic industry defense. They said the real issue is not her cancer and what caused it, the issue is she was an independent, intelligent woman and she knew a lot about the controversy regarding smoking, and she made an independent decision to continue to smoke. It would be wrong for the jury to hold our companies responsible for the independent and autonomous decision that alone made. These are the brands to smoke d. There were similar slide in the trial. In the closing arguments, they we saw a lot of great documents. We know they knew it caused cancer. They knew it was addictive and yet they put out apps like this like this and had a campaign to confuse their very patrons. At its time for companies to begin to take responsibility for the health carnage that over the course of the 20th centurys has caused. In the end, the jury found in favor of the company and said lone should be held responsible for her smoking. If theres any single theme in my project, it was an analysis of this question of individual versus Corporate Responsibility and how those questions have been articulated and manipulated and now im prepared to argue into our own time for questions of responsibility and adult smoking are beginning to predominate again. These are characteristic tobacco ads of the later part of the 20th century. Notoriouscampaign is for its pitch to kids. Knew itnow the industry but couldnt get at the youth market, it was done for the company and the competition with phillip morris. Even though it took great heat for running a cartoon Character Campaign pitch towards case, it did it because it knew it needed a significant percentage of the youth market. This is well documented. The industry continues in the 21st century to spend over 15 billion a year promoting cigarettes in the u. S. Alone. Some campaigns have been successful. One of the things that turned the tide against smoking were the ideas doctors were quitting. That help patients a lot. The Critical Issues of secondhand smoke. As long a smoking was perceived as individual risk, Tobacco Control programs are not going far. The idea of this risk was imposed on nonsmokers as we know from the work done here radically transformed the meaning of smoking in the second half of the 20th century. These are some of the suits that have been success will to some degree successful to some degree. This is mike moore who led the state attorney general sued suit. We dont have labels like this in the u. S. But these are labels from canada and brazil. Two summers ago and wanted to buy a pack with this label and i asked the clerk for that pack and i was crazy because customers have been trading it back for less offensive warning label. This leads me to what turns out to be the final question. Weve seen substantial reductions of smoking in the u. S. Its one of the Great Stories of Public Health in the 20th century going from almost half of volatile smoking to one in five. Obviously thats a very big number that produces many diseases but for people who say ,ts hard to change behaviors weve had significant success in reducing the numbers of smokers. I originally thought the book because because of the rise and fall of the cigarette but i realized how parochial that is. The industry has been remarkably effective in the new smokers. This raises profound moral and ethical issues for Public Health. In 2000, 4 Million People died of tobacco related diseases worldwide. Half in the developed world, half in the developing. To2030, the number will jump 10 million but of that, 7 million will be in the developing world as a result of the dramatic expansion of smoking taking place over the last 25 years. 45 timesris is doing his business in the u. S. Overseas. Its making most profits by a wide margin by selling overseas. This is a chart from my colleague robert proctor. Cited itsdely a figure widely cited. 100 Million People died of tobacco related diseases worldwide in the 20th century. The World Health Organization x more than one billion Health Organization expects more than one billion people will die of smoking related illnesses the 21st century stop this inverts our knowledge of the relation of science to practice. If we know more, we can use the knowledge in socially productive, important ways. We know more about the harms of smoking than any product and consumer history but we can expect a 10 time growth in the number of deaths in the 21st century. This raises profound questions about capacity and morality. On the left are cambodian monks. On your right is a tobacco vendor in indonesia. Scenes, one street from shanghai. Sergei, at is of sevenyearold in st. Petersburg. Smokingts on only marlboro cigarettes. This was taken in 1995. I can help but think what has happened to him, a street child in st. Petersburg. Funny finish by telling you one last story from the book. Graham d everything everet graham. He was skeptical that smoking caused lung cancer. You develop the surgical techniques for treating individuals with lung cancer in the 1930s, trying to save the lives of individuals with lung cancer. He had a debate with a colleague , a wellknown surgeon, and when he first saw the charter of the and hiscancer colleagues had never seen a lung cancer patient who didnt smoke, graham was skeptical. Eventually, graham as a result of doing his own work becomes convinced that smoking causes lung cancer. I like to read you one last paragraph. Graham had quit smoking. Be well understood the difficulty of withdrawing from nicotine. But as decades of exposure to tobacco smoke would confirm in the most personal way, what his and wonders research demonstrated. Friend, he wrote to his perhaps youve heard i recently been a patient because of a bilateral carcinoma. Oxner wrote back, thank you for your letter, which crushed me. To thinkrrible thing you have carcinoma, a condition for which youve done so much. Two weeks later, graham died, the victim of the disease that had been the center of his professional life. In the end, he became one more data point in the legal history of smoking. Smoking. History of thank you very much. [applause] mr. Brandt i would be happy to take questions. There is a microphone that will go around so we can get your questions. If you have a question, make sure you get the mike. Ic. Mic. Participant ina litigation and i wonder if you could Say Something about your colleagues in the extent to which they may have testified for one side or another and tobacco litigation. Proper nose a bit about how i feel about this he knows a bit about how i feel. Ive been skeptical about testifying in tobacco litigation. Lawyers would come to see me and i would say talk to robert proctor. I felt in a way working on the book, i wanted the book to have a standing outside of the litigation. Came to see mey from the department of justice and showed me a for statements written by expert statements written by wellknown historians. People like P