Shadow of a doubt: how they fooled us about a killer habit


ANALYSIS:For decades, cynical PR twisted the medical truth linking smoking with death – what next?

FIFTY YEARS ago this week, the UK’s Royal College of Physicians published its landmark report, Smoking and Health. It stated conclusively that cigarette smoking was a leading cause of lung cancer and bronchitis, as well as contributing to heart disease.

Public reaction was muted. Some 70 per cent of men were smokers at the time, and the habit was widely socially acceptable. Few wanted to hear that an enjoyable habit could also be so dangerous. Coming to accept the uncomfortable new facts about smoking would mean having to decide if it was really worth the risk. At a societal level, a product that was killing as many as one in two of its customers would at the very least have to be regulated.

Then again, in 1962, your family doctor quite probably smoked in his surgery, while his female patients continued smoking throughout pregnancy. That’s how widely accepted and poorly understood the consequences of tobacco consumption were just half a century ago.

The toll, for such a seemingly minor vice, has been astonishing. In the 20th century, about 100 million people died prematurely as a direct result of smoking, with millions more suffering nonfatal illnesses. That’s more than the total number killed in both World Wars. The World Health Organisation describes tobacco use as “the leading cause of preventable death in the world”. It is a risk factor in six of the eight leading causes of death globally.

In Ireland, smoking kills up to 7,000 people annually – that’s 35 times more than our total road fatalities. Despite the risks, at least one in four Irish adults still chooses to smoke. Tobacco is also a class issue in Ireland; prevalence among lower socio-economic groups is almost double that of professionals. Some 56 per cent of poorer women under 30 are now smokers.

Medical evidence linking smoking to lung cancer first came to light in Germany in the 1930s. The world’s first antismoking campaign was run by the Nazi government, while Hitler forbade all smoking in his presence. The tarnished reputation of German scientists meant little wider notice was taken of these findings.

Then, two decades later, US researchers established a direct link between smoking and cancers in 1953. This breakthrough study provoked a firestorm of media coverage. The tobacco industry was plunged into crisis. Marketing a popular, lucrative product suddenly found to be inadvertently causing the deaths of millions of your customers is a nightmare scenario for any business.

The rapid accumulation of hundreds more scientific studies throughout the 1950s confirming the dangers inherent in tobacco products left the industry with a clear choice: either accept the science and agree to more regulation and taxes – or wage war on the science itself. Fatefully, they chose to fight.

In what decades later was described by the federal courts as one of the largest conspiracies to commit fraud ever perpetrated in the US, tobacco industry chiefs called in their PR experts and together devised a plan to undermine the scientific evidence, befuddle the media and lead the public to mistakenly believe the “science wasn’t settled”. To succeed, they had to create the impression that many scientists disagreed that cigarette smoking was in fact dangerous.

The blueprint for this widescale deception became known as the Tobacco Strategy. It was brilliantly successful in delaying regulation of tobacco products because it was, at heart, simple. The PR strategists recognised the public has a poor grasp of how scientific or medical understanding is developed and advanced, and, crucially, so does the lay media.

“Doubt is our product,” an industry memo from 1969 said, “since it is the best means of competing with the ‘body of facts’ that exists in the public mind.” If tobacco causes lung cancer, why are some smokers unaffected? Why do more men than women get cancer? Why are lung cancer levels higher in some cities than others if it’s really tobacco to blame?

The genius of this tactic is even though the industry knew there were legitimate explanations for all these anomalies, simply asking the questions inferred these were real scientific controversies. The media was drawn into this bogus debate and began to frame its function as “refereeing” between scientists and industry spokesmen in the newly minted “controversy” about whether or not tobacco causes cancer. The New York Timesuntil 1979 had a formal editorial policy of including tobacco industry comment in every article on tobacco and health.

The tobacco industry also channelled enormous sums of money into biomedical research in an attempt to develop explanations – other than tobacco – for a range of medical conditions. This also allowed the industry directly to fund hundreds of researchers, many of whom would later testify as pro-industry expert witnesses in legal actions.

In the book Merchants of Doubt, science historian Prof Naomi Oreskes uncovers how a handful of once-reputable scientists, bankrolled by industry funding and channelled through libertarian “think-tanks” and phoney grassroots (astroturf) movements have applied the Tobacco Strategy blueprint repeatedly to argue against health and environmental regulations on issues from mercury to acid rain, ozone depletion and global warming.

Conservative Yale economist William Nordhaus recently pointed out that while tobacco sales in the US today are under $100 billion, its energy sector is a trillion-dollar business. Since addressing global warming would hit fossil-based businesses, he warned of the need for “extreme vigilance to prevent pollution of the scientific process by the merchants of doubt”.

Evidence of this contamination emerged with the recent leaking of internal documents from the Heartland Institute, a libertarian group that has long fought regulations on second-hand tobacco smoke on the false grounds that it is not harmful. The same group is now, with energy-industry funding, seeking to corrupt the teaching of basic science to US schoolchildren as part of its war on climate science.

The president of the American Association for the Advancement of Science said recently she was “scared to death” by the success of antiscience zealots. “We are sliding back into a dark era,” was Nina Fedoroff’s conclusion. The lessons of the Tobacco Strategy brings to mind the old proverb: fool me once, shame on you. Fool me twice, shame on me.

John Gibbons is an environmental writer and commentator. He tweets under @think_or_swim and is online at