Preface

Tobacco is the leading preventable cause of death: cigarettes and other tobacco products kill 420,000 American smokers and 53,000 nonsmokers every year. This toll exceeds the deaths resulting from alcohol abuse, AIDS, traffic accidents, homicides, and suicides combined . Nevertheless, the tobacco industry continues to promote and sell its products, unhampered by any meaningful government regulation except for mostly local restrictions designed to protect nonsmokers from the toxins in secondhand tobacco smoke. In fact, the tobacco industry is unique among American and worldwide industries in its ability to forestall effective government regulation and to hold effective public health action at bay while marketing its lethal products. The industry manages this, despite the overwhelming scientific evidence that tobacco products kill, through a combination of skilled legal, political, and public relations strategies designed to confuse the public and to allow it to avoid having to take responsibility for the death and disease it inflicts.

Many public health workers and tobacco control professionals—including the authors of this book—have long suspected that the tobacco industry has known that smoking is dangerous and addictive. But proof to substantiate this suspicion has not been available to the medical and scientific communities, much less to the public. This situation changed dramatically in mid-1994, when an unsolicited box containing several thousand pages of documents from the Brown and Williamson Tobacco Corporation (B&W) arrived at Professor Stanton Glantz's office at the University of California, San Francisco. Like the Pentagon Papers, which

revealed private doubts about the Vietnam War inside the government a generation ago, these documents, combined with other material obtained from Brown and Williamson by the House of Representatives Subcommittee on Health and the Environment, and some private papers from a former research director at B&W's parent, British American Tobacco (BAT), provide a candid, private view of the tobacco industry's thoughts and actions over the past thirty years. This view differs dramatically from the public image presented by the industry during that time.

Early in this period B&W and BAT frankly recognized that nicotine is an addictive drug and that people smoke to maintain a target level of nicotine in their bodies. The companies also recognized that smoking causes a variety of diseases, and they actively worked to identify and remove the specific toxins in tobacco smoke that cause these diseases. This scientific work was undertaken many years before the mainstream scientific community had a similar understanding of these issues. Nevertheless, in the mid-1960s, when the US Surgeon General's Advisory Committee was preparing the first Surgeon General's report on smoking, B&W and BAT withheld this important information, even though the Surgeon General's Advisory Committee had requested that the tobacco industry voluntarily provide the relevant results of its research for the committee's deliberations. Later, when it became clear that a "safe" cigarette could not be developed, tobacco industry lawyers took increasing control of scientific research as they tried to insulate the companies against products liability lawsuits. In the process, concerns about legal matters and the public's perceptions of the dangers of smoking and the tobacco industry increasingly took precedence over public health.

This book represents our complete analysis of the Brown and Williamson documents. On July 19, 1995, we published a series of five articles, based on these materials, in the Journal of the American Medical Association . The decision to publish these papers represented a courageous stance on the part of the editors of JAMA and the leadership of the American Medical Association. We are grateful to the editors of JAMA , in particular Drummond Rennie, for providing the first forum for our work.

We are likewise grateful to the National Cancer Institute (Grant CA-61021) and the University of California Tobacco Related Diseases Research Program (Grants 2KT-0072 and 4RT-0035) for supporting this work. We also thank Phil Lollar of UCSF and Robin Barthalow and Tim Nolan of Lieff, Cabraser and Heimann, who provided assistance in indexing the documents. Adriana Marchione of UCSF was invaluable in

final manuscript preparation, particularly in helping us track down all those irritating last-minute details. We thank Karen Butter, Nancy Zinn, Valerie Wheat, and Florie Berger of the UCSF Library and Center for Knowledge Management for being good-natured when B&W tried to have the documents removed from the UCSF archive, particularly when B&W had private investigators stake out the library. Henry and Edith Everett provided funds to help the library put the documents on the Internet, and Jane Dystel tried to find a publisher. Naomi Schneider served as our sponsoring editor at UC Press, Dorothy Conway did a superlative job of editing the final manuscript, and Bill Hoffman provided a thoughtful legal review. Joseph Cowan and Cynthia Lynch of the UCSF legal office provided valuable advice on how to navigate the legal shoals that surround these documents, and Christopher Patti of the UC Office of the General Counsel did a fine job of protecting our academic and intellectual freedom to pursue this project, in the face of B&W's efforts to keep the documents from public scrutiny.

Finally, in an era in which public institutions are increasingly held in disdain, we would like to thank the University of California for providing an environment committed to academic freedom and the public interest. It would have been simpler—and cheaper—for the university simply to walk away from this project. After all, the history of the tobacco issue is one in which many large institutions have followed the path of least resistance and failed to confront the issues raised in these documents. No administrator or other official ever told us to stop. Quite the contrary, we were encouraged and protected in our work. This behavior is what makes the University of California a great public institution.

Most of all, we owe thanks to Frieda Glantz, who tolerated the authors' tiptoeing through her room at all hours to get to the computer in the study. No teenager should have to make such a sacrifice.

These documents provide an opportunity to see firsthand how the brown plague of tobacco has been allowed to flourish and to spread. Although the papers are sometimes technical, we hope that readers will find them as eye-opening as we have. Perhaps this understanding will finally lead the public and public policy makers to deal with the tobacco industry in a manner appropriate to the amount of death and suffering it knowingly creates.

San Francisco
October 1995