Foreword

It was my privilege to serve as surgeon general of the United States Public Health Service from 1981 to 1989. The issue of smoking was on my desk when I arrived; it was on my desk when I left. As I learned more and more about smoking during my tenure as surgeon general, I was increasingly disturbed by the way the tobacco industry treated the American and world public. The analysis of the previously secret papers from a major tobacco company presented in this book demonstrates that the tobacco industry was even more cynical than even I had previously dared believe.

The surgeon general is perhaps best known for the Surgeon General's reports on smoking and health. During my tenure, eight reports on smoking and health were submitted to Congress and the American public, including the 1988 report, Nicotine Addiction , which concluded that nicotine is an addictive drug similar to heroin and cocaine. At the time—as it does today—the tobacco industry vigorously attacked the report (and me) for going beyond the scientific evidence. But now this book confirms that scientists and executives from Brown and Williamson and British American Tobacco routinely appreciated the addictive nature of nicotine a quarter century earlier, in the early 1960s.

All the Surgeon General's reports are modeled on the original 1964 report, Smoking and Health: A Report to the Surgeon General , which was made by an advisory committee appointed by the surgeon general to investigate whether or not smoking causes disease. This initial report was mild in its condemnation of smoking, finding primarily that smoking

causes lung cancer in men. It did not identify tobacco as an addictive substance—just habituating. These conclusions were much weaker than those the tobacco industry's own scientists were making at the time. They considered nicotine an addictive drug. This information—as well as a wealth of other important information the tobacco industry possessed—was simply not made available to the Surgeon General's Advisory Committee and the public.

One can speculate, with enormous regret, how different that 1964 Surgeon General's report would have been had the tobacco companies shared their research with the Surgeon General's Advisory Committee. What would have been the history of the tobacco issue in the United States—and the world—if that report had had the benefit of all of the information available on tobacco and held privy to the inner circles of the cigarette manufacturing companies? The contrast of public and private statements from the tobacco industry reveals their deceit.

During my years as surgeon general and since, I have often wondered how many people died as a result of the fact that the medical and public health professions were misled by the tobacco industry. Now we can see in retrospect, as the documents discussed in this book reveal, that the tobacco industry was demoralized and in disarray in the mid-1960s, but the public voluntary health agencies and others did not take the kind of decisive action against the industry that some inside the industry expected and feared.

In the course of my own annual press conferences on the release of the Surgeon General's reports to Congress, I frequently spoke of the sleazy behavior of the tobacco industry in its attempts to discredit legitimate science as part of its overall effort to create controversy and doubt. Well-funded tobacco interests attacked (and continue to attack) not only the surgeon general, but also the Environmental Protection Agency, the Food and Drug Administration, the Occupational Safety and Health Administration, and individual scientists who are working to end the scourge of tobacco. This book reveals these campaigns from the inside.

But, although the tobacco companies possess enormous clout with Congress and almost inexhaustible funds for advertising, promotion, and propaganda, the public knows about the deleterious effects of smoking, and most smokers would like to quit—a difficult task because they are addicted. Even smokers do not believe what they hear from the tobacco industry. Smokers and nonsmokers alike should feel misled by the tobacco companies and their deceptive practices.

This book is a vital weapon in the battle against tobacco. I do not believe that anyone who reads it can remain passive in the struggle against tobacco. We all need to raise our voices to clear the air for a healthier America.

C. EVERETT KOOP, M.D., Sc.D.
SURGEON GENERAL USPHS 1981-1989