Medical opinion at first took little heed of the
growing popularity of cigarettes. Physicians tended
to take an ambivalent or qualified position on the cigarette phenomenon. For instance, although Dr. James
J. Walsh wrote in 1937, “We physicians of the older
generation who have seen the smoking of cigarettes
grow from what seemed scarcely more than a toy into
what is now one of the most significant of social institutions are under an obligation to the rising generation to warn them of the serious dangers associated
with the abuse of cigarettes in our day” (Walsh 1937,
p. 665), even Walsh admitted to smoking an occasional
cigarette himself. He further attested that many doctors he knew smoked 20 or 30 cigarettes a day and yet
were “as healthy as the proverbial trout” (p. 665). He
held that “not the cigarette smoke so much as the excess of it” (p. 665) brought about serious conditions
like Buerger’s disease.
The Puritan temperament that had fueled anticigarette activity early in the century was on the defensive.
Antipathy to Puritan moralism was strong enough to
weaken faith in any research tainted by it. For example,
Alton Ochsner’s suggestions in the 1930s and 1940s of
a connection between cigarette smoking and lung cancer were discounted by his colleagues because he was
known to be “an anti-smoking enthusiast” (Burnham
1989, p. 18).
During these crucial times when cigarette
smoking became widespread, “physicians tended to
absorb the common sense of the general population”
(p. 11). By the 1930s, common sense, in some measure
influenced by the advertising claims of the era, held that
smoking in moderation was not a health hazard
(Burnham 1993).
In 1938, Raymond Pearl published one of the first
significant epidemiologic studies that indicated smoking to be “statistically associated with an impairment
of life duration” (Pearl 1938, p. 217, quoted in Breslow
1982, p. 134; see also Brandt 1990). But only in the late
1940s and early 1950s did definitive evidence begin to
accumulate from various sources and studies showing the association between cigarette smoking and
overall mortality. First retrospective and then largescale prospective studies confirmed that smoking was
associated with higher death rates; excess mortality
was especially pronounced for coronary artery disease
and lung cancer.
In the late 1940s and early 1950s, research linked
lung cancer to smoking. The initial report by Wynder
and Graham (1950) just preceded an article by Doll
and Hill (1950). Subsequent articles by Doll and Hill
(1952), Levin (1953), and others confirmed the association. Levin’s contribution was of particular interest, because he derived the formula for attributable risk
in a footnote to the article—an overt demonstration of
the link between the smoking etiology and the emerging methodology of epidemiologic analysis.
Public Dissemination
The findings from these and other studies of the
era were publicized in a 1952 Christian Herald article.
In December 1952, that article was reprinted in the
widely circulated magazine Reader’s Digest as “Cancer by the Carton” (Norr 1952). Popular concerns
aroused by this publicity apparently led to an almost
immediate decline in cigarette consumption (Tennant
1971). The decline was temporary but severe enough
to lead the tobacco companies to step up their market
promotion of the relatively new filter-tip cigarette.
Originally intended to attract new smokers by offering a milder smoking experience, the filtered cigarette
assumed a marketing prominence that was seen as a
tacit acknowledgment that there might be a health risk
in smoking (Fortune 1953). Whether for smoking comfort or for supposed health advantage, the market
share of filter brands increased from less than 1 percent in 1952 to 73 percent in 1968 (Tennant 1971).
The nonprofit consumer advocacy organization
Consumers Union paid attention to smoking throughout the 1950s. Early mentions in the organization’s
monthly magazine Consumer Reports, like so much
commentary elsewhere, warned only against excessive
smoking. In 1953, Consumer Reports found the evidence
connecting smoking to lung cancer “suggestive” and
recommended that until further research results were
available, “those who can” should reduce smoking to
a “moderate” level, which was defined as not more
than one pack a day (p. 74). In the same issue, however, the magazine reminded readers that smoking had
health benefits; specifically, smoking reduced “the
inner nervous tensions and strains resulting from
man’s exposure to the stresses and responsibilities
imposed by society” (p. 74).
Smoking, the magazine
further observed, relieved such pressure in a way less
harmful than alcohol or overeating (Consumer Reports
1953).
38 Chapter 2
Reducing Tobacco Use
In 1954, medical advisers for Consumers Union
spoke more strongly about the research link between
smoking and lung cancer, but the organization
remained vague in its advice to smokers (Consumer
Reports 1954). In the absence of further scientific support, this tentativeness was not surprising. It was hard
to imagine that a habit so widespread, so apparently
normal, so integrated into American culture, and so
ennobled by its wartime use could turn out to be fundamentally destructive. In 1954, the American Cancer Society’s (ACS) Tobacco and Cancer Committee
adopted a resolution recognizing an association between cigarette smoking and lung cancer (Breslow
1982), but the board of directors did not consider the
possibility of a causal association. Efforts of the physician members of the board were blocked by lay members in meetings that were themselves “filled with
smoke” (Breslow 1977, p. 849).
By 1958, Consumers Union agreed that the medical research provided nearly definitive evidence on
the risk of lung cancer posed by smoking. The organization further argued that smokers should not try to
allay their concerns by switching to filter cigarettes, as
no evidence indicated that filters reduced the risk of
cancer. Smokers were thus advised “to cut out or cut
down” on cigarettes (Consumer Reports 1958, p. 636).
