TRACING THE CIGARETTE'S PATH FROM SEXY TO DEADLY
By Howard Markel, MD
In contrast to the symbol of death and disease it is today, from the early 1900s to the 1960s the cigarette was a cultural icon of sophistication, glamour and sexual allure - a highly prized commodity for one out of two Americans.
Many advertising campaigns from the 1930s through the 1950s extolled the healthy virtues of cigarettes. Full-color magazine ads depicted kindly doctors clad in white coats proudly lighting up or puffing away, with slogans like "More doctors smoke Camels than any other cigarette."
Early in the 20th century, opposition to cigarettes took a moral rather than a health-conscious tone, especially for women who wanted to smoke, although even then many doctors were concerned that smoking was a health risk.
The 1930s were a period when many Americans began smoking and the most significant health effects had not yet developed. As a result, the scientific studies of the era often failed to find clear evidence of serious pathology and had the perverse effect of exonerating the cigarette.
The years after World War II, however, were a time of major breakthroughs in epidemiological thought. In 1947, Richard Doll and A. Bradford Hill of the British Medical Research Council created a sophisticated statistical technique to document the association between rising rates of lung cancer and increasing numbers of smokers. The prominent surgeon Evarts A. Graham and a medical student, Ernst L. Wynder, published a landmark article in 1950 comparing the incidence of lung cancer in their nonsmoking and smoking patients at Barnes Hospital in St. Louis. They concluded that "cigarette smoking, over a long period, is at least one important factor in the striking increase in bronchogenic cancer." Predictably, the tobacco companies derided these and other studies as mere statistical arguments or anecdotes rather than definitions of causality.
In the 1980s, scientists established the revolutionary concept that nicotine is extremely addictive. The tobacco companies publicly rejected such claims, even as they took advantage of cigarettes' addictive potential by routinely spiking them with extra nicotine to make it harder to quit smoking. And their marketing memorandums document advertising campaigns aimed at youngsters to hook whole new generations of smokers.
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