The lamentable history of the cigarette is that of a mortally corrupting addiction having been embraced by millions of people in the spirit of childlike innocence. It is a history which is also strikingly brief. Cigarettes began to be manufactured extensively around the turn of the century, but it was not until as recently as 1921 that cigarettes overtook chewing tobacco, as well as pipes and cigars, in per capita consumption, and the 1930s were well along before cigarette smoking became the accepted thing for ladies.
The popularity of cigarettes was inevitable and overwhelming. They were not offensive in close quarters, nor messy like pipes and cigars. They were easily portable. They did not look gross and unseemly in a lady’s mouth. They were cheap to manufacture, and they were inhalable. Unlike the great majority of pipe and cigar smokers, whose pleasure is predominently oral and contemplative, most cigarette smokers inhale deep into their lungs with bladelike, rhythmic savagery, inflicting upon themselves in miniature a particularly abrasive form of air pollution. Further, the very fact of inhalation seems to enhance the cigarette’s addictive power. Unhappily, few suspected the consequences in terms of health until long after cigarette smoking had gained its colossal momentum. That this type of auto-contamination is a major cause of lung cancer—that it is also a prime causative factor in deaths from coronary artery disease, bronchitis, asthma, emphysema, among other afflictions—was established, and for the first time well-publicized, only a decade ago. The effect this knowledge has had upon the public consciousness may be suggested by the fact that sales this year reached the galactic sum of one-half trillion cigarettes—one hundred billion more than in 1953. There is something historically intimidating in the idea that cigarette smoking as a mass diversion and a raging increase in lung cancer have both come about during the lifetime of those who are now no more than fifty years old. It is the very recentness of the phenomenon which helps make it so shocking. The hard truth is that human beings have never in such a brief space of time, and in so grand and guileless a multitude, embraced a habit whose unwholesome effects would not only totally outweigh the meager satisfactions, but would hasten the deaths of a large proportion of the people who indulged in it. Certainly (and there seems little doubt that the Surgeon General’s report, being released this month, will make this clear) only nuclear fall-out exceeds cigarette smoking in gravity as a public health problem.
For its lucid presentation of the medical evidence alone, The Consumers Union Report on Smoking would be a valuable document. “The conclusion is inescapable,” the Report begins, “and even spokesmen for the cigarette industry rarely seek to escape it: we are living in the midst of a major lung cancer epidemic. This epidemic hit men first and hardest, but has affected women as well. It cannot be explained away by such factors as improved diagnosis. And there is reason to believe that the worst is yet to come.” Yet despite this minatory beginning the tone throughout is one of caution and reasonableness, and the authors—who manage an accomplished prose style rare in such collective undertakings—marshal their facts with such efficiency and persuasion that it is hard to imagine anyone but a fool or a tobacco lobbyist denying the close association between smoking and lung cancer. Yet, of course, not only lung cancer. The Report quotes, for instance, data based on an extensive study of smokers and non-smokers among English physicians, where the death rate from all causes was found to be doubled among heavy cigarette smokers in the group of men past 65, and quadrupled in the group 35 to 44. And the Report adds, with the modest and constructive irony that makes the book, if not exactly a joy, then agreeable to read: “These death rates among smokers are perhaps the least controversial of all the findings to date. For with respect to any particular disease there is always the possibility, however remote, that mistaken diagnosis and other conceivable errors may cast doubt on the statistics. But death is easily diagnosed.”
In the end, however, what makes the Report’s message supportable to those distracted souls among the millions of American smokers who may wish to kick the habit—or who, having kicked the habit, may wonder if it is not too late—is a kind of muted optimism. For all present evidence seems to indicate that the common cocktail party rationalization (“I’ve smoked too long to stop now, the damage is done”) has no real basis in fact. In research carried out by the American Cancer Society, microscopic studies of the lung tissues of ex-smokers have shown a process in which precancerous cells are dying out instead of flourishing and reproducing as in the tissues of continuing smokers. Here the Report states, in regard to a carefully matched group composed in equal numbers of non-smokers, ex-smokers, and smokers: “Metaplastic cells with altered nucici [i.e., precancerous cells] were found in 1.2 per cent of the slides from the lungs of non-smokers, as compared with 6.0 for ex-smokers—and 93.2 per cent for current smokers.”
Certainly such evidence, combined with the fact that ex-smokers have a lung cancer death rate which ranges down to one-fifth of that of smokers who continue to smoke, should be of the greatest practical interest to anyone who ponders whether it may be worthwhile abandoning what is, after all, a cheerless, grubby, fumbling addiction. (Only the passion of a convert could provoke these last words. The Report was an aid to my stopping a two-pack-a-day habit which commenced in early infancy. Of course stopping smoking may be in itself a major problem, one of psychological complexity. For myself, after two or three days of great flaccidity of spirit, an aimless oral yearning, aching moments of hunger at the pit of the stomach, and an awful intermittent urge to burst into tears, the problem resolved itself, and in less than a week all craving vanished. Curiously, for the first time in my life, I developed a racking cough, but this, too, disappeared. A sense of smugness, a kind of fatness of soul, is the reward for such a struggle. The intensity of the addiction varies, however, and some people find the ordeal fearfully difficult, if not next to impossible. I do have an urgent suspicion, though, that the greatest barrier to a termination of the habit is the dread of some Faustian upheaval, when in fact the deprivation, while momentarily oppressive, is apt to prove not really cruel at all.)
But it the Report is splendidly effective as a caveat, it may be read for its sociological insights as well. Certainly the history of commerce has few instances of such shameful abdication of responsibility as that displayed by the cigarette industry when in 1952 the “health scare,” as it is so winsomely known in the trade, brought about the crisis which will reach a head in this month’s report by the Surgeon General. It seems clear that the industry, instead of trying to forestall the inevitable with its lies and evasions, might have acquitted itself with some honor had it made what the Report calls the only feasible choices: to have urged caution on smokers, to have given money to independent research organizations, to have avoided propaganda and controversy in favour of unbiased inquiry. At the very least the industry might have soft-pedalled or, indeed, silenced its pitch to young people. But panic and greed dominated the reaction, and during the decade since the smoking-lung cancer link was made public, the official position of the industry has been that, in the matter of lung cancer, the villain is any and everything but the cigarette. Even the American Cancer Society is in on the evil plot and, in the words of one industry spokesman, “relies almost wholy upon health scare propaganda to raise millions of dollars from a gullible public.”
Meanwhile, $200 million was spent last year on cigarette ballyhoo, and during these last crucial ten years the annual advertising expenditure has increased 134 per cent—a vast amount of it, of course, going to entice the very young. One million of these young people, according to the American Public Health Association, will die of smoking-induced lung cancer before they reach the age of seventy years. “Between the time a kid is eighteen and twenty-one, he’s going to make the basic decision to smoke or not to smoke,” says L. W. Bruff, advertising director of Liggett and Myers. “If he does decide to smoke we want to get him.” I have never met Mr. Bruff, but in my mind’s eye I see him, poised like a cormorant above those doomed minnows, and I am amused by the refinement, the weight of conscience, the delicate interplay of intellectual and moral alternatives, which go into the making of such a prodigious thought. As the report demonstrates, however, Mr. Bruff is only typical of the leaders of an industry which last year received a bounty of $7 billion from 63 million American smokers. Perhaps the tragic reality is that neither this estimable report nor that of the Surgeon General can measureably affect, much less really change, such awesome figures.
December 26, 1963