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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 July 7; 335(7609): 46.
PMCID: PMC1910676
Review of the Week

Killing you softly

Reviewed by Stan Shatenstein, contributing editor, Tobacco Control, and editor, GLOBALink News & Information, Montreal

The Cigarette Century: The Rise, Fall, and Deadly Persistence of the Product that Defined America. Allan M Brandt. Basic Books, $36, pp 600. ISBN 0 465 07047 7. Rating: ** .

A history of the last 100 years of cigarette use fails to consvey the scale of plague we have unleashed on ourselves, finds Stan Shatenstein

The images are iconic. The Hindenberg zeppelin ablaze at its New Jersey moorings. A Spanish loyalist shot dead under the unforgiving lens of Robert Capra. A naked, napalmed Vietnamese girl running towards the camera. Jack Ruby jumping into the path of John Kennedy's assassin, Lee Harvey Oswald. United Flight 175, its gleaming wings slashing into World Trade Center tower 2 as tower 1 stands nearby, mortally weakened. Human forms dropping from the towers' heights like dark, crippled birds before our disbelieving eyes.

But we do believe. We understand, if but dimly. From still photos, motion pictures, and video captures, death compels us, frightens us, convinces us. We wish to look away, but that desire is submerged by succeeding waves of fascination—morbid, human, ever present.

So when an author tries to explain the avoidable loss of 100 million lives over only a century, what are we to make of this plague we have brought on ourselves? When he insists that the figure will rise 10-fold in the current century, what sense do we make of the devastation? Do we see bulldozers ploughing limp bodies into the soil of liberated concentration camps? The endless skull and bones mountains of Pol Pot's Khmer Rouge? Lines of machete wielding Hutus hacking their Tutsi neighbours to pieces? No—and ineffably sadly, we sense but dimly the waste brought by smoking and can scarcely imagine its scale.

Allan Brandt, a Harvard University professor of medical and scientific history, has assigned himself the unenviable task of summarising the evolution of the cigarette in American life and predicting the future of the “little white slaver.” He has made a commendable effort on a topic that is as vast as it is vexing, yet ends up with ash on his shirt at times.

Brandt relies on the accretion of detail to suggest the scope of the nicotine cartel's limitless corporate fraud. He details tobacco's central role in the development of the early American colonies; the critical 1881 invention of the Bonsacker cigarette rolling machine; James “Buck” Duke's monopolistic expansion of the industry; the first world war's popularisation of smoking; and Edward Bernays' “Torches of Freedom” staged event in the 1920s, where a group of models posing as women's rights activists lit up their Lucky Strike cigarettes for photographers during the New York city parade, a stunt that helped end the taboo of women smoking in public. Brandt also wades through decades of research into smoking and disease, which was matched by industry attempts, under the mantra “doubt is our product,” to deceive courts and the public about the risks of tobacco use and secondhand smoke.

Brandt acknowledges a great debt to Richard Kluger's 1996 classic Ashes to Ashes, which documented those topics well. Brandt also effusively thanks his colleague Robert Proctor, author of the provocative 1999 work The Nazi War on Cancer; yet The Cigarette Century elides all discussion of the Third Reich's smoking studies, and the Argentine pioneer Angel Honorio Roffo receives but fleeting mention. And although Brandt offers astute insights on some subjects—particularly the conflation of cigarette marketing and women's liberation—he leaves out others entirely.

We get another recounting of the mendacity of big tobacco company chief executive officers before the US Congress and the internecine anti-industry battles over the master settlement agreement, the $246bn (£123bn; €181bn) multistate agreement of 1998 in which tobacco companies agreed not to target advertising at young people, not to use cartoons in advertising, and not to advertise on outdoor billboards. But instead Brandt might have done well to highlight the under-reported intrigue over Y-1 cigarettes (genetically altered, high nicotine cigarettes); explore worldwide industry involvement in cigarette smuggling; study internet marketing of tobacco products; or assess the paradoxical efforts at corporate social responsibility by an industry whose products kill half their consumers when used as intended.

Brandt wrote The Cigarette Century “to trace the remarkable rise and dramatic decline of cigarette consumption in the United States.” He has done this reasonably well, but he also allows, in a too brief final chapter centred on the World Health Organization's framework convention for tobacco control, that the future menace posed by tobacco will be felt most keenly in the developing world. The disappointment with this work lies in its disproportionate emphasis on the distant over the recent past, in a fast evolving and urgent subject.

In 1948 Vittorio De Sica's neo-realist classic film Ladri di Biciclette (Bicycle Thieves) was released in the US as The Bicycle Thief. The difference is not trivial. There were two thieves in the film, and the elements that united and distinguished them were key to understanding the film's deep lessons about social inequality and prejudice.

Similarly, there are two cigarette centuries, not one, and Professor Brandt's error is one of his own making, not that of a poor Italian English translation. He allows that the tobacco industry, “remarkably successful in devising new ways to resist public health regulations . . . is here to stay,” but he spends not nearly enough time exploring how its well documented past is a prologue to an utterly frightening future. Instead, Brandt ends his decades in the making story with an awkward defence of his role as an expert witness in tobacco litigation.

Brandt's legal “advocacy” is not a problem, but he fails to deliver the promised “strong foundation for a critical discussion of new strategies to avert a potential global health disaster.” He virtually admits that the disaster is unavoidable, and despite considerable skills he cannot make us see what the tobacco plague looks like or how much worse it will get.

We can imagine a chain smoking Humphrey Bogart or Yul Brynner gone too soon, but where are the countless heart attack victims, the nameless sufferers of emphysema? For the tobacco industry the cigarette will continue to match Oscar Wilde's description of a “perfect pleasure. It is exquisite, and it leaves one unsatisfied.”

Paraphrasing Shakespeare, “Tis not the worst cigarette century, so long as we can say ‘this is the worst.'”

Ineffably sadly, we sense but dimly the waste brought by smoking and can scarce imagine its scale

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