The Cigarette Century

Nursing Book Club

The Cigarette Century

By Sallan M. Brandt
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Reviewed By Elizabeth Hanink, RN, BSN, PHN

Still puffing, are you? Can’t quite give them up, even though as a nurse you know, better than most, how cigarettes damage your health. Well, take heart. You have lots of company and, of course, this problem isn’t entirely your own creation. Indeed, even if you believe firmly in personal responsibility and the obligation to care for your health, the nation’s tobacco companies have played a major role in your predicament.

Allan Brandt lays it out for us: how the cartel of tobacco companies helped make cigarettes, rather than cigars and pipes, the medium for consumption; how it worked to create the perception that smoking is a sophisticated, even beneficial activity. For instance, did you know that smell is “socially contingent”? What strikes us as putrid can change with time and context. It’s hard to imagine that yellow teeth, stale body odor or nicotine-stained fingertips don’t register. Ah, but what if the cause of all these is linked with intensity, maturity and success?

Savvy marketing, though, is not the worst crime in the collection of misdeeds that Brandt chronicles. The willful distortion of scientific evidence and the effort to change the rules of inquiry are far more serious. Factor in the astonishing length of time the companies enjoyed unparalleled immunity. Even the medical community lagged in its recognition of the danger and, when it saw the light, the boundary between clinical medicine and public health still kept officials from acting effectively.

For 30 years, and through over 300 lawsuits, big tobacco prevailed. Not until 1983, when attorney Marc Edell took the case of Rose Cipollone, did the industry finally lose ground. And it isn’t defeated yet. Despite several significant legal losses, tobacco companies are still going strong. Yes, the figures for U.S. consumption have decreased, but worldwide they continue to grow, as do the related morbidity rates.

China, to name one country, actually has a government-controlled tobacco industry, a dilemma which ultimately will force its leaders to choose between the significant revenues produced in the short term and the horrendous health costs of 350 million cigarette addicts.

A leading British epidemiologist, Richard Peto says, “My message [to the Chinese leaders] was very simple: If the Chinese smoke like the Americans, they will die like Americans.” And how many nurses have watched them die, from emphysema, lung cancer and cardiovascular diseases? Yet the fascination with all things American, from Levis to iPods to Marlboros, will keep the tobacco industry solvent for generations to come.

The Cigarette Century is not something to read in one sitting. It took me several weeks of sporadic effort. But it’s a vital and complete account of the history of an industry that, more than any other, has had a profound impact on public health. And it’s clear why Harvard Medical School’s Allan Brandt ranks as America's premier medical historian.

Elizabeth Hanink, RN, BSN, PHN, is a freelance writer in Los Angeles, She has 30 years' experience in hospital and community nursing.

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