Prohibition no, abolition yes! Rethinking how we talk about ending the cigarette epidemic.

As public health advocates struggle over how best to end the cigarette epidemic, one persistent obstacle to developing appropriate policies has been the lingering spectre of 'prohibition'. A misunderstanding of the USA's experience with the national ban on sales of alcohol more than a century ago has led even public health advocates to claim that we cannot end the sale of cigarettes because 'prohibition does not work': a ban on sales, we hear, would lead to crime and to black markets, among many other negatives. In this Special Communication, we show how the tobacco industry has carefully constructed and reinforced this imagined impossibility, creating a false analogy between cigarettes and alcohol. This improper analogy, with its multiple negative associations, continues to block intelligent thinking about how to end cigarette sales. Instead of prohibition, we propose abolition as a term that better captures what ending sales of the single most deadly consumer product in history will actually do: enhance human health and freedom.

Big tobacco focuses on the facts to hide the truth: an algorithmic exploration of courtroom tropes and taboos.

OBJECTIVE: To use methods from computational linguistics to identify differences in the rhetorical strategies deployed by defence versus plaintiffs' lawyers in cigarette litigation. METHODS: From 318 closing arguments in 159 Engle progeny trials (2008-2016) archived in the Truth Tobacco Industry Documents, we calculated frequency scores and Mann-Whitney Rho scores of plaintiffs versus defence corpora to discover 'tropes' (terms used disproportionately by one side) and 'taboos' (terms scrupulously avoided by one side or the other). RESULTS: Defence attorneys seek to place the smoker on trial, using his or her friends and family members to demonstrate that he or she must have been fully aware of the harms caused by smoking. We show that 'free choice,' 'common knowledge' and 'personal responsibility' remain key strategies in cigarette litigation, but algorithmic analysis allows us to understand how such strategies can be deployed without actually using these expressions. Industry attorneys rarely mention personal responsibility, for example, but invoke that concept indirectly, by talking about 'decisions' made by the individual smoker and 'risks' they assumed. CONCLUSIONS: Quantitative analysis can reveal heretofore hidden patterns in courtroom rhetoric, including the weaponisation of pronouns and the systematic avoidance of certain terms, such as 'profits' or 'customer.' While cigarette makers use words that focus on the individual smoker, attorneys for the plaintiffs refocus agency onto the industry. We show how even seemingly trivial parts of speech-like pronouns-along with references to family members or words like 'truth' and 'facts' have been weaponised for use in litigation.

'The industry must be inconspicuous': Japan Tobacco's corruption of science and health policy via the Smoking Research Foundation.

OBJECTIVE: To investigate how and why Japan Tobacco, Inc. (JT) in 1986 established the Smoking Research Foundation (SRF), a research-funding institution, and to explore the extent to which SRF has influenced science and health policy in Japan. METHODS: We analysed documents in the Truth Tobacco Industry Documents archive, along with recent Japanese litigation documents and published documents. RESULTS: JT's effort to combat effective tobacco control was strengthened in the mid-1980s, following privatisation of the company. While remaining under the protection of Japan's Ministry of Finance, the semiprivatised company lost its 'access to politicos', opening up a perceived need for collaboration with global cigarette makers. One solution, arrived at through clandestine planning with American companies, was to establish a third-party organisation, SRF, with the hope of capturing scientific and medical authority for the industry. Guarded by powerful people in government and academia, SRF was launched with the covert goal of influencing tobacco policy both inside and outside Japan. Scholars funded by SRF have participated in international conferences, national advisory committees and tobacco litigation, in most instances helping the industry to maintain a favourable climate for the continued sale of cigarettes. CONCLUSIONS: Contrary to industry claims, SRF was never meant to be independent or neutral. With active support from foreign cigarette manufacturers, SRF represents the expansion into Asia of the denialist campaign that began in the USA in 1953.

The changing public image of smoking in the United States: 1964-2014.

Tobacco use behaviors in the U.S. have changed significantly over the past century. After a steep increase in cigarette use rates over the first half of the 20th century, adult smoking prevalence rates started declining from their peak reached in 1964. Improved understanding of the health risks of smoking has been aided by the U.S. Surgeon General's Reports, issued on a nearly annual basis starting in 1964. Among the many forces driving down smoking prevalence were the recognition of tobacco use as an addiction and cause of cancer, along with concerns about the ill effects of breathing secondhand smoke. These factors contributed to the declining social acceptance of smoking, especially with the advent of legal restrictions on smoking in public spaces, mass media counter-marketing campaigns, and higher taxes on cigarettes. This article reviews some of the forces that have helped change the public image of smoking, focusing on the 50 years since the 1964 Surgeon General's Report on smoking and health.

Why ban the sale of cigarettes? The case for abolition.

The cigarette is the deadliest artefact in the history of human civilisation. Most of the richer countries of the globe, however, are making progress in reducing both smoking rates and overall consumption. Many different methods have been proposed to steepen this downward slope, including increased taxation, bans on advertising, promotion of cessation, and expansion of smoke-free spaces. One option that deserves more attention is the enactment of local or national bans on the sale of cigarettes. There are precedents: 15 US states enacted bans on the sale of cigarettes from 1890 to 1927, for instance, and such laws are still fully within the power of local communities and state governments. Apart from reducing human suffering, abolishing the sale of cigarettes would result in savings in the realm of healthcare costs, increased labour productivity, lessened harms from fires, reduced consumption of scarce physical resources, and a smaller global carbon footprint. Abolition would also put a halt to one of the principal sources of corruption in modern civilisation, and would effectively eliminate one of the historical forces behind global warming denial and environmental obfuscation. The primary reason for abolition, however, is that smokers themselves dislike the fact they smoke. Smoking is not a recreational drug, and abolishing cigarettes would therefore enlarge rather than restrict human liberties. Abolition would also help cigarette makers fulfil their repeated promises to 'cease production' if cigarettes were ever found to be causing harm.

The history of the discovery of the cigarette-lung cancer link: evidentiary traditions, corporate denial, global toll.

Lung cancer was once a very rare disease, so rare that doctors took special notice when confronted with a case, thinking it a once-in-a-lifetime oddity. Mechanisation and mass marketing towards the end of the 19th century popularised the cigarette habit, however, causing a global lung cancer epidemic. Cigarettes were recognised as the cause of the epidemic in the 1940s and 1950s, with the confluence of studies from epidemiology, animal experiments, cellular pathology and chemical analytics. Cigarette manufacturers disputed this evidence, as part of an orchestrated conspiracy to salvage cigarette sales. Propagandising the public proved successful, judging from secret tobacco industry measurements of the impact of denialist propaganda. As late as 1960 only one-third of all US doctors believed that the case against cigarettes had been established. The cigarette is the deadliest artefact in the history of human civilisation. Cigarettes cause about 1 lung cancer death per 3 or 4 million smoked, which explains why the scale of the epidemic is so large today. Cigarettes cause about 1.5 million deaths from lung cancer per year, a number that will rise to nearly 2 million per year by the 2020s or 2030s, even if consumption rates decline in the interim. Part of the ease of cigarette manufacturing stems from the ubiquity of high-speed cigarette making machines, which crank out 20,000 cigarettes per min. Cigarette makers make about a penny in profit for every cigarette sold, which means that the value of a life to a cigarette maker is about US$10,000.

The secret and soul of Marlboro: Phillip Morris and the origins, spread, and denial of nicotine freebasing.

Philip Morris and other tobacco companies have been using ammonia in their manufacturing for more than half a century, and for a variety of purposes: to highlight certain flavors, to expand or "puff up" the volume of tobacco, to prepare reconstituted tobacco sheet ("recon"), to denicotinize (reduce the amount of nicotine in) tobacco, and to remove carcinogens. By the early 1960s, however, Philip Morris had also begun using ammonia to "freebase" the nicotine in cigarette smoke, creating low-yield (reduced-tar or -nicotine) cigarettes that still had the nicotine kick necessary to keep customers "satisfied" (i.e., addicted). We show that Philip Morris discovered the virtues of freebasing while analyzing the impact of the ammoniated recon used in Marlboro cigarettes. We also show how Marlboro's commercial success catalyzed efforts by the rest of the tobacco industry to discover its "secret," eventually identified as ammonia technology, and how Philip Morris later exploited the myriad uses of ammonia (e.g., for flavoring and expanding tobacco volume) to defend itself against charges of manipulating the nicotine deliveries of its cigarettes.

The political iconicity of denominative suffixes in science (or, phonesthemic tints and taints in the coining of science domain names).

How are names for new disciplinary fields coined? Here a new (and fun) way to look at the history of such coinages is proposed, focusing on how phonesthemic tints and taints figure in decisions to adopt one type of suffix rather than another. The most common suffixes used in such coinages ("-logy," "-ics," etc.) convey semantic and evaluative content quite unpredictable from literal (root) meanings alone. Pharmaceutical manufacturers have long grasped the point, but historians have paid little attention to how suffixes of one sort or another become productive. A romp through examples from English shows that certain suffixes have become "hard" or "soft" in consequence of the status of their most prominent carrier disciplines. The "-ics" ending came to signify hardness in consequence of the prestige of physics, for example (with "-metrics" as the arteriosclerosis of suffixes), while lower-status (less "hard") disciplines have developed alternate endings (such as "studies"). Some suffixes are eschewed for their perceived ideologic slant (the "-isms," for example). Historians of science need to think more about the pragmatics of language, a task made easier by information technologies and databases that allow searches for words by suffix and first known use.

"Everyone knew but no one had proof": tobacco industry use of medical history expertise in US courts, 1990-2002.

Historians have played an important role in recent tobacco litigation, helping the industry with its defence of "common knowledge" and "open controversy". Historians re-narrate the past, creating an account for judges and juries that makes it appear that "everyone has always known" that cigarettes are harmful, meaning that smokers have only themselves to blame for their illnesses. Medical historians are also employed to argue that "honest doubts" persisted in the medical community long past the 1950s, justifying as responsible the industry's longstanding claim of "no proof" of hazards. The industry's experts emphasise the "good science" supported by the industry, and ignore the industry's role in spreading doubts about the reality of tobacco hazards.

The global smoking epidemic: a history and status report.

The World Health Organization estimates that tobacco causes approximately 5 million deaths annually worldwide, a number expected to double by 2025. Cigarette consumption grew from only a few billion per year in 1900 to present values of approximately 5.5 trillion worldwide. Historical causes for the rise of smoking include the invention of flue curing, safety matches, and cigarette rolling machines, but also the distribution of cigarettes to soldiers during World War I, mass marketing, the failure of governments to limit consumption, and the duplicitous denial of hazards by manufacturers. Cancers of the lip, throat, and tongue were linked to tobacco as early as the 18th century, but a lung cancer hazard from smoking was not suspected until the first decade of the 20th century. Epidemiologic evidence began to emerge in the 1920s, and by the 1950s, the causal link with cigarette smoking was well established. Epidemiologic studies, animal experiments, and studies demonstrating pathologic changes in lung tissues at autopsy were 3 pivotal sources of evidence. However, the tobacco industry refused to concede the reality of tobacco hazards until the late 1990s. Instead, the industry sought to target physicians and others with its message of "no proof," using subtle techniques of deception, including the funding of spurious research, duplicitous press releases, propaganda efforts directed at physicians, and the employment of historians to construct exculpatory narratives. The World Health Organization's Framework Convention on Tobacco Control promises to standardize global tobacco control measures, including policies to limit smuggling. Effective means of reducing tobacco use include counter-advertising, increased taxation, smoke-free workplace legislation, and litigation against the industry.

Learning from Philip Morris: Japan Tobacco's strategies regarding evidence of tobacco health harms as revealed in internal documents from the American tobacco industry.

Japan is in the midst of a rapid increase in tobacco-related disease mortality, following the rapid growth of smoking after WWII. Stomach cancer was the country's leading cause of cancer death for most of the 20th century, until lung cancer took over this position in 1993. Cigarettes are the major cause of lung cancer in Japan, but the country's leading manufacturer, Japan Tobacco, two thirds of which is owned by the Japanese government, continues to question whether tobacco is a major cause of disease and death. Japanese courts do not have the power to subpoena a company's internal records, which has made it difficult to document Japan Tobacco's strategies concerning tobacco and health. Our interpretation of online archives of internal documents from American tobacco companies, however, is that Japan Tobacco has long known about the potential health risks involved in smoking and has sought to obstruct effective tobacco control. Beginning in the mid-1980s, these efforts were often co-ordinated with American tobacco manufacturers. The documentary evidence shows that cigarette manufacturer Philip Morris in particular assisted with and sometimes also supervised Japan Tobacco's actions and statements on smoking and health. In one instance, data gathered for an article published by the Japan Public Monopoly Corporation (Japan Tobacco's predecessor) were deliberately altered to lower the reported value of a hazard indicator (nicotine concentration in the air). International collaboration has made it easier for companies such as Japan Tobacco to develop effective anti-antismoking strategies. Evidence of such global industry collaborations might grow as lawsuits begin to be filed in other nations.