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Citation Gardner, Martha N. and Allan M. Brandt. 2006. “‘The Doctors’ ChoiceIs America’s Choice”: The Physician in US Cigarette Advertisements,1930-1953. American Journal of Public Health 96(2): 222-232.

Published Version http://dx.doi.org/10.2105/AJPH.2005.066654

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PUBLIC HEALTH THEN AND NOW

o Hoctars' ChoiceIs America's Choice''

The Physician in US Cigarette Advertisements, 1930-1953

In the 1930s and 1940s, smoking be-

came the norm for both men and

women in the llnited States, and a ma-

jority of physicians smoked. At the

same time, there was rising public anx-

iety about the health risks of cigarette

smoking. One strategic response of to-

bacco companies was to devise ad-

vertising referring directly to physi-

cians. As ad campaigns featuring

physicians developed tfirough the early

1950s, tobacco executives used the

doctor image to assure tiie consumer

that their respective brands were safe.

These advertisements also sug-

gested that the individual physicians'

clinical judgment should continue to

be the arbiter of the harms of ciga-

rette smoking even as systematic

health evidence accumulated. How-

ever, by 1954, industry strategists

deemed physician images in adver-

tisements no longer credible in the

face of growing public concern about

tbe health evidence implicating ciga-

rettes. {Rm J Public Health. 2006;

96:222-232. doi:10.2105/AJPH.2005.

066654}

Martha N, Gardner, PhD, and Allan M, Brandt, PhD

IN 1946, THE RJ REYNOLDS

Tobacco Company initiated amajor new advertising campaignfor Camels, one of the most popu-lai- brands in the United States,Working to establish dominancein a highly competitive marketReynolds centered their new cam-paign on the memorable slogan,"More doctors smoke Camelsthan any other cigarette," Thisphrase would be the mainstay oftheir advertising for the next 6years. Touting surveys conductedby "three leading independent re-search orgajuzadons," one typicaladvertisement proclaimed that ac-cording to "nationwide" surveysof 113 597 doctors "from everybranch of medicine." Camel wasthe brand smoked by most re-sprondents. It also asserted thatthis statistic was an "actual fact"not a "casual claim,"

In realit>', this "independent"surveying was conducted by RJReynoids's advertising agency, theWilliam Esty Company, whoseemployees questioned physiciansabout their smoking habits atmedical conferences and in theiroffices. It appears that most doc-tors were surveyed about their

cigarette brand of choice just afterbeing provided complimentarycartons of Camels.'

Even without the suspect na-ture of the data used in the "MoreDoctors" campaign, the frequentappearance of physicians in ad-vertisements for cigarettes in thisand many other ad campaigns isboth striking a:id ironic from thevantage point of the early 21stcentury. Any association betweenphysicians and cigarettes—theleading cause of death in theUnited States—is jarring given ourcuirent scientific knowledgeahout the relationship of smokingto disease and the fact that fewerthan 4% of physicians in theUnited States now smoke,

In 1930s and 1940s, how-ever, smoking had become thenorm for botli men and womenin the United States—and a ma-jority of physicians smoked,'' Atthe same time, however, risingpublic and scientific anxietyexisted about cigarettes' risksto health, creating concernamong the tobacco companies.The physician constituted anevocative, reassuring figure toinclude in their advertisements.

In retrospect, these advertise-ments are a powerful reminderof the cultural authority physi-cians and medicine held inAmerican society during the mid-20th century, and the manner inwhich tobacco executives alignedtheir product with that authorily,

Even before modem epidemi-oiogicaJ research would demon-strate the health risks of smok-ing at mid-century, there hadalready arisen considerable con-cem about the health impact ofcigarette use,' Questions of themoral and health consequencesof cigarette smoking that badbeen prevalent at the beginningof the 20th century still lin-gered. Although many physi-cians were unconvinced by thisolder research, some had begunto recognize a disturbing in-crease in lung cancer, and somehad also started to consider therespiratory and cardiovasculareffects of smoking. A commontheorj' held that cancer resultedftxjm chronic irritation to the af-fected tissue, and many won-dered whether cigarette smoke"irritated" lung tissue in this

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PUBLIC HEALTH THEN AND NOW

Well aware of these concerns—and their impact on cigarettesales—the tobacco companies de-vised advertising and marketingstrategies to (1) reassure the pub-lic of the competitive health ad-vantages of their brands, (2) re-cruit physicians as crucial alliesin the ongoing process of market-ing tobacco, and (3) maintain thesalience of individual clinicaljudgments about the health ef-fects of smoking in the face ofcategorical scientific findings.

These elements would be ofgrowing importance as the healtlieffects of smoking came to bemore fully elucidated. One aspectof these promotional strategieswas to refer directly to physiciansin botb images and words. Weexplored how physicians weredepicted in these advertisementsand how the ad campaigns devel-oped as health evidence implicat-ing cigarette .smoking accumu-lated by the early 1950s.

EARLY MEDICAL CLAIMS

American Tobacco, the leaderin the splashy ad campaigns thathad made its Lucky Strike branddominant by the late 1920s, wasthe first to mention physicians inadvertisements. The physicianwas just one piece of a muchlarger campaign on bebalf ofAmerican Tobacco. As cigarettesales grew exponentially in theUnited States in the early 20thcentury. Lucky Strikes had be-come the preeminent brandlargely because of its massivepromotional elTorts. Companypresident George WashingtonHill worked with ad man AlbertLasker to develop a "reason why"consumers should purchase theirbrand. With no real scientific evi-dence to back their claims,American Tobacco insisted thatthe "toasting" process that Lucky

Strikes tobacco underwent de-creased throat irritation.'' In fact,Lucky Strikes' curing process didnot significantly differ from thatof other brands.

Related campaigns empha-sized that "Luckies" would helpconsumers—especially women,their new market—to stay slim,since they could "Reach for aLucky instead of a sweet." ;\longwith these persistent health

American Tobacco, We leaderin the splashy ad campaigns

that had made its Lucky Strikebrand dominant by the

late 1920s, was the firstto mention physicians

in advertisements.

claims, a ^ i c a l advertisementfrom 1930 boldly stated that"20,679 Physicians say 'LUCK-IES are less irritating'" and fea-tured a white-haired, white-coaled doctor with a reassuringsmile (Figure 1).'

In this manner, American To-bacco advertisements refiectedan awareness of ongoing publicconcern about the potentialhealth effects of cigarette smok-ing. Referring to a large numberof physicians who they claimedbacked up the superiority ofLucky Strikes, the ad text notedin small print that their account-

ing firm had "checked and certi-fied" this number, independentlyvalidating the claim.** Their ad-vertLsing agency. Lord, Thomasand Logan, had sent cartons ofcigarettes to physicians in 1926,1927, and 1928 and asked themto answer whether "Lucky StrikeCigarettes . . . are less irritating tosensitive and tender throats thanother cigarettes."

Ibuting the toasting process inthe accompanjong cover letter,adveitising executive ThomasLogan pointed out the virtues ofLucky Strikes and claimed that

FIGURE 1—Advertisement:"20,679" physicians say 'LUCKIES

are less irritating.'"Source. Magazine of Wall Street.

July 26, 1930.

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PUBLIC HEALTH THEN AND NOW

HGURE 2—Advertisement: "A

report on the findings of agroup of doctors.*"

Source. Saturday Evening Post.October 16,1937.

they had heard from "a goodmany people" that they couldsmoke Lucky Strikes "with perfeetcomfort to their throats." Ameri-can Tobacco used the physicians'responses to this survey to vali-date their claim that Lucky Strikeswere "less irritating," claiming itconfirmed their enduring asser-tion that their "toasting" processmade cigarettes less irritating.Toasting, the advertisement wenton to explain, was "your throatprotection against irritation—against cough."^ Although therewas no substantive evidence thatthis process of curing tobacco wassuperior to the methods tised byother companies, American To-bacco made the bold claim andtied it to physicians.

By the mid-1930s. PhilipMorris, a newcomer to the mar-ket took the use of health claimsa step ftirther, designing a cam-paign that used a new strategy of

REPORT ON THE FINDINGS)F A GROUP OF DOCTORS*

tiocror kcpr a r«wd .f ..,,,

referring directly to research con-ducted by physicians. Both inmagazines targeted to the generalpublic and in medical journals,Philip Morris claimed tbat theircigarettes were proven to be"less irritating." For example, ina 1937 Saturday Evening Post ad-vertisement, Philip Morris's ball-mark spokesman, bellhop JohnnyRoventini, announced that accord-ing to "a report on the findings ofa group of doctors . . . whensmokers changed to Philip Morris,every case of irritation clearedcompletely and definitely im-proved" (Figure 2). The text re-ferred specifically to faithfijl doc-tors "day after day... [keeping] arecord" to "prove conclusively"the decrease in irritation."^

These "findings" resulted froman aggressive pursuit of physi-cians and focused on the conceptthat adding a chemical to theircigarettes, diethylene-glycol. madethem moister and less irritatingthan other brands. As Alan Blum,editor of the New York State Jour-

nal of Medicine, explained in bis

1983 assessment of cigarette

advertisements that had appeared

in the journal from 1927 to

1953, Philip Morris—armed with

papers written hy researchers that

the company bad sponsored—

attempted to use "clinical proof

to establish the superiority of

their brand." Specifically, Colum-

bia University pharmacologist

Michael Mulinos and physiologist

Frederick Flinn produced findings

(on the basis of tbe injection of

diethylene-glycol into the eyes of

rabbits) that became the center-

piece of the Philip Morris claim

that diethylene-glycol was less irri-

tating, although other researchers

not spoasored by Philip Morris

disputed these findings. ^

Thi.s highly successful campaign

made Philip Morris into a major

brand for tbe first time.'"* As a

1943 advertisement in the Satur-

day Evening Post proclaimed,

Philip Morris provided "[fjull re-

ports in medical journals by men,

higb in their profession—regularly

offered to physidans on request."'

These advertisements used

physicians and science to make

their particular brand appeal to

the broader public while at the

same time they curried favor with

physicians. Company operatives

appeared at medical conventions

and in physidans' private offices,

providing pbysidans with free dg-

arettes and reprints of sdentific

articles on the subject. As a 1936

Portune Magazine profile of Pbilip

Morris & Company made clear:

TTie object of all this pmpa-ganda is not only to make doc-tors smoke Philip Morris dga-rettcs. thus setting an examplefor impressionable patients, butalso tn implant tbe findings ofMtilmos so strongly in tlie med-ical mind tbat tbe doctors willactually advise their coughing,rtieumy, and fur-ttingut'd pa-tienLs to switcli to Pbilip Morrison the ground that Ihey are lessirritating."

With careful, deferentiiil ap-peals to physicians, Philip Morrisaimed to gain tbeir approval. Thespedfic positive references to clin-ical evidence tbat had appearedin medical journals helped to es-tablish and maintain this connec-tion between physicians and to-bacco companies, and betweenhealth and dgarettes.

TOBACCO INDUSTRYCOURTS DOCTORS

According to a number of ac-counts, medical professionals-having themselves joined theranks of inveterate smokers-doubted the connection betweensmoking and disease after1930."' Although hygienic andphysiological concerns continued

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PUBLIC HEALTH THEN AND NOW

to be voiced, clinical medidneclaimed that individual assess-ment and judgment was re-quired.'^ During this era, therewas a strong tendency to avoidaltogether causal hypotheses inmatters so clearly complex.There was—and would remain—a powerful notion that risk islargely variable and thus, mostappropriately evaluated andmonitored at the individual, clini-cal level."*

According to this logic, somepeople could smoke without riskto health, whereas others appar-ently suffered untoward andsometimes serious consequences.As cigarette smokiiig became in-creasingly popular in the earlydecades of the 20th century,medicine offered no new insightinto how best to evaluate suchvaiiabiiity other than on an indi-vidual post hoc basis. If, andwhen, an individual developedsymptoms, a physician might ap-propriately advise restricting oreliminating tobacco. As a restilt,rather than being located withinthe sphere of public health, ciga-rette use remained within thedomain of clinical assessmentand prescription. The tobacco in-dustry would actively seek tokeep cigarettes within this clinicaldomain.

For the tobacco companies,physicians' approval of their prod-uct could prove to be essential,especially since patients oftenbrought smoking-related symp-toms and health concerns to theattention of their doctors. Throughadvertisements appearing in thep ^ s of medical journals for thefirst time in the 1930s, tobaccocompanies worked to developclose, mutually benefidai relation-ships with physicians and theirprofessional organizations. Theseadvertisements became a readysource of income for numerous

medical organizations and jour-nals, including the New EnglandJournal of Medidne and the Journalof the American Medical Associa-tion (JAMA), as well as manybranches and bulletins of localmedical associations.'''

Coming during the Great De-pression, the placement of adver-tisements in medical journalshelped to keep medical organiza-tions financially solvent when re-sources were scarce. Philip Morrispraised physidans in these adver-tisements with taglines like "Everydoctor is a doubter" and "Doctoras judge" as they appealed tophysicians' expert ability to evalu-ate the evidence, referring themto scientific articles that theydaimed illtistrated the superiorityof their brand. As one sudi adver-tisement explained in its entiretyin 1939, "If you advise patientson smoking—and what doctor doesnot—you will find highly impor-tant data in the studies listedbelow. May we send you a set ofreprints?""'

Not only, then, did physidans'findings help to make the PhilipMorris brand appear superior inthe eyes of the public, but thecompany also turned to physi-dans with great effect Physiciansbecame, through this process, anincreasingly important conduit inthe marketing process.

RJ REYNOLDS'S MEDICALRELATIONS DIVISION

Althou^ Philip Morris mayhave created this strategy—andgained a leg up in tbe competitivecigarette mai'ket-Rj Reynolds be-came the leading force in solicit-ing physidans. Reynolds created aMedical Relations Di\Tsion (MRD)in the early 1940s that becamethe base of their aggressive physi-cian/health claims promotionalsti-ategy. They directly solicited

doctors in a 1942 advertisementthat appeared in medical journalsdescribing the MHD. Declaringthat "[tlhe most significant med-ical data is derived from theevery-day records of practising[sicj physicians," the text asserted"your office record reports in stichcases should prove interesting tostudy." '

The MRD, induding its long-time director. A. Grant Clarke,was in fact a part of RJ Reynolds'sadvertising firm, rather than anykind of professional scientificdivision of the company. TheMRD's mailing addmss was tbeside door of tbe William Hsty Ad-vertising Company. ' The workof the MRD focused on promot-ing Camels mainly through find-ing and courting researchers tobelp suKstantiate the healthclaims RJ Reynolds made in theii-advertisements.

In the late 1930s and early1940s, Clarke—wbo had nomedical or scientific training-corresponded with many re-searchers who were pursuingquestions relating to smokingand health. The MRD financedresearch tbat Reynolds thenreferred to in advertisements.Rather than emphasizing claimsof moistness as Philip Morrishad done, RJ Reynolds foctisedon nicotine absorption, insistingthat Camels were the slowestburning of all cigai-ettes. Thesafety of nicotine—like the issueof chronic irritation—was asource of ongoing concern;Reynolds maintained that nico-tine was "the chief componentof pharmacologic and physiolog-ical significance." Camels' slowburning rate, their advertise-ments now asserted, decreasednicotine absorption; as a result,Camels offered smokers anadvantage over other, faster-burning ^

February 2006, Vol 96. No. 2 | American Journal of Public Health Gardner] Peer Reviewed | Public Health Then and Now | 225

PUBLIC HEALTH THEN AND NOW

AT THE A. M. A. COiXVE-VnOX

SC'8

MmlLv (he

your Club

YOt-'LL Ei« i[ m iht Aliulir I'll) Ainfihv,).!!. uis i ^nhiMl tHT . . . in^il li» law o n l v l Dnf i>

i * .Ilk . - , <«pjB'>I. f ^ . « - >•Jmvuuil r-JV LJ« hj** jpwe IHW

Philip Morris

FIGURE 3—Advertisement:"Philip Morris invites you tot h e . . . Doctor's ^

As they made this claim, RJReynolds also asked physicians touse the infomialion when advis-ing their patients. They referredto "a number of reports fromphysicians who recommendCamels" and called on those read-ing the advertisement to send intheir own ctimcal experiences andto request copies of medical jour-nal articles from the MRD thatproved their assertions, llse oflerserved to legitimate R] Reynolds'sclaims. The main article dted ditinot in fact address Camels specifi-cally, although it did make theclaim that slow-burning cigaretteswere superior. "* With no deai-knowledge about whether nico-tine absorption was even an areathat should concern smokers, andwith very little data showingCamels' slower absorption, thescientific basis for Reynolds'sclaim remained obsnire.

Nonetheless, such health claimswould become the basis for tbeaggressive recruitment of physi-cian.s as allies in the promotion of

their products and brands. To-bacco companies' participation inmedical conventions provided adeal- example of their efforts toappeal to physidans. For example,sodal commentator BernardDevoto described tbe exbibit hallof the 1947 American MedicalAssodadon (AMA) convention inAtlantic City, where doctors"lined up by the hundred" toreceive iree cigarettes. ^ At the1942 AMA annual convention,Philip Morris provided a lounge inwhich doctors could relax and so-dalize. The lounge, an advertise-ment explained, was "designed foryour conifort. Drop in. Rest...read . . . smoke . . . or jtist chat"^^(Figure 3).

Besides welcoming physidansto the convention, Reynoldstouted their scientific researchinto dgarcttes. In an advertise-ment that appeared in medicaljournals across the country in theweeks before tbe 1942 AMAmeeting, Reynolds reiterated theirclaim tliat 'Tt]he .smoke of slow-burnmg CAMELS contained lessnicotine than that of die 4 otherlargest-selling brands tested," andcondnued to direct its healththeme at doctors. The advertise-ment also referred to "the inter-esting features of the Camel ciga-rette exhibit," including "thedramatic visualization of nicotineabsorpdon from dgarette smokein the human respiratory tract"and "giant photo-murals of Camellaboratory research experiments."At a dme when laboratory sd-ence had garnered espedal admi-ration, the advertisement linkedclinical medicine to the authorityof invesdgadve science. '

Along with directly solidtingphysidans, the tobacco advertise-ments portrayed a glowing imageof physicians in both medicaljournals and popular magazines.In advertisements that were

precursors to the "More Doctors"slogan, Rj Reynolds spedficallyfeatured dedicated physidansserving their country and its sol-diers during World Wai' 11. As a1944 advertisement that ap-peared in Life Magazine entitled"Doctor of Medicine . . . andMorale" illustrated, doctors on thefront received hero status:

He wears the same uniform....He shares the same risks as Iheman with (he giin, , , , Yes, themedical man in the servicetoday is a figlitiiig man ihroiighand through, exeept he fightswithout a gun. . . . [Hit's atrusted fnend to every fightingman,. . IHjc well knows thecomfort and eheer Ihnre Lsin a few moments' relaxationwith a goixl cigarelle , , . likeCamel . . . the Favorite dgarettewith men in atl the serviecs.""

With this and similar advertise-ments, the positive place thatphysicians held in American cul-ture was both exploited and un-derlined by RJ Reynolds's adver-tising scribes. Linking physiciansto wartime patriotism further ele-vated their status and, with it,Camel dgarettes.

THE "MORE DOCTORS-CAMPAIGN

When the "More Doctors"campaign began in January 1946,it also focused on die respectedand romandc image the medicalprofession had achieved in Ameri-can sodety.^" Featuring 6 illustra-tions of physidans with patients—in the laboratory or sitting backwith dgarette in hand—this firstadvertisement personalized thephysidan for the readers of suchpopular magazines as Ladies'Home journal-And 7ime.'"'Pref-

aced with the bold statement that"Every dodor in private pracdcewas asked:—family physidans,surgeons, spedalists . . . doctors ineveiy branch of medicine," the

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PUBLIC HEALTH THEN AND NOW

advertisement touted the thor-oughness of their survey and in-sisted that "yes, your doctor wasasked . . . along with thousandsand thousands of other doctorsfrom Maine to California."

By linking their depiction ofphysicians to the consumer's ownphysician. Reynolds brought im-mediacy to their claims. Any fearsthat smoking might be harmfulwere also easily contradicted bythe physician's being a smokerhimself. Admirable, forthrightphysicians—including the con-sumer's own—had "named theirchoice," and that choice, the ad-vertisement insisted, was Camels,hands down.

Even though a few of these ad-vertisements did appear in print,the Reynolds advertising depart-ment soon realized that theymight have overstepped their evi-dence. With the Federal TradeCommission already challengingsuspected health claims in ciga-rette advertisements, RJ Reynoldstoned down their copy, quicklyshifting their claim to "113,597physicians" surveyed rather thanfl//physidans.'"

At least some individual physi-cians questioned the originalclaim. In a letter to Howard TBehrman, a physidan who had re-quested "more specific Intbrma-tion concerning the survey ofphysidans' smoking preference,"RJ Reynolds advertising executiveW T. Smither assured liim thatthe surveying had heen thoroughand sdentific. Explaining that thequestion about brand preferencehad been embedded in a surveythat included less relevant topics-such as medical journals, medicalconventions, and ntimerous con-sumer products—Smither empha-sized how 3 independent surveyshad garnered "similar findings,and in doing so, sei"ved to conlirmthe acctiracy of each ^

Beyond the questionable meth-ods used to gather data. Reynoldswas also careful how they de-scribed the survey findings in ad-vertising copy, making sure toavoid conflating doctors' choice ofa dgarette with any belief on theirpart that Camels were healthier.In theii- advertisements, Ihey as-serted, "Doctors smoke for pleas-ure just like the rest of us."'' In-ternally, Reynoids's advertisingexecutives cautioned WilliamEsty. their advertising company,to be careful of what theyclaimed, insisting that "in no way[shotiid] the copy.., intimate thatdoctors recommended smoking ofCAMELS, [or] that CAMELS aregood for health." '"* This caution-ary approach reflected the grow-ing industry concern about poten-tial regulation and litigation." ^

Even so, the "More Doctors"campaign resonated effectivelywith American cultural valuesabout contemporary medidne.Throughout 1946. the sloganflooded print, radio, and televisionmedia. Doctors were often ideal-ized, as in the 1946 advertise-ment "I'll be right over!" Here, amiddle-aged physidan, in bed inhis pajamas, telephone in hand, isabout to grab the black bag lyingready on his bedside table andmake a middle-of-the-night visit toa patient in need:

24 hours a day your doctor is"on duty.".. . [l]n his daily rou-tine he lives more drama, anddisplay.s more devotion to theoath he has taken, than themost imagijiative mind couldever invent. And hf asks nospeciai credit. When there's ajob to do, he dops it. A fewwinks of sleep. , a few puffs ofa eigaretle. . . and he's back atthe job again.^''

This neighbortiood familyphysidan is saintly and deservingof trust, r'eprescntiiig (as another1946 advertisement explained)

"an honored profession . . . hisprofessional reputation and hisrecord of service are his mostchenshed possessions,"'*' The im-portance of professional autonomyloomed large, and tlie industrywas eager to sustain this view. Asphysidans geared up to fight (heTruman administration s nationalhealth insurance proposals, theirimage as loyal and deserving ofrespect was especially important"^

Along with providing imagesof professional trustworthinessand dedication, the "More Doc-tors" ad campaign also exploitedthe popular faith and admirationof medical science and technol-ogy. In one such "More Doctors"ad. a 5-year-old girl sits next toher mother in a doctor's officeand proclaims, "I'm going togrow a hundred years old" to thekindly man in white (Figtire 4).

FIGURE 4—Advertisemerrt fromthe Camels "More Doctors"

series: "I'm going to growa hundred years oM!"

Source. Good Housekeeping.July 1946.

More Doctors smoke (>amcls

N

CAMI:I.S

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PUBLIC HEALTH THEN AND NOW

Referring to the "amazing stridesin medical science [that] haveadded years to life expectancy,"the advertisement goes on to"thank medical science for that.Thank your doctor and tliou-sands like him.. . toiling cease-lessly. .. that you and yours mayenjoy a longer, better life."''*With medical advances having

Figure 5—Advertisement: "How mildcan a cigarette be?"Source. OMo State Journal ofMedicine, iuly 1949:45:670.

captured popular imaginadon,connecdons drawn between sd-endfic discovery and Camel-smoking doctors added to the ap-peal of their cigarette of choice.""'

MEDICAL AUTHORITYAND TOBACCO

After the inidal onslaught ofheroic physidans and medicalmiracles in 1946. the "MoreDoctors" advertisements in 1947

and 1948 continued to remindreaders about the survey as thefocus of the adverdsementsshifted. Tbe main slogan of onesucb campaign was "Experienceis tlie best teacher." In this seriesof adverdsements, Rj Reynoldsexplained that the cigarette short-age created by the war hadforced many to smoke whateverbrands were available, and thisexperience, they claimed, hadmade the superiority of Camels'quality dearly evident. Thesmoker was able to tell the difler-ence between brands, and such"experience" translated to otherareas where someone might haveknow how. When the slogan ap-peared in magazines like Life andSaturday Evening Post, the "expe-

rience" dted might be that of atalented celebrity athlete able todiscern quality in his or hersport. In medical journals, thereferences were to famous scien-tific researchers. These advertise-ments championed physiciansand medicine and reminded theiraudience again that "More doc-tors smoked Camels" as they alsocontinued to praise science,""

But the idea of "experience"also figured into another preva-lent theme communicated in RJReynolds's adverdsing—that of in-dividual authority, both thephysician's and the individualconsumer's. The quesdon ofthroat irritation so central tomany 1920s and 1930s ad cam-paigns again emerged here as RJReynolds introduced a "mildness"theme. With the central claimthat Camels did not irritate thethroat, Reynolds featured boththe physician-researcher and theeveryday smoker to convincereaders of Camels' mildness.

In July 1949 issues of bothlocal and nadonal medical jour-nals, Rj Reynolds asked, "Howmild can a dgarette be?" In

answering this quesdon, the ad-verdscment juxtaposed a "doc-tors report"—illustrated with aphysician, cigaiette in hand andhead mirror sd'apped ai'ound hisbrow—with a "smokers report"—illustrated with a smiling "SylviaMacNeill, secretary." Physidans,the adverdsement explained, hadconcluded after scientific invesd-gadon that there was "not onesingle case of throat initadon"from smoking Camel dgarettes.In fact, "noted throat specialists"had conducted "weekly examina-dons" of padents in making thisdeterminadon. Reynolds usedthis depicdon of careful, clinicalobservation to substandate theirhealth claim (Figure 5).^^

The adverdsement went be-yond medical authority, however,asserdng that smokers didn't evenhave to take their pbysidans'word for it Instead, they couldtake their "own personal 30-daytest," as Sylvia MacNeill had done.She concluded that she "knew"that "Camels are the mildest best-tasdng dgarette I ever smoked."Advertisements in popular maga-zines took smokers' ability tojudge for themselves even further,with Elana O'Brian, real estatebroker, declaring in a typical ex-ample, "I don't need my doctor'sreport to know Camels are mild"'Yhe adverdsement underlinedher asserdon with photos of 6other smokers from various walksof life under the heading "Thou-sands more agreel" '

In another example, Anne Jef-freys, a stage and screen star, in-sisted, "The test was fijn and itwas sensible'." Parallel to earliersolidtadon of physidans' opin-ions, in this series of adverdse-ments RJ Reynolds requestedthat smokers determine thesafety of Camels on their ownand praised their acumen. Withsome advertisements calling on

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PUBLIC HEALTH THEN AND NOW

smokers to "Prove it yourself!' andeven guaranteeing a money-backguarantee for dissatisfied cus-tomers, Reynolds insisted on thesuperiority of their product. '•*These advertisements worked tosubvert the emerging population-based epidemiological findingsby emphasizing the primacy of"individual" judgment.

By 1952, advertising copywent beyond the typical individ-ual smoker to emphasize thesheer volume of people whochose Camels as their cigarette.Highlighting that Camel was"America's most popular cigaretteby billions." the ad copy men-tioned that "long before Camelreached those heights, repeatedsurveys showed that more doctorssmoke Camels than any olhercigarette.""* The cigarette's popu-larity in itself became a sellingpoint; how could so many peoplebe wrong? And physicians' ciga-rette choice served to contirmthis popularity. As the heading ofa similar advertisement ex-plained, "The doctors' choice isAmerica's choice.'"*^

THE DISAPPEARINGDOCTOR

Ultimately, however, the useof physicians in Camel advertise-ments could not be sustained asthe health evidence against ciga-rettes accumulated. When dis-turbing scientific results connect-ing lung cajicer and cigarettesbegan to emerge, Camel adver-tisements shifted away fromphysicians' judgment and author-ity. In 1950, the publication ofthe now-famous work of EvartsGraham and Kmst Wynder inthe United States—as well as thatof A. Bradford Hill and RichardDoll in the United Kingdom-showed that there was cause foralarm.'*'' The reporting of their

findings connecting lung cancerto cigarette smoking in nationalmagazines like Time andReader's Digest—and the corre-sponding declines in sales andstock prices—forced tobacco ex-ecutives to assess strategies forresponding to growing medicaland public concerns about theirproduct.*"

By 1953. when Wynder, Gra-ham, and their colleague AdeleCroninger published laboratoryfmdings confirming that ciga-rettes were carcinogenic, scien-tific fijidings constituted a criticalthreat to the industry."''* Tobaccoexecutives were well aware bothof these findings and of the pub-lic attention they were receiving,and their statements and actionsreflected an understanding thatthis new scientific evidence con-stituted a full-scale crisis for theircorporations.

Most notably, company execu-tives realized that they wouldhave to work together in the faceof the scientific evidence. Al-though each company still soughtan advantage over its competitors,the new healtli evidence threat-ened the hilvre of the entire in-dustiy. In December 1953, the to-bacco executives met to devise ajoint strategy. They hired promi-nent public relations firm Hill &Knowlton to aid in this effort. Asa planning memo makes deay,health claims were considered tobe no longer viable. According toEdward Dakin, a Hill & Knowltonexecutive, it would be critical to

Develop some understandingwith companies that, on thisproblem, none is going to seeka competitive advantage by in-ferring to its public that itsproduct is less risky than oth-ere. (No claims that special fil-lers or toasting, or expert selec-tion of tobacco, 01' extra leii(rthin the butt, or anything else,makes a given brand less likely(o cause you-know-what. No

"PIay-Safe-with-Luckies" idea—or with Caniels or with ajiy-thing else.)^"

Hill & Knowlton's advice wasthat the industry as a whole mustdesist from health claims thathad been a centerpiece of the ad-vertising that featured physicians.Such claims, the agency nowcontended, would now draw at-tention to the "health scare." asthey professed to call it. '

Tobacco executives were well aware bothof these findings and of the public attention

they were receiving, and their statementsand actions reflected an understanding

that this new scientific evidence constituteda full-scale crisis for their corporations.

In popular magazines, the lastnotable reference to doctors in anadvertisement came in 1954,After the other tobacco compa-nies had left such marketing tech-niques behind, Liggett and Myers{which had declined participationin the joint industry programdirected by Hill & Knowlton)made the claim that their L&Mfilter cigarette was "Just what thedoctor ordered!" In a typical ad-vertisement that appeared in aFebruary issue of Life magazine,Hollywood star Fredric Marchmade this assertion after havingi-L'ad the letter written hy a"Dr Darkis" that was inset intothe advertisement Darkis ex-plained in this letter that L&Mfilters used a "highly purifiedeilpha cellulose" that was "entiretyharmless" and "effectively filteredthe smoke" (Figure 6),

Dr Darkis was in fact not amedical doctor at all but a re-.search chemist, yet another ex-ample of misrepresentation in atobacco ad. ^ More significantly,

February 2006, Vol 96, No. 2 I American Journal of Public Health Gardner | Peer Reviewed 1 Public Health Then and Now I 229

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FIGURE G—Actor Fredric March inan advertisement for L&M RHers:"This ts K."Source. Life Magazine. February 22,1954.

this use of implicit doctor en-dorsement of cigarettes wouldnot occur again in American ad-vertising after this campaign.Much in the way that the indus-try had used doctors to reassuresmokers in the 1940s, filter ciga-rettes were heconiing the indus-try's new strategy for appealingto consumers, whose concernsabout the health risks of smokingwould be repeatedly confirmedby new research studies. In1950, filter dgarettes were 2'Viiof the US dgarette market; by1960, they were 50"/[j. -'

In medical journals, the last-gasp attempt by a tobacco com-pany to ally itself with physicianscame in 1953, when the Loril-lard Company appealed to physi-cians as they promoted their newfilter dgarette, Kent. These ad-vertisements queried, "Have youtried this experiment, doctor?"

and "Why is it, doctor, that onefilter cigarette gives so muchmore protection than any other?"One advertisement mentionedhow "thousands" of physicians ata recent AMA convention wit-nessed "a convincing demonstra-tion. . . [of] the effectiveness ofthe MICRONITE FILTER" andincluded photos of the experi-ment demonstrated there. Intheir marketing of Kent, Loriltardhad created a campaign reminis-cent of those designed by PhilipMorris and RJ Reynolds in the1930s and early 1940s. *' Just asin those earlier advertisements,Lorillard called on physicians tointerpret scientific results usingtheir individual, clinical judg-ment But tbe swift and vehe-ment reaction to these advertise-ments clearly illustrated bow thesocial and scientific climate hadshifted, A 1954 JAMA editoriallabeled the reference to physi-cians and the MIA conventionan "unauthorized and medicallyunethical use of the prestige andreputation of the American Med-ical Assodation. " ^ No longercould tobacco companies counton physicians to serve as publicadvocates of their product.

In fact, in \953JAMA had de-cided to stop accepting cigaretteadvertisements in its publicationsand banned cigarette companiesfrom exhibiting their products atAMA conventions. '* After con-ducting its own survey of physi-cians, the AMA explained in aletter to tobacco companies that"a large percentage of physiciansinterviewed expressed their dis-approval" of dgarette advertise-ments m medical journals. OtherJAMA advertisers had come todislike having their productsappear next to cigarette adver-tisements as well.'^ With tbeAMA publidy condemning theKent ad campaign In 1954 as

"hucksterism," it became evenmore clear to tobacco companiesthat the purported allegiancewith physidans was no longerfeasible or effective.

One additional indicator ofthe growing medical disdain forcigarettes was the very fact thatmany physidans who followedtbe emerging health evidencebegan the [irocess of giving upsmoking. According to one studyof physicians' smoking practicesin Massachusetts, nearly 52%had reported being regularsmokers in 1954 (over 30% re-ported smoking at least a packper day); just 5 years later, only39% were regular smokers. Ad-ditionally, only 18% now re-ported consumption of a pack ormore per day. "

Although the industry wouldcontinue to solicit physicianswitb materials disputing the rela-tionship between smoking anddisease and would also seek outphysicians who doubted theharmfulness of cigarettes inorder to imdermine emergingscientific findings, such effortswould be gi eeted with risingskepticism.''' The era of explicituse of pbysicitins and healthclaims to promote smoking hadended even though the AMAwould not publicly acknowledgethe harms of cigarette smokinguntil 1978."" The smokingphysician had become a visualoxymoron. The industry wouldturn to new images and more so-phisticated strategies to hawktheir dangerous product. •

About the AirtliorMartha N. Gardner is with the Depurt-ment of Arts and Sciences, MassachusettsCollege of Pharmacy and Health Sciences,Boston. Mass. Allan M. Brandt is with theDepartment of Social Mediane. HurvardMedical School and the History of ScienceDepartment. Harvard University. Cam-bridge, Mass.

230 I Public Health Then and Now I Peer Reviewed I Gardner American Journal of Public Health | February 2006, Vol 96. No. 2

PUBLIC HEALTH THEN AND NOW

Requests for reprints should be sent toMartha N. Gardner. PhD. Department ofArts and Sciences. Ma'isachuseits Collegeof Pharmacy and Heatth Sciences, 179I.ongWDod Ave, Boston. MA 02115(e-muil: martha.gardner@bos.mcphsedu).

77iis (irtide uxis acceptedfune 20, 2005.

ContribiftorsBoth authors lieveioped, researched, aiidwrote the artide. M. N. Gardner is prttid-pa] aulhnr and A, M. Brandt is coauthor.

AcknowledgmentsA. M. Bi-ajidt is the recipient of theWilliam Calian Distinguished ProfessorAward, granted by the Flight AttendantsMedica] Research Institute. This awardprovides finandal support for research.

A.M. Brandt served as a consultantand expert witness on behalf of theDepartment of Justice in USA v PhilipMorris el al. M. N. Gardner also servedas a consultant in the case.

Endnotes!, See P. Crist, W.K.Marple.S.J,Kaczynski, and T. [„ Abrams, "re.Jones/Day Liability Summary ('Corpo-rate Activity Project")," pp. 379-381,t986. Bates No. 681879254/9715,available at tobaccodocu ments.el's/ness/37 37 5.html (acces.sed November12. 2005, as were all Internet dtations);"[Memo to John \V, Hill] Re. RJR Claimof Doctor's Use of Camels." J. J. D. toJohn W. Hill, December 14, 1953. Wis-consin Historical Society, John W. HillPapers, Box 110. Folder 10.

2, D. E. Nelson, G. A, Giovino, S. L.Emont, et al,. "Trends in CigaretteSmoking Among US Physicians andUurses," Journal of the American MedicalAssociation271 (19941: 1273-1275.

3- [„ S. Snegireff and O. M. Lomhaitl,"Survey of Smoking Habits of Massachu-setts Physidans." New England fimmal ofMedidneim (24) (1954); 1042-1045;"The Physidan and Tobacco." Southwest-em Medicine 36 (1955): 589-390.

4, H. L, Lombard and C. R. Doering."Cancer Studies in Massachusetts. 11:Habits. Characteristics and Fnvironinentof Individuals With and Without Can-cer." New England foumal of Medicine196 (10) (1928): 481-487; FL.HofT-man. "Cancer and Smoking Habits," An-nals ofSurjieri/ 93 (1931); 50-67; A,Ochsner and M. DeBakey, "Symposiumon Cancer: Primary Pulmonary Malig-nancy. Treatment by Total Pneumonec-tomy. Analysis of 79 Collected Casesand Presentation of 7 Personal Cases."Surgery, Gt/necology and Ohstetrits 68(1939): 435-451.

5, J. Patterson, The Dread Disease-Cancer and American Culture (Cam-bridge. Mass: Harvard Universi^ Press,

1987), See Ochsner and DeBakey,"Symposium on Cancer," for a din;(-treference to "chronic irritation" and can-cer (p. 446),

6. See "Good laste in Advertising."Fortune 1 (1930): 60-61, aaid TheAmerican Tobacco Co.," Fortune 14(1936): 96-102, 154-160,

7. R. Marchand, Advertising the Amer-ican Dream: Making Way for Modernity(Berkeley: University of California Press.1985). 21-22; R. Sobel, They Satisfy:The Cigarette in American Life (GardenCity. [S[Y: Anchor Books; 1978), 101;G. H. Allen. "Alhert Davis Lasker," Ad-vertising and Selling 19 (1932): 21-22,16-37.

8. In a report to the Federal TradeCommission, Amencan Ibbacco Com-pany detailed this survey. See AmericanTobacco Company, "United States ofAmerica, Federal 'Trade Commission:Memorandum Submitted by the Ameri-can Ibbacco Company." pp. 18-22,80-89, 1976, Bates No. 980306396/6603. available at http;//legacy,libraiy,ucsfedu/tid/rum85!00.

9. Lucky Strike advertisement frotnGolden Book 12 (70) (1930), available athttp: / / tobaccodocuments.org/pollay _ads/Luckn.07,html.

10. Philip Morris, "Report on theFindings of a Group of Doctors Call forPhilip Morris," October 16, 1937.Bates N(j. 2061014890, available athtl4]://tobaccodocuments. org/ads_pm /20610I4890,litml.

11. A. Blum. "When 'More DoctorsSmoked Camels': Cigarette Advertisingin the Journal," New York State foumalof Mediane 83 (1983): 1347-1352.

12. M. G. Mulinos and R. L. Osbf>me."Irritating Properties of Cigarette Smokeas Influenced by 1 lygroscopic Agents,";Veui York State fourruil of Medicine 35(1935): 1-3. and "Pharmacology of In-flammation, III: Influence of HygroscopicAgenis on Irritation I'rom CigaretteSmoke," Proceedings of the Sodety forExperimental Biology and Medidne 32(1934): 241-245. For disjiute on theirfindings, see internal memas from ll.H.Hanmer, research director at AmericanTobacco, to C. F, Nailey (August 29.

1935, Bates No. 90516197711978,available at http://legacy.lihrary.ucsf.edu/tid/Tioj54n30) and to E. Bogen (l^ecem-ber 27, 1935, Bates No. 950143321/3,328. available at http://!egacy.library.ucsfedu/tid/pko54fOO). Howaid C. Bal-lenger had findings tbat contrailirtedMulinos in "Irritation of the Throat ["romCigaret Smoke: A Study of HygroscopicAgents," .Archives of Otolaryngohgy 29(1939): 115-123.

13. "Philip Morris & Co.," Fortune. Manh1936. ip. 106-112.114.116, 119.

14. Philip Morris advertisement,from Saturday Evening Post. Septem-ber 25, 1943, available at http://tobaccodocuments,org/pollay_ads/PbilO3.O4.html,

15. "Pliilip Morris & Co.," 116.

16. C. A. Wemer, "The Triumph of theCigarette." American Mercury 6 (1925):419-420; W, M. Johnson, "The EU'ecLsof Ibbacco Smoking," American Mercury25 (1932): 451-454; A. G. Ingalls. "If'You Smoke," Scientific American 154(1936): 310-313,354-355.

17. J. C. Bumham, "American Physi-cians and Tohacco Use: Two SurgeonsGeneral. 1929 and 1964," Bulletin ofthe History of Medicine 63 (Spring1989): 1-31.

18. See R. A, Aronowitz, Making Senseofniness: Science, Society and Disease(New York: Cambridge UnivereiQ' Press,1998), 111-144.

19. H. Wolinsky and T. Brune. TheSerpent on the Staff: The Unhealthy Poli-tics of the American Medial Association(New Yoi-k: Jeremy P. TaiT:hor/Putnam,1994), 145-147; ''When 'More DoctorsSmoked Camels,'" 1347.

20. Philip Morris, "If You ,Advise Pa-tients on Smoking," August 1939, adver-tisement. Bates No. 2061011925, avail-ahle at http://tobaccodocuments.org/ads4)m/2O6IO11925.html.

21. RJ Reynolds, "The Medical RelatioasDivision of Came! Cigarettes BelievesThat," September 1942. advertisementavailable at http://tobaccodocuments.org/po llay_ads/CameO 2.16 .html.

22. Crist et al. "re. Jones/Day LiabilitySummary." 379-381.

23. RJ Reynolds, "When You Recordtbe Effectiveness of Nicotine Control-Less Nicotine in the Smoke. Camel-The Cigarette Of Costlier Tobaccos,"July 1942, advertisement, availableal http://legacy.library.ucsf.edu/tid/sgt78dOO.

24. C. W. Crampton, "The Cigarette,the Soldier, and the Physidan." Tlie Mil-itary Surgeon 89 (1941): 1-13.

25. B. DeVoto. "Doctors Along theBoardwalk." m Harper's magazine(1947), repnnted in DeVoto. The EasyC/iuiV (Boston: Houghton Mifilin Com-pany, 1955), 91.

26. Philip Morris, "At the AMA. Con-vention," June 6, 1942, Bates No.1003071327, available at http://legary.libraiy. ucsf.edu/tid/ fvmO 2 aOO.

27 RJ Reynolds, "Camel Invites You toEnjoy the Interesting Features of theCamel Cigarette Exhibit at the .\MA.Convention—June 8 to 12," June 1942,Bates No. 502596871/6871. available

at http://iegacy, library, ucsf.edu/tid/cst78dOO.

28. RJ Reynolds, "Camels Costlier To-baccos," advertisement, available atbttp://tobaccodocuments .org/po II ay _ads/Camel4.17.html. This ad appeared inSaturday Evening Post. Life, and Colliersin May 1944, and similar ones ap-peared in the New England Journal ofMedicine and the Journal of the AmericanMedical Association.

29. J.C. Bumham, "American Medi-cine's Golden Age: What Happened toIt?" Science 215 (1982): 1474-1479,

30. R] Reynolds, '"Every Doctor in Pri-vate IVactice Was Asked. According toa Recent Nationwide Survey: More Doc-tors Smoke Camels 'ITian Any OtherCigarette!" March 1946, available athttp: //www. trinketsandtraih. org/re-sults.asp. The Trinkets and 'Trash Website notes that the ad appeared in theMarch 1946 Ladies Home Journal

31. See letters from Helen Tiemann.secretary to William Hsty, to the RJRAdvertising Department dated Januaiy9, 1946 (Bates No. 502597537, avail-able at http://legacy,library.ucsfedu/tid/ijs78d00) and December 26,1945 (Bates No. 502597519, avail-able at http [//legacy.library,ucsf.edu/tid/qis78dOO).

32. Letter from W.T.Smither.RJReynolds Tobacco Company, to DrHoward T. Behrman, February 22,1946, Bates No. 2022238658/8660.available at http://legacy.library.ucsf.edu/tid/rtx74e00.

33. RJ Reynolds, "liveiy Doctor in Pri-vate Practice Was Asked."

34. W. T. Smither, "Memorandum ofVisit to William F:sty," June 10, 1946,Bates No. 501689543, available athttp://legacy.lihraiy.iicsf,edu/tid/guv29dOO.

35. See also James T. Weldi to A. G.Clarke, February 4, 1952. Bates No,502400834. available at http://legacy.library.ucsf.edu/tid/blc 19d00.

36. RJ Reynolds. "More Doctors SmokeCamels." advertisement available atbttp: //tobaccod ocuments.org/pollay^ads/Camel8.]7,htnil. Internal RJReynolds records note that this adver-tisement appeared in Life. Limk, LadiesHome Journal. Colliers, and Country Gen-tleman tinder the heading "I'll Be RightOver!" RJ Reynolds, "According to a Re-cent Nationwide Survey: More DoctorsSmoke Camels 'Than Any Other Ciga-rette!" May and June 1946, advertise-ment Bates No. 502470699. availableat http://legacy.lihrary.ucsf.edii/tid/jyi88d00.

37 RJ Reynolds, "l"he Doctor MakesHis Rounds: According to a Recent

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Nationwide Survey More DoctorsSmoke Camels Than Ajiy Other Ciga-rette!" August and September 1946.Bates No. 50247074:*, available athttp://le8acy .library.ucsf edu/Eid/

38. Compulsonf Health Insurance: TheContinuing American Debate, ed. R. L.Numbers (Westport, Conn: GreenwoodPress. 1982).

39. RJ Reynolds internal doaiment.Bates No. 502470717, available atbttp;//legacy.librdry.ucsf.edii/tid/bwj88dOO.

40. See [' Ue Kniif, Micrvbe Hunters(New York: Blue Ribbon BtHjks, 1926),and B. SokolofT, The Miracle Drugs(Clucago: Ziif-Davls Pub Co. 1949).

41. RJ Reynolds, "E- xperience Is theBest Teacher Sir Cbarles Bell." Maj-cb1947, Bates No, 502470841. availableal btlp[//legacy.library iicsf.edu/tJd/moj88d00, and RJ Reynolds, "Experi-ence Is tbe Best Tcacber. Mildi-edODonnell," May and June 1947,Bates No. 502470864, available atht^: //I egacy. library ,u csf.edu/tid/jp]88d00.

42. RJ Reynold.s. "How Mild Can aCigarette Be''" July 1949. Bates No.502471375, available a! bttp://legacy.libiary.ucsf.edu/tid/nii8BdOO;RJ Reynolds. "Mow Miid Can a Ciga-rette Be?" July 1949, Bates No.502598073. available at bttp://legacy.library.ucsf.edu/tid/ztr78dOO.RJ Reynold.s bad also bad a relatedlong term campaign in tbeir ads, ask-ing consumers to take a "30-day test"of their "T-iione" so tbat tbey cnulddecide for themselves abnut tbe effectof Camels on tbeir tbroat.

43. HJ Reynolds, "Not One Single Caseof Tbroat Irritation Because of SmokingCamels! Noted Tbiijat Spedalists Reporton 30-Day Test of Camel Smokers," Jan-uary 1949. Bates No. 502598158, avail-able at http^/legaty.library.ucsf edu/tid/flr78dOO.

44. RJ Reynolds, "SO-Day SmokingTest Proves Camels Mildness!" Novem-ber 20. December 4, 6, 7. 1948, Janu-ary 1949, Bates No. 502597957, avail-able at bttp [//legacy .library.ucsf edu/tid/obs78dOO.

45. Display ad. New York Times.August 25, 1952, p. 6.

46. Display ad. New York Times, June16, 1952, p. 10.

47. K, L. Wynder and 1:;. A. Grabam,"Tobacco Smoking as a Possible Etio-logic I'actor in Bronchiogenic Carci-noma: A Study of 684 Proved Case.s,"Journal of the American Medical .-Issoaii-tion 143 (1950): 320-336: R. Doll andA. B. Hill, "Smoking and Carcinoma of

the I.ung; Preliminary Report," BritishMedical Journal 2 (1950): 739-748.For a discussion of the significance ofthese ajticles. see Ernst L. Wynder, "Ib-bacco as a Cause of Lung Cancer: SomeReflections," American Journal o/F.pide-miologif 14(i (9) (1997): 687-694, andAllan M. Brandt, "line Cigarette, Risk,and American Culture," Daedalus 11914) (19901: 155-176.

48. For examples of coverage in thepojjutar press, see R. Norr, "Cancer bytlie Carton," Reader's Digest. December1952, pp. 7—8: "Smoking & Cancer."rime, July 5, 1952, ji. 34; "Beyond AnyDoubt," Time. November 30, 1953, pp.60-Hl: L. M. Miller and J. Monaban,"Tbe Facts Behind the Cigarette Contro-versy," Reader's Digest, July 1954, pp,1-6; "Smoke Gets in tbe News," Life.December 21, 1953. pp, 20-21. Seealso Hans 11. Tocb, Terrence M. Allen,and William Lazer, "Efiec-ts of the Can-cer ScaiTs: Tbe Residue of News Im-pact," you r««/is"i Quarterly 33 (1961):25-34.

49. Enist L. Wynder, FIvarts A. Gra-ham, and Adele B. Croninger, "Experi-mental Pnxluction of Cai-cinoma WithCigarette Tar," Cancer Research 13(1953): 855-864.

50. Edwin Dakin and Hill & Kiiowlton,"Forwarding Memorajidum: To Membersof tbe Planning Committee," December15, 1953, Trial Exbibit 18,904. avail-able at bttp://tobaccodocumenLs.f)rg/ness/3793.html; also available at Wis-consin Historical Society, Jobn W. Hil!F^pet^, Box 110, Folder 2, pp. 8-9.

51. See K.M. Cummings, C. P. Morley,ajid A. Hyiand, "Failed Promises of theCigarette IndiLstry and Its EHett onConsumer Misperceptions About thellealtb Risks of Smoking," Tobacco Con-trot 11 (SuppI 1) (2002): 1110-1117,and R. W. Pollay, "Propagajida, Piiftirigand the Public Interest: Cigarette Public-ity lactics. Strategies and Effects," PublicRelations Review 16 (1990): 27-42.

52. Liggett and Myers,"[ redric MarchSays-Tbis Is It: 'L&M Filtere Are JustWbat ibe Doctor Ordered,"" February22, 1954, Bates No. 2021368933, avail-able at http://tobaccodoaiments.org/pm/2O21368933.btml.

53. See R.W. Pollay, 'Tbe Dark Sideof Marketing Seemingly 'Light' Ciga-rettes: Successful Images anti FailedFact," Tobacco Control 11 (Supjil 1)(2002): 118-130.

54. l.orillard, "Have You Heand theStoiy of New Kent Cigarettes, Doctor?"1953, Bates No, 92373155, availableat bttp://Iegacy.library.ucsf edu/tid/eej54aOO: l.oi-illard, "Wby Is It, Doctor,"ITiat One I iltcr Gives So Mucb MoreProtection TTian Any Otber? Kent. Tbe

Only Cigarette With the Micronite Filterfor the Greatest Protection in CigaretteHistory," 1953, Bates No. 92373147,available at http://legacy.library.ucsf,cdu/tid/mej54a00; Lorillard, "HaveYou Tried Tbis Fxperiment. Dactnr?"1953. Bates No. 92373153, availableat bttp://Iegacj.libriiry.ucsf edu/tid/gej54a00; Lorillard, "Some QuestionsAbout Filter Cigarettes That May HaveOccurred to You, Doctor and llieir An-swers by tbe Makers of Kent," August22. 1953, Bates No. 89749655, avail-able at http://legacy.librarj.ucsfedu/tid/dnml3cOO.

55. "Cigarette Hucksterism and tbeAMA." Journal oj the American MedicalAssociation. April 3,1954, p. 1180.

56. Serpent on the Staff. 152-154.

57 " 'AMA Journal' Stops Taking Ciga-ret Ads," Adifertising Age 1 (1953): 93.

58. L.S. Snegireif and O.M. Lombard,"Smokuig HabiLs of MassachusettsPhysicians: Five-Year Fotlow-Up Study{\954-1959): New England Journal ofMedicine2bl (1959): 603-604.

59. For a discussion of a newsletterdistributed across the counti^' in doc-tors' and dentLsLs' offices, see Hill &Knowiton, "i. Tobacco ajid Health—1962," (November 15, 1961, Bates

No. 966046705/6719, available atbttp://legacy.library.ucsfedu/tid/zgo21aOO.

60. Serpent on the Stajf. 155.

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