Jackler & Ayoub's analysis of the cigarette advertisements in medical journals, 1936–53, provides an intriguing historical example of connections between industry and medicine. Tobacco companies’ motivation to influence physicians is clear, but the contemporary understanding of the harms of the cigarette and the ethics of this connection differed significantly from our current context. Medical journals, advertisements and cigarettes: a potent combination. In this paper, Jackler & Ayoub have provided a valuable analysis of cigarette advertisements from medical journals, 1936–53 1. Their work relies in part upon the virtual treasure trove of more than 25 000 cigarette advertisements that are available online through the Stanford University Research into Tobacco Advertising (SRITA) research group, for which Jackler is the principal investigator 2. In my own writing and teaching, I have found this collection to be invaluable, and I am very appreciative of the work these authors have conducted here. Their essay is one piece in helping us to understand the complexities of scientific knowledge, the physician–patient relationship and cigarette marketing. Especially useful is that these authors have gone beyond the advertisements themselves, also exploring the correspondence between medical journal editors and cigarette company executives and marketers. Another virtual treasure trove that has made this exploration possible is the more than 14 million internal tobacco documents available at the University of California San Francisco ‘Truth Tobacco Industry Documents’ website 3. Full-text searchable, this collection of documents gleaned largely from lawsuits against tobacco companies has been a godsend for tobacco control advocates and historians alike. The ‘motivation and tactics’ revealed by Jackler & Ayoub shine a light on the internal workings of industry, typically hidden from public view. Jackler & Ayoub rightly highlight the way in which these advertisements did more than just attract individual physicians to their brand. Rather, the climate of the times was one of high respect for physicians, a ‘golden age’ in which Americans had a glowing perception of physicians 4, 5. Physicians’ influence on patients, and the corresponding money stream for medical journals, fostered a reciprocal relationship that now seems damning. The tricky part, however, is assessing this relationship in context. Imagine an analysis of soap manufacturers advertising their brands in medical journals, a product that did not then become the leading cause of death in our country; perhaps our outrage might not be as great. We need to attempt to maintain a clear-eyed view of the knowledge of the harms of cigarettes in the time-period examined by the authors. Not until 1950 did published epidemiological studies show a convincing connection between smoking and lung cancer. As late as 1949, researchers who would become the anti-tobacco experts by the mid-1950s often scoffed at the connection, and many were smokers themselves (6, 7, pp. 130–157). When cigarette consumption began to increase in the early 20th century American lungs were also exposed to the effects of factory production, automobile driving and asphalt road-building. Also, the physician–tobacco industry connection perhaps now appears more conspiratorial than it did then. Americans loyally championed industry after World War II, including the tobacco companies who had donated boatloads of cigarettes to American soldiers. When concerns about the cigarette began to emerge in the 1950s, many felt that their makers could be the ones to fix the problems with their product, rather than obfuscating the harms as they ultimately did. Researchers and advocates voicing the harms of cigarette by the early 1950s expressed support for industry funding of research into finding ways to make the cigarette safe, making physician–tobacco industry connections seem more natural and productive rather than corrupt 8. Significantly, cigarette advertisements are only one aspect of the connections between physicians and the cigarette industry, which did not end when journals stopped accepting cigarette advertisements. Even after the 1964 Surgeon General's Report on Smoking and Health removed any credible doubt that cigarettes caused lung cancer and shortened the life-span, the American Medical Association (AMA) refused to publicly condemn cigarette smoking and instead simply called for ‘more research’, the hackneyed phrase already run into the ground by tobacco spokespeople. Morris Fishbein was therefore by no means alone in his complicity with tobacco companies (7, p. 249). Jackler & Ayoub have expanded and complicated our understanding of both medical journals and the tobacco industry in their essay. Advertisements such as those presented here are compelling markers of connections between consumer culture and medicine, a useful, but complex, endeavor. None.
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Oct 27, 2024
Malika Chaudhuri + 2
Just Published
Open Access