1、1Unit 3Text ATracing the Cigarettes Path From Sexy to Deadly HOWARD MARKEL, M.D.For many Americans, the tobacco industrys disingenuousness became a matter of public record during a Congressional hearing on April 14, 1994. There, under the withering glare of Representative Henry A.Waxman, Democrat of
2、 California, appeared the chief executives of the seven largest American tobacco companies.Each executive raised his right hand and solemnly swore to tell the whole truth about his business. In sequential testimony, each one stated that he did not believe tobacco was a health risk and that his compa
3、ny had taken no steps to manipulate the levels of nicotine in its cigarettes.Thirty years after the famous surgeon generals report declaring cigarette smoking believed otherwise.But it was not always that way. Allan M. Brandt, a medical historian at Harvard, insists that recognizing the dangers of c
4、igarettes resulted from an intellectual process that took the better part of the 20th century. He describes this fascinating story in his new book, “The Cigarette Century: The Rise, Fall and Deadly Persistence of the Product that Defined America” (Basic Books).In contrast to the symbol of death and
5、disease it is today, from the early 1900s to the 1960s the cigarette was a cultural icon of sophistication, glamour and sexual allure a highly prized commodity for one out of two Americans.Many advertising campaigns from the 1930s through the 1950s extolled the healthy virtues of cigarettes. Full-co
6、lor magazine ads depicted kindly doctors clad in white coats proudly lighting up or puffing away, with slogans like “More doctors smoke Camels than any other cigarette.”Early in the 20th century, opposition to cigarettes took a moral rather than a health-conscious tone, especially for women who want
7、ed to smoke, although even then many doctors were concerned that smoking was a health risk.The 1930s were a period when many Americans began smoking and the most significant health effects had not yet developed. As a result, the scientific studies of the era often failed to find clear evidence of se
8、rious pathology and had the perverse effect of exonerating the cigarette.The years after World War II, however, were a time of major 2breakthroughs in epidemiological thought. In 1947, Richard Doll and A. Bradford Hill of the British Medical Research Council created a sophisticated statistical techn
9、ique to document the association between rising rates of lung cancer and increasing numbers of smokers.The prominent surgeon Evarts A. Graham and a medical student, Ernst L. Wynder, published a landmark article in 1950 comparing the incidence of lung cancer in their nonsmoking and smoking patients a
10、t Barnes Hospital in St. Louis. They concluded that “cigarette smoking, over a long period, is at least one important factor in the striking increase in bronchogenic cancer.”Predictably, the tobacco companies and their expert surrogates derided these and other studies as mere statistical arguments o
11、r anecdotes rather than definitions of causality.Dr. Brandt, who has exhaustively combed through the tobacco companies internal memorandums and research documents, amply demonstrates that Big Tobacco understood many of the health risks of their products long before the 1964 surgeon generals report.H
12、e also describes the concerted disinformation campaigns these companies waged for more than half a century simultaneously obfuscating scientific evidence and spreading the belief that since everyone knew cigarettes were dangerous at some level, smoking was essentially an issue of personal choice and
13、 responsibility rather than a corporate one.In the 1980s, scientists established the revolutionary concept that nicotine is extremely addictive. The tobacco companies publicly rejected such claims, even as they took advantage of cigarettes addictive potential by routinely spiking them with extra nic
14、otine to make it harder to quit smoking. And their marketing memorandums document advertising campaigns aimed at youngsters to hook whole new generations of smokers.In 2004, Dr. Brandt was recruited by the Department of Justice to serve as its star expert witness in the federal racketeering case aga
15、inst Big Tobacco and to counter the gaggle of witnesses recruited by the industry. According to their own testimony, most of the 29 historians testifying on behalf of Big Tobacco did not even consult the industrys internal research or communications. Instead, these experts focused primarily on a sma
16、ll group of skeptics of the dangers of cigarettes during the 1950s, many of whom had or would eventually have ties to the tobacco industry.“I was appalled by what the tobacco expert witnesses had written,” Dr. Brandt said in a recent interview. “By asking narrow questions and responding to them with
17、 narrow research, they provided precisely the cover the industry sought.”Apparently, the judge, Gladys Kessler of Federal District Court for the 3District of Columbia, agreed. Last August, she concluded that the tobacco industry had engaged in a 40-year conspiracy to defraud smokers about tobaccos h
18、ealth dangers. Her opinion cited Dr. Brandts testimony more than 100 times.Dr. Brandt acknowledges that there are pitfalls in combining scholarship with battle against the deadly pandemic of cigarette smoking, but he says he sees little alternative.“If one of us occasionally crosses the boundary bet
19、ween analysis and advocacy, so be it,” he said. “The stakes are high, and there is much work to be done.”追寻烟草的历程：从性感到致命霍华德马克尔，医学博士对许多美国人来说，烟草业的不诚信计入公众档案始于 1994 年 4 月 14 日的一次国会听证会。在加州民主党代表亨利A 韦克斯曼的怒视下，美国七大烟草巨头的首席执行官出现在了这次听证会上。早 20 世纪 30 和 40 年代，香烟要么意味着健康因为有一位仁慈的医生含蓄地推荐它，要么就意味着性感。美味总裁举起右手，郑重宣誓要对从事的业务实
20、话实说。在随后的证词中，每个人都陈述自己不相信烟草会给健康带来风险，而且自己的公司从未采取措施来操纵香烟中尼古丁的含量。30 年前，一位卫生局长就发布了关于抽烟危害健康的著作报告。如今看来，烟草业总裁们属于不相信该报告的极少是人的行列。但事实并非始终如此。哈佛大学医学史专家艾伦M布兰特坚持认为，对香烟危害的认识源于持续了大半个 20 世纪的一个智力过程。在新书香烟的世纪：界定美国的产品的兴衰和死命的坚持中，他讲述了这个引人入胜的故事。虽说当今香烟是死亡的疾病的象征，但从 20 世纪初到 20 世纪 60 年代，香烟在文化上象征这成熟练达，美丽和性感诱惑是当时半数美国人大为追捧的商品。从 20
21、世纪 30 年代到 50 年代，许多广告运动都颂扬香烟的健康品质。在全彩的杂志广告中，身罕白大褂的仁慈的医生骄傲地点起香烟或是吞云吐雾，上面还写着更多医生选择骆4驼牌香烟”之类的广告语。20 世纪初期，对香烟的抵制带着道德的口吻，而不是出于对健康的关注。对想抽烟的女性更是如此。不过即使在当时，许多医生已经关注到吸烟会给健康造成风险。在 20 世纪 30 年代这一时期，许多美国人变成了烟民,，而抽烟对健康最为显著的危害尚未显现出来。因此，这一时期的科学研究无法从严肃的病理学上找到清晰的证据，竞起到了为香烟开脱的反效果。到了二战后，流行病学思想取得了不少重大突破。1947 年，英国医学研究会的理查
22、德多尔和 A.布拉德福德 希尔创立了一种复杂的统计方法，以记录肺癌上升率和烟民增加之间的联系。著名外科医生埃瓦茨 A 格雷厄姆和医学专业学生欧内斯特L温德尔于 1950年发表了一篇极为重要的论文，比较了圣路易斯市巴恩斯医院内烟民和非烟民肺癌患者的发生机率。在结论中，他们认为“长期抽烟至少是支气管癌发病率飙升的重要因素之一。不难想象，烟草公司以及他们的专家代言人们嘲笑这些以及其它研究，称这些仅仅是统计上的论据或趣闻轶事，根本不能确定其因果关系。在详细梳理了烟草公司的内部备忘录和研究文档后，布兰特博士用充足的证据证明，旱在 1964 年的卫生局长报告发表前，各大烟草巨头就已了解了自家产品对健康造成
23、的诸多风险。他还描述了这些公司在半个多世纪以来，一直合谋炮制假消息，同时混淆科学证据，散布这种论调：既然大家都知道香烟在一定程度上有危害，抽烟与否从根本上说是个人的选择和责任问题，责任不在烟草公司。在 20 世纪 80 年代，科学家们建立了一种革命性的观念，即尼古丁具有极强的致瘾性。虽说烟草公司公开否认这些说法，但当时他们已经利用香烟的致瘾性来赚钱了，他们加大尼古丁含量，将烟民勾住，使得戒烟愈发困难。在他们的营销备忘录中，记录了他们针对青少年发动的广告运动，旨在诱惑一代代的新烟民。2004 年，布兰特博士被司法部聘请为重要专家，在指控烟草巨头的联邦欺诈案件中作证，并与烟草业雇佣来的一伙证人进行
24、对质。根据为烟草巨头们出庭作证的 29 位历史学家们自己的供述，他们中大多数甚至没有参看过烟草业内部的研究或交流文档。相反，这些专家主要关注的是 20 世纪 50 年代的一小撮对香烟危害的怀疑论者，他们中的大部分人要么当时就与烟草业有勾结，要么最终也会同烟草业勾结起来。布兰特博士在近期一次专访中说：“这些专家证人写下的言论令我怎到震惊。他们靠问一些片面的问题，并用片面的研究来解答，从而为烟草业提供了他们，给好需5要的挡箭牌。显然，哥伦比亚特区联邦地方法庭法官格拉迪丝凯斯勒同：、这一看法。去年八月，她总结道，烟草业策划了一场长达 40 年的阴谋，向烟民隐瞒烟草对健康的危害。她的观点中引用布兰特博士的证词达 100 多次。布兰特博士承认，将学术研究和与抽烟这种致命的世界性传染病作斗争结合起来，这当中会有陷阱，但他说他几乎看不到有别的选择。“如果我们中有人偶然跨过了分析和倡导之间的边界，那就跨过吧。 ”他说：“风险很大，还有很多工作要做” 。
