It was a press conference on a cold Saturday in January 1964 that had garnered international attention, but the trappings were those of a secret government meeting, behind locked doors secured by uniformed guards. To the chagrin of the reporters, “no smoking” signs had been hastily posted around the conference room. This should not have come as a surprise, however, given the circumstances that had gathered them was the release of the much-anticipated Surgeon General’s Report on Smoking and Health delivered by Surgeon General Luther Terry.

The 400-page report concluded that cigarettes caused death from lung cancer, emphysema, and coronary heart disease, a bombshell that reverberated through a country that, at that time, was a heavily dedicated smoking culture in which doctors themselves smoked prodigiously and put their faces on tobacco ad pages. However, more than just a public health issue, tobacco was a battle over corporate influence, glad-handing lobbyists on Capitol Hill, individual responsibility, collective choice, and the scope of governmental power. All of this sociopolitical drama and more is captured on the pages of the recently released book The Cigarette: A Political History by Sarah Milroy, Professor of History at the University of Virginia who has written widely on the tobacco industry, the rise of e-cigarettes, and the grassroots fight to battle climate change.

The Cigarette is organized into seven chapters and a conclusion that succinctly ties the book’s central issues into a well-formed argument about the socioeconomic disparities that dwell hidden within the data. They boil down to a simple human equation: smokers are poorer and less educated than nonsmokers. The seed-to-smoke arc is fraught with social complexities, such as those that turned a once-acceptable behavior into a vice.

Early Anticigarette Movement

Given the mass popularity of cigarettes in the post–World War II generation, during which upward of 60% of Americans smoked, the author details a fascinating story about Lucy Page Gaston, an activist who had begun her career in the Women’s Christian Temperance Movement and then formed the Anti-Cigarette League, which remarkably had more than 300,000 members by 1901.

Not surprisingly, Ms. Gaston was cast as a sanctimonious scold by male-dominated chain-smoking media. She was, in fact, a tall, coarse-looking woman who stood over six feet, but one with a sense of humor about her unrelenting opposition to smoking. She once said that her qualifications for leading the anticigarette movement was “my physical resemblance to Abraham Lincoln…. If he could free the slaves, I can emancipate the nation from the scourge of cigarette smoking.”

The early anticigarette movement was not about the health risks of smoking (largely because they were not established), instead advocates asserted that smoking reduced worker output and efficiency, a contention that would reemerge again decades later, when the iconic automaker Henry Ford published a pamphlet titled, The Case Against the Little White Slaver. Mr. Ford contended that he never knowingly hired smokers, noting, “We believe that men who do not smoke or frequent the saloon make better automobiles than those that do, period!”

War and Smoking

In effect, the history of the cigarette is a cultural road trip that offers deep insight into the nation’s psyche and how external events shape public opinion. Just as the antitobacco activists were making real progress in their efforts to demonize smoking, the World War I changed the history of the cigarette, as the wave of reform got sidelined by the urgency to mobilize troops and arms. The federal government, in fact, took a leading role in buying and distributing cigarettes to the soldiers readying for battle. Then, after the war, cigarettes took on a fundamental role in American consumer culture, one that was unstoppable, until, of course, the War on Tobacco was kicked off by the Surgeon General’s Report.

Money and Politics

This fine book recounts the uphill battles to educate the public and policymakers about the harms associated with smoking. Many of the players and stories in those battles will be familiar to readers of The ASCO Post. Nonetheless, it is a fascinating tale of a sociopolitical struggle that yielded the most important public health victory in our history: reducing smoking incidence from a high of 60% down to the current level of about 16%. One of the book’s most interesting sections is the fight by advocates to eliminate smoking in the workplace and public gathering areas. A surprising number of scientists sided with Big Tobacco’s claim that second-hand smoke is harmless.

The history of the cigarette is a cultural road trip that offers deep insight into the nation’s psyche and how external events shape public opinion.

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Even when the Environmental Protection Agency stepped in and classified second-hand smoke as a known carcinogen, there was furious pushback by the tobacco industry, which submitted doubt-mongering science to counter the claims. In a full-page ad in The Washington Post, R.J. Reynolds denounced the proposed tobacco regulation as, “nothing less than an attempt at tobacco prohibition.” Along with the clearly drawn history of smoking in America, Ms. Milov gives the reader compelling material about why labor union leaders wanted smoking allowed on the job, even after the Surgeon General’s damning report on the link between cancer and smoking: Unions did not want to surrender control over what became of the mandatory smoking breaks.

The Cigarette is a well-written book about a deadly product that has taken the lives of countless millions of people worldwide and still remains the number-one cause of preventable death. This book is recommended for readers of The ASCO Post. ■