“The evidence presented also permits the jury to find a tobacco industry conspiracy, vast in its scope, devious in its purpose and devastating in its results.”

District Judge Sarokin, the Cipollone Decision, April 21 1988

“… at all material times and in particular by 1964 the general public in the United Kingdom were well aware of the risks to health associated with smoking, above all the view that cigarette smoking could cause lung cancer”

Lord Nimmo Smith, McTear case, 31 May 2005

The release of secret industry documents as part of the litigation wars in the US in the 1990s has fomented the idea of a vast industry conspiracy to hide the truth about the risks of smoking. Moreover the past is regularly raised as a reason not to trust the industry today, as stated explicitly by Article 5.3 of the WHO’s Framework Convention on Tobacco Control.

It is certainly the case that the industry challenged the epidemiological evidence linking smoking with illness over very many years, and to suggest that it did not would be simply wrong. It also raised questions regarding addiction, but quite fairly in my opinion. But to suggest that the tobacco industry, and the industry alone, framed the debate about smoking’s risks in the period is equally wrong.

Roy Norr, author of “Cancer in a Carton” published by Readers’ Digest in 1952 gave a speech in 1953 in which he referred to the warning of Ewing in 1926 that “cancer propaganda should emphasise the danger signs that go with [smoking]” and highlighted similar concerns from Tylecote (1927), Hoffman (1929), McNally (1932), Lickint (1935), Arkin and Wagner (1936), Raffo (1937), Muller (1939), Proetz (1939), Flory (1941), Ochsner (1949), Wynder and Graham (1950) and, of course, Doll and Hill (1952). As those “secret” documents make clear the suggestions of a link between smoking and ill health “have been given extensive publicity in magazines of national circulation”. Despite all of these warnings, in 1957 the Surgeon General did not advise smokers to give up and the view that causality did not follow necessarily from correlation was not a view held solely by the industry.

On 13 February 1954 the UK Government declared that the relationship between smoking and lung cancer should be regarded as established. Since that time there has been an ever rising level of regulation of the product and packaging; consistently tightening restrictions on advertising and promotion; and restrictions on where and when smokers can smoke. Health warnings have been introduced, enlarged and made graphic. In addition taxes have risen inexorably. Smoking has not, however, been prohibited (except in Bhutan). To suggest that the tobacco industry has successfully lobbied against any of these developments is to ignore the evidence that every demand made by Tobacco Control to date has been implemented.

While fully recognising the (increasingly distant) past, it is also important, in our view, to consider the present and the future. The fact is that for almost two decades the various tobacco companies have made no secret of the fact that smoking comes with risks. It is also the case that each of the majors now has at least one form of product in the category of “reduced harm” be it in nicotine replacement, snus, heat-not-burn or e-cigarettes. A number of the companies have much longer histories in attempting to develop “less hazardous” products for consumers, based on the knowledge and understanding of the complex nature of the risk exposure as it was understood at the time.

Until relatively recently reduced harm products have had very limited experience of success with customers. Reasons for this are many including, but not restricted to, the failure of the product to replicate “the theatre of smoking” much less the physical experience of smoking. It is also the case that attempts to introduce potentially safer products have encountered hostility from regulators and/or Public Health bodies where the attitude in the 1960s of “harm reduction” had stiffened into the harder line of “quit or die”.

The increasingly hard-line attitudes of some elements of Public Health have been vividly demonstrated by the response to the latest innovation in reduced harm, namely e-cigarettes. The behaviour of some elements of Public Health, in questioning the accumulated and accumulating science in favour of e-cigarettes and in dismissing the views of proponents of e-cigarettes, is reminiscent of the behaviour of the tobacco industry in the 1950s so lambasted by Tobacco Control campaigners. Opponents of e-cigarettes are accused, fairly we believe, of selective use of science, of ad hominen attacks on opponents, and of creating increasing uncertainty with respect to the relative safety of e-cigarettes compared with combustible cigarettes.

The science of tobacco smoke is no less complicated today than it was in the 1950s but today it is only the tobacco industry which has the financial resources and more importantly the inclination to pursue the science to seek a reduced harm product which is acceptable to consumers. Of course the tobacco companies have a vested interest in this, but the whole point about e-cigarettes surely is that they have been a free market answer not having been sought, financed or developed by Public Health or by tobacco regulators.

The interesting question is the degree to which the e-cigarette debate being had within Public Health today reveals a new policy or simply one which has highlighted past behaviour by Tobacco Control. In our opinion the traits are not new, and have been justified previously by being part of a noble lie that “smoking is bad”. But a lie repeated often does not become the truth, and our reading of the analysis is that the case against tobacco has been wilfully exaggerated by a relatively small number of individuals with a personal dislike of smoking and smokers. We may share that dislike of smoking, but ultimately that is a personal opinion not an ethical stance.