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Should Historians Be Working for the Tobacco Industry?

Historians of medicine last year were shocked to learn that Kenneth Ludmerer, president of the American Association for the History of Medicine, has been quietly working as an expert witness for the tobacco industry since the late 1980s. In a deposition[1] submitted for his work as an expert witness in USA v Philip Morris Inc et al, the ongoing federal case against the industry, Ludmerer admits to having worked on at least thirteen separate trials over the past 15 years, always for the defence, earning over half a million US dollars.

Ludmerer is not the only historian who has served in this capacity.[2] From court records,[3] we know that at least 29 have witnessed for the industry, most often testifying that everyone has always known that cigarettes were dangerous, and that even after 1964 there was still “room for responsible disagreement”[4] with the US Surgeon General’s conclusion of that year that tobacco was a major cause of death and injury. Common knowledge and open controversy have long been the twin pillars of the industry’s defence, from which it is concluded that people have only themselves to blame for smoking-related harms and that the industry acted properly in denying any proof of a genuine hazard.

David Rothman,[5] Director of Columbia University’s Center for the Study of Science and Medicine, has recently argued that it is possible for historians to serve as expert witnesses without compromising professional integrity. Some historians have, however, presented inaccurate accounts of tobacco and health history in their capacity as witnesses for the tobacco industry. In his 2002 brief for the ongoing federal case, for example, Ludmerer[6] stated that there was “no credible scientific evidence linking cigarette smoking to lung cancer or any life-threatening disease before 1950”, ignoring both the pioneering epidemiological studies in Germany before this time and the lip, throat, and oral cancers discovered already in the 18th and 19th centuries.[7] Similarly Peter English,[8] in his expert report for Philip Morris et al in the same trial, stated that toxicologists discovered benzpyrene in tobacco smoke only in 1954, when the fact is that Roffo[9] had already made this identification in the 1930s. There is actually quite a sizeable literature on tobacco carcinogenesis before the 1950s.[7]

One reason slips of this sort might be expected from the industry’s experts is that they are almost always asked to testify in areas where they do not have a lot of peer-reviewed expertise. Ludmerer, for example, best known as a historian of medical education, has never published on the history of tobacco, on lung cancer, on the impact of tobacco on health, or on the industry’s claims about smoking and health. The same is true of other historians who have testified for the industry: Theodore A Wilson[10] is a military historian who is best known for his work on the Cold War; Elizabeth Cobbs-Hoffman[11] specialises in American foreign relations; Jon Harkness[12] writes on the history of clinical medical ethics, and Peter English[8] is a pediatrician who has also testified for the lead industry. Ludmerer defends (or explains) his record of nonpublication by stating that in the course of his 1000 hours of research for the industry he “didn’t learn anything new”.[1]

Among the many historians who have worked for the industry, John Burnham[13] of Ohio State University is one of the few to have actually published on the history of tobacco. Burnham was one of the original historians recruited by Philip Morris for its Project Cosmic (1987–93), the goal of which was to build “an extensive network of scientists and historians from all over the world”[14] to serve as paid consultants and/or project investigators for the company. David Harley of Oxford University and David Musto of Yale were among those recruited for this project, which resulted in several publications,[15],[16] none of which acknowledged the industry’s support. Musto alone by 1991 had received about $220 000 from Project Cosmic, with another $250 000 approved for his use.[17]

Industry use of historical expertise generally does not, however, involve deliberate falsification or fabrication, but rather what appears to be a careful selection (and omission) of facts. Were some scholars slow to accept the research of the 1950s showing a major health hazard from cigarettes? Of course—the industry’s favourites are the biostatistician R A Fisher and Joseph Berkson of the Mayo Clinic, both of whom are cited to buttress the idea that there was always “room for responsible disagreement”[4] with the tobacco hazards consensus. Did many people know cigarettes were dangerous? Of course they did, as we often hear from the long lists of such examples from the industry’s experts.[18] These seemingly carefully selected facts build up an impression of the industry as having acted responsibly in rejecting proof of tobacco’s harms until the late 1990s. Surely many people did know that cigarettes were harmful—but was this true of 12–13-year-olds just beginning to smoke? Did these children know that cigarettes could cause emphysema or pulmonary tumours? How many people even today know that cigarettes can cause blindness[19] and bladder cancer?[20]

For many years the industry claimed that the evidence linking tobacco and disease was weak or non-existent: epidemiology was mere statistics; animal experiments said nothing about humans; and pathological evidence was merely anecdotal. The industry is now hiring historians to assist in its defence, mainly by having its experts narrow their focus of attention to only those topics that show the industry in a favourable light. The industry’s lawyers have become adept at this art of obfuscation, directing jurors’ attentions to trivial or confusing issues that raise various forms of doubt—the key to victory in the US legal system and a long-standing goal of the industry (recall Brown and Williamson’s 1969 claim that “doubt is our product”[21]). There is a saying in American public-relations circles that for every PhD there is an equal and opposite PhD, but when big money is at stake, there appear to be asymmetries in what kind of expertise gets heard. The tobacco industry has usually been able to outspend its opponents, which can be seen even in the number of historians thus far arrayed in the tobacco trials. As of February, 2004, around 30 professional historians have testified for the defence in such cases, whereas only two have appeared on the stand for the plaintiffs (myself[22] in Ironworkers v Philip Morris and Louis Kyriakoudes[23] in Boerner v Brown & Williamson, though Allan Brandt is now preparing to testify in the Federal case). There are lessons here about the nature of historical truth—and bias—because historians may well believe they are in no way misrepresenting history by working for the industry. Ludmerer, for example, claims that the funding he has received has not influenced his testimony. Asked in deposition whether he believed that “the source of funding can ever influence scientific independence”, Ludmerer replied “I don't know” and that while there might be “an occasional instance” in the historical past, it would nonetheless be “an aberration”.[1] Ludmerer also admits, though, that at least some of his expert reports were not even drafted by himself but rather by the law firms representing the industry. Asked about his 2002 expert report for the defence in USA v Philip Morris, Ludmerer testified under oath: “I did not draft the original report. It was drafted for me to save me time . . . it reflects my views”.[1]

Historians who render expert advice to the tobacco industry are playing a dangerous game. The industry may not ask them to lie, but it may well ask them to confine their research to only such topics as will be useful in the industry’s defence. Historians are used to normalise the industry’s conduct, to make what happened seem naturally embedded in the context of its times. Historians are good at this; we like to situate, to complicate, to show how messy history can be.[1],[12] I am not suggesting that historians have deliberately misrepresented history; their usefulness to the industry lies more in what is not presented. They will never be asked to explore those areas of history that could show the industry in a disadvantageous light, and when asked on the stand what they might have to say about such topics (eg, the long record of claims of “no harms proven”), they usually respond that they have not researched that topic. They can honestly say they do not know. Peter English testified in USA v Philip Morris[24] that he had not reviewed tobacco industry documents apart from those shown to him in cases on which he has worked.

Tobacco and several other polluting industries have fostered a great deal of research by historians in recent years. Millions of dollars have been given to trace the history of lead, asbestos, and radiation, for instance—and some of this is no doubt good history. A question then arises: should historians wanting to publish some of these materials be allowed to do so without disclosing the source of their funding? Jon Harkness of the University of Minnesota has earned around $300 000 testifying for the tobacco industry; [11] David Sansing[25] of the University of Mississippi has earned more than $500 000 in eight different tobacco trials. If these scholars want to publish on this topic, should they be required to disclose their funding sources? I think it is remarkable that none of our leading journals of medical history—or history more generally—require disclosure of funding support for research or stakes in past or ongoing litigation. The American Medical Association in 1996 adopted an even stronger policy, urging scientific journals to reject for publication research funded by the tobacco industry.[26] Is it time for historians to consider some of these options?

I thank Josh Dunsby for alerting me to David Musto’s role in Project Cosmic. I have worked on several occasions as an expert witness in plaintiff’s lawsuits, including USA v Philip Morris Inc et al.

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    This article was first published by the Lancet and is reprinted with permission of the author.