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has been entrenched in American society for so long that it is extremely difficult to sort out the precise roles of various commercial, medical, social, and cultural forces in sustaining the tobacco problem. The tobacco industry’s forceful strategies, however, have provided a powerful counterforce to the public health effort. As the 2000 Surgeon General’s report would later state, in admittedly simplified terms: “The history of tobacco use can be thought of as a conflict between tobacco as an agent of economic gain and tobacco as an agent of human harm” (DHHS 2000).

The medical establishment was initially slow to embrace the imperatives of the growing findings about smoking and heath. The tobacco industry, on the other hand, quickly sprung into action in the early 1950s to counter the studies connecting smoking to higher mortality rates. In the late 1950s, cigarette manufacturers created the Tobacco Institute, which claimed to represent not only cigarette producers and distributors but also hundreds of thousands of farmers and others with economic interests in tobacco (Kluger 1996). The Tobacco Institute was the driver of the industry’s extensive public relations and lobbying campaigns for decades. It sought to underscore the economic importance of tobacco and, together with the industry’s Council for Tobacco Research (initially called the Tobacco Industry Research Council), to undermine the scientific evidence identifying the risks of smoking and documenting its effects on health. By disputing the scientific findings about the dangers of smoking, the industry sought to reassure its customers and to obscure the public’s understanding of the risks.

The industry also assertively sought to counter and displace the message about the dangers of smoking with a message tapping into the American spirit of individualism, freedom, and unease with government paternalism. The industry’s message was simple: Smoking is an individual’s free choice and no one else’s business and certainly not the government’s business.

Although the voluntary health organizations leading the early public education effort tended to avoid controversy and politics, tobacco interests built a powerful presence on Capitol Hill. They sustained their influence by lobbying, making campaign contributions, and building allegiances with members from tobacco growing states, many of whom held key leadership positions (Kluger 1996).

Through their efforts, tobacco industry advocates were able to influence key legislation. For example, Congress denied the Consumer Product Safety Commission jurisdiction over cigarettes, reversing the position taken by the agency’s first chairman, who said that the commission had authority to regulate or even ban cigarettes. Tobacco was also expressly exempted from regulation under the Toxic Substances Control Act (1976), even though the law was intended to regulate chemical substances which present “unreasonable risk of injury to health of the environment.” Although the nicotine in tobacco is highly addictive, tobacco is also explicitly exempted

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