Organizations such as the American Heart Association, the American Lung Association and the American Cancer Society estimate that direct smoking kills about 400,000 people per year in the United States--or, if you use the World Health Organization's estim

Philip Morris would not retreat from its decades-long denial that direct smoking causes cancer until the year 1999. Privately, however, its attorneys and PR advisors were already planning a strategic retreat from this position as early as the 1970s. In its place, they set out to build a scientific case against the mounting body of evidence showing that nonsmokers also suffer adverse health effects from secondhand smoke inhaled in bars, restaurants and other public places. Secondhand smoke appears under a variety of names in the industry's internal documents, which refer to it variously as "indirect smoke," "passive smoke," "sidestream smoke" or "environmental tobacco smoke" (often abbreviated ETS). Industry executives realized early on that the issue of tobacco's indirect effects posed a potentially greater threat to profits than the issue of its direct effects on smokers themselves. Once the public realized that cigarettes were also killing nonsmokers, anti-tobacco activists would press forward with increasing success in their campaigns to ban smoking in public places. "If smokers can't smoke on the way to work, at work, in stores, banks, restaurants, malls, and other public places, they are going to smoke less," complained Philip Morris political affairs director Ellen Merlo in a speech to tobacco vendors. "A large percentage of them are going to quit. In short, cigarette purchases will be drastically reduced and volume declines will accelerate." A 1993 Philip Morris budget presentation complained that "smoking restrictions have been estimated, this year alone, to have decreased PM profits by $40 million." The industry's campaign to cultivate pro-industry scientists on the secondhand smoke issue was massive, multi-faceted and international. Some scientists were positioned as public voices in defense of tobacco. Others played behind-the-scenes roles, quietly cultivating allies or monitoring meetings and feeding back reports to the tobacco industry's legal and political strategists. A 1990 memorandum by Covington & Burling, one of the main law firms representing Philip Morris, reported on efforts by industry consultants in Lisbon, Hanover, Budapest, Milan, Scotland, Copenhagen, Switzerland, Norway, Australia, Finland and Asia "Our European consultants have organized and will conduct a major scientific conference in Lisbon next month on indoor air quality in warm climates," it stated. "More than 100 scientists from throughout the world will attend. . . . The focus of the conference will not be tobacco; rather, the point of the conference is to show the insignificance of ETS by emphasizing the genuine problems of air quality in warm climates. Some degree of 'balance' in the presentation of the issues is of course necessary to achieve persuasiveness, but the overall results will be positive and important. . . . We ask our consultants to cover all substantial scientific conferences where they can usefully influence scientific and public opinion." In addition to scientific conferences, consultants were at work giving media briefings; trying to sway airline flight attendants in favor of in-flight smoking; producing and appearing in videos and op-ed pieces; and testifying in court proceedings regarding allegations of fraud in tobacco advertisements. "Our consultants have created the world's only learned scientific society addressing questions of indoor air quality," the report boasted. "It will soon have its own periodic newsletter, in which ETS and other [indoor air quality] issues will be discussed in a balanced fashion to an audience of regulators, scientists, building operators, etc. It will also have its own scientific journal, published by a major European publishing house, in which [indoor air quality] issues will again be addressed." Other consultants were writing books, one on environmental tobacco smoke and health, another "exposing the vagaries of medical truisms, including those relating to tobacco" as "a clever and entertaining way of suggesting that medical 'certainties' are frequently without genuine scientific basis." Another hired expert had published a scientific paper showing that keeping pet birds was a bigger cancer risk than secondhand smoke. Yet another was an editor at the Lancet and "is continuing to publish numerous reviews, editorials and comments on ETS and other issues." Straining at Gnats, Swallowing Camels In 1986, U.S. Surgeon General C. Everett Koop released an analysis concluding that secondhand smoke was a significant health threat to nonsmokers, and a host of other studies by prominent health organizations have reached similar conclusions. The most common and serious effects are asthma, emphysema, and heart disease. Estimates of the number of ETS-related deaths from heart disease alone have ranged from 37,000 to 62,000 per year. Children's lungs are still developing, and they are therefore considered especially sensitive to environmental tobacco smoke. According to one estimate by the state of California, ETS causes 2,700 cases per year of sudden infant death syndrome in the United States. The U.S. Environmental Protection Agency's risk assessment of environmental tobacco smoke was published in 1993. It estimated that secondhand smoke causes some 150,000 to 300,000 cases per year of lower respiratory tract infections such as bronchitis and pneumonia in children up to 18 months of age, resulting in 7,500 to 15,000 hospitalizations, plus somewhere between 400,000 and a million cases of asthma. The EPA also decided, for the first time, that secondhand smoke should be labeled a "Class A carcinogen"--a government term which means that ETS is not merely suspected but known to cause lung cancer. The impact of secondhand smoke is small compared to the effect of direct smoking, but EPA estimated that some 3,000 lung cancer deaths per year among U.S. nonsmokers should be attributed to secondhand cigarette smoke. Tobacco's defenders realized that challenging the entire body of evidence in EPA's risk assessment would be impossible. Its conclusion that secondhand smoke causes respiratory effects in children was widely shared and virtually undisputed, so industry's response to that part of the risk assessment was simply to ignore it. EPA's conclusion regarding the link between secondhand smoke and cancer was based on several different types of evidence, most of which are hard to dispute: Secondhand smoke contains essentially all of the same cancer-causing and toxic agents that people inhale when they smoke directly. Tests of humans exposed to secondhand smoke show that their bodies absorb and metabolize significant amounts of these toxins. Exposure to secondhand smoke has been shown to cause cancer in laboratory test animals, which suggests strongly that it does the same thing to humans. EPA reviewed analyses of some 30 epidemiological studies from eight different countries and found that women who never smoked themselves but were exposed to their husband's smoke have a higher rate of lung cancer than women married to nonsmokers. Taken together, these pieces of evidence make it difficult to avoid the conclusion that secondhand smoke causes lung cancer. However, EPA's estimate of the number of deaths was based solely on epidemiology, a branch of medical science that uses statistical analysis to study the distribution of disease in human populations. Epidemiology uses statistical correlations to draw conclusions about what causes disease, but it is a notoriously inexact science. In order to estimate someone's lifetime exposure to secondhand smoke, researchers must rely on that person's memories from years past, which may not be entirely accurate. Moreover, surveys cannot take into account all of the possible confounding factors that may bias a study's outcome. Were the people surveyed exposed to other lung carcinogens, such as asbestos or radon? Did they inhale more secondhand smoke than they remember, or maybe less? Owing to these uncertainties, the EPA's estimate of 3,000 deaths per year from ETS-related cancer is only a rough guess. It may be too high, or it may be too low. The tobacco industry's propagandists seized on this sliver of uncertainty like a starving dog lunging for a meatball. There is no particular logical reason, from a scientific or policy perspective, why anyone should focus on lung cancer. After all, it represents only a fraction of the total number of deaths attributed to secondhand smoke, and there is no particular reason to prefer death from emphysema or heart disease over death from lung cancer. The lung cancer estimate, however, was the part of the EPA risk assessment that was most open to debate on methodological grounds. By focusing on it, the tobacco industry hoped to distract attention from the report's irrefutable broader conclusions. A Not-so-Independent Expert Professor Gary Huber was one of the industry-funded scientists who responded to the call. Huber had built a career for himself as one of the contrarian scientists who regularly disputed the growing body of scientific evidence about tobacco's deadly effects. Over the years, he received more than $7 million in tobacco industry research funding, and although his reputation as a "tobacco whore" cost him the respect of friends and colleagues, in industry circles he was something of a star, hobnobbing with top executives, fishing with senior attorneys and participating in legal strategy sessions. Huber worked first at Harvard until the university took away his laboratory. A stint at the University of Kentucky's pro-industry tobacco and health research institute ended when he was fired for alleged mismanagement, but he always managed to land on his feet, thanks to the tobacco money that followed him wherever he went. After Kentucky, he landed at the University of Texas, where he ran a nutritional health center while simultaneously offering secret consulting services to Shook, Hardy and Bacon, a national law firm that represented both Philip Morris and R.J. Reynolds. During his time in Texas, industry lawyers paid him $1.7 million to collect and critique published scientific studies linking smoking to emphysema, asthma and bronchitis. The tobacco attorneys went to extraordinary lengths to keep its payments to Huber a secret, routing the money through an outside account that bore a Greek code name to keep it off hospital books and make it difficult for an outsider to find. The purpose of the secrecy, of course, was to preserve a veneer of third-party independence so that Huber could appear credible when he spoke out publicly in defense of cigarettes. By the late 1980s, he had become one of the most vocal and visible scientific critics of studies probing the hazards of environmental tobacco smoke. In 1991 Huber authored an article that picked away at EPA's epidemiology for Consumers Research magazine, a Consumer Reports lookalike that is partially funded by the tobacco industry. The scientific studies linking secondhand smoke to cancer, he wrote, were "shoddy and poorly conceived." His article was repeatedly quoted by the tobacco industry's network of columnists and by opinion magazines opposed to government regulation of smoking.

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