Of Mad Men, Crusaders and Cigarettes

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A cigarette dangles from every hand in the chain-smoking advertising agency in the smash television drama Mad Men, a symbol of tobacco's grip on American lives in the 1960s and its role as a Madison Avenue cash cow. At the time, Joe Califano, the real-life government official who would later launch a controversial anti-smoking campaign, was himself a four-pack-a-day smoker working as then-President Lyndon B. Johnson's chief-of-staff in the intense White House cauldron. This week he received a prestigious health award for his professional career as a crusader against tobacco, alcohol abuse and illicit drugs.

Reached by telephone, Califano recalled that America's changing attitudes toward cigarettes began with the release of the first Surgeon General's report in 1964. The government's top health officials' definitive warning that "Cigarette smoking is causally related to lung cancer" was considered such a bombshell that the top-secret report was released to reporters on a Saturday morning in a locked State Department auditorium. 

The report put one of the first nails in the coffin of this deadly habit--one that was tacitly acknowledged in a recent Mad Men episode dubbed "Blowing Smoke" and is highlighted on Mad Men's own AMC blog. After losing the Lucky Strikes advertising account, Don Draper, the creative genius of a fictional ad agency, launched a bold--even cynical--counter-attack in a full page-ad in the New York Times.

In his fictional open letter, "Why I'm quitting tobacco," Draper wrote: "For 25 years, we devoted ourselves to peddling a product for which good work is irrelevant because people can't stop themselves from buying it. ... The product has never improved, it causes illness, and it makes people unhappy. But there was money in it. A lot of money. In fact, our entire business depended on it. We knew it wasn't good for us, but we couldn't stop." He went on to announce, "Here was my chance to be someone who could sleep at night because I know what I'm selling doesn't kill my customers. So as of today, Sterling, Cooper, Draper, Pryce will no longer take tobacco accounts."

If only it had been so. The reality, however, was that advertising agencies were not about to blow the whistle on cigarettes. They were too busy getting rich pushing cigarettes to the public, glamorizing their image in television and print ads with rugged cowboys and movie stars helping to sell them to Americans of all ages. In 1964, after the Surgeon General's report, tobacco companies agreed not to promote cigarettes to those under age 21 but have repeatedly been questioned about the reality of this pledge.

It was not until 1978 that Califano, using his Cabinet platform as Secretary of Health, Education, and Welfare, launched a controversial government-led health campaign to curb smoking, which he dubbed "slow-motion suicide." This week the Institute of Medicine bestowed its prestigious 2010 Lienhard Award on Califano for his career efforts to curb smoking and broader work in reducing addiction and substance abuse.

Califano acknowledged that back then he could never have imagined that the national anti-smoking effort that he and others championed would have so much impact in the decades to come: smoke-free airplanes, offices, hotels, restaurants and even bars in many parts of the United States have pushed smokers into an endangered minority. Today about 20 percent of American adults still smoke, down from about 42 percent in 1965.

"To be honest, I doubt if I ever foresaw this much progress," said Califano, the founder and chair of the National Center on Addiction and Substance Abuse (CASA) at Columbia University. "I used to say, 'I want a world in which instead of, Do you want a cigarette? people would ask, Do you mind if I smoke?'" said Califano. The growth of public smoking restrictions have so dramatically changed the cultural norms that "today smoking is simply not cool. It is not socially acceptable," he said.

Califano recalled the political firestorm that ignited following his January 11, 1978, announcement of a broad government campaign to educate the public about smoking's widespread health hazards. He also made his department's headquarters smoke-free--immediately--so when he came to work the next day "there were employees protesting in front of the building because they couldn't smoke in their offices" (he characteristically did not back down).

At the time I was a national health and science reporter for the now-defunct afternoon paper, The Washington Star. To my surprise, the 1978 anti-smoking announcement received a six-column headline across the top of the front page, "Califano Declares War on Smoking," above my two bylined stories, one on the antismoking campaign and the other on reaction, particularly from the powerful Tobacco Institute which represented the top cigarette manufacturers. (A cartoon by the Star's Pat Oliphant picked up on it: a school principal hovering over some elementary school kids sneaking a smoke barks, "No, I'm not going to tell your parents! I'm going to do worse than that--I'm going to turn you in to Joe Califano!")

In 1979, on the 15th anniversary of the first Surgeon General's report on smoking, Califano and the nation's top health officials released an update that was a massive indictment of tobacco's impact: "It nailed heart disease and a host of other cancers. It was an accumulation of all the peer-reviewed research, putting it all together in one place," said Califano.

That report received massive media coverage on television and in print, including whole morning television shows and political cartoons galore. "I think more people quit smoking in the two weeks following that report than in any other two-week period," said Califano, who had quit himself in 1975. "It drove me and others to say we just have to keep going public. It really had an impact."

As a young non-smoking reporter, I was struck by the omnipresent smoking in the late '70s by those who should have known better. It was a sign of the times that at hearings on Capitol Hill for the National Cancer Institute, those smoking during breaks in the hallways included some of the top health officials (a sign of the addictive grip of tobacco) as well as other health reporters. Our newsroom, of course, was filled with smoke and burning cigarette butts that regularly set the trashcans on fire.

Califano noted that despite the predictable pushback from the powerful tobacco lobby, which wielded enormous political clout (including in the Carter White House, which was not pleased with his efforts), "the issue was not partisan." One of the next big anti-smoking crusaders was the Reagan Administration's outspoken and conservative Surgeon General Dr. C. Everett Koop (I recall him passing out buttons at his press conferences that said, "The Surgeon General personally asked me to stop smoking," stepping down from the podium to pin one on some of my chain-smoking colleagues.)

Califano cited two other things that pushed the smoke-free initiatives forward. Traditionally, political opponents charged that adults should have the right to smoke where and when they wanted. But when a 1986 Surgeon General's report on "involuntary smoking" warned of the health hazards to others, particularly children, from second-hand smoke, the movement took fire (hard to resist). A 1988 report documented "nicotine addiction," bolstering the case for how hard it was to quit once starting.

In addition, the economics of smoking started to kick in. In addition to the added health costs of smokers to companies and insurers, "Corporate America saw the tremendous commercial impact," said Califano. "The commercial advantages of having smoke-free buildings made a big difference to real estate people and hotels." And rising cigarette taxes have been shown to reduce consumption too.

But the war on smoking is far from won. In addition to the smokers themselves, antismoking advocates say that large numbers of Americans, and children, are still exposed to second-hand smoke. While 28 states, and the District of Columbia, as well as about 550 cities have enacted laws requiring smoke free restaurants and bars, this only covers about 60 percent of the population.

A key target is keeping young people from starting. Today, nearly one in five high school students report current cigarette use. "The constant challenge is teenagers. You have to keep doing it. Every generation is new," said Califano. Studies have shown that most smokers get hooked as teenagers, so "if we can get people through 21 without smoking they are never likely to smoke."

And what about the role of advertising agencies, a la Mad Men? Merchants of Doubt, a recent book by historian Naomi Oreskes of the University of California, San Diego, puts them at the center of efforts by industry to foment doubt about scientific evidence across several issues, from second-hand smoke to climate change.

"Oh my God, they were smarter than we were. They knew it was a culture issue. They had all the stars smoking...They knew the glamor things and the kids thing way before we did," said Califano, now 79, in reference to cigarette advertising campaigns. He recalls talking to LBJ in 1965 about the prospect of pushing for a ban on cigarette ads on television. "We were literally in a car and I was smoking. He said, 'The day you stop, I'll send it up.' He knew there was no chance I would quit then." In fact, that year Congress did approve a federal cigarette labeling and advertising act that required warning labels on packages but not on the ads themselves. In 1969, the government pushed further, banning cigarette ads from television and radio.

But smoking is center stage once again in the depiction of 1960s Manhattan life on AMC's Mad Men, which has its season finale on Sunday. Despite Don Draper's passing acknowledgment of the health hazards of cigarettes, I wonder whether the glamorous images of the chain-smoking stars on the show will implicitly encourage young folks to smoke.

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Cristine Russell is a senior fellow at Harvard Kennedy School of Government, president of the Council for the Advancement of Science Writing, and consultant to the documentary Escape Fire: The Fight to Rescue American Healthcare. More

Russell is a Columbia Journalism Review contributing editor on science and the media. Russell was a national science reporter for The Washington Post and The Washington Star and appeared on PBS' Washington Week in Review. She serves on the boards of the USC Annenberg School for Communication, the Reporters Committee for Freedom of the Press, the Commonwealth Fund and Mills College and is on the selection committee for the National Academies of Science Communication Awards. She was a 2006 fellow at Harvard's Shorenstein Center on the Press, Politics and Public Policy. Russell is an honorary member of Sigma Xi, the scientific research society, and has a biology degree from Mills College.

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