Another What-Might-Have-Been

Only four years ago, the United States verged on a historic public health victory—tobacco companies had agreed to make a stunning series of concessions in return for protection against lawsuits. The concessions included payouts of billions of dollars, acquiescence to federal Food and Drug Administration control of their product, advertising bans, and penalties to ensure reductions in youth smoking.

Within a year, the deal was dead. It was a kind of a group rub-out. The villains included not only the usual list of tobacco company lobbyists and pro-tobacco Congressmen, but also a bunch of the guys in white hats—the tobacco-control advocates who had fought the tobacco companies for years but, in the end, failed to embrace the deal of a lifetime.

Michael Pertschuk is a tobacco-control advocate (and a former chairman of the Federal Trade Commission) who remained at the margins of this particular battle. With Smoke in Their Eyes: Lessons in Movement Leadership from the Tobacco Wars he steps forward with the inside story of a campaign that allowed itself to be split by egotism, near-paranoia, and rhetorical excess.

The central and sympathetic figure is Matt Myers, a lobbyist for the Center for Tobacco-Free Kids and the sole representative of the public health community in the negotiations that led to the deal. Myers bore the brunt of criticism from fellow advocates, who accused him of arrogance, naivete, and even a secret agenda to gain millions of dollars for his advocacy group. This book is largely a defense of Myers and the deal he helped to broker.

By 1997, nine states had launched lawsuits against the tobacco companies on novel grounds. The states demanded billions in reimbursements for money spent on health care for sick smokers. If they won and other states followed suit, the tobacco companies could have faced bankruptcy.

The suits were far from sure winners. But the prospect of losing was enough to bring the tobacco companies to the negotiating table. In return for Congress's putting a cap on their liabilities, the companies were willing to make payments and accept limits they had fought for years.

As Pertschuk tells it, Myers's participation was crucial in keeping the deal from being simply a monetary settlement. He forced negotiators to push for limits on advertising; to accept the idea that the FDA would be allowed to regulate nicotine as a drug; and to include additional billions of dollars in penalties if youth smoking did not drop substantially. In return, the tobacco companies would get congressional protection against punitive damages from future lawsuits.

"This agreement isn't perfect. You only make perfect agreements when you don't have to face real reality," Myers said at the time. "However ... it represents the single most fundamental change in the history of tobacco control in any nation in the world."

Pertschuk agrees, and asserts that strictly in public health terms, the deal was a winner, because it promised to prolong the lives of tens of millions of people. But instead of embracing the agreement, the tobacco-control community reacted with suspicion and hostility, even after the deal was toughened and drafted into a bill by Sen. John McCain, chairman of the Commerce, Science, and Transportation Committee.

Part of the problem was an honest concern about whether the deal represented the best way to advance tobacco control. But Pertschuk thinks that the main obstacle was the hostility of part of the tobacco-control community, which quickly escalated into an electronic scorched-earth campaign on the Internet.

He especially blames Stanton Glantz, a tough anti-tobacco activist from California who is famous for courageously publishing secret tobacco-industry papers. Glantz led a small but very hostile chorus that created "a harsh, crudely distorted composite portrait of Matt and the center's perfidy ... growing uglier with each exchange of outrage." More-reasonable voices, Pertschuk says, were intimidated into silence.

In the end, the tobacco industry turned against the tougher deal and managed to kill it with smart lobbying and television spots. The state attorneys general settled for $206 billion to be paid out over 25 years (less than half of the amount called for in the McCain bill) and generally weaker advertising controls and public education campaigns. Dropped were regulatory powers for the FDA and penalties against the tobacco companies if youth smoking didn't decrease.

Pertschuk says that the activists, who had learned to thrive in the underdog role, weren't the best leaders for the movement when the tide turned, briefly, against the tobacco companies. Such figures as Glantz, Rep. Henry A. Waxman, D-Calif., former FDA Commisioner David Kessler, and former Surgeon General C. Everett Koop forced tobacco reform through in circumstances that required combativeness and a healthy helping of self-righteousness. But they failed to recognize an opportunity to win through compromise.

It's not clear from Pertschuk's analysis, however, that a united anti-tobacco movement would have carried the day. His advice for present and future movement leaders seems reasonable and useful. His main points: Build grassroots consensus, keep your eye on the ball, stay civil, and try not to flame one another.