From the 1930s to the 1950s, ‘doctors’ once lit up the pages of cigarette advertisements.
In the grand scope of the history of medicine, the relationship between
doctors and patients has changed quite a bit in recent years. The internet and
direct-to-consumer advertising have empowered patients to become active
participants in their health care. However, it was not always this way.
For a long time, physicians were the authority on health. Patients
trusted in their doctors' education and expertise and, for the most part,
followed their advice. When health concerns about cigarettes began to receive
public attention in the 1930s, tobacco companies took preemptive action. They
capitalized on the public’s trust of physicians in order to quell concerns
about the dangers of smoking. Thus was born the use of physicians in cigarette
advertisements
“When you knit this together into a full story, the scope of it and
the way it duped the public was just incredible,” said Robert K.
Jackler, MD, Sewall Professor and Chair, otolaryngology – head and
neck surgery at Stanford University Medical Center. “The public was
becoming increasingly worried about the health consequences of cigarettes. They
started to refer to cigarettes as coffin nails and started talking about
smoker’s cough and smoker’s hack. The companies saw a threat to their
success and business model.”
Executives at tobacco companies knew they had to take action to suppress
the public’s fears about tobacco products. “Tobacco companies asked
themselves: How can we go about reassuring the public that particularly
cigarettes, but also cigars and pipes, are not harmful?” Jackler told
HemOnc Today. The answer was to use medical research and
physicians to show the public that cigarettes were not harmful. Although the
doctors in these advertisements were always actors and not real physicians, the
image of the physician permeated cigarette ads for the next two and a half
decades.
During the 1920s, Lucky Strike was the dominant cigarette brand. This
brand, made by American Tobacco Company, was the first to use the image of a
physician in its advertisements. “20,679 physicians say ‘Luckies are
less irritating,” its advertisements proclaimed. The advertising firm that
promoted Lucky Strikes had sent physicians free cartons of the cigarettes and
asked them whether Lucky Strikes were less irritating to ‘sensitive and
tender’ throats. The company claimed that its toasting process made its
cigarettes a smoother smoke.
By the mid-1930s, Lucky Strike had some competition. A new advertising
campaign for Philip Morris referred to research conducted by physicians. One ad
claimed that after prescribing Philip Morris brand cigarettes to patients with
irritated throats, “every case of irritation cleared completely or
definitely improved.” This series of advertisements, along with others
referring to “proof” of superiority, made Philip Morris a major
cigarette brand for the first time in its history.
“There was an interesting paradox in the ads. In one ad a company
would say cigarettes aren’t harmful and then in other ads they would say
our cigarettes are less harmful than the other brands,” Jackler said.
“You would get things like ‘not one case of throat irritation’
with a picture of a throat doctor holding a throat mirror wearing a mirror on
his forehead.”
One of the most famous of the campaigns of this era was the “More
Doctors” campaign for RJ Reynolds Tobacco Company’s Camels brand
cigarettes. These ads, which appeared in magazines from Time to
Ladies’ Home Journal, claimed that according to a nationwide
survey, “More doctors smoke Camels than any other cigarette!” These
ads pictured doctors in labs, sitting back at their desk or speaking with
patients. “The idea was that if you show a physician being an enthusiastic
partaker in smoking, the public gets the notion, ‘With what doctors know,
if they choose to smoke this brand it must be a safer, better brand,’ or
the public thought that smoking itself must be OK,” Jackler said.
Physicians were also not immune to the addictions of cigarettes and
tobacco products and tobacco companies knew it. Many physicians still doubted
that there was a wide-spread connection between smoking and disease. Instead it
was believed that only certain individuals' health was affected by smoking; it
was thought to be a case-by-case situation.
Tobacco companies targeted this thought process by telling physicians
that if patients are going to smoke cigarettes regardless of what was advised
for their health, at least prescribe for them a ‘healthier’ brand of
cigarettes.
“There were big ad campaigns with hundreds of ads in medical
journals,” Jackler said. “For example, there is an ad showing a
physician writing on a prescription pad, ‘For your patients with sore
throats and cough, Phillip Morris cigarettes.’”
The pages of The New England Journal of Medicine and
The Journal of the American Medical Association were home to many
tobacco advertisements throughout the 1930s, 1940s and beyond. However, tobacco
companies’ courtship of physicians did not end in medical journals.
“Cigarette companies also wanted doctors to smoke their
brands,” Jackler said. Companies like Phillip Morris and RJ Reynolds
participated in medical conventions by sponsoring doctors’ lounges and
giving away free cigarettes. But the most inventive method to influence
physicians was RJ Reynolds’s creation of its Medical Relations Division.
This ‘division’ was based out of an RJ Reynolds advertising firm and
focused on promoting Camels cigarettes by finding researchers who could
substantiate the medical claims that the company was making in advertisements.
Now the company was able to refer to research findings in their advertisements,
both to consumers and to physicians.
In the late 1940s and early 1950s, a transition began to appear in these
ads. Advertisements for Camels began to incorporate a ‘try it for
yourself’ approach. Although the ads still pictured physicians proclaiming
cigarettes to be less irritating, they also now encouraged consumers to test
the cigarettes themselves: “The test was really fun! Every Camel tasted so
good! And I didn’t need my doctor’s report to know Camels are
mild!”
But it was only a matter of time until science caught up to the
advertising. By the mid-1950s more research was being published that confirmed
a link between tobacco products and lung cancer. Growing concerns among the
public about the dangers of smoking cigarettes meant the slow disappearance of
the ‘physician’ from cigarettes ads. Slowly, the tobacco companies
began to band together as they realized that their entire industry was in
danger.
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 All photos courtesy of Robert K.
Jackler, MD, and Stanford University.
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By 1953, JAMA banned tobacco ads from its pages and from
AMA conventions. Other advertisers in the publication disliked having their ads
placed by ads for cigarettes. Physicians also began to give up the habit. A
study published in The New England Journal of Medicine in 1959
found that the number of physicians in Massachusetts who reported being regular
smokers declined from 52% in 1954 to 39% in 1959.
On Jan. 11, 1964, Surgeon General Luther Terry announced the findings of
the Surgeon General’s Advisory Committee on Smoking and Health. The
report, Smoking and Health: Report of the Advisory Committee to the
Surgeon General of the United States, concluded that there was a link
between lung cancer and chronic bronchitis and cigarette smoking. In a press
conference, Terry said, “It is the judgment of the committee that
cigarette smoking contributes substantially to mortality from certain specific
diseases and to the overall death rate.” By the end of 1965, the tobacco
industry was required to put warning labels on its products and advertisements
to warn the public of the health risks associated with smoking.
After a couple hundred years of tobacco use, tobacco companies would
lose several more major battles throughout the next few decades, including the
ban on television ads in 1970 when Richard Nixon signed the Public Health
Cigarette Smoking Act. In 2005, tobacco companies made a settlement with the
National Association of Attorneys General that included an agreement to remove
tobacco ads from the school library editions of Time,
People, Sports Illustrated and
Newsweek.
Despite all this, about 45 million Americans still smoke. Although the
CDC estimates that tobacco use decreased by almost one-third between 1990 and
2007, it is estimated more than 400,000 people still die before their time as a
result of tobacco products. – by Leah Lawrence
For more information:
- For more images on physicians in cigarette advertisements visit:
http://lane.stanford.edu/tobacco.
- Am J Public Health. 2006;96: 222-231.
- J Natl Cancer Inst. 1994;86: 1048-1049.
- N Engl J Med. 1959;261: 603-604.