Tobacco War: Inside the California Battles (review)

Stanton A. Glantz and Edith D. Balbach. Tobacco War: Inside the California Battles.Berkeley and Los Angeles: University of California Press, 2000. xvii + 469 pp. Ill. $50.00 (cloth, 0-520-22285-7), $19.95 (paperbound, 0-520-22286-5).

Since the first evidence linking smoking to lung cancer was reported in the 1950s, efforts have been made to control the initiation of smoking by youths and to promote the cessation of smoking by adults. In attempting to control smoking, the public health community has been engaged in "warfare" with a powerful and deceptive enemy—the tobacco industry. This book describes one unique campaign in the "war": the efforts of tobacco-control activists, voluntary health agencies, and politicians and public health officials in California to reduce smoking in the state through an ambitious series of initiatives to fund tobacco-control interventions and research and to restrict smoking indoors. The story spans nearly thirty years, ending with a final victory as a strong law was successfully implemented in 1998 that banned smoking in bars. In its 379 pages, Tobacco War sets out this story in a series of chapters related to the various "campaigns" in the war. The authors' aims were to document that the tobacco industry can be successfully countered, and to describe the "lessons learned" from their experiences that may guide others in the same war.

One of the authors, Stanton Glantz, was a key figure in the story, and the book's meticulous documentation likely reflects his insider's knowledge. The authors take readers through careful descriptions of the many players and artfully describe the tactics of the tobacco industry, as it both aggressively uses its financial resources in an attempt to counter tobacco-control programs and simultaneously uses its power, often behind the scenes, to influence key politicians and organizations, including the California Medical Association. The battles are each related in detail; for example, accounts of the many bills and ballot initiatives are compulsively offered. At times, these details tend to overwhelm the reader. Some parts of the story do engage, however: the waffling support of the California Medical Association and its subtle but now exposed connections to the tobacco industry, and the skirmish with Governor Wilson, who attempted to restrict antitobacco measures mandated under the state's pioneering Proposition 99.

This new book is one of many recently published on the tobacco industry and the tactics used by that industry to assure that its remarkable profitability is sustained. These tactics, some well documented in Tobacco War, have been both visible (such as advertising, promotions, and lobbying) and less visible—such as funding politicians, debunking the scientific evidence on tobacco and health, and creating front organizations seemingly unlinked to the industry that have the purpose of countering tobacco control. The latter activities, long suspected, have been openly revealed since the release of millions of industry documents through litigation and other paths. Glantz and Balbach use snippets of the documents effectively. The documents for most of the major companies, except British American Tobacco, can be readily accessed through the World Wide Web, and thematic trails can be traced through them.

The last chapter, "Lessons Learned," offers the message that it is possible to "beat" the tobacco industry. That message and the evidence that "beating" the industry improves the public's health should motivate and sustain tobacco control activity throughout the world. On the other hand, however, the "lessons learned" in California may not so readily transfer elsewhere. The opportunity to fund tobacco control activities in a dedicated fashion through a citizen-passed measure, Proposition 99, is almost unique to California. The state also had strong and committed voluntary health agencies and widespread support from its citizens for a clean environment, both outdoors and indoors. Of course, it also had a band of effective advocates, including Stan Glantz, who used the scientific method to counter industry claims. Many states do not have these units in...