Are tobacco control advocates a sentimental lot, prone to overlooking the fact that, as tobacco industry apologists never tire of pointing out, “We all die eventually”? Or is it perhaps a case of those able to do Big Tobacco’s dirty work being either a self selecting bunch of tough guys, or a group with a knack for denial about the medical consequences of their products, or both? Whatever accounts for the differences in the way the two sides view tobacco induced disease, an industry document that surfaced recently shed an interesting light on how a tobacco industry executive viewed a sudden death almost certainly aided by the free cigarettes that were routinely given to industry employees until comparatively recently.

In February 1972, almost exactly 10 years after the world’s first expert review of the scientific evidence about the effects of smoking on health was published by the Royal College of Physicians of London, which included some strong conclusions about smoking and sudden cardiovascular death, a series of tobacco industry meetings took place in Australia. An American executive identified only as Bill, possibly William Kloepfer from the US Tobacco Institute, wrote home to a colleague, “Dear Alex [almost certainly Alex Holtzman, general counsel to Philip Morris in the United States], Informal progress report. Damn good trip so far...” and went on to describe his first few days down under.

Describing a lunch at British Tobacco, he related how “Unfortunately, William Bengtsson whom I had just met and who was our host a[t] luncheon collapsed and died at the luncheon table, and my attempts to resuscitate him were completely fruitless. It was quite sad, as he was much liked and highly competent.”

Quite sad? Is that all? Was it a form of manly understatement, or just a colloquial turn of phrase of the time, as in the English translation of the famous 19th century German book of terrifying cautionary tales for children, Struwwelpeter? In that, young Conrad, who ignored his mother’s instructions and sucked his thumb, had both thumbs summarily amputated by the big tall tailor: on mother’s return, Conrad “looked quite sad and showed his hands”.

But in 1972, in Sydney, how did Bill really feel? In particular, did it enter Bill’s head, even for one fleeting moment, that this might be the very kind of thing the doctors were on about? If so, he gave no hint of it in the letter, though his business responsibilities clearly included responding to what doctors were increasingly saying about tobacco. His letter went on to give an upbeat description of how he had impressed the Victorian state health minister with evidence about a 25% error in assigning causes of deaths in autopsied cases, “ergo, much higher in non-autopsied cases”. He ended confidently, “Tomorrow, I meet with a group of Melbourne physicians. So far so good”.

The tragedy is that, despite the now irrefutable evidence, more than 30 years after Bill wrote his letter, his final comment could equally describe, with a few exceptions, the continued fortunes of the tobacco industry.