Through role playing, Kessler recreated the process by which the FDA determines to what extent tobacco products should be regulated. He chose one member of the audience to be a high-ranking officer in a big tobacco company, and he treated everyone else as if he or she were the commissioner of the FDA. At every point in the mock FDA investigation, Kessler asked the tobacco company what its position was, and asked the FDA commissioners' what they had decided.
As part of its investigation into potential regulations, the FDA examined cigarettes, journals and patents of different tobacco companies. According to a slide Kessler showed, many patents granted to various tobacco companies were for products that increased nicotine on cigarette filters or for nicotine analogs with tranquilizing effects. "In the lab, the FDA discovered that light cigarettes, often thought to be the 'safest cigarette,' actually had a higher percentage of nicotine than all other types of cigarettes," said Kessler. "Also, the amount of nicotine was more uniform from cigarette to cigarette than pharmaceutical agents are from tablet to tablet."
Kessler said that in 1952, Reader's Digest ran the first article that connected cigarettes to cancer, even before the surgeon general publicly made the connection. The tobacco companies' response was to insert filters in cigarettes to take out tar and nicotine.
Kessler also discussed the process through which the FDA found out that nicotine levels in cigarettes could be higher than previously believed. It started when the FDA discovered that tobacco harvested higher on the stalk has more nicotine than the lower leaves. "The FDA also found a Brazilian patent for Y-1, genetically engineered high nicotine tobacco, and a tobacco company's purchase order for millions of pounds of Y-1," said Kessler.
Kessler said that the FDA received an anonymous tip in a white envelope. The tip advised: "Ammonia in cigarettes can liberate free nicotine from blend, which is associated with increases in impact and 'satisfaction' reported by smokers." Indeed, the FDA's labs determined that the more basic the pH of the cigarette smoke-and ammonia is a base-the more free nicotine is released. Kessler showed a graph which indicated cigarettes with higher levels of free nicotine had higher sales.
Next Kessler showed a video of Steve Parrish, senior vice president for corporate affairs for the tobacco company Philip Morris, denying that nicotine was addictive. In response, Kessler said that the FDA ran laboratory tests which proved that rats would self-administer nicotine, which essentially confirmed that nicotine was addictive.
Kessler also discussed the groups of people targeted by the tobacco companies. He first focused on women, showing a graph comparing breast cancer to lung cancer. Throughout the last century, the number of incidents of breast cancer has been stable; however, the number of incidents of lung cancer in women continues to increase. In 1986, the number of new cases of lung cancer in females surpassed the new cases of breast cancer.
Kessler noted that the fight against lung cancer does not receive as much public attention as the fight against breast cancer, particularly because lung cancer patients often bring the disease upon themselves, while breast cancer patients do nothing to get the disease. "It is hard to have outrage [against lung cancer] if you brought it upon yourself," he said. However, he suggested that anyone who looked at the numbers of female lung cancer patients would see that the disease is becoming more prevalent than breast cancer.
Kessler addressed the other target of tobacco companies, children, by suggesting that if a person gets to be 18 years old without smoking, he or she is likely never to smoke. When Kessler posed a question about the FDA's tobacco regulations, many people in the audience supported a total ban on tobacco products and the rest agreed that some regulation is necessary.