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Why would physicians testify that smoking isn’t addictive? Maybe the money. Lots of money.

REUTERS/Lucas Jackson
Tobacco companies pay the doctors handsomely for their testimony — up to $100,000 per physician per case.

Some physicians are repeatedly willing to stand up in court on behalf of tobacco companies and testify that a lifetime of heavy smoking did not cause the cancer of dying patients who are suing the companies — despite overwhelming scientific evidence that suggests otherwise, according to a new and disturbing study from Stanford University. 

In fact, those so-called medical experts are even willing to testify that smoking is not addictive and to characterize reports from the Surgeon General on the health dangers of smoking as “not authoritative.”

“I was shocked by the degree to which these physicians were willing to testify, in my opinion, in an unscientific way, to deny a dying plaintiff — suffering the aftermath of a lifetime of smoking — of a fair trial,” said the study’s author, Dr. Robert Jackler, chair of Stanford’s otolaryngology-head and neck surgery department, in a released statement.

Here’s a finding, however, that may make that willingness seem less shocking: Tobacco companies pay the doctors handsomely for their testimony — up to $100,000 per physician per case, according to Jackler’s research. 

A narrow focus

Jackler focused his study on a specific group of physician expert witnesses: other otolaryngologists (physicians with special training in the treatment of diseases of the head and neck) who testified in Florida lawsuits involving head and neck cancer between 2009 and 2014. A search of legal databases turned up six board-certified otolaryngologists who had testified in defense of the tobacco companies in nine cases during that time frame (and several dozen additional cases at other times). 

The nine cases all centered around the issue of whether smoking caused the patient’s cancer. A Florida Supreme Court ruling in 2006 made it possible for plaintiffs to proceed in such cases without have to re-litigate matters such as the dangers of tobacco or the fact that the industry has a history of deceiving the public about those dangers.

Jackler read through all the depositions and trial testimony of the six physicians in these cases and compared that testimony to the scientific literature on cancers of the head and neck. He found that the physicians had repeatedly misstated, obfuscated or outright denied commonly accepted evidence.

Many of the physicians “refused to agree that nicotine is addictive, citing lack of expertise, even though it has been widely accepted by the medical profession for decades,” Jackler writes. “[They] also denied the validity of widely recognized authoritative sources such as Surgeon General’s reports.”

A cynical strategy

One very common strategy used by the tobacco company’s expert witnesses was to cite an exhaustive list of possible risk factors for head and neck cancer, including anemia, cleaning solvents, gasoline fumes, mouthwash, eating salted fish and meat, and living in urban areas.

This list — which Jackler calls “an etiological soup” — has a cynical purpose: to confuse the juries.

“Tobacco legal defense teams have honed methods to implant the notion in the jury that tobacco’s role in a plaintiff’s cancer is controversial and that the scientific evidence is debatable,” writes Jackler. “Their strategy is to manufacture doubt in the mind of jurors, who lack the technical background needed to critically analyze testimony on cancer causation. With extensive case experience, tobacco lawyers have crafted arguments carefully tailored to persuade those lacking scientific background.”

As Jackler painstakingly points out, none of the risk factors on these lengthy lists — even if they were all credible (and they’re not) — comes even remotely close to approaching the risk posed by smoking.

Indeed, one 2009 meta-analysis of more than 85 studies found that smokers are more than four times likely to develop cancer of the upper aerodigestive tract (lips, mouth, tongue, nose, throat, vocal cords, and part of the esophagus and windpipe) than non-smokers and 19 times more likely to develop cancer of the larynx.

The tobacco companies — and their physician-witnesses — know all too well that long lists of theoretical causes may sway juries, says Jackler, despite the “obvious fallacy” of the argument.

“That fallacy lies in the fact that literally billions of nonsmoking people are exposed regularly to gasoline fumes, use cleaning solvents, eat salted fish, or live in urban environments,” he writes. “Were these causative factors for head and neck cancer, with even a minute fraction of the potency of tobacco, the rate of head and neck cancer among nonsmokers would be much greater than what has been observed.”

‘The best that money can buy’

“The tobacco industry identifies the best experts that money can buy, trains them in their well-honed narrative to manufacturer doubt in the minds of the jury and makes use of them over and over in case after case,” Jackler concludes.

The medical community — including specialty societies such as the American Academy of Otolaryngology-Head and Neck Surgery — needs to engage in more formal reviews of such testimony to make sure it adheres to professional ethical standards, he adds.

The study was published online in Laryngoscope, and can be downloaded and read in full at that journal’s website.

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Comments (10)

  1. Submitted by Rod Loper on 07/23/2015 - 12:50 pm.

    Pick any poison

    or harm to people by industry or agriculture and view the same strategy at work.

  2. Submitted by Russell Booth on 07/23/2015 - 02:02 pm.

    And Worker’s Comp

    My lawyer and chiropractor each told me separately what to expect from the corrupt but handsomely paid doctor who would ‘examine’ me for my case. Aren’t there any regulatory bodies in the field of medicine?

  3. Submitted by Russell Booth on 07/23/2015 - 04:33 pm.

    I’m not an expert either.

    The chiropractor and lawyer both told me that the doctor would pass his hands lightly down my back for a duration that should not exceed 5 seconds. The lawyer said I could take a stopwatch so the doctor would see me time his ‘exam’ but it would not do any good in court because of the doctor’s ‘credentials’. That was exactly what happened. Apparently this practice is well known and the ‘expertise’ of these doctors is accepted by the court as if it was competent practice. I would be surprised if the Minnesota Board of Medical Practice is not aware.

    I wondered what would have to happen to a doctor like that to become a high paid liar. But I just don’t know. I saw two of them. Same ‘exam technique’ both times.

    • Submitted by Pat Berg on 07/23/2015 - 06:29 pm.

      I wonder what would have happened . . . .

      I wonder what would have happened if you had jumped up and shrieked as if in pain as he did his “exam”?

      What’s good for the goose and all that . . . . . .

    • Submitted by Paul Brandon on 07/23/2015 - 07:07 pm.


      If it’s simply a question of whether there is a lump there or not, it might not take an experienced examiner more than five seconds to make a diagnosis.
      I do believe that you’re entitled to a second opinion and an appeal.
      Again, I’m neither a lawyer nor a physician, but even as an educated layman I’d need to know a lot more about the situation to know how reasonable the examination requirements are.
      Five seconds is much too little for a general diagnosis of an unknown ailment, but if the question is simply whether or not you have one specific medical condition, it might suffice.

  4. Submitted by Pavel Yankovic on 07/23/2015 - 07:50 pm.

    Everyone has known…

    the dangers of smoking since the 1960’s. If one develops a smoking related illness whether it is COPD, heart disease or cancer it is their own fault and tobacco companies should not be held responsible. People need to take responsibility for their own self destructive habits. No sympathy here.

    • Submitted by Robert Moffitt on 07/24/2015 - 07:46 am.

      No one “deserves” lung cancer or COPD

      Both smokers and nonsmokers develop lung cancer and COPD. To suggest somehow that anyone “deserves” these terrible diseases is unjust and just plain wrong.

    • Submitted by Paul Brandon on 07/24/2015 - 09:36 am.


      is a classic case of an addictive drug,
      and most users are addicted while in their early teens.
      Tobacco companies target kids (see the ads on TV).
      Your argument could be used for any addictive substance.
      Do you advocate legalizing cocaine?
      Same logic.

  5. Submitted by jack listerio on 07/26/2015 - 09:21 am.

    no proof of disease causation

    7 October, the COT meeting on 26 October and the COC meeting on 18
    November 2004.

    “5. The Committees commented that tobacco smoke was a highly complex chemical mixture and that the causative agents for smoke induced diseases (such as cardiovascular disease, cancer, effects on reproduction and on offspring) was unknown. The mechanisms by which tobacco induced adverse effects were not established. The best information related to tobacco smoke – induced lung cancer, but even in this instance a detailed mechanism was not available. The Committees therefore agreed that on the basis of current knowledge it would be very difficult to identify a toxicological testing strategy or a biomonitoring approach for use in volunteer studies with smokers where the end-points determined or biomarkers measured were predictive of the overall burden of tobacco-induced adverse disease.”

    In other words … our first hand smoke theory is so lame we can’t even design a bogus lab experiment to prove it. In fact … we don’t even know how tobacco does all of the magical things we claim it does.

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