Open Doorway to Truth: Legacy of the Minnesota Tobacco Trial

More than a decade has passed since the conclusion of the Minnesota tobacco trial and the signing of the Master Settlement Agreement (MSA) by 46 US State Attorneys General and the US tobacco industry. The Minnesota settlement exposed the tobacco industry''s long history of deceptive marketing, advertising, and research and ultimately forced the industry to change its business practices. The provisions for public document disclosure that were included in the Minnesota settlement and the MSA have resulted in the release of approximately 70 million pages of documents and nearly 20,000 other media materials. No comparable dynamic, voluminous, and contemporaneous document archive exists. Only a few single events in the history of public health have had as dramatic an effect on tobacco control as the public release of the tobacco industry''s previously secret internal documents. This review highlights the genesis of the release of these documents, the history of the document depositories created by the Minnesota settlement, the scientific and policy output based on the documents, and the use of the documents in furthering global public health strategies.BAT = British American Tobacco; FCTC = Framework Convention on Tobacco Control; JAMA = Journal of the American Medical Association; LTDL = Legacy Tobacco Documents Library; MSA = Master Settlement Agreement; NCI = National Cancer Institute; PMI = Philip Morris International; RICO = Racketeer Influenced and Corrupt Organizations; TobReg = Study Group on Tobacco Control Regulation; TTC = transnational tobacco company; UCSF = University of California, San Francisco; WHO = World Health OrganizationMore than a decade has passed since Minnesota settled its litigation against the tobacco industry. The Minnesota settlement has been recognized as one of the most important public health events of the second half of the 20th century because it exposed the tobacco industry''s long history of deceptive marketing, advertising, and research.¹ It has also been more than 10 years since the tobacco industry''s individual settlements with the states of Mississippi (1997), Florida (1997), and Texas (1998) and since the signing of the Master Settlement Agreement (MSA) between 46 US State Attorneys General and the tobacco companies (1998). These agreements are the 5 largest settlements in the history of litigation.²Before the Minnesota tobacco case, filed in 1994 by the Minnesota Attorney General and Blue Cross Blue Shield of Minnesota, successful litigation against the cigarette manufacturers had been almost universally unsuccessful. The “first wave” of suits from the 1950s to the 1970s were met by an industry that had adopted a “scorched earth” litigation strategy, outspending individual litigants by orders of magnitude while vehemently denying any association between their product and diseases such as lung cancer.² Through hundreds of cases between 1950 and 1970, the tobacco industry disclosed only a few thousand internal documents, thereby maintaining an impregnable wall of silence.³ The first crack in this wall occurred during the “second wave” of tobacco litigation; this wave was marked by the 1983 Cipollone case, in which plaintiffs aggressively sought and received a small cache of damning documents.⁴Other events converged in the mid-1990s to expose the tobacco industry''s wrongdoing. In 1994, copies of internal documents from the Brown & Williamson Tobacco Corporation were leaked and were ultimately published in the Journal of the American Medical Association (JAMA) in 1995.⁵ Although these documents were not numerous (4000 pages), they were selected because of their damning content and were sent anonymously to Stanton A. Glantz, PhD, a widely recognized tobacco control researcher. These documents became the basis not only for the articles in JAMA but also for the book The Cigarette Papers.⁶ The publication of this book was a historic event and provided the deepest look inside the tobacco industry before the Minnesota litigation. In 1994, the US Food and Drug Administration, under the leadership of then-director David A. Kessler, MD, sought to regulate tobacco products by claiming not only that these products were drug delivery devices but also that the industry controlled and manipulated the form and quantity of nicotine contained within their products.⁷ In addition, Jeffrey Wigand, PhD, a former vice president at Brown & Williamson, began to cooperate with the Food and Drug Administration and ultimately told his story on the television program 60 Minutes.⁸ The industry was further exposed in Congressional hearings chaired by Representative Henry Waxman (Democrat, California),during which chief executives were forever immortalized on videotape as they swore before Congress and the American people that nicotine was not addictive.⁹ All of these events were damaging to the tobacco industry, but even collectively their legacy does not compare with that of the Minnesota tobacco trial, which changed the tobacco control landscape forever.Although the terms of the massive tobacco settlements included large monetary awards and unprecedented public health relief (Open in a separate windowThe first peer-reviewed article based on tobacco companies'' internal documents introduced during the Minnesota trial by the plaintiffs'' witnesses was published 10 years ago in JAMA.¹⁰ The article and the authors'' testimony focused on nicotine addiction, pH manipulation, and low-tar/low-nicotine cigarettes. Since then, several hundred peer-reviewed articles have been published. We summarize the multiple legacies of the Minnesota trial and the MSA by highlighting the effect that these internal documents from the tobacco industry have had on tobacco control around the world.