[This is a footnoted version of an article that appeared in _Z_, April 1992. A revised version appears in my _Imperial Alibis_ (Boston: South End Press, 1993).]

MADE IN THE USA: DEADLY EXPORTS

STEPHEN R. SHALOM

 

There are many hypocrisies in the foreign policy of President Bush's War on Drugs.

There is the hypocrisy -- so powerfully documented by Al McCoy in his _The Politics of Heroin_ (Lawrence Hill, 1991) -- of Washington's denouncing international drug traffickers, while U.S. covert actions were often strengthening these very traffickers: in Marseilles after World War II, in Southeast Asia during the Vietnam War, in Afghanistan and Central America in the 1980s.

There is the hypocrisy of Bush's invading Panama for the declared reasons of bringing drug-trafficker Manual Noriega to justice and stopping the drug flow through that country, only to find that the individuals that U.S. troops installed in power in Noriega's place own and run the banks that launder the narco- profits, and that more drugs are smuggled through post-invasion Panama than ever before.

And there is the hypocrisy of the U.S. arming the military in Colombia and Peru supposedly to combat the drug trade, but knowing full well that these soldiers fight not drug traffickers, but leftist guerrillas and civilians unhappy with the status quo (see Richard Hutchinson's article in the Nov. 1991 _Z_).

But there is another fundamental hypocrisy in the foreign policy of the War on Drugs. Bush would have us believe that illegal narcotics are the only harmful substances pushed on innocent victims around the world. In fact, there are many such deadly products, often far more pernicious than crack or heroin, exported not from the coca lands of Bolivia or Peru or the poppy fields of Burma or Afghanistan, but from the United States.

U.S. firms have exported to the Third World vast quantities of pesticides that have been banned for use in the United States. One government study found that thirty percent of U.S. pesticide exports were not approved for use in this country by the Environmental Protection Agency, and one fifth had actually had their approval canceled or suspended by the EPA. Ironically, food products grown in the Third World with the aid of these unsafe pesticides are then imported into the United States. The Food and Drug Administration estimated that some five percent of U.S. food imports contained illegal pesticide residues, a figure likely to underestimate the threat to U.S. consumers' health given that there were more than 170 pesticides for which the FDA didn't test.<1> This "circle of poison" -- in which harmful U.S. pesticides show up on the American dinner table -- finally moved liberals in Congress to act in 1990. They tried to amend a farm bill to include a ban on the export of pesticides not approved for use in the United States. Chemical companies argued that since the FDA inspected so little of the food entering the U.S., foreign farmers would simply buy the banned pesticides from manufacturers in other countries, costing U.S. jobs. The amendment did not make it into the final bill.<2>

An even bigger trade in dangerous substances is the export of unsafe medicinal drugs to the Third World. Pharmaceutical companies, of course, try to make a profit everywhere, and they push drugs that have serious side effects in any country they can. For example, Hoffman-La Roche marketed the sedative Versed in the U.S. that (according to internal company documents) was known to be unsafe; and Upjohn, the manufacturer of the sleeping pill Halcion, has been charged with hiding evidence of the drug's dangers.<3> But it is in the Third World, with their weaker regulatory structures, where the multinational drug companies have run rampant. Drugs that in the U.S. are banned or severely restricted have been pushed on poor countries by U.S. firms.<4> The pain-killer dipyrone, for example, sometimes causes severe hemorrhaging, yet it has been advertised in Mexico for the relief of menstrual pain. In 1977 the drug was banned in the U.S. even for the terminally ill, yet it continued to be sold by U.S. and other firms in Malaysia and Singapore for the treatment of headache and flu.<5> More generally, the warnings and contra- indications routinely distributed with prescription drugs in the United States are sanitized or omitted entirely when U.S. firms sell their products in the Third World.<6>

The pharmaceutical companies claim they are doing nothing illegal. Prescription drug laws and regulations in the Third World do tend to be relatively weak, but some countries have laws requiring disclosure of drug hazards and contra-indications; the laws may not be enforced, but they are on the books and the U.S. firms are in violation of them.<7> Most Latin American countries now have laws allowing the sale of imported drugs only if the drugs are approved for marketing in the country of origin. But U.S. firms have gotten around this requirement by setting up plants to produce (or put the finishing touches on) the drug in some third country which has no restrictions and this third country is then counted as the country of origin.<8>

U.S. drug marketing has also been helped along by lavish bribery. In 1976, 22 U.S. pharmaceutical and health product companies reported making more than $30 million in what were delicately termed "questionable overseas payments."<9> In 1977 a U.S. law made it illegal for U.S. firms to bribe foreign officials, but there is no reason to suspect that such payments have ended. In any case, it is still legal under U.S. law to bribe foreign doctors<10>, and this is widely done. A Nigerian expert estimated that perhaps one-third of the total wholesale cost of all prescription drugs went for bribes and graft, and in other parts of Africa the situation may be even worse.<11> A television documentary in the Philippines revealed that a multinational drug firm in that country ran seminars for doctors complete with women and pornographic films to entertain the physicians at night.<12>

Modern medicine undoubtedly is beneficial, but each year at least one million people in the Third World die from adverse reactions to medical drugs. Some of these deaths are the inevitable result of the primitive state of our medical knowledge, but many must be attributed to the reckless marketing practices of multinational firms.<13>

Another million Third World citizens -- these exclusively children -- are estimated to have died each year from malnutrition and diarrhea resulting from the use of infant formula.<14> Experts agree that mother's milk is by far the healthiest food for infants, particularly in poor countries where nutritional deficits are common. Human milk is also the cheapest source of nutrients. Mothers who bottle feed are frequently forced by financial hardship to dilute the formula with water, often contaminated, with grim results. The international companies that sell infant formula don't make money when mothers breast-feed, and so they have invested heavily in encouraging Third World women to switch to formula. Among the marketing techniques favored by the companies for securing their multi- billion dollar market have been slick advertising campaigns associating bottle-feeding with modernity, free samples given out in hospitals (if the mother can be kept from breast-feeding long enough, her milk will dry up), and the use of "milk nurses," employees of the infant-formula firms disguised as health professionals.<15>

The dominant firm in the Third World infant-formula business has been the Swiss-based Nestl‚ company, but three U.S. corporations have also been major exporters of the product and have engaged in hard-sell marketing.<16> An international consumer boycott of Nestl‚ products helped to mobilize public opinion, and in May 1981 the World Health Organization voted to adopt a non-binding code restricting the promotion of infant- formula products. The code prohibited giving free samples to pregnant women, having salespeople contact mothers, and advertising infant formula to the general public (as opposed to doctors). The vote was 118-1. The lone dissenting vote was that of the United States. The State Department's Elliott Abrams explained that the U.S. government considered the code to violate First Amendment guarantees of free speech.<17>

 

NARCO-TRAFFICKERS

There are other lethal exports. The United States, for example, has become the major source for assault weapons used by drug cartels in Central and South America. High-powered weaponry purchased under the lax gun-control laws in force in Miami are smuggled to drug gangs in countries like Brazil, where the laws are far more stringent.<18> Even more harmful than weapons, pesticides, prescription drugs, and infant formula, however, has been the trade in the most deadly narcotic of all, tobacco. Some two and a half million people die worldwide each year from the health effects of smoking, accounting for perhaps five percent of all deaths.<19> In addition, tobacco growing has added to the problems of deforestation and global warming and, by replacing edible crops on scarce arable land, has driven up food costs in the Third World.<20>

The global tobacco epidemic is not simply the result of people choosing to smoke. It is an epidemic driven by the unparalleled greed of tobacco companies. Many nations have domestic, government-owned tobacco monopolies, but six giant transnational corporations -- four of them U.S.-based -- dominate the international trade in tobacco products.<21> These firms use every gimmick of modern advertising to sell their lethal product and have been able to enlist the help of the United States government in pushing their drug.

Dope pushers are well aware that the best time to hook addicts is when they're young. As U.S. Assistant Secretary of Health James Mason put it: "Anyone who thinks cigarette makers aren't after the youth market -- in America or worldwide -- must live in a cave."<22> Thus, in the U.S., cigarette companies advertise in such magazines as _Sports Illustrated_, _Rolling Stone_, _TV Guide_, and _Glamour_ with their large teen-aged readerships; give out free magazines full of cigarette ads in movie theaters; pay to get their products shown in movies like "Superman"; feature cartoon camels; offer cartoon posters; and sponsor countless sporting events.<23> Smoking, however, has been on the decline in the U.S., and to make up for their diminishing domestic market, the U.S. cigarette companies have been expanding overseas. In the developing countries particularly, smoking has been on the increase, "fueled mainly," as the World Health Organization noted in January 1986, "by intensive and ruthless promotional campaigns on the part of the transnational tobacco companies."<24>

In Kenya children are given t-shirts with Marlboro on the front; in Guatemala they are given Marlboro clothing.<25> In Thailand, cigarette logos have appeared on kites, t-shirts, pants, notebooks, earrings, and chewing gum packages.<26> In Japan, attractive young women are hired to give out free Larks on the streets<27> and U.S. firms have dominated the TV advertisements, many of which have been shown during children's programs.<28> In South Korea, U.S. companies held promotional beach concerts.<29> And in Taiwan, U.S. transnationals distributed free cigarettes at discos and nightclubs frequented by young people.<30> In February 1988, R. J. Reynolds sponsored a rock concert in Taipei featuring Hong Kong teen-idol Hsow-Yu Chang, with admission offered only in exchange for five empty packs of Winstons (ten for a souvenir sweat shirt).<31>

One tobacco marketing executive explained: "Nobody is stupid enough to put it in writing, or even in words, but there is always the presumption that your marketing approach should contain some element of market expansion and market expansion in this industry means two things, kids and women. I think that governs the thinking of all the companies."<32>

In countries where women's smoking rates have traditionally been very low, aggressive marketing by U.S. firms has been especially pernicious. In Hong Kong, where only one percent of women under forty smoke, Philip Morris recently launched Virginia Slims with a flood of "women's liberation" ads.<33> Despite rules and voluntary industry codes in Japan prohibiting the targeting of women in cigarette ads, U.S. companies have run TV commercials aimed at women and one company placed a billboard outside the entrance to a women's college in Tokyo.<34>

Many countries have laws banning cigarette ads, but the tobacco companies are rarely bound by such legal niceties. In Thailand, a cabinet resolution prohibited all cigarette ads, but the U.S. firms refused to comply, claiming that a cabinet resolution was not a law. When an official law was passed in February 1989, the U.S. companies continued to advertise.<35> In Malaysia and China, where cigarette advertising is banned, ads appear for trips to "Marlboro country," illustrated with scenes of the Marlboro man riding around, though without a cigarette in his mouth.<36>

The tobacco companies are not content to push their deadly products on their own. To help them in the task, they have recruited -- or, more precisely, bought through their campaign contributions -- the U.S. government. On the domestic front, the cigarette lobby has able to chalk up such accomplishments as getting the U.S. taxpayer to subsidize the growing of tobacco leaf or getting Congress to delete funds from the federal budget for anti-smoking education programs in the schools.<37> But the government has also given powerful support to the cigarette companies in their overseas efforts.

It must be emphasized that Washington's exertions on behalf of the merchants of death has not been for lack of knowledge of the adverse health effects of cigarettes. As far back as the mid-fifties a Virginia Senator wrote to the State Department urging its help in preventing foreign nations from imposing tariffs that would hurt the U.S. tobacco industry, already imperiled as it was by "the rapid increase in lung cancer" that "has cast a cloud upon cigarette smoking as a possible contributing, if not a major, factor in that dread disease."<38>

In 1954, tobacco was included in the U.S. Food for Peace program, under which the government would buy domestic crops and distribute them abroad in an effort to win friends for the Pentagon and win markets for U.S. agriculture. Over the next 25 years, almost $1 billion in tobacco exports were financed through this program.<39> In the early 1960s, the Agriculture Department spent hundreds of thousands of dollars to advertise cigarettes overseas, including the production of a 23-minute promotional color movie called "The World of Pleasure" designed for free foreign distribution.<40> Other federally funded market development programs continue to assist the export of U.S. tobacco products.<41> In the current year, the Agriculture Department is providing $3.5 million to promote the foreign sale of U.S. tobacco leaf.<42>

During the Carter administration, Secretary of Health, Education, and Welfare Joseph Califano became a vigorous critic of smoking. Among other actions, he asked cigarette companies to devote ten percent of their advertising budget to a campaign to discourage children and teen-agers from smoking, an idea rejected by the companies on the grounds that "the mothers and fathers of this nation, whether smokers or non-smokers, should continue to have freedom of choice in the education and training of their children."<43> Warned that Califano's position was going to cost him political support in North Carolina, Carter went on the stump, joined by his Commerce Secretary Juanita Kreps (on the board of directors of R. J. Reynolds), to sing the praises of the tobacco industry. In 1979 Carter fired Califano.<44> During the 1980 Presidential campaign, Reagan sent a letter to tobacco farmers declaring: "Tobacco -- no less than corn, wheat, or soybeans -- should be viewed as a valuable cash crop with an important role to play in restoring America's balance of trade. I can guarantee that my own Cabinet members will be far too busy with substantive matters to waste their time proselytizing the dangers of cigarette smoking."<45>

Indeed, Reagan administration officials were able to find the time to actively promote the export of cigarettes. Many East Asian nations prohibited the importation and advertising of foreign cigarettes, leaving all tobacco sales to government-run monopolies which did minimal advertising. In 1985, Reagan directed the U.S. Trade Representative to coerce Japan, under threat of trade retaliation, to open its market to U.S. cigarettes, including the right to advertise. (Such actions by the Trade Representative actually began under Carter, when Japan was pressed in 1979 to remove restrictions on the sale and advertising of U.S. cigar and pipe tobacco.) The Trade Representative brought similar pressure on behalf of U.S. cigarettes against Taiwan in 1986, South Korea in 1988, and Thailand in 1989.<46>

The impact was seen almost immediately. In Japan, cigarette ads had risen from fortieth to second place in total television air time by 1987, and two-thirds of the ads were for U.S. brands.<47> As U.S. companies went after Japanese women and teen-agers, the government tobacco firm responded with its own products appealing to these same groups.<48> Japan had had a 20- year decline in smoking rates, but there was a three percent increase after U.S. companies entered the market.<49> In Taiwan and South Korea, a similar pattern was seen -- U.S. pressure to remove restrictions on advertising, U.S. insistence that print ads be allowed to appear without the Surgeon General's health warnings, U.S. cigarettes becoming one of the most heavily advertised products in Korea -- with an attendant increase in cigarette consumption.<50>

Threats of trade retaliation from the U.S. Trade Representative were supplemented by lobbying efforts from private citizens who had served in the Reagan administration: Michael Deaver, Richard Allen, and Alexander Haig. Additional threats were delivered by Senator Jesse Helms and other U.S. legislators.<51>

The profits from this narco-trafficking have been immense. In 1986, the U.S. exported 64 billion cigarettes; by 1989, the figure was 142 billion. Fifty-five percent of the increase was attributable to imports by Japan, Taiwan, and South Korea.<52> Philip Morris had $1 billion in overseas sales in 1986, which grew to $8 billion four years later.<53> Tobacco and tobacco products produced a trade surplus in 1989 of $4.3 billion, up from $2 billion in 1986.<54>

At an international conference on Tobacco and Health held in Australia in April 1990, a resolution was approved urging nations not to use trade leverage to compel other nations to repeal restrictions on the sale, import, or advertising of tobacco products; the United States was specifically called upon "to cease pro-tobacco trade actions against Thailand and other countries."<55> The U.S. Assistant Secretary of Health James Mason told the conference that it was "unconscionable for the mighty transnational tobacco companies...to be peddling their poison abroad."<56> But by the next month the Department of Health and Human Services had backed away from its criticisms of efforts to open markets for U.S. cigarettes around the world, and HHS Secretary Louis Sullivan refused to allow Mason to testify before Congress on the issue of tobacco exports.<57> The administration position on the issue was ably put by Vice- President Dan Quayle: "Tobacco exports should be expanded aggressively because Americans are smoking less."<58> C. Everett Koop, Reagan's Surgeon General, expressed a different view after he left office: "At a time when we are pleading with foreign governments to stop the export of cocaine, it is the height of hypocrisy for the United States to export tobacco. Consider these figures. Last year [1988] in the United States, 2,000 people died from cocaine. In that same year, cigarettes killed 390,000 people."<59> He urged U.S. citizens to refuse to tolerate the export of "disease, disability and death."<60>

These were strong words, but Koop actually understated the hypocrisy.

In "pleading with foreign governments to stop the export of cocaine," Washington has not been asking Colombia or Peru to desist from openly pushing drugs, but to be more vigorous in clamping down on illegal activities. Tobacco exports, on the other hand, are actively and openly promoted by the U.S. government.

The cocaine and heroin epidemics in the U.S. are problems not susceptible to supply-side solutions: answers must be sought instead in programs of social investment, and in drug education and treatment. The global cigarette epidemic, too, needs demand- side answers, but efforts in this direction -- restrictions on advertising and promotion -- have been directly undermined by Washington.

Imagine if the Colombian government were subsidizing the growing and marketing of cocaine. Imagine if the Colombian government were able to pressure "consumer" nations into allowing crack advertisements and marketing aimed at children and other groups not sufficiently addicted. Add this to Koop's four hundred thousand instead of two thousand annual deaths, and the full magnitude of what the United States government has been doing can be appreciated.

Tobacco, along with unsafe pesticides, prescription drugs, and infant-formula: these are the deadly exports that make cocaine trafficking pale in comparison.

 

 

NOTES

The author would like to thank Bill Clark, Judy Feldman, Stan Karp, and Bob Rosen for their help.

1. Ruth Norris, ed., _Pills, Pesticides & Profits_, Croton-on- Hudson, NY: North River Press, 1982, pp. 7, 26; _Congressional Quarterly Weekly Report_, June 9, 1990, p. 1783; GAO, _Food Safety and Quality: Five Countries' Efforts To Meet U.S. Requirements On Imported Produce_, GAO/RCED-90-55, March 1990, pp. 12, 34-35. The GAO found that of 26 pesticides for which US registration had been canceled or suspended as of 1988, 35% were registered for use in at least one of 5 Latin countries studied; an additional 110 pesticides for which no U.S. tolerances had been established were registered in one or more of these countries (GAO, _Food Safety and Quality_, pp. 26-27, 32).

2. _Congressional Quarterly Weekly Report_, June 9, 1990, p. 1783; Oct. 13, 1990, p. 3411; _Congressional Quarterly Almanac, 1990_, p. 349.

3. Gina Kolata, "Drug Maker Didn't Heed Warning on Deadly Effect," _New York Times_, (_NYT_) 4 July 1991, pp. A1, A10; Gina Kolata, "Consumer Group Says LaRoche Withheld Data on Drug's Safety," _NYT_, 1 Aug. 1991, p. B7; Robert Cohen, "Hoffman-La Roche Investigated for Alleged Withholding of Safety Data," Newark _Sunday Star Ledger_, 16 Feb. 1992, p. I:16; Gina Kolata, "Maker of Sleeping Pill Hid Data on Side Effects, Researchers Say," _NYT_, 20 Jan. 1992, pp. A1, B7.

4. Robert J. Ledogar, _Hungry for Profits: U.S. Food and Drug Multinationals in Latin America_, New York: IDOC/North America, 1975, pp. 27-36. Laxness in monitoring drugs is not confined to the Third World: see Warren E. Leary, "Report Says FDA Is Lax On Over-the-Counter Drugs," _NYT_, 27 Feb. 1992, p. A12.

5. Ledogar, _Hungry for Profits_, pp. 31-33, 41-42; Norris, ed., _Pills, Pesticides..._, pp. 42-43.

6. Norris, ed., _Pills, Pesticides..._, pp. 39, 48-49; Milton Silverman, _The Drugging of the Americas: How Multinational Drug Companies Say One Thing about Their Products to Physicians in the United States, and Another Thing to Physicians in Latin America_, Berkeley: University of California Press, 1976, passim; Ledogar, _Hungry for Profits_, p. 51. It is conceivable, of course, that the social benefits and costs of a particular drug may vary from society to society, so that what ought to be banned in the U.S. ought to be legal in some other country. (The birth control drug Depo-Provera is sometimes said to fall in this category. See Norris, ed., _Pills, __Pesticides..._, p. 45.) For most of the drugs considered in the studies cited above, this claim cannot be seriously offered.

7. Milton Silverman, Philip R. Lee, and Mia Lydecker, _Prescriptions for Death: The Drugging of the Third World_, Berkeley: University of California Press, 1982, p. 116.

8. Silverman, _Drugging of the Americas_, p. 117.

9. Silverman, Lee, and Lydecker, _Prescriptions for Death_, p. 125.

10. Silverman, Lee, and Lydecker, _Prescriptions for Death_, p. 126.

11. Silverman, Lee, and Lydecker, _Prescriptions for Death_, p. 121-23.

12. Silverman, Lee, and Lydecker, _Prescriptions for Death_, pp. 120-21.

13. The one million figure is an extrapolation from U.S. data, which overstates the Third World toll because poor countries have lower per capita drug use rates, and understates it because of the widespread use of drugs considered unsafe in the U.S. See Silverman, Lee, and Lydecker, _Prescriptions for Death_, p. 86.

14. Norris, ed., _Pills, Pesticides..._, p. 75; Stephen Solomon, "The Controversy Over Infant Formula," _NYT Magazine_, 6 Dec. 1981, p. 94, citing estimate by Dr. Stephen Joseph, an AID official who resigned over the issue.

15. Norris, ed., _Pills, Pesticides..._, p. 78; Solomon, "Controversy Over Infant Formula," pp. 100-02.

16. Norris, ed., _Pills, Pesticides..._, p. 76; Ledogar, _Hungry for Profits_, p. 137.

17. Norris, ed., _Pills, Pesticides..._, pp. 80-81; Solomon, "Controversy Over Infant Formula," p. 94. For Abrams's statement, see U.S. Department of State, _American Foreign Policy: Current Documents, 1981_, Washington, DC: 1984, pp. 249- 50. Arthur Hoppe writing in the _San Francisco Chronicle_ of May 27, 1981, commented: "Some critics worry that by causing one million deaths a year, the infant formula industry may be curtailing its market. Fortunately, this isn't true. As luck would have it, the breast-feeding mother is unlikely to get pregnant while lactating and thus won't breed again for another year or two. The mother who employs the lethal bottle, on the other hand, can produce another offspring nine months after the birth of her first -- thus assuring the industry a constant supply of hungry little customers." Breast-feeding, he noted, "obviously instills in both mother and child the socialistic concept that there is, indeed, such a thing as a free lunch." Quoted in Silverman, Lee, and Lydecker, _Prescriptions for Death_, p. 118.

18. U.S. House of Representatives, Select Committee on Narcotics Abuse and Control, _The Flow of Precursor Chemicals and Assault Weapons from the United States into the Andean Nations_, Hearings, 101st Cong., 1st sess., 1 Nov. 1989, pp. 16, 44; James Brooke, "Gun Runners From Miami Give Brazilian Drug Gangs Lead in Arms Race," _NYT_ 23 Feb. 1992, p. I:3.

19. See Council on Scientific Affairs, AMA, "The Worldwide Smoking Epidemic," _JAMA_, vol. 263, no. 24, 27 June 1990, p. 3312. Estimates from 2-3 million are given in U.S. Senate, Committee on Labor and Human Resources, _Smoking and World Health_, Hearings, 101st Cong., 2nd sess., May 4, 1990, pp. 1, 3, 7, 27.

20. Council on Scientific Affairs, "Worldwide Smoking Epidemic," pp. 3313-14; Alexander Cockburn, "Beat the Devil," _Nation_, 30 Oct. 1989, p. 482, citing Susan Motley in _Multinational Monitor_, July/Aug. 1987.

21. Council on Scientific Affairs, "Worldwide Smoking Epidemic," p. 3313.

22. Patrick G. Marshall, "Tobacco Industry: On the Defensive, But Still Strong," _Editorial Research Reports_, vol. 1, no. 35, Sept. 21, 1990, p. 541.

23. Larry C. White, _Merchants of Death: The American Tobacco Industry_, New York: William Morrow, 1988, pp. 122-24; U.S. Senate, _Smoking and World Health_, p. 36; Morton Mintz, "Marketing Tobacco to Children," _Nation_, 6 May 1991, p. 594; Elizabeth M. Whelan, _A Smoking Gun: How the Tobacco Industry Gets Away With Murder_, Philadelphia: George F. Stickley Co., 1984, p. 186. On the camel cartoons, see Jane E. Brody, "Smoking Among Children Is Linked To Cartoon Camel in Advertisements," _NYT_, 11 Dec. 1991, p. D22; Geoffrey Cowley, "I'd Toddle a Mile for a Camel," _Newsweek_, 23 Dec. 1991, p. 70; and, for the enthusiastic views of advertising executives, Stuart Elliott, "Camel Cartoons Draws Buyers, Too," _NYT_, 12 Dec. 1991, pp. D1, D5.

24. Quoted by William H. Foege in U.S. Senate, _Smoking and World Health_, p. 11.

25. Testimony of Dr. Gregory N. Connolly, Mass Dept of Public Health, in U.S. Senate, _Smoking and World Health_, p. 16.

26. U.S. Senate, _Smoking and World Health_, pp. 65-66, 72-73.

27. Peter Schmeisser, "Pushing Cigarettes Overseas," _NYT Magazine_, 10 July 1988, pp. 17 (picture), 22.

28. U.S. Senate, _Smoking and World Health_, pp. 36-37.

29. GAO, _Trade and Health Issues: Dichotomy Between U.S. Tobacco Export Policy and Antismoking Initiatives_, Report to Congressional Requesters, May 1990, GAO/NSIAD-90-190, p. 26.

30. GAO, "Dichotomy Between U.S. Tobacco Export Policy...," p. 26.

31. After protest, the concert was canceled, but fans were told they could still exchange spent packs for a cassette. Schmeisser, "Pushing Cigarettes Overseas," pp. 22, 62; U.S. Senate, _Smoking and World Health_, pp. 10, 35.

32. White, _Merchants of Death_, p. 123.

33. Lori Heise, "Unhealthy Alliance," _World Watch_, Sept.-Oct. 1988, p. 24.

34. U.S. Senate, _Smoking and World Health_, p. 39; Philip J. Hilts, "US Tobacco Ads in Asia Faulted," _NYT_, 5 May 1990, p. 35; GAO, "Dichotomy Between U.S. Tobacco Export Policy...," p. 25.

35. U.S. Senate, _Smoking and World Health_, pp. 66, 73; Morton Mintz, "Tobacco Roads," _Progressive_, May 1991, pp. 26-27; GAO, "Dichotomy Between U.S. Tobacco Export Policy...," pp. 28-29.

36. U.S. Senate, _Smoking and World Health_, pp. 25, 38, 39.

37. Peter Taylor, _The Smoke Ring: Tobacco, Money, and Multinational Politics_, New York: Pantheon, 1984, p. 215.

38. A. Willis Robertson to John Foster Dulles, 24 May 1955, Dwight D. Eisenhower Papers, Eisenhower Library, Abilene Kansas, OF 149-B-2, Tobacco.

39. Whelan, _Smoking Gun_, pp. 167-68; Taylor, _Smoke Ring_, pp. 262-3; U.S. Senate, _Smoking and World Health_, p. 100.

40. Whelan, _Smoking Gun_, pp. 97-98; Thomas Szasz, _Ceremonial Chemistry: The Ritual Persecution of Drugs, Addicts, and Pushers_, rev. ed., Holmes Beach. FL: Learning Publications, 1985, p. 205.

41. GAO, "Dichotomy Between U.S. Tobacco Export Policy...," pp. 5, 44-45.

42. AP, "U.S. Aids Promotion of Smoking Overseas," Newark _Star Ledger_, 10 Feb. 1992, p. 3.

43. Taylor, _Smoke Ring_, pp. 214-15.

44. Whelan, _Smoking Gun_, pp. 123-24; Taylor, _Smoke Ring_, pp. 216-17, 223. On Kreps, see Bryan Burrough and John Helyar, _Barbarians at the Gate: The Fall of RJR Nabisco_, New York: Harper Perennial, 1990, p. 60. As governor of Georgia, Carter had published a pamphlet on "killers and cripplers" which discussed the causes of heart disease and cancer without any mention of cigarettes or tobacco. Whelan, _Smoking Gun_, p. 123.

45. Taylor, _Smoke Ring_, p. 228.

46. GAO, "Dichotomy Between U.S. Tobacco Export Policy...," pp. 17-18.

47. U.S. Senate, _Smoking and World Health_, p. 36.

48. Heise, "Unhealthy Alliance," p. 23; U.S. Senate, _Smoking and World Health_, p. 37.

49. U.S. Senate, _Smoking and World Health_, pp. 4, 9-10.

50. Testimony from Dr. Gregory N. Connolly, in U.S. Senate, _Smoking and World Health_, pp. 16, 34-35, 51; Schmeisser, "Pushing Cigarettes Overseas," p. 20; GAO, "Dichotomy Between U.S. Tobacco Export Policy...," pp. 6, 12.

51. GAO, "Dichotomy Between U.S. Tobacco Export Policy...," pp. 22-23; Gregory N. Connolly, "Tobacco and United States Trade Sanctions," in Masakazu Aoki, et al., _Smoking and Health 1987: Proceedings of the Sixth World Conference on Smoking and Health_, New York: Elsevier Science Pub. Co., 1988, pp. 352-53; Gregory N. Connolly, in U.S. Senate, _Smoking and World Health_, p. 51; Heise, "Unhealthy Alliance," p. 22; Schmeisser, "Pushing Cigarettes Overseas," p. 62.

52. GAO, "Dichotomy Between U.S. Tobacco Export Policy...," p. 39.

53. U.S. Senate, _Smoking and World Health_, p. 16.

54. GAO, "Dichotomy Between U.S. Tobacco Export Policy...," p. 5.

55. GAO, "Dichotomy Between U.S. Tobacco Export Policy...," p. 34.

56. Marshall, "Tobacco Industry," p. 541.

57. Philip J. Hilts, "Health Dept. Softens Stance on Cigarette Exports," _NYT_, 18 May 1990, p. A14; Mintz, "Tobacco Roads," p. 26.

58. Mintz, "Tobacco Roads," p. 28.

59. Quoted in U.S. Senate, _Smoking and World Health_, pp. 62- 63.

60. Schmeisser, "Pushing Cigarettes Overseas," p. 18.