Background: In January 1954, US tobacco manufacturers jointly sponsored an advocacy advertisement entitled "A Frank Statement to Cigarette Smokers" which appeared in 448 newspapers in 258 cities reaching an estimated 43 245 000 Americans. The advertisement questioned research findings implicating smoking as a cause of cancer, promised consumers that their cigarettes were safe, and pledged to support impartial research to investigate allegations that smoking was harmful to human health.
Objective: To examine (1) the extent to which cigarette companies fulfilled the promises made to consumers in the 1954 "Frank Statement", and (2) the effect of these promises on consumer knowledge, beliefs, and smoking practices.
Methods: This study reviews statements made since 1954 by the tobacco companies individually and collectively through the Tobacco Institute and Tobacco Industry Research Committee/Council for Tobacco Research on the subject of smoking as a cause disease, and the industry's pledge to support and disclose the results of impartial research on smoking and health. Many of the industry documents evaluated in this study were obtained from a collection consisting of 116 documents entitled the "Statement of Defendants' Misrepresentations" prepared by attorneys representing the state of Connecticut in the Medicaid litigation against the tobacco industry in 1998. In addition, we searched for corroborating material from tobacco industry documents collected from the tobacco industry's document websites. In order to contrast industry statements on smoking and health with what smokers' actually believed about smoking we reviewed reports of public polling data on smokers' knowledge and beliefs about smoking and disease gathered from tobacco industry sources and from surveys conducted by public health researchers.
Results: Analysis of public statements issued by the tobacco industry sources over the past five decades shows that the companies maintained the stance that smoking had not been proven to be injurious to health through 1999. The public statements of the tobacco industry are in sharp contrast to the private views expressed by many of their own scientists. The tobacco documents reveal that many scientists within the tobacco industry acknowledged as early as the 1950s that cigarette smoking was unsafe. The sincerity of the industry's promise to support research to find out if smoking was harmful to health and to disclose information about the health effects of smoking can also be questioned based upon the industry's own documents which reveal: (1) scepticism about the scientific value of the smoking and health research program established by the industry; and (2) evidence that research findings implicating smoking as a health problem were often not published or disclosed outside the industry. Industry documents also show that the companies knew that their own customers were misinformed about smoking and health issues.
Conclusion: It is clear that the cigarette companies failed to fulfill the promises made to consumers in the 1954 "Frank Statement" advertisement. The failure of cigarette manufacturers to honour these promises has resulted in a public that even today remains misinformed about the health risks of smoking.