Monday, 19 August 2013

Day 157: Yet another history

For information on accessing documents linked to this blog, see note at the end of the post.

After an eight-week break, the Montreal tobacco trial resumed on a beautiful can-this-really-be-the-end-of-summer morning. Justice Riordan greeted the room with a warm "Bonjour! Welcome back," but Imperial Tobacco was even more enthusiastic about la rentrée.

Any doubts you might have harboured that the company was not having a good time in the trial could be dispelled by its assurance in this morning's press release that it was looking forward to the trial and to "shedding light on the parts of the story that have thus far been left out." The company is confident that as a result of the trial "a more fair and balanced view of the industry will emerge."

For the most part, however, today day felt much like any other trial day. In a windowless room occupied by lawyers in a formal court dress that makes no concession to the centuries let alone the seasons, the summer break soon fell from view.

And as they entered the 17th day of their defense, the companies picked up where they had left off - setting the scene by putting their historical lens to events.

Professor Robert Perrins

Prof. Perrins
(teaching in China)
Today's witness - Professor Robert John Perrins - is the third professional historian to testify for the tobacco companies. Unlike the first two (David Flaherty and Jacques Lacoursière), this Dean of the Faculty of Arts at Acadia University did not address whether there was "common knowledge" among smokers and the public about the fact that tobacco products caused fatal diseases.

Instead Mr. Perrins was asked by JTI-Macdonald to look at the measures "government(s), as well as the public health and medical communities [took] in assessing and publishing information on the health risks associated with smoking, as well as the actions taken by them in relation to such risks, principally over the course of the latter half of the twentieth century."

One reason that JTI may have asked Mr. Perrins to focus on the government's role is that he was brought into the case at a time when the companies were preparing to argue that it was Ottawa that should ultimately be held responsible for wrongdoings related to tobacco sales.

(In 2009, JTI-Macdonald, like the other companies, had an "action in warranty" filed against the Crown in both the Blais and the Létourneau cases now being heard. It was not until November last year that this claim was struck down by the Quebec Court of Appeal.)

A quick learner

Like the other historians engaged by the tobacco companies during this trial, Mr. Perrins came to the task unencumbered by any previous experience in tobacco history or knowledge of tobacco issues. His twenty-year university career has focused (as shown on his CV) on the history of and infectious disease control in pre-revolutionary China.

Nonetheless, Mr. Perrins appears to have taken to this new research focus with gusto!

He told the court today that in the three year period he worked on the report he spent about 3,000 hours researching and writing his opinion. These efforts were in addition to the responsibilities associated with his regular work! As well as being Dean of Arts, Mr. Perrins has appointments in no fewer than four university departments (the departments of history and politics at Acadia University, the department of History at St. Mary's University and the department of Chinese studies at Beijing Normal University).

His report that was filed today came in three parts - Exhibits 4034640347 and 40348. All together it is a heft 750 pages in length, and includes more than 1,600 footnotes.

Mr. Perrins based his analysis on material he gathered from 6 archives in 3 countries (Canada, the UK and the USA). In addition to the work of medical and other historians on the topic,, he personally retrieved more than 10,000 pages of archival records, photographing and filing the documents in picture format. He also searched among the 700,000 records that were "disclosed" to the industry lawyers by the federal government when it was still caught up in the trial. Altogether, he gathered so many records that the bibliography to his report is about 150 pages long!. And he did it single handed - without any help from research assistants! And without any word search capacity on his archival material!

This may seem like an incredible amount of effort for one scholar to accomplish while moonlighting from his regular teaching position.

Incredible yes. And perhaps not entirely believed. The tone of the questions put to Mr. Perrins from plaintiff lawyer Philippe Trudel during the 'voir dire' process suggested that there at least some in the room that found the apparent productivity of this witness a tad suspicious.

Nonetheless, Mr. Trudel gave no formal objection to Mr. Perrins' role and before the morning break the historian was recognized by Justice Riordan as - if I got it right -  "an expert in history, in the history of medicine, and in the history of smoking and health in Canada as it relates to the federal government's, the public health community's and the public health response." 

(The plaintiffs raised no objections during the day, although Mr. Trudel signalled that he felt a case could be made for sections of the report to be struck out.)

In case you didn't get it the first time

During the rest of the day Guy Pratte, who leads JTI-Macdonald's defence, invited Mr. Perrins to elaborate on the sections of his report that lead to his conclusions that:
• During the late 1940s and 1950s there was a growing concern among governments as well as within the medical and public health communities regarding the rising number of diagnosed lung cancer deaths, as well as the association between the rise of this disease and cigarette smoking.
• While early studies on smoking-related health risks were conducted and published prior to the 1940s, the post-war era witnessed a tremendous growth in the amount of research on this topic. This research was conducted using a variety of approaches, including those associated with the fields of clinical, experimental, and population-based (epidemiological) medicine.
• A consensus ...that cigarette smoking was a causal factor in the development of lung cancer was reached in Canada between the November 1963 National Conference on Smoking and Health and the 1969 report of the Isabelle Committee—two important events in the story of smoking and health in Canada.
• One of the Federal Government's public health strategies from the 1960s through to the 1990s was that people who smoked cigarettes should quit, but that if they continued smoking they should smoke lower-tar cigarettes.
Once again the court heard of the events of the 1940s, 1950s and 1960s -- the pioneering research of Adler, Doll and Hill, Ochsner, Wynder and others. Once again the court was told of the importance of the mid-1960s in marginalizing any scientific dissent to the idea that smoking caused lung cancer or laryngeal cancer, and how by 1970 there was a consensus about the harms of tobacco use. Once again, we heard that reducing tar levels of cigarettes was widely endorsed as a way to reduce the harmfulness of smoking, and that the federal government spear-headed such efforts.

Mr. Perrins talked about the decisions of the federal ministry of health to focus on efforts to educate the public about the harms of smokers, to encourage smokers to quit and to discourage people from starting to smoke. He described it as "the beginning of a federal program of action." But he made no link between the actions of the companies and the government's decision to prefer a programmatic response over a regulatory one.

The missing pieces 

In Mr. Perrins' version of events today, the tobacco companies appear exogenous to public health history. He made no suggestion that they could have influenced scientific or popular knowledge, and he rejected the suggestions of others that this might have been the case.

Such tunnel-vision was heavily criticized earlier in the trial by Robert Proctor (see Exhibit 1238). Before his opponent could do the same, Mr. Pratte gave his witness the opportunity to respond to criticisms that industry behaviour was an important context in which to view tobacco related events.

Although he had earlier stressed the importance of "not taking anything for granted" and the need "to identify bias," Mr. Perrins responded to Mr. Proctor's criticisms by stating firmly that he saw no value in going beyond the governmental records.

Despite reading criticisms made of others who had taken the same path, Mr. Perrins said he had made a "conscious decision" to focus only on secondary sources and government archives. He confirmed that this decision was his alone, and in no way influenced by any lawyers.

Later in the day, he specifically rejected the conclusions of other medical historians that the industry played a role in slowing the acceptance of causality by the American Medical Association. Although other medical historians have identified its research partnership with tobacco companies as a factor which influenced the AMA being out of step with history, Mr. Perrins does not.

He said that on the basis of the records he reviewed, he thought it was much more likely that the reason for the delay was the scientific conservatism of the membership of the AMA. The problem was that these doctors were not yet willing to trust epidemiological conclusions.

The testimony of Mr. Perrins is scheduled to continue throughout the week.


To access trial documents linked to this site:

The documents are on the web-site maintained by the Plaintiff's lawyers. To access them, it is necessary to gain entry to the web-site. Fortunately, this is easy to do.

Step 1: Click on: https://tobacco.asp.visard.ca

Step 2: Click on the blue bar on the splash-page "Acces direct a l'information/direct access to information" You will then be taken to the document data base.

Step 3: Return to this blog - and click on any links.