“Does it trouble you to answer that question?” one of New York’s highest paid attorneys asked Cliff Douglas, then a 36-year-old activist who had found himself at the center of a $10 billion libel lawsuit brought by the cigarette giant Philip Morris.
Philip Morris’ lawyer Herbert Wachtell demanded to know: Were cigarette companies intentionally killing people?
“I believe the companies are knowingly producing products that do kill people,” Douglas replied.
Douglas spent two full days in December 1994 holed up in a Bethesda, Md., conference room being interrogated by Wachtell, who insisted that Douglas also share his views on whether the cigarette industry was “the enemy,” whether the companies were liars, and even whether they were the equivalent of Colombian drug lord Pablo Escobar.
Douglas was there because he had been a key source for an ABC News investigation that showed tobacco companies were intentionally manipulating nicotine in their cigarettes, a bombshell revelation that set in motion the libel lawsuit.
“I woke up every day, from my first day in this career back in 1988, devoted to making life as difficult as possible for Big Tobacco,” Douglas said in one of a series of lengthy interviews with STAT.
ABC eventually settled the lawsuit, but the thrust of Douglas’ findings were corroborated by the Food and Drug Administration. The revelation that tobacco companies could control the amount of nicotine in cigarettes sparked two decades of work in Washington that eventually led to the FDA gaining the power to regulate cigarettes in 2009. It also launched Douglas’ decades-long career in tobacco control, which saw him suing cigarette companies, working for the American Cancer Society, coordinating a congressional task force on smoking, and being tapped to craft the Obama administration’s strategic plan for “ending the tobacco epidemic.”
Now, nearly 30 years after that grueling deposition, Douglas is the new president and CEO of a foundation that many of his former colleagues in the fight against cigarette companies say is inextricably linked to his former adversaries in the tobacco industry.
Last fall, Douglas announced he was taking the helm of the Foundation for a Smoke-Free World, an organization with the stated goal to “end smoking in this generation.” Philip Morris International, which sells cigarettes globally but not in the United States, has been the foundation’s sole funder since its inception in 2017. (The cigarettes synonymous with the Philip Morris brand — Marlboro, Virginia Slims, Parliament — are sold in the United States by a separate company, Philip Morris USA, which is owned by Altria. PMI was split off from Altria in 2008.)
Douglas said that PMI had no role in his hiring, and that he was selected by the foundation’s wholly independent board of directors. He negotiated a split with PMI before taking the job, though the foundation will likely be dependent on its funding for some time thanks to a $140 million final payment.
He also is renaming the organization, which as of Monday will be called Global Action to End Smoking, according to an announcement shared with STAT. The group has also pledged to never again take any funding from tobacco or “non-medicinal nicotine” companies, and has begun distancing itself from terms like “smoke-free” because of their use by cigarette companies, including PMI.
All of the changes are a conscious effort to convince the public health world that the tobacco industry is out of the picture, and Global Action can be trusted. “We are public health, pure and simple,” Douglas said.
By taking the job, Douglas, a lawyer and part-time University of Michigan professor, has firmly planted himself at the center of one of the most controversial debates in public health. Since the widespread commercialization of e-cigarettes roughly a decade ago, the anti-tobacco community has fractured over the questions of whether it should embrace a harm reduction approach — recommending smokers switch to products like e-cigarettes that are less likely to prematurely kill them — and what role the tobacco companies themselves should play in helping to reduce the harm they caused. Douglas has pledged to help mend that divide.
Whether he can remains to be seen. Some skeptics say Douglas will only be able to prove his independence if he stands up to Philip Morris International, which still generates 60% of its revenue from cigarettes.
“Scholars working for powerful [companies] may feel they are remaining ‘independent,’ but corruption is often revealed in what is not or cannot be said,” said Robert Proctor, a professor of history at Stanford University. “Will the Foundation for a Smoke-Free World call for cigarette makers to stop selling cigarettes? I don’t think so!”
Douglas’ answer to that challenge is not likely to placate his critics.
“This quitting selling cigarettes tomorrow is not real life,” Douglas said. “There are many experts in the field who would say: You have to be strategic and approach it from the perspective of setting up real-life incentives and disincentives … to change this marketplace.”
Internecine warfare is a term usually applied to civil wars and genocides. Douglas uses it to describe the ongoing feud in the community of organizations, academics, and doctors working to reduce smoking rates.
“I urge all of us in the tobacco control community to climb out of the bunker, come to the table, and try to genuinely work together,” Douglas wrote in a March 2021 essay, which he self-published on Twitter, now known as X.
The warfare concerns whether public health groups should recommend vapes and other lower-risk tobacco products to smokers to reduce their risk of cancer, much like nonprofits hand out clean needles to people addicted to opioids to prevent the spread of hepatitis or HIV.
Mainstream public health groups claim tobacco companies are trying to co-opt the term “harm reduction” to sell new products that are themselves addictive, while proponents of harm reduction say public health groups are keeping lifesaving information from smokers all because of their hatred of the industry. The debate has strained decades-long friendships, prompted campaigns to retract articles from scientific journals, and resulted in the ouster of harm-reduction advocates from major professional societies. It’s also spawned ugliness on X, with most of the grenades — accusations of corruption and callousness — thrown by the pro-harm-reduction army.
Douglas is less extreme: He mostly posts polite attempts to call out what he sees as the flaws in anti-vaping research.
Douglas seems like an ideal peacemaker, having spent years at the very organizations that strongly oppose tobacco harm reduction. He says he decided to take his new role — which pays $525,000, according to news reports — because it gives him a bigger platform, and budget, to bring the two sides together, and to disseminate fact-based – rather than ideologically tinged – advice to smokers and their doctors.
That advice is sorely needed: A 2018 survey found that roughly 80% of doctors surveyed believed that nicotine, the addictive substance in vapes and cigarettes, directly contributes to cancer. (Cigarettes contain dozens of carcinogens, but nicotine is not one of them.)
“If we can achieve … strict independence …and then move toward really refashioning the organization with a new face, a new name, new allies, and new opportunities, this is what I’m going to take a risk and do, because it looks to be the best shot by far to try to make progress,” Douglas said.
That’s easier said than done, especially from the perch of an organization running off tobacco money. The only thing more controversial than the concept of tobacco harm reduction is the involvement of tobacco companies in that effort.
Many of the world’s top tobacco control groups — including the American Cancer Society, where Douglas spent five years as vice president of tobacco control — have a formal position against engaging with the foundation. The World Health Organization has pledged not to work with the group as well.
Some are still so skeptical of the foundation’s mission that they urged STAT to completely ignore it, for fear that news stories would give it legitimacy.
“My main piece of advice would be NOT to engage with anyone … nor give them a platform since they would no doubt use it in attempts to persuade the public and experts alike that they (and the tobacco industry) have a key role to play in science,” wrote Tess Legg, a research associate at the University of Bath in the U.K., who has published research analyzing the Foundation for a Smoke-Free World’s scientific activities, which she argues have helped further the tobacco industry’s interests.
Douglas is used to being told he’s idealistic, or just flat-out wrong. He was, after all, one of the first in the country to advocate for smoking bans on planes — a widely accepted policy in 2024 but one that put Douglas, fresh out of law school in 1989, in front of a C-SPAN camera as caller after caller accused him of wanting to “take away more of our freedoms” and of being a “young yuppie blue nose.”
“Having passed my thirtieth birthday I don’t feel very young anymore. I appreciate your comments,” Douglas responded.
But this time Douglas, now 66, has a lot more to lose, and a lot more eyes watching his efforts.
Douglas describes his efforts to extract one final payment, along with a new pledge of independence, from Philip Morris International as a triumph. He tells the story of how a longtime colleague, when he was negotiating the agreement that formally separated the foundation from Philip Morris, told him he would be a hero if he achieved a clean split from the company.
But even public health colleagues sympathetic to his cause acknowledge that he needs to continue to show independence from Philip Morris International.
“If I were giving him advice it would be to demonstrate … your independence by tackling the industry and using what was in the past their money to piss them off a little bit,” said Jonathan Foulds, a professor at Penn State University, who also acknowledged Douglas negotiated the foundation’s independence from PMI.
His efforts to distance the foundation from Philip Morris International have been given mixed reviews thus far. The Campaign for Tobacco-Free Kids, for example, has said it is “ludicrous” for the foundation to be called independent given it continues to operate with funding from the company.
Recently some of Douglas’ longtime allies in tobacco control penned an editorial lamenting they were unable to determine if the foundation is truly independent “because critical details related to … governance, decision-making, and process have not been announced.” Douglas told STAT he continues “to be just a little mystified about exactly what [they] want to see done,” though he says the group is in the process of assembling a group of outside reviewers to help guide the organization’s priorities.
For some, the true test of Douglas’ independence will be if he publicly pressures cigarette companies, and particularly Philip Morris International, to stop selling cigarettes. While PMI has pledged that more than two-thirds of its net revenue will come from smoke-free products by 2030, and a spokesperson tells STAT the company is “well on the way to meeting that goal,” the company still raked in $22 billion in combustible tobacco sales globally last year.
Douglas was reluctant to take advocates up on their challenge to pressure PMI to give up selling cigarettes.
“If they want Cliff Douglas to say I want them to do it, I don’t know what the value of that is,” he said.
Instead, he speaks at length about incentives and the black market that would pop up should PMI or another company simply stop selling cigarettes on any given Tuesday.
“I would like this world to be cigarette-free, let’s get there in ways that are actually achievable,” he said.
He points to the organization’s charitable tax status as a reason why the foundation cannot lobby for public health policies, and he insists he publicly supports policies that hurt the industry but would lower smoking rates — including banning menthol cigarettes and reducing the nicotine in cigarettes to non-addictive levels.
When asked whether tobacco companies, now selling lower-risk products, can be a force for good in the world, he calls them “neutral profit-making corporate entities.”
“Market forces, and public health, and scientific research, and public advocacy, and government health authority regulation can combine to lead the industry to act in ways that benefit public health,” he says.
It all feels like a softening from the Douglas who just a few decades ago was willing to publicly slam the “billionaires in fancy suits who purely out of greed and an attitude of simply caring less for the welfare of the public are perpetuating [smoking].”
Tobacco companies have a history of hiring well-respected health experts to give the industry an aura of legitimacy and then sullying their careers.
It’s a story that dates back to the early days of one of the most effective voices in the fight against cigarette smoking — and Douglas’ former employer — the American Cancer Society.
Before taking a role as the top scientist at the Tobacco Industry Research Committee, the organization synonymous with casting doubt in the 1950s and ’60s on new scientific discoveries finding tobacco smoke causes cancer, C.C. Little was the managing director of the American Society for the Control of Cancer, the precursor to the American Cancer Society.
Little, despite his early enthusiasm for eugenics and euthanasia, was revered in the world of cancer research. And his decision to work for the tobacco industry rippled through the field.
“It seems astonishing to me that a man of his eminence in the field of cancer and genetics would condescend to take a position like that,” wrote surgeon Evarts Ambrose Graham in 1956.
The Foundation for a Smoke-Free World’s first president, former WHO executive Derek Yach, became so ostracized in the field after taking the job that he was banned from attending the WHO’s global tobacco conference in 2018, which was being held in Yach’s birth country of South Africa.
Organization after organization pledged not to work with Yach and the foundation. The World Health Organization announced it would not partner with the foundation, and urged member countries not to as well. The American Cancer Society called it a “continuation of a decades-long effort to paint over tobacco’s role in spreading death and misery around the globe.” Deans from top public health schools, including Harvard and Johns Hopkins, announced they would not take funding from the foundation due to its “close association with an industry and a company whose products have killed millions of people around the world.”
“It was a very sophisticated, well-organized, highly financed effort. I met some of the people brought in by outside agencies to direct themselves against me personally,” said Yach.
Some of Douglas’ critics are already betting he is going down the same path.
“Yach had a long and distinguished career at the WHO and before that in South Africa as a leader in tobacco control and he basically destroyed his reputation. I think Cliff is doing the same,” said Stanton Glantz, a retired researcher from the University of California, San Francisco, who maintains that e-cigarettes carry serious potential health risks.
Even some of his closest supporters worry about his decision. “I think it was courageous,” said Michael Cummings, a professor at the Medical University of South Carolina and a frequent co-author. “I advised Cliff not to do it.”
Cummings added that he feared the move would sully Douglas’ otherwise “stellar” reputation.
Douglas insists his relationship — or lack of a relationship — with the tobacco industry makes his situation different. He points, again and again, to the new agreement with Philip Morris International, which he says forced the company to “throw the money over the wall, turn around, and walk away.”
“No one else took the time or made the effort, especially over a long period of time, to see if they could arrange something that had never been done before,” Douglas said.
The foundation remains somewhat ostracized, he acknowledges, but the situation is improving. He points to a newly announced funding agreement with the Urban Institute, shared first with STAT, which will analyze Medicaid data to help improve access to smoking cessation services for the poor.
“We would not have considered working with this organization before it became fully independent of the tobacco industry,” said Lisa Clemans-Cope, who is leading the Urban Institute’s research funded by Global Action.
To Douglas, the funding agreement is a small but telling example of the progress being made. Others are coming, he insists.
“Folks are rooting for us,” Douglas said. “And [are] waiting for the moment when this journey warms up the water sufficiently, and we can start to have more open [collaboration].”
He’s grateful that opponents have “steered away from at least ad hominem attacks on me.”
“It speaks to their understanding that I, with other experienced colleagues devoted to this, are at least personally legitimate actors,” he said.
The optimism is reminiscent of his final words after nearly eight hours in that Bethesda conference room on Dec. 20, 1994.
Philip Morris’ lawyer demanded to know if Douglas ever lost hope that the story he had dedicated years to — the one that led to the FDA finally regulating cigarettes — would air.
“Sir,” Douglas said. “I never lose hope.”
STAT’s coverage of chronic health issues is supported by a grant from Bloomberg Philanthropies. Our financial supporters are not involved in any decisions about our journalism.