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A Question of Intent : A Great American Battle With A Deadly Industry Hardcover – January 9, 2001


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Product Details

  • Hardcover: 400 pages
  • Publisher: PublicAffairs; 1st edition (January 9, 2001)
  • Language: English
  • ISBN-10: 1891620800
  • ISBN-13: 978-1891620805
  • Product Dimensions: 9.6 x 6.5 x 1.7 inches
  • Shipping Weight: 2 pounds
  • Average Customer Review: 4.6 out of 5 stars  See all reviews (40 customer reviews)
  • Amazon Best Sellers Rank: #731,101 in Books (See Top 100 in Books)

Editorial Reviews

Amazon.com Review

This is the David-and-Goliath story of how an American bureaucrat took on the tobacco industry--and helped topple it. David Kessler, head of the Food and Drug Administration for seven years under Presidents Bush and Clinton, earned the nickname "Eliot Knessler" from The Washington Post--a pun meant to evoke the memory of the Prohibition-era gangbuster--because he rejuvenated a moribund agency. The FDA regulated, in Kessler's words, "one quarter of every dollar Americans spent--from the food they eat to the drugs they take to the cosmetics they wear." Yet it lacked the courage to take on the country's most lethal product: cigarettes. So did Kessler, at least initially. He agreed with aides and others that Big Tobacco was too powerful a force in Washington, D.C. "The industry perceived threats everywhere, and responded to them ferociously," he writes. Moreover, challenging the industry would waste important resources that could have a more tangible benefit for consumers if they were spent elsewhere. Even before making the choice to go after cigarettes, Kessler was a figure of controversy, and this only intensified when he became one of the few Republican holdovers in the Clinton administration.

Much of the book deals with the routine business of the FDA: orange-juice seizures, a fight to restrict the sale of body tissues from foreign sources, how he responded to complaints that syringes were found in Pepsi cans, and so on. But the driving force behind Kessler's narrative is how he slowly woke up to the possibility of regulating cigarettes. "It is too easy to be swayed by the argument that tobacco is a legal product and should be treated like any other," he writes. "A product that kills people--when used as intended--is different. No one should be allowed to make a profit from that." His story is a lesson in Washington power politics--a game he played with naiveté when he started but was expert at by the end of his tenure.

To say Kessler and his team of FDA regulators "defeated" Big Tobacco is an overstatement: they were part of a broader effort that included trial lawyers, consumer groups, and crusading journalists, and the industry hasn't exactly gone away. But they were instrumental in forcing tobacco companies to admit that nicotine is addictive and cigarettes cause cancer, and in bringing about a sea change in the industry's legal and popular standing. Kessler now believes in regulation so tight it will strangle Big Tobacco forever: "If our goal is to halt this manmade epidemic," he writes, "the tobacco industry, as currently configured, needs to be dismantled." A Question of Intent is a well-told muckraker. It unfolds deliberately, like a good detective story. Admirers of Jonathan Harr's A Civil Action, especially those with a taste for public policy, won't be disappointed. --John J. Miller

From Publishers Weekly

"My understanding of the industry's power finally forced me to see that... the solution to the smoking problem rests with the bottom line, prohibiting the tobacco companies from continuing to reap profits from the sale of a deadly addictive drug.... " These strong words from Kessler, now dean of the Yale University School of Medicine and commissioner of the U.S. Food and Drug Administration from 1990 to 1997, testify to his commitment to regulating tobacco, as well as to the frustration involved in taking on the powerful tobacco industry. In understated, lucid language, he details how his interest in smoking as a public health issue grew into a full-scale investigation into the practices of the tobacco industry. Drawing on legal and scientific research and the notes he kept during his terms as commissioner, Kessler documents how the team he assembled built a case that implicated the industry in nicotine manipulation that increased the addictiveness of cigarettes. With the assistance of informants like Jeffrey Wigand, a former Brown and Williamson researcher and subject of the film The Insider, the team learned about genetically altered plants created to produce higher nicotine levels. Kessler indicts the tobacco industry for lying to Congress and the public about these activities, denying the strong relationship between smoking and lung cancer and launching ad campaigns to encourage smoking, particularly among children. With the backing of Vice-President Al Gore, the FDA issued regulations to curb smoking that were eventually overturned by a 5-4 Supreme Court decision in early 2000. This is an important study of the influence of big tobacco and the high cost to the public health of the nation that smoking has caused.

Copyright 2001 Cahners Business Information, Inc.


More About the Author

DAVID A. KESSLER, MD, served as commissioner of the US Food and Drug Administration under presidents George H. W. Bush and Bill Clinton. He is a pediatrician and has been the dean of the medical schools at Yale and the University of California, San Francisco. A graduate of Amherst College, the University of Chicago Law School, and Harvard Medical School, Dr. Kessler is the father of two and lives with his wife in California.

Customer Reviews

Thank you, Dr. Kessler, for pursuing the tobacco dragon and for writing this book.
Scott Babcock
The travail involved in getting tobacco executives to admit what everyone else knew to be true should frighten every reader about what "authorities" tell us.
wildbill
This is a great read and entirely worth buying in hardcover.... Please buy this book....
J. Michael Showalter

Most Helpful Customer Reviews

22 of 22 people found the following review helpful By J. Michael Showalter on April 8, 2001
Format: Hardcover
It's funny that when I purchased this book, I never really suspected that it would be quite the page-turner that it is. In this book, David Kessler (former head of the FDA) speaks first of his agency's enlightenment that it COULD and SHOULD fight Big Tobacco and then of the fight itself. This is gripping and compelling a story that public policy has to offer: it's hard to remember that ten years ago, the tobacco industry still held that nicotine a)was not addictive and b)did not cause cancer; this book shows how these myths were finally put to bed in the public sphere. Second, this is a neat story. Kessler has much more of a knack for putting words down on a page than one would expect for a medical doctor (perhaps his wife, whom he declares was a fan of Anthony Trollope, rubbed off on him!) He puts together a story that is worthy of John Grisham; seeing that Erin Brockovich became one of the big pictures of the past twelve months, this fella might have something going for himself here....
Setting all of these aside, this book has something to offer for people interested in how the American political system works. In much the same way as books like 'Boomerang!' chronicled the downfall of the centrally-funded health care system also circa the early Clinton-era, this book deals with one of the great succeses (or a part thereof) of the same period. This is a great read and entirely worth buying in hardcover....
Please buy this book....
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20 of 22 people found the following review helpful By A Customer on January 10, 2001
Format: Hardcover
This is a wonderful book that should appeal to tobacco warriors and the general public alike. It reads like a novel, yet its copiously documented throughout.. It will be equally at home on your coffee table and as required reading in graduate schools of public poicy.
Whether you agree with what David Kessler did or you don't, the message here goes far beyond tobacco. At a time when there is a feeling that government no longer matters, this book shows how a small group of people,in one government agency,led by a leader who believed deeply in the law and his cause, can make a difference..
That Kessler's tobacco war ended in defeat with a 5 to 4 vote in the Supreme Court provides an eery parallell to recent events. But no one felt good about the election mess in Florida. Most Americans, liberal or concervative, will feel pretty good when they finish this book. It shows that leadership can still make a difference and that our government can still matter.
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19 of 21 people found the following review helpful By A Customer on January 11, 2001
Format: Hardcover
A great read, one of those books that justly deserves to be called a page-turner. If any doubt remained about the character of the tobacco industry and the damage it inflicts, A Question of Intent lays it to rest. Funding volunteer firefighters who then make public statements downplaying the risk of cigarettes as a source of fire? Adding chocolate to tobacco because when burned it gives off a chemical that may make it easier to inhale? Identifying Islamic religious leaders who oppose an interpretation of the Qur'an that would lead to a ban on tobacco use? Who knew?
But this is no predictable polemic, far from it. It's more like a detective story, with shrouded informants, driven investigators, and the pursuit of long-shot leads and buried clues. David Kessler comes across as agile, self-effacing, and very smart, with a surprisingly ironic sense of humor. A Question of Intent is about more than tobacco. It is also about the education of a political neophyte and an insider's look at Washington -- that messy, unseemly place where someone with vision, commitment and wiles can still make a difference.
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9 of 9 people found the following review helpful By David Elsasser on March 9, 2001
Format: Hardcover
I've always been a little suspicious of the anti-tobacco crowd -- it seemed a bit Puritanical, a bit holier-than-thou -- so I admit to approaching A Question of Intent with a chip on my shoulder. By the time I had raced through this book -- which literally kept me reading through the night -- my view had changed dramatically. Like many Americans, I had bought into the myths created by the tobacco industry to protect its own vast profits. My perspective had been almost painfully naïve. There's nothing inherently glamorous about holding a smoking stick, but the industry's aggressive and long-lasting public relations campaigns have somehow convinced us that there is. The argument that people smoke of their own free will is unsupportable when the industry works to addict the nation's children, but we've allowed rhetoric to persuade us otherwise.
The FDA's efforts to bring this industry into line through commonsense regulations that carefully avoid the taint of Prohibition are chronicled here, with the author revealing a deft touch for detail, a strategic mind worthy of Bismarck, and no small degree of humor. And the decision by the Supreme Court to undercut Kessler's effort (the same five judges who voted to defeat the FDA's tobacco initiative also made that dead-of-night decision to cheat Al Gore of a fair election count) will surely go down in the history books as a great opportunity squandered. Rather than showing the courage to change public health forever, the Court chose to bolster the profit margins of an industrial killer. That's something we should all remember next time we go to the polls.
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