Much of Yergin's testimony involved detailed questions about what he suspected about Carter's diagnosis, when he made the diagnosis, what Carter believed and what Yergin told Carter when. The reason for this is that the statute of limitations is four years, and Carter's suit was not filed until four years and two days after his first visit to Yergin. The plaintiff contends the diagnosis of cancer was not made until February 14, 1991. The defense says Carter knew he had cancer no later than February 5.
Carter brought an x-ray with him that revealed a large lesion in the upper left lobe of his lung. This lesion most likely was cancer, but might have been tuberculosis or pneumonia.
Yergin scheduled follow up tests for Carter. On February 12, he did a bronchoscopy and biopsied Carter's lung. A few days later, the pathology report confirmed lung cancer. Carter was told of the diagnosis on February 14.
Yergin scheduled Carter for a bone scan because there was some indication the cancer might have spread to Carter's lymph nodes and bones. The bone scan was negative.
Yergin also followed Carter after (but did not perform) the surgery which removed the entire left lobe of his lung.
Since the surgery, Carter has been cancer-free. There is however a possibility that a new lesion could appear. Yergin said Carter should have follow-up doctor visits every 2-3 months, an annual lung x-ray, and a Cat scan every 2-3 years. The cost of follow-up treatment will be several thousand dollars a year.
Since the surgery, Carter has had one CAT scan. Carter also suffers from mild chronic obstructive pulmonary disease (COPD), chronic bronchitis and/or emphysema -- other smoking-related diseases. Yergin said the lung cancer and COPD were caused by smoking.
Carter smoked from 1947 to 1991. He changed brands in 1972. Yergin testified that Carter's smoking of Lucky Strikes from 1947-72 was a substantial contributing factor to his lung disease, but acknowledged the later smoking also contributed.
The doctor conceded there is no way to tell whether Carter would or would not have gotten cancer if he had quit smoking in any particular year. The plaintiffs cancer could have begun in 1982, but Yergin said it was not likely. Some of the literature suggests most human malignancies originate less than two years before diagnosis, but other sources estimate much longer times. The growth of cancer is affected by a number of factors and it can remain latent for long periods.
Smoking can be an addiction, Yergin said. Although most of his patients would like to quit, only 10-20 percent are successful.
July 25
Robert K. Heimann, the former CEO of American Tobacco, testified in a 1986 video deposition that he was aware of various studies linking smoking and cancer in the 1960s and 1970s. Heimann admitted that the company did not warn consumers of the risk of addiction or potential health consequences, and acknowledged that it continued to try to attract new smokers through its advertising and other promotional activities. He conceded the company wanted people to believe smoking was not injurious to health, and insisted that is his belief. He maintained that literature attributing cancer to smoking is wrong --"a reprehensible propaganda campaign based on spurious statistics" -- but admitted a statistical association. He acknowledged that the company conducted no studies of its own.
The jury then heard the deposition testimony of Robert S. Sprinkle III, a chemist who held various positions at American Tobacco before leaving the company as executive vice-president for research.
In the early 1960s, Sprinkle did a chemical analysis of tobacco smoke, and the company conducted studies of the components of tar in the late 1980s or early 1990s. The findings were not made public and the company made no effort to determine whether the constituent compounds of the smoke were addictive or presented human health risks. He first became aware of scientific evidence that nicotine was addictive at the time of the Surgeon General's report in 1964.
The various types of tobacco and each lot of tobacco contains different amounts of nicotine. Sprinkle acknowledged that the company monitored the nicotine levels in its tobacco and controlled the amount of nicotine in its cigarettes by adjusting the tobacco blend used in manufacturing them. He was aware of the company's nicotine fortification of reconstituted tobacco, but did not know where the company obtained nicotine to add.
Sprinkle maintained the causes of heart disease and cancer are unknown, but stated his belief that neither is caused by cigarette smoking.
Dr. Alan Feingold, the Chief of Pulmonary Medicine at South Florida Hospital, treats lung cancer patients on a daily basis. He also previously worked on asbestos cases with plaintiff's attorney Norwood Wilner and co-authored a book with him on the medical/legal issues relating to asbestos.
He has studied the health effects of smoking for 20 years and is testifying for free because he considers it his responsibility to his patients and his community.
Feingold labeled smoking the public health issue of the century and stated that smokers are addicts, unable to rationally evaluate their habit and compelled to smoke by the chemical alterations in their brains.
Feingold said lung cancer was practically unheard of prior to the 1920s. During that decade, he said, people began to see a marked increase in the disease among smokers. The incidence of lung cancer has increased since in a "straight upward line."
The currently accepted figure of 90 percent of lung cancers caused by cigarette smoking was first published in 1936 in the Journal of the American Medical Association. By 1939, a medical article reported that there was "ample evidence" that tobacco contained addictive drugs. At that point, Feingold said the tobacco industry should have begun its own research and warned consumers of the risk -- "before people were trapped."
Animal studies of the health effects of smoking were conducted in the 1940s. Feingold said that by 1941, when the epidemic had just begun, there was a definite conviction that the increase in lung cancer was due to cigarette smoking. "In 1941, people had figured this whole thing out," he said.
He insisted that lung cancer is entirely man-made and the tobacco companies had an overwhelming duty to warn consumers starting in the 1940s.
Feingold's testimony continued to detail studies through the 1950s that confirmed the causal relationship between smoking and cancer and the addictive properties of nicotine and that documented the increasing number of lung cancer deaths. He suggested that the tobacco companies were "criminal" in their efforts to refute the medical evidence.
July 26
Dr. Alan Feingold continued to testify about the addictive properties of nicotine.
He elaborated on seven properties of addictive substances -- a psychoactive effect that controls behavior of the user, compulsive use, reinforcing effect, tolerance, dependence, withdrawal and tendency to relapse -- and testified that nicotine produces all seven.
Psychoactive effect: Feingold testified that nicotine use actually causes the creation of special receptors the brain -- the greater the exposure, the more receptors develop -- and these receptors cause a craving for more nicotine.
Compulsive use: The witness noted that people go out in freezing temperatures in the middle of the night to buy cigarettes and opined that smokers, like heroin addicts, would steal if necessary to supply their habit, except that cigarettes are legal and relatively inexpensive.
Reinforcing effect: Nicotine use supplies a pleasurable sensation and stress relief. The witness describes smoking as crack nicotine or free-basing nicotine.
Tolerance: Like other drugs, use of nicotine tends to increase over time. The longer the user is exposed to the drug, the greater the doses he requires.
Dependence: The witness notes the spectacle of smokers trooping outside the building at regular intervals for a nicotine fix and to the fact that smokers have their first cigarette within a half hour of waking--the need to "feed those angry nicotine receptors."
Withdrawal: Smoking cessation produces physical withdrawal symptoms.
Relapse: Only about 25 percent of smokers are successful in their efforts to stop smoking after one year, and the success rate drops to 5-10 percent after five years. Most smokers relapse several times before they are able to stop.
Feingold also disputed the scientific accuracy of a series of American Tobacco Co. press releases from the 1950s and 1960s. He went so far as to characterize them as "criminal lies that caused all these deaths ... that caused Grady Carter's cancer."
He specifically disputed suggestions in the releases that there was scientific information casting doubt on the link between smoking and cancer or that more research is needed to determine whether cigarettes cause cancer.
The 1964 Surgeon General's Report concluded that cigarette smoking was not addictive but a habit supported by pharmacological effect. Nicotine was declared an addictive drug in the 1988 report by Surgeon General C. Everett Koop.
And in a victory for the plaintiff, the trial judge ruled that 21 internal Brown & Williamson documents were relevant and could be introduced into evidence during the trial.
The documents include communications from 1963 regarding the advisability of producing research reports, apparently produced by American Tobaccos British parent, to the Surgeon General and the decision not to do so unless a specific request were made.
The documents from 1963 and 1965 also refer to British research confirmation of the "weak carcinogenic effect of smoke, and a research report on the implications regarding cardiovascular disorders. There are also references to an effort to find ways of obtaining "maximum nicotine for minimum tar."
July 29
The direct examination of Dr. Alan Feingold concluded with a review of a number of the Brown & Williamson documents. These documents appear to reflect recognition at B&W, beginning in the early 1960s, of the addictive qualities and carcinogenic effect of cigarettes, as well as the existence of company-sponsored research, during the same period, aimed at developing a safer product.
The cross-examination of the witness began with a review of scientific literature, dating from the 1940s and 1950s, that appeared to refute Feingold's contention that there was consensus in the scientific community by 1953 that smoking caused lung cancer.
Feingold testified that he became aware of the B&W documents when the Journal of the American Medical Association published a special edition on them in July 1995. Feingold testified he informed attorney Norwood Wilner about the existence of the documents. The witness testified he then read The Cigarette Papers, a book on the documents published by a professor at the University of California at San Francisco, and obtained and reviewed the documents.
The documents, according to the witness, reflect research, performed in Europe by Battelle but sponsored by British American Tobacco, the parent company of B&W, as well as research performed by BAT at its own research facility near London.
Feingold testified the documents indicate that B&W knew, prior to 1964, that cigarettes were addictive and carcinogenic and that research sponsored by them was years ahead of the rest of the scientific community in understanding the mechanism of nicotine addiction.
The documents also reflect, Feingold testified, that B&W made a calculated decision not to make this information known to the Surgeon Generals committee. In the witness' opinion, the 1964 Surgeon Generals Report would have been very different had the Battelle research been made available to the committee.
Other documents, according to the testimony, reflect BAT animal studies in the mid-1960s establishing the carcinogenic properties of cigarette tars and awareness by BAT scientists that the last third of a cigarette delivers an increased dose of carcinogenic elements.
Feingold said the documents establish that -- contrary to its public pronouncements -- B&W had biological as well as statistical evidence that cigarette smoking caused cancer. The companies knowledge was not revealed until 1995.
According to Feingold, the documents also show that in the early 1960s Battelle was working on filters to remove carcinogenic elements from cigarette smoke and that by the late 1960s the company had developed and patented an almost smokeless cigarette. Work also was being done at this time on a non-inhalable cigarette. Each of these products would have reduced the risks of smoking, Feingold testified, but none were ever marketed.
Feingold offered the opinion that the cigarette warning adopted by Congress in 1966 -- "may be hazardous to your health"-- was grossly inadequate, and he suggested that the warning would have been stronger had B&W's knowledge not been concealed from the Surgeon General, Congress and the scientific community.
Feingold also testified that Grady Carter's cancer was not diagnosed until after the February 12, 1991, bronchoscopy, and that Carter's current life expectancy is reduced from 81 to 75 years simply because he smoked. Feingold also testified that Carter, now 67, has an even shorter life expectancy because he had lung cancer and that his smoking prior to 1972 played a greater role in his disease than his later smoking.
Under cross-examination, Feingold admitted he was aware, but did not point out to the jury on direct examination, that in 1948 -- the year Carter started smoking -- that two scientists published seven articles questioning their 1941 conclusion -- which he had brought to the jury's attention -- that there was proof of an association between cigarette smoking and lung cancer.
The witness defended the omission by insisting that the scientists were right in 1941, by suggesting that a co-author on some of the later papers may have been responsible for the repudiation of the earlier conclusion, and by noting that the later articles were focused on treatment while the former was specifically addressed to cause.
Defense attorney Bruce Sheffler also confronted Feingold with statements and articles dating from the 1940s and 1950s by reputable scientists that the causes of lung cancer were unknown, that the association between smoking and cancer was doubtful, and that there was no evidence upon which to base a recommendation to give up smoking.
Feingold responded that there were dozens of studies, some right some wrong, and he questioned the good faith of some of the authors. He continued to vehemently insist that, at that time, there was no controversy about the relationship between smoking and cancer and that there could have been no doubt after 1953 that smoking caused lung cancer.
Sheffler also brought out that the witness is not being compensated by the plaintiff in this case. But Feingold charged B&W $7,000 for his deposition, he earned $2.5 million testifying on behalf of asbestos companies in cases handled by plaintiff's attorney Wilner over the last 10 or 15 years, and he is aware Wilner has a large number of pending tobacco cases.
July 30
The defense confronted Dr. Alan Feingold with evidence of a continuing dispute in the scientific community, throughout the 1950s, about the association between lung cancer and smoking.
Defense attorney Bruce Sheffler also confronted Feingold with a number of mass-circulation, national publications from the 1950s that reflected prominent coverage of concerns about smoking and health, suggesting that the American public was well aware of the risks.
The defense also suggested that the type of cancer suffered by Grady Carter may be less likely to result from smoking than other varieties of lung cancer, that nicotine addiction differs from and is more controllable than addiction to narcotics, and that the Brown & Williamson documents offered by the plaintiff had been taken out of context and/or misinterpreted.
The defense played a 1955 tape of a television address by the director of the National Cancer Institute stating that although cancer risk was greater for smokers, scientists were divided about whether smoking was the cause of the disease.
Feingold replied that while opinions among doctors may have differed, the facts all supported the causal link between cigarette smoking and lung cancer and that contrary opinions were therefore fanciful.
Feingold continued to insist that the evidence, by 1955, was overwhelming, that the failure of the public health agencies to accept it and to warn the American public was "sad" or "stupid" or corrupt.
Confronted with a series of articles in the popular, national press, dating from the 1950s, that revealed concerns about smoking and disease and that reflected the opportunity to reduce risk by smoking cessation, Feingold countered that public appreciation of the problem was obscured by tobacco advertising and by misinformation disseminated by the industry.
Feingold also asserted that statements by the American Medical Association on the subject were suspect because the organization had accepted $15 million from the tobacco industry. Sheffler insisted that the money funded a research project on chronic disease involving not only the AMA but also the National Cancer Institute, the Public Health Service, and the American Heart Association, but the witness countered that the project was a sham and a boondoggle which produced no research of value.
Feingold dismissed defense suggestions that carcinogens are present in greater quantity in auto exhaust and in food than in cigarette smoke, noting that few people smoke an automobile tailpipe and that food is ingested not inhaled.
The witness also dismissed the suggestions that diet and exercise may have a greater impact on human health than smoking, that smokers who quit can ever reduce their cancer risk to the level of a never-smoker, and that Carter has had greater success controlling his nicotine habit than his diet.
Sheffleršs cross-examination bogged down for part of the day in dense, highly scientific questions relating to the specifics of Carteršs disease and theories about the development of various types of lung cancers. The point appeared to be that there is some question about the relationship between smoking and the particular type of cancer suffered by Carter. Feingold would have none of it.
Feingold also gave no quarter on the suggestion that nicotine addiction is of a lesser sort than other addictions.
Sheffler offered other examples of Brown & Williamson internal documents that he suggested gave a different perspective that the one discussed during Feingold's direct testimony. The defense lawyer also suggested that the documents reflect that research B&W decided not to turn over to the Surgeon General was considered to be highly favorable to the company and was withheld because it was incomplete and B&W wanted to avoid charges that it was trying to propagandize the Surgeon General's Committee. Needless to say, Feingold remained adamant that the documents reveal a conspiracy.
July 31
Dr. Alan Feingold acknowledged that some doctors were saying in the 1940s and 1950s that they didnšt believe smoking and cancer were linked, but he disputed that there can be a scientific controversy without data on both sides. He said there was never any evidence to cast doubt on the link and the evidence supporting the relationship between smoking and lung cancer just continued to grow.
Even if there had been a true scientific controversy, Feingold believes the tobacco companies had a huge responsibility to determine the truth and a duty to warn smokers.
The witness testified that at the same time the press was trying to report on the mounting evidence of health risks from smoking, the tobacco companies were undercutting the message with skillful advertising campaigns and misleading statements.
Feingold testified that there were reductions in cigarette use following the initial publicity about increased death rates for smokers. Then an increase -- in response, he claimed, to a vigorous advertising campaign by the tobacco companies. With another decrease at the time of the Surgeon Generalšs 1964 report, followed by a slight increase and then a decline with the introduction of warning labels.
The witness testified that there are many carcinogens in cigarette smoke, and that the smokeršs body is exposed to these chemicals both through direct contact with the lung and through the metabolic process. Some of the worst carcinogens, he said are produced by the combustion of nicotine.
Feingold testified that there are cancer "hot spots" -- locales which have an usually high incidence of certain cancers and that Jacksonville has a high incidence of lung cancer. He attributed this to asbestos exposure at ship yards and paper mills. Asbestos causes lung cancer in conjunction with smoking.
If Grady Carter stopped smoking in 1972, his cancer risk would drop, but not disappear. If he started smoking in 1972, however, his cancer risk would not be substantial until he reached his 90s, so he probably wouldnšt live long enough to get the disease. Therefore the witness concluded that Carteršs smoking of Lucky Strikes was a greater contributing cause of his smoking than his later smoking.
Grady Carter testified about growing up on a Georgia farm which grew tobacco before moving to Jacksonville when he was 13 years old. He began working for the FAA as an air-traffic controller in 1956, and retired in 1990 as a manager.
Carter smoked his first cigarette in 1947, the year he turned 17. He smoked unfiltered Lucky Strikes until he switched to Tarryton for the charcoal filter in 1972. He quit smoking on January 29, 1991.
Carter initially smoked about a half pack a day, built up to a pack a day, then to a pack and a half by the end of the 1950s. He doesnšt recall ever smoking more than about a pack and a half a day of Lucky Strikes.
The plaintiff became aware of the risks of smoking in the 1960s and by the early 1970s was concerned about the risks. He was somewhat reassured, however, by tobacco company statements that the incriminating research was flawed and that cigarettes were being unfairly criticized.
Beginning in the 1960s, Carter tried repeatedly to quit smoking. Without cigarettes, however, he felt miserable and couldnšt concentrate. He tried switching to a pipe or cigars and quitting cold turkey, using Bantron, using graduated filters and using a special watch. All were unsuccessful. When his second wife became ill, she was advised to quit and she and Carter both tried. Neither succeeded.
In the 1980s Carter went through a nicotine withdrawal clinic, at a cost of more than $150. He received a series of 6-12 injections and took off a week from work because he couldnšt function. He was lethargic and nervous. The day he went back to work he was given some cigarette samples and started smoking again.
Carter also tried unsuccessfully to quit smoking with hypnosis and Nicorette gum.
In late January 1991, Carter began spitting up blood. He was afraid he had lung cancer or tuberculosis. He saw his doctor on February 4, and had a chest X-ray. His doctor then referred him to Dr. Bruce Yergin.
Yergin first saw Carter on February 5, and ordered various tests including a bronchoscopy, which was performed on February 12, 1991. Two days later, Yergin told him he had cancer. On February 25, Carter had surgery to remove the upper left lobe of his lung.
Carter had stopped smoking before he went to see Yergin, and Yergin gave him a new prescription for Nicorette. Carter said he still uses the nicotine gum to help him not smoke.
Carter now leads a relatively normal life. There has been no recurrence of his cancer, and he has been told that chances of recurrence from the original disease are slim. He remains fearful, however, and he suffers from chronic obstructive pulmonary disease and mild emphysema.
In 1947, Carter was totally unaware that smoking could cause harm of any kind or that he might have trouble quitting.
Carter said he was motivated to sue when he saw the 1994 congressional testimony of tobacco executives continuing to deny that nicotine is an addictive drug. Carter wants to be compensated for the loss of his lung and the misery he has suffered. He believes he is responsible for buying cigarettes and smoking them, but that American Tobacco is responsible for not telling him what they knew.
On cross-examination, Carter said he liked the taste of cigarettes and sometimes used them as a reward.
He read various publications in the 1950s but doesnšt recall whether or not he read specific articles about health risks of smoking.
Carter became aware of the surgeon generalšs findings around the time labels appeared on cigarette packages in 1966, and he was aware that tobacco ads were taken off TV because of health concerns.
Carter said he recalled reading about Dr. C. Everett Koopšs report in the 1980s. Carter also recalled seeing television spots made by Hamilton Berger and Yul Brenner for the American Cancer Society.
Carter knew that smoking was risky and knew that less tar and nicotine was better than more.
He said his wife and son urged him to quit smoking, but he kept making excuses. He could have declined to smoke again after he stopped for a week. He wanted to smoke because he felt so miserable when he didnšt. He was aware one in three smokers dies of smoking related disease, but he was not motivated to quit. He was such a compulsive smoker that it did not matter what anybody said to him.
August 1
Grady Carter completed his testimony, claiming that he was aware of information about health risks related to smoking but also knew that tobacco companies disputed that information. He said he was motivated to quit many times. But whenever he tried, he felt miserable and sick. At the time, he didn't know what was happening, he said. Now he understands that he was in withdrawal.
Mildred Carter, testified that her husband Grady's smoking caused problems in their marriage. He promised to quit but couldn't, she said. The couple learned of Grady's lung cancer on Valentine's Day of 1991 and believed he had been handed a death sentence.
Following the surgery, Grady Carter was in considerable pain, she said. For the rest of their lives, she said she and her husband will live in fear of a recurrence of the cancer. Following her testimony, the plaintiff rested.
The defense made a motion for a directed verdict on the grounds that the plaintiff's claim was brought too late and had failed to prove a product defect.
The plaintiff's complaint was filed less than four years after he was diagnosed his lung cancer on Feb. 14, 1991. But the defense argued that Carter knew of his condition earlier, when he began spitting up blood.
The defense also argued that the plaintiff had failed to prove defective design because no alternative design would have prevented Carter's injury.
The motion was denied.
The defense's first witness, Dr. Peter O'Hanley, an epidemiologist, testified that it is impossible, given the current state of scientific knowledge, to determine the cause of Grady Carter's lung cancer.
O'Hanley agrees with the surgeon general's findings of an association between smoking and cancer. But he claims that the cause of Carter's cancer cannot be determined until more is known about the mechanism of the disease.
Under cross-examination, O'Hanley insisted that the cause of any particular cancer will be unknown until science understands the disease well enough to design objective tests for cause. However, he acknowledged that he cannot say smoking did not cause Carter's cancer.
August 2
The defendant's first expert, epidemiologist Peter O'Hanley, admitted under cross-examination that smokers face serious health problems, and that he teaches physicians to get their patients to quit, even if the precise mechanism of smoking-related disease is not known.
O'Hanley admitted that he is not an expert in malignancy or in the causation of cancer. He is not an expert in what caused Grady Carter's cancer.
He said he is aware of literature suggesting that a transversion-type change at one specific location on the human gene has been associated with exposure to one of the carcinogens -- benzo(a)pyrene -- found in cigarette smoke, while a transition-type mutation at the same location is believed to be a spontaneous mutation. He is not aware, however, of literature suggesting that the transition-type mutation at that location -- found in tissue from Carter's tumor -- has been linked to a different carcinogen--nicotine-specific nitrosamines-- found in cigarette smoke.
On re-direct examination, O'Hanley testified that mutation of a particular gene does not establish cause, and that we do not yet know whether cancer causes genetic mutation or whether genetic mutation causes cancer.
The witness was asked about the specifics of the article linking nicotine-specific nitrosamines to the particular transition mutation discussed on cross-examination. He acknowledged that the study involved nicotine injected into mice to test a theory about deep-inhalation of low-yield filtered cigarettes.
O'Hanley asserted that the 1964 Surgeon General's report used the word "cause" in a epidemiological sense and recognizes that statistical analysis cannot be applied to determine cause in an individual patient.
Additional portions of the deposition of Dr. Robert Sprinkle, former vice president for research and development at American Tobacco, then were read by the defense to establish attempts by American Tobacco to develop a safer cigarette. Sprinkle also testified that American Tobacco funded independent medical research on smoking and health.
The second defense witness, Dr. Gary Pearl, a pathologist, testified that the type of lung cancer suffered by Carter is not associated with smoking.
He described the cellular structure of various parts of the human lung, He also described the four major types of lung cancers and their development. Pearl stated that the type of cancer suffered by Carter, peripheral adenocarcinoma, is not associated with smoking.
On cross-examination, attorney Norwood Wilner established that the witness is not an expert in smoking-related disease and that he has never before given his opinion on whether smoking causes a particular disease.
Pearl also acknowledged that his conclusion about Carter's cancer is based on the assumption that only one type of lung cell is affected by cigarette smoke. Pearl agreed that smokers have a 2,236 percent greater risk of lung cancer than non-smokers and that 90 percent of all lung cancer is attributable to smoking.
The witness admitted that he can't say Carter's cancer is not due to smoking -- he cannot say either way. He insisted however that while central tumors are clearly associated with smoking that the association is not as clear with peripheral tumors, because inhaled carcinogens do not have the same direct contact with the peripheral cells.
Pearl said he doesn't know whether carcinogens in cigarette smoke enter the blood stream, but that would be an important fact in determining the mechanism of a non-airway -- or peripheral -- tumor.
August 5
A psychiatrist testified that Grady Carter could have quit smoking at any time but was not motivated to do so until 1991.
Dr. John Thompson also testified that he had reviewed a document relating to the Battelle study on nicotine and addiction. In his opinion, knowledge of that study would not have changed the Surgeon General's conclusion in 1964 that nicotine was not addictive. Addiction is not a scientifically precise term now, Thompson testified. In 1964, the definition included a requirement of chronic intoxication which made it more specific. The expansion of the concept of addiction to include dependence, according to the witness, has blurred the distinction between addiction and habituation.
The symptoms Carter attributed to withdrawal may have been anger at pressure to quit from his wife or frustration, rather than true withdrawal, Thompson testified.
Thompson said Carter smoked for as long as he wanted to smoke, quit when he wanted to quit, that is when he spit up blood and the risk became personalized to him. Before that, Thompson testified, Carter believed he'd be one of the lucky ones that smoking-related illness would never happen to him. In his opinion, Carter was not dependent on nicotine, he was habituated not addicted.
In his opinion, Carter was aware of the risks of smoking and did not want to hear additional information and was not ready to act. Thompson testified that Carter's decision to smoke despite the risk was similar to other decisions he made -- to fly a plane, ride motorcycles or fail to change his diet despite his doctor's advice.
On cross-examination, Thompson conceded he is not an expert in the pharmacology of nicotine and has not read the Journal of the American Medical Association or Brown & Williamson documents.
August 6
The plaintiff continued its cross-examination of Dr. John Thompson who said he believes no one is addicted to nicotine because no one is chronically intoxicated by nicotine. People do not have the same difficulties with nicotine as with other drugs, he added.
The witness admittedly prefers the 1964 Surgeon General's approach to the question of addiction--which excludes nicotine -- to the approach taken in the 1988 Surgeon General's report, and in the DSM IV which focuses on dependency and includes nicotine.
Although Thompson considers the quantity of drug use important in treating his patients, he made no effort to determine Carter's nicotine intake. His evaluation of Carter is based on behavioral factors -- that Carter enjoyed smoking and continued to function at a high level.
The witness admitted he is not an expert in pharmacology and acknowledged that the pharmacological effect of nicotine in the brain is a factor to be considered. Nevertheless, he insisted that the pharmacological effect does not override the ability of someone to stop smoking if they really want to.
Thompson does not accept that nicotine produces compulsive use, rather he believes it is characterized by ''urges.''
The witness admitted he is not aware of the Food & Drug Administration's proposed rule asserting jurisdiction over nicotine. He testified he believes nicotine is already regulated.
The witness stated that with repeated attempts, many people are able to quit smoking for a year, and that he therefore does not consider there to be a dramatic failure rate for smoking cessation. He agreed that it is difficult for people to quit smoking but pointed out that many people also have difficulty controlling their diets.
Thompson insisted that in his opinion, no warning would have affected Carter's smoking -- that Carter failed to heed the personal warnings from his wife, son and friends. He stated that the risks of smoking were common knowledge in the 1940s and 1950s, but he admitted he is not aware of what information was being disseminated by the tobacco companies at that time.
The defense then introduced deposition testimony from Carter's step-daughter Wendy Lenninger. She said Carter and her warned her about the health risks of smoking. They knew it was bad for their health and would talk about quitting but never did much about it.
August 7
The defense rested after reading portions of the deposition of Grady Carter. In rebuttal, Carter's lawyers introduced a tape of 1950s-era television ads for various brands of cigarettes.
In concluding its case, the defense introduced Carter's deposition testimony in which he admitted becoming aware of the Surgeon General's report around the time that warnings were placed on cigarette packs. Carter stated he was aware that the report linked smoking to cancer, heart disease and stroke.
The plaintiff read additional portions of the deposition in which Carter said he doubted the Surgeon General's report because the tobacco companies said it was wrong.
The plaintiff played a compilation of cigarette ads from the 1950s featuring endorsements by Ronald Reagan, Lucille Ball, the Flintstones and other celebrities, along with claims that cigarettes were healthful.
August 8
After closing arguments and instructions to the jury, deliberations began at about 2:30pm ET.