The concept of 'donor fatigue' is well known to most of us—charitable agencies recognize that regardless of how compelling is their request, there comes a time when society simply stops responding. But, after a spell, interest reemerges. A similar pattern can be seen for the issue of tobacco and health. Waves of enthusiasm are followed by lulls of complacency and relative disinterest. After the 1998 hiatus in the US that culminated in the $206 billion, 25-year deal between 46 states and several major tobacco companies, the news wires have been relatively quiet. Fortunately, things are once again picking up.

On 7 July 1999, a Florida jury hearing a suit against four of the industry's biggest companies decided that the tobacco industry sold a dangerous product but had not been open about those dangers, and that they should face both punitive and compensatory claims. Although this is not the first major settlement against the tobacco industry this year, it is the most significant, as it is the first class-action case to reach a verdict. If the second phase of the trial goes ahead (the industry may try to have the class action disbanded), it would open the industry up to claims from thousands of Florida smokers. Pundits have suggested that such claims could amount to $200 billion. From there it could easily spread to other states, raising potential settlements to unprecedented levels.

The day after, on the other side of the Atlantic, Frank Dobson, the UK Secretary of State for Health, threw his weight behind the launch of a new, Cancer Research Campaign (CRC)-funded anti-tobacco research center that will look for any attempts to circumvent the UK ban on tobacco advertising that will come into effect 10 December 1999. In a melodramatic news release ("Undercover spies target tobacco barons' license to kill") that risks trivializing the issue, the CRC explained that the Centre for Tobacco Control Research, will "monitor the activities of the tobacco industry and seek out and expose clever tactics employed by cigarette companies to recruit young smokers". Gerard Hastings, of Department of Marketing at Scotland's Strathclyde University, will lead the new unit; he hopes that with the help of a team of undercover smokers, his research will uncover any new promotional or marketing tactics employed by the industry. Although he notes that the government's new advertising ban should prevent this, Dobson promises "further legislation" to scupper any new initiatives, "should that prove necessary."

This increased activity is welcome. Each event raises awareness and adds to the confidence of those attempting to curb the tobacco industry. But what has been missing so far, however, is the coordination that will help ensure that all those working to limit the damage done by tobacco achieve the best effect for the least effort. In an example of how cooperation can work, ASH (Action on Smoking and Health), the Imperial Cancer Research Fund and the US State of Massachusetts were, as Nature Medicine went to press, releasing a report on steps taken by tobacco companies to make cigarettes more addictive.

The 14 July 1999 report "Tobacco companies engineer high addiction cigarettes with additives" highlights tobacco industry internal documents confirming that for many years industry scientists have understood the pharmacological mechanisms by which certain cigarette additives make cigarettes more addictive or, to quote a 1974 Liggett Group document, provide "a higher nicotine impact." Much of the report focuses on attempts to increase the free nicotine content of the smoke.

According to a 1964 B.A.T. Industries document "...it is almost certain that the free nicotine base is absorbed faster into the bloodstream." A 1965 document, also from BAT, explains "...ammonia treatment causes a general increase in the delivery of bases including a 29% increase in nicotine. .... In other words, the nicotine transfer has increased as a result of ammonia treatment." And closing the loop between nicotine, addiction and sales, an RJ Reynolds document explains that "Philip Morris began using an ammoniated sheet material in 1965 and increased use of the sheet periodically between 1965 and 1974. This period corresponds to the dramatic sales increase Philip Morris made from 1965 to 1974."

This report is impressive in two important ways. It shows how a public advocacy group (ASH), a charity dedicated to research to combat cancer (ICRF), and a state (Massachusetts and the Massachusetts Tobacco Control Program) can pool their resources, expertise and commitment to deliver a useful report to the largest possible audience. Second, the report highlights shocking details about how the industry has "deliberately use[d] additives to make their bad products even worse." The combined resources and respectability of these groups makes a strong statement.

Those groups who are most earnest about limiting the damage (physical and financial) done by tobacco, seeking damages against tobacco companies, and delivering better funding to the biomedical research community involved in fighting tobacco-related disease, would do well to consider this report and what they may have to offer other groups doing battle with tobacco.