Authors: Richard Kluger
Besides rhetoric, Koop seized on the annual release of the Surgeon General’s reports as an ideal occasion to hammer home the case against smoking. The reports became almost the sole mission of the Office on Smoking and Health, which had its budget tightened anew and was again placed under the supervision of the Atlanta-based Centers for Disease Control. The new director, Joanne Luoto, was a young PHS careerist lacking both familiarity with the subject and the political savvy to run a tiny, sensitive agency with an outsized assignment. Though conscientious, Luoto deferred in substantive matters to the far more knowledgeable staff technical expert, Donald Shopland, and the senior scientific editor of the Surgeon General’s reports, pulmonologist David Burns. Applying increasingly stringent peer-review standards to the reports, Shopland and Burns avoided enlisting evaluators who they felt might have social and political agendas beyond a purely scientific one, including those in the hire of both the tobacco industry and the health voluntaries. While they did engage some scientists funded by the Council for Tobacco Research, they did so with high caution. “It’s hard to dance with the bear and continue to lead,” Burns would later remark.
The first report on Surgeon General Koop’s watch, the 1982 study devoted entirely to what the world knew about smoking and cancer, reached his desk only a few months after he began his job. When Shopland returned to Koop’s office a few days after presenting him with the final manuscript, he was astonished to see that the pages were dog-eared and speckled with inquiries that the Surgeon General wanted answered before signing off on the hefty document and publicly endorsing its findings in strong language. The dimensions of the pathology were now catastrophically clear, the report indicated: 21 percent of all U.S. deaths were due to cancer, and 30 percent of those were attributable to smoking—a total of about 111,000 a year by then, a threefold increase over the preceding twenty years. Among the key recent findings noted in the report were a study by Richard Doll holding that air pollution was responsible for fewer than 5 percent of lung cancer cases, and bioassays with mice showing a detectable, if inconclusive, decline in the carcinogenic potency of smoke from cigarettes with lowered tar and nicotine yields.
The following year’s report, devoted entirely to smoking and heart disease, asserted that tobacco use was the most serious risk factor, noted that heavy smokers were two or three times more prone to die from cardiac complications than nonsmokers, and examined the growing evidence on the likeliest mechanisms by which cigarettes contributed to atherosclerosis, the most prominent form of the affliction. The 1984 report was concerned only with chronic obstructive lung diseases and smoking, which was their “major cause” in the U.S. Some 95 percent of all smokers were found to be stricken with some degree of emphysema, the prime cause of which now appeared to be the excessive release
in the lungs of the enzyme elastase by irritant-scavenging macrophages inflamed by cigarette smoke. Taken together, the three reports formed a triptych that put the scientific case against smoking beyond serious quarrel.
In May 1984, a few months after the release of the report on lung disease, Surgeon General Koop broke irreparably with the tobacco industry by delivering an address at the annual meeting of the American Lung Association entitled “Toward a Smoke-Free Society by 2000
A.D
.” In it he promised, with true missionary zeal, to minister to the plight of the nation’s 53 million smokers: “We are not abandoning them, whether they appreciate it or not.” He added that the abatement of tobacco use could not be achieved by his own or the administration’s crusading; it had to be, rather, “the triumph primarily of private citizens and of the private sector.” The speech led R. J. Reynolds’s tobacco chief, Edward Horrigan, to write President Reagan on July 12 of that year to express his dismay “at the increasingly shrill preachments” of the Surgeon General “and his call for a second Prohibition,” which amounted to “the most radical antitobacco posturing since the days of Joseph Califano.”
Koop was able to command the media spotlight almost at will. “He was single-handedly responsible for reinvigorating the antismoking movement,” said Guy L. Smith IV, then Philip Morris’s vice president for corporate affairs. Smith thought the Surgeon General smart, sincere, and masterful in his use of the media, but he questioned Koop’s “intellectual integrity” for often going beyond the careful language of the annual reports, especially the 1986 document on the hazards of secondhand smoke, which was “chockful of caveats that didn’t appear in the Surgeon General’s press release. His goal was to generate a good story, and the nuances—the statements hedged or mitigated in the text of the report—didn’t work well for that purpose.” Koop found such charges against him to be a case of a very charred pot calling the kettle black. “We felt we had enough to go on,” he said of his casting ETS as a serious health peril.
II
A
s Everett Koop commanded the public eye and ear, a far less visible figure established himself on Capitol Hill as the tobacco industry’s most dangerous foe. Ex-chain-smoker Henry A. Waxman had none of the sound, look, or glow of power that seemed to radiate from the Surgeon General, but the California congressman was skilled in its acquisition and deployment in a way that Koop, essentially a figurehead, could never hope to match.
Short, potbellied, and balding in his early forties, Waxman presented a mild exterior and sweet-tempered disposition that camouflaged his determination and toughness, qualities rare in an unabashed liberal committed to using government to help those who could not adequately help themselves. His grandparents
had been fugitives from the Russian pogroms, his father had run a grocery in the Watts section of Los Angeles; and Waxman himself was the first member of his family to gain a college education, winning a law degree from UCLA. He soon entered the California legislature, did well, and, after moving to a far wealthier area embracing parts of west Los Angeles and Hollywood, where the well-heeled residents tended to be Democrats and generous campaign contributors, was elected to the U.S. House of Representatives in 1974, at the age of thirty-four, as part of the “Watergate Revolution” in Congress.
A protege of maverick San Francisco Congressman Philip Burton, a master at forging unlikely alliances and fond of preaching that the point of politics was not self-expression but winning, Waxman carved a niche for himself on the House Subcommittee on Health and Environment, where he pushed for health services for the needy and consumer and environmental protection measures while impressing colleagues as affable, hardworking, and smart. The Americans for Democratic Action, guardians of liberalism at a time when that political creed was waning, gave his voting record a 95 percent approval rating. In 1979, at the outset of his third term in the House, Waxman made a reach for power startling for one so young and new to Washington. The vacant chairmanship of his subcommittee, which had jurisdiction over such politically potent matters as health insurance, hospital costs, air and water cleanliness standards, and the safety of food, drugs, and cosmetics, had been all but conceded to a moderate and well-regarded North Carolina Democrat, former federal judge Richardson Preyer. The Washington
Post
endorsed the diligent Preyer, who had six years of seniority over Waxman.
With ungentlemanly resolve, Waxman contested the key job, arguing that he better embodied the party leadership’s political tenets and, more to the point, that Preyer, whose family held a fortune in stock in a major pharmaceutical company, was hardly an ideal choice to head the health subcommittee, especially at a time when it was contemplating a reform bill to facilitate the sale of unbranded drugs. Preyer’s strong backing of the tobacco price support program and derogatory comments about the comprehensive 1979 Surgeon General’s report on smoking further weakened his credentials to be chief House overseer of public-health issues. And Waxman was not above using a legal but suspect expedient to win the votes he needed to beat Preyer: he contributed some $50,000 of his own surplus campaign gifts to the war chests of forty fellow congressmen—“deserving progressives,” he called them—including ten on his subcommittee’s parent Energy and Commerce Committee, which decided the chairmanship issue in his favor.
If his prize was a touch tarnished because some critics said he had purchased it, Waxman at once set about disarming them by his conduct in the health subcommittee chairmanship. He was unfailingly courteous and accommodating
to his colleagues, assembled a crack staff of workaholic aides, adjusted the parliamentary wheels and levers adroitly, and soon formed an unlikely cordial alliance with Republican Senator Orrin Hatch of Utah, chairman of the upper chamber’s Labor and Human Resources Committee, holding jurisdiction over health issues. As certifiably conservative as Waxman was liberal, the tall, athletically lean Hatch had a transparent yearning for recognition as a statesmanlike achiever among his antismoking constituents back in Utah. Waxman found common ground with him in mutually advantageous legislative trade-offs.
In the age of Reaganomics, Waxman was able to fend off the budgetary ax-wielders who sought to roll back Medicaid benefits, close community health centers in poor neighborhoods, and gut family planning programs. Inch by inch against an inrushing tide, he managed to get disability coverage expanded during the Reagan years. In 1982, he demonstrated his grit in a battle with the formidable new chairman of his parent Commerce Committee—Michigan Democrat John Dingell, who had the biggest budget and staff of any House committee boss, with jurisdiction, it was said, over anything in America that moved, burned, or was sold. While Dingell’s voting record was almost as sterlingly liberal as Waxman’s, they were opposite sorts of operatives; the Michigander gloried in his role as power broker and loved the political process, part of which for him involved leveling a vindictive glower at anyone who defied him. The two were on an inevitable collision course because of the very different congressional districts they represented. Dingell’s was the heart of auto-land, and the cars it churned out gave Waxman’s district the most polluted air in the nation. When Dingell moved, in the deregulatory spirit of the day, to ease the auto emission standards in the federal Clean Air Act, Waxman used every device at his disposal to foil him. His success, assuring him of Dingell’s enduring enmity, would hobble Waxman’s efforts now, as he began to address the major health peril of smoking.
III
HENRY WAXMAN
harbored genuine moral indignation over the way tobacco lobbyists and those who did their bidding in Congress declared that the cigarette industry was essential to the economic well-being of their region, just as Southern lawmakers had defended slavery during the first half of the nineteenth century. He was thus highly receptive to the approach of Matthew Myers, lobbyist for the Coalition on Smoking or Health, who proposed Waxman’s sponsorship of a bill embracing the chief recommendations of the 1981 FTC staff report Myers had shepherded into being. The tobacco companies, Waxman wrote on the Washington
Post
op-ed page in August of
1982, “do an excellent job disguising the [health risk] warning with clever, thematic imagery suggesting the youthful, healthy or athletic attributes of smoking.” He expected that his newly introduced Smoking Prevention Education Act would be hotly contested in Congress but hoped that “the days of plantation politics, when tobacco was king, are on the wane.”
Using the full powers of his chairmanship, Waxman showcased hearings on the bill, giving antismoking forces maximum exposure and featuring celebrities like Bob (“Captain Kangaroo”) Keeshan, who lamented the lure of cigarettes for children; actor John Forsythe of the top-rated TV series “Dynasty;” and the widow of Barney Clark, who testified that her husband had succumbed not because of the failure of the first artificial heart to be implanted in a human patient but due to the ravages he had suffered from smoking. An important new theme sounded at the 1983 hearings was the addictive nature of smoking, for if young smokers were quickly imprisoned by the habit, they were victims and hardly free and willing patrons of the tobacco companies. Director William Pollin of the National Institute on Drug Abuse (NIDA) testified that three out of four smokers polled said they wished they could quit the practice, that fewer than 2 percent of smokers used cigarettes only occasionally, and that smoking was “the most widespread example of drug dependence in this country,” every bit as hard to break as the thralldom to heroin and cocaine. “Dependence” rather than “addiction” had become the preferred term among pharmacologists for the habituating effect of such psychoactive substances, which aroused the pleasure centers of the nervous system, reinforced a craving for them as they traveled through the body’s chemical pathways, and promoted their compulsive use. Whatever the term, researchers were fast concluding that those who turned to alcohol, nicotine, or hard drugs to relieve psychological stress and emotional instability were in fact compounding their condition, because the absence of such addictive drugs only intensified anxiety and stress levels; instead of being a form of self-medication to help users control their lives, Pollin and others now contended, dependence on smoking represented a decided loss of control, with dire health consequences. Thus, in a society where instant gratification was every consumer’s right and cigarettes were legal, cheap, and everywhere available, the public needed to be told on packages and in advertisements that they were also addictive.
But the tobacco manufacturers would not hear of it and chose instead to continue denying the health charges against them. Typical were the remarks of Lorillard’s chief executive, Curtis Judge, who in testimony before Waxman’s subcommittee insisted that the public was aware of the claim that smoking is harmful” but nevertheless chose to disregard it. Waxman’s bill “erodes the concept of individual decision-making,” the Lorillard executive added, and called upon Congress to stop using smoking as a scapegoat for “the many factors associated with disease.” Hearing this, Waxman retorted that if the
industry thought the warning labels so useless, then perhaps Congress ought to repeal the 1965 labeling law. That, though, was the last thing the cigarette makers wanted, since the warnings were now their chief shield against liability suits.