Authors: Richard Kluger
Liggett & Myers alone of the major players in the cigarette industry held itself aloof from this joint undertaking. The company may have feared renewed
antitrust action against the industry for this combined effort or merely been registering deep distrust of its competitors, but at least as likely an explanation was that, obtuse as Liggett’s advertising seemed to have been on the health issue
(e.g.
, “Just What the Doctor Ordered”), intramurally the company conceded that the public’s awakening alarm was not groundless. According to the minutes of a March 29, 1954, meeting of Liggett scientists and advisors, for example, research chief Frederick Darkis remarked that “if we can eliminate or reduce the carcinogenic agent in smoke we will have made real progress,” and that while the company had indeed made real progress in the reduction of the nicotine content of its brands through filter tips and leaf selection
(i.e.
, the lower the leaf on the stalk, the less nicotine it contained), the blenders still “have a ways to go.” Here was acknowledgment that the product probably contained harmful ingredients that ought to be removed or reduced.
Toward that end Liggett undertook, without public announcement, its own ongoing research effort by hiring the leading industrial consulting firm of Arthur D. Little, Inc. (ADL), of Cambridge, Massachusetts. The ADL team on the Liggett account met regularly with the company scientists at their laboratory in Durham, North Carolina, where a pair of top chemists from Duke now joined the research program on a consulting basis. While the rest of the tobacco industry was slowly gearing up for health research funding, Liggett scientists gathered at Cambridge that spring heard ADL consultant Louis Fieser of Harvard, author of perhaps the most widely used textbook on organic chemistry, tell them that the first step in their program ought to be an effort to replicate Ernst Wynder’s mouse-skin experiment. In charge of that project, to which Liggett promptly agreed, and the company’s future efforts was prominent toxicologist Charles J. Kensler, a bluff, cigar-smoking authority on liver cancer who had lately left Cornell to take a joint appointment at the Arthur Little labs, where he was to become chief of life sciences, and in the pharmacology department at Harvard. The attempt to reproduce Wynder’s skin-painting study—or, better yet from Liggett’s standpoint, to repudiate his findings—was based, Dr. Kensler recalled, “on the assumption it had something to do with the human condition, but you couldn’t be certain.” That such an investigation by a cigarette manufacturer bespoke a seriousness of purpose and not simply an effort to whitewash its own brands was evident to Kensler, who long afterward remarked, “You can’t brag about getting fewer tumors” than other brands produce in a skin-painting bioassay. “If you get one, you’re in trouble.”
That the Tobacco Industry Research Committee (TIRC) effort would, by contrast, be aimed in significant part at rebutting the health charges against smoking became evident three months after the announcement of the program, when the joint committee issued an eighteen-page pamphlet that amounted to
a brief for the defense. A compilation of pro-industry statements by cancer researchers, medical school faculty members, and private practitioners, the TIRC’s first publication included the view of none other than Clarence “Pete” Little, former executive director of the American Cancer Society, who stated that from the perspective of the laboratory clinician, no definite cause-and-effect relationship between smoking and lung cancer had been established on “a basis that meets the requirements of definitiveness, extent, and specificity of data, which the seriousness and implication of the problem deserve.” But nobody among the health investigators had suggested that the case against smoking was closed—only that it ought to be fully ventilated. The American Medical Association’s president-elect, Walter B. Martin, was quoted in the TIRC document to the effect that the evidence thus far gathered was not convincing enough “to establish as a positive fact that cigarette smoking is necessarily the cause” of lung cancer. But nobody authoritative had proclaimed smoking to be
“the
cause” of anything other than a high level of corporate profit. A Chicago surgeon, Dr. Max Cutler, offered a gem of sophistry in declaring press statements of a “causative” relationship to be “absolutely unwarranted” and adding, “Simply because one finds bullfrogs after a rain does not mean that it rained bullfrogs.”
The moral dilemma beginning seriously to confront the cigarette makers at this time was perhaps best, if unintentionally, rendered by Philip Morris’s chief executive, Parker McComas, who, in his capacity as temporary chairman of the TIRC, stated, “If the industry leaders really believed that cigarettes cause cancer, they would stop making them.” But what McComas or any other tobacco industry official believed or chose to believe was less to the point than what their responsibility was as far as uncovering and reporting scientific information that the smoking public ought to possess when deciding to buy and use their product. Indicative of how they viewed that responsibility, the industry chiefs in mid-1954 selected as scientific director of the TIRC and chairman of its Scientific Advisory Board an apparently sterling catch: Pete Little, founder and retiring president of the Roscoe B. Jackson Memorial Laboratory and at age sixty-six an internationally known, bona fide cancer-fighter. Ten years earlier, while he was the director of the nation’s top anticancer organization, he had written about the imprudence of smoking; now he was a hireling of an industry facing charges that it was intimately implicated in the spread of the most virulent form of cancer. Here supposedly was “a scientist of unimpeachable integrity” who the tobacco industry had promised the public in its “frank statement” would head its research.
If Pete Little’s science was of “unimpeachable integrity,” his character was not quite so free of tarnish, given previous accusations of moral misconduct at the University of Michigan and the American Cancer Society. While some at the ACS remembered Little as a rather emotional man, somewhat distant and
formal—one publicist termed him “a self-conscious bigshot”—his appointment to run the tobacco industry’s research program came as a shock to many at the society. The suspicion was that he had taken the job out of lingering bitterness over having been jettisoned by the cancer society after his clash with Mary Lasker. Others who knew him felt that Little, fearing a kind of intellectual impotence with his pending retirement from the Maine laboratory he had built, was highly susceptible just then to the tobacco industry’s invitation and currying; a restorative pride accompanied the power to distribute the research funding of a major American industry. ACS medical director Charles Cameron thought that Little “must have been pretty hard up” and that his accepting the new position was “purely a mercenary kind of thing,” to survive financially in his old age. Whatever the reason, Cameron added, “Nobody at the society admired him for it.”
VIII
IWAS
very dubious—and personally a heavy smoker—when we went into it,” explained American Cancer Society epidemiologist Cuyler Hammond as he faced the press after delivering his paper, readied at the last moment, before the annual convention of the American Medical Association in San Francisco near the end of June 1954, just twenty months after he, co-investigator Daniel Horn, and their support staff of thousands of ACS volunteers had launched their massive prospective study on the effects of smoking on health. One measure of their preliminary findings was that both Hammond and Horn had switched from smoking cigarettes to pipes.
They had not intended to make their first interim report for another year or two, but the numbers tumbling out of the data-processing punch cards in the second annual follow-up on the 187,766 subject white men between ages fifty and sixty-nine documented a trend too apparent to withhold from the public. The mortality figures for the 4,854 men who had already died showed significantly higher rates for cigarette smokers: 65 percent more smokers than non-smokers had died in the fifty-to-fifty-four-year-old range; 60 percent more in the fifty-five-to-fifty-nine range; 102 percent more in the sixty-to-sixty-four range; but only 30 percent more in the sixty-five-to-sixty-nine range, presumably because the most susceptible smokers were dead by then. The death rate for those who smoked cigars only was slightly above that for nonsmokers, while the rate for pipe smokers was not at all elevated. And the more you smoked, the greater your chances of dying prematurely. Among those smoking under a pack daily, the overall death rate was 52 percent higher than that of nonsmokers; for those smoking a pack or more a day, the rate was 75 percent higher.
Since air pollution, especially what was generated by urban automobile traffic, had been a prime suspect along with cigarettes for the big jump in lung cancer rates, the ACS findings were particularly revealing, because they showed that there were proportionately fewer rural than urban smokers, that rural smokers consumed fewer cigarettes than urban smokers, and that in the rural and urban categories alike, smokers posted significantly higher death rates than nonsmokers. If air pollution, not smoking, was the prime culprit in lung cancer, why did nonsmokers, breathing the same fouled air, enjoy a notably lower death rate in general and lung cancer rate in particular? And by way of suggesting seriously for the first time that the ravages of smoking might not be limited to lung cancer and bronchial diseases, the Hammond-Horn data showed that pack-a-day smokers in the fifty-to-sixty-four age category died from coronary heart disease at a rate twice as high as that for nonsmokers.
Finally, and most overwhelming of the ACS statistics, was the analysis of the 167 men who had died of lung cancer in the twenty-month period. Depending on their age category, smokers were struck down by the disease at a rate from three to nine times as frequently as nonsmokers, while those smoking a pack or more a day died of lung cancer at a rate from five to sixteen times higher. All of their evidence, Hammond and Horn declared in concluding their bombshell report, was consistent with the hypothesis that the association between smoking habits and elevated death rates from lung cancer and heart disease was not coincidental. “We know of no alternative hypothesis that is consistent with all of the known facts,” they wrote. On almost the same day, the
British Medical Journal
carried a preliminary report by Richard Doll and Bradford Hill on “The Mortality of Doctors in Relation to Their Smoking Habits.” Of the 789 British doctors who had died during the first twenty-nine months of their prospective study, 35 had succumbed to lung cancer—all of them smokers, and the more they smoked, the greater their chances of dying sooner than nonsmokers of the same age.
The gravity of the Hammond-Horn numbers was evident from the industry’s instantaneous rejection of all that they implied. Timothy Hartnett, the acting chairman of the TIRC who half a year earlier had cautioned his fellow tobacco executives against intemperate reaction to their scientific critics, now went off like a loose cannon. The preliminary ACS findings, notwithstanding the immense scale and scholarly care that went into the effort that produced them, were “biased, unscientific, and filled with shortcomings,” declared the heated Hartnett. A few weeks later, Hartnett, by then retired from Brown & Williamson and named the first full-time chairman of the TIRC, had cooled off enough to issue a statement that would serve for years, with slight variations to meet the need of the moment, as the industry’s standard response to the growing critical mass of evidence against it. There was “no conclusive scientific evidence” against cigarettes, said Hartnett from his Louisville office,
adding, “The millions of people who derive pleasure and satisfaction from smoking can be reassured that every scientific means will be used to get all the facts as soon as possible.” Implicit in that pledge was a specifically targeted, carefully coordinated, authoritatively supervised, and amply funded program. Not even a shadowy resemblance to such an effort would materialize.
By the first autumn of its existence, the industry research committee’s chief scientific spokesman had already perfected the scripted remarks that would be invoked to repulse the health community’s escalating onslaught. Consider Dr. Little’s response to a statement issued by the executive board of the Public Health Cancer Association, a professionally dominated offshoot of the American Public Health Association, at its eighty-second annual meeting in October of 1954. There was enough evidence, said the board, “to justify advising the public to stop smoking cigarettes,” and youth in particular to ponder the risks of taking up the habit. Little stated in reply that “unreasoning fear based on incomplete information is not a constructive force … ” and that “No convincing clinical or experimental evidence” had materialized to indict smoking as the positive cause of lung cancer.
More curious than Little’s pitch in behalf of his new employers were the ambivalent remarks by his opposite number at the ACS, Charles Cameron, in the immediate wake of the first Hammond-Horn report. The hazards of smoking “do not appear to differ significantly in degree from lots of other calculated risks to which modern man exposes himself,” said Dr. Cameron, who then registered his sympathy with those “willing to shuck off this mortal coil a few years ahead of schedule as the price for a carefree, full-blooded—some mould say undisciplined—life.” But within a few months, Cameron had apparently thought better of such expansive tolerance of a dire health hazard that the organization for which he worked was conceived to combat. At his and Cuyler Hammond’s urging, the ACS board that October issued its first formal warning about the possible peril of smoking: The “presently available evidence” indicated “an association” between smoking and lung cancer—nothing was said of a causal relationship—and the U.S. Public Health Service ought “to devise and pursue public health education and other measures” to check the rising tide of lung cancer. Hardly a rush to judgment. Officials with the American Heart Association were still less outspoken, primarily because the ACS-funded report on smoking by Hammond and Horn had had the audacity to disclose its findings in connection with heart disease as well as cancer.