Authors: Richard Kluger
But neither Schuman nor other uneasy committee members could do anything to sway the judgment put forward by Maurice Seevers, the pharmacologist among them, in his chapter on the possible addictive nature of tobacco. Without a psychologist or other specialist in human behavior on board, there was no panel member with the credentials to combat Seevers, whom Schuman remembered as “one tough hombre”. To Seevers, addiction meant an overpowering desire to continue using a drug, a tendency or need to keep increasing the dose, a physical dependency, withdrawal symptoms that could be life-threatening, and the user’s willingness “to obtain it by any means”—a none too thinly veiled reference to antisocial acts like robbery to pay for the habit. The alternative term, habituation—which was how Seevers characterized cigarette smoking—did not involve constantly escalating dosages, implied a psychological rather than physical dependency that could be rather more easily broken, and was not associated with antisocial acts. This last observation, Seevers’s text failed to acknowledge, may have been valid with respect to cigarette-craving because the product was cheap, ubiquitous, and legal, none of which was true for most drugs acknowledged to be addictive. Instead, Seevers repeated the standard psychiatric view of the day: that addiction was “based upon serious personality defects from underlying psychologic or psychiatric disorders which may become manifest in other ways if the drugs are removed.” How, then, could smoking be branded as addictive unless the SGAC was prepared to ascribe “serious personality defects” to nearly half the adults in America?
A more measured analysis of the addictive hold of cigarettes might have found that some smokers were able to quit cold-turkey while others trying to do so suffered long and painfully in a variety of ways and eventually gave up, with most would-be quitters falling somewhere in between—the difference depended possibly as much on the pharmacological hold and behavioral conditions of the habit as on any flaw of character or want of willpower on the part of the smoker. But Seevers would not entertain any such nuances. “None of us were well versed enough in the field to pass judgment on his judgment,” Schuman recounted in explaining the committee’s deference to Seevers. “He was cocky enough to impose his view on us without ever once conceding, This is a controversial area,’ or that the weight of the evidence is such-and-such.” Thus, smoking was decreed a habit, not an addiction, and the tobacco industry was rewarded for its championing of Seevers as a member of the Surgeon General’s elite panel.
What emerged, finally, was a highly detailed, closely reasoned, but far from combative report, that was substantially compromised. Understated and embodying
the lowest common denominator of agreement among them, the report nonetheless offered as its final finding, “Cigarette smoking is a health hazard of sufficient importance in the United States to warrant appropriate remedial action.” With eloquent simplicity, the social challenge was put forth, but there was not a word about what form such a remedy might take. That was left, for the time being, to the politicians, who were in no hurry to address the consequences of a custom, however self-destructive, that so many of their constituents clung to fiercely.
X
AS
the advisory committee’s report to the Surgeon General was being assembled under conditions of extreme secrecy in the closing months of 1963, public and industry speculation about the contents intensified. At the committee’s makeshift headquarters in the bowels of the National Library of Medicine, pestering inquiries from the outside were mounting by the day, along with staff tension as the drama grew amid that swirl of underground activity. “It was almost a Manhattan Project mentality,” recalled John T. Walden, brought in during the late stages of the work to help edit the report and head up the arrangements to reveal it to the public. The armed guards were instructed to be more vigilant; an editor who leaked some of the findings to
Newsweek
was summarily dismissed; and Surgeon General Luther Terry was more visible now, outwardly affable as always but his eyes on red alert. The momentous nature of the pending report was not lost on any of the SGAC staffers, including their youngest member, Donald Shopland, a high school student who smoked two packs of Pall Malls a day while working as a stockboy and gofer. “We were all aware of the scientific and political implications,” recalled Shopland, who would quit smoking as soon as the report was issued, drop out of school, and devote his career as a federal employee to fighting cigarettes as a health peril.
The report, for all its urgency, could not be rushed unduly, for it would prove, in that era before computerized word-processing, a highly complex printing job, impossible to complete with the mandatory care before the year was out. While the report included a synopsis and boldface type to make its more important passages accessible to laymen, it was in fact a highly technical document. Chapter 8 alone, on the mortality of smokers, contained thirty tables set in agate type; chapter 9, on cancer, running 136 pages, cited 396 studies as its sources, including 21 attributed to Ernst Wynder and his associates, the most credited to any single investigator in the field. The type was composed behind a fenced section of the U.S. Government Printing Office, where
the printers were used to dealing with sensitive federal documents, and the chapters were sent separately to outside peer-reviewers, so that no one beyond the committee and its staff ever saw the document as a whole until it was made public.
The whole world discovered those contents on the morning of Saturday, January 11, 1964, when some 200 members of the press were admitted to the State Department auditorium, the same room in which President Kennedy, slain less than two months earlier, had been questioned on the smoking issue, and were handed the 150,000-word report by the Surgeon General’s advisory committee. A Saturday was chosen for the press conference to minimize the impact of the report on the stock markets and to maximize its coverage in the Sunday papers. What the reporters read was the language of cautious, prudent scientists who were convinced by the converging lines of evidence that “many kinds of damage to body functions and to organs, cells and tissues occur more frequently and severely in smokers” than in those who abstained.
To rebuke the tobacco industry’s contention that no carcinogenic substance had yet been found in cigarettes in sufficient quantity to be held responsible for lung cancer, the report noted that (1) seven cancer-causing compounds had thus far been found in a heavy enough concentration to arouse concern; (2) these compounds were so volatile that perhaps half of their potency was vitiated during the fractionation and purification process used to measure them, suggesting that they were likely present in heavier amounts than scientific instruments could calibrate; and (3) “Whether there is a threshold for effective dosage of a carcinogenic agent is controversial at the present time,” meaning that nobody could tell for certain, regardless of the tobacco industry’s reassurance to the contrary, how small a dose of a cancer-causing substance was enough to plant the disease. As to the crucial microscopic findings by Oscar Auerbach, on whose exhaustive studies the committee relied heavily, the report concluded that “some of the advanced epithelial lesions with many atypical cells, as seen in the bronchi of cigarette smokers, are probably pre-malignant.”
Unlike other prior inquiries, the report to the Surgeon General gave the tobacco industry at least brief consideration of the possible benefits of smoking. It seemed to promote “good intestinal tone and bowel habits,”
i.e.
, had laxative effects, and served to counter obesity, but these were scarcely adequate to counterbalance the “significant health hazard” posed by cigarettes. And while smoking appeared useful to stimulate smokers when fatigued or to calm and sedate them when tense or excited, the cigarette was found to be predominantly a tranquilizing agent—but it was impossible to determine with any objectivity whether smoking “induces pleasure by creating euphoria or by relieving dysphoria.” The report had the grace—or bad manners, depending on
one’s perspective—to note the utility of cigarettes for “a large fraction of the American population to satisfy the total need of the individual for a psychological crutch.”
Press coverage of the panel’s report was immense and accepting. The nation’s foremost daily,
The New York Times
, called the findings by the committee “a severe blow to the rear-guard action fought in recent years by the tobacco industry. It dismisses, one by one, the arguments raised to question the validity of earlier studies.” The New York
Herald Tribune’s
astute science writer, Earl Ubell, in the paper’s leading story headlined “It’s Official—Cigarette Smoking Can Kill You,” found the report “far harsher than anticipated” and said that it emphatically shifted “the burden of disproof” to the industry. The Washington
Post
gave the story top billing but provided tobacco industry spokesmen almost as much front-page space to answer the charges. Perhaps the most obtuse—or at least industry-friendly—coverage in the popular press ran in
Newsweek
, which wrote that the report, while exhaustive, “carefully buried the argument that the evidence … is largely statistical.” Rather than burying that criticism, the report had by any standard met and massively rebutted it.
The immediate response by the tobacco industry and its allies varied from moderate to shamelessly dismissive. The Tobacco Institute’s George Allen was the most guarded spokesman, saying that the report deserved and would get careful study but hardly constituted the last word on the subject. At the other extreme was Howard Cullman, president of Cullman Brothers and the Tobacco Merchants Association, a board director of Philip Morris, and uncle of Joseph Cullman, that company’s president. Like an obstinate envoy from the Flat-Earth Society spurning the survivors of Magellan’s crew on returning from their round-the-world voyage, Cullman asserted, “We don’t accept the idea that there are harmful agents in tobacco.” Dr. Kenneth Lynch, then chairing the Tobacco Industry Research Committee’s scientific advisory board, nicely encapsulated the bias of his region by trivializing the SGAC report as mostly epidemiological and claiming “some kind of an association between any and all of these [pathological] conditions and the use of tobacco. But what it means, nobody knows. Such diseases can occur without any use, or exposure to use, of tobacco.” Terry Sanford, governor of North Carolina, the leading tobacco-producing state, called the report “a review of previously existing evidence, none of which is conclusive and much of which is based on statistical studies.”
In fact, the careful, temperate, and comprehensive report of the Surgeon General’s panel had but one glaring fault—an omission that was never admitted or subsequently corrected. At the press conference following the release of the report, Assistant Surgeon General James Hundley commented that “there was not enough evidence to make a judgment that filters do any good.” But
this almost casual remark skimmed over a central fact of all the population studies: The elevated mortality rates of smokers, so neatly corresponding to dose-response measurements, were entirely or largely based upon the use of pre-filter cigarettes. During the five years prior to the report, the industry had reduced the tar and nicotine yields of the filter brands by an average of 40 percent; half the smoking population, moreover, was now using filter brands.
When U.S. Senator Sherman Cooper from Kentucky, the No. 2 tobacco state, wrote the Surgeon General two days after the report was issued to point out this potentially significant shortcoming, Terry backed away from Hundley’s airy comment at the press conference. It was erroneous to conclude from the report, the Surgeon General wrote Cooper, that cigarette filters had no effect; indeed, filters then in common use “do remove a variable portion of the tars and nicotines. … [T]he committee felt that developing better filters or more selective filters is a promising avenue for further development.” But he did not concede the key point—that nobody knew with any certainty whether the product had been modified sufficiently by its manufacturers to negate the whole thrust of the advisory committee’s report. Cigarettes with a filter that was more than cosmetic simply had not been on the market long enough for epidemiologists to conduct a meaningful population study—and the better part of another generation would be required before the mortality rates of those who smoked high-filtration brands exclusively could be calculated. In fact, such a study has never been made in the three decades since the original report to the Surgeon General, doubtless because the public-health community has long since considered the case against cigarettes conclusively proven. That the preponderance of the evidence strongly supports that judgment does not alter the validity of the objection that the bedrock statistical data used in reaching that judgment stemmed largely from a product—the unfiltered cigarette—swiftly going out of use at the time of the first Surgeon General’s report. The industry elected to protest only meekly at the time; a more vigorous denunciation would likely have been taken as the companies’ tacit acceptance of the SGAC’s findings with regard to unfiltered cigarettes, as well as an undemonstrable health claim for the filter brands that might have invited the Federal Trade Commission’s wrath. In hindsight, the decision not to make a major point of the possible efficacy of the filter was probably one of the industry’s two worst mistakes in dealing with the health issue. The other was its insistence on reflexively and incessantly denying every shred of scientific evidence against it, in the process insulting the intelligence of smokers and nonsmokers alike.
At the close of its business, one member of the Surgeon General’s committee acted in a way he would live to regret soon thereafter. When asked at the panel’s press conference whether he still smoked and what brand, Louis Fieser, who continued to consume four packs of cigarettes a day despite a
chronic cough and poor sleeping habits, believing that tobacco would surely have done him in already if he was fated to succumb to it, replied, “I still smoke Larks, the cigarette with the activated charcoal filter.” Ten days later, he told the
Harvard Crimson
, the undergraduate daily at his university, that the Lark filter “represents a definite encouraging advance.” In neither case did Fieser reveal a conflict of interest stemming from his position as a consultant to Arthur D. Little, Inc., and through that firm to Liggett & Myers, makers of the Lark. His endorsement of the product under such circumstances was ethically reprehensible. Less than two years later he was operated on for a tumor in his right lung; heart disease, bronchitis, and emphysema were also discovered to be present.