Authors: Richard Kluger
There was the further problem of finding well-qualified researchers to accept the tobacco-tinged grants from the AMA. According to Charles LeMaistre, another original SGAC member who agreed to serve on the AMA-ERF grant-doling panel in order to advance the cause of research into his specialty, chronic lung disease, the enterprise proved “not very productive” during the two years he was connected with it, largely because “the flood of competent investigators we had hoped would occur” never did. Dr. LeMaistre, however, apparently did his best to counteract this problem; some $2 million or a full 20 percent of the original grant was directed to researchers at the University of Texas’s Southwestern Medical School in Dallas, where LeMaistre served as dean.
Finally, there was no driving force at the scientific heart of the AMA-ERF endeavor. The meetings of the advisory board were, above all, pleasurable social occasions, often held at resorts with deluxe accommodations, and Kotin, for one, a liberal who had long found the AMA’s social policies and political positions less than enlightened, was pleased to accept the organization’s money and courtesies while enjoying exchanges with intelligent fellow scientists. “We were also indictable for having relaxed for the last 30 percent of our tenure,” he confessed, “but those meetings were delights.”
The AMA directorate was by no means unaware of the boondoggle being perpetrated under its banner. In 1971, the Tobacco Institute’s public-relations head, William Kloepfer, had a conversation with the AMA’s executive vice
president and chief operating officer, Ernest B. Howard, who told him that the AMA had come to regard the tobacco research program as “a great liability” that had caused only “further blackening of the AMA’s image.” Howard wanted to see the project ended but would not terminate it unilaterally, because, as Kloepfer wrote to his boss, Horace Kornegay, the AMA was “most anxious to avoid any incident that will create displeasure with AMA among tobacco area Congressmen—he said AMA needs their support urgently.” And so the program trudged on seven more years, during which the tobacco industry continued to point to its existence as a measure of its bona fide desire to get to the bottom of the cigarette “controversy”.
An authoritative and withering inside assessment of the industry’s joint research efforts was offered by Lorillard’s R&D head, Alexander W. Spears, in a June 24, 1974, memorandum to his company’s president, Curtis H. Judge. Spears, widely regarded along with Philip Morris’s Helmut Wakeham as a genuine man of science as well as a strong company loyalist, summarized for Judge the whole range of tobacco research, from the CTR grants to industry-backed studies at individual universities, like those at Harvard (on the effect of smoke on host genetics, among other subjects), UCLA (on the nature of macrophages, the lung’s scavenger cells), and the University of Kentucky (where tobacco studies were a whole subdepartment), to the U.S. Department of Agriculture’s experiments to reduce the tar and nicotine yields of tobacco plants, to the efforts of the industry’s own ad hoc committee of lawyers whose grants, as Spears put it, “primarily aimed at seeking alternate hypothesis
[sic]
of disease causation,”
i.e.
, other than tobacco-induced. The studies had “historically” not been selected with specific scientific goals in mind, and so were not closely relevant to the health issue. “In general,” Spears added, “these programs have provided some buffer to public and political attack of the industry, as well as background for litigious strategy.” In short, the overall industry effort may have been more than lip service to tobacco executives’ avowal of concern about the health charges against their product, but they fell far short of an earnest crusade for what their exalted scientific spokesman, Clarence Little, liked to call “the whole truth”.
Most troubling of all were industry-funded researchers who came too close to the truth for their patrons’ comfort and were abruptly dropped. Perhaps the most egregious instance was the experience of Swiss-born pathologist Freddy Homburger, who enjoyed nearly a million dollars of tobacco funding over almost twenty years, largely through grants to his commercial laboratory, the Bio-Research Institute, in Cambridge, Massachusetts. In the early 1970s, Homburger and his associates began a one-hundred-week inhalation study with 200 Syrian hamsters under a CTR contract, which, in contrast to the terms of outright grants to researchers, preserved the funding group’s right to review, but not suppress, any papers on the investigators’ findings submitted to scientific
journals. At the close of the study, Homburger’s team found that 90 percent of the exposed hamsters showed severe hyperplastic and neoplastic changes in the epithelium of the larynx, greatly similar to the changes Oscar Auerbach had observed in the lung lining tissue of his smoking beagles several years before. More revealing still, 47 percent of his animals showed either cancer or what Homburger termed “lesions that are known to precede cancer,” which greatly resembled those in the cancer-stricken human larynx.
He wrote up his group’s findings and submitted the draft to the Council for Tobacco Research. Before long, Homburger was paid a visit by a member of the CTR’s scientific advisory board, who read him the riot act for alleged viral infections he said the council had heard were affecting his hamsters. Homburger hotly denied the charge, later proved fallacious, but the accusation as perpetuated by the CTR and some of its paid consultants would tar the reputation of Homburger’s Bio-Research lab long afterward. Homburger was then descended upon by the CTR’s associate scientific director and its outside counsel, who made clear their unhappiness with his paper, because it claimed that the experiment had at long last achieved what his lab had been repeatedly paid to accomplish—cancer in smoke-exposed animals. Long, technical discussions followed in which the CTR representatives asked for changes that, in Homburger’s estimation, “would have completely castrated the paper. They didn’t want us to call anything cancer. They wanted it to be ‘pseudoepitheliomatous hyperplasia,’ a euphemism for lesions preceding cancer. And we said, ‘No, that isn’t right. It is cancer.’” The discussions continued until, according to Homburger’s testimony in court fourteen years later, Jacob told him point-blank, “You realize if you publish [this paper], you will never get a penny more from the Council for Tobacco Research”—no idle threat, as Homburger soon learned.
To avoid possible CTR intervention in the publication of his hamster study, which ultimately ran in the October 1974 issue of the
Journal of the National Cancer Institute
, Homburger had to resort to minor subterfuge by making changes in galley proofs at the last minute after the CTR had signed off on them. His chief concession to his longtime funders was to call the laryngeal lesions “microinvasive cancer,” but this was not enough to allay the CTR’s wrath. Having burned his bridges to the industry and grasping now the nature of its scientific integrity, Homburger attended the April 1974 annual meeting of the American Federation of Biological Societies in Atlantic City to deliver his hamsters paper and arranged for a press conference afterward at which he intended to tell the world of the tobacco interests’ attempted censorship of his findings.
But knowing that it had a potential loose cannon in the now defunded Homburger, the CTR bird-dogged him in Atlantic City in the person of its outside publicist, Leonard Zahn, who, in an April 22, 1974, memo to the CTR labeled
“Confidential,” boastfully described what happened next. On learning of Homburger’s planned press conference, Zahn looked up an old friend of his who was the public-information officer for the American Society of Experimental Pathology, one of the organizers of the convention, and advised her that Homburger’s censorship charges were bunk and that, “on the contrary, he’d been asked to publish,” that Homburger “had not lived up to the terms of his contract,” and that his contract was not renewed “because its intended goal had not been attained”—all lies. And Homburger was reporting old material, to boot, Zahn went on, and told his acquaintance that the CTR had never had such a charge leveled against it before. Zahn’s friend promised to check up on the situation and soon came back to him with word that Homburger was perceived to be “an operator” and that his charges violated professional courtesy and decency, and thus his scheduled press conference would serve “no useful purpose”. Accordingly, “and with her [the organization press officer’s] okay, I arranged for it to be canceled … because of scheduling difficulties in the press room,” Zahn wrote with detectable pride in his achievement. When Homburger showed up there anyway under Zahn’s watchful eye, he “was given a cordial welcome and nicely hastened out the door.”
III
THE
Nixon administration was no more eager to involve itself in the issue of smoking and health than any of its predecessors, but through benign neglect—its chief policy instrument for addressing the problems of poverty—it also performed two useful services for the public-health camp.
First, it did not try to derail congressional passage of the ban on broadcasting cigarette ads. And it tolerated, at least during Nixon’s first term, two employees within the HEW Department complex who were avowed, active foes of smoking. One of these was the outspoken Surgeon General, Jesse Steinfeld, whose public remarks on smoking were far more passionate and sweeping than those by any of his predecessors. The other was the director of one of the smallest fiefdoms in the federal bureaucracy—the quirky, rumpled intellectual Daniel Horn, now running the National Clearinghouse on Smoking and Health, which never employed more than thirty or had an annual budget much above $2 million throughout the nine years he ran it.
Coming from USC to the National Cancer Institute as a ranking administrator in 1968, Steinfeld had been tapped by the Nixon White House to be deputy assistant secretary of HEW, with oversight of the National Institutes of Health and the Food and Drug Administration. Although beset by the war in Vietnam and problems of crime, drugs, racial and generational strife, and inflation, the Nixon administration did not ignore health issues. It put major new funding
into cancer research, helped launch the Environmental Protection Agency, and countenanced such un-Republican measures as a federal role in fluoridation of the U.S. drinking water supply and the banning of cyclamates, the widely used artificial sweetener, because it had been found, in dosages fifty times the equivalent of human use, to cause bladder cancer in laboratory rats. Steinfeld was deeply involved in these last two issues, showing himself to be an aggressive government interceder in the public-health area and overcoming resistance at the FDA to his conviction that there was no safety threshold, or tolerable minimum, for carcinogens ingested by humans—a view that also made him keenly attentive to the perils of smoking. “But I had no mandate on the smoking issue,” Steinfeld recalled, and he did have plenty of other pressing matters to deal with when named Surgeon General, including the hazards of pesticides, a widespread infestation of fire ants, restrictions on phosphate detergents, and the effects of television on children.
But Steinfeld did ally himself with the U.S. Clearinghouse on Smoking and Health, and especially its most visible achievement, the annual Surgeon General’s report to Congress. Unlike the initial 1964 report by a panel of outside experts, the later reports were carpentered by the Clearinghouse staff and amounted to little more than a synthesis of old and new studies and data, issued under the Surgeon General’s signature. Steinfeld ordered an upgrading of the report, and the result in 1971 was a 488-page document, the largest ever, calling attention to important new developments in smoking research. Among these was the matter-of-fact—and quasi-official—endorsement of Oscar Auerbach’s beagles study, so assiduously assaulted by the tobacco industry: “Lung cancer has been found in dogs exposed to the inhalation of cigarette smoke over a period of more than two years.” Findings were noted that paralleled the secret and by then aborted studies by Reynolds Tobacco researchers on an enzyme known as alpha
1
-antitrypsin, which counteracted substances in the lung that attacked the linings of the air sacs and thus promoted emphysema. Maternal smoking during pregnancy now stood accused of a retarding effect on fetal growth (manifested by low birth weights), and contributing to the chances of premature delivery. Most striking of all was a number of new studies on the possible effects of carbon monoxide (CO) in smoke as a promoter of heart disease, in particular atherosclerosis. Animal studies, most prominently those by Danish investigator Paul Astrup and his associates, were now showing that heightened levels of CO in the bloodstream of smokers were associated with increased permeability of blood vessels, inviting infiltration by fatty lipoproteins that accumulated on arterial walls and led to the buildup of obstructive plaque, a major cause of heart attacks. Related studies suggested that insufficient oxidation caused by smoking, due to CO’s affinity for—and, in effect, molecular replacement of—oxygen in hemoglobin, had complex metabolic consequences for human tissue, such as a decreased ability to break down carbohydrates.
Building on these studies over the 1970s, other investigators concluded that GO levels in smokers of filter brands might actually be higher than in those who used the unfiltered product because the filter material and wrapper were less porous than plain cigarette paper, which allowed more of the gas to escape. This phenomenon prompted manufacturers to add tiny holes around the filter in compensation.
Despite this substantive new contribution by the 1971 Surgeon General’s report, the Tobacco Institute’s Horace Kornegay dismissed the document by asserting, “The question of health and smoking is still a question,” and noting the rise in cigarette consumption the previous year; the latter suggested to Kornegay that the American public was not so gullible as to buy the Public Health Service’s “high-priced publicity campaign.” Such denigration of the findings of the nation’s highest-ranking health officer represented a new level of scorn heaped by the tobacco industry’s designated spokesmen upon the labors of scientists around the globe who were dedicated to learning the truth about smoking and not, like the industry’s paid and unclean hands, to hiding it.