Authors: Richard Kluger
When Dr. Arthur C. Upton, a former chief of pathology at the Oak Ridge National Laboratories, took over as director of NCI in 1977, he had to address
two principal concerns regarding the value of the less hazardous cigarette project. First, the contracts for the research were peer-reviewed either inadequately or not at all. “The sense was that there was too much favoritism, too much back-scratching, collusion, and at best irresponsible uses made of the money,” said Upton, who ordered a gradual shift from contract research to grants made on a strictly merit basis. Second, there was Gori himself, who was seen by some as beyond the control of his divisional director and “not a credible spokesman,” as Upton phrased the consensual assessment, “for the large cadre of technical people” who formed the backbone of NCI. “They questioned his ability and capacity to reflect what they were doing” and wondered if he was in beyond his depth. Upton himself found Gori to be “decent, thoughtful, decisive,” and what he lacked in the way of scientific credentials, “he compensated for by his dedication to the job.”
The delicacy of Gori’s position under a new NCI chief, an outsider who did not care for bureaucratic boondoggling, was underscored by the growing realization that, for all the hopeful talk, his program had not yielded any notable breakthroughs. Summed up Frank Resnik, who had started as a research chemist at Philip Morris in the ’Fifties and ran operations at the company’s research center in the ’Seventies, “NCI did a lot of work, but they didn’t come up with anything more than the industry had.” Many public-health officials were coming to the conclusion that NCI needed a broader focus if smoking was to be combated and not condoned in a dilute, but possibly still fatal, form.
VII
HISTORY
is perhaps less likely to judge Jimmy Carter an ineffectual President than it is to note with astonishment how so obscure a figure ever came to occupy the White House. Similarly, Carter should be less faulted, perhaps, for having played a hypocritical game on the smoking issue than commended, given his political base in the same geographical region as the tobacco industry, for having allowed his administration to pay even lip service to the public-health need for curbing cigarette use.
An outsider in Washington and suspicious of the capital’s power brokers, Carter surrounded himself for the most part with an inner circle of like-minded, down-home advisors. But to manage the government’s most unwieldy bureau, the Health, Education, and Welfare Department, he chose as Secretary a classic, aggressive Washington insider. Robert Strauss, Democratic Party chairman, advised the President-elect, “If you pick Joe Califano, he’ll irritate you every single day, but at the end of the day you’ll look back and see he’s been a great asset.” And competence more than personal compatibility was what Carter needed to bring order to HEW, a potpourri of 150 programs,
150,000 employees, and a 36 percent slice of the federal budgetary pie. Administrative mistakes were routine, contracting and accounting procedures a muddle, and fraud and other abuses rampant.
Joseph Anthony Califano, Jr., a short, plumpish, Harvard-educated attorney, was known to be a good-humored and compassionate political activist who, as a powerful assistant to President Lyndon Johnson, had helped formulate and drive through the Great Society social programs. But Califano was also known as complicated, nakedly ambitious, and sometimes brutal in seeing that his orders were followed. A Brooklyn-born graduate of Holy Cross, he had made the law review at Harvard, joined the Wall Street firm of Dewey, Ballantine after military service, and gone to work for the Kennedy administration like many another high-minded young attorney, starting as an assistant counsel in the Pentagon under Robert McNamara. By the age of thirty-three, he was general counsel to the U.S. Army and soon on his way to the White House, where he served as a key aide until Nixon ousted the Democrats in 1968. Califano then became one of the most highly paid lawyers and effective lobbyists in Washington.
At HEW, Califano promptly showed his spine when he declined to staff his department with political pals of dubious talent sent to him by the White House staff chief, Hamilton Jordan, who early on took a dislike to him for failing to play ball. Califano put together a heavy agenda to help the ill, the needy, the poorly schooled, and others he thought had been neglected under eight years of Republican rule. The programs his department advanced were costly and controversial, and Califano soon found himself a convenient lightning rod for an ideologically moderate and politically insecure White House.
With so much else on his plate, Califano did not pay much attention to the smoking issue until toward the end of his first year running HEW. But he had asked his Surgeon General—a post that had lain dormant for four years—to look into the matter, and Julius B. Richmond, a soft-spoken pediatrician who, in keeping with his specialty, was a strong advocate of preventive medicine, suggested an aggressive attack on tobacco. Califano was receptive for two reasons. In drawing up his HEW program, he was repeatedly told that preventive medicine was the key to extracting maximum value from the government’s investment in public-health measures. The drop then being achieved in heart disease, for example, was due in no small measure to new dietary and exercise habits taken up by a population freshly aware of their role in enjoying a full, hardy life. Califano, moreover, had been jarred into adjusting his own health habits two years earlier, after he asked one of his sons what he would like as a present for his eleventh birthday. The lad told his father, who had begun smoking at sixteen and was now up to three packs a day, that he would like no greater gift than Califano’s quitting the habit. And he did, painfully.
But an administration program to combat smoking was sure to be a political
hot potato. Indeed, one of the proposals offered the Secretary by Surgeon General Richmond’s task force on tobacco control—ending the Department of Agriculture’s $80 million price support program for a crop that did grave damage to the public health—ran into trouble as soon as word circulated in the capital that HEW was even contemplating such a recommendation. Agriculture Secretary Bob Bergland promptly made his opposition known in noting that his responsibility “begins and ends with the interests of the farmers. … The Department of Agriculture cannot involve itself in the health aspects of tobacco.” Presumably Bergland would have opposed the added costs of milk pasteurization as an undue burden on dairy farming, had he held office at the time that advance in public health was made. A delegation of tobacco-state lawmakers hastened to the White House for assurances that the price support program was not about to be gutted.
On January 11, 1978, the fourteenth anniversary of the first report on smoking and health issued by the Surgeon General’s office, Secretary Califano out-fined an anticigarette program that was by far the most vigorous of any ever proposed by a U.S. official of Cabinet rank. Declaring smoking a major cause of an estimated 320,000 deaths a year in the U.S., nearly two-thirds of them a result of heart disease, Califano labeled cigarettes “Public Health Enemy No. 1” and said their users were committing “slow-motion suicide.” He called upon every school in America to teach its students the dire risks of the habit; upon the Civil Aeronautics Board to ban smoking on all commercial flights; upon Congress to increase the federal excise tax on cigarettes (fixed at eight cents a pack for the preceding twenty-seven years); upon the broadcast networks to reinstate their free, prime-time antismoking announcements; upon his own vast agency to prohibit smoking on its premises except in explicitly designated areas, and upon other departments and the General Services Administration, which managed some 10,000 federal buildings across the nation, to follow suit. The Secretary also said he would soon move the practically defunct U.S. Clearinghouse on Smoking and Health back to Washington from its four-year exile to Atlanta and rename it the Office on Smoking and Health.
Public-health advocates like John Banzhaf’s ASH and the consumer groups allied with Ralph Nader dismissed Califano’s call as all gesture and little substance. HEW’s proposed antitobacco budget of $25 to $30 million was denounced as a spit in the ocean to counter the billion dollars then being spent by the industry on advertising and promotion—and it was laughably small when compared even to the $250 million that HEW itself had squandered not long before on a mass inoculation campaign to head off a phantom swine flu epidemic. The Califano antismoking program was a popgun attack when heavy cannons were what the public-health community had in mind.
To the tobacco industry and its defenders, growing ever more paranoid,
Califano’s words were a red flag. Kentucky’s Senator Walter Huddleston, a reliable defender of his state’s big Burley crop, reflexively denounced Califano for proposing “a massive propaganda campaign against cigarette smoking without having sufficient scientific evidence to justify it.” North Carolina’s Jesse Helms faulted the HEW Secretary for “demonstrating callous disregard for economic realities, particularly for the economy of North Carolina,” while that state’s governor, Jim Hunt, urged Califano to come for a visit so he could learn what the tobacco crop meant to Tarheel farmers. U.S. Representative Charlie Rose, not to be outdone in the stout defense of his constituents, promised, “We’re going to have to educate Mr. Califano with a two-by-four, not a trip.” The health worries of tens of millions of their countrymen did not enter into this elevated discussion.
The industry’s own spokesmen stressed the claimed $50 billion that the tobacco companies contributed to the gross national product and the alleged 2.3 percent of U.S. employment accounted for by the smoking business. At one extreme, Califano was attacked crudely and in a personally offensive manner by Liggett & Myers’s chairman, Raymond Mulligan, as “a silly ass.” At the other end of the subtlety spectrum was a letter to the editor appearing in
The New York Times
from Philip Morris’s president, Ross Millhiser, who argued that if cigarettes were not beneficial to smokers, there would not be so many of them, and cited several among the relatively short list of contrarian scientists who did not accept the health charges against smoking. “As for the lack of research on the ‘harmful’ effects of smoking,” Millhiser went on, “the fact is there is good reason to doubt the culpability of cigarette smoking in coronary heart disease.” The “fact,” actually, was quite the opposite. Only thirteen months earlier, to cite just one study of many by then implicating smoking in heart disease, Oscar Auerbach had reported that autopsy studies on 1,056 men disclosed, upon microscopic examination, a rate of advanced atherosclerosis 4.4 times higher among men who smoked two or more packs of cigarettes a day than among nonsmokers, while somewhat more moderate thickening afflicted the heart vessels of 72.6 percent of those smoking one to two packs a day, compared with 29 percent among nonsmokers. Still more dubious than Millhiser’s comments were the remarks of Philip Morris’s honey-voiced chief publicist, James Bowling, who told
Business Week
, “I really believe the Califano type of thing is a tragic disservice to science. The real need is to find answers.”
Far more surprising than the industry’s response to the Califano program was the duplicitous game played by the White House under a President who had been an enlightened advocate of preventive public-health measures while governor of Georgia and whose own father, a heavy smoker, had died of lung cancer. The politically adept Califano had not looked for vocal White House
support in promulgating his antismoking project. “It was too controversial,” he recounted, “and not the kind of issue you dump on the White House doorstep.” Carter, he knew, “wouldn’t want to go out front on it.”
The President and his people, apprised of Califano’s antismoking initiative before it was launched, distanced themselves from the HEW Secretary’s effort without disavowing it. A few weeks in advance of Califano’s speech, Peter Bourne, a psychiatrist who served as special White House assistant on health issues, addressed the American Cancer Society’s committee on smoking research and sounded more like a Tobacco Institute publicist than a public-health officer. Bourne spoke admiringly of the emotionally stabilizing effects of tobacco and cautioned against an excessive repression of smokers’ “rights” by restricting the places where they could indulge their habit, as Califano would shortly propose with regard to federal office buildings. When Califano asked to deliver his initial antismoking speech from a White House rostrum, he was turned down. After the antismoking drive went public, Bourne continued to offer sniping comments, speaking of the “pleasure and relief factor” in smoking, questioning the cost-effectiveness of “programs designed to scare young people out of smoking,” and needling that however much some people might favor the prohibition of tobacco, “we are 300 years too late”—as if a quarter-century of scientific findings on the hazards of smoking did not justify governmental steps to discourage the lethal habit. “The sole thing dictating what I did,” Bourne later told a British journalist, “was what was in Carter’s interest in maintaining his political base.”
The administration declined to take up Califano’s suggestion to all federal administrators to restrict smoking on their premises, and the President himself reassured the South generally and tobacco farmers specifically that they had little to fear from the HEW antismoking campaign. By the spring of 1978, the
Washington Monthly
was quoting well-placed Democratic officials as saying that the President and his staff were unhappy with Califano for “making war on [Carter’s] voter base” and that the HEW Secretary’s “loyalties just don’t run to the President. His loyalties are to himself.”
VIII
THE
strategic core of Joseph Califano’s effort to achieve a major shift in the social acceptability of smoking was the argument that the freedom of young people to make an informed choice in the matter was massively compromised by the tobacco industry’s ceaseless campaign to glamorize its product and sow confusion and doubt about the grave risks that accompanied its use. He wrote to the nation’s 16,000 school superintendents to push smoking education programs, to the broadcast networks to increase their public-service
announcements, to life and health insurance companies to lower their premiums for nonsmokers, to the governor of every state to back laws restricting smoking in public places, and to medical groups to implore high-risk smokers, such as pregnant women, to avoid the danger they were courting. And every chance he got he spoke out against cigarettes, soon prompting bumper stickers to sprout in tobacco country that declared, “Califano Is Dangerous to Your Health.”