Authors: Richard Kluger
One-man crusades rarely get very far, though, and so Califano turned to the only, operation within his department’s huge apparatus which was devoted to addressing the public on the smoking problem. “I was appalled by what I found,” he recalled—the old U.S. Clearinghouse on Smoking and Health had become a tiny hovel at the Centers for Disease Control in Atlanta. Only two hands were left from the Clearinghouse’s exuberant pioneer days as an effective public-education shop—the aging ex-director, Daniel Horn, no longer a strong functioning force, and his devoted technical information officer, the modest Donald Shopland.
Califano ordered a fresh effort, to operate out of the capital once again for improved access to national media, and renamed it the Office on Smoking and Health (OSH). To run it he chose John M. Pinney, who had no expertise in the subject and no compensating scientific or technical training. But the 1965 graduate of Yale was cocky and verbally slick and knew his way around Washington. His professional credentials consisted of two years as an administrative assistant in the HEW Secretary’s office and five with the National Council on Alcoholism, the last three running its Washington office. So Pinney knew a thing or two about addiction and was politically adroit enough to take the OSH post only when it was yoked to his designation as an Assistant HEW Secretary, giving him direct access to Califano and Surgeon General Richmond. The latter, while seriously concerned about smoking, lacked the forcefulness to project the issue and delegated much of the task to the eager Pinney.
The new OSH director had a clear-eyed view of HEW’s only other effort on the smoking problem, the National Cancer Institute’s program under Gio Gori to develop a less hazardous cigarette: “It would be hard to have thought up a more ludicrous thing than this for the U.S. government to be spending public dollars on—for something the industry itself should have been doing. … [I]t was a waste of money and time when the bastards knew more than we knew, and the NCI could point to [its Smoking and Health Program] and say to Congress that it was doing something. I felt it was wrong and a sham.”
To gear up his own operation, Pinney brought back the old Clearinghouse’s gifted publicist, Robert Hutchings, who was rejuvenated by “the excitement of a new enterprise” that Pinney generated, with Califano as a spiritual and at times almost corporeal presence. “You could hear his voice coming over the phone down the hall,” Hutchings remembered. But Pinney’s budget was not
large enough to accommodate a full-time medical officer or scientific director, a void that became all too noticeable as he set out to satisfy his primary command from Califano and Richmond—producing a new Surgeon General’s report on smoking to be issued on the fifteenth anniversary of the original one and to set a new standard for accuracy and comprehensiveness.
“We designed the 1979 report to put an end to the controversy the industry kept alive over whether smoking was a health peril,” Pinney recounted. “It had to be a single volume, no matter how large—I insisted on it—so that you could take it in and throw it down before a congressional committee and say, in effect, There it all is, gentlemen.’“ Pinney had only nine months to produce that volume. The OSH staff was overwhelmed by the scope and depth of knowledge needed to carry out the assignment, and it was August by the time Pinney got the idea of summoning a reluctant Shopland, who had been involved in every Surgeon General’s report from the first, back from Atlanta. Shopland found the effort “a shambles,” especially the chapter on causality, which was loaded with technical detail but failed to spell out the degree of risk adequately, and the one on heart disease, which lacked hard data and illustrative tables. “If it hadn’t been for Shopland,” said Pinney, “I don’t think we would have succeeded.”
Shopland knew where to turn for authoritative writers, editors, and reviewers. His chief recruit was a brilliant, Harvard-educated pulmonologist, David M. Burns, then thirty-one, who had been the Clearinghouse’s medical officer at the end of its residence in Washington and the beginning of its exile to Atlanta before he transferred to the University of California Medical Center at San Diego to pursue his specialty. Burns hurried to Washington to help Shop-land unscramble the mess and then worked over the emerging text from his West Coast base. The team succeeded not least because Burns understood Shopland’s unique skills. “He is a testament to the good things that can happen in government service to someone who’s bright, conscientious, selfless, and focused,” said Burns. “He put purpose and effort ahead of his own advancement, he sacrificed himself. … He could argue with Ph.D.’s at the NIH and deal with people who headed big programs, because he always had the facts and had them right … .” Shopland also wrote with what Burns called “a remarkable grasp of what the critical elements were,” as the pair of them reshaped and reorganized the mass of material pouring in on them.
To raise the report to a higher level of scholarly acceptance required the enlistment of top-flight peer-reviewers, whose critical appraisals of the steadily growing mass of findings had to be integrated into the emerging text if it was to constitute a true scientific consensus. It was no easy task to find reviewers with both a detailed knowledge of the field and what Burns termed “a global view”. He added, “And the science had to be watertight and not step beyond the evidence, because you knew it wasn’t just going to slide by out there.”
This high degree of scientific conservatism meant there could be no such thing as pride of authorship during the process. Writers, who were paid a few thousand dollars to compose a chapter, understood that they were participating in a group project and knew that the editors and peer-reviewers might pull their prose apart. The reviewers were not paid at all, Shopland recounted, “because we didn’t want them to feel beholden,”
i.e.
, to slant their critical evaluations in a way they may have felt the OSH preferred and thus assure themselves of a reward. In marked contrast to many of the scientists paid to vouch for the industry’s denials or nitpick the medical evidence against smoking, those who worked on the Surgeon General’s report did so not for monetary gain but largely for the professional recognition that came to them for weighing the case strictly on the merits of the evidence.
The 1979 Surgeon General’s Report and those immediately succeeding it attained a breadth of scope, precision of balance, and degree of completeness rarely if ever matched in the annals of public-health literature. No other pathological process got reviewed with the same intensive, ongoing scrutiny for so many years as smoking and its ravages, and while the reports were largely incomprehensible to laymen, they effectively put an end to the scientific “controversy,” which lingered in the public’s mind only because the cigarette makers had the money, power, and brass to claim that there still was one.
IX
ALTHOUGH
Jimmy Carter remained aloof from the public-policy issues surrounding smoking, he had made another appointment in addition to Califano that would eventually have an impact on government regulation of cigarettes. Asked by the President who could chair the Federal Trade Commission most ardently in the public interest, Ralph Nader had recommended the Senate Commerce Committee’s chief counsel and staff director, Michael Pertschuk, who for thirteen years had helped shape consumer-friendly laws. Pertschuk cut a unique figure among Capitol Hill operatives, in his hornrimmed glasses, turtleneck shirts, and tweed jackets. But a guileless manner and disarming humor were deceptive accouterments of a politically activist tendency with which he animated the commission as never before in its lackluster history.
Pertschuk did not give the smoking issue much priority at first, though he had had a major role in every measure, however ineffectual, the government had taken in the previous dozen years to regulate the cigarette companies. Part of this hesitancy stemmed from Pertschuk’s uncertainty about what action the FTC could now undertake that would be tolerated by the industry and its allies in Congress. A toughened warning label was talked about, but few believed
that any warning would do much good, and while some hyperactivists favored extending the broadcast ban to include all cigarette advertising, the most that realists were willing to propose was limiting cigarette print ads to the “tombstone” format of text without illustrative elements beyond a picture of the brand package. But the prospects for such a curb were bleak, and Pertschuk chose instead to press other battles, including those against abuses in the television advertising of children’s products and the exploitation of the poor, gullible, and otherwise vulnerable by, among others, funeral directors, used-car dealers, mobile-home manufacturers, and life and health insurance companies.
All this out-front activity came at a time when the public was losing its sense of outrage over unethical business practices against consumers—a shift that Pertschuk had not detected. Instead of lubricating congressional concern with quiet backroom dealing of the sort he had mastered while working on Capitol Hill, Pertschuk assumed a noisy, even tactless tone in his pronouncements and soon was perceived in Congress as overreaching for power. Influential enemies began to tab the FTC chief as a nagging nanny to the nation.
With regard to the cigarette business, such “nannyism” in the form of state paternalism—
i.e.
, telling people to do what was good for them—had ample justification. Parents did not usually allow their children to suffer by learning from experience about the perils of electric sockets, household poisons, railroad crossings, and the like, and so the government, acting
in loco parentis
, had a vital role to play in warning youngsters about the risks of smoking. As James Fallows observed in his article “The Cigarette Scandal” in the February 1976
Washington Monthly
, “The forces that draw children toward smoking in those awkward teenage years may be only temporary, but the consequences are not.” That same year, the FTC had initiated an investigation to determine whether government actions had “effectively remedied deceptive practices” by the cigarette industry’s advertising. Did the companies’ marketing strategy amount to wholesale seduction of the innocent? Did their ads deal adequately with the probability or severity of the dangers of smoking? How much did the public really know and understand about this subject? Were the current warning labels useful? What further steps ought the government to take?
Pertschuk added impetus to the inquiry by insisting that the industry provide not only routine data on its advertising and promotion outlays but also any extant documents detailing advertising strategies, what efforts the cigarette manufacturers had undertaken to attract new smokers, and any research studies they had conducted about smoking behavior. When the industry balked at this as an invasion of privacy and its right to do business free of harassment, the FTC issued fifty-six subpoenas requiring the companies, their ad agencies, and research consultants to provide documentation of their marketing programs and strategies dating back to 1964. The commission offered assurances that all
documents would be kept confidential, but the industry, dismissing the pledge as meaningless and the whole sweeping investigation as a fishing expedition, went to court and for more than two years kept Nanny Pertschuk and his staff at bay.
During that period, the commission staff persevered, and its findings were not encouraging. The per capita consumption of cigarettes by Americans eighteen or older had barely dropped, from 10.97 to 10.57 cigarettes a day, between 1970 and 1979, and smoking was on the rise among teenagers and women. Taking inflation into account, the cigarette companies were spending 50 percent more on advertising and promotion by 1979 than they had in 1967, and theirs had become the most heavily advertised product in the U.S. economy. R. J. Reynolds was the largest individual advertiser in American magazines, and almost half of all billboards across the land were pitching cigarettes.
Thematically, cigarette ads had not materially altered their practice of associating smoking with youthful vigor, sports and other strenuous activities, and social, professional, and sexual success. It was as if all the industry ad codes had never existed. Kool still tasted like “menthol mist” materializing from a picture-book waterfall or ocean spray, and “country fresh Salem” was still synonymous with “light mountain breezes” and “clear rippling waters.” Camel Filter invoked boldness and adventure: “Some men taste it all.” Old Gold displayed a young backpacker taking a smoking break while overlooking an expansive valley from a mountain crag. Winston was being pushed as a totem of adulthood; it was the brand that “may not be where you start. But when your taste grows up, Winston is for real.” Brands aimed at the health-conscious were less subtle than earlier in implying a margin of safety: “With Vantage, I don’t have as many problems with smoking.” Lorillard went a step beyond that: “Considering all I’d heard, I decided to either quit or smoke True. I smoke True”—as if to say the alternatives were equally therapeutic. And, of course, nowhere in any cigarette ad, even in the government’s warning label, was there a hint of the grave reality of the habit: one in seven U.S. deaths was thought to be smoke-related; pack-a-day smokers had a life expectancy six years shorter—and two-pack-a-day smokers eight years shorter—than non-smokers; a smoker was 70 percent more likely to die at any given age than a nonsmoker; and 70 percent of lung cancer victims died within a year of detection.
The image merchants of Madison Avenue were more than capable, moreover, of upstaging the warning message from the Surgeon General. The FTC regulators, mostly lawyers, had naturally been inclined, as wordsmiths, to dwell on the textual content of cigarette ads rather than their visual aspects. But even untutored analysis of the industry’s print advertising disclosed how effectively it had used overpowering graphics—bold imagery, lush landscapes, huge scale, vivid coloration, sharp contrast, simulated movement—to divert
the reader’s eye from the health warning. In an astute article titled “Graphic Propositions” in the
Tobacco Products Litigation Reporter
, Charles Zerner of the Massachusetts College of Art analyzed a number of 1974 cigarette ads and concluded that the cigarette makers’ skillful disguising of the cautionary message and use of thematic implications contradictory to the warning label could well amount to a negligent failure to warn smokers. No company was more adept at this artifice than Philip Morris, and no brand more skillfully took the smoker’s mind off the health risk than Marlboro. A classic instance was its ad in the February 2, 1974, issue of
Newsweek
showing a pair of horsemen set against a latticework of snow-clad birches in what Zerner described as “a landscape of poeticized winter-white images” over which the thick, white, Old West-style letters of the brand name “float like manufactured clouds above the environmental drama of Marlboro Man, horses and snow.” The effect was to suggest that Marlboro was inextricably bound up with nature itself, that Marlboro smokers were rugged and capable, that inhaling Marlboro filled you with air as pure as wilderness and crisp as winter, and that “Marlboro Country,” as Zerner put it, “is breathing room. In its immensity and exteriority it is … a pictorial counterbalance to what many smokers have come to experience and fear: the constricted, polluted, stained, and diseased interiority of cancerous lungs.” Thus was the warning label trivialized.