Authors: Richard Kluger
Upton roused his top biostatitician, Marvin Schneiderman, then vacationing in Maine, and sought his views on Gori’s article. Schneiderman had indeed seen Gori’s computations and told Upton that by his arithmetic, smoking two of the unfiltered, pre-1960 cigarettes a day was sufficient to double a smoker’s risk of lung cancer. He thought Gori’s claim was “overstated and wrong” and added his belief that there was simply no known threshold of safety for lung cancer. “My concern was that if we say there is a safe level of smoking, we’re going to encourage kids to start smoking,” Schneiderman recalled.
Upton’s initial comment to the press on Gori’s computations was a moderate rebuke, noting that “our present knowledge does not allow us to establish [any levels] below which smoking might be safe” and that “no cigarette now on the market can be considered wholly without risk to health.” By the next day, though, Upton’s distress was showing in the
Post’s
follow-up article. He lashed out at Gori’s “assumptions” that anyone can smoke any given number of cigarettes at low risk, found the use of the term “tolerable” to be “unfortunate,” and charged that Gori’s statements “set back our cause, and even if we can correct the misinterpretation, we will have lost valuable momentum.” Two weeks later, Upton told a writer for
Science
that the nub of the problem was that Gori’s case depended upon the assumption that the risk of dying from smoking decreased “in exact proportion to the decreases in the concentration of those six toxic agents,” but there was no evidence to support it. And there might well be other dangerous ingredients in cigarette smoke with effects as yet uncalculated.
Over at the Office on Smoking and Health, where they were scrambling to turn out a definitive Surgeon General’s report by early January, the Gori article “came as a bombshell” to David Burns, the senior scientific editor. Gori’s claims seemed “off the wall” to Burns and his colleagues and lacking in corroborative evidence in the form of smokers with actual histories of the cited “tolerable” doses. In dealing with millions of smokers, to speak as Gori had of abstract equivalency ratios of yields of toxic substances and “tolerable” risk levels was a very sticky business scientifically, “because you’re still talking about a whole lot of deaths,” said Burns. Gori’s whole approach, in the view of OSH’s technical officer Donald Shopland, amounted to “false reassuring of the public.”
Besides grossly overselling his idea, Gori made a second mistake that was fatal for him. He did not accept critical advice by outside experts from whom he sought it and did not invite his own organization to undertake a stringent review of his paper, even when he knew that his parent department had adopted a strong antismoking policy. Having spurned the skeptical views of his NCI
colleague Marvin Schneiderman, Gori turned to the keenly admired epidemiologist Jerome Cornfield at Johns Hopkins, who, according to Schneiderman, approved of some of Gori’s paper but had serious misgivings about other parts of it. More revealing still was the view of Gori’s role model, Ernst Wynder, who admired him as “a very clever fellow” and appreciated his help in funding smoking research by Wynder’s American Health Foundation during its fledgling years. According to one close associate, Wynder told Gori “in no uncertain terms not to publish the article in that form, that it would bring down a firestorm around him, and provide his critics with the ammunition to blast him out of his little empire.” Wynder himself acknowledged later that he thought it a great mistake for Gori to move beyond his theoretical construct by citing brand names and their equivalency values.
Within NCI’s official channels, Gori had taken the path of least resistance. As he later explained it, “Internal review at the NCI was always performed by the experienced Dr. [Bayard] Morrison [the assistant director], who also approved this paper. Had it been published six months earlier, it would have been just another report. Instead, it came out at a time of abrupt policy changes.” In fact, Morrison had passed on the paper in June of 1977, a full half-year before the HEW’s antismoking initiative was announced by Califano and nine months before
JAMA
accepted Gori’s article—plenty of time for Gori to have shown a study of such debatable conclusions to many of the other experts available to him on the NIH campus in Bethesda or even to have sought the advice of the review board of NCI’s own journal. Instead, he relied on Morrison, a longtime NCI survivor and an adroit technocrat but, in the view of some, an inappropriate judge of a subject as controversial as the Gori-Lynch hypothesis. Morrison himself disputed the view that Gori was not enough of a scientist to have posited the tentative conclusions he had formulated: “You didn’t have to be a Nobel laureate to be a perfectly adequate interpreter of the data … . There was real substance behind what he was saying, and it was not such a Machiavellian thing, after all. All his correlations and equivalents were scientifically determinable … .” What was not determinable, however, was the validity of the threshold concept of “tolerable” risk, upon which the whole paper was premised. Gori, perhaps fearing that his article would be quashed, chose not to call it to the attention of either NCI director Upton or his deputy director, Dr. Guy Newell, who said of the claim that the article had been sent through proper channels, “In my opinion, Dr. Gori misjudged how much end-running the [NCI] administration would tolerate.”
In the view of Surgeon General Julius Richmond, Gori himself may not have been a captive of the cigarette manufacturers, but his years of salesmanship in behalf of “low-risk” smoking “were like a gift from heaven for the industry.”
Business Week
, for example, had headlined its report on the Gori-Lynch article “A Cigarette Study the Industry Likes.” By the end of
1978, Gori’s star at NCI was in decline, he had been transferred from running the smoking research program, and the institute had begun the process of shifting its focus from modifying cigarettes to modifying the behavior of their users. Gori hung on for several years before departing for a post at the Franklin Institute and consulting work for cigarette maker Brown & Williamson.
II
ALTHOUGH
Gori’s endorsement of milder cigarettes as an alternative for those lacking the will to quit the habit upset many in the public-health community, smokers were grasping his point. Sales of Carlton, the brand Gori said could be smoked in the highest quantity with “tolerable” risk, jumped 50 percent in 1979. By that year, about 35 percent of smokers were using cigarettes in the low-tar range of 15 mg. or under—a big increase from the 2 percent smoking such brands only a dozen years earlier. And 11 percent of smokers were buying brands with 9 mg. or fewer. Between 1965 and 1980, the tobacco industry had brought down the yields of the sales-weighted average cigarette from 37 mg. of tar and 2 mg. of nicotine to 14 mg. of tar and under 1 of nicotine.
These figures did not set off a celebration, however, at the Office of Smoking and Health, precisely because Gori’s proposition seemed mischievously seductive. His enticing message was interpreted, in the words of OSH’s Don Shopland, by the typical listening smoker this way: “I may not like these weak smokes and may get a hernia drawing on them to extract any pleasure whatever, but wow! they’re practically risk-free.” Smokers not only felt they could consume more of the lower-yielding cigarettes but also were smoking them now, as Shopland put it, “down to their fingernails.”
Such compensatory behavior was soon documentable. Where the average smoker had consumed twenty-two cigarettes a day in 1954, he or she was smoking thirty a day in 1978. This increase suggested that the quitting rate was higher among those who smoked less than average and/or that those buying the “less hazardous” brands were smoking more of them than of their previous, and presumably more hazardous, brands. Investigators in this period led by Lynn Kozlowski were putting together detailed evidence of smokers’ compensatory devices. Although half of all cigarettes manufactured by 1980 had tiny holes in the filter overwrap in order to ventilate carbon monoxide and dilute tar and nicotine, some 40 percent of smokers were found to block the holes, consciously or not, while they smoked. A second major modification in cigarette manufacture—a faster burning rate, achieved by looser packing of the tobacco, more porous paper, and burn-enhancing chemical additives—further reduced tar and nicotine yields. But the typical smoker, who averaged about ten puffs
per cigarette, could derive a lot more than the machine-rated yield of the low-tar brands by managing an extra drag or two from each or smoking them more intensively. Kozlowski estimated that someone smoking a low-tar cigarette the same way users of marijuana smoked theirs—inhaling deeply, holding the smoke down a while, and consuming every fraction of an inch—could derive as much as 70 mg. of tar from it.
However much any given smoker was compensating after switching down in brands, the sales trend toward the lower-yielding segment of the market was clear, and the industry competition heated up accordingly. But without television and radio advertising available to them, the cigarette companies found the going rough, especially when they tried to launch new, freestanding brands rather than extend their established lines with lower-yielding versions. One particularly unhappy example was R. J. Reynolds’s 9-mg. entry in 1977—Real. In celebrating Real’s “natural” goodness, RJR seemed to be trying to make tobacco into a health food of sorts, like granola or yogurt with perhaps a dusting of wheat germ, without noticing that smokers by and large were not exactly health faddists. Despite a $50 million ad campaign, 25 million sample packs, and 150 boxcars of promotional material, the brand struggled to get off the ground. Realizing the fatuousness of its health-food slant, Reynolds ditched the “natural” idea and replaced it with the ambiguous slogan “Low tar and taste.” By 1980, Real was pronounced dead, and Reynolds was pushing line extensions to bolster its share at the low end of the yield spectrum.
The year Real died, Philip Morris decided to attack the ultra-low end of the market with a new brand. Carlton and distant runner-up Now, the only two entries in that l-mg.-and-under category, commanded less than 3 percent of the market between them, so PM reasoned that it could make a big splash in that quiet little pond. But in bringing out heavily ventilated Cambridge, with 1 mg. in its soft-pack version and a mere 0.1 mg. in a box (so it could claim to be the lowest on the market), Philip Morris forgot all the lessons that had brought it close to the top of the industry. The packaging was unappealing, there was no unique selling proposition beyond the minimal yields, and its taste was barely detectable. Even a $60 million advertising send-off could not cure the built-in problem. “Everybody felt we had to do this,” recalled Shepard Pollack, then president of Philip Morris USA, “but we probably outsmarted ourselves and overintellectualized the need. The brand had no parents [at the company] other than necessity. It was a flat, me-too offering.” Cambridge sold fewer than a million packs a week for three years, and by 1983 was selling only half that. Philip Morris turned instead to Merit Ultra Lights with 4 mg. of tar and at least a
frisson
of flavor.
Far more needy than industry leaders Reynolds and Philip Morris to stake and hold a claim in the ultra-low field was Brown & Williamson, which in 1973 had overtaken American Tobacco for third place in market share but by
1980 had only 14 percent of the U.S. market, and that figure was softening. To reverse its slide, B&W put down a great many chips in the fall of 1980 on a new brand it called Barclay, which won a 1-mg. rating from the FTC’s smoking machines. Barclay’s purveyors said of it, “The pleasure is back,” meaning that it had more flavor than other brands in its niche. Behind this claim was some interesting cigarette engineering. In place of the 20 to 250 little air holes that other low-tar brands had punched into the filter overwrap, Barclay had four air channels, little tunnels placed equidistantly around the circumference and running from intake holes about two-thirds down the filter, beneath the overwrap, which delivered the ventilating air directly into the smoker’s mouth. Where the holes in other brands’ filters diluted the smoke before it entered the mouth and speedily whooshed straight to the back of the oral cavity, missing the sensitive taste buds at the tip of the tongue, the as yet undiluted smoke in Barclay entered the mouth more slowly, mixing with the air brought there from the little subsurface tunnels and rolling more leisurely over the tongue to produce a keener taste sensation.
The device was promising enough for Barclay to aim for a quarter of the ultra-low market and for B&W to budget $150 million for the launch. Within nine months, Barclay had grabbed a 1.2 percent share, even better than the Louisville-based manufacturer had hoped, and its rivals were growing envious—and also suspicious. Reynolds and Philip Morris researchers tested Barclay and saw that the air tunnels in its elaborate filter produced a slightly ridged effect to the touch, tempting the fingers or the mouth encasing them to smooth the little bumps by crushing them down level with the rest of the filter overwrap. This, of course, destroyed their diluting effects and raised their yields well above the rating recorded by the FTC laboratory’s smoking machines, which, devoid of tactile sensation, had no desire to exert pressure on the elevated air channels. In short, Barclay appeared to its competitors to have been intentionally designed to fool the FTC’s testing devices in order to obtain a low-yield rating.
After urging Brown & Williamson to modify its ultra-low yield claims and being urged in return to go fly a kite, Philip Morris joined with Reynolds to protest Barclay’s “design defect” to the FTC, arguing that whether it was deliberate or unintended, the brand in the hands and lips of real smokers produced a yield of 7 to 8 mg. of tar, not the 1 mg. Barclay claimed. B&W angrily denied the charge, complaining that it was the victim of “natural hostility from entrenched leaders” of its industry. To settle the squabble, the FTC named a three-man panel of independent experts, including Lynn Kozlowski, who concluded that the Barclay’s air channels were “compromised with great regularity,” and as he described the process, “lip pressure can cause the channels to buckle; place a Barclay carefully in your mouth and squeeze; you can ‘hear-feel’ the channels buckling … .” The net effect of the design flaw was a true tar
yield in the 3- to 8-mg. range, the investigating panel reported to the FTC. Eventually the commission settled on a 3-mg. rating for Barclay, but by then, the initial momentum of the disputed brand had dwindled and, after peaking at a 1.3 market share, it tailed off badly.