Authors: Richard Kluger
Kensler undertook missionary work among several top public and private health officials and academics, trying to pave the way for publication of the palladium findings. Articles were prepared for
Science
and
Preventive Medicine
with careful vetting by the Liggett lawyers, along with a paper by Kensler and Mold for delivery at the International Cancer Congress held in the fall of 1978 at Buenos Aires. Meanwhile, using such published reports—the only one at hand thus far was the abstract run by
Cancer Research
—Liggett’s marketing people began working up sample ads for the palladium brand, now dubbed Epic, that they hoped would withstand the FTC requirement for scientifically supportable health claims. The most straightforward of the prepared ads stated, “This abstract appeared in the journal of the American Association of Cancer Researchers,” gave the text and Liggett’s name as sponsor of the research, and added blandly, “This process of treating tobacco is patented by new Epic cigarettes.” A more deviously aggressive version stated, “It’s worth trying just for the taste but—
UNTIL THE GOVERNMENT CHANGES ITS POLICIES, WE CAN’T REALLY TELL YOU WHAT’S NEW ABOUT NEW EPIC
.” The most confrontational of all the proposed texts read, “We don’t believe that mice-painting tests can be extrapolated to humans. But you may believe. And we think you deserve a choice. Which is why we now report … ,” and gave details on how the Epic reduced cancerous tumors in mice up to 100 percent.
But these ads, prepared in September of 1978, were never brought to the FTC for its approval. And when Kensler and Mold showed up in Buenos Aires in October, ready to pass out publicity releases and hold a press conference in support of their presentation on the palladium development, the plug was pulled on them at the last second. Mold remembered their getting “a frantic call from New York” canceling the publicity blitz. No more than a few dozen scientists were on hand for their oral presentation, and the paper was only abstracted and not run in full in the published proceedings. House counsel Greer ordered articles approved for submission to
Science
and
Preventive Medicine
to be killed, the research and development staff was slashed severely, and efforts were intensified to find a taker abroad for the palladium concept. The Epic was stillborn.
The decision to put it aside was made by many at Liggett, prominently including a newcomer to the company, Kinsley V. Dey, who had taken overall
charge of tobacco operations. Dey was unwilling to bet the whole store on Epic, and, as he told congressional investigators ten years later, “We could not substantiate the health claim,” beyond the circumscribed and highly ambivalent manner of the sample ads cited above, so “[i]f you can’t say anything about it, you can’t put it in the marketplace. … If we could have found a way to do it fitting within the rules and regulations we had to live under, you betcha we would have marketed it.” Dey was probably being more forthright when he added that if Liggett had marketed the palladium brand, the company believed it “would have been attacked from all sides—the government, health authorities, antismoking groups, and especially our competitors.” Furthermore, Liggett was by then into heavy discussion with would-be buyers like Grand Metropolitan, a British conglomerate eager to get hold of its lucrative liquor franchises; why endanger an attractive buyout with all the uncertainties of the palladium option?
When Mold and Kensler were denied permission to attend a conference on the less hazardous cigarette with other leading authorities in the field, held in the fall of 1979 at the Banbury Center in Cold Spring Harbor, New York, the Liggett scientist had had enough. After more than a dozen years on the palladium project, during which he suffered two coronary attacks, Mold was heartbroken in more ways than one. The experience was “a total frustration” for him, one that he had endured because “it looked to me as if we were trying to do the right thing.” In the end, they took the course safest only for the company’s bottom line. For Mold, whose passionate belief in the palladium process had kept the project alive as long as it was, it amounted to a vivid lesson in how corporate capitalism deals with its technological innovators: “The creator has no options whatever … .”
The whole saga was not without its surreal aspects: “Here these guys develop a product that’s really innovative—and therefore dangerous,” said an outside attorney of counsel to Liggett during these years. “And thereafter half the executives in the place were trying to figure out how to bring it to market while the other half was trying to kill it.”
IV
IN
the fall of 1978, President Carter appeared at a Softball game in his native Plains, Georgia, wearing a cap with the stitched inscription “Pride in Tobacco”. Near the end of the year, U.S. House of Representatives Speaker “Tip” O’Neill warned the nation’s most vocal antismoking advocate, HEW Secretary Joseph Califano, “You’re driving the tobacco people crazy. These guys are vicious—they’re out to destroy you.”
Califano nevertheless made a media show out of the release of the 1,100 page
Surgeon General’s report that the devoted little band at the Office of Smoking and Health had struggled to have ready by the fifteenth anniversary of the pioneering report that had been the public-health community’s declaration of war on smoking. In the intervening years, as Surgeon General Julius Richmond wrote in the preface, the scientific evidence on the hazards of cigarette use had become “overwhelming”. True, an average of 2 million Americans had quit each year since the 1964 report, lowering the percentage of smoking adults from 42 to 33 percent in that span, but the number of young people taking up the habit had not declined, and women, especially teenagers, were smoking more heavily now than then. The report placed the economic cost of cigarette smoking at $27 billion a year due to increased medical care, absenteeism, decreased work productivity, and smoking-related accidents; nonsmokers were said to bear a large portion of the bill through higher health insurance premiums, disability payments, and other tax-supported programs.
Of particular concern in the 1979 report was the news that the once-low death rate due to lung cancer among women, long cited by tobacco industry defenders as a disparity undermining all the population studies on the health risks of smoking, had risen threefold over the previous fifteen years. As Califano grimly put it at his press conference, “Women who smoke like men die like men who smoke.” Pregnant women who smoked were on average 40 percent more likely than nonsmokers to give birth prematurely and about 30 percent more likely to lose their babies soon after birth. A second major area dealt with in the new report was the effects of carbon monoxide, hardly touched upon in the 1964 report but now understood to be one of the most harmful components of tobacco smoke and a “possible critical factor” in the onset of heart disease. The systemic toll taken by the toxic gas was most obviously manifested by the reduced pressure at which the blood, its hemoglobin depleted by the carbon monoxide in smoke, delivered oxygen to the body’s tissues, dependent upon it for growth and sustenance; this was especially true of fetal tissue, which was often malnourished in expectant mothers who smoked and as a result had low-weight babies. A third subject on which investigators had gathered much new information was how emphysema likely developed. The hypothesis was based on the discovery that the disease was common in individuals deficient in alphapantitrypsin, an enzyme that inhibits the effects of protease, another enzyme that gives elastic capability to the lung’s little air sacs, allowing them to expand and contract. An inadequate supply of this inhibitor made the air-sac walls lose their resiliency, distend, and readily rupture, thus reducing the surface area of the lungs exposed to the bloodstream and lowering their capacity to deliver oxygen and remove gas wastes. This imbalance of enzymes was now believed to be fostered by cigarette smoke, which excited the macrophages, the lung’s scavenger bodies, to synthesize and release too much protease.
The President made no comment about the weighty new report from the Surgeon General indicting smoking as America’s foremost preventable health menace—but then none of Jimmy Carter’s predecessors had ever urged his countrymen to forbear the killing custom; that was the job of the Surgeon General, who did not have to stand for reelection. But without presidential endorsement, the report was a vulnerable target for those with a vested interest in tobacco. North Carolina’s state commissioner of agriculture, for example, told reporters after HEW’s press conference, “I’m sick and tired of Joe Califano’s ballyhooing the smoking and health question,” and dismissed the new Surgeon General’s report as “just another statement … 90 percent of it propaganda” and part of a “personal vendetta”. Before anyone on the Tobacco Institute’s staff could have read the volume, a spokesman called it “more rehash than research” and more of a “publicity stunt” than a serious scientific document.
In this latter characterization, the tobacco manufacturers did have a point of sorts, but at best a minor one. Arnold S. Relman, then editor of
The New England Journal of Medicine
, has suggested that it was not the function of the Surgeon General’s report to present new data and findings, as his own magazine did; rather, the annual HEW reports to Congress were “public documents, public events, not scientific documents at all … .” But as one of the reports’ leading organizers, Donald Shopland at the Office on Smoking and Health, noted, since the reports were “a legitimate response by the public-health community to a perceived peril,” why not advance them directly into the arena of public consciousness as the occasion for media events? Too technical to be read in detail by laymen, the reports—especially the 1979 one and those over the next seven years—were accepted at face value by most of the public as balanced and accurate statements of the scientific consensus on smoking. The tobacco industry, without authentic evidence to the contrary, was reduced to trying to trivialize the reports by remarks like those by TI spokesman William Dwyer, who, referring to the 1979 document, quipped, “America, beware if Joe Califano ever decides to give up drinking and other pleasurable pursuits.”
The cigarette makers, at such moments of authoritative rebuke, could have said nothing so long as they were left free to profit hugely from their certifiably dangerous product. Instead, they continued to behave as if silence were a confession of guilt. Thus, the day before the Surgeon General’s report was issued, and without troubling to familiarize themselves with its contents, the Tobacco Institute published a 168-page booklet,
Smoking and Health, 1964–1979: The Continuing Controversy
, in rebuttal. The TPs president, Horace Kornegay, wrote in its preface: “The process of making public policy is better served when areas of scientific unknowns are illuminated by the light of reasoned deliberation rather than the heat of emotional rhetoric … . It is time for all parties to this [smoking and health] controversy to admit that there is much that, is unknown.”
This model of sanctimonious self-justification was censurable not merely because it was disingenuous on its face but because it soared so far beyond the boundaries of legitimate advocacy. The last thing the tobacco industry was interested in was “reasoned deliberation”. If it had cared to join in a rational discourse on the scientific charges against it, it might at least have considered them on their merits as rendered in the new report before spieling off the same old mocking denials—the same dismissive allusions to “flawed population studies” and the rise in lung cancer as the result simply of “better diagnostic techniques”. The last thing, furthermore, one could have fairly said of the Surgeon General’s 1979 report, like those before and after it, was that it was heated by “emotional rhetoric”. If anything, the government reports were too clinical to rouse the public over the enormity of their implications. Finally, by conceding nothing and challenging everything in their vehemence for self-preservation, the cigarette makers and their dependents fell well short of even marginally acceptable moral conduct. For while it was true, as the Tobacco Institute’s attack literature argued, that much remained unknown about the specific mechanisms of how a cancer began to grow, why human arteries became clogged with lipids, or the exact pathogenesis of emphysema, these were towering irrelevancies when placed alongside the consensual understanding, beyond any reasonable doubt, arrived at by thousands of disinterested investigators, of how severely cigarette smoke insulted human tissue.
Ironically, one of the fiercest critics of the 1979 Surgeon General’s report was John Banzhaf of Action on Smoking and Health (ASH). The report, he charged, was “criminally deficient and misleading,” mostly a rehash, a gloss on-the addictive nature of smoking—a finding that might “dramatically alter the way we deal with the entire smoking issue”—and “incredibly weak” on secondhand smoke. Banzhaf was also unremitting in his overall charge that HEW’s antismoking campaign as voiced by Secretary Califano had been “completely ineffective,” largely because he had asked people politely to act on the smoking peril—and “they have told him no.” A glaring example, said Banzhaf, who had a tendency throughout his antismoking career to mistake the real enemy, was Califano’s appeal by letter to the chief executives of the nation’s 500 largest corporations, asking them to confront the smoking problem; the only response was the establishment of a separate nonsmoking section in a few company cafeterias. But what could a single Cabinet officer, unsupported by his President or a serious budgetary allocation for the purpose, really accomplish in a single year against a large industry outspending him hundreds of times over to persuade the public not to abandon a beloved social custom, however dangerous?
What Califano achieved was to ventilate the smoking issue as no federal official had before him—and in so doing put his political neck on the chopping block. In April 1979, Califano’s friend Senator Edward Kennedy told him he
would have to remove himself from the Cabinet well before the 1980 election, because Carter could not carry North Carolina and perhaps a lot of other Southern states if the HEW Secretary remained in office. Unable to please either side in the public-policy debate over smoking but successful in reaching countless multitudes in the middle ground, Califano became the thankless victim of his antitobacco crusade a few months later, when he was made to walk the plank by a President who could only commend him for his energetic performance in office. Tobaccoland cheered.