Cornered (20 page)

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B
EFORE THE
1950s the tobacco companies had no serious predators, only moralizing tub-thumpers who repeated, to no enduring effect, that tobacco was inherently dirty and ungodly and encouraged crime. Some scientists and medical authorities had claimed for years that the use of tobacco could contribute to cancer-cell development in susceptible people, but so meager was the actual knowledge that the warnings were easily dismissed by the cigarette manufacturers. The companies concentrated on production efficiency, improvement of tobacco drying techniques, and stronger marketing methods. Sales boomed, especially in wartime.

Like the arms merchants, the tobacco companies came out of two world wars with remarkable prosperity: sales had shot up from 18 billion cigarettes in 1915 to more than 360 billion by the end of the 1940s. On the front lines, the generals respected nicotine's calming influence on troops before a battle as well as its ability to suppress the appetite and they demanded almost as many cigarettes as bullets. When the United States entered World War I in 1917, General John Pershing cabled Washington, “Tobacco is as indispensable as the daily ration; we must have thousands of tons of it without delay.” Army doctors reported that “as soon as the lads take their first whiff they seem eased and relieved of their agony.” The doughboys and the British Tommies came home singing one of the most famous songs of the war, “Pack up your troubles in your old kit bag and smile, smile, smile / While you've a Lucifer to light your fag, smile boys, that's the style.”

Early rumblings about the harmful effects of tobacco among a handful of doctors were quickly subsumed by patriotic fervor. The
Lancet,
the oldest of the British medical journals, commented, “We may surely brush aside much prejudice against the use of tobacco when we consider what a source of comfort it is to the sailor and soldier engaged in a nerve-racking campaign.… Tobacco must be a real solace and joy when he can find time for this well-earned indulgence.”

In World War II, President Roosevelt made tobacco a protected crop and draft boards gave deferments to tobacco growers. On the front lines in Europe, Africa, and the Pacific, tobacco was part of the daily ration. There was intense competition between the tobacco companies to produce the favorite smoke. It became a race between Camel, Chesterfield, and Lucky Strike. Reynolds claimed that “Camels are the Favorite! In the Army!… In the Navy … In the Marines … In the Coast Guard.” Chesterfield recommended, “Keep 'em Smoking: Our Men Rate the Best.”

In the postwar years, murmurs that cigarettes might be seriously harmful went unnoticed or were simply ignored by a confident and increasingly prosperous tobacco industry. It had understandably come to see its enterprise as one of the most commercially solid and legally untouchable in the world. Only the mint makes money more easily, was the saying. Seventy million Americans smoked, hundreds of millions more in Europe. The markets in Japan were opening, the Pacific rim presented a new opportunity, and Africa was untapped. Tobacco executives dreamed of the day when the communists would be thrown out of the Soviet bloc and those markets freed for the Marlboro stampede.

Why worry about a handful of isolated reports from a few young researchers who had found a statistical association between smoking and lung cancer and heart disease? Why be concerned that chewing tobacco had been blamed for the development of cancer of the mouth?

Public health officials in Britain and the United States were very worried, in fact, about the staggering increase in the number of deaths attributed to lung cancer. The disease had reached epidemic levels. In Britain, there had been a fifteen-fold increase since 1922. In America, the number of lung cancers per 100,000 males shot passed prostate, colon, and stomach cancers in the early 1950s, and kept on rising. Doctors thought the most likely cause would probably turn out to be industrial pollution, automobile exhausts, and possibly even the tarring of the roads. British researchers thought that arsenic might be the culprit because of its increased use in the treatment of syphilis.

There had been only hints about the link to smoking. At the turn of the century, tobacco workers in Leipzig had been observed to be especially prone to lung cancer. In the 1930s, an Argentinian researcher had produced cancers on a rabbit's skin with tobacco “tar.” His study was largely discounted, though, because his “tar” was distilled at temperatures much higher than those found at the end of a burning cigarette. German and American studies at the beginning of World War II first suggested that smoking might cause an increase in human lung cancers, but the evidence was weak. Perhaps, some researchers thought, lung cancers were the result of a combination of atmospheric pollution and cigarette smoking.

In 1950, health officials were surprised by the results of two epidemiological studies of lung cancer patients, one in the United States and the other in Britain. In the American study, the New York researcher Ernst Wynder and his coworker Evarts Graham, a St. Louis surgeon, concluded that “successive and prolonged use of tobacco, especially cigarettes, seems to be an important factor in the induction of bronchiogenic carcinoma.” Two months later, Richard Doll and Bradford Hill produced similar results from lung cancer patients in London. During the next few years there were more than a dozen studies, all supporting the first two. The medical profession was skeptical at first. Chest physicians had not concentrated on smoking as the cause of disease. They had not even attributed chronic bronchitis to cigarettes, though doctors acknowledged the existence of “smoker's cough.”

Statisticians were also skeptical. In America, Joseph Berkson, the country's most eminent medical statistician, argued that the hospital patients used in the British and American studies did not represent a truly random population. In England, Sir Ronald Fisher, the leading theoretical statistician, attacked the epidemiological studies, suggesting that the supposed effect was really the cause: that people first developed cancer, then they smoked. The real causative factor was the individual genotype, he argued. Like Dr. Little, Fisher deplored the “excessive confidence” that the solution to the lung cancer problem had been found, because such a conclusion would be an obstacle to more penetrating research. And Fisher picked up on the one apparent flaw in the first British study: that those smokers who inhaled seemed less likely to get cancer. He also cited a study that showed monozygotic twins—from the same egg—tended to have similar smoking habits, and called this evidence that genetic factors were involved; genetic factors, he argued, caused a person to smoke and to be unusually susceptible to the disease. Fisher, like Little, had been a prominent member of the Eugenics Movement, and he believed in the “constitutional hypothesis” that relied on genotype. Like Little, Sir Ronald would also become a paid consultant for the tobacco companies. (In later British reports, which Fisher ignored, inhalers of tobacco smoke were found to have an increase of certain tumors. Fisher's “twins theory” was also later discounted by follow-up studies.)

Despite such attacks, word began to spread from the medical journals to the popular media. Coverage of the new studies had been minimal, largely because publishers were reluctant to print bad news about some of their best advertisers. The exception was
Reader's Digest,
which, as the magazine with the largest circulation in the nation, was not worried about losing tobacco advertising and had long taken a stand against smoking.
The New Yorker
would also stop cigarette ads.

In 1953,
The New York Times
published twelve health and cigarette articles, and twenty-one more in the first three months of 1954. The stories there and elsewhere had an impact on smokers. Cigarette sales started to decline for the first time. The years 1953–55 are key because it was at the end of 1953 that Ernst Wynder made public the results of his devastating “mouse-painting” study. There followed a distinct change in the disdainful attitude of the tobacco companies. “Even the old families have been shaken. Philip Morris has retreated from gloomy reality to find solace in its new snap-open pack,” observed
The New Republic. Business Week
noted that “fast-paced events loosened up for the first time official tongues of the tobacco industry, which up until now has preserved a rigid silence on lung cancer.” Paul Hahn, president of the American Tobacco Company (Lucky Strike, Pall Mall, and Tareyton), complained about the “loose talk” on the issue, and another tobacco executive promised, “If we are guilty and they find out what causes cancer, we'll remove it from the cigarettes.” Even so, the industry leaders knew the crisis warranted more than reassuring statements. So they took their battered image to Madison Avenue.

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E
VEN AS
L
ITTLE
sought funds for his laboratory from tobacco giant R. J. Reynolds, the tobacco company mobilized to lead an industrywide effort to stave off potential disaster from the lung cancer scare. Tobacco stocks had fallen sharply in the wake of Wynder's study, and Reynolds and the other big companies—Philip Morris, Lorillard, and Brown & Williamson—joined in the search for a public relations firm “to get the industry out of this hole.” They chose Hill & Knowlton, of New York.

Although most of Hill & Knowlton's experience was in heavy industry—it had big accounts in steel and aviation—the company had worked for the distillers and so already had some experience with a potentially harmful product. Its founder and chairman, John Hill, was a strong believer in free enterprise. Leaders of industry tended to trust Hill instinctively, and he had worked hard for this reputation, deliberately creating a somewhat conservative operation in contrast to the razzamatazz often found in the rest of Madison Avenue. Hill resisted anything fast and flashy. The tobacco companies liked his subdued approach, but they were in need of a quick fix. Hill obliged by working unusually fast.

A week after he took on the job, Hill produced his “preliminary recommendations.” Wynder's and Doll's research could cause great panic among smokers, Hill said; the industry's situation was such that “there is no public relations nostrum, known to us at least, which will cure the ills of the industry with one swallow.… There is nothing the manufacturers can say or refrain from saying that can stop people from being interested in their health, nor allay their fear of cancer. So long as the causes and cure of this dread disease remain unknown people will be subject to waves of fear regarding it.”

As a matter of priority, he advised, the industry should reassure the public that it would get to the bottom of the cancer scare. Part of his strategy was to create one of the most notorious documents in tobacco industry history. It was to become the basis for all later plaintiffs' lawyers' fraud charges. Entitled “A Frank Statement to Cigarette Smokers,” it included two key points: one was that the industry “accepted an interest in the people's health as a basic responsibility, paramount to every other consideration in our business.” The second point was that there was no “proof” that smoking caused cancer.

To create and sustain the attack on the link between smoking and cancer, Hill launched the Tobacco Industry Research Committee (TIRC), a research and public relations arm that, he insisted, must have a scientific director. The tobacco executives agreed to appoint a scientist of “unimpeachable integrity and national repute” to oversee the research program. The PR agency's grand strategy was not only to create a doubt about the validity of the evidence being produced, but to sustain it for as long as possible. The director had to be a credible spokesman for the group and one who would continue to point up the controversy, whatever independent research was produced. Little was such a man, but neither Hill nor the tobacco executives could have foreseen how quickly the mouse-house director would rise to the occasion.

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I
N
F
EBRUARY
1954, Little accepted an invitation to become one of the scientific members of the newly formed TIRC, but he was really hoping to be made scientific director. To bolster his candidacy, he prepared several statements saying he did not feel that “the definite cause-and-effect relationship between smoking and lung cancer has been established,” and that “further and more accurate factors involved should be devised and utilized.” Even more disdainfully, he said, “If smoke in the lungs was a surefire cause of cancer, we'd all have had it long ago.” And, almost offhandedly: “I doubt very much you get tar out of the end of a cigarette.”

Hill's well-oiled publicity machine channeled Little's pronouncements directly into the newspapers, bringing him a barrage of criticism from colleagues as well as strangers. Several of these attacks are to be found in his archives at the University of Maine. A real estate agent in Manhattan wrote him, “Don't you think that in your position as a doctor, and hence what would be considered one of the great leaders of the community, that you should be more careful in intimating that cigarettes are all right?”

Those same archives show that Little was prepared to be more than a mere spokesman. He campaigned actively behind the scenes, as well. For example, in the spring of 1954, the Boston publishing house of Little, Brown & Company, interested in producing a book for doctors about the new debate on smoking and lung cancer, contacted him. They had in mind a book in which chapters would be written “by top authorities in various fields.” Would he be interested in contributing? The last thing the tobacco industry needed was an intelligent debate on the lung cancer “scare”; any discussion was bound to be negative because each new study was more definitive in its support of a link between cancer and smoking. Little decided to crush the proposal and ingratiate himself with the tobacco companies, at the same time.