Cornered (21 page)

“My own feeling,” he wrote the Boston publisher,

is that at the present time (and possibly for a considerable period in the future) there is not, and will not be, a sufficient body of accurate and pertinent experimental and statistical data to prevent such a book from being superficial and controversial.

I realize that in some cases a controversial topic is a good way of selling books.… But when the general practitioner is likely to form immature and erroneous conclusions, and to obtain an incomplete or warped picture of cancer risk from any substance or substances, I think that the situation is a serious one.…

Please understand that I have no desire to smother any freedom of expression, but that because you mentioned the topic to me I am honestly and directly giving my opinion and personal reactions. In other words, I am not making an “official” statement, but am simply writing as one who for a great many years has watched the various books on different phases of cancer, the majority of which, unfortunately, have delayed progress, rather than accelerating it.

Little sent a copy of the letter to Hill & Knowlton, hoping it might help his chances of becoming scientific director. It was unnecessary. The tobacco companies had already decided he was their man. A letter of appointment was in the mail. He was to be paid $20,000 a year plus reasonable traveling expenses and a further $10,000 for an assistant “who would do the necessary legwork around the country, giving you time for more important work.”

Little, without question, performed his duties as though his life depended on it—and to a large extent it did. Undoubtedly, the life he sought—of a high-profile cancer researcher with trips to New York and beyond—could not have been financed by the Bar Harbor mouse house alone. For almost two decades, until his death in 1971, Little dismissed the concern of friends and colleagues that he had “sold out” to a callous industrial enterprise that cared not at all for the health of its captive clientele. He wrote in glowing terms of the benevolent intentions of the industry. He was convinced, he told a colleague at the University of Chicago, of the industry's desire for an “unprejudiced investigation, regardless of whether evidence of harmful effects of tobacco is forthcoming.” The companies realize, he said, that “they cannot maintain their industry without facing any and all problems of health, whether these are welcome or not.” Whether he suspected it or not, the industry would do its best to curb unprejudiced investigation, especially its own.

In June 1954, the American Cancer Society published a landmark study by two researchers, Cuyler Hammond and Daniel Horn, showing that death from lung cancer was up to nine times more common among one-pack-a-day cigarette smokers than among nonsmokers, and up to sixteen times more among those who smoked over a pack a day. Heavy smokers also showed twice the death rate from heart disease. Tobacco stock prices fell. Hammond, who was a four-pack-a-day smoker, and Horn, who smoked one pack a day, switched to pipes, which had shown lower disease and death rates. (Dr. Little smoked a pipe, too. But he joked about it. “My nose is so long that when I smoke a cigarette down it's rather unpleasantly warm.”)

In their report, Hammond and Horn concluded that the association between smokers and lung cancer and heart disease was simply no coincidence. “We know of no alternative hypothesis,” they said. Within days the British epidemiologists Doll and Hill produced another new study showing mild smokers were seven times more likely to die of lung cancer than nonsmokers, moderate smokers twelve times, and heavy smokers twenty-four times. Dr. Little downplayed the results as “preliminary,” called for more research, and emphasized the possibility of a “more fundamental cause of a constitutional or hormonal nature.” No cause and effect relationship had been proved, he said, adding that the result might have been obtained because the “type of person who is an excessive smoker is a poor health risk—he has more accidents, more ailments.”

Throughout the late 1950s, Dr. Little continued to proclaim that his TIRC had but one purpose, namely “to find the truth, the whole truth and see that it is made known as quickly and effectively as possible.” Yet the annual reports of the TIRC's scientific board might as well have been written by a PR consultant. Perhaps they were; he was certainly required to submit drafts that were then vetted by the TIRC's office in New York.

By the late 1950s, Dr. Little had moved beyond the talk of a debate between two scientific hypotheses and was making misleading statements and stating downright falsehoods, ignoring work that was being produced in the research departments of the tobacco companies. For example, Little maintained that there were no known carcinogenic substances in tobacco “tar.” And even if cancers were found, there were many substances that caused tumors on the skin of mice and yet had been used by man without harmful effect for years—sugar, albumen, and even tomato juice.

Yet in February 1953, a year before Dr. Little signed up with the industry, R. J. Reynolds researcher Claude Teague wrote a report titled “Survey of Cancer Research with Emphasis upon Possible Carcinogens from Tobacco,” in which he said, “Studies of clinical data tend to confirm the relationship between heavy and prolonged tobacco smoking and incidence of cancer of the lung. Extensive though inconclusive testing of tobacco substances on animals indicates the probable presence of carcinogenic agents in those substances.”

In 1956, a chemist for R. J. Reynolds, Alan Rodgman, wrote a paper entitled “The Analysis of Cigarette Smoking Condensate. 1: The Isolation and/or Identification of Polycyclic Hydrocarbons in Camel Cigarette Smoke Condensate.” Rodgman wrote, “Since it is now well-established that cigarette smoke does contain several polycyclic aromatic hydrocarbons, and considering the potential and actual carcinogenic activity of a number of these compounds, a method of either complete removal or almost complete removal of these compounds from smoke is required.” A year later, five such compounds had been isolated.

In 1957, Paul Kotin, a young pathologist working at the University of California, who was on Little's scientific advisory board, said, “The statement … to the effect that ‘the sum total of scientific evidence establishes beyond reasonable doubt that cigarette smoke is a causal factor in the rapidly increasing incidence of human epidermoid cancer of the lung,' represents a view with which we concur.”

In March 1961, Liggett & Myers received a report the company had commissioned from the Boston laboratories of Arthur D. Little on the constituents of tobacco smoke. The report began, “There are biologically active materials in cigarette tobacco. These are: a) cancer causing; b) cancer promoting; c) poisonous; d) stimulating and pleasurable.

If Clarence Little ever saw these reports, or even heard about them, his knowledge was never reflected in his public statements, some of which even mocked the growing concern. “About fifteen years ago there were headlines and a propaganda flurry based on statistical evidence that direct exposure to sunlight was a causative factor in skin cancer. This point of view, which was widely accepted, received support from experiments showing skin cancer on the ears of rodents following exposure to ultraviolet light, a component of sunlight. In spite of this, no one asked for legislation to bring back the bathing regalia of the gay nineties, and no one attempted to educate children not to visit the beaches or wear swimsuits, nor were farmers and sailors urged to carry umbrellas.”

As the evidence against smoking grew, Little's position became more isolated. By 1957, the British government had accepted the link between smoking and cancer and in that year, too, the U.S. Surgeon General's report showed movement toward an acceptance of such a connection. His report said it was “clear that there is an increasing and consistent body of evidence that excessive cigarette smoking is one of the causative factors in lung cancer.” Echoing his old refrain, Little responded that the evidence was not yet sufficient, more research was needed. And he suggested that the alarming increase in lung cancer mortality rates might be the result of improved diagnostic techniques, greater attention being paid to the disease, the aging of the population to a point where cancers were likely to occur, and better methods of reporting and classifying causes of death. But while techniques for detecting lung cancer had improved, Little ignored factors that indicated the increase was real: it had been adjusted for aging, and it was faster in men than in women, and men smoked more than women.

By 1961, more than twenty-five retrospective studies in nine countries demonstrated the link to lung cancer. As doctors and scientists continued to attack him, Little's responses became more and more inadequate. When the companies launched their own in-house research programs to block out some of the harmful substances in tobacco smoke with filter tips, Little never bothered to follow the research. During one of several congressional hearings into smoking and health, Little was asked what he knew about the new devices. Remarkably, he said he knew nothing. He had never received any reports on filters from the industry and had never been shown filter experiments on his trips to cigarette factories. “I have no opinion about the filter at all. I don't know why it was done and I frankly care—if you don't think I am in contempt—care very little. I care less, really.”

In his private papers, Little wrote grandly of the “pure science” and “pure research” he was funding. But despite his million dollar budgets, the TIRC never performed such basic research. Through December 1961, the TIRC had spent five million dollars and its grantees had published 197 papers of great diversity, from the chemistry of tobacco smoke to cancer research to human lung, heart, and circulation studies. But many were only remotely connected with the smoking debate and there was no overall plan, no central focus. The TIRC never set up a study to answer the crucial question, Would a decrease in cigarette smoking result in a drop in deaths from lung cancer? Those researchers who produced results the industry did not want to hear—such as a Rand study that found burned cigarette paper to contain a carcinogen—were not funded again. Instead, through his many public appearances in the media, Little distorted, misconstrued; and misrepresented the original efforts of others who were finding a credible link between smoking and cancer.

The tobacco companies could not have been more pleased by his performance, of course. A TIRC executive memorandum in 1962 congratulated Little: the 1954 emergency had been “handled effectively”; the operating principles of TIRC had been outlined with “humble but magnificent judgment.” TIRC had “carried its fair share of the public relations load to stamp out brush fires as they arose.”

Perhaps the most shocking aspect of Little's service to the tobacco companies was his failure to reflect in his public pronouncements the work being done outside the TIRC—and outside the U.S.—that was important to the debate on smoking and health.

In 1962, Britain's Royal College of Physicians released a report entitled “Smoking and Health” that concluded “cigarette smoking is a cause of lung cancer and bronchitis, and probably contributes to the development of coronary heart disease and various other less common diseases.” The report suggested five immediate steps to curb cigarette use: substituting pipe and cigar smoking for cigarettes; discouraging smoking by adolescents; restricting the advertising of cigarettes; restricting smoking in public places; and increasing taxes on tobacco. The Royal College is the preeminent association of the British medical profession and could not be lightly dismissed as a campaigning body; the last time it had made representations to the House of Commons was in 1725, when it expressed concern over the rising consumption of cheap gin and had succeeded in bringing about legislation to control that epidemic.

Sir Charles Ellis, the chief scientific adviser to British American Tobacco (BAT) downplayed the Royal College conclusion, calling it “emotional,” the work of doctors who were overcome with anxiety about the spread of lung cancer. They had hastened to find a culprit, Ellis said, though he agreed there were some facts about tobacco use that could not be disregarded. For example, smoker's cough, the lower airway irritation caused by smoking, was a “real phenomenon and obvious to everyone.” If further research showed there “really was a chemical culprit somewhere in smoke,” then it should be brought out into the open. Sir Charles was quite confident that once identified it could be eliminated.

One of the more enlightened officials to join BAT during this troubled period was Jim Green, an industrial chemist who was taken on as director of research immediately after the publication of the Royal College report. Considering his position, Green made some bold, even radical suggestions. The best protection for the “serious” situation facing the company was candor, he suggested; the company should “adopt the attitude that the causal link between smoking and lung cancer was proven—because we could not be any worse off [in denial of the link].” Heresy though this was at the time, it became an increasingly widespread view among the industry scientists in Britain.

In America, the industry issued its own pamphlet, “Cigarette Smoking and Health: What Are the Facts?” There was no proof smoking caused any disease, it declared yet again; the Royal College report was incomplete. Other factors—viruses, pollutants, heredity, stress—should be considered. Dr. Little's annual TIRC report for 1962 said, “The unquestioning, unreserved endorsement [of a report like that of the Royal College] … which contains no new or original data but amounts to a statement of opinion, is a disservice to scientific research.” The real disservice, of course, was being committed by the TIRC and by Little himself.

He also ignored new work in America—key studies that took the causation issue beyond the soft science of epidemiology and the uncertain relevance of mouse studies right into a laboratory where human tissue was examined under the microscope.