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, , Tobacco and Health ,I . . Published by the Tobacco Information Committee, representing tobacco manufacturers, g-rowera and warehouaemen. 150 East 42nd Street. New York 17, N. Y. Volume I Number 1 Mayo Cliruc Head Believes Smoking Not Cancer Cause Dr. Charles W. Mayo, one of the country's most noted medical men, does not believe there is a connection between smoking and lung cancer. "I just don't believe smoking causes lung cancer," Dr. Mayo was quoted in a recent story by Severino P. Severino, medical writer of the Cleveland News. Dr. Mayo, head of the world- renowned Mayo Clinic in Rochester, Minn., was interviewed by newsmen while in Cleveland to address the 1.'ationa] Medical Association. Another Doctor Agreea Taking the same stand on the smoking question was Dr. Charles Puestow, professor of surgery at the University of Illinois and a man of similar prominence in American sur- gery, Severino wrote. Dr. Mayo said be believes that "in some individuals who have a tend- ency there are many things outside of smoking that may contribute to malignancy," the story said. D'uputea Dr. Ochaner The story said Dr. Mayo "disputed the evidence firat presented by an old surgeon friend of his, Dr. Alton Ochaner of Tulane University in New Orleans." Dr. Puestow, according to Sever- ino, said "smoking may play a role in cances, but I am not convinced of i t." No One Factor Lung cancer incidence has in- creased at the Veterans Administra- tion bospital with which Dr. Pues- to-w was affiliated, the story said. 'T.renty years ago lung cancer was only 2 per cent, last year it was 21 per cent. Why, I cannot say. But I don't think any one factor, such as stnoking, is responsible," be was quoted. October 1957 Six Experts State Doubts On Smoking-Cancer Theory Tell Congressmen Reasons for Position Six experienced doctors and cancer research scientists have recently set forth for a Congressional aubcotnmittee their reasons for not accepting the theory that smoking causes lung cancer. Four of them testified before a CongTessional bearing and the other two submitted statementa stating their position. New Book Says Tobacco 'Scare' Not Justified A new book covering the scienti8c facts relating to smoking and health is being widely reviewed and quoted by writers, editors and others throughout the country. "Science Looks at Smoking," by Eric Irorthrup, science and medical writer, analyzes recent scientific re- search into smoking and covers much major work not generally familiar to the public because of its non-sensational nature. Northrup quotes numerous scien- tific authorities to show that data used to "prove" tobacco ia harmful often are unreliable, contradictory and unsound in terms of scientific procedure and judgment. Olber Factors Involved He covers medical and scientific reports suggesting that lung can- cer, heart disease and other ailmenta are caused by factors other than smoking. The book has an introduction by Dr. Harry S. N. Greene, Chairman of the Department of Pathology, Yale University School of Medicine. In an editorial entitled "Ciga- rettes: Case Not Proved" the New York Daily News said: (Continued on po6e 3) No Single Cause Dr. Clarence Cook Little, Chair- man of the Scientific Ad%isory Board to the Tobacco Industry Research Committee, aaid that research find- ings "disprove a single, simple, striking cause and effect relation- ship between cigarette smoking and lung cancer." Dr. Little, from 1929-1945 head of what is now the American Cancer Society, stated that "non-smokers get lung cancer. The vast majority of heavy smokers never get lung eancer." Experiments Negative Another Q-itness, Dr. Harry S. N. Greene, Chairman of the Depart- ment of Pathology, Yale University School of Medicine, said the "case against tobacco is based mostly upon statistical associations and some ex- perimental work with animals." Statistics do not in themselves es- tablish a cause and effect relation- ahip, be said, and various experi- ments with tobacco derivatives and animala failed to produce any sign of eancer. No E.idence 1`siats Also appearing was Dr. Ian G. Macdonald, profeasor of aurgery at the Univeraity of Southern Califor- nia School of Medicine and a director of the American Cancer Society. Dr. Macdonald said there is no evi- dence showing a cause and effect relationship between cigarette smok- ing and lung cancer. Studies exist (Continued on pa6e 2) r. T R 4008 CTR, HN 00E__1G,10

, Editors view Smoking-Cancer Tie As Unproved, Open Question . From the New York R'orld-Tele;ram and Sun Do.ve have an opinion in this cigaret•lung cancer controveray? We do. We offer it as no more than our opinion but, briefly, It is this: A relationship obviously has been drawn between ezcearive cigaret smoking and incidence of lung eancer. But we bave yet to bear anyone offer evidence that moderate cigaret smoking, per se, is a cause of lung cancer. We can't resist the feeling that other areaa cry out for ezploration. We would like more and deeper reaearch, for e-1umple, int.o.vhether the irritants and poisonous fumes in poUuted air may be an important contributing factor in lung uncer. Frankly, we're bew-ildered and we feel the public is, too, by the vast number of claims and counterclaims. For our part, we want to hur a lot more on the entire subject before we'll be convinced one way or another. But when we say more, we don't mean an interminable rehash of points alre.ady on the record. Thoae can be argued indefinitely and inconclusively. What we're interested in is neu evidence. Excerpts From tditorials From the Sacramento (Cal.) Union The causative chain between smoking and cancer is purely statistical. The causes of cancer and coronary disease are for the most part unknown. Cigaret smoking might conceivably be the outward behavior manifestation of certain types of individuals who, by constitution, might be more predis- posed toward coronaries or cancer. The emoking and the disease would then be only two elements in a constitutional constellation. The fact that pipe smoking is relatively harmless, and cigar smoking less so than cigaret smoking indicates that there may be a factor other than tobacco present as a precipitator. rette smoking causes lung cancer." "On the contrary, I have found From the more and stronger reasons to doubt Washington (D. C.) Evening Star this conclusion," wrote Dr. Berkson, Dr. Burney and the PFiS, how- who two years ago published an ever, have given voice to some irn- analysis of the American Cancer So- portant qualifications. One of these ciety's statistical study in which be is that more biological and clinical took issue with the report. research, as well as more statistical Dr. Milton B. Rosenblatt, New study, is needed to establish a defini- York chest specialist and co-author tive case against cigarette smoking of a recent book on lung cancer, in relation to lung cancer. Another wrote the United States Surgeon is that there is no "convincing" evi- General: dence as yet that heavy use of to- "In an issue which seriously in- bacco is a "causative factor" in heart volves the public's welfare and disease. And a third is that air pol- which is to highly controversial, the lution (urban smog and the like) is official promotion of one point of a highly suspect thing that calls for view denies the public the opportu- intensive investigation to determine nity to evaluate the data which re- bow big a.nd villainoua a role it may ject the proposition that a causal be playing in this matter. relationship between smoking and In et!'ect, these qualifications con- lung cancer has been established." cede that the whole subject still en- Dr. Rosenblatt then listed eleven tails such a me.uure of uncertainty facts dealing with lung cancer, and and speculation that the time is not concluded: yet here for a final judgment. The "Until the etiology of lung cancer Tobacco Industry Research Commit- has been firmly established more tee, for example, bas cogently chal- will be gained by a circumspect point lenged the validity of the anti- of view. Medicine has had its share smoking statistical conclusions. And of colossal blunders in the past. Not numerous independent authorities- too long ago, tuberculosie was at- distinguished doctors in no way as- tributed to night air and lung can- sociated with the business of selling cer, to tuberculosis." (Continued on poae 3) About This Publication "Tobacco and Health" is published by the Tobacco In- formation Committee. While charges against to- bacco are widely publicized, the existence of conflicting opin- ion does not always receive comparable public attention. This issue of "Tobacco and Health" preaents a selection of materials indicating that there is more than one side to exist- ing scientific opinion on the possible effects of tobacco use on health. "Tobacco and Health" will continue to report selected ma- terial from a variety of sources, including lay and scientific publications. The Tobacco Information Committee represents the to- bacco manufacturers, gtowers a.nd warehousemen who sup- port the Tobacco Industry Re- search Committee. However, the opinions quoted herein are those of the identified sources and do not necessarily repre- sent the official policy or posi- tion of members of the Scien- tific Advisory Board to the Tobacco Industry Research Committee or any recipients of TIRC research grants. Smoking-Lun, i , Cancer Link Disputed by Six Experts (Continued /rom poge 1) which show other factors that may be importantly related to this dis- ease, he said. He said "discrepancies and falla- cies in the cigarette theory are shown, even from those studies often cited in the attempt to incriminate cigarettes." Dr. R. H. Rigdon, professor of pathology at the University of Texas Medical Branch, Galveston, said the data on which lung cancer is uusa- tively associated with cigarettes are not accurate enough "to permit the conclusions which have been drawn." Dr. Joseph Berkson, head of the Section of Biometry and Medical Statistics of the Mayo Clinic, wrote the Subcommittee chairznan that "I find no reason to modify my previous opinion that the evidence, taken as a whole, does not establish, on any rea- sonable scientific basis, that ciga- Page 2 r T R d fl fl 9 C `f R 1-111 0 0 ~iGo I I

. B'ritish Scientist Opposes Campaign Against Smoking Sir Ronald Fisher, a prominent British st.atistician writing in the British Medical Journal, has taken issue with that publication's demand for a publicity eampaign to warn the public of the alleged dangers of cig- arette smoking. "That is just what some of us with research interests are afraid of." Sir Ronald said in a letter to the editor. "In recent wars, for example, we have seen how unscrupulously the 4nodern devices of publicity' are lia- ble to be used under the impulsion of fesr; and surely the 'yellow peril' of modern times is not the mild and soothing weed but the organized creation of states of frantic alarm." 'Imaginary Cause' Ae said that "a comzron 'device' is to point to a real cause for anxiety, such as the increased incidence of lung cancer, and to ascribe it in ur- gent tones to what is possibly an entirely imaginary cause. "Another ... is to ignore the ex- tent to which the claims in question have aroused rational scepticism." Furiber Research Needed Sir Ronald said many statisticians "would still feel, as I did about five years ago, that a good pr:r :a facie case had been made for further in- vestigation. N one thinks that the matter is already settled. "The further investigation seems, however, to have degenerated into the making of more con5dent ex- clamations, with the studied avoid- ance of the discussion of t^ose al- ternative explanations of the fact.s which still await exclusion." New Book Cites Facts on Smoking and Health (Conrinued frorn pa6e 1) "Northrup and Greene between them shoot the cigaret-cancer and heart disease merchants so full of boles that it's hard to see how any- body who reads this book will ever be frightened by these nightmare peddlers again. "1f you're looking for the facts on bow little science yet knows about. cancer of any ty-pe, and how little evidence there really is against the cigaret, 'Science Looks at Smoking' ia right up your alley." 'Pick Your Expert, Take Your Choice' From the Wa.hington (D. C.) Daily News R'ashington was the cancer iumor capital of the world last week. You could pick your expert and take your choice. In addition to vvitnease.s linking cigareta with lung cancer (and the doctor who aaid he smoked to cure colds) others testi6ed before a House Operations tub-comm.ittee: One test showed more lung cancer among cigaret smokers who do not inhale; amokerawho alternate cigars or a pipe with cigareta seem less prone to cancer no matter how many cigar'eta they smoke. Lung cancer rate among women seems to have gone down even as cigaret smoking increased. Lung cancer rate in Southern Cal- ifornia is highest among Mexican women tho they smoke less than other racial groups. One survey showed beer drinking seemed to raise cancer rate; milk drinking had no effect. Studies in Copenhagen and Pak- istan indicated lung cancer was most prevalent among poor, male, manual workers. Of 20 cases studied in Pak- istan, only two were heavy smokers; 14 had never smoked. Residents of Idaho and New York smoke about same number of cig- arets per person a year. But New York's lung cancer is four times as high as Idaho's. A British study ahowed lung can- cer deaths proportional to the num- ber of chimneys per acre in towns studied. A test on mice linking cigaret tar to cancer used amounts equal to 100,000 cigarets a day. The cancer rate dropped when this was reduced to the equivalent of 60,000 cigarets a day. When products filtered out of Los Angeles air were applied to mice, 9 of 85 developed cancer. . St.atements Available Copies of the official atate- ments presented by six aden- tist. to a Congressional sub- committee (see main ator7 on page 1) may be obtained upon request to the Tobacco Infor- mation Committee, 150 East 42nd Street, New Yorl 17, N.Y. Page 3 Excerpts From Editorials (Continued from poae 2) cigarettes - have joined in sharp criticism of those conclusions, ap- parently because the conclusions lack the support of sufficient biolog- tcal and clinical evidence. Nevertheless, regardless of all such reaervationa, the general pic- ture looks disturbing enough, if not alarming enough, to warrant the most complete kind of continuing study. This is a challenge not only to the tobacco iDdustry but aleo to every governmental agency charged with the responsibility of safeguard- ing America's health. From the Jonrnal of the lowa State Medical Society . Although In midJuly Surgeon- general Leroy Burney announced that the American Cancer society had convinced him as regards the alleged eause-eSect relationship be- tween cigarette smoking and lung cancer, there are a number of au- thorities who persist in thinking that the Cancer Society's contention is no more reasonable than is the theory that hospital wards and ordi- nary bed rooms must be extremely dangerous places, since a vaat ma- jority of deaths occur there. From the Hopklniville (by.) New Era The latest charge is that the use of the weed frequently causes lung cancer or that those who smoke are more likely to have this disease. Statistics have been gathered that tend to indicate that there may be some truth in this assertion. How- ever, there are many prominent doc- tors, who have, themselves, been studying lung cancer who declare that the case has not been proven. They point out that, in the first place, cancer can only be definitely discovered by laboratory tests and poat-mortem examinations and that very few of the cases of death by cancer were subjected to these tests. Most of the statistics were gathered from only a clinical analysis as shown on the death certificate is- sued by the atte.nding doctor. Most doctors agree that the find- ings on the effect of the use of to- bacco in relation to lung cancer are sufficient to.carrant a further studyy of the question. So far no actual cause for cancer has been definitely determined and all will agree that all possible causes for the disease should be thoroughly investigated. (Con.tinued on page 4) CTR 4010 Cf R H! `t C)01~=561'e'

;I , -Editorial Excerpts on Smoking-Cancer (Continued from page 3) From the Mansfield (0.) I1e.n•Journal As for the flurry of statistics link- ing smoking and various diseases, it would appear that the major atatis- tic has been overlooked: For the past 60 years a high per- eeatage of the male population of the U. S., Canada, and Europe has used tobacco. For the past 25 years, a fairly high percentage of the female population of those areas ha-s smoked cigareta. If tobacco in general or cigarets In particular were reaponaible for any diaease or series of diseases, it should have been clearly obvious, first to the general medical practi- tioner and then to the public at large. There bss been nothing obvious at all. To take the lung cancer hullaba- loo: It ia estimated that 25,000 Americaas died of this disease last year out of a population of 170 mil- lion of whom at least 50 millions are probably axiokera to some degree. We w.nld guess that probably 25,000 people died as the result of falls in this country last year. Maybe amoke got in their eyes! From the New Londee (Conn.) Day The wbole subject is pretty well fogged ap anyway. Some scientific investigators, puszled by the fact that tobaeco smoke from pipes seems much less connected with occurrence of lung cancer, even susp ect the ciga- rette paper - that, when it burns, some irritating substance is released which may be the cause. Others sug- gest that the difference bem•een the , `StiIi Open Question' (Ir.w . N•.,e r«1 r+.... .cu.y) SCHR00N LAI:E, N. Y. - An authority on cancer of the lung says "it has not been proven conclusively that smok- ing causes lung cancer." Dr. Edgar Mayer of New York told a news conference that "until someone does actu- ally have animals inhale to- bacco smoke to the point of developing lung cancer similar to that afflicting human beings, the question of whether smok- ing alone is responsible for the disease is still open to question." pipe smoke and cigarette smoke Is habit of the users, the pipe smoker seldom "inhaling" the smoke. (VVom- en, bless 'em, are apt to say in these circumstances, and with reference to very strong pipes, "If they did in- hale, it would kill them!") Hence it'a questionable how much reliable information the congrea- aional committee can possibly dredge up at this stage of knowledge of cigarette smoking and lung cancer. Some of the experts are still doubt- ful that it can be shown cigarettes can and do increase the hazard of lung cancer; they suggest that ele- ments on the air in modern day cities may be irritants, too. It does seem to be a fact that a few acientist.s insist that the rural dweller, away from the fumes and smog of cities, is decidedly less apt to contract lung cancer, vc-ith or without smoking. But in this instance the congres- aional committee is biting off a larger assignment than it may be able to handle - If it is hoped to reach any reliable conclusion and recommendation. The unassailable evidence just isn't able to reach this conclusion. From the Knoxville (Tenn.) Journal In this connection, the proposal of Sen. Wallace Bennett, of Uteh, that a law be passed to require all ciga- rette manufacturers to place the following label on their packages, deserves comment: "K'arning: Prolonged use of this product may result in cancer in the lung. heart and circulatory ailments and other diseases." It will occur to a great many of us, whether tobacco growers or simply users, that the Utah senator's pro- posal covers a great deal of territory, especially in view of the lack of una- nimity among the authorities as to the issue under debate. Perhaps, at this juncture, Senator Bennett's proposal could be applied to practically any product manufac- tured in the world. With equal pro- priety his label warning of the dire results of misuse might be applied to bread, automobiles, buttermilk or breakfast food. There is scarcely anything under the sun which, either by misuse or overuse, cannot be rightly considered a menace to health and happiness. Man has been bringing about his own destruction by excesses of various kinds from the day old Adam was bounced out Page 4 Smoking and Death Rates a(wwi (fla I D.By N.v. There would be no aignifi- unt change in the death rate if everyone stopped amoking, atcording to Dr. J. V. Hand- werker, chairman of the public relations committee of the Dade County (Fla.) Mediul Association. He made the com- ment following issuance of the American Cancer Society's so- ulled Hammond-Horn atatis- tical report in June. Dr. Handwerker said he had no doubt that "heart disease still would be the greatest killer, and cancer still would be second, if there were no cigareta." of the Garden of Eden. Most of us would not think the Utah senator's proposal was quite fair unless he expanded his law to put a similar label on every-thing used by the human animal. From the Ea.t Liverpool (0.) Review But the risks singly or collectively do not mean there is anything in- trinsically wrong with the use of tobacco. They can be justified in the aame wav that the risks of radio- active fall-out from fission and fu- sion explosions can be justified. They are worth taking, in other words, if they are understood by the human beings who take them. People will continue to do a hundred other things riskier than using tobacco. The Tobacco Industry Research Committee, which questions the re- tults of the American Cancer So- eiety study, is conducting its own research. There is no reason to be- lieve its researchers are any less ob- jective than those who are working for the American Cancer Society. Altogether, their work will add up to a vast store of knowledge about the calculated risk of one of man's favorite pleasures. From the Erie (Pa.) Morning Ne..•a V4'e are afraid that the conflicting reports on this subject as well as the nuclear fallout are causing the pub- lic to lose faith in all scientists. This is unfortunate but has been brought on by the scientists them- selves and their lack of clear cut stands. CTR 4011 CTR HN 005--CA-'_'~