Tobacco Documents Online

v , By CLARENCE COOK LITTLE , (Reprinted by permission of The Atlantic Monthly) C T R 4015 C../ TR i f N 0056 t•Sl

. THE PUBLIC AND SMOKING Fear or Calm Deliberation ? BY CLARENCE COOK LITTLE A biologis/ who yraduated from Narmrd in the fanwus class of 1910, CL+tar.NcF C. LrrrLy- rerrcd as pruidend of the Uniccrsilv of AJaine and then of the Unir•crsilv of Alichipan before taking up a leading role in caruu ruenrch. Ne is pres- ently scientific director and chairman of the &itnlific Adrisory Board to the 7'obacco Industrv Rescarch Corrvnittee. ,`,t Att ac:ec, I ar.: sure. that cxccss in and abuse of any human activity are undcsirablc and should •bc discouraecd. .+•hcther it is the use of alcohol or coftcc or tobacco, or the function of eating. of exercise or inacti.•it.•, of work or rccrea- tion. For the vast majority, ho,,%•c\•cr, the tcm- pcratc expression of most of thcsc sarnc activities is an cssentia] part of totaJ health and ..•ell-bcing. When any of thcsc commonplace activities falls under suspicion as being a specific factor in the causation of human disease, we can agree also that this is a matter for serious consideration, but wc must be extrcmcly cautious in evaluating the basis for such suspicion and the extent of the supposed risk involved, and in avoiding the crea- tion of fcar and panic. This is espccially true today, when we are deal- ing with ailments, such as cancer and heart dis- casc, of people rnostly in advanced age groups. Tbese do not, so far aa our present knowledge goes, fit into the categories of the old-time pathologists --- they arc not specific diseases produced by specific causcs with specific patterns of injury to specific tissues. It is now gencrall•• agreed that they arc, at least in part, diseascs related in some way to present-day stress, modern environment, and to extension of life into the problem of old age. The ..•orTics of home. of busincss, of driving along highways, of crowded living, the scarch for rclaxa- tion and, not the least, thc fears of being sick or of catastrophc havc an untold effect upon the body and, if sufficiently intense, may certainly lead to illncss, if not causc it. .- •-- ? As to seeking specific causes of cancer, and also heart diseasc, science is only now on the threshold of what I hope will be grcat advances in develop- ing better methods of testing the biologic activity of many, many substances that we all use or are exposed to from day to day and, more important, of assigning to them their relative place in the scale of risks we assume in our daily livcs. For it cannot be gainsaid that while there is an absolutc- ncss about the hazards to lifc, there is no such thing as absolute safcty for life. The very things that are essential or important to continued, effective living may bc harmful or even fatal under conditions of misuse or abuse. -• In the field of tobacco use and health, all con- cerncd admit the need for more knowledge and research. Differences exist mainly over the evalua- tion of our present knowledge, or lack of it, and the direction and emphasis of future research. There arti some who feel and proclaim that "beyond reasonable doubt" cigarette smoke con- tains one or more as yet unk-nown substances that 74 CTR 4016 MR\M1 N 0V• 5\r.-l .1. G

Ttll: TUIILIC AND iMOKtr(C may cause cancer in man. • They would concen• tratc their research on isolating, identifying, or "rcmoving" these substances even though no such agent has been discovered experimentally. Others believe, however, that the existence in tobtcco smoke of substances earcinogenic to the lungs of azen has not been and cannot be proved by statistieal associations or by painting the skin of mice of certain specific atrains with highly concentrated extracts of tobacco smoke. They therefore focus attention on development of more exact and more direct methods of assaying the eancer-inducing powcrs of suspected substances. In this direction may be found contributions not only to the smoking question but also to the total problem of bio-assay of other substancts. FEAR OR CALM DELIBERATIO':' Gencrahy speaking, the public believes in dicta from scientists or public health groups. Doubt, suspicion, fear, and mental tension can be ereated and maintained by one type of presentation of a situation. Balance, poisc, a judicial attitude, and calm deliberation can be engendered by another. For at least four years there have been repeated, sensational, and fear-arousing statements and resultant headlines on the theoretical lethal nature of tobacco smoke. Thc repeated expression of thcsc vicKs, how- ever, is no measure of their general acceptance by all who are concerned .,•ith the problems involved. For instance, the statistical evidence in support of the cigarette thcory has not been accepted as proof of gcncralizcd conclusions about srnoking by a number of distinguished statisticians, among whom may be mentioned espccially Dr. Joseph Bcrk_wn, Section of Biomctry and Medical Statis- tics of the Mayo Foundation for Medical Educa- tion and Research in Rochester, Minnesota. There are certain unfcatured but fundamental contradictions in difterent statistical papers from w,hich points of agreement have bcen selected for presentation by advocatcs of the "cigarette guilt" thcory. For example, thc implication of the American school of cigarette theorists is that inhalation and, therefore, direct contact of smoke with lung tissue is an important factor in the origin of lung cancer. On the other hand, certain British investigators state that it would appear that inhalation is a "negligible" factor. If this is the ease, direct contact is not an important element. In any attempt to identify a suspected agent or agents, these two possibilities are an unsolved complica- tion and are evidence of incomplete knowledge. The clinical pathological data of one American Cancer Society grantee was hailed by the then mediul director of that society as "the very evidence skcptics demanded." These s.ame data have not been so evaluated by a considerable number of trained clinical pathologists not affil- iated with the American Cancer Society but fami.liar with much more data of a sitnilar nature. The reports of indudng skin uncer on aome mict by s.me.aring highly concentrated tobacco smoke condensates have been countered not only by similar experiments failing to result in eancer but by univerully negative earcinogenic results reported by a number of investigators following the inhalation of cigarette smoke or its injection directly into the lungs of rodents. Such eontradictiotu in findings and interpreta- tions could be continued at length, and indced have been in many authoritative scientific publica- tions, but these few arc cited merely as evidence that the status of research into lung cancer involves many unresolved differences in concepts about possible causation and also about its relative incidence and increased frequency. In accepting and carrying out the responsibility of developing a research program in tobacco use and hcalth for the Tobacco Industry Rescarch Committee, my eollcagues on the Scientific Advi- sory Board and I believe the cause of scientific investigation is brst served by adherence to our stated position that definitive conclusions or predictions of individual risks are unwarranted - by the present state of knowledge in this complex -field. I'rDUSTRY /cSSUR.ES FRFEDOM Ii: RF.SEARCH Some people question, as might be expected, ,whether the tobacco i.ndustry is honest in its efforts to find the whole truth. The conditions under which Tobacco Industry Research Committee grants are made guarantec complete freedom, unhampered conduct of research, and uncensored publication of any and all results. The tobacco industry was and is aware tif the seriousness of the implications in the charges against smoking. The industry intends to support research until t.hesc charges can be proved or disproved by direct experimental evidence. Even cynics will admit that the industry cannot afford as a practical business matter to offer products which, have been so definitely attacked without making every effort to find out the whole truth and, if and when any substance is identified and is shown to be harmful, to do lts best to eliminatt it. The industry is aiding rescarch for scientific facts and will continue to do so. But it need not accept as final opinions based on incomplete evidence that is challenged by others. Nor docs it feel able to "remove" from its products substances 75 C1R 401"1'

r The Al!o nl i c A f o n1,11y . ~. the naturc, prescncc, and existence of which are generally admitted to be unknown. In these circumstances, the industry chose a course that is unusual, if not unique, for busincss- supported research. Scientists were given full responsibility for determining what rescarch is ne<ded and who should do it. The Scientific Adviwry Board, of which I am chairman, has complete freedom in allocating the rrscarch monies, now amounting to some $2.2 million, to investigators in leading U.S. research, medical, and educational institutions. The board considcrs proposals for projeces on their scientific merits and the prospects of constructive findings. The board may also iniuatc research ideas and then seek out qualified scientists to develop and conduct the needed lines of investigation. It is important for the public to remember that the members of the Scientific Advisory Boa.rd, in their approach to this research responsibility, take thc position that smoking has not been proved guilty or guiltlcss in matters affecting human health. Their attitude is that statistical and indi- rcct evidence docs not prove its guilt as a causative agent. The open question of its innocence or its guilt can best be answered through unhampered rescarch for the full (acts. 7HE RIGKT TO LEARl: AT:D TO rNFORli The board mcmbcrs do not deny the right of any individual to state his belief in the guilt of smoking. Along with many independent research scientists, they do and will as scientists insist on ma.intaining their right to their own criteria for judgment and for the opportunity to inform the public concerning the rcasons for their position. They will do this until they possess evidence which they consider meaningful and conclusive on each and cvcry rescarch step. They will do this in spite of expensive and extensive pressure propaganda, and in spite of personal misintcrprc- tations and attacks. These statcmcnts of honest doubt, shared by many acicntists, do not constitute a"contro- vrrsy," and those who feel as does the Scientific Advisory Board will not be driven into admitting it to be such. There has been no organized cfl•ort or campaign to claim that tobacco has been proved innocent, bcuuse thosc who, like the Scicnti6c Advisory Board, desire a full and complete analysis of its effects are still in scarch of the answers. Similarly, there has btcn little widely publicized prescnution of negative evidence rrlating to tobacco use, such r as t.herc has been of reports by thosc who are already convinced that they have found proof of its guilt. This is not surprising, for it is satisfying to proclaim you have surrounded the enemy and that mopping up activities are all that is needed. But to state that strong enemy forces are still unde- tected and that a long hard campaign lics ahead is irritating to the generals who arr claiming the vic tory. It secros, however, to those who wsll have some responsibility for the continued campaign, that the public - the troops on the firing line - deserve to be told what the whole evidence is and of the likelihood that the battle is not won and then be allowed to decide for themselves what the dangers, real or imaginary, may be. About fifteen years ago thcrc were headlines and a propaganda flurry based on statistical evidence that direct exposurc to sunlight was a causative factor in skin cancer. This point of view, which was widely accepted, received sup- port from experiments showing skin cancer on the cars of rodents following exposure to ultra- violet light, a component of sunlight. In spite of this, no one askcd for legislation to bring back the bathing regalia of the gay nincties, and no one attempted to educate children not to visit beaches or to wcar sun suits, nor were farmers and sailors urged to carry umbrellas. From the first charges that tobacco might be a causativc factor in lung cancer and cardiovascular discasc, there have been repeated efforts by some ardent laymen and some already convinced scientists to activate debate and controversy with thosc who desire further information before they feel ready to take the trip to Canossa. It may be that some day-perhaps soon, per- haps years from now ---- we shall kno,%• what part or parts various factors play in the etiology of lung cancer in man. When we do, tobacco use may or may not prove to be one of them. Today, while we are making real progress in lifting the canccr curtain, we should not bc misled i.nto thinking that one glimpse behind a raised corner of this curtain reveals to us all the knowl- cdgc that remains to be unearthed. The public has been heavily propagandizcd along one dcfinite theory of causation by those convinced by one level of information. Some of us dernand a different order and level of knowledge before we accept causation or condone prescnta- tion of conclusiotu to the public. We claim merely the right to pursue knowledge through acicntific research, the right to hold our point of view, and the right of the public to be aware of it. 76 cTR 4018 C~~~~ ~~~~( t~~~~~ ~.'.0