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HILL ANr. H?:OH'LTOV, I.c. ATPACRKW #2 COBFIDBRTIAL POBLIC REIATI016 REPCHtT to the TOBACCO I]®1S'IItY RSBEARCH GaAQTEE Tuesday, October 9, 1956 Introduction I It has been nearly three years since the Tobacco Induatrr Research Ca®it- tee rrae conceived end organizRd. This period has been one of videspread public attention to and distulrbance o.er health accusations asde against tobacco use. The tobacco indvstrr's deci- sion xss to sieet this ahallenge with a forthright and sincere effort to let science and.research find the answrs. Thie policy st first was set by considerable sci- entific and editorial skepticisa rhich, in the face of performanee, has been ecn- aiderably allaqed essong influential segments of the public. The first vave of press and public near-hysteria over the reports ot an association between cigarette ssolq.ng and lnmg cancer hss srept bf, bat in its wake were left a number of continuing problems, not the loest cT which is the re- ourrence of attacks. (iuidine Principles Certsin lbndsmental principles have guided the TIRC operations in both the scientific and public relations fields since the beginning. i'hese have yroeed sonnd. Ther have provided sufficient flexibility to deal vith difficult and changing situations, at the sane tis,e establishing an acceptable position for the iaduotry beforo the public. The lrmdsnentals, in brief, are: 1. That the tobacco industrs sincerely sssmles a respossibilit: in the atiter of people's health ard in getting at the truth concerning the suspieions aroused about tobacco use. 2. That snhampered scientific research into tobacco use and health should be eneonreged aAd financed, with complete freedam of operation, letting the faots speak for thesl.el.es.

H 1 ED 11 1 1 :12 N" 2 2. I 3. That the Tobacco Industry Research Committee sbould not enter into di- rect controversy vith accusers of tobacco, but should strive for a balanced public perspective shile the facts are being fotmd. 14. That the public is entitled to full knowledge of what the indnstrT is doing and of the findings of the scientific and medical worlds relating to tobae- co. Public Relations Ob3ectivee Conforming vith these principles, the public relations objectives of the TIRC are: 1. To moderate public alarm and fears resulting irm sensational publica- tion of inconclusive statistics and research fiadings. 2. To gain the broadest possible public understanding of these facts: that charges attempting to link cigarette smoking and lung cancer incidence are neither proved nor generally accepted by the medical and scientific world; and that the cause or causes of lung cancer ere not yet known anid maT invol.e mae~y factors of the individual and of modern-day living. 3. To islpress upon the lay and scientific publics -- by reaching broad segaents of doctors and scientists, the press, magazine and radio-TV writers and editors and the public in general -- that the tobacco industrT through the TIItC sincerely esss.oes a public responsibility for assisting in the scientific search for facts about lung cancer and for developing sound scientific knowledge con- cerning tobacco use and hvaoan health. REYIEit OF TRRRDB 'PD DllTE What has been the trend since late 1953 when the sensational public attacks on cigarette smoking as a suspect in lung cancer caught hold? General Public Daring 1954 and into 1955, the reading and listening public constantly was receiving the impression that cigarette smoking was accused as the only cause of lung cancer and that anyone who smoked cigarettes would get lung cancer, sooner or later, if he lived long enough. Today, there is growing avareneee that lung cancer, like all cancer, is a easg;lex disease, that its causes are not known, and that there are many susp.cts; that the role of cigarette smoking is an unresolved and disputed question; that lung cancer is by no means an inevitable consequence of cigarette ®oking; end that the disease has, as Dr. Paul Steiner recently wrote, a"ama11 attack rate." \

Ei I ' r, I g-. 1" 3 3. Newspapers and Win Serv:ces Most major nevepapers and press services are more moderate In their hsmdling of cigarette ners and present more balanced stories. 9hey still pick up and some- times blow up anti-cigarette stories and tend to miss thm less sensational ones that don't accuse smoking. The September 28 story featured by Scripps-Hovaud papers is a recent example of sensational treatment. Significantly, though, many papers, including The New York Times and the Herald Tribune, did not use this story at all. We see such papera as the St. Louis Globe-Democrat saying, "Some 65,000,000 to 70,000,JCa smokers will be happy to hear that the tobacco industry is seeking soberly and without bias to have this question ansvered finally. Smoking is a hab:t that gives pleasure to many millions. And. it +rill give more if they know the.t it is a harmless habit." A major press service writer said recently he didn't like to write sensa- tional stories to scare people -- "they're scared enough" -- but this seane reporter had just written a long, though well-balanced, piece about the statistical ansocia- tion of smoking to lung cancer. Press trzatment has improved but cannot be considered !ully satisfactory. ines I Among magazines, there has been little recent capitalising on the "cigarette scare." Zhe:e was a period of reaction in which several major magazines sought to Imock down the "scare" stories. With a couple of notable e:ceptions, most maga- zines seem to have dropped the cigarette-health story for the present, and editors report they are "laying off." Sinca magazine stories seem to run In cycles, there is reason to suspect the subje:t may be dormant end not dead. Not infrequently some vxiter -- usually a free lancer -- tries to figure a nev angle, but editors seem to have little Interest. ihe Sat Sveniag Post re- eently featured an article on cancer of the larynx and cigarettes were not e.en mentioned. Science Writers Science writers -- a group of specialiaed professionals in the 3ourna7.istic profession -- are looking more carefully at reports which in.ol.e cigarettes. !(aking em•e these writers see and know about diverse .iem and findings of the scientific world has been helpful. Sensitive havdling In required since science vriteMS generalir tend to be suspicious of interference In scientific matters, sz- cept on a strictly scientific basis. 9bd.pr, science writers, vith their broader background, are more likely to give so=d haedling to a cigarette story than a regular nevs reporter being exposed to the subject for the first time. me recent World-Telegrami story on the $a®ond-Horn study was written by a non-science writer, and, so far as can be learned, no science editor or writer of any publication bothered with the story -- at this time. I

HTM0 1 1-5294 4. I ( As another example, we see Earl Ubell, Science Editor of the lfev York Herald Tribune, earefv].ly inserting into a story about using cigarettes for a heart test a sentence pointing out: "Bor was the studT designed to show that cigarette nrok- ing produces heart diseaee." Similarly, 2bomes R. Henry, Science Editor of the Washington 8venia8 Star, recently vrote cautiously: "Perhaps a guarded vord of yraise is nor not too far, far off the mark for the medically condemned, televi- sion touted cigarette industry." Mr. Henry vent on to write a sound eoluan on the vork of the Tobacco Industry Research Committee. Rsdio-TE'_evision i Since the Sdvard R. *x-rcnr double-feature in mid-1955, radio and television has given little feature attertion to tde eubja=t. Neva reporting on the air has gererally been fair and restrained. Occasional local programe on cancer continue to be closely ratched. Scientific and Medicel Journals Medical and scientific Lrublications als: cautiously began to give seme encouraging recogaition to the vork that is being done by the TIRC. The re- spected New ard Journal of Medicine this year commented, "The whole setup of this camprehensire investigation indicates that the tobacco empire is now funy mrare of its responsibility in the matt.er and the distressing implications of any attempts to pass judgment before trial." Additionally, this seme journal pro.ided publication for the first coeapleted research project under a TItiC grant -- the paper of Dra. Cooper and Knight. In eomsenting on the 1956 Report of Dr. Little and Mr. &artnett's statement concerning the British work, the Journal of the Iora State Ikdieal Soeiety noted that there is support for "the contentioa that t eeearch for the cause or causes of lung cancer must be broadened and intensified." And of the i'!RC work, the edi- torial cont•inued: "From all appearances, the search is being conducted eltogelher fairly, no pressure being put upon the reciplents of grants to produce findings that suqpport the donor's point of view." Dr. Little's guest editorial on cancer research in Csneer Research, the 3omual of the American Association for Cancer Research, pro'k-Gs an outstendiag e:mzple of recognition by scientitie journals of the TIRC work. Doubters Speaking Up 'mrse Ysare ago, critics of tobacco among men of soienne and medicime eBoke out lreel,T and frequently with little challenge, but fev of their colleagaes eosld voice their doubts about the charges. Rov, there are more mho, either as a result of their own trork or fron analyses of work that indict tobacco, are voicing doubt that neoking can be der.lared g;tiltr on the bssis of the evidence aor at hand. 'me critics have not been sileneed, but scme have been severely criticised by their peers !or non-

,~ I 1? ! i d '.s* - '. J ( 5• scientific opinions, as vitaess the adverse revievs of Dr. Alton Ochaner's book in several journals oi'science, snd critical discussion from the floor vhen Dr. Oscar Auerbach presented his cleims in Detroit and Chicago early this past sum- mer. Scientific Source Material In the early stages, most source material on the subject and most experi- mental work vere almost entirely against smoking. Each new report seemed to be more demaging than the previous one. Today, there are available numerous citations or doubt concerning the role of cigarette smoking and even greater numbers of scientific sources that cite other factors to be taken into consideration. Some, such as experiments reported by the British Rmpire Cancer Campaign, are at variance with vork cited to indict tobacco. The research work being done three years ago was scattered and generally uncoordinated. It was of insufficient volume and frequently too new and limited in scope to permit adequate interpretation, verification and criticism. Nov several planned programs of scientific research are nnder vay into problems in vhich tobacco use is involved, not the least oi these being the expanding program of the Tobacco Industry Research Ca®ittee. Out of these works are coming not only previously unknown facts about tobacco use, such sa the --ecent Cooper-Knight report that cigarette smoking doesn't seem to affect the gastric secretions or ulcer patients. There is slso coming a sounder knowledge of the aomplexities in- .olved in the major constitutional diseases -- cancer and cardiovascular. Problem of Increased Scientific Reporting A problem that has been in the sating for several years is becoming more compelling. This is the increased frequency of scientific reports and discussions relating to the issue of tobacco use and health. Some indication of thiw is seen in the suoohary of papers reported in the Current M t, rhich has been distributed recently. Current Di s~t was inaugurated to e aeep abreast of the groring volune of ior~Tc a t~is feld. The Digest is a by-product of continual eollation of scientific material on the snbject vhich has proved a.aluable resource. This trend has mixed implications. Research prompted by interest sroused two and three years ago is now being reported. Ilnch of this represents efforts to substantiate previous work accusing cigarettes. Bome fails to support the cigarette theory. Attempts to in.ol.e ssoMng with heart disease show ro~p oaea- sionally, but these have not so far been of serious i:<port. The work being doae under TOC grants trill doubtless prove a.aluable contribution on this subject, when published. The effect of this situation has been to require broadened and intensified efforts to keep on top of Important medical and scientific meetings and ptiblica- ~ tions. Reports or talks indicting cigarettes can emanate frcot a vide variety of -- and sometimes most unexpected -- platforms -- dentists, chemists or Life IfaBa- sine.

( H i Pti , ,. ? ,1 ~fi A Point of Progress 6. All this represents progress, not total achievement. In short, we are not at a point where we can be sure of balanced and non- sensational treatment of adverse news concerning tobacco. Misinterpretation and sensational handling still must be expected and efforts eontinvally sade to seek for balanced handling. similarly, ve cannot expect spontaneous emphasis on news that questions any role of cigarette smoking in connection with lung cancer or heart disease. Bad news makes bigger headlines. The report this mid-swnmer of the British Ehpire Cancer Campaign, although widely printed in England, was virtually ignored in this country until Mr. Hstrbnett iesued his statement cal].ing attention to the findings. Subsequently, a fair a- mount of use was noticed, in general and medical press, including a lengthy report (ffrom England) in the Jo:ana.7l of the American Medical Association. OUTLOOK FOR 'PHE FD19IItS 'lhis review of the situation provides several guides for the future eonrse. We must expect that: -- Proponents of the "cigarette smold.ng theory," who inciude seientists as vell as out-and-out anti-tobacco propagandists, will continue to air their allega- tions in both the lay and scientific press. -- Charges against cigarettes vill continue to make news while doubts and negative findings are less likely to attract press attention. -- Idost existing scientific and popular literature relating to cigarette saoking is nou weighted against cigarettes, although the balance is ehanging. Constant effort and alertness are therefore necessary to do all possible to make swre that any public discussion of the cigarette and health yroblei be kept in proper perspective consistent with the Inova facts. This calls for activities that will: 1. Seek fair and bal.nced treatment of stories involving tobaceo ase, without unnecessarily stimlating increased discussion of the subject, and antiei- pate ad.erse stories before their appearance through continual re-ehecking of likely sources of attack, in the daily press, lay periodicals, scientific pnbliea- tions and metings. P. Ta}e prm,qt action through forthright public stateiments to offset ez- aggerated claims and darsging attacks that threaten to receive wide circulation.

I y I ~;zr ~ l~p'a 7. 3. Maintain and enhance TIItC's prestige among scientific and lay opinion leaders. This includes continuation of conferences with publishers and editors that have been under way since 1954, such as those recently held with officials of Time-Life and The Reader's Digest. Contacts vith science ani.editorial writers, vitFWblic relations representatives of scientific organisations, with other sources of information are constantly reneved and extended. 4. Bring increasing attention to the work of the Scientific Advisory Board and the results of the research program, in a manner that vill be acceptsble to both the members of the SAB and the scientific participants in the grant pro- grem. 5. Provide an accurate and up-to-date soume of information concerni scientific progress being made both here and abroad (particularly in EnglandJ, not only in the study of the effects of tobacco nse but in the resolving of the cc®ples health problems with which tobacco has been publicly associated. F[A1IIiE PLANS AND RECSAT RIGEII.IGH'RS A discussion of major public relations functions, what is being done snd what is contemplated, follows. 1. Important scientific and medical Journals, imporEant local, regional and national scientific meetings, and scientific papers, are closely checked for significant references to smoking and health. e. Neetings Recent meetings attended by Hill and Knowlton, Inc., representatives include: a. American Chemical Society, Long Island gub-section, Brooklyn, February 2$. Dr. Wynder spoke, with no adverse publicity. b. tev York Academy of Science, New York, April 3. Dr. Alvin Kosak of New York University spoke on his research involving mice and cigarette tars. c. American Association for Cancer Research, Atiantic City, April 13-15. Several papers and a press conference related to tobacco research. ATItC statement was issued. d. National Tuberculosis Association, New York, May 23-25. Dr. Hanrice Segal, a TIRC grantee, and his associate, Dr. E. Attinger, reported cigarette smoking does not harm the mechanics of breath- ing in healthy persons. Third National Cancer Conference, Detroit, June 4-6. Dr. Auerbach'e report on his pathologic studies of heaan lung tissues vas the major story. Re and several of his associates, enong them Dr. E. C~Wler 8emmond, were inter+rieNed by the press prior to delivexy of his paper. A 4IAC statement was issued.

8. t f. American College of Chest Physicians, Chicago, June 6-10. Dr. Auerbach delivered the same paper at this meeting but nith little press mention. Dr. Little also was on the program and was interviewed by local science editors. g. American Chemical Society, Atlantic City, September 16-21. ao paperw dealing directly with smoking at this meeting. Symyosia on air pol].ution were held. Contacts made with science writers. h. American Medical Writers' Association, Chicago, September 28-29. A meeting of many doctors and scientists who edit professional Journals and write syndicated columns for contact purposes. i. American College of Surgeons, San Francisco, October 8-12. Dr. Ochsner and others on program. No major story resulted. Among forthcoming meetings that vill be closely watched are: a. October 22-25, Interstate Postgraduate Medical Association of North America, Cleveland, Ohio. Dr. Oehsner, president, is to speak on stamach cancer and vill have an exhibit on lung cancer. b. October 27-31, American Heart Association, Cincinnati, Ohio. c. October 29-30, American Cancer Society, Scientific Session, New York. d. November 12-16, American Public Healtti Association, Atlantic City. The Public Health Cancer Association, a member group, vill aeet concurrently. Dr. Hueper is to speak; air pollution, heart disease and cancer are among subjects. e. November 25-26, 7nterim Vret+ng, American College of Chest Phyei- ciaios, Seattle, Washington. f. December 26-31, American Association for Advancement of Science, Aew York. An annual large and important meeting of scientists of all interests. Scientific Papers Reference extracts of important research, for both scientific and in- foimational purposes, are being kept vqp-to-date, along with a topieal catalogue of all recent scientific references to ssoking and health and varl.ons related interests. P'rae this vork, the Current DiBest was recently inaugurated for iafor- nation of ~iC a~bers, ei-r" authorized personnel, and the Scientific Advisory Board. kLditienelly, this rork provides the fundemental souree of iafosaation for stcsy idew for the lay press, vhen desirable, and for su~+plTing specific infootiation to vriters morking on stories relating to tobacco and health or TIAC.

9. ( Recently, iaformation bas been supplied to writers for Time, Life, Newsweek, eant The Reader's Digest, The Washington Post, Scienee Service, Coronet, as vell as a number ot free lance writers. Specific material has been correlated to substantiate iIRC statements and for documentation of answers to attacks. 2. Press and publication matters are handled for the TIRC Chairsan, the Scientific Director and the Scientific Advisory Board. Press Announcements Olricial TIRC press releases have been issued on the following occa- sions: Wednesday, February 1, 1956 -- Announcement of increase in funds to $1,500,000 was made.. Monday, February 27, 1956 -- Special statement was issued by Mr. 8art- nett c®enting on stories reporting Dr. Evarts Grahem's painting of rabbit ears with cigarette tars. Tuesday, April 10, 1956 -- Continuation of the felloWship progra® at an increased level of $35,000 was announced. SaturdaY, April 14, 1956 -- Statement by Mr. Hartnett oonnenting on reports at the week-end session of the American Association for Cancer Research ras released in lfev York and Atlantic City. Wednesday, June 6, 1956 -- Statement by Mr. Hartnett concerning the report of Dr. Oscar Auerbach was released in lFev York and Detroit in advance of appearance of news stories. Sunday, June 17, 1956 -- mr. Hartnett's comment on the Eaenszel-Shimtin statistical report in the dournal of the National Cancer Tnetitute was issued to appear simultaneously riM press atories on s stnU. Sun,daY, July 22, 1956 -- Quotations from the British Wre Cancer CUpaign eoncerning experiments with cigarette tara and animsls *ere cited by Ifr. Sartnett in a special statement. Thursday, August 2, 1956 -- A press suseary of Dr. Little's 1956 report on the resesroh grant program xas issned. Fiid4Y, SePtember 28 -- A statement fYcn Mr. BarF.nett oosmenting on the Yorld-SS61e9z story about the Ssmond-xm . report ras issned to Rsr York papers, wire services and sagazisAs. Fridy, October 5 -- A special statement t'ram Dr. Little about the complete freedom extended scientists by the TIRC was used by all San lrincisco papers in oonnection witb + charge of industry pressure made by Dr. Alan Gregg of the Rockefeller Fousdation.

N T "`~~' ", `?30 10. { Sunday, October 7 -- Casment by Mr. bartnett on a Eerald Tribune story concerning blood tests and smoking reported by Drs. S'isen and Ssismond appeared with the story. The statement vas also used by the Associated Press, vbich also reported the Eisen-Resffiond vork. Other Activities Assistance was given in preparing for publication the "1956 Report of the Scientific Director," of which 10,000 copies vere printed and dis- tributed to doctors, scientists, science writers, and scientific and lay media. Press releases vent with those copies sent to public informa- tion outlets. Widespread lsy and scientific attention vas noted and is continuing. Copies of the March issue of Cancer Research, publication of the Ameri- can Association for Cancer Research, vhich contained a guest editorial by Dr. Little on "Smoking and Leuig Cancer," .ere msde available to science editors and others, for their information and possible uee. Publication in the IIer _ and Journa]l of Medicine of the TMC supported work of Drs. Coopei and Rnight was called to attention of science oriters and used by such publications as Time Magazine and the Providence, R. I., Journal. ~ Dr. HockRtt spoke March 6, before 1bbacco Associates, Inc., at Raleigh, A. C., and stories on his talk were carried by the United Press and ap- peared locally. Business Week (March 3) mentioned TIliC's research progrsm, vith an error on the amount of grants. A letter from Mr. Sartnett to the Sditor, eor- recting the error, vas printed. A etatement from Mr. Hartnett concerning the TIRC ti+as fvraished Bevsweek for n planned article that, in publication, did not refer either to the health aspects or TERC. A special telegram !rom Mr. 8artnett vas sent to Henrir Luce, editor-in- chief of Time-Life publications, following the appearance in the June 11, 1956, iseue o! Life of a one-sided discussion of the cigarette-lung cancer issue, based mainlly upon the Auerbach paper. Pl,ans An a=uncement of nev research grants is in preparation. pesture stories sse being wfrked on concerning the TIItC fellovship progpgm aed the Pathologic-Anatomie proJect, whose participants are meeting in Deeember for d.iscussion of progress. 'me 1955 Background Nesozeadaa esplainipg the organisation, punposes and activities of Y'ISC is being brought qp to date for ftture use.