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The Smoking Controversy: A Perspective A Statement by The Tobacco Institute December/1978

Introduction / 1 I. The Monolithic Judgment / 5 II. The Psychological War Escalates / 13 III. The Cancer Clique IV. Conclusion / 25 End Notes / 27 Bibliography / 31 This paper is published by The Tobacco Institute in the belief that public discussion about tobacco smoking is in the public interest, and that the smoking controversy must be resolved by scientific O research. w ~ W Clt OD W

INTRODUCTION Are we on the brink of paranoia? There has been a profound and ominous change in attitudes toward health. Dr. Lewis Thomas, president of the Memorial Sloan-Kettering Cancer Center, recalls that not many years ago, when a patient visited a doctor, it was for an ailment or injury that could be readily discerned. Now, it is estimated, as many as 75 percent of all visits to doctors are by people who have nothing organically wrong with them.' Dreaded killers and cripplers like tuberculosis, pneumonia and polio have been brought under control. People are living longer than ever. Yet perhaps as a result of mass communications and widely publicized "wars" against disease, many have dark perceptions of the world as a place where, in Dr. Thomas' words, "the microbes are always trying to get at us, to tear us cell from cell, and we only stay alive and whole through diligence and fear." Dr. Herman T. Blumenthal, a gerontologist writing in Harper's, focuses on cancer, wondering whether we really are having an ep- demic of it, "or of cancerophobia-or both?" He says that "the present climate seems to be a particularly alarmist one, perhaps bordering on hysteria."2 Susan Sontag, widely regarded as one of today's most astute in- tellectuals, has observed the phenomenon. "Cancer is now in the service of a simplistic view of the world that can turn paranoid," she says.3 In the minds of many people, it has been erroneously blown up to "epidemic" proportions. And when society feels threatened by an epidemic of indeterminate cause, she points out, many look for a "scapegoat external to the stricken community." Toleration pY7s3584 of pleasures Dr. Sherwin J. Feinhandler, cultural anthropologist on the faculty of the Department of Psychiatry at the Harvard Medical School, has arrived at parallel conclusions. "In a society where tensions and anxieties give rise to anger and frustration," he says, "there is always a danger in allowing pressure groups to influence legislation re- stricting individual freedoms simply to alleviate annoyances to another segment of society. In times of high tension and anger, it is in- cumbent upon government to move with caution and deliberation."4 Tracing the phenomenon through history, he has found recurring instances where the denial of pleasure was, at bottom, an attempt to 1

seize or maintain political power. This was true of ancient dietary laws, sexual taboos, restrictions on the theater and Prohibition, Dr. Feinhandler says. Others would say it is true today of anti-tobacco programs. Others have cited the repressiveness of sumptuary taxes, devised by authoritarian nobility to keep peasants in their place by limiting their pleasures. As early as Chaucer's time, ale and good food were taxed (in public houses, but not in castles), ostensibly because the enjoy- ment of them was physically debilitating, that is, hazardous to health. Cigarette taxes, of course, are examples of today's sumptuary taxes. The "war against cancer" . . . degenerated into a war against cigarettes ... Now it has further de- generated into a war against smokers . . . 2 Beyond the realm of reality Clearly the current controversy over smoking and health involves some elements of the politics of pleasure and the use of disease as a political metaphor. The declared "wars" against disease are being waged by the government and voluntary health agencies beyond the realm of science. Initially, their "war against cancer" concentrated on medical re- search. It was a scientific program conducted against disease. Then it degenerated into a war against cigarettes, with untold billions of warnings every year about the alleged health hazards of smoking. Now it has further degenerated into a war against smokers, waged through vilification, banishment from public places, denial of em- ployment and repressive taxation. No one really knows whether this personalized warfare against tens of millions of Americans will prevent a single case of lung cancer or heart disease. But as noted, many people do look for a "scapegoat" when they feel threatened. In this case, it is smoking. We are on the brink of paranoia. As observed recently and critically by New York Times editorial writer Harry Schwartz, "a mounting current of opinion is coming around to the conclusion that certain major illnesses in certain large classes of people are the fault of the victims, and those victims should be dealt with in a stern manner.... "It arises from the fact that most medical costs have been col- lectivized and are paid either by private insurance or from the gov- ernment's funds, as in Medicare and Medicaid."5 037s3,S The declaration of war can be seized by some as a license~or8e`~x- treme measures. They demand unquestioning allegiances and faith in the righteousness of their case. They brook no contrary views. Facts inimical to the cause, as they perceive it, are to be ignored or suppressed. Dissenters are dismissed as "self-interested." Passions blot out reason.

The more elusive victory appears, the greater the resort to harsh and unjustified means, including the denial of personal rights and the stretching of truth. In this instance, there is one overriding truth: No one knows the root cause or causes of cancer. And while such contributing factors as high blood pressure and obesity are known to be involved, leading scientists say the root cause or causes of heart disease are unknown as well. The anti-smoking forces refuse to face up to that truth. Instead, they persist in perpetuating the idea that the case against smoking is proved. Period. They proceed with their multi-million dollar pro- grams against smokers. In the meantime, the quest for knowledge about disease is prejudiced. This paper cites state- ments by many inde- pendent authorities with impeccable credentials ... 3 The other side Those who produce and market tobacco products have become a natural target of the forces who would purge the leaf from society. In accepting a defensive role, they have developed a unique knowl- edge of and sensitivity to more aspects of the controversies than any other single source. They know that the controversy is multi-faceted, regardless of the closed-minded attitude of smoking critics. They also know that their own views are widely regarded as self-serving and subjective. Notwithstanding, they have chosen not to relinquish the battle- field, in the adversaries' metaphor; instead they have thrust them- selves vigorously into the public policy debates in mass media, regulatory and legislative deliberations and even in courtrooms. While providing impressive and ongoing support of medical and scientific research, the tobacco industry continues to present aspects of the controversy little known to the public and little understood by many in the health professions. It is in the interest of promoting a balanced, reasonable and re- sponsive debate on the question of smoking and health that The Tobacco Institute presents this paper on "the other side," concededly the industry's side. But it also cites statements by many independent authorities with impeccable credentials-statements that have not been given a milligram of weight in the multi-million-dollar pro- grams against smokers. 03''fs358s This paper will develop and document the following points: 1. Millions of smokers choose to smoke for reasons and satis- factions not fully understood. What would be the consequences if tobacco were banned or all smokers were convinced to quit smoking? A number of leading authorities, including even the authors of the famous 1964 Surgeon General's report, acknowledge that tobacco

smoking has beneficial aspects. The report warned that its elimina- tion could promote the use of other substances which could create "a gamut of social problems." 2. Many health agencies have created the myth that the case against smoking is closed. However, their conclusions are based largely on statistical associations, the interpretation of which has been questioned by leading epidemiologists. 3. Another myth-that nonsmokers are somehow harmed by tobacco smoke-is being perpetuated. Yet the great preponderance of evidence from independent and government studies shows that so-called "ambient" cigarette smoke is not a health hazard to normal nonsmokers. 4. The belief that smoking in fact is the principal cause of lung cancer may be diverting attention from occupational and environ- mental factors which have been found to be associated with the disease. As a result, employees and others may be unnecessarily af- flicted. Such is the climate created by the health agencies. One re- searcher who has examined the relative effects of smoking and occupation on lung disease has asked, "Does smoking kill workers or does working kill smokers?" 5. The public has an exaggerated notion of how much the American Cancer Society, the American Heart Association and the American Lung Association spend on smoking and health research. 6. A leading independent monitoring service for contributors has questioned the propriety of appeals for more funds for research at the very time the private agencies are enlarging their cash reserves and increasing their non-research expenses. This monitor suggests the public appeals by the ACS have been misleading. 7. The single piece of laboratory research said to prove conclusive- ly that smoking causes cancer has been largely discredited. It was the famous "smoking dog" study, announced with public fanfare at a televised press conference by the American Cancer Society. 8. Because of their preconception that smoking is guilty, private health agencies have diverted substantial funds to "educating" others to this opinion. This unscientific approach has failed to provide scientific evidence about the cause, prevention and cure of disease. 9. There is an alliance between the private and public agencies, with collaboration in the acquisition and allocation of funds. 10. The "official" position is dictated by this handful of well en- trenched people wearing a cloak of power, prestige and rectitude. Their pronouncements are embellished, overladen with emotion and disseminated by a volunteer army of people, many with the best of 4 intentions, yet misinformed.

Years of scientific re- search have failed to provide conclusive evidence that smoking causes disease. 5 I. THE MONOLITHIC JUDGMENT In the tobacco and health controversy, there is a monolithic mindset that extends to many individuals in the media and the medical pro- fession. Media that customarily take an objective and skeptical stance in most controversies unquestioningly report outlandish al- legations against cigarettes. Many reporters and doctors have un- critically joined the anti-smoking crusade. Are statistics proof? Yet few are aware that years of scientific research have failed to provide conclusive evidence that smoking causes disease. The statisti- cal associations merely raise questions without providing answers. For example, the reported rate of lung cancer has increased, though certainly not to the "epidemic" proportions predicted year after year. One often overlooked though logical explanation is that lung cancer largely afflicts older people, and more people are living longer. And it has been impossible accurately to assess how much of the recorded increase is the result of improved diagnostic techniques and equip- ment, a fact that in itself raises questions about the validity of the statistics.6 Serious questions have also been raised by autopsy studies, con- ducted after the recording of statistics on which mortality rates are based.7 Such studies often show that lung cancer has been, on the one hand, incorrectly stated as the cause of death or, on the other hand, overlooked as the cause.8 (See End Note #1). Dr. Alvan Fein- stein of Yale has pointed out that physicians tend to look more closely for lung cancer in smokers because of the conventional con- victions against cigarettes. "Cigarette smoking," he says, "may contribute more to the diagnosis of lung cancer than it does to pro- ducing the disease itself."9 This may mean inadequate medical care- for the smokers mistakenly believed to have lung cancer and the nonsmoker cancer victims treated for other ailments. Since these troubling matters are rarely presented by the medical as well as the general press, they are virtually unknown to general practitioners. How can it be in the public interest to keep the public and the medical profession ignorant of the facts? 03763588 The obsession with smoking has led many doctors automatically, unthinkingly, to advise all patients to stop smoking without any con- sideration of how this will affect the individual patient. This runs directly contrary to enlightened medical practice, which is to treat the whole person.

The scourge that never came Smoking provides some pleasures and satis- factions for hundreds of millions of people. The undaunted smoker ... must be reckoned with. 6 The historical facts suggest something altogether different from the popular belief nurtured by anti-tobacco forces. Throughout the past four centuries, the enjoyment of smoking became common in every society which encountered tobacco. No one could reasonably deny that smoking provides some pleasures and satisfactions for hundreds of millions of people. Whether it has been harmful to any society at large is questionable. Moreover, the use of tobacco has become most common in industrialized societies that have achieved the highest standard of living and the greatest longevity. The example of cigarettes, which are the primary target of many health agencies, makes an even more dramatic point. Cigarettes first gained popularity near the turn of the last century. According to the anti-tobacco hysteria of that era, cigarettes caused tuberculosis, in- fluenza, insanity, sexual perversion, nightmares, insomnia and slavering.10 The New York Times, for one, editorialized that if cigar- ettes continued to catch on, there would be a veritable scourge and the U. S. would suffer a decline like that of cigarette-smoking Spain." (See End Note #2). Cigarettes did continue to catch on, at a remarkable rate, and the predicted decline in public health did not occur. Since 1900, cigarette sales in the U. S. have risen from fewer than three billion cigarettes annually to more than 620 billion.12 During this period, for many reasons, average life expectancy has increased from 47 to 72 years.13 These statistics cannot establish cause and effect, but they can show the absence of the dire effect predicted by the New York Times and others. Why do people smoke? How smoking of cigarettes continued to grow despite formidable opposition and campaigns waged on the two personal levels of mor- ality and health is a sociological phenomenon never adequately analyzed nor sufficiently explained. The undaunted smoker, who continues to smoke for whatever reason-perhaps for an enhancement of faculties and effectivness- must be reckoned with. If, as is now seriously advocated, smokers are to be coerced into not smoking through punitive taxation, prohibitions and propaganda, and smears of shame and guilt, a rational and decent society would determine first why the smoker continues to smoke. 03763589 In most questions of personal satisfactions, our increasingly in- dividualistic society reasonably is leaving decisions to the individual,

without coercion. Pleasures once condemned as vices, such as dancing and theater, are now condoned. Our society permits people to fly airplanes and to climb mountains and to ride bicycles in New York City, however dangerous such acts may seem to some onlookers. Bathers, a fraction of whom drown, swim at beaches without puni- tive taxation. Joggers are regarded with approbation, although it is known that some suffer heart attacks. Consumers whose dietary practices are asserted to be unhealthful by some authorities are sub- ject to nowhere near the all-out attack that smokers are. A decent, libertarian society is committed to private choice rather than public fiat. It believes that the adult individual knows-logi- cally, psychologically, perhaps intuitively-what is right for him. Individual freedoms are denied only when the larger interests of society overwhelmingly dictate the denial. The costs of such im- positions of will on others are carefully weighed. A section of the Surgeon General s Report is devoted to "Benef icial Ef f ects of Tobacco." Surgeon General's report cites benefits 7 This clearly has not been done in the smoking-health controversy. One searches in vain among the anti-cigarette pronouncements and tracts for a hint that people smoke for various personal reasons. The very real possibility that prohibiting smoking without considering those reasons could have serious repercussions for individuals and society at large is never entertained by the health agencies. Yet ironically, there is a clear warning to that effect in the very report that is the foundation of the current campaigns against to- bacco. In "Smoking and Health: A Report of the Advisory Com- mittee to the Surgeon General" published in 1964, a section is de- voted to "Beneficial Effects of Tobacco."14 It states: "Evaluation of the effects of smoking on health would lack perspective if no con- sideration was given to the possible benefits to be derived from the occasional or habitual use of tobacco." The report also states: "The significant beneficial effects of smoking occur primarily in the area of mental health, and the habit originates in a search for contentment."15 The Surgeon General's report warns that if smokers were denied tobacco they might well turn to less acceptable means of relieving stress and attaining pleasure. This warning from the cornerstone of their campaigns, in a classic case of selectivity, is absent from the pronouncements of the health agencies. .00-Mas"_ Since the 1964 report, an enormous amount of energy, passion and funding has been expended (1) by the government to find medical evidence to prove the hypothesis that smoking causes lung and heart disease and (2) by the government and many health agencies to

convince smokers to stop smoking. Success in attaining those ob- jectives has been notably lacking. "We really don't know anything at a deep level about the mechanism o f heart disease, or cancer ... " What are the medical facts? Significantly, some leading medical authorities have protested such a narrow approach to the smoking and health controversy (see End Note #3). The Nobel Laureate, Professor Ulf von Euler, said that it is surprising that so little research has been devoted to the "positive effects" of smoking. "No one really believes that such a large group of humanity would be using tobacco or products containing nicotine ... if it was not for the fact that it gives effects that can be con- sidered positive," he said. Professor von Euler emphasized that little is known about the effects of smoking on different kinds of individuals.ls Another eminent researcher, Dr. Carl Seltzer of Harvard, says the evidence suggests that for some individuals to give up smoking might subject them to critical levels of hypertension.17 That view is echoed in a different way by Dr. Walter Menninger, of the Menninger Foundation, who says smoking relieves tension in certain types of individuals. If they do not get this relief, he says, they could well develop psychosomatic illnesses.18 Other scientists have raised still other questions. For example, an exhaustive, seven-country study was coordinated by the renowned Dr. Ancel Keys, director of physiological hygiene at the University of Minnesota. In his summary of the study, Dr. Keys said: "Exam- ination ... of the so-called risk factors shows that most of those factors, whatever may be their influence ... cannot explain the ob- served differences in the incidence of coronary artery disease ... cigarette smoking cannot be involved as an explanation."ls The mechanisms are not known 8 Dr. Lewis Thomas, as president and chief executive officer of the Sloan-Kettering Cancer Center in New York, heads one of the leading health research laboratories. Says Dr. Thomas: "We really don't know anything at a deep level about the mechanism of heart disease, or cancer, or stroke, or rheumatoid arthritis. We can make up stories about them, and it could be, I suppose, that they do have multiple causes, and are due to things we can't control in the environment. 03763591 "If that's true-if that should turn out to be true-that would be