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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

"There may be a lot of other things going on . . ." That the case is proved is not supported by many of the world s leading scientists. 9 quite a piece of news. Because it has never happened before. Every disease that we do know about, and for which we have really settled the issue, so that we can either turn it off, switch it off, or prevent it once and for all-every such disease turns out to be a disease in which there is one central mechanism. "There may be a lot of other things going on, and maybe a lot of things that we don't know about have to do with a predisposition to the disease, and maybe a lot of things aggravate the disease once it is established, but there is always a chairman of the committee. "In the case of pneumonia, it's the pneumococcus, and in the case of tuberculosis it is the tubercle bacillus, and in pellagra it's a single vitamin deficiency. And I have a hunch-of course, I can't prove it- that it will turn out to be that way for cancer and probably for coronary occlusion, probably for stroke and probably for the kind of kidney disease that develops into chronic renal failure." Note that smoking has been regarded as responsible for some of these ailments. As Dr. Thomas suggested, scientists suspect a wide range of factors leading to these diseases. Among them are genetic predisposi- tion, aging, stress, obesity, high blood pressure, cholesterol, radiation, chemicals and the growing number of occupational and environ- mental pollutants. So many suspects have been named, in fact, that news stories have begun referring to the "carcinogen of the month." Whether actually one factor or a combination of factors is involved remains unknown. VVhat serves the public interest? The flat assertion that smoking causes lung cancer and heart disease and that the case is proved is not supported by many of the world's leading scientists. How can it be in the public interest, then, to divert precious funds from scientific research into propaganda programs against the smoker? How many deaths and how much suffering may be caused by the delay in establishing the causes? To what extent do health authorities diminish the credibility of factual information which should be heeded by laymen in the interest of better health? The editor of the British journal, Public Health, recently concluded that "If we are to retain the confidence and respect of the public ought we not to take the greatest care not to mislead them?" The editorial said this is especially important when potential interference with "personal pleasures such as smoking and eating" is involved.20 To no one's surprise, the editorial was roundly denounced by leading spokesmen for Britain's anti-tobacco movement.21 O.IM3.499;Z

Inadequate statistical research could be the basis for "a major public health disaster." 10 The silent thunderclap In March 1977, the head of the Institute for Clinical Chemistry at the German Heart Center in Munich said that nicotine may be beneficial for smokers in its calming and stimulating effects and that it does not cause heart attacks.22 After intensive laboratory research with rabbits who were given nicotine equivalent to smoking six packages of cigarettes a day, Professor Helmut Schievelbein said: "The nicotine contained in cigarette smoke neither constricts the coronary vessels nor does it lead to cardiac infarction in this manner. On the contrary, nicotine probably has beneficial effects on smokers by exerting stimulating and calming action." One German newspaper described this as a "thunderclap." But it escaped the notice of the press in the U. S. Thunderclaps that would seem to contradict the conventional dogma somehow go unheard. But if that was a thunderclap, a joint paper issued by leading scientists in three U. S. government agencies in the fall of 1978 may be regarded as a major earthquake.23 Prepared jointly by nine top U. S. government scientists including the director of the National Cancer Institute and the director of the National Institute of Environmental Health Sciencies, the document declared that conventional single-cause theories about cancer causa- tion are wrong, are based upon inadequate statistical research, form the basis for wrong estimates of cancer risks and could be the basis for "a major public health disaster." In one particularly dramatic passage-dramatic, considering its auspices-the document asserted forthrightly that "If current theories of a multi-causal process are correct, it seems likely that a large fraction of cancer which at first appear to be 'attributable to' smoking should also be 'attributable to' asbestos, radiation, and/or other occupational factors." The government manifesto was specifically critical of the work of certain epidemiologists who had provided the foundation of the first so-called Surgeon General's Report on Smoking and Health 14 years earlier. The strange ~ w statistical anomalies ~ Apart from the fact that statistics cannot establish cause and effect~ they have presented some strange anomalies that do not conform w with the hypothesis that smoking causes disease. They vary widely by different populations, for example. Citing one - instance, Dr. Domingo M. Aviado, former Professor of Pharmacology i

A number of leading epidemiologists question the causal hypothesis. Stress may be a factor in heart disease and possibly cancer. 11 at the University of Pennsylvania School of Medicine, reported: "While the average 'tar' and nicotine content of Filipino cigarettes is 200 to 500 percent higher than U. S. cigarettes, the incidence of lung cancer is only six percent of that in the U. S. and the incidence of heart disease is only four percent of that in the U. S."24 Such inconsistencies have caused a number of leading epidemi- ologists to question the causal hypothesis. Dr. Seltzer of Harvard found that the rates of coronary heart disease (CHD) reported in one research project were lower for smokers who had stopped smoking than they were for people who had never smoked.25 Following the conventional hypothesis, he said, it would be better to smoke and then to stop than never to smoke at all. He rejected the notion, of course, but said the anomaly does not lend credence to the research report. In a paper in the American Heart Journal, Dr. Seltzer reviewed that and other statistical anomalies and concluded: "Unless these inconsistencies and conflicts in the data are satisfactorily disproved or reconciled, the current hypothesis for cigarette smoking as major risk factor in CHD must be re-examined and alternatives must be sought."26 Professor Philip Burch of the University of Leeds in Great Britain came to a similar conclusion concerning lung cancer: "Those epi- demiological studies that purport to show a causal connection between cigarette smoking and various cancers, but particularly lung cancer, fail when examined critically to establish the causal claim."2 7 Professor Burch quoted the late Sir Ronald Fisher, regarded as the father of biostatistics, who said that the hypothesis concerning smoking and lung cancer may well prove to be a "catastrophic and conspicuous howler."28 (See End Note #4). The role of stress Since the 1964 Surgeon General's report, a new body of medical fact and opinion has emerged concerning the effects of stress in today's society. It is now widely accepted that stress may be a factor in a number of other afflictions, including CHD and possibly cancer. One of.the world's foremost authorities on stress is Dr. Hans Selye, author of more than 600 scientific papers and 12 books. He has re- ceived numerous awards and honors for original work in the pre- vention and treatment of disease. 03763594 In a statement on smoking and health, Dr. Selye declared that it is "frightening" that no one mentions the benefits of tobacco.29 "Man will always seek gratifying relief from stress," Dr. Selye said, "as he does from hunger, thirst or the sexual urge; our responsiblity is not to lock up avenues that may be dangerous, but to determine as ob-

jectively as possible which are the most and which are the least dangerous in proportion to their benefits. Only comparative studies of this kind are meaningful because, if a tense person who would normally smoke is prevented from doing this, he will undoubtedly seek relief from stress in some other way which may be still more dangerous." As one example, Dr. Selye cited evidence that being overweight is a risk factor for CHD and observed " . . . it is a well-known fact that people who give up cigarettes often turn to overeating instead." (Dr. Christiaan Barnard,.the renowned heart surgeon, is reported to have recommended cigarettes to his daughter as a means of losing weight.30 (See End Note #5). The making of hypochondriacs Dr. Selye concluded his statement with comments that grow more relevant each day: "I think it is very important to keep the public informed of the progress of studies on smoking, but this should be done perhaps with less over-dramatization. I am sure that often more damage is done by creating, through well-meant crusades of enlightenment, innumerable hypochondriacs whose main sickness is really the fear of sickness. "We have seen many examples of this in medicine; for example, in connection with the so-called 'cardiac neurosis' which can make an es- sentially healthy man miserable all his life. Such an "over-enlightened' anxious layman has read so much about the dangers of heart disease that each time he feels a mild pain in his chest or an occasional abnormal heartbeat, he believes himself to be in imminent danger of death. "I wonder how many people who just could not give up smoking might have continued to lead a perfectly normal life had they not been plagued by fears of being not only in great peril, but actually sinful." 12 ~ CR

II. THE PSYCHOLOGICAL WAR ESCALATES Dr. Selye's concern takes on additional significance in light of the announcement in January 1978, by Joseph A. Califano, Jr., Secretary of Health, Education, and Welfare.31 He said his department would wage "the most vigorous and hard-hitting program against smoking that this country has ever had." Secretary Calif ano declared that the program, at a cost of $23 million in its first year, would concentrate on education and in- centives. The proposed "incentives" include higher taxes on cigarettes and further prohibitions of smoking in public places (see End Note #6). Less than one-tenth of the 26-page announcement was concerned with research, but to the degree this murky reference can be under- stood it means research into methods of "helping people overcome their addiction to cigarettes." (It will be recalled that the Surgeon General's report said smoking is an habituation, not an addiction.14) A voice of reason A few weeks earlier President Carter's top health advisor on the White House staff took a different position, but his was a muted voice of reason.32 He reiterated the President's observation that the public has been "adequately warned" about smoking and advocated more research into the cause of disease. And he emphasized that the research should not be restricted to tobacco. The announcement by Secretary Califano, a lawyer, was covered extensively by all the media. By contrast the position of the White House medical doctor was virtually ignored. Still another offensive launched The fact that a declaration of war or the launching of a new of- fensive can draw publicity is well recognized by the anti-cigarette forces. In 1977, the American Cancer Society announced "Target 5" (military terminology again), a five-year political and propoganda campaign to be highlighted by anti-smoking media events and lobby- ing for more anti-cigarette legislation.33 D3W3596 Diverting the Society's efforts from research into propaganda, overt and covert, the program is aimed directly at smokers. Its method is to instill blame, shame and fear among them. It attempts 13

The profound sense of alienation among the victims of disease is a growing cause o f concern. The burden of proof must rest with those who advance the hypothesis. to make them second-class citizens in society, pariahs in their own families (see End Note #7). The possibility for psychological strain among the tens of millions of people who enjoy smoking is ignored. Tragically, the forgotten ones are the victims of the diseases the health agencies purport to be fighting. The profound sense of aliena- tion among the victims of disease is a growing cause of concern. They tend to blame themselves for their afflictions, and members of their families tend to agree with them. The tactics of the health agencies can serve only to intensify their alienation at a time of deepest distress. A metaphor for hate Susan Sontag, herself a victim of breast cancer, observes: "Ostensibly, the illness is the culprit. But it is also the cancer patient who is made culpable."3 Ms. Sontag conducted extensive research into the historical and medical literature on the macabre use of "disease as a political metaphor"-that is, an excuse for attacking non-victims of the disease. She goes back to the plague of the 14th century, which in the twisted mentality of the times led to a massacre of Jews. When the plague subsided, the pogroms ceased. Particularly when magnified to "epidemic" proportions, Ms. Sontag suggests, cancer can be used by extremists to justify radical actions. It is altogether clear that this is what is happening to smokers today. The "incentives" proposed for smokers follow a classic pat- tern of prejudice: discrimination in employment, segregation in public places, economic repression (through taxation) and emotional belief in condemnatory mythology. 14 A question of proof U3763S9'7 On what basis can organizations be justified in their "wars on disease" that inflict distress on members of our society? In their scare campaigns, the health agencies have both publicized statistical "epidemics" and provided scapegoats. They make the flat judgment that smoking causes lung cancer and heart disease. On the face of it, the judgment violates the laws of science. Many smokers suffer neither of those diseases. And many nonsmokers are struck by one or the other. Neither phenomenon is explained. There is another law of science that pertains. A hypothesis con- cerning the cause of disease remains merely a hypothesis until and unless conclusive laboratory and clinical proof can be found. The burden of proof must rest with those who advance the hypothesis. The most insistent enemies of smoking are well aware of that fact.

It cannot be proven that smoking has "no effect." 15 E. Cuyler Hammond, Sc.D., vice president for epidemiology and statistics of the American Cancer Society. stated it quite articulately: "You can't prove that something produces no effect. You can't prove that one out of a trillion people won't get cancer from being exposed. Nor can you prove that out of a trillion people, there wouldn't be one that was prevented from getting cancer by this exposure."34 (See End Note #8). Thus it cannot be proven that smoking has "no effect." The people who make tobacco products do not claim that smoking has no effect. This paper cannot prove and does not imply that smoking is "safe." On the other hand, it must and does challenge the simplistic transi- tion from statistical hypothesis to blanket charges to the absolute conclusion that the case against smoking is proved (see End Note #9). To dismiss the tobacco industry's position because the impossible disproof is not forthcoming deviates from the issues. Yet this arrow frequently is shot from the anti-tobacco bow. Proof as to the cause of disease is indispensable. Where is it in the case of lung cancer? The American Cancer Society remains well aware of the need for laboratory evidence because the one time it claimed to have such evidence became an abiding embarrassment. On February 5, 1970, the ACS held a news conference at the Waldorf Astoria Hotel in New York City.35 Without the customary review by scientific peers and acceptance by a reputable scientific publication-a procedure considered essential in the scientific com- munity-research purporting to show that the inhalation of tobacco smoke caused lung cancer in beagle dogs was announced to the general public.36 The study did have the endorsement of the then Surgeon General, Jesse Steinfeld, a testimonial highlighted by the ACS. It was later learned that he had not even reviewed the study before giving it his endorsement.37, 38 More important, it was also disclosed later that the study had been rejected for publication by both the New England Journal of Medi- cine and the Journal of the American Medical Association.38,39 The unorthodox public press conference received front-page coverage by newspapers and was featured by the television networks. Walter Cronkite reported the Society's claim that "this is the first cause-effect link" between cigarettes and lung cancer in higher animals.40 03763598 ACS has never released the full details of the study for independent review (see End Note #10). The National Academy of Sciences questioned the study on the basis of four separate points that still remain to be resolved.41 Many people mistakenly believe the "cause- effect link" has been established, and the ACS does nothing to disabuse them of the false notion which it created.42

That smoking was the cause was "a meaningless argument to throw in . . ." 16 One author of the study, Dr. E. Cuyler Hammond, remains em- ployed by the ACS. The second, Dr. Oscar Auerbach, is an ACS grantee. Dr. Steinfeld, whose unqualified endorsement of a study which he had not seen added to its original and misleading credi- bility, is closely associated with the Society. But experimental scientists have yet to induce, by exposure of tobacco smoke in animal lungs, the type of cancer associated with smoking. In the public disservice Grisly results of the rigid dogma promulgated by the anti-smoker agencies are beginning to come to light. One reported example in- volves BCME (bis-chloro-methyl ether), a relatively new chemical important in the refining of low-grade uranium and other uses. In 1971, a group of researchers at New York University concluded BCME is the most potent carcinogen among those it tested.43 For more than 20 years, BCME workers at a plant in Pennsylvania suffered an inordinate rate of lung cancer, but the cancer deaths were attributed by company officials-and outside medical experts!- to cigarettes. Concerning that plant, an inspector from the Occupational Safety and Health Administration in 1971 glowingly noted in his official report that the plant had "recently completed 365 calendar days without a lost-time injury." During those 365 days, ten of its workers had died of respiratory cancer. By 1974, more than 50 employees who had been exposed to BCME in the plant had died of respiratory cancer, but the company resolutely maintained that the deaths were not related to occupation. Finally, when it was clear that nonsmokers as well as smokers were cancer victims, one OSHA doctor commented that the company's insistence that smoking was the cause was "a meaningless argument to throw in; 60 to 70 percent of the working population smokes." By July 1975, the company had settled 27 compensation claims by survivors of workers who had died of cancer. An investigative article in the Philadelphia Inquirer's Sunday magazine, Today, reported that 54 employees had died of respiratory disease after exposure to BCME. "Something else is going on" Q3W35q9 To suggest that the BCME incident was isolated would ignore con- trary evidence. In 1975, the.National Cancer Institute issued an atlas showing cancer death rates over a 20-year period for each county in 3 4

Statistics. o f lung cancer bear little or no rela- tionship to nation-by- nation di f ferences in cigarette consumption. the United States.44 The patterns of lung cancer bore a highly incon- sistent relationship to the presumed patterns of cigarette smoking (see End Note #11). The incidence of lung cancer was extremely high along the East and Gulf Coasts. Commented Dr. Joseph Fraumeni of the NCI: "Something else is going on." When the NCI atlas was released, Newsweek noted that is was "called 'a surprise."' But the warriors against cigarettes seemingly ignored it and, characteristically, intensified their efforts. The atlas could hardly have been surprising to the epidemiologists who for years have noted that the worldwide statistics of lung cancer bear little or no relationship to the nation-by-nation dif- ferences in cigarette consumption.45 The smoker diversion Among the states with the highest rates of lung cancer is New Jersey, whose large number of industries includes chemicals and asbestos, widely held to be one of the most pervasive carcinogens. Asbestos manufacturers, however, have used the anti-cigarette conviction to muddy the issue.46 Recently a Congresswoman from New Jersey introduced federal legislation to enact a special "health insurance" tax on both asbestos and cigarettes.47 The tax would be used to compensate asbestos workers or their survivors when those workers have been afflicted by respiratory disease. Within the Congresswoman's district is one of the world's largest asbestos companies. Her legislation, it was dis- covered, was drafted by the company's lawyers.48 As the number of suspected carcinogens has grown, the number of those with a vested interest in the anti-cigarette ritual has grown apace. More than 500 worker's compensation cases are pending against one asbestos company.49 (The company has already paid several50). Between eight and eleven million workers are believed to have been directly exposed to asbestos and other carcinogens in their occupations.51 Attempts to spread or divert the blame by ex- ploiting the charges against cigarettes, of course, do not advance the search for the true causes of disease. ~ I O G.i 17 M 8

t 03763601

III. THE CANCER CLIQUE What the superstructure did was to concentrate power in a tight little pro fessional in-group . . . When one considers that hundreds of millions of dollars have been spent for cancer research through the public and private agencies with comparatively little discernible advancement of knowledge, there is good reason to suspect waste and misdirection. Such charges have been made by people in a position to know. One is Dr. Irwin D. J. Bross, Director of Biostatistics for the Roswell Park Memorial Institute, who testified on June 14, 1977, to the House Intergovern- mental Relations and Human Resources Subcommittee.52 (See End Note #12). Dr. Bross, a well-known foe of cigarettes,53 pinned the failure of our nation's cancer programs on the administrative superstructure that controls the National Cancer Institute, and he did not hesitate to name names: "The superstructure was largely engineered and controlled by the American Cancer Society, a principal beneficiary of NCI funds. The liaison with the White House, Benno Schmidt, and the Director of the National Cancer Institute, Frank Rauscher, and many members of the National Cancer Advisory Board ... all had close ties with ACS. This is also true, for that matter, for proposed replacements for Frank Rauscher (who is now an ACS vice president). What the super- structure did was to concentrate power in a tight little professional in-group which then proceeded to run the Conquest of Cancer pro- gram as a closed corporation with a total disregard for the public interest. "In any other area of the federal government," Dr. Bross continued, "this cozy set-up would have been regarded as very questionable or outright corrupt. This set-up is not worth revamping and should be junked. The American Cancer Society should be barred from getting any NCI grants ... for the next four years." (See End Note #13). Manipulating media Dr. Bross has been engaged in cancer research for 25 years,-14 but his grave allegations largely escaped attention in the press. Perhaps the media were sensitive to his implication that they were being manipulated: "The programs for other environmental carcinogens are little more than public relations gimmicks, 'paper tigers' designed to reassure a concerned public that something is being done when it isn't. This is standard practice in the NIH (National Institutes of Health). The program on cigarette health hazards is a farce. It con- O sists of noisy scare campaigns which are counterproductive-like w ~ 19 0~ tJ O iV

The Reader's Digest has carried anti-smoking articles written by a paid staff f member of the American Cancer Society. Growing constraints on smokers are based on emotional antagonism. 20 most of 'cancer education.' It sets up meaningless 'clearinghouses' to shuffle paper around-a successful gimmick that is now used for chemical carcinogens. It will kill a lot of beagle dogs in a cruel and stupid experiment that will tell us nothing about human cancer . . ." The use of the media by the Cancer Society has assumed question- able proportions. The Reader's Digest, for example, has carried anti- smoking articles written by a paid staff member of the ACS.55 Readers were not informed of the author's affiliation, although his special interest is certainly relevant. At virtually the same time Dr. Bross was delivering his testimony, ACS was launching its "Target 5" propaganda program with so- called "forums," actually staged media events in major U. S. cities. At the first one it presented a young man who had held a hostage at gunpoint on the roof of a Los Angeles building.-6 He had refused to release his hostage until the media reported that his father had died from smoking; here again, an allegation and not a proven medical fact. The media complied.57 To the ACS, the terrorist and accused felon was an invited witness whose views deserved publicity (See End Note #13). Stigmatizing smokers The implied objective of the "Target 5" program is to create social scorn for smokers. The implication was clear to the Chicago Metro News, a black publication that is understandably sensitive to man- ifestations of oppression. In an editorial, it stated: "If the ACS is allowed to continue in this direction of setting up 'veiled' rules for setting the lifestyles of citizens, the precedent will have been set for hundreds of organizations whose actions and programs are already suspect, to openly get involved in setting up 'people constraints' geared to regiment the people in this country into a state of terror described by the author of the classic novel '1984' in which 'big brother' determined the existence of all people on the planet."-8 (See End Note #14). Diffused cigarette smoke The concerted effort to stigmatize smokers as second-class citizens has been magnified into a furor over smoking in public places. From the earliest history of tobacco, the sight of someone smoking has been disagreeable to some people. 03763603 The Chicago Metro News had a good reason to perceive social prejudice in the growing constraints on smokers, because they are based on emotional antagonism, rather than reason. A comprehen-

Men have physically attacked other men for smoking. 21 sive review of the research into the question of so-called "passive smoking" was conducted by the American Health Foundation and published in 1975 in the journal, Preventive Medicine.59 The con- clusion: "On the basis of available epidemiological evidence, it ap- pears passive inhalation of tobacco smoke by nonsmokers or smokers does not increase their risk for chronic illnesses such as cancer of the respiratory tract, emphysema, or cardiovascular disease." Two articles supporting this view appeared in The New England Journal of Medicine in April 1975. In "Concentrations of Nicotine and Tobacco Smoke in Public Places," a research paper by William C. Hinds and Melvin W. First of the Harvard School of Public Health, the authors concluded that measured levels of ambient cigarette smoke "would not be expected to produce the strong public reaction to tobacco smoke that has developed in the past few years." Hinds and First suggested that "annoyance from tobacco smoke is caused by factors other than the average concentration of particulate matter in the indoor atmosphere." In the same issue, Dr. Gary L. Huber of the Harvard Medical School wrote that nonsmokers' reaction to tobacco smoke may be psychological, rather than physical.60 There have been numerous reports of nonsmoker behavior that could best be described as neurotic. For example, men have physically attacked other men for smoking in supermarkets.sl Growing concern led to a Congressional hearing in September 1978, at which nine scientists testified in refutation of charges by anti-smokers that tobacco smoke in the air can cause disease. Fol- lowing the hearing, ten other experts provided additional scientific refutations to the committee. It was their outspoken contention that ambient tobacco smoke cannot cause illness in normal nonsmokers.62 Generating fear and hate How much psychological distress is reinforced by unfounded charges by some of the health and propaganda agencies, notably the Ameri- can Lung Association and Action on Smoking and Health, is a matter of conjecture. But innumerable nonsmokers have written letters to the editor stating the new shibboleth: "Your smoke is killing me." To the degree such people believe what they say, the propaganda causes distress and animosity. The frequency of such unsubstantiated charges in letters columns also brings up the question of editorial judgment. Against what group other than smokers would editors repeatedly print the unsubstantiated charge of killing? 03763604 The irrationality of the allegations is heightened by the fact that most public places are now air conditioned. A major government

study, for example, concluded that tobacco smoke on aircraft does not represent a significant health hazard to nonsmoking passengers.r3,3 In planes with a typical ratio of smokers, it found the air more pure than the outdoor air in urban environments. Yet the activists, not satisfied with the back-of-the-plane segre- gation of smokers, now want a ban on smoking in all public transportation. A witch trial of smokers gets public attention. 22 Are health agencies believable? As in the Salem witch trials, a segment of society is acting on the basis of emotion when it mistakenly thinks it has the facts. The blame for this distortion of the public interest must be assigned to the health agencies, for society reasonably assumes these agencies deal dispassionately with facts and concentrate on conquering disease through research. Society has been misled.64 The private agencies concentrate on propaganda and the accumulation of assets, only a small percentage of which is spent on research into the cause and cure of disease. 65, 66 A witch trial of smokers, whether it threatens public welfare or not, gets public attention, inflames the passions of volunteer fund raisers and produces big budgets and oversized reserves in such private agencies as the American Cancer Society, the American Heart Association and the American Lung Association. Research into the cause and cure of disease does not. There is an independent non-profit service for contributors, the National Information Bureau, that monitors the finances of "phil- anthropic" organizations. In a recent report on the American Heart Association, it states: "Question arises with respect to the reasonable- ness of AHA's accumulation of assets beyond the amount required for its next year's budget."67 Its reports on the American Lung Association and the American Cancer Society raise additional questions. With respect to the Amer- ican Cancer Society, NIB further noted that " . . . for many years the primary focus of the society's promotional and fund-raising materials has been on the need for funds for research for which the percentile allocation has actually declined over this ten year period."68 ACS practices 03763605 called misleading NIB also reported that ACS assets increased from $76,500,000 to $186,800,000 during the ten years while it was saying it didn't have - enough money for research. The report concluded: "NIB believes that

The American Lung Association devotes only 2.3% of its budget to research. it is misleading to the contributor for an agency to state that funds are not available if this 'unavailability' is in part a result of previously budgeted allocations and not based on actual funds on hand." ACS spends 13% of its budget on fund raising, and more than 27% on "education"-a large but undisclosed portion of which is for anti- smoking propaganda.69 "Education," of course, keeps ACS before the eyes of potential contributors, and ACS spends less on research than it does on "education." The handful of paid executives who run the ACS receive salaries of up to $75,000 or more per year. One such employee is Dr. Frank R. Rauscher, who left the National Cancer Institute, which works closely with the ACS, to become senior vice president for research. Because ACS works closely with the government agencies, the propriety of such job switching has been questioned.70 The American Lung Association devotes only 2.3% of its budget to research.66 The NIB report states: "Attention is called to the ALA's fund-raising costs." This attention is certainly justified. For every 2.3q ALA spends on research, it spends 284 on its fund drives. ALA reports that it also spends about 28% of its budget on "educa- tion." The "education," to cite one example, takes the form of a scare booklet replete with unsubstantiated allegations and dire conjecture about the effects of tobacco smoke on nonsmokers.71 After attempt- ing to frighten nonsmokers concerning the imagined perils (no scien- tific source is cited), the booklet advocates agitation for all sorts of restrictions on smoking in public places. The unscientific allegations are dutifully echoed by legislators who have found that anti-smoking declarations get them press coverage. The ALA booklet also urges direct action against smokers: "Let family, friends, co-workers and strangers know you mind if they smoke." Also "... voice ... objections when smokers light up without asking permission." In other words, make one class of citizens beholden to another for the right to enjoy a simple satisfaction, and invoke the police power of the state to deny that right. The militancy involved has led to actual incidents of physical violence. Certainly this could not be the intent of most people who contribute to an organization called the American Lung Association. They undoubtedly expect a positive approach to solving the riddles of respiratory diseases. The anti-smoking agencies 03'7636% The party line has been adopted by dissidents in search of a cause, who have penchants for setting up organizations with acrimonious acronymns. 23

"You don't know what a rewarding feeling it is, the f irst time you spray a smoker in the face." Among the most active is ASH (Action on Smoking and Health), whose founder and paid head is John F. Banzhaf III, a law school professor. Like more than 30 other organizations, ASH agitates for legislation restricting smokers. Mr. Banzhaf's motto is: "Sue the bastards!"72 The activists seem to revel in their sense of power, and, indeed, at times their influence is grossly disproportionate to their numbers. Julia Pendino, a Rochester, New York housewife who lobbied for bans against smoking in public places under the banner of GASP (Group Against Smoker's Pollution), boasted, "When I went up to the legislature, they thought I had about 10,000 people behind me. That was a laugh. It was just me. I had laws passed by myself." 73 (See End Note #15). Another example of an extreme anti-smoker organization is SMASH (Society for Mortification and Smoker Humiliation) whose organizer suggested implantation of bits of explosives in cigarettes and development of a spray which would cause smokers to vomit.74 In November 1977, Bob Greene, a writer syndicated by Field Enterprises, devoted his column to Paul Wright, executive director of the National Association on Smoking and Health.75 He wrote that Wright is intent on building an "army" of 2,000,000 militants who will go about "zapping" smokers in the face with spray from aerosol cans. As quoted in the column, Wright said, "You don't know what a rewarding feeling it is, the first time you spray a smoker in the face. It's hard to work yourself up to the first spray. It takes guts. But once you've broken the ice, it's easy. And you feel exhilarated." Asked what would be done if the anti-smoking spray cans prove ineffective, Wright said, "Then we move on to the anti-smoking billy club." Columnist Greene found this commendable. "At last, a genuine American hero," he wrote. "All hail Paul Wright." We indeed are on the brink of paranoia. The antagonism against tobacco has degenerated into a vendetta against smokers. The on- slaught has grown shrill, even hysterical, as the frustrated militants realize that they cannot easily impose their will on the nearly 60 million Americans who continue to enjoy cigarettes. While the noise level some time ago drowned the voices of reason, millions of Americans obviously continue to smoke tobacco because somehow it provides personal pleasure. There is substantial evidence that smoking may be a safety valve in an increasingly stressful society. O !a ~ ~ ~ 24 ~

IV. CONCLUSION Choice: A fading freedom At heart, the issue is one of personal rights. Both smokers and non- smokers have a right to an open airing of the facts, not the monolithic mindset purveyed by the anti-smoker agencies. And they have the right to decide for themselves. In his masterful and classic essay, On Liberty, John Stuart Mill wrote: "The opinion which it is attempted to suppress by authority may possibly be true. Those who desire to suppress it, of course, deny its truth; but they are not infallible. They have no authority to decide the question for all mankind and exclude every other person from the means of judging."7s Mill's words strike to the heart of the question: Who has the authority to decide? As historians have pointed out, the most revolu- tionary idea in the Declaration of Independence was expressed in three words: "pursuit of happiness." This was no mystical abstraction. Robert Green Ingersoll, the gifted orator who identified James G. Blaine in a presidential nomination speech as "a plumed knight," observed that "the way to be happy is to make others so;" 77 in other words, to help relieve life of grimness, meagerness and anxiety. Ty- rants of the American colonial era had never entertained the idea that the masses should have such personal rights. The efforts to deny the right to pursue the satisfactions of smoking add up to nothing less than tyranny by a minority of anti-smokers. It is relevant to note that many, if not most, of the framers of the Constitution enjoyed the use of tobacco, as well as tea. How indignant they would have been at any attempt to infringe on that personal right through taxation, restrictions and prohibitions! 25 I

0 w ~ w 26 m ~D

END NOTES 1. One of the most definitive and disturbing studies of the diagnostic problem, discussed on p. 8, was made by Dr. K. M. Herrold 78 and analyzed by Dr. Milton Rosenblatt, clinical associate pro- fessor of medicine, New York Medical College, in a paper pub- lished by New Scientist, May 9, 1974. It involved 1,477 certified lung cancer deaths among U.S. veterans. Autopsies confirmed primary cancer of the lung in only 1,047. With almost 30% of the lung cancer death certificates proven inaccurate, the validity of lung cancer statistics becomes suspect. Concluded Dr. Rosen- blatt: "The smoking-lung cancer theory is fraught with incon- sistencies, both statistical and biological." 2. The New York Times error in forecasting the effects of cigarette smoking, reported on p. 10, was not unique. In the Journal of the American Medical Association, March 2, 1901, Dr. I. N. Love wrote that smoking was a factor in pneumonia, grippe and tuberculosis. Much earlier (1857), The Lancet, still today a leading British medical publication, said of smoking: "It impairs the vigor and energy of the English people, and causes them to sink in the scale of nations . . ." Great Britain's golden age ensued. 3. Many foes of tobacco view the kinds of statements referred to at p. 13 and after as heretical. For example, Dr. Gio Batta Gori. was head of a U.S. government project to develop "less haz- ardous" cigarettes. In August 1978, he announced what he re- garded as significant progress. Outside the hierarchy of the U.S. Department of Health, Education, and Welfare, where Gori is employed, this was widely interpreted as an indication some brands of cigarettes on the U.S. market were "tolerable." Gori's superiors expressed their dismay and he took another position outside Washington. This led one U.S. Senator to exclaim to his colleagues, "Why are they afraid of the truth?" 79 p3'763610 4. Professor Burch, quoted on p. 18 as faulting epidemiologic studies, has also cited Swedish studies of identical twins, who have the same genetic makeup (See Bibliography note 28). The data show little difference in disease has been found between twins who smoke and those who don't. Other scientists have also suggested that genetic makeup predisposes them to smoke. There is no really satisfactory explanation of the "self selection" phenomenon which divides populations into smokers and nonsmokers. Professor Burch has noted that the very statistics used to indict cigarettes for lung cancer show a lower incidence of Park- inson's and other diseases. He does not, however, advance the 27

hypothesis that cigarettes cause some diseases and prevent others.80 28 5. Dr. Barnard, mentioned on p. 19, has also warned of prejudiced scientists in his book, "Heart Attack: You Don't Have to Die," (Dell Publishing Co., New York, 1973). "These men read the literature and do research to sustain their theories rather than to examine them," he observes. "They react to criticism with snarls and anger because their theories contain such a strong element of their emotional selves that they interpret any attack on their theories as an attack on their persons." 6. The address by Joseph A. Califano, Jr., referred to on p. 21, was delivered before the National Interagency Council on Smoking and Health, January 11, 1978. Secretary Califano opened his remarks by noting he is an ex-smoker. He said he discontinued smoking on October 21, 1975, at the behest of his son, then 11. Of the 45 most senior HEW executives at the time of the announcement of the huge HEW program, 19 were reported to be smokers.81 In response to a reporter's question concerning Secretary Cali- fano's new anti-cigarette drive, Jody Powell, President Carter's press secretary, said as he smoked a cigarette: "We are all aware of the possible dangers of cigarettes, alcohol and a number of other pleasurable things."82 This contrasts with the vehement self-righteousness of some anti-smokers and their knowing resort to half-truths. Many turn out to be former smokers. There may be a deep resentment of the enjoyment of pleasures they have denied themselves. 7. For a full description of "Target 5," first noted on p. 22, see Report to the Board of Directors, American Cancer Society, by the Target 5 Task Force on Tobacco and Cancer. In addition to soliciting free time from broadcasters for anti-smoking com- mercials, the report says, among other things, that "Every effort should be made to integrate anti-cigarette messages in on-going radio and television programs (dramatic, family and comedy series, as well as soap operas)." In intelligence circles, such un- attributed "messages" are known as covert or "black" propaganda. 8. Within weeks of Dr. Hammond's observation that it is im- possible to prove "no effect," as quoted on p. 24, the American Cancer Society, his employer, took the opposite position with a recommendation that either the U.S. Food and Drug Administra- tion or the Consumer Product Safety Commission should hold "the industry accountable for the safety of its products."83 p 9. The fact that relatively few dissenters to the conventional .w M W M N 64 I

hypothesis referred to on p. 24 have surfaced in the general media has made it easy to dismiss them as "rare" and "merely a handful." Actually, there are many more than the several cited in this paper. The accusative nature of the controversy, involving as it does unsubstantiated allegations, permits just one answer and it becomes repetitious: the known facts don't support the accusations. 10. Similarly to its sequestration of details of its "smoking dogs" study, mentioned on p. 26, the American Cancer Society has refused to release for independent review the raw data from its huge population study begun in 1959 and 1960. As this study provided much of the statistical base of the 1964 Surgeon General's report, its refusal has raised questions in the minds of other scientists.84 11. On p. 27 we refer to "Atlas of Cancer Mortality for U.S. Counties: 1950-1969," U.S. Department of Health, Education, and Welfare. As reported by The Tobacco Observer in February, 1977, of the 100 counties with the highest cancer mortality, 27 were in Louisiana, the most in a high cancer mortality state. Of the 100 counties with the lowest morality, 14 were in Minnesota, the most in a low rate state. Yet in 1959, midway in the study period, per capita sales of cigarettes were higher in Minnesota then Louisiana.85 12. Certain of Dr. Bross' views, as noted beginning on p. 30, are shared by two of the nation's leading writers on the U. S. health system, Daniel S. Greenberg and Judith E. Randal: "The power of the ACS doesn't come from its money or programs, which are relatively small in comparison to the burgeoning budgets of the National Cancer Institute. Rather, ACS' power comes from its ability to influence the spending strategy of the politically passive NCI. ACS actually receives only a small slice of NCI's money, but it wields great influence over where the bulk of the money goes."70 Q3"l6~612 13. The witness described on p. 32 is Dolphin Lair, tnen 21. everal weeks after the abduction by gunpoint the Los Angeles Times (January 11, 1977) carried a long and sympathetic interview with the abductor.86 It emphasized his religiosity and quoted him as saying, "If the Lord had a way to help the people, I figured, why can't I do the same? I would sacrifice myself to help others." Eight days after his testimony before the American Cancer Society anti-smoking forum, Lair was charged with assault with intent to commit rape. He was later convicted and imprisoned. 14. The Chicago Metro News editorial quoted on p. 32 further stated 29

that "if the ACS persists in concentrating on politics instead of research, then it must be re-identified as a political organization and its tax-exempt status must be withdrawn ..." 58 Others have also discerned the taint of prejudice in the campaign. Peter L. Berger, Professor of Sociology at Rutgers University, wrote in the November 1977, issue of Worldview: "Antismoking is the new anti-Semitism." He said the mood of the campaigns cannot be explained by rational grievances. "Not for a moment do I believe that these people want to protect me from emphysema," he observed. "As a matter of fact I believe they would be quite delighted if I got emphysema-or worse-as just punishment for my wicked habit." 87 A pattern of prejudice can be seen in the press reports on the deaths of famous people. If they had been smokers, the fact is duly noted. If nonsmokers, it is routinely omitted. 15. A leaflet distributed by GASP, the organization mentioned on p. 38, states "Sidestream smoke-the smoke from the burning end-has higher concentrations of noxious compounds than the mainstream smoke inhaled by the smoker." Considering the im- mediate dilution and fast dissipation of "sidestream" smoke, the innuendo is ludicrous. 30

BIBLIOGRAPHY 1 Bernstein, Jeremy. "Biology Watcher." The New Yorker, Jan. 2, 1978, pp. 27 ff. 2 Blumenthal, Herman T., Ph.D. "The Cancer Lottery." Harper's, Sept., 1978, pp. 12 ff. 3 Sontag, Susan. "Disease as Political Metaphor." The New York Review, Feb. 23, 1978. 4 U.S. House of Representatives, Committee on Agriculture, Sub- committee on Tobacco. "Effect of Smoking on Non-smokers." Hearing, Sept. 8, 1978, tr. p. 92. 5 Schwartz, Harry. "Why Should We Pay for Medical Criminals?" Wall Street Journal, Oct. 5, 1978. 6 Rosenblatt, Milton B., M.D. "Lung Cancer and Smoking-the Evidence Reassessed." New Scientist, May 9, 1974, p. 332. 7 Rosenblatt, Milton B., M.D., et al. "Prevalence of Lung Cancer: Disparity Between Clinical and Autopsy Certification." Medical Counterpoint, Oct., 1971, pp. 53 ff. 8 Bauer, Frederick W., M.D., and Robbins, Stanley L., M.D. "An Autopsy Study of Cancer Patients." Journal of the American Medical Association, 221:13, Sept. 25, 1972, pp. 1471 ff. 9 Feinstein, Alvan R., and Wells, Carolyn K. "Cigarette Smoking and Lung Cancer: The Problems of 'Detection Bias' in Epidemi- ologic Rates of Disease." Paper read to Association of American Physicians, Atlantic City, May 7, 1974. 10 Robert, Joseph C. "The Story of Tobacco In America." The University of North Carolina Press, Chapel Hill, 1967, p. 108; and Shew, Joel. "Tobacco Diseases." (In the Arents Collection) 1854, pp. 7-13. 11 "Cigarettes." The New York Times, Jan. 29, 1884. 12 Tobacco Situation. U.S. Department of Agriculture, quarterly, 1976-77 data. 13 "Vital Statistics of the United States." U.S. Department of Health, Education, and Welfare, Vol. II, Sec. 5, 1975, p. 5-15. 14 "Smoking and Health." Report of the Advisory Committee to the Surgeon General of the Public Health Service. U.S. Department of Health, Education, and Welfare, 1964, pp. 354-6. 15 See note #5, p. 32. 16 von Euler, Ulf Svante, M.D. "Some Views on Tobacco Research." Address to the board of directors of Svenska Tobaks AB, April 11, 1975. 17 Seltzer, Carl. C., Ph.D. "Effect of Smoking on Blood Pressure." O American Heart Journal, 87:5, May, 1974, pp. 558 ff. ~ 31 w ~

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33 36 Russell, James R. "Smoking-dog Study Still at Heart of Cigarette Controversy." The Courier-Journal, Louisville, Ky., June 21, 1971, p. A10. 37 U.S. House of Representatives. Congressional Record 116:141, Aug. 14, 1970, pp. E7750-1. 38 "AMA Journal Decides to Withhold Reports on Dogs and Smoking." Wall Street Journal, July 8, 1970. 3s Wade, Nicholas. "Premature Puff for Smoking Beagles." Nature, 230, April 30, 1971, p. 547. 40 Cronkite, Walter. CBS Evening News, Feb. 5, 1970. 41 "Biologic Effects of Atmospheric Pollutants: Particulate Polycyclic Organic Matter." National Academy of Sciences, Washington, D.C., 1972, pp. 178-9. 42 "1978 Cancer Facts & Figures." American Cancer Society, p. 18. 43 Randall, Willard S. and Solomon, Stephen D. "54 Who Died." Today Magazine, The Philadelphia Inquirer, Oct. 26, 1975. 44 Lord, Mary and Clark, Matt. Newsweek, July 7, 1975, p. 42. 45 Sterling, Theodor D., Ph.D. "A Critical Reassessment of the Evidence Bearing on Smoking as the Cause of Lung Cancer." American Journal of Public Health, 65:9, Sept., 1975, pp. 939 ff. 46 Steinbrook, Robert. "Asbestos Particles Kill as We Live and Breathe." Chicago Tribune, July 23, 1977. 47 U.S. House of Representatives, (Bill No.) H.R. 8689, Aug. 2, 1977. 48 Wyrick, Bob. "Tobacco Firms May Have to Cough Up." Newsday, Sept. 2, 1977. 49 Brody, Jane E. "Warning to Workers Seen as Start of U.S. Effort to Put Focus on Asbestos." The New York Times, May 2, 1978, p. 26. 50 "Workers and Asbestos Makers Settle." The New York Times, Dec. 29, 1977. 51 Seligman, Jean, et al. "The Asbestos Peril." Newsweek, May 8, 1978, p. 66. 52 U.S. House of Representatives, Subcommittee of the Committee on Government Operations. "The National Cancer Program." Hearing, June 14-16 and 23, 1977, pp. 106 ff. 53 "Filters are Safer." Newsweek, Sept. 2, 1968, p. 42. s`' Wynder, Ernest L., M.D., et al. "A Study of Environmental Factors in Cancer of the Larynx." Cancer 9:1, Jan.-Feb., 1976, pp. 86 ff. 55 Ross, Walter S. "Cigarettes: What do the Smoke Signals Say?" Reader's Digest, April, 1978, pp. 95 ff.; "World Smoking and Health." American Cancer Society, Spring, 1978, Walter S. Ross, ed.; private correspondence. 56 Del Olmo, Frank. "Smoking Increase in U.S. Halted, Expert w Testifies." Los Angeles Times, March 23, 1977, Part II, p. 1. .1 M W M N ~

57 Paegel, Tom. "Gunman Holds Hostage Atop Skyscraper; Youth Gives Up After Antismoking Message is Read on Radio." Los Angeles Times, Dec. 7, 1976, p. 1. "Cancer Society Spending $1 Million on Propaganda." Chicago Metro News, May 7, 1977. Schmelz, Irwin, et al. "The Influence of Tobacco Smoke on Indoor Atmospheres." Preventive Medicine 4, 1975, pp. 66 ff. Huber, Gary L., M.D. "Smoking and Nonsmokers-What is the Issue?" New England Journal of Medicine, 292, April 17, 1975, pp. 858-9. "Pipe Smoker is Assaulted; Man, 62, Is Arrested." Modesto, Calif., Bee, Oct. 10, 1976; "Smoke Signals-No Place for a Cigarette." Sacramento, Calif., Bee, March 21, 1974. See note #4. U.S. Department of Health, Education, and Welfare, National Institute for Occupational Safety and Health. "Health Aspects of Smoking in Transport Aircraft." December, 1971. The Tobacco Institute, News Release, May 12, 1977. National Information Bureau, Inc. Report #1102, American Lung Association, Dec. 1, 1975. "Young Lungs are for Life." Annual Report, 1976-77, American Lung Association. National Information Bureau, Inc. Report #1101, American Heart Association, Dec. 16, 1976. National Information Bureau, Inc. Report #1100, American Cancer Society, Dec. 16, 1976 and Feb. 16, 1977. American Cancer Society, Annual Report, 1976. Greenberg, Daniel S. and Randal, Judith E. "Waging the Wrong War on Cancer." The Washington Post, May 1, 1977, p. C1. "Second Hand Smoke." American Lung Association, 1974. Page, Joseph A. "The Law Professor Behind ASH, SOUP, PUMP and CRASH." The New York Times Magazine, Aug. 23, 1970. Holtzberg, Barbara. "Where People Smoke There's a Fuse." Upstate Magazine, Rochester, N.Y., Democrat & Chronicle, Dec. 4, 1977. Sanger, S.L. "Now ... Tar Wars!" Seattle Post-Intelligencer, July 13, 1978. Greene, Bob. "How to Protest Smoking at Your Own Risk." Jacksonville, Fla., Times Union and other newspapers, Nov. 1, 1977. Mill, John Stuart. "On Liberty," Liberal Arts Press, Inc., 1956, p. 21. Bartlett, John. "Familiar Quotations," 14th ed., Little, Brown and Company, Boston, 1968, p. 749. ~ Herrold, Katherine McD. "Survey of Histologic Types e~s of rimary Lung Cancer in U.S. Veterans." Pathology Annual, 1972, pp. 45 ff. - U.S. Senate, Congressional Record, Aug. 25, 1978, p. S 14535. 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 34

80 81 82 83 84 85 86 87 See Note #27, pp. 308-10. Russell, Christine. "Finally, the Cancer Leaders Start to Quit Smoking." Washington Star, Nov. 6, 1977, p. 1. "Good Morning America." American Broadcasting Company, Jan. 12, 1978. "A National Dilemma: Cigarette Smoking or the Health of Americans." American Cancer Society, Jan. 31, 1978. Sterling, Theodor D. "Access to Data." Science 173, Aug. 20, 1971, pp. 676-7. "The Tax Burden on Tobacco." Tobacco Tax Council, Inc., 1977, p. 22. Siegel, Barry. "'Stop Smoking': The Media Got His Message." Los Angeles Times, Jan. 11, 1977. Berger, Peter L. "Gilgamesh on the Washington Shuttle." Worldview, 20:11, Nov., 1977, pp. 43 ff. I O ~ ~ 35 ij M MA at

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