Tobacco Documents Online

"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

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