Tobacco Documents Online

LEONARD M. SCHUMAN Public-health epldemiologist from Univ of Minn who was one of ten members of the SGAdvisory Committee for the original '64 report~ interviewed at 5 Ridgeway Rd, West Orange NJ 7-15-88 --INITIAL INVOLVEMENT, Got phone call in London where he was after attending an international cancer conf., on way to see a leading Welsh pathologist about a new method of mounting specimens for histolic rsearch when Dr Peter Hamill phones to explain~ "I have to admit to a certain amount of ego-satlsfaction .... " I ~s such an inveterate smoker_ that I d~n't think I wanted to believe there was"a relationship./ ~bet. smoking & disease, so he _slw t~'e offer as "a c~allen~e to my scientific inte~Tity -- a chan~e TS~me co review the literatu~e"//he h~dn.'t published in the area but was doing hvy research into the causes of silo-filler's disease & how the fermentation process of grain might cause respiratory illness/LMS did think smoking might cause respiratory probs.//w~en he was in Korea doing work on .frostbite. he was surprised ~to learn that smokers, whose circulation might have been expected to be worse due to constTicting nature of nlc~tlne on vascular sy~tem in fact did better (because. they were more restless types)...He'd often expressed doubts to his scientific colleagues that smoklng's deleterious effects "weren't what they were cracked up to be..,.he smo_ked a..p~ck & a h.alf. ~ day~ even during me~u1_~ --ENCOUNTERING COLLEAGUES ON THE COMMITTEE~ Didn't know who they were before he arrived//SG Luther Terry & Deputy SG Hundley stressed they were not going to interject themselves but PHS would provide "all necessary support in form of staff, materials,. rssearchers,..LMS became the bursar for the SGAC, having been in the PHS: all expenses cleared ~~%~ithru him so SG's office didn't even hold power of the purse: ultimate freedom to do what the~ wished with the whole undertakin~/the~e was to be 'no taint of "thei~ cajoling' or influencing i~ any way/~".A ~Tea~ deal of respect flowed among us." a ~uite eolle~lal & con.vivid1 IT~_~ ing by & large p~.evalleG..~ ' ' ~%~.q~9.a.~s~,~.~.r=~e.wu~K~.~eld on weekends (so as not "t~n e~-~f~-~y~ar co~nq%m-~'~Y/2~[~waY thru first day they heard t~he _Bob Newhar~t record of his one-way conversation w/Sir Walter'' Raleigh ~ nobodv lthou~ht it was macabre_theD, Just funny & an icebreaker for them//toid they could call in ".anyone they wanted for help...BA.~NE-JeNES acted .a..s their quasi-chalrman/was sr~.most member,, LMS had used his~extboOk "ih microbiology 'W~lle at med. school so he iAspirea a cert'~'in element of' awe in him/his_ skills cut across all the. others' & he'd been administrator as Yale med. d~an~ he was "the 'faSher ~' for the ~rouD//DIMENSION OF THEIR TASK~ didn't seem at once clear I to ~he~n'hbw to get down to the nitty-gritty so "the;e was ~ certain ~--~,amount of foot-dragging.at first" as they ~roD~d for a ~ethod .& l[n~ o~ ~]~a~zacK., ~nere were _6,0.00 Dieces of 'literatu;e to .be,.re~iew~.,..they met |~n the avg b2 o~ce a month + suocomm~tee or smaller mtg-s w/some fre- |~quency + regular telephone communications among them: consta~.t cross- |~fertillzation,..They were all performing two jobs, in effect/subtle |~pressures were applied to them to get the job done but the group was not inclined to rush into a premature judgment...there was an overwhelm- in~ arra~ of ~uestions to be answered or~exp!.qr .9~//movea w~ll once they g~t organized...started to get itchy by AUguSt when there was no paper product yet in sight except rough notes...LMS took a month he had coming at univ. as vacation & devoted it to working on ch. 9 on cancer --HIS COLLEAGUES ~ ***~AYNE-JONES~ august, dignified~ compassionate/an objective ~...a father figure', :'.~6u 50uld ~onfi--de in nim_"/he was tall, su~t~t_ial frame, spoke Judlcxousl.v, was re~'lec~e...he pulled his Weight on-the SGAO, read & reviewed everythinK, kept a loose rein: was more of an arbiter th.a~"' an,ythln~ e~se, could smooth,,o.v.er differences or tamp down a pending exploslon~ "a fighter for truth //NONSMOK~.R ***~URDETTE~ (An egotls.tlcal~ somewhat pompous ch.aract~r), a s~urgeon whose h.obby-was genetics; ham con~ ooo~ on genetics of cancer, o. no bias on the smokinM, issue though from Mormon Utah..,He~id.f..iTs.t d~raft of ~ancer/smoking c~hapter & 16aded it with genetic material which amoCO%tea ~o strong sup2ort for %he ho~'~ti~utional th~DIy/hypothesis e oenoe,,o genetic" approach.,."AN ARROGANT PUP"//when his draft on cancer chapter came in, LMS was very concern@d, spoke to Guthrie (Ham'.lll's ~succ.essor) out of hi~ own conscience & said h_~: couldn't....ac.cept th.zs sor~ or & if it were allowed to prevail he d have to part co. w/SGA_C...by the ~xt {~tg. of ~n~ x%U~l comm., BurdeZ~e ham oeen talked to & consensus was that many other approaches had to be taken into acct. -- statistic- cal data, experimental, etc., hqn~apter couldn~'t be exercise in Burdette's

Iridin~ his hobby-hors~...Burdette was resistant at first, took supersilious atti%ude//staff didn't want LMS ~o leave SGAC & suggested that he himself re-do the chapter...diplomatic approach made to Burdette, who had %o concede he hadn't done anything re ~he epidemiology of the disease., ***.COCHRAN, "H~ kept us honest, " was rigidly conformist to certain rules &. prooeduges of .pcience//on'e of the leadin~ statisticians in th'e world, had done brilliant work in a~rlcul%ural studies while at Iowa l& then medical on moving %o Harvard/s~ressed that there had ~.o be con- s~isten..cy in their approach & methodology & findinss//somewhat rigid ' p~sonallty, no naxl-xel~ow-weil-met//at time of uipollone trial, Peter Hamill warned him that industry was. %Tying tO claim that the SG staff had dictated the terms for judgment-of-causality rules, criteria...in fact, not at all what happened, SGAC s~en~ a lot ~ ~.~ ~.~nIL~vvNC. THE, CRI .TE..RIA they'd use & Cochran ma~ the~ llve ~V, constantly reminding %hem that there haa zo De coHsis~'ency, "~Here are the conditions that have to be fulfilled before we can reach a Judgment...conservatlve, he subscribed to the "lowest common denominator" theory: i.e., they would put out only what they all could agree with or llve by...SMOKED CIGS~// (note~ Luther Terry switched from cigs. to pipe during .th~ course of the proceedings & SGAC was a bit concerned that "he was giving the act away" by this behavior modification) ***~EISER, q~iet mos~ of.the time/an organic chemist & expert, was DE!/ELOPER OF NAPALM during WWII, used in Korea, where LMS saw its effects/ not medically oriented nor pharmacologically either...HE~yY CIG. SROKER. died of lung cancer & while terminal told a magazine "If I had had any doubts at all about the relationship (of smoking & cancer), I don't have them now" which LMS thought really dumb because it left open inference that SGAC had had disagreements ***~ Started in PHS as member of Environmental Investigation Service, studied at CDC & took lectures from LMS, who found him i_n~ guy "but very ca~tious, " knew when to pull in his. horns, non-coD- f~ontational, agrees w/RK characterization as "~killed pr..actitioner of ~medic~l politics"//knowledgeable, solid foundation in epidemiology... youngest_member of SGAC but LeM is hardly re~irlnK therefore: there was no pecking order or hi~'~archv oV Age...he became the SGAC expert on %e'spiratory disease.. ***FARBER, "A damned good pathologist" who caught, on to epidemiolog- i_cal P~inciples ~er/~ quickl~v'& did.n..'.t stand', on his h~h horse,, ,didn't subsc@ibe to necessary-cause Or sufficient-cause theses/muc.h more roll- lent than Furth...he'd done work in experimental Datholo~., .~ swee.t ~ms,n ~./a ver.v c~ear~i~, "one of the more impressive people there,. ,,NQHSM0k~R' ***FURTH!. Very prominent i.n his field of pulmonary medicine, hel.d endowed chair at ColumDia, ~author.ity on patholo~r~ of lung diseases/he retained a trace of a Ger~..an or 'European acce~t.. ,neither suffered the .~9~quen.t ~usi~n Of graneur~ (Fu.r.th no.r .Farb..er) ~kat so.me ~a~ho~lpgists ~ave, ree±i.n~ ~nav ~ave the pipeixne ~o zru.~n oeca~se ~ney are ~ne ones who do autopsies & examine the tissues under a microscope & see the final effects of disease, ~ow the mistakes of the su~geQD or +.~ ~- Doses, theM. have th~ pow~ r~'t" ~%%~'}.,'~ the f~n~l word. arbiters of med- ***~j~ very p_leasant~...handled the cardiovascular aspects of the report/later died of &" So~onary...special~y was internal medicine// no res~Sy known "gatho~enlc pathways" then available so they couldndt " o~beyonc the 'sta%is~iSal rei'ationshiD Of h'ea;t disease to smoking...HE ~]~OKED ~!~ BLACK CTC.AWS AT THE MTGS ***SEE_~ LMS now knows that the rob. industry recommended him ~as it did Feiser), which may held ~o exDlaln why he was such "a tough ~omDre" in terms of'being convinced on the causal.$.ty issue, had diffic- Culty e'ven acknowledgin~ the str'@ngth of the assn, in CHD~ "He seemed reluctant to make the judgment" that smokln~ can kil~l..,recalllng a mtg a~ ~ motel once west of Bethesda where Seevers"was adamant vs. some of the final judgments others had come to re causality, p~ resistsnt t~ evidence on CKDo..things were threatening to get out of ~and & Gene~ G~thrie passed around table a little booklet that parodied the Charlie Brown "Happiness Is..." books then in vogue & had opened it to a page reading something like "Happiness is when your bro ,-in-law, whose virtues yr .wife constantly & vocally calls %O your att., con- tracts the clap"/a chain reaction of laughter ripple~, or snaked.around the table as the ~ook' Was .passed. fr...om h.and to hand & de-escalated the clea -ed the alr a bit"//Seevers De son"// on the addiction issue, he as a pharmacologist ought to ha been more in the forefront & open to possibilities but instead he flatly ruled

schuma~/3 that smoking was a habituation, not addiction, and "None of us were well versed enough in the field to pass judgment on his judgment" so they had to defer to him~' the[ depended on his expertlse. .J "He was |~y enough to impose this. vlew on us .... He n_ever one4 .said 'This ~ a controversial area, or that the weight of the evidence is such- and-such/flatly de~larec it "a habit" & that was that.,.A.gIGAR. SMOKER, maybe more than Hickam even • ~.*.*SUM-UP OF WORK OF MEMBERS from LMS viewpt., himself excluded, Cochran & ~srber as most useful, then Hickam, B-J, LeMaistre, Furth -- ~ as a group ~e didn't much find helpful Seevers, Feiser & last but least Burdette --THEIR SMOKING HABITS, They were not self-conscious abgut it, at least not Dublicly/DMS's use of cigs. increased to about 2~ wacks~ ~ay as She~tenslo~ rose ',& p~essure-built'to 6e~ ~e,..report. ~.. :.I.t_w.a.s tacitly agreed that t~ey_d withhold th.elr ,jua~.enz.s. on smoKlng ~.xll ~e report was being writter~no one was going ~o glve ~ne game away Dy a change in his smoking pattern --WORKING ENVIRONMENT~ All files &. ;ecords under lock..& key & not Just little locks, big bar~ & padlocks//an armed guard At the entrance to the SGAC's work area...Library of MediciBe was ~n ul.tramode~n bldg. w a . a odallke roof/they worked in a co/nfPere~°nce rqo~.w~/~f~.i~es overflowing in"~o~~h~'~'~'w~, '~n~'~'e~'~"~ar-- ~~~~Y W~,~_, VE~TIL~m" {~-~-.- ~.o ~.~. ri~ of their ~...They stayed _togethe~ at motel nearby..on W~s. Av~., ate meals ~ogether, ~ha~ privileges at USNaval' Officers Club across the street... ~ecuri~y arrangements, "~e didn't want anything divulged to the public prematurely" so they'd have to waste their time & energy making explan- ations or rebuttals to industr.y attac~s...One staff PR guy leaked some info. to Newsweek & got fired/the leak was accurate enough --WORKING ON WEEKEND AFTER JFK ASS4SSINATIO~, LMS ass.~med She mSg l would'be cancelled but Gene Guthrie said no, they weren't going to do £haZ & that JFK (#ho after all had authorized~ the pro~ec.t! would h.ave wanted them ~o steam ahead business as usual/"I thou.ght. ~. was cal±ous"/ during the saturday session LMS got up midway thru e sa~a ne was going across the st. to memorial service for JFK at the Naval Med. Center whether anyone joined him or not, which caused the session to be abandoned for the da~//pt, here is the growing pressure the PHS was applying --D~ECISION TO SUBMIT UNANIMOUS REPORT, ~hing fQrmal but sense ~ust grew amon'~ ~hem that ~f...they made ~ ~udgment~ "we wanted it to.b.e~be~- l~ex~ -- and if we'd been objective enough, we~an~ec tne wor±a ~o I b-~e~e it"...!t was a...matter of "credibility -- even if that~meant ~their foregoing certain things" such as disqussing the causality factor ~ in CHD as majority would probably have done/"WE DIDN'T WANT TO BE SECOND- | GUESSED," felt that a minority reD0rt would vitiate impact of the whole thing, as if %~ ~vi~ 9esponse "See! even they had their doubts & mis- ~i~ings"/dldn't want their results d~luted in that fashion, fe'e'llng evolved that "W..e can't afford a minorit[ fedora" --LEARNING FROM HIS COLLEAGUES, Th'e whole enterprise was really an exercise in epidemiology & assessment/Farber was the easiest of the~ clinicians to orient to the epidemiolo~ic way of thinkiDg -- i.e., 'the partnership in mem. whereby the eplCemlologists provided clues to the experimentalists & researchers/"We looked at the herd, at the way people lived .... "//LMS himself learned a tremendous amount of pathology, got a course in advanced organic chemistry from Feiser//from Hickam & LeM he learned a lot about enzymes & their detergent function, in .the_ lungs. . ..much time devoted to codifying the criteria for a ~uc~ment_ox- ~ausalit~ in a dlsease,, this was "a major contr.ibution to epidemiology," he felt. , .long talks w/St~llones of UT on th~_is/ke.y query, how much of the disease can De accounted for by this factor?/in case of lung cancer, 90% could be attributed to smokin~c.onstantl~ as.kxn.~ themselves~_ .Ar .. I~. all of..these criteria fulfilled?"//consistenc[ e conerenQe as v~s_~-- ~ ~f there was more lun~ csneer among Dine-collar people, was there d ~? .... ditto in other sub-groups --R~.~SING THE REPORT, SGAC waited in aDterm while press read, then precisely at 10am they filed i.nt6 ver~ lar.ge audi.torum, j .a.mme. d w/.repo.rters & TV cameras, people...'~erry rxeiaeS quest~o..ns, _c±amorous ou.~.nom o~u~- of-control scene, like s presidential press c~r., some ques~lons ~urnea over to commo memb~s//it was "an overwhelming situation for us..-- even ~though we'd lived w/this for 15 ionths, Do~ tx±l ~nen sis we f~el th~e .~omentousness of the occasion -- to affect the lives, & healzn oi" people ~ll over the wor/~...it was an overwhelming event"//~ne sense ~na% th~s 6ne element -- smoking -- was the most important single factor in the generating of disease worldwide

schuman/4 --PETER V.V. HA~ILL, staff dir. for SGAC, a friend of LMS, had ~ known him, too, in Atlanta at CDC, was .a ~assicist. educated ~$ ~e of Annapolis where the Great BooMS education was f~unde .d~..He was "TNT~NSE,..HE CQ.b-LDN'T STAY OUT OF THE ARE~ OF JUDG~ENT-~..KING .... In trying to be helpful, he interjected biased • comments°'..ohis energ~ & involvement were salutary but the c.~mittee w_as acutely aware orris intrusiveness but was courteous to him rather th~n chastening. . .Discussion w/B-J a-t his apt. in private about what do do about PH, who was becoming less than helpful to the SGAC, was "emotionally volatile" out of, his desire to be helpful "& part of the ,act,,, B-J said "We've got to do something about thxs, Len"...N/o ~ ~¢~ubt PH should not have characterized .,the TIRC material that he was ~ dispatching ~o" the SGAC members.'.~ "His role ~as t~ ~ ~e th~ co~mi~- ~ ~ee's work. not to ~art~cipate ~n ~t"~..He was not efficient & was ~ somewhat, s~atter-br~ined in his approach//see h~s 7-31-63 letter, it ~as "in poor taste" & biasing in its judgmental content, as if he |believed that the final judgment was dependent on him & he had to Ish.ape it/he, never exolained his ~articipation//he tried t8 keep up _w/it al_l -- all the readings, the gist of the thinking~ the various committees & subcommittees//he was rash in his ,~ud~ments & aoDarently found it ego-satisf~ving to...iry to shap..e &~articiwa$.$...Later suspicion that the industry wined & dined him to influence him, possibly why he was open to Seltzer as consultant --~CARL SELTZER~.~.. "I think he can be a fake scientist"/on the day he came to brief the SGAC on his theories of body-types & classifications he spoke to L~S in the hallway on the way to lunch in tone...~.f confi- dentiality & presumptuousness, "Len~ you're not reall# going to make a .~ud~men% that Smokin~ cau'ses lung cancer, are ,you" as if it wou>d be ~he height, of folly//L~S a~...swers, "Who k~ow~s?" & adding the jury was out on the evidence//it was t~he same incredulous tone that Jos .Berkson u.sed in speakin~ to L~S.on~ th~ phone 'o~±~no"..,.i had a bad taste from ~Seltzer).,.he was almost lobbying us, trying to interject his views & biases"...SGAC quite willing to listen to his presentation of what amounted to a constitutional theory of disease --GENE GU_E~, took over Hamill's job & was strictly an admini- strative support, d~idu't h~ve as profound a grasp of i~'~e subject area as PH...a bit of a whip-cracker, though ---T--LUTHER TERRY, SG, Well remembers h~is "race-track sports...coats" rather than the naval uniform Koop has made famous/PHS had been the medical arm of the USNavy...remains a uniform service till this day// a nice. ~asy-~oing man...was pushed by JFK to act after the voluntary ~ealth agencies ganged up on him//he became "a very ardent spokesman afterward" in the antismoking cause, SGAC Eave him the backbone for it ~bu~ definite sense that "he was pushe~in..to doin~ it"//very pleasing couple soci'~lly, not stodgy//LEROY BURNEY, very dignified, wrapped him- self in the SG's cloak, his study of the problem was much less systematic & comprehensive, merely asked for opinions f~um various PHS depts rather ±han enlisting independents for an intensive review --J0S. V BF~, One of the early med. statisticians, subscribed to Fi~her's constitutional theory, passionately devoted to his disci- pline, felt smoking/health connection was specious. . ._frequently in phone contact ~/L~ who was 80 miles away, "~'d listen.to his tirades" & drop a hint that t~is was costing a lot of money but JVB would say "That's OK -- I've got a W~ATS line"//~his appeals were incessant, "You!re not going to...are you~?"//he felt when a s~ngie cause, i.e., s~ing, ~as o±amem ~'or so many things, the relationship had to be suspect/L~S would reply that smoking or cigs. may be one word but its smoke was many diff. things in its gaseous form & could have multiple effects... He was typically skeptical of the growing data on bladder cancer (where nitrosamines were collected for purging from the body) & would say, ~"Nonsense, we don't smoke through our urthera~..B_est known for. his t~heory that people select their own hospitals for particular reasods. &~h0se ~'ormem a pre-selective or self-sel~c~.~ b~as, thus called the ~erksoni'an Bias/r. esearcher.s try no$ to stick to-a sing~,e hospital in pickin~ their co~ort ~r9~D...SGAC took his theory into acct in eval- uating the studies befo~re it, applied it to their assessment of the prospective studies but there was such a variety of them that the Berkson concern was taken care of//SECOND CONTRIBUTION~ urgin~ Hammond Sn formulating his second (25-state~ s~umy .~o ~a~e'"'in~o acct. any number of critical confounding factors, e.g., longevity of families of suh- "~ects, recorm of previous diseases, use of tranquilizers -- and Hammond too~ nls acvice, building ~n more & more factors that strengthened the second study considerabl~/SGR itself acutely aware of the "confounding

variables" in assessing various studies, "so Joe ind.ir~actly~ made a er~ contribution'°*****he was married to an It~liau woman who had a vill~a zn IZ~y~ was held in hi~ regard as a statistici~, he helped introduced f~ously throu~ record-keeping practices at~ ~e Mayo Clinic, "a model" & thus u~e~ to rese~chers...BUT, T~Y DIDN'T W~T ~M ~ ~ ~ WASHING~N/BE~ESDA ~o m~ke his pitch befor~ ~e' SGAC -- his ~ews were well ~o~ "~d" he had no new data to contribute" " --REBUTTING STUDIES ~A~ S~O~D ~B. CO._WO~S had lower ~cer --~te {h~ gener~ DoD./LMS says this is "the heathy'workers ~ule" ~w~ Hol~s ~nat ~y gainf~ly employed cohort in ~ industry will have ~better mort~ity & morbidity figs. th~ avg. just because it is so de- fined -- i.e., those who are ill, slc~y, dys~ction~ pull do~ the gener~ heath numbers --T~ C~EB~ZZE ~AP: Not a major thing to most SGAC members/"We were reassured (by the staff) that we'd have the freedom to present what we believed" so not to worry --RIC~ ~LL & ~Y INH~ERS ~AD LOWER L~G CANCER MQRT~ITY: the ~deeper you i~e, ~e finer %n~ smoke gets & less likely to cause disease deep in ~e orgy/most co~on site is where the bronchus bier- cares -- "IN T~ S~E, AS IT ~" -- • this is where t~ co~ects, even for ~e non-inkier, it penetrates there...Li~ter smoker mi~t .~ ~so i~e//inh~ing ~s~a subjective concept...~so d6se response is not rectiline~ --W~T IMP~SSED HIM MOST ~ THOSE ~0 C~ BE~ SGAC?~ Kensler's report on L&M rese~ch re filters, their work on ciliar ~xcicity & trying to do a better filter to reduce that effect on COPD...firm was ~en trying to develop the L~k & they conceded ~is was effort ~ produce a less haz~dous cig. --AS~NISHING CONCESSION --~T CI~0NE & PETER BLEA~EY: very impressed by him, "a re~ me~ son of a bitch," so bent on destroying the credibility ~it- hess thi% he bore do~ u~erei~ly/struck by ~ose ~asses he ~ore, [outslzed, like airm~'s go~es, "the~ look concaz~ u_ ~ney made his eyes" lbo~ sm~Aer e"~ the morepiercing..,. (T)hey make the wi~ess ~qui~ EVOLVING CONSENSUS ON THE WEIGHT 0F THE EVIDENCE: By July they were ready to proceed w/the chapter on c~cer/Cochr~ was do~g the chapter on mort~ity//~ PROSPECTIVE STUDI~ WE~ ~0ST IN~UENTI~ in forging the consensus, including Ha~ond-Ho~'s pair, ~'s, Breslau (sp?) in C~if., sev. Brit. s~dies...struck in the l~g c~cer ~ea~y ~e consistency of the findings in over 30 case-controlled studies/the rela- ~iy~risks were so q~e~r + d~se-~espons~ r~l~t~o~shi~s + duration of of t~e method61o~, reg~dless of ~e consols, re~r~ess of the char- acteristics of the case s~ples -- there were such., d~verse populations -- ~ 0UTC0~ W~S ~E ~E"*******use" ~ --WRITING T~ ~RT~ ~e members themselves did ~e ~itin~. there were no ~osts...In c~ce~'chapter, LMS included as concession ~ Bur- ~ette fair ~o~t on genetics.~.insisten~ on doing it ~i ~emselve~: they w~re "so j~ous that ~is ~e' ~he D;oduct of our "o~ thinking"... ~ey'd sit at next ~l~ mtg. after ~i had read a chapter & edit it #, en masse, right do~ ~ the co~as//LMS felt HiP~ may "hays. been ~r- ~rita~ed by my T~mudic s~ylel' w/so m~y condition~ statements & qu~- ~ifiers...he finely said "~y don't you come to the point?"//~t over it w/a fine-tooth comb - 'LSTICKING ~INTS? No~ re~ly m~y because by then they had codified ~elr criteria Zor jud~ent of caus~ity//the stern requirement for consistency of data made it easier, very few h~d c~l~//effects on women co~'t be dete~ined because of insufficient data...~at disputes they had were more of ~ education~ nacre, not truly confrontatlon~ --SMOKING & CHD, S~dies were not yet done but wo~d be soon ~ter that clinched or pointed way to causes, "~.thoKenic pathways"/~l they had then were ~e statistic~ assns//la~e~ it..wo~d be learn&d, as e.g., ~t~%double whammy from smokin$: (~) nic. ~s a sensitizer of th~ ~diu~, thereb~ ~ibiting th~ c~clac ~M9scle from contractin~ & ~i t ~needs more ox[6en & nu~ri'~h~s .~n~ other or~s. Kiven ~ ~s x'~c~i~bu ~i~) C0~ delivers l~ss ox~en/~eart needs a separate 5~en supply ~o do its job, co{onar~arteries supply it (three of them)//if there is blockage of this blood/oxygen supply via ~y of ~ese ~teries, the muscle w~l will die in that sect .... ~y occlusion there hilly d~gerous// ca. 52% of ~l mort~ity is due to c~diovasc~-ren~ diseases e about 3/4 of those c~dovascular cases ~e coron~y or C~ ~ - -IM~RTANCE 0F OSCAR AU~ACH'S ~ORK, (1) it showed the pro~ession of cellular ch~ge £~w~d m~i~cy 9q6ord~g Sq. t~.e...qu~ti~ of smoki~

schumsn/6 (dose-related)...and (2) w/regard to emphysema, he showed that cessa- tion was helpful in restoring function (COPD reslly) --THE AMA & ITS ERF REPORT, He doesn't really know why the close- ness, perhaps JAMA did need the cig. advs., m~be the political -- but says it's true there was a lot of rsearch that needed doing so a legit. program -- the AMA-ERF proJect...LMS had no qualms about industry- supported research provided (1) researcher controlled the work from beginning to end & (2) researcher has total right to publish findings// "~en so, I have my doubts that the public will believe the work isn't tainted..."They can't undo the stigmata that have accrued to them (in- dustry) over the yrs" --THE "SAFER" CIGARETTE: LMS wason the Clearinghouse task force whose~oo Was to pro~vide the annual updates to FTC/Congress on what were the contents & additives to cigs. that ought to be controlled... trying to formulate ideas for how to exert smoking control/how to inter- vene ~/the med. profession..."ONE OF THE RECOMMENDATIONS I COULD NOT BE A PARTY TO WAS FOR A SAFER CIGARETTE'~Wynder argued strongly for it & "I argued the opposite, asking what is the byproduct psychologically if you're going to give them a crutch (people in general) to keep on smoking"...E~RNS~ WYNDER., '~Qne of the luckie.st scientists.I kno~ -- h~ ~!sinevitably-validated in his positions despite the inadequac~ of his ~".,.his data often no~ adequate yen he'll jump to a'concl~sion/ he~ little rash"...seen as a wheeler-dealer, "a great instigator" of plans, ideas...hurt when left off a big HEW-named advisory committee in '68 for evolving preventive medicine appr0aches//LMS once asked £o join him & his date, "a swishy sexpot,' for an evening at the Stork Club or some nite club...Wynder offended D9on~.e: too biased or outspoken ~n h~s views~ his authori%/rian'uermanic manner, d0mine~r1~g & one-%rack in, is thinking + .hi~ taste in women, mode~, stewardesses, ac.~resses --2. CUTLER HAMMOND, "A snoD~ aloof," sense that he looked down his nose a% LMS at first...suspicion that as a non-physician he compensated for this in the medical field by a certain need to throw his weight around//his work good but not great, his "grab-sample" technique now accepted because it's so large but skeptics charged it was not scientif- ically selected -- but the numbers were so large it didn't matter//and he was responsive to criticism, even taking Berkson's advice re confound- ing variables//he was "yerv possessive"..~bout his data --DANIF~ HORN: Always a sweet ~. d~dn'% cloy on ~ou though//his approach psyc~osociological/his behavioral studies sounder than most in his field/developed usefu~ techniques for cate=o~[z~nE dedicated worker//went to Atlanta~v'~ry reluctantl9 - •--¶~gYSGR, He wrote summary chapter, he says//struck by how many people they had working on this effort//impressed by (1) vast number | of studies that had accumulated in the 15Yrs since the first SGR, (2) how their orig. findings had been corroborated & strengthened & (3 ~anta~ic amount of progress in.determin~n~ "watho~enic ~ehhan~s for the causality + the s~nergis~ that were belng found, of which asbestos & alcohol were mbst' apparent//recalled work of DAVID BURNS, whom he remembered from his work on the Health Consequences reports, very nice & competent --THE VOLUNTARIES: The ACS, despite its vast number of volunteers, was essentially under control of physicians "who don't like political confrontations"...AL&.'_t'v~erx_active & viggro~" paying for more anti- smokxng advs. on mT~~[Tf~ ~ o~os~ng i~dustry's acts...even the epidemiologists (who know the score re cigs.) feel they can't mix politics & science" -- which LMS thinks "absur".~~.~.E@.~.~, he sa~s,. '[~i~t.~.,s~ho~u~d be b~ug~.,..t.~,~o~ear...AHA, most conse~v~t~v~ in~s~t~ ar~ "~E~ .~-~'~k~ o~ ihe'~#@~f~.~io~'' --~MARC EDELL, ful~ of admiration "for the .quts they have demonstrated ~ntacklin~ such a ~ian~:'/admiring Cynthia Waiters for her ~astery or een familiari~;y w/medical issues involved...Jeffrey Harris:.~ite th~ ~ctivist, "nobod~ scared him" THE 0RIGINS OF THE REPORT OF THE SGAC, Jour of Pub Health Policy 3-81 --Cancer link t~ smoking noted in 18th cent. re lip cancer/first systematic approach in 1920 by Broders, Lombard-Doering in '28 note higher proportion of smokers than controls had cancer...but intensive inquiries begin in '90s as lung cancer numbers jump...growth of early '50s studies ~rom9ts. Burney in '~6 %~ ~%~I~h scientific study grouD

~chum~/7 by NCI, NHI, ACS and AHA to assess the data/group agreed that a causal relationship existed & SG Burney places PHS on record to that effect ?-12-57...Lamenting the power of the tob. subsystem that k~eeps health advocates off balmace + nearly hslf the adult.pop, smoked/TI established following Jan .... .ke~ "counter-event" was '59 br~11 i~n~ analvsi~ ~.defeD.s.e" by Co .r~fi~ld et al~ ~n JNCI re causal rel'~tionshiD.. >ed Burney ~declare smoking the principal £actqr in increased incidence ~of l~n~ Cancer -~ ~..u.'4 THIS.DIDN'T. CO~STITOTE FO7,~Cy, carried ho reco~iendations ~or intervention & cont~01********merely. . advisory....bxlls" began to be introduced//what was needed was an objective appraxsal of the s~t., .relatively divorced from govt. & industry influence...to provide the ~ most dispassionate jud~ments....0n 6-1-61. h.eads of .ACS, AHA~ APHA &. NatlTBAssn urged .JFK to form pres~-commission to explore rob. problem & I-4-62 rips. of these group~ met w/SGTerry/meanwhile some efforts being stirred on Cong .... Sen. Neuberger urged FTC chairman~Dixon_to issue rule vs, ~i~s for not having~. ... health warning_ - & wer._e t~er.efore~decep~ive/Dixon-- ~sks in return for compet~en~ probative ~v~dence including that furnished b~ PHS" that causal relationship exists, needs to withstand court test... reporter's question of JFK in May followed by early June announcement by Terry of SGAC, mtg 7-27-62 to outline objectives & get names: 150 names offered then, boiled down soon thereafter --SGAC PROCEEDINGS: See ~25 for conditions of independence/"a deep sense of personal responslbxlity for a nat'l problem pervaded the group"...wor.ked in deepest sub-basement at Lib. of Med., e~mployed i55 consultauts/posltion papers & data invited from all sides//the report "represented conclusions unanimously acceptable" to its members PROGRESS & RESPONSIBILITIES OF EDUCATION IN SMOKING CONTROL 11-18-83 --It's calculated that 33+% of all deaths in .35-59 & 44% of those in 45-49 yrs old due to smoking-related disease/"BECAUSE OF THE DIVERSITY OF DISEASE caused by smoking &...the magnitude of the relative risk for a number of them, cig. smoking can correctly be considered THE MOST IMPORTANT SINGLE CAUSE OF DISEASE & DEATH IN OUR POPULATION".... C~R since its founding "has continued w/ever-increasing militancy & w/enormous expenditure of funds not only to combat attempts at reg. but also to counteract any programs aimed at discontinuance of smoking, discouraging the initiation of smoking, or establishing environments PREVENTION: personal health services, environmental control & health ed. of the pop.//"...in the area of prof. ed., the concept of primary prevention & its transfer to succeeding generations of practitioners is lacking .... (T)here is an urgent need for the total reorganization of our thinking on the position & role of preventive medicine in the curricula of our med. schools. So long as preventive med. remains departmentalized instructionally as well as administratively, the role & obligation of the Amer. physician in true prevention of disease will be neither understood nor achieved. So long as prey. med. remains only the tolerated partner, if that, in the med. school curriculum," etc.//industry now starting to recognize its duties in health super- vision SGAC COMMITTEE SELECTION/document from H~mill (P-8108) --Staff report on proposed members//~0UIS FIESER, 63, Sheldon Emory prof of organic chem. at Harvard since v~, recomm6Rded bTI_y_~ princips~ PHS endorser is Endicott, "Towerin~.unlve~sal v~w of or~s_nic C~$~is.try. A brilliant Shinke~ & talker"...LMS, recommended by PHS, '~Well kno~D & Well i~.ked ..in PHS. Broad. fl~e~e. Skilled in complex eti01o~Y of chroni9 disea~9~s. Operates very well as ~ coh~slve ageDt in panels"...~_~u~_~, 40, med. dir. of Woodlawn Hospital, prof of med at SW Med College, Dallas since '59, recommended by Amer. Thoracic Society, "Young~ bright, energetic. Highly recommended by ATS. One of the be~t possfble c~0ices from the South (Alabama, Emory, Dallas)."

! DEPOSITIONS OF LEONARD SCHUMAN -- FIRST SESSION 1/13/86: Details on the AMA convention in SF &n '68, 160... his skepticism over AMA/ERP project & how the industry ballyhooed it, 169...hls growing suspicion about AMA: "...by the time I became aware of what I thought was this distortion in the rept & the attitude that they were out to do something about the controversy, I began to be suspicious, but by that time I think most of the monies were already expended or going to be," 170..."(E)verything we said about the weight of the evidence, and so on, was always refuted, as it were, by statements that 'its only statistical.' & we got this from every side. So it made me a little Jaundiced about the sincerity of the industry," 172...Example of Bleakley's bad manners to Cindy Welters, 183...JOS. BERKSON: His reaction to the Hammond-Horn Study, being hypercritical about it & being named by ACS to an advisory committee for the development of the 2nd big prospective study, 189/more on confounding factors, 191...they don't basically effect the findings, thus Berkson helps solidify the ACS evidence, 192. -- DEPOSITION OF 6/16/87: LMS & his Immediate circle of prof. colleagues were Iskeptlcal of early studies on smoking b~cause they w~re all pre;ty he_cry, smokers... comments on why SGR was to be unanimous, some doubts about effects of smoking on CHD, 64...His being impressed by rept of Dr. Kensler for L&M, how he brought photos of their experiments, 78...more on 85...CARL SELTZER: How he was a consultant to SGAC, "I do believe that Seltzer happens to be impulsive in his decislon-maklng processes - that is s disparaging remark, I must admit, but I can't help but say that..o.(H)is work is frequently froth with biases in terms of hls-failure to recognize certain biases that are attendant therein," 91-92...JOS. BERKSON: His relationship to SGAC, his cautioning reservations about prospective studies prove to be helpful although "his ultimate or continuing interpretations were not part of my philosophy," 97-98...The Berkson Fallacy noted as well as concession that Berkson was "considered a brillant statistician" 99..olndlcatlng why he and some ~f his colleagues were skeptical about evidence against sm0klng"because of the emotional bias being a heavy smoker... [n other words, we Just didn't care to be ~[old..that may be ~hls is bad. for US..~.gcause it was a_pleasurable, habit that we were enga~inK in & now we have to give it up. There was some subconscious attitude, I think, because once the study did occur, &, my gosh it was almost irrefutable after the accumulation of all the evidence," 102...Discusslon of developing criteria for determining the causation of chronic diseases vs. the established criteria for communicable diseases, 122...It might be said that "we clarify the meaning of a relative risk as a measure of the strength of an associatlon...I would say that was an innovation in terms of the committee's work, 130, more on association & temporal relationships, 131ff./Koch's postulates required "the recovery of the agent from the infected animal, so not applicable to chronic diseases, only infectious ones, 132/in effect, S__~GAC set out to develop its own version of Koeh'~ no~tulates 136... more on 139, "there are many entities in which a given agent, I wouldn't u~e the word cause, but a given agent in attacking the host will not lead to disease at all," citing polio as his example...He ~isagree~ wlthHamill's depos~tlon t_here were all kinds of ~2bates and tou~h ~iscusslo~ns~ 147/denies there ~ere arguments over establishing the criteria for Judgment, but concedes that "some of the clinicians were totally unaware" of the epldemiology & its philosophy, they had never heard of these criteria, "It was an educational procos@," 149...dlscusslng the limitations of animal skin-p~inting~97/how animal skins may not be comparable to the insides of a human lung & therefore the inhalation studies have limited applicability...OSCAR AUERBACH: The importance of his work re progressive damage to lungs from smoking, 200. -- DEPOSITION OF 6/~7/8;: OSCAR AUERBACH and his contribution, 18...see 236 & 167-73 of '64 SGR for references to Auerbach's work...see pp 26-29 for p~ogresslon )fyom hyperplasla to neoplasla & descrlptlon of stages $f cancer...h~.~i involves thickening of basal Cells & stuntln~ of... the c~l~a, 29...carclnoma in sltu is form of dysplasla nested separately & not displaying evidence of invasion into surrounding tissues, 30...squamous cell is a flat cell, 50...how the trachea is different from lung tissue & in its susceptibility to cancer, ?7-78//Women's data did not meet rigid standards SGAC established, the' LMS felt there was enough to go farther than report finally did, 171-2*****...The studies of HA_~, c_oonsldered l~t-ra.~e~ 25-26...dlsagreement w/clalm that rise in lung cancer is due to mlsdlagnosis, LMS says only slight improvement in cancer diagnosis since 1930, 43-45...Discusslon of ~rospectlve studies & why they need not be re~resentatlve l qf the ~opulltio~, 50~51°..exp~inlng why the Hammond-Horn~'tudy did n0~ need a ~long ~erlod of time t~ reach valid findings, yery large sample al~ow~ quicker ~resul.ts, .~9...Ha~mond's data ~Iv#~ to SGAC & re.a~alyzed .~Z NIH statlstlc~an~, 60... /[IIp~-unanlmi~v.'." "...~ all had ~aid from the ver~ b~In~in~ in ,committee that, ,we ~'w0uld not push anything beyond that which is acceptable to all members of the ~roup," 69...~ter Hamill was present throu$h0ut SGAC de,llberat~gns until he was relleve~d, 73...How LMS quit ~moking & his reactibn, 85-6...Benefits of smoking in SGAC rept in area of mental health noted, 95/'~hese benefits originate in the

~sychogenlc search for contentment & are measurable ouly lu terms of human behsvlor"...excellent quotation from 64 SGR re the use o£ rob. as a psychological crutch, 'This human drive is so universal & may be so powerful that mdn has always been willing to risk and accept the most unpleasant symptoms & signs-halluclnations &delusions, ataxia & paralysis, violent vomiting & convulsions, povery & malnutrition, destructive organic lesions & even death' 107/"If this is accepted, that the fundamental nature of man will not change significantly..., it is then safe to predict that man will continue to utilize pharmacologic aids in his search ifor contentment. In the best interests of the public health this should be accomplished with substances which carry minimal hazard to the individual & for society as a whole," 108...Time pressure on SGAC, unclear whether project would take yrs, w__ork reeulred 70-80 hrs a wk sometlm~s, ll3...important addenda on IHAMmOND-HORN study: concerns about self-selective na~.~re of ~ample & how those particularly concerned about their health may volunteer to be subjects or to seek su._bJects for inclusio~n, 137-8...no sense among SGAC that clgs ought to be prohibited, 146.

SCHUMAN ~S~IMONY IN CIPOLLO~ TRIAL 3/21/88 -- BACKGROUND: H$ defines epidemiglo~y as "a science that deals with distribution of disease in human populatlons...more importantly, it deals wlththe ascertainment of causal factors in disease, so that we can, indeed, ultimately, hopefully, apply some control methods to prevent the d~sease from occurring," 5723...At the llllnols State Health Dept. he was primarily involved in control of communicable dlseases...he went to Korea to investigate frostbite among US troops & expected to find higher percentageamong men who smoked because it was known that smoking did lower skin temp. of fingers & other extremities; the opposite was found to be the case apparently because smokers were "of a certain personality type, kinds that couldst lie still even in ambush patrols or combat patrols" & because they were more restless they were more inclined to be shot by enemy but their constant movement helped to prevent frostbite, 5?31...worked at Univ. of Minn. 29 yrs in Public Health Dept..while on the SGAC he was responsible for the epldemlology of smoking and health problem w/major emphasis in the cancer area. -- DIRECT EXAMINATION: D~ Cochran was "strictly a statistician who would keep us all honest by being very critical of all of the statistically analytical techniques involved in any deliberatlo~'...Fieser acted as a consultant to Dr. Little in the '50's for work done for L&M...no real disagreements within SGAC re cigs. as cause of disease..."(W)e wanted to be solidly unanimous about that particular opinion so that the danger of a mlnor~ty rept was ever present in our minds. For that reason this rept then became the least common denominator to which everybody on the committee agreed," 5769...Sidebar on 5775: ~ud~e over~_ rules defendant's objection re introducln~ discussion on diseases other than cancer ~ince plaintiff died from~It, "I have ruled on several occasions that the other Idlseases...are relevant to the scope of warning, & that even though Mrs. C. may have suffered from one of the risks, that the Jury could conclude if she had been advised of all the risks, it might have made a difference in her ections"...Good example of how Jury got educated, LMS' ~xplanat~gn of "...the air sacs rupture & produce hollow cavities in various areas of lung which is of course an impediment to breathing & ultimately the individual may so to spea~' 5776...discusslon on effects of CHD, 5777: "One problem that troubled us was the fact w~e did ~ot have what we call'~patho~enic pathway. By that we mean how does indeed a given cause ultimately lead to a given disease & what was lacking at that time with respect to the way CHD was Just how cig. smoke might indeed produce the ultimate obvious effect..."/how nlc. affects the myocardlum, which is the heart muscle, discussed here with reference to subsequent research & flndlngs...new term for retrospective study is a "case control study" & instead of prospective study the term today is a "cohort" study...LMS was a 2 i/2 pack a day smoker at the time but as a result of info learned from participation on SGAC he quit & went cold turkey the day after rept was released, 5786...more detailed discussion as to why he himself hadn't quit smokin~ as scientific llt. appeared/he says "this habit was pretty strong in me" but notes that as a scientist he was not overly swayed by mere newspaper repts of health danger, he was also very busy lw/other research & he may have had "a subconscious reaction he~n~ a heavy smoke~ a~alnst ~iv~n~ up the hab~Lt" which I thought at the time was likeable if not ~e~fi~lal S0 he did not explore the lit./he made no decision to quit "until all the chips were down & in", 5789...argulng generally that rob. cos. should have been aware back in'30s and '40s of emerging llt. on dangers of smokin~.."Cancer is not a disease but many diseases," 5812/"They were in command of financial resources with the growing prod. of rob., with the growing income derived from rob. & if it was there, l~thlnk moral r~ponslbillty to do someth%n~ about a possible hazard &! ~herefore~ they should have ~ndertaken the 7e~=~h" 5814...no fed. cancer control program tll late '40s & then only in form of establishment of diagnostic centers... "Certainly, I would have brought attention to the consumers of the emerging published studies on the cllnlcal obser~at!ons of lung cancer, for example" 5825. -- AFTERNOON SESSION: LMS was.gn..commlttee to screen ~ants ~iven by AMA-ERF ~esearch p~9~ram...he was upset when attending a conference sponsored by AMA-ERF to give progress r~pt & he read what he thought was "quite a distortion of what actually had transpired" at the SGAC proceedings, distortion in the sense that the rept lead "readers to believe that no efforts so far had established that there was a causal relationship between smoking and let us say some of the cancers, partlcularly lung cance~ This was a false statement," 5832... he & B-J issued ~olnt statement of protest that upset hosts & Seevers.who was also on hand, 5834... Idebar: Edell tells Judge relevance of this AMA material is that "internal documents of tob. industry reflect that there was a political relationship between the AMA and rob. industry, which I think affected the work & publications of certain work of the AMA-ERF program & that explains why there were certain mis- statements concerning the causation issue at various points in time" 5835...Edell |[ ?s the prop.tier7 ,of the, AMArERF ~ro~ram, s a~in~ ~ts re~,l purpose was public relations for the rob. industry "in an attempt t,p,,contlnue a cont~vers~ that