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d Unifed States 01 America Vol. 116 .e......~.,,.......... ,e,,, . st PROCEEDINGS tiND'DEBI:TES OP THE 9 I CONGRESS, SECOND SfiSSIOI4' WASHINGTON, FRIDAY, AUGUST 14, 197'& H! 0 lS e of- .~~e. STUDY ON DOGS AND SMOKING HON. TIM LEE CARTER O} ICLrrZVCt--T IN TRS HOUSE OF REPRESEnTATIVFS Fridav. AuyftsC' 14, 1970 Mr. CARTER. Mr. Speaker, recently, Drs..Auerbach and Hammond reported resuts of a smoking dog study in an eS- fort to show the relationship between amokirlgand health: The scientificc methods used ~ in thisatudl havce been questioned:The nmerf- eas Medical .Lsociatio:y and thee netv. Etleland.:oultla] oi Medicine rejected the rezeafroh~papers outright. I enclose copy of a letter to Dr. Jesse L- Steiltfeld for your perusal: HOt'sC or Rl.TaEstNTATlI'La, Wvhinpton, D.C-, Auyust 11„1970. Dr. JFSSE L STC:r:rLLD, TheSurqeon Genoai, U.S. Public HeclthSeivice,. D^c-r:~rc :t cf Aealth, Educa- fion, aad T, e7/are, Washington, D.C. Deaa Jlssc: I have received your Jttly 10th reply to my letter to.you of alay. 199 concern- 7ng the Arrerlutch,Hammond smokingdog study. As you can imagine. I wa:s stiorked anddisappotnted too learn that In yourletter ofJunel3 to the American Cancer Society you gave an unquallfled endbrsement to the valldity.of thestudy,.basedou nothing more . resen, ta A-1, ves No. 141 fndependent.revlewers hadunanfmously ree- reporting to the Congress perlodieally on theommended rejection of the e.rtlcle. I bellevestate of eclcnti5creaearch concerntng.elg- that Dr, Dorman would confirm that Infor- arete amoklhg and bealtA:..I Icar that yourmatlon ff you were to lnqulre. yncritieal lacccptance of, this research, which : Among the things that' partlGulariy dis- Is to this date vnpublished In any scientific turb me; as' a physician, about your letter to journal, Is n clear refleetton ~ef the superLclal'the American Cancer SocletyIs your tnstst- and biAsed manner ln which the In:ormattonencethat no fornmlrcctewIs ncccssaryto'whieh [:oes dnto those reports. Is evaluated. I establish the vatiditr of this studyht.vie•^of alsobelieve tAat.your actlon~ln this matter (a) its emtnentsponsorshlp,, (b)'thereputa- casts serious doubtsupon the Inttgrityy and tton.of the investlgators cnd (c) tliefa¢te authority of~Ififormation, issuing.from the ' thatta•o scientists Ingovernment servi:.e had publdcHCalth Senice.ln reg:ard to the nealth the.opportunfty too review, the dataand ap- parentlya5-ed with the reportcdfit:dings.. As to the past polnt; 1tt seems you have had some badadvice. At.the4tme yrou wrotee y'ourletttr, one of, the pathologistswhoseopnnlon.yous rellcd on, Dr. l:aymond Yesner of the YeteransAdminlstratton;,had already beconte lyre center of.controversy hr con:nec- tion with another resFarch study rclating to~ olga:ette amoltng. It scems that aGanctd.tcal meeling Dr. Yesner took the libertyofancery preting certaln data frofnm an unpublished atudyorlgfnated.byDr. Alvan Fefnstcin of Yale. As you w11l see.from tlie enclosed Lettcr to the Edltorof thc ~lournai of !h'c Amcricas aledicalAa.soeialiorv Dr. Feinstein haspub- litly conttadlcted Dr. Tesner's Interpret5tion of that date. You.mightalso.have takenao- counLof the fact that Dr. Yesnenlsemployed by the.Peterans. Admihistratlon.whfch w'as aa co-sponsor of the.Auerbach-Hammmnd study. In view of these facts, I think youwllle;rce that your reliance on Dr..Ycsner rasprob- ably fil-advised. tsnglblctha,y hearsay reportsaf the findings I~ thltrkk you might atso agreee thatt such and yourr orn strngg feelings about amokingg conslderations as the "'eminenocponsoushlp':• and health. This serms to havebeen.an irre- of thestudy and the. "reputatlons"' of the aponslbie act on your part and not in keep- lmestlgetorserenot proper criterla:foz )udv- 1ng eltbthe acieatifre. obJeetivltqwhlch: ingvalidity,TheAmericanCanceeSociety,ns should aocompany your high ofGce. As you must have anticlpated, the neas bureau of the Amerirxn. Cancer Society promptly released your letterr to the press. 1n an at- tempt to bol>:cr thetrposltloawith the presttge of yotu office. AaI lold you 1n myJetter of May 19, serious questlons abouCihe validity of thls study had.bcen raised'~by a distinguished pathol- ogiit whosee lctter I forvarded to you. You maybynor have.seen the enclosedarttcle front the. l7ati! SU<rr Journat'of Juty. 8..The art[cie reportst hatthe Journal o j, IJhe A nceri- een Afemicat' Aasociationhas d@Gdcd'.V noV to publish the Auert~aeh-Hammond paperson the bssis of reriews by tvrelve. Independent authortites. The arttcle pointedoutd that thee numberof reriewrrs ~Igned to ttie. Aucrb,uh-Y.ammoad data w-asmuch greater than sssual because of~ the controversial na- ttue of the esperimentt Wben I atte.nded the meeting of the. Amer- lcars aledtcal Assxiatlonln Chlcngoon June 22, I I~trned'that the.l'resldent of the. A>fA, Dr. Gerald DormanI had dcterminedfrom a Corsver,natbn w.itli,lhe. e:ditor of the Journal oJthe Awerican Afcdical Asroeiatioa that the you ~.probablyy know, has sponsored ~antfstnok- Ing commercials feeturitrg a nrorie.star wtifioo was recentlyeonsicted of Illegal possesslon of mariJuans: Lloreover,the.twro IncestigatorslastFebru- ary, released their findings to the popular press.before presenting.ttiem to their sct= eutlfiecolieagucs,.a procedure which Iston- elHered highlylmproper among rclenttGcre- aearchers. In fa:t, their action caused the authoritativeNCtaEng7an3 Journal oJMedi- cine to reject the rraearch,papers outr7ght..I think you.might have considercd.thcse facts In assessing.the."reputations"'o/ttre orgo- nwAtion slid people Involvedi. In.viewof the)u.dgmcnt you have pro- nounocd, tile /ntel;riiy, of your ottlce requires youU to make.every etPort to dcterminewhat criticlsms- theJournal oJ' the Ar.terfeen Ncdical Association revlewers rnade of the study and to amend the comments which you Dudeto the AmcrlcanCanccr Soelety 1n your letter of June 12 andtod correcD the erroneouslmpresslon your letter has left w4th~theAnteriaw public. As you polnted out' In your ]ettcri yqur.De- partment lias the atatutoryresponslblllty of eonsequenees o>~,noking, and t!:atlmyeol- leaguesnndithc..,merlean.people should be so adi'ised. The Congress Islncreaslhglyczlled. upon to nlakepuhace policy In ther. fact o1 thee pro- 1lferat!on health'controveaslesh v.'hlcn~~ are confronting the American people. We mustt have obJectii'ee sctentistss to guice our, ac- tions. The. American people atar_d too losemuch, more than thee right to , C.no'1ee cig- arettess ifscientift_ jUdgments are made on such a capacious basis. I c:ou:d' be most pleased to have yotir comments on the Observations I have made. 1n 6hls letter. Sincerely yours. Tul Lee . CAarr:a. lFrom thetCallStrect Journal. July, 8„1970) ALIA' Jouarrrnc Dectnrs To Wrxtraotn RrPOars OND9cs ANDSTIOS-a--C0\ia0\•LPS]AL. TLSTS SOPPOSFDLT CAtis- . C.1S"CCP,'; j1rLLIAGAZINL SAl"s ALTICLrS 1vEr:D N,LVISIONCrrrcACO.-Tiie Journal of the American Medical Association h.as dccided not to pub- ]tsh.two previously, announced r^portson a controversial ezperimept', with dogs that /s aupposed to link cigaret smoklub with lung cancer. Dutt the magaalne: which Is probataly, the most uldely nvud medlcai journal in th.eU.S.,. tnsist5s that thr.articdeshaven't been rejected outright but simplyreturned forrevistbn. The reports have tren caustngcontroversy sincee early May, a•hen the Tobacco Institute, the Industry"s.trade assoclattbn, announccd. Itwas mou.nting a maJor attack.-lnst the vadldlty of tfiee researehers' Ilndlitgs: The articles describe the results of, a 2112. .o,gs year ezperiment on 99 pcdigrced bea.^,:le d that w2scarried out byy tao ernlneut scien- tlsts. The Arne¢ican Caneer.. Sxlety has clalmed tfiat theexperlment.was signltleant Sn at Icast twoways:It producedilung.can- eer as a result Of ciparet emolahg In a.signlfa lcantly. Iarge esprrimentall anlrnnlll and It marked tile frst'tin:e that tanecr had been Induced ln iaborotory, anlmals byoausing them to Inhale tobacco rnxoke. al:J£CS]DN rs DENrrD Dr..Hugh I[. lIusscy„editor of the medirDl publlcatlon, dcnledtn eu..lhterticw.that the articVes hnd tmen rejeeted Icr puliltcatlon.. "Ttsey'are not acceptable forr publlcutlonln

their present fonn;' he cald: The articles have been returned to their authors, he said, for "extensive revision:" The twoscientists who carried out the cx- periment are Dr. E. Cuyler Hammond, a vice president of the American Cancer Soc]etf, and Dr. Oscar Auerbach, senior tnedlcel ih- vestigator for the Veterans AdminLstrat9on Iiospitial, East Orange, N.J. in telephone- interviews yesterday, both Dr. Ilammond end Dr. Auerbach dcclined to cr(ticize the mcdicaL journal for returning their articies. '1ve sent the articles to them in good faith, and' we believe the American Medical Association also acts 1n good faith," saldDr. . Auerbach. Neither Dr. Hussey nor the two researchers, would disclose details of the suggested ehanges. But Dr. Hammond said some of the objections eentered on photographs accom- pnnylhg the te=t. "There werem compla!nts that the pictures were out of focus. But that's to be expected since the slides orig- inally, were In color but had to be printed In black s.nd white (because) the magazine considers color pictures too expensive;" he baid. EEYrEN'EES CALLED FAIH Commented Dr. Auerbach: "The reviewers were as fafr as they thought they could be. I may not agree with them, but' !t's a1F part of the gtve and talce: ' When the artlcles will appear In print Is undecided. Dr. Lussey said the journal will roeonsider the rsticles, if they are resub- mitt'ed with the revisions. Or, he said, the authors may decide to submit them to an« other publication. The two researchers said they haven't de- elded which course they will take. Dr. Hussey rejeet.cd any suggestion of pres- sure on the nragazine either from the tobacco Industry or the Amcrican N:edicaliAssocintion no: to publish the reports. "There was no pressuro whatsoever," he said. EIPFT.TS CONSIILTED The dccision not to publish the artfeics, Dr. Hussey said, was made on the basis of re- views by about 72 indepondent authcrities. These included an expert onv-etcrinary mad- Ic1ne pathologs, an expert in pulmonary di- sease and several pathologists. The number . of reviewers, he said, wna much £rer.ter than is usual for anarticle s.ILnllttcd for pnbl:ca- tion in the tnasazine "because Gf the great • amounG of publicity Involved." The e>:perimcnt alr-rdy has won the ap- proval of the U.S; Cencral, who re- cently said it vrasi :" s:'.:::ssary to carry out a formal rerlew of ti,,~ <-_pcrilnellt' "to estahlish validity." TIIe surgeon general ssid In a letter to Dr. Auberbach that "if the que.tlon at Issue is whether huu;an-type luul; cancer has been discovered In the lunl;s of do-,s exlzo::cd to clgaret smake, then the answer is ycs" Tl:ii; finding he said, vras the vicw• of both Dr. John W. Berg apatholo;ist vritll the 1:ntlonal Cancer Institute;, and Dr. Fsymo:;zl Ycs:u-r, associate professor of pathology at Yale Uali. versity Sohoollof Medicine. Dr. Auerbach said that the mcdical journal reviewers didn't the claim that the tumors fund in th,; were of human type. IrdPACT' WAS FORECAST , When the results, of the expriment were first reported at a meeting of the American Cancer Society last February, a society spokesman said the experiment "should have a signficant impact on the srnoking of: ciga- rets In this country and will probably lead to a reassessment of advertising claims and polices of the c!g aret lndustry:" A few weeks later the Tobacco Institute replied by challenging the Cancer Society to release the unpublished data on lung cancer 1n dogs for further scrutiny by "men of out- standiilg competence and SntegrSty."' An lnstitute spokesman said the "TObscco Institute does not, and the public should not,,aeeept at a face value the findings of this study." (iFhrom JAMA, July 6, 18 701 ShtORI\C AND CANCEP.. MORPHOLOGY To the Edi*or: IHaving ihitiated the >tudy of cigarette sinol;ing arifl histologic morphol~ ogy in patients with lung cancer that v:as "reported" in THE JoLeN+L (2111:10B1, 1970),. F regret its premature publication In your MEDICAL NtWs se¢tion., Your report K•as based on material present- ed at the recent meet'ino of the American /7_3 Associat'lon of Dathologlsts e.nd Bnctcrio:o- gi:,ts by Dr. Raymond Ye>r:er wiw collobo- rat.cd In this projhct ai:d recorcied' niDn}• of the hLstologie finclin{;s. The result5 preser.tcd at t1let nieeting were b:+sed on a prclint!liary analysts of the data, and they conta in only Dr. Yr.-.ncr's interpretntioas of those data. The final report may show dificrences in the percentages because new statistica 1 tab- ulations have bcen necessitated by a recent change In the crirerSa used for con.wadr.tlbn of histologic categories. Even If the percent- cges rcmatn tuichauged, however, I dis9greo with the interpreGation that heavier st,;ok- 1ng "eausedr' greater degrees of mtilignnncy in lung cancer. The "ba se populaS.!on1' In this study consist'ed not of a general group of smokers and nonsmokers, but' of peuplc who already had lung cancer. Con"uently, no causal Inferences can be drawn aboltt the role of stnokiiig arrd creating either lung cancer Or dlfleront ccll' types of cancer in a general population of smokers and nonsmok- ers: Furthermore, although increased rates of smolling, were assoclated with increased rates of undif:erentiated small cell cancers, such canc-rs were not found to be the Inost clinically "nmalignant'." tumors ih the patients we studied. My owiv interpretation of the preliminaryy dLts is that they contradict a long-stauding belief the pathooenesit of lung cancer. Al- thouoh epldermoid carcinoma 15 generally re- gardr,•d as exclusively a"cigarettc smoker's cancer," four of the 42 people currently clas- sified in our survey as having this type of cancer had not smoked cigarettes, and the rate of epldermold c3rcinuma did not rhow, an increase in assoeiation with increased amounts of smol:ing In the 449 patients we studied. I apolo-oize to any readers who assumed I had approvcd the eontents of your report because they saw my name there, rmd I urge them to awaet fo:mal publ!c~ition~ of the cnmplete results before drwwir s a::y cOlaeiu;.:ons. ALt'AN R. FEINSTLIN,. M.D. NEW IIAVrN, Co::N. ~ . 4