Kotin, Paul, M.D.
(CTR SAB; Associate Prof. of Pathology, USC)Biographical Information:
Public health professionals must sometimes decide how closely they can work with corporations accused of manufacturing an unsafe product without compromising their professional integrity and undermining the public's safety. The long, and sometimes controversial, career of Paul Kotin was characterized by a number of attempts to work closely with such manufacturers and at the same time maintain his respectability as a leading public health figure.
Paul Kotin was born in Chicago on August 13, 1916, the third of four sons of Elias and Rose, both Russia immigrants of Yiddish heritage. His father ran a grocery store and the family lived in a poor neighborhood, but Paul Kotin looked to education as the key to a more prosperous life. He earned a B.S. from the University of Illinois in 1937, followed by an M.D. in 1939, then completed a pathology residency at Chicago’s Deaconess Hospital. After the entry of the United States into World War II, he served in the U. S. Army Medical Corps from 1941 to 1946. He spent the first two years as a pathologist at the 21st Evacuation Hospital in the Pacific Theater. He returned stateside in 1943, serving for the remainder of the war as pathologist-in-chief at the station hospital at Camp Roberts, a training base located in the Salinas Valley region of California.
Kotin chose to remain in California after the end of the war, spending two years in private practice and then accepting appointments at the Los Angeles County Hospital and the University of Southern California. He remained affiliated with both institutions until 1962, gradually ascending the ranks and becoming Attending Staff Pathologist at the county hospital and Paul Peirce Professor of Pathology at the USC School of Medicine.
Chronic lung diseases became one of the main focuses of his research and his career, which led him to become involved with many organizations in the fields of environmental health, public health and cancer research. Among these associations were being a diplomate of the American Board of Pathology, chairing USC’s Interdepartmental Cancer Research Committee and the Subcommittee for the Role of Chemical Carcinogenic Agents Present in Air Pollution, and serving on the Committee for Research on Factors in Carcinogenesis, the International Union Against Cancer, the Tuberculosis and Chronic Diseases Study Subcommittee of the Tuberculosis and Health Association of Los Angeles County; the Subcommittee on the Relationship Between Air Pollution and Respiratory Diseases of the Tuberculosis and Health Association of Los Angeles County and the Clean Air Committee of the Los Angeles Chamber of Commerce.
In addition, Kotin made the far more controversial decision to sit on the Scientific Advisory Board of the Council for Tobacco Research when it was founded in the spring of 1954. He was the youngest of the original Scientific Advisory Board members and he stood out in other ways as well – according to Richard Kluger, Kotin was “a liberal in a profession dominated by conservatives” and, because of his humble origins, enjoyed sitting “among the scientific elite” and being able to “think of himself as something of a subversive.” Kotin also believed that his board membership would put him in a position to do great good. He was the only original board member for whom lung cancer research was a primary focus and saw this as an opportunity to fund important initiatives. He had previously done consultant work for such companies as Ford, Standard Oil and Sears and “felt that private industry had contributed more to the understanding of carcinogenesis than the scientific academy had and so he did not dread Mammon’s money.” As he put it, “You weren’t going to change their policies by calling them murderers, but as an advisor, you could work from within.”
He obviously continued to find no conflict, as he served on the Scientific Advisory Board from April 12, 1954 to November 26, 1965. He continued his association after moving to Washington in 1962 to become Chief of the Carcinogenesis Studies Branch of the National Cancer Institute. It was only after three years at the NCI that Kotin finally resigned from the Council for Tobacco Research’s Scientific Advisory Board.
In that same year, Kotin began making plans for a new branch of the National Institutes of Health that would concentrate on the increasing number of environmental toxins. He believed in particular that there was a dire need for toxicity studies of the effects of long-term exposure to low levels of noxious environmental agents, so as to establish a scientific basis for the public’s protection. As a result of his urging, the NIH Division of Environmental Health Sciences was officially established in November 1966 and Kotin was placed in charge. In 1969, the division was elevated to institute status – the ninth institute within the NIH – and Kotin was named its first director and given a budget of $17.8 million. A new name was also selected: the National Institute of Environmental Health Sciences (NIEHS).
Scientific excellence, multidisciplinary methodologies and the use of innovative, extramural research programs based on close relationships with universities were the hallmarks of his tenure as NIEHS director. “Times for the NIEHS when Paul Kotin started as the first director,” recalled colleague Sandy Lange, “were challenging and exciting. He was totally committed and dedicated to educating and translating the mission and role of the new division to the scientific community at large, including the other NIH institutes and other government agencies, Congress, industry, labor, and the public interest groups. He laid the foundation for university-based centers of excellence and training programs when there were no environmental health programs within the universities. He and [Scientific Director] Hans Falk laid the scientific foundation for the division. He built partnerships and did battle as was necessary to protect the role and location of this new program as a centerpiece within the federal government. During the years following his tenure at NIEHS, we spoke relatively often, and he followed the institute’s growth with interest. He had great respect for the institute’s accomplishments,
its leadership, and its contributions – he often said to me that it takes one type of leadership to start a program and another to build it. He praised the work of the leaders and the scientists who followed. He was that kind of man; and it was truly an honor to work with him. NIEHS owes much to his early work.”
Kotin left the NIEHS in 1971 to become dean of the School of Medicine, vice president for Health Sciences and provost of Temple University. Then three years later he made another controversial decision when he moved to Denver to accept the position of senior vice president for Health, Safety and Environment for the Johns-Manville Corporation. Johns-Manville was facing the prospect of crippling class action lawsuits as a result of its use of asbestos, and raised the question of whether it was an appropriate place for a physician to work. But Kotin saw the matter otherwise, believing he could balance the company’s interests and those of the public. Johns-Manville eventually filed for chapter 11 bankruptcy protection in 1982, but survived after the formation of the Manville Trust to pay asbestos tort claims.
Kotin retired upon reaching his sixty-fifth birthday in 1981, but continued to work to further the public health as a member of the National Academy of Sciences committee that provided oversight of the Department of Energy’s management of the U.S. nuclear stockpile. His consultant work also continued, and he accepted another position that offered striking parallels to his earlier involvement with the Council for Tobacco Research.
Beryllium first began to be widely used by industry in the late 1950s, and its high melting point and other unique qualities made it ideal for the nuclear industry and a wide variety of other purposes. But health concerns soon ensued in the form of a disease that became known as beryllium disease, a chronic lung ailment caused by inhaling particles of beryllium dust. Beryllium disease is often fatal and has no cure. The effect was especially severe on Brush Wellman, a Cleveland-based manufacturer that bills itself as a “global leader in beryllium materials and high performance alloys.” According to a 1999 article by Sam Roe of the Toledo Blade, of an estimated 1,200 Americans who had been diagnosed with beryllium disease, 127 were workers at Brush Wellman’s plant.
With a potential health crisis looming, top Brush Wellman officials spent two days in 1986 deciding how “to protect the company from adverse medical, legal, public relations or legislative consequences.” The resulting strategy included expanded safety programs, worker training and – in a page borrowed from the tobacco industry’s playbook – a proposal to write a textbook and create an industry-funded Beryllium Industry Scientific Advisory Committee.
The company-sponsored textbook was published in 1991 under the title Beryllium: Biomedical and Environmental Aspects. In addition to paying for it to be written, Brush Wellman sent copies to hundreds of medical schools, businesses, and libraries across the country. Not surprisingly, the chapter on beryllium’s health risks, which was written by former Brush Wellman medical director Dr. Otto Preuss, follows the company’s long-held position that no worker has ever gotten sick after exposure to levels of beryllium dust that fall within federal safety limits. But many have denounced the work, with Peter Infante, a senior administrator at the U.S. Occupational Safety and Health Administration, denouncing the “textbook” as “propaganda.”
The company also followed through on the plan to create a Beryllium Industry Scientific Advisory Committee and Paul Kotin was one of the scientists who agreed to serve, eventually becoming chairman. As had been the case with the Council for Tobacco Research, the line between science and advocacy was sometimes blurred by the advisory committee. The minutes of one meeting show a discussion of the health crisis as a “public relations and marketing problem,” with the result that a company attorney was asked to address the “broad strategy considerations.” James Heckbert, an attorney representing beryllium disease victims, called the Scientific Advisory Committee “an industry-funded group of doctors who are hired to provide specific information that the companies can use for ammunition for public relations.” But Kotin felt otherwise, maintaining that beryllium science group was legitimate, adding, “I have been on advisory committees for many, many industries and many, many unions. This is as good as I’ve ever been on.”
In 1993, Kotin even traveled to Lyon, France, to persuade the International Agency for Research on Cancer (IARC), then deliberating on the status of beryllium, not to classify it as a human carcinogen. Kotin would later acknowledge that this trip contained “an element of industry advocacy,” but he maintained that his presentation of industry data was merely intended to make sure that both sides were heard. In the end, the IARC rejected his contention and ruled that beryllium was a human carcinogen.
During his long career, Dr. Kotin was the recipient of such awards as the US Department of Health, Education and Welfare Superior Service Award and Distinguished Service Award and the American Occupational Medicine Association’s Knudsen Award. He died in Laguna Beach, California, in May of 2008 at the age of 91. Press reports stated that his death occurred on May 12, but the Social Security Administration gives the date as May 9.
Sources:
Eddy Ball, “First Director of NIEHS Dies at 91,” Environmental Factor, June 2008.
Allan M. Brandt, The Cigarette Century: The Rise, Fall and Deadly Persistence of the Product that Defined America (New York: Basic Books, 2007).
Stanton A. Glantz, John Slade, Lisa A. Bero, Peter Hanauer and Deborah E. Barnes, The Cigarette Papers (Berkeley: University of California Press, 1998).
Richard Kluger, Ashes to Ashes: America’s Hundred-Year Cigarette War and the Unabashed Triumph of Philip Morris (New York: Vintage Books, 1996).
Sam Roe, “Brush Devised Strategy to Shape Knowledge,” Toledo Blade, March 31, 1999.
For More Biographical Information:
American Men & Women of Science. A biographical directory of today's leaders in physical, biological, and related sciences, various editions.
Biographical Directory of the American Public Health Association. 1979 edition. (New York: R.R. Bowker, 1979).
Who’s Who in America and Who’s Who in Medicine and Healthcare, various editions.