Cornered

by Peter Pringle

  As the liability lawyers fashioned their new legal weaponry, the life and times, not to mention the sayings, of Dr. Clarence Cook Little became a key part of their arsenal in the Third Wave of tobacco litigation. While the rest of the scientific world began to accept the link between smoking and disease, Little adhered absurdly to his “not proven” line. Some of his sayings were almost too good to be true for plaintiffs’ counsel. By 1960 many government agencies, including the American College of Health Physicians, the U.S. [Government] Study Group on Smoking and Health, the British Medical Council, the British Ministry of Health, the Danish National Health Service, the National Cancer Institute of Canada, the Netherlands Ministry of Social Affairs and Public Health, the Royal College of Physicians, and the World Health Organization, had concluded that there was sufficient evidence to establish a cause-and-effect relationship between smoking and lung cancer. Little had rejected them all as “oversimplified and perhaps superficial conclusions … that concern themselves solely with suggestive or incomplete data.” He claimed such surveys “stifle or delay needed research to find the basic origins of lung cancer and cardiovascular diseases, which are most powerful, diversified and deadly enemies to our well-being.”

  After his death in 1971, no one showed much interest in Dr. Little, but in the internal company documents unearthed during the Third Wave of litigation against the tobacco companies, his name popped up time and again. His papers, which had been stored largely untouched in the archives at the University of Maine, were suddenly in demand. In the spring of 1995, much to the astonishment of the archivists, lawyers arrived and burrowed into the files. Their aim was to create a portrait of the man who had taken tobacco’s shilling. Little’s story became an essential part of the plaintiffs’ case: that the tobacco companies had engaged in a massive deception of the scientific evidence by intentionally promoting the “controversy” about smoking and cancer. The industry’s choice of Dr. Little, a retired biologist not on the cutting edge of scientific research, demonstrated how the tobacco companies never had any intention of supporting the best research into the effects of their product.

  For as long as biologists have studied cancer they have assumed that damaged cells can result in odd, cancerous growths. That these cells could be inherited was also accepted. The question was what “initiated” the abnormal growth. Was it the damaged cell itself, or was it an outside agent? One of the man-made chemicals then proliferating in industrial plants, perhaps? Was it the exhaust from automobiles? Was it agricultural pesticides and insecticides? Or could it be some of the thousands of chemicals formed when tobacco is burned in a cigarette? When it was found that condensed tobacco smoke did cause cancer on the shaved skin of laboratory mice, Dr. Little said it wasn’t relevant to human beings. As the evidence of the link between smoking and lung cancer grew from medical statistics, Dr. Little told his audience not to worry, some smokers live to a ripe old age so smoking couldn’t be a cause of cancer. For all his pledges to be concerned with “pure science,” Dr. Little promoted “junk science.” As the liability lawyers sought to paint the tobacco industry as the Evil Empire, they could not have wished for a better image than the socially privileged peddler of their junk science himself, Dr. Clarence Cook Little.

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  THE SON of Boston Brahmins—his mother a descendant of Paul Revere and his father the son of a textile and shipping merchant—Little grew up in luxury at the end of the last century on a huge estate in the suburb of Brookline. There the young Clarence was indulged, even encouraged in his youthful obsession with breeding pets. His father, who lived off a trust fund, bred dogs. At the age of three, Little was given some pigeons and by the time he was seven had bred a pair that won first prize in a local show. He became fascinated by the inheritance of color in his menagerie of mice, dogs, doves, and canaries. By the time he went to Harvard to study biology, he took with him a pair of mice inbred over several generations and he studied their descendants in the college genetics department.

  His was the class of 1910 that included Walter Lippmann, John Reed, and T. S. Eliot, and although he was not a brilliant student, Little was an all-round success. Tall, square-shouldered, and athletic, with a closely clipped black mustache, he cut a dashing figure on the track team. He was articulate, witty, and charming. He had two nicknames, “Prexy” and “Pete,” which endured for his lifetime.

  After Harvard, he first attracted national attention as a college administrator. At thirty-four, he was made president of the University of Maine, then later of the University of Michigan. (He left Maine under the cloud of an extramarital affair, and he eventually divorced his first wife and married his assistant.) Like others of his generation, Little had great faith that science would improve the human race. He embraced the Eugenics Movement, a turn-of-the-century club of intellectuals who believed the human race could be improved by selective breeding. By the 1920s, they had picked up adherents among the members of America’s Yankee ruling class, fearful of being overrun by the “lower elements,” as they saw the Slavs, Latins, and Jews who made up the tide of immigrants. If something were not done to stem the tide, the Anglo-Saxon stock would be tainted beyond recognition. These fears, which led them to support restricted immigration laws, created a climate of approval for eugenic theories. The eugenicists advocated institutional isolation and sterilization of incorrigible criminals, the insane, and the mentally retarded. By the end of the 1920s, twenty-four states had laws permitting involuntary sterilization.

  At the University of Michigan, where Little had landed after Maine, the college authorities were outraged by his advocacy of “selective birth control.” The “uncontrolled and unintelligent addition of more people to the world by the production of undesired and neglected children is in my opinion as great a sin as the murder of these children by slow means,” Little declared at his inaugural address on November 2, 1925. He advocated the sterilization of “criminals and mental defectives,” and called state legislators who opposed such moves “nincompoops.” His continuing speeches on this theme made headlines and horrified many of the God-fearing midwesterners who had hired him, especially the Catholics. The university forced him to resign. A former Michigan governor observed at the time, “Little is an ass.”

  He returned to the East Coast intending to devote his life to cancer research, using his fast-growing colonies of inbred mice. He said he frankly preferred mice to people, a statement that has the ring of truth in retrospect. Always short of funds, Little ran the “mouse house” like a summer camp, encouraging and comforting his staff with potluck dinners, holiday picnics, fishing expeditions, and campfire songs. In return, the staff worked hard and built up an international laboratory-mouse business.

  In 1929, the year the lab opened, Little agreed to serve part-time as managing director of the fledgling American Society for the Control of Cancer, which later became the American Cancer Society. Run by medical doctors, it had been largely ineffective in its primary mission of public education about the disease. Little launched a nationwide program to teach local physicians better methods of examining patients in the early search for cancer and also persuaded the matrons of the American Federation of Women’s Clubs to start a project to teach their members how to detect signs of unusual growths. The program was a big success and brought him considerable praise. It was only when a group of industrialists wanted to transform the society into a vast volunteer health organization, with a board made up of an equal number of doctors and laymen, that Little, voicing his disapproval, returned once again to Maine.

  In those days, Little’s view of the effects of smoking was no different from the one essentially shared by scientists, doctors, and most thinking people through the ages: that repeatedly filling one’s lungs with the fine particles of tobacco smoke could not be good for you. “It is difficult to see how such particles can be prevented from becoming lodged in the walls of the lungs and when so located how they can avoid providing a certain amount of irritation,” he wrote
in 1944.

  But that was before the tobacco companies offered to pay him to sing a very different song. Desperately short of funds for the lab, he began casting around for support from his friends and relatives. At the beginning of 1954, after a particularly lean year at the mouse house, he was advised by a relative to try R. J. Reynolds, the tobacco company with headquarters in Winston-Salem, North Carolina. “There is a tremendous amount of money in Winston-Salem,” he was told. “Under the proper auspices you might get something out of it if you made a speech there.” As it turned out, the tobacco companies needed him quite as much as he needed them.

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  BEFORE THE 1950s the tobacco companies had no serious predators, only moralizing tub-thumpers who repeated, to no enduring effect, that tobacco was inherently dirty and ungodly and encouraged crime. Some scientists and medical authorities had claimed for years that the use of tobacco could contribute to cancer-cell development in susceptible people, but so meager was the actual knowledge that the warnings were easily dismissed by the cigarette manufacturers. The companies concentrated on production efficiency, improvement of tobacco drying techniques, and stronger marketing methods. Sales boomed, especially in wartime.

  Like the arms merchants, the tobacco companies came out of two world wars with remarkable prosperity: sales had shot up from 18 billion cigarettes in 1915 to more than 360 billion by the end of the 1940s. On the front lines, the generals respected nicotine’s calming influence on troops before a battle as well as its ability to suppress the appetite and they demanded almost as many cigarettes as bullets. When the United States entered World War I in 1917, General John Pershing cabled Washington, “Tobacco is as indispensable as the daily ration; we must have thousands of tons of it without delay.” Army doctors reported that “as soon as the lads take their first whiff they seem eased and relieved of their agony.” The doughboys and the British Tommies came home singing one of the most famous songs of the war, “Pack up your troubles in your old kit bag and smile, smile, smile / While you’ve a Lucifer to light your fag, smile boys, that’s the style.”

  Early rumblings about the harmful effects of tobacco among a handful of doctors were quickly subsumed by patriotic fervor. The Lancet, the oldest of the British medical journals, commented, “We may surely brush aside much prejudice against the use of tobacco when we consider what a source of comfort it is to the sailor and soldier engaged in a nerve-racking campaign.… Tobacco must be a real solace and joy when he can find time for this well-earned indulgence.”

  In World War II, President Roosevelt made tobacco a protected crop and draft boards gave deferments to tobacco growers. On the front lines in Europe, Africa, and the Pacific, tobacco was part of the daily ration. There was intense competition between the tobacco companies to produce the favorite smoke. It became a race between Camel, Chesterfield, and Lucky Strike. Reynolds claimed that “Camels are the Favorite! In the Army!… In the Navy … In the Marines … In the Coast Guard.” Chesterfield recommended, “Keep ’em Smoking: Our Men Rate the Best.”

  In the postwar years, murmurs that cigarettes might be seriously harmful went unnoticed or were simply ignored by a confident and increasingly prosperous tobacco industry. It had understandably come to see its enterprise as one of the most commercially solid and legally untouchable in the world. Only the mint makes money more easily, was the saying. Seventy million Americans smoked, hundreds of millions more in Europe. The markets in Japan were opening, the Pacific rim presented a new opportunity, and Africa was untapped. Tobacco executives dreamed of the day when the communists would be thrown out of the Soviet bloc and those markets freed for the Marlboro stampede.

  Why worry about a handful of isolated reports from a few young researchers who had found a statistical association between smoking and lung cancer and heart disease? Why be concerned that chewing tobacco had been blamed for the development of cancer of the mouth?

  Public health officials in Britain and the United States were very worried, in fact, about the staggering increase in the number of deaths attributed to lung cancer. The disease had reached epidemic levels. In Britain, there had been a fifteen-fold increase since 1922. In America, the number of lung cancers per 100,000 males shot passed prostate, colon, and stomach cancers in the early 1950s, and kept on rising. Doctors thought the most likely cause would probably turn out to be industrial pollution, automobile exhausts, and possibly even the tarring of the roads. British researchers thought that arsenic might be the culprit because of its increased use in the treatment of syphilis.

  There had been only hints about the link to smoking. At the turn of the century, tobacco workers in Leipzig had been observed to be especially prone to lung cancer. In the 1930s, an Argentinian researcher had produced cancers on a rabbit’s skin with tobacco “tar.” His study was largely discounted, though, because his “tar” was distilled at temperatures much higher than those found at the end of a burning cigarette. German and American studies at the beginning of World War II first suggested that smoking might cause an increase in human lung cancers, but the evidence was weak. Perhaps, some researchers thought, lung cancers were the result of a combination of atmospheric pollution and cigarette smoking.

  In 1950, health officials were surprised by the results of two epidemiological studies of lung cancer patients, one in the United States and the other in Britain. In the American study, the New York researcher Ernst Wynder and his coworker Evarts Graham, a St. Louis surgeon, concluded that “successive and prolonged use of tobacco, especially cigarettes, seems to be an important factor in the induction of bronchiogenic carcinoma.” Two months later, Richard Doll and Bradford Hill produced similar results from lung cancer patients in London. During the next few years there were more than a dozen studies, all supporting the first two. The medical profession was skeptical at first. Chest physicians had not concentrated on smoking as the cause of disease. They had not even attributed chronic bronchitis to cigarettes, though doctors acknowledged the existence of “smoker’s cough.”

  Statisticians were also skeptical. In America, Joseph Berkson, the country’s most eminent medical statistician, argued that the hospital patients used in the British and American studies did not represent a truly random population. In England, Sir Ronald Fisher, the leading theoretical statistician, attacked the epidemiological studies, suggesting that the supposed effect was really the cause: that people first developed cancer, then they smoked. The real causative factor was the individual genotype, he argued. Like Dr. Little, Fisher deplored the “excessive confidence” that the solution to the lung cancer problem had been found, because such a conclusion would be an obstacle to more penetrating research. And Fisher picked up on the one apparent flaw in the first British study: that those smokers who inhaled seemed less likely to get cancer. He also cited a study that showed monozygotic twins—from the same egg—tended to have similar smoking habits, and called this evidence that genetic factors were involved; genetic factors, he argued, caused a person to smoke and to be unusually susceptible to the disease. Fisher, like Little, had been a prominent member of the Eugenics Movement, and he believed in the “constitutional hypothesis” that relied on genotype. Like Little, Sir Ronald would also become a paid consultant for the tobacco companies. (In later British reports, which Fisher ignored, inhalers of tobacco smoke were found to have an increase of certain tumors. Fisher’s “twins theory” was also later discounted by follow-up studies.)

  Despite such attacks, word began to spread from the medical journals to the popular media. Coverage of the new studies had been minimal, largely because publishers were reluctant to print bad news about some of their best advertisers. The exception was Reader’s Digest, which, as the magazine with the largest circulation in the nation, was not worried about losing tobacco advertising and had long taken a stand against smoking. The New Yorker would also stop cigarette ads.

  In 1953, The New York Times published twelve health and cigarette articles, and twenty-one more in the first thre
e months of 1954. The stories there and elsewhere had an impact on smokers. Cigarette sales started to decline for the first time. The years 1953–55 are key because it was at the end of 1953 that Ernst Wynder made public the results of his devastating “mouse-painting” study. There followed a distinct change in the disdainful attitude of the tobacco companies. “Even the old families have been shaken. Philip Morris has retreated from gloomy reality to find solace in its new snap-open pack,” observed The New Republic. Business Week noted that “fast-paced events loosened up for the first time official tongues of the tobacco industry, which up until now has preserved a rigid silence on lung cancer.” Paul Hahn, president of the American Tobacco Company (Lucky Strike, Pall Mall, and Tareyton), complained about the “loose talk” on the issue, and another tobacco executive promised, “If we are guilty and they find out what causes cancer, we’ll remove it from the cigarettes.” Even so, the industry leaders knew the crisis warranted more than reassuring statements. So they took their battered image to Madison Avenue.

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  EVEN AS LITTLE sought funds for his laboratory from tobacco giant R. J. Reynolds, the tobacco company mobilized to lead an industrywide effort to stave off potential disaster from the lung cancer scare. Tobacco stocks had fallen sharply in the wake of Wynder’s study, and Reynolds and the other big companies—Philip Morris, Lorillard, and Brown & Williamson—joined in the search for a public relations firm “to get the industry out of this hole.” They chose Hill & Knowlton, of New York.

  Although most of Hill & Knowlton’s experience was in heavy industry—it had big accounts in steel and aviation—the company had worked for the distillers and so already had some experience with a potentially harmful product. Its founder and chairman, John Hill, was a strong believer in free enterprise. Leaders of industry tended to trust Hill instinctively, and he had worked hard for this reputation, deliberately creating a somewhat conservative operation in contrast to the razzamatazz often found in the rest of Madison Avenue. Hill resisted anything fast and flashy. The tobacco companies liked his subdued approach, but they were in need of a quick fix. Hill obliged by working unusually fast.