The Cigarette Century

by Allan Brandt

  The industry was aggressively solicitous in identifying and supporting skeptics. They were invited to join the Scientific Advisory Board of the TIRC; they and their home institutions were provided with research grants; their views were sought and broadcast widely. In this way, the tobacco industry managed to sustain the widespread perception of an active and highly contested scientific controversy into the 1960s despite overwhelming evidence and scientific consensus that smoking caused serious disease. According the TIRC, many independent and responsible scientists continued to voice opposition to these findings. In reality, over the course of the decade, such views were increasingly marginal and limited to those with financial ties to the TIRC. One central question for the evaluation of skepticism is “what evidence would be convincing?” One sign that open-minded doubt has turned intractable is the answer: “I cannot say.”

  But skepticism does not indicate that there is not consensus. With each passing year, skepticism concerning the relationship of smoking and cancer was increasingly dominated by industry resources and activity. Doubt was no longer a matter of culture or training, but the carefully crafted center-piece of an industry effort to sow confusion and heighten debate through explicit attempts to disrupt the process of normative science. The TIRC marks one of the most intensive efforts by an industry to derail independent science.

  The process of coming to understand the coherence, accuracy, and significance of the findings on smoking and lung cancer is illustrated by the manner in which the various scientists at the NCI considered the question. By 1957, Joseph Heller, NCI’s director, would make clear that consensus existed among the scientists there, but the arrival at that consensus was a complicated process. Some NCI researchers, like Wilhelm Hueper, worried that acceptance of the cigarette hypothesis would deflect attention from other potential carcinogens, such as occupational toxins and environmental pollutants.74 Most of the remaining handful of prominent pathologists and laboratory investigators at NCI and elsewhere who resisted the consensus found support for their views in the tobacco industry PR campaigns.

  According to the Hill & Knowlton design, the Tobacco Industry Research Committee consisted of a Scientific Advisory Board with a scientific director as well as an administrative staff. The SAB was to evaluate research proposals and make decisions about funding, which it did in regular meetings. The initial slate of seven respected senior scientists was chosen by the industry. Their appointment lent credence to the industry’s contention that it planned to seriously examine the question of tobacco and health. The SAB had a number of distinguished members in the forty-plus years of its existence.

  Although the independence of the SAB was widely publicized, the SAB’s work was directed by the full-time staff of the TIRC, specifically W. T. Hoyt and, after November 1954, Assistant Scientific Director Robert Hockett, a sugar chemist. Both men exercised considerable authority over grantees and day-to-day practices. Numerous Hill & Knowlton executives also spent a great deal of time attending TIRC meetings and drafting TIRC PR initiatives.75 Strikingly absent from the initial list of SAB members was any statistician, and although by the summer of 1954 they had found one willing to join, the TIRC never sponsored statistical or epidemiological investigations. It supported some research exploring alternative hypotheses of carcinogenesis, but little direct research on cigarettes and disease. Most of its resources were devoted to exploring alternative theories of the origins of cancer, centering on genetic factors and environmental risks.

  Most sponsored projects had nothing to do with smoking but were concerned with basic questions in immunology, genetics, cell biology, pharmacology, and virology. In 1954, its first year of operation, the TIRC budget approached $1 million—almost all of which went to Hill & Knowlton, media ads, and administrative costs. Funding for the grants program increased substantially in later years, reaching $800,000 by 1963.

  Under Little’s leadership, the SAB settled into a program of funding research principally on the basic science of cancer, with little or no relevance to the critical questions associated with the medical risks of smoking. This focus apparently suited all concerned. It was certainly ideal from a public relations standpoint since unrelated research would not condemn cigarettes. SAB members could assert that they were offering valuable resources, yet distance themselves from the specific question of the harms of tobacco and thus avoid accusations of bias; SAB members frequently told the TIRC staff that they did not wish to be associated with the TIRC’s public statements. They were generally skeptical or agnostic concerning the harms of smoking but felt that their direct association with TIRC statements asserting “no proof ” would make them appear prejudiced and partisan.

  In February 1958, a number of members of the Scientific Advisory Board communicated that they were “disturbed by a misunderstanding of the relationship between the TIRC and the SAB.” Several board members expressed concern about the public statements of the TIRC. Physiologist Julius Comroe apparently threatened to resign because he and other members of the SAB had been placed in the “awkward position of unwittingly endorsing everything that the TIRC said.” Leon Jacobson echoed this worry and, according to the minutes of the meeting, explained that “he did not wish to be linked with any of the statements made by the TIRC.” Although the founding members of the SAB would steadfastly defend their independence from the industry, the reality is that under the Hill & Knowlton plan, they had been manipulated for effective PR, a fact they periodically acknowledged with some bitterness.76

  By steering funds away from the effects of tobacco toward basic science in cancer, they avoided the implication that they served industry interests. SAB members were frequently in a position to secure funding from the industry to support the work of colleagues and associates, as well as other research at their home institutions. Such arrangements gave them considerable influence and clearly sustained their loyalty to the TIRC.

  The TIRC never developed an approach to carcinogenesis and tobacco that could resolve the question of the harms induced by cigarette smoking. At the same time that they demanded experimental evidence, the TIRC refused to acknowledge that new results came not only from additional observational studies, but from pathological and experimental findings. Pathologist Oscar Auerbach’s research, for example, was especially notable because it demonstrated the characteristic precancerous changes in lung tissue among smokers. Auerbach’s study, published in 1957 in the New England Journal of Medicine, involved autopsies on 30,000 deceased patients with confirmed smoking histories. To ensure against bias, microscopists were kept ignorant of these histories. Auerbach concluded in his paper that

  These findings are fully consistent with the hypothesis that inhalants of one sort or another are important factors in the causation of bronchogenic carcinoma.

  The findings are also fully consistent with the theory that cigarette smoking is an important factor in the causation of bronchogenic carcinoma.77

  In light of such studies, to claim that the evidence for a causal relationship between smoking and lung cancer was based exclusively on statistical data—as the tobacco industry would repeatedly insist—was to fundamentally misrepresent the emerging scientific knowledge.

  By mid-1956, the industry found itself in yet another public relations dilemma. The utility of the TIRC lay in its commitment to “objective” science and the search for the “truth,” but the SAB had expressed “strong opposition” to being drawn directly into the PR campaign. Little found himself caught between his handlers at Hill & Knowlton and his scientific colleagues on the SAB. Eventually, given the SAB’s discomfort with Little’s prominent public role in denying any proof of tobacco’s harms, Little relinquished his title of chairman of the SAB while remaining a member and scientific director of the TIRC. Hill & Knowlton and the TIRC staff worked to maintain the image of the SAB as impartial and scientific while still calling on Little to make statements in the media.78

  Hill, in turn, was under increasing pressure from his industry cl
ients to deliver a definitive statement that cigarettes posed no risk. Tobacco executives repeatedly asked for a more aggressive public relations campaign than the measured approach Hill & Knowlton had engineered. They expressed frustration with the TIRC approach to staying above the fray: Philip Morris President McComas wrote to Hartnett in July 1957 that “the very substantial part of the money which Philip Morris has contributed to TIRC for public relations has been wasted.” Threatening to withhold further funding unless the organization took the “offensive against its detractors,” McComas insisted that the “SAB will only be consulted on publicity activities which have to do directly with the SAB or its projects.”79 The SAB became increasingly isolated from the more ambitious PR activities of the TIRC even as it was invoked as proof that the tobacco industry was honoring its commitment to scientific research.

  By the 1970s, the status of the TIRC (now renamed the Council for Tobacco Research, or CTR) as a public relations enterprise had become clear to almost everyone. In 1972, Earl Newsom & Company, a public relations firm, evaluated the content of the CTR (and earlier, the TIRC) annual reports for the industry:From a public relations point-of-view, if from no other, it would seem that the Council should continue to receive support from its members, particularly in these times of mounting consumerism. . . .

  More specifically, we get the impression that when the use of laboratory animals indicates that the findings are favorable, or at least not unfavorable, to the use of tobacco, then the covering report either makes a positive statement about the use of animals or no statement whatever. On the other hand, when the findings from any particular project indicate that tobacco use may be contributing to a discernible and unhealthy change in laboratory animals, then we get, in the covering report, mention of the limitations imposed by the use of animals. . . .

  Whenever possible the reports pointedly refer to “some who would” say smoking is dangerous, based on any given test, as scientific crackpots. When possible, Dr. Little qualifies the results of animal tests that tend to be critical, but emphasizes them when they do not find evidence of carcinoma, implying that smoking is harmless. The aim of his summations, much too apparently, seems to be to protect smoking. . . .

  More recent annual reports show decreasing editorial comment. This may be the result of accumulating evidence, in the Council studies as elsewhere, which shows some of the deleterious effects of heavy smoking.80

  In 1974, Alexander Spears, then director of research and development at Lorillard (he became CEO and chairman in 1995), confirmed this assessment:Historically, the joint industry funded smoking and health research programs have not been selected against specific scientific goals, but rather for various purposes such as public relations, political relations, position for litigation, etc. Thus, it seems obvious that reviews of such programs for scientific relevance and merit in the smoking and health field are not likely to produce high ratings. In general, these programs have provided some buffer to the public and political attack of the industry, as well as background for litigious strategy.81

  At the same time that Hill and his colleagues were establishing the Tobacco Industry Research Committee, they worked aggressively to reshape the media environment. Hill & Knowlton’s public relations strategy relied on intensive contact with authors, editors, scientists, and “opinion makers.” Hill understood that the success of any public relations strategy was highly dependent on face-to-face interpersonal relations with important media outlets. Each time the TIRC issued a press release, the Hill & Knowlton organization had initiated “personal contact.” The firm systematically documented the courtship of newspapers and magazines where it could urge “balance and fairness” to the industry. Hill & Knowlton staff, for instance, assisted Donald Cooley in preparing an article entitled “Smoke Without Fear” for the July 1954 issue of True Magazine and then distributed more than 350,000 reprints to journalists throughout the country. “If you are a man or woman who smokes, relax and enjoy it,” Cooley advised. “If you have tried to give up smoking a dozen times and failed, quit trying.”82

  As Scientific Director of the TIRC, C. C. Little was integrally involved with Hill & Knowlton’s media strategy. By the 1960s even Little’s allies in the industry complained that his constant refrain of “no proof ” increasingly lacked credibility and that he had outlived his utility to the industry. But he was undeterred, insisting that the relationship between smoking and disease remained an “open question.” “If anything,” he maintained, “the pure biological evidence is pointing away from, not toward, the causal hypothesis.”83 It was one thing to voice such a view in the early 1950s, quite another by the end of decade. Some accounts of the controversy fail to adequately calibrate the character of change over the course of the decade. Little was unshakable in his commitments, and he thrived as a combatant. These qualities stood him in good stead with his employers, and his position of “skepticism” was sustained and broadcast by his handlers at Hill & Knowlton.

  Given his role as the industry’s most preeminent spokesman on science and health, Hill & Knowlton worked to burnish his reputation. For instance, Dick Darrow of Hill & Knowlton directed his staff in 1955 to focus “stature-building attention on Dr. Little and his own work.”84 Little’s value lay in his status as a prominent scientist, his historical role in cancer research, and his past leadership of the American Society for the Control of Cancer. As the politics of tobacco became more intense in the late 1950s, Hill & Knowlton was careful to protect Little in this sphere. Carl Thompson wrote to Hill explaining, “Dr. Little should not be brought too much into discussion of direct [political] action.” Little’s crucial role would be his insistence on scientific uncertainty and his perennial calls for more research.

  Moreover, the executives at Hill & Knowlton understood the value of Little’s insistence on his independence. Although he frequently asserted to the press that “I am my boss,” in reality he closely followed the script prepared by Hill & Knowlton. And when he was perceived early on as not sufficiently making the case for “two sides” to the tobacco question, he heard directly from John Hill.85 “All the industry has any right to ask or expect now is for the public to understand that the case has not been proven and that there are ‘two sides,’” Hill wrote.86 And Little used his allies on the SAB to attack new scientific findings. In one instance, he asked William Rienhoff, a member of the SAB, to respond to the publication of Alton Ochsner’s 1954 book, Smoking and Cancer, with the following statement: “Doctors Ochsner and Graham . . . have long been recognized as the foremost and most vociferous medical, anti-tobacco propagandists.” Rienhoff readily complied.87

  Hill & Knowlton operatives made Little available to editors, journalists, and others in the media. Most of these people, lacking much scientific sophistication, eagerly portrayed both sides of the “controversy.” The controversy, after all, made it a story.88 Little’s statements, shrewdly broadcast by Hill & Knowlton staff, were part of a much broader effort. The other branch of the TIRC, beyond its carefully orchestrated scientific research, was the construction and implementation of a consistent industry-wide public relations message. TIRC representatives frequently issued statements during this period explaining: “[TIRC’s] purpose is solely to obtain new information and to advance human knowledge in every possible phase of the tobacco and health relationship.”89 But such statements misrepresented the preeminent public relations origins and functions of the program. While publicly repeating its research focus, tobacco executives knew that the TIRC was primarily a public relations vehicle. In April 1955, W. T. Hoyt, executive secretary of the TIRC, explained the relationship of PR and research in the TIRC’s program:Essentially, the major purposes of the TIRC are Research and Public Relations. Our job is to maintain a balance between the two, and to continue to build soundly so that at all times Research and Public Relations complement each other. In that way we intend to assume the mantle of leadership and, ultimately, to create a condition where the public will look to the TIRC
for answers rather than to others.90

  The White Paper issued in April 1954 was the primary vehicle of the TIRC’s early media strategy. Formally entitled A Scientific Perspective on the Cigarette Controversy, it comprised eighteen pages of quotations from physicians and scientists casting doubt on the link between smoking and lung cancer. Over 200,000 copies were distributed to the medical community and to the general media.91 The White Paper catalogued the widest range of criticism and skepticism, including that of scientists from the NCI and elsewhere. Its arguments would be deployed by industry interests for the next half-century. For example, according to Max Cutler, a cancer surgeon and TIRC favorite—“simply because one finds bullfrogs after a rain does not mean that it rained bullfrogs.”92 The recurrent theme of calling for more research was loudly sounded in the White Paper, as were claims that scientific reports of cigarettes’ harms promoted public hysteria.

  Not everyone was enthusiastic. Joseph Garland, editor of the New England Journal of Medicine, commented:Many persons recently received a brochure entitled “A Scientific Perspective on the Cigarette Controversy” emanating from the Tobacco Industry Research Committee. The title is pretentious, for the publication seems rather a series of testimonials than a scientific study.93