Ashes to Ashes (49 page)

If rivals fumed at this bold move and its implicit concession to the rebuke that many in the industry expected to suffer momentarily from the Surgeon General, at least one vocal critic of the industry praised American Tobacco for lowering the yield numbers so dramatically. Senator Maurine Neuberger, whose new book,
Smoke Screen: Tobacco and the Public Welfare
, had denounced the tobacco industry for reaping record profits of late by “suppressing, distorting, and overcoming by psychological manipulation, the truth about smoking,” introduced a bill into Congress requiring all cigarette brands to follow the Carlton lead by listing their strength on the package. More than thirty years later, by which time almost all products taken into the human body
were required to carry a notice on the package listing their ingredients—unhealthful ones in particular—cigarettes remained implausibly exempt from the requirement.

VII

MIDWAY
through the first gathering, on November 9, 1962, of the Surgeon General’s Advisory Committee on Smoking and Health (SGAC), the panel members were treated to a bit of comic relief in the form of a new record featuring the routines of stand-up comedian Bob Newhart, who would become a bigger success later as the star of several situation-comedy shows on television. Newhart’s most effective comedic device was the one-sided telephone conversation, in this case re-creating an imagined exchange between Sir Walter Raleigh, credited not entirely without foundation as the prime promoter of tobacco in England, and the nameless chief executive of a London-based importer of the New World’s exotic commodities. In Newhart’s inspired anachronism, the transatlantic exchange ran in part:

Things are fine here, Walt … . Did we get the what? That boatload of turkeys. Yeah, they arrived fine, Walt. As a matter of fact, they’re still here, Walt. They’re wandering all over London as a matter of fact. … See, that’s an American holiday, Walt. What is it this time—you got another winner for us, do ya? … Tobacco. What’s tobacco, Walt? … It’s a kind of leaf. And you bought eighty tons of it. Let me get this straight, Walt—you bought eighty tons of leaves. This may come as kind of a surprise to you, Walt, but come fall in England we’re kind of up to our—it isn’t that kind of a leaf? What is it, a special food of some kind, is it, Walt? … Not exactly. It has a lot of different uses. Like what are some of the uses, Walt? … Are you saying “snuff”? What’s snuff? … You take a pinch of tobacco
[laughing]
and you shove it up your nose. And it makes you sneeze. I imagine it would, Walt, yeah. Goldenrod seems to do it pretty well over here. … It has some other uses, though. You can chew it or put it in a pipe, or you can shred it and put it on a piece of paper and roll it up and—don’t tell me, Walt, don’t tell me—you stick it in your ear, right, Walt? … Oh, between your lips? Then what do you do to it, Walt? … You set fire to it, Walt? Then what do you do, Walt? … You inhale the smoke? You know, Walt, it seems offhand that you could stand in front of your fireplace and have the same thing going for you

A laughable perversion when seen outside of its historical context, the smoking of tobacco—and of cigarettes in particular—was a deadly serious concern to that roomful of blue-ribbon scientists convened by Surgeon General Luther Terry. Although disparaged as a political appointee, selected to head
the 33,000-member U.S. Public Health Service from outside the ranks of the commissioned officers’ corps at the heart of the PHS, Terry brought an innate decency and the reassuring bedside manner of the old-time family physician to the task of administering fourteen government hospitals and some 200 federal institutes and programs. He had the competent administrator’s essential knack of picking able assistants—in this case, his Assistant Surgeon General, James Hundley, a more severe and brighter man than himself, to serve as chief liaison with the advisory committee on smoking, and as scientific coordinator for the project that would prove Terry’s monument, a young star from the officers’ corps, Dr. Peter Van Vechten Hamill. Brilliant and intense, Hamill was a University of Michigan-trained chest physician with an advanced public-health degree from Hopkins, who had done useful work for the PHS in the areas of frostbite and air pollution. All three of them—Terry, Hundley, and Hamill—were serious cigarette smokers at the outset of the SGAC’s deliberations, and at Hamill’s suggestion, it was agreed that all of them ought to quit the habit then and there or stick with it throughout the committee’s existence in order not to tip off outside observers prematurely about any emerging consensus within the study group. The same course was prescribed for the five regular smokers among the ten committee members, three of whom used cigarettes heavily and two a pipe or cigar. None of them quit until their report was completed—and indeed, several increased their tobacco intake amid the growing tension of the undertaking.

The Surgeon General insisted on one other rule of conduct: the deliberations of the advisory committee were to remain absolutely secret until their report was issued. Their subject, after all, was of surpassing interest to nearly half the adults in America and affected the very existence of a major U.S. industry. When, after his first weeks on the job, the advisory committee’s staff director commented to a newspaper reporter that current knowledge on the subject “definitely suggests tobacco is a health hazard,” Terry fired him before 9 a.m. the next morning. The staff director’s job was added to the responsibilities already being handled by the driven and ambitious Peter Hamill.

Hamill’s initial task had been to sift through the list of 200 names proposed by government and private health officials and the cigarette makers to find the ten most able and willing to serve on the committee. Their seniormost member and unofficial chairman was one of the grand old men of American medicine, Stanhope Bayne-Jones, then a seventy-four-year-old bearded savant with still twinkly eyes that made him seem a kind of Santa Claus in mufti to some of the committee’s younger staff people. An eminent bacteriologist and the author of a leading textbook on that subject, Bayne-Jones had served as dean of Yale Medical School before World War II and later presided over the administrative board of New York Hospital, among the nation’s top health-care facilities. “B-J,” as almost everyone connected with the SGAC effort referred to him affectionately,
had the intellectual toughness and openness of mind to serve as the committee’s conscience, urging his colleagues—men from many varying medical specialties and of unequal intellectual acumen—to educate one another as they proceeded.

The youngest and probably most efficient committeeman was its sole Southern representative, pulmonary specialist Charles LeMaistre, a full professor by age thirty at the University of Texas’s Southwestern Medical School and now, eight years later, medical director as well at Woodlawn Hospital in Dallas. Cautious in judgment and politic in manner, “Mickey” LeMaistre carried himself with an air of authority that would in subsequent years earn him the chancellorship of the entire University of Texas system and directorship of the largest U.S. cancer treatment and research center west of the Mississippi.

Perhaps the single most useful of Hamill’s enlistees for the SGAC owed his selection to a decision by the Metropolitan Life Insurance Company, the nation’s largest insurer, preventing its chief actuary, Mortimer Spiegelman, a pioneer in the development of life tables and the ideal choice to evaluate the population studies at the core of the medical case against smoking, from accepting the Surgeon General’s invitation. But Spiegelman recommended a Harvard mathematician, William G. Cochran, whose textbook on statistics was rated among the very best and whose remarkable technical skills had been applied to solving problems in Corn Belt agronomy as well as to critical calculations for the famed Norden bombsight that had allowed pinpoint targeting by Allied aviators during World War II. A somewhat bleak Scotsman and devoted cigarette smoker, Cochran was less than overjoyed at the prospect of joining the Surgeon General’s panel, but Hamill traveled to Cambridge and, beside the fireplace after a meal at the Harvard Faculty Club, succeeded in thawing the wintry Cochran. Although the only member of the committee who was neither a physician nor a Ph.D., he brought a rock-hard rigor to their joint intellectual analysis, along with an ample portion of horse sense—qualities that led one of his SGAC colleagues to say of Cochran long afterward, “He kept us honest.”

Probably the most original thinker in the group was the chairman of the pathology department at the University of Pittsburgh, Emmanuel Farber, whom Hamill recalled as “a volatile little guy with a highly superior I.Q.” While not a cancer specialist, Farber had undertaken experimental studies on the growth and destruction of cells which won him some keen admirers at NCI. Possessed of a sweet manner and clear mind, he was far more open than many pathologists to the uses of epidemiology and thus served the critical function of integrating the statistical and microscopic evidence before the panel.

The most disappointing performance by a committee member would be turned in by the scientist among them certainly most eminent in his field—Harvard’s Louis Fieser, a towering figure in organic chemistry. The author of
eight books and some 300 articles, Fieser had done pathbreaking work on vitamin K and cortisone as well as less ennobling wartime research vital to the development of napalm as an incendiary weapon. Perhaps because he was ten years past his prime, he seemed somewhat bemused by and almost indifferent to the review process engaged in by his SGAC colleagues. Nobody among them knew of his prior consulting work with Arthur D. Little, Inc., for Liggett & Myers or that he was one of the two panelists endorsed by the cigarette manufacturers.

Presumed to be as knowledgeable on the biology of cancer as Fieser was supposed to be on the carcinogenic chemistry of hydrocarbons was Columbia pathologist Jacob Furth, who rejected the committee’s initial overtures but whom Hamill pursued in his New York lair. Furth, though, once captured, would turn out to be more a conciliator than a stringent critic of the evidence, leaving Hamil| with the feeling that the Columbia scholar had come to the task perhaps five years too late.

The most sociable and heaviest-smoking member of the committee was University of Minnesota epidemiologist Leonard M. Schuman. A specialist in venereal diseases and other communicable afflictions, like polio, which were the original terrain of public-health investigators, Schuman was a gabby raconteur and a bit full of himself, but when finally mobilized would turn into the SGAC’s workhorse in shaping consensually acceptable language for its final report. By that point, his tobacco consumption was up to two and a half packs a day. “I was such an inveterate smoker that I don’t think I wanted to believe there was a relationship,” Schuman remarked of the smoking and health connection. “The chance for me to review the literature was a challenge to my scientific integrity.”

Staff director Hamill’s eventual selection as the panel’s authority on the likely effects of smoking on the intimately connected heart and lungs system was a relatively uncelebrated clinician, John. B. Hickam, chairman of Indiana University’s department of internal medicine. Straightforward, knowledgeable, and conscientious, Hickam was hungry for a better understanding of the underlying mechanisms in the pathology of cardiovascular heart disease as compounded by smoking. But since the evidence took the forms primarily of statistical association and reasonable inference rather than clear pathogenic pathways, Hickam urged his colleagues not to venture beyond a statement expressing a strong suspicion that tobacco was a cardiac killer.

A far more egregious protector of the industry’s interests was the second committee member to be put forward by the tobacco manufacturers—Maurice H. See vers, chairman of the pharmacology department at the University of Michigan and an expert on habit-forming drugs. A lusty, two-fisted type fond of liquor, cigars, and bawdy jokes not always appreciated by his committee colleagues, “Mo” Seevers was, despite appearances, a complicated man who
had been dean of the medical school at his university when Hamill attended it. But his former mentor disappointed the young public-health official now for what seemed an adamant refusal to consider labeling the use of tobacco as addictive behavior. The fault, if any, lay with the user, not the substance, by Seevers’s reckoning.

Equally useful to the industry’s defense, if unwittingly so, was the final member of the Surgeon General’s committee—Walter J. Burdette, head of the surgery department at the University of Utah, ironically a state where smoking was widely frowned upon due to the precepts of the Mormon church, the dominant religious group. Perhaps the least brilliant bulb on that panel of luminaries, Burdette struck some SGAC colleagues as an opinionated and somewhat narrow-minded egoist who fancied himself an expert on genetics because he had written a book on the subject. This credential left him highly susceptible to the tobacco industry’s most fervent argument—the “constitutional” theory that certain people were born prone both to smoking and to the development of lung cancer, but that the two were not necessarily causally related. Of Burdette, Hamill would later remark, “He never really understood what we were doing”—a view that also revealed Hamill’s reluctance to restrict his own role to the mere gathering of materials for the committee’s consideration; instead, at times he played the undesignated eleventh member of the panel, eager to exercise a shaping hand in its deliberative process.

All in all, the Surgeon General’s committee was as sensible a panel of scientists not predisposed against smoking as the tobacco industry could have wished for. From the first, it was clear that the committee’s basic challenge was to define its task, for discerning public-health officials understood that no truly comprehensive, critical overview had yet been attempted on the relationship of smoking to health, even though the subject had already generated some 6,000 reported studies and scholarly articles. Even the Royal College of Physicians report, issued a few months before the SGAC first met, had dealt with only a fraction of the literature, and in the view of some at the U.S. Public Health Service and on the SGAC staff, the British doctors seemed almost to have made up their minds beforehand; their findings were, at any rate, less than a meticulously argued exegesis of the case against tobacco.