Ashes to Ashes (73 page)

Steinfeld’s 1972 report on smoking and health was worse news yet for the industry. In it, for the first time, the Surgeon General dwelled on the likely hazards of secondhand smoke—the stuff in the air either exhaled by smokers or emitted from the burning tip between smokers’ puffs. This was a daring initiative—possibly even imprudently premature—because there was as yet very little scientific evidence to support it, and there seemed to be no practicable way to measure exposure levels and dilution rates. Steinfeld was caught up with the dangers of environmental pollution, now an official target of federal public-health guardians, and to him, secondhand smoke was precisely that—an environment pollutant—and an obvious peril to those already impaired with heart or respiratory disease. “Biologically it had to be,” Steinfeld recounted, “and laboratory experiments showed that no animal smoked voluntarily—there was systemic resistance and histologically observable [by microscope] changes in the cells of exposed animals,” which were, in effect, passive (or secondhand) smokers. He was convinced that secondhand smoke was also implicated in the deaths due to lung cancer of nonsmokers—“not a trivial problem,” he commented, since as many as 15 percent of the overall lung cancer toll of about 65,000 a year at that time occurred among nonsmokers, a sizable portion of whom were no doubt environmentally exposed to tobacco smoke by their spouses or co-workers. Wherever he spoke, Steinfeld called for a serious investigation of the effects of secondhand smoke and proposed a ban on smoking in such enclosed public places as restaurants, theaters, and mass transit systems—recommendations added at the end of the Surgeon General’s annual reports but regularly removed by Nixon’s Office of Management and the Budget (OMB).

Steinfeld distanced himself from the tobacco industry by closing his office
door to their tireless missionaries. “I would not see the Tobacco Institute lobbyists,” he recalled, despite their eagerness to wine and dine him and wave their data under his nose. Invariably, though, he would run into their representatives at Nixon administration functions or in the office of Steinfeld’s chief, HEW Secretary Elliott Richardson, a man known to harbor presidential ambitions and not above currying favor with allies wherever he might find them. On such occasions, “the tobacco people would give me the business, saying in effect, ‘See, we can meet with the Secretary or top people in government without worrying about the Surgeon General,’” Steinfeld felt. “There was a message there.” It was manifested in the disappearance of the tiny allocation for the Clearinghouse on Smoking and Health from the 1971 and 1972 budgets until Steinfeld forcefully intervened with the HEW Secretary to have it restored. The Surgeon General, though, would not blunt his attack. His 1972 report stated, “There is no disagreement—cigarette smoking is deadly.”

Steinfeld’s unflinching candor was his political undoing. When the commission under his charge on the effects of TV violence on children made its findings known in 1972, the White House considered them too critical of the broadcast industry and ordered the Surgeon General not to testify on the matter before Congress. But Steinfeld was subpoenaed to appear, and rather than clear his proposed testimony with the administration, which had in the past required him to attest to views he did not fully endorse, he spoke his mind, raking over the broadcasters. For his troubles, Steinfeld was not reappointed for Nixon’s second term. The ouster was strongly endorsed by the tobacco companies, at least one of which reminded the White House of its campaign contributions and urged that the Surgeon General be sent packing. He became head of oncology at the Mayo Clinic, and four years passed before a new Surgeon General was named.

IV

NO
other agency or office throughout the entire federal bureaucracy was devoted to combating what was increasingly recognized by the public-health community as the nation’s leading preventable cause of death, yet HEW’s Clearinghouse on Smoking and Health had to sweat out every penny of its pitiably small appropriation and justify its previous year’s expenditures under intense scrutiny by tobacco-state congressmen. Operating at first out of a warren of small offices in a nondescript building in Arlington, the Clearinghouse bounced around the Washington area for eight years beginning in late 1966—an unwanted orphan and political lightning rod that was sustained by a sense of mission among its mostly youthful staffers.

The Clearinghouse’s core function, as its name implied, was as a technical
information center, collecting all the studies, articles, and data on smoking it could and serving as a reference service and bibliographic tool to researchers everywhere. This material, which provided the essence of the annual updated Surgeon General’s reports to Congress, was overseen by Donald Shopland, the self-taught young man who had been so caught up in his work as an aide to the original Surgeon General’s panel on smoking that he stayed on at the National Library of Medicine, became the keeper of the smoking and health archives when they were turned over to the Clearinghouse, and, though he lacked a college education, made himself a walking encyclopedia on the subject. In time, his would become a prominent voice in the allocation of tens of millions of dollars aimed at combating the perils of smoking.

The Clearinghouse’s other principal function was to alert the public, to the extent that its meager dollars could be stretched, to the smoking problem. That it did so with notable success was due to the talents of its chief publicist, Robert Hutchings, a low-key charmer who was adept at cajoling more powerful federal agencies to approve of the pointed material he and his staff generated. These included pamphlets on quitting, posters distributed to public school classrooms (“If you smoke, you’re a turkey”) and affixed to the sides of U.S. mail trucks, placards that appeared in the New York subways and other public transit systems, and unpaid antismoking television commercials when they were ordered by FCC edict during the late 1960s.

But the heart and soul of the place was its director, Daniel Horn, the Harvard-trained psychologist who seemed far more the research professional polishing his ivory tower than the administrator of a politically sensitive government program surrounded by a clutch of charged-up youngsters. A stocky figure wearing his trademark bowtie, a nearly threadbare suit, and Hush Puppies shoes often caked with mud (or, according to office whispers, dog excrement from the prizewinning Chesapeake retrievers that he and his wife raised and showed as amateur breeders), Horn might hole up in his office for days to tinker with a report based on a public survey he had commissioned on smoking habits. Or he might go off for a two-day seminar somehow linked to the issue and forget to tell his subordinates where he was. Once, much to Hutchings’s anguish, Horn failed to show up for a filmed shoot with the crew from “60 Minutes,” one of television’s most widely watched shows.

Yet for all his head-in-the-clouds idiosyncrasies, Horn had a deeper understanding of the smoking problem than any other federal employee. He knew full well that the value of his enterprise lay in figuring out not merely how to put a fresh spin on the ever-accumulating body of statistical data but how to transform that indictment into a program to help the smoking public modify its self-destructive behavior. An example of Horn’s strengths and limitations was a twelve-page pamphlet he developed,
The Smoker’s Self-Help Kit
, available for ten cents from the Government Printing Office, which included a seríes
of tests that allowed would-be quitters to grasp, on the one hand, how their tobacco habit seemed to help them manage their emotions and structure their lives yet discover, on the other hand, their feelings of self-disgust over their enslavement to smoking and its nasty by-products, like reeking clothes, breath, and hair. As a behaviorist little interested in the pharmacological aspects of tobacco
qua
drug, Horn was a proponent of quitting by going cold turkey, once an unhappy smoker fully understood the nature of his addiction. The key to success, he wrote, was for the reluctant smoker to ask with each new smoke, “Do I really want this cigarette?” Yet Horn’s “kit” had disappointingly little impact because, in shying away from scare tactics, it intellectualized the problem and lacked shock value.

Horn made up for his want of flashiness by perseverance and an ability to draw from the data in the field surveys he ordered sociological insights into the nature of smoking. In 1970, for example, he elaborated on the alarming rise of teenage smoking by noting that the phenomenon, most marked in households where one or both parents were no longer present, was a manifestation of the disintegrating structure of the American family. Other findings led him to suggest, earlier than almost any other observer, the reasons that women found it harder to quit and stay off cigarettes than men: smoking seemed to help them reduce tensions in a culture in which they played more roles than men and had fewer sanctioned outlets for venting their aggressions and frustrations; women were more worried about gaining weight, as quitters often did. In capsulizing a 1971 survey of 5,000 adults, Horn reported that 36 percent of the population still smoked, that three out of five Americans favored a total ban on cigarette advertising, and that, by way of endorsing compassion over contempt as a curative, “We have in the population a lot of people who simply feel that they are incapable of changing their smoking behavior—[and] need encouragement and help rather than a collection of sermons on how great it is to be a nonsmoker.”

Soon after Jesse Steinfeld was dropped as Surgeon General, Dan Horn found his little agency zeroed out of the 1973 federal budget and had to beg for an emergency allocation of $900,000 to sustain even its basic data-gathering function. Begging got him nowhere in 1974. The Clearinghouse was swallowed up as a subsection of the Centers for Disease Control and moved to Atlanta, where its public-health message became a plaintive, all but inaudible whisper and its passionate staff, with the exception of Shopland and a few others, got reassigned. Lacking a Surgeon General, HEW’s annual report to Congress on smoking and health became an emaciated and unnoticed document. Frustrated and disappointed, Horn left Washington to work for the World Health Organization.

V

ALTHOUGH
fifteen years would pass following the ban on broadcast advertising of cigarettes before Congress would impose any new regulations on the tobacco manufacturers, the industry was not quite out of the woods, particularly at the outset of that relatively blissful spell.

The Federal Trade Commission, severely whacked in 1969 by reports from two sharply different sources—consumer advocate Ralph Nader’s “Raiders” and a special study committee of the American Bar Association—for frittering away its energies on trivial pursuits, was in the process of reenergizing itself. Among the new, younger talent enlisted was Robert Pitofsky, named director of the FTC’s bureau of consumer protection (and later to serve as a commissioner and chairman of that agency and dean of the Georgetown law school), who set about implementing several key features originally proposed in the 1964 regulatory rule for cigarettes that Congress had severely emasculated with the 1966 labeling law. Backed by a fragilely balanced commission and thus a moderately activist mandate at best, Pitofsky pushed the tobacco industry in the early 1970s to accept the inclusion of the tar and nicotine contents on cigarette packs and as part of the warning labels to be included in all advertising. The industry did not precisely roll over at the snap of Pitofsky’s fingers.

Allowed to list their tar yields by the FTC’s 1967 policy reversal, the cigarette makers did so only on a few brands aimed at the health-conscious smoker. Their reasons for hesitating were not baseless. To state the numbers in ads or on the packs was to risk their being taken as a kind of undeclared index of safety (or danger). Thus, a high-yielding Winston might be perceived by the public as a dozen times more perilous than a Carlton when there was inadequate scientific support for such a supposition. The problem was even more pertinent in the case of small differences between brand yields, since the FTC insisted that no health advantage could be claimed for any such differential without valid scientific backing. Furthermore, the two items to be listed differed in important ways from the ingredients to be disclosed by manufacturers under the 1960 Federal Hazardous Substances Labeling Act and other regulations. “Tar” was technically not a discrete substance but a distillate extracted from the combustion process; it was an amalgam of several thousand volatile compounds. Nicotine, the other alleged chief culprit in smoke, had been largely absolved as a health menace by the 1964 report to the Surgeon General, which found its effects to be mostly transient and its pharmacological impact to be habituating rather than addicting. While indicating the industry’s reluctant willingness to deal with the FTC on this matter in 1970, Tobacco Institute chieftain Kornegay recited the companies’ lawyer-sanitized understanding:

“There is, of course, no way to know that any given levels [of tar and nicotine] are of any relevance beyond simple matters of taste to individual smokers.”

But the FTC had grown impatient by now with an industry that insisted, to protect itself against product liability suits, that any modifications it was making in the strength of cigarettes were not necessarily related to its customers’ health. Particularly offensive to the federal regulators were ads like those for the charcoal-filter brands Lark and Tareyton, which plugged their alleged efficacy in reducing “certain harsh gases” without ever disclosing the condition the charcoal was supposedly ameliorating, namely, the ciliatoxicity of smoke that damaged one of the bronchial system’s principal weapons of defense. Instead, typical ads read, “If you like the taste of gas, you’ll hate the taste of Lark,” and “If you could put Tareyton’s charcoal filter on your cigarette, you would have a better tasting cigarette.” Requiring a disclosure of tar and nicotine yields would serve at least as a partial antidote to this sort of pussyfooting on the health issue.