december 1957

8/14/2019 December 1957

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D e c e m b e r 1 9 5 7

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THE PUBLIC ANDSMOKINGFear or Calm Deliberation ?

BY CLARENCE COOK LITTLE

(Reprint ed by permission of The Atlanti c Monthly)

8/14/2019 December 1957


THE PUBLIC ANDSMOKINGFear or Calm Deliberation ?

BY CLARENCE COOK LITTLEA biologist who graduated from Harvard in the famous class

of 1910, CLARENCE C . LiTrLE served as president of the

University of Maine and then of the University of Michigan

b e f o r e t a k i n g u p a l e a d i n g r o l e i n c a n c e r r e s e a r c h . H e i s p r e s -

e n t l y s c i e n t i f i c d i r e c t o r a n d c h a i r m a n o f t h e S c i e n t i f i c A d v i s o r y

Board to the Tobacco Industry Research Committee .

W A LL a g r e e , I a m s u r e , t h a t e x c e s s i n a n d

abuse of any human activity are undesirable and

should .be discouraged, whether it is the use of

alcohol or coffee or tobacco, or the function of

e a t i n g , o f e x e r c i s e o r i n a c t i v i t y , o f w o r k o r r e c r e a -

tion . For the vast majority, however, the tem-

p e r a t e e x p r e s s i o n o f m o s t o f t h e s e s a m e a c t i v i t i e s i s

a n e s s e n t i a l p a r t o f t o t a l h e a l t h a n d w e l l - b e i n g .

When any of these commonplace activities fall s

under suspicion as being a specific factor in the

causation of human disease , we can agree also

t h a t t h i s i s a m a t t e r f o r s e r i o u s c o n s i d e r a t i o n , b u t

we must be extremely cautious in evaluating the

basis for such suspicion and the extent of the

supposed risk involved, and in avoiding the crea-

tion of fear and panic .

This is especially tr ue today, when we are deal-

ing with ailments, such as cancer and heart dis-

ease, of people mostly in advanced age groups .

These do not, so far as our present knowledge goes,

f i t i n t o t h e c a t e g o r i e s o f t h e o l d - t i m e p a t h o l o g i s t s

- t h e y a r e n o t s p e c i f i c d i s e a s e s p r o d u c e d b y

specific causes with specific patterns of injury to

s p e c i f i c t i s s u e s .

It is now generally agreed that they are, at

least in part, diseases related in some way to

pr,ment-day st . * s s , , n t i t a c l e x.a eavimnox= aad `ammkw d' lpiic inft t hc pr di ie+o d dd aga TVe

worries of home, of business, of driving along

highways, of crowded living, the search for relaxa-

t i o n a n d , n o t t h e l e a s t , t h e f e a r s o f b e i n g s i c k o r o f

catastrophe have an untold effect upon the body

and, if sufficiently inten se, may certainly lead to

i l l n e s s , i f n o t c a u s e i t .

As to seeking specific causes of cancer, and also

heart disease, science is only now on the threshold

of what I hope will be great advances in develop-

ing better methods of testing the biologic activity

of many, many substances that we all use or a re

exposed to from day t o day and, more important,

of assigning to them their relati ve place in the

scale of risks we assume in our daily lives . For it

cannot be gainsaid that while there is an absolute-

ness about the hazards to li fe, there is no such

t h i n g a s a b s o l u t e s a f e t y f o r l i f e . The very things

that are essential or important to continued,

effective living may be harmful or even fatal under

conditions of misuse or abuse .

In the field of toba cco use and health, all con-

c e r n e d a d m i t t h e n e e d f o r m o r e k n o w l e d g e a n d

resea rch . Differences exist mainly over the evalua-

tion of our presen t knowledge, or lack of it, and

the direction and emphasis of future research .

T h e r e a r e s o m e w h o f e e l a n d p r o c l a i m t h a t

" b e y w a d r c a w n a b c cL a r u b t" d g a m w e e m i m e c a n -w: .r we ®r mw-e ar y~et UeL:. c i w 4 a u b6Li r c m u ~ t

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THE PUBLIC AND SMOKING

may cause cancer in man . They would concen-

trate their research on isolating, identifying, or

"removing" t hese substances even though no such

agent has been discovered experimenthlly .

Others believe, however, that the existence in

tobacco smoke of substances carcinogenic to t he

lungs of men has not been and cannot be proved

by statistical associations or by painting the skin

of mice of certain specific strains with highly

concentrated extracts of t obacco smoke . Theytherefore focus attention on development of more

exact and more direct methods of assaying t he

cancer-inducing powers of suspected substances .

In this direction may be found contributions not

only to the smoking question but also to the total

problem of bio-assay of other substances .

FEAR OR CALM DELIBERATION?Generally speaking, the public believes in dicta

from scientists or public health g roups . Doubt,

suspicion, fear, and mental tension can be created

and maintained by one type of presentation of a

situation. Balance, poise, a judicial attitude, and

calm deliberation can b e engendered by another .

For at least four years there have been repeated,

sensational, and fear-arousing st atements and

resultant headlines on the theoretical lethal nature

of tobacco smoke .

The repeated expression of t hese views, how-

ever, is no measure of their general acceptance by

all who are concerned with the problems involved .

For instance, the statistical evidence in support of

the cigarett e theory has not been accepted as

proof of generalized conclusions about smoking by

a number of distinguished statisticians, among

whom may be mentioned especially Dr . Joseph

Berkson, Section of Biometry and Medical Statis-

tics of the Mayo Foundation for Medical Educa-

tion and Research in Rochester, Minnesota .

There are certain unfeatured but f undamental

contradictions in different statistical papers from

which points of agreement have been selected for

presentation by advocates of the "cigarette guilt"

theory .

For example, t he implication of t he American

s c h o o l o f c i g a r e t t e t h e o r i s t s i s t h a t i n h a l a t i o n a n d ,

therefore, direct contact of smoke with lung tissue

is an important factor in the origin of lung cancer .

On the other hand, certain British investigators

state t hat it would appear that inhalation is a

"negligible" factor . If t his is the case, direct

contact is not an important element . In anyattempt to identify a suspected agent or agents,

these two possibilities are an unsolved complica-

tion and are evidence of incomplete knowledge .

T h e c l i n i c a l p a t h o l o g i c a l d a t a o f o n e A m e r i c a n

t . . m r o lE r S a K i R ' * 1 ' g:'wt4 R Mlrm h . i l e d 1 T y t i m ' W a m

medical director of t hat society as "the v ery

evidence skeptics demanded ." These same data

have not b een so evaluated b y a considerable

number of trained clinical pathologists not affil-

iated with t he American Cancer Society but

familiar with much more data of a similar nature .

The reports of inducing skin cancer on some

mice by smearing hig hly concentrated tobacco

smoke condensates have been countered not only

by similar experiments failing to result in cancer

but by universally negative carcinogenic results

reported by a number of investigat ors following

the inhalation of cigarette smoke or its injection

directly into the lungs of rodents .

Such contradictions in findings and interpreta-

tions could be continued at lengt h, and indeed

have been in many authoritative scientific publica-

tions, but these few are cited merely as evidence

t h a t t h e s t a t u s o f r e s e a r c h i n t o l u n g c a n c e r i n v o l v e s

many unresolved dif ferences in concepts about

possible causation and also about its relative

incidence and increased frequency .

In accepting and carrying out the responsibility

of developing a research program in tob acco

use and health for the Tobacco Industry Research

Committee, my colleagues on the Scientific Advi-

sory Board and I believe the cause of scientific

investigation is best served by adherence to our

stat ed position that definitive conclusions or

predictions of individual risks are unwarranted

by the present state of knowledge in this complex

f i e l d .

INDUSTRY ASSURES FREEDOM IN RESEARCHSome people question, as might b e expected,

w h e t h e r t h e t o b a c c o i n d u s t r y i s h o n e s t i n i t s e f f o r t s

to find the whole truth . The conditions under

which Tobacco Industry Research Committee

grant s are made guarantee complete freedom,

unhampered conduct of research, and uncensored

publication of any and all results .

The tobacco industry was and is aware of the

seriousness of t he implications in the charges

against smoking. The industry intends to support

research until these charges can be proved or

disproved by direct experimental evidence . Even

cynics will admit that the industry cannot afford

as a practical business matter to offer products

which have been so definitely att acked without

making every effort t o find out the whole truth

and, if and when any substance is identified and is

shown to be harmful, to do its best to eliminate

i t . The industry is aiding research for scientific

facts and will continue to do so . But it need

not accept as final opinions based on incomplete

evidence t . ba . t i s c h a l l e n g e d b y c a t l a e ~ s . Nor dces it

fed aWr *a "reonaewe" W . r m i i ~ p r w i r c t r s r i .tamenm

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T h e A t l a n t i c M o n t h l y

the nature, presence, and existence of which are

generally admitted to be unknown .

In these circumstances, the industry chose a

course that is unusual, if not unique, for business-

supported research . Scientists were given full

responsibility for determining what research is

n e e d e d a n d w h o s h o u l d d o i t . The Scientific

Advisory Board, of which I am chairman, ha s

complete freedom in allocating the research

monies, now amounting to some $2 . 2 m i l l i o n , t o

investigators in leading U . S . research, medical,

and educational institutions . The board considers

p r o p o s a l s f o r p r o j e c t s o n t h e i r s c i e n t i f i c m e r i t s a n d

the prospects of constructive findings . The board

may also initiate research ideas and then seek out

qualified scientists to develop and conduct the

n e e d e d l i n e s o f i n v e s t i g a t i o n .

It is important for the public to remember that

the members of the Scientific Advisory Board, in

their approach to this research responsibility, take

the position that smoking has not been proved

guilty or guiltless in matters affecting human

health . T h e i r a t t i t u d e i s t h a t s t a t i s t i c a l a n d i n d i -

r e c t e v i d e n c e d o e s n o t p r o v e i t s g u i l t a s a c a u s a t i v e

agent . The open question of its innocence or its

guilt can best be answered through unhampered

r e s e a r c h f o r t h e f u l l f a c t s .

THE RIGHT TO LEARN AND TO INFORMThe board members do not deny the right of

any individual to state his belief in the guilt of

smoking . Along with many independent rese arch

scientists, they do and will as scientists insist on

maintaining their right to their own criteria for

judgment and for the opportunity to inform the

public concerning the reasons for their position .

They will do this until they possess evidence

which they consider meaningful and conclusive

on each and every research step . They will do

this in spite of expensive and extensive pressure

propaganda, and in spite of personal misinterpre-

tations and attacks .

These statements of honest doubt, shared by

many scientists, do not constitute a"contro-

versy," and those who feel as does the Scientifi c

Advisory Board will not be driven into admitting

i t t o b e s u c h .

There has been no organized effort or campaign

to claim that tobacco has been proved innoce nt,

because those who, like the Scientific Advisory

Board, desire a full and co mplete analysis of its

e f f e c t s a r e s t i l l i n s e a r c h o f t h e a n s w e r s . Similarly,

t h e r e h a s b e e n l i t t l e w i d e l y p u b l i c i z e d pr e s e n t a t i o n

of negative evidence relating to tobacco use, such

as there has been of reports by those who are

already convinced that they have found proof of

i t s g u i l t . T h i s i s n o t s u r p r i s i n g , f o r i t i s s a t i s f y i n g

to proclaim you have surrounded the enemy and

that mopping up activities are all that is needed .

B u t t o s t a t e t h a t s t r o n g e n e m y f o r c e s a r e s t i l l u n d e -

tected and that a long hard campaign lies ahead

is irritating to the generals who a re claiming the

victory .

It seems, however, to those who will have some

responsibility for the continued campaign, that

the public - the troops on the firing line -

deserve to be told what the whole evidence is and

of the likelihood that the battle is not won a nd

then be allowed to decide for themselves what the

dangers, real or i maginary, may be .

About fifteen years ago there were headlines

and a propaganda flurry based on statistical

evidence that direct exposure to su nlight was a

causative factor in skin cancer . This point of

view, which was widely accepted, received sup-

port from experiments showing skin cancer on

the ears of rodents following exposure to ultra-

violet light, a component of sunlight . In spite of

t h i s , n o o n e a s k e d fo r l e g i s l a t i o n t o b r i n g ba c k t h e

bathing regalia of the gay nineties, and no one

attempted to educate children not to visit beaches

or to wear sun suits, nor were farmers and sailors

urged to carry umbrellas .

From the first charges tha t tobacco might be a

causative factor in lung cancer and cardiovascular

disease, the re have been repeated efforts by someardent laymen and some already convincedscientists to activate debate and controversy with

those who desire further information before they

feel ready to take the trip to Canossa .

It may be that some day - perhaps soon, per-

haps years from now - we shall know what part

or parts various f actors play in the etiology of

lung cancer in man . When we do, tobacco use

may or may not prove to be one of them .

Today, while we are making real progress in

lifting the cancer curtain, we should not be misled

into thinking that one glimpse behind a raised

corner of this curtain reveals to us all the knowl-

edge that remains to be unearthed .

The public has been heavily propagandized

along one definite theory of causation by those

convinced by one level of information . Some of us

demand a different order and level of knowledge

before we accept causation or condone presenta-

t i o n o f c o n c l u s i o n s t o t h e p u b l i c . We claim merely

the right to pursue knowledge through scientific

research, the right to hold our point of view, and

the right of the public to be aware of it .

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december 1957

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