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8/14/2019 December 1957
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D e c e m b e r 1 9 5 7
THAt/wit i c
THE PUBLIC ANDSMOKINGFear or Calm Deliberation ?
BY CLARENCE COOK LITTLE
(Reprint ed by permission of The Atlanti c Monthly)
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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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