For thirty years or more the scandal sheets have printed articles on ╥The Tobacco Habit╙ as a mild variation on their standard high-voltage treatment of such shockers as prostitution, political graft, and the traffic in dope. Most of these pieces, furtively hinting at heart trouble and even tuberculosis, were about as medically convincing as the ╥Methodist╙ credo that smoking stunts the growth. The tobacco companies paid only sidelong heed to them, with bold hints that, on the contrary, a cigarette was a relaxant, a soothing syrup, and a social grace. The manufacturers were not much better than the Puritans in their respect for the known scientific facts about tobacco and have tended to meet every impromptu accusation with an equally flip defence. In the social history of our time, it may well be that the ╥Reader╒s Digest╙ will come to claim a decisive part in dating the fashion of cigarette smoking.
Although three separate reports were published here in 1949, suggesting a plausible relationship between smoking and cancer of the lung, they were folded away inside the pages of medical journals. But a year later the ╥Digest╙ ran an article with the resounding title ╥Cancer by the Carton.╙ This started a lot of talk in America and a noticeable adjustment of cigarette advertising to remind the customer that the tobacco companies keep a 24-hour laboratory watch on every chemical intruder that might possibly sully his breath, tickle his throat or otherwise impair his health and comfort. A few of the tobacco companies had in truth been financing quiet research, but it was concerned with heavier matters than a sore throat or an acrid taste. And, since Americans went on buying cigarettes by leaping billions, the manufacturers maintained their code of contemptuous silence, which is almost as rigid as the taboo of a Victorian dinner-table on the mention of the female leg. Two years later the ╥British Medical Journal╙ published a weightier study and it began to look as if the cigarette manufacturers would never be shut of the nuisance.
MICE AND TAR
Last November their long golden age ╤ twenty years of continuously soaring sales ╤ exploded in a bombshell prepared by Dr. Ernest Wynder of New York and Dr. Evarts Graham of St Louis. They reported that they had produced skin cancer in 44 per cent of the mice they had painted with tobacco tar condensed from cigarette smoke. This study was hardly as comprehensive as the British study of nearly fifteen hundred human lung-cancer patients, but it was piquant. It sprouted the joke that ╥It only goes to show: mice shouldn╒t smoke.╙ But the newspapers sat up and took notice, in their heartless disinterested way, when the Institute of Industrial Medicine of this city, an incomparable branch of the New York-Bellevue Medical Center, examined all the tumours reported in the Wynder-Graham study and declared them to be malignant.
Last December 9 the papers carried the report of two speeches made by Dr. Wynder and Dr. Ochner, Chief of Surgery at Tulane University School of Medicine, before a meeting of New York dentists.
Dr. Wynder quoted thirteen American and foreign studies, to conclude that ╥the prolonged and heavy use of cigarettes increases up to twenty times the risk of developing cancer of the lung.╙ Dr. Ochner was bolder still. He foresaw that the male population of the United States might be decimated within fifty years by this type of cancer if cigarette-smoking increases at its present rate. Within an hour of the opening of the Stock Exchange that day big blocks of tobacco-stocks were up for sale. One stock, which opened at 65 3/4, dropped to 62. Others lost between two and three points. By the first of this year the horrid truth was out that the sale of cigarettes in the first ten months of 1953 was off 2.1 per cent. It seems a negligible fraction in the face of the triumphant record that in the past twenty years cigarette sales have gone up from 100,000 millions to over 400,000 millions. But nothing gets to feel so normal as unrelieved luxury, and a desperate tobacco executive reflected that if every American smoker used ╥one cigarette less a day, our sales would drop by 5 per cent,╙ which is to say three million packs a day, or an annual loss of $255.5 millions.
The makers of filter-tip cigarettes made a virtue of adversity and came out celebrating the providential insight that had led them to manufacture a cigarette that ╥filtered out╙ all those menacing and by implication cancerous tars and fumes. Filtered cigarettes sold as many in 1953 as they had sold in the preceding seven years. The dignified silence of the tobacco companies was broken. At last some of them reluctantly confessed that for several years they had been subsidising cancer research. Their advertising took on an almost testy tone of reassurance, but it was a reassurance about their concern for the health of the smoker, an apparent psychological blunder in that it insisted on the very context of disease from which they were consciously praying to be set free. The advertisers defend this reflection on interesting grounds. They say that their studies over many decades have shown a deep-seated public guilt about smoking, which has nothing to do with medical findings and everything to do with an old Puritan tradition, and which can best be allayed by a bedside manner, carefully sustained through what is already known to the trade as ╥anxiety advertising.╙
Donation for Research
The way to restore their phlegm and their prestige might be obvious to an Englishman: to combine in a huge donation for cancer research. It is not as easy in this country as in Britain. Whenever two manufacturers of the same product think to strengthen their case by joining forces the shadow of the Sherman Act falls across their best intentions. The tobacco companies are still wincing from the bruises of a famous anti-trust suit of 1941, in which they were punished for an alleged conspiracy. However, they have appealed for help to the middlemen, the tobacco distributors, who have taken the risk of forming a Tobacco Industry Research Committee, to finance an independent study of lung cancer.
Meanwhile the medical profession is going ahead on its own. The Institute of Industrial Medicine means to break down tobacco tars into their component parts and hopes to discover which fraction caused the skin cancer in mice. This ambition is evidently so beset with chemical and biological problems that it has taken almost a year to build and set up the necessary equipment.
Standing apart from all the interested parties who would seek to prejudice the truth by arraying the doctors against the manufacturers, there is one odd and important figure, a man possessed of a Voltairean disdain. He is Dr Cuyler Hammond, the American Cancer Society╒s chief medical statistician. He has deep doubts about all the studies reported so far. He suspects that the interviewers of lung-cancer patients probably induce an emotional bias in their victims who will thereby be led to make suspicious confessionals of heavy smoking. He says that it is extremely difficult to find a control group with the matched characteristics, of age, social standing, occupational habits, and regional location, of any given sick group. He warns against the false premise which might be exposed to prove only that smokers produce earlier symptoms rather than more cancer. He suggests that even if there were no significant association between smoking and cancer in the general population, a telling one might be found in the hospital population. He is even sour about the claims of the filter-tipped cigarettes, remarking in his wry way that the carbon in tobacco smoke probably neutralises some toxic agents, and that if the filter removes those carbon particles ╥filter cigarettes would do more harm than good.╙
Dr Hammond is an ominous figure in this whole controversy because he happens to be conducting, on behalf of the American Cancer Society, the most exhaustive study yet attempted. He began in January 1952, composing a staff of interviewers who will study the life histories of 204,000 healthy white men between the ages of 50 and 69, who together form a statistical sample of the American white male population. Their smoking habits in particular are being punched up on the bewildering file cards of the International Business Machine company. Whenever a man dies his clinical history is recorded and any cancer history traced and studied. The study will not end until the whole two hundred thousand are dead, but Dr Hammond says he will have the first significant findings ready by the end of 1955. One leading cigarette company has already said that it will accept the results as unquestioned. What Sir Walter Raleigh began, Dr Cuyler Hammond may either end or set free for a new lease of life.
