Before 1953 (health issues)
This is a timeline to expose what was known about the relationship between cigarette smoking, lung cancer and heart disease before the critical year 1953 when the scientific evidence of the connection spilled out into the popular media and became public knowledge.
The value of this timeline is in understanding the inertia of the public health regulatory process. The attitudes held by most people in the 1930s was quite different to the attitudes n the 1940s when the world was at war. These, again, were quite different to the attitudes in the 1950s when the good times had begun to roll in the USA, and hedonism was the dominant youth culture.
It is also valuable in appreciating how much medical knowledge was available to the tobacco companies if they had wanted to look.
1759: In this year John Hill described an association between the heavy use of snuff and oral cancers. This appears to be the first scientific indication that tobacco can cause cancer.
1761: An English physician noted several cases of cancer of the nose which he attributed to snuff use. (possibly John Hill again)
1819: Lung cancer was first described by French physician Laennec in his classic book on disease of the chest (translated into English soon after).
1849: A Boston surgeon who had made a 20 year survey of his patients with cancer of the mouth found that most were tobacco users (chewers) and that the cancer typically occured on the side of the mouth where the quid of tobacco was held.
1857 March:: Lancet magazine (the magazine for English physicians) discussed the smoker's lungs and heart:
"On the respiratory organs, [tobacco] acts by causing consumption, haemoptysis, and inflammatory condition of the mucous membrane of the larynx, trachea, and bronchia; ulceration of the larynx; short irritable cough; hurried breathing. The circulatory organs are affected by irritable heart circulation."
1859: A French study of 68 oral cancer patients found that 66 were smokers and one chewed tobacco, and that the cancer usually occured at the spot where the pipe or cigar was held.
1881: James Buchanan (Buck) Duke who established the American Tobacco Co trust, introduced the first pre-packaged (hand-rolled) cigarettes.
1884 Apr 30: The first modern machine-rolled cigarettes came off the line of W Duke and Sons North Carolina factory. This was the Bonsack cigarette rolling machine which revolutionised the industry.
1886: A headline from the Annapolis Evening Capital included an early use of the slang term "coffin nails". The headline talks about "The coffin nails of our youth." This is said to show that the term "coffin nails" was commonly used for cigarettes in 1886. [This is a dubious claim. People often talk about all types of events in life (ie birthdays, marriages) as "hammering another nail in your coffin".]
1890: Before the turn of the century lung cancer was virtually unknown in the USA. [By 1945 there were about 4000 deaths a year.]
However in many US States smoking cheap cigarettes (as distinct from pipes and cigars) was considered a crude and unhealthy habit, and tobacco chewing was increasingly being seen as quite obnoxious.
The emerging anti-tobacco movement destroyed many of the smaller tobacco companies, while the others consolidate into large corporations selling roll-your-own, pipe and chewing tobacco. Specialty hand-rolled cigarettes were given a kick with marihuana and other additives. By 1890:
- Washington, Iowa, Tennessee and North Dakota had outlawed the sale of cigarettes and the US Supreme Court had upheld Tennessee's ban on cigarette sales. One Justice, repeating a popular notion of the day, said of cigarettes, "there are many whose tobacco has been mixed with opium or some other drug, and whose wrapper has been saturated in a solution of arsenic."
- The inventor Thomas A Edison, also maintained that cigarette papers released toxic substances when burned [He is a rabid anti-smoker],
- RJ Reynolds, one of the last to hold out, now joined Buck Duke's tobacco trust.
4.4 billion cigarettes are sold this year and the trust held 90% of the US market.
- In 1991 Duke adds most of the remaining American companies and makes a raid on the British tobacco industry. Imperial Tobacco (a UK tobacco trust) is formed in England to counter Duke's US trust. Later, a territorial deal is made between the two trusts.
1900: In this year a researcher named Brosch (or Broach), painted guinea pigs with 'tobacco juice' and declared that he had produced skin tumors.
1902: The Sears, Roebuck catalogue is now promoting a "Sure Cure for the Tobacco Habit" using the slogan "Tobacco to the Dogs". They claim that their product "will destroy the effects of nicotine".
1903 Aug:: Harpers Weekly carries an editorial on tobacco addiction saying,
"A great many thoughtful and intelligent men who smoke don't know if it does them good or harm. They notice bad effects when they smoke too much. They know that having once acquired the habit, it bothers them  to have their allowance of tobacco cut off."
1904: In New York CIty a woman is arrested for smoking a cigarette in an automobile. "You can't do that on Fifth Avenue," the arresting officer says.
1907: President Theodore Roosevelt's Justice Department files anti-trust charges against American Tobacco. The tobacco trust is finally broken up by US Supreme Court on 29 May 1911: by this time it had 240 subsidiaries. A half-dozen separate companies are formed: RJ Reynolds is re-established; American Tobacco is now only the rump of the trust (but still the most powerful).
British-American Tobacco was not subject to the break-up. It now held 85% of the old British Empire market — so Buck Duke moved to the UK in 1913 and took over BAT. Outside the United States, British-American Tobacco becomes the most powerful of all the global tobacco companies.
Tobacco is now so obviously highly profitable that many national-states decide to take over their local industry and run it as a nationalised monopoly.
1907 Aug: 8: Some business owners are now refusing to hire smokers: the New York Times writes: "Business ... is doing what all the anti-cigarette specialists could not do."
1909: Fifteen American states have passed legislation banning the sale of cigarettes.
1910: The New York Times editorial praises the Non Smokers Protective League (led by Dr. Charles Pease), saying that anything done to allay "the general and indiscriminate use of tobacco in public places, hotels, restaurants, and railroad cars, will receive the approval of everybody whose approval is worth having."
1912: Dr I Adler is the first to suggest that lung cancer is related to smoking in a medical monograph.
1914–18: Soldiers in the Great War are encouraged to smoke to calm their nerves. General John J. Pershing writes:
" You ask me what we need to win this war. I answer tobacco, as much as bullets. Tobacco is as indispensable as the daily ration; we must have thousands of tons without delay." An entire generation returned from the war with a nicotine addiction.
1919: Alton Ochsner, a Washington University medical student, is allowed to observe lung-cancer surgery. He is told this is a condition that he may never see again ... and he doesn't see another case for 17 years, but then he sees eight cases in six months — all smokers who had picked up the habit in World War I.
1919: Anti-smoking activism is growing. Alcohol prohibition is seen as a precusor to tobacco prohibition among many activists,
1920 June 11:: The Republican nominating convention had become deadlocked, and Ohio's top Republican political organisers and funders (aka the "Ohio Gang") engaged in some extraordinary deal-making and political machinations to force the selection of their 'dark horse' candidate.
This night they met in Suite 408-10 of Blackstone's Hotel in Chicago, and after many hours managed to engineer the presidential nomination of newspaper magnate, Warren G Harding as the 29th President of the USA.
The nomination led eventually to the "Tea-Pot Dome" and other scandals, and the dubious nature of the deals were subsequent emphasised by reports of "meetings in smoke-filled rooms" ... which, thereafter, became the cliche (used appropriately) to suggest corporate-political corruption.
1922: RJ Reynolds, now the leading tobacco company, was now spending $8 million pa on advertising, mostly for their Camel cigarettes, which now held 45% of US cigarette market, The popular media has come to depend in tobacco advertising.
Atlantic Magazine used its own editorial space to defend tobacco advertising revenues; an article in the magazine "Is There a Cigarette War Coming?" says that,
"scientific truth [has found] that the claims of those who inveigh against tobacco are wholy without foundation [and this] has been proved time and again by famous chemists, physicians, toxicologists, physiologists, and experts of every nation and clime."
1923 Jun 11: Dr EJ Farr published a report which claimed that "the increase of deaths by lung cancer in direct relationship to the increasing consumption of cigarettes."
1923: A later history of scientific research into S&H cryptically notes that " Negative animal results were reported by Leitch." This is only the first of a dozen-or-so mouse-inhallation experiments conducted over the next few years which produced no respiratory cancers. We now know (and the tobacco industry knew by the 1950s), that rodents were particularly resistant to respiratory cancers — especially with their very short life-spans.
1925 Jun 11:: American Mercury magazine claims that
"A dispassionate review of the [scientific] findings compels the conclusion that the cigarette is tobacco in its mildest form, and that tobacco, used moderately by people in normal health, does not appreciably impair either the mental efficiency or the physical condition." This is the flapper era when women begin to smoke and image-advertising begins; cigarettes = sophistication. Smoking initiation rates among adolescent females triple between [1925-1935.]
1927: Frank Saunders, Corporate Relations and Communications at Philip Morris, in his review: "The War on Tobacco in Historical Perspective" (in 1977) says that the industry's first great battle was won in 1927"
1928: A "large field study" (unspecified — probably the combined Massachusetts Department of Public Health & Harvard School of Public Health study) associated smoking with cancer. The tobacco companies later claimed vaguely that this was "... the first public suspicion of the link between cigarettes and lung cancer."
Lombard and Doering examined 217 Massachusetts cancer victims. They compared age, gender, economic status, diet, smoking and drinking. Their New England Journal of Medicine report found overall cancer rates only slightly less for nonsmokers. However it did find 34 of 35 site-specific (lung, lips, cheek, jaw) cancer sufferers were heavy smokers.
<19280000> 1928 " Negative animal results were reported by Helwig." (Inhalation study using rodents)
1930: Beginning of the Depression: The top selling cigareetes were:
Lucky Strike Regulars = 43.2 billion pa;
Camel = 35.3 billion;
Chesterfield Regulars = 26.4 billion;
Old Gold Regulars = 8.5 billion;
Raleigh 85s = 0.2 billion.
There are now 2,357 cases of lung cancer reported in the US each year and the lung cancer death rate in white males is 3.8 per 100,000.
Federal tax revenues from tobacco products are over $500 million 80% of which comes from cigarette sales.
1930: A German public health researcher in Cologne identify a statistical correlation between cancer and smoking, and a German doctor suggests tobacco use might be one of the causes of lung cancer.
1930: "Negative animal results were reported by Hertens" (Probably an inhalation study using rodents)
1931: Frederich L Hoffman, a top statistician working for Prudential Insurance Co , linked smoking with cancer. He had previously reported that there was no link.
1931: The cigarette brand "Parliament" features the first commercial filter tip: a wad of cotton, which had been soaked in caustic soda.
1932: "Negative animal results were reported by McNally and Cooper." (Probably inhalation studies using rodents)
1933: Dr Everts Graham became the first surgeon to actually remove an entire lung (lobe) from a lung-cancer patient — the first 'successful treatment' of this disease. He later co-authored with Ernst Wynder the first true academic study in America linking lung-cancer and cigarettes.
1933: The Agricultural Adjustment Act institutes price supports and saves tobacco farmers from ruin during the Depression, and the following year the US Garrison Act is passed outlawing marijuana and other addictive drugs. But tobacco is not considered for prohibition.
1934: However addiction becomes a factor in smoking and health for the first time. An Australian author, Victor Stanton claimed that nicotine was "a habit-forming drug [which] sets up a craving for itself [and becomes] very difficult to discontinue."
1935: "Negative animal results were reported by Schurch." (Inhalation study using rodents)
1935–36: : The American chest surgeons, Alton Oschner and Richard Overhold , published their observations that the patients they saw with advanced lung cancer were predominaently smokers. Oschner begins his life-long crusade against smoking.
1936: "Negative animal results were reported by Campbell." (Probably an inhalation study using rodents)
1936: The AMA published an article in JAMA strongly implicating cigarettes in lung cancer. However the administrators of the AMA refused to take a stance against cigarettes.
1936: Brown & Williamson introduces Viceroy, the first serious brand to feature a filter of cellulose acetate which it claimed removed half the particles in smoke. This is the real beginning of the "tar derby" — and attempts to make a 'safer cigarette'. The industry concern at this time is mainly with throat irritation and coughing by smokers.
1936: American Tobacco begins funding physiological research on the components of tobacco smoke at the Medical College of Virginia. According to their own report, this was
"part of the interest of the Company in the broad field of smoking & health research [but] none of the research has directly involved smoking and lung-cancer."
1937: Dr AN Roffo, a Germany cancer specialist working in Buenos Aires reported that he had produce tumour by painting tar-like products on the backs of rabbits.. He reported that he had found that the painted tars contained
"a violent cancer-provoking agent (3:3benz(a)prene) in tobacco. I use tobacco residues — those which make the smoker cough and stain his fingers — to produce cancer in laboratory animals" [The cigarette companies later said they discounted these findings because Roffo destructively distilled his tars]
1937: The US Federal Government established the National Cancer Institute at Bethesda, MD. By this time doctors worldwide were discussing three common and related discoveries.
- that pipe smokers were getting oral cancer at alarming rates
- that lung cancer rates for men were skyrocketing (few women smoked)
- over 90% of men with lung cancer were chronic smokers.
1938: The population biologist and biometrician, Raymond Pearl, working at Johns Hopkins University, show that there was statistical robust evidence that smokers have shorter lives. Non-smokers live about seven years longer, on average. This information was published in the popular journal 'Science'.
The medical profession (if not the AMA) was now becoming aware of the causal links between cigarettes and lung-cancer.
1939 (c): Germany carried out the first of a world-wide series of epidemiological studies of patients with lung-cancer. This showed that there were more smokers among cancer victims than other hospital patients or healthy individuals.
This is now credited as being the first of the so-called retrospective studies (after a patient has disease — looking back for possible causes) which associated the disease with smoking.
1939: A report, "Tobacco Misuse and Lung Carcinoma" by Franz Hermann Muller of the University of Cologne's Pathological Institute found an extremely strong dose-effect relationship between smoking and lung cancer.
Nazi Chancellor Adolph Hitler is a fanatical anti-smoker, so smoking is banned among the Hitler Youth. Hermann Goring issues a decree forbidding the military to smoke on the streets, on marches, and on brief off-duty periods.
1939: In the USA, however, Fortune magazine found that 53% of all adult American males still smoked, and that 66% of males under the age of forty smoked.
1939 Mar 11:: JAMA publishes "The Effect of Smoking on the Alimentary Tract" by Dr KG Schuedorf and Dr AC Ivy.
1939–45: : WORLD WAR II As part of the war effort, Roosevelt made tobacco a protected crop.
War was good for the tobacco industry, but tobacco eventually killed more soldiers than bullets..
- General Douglas McArthur made the corncob pipe his trademark.
- Cigarettes were included in every GI's C-Rations.
- Tobacco companies sent millions of free cigarettes to GI's (mostly the popular brands);
- In the American psyche, short-termism replaces life-time concerns about maintaining human health
- Tobacco consumption was so fierce during the war that a shortage develops.
- By the end of the war cigarette sales are at an all-time high.
1940: "Negative animal results were reported by Suguirm." (Probably an inhalation study using rodents)
1940 Apr 15:: Carl Voegtlin, the head of NCI wrote to American Tobacco Co. saying:
"There have been suggestions that tobacco smoking may play a part in the production of cancer of the lung. Positive as well as negative results, so far, have been reported, and the whole question needs unbiased investigation. This Institute is planning to perform some preliminary experiments with mice." He suggested that a biophysicist, Dr Egon Lorenz of NCI, might visit the ATCO Research Labs to get advice on the producion of tobacco smoke for inhalation tests with animals. [Later, Lorenz's negative results appeared in Cancer Research (1943)]
1940: The Mayo Clinic conducts a retrospective study that links smoking with heart disease.
1940: In this year 7,121 cases of lung cancer are reported in the US and the adult per capita consumption by Americans has reached 2,558 cigarettes — nearly twice the rate of 1930. Most large-run magazines and many newspapers now rely on cigarette advertising and many refuse to run anti-smoking articles.
1941: Isaac Berenblum carried out a classic experiment which established that the development of cancer was a multi-step process. Induction of cancer in the skin of an animal required an initiation phase with one chemical, and then promotion phase by applying a second chemical at a later time. Exactly how a cell becomes malignant was only understood with the discovery a decade or so later of oncogenes, tumor suppressor genes, and other regulatory genes involved in cell proliferation.
<19400000> 1940 1941: Reader's Digest publishes an article "Nicotine Knockout." Dr. Michael DeBakey cites a correlation between the increased sale of tobacco and the increasing prevalence of lung cancer. The article has no effect.
1941: Hitler's Germany laid down rules regarding tobacco advertising. The vaalue of image-advertising was well understood at this stime:
"Images that create the impression that smoking is a sign of masculinity are banned, as are images depicting men engaged in activities attractive to youthful males (athletes or pilots, for example). Advertisements were banned from films, billboards, posters and "the text sections of journals and newspapers."
[Advertising] may not be directed at sportsmen or automobile drivers, [while] advocates of tobacco abstinence or temperance must not be mocked."
1941 Apr:: Cancer Research publishes "The Production of Tumors by Tobacco Tars" by Dr. Curtis Flory.
1942: British researcher LM Johnston successfully substituted nicotine injections for smoking — thereby establishing the addictive nature of nicotine. In his report published in the British medical journal Lancet, Johnston discussed aspects of addiction, including tolerance, craving and withdrawal symptoms. He concluded:
Clearly the essence of tobacco smoking is the tobacco and not the smoking. Satisfaction can be obtained from chewing it, from snuff taking, and from the administration of nicotine.
1943 Aug:: Dr Lorenz at the NCI wrote to Hanmer at American Tobacco seeking further help. He had failed to generate cancer with his rodent inhalation study.
He now proposed testing subcutaneous and intravenous injections of tobacco tar in mice, but he assured the tobacco company that he "expected them to be negative,. I undertake them only to settle the problem of carcinogenity of tobacco tar once and for all from every possible angle."
1944: Dr Clarence Cook Little, the Managing Director of the incipient American Cancer Society, warned against smoking. Later he became the tobacco industry's chief scientific lobbyist and science corrupter.
1944 July 15:: JAMA publishes "The Effect of Smoking Cigarettes" by Grace Roth PhD.
1945: The Federal Trade Commission issued the first of seven Cease and Desist Orders (in the next decade and a half) prohibiting various false claims in cigarette advertising.
1946: American Tobacco's Research Laboratory has "smoked" a colony of rats for their entire life span (about 2 years) The "smoked" rats lived longer than the controls and gained less weight. No other differences between the experimental animals and controls ware noted. [Rodents are particularly resistant to respiratory cancers, especially over such a short exposure period.]
1946: "Negative animal results were reported by Haag." (Probably an inhalation study using rodents)
1946: A letter from a Lorillard chemist to its manufacturing committee states: "Certain scientists and medical authorities have claimed for many years that the use of tobacco contributes to cancer development in susceptible people. Just enough evidence has been presented to justify the possibility of such a presumption." (Maryland "Medicaid" Lawsuit 5/1/96)
1946 May 18:: JAMA publishes " Smoking and Arteriosclerosos" by Dr Leonard Weinroth.
1946 Aug:: The tobacco industry says that the Readers Digest article, "Cigarettes Cause Cancer?" written by Leonard Engel was "based on the already discredited work of Roffo."
1946 Aug 24:: In support of the tobacco industry, the Science News Letter published a counter-article to the Readers Digest entitled "Tobacco Not Believed to Cause Cancer" which stated that, in preparation of the article,
"authorities at the NCI were consulted. They advised that there is no experimental or clinical evidence which would indicate that tobacco smoke is a factor in the cause of cancer.
There is some clinical evidence, meaning from studies of men not mice, that tobacco tar may be a cause of cancer, but it is not very conclusive."
1947: The song "Smoke! Smoke! Smoke! (That Cigarette)," Written by Merle Travis for Tex Williams, is national hit. The lyric "Puff, Puff, Puff, And if you smoke yourself to death ..." is later used by the defense in the Cipollone law-suit when the tobacco companies claimed that Rose Cipollone, and almost every adult, already knew that cigarettes were dangerous.
1947 July: The American Heart Journal published a report on "Tobacco Angina" by Bryant and Wood.
1947 Oct 18:: JAMA published "The Effect of Smoking Cigarettes on the Heart" by Dr Robert L Levy
1947–48: : About this time surgeon/scientist/statistician, E Cuyler Hammond (a 4-pack-a-day smoker) began a nationwide smoking survey for the American Cancer Society (ACS). This is an enormously ambitious five year survey of 200,000 people, conducted by 22,000 experts/members of the Society.
Hammond was the immediate past-President of the American Association for Thoracic Surgery and the then-current President of the ACS.
1948 (c): In Norway, deaths from heart disease halved during World War II when cigarettes were almost unobtainable during the German occupation. Immediately after the war, when Norwegians began to smoke again, heart disease deaths began to increase again. Tobacco's cancer-promotion effect takes many years, but its influence on coronary heart disease (CHD) is almost immediate.
1948: In the decade since the war (c 1938) lung cancer had grown 5 times faster than other cancers. It is now just behind stomach cancer as the most common form of cancer.
However, the Journal of the American Medical Association argues,
"more can be said in behalf of smoking as a form of escape from tension than against it . . . there does not seem to be any preponderance of evidence that would indicate the abolition of the use of tobacco as a substance contrary to the public health." In this same year the environmental begins to emerge as an important health issue
In the fall of 1948, a deadly smog settled over the small steel mill town of Donora, Pa., in the Monongahela River valley. Before winds swept away the acrid air inversion, 19 people died and thousands became ill. The legacy of Donora is the Clean Air Act administered by EPA.
1948 Jan:: In the UK an unknown medical doctor named Richard Doll began working with the famous statistician Bradford Hill at the government-supported Medical Research Center (on a 3-day per week basis). Hill is the promoter of randomise controlled trials (often considered unethical by doctors because it involved the withholding of treatment that 'may' be effective).
Government statistician had drawn the MRC's attention to the huge recent increase in lung-cancer deaths (mainly with men), but it was generally thought that this was the result of coal-fires, motor-car pollution and various other environmental factors associated with the recent war.
<19490100> 1949 At an AMA convention with an audience of 1,500 doctors Hammond announced the preliminary findings of the official ACS cancer investigation into smoking and health. He said:
"We have no right to wait for the end of this investigation. Too many lives are in danger. Of 32,381 non-smokers observed, only four lung cancers were reported, while among the 100,000 smokers ... we already have a total of 265." They also discovered (unexpectedly) a 68% greater incidence in the risk of Coronary Heart Disease. The full final report came out in 1951.
"When I started this investigation, I smoked three packs of cigarettes a day. I stopped the moment I learned of the first results. Nothing, nothing in the world could make me start again." he said
1949: Morton Levin, director of Cancer Control for the New York State Department of Health (and two associates) begin an epidemiological survey of Buffalo patients between 1938 and 1950. Their report appeared in JAMA May 1950. The conclusions were that smokers were statistically twice as likely to develop lung cancer as non-smokers.
1949: Ernst Wynder, then a medical student working under thoracic surgeon Dr Everts Graham at Washington University began collected statistical evidence (initially from Graham's files - later from other sources) which showed that, of 200 lung cancer victims, 95.5% were men with long histories of cigarette smoking. Eventually Wynder built this database up to 684 cases.
1949: Hill and Doll in the UK report to the head of the Medical Research Council that their study of London hospital patients had shown ‘cigarette smoking is a cause, and an important cause, of carcinoma of the bronchus’. They were sent off to study lung-cancer patients in other British cities to ensure the link wasn't with London's pollution problem.
1949: At a New York FTC inquiry, Dr Alvan Barach, an early 'independent' medico-witness employed by the tobacco companies, says "I don't believe cigarette smoking produces any damage with respect to the lungs; I don't believe so-called cigarette cough is a reality."
1949 Oct 16:: JAMA publishes "Tobacao.and Coronary Disease" by MD John P English. This is the first substantial link to CHD as distinct from lung-cancer.
1950 Jan:: Reader's Digest publishes an influential article by Roger William Riis "How Harmful are Cigarettes". It notes that
The article also questions the action of nicotine on the heart and nervous system; identifies Buerger's disease (which sometimes required amputation) with smoking [100% of those with the disease are heavy smokers].
- 60 million Americans are consuming 400 billion cigarettes each year.
- two in every three men; two in every five women; and one in seven boys aged 14 now smoke.
- Nicotine has been detected in mother's milk.
- Pregnant women are advised not to smoke.
It also quotes the ACS as promoting a new study by Graham and Wynder comparing New York citizens with the Mormons of Salt Lake City (who don't smoke) as a way of answering the question on causality. Alton Ochner is now running anti-smoking clinics in New Orleans, and anti-smoking scientists like Everts Graham, Ernst Wynder and Pearl are quoted extensively in the article.
1950 Jan:: The Journal of the American Medical Association (JAMA) reports on four retrospective studies which have linked smoking to lung cancer. However the cigarette companies "didn't take them seriously" (so they said). They did, however, refer them to some friendly scientists for further review.
<19500200> 1950 Feb American Tobacco sent the four JAMA articles to Dr WE Colwell, Dept of Agronomy, North Carolina State College of Agriculture and Enginering at Raleigh, asking for comments. The College's statistician, Prof Robert J Monroe, prepared a confidential commentary (See Dec 13 1950).
<19500203> 1950 Feb 3: The US "News & World Report" carries an article about Lorenz's mouse inhallation study at the National Cancer Institute (NCI) . In addition to the absence of inhalation cancers, it also reported that he found no positive results from skin-painting or by subcutaneous injection of tars. It was entirely reassuring.
1950: The American Cancer Society (ACS) made a public statement that it had "an open mind" on the smoking and health question.
1950 May 27: The Journal of the American Medical Association. published two highly influential scientific reports in the same issue:
- Morton Levin, Hyram Goldstein and Paul Gebhart — their first major study definitively linking the use of tobacco products to various forms of cancer.
- The Graham-Wynder retrospective study: "Tobacco Smoking as a possible Etiological Factor in Bronchogenic Carcinoma: A Study of 684 Proved Cases". This showed that 94.1% of the patients with lung cancer were smokers, and 96.5% were moderate-to-heavy smokers.
1950 Sep 30:: The Doll-Hill study "Smoking and Carcinoma of the Lung" is published in the British Medical Journal. They reported that heavy smokers were fifty times as likely as nonsmokers to contract lung cancer.This was a far more troublesome, and much more scientificallu robust study than the Graham-Wynder finding. It involved many more cases, and it was extended from London to other UK cities to examine possible differences in environment and climate. However, Britain was still more concerned with rebuilding after the war, and with the problem of city pollution.
<19500100> 1950 Jan
From this time on, scientific opinion is very substantially against the tobacco industry.
1950 Dec 13: Statistician Prof Robert J Monroe of the North Carolina State College prepared a confidential commentary on the February JAMA articles for the tobacco industry. He points to their best line of defence it to take a purist position, as if the statistical evidence stood in isolation:
"All articles seem to be the results of substituting the idea 'cause and effect' in place of 'association.' [he wrote] Such correlation or association can never be take as proof of a 'cause and effect' relationship per se without considerable more evidence than is presented in these instances. It might well be argued from these data that people with lung cancer or predisposition thereto tend to smoke more." He was also critical of the claimed time-trend (lack of statistical significance) ... but the industry saw "no point in repeating this work."
This set the pattern of the cigarette industry's defence of "correlation does not equal causation" which served them well for many decades.
1951: Dr Alton Ochsner et al published "A review of Experiences with 1,458 Cases of Bronchogenic Carcinoma." He declared "I am firmly convinced of the relationship between smoking and lung cancer. Men who have been heavy smokers should have routine chest X-rays at least every six months."
1951: Richard Doll, now working with statistician Julian Peto begin a prospective study of smoking and health among British doctors. They reported first on this study in 1954, and again in 1956, and the study continued for another 50 years (until 2004). http://www.bmj.com/cgi/content/full/328/7455/1519
1951: The final Hammond 20-page report (done for the ACS) was released at the 7th International Cancer Congress in London. (a meeting of the largest group of doctors and scientists in the world) Hammond says:
"We are now certain that smoking shortens life, and that there is a certain causal relationship between the use of tobacco and a specific group of disease, including cancer and coronary thrombosis..."
1951 April: Ernst Wynder, now working through the Sloan-Kettering Institute in New York (but still under Everts Graham) in association with New York University (and some funding from the Damon Runyon Memorial Fund and American Cancer Society) began a 18 month trial with skin-painting cigarette tar fractions onto the shaved backs of mice.
1951 Nov: Duke University (which had been founded and funded by tobacco trust boss Buck Duke), was given $50,000 pa for five years to conduct research into lung-cancer. After a year of negotiations Duke University had been chosen because the tobacco industry considered it
"... most desirable for the research to be pursued at some institution already possessing some knowledge of tobacco and a record of research on tobacco." Newsman Walter Winchell and the American Cancer Society were also involved in the administration of the funds. The money was channeled from American Tobacco through the Damon Runyon Memorial Fund on a "no publicity, no embarassment" deal. An industry report said that the university was to maintain that this was only a study on "air-pollution" and the research was limited to chemical and physical properties in order to
"... remove any fear of linking Duke University or the tobacco industry with cancer or any possible damaging effects of tobacco on health."
"They are almost as desirous as we are in getting the spotlight off tobacco."
1952: A followup by Doll and Hill of their 1950 study, published in the British Medical Journal, confirms and strengthens the already-robust findings. This was the prospective study of 40,000 English doctors. During the two and a half year period from the initial interviews, 789 of the doctors died. Thirty-five of them died of lung cancer and all 35 were smokers.
1952 June: At the American Medical Association convention in San Francisco. Dr E. Cuyler Hammond and Dr Daniel Horn reported preliminary findings of their prospective study of the effects of smoking on lung cancer, cancer in general, and on heart disease. The study dealt with the smoking habits of 187,766 men between
the ages of 50 and 70. This was the ACS study which began in January 1952. It was a bombshell.
1952 Nov 17: At a St Louis meeting of National Academy of Sciences. Wynder makes an announcement that he and everts Graham had, through skin-painting, established that eondensed cigarette tar was a definite carcinogen for mouse epidermis.
"About 22% of the mice painted with tobacco tar developed cancer of the skin and about 50% of the mice still alive at 18 months have developed skin carcinomas" American Tobacco complained that the Damon Runyon Trust was "not controlling either the course of the experiments or the publication of results."
Wynder claimed that cigarette tar applied to the back of mice in a dosage of 40 mg of tar (in acetone) three times a week induced cutaneous cancer in about 44 % of 81 mice. The average time of appearance of the carcinomas was 71 weeks. [No one has ever matched this cancer promotion-rate since! It may have been exaggerated by Wynder's selection of solvents.]
1952 Dec: The Reader's Digest republishes Roy Norr's "Cancer by the Carton" article from the "Norr Newsletter about Smoking and Health" This is the first mass-media public presentation of the evidence of the S&H link, and it triggered the first real public health scare. The tobacco industry responded by increasing advertising expenditure.
From this time on the media, politicians and most of the reading public were aware that a link had been established between smoking and lung-cancer, and also aware of possible links to heart disease.
1953: Dr Anton Oschner, the chairman of the department of surgery at Tulane University School of Medicine in New Orleans, now spends a large part of his time on speaking engagements among medical and paramedical professionals promoting the reality of the connection betweem smoking and lung cancer. His anti-smoking clinic in New Orleans is doing brisk business.
1953 Apr:: Time magazine reports that in England, Dr Harvey Graham had suggested that the tobacco companies should be made to fund research to produce a safer-cigarette. Despite being contrary to free-enterprise fundamentalism, a large number of influential Americans were beginning to think the same way. Everts Graham was reported as saying:
"The cigarette companies are trying to induce more cigarette smoking particularly among the young ... many of whom will become cancer victims 20 years or so from now.
It is certainly the moral obligation and common sense on the part of the manufacturers to support research. If we here at Washington University bad more funds. we could get along faster and perhaps arrive at satisfactory conclusions within a couple of years or so."
1953 May: Members of the public now begins to sue the tobacco companies when they contract lung cancer. In this early example, the Damon Runyon Fund (through Walter Winchell) is being offered a piece of the action. This is the start of the litigation explosion (which the tobacco companies inevitably win until 2000)
1953 Sep:: The tobacco companies now realised that they needed to have more independent research done, but many of the universities didn't want to be publicly linked to such a pariah industry. To solve this problem, a tobacco "discussion group' of university and research science administrators and counter-science executives from the tobacco industry met in New York:
Clearly tobacco money for research was already being seen by academics as 'tainted'. New York University wanted to receive its funding through "some organisation that would stand as an intermediary between it and the tobacco industry". A memo exchanged after this meeting accepts that:
- Robert Du Puis and Clifford Goldsmith of Philip Morris
- A Grant Clarke of Reynolds
- HB Parmele of Lorillard
- HR Hamner of American Tobacco
- Dean Hobbs of Duke University
- Drs Rhoads and Emerson Day of Sloan-Kettering (SKI)
- Dr Nelson from New York University (NYU)
- Dr Ernst Wynder who was working at both SKI and NYU
"There are data now available which suggest a causal relationship between smoking and cancer of the respiratory system ...."
1953 Oct: The tobacco companies now begin meeting in a "round of conferences" with the research groups. The three universities and SKI were trying to tie up all the available research funds from the tobacco companies and split it among themselves. In exchange for this unding monopoly, the tobacco companies wanted limitations on the research, and a say in the final reporting processes.
After his skin-painting research, Ernst Wynder was already seen by the companies as too "biased", while, to the director of SKI, Dr Cornelius Rhoades, he was a loose-cannon who threatened the Institute's funding. A tobacco industry history records that:
"Rhoads at the SKI had taken Wynder off tobacco research. [He] commented that although he could control Wynder's work and his publications, Wynder was a free agent and he, Rhoads, had no control of his activities outside the Institute."
1953 Nov: During its annual general meeting, the American Cancer Society held a seminar on "The Place of Tobacco in the Etiology of Lung Cancer," Smoking is now very much at the top of the ACS agenda.
1953 Nov 13:: Ruder & Finn Associates PR (Bill Ruder was ex-public relations at Philip Morris) is planning to set up another conference which would include scientists being funded by the industry. This is the beginning of what became a major tobacco industry tactic of taking control of scientific seminars, conferences and peer-reviewed journals (often secretly) to pre-determine what was produced and published,
1953 Dec 1: Cancer Research magazine publishes the full report of the Wynder-Graham mouse-painting experiment.
1953 Nov 30: Time Magazine article "Beyond any Doubt" blows the any remaining shreds the tobacco industry public defense out of the water. Even Rhoads at SKI is forced to concede that smoking causes cancer.
1953 Dec: 9: Some of the tobacco companies now have a program of delivering free cigarettes to medical practitioners. This is another defensive tactic which became popular, especially with politicians and their staffers. See
Panic has now sets in at the tobacco companies. They realise that instead of competing, they now need to collaborate. However meetings of this kind had been specifically prohibited under the 1913 Anti-trust agreement.
1953 Dec 14:: Executives from every tobacco company (with the exception of Liggett, who thought the scare would blow over) met in secret at New York City 's Plaza Hotel, and the great tobacco industry conspiracy began.
See details of the Plaza Hotel Meeting.