r«b6c f.adk Pvbcr Fa 



552 



examined ihc hcalih effects of snx*ing.» 

 Funhcrmore. ihc vast majonty of ii«h»- 

 iry^upponcd research that has addressed 

 the health effecis of smokjng has produced 

 findinc> consisicni with the Surgeon Gerv 

 cral's conclusion that smoking is a major 

 cause of numerous diseases.'"' 



The second sentence of the Tobacco 

 Insiiiuic's statement might readily be in- 

 icrprcicd to mean thai eminent scientists 

 question whether smoking causes disease. 

 V-Tule scientists do have questions about 

 the specific mechanisms of causality, 

 there is vinually no disagreement that 

 smokjng IS a major cause of disease. In the 

 above-mentioned survey of CTR grant re- 

 apients. for example, over 90 percent of 

 the respondents concurred with each of 

 the following; "most deaths from lung 

 cancer are caused by smoking", "snKike 

 from someone else's cigarette is hannful 

 to a non-smoker"; and "dgaiene smoking 

 IS addictive."* 



In addition to disioning reality in its 

 printed matter disseminated to the public, 

 the tobacco industry has appealed to its 

 ongoing "cotnmit[meni] to advancing sa- 

 entific inquiry into ihe gaps in knowledge 

 in the smoking controversy" in dealing 

 with the media, in presenting congres- 

 sional lestimony , and in defending itself in 

 court against charges of produa liability. 

 Examples are noted below. 



The industry's use of the CTR grant 

 program raises a number of difficult and 

 uoubling questxjns, including the follow- 

 ing: Should saenttsis directly lend their 

 credibility to the industry by serving as 

 members of its Saentific Advisory Board, 

 the body of independent saenusts who 

 perform grant review and selection'' As 

 either advisors or reapients of funding, 

 what obligations, if any , do scientists have 

 10 the larger soaety as a resuh of their 

 mvolvemeni in the CTR pnxess? For ex- 

 ample, do they have a moral obligatmo to 

 publicly suie their disagreement with the 

 tobacco industry's position that smokiDg 

 has never been proven to be a cause of any 

 disease? Ai a purely pragmatic level, does 

 the scientific knowledge generated by 

 CTR-funded resean:h pnjduce sodal bet>- 

 efits that outweigh the costs of the indus- 

 try's deceptrve pubbc relations use of the 

 process? At the most fundamental level, 

 should researchers accept financial sup- 

 port from an industry that annually know- 

 ingly causes the deaths of sottk 400,000 

 Amencans?' 



These questions could be the subject 

 of a detailed treatise in the general domam 

 of the ethics of science. I leave that task to 

 others. Rather, my purpose in this paper is 



simply to relate, and put into context, the 

 saga of my attempt lo poll the members of 

 the Soenufic Advisory Board to deter- 

 mine whether or not they bebeve that 

 smoking causes lung cancer. The experi- 

 ence offers lessons to ihose who iTughi 

 wish to tackle ihc more formidable assign- 

 ment of an eihjcal analysis of saentists' 

 involvement in tobacco industry-funded 

 research. 



PoO Process and Results 



Elements of the public might be led 

 by industry siaiements such as that quoted 

 above to infer that the CTR's Scienufic 

 Advisory Board (SAB), representing the 

 broader biomedical saence community, 

 shares the industry's "uncertainty" about 

 whether smoking is a true health hazard. 

 Because, as a body, the SAB has never 

 gone on record as rejecting the tobacco 

 industry's position, I wrote to each Board 

 member on August 4, 1987 asking for a yes 

 or no response to the following question: 



Do you t>e)ieve thai cigarette smoking 

 causes lung cancer'' In answering this 

 question, mierpret causality in its lay 

 public meaning. You should respond in 

 the afiiniuiive if you believe that smok- 

 ing, or any of the components of aga- 

 rene smoke, either iniuatesor prtxso<es 

 lung cancer. 



I restricted the question to a single disease 

 to make the question specific and to have' 

 It address the smoking-related disease the 

 public most fears and most strongly asso- 

 ciates with smoking. In addition, the vast 

 body of evidence indiamg smoking as a 

 cause of lung caiKxr is uncontroverted 

 and of long standing.^ 



The 13 Board members were assured 

 anonymity. Two profnptly returned affir- 

 mative responses through the mail. One 

 other responded allinnaavely by phone 

 within a week of the mailing. A fourth re- 

 sponded affirmatively in early September 

 1987. Of the remaining nine Board mem- 

 bers, six refused in wntmg or by phone to 

 respond to the question; the other three 

 cotild not be reached following three writ- 

 ten communications and repeated phone 

 calls. 



To ascertain whether Board mem- 

 bers had discussed the relationship be- 

 tween smoking and lung cancer in their 

 professional wntmg. a MEDUNE litera- 

 ture search was undertaken. The seardi 

 revealed that two Board members who 

 had declined to answer my inquiry had 

 published their soentific judgment that 

 onfilnng causes lung rancrr. Two of the 

 affirmative respondents lo the poO woe 



also identified as having adopted this po- 

 sition in wnung. Consequently, bervwen 

 their direct poll responses and publisfaed 

 work, SIX of the 13 Board members have 

 agreed expliatly that smoking causes lung 

 cancer. Of ihe remaining seven Board 

 members, none was found lo have taken a 

 position on this issue in his published 

 work. Typically, this refleaed the faa that 

 the sciennsl's work had not involved lung 

 cancer. 



The response rate to the poll may 

 have been influenced by a communicatian 

 to each Board member from the office of 

 the SoeniiAc Director of CTR informing 

 the Board that I had been listed as an ex- 

 pert witness in three tobacco product lia- 

 bility lawsuits, including one in which 

 CTR was named as a party. Thereafter, 

 two additional leneis to Board members 

 and follow-up phone calls produced no 

 more poll responses, despite renewed as- 

 surances of anonymity .* One Board mem- 

 ber, who had responded to the poll previ- 

 ously, said, "I don't think there's a guy on 

 that [Board] who doesn't bebeve that cig- 

 arette smoking contributes to an increased 

 risk of lung cancer . . . fW]ithin the ortli- 

 nary use of language, you've got to siy 

 that smoking causes lung cancer." He ex- 

 plained, however, his bebef thai the mem- 

 bers of the Scientific Advisory Board were 

 "terrified" (his word) of involvemeni o 

 tobacco produa babdity lawsuits. He la- 

 mented a state of abirs in which reputa- 

 ble, well-intentioned scientists would ooi 

 acknowledge thai they believed thai 

 smoking causes lung cancer." 



A Broader Contest 



In the three and a half decades smce 

 its formation, the Council for Tobaax) Re- 

 search (and its predecessor, ilkQ has 

 contributed many millions of doOars to re- 

 search. CTR served as the tobacco indus- 

 try's liaison on a SIS million award from 

 , the SIX pnncipal tobacco companies to Ihe 



'In the final lener, I infonned ihc Board mem- 

 hen thai the one trial (not three) (or which I had 

 agreed to serve as an c ,ii4J ei i witness iiad beea 

 completed, the case had not included CTR as a 

 party, and I was on called upon lo lesafy. Siil>- 

 sequenily. ihe fits trial WIS declared a inisihaL 

 I testified al ihc rcmaJ on September 11, 1990. 

 My lestumiy did not indude mentioo of tbs 

 poO. 



' "CoQsisieni wnh tins Board member's a 

 meni was i ptene convemoon wn)) mother 

 Board member. Each of ftpproxmuiety 20 

 quesuons 1 asked efaaied the uirvvyuf reply. 

 "May I )us thaok you far caOmg?" He refused 

 tocqriaMi wfay be woutd OOI rofxind to the poL 



^ Amencvi JounuJ of Public Health 



July 1991. Vol. 8U No. 7 



