Ashes to Ashes (70 page)

On the strength of these findings, Auerbach and Hammond—after a disagreement with Cahan over who was to run the show—took over the beagle experiments and obtained $750,000 from the ACS to erect a laboratory building with five air-conditioned wards and carry out, with a staff of thirty lab technicians, a longer and larger study. Begun in May 1967, the study, by far the most ambitious of its kind ever tried, involved ninety-four pedigreed male beagles, in their physical prime, all purchased from the same breeder in the Adirondacks. The animals, exercised daily, checked regularly for worms and other doggy afflictions, and visited every day by Auerbach, who was constantly concerned about their sanitary conditions, were divided into five categories: eight controls, who were sham smokers
(i.e.
, underwent the tracheostomy and visited the smoking apparatus but were exposed to no smoke); twelve who smoked only filter-tip cigarettes; twenty-four who smoked only unfiltered cigarettes; thirty-eight heavier dogs who smoked only unnfiltereds; and twelve who smoked half the number of unfiltered cigarettes as the rest. The cigarettes were all the same filter-tip brand that had 17.8 mg. of tar each; the filter was broken off from the cigarettes used for beagles consuming only unfiltered smoke, each yielding about twice the tar content of the intact filter version. Hammond calculated that the ideal length for the experiment would be 875 days, or the equivalent of about sixteen human years—long enough to produce many of the signs of smoking-induced disease, if not frank cancer, without killing most of the subject animals. The daily average dosage was seven cigarettes—the equivalent of a few cigarettes under two packs a day for a 150-pound man—except for the dozen lighter smokers on half-rations.

Such an exercise could hardly be carried out in a residential neighborhood without public awareness of it. When some of the details were reported by the media, including that all the dogs would be sacrificed at the end, Auerbach and his colleagues received written and telephoned death and bombing threats, and one day two busloads of picketers arrived for a protest march in front of the
laboratory, with signs likening the place to Auschwitz. Given the enormity of the human health peril he was investigating, Auerbach suffered neither fear nor pangs of conscience.

Twenty-eight of the beagles died during the course of the study—about 30 percent of the total—nineteen of them from blood clots in the lungs, but none of the nonsmokers succumbed prematurely. Tumors were found in thirty-six of the ninety-four beagles when autopsied, including some in several of the non-smokers, but the key finding in Auerbach’s view was that twelve of the smokers—but none of the eight nonsmoking controls—were found to have what Auerbach called “invasive” or malignant tumors, by which he meant a proliferation of basal cells of the bronchial lining, with atypically enlarged nuclei, which had penetrated the underlying framework of connective tissue, blood vessels, and nerves that hold hollow organs in place. Some of the dozen beagles so stricken had twenty or more such tumors in a single lobe. The heavier smokers had more tumors than the lighter smokers, and 72 percent of the beagles who smoked unfiltered cigarettes showed tumors, compared with only 33 percent of those smoking the filtered cigarettes, suggesting a prophylactic effect from use of the latter.

“I knew what we had,” Auerbach later recounted. “We’d been able to duplicate all the changes we’d found earlier in human beings who smoked and suffered from lung cancer. And so the hypothesis [that smoking can induce cancer] was answered in the affirmative.”

What the beagles study had not produced, although Auerbach believed it would have if the experiment had continued, were massive tumors; only microscopic ones were found, and none had metastasized to other sites through the blood or lymph vessels. But the findings had been reviewed and confirmed by three outsiders: one a veterinary specialist, and two well-regarded pathologists, John Berg of the National Cancer Institute and Raymond Yesner of Yale Medical School. Visiting Auerbach’s lab, Yesner was satisfied that the beagle slides showed “local invasion of the pleura” and cellular abnormalities, though no masses of traveling cancer. Thus corroborated, the findings were deemed sufficient to take them public with a flourish. The cancer society, which had paid for the study, was headed then by William H. Lewis, retired chairman of the Kenyon & Eckhardt advertising agency and a fierce foe of the tobacco industry who had risked losing business for his firm by outspokenly favoring the broadcast ban on cigarette commercials. Having thrived in a world where hoopla was routine, Lewis saw no reason not to stage a big press conference at the Waldorf-Astoria early in February 1970 to break the news of the beagles study findings. Auerbach was on hand for the occasion, using a pointer to indicate to lay reporters the tumors in his blown-up microphotos. On its front page the next day,
The New York Times
stated that the study marked the first time that malignant tumors had been produced in large animals by exposing them to
cigarette smoke and quoted the cancer society’s claim that the findings “effectively refute” the contention by tobacco manufacturers that there was no proven link between cigarettes and cancer. Every television network news show that evening led with the story of the smoking beagles.

Caught off guard by the news, the Tobacco Institute initially appealed to offended animal-lovers and then befogged the findings as unrelated to human smokers. The tobacco industry’s “institute” professed intense interest in Auerbach’s experiment but said wide agreement prevailed in the scientific community that “there is no satisfactory animal model for smoking experiments.” In other words, the tobacco industry declined to concede the cancer peril from smoking unless it could be confirmed by laboratory experiments, but unfortunately such confirmation was impossible since no animal could properly serve as a human surrogate.

Such a transparent dodge could not cushion the blow. The industry lawyers and their hired scientific consultants felt their chief hope for damage control lay in the fact that the beagles study was disclosed to the general populace prior to publication in a scientific journal, the usual outlet for reporting serious medical findings. No doubt the ACS was confident that the AuerbachHammond paper would be published by a top journal, as all their other work had been; the staged press show at the Waldorf had been arranged to extract maximum publicity for the findings—and until Auerbach’s data and slide photos were published, it was supposed, the tobacco people could not begin punching holes in them. Although Auerbach was liked and respected by his peers, there were some who felt he had a tendency to “overinterpret” by making excessive claims for his findings on the effects of smoking. Perhaps he had done so once more, the industry’s scientists hopefully speculated.

First choice to publish the beagles study was the
New England Journal
, perhaps the nation’s most highly regarded general medical periodical, which had carried some of the earlier smoking studies by both of the prime investigators. But only six months before the ACS press conference at the Waldorf, the
Journal
had carried an editorial on its policy of accepting only previously “unpublicized results” on the ground that articles in reputable scientific journals had been reviewed by competent editorial boards of peers, allowing the lay press “to guard against impropriety and inspiring false hopes.” Studies that were ventilated without benefit of such a review process made it far more difficult “to sustain such probity.” Accordingly, the
Journal’s
editor, Franz Ingelfinger, returned the smoking beagles paper to its authors a few weeks after its receipt, saying that the decision to reject it on procedural—not substantive—grounds had been “agonizing” since the pair of them were “frequent and esteemed contributors” to the
Journal
, their work was unquestionably important, and “the
Journal
is emotionally involved in the anti-smoking campaign.”

The paper was dispatched at once to the
Journal of the American Medical Association
,
whose editors asked for a copy of the Auerbach-Hammond correspondence with Ingelfinger and extra sets of the microphotographs. After three months of silence, a letter from
JAMA
senior editor Therese Southgate advised that no decision about publication had yet been reached because an extraordinary number of reviewers were being consulted in view of “the controversial nature of the work.” But since the authors were scheduled to present their paper at the annual convention of
JAMA’s
parent, the AMA, later that month, she thought they might find it useful to consider the comments thus far received, which showed, as Southgate put it, “a certain consensus.”

The two dozen or so reviewers who would ultimately evaluate the beagles paper for
JAMA
had a good many reservations, chief of which were that the number and quality of the microphotographs inadequately illustrated the authors’ claims of invasive tumors; that neither emphysema nor fibrous thickening of the alveolar walls was shown “in a convincing way.” One reviewer wrote, “I think it would have been better for the authors to wait until they could demonstrate at least one true, unequivocal, grossly recognizable mass of neoplastic tissue.” The distinction between benign and malignant tumors, noted another reviewer, “is difficult in the absence of lymphatic or blood vessel invasion.” Added a third reviewer, who claimed “the highest regard for Dr. Auerbach’s ability” and asserted that he himself was “absolutely convinced as to the etiologic relationship between cigarette-smoking and human lung cancer,” the beagles paper “as presently presented … could be used as a demonstration again of the failure to produce cancer comparable to the human disease in experimental animals.”

Meanwhile, the Tobacco Institute executive committee, chaired by Philip Morris’s Joseph Cullman, was hearing from its lawyers and the industry’s scientific hirelings that the beagles study findings would prove attackable, once the details were available. Their strategists felt that an independent panel of experts to review Auerbach’s findings was likely to come up with a mixed and ambiguous assessment, allowing the cigarette makers to argue that despite the ACS claims, the case remained unproven.

Cullman put his professional and personal credibility on the line three weeks after the Waldorf press conference by writing to ACS chairman William Lewis that the tobacco industry was “entitled to have a full understanding of the nature and significance of the [Auerbach] findings as quickly as possible.” He proposed that “several highly qualified scientists” chosen by the Tobacco Institute and acceptable to the ACS be granted access to all relevant materials and data for independent review—and at the industry’s expense. Lewis replied—somewhat wishfully, as it developed—that the beagles study would be “published in the very near future” and would speak for itself.

Soon, however, word reached the industry from its paid agents in academia and its allies at the AMA that the
New England Journal
had spurned the author’s
submission of the beagles paper, albeit for a reason unrelated to its merits, and that
JAMA’s
peer-reviewers were somewhat skeptical of the bold con-, elusions reached by the investigators. Like the cat all but tasting the canary that had dozed off outside its cage, Cullman wrote Lewis a second time to say that publication of the beagles paper did not appear imminent, that the ACS’s exploitation of an unvalidated study was regrettable, and that mere publication of the Auerbach-Hammond findings would not satisfy the industry, given the sweeping claims made for the experiment; only open access to the beagles data and review by independent outsiders would do. Lewis fired back that the study had in fact been reviewed by distinguished pathologists and others who praised it; that the beagles slides were available for inspection by qualified observers at Auerbach’s VA laboratory; and that the cancer society did not “intend to ask that these two eminent men [Auerbach and Hammond] submit their findings to any … committee chosen by the Tobacco Institute … .”

Lewis’s huffy letter served Cullman’s purpose. At an April 30, 1970, press conference, he revealed his exchange with the ACS chairman and wondered aloud why, if the beagles study was as sound as its patrons claimed, there was any objection to an impartial review. If the ACS, Cullman charged, continued to deny access to the data and hewed to its unexamined claim that cigarette smoking had been definitively indicted, “we believe this will serve as convincing evidence to the public, lay and scientific, that the data will not support the allegations made … .” Ten days later,
The New York Times
in an editorial said the industry’s request was understandable and the beagles findings were undoubtedly “path-breaking and important, but like all pioneering investigations they must be scrutinized with particular care.” Incensed, Lewis wrote to the
Times
charging that the implication that the ACS had perpetrated a publicity stunt in the form of the beagles study “comes from an industry that for years relied on publicity and advertising to obscure the fact that cigarette smoking is the main cause of lung cancer in man.”

But the ACS was getting outmaneuvered by the industry the longer it took to find a journal to publish the beagles paper. Thus, in a June 3 letter, Auerbach and Hammond invited the new director of research for the Council for Tobacco Research—Sheldon C. Sommers, chief of pathology at New York’s Lenox Hill Hospital—to the VA hospital to examine the beagles’ tissue himself directly under a microscope. Sommers, who was traveling abroad at the time, wired back acknowledgment of the invitation on June 16 and added that he thought it desirable for other outside experts to see the slides, since “review by me alone might be considered biased,” and concluded that he would appreciate the opportunity for further discussion on his return at the end of June.

But Sommers never did get back to Auerbach and Hammond. Instead, as he would explain long afterward, he relied on discussions he had had with a number of the
JAMA
reviewers who found the authors’ conclusions invalid. Fifteen
years later, while being deposed in a product liability suit in Texas, Sommers stated, “I made every reasonable effort to be permitted to examine the microscopic slides” in the beagles study, and denied that Auerbach had ever invited him to his laboratory to view the slides.