Manufacturing Doubt

Distraction and Subversion Research at the Council for Tobacco Research

Stephan Risi

Doubt is our product since it is the best means of competing with the ‘body’ of fact’ that exists in the mind of the general public. It is also the means of establishing a controversy. [...] Unfortunately, we cannot take a position directly opposing the anti-cigarette forces and say that cigarettes are a contributor to good health. No information that we have supports such a claim.

Since the 1950s, creating doubt has been at the center of the tobacco industry’s efforts. Allan Brandt. The Cigarette Century: The Rise, Fall, and Deadly Persistence of the Product That Defined America. New York: Basic Books, 2007: Ch. 6 and Robert Proctor. Golden Holocaust: Origins of the Cigarette Catastrophe and the Case for Abolition. University of California Press, 2011, Ch. 17. Industry executives knew that they couldn’t show that smoking was harmless and instead chose to fund scientists that would claim, in their name, that many things might cause cancer; that the strong correlation between smoking and lung cancer didn’t imply causation; and that more research was needed. The industry’s strategy hinged on amplifying the voices of this tiny minority until it seemed as if half of the scientific establishment was unconvinced by the case against smoking.

This campaign to cast doubt on the science behind smoking’s health harms had its beginnings in 1953 when the major U.S. tobacco companies came together to hire the PR firm Hill & Knowlton to defend them. Hill & Knowlton’s strategy was to argue that the jury was still out on whether or not smoking was harmful while claiming that the industry did everything it could to support scientific research on the topic. On the Frank Statement and the CTR, see Proctor, Golden Holocaust, Ch. 18. To support this narrative, the tobacco industry in 1954 bought space in 448 newspapers across the United States to print its “Frank Statement to Cigarette Smokers.” One of its key sections read:

Distinguished authorities point out:

1. That medical research of recent years indicates many possible causes of cancer.

2. That there is no agreement among the authorities regarding what the cause is.

3. That there is no proof that cigarette smoking is one of the causes.

4.That statistics purporting to link cigarette smoking with the disease could apply with equal force to any of the many other aspects of modern life. Indeed the validity of the statistics themselves is questioned by numerous scientists.

The Frank Statement was a brilliant piece of rhetoric. Its goal, first and foremost, was to keep Americans smoking. And it did so by claiming that modern life was dangerous in many ways and that smoking’s contribution to disease or mortality remained entirely unclear. Attacks on tobacco, the Frank Statement continued, were nothing new. For the 300 years during which tobacco had been used, “critics have held it responsible for practically every disease of the human body. One by one these charges have been abandoned for lack of evidence.” The link between smoking and lung cancer, it implied, would be no different. At the same time, the Frank Statement presented the tobacco industry as a responsible corporate citizen who, in response to all the supposed confusion, had set up the “Tobacco Industry Research Committee” (TIRC) to fund research into smoking and health.

The problem for the industry was that there existed no real controversy around smoking and lung cancer. Certainly, some things still needed to be figured out. But large scale epidemiological studies with hundreds of thousands of test subjects in both the United States and the United Kingdom had shown that smokers were at elevated risk not just for lung cancer but for most other cancers and cardiovascular disease as well. At the same time researchers could produce cancers by painting the skin and ears of mice and rabbits with tobacco tar, demonstrating that tar could indeed cause tobacco. The available pieces of evidence all fit together and indicted smoking as the main cause of lung cancer as well as a contributor to other kinds of cancers and heart disease. If there was to be a scientific controversy, the industry had to create one.

The TIRC, which was renamed to Council for Tobacco Research (CTR) in 1964, stood at the center of this process. The CTR, according to the Frank Statement, came to be because the tobacco companies pledged “aid and assistance to the research effort into all phases of tobacco use and health.” “A Frank Statement to Cigarette Smokers.” January 4 1954. American Tobacco, Brown & Williamson, Lorillard, Philip Morris, and RJ Reynolds would jointly fund this new organization, which, under the guidance of a “scientist of unimpeachable integrity and national repute,” would disburse millions of dollars in research funding to scientists across the United States.

The reality was rather different. The CTR, in the summary of Robert Seligman, Philip Morris’ Vice President of Research and Development, was both a “shield” and a “front” for the industry. Robert Seligman. “Meeting in New York - November 15, 1978.” November 17 1978. It was a shield because the hundreds of millions of dollars spent on tobacco related research enabled the industry to say not only that the case still wasn’t settled but also that they were still committed to funding more research. (In reality, the CTR funded basic research that had little to do with smoking and health.) But the CTR was also a “front” that enabled the industry to give money to its strongest allies in science by giving them funding for so-called “Special Projects” that were selected directly by the CTR’s lawyers and did not have to pass review by the CTR’s Scientific Advisory Board (SAB). The recipients of Special Project grants were then expected to produce research that directly helped the industry, for example by challenging the link between smoking and lung cancer. But the industry would also call on them to speak out in public. As Seligman noted, through the Special Projects, the CTR “supplied spokemen for the industry at Congressional hearings. The monies spent at CTR provides a base for introduction of witnesses.” Ibid.

In this essay, we will see how the CTR’s functions as a “shield” and a “front” were both integral to the industry’s campaign to create doubt about smoking’s health harms. We will first explore how the CTR functioned as a “shield” by drawing on the more than 12,000 grant applications that the CTR received for its grant program. You can explore this as well as the Special Projects dataset here. This grant program required balancing two different imperatives. On the one hand, in order to be of PR value, the CTR had to appear like any other grant agency, set up by the concerned tobacco industry to support a wide range of projects. This would allow tobacco industry representatives to claim that the relationship between smoking and health was still unclear and that the industry was committed to fund more research. On the other hand, the projects funded by the CTR had to be “safe,” this is: they couldn’t add further evidence that showed smoking’s health harms. In practice, this meant that the CTR mostly funded “distraction research”--basic science projects that were of little importance to health related questions.

Below, we will look closely how this dynamic played out in the case of nicotine-related projects. From the 1950s into the 1970s, the CTR considered nicotine research to be safe because nicotine was found not to cause cancer. Hence, the CTR poured millions of dollars into projects that sought, for example, to better understand how bacteria degrade nicotine. Funding nicotine research was perfect for the industry because it was clearly related to tobacco and yet, the results produced by these projects would almost certainly be irrelevant to questions about smoking and health. However, as soon as nicotine became linked to addiction in the late 1970s, CTR support for nicotine research swiftly dropped. To make sure that the CTR would receive the kinds of applications that suited its purpose, it continually revised its stated funding priorities. At the same time, the CTR could count on its applicants to self-censor. It wasn’t just that the CTR stopped funding most nicotine research in the 1980s, they also didn’t receive many applications in this area because researchers knew that a funding agency set up by the tobacco industry was unlikely to support their addiction research. By looking at the nicotine research that the CTR supported or rejected, we can gain an understanding for how the industry adapted its distraction research program for ever new priorities.

Ultimately, one of the main uses of the grant program for the industry was to provide the CTR cover its most important program, the 140 “Special Projects” through which the industry paid its most trusted allies. These allied scientists would then, for example, attack scientists who showed that smoking caused cancer or cardiovascular disease, or that not just mainstream but also second-hand smoke was dangerous. In the Special Projects, the CTR acted as a “front” for the industry, allowing them to (or really: their lawyers) to hand-pick the projects and researchers most suited to their needs. In this essay, we will follow Theodor Sterling’s trajectory from computer scientist to becoming the highest paid CTR scientist to get a sense of the broad range of topics that the industry was interested in.

Lawyers, Administrators, and the Scientific Advisory Board:
Anatomy of a Grant Application

Before analyzing the grant application dataset, it is worth to have a look at the CTR’s funding process overall because it reveals the close interplay of applicants, the CTR’s administrative personnel, and its legal counsel, the law firm Shook, Hardy & Bacon.

For PR purposes, the grant application process was supposed to be simple and straightforward. An applicant would submit an application to the CTR. There, it would get reviewed by the Scientific Advisory Board (SAB). The SAB, according to the Frank Statement, was to be a “group of distinguished men from science, medicine, and education,” who were all “disinterested in the cigarette industry.” “A Frank Statement to Cigarette Smokers.” January 4 1954. These “distinguished men” would either accept the application and start a grant or reject the proposal.

In reality, the process was much more convoluted and involved the industry’s lawyers at every step. The SAB, consisting of industry “yes men,” had comparatively little say and could be overruled. Below, you can follow the web of interconnections between applicants, CTR employees, and the industry lawyers through one particular grant application submitted in 1972 by Thomas Mancuso.

Following Mancuso’s application clearly shows how the CTR managed the grant application process for maximum industry benefit. The true power didn’t lie with the SAB (which only met up once per quarter) but with the CTR’s everyday staff as well as with the industry’s lawyers. CTR employees like Robert Hockett, the scientific director, would often actively solicit applications directly from researchers as we will see below in the case of Theodor Sterling. Hockett could also send copies of grant applications to Shook, Hardy & Bacon to evaluate months before the SAB got to review them. And if an application was rejected by the SAB, Shook, Hardy & Bacon could then seek funding for the application as a Special Project. As a result, the CTR became a machine to fund either distraction research (through its grant program) or subversion research (through the Special Projects).

Funding Irrelevance: Nicotine Research at the CTR

The nicotine-related CTR grant application provide a useful case study on planned irrelevance. During the early years of the CTR, from 1954 to 1975, nicotine-related studies made up 15 to 25% of the CTR grant applications. See figure 1 below. That’s not an accident: From the 1950s to the 1970s, nicotine was a “safe” research topic. By the mid-1950s, it had become clear that nicotine was not the cause of cancer and probably was not responsible for the cardiovascular diseases associated with smoking. And it would take until the 1980s for nicotine addiction to become a major research topic. Tobacco companies, by and large, had caught on to the importance of nicotine in the late 1960s and early 1970s. Hence, the CTR poured millions of dollars into basic research involving nicotine because the results would almost certainly be unimportant.

Just as with other research topics, the CTR received applications from and distributed funding widely across most major research universities. Funding research at top universities was important to the industry. Shook, Hardy & Bacon’s Bill Shinn noted, for example, that “the industry received a major public relation “plus” when monies were given to Harvard Medical School.” R. B. Seligman. “U.S. Exhibit 20,467. Draft Meeting, ‘Meeting in New York - November 15, 1978.’” 17 November 1978. And indeed, Harvard and Harvard affiliated hospitals submitted the most applications to the CTR overall, a total of 496. In terms of nicotine-related applications, they (together with the University of Colorado system) came in second place with 32 applications. At the top spot with 41 applications was the Virginia Commonwealth University, the institutional home of tobacco industry researchers like Harvey Haag and Paul Larson.

The nicotine-related questions that researchers brought up in their grant applications during the 1950s and ‘60s and to which, again, about 20% of the CTR’s funding went, were basic chemical and pharmacological questions tended to be of limited importance to tobacco’s health effects: How did bacteria degrade nicotine? Sydney Rittenberg. “Application for Research Grant. The Bacterial Degradation of Nicotine and Related Compounds.” 15 July 1957. What gaseous oxygen mechanisms were involved in the oxidation of nicotine? Robert Linnell. “Application for Research Grant. The Oxidation of Nicotine by Gaseous Oxygen: Mechanism, Products and Kinetics.” 20 November 1958. Did nicotine impact the ascorbic acid metabolism? Paul Larson. “The Effect of Tobacco and Nicotine on Ascorbic Acid Metabolism.” 27 July 1961. How did peripheral veins respond to the intravenous administration of nicotine? John Eckstein. “Application for Research Grant. Responses of the Peripheral Veins in Man to the Intravenous Administration of Nicotine.” 17 February 1957.

Clearly, there were more important questions to be asked. And curiously, tobacco industry researchers agreed. When two researchers from the British Tobacco Research Council (roughly similar but more independent than the CTR) visited the United States, they reported that the “CTR supports only fundamental research of little relevance to present day problems.” Geoffrey Todd and PJR. “Report on Policy Aspects of the Smoking and Health Situation in U.S.A.” October 1964.

An even more damning assessment came from Helmut Wakeham when he reviewed the American Medical Association’s Education and Research Foundation (AMA-ERF) in 1965. The AMA-ERF was a $10 million hush fund, created through an unholy alliance of the American Medical Association and the tobacco industry, which supported distraction research just like the CTR. The industry supported the AMA in its attacks on Medicare and Medicaid (which doctors regarded as socialized healthcare with its fixed fee schedule) while the AMA neglected to comment on smoking’s health harms and instead echoed the industry’s mantra that more research was needed. This “more research was to come out of the $10 million given by the industry to the AMA for the AMA-ERF. See Richard Kluger. Ashes to Ashes : America's Hundred-Year Cigarette War, the Public Health, and the Unabashed Triumph of Philip Morris. New York: Vintage Books, 1997, p. 286 and 360-62. However, Wakeham, Philip Morris’ Vice President for R&D, strongly disapproved with how the fund distributed funding:

While we recognize that in spite of the very extensive studies which have been made in the past there may still be gaps in our knowledge of the pharmacology of nicotine which the AMA Committee might feel it desirable and necessary to close, we are wondering if this area of effort should receive as much attention as they are giving to it to the almost total exclusion of carcinogenesis which we thought was the major smoking and health problem.

From the 1950s through the 1970s, the CTR and the AMA-ERF supported nicotine research that was so irrelevant that it even upset industry insiders. By the 1980s, however, things had changed. Nicotine slowly became recognized as an addictive substance. In 1980, the DSM-III listed “tobacco dependence” and “tobacco withdrawal” for the first time. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 3rd edition. 1980, p. 176-178. Already a year earlier, a Surgeon General’s report had devoted three chapters to behavioral aspects of smoking and concluded that cigarettes produced dependence. U.S. Department of Health, Education, and Welfare. Smoking and Health. A Report of the Surgeon General. Washington, DC: United States Public Health Service, 1979. By 1988, the authors of a new Surgeon General’s report had accumulated enough behavioral and neuropharmacological evidence to declare nicotine an addictive drug on par with heroin and cocaine. U.S. Department of Health and Human Services. The Health Consequences of Smoking: Nicotine Addiction. A Report of the Surgeon General. Washington, DC: United States Public Health Service, 1988.

During the 1980s and ‘90s, nicotine dependence and smoking cessation developed into major research fields--just not at the CTR. We can compare the CTR dataset to biomedical research more broadly by using the PubMed dataset. PubMed is a dataset of over 28 million articles from biomedical journals, maintained by the NIH. By looking the frequency with which nicotine appears in the article titles, we can get a sense for when nicotine became a more or less important research topic. Namely, we can ask: What percentage of CTR projects mention nicotine in the application title? And what percentage of published biomedical article mention nicotine in the title? This gives us a sense of the relative importance of nicotine at the CTR and in the biomedical research writ large.

The pattern that this comparison shows is unsurprising: Just as nicotine--and really: nicotine addiction and smoking cessation--became important topics in biomedical research, CTR applications for nicotine research fell away.

It’s worth remembering here that the dataset contains CTR applications not CTR funded projects. In other words, there is nothing per se that would stop a researcher from applying with a project that could obviously damage the industry. However, grant applications are usually dozens of pages long and take a lot of effort to write. They are tailored to the funding agency’s goals to maximize success chances. That pattern is of course not limited to the CTR. The essay you’re reading right now was supported by a grant from the Tobacco-Related Disease Research Program (TRDRP) under the title “Fighting Big Tobacco with Big Data.”

At the same time, the CTR reviewers didn’t suffer the fools gladly who still applied with addiction-related projects. The only researcher ever brave enough to mention “addiction” right in the application title was Burt Martin Sharp, an endocrinologist who sought support for his research on “The Role of Brain Opioid Peptide Systems in Nicotine Addiction” in 1983. Burt Martin Sharp. “Application for Research Grant The Role of Brain Opioid Peptide Systems in Nicotine Addiction.” 24 May 1983. The CTR reviewers didn’t take kindly to the proposal and Sharp only got a curt two paragraph rejection letter in response. Robert Gertenbach. “Application No. 1610.” 4 November 1983. Eric Fung received the same “We regret to advise you...” Robert Gertenbach. “Application No. 2709.” 4 May 1990. response for his application to study the “Effects of Nicotine on Dopaminergic Systems in the Nucleus Accumbens” Eric Fung. “Application for Research Grant. Effects of Nicotine on Dopaminergic System in the Nucleus Accumbens.” 26 September 1989. as did Richard Michael for “Effect of Nicotine on the Brain’s Reward System.” Richard Michael. “Application for Research Grant Effect of Nicotine on the Brain’s Reward System.” 25 November 1977. Michael, in a response letter, took issue with the rejection. Richard Michael. “Unknown.” 10 May 1978. Apparently, he pointed out, the application had “not been rejected for any scientific reason, but as a consequence of a new ‘policy.’” The new policy he outlined, however, was very curious. Namely “[T]he Council saw the possibility of some of the results of the research being useful to industry, and that the Council was very concerned that there should be no interaction of that nature.” How it might be beneficial to CTR if one of their grantees used animal models to demonstrate nicotine’s rewarding effects is anyone’s guess. Given that the rejection happened in 1978, just as nicotine started to become linked to addiction, a much more likely explanation for the rejection is that the CTR higher-ups finally (and correctly) started to worry that nicotine research was becoming dangerous.

Still, a few studies in the addiction/dependence nexus made it through. In 1995, Torgny Svensson of the Swedish Karolinska Institute received CTR funding for his study on “Nicotine Dependence in Psychiatric Illness: An Experimental Study.” Torgny Svensson. “Research Grant Application Nicotine Dependence in Psychiatric Illness: An Experimental Study.” 24 May 1994. A closer examination of the grant reveals why it made it through the review process successfully. While Svensson’s proposal to study smoking cessation programs for mentally ill patients must have raised some red flags, his secondary goal-- “to understand the usefulness of nicotine or nicotine-like drugs for the psychiatrically ill patients”--must have endeared him to the CTR.

Svensson’s study fit right in with other research into the beneficial effects of nicotine, which dominated the nicotine-related applications that the CTR received from the 1980s onward. From Parkinson’s (5 applications) to Alzheimer’s (3 applications) and memory/cognition improvement (4 applications), applications to investigate the positive effects of nicotine became popular (and often funded) at the CTR. Duplicates and grant renewals are not included in these numbers. (As an aside, whether or not nicotine has beneficial effects does seem to depend at least in part on the scientific climate. During the 1990s, when researchers tried to convince smokers to give up cigarettes with the help of nicotine replacement products like gums or patches, we can find quite a few articles on nicotine’s beneficial effects. In 1991 for example, Murray Jarvik, the co-inventor of the nicotine patch wrote a whole article on the “Beneficial Effects of Nicotine.” Murray Jarvik. "Beneficial Effects of Nicotine." British Journal of Addiction 86, no. 5 (1991): 571-575.

Nicotine research at the CTR, then, is an excellent example of distraction research. From the 1950s to the 1970s, the CTR poured millions of dollars into basic research involving nicotine with the goal (sometimes even acknowledged) of producing irrelevant basic research. It wasn’t results the CTR was after, it was the ability to say that the industry was committed to support more research while the (industry-created) “controversy” around smoking’s health harms continued. As soon as it became clear, however, that nicotine and its liability to produce addiction could become problems of their own to the industry, the CTR stopped supporting most nicotine research projects. The fact that the CTR supported researchers at top universities across the country gave the CTR a sheen of legitimacy. As Bill Shinn had put it, in its capacity as a funding agency, the CTR functioned as a "shield" for the industry. And it was precisely this shield function that also allowed the CTR to work as a "front" for research directly attacking the existing consensus about smoking's health harms.

Manufacturing Doubt: The CTR Special Projects

This attack on the scientific consensus played out most importantly in the 140 so-called “Special Projects.” Through these projects, the CTR (and primarily: its lawyers) funneled money directly to researchers that it deemed most useful to the industry. In many cases, they were projects that the CTR’s slightly more scientifically oriented scientific advisory board had rejected, The original idea, at least for PR purposes, had been that the CTR would be a normal, peer-review based funding agency. but which CTR higher-ups or industry lawyers deemed important. To get a sense of the kind of research the CTR supported through special projects, it’s worth sampling some of the findings that someone at one of the tobacco industry’s law firms helpfully compiled for many of the projects:

If the CTR applications document how distraction research work--spending millions of dollars on irrelevant research--the Special Projects document the industry’s frontal attack on the existing consensus about smoking’s health harms. The CTR grants might have helped to sustain doubt by allowing the industry to claim that still more research on smoking and health was needed, but it was the Special Projects that most actively sought to create doubt.

Given this goal, it’s not surprising that a lot of CTR Special Projects were concerned with how to to science in the first place--what, for example, could count as “cause” or “proof”? The goal of the industry, in particular with regards to lung cancer, was to continually move the requirements for what constitutes proof that smoking caused cancer further out. The CTR, in other words, was looking for scientists that could also pose as philosophers of science. Chief among this group was Alvan Feinstein, an epidemiologist at Yale University, received $712,960 to study “Scientific Standards for ‘Basic Scientific Research’--Bias, Criteria, Indices, etc.” “Special Project Number: 135, 135R1, 135R2. Scientific Standards for ‘Basic Scientific Research’--Bias, Criteria, Indices, etc.” Feinstein’s main concern was “detection bias,” the assumption that epidemiological studies of lung cancer were flawed because lung cancer was far more often correctly identified in smokers than in non-smokers. A similar grant for $357,185 funded Richard Hickey, an epidemiologist at the University of Pennsylvania, who studied “Scientific Malpractice in Epidemiology: Hormesis, Ideology and Misuse of Statistics.” “Special Project Number: 110, 110-R1-4, 110R4S. (Epidemiology-Critique) Scientific Malpractice in Epidemiology: Hormesis, Ideology and Misuse of Statistics.” Hickey was primarily paid to endorse the idea that people smoke because certain genes predispose them to, the same genes that also make it more likely that they will get cancer. According to this theory, even if smoking and lung cancer were correlated, it was a smoker’s genes (rather than their cigarettes) that caused the cancer. Other epistemologically oriented Special Projects include # 126, “A Pilot Study on Causality (An Investigation of Mathematical and Statistical Approaches to the Study of Causality in Epidemiologic Research)” “Special Project Number 126: A Pilot Study on Causality (An Investigation of Mathematical and Statistical Approaches to the Study of Causality in Epidemiologic Research).” and #132, “Methodology For Quantitating Exposure To Inhalable Ambient Tobacco Smoke.” “Methodology For Quantitating Exposure To Inhalable Ambient Tobacco Smoke.”

Theodor D. Sterling: The CTR's Most Trusted Ally

At the center of many of the Special Projects was Theodor D. Sterling. Sterling had started his career as the Director of the Computing Center at the University of Cincinnati where one of his interests had been to apply statistical and computational methods in biomedical research. Stanton Glantz, John Slade et. al. The Cigarette Papers. Berkeley: University of California Press, 1996, p. 296-301. A contrarian, he soon become one of the tobacco industry’s key allies. From 1968 to 1990, he worked on nine different Special Projects, pocketing a total of $5,560,210 for his troubles. By the time that his last Special Project grant expired, he had long started his own consulting firm, assuring that the CTR’s plentiful funding didn’t have to pass through the pesky oversight of a university. In the meantime, he had worked on everything from lung cancer causation (factors other than smoking are more important) to data collection (National Health Survey data is not valid), and second hand smoke (unimportant compared to indoor air pollution). Because of the length of Sterling’s involvement and the range of topics that he worked on, he provides us with an excellent case study to better understand how the tobacco industry (through the CTR), its lawyers, and scientific allies worked together to create and sustain fake controversies.

What attracted the attention of the CTR was an article that Sterling published in 1962, entitled “New Developments in Chronic Disease Epidemiology.” Theodor Sterling, John Phair, et. al. "New Developments in Chronic Disease Epidemiology: Competing Risks and Eligibility." American Industrial Hygiene Association Journal 23.6 (1962): 433-446. Sterling’s argument was quite straight-forward: The epidemiological link between smoking and lung cancer might well be a statistical artifact. The support he presented for this argument, however, was rather flimsy. First, he pointed out that it was rather curious that smoking seemed to correlate not just with lung cancer but also with other cancers and cardiovascular disease. “One had a choice, of course,” he noted on this point, “of assuming that increases in all diseases were due to smoking.” However, the “of course” in that sentence can cue is in on the fact that Sterling had a different hypothesis, namely that the difference arose because smoking and non-smoking populations were not equivalent. Why this might be, Sterling admitted, “was never determined satisfactorily nor was much effort expended in exploring this difference.” But that doesn’t seem to have kept him from assuming that it was nonetheless true. The rising death rates for all diseases were, for Sterling, an indication that something must be wrong with smoking data in general.

His specific statistical worry concerned the limited age range of the subjects in data compiled by Joseph Berkson (who was himself skeptical of a link between smoking and lung cancer). That dataset tracked smokers and non-smokers aged 60-64 for 44 months and compared their rates of death. Unsurprisingly, smokers had a fifty percent higher death rate than non-smokers and a ten-fold increased chance to die from lung cancer specifically. But, Sterling worried, what if this was mainly a product of selecting that particular age group? Suppose, Sterling seems to argue, that there is some reason that gives smokers a larger chance to survive to age 60 than non-smokers--only to then die in higher numbers. In that case, it would appear as if smoking was a major cause of death even if that’s not the case once one expands the age group from 60-64 to ages 20-80. Along similar lines, Sterling worried that the increased death rates of smokers might be a cohort effect, that is: a similar group of 60-64 year olds 20 years in the future might not show the same differences between smokers and non-smokers. Why this should be the case, Sterling did not elaborate. Indeed, the whole study seems to be advanced sophistry that relied on ignoring already published studies that tracked much larger age groups. The whole study seems to be advanced sophistry that relied on ignoring already published studies that tracked much larger age groups. Hammond & Horn had studied men from ages 50 to 69, Dorn U.S. veterans from ages 30-80. E. Cuyler Hammond, and Daniel Horn. "The Relationship Between Human Smoking Habits and Death Rates: A Follow-up Study of 187,766 Men." Journal of the American Medical Association 155.15 (1954): 1316-1328, and Harold Dorn "Tobacco Consumption and Mortality from Cancer and Other Diseases." Public Health Reports 74, no. 7 (1959): 581-594. Both studies confirmed the increased death rates not just from lung cancer but other cancers and cardiovascular diseases as well.

Despite these methodological flaws, the article endeared Sterling enough to Robert Hockett, the TIRC’s Associated Scientific Director, that Hockett invited Sterling to apply for funding. In 1964, the “Tobacco Industry Research Committee” was renamed to the more neutral and independent sounding “Council for Tobacco Research” and Sterling got his first assignment: Write a review of the 1964 Surgeon General’s Report. Theodor Sterling. “An Evaluation and Review of the Report on Smoking and Health by the Advisory Committee to the Surgeon General.” March 1964. The Surgeon General’s Report was a consensus report which concluded that smoking caused cancer as well as heart diseases beyond all reasonable doubt. Sterling, unsurprisingly still had doubts. The fact that much of the evidence cited by the Surgeon General’s advisory committee was based on statistical associations between agent and diseases bugged him. “For many purists,” he noted, “such an association does not reach the status of scientific fact until the disease itself can be called forth or prevented under controlled conditions.” Ibid., p. 4. Of course, cancer could be produced in controlled conditions but only in animal models, so Sterling could maintain that it was an open question whether humans would react in the same way. His overall conclusion was that the Surgeon General’s report constituted not a scientific but a public health evaluation, which introduced “a definite bias as far as the scientific decision process is concerned.” In other words, Sterling took issue with the fact that the Surgeon General was ready to close the case and try to save lives even if he was only 99.9% sure that smoking caused cancer. A real scientist, he seems to argue, would have waited another twenty years to root out the remaining 0.1%. Naturally, the tobacco industry would have moved the goal posts for what constituted proof further and further out during those twenty years, meaning that if we took Sterling’s conclusion seriously, the case would never be closed--exactly what the CTR wanted.

The CTR was very happy with Sterling’s first assignment and from there on out, he became one of the industry’s point men whenever they needed someone to cast doubt on the work of independent scientists. “Dr. T.D. Sterling’s Evaluation and Review of the Surgeon General’s Report.” When E. Cuyler Hammond produced a study on the increased death rates caused by smoking in one million men and women in 1966, Sterling received $57,865 to express his “enormous doubts about validity of National Health Survey Data conclusions,” (those doubts being expressed most importantly in front of the Congressional Committee on Public Works in 1968). “Special Project Number 51, 51S. Feasibility of a Definitive Evaluation of the Data Concerning Smoking and General Morbidity and Disability.” When the CTR sought someone to look for environmental causes of lung cancer, Sterling was there to suggest that he had identified the antecedents for lung cancer in “constant exposure to atmospheric benzo(a)pyrene,” i.e. soot “Special Project 58, 58S. Gathering and Evaluating Data Investigation into the Relation Between Environmental Factors and Lung Cancer.” but also spent more than a decade investigating how social class and occupational hazards might be ultimately responsible for health outcomes attributed to smoking. “Special Project: 94, 94R1, 94R2, 94A, 94B, 94C, 94D, 94E, 94F, 94G, 94H, 94I, 94J. On Computer Analysis of Health Related Data.” Finally, when the industry started to worry about the health effects of second-hand smoking, Sterling was ready to claim that “cigarette smoke has been blamed for increased indoor pollution in sealed buildings but there may be other factors that cause office building syndrome (health problems) - lighting and ventilation, type of air, presence of smog types.” “Special Project: 94, 94R1, 94R2, 94A, 94B, 94C, 94D, 94E, 94F, 94G, 94H, 94I, 94J. On Computer Analysis of Health Related Data.” By 1980, Shook, Hardy & Bacon’s William Shinn noted that Sterling was “quite busy in at least nine areas,” William Shinn. “Letter from William W. Shinn to Thomas F. Ahrensfeld Regarding Budget for 1980-81.” 27 February 1980. including papers on the possible relationships between lung disease and everything from occupation to dust, fumes, and gas stoves or a study of errors in a study on smoking and mortality among U.S. veterans.

Sterling’s eclecticism (or: opportunism) also meant that his expertise in any given area was shallow and the overall scientific value of his work limited. One particular conference presentation gone awry is a case in point. In 1972, Sterling was invited to give a paper at the annual meeting of the American Association for the Advancement of Science. JMB. “Report on Difficulties of Measuring the Effects of Air Pollution vs the Effects of Smoking - A Paper Presented to Theodor D. Sterling at the 138th Meeting of the American Association for the Advancement of Science. December 27 1972.” 10 January 1973. His presentation, “Difficulties of Measuring the Effects of Air Pollution vs the Effects of Smoking,” was mainly an attack on epidemiologists like Hammond, charging that they did not make their data freely available for review, which might a valid charge in and of itself. However, the presentation must have really gone off the rails. A reviewer noted on Sterling’s paper that he was “presenting no new data and it was most obvious that the author had an axe to grind--the paper has no scientific merit or worth.” The CTR’s reporter noted that a “defensive, poorly written paper is poor public relation for the Tobacco Industry.” Still, the CTR can’t have minded the performance too much--they kept funding Sterling’s many projects.

And given how well Sterling was paid by the CTR, it’s unlikely that he much cared about how he was perceived. All in all, he received $5,560,210 from 1968 to 1990 for his work on nine different special projects. However, Sterling also worked directly for tobacco companies as well as the law firms that represented them and it is likely that he receive more than $10 million in total. Robert Proctor. Golden Holocaust: Origins of the Cigarette Catastrophe and the Case for Abolition. University of California Press, 2011, p. 278. Technically the CTR funding was intended to only support research. Practically, however, we can assume that a good chunk of it went directly to Sterling. While he initially listed his universities as the institutions, from 1979 onward, his university affiliation was replaced with “Theodor D. Sterling and Associates Ltd.” in Vancouver even though he continued to teach at Simon Fraser University. “Special Project Number 105. Evaluation of the Interaction Between Geographic, Geocultural, Smoking and Health Variables and Indices.” His invoices certainly seem to have increased after starting his own company, reaching $300,000 per year for a single project in the early 1980s. “Special Project Number 71G, 71H, 71I, 71J, 71K, 71L, 71M.” This was enough for the CTR to start inquiring why he needed such a large budget but not enough for them to cancel the project. Ibid., p. 25. The going for Sterling was good enough that he even got his two sons involved. In 1981, he was the co-PI in a $200,160 project on “sick building syndrome” with his eldest son Elia Sterling that was bankrolled directly by Brown & Williamson. E. Pebbles. “T.D. Sterling and Elia Sterling.” 4 May 1981. His second son, in turn, received $70,000 for Special Project 130 to study the “difficulties inherent in attempts to ascribe ‘passive’ smoking to tobacco smoke through use of questionnaires alone.” “Special Project Number 130. Investigation of Self-Reporting Questionnaire for Environmental Tobacco Smoke.”


Sterling’s case makes it clear what Robert Seligman meant when talked about the CTR acting as a “front” for the industry: Through the CTR Special Projects, the tobacco industry funneled millions of dollars to its most trusted allies. In return, the industry’s point men like Sterling, Feinstein, or Hickey mounted frontal attacks on researchers who had concluded that smoking caused cancer or that second-hand smoke was harmful. At the same time, the industry could call on these men to testify for them in court cases or congressional hearings or have them interviewed for newspaper or magazine stories. By amplifying the voices of these bought researchers, the industry could make it appear as if there was still a major controversy about smoking’s health harms.

But the CTR could only act as a front because of the thousands of projects that it supported through its grant program. It was this mass of largely irrelevant projects that gave the CTR the appearance of supporting objective, disinterested scientists, and which allowed it to hide its most important Special Projects. Funding acknowledgement from Theodor Sterling, W.L. Rosenbaum, and J.J. Weinkam, J. (1992). "Bias in the Attribution of Lung Cancer as Cause of Death and Its Possible Consequences for Calculating Smoking-Related Risks." Epidemiology Vol. 3, No. 1 (1992): 11-16. While Special Project awardees would sometimes not acknowledge the funding they received, The acknowledgements (or lack thereof) are usually listed together with the Special Project. See for example “Special Project: 94, 94R1, 94R2, 94A, 94B, 94C, 94D, 94E, 94F, 94G, 94H, 94I, 94J. On Computer Analysis of Health Related Data.” they usually had no problem noting that they were supported “by a special research grant from the Council for Tobacco Research, Inc.” Who could ultimately be expected to distinguish between a “research grant” and a “special research grant?” It was the close integration of legitimate if irrelevant research with lawyer-selected Special Projects that made the CTR a valuable investment for the industry.

Taken together, the CTR’s distraction and subversion research proved devastatingly effective at deceiving smokers about the harms they incurred by smoking. We can track the reach of this deception through public opinion polls, which both the tobacco industry and its opponents conducted from the 1950s onward. For more on ways to measure smokers’ ignorance, see Proctor, Golden Holocaust, Ch. 18. A 1966 U.S. Public Health survey, for example, found that more than 60% of current smokers strongly or mildly agreed that the “connection between smoking and disease is not yet proved because it is only based on statistics.” U.S. Department of Health, Education, and Welfare. “Use of Tobacco: Practices, Attitudes, Knowledge, and Beliefs. United States - Fall 1964 and Spring 1966.” July 1969, p. 743. While about 50% of current smokers agreed that smoking is the major cause of lung cancer, a full 72% thought that being overweight is more harmful to health than smoking. Ibid., p. 689-690. In fact, it was only during the 1970s and ‘80s that a majority of smokers came to understand cigarettes as a major cause of death. Still, even in 1982, the Roper Organization, in a study for the Tobacco Institute, could report that “in context with other problems that can affect health and safety, smoking and being around people who are smoking are low on the list of things people are concerned about [...].” Roper Organization. “A Study of Public Attitudes Toward Cigarette Smoking and the Tobacco Industry in 1982.” July 1982, p. 3. In fact, only 53% of respondents thought that smoking a pack of cigarette per day “makes a great deal of difference in longevity” compared with 77% for “living under a lot of tension and stress” or 43% for regularly eating high cholesterol food. Ibid., p. 21.

Through its support of distraction and subversion research as well as its extended disinformation campaigns, the tobacco industry managed to create precisely the smokers it needed: Vaguely aware that smoking was in some form harmful (meaning that they would lose a lawsuit against the industry) but ignorant of the true risks of smoking; ignorant of the fact, for example, that if they continued to smoke one or more packs per day, they would lose, on average, 10 years of their life and have a 50% or higher chance of dying from a smoking-related illness. Richard Doll, Richard Peto et. al. "Mortality in Relation to Smoking: 50 Years' Observations on Male British Doctors." British Medical Journal 328, no. 7455 (2004): 1519-1528; Jha, Prabhat Jha, Chinthanie Ramasundarahettige et. al. "21st-Century Hazards of Smoking and Benefits of Cessation in the United States." New England Journal of Medicine 368, no. 4 (2013): 341-350. This ignorance wasn’t accidental. It was the deliberate product of a campaign, directed by the industry’s lawyers and PR experts, to produce doubt and ignorance under the guise of supporting scientific research.