Stubbing out the truth

As the extent of British science's collusion with the tobacco giants becomes clear, American medic Stanton Glantz tells of his battle for academic freedom and the right to publish secret documents proving that the industry knew that cigarettes were addictive and probably caused cancer.

My life changed on May 12 1994. Just as I was leaving to teach my biostatistics class, a box with 4,000 pages of secret documents from British American Tobacco and its American subsidiary, Brown and Williamson, arrived in my office. The only return address was "Mr Butts," presumably a reference to the cartoon character that represents the tobacco industry in the Doonesbury comic strip.

Even a cursory reading of the documents made it obvious they were very important. The box included documents covering the quarter century from the late 1950s through the mid-1980s, including scientific reports as well as related legal and public relations memoranda. It even included a letter in which actor Sylvestor Stallone agreed to smoke Brown and Williamson cigarettes in six movies for $50,000. These documents provided the first clear and comprehensive look inside the tobacco industry during the period in which the modern "smoking and health controversy" developed.

What do they show? Quite simply, that BAT and Brown and Williamson had known nicotine was an addictive drug and that smoking probably caused cancer since at least the early 1960s, that they had conducted extensive, high quality - and secret - research on nicotine addiction and cancer that was years ahead of what was going on in the academic community, and that they had developed and implemented sophisticated legal, public relations, and political strategies to keep this information away from the public, the government, and the courts.

BAT's inside and contract laboratories developed extensive, sophisticated, and honestly reported medical and scientific research into the pharmacology of nicotine and how smoking could cause cancer and other diseases. In the 1960s, BAT management viewed nicotine as a "beneficial drug" that both stimulated and relaxed the user. They also recognised smoking as an excellent way to deliver the drug. The problem, however, was that the smoke had other things in it which caused disease. The goal was to identify and remove or neutralise these dangerous compounds.

This reasonable goal and the research that supported it, however, created major legal and political problems for the tobacco industry, which was publicly claiming - as it does to this day - that there was no evidence that smoking caused any disease whatsoever. Over time the industry exerted increasing control over what scientists could study and write in an effort to avoid creating a record that could undercut the industry in court.

In contrast to the high quality of the "private science", the industry also organised "public science" through a large and sophisticated network of scientists and other academics financed through secret "special projects". These individuals were charged with developing and publishing research to contest the overwhelming and growing case that smoking, and later secondhand smoke, could cause disease and death. This work was then, in turn, used by the industry in its political activities to avoid regulation, in court, and in the media to "create controversy" about the "alleged" dangers of smoking. The financial ties to these scientists, including many in England and Europe, were not disclosed. Instead, their work was presented as work by disinterested outside experts.

More than anything else, the "special projects" show the real contempt that the tobacco industry and its agents have for the truth and the scientific process.

As soon as I started reading them, it was obvious to me that these documents were of tremendous historical importance and that I wanted to write something about them. After getting the documents organised, I recruited a team of specialists on nicotine addiction (John Slade), law (Peter Hanauer), and science policy (Lisa Bero and Deborah Barnes) to work with me.

It was also obvious that this was to be no normal academic undertaking, particularly since some of the documents had also been delivered to the media and my phone was ringing off the hook. After consulting with the University of California's lawyers, I decided to respond to the reporters' questions based on what was in the public record, but to keep my own counsel about the work we were doing until it could be published in an academic forum. Even so, word spread quickly that I had the documents, and I was besieged with reporters, government officials, and lawyers who wanted to examine the documents.

While I made them available to anyone who asked, I also asked them not to disclose that I was the source, because I wanted to spend my time studying the documents and writing about them, not dealing with the inevitable lawsuit from the tobacco industry. The press cooperated, and those that obtained the documents from me simply identified the source as "a professor".

Indeed, about the only one who did not know that I had the documents was the tobacco industry, which assumed "the professor" was Richard Daynard, a professor of law at Northeastern University who specialises in tobacco litigation. Brown and Williamson subpoenaed Professor Daynard, demanding any relevant documents from his files. To protect us and buy us time, Professor Daynard fought the subpoena on legal grounds for several months, until it was dismissed.

At the same time, the constant stream of people wanting to see and copy the documents was becoming a real nuisance, so I gave them to the University of California San Francisco Library, which put them into the archives and special collections and made them available to the public.

Over the next several months, the document collection grew to about 10,000 pages, with the addition of documents that Brown and Williamson made public in an effort to counter stories in the press, documents produced at the request of the US Congress, and some personal papers from S. J. Green, former BAT chief scientist and member of the BAT board of directors.

We continued quietly reading and analysing the documents until early January 1995, when a lawyer representing a nonsmoking barber who had contracted lung cancer from seemingly breathing secondhand tobacco smoke tried to get the documents accepted in evidence. In response to tobacco industry claims that the documents were "secret'', he told the court that since the documents were in the (public) University of California Library, they were obviously not secret. At the time, the judge was unmoved, but Brown and Williamson now knew where the documents were.

Brown and Williamson's lawyers demanded that the University of California immediately take the "stolen'' documents out of the library and return them to Brown and Williamson. They also demanded to see the circulation records so they could see who had looked at the documents, a violation of California law which guarantees the privacy of library circulation records. They also sent private investigators to stake out the library and observe people entering and leaving the archives.

When the university refused to turn over the documents, citing its public obligation to disseminate knowledge, Brown and Williamson sued.

In the meantime, we had finished what became a book-length analysis of the documents as well as a series of five related articles that we submitted to the Journal of the American Medical Association, one of the world's leading medical journals. We also retained a top agent in New York City to find a publisher for our book. Our agent thought the manuscript was good, the topic hot, and assured us that she could sell the book in two weeks.

She was wrong. The manuscript was turned down by more than 30 of America's leading commercial publishers, as well as several academic publishers. Some editors found the topic dull or the book too technical. But many were excited about it; several called it the "Pentagon Papers of Tobacco" and excitedly asked if I would be willing to do a book tour and work on aggressive publicity.

Then their lawyers got in the act. All agreed that we had done good work and all agreed that Brown and Williamson and British American Tobacco would not be able to bring a successful libel suit against the publisher, but they warned that it could be expensive to get even a frivolous suit dismissed and all the potentially interested publishers - including Oxford University Press - decided that, despite the book's importance, it was just too risky.

To make life even more interesting, some of the tobacco industry's Republican allies in the US Congress attempted to force the US National Cancer Institute to cut off my research funding, funding which, in part, had supported our analysis of the Brown and Williamson documents. After a long battle, in which the academic community, the National Cancer Institute, and the American Cancer Society, among others, rallied, Congress backed down and my research has continued.

Meanwhile, the reviewers and editors of the Journal of the American Medical Association had reacted favourably to the manuscripts we submitted there and wanted to publish them. JAMA accepted all five papers and devoted essentially the entire July 19 1995 issue to our discussion of the Brown and Williamson documents, together with an accompanying editorial signed by all the trustees of the American Medical Association that was a ringing denunciation of the tobacco industry. The JAMA articles attracted worldwide attention and, according to press reports, helped convince President Bill Clinton to allow the US Food and Drug Administration to move forward in its plans to regulate cigarettes and other tobacco products as drug delivery devices.

By the time the JAMA issue was published, the university had prevailed in court, by arguing that the university had done nothing wrong and that the constitution's first amendment - which guarantees free speech - and the public interest demanded that the library be allowed to make the documents available to the public. The library not only put the documents back on display in the library, but it put them on the Internet World Wide Web for all to see. (They are available at http://www.library. ucsf.edu/tobacco.) Since July 1995, when the documents went up on the web, more than 420,000 pages of documents have been distributed throughout the world.

All the commotion also convinced the University of California Press that they should publish the book, which was published in America in May as The Cigarette Papers. (The book is now also available in England as well as on the Internet on a subscription basis at http://www.library. ucsf.edu/tobacco/cigpapers.) While the tobacco industry has grumbled, it has not sued anyone. And, by academic publishing standards, at least, The Cigarette Papers is a bestseller.

BAT's worst nightmares about the documents came true last month, when a Florida jury awarded a smoker $750,000 to compensate him for the lung cancer he developed because he smoked. The evidence in the documents that the tobacco industry did not level with the public played a key role in the jury's decision to hold the tobacco industry accountable. This case is but the first of a flood of cases that will come to trial in the next months and years in the US.

The tale of the Brown and Williamson documents and our research and publication efforts illustrate the important role that universities play in society. The real commitment of the University of California and the Journal of the American Medical Association to free enquiry, academic freedom, and publication in the face of the tobacco industry made our work possible and, in the long run, will save some of the millions of lives tobacco takes worldwide every year.

It also highlights how large numbers of other institutions, though they recognised the importance of our work, refused to risk the ire of the tobacco industry. The tobacco industry depends on the willingness of individuals and institutions to hide from the fundamental issues raised by the tobacco industry and its behaviour.

The tobacco industry's behaviour raises special concerns for academic institutions, who exist to promote an unfettered search for the truth. The tobacco industry, with its secretly funded "special projects," public relations campaigns against legitimate scientists, bullying tactics directed at publishers and the media, refusal to make its extensive knowledge on nicotine addiction and tobacco and disease available to the scientific community, and use of private investigators to stake out a university library is simply antithetical to the defining principles of the university.

The tobacco industry does, however, have one powerful attraction: money, and lots of it. Cigarettes are immensely profitable and the industry can afford to buy a seat at the table in respectable society.

While there are many examples of how the industry uses its money and political connections in The Cigarette Papers, the starkest recent example was Cambridge University's decision to establish a named chair in international relations in honour of BAT's retired chairman, Sir Patrick Sheehy, for Pounds 1,600,000. In making this decision, Cambridge chose to ignore BAT's long history of hiding the truth about tobacco from the public and its victims.

Cambridge's leaders should read The Cigarette Papers and reconsider if BAT even remotely shares the university's goals of discovering and disseminating the truth, the whole truth and nothing but the truth. They may then want to reconsider their decision to sell their good name to a cigarette company.

Stanton A. Glantz is professor of medicine, University of California, San Francisco. The Cigarette Papers is available in the UK from: The University of California Press, c/o John Wiley & Sons.