ASHES TO ASHES

EXCERPT

Pages 364-367

 

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ASHES TO ASHES                                                                   Pages 364-367

 

 

Too feisty a Surgeon General

 

 

THE NIXON ADMINISTRATION was no more eager to involve itself in the issue of smoking and health than any of its predecessors, but through benign neglect – its chief policy instrument for addressing the problems of poverty – it also performed two useful services for the public-health camp.

First, it did not try to derail congressional passage of the ban on broadcasting cigarette ads. And it tolerated, at least during Nixon’s first term, two employees within the HEW Department complex who were avowed, active foes of smoking. One of these was the outspoken Surgeon General, Jesse Steinfeld, whose public remarks on smoking were far more passionate and sweeping than those by any of his predecessors. The other was the director of one of the smallest fiefdoms in the federal bureaucracy – the quirky, rumpled intellectual Daniel Horn, now running the National Clearinghouse on Smoking and Health, which never employed more than thirty or had an annual budget much above $2 million throughout the nine years he ran it.

Coming from USC to the National Cancer Institute as a ranking administrator in 1968, Steinfeld had been tapped by the Nixon White House to be deputy assistant secretary of HEW, with oversight of the National Institutes of Health and the Food and Drug Administration. Although beset by the war in Vietnam and problems of crime, drugs, racial and generational strife, and inflation, the Nixon administration did not ignore health issues. It put major new funding into cancer research, helped launch the Environmental Protection Agency, and countenanced such un-Republican measures as a federal role in fluoridation of the U.S. drinking water supply and the banning of cyclamates, the widely used artificial sweetener, because it had been found, in dosages fifty times the equivalent of human use, to cause bladder cancer in laboratory rats. Steinfeld was deeply involved in these last two issues, showing himself to be an aggressive government interceder in the public-health area and overcoming resistance at the FDA to his conviction that there was no safety threshold, or tolerable minimum, for carcinogens ingested by humans – a view that also made him keenly attentive to the perils of smoking. “But I had no mandate on the smoking issue,” Steinfeld recalled, and he did have plenty of other pressing matters to deal with when named Surgeon General, including the hazards of pesticides, a widespread infestation of fire ants, restrictions on phosphate detergents, and the effects of television on children.

 

 

 

 

 

ASHES TO ASHES                                                                   Pages 364-367

 

 

But Steinfeld did ally himself with the U.S. Clearinghouse on Smoking and Health, and especially its most visible achievement, the annual Surgeon General’s report to Congress. Unlike the initial 1964 report by a panel of outside experts, the later reports were carpentered by the Clearinghouse staff and amounted to little more than a synthesis of old and new studies and data, issued under the Surgeon General’s signature. Steinfeld ordered an upgrading of the report, and the result in 1971 was a 488-page document, the largest ever, calling attention to important new developments in smoking research. Among these was the matter-of-fact-and quasi-official endorsement of Oscar Auerbach’s beagles study, so assiduously assaulted by the tobacco industry: “Lung cancer has been found in dogs exposed to the inhalation of cigarette smoke over a period of more than two years.” Findings were noted that paralleled the secret and by then aborted studies by Reynolds Tobacco researchers on an enzyme known as alpha1-antitrypsin, which counteracted substances in the lung that attacked the linings of the air sacs and thus promoted emphysema. Maternal smoking during pregnancy now stood accused of a retarding effect on fetal growth (manifested by low birth weights) and contributing to the chances of premature delivery. Most striking of all was a number of new studies on the possible effects of carbon monoxide (CO) in smoke as a promoter of heart disease, in particular atherosclerosis. Animal studies, most prominently those by Danish investigator Paul Astrup and his associates, were now showing that heightened levels of CO in the bloodstream of smokers were associated with increased permeability of blood vessels, inviting infiltration by fatty lipoproteins that accumulated on arterial walls and led to the buildup of obstructive plaque, a major cause of heart attacks. Related studies suggested that insufficient oxidation caused by smoking, due to CO’s affinity for – and, in effect, molecular replacement of – oxygen in hemoglobin, had complex metabolic consequences for human tissue, such as a decreased ability to break down carbohydrates. Building on these studies over the 1970s, other investigators concluded that CO levels in smokers of filter brands might actually be higher than in those who used the unfiltered product because the filter material and wrapper were less porous than plain cigarette paper, which allowed more of the gas to escape. This phenomenon prompted manufacturers to add tiny holes around the filter in compensation.

 

 

 

 

 

ASHES TO ASHES                                                                   Pages 364-367

 

 

Despite this substantive new contribution by the 1971 Surgeon General’s report, the Tobacco Institute’s Horace Kornegay dismissed the document by asserting, “The question of health and smoking is still a question,” and noting the rise in cigarette consumption the previous year; the latter suggested to Kornegay that the American public was not so gullible as to buy the Public Health Service’s “high-priced publicity campaign.” Such denigration of the findings of the nation’s highest-ranking health officer represented a new level of scorn heaped by the tobacco industry’s designated spokesmen upon the labors of scientists around the globe who were dedicated to learning the truth about smoking and not, like the industry’s paid and unclean hands, to hiding it.

Steinfeld’s 1972 report on smoking and health was worse news yet for the industry. In it, for the first time, the Surgeon General dwelled on the likely hazards of secondhand smoke – the stuff in the air either exhaled by smokers or emitted from the burning tip between smokers’ puffs. This was a daring initiative – possibly even imprudently premature – because there was as yet very little scientific evidence to support it, and there seemed to be no practicable way to measure exposure levels and dilution rates. Steinfeld was caught up with the dangers of environmental pollution, now an official target of federal public health guardians, and to him, secondhand smoke was precisely that – an environmental pollutant – and an obvious peril to those already impaired with heart or respiratory disease.

“Biologically it had to be,” Steinfeld recounted, “and laboratory experiments showed that no animal smoked voluntarily – there was systemic resistance and histologically observable [by microscope] changes in the cells of exposed animals,” which were, in effect, passive (or secondhand) smokers. He was convinced that secondhand smoke was also implicated in the deaths due to lung cancer of nonsmokers – “not  a trivial problem,” he commented, since as many as 15 percent of the overall lung cancer toll of about 65,000 a year at that time occurred among nonsmokers, a sizable portion of whom were no doubt environmentally exposed to tobacco smoke by their spouses or co-workers. Wherever he spoke, Steinfeld called for a serious investigation of the effects of secondhand smoke and proposed a ban on smoking in such enclosed public places as restaurants, theaters, and mass transit systems – recommendations added at the end of the Surgeon General’s annual reports but regularly removed by Nixon’s Office of Management and the Budget (OMB).

 

 

 

 

 

ASHES TO ASHES                                                                   Pages 364-367

 

 

Steinfeld distanced himself from the tobacco industry by closing his office door to their tireless missionaries. “I would not see the Tobacco Institute lobbyists,” he recalled, despite their eagerness to wine and dine him and wave their data under his nose. Invariably, though, he would run into their representatives at Nixon administration functions or in the office of Steinfeld’s chief, HEW Secretary Elliott Richardson, a man known to harbor presidential ambitions and not above currying favor with allies wherever he might find them. On such occasions, “the tobacco people would give me the business, saying in effect, ‘See, we can meet with the Secretary or top people in government without worrying about the Surgeon General,’”  Steinfeld felt. “There was a message there.” It was manifested in the disappearance of the tiny allocation for the Clearinghouse on Smoking and Health from the 1971 and 1972 budgets until Steinfeld forcefully intervened with the HEW Secretary to have it restored. The Surgeon General, though, would not blunt his attack. His 1972 report stated, “There is no disagreement – cigarette smoking is deadly.”

Steinfeld’s unflinching candor was his political undoing. When the commission under his charge on the effects of TV violence on children made its findings known in 1972, the White House considered them too critical of the broadcast industry and ordered the Surgeon General not to testify on the matter before Congress. But Steinfeld was subpoenaed to appear, and rather than clear his proposed testimony with the administration, which had in the past required him to attest to views he did not fully endorse, he spoke his mind, raking over the broadcasters. For his troubles, Steinfeld was not reappointed for Nixon’s second term. The ouster was strongly endorsed by the tobacco companies, at least one of which reminded the White House of its campaign contributions and urged that the Surgeon General be sent packing. He became head of oncology at the Mayo Clinic, and four years passed before a new Surgeon General was named.

 

 

 

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