The Making of the 1964 Surgeon General’s Report on Smoking and Health

Clearing the Air: The Untold Story of the 1964 Report on Smoking and Health

By Charles A. LeMaistre and Donald R. Shopland, with Emmanuel Farber, Eugene H. Guthrie, and Peter V. V. Hamill

San Francisco, CA: University of California Health Humanities Press; 2024

385 pp; $29.95 or downloadable for free at: https://escholarship.org/uc/item/1f84x7hv.

ISBN: 979-8-9899229-2-5

The year 1964 was an important one for human health fortunes. On January 11, US Surgeon General Luther Terry released his much-anticipated report, concluding that cigarettes cause cancer, chronic bronchitis, and several other maladies. The event was held on a Saturday, to prevent a stock market collapse like that caused by the release of Wynder, Graham, and Croninger’s mouse painting experiments in December 1953.

The report itself was not so much new science as a juried review of previous publications. Care was taken not to offend powerful interests: cigarette makers were allowed to veto anyone suggested to serve on the Advisory Committee responsible for drafting the report, and half of those chosen were smokers, half were nonsmokers. And no one was allowed to serve on the committee who had already stated publicly that cigarettes cause harm. The committee in this sense was more like a jury of innocents, or as Charles A. LeMaistre and Donald R. Shopland explain in Clearing the Air: The Untold Story of the 1964 Report on Smoking and Health, “none of the ten Committee members were experts in the field of smoking and health.” Which is also why Michael Shimkin at the National Cancer Institute called it “the Flat Earth Committee.” To put that in perspective, imagine if the authors of today’s Intergovernmental Panel on Climate Change reports were barred from having ever recognized climate change as real!

There’s much that is new in LeMaistre and Shopland’s book. We learn that the Surgeon General’s Committee was originally composed of 11 members, including Herman F. Kraybill from the National Cancer Institute. Kraybill had been named to serve as the committee’s executive director, but in August of 1962 he made the fatal mistake of telling a journalist that the evidence “definitely suggests tobacco is a health hazard.”¹ The industry’s legal goons jumped on this and got Kraybill removed from the committee. It was not enough that he himself was a smoker, or even that his father grew eight acres of tobacco on his farm in Pennsylvania. Kraybill was fired for speaking truth to a hometown reporter.

As for truth, much of the controversy swirling around cigarettes at this time was being ginned up by the industry. The science linking cigarettes to cancer and heart disease had been nailed down by the mid-1950s, and even earlier in Germany and Argentina.² And cigarette makers admitted as much in their internal documents. An epidemiological study financed by Reynolds in the 1940s had shown that smoking causes mouth cancer, and Claude Teague’s clandestine 1953 “Survey of Cancer Research” had noted the confluence of evidence from epidemiology, animal experiments, and chemistry. And in yet another report by the industry’s main PR firm we find two of the companies’ research directors assuming the reality of both cancer causation and addiction: one exclaimed, “Boy, wouldn’t it be wonderful if our company was first to make a cancer-free cigarette”; another remarked on the money that could be made from compulsive smoking: “fortunately for us it’s a habit they can’t break.”³

None of this was shared with the Surgeon General’s Committee. Reynolds also kept secret its 1962 assessment that whereas the evidence linking cigarettes to cancer was “overwhelming,” the evidence against was “scant.” Cigarette makers also didn’t provide the committee with documents from Project Ariel, a secret collaboration between Brown & Williamson in Louisville, BATCo in London, and Battelle Labs in Geneva. Project Ariel, named for Britain’s first satellite, developed an effective nicotine inhaler, designed to deliver addiction without the “unattractive side effects” of cancer and emphysema.⁴ Cigarette makers also concealed their secret Ecusta experiments, conducted by the world’s largest producer of cigarette paper—and tax forms and Bible paper—which showed that it was the tobacco and not the paper that was making cigarettes so lethal.

The Surgeon General’s Committee was called into being by President Kennedy, who on May 23, 1962, was asked at a press conference whether he agreed with reports linking smoking and cancer. Kennedy asked his surgeon general to form a committee to investigate the matter, and although the final report got a lot right, they also got some things wrong. A chapter on the “Beneficial Aspects” of tobacco, for example, concluded that smoking was a “habit” rather than an “addiction.” The author of that chapter, Maurice Seevers, had previously worked for the industry; cigarette makers also appointed him (in 1964) head of the American Medical Association’s Education and Research Foundation (AMA-ERF) with $18 million from the industry. Cigarette makers by this means forged a 15-year alliance with the AMA, during which time that august body refused to say that cigarettes cause cancer and denied there was any need for warnings. In 1986, when Don Shopland was asked about the AMA’s cozying up to Big Tobacco, he quipped that the medical association “should be horsewhipped.”⁵

The formation of the AMA-ERF is only one of several ways the industry tried to undermine the report. Most remarkable, perhaps—and new to me from reading this book—is that cigarette makers pressured their friends in Congress to remove the surgeon general as head of the US Public Health Service. The Public Health Service had been captained by the surgeon general for nearly a century, but cigarette makers successfully pressured President Johnson to demote and defang that office. The Office of the Surgeon General was “technically abolished” in 1967, and Clearing the Air tells how its eviscerated support staff—the National Clearinghouse for Smoking and Health—was moved from Washington, DC, to a former girl’s dormitory at Emory University in Atlanta.

Cigarette makers accelerated their attacks in the 1970s, with the Tobacco Institute launching its “Truth Squad” and “College of Tobacco Knowledge”—and dozens of other bodies designed to deny or distract from cigarette harms. The industry by this time was riding high, with total consumption not peaking until 1981—when more than 630 billion cigarettes were smoked in the United States. Clearing the Air points out that President Nixon in 1973 fired Surgeon General Jesse Steinfeld for raising the secondhand smoke alarm, and for several years thereafter we didn’t even have a surgeon general. Other courageous public servants eventually stepped up, like Joseph Califano, who revived the Office on Smoking and Health (in 1978) and became the first secretary of health to recognize smoking as “slow motion suicide” and the nation’s “leading preventable cause of death.”

Clearing the Air has had a long gestation. Charles LeMaistre, one of the 10 original members of the committee, proposed the volume more than 20 years ago but died before it could be brought to completion. Donald Shopland, the only surviving author, was only 18 when he started working as a staffer for the committee and would go on to have a long and courageous career in public health.

Much of the book reads as a day-by-day chronology, with fascinating observations on the sense of fear surrounding preparation of the report, and the enforcement of military-grade security. Readers will learn about a disturbing effort in May 1963 to force the report to a premature ending, causing a mini revolt within the committee to reassert its independence.

Rose-colored glasses have led many people to celebrate the report as the beginning of the end of tobacco, but the reality is that most cigarette deaths have occurred in the decades since. American cigarette makers in 1963 spent only about $250 million marketing cigarettes, but 40 years later they were spending more than 60 times that amount ($15.1 billion in 2003).⁶ We still live in a world where the leading preventable cause of death is trivialized as a “personal” or “lifestyle” choice, a world where shark bites get more attention than the daily toll from smokes. If 1964 was a fruitful beginning, we still have a ways to go to understand the depths of Big Nic’s chicanery,⁷ and how best to escape from its frightful clutches. This fine book will help us move in that direction.