The “Father of Stress” Meets “Big Tobacco”: Hans Selye and the Tobacco Industry

Abstract

The concept of stress remains prominent in public health and owes much to the work of Hans Selye (1907–1982), the “father of stress.” One of his main allies in this work has never been discussed as such: the tobacco industry.

After an analysis of tobacco industry documents, we found that Selye received extensive tobacco industry funding and that his research on stress and health was used in litigation to defend the industry's interests and argue against a causal role for smoking in coronary heart disease and cancer.

These findings have implications for assessing the scientific integrity of certain areas of stress research and for understanding corporate influences on public health research, including research on the social determinants of health.

An analysis of internal tobacco industry documents since the 1990s has revealed extensive efforts by the industry over decades to undermine the scientific evidence on smoking and health. These efforts include commissioning research from pro-industry scientists to challenge scientific findings and offer alternative explanations. To this end, the industry created the Council for Tobacco Research (CTR) in 1953, initially known as the Tobacco Industry Research Council, to fund research with significant “adversary value.”¹ Award letters for CTR “special projects” instructed recipients not to disclose that such research was undertaken predominantly for litigation purposes¹ or that industry legal reviews, rather than the normal scientific peer review process, served as the basis for publication.^2–4

Previous analyses have shown how scientists were used to defend and promote smoking, thus giving the impression of “a chorus of seemingly authoritative voices from respected institutions around the world spreading damaging arguments designed to benefit the tobacco companies and damage health.”⁵ Smoking bans to protect against secondhand smoke (SHS) were undermined by paying scientists to disseminate industry messages in the United States.⁶ In Europe, the industry attempted to infiltrate the World Health Organization's cancer research arm and the International Agency for Research on Cancer; under what was known as “Project Whitecoat,” it aimed to recruit “groups of scientists [that] should be able to produce research or stimulate controversy in such a way that public affairs people in the relevant countries would be able to make use of or market the information.”^7,8 In China, British American Tobacco funded liver disease research to divert attention from SHS.² It has also been shown that social scientists were used to promote smoking in many countries, including the United Kingdom, the United States, Australia, New Zealand, South Africa, and Germany.⁵

We analyzed another important strand of tobacco industry–funded research not hitherto described: the relationship between stress and illness. Stress is regularly cited as an important social determinant of health.^9–15 Contemporary research on stress, however, must take into account the decades-long support by the tobacco industry for stress-related research beginning with the role of physiologist Hans Selye (1907–1982). Selye developed the concept through animal studies from 1933 to 1945^16,17 and popularized it in many best-selling books.¹⁸ In 1977 he retired and set up the International Institute of Stress in Montreal and the Hans Selye Foundation to fund stress research.¹⁹ Selye drew parallels between his own career and that of the chemist and microbiologist Louis Pasteur.¹⁷ He died in 1982, having been hailed the “father of stress.” During his career, he wrote 1700 articles and 39 books, was nominated for the Nobel Prize 10 times, and received the Order of Canada, one of the country's highest honors.^20–22

Selye's links to the tobacco industry have not been hitherto examined, to our knowledge. We analyzed internal industry documents and describe how the industry funded his work, used him as an expert witness in legal proceedings, and made extensive use of his research for litigation and public relations. Our findings raise important questions about assessing the scientific integrity of stress research and about the scope of the industry's influence on public health research and policy.

METHODS

We reviewed internal tobacco industry documents by searching the Legacy Tobacco Documents Library (http://legacy.library.ucsf.edu) using as keywords relevant terms (i.e., “stress,” “cancer,” “heart disease,” “personality,” “emotional,” and “psychological”) and individuals (Selye and his industry contacts). This initial search identified 6225 documents, most of which we assessed as not relevant to this specific analysis (e.g., bibliographies citing papers on stress). We downloaded 594 documents and coded them according to whether they related to Selye, his research, his funding, or the industry's use of stress research. From this we identified a subset of documents directly relevant to Selye's work with the industry (cited herein). We used triangulation with secondary sources about Selye, his published work, and tobacco litigation to validate findings from industry documents.^3,23

RESULTS

Contact between Selye and the tobacco industry appears to have been initiated in 1958 when he wrote to the American Tobacco Company seeking funding. Although his request was declined,²⁴ the following year Edwin Jacob (of New York law firm Davis, Polk, Wardwell, Sunderland, and Kiendl) wrote to him when preparing a defense against liability actions brought against tobacco companies. Jacob explained that the firm wished to argue that a statistical association between smoking and cancer is not proof of causality:

We should very much appreciate it if you would … give us the benefit of your views as to the medical material we might use. For example, we should be very interested in demonstrating that medicine has previously seen striking correlations suggested as representing cause and effect, only later to find that the significance, if any, of the correlations was otherwise.²⁵

The firm offered to pay Selye US $1000 to produce a memorandum to that effect. Selye agreed but would not testify and preferred not to be quoted.²⁶ He eventually wrote 2 memos (unavailable in existing collections).²⁷

In 1966 industry lawyers including Alexander Holtzman, counsel for Philip Morris, and William Shinn, counsel for Lorillard, Philip Morris, and Brown & Williamson, again contacted Selye.²⁸ Writing to industry lawyer David Hardy (Shook, Hardy, and Bacon), Shinn noted that Selye's earlier memoranda were problematic: “I think we were all aware that the problem with the memoranda which had been prepared earlier was [that] the approach appeared to be one that conceded some carcinogenic factor in tobacco.”²⁹

Shinn also reported that Selye was willing to write a paper on smoking and stress but wanted guidance on what to write. He noted that “Dr. Selye should comment on the unlikelihood of there being a mechanism by which smoking could cause cardiovascular disease.” Selye could also emphasize the “stressful” effect on the US population of antismoking messages. Selye met again with industry lawyers in January 1967 to advise how the industry should adopt a defense emphasizing the “prophylactic and curative” aspects of smoking.^28,30,31 Shinn reported that at this meeting Selye recalled and retrieved the 2 memos he had written previously. In May 1967, Shinn set out his “ideas on Selye” in a letter to Holtzman and outlined the procedure for using his work on stress: “The desirability of adjusting to a stressful life by seeking diversions … would be established as a general proposition… . The theory should be promulgated through articles, books, TV appearances etc… .” with the “creation of [the] image of smoking as a right for many people—as a natural act for man.”³²

This reference to “diversions” reflected Selye's view that disease was a result of unsuccessful adaption to environmental stimuli.¹⁷ This stress could be counteracted by other stimuli, a process he called “deviation,” of which smoking was a form.

Publicly, Selye did not declare his consultancy work for the tobacco industry. In a 1967 letter to Medical Opinion and Review, he argued against government overregulation of science and public health, implying that his views on smoking were objective: “I purposely avoided any mention of government-supported research because, being too largely dependent upon it, I may not be able to view the subject objectively. However, I do not use … cigarettes so let these examples suffice.”³³ Though not a cigarette smoker, he did smoke a pipe.²⁹

In June 1969, Selye (then director of the Institute of Experimental Pathology, University of Montreal) testified before the Canadian House of Commons Health Committee against antismoking legislation, opposing advertising restrictions, health warnings, and restrictions on tar and nicotine. When approached by Philip Morris in March 1969, he initially declined; according to Holtzman,

He told me during an interview last Friday that he has no information to give the Parliamentary Committee since we had declined to support his proposal more than a year ago. He felt that if the work had gone forward, he might, by now, have had some results.³⁴

A week later the proposal was recirculated within Philip Morris, and on March 28 William Hoyt (CTR executive director) informed Selye that he had been awarded US $50 000 per year for a 3-year “special project,” with another US $50 000 a year pledged by the Canadian tobacco industry.^35,36 Subsequently, Selye testified on June 12, 1969,^37,38 arguing the benefits of smoking and arguing against antismoking messages:

the question is not “to smoke or not to smoke,” but to smoke or drink, eat, drive a car—or simply fret. Since we cannot discard our surplus energy, we must occupy it somehow … that often more damage is done by creating, through well-meant crusades of enlightenment, innumerable hypochondriacs whose main sickness is really the fear of sickness.^39,40

A few days later he appeared on a Canadian Broadcasting Corporation radio program citing the benefits of smoking for people under stress, such as expectant fathers and condemned criminals.⁴¹ In July that year Helmut Wakeham (Philip Morris director of research and development) recorded that Selye would be available as a consultant.⁴²

However, although keen to benefit from his supportive statements, privately some in the industry saw Selye's work as “not really pertinent to the task of proving the benefits of smoking in overcoming stress.”⁴³ Nonetheless CTR continued to fund Selye, and the tobacco industry continued to cite the concept of stress in litigation and public inquiries. Selye wrote to CTR again in 1971 seeking further funding,⁴⁴ and in 1972 “special project” funding for Selye's work was awarded, amounting to a further US $50 000 per year for 3 years.⁴⁵ Industry lawyers appear to have influenced the content of some of Selye's writings:

He is willing to write for us and wants us also to provide a suggested guideline… . Dr. Selye should comment on the unlikelihood of there being a mechanism by which smoking could cause cardiovascular disease… . Dr. Selye can point out that even if cigarette smoking had some carcinogenic effect … it might account for only a markedly small number of deaths, the balance being the result of other influences… .^28,30,31,46

Philip Morris subsequently used Selye's statements on the benefits of smoking to argue against the use of health warnings on tobacco products in Sweden⁴⁷ as well as in other rebuttal materials.⁴⁸ Similarly, in 1977 the Australian Cigarette Manufacturers quoted Selye extensively in their submission to the Australian Senate Standing Committee on Social Welfare.⁴⁹ In 1990, the Tobacco Institute of New Zealand deployed the stress argument to criticize a Ministry of Women's Affairs policy document on female smoking:

Clearly it is not the “glossy images of advertising” which draw these women to smoke. The problems as depicted reflect a high level of stress… . Perhaps the Ministry could address the stress problems … rather than the alleviators of the stress.⁵⁰

The San Martin Conference

Selye was a key contributor to a major Philip Morris initiated conference in January 1972.^51,52 The event, the Conference on the Motivational Mechanisms of Cigarette Smoking held on San Martin in the French Antilles, involved prominent behavioral and social scientists, and all 6 major tobacco industry companies attended. Internal documents noted that “the conference will provide authoritative statements in support of smoking. These statements can become the basis for a pro-cigarette public relations campaign.”⁵³

William Dunn (Philip Morris assistant principal scientist) observed that, although 16 of 23 attendees had received support from the tobacco industry, some had also been funded by other organizations, including the American Cancer Society and the National Institutes of Health.⁵⁴ Along with the speakers’ stature, he believed this ensured that “no question could possibly be raised by the scientific community about the objectivity of the conference … the published proceedings will be credible to the scientific community.”⁵⁴

Dunn also described an informal discussion with Selye to Helmut Wakeham (Philip Morris vice president of research and development) after the conference, suggesting that Selye was interested in the scientific directorship of CTR:

Professor Selye's world eminence makes his name a most valuable commodity. The association of his name and presence with a research institute or foundation would be a most beneficial arrangement for all concerned.⁵⁵

This did not happen, however, possibly because of doubts about the relevance of Selye's work.

The perceived importance of the 1972 San Martin conference to the industry is clear from a scribbled note on an internal memo: “This is probably the most important conference ever for the tobacco industry. Every word should be taped and transcribed.”⁵⁶ Publication of the conference proceedings as a book (titled Smoking Behavior: Motives and Incentives) followed, subsidized by the CTR.⁵⁷ Cigarette manufacturers’ evidence to the Australian Senate Standing Committee on Social Welfare in 1977 quoted the proceedings, and Selye, at length. Selye's contribution had been edited and partly rewritten by Robert Hockett, the acting scientific director of CTR, with other modifications suggested by Dunn.^58–60

The International Committee on Smoking Issues Working Party, set up by tobacco companies to agree with industry positions on issues that “affect the long-term interests of the tobacco industry primarily in the area of smoking and health,”⁶¹ also noted the importance of the San Martin conference as a “starting point for its work.”⁶² The 1983 British American Tobacco Board Guidelines on Public Relations—which set out general strategies for dealing with government, medical authorities, and the media—cite Selye's foreword.^63,64 Philip Morris also cited the book in 1995 as an example of the industry's openness when rebutting accusations of secrecy by US congressman Henry Waxman:

Why does Mr. Waxman characterize Philip Morris's research interest in why people smoke, including the possible role of nicotine, as “secret” when a scientific conference on this subject was organized by a Philip Morris researcher in 1972, and papers from the conference were published in a 1973 book? The book … is available in public libraries and has been cited more than 500 times in the scientific literature.^65,66

Selye also appeared in a Tobacco Institute public relations film, The Answers We Seek, described by the industry as “an honest, no-punches pulled look at the facts about tobacco and health” and produced in 1976 for free circulation to community and civic organizations.^67,68 A 1977 memo from Ray Fagan (Philip Morris scientist) to Robert Seligman (Philip Morris vice president of research and development) noted that another film had been made that included Selye and British psychologist Hans Eysenck, also a tobacco industry consultant and, like Selye, a recipient of CTR special project funding.⁶⁹ Fagan noted that “the film's message is quite clear without being obvious about it—a controversy exists concerning the etiologic role of cigarette smoking in cancer.”⁷⁰

In July 1977 Selye sent details to RJ Reynolds of other scientists working on stress who, he believed, could be approached as potential consultants.⁷¹ By this time, however, Selye's value to the industry may have been dwindling. That same year he sought US $50 000 from RJ Reynolds to support the development of a US $1 million project on coping with stress.^72,73 This request was not well received. One memo described Selye as showing signs of senility and having “contributed little to the field in the last 10 to 15 years.”⁷⁴

Despite this cooling of relations, the industry continued to use Selye's prosmoking statements. This is highlighted by the Tobacco Institute's 1978 publication “The Smoking Controversy: A Perspective,”⁷⁵ a document Landman described as “one of the most strongly-worded and comprehensively-misleading missives issued by the industry … written before the industry chose its words more carefully.”⁷⁶ It quotes Selye at length, stating, for example, “It is frightening that no-one mentions the benefits of tobacco … I am sure that often more damage is done by creating, through well-meaning crusades of enlightenment, innumerable hypochondriacs… .”^75,77

Stress as One Risk Factor Among Many

Even after Selye's research had fallen out of favor with the industry, stress research continued to be used to stoke controversy. In particular, it was often argued that the causes of cancer and heart disease were multifactorial (with stress being 1 factor), with any observed relationships with smoking probably attributable to confounding, or that smoking was a helpful diversion. These arguments were promoted in academic papers written by industry consultants.^78–80

Stress research was used in this way. A 1981 British American Tobacco document cited Selye's claims that the association of smoking with cardiovascular diseases is relatively weak compared with other factors, including stress.⁸¹ This was also used as an argument against the carcinogenic effects of SHS.⁸² Stress is similarly put forward as an alternative to what was termed “the smoking hypothesis” in a 1989 British American Tobacco document written for circulation to UK government ministers, regulatory authorities, and scientific and medical professionals.^83,84 Similar arguments were rehearsed in other documents,^85–87 including briefing materials.^88–90 For example, the suggested response to the question “Does smoking cause disease?” is the following:

While some scientists have associated cigarette smoking with heart disease, it is reasonably [here, the word “reasonably” has been deleted, and the word “certainly” inserted] clear that a number of other factors including life-style, blood pressure, biochemistry, genetics and in particular, stress, may also be involved.^91,92

British American Tobacco also used the multifactorial argument in 1994 to argue against restrictions on smoking in Uzbekistan as part of the “Tashkent Decree,”⁹³ and stress was cited by Irish company PJ Carroll Limited (then part of Rothmans International) in a statement to the Irish Joint Committee on Health and Children in 1998: “These diseases are also statistically associated with many other variables, such as diet, lifestyle, heredity and stress… . But the existence of a statistical association does not mean that smoking causes these diseases.”⁹⁴

Similar arguments were made in the Irish and Brazilian courts.^95–98 In 1995 industry lawyers Shook, Hardy, and Bacon supplied Philip Morris with a detailed summary of the epidemiological evidence linking workplace stress and heart disease⁹⁹ to be used as an argument against the US Occupational Safety and Health Administration plan to regulate workplace SHS. Stress was also used as an argument against giving up smoking in a 1979 BMJ paper by tobacco industry consultant Peter Lee.¹⁰⁰

DISCUSSION

The extent to which the tobacco industry sought to undermine the scientific process relating to tobacco and health is well documented. Our study shows that the concept of stress is a further area of public health research that has been subject to extensive tobacco industry influence. Using the categories of industry influence identified by Gruning et al.,¹⁰¹ Selye's expert evidence diluted existing evidence of the adverse effects of smoking and distracted attention from its harms. In failing to declare his receipt of tobacco funding when expressing his views against tobacco control, documents suggest he concealed a lack of scientific independence; and by involving tobacco industry lawyers, Selye allowed the industry to manipulate the scientific process.

Assessing the public health effect of the industry's influence on stress research is difficult. Although Selye spoke out against smoking restrictions, there is no clear trail between his research and policy decisions. Rather, his research added to a multipronged effort by the industry to cloud public debate about tobacco and health, and his role as expert witness, consultant, and “talking head” in industry publications and films lent scientific credibility to industry efforts to undermine tobacco control. Since 1999, as part of an antiracketeering case brought by the US Department of Justice against 7 tobacco companies (British American Tobacco, Brown & Williamson, Philip Morris, Liggett, American Tobacco Company, RJ Reynolds, and Lorillard), the CTR, and the Tobacco Institute, the implications of the industry's influence on stress research has begun to be revealed.¹⁰² Among the 116 racketeering acts listed in the legal action successfully concluded in 2006 and upheld in May 2009,¹⁰³ Act 15 states,

CTR proposed to support and publicise research advancing the theory of smoking as beneficial to health as a stress reducer, even for coronary prone persons; [and] representing that stress (rather than nicotine addiction) explains why smoking clinics fail … and proposing to publicize the image of smoking … as a scientifically approved “diversion” to avoid disease-causing stress.¹⁰²

Racketeering Act 25 related to the 1973 San Martin conference, whose organization and communications were deemed to be in violation of anti-racketeering laws. Racketeering Acts 44 and 45 related to a 1979 proposal to fund research on stress and cardiac disorder by British psychologist and tobacco industry consultant Hans Eysenck.^102,104 Selye's letter to Robert C. Hockett (CTR) regarding this project's “elimination of arguments presently used against smoking” violated US Code Title 18 §1341 (“Frauds and Swindles”).^105,106 CTR support of Selye was also cited in The State of Florida v. The America Tobacco Company et al. as part of the plaintiff's case, citing the tobacco industry's “perversion of the lawyer-client relationship as well as the language, mechanisms, and institutions of scientific research.”¹⁰⁷

Selye remains a significant figure in this field, and at the time of his induction into the Canadian Medical Hall of Fame in 2006,¹⁰⁸ it was suggested that the time was ripe for a comprehensive evaluation of his life and work.¹⁶ Such an evaluation should include the extent to which his research on stress was entwined with tobacco industry interests.

Our findings also point to the tobacco industry's broader interests in research in to the social determinants of health. For example, there are many industry documents relating to unhealthy lifestyles, and in the 1990s British American Tobacco–funded research on fetal programming.^109–112 This suggests the need for further analysis of the extent to which the tobacco industry has played a role in funding contemporary public health research.¹¹³ These findings relating to Hans Selye also have wider implications, given similarities between tobacco industry strategies and those used by the food industry, including disputing the science, focusing on issues of personal responsibility, and using paid scientists to attempt to influence key decision-making bodies.¹¹⁴ The case of Selye, therefore, has implications, not just for how the tobacco industry sought to influence research on stress but also for understanding corporate influences in general on public health research and policy, and it strengthens the case for improved disclosure of all industry influence on research.