Article Text

PDF

“We are anxious to remain anonymous”: the use of third party scientific and medical consultants by the Australian tobacco industry, 1969 to 1979
  1. S Chapman
  1. Professor Chapman is also Associate Direcor, VicHealth Centre for Tobacco Control
  1. Correspondence to:
 Professor Simon Chapman
 School of Public Health, University of Sydney, Building A 27, Sydney, NSW 2006, Australia; simonchapmanhealth.usyd.edu.au

Abstract

Objective: To document the history of visits to Australia by tobacco industry sponsored scientists and news media reports about smoking and health matters generated by their visits.

Design: Systematic keyword and opportunistic website searches of tobacco industry internal documents made available through the Master Settlement Agreement.

Results: At least nine sponsored scientists visited Australia from 1969 until 1979. The industry sought to promote the scientists as independent from the industry and on occasion, scientists publicly lied about their industry connections. The industry was sometimes delighted with the extensive and favourable media coverage given to the visits.

Conclusions: These media reports are likely to have influenced many who were exposed to them to believe that the evidence against smoking remained equivocal.

  • tobacco industry
  • scientific consultants
  • medical consultants

Statistics from Altmetric.com

The overwhelming body of evidence that smoking causes disease has always placed doctors and scientists in the foreground of public statements about tobacco and health. Doctors are assumed to be close to patients’ experience of illness and so bring authenticity to public discourse about smoking. When the epidemiological evidence about the harmful effects of smoking began to build from 1950, the tobacco industry found itself accused increasingly of marketing a product which caused dreaded diseases such as lung cancer. Efforts to defend itself inevitably suffered from questions of self-interest.

Unlike today, when doctors are among the subpopulations least likely to smoke,1 in the 1960s, about a quarter of Australian doctors smoked, prompting tobacco control activists in the period to urge them to not smoke in public.2 As late as 1992, 59% of Australian smokers believed “a lot of doctors smoke”.3 Such debates would have provided fertile ground for the tobacco industry in which to sow the notion that doctors themselves were also divided over the evidence that smoking caused disease.

Not surprisingly then, one of the most enduring themes throughout the tobacco industry’s internal documents is the efforts it made to engage with scientists and doctors working outside the industry, and to involve these people in publicity efforts intended to further its objectives. Several other studies have highlighted the industry’s use of scientists.4,5 This paper reviews the Australian industry’s use of international medical and scientific consultants in its public communications about smoking and health. The paper provides a chronological overview of these efforts, commencing with the earliest examples when visiting consultants were brought to Australia to publicise views that smoking was being unreasonably vilified as a cause of disease.

The evidence cited in this paper was obtained from systematic searches of internal tobacco industry documents made publicly available through the Master Settlement Agreement.9 A full description of our search strategy can be found at:http://tobacco.health.usyd.edu.au/site/gateway/docs/research.htm#search.

THE EARLY DAYS

In the 1950s and 1960s, Australian tobacco retail trade magazines regularly featured news items about international scientists and doctors who questioned and criticised the emerging evidence about smoking and disease.10 Some of this material found its way into the public news media. In 1970, the Australian industry produced a brochure A memorandum to smokers11 containing quotations from what the Sydney Morning Herald described as “seven leading US doctors who, in general, say there is no link proved between smoking and cancer or heart disease”.12 The cover quoted Dr Milton B Rosenblatt, president of the medical board of Doctors Hospital in New York stating that the “concept that cigarette smoking is a cause of the increase in lung cancer and emphysema is a colossal blunder.”11 The Herald reported that some 2500 copies of the pamphlet had been distributed to tobacconists in Sydney. “Tobacconists supplied with copies of the document have been asked to hand them out only to people who talk about the health risks of smoking when buying cigarettes.”12

The earliest mention of the local Australian industry’s interest in touring scientists we have located comes from a suggestion made in 1968 by British American Tobacco (UK)(BAT) following a visit by an Australian BAT official, that certain nations—including Australia—be designated “red territories” whereby local BAT subsidiaries could be alerted via a “warning system” if “particularly favourable or unfavourable scientists and doctors” were about to visit any of the proposed nations.13 When Hugh Cullman, chief executive officer (CEO) of Philip Morris International, visited Australia in August 1969, minutes of the directors’ meeting he attended recorded that it was “planned to invite several well known overseas medical scientists to Australia to speak against the smoking/health link”.14 This was at a time when Australian governments were debating intensely the introduction of health warnings on packs,15 a development that the US tobacco industry saw as establishing “a most urgent need for an early visit to Australia by American experts who might...outline facts about the cigarette controversy to Australian officials and journalists”.16

THE MOONLIGHTING SWEDES

This first of these visitors were Dr Rune Cederlöf and Dr Lars Friberg from the Karolinska Institute in Sweden, whom Philip Morris’(PM) chief legal counsel in the USA, Alex Holtzman, arranged to tour Australia. These researchers had published work on monozygotic twins discordant for smoking where they concluded:“It was not possible to reproduce the association [between smoking and cardiovascular symptoms] when studying monozygotic smoking discordant twin-pairs.” However, they also noted that in their study:“The number of such pairs is admittedly low.”17,

In a classic illustration of how the industry would clutch at even the smallest of hopeful straws from a study with low statistical power, Holtzman believed their findings “might be publicized to good advantage” and noted that Friberg felt he and Cederlöf could “put on a good show”.18 PM USA sought to “find ways and means of having sources other than the industry” to invite the pair.19 The obliging host institution emerged as the University of Melbourne where the head of the department of pharmacology, Professor Michael Rand—someone who would be of longtime value to the industry6 informed PM that he would invite Cederlöf to Australia. PM was paying the bill,20 which amounted to “first class airfares, $U.S.2,000 each for lost income, plus a daily per diem pay-out of $A20 per person”.21 In a candid note written on hotel notepaper, Cederlöf requested that PM pay him cash as the visit caused him “to give up my ‘moonlight’ teaching which I in fact are completely dependent on! I would appreciate to be able to cash the money in the USA before I leave Dec 13. Thanks a lot! Please be discrete about it!”22(sic)

Rand organised for Honorary Associate titles to be extended during their visit.23,24 PM Australia’s Andrew Whist advised:“The next phase of our operation is to make similar arrangements with other universities in Australia.”23,24

The Swedes toured in November and December 1969. Reports of their visit appeared in the Sydney Daily Mirror(20 November 1969)25 and the Adelaide Advertiser(12 November 1969).26 In the Daily Mirror report, they were quoted as saying:“But our other research − and the available literature − has shown there could be an association between smoking and lung cancer.”25 PM’s Whist reported back to New York:“... Lars needs indoctrination, if such a thing is possible, as we had a few edgy moments with journalists. We were able to straighten out some of his statements through personal contact with his interviewers − a fact which he suspected.”27 The Advertiser report was headlined “Smoking link not clear cut”.26

Whist wrote subsequently that he was “disturbed to learn that [Dr Nigel Gray] will visit Lars Friberg in Stockholm. However, I feel sure Lars will protect us following your conversations with him”.28 Whist also suggested that Birgitta Floderus, also from the Karolinska, might be brought out to Australia “provided she is willing to front the media and make helpful statements. She would have to be more committed to our views than Lars if she is to be widely exposed to media, and would have to agree that we remain anonymous as sponsors.”28 We found no record of Floderus having come to Australia.

In 1970, the visits continued with Professor John Wyatt from the University of Manitoba in Canada touring in June. Wyatt’s message was that air pollution was primarily responsible for the differences in the prevalence and severity of emphysema in various parts of the world29 and his performance was far more compatible with the industry’s expectations. His visit was widely reported in all news media which Whist trumpeted to Holtzman as “no mean achievement”.30 In the Sydney Sun’s article headlined “A theory up in smoke”, Wyatt espoused his views on air pollution causing lung cancer and respiratory disease and was photographed smoking.31

Wyatt’s visit was carefully scheduled so as not to clash with a Royal tour by Queen Elizabeth, which would have created insurmountable news competition.28 Again the industry tried to stay out of the limelight. Whist passed word down the line that Wyatt should contact Australian academics that the pretext for his visit was “to discuss the setting up of ‘lung banks’ at the various ports of call” on his world trip.28 Whist reassured Holtzman that “we are anxious to remain anonymous, and we are relieved to hear that Professor Wyatt understands our predicament.”28 Significantly, the aim of the visit was “to get whatever publicity we can, rather than have him address the academic community”.28 Wyatt subsequently went on to become head of the industry sponsored Tobacco and Health Research Institute at the University of Kentucky.32

Dr Sheldon “Charlie” Sommers, described by PM’s Alex Holtzman as “one of our finest spokesmen” who “...has firm and favorable views on the matter of lung cancer and...would be an ideal candidate for [PM Australia’s] program”29 also visited Australia in June 1970. Alex Holtzman (PM USA) wrote to Sommers about preparations for the trip:“... arrangements will be made for television interviews with you in both Sydney and Melbourne... There will probably also be a press interview with you at each city... You will also be invited to meet with Professor Vickerton-Blackburn [sic], who is the head of the recently established Australian Tobacco Research Foundation, the Australian counterpart of CTR. I am sure that the tobacco industry in Australia will appreciate your taking time to help them with their problem.”33

“PROVIDING A CRUTCH TO RATIONALISE SMOKING”

In July 1972, the advertising agency John Clemenger Pty Ltd prepared a commissioned report for the Australian industry “...to combat existing and proposed restrictive legislation on cigarette advertising and promotion”.34 Perhaps stimulated by these early publicity tours, the 30 page report had much to say about the importance of using doctors to counteract tobacco control. “It is highly unlikely that the right sort of man with the necessary experience and qualifications could be found to act as spokesman for the Australian Tobacco Industry. In our opinion, the person required would need to be a medical expert in a great many fields. He would also need to have the ability to present and debate the issues at stake on a face to face basis with Dr. [Nigel] Gray and his counterparts. The agency believes that even if such a man did exist, it would be unwise to give one person the overall responsibility of representing the Industry. Problems of acceptability and credibility would almost certainly arise.”34 Carl Seltzer and Milton Rosenblatt were named as two speakers who could be used to address a “...‘closed shop’ medical debate in each State... This style of approach would not upset the mystique surrounding the medical profession – qualified members of their own kind would be stating personally that ‘a reasonable doubt exists’”.34 Draft press advertisements were written citing these two consultants and a headline proposed “The Doctors Disagree over Cigarettes”. Significantly, the report states “A side benefit of our television campaign would be in the area of cigarette consumption. In our opinion, this could be expected to increase as we are providing existing smokers, doubtful smokers and those who have just quit, a ‘crutch’ to rationalise their smoking habit. We could also expect to receive support for this campaign from the television industry”,34 which at the time was deriving considerable revenue from tobacco advertising which was not banned from television until September 1976.

PM’s Australian smoking and health program was overseen by the company’s New York headquarters, and so the Clemenger proposals were put to PM’s US chief executive, Hugh Cullman:“Consideration could be given to the possible value of influencing a prominent Australian who is not connected with the controversy to say that the controversy should be placed into proper perspective and that Australia has many more important things which should be given prior consideration. Consideration should be given to obtaining comments and quotations from Australian medical sources as well as the other statements which have been obtained from U.S.A. and other non-Australian doctors.”35

A FILM “REASSURING TO SMOKERS”

In April 1970, plans commenced to develop a “film on smoking and health for general release”. It would be shown in cinemas, television and by the manufacturers in the “normal promotions, i.e. theatres, sporting clubs, other organisations connected with or sympathetic to the industry... The film would set out to show that the case against tobacco is not proven. It would pose questions that could be shown to be unanswerable on knowledge presently available... The viewer should be left with the clear impression that there is another side to the smoking and health question, reassuring to smokers.”28 The film would draw heavily on the international coterie of industry consultants and “will be a very valuable addition to our presentation kit which is used for meetings with influential politicians, media chiefs, etc”.36

In July 1974, Andrew Whist wrote what he described as a “serenade” to Alex Holtzman in New York, describing his reaction to footage for the film brought back to Australia from the USA:“[Ted] Sterling is most impressive” and threw blicity we have suffered ever since”.37 He was very unimpressed with Domingo Aviado’s nervous performance:“...the resultant impression is one of lack of clarity and force. Nevertheless, by astute cutting, we might be able to save some of that footage. ... Philip Burch, to my mind, comes across very well and much as we expected. He is long-winded, very scholarly and every bit the image one has of British academics.”37 Whist suggested that two films be made, one of 25–30 minutes and a longer one featuring Burch that “...would be used with restrictive audiences in mind, such as medical scientists and staff members of the various health departments”.37 Whist noted that “our existing film in Europe” appeared to be making a better impression on audiences in the sections that dealt with heart disease rather than lung cancer. “We think this has been brought about by the world-wide stanza of the Anti Cancer Societies...which has obviously had a strong impact on medical people, even on research scientists who ought to remain objective.”37

In a remarkable passage, Whist writes of selectively editing one doctor, Hiram Langston, from future editions of the film:“...we have never been particularly enamoured with Hiram Langston’s argument regarding the occurrence of cancer in both lungs simultaneously... So if and when we include him in our next version, we will simply take that point out.”37 Extensive transcripts of the interviews are available among the documents.38,39

We have located no documents detailing the extent to which the film was screened in Australia, although one document suggests that because of the “emotional heat” generated by the topic, the industry tried to be “...very careful to show the film whenever possible to one or at most two persons”, “...mostly accompanied by a pleasant lunch or dinner...away from the viewer’s own offices or domain, in quiet pleasant settings, nothing too ostentatious or fancy”. Beforehand they would explain “...that there is a considerable amount of disagreement amongst serious scientists on points which have been picked up by legislators and used as an excuse to pass punitive legislation in order to assuage a vocal minority operating from a narrow moral or grossly overstated medical basis”.37

Whist claimed the film had been pivotal in averting tobacco control legislation in Western Australia:“One or two health ministers...changed their mind completely after viewing the film. One such person was the Minister for Health for Western Australia [Ron Davies], a Member of the Socialist regime over there, who was shown the film just prior to some pretty nasty legislation going on the books in that state. Having seen the film, he called in his departmental officers and told them that he had changed his mind and would no longer subscribe to antismoking legislation except if they could come up with conclusive evidence. The impending legislation was scrapped.”37

In October 1974, The Bulletin magazine published an extensive cover story article titled Smoking: new facts and theories.40 The article was an exposition of the views of Leeds University’s Philip Burch, opening with a statement from Burch:“The direct connection between smoking in cancer of the lungs in fact turns out to be something of a modern myth based not on any convincing scientific research but on the circumstantial evidence of a mass of statistics much of which, particularly in the area diagnosis of death by lung cancer, turns out to be very wobbly indeed – under estimated in the past through ignorance and overestimated the present climate of anti-smoking hysteria.”40 Burch’s views were also covered in a newspaper article titled “Are cigarettes really killers?” published in the West Australian News in August 1975.41

In 1976, the industry’s Kansas City legal firm Shook, Hardy & Bacon liaised with PM Australia to have Dr Theodore (Ted) Sterling from Simon Fraser University, Canada to come and speak at a smoking and health conference being organised by the industry in October.42,43 Sterling was a major industry consultant.44 At least two press reports resulted, “Big smoke the real hazard”45 and “Cigarette-cancer link challenged”.46 In the report in The Australian, Sterling’s support from the tobacco industry was acknowledged. He stated:“Let me put it this way... In my long years of service as a consultant to government and industry I have found that whether sponsorship influences what one says depends on the person. One is always viewed as a tool of vested interests. But it doesn’t matter whether somebody is sponsored or not. What matters is whether what he says is an honest presentation of his findings − and my findings are supported by other researchers”.45

Dr Hiram Langston was brought to Australia by the industry in July 1978. Apparently responding to publicity about Langston’s tour, five senior cancer officials held a press conference to counteract Langston’s claims that centred around air pollution being the cause of lung cancer.47

CARL SELTZER

Perhaps the most successful travelling scientist to come to Australia for the industry was Carl Seltzer who toured in May 1979, receiving widespread media coverage48,49 that was regarded as “an extraordinary success”.50 Seltzer was apparently quite active in his willingness to consult for the industry. In March 1978, he wrote to James Bowling at Philip Morris in New York warning him that Dr Abraham Kagan would be soon touring Australia. Seltzer advised:“Since my position [sic] with respect to smoking and heart disease are dissimilar to those of Dr. Kagan, lectures by me following Dr. Kagan could be most effective. Could you let me know your reaction?”51 Photographed smoking by the press, Seltzer attracted headlines “Doctor slams link between smoking and heart disease”,52“Former-smoker studies challenged”,53“Theory up in smoke”,54 and “Smokers – take heart!”55 in which he lied:“I have no connection with the tobacco people. I don’t care whether they sell cigarettes or not.”55

Seltzer had been employed by Harvard University as a professor until 1976 after which he continued his research at the Peabody Museum at Harvard on the constitutional and genetic hypothesis favoured by the industry. The Peabody Museum is a natural history museum, described by Glantz and colleagues as “an odd place to do tobacco and health research.”56 While there, Seltzer was awarded grants of more than US$750,000 from 1976 to 1990 through the industry’s Council for Tobacco Research.56 In Australia, Seltzer was described by the media as “an honorary research associate at Harvard”,52 which by the time he came to be interviewed on television had morphed into “a Harvard University professor”57 and “the man who came up with it [the evidence on smoking and heart disease]”.58

Seltzer’s broadcast comments included:

“Now that I’m quite convinced from the new evidence that stopping smoking does not reduce heart disease, then the whole heart disease picture is eliminated from the potential smoking hazard... And if it’s true that heart disease is not related to smoking, then what is left is very, very minor and insignificant in terms of the actual numbers of deaths.”57

Interviewer:“You smoke don’t you?”

Seltzer:“Yes, I’m a life long smoker. I started to smoke maybe at 14 years of age...”

Interviewer:“But you have spent the last ten years at least investigating smoking and its effects, doesn’t it frighten you a little bit?”

Seltzer:“Oh no, I’m not the least bit concerned.”59

Newsreader:“Light up, drink up and stay healthy! That’s the good news from American expert Dr. Carl Seltzer, who claims that smoking is not related to heart disease... The Harvard University lecturer says he’s never been challenged by the medical profession...”

Reporter:“...Dr Seltzer’s word must be taken very seriously. After all, he IS the doctor of Harvard University...”

Seltzer:“...As a matter of fact, the Surgeon-General in his brand new report which was...came out in January 1979 states in there, and I can quote him: that there is no relationship that they have found between the time of a heart attack and smoking.”

Seltzer (later in interview):“...But it has also been determined by psychologists who describe them [smokers] as being much more interesting people [than non-smokers].”

Reporter:“What you’re really saying is non-smokers are boring?”

Seltzer:“Well, they say that. But then it’s not the boring...if you want to describe people who are more introverted, more inner-directed, more quiet, more introspective, if that’s boring, well, OK, then they are more boring in that sense.”60

Reports of Seltzer re-emerged in 1980 following the publication of a paper by him in the American Heart Journal, laying out his views on the relation between smoking and heart disease being only “statistical”. This received extensive coverage in the press around the world, including in Australia, thanks to efforts by the industry public relations consultant Leonard Zahn.61 In Australia stories appeared in:TheSydney Morning Herald(“Smoking, heart disease link denied”), 29 August;West Australian(“Smoking, heart ills link queried”), 29 August;Sun(“Smoking and cancer link denied”), 2 Sept (even though the story made no mention of cancer);Australian(“Scientist disputes smoking ‘theory’”), 30 August;Herald, Victoria (“Expert rebuts smokes claim”).62

QUALIFYING FOR A SEAT ON THE PLANE?

As we have seen, the industry sought to hide its relationship to several of the scientists they sponsored on publicity tours, sometimes taking elaborate steps to mask their association with the visitors. Some understood the industry’s “predicament”28 and played along. At least one—Seltzer—went further and openly lied about his association with the industry. Aside from delivering a message consonant with the industry’s position on smoking and health, those independent scientists it embraced needed to be willing to be “media managed” and vetted by the industry’s lawyers.

John Ashford from “Exeter Health Information Services Ltd” had been approached by Rothmans International Tobacco Ltd in the UK, who sounded him out about his views on environmental tobacco smoke (ETS) and his availability to fly to Australia. An eager Ashford replied:“I believe that you are aware of my position on the health effects of smoking generally. Put very briefly, I believe that it will never be possible on the basis of available epidemiological data to demonstrate or to quantify any effects of smoking using conventional scientific methodology. I also believe that many of the adverse effects attributed to smoking are probably associated with confounding variables, particularly social class... As far as ETS is concerned, I believe that the basic physics precludes any significant effect. Does this qualify me for a seat on the plane?”63

A Rothmans executive cautioned the Tobacco Institute of Australia that they “...need to get absolute clarification on his willingness to be managed for media appearances which I am quite convinced he would do extremely well”64 and that Ashford “...might be quite useful to you and the TIA whilst in Australia to look at critiquing the Holman study”(this was a major report quantifying drug caused death and morbidity in Australia, including that caused by tobacco).65 Rothmans also noted that Canadian George Feuer who was coming to Sydney to give a talk which “must be on Scholem...he must certainly should be seen by Clayton Utz [Rothmans lawyers in Sydney] before giving his talk, which may well have media coverage”.65(“Scholem” meant Liesel Scholem, a woman who has successfully sued her employer for health damage arising from exposure to secondhand smoke). It is not known if Ashford ever came to Australia, but the correspondence preceding his planned visit spells out plainly the way the local industry sought to media manage such visitors.

DISCUSSION

Globally, tobacco industry defences to litigation brought by smokers have centred on arguments about smokers’ informed consent. These defences have often relied on industry lawyers submitting vast amounts of anti-smoking news material broadcast and published over the years and arguing that smokers could have only wilfully ignored this by choosing to continue smoking, and that therefore dying smokers must take full responsibility for their health problems. Against this view is the evidence, such as that shown in this review and others in this supplement, that the tobacco industry sought to counteract government and health agency warnings about smoking: that it was their intention to do all they could to dissuade smokers from thoughts of quitting.

Throughout the 1970s, the Australian tobacco industry sought to fuel such beliefs by sponsoring and actively promoting the views of visiting scientists it selected as being both prestigious and willing to be “media managed” to advance messages helpful to industry objectives. The median age at which Australian smokers commence smoking is 15 years. This means that today’s cohort of 39–49 year old smokers were in their formative years of smoking when the touring scientists described in this paper were obtaining media publicity between 1969 and 1979. Furthermore, many older smokers who would have been considering quitting in the 1970s would have also been exposed to the publicity generated by the visits documented here.

There exists no longitudinal Australian data that compare the frequency of news media appearances by doctors and scientists warning about the harms of smoking with those by doctors promoting messages that counselled scepticism about such claims. However, judging by the overall predominance of negative reports about smoking in two studies of the Australian press publicity66,67 it is certain that such a study would show an overwhelming dominance of anti-smoking advice from doctors.

What this paper adds

Since the 1950s, the global tobacco industry has sought to use prestigious doctors and scientists to assist in its public efforts to refute, counteract and obfuscate evidence about the health effects of smoking.

The Australian tobacco industry supported a programme of visiting scientific and medical spokespeople in the 1970s, selected in part for their willingness to be “media managed” in advancing messages helpful to industry objectives.

Our study of industry documents found that a relatively small number of consultants toured Australia for the tobacco industry from 1969 to 1979. While some appeared to receive publicity that delighted their industry hosts, in aggregate, these incidents remain in the small minority when compared with the frequency of anti-smoking material reported in the news media.

However, cognitive psychology offers many insights into the complex ways in which individuals can maintain erroneous beliefs despite being presented with overwhelming amounts of information challenging such beliefs.68,69 Individuals do not make decisions by simply “weighing” the amount of evidence to which they have been exposed and deciding to think and act according to the side which exposes them to the most evidence. Rather, people selectively attend to material, filtering out and rationalising facts and arguments which are not consonant with their own behaviour, and seizing on information that reduces cognitive dissonance between their own beliefs and those to which they are aware are widely held by others. With smoking, such information can include notions of personal immunity, fatalism, beliefs that “everything (such as air pollution) causes cancer” these days, and that scientists remain divided on whether smoking harms health.70

The tobacco industry’s intent in sponsoring touring scientists was initially to assist in the defeat of proposals to introduce health warnings, but more broadly, it was to cast doubt among health policy makers and the public about anti-smoking claims and thus contribute to the foment of public scepticism and smoker reassurance.

Acknowledgments

The research reported in this paper was supported by grants from the National Health and Medical Research Council (2001–2003 #153857) and the US National Institutes of Health (2001–2005 # R01 CA87110-01A1).

REFERENCES

View Abstract

Footnotes

  • This paper should be read in conjunction with companion articles on the formation and history of the Australian Tobacco Research Foundation (the Australian version of the US Council for Tobacco Research);6 with case studies on how the industry promoted the views of an Australian pro-smoking doctor;7 and the indoor air consultancy firm it helped establish in Australia, Healthy Buildings International.8

  • In 1988, their research group published a 21 year follow up of their original twin cohort, concluding: “The impact of smoking on mortality, CHD death and lung cancer is also valid among smoking discordant twins.” Floderus B, Cederlöf R, Friberg L. Smoking and mortality: a 21-year follow-up based on the Swedish Twin Registry.

    .

  • * Whist A. Letter no. A37 [Letter to A. Holtzman, Assistant General Counsel, Philip Morris International]. 2 April 1970. Philip Morris. Bates No. 2015047992/7997. 4 July 2002. http://legacy.library.ucsf.edu/tid/pvr53e00.

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.