The Emperor of All Maladies

  220 In 1972, as the NCI was scouring the nation: G. Bonadonna et al., “Combination Chemotherapy as an Adjuvant Treatment in Operable Breast Cancer,” New England Journal of Medicine 294, no. 8 (1976): 405–10; Vincent T. DeVita Jr. and Edward Chu, “A History of Cancer Chemotherapy,” Cancer Research 68, no. 21 (2008): 8643–53.

  220 “The surgeons were not just skeptical”: Springer, European Oncology Leaders (Berlin, 2005), 159–65.

  221 Fisher’s tamoxifen trial: B. Fisher et al., “Adjuvant Chemotherapy with and without Tamoxifen in the Treatment of Primary Breast Cancer: 5-Year Results from the National Surgical Adjuvant Breast and Bowel Project Trial,” Journal of Clinical Oncology 4, no. 4 (1986): 459–71.

  223 “We were all more naive a decade ago”: “Some Chemotherapy Fails against Cancer,” New York Times, August 6, 1985.

  223 “We shall so poison the atmosphere of the first act”: James Watson, New York Times, May 6, 1975.

  225 “If there is persistent pain”: J. C. White, “Neurosurgical Treatment of Persistent Pain,” Lancet 2, no. 5 (1950): 161–64.

  225 “a window in [her] home”: Saunders, Selected Writings, xiv.

  225 care, she wrote, “is a soft word”: ibid., 255.

  225 “The resistance to providing palliative care to patients”: Nurse J. N. (name withheld), interview with author, June 2007.

  226 “The provision of . . . terminal care: Saunders, Selected Writings, 71.

  Counting Cancer

  227 We must learn to count the living: Audre Lourde, The Cancer Journals, 2nd ed. (San Francisco: Aunt Lute, 1980), 54.

  227 Counting is the religion of this generation: Gertrude Stein, Everybody’s Autobiography (New York: Random House, 1937), 120.

  227 “These registries,” Cairns wrote in an article: John Cairns, “Treatment of Diseases and the War against Cancer,” Scientific American 253, no. 5 (1985): 51–59.

  229 John Bailar and Elaine Smith’s analysis: J. C. Bailar III and E. M. Smith, “Progress against Cancer?” New England Journal of Medicine 314, no. 19 (1986): 1226–32.

  231 cancer mortality was not declining: This was not unique to the United States; the statistics were similarly grim across Europe. In 1985, a separate analysis of age-adjusted cancer mortality across twenty-eight developed countries revealed an increase in cancer mortality of about 15 percent.

  231 There is “no evidence”: Bailar and Smith, “Progress against Cancer?”

  231 “a thorn in the side of the National Cancer Institute”: Gina Kolata, “Cancer Progress Data Challenged,” Science 232, no. 4753 (1986): 932–33.

  232 As evidence, they pointed to a survey: See E. M. Greenspan, “Commentary on September 1985 NIH Consensus Development Conference on Adjuvant Chemotherapy for Breast Cancer,” Cancer Investigation 4, no. 5 (1986): 471–75. Also see Ezra M. Greenspan, letter to the editor, New England Journal of Medicine 315, no. 15 (1986): 964.

  232 “The problem with reliance on a single measure”: Lester Breslow and William G. Cumberland, “Progress and Objectives in Cancer Control,” Journal of the American Medical Association 259, no. 11 (1988): 1690–94.

  233 “Our purpose in making these calculations”: Ibid. The order of the quotation has been inverted for the purpose of this narrative.

  234 prevention research received: John Bailar interviewed by Elizabeth Farnsworth, “Treatment versus Prevention” (transcript), NewsHour with Jim Leher, PBS, May 29, 1997; Richard M. Scheffler and Lynn Paringer, “A Review of the Economic Evidence on Prevention,” Medical Care 18, no. 5 (1980): 473–84.

  234 By 1992, this number had increased: Samuel S. Epstein, Cancer-Gate: How to Win the Losing Cancer War (Amityville, NY: Baywood Publishing Company, 2005), 59.

  234 In 1974, describing to Mary Lasker: Letter from Frank Rauscher to Mary Lasker, March 18, 1974, Mary Lasker Papers, Box 118, Columbia University.

  234 At Memorial Sloan-Kettering in New York: Ralph W. Moss, The Cancer Syndrome (New York: Grove Press, 1980), 221.

  234 “not one” was able to suggest an “idea”: Edmund Cowdry, Etiology and Prevention of Cancer in Man (New York: Appleton-Century, 1968), xvii.

  234 Prevention, he noted drily: Moss, The Cancer Syndrome, 221.

  234 “A shift in research emphasis”: Bailar and Smith, “Progress against Cancer?”

  PART FOUR:

  PREVENTION IS THE CURE

  235 It should first be noted: David Cantor, “Introduction: Cancer Control and Prevention in the Twentieth Century,” Bulletin of the History of Medicine 81 (2007): 1–38.

  235 The idea of preventive medicine: “False Front in War on Cancer,” Chicago Tribune, February 13, 1975.

  235 The same correlation could be drawn: Ernest L. Wynder letter to Evarts A. Graham, June 20, 1950, Evarts Graham papers.

  “Coffins of black”

  237 When my mother died I was very young: “The Chimney Sweeper,” William Blake, The Complete Poetry and Prose of William Blake, ed. David V. Erdman (New York: Random House, 1982), 10.

  237 It is a disease, he wrote: Percivall Pott and James Earles, The Chirurgical Works of Percivall Pott, F.R.S. Surgeon to St. Bartholomew’s Hospital, a New Edition, with His Last Corrections, to Which Are Added, a Short Account of the Life of the Author, a Method of Curing the Hydrocele by Injection, and Occasional Notes and Observations, by Sir James Earle, F.R.S. Surgeon Extraordinary to the King (London: Wood and Innes, 1808), 3: 177.

  238 “Syphilis,” as the saying ran: Michael J. O’Dowd and Elliot E. Philipp, The History of Obstetrics & Gynaecology (New York: Parthenon Publishing Group, 2000), 228.

  238 In 1713, Ramazzini had published: Bernardino Ramazzini, De Morbis Artificum Diatriba (Apud Josephum Corona, 1743).

  238 “All this makes it (at first) a very different case”: Pott and Earles, Chirurgical Works, 3: 177.

  239 Eighteenth-century England: See Peter Kirby, Child Labor in Britain, 1750–1870 (Hampshire, UK: Palgrave Macmillan, 2003). For details on chimney sweeps, see ibid., 9; and Parliamentary Papers 1852–52, 88, pt. 1, tables 25, 26.

  239 “I wants a ’prentis”: Charles Dickens, Oliver Twist, or The Parish Boy’s Progress (London: J. M. Dent & Sons, 1920), 16.

  239 In 1788, the Chimney Sweepers Act: Joel H. Wiener, Great Britain: The Lion at Home: A Documentary History of Domestic Policy, 1689–1973 (New York: Chelsea House Publishers, 1974), 800.

  239 In 1761, more than a decade before: John Hill, Cautions against the Immoderate Use of Snuff (London: R. Baldwin and J. Jackson, 1761).

  240 a self-professed “Bottanist, apothecary, poet”: G. S. Rousseau, ed. The Letters and Papers of Sir John Hill, 1714–1775 (New York: AMS Press, 1982), 4.

  240 “close, clouded, hot, narcotic rooms”: George Crabbe, The Poetical Works of the Rev. George Crabbe: With his Letters and Journals, and His Life (London: John Murray, 1834), 3: 180.

  240 By the mid-1700s, the state of Virginia: See Paul G. E. Clemens, “From Tobacco to Grain,” Journal of Economic History 35, no. 1: 256–59.

  240 In England the import of tobacco: Kenneth Morgan, Bristol and the Atlantic Trade in the Eighteenth Century (Cambridge University Press, 1993), 152.

  240 In 1855, legend runs, a Turkish soldier: See Richard Klein, Cigarettes Are Sublime (Durham, NC: Duke University Press, 1993), 134–35.

  240 In 1870, the per capita consumption in America: Jack Gottsegen, Tobacco: A Study of Its Consumption in the United States (New York: Pittman, 1940).

  241 A mere thirty years later, Americans: Ibid.

  241 On average, an adult American smoked ten cigarettes: Harold F. Dorn, “The Relationship of Cancer of the Lung and the Use of Tobacco,” American Statistician 8, no. 5 (1954): 7–13.

  241 By the early twentieth century, four out of five: Richard Peto, interview with author, September 2008.

  241 “By the early 1940s, asking about a connection”: Ibid.

  242 “So has the use of nylon stockings”: John Wilds and Ira Harkey, Alton Ochsner, Surgeon of the South (Baton R
ouge: Louisiana State University Press, 1990), 180.

  242 “the cigarette century”: Allan M. Brandt, The Cigarette Century: The Rise, Fall, and Deadly Persistence of the Product That Defined America (New York: Basic Books, 2007).

  The Emperor’s Nylon Stockings

  243 Whether epidemiology alone can: Sir Richard Doll, “Proof of Causality: Deduction from Epidemiological Observation,” Perspectives in Biology and Medicine 45 (2002): 499–515.

  243 lung cancer morbidity had risen nearly fifteenfold: Richard Doll and A. Bradford Hill, “Smoking and Carcinoma of the Lung,” British Medical Journal 2, no. 4682 (1950): 739–48.

  243 “matter that ought to be studied”: Richard Peto, “Smoking and Death: The Past 40 Years and the Next 40,” British Medical Journal 309 (1994): 937–39.

  243 In February 1947, in the midst of a bitterly cold: Ibid.

  243 One expert, having noted parenthetically: British Public Records Office, file FD. 1, 1989, as quoted by David Pollock, Denial and Delay (Washington, DC: Action on Smoking and Health, 1989); full text available through Action on Smoking and Health, www.ash.org.

  243 Yet the resources committed for the study: Medical Research Council 1947/366 and Ibid.

  244 In the summer of 1948: Pollock, Denial and Delay, prologue. Also see Sir Richard Doll, “The First Report on Smoking and Lung Cancer,” in Ashes to Ashes: The History of Smoking and Health, Stephen Lock, Lois A. Reynolds, and E. M. Tansey, eds. (Amsterdam: Editions Rodopi B.V., 1998), 129–37.

  244 “The same correlation could be drawn to the intake of milk”: Ernst L. Wynder, letter to Evarts A. Graham, June 20, 1950, Evarts Graham papers.

  245 Wynder and Graham’s trial: Ernst L. Wynder and Evarts A. Graham, “Tobacco Smoking as a Possible Etiologic Factor in Bronchiogenic Carcinoma: A Study of Six Hundred and Eighty-Four Proved Cases,” Journal of the American Medical Association 143 (1950): 329–38.

  245 When Wynder presented his preliminary ideas: Ernst L. Wynder, “Tobacco as a Cause of Lung Cancer: Some Reflections,” American Journal of Epidemiology 146 (1997), 687–94. Also see Jon Harkness, “The U.S. Public Health Service and Smoking in the 1950s: The Tale of Two More Statements,” Journal of the History of Medicine and Allied Sciences 62, no. 2 (2007): 171–212.

  245 Doll and Hill’s study: Doll and Hill, “Smoking and Carcinoma of the Lung.”

  246 When the price of cigarettes was increased: Richard Peto, personal interview. Also see Virginia Berridge, Marketing Health: Smoking and the Discourse of Public Health in Britain (Oxford: Oxford University Press, 2007), 45.

  246 By May 1, 1948, 156 interviews: David Pollock, “Denial and Delay,” collections from the public record office files deposited in the Action on Smoking and Health archives, UK. Also see the Action on Smoking and Health Tobacco Chronology, http://www .ash.org.uk/ash_669pax88_archive.htm (accessed January 21, 2010).

  247 In the early 1940s, a similar notion had gripped: R. A. Fisher and E. B. Ford, “The Spread of a Gene in Natural Conditions in a Colony of the Moth Panaxia diminula L.,” Heredity 1 (1947): 143–74.

  248 And the notion of using a similar cohort: Stephen Lock, Lois A. Reynolds, and E. M. Tansey, eds., Ashes to Ashes (Amsterdam: Editions Rodopi B.V., 1998), 137.

  249 Doll and Hill’s study of smoking habits and lung cancer in doctors: Richard Doll and A. Bradford Hill, “The Mortality of Doctors in Relation to Their Smoking Habits: A Preliminary Report,” British Medical Journal 1, no. 4877 (1954): 1451–55.

  “A thief in the night”

  250 By the way, [my cancer]: Evarts Graham, letter to Ernst Wynder, February 6, 1957, Evarts Graham papers.

  250 We believe the products that we make: “A Frank Statement to Cigarette Smokers,” New York Times, January 4, 1954.

  250 Cigarette sales had climbed: See, for instance, Richard Kluger, Ashes to Ashes (New York: Vintage Books, 1997), 104–6, 123, 125. Also see Verner Grise, U.S. Cigarette Consumption: Past, Present and Future, conference paper, 30th Tobacco Workers Conference, Williamsburg, VA, 1983 (archived at http://tobaccodocuments.org).

  250 cigarette industry poured tens, then hundreds: For a succinct history of postwar advertising campaigns of cigarette makers see Kluger, Ashes to Ashes, 80–298.

  251 “More doctors smoke Camels”: See, for example, Life, October 6, 1952, back cover.

  251 At the annual conferences of the American Medical Association: See Martha N. Gardner and Allan M. Brandt, “‘The Doctors’ Choice Is America’s Choice’: The Physician in US Cigarette Advertisements, 1930–1953,” American Journal of Public Health 96, no. 2 (2006): 222–32.

  251 In 1955, when Philip Morris: Katherine M. West, “The Marlboro Man: The Making of an American Image,” American Studies at the University of Virginia website, http://xroads.virginia.edu/~CLASS/marlboro/mman.html (accessed December 23, 2009).

  251 “Man-sized taste of honest tobacco”: Ibid.

  251 By the early 1960s, the gross annual sale: Estimated from U.S. Surgeon General’s report on per capita consumption rates for 1960–1970.

  251 On average, Americans were consuming: Jeffrey E. Harris, “Patterns of Cigarette Smoking,” The Health Consequences of Smoking for Women: A Report of the Surgeon General (Washington, DC: U.S. Department of Health and Human Services, 1980), 15–342. Also see Allan Brandt, The Cigarette Century, 97.

  251 On December 28, 1953, three years before: “Notes on Minutes of the Tobacco Industry Research Committee Meeting—December 28, 1953,” John W. Hill papers, “Selected and Related Documents on the Topic of the Hill & Knowlton Public Relations Campaign Formulated on Behalf of the Tobacco Industry Research Committee,” State Historical Society of Wisconsin, http://www.ttlaonline.com/HKWIS/12307.pdf (accessed December 23, 2009).

  252 The centerpiece of that counterattack: “Frank Statement,” New York Times.

  253 In January 1954, after a protracted search: Brandt, Cigarette Century, 178.

  254 In a guest editorial written for the journal: C. C. Little, “Smoking and Lung Cancer,” Cancer Research 16, no. 3 (1956): 183–84.

  254 In a stinging rebuttal written to the editor: Evarts A. Graham, “To the Editor of Cancer Research,” Cancer Research 16 (1956): 816–17.

  254 “We may subject mice, or other laboratory animals”: Sir Austin Bradford Hill, Statistical Methods in Clinical and Preventative Medicine (London: Livingstone, 1962), 378.

  254 Graham had invented a “smoking machine”: Ernst L. Wynder, Evarts A. Graham, and Adele B. Croninger, “Experimental Production of Carcinoma with Cigarette Tar,” Cancer Research 13 (1953): 855–64.

  255 Forbes magazine had famously spoofed the research: Forbes 72 (1953): 20.

  255 Bradford Hill’s nine criteria for epidemiology: Sir Austin Bradford Hill, “The Environment and Disease: Association or Causation?” Proceedings of the Royal Society of Medicine 58, no. 5 (1965): 295–300.

  256 “Perhaps you have heard that”: Letter from Evarts Graham to Alton Ochsner, February 14, 1957, Evarts Graham papers.

  257 In the winter of 1954, three years before: Alton Ochsner, Smoking and Cancer: A Doctor’s Report (New York: J. Messner, 1954).

  “A statement of warning”

  258 Our credulity would indeed be strained: Eva Cooper v. R. J. Reynolds Tobacco Company, 256 F.2d 464 (1st Cir., 1958).

  258 Certainly, living in America in the last half: Burson Marsteller (PR firm) internal document, January 1, 1988. Cipollone postverdict document available at the UCSF Legacy Tobacco Documents Library.

  258 In the summer of 1963, seven years after: See Richard Kluger, Ashes to Ashes, 254–55.

  258 Auerbach’s paper describing the lesions: O. Auerbach and A. P. Stout, “The Role of Carcinogens, Especially Those in Cigarette Smoke, in the Production of Precancerous Lesions,” Proceedings of the National Cancer Conference 4 (1960): 297–304.

  259 Auerbach’s three visitors that morning: See Kluger, Ashes to Ashes, 254.

  259 In 1961, the American Cancer Society: “The 1964 Report
on Smoking and Health,” Reports of the Surgeon General, Profiles in Science: National Library of Medicine, http://profiles.nlm.nih.gov/NN/Views/Exhibit/narrative/smoking.html (accessed December 26, 2009); U.S. Surgeon General. “Smoking and Health,” Report of the Advisory Committee to the Surgeon General of the Public Health Service, Public Health Service publication no. 1103 (Washington, DC: U.S. Department of Health, Education, and Welfare, Public Health Service, 1964).

  260 “a reluctant dragon”: Lester Breslow, A History of Cancer Control in the United States, 1946–1971 (Bethesda, MD: U.S. National Cancer Institute, 1979), 4: 24.

  260 he announced that he would appoint an advisory committee: U.S. Surgeon General’s report: Smoking and Health, 1964.

  261 Data, interviews, opinions, and testimonies: Ibid.

  261 Each member of the committee: Ibid. Also see Kluger, Ashes to Ashes, 243–45.

  262 “The word ‘cause,’” the report read: U.S. Surgeon General’s report: Smoking and Health.

  262 Luther Terry’s report, a leatherbound, 387-page: “1964 Report on Smoking and Health.”

  262 “While the propaganda blast was tremendous”: George Weissman memo to Joseph Cullman III, January 11, 1964, Tobacco Documents Online, http://tobaccodocuments.org/landman/1005038559–8561.html (accessed December 26, 2009).

  263 the commission’s shining piece of lawmaking: Annual Report of the Federal Trade Commission (Washington DC: United States Printing Office, 1950), 65.

  263 In 1957, John Blatnik, a Minnesota chemistry teacher: “Making Cigarette Ads Tell the Truth,” Harper’s, August 1958.

  263 The FTC had been revamped: “Government: The Old Lady’s New Look,” Time, April 16, 1965.

  264 A week later, in January 1964: Federal Trade Commission, “Advertising and Labeling of Cigarettes. Notice of Rule-Making Proceeding for Establishment of Trade Regulation Rules,” Federal Register, January 22, 1964, 29:530–32.

  264 they voluntarily requested regulation by Congress: “The Quiet Victory of the Cigarette Lobby: How It Found the Best Filter Yet—Congress,” Atlantic, September 1965.