The tobacco industry paid thousands of dollars to scientists to write letters to influential publications criticizing a major 1993 government report that said secondhand smoke caused lung cancer, according to once-secret legal documents.
The records show that, in many instances, lawyers for the tobacco industry edited the scientists' letters before they were submitted for publication. There are indications the law firms wrote some letters for the scientists to sign.
The letters, aimed at casting doubt on the Environmental Protection Agency's landmark report on environmental tobacco smoke, or ETS, brought different prices. The tobacco industry paid a biostatistician $10,000 to write a single letter to the Journal of the American Medical Association. A former government health official got $6,000 for a letter to the editor of the Wall Street Journal.
In all, 13 scientists were paid more than $156,000 for their letters and some manuscripts, the records show. It appears they were paid whether the material was published or not.
As soon as the EPA report came out it sparked a debate among scientists on its methods and findings. Since then, many independent epidemiologists have studied the issue and are satisfied the EPA's conclusions are scientifically valid.
Anti-smoking advocates and some scientists say the orchestrated letters misled the public by exaggerating the extent of genuine scientific controversy over the effects of secondhand smoke.
"It's a systematic effort to pollute the scientific literature. It's not a legitimate scientific debate," said Dr. Stanton Glantz, a professor of medicine at the University of California, San Francisco, and author of the 1996 book "The Cigarette Papers."
"Basically, the drill is that they hire people to write these letters, then they cited the letters as if they were independent, disinterested scientists writing," said Glantz. "Then they use that to build up a phony literature to show people like Judge Osteen as evidence that the EPA has been naughty."
Glantz was referring to U.S. District Judge William Osteen of North Carolina, who ruled last month that the EPA report was based on inadequate science. The EPA has criticized the judge's ruling and said it will appeal.
Spokespersons for the Tobacco Institute and the two law firms that handled the letter-writing project, Covington and Burling of Washington and Shook, Hardy & Bacon of Kansas City, declined comment or didn't return calls for this article.
Editors of the publications contacted by the Pioneer Press said that while some of the authors disclosed ties to the tobacco industry, the editors were unaware those authors were paid thousands of dollars to write the letters.
Some of the editors also said they knew why cigarette manufacturers would have the scientists write letters instead of scientific papers: Letters go through less scrutiny before they are published.
"Sometimes, what we publish as letters are, in essence, very short scientific papers. However, the letters don't go through the same peer review as the articles, commentaries and reviews go through. There is a difference," said David Lewin, senior editor of the Journal of the National Cancer Institute.
Lewin's publication was one of those targeted by the tobacco industry project; in one six-month period in 1993 alone, five scientists were paid $28,550 to write seven letters to the NCI Journal.
The documents also show the industry paid the scientists to write articles for various scientific publications. One was paid $25,000 to write an article for the publication Risk Analysis. A member of the editorial board of the Journal of Regulatory Toxicology and Pharmacology, along with a colleague, was paid $25,000 to write an article for his own publication.
"To the extent these guys are taking these points of view, they're probably points of view they wouldn't take if they weren't paid to do it," said Jim Repace, a former senior policy analyst for the EPA who has authored more than 50 scientific papers on the secondhand smoke issue.
"What we have is massive evidence of a propaganda machine being run by lawyers, directed by lawyers, most of them external to the industry," said Repace.
Julia Carol, co-director of Americans for Nonsmokers' Rights and a longtime anti-smoking activist, was more blunt.
"They're not scientists, they're prostitutes," she said. "It's just simply not science, and they are therefore not scientists. They are guns for hire, masquerading as scientists. It's absolutely, completely, utterly appalling."
Still, she said, "it doesn't surprise me in the slightest."
The payment records are among the millions of pages of long-secret tobacco industry documents made public as a result of Minnesota's recent lawsuit against cigarette manufacturers. That suit was settled in May, with the companies agreeing to pay $6.6 billion to the state and co-plaintiff Blue Cross and Blue Shield of Minnesota.
In January 1993, the EPA officially labeled secondhand smoke as a human carcinogen, saying that it is responsible for 20 percent of all lung cancers in the United States among people who don't smoke.
The agency began studying the issue in 1988. In the months leading up to the agency's final report, Tobacco Institute officials began planning ways to blunt what they anticipated would be the study's negative findings. They began an international search for scientists willing to criticize the report.
In one unsigned institute memo dated July 9, 1993, under the heading "Project: Recruitment of additional scientific consultants," the author expressed what the cigarette companies were looking for:
"Top priorities are a cardiologist and a numbers person (epidemiologist, biostatistician)," it read. "Ideal are people at or near retirement with no dependence on grant-dispensing bureaucracies."
Among the people they came up with was Dr. Gio Batta Gori, a former top official at the National Cancer Institute who now works as a consultant to the tobacco industry.
Between December 1992 and July 1993, Gori was paid $20,137 for two letters to the Wall Street Journal, one letter to the British medical publication The Lancet, one letter to the NCI Journal and one opinion piece to the Wall Street Journal, the records show.
The opinion piece was rejected by the editors of the Wall Street Journal, but that didn't stop Gori from billing the law firm of Covington and Burling $4,137.50 for it.
Gori, now a private consultant for tobacco in Bethesda, Md., said he didn't particularly remember the letters. "This is six years ago. Who the hell remembers those things?" he said.
He said there was nothing wrong with getting paid to write the letters. That's his job, he said.
"Are you getting paid for what you're writing?" he asked. "We're all out there working."
But Dr. Steve Miles, an ethicist at the University of Minnesota's Center for Bioethics, said the science-for-hire aspect of the letter project "is enormously destructive."
"It profoundly confuses the public debate of important questions," he said. "What it does is turn the scientific enterprise itself into another form of punditry."
The public, he said, "already has difficulty in understanding scientific data and knowledge, and when we make scientific data and knowledge -- and the interpretation of it -- subject to this type of practice, what we do is put it on the same level of punditry . . . as `Firing Line.' "
Repace said that because of the complexity of the subject, the scientists' letters could easily sway public opinion.
"You can count the number of people who understand statistics in public life on one hand, and the number of people who have actually read the EPA report is even smaller," he said. "These scientists can basically get away with whatever they want. They can influence public opinion."
Another scientist whom the Tobacco Institute paid to write a letter on the secondhand smoke issue was biostatistician Nathan Mantel of American University in Washington. He got $10,000 for an eight-paragraph letter printed in the October 13, 1993, issue of the Journal of the American Medical Association, or JAMA.
In the letter, he criticized the authors of a Greek study linking ETS to cancers in nonsmokers that JAMA had published in 1992.
"The Journal appears to have published the study . . . not so much because its results withstand scrutiny, but because the claims advanced in the article seemed at first blush so startling," Mantel wrote.
A small note at the bottom says "support for the analyses contained in this letter came from the Tobacco Institute. The views expressed are Mr. Mantel's and do not necessarily reflect the views of the Tobacco Institute or the American University."
The billing records, however, show the letter was drafted at least in part and edited by attorneys at Shook, Hardy & Bacon. Under the heading "Status" on the billing record, it says "Draft from SH&B (Shook, Hardy & Bacon) 11/2/92; new version to SH&B 11/9/92; submitted 11/9/92."
In an interview, Mantel said he has never been hired by the tobacco industry, "but I'd be called on occasionally to respond to the articles."
Mantel said that while he believes there is ample evidence that smoking causes lung cancer, the evidence that ETS causes cancer is lacking.
"The evidence about the effects of secondhand smoke is very unsuitable," he said. "I would never actively do anything for the tobacco industry. It's just that if something was published that was unsuitable, I'd write a letter to the editor questioning that."
JAMA's editor, Dr. George Lundberg, said authors have a duty to reveal whether they have a conflict of interest in the matters they write about; JAMA has a special disclosure form contributors must fill out.
The form, however, doesn't ask contributors to say how much money they've been paid to write a particular article or letter. Told of the money Mantel and others were paid to write to his magazine, Lundberg said, "we're very suspicious of things like that."
"In this instance, if a letter writer were to challenge some research published in JAMA, that person should challenge it based on the merits of the research," said Lundberg. "But if that person was paid by an organization to write a letter to say such-and-such, we would want to know that."
He said there are times "when you can infer from these financial elements a real conflict of interest which might cause a reader or editor to look askance at such written material."
"We think the reader deserves to know who pays for what," he said.
One journal editor, however, said he didn't care who paid the scientists, and he says he would never ask them.
"I never asked that question, `Were you paid to write that?' " said C. Jelleff Carr, editor of the Journal of Regulatory Toxicology and Pharmacology. "I think it would be almost improper for me to do it."
Carr said articles sent to his publication are sent to two scientists for peer review. "If the decisions are sound, that's it as far as I'm concerned. I don't get into the issue of whether it's paid or not paid."
The tobacco records show $25,000 was budgeted for an article on "EPA process, risk assessment-risk management issues" to be written by former EPA official John Todhunter and tobacco consultant W. Gary Flamm.
Flamm is a member of the publication's editorial board. Industry consultant Gori is one of the journal's associate editors.
Told how much Flamm and Todhunter were paid, Carr responded, "that's a lot of money to write a paper."
"Money talks," Carr said. "We'll never be able to change that."
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