Puerperal Fever from Hippocrates to Pasteur
Date: April 6, 2016
Speaker: Eric J. Solberg
Mr. Solberg is Associate Vice President for Academic & Research Affairs at UT Health.
INTRODUCTION THOMAS COLE, PHD
THOMAS COLE
00:00:00 Today, as you know, the theme of our History of Medicine year is Living History. And for the
most part, we've had first person accounts of people who've observed or been patients or been
scientists or physicians who've taken part in notable achievements or experiences in the history of
twentieth century medicine. here at the Texas medical center. And today, we have Eric Solberg who is,
at the moment, UT's vice president for academic and research affairs and has been working in the field
of tobacco, the science of tobacco, the politics of tobacco, the policy of tobacco since the seventies?
ERIC SOLBERG
The eighties.
Houston History of Medicine
The Politics of Lung Cancer
April 6, 2016
THOMAS COLE
00:00:49 Since the eighties. And the theme today is the politics of tobacco. And one of the things we
have not focused on very much in our series is the importance of understanding the politics, the
economics, the lobbying, the corporate influence on people's perception of science, the shaping of
policy because history, history of science, history of medicine, do not take place in a vacuum. They take
place in specific political, historical contexts. And today we have, as I said, Eric, who has worked in this
arena for many years and is able to talk to us about the tobacco industry's impact and role in public
perception and policy, to which I should add, this is exactly what's been happening in the fossil fuel
industry and in the science of climate change. in the last twenty-five or thirty years, the same kind of
corporate sponsorship and payments and lobbying on behalf of certain interests that obscure much of
the scientific data about the impact of burning of fossil fuels.
So just a couple things about Eric. He's been at the TMC for twenty-six years, ten at Baylor, five at MD
Anderson, and nine at UT. He worked for a bio-tech company He's trained in exercise physiology. And as
you can tell from how fit he looks, he still does Iron Man and still is a nationally ranked runner. His
master's degree is in cardiac rehabilitation. And he's also gone back to school over the last few years to
get a doctorate in the School of Public Health.
In his free time, Eric has often been a health and medical activist. and is very critical of certain kinds of
public health models, which I don't think we'll get into today, but he's always been interested in
understanding the foundations of traditional public health models, and in particular, lung cancer, which
as he says, is the biggest public health failure on the planet, something we really have not yet learned to
deal with. So what I want him to tell us is how he became involved in lung cancer issues and smoking
and tobacco companies in his own personal life and then to move into what he has learned over the
years as an advocate, as a scientist, as a policy person. But I think the key thing from a point of view of
living history is that Eric has lived this history as an administrator, as a policy person, as a student, as an
advocate, as an employee.
And so for the key points, I would just say that we were talking about the other day, are not very
encouraging because what he talks about is the failure, a failure, of the public health models, the
influence of industry on science and medicine, which has not be saluatory, and the influence of money
in the shaping of our public policy around tobacco and its impact on American health, or lack of it, and,
indeed, health around the world. So why don't we get started. You can—he's given me permission to
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interrupt him. And you can tell us how you got into this field, and there will be time for questions
afterward. And if you have questions as we're going, please raise your hand and we will call on you.
ERIC SOLBERG
00:04:54 I got into this field completely by accident. I was a graduate student at the University of
Minnesota working in exercise physiology and was training in clinical applications of exercise physiology
with the Minneapolis Heart Institute. And toward the end of my master's degree I had been accepted to
a doctoral program there, but toward the end of my master's degree at the Minnesota Heart Institute, I
saw a heart transplant. This was in 1986 or '87, I guess, '88. Somewhere in there, '8—I can't remember.
But anyway, it was in the late eighties. It was a sixty-two-year-old man with a fourteen-year-old heart.
And that one patient has stuck with me my entire career. And I really needed to make some decisions at
that time if I wanted to continue a path in clinical exercise physiology or if I wanted to do something
else.
I decided, with no foundational knowledge whatsoever, I decided I wanted to move into sort of public
health to preventive medicine, not really knowing what that meant until I started to apply for jobs
rather than register for another term in graduate school. I was applying to the American Heart
Institution, the American Cancer Society, things that you would think of traditionally as being wonderful
health organizations. I didn't get any interviews whatsoever, and in those days, to find a job you actually
had to read a Sunday newspaper.
So I picked up the Sunday Minneapolis Star Tribune and opened it up, and there'd be this thick section.
And I saw this position at the North Dakota State Department of Health. And I said, "Wow, that sounds
interesting to me." It was really running the CDC's behavioral risk factor surveillance system within the
state of North Dakota, this was something that happens across all fifty states, collecting data on various
health behaviors. and then shipping that off to Centers for Disease Control. The only person I knew in
North Dakota—I was actually born in Bismark, North Dakota—but the only one I knew that worked
there at the time was my dad. So, he worked at the state hospital in Jamestown. And so I called him on
the phone.
I said, "Hey, do you know anybody at the state health department. "
He says, "Well, yeah. I know a couple of people, but the only one I really know very well is Dr. Robert
Wentz who is the state health commissioner.
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And so I said, "Great." I wrote a letter, cover letter, directly—
THOMAS COLE
Tell us what your dad was working as.
ERIC SOLBERG
00:07:48 He was the chaplain at the state hospital in Jamestown, North Dakota. So he hadn't really
interacted a whole lot with the state health commissioner, but I figured I might as well start at the top
and see if I can get an interview. Sure enough, I got an interview. The problem was though that three
days before my interview, I was going to drive from Minneapolis to Bismark. I get a phone call from the
state health department. And they said, "We have actually filled the position that you applied for. But
we have another position that may actually fit your experiences better because it deals with community
health promotion, networking with city and county health departments to promote health and exercise
and diet and nutrition. And, oh by the way, there's this 50 percent of this role is dealing with how we
deal with smoking and tobacco issues in our state. Would you still be interested in coming to interview."
I said sure because that was the only interview I had been offered.
And so I got there about twenty minutes before the interview. It's a six hour drive from Minneapolis to
Bismark, North Dakota. And I didn't know what they were going to ask me. I had not been coached how
to sit or answer or respond in an interview. I just knew that fifty percent of that job they said was
something about an area that I knew nothing about, really. And so I was really unprepared, but as I was
sitting in the waiting area, I glanced down at the table, the side table. And there was a magazine, US
News and World Report. This was September of 1989. And on the cover of that magazine, it says,
"Twenty-fifth anniversary Surgeon General's report on smoking and health." I’m like, wow. That looks
helpful. So I picked it up. It was two pages, but there were charts and graphs that sort of provided some
of the history of tobacco use in the United States, smoking rates, what contributed to higher smoking
rates in different parts of the country. And so like I did in graduate school, I memorized charts and
graphs because a picture was worth a thousand words. I walked into the interview and I blew them
away because I was just regurgitating data that I had just literally read fifteen minutes before.
So they hired me. And part of my job was trying to understand what nudges the state of North Dakota
had done on smoking issues and tobacco use and lung cancer that really weren't going on around the
country. And so that's really how it started. It was literally by accident.
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THOMAS COLE
Tell us about the surgeon general's report and how you became familiar with it.
ERIC SOLBERG
00:10:40 Actually, I brought a copy. Anybody who works in the field of lung cancer or smoking issues,
public health even, knows about the 1964 Surgeon General's report. The Surgeon General at the time
was Dr. Luther Terry from Alabama. The president, when it was released, was not the president who
charged the commission to actually develop the report. So the report was released in January of 1964,
but President Johnson—and that was of course after President Kennedy had been assassinated—but
President Kennedy was the president who actually commissioned the report.
THOMAS COLE
[coughing] Sorry.
ERIC SOLBERG
And there's great Texas ties. Two of the members of the Surgeon General's committee that developed
the report are from Texas. One was Dr. Walter Burdette who was a medical geneticist at MD Anderson
for much of his career. He actually also taught at the medical school here in the seventies and early
eighties because he had a joint appointment. And then a name you might be familiar with, Dr. Mickey
LeMaistre was also—he was actually the youngest member of the Surgeon General's committee, and is
the only living member today of the committee. I believe he's ninety-two. I'm not sure. He might get
mad if I'm over estimating his age.
THOMAS COLE
I think you're overestimating how many people know who Mickey LeMaistre is.
ERIC SOLBERG
So Dr. LeMaistre was—so at the time he was on the report, he was a professor at UT Southwestern
Medical Center up in Dallas.
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But his career included being the chancellor of UT Systems, the president, the second president, of MD
Anderson Cancer Center. Obviously, he is retired now, but he is extremely well known throughout the
state of Texas, much more so than Dr. Walter Burdette was who was just faculty member at MD
Anderson and here at the medical school. So, yeah, a little bit of background on Dr. LeMaistre, I've
actually talked to him because he was writing his memoirs about what it was like to serve on the
Surgeon General's committee. And the committee itself is very interesting. So the members of the
committee were selected in one of the most—so there were some criteria. Number one, they could not
have written or spoken publically on the topic of smoking and health. So basically, the committee
members had no experience just like me when I had my first job. Right?
0:13:25.5 So that was criteria number one. Number two was that all of the members that were being
nominated to come forward, in order to get on there, there had to be agreement that these members
should serve on the committee. And the agreement included numbers of the executive offices of the
major cigarette manufacturers in the United States. So they had to pass muster not just with the
Surgeon General and members of the US Department of Health and Human Services, but they had to
pass muster and be a prude, literally, by the tobacco industry. And at any point, any partner looking at
these members who were being nominated could say, "Nope, that person's not going to be on the
committee." So that's how the committee was formed.
THOMAS COLE
So tell us, what companies were represented in the tobacco industry?
ERIC SOLBERG
It's changed quite a bit over the last ten to fifteen years through consolidation. But the name of the
company most known throughout, not just of the United States, but throughout the world is Philip
Morris. They still have major operations here in the United States. They're headquartered here. They
also have international operations. They've changed the name of their quote unquote company which is
called Altria, but they are the number one cigarette manufacturer on the planet. And they sell the
number one cigarette brand around the world, which is Marlboro. So R. J. Reynolds is another name that
you might have heard. Some of these you might have heard growing up because Philip Morris used to
own Kraft food products, General Foods, Miller Brewing company. Now, they've since sold that and
those are owned by other people. R. J. Reynolds Tobacco Company had diversified itself to include
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Nabisco crackers and cookies, like Oreos, Ritz, okay, and several other companies that they had acquired
along the way.
0:15:31 A lot of that was done for political purposes. It was really to disguise themselves so that people
didn't think, "Oh, that's just the big, bad tobacco industry." And they were very good at it. They did it in
Congress. They did it in state houses around the country. They had a very big presence in the state of
Texas over many years. They were so good at disguising themselves that in the early 1990s, I read a
report on lobbying by the tobacco companies in the state of Texas, and they had hired lobbyist, who also
represented health organizations in the state of Texas. So you've got somebody lobbying for Marlboro
cigarettes and how we can increase their sales and reduce cigarette taxes and so on and so forth. At the
same time as representing Philip Morris, you had the same people representing, for example, the Texas
Society for Respiratory Care. You can't make this up. The Texas Hospital Association at one time was
represented by a cigarette lobbyist at the same time representing them. So many, many of these
examples—we did a whole report on these back in the mid 1990s called Sick Bed Fellows. And it was
really to try to bring to light that it's not just the tobacco companies that we're talking about here that
are part of the—the biggest part—of the problem.
It's those who are sort in bed with them and colluding with them.
THOMAS COLE
Who was the report written to and what was the effect of it?
ERIC SOLBERG
So the report was really done, it was really written for the media. We—at the same time—you have to
remember, so a little more on history here. So this report came out January 11 of 1964. It was released
on a Saturday because they were concerned about what might happen in the stock market when this
report came out. It was not embargoed for release, which means they gave out early copies of it for the
media to review. The media received a copy of the report in summary when they arrived to the press
conference. They locked them in a room for four hours, and then they answered questions. That's how
controlled this document was. So Dr. Luther Terry, when he spoke at the press conference, said—and
the main conclusion in the report I should have said earlier—was that smoking causes lung cancer. So it
took them a report, 7,000 studies that were reviewed, to confirm things that really people like Dr.
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Michael DeBakey and Alton Ochsner, who were co-publishing in the 1930s, had already been writing
about.
0:18:11 They had already documented all of this by 1939. That really should have been when the report
came out. Of course, politics would hold back on that, which is not a good connection here. I mean,
obviously Dr. DeBakey is well known at the Texas Medical Center for having been at Baylor College of
Medicine for so many years. But the first action, so the Surgeon General called for appropriate remedial
action. And the first action came just three weeks after the report was released. And that was the
American Medical Association. They said, "We're going to do something." And what they did was they
signed a contract with six cigarette manufacturers for $10 million to do more research. And that's all
chronicled in this book that I contributed to, Serpent on the Staff: The Unhealthy Politics of the
American Medical Association.
That relationship between the American Medical Association and those six cigarette companies lasted
for fourteen years. And $18 million later, the AMA finally said that the Surgeon General's report basically
was right fourteen years earlier. I don't want to just pick on the American Medical Association because it
was permeated throughout our country. The American Cancer Society, until 1976, was benefiting from
a cigarette company sponsored tennis tournament. It was called the Virginia Slims. And proceeds went
to—named after Virginia Slims cigarettes—and the proceeds were going to benefit the American Cancer
Society. It was—up until 1996, MD Anderson Cancer Center, the number one cancer center on the
planet, was still receiving research dollars directly from cigarettes companies.
So the story is pretty sad, and I think one has to—I'm going to quote Father Thomas Garret who was
professor of ethics at Scranton University in Pennsylvania, and he said—you know, in 1964 he was
saying this—he said, "You know, it's not just the guy who holds the gun to the teller who's the bad guy.
It's the people who are driving the getaway car." And I think in many ways, the American Medical
Association and many other major organizations were driving the getaway car for the industry. They
were getting away with murder literally. And 1996 is when MD Anderson finally developed a policy to
stop taking tobacco company money for research at that institution. So really, you cannot make up this
story. And the failure of not just the public health community, but all of us to really have done more to
deal with the issue. The appropriate remedial action that Luther Terry called for in 1964 when he was
Surgeon General, in my opinion, still hasn't happened.
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THOMAS COLE
Which is?
ERIC SOLBERG
We've got to get people to understand that this is not your typical public health model of behavior
change, okay? We can't go about one person who smokes at a time and get them to change their
behavior when you've got this other behavior going on with cigarette companies and health
organizations aligning themselves in the most strange sorts of ways. And I think what we've got to do is
develop new models, get away from traditional thinking and really begin, I think, to look at this more
from a business perspective, a consumer perspective. I mean, people don't go into the store and say,
"Hey, I'd like to buy a package of just nicotine."
00:22:16 They go into the store, and they say, "I would like to buy a pack of Marlboro 100 Menthol
Lights in a box." That's one of about forty-five different types of Marlboro brands that you can buy.
They're very specific. Is there any difference about any of these? No, no. no. Different chemicals that are
added. What color is the menthol? I always ask this of medical students. What do you think the color of
menthol is?
Female Speaker
On the box?
ERIC SOLBERG
Well, most people say green because it's green on the box and it's green in the advertising, you know,
from Newport cigarettes, Marlboro Menthols have a green package. It's not. It's colorless. It's an
anesthetic that deadens the throat so that people can inhale deeper and smoke more cigarettes. I ask
people why do you buy cigarette brands that have a filter on them because 98-99 percent of people who
smoke cigarettes buy filtered brands. And they say, "Well, it's safer." It's safer than what, than fresh air?
I mean you would not jump off the top of the hospital, you'll just jump off like the thirteenth floor.
Again, these are consumer issues that the tobacco companies have drilled into society across our
country and around the world. And we've got to look at it differently than traditional public health
models or traditional medical models we look at.
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THOMAS COLE
So can we go back to the tobacco company's response to the Surgeon General's report? You said they
started pouring money into other forms of research to disguise the requirement that remedial action be
taken. So they wanted to kind of disguise some of the findings. So what kinds of research did they
support, and what were the affects of those?
ERIC SOLBERG
00:24:04 So actually, it's—I’m glad you asked that because their activities in the field of research actually
happened before the Surgeon General's report was released. So in 1954, after some major studies had
been reported in the medical literature linking smoking and lung cancer as a causative factor of lung
cancer, they formed—it was called, at the time, the Tobacco Industry Research Council. And it was,
basically, the major cigarette manufacturers in the United States, they took out full page advertisements
across the country. And the headlines of the advertisements were something about the cigarette
controversy. And what they wanted to do was to build this notion that we just don't know what causes
lung cancer. And they were very good at it. So they did it through the press. They did it through politics.
They did it through aligning themselves, finding allies, through the sponsorship of research, basically. So
they were doing their own internal research as well. And a lot of that came out in the 1990s when they
were sued, but a lot of this stuff started in the mid 1950s really.
THOMAS COLE
Okay. Good. When did the tide start to turn in terms of public opinion, public policy, smoking rates? Is
the tobacco industry still trying to do things which obscure the reality of the science? Of course they're
still advertising. That's what capitalism is about, but when did things begin to change? When did the tide
begin to turn because we already know that in 1939 there was this definitive article written that
DeBakey was the co-author on. Then we know that in January 1964 the Surgeon General's report came
out. You got into this in the 1980s when not much had changed.
ERIC SOLBERG
Right.
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THOMAS COLE
So what about sort of rates of smoking, rates of lung cancer, rates of death, what population, what parts
of the country?
ERIC SOLBERG
0:26:26 So it's fascinating actually. I was looking—when I was at the North Dakota State Department of
Health, we were developing a proposal for the National Cancer Institute. And so I spent a lot of time in
the state archives, the state library, looking at information and data, but some of the information was
really interesting. So there were sixteen or so states in the United States from roughly about 1980—
excuse me—1885 until the early 1900s, 1910, 1915, that actually banned the sale of cigarettes. They just
banned it. It was part of the temperance movement at that time. North Dakota was the state who had
the longest ban. And they didn't permit the sale of cigarettes again until, I think it was, 1920 or 1925. I
haven't looked at it in many years.
And so what we did was we compared the lung cancer rates in the state of North Dakota to lung cancer
rates in the rest of the country. And there's a twenty year lag time where you see that line increase in
the incidence of lung cancer in the state of North Dakota. But it mirrors it exactly with the rest of the
country, it's just twenty years behind. And that was because there was not a lot of consumption of
cigarettes for about an eighteen to twenty year period in the state of North Dakota. So kind of brining
you up to speed a little bit more, I think after the 1964 Surgeon General's report there were many,
many, many missed opportunities. They're still going on today. And I would argue that the tide really
hasn't shifted all that much.
So the number one—so if you look at lung cancer survival rates over the last thirty to thirty-five years,
even with a place as good as MD Anderson Cancer Center, they are almost unchanged. Five year lung
cancer survival rates have almost unchanged. People now, today—and so if you think about, well, the
smoking rates have declined as a percentage of the total population. So that's right. So if you go back to
1964 when the Surgeon General's report came out, about 42-44 percent—and certainly different
between males and females—in some states, male smoking was close to 60 percent. Even among
physician at the time, it was in the fifties, fiftieth percentile.
So smoking rates have declined over the years, but our population has boomed, almost doubled since
then. And so fifty-five million people were smoking in 1964. About fifty-two million people are still
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smoking cigarettes today. Unfortunately, a lot of the attention has shifted now to e-cigarettes and
vaping. So there's so much attention focused on this area, it's almost like, "Oh, we've dealt with the
tobacco smoking and cigarette smoking," but we really haven't. We've not really done a whole lot to
change—now, we've done a lot of things like moving it outdoors. So you can go to a restaurant in most
major cities in the United States, and you won't have a smoking section. Up until 1989, and actually until
1992, you have to remember there were smoking sections on airplanes in the United States.
0:30:07 So in 1989, they developed a ban on smoking on flights of two hours or less in the United States,
meaning—okay, so if you've got six hour flight or five hour flight from LA to New York, you can be
exposed the entire five hours, but for two hours we don't want to have it, right? It made absolutely no
sense whatsoever. And so it wasn't finally banned in the United States until 1992. And then that didn’t
even include international flights. And I would say that the tide began to change a little bit when that
part of the history came into gear. So there was a flight attendant—all right, some good Texas history—
there was a flight attendant named Patty Young from Dallas, flew for a major airline. She still lives in
Dallas today. She tried to get the flight attendant union, she tried to get the airline, she tried to get
everybody to help. Nobody would help her. And so she basically took this issue on by herself. And all she
wanted to do at that time was to ban smoking on airlines because so many of the flight attendants that
were exposed to it for hours and hours and hours a day were having incredible—lung cancer, throat
cancer, all kinds of health issues that were related to breathing in the smoke in the air planes. I think
that's when—
THOMAS COLE
What was the result of her effort?
ERIC SOLBERG
So she was very involved. She presented it before Congress numerous times. She was very involved in
getting the final bills to ban smoking on airlines in the United States. She, and a handful of others, really
did it on their own. It wasn't until much later that the flight attendant unions came in to back them up.
So they didn't even their own union to help them. So it was interesting. So I think that's really when,
public opinion at least, began to sort of take a different direction in the country. And that would have
been in the late 1970s, early 1980s when that was really beginning to form, like the anti-smoking
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movement in the United States. It's now got a big term. It's called Tobacco Control. It has really become
an industry of itself, sort of a cottage industry.
0:32:13 There's a journal put out by BMJ Publishing that I used to be one of the assistant editors. It's
called Tobacco Control, an international journal. So it's really, if you look at what's happening now—I
mean in the 1990s, a big sort of public opinion change in direction was litigation against the major
cigarette manufacturers in the United States. They settled with all of our states, including with Texas.
Texas got $17.3 billion dollars in a settlement keeping in mind that when they filed the original
complaint, they were only asking for $4.2 billion. The lawyers who represented the state of Texas,
private attorneys, received $3.2 billion in fees. The UT Health Science Center of Houston received a $25
million endowment as part of the settlement. MD Anderson got $100 million endowment as part of the
settlement. The Health Science Center in Antonio got a $200 million endowment as part of the cigarette
litigation settlement in the state.
People always say, "Why did San Antonio get $200 million and the Health Science Center in Houston
only got $25 million?" Well, it's because the Attorney General at the time, Dan Morales, was from San
Antonio. So that's why they got $200 million. Dan Morales, however, went to jail. He went to prison
because he tried to fudge—they call it fraud—he tried to fudge a contract in order to get one of his
friends, who was an attorney, paid part of the big settlement dollars. So both he and his friend ended up
going to prison. Now, there's an irony in that because he went to prison, a federal prison, in Texarkana,
Texas. And when—that's where the state lawsuit against the cigarette companies was filed. It was not
filed in a state court. It was filed in a Federal Court in Texarkana, because they thought that would be a
good judge to get their case to go forward. And that's where he ended up going to prison. Now, he's
been out for several years. I think he's been out for about ten years.
THOMAS COLE
And what kind of endowment has been paid?
ERIC SOLBERG
You know, it ruined his career. I mean Dan Morales was a democratic Attorney General. He was slated to
be a governor of the state of Texas. He's been disbarred. So I don't know what he does now.
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THOMAS COLE
Can we go back to the question of why rates of tobacco cure have not increased? Why tobacco rates,
why the survival rates haven't changed? I know you're not a physician or a scientist, but you would think
that since so many cancers we've made improvement on, you would think we would have made
improvement on lung cancer.
ERIC SOLBERG
So part of the problem is early diagnosis in lung cancer. So it's very hard. So they have—there's new
technologies that have been employed trying to detect lung cancer early. You have to remember, so 90
percent of all lung cancers are caused by one thing, and that's cigarette smoking. So that number hasn't
changed in all of the years of medical literature. That's still right. About 88 to 90 percent of all lung
cancers are caused by smoking.
0:35:44 So rather than doing something about the cause of it—this is sort of like why we're in Central
America, we're killing mosquitoes carrying Zika virus, right? We're not going after the people who get it;
we're trying to end the problem before it begins. Right? So you go after the mosquitoes. You drain the
swamps, so on and so forth. In this issue, that would mean going after tobacco companies, and nobody
wanted to touch that. Okay? They wanted to take money from them to do other things. So there's been
a major focus on early detection and screening for lung cancer. There have been many trials. There's
new shop next door at MD Anderson that is focused—on the technology is spiral CT, which can detect
much, much smaller cancer nodes in the lung than have been previously.
You have to ask yourself, how did we get on that track, right? So why are we ignoring the cause of this
and really focused on the cure? That's a lot of the political history. Part of the cure, though, came from
the original sponsors of the research for spiral CT in lung cancer were cigarette manufacturers. So they
were providing the sponsorship dollars to major universities and cancer centers in the United States. In
the 1990s is when it was started.
THOMAS COLE
Yeah.
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ERIC SOLBERG
Unfortunately, even spiral CT hasn't—if you're not screening the population at the right time, you're not
going to detect it early enough. And so when they present with a stage II or stage III lung cancer, there's
not a whole lot that can be done.
THOMAS COLE
0:37:19 So if I understand what you're saying, the tobacco industry had a financial incentive to support
research into the cure of lung cancer, but no financial incentive to stop the cause of the cure because
they were the cause.
ERIC SOLBERG
Right.
THOMAS COLE
Yeah.
ERIC SOLBERG
Now, don't get me wrong. They did fund projects called—one of them that was developed came out of
R.J. Reynolds tobacco company. They sponsored quote unquote behavioral research. And the end result
was not publications and journals, but it was a big pamphlet and campaign, media campaign, called
Smoking or Tobacco Use: Helping Youth Decide. It was basically a pamphlet that could be handed out to
school counselors. And it wasn't—it had nothing to do with the health effects of cigarette smoking or
the fact that it is addictive. It simply said how to address whether or not you should smoke or not, right?
So that was the only two options that were really, it was crazy. And that went on through most of the
1980s and all of the 1990s.
To this very day, if you go to Philip Morris' website, you will find health information. You will find quit
lines in states. You will find all of the help that you really need to quote unquote stop smoking right on
their own website. Now, they did this after the litigation was settled. They certainly couldn't admit this
in court, right, that smoking was addictive, that it caused all these diseases. So that's why they settled.
And then they were free. They could do all these things. Well, we want to caution all of our consumers.
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This is a decision that you're making. Just want you to be aware that there's some harmful effects
associated with cigarette smoking. So you go to their website now, and you could almost compare that
section of their website to the American Cancer Society, and they're saying the exact same thing. Now,
the American Cancer Society would say, "Well, no, no because we're very critical now of the cigarette
companies." And we—my comment back to them is to say, "Where were you for fifty years? You were
taking money from them for that long."
0:39:43 I give you a good example of where I think we've done a poor job of capturing the importance of
this issue. So about a year ago, CVS Pharmacies made a major decision. They were going to stop selling
tobacco products in their pharmacies. Hey, the first question you have to ask is, why are pharmacies
selling tobacco products to begin with, not to mention beer and wine, but let's just stick to the issue at
hand. So that would be the first question. The second question is what would motivate them to do that?
I mean, so there's a lot of profit in cigarettes because costs about eight cents to make a pack of
cigarettes. Does anyone know what it costs to buy a pack of Marlboros in Houston? Five or six? You're
getting warm. Six dollars and forty-three cents. I bought one a little while ago so that I knew exactly
because I gave a presentation and I wanted to know. But it's actually a trick question. I bought that pack
in the suburb up near the Woodlands. If you go over here to the Third Ward, it's about seventy cents
cheaper for the same pack of cigarettes.
THOMAS COLE
So now we all know where we're going to buy our Marlboros.
ERIC SOLBERG
Right. You have to go to the Third Ward. The point is CVS wasn't, "Oh, we're going to do the right thing
and forego those profits that we're making from the sales of cigarettes." They were developing Ready
Clinics in their pharmacies. And many states, in fact most states, the majority of states, have regulations
around health care providers. Some states even have regulations that say you can't sell tobacco
products where health providers are providing their service. So that was their primary motivation was to
bring Ready Clinics into their CVS Pharmacies around the United States. It had nothing to do with doing
the right thing nor did they apologize. I mean, I've got photograph of CVS billboards promoting Marlboro
cartons for only thirty bucks not too many years ago, okay? So it wasn't like they were just selling them.
They were actively promoting CVS as the place to get your booze and your cigs.
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THOMAS COLE
0:42:07 Well, good. There's one on the corner of Richmond and Montrose right next to my house.
ERIC SOLBERG
Well, they don't sell cigarettes anymore.
THOMAS COLE
So—
ERIC SOLBERG
But Walgreens still does. So everybody's asking when is Walgreens going to drop, right?
THOMAS COLE
Dr. Viera has a question.
DR. VIERA
I think your statement several tax dollars are based on the selling of cigarettes. Has that been a
deterrent in any way to the actual selling of cigarettes?
ERIC SOLBERG
So question is taxes. And they've gone up tremendously over the years. It's over a $1.40 I think now in
the state of Texas, something like that, per pack, right? So the argument in taxes was developed by
economists in the 1950s and 1960s. So that's a little different sort of disposal income, shall we say, back
in that time than it is today. But those studies have been referenced over and over and over and over
again to the point where no one references those any more. You just reference the one that referenced
it in 1985 and then the one that referenced it in '99 or whatever. You see how it works.
The problem is, and if we took a different look, so that was a traditional, conventional public health
model, tax it and consumption will go down. Right? So sometimes it has an initial drop, and then it
comes back. But if you ask people who buy cigarettes, who smoke, and you ask them what brands they
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buy, what you learn is that the number one selling brands are the most expensive brands, Marlboro
being the best example. But it's kind of—it doesn't make any sense if teenagers who want to look cool
when they start smoking are buying the most expensive brand. They have the most disposable income.
Whatever it is that they're making, they don't have any other payments to make. They might have a car,
but most of them don't. So it really hasn't worked the way they'd hoped.
DR. VIERA
The second part of the question is what do the state and the federal government do with the tax dollars
raised with cigarettes?
ERIC SOLBERG
0:44:21 Right, so in some states, they have earmarked portions of the cigarette taxes to fund state
health department programs, California being probably the most noted. They had something back in the
late 1980s called Prop 99 that was passed by the voters in California. And it was the first state to
increase their cigarette tax and earmark it to public education around smoking.
DR. VIERA
So the third part of that question is, is that any different from the American Cancer Society accepting
money from the tobacco companies?
ERIC SOLBERG
Perfect question. So now, to this—I'm glad you asked that because it's still—so the FDA, a few years ago,
there was a law that was passed to give the FDA regulatory authority over conventional cigarettes, okay,
and that includes—but the brands that were already in existence were not going to be included in this
review. It's only new brands that were coming up. The FDA could then have some oversight. So just like
the FDA model works for pharmaceutical companies, the pharmaceutical pay the FDA to regulate the
industry, so to the tobacco industry pays the FDA to regulate whatever. And then the FDA hands that
out in grants. I say it's no different. It's all the same. The money that we get in taxes from our cigarette
taxes and from the settlement, which by the way, that $17.3 billion number—the B—that I gave you
earlier for the Texas cigarette settlement, litigation settlement, that was just the number that they could
put on the first twenty-five years. Those dollars are in perpetuity as long as the cigarette companies
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remain viable. So we're on the hook, literally. That's why it's so—a good friend of mine in New York,
physician, Dr. N. Ansell said it best, I think, around 1988-89 when they were talking about these billions
of dollars going to the states. He said, "The most addictive thing about tobacco is money." And it is.
0:46:35 What has happened now is they're still in control. So the cigarette companies have willingly paid
these dollars. We'll be happy. We're settling with you. We're going to give you billions and billions of
dollars over however many years they're in business. And they have already shifted themselves. So
Philip Morris, the maker of Marlboros, they make e-cigarettes. They purchased U.S. Tobacco Company,
which was the biggest manufacturer of spitting tobacco products. So they just accumulated even more.
And again, the profits are through the roof to the point that they can pay all fifty states billions of dollars
every year both in taxes that are collected and in settlement dollars and still have money to dole out for
research, give to the FDA, whatever. And I agree with your comment. It's no different than when they
used to just give it directly to MD Anderson Cancer Center or the American Cancer Society. Now it's sort
of—in fact, this question was posed by another colleague of mine. The American Medical Association
held a meeting in 1997 or '98. And it was during the discussions with cigarette companies were going on
about how much they should settle for. And the president, Lonnie Bristow, AMA at that time, said, "We
need to make sure that those dollars get earmarked and donated to finding smoking. And again, this is
coming form the American Medical Association who used to get money to pretend that smoking didn't
cause lung cancer. So a little irony there.
But I think it was—what was so amazing about it was his comment was, now they can give them money
from us, meaning industry give it to me, and then I hand it out instead of the industry sponsoring the
science. It was just a ridiculous comment, made no sense whatsoever.
THOMAS COLE
Here's a question.
MALE SPEAKER
When did the cigarette vending machines get removed from hospitals?
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ERIC SOLBERG
00:48:44 Yes, so it varied. And it varied by state. I remember in the state of Texas I want to say it was
around '91 or '92 because I was already here. Most of that was done voluntarily, although some of the
gift shops were still selling it after the vending machines were gone. I know they didn't get rid of
cigarette vending machines at the Astrodome until around '95, '96. There was a big push to do that. I
think when Drayton McLane bought—the irony there too because he's a grocer supply company that
had been carrying cigarettes in grocery stores. But he actually removed the Marlboro billboard in the
Astrodome in the late 1990s. And he removed cigarette vending machines. So Drayton McLane, I guess
he was making plenty of money trucking cigarettes around the state of Texas. I don't know the answer
to that specifically, but I can kind of give you a time frame.
THOMAS COLE
I think Dr. Ray has a question.
DR. RAY
So some of my students in class where talking about lung transplants, and they started talking about
raising the legal age to buy cigarettes similar to alcohol. I suspect I know what your thoughts are about
that, but can you tell me what they are?
ERIC SOLBERG
Yeah, I guess legal ages has been a failed—I would say that's a conventional thinking kind of approach
because the average age for adolescent onset tobacco use is around seventh or eighth grade is when
they start getting a hold of their own cigarettes, not stealing them from their parents. They're doing that
younger. But their starting to find a way to get their hands on them. One of the biggest campaigns that
both Philip Morris and R. J. Reynolds Tobacco companies both had throughout the seventies, eighties,
nineties, and even into the early two thousands was one of—R. J. Reynolds was called "It's the Law."
They had these signs on the door, all of these things that you can't buy until you're eighteen years of
age, whatever. So I'm not sure that that would do a whole lot. So we have this incredible advanced
therapies and transplantation center at UT Health where last year, they did sixty-eight heart
transplants, over 500 left ventricular assist devices. I don’t know how many lung transplants are on the
schedule, but that would get back to my comments from when I was still in graduate school trying to
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figure out what I was going to do. I just kept telling myself, "If you can just sort of cash in for some new
parts later on, and that becomes the main option, what are we really doing?"
THOMAS COLE
0:51:38 So are there any bright spots number one, and number two, what are the next fights that are
worth fighting?
ERIC SOLBERG
The bright spots are the next generation, are students that are sitting in this room because I think it's
going to take the next generation to solve this problem. And I don't know how many medical schools
include courses that would even talk about things like this. So kudos to having this as a topic in the
History of Medicine series. I think, I really do think those are the bright spots. I'm looking at some of our
younger people in the room, and my telephone line is open. And I still work on this nights, weekends,
and holidays. And I get paid to do this. It's a passion of mine. And if anybody else feels passionate about
it, I'd be happy to take you along with me.
Number of students—for about ten years when I was at Baylor College of Medicine, I ran a program
called DOC. It was called Doctors Ought to Care founded by a family physician back in 1977, actually Dr.
Alan Blum, who was on faculty at Baylor for about sixteen years. He's now at the University of Alabama.
He and I still talk daily. We have that kind of connection. But he really had the foresight, I think, in the
1970s as a resident in family medicine to get the medical community a little bit more engaged. And so a
lot of the stuff that we did when I was working with him in the early 1990s was working with medical
students across the country to sort of think outside the box; what can we do? We got them very
involved in their local communities, not that there's a lot of funds. If students have an interest in reenergizing it, I'd love to do it.
THOMAS COLE
More work to do here. I hope you all are listening. And some of it is outside the scope of medicine per
se. Some of it is about lobbying. Some of it is about being vocal just the way you're vocal in public
climate change, in global health, being vocal and active in smoking, and in particular, these kind of really
difficult, long-standing corporate and political ties that needs to continually be challenged. Any other
questions? There's one more.
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FEMALE SPEAKER
Did cigarette companies who actually were funding companies, were they influencing the outcome of
the research?
ERIC SOLBERG
00:54:20 I'm going to read you some of this to see if I can find it. Then I'm going to let you decide. Let's
see. Here we go. So now, this is a statement before Congress in 1982. And the statement is made by Dr.
Eleanor J. MacDonald, professor emeritus of epidemiology, Department of Cancer Prevention, University
of Texas, MD Anderson Cancer Center. This is her testimony before Congress against a bill to do more
education on the issue of smoking, lung cancer, so on and so forth. "My name is Eleanor MacDonald,
professor emeritus," I said that already. "I have worked in the field of epidemiology for over forty years
in three state programs in Massachusetts, Connecticut, and Texas. In fact, I established the first state
cancer registry in the United States. From 1948 through 1974, I chaired the Department of Epidemiology
at MD Anderson Cancer Center. I have authored or co-authored about 150 plus publications." Okay,
enough of that.
"I share the concerns of this committee regarding cancer morbidity and mortality, and I encourage
legitimate efforts to control the disease. However, as a scientist who has dedicated her professional
career to a careful study of the cancer epidemiology, I am appalled at the belief implicit in Senate bill
772 that Congress can legislate scientific fact. I urge this august body of well intentioned legislators to
avoid putting itself in such an untenable position. This bill is a misdirection of governmental energy and
purpose because of its narrow focus on smoking as the primary cause of lung cancer." I'm not going to
read the rest of it because it goes on for eighteen pages. So your question was did the money that the
cigarette companies provide for research have an influence on the outcomes. And the answer is yes
because Dr. Eleanor MacDonald for twelve years was taking money directly from six cigarette companies
while working at MD Anderson Cancer Center. That is how she finished her career as department chair
and then as a faculty member at MD Anderson. Her focus of her entire career was to point at other
causes. And Houston Texas gave her the opportunity because what have you ever heard about the ship
channel and lung cancer? There's always been higher rates of lung cancer on east Texas, east Houston
area. And she documented this in her epidemiology, wrote several books about it, published numerous
papers about it, but she wasn't asking the question which was of the people who were working there,
what was the percent of those who smoked? It was in the 66-68 percentile for males, right? But she
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wasn’t interested in that question. She just wanted to point to the air pollution from the petrol
companies.
THOMAS COLE
0:57:38 And that was a question that could have been teased out if she'd compared the smoking group
to the non-smoking group.
ERIC SOLBERG
Sometimes they would actually list the causes of lung cancer in alphabetical order so you would see
asbestos at the top and tobacco down at the bottom, right? Even though—I mean, that's crazy, right?
Who would do that, right? Interestingly enough, when cigarette filters were introduced in the world, it
started here in the United States, in the 1950s, one of the first ones was for Kent cigarettes. It was
advertised as so clean, so pure, used to filter the air in hospitals. It was made from asbestos. The
cigarette filter was made from asbestos. It's amazing.
THOMAS COLE
I think there's one more question, and then we have to wrap.
MALE SPEAKER
So what should be the new model for funding of this research that should be analogous that should be
analogous [inaudible] therefore, we should stop all the funding of it?
ERIC SOLBERG
Yeah, that's a good question. You know, I would like to see more in the way of instead of sort of
traditional behavioral research, I would love to see some research dollars going into how we could really
actually deal with the problem to begin with rather than hitting individuals to change their minds about
some behavior they've adopted over the years. I think that it's, to be honest with you, I think it requires
an internal look. Both public health and medical professions need to look at themselves and say, "What
have we created here?" I mean certainly we've created a pipeline of funding because we've got the
industry paying for it. So there's tons of research dollars now. You can go to the FDA website, and we
have a grant at our institution at UT Health Science Center, our regional public health campus, regional
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campus in Austin, they have one of the FDA-centered grants, 16 million bucks over five years. Huge,
huge. Now, I will give—so Dr. Cheryl Carey is the PI on that. And I give her a lot of credit because she's
using those dollars to actually study consumer behavior among adolescents. You don't see that much in
a school of public health. So my hope is that people would do more of that to take a look at new
avenues. The money's going to be there. It's going to continue to flow. I think we could do— I would
love to see public advertising campaigns. So not the public service ads. Those are the ads on at three
o'clock in the morning showing kids not to take rides with strangers when the only one's up listening are
the strangers. Okay?
1:00:15.5 It's a great quote actually. It actually comes from Tony Swartz, media guru in New York,
handed down to me from Dr. Allen Brown. So paid advertising, why don't we put all our money where
our mouth is. That's what the industry does. They're advertising. Why are we not doing the same thing?
There's been small examples of that that have shown success. We had an example of that in Houston
that showed success back in the '90s. And I think we just need to see more of that.
THOMAS COLE
Great. Well, I'm sure you will join me in thanking Eric Solberg for an amazingly knowledgeable hour with
us.
Transcribed by Adept Word Management
01:00:51 (end of audio)
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A
Alton Ochsner ................................................................................................................................................................8
Altria ..............................................................................................................................................................................6
American Cancer Society ......................................................................................................................... 3, 8, 15, 18, 19
American Heart Institution, AMA ..................................................................................................................................3
American Medical Association................................................................................................................................. 8, 19
Ansell, Dr. N. ................................................................................................................................................................18
Astrodome ...................................................................................................................................................................20
B
Baylor College of Medicine ...................................................................................................................................... 8, 21
Blum, Dr. Alan ..............................................................................................................................................................21
BMJ Publishing .............................................................................................................................................................13
Bristow, Lonnie ............................................................................................................................................................19
Burdette, Dr. Walter .....................................................................................................................................................5
C
Carey, Dr. Cheryl ..........................................................................................................................................................23
Centers for Disease Control, CDC ..................................................................................................................................3
Congress ............................................................................................................................................................ 7, 12, 22
D
Doctors Ought to Care, DOC ........................................................................................................................................21
Dr. LeMaistre ............................................................................................................................................................. 5, 6
F
FDA .................................................................................................................................................................. 18, 19, 23
G
General Foods ................................................................................................................................................................6
H
Health Science Center in Antonio ................................................................................................................................13
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K
Kraft ...............................................................................................................................................................................6
L
LeMaistre, Dr. Mickey ....................................................................................................................................................5
M
MacDonald, Dr. Eleanor J. ...........................................................................................................................................22
Marlboro .............................................................................................................................................. 6, 7, 9, 16, 17, 20
McLane, Drayton .........................................................................................................................................................20
MD Anderson ....................................................................................................................... 2, 5, 6, 8, 11, 13, 14, 19, 22
menthol .........................................................................................................................................................................9
Miller Brewing ...............................................................................................................................................................6
Minneapolis Heart Institute ...........................................................................................................................................3
Minneapolis Star Tribune ..............................................................................................................................................3
Morales, Dan ...............................................................................................................................................................13
N
Nabisco ..........................................................................................................................................................................7
National Cancer Institute .............................................................................................................................................11
Newport cigarettes ........................................................................................................................................................9
North Dakota State Department of Health.............................................................................................................. 3, 11
P
Patty Young..................................................................................................................................................................12
Philip Morris ............................................................................................................................................ 6, 7, 15, 19, 20
President Johnson .........................................................................................................................................................5
Prop 99 ........................................................................................................................................................................18
R
R. J. Reynolds ........................................................................................................................................................... 6, 20
Ready Clinics ................................................................................................................................................................16
S
Scranton University .......................................................................................................................................................8
Sick Bed Fellows .............................................................................................................................................................7
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spiral CT .......................................................................................................................................................................14
Surgeon General's report .......................................................................................................................... 4, 5, 8, 10, 11
T
Texas Medical Center ....................................................................................................................................................8
Texas Society for Respiratory Care ................................................................................................................................7
tobacco ....................................................................................... 1, 2, 4, 6, 7, 8, 9, 10, 12, 13, 14, 15, 16, 18, 19, 20, 23
Tobacco Control..................................................................................................................................................... 12, 13
Tobacco Industry Research Council .............................................................................................................................10
Tobacco Use, Helping Youth Decide ............................................................................................................................15
U
U.S. Tobacco Company ................................................................................................................................................19
University of Minnesota ................................................................................................................................................3
UT Southwestern Medical Center..................................................................................................................................5
V
Virginia Slims .................................................................................................................................................................8
W
Wentz, Dr. Robert ..........................................................................................................................................................3
Z
Zika virus ......................................................................................................................................................................14
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