This year, 2024, marks the 60th anniversary of U.S. Surgeon General Luther Terry's 1964 landmark Smoking and Health report, which authoritatively linked cigarette smoking with diseases such as lung cancer and emphysema. In this two-part interview, we speak with former National Library of Medicine (NLM) employee Donald R. Shopland, who was detailed to the Surgeon General's Advisory Committee and later went on to become Coordinator of the National Cancer Institute's Smoking and Tobacco Control Program. Shopland recently co-authored the open-access book Clearing the Air: The Untold Story of the 1964 Report on Smoking and Health, which provides a first-hand account of the circumstances leading up to the publication of this historic document. Read Part I of the interview.
CN: How long did it take to write the Smoking and Health report? Was the work kept a secret? Were there ever leaks or other issues with secrecy?
Donald R. Shopland: The report itself was not written in one fell swoop but emerged in piecemeal fashion. And keep in mind that when one or more sections were complete, there was not an attempt at that point to integrate them in any fashion -- that didn't come until much later in the process. I'm not sure, but I suspect chapter 10 on Non-neoplastic Respiratory Diseases was the first completed. The chapters on overall mortality and Cancer were the last major chapters to be finished, but that was partly because the Committee was waiting for the results of the new American Cancer Society's Cancer Prevention Study I, which included data on over one million men and women living in 25 states.
The Surgeon General's Advisory Committee (SGAC) work was indeed kept secret and for good reason. The tobacco industry in the early 60's was a major economic force. Hundreds of thousands of people were employed in tobacco factories and the industry was a major consumer of all manner of other products, such as paper and agricultural supplies. Some 750,000 families were involved in growing and harvesting tobacco, and millions more derived their living from the retail sale of cigarettes and other tobacco products. Excise taxes derived from the sale of tobacco were also significant sources of revenue for both federal and state coffers. Anything that disrupted such a large industry could have significant ripple effects within the larger economy. This was also a major reason why it was decided to release the Report on a Saturday morning, when the stock market was closed.
Despite all of this, the only serious security breach we experienced was when a Newsweek photographer and reporter accompanied a reporter from the NIH Record down to the workspace on C level (known to current staff as Basement level 3, or B3) when the Committee was meeting. The PHS had previously arranged for the NIH Reporter to take some official photos of the Committee in action, but the presence of the Newsweek personnel was unknown to anyone on staff. In the November 18, 1963 issue of Newsweek there was a large story about smoking and health as a result of this incursion. The reporter didn't get to see anything of importance and a lot of what they reported on -- like the fact that the cigar-smoking President Kennedy would have to clear the report -- was just pure speculation. The SGAC staff member who was involved in allowing the Newsweek people in was fired on the spot.
To guard against any premature leaks, Dr. Eugene Guthrie, Staff Director to the Committee, arranged to have all galley and page proofs of the final report printed by several printers scattered in and around the DC area at night after normal business hours. This prevented any one printer from having the entire report. Any scraps of leftover paper had to be put in burn bags and destroyed. The Government Printing Office printed the final report and delivered it to the State Department Building the afternoon of January 10, 1964, the day before it was released to the public. It was put in a secure room and a guard was posted. The 1964 smoking and health report was the only civilian, non-military top secret document ever printed by the federal government up to that point.
CN: What do you remember about the people you worked with? Did you make any lasting connections?
DS: I kept in contact with several people I worked with, both on the Committee and at NLM. Our agency, the National Clearinghouse for Smoking and Health, moved down to Atlanta in the mid-70's, but was relocated to the DC area in 1978, and after I moved back, I made at least one or two visits to NLM. Some of the same staff were there but quite a few had retired or taken jobs elsewhere. The library technician job was pretty clerical in nature, and most people tended to move on within a few years. I know I only worked in the stacks for about two years or so before taking another position within NLM, and I left permanently in the summer of 1966 to work for the Clearinghouse. So, I was at NLM for not quite four years total. Still, it was my first "real" job, and I have lots of good memories from those early days.
As for the Committee members, the two I kept in contact with the most were Dr. Len Schuman and Dr. Mickey LeMaistre. When I worked on subsequent Surgeon General smoking reports -- starting in 1967 they were required by Federal law -- we often tapped Dr. Schuman as a reviewer. We also worked with him again when we had to do the massive 15-year anniversary report of 1979, when he was asked to write a summary of how the report conclusions differed from those in 1964. And, of course, for nearly 15 years, Dr. LeMaistre and I undertook to write a book about how the 1964 report came about, which culminated in the open-access book Clearing the Air: The Untold Story of the 1964 Report on Smoking and Health being published this past March.
In terms of the core Committee staff, many of them -- including both myself and Mildred Bull -- joined the National Clearinghouse for Smoking and Health that Dr. Terry established in October 1965. Mildred left in the late 60's and started her own court reporting company, but we stayed in touch and my wife even went to work for her for a few years.
CN: Your time with the committee was very early in your career. How did that experience shape your future work? Tell us a little about your career.
DS: Simply put, working on the SGAC was life changing. As an 18-year-old kid with only a high school diploma, I had little or no life goals. Long term planning for me in the early 60's consisted of what I was doing next week. A career in public health was not even in my vocabulary. I couldn't have told you the difference between an epidemiologist and a proctologist, and boy could that get you into trouble. In the summer of 1966, I joined Dr. Terry's newly established National Clearinghouse for Smoking and Health -- it's now called the U.S. Office on Smoking and Health -- as part of its Technical Information Center (TIC), which housed all the studies that the SGAC had amassed as well as those that the staff acquired afterwards. The TIC was essentially the clearinghouse function of the Clearinghouse.
The TIC ended up being integral to subsequent Surgeon General reports, and I was at the center of it because I knew how the original database was organized. I was in charge of deciding which new studies were entered into the collection and I also became the point person for anyone who wanted to retrieve anything -- including the in-house scientific staff. And an amazing thing happened along the way: I increasingly became a sought-after source of information on the health effects of smoking and the Surgeon General's reports.
By the time Secretary Joseph Califano established the Office on Smoking and Health (OSH) as a successor to the Clearinghouse in 1978, I had established a pretty good reputation for my knowledge of smoking and health. It was with OSH that my name became virtually synonymous with the Reports of the Surgeon General, having worked on the first 18 of those reports issued between 1967 and 1986. However, in the fall of 1986, the powers that be decided that OSH was going to be removed from the immediate Office of the Assistant Secretary for Health and placed within the Centers for Disease Control. At the time I was Acting Director of OSH. Unfortunately, I butted heads with the director of the Center within CDC we were being placed under.
Well, I know when I'm not wanted. So, after the new director was announced, a very capable fellow by the name of Dr. Ron Davis, I decided it was best if I moved on. So, I came back to the National Institutes of Health and joined the National Cancer Institute's (NCI) smoking research program, where I started a series of monographs on smoking that looked at a variety of topics, mostly based on NCI's large portfolio of smoking intervention trials. I published 15 in total. In 1992, I was named Coordinator of NCI's Smoking and Tobacco Control Program, a position I held until I retired from Federal service after almost 40 years. Even after leaving federal service, I continued to serve as a senior reviewer and occasional contributor to the Surgeon General's reports up until 2014. In effect, I was involved in 32 reports on the health consequences of smoking issued from 1964 through 2014. It's the thing I'm most proud of, and I dare say I'm the only person who can boast the distinction in having their name listed in all those reports.
CN: Is there a particular memory or anecdote you would like to share about your time at NLM?
DS: While I have many good memories of my time working for NLM and the Committee, the one that stands out amongst them all was the day of Kennedy's assassination. I was working on the SGAC and a few of us staffers were going out for a late lunch. We were preparing for a busy weekend of work as the full Committee was expected for one of its most important meetings, finalizing issues for the report and developing final conclusions. As we passed by the guards' office that leads to the staff parking lot, one of them mentioned a news flash reporting shots fired at the presidential motorcade in Dallas. But nothing else as the story was just starting to unfold.
One of the secretaries with us said her husband worked for the FBI downtown and she called him to see what he knew. Ironically, he had heard nothing but put her on hold while he went down to the teletype room. Within a few minutes, he was back saying that it's true, all the wire services were reporting there were shots fired, but that was all that was known. Of course, within the next 40 minutes or so the whole world knew and both radio and TV reporters came on the air with nonstop coverage of the event. At 2:00 EST it was announced that Kennedy was dead and Texas governor John Connally was wounded.
We would learn later that Dr. LeMaistre, who worked at Southwest Medical Center in Dallas, was called in with another physician to attend to Gov. Connelly at Parklawn Hospital. He would also be asked to call Mrs. Kennedy's secretary to see if the Committee should even meet that weekend given the circumstances. He was told this issue was important to the President and that she thought he would want the Committee to meet. Needless to say, it was a very somber weekend for everyone, and the Committee had a difficult time focusing on their assigned tasks. On Monday, they decided to pause work to join the rest of the nation in mourning and watch Kennedy's televised funeral. Ironically, Kennedy's body was brought in for autopsy to the National Naval Medical Center, which was right across the street from NLM. Several of us who were still working late that night in preparation for the Committee's forthcoming meeting that weekend witnessed the event.