M.D. Anderson Cancer Center banned the sale of cigarettes back in the mid-1970s, becoming one of the first hospitals in the country to do so. The University of Texas-affiliated institution also led the way in creating the smoke-free environment that exists today in most large buildings when its president, Dr. Charles LeMaistre, outlawed smoking inside M.D. Anderson's facilities in 1989.
"Everybody here," explains Steve Stuyck, M.D. Anderson's vice president for public affairs, "abhors tobacco and is opposed to the marketing of tobacco products."
As Dr. Joel Dunnington has learned, however, that abhorrence is not so pronounced that it keeps scientists at M.D. Anderson from taking money from the Council for Tobacco Research, an arm of the tobacco industry that has been censured by no less an authority than the American Medical Association, an organization not exactly known for its cutting-edge activism.
Dunnington has been working -- unsuccessfully -- to wean M. D. Anderson, considered one of the nation's premier cancer research and treatment hospitals, from its reliance on tobacco-tainted funding. Last summer, the radiologist stood before his colleagues on M.D. Anderson's faculty senate and delivered an impassioned plea urging the cancer center not to accept research grants from the Council for Tobacco Research. His speech carried the day, as the faculty senators voted 15-12 in favor of his recommendation.
But Dunnington's eloquence was for naught. M.D. Anderson's research council, an internal group of faculty department heads who oversee research funding at the center, refused to go along with the faculty senate's vote. And without that group's backing, Dunnington's long-standing ambition to ban tobacco dollars was doomed, since it was assumed that LeMaistre, who helped write the landmark 1963 Surgeon General's report on the dangers of smoking, would change the institution's policy only if the research council supported the faculty senate vote.
"We did away with selling cigarettes at M.D. Anderson many years ago, as a statement that we are a cancer center and that we shouldn't be selling them," says an exasperated Dunnington. "But yet we'll still turn around and take the money from the profits on those sales to our patients and use [it] to do research."
Dunnington estimates that the Council for Tobacco Research -- which he dismisses as a "fraud" perpetrated by the tobacco industry -- has funded about $500,000 worth of research at M.D. Anderson in recent years. Dr. Anthony J. Mastromarino, M. D. Anderson's associate vice president for research, says the council provided only $176,000 in this fiscal year for three studies on mammary tumors, colon cancer and gene expression in muscle tissue. Those figures represent only a small fraction of the center's total research budget, which this year amounts to about $86 million. Both sides cite the relative monetary insignificance of the council's largess to bolster their arguments -- with opponents claiming it allows the tobacco industry to buy respectability for a pittance and proponents maintaining that it's such a small amount that it's hardly worth arguing about.
That the Council for Tobacco Research uses its research funding for its own public relations purposes is not contested by either side. The council was created in 1954 by the tobacco industry and to this day is funded by tobacco companies. From 1954 through 1991, the council's board of scientific advisors has bestowed funding of more than $185 million for 1,246 original articles by more than 850 scientists. That's a lot of money, but it pales when compared to the 1993 advertising budget of the tobacco industry -- about $5.2 billion.
In addition to its deployment in the public relations battle against anti-smoking forces, the council-funded research also is cited in defense of lawsuits against the tobacco industry, Dunnington says. In one recent unsuccessful lawsuit brought in Mississippi by the family of a deceased smoker, tobacco industry lawyers showed the jury a poster listing the institutions that received funding from the Council for Tobacco Research. M.D. Anderson was one of those listed.
"They had funded this much money, hundreds of millions of dollars over the past 30 years," Dunnington says the defense attorney told the jury. "And there was no clear-cut cause and effect of cigarettes and cancer and other diseases, but that they were a very interested and honorable industry and they were going to keep funding these things until they found something."
In reality, even those who support the acceptability of the funding admit -- even emphasize -- that very little of it supports the study of tobacco's effects on health. Mastromarino, after examining the grants M.D. Anderson has accepted from the council, acknowledges that "few if any dealt with any kind of pulmonary disease or tobacco-related illnesses, or how tobacco directly affects body systems or disease. It's really basic research."
One national survey showed 80 percent of the studies had nothing to do with tobacco. So at least in name, the Council for Tobacco Research is suspect. In one court case, U.S. District Court Judge H. Lee Sarokin branded the council a "hoax created for public relations purposes with no intention of seeking the truth or publishing it."
But scientific research funding isn't abundant these days, and Mastromarino admits that the scarcity is one reason M.D. Anderson has allowed its researchers to keep taking the money. "I'm not saying this necessarily justifies the position," he says, "but the money is going to be expended for research (anyway) and 'better my lab get it than Joe Blow's in another institution,' or someplace else, particularly during a time of tight budgets and shrinking research dollars."
That view doesn't explain, Dunnington says, why M.D. Anderson took funding from the tobacco council for years when research money from other sources was "flowing fairly freely." And scant resources, he argues, are no reason to willingly take funding from an industry whose product causes an estimated 419,000 deaths per year.
"They always say research money is tight. It certainly is and it's going to get tighter," Dunnington says. "But I'm sure if you look back to 1640 they said research money was tight and in 1790 research money was tight. In 1905 I'm sure the research money was tight. In 1954 when they set up the Tobacco Institute's research council I'm sure they said money was tight."
Dunnington says scientists need to examine their work in a larger context and ask themselves if their projects are more important than the public relations or legal defense benefits the tobacco industry gets from the association. "Is your project really going to supersede the importance of the tobacco industry putting this on and getting another year's worth of saying, 'The jury's still not in,' and, 'We still aren't sure if cigarettes cause lung cancer, emphysema, heart attacks or not'?"
Another argument against the prohibition was the maintenance of academic freedom: that faculty members "should not be dictated to" when it comes to where they should seek funds. Other reasoning included the "where-do-we-draw-the-line" argument, since other companies that profit from tobacco sales (Kimberley Clark makes paper used for cigarettes) fund research projects. Following that argument, perhaps to an absurd point, the tax dollars that support University of Texas' M.D. Anderson include money from taxes on tobacco and could be called into question. "Do we distance ourselves from state appropriations? I think not. We couldn't," Mastromarino says.
The anti-tobacco contingent does not have much patience for those arguments. No one, at least not yet, has proposed prohibiting accepting funds from second-line industries who do business with cigarette makers. Certainly no one has advanced the notion of rejecting state funding, which accounts for 15 percent of M.D. Anderson's total budget.
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Though Dunnington is disappointed in his most recent run at banning the Council for Tobacco Research funds -- a similar effort in 1991 also failed -- he thinks the tide is turning. The increasing awareness of the hazards of smoking and the growing acceptance of non-smoking areas in public places has put the tobacco industry on the defensive. The appearance by the chairman of the Council for Tobacco Research before Congress last May focused attention on the group's origin and methods, and lately some mainstream organizations have come out in opposition to its funding.
The American Medical Association last year defined the Council for Tobacco Research as part of the "tobacco industry" and now refuses financial support from it. The AMA also encourages all medical schools and their "parent universities" to follow this lead. In a Nov. 8 letter to the dean of Ohio State's College of Medicine, AMA executive vice president Dr. James Todd wrote that the mission "of medicine and of legitimate medical research can never, in our opinion, be compatible with the purposes of the tobacco industry. Medical school use of tobacco profits to fund its research compromises the trust, built over decades, with the public. The AMA strongly urges medical schools to cease accepting research funding from tobacco companies and their research front organizations."
On the state level, the Texas Medical Association passed a resolution last year to "discourage" medical school faculty from accepting tobacco-related funding.
Despite Dunnington's failures thus far, the conflict at M.D. Anderson is far from over. "I think it's going to come up again, particularly if Dr. Dunnington has anything to say about it," Mastromarino predicts. "He's not going to be content until he gets a decision not to accept the support.