A nationwide advertisement by the second-largest tobacco company is under legal challenge for using a federal study's results to claim that "the controversy over smoking and health remains an open one."
In the ad, titled "Of Cigarettes and Science," R.J. Reynolds Co. contends that a federal study completed in 1982 failed to find a clear link between smoking and heart disease.
But doctors and public health experts, including scientists who conducted the research, say Reynolds misrepresented the study's purpose, findings and conclusions.
A coalition of prominent health groups has petitioned the Federal Trade Commission to halt the ad, calling it "false and deceptive" in violation of the law. The 31-page petition -- which the American Heart Association calls the biggest challenge to tobacco advertising since cigarette ads were banned from television in 1971 -- also asks the FTC to order Reynolds to pay for corrective ads.
The Reynolds ad, published in 25 newspapers and magazines, including The Washington Post, says the conclusion that smoking, high blood pressure and high cholesterol cause heart disease is "an opinion. A judgment. But not scientific fact."
That infuriated public health experts.
"It's like an ad that says, 'Eat a carcinogen -- we need more time to think about this issue,' " said Dr. Lewis Kuller, epidemiology chairman at the University of Pittsburgh's School of Public Health, who was a chief investigator for the federal study cited in the ad.
"There are a ton of studies showing that smoking is related to heart disease," Kuller said. "A good part of the epidemic of heart disease from the 1940s to the 1980s can be explained by smoking."
"With this ad, R.J. Reynolds has stepped well over the legal boundary, as opposed to the moral boundary, which they stepped over a long time ago," said Matt Myers, staff director of the Coalition on Smoking or Health, which includes the heart association, the American Cancer Society and the American Lung Association.
"They [Reynolds] totally misrepresented the intent of the study," said Dr. John Holbrook, associate professor of medicine at the University of Utah and a consultant to the U.S. surgeon general's 1983 report, which concluded that between 1965 and 1980 more than 3 million Americans died prematurely from heart disease attributed to smoking.
"Ask any health group that has looked at this issue, with no money to gain from the sale of a product," Holbrook said. "There's not one anywhere in the world that concurs with the tobacco industry.
"We have the data and they have the money."
Reynolds, based in Winston-Salem, N.C., makes Winston, Salem and Camel cigarettes, among others, and accounted for 31 percent of the nearly 600 billion cigarettes sold in the United States last year. It ran a close second to Philip Morris.
Reynolds launched a series of ads early last year on topics ranging from fire safety to courtesy between smokers and nonsmokers.
The ad under legal challenge is somewhat unusual in that it tries to address a health issue and cites a specific scientific study.
"We took issue with all the ads, but this one was so flagrant, because it dealt with a specific scientific study, that we had to answer them," said Dr. Alfred Munzer, associate director of the pulmonary disease department of Washington Adventist Hospital in Takoma Park. "The integrity of scientists was involved."
The focus of the controversy is the Multiple Risk Factor Intervention Trial (MR FIT, or "Mr. Fit," as it's popularly known), a 10-year, federally funded study of nearly 13,000 middle-aged males at high risk for heart disease because of high blood pressure, high cholesterol and smoking. The study was designed to test whether aggressive intervention could help lower their rates of heart attack.
Half the men received special treatment aimed at reducing those three risks -- for example, counseling to help them stop smoking and change their diets. The other half got "usual care" -- an annual checkup and referral to their own doctor.
After 10 years, there was no statistically significant difference in the coronary death rates of the two groups. What happened, said MR FIT researcher Kuller, is that both groups reduced their risk factors, including smoking, as did the American population as a whole during that period.
The key finding with regard to smoking, he said, was that in both groups, those who quit smoking reduced their coronary death rate by nearly 50 percent.
MR FIT was designed to test only the effectiveness of aggressive intervention versus "usual care" for high-risk men. It did not test the link between smoking and heart disease, Kuller said, because the scientific evidence on that issue was considered beyond question.
Yet Reynolds used the MR FIT results to cast doubt on the link between smoking and heart disease.
"The bottom line is, we're not saying smoking is good for anybody," said David Fishel, vice president of Reynolds. "We're not saying smoking is not harmful.
"What we are saying is that there are scientists who believe both ways. There is still a debate out there."
But the American Cancer Society said in a statement there is "no controversy about the health effects of smoking. The case is closed. The only place where this controversy may still prevail is in the policy making, public relations and executive offices of R.J. Reynolds Co."
"It's the height of editorial irresponsibility and the acme of self-serving interest," added Holbrook, "to look at hundreds of studies and claim there are no data."
And Kuller said scientists who don't believe smoking is related to heart disease "are few and far between. If you look, some of them get paid handsomely by the tobacco industry."
Asked to comment on the criticism by the health groups and by researchers who conducted the MR FIT study, Reynolds' Fishel said: "I don't know any of these people. I can't begin to guess about their motives.
"But I can tell you we are prepared, should we be asked by the FTC, to appear before them to answer questions about that ad."
FTC staff will review the petition privately to see whether the Reynolds ad violated the law and, if so, what further action is warranted, said Judith Wilkenfeld, the agency's cigarette program adviser. That preliminary decision could take anywhere from one to six months, she said.
A spokesman for the Tobacco Institute, an industry group, declined to comment specifically on the ad or the petition to the FTC because it involved only one firm.
"What R.J. Reynolds did was really sort of to go out on their own," said Bill Aylward, assistant to the president of the Tobacco Institute. "Our advice was officially, 'Don't do it.' They did it, and now that they have, we're supporting them."
He called the Reynolds ad campaign "quite successful," adding, "The dialogue is established, and that's just what they [Reynolds] wanted."
Although Aylward claimed the MR FIT study was "not even mentioned in the press" until after the Reynolds ad appeared, the National Heart, Lung and Blood Institute has documented that during the seven months following the study's release, MR FIT was covered in at least 215 television and press reports and more than 50 articles in major scientific journals.
"I don't think we have a legitimate debate" anymore over the risks of smoking, Kuller said. "The only legitimate debate is over the best possible way to eliminate smoking in this country."