For more than three decades, epidemiologist James Enstrom has labored quietly at UCLA, studying the effect of tobacco smoke on human health. In recent years, his work has challenged the conventional view that second-hand smoke poses a serious health risk.
He calls himself a lone wolf, a maverick and a rebel. His critics call him a turncoat.
Enstrom once worked closely with the American Cancer Society, but today his sponsor is the tobacco industry. Over the last 15 years, he has received $1.4 million plus undisclosed consulting fees from the industry while producing research that supports industry views. One study used the American Cancer Society’s database to contend that second-hand smoke was not a serious health hazard.
Now Enstrom has become a symbol of industry influence for activists who support a proposal to bar University of California researchers from receiving tobacco industry money. The regents will take up the issue in May. Mirroring divisions elsewhere in UC, some university regents back a ban, while others oppose it on grounds of academic freedom. The 63-year-old Enstrom maintains that he is simply a scholar in “pursuit of truth.”
“If I was so corrupt, how could I survive for 33 years at UCLA?” he asks. “The effort is to smear me and libel me.”
Unfortunately for Enstrom, much of his correspondence with the tobacco industry became public during lawsuits filed by government agencies against the companies. Some of his letters are more revealing than he would have wished.
Seven months ago, his research and correspondence were cited by a federal judge in a racketeering case as evidence of the tobacco industry’s manipulation of the scientific process. In January, the ethics of his research were called into question at a public meeting of the UC Board of Regents.
Enstrom, tall, forceful and passionate, believes the proposed ban at UC is aimed personally at him and says he is being vilified by a powerful lobby that places “political correctness” above science. He denies that tobacco money influenced his results, says no one has found errors in his calculations and contends that other studies corroborate his findings.
“It’s unfortunate to end up in a racketeering lawsuit for writing an article in a British medical journal,” he said ruefully.
University officials have kept their distance from Enstrom but note that he has faced tremendous pressure from his critics.
“In some sense I will stand up for Dr. Enstrom,” said Roberto Peccei, UCLA vice chancellor for research. “He’s got all these people beating on him. I’m not here to defend him, but I do think he was hit by a Mack truck.”
Enstrom went into the field of health research by chance.
A native of Alhambra, he earned a doctorate in physics at Stanford University. He was doing postdoctoral work at Lawrence Berkeley National Laboratory when he happened on a map showing cancer rates in the U.S.
He was intrigued to see that Utah had the lowest incidence of all 50 states. Theorizing that Utah fared better because Mormons don’t smoke or drink, he began collecting cancer data in his spare time.
In 1973, he abandoned physics and got a postdoctoral fellowship in epidemiology at UCLA. In 1975, he produced a well-received study funded by the American Cancer Society concluding that Mormons in California had lower cancer rates than other Californians.
He has remained at UCLA since, not on faculty but as a researcher in the School of Public Health. He receives no salary and has no university staff but supports himself through grants and contracts, using the money to hire part-time assistants.
During the first half of his career in epidemiology, he received funding from the cancer society and collaborated with two of its top scientists. In the late 1980s, the society gave him permission to use data from a survey of 1 million Americans conducted between 1959 and 1972.
But by 1992, the society deemed his work marginal and refused to fund more research. A grant from the state’s anti-smoking fund was short-lived. Enstrom said he reluctantly turned to the tobacco industry.
“If you want to do research, you have to get money from somewhere,” says Enstrom, a lifelong nonsmoker from a family of nonsmokers. “In an ideal world, I would not have taken it.”
According to documents filed by prosecutors in the racketeering case, Enstrom received $94,500 from the industry between 1992 and 1997, becoming “a key tobacco industry researcher and consultant.”
From 1993 to 1996, he also worked as a consultant for the North Carolina law firm of Womble Carlyle, analyzing other scientists’ studies for Philip Morris and R.J. Reynolds. He declines to say how much he was paid.
Despite his industry funding, Enstrom kept the cancer society data. In 1996, he sought industry funds to use the data to study the effect of second-hand smoke by analyzing the cause of death of survey participants who never smoked but were married to smokers.
The society had earlier rejected his plan, noting that there had been no follow-up since 1972 to learn whether subjects had remained married or changed their smoking habits.
“I told him repeatedly that the results would not be meaningful,” said Michael Thun, the American Cancer Society’s chief epidemiologist.
Without informing the society, Enstrom asked Philip Morris for funding. In a letter to the company -- cited in court documents -- he wrote:
“A substantial research commitment on your part is necessary in order for me to effectively compete against the large mountain of epidemiologic data and opinions that already exist regarding the health effects of ETS [environmental tobacco smoke] and active smoking.”
Enstrom says the letter was part of the normal grant process and his words were “taken out of context” by the court.
In 1997 and 1998, he received three grants from the tobacco industry totaling $700,000, most of it for his study using the cancer society database. Industry officials also lined up a coauthor, Geoffrey Kabat of the American Health Foundation in New York, court documents show.
Thun alleges that Enstrom misled the cancer society by not alerting the group when he began seeking industry funds or disclosing that he had begun receiving the money. “He’s a double agent, really,” Thun said.
Enstrom denies misleading anyone. “I told the American Cancer Society in 1998 that I got tobacco funding,” he said. “There was no reason to tell them in 1992 because I was not using their data.”
In 2003, Enstrom and Kabat published their peer-reviewed study in the British Medical Journal concluding that the link between second-hand smoke and lung cancer may be considerably weaker than generally believed. Since then, the tobacco industry has cited the study -- and its connection to the American Cancer Society and UCLA -- when arguing against local smoking bans.
“They are misusing the research process,” said Thun, “by sponsoring invalid studies and then using them as part of their public relations campaign.”
Among Enstrom’s harshest detractors was another UC scientist: UC San Francisco professor Stanton Glantz, a bulldog of an activist who has fought the tobacco industry for decades.
Glantz and the cancer society blasted Enstrom’s assumptions as flawed. In a radio interview, Glantz called his findings “crap.”
In July 2005, Enstrom brought charges of misconduct against Glantz, alleging he made “blatantly false statements” about Enstrom. After an eight-month inquiry by UC officials, Glantz was exonerated.
Last August, Enstrom’s ties to the tobacco industry took on a higher profile when U.S. District Judge Gladys Kessler in Washington, D.C., ruled in a lawsuit that had been in court for seven years that the major U.S. cigarette companies were guilty of racketeering, a crime usually associated with the Mafia.
Kessler concluded that the companies conspired for decades to deceive the public and had manipulated research to make it appear that scientists disagreed on the effects of second-hand smoke. As evidence, she cited the study by Enstrom and Kabat.
Enstrom learned he would be singled out in the judge’s 1,653-page ruling and called prosecutors and made “naive and ridiculous demands” that his name be removed, said lead prosecutor Sharon Eubanks.
Enstrom’s inclusion in the lawsuit has made him Exhibit A in the continuing clash between anti-smoking activists and tobacco companies as the battle shifts to academic research, one of the last bastions of tobacco industry influence in the U.S.
Across the nation, more than 20 academic institutions have banned tobacco industry funding of tobacco research.
Within the 10-campus University of California, seven academic units attempted to ban tobacco funding in 2004, including the UCLA School of Nursing, but were overruled by UC President Robert Dynes, who said the schools lacked that authority.
Opponents of the ban maintain that academic freedom means researchers should be free to study whatever they wish and to receive money from whomever they want.
Under UC’s code of conduct, researchers can accept money from any source to finance their work. UC does not review any research projects except to ensure that human and animal subjects are not mistreated.
“There is no oversight at all,” said Peccei, the vice chancellor.
Enstrom says there is no reason to restrict research money because the peer review process safeguards scientific integrity.
The issue came to a head at the January meeting of the Board of Regents. Glantz, described by one regent as a “national treasure,” presented the argument for the ban.
Enstrom, listening in on the Internet from UCLA, bristled at the praise showered on Glantz.
“Basically, we have a group of racketeers funding research,” Glantz told the regents.
Unable to reach consensus, the regents agreed to reconsider the issue in May.
Regent John Moores argued in an interview that taking tobacco money damages UC’s reputation. Of researchers who take tobacco money, he added, “I don’t know how these people live with themselves.”
According to UC, scientists at four campuses -- UCLA, Berkeley, Davis and San Diego -- are getting $15.9 million from Philip Morris for 19 tobacco-related research projects. For a study on smoking and mortality, Enstrom is receiving $661,443.
In October, the American Cancer Society wrote to the regents, urging them to adopt the ban and accusing Enstrom of “scientific misconduct.” After a two-month inquiry, the university concluded March 22 that evidence provided by the group did not show misconduct.
Enstrom recently founded the Scientific Integrity Institute to air his views. He says it gets no tobacco money and consists mainly of a website, www.scientificintegrityinstitute.org. The website mounts a spirited and lengthy defense of his life’s work.
“The American Cancer Society turned on me because they didn’t like my results,” he said. “It’s outrageous what they have done.”
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Philip Morris’ grants
Tobacco company Philip Morris sponsors 19 tobacco-related research projects at four University of California campuses. Here are the total awards, by school, as of Dec. 22, 2006:
UC Davis... $4,853,732
UC San Diego... $1,494,613
UC Berkeley... $1,170,871
A complete breakdown of the 19 projects is available at www.universityofcalifornia.edu/regents/regmeet/jan07/re89attach1.pdf.
Source: UC Office of Research