Tobacco Documents Online

---

CIGARETTE LABELING AND ADVERTISING HEARINGS C0 .~'[NITTEE ON~ COM~IE k(~E UN1T F'D STATES SENA [E EIGHTY-NINTI{ CONGRESS pI~T S~SSION O~ S. 559 and S. 547 ]3ILLS TO REGULATE LABELING OF CIGARETTES AND FOR OTHER pURPOSES PART 1 MAEO~ '2*2, 23, g4 25. '~. ~0, ~P~IL • ~*-ND 2, 1965 Serial 89-5 f ~[Ir iil~i lOT the US~ O~ th~ ~m~d tgee Oil ~nlme~ce 15 ~79 I~ S ~O~ERN~[7~NT P~IN~IN80F2'ICE WASTrING £O N 19~5 FC¢ sa~e by ~h~ $apednbn<1~nL o~ DocL~m~-t~, U S. G0~erzn~eat prlatmg Ofla~

CO~IMITTEE ON C0~I~CE W,\R~N G. ~AG~[ISO~ Washington, ¢I~i~ JOHN 0 PAS~TORE. Rhode I~an~ A S Mike] MO~0~l~Y. Oklak~m~ ~II[A N~ J. L~USCHE. Ohio V~NCE ~-A RTK~, l~d~an~ G~KLE W. MCGEE, ~y0min~ p}IILIP A ~A~T, Miehlg~ T~0~VARD W CA~NON, l~eva~ DANIEl, B BI~W~TER, M~ry~ad ~AUx~II~E B ~EI~]BE~(3B]I~ Oregon I~0$S B~j Tenn~Isee D~0I~RI~ C OS'~ON~ N~W ~m~hlre TSI<USTON B. ~iOR~0N l<~ntuck~ ~JG }~ $COTT, pe~n~vl~nl~ WINSTON L PR 0UTy. Vermon~ P~TE R H. DOMIN ~CK, Colorado

CONTENTS Psge Text of ~ 547 ....................................... 2 Tex o S 559 .................................... 3 Ag~n ey commeut~: D~partment of AgTimflture. = _ 98, 29 D~p~l hnezlt of Comr~roe ........ 2~ Depot t men~ of Defense ......................... 30 Dep~rtment of IIeM~h Educa%ion and Welfare ................... 22 DepaF[inent of Justice ............. 9111' Department of tke Treasury ..................... g16, 918 ]~lr~{% of Co]urfLl3ia Bo~rlt Of CO]~IFDi~siOII~rS ~ ~ J~edcral Trade Comra~slon _ 411 Federal Comm ~idc~ion~ Commission ............... 9]7 ~ e~ler~[ ACOOUlltillg OlI~c~ ................ QI6j D]~ 1~ ~liaT, al Sclence I~oundation ........................... 3J Stateme~t~ of B.*rYetL Dr. Rl~yrndmd J chief of thoracic sul~ery Detmlt MemorlA and SL Joseph Mercy ~{ospkal~, I)~id Whitney ~uildJ~g~ Detroit, Mich ................. 783 [las~, Frm~k M, p]'ofesso~ iu,h~£tlul ~dmlnistradm, %h~ Krannert School of h,du~triaI Adminlstra %n, Putdu~ Universiky, Lafayette, Ind 640 Bennett, Hen. WMlsce F., U.S S~n/,tor from Utah _ 9 Be~uer, Dr. Mary /{, plof~sor of health cdueatlon, Ohio ~tn/e Uni- versity Columbus Ohio for lhe Azaetiean Assocl.diou fo~ Hed~h Phy~ c~ ~ducfl~ ov & Recreation, a departmerlt of the N~tioDal Edl] eM/on A~qo ciat i~, _ 705 ~1e% M/S. Myron I%. mtilonM ehfirman, (!emmi~tc~ on Logi~]atior~ l\-asion~l (~ou~ress of ]~ll%s & T~schers~ pre~en%ed by },[r~. Thom~ Kouzes, 624 B~rkley Drive, F~irfax, Va ............ ~37 B~wiflce, Prof K A, ~soci~te professor of s~istics, University of Chicago Chicago, I11. 814 ~ucfold~ ~)r. Thomas, profe~.~or of thoracic ~urge~: Washi~gson lni ~ersky, ~t Louis, 5{0 26g ~urney, Or Leroy E. vice p~sident of heglih ~c~enee~ Temp]~ UnL versitv, Phfi~delphia~ Pa, aoco npan ed by Dr, ~ o ton I. ] e~i)l, chief "I)e ~rtmenI of I~pidcmlolo~T, i~osw~ll Par ?, e no a I s - rut% Bu~a o, N ¥~ oil beh.~]f of ~oHcsn Public Heahh A~SOCI~- tion ..................... 141 Carlile, Dr. Thoma% chah'msa Comrnittee on Tobacco and Cancer, Aineric-+n C~ncer Society, the Ma on C n c, Sea e, %~a h , ~ccom- p auie~l by Dr. Oscar Auct b~ck, professor of p ~tbo]ogv at New York ~e~i~a[ College New York, N Y~ o~ beha o A~e can C~ncer ~ocle~ _ ....................... 1~7 O~rnes, Dr William H., Salt Lake Oi~y Gen~-al Ho~pilal, Salt Lake City, Utah ............... 735 C~n., De. O,nmc, professor ia surgery at the University of Tcn~aessee College of M*~ieiue, Menlplds, Teml 711 Clerf, D~. Louis H., pl~fes~r of Layyngol~gy m~d bl~n~ho e~ophagol ogy, cu~crkus, Jeff r~on h~edical College Fhibdclphht Fa ........ 325 Coopcr, lion. John ~herm~m U.S. S~,mtor fwm Ken4~ckv 895 Crissy, Dr ~ am , . E., pro ~or of marke1~ng a d associate dc=au of he Gradua%e School of Bnsir~c~s Admfi:tztraticm, Alichigm~ St~e l-Mwrsity, Lm~s~ , Mizh .... 55~ Dixon, h~sn. paul l~nd ~l'~irm~u Federal Trade Cormni~slon ae- C4/~n]~rded by John ~. ~nfSr, glo~l, ~istt~nt to the C!/I~ilm~TI Joh,t N. ~'/e~]ock, D~'xecutlve ])ir(,c%i)t Charles ~wemlev, C}ief~ an<l Frederick I~o~u~ Collie ~ Div 5 e?/ Of D~coptive Pl&~li~(s~ Fill](l and Drng Advcrtishlg~ [,'cdutlt] Trade Coma 5~ on %'a Dg on> D.C .............. i ...... 407, 4H, 465

8~ t~nletx~s 0d~ontinRed Donnahoe Alan S ~tatlst[eian, executive vlef presid!mt, and a~i~t 2~mg pllblishor~ Piehmond T nv~s- spa eh and t,h( Rio unond iXew~ page Leader, PAehmo~d, Va ........ 272 ]EI"ViTq Hen. Sam J. ,It. U,8, S~na~lr h~m No±bh (3aloJina. - 387 Foe[e, EInGt~oI~, chairraan, ae~oinpa itcd by Dr, "dam d ~. Diehl, VD.C ~llaitraall~ National Inte~ageney Councl[ or~ Smoking and llealth, Ne~' York, N.Y ..... 103 Gray Bo~rna ~, eha raan of board~ aeco~/2pan[ed hy ~ff ~. T{a[um ~qee pre~icl~rt~ add encra[ 0oalise], 1{, J, l~@ynol]is Tobacco (30. Winston-Salem, N.(~, ............ 244 (Ire r~ Dr. Alvi% managing (lizector, Greet C~inlc, lIous~on, Tex - 381 l~ock~tt, Ol, B~berb 0., council for lobacco r~starch, New York, ~N.y ............ 807 lluff, D~,rrell, Pacific Grove, Ca]Jr 740 James, I)r (h~*rge, e01nlrti~io~er of hoMbh, O(pat~ulott of 14eslth, city of New York~ New York NY .......... 691 Jtnkln% Dr. DaMel E,, B~y or University College of ~,led~eine, Homsion, for the National 2ubereulosls Assoe~a~io~ New York, N. y .............. - -.. 226 Xatz, Dr LolXlS N., direelor of the CardJovascn!m- ITmlItuL~, JMieh~ei ~e~se l/0spit~ ~nd )dedioM Cmlier Clficago, IlL, accmnpmded by Dr George Wakerlin. med%al dileuLor, Amel~0alx {cart ASSOC at on, N~w YO k, N Y - i- 152 ~{olodny, Joseph E., lrtematlng ([ire¢~or~ Nnt~omxl AggoeJAtiol2 of Tobacco Dis~Iibutors, New YI)rk~ N.Y., repre~elt~ed b5 Zigg3 hart% field Co01 d/ll~0r .............. 63f* ~L, lYtO~ radio ~ttt] TV station, SMt L~ke City, ~3tah, pre~ented by Rober~ W. Broker, of Wilkinson, Cragun & ]~kor, Washington, D.C - - - _ ............. 799 L~ngston, Y)r. H ram, chief of rg~y~ Chicugo SLabe Tuberculosis Sa,mto~inra Chium.o ill ............. 790 Lizzie, Dr. C3~mnee ~., Ellsworlh, 3 a ne 801 ~yer, D~ Jdill [L, Sr, t}mracac ~nd (udio~'~ular surgeon, Kansas Ci~y, Me ........................ 351 Mevn~r Gov l~ob~t B, ~dtr~inJst~ator, C~g~r*,bte Ad~er~isir, g Code, New ~ork, N.y., aoeomp',~rded b Joseph }]offma~l ...... 562 Moore, Dr. G~J~ge 2],~ diz~e~or and zhiof of sllr~/!ry, ]~OgWel] Park Mem0t IM Insti~ute, Buffalo, N.Y -. @.18 Blomn, Dr. ThomI~ J., pathologist, hlemoriM ]~ospital, Dmzviile, Va ....................... 280 ~io~, Hen. Frank E., U,S, Sen~Lor f~om /t~ ..... 13 Ob-r Dr. Williar~ J~,, patholo s%, dhee~or of Iid)o.~or{(~ ]<nicker becket II0spita , New ~ ork, ~,Y ......... 340 J~oys~el', IIon Fred ~ ~,l~e sens.tor, [Icnderson, ~.C., ropl'o~nilf~g Tob-±c0o G~owels I)f the United ~a~s .............. 641 ~. sek DJ" ]~O l'y ~ ~t~R ~$[~Dd ~.Y,* Coll$ultgtn~ it~ eard]ov~scl]le*r di~s~' i .S. Pub c l~eaith Rt~earch Hospital, Bvnien sLand, N.Y- 366 Saoh~, Dr. Bernice C., Seattle, Wash ...... 795 ~/ig@r Dr. ~or~ L 0o[l~il}t~it ill i~ec]~e~tl/'~arI~h~ oll BIIIoK]I~ ~nd heSltl~, p~i/salo (For, Lee), ~.J ................ 718 ~plUn% Dr. I~)onglas H.~ ptofoNaor of paiholog3 ~nd ohMrmml of Cae Depar%ment o~ P~ihulog~ a~ the Univ cr ~iLv of Tennessee, },iemphi~, Tenn ............. - ..... - 731 Sve~ ka, i~ rosla~ J. ~'~biDg%on, I) 0, 1724 T,~ lOT Street N~., Vt'~shington, DC ........ i ~ .... 877 T~bb, Harold ~3, prole~sor and el~ilrnan, D( p~rtmel] t of Oft~laI yngof gy TU &r,e ~zdvetsit , School of 51~/icir~e Nel~ 0rie~ns, L~., on be/¢,K of Dr Joseph ~ Ogura urofessor of ot~la~'ngologv, Wash- ington University, ~t. Louis, }~o.; Dr Alde~, 1I. 3Iiller~ h~d of dep~rsnlen~ end ellMeal pr0fea~or of sur err Department of 0to h,rvngolo,g~, VJnivor~ity of Cal~foln~a, ~chool of Medlcfn% Ltm An'geles, Cu if ~nd Dr. Qeorg~ A. Sissol] ciild~] Drofes~r of @o- l,lryngology, State University of New York, .'~ehool of Med~cme, .~)racnse, N Y .............. 377

C0~TENTS V 8$a O, menls o[--(3olltirl~ ed Terry~ Dr. Luther L, ~urgeon CeD~rfllt aceompgnlcd by Dr ,lsm~ Iltllldley Assistan~ Attorriev (~en~ll for Op[~r~tions~ Pub[io ]Iealth Sere.ire Dr. Daniel lIom, ~hlef Speei~,l Projoem Bec~ion, DLision of Chronic Disc~; ar, d Theodore E~l~ilbogclG A¢ llg A~ s ;a l~ago General Counsel ]De 5rbnl~[~ o/~ l~ED]~llI J~/lCari(Jll, and R elfare 31 Wolffe, Dr Joseph B., ~c~irccter. \Mley Folge Heart Hosp ta & ~,iedlcal Ccn4~¢r~ Norii8 ol'$n, la,~ ............ 724 ~rgnlell(~ subllllt L~x] Ablard, Chales D, },iagasine Pub]ishcrs A.ssoeisMon, Inc., New York, N.Y ...................... 938 • Mica George V. president the To)~tcco ~ t e .no 940 • Ml orb. ]Pcbcr %'V., on behalf of the A~SO(~I 9.t ion of Nat l(Jrlgl A(tver tmors ~c New York N.Y ........ 944 BeN, Fio~/srd H. code s,uthor ty dilcc or, NatlouM Associat on of Broadsl~stcrs 1771 N Sbrecb N~4,, Washington, D.O .... "590 2':~lris, I)/.. Jack M~ associate c nxleal pro c~sol o Suasgery~ L~II V~r~ ty of Californis~, Los Angeles, Callf .... 972 (~d~IId l}i. L ~el]l'V~ C]IIL~EII] T)rof~ssor Oil r~di0lrlgv Sh/r~ford UnivcrMty Medic M SShool, 2elo 41~c)/ CMif " . 964 Greene, Dr. lIarrv ~ N ~ th( Anthony ~ ~r~dy profc~sol of pathology and chairnum of the ~)8p~rtrll~II of t'attlology, Yale UiAversity School of Medlciae, New IIa~en, ()ann - . 966 IIelwig, Dr. Ycrdi:n, nd Christian patbologl~f~ St Lukos ,qospit:d X~nsas City, Me - - 946 Herbert, John K, p/~gideni, %Ut~mim Pabllshe*s As~ociatlon Ir, c -New York N.Y - ....... 938 Jol'd~n, I oa B. l,/~et , US. Sen~ or flozn ghc S ~te of Nor h Carolina ......... ~85 K~*]:m l)r ~her:rmn,. eh~irrnan DeI}~ ment o ~Icd ~ine, lk~onnt ~lnal ~OSplt~ MI&D~I ]~e~ch, F a ................ 9~I K~t ~ Dr. Leo, pro/%ssor of st atlgti¢$ and director of sfa~JstieaI l~,t,m'a- ~oc, 5, c g~n S ~* U ,er tv E~st Lansing, MJch 983 I£enucdy, TIon l~obez4 F., Urd~c4 States Se./ase ........ 985 Kermedy, John J, Ph D, chflilmalb [/ew~rtmen~ of Malketing~ Univr:rsity of -Not~*, Dame, Sou~h Bend~ ~n)d ........ 988 L/lC~y Dr. D~[td] B, chairman of rnurk ring, (~(&(/l.~te School of Basin,s Ad e~ c~ on Now Yo k [hd~e~Mtv -~cw York, X'y 01g~ acDo a d, i)r la c n c pro e ~or o urger, I~viw:rslt, of South mn C lifo{nia -R/edieM School, Los Ang(lcs, (~/if ~ --. 074 ~IcM ~hon, Dr Henry Ea ~n, New York Po/yelhfic Medical School New York~ NY ................ ~79 O'Ilare, John~ pzcside/t* "/'ob~e~o Workers Iutelr~%~ional l'z ion, 1522 K S%l~et NW ~%rasldngton, D.¢$ _ - ~90 P ereo ~, IPra*~k F.. Jr., c ~a rman Dc f~wa,'~ Tn arx#vney on 8rno <ll, g and Hea!!h and cx cutivc se(q,etm,y of Dilaware 'Juberlilos~ & II, nlth gtoi,ty, Wi]rnb~gton, Del .... 956 P~d o A~ ,e 5 a ng}3 ea ,~ 6c ue ~ i bruit ed by Joseph M Xittner at~r;*c~ hfcI¢~r,.a & Wilkiuson, W~sbiD~0a, D C q59 l~l)papo~t, Dr Isl~-. coiFsll tgrt¢ (q~es s{~ieQ~ ~Tf~ss]~n~ s I ¢ospl{~ We~gcbester (!uu*tty N.¥ .............. 992 Rigdor,, T)r. R. lq., professor of Dg~thoiDgy Ulli~(~t~isy Of TO'~s MeJical School (5alveston Tax ... 968 1]obertson, Ilon. A. Willis, U.S. Sen2tor rom the S ate o ~. r~:[n, Sen tie Office Ilofiding, Washiug~ou~ J3 () ..- 405 R~qcnbl/Ah, Dr ~[i]~on S~ as~o~i~t6 0]in]ca] prof(!sso/ Of },iedichlc, Now York Mcd ca Co ego, New York, N.Y - ...... 997 8cielme news lkrtilfle by University of l"oronto's ]~angln~. llesco~h lrtstivute, sttb~y itsed by Leonard B,-rti* , geiellca~ editor, Dcp~rclneDt of I~formation, Simt~e llnll, 17niv~rsity af Tolonto, "foronto, C~mada ...... 960 Sommers, Dr, S e o C a~o l e professor of pathology, ('Ohllf~[~i£L ta-i~a, /)eMffeld }lospiv.al, New Ymk, N.Y - ...... 952

CO-~TENT~ Statements submlgted Continued Si,erling, Dr. Theodor D., OoUege of Me4icine Uilive~i$ • of Ci~lcill- Pag~ n~,f Ci~L~n~tl Ohfo ........ 1017 V~asllcwski, ~,ince~ T~,Irresidcalt lq~tional hssocm~ion of Bro~d- ea.~L~rs, 1771 N Street ~W. Washington D.C 592 x3/ilc ~s~ Dr. Sigrund 1~.~ chief~ l~b~ratory service, ~ew York Ye'~r ~ns Hospital, FTr~ Avenuo at 24th ~trcc¢~ New York, N.Y 971 Wbfick, Dr. Charle~, New York Univcrsity~ New York, ~.Y ....... 9~ .~rmisCea4 III, M. W., chah'n~u~, Federal Law~ Gomlni~e, ~neriean ~p~pcr publishers A~ocia~ion, ~ew Y~rk, N.Y ........ 918 Bovcc~e~, HOII. Ward, ~cretary of ~he Washington S~ate ~e~ate, O]ympi~ Wash, ~s oIu~ion .......................... 9 par~men~ of E4uoatlon~ CcnLcnni~ Off~ Building, St. )~au[, Mmn ........................ 9~0 ~wwn~g~ Dr. V~alt~r W. pl'~id~rlt. Ber/g~r~ (~all~y pharCr~,ical Society, ~erge~ficl~, N~ ~ L ..... 92~ ~c~/~ Dr. ~rn~rd~ ~h~irr~ In~r~e~cv H~l~h F~du~ti~ ~d Welfa~ Progr~r~ Committee and Spendlo~ce, Dr. ~eorge, 0h~irman, J[n~ro~g~/Lu~y ~ubcomir~itL~e ot ~m~lli~lg ~d ]2(~1~h~ ~h~ ~t~t~ of Wa~h~i~g%~n, Departmen~ of 14eal~h, l~ubli¢ IIealth ~,uild~g, Olyrapia. Wash ~ Byb~% Don 1L, chief~ ~eal~b ~duc~ti~n ~nd Tra~i~ S~ction, Idsho 92[ ])op~r~r~all~ of I4~al~h~ ~¢~i~e~ Idallo ................. 921 Celebr~ze. Hou. ?mthnny J., Secretary, Depar~l~le~ of ~eMth, E~u- c~tion, and Wclfi~re (Le~¢er ~o Warren G. ~l~gnuson dated ~ch 22, 1965) ............................ 22 Cigarette AdvcrLisln~ Code . ~ - 5~g CI~ere, Dr. R. L.~ director of public h~It h, ~qtato of Colorado, Deps~ m~n~ of Publi~ 14eal~h, D~ver, Colo ............... 922 (~nne~ l~o~re~ E~ e~cutive ~ecvet~ry~ A~merlcan A~sociation of Sl~aool A~rm~istrators, W~shi~gC~n, DC 923 Cooper, 5,iar k k~., pr~ident and general m~umger, Adv¢~i~ing Fecl~ra- tlon of ~.m~ri~ ~x~c~ York N.Y ....... 925 Da ryrap e, l)r. ~i l~rd, dir~or, University l~ea ~h ~ervic~s, p± n~c. t~n Univer74ty; in~ru~r in medil~ine, C~h~nbia ~Sniversity; ch~irln~n~ ~ec~or~ on Cli~Jo~,l Medi¢i~,~, A~er~/~ College He~h As~oc~ti~)n~ princeton Un~ver~ity~ P~e~on~ N.J ~ • . 925 ~2~ Di~J~, Dr. Harold ~., Am~rica~ Cancer So~ie~y~ Inc., ~cs~a~c~l Edu- c~tio~ Ser~,ic~, N~w York, N. ~ .................... ~4~ Dixou~ )zion, p~,~l R~td) (~halrm~n~ F~d~r~l Trade Comminatory, W~shi~gt~n, D~, I~r~r~ d~e4 ~*~rch ~3~ 31~ I,nd April ~ to Senator Ma~nusnn ~ ~ ~ 40~ 111~ ~6~ Dunn, Dr. Jo~ E.~ prc~idcn'~ Publi~ ~Toalth Cancer Assooi.~l, ion of Americ~ ~ k~[~y~ (~a[if ........ 92~ ~dward$, Dr. Kay K., ~hief, D±visio~ of Adu]~ ilealth Servlce~; chairln~ ~I~ yl~,~d Comra ~ o~ ~mokil~ ~lzd ~c~]th I~eparg- Inc~ of Heai~h, Baltimore, ).~d ~27 F~rbcr~ Dr. Emm~uel~ pro~cssol" and chairmf~l~ ])~p~rtmei~l o~ ~athology, U~iv~r~i~y of ~i~t~bt~gh, ~ho~l u~ B~edicine, r~ember Pit ~bur g~ Pa ..... 9~7 ~yer~ ~1~l~on~ pre~idell~ Collectivist Hea|~h T~e~l~'~ Coiua~c~i~u~ ]~e~rt A~o~t~io~ ~rtford ~onn ...... 927 Graham, J~rla~h J., m~nag ~g e~ tot, ~dv~rtishlg A~ Chicago, I., 1~(~ d~l April 5 ~o ~i~l~o ~ ~2~gllu~on • ~ .... ~33 ~tI~trrcl~on, William J~.~ oommi~ioner Of ~gri~tl]~l~y~ ])~p~rtm~ o~" Ag,'icult, ure~ Columbia. S.C ~_ 928 H~r~,z~ Dr. ~or~r V~ ~]~n~]lor~ Amerlean C~oll~g~ of i~c~diology~ Sea~!e, Wa~l ......... 9~ H~rve~, Or. ll~o~i¸ ~., pre~den~ Arcter ~a~l (~,ll~r ~oclety~ llli/lois Divi.~ion~ Chic~o, Ill ........... 92~ J~l~r~o~ City, 5,~o ..... ~ ..................... 929

CONTENT~ VII

CIGARETTE LABELING AND ADVERTISING I~.OI~IIIA¥, ~6/~.IlCI{ 22, 1965 1L S. S~xa~, Wcz,*gi~y~c'r~: D,gg The comm~Lfee met at 10;10 ~.m. in room 5110 Nc~w Sefmls Office Buildilag, dxe Hen. ~Va~wen G. ~[agnuson~ ChMnrmn of iiLe cummitt ee, presidi1~. The C]~*~I,~N, The cm llr~ttee will (ome to or[b.'. We have a long list of wdl,essc~ and we ~ ant to proceed ks rapidly as possible, The Chalr has a shoi~; opening staLement wblch he would like to t~ead at this time. The committee opens he~L~ings tllis mornhlg o. a questiol~ ~ldeb iS Of VCI'¥ ~l"~at concerl] fo YIIglI~T nlil]i0n~ o~ ~Ltleti~'~,DS : ~rlla~t II%llS~ be done to assm'e tba~ all A~ner~eans are adequately htforrned ~f the hazards of smoking ! O~t January 15, vf this ye~r~ I i{lfroduced ~ proposed Federal Cigarette Labeling Act~ S. 559 to ~qun~ Ihat each and ewwy p~'~ge ,~ cl arettes oaz~:y in • "prominel~t" pla~e on d~c !abel it} "eo~sp~cueus and ffeg~ble t~pe~ tile statement W~mung: Continual cigarette smok- lllg lllay be hazardous to yollr he~lt]l ? This bil] wmdd also requi~ d~a5 e$~cb and (wery ])gckggc* of cigarettes sfafx~ ~}te a~ el'~g~ tar ~nd rdcodne yield per { igaretR~ ~s~miferm] y de- %erlnined b~ the one method approved by the Federal Trade Cmmnis- siom The Fe~lerai lr~de Commission has issutad , trmle regtd,~don rule, to become effevtive on July 1~ 1965~ which w(mld rcqnh'e %]early a~d prl]l]] i lit!Ill] V~ ill }all ad ~ artlshlg and oil ev~l~" pack. box. ('~r t Ol~ or o[her e~antainer in which cigarettes ~t~ sold to the eonmunlng publ i{%" a slate- irlartL ath~t cigare~Le smokin~ is da]~geyOll8 it} h~'a]l h and lfl~y Callse death Yrom cancer and other d~seasesd O r co e~gu% Senator M~urine Ncuberger. of Oregon has intro dileed ~ prn o[!d CtgltndN~ Advertlsin~ and Labeling ~ct, ~. 547~ which wouldPrequira (1 that each packable alnd each ~dvertisement contain the words "Caution : }Iabi~ll~l Slnol~ing ]8 inj lkrio11S tO heaidl~ ; ~} that each package disclose the aven~ge hi.Iris of ~;incrlmmated ug~ts'; and (31 tlmt the Federal Trade Commission set standarda to "provide ~vr r}m cllmdlation of all advertising matter which ~atds t~ make eig ~rette smoking attractive to children ~' l)nrin, g })ur grct_ ~ days of hearings~ we w 11 ei,. rimarilv, from., med~caI and educatto~ml/.~roups f~worable to ]~belm~ and adverhsmg reg~]ation. On Wednesday and Tlmrsday we expect to bear ,medicM wiNms~s in oppesb bm I o the leKislation. Next Monday and ~ uesday~ NOXE NtaJl Count1 ~s~iK~e~ l~ this b~&~l~ ; ~[le~2a~l p¢,~I gchuk. 1

2 CIGAl~TT~ LABELEqQ A~A,7) AD~t~ITVISYIqG and if necessary Thursday and Frldav, we will hear the Chairman of the Federal Trade Commission Paul ]~and Dixon, and repres~ntatlves of the affected indnstrie~, I would ~lso like to pu~ in the l~co*~I at this point a copy of S, 559 ~ad S. 547 and a copy of the s~ ~t ement I m~]~ ulmn *he int r c~duetlon of S. 559 and Senate Resohi~ion No. 196~32 of th~ State of Wa~hlngton Senate, tog6ther with a letter of tralxsmit~k (The material foilows :) [S 547, 89th Cong. l~t seas] A BILL TO r~nf~r ulmu the Federal Trade Commi~sic~n the power and duty to regttlate the a(Ive rtising mJ d labeling of cigarettes. Be ~t v~e(I by $~ Solate wad llo~e o] ltl~res~ta~veg el lhe ~l~ed ~lolq~ ~1Io~2 ~rLE S~¢'rIOX J This Act may be cited as the "~igarette Ad~eriising mad l~bollng ~f.. 2. The Co~gress hereby finds amI deelare~ that the ~lnrestr~ct~l promotion and advertising of cigarettes in interstate commerce, in the Hght (*? the eom elusive evidence that ¢$ga/'etle ~moking is InJurions Go health, cens~iV~tes grave threat to the puidic welfare. Sic. 3. It is therefvre the policy of the Congress, a~d the purpose of this Act-- (~) to rcqgire #hat cig'areIte packages coat,hi a w~rn~ng, that habitual srr/oki*~g of c~garet tes is inJw[ous to health, (b) to *~eqaire that each eigal~tle i~ekage disclose the average y~elds of Inerlrahmted a~e~]ts (a~ de,ned in section 4(f)} from tile cigarettes COn rained therein Imd (e) to eltminn t e elga~tte advertisImg ~hat tendu to make cigarette smok- ing attractive to children. Sr~. 4- AS VSed ]21 [hi~ Ae~ (a) ~he term "ei~amttte" mealls a~ly roll o~ Lobated, Wrapped i~ paper ov any substance other than fOba¢,~o. (b) The texm "Gomn~sslor;' ~eans the Federal Trade Commission. (e) The form "Federal Trade Gommission Act" means the AC< entifled "An Act re creah~ a Feder.tl Trade Gommissio,h ~o define its powers and duties, and for ol/le~ purposes", u~ilroved ~eptenlber 2G~ 19~4, as amended. (d) The term "comment, e" mean~ eoau[lcrc~c between any ~a£e, terrltory, o1" ~ossession of *he Uulied States, or the District e£ Col~mbia, s=d may ][*lace outside thereo~; or bet~n poi~l~s within the s~ine ~tate. territory, ov imssession~ or lhe Distr]et of Columbia, but through may place outside thereof; or withiIi any t~rr~t~)ry ~r possr~ion or the DiC,-~riet of Columbia. (e) The term '*United States" lrteans the sewrsl Sta~es, the District of Culumbia, anti the tezritori~ mad pos~<,ssions of the United S~ates. (f) The term "incriminated agent" means any substance found in cigarette Smuke which, as detezmined by the Oammiaslon, ~end~ to contribute to the medi~.al hazards of smoking. PALSI~ An~]'ISI~ AI~D LZ~EIINO OF ~[~ARETT~ S~.c. 5~ (a) 'the Federal Trade Commission, with the eool~rati~a of t~e Secretary of Heal/h, Educ~ivn, and Welfare. shall nstablish such staudard~ and requlremeuLs for tile labeling and adTertising (,~ cigarettes which are i~ eommer c~ as it may deenl ~ecessary to protect the public health

(b) ~[T6~I stgnd~zd.q aud ~oqt~meuts for the IRb~li~ Of elg~rett~s ~il~II lmelnde 12a~ reRuh~ment tll~t e~¢h p~lck~a~e Or contf~loer in '~ilIPh i!igareites ~11 I?omm~rce ll~e o~ered f~r s~e to c~l~t~lers ~fu~ ~l o~car ~.lx/1 di~,tillC~ lab~l whieh~ (1) contains %l~e l'ollOwing w6rds: "CRution--l~f~bitu~l Smoilng Is In jill leli~ to t:{er~lt h" ; ~nd (2) set8 forth the ~lver~ yield, 01: othe~ [nd~, o~ eac'h illcri~llnat<*d a~el~t to b~ ~ounll in ~l~ S~LOke ~ the cJg~l ~f~es cout~Illed ill ~l~ch j~t~h~e ~r t~R~aine~ (C) ~u~?h .~t~li~da~d~ and t~tlil"erl~nt~ Wltl~ resider to ~he R~'~cr[isin~ ~f cigar e~[~s ~llrtll (1) ~ovide ~a~t eac~a cigar e£~ o rl~'~r ~s~ill o11~ ~ontahl the ~llIl~ing W~- Jng : *'(3aution It~IbttUal Oigarett~ ~m~i~kg is I~gu~ous to lle~lth" ; a.rl (2) provide fc*r the eliminr~tl~ll of ~ll advertising matter which tends ~1 make ~aret~e ~mokilt g ~tt r~l~ti~ to ehildLr en, W~Cb ~ils to comply with tI~o stantl~rds Rnd requilemen~s established by ~ho Clma~li~siol~ und~z the precedlrg ~11"o~o118 of~ this se~tioll ~h~lll be deemed to be R fulse a~'~el~ise~lent of drlkg~ for tile ~llrpose8 Of s~t~ons 12, 1~, ~4~ aIxd 15 of the Feelers1 Tr~td~ Commisslou .4.~ (~I Stat 739; lg, U.SC. ~2~ ~. ~4~. and 55), ~1~ ~monded, tl~ ~e Cellltui.~i~n ~ha[[ h~lve ~}e I~llty ~nd ~uthori(y l. 13re~ed wi~h r~]~ct t~ ally such f~/lg~ R~e~ent ~1~ the s&lxle rmal~ler ~l~d t~ tlle ~uii~ i~x~llt as with r#s~ect ~o other false llllYer~a~l~ of 0zugs ~hich l~r~ inlla,~fR[ under the Ifedergd "l~de Comml~si~u ~t. l~ 5,59, ggth C0n~ 1~t SSUS] A BILL ~0 reg~la1~ the 1 ~beling of (,igs reties, al~d for other pucpose~. ~ri~ i~l 0o~r~ ~8~ ~t~t £his ~ct ~t~~ be cited ~ the ~FedCr~l Ci~r~tte L~be~in~ ACU'. D~IO~8 (~.) The £er~i ~ig&re~t eTM ~neailS ~tl1.~ rol] ~f to~r~oe~, wrapl~od ir~ ~ai~r Or ~y ~llbst~t~nee o~hez ~h~.ii ~ob&ce~ (b) Tho ~erm "ilt~koge~ ~eRn8 ~ !D.~Rg~, ~0X, ~ttrton, or ~oR~i~er Of ;~lly ]rind la ~hlch ci~are~ ~re offered ~OP ~R~e, ~(], or ot~er~-i~e sullied to cons~rs. (e) ~e ~Im "p~r~it" ~ue~s an~ individl]Rl, p~rt~ership~ ~o]'~ora~[~Jn, ~r ~31y Other bl]sines~ ~r ]~gal entity. (d) ~I~e te~ "8aI~ or distribution~' l]3el~de8 m~ipli~g a]~d 1~eali~ of di~- tr~bu~io~ ~her t~a~ sale~ (e) Th~ ~ortu "Ca~by~dge Filter ~,~ctho(l~ ]8 th~t~ me~hod of n~e~sur~ng ~*qr a]nd I~COV~O ~8 ~P~£~d ~l~ fJle ~v~m~eat~ g~)]~1]~ ~eefi~g of the ~88c~iati~l~ of O~e!£tl Agrieul~ur&l Chemists, On Octoliez 16, ].q~ ~tt W~sh- Jn~til~ DIs~rle~ of Cohlmbi~t. (f) Th~ ~rm ~'tIi*~Lod ~tes" m~an8 the ~eye~1 ~lt~, tho District of Columbia, and posse~slons of ~he Unite~ Brutes, age fo~ ~ale or distribution W~thln the If ni~d State8 any cigarettes ~he pa~ge of w J~ich (1) f~ils to b~r ~e f¢ll~x~in~ stotem~t : "~V~rr~u~: Contii~ual Cig~rett~ ~mol~g ~ay Be Hazardous to ~o~r ~e~Ith " ~Jr (2) fail~ to ~(~tte Lh~ ~Vel'~ge tar t~Ud nicotine y~]ds p~r ci~re~e &~ detor mained ~ ~he C~.mbrid~ ~ilter ~eth(~ Or such othe1" r~ethod ~ 13~q~ hel~af~er be t~p~roved for ~ch ])urpo~e by the iWatio~al ~Jm~l ilf ~t~tnd~rds. "I~e fore- going ~t~tements ~hall be loc~t~d pr~mlncntly on t~e pa~ge In ¢on~qlous I~]~L[ legible type ill e(~l~trllst by ty]3og1"a!~l~y~ layout* ~r cul~r wit~ ot~er pz~ted m~t t~ ~u [hc p~oka~ PP~E ~ ~ z zoz{ SE~ 4. I~o other w~rnin~ r~ulrem~t shall be iml)osed o~ ciga~te labeling or Da~agl~g bY any ~red er~t, Sta~e, or local autl~ orig.

CIGARETTE LABELL~G AND ADXVERTISING CRI~I~AL I~r~ ALly ~E~ ~. AU~V p~r~3n who vio]~ the pi~visioi~ of ~his ACt shaU be g~ilty ~, misdemeanor ~ad ~lall on conviction there~ be ~ubJect to a fi~e o~ Dot ~or~ thaa $100,C~tk i~ j~y~o~ pROCEEDIlV@$ ~ ~. ~he ~veral ~Lri~t courts ~ th~ Unite~ ~fl~n~ Rr~ IIlvos~d witch jRrisdic~ion, ~or C~use ~how~ r~nd Stlb~t to the provisions ii~ ~eC~ll 381 (relating to notice ~o ~he ~posi~ par~y) of tlt~c 28, I~ited ~tates C~de, to i)reven~ and r~rain violations ~ thls Act upon ~pplicat~n ~£ ~h~ Attorney General of the United ~at~ aeflm~ through the soveral United St~ies attorneys in t]~e~r s~vernl di~rict~ ~c. 7, ~g~trettes 7a~n11~o~red, imoorted ~ oackaged (i) i~or e~port ~ro~ tho Unite~d ~tates or (2) for doli~ery ~o a Vessel oi" aI~raft~ R~ ~ll~plie~* ~r ~on~,~p~Jon b~-~,~1~d ~he j~Irl~dio~io1~ ~f ~h~ in~l'na] rev~l111~ ~IWS o~ th~ UaiI~d ~t~s ~hall I)e ~mi~t ~zo~a ~h~ ~uLrem~L~ i~ thi~ ~ b1~t ~uch ~mp~ioIl ~h~ll Ilot ~p~1~" to ~igar ~t~ ~&al~&c ~t~e~d, i~po~.~ed, o~ p,~ck~t ged fol~ ~b~p~eil~ ~ ~ili~d ~tttt~ ~ili~try v~ss~Is, i~s~llation~, or ~hore based ao~ivlties where- ~vor su~ Vessels, i~s~al(ations~ or a~i¥itn~ maay b~ 10cared. S~R~LIT~ ~, ~. I£ any pr~vi~i~u 0£ Lhls AC~ or Lhe a~licaiion ~hereo~ to ans" perso~ or circulnstRnce is held in~li~, ~he ~ther provisions of this ~¢t and t~e app]i- ca~on ~ ~uc~ provision1 t(~ o~h~r L~rson~ or ¢Jrcu~stauces shrill ~ot ~o ~'~d thereby. S~C, ~ Thls Act shall tak~ effec~ ~e bundxod ~nd Lw~iLy days after the dato o~ i~s ~R~t~0nt. [I~a, the C~n~ce~si~,,al 1~rd, J~i~ iS, I~51 M~ M~c~o~, Mr. Pr~id~t. T believe JJ1~i an ~L~II h~ ~,~ l.i~ht to choose his own ~ison~ BU~ I also b~ieve ~h~t he h~ lhe ri~hL to know jttst what ]~ind ~ ~ ~sk he is ~aki~g. I ai~ ther~L'l)re toda~ i~tttc~d~c±ng ~t proposed C~are~e L~b~ing A~ to r~quiro adequ~r~ warlnI~g fl~(I tal~ ~nd ~(~lO ~&te~l~tlts oa ~I~ ~ig~rolt~ packa~. Th o American peol~e w a~ ~his prob~o~ioll. ~k Publi~ LI~IIh S~rv~c~ survey ~as hazftr(l ~r ~omothl~ to bo (lon~ .~bd~i~ i~," And~ by • r~Jo o~ ~e~x']y 2 to I~ This survey ~how~ that ~o~igh ~ny A~meri~Lns ar~ D(~W awaro that ~m o1¢i~g is ha~uL too ~t~y o~he~s, I)arti~]~rly t~g~g, have I~ ~vet go~ tho ~oo InS~ ~tre ~ll te~(l to s~7 "Jr ci~re~e~ w~r~ ~'~lly sil harm~ ~he Govo~nm~n~ wo~Id ¢~r ~inly do some~n~ nbon5 It" I ~IIl ~(~nvil~d ~h~iL ollly ~ p£~rib~ warl~Lt~g o]t C~Ch Cigarott~ package would ~a]~v ~riilg ho~ to t~t~ ~c~k~. (~T ~lle t~r ~out to become smoker, the ~bor ~,~t~ that ~igarette ~n~oking i~n b~' i~j~riOllS ~ him. Wl~t abou~ ~af~ ci~arett~? D~, tar ~nd lli~ot~ yields ~ally m~k~ a ~ifferenoe? The p~I~ IIealth Set vlc~ belJev~ tb~y 0~). "W~ fir~ ~onvii~o~d'' th~ ~1~tct~ ~urgeon ~euer~l i~Id u Ho1~e ~m~mitt~e ]as~ A~g1~s~"y~11 ~fl~ l~ke ~ s~r c~ ~zo~e, much sa~. Some oigare~tes havo b~i~ (lovol~o~ hTaR~ h~ve ~U~ ~t tenth (~ ~ i~o~ne and tars of ~he ~rdmary EJ~h~ (~11t (if ~n ~pl~u~lod~r~g ~ out ~f eveiy ~0 (~ ~e ~m~1¢~im]]~d ~y Lh~ pl~bii~ l~oa[th ~v~ w~ntcd ~o bo told just w~t ~lle t~r a~d ~00~I~ score i~, A~ I have £c~r many lo1~g y~r~ w~rke:~ t~ promotf~ th~ d~ve~o~oRt and grow~ o£ the Natio~l Cane.er Institnt~ ~ ~k L~ ~ll~I'~ LO ~]~e cancer

---

CIGARETTE LABELLNrG ~ AD~RTISING ~We ~w ~er~ ie~u~y ~m~eted some stu dl~ which show a di~er~u ~ result. L~ L~ ]Jl&c~ ~hem in hist orioal ~r~e~tve. "In 1955, a ~ur~ey made by th~ Bureau of the ~ns~s at f~ r~u~t of tb~ public Health ~rvice ~uud that 59 per~nt of adult r~en and 31 pel~nt of ~du~ Women wer~ ci~aret~e smoker~. ~In 1962, a ~rv~y u~d~r~ak~l by t~e ~er~c~n ~ln~r ~l~ie~y foun~ ~ Lhe of ~mal~ ~mok~r~ had l~ro~s~ by ~ p~re~ge points, "~ Jl~y ~ 1~ y~ar, ~he P~blie Health ~rvice's National Center for H~aI~h ~'A preliminary ~lal~s Of Lh~ C~IL~r~ ~g~res for ~1~ mo~th~ Of J~y. AU~l~ and ~eDt~mb~r i~d~ tha~ ~e pl~por~ion of ~dul~ cigar~te smoker~ has ~c~ually ~iecIin~, 'L]Jast f~ll the ~erv~e undertook a survey to ~i~ m~e a~rate ~a~ ~n ~e~ on the smo~ng habits, ~ledg~, a~d ~ttitude$ ~ the ~era] ~pll l ~tiouL I~ore than 8(~ i~er~ Of ln~mat~orl w~r~ ~gbt fror~ ~ randonl n~ti~widc o~ adult c]garett~ smokers. £~lmated as follows : ~In~t~d i~ th~ ~9 t~rcei~ of ~ and ~, there tll~ n~w only ~bo~ l~en~ male ~r~ smoke~ in oux Dopula~i~ "A d~i~e ~ 7 ~r~ta~ po~ts dOeS ~ot appear ~o be much and it is ~r- ~inly 1~ ~h~n ~ve would wish. ~11~ if ~es~ figui~ ~and up ~der fi~al a~ly ~re are now n~srly &~ ma~y m~n wh~ ar~ noncigar~ smoker~ as ~her~ are ~l~l~o~gh Lhe ~]e~ine i~ sm~ll~nly ~ to 3 I~rc~age ~in~s--this i~ ~he ~rst timo on record in which tll~ ~nd h~s been do~vn~rd "If we consider both ~en ~ ~omen, it ~ouId ~ppear that there a~e as ~any ~lltg ~o~v Who ~a~e n~v~r been c~arette ~moke~ a~ there are s~nokers. "If ~molri~g h~Dits had ~n~i~ll~d ~ ~ I~vel of ~ year~ Sgd/~ th~r~ Wo~l~ be ~b~ 3~ million more ~moker~ tb~ln ~el~ ~tl~]ly ar~ t~2y, ~ ~ou]d r~t their vTe i~ ~h~ PIlb]l~ H~]th ~rvi~ ~r~ ~y ~o m~ll~ ~a~is- ~ed wi~ th~ ~r~gre~s t~at ha~ ~ l~de. On th~ ot~er hand, I a~ £o~inced tbs[ e~r fitl~lh~gs ~ a year a~o, ~idely pub~ized and ~llow~ ap throughout ~e year b~ an alert anr~ r~sponrd~le pre~s, I~a~e 1~1~ a dlsce~nil~le ~n~ en£~u~- a~in~ e~ on ~he smoking ~ob [em. "Tllat pllblie sw~re~g o~ ~e hazards involved is ~videspre&d is evlden~ in ~In ~b~ area of b~i~fs ~n~ a~]tlld~s the d~t~ are bo~h ~tlmuls~ug ~nd en- co~rag~Ilg, For L]~i~ rea$ol~, I waut to Sllar~ th~ ~r~ r~u~Ls wlL~ y~. ~ell In a~van~ of ~h~r Dublica~ion. The ~g~es, I am L~I~, ~ pre~n~ary Dut ~easonably firm. th~ r~latio~ of smok~ ~o s~ifi¢ ~i~easgs Fer example, ~ople ~ver~ asked : Is ~bere ~yt~i~lg a ~r~o~l m~ht do t~t could ~a~s~ |~llg ~er? ~rn~d ~out the habit. A lar~ majeri~y ~ ~le clga~e~ smoker~ surveyed indicated LhaL th~ b~i~ved ~l~i~g to ~e h~rmf~, ~A nllm~er 9f ~ti~s ~gh~ to e~@re th~ ~sillJll~y Of ~em~ial ~]O~ Pre~e~d wi~l tbe ~tate~oent : ~re~e smoking is ~ of a heaLt~ ~azar~ ~ something to be do~e about it/ 7 OUt of 10 agreed and only 1 ~u~ ~ 6 ~tNIne o~t Of t~ ~ they w~r~ in favr~r of more pubI~c ~du~ti~n On ~1~ health h~ar~s of ~i~ar~te s~oklng, for b~h adults and e~[ldren. "Font o~t Of five ~OD~ ~ld ~hey were OpF~S~ ~ t~ pr~l~t~ of ~e~ri~ ~h]~t ~S and cel~r~ti~ ba ¢i~r et~ ~dver ti~in~ ~are~t~ llal~ Isbels a~ In a~v~rtising ~Elgh~ eut ~ ~en~n~u~ng 7 on~ of 10 ~o~r~-also s~id tD~y b~]ie~d ~at ~e ~u~llc ~al~h ~ervIce durln~ ~his F~r ~S ~tercst~ l~el~ ~IS~ i~ th~ behaver and ~itud~ t~var~ smoking af stude~ in ~he health professions.

(~IG.a,R~ETTE L.~BI~LLNG ,4-~ID ADVERTISL~TG 7 Jk study conducted among more than 10,0CO sea/or mediCaL dental, and 0steo- pattie ~de1~ ~s y [elding interesting results. ~'~m]3g[l'~d te the general iY1$t]~ po]~u]ation Of comp~r~o]e ~ ~]2i¢)r l~di¢~ ~11~i~]itB1 ~o]" ex~imple, show far le~ ~nden~y to ta]~e tlp eigarettes~5 peroen~ ng~Ins~ $3 percent. And among medical $t~dent~ who take up the habi~ there i~ £~r gre~er tendency to quit~4 ~erce~ as against i~ Percent i~ a given tlme period. "Thi~ ~ggest$ tlzat in ~o~p~ Which ~ohl he~Ith i~porta~t, ~v~ tl~e ~'~tcts, a~ understand the health implications ~ ~h~ f~ts. the ~garcttc h~iL is ~e- ~-evsib]e, ~,ec~l~ tt~e mt~ical profes~io]l i~ freql]~I:~ $iI~e to ~et ~]I ~x[L~qple in personal h~alt]~ tha~ ~h~ b~e~era] pop~hl~ion ten~ t~) fOlh~w, this finding o~a~llg m~ic,~tl st~d~11t~ i~ ~ h ~]~ fnl] ~tngllz~~ for th~ ~liture. ~'Th~ ~o(-~ie~c~ Of ~ ye~r~ in Ilr[~]~, deIllOIIS~]~t~ th~It St d~eDly iIigi~aillL:~ personal ha~t can be ehaI~ged wllert. Lh(~ ~fl~t~ ~t~e Inad~ Widely known. I migh~ &dd that, ~) f~r~ ~o~t Of this hu~ b'een ~Joiilpli~hel] through the mas~J commun~catlo~s ~cdia~ I doubt th~ ~ny h~alth ~essago ]]a~ e~er re~ched ~o many in ~o ~hor~ ~ time~ ~'~v]2ttl h~v~ be~/l s~me Of ollr ~rvice e~ort~ ~ring ~hi~ p~t :7(~r? ~'~o~ will p~r~p~ ]3e interested, first o~ ~U, ill the distribution ~ the r~port "~to~eth(~ dtl/~ the ~r~ct ~'e~r, in~hlt~ing s~le~ b:: the ~uI~xint~ICll~, 0~ Doc~i~ents~ m~re thall ~50(}00 c~ple~ ~)f ~he ~'ll]l rep{>r~ Ot~ smolEing tied ]l~Ith ~a¥(" bce~ (]I~trlb11~e(]. ~or ~ s~en~II~a i~llic~t[on, Lhis is ~!ii~ ¢~tlb~tailti~l. Equ~]l~ g~'~ifying ~ve be~n t~le ~um~r an4 d~tx~])ilt]~n ~ ~u~mm~rie~ ~nd ~pec~al o.udi~ce ]ollblic~tion~ inspl~¢l b.v t]~ l'~[3or~. The ~(~rvi~e ht~ worked ¢lo~y W~h lo~ny (~ove~nmen~ agencies and vol~at~y organi~tio~ ~o make ~h~se ~--~ndehil~' p~li~ions both appealin~ and ~cllr~tek Five ~[~r~(~ ]it~ll~h in~l~latio~ ~amp~le~$ o~ variou~ a~pe~ of the r~DOr~, ~r ~xQmi~]e, w~ve premiered snd (~i~tribll~e~ by v}tri~l~ iinit~ i~f ~]a~ I)~bli~ HC:&l~h ~¢~rvi~c~ ~I~(I ~dr~&~ol~ ~rol]p~1 W~ have di~ri]~ecl ~bou~ ~.000 infoz~u~tion kits o~ ~ample publieatlon~ on ~moking and health. "We ~r~ iI~VOlved ~ Wt'll in ~m~ ~5 ll~i~vior~] ~11di~ ~o ~t ~ ~e Ix~h~ so~ dyn~l~ies i~f smilking: why l~eople ~t&rt s~oking alt~ o~h~r~ don't, WbX ~ilm~ c~an stop ~i~ of~hei~ huv~ ~i/]~tdt.v. ~e~ ~n~lud~ sLudles o~ ~d~II &]ud youfll edu~i(~1~l programs, w~thdr~wal el~n~c~, the ~des o~ phy~e~n~ Stud ilrJae~ llr~fes~[omL1 he~]~hw~ei~• and ~h~ valu~ of grou]J treaL~ent "0~ of th~ most imme4ia~ and ~ar-~eaching byl)rod~cts o~ the smoking ~d J~a]th repor~ [~as be~n t~ imp~t~l~ it h~ gt~e~ to reSeal~h o~ ~he components ~f sinok~ and t~eir physiologie~l effe~48. ~ot only has the report stimll]ate(~ mo~ r t~t~ v~h, btlt t~e field ha~ a~tra~ted ~oi~pe~en~ inve~i~tt~ors who p~ev~o~l~ h~d b~cn giving pri~r ~t y to o~her p~ohlem~. "~a addition ~ e~panded work at the ~-ati~nul ~nstitutes ~f Health. n~v ~esearch is be~ng ~onsor~d ~.v univer~i~ie~ and ~ul~da~]oJls, alld, ~ ~o~ ]~l~Ow, by ~he ~mertc~]a ~edl~1 ~.s~i~tion with financial ]ael~ J'rom ~h~ ~Ob0.CC~ indu~t~ itself. Aml~ri~in Ca~i" ~c~I~ty, ~nd tl2e ~t~dy o]" £he ]~ti~h physicians ~on~in11~ ~o ~Id'orce t~1~ e~r]~ ~ndi~g~ ~¥~I~e4 ill ~h~ sl~91~iJag ~i~ll h~ittlf~[i repqJ~. All th~t~e strel~g~hell the evi(]eJ2e~ ~]laL pgop]e who slop ~moki~g ~l'e gr~.t]y bene~iLed, even if they h~e ~meke4 fo~ ma~y :~earu. J~he w(,~i~h Of r et,~ar ~]l i~J'ormation ac, e~lat e(i £o11 tb~ Advisory Com2~iL~ i~ being kept l~p to d~te thr~IZh the u~e of the .~edlar~ ~om~te~ system a~ the ~t[oIlal LIb~Iy of ~i~ine, Pla~ ~re b~i~g develol~ed for a ~itl]~l~ re- new alld a~al~ o~ th~ worldwide ii~eratu~ im ~i~ snlbjef~ L'~s~ o~ the a~'itle~ I hav~ me~tloIic~:l te~(]ay a~e ~o~ii~ prog~s wi~h ~ and local health agencies, education i~st~tutionsI a~(l oLh~r~. I l]ttve ~ii~tf~t$ groat m~Ily which¸ in the a~e~ce o~ ii~ci~l ~upp~r~, We h~ J3e~ abl~ ~O ~s~i~ only b~" consultation ~nei t echni~a ] ~(Ivic#~ "O11o of ~he principal ~y~ b~ which w~ keep informed I~ ~]Iro~h the ~a~ tic>hal Inb~lagen¢~" (~oula~il, w]J~ch ~Ja~ ]~rongh~" ii~ t~g~her ~e:~e today¸ The ~ubllc Iicalth ~e~vice i~ delighte(l wJ~h ihe rapid pr~gr~s~ being made by ~he ~ou~eiL

CIGA~E'I'TE LABEL~G AIqD AI~RTI~G "We pa t~ieular ly wan[ to w~lcolue our d] ~Lin44 u]~lled now ehalzms n, l~rr 3~r¢~er- ~on F0~e, ~ho~e ~zligh{ellefl e~amp]? Will ~arve ~he C~llJ~ClI'S c~lls~ ~ it h~ ~ece~tI.v s~rvocl the PJce~ldong~s C~zlll~i$sioli oil l~l~¢tl~ 1)i~,a,~ (:~itl~.r~ ~lyld ~troke "Th~ r~,i~or~ t~f that Coml:oJssion~ n~ nlo~t Of yoli ~:i~ow. ill~lLl~ed ~ strollg endorsemOll~ of ~h~ rel~ort ot~ slnokh/,g a~d h~tglth and r~Jolnlu~l~ded an ~Xpelld i~llr~ (~ ,ql0 million o~r ~ ~y~av pe-rio~l. "0nr rP~e~g fo~ a Sl~p~eme~tal aplar0priag~on o~ $1.9 million las£ ~ummer • v~ d~rr~ ~ tlte C, ollgr~s~. We recoiled ~l~cour~tgemeng ~ronl a l/umb~r i~ ~M~mbers Of q~llC Collgl'~ to rp~tcw the t~ln~ thi~ yea~ This we hoi~e ~o do Lrl g3a~ w~2i~s ~l~fld I~ w~ az.~ t~3 ilut ~he N~lriollal Cle~tt4ngho~s~ On ~kin~ and l~ealtlz into £uU ol~ratlo~l it is c~le~r tbst fu~dz/ will be n~0e0. "LasL yett~, the C~ngress dltl aDDrop~ia~ e $1.5 mllll~ to s~dy the heal~.r claret] Dl~blems 0~ Lobac~ Thi~ ~tl~i~ropriation, which w~s made ~ ~h~ Department of A~rlcl~lture, htgs been highly useful. ~he ~13~r ~rn~at o~ A~'~cli~ ~1i ro I~ "~v~r~. ing yery cl0se~y with ~h~ l~ll~[ic ~&llh Service ~t de~e]edj~i~lg ~lliLal)le r~arl~h i~ ~he ~per~i~ of t01)acco ~1~o1¢~, And lea~ C01~sgit~e/~ts arid ~heir l~iologi¢" eff~c~s. "In SlllZilzl~ryr Where t~o We ~rc~ld ~d~y, 1 y~tr f/~,r lh~ p~r~ ! "First ~f aii, despite the charge that n0ihil~ h~ re~lIy ha~Derz~l, and ~hat tll~ smokIDg ll~Dig~ Of the Xa~on ~r~ right "oaek ~h~t,~ ~he~ Were, ninny Ch&lJ~ have [tlre~dy ~[tk~l DI~Ce, "Adtllt ¢igat~gg~ ~a~kor$ [o~ showilig a cles~ trend ~lwlt~ ~rom th~ ]2~bit. A~ Iea~ 1~ million Americ'an~ ~lr~ ~o~ ¢~-cig~ret~ slnok,2~l~d tlaey have been o1~ IOllg ~lol~gll for mo~t o~ them to ~t~y Off ;if W~ tallc" Into ~0Dgld~r~10lt th~ illerec~e i~l pop~lJ~10~ tl~, drop i~ total ci~o.r~e ~n~lzlap~iOll ~is I)as~ y~ftr [8 su~£&n~i~] If, In ~l~, ~Iio[l~lllg llf~d h~D f~n~d,' ~i~ r~t~ co i~s ~tD plAoll wo ulcl now be rntl~h Ill,her gha]a i~ W~s It yeflr "l'~{ i a cla more illll~C*r t a~q t ll~V0 ~li th0 ~h[t lage'8 ~al~ng 131~c~ ~431ow ~he .~tlr~a~¢, • ag tile ~0v~ls o:[ 0.tt±L~de ,~lt(I I'A,llef, which are o~?.en ~he pt'*2t,~r~o~s Of ~'llgtll~ 112 be]savio~ "~ny ~molz~rs llave become tlrle~ly ~bo'~t ~]10 r~ha~ti~n.~aiD Of cigarettes illness. .~illJo/l~ i~ I~dult i~ig~rot~ sanok~r~ ~r~ read~ rt/ 13~ frilly ~o~¢'~1 gh~t ~h0 fJrne ha~ ~om~ go ~hflit~ their ~m~king ~al~i~ An(l, Chef,fore ~e oi)por£~llJLy to c~/lvili~2~ ~he~21 in L~ and t~h~ y~ar~ ~h~d ]~ groag, "~l view Of the lit~ [~e 0DDOI%IUll t y for I/OSi~Ve ~ egl0~, ghe gitu~ ~ ~lIreI y ripe ~o launch ~ tr~aly n~tgionDi el~0rt that Will ~OZlVXJICe p~ot>l~ Of tIl~ d~tngers of cigarett~ s~lokin~ ,,y~" we e~rt'~t ~t~ch ~n ~ff~rt I ~m convinced that i~any nai21ions o~ smoker~ nov" On ~he fent*e will dec'ide ilq fa¥0r o~ gDei~" owi1 he~tlgh and well/leing' real llop~ ~or £h~ ~ll~r~. l~ut, a~ Win~[orl ~hurcl/il[ l~]lrds~d ~g~ ~we Dle only a~ the b~girining ~)~ tl~ [~a ~J~tli~ g,'~ ' Unless w~ collgirl~ t~ ~rt ilu~elwe~ in ~he struggle ~lat ~es allead, we Call 10se: Wh~t gr0~ln0 h~$ I~et~ gai~ed. In the f~aee Of th~ thr~ ~o hes.lth ~vhich cigarette ~nuok~n~ pres~ilgs, o~r gatlls lzave been more, pelops, Lh~.ll we migh~ Ii~ve e~ti~c~ed but they ~re le~ th~n W~ might have h~Ded for 9p~I~, real Job ling b~re us. "]'or our t'~.r~, I pr~l~i~ LIl~ in t]xc monghs all~a(1 ~he Pt~b]I~ Ffenlt/1 ~ervI~ will do all i~ cad ~ Drink' ~bola~ a l"~l~Lio/l ~ clg2reL~e s~llki~g izi the cl~r ~l~(l e~s~blisllod Dl~erest~ ff£ th~ -Xa~on'$ llealth." ~ MA~r~0~, ~r presld~nt. I ~1~o a~k unalziI~aolIs con~e~t ~ha~ ~he D~ll lh~ on tlle table unfil Frid~y~ J~rlll~ ~, for ~Do~lso~s. The p~n~C~ O~Pr~. TJ3O bill WLII i~e i'~c~'ed and ~DDropri~tel~ r~f~rrtwl, tt xl~l will lie on ~he ~able tcs reqnos~ed, 'igle bill (g. ~5~) tt~ regulatv th~ lttbclLug of elg~l~tes, add for other i~ulT,0 s~s, in~odtlct,d "07~ ,~,[~. l~agll~on ifor hl~lD211~ ~nd otll~r ~,ntt~l~), was r~e[ved, reafi gwice bY lgs ~itl~ alld refelq'ed to* tl~ COll~ati~e~" On (~J~l~el~2~'.

CIGARETTE LABELLNG ~I) ADVERTISING 9 IATAgIII~GTON ~'4T ~ TT ~N~T~, Jla~:h 9, 196~ Washi+~#to~£, D.O DE~R ~]gNA~O~ I~AONUSON~ i iflaV0 ~ boater ~/ LrttlislllJt herewith a certifie~l copy of ge~ate ~esolntioa NO. IIKi5 32 which was adopted by the betlar~e ~ff the State of Wm~h[ngton <m Mltreh 6, I965. N~'r~t~iry of Ih~ ~J~atc. ~enate Re~ol~tJon No. 196+%~2~B Se,Lalor~ A L l~a~mu~sen, Wilbur II lYe]hiller ~ Js~l~Lrgl 7Y* t~ //on¸ L~JII~O~ /~ ,,rl~l~o~l, prc~id~t Of ~h~ U~ed ~,t,lt~,~, to th~ l~ ~idt~it W@ your m~moYinlis~F~ the Dlel~ers o~ the ~qen~te Of th~ ~t~tt~ ~ Washin~ ton, ill lCg[~l~iye se~si01~ ~lss~mbled, re~I>ect~ully represent ~nd pe~ltlotl ~S follows: Whereas, ~vithil~ r£~-ent mot t]/~ ~11c~ llatJOllally l,'~owl~ ~gtlT~s as Edward I~+ ~llrrow, John Wayl~e~ ~eedtlie l~ll~r!hinsllu, ~lld Na~ ~'K]l~g'~ C~le. have received operaFions ~o~ Inng elllloor, brlllging t~ the ~itel~tlon Of the V~ople elf lahe elltlll try, ,~nd 1~ r t[~l~t fly L~ oltr youth, l]l~ dangler s inh~.r ent ill th~ U~ 0~ el~arett e~ ; ~llel Wll~re&s, ~n~t~r l~ag~lson ha~ proposed ~at a hill he introduced in th~ Coylgre~s Of tll~ I]I~it~l ~tate$ r equiri~ g that ~i~rl2~f~ lie ]~J I~l~{l ~S h~lzard~lls ta health ]NOW, ther~for~ b~ i~ ~o~d, Thai ~ollr Memori~list~ al~pIl~Ud ~he F~Siti~rL fak~ by ~lla ~I" MII gI~ tl s~c*n, and urg~ []1~ M~nlbers of IJongre~s, and ~*ar til!uh~riy tile M~bera of t~ congl:~illu~l del~ation frOl~ tile ~t~re Of W~i~l~n tll giYe fllll ~ll]9port to ~ch a+ bill, or to ally Other bill o~ like' l~Urpor~ or inrxmL Ih~t m~y be ill [ rod~le~l ~1 tl~@ Con L,r es~. B~ ~l f~he~- r~oIv~¢t, ~Phat the Igeere~l'y ~ th~ ~cLllrt~ tr~lil~miL ¢~;i~ (ff this reso[tltioll to tho Hon. I~vndon B Johnsim, pr[~[tlo~i of ~he Unit~t~ ~ss~t~+ to [h~ pr~i(iel~t ~ ~e ~n~te fllld ~pl~ak~r (~f the Hoa~,~ ~ II~epre~I/l,~iiw's <~ the Untied ~t~, and tn ~a~ll ~ell~or ttild Repi'~t*rl~i~ ~rom ~he ~tate ~£ Washington l, Ward l]ow~] on~ S~r~t~ry o~ LII~ ~ena~, do h~re~ eer ti£y t'0i~ is ~1 ~rll~ alld corr¢~ eol)y ~f ~nate l~ol/l~ion No. 196~32 adO~p~d ~ th~ ~ate Oll ~*~r~h 6, lq65. The CItA]~.~. "Smoking and Hcnlth,'~ t]m repot5 of the Advisory Colmnittee to tim Smgeua Genm'+d. will be i~corporated by reference hdo tin+ hearing record in its entirety and part I, the m+roduct]rm. mtmmarles and conclusions, will be pri{~t ed i~ the appen dix ro i}m lmat ~n~ record. ~¥e have as our fi~t wJtnes~ ibis m~H~ing onr dis"dn~ui~hed colleague from IYt+zh, the HonorM)l~ ~Vallace F. Bennett. ~*÷e will be glad to }lear from you. STATEMENT 0t' THE HONORABLE W~{)E ]~, ~EI~,TT, UI~T~D STATES ~ENAIN)R, ~TAT~ O~ IJ~AI{ Senator B~.~- ~+r'r+ Mr. Chait~na~ I want to express m y appre~;ialkm to the committee for ext endin g time to me to testiS" in ~. plm~ t ~ leg's lation to regulate tLe labeling and advertising of aigatett~s. 15 f)79 65 ~K ~

10 CIGAEEWfR LABELING A~ND ADV~RTISh~TG On July 16~ 1957, I sponsored S. ~65~# in the 8501 Congress which I believe was the first cigarette labeling bill to be introduced in th6 (~ong~ss. This bill just dropped into ~ deep hole and disaplic~m!d, and I am del'~hted to Imow now tlmt as a resulg of fur~lmr ~Jrk by doctors and el t~ers concerned with tile problem, ~¢ ~ow bays two bills before us introduced by mere bel'~ of tin~ committee: In e~eh Congros~ since flu! 8oth sessiun~ I h~ve introduced or cos pen so~(l bills tn r't~ tfire ~ wam~ing l~bel to be attached to cigarettes to w~I~l smokerg o f ~he ~e~'dth hazard involved. Unfot~;ungtelv~ nearly 8 years lmve p~ssed since tile introduction of that first bill a~d Confess sti]l Ires not taken action to protect our citizens by means of adequate warn in~ ]abCs. . . . . ~{r. C]@l~an, tile bpdy of my sc~temen~ slmp.ty 3x'~ ,ews ! ue lnstory of the legislative S1E~&£Gt&O/1 add I we]lid llh]¢ pI}I'n kltk%lO~ tl~a~ It be put in zb e r e~,or d as thougb I h,*l reu d it. The CuA*m~*m Thank you. lVkbout oh5 action that will be done. ( Balance of statement fellows.) ~ l~[I F~cPON~, IN PI~OGI%FS~ A great mi]estmm was aehleved on January 11,196~ whea~ the Sur- geon GenerM~s Advism7 Comnfitte~ on Smoking and Heald~ ssae; t~ report. The judgment of the eomlolfitec was flmt- Gigar¢@te smokhlg Is a health hazard of su~e[ent ~nDo r t arle~ in f~a~ U[d~ed *~tates ¢o warrant opprop~iate maxIledial aetiolL During the past year several ma'm" ~a¢ions including Lh÷at Brkain and Italy', have taken action to lhait ei~aretle advcrrismg and to wa~n the imbhe of the danger which smoking pose~ to the healtl/ lv~d wall being of its ci~izaI~r). On dlmua~3e 18~ ] 96i, Paul Rand OJxon~ fhe Chai~mmn o~ the Federal Trad/I (hmlmission. m~de a lSstorle anneuncetoellt that the FTC would issue a set of proposed t~ad~ regu ations gov~rnir, g the adverlislng and labeling of dg~rettes. These rule~ were published in tlm Feder".l-Reg- ist er o~ danm~D, ~, 196g. Hearings were beht on the~e rule~ on i~arch 16, 17 and 18 1964, ~md intem~%ed mriit~ were g[ven until ~iay 15, 19~4, to submll Sl ~0 eluonta either in support or opposition to th~ r~fle~. ~t ll'n ~I ~ll ~J00 Wi~l~sses testili~d or stlbllliLf ~d ~zatements. TOBA¢00 INDVSTRX aliAS -NOT PEOD0C~9 Awsw~ At tho FTC be~:ing~ the tobacco industry was given evetT oppor- tunilr to testify ~nd present its ease. However~ th~ indust chose to raake" only a limiled present ation in the proeeedin t,,% Aeeo~'~ingtoflm FTC published report the tobacco industry-- tOOk the lmslti(m that /he Commisslol~ looks a~thorit:f to conduct such a pro ~ediIlg alld altel]oa~iv~ly, that if t~e (]oil%mission has ~l~cll allthol'i~y, it Mmtlld rmt exercise it at tl~ time. The report fmther s±at ed ~hl in(hlst r~ ha8 submit?ed no data or iRforma ~ion with r~sl~e~ to such m~ttors a8 the. hc.attb haz~rr]s of elg~ar et~e saaokin~, tile urospe~fs for (l~veloplt~ent of 1~8 hazard0u~ cigarettes, an4 the pu~se and et~eets of e]gv~tt~ aclv~r ~]slng,

C1GARETI'~ LABELING AAND ADVERTISING J. 1 ~T(~ TOBAGCO R}:~ULAI'IOI¢ I~FLI]S SHOI:LD BE I~II'LI]~IENTI2D a.s a result of the hearings the FTC alarmed it8 decision to pl}tce into ~ffect oft January" 1 1~165 'ee trnde regul~tlo~ ru]e~ regard g cant on ~be s and adve~t]smg of cJgra'ettes. Unfortunatel), tim cite - t ve date for im )lementing I2Le.~ new cules was later postponed until July 1 1965~ a~ the request of ihe Ilouse Conxmlt~ce on Inteistate and ~reigll Co r~cnerce In t ng ~' th tlm stuff of the FTC I h~ve determined that the Commission i~ most anxious to implemenl its tobacco ~eguht]on rules a~L ~c~L" es pos~beda e However theprosi~ t (dfur lerdehvis qu te k~ly because of three factors : ( ] ) A iw~xd~o was inserted in'the FTC order which permits the 0ommission ~ antcrtaln all ai)pllcation filr~1 prior to May 1, 1965, by any Interested tmrLy to po~ffone tht, cffeetiTe dale ur o/herwise susI~elld, modify, ~r abrogate tile provi- sions of the rule as to a(lver tf~fng, UDnn a ~howiug of stleb change in cil'eumstances as to just ify such requested tctioll ill the ptlblic int ~re~t ; congressional action on pendh~g tohacc~ regul~ ~ion bills may result rt ful~ erreq~ est fl.omCongresstodelaythe effeeHw~ iateof the.l~eg~l ]a~ions: ~ the ~obacco iI~[l[1s~ry ]~]lly ,g~"~l£ 111]ttn('h~'e relief m the courts (o delay or n ulllfv thc FT(~, t~b~'co trade i~gnlations. CO~ORI2~S ~x~t)]D~D ~OT {_'Atwfql~ ]PUIRTI4~R ]~A~" Mr. Chairnmn I do~ think Co]~grcs%wangs to be responsible ~,~r u~*y 5,rfher delay in safeguards which will help warn tlte pubhc ~nd particularly you~g s]c, oke~ of the inherent health h ~zard ~ hlc]~ exists in cigarettc smoking. For that reason~ it is u.~l: important that Con- gress ]m~aediat ely exp r(~s its will ]n lwgard l o the sev~r~] e~garette balls llow e~xding before ~fis committe~ :rod the House Interstate and For- ei~u ~omme~ ce C ommitt ee. Congressional ~ppr oval of an appropr ia Le cig ~rett a l~beling and advertisin bilI wil] resoIve a~D' IegM dispnte as to whether the FTC or some ot~er Federal agenc~ should have the power to issue etfect~ve controls on the tohneco indus~ly, Our scientists have resolved any do~hg which onec exlsled as to the cancer produciIlg effect which prolo~g~zd cigrald le sift okint~atbas on the human body. Good evidence h~s }melt pn~duced to show tobacco ~lso has I~ de] gt fwio]i~ c~ffe( t on the heart. ]UllgS~ o,1]d other vital organs. Wily Them ]n the name of common.rise should wa proet'asripat~ m m- p]en~entin~o roller IRlles~ which do IlOt pro}uhlt th(! s I]e or dl~Lrlbu~lon of tobacco, ~ut onlg ~ml users of he~,]th (h~qge~s which resul~ from its use Ample precede~ts exist for such waI~ing l~bels. The ]C~d and Dru~ ~dlninis-~rathm now requires iv formative labels to be pl:t~d on ,%11 lrLedl¢]]l~ and drugs and I]lally o~hsr pro(hl[~[s which lllgy prove in~uriou~ to human health if not us, d itt accordance with prescribed ]nstmlctions, '] h[~skLi]] ~lld cross,ones w~rnin~plaeedonmanyhouse- hold produck% such ~s disin~ec~nts~ is a s]gh~ well known to every housewife. Is it not re~sonabIe, therefore,-W require the cigarette

]2 CIGARETTE LABELING A-~D ADVEIITISLNG nlDiluf[i(t{ursr [~) place s~ eautlollalFy 19)~I ell ~ach pack~,~eI cartonI or 1 mx of eigar~tes w~nfi~l tl*e mnoker that "Coutinual (Jigar~tt~ Smok- ing lsa HeMth Hazard'S; or "Caution: Cigarette sumking is ~nger- ous to hea]th. It m~y cause death from c~ncer and other discloses ~ ? CoNor~ss ShOUteD AOl' FO~T~WITn Mr. Chairmm, while I am ~ cospmlsm" of your bill S. 559 I am not wedded to ~mv one upproa( h in resolving the labeling and adx erllsing rol,lean relating to mgarette smoking. Our colleagu% Senator Neu ~r~rger~ ba~ introduced ~n excellent bill S. ~47. Likewise, the langaage contained in the FTC tobacco trade regulations might Iogieally ho in cinded in a bill reported by the Co~nerce Committee and would have my full support. It boils down to the simple fact that "wh~0 dmuld I~ don~ mus% be done.n and the Coll~'(~ss shonld, without delay~ pass egeetiw* ]egis]atinr± to deal with the mgaJ~te labeling and advertising problem. Again I want to express my appreciation for ~he time affor(h d me to te.~tifv and, in cone/uding, urge th(l [ummdtt~ ~x) repo~% a bill forth- with tel: a~ tion on tile Senate floor. Thank you. The CHA~m~a~. Senator Bennett, of course rm ~ne is more f~uniliar tlmn yon, with 5,our long experience in tbe Congress and in Ihe Senate, that ~mny bills are introduced without any par ticnla r pride of autlmc- sh ~'~%'enat or;~ ]3~)r~. That is right. The C~Am~a~. Wording or otherwise. Sometimes they are in t reduced so that the matter can be laid on the table so tha~ we e~n lmve the benefit of *tinny people's views, to modify, change llm bill~ make thernbetter. LnO~ese arfieularca~esmentio~mllby¥ourself, tbebil~ that i introduced and t~o one ths.t Mrs. Neuber~r a*/d I believe there are olhers in the Congress, we are hopeful to tM;e them all and find out r~e good parts of each. know you have bad th at experience yourself. Senator B~N~. Obviously the purpose of this whole legisladve. process is to try and take a basic hle~ and work it into tim most effective b~w and every ~feraI~er of the C~ngq'ess and evmT Member of the Senate can make contributions to the ultimate length. The CHnm~Ax. I don't think the fa¢~ that the chahana~z introducezl a bill at M] rules ou~ any o~her suggestions m~de in oilier bills or rules ut the eonshle±aLion of ary other b t at at er Members may hllroduce. Senator D~T~. I am sure the ehalrm~n of ths commlttoe is fair, impartial and amxi~s to get llte job done, and wil/ co, raider any worthwhile proposM. The C~n~ax. I thank tim Senator from Utah. Any questlons ~ Senator Pastore ? Senator PASTO~, I~o. The O~m)ia~. Senator Morton? Senator Mol~o~-. No. Tim CHA~a.~. Senator Pea~on~ Senator ~ox. ~o.

CIGARE'~rE LABELING AND ADVERTISING 13 The CH.~m}iax. Senator iqeuberger? Senator XgEuBsa~oE~. I would like to complimellt the Senator from Utah and the I)ioneer spirt in the way he comes. I ~dso say the intro- ducllmL of legislation is an educational process ~n4 I fitink we owe a great deal to your early interest and I would like to menlion at tiffs time Congressman Blatnik, who has also bee11 concerned. Every !.ime~ as the Chah'man saws, abil] goes in. it goes m fin' st utty and ~onelder- alien, and we owe you a ~'~t deal for your time and effort on this bill. Senator B~--~:~u'. I appreeitae thos~ kind statements. The Ci~e~l~-w. Senator Ba~s? 8~mator Bass. Oaly one question. Do you knm~ of any oilier commodities on the .&merie~n market that ~re hazardous or injurious to health that should come within the put view o~ this act? Senator B~NX~T. it is my impression that tlm Am~rJca~l pc.c,ple expect the Federal Government to protec~ them from known hazards whe~ tilose hazards become hmwn or obvious. There may be ~¢ther (!onunol]gie.~ t¢l{l~t~*- tlmrl~ Imtv be of,llel eomlllodi[ies t{~morrow. We must eontiml~lI} b~ on the ale}t to continue this principle of protecting people from izazaedcms commodities. I hav~ the feeling that i~ might be wise to confine ~his bill to this pal~acuhr problem zather tban to go off into the fie]~] of drugs or other ~hings. S~mator B~s~. Tlntt is alh Th~ Cm~mm~x. Yes and this eoinmittee~ of course, has on many om~usions pas~ed ~nd considered so called labeling bills for v'ariou~ pur]!)oses in protection of tI*e consumer wha~ he is get~ing, wh~tL he is buying, ~md it is not wit/rout precedent to diseu~ the.se ~h rigs one at It time. ~lmlLtor Bnr~*CI~T~¢. I don't l/bn]¢ you bare seen th~ l~st of them. Throe wilI be nulre. The C~a~>r. Th~l~k you very much S~nator Bennett Sena or B~Ne~'r'r. Thank you~ hfr. Chatrman. The CH~n~ta~. Now the distingufi~ted Senator from I-I ~h, Frank ~[I)S~ lind w¢l will le g-Jlld t~ hBItr ~i'onl you. STATEMenT 0t' TIIE HONORABL~ i~K 82[K E. l~ 0 ~S, UI~ITED STATES SE.WATOR ~KOM T~ STATE 0~ UTAH Senator Moss. ~fr. Clmirmgn and meanbers o~ the committee: I uppreciate the oppor~'uniW of ~ppearing t~ds morning to testi fv briefly o~t the merits of 8. 559, w~deh was introduced by the ( hailmmh of this eomlrdttee. I ~as ~ery pleased nnd happy to be in~ittul and to par~eip~te ~s a ~(~SpO]~Ol" O~ {tie ](g]Bh~t]l)l] ~OF f]l~ eOlllllliL~ee, I also oomplbnent Mrs. -Xeuberger for lmr hill on labeling that she has introduced. I have par[trip.ted with her before as a cosponsor h~ laheline" hills. I will ~ry to be brief this morning because i ~ow the eonunitt ee b as many witnesses to hear I f2aink there is ample evidence now t xisting to prove th0.~ ]he (:/}ii~[nned nse of t~}lnl(!(!o prlllhlc~f~ is Iu~lll~Ltl to .'~n individual s health. The rising* nulnber of deaths from cance~ of tl~e lung ~nd other parts of the r~s~plr~tory tra~t, emphysema ,~nd hcar~

14 disease attributed to continued use of tobacco ~oroduef~% is a nations! prohle~n which miter ~6t gO um~net. To~l deaths± from ull cause, have¸ d~r3~l~d since the turn of the celltnry in tJae 17nlted States. l)eaflls from hmg cancer h~:e~e~tly inere~exl, however~ to the point where this disease ranks wlth auto- mobile accidents as a modern-day killer. The prlntlng of an appropriate label on each package of cigarettes: ~s called ~or in our bill will be ~i~ important step in informing and perhaps convincing both the confirmed adult smoker and the teenager of the deadly dan~er of ~igareLtes. All inn m~nv t~nagers are t~king up the cigarette hgbit in this eountL~. Theuae of tobacco product~ hg~ been made to appear matur- ing, rein ~n~ic, and ~liurlng to the teenager who w~t~ t~ grow up lit e faster. According to the statistics puhllshed by tll~ #~nerican Public Health Associ/ttio~ one mill ion school children'witl die of lu~lg ctm¢[!r he tore they reach .0 yell es ~f aEa f they begi~ ~sin~ toha~ pr~d~zcls whil~ they ~1~ to~ll~t~rs. C~T~ainly it is more than coincidental tha~ fewcT', by far, noJ~smokers di~ of lnng cancs~: tha~ smokers¸ I3ut, ev~n with the increase in lurtg cancer deaths, heart diseas~ still le~d~ the mo~]ity~ate amonff thos~ who smoke. ~rhe dealh ~'~te ~rom h~rvt disease is ~0 percent higher axlo/lg SlllOkt~r~ thorn n~ng~ok~rs, As • n~tlon, over the past decade, much has been ~l~c:i~upli~l/ed ~o make the driver~ ~nd p~sseligers of motor vellh~]es ~afer wb~le ~dmg in a car or trt~ck, Le~islatinn mgking seat, boils ~na~d~terv in ~ew cars has been successful, and m et with *~o opposition by th~ automotive in~ues[~raYinlv tile numh¢ r ef lives to be s~ved by s~fe~v belts altd other protectlve ~deviccs, ordered ix cars by. leoisla{io, sme~. sgf. 11 m d ~mportant. Other ls~ws }~ave been pos~e~provldmg industrial safe~y for millions cf workers. Many laws ~md regulations have been pro- vided ~gaa'ding the use of <Image and ~a~ain ~nadiehxes which can be harn~ful when e~onsun~ed hy humans. There arc. rnaay other exam los of legislation whielx ht~s provsn eff~cllae in prot~cth~g the healt~ and g-eneral welf~tr'e of a ma~rily of ore" eltize~s. Now, Congress has aa opportunity to cm~:~ a bill which will provide a definite, clear warning of tim lmz~nful effeer~ of a ha~m~fal produc~. The labels pJaeed o*a e~,s f~b~rs ot poJso~ ha~ eertai~)3~" been Tahiable to the American citizen. Alfi~malive consideration s~ould be given to ]abelis g another harmbal product. Now, tb address mysel~ to the ~natter of tel.coo adver~Mug, the tool of entieemen~ which so effo~ti~ ~dy eo~vinzes young people that smoking is ever,'yfbi~g but harmful to health. The United Stoics is becoming a laember of a ~nlaority g~o~p. Itfs~v Western e0untr]es have ali'eadv taken s[rong nn~sures to lhait or prohibit file advertising of rebecca'products. M~ay countries have taken, ste s to remo~e ~he. adve*~tia ng~ emphas;s: o~ pleasure to be obtained ~[em the use of e~g'arettcs. ]~egulal~ons in IZ, ri~ain prevent fe~turlng young pe~ de~s heroes hi toh.c,~o advartls~m~nts, and for good reasos. I c.n imagine what

CIGARETTE LABELING AND ADVERTISLNG 15 roblems the curl~±rtly popular singing group expmted fmm Great ~r]lail, ~mld cmmc il! tl~5~ suddenly sol~ I~eit' c.dor se.,cnt of t .hacc~ products. The ]~lliled SLates h~m no tomb t~ur~ls on Lob~ll~e(i al]vevtlsln~ ~av~ a few attempts ~t "volurltary~ con~ol and ~f policing." In too lnany cases: the tobacco hlgRstry has failed to regular e i~e]f and its advertisingp~ract]ces. Television commct~ials show sup posedlymau]vindlvd~ se gaged np vsca abe" savo'ngapar- ticublr brancf of ~igarettes, and suggesting that i! you wmt to be nmnlv, smoke tobacco. Otber commercials a~.d ad~ ertJsements stress v~ rious so o;d h,d p]easnres to be derived h~m the use of tobacco. (~mq~/]ltly~ tlds eonmfi~tee and C~n~oTess must now act to jog tbo public~ back to ,'cmlit~- -the ~iLv of the Surgt~un GencTM's ~> ~lolt issued alX}lll ~l Vl~l P ll~O; iiT!d ~)11] e S{/V KIt httt forgotten now, Tbe azards I)f sntokln~ shouid ,,,!Iv he proe]Mmcd and ~iveu promillent distribution, just as the nonexistent pleasures are a(lvertised. 't'be ]abel~n~ cf tobacco packages ~dth the message called fo~ irt our bi]I is ordv partial fui~Hhnent of our res )magibiIity to inform S~1 oker 8 fln~ J/(T] 1 ~ I IIOk(!l S O]~ the possible harm~effects of tobseeo use. Ol~r other res )on ibiliry is to adv~ each emffn']ned ~noker l*liahIe infm~nafion on the tar at;d nicot h~e content of each particular brand of cigarettes, This bill ca]ls for this marking on each package, along with the warning about the possible health hazards presented by smoking, Perha, ps IITlIter COn~reSSiOD~ll in]DeLllS, ~Ili;']l "aou]d tie n'mdded by passage of this bill t~aeco manuf[mlure~ ~il] st rN.e to fiud the safer cigarette wl~icl~ can he prodt}eed, according to health eltieials. I do not propose a pro]nb~t]onlst p~ece of ]egns]atmn because we eallnO! i~xpl (!~ to erfl~<~ ~roIxl ~he fl~ market the tobacco ndust~r, any more n we d d "~ v v ltlcolao ie beverage, eoll~ Tl]Yl, i~ I0~i, Bllt I stroIlgJv bel eve ~e ,~ , s ~ re. he qmolzer~, •gild 11Oll Sl/1 oker $ ~ll tke facts~ and let them 11] ak ~* lip [heiF o~111 lIi/f!d8. I sd rongly su.egest ~,vd ~ree favorable committee action on this bill at the earJies~ thne, Th~ ~AI~MAN. ~l~nk ~rou~ Sell[k~Or kfo~. S~nator Pastore~ any questious~ ~1! at or PAS~-,R~, ~rO questiOl/S, r~'lle (]ItA~XA~. Senf~toF~d~oFton? Senn¢or hioRax-,~c Senator. you have used in ~onr statement tke ~guro tt~al, 1 million teenag6rs will die 0f cancJof the lung before riley are ~0. ~grhal; do ~ ou b~] se that on ? Senator k{(~ss, I have taken that from a medicnl rello~t that i don~ lmve wilh me this mo~ing, bu~ i will be ~lad to ~urnlsh the emnmittee a~d put it in t 1.~ record if t}~e committee so deskes. Senator Modem'. 1 g.ess i have seea~ that same report. This is ba sod prim a rily on statl llcs ! Sen~tor Noss. That is cor~ eel. Senaior IKo~ox. And n<~t on ~mv clinical findlrzg ? Senator Jffoss. I think that is c6rrect to say not clinical fh~dlngs in that it hasn't been a controlled group over a period of time, b t this is pro!cereal from e~qdem e th t we have of smal er ~'oups and slat s- t call3 e~xpanded, that is correct.

16 CIGARETTE LABELLNG AND ADVNR~S/NG Senator MORTON. No one yet has come up with what is in cdguret6e smok~ that might eau~ dhts gancer Senator Moss. I suppose I would have to ag~'e ~ith that not being a medicM doctor ~md I am not awa,'e that the)" hg~e pinpointed ere vlsely Lhe ingrcdlen~, that causes it, but the cause and efi'ec*~ certainly h~e been dncumented, . over and. over, ag~ain sJld I flank the Sm'geoa (den cml's report 1 s the best swdev ce of tllgt. Senator Moawox. Doy'ou kno~ of this Caminddge filter method of evainating the amount ofnicotin% or so-(~dled tars in smoke Senator Moss. I have healq of it. I am ~ware o~ it, but d dolt~t know (he technical hasis o l (loh~gil. Stmamr MORTOn. It is in Your bH1 aJLd I don% know it, end having been~, exJ~osed in. an educatio~'in.New. Haven. I have some d~ubts about (,ambrldge, so it left ~me question m my mind. [Laught er.] d have ~ ~r~ds here, Senn~or, ~rhich ~s written by 3I~. Peter Norman. of the Toronto Star S~mdicate. dateline London~ ~'hieh ap- peared in ms~y of the weekly ne~,s magazines~ Sunday news mag~mes said the pregs. It has az~ interesti~ng headline : "A Xil]er in tht~ Sugar Bowl~" It st~.r~s OXlL : A killer st aHc,S ~rit ain and cuts down more than 1~,(1~) peo~le a year, many ill their prime Heart a£sea~e Is the Nation's NO. ] k~llex; it o~tr~s ~-~n e~ncer Thia i~ the detective g~ry off ~t man who l~llLye~ a hunch; a scientist who cast skeptical oy~ on a meows and ~vlmd it warning This articl~ goes on to develsp the fact that we h~ve heard a lot of facts about protein and wlla~ not~ ~md he st.'ted Jooking inlo mlXar. For i~sta~ce, he found that the ,Jewish out migr ~.t dm from Yemen was veLT hea~y into israel. Their per capita, consmnptinn of sager when they left Yemen whex~ they lived h~rgely oll fats., go~t's milk etc., Ool/d cam~ bilbo ~sl*~el w~t, llT) g{~[~ sharply, They had no heavy dmhlenee of heart 81scare in Yemen, aad when rhl'~ ~smc~ to Israe~ riley did. He does say in his article that these statistie~ have got to be further im estigateA. H~ doe~'t accept this necessarily as fgetual. I am not going to introduce., bill to put a sknil and erossbo~es on every package of slight. 11/ lg~t I woulfin~t even o~sI~)n~r SlJch a bill until I knew fl~e ~acts much moi, e sharply than a~e o Dpl~rel~t today ~n this question of a definite ~tio ~n affinity beLweelx the araour~t of sugar intake glad coronary problems. T ]1 olle thft% ill i his area we ar'e u~ r e, hing tod~y, we will find wh.t is ~he CII]]s% if ~kelcd iS ~i/l~ association between lung c~x~eer, if, indeed, th~ r~ is any, and the use of ei~a~ottes. "; hoe ~e will fired n-~a~ it T~s because I am st*so daa~ ~hrou~h a~Ti enltur~ chemisu~" or the processisg of Lobar:% we w/l] be able Io eihMnat~ it~ if, indeed, it exi~s at si]. I hope. we don't. ,talc, he~. I'erso~mlly I think, we o g t .t~ I ass, sere lr f le~slaUon. I have some suggest o is Iot ~e C a rnlans hill whmh I tinnk I couhl support ff they ~xes~ adopted~ but I do think we have to be g little bit careful ,b{~i~t thls business. T~ae first thing you k~ c)w, we ~n~ no~ going 1 o be able t~ ~t ~ny tl.Liyg, sraoke aiD,thing, for h~t m~dter, or drink anything, winch is of lIa- lmrtnnec m my SLMe, ~o% I might add.

GIGARETTE I~ABELING AND ADV?IRTISING 12" Senator ~foss. If I may respmid~ I weald hope I,lm invex, li~llhm went` on on sugar. I don*t know whetller it~ effects are hai~lCfl or nol. But I think it has been re~olved pretty well on tobacco. 1 think tile ~m'geon General s repolt was detlnite that thm~ is a causal eomtection~ at leasL deaths are much higher among smokers that± they are ncmsm oket~. Senator MolrrON. The Board uses rdae word ;*e~llaP~; I10~ acausMY Seammr M~Jss. All right~ but I think that~ our people al~ entitled to tlx~ waEnlng~ and tbltt is what this Bill puts on 51±ere is a w~rning~ artd~ eml~llnly~ they ~ ay then tltke their optio~ whether they use toMeco or n or. Senator ~iom'ox. ~i/~lto]-~ %%h&t /ereent~ge ~f the ~b~(Ifor~tte of yol/r Sta~ are membex s of the Men,non fath ! Senator Moss. I think abou~ 70 percent. Senator MoRale. Isn% it a matter of morality or religien~ or what- ever you want to call it~ against snaoking with ~heml Sen.lz~r kloss. The Mormon Church does teach the use of tobacco isharmfal. Senator Mom'o~. Is i~ predicated on the fact tha5 it is harmful, or s it a moral issue a Senator Moss. I don't bIdnk it is a mo~al issue. It, is harmful It is s~dd it is n at good for tl~e body Tb~ {~HAVR~,IAN. SI~ H Ii ~ i I l' Bell j'~J ol1 ! Senator PL~r~o~r. i ~onder i l Ihe Senat~>r ~tlluhl refer to page 2 of h s testimony, the second paragraph thtt s~a~ts theze, which So,later Now, 0on~ress has an opl~rltmi~y to @gore gt biU which will pro~id¢, a rleflniCe, clear warning of the harmful rife<its of a llttrmf/l[ l,roduet. Th~ question i would put to the Senator is that do I re~d into that 8Ia[l?nl~llt that v~heil tile Se~talor drafted ~}ltlg s~erdenc*:~ 11{3 Wg8 tlltdel" the h~preK~ion thai 8111oldItg ",v~l~ ]aarmfnl to all persona at all times ? Senator I~foss. Yes, sir, )hm, is lug- exmeh~slun frlnu i'e~ldhl~r []m Surgeon GeneraPs l~eport~ anaong other ~hings, that tl~e use of tobacco is h}maful and, over a long perlrd of time, has ,z yew ma~ked egret tb af er~ u be meltsured. Senator I~:~eso~. The re&son I asked the question was that 1 c~ume !~ere this morning with the h.pre~si~m, ,rod g don't know wlm,'e I trot lg perhaps ust generalread ng. at s ok g e o e ' gs was ha~Tnful t~ different pe~ de in diffezent deg~;ees at different ghn¢~ and I *~mIed to give the Senator an opportufil~y to make an observa- tion on what intl~ression I migh~ hg~'e, Senator ~[oss. I would ]rove rr~ a~knowledg~e as I think we MI ,lo I~lt ~ 1~r~ 18 }~ ( ~erenee in the brady ('h(51lds[r.~r ~!ltd all i)[h(:i" l~eiol'fl amm/g our populal&m, and eei'tahfly I think i~ could be fOulqd that 8rune people, ~ho ]ivrut to re,.5 adv01med age, usell tobacco over a long period of time, perhaps, ewm h~avily of it but in order to measur~ it, as we do for life insm'a~{ce, of ~1 J] },Ill'hit t~lsl!, Yell have to take a wl?o]6 group of people artd compare them arid th~n find m~t the digelenee on a groin>, m' mea~ ratio, ~rul that is what I think has been proved in the 118~ O~ ~ oh}lore CertMnly yon een'l, pi~k out A arm say, %~ w~ll dle iust beeaus~ he uses tr~b~ero," as he naav rmt, IIe may li~e a king time. and to that extent~ t will agt'ee wit]{ the Senat~r~'stnlem~nt,

18 CIGA~ET0~E L~LiNG A~D ADVERTIS]~G We ~an%, at this point, precisely say which indi vid~ls arc goiter" fie be ha.Tc~ed and which are notgL oin~ t~ be h~vmed. Senator P~so~. Sem~t~)r whenyon spoke of advE~vllsin~ ~ud men- tioned a popular singing ~roup from Grea~ ]d~.itam and their endorse- men~ affeetm chfldrei,.didtheSen~orhaverefet~,metotheBeaties? Senator ~0ss. ]L wn~ *~fe~i~g to the Be~tle~. SeImtor PL~RSOX. I don% want to be glib about a serious sub~ect, but f t m ght ~ffcd h ldre t I we Id say to fle Senator many adults would s~op smoking i~urmdlate]y, Scltat or ~foas. I apl0 Jecigt ~ the snggesdon. [Latt~ht~r.] The OHM,~-. Does the Ssnator from Michig~m h~e ar*y question,s ? Sea~t or PI~T. Th~nk you. The C~A~}~A~. The Senator from lndi~lu~ ? The C}~r~aN. Senator ~euborge,r, do you h~w any que~iol~s? Senator N)~t~(nnt. Mv o~:n s~telnent wJ.]l eo~er home < ues~ions but I would lik~ t~) comment on some of the t]dn~s the Senator from ]Kentucky said, I would like to answer at thLs time snd say the mot tMity ra~,io that the Seawater from Utah ref(g~ed to, which a lot of us use about the pro e~tton of ~hose who will die. is well doculc, rmted h~ o~r a~mokblg ~nd Mex-~l~h~ report here ~ ~h~ elaborate mortality ratio on~o~aae llg and p a~e 11? , and in mv o~ n stl~fement~ , l will ~nswer some of it. 1 ~ st wanted to skt e Senator ~rom Ut)D o e question on ps~e 1 of hm stu~ement~ when he says in the fout'¢,h paragraph: All toe, many tt~.nag~rs are takhlg u~) the cigarett~ ]2ablt in this ~o11~#~. Without putting wm'ds iD your mouth~ 1 just ~onder if you think mayb~ th(4 rea~'o s t a~ ~d~t'l sing s appea g to ehe n! Senator Moss. Yes) I do, Senatm' Ncuberger. X think advertising has bee~ geared to glamorize (~[ltoking~ arid yotm~ people l/ow~ as they have done, and 1 suppose will do forever, g~ alLxiou n for thin growing up prOcE~. Tht~y wan~ to Rrow up and they want to 1~ mature and they w)mt to beglamomus.~ and if it is suo'gasted~ to them ti~t this is a mark of l£tatlll'ltV aitd ~lalftOl'~ why then thtw ~l'~ ell~Ollr~t~d ~¢) ~flh(~ up the ei~arett~ habi~ " " Sertat or N~rra~. ThaDk yOU. Th~ (~.~Z~AN. 'l~xe S~nafor fr'~m [ ~nne~e~ *~eDntor ~)ass. Sonaf~r~o~s,(]ovoulo~owo;Yanvo!heruroduotrcv7 ~n he American m~rket t}~ should come urtder this samo t wf>e of labelling scrutiny that is dangerous to hea~th Senator Moss The examp es I wo ~ d pont to are primarily h~ the drug l%hL [k[a~v products are ~aheled as being deleterlou~ to h,eMth. ,~ome a ,'e lnbele~ th~'t cont~r, uecl use would h~ b arm~ll. ~o I th; tk we hnw already moved late tlat arE~ Senator B.~ss. I wan refe~dn~ to products that we .~e for sport, ple ~sure, luxury, and this so~ o ~ (ldn~. Senator Mos~ %Vell, it is halxI to dr~w the lhte. I can't lhink of ~nything aa eomvton as tobacco, that is, in cou~non ~me~ as t~b~ceo.

CIGARLV~TE LABELING A~qD ADVERTISING ~9 Senator Bass. :Do you inteng daat M1 tobacco products such as snuff chewing tobaceo~ p~pe tobacc% cigars~ all types of tobaeov~ be hbeled as harmflll er just clg~rettesi Senator Mess. Ths b ll s confined ast to c garettes. Senator BASS. Thank you. The CH.UR~X. ~V farther questions ? Thank you, Senator Moss. I appreciate )'our coming and giving us he benefit (~f your views. Senator ~[oss. Thank you. The CnAlu~,.<~. ~ ow~ Senator ~euberger~ al [hough ~he i~ a member ~1~ Ilm ~u)mmlttce~ be, s bed ~ very deep ~:n~l ~:bhllr~g i~dcrcst in this matter, and inasmm fi as she has one of the pieces of legislation before the committee and has introduced )reviously other legislation hi this fie d, she wou d like to make a short statement for the record. T ]ei~ of com~e, later on~ the commitvee e~n discuss parts of her statement wlfh her. I don~t f hillk the committee need ask you questions about this, because I presume we ~ii] have some discussions about this mf~tter later, within ~he collllll]/l~H% S~nator N~e~. l~fr. Chairman~ the issue is quite simple: Will Congress finally move t~ implement the conclusion of the famous 1964 Surgeon GeneraPs report that.- cigarette smoking is a health hazard Of sufficient lml~ l't once ha the Ultimo(1 State~ to w~rranc appropriate rem~tia/action. There a~e two bills before this colnmitt~ wl~ich cvrna under such a category. S. 559 has been introduced by our able ChMrman, the senior Se~mtor from Washiilgton. hly own measure is S. 547, th~ Cigarello Advertising aud Labc]h~g Act, which was first iavroduccd i~ tile 8Sth Congress. I welcome the opportunity to m~ke this brief sfatemcnt as we begin the hearings thi¢~ mornin~¢,~ ~lthough I anticipate adding substantially t~ the record as the hearmge p~g~ress du "rag tfie week. S. 547 has throe m~h~ )revisions : 1. I{equ rcs tha~ each cigarette package contain a I ~ ~rdous h~alth ~:~ ar lllllg, 2. By requiring that each cigarette package disclose fl~e a¢-erage tar and nicotine yields, it attempts t~ stiranh~te competition among the cigarette producers'to reduce the lex els of these incriminating agents. 5. Requires t~at eav~ cigs.retto ad~rfiselnent eont~in ~ hazardous- health warning. These thr~e steps are lhe nh~lnta m~n~ml~m that we c.~ ore/shier as effective and me~mingful "]~medial actions?~ The public interest requirement sar e obvious. There is no longer ~y doubt that cigere~e SlllOkel~ }nLvo }/ higher dead~ rate tfiau r, ousmokcrs, Th~ Ameril~l~/l Cancer Society th~ Ame,'ieau Hcar~ Asso~iatkm the X~f hlnal ruber cu osis Association the IT ~ Public Health Service, all decla~ that • 2 .~. c~gerette smoking ms casually related to disease and ab~ormaUy high death rates. Tfie issue has moved from defining the p~ob]em, to what to do al~Jut IL S. 547 lS cIe,~rly a compromisl~ Cig~rcLtes~ ~f[ m. ~11~ are fialn[ u*~ltmg stimulale disease a~ d finally are de¢{h dealing. I receive ma~,y eom- -~aun oct one each week asldug for c]ga,~ette prohibition legislation ¢>r

20 C'IGAI%E~fE LABELK'qG AND ADVERTISING at the very least ~ eompIete ban on cigarette udverilsh~g. I lmve t~ jeered these counsels because l believe in i. m abililv of the American eople to make intelligent decisions when glven ~all the f~ets, and ~cause a complete Government b~m on cigarette ad~et'tlsh~g clouds the issue of free spe~dk, Tborefore: I hRve tlll~llBd to heatth-h~zard w~rning statements as the tin>st s~is factory middle ground. l lmve .sl one additional point to make at tiffs time. Often I be~r i~ said if w:~rning statements are re dlred of eigai~ttes, what is m stand in the way of logic I~Ciulring s'u~ statements on ali other products which can also be hazards to health, such as aut~irtobiles, p}t riD~ knive, s, and aspirins. Surel, the point here is tlmt neither the aulomobile, the paring knives, nor ~e aspirin presemts a hazard if u~ed in the manner in which i~ is normally intended to tm used. But tbo one-hMf to one- pack a-they smokm (ira moderate smoker~oe~ subject hnnself to considerab]e hazard though he utilizes cigarettes in precisely the trmmler envisioned bythe c!garette comm~rmals. Such a speciM ease demands special ¢onsider~tlon, stud tlmt m wh~t tbe~a hearmg~ are about. Now I would like Load& since we are talking about other rlfirJgs tha~ might be harmfut to health if used excessively, in reply to tim Senator from K~ttucky quotlng the use of sugar a~ referring to the effect it might have on high cholesterol count there is some evidence ~mt cer fain foods may increase ~he icy'el of ebo] est erol in the blood and Lher~b ~ seriou~Iy e~tdanger the lla~ltl~ of the e~ter. Ho~ ever sxmh evidence has net, to our knowledge, i'~aehed the point at wbic remedi d action by this Commlss on weald probably be War ranted. ~re are aware of no counterpar~ to the Surgeon GenerM% AdvismT Oommitte~ on Smoking and }Ie~lltb width has found butter, eggs, or ~nv of the other COll~Yton riek foods to tm go h~zardous as Lo warranL~ in the Advisory Oom,rittee's words, "rernedlal aetionY Should it so~ne day be established that ~he amtsumptgm of any of these foods is as dangerous as cigarette mnoking rcme*hM a~ion by the Fedora Trade Coi~aission, Department of Agriculture, or some other a~encv might be appropriate. We hi/re, ho'.levez, a number of dis- tmgu{~bmg factors in additkm ~ the basic difference regardil~g the n~tur~and wei~]~t of tlme~ideaxcelinkin the produe~ to d[ co,sound death, as bet*~e6n cigarettes and rich fo~. Olgaret~ smoking is h~b~ forming; it ~s.pe~udlarly attraqL~e ~o child~*n and t~nagera and cigarette ed ver Lml~tg has been lxtass~ve and {~l} rl f i IXUIIllB 1Hal du!, ~or ex~ullp~l egg ~dveItislzL~, Ti~ank you very much. The CHa~A~. "£ha~xk you Ik~r s. Neuberger. I think before we proceed ~y fm'ttmr here, you mentioned ~hat is "C~,l~sa!ty" or "c~eually" which ? Senator _N~s~ilo~tl. I s~y "casually. The repose s~ys that. mgarette smvklng is "casuslly" related to luug cancer. The tJ~:~R~Y~KN, Cf~gl~lt~. :kS ]o"g as we ha,~e e.stabli,~hed that, Senator ~foRTON, ~[r, (~halt'lllau to ~0 lla~sk OD sug~r, ki ds eat ~mdy, too. 3f~3 I have permission f~ put this article f referled go m the reez,rd ~t !his pomt~ 'Pha CI~alR~r~-. Yes, w~ wl]l p.I tl±e arile]e on SUg, Lr in the record, wMmut objection.

CIGARETTE I~ELI~G AND ADVERTISL~G 2] (ThB refslTed to article h~llows :) A KILLER 2N THE ~UGA~ B01~'L? (Ry peter Norman, To.rite Star Syndicate) LOxDO~. A killer stalks ]3rltuJu and cut~ down more tha~ 100000 D~Ople a year, maa.v in their l~riYae~ E~al~ (]isectse JB Lhe IlaJJon~s NO. 1 killer ; ~L ol2~- ranl~s eves canver. This is the de~e~ tlve s~ory vf .~ i,mn ~ he pla~ cxi a hunch ; a scientist ~ho cast skeptical eye~ on a theca y and f~und i5 wanting. And now pI~fes~or JohR ~udkhl, who he~J~ l]le depargme~t el nubriLiun at ~ondon Univepsity, believes be has folmd tee dletary a~e~L which kills 1~ ~im~ more D~ple in BrJt sin every year than d[~ on fhe ~oads. ~fhis ~]2er sits on the dining ~able 02 (.ve*ry home; it ]~ks inoffensive but Is capable of giving a coronary [Vh~, pe~*son who reaches our for the ~k~ar bowl to add tw0 Spoons t0 a cup o£ tea does so st his own ]peril. ]'h~ ~tory really begin~ ~me 10 yel~rs s~o when ill~}ieal science sluiced to ]oo~ ~or ill@ ~l]~ of ~h~ Jnei'e~iR~ incidenle of hellrt ilis~lse* A e]~c W'a~ J[oun(l i/1 nc~ticm~qde statistics on fo#Kl. The only dpI~r~ll[ rise ill eOllSlll~I)t[~)ll hml been in fat and proteins. "Ah/' said the scientists, and se~ abou~ relating this con~u~nptlon i~czease NI h~rt disease. ]n hls WOrk as a nnt~i~]o~ e~ p~, ~Ddkin was o~t~ll asked to comment about the /he~y ~e a~sess~d the evidence and feun~ it "[e~s rhan convincing." recen I]y ~,t }u his of%,e al~d be !old m~ how s~ar c~me into the pk~ ~r e. "In 19,57 I thllu~ht il worlh~hHe ~o ~ummar~ze hi a ~pcr ~he pl'(*s a,ld ~iis e£ the fa~s Lheor~. My main con lus[on w~s ~ha~ ~her~ ~as li~le evk]imce ~r the invulveme~g ~f fat or any oLher dietary ~lls~i~enl A~ far as th~ gt~tistlc~ were concerned, I 0oinked OUt tha~ ~lere ~a~ a slightly bett~r clue to be found in s~gar e~nsump~ion, ' he said A shorl tir/~e la t£,r he became more interested "The real dietary ~h~nK~ ~n ~he we]l~ff ~u~t~ies has been i~ sugar COn- smnvthm," he said. "Coupled with this is th~ increase in protein, ~t is often t~Uld ~hat the weal~lly ea~ less c~rbohydrate~.: ~hi~ category Jnclud~ sugar. Alkd ~l]S IS wh~l~ I ~illk e~he f~(~8 ~heozy ~rs~ went wrol}g. If yo/~ h)~k fll ~he s[atistic~ for the affluen~ c~untric~, yon wJU see that the co~umptlon of eart~ hydrates is comparatively sbatic. Buk th~s eonceal~ the koy evidence. There ~re etwo subva~e~ori~.~ in carbohydPa~¢*: s~arch and ~uga~. A closer lOOk a~ th~ Statistics SHOWS ~]~lt sugi~v c~n~nm]btioD ha~ r~sen while there ha been c~rre~on din g fall in starches. But when the es~bohydrates are lmnped together, LRis £~ct is masked. "What ii means is tlmt lea now e~t less bread and l)Omh,es and much more sweets, puddings ai~d chocolaf~s, and sugar in ollr tea alld Co ~'ce.~ The professor WId me that evenc'one in Britain now eats a quantity of sugar in 2 weeks which 2~ years ag~ equalled a ~bole year's consumption. "~wn I realized ¢h~ f~ets about sugar." said ¥udkin, "my atli~nde t~* the fats theory began to chsnge fl~om negative to i~lsitive. And then in 1960 I rea/~ a vmy interesting report from I~rael, Many Je~ish people bare left tile ~'el~o~ ~nd have settled ill Israel and when Lhey attire, they have Iittl~ evldenee ~f ('oronarie~. AIId yet in the ~emen their diet was nigheSt entirely made of f~tty foods such as mll~ton and butter If tile tats theory ~as correct, they should have all been Iaid low, "lint after 20 yom~ m israel, the Yemenite Jews show j~st as high a propor- tion of heart troubles as these who have immigrated from the %'est. And the o~ly raaJor change in their diet is sugar" It was at this stt~g~ that the pro2essor started to ~hLnk aJout a research pro- gram. ~/1~ he lied a har~ time, raising tunney for ~t snd ollly ~fter much e~ort and disap~)inting results in a;)ptvachlng Government bodies ws. thoro ennugh to start a three-0~enged lures tit..a tien. "Two of the sttldies are still ~oing On," said ylldkin. "~1 tile first we are eond~leting expe~ments wi~h animal~; secondly, we are seeing what effect sugar dietary changes have on the human body." I~ was in ~tle slmrt~erm experfTrlent ~hat the profesSor got the revol~tiormry retail ts that have startled the l~ledieal w~r]d. He and a research assistant spent 3 months prt~arJng a questionnaire which was then presented ~o two groups of men, In one group (all ill hospitals) were those suffering f~ (~)naries. In the other group were people (eomparabIe

22 C~QAEEITE L.4J3bILING A~,D ADVE~'Iff~f~ in ago and soeiat backgTound } l~ hospitals far ~ueh ~hing~ &S broken bpne~, but ~therWise hea]t h~L 5~e plmfessor t~kea llD t~e story : ~'~ qlle s t iouz/exii~ Wa.~ designed to Iilid ollt the ~ng~r conSUllll~t lo]a o~ botll gTollp~ al~d I ~onght We would h~%ve to go thrlmgh as ~many *'IS F,A) h~J~re ~hel~e wolald be aI~ t'ee0g]migab~ ~ret~d. l]tlt by tJ~e time W~ had intervie'~ed 25 Of Lhe men. it wa~ obvio/l* that ~he Ones i~ hospitnls with hear[ diseas~ had for m~l~ y~ars taken large qoantlties of ~ugar an~ ~at tile llati~l~r~ in the o~her group took ver~" little." I asked what effect sugar ~as on the body. yildkin ezpl~iu~ that sugar and starch become gluc, ose~ wllleh i$ ai0~l~rbed int~ t~e blood. ~he glueo~ con~n~ Of th~ blood rises after every meal," lie sftid. "~nen y(m take o~dlllt~ry ~ug~r~ the sll~eal of ~is~ is ~oI~ rrll)id thaR that ~of starch¸ When there is g ~lse o~ blo ~KI ~uc~e, the l)allt.t~as ha~ to prodtl~o morn ~n~tlI~n ~o koop the ~tlcose level constaiiL On~ l~vp~hesis is that when you e~n~t~ntly ~Lild sllddenly al~er the gluCOse content, the DaYlereas is o%-er~.orlKtd~" Already ~ldC[iDona] i~forlnn~inn is flowing in. The ~tt~si of ~allga~,yik~t eat mea~ and t~rihk hllge qlmntiti~s n~ milk, yeL lher~ is iLo evidellee of ~rona~es "Much renlaiD s to lie done" ~tld ~l]dkln. "~h~ first tiling will be ~or other p~o pie ~o confilln ollr ~g~ ~n~ ~en r e~eAr 2h ~tnd e XDel~Inellt $ oil ~ wide ~o[it will h~lve ~ I~ car rl(~l out," ~qi~iihcan tly, perhaps, a ~nmber of no~doll r ~L%llr "1 lit ~ now provld~ both sugar ~nd ~cc h~rill on t~eie tablns. The C]~[AIR~AN. The ncxb w~tne~s we huve is Dr. Lutker L. TErry, Surgeon Gcner~J] c~f lhe U.S. Public fIealth Servic% Dep~mnevt of IIea]th, Edu~:~tion, and Wclfare. We uill be gl~d to he~r from you~ Dr. Teri.y. Dr. "l~a~v. Thank you~ sir. The CH* ~ax The people 5on ]moo with yo~ az~ welcome to come up to the with c~s t~ble. Before you testify Doctor. I want to mt in ihe recard Secretary Celebrezze's letter ~l{ich re]a{es sl~cificMly to flxe~ legislatlon~ together with the comments of ~he e~ther ag~ncie~ witb ~e exception of the Federal Trade (Jommi~i(m whoa~ e~]~llr±ent8 wed WL]I p ~(~ ill flhe ~e~Dr d when Chairmun Dlxon tesIXfies next Monday. Dr. Tsaa~Y. Yes sir. ( The letters follow : March ~2,1965. II~,n. ~'&l~xExff G. MAGNL'~O~, Chairman, Oawmittcn on Co~n~e~'oe, US. Seaale, Washington, D.~7, DE£~ ~I~. C/XAI~I~*~ : This is in response to yaw- reqeeat of ffauuary 18, 1965. for a repor~ OIL S 54;, a bill "To ~fer upn ~he Federal T~'ade Commissien the power and ~UW to rega]late ile advertising and labellng of c~arette%" and your ~.qnesc of ~Pc~llaI~ ~, 1~. ~o~ a re;;orL on S. ~, a bill "To reg~late the labe]h~g of cim~ rettps, and fvr o~her tmrpose.s." b47 (the proposed "Cigar~lte Advertising and Labeling Apt") wou]d wst in the Federal Wrado Cnmnxissior~ resI~nsihility to establish standards for ~he Labe['ug and advertising of cigarettes neeassary t~, protect the public health; SUCh standards would, u~(ler the bE1, be esLabllshed witll the cooperation of ~hls Department ~ese s~nndards wool~ inel.de a requir;*men~ that each package or container o£ ei~ret~es bear a cleat' ariel distine~ labe± ctm~ining ~he words, "(]su~in~ttbltllol ~mokin~ IS Injurious ~o ~ealth" ~noll labol mus~ furtlmr s~ate the a~erage yield, or other index, of each incriminated a~en~ (defined as ally sub~tance fouIld in cigarette smnke which, as determined by the Col"mis Slob. tends to e~,tribure to the rnc~ival hazard of ~oking} in ~uch eigaI~t$~s. Cigai~t [e adver tisetn~nts would be rvquired to eon~alll this warning : "Cs~rien-- Hsbitlml Cigar, tie, ~mnking Is lnJ~Jrious to Ile~lth," ftnd the Comlni~sion*s S~al~t~a~s must "provide for ~he elimination o£ all ad~er±ising matter ~luch D'nd~ to make cigarette smok~g attractive t~/ ehihlrez." The bill would DrO

CIGARKRTE LABEL~G A%~ ADVERTISING [ fl~dtngs ~md ~ ~ t~e ~rt." "J~i~ ~ ~tmt has a coupled ~ed t~ *d~ry ¢ommit~'J ~por t ~ fi~ing~ ~ment. M t~ major F~e~a/ vge~y ¢~rg~ wlt~ the p~t~Uon ~<. health a~d ~ the a~nlni~t~ator ~ Lhe F~. Dr~. and Cc~eti¢ i~er~ ~L~ard~us Subtracts L~.Ling ACt. ~d o~er (~w~er p~ ~gt~tlo~. believes tY~at ~.I~g end ~vt~ ~g ~h~uld; in general. ~rve a me~t~ ~ lde~L~cat~ ~md ~ket promotion of a product bnt the ~nter~t o~ honesty ~nd fair des~l~g, neither mbdead n~r fs~l c~v~er ~ i~bf~rma~3~ cence~i~g ~e pr C~ ueL th~L ~e ~eeds i~ o~r ; ~m ~vtorme~ dcc~m. 1~1~ ~ ¢~ect~ty ~ where the p~duet b~ a ! f~ h~rm. ~ ell ~p m~ SO wh~ ch~l~re~ ~r~ young pe~]e ~re not ~ar~ the rl~ ~ t~ who a~e t~st. sl~Ce the he~[t~ Ji~.~ ~n ~pv~pr~t* ~l~de~ o~ t~s~ ri~k~ iD i~orm~tion to the c~no iWe l~]ieve. ~'~ther. that n~t only ~eclfle warnLqgs, bur al~ other r~. ~s to pve~ent mi~.ading e~n~e~t~ or o~ J~ ~u~ pro~otio~/ w~ld hetp to ~.~d out o~ e~'o~ by way of p~b~ie ~nf<~'m~t Ion ~nd n to L~p~ u~n t~e public the hater,s ~f ~mok~ Thf~ ~ Tm~- ~e In view of Lhe ~ct~ fact ~]y ~nifle~t ~or young T~p}e~ ~t~ [~ t~e ~dvi~ory commit~e's ~OT~. the "overwhe~ing ev[de~e i tb~t ~mk~g--xt~ be~nning. ~abit~mt~ a~d ~siona| disc~- ~--~ to • large e~t p~yc~oleldcaJly ~md ~l~v dete~." F~de~J Tr~d~ CommL~m in giving uo~ic~ of propo~ t~de r~gu. ~ ~" the adver~l~g m~d ~be~Lv~ ~ cLgarettes : Cc.mm~on ha~ ~ t0 believe that ~ucb cm'r~t adve~dsin~ b~ag- or portrays ~tte ~k~vg as ~n~ I~ea~ble or deS~r~bk% c~m. hie w~t~ phy~d¢~l health, fl~ or wPtl be~. or b~d~p~nsable to ft~ o~ development ~d ~ ~cce~s. ~t~u ~ at ~P ~ame ~me remindir~ ¢~m~m~ ~f ~ ~ei~ h~tl~ h~r~ of clz*r~.e .~mki~g. Such ~t~g m~y ~-eate a ~l~gleal ~d ~sl ~rrier to the ~ ~c~ vn~.~mdi~@ and ~p~iati~ ~ the gr~tT o~ t.he rl~J~ to ~2e enc~u~ged by. a~L ~lcem~. the cur~mt effort o~ the Industry ~t I~flon. as evlde~'~d in t3~e Cig~y~.t~e Adrertising Code a~ ~po~ by mufac*m~ which ~ ~over~ ~bel~g ~<1 which L~el~d~ a ~t~me~t o~ ~da~ tyat ~v~glon~ for el~r~<~ with ~ ~d~ ,c0~e ~mtnistrat~>r by me~rs ~ the vo~ntary ~v~em. ~d for T ~lon~ Zbnd puberty ~y ~ a~i~tr~r ~i~ vlo~tor~ ~d~ . ~'e he,eye ~t I~ B~te vo]~/~ry ypro~.ra~l mi~t offer ~ reA~- lflon to ad~rt~s~g prob~m~. ~d we support efforts L~ tb~ directs. . howeve~ t~t the ~ code. though progressive ~ a n~mb~r c~ ~a~]ingw~.. ~T written, p~ted, or ~aph~c matter ~p~n or acct.. t~e cvns~w~ ~c~agv a~d ~ayton~nd ~o fldverti~i~g (o~hpr L~ I l~ 1~ wart~ #~. With ~ ~ label~ we bv~ieve, for ~e ~tt~ below, the* ~t~c~ ~h~ ~ ~na~t~ to reg~llat p tb~ l~t~ling ~tt~. ~ that. ~ffi~e~b~. this ~o~ld bc do~e by ~ay ~ app~prla~ ~err~ln~fion of the sppr<~ete ~eie~ m ~ c~sr~d ~th r~l~fl~ I~]d ~nts a d~c~t q~t/~ WitJ~ou~ qu~oni~ in any ~y ~e c~ tt~ F~eral ~rade C~mi~i<~ t~t the faUurc to i~clud~ ~tte ~e~|th.rt~.k war~lng, o~ the inclusion of ~r~in c~im~. I~ e]~ar~t~. Or ~d~R con~iLut~m ~ ii~l~w~[ tra~e l~actl~- ~er the ~.~e~l ~m~lc~ Act. It ~eem~ ele~r t~at ~A~e obJC~v~ bore invo]v~L i~ the ~ce ~ th~ ~e~l~ fl~ ~ere to be alone de~rmiv~tive of the pl~ce w~r~ ~to~y au~bo~y t~ a~m~F*h the obJ~<~ive ~hG~d re~ it ~O~dd t~t t]~e ~ntbc~y ~bc~d bc r~I~ in ~!~ 1~r~n~n~ At the ~wp CIGAI~.~'~J~ LABELE~-G AXD I~DVERTIKI~'G 23 • "~d~ t~aL a~y d~c~t te ~¢ka~ or ~n~er or aDy m d~er t~m~t o~ ¢~,eJ~ t ~ wbleh ~a~ts to ¢~mF4y w~th ~ch L~b~ILu~ ~d adverti~iv¢ ~tand~rds PJ~s~[ b¢ deem~ a ~I~ ad vet t~eme~t of drd¢~ ~r ~ar!w~ ~ m 12-15 ( W~mek, r- Le~ m~mdme~t) of thP F~deral Trade Cor~mh~doo ACt, and the ~u wv~d h~,~ t be ~foR'~ee~ snt~rltY~ItY 4n rmp~¢ to a~y ~Rh Cake *dw~e- ~L~ a d.ve~'is~ng of f~,d, d ~g% de~, a~d eoemetle¢ S, ~ (the l~opc~d "~de~1 C~g~P~e ~ A~~) woo]d ~ It ~- l~d to m~¢tQ~c~, L~port, or ~ C~ for ~a~ or dia~dPmt~on ~In the U~ted ~mt~B ~ fox s~Apzce~ m U3. ecL~t~L,~ ~ ~si~l ati~ ~ o~ K~ore-based ac'.3~ttl~ w~*~v~" Io~t~.. ~3c~ the p~ is prominently Ced eo~leu¢~a~ ~ ~ t~e words ~a~Jng: C0mlnual ~mokJmg May Be Ha~a~o~s tn your Health,- s~d wl~h a stffit~m~mt Ot th~ ~r~e tsr and meotl~e :H Pl&~ l~,r ~ (as det~mtn~ by t~P C~mbx4d¢'e fllte¢ mel~o~l Or ~my othex method ~ appro~ by thP NationaI BUI~u m~y be ~ c~ ef~-t~e labe~ ~r ~e~g by ~y Federal ~ ~ VioL~tIC~ o~ tb~ bUl'~ ~o~l~I~s wc~ld be a mL~eme~uor pnulshable by a ~on of the &tto~Bey ~ thrOUgh the appropriate U.S. altorney, ha~ Juris~etlc~ to pP~t aI~d re~trMn vlo!aUo~ o¢ the bt!L Tbo bill would tak~ r~e bmde ob~tiv~ of ~e~ ~lh~-fa/r warning of hen/l~ rlsks ~* l~e pros- pe~Ive ~ o~ cig~ttes and, i~ ~e e~e of S, ~o~7, eUJ~in~t~c~ of cI~tte adV~-L1s~ aFpealtng to Chi]drtm-~are ~d~ that this ~eut s~o~¢~r The xe~r~ of the Sm~-~ Ge~eca1~ ~ Ad~y C~mam~t~PP ~ SmoMng and Health e~nel~d~, o~ L~e but~ of ~long*d stuay am1 eval~mtlon of ~auy L~es o£ cenvergl~g evid~mce,+' ~b~t '~tre~e ~okln¢ Ls a b~l~h h~rd ot so~cieut im~ortacee ~n the United ~htt~ to ~t~mt ag~¢olr~tto z~l • ~on~ ( p- 3.31, a ¢¢mel¢~Jon with ~b~e~ we x'n/]y agree. ~om~ of the ~0aJor flndln~-'s ~md co~clu~i¢~s Of f~- Ad~l~ry C~mm~1~e~ on Cigarette mmoklng is at~Bc~ed with a ~0 pt.r~t ]~ h~ the ~R~speclfle dea ~k ratp~ ~" m~le¢ I~ ~iew ot th~ eo~ti~mL~" a~d mo~t~ng ~,~ ¢i~m.e fr~n m~By sonrees, it is ~2~e ~ad~0~ent of the eom~Jlttee that c~t~ ~okL~g ~on~t~s BnbBta]~tlall.v to morIJ~ll~, ~ ~rtain Sl~eifle ~B~,atm~ at~i to t~ o'w,rall ~f~ tats. In gen¢~al, the ff~ater the numt~Br of e3~;~ett~ smoked d~ty. ~e ~gber t~e C~r~te ~mokl~g ~ ~saI~v re~te~ to ]~5¢ ~m¢~e ~ ~ thp m~ ~it ~c ~t the effect of et~trPtm ~k[~g ~ ouL~elch~ an other yactor~ The dst~ for wome~ thot~h l~ P~t~ive, point in the ~e~me directi~ si~iflea~t ~e~or In Lhe eausa~10u ~ htrynlr~tl e~r In ~e ma~e. C~tte ~ok]~.~ J~ t~ roost Im[K)rt~nt of t~e ~9~S o¢ chro~lc brn~e~iti~ L~ the Uuit~] SL~Ie~ and ~rea~ t~e rusk ~ ~I~ ~r~ chronic br,nehiti.< but ~t b~s not be~ e~'~]i~hed that ~he relatic~hJp t~ ~1~l. Th~ ~mo~in~ .~J~ ]e ~g~rpt~P ~OkC~S ha~e ~ ]}igber d~th PM~ ~r0m ~.'~nary ~r~ery dl,~n~p tb~n n~l~'mokJng m~le~. .~]th~gb ~ e~tu~tive ]~le of el~t~tte 8rooking in d~h~ ~l~rn ~r~nary di~ I~ ~O~ proren, the eolDJ~ltte~ ~dct~ ~ mo~ p~t~dF~Bt ~0~ the p~bli~-h~lt~ Viewpoint to Bt~e that the ests~L.~ted a~s~- ~ittlic~ ~ ~tt~,~l ~in~ tha~ to ~1]spet~d ju¢~m~nt ~t~ n~ uncertainty EpLd~miologieal ~tudles I~li~l~. ~n a~c~ia~on b~ Cig~e~e ~nok3ng ~]0d pPp~IQ ~h'Pr w~ieh i~ g~ter for ~+~ie th~a for d~at Ule~g, 'j~be ove~vhetmiag evidence p~tut~ to the ~oncl~Mon t~at ~a~okt~g--lt~ ni~g, hsbit~ation. ~nd cc~sJ on~l dis~on~Luuatlon--ls to ~ large ex~t I~yCholo~l- ~he ~dvl~0ry COnlm~'~ ropor t w~ ~ade public on JzLnoat2~ 11 o~ I~s~ ypar

---

---

CIGARETTE LABELING AND ADVERTISING 27

28 CIGARETTE LA~LI~G A?~-D ADVE~TISYNG on Smoklng and HeolLh, eiLed ¢~e[s aod figures SOlppC~r[ing his ~*eme~ thor "mea.~rable ~d ~L~o~ir~t~ng l~rogres~ 1~8 b~n ~l,Jd~ ~uring the y¢.al%" ~ ~lr ther stated t~at "l doubt that an3¸ health mes~ag~ lms ever reached ~ ~ny ~ so short ~ time." A]~, ile commellt~(i oI1 the ~xt~2&~ive "research on th~ corn pon~ts of smoke and ~heir physiolodical e~eet s,~ being conduct ed b.~ the National ~nstitutes ~f Ilealt h, by the Z~par~me~t o~ &gvicu l~lr e 1~ e[o~e coopei~t ~on with ~he p~b~ ~ealth Service, by unive~si*ie$ a~cl fotmdations, and "by Amexiean bied[e~l ~0eLa~lo~ with financial help f2om ~he ~obae~ ~nflu~ i~elt~" In the l!gbt or thl~ b~ekgroun~, wl~ile we s~r~ngly f~ ~ov ~ece~alT or desirable l~Iatio~ ~o ~r otx~'L file health anti ~f~y of the ec~llr;ti~ I~ al~ to pr~ v~t d~eptlve o£ ul~ir l~belin~ ai~tl ad~relffi~in~ of ~m~umer prodder0* W~- Ore ,~,~ ,.euvia~d or a need for the propo0ed legislation at thl~ tim~ We believe th~L tI~ (3~l~i~'~ ill ~lo~erminiI~g ~h~ ~cl for ]eG, i~l~ti~ln ~ho~ld confider" th~ rel~edi~l actors already tak~a. L~gi~la~i~e action migh~ ~roperly await ~ome i~di~2atio~ o~ the ~ffee~iveLe.~s of ~h~ ~emt~dial action ~aken ~ntl Dr ~Do~ed ~ tht~ ~ier~l Tr ~de~ ~ommi~slon #~d by tl~e tobacco i~td~s~iy. We x~,flly recognize ~h~ t ll~.r~ ~ ~o a~ranee that this eombix~ ~ tiot~ of aet~otx by ~be O~mmis~ on an(I the I~U~tly will l~ro~'lde ~he public with suitablo warnings ~nd protoet[on. N~ver. *h~e~s. w~ feel it sll~ulel b~ given a ~atr ~Lal b~.fo~ l~glslotl~n to oceomD~eh ~'ur ther, with ~pecifie i~fel~ne~ to the provision in both S. 547 and ~. 559 ~hat th~2.r~ ~e sho~ ~t~ ~he ha~I of each ~ka~ c~ eigarett~ ~h~ ~e~'~ge 3,1e~c(~ ea~lx ~illeri~i~0~t~d agents" Or "ta~ al~l nI~otine*' to b~ ~o~nrl i~t ~he cigarette smokeI we il~vi~ at t ensign ~o ~7~e i~die ~ed ex~n~iv~ research cle~mett ii~ax'y and e~rI~ntly l~i~ eo~duct~l i~ this field. VVe do ~ot ~i~ve ~h~t it ha~ i~n ~ei~ifi~!~]~ es~b31Shcd th~ th~ reduction or eHmt~at±on c~ t~, tileo~ine, or ttl~¸ ~tl~er sp~il~¢ iJl~l~dient i~l cig~r~t ~ ~xaoke will ~,]aiflcall~ly le~ l~e health hazard~ ~ dgarette smokin~ Until there is more sl~ientific iclen~ifleation ~ct da~a ~r~ the in~l.edienr~ in cigar ~ ~mok~ w~ich ci~a~ ~i/e health h~zard ~ o~1 the exte~ t~ w~ieh ~7~e~ L~a gr(~i~ ~s ~ax u~t I~ :~el~ove~ ~o b~ ~igni~c~n~ ~n ter~s health we ~ae t~at ~y shOWing" of the yield of ~pecified ing~dient~ in ci~ vetoer ~mol~ ~ pr~v~e ,a ~e~ Of false. ~ltrity ~nd iu~d~v~y mislead, r.at he~" than prote~ eon~nm~s of ei~a r e~t e.~. IOur thor, ~uoh • ~hll~ hl~ rL~7~'~t big nicotine, tar~, or other evmpo~[~ o~ e~gat~t~ smok~, w~eh i~ tol~ub~allli0~e<J a~ slg~il~e~ ~ L i~ terms o£ healL~, ha~ b~n x~garcled by t)le Federal Tra~ ~3om~ ~li~*'i~t as an ~lnfair o~ d~l~i~re ~l~de Drae~iee and, ~a co~for~a~ty ther~vitl~, is prohil~d under the eiga refit e a dvextiM~a~ eoae of &~riI 27. 1964. X~'e have ~ aflvi~ed b~, ~be Bnr~ of ~he ~lflg~ that t~ler~ wotll~ b~ n~ objection ~ ~h~ stl~r~l~ion of r&i~ report from the ~t~dpoin~ ~ tlm adminL~t~ FJincex ely. RO~T ~. Gt~ES, Gene:m~ G'~u~cel DEI'A~TM~'~ OF A~mCXm~TUm~, Waahinglot*, D.C,, March ~ '~, 3 965 a report On S ~7, ~t [bill to eo~er ~po~ t~e ~eC]el~,~l ~r&(]t~ Co~mmi~iolt ~ power a~d duty to r~e~u|ot¢ the ttdveri~sln~ and ls b~lng O~ O~g~tr~ct~. l'nd~r the p*'o~i~llms of thls ~i31 t~) COZlgTeC~ WO~I~ ~oll~ ~ 0. li~cdl~ of ~tte~ th~ ~InI'ec~r~¢~L~d ~r omoLion a~/d adv~rLi~in~ ~ ¢igar~e~ cou~tit~ates a ~r a~ e t]ltea~ to ~e public WOl~are; (b) ci~al~ pac~a~x~ ai~ ¢igar~te fld~Cett~ng wotlld I~¢. ix~ll~ red t~ st at e : "~3aution IIa bitua i ~m Okill~ T~ Tn jlxl'iO~l~ t o I~al~h'~ ; (e! ea~ eigaretto p~liage wou]d b~ re~ii~T~d t~ ~ *]1~ av~r~l~ ymlds er in c rimi~a~e(i a~-rtt S in the ~moke o~ ~i~,~r ~t ~* eon~ln~ t~r~ii~ : &~d ( ~ ) cig~'~t± e adver~i~llg ~e~ to muk~ eigar~t~ ~moking o~t~rae~ive Lo ehil(Ii'~n wca~ld be elir~in~ted. 1~* the C on g°~q ~m~ 1~ ~I~r~I)Ii~ [o en~ leglslat~on r~la~ing eig'a~et ~e ~dv~r~Isi~g ~1 ix~!ui~ii~ ~a~ a wa~I~g or e~utio~.ry ~at~xt~e~t ~pI~r ola eig~l~'LL~ ]~kage~, the re~ui~melxt~ ~h¢~ld b~ ill ~C~ping ~t~ the fl~tdJ~%~ c~ t~o S L~u General's &dvisoi y C~mr~it ~ which ~po~d ~ g~aler td r ~la~iol~ki]~ L~t wc~ ~moking ~d health, ~t ~o~ aa ab301~e Y~lati~sl~Ip ~ egel~ L~dlvxduo]

CIGAI{E'I~I~E LABELING .~ND ADVerTISING 29 e~. Also r~o~lition should b~ given to t~e ~¢t that tho (.igar/.t~e illdll~l:r5 ha~ adopted am~ placed in el~ec-t ~ voluntary advertising code en£orced 1~ a~ independen~ administrator, With r~pe~t to t]Je provi~[c~n re(!~iriil~ St ~t~tL~I~ ~rl i~ig~ret~(, p~ek~lgoq o~ ~verage yieIds o£ "incrLminated agents in ~he ~10ke," Ibis is n~t now po~ll~le b~-~nse o~ the l~ck of k~towledge C ~ll~el.ni]~g ~ilch a~s a~ld their ~a~ ur~m~ntk A~ l.u)l n ~ed out i/~ ~h~ smoki~ and ]aea~h lvcpor~ to t21e ~ur~n ~rStI~ ei~ar~tt~ ~111~o i8 a ]l~c'ro~e~ e~Su~ mi:~t tlr~ O~ ~se~, n ~eon de~e~ v~I~r~ and l]q/~id ]~ar- tieul~.to m&t~r. Th~ nllmi~r a]2d variety Of c~OUadS in tcd~o ~lllol~e~ tal i.~ l~r ~9~o ~(~ ~lLff~re.nt co~)c*~ln~s have ~)ee~ id~nt ]~ed in the p~r titular e a~l~ gas phase~ of ~igar~t~ smol~e. The Sutton O~n~r~[, L~a h±s a0p~al~n¢o before ~he To[~a~ ~ ubcoill~itt ~r, o~ tile H~ll~ing Co~itt~ oil Agr tcul~llre, o~1 Janizary 29. 19~. said: "It is diflico it to desigIl a method of re=moving SOl)I ething if yoll don't krlow wlla t it is. For examp]e, the kIlown 8(~h~nce~ ~l~ t~)bfleoo ~moke can ~}11n5 for o~ly it is in tobacco s~loke that influenee~ cor(*n~lr2 ~lrtery dfseasr~if il~de~ed it does." The Surgeon G(.~leral's Committee on Eraokiag mad Health ill (li~ellssiog ~ss~ datior~8 and ca usali~y ~id ~ i~ report ; "lt is recognized that no ~r~ple oause-~nd~ff~-t reL~Liol~sllip is likely ~l) exist betwe~ a co~lplo~ product llke tobacco s~loke a~d a sp~,ilie di~ell~e []] the ~,ari able human orgards~a. It is als~ r ecegnized ~hat often ~he coe×iaLei~c~ o£ sever,1 fac~or~ is relll]ired for the oc'eurren~c~. Of a (ltsease. arid that ell~. o~ ~he factors may play a de~ei~nl~nt rllle; t~]at is~ wiOtotlt it, the other ~sctors (s~;ch as g~netic /~ ~scep lil~i]it y ) y(qdo~l lead to the e~eur mar~(-e o~ lhe (~i~ea so" (p 21). Th(~ Del)al~l~len~ of -~gl"Jc~]~arc, the Dei~*l~i]ilent O~ HeaJ[h Edilealion~ ~;1]~ ~'elf~]ve, the ~.meric~al~ Me~L~ca] _a-ss(~ia~, ai~d i 1ally ~ledieal schools. ]abora torie~, al/d o/~¢.r facilities have increase~l and i[l~ensili~,d their research /,f~oct6 on the llrol~](.r~l S Of [obac~ ~ Smoke a~ related to heal t/1. .~] )~ ¢11 ~lore e x pli.~it idol1 ~i ficat ioll~ o~ the COll~it ile~t $ o~ ¢~lh 8 COO s~oke a~d a naore ~mi~leto u~der~t ~Lr~d- i]]~ O]' their role as r~]aCed t~ h~lrh mu~[ be sought and achieved. ~ )l~]y this will provide an ade¢~/latc basis for de~idi~ whether or 11o¢ ~uch stril~gent prl~ision~ os those ia S. 547 art, war±*anted The fin~'l ~'oqt~irement~ the ~limLuatlon ~f all advertising matler whi(~h tends t~) make cigarette smoking attractive t~ ¢*hihlron. relates also ta all are~ of a~tivity in Which pr(~gro~$ is now un~erwo.y through ~he adlnilli~ralio~l o/I lhc vol~211t*'lry itldll~try code Standards already have b~R i](.veleped tmd~r lhe code ~0 ]3re~lUde ilre~mo~Ion &n(I ad~-er rising dir~ted a~ ]5~rson8 1111(]Ol 21 ~ oars (if "~ge, and this phase (~f ~he Drogra~ now is bebag carried out. r~he ~ureau [J~ tla~ Bndge~ &dvi!os tJaa~ there i~ ~o objeefi~r~ to ~he )~leseT~a- ~io~ of this report from tile s~andpolnt Of the ~.dministra~ie n'~ progr~ r ~ ~iY~eere] y yollrs~ CHARLES g. h~ ~:aPZ~ V AClinff 2~(~refd~ D~PART~E~T ~F A~RICUT~ URn. D~R ~[1~. CIIAI~A'~; 'rhi~ i~ In r~l)l~ ~ your req/l(~ £ur a rel)orL (~1~ ~q. ~, ~l hill to r(~lllate tile lahelin~ Of ~qgat~*~t~ alld for o~her pIlrposr~ llnrlel" th~ !~ r o~-isi~s of r~is hill, ~gRr~te~ ~.y Ilot lie nlanllfa~tllr~d. ~l~lD~r led~ or ~l~k ago~l for s,~l~ or dlq~Ibtltio~ iTi the Unitect ~t~t~s lnl]~s t]~e pael~ag~ (1) is l~b~lt~l 'lWa~llllg ; Continllsl Cig~I~tte ~IilOkln~ .~I~ly l~e H:lT~rdotts ~o YOlI~ H~altl~.*' all[1 (~) ~1~'~ ~ho avcrago tstr ~lnd ]lisotine yield~ I~or ~i~retre as deterr~iil~i ~ Lae C~lllbridge lilL~r m~511(id~ Or 0~her ]ill~od aI~I~rl)ved by the N~tional ~ure~l ol~ ~tand~rds~ If tl~0 C~ilgre~s dee~l$ it ~pllr~0ria~e ~x) ellRct legis]~ t~ll ~1 tli~ 11~ p. tIl~l~ a wlll~ll • in~ or c~tllti0~ary statement Rp[le~r o~ cig~,~ t e~te p~e~,r~ges, fl~e w0rd]llg sll(luld be il~ keeiling wi~h the ~ Ildil/gs Of the Sur~eoR ~ene~,~l~ 2t4vi~ory Commit toe whi~.h r~or t~d a general r~la t~ollghip b~wc~la ~lrlki~lg ~nd he~]~I1 IIilt Ilot all ~lb~lllte r el II t [otl~ll [10 i11 eTl*lry i[ldi¥ [dllrll eflsc.

---

CIGARkyI~IE LA~EUNG A.ND ADVEI~TI~ING 31 .~AII~N~L ~01EI~CE rOU~DATrO~, OFFICE OF TI~ DrRG~;rOlI~ Was~li~cJtvn, D II , Mareh ~, ~@65. tI~Ju. WA~REE~ ~. ~fA(~:~I~gOh', DEAR .~IR C~AI~AX ; ~i~ is in reply to your requests of J~ nnary 1~ t~ad Janu- • lry 25,196o, for ~h~ c~1 men~s o~ ~he l~ationa ~ ~ien~e l/ollnd~t iilil o~ S ~7 alld S. ~9 S, 1¢,47 is concerned with regnlati~g ~he advertising mid labeIill~ of eig~- rettes~ whllt~ *~ ~D irertaiDs to la b~ [ilIg only ~e do nl/~ ~l Lha~ the ma~er$ with which ~. ~7 a.lld ~ .~9 ~rl~ concerned ~e ~l~]Cielltly related to the r~s]aousibil[~lo~ of tile Nallon~l ~ci~nce lVo~ndation 2~ ~o make it ~DDroDriaT~ for the FollnCiatlon to ol~r comments On tile bill~ The I]uro&u of tile lIIltlg~ t tins ~1 i1 "~i~2d ll~ it 1~11~ not objec~ioll to th~ sHbr~is~iiill ~f this rel~)ri frolrl the s~aIl~polD~ Of ~h~ atlmilli~tration's Dro~r~tm. ~incere~v yours~ D~.~ ~z~Ar o11 .XcIA~X ~SO~ : Fill~her V~rcnce i~ lllade ~o your letter d~d ~l~nll ~r~~ 1~ 19661 encLosiDg (t copy ~f S. ,~i7 t~ ~ol~er 111~) n the ~deral Tr~I~ ~mmJs~ ~iou ihe illlw~ alld duty to r~ula~e th~ advertisill~ and lall~iu~ of cigarot~es~ 'l~he I~ill r e~lllir ~ ~ tiler oath ~a~k~ o~ ~ontainer in which ~i~8 re~te~ arc offc~d £or ~11~ b~r ~he ~:~llowing words '~O~llti~n Habitu~tl Sm¢~killg i~ ll[j~riou~ to Health." Tile bill als~ req~h.e$ th~ the pacl~ge ~ontaLuilig cJgal~t~ set ~rlh fllle fly,rage yield of each illc~lminated agent ~c~und ill th~ slnok~. Thl~ Dill re- <]uire~ tha~ ~ar~tte ad~,el ti~illg iDC] ~de" th~ ~ollowing wait ni~g L'~utio~lIabi~ ual fJi~arette ~Okill~ IS IllJllri~ll~ ~0 ]~e~llth," alld ~1~o reqllir~s eiiminatic~n Gf ~11 a(lvertf~ng m~b~r which Lends ~o make cigarette smol~ing II~trll~ti~e ~z~ 4~hiltlr e~l. ~l,h~ C~mis~o.Aers &re lllf(~rmed ~hat the re~ler a] Tr~ de Commission and o~]l~Lr Feil~i~l agendes have givon a ~rost deal Of stlldy to th* DrObJ~lll en~'omp~secl Dy th~ biH. The Commis~ioD~rs r¢~r-olnlnend ~n~ictment of ~r, b~lL In ¥J~w Of tlae fi~ldin~ o2 the Public liealtl~ ~ervice, we re~ammen{1 ~ha~ lines 22 au~l 2~ o~ page ~ of th~ biJl b~ strick~n and ~ha~ tile fOllOwfllg l~a ~nsertetl [11 h~u th~reo~: "(1) ~ont~in~ the fol]ow]Dg WOrd~: LWal'llillg; C011tID12~I ci~aI~t~ smOklllg may be haz~rdOllS ~ voQr h~al~h' ; ~ntF'. Thi~ is ~he same language which al~l~*~rs in llnes 18 ~nd 19 on p~ ge 2 o1' S. ~9, 89L11 Con~z~, The same w~rniDg should be su'o$~it ute~ fo~ tho ~lrds f o llo,8,ing lh* semlcoi~n in lines ~ and tl on page 4 of ~h~ lailI. The Colllmis~io lier s ha~ b~,~n ttdvised by tll~ l~nr~nll o~ th~ l~udg~t L]la[, from th~ staI~dpoint ol~ the a~huinist l'atl ou~s 19r~lgr an4 lhol'~ i8 ~ ob~e:t Ion to the su~ miss~o~ o~ ~hi$ ~epor~ to the Co~gr~, ~inceraly y~urs, STATEMENT OF El% LUTHER L. TERRY, SU~GEOH GEHERAI, PUb- LIC HEALTH SERVICE DEPARTMENT OF HEALTH, EDUCATION, AN]} V~rELFA]~.E, ACCOMPANIED BY DE. DANIEL HORN, DR* SAMES M. Rq~NDLEY, AND ~1% THEO~EE E£LENEOG~ The C~n~-~. ~ow would you ~ive the ~porter tb~ names of ~O]ll~ ~88OCi~t8S SO t~i~t she l~1~y h~vo f11(~£E. Dr. 'l'~e~¥. ~es I wiJ]. %Vith me he~ ~t, the fable on m'~y imme- diate right,, is 3h'. Tlmodore Ellenbo~en, ~vho is Acting Assist,~ Gem,~l,, Comisel fox" the I)ep~r~ment of Health, Educslion, ~nd ~,Velfare,

32 CIGARETTE LABELING AND ADVERTrSLNG O~I my dmnediate left is ])r. dames Hundley, Assistant Attorn6 f Genertd for Operations ill my immediate office in ~he Public Health Se~wic% aJld oR his ]eft is Dr. Daniel HonL who is C}def~ Special Project~ Ss~l,ion of the D[vlsion of Chronic Diseaxses. Dr. Horn is a ps ekologist ~nd statlstdcian. ~he ,Cn~I[~AX. *~]1 riglit, ws wit] be glad to he~r your srLatemenfl. Dr. /~nl~y. Mr. Chairma& and me~nbers of the committee I am grate fui for the o)pportunitv to a, ppeear before your committee today on behalf of the Department of I:/eultl% Education, and ~¥elf~r~ to dist~uss the problem of $raoklng and bealth. ][ ;ml sure I neeti not remind the commit tee of the prolonged centre vet~y over stuck{ ng and heldth that has occurred ~ci rids ~tmtry. Physlc}~ns beg~n to nofic~ the relationship of clgarette smolchlg and lung cancer as early as 19~08. Izl th~ early 1950's the shoe]dug scope and magnitude o~ the problem were revealed by two studies which have since taken theh" pla~c as el a~sie~ in the medical literature. I lx~feG of t~m*'sa, to the study by Dr~ Hammond lut6 Horn ni Lhe TJnlted States and the report of Drs, Doll and Hill ill Elll~ll~lld. In 1959 Surgeon General Burney speaking for the Public Health Serv ce in the Journal of the Amel"ican MedicM Associatiort s~Sd: The weight o~ evidenee at present impheates smokil~g as the 9rlmc'Ipal e~ioloK, l~I f~eGo~ ill the Inc~a.~ed evldo~ c~ o~ lUB~ CanCer. In 1964 10 years after the IIammond Ilorn repor~ my advisory committee l~ele~sed its report,. Durirr~ tkose Id1'ears, study after study, scientist ~*fler s~ientJst, and ~aG ~.fter fact ~dded to our knowl- edpo~,, about the hazards of smoking. /'bo ri~rs were clearly delineated and publicly )renounced time nml again. Yet the natm~ of the problem is s~h tha~ ~igareLt8 ~/l~s continued {o increase. The only ~evers~ls in the upward trend occut'*~l ]n ]9M following the Hammond-Horn report and the dr~stl¢ change in cigarette tax reeeipt~ in the first quarter of 1964 which followed r~lease of my advisory committee's l'Pport. Ix* spde o~ a l'iShlg level of publh~ i*wareness and concern, it has proven difficult for people to stop m~toking. It ll~s proven difficult also to convince young people that th~ sn]oklnff habit is a dangerous one to acquire. Cigarettes and ashtrays have become such commonplace accouter- mezlts of llfo that clgal~tto smokgig~ for many has become ~ deeply rooted hablt~ sad for others, particularly yollngsters~ a habit to be desired. ~fmleh was learned in those 10 years from 1954 to 196~ but bundreds of thousands of lives were l~eedlessly lost. Theprohlemlscle~rnow: d~arette smoking ~ a he~tI~ hazard of sl~fl~e~]t Importa~ace * * * te warr~]lt appropriate rel~ledJ~l ttCt lo][t. We c-an no longer walt. It is imperative tlial: all appropriate steps be taken to safeguard the American public f~'om the h~zards of clga- rette smoking. %¥hnt can he done? What will ~¢o~rage smokers to stop and nonsnlokersnottostart~ Puh]5o hlformatio)~ aml educallonareanrely one answer, ~n 1954 and again in early 196~ the evidence f~'om tax fi~ures sug- gests t/*at millions of people tried to change their smoking habits.

CIGAH~'PTE LABELING .4~qD ADVERTISIMG ~3 That they found this difficult goes without ssying, but millions tried, and many succeeded. ~re have been and am continuin to inform the public about the hazards of cigarette smoking. Wg are currently askhlg for $1.95 million for the fiscal year 1966 to develop an even more egecdve program. l{uJ, more than money is needed to infolma the public adequately. Warning labels on alg'arette packages and eautlonary statements m cigarette advertisements, in our opinion, would be an additional measure o~ bealBfit, Thence is evidence that the public is awaiting and expecting these steps. Such warnings could mar~-ially increase public awai~eness of the health hazard by providing concrete evklence of governmental In additicn~ the wat~fings would prevent the consumer from being led to the belief dmL the product is safe. Two kills I)~vidlng for such steps are cmTently before this committee. S. 54J the pro osed C~garette Advertising and I,a!~lfilg Act-- would g~ve the F e~er al Trade Commission t t,e re~ppnslblh~y to estab- sh standards for the labelhLg and ~clver~,smg of clgarettc~, with the cooperation of the Depar t anent of IIealth, Education, and Welfare. A requirement is inc]uded that each package of e]garettes bear a ¢ ear abe containing the word~ "Caution Habltu~l Smelting Is Injurious to Health." The label wlmld also h~ve to include a stale ment as to the amount of any incriminated agent in ~ue]] elgarettcs. Cigarette advertisements would also be required to (~{mlain the ~rarmng: "Caution--IIabitoal Cigarette Smoking Is Injurious to Health" and the Commission's standards must provifle for the elimin~don of all advertising matter whleh tends to make dgarett e smoking attractive to children. S. 559, the proposed Federal Cigarette Lzbelh,g Act would requh~ that all cigarette packages distributed in Ihe United States bear prom- in entl~- the fol]owJng label staterncn ~ : "~¥arning : Continual Cigarette Smoking ?,fay Be Us zardo,~ to Your/IealthY Th~ hiI1 also requhres that a statement of the averz~e tlw *rod nice tlneylelds er clgarette be printed on the p~ckaRv. The bilI provides that no ot~er warning requirement may be hnposed ~n c~garette ]nbe]ing or )aekaglng by any Federal~ State~ or local authority. Under this h!ll. no re~ml~tory-ageney would he charged with ils en ~oreement: rather the Justice Department ~ould be leo]red to for po]icin~ and ea~forclng compllance with the bill. Tlds would create dil]~enlt~es. For example manufacturers desiring lo comply with the reqllil~me~] ~s of ~he bl]] would ha~e no assurance, such as a regulatory agency could provide, tbat ~ts proposed label staterne~t would be ev. s~dered to comply with the bilPs mandate as to prorMnence, hma~icm, and layout o~ the label on the packaffe. Tlae has cob ecti~es of t rose bi s fair warning of heMth rasks to {]~e prospective consumer of cigarettes and, in the ease of S, 547, el{mlnafivn of cigarette advertlsh~g appealing to cbildren--~re ob jectives that our Dep~tr~ment strongly supports. T{'e ]lave several recommendations c~neerninff tim prov]slons of S. 559 and S. 547.

34 CIGARETTE LABeLInG 2~ND AB~,rERTISJTNG Each o~ the bills would r hire warni~lg labels ~nd tim wordi,,g o~ t h ese labels is speeifled i~ ~hee~l!ll~. It seems pre retable to leave formu- lation of the precise Warning required. ~0 admlnistra~ive regala~ion. 'f~is would aI[ow for changes thron~h researcJ~ or t echmcal lmprove~ nlL,~ts which mlght~ in the course of time result il~ a safer cig'arette. Su~h changes might u~til3" a re~luced warning or perhaps even it~ omission. II is ~o~]b]e ~at othcr staLelnen~s ~i~ the p~ckage or in other labelln~, or in aclwr~s~ng m~gh~ ~erve to ~egate such a ~ ar~i~g. however subtly. We would fartIl~r ~ufgg~t ~hat sp~ci/~c aulhorily be included to prohlb~t, or regalate the use of. statements that ~ith~r negate the warmng or~ whll~ no~ clearly doing so ~nd at ]east nol: demonstrably false might glv~ th~ consumer the mlsle~dlng ~mpres siam tha~ a giver~ cigarette is safer th~n others. ~o~h bills provld~ ~or a s~tement as to contents. S~ 547 would require that each package bear a statement as to 1he conient of each "incriminated agent'~ foun~l in dgurette smoke and ~. 559 ~oUld re- ~uirc a ~atemen~ as to the average ~a~: and r~.cotln e yield as m~asure~l y • s lec~ed m~hod. A~ one time the us~ ~f m~ch claim~ cau~d w~de~pr~d confusion ~s ~o Lhe posslb]e lle~l]t h fl~]ncs~ of on~ ~]gl~rett~ as opposed to ~no~her. ~'lll]~ it seelns al, ]el~s~ plau~bh~ Iha~ c~o'arettes with ~ow~r tar and nleotlne m~y pre~e~ l~ser h~]th hazar~Is~ ther~ is l?resently no proof tha~ thi~ is so. There is some evidence that s~rrnpl~ms ~s~cia~cd ~i~h certain di~e~s are les~ common in ~ho~ may d]~Iose other agents~ or 8peeifi~ ~ar ~x~mponents~ ~hat may be rela~ed to ~he ]ncidenco of serlol~s ~I]sea~. Bu~ ~ is exceedingly im~ ortant that th~ ~o~smner be warned ~h~ while such a c~garette may ~e s~fer, it is no~ safe. Anv~tatene t~s o • • '~s o rvew be ba.~esl s~nd~rcllzed det~rmmatlon m aceot~ee with re~ulal,lons, ancl should be ~tfl~ed to prese~l~ meanin,~_fu] information to ihe con~ suraer--infomaation which will allow l{im or her to make art intelli~ ~n~ ~l~o~ce. W~ wo~ld recommend ~h~ instead of settlng ~rth ~r~ the ~,~e p~icul~r ~omponents of t6baeeo ~molrc i~hal~ mu~t b~ d~scl~sed ~n the lab~J and the method of dctermh~h~ such ~ompenents q~u~ntlta~vely reg~Iatory, anlhor]ty be pro~,ided lo: decide which ~ar- t~cuI~r e, omponents of clg~re~t~ smok~ should be d!sclo~e¢l on th~ ~be|. Tl~]s anthori~y should ~]~o extend to the a~ivtieal m0tbod~ to be ~sed, ~nd the manner in which the inf~rmatio~ is prese~cd t~ th~ be a~hori~ed to require the manuf~et urer~ to p~v~de the ag~/cy wi~ information as to th~ ingredlen~--inchdin~" adclit]ves--ef c~g~,re~'ze¸ ~gencles in which ~,h~ ~tmctio~ shr~uld b~ ves~d. It is c]e~r~ in view of wha~ ~ ]l~ve already s~id~ that it would o~'evslmpli~ th~ nlatier in our opnlon ~o ~tempt ~o spell out the req,~remen~'~ in t~ sla~ .~ ~c f ~nd di,~penge a t~c~h~r w th regu afo~ alm rt str~ on. ~P'itl~ r~art[ t~ ]~dn~l~i~ n~gu]afiort~ ~f ~i~L~l~ {he De~r~mnt h~ conclude,.1 on balance that responsibility shouJcl be vesied in our I)~Dartment, preferably by "~'av of ~pDropr~t~ amendments to th~ Fe~ler~l Hazardcus L~belin~ 32ct o~ whic5 Mr. Ch~ir~nan, you ~r~ Ih~ aul~hor. 'fhis conclusion was reached a~ter ~on~idera~ on of tl~

---

CIGARETTE LABELI~'G A~D ADVERTISING AR even greater consensus i~ found in respo%lse {D the fo]lowlng statement : There sheuld be more education ot the public about the heal~h risk eonneci~d ~th cigarette ~mokinff, 90,4 percent of theI~'PIc ~thed ugq'~ed with tha~ statement. In thorL it ~oukt appear that ~ substantial m~jorky of the Ameri- can people is ready and willing to see wanlhlgststeteraents and the tar and nicotine content placed on cigarette packages and cautionary statements inohidM in cigarette advertisements.,, More thanthat, tbey see such action as an appropriat~ and ustifled l~x uiremenh Mr. Chag'mau, cmr national study of ~ttitudes andopo inions about smoking snd heaith also included ~ question regu]ding whether people agreed ~;r diuagreed ~ itt~ tlm shdement, lha~ 13efo~e people wiR be coilvilxced that cigarette smoking is harmful to health, the Government has to show it is l~ally worried abo~t iL 76.0 percent of the people asked indlcat~d agl~mcnt with that statement. The ,assage of legdslation along th~ lines discussed here today would ~o a long ~av~ towards implementing the i'ecommendatlons of ~be ~d~isory commf±te~ tlmt ~ppropriatc remedial action }~ taken. It would al~ demonstrate our national cona~rn over this ne~ctless and co~l inuiug loss of lives. It. (h~m ar ~ I l~ e nly ¢o Jched on the h ghl ghts of tI ese,~ery complex l)VOhlems. The Department's position on S. 547 and S. 559 is pl'e~mIE~d lit nlor~ dehLil hi tim Dept~rtnle~t~s report on th~se bills to l]/e comndttee. I ~d]l be i)leas(~] t~) ~ttem )t t~) shower any que~tlons or to amplify any points hi which the committee is pmticularly interested. The C~,lln~ax, Thank you Doctor and we appl~c~at~ vent sug- gestions madt~ in the letter whicL I put in the record, el'here are seine suggested modifications in the legisl~tten hefore the committee Itlld F}I i'~ i8 3x~h }tt W~ ill*Z5 tlerf~ fctP: to ~cqst yol]F views il~ t]d8 m ,q ~tlw ,rod we ap]:n eei~te th;~t. Now, I ju~t have two or thi-ee questions and I know the committee has some questions they want Lo ask you but hi your review of public IItt ihl(hk'J~ IlL least, as rough ~Ls you ~ang{rct ]UtO the n~[~(5~" by op] Ilb}ll fOl'lllS* I1 u5 the qllesl][)ll pl~'~l~ed hl these llO]ls Ih~t VOU 1U~¢3 or Ut leas~ x'o~ hav(~ hnxl access h, about~ should cig~rette'adver~ising be prohil ited alto ether? Was that askedl Dr. Ilmtv. ~.Sil: th~*~ was 5skeW. Tim (Jn~m~N. What w~s the percent~ge ozt th a~ ! lh'. ]¥tmy. Dr. tIomt could give us the information ou tlmt. Dr. Hoa~, Thirty six percent of the publie a~reed with th~s 55 per- cent disagreed. The stateme~t was worded "Cigarette advertising should be stop )ed eompleteav ' and the majority disagreed with this. The CII~ZRX~-. And the~(many of thos~ though answered the fur th~ r (tue~lion that there should Ir~ ~ome ahang~ in the typ~ of eiga,rette ad ver tls~ng tz~ poiu~ oug Llte ha z~mt ? Dr. Iloa~. Yes. The C~ ~r~i*~-. I think tkat was in Dr. Ter D"s st atemcnt. I h'. T~:mcc That is quite clear, ~*Ir. Chairman. TII~ C,,Am~r*~. You ai~ suggesting--and, we will go into .this. furtlmr, I don% wall to belabor the pore now hat the reapons~bthty

CIGAKETI*E LABELING AND ADyEI~i~L~G 37 in regard to labeling of cigarettes, wh~l wording should be put or the fl0xibilit of labeling oh c'~arette~ should be vested in the Department of IIealt~ Education, andJ~reifare? Dr. TERar. We have suggested this ho eft up to the agency whc is }~sponsible for this. ghe C}1~I~I.~. 'i'h ~t would be your Department. lit. 'l"~g~y. It might no~ be. '1he Congress migh5 decide ofllerwise aml deMgnatc Otis rcspo~sibilitr~, to th~ Federal Trade Cormnissioa. 'fhe CTIam-,rA~-. I undel~tand one of th~ re~sons for this, "to the appropriate agency," ]~ us put it that way-- Dr. TERRY. Yes, sir. ih~ Q]IIAIRN.M% TlllS situation may ch~r±~ from l.naB te tlme and that, therefor% a legislative dictum ~s to the wording on a package might bo too teffcxibie to take care of the situations as they change fl'om time Io tim~ ? Dr. T~R~. This i~ our position, bn. The CHaze~.~ m Wha~ do•'ou oon~ider the rol~ of the F~deral Trade Conmfission in this mat~er~" I am r±o~ quite dear how you want to divid~ this r~sponsibflitg. D~'. I~am~. _\ft. Chairman f should I)oint out th,t t}ds is d~e depart mentalp~osltion whleh has been taken after c~msiderabl~ consideration in the ISepartmen~ arid it is felt that certainly, from the standlmgn of anything except the question of labe]iiag the responsibility more natur~d]y falls to the FederM Trade Commission. rll~ ~IIAII~[AN, l~h~ %1 o[lld be, iLL did lleld of ~dvmmidng and o~her T]17 (~llAiRl~lt~. So yotl llaee. Btl~gest~ therl> that to lll~t lhis rohlem to follow on out tim ob~eoL1 e~. of., tln~ lnl]~ lhttt, yfJ]] WOl~Id. ~ave tile ~del'~l Trado Oommitlon adlllnllstel" one por loll of it anti ~notl~er portion would bo adrMnisfered by the appropriate agency on l~belfiig? 13r. *]7~Rl." 1'} "s "s the suggest'on of the Depar tin.it of HeMth, Education and l~elfal>e; yes. TII0 C~l~.IIR)fa~ I /~nt to ~sk ~Ilo~hoI" quest on~ ~}ial lnakt~s Ir~r in a eig~ret~a 7 Dr, T~RKy, ~hal, m~c~ ~ar 7 The CHA~AN. ~,V]ly ]S t, llero ~1I in a el fir t~l£e. Dr, T*emy. Because of the burning o~ the lnaterlM I~ElllI$ ]11 t)tl0 forrrcatlon of t ~rs and other ch~leal eom omldt, I lie C~arm~fA~. Is there tar m a cigar, Dr. T~. Yes, sir. The C~a~ix. Because of Clie bm~ing of [ht~ t obaoeo ? Dr. h~. 'l'al~ are produced by bulTfing of m~terlals, vegetable and ottmr m~teri~is ~ir. TIle CtlAIR~AN. t)o¢~ the wrapper h~l'e gnyLhJng to cto wifh more tar or ]e~ tar7 Dr. Tr.any. %%% do not believe that the wrapper of the eigal~fite h~#~ glly ~lil]g tO do %~Jth lh7 t~l oont eDt sir. 'l_~ll~ 01I.¢IR_~&jq. Do Big~IrS }lave e~ tar t,1]axt cig~l'ette.f n l~tio to the tobacco ? 20r. T~•~i. I do not k~mw tim exact answer fol" I h~l,. The On~m~*~. Or pipe tobaoeo, you do not know ?

Clfi%~E'P~E LABELING hND ADVER~ISTNG Dr. T~RRy. I do not k~ow th~ expect answer for that 1¸ c~n prob ~h]y provide it for the record if you ] flce~ ?cir. ChMrmam The C~x~x. If cigars contain as much t~t~ and nic~ltin% why ,:lees the report ~tm( hde th~t they axe not as llaz~uslmm ~.~ cigar~it es ? Dr. ~lNe~y. Because all of the stmlles which ~vcre ~evbewcd,.com- lied and analyzed by the c0ramlttee substantia[ed these f~cts. Now ~e~t ms h~sten in add-- The ( ~raz~:~a~. I~" ould it be tfie mhalmg. Dr. TI:Rn~. Let me hasteJl to add, Mr. C, lmirnlan, that the commil, tee found ~ slightly higher overall mortality amon~ cigar ~nd pipe smokers thsn among lm.~moker% but th~ degree of increase hi either overall morta/fty ~r in ~peslfi¢ disease} entities was re*~lly not com- ~rable to the inerea~ seen assoeiated with cigarette snmki]~g.. There- ~re, tlm c<>~mnittce felt that there was not adeq,mte ju~tlficatioh to lnak~ ~ c~usM Kssocintion be~weeu the smokln~ of eig~%rs ~nd pipe tobaccos exce ~t iu e~rrMa ins{am~es. .%nd in that respect, ~fr. ChMr man if I may, I ~o,dd like to cite to you on page 37 of tile ~d~iso~w committee's report-- 1"he Cu.~z~a.~. I am askiz~g you ~If s~rving qltost}ons now~ }~e- ~-~,tl se I ~iu u eig, ~r slTtok*~r, [Laughter.] I ~m seeking fz'ce azlvic~ here. Dr 'P~mc,'. Tllere h~s been some eon~asion aI~imt~ ~lmther point in the commiLlee's report I w~nt to strMghten (,.d ~t this ~ime, if I m~y. On p,~ge 37 o:~ the C~mmittee s repm't imder the section "Cm~cer by Sil,~*' ~nd s.bseetion "Lung Ca~c~r" the first sentence reads : ~igarett e sl noking is ~l/.%al] ~ related %0 I/lllg cancer In teen. Th~ C¢~:~.~. Y~,. say causally and they say casually. Dr. Tt'mlv. The statement was made th~[ the committee reached the coneluMon that ~t was a casual assochttior,. This is incom'ceh I am citing from the eomxnitte~'s reporG it is causally tainted in view- point of tke committee. The (?~L~a~. Go ri~hi ahead, Dr: T~Y. Th~ completes that, sir. The Ca~.u~ta~:. They is on pag~ 37 o~ the report. Dr. TE~Ry. Tl~t iS right. The Cx~a~t~. P;~ge 86 a~d 37. Senator NEum~,~mc ~he 0hainnan might h~ interested in tImt sentence on pug. N~ that says~ Death rates of cigar snmkers are about the same as ~hose of n~lsm0kers fee l~lell ~,rqok ing less th~n five ci~ar S dail.v. The C~an~t~.~. I will heed that w~rning. I fl,ink clgar smokers will tell you theft if ~hev buy 10 ci~ es daib', ~hoy act:ually smoke less than 5 bce~m~ yon chew on 1hem M1 the dine, you so% and they go out M} the time. Now, when w~ talk ~bont a slalemen~ us to tar ~nd nicotineyJJeld me~surec[ by ~ specific metImfi~ how wo~Id we me~sur~ it~ Wh~ method is nr~w proven or whaL method is the melhod that you would recotnmea]d would 1)~ nsed supposlnN2 we were going to pill the meas- ~rernents on~

CIGARETTE LA/3t~LIN¢) 4~ND ADVER'f'ISI~G ~9 Dr TI:RI~I" M " Chai Tnal~ in olr report to yotl~ ~nd ill my slate- rnelqt, we have no~ reeonlme~d~d ~n}, one speeit~¢ ])roeednre. We h~-ivo reeominended~ however~ that ~he reguiatiolls~ at the time they orb dr~l~ted ~o hnp]ement the law. that tile l:egu~atlolt~ eol~.ilt st/oh .~s e¢ifi¢~tion. ~he (~I~AI/~I~rAX, In other words~ there ~re several ra~thods to detx,r mine it. I)r. 'I"~RR~'. 'rh~Lt is correct. The CIE~.~:~AX. 'f}l~t woll]d h~w. to be' emls~dl!rud furtlmr by ex- perle as to Milch migilt be tile best ~r~thod to use to ~rrive a~ the ~tll ~S wt~ llllghL ~Illl L [G [Ju[ f311. Dr. T~aa~. TIs s eomec ,Mr.(,h~ rm~m. Tb~ C~ L~ mx~. On p~ge 4, you say-- it wo~lfl ~eetn praf~t'nbl~, t~ leave the f~rmulatlon o£ tile precise w~rr~g required to a rlm~n/straflve l~g~Eat fen And I w~nt m reiter~tte tha~ and also say this will Mlow for el~anges tllrough r~e~relt or t eclmlc~d hrqproven/en t s which might in tile / ourse of time result, in ~ ,~afer cigarette.. Such cl~anges. . g t jnst fy a r~ducod war/ling or il~rha )s 112 ~llfl8 ii3 l~x/b~ f~l,el/oln 18SlOri. This ~ould allo~. ~(mM it lot. the industry to d~ ~llat I am sta~ :they ~re debug, trvii~g all methotfs of ~v~earch they ~n £md to make this afer Vl'rmldth~tl~(or~eet! Dr'. F~:mlv. '1 lnA 1~ eel rect ~na~or, The C~sx~at,~m And ~ tha~ cou d be eerie uded and there w~s that kind of re-;eareb, it xlight be more difficult to /bongo the h~ tIu~n it xveuld be to have the flexibility of regal~ing au [imri£). ]hL TI;IIRY. Tbi~l i8 fill I" ~lli8~Lioll, Slit Tim C.~n*~tA~. One other poin~ you mentioned, the hill provides, and I quote on pag~ 4 : That n~ other w/irning I,~llllir~u~¢2II[ may be imposed on cigarette labeling o¢ ,packaging by any Federal, 8~t¢, or ltteal ~u/ho~ity. The (hMr ust wants Ie make a st~tem~m~ there. I am sure h~r~ Neuberger, my~ f ~r fray ¢d us interested~ hove no intention to en- ¢~rolll~h I1 IIIH WII&L ~ ~at~ I][lfty or lfif~y 110~ w~nt ~A~ do hl tills in&trot. But we did feel that because t s in ntezstate commerce t~at t~ere might be more uniformity to aehieve the oh cerise i. n Federal law than 50 different rcgnllltilm~. Thlre are lfmnv l~',~s that ]l~ve been ntrednc,.1 i~ legis]M ures that are now meeting, due to the 196{ report tlu£ I llnd tlla~ 131itny of them have Sellt Us e~mmunicaLions---~nd Matt- rine you lnaow ou~' own State l~isl~ture is waiting for us, waiting to see whag the Fedei'al (]Qv~r lllrlell t. lfl~. el' hilly rl¢ll 1]o }11 lhiH IK~tth~r1 so that is the re~so ~ for the provision ~equh'emen~ in thebilL thi~nk unifllrln legislatlm~ would be, would you a&n'ee~ ~nueh more s,~tisfaet~ry ? Dr. T~a~*. Yes. alr. Mr. Chairman. Cet~inIy this is a nation'M ~ngtustry~ so to -;pl~k~ reg~rd[ess of wherever r'rm iu(l.strv [s l(~!ntl!d~ in terms of its distribution. ~.s 3'on i.d h~:~ied, laws trove been proposed in umny el U~e S~nt~s already. 1"here is f~ certain ~mount of f,c,]ng at least as ~osen~it fh~t rues% of tire Stales are willin~g to await ancl see whether ~he Congress is go~n~, to adept such legislation: ~nd if so, I ~hblk the as a ajor ty of t~e States, if not MI of them~ would

40 CIGARErI~rE LABELI\'G AR, D ADVF~RTISING rather see it done because of the problem of dlstribution, Cigarettes manufactured irt one State are li~¢rally distributed in every State. One can imagine the eonft,~sion that would result if you were ~*ttempt- ing to l.wc ~ different l~bcllng for the cigeretr~.s in each State, so that ~o my mind it is rmt only rational: but prae~ieal~ to have this oa rJatbll~}l] basiK The 0rr~]R~,x~. ]t would be extl'emely di/geldt~ I would lli[nk, be cause of the interstate nature of s~]e of eig.arettes and the tfansptJ~ia tion of cigarettas~ if one State had a law~ al~d say a distributor got buying cartons of ci~mrettes: he would have to open every carton arid every package or l~-" at every package ¢o see that he wasl~t in ~fiola- lion of a local law and lllis would cause, I would thinlh a great deal lit I!ln/fu~ion and wo.ldn~t al!hhw¢~ tile broad objective that we have hi tlfis legislatiol~. That. is the. reason I,sa~' it, is in ibe bilI., ~acnot her rcasoll too is that m your st atlstlcs: I h~ve found th±s, and I gu~s public opLnion research wotfld bear li~is out, mollify people.-- you ask thera are cigarettes harmful or is smokh~g harmful~ and they have said Well, I don't know whether it is or not. 1~ it was, the ~ederal Goverrmlent v~oll If] iI(i something ab~mt It. ~4 1 think tbe~ are a. ~, ~t aumber of people Iooki~ag to the Federal (dovernI/le?~c for a~l,)n~ ll ~tlo~ m deemed necessary. ~ou are a~kil~ for $1,950~000 for 1!)6(~ in w}ur' approprit~ihms to develop a more effeztiv~ pxogram. ~ha s le nam~ of tlat program ! Dr. 'l'~m~. "l~ish Mr. Chairmaa~ is a par~ of our r%nllar app~- prlathm r~luc~wbichisbeforeth¢Congr~ssat thepreset~tttme. The mLentio~ ~f tiffs pmp~d is that it would allow the Public Health Service to step up its program in terms of lbe ~:mm.d~[,iug of scion- title informatio~ and th~ dlssemh~tion <d this b~ll)rma~ion ~o tim publi% to tam medical and health professions as well as to improve the gen¢~ral overall ~dministr~do~ of our nfot~±at on and edueat on pro ral£1. ~n~e C~. Now do you uader vottr prod'am ad f you bare this 81 950 000 do you intend to us~ ad~,er~ising that is pubh~ serv~e~ advertising, to eoavey what you Uffak your conclusion,s are ? Dr. 'b~a *. I think it, is eat i~clv possible that we would on ozc~siola~ and .... we ~.re aI~dv., h~ this. ~speet, Mr. Ch~, .~vm n, o n~ somethh~g m this d~x~ct~on. Subsequent to ~ha publication of flie ~dvisor~- eom- milt~Js repor% s~ver al constituent p~r~s ef the Public ]dea]th S0~wiee~ ll}r b,stan(~ the Cancer Institute. th~ National tKeart Institute have put out pamphlets wlfieh h~ve 5,~ught out the htformation t]mt is speeificallly related to chair particular di e~se cu~egotT a~ it applies thez~, audI supImse one would call this public axtwrtising. The C~ax~_n. What I am tiff&ling about is do you bave say radh~ and television stations have a ee~ail~ amouut o~-publi¢ service time. Do you utilize th~,t at all or would you plan to ! Dr. T~R~. I do not halleve that we l(~ve ut~izod tiffs and I lcuow of no spe~ifi¢ plaits to do th~s. The Cm~r~A~'. Of course it will be up fo the individual licensees to I~ke ]t or not take it. Dr. Tm~. That is rlght~ sir I ~hir& you must ap restate, Mr Clmirman~ that there are quite" a few other organiz~t~o*m who ar~

CIGAR~I~I~k LAB}SLING A/~D ADV~KTISIN(~ 4~ vlt~lly concerned about this problem ~nd will be te~tifging befm~ ¥ollr comr~fitte~ that ma "¢or well propose this and, as a matter of fact, it is conceivable t~at ~{e Interageney Cound| could wisll to sponsor such public service advertising. The OHAIY~AN. Of eotl]T$e~ when you issue a report t}l~t has some news value, they ~Jve it full coverage~ as they did this report, in m~my, m~Jly ways. Dr. T~,o~r. Yes sir. ']['he C]],~mMAN. h~t~wspapers~ te e~ s on: ±adio, ~md al/ means of C oIfwllunic allen. All right. On page 6, you may say tha lie Con IJ iss on s andards must~ and you ql]ote~- Provide for the eliminatlon of &ll adv~rdi~ing luaLle]~ Which t~llds to inRke elgare~le smoking aOractive to t£aild ran. Where is Jhal q,mle h'om ! Dr. T~m~y. ihat is from the S. o¢7 Senatm Neuhe~gm e bill. Tle CHa]P~AX. Do you have any s~ggestiol£s as to who wouM be the ce~sor of that ? Dr. T, ,~ur. I thinkit would be fl±e agency of the Govtrnme~xt which is delegated responsibilky in II*is tlchl by the Congres , sir. The C~IAIJ~AX. Ihn ust thinking out loud and the er0y one I c~qn t Ink of offhand who can make a dee s on h~ this field would now be ~be Federal Trade Commission. Dr. T~:Pmr. This se~uns apprvprildc to me sir The CHarea+ax. i dent l~ow llml +he~ have ever tackled this la~ttter and I caner sag that I know exactly now, I h++ven't looked it up what their authority would be in this case. 0f coarse they hm+ +unffle m+thorit " on misleading ad++er+ising but this is + little dif- ferent Lhan mls~tding. l)r. T~m~y. Of tours% l am nol, quMified fo speak in this field~ but I think it is stated bg the Commissinn they ft~] they have the anthcritc7.. Tlne (2H~mXZAX, NOR don~t suggest that your Depalgment would go hlgo Lhis find! Dr, TEvaY. No, sir ; I do noL The CHA~Ia~. I would think you would have enongh I*~ do ~l[it ~mt that. Now you sa~ cigaxe~te)a es cent hue to nerease Is that bex*ause of the increase in population or is there an increase over and above in ratin to population ? Dr. Ts~r. Actually it is beth, Mr. Clmi~mmn. Over recent yegz~, there has been both an actual: as well as a ratio increase, if you want to speak of it that wa~y, increase in proportion to th~ polm]ation, the sole ex(~ )gkms being during1954 artd 1964 as I mcntinned. I thhak t wo~s found~ for instance, there was a slig ~t decrease for the overall calendary~ ear of 1964, v~hieh was largely manifes9 in the ~rst 6 months of that )'ear immediately following our advisory committee's re ort~ ~l~i(l ~IIAIII~IAN. J have Sore# questions here that you may want to answer, not in detail today, but to put Lrt the reco/~ ater One is, we know of the statistiea]'l:/~lalion between smoking and disease. Is there also substm~tlal clinical and hboratorg uvideriee of a c~use and effe~fi feint iondfip ? 4~ 979 (~5 pt 1--4

~2 CIG,~RETTE L2D3EL~XG A~D AD~RTISIA~G Dr. T~miy. I ttdnk th~ro is, Mr. Chalrm~u. The~ are stltdi~s which very clearly ~udi¢~te for Jnst~lce chan~,~ ir~ the ~mlco~e or ]inlng o~ the t rach'eobronchial t~act of ~mokers ~d this is a consistent ~ndinff. ]'heE~ are c~ller laboz~o~y s~i~s ~,iL~t imdic~e ~hBabklJty of substarl~e.~ ~b$~r~cted ~onl cigarette ~r~l~ik~ to produce ¢an~r or tumor~ m exp~r m~ntal ~hnmls. There is a gre~t de~l of ev denee ou~side---- ihe C~I~. T thml~ wtthout g~lng m~o d~d if vo~ want to it wo~ld ~ vMu~bl~ infolu~mtion~ but w~ won't pursu~ i~ i~t detail this Dr. T~I~. Th~nk you, sir. The C~.~A~. Whut percent¸ o~ smok~t~ ~eun(t their health im- paired ~ smokinff~ Do ~ lr~ve ~e~ ~gures~ ~e~ they in th~ Dr. TFmr~. ~qo~ a~ ~ ~peoifie ~t/ltement to that ~ff~t, a~ I ~ea]L I thil~k on~ of tho di~culties there. A4r. Chairman is ~}~ ~ aes~ion of Jn ~his b~'o'a~ gr~y zon~ where th¢~e may ~m v s i~ ~ e~ec~s~ of how d~e~ one ~valn~ ~ld ~s~ima~o ~he~ elT~*o~ ~ ~ha~ I lh~: ~he ~2~ thing upon which w~ can have reai reliability ~r~ ~hos~ eut~t~u]ilig ~nd ~l~r]y (~bjectiw manifestations. Th~ CJ~n~. Do you h~v~ any ~g~l~ ~i1 Ihe bamling of TV advel~i~ng in Italy and Iqn,~lar~ ~ i ~ affect~ ~ ~l~t~ ~o~2~lll~ptJo12 t ~ ~ g Dr. TE~y. Mr. Ch~hunan~ with reg~rd~ to It~ly~ ~or the ~ ye~s ~orior to. t~e ~hu9 adver~islng w~s b~med in Italy there w~ a 6 perc~n~ morease m th~ ~]~ of qi~r~s in Italy for ~ach of r]~ose 2 years. Subsequent to the bannh~g of ~dvertisi~g~ th~ fi~res show that t]~er~ w~ onJ~ o~ ~la]~ ~o 1 p~r~o~ fol]owJn~ ~Jle year a~er the ban ~ imposcd so I}~a~ we haw those specific figures ~r~m italy. Wi~h r~g:Lrd ~o Gr~ i~rltalr~ as yo~ r~lize~ it h~s just bcc~ an- no~u~oed th~ this i~ tO b~ done and it has not ~c~Ll/y ffont~ inl.o ~ffect at this ~hne. Dr. '1~. One hal/~o percent i i~ otll~r words~ b~twe~n o~e-haLf q~h~ Cii~n~. ~ lower ~m~u~lt o~ oi~nre~ con~lmq~[ion I ~us- p~ct the populatlo~ incl~ase is gre~er tJ~n that ! Dr. T~m~y. I ~hinl~ 8o but I d~n~t ]l~lV(~ lll(~ t'~x aOt ~iL~u~'es on t]~at. Th~ C~.~x~r~. By t}~o w~y~ ~c h~ve som~ students this morning ~r~m tho ~e~el~O~ gr~d% l~[ount Vernon ~cheel in A.lex~ldri% V~. ~e~r~ ghJ~ ~o h~ve you. S~n~tor~ Pas~ore~ 4o you have any questions. ~enator P~s~ ~cs i lmv~ ~ev~ra] qu~s io~. D~tor~you ]~ave r~ther strong ~llng ~ha~ ~h~re is ~ c~u~] e~e~t b~twcen smo]dn~ • nd lu rig ~an~r~ is that correc ~ I)octor ~ ° Th.. T~. Ill my mln~ tI~ is no qu~ion but tl~t ~1i~ i~ I~l~e~ Sena~r. ~4e~tator I~ASTO~m. Ar~ you s~tisficd ~h~t. this bill ~o~s f~r enou~h~ You ~re the le~dh~g h~h o~er of the Uni~l S~at~s of America. ~ou }~ conduct~ ~ very exhaus~iw ~l~d se~rchin study of this s,lbiecL arid ~aot only ~1~ you tJte leading health o~@(~i', }~0[I ~[Y~ ~euowu(~d doctor ~n~l ~ou f~ve ~st hap/~me~t,~, and suppleme~ted

CIGAREI~pE LAItELL\G ~ND ADVF, IITI~ING 43 m this cfforl b other m~dical men. Now, do you fecl flint merety pu~ting ~L c~Lutlon on a c~gsrette pa(k is going [~ spal~ Ihe lives of /~l~]erh~ans Dr. ~[EPm~. Se~lator PasWr% i thi~d¢ thLs wouhl have some effect ; alt holt of~ i t hi~k, as you may recall m my srat elnent to the committ e% I ram:legitquit~ clear that I t61d the Public llBalth Service ~nd tba De- part, lent ~r~ in favor no~ onb of ]abellng, but also of a w~rulng associat M wltil advertishlg, ~en~tor P~s.x~m~, ~:[as the nn~erlealx ~ed](:~l _~ soekllion iltkell all olilci~l p{~it;hm on eige*c~les i Dr, TEu,tr. Th~ Amerlcaa 5IedJcal Association kl~s and has not, so lo speak, in my iute~prBtation, 8enat¢~r PASTOral. Could you explsin ~lm~ ? Dr. T~m~. Se:a~o:, tl e American Medical AssoBiatJol~ h~s ac- iD ed a gi~ or a grant fl'om thB h>baeco industry to pUI~uB research ot~ this question. In addition, ilm Ame~ic~m .~Iedic~] Association i~,m issued e~ ~ s or psmphlets which have brought oat much of the sub ~t f e ad sor~. committee's report so that though they have not ioind th~ Inl~r~genc3 Council a~d though some p~ople feel that they have ~mt sicken out as strongly ~s they :houltl~ on the other hand, they lmve t akc~/positiv~ steps in this direction, Senat i it' p,~SI-ORIL ~*~el l~ what <]oes ~}t~t mear±~ Doctoi'~ [h~l ] t I~ ]la rill ful or tlmt it isn't Imrmful or that they donk know Dr. T~Y. I d~h~k dmi my interpretation fPom ~ba leafier, ~shich they have produced is ~h~t they do feel that eigare[te smoking is :armful. Certainly polls o~" ph~siciams of senior medical denrM and o ,e' / ~drh professional stud&rs haw clearly indicated tlmt t},{ 1}rofa~'~o~. ~.a whole~• by a very largo majmit~,~ lc c BB .1 at e g - I'et t e ~lFiokli is kaFl[] fu[ {o h~l[h ~nator ff~STOg~. IS smoking ia America percent~g~wise mere prevalent than i l is in otlmr coL~rtu'ies of ~he ~ orld~ ]Dr. 'I~m:r. It varies considerably. The:'~ may be other countries thttt sr~oke inort,--- Senator P~sTou~. What Ihn getting al is this. In tlfis survey tl3at was col](LneIed~ t hes(~ quest ions that Wel'~ ~l,ql:ed ~ were lhey ~b~kell of ~t]l of t}le ~11/3o ImOl}] {~ l)r. '1'~-. Mr. Ch drm~m and Senzlor Pastor% if I may, ] wj,~uld be wry happy 1o havB Dr. Horn eomiaent on this hBca~e I think. {)me backgrmmd of Ihe nature and t~pe of the surwv is of importaue0 to this commit~6B. Dr. DaMel lYmn. ]DL Hom~. What would yolt llke me to repmt on Senator P.~STO~. What I am getting at is thi~. You hnvB ~r multi ttule of questions. Number 1~ 1 w~nt to know if lhey we:'e aske~l of the ...... ~ame ~eopB T~ethi g ~m ' • sabout andIden~t want. to rhe s~un~ /~eople ~heibar or no~ advertish~g should be banned peo }le who reoogulze tha this is harnlfu]v the roll ority Stly~ }{~r ~nLaffe~lS0 it shouhl not be hl/nned. The clue~stion I ask is Ihi~, ~as thaB question followed up wid~ nm}ther ~ ue:~t,ion, why do they feel that way ! In other words, is th is ti~t up ~il h [ ['ee ~ elesdsion Dr. Ito~.~¢, Well. I can't answer whether this is tied up with fre~ televisien or not, On the basis of our prB~es~s when we wor~ eon- sklering the /liifo~nt kinds of questions ~hat e, ou]d Ko inlo that and

44 CIGARETTE LABELING AND 2.DVERTISL'4G ~ e ll~d aE opportunity to question people about what the~e quesd ons" mt,~mt, Lo IhemI I wou]~] say that tiffs was more of a reaction indicating that people are reluctant to impose bans and prohibitions on things m ~enel'a I. Senator PASTOaE. Even though it nmy be h~rmfld, cyril, lhough the2l~ductbeingsoldt!leya~reeisharmfuH Weren surl) Y[~ed you Catffmt an~ er really ! Dr, ]~o~tN" No. ~@ll~£or P~ STO~. ~lve rile a I~e~SOD ~vh~ vo i wl re not. Dr. Ho~. I am ~ot surprised bec~us~ f]mre ~re still a num}~r o¢ )mol)l~ who* are nncx~rt.uin a~ lo the degree of ]mrrafu]ne~ that is introduced by cigarette smokin . Sen~to~ P.~sroa:m ~¥ouldn't t~ be t~ue o~ the ItMtaa population ! on hgve already stated the fact here during the peri~)d of ~ ,e.ars, when it was not hamlcd, there wa~ an inereas~ of~ did you say~ 5 per~,em,? Dr. T~aY. 6 percent per year for the ~ previous veals. ,Sonator I~ASTOrC¢. i]Qien you did ban it on advot~isit~ , ~t w~s (rely one hMf or 1 percent Now with tho~e figt.'cs in mhi~ Wel, en'~ you surprised a~ aI] a~ this reaction ? r Dr. I{rmx. ~o, I don tJtmk there is a necessary concomitant. People do • g~*at many ghings that they know are harmful to them. They drive cam ~oo fast~ they clhnb mc~nntains, they do il fit sports and they do nil sorts of thin~ which we recwg:J~e ;r~tr~nr~ some element; of rhsk. 1 thh~k the ec-sential problem here is how nmch risk is introd~d and whc4.Iaer ~r not an individual has a complete unders~andlng of tlte degree of risk which is involved so that he can make his choice as to what he is to do, S~nater PaSTOr. ~V~s @m question a~ked how ma~w pe~ l~ were ~a ~ h~r Wlth this colx/~ vel~b of ~ he[her Op llO S]l]O]~ ng O~ (~l~l~et tea does or does noL attribute to hmg cancer ? Dr. ]~o~. Th~ structure of the interview wa~ quite complicated, At one point in the interview, they were asked whether ~r no~ they wer0 aware of an~ special event with regard to dxe problem of smok h~g cig~retfe~ and het~lth and many poe}pie g )on nne~usly e oned the v~por~ of the Surg~n (h~neraI~s Co~rmfittee. Those who did not memion it spomaueouslg, when they were asked whether or no~ they had heard of tiffs ~epo~ were able to report the~ had~ so that a}nmt two t ~ rds of the public evidenced an awareness of the repor~ and an ~w~*~elle&s of the eoDtrove?~. Senator P.~s,n~m¢, W]m~ *;,akea people smoke, anyway, r~a]izing that iL is harmful ? I notiseA s~e of my colleagues he{'e not'only have been smoklng~, but Chey~ w~nt evezh, bodv "~o see 6". TI e~ have been ~ d ng their hands up h~h, Dr. Ito~-. I th~k there are severM things. ~mlaror MOR~-~. I will show y(m f}u! bt'al±d, I~ ia made Jn I~mls~il]e. [Laughter.] Dr. Ho~z~. There have been studies thu~ I~ave be~ <~nducted or, why children tak~ up smoldn*g in tho fir~ plac~ and t~ere ~re a nUalber of diffe*~lt facbors involved there. Thero ar~ cultural f~tor~ of seeing so many pe~pI~ around them, parti~darly their p~rents and thel~ frlends and tem~hers, and so on, sm~ki:lg, ~ere ur~ soclo-

CIGARETTE LABELING MND ADVERTISING 45 ogic~ fg(~tot~ 8tlC]t ~ slnokiItg on the part of tbolr )cn~onM friends a t t ere are d vidua faetor~ Sometimes it is a symbol of rebM- t on but by and ,~rg% tho most important factor ~n tho tMdng up of smaking g thltt t ~s ~ s3m~] ol of bce+~ming an adult, a symbol of bo- coming a member of society in which smoking is ~mcepted as a perfect y normal tl~ing fat" peop]e to do. The question of why people continue to smoke is a more difficult one because many people continue to smoke becau~ they Ere unable to change ~helr habits wkh regard to smoking. There ~)e many people who wish to change the r hab ts and who a~,e unable to do so. Senator ]~ASTOP~, Phe reason why I asked yell the question, sir~ it is • followup to the first question d asked you as t~ whether or not wo ~vo arty fignlres as to the prevMeacy of smoking within onr An etdean s~eletv as compare~l to other societies aItd wimtlmr or not it is • llaaLter of tlmslon trlld whothgr or not ~omt~ i~ople w~mld I'at h~ rl~]lDg~e ~heir [~flSiO]]~ [I,Dd t~lke I~ ~ha[l ~e o11. earle~dr ol. ~1c~ ve f~., You gentlemen are doctors and I would like to get an answer to tha~ question. XYhat l'na~es people smoke r~iizing that indeed it ~s harmful? Dr. H~nr.~r. The fh~t part of your ( uestiqa sir there are figures avMlabla for all of the more advanced com~U'ms, at ]cast on lxdatzvo per capita cig'a~ste (:onsumptiom g'm *orr~ T deny t~all the figur~ specigcallv except that the United States i~ either at the top or very close to th% top at the present time in average per-~rpita consumption of edgtm~ttes. Senator 3'[0tITO~q. XVill the Sender yield ! Senator Mom'o~. Tkls mi ht be connected with per eapita income, t~3o n other wrests, if you ~uy cigarettes in many of the Europea~ eounlrk~s where the5, are taxed more heavily tha'n they are in this eountlW []1~5 i!oiisllmlltiol~ is down. Olle reosort dilly he ~ko cost ratio to the total income el Lht~ srnl,km'. ~ th~k anrlUeStio~ably ~xe highest per-capita consumption of cigarettes is in rids *xmnt r v and not by any means the highest incidence of lung cancer, tlowever~ M is ttul(hh ]dgher in Wale% for h~sta~ce, and parts of England and IIollaml an d other couulries than it is here. Dr. I{~L~. Tim ~x~ason that people continue to do something that is harmful to their healtl~ is ~ very c~.nplex question. I ~tl~t want tO point out it is not at all unique t~ eigaretlea. The thing tha~ makes cigarettes so unusually difficult, and there are other examples of tl~i:~ m t~ he~dd~ gel4. ~ tk~ ~us¢ ~n4 the ¢ff~t ~re ~ fo.r s~parate4 m time. If you o~e~use alcohol, you know it right away. Or, if you drive an automobile toe, fs.st and ~'tu~ infi( a ~e]ephqne pole, you know it riglst aw~v. If you smoke too many c~garettes, ±l may be 30 yeats later befme ~,oa fin& out you have smoked t9o many ciga ~,e~l e~a. Senalnr P~STO~. The ~eason d ask th~s, I dent t)nnk tiiore m home in America or a school in _dx~e:cie a or a meeting place in Americ~ wi~ere this questio~ of cigarette smoking contributing to lung cancer hasn't be~n ta ked aleut It ha.~ already been bx~ught out there is an awareness on the art of the American public and [he thing that is disturbing m~ at t~is monmnt, if that is the case and so much has been said about it and so many eminent people~I notice even tile Sur&~z~m General was on ~elevlsion when the report was made and that was

46 CI~A~E'I"T~ LABET~TNG AND ADVE~T]$IXG glV~/ natloawlde publicity5" and everyone is talking about it. There is Jlo ~lU~Sti~ at all ~bo~ that, hilt still~ it ¢oat~lues ~nd ~he tdaing t]~ i~ trol$1in~ the Senator froth Rhode Island who dcesrl~t smoke cigarette% nor clg~r~ or pii~e I ~]on~t smoke at gll ~nl] ~1~ on~ ht my f~Lm~ly smo[~es so I h~tve~P~ the prob]em-~nd ~ h,~'e~t Ih~ problem~ but the ~a~ ren~L~ tb~, many peffple ~1~, ~e~lizing t,|/~ there is a~ ~rgumen~ here us to whcl/mr or no~ ~t might or might ilot b~ l~arm ful. .Xo\v the question ~!m asking is th~s d~ y~u ~e~5~]y fe~l that just by p~tti~tg this littl~ g~clget on ~ packag~ of c~g~rettes it i~ goin~ ~ c~ang¢ ~e f~iet ~re ~ whole 1~ vch ~l~eo~l~ already/¢a~W ~h~ s~ory Dr. It v ~n~y. I think the Surgeon Ge~er~] g~ve ~1~ ans~ver to t~a~ sir it will be one me~sur~ tha~ w~ll help. I~ will n~t be the i~ns~er. I)r~ 2"~m ~. :I thi~]~ ~n ot~r th~g~ Sen~tvr ]Psst~re~ jn~f ~o c~mme~t ¢9rl ~llr i~mark~ t]3~,Te ~11d to I'eiter~l:~ ~ $ 0.te~aEq2t wl ~h ~-~t~ 11 my ieapttr~ st$.t~ll~ea~tt ~1~ ~ ~II2~'¢~'1 wh~!l ~l"~o~g w~r~ t~ed ~bout 1~1t,¸ ~llowi~lg statement whether there sh~ be more education of the public ~bo~t the health r~k colmected with smoldnff cig,'~rettes~ 9~).~ l~rcea~• s~icl y es. . Sector ]PA~TOm~. I ~oTee with that¸ ~r~d I gue~ a]] of us will ~gree ~'i~h ~h,~t. l~ am su~rlse¢l ~h~t isa~ ~00 pc~t. I can't unc/~rs~an ~nyone dl~a~reem~ wl~J~ th~t~ Dr. T~rm~'. LaF~ling, to my ~ind~ i~ another method ~nd ~ne o~ l~mlly m~tb~s ~f e,d~va~o~. Senator PAS~O~E. I jll~r hope you are right. ~cnat~r H.~T~. The q~e~tlo~ cx~mes to me~ why ~d yo~ tak~ ~he p~l] ~a the first place ? Dr. 'I~. l~ecau~ th~ ~s ¢ertala information ~ wa~lecl Lo derive which we thought would be llelpful to u~ in p~l~su~ng ~r ~ spons~bilitdes in this ficid. Senator IaLX~T~. If it i~ h~rmfml~ i~t it h~rmful as ~ m~l,tler o~ medical d~I'n~in~tlon and ~ot as ~ ~mtter of public ~pin]~n ~ :[ mean ~hc pl~l~l~, ~ter ~I1, is go~n~ ~o rely upott people/ike ~q3ui~l t~ f~r ~l~a~ i]~erm~na~ion~ aw they n~t ]Dr. T~rm~. I~ wa~ ~m~ Ol~r inte~tlon b tl~is suvvey to elthe~ est~tl3- smoldn~. IE, ~s r~ther the inte~t~ to ~r~d out tile p~blic ~c~n ~o th~ inf~rm~tlo~ a~d te v~,ious aspects o~ the s~b ect i1~ order tha~ we wo~lc] know better how t~*c~rceeecl wlth our in for ~lio~ ~nd educ~t]o~ respo~sibilit~es which ~h~ ]~ublic ]~e~lth Service h~s. ~¢~ll~.tor IIAill I~E. Lel u~4 come 13ac[v oli th~. On ~]~ ~le~n~ ~l~r example ~h~t ~qenator ]P~tore l~ad re~erence t% ther~ ~s beert az~ ind~c~l~a al~d cer tainlv • ~atenmll f ~ ~ou t~at i~ ~s • ¢t~n~er ous and¸ h~m3 f~zl ~ub~t t~nce to ~se alid ~h~t statemen~ i~ ~'e,~ wi~tel~ ~dvert~d through the o3mmun~v, ~t least in the t~rms o~ know]eAge ~l~d I'm s~rpzised ~ ~,~ did~'~ ha~'e a 100 i~ rep~ to the qi~s~iw, d~ ~ou '~ltat more exlucat~on or mor~! iilforrn~t~o~ ~po~ ,~ll~]~ U ~aatter~ ~Vl~Lt, 13ossib e u~ c¢~u d ~uch an ~ ~ er be ether to :~ou ~r to us ? Dr. ~P~, ][ should t~/b~k it woll]d m~ke • ~r~t de~l ~f diffe~.ence to ou, slr, to know 9~) pcrcen~ of the people in th~s country fuv~" ~h~s. ~en~tor ttA~:r~ I am interested in wh~ the peo]~le think but basically I ~m int~restecl ~n t~'in~ to d~ wha~ ia r~gh~ f~r the people and tT/n~ WOllld h~ve f~ be b~ed, ~ltkmber ¢,ae~ on ~clcr/{if~c ~rm~on.

C;IGa.RErI~ I+ABELI'q(~ A~qtJ ADVERTI~IN~ 47 What if 100 percent of thean sMd they di(ht% want to k21o,~ arty more ~bout it ? Dr. T~Y. i think t~is wou]cl raake a great deal of cllffercnce to you. Senator ~L~rkz+ I do~t think i~ would. ~t.+ T~R~+ Ti "a o/i]~ %e~t/i to m~ as a t~pl~Sen~atl ve o~ yotlr ccm~tlfll ency~ that yon would lik~ to r~fiedt thsir viewpolut ~nd suI~po~ tkMr viewpoint. Senator IgA~TKm. I w~uld like to reflect it hut if I fotmd out for example+ radinaetive material in the air is going to de~r~y a nation+ I ~uldm~t care if they wanted ~s to k~p ~n testing~ i w~uld wte in favor of a test ban+ Smlat or PA~'r~. You d~d+ Se~mtor H~. I wouhI+~% mak~ up my mh~d o1~ that ha.~s+ If I w~re ~vinee¢] th~t this w~m r~]]y dan~roum and h~rmfu[ to our p~ople, I wot~lcl be ~r it if they pnt me out o~ oallce+ I cannot possibly conceive of what ~a~hly ~ain~ or what v,~hle to the I*uhlJe IIealth ~ervi¢~ or the .National ][nstltutes of t:[ealth or to this ~o~gress s~xch informatlon could be. D~'. T~m~y. i think it giws us a ~reat tteal o~ tt~de~siaJ~clil~¸ ~bol~t people'~ aPtitlTdes wq~h regard to sm~ldn~+ why they smoke or c0utinne to smoke and what they feel should be done ~out it+ Senator IIAR~K~, IS that ~ part of thi~ report [indlcatlng] Dr+ T ~a~. _Nro~ sir ~ i~ is not. Senator iG~x~. Th~ is a separate stndy ? D±¸. T~mt~. Theft i~ a ~p~r+~t ~ ~u rv~W <~r s~mly. Senator IL~RT~E. Wh~ pMd for it ? ]Dr. T~R~+ Public Ilealth Service. Senator H~I~KE+ HOW much did it cost Dr. Tzm~y. About $1'20,00~+ Senator ]~[A,I J'l~ n. ~low were t}lc ~+t In~l]l!s sl!h~lt'~I ! Dr. TIa~Ry. ~)r. ]~lll tL ,!+ut ~ivl! v,>tJ Iht~ i] et~t i1~ of ~he ~t~rve~. Dr. !I~_x. The s~r~ey wa~ designed within the Public lle~lth Serv- ice and then i~ was put out on competitive bids ] ~ -~Iay. A ~mlr~ber ~f +ror~inent firms bid ~n it and the bid was ~warded t~ the lowest bidder. ~ tolgl of appr~+x brmto]y 4,8t)0 people wt+rc it. crvit~wed, lhey r~pre~ ~e~t~d ~]1 of the ~dul~s~ ~1 ~nd ove~'~ hi 3~500 households ~hro~lgho~t the eonntry~ ex~el~t t~mt ~ur interv~e~vln~ ~a~ done ~1. only olaf+ha.If o~ thos~ who had never smoked cigarettes ~o ct~t dow>_ on tahc total co~. The h+>u~ehc~Ids were .~el echoed by probability s~mp!e me,ms, ~]Jat is~ the cou~t l"y. wt/s (liveried. to~o 106. ~rinnti~ sl~i~l ~lhl~ tu~it~. • re~re~ent~n~ , d~fere~t populations and d~fferent t~es of p~pulatlotl m the ~ hired S~ates to represent the total ~-nit~d States. Within those i06 prinmry sa~npTing units, 4 d~fferent zegnnents of approximately ~5 interviews tlpiece ~ere dr~ so that this does represent a randomly chosen probability ~mple of people I~h~g ~n households hi (he ~Tni~e~] States. .Rena~or FfAIIJK~. ~¥ns the ty~a and s~ze ~f s~mplln~ tn be a matter of determ~natlon by the firm ~csivln~ the award ~r m~ki=~ this survey, or was that all specL~ed in the ~ver~isement ! Dr. I hmx. "J/hls ~x as specified. Senator H^m ,~ ,,:. A ~ d the to~,~iq~les to be us~'d ? I)r. ~IoR~. The sampl[n~ f~.~<~qlllre w~m ~ pt+sifie~I hi the bid~ yes. Senator I:~ARTF_~, \V~ts any attempt made to refer ~hls to the I~llrea~I o~ the Cel~sus~ whlch ~s en~ged in t s type o~ activiU ?

48 CIGARE'I~E LABELING A~D ADVEI~9~L~G Dr. tiomv. Oh, 3~s, this was reviewed by other segments of the Hovevnxnent. Senator HARTXx. I didn't ask you that, I said, was a reques~ made of the J3ure~u of Census to ¢ondll~¢ Fmeh a survey! Dr. HORN. The Bureau of the Censt~ was asked if they could do this and they did not have the facilities to do this. Senator H~vrm~. But they do do samplhlg all of the time to deter- mine the ~reen~age of ane*~Lployed~ Dr. Ho~*s. Ye.% t let~ are a great many s~mple studies that go on within tim Govemur±ent said there are organizations wishha the Govern anent sh.'~t do this. However, they have commitnlellts and could net ~it tMsin. Senator IIARTKZ. They refused to do it? Dr. HoR/e. They would not have been able to do i~ at the time. Semltor HA~rr K~;. Did riley refuse to do it? Dr. I-IoR~. There was no formal refusal. Senator HA~IX~. Was there a formal request ? Wh~t I am ti'yln.g to find out~ why was it taken in the first place and who originated 0ns idea ~nd where the money came from ~nd who gave t~ authorit to use this money in this fashion and l~uliy, wh~t the l~rpose of the w~ole thing w~s all "~bout ? Dr. Hoax. ~£uy I s,~y dm purpose of this study was to develop information on the basic behavioral facts underlying smoking be- t ,h r Th~ problem of clg~r~tte smoking is a relatively mdque one in the fie d of publ e xea th. It involves human behavior hUlnan react on to something which the~ have /ten doln~ for a long period of time, accepting thin as a relatavely harmless matter. Now there is scientific evidence that it ~s harmful and there are a number of problems obv ousv ssx c ~ted with this because people aa~e unwilJing to accept fads infotm~tinn in some eases and in otber eases they fir~d dmm~elves unable to do anything about their smoking habits, despite the fact shut they wish to do so. It seemed that it would he hnproper to proceed to trytodeveo som~klndof rogoamtodealwzshtheproblemw~thout having a ~a°~ compl ate nn~rst anding of just who are the people who smoke, wh~ do they smoke~ what are their beliefs abo~lt smoking, what does sanolfin8 mean to them, what are the conditions under which they e]lm~god thezr habits or deedde to c~mngo their habits, what ai~ the influences that have affected thear t~k~ .g up smoking or what have be~n sheir experiex*ces in giving up ~mokin g. Senator HARTI~. A ~,vho]e chapter was devoted to tlat in the Sur- geon General's re oft, i~'t that time ? Dr. ~Iomw. An~ tlmt chapter conelu<leA veYy little is kno~ about this and more research is needed in this area. Senator ~I~ Do you ~hink that such a survey is perti~m.t t~ tb~ dot erndimtinn of flxe'type of legislation that we shcmld e~act hero In olher words, sholfld we enact this ~pe of legis]afion on the basis of wh~t the people sMd in this survey ? . ~ . . Dr. Hv~.r~Y. We did not umlet~ake tins surge with the anten~ of influencing le#slation, Senator. We undertook ~is sm'vey for our own tlrogl'an~ needs for the reasons that Dr. Homl has l~lready 0A- vanced. It was done by the I~ub]is Health Service, to ans~ler .v0ur ~uestion, It was financed by the Public H~dth Set,ace. I author lzed it. It is per~ecffy within our ~uflmrlty t~ do it.

CIGARETTE LABELL~G -h~D ADVERTIBING 49 Senator H~E. It has consumed about half of the oral testimony here of Dr. Terry. Dr. Hu~mLEy. Not in the prese~ted testimony, sir. The questions ba~e dealt with it extensively. Senator ~AIITKE. Ill the testimony presented ilere today, it con sumed ~bout half of lhe presentation m~de by D~'. Terry this morning. Dr. 3~rmz. It consumed a significant propor~inl~ because I thougi~t the information was of interest and appropriate information for this comraitte~ Senator H~r:I~E. Let me ask you another question and then I will drop this matter. ~3~y do you feel that under the Hazardous Sub st~mee~ Labeling Act that the actisn which is sought b riffs bill could not b~ undertaken bT you administratively today ? Y ]Dr. Tr:mtr. May Iask hfr. Ellenbogen to reply to this. The CgAmx,tm Sure. S~llalor H~A~TICE. I dotl'L oar~ ~ho allSWel% it, Mr. ELLr,wsocr.w. Senator ttartke I think it could be argued that the terms of the Federal Hazardous ~ubstances Labelbrg Act do cover e~garettes. 1 think it could be so art,reed oa the basis ~f the ad~dsory committee's ~eport oil slnoldnlg and he~¢dth. Rut tbe P~od and Drug Administration has conclude¢[ that in the light of the legislative his- tory of the Federal llazardous Substances Labeling Act it would st rain the act to attempt to cover cigarettes under the act in its present forill. The Departmen~ is rec~mmendlng that that be clarified and that labeling regala~ion of cigarettes be brought raider the act, but it Imsn:t felt that iffthe li ht of~that history~ which involves primarily things f~aat are used in (~c bmlsehold such as ho,aehold chemical% we *~'ouid be "ustified in attemptln ~ to reg~ll ala that matter. ~enator IIA~TK~. Let me re~d from section 161 of the Code, title 15, subsection { g) The term "~oxle" shall apply te any re[baLance (other th~n u radioactive sub Stance) which has the ealoaeity to ]~r~t~ce personal injury or illness to real) through ingestion, inhalation, or absorption thrm~b any body surface Ther~ isr*k any question that ~'our contention is that this causes ill- n~s to man through inhalatin~(, im~'t that tru% and ingestion! Mr. Er,~NBO~EX. Tim[, sir, is the conclusion of the experts. Senator tIAm~r. So eerLainly it wouhl come wbldn that dedai(ien of terms Mr. EL~O¢~-'¢. I believe that cigarettes would come ~ithin the definition of the term "toxic," yes. Senator H~m,~l]. As conUdned in that act ? Mr. ELLE-WB0Cr~. Yes, as you read it. As I said beast% it could be argued that so ~ar as tbe terms of the ac~ are concerned they could be brought within it, although the tern "toxic" alone does not answer t~e qua~tinn alto&rather. You have to go to other b3iwns, the other relevant part which would be subsection (f) : which dallaes" hazt~edm~s substance to mean-- ~y Substance or mIxt~L'~ of substan~e~ whIc]~ (l) Is toxic. (2) is eorsr~sive. and so forth-- if such substance er mixhlre of substances may cause* substantial personal in- jury or s,&s~antial Illness dnring ~r as a proximate resul~ of any customary or

50 CI~A]{ETTE LABEL~G ,~N]) ADVERTISING ron~onab]y ~r/~e~able handling Or use, including reason~My foreseeable ir~ges ~iou by <.h[Idren. Senator HAmK ~. l~n% that the ¢ont entinn of the Surgeon GcncraPs report ~ ~fr Eu~x~m I thhJ{ that over a long period of time, the repro% Of the ~lLrge~n CnmeraPs con~ttee and the Surgeon OeneraPs tr.st,i- mony indlcates that in ury could flow from the use of cigarette~. But I was d~tly involved myself in the consideratlcn ~n3 deve]o ment o{ thnf part]cular le~isl~tinn and certainly I elm say with cx)n~ence that no one at that time thought o~ the posslhililv Wen of including el ~rettes under that act. ~ thlnk tImt has probably ~ gr~at (lea] of influence on the Food and Drug Adm nis radon% c~nclnsion [hat thev-- SenatA) • HA~ Let me ask you in other words, the ~c't ~l~t el a- re.ttes ar~ so commolfly used ~nd involw a big industry, you ~el they require special atte~Rion and special legislation, Ks that what you are saving? 3ft. GLr.~m~. ~'o that ~s not what I am savin~, not th,t, il~ ]]l- VO]VeS ~1 hl~ indll~tr~ or it is eomn]oDl~ l]Se.~. [he ,~r~cl~ t,~t are em~et~d by that act are ~rticles that are very I~l/t{!h in 11~ alld ~r~" commonly used• The ~rtieles that wert, tL en ~n th~ minds of ~ong~gs n~f~ in Ih~ tmusehold and are sold in p~ck~ges suitaMe KSv ]mase- o use1 but which contain h~z~rdous elemefi~s sm!h ~ te£r~chlor- ide. I think, in cbanse~ and floor waxe% wlmv{~ one couhl e~si]y slip if oI~e w~sll~t c~,reflll ~nd whie~}l i~qu]l'e Wal~lin~:~ ahd c~u~iot~s f~s ~0 ho~. dmy should be us~]. Senator H,t~er~, I t(~ok i~ from ]~r. Terry maybe I bett~r m~k hi~n of wh~w~r as "e~poDsibility ~or that pa~ o£ the stztemerd f,ll~t lns common e~;mplaint against tim propose~t acts was thtl~ lie ~anted the De/artment to have the exact same type of auth cwiD' ~ h~ch is specified in the ]Iazardous ~uhstar~(es Lahe]in~ Acl. In other words, give to the Department the mune type ~f authoritv; add this is a complaint against the proposed ]~ s a[ 0u and th s is ~hat you want. }I ' ]~N~WmOnE~. I aLrree, that the SecrefaI:V slid ttm Departn]ent have c~ncluded that so far a~ ]~beHng is concerned as distln~ished from ~.d ~evtising. the legislative te£tmique, the npi~roaeh, the sanetinns, the methods the insr)e<~ion, tbc .nlhor~ly, the experience of the ])e- partment armies rather eompe]l]ngly f~r ves~llg that aspect of the leg~s~ a~ion in the Depar{men~, ultder t]mt ac~. Sea a or FfAwr~. In other words, that is ex.etly whM yon are say- in~% 9hat realty what yon wan{ to do find wha~ your su~'¢.$t[ol/ {s is to model ~ho act ~.~er the Hazardou~ S.bstances Labelin~ Act Mr ]Zhm x~ ,3~. IVe nm recomn]~qld~nK that it be ae~ua]l~ ineorpo- I~ ted il1 ~lla~ glct ~l~lll)l~ ~]1 we ~re recolrlfflelldiD ~ a~ tile same lime, tl~at amml ¢]meuts ha made Lhat would. I would stay, ts~lor ~]le reqmrellDent s o~ *h,. act to fhis partlcular ~)rodnet. Senator I ~AI~T]IE. ~nd ~5"]lat [%re thog~ sI]~ci ~c reo1 nln~tlda~ms ! ~[r. I~L~Z~n~O¢Z~. They have t~eu set Imqh in d~e Surgeon Gener~fl% tes mony and n our ~eport. For e×~mp]e that we should have au- thority to devise a spt~fifie warning; that we should b~ve audmrliy to ~Tfire ]uform~llem as to Ln~-ed~ents; tha~ w~ shmfld hare to de-

CICARETTE LABELII~'G ~ND ADVERTISING 51 velop standards or requi*~ements as to the m~ghod of measurement of in- Criminated agent% and He forth. Senator Ha~rK~. ThM~ authorky is also under the hazardous lab~l hlg section where it suys : ¢ * * regulations e~tabiish such reasonable variations or addldoual labelin~ requirements as he rinds necessary for the protection of Ihv public hea]lh all~ safe~y. That is pretty broad. Mr. ELi~mom:~. Yes. Senator H*RTIC~. IS ther~ any~lfing within Ihat definition that you are not seekin~ or ar~ wm s,~eldng a ]hnlt~tion of that authorlfy or expansiort 0f that auth oritv ! Mr, Eta ~:m~oos~-. We arc seeking no limitation of our uuthm'i/y. If m.v be necessary to spell Out r~ther soeeifically with vespecl E o Ihis part h~,dar produc(the authority or. if not rmcessary~ at Jc/Jsl dsslrable. ~mlalor I fART~. It ~s your conside*~d judgment d~at the H ~z~rdous Substance Labelin~ Act is not suffieh ntly broad at the present time io owha ever you think ~ cecss 'v g 5oftleevidence~ouhave is that right Me./~r u,r~m~ ~:x. Mv e~msidered judgm~enf as I said before, is Ihat it may b~ argued ~hat the terms of the act takeu medically wanId he .qpp]icahle ~o. eig,tlxtu, s. i a]~o. ,ran ~mfident, t t e g t J e hlst~ry Of fhl~ te~ 111 W}tlOh ~ ~,11% d et~lll.y lll¥olved~ ilo one ever drealaed that it xvould extend to this ~r odt,¢:l. S~'n }t ] IclP ~ %RTI~E. Ln~t i~ true Ihough that no one ever dreamed fhtl~ this act would apply to a lot of i~ems which were nvt e~ltsldsr ed at the time because the ~act of the matLer w~s it wasn't known they were a huz~rllous substance at the tilne 3~r. I!;Lr.~'~l~)~'~. There are m~l~ )re,hints bein~ developed d~y after da) LhaL wel~ ]lot even irt exlS'lellce whe11 this act WAS ermcted. I v.mld sa) dt a broad ~*av, they (ome w~th~n the genera] pmMew of the intent of thc~se peo~opJle that developed th6 acL at that time. Senator IL~I~. What i~ there abont ei~are~tes nnd wh~d, I an] trying t~ have you s }eli ont for me, ~ I~nt is there about cigarettes that requi~s such special attenlion other tds~n the fac~ that it is a bin ind ust rv and bein~ used hv ~o many people ! Mr. Eim~¢~;~. The f~ct theft it is a big industry, sb': has no bea~ing on it wh~/tsoever so far as what I ~ua savin~" is eon~erned. Senator f~A]R'l'lqE. ~[a t]1(I~2 II ftletDP, ill other %v(~rft~* that you csn point to that, vo~ can gi~e me that would help me identify what m~kes it reasonable to assume that you do nol have that authomty tod~'~ Mr. Eu~m~*~. I ~a~d hefmx~ that you could argue lherldh that it, does cover ci~arette~. I also said that thr~ Food lind Drug Adminis- tration eonelnded that they wou]d rmt feel i,2~tified in the light of the h]stoqv of this ~u:t to wlu~t may be called stretch this act to cover tlmt p~oduet. . . Senator II~T]¢~. Let me ask ~7Oll ~bis iS the e~qch'nce surer:tent 11~ far as the Snr~eou Gener:~l's ollDe is concerned, ~ssurn ng lhat laese (lefiMl~ons areJtrue ~ncl eorrr~t, i~ the iw]lh~i/e suflleient ~or y011 '~0 nnlht~lbal, th~lerlrlhm[iol/! Tslh*~l [~tlereasollforfhehesitanov~ Mr. Eux.~ ~c×~x. I I h k, k. and lawyers may d~ff er o~ er this, I think that there ~s a ivM doubt whether the co~l'ts would sustain l~s if we ,~ttempt ed to u~e the act now in its present fOrlft 10 cover rids prolhl (~L

52 CIGAI~ETTE LABELINfi .~I~D ADVERT~SINC Senator ItAR'rK~. On the basis of the evldencey( ou have, is that it? ~Ir. ]~LL~BOt~EN. On the basi~ not so much of t~e evideilce we have~ but on the basis of the history of this act and that it lust doean~ seem to lend itself very well to thi~ preduct. SenatorHART~. I~mnotgohLgtobe/ab0rthepokn~. I ~tmhoncsf with you~ I do not see where you dr~w the distlnctiau~ whttr~ it. doe~ not lend itself in view of |be re~ding of the de fruition of the word "toxic" and the definition ~l~d ase of |be word "lmzardou~ s~t0mce" and the ~thority con~]ned in tl~e ~ct to g~ve whatever t~e ~f vari~tlon or t~dditiOll~l l~bel that you wanted to put on the package. Mr. ELL~NBC~E~-. I said be~r~ that ~ou could ~rguee that it is covered. It may well be that I am influenced ia my ju~ment by the fl~t o~ my ~ssociation ~ith |be hi~torv of this ~ct~ ~s the Chalrm~m ~as ~s~c,e~t~d with it~ ~t~ld that ~orac~n~ who has )|ever }~n as~oci- ~d with it, h~king ~1 it m~re ~i~J~vely, reich1. I~k~ u different ".'Jew. Senuto~ HARx~. That is ~]h Senator N~v~er~n. Would the Senator ~rom Ind}an~ yield t~ me Se~mtor/]x~r~m. Yes. Senator N~m~E~. You might be interested ia knowing the hbe t~ry of this. Whea I g~t very interacted in som~ legi~l~tion~ I ~lso th~mgh~ theft the Hazardous ~ubst~nc~ Labeling Ac~ wou]d apply ~tnd that| we d]/lll¥ lleel| Imy ~.(Jl|]tion~] h!g]~]ntioTl. Two .~t~r~ ~t~o I went to the Commissioner of the F])A ~nd a~ke~l h~m and he turacd ~ne down. He said th~tt th~s did not ~ffcct ~oba~co. It is neither a food nor ~ d~g. 1 had clecided ~ccorcl!ng to my ~nterpret~tio~ it wa~dd~ b~lt ][ d~t request their mterpretallon and I was turned down. So I ~gm'cd from ~l~t udditloa~l ]eglel~ioxL w~Ls nee~le<l~ Senator B~ss. ~rl]l the Senator yield and |el me a~k one questior~ in view of wh~ ~ ~slcexl Senator Ii~:~m. Yes. ~enator 13±ss. Counselor woldd you ~dvise tile Surgeon G~r~l~ if you wcre ~ed ~t dlree~ qua|ion that the evidence is ~,fl~el~nt ~ncI ir~e~lc~]~]~ Ix~ be~r ouL ~ c.~u~t su~talnlng s~ch o~ers i~ the act were • p ]i~ble ? ~r. ELL~r~OG~. If |be a¢~ were upp|ic~bl~ I woulll a~lvls~ the Adminlstr~tor--that ~uthorlty has been delegated not to the Surgeon Gencr~l but to the/0 ood ~,~ ~)cL~g Adn,b~i~ratinn that in my judgL mcn~ thcr~ is ,L su~cisn~ basis ~,r th~ conc]asion that this product could be c~nsidere~l to be ~ hazardous subst~l~ce. Senator B.tss. That there is all the clinical evidence needed to s~pport such ~ decision ~ ~[ ~m no~ t~king abou~ ~xu'vey~ nr sLutis~ics~ 1 ~m t ~lking ~bout clinical ~videace ? ~fr. ELL~UOO~. I ~m not ~ure that the ac~ specifics|Iv re~ers th clln~c~I ~vidcnce~ ~ th}nk whatever ~vidence experts in the field con- sider a rea~onable basis for their conc~sioa, ~ court would ~1~o ~ccep~ ~s ~ I~on~bl~ basis~ Senator BAss. ~q~n~ ~ ~]l. S~mtinr ~lA~r~!. Let me ask you aooa~n~ in your opinion, the evi- dence is sufficient in this c~se to "usti~y that b~ic~llv m lin~ with the provision of th~ l:I~rdous Su~it~nc~ :[~ab¢]ing ~c~ is ~11~ tr,,e~ Mr. ELL~N~0~E~. Thatistru~.

CIGARETTE L.~BELING LND AD1/~RTISL\'G 53 Sealator ILgerxx, In other words, the evidence would sustain that! Mr. ELImXBOCmN. Yea sh'; pa~icuhLrly tts a legislative judgement. Senator HARTKE. 1lava you asked the Attorney Ccnm~l for an opinion? ~h'. ~LLX~,mFKtl]/q. "~%7t* hu ve ilol, Selmfor HAR'i'KE. Why not ? Mr. ELLEXBOCmN. Beeau.~ the Food .nd Drug Admhlistrittion concluded that it, was not covei~xl, "vVe do [tof, Iis ti rulq, go to the Attorney General for an opinion unla~q we hav¢~ very serious doubt. ~na(or Iff~T~. I filollght you s.%id that it could he ar~ed that ~his act cmfld apply ! Mr. ELLEI~I~0OES. i think it could so be argued gild has been Ill'gll~s~l hv some. Sen n tx~r HAI1TKE. But you did nof~--- Mr. ELI2~S~OC ~:N. The I'e itre many legal questions sir tha~ we resolve da~" by day witho/ll~ go] n g to the At tOlaie¥ Ger±exal about it. Senator HAI~TI*E, Thei'~ are not many questions w]d6h h~ve been considel~4 probably by as many people in our Department as the qut~tion of cigarette smoking and its hazln~ul effect or what it does aS ~r as ~,~4 rl~er 18 (~)IfI~!lqled ; iSl~Yt t~l al~ t 1,11e ! Mr. ELLENBOOE.NL Well. I dolfl, .knew" Tt/el~ are manyqnestions sublhltted by die opel~tlng agencies to o~lr ({*AIm.M Co[lIiS/dl and I might incidentally say that I was not asked ~or an opinion beeau~ I'm ip the Legislative Division. I don~t give ophtions on legal questmns with respec~ to existhlg laws. Senator I]~ArCTK~. Would the Ol.~irmari he willing to have the Attolaxev @eneraI called for an opinion as to whether or not t]ds act is appli~ble ! Semtt~r },fORbear. He is busy righ~ now. The CHAII~3~AN, lie is bus3 right now. i don~t wm~t to belabor this~ bu~ I agree x~iLh /lie wKn~s that at the time we took up the Hazardous Substances Labelin~ AeL~ we dhhgt ho~ve an testinmn~" whatsoever or~ eigarctOes or smo~hI~" and that it wss not ~t~o int*.ntloh at that time to discuss tiffs palticular matter~ nor did we haxe IJm san~ alnount of evideaco before us. The act is broad and it might apply. This is not imllHnaJ il~ the CongTegs, "We have many gels which some people think an agt!Imy line authority to do eertahl things but for some reason or other, because i}ley th [Ilk it is not clear, the • don't do it and this commilte~'s thne is taken np rluit~ st Io~ wlth3glving Gon~L~K~] O H II,1 diD~3tive, g on t h~-e~ mat t ei'K One of tile ~asnns that Chese hills were introduced i~ there was any question as to/lie authority, as Mrs. Neuherger pointed out under the Hazardous Substances Labelh~g A(% the matter wou d t en and in the courts and I don't know how long if would be in the courts aud we wouhln't achieve our objective in getting at ~hls ~roblem. So part cf the reti~n for the legislation is to make it crystal clear that the autborlty will br~ g4ven to some department or some agency to do ~his job by Conga'ess. Number two, the Federal Trade Commission has a lol (,f *mthority hi thls particldar field, the3, are even listed in the blls, bu we a'e making it char that we want ti~em to act on this particular matter and that is the n,:~>ti for some of this legislation,

CIGAR~tTI'E laABELING AND ADV~HTIS~ I tml sta~ ths,t £11¢re is scattered aromld in the t~me ~geneies 1orob ably som~ sembl~mee of authority to act in this ease with file eliracffi prJof so there ~ould be no question about it, but we aie txking to put Otis mg~tAer ~uld a~t~tck tiffs one probleln ~ we ~e~ it. lie ~a rotor f om lndan% of course, w~s very active in tiffs lYazardo~s Sabstances L~beling Xe~ twd }m feffis very keeaffv about it because l think h~ was one ot the g~¢a[ )ro )re!ants of this ~li. He is no~ a~ oral)ring to dlseo~n~ th s hu~t and I wanted to nm(e that Off the re~xmI. ( I )iseussior± off the record, ri ~ ( ~a~ ~,~. The comm ttee w 11 recess ndl ~ 3() Ihis affierx,oon. ~VheI~llpo]l. ~t i~:15 p.m., [lie eonlndttee was l'~Ce,'~ed to l'~oon wne a ~ ~ ::lO p.n{, ~hi~ ~ ~m~ day. ) AF~P~r OOA- 8ESS~0~ S~n~torlhm', Itcoome ~ ~willbelz~ot-der. to eugage the hill a~tentlon of your office for so h)ng~ but I think tile subject ma~ter is not 0nly o~ sueli nI~donnl in~erest as to ~astify it~ bat it is of suel~ concern (o you that you will be sympathetic with us. Dr. r~m~y. We sineerdy agree with you, Setlator Hart. ~ealatm, H.~m'. Se~mtor ]]atthe ~ ~ in~tuirmg- ~itb n~pec¢ t(~ one aspect of it. ~enai(m HAm~E. I would like to ash a question or two mm~. l)o you kno% oa tlm poll who struet ~re~l the poll ! Was it structured by th~ p~o le who took the poll, or was it structured in your office ! ]Jr. ~o~N. The i~Iexffiew form wa.~ strllctul~d in our of~tu~ o1'~ inallv. Tbcn it was pretested by tl~e Organization of iS'ational Analysts which conducted tile poll. It was changed cooperatively then pretested again; then revi~ed to the final %vm. I wouldn't say it was one or the other. W~ ~ orked t~geth,r on it. • Senator. tLu~a~m Gmaerally ~eaking .... among pollsters, isn't it I~ue it x~ considered ~ha~ the structuring of the i~ll is ~, v~tM factor m tim ~sults which are ulth~tdy obtuincd Dr, iIo~. Tiffs ia ti~e why y~u insura ~t) ecfivity ~es sir. S~ator H.*t~'r~m. It is a wt~y to h~sure ob ectivity or to ins.re against objeet!vity, depending on the s~rue~u~. Y)r~ htonx. Phis is why we w~t to roar diffcrc~t structures in order to a~oid the possibility that there ~ere any bi~es inherent in the slructura, itsdL Senator IKA~. 5-aLional ~talyst8, It:e. IS tha~ a (xmbinlfing firm? Dr. Holm. Yes sir. Son ator Hax~x. ~q~o owns t~ Dr, iIoz~. I really dong know. It is a market re~eard~ org~uffz~- don incorporated in Phil~d el ikia wifl~ headquar[ers m Phdadel~lh~a. ~enatof Iq[AnTKI< Or ~ro t Icy owlled n []~r[ or whole ~$ & publishing company Dr. Hoan. I don~t believe so, I believe initiali% they started as an office of the CUrtis Pubfishing Co. I believe ti~ ~ was ~ SiOl' oa, I am not sur~ of the details,

C~GARETTE LABELING AND ADVERTISING O5 Senator plarT~E, Cm~]d you furrd~]t that for tha record ! Dr. HORN. Yes, I will. (There follows a letter from Dr. Arnold J. King, pl~s[deilt of Xat~onal .~lalysts, Inc., describing the muctul~ o~ that company.) Phih//lglpMa, pa, April ~, 19~5. D~I, Ss~.~ro~ Mz~,nuson: It has u~Jme to my attcl,tlon that the Senate Commerce ~ubcorltmi tee conducting hearings oI~ tile pr~nti~lg of warnings on packages of cigarettes has had a question raised about ownership o£ Xqat~onat Anab'~s. In¢.. the lJrivate research firm that has collected and processed /he d~ta of the l!J6~ stud~ of smoking b.havior. COlld]lCtefl tlll(~¢z contracL with tile /..8 L'ubU¢ Mealth Service. i should like to Lake this opportllnity to provide yea with im'ormatioa about our ownership Ilia opera,bin N,utional Anal~ sts, Inc., is a wholly owned snbsiclia~y (if the ~ur tis Pnblishtng Co it has its 0%%a full-t~me ~tal~ headed by myself, pres den~ and chatrma~ o~ the board of dh~etOl'$. The operating o~ieers of ~a~ioEtfll AHtl]ys~ de,off full thue h~ this org~alliztl tion wl:hout rcslmnSlbillty to or dirl~tion by th*, parenl c~mpany, Their i~s1)l)i/ ~MKty ~t/~ s dhecdy to Nut[o:ud Ai~u~sts v, iti* ~he Ooskion of Cllrtis being no *no~e ~han that of a S~¢kholder. This com~,an~ has alway~ serupntonsly maintaine~l an existence s@arate £rom its pa:cms. 3'o that end it mahuaius its o~ces otoer tilan ±n the t]l~hl ('uiLis hlild[ng in Philadeli~hia I¢ COml/ele$ £or Ct~rtis ¢o~trac.ts on bia on the same fooci~g as any 41~he], research ~xmlD~tl~ and, in ffl~, h~s o~Een lost ]'esonrch jo[,s l'eqldred by ( urtis to o~her Olgani~tion~ ~oc~£11s~ I>f lower bids Sllhl]]itl~([ DI, i~s qomDetiNtrs. Full i'espo~sibiliLy £or the teeh~lieal ec, mpeLenee ~£ 13ro£~ssional star? and o£ scien ~ifi rigor of r ~.seareh per fro.meal lles with the p~'sldenL of Na uional Amdl st s 9'h¢ pro/¢,ssioilal codes of the associa~ioas izl which our staff have meA3abers/l~ps are t~e o~rating bases for thus camDany. O~er the )cars ~adonal A~al~ sts has built a ~putation for having ~he highest stsndo~ls aud objectiviW in survey research which is why universities and gow~mmlmlt~l ~genmes call npon ~ for as~k~tanee In oort(1]lntDlg t~mir d~t3eul~ studie~ Ou policy is to maintain a highly trained prof~'ESiOllRl staff Who can p~vide the gllldanec and service~ rcq/iire~ to assm'o that the research ohioet~ves are achieved. All~Ortoiny of the research staff is a~ essm*tial and imteg~ai ¢haraeleristic of this erganizatien. If yotl ~hotdd t~qn[re anF ad~tionai infol~tion 813oat National ~na]Fs~s I Weald be hallpy to be of service. I have ~he h~l[o F ~o remain. "~O31~S wry t~uly, Senator IYa~:jx~. How many qnestim~s were asked in the poll~ Dr. HORN. ~hat is a hard 9~esdon to 5{any questior, s answer, fire ske , ~u)n i iona y '1 ~at s, f somcl~3dy says ycs~ you ~sk other g,,e~iorm. Tf th~,~ s~y no, yo~ skip a question and go on ~o ~till ,n edger section. So that, some peopl~ get asked more quesLions I,han edgers in order to elaborate oil the p~e~edlng an~wm'~. The total number ef questions identified by munber in the storey ~onn is ~60. Sena~orH~,vvt~,~. ~60possibiliNes! }4ight? Dr. Hor~. Yes. Smmtor H.~'~a~r, A pm'~on could have been ask6d all Et.0. Dr. HORN. No, because there are ~hree sections ir~ the middle. One section is asked only of people who had never smoked cigarettes. An- O~h~l" sPotio~ ~S Ilsk(~d o~ ~Ilo~(~ %%ho w~£'~ ~orJqq~F S/IIOK~Fs of cigaze~t~%

56 CIGARETTE L.~ELING ,LXD ADVERTISING and still another is asked of those who arc~ CmTelKly smokel~s of cigarettes. Senator tIARTS~. But the poll, i{self would take a conmderable time, even for anyone who we.t through the shol f~st port on, thereof. Dr. Home. The average length of the intel~dew was about 1 hour for the per~oa who had never smoked dgarette~ and abou5 1 hour and '20 minutes for the-De erson with a hlstolT of ~moking. Seimtor ffa~T~, it c[ea]~ with sabiect% some of which, had noth- hlg to do with cigarette ~aoking. Dr. Ho~. They :tll had stmle reason for beillg there in terms of its potential relationship Jo ~mking: and changing their smoking habits. Sen~ta:r HARlem. The first question started OUV-- First, I ~vonld like yon to rea~i with me a list of a ntmtlmr of things that mauy Deople c~qnslcler important 'Rhea, w'ill you tell me~ please, w]lich one is the most important to you, tha~, which is next me~t important to yOll~ lind ~c* o11~ to the last ? ] )r. Ho~m Yes~ sir. Senator I{*r~sm. That grouping w~s-- (a) hawing ti go.el family life; (b) being able to do what you wa~ted to do; tel being healthy; (d) having good frlemds; (e) doing work you care about; (Z) ll~t having to worry about motto.v, and (g) ~nJoying life. Dr. HO~N. Yes, sir. Senator ILUvrK~. And the second question-- Would you ss~v whether ~ person i~ healthy or not c]epends i~tinhv on how luck~ he Is~ Or mainly o~ hOW Well he takes ~qre of hlmself~ o~ dolJ~]~ds oll abeut an eqtm/mixture of ;sot h. A series ofqu uestions fol/ow I Dr. Ho~-. Yes, sir. Senator IIARTX~. Mr. Chairnmn~ I wmfld like to not mix the record up but ust for the sake of refinance for the committee whoever wants to look at i~ b~ reference, include the copies o~ these polls upo~ wtdeh ibis testimony was given. I ddnk it would be belpfu) if ~e had a oomplete rather than ~ selective returr~ upon the ~m~wel~ to these polls. Dr. Houm Sir, we are in the )r/x:e~ of receiving approximately 16,000 statiatiaa] table% some of which ~t~ in, off the computer, ~nd some of them are not. There wJli be a series of reporls as the tables bee)me available to us. Sexlator tLkeT~X. -is notthis poll don~ Dr. Ho~m A1] the tabulations are not vet ~ully completed. The poll h~kq been compiated~ the dat~ has all I~en punched on card% and abu ~t onsarestillht recess. Senate" IL~T If ~may Jn~en'u~t. ~e might make clear in the record if there is 1,o ob oction, we wdl rec~ivefcr ~he files the several questionnaires. ~Saen would you anticip~t~ that tbe full return on dm survey ~ ould be available ? Dr. Hoax. The table, all of the U~hles I spoke of. should be avaiI~ble very shortly. However, it takes time slraply tOpi~pare tbeI~} fix tabular form add wifb ~he necessa.ry de~riptlons of the poptllatmns on which they ~,'e ba~d, and so on. I ~mdd s~v Lhia would fake ~ or 8 months to ge~ all the material, to make adl th'8 material ~vaflable.

~G_%I~I~TTE L~BELING AND ADVERTISING 57 Senator HA~TXE. DO all of tho~¢ :[orms lind cb~,rts deal w~th tbls poll I~r. ~ffoRx. A 1 which forms. Senator Sermt~r HAR~. I am 1:or clear at ~h is moment what you arc talking about, Are you talking about charts that you are going to prep~l~ wldch are sep:~rate ~ad distinct f l'on/the poll~iinel f ! Dr. Ho~:¢. ~N'o. I am t~dking ~bout tabulations of the data that result from the analysis of the poll, Senator I-L~'~un. Of this poll. Dr. HogaN. Yes, slr. Sena(or HARTKE,. I though Dr. Terry wl~s testlfyh:g from the results of tb/s poll. Dr. HORn. Yes sir, he was, from Ihe 'answers to one series of ques- tkins whlak h~:l to do whh pub ic reaction to various proposed reme- dlal actions. This is o:~c very small p~rt of the total survey. The pr/mazT put ~ose of the survey was not ~u~t Lo ohtah: ~fis information. TlHwe wer~ a great mlmy other purposes in the develop- ment of the survey. S~nat~r Iff~T~. Including -~'tmt brand of c~ga:'~ttes people were smakSng .~ Dr. Ho~. Yes~ sir, that information was sought. Inltia]ly, the survey was designed to be administered befo:'~ Lhe release of the Sur- geon Gene:uFs report. We had hoi~d that we would have an op por tu~:ity at that point t~ then measure the ehange~ that too/: place h~ publlc knowle.d~!'~ public attitudeg public beliefs, after the ~e~ort of the Sm~gon t+enea'al's Committee. }towever~ it was impossible to do this. So we had to make do with a survey which was conducted later although this does provide a hasellne o~ what the presel:t stat~ of knowledge~ belief at:d attitudes are with rega~'d to smoldug as of October 1964~ wbicb was when the poll was taken. Senator H~xm'r~r:. Is th~ poll complete~ or ia}~t it co~nplete i)r. ]]omw. The anaiysis of the poll i~ not complete. The taking of lho poll is. Sen~ttor I~m'r~E. Returns cafmot be ~iven on the answers to these questions ~ You cannot give an answer.~ I thought you said you h~d 48 tested. Dr. ]-Io~r~ Yes" I can "re numerical answers to the distrlbutiong of the entire populatmn to any one of these questmas, i lmv¢ these tam o~ice now, in ~orm as t hey come off the conlput er. "~:at I am saying is tha~ it takes time in Ol<Ier to convert these to tables with sultableheadJngs. Everything is codt.d in the table forms as tbcy come uff the computer. There is no [anguao~ on these tables. Furthermore~ a series of t:~hles breaking thes~ ~oxvn by men and women breaking them down in various age grou )s vltrious sc~ial economic claases~ and so on, a~e st~ll in the proee~ of be:n~ run off. Se~tl~or Ha~'~ Mr. Chalrma~ all I sm trylI~ to do Is ¢t the resu]tsofthepo]l. IamnottcosureIknowbowtogetthem. ~anwe instruct then~ m give us tbe answer some time, some place, before these bearings are completed Senator ~l~wv. I take ~ that the complete tnbub~tSm~ you would antici ate to be available ia 3 months ? ])r.~Io~. Yes, sir.

C~GARETTE LABEL~G AND .4J)VERTISENE+ Stmator HA~'r. I t~s~urrm lhat mlpldyinff the rew data to the com- m iq I e~ would not ergigh~n us one bit, wou]d it ! Dr. Ho~. I am afraid it wouldn't, sir. Senator H/mr, I sympathize with the Senator from IndianWs defire to clarify the exteaLt to which the fi~ire~ that 10T.. Terry gave us are corn lete and fi~mt. D~ I take it that yoli now know tha~ of ~]l Ihe peol|~e surveyed, 77.*/of them agTee wi[h the statcmenL a~ Dr. Te~'ry indicated '! Dr. HOR~. Yes, sir, this lrmterit0 is eumplel~ and final. And th~ responses to the "28 srl~temen~s thIH. 1of erred Ix* lemedial a~tlons are el)ylip]t~. TIdH w(~ [~liii nltl~e ILVa d~d)18 it) tht~ COll:ul~i~ iminedla*e]y. Selu~lor IIART. I assume *lleib tllat wl~ott we should plmdently do is ask fllatyou give us ~]1 tlmt 3 on now h~ e in final ferns and the staff then can, through the Senator from Indiana and ether% determine if there are any other quesl;ions t~at would be helpful, i~ lhd is satisfactory. Senator HaR~. It seamed r~ther remarkable to me that we have a matter of a poll resu]~ here oi2 behalf of the tesihnony from one of tile principal witnasses who is here tod~y~ and we find Wd~y the rest of the poll is incomplete. Senator Y~T. Th~ re~son for my asking the clarifying question is t~ set~ if this is true or not. :Dr. TerQ" said 77.7 percent of the people asked ~greed with the statement that cigarette smoking is enough of • health hazard and for something to be done about it, is there any modificotion or ~d~stmenv yet to be mltde of the figure 77%? Dr. Hrmg. No, sir. Senator I~. ~q~t modification or ~dditlonal inforln~fion will be av~ihb]e when y~u complete the poll with respect Lo tills question Dr. Ho~m In timt p~rticular question, we have an eaalysis of thc i$ remediM-~etion items in which we have presented tha ext~nt to which pt~op]e ngreo or ilisl~gre~ w~th fh}s ~Sltelnenfl wlmrl it is pro sent~d at the be~innlng of ghe inIervlew and when iL is presented at the end of the int ervaew. ~r]~e llit is presented, stated lmsltlvely when i~ is presented, stated negati~;eIy~ when it is pl-egent~d at the begiltnin g of the sequenee o~ the remediai-a~tion guestions~ or when it is preserged a~ ~]m end. TI]~ are col~lpal'ed t~o show the ]el-cenL~e difference~ which ~111" according to the.% variations n p]acemea~t in ~]~e structure ef t ]e interview ~nd in wording. This is e~sentiaI because stability of response across the~e various means., of presentations. . i~ one of fl~e ~hniques that. i~ u~eg. ~[1 l)uhlio opinion polling in ordm" t~ ~mlre oneself that one is dealm~ wt~h an expression of a bm~c opinion rMher than one is receixdng ~ result thg~t iS more or less predet el mine~l by t he wording of the questioD. Senator II~. If ~r. Terrv's statement had~een prepared three months from ~low artd tie t~blllation had been e~Jmp]eteg~ as yml stay il. will Ira. wouhl t]~ere be any vaa'iati~n in the staLemtqlt he mad~ today~ Dr. ll(mx. ~o, sir. That statement is etll~eet arm it stands. Senator X:L~lerK~. L~t nle ash you~ is ~hat bese(l on question ~167

CIGARETTE LAB]~LIN~ ~D ADvEr~TI~(t ])Z~ IffOP~. Yes, sir, Question 21t3, ill form A~ t]l~t g~ppears wlth a diffel~nt questioil number~ but it is basically the same question in the ot]£er fm~ns. Senator HART~/~I. Forllg- -&- is the white shee~ Dr. Hom~. I have here sir, ~ nine-page report on ~his section of the su~'vey whid~ i~ complete a]ld deta ed for the '23 remedial-action sections. Ii" fl/~ c~nmlitti,e ~ w~shes, flti~ c~,d he placed in the re~,ard, Senator H~r~. I thi~k ~hat mighB well he in the record. Senator lq~rrr. If there is nv obje~io[b it ~ill be Ju the record at this ,p,o] n ~* (q£he report r~4em ed t~ fell ows :) I~E~ED~,~L AC~ION ~T~.TSME~TS: PA~r O~ ~ NA'~O~AL ~UDy 0~" S~OKIX~ ( D~niel ]~orn anrl ~elwyn IVain.~row ) In O~6aber :1964, a l~aLienul prob~lhility study of Smoking b~havior, attittlrle~, and beliefs was conducted ul~der Public Health tgerviee direction amo]~ adults, ~1 &nrl over, ~I1 about ~,,~00 11 ouSe~lO]tls £rDado~y seloetefi in II]~ i}lt ~e~et ~ ~ s~mlDle design within leg primary sampling units ~rom whi*]h were ilr~wn 42q, ~e&-nmnt ~ The Inter view itself laste~ from about 1 hour t~ ~n hour and a ha!t, d~pending U.90~Z the pers0u'S ~Z~0~g h]st0r~, and inC]tldiu~ among ~h~ C!ueat[or~8 ~ ~gr ee' ~21~oa ~fio~ O~ 28 ~(Rb~ln~rlt~ veld~h the iules~ig~t*/rs have l~beleO the "renle{ila[ action ~atemouts" ~inee they rleal with either general or specific ~etlt>ns ~leh mlgh~ p~*sslbl,g be O~ken in the. control of ei~l'ell~ ~mnRi~g eflitori~ls, al'fi(,le& or letters t*} the editor after the report to the ~urgocm Gelleral was r~i~sed o~ ~R~ry l [, ]/)64, an~, while l~*os[ of their original [~ne a/~ [nt ~,~ t was generally maintalmu/, ~lley were usl~ally paraphrased in o~der ~o bet~r fi~ wirllin tile context of al) inlerview sitlIstJo~, AS p~l't OJ" ~]2e ~'~are~ d~$i~ll the fltlAte~lent6 were tw~sented differently J~ the follr 2ornls used by the interviewers, with ~he seleetio~l of the ~Ol'm to be us~l being predetenni ~e{I on a randomly selected basls s~ t~t e~ eb r~8i~ndent %11e tlLLr~renc*es ~nd ~imii~lrities bet'xeen the four ferlns~A, ig, C, ~nc] D- are as ~ollows ; wol'~ng.--Some of the statements were werdecI exactly" alike on RII four fol'~r/8 btlt oth~r s£at~lJlell~s were Dresol]lol] con~.ersely in erie ef t~e fovsns (l)). ~0~ ~ y~m]/}l e, i~ f~rm8 .&, ]3, and C eont~ine d~ IJm iiosi tP~rl v er~l[o~ of a ~t~e~ent~ then otl term D t~ converse o£ that s~atemeut was presented, that t.~ a mcgat£vely WOl'i]ed ~er~ion, The l~erce~l~age agreein~ Or dJSag[eei]l~ 1~ response r~ ~e verslor~ ~i'~e[i ell [,1~ J'~;HI~ (ft.* R, &12d 0) ~re pl'o~i(J~'d 111 {'0]~11212 ~ £11t~], ~orms A, B, (3 of the attached table, while t))e l~er(enta~ ]'or the conver~e ~mtemmlt are pre~ent~d in column 3, form D, Cow,verse. Idowever, the a~sur~ed effect o£ differences in wording is bes~ estimltted, ~or reasons expllllu~¢t below, by ¢~lrlporing l~*l'eentetges in eo]l~lllm ~, l'~rnl D witll '11to diff~l.e/l.,es i]2 t]l~* i}~l~en~a~es between ~hese two ~{Irms are ]isLet] i~l column 7, [~-D. Wol,d big. ~l'eSe]l~(~ ~Sfly i~ ~he Dltervie'v ~Jt~f~fion in reties t~ and I), bRt late Ju £orlu~ all~ ~. Al~ollgh in £e~l~s e£ /heir posltlrm ~iLhl]l the Jntel'Tiew ~l~exlule ~orm d R]2d 7) ~1~ equal ss are terms .~. ~nd 1¢, Lhe best estimate /if the assumed effect ¢2 position upon ~nswers is achieved by eompari~ th~ i}~reontages in ~'he dJffereilee~ irt tJ~e poreeutage~ beh~een these two ~Ol'IIIS are lister1 in ¢~[11 mn 8, A G, Po~itie n.

6O CIGARETTE LABELI~rG AND ADVERTISIi~G Ord~ within ~ht8 particular se~es.--The statements ~,er~ predated in the ldentlc~l order ~n f~rms A, C, and D but ~ere r~ver~ed on ~orm B, with the I~, first, ~nd tb¢~ first, l~t~tt 11~1d ~c* ¢Jn. ~ince there Wer~ ~ ¢Jdd numb(~r o~ ~tatements, state~aent ~o. 6 ~ this leport (Letter I on the ~olms) remand in the middle on ~l[ fo/~ ~rin~ For ~pp~r~t reasonz described in the ~bov~ ~wo se~ion~, the ~m~med effect ~f the or~lcr ~f ]pre~ent~ti~ within the ~erie~ of ~t~ement$ i~ be~t (~s~im~ted by c~mparing the F~rc~nt~ges In column ~, ~'~rm B with those in c~ll~mu 6. form A. Tl~ dl~crenee~ In the ~¢entages betwccn t]2~ two ~orm~ are ~iste4 ~a column 9, A-B, O~]e~ Yhe perc~laye~ a~d d~ere~e~ bellveva lhe ~ercent~es,--Th~ following is ~mi~te[[ &~ a g~n~ra] guide lo tll~ sta[Is~]~al ~i~ili~ l~c~ o~: th~ d~ta presented ; Since e~ch of the form~ wa~ u~ed in apl)ro~imately 1,2~0 int erviewsl ~he ~t and. • rc] error ~f ~t g~en pedant obtained from any on~ form i~ in m~st ca~es ~p- proximately 1~ percentage ]p~int~; therefore, di~erences betw~n percentsge~ r)b~a~ned from two die.refit foi'D~ &r~ probably n~ stati~tico[ly slg~l~l~ whe~ the diff~r~]lce ~s le~ th#~ 4 l)erc~n~ge i~int~. In ~$~ W~e ~ ]~r- ~e~]tag~ being compared ar~ less th~n 20 perc(~l~ euch (it ~re L]aO.I~ ~0 percent each, differenves of less than ~ Del~e~tage polnt~ ar~ probably ~t ~$.atL~ticall~v A[tho~lgh pt~r~t$1g¢~ ~¥~. h~8 gi~l in tsrm~ o~: ~Fr~e" ~r ~dis~gr~e~~ pelu oe]]t ~lg~$ ar~ ~lso available ~oa" each sfat~en~ illdtca Ling th~ ~t~nt t(~ whi~}l Ih~ p~si~i~t~ W$.~ *'~tron~]yTM (~r ~ai]dly" held. |n ~ddl~[o~l. ~([tho~h I]ot pl~nte~ he~e, ~r~ for each ~tateme~ ba~ed t~p~n ~ /iv~-poin~ scal~ ~r~ also ~valD.b~e,

CIGARE~B LABELING ~D ADVERTIBING i m~ +lir+i~ji+iE~Ti+it++t+li++~.lli+ rl ................................... ~ ~ +1 T TI +1 II ,i I +J ++ + 61 c~

62 C, IGAR~TTE I,.~ELING ~D ADVERTISL~G + II~ ÷ ~+ + ~+ +E+ + + ++ ++ + i• o<~,~ +l++lJ+i +l+l~+' +l~l+ I++i++ii+E+ ~N=NNeNN~NN,~eg~;NgNg~N~NN~g~Ng~N~ a~

CIGARETTE LABEL~C AND ADV~IITISING 63 Senator HAR~E. Tile d]fferertL colors mesa the questions were at" rangedl in different order ? ])n HC~N. Yes, sir. Therl~ a~ four different ~rms, A~ B, C~ and I). Senator H~i{'c~Ji. ]But/he ques%ions basically, what you ,ere saying, ar~ the sanle in ttm ~our q,Jeslionnaires Dr. Hot~N. T(~s, ~ir. There are r~vlslons in wording. Some~ime~ stat~ment~ itre nmde posidvely~ semeth~les negatively. The order of ]')1~ seIlt ii ~ioD var]t,s sl}ul~wh~[. S~nat~r H~R~. I think i~ would be informative for the c~mmltt~ to l~k at fills series of q~e~dons i*t 916~ becaase it is quite l~lgthy and it will require a ]itde bit of retention± to remember wha~ eacJ~ erie of them was in time. I thi*~k it is all vary well. I am not obiecting t{* dm poll. I am just tryhlg to find out what tile poll shows. Seamier HA~T. i think it might be useful al this point in the record to select th~ series of questions that arc coal ained in th~ question 216~ and th~ balance of dm n}atcrial will ba in the file. ( The re~orred to question follows.) 216 (Ask everyone) AgMn, I'm glli~g to tell you what some people haw said ~nd, ])lease tell me whether you strongly agree, mildly agree~ m~ldly diS- agree or strongly disagree with these sT~temenls. (a) The general public knews all it needs to l~ow about th~ effects o~ ~mok i~g and health. (b) Cigarette smoking is encmgh of a health hazord for something to be done about i~. (v) It is not the Gow~ament's business to do some~hLu~ about eigarctt~ smoking ((/) The smoking ~f cigarettes should be al/ow~I £u fewer places than it is now. {v) The adve~tisin~ of clgarett.es should not be cor~troI]ed or limited. (~) Individual doctors should be setive in making speeches to the general public about lhe barm£alness of cigarerte ~] eking. (if) (~[ga~e~te manufacturers Should not be required to rut oa tl~o outside ]~aekage a warning label like, "eig~rett~ smokiIlg lu dangerous to health." (h) T~e Federal Oovermneiit ~h~nhl continue its practice of tobacco price support for the farmor. (i) '~here shonlfl he more education e£ the public about ~he health risk con- me~ted with smoking riga r et~(.s, (~) ~les ef cigarettes 1~ people under a certain oge should not be against thelaw. (~) If cigare~te~ are really harmTu] then }~ederal Government mm~ey should ~pont on research to find out why. (Z) Cigarette companies shouId be required to put on the packllge ~le amount of tar and nieatlne in their cigarettes. (m) Selling cigarettes ~hrough cigarette maehine~ shou]4 not be against ~he law. (n) Athletes and entertainers who ure well known to yo~ters should not be used in cigarette adver ti~ng. (o) Cigarette *ldvertishlg or commercials should net be reqnlred to curry a warning sta~m*nt to the effect that 8mokir, g may be harmful to health. (~) Federal Government money 8~lould be spen~ on rese~r(b to develop a really s~fe cfgaret re. (q) There sl~ml]~l be a speeis/ program (ff edneatlon abou~ vigaret/~ sraokin~ ~d health aimed lit the dren ir~ ~cheol (T) Cigarot t e ad ~ ~rflMng sh(nlhl be stOlll~d eOUllO]r'tely, (.*) A cigarette company zhmtld have to prove that its cigorettes are not harm- ful to hestth before they are silo i'~ e.1 to ~/1 them. [~} Clinics to le~n how to give "~p smoking should be set up to help those who w3~t to quit but haven't been able to do it by themselves, (u) The selling of cigsrette$ should not b~ stop~'d completely. (v) Taxes or. cIgaret£es should he much higher flhan they are no*w.

CIGARE~'PE LABELING AND ADVERTISINC~ I ~ I Nothing should b~ do~ about ei~arette~ until the cigarette I~allufacturer$ are given tt reasonttbl~ omoullL of ~im~ ~o come 1113 with a safer eiga~et t ~. Senmtor I-lal~T~CE, I will leave the poll I am not sure what we proved by it. I will lesveit. Dr. Tert% on lung canc#r it~]f, ~1~ there otll~r factors which ~t~ ~mlsidered to he the cause of lung cancer? Dr. TE~Y. T]ler~ mxy be other factors~ yes. . Senator lla~. A~'e any ~f them considered m~ufieant ? Dr. rXRRY. I would say tlfis~ that tim committe~ weighctl the seien title evidene~ rela~ing t~ the c~use of lung efmoer ~nd reltched tl e conclusion that this was the primary clmse of hmg c~ancer in thin country. Senator ]t~R~K~. Is thet~ any diffe~enee based upon th~ section of tile com~ try in ~ hieh peep] e llve ? ]Dr. TE~Y. There is some diffe*~nee. There is g slightly higher incidene~ of lung-, cancer among clty dwellers than ~rnong rural dweIlers. Senator H~R~. In f~et, ~ou rn~tlle o, fandJ]xg of that just recently, h~ve yon not ? Dr. 1¥RRy. Yes, sir. Sen,~tor IGt~T~. Aa~d published it off the p~ss today ? Dr. 'i~v. I believe it has been published, 3 es, sir. The information has been released. St'flit for HA]~TF, N. This is the publicatlon~ "Air Pollution and Respi- ~,torv Dise~mes." It is your publicatlon ? I)r: "I~xx. I believe so ; yes, sir. Senator H~lvr~. This is the st a~emealt thut~ "~hlg presentation m~st be viewed with the knowIeflg~ that the cause of human Cancer generally is not now kllown, even thotlgh we do know that we can aetUall bring Oil cancer in certain mmmal~ treated in a special way. Dr.T~lci'. Yes sir. Senator I~.*rer~. You s~gt~e with lhat s~t~men ;~ ¢, Senator HAn~r~. And-- Lung cancer occurs with higher frequency in cities tha~ it does in rUral are0s with their lesser sir poI bltitln. Dr. TE~Rr. Yes, sir. Senator ]:{~T~K~. And Thl~ ls fOll~ t~3 be the ease even when eorr~ti0n of the data i~ made for all the factors than can be reeogniz~w] and centre*list, in¢l~ldL~g m~aoki~g, variation In population density, alld occupation, Dr. Te~wr. Yes~ sir. Senator ~Ia~xx. And-- ~l=ne alr of urban areas i~ known to carry ~ore of the p0t~ntlal c~nee ~'-]pr ~due- ing agenLs tlm~ does the air in rural areas. Dr. T~m~v. Yes, ~r. Senator tIa~T~£~. And-- In fact, one sneh Inve~tlgation has shown a direct agsoeiatt~n between the ~ar!dng amounts of benso(aIpyre~e {a labOratory proved etmcer-producI~ agent) in tJa~ air and tile vartatiotx ~n lung cancer death rate. Dr. TEmpt. Ye~, sir.

CIGA]~ETTE LABE~IAG AND ADVERTISING 65 S~nator HAR'r~. Tile sllmmary : Air polllltion, aS it eXi$~ in 8ollle of onr c om~qllllid~, ~ntr~but~ sI~lific~ n{ [y as a ea~s~ or aggr~l'adll~ eaetor for the following medical c0/lditions: Acllle i esph.a to~. Dlf~eti~l~, ~hronic brllnehltIs, ehr0ni~2 e0tlsrriet]~-e ventilat~ry ¢[] se.~e, pulmoDary enaphyse in R, brollchial fl~hma, l/~d [ling ealleer, Is (hat cerrect I ]Dr, T~mxy. Ye% sir. Senator HART~. Those are 1111 rite questions that I b~ve. Senator HART. If there is no ohjectioa. Senator Morton ! Senator 3fORa~m Dr.T~rry w~g,ot into the ltalia~ thing a litt]~tdt alas morning. I think you said IT~at after they st())ped advertising elga~tica in Italy~ that the s~l~s went up only ~l,out 11~ percent It, ~ Ll'/le. JSll~t it, thaf American cigarette ex lofts to It~ly went up 39 percent in 1963 and some lg percent in 1961 ~ Of course.the total consumption could h~ve been down, but I assnma that Presld~nt John- son is very hap]py w]th the tact tha~ ~ e ],ave done that much to increase our balance-o~p~lyru~nts problem wIdeh I worry with as a member of the Firlgnee Committee. I hike it. Dr, Tcrry~ that 3'on accept fl~e findings of your advisory eommitte~ ,~ Dr. T~my. Th~t~s right, slr. Senate~" MonTox. And you s~|d--and I quote : The//mit of our r~pgnTihillty l~ to i~l'e l]~a~ each Jls~ J 'Tid~lal h~S f11]] a~F~3 to the available facts oft cigarette slnoktug as il lllsy s ffecf his health and aMli[y tO p]'ov[de for hllns~]f 11111] his falllil~, l~eyoad ~his. the decision to tare I1]] and to continue to smoke is autl shol~ld remaill the prerogative I)~ the illdivi~qttL That wa~ in file Progressive Farmer, the current isslle. ] c~mtlnend you on th~l, st ~xl emea~g. Nmv, let me ask you first about the ft~efs on cigarette smoking, which you a~¢piroviding on purpose to the p~tblic. Am I e~rreet in saying that the f~ ets you are proxqding are largely based on fhJs repro% which ~,~s been acc~ pie by the Pub]it Health Service ! Dr. Pc mr. The fgcfs I hat I am providi g t} is ~, nKle~ here are largely [rased on this eommittee:s report. This is tru% targelv. ~en~ter Mom'~x. ls the Service informing the mblic thr~t ~here are rep~tab e doctors alld sei[!ilk sis W}~O d sagree w th tile c~rle llS]ons which form the b~sis of Lhi~ report 3Dr. iF~,:~m~. Yes: sir. I think it is well kn~own thak Lherc are d~ctoi~ Who disagree wkh it. Senator -'VIORTO~'. ]~Ut is the Pud]ie Health Service giving the same attention to the fact that tl~ere is disaga'eament to the conclusion~ of the report Dr. TError. No~ s~r; we are not giving tl~e s, me ~ttcntlon to ]g be: cause we feel that the evidence is so ov~rwheJming on tile other side that it doesn't deserve fh at, sir. Senator M o.~'o~. E~cn though there are--~nd they appeared before the House Comm~ttee~many eminent physicians and s(dentists who tak~ the oti~er s~de of the coin. Dr. ~,~. There are persons who do. Senator MOR~O~. Wouldy'ou ~upport this statoment that I have he*~ from Dr. Gutht~e, who Iamderstand~ was the st~ff director of this ndvs:'ye~ mt ~

---

CIG~ETTE LABELT-N'C AND ADVEIITISING 67 Senator TE.~SON. Dr. Terry, I will address a couple of que.sfions to T011 but perhaps Dr. Hol~o might ,wn~ [o make ~m observation, i am concerned about flint par~ of this legislation theft refers to the labeling. Iwonde,.asl ink be, iidm'mgthetest~mony~Idoubt ve'~ seriou~lv~ ifmanvpee/lcpay. . a ~ ton ea abe 'on a pack of cigarettes except tlmt perbei/s d m~gh~ have a greater effect on the new smoker or rite poteTitial ~amk~r. Would ycm s~ty thnt ~as a rot'roe t obsel%.at ion or ff~on c] U~lOll 1 Dr. TzemY. I ~ould say this, sir. in thM z~spect : I think theI~ is reasonable question in our mincl as to how great the influence wi]l be. t~owever9 we do feel ~h~t there will be a defirgte infltlene(~ ill the direction of diseoura~ng stacking. Senator l%:.x~so~r. You t~aink i~ is just a eontrlbution, as you said tiffs morning, towards the tul .c~lional a~peet o~ this problem Dr. 'l~l~ity. Thll( is col~['~el~ sir. Seawater Pt,~.~.s.~. Would you. }3(¢tor aga'ee with the wording that is~mtM,mdin Ithinkitls BerttcM nbet~b '~lr~iBg: continual cigarette smoking ~ay be hazard0~L~ ~o ~o~r health? I would ]iIre ¥(nn' observalion on the wording contMned therG • belleve it is the'same in both MIls. Dr. 'I¥~mv. It ~s roughly the same. On the other hand~ frankly I have a wording zhat f would prefer to eitb cr of iI,ese. Sons,or P~SON. ~Vf, st]l hi. your ~lut imoily 6hls lllorrlillg ? Dr. T33an a'. hro. sir: ~t was not. Sonz~t*3r P~AItS(~IN. Would you give us the benefi~ of yore" thinking on th~t~ Or. T~RRY. Surely. I believe that the following wordiu --this is mv personal reactiork slr--tha~ the following wording woul~ be mm'~ effective: ~Igar~Lt~ ~l~lOld~ g is a ~e~iou~ health ha~l ~I and ma~ eat~e (,~ near ii~d other Senator P~:~t~so~-. What is the effect both in your language lind ill the language of one of these hills of the wor:l "ma~'~ Dr. T~Y. I think just exactly the wuy yon ~e~d ~ thet it will not do it ill every restart c~, l~ut It 1 n P~3'. Senator P~ARsom Dr. IIom~, do you have any thought on that on the~.i.g.niflcanee .... of the word "may" in this . The ~,x~m. I a.sh the qnestmn is that I think if I smoked c~garettes lu~d pmhed u ~ p~ek ~md it said "may" thnt 1 IWolmhly wouht feel that thi.~ m~g ~e so for ~n~ c~ pe~ple~ hnfl p~rl~ap~ not for me. Dr. IIo~x. Sir I thi~k in order to be teelm~og]]y correct it is neees- s~rv to put in that it Inav c~us# c~ne~r, because 1[ ecrtltinlv does IlOt ina~'itably ~us~o~eer. ]in teycnsofitsh~flnen(:eoit ~h~pu~lio which is an ent h'e] y diff~ ~mt q~msli<m Senator PsA~som That is the point, gghet is tlae inltuence on the pttblie of the word "may" ! I)r. Hoist'. l)r. Terry~s recommended wordin~ does state that it % a ~r~ous he~ 1 th haz~rd. This i 1~ ~tl~temt, n t of hmli W]l~Ch ~s appropri- ate and does not h~ve ~my qn~lific~ion~ in St. I don't think it would be proper to state that it does cause or that t nevit~bly causes cancer, bee~ttse it simply does not do thi% inev -

CIGAR~E LABELING ~D ADVERTISING tsbly. This is a matter of the technical characteristics of the statement alld the t eclmical accuracy of the statement. Senator P~so~. A~F languag~ Dr. Hol~. Rather them its effectiveness. Senator P~soN. Dr. Terry, let me ask you this: In this labeling, how many people would understand rke recith~g of an average yield or other index of b~cfimlaath]g agente? I tlfink that is contahled in this bill. I~ that is I)rinted on the package, is that going to serve a good pur- oSe only as competing cigarette eompmfies seek to measure their capa- bility i~ takin~ ou~ these agents, or is it going to have any meam~ for (he people.~ o ]Dr. Tr:a~a-. I think that this i~ a que~ionalge fealm'e~ and it i for that reason that in my testimony we suggeested that the type of con- t~amlnant or material to be labeled should be left up to regailatlon, because I think there is serious question ~nd it would involve further study before I would be able to make a definite eommRment on it. There is a general feeling that the lowm" the tar arid nicotine c~ntent probably t he lower cel~aln of the other hazardous substances are. But this is open to some question. Senator P~aRso:¢. On page 8 of your testimony thls morning you me~ttion tlmt the FTO standards must provide--anti I quote now : Provide for the elimination of all advertising ma~er wl~ch terlds to make cigarette ~moi~ng attractive to ehildren. "~Vhat kind of adverfishlg did your advisory committee or you have in mind ! Dr. "l~n~Y. As I recld], our adviso~7 committee dkt n~t spled¢ 1o ~his subjetff.. Sc~ tha£ mtytkillg lha~ I say wtm]d be speakh~g for myself~ alzd for my orgunlzatlon as I got it from my staff. The ma or thing one refers to in that respect has to do witb the ~gge~ion in pln'aseology wording advertising, which would make it appear that a yom~gster needed to smoke in order to ffain the primal- nonce of adulthood or the social r t!l~O~l] l]ll]/ Senator P~so~, Or tbe football star who smok~ aX" brand and so forth~ Dr. Trmt¢~. ~es~ sir. This is what we were referring t0. Senator l*cansoN. This i~ going to be tremendously difficult to (to~ isn't it, in the fiehl of advert~sing~ balanch~g off tlmsa interests and frexqloms and so forth Dr. T~a~. I think it will ha~e its difficulties, but I don't Odnk that it is unmanageable. Senator P~I~SO~-. Thank you, Doctor. Senator HA~T. The Sena(or from O~g~n. ~fI~. Ne~berger. Se ator N~an~r~. ~Ve have so many wirncsses today~ I Ila~e to prolong this. Senator II.,~. May I iuternwt tv say that Senator Bass was tee un'ed to go to his office for an appolnt ment he had long bad, but he indicated that he ~as very anxious that the Surgeon General ?lot. leave before k8 got back. Maurine feel very free D . Tzvur. At your d~recfmn~ Mk Chairman.

CIGARETTE LABELING AND ADVERTISING ~ Senator INEU~Rarm I am satish~d with the report of the Surgeon General. I read "Smoking and Hea]th" practically word for Word. But Jhere was o~e question I had irt the testimony on page 6 : We would fortI~er recommend that flee regulatory agency be authoriged to require the mamtfaetmrers to provide the Agency wt~h information as to the ing~edients, including additive% of <-igareete tobacco. In other words this is not now done. You juse take on face value what is in the cigarette, is that it~ Dr. 'i~mY. May i ask Dr. tfundley to speak to this, Seamier Neu- herger ? I)r. ][IUNDLEy. ~e havB no wLty a~ tho moment of ~nowhlg what mamzfacturers do or do not puL into cigarettes. There is no disclosure reql]irement and dlsclosl~res are not made. For example additi~-es of various kinds are used in cigarettes. But we have no way of knowing whetkel~they could add an~bing if they chose, and we would have no way of knowing. Seit~ttor ~EUI~EI~(~L~R. ~OlI l[le~lll ilke iil~trihuEIxlfft I)r. IICNDLEY. Tec]mlcal]y~ yes. Senator ~E~E=Oe~. You mean they could put in a few poppy seeds? Dr. IIuNDLEV. There are no standards of idelltity, if you wiIh Senator NEI~EROER. I would thi[~k that no matter what ]mppens to any of this legislation that we ought to have some way of having a requirement of knowing. Wc know what is in bread, we kamw what is in c,~tsup, we kllow in all studs o f goods we consNme. It would seem logical~ at ]east. We are goin~ to go on and on all week with varlous, testimony on both sides. IPe are ~ng to have reputable and eminent doctors speakin~ on both sil/e~ of t his subjert. I am interest ed, t houglh because I dt~ hellene in st at isties, that a few statistics at tiffs time for the record might be of interest,. More than 60000 physicians have made {~ c~ear in a natlonw~d~ sure'e3, that U.S. medical opinion is nearly mml~knous on one subject : Ci~a~x.lte smelting ]s dangerous. Many physicians report they have c]lan~ed their o~n smoking hid}its hy s[o ))illg cutting dowE o1~ sw~tcbin~. ~ away ~r~m clonrettes~ .: Tb~s survey" was. cond/Ictcd by the me&ca[ 3ourna], Modern Medmme. A questmlma~re was sent to the 19°-,O00pb'~'siciatlslnactlve. ]2rac ice an¢ wasre urne byh0¢0o,- ~ nearly a d~lrd. Tl~e resuhs a ~pearm~ ]n the March ~ issue of Modern Medt* ck/e showed that 95 )ereent o~ the zespondents declared dm~ belie~,e ei~trett¢ smok ng is a "bealtb haxard." Evidentlyf~eople in the medical professic~x believe ia question* aai~'~s and polls and statistics. AIso-- A 7 yeae 8rn03" eond~cted by a L~mi~qille. Ky., ~urg~on shows evidence more convincing than ally prvvious data fi~a~ there is a ]itxk between l~*lmeco and cancer. This ~tudy Involved 102 ean(~r-m~eeptilfle smokes, all of whom ortce had cancer of the ilio/,th or throat. It wF~s ('eildllet~f] by Dr. Cimdnc~ :Moore of the University of LouL~vilie. School of Medicine, and was relmrted in the Jam nary ~ issue o£ the J~urnal o~ the American Medical Asaocla~ioll. I am not going to take time ~o read the ro~st of th~s hut 1 would lilv~ to have it inserted in the reeord~ as well aa the evidence from the Mexte~m Medicine publication.

70 C1GA-RETTE 5ABBLI-XG .~ND ADVEI~TISIN(~ Senator }IA~, Both of rinse will be mad~ part of the record, (The aboye materi~l follows :) [From tha f~uver ~f~l-ke t ~e ~,s, Jax( 2~, ~9i~] ~E~EN-y~AI~ STL~" Op ItU~2.N$ LI.NK~ CA~, T(~A0~ CH~OAC, O. A 7~ear ~udy eou(lu('t~d by a I~ot~sville snrgeOll shows evi~]l~ ,3nnre ccnvineltlg" than any previoua d~ta thaL there i$ a link betwee~ tobacco a~d cua~r. The ~t/ldy ~lVO]Ve(l 10"2 "(~/iC@r susceptible" smoker~, all of whom once had e~eer of ~he }~outh or thr~ah It was conducted by Dr. Conduct Moore of the University of Louiswlle School o~ Medicine and was reported iu the January 25 issue of the Journal of ~he ~leri~an Medical Ass(~eiation, The patxeuts, according to the doctor, were divided into groups o~ those who eontinaed the use of tobaCCO and those who quit, Ara~llg 6~ patients wi~o con- tinue d, 21 developed e:~neer s second tlme in the %obacco area" the dOCtor said; whllo only 2 of 37 in the ~o11~) el "quit±ors" developed eaileer a secol~d time. ~Sueh ~. finding ivOtlld be quite arresting in a laboratury study," the d~tor noted, "but in a hv2~a~ study it is doubly so.n He noted that '~he study implicates ~ob~lcc0 in the caretno~enic pr~ss more ¢~n~incingl~v thall ]prevtol~ .~tudie~ hec~use i~ al)proximate~ aa ideal planned htmian experlznent, althO~lgh it wa~ a¢~u~lly ~mly ~ii observation of a natural occurrence.:' Dr. M~ore's eonelnskms Luetuded ~he ~ol/owing: "In thll~ smokers who do get mou~h-throat cancer, t~bacco appem~ to play a n~,{~ssary, eo.uea~l~e role in 90 ~roellt o£ them. ,,Smokers who Sto]~ after theh- first mouth-throat cancer ~m only • small risk of g~.t~i~ another?' ~ost of the secvnd-time esneer victims were (~igar~e smokers, Dr. Moore pointed o~t. 'Phis wonld tend to re£ute £he ~easonl~ of "most older reports," h~ said b~¢.~use they 'Cleave the llnI)ressiou that only cigar ~d pipe ~¢kers, or ch~wer~, gctlcraIly acqatre mon~ c~l~car, ' "It wonhi m~w a~*pear that tobacco in any form can caa~e cancer of the month and ~hroat," Dr. Moore ~'epotted. ~e said the study did ~ot intrude recurrences O~" ~ld can nets as o~I)o~ed to the £o~atto~ ~f new one~. Only t~amors which appeared 3 years after the first had leben removed~nd a~pcared ~n a different a~.ea of the mo~h or throa~ were eoun~e~l Lu the study, fine dOCtor ~aid. [~m the Modern t~edletn~ publie~c~lons. Ins,, F~b, 24, 1964] M~x~ce~s~ ~'~'.--~ore than 60,9(~0 phyMcian~ have ma~e 1~ clear in ilationwi~e 8ui~ey that U.S. raedleal opinion in nearly unammous o~ One SUb- jeer : cigarette smelting is dazl~erou~. Many physiei~ns rel)or~ they bane changed ~hei~ own smoking habits by st~pping, cnt tb2j dw~ or switching away ~rom cigarettes The sarwy was eo~dueUed by the medical Journal Modern Medlvine, k questionnah'e was sent to the ~92,C~30 phystetan~ ha actil,e i)vactice, and wa~ r>turned by 60,202 nearly a ~hird. The ~SBlt~, appearing in t~e March 2 issue of MOderi~ Medicine, show that 95 percent of the resv)ndents declared they believe eigaxelte ~oki~g is a health hazard. A~ to their own habiLu, 80 percent said thoy have snacked at some time in their llve~ At present, he.ever, 52 percent do not smoke, an& many who ccl~tinlle to smoke USe cigars and piDeS. 0ely 225 percent are nOW smelting ek~arette~, antl 89 ~rc~nt el" theSa consider the habit a health hazard. Slg~fl- cant, too is t~e ~aet that thoracic (chest) surgeons and I~thotogists, specialists me~t likely to get fr~iuent, good looks a~ the lungs, rank at the very bottom o~ cigarette, smoker~ Slightly more th~n half the respondents said they had changed their smoking habits. Of these, two-thirds ehal}ge4 by st~,p!0ing entil~ly and the ~emainder either put flown, switehe~ f~m eigarette~ or. luuoh le*~a f~,qlls~t~y~ ~wl~hc~[ to fitter cigarettes.

CIGA~B'l~l~ L&BELING AND ADVERTISL\G 71 Only 14.5 perce~ ~f these doctors attributed their changed ~abits solely to the I'.~ Public Health ~ervice report on smoking and hea]tJa, which came ou~ ~hortly h~fore tl~e ~urvey ; ~.4 13~rce~t W~r~ J~fl~ced by ea~li~r r~orts anal 6~.S percent by ot~er factors. ~lany cited more t~an one o1' t~ese re~tson~, Among ~y~icla~ ~dvi~i~t~ all J3,q ~ien~ not to ~oke~ the n~amber ryan~ed frol~ I~w o~ ;~.q.7 pero~nt ~y I~y~hia~rlst~ ~o • ~olld (;~ l~reent by I)~(]ia~riei~n~, b~l~e~ {.igor relte ~[~llki~Jg J~ d~t~l~rol~ th~n y~lEl~g~ tlc~lor~ ~/~t ~tve ~ore like] y (o ~tdv~ ~tll pali~n£~ LI~ ~io~} ~kin~, A ll~gh~r pr~o~Llon o~ tIocLor~ over ~0 la~tve smoked ~ ~nae tL~e~ bu~ more gt~o ha~e {iLd~ ~td t~le hi~e~t plO]3ot~ tiolt o~ non~m~ i~ ill Lhi~ ~ge ~ro up. When Modern ~etticine's ~l~rvey on ~moking~ f~ compared with pieviou~ ~qte ~ur~ey~ of (~llctccr$~ ~moki~ habits, ~ ~b~t~nti~l r~du<!~on of ~m~t~kin~ p~t~tie~a- la~y c~garett e$~ J~ evide~ d~ilg the past 10 year$~ In ~t survey of ~rew Jersey phy~ici~tns in 10~, GCL~ pe~ent w~e ~okeX~. ~udie~ of ~i~re~te ~mokin~ among* Ma~a~)~t~tt~ phy~icJ,q~ Were m~fle lI~ ]+~ ~ln{l JD~}. ~l~d ~m~g" Rhode ~l~n~ tlhyfli<d&n~ ill ]~. T]~ p~recttL~ o~ ei~rel~e smokers ea/lh ~l]rv~y w~: 1~5I.S iI~2ent; ~,~5~J~.~ ~re~t~; which ~tl~g~Ll~d w~y$ ill WlliCh the ~mokin~ Im~bl~ ~?ollld be ~t~rtl~er ~lI$- coura~, They ran~ed ~T0m Jncre~in~ taxe~ o~ ~ob~¢~o ou~ o~ p~oport~or~ it~ ~lt~. ~&iv~ oil llf~ ~s~ r~, Which Wotlld be ~isad~n~geo]~ to ~maoker~ t~ prohibitio~ Of ~dv~ti~i~g On ~o whlllo h~l~v~,vt, i.I mo~t phy~ic~an~ as~/tmed ~ t~r~n&l resi~o~bil~ty in the ~lrea~ ill ii~ll}Iil~ efluc~t~io~ and ~ub~c ~ll~l~l~ ~ ~Je ~ysi~l ~mmed it ul~ : "The m~jorl~y ~ tl~e medical ~ur sing, dental and *tl]~d ~ro f~iollA]~, ~a~t co- operable to ~how it~ (~Iuo~in~) litany d~oe~. 1~ J~'l ~nly ~ ~robl~in of ~a~c~* b/it ma~y other~ ~ W~II. l~ doe~or~ will ~ ~E~ok~ 111 t~e I)r~O~C~ o~ thel~ lla~i~nt~1 l~rnhihit slnol<l~ I~ their ofiil~e~, ii~/lJil~it l~t~n(~ ~'onl ~lnokiIig ill ]~/l~Ilit~t]S~ ~he l~igge~t t~rt of ~he pro~Ien~ i~ llcked~" {~f)i~ol~'~ l~o~t2; '£11e ~Llrvey U~00~ wltle~ th~ m*tt~r~Ll J$ base~ was condlleted in the l~e~i~mry 3 issue of Modern ~edicin~. A b~allot card W~ ~tt,%ch~d to th~ ~ove~ of the i~sue~ which w~s received by 1D*~ 000 U~. phy~ioi~ (~11 thos~ in ~tlv~ igr,q¢~l¢o). ~ta~i~tIc,ql b~al<do~l~ ~ replJe~ ~ the ba~il~ qlle,~tilln~ tire ~D~h~ci J~l chart ~orm. Ta~al~lons W~ro "o~L~ed im the l~r~t ~(J.004 r~i~on~s received. Research ex~r~nt~e wo~ld indiea~ tha~ ~td(lliioll&] L~bla/~t~o~t o~ the ~/~b~l~e~l~ r~turn~ will no~ ~lt~ Lh~ V~celltAge ~gur~$ lno~e Lhan a f~a~on of Emeeu~ Edit~ m 1. To~al response (broken dow~ by a~e an~ ~ype o~ i~raetice). H~e you ever ~rnoked ? ,2. /{esDon~e by ~;~. e. ~espoI~e by ~ta~. ~. 13C* yoll ~OW Smoke a~y Of ~he fOllOwing? ~ Re.~Ilonse by a~e. ~. 1~spon~e by typ~ of practice. c. ~esponso by State. 4. Have yo~ chal~ged your smoldn~ laa~i~s ? 5 [J* ~o~ ch~n~e~ your l~abi~, w~e yott J~fl~e~ced by : (~. DO ~o~ b ~lieve ~i~ai'et~e s~ o kin~ is tt health hazard? 1~, ~e~po~se by Sta~ "L Do you ad~i~e all p~ien~ not ~o ~aoke? tz. ~es/~ons~ by ~e. ~. Ile~ponse by zy~e of prior ice.

CIG2~RECI~B LABELI~-G A~D ADVERTISLNG [In ~er ~lt ] GP's Bpma~is~ I N~spe~ltled --I 6~ and over ............................ 43] B6,4] '5 Age unkno~m ............................... ~{) ~t 1~.9 CHART 2a.--//ave ~]0g ~v~ ~poked f [in i:~rceut] A~ ~+~ No No ~onse Under 40 .................................................. 74 7 ~ 2 ~ O~er~ ..................... ~ ]?~ ~i~ ~4 .2 [In per~nt] Type of pr~c~ie~ Get e~l pr~t[ce . ~:~ i A .est h~ol~y ..................................... ~34 ]E EN'I. .................................... ~8 Oy~eol~ ........... O,~t roen ter oto~ ............................... ~6 I~l~r~l~ mefltc~ne ................... ~ v Cccup4t[on~l ma<t~]ne ._ . or t hot,relic m~gory . ................................... ~t,. pedhll f I~ ............................................... p~cet Olog __ . ] p~yeh ~ ry .... ? gtlr~ery ..................................... ~ ~ I • horat ic ~ry .................... ~ • AI] other ............... ~,~L : ........................ ~71 ~L5 0~2 18 ~ .2 .3 .2 2.1

CIGARE~E LABELING .~,~ND ADVERTIS~G 73 II~ percenl] Bi~te Alslm:n ~ .................... Ancona ................... Ark~L~a~ ..................... Color~o ......................... CounecH~ut ...................... I~h td~t oi CO]VunIAJ]~ ..... . ]~Iorld~ ........................ Id~he ............. . ....... I]~irlV1~ .... . ............. I f,~ila,iiL ...... ~ ...... Io~va .................. J<~as~ .............. Xentacky ....................... d~ in~ta ......................... ~i~seuri ........... New l~r,~ pshh~ ................................... ~erth C~Ol~na ................ O~i,, ................................ ~ut h Ca~nl~n~ ...................... men~Le~e .................................... T~×aS ....................................... U~h .................................................. V~E~,ant ................. Ah~ ............................................ Tot~1 ..................................... E ..... I ~0~$ ~ ~ 0 ~ ~z~I ~ ~ 7~7~I ~ .............. ~ r 45~78-- GS--Dt I--@

CIGA~'~TE L&B2]LIN(~ AIND ADV2~I~TISI~'G [I~ percent] ",~he above ~res adcl to more t~an 100 percent due to mu] ti~o[e rc~pen~e~.

CIGARETTE LABELIqffG A/riD ADV]~IITISING 7~ CnAUT ~.--DO ~ ~Iow ~nol¢~ a~t~ o~ t]~¢ 5olb3w4ngr [~n p~reeut) sta~ An on~ .................... Ark~m~ .................. (~llfomla ......... Color.do ......... C~.~tieut~ ........ I~el~w~e .... ~ ... D~td~t ~1 CoIWmbm- ........ Id~h~ .................. lnd~ .................... X~rLtu~ky ................ L~UL~a .... ~a~s~xh~t~s ...... ]41c~i~u ...... Minn~ .............. ]4i~ipp[ ............. Nel~n~.~a ..... New ~[~rn~[~ire .............. New .ler~y ..................... N~w ¥~)rk ................. ~or~h t arul;m; .... i';ur~h D~k~ta ......... Ohb ............. O ~l,,,t,~a ............. l~enns ]va~da ..................... r 1~ hot ~ l~lL~ud ..................... S0UO* C ~tiu~ ......... ~outh D~kr,~. .... T~tlne=,~e- .......... ~ ermor, t .................. Vlr~h/~a ......................... Wi~,n~tt~ ....... W om[r~g .............. ¢l'~ml ................................... --!--I--I 16 0 ~L.I zk ? I ]~1 ~2. I 1~1I N~F L~2 ~J. 8 19.9 ,. ~ i 15 4 5C ~ N ~ 211 ~ 17~ td ~ The ~%bove flgvxes add to more thau i00 perceat due to multiple resDollsos.

7~ CIGAI~E'I~ LA~ELING AND ADVEBTIS~G 4o50 .............................................. ~.9 ~1~ 1~ (I/ lh6 a~w~ 10 lh8 ~,DO~ g~e~lio,'~ {~ "y~#," ~ halo ~ho habit8 beo{t eh6~cJd ?) L A By~utt~g By ~i~g l BYS~q~ch{ng ge By ~u9!~ down ~om ¢ig~s o fllt~r UndO240 ~o ~I7 ~5 5.1 O~er~ ........................... ~,6 178 9~ 7.1 Age ~uk~own ..................... GZ 3 24 3 ~ I~ $ 4.0 • ot ............ [ ~Sl ~o0I 77~/ Q.0 The above ~/yes ~tdd to mow'o f,h ~t~l 100 p~roe~ d~e ~o multiplo responses. [lu r~e~nl] I[ yotz ha~ eh~n~ed ~ol~r hablL were yr~ I~- Age p~bHo~alth ~ar~er~p,x*s Ot~rf~ors repo*~ Under 40 ............................................... I~6 57~1 64~6 Over e~ ........................................... I? o 22 7 7~, 1 A~0 ~k~ov~ ................. lao ~KS 7~.~ • o~ ..................................... ~ ~ Totals mo~ than 100 percent due to multipie answers. C~'~ ~. ~ ~o~ bvZlev~ ofga~lte s~o~tng f~ a I~eal/h hazard? rj~, ~e~c~tI ---j-- U{}der ~0 .................................................. 919 { i,i ]0 Ovor ~0 ............................................ ¢~1 ~8 4.6 Ace l~known .......................................... 74.6 ~ ~1.9

CIGARETT~ LABELING AND ADV~RTISL~G 77 O~A~T ~b,--Do you ~If~ cigarette ~o~g i~ • heath ha~ar~f [ls~ ~er,~nt] Stale Ark~ns~ CiJJfOr~ia ..................................................... ColOrado .................... Connec~lcu~ .......................................... Delaw~-e : ........ Distri~ of Col~mbl ..... Florida ...................................................... Geur i~ ...................................................... : ds o llhnoz In,zmna IoWa ............. X~1~ns .............................................. ~ent(iCky .................................................... bI~ne .... Mnw1~ad ................ M~s~c hU~v~s ......................................... N~hr~mka N~vMa ~e,,v Ha~ng~Mro~ ....... New JC,~oy ............................................. N~w blexic~ .................................................. ~qew york ................................................... Noah C ar oliua ...................... I~ or th D~Ota ................. Ohio O~la~o~ .... OteffJn .............................. Rlmde I~au d ......... Y~ 94~ ~7 4 ~ 7 ~2g ~7 ~37 94s ~L ~,~U t ~ rlak~a . : ~ J I 94 8 , 17r~h ................... I g5 1 ; ~zerc~mnt ..... ~24 .... ~ 1 I ~'lr ~4])i~ .................................................... ~ I ; Wa~hin~t~ ~ 4 J NO i NO/~ 4~i 2J3 ~.1 &3 3.g ,,I ¢~ Z~ v.i~consi~ .• . ~4 ~ • • Z7 AI,ska ........ 91. Z ........ i ~9 ~tat~ u~kn0~ ............................ i 91 1 •., 3 Tom~ ................... ~ s , ~ 2 4 CE~ T~. i)0 llO~ qcI~'is~ alI Oali~lll~ ~l~ ~0 2~ok~ ~¢~ J N~ ~ No ~s~onsc Under 4O .......................... ~2 3 44•? [ ~

CIGARETTE L.4~ELL~,~G AN]) 2*DV~.R3~ING [In l~r~nt] G~n~ral pr~l~ ....................... De~m~t ot~gI, ENT ............. N~ur o~ogle~ sarg~r ¥ ObStetrics, Obst ~rie~ gyr e~le4,~, ........... Opht hat~:ol~y ............................ Pl~st Jc ~-g~y ............ ¥~ I NO ~SJ ~2 49O .... 4,~.~ 44~I bl,~ .... 4~,0 49 ~ ~ycbiatry ............................ ~,+~ ~ i ~2,~ T~gcry ....................... ~ 5 3~ 2 49 ~ ~ A~I Ot l~er ............................. I No respon~ 3,$ 2,~ ~4 1,0 2,1 3,~ 9,: .%1 ~9 S~m~tor N~u.~o~. I h~w ~ r~port from the Journml of the A~neri- can Medical Assecis~ion~ De~ember '~, 1964, which moves out of t!m are~ of the relationship to lung cancer and point ~ ou~ th~ rel~tlon~hzp of cigarette smoking to coronary heart disease. I would film to quote from tlmt: It was fo~ tha~ In men ~]~o ~port ~aabltnal eol~m~t~on ef 20 or more ci~ar~t~e~ per day the risk of myocardial infarction was abou~ tlnree time~ gzeater th~n in nensnloke/~ for~el ci~re~ sm0ker~, or pl!0~ aI~ ci~ar smokers. I~ g¢~ on to stay It is fafer~ed that stopping cigarette mmokin~" lessens the l~Sk of coronsry heart These are quotes also for the record of people who ~r~ r?put~bl~ doctors. The mos~ authork~t~ve source I know o~ in the m~:ll¢~l pro- ~e~ion is th~ JAMA, which has~disa d with me on some other l~gisl~tion that I have been inlereste~ but nevertheIe~s I respect them because they ~r~ ~ very hlgb/y thought of scien~i tic source. A~ this festlmony is brought ou~ durin the week • ~m sure we ~ Ko]n~ Lo h~r f~om many other people ~o ~re not convinced of the rel~tlonshi~. I would'lik~ to s~y on~ thing at this time, that owr s2me 30 y~rs that we ~ve been collecting d~t~ rand I thi~k I am being co~- ~w ~]mre tha~ ther~ h~ never been any regression in the emphas~s on thc eonnecfio~ bBtween smokln~ ~nd ¢~is~se. Each year the ew d~aca plies up. It becomes euma]ativ~, it beccme~ mon~ ~nd mor~ emph~fic. And th~ urc the f]~ings I think our (9overnment needs to t~kc ~nto canslder~t~on. Th~nk yo~. D~ Tmm~. Mr. Chairm~n~ Senator IL~r. Dr. Terry.

---

CIGARETTE I~BELING AND ADVNRTISI~G As you realize this is intended to extend over a period of several years and I would expect individual reports from scientific observe: tie,in to become available at various intervsls duril~g ibis time to be published in various medical journals by the individuld scientists who are responslble 1or the work. Senator }I~T. Thank you, Doctor. Tbe Senator from Kentuek~3 Mr. Mort on. Senator MORTON. Dr. Terry, ~chat percent ~ge of the grunts that are necessary for this very impoltant research in cane6r and heart diseuae conic from the Fedcral Government ! I don't want to pin you do~ut. Dr. TER~v. q don't know. I would say z relatively smatl pereen~- age. Ix~ th~n bail Senator MoRrom Less than half is not necc~s~u'ily n reladvoly small ercentt~g,e. Would you say it, is in the Im~n of 44) pezrAent? I lmve ~en voting for bills in the Iast 18 years lo inel~ase appropriatbns for research iJj the areas of bearg e~neeG rbaps to a point that seientige ability elul~t even absorb it. We have~eeen criticized for this at times. I remember working with my good fri,nd Corlgr'es.~man Fogarty, of Rhode Island, back in 1947 and 19~8 in this pal'tlcalar area. ~ was wondering ii tile facL Iha~ so much of the funds, such a portion of the funds, com*s from the FederM Government i~ tbis might b,ve Somct dug fo, o with the fact that eerta n doctor~ and eeria n ,In ver- sit ie.q and certain medical schools are ~ little hesitaut to criticize may- thing tha~ yore" Department does. Dr. Txm~v. In my judgment tk6s is not trn% s~r. When we ~ttempted to evaluate last year tbe amotalt of fuDds tlmt w~re bei~tg spe~d from our research funds in t],is Gel<l~ it was ~,methb)g ~ighfly in e~e~ss of $3 rail]ion - about $3.9 milllon, o~ researcL Sen ator Mc, m.o_~-. In the cancer field ? Dr. Tl:Pmv, No sir. On any researcii which hod any relatlon~lfip or any applicatlon to thequestion of smoklng and hca d~. Some of it was iil the field of cancer sob~c ~a~ in the field Of heart disease, so ne was in the ~eld of bt'onch[lis artd empllysema, some ~gs llDt rebtted I[() dl%hlllte dlgs~a~ ertt~t~Cs hilt re]atefi to vamous types of studies of tbo mucous membranes tbe ]irdng mentbraiie of the tracheal bronctJa tree, some re ated to the effect of n cot ne on the bod~ and 5'arious sections of the body. So that it was a ~oa~lat variety of s(udies. ]htt ~t tbe same tbne yon re~Jize~ for instance tha~ the Anmrle~a~ Medical Assc~dadon has $10 milIion available for this over ~t period of several 5 ears. There are other organizations, Jn~] udblg the Amer- icait Cancer Society, the American lleart Association, and other vo]untal7 organizatious which support research in this direetien. I delft know rite exact amount of all of tbesa but I wouhl judge ~mtblsrt~peetlhat~e~'esuppo~tln ie~ lhar~ hal f. Senator Mealox. ¥es~ less than h~i~ of the overall research in the field of cancer and-- Dr. Tza~v. Ilt the field of smoking and healtln Senater l~forton. Senator N[okTo~. I w~s speaking of the broad probloxqL I wes ~l)eakin~ of cancer heart gilmlmt s~ the whole picttlre. Yon read, l)oetor, tbe ~x~olutlm~ of the Araer e~n ?,fled ca Assoe - ation. A have hero • I~ews item from it hapgens to be from "The ~tate" Cohlmbla, S.C., on the 18th of MarcL 1965~ which quotes Dr. Appe. _a~nong other things t sa t

CIGARER~E I~ABELINC .LND ADVERTISING ~] Appel said the AM,~-'S researeh i~to q~a~eer and cigarette smoking is ~imed ill three dir~tions, ~t the rate oi" $I millioIl a yoar, ~h~llk~ to a grant fi~m the major cigarette ¢ompa~ie~ AIII& is administerilJg the gTltnt to l~ir~ find Ollt if there i~ anythimg in clgll rettes tha~ eRus~s eallcer. The ~eoI1d (lllestion to be answered is wllat ~aetly th0 element is, and third i~ how to o]ilminute iL, ,kDpel said, I fifink to make the record complete, ~[r. ChairmaIl~ I would like to have this entire news article pri~lted in the ]~eo,,zL Sem~tor IlaR¢. it will be made • part of th,~ t~cord at rids polnr. (Tim artlcle refBrred to follows.) [~0DI Th S~a!e, ),l~r 28~ I9g5] (pee Dee ~ureau) ]~L~RENCE.--The l~r~sident elect of the Alac~lcan Medical AssC~eiotiou (.'~A) leaned back in hischair, i)llffed on his pil3e otul talkcrt about the smoking and heallll ~ oat rnver'sy here Wedm~da y. "There must be a relallonsIfiI* be>xeen cigarettes and brag caneer, hut I--]7or tha~ nm tter, ~uyone els~doo'L knew what it is." Dr. James Z. ~ki)pel said. "The only evidence we have is p~inlarily fit~tlstical * ~ * perhaps a little more than that. but that's ahou~ ~lL" ha said. 'the 37.year~ld AplmL whnse native Lancaster, Pa., is in tbo largest tf/b~cr~ growing eotnlt:~ ill the Unite4 States. aflmi~ed l~e(iO[o are not goillg to Stall smoking. ,,Cigarettes are a tiara]endows Dar~ of ou~ economy--we jllt can't rhrnw thelu 0or all at once." Appei said in the oflfiee of his Inn~tim~ £riencl. ]3r..l.P. Frier, a ~lorence pediatrician In a joint eff~rt w~th nther agencies. Appel said* g~ education program to ~np ~voung people from starting to sin.lie eigar~ties "probably has done some gexMY PrngIums aimed at adults t~l'o few ~ nd tint very SUCn~SS£nL he ~aid* Appct said the AMA'a research into cancer and cigarette smoking is aimed In three dtreefions, at the ram o£ $1 million a year, thanks to a grant ~rom the majnt, cigarette ¢om~anle*. AMA Is administezing the grant to first find out if there is anything In eiga~- rattcs tiler eause~a ea~eer The second question to be ~nswerod is, wh&t exactly the el~inent is. ~nd third ]s h*]w to eliminnt e it, ApDel said. Air pollUtio~ and* climate are ~mong those things which must be researched. A!0prd said. ~x (~pel witl address a sclenti~c "oanquet Thur ~1~ y night at the conclusion of the 26th annual Dr. Fra~]¢ Hilton MeLeod Memo~al Sclentifis Assembly. Ileld in honor of the founder of Mel.er~l Infirmary hare. He a]*o will address a Kiwanis ~nal* meeting Thursday. hppel said virdogisLs aml geneticists already have their own theorie~ on ~lleev e~us~tion, Dr. JiJnas Salk, faint,us ~or his ffiseovery of the i>allo wceine belleves a viru~ nausea cancer. ~ome get~etlcists, on the other hand. believe some cells in tll~ bo6y ~re i~here~t]y ~mleer-en r I~i ~g ~IIL are Ollly ~etivatetl by et~r tgill thillg~* including po~ibly cigarette smoke. ADpo] ~RId a major discovery ill ~-anepr, h~ar~ disease or mental h~alth could come at any time, sineo r esea rr.h Is ermrentra~ed on {ho~e areas. k Ithnnah he sold lie does lint [~now o~ I~]]~ ~¢periment~ on the verge ~f solving any major" m~lie~al problems, he* ~id it I~ "quite Oosgible the ncxl Mg door to be opened may be o~ something. KRe the common COl~, oil which nr.t much research is batng done." • 'De*liars d on't blly remllt~ In research." Apt+e] said. D~e to South Carolln~'s blab ineI¢lenee of h~art-related (l~aths, App~l said tlle ~{llte prol~b]y wm b~ome a f~XtIle ground for h~art re.e~rrh. The S~ate. deemed t~ have the high,st race of deaths from ]~ear[ diseases o£ arty in the Naticm, could bernice a labC.rn~ory for eardlologieal opi~elnolo~s~ whn ~tu¢ly h~arr diseas ~. The high South Carolina rate rnak~'a it ideal for re-earth and study of con- d{tiolle Appel said. "and in ~hat real>eel, perhaps the high ratr* is ~ovd, bev~uso ÷boy might find out something here."

82 CIG.~A~ETTE LABELLhG A~D ADVEI~I'~llNG TM ~ ~L~.TIOV8111~ o~ 0IDAR~I~E ~MOKI:~G TO (~)P~)N~y F~ F.A~ T DISEASE ( Joseph 'l'. Doyle, ~ID, Thomas I%. Dawb~r, MZ), William B. Kmm~l, M]), Sm~dra I:I. Kinch, ~IS, sad Ha~id A. ~ahn~ MA ) '[~o r~tionskip of Smoking hal)it to total ~or~ality and to the incidence new m~ni~st~ti~ns of corlmary h~art disease (C]~D) has bee~ examined i~ ~282 middl~ gell ~]] llnCi£.r merited stlr~ eilla~ce for ten years ~n Framiughama, ~lass. ~ml ~ ,~$ mlddle-aged men J:~l~we0. ~or 8 years in Albany, N.Y, It was fo~d ~ha~ in m~n who r e~r t habithal cons~nptioa 0~ ~0 or more eigar~e~ per day the ~ of myo~azdi~l infarction was abo'at th~e~ times greater ~ha~ i~ nonsmokers, forme~ e~g~rette smok~r~, Or pipe and cigar smokers. ~o relation- ship w~s shown beLwe~en mmokl ng h~]Mt a~d ~]~gi~it ]De~U~rm wh~a this s~'mlOt om was the sole manife~[~td~ of OleO. Tho a~soelat~on lletw~n hcaVy e~aret~o smoking and in~l~ased mor~idii;y and mortality ~om C~D yeas mleX~lfllned, although it a~peared to be r~lalively £m~edlat~, IL is hl£~ru4 tha~ ~b0pplag ~gure~e smOkill~ lesse]is the risk: o~ CHD. Thrt~ yea~s ~Ig~ two l~Irge Dlx~p~'~ve studi~ of c~rdi~vasu~IxI~r d~sease in- dioat~J il~L m~n who Imbltually smoke 20 or m~ro cig~rette~ daily experience a tick of ~v¢~ardlol i.far(:tion or of (~eg~th from all c~11~ thrt~ £imes gl~at~r than llo/ismok~rs or ~o~r~ Of pipe~ [m~] elg~LL~ (I}~ On ~]le othe~ "n~nd~ ~igllrette smokin~ bore ~o apllar~t reb~ti~)i~hiD to ~ I]2~:~ffn~. oT~a~Rft ]a~.~ri~, consid~l~d as an i~o~ated manif~ta~ion of c~r~nar)' heart dlse~e ICHD), an ol-r~ervs~tion similar to that ma&(ha ill an e~rller clinical Stl~dy I)y Whi~ and Sharl~ar 1.9). These findings, taken with the m~ssive dOC~menla~.c~a of a ]~sR[ve rala~ionshlp b~tw~n ¢igaretbe sr~oking end C]:ID acer~iag in the l~rg@ s~al~ Studi¢~ i~f thc ]'olc Of a~Ll0kill~ in ]11ng e~n~er i.~ .~, ~I, ~tIy led The Surgeo~ G~n~rai's Committee to c~mehlde that : *,* * • a sig~li~ic-a~at relalionshIl} ha~ boen established batwe~ eigare£ta smo]~ i~g ~nd tho ~ ~ciden¢~ of~ myocardial in f~reati*u and sudr~ death ~n mal~s. ~. l)~.iall y iu mi(~dl~ life, in population gzouos ~vh~e m~mbeA~ appear so fa~ £o be s~/Dilar f~ir sr~loki~ 11~l~ts (6)." 'Ivll~ pre~-allt report oo~I ft rm~ fl~d exte~0s the o~s~rva~ion~ pl~aDt ed ea ~lier. ~ETII01)S The data pr~s~tod in both thi~ and i~ th~ 1]r~ r~port are derived from two ilr~Dootlve studies o~ deg~ll~r~tive cardl0Vascular d~ses~**, the Irr~mil~gh~m s£udy e~bII~hed in 1949 by tl~e LLS I*ubli¢ ]~ea~th ~ezv~ and th~ Albany study e~tab li~h~l ~n ~.9~2 ~y th~ ~w York ~ate Department of Health. l]a F~ minghom, i~uss, 4~4~I) m~ s]l~I w~met}, initially between ~0 a~d ~2 ~rs of age ((~) per~ @f a randomly s~ected ~amplo), agreed to .oartieilmte in a Ion~[tudinal st~l(~y o£ I~ear~ dlseas~ TO tl~osc halvo b~/l flddad 734 vOltlllt~r s~bjects. 2~ ~2~iled apv~raisrd ~ eac]l illt~ividu~l Inc111(~Ing a ~IsTory, lfl]~v~ eld exami~ atio~, [t1~ ~-ray of the ~est~ art e[~troc~r die gr area, and o~h~r labot~t_ ~ory t~t~ hsve l~en do~e ~ total of 2,'2~ men origlilaHy free of coron~ly h~r~ disease ~nd followed for i0 years constitute the ]001aolation at risk co]Isld~red in ~i~ rc~por t. Im Albau.v, Ik'.y. 2,913 mole ciVil ~ervan~ 3~ to 55 years a~ ag~ (89 percent of thoso oHgi~le), v~luat~red ]~(*r e aim~l~r in~igation (~f ~he illeide~l(~ Of d~nerativo c~rdio~'a~lar ~i~ea~e, A ~i~l~Wh~£ niilre det~le~] examil~m£1o~l ~s done than I~ l']¢alJaila~hfim Stud a]2 ~]ecLr~estrd~ograp]ife Ir~ress ~s~ is dO~l~ Those in(~ivldtalls ev~n~Ig ~n ~normal el~txo~ar diogra~hlc respo~e t~ ~xer eds~ as ~e ~ole manifestation of C~/D are not in~lud~l as ease~ in thi~ relmr~. A [~La[ Of I,$,~ men or~glng[lly 1'ree of e0r0~ary heflrt di~s~e and f~llowt~l fol- i~ yesrs are inelude[l fn this report. l~(h pOpula~i~s are :qomo~o]lOOUS In terms ~ ~ex, ftg~ r~ce, o~eup~t[oI4 ~ dleL ~wer thall I percent of eithel* ~opllla.tban Itas b~n ~(~t ~ fOllowil~ ~ur~]~er, it ~s kl20~n theft the oeollrr~y*¢e Of O~D ill ~h~ ~rson~ i~ b@t~ grollpS is simil~ r to that i]I the parli~i]0 ~.~ts. From the ~rdiova~eu1~r H~alth (~nt~r Albn~ 5~edlc~ C~lle e AI~y, %'.~.. a~d th~ Ivatlon~ H~rt ~stft~tc ~etlonal Ius~Itnt*s o~ I~ I¢k, l,ubl~e~ I~calth Serwee. U~. Dep~r~ment o£ Heml~h, ~dueatlon and Welfare Wear~ ~is~a~e :~pld~mlology i~tudy, ]¢raml~.ham 51ass. IIepn~ reque~¢s to Albany )le~i ~ COI e~ Un on I~n v r~dty Albany Ig.~ 12~08

i~te~ory~ H

CIC~E~E LABELING A~=D ADVERTI~ At the first exa~atien in Fram~gham a~d in Albany, a detailed ~mok~ hi~or~ w~ taken from eael~ partmipa~, ThLs ~f~rmati~n has ~eu corr~ ~t~ with ~ho ~eideuce of CHD for over 10 ~ars in Fram~gh~m and 8 years m Alban7 irresp~tive of ~ulmequent eha~ in smoki~g habit¸ • he ~Uowin~ manifestations ~f CHD have been eorrela~d wit~l lu~ally r~ ported ~oklng habit: myocardial Juf~retion, ~dnn l~e~*r~, sudden de~tb, aud de~th a~tribu~d ~ ~rteriosel~otie hear~ dis~n~, ln~I~viduRls su~er~ng from both angina p~rls and ~rdtat infaret~n ar~ l~d u~er the l~tter eR~go~* Th~ erlt~rl~ fo~" ~ ~l~g~o~tic ~tego~e~ l~ b~n rigorousty a~fin~d eoIlaboratl~ly bY the Framlngham and ~he Albalkv invest~ators and e~rr~spond closely to ~ho definitions ~0ropo~de6. ~t ~be Beaconsfield a~d Prin~ ~o~ ~c~nees a~d l~[cr by WHO e~p~r~ eo~t~+ ( 7, ~ ~ } Of ~Rrti~Iar importance is the ~urren~e e~ .death ~nd ~lsabi]i~" i~ m~n in the prime o£ life+ '~abl~ 1 ~ets forth the total mortality experien~ o~ ~e~rly 2,100 men i~ the e~mb~ned Al~ny-Framh~ham ~up, eri~inu~y be~we~ 40 and 49 ~ar~ of n~, fl~eording to ~g~r~ habit. ~tho~gh th~ i'~m~i~d~r of the ~r~e]3t f~]on ap~lI~ ~o fhe entire ~p~ u~der Observation in e~ studY, tab[~ 1 eoasider~ only th~ large~ dir~tly com!0arable incidence rate~, "~o dat~ for ~h st,2~iy eo~er equivalent lengths nf t~m~* L~, years fo~ e~eh gro~, ~nd ~h~reby the rates ~ e&ch study represent eomp~bLe period~ of expo~ur~ to ri~k for me~ ~f the same Rge. I~ is ~bviot~ ~har cigarette ~ok~ dl~ ~t s rate much hi~r ~kan noneigare~ ~mokPrs with m0eh ef the ex~e~ p~e attrl~tabl~ to myocardial infarction. There i~ no ~tllm rPm ~ r e~n ~illn~ill, howc'ter, bctwe~ ~ig~rett~ habit a~d ~ngi~R ~ori~ When it is the sole mani~'e~LaflOll o~ CHD. ~he de~tb rRte from ~R~ other ~n CHD m ~¢amin~a~ Is higher th~n in ~.lb~v, but th~ number ill'

---

O0 ~J L~ t~

CIGARETTE LAB~LYNG AND ADVERTISING 87 and the difl'~rence is statistical~ far less striking Arthough these smal/~r dilrerPnc~z could be geIltllllo, they inky be st~ti~ticel ar~if~et~ d~e to small ]2t~mb~]'8. ~ince the Dc*t~/ltla] ~tfli(~ut]ons of thl~ o]l~ervation s.re so il~porL~nt. ¢~.e a~so~ia~ion het~e~n ~gurette ~oking, ch~[~ei~ll coneentration~ an4 in- cid~n~ ~f OHD del~l~.nds cent ]naetI (4oso serlltllly. tSO~I~E~T The relationship between I~ba~o habit and ~he InCidence of OHY~ over an 8 to l(gyear period in two larg~ groups of middle-aged men is striklngly con- sistent and ig virtllaEy identical w~th fhe findings r~p~rted prevlo~y ~'ter a ~ and an 8 y~ar follo~p. The LOallnel" I]~ ~hil*h ~,ig~]'c.tt~ ~m0king impairs ]ongevity I~mains ~11 explained 'l'h~ exce~ mOl~aIl~y 1]1 h~avy cigarette ~mok~rs is d~]~ x~ot to a ~J~.oI'oport[oil&te increase in the frequency of any partielllar disease save l~ng cancer, but to ~ g~n~tal increase in ~he rate. ~f dying from a]~ causes, of w~ieh CHD ~s milch the mo~t e'omamo~ (11}. This WOUB1 point ~r* a ~or~sDeei~e lef:nal effect, prosum~b]y (}per~lci~2$ through a respixatory porLa[ of entry In Ihe ease o£ cigarette smokers, ]n~s~nl~eh as ~oninhaling cigar and pipe s~okor~ are relatively imn]une [o the J ll-effcet~ of t~b aeco. Th~e acute circtflatory responses to smoking are greatest in cigarette mnok~r~ and are attributed to the rapid ahsorl±~lon of nicotine :~rom the broncho- pulmonary muco~a, a slower and less complete proees~ from the li]ling 0£ the mo~th. 1~o oar~oaent of tobacco smoke other than nicotine e~erts a measur. able acute circulatory effec.t. ~hronie he©aodynamle or morphnlegie vlls~u]sr change~ a~ributable to t~im~eo usagP or to nicotine, with the possible and con. trover~ial exe~gtiou of thr~mboangiitis obl~t~ans, have ~ever been flemo~ strated (15). •hat the smoking- effect may D~ aen~e is ~ggest~d by %he r~version of risk to virtually that of the non~moker~ after c~ssatlon of ci~srett~ s~oking, amelilg boa v:¢ ~]°kers, a Isek of ~dient for CitD ri~ in relation to yp~lrs of e~pos~r~, and the absence of a relationship between c4garefte smoking and the IT~e~denec, of angina peu4orN. The risk of (~FIT) or death ]'or exeigaret~ smokers iu the~e two popuLRtions Was IleV'lzly O:!lla] to the ri~k for thOSe who never smoked; in contras~ with the observations in the prospective studi~s ,of Ila~mond and ][=[or ~ {~) and ~f ]De)l[ and ~lill (3) r~ hleb show r~lt~ for exsm~kerS Jutermediate between Dres~nt smoker~ ~nd ~hoSe who never smoked. The cause of these di~l~mces is tmexp]sl~ed hut may he related $~ lllethodolegy nnd to sele~:tion of populations. Investigation of prior smoking habits in these who stoi~ped smelting ind~eate~ no importsnt ~iff~renees from those who eo]lthlue to smoke. T~zese observations may be eonsCr~ed as evidenc~ that athe~ogenesis is n~ r~,lated to the ~e of tobacco. The mor!ohologie observations of Wi/ens and Platy sui~port this eollel~sion (1~). On ~h~. olhep hlllld, The acute occlusive corn- Dtieations of atheroselerosis are, appsrent]y, aggravated by to.teen ~mok~ng.

CIGARE2TE LABELLX-G A2~B XDV~I~r~sI~G The m~hauism of this effect i~ unknown+ Coronaw~ ar~e~iosp~tsm, often pro- posL~l ~s a possible re~ot~on to tobacco sm~]Ke, has never beei~ proved. ~ho even more plausible poc~ibility that tob~cl.o smoke may aeeel0ra~e thrombvs ~rt~,~fiqn h~s vo~ bees ~i'i~ci2gIy ~ubst~nt~ted, The exFMim~on el the lll-~ffeets of tobacco must allnost certainly take i~to account the fact that illhaled smoRe Co~tes itlto rept.sted and i]~I~te (.,olt~al:t ~Yith the e~Ure eireo- lathkg Mood volume, TOlIC substan(~eg ~U)llid Ih~s b~ rspidly ¢OIlVeyed through- out the body and p~eeiplLat~ a~ occlusive epLsgde, ffJ~L~ ~.--[ncq~ence of myooa~'diot i~faretion (i~lu~i~g ~ffD ~at~) in mea smok~g ~0 ~g~retle~ or ~ore ~r d~y a~or~ ta ~r~l¢on of clg~l~He smoking Ob~ar veal, nurser ] Ra~io 0bservgd t9 e~pec~ed [ Dt~tlv~ of smokI~, ~ ..... ,-- ~ -- No ....... ~ .... y~ ................ N* ......... ye~ ......... N~ ................... Yes .................. NO ...................... yes ................ Cla~Gea~lon in e~ch %tlJdy: + Sy~c~[tc blood ~re~'e~ r~l ~[g ........ F~r~tl~g]mm .................. ~l~ 139 mtd o~¢r. All~a/y ..................... <1:~ i~o at*o o,/~r. Ch0io~t~tq], mm~l~ CO. .......... : ___.FM;d~lgixm~ ................... ~:~ ~'20 220 and 0~x. a ExpeCted ~l.~ ba.~ on I~ age~i~'clfie rat~ wlthgut r e~a~ to ~2ao~lg s~¢ua Since it appears that it is onl~ tho Immediate and txot ~ny cumulative effect of i~h~llng cigarette ~moke which pr~ipitate~ m~oeardial in~aretioa and deuth from CLID, tile Impih:atiott~ fol~ prev~otion for the general Imbll0 ~tnd e~eIolly for the ~tient with ellxleally of, err CHD ~em evident V,'bite it 1~ i'eeogni~e0. that those who ga~o up smoking were not randomly selected a~d iadueed to give it Up* Lhe f~.c.f that th(f~e who ~d given u~ smoklllg de~oloi)c~d n~ mote disease tht~n the~v who h~rl nevor smok~ suggeats strongly t~t a substant Lnl t eduction |~ CHD mor0Mity a~d morbidity by the redv~c~on In tha colt smptiol~ of cigarettes by the generat public may be achieved. T~* total mortality and the iaeidenee of raew manlfe~ations of coronary heart disease (OHD) in 2,282 men, originally 30 to 62 years of age, has been reported for u 10.year perioci In rr mm~ham, Mas~,~ and i/t 1,8.~8 me~a, origtua]ly 3~ to 55

CIGARFIT~rE LABELING ~ND ADVERTISING ~9 y~r~ of agc~ fo~ ~ua ~-yeal• ]~iod i~ .~lb a~ly, JN.~. Thes~ observ~ttion$ have be~t related to smoking habit repo~te4 at the time of admi~ion to the respective stlldies. ~eu reporting t~ babItuat consuua~tien of 20 or mo~e cigarette~ daVY exi~rie~cetl a deat~ ~ate from aLl ca~e~ abo~ three tiy~es grestev th~a ~f nonsm6kers, ~ormer cigarette ~mokeIS, or I~ipe ~n(1 cigar ~CLOk~rS. Iz~eav~7 eight et ~ ~ok~rs ~xper te~ ~. mmilar £11cre~se i~ I~$K O~ myocardi31 l~rctlo~ c~m~arecl wi~h ~0n-c~g~rette smokers. Incr~sed risk o~ my~rdial in~retIon or d~a~h was associated witl~ cigarette ~nol~ng in all eom~natio~ of high Rnd lOW ~,V~ ~1i~ blood p~'ess~lr~ ~t~d ¢ hol~st e~0~ levels. ~l~e risk O~ ~t ~lh~i~ pe~oris ~ t~e sole 0x" i~itlal maDJf~t~tion o~ C~ll9 ~[ip~fl r ~ to be ~Rrela~ed to the ~oba c~o h~6it The ex]~l~ R~t~n ~f ~Jlc assoei~ ~ioI~ bctweeD heavy cigarette ~mok~g and tile i~¢ren~ed r~]~ of de~th from a~l eau~efl arc] of death or disability from C~ ia particular rem~irLs ~illative, but the effect ~ppea~ to be ~elgtiv~l~v im~01~. ~o ~lmnl~tive effeeL /m the de~opJ~e~ of the ~mlerlying ~the~seleros~ ~pears evick, nt, The in£e~ence ~hat ~opplng cigar~tt~ smoki~0~ ha~ fl bellC~ial ~ff~t lit p~ov~l~ing or d~ltLy~lg the Oll~ O~ the leth~l ~nuili~es(a(iol~s Of CH]) appear~ wa]']'~l~ted, ~ (}.--De~th~ from ~-o~v~ry he~t dis~as~ i~ ~te~ ~e o~ dt$¢~ at e~ In t~t~on to ]~aI mccOY ' I C h01est ~01 I N~ ..... yes ................... - + ....................... Y~s ............... NO ........... Y~s ................ No . OC'~rvo~JuI llat~o o~ eOrablncd scrwd ~o popu]a~len, ~xpeeted~ number il ° ~A ~I i,, ~i,~nifl can~ level bEtv~en smuk- ia~ eat e$o~i~ P~D D1 p~O05 In~l~tI~ tolo~me4~ * I [ observeo in I Cl-~m~t!~ sm~'~n¢ ]~ab~ ~m ~ue~ $ySmll~ blOOd Z $ I NU ......... ~ Yes ........ 3~ ~ Yes 83 I 1¢a¢io o1~ se~ed ~o 44 04 187 Sigul/~canvOlevel ~rdtt~em~ b~twe~R~ok. p~o o~ p<oo5 , Comb,[ted AIb~7 ~ h~ d~t~. -- -b AlbS~F ...... <13~ 1~ ~nd o~ C bolC~o]~ mmqO0 c~ Framing h*X~ . <22O ~ rind c*rer Al~r ~. ~ ~25 nnd ~ver E~eCted values b~ed on 1O014 rage.specific ratc~ wi~bou~ reg~d ~o smok/ng ~tl~s ~5 97965 pt i 7

90 O[(tAIIErI~I'E LABELINO ~ND A])VI]r~I'ISLNG (1) Doy]e~ J. T., vt aZ : C]gt~et~e Smoking and f~ImmmzT Heart Disease: CorJl. ])~ned Albany and Fruminghmn Exlmrience, N~I Rng. J ~te~. 266: 79¢~ 8(}1, April 19, lf~. (2) White, l'. D., and Sharbcr, T.: Tobacco, Alcohol and Angina Peet<bris, J A. M,A. 102 : 65,5 657, ~Iarch 3,1984, (3) Doll, R., a~d Hill, A, B.: LU~a~ Ca~eer and OJher Cauues of Death in R~ialloa to Sn/oklng; Second P*eport 0n )IorlaliLy of British DUCtOr~, ler{l..~e~. J. 2:1071 1(h~1, l~ov. 10,1956 Hammond, k~. O_ alad ~4orn, D : Smoking and Death Rates /~er~rt on FOrty-pour ~lo~ths of Fel/ow-Up of 187,783 Men: I. Total ~ior~ality, J.A.M.A. 166: 115~1172. Mar. 1, 1~8; 1I. Death Rates by Cause, ibid. 166:1294-1808. March 15 1~)8. (5) Dora, H ~ : T/>bac~) (Jiinsumption and ~fovtality From Cancer and Other Diseases, PuhIiz Ilcalth/~7~. 74 : 581 5%~, J ii]~ 1959. ~lukiny an~l HCUI~ll. I~cl)ort of A¢lvis~ry Comm~t~c-e tn Slll'genn Getter's] Of Public Hc,alth Servlce, Wa~hil~,tou Public Ilea/~h Service Publication Stugie~ at Hote~ B eetvonMfcld, Brool~line, Ma~sx ffu~e 17-~8,1957. CoHr dt~ec o~ Cvltcria for II(a~losis o~ Disea,~. ~/nd {]lhfieal ~]valu~ion. ~mt~" J Publi~ Health (suppl) 59:20-27, 0etober19~O. (9) r~ypertm~i~n fllld Cnronnry Heart DIse-2se: ~lassJflcatJon and ~iteria ~or Epid~mioh~ical S~dies, WHO Teeh~/~p. Nc~'. 16~ : 1 2~, ] 9~9 (10) Kahn, l:l. A.: ~elationship of P-elmr~ed Coronary Hear~ Disease Mor~ality to Fhysical Ac.livit> o]" Work, Amer. J. p~bl~o rJealth $~: 105~1067, ~uly ~9~. (11) tlerkson, J. : NnaolAng mad Caucer of Lmag, Proc. Mayo CIin. 35 : 3(;7~185, ~Ii1 ne 22,1969. (19) ~essler, S.. ~t aL : Crltic~ I Evahlatlon Of Th r olnb(m nglit 1~ Oblil eralls ~ C~$e Agai~s t Buerger's Di~.a~, .A'ew Eng. J. M~& 262 : ~ ]4P-1165} Jnne 9,19EO (~3) Wileus. S. L., ~d Plair, C. M.: Cig~ctte SmoMng all(l hrterioaclerosi3, Ncience l~S : ~75~977, NOV, 30, ~ 962. ~en~toi ~ORTO~. Doe~or I hftse ~1 )lli[[ )bJ~t PIqtlt]ff(] Smo~rl?~Vt fl~q(l ~he l][e~Ii t, Ol~ ~ts fl Oil~.p~(o ~t h~s ~ fE~CSlIIliI~ Of lhe frollLSplPAW (]f the report "Smoking andHealth~" which I suppose in the eyes of m,my gives it a de~'ee of credence. It is being c]rcnlat~d by the Public IIe~dl h Servic~ Dr. ~l~y. I believe so. I haven't looked at this one in deCail. Senator Morn c_w.. This is ~ part (ff .your ~,~lucllthmal c~lnlp~d~u n~.lIy w*th regard to clgare e smoking ! Dr. 'I~IIRT. ' ~ " " Ilatsrj ,s . SeI1~tor ~foRToi<. Weie ~oll aware that ~h~s c]oesn~ evell mention the c~nclusion io the effect, it is not clear whether the assoda(ion he,wee ~ sm]d g a~Id COF4)Ii~I~ 0ripeLy, (~Ise~S, , , h~S al~y. C~SII}II tiw[li~ car ce, or causal, I "~*l] shy, s~ gm fic~me e 'l Dr T~Ry -N'o, sir;Iamnot awareo:flhatpartlcular fact in rel~tlon to t,Imt paniphlet. S~ n~ ~or Mo~ox. h~ your book you did reach t}ta~ conclusion ? Dr. ['~m~ ~. Tim eumc[usion reached in the committ* e'~ i~porL Senator hlo~wo~-. T mea~, the committee's report Dr. T~. Niay I ue~e from tlm rcl~rt, sir ? ~cn~ter Morn'on. ~ertMnly. . . , . • Dr. T~x'. Thls ]s on page 38 of the advtserv committees ~eporl mtd~r the heitdi*~- of cardiovascular disease I~eo=:binh~g tile fmlrth ibm from the lm~t o~a of ~h~ pugt~: The cat~s,'ati~c rc4e of the~se faz¢ors In coronary he~l~ d~(llf4(~. []2on~h 11o1~ plovon, is sIlspecteO~ s~rongly eii,Ju~h t~ he a major re~]~vln far ~nking (?;? in[:?~

CIGARETTE I~ABELIh'G A~ND ADVERTISING Ol ll/ea~Hres a~sill~£ Lhem, IL is tt]~l more t}rtldenL tll a~ume th~£ the ~srtl[/li~]l~] a~0~i~t[on betw~n ci~r~tLe smt}kiiig aJld c(}r0n~ry (lis~ase ha~ ('B/Isa~ive I~eallil~g ~alx to s~l~lld jt~dgmell~ tltlLil u0 ll~"~r~i~{~ r~u~ains, A~xd fbt~.: in [~b] p~'h~ it s~ys : Male cigarette smol~ers huye a hi.~ber death tale from Coronary artery (lis(~aso ~ltau Ilon~toking m~tle~ but it i~ not dear th~tt the association ha~ Sel~tor MOR'mX. I en*i)h~tsize the last lines of the =elltenee~ '~I~ is zto~ clear that i~ has causal sigrdfie.~nee." I think ~}xat is the petit here. We are all for good ]*e~lth, We ~'e all for getting rid of any h~z~'d~ to otzl' health, b4ut it seems to me that we have to I~e x'e~" e"tl'elt;] bl ~I'~IH'O"cldT~g ~, situlltion of this kil~d. " 3~re }zave de~lf, ',vilh sl~l;s/i~s rOdtLy ~t grl~tt h~g~h, T suppos~ if cigarettes were completely hanned~ if'~ e [~ied to cb) ~o eig~t eKies ~,haL we did to ~!~stilled splrits h~ ti~e second deep,de of this century, and if no one e~er ~mokt, d ~mot]~er eig~trette~ the mortality rate in ~l~is eour~tl'y ~ould still 1:~ 100 I ereen We are all going" to die. ])r. T:,:RItY, 011 this we e~uldn~t dis~* !T~e ~it" ~ fllo • ~[O~: l ij N. T itL% Is on~ s ~LtlSL] 0 ~h ~%t ~A,~ c~rt 8.~I'0~ 3\,ith. Dr. T~a~r. Yes, sir. Senator H~r~ke~ S(!nll~Ot" JT~ARTKE. -~1}11 ~tl'e ]Jr. ~IOl'Ii~ but you &re Wllat kind of a d ol~gl)±" ! Dr. IIo~-, I h~.{ a Ph.D. deg~ ee. Seawater ~IAR ~'KE. -l'OU ~re a ps)'o]~ologi~t ? Dr. HO~'¢. Yes, sir. S~t~lltor HAXXXE. ]~[~Ve yOU done xvo~k b~ poIIs before? ])r. HOR~. ](CS~ sir. Se ~torlL~r~. Az*(lvol~h~l~vestrxle~lre~ 1o s! Serl~tor ~IRTK[, ~II ~]I~ ~llml/l~y of the doeLor's i~ol]{~]llsblrls, T Sttl)pose. you prepI~red it fox Dr Te "*'5," and n h s ~'ou co /e to, ~<o*~e• eo~l~Ictslo~s about pereelltages. And they ~re base(] o*i question 216 £IS ,yoII ~aid. ][ow~vel-~ %v]l~n volt ~m~ bwk ~o fhoge qlles~ions~ it really is no~ just as cut and d{'Jsd as it would appear from yore' ~,swt, rs hot'o beeal*se yo~t do no~ break i~ down into tlle eategori~.~ itl whlet~ t]le qllestiol~ f~ze answered. is~P~ ~h~tt true ! It is not strickly a yes-or no ans~ver ? Dr. I~o~-. The ({lmstions in this seetJoll wel'~ ~sked--were phr,~sed • s follows : X will tell you what some people hs~e s~id, J~leltge te~l me whether you R[ro]]gly ~Igreo, m ¢I y ,9~ree, m~]dly di~a~;ree: fir strongly disag~,ee with ~hese ~t~te~teI~f~. J~'or tl~e pnrpos~ of the r6po~% we have colnbht~l t, hc strongly agree al~d mi]dly agree to agree~ a~d the mildly- dlsagr~ ~{lid ~Lt'or/gh' dis~gre(~tx~dis~lgree, For two ]evels of emph}tsis. ~l]~teoI" PIAI~I'](I,]. Yol[ ]lf~Ve JIl there re~ily six eategoz'i~s not just fore' as you indicated, but, six. "}'ot~ h'~ve ~ no opinion category? Dr. HO~', Yes, sir.

92 ~IG/~']~ LABI]Id!qG AND ADVERtH$LNTG Dr. Ho~. Yes~ sir. I~ the ~% whleb [ haveplaced in the record~ thls ]s glvon in terms of the pe~e~dage agr~ed~ the pereeRtage that disagreed and the percentage th~L expressed no opinion. The~ no answer" is a trlvial kind of thlng, one-tenth of 1 pcrt~nt~ o~e tb~d o~ 1 psi'cent; Sen~r tL~E~z, i he only reason I anl concerned about thi% if this $12G0~ statistlcal poll is going to affect the rest of the coumfittee, I wan~you to k/low it is not going to hav~ any effect llpOn me, I want V/~t~ to know that now If it,s going to affeet~ the rest of the ¢ommgtee I tbmk we sh~nid have a ~ nplete expl aamtion of ~nst how thi~ propaganda is supposed to a/fec~o~hi~eommitte~.menat~e~. Dr. n~. I think you will filtd there is a, complete reDort on tbcse st al:eanents i~ the decument d~at I spol.e of. Seamier IIaR'e~. But w~ ~re not going to have thc~e for 3 months. Dr. EORW. % % no. You hsve tMs now, you lmve a copy of it here now to put ix~ the record. ~(mator ~IA~TXE. To nay doctor friend on tile oth~r aide. on tbe Hazardous ~ubstances Labeling Act, i checked the record ks'hich i thouaught wus con~c~ this morning. Th~ only Senator who partici- patrol in those hettrings was the senior Senator from Indlalm. I ¢onducze4 them a]l. by l~ljgself, not ~nother Senator asked another qnes~hm. Sol was pre~t~ familiar wi~h the ael;, ~oo. -~i'. ]~LLn~r~OE~Zq, I think I remember that, sir because I was herb he~ore you, with the Comma ss on~r of t~e l~oo~ and Drug Adminls~r~- lion. Senator HART. Doe~ the Senator from indiana h~we any further qu~tiens Senator ~IAr~EZ. No I have nc~e. Senator BASS. Doctor, first of ,~ l ~t me ~v t ~at I am l~ppy t~ tare you before the committee, arm all of )'our a~sistants tu give us ]n formniicdq. _%llhou.a~h I might be ~ferred, to as a pre udlced wkness I mean. a pre]ll&eed ~nestloner, coming from z telzu!eo a~?a~ I am just as interested in finding the cause of ctmcer fi2~ding a cure for cancer, ~lld ttm ~im nation of ¢atlse% as Itny mart in America. ]~ut I also want to be ~nre that we donrt pass puni£ivo legislation, nor tha¢ we dorl~ pardc otI s~methlng th~c is r~o~ or les~ circum- stantial, that is the evldenee--not ihc lea. IVben I ro~d t~e testimony ~uld ~ t~fiM~ you will agree with me the~ are many ~minent clinical experts in the ~nited Stoles today Is that ~ ~ir sfiatemenL ~wh° disa tee @llh the premise that smoking is a direct cause of caxteer. Dr. Ta~. Tbel~ are persons who dlsltgrce. I would say that the ~ast mltjurlty of physicians do not. They agree that the evidence indicates that cigarette smoking is a causative, a pri~cipal ca~*sative ~aelor in the production cf hm.~ cancer.. , Se~ater B*ss. Are you familiar with the malor nses of tobacc*, how it i~ ~sed o~tside of eigamtt~s~ Dr. T~a~Y. [ c~me from Alabam% and maybe I know about that as much a s you d o in Tennessee, Senator BASS. ~rllat about snuff dippingt Dr. TYm~. Ye% sir ; i am qui~ wel I acquainted with tha6,

CIGARETTE LABELING AND ADV~,RTISING 93 Senator BAss. Some peop c ip snuff and keep it in their lower l!p all the time. Is there any evidence that it produces cancer of the lip or the i~mer part of the mouth ! D' T~Rgy. Yes, s r There is a definitely higher ineideoce of cancer of the llp among these i)eopl~ who carry ~luf~ m ti~elr hlwer lip 0±an amoILg those who do not. Se~lator Bass. How lolig has that been known ? D'.TE~Y Many,manyycars. . Senator B~ss. Is Lhel~ anything an the repor~ flml hrmk~ tins out. Dr.'i~z~v. Yes, sir. Iamquitesurethatit~sinthereport. [can't give you rheex~cL age. Senator Ba~s. ~re you recomraending legislation to put on the snuffbox - Dr T~eRY No sir" I am not for t e smp e reason that I think h s is re]at~vely minor m coInLp~r~on to the incidence of inng cancer nd o~ other d~seases produce¢l by elgarett~ smoking. S~n~.tor BASS. Did you know t a5 e use of snuff has incrcmsed l)r. TEar. I hm] h~rd that. Ilowever, th~ figures that were avail- able to o~lr cxm,mittee I dolgt believe st~teA thin. Senator Bass. It is on the incl~ as~ iit industrial, plants, people who smoke but are not allowed to smoke dnring wor]~mg lmurs u~ snuff qu ~ ex ens ve v n the industrinl plan~s of the Nation. I ge~ this information h~x~rlg served on the Committee on ~grilmll;ure and having wor]~ed wil.h tile people in tobacco. Now, le~'s go to cigars. ~'ou say that cigars arc not as likely to ca se g cancer as c~g~rette smoking. Dr• TE~Y. I think the evidence dearly m*~kes n dlfferentiat~on. Senator B~ss. Didn't you al~O 9D.y h]ng ¢.~ ~ r ~rl]on~ Ii±~n ~-Ag more prevalent than al Ilollg WOIll¢lq ~enator R_x~s. ~rer~ ~ew women ~moke ci~,~l~3~ ~nd more meB s[mIke C]~aFS ~han WOli~en, S0 why wou]gn~t ~here be ~OHl(~ right, ion to this ea~lsin~ ]ung ¢~ncer ! Dr. TrmRv. On the other h~nd thc~r~ Itre illOLe lriell ~'Ilo SI)~ok~ cigarettes tlmn there are women who smoke cigarettes. S t r B.~ss But peeve tagewise! You were t~lking about pe~entage~vlse. Dr. T~v. I am talking about total mmtbers as well as })ereouf ag~wise. There are ]~lore zfiel2 who 8]rloke ciga~et~o~ Ihnn there ~r~ w()men who smoke cigarettes. Sen:, ~ • ~3~ss ~ ~ ~'o~ ~ ta]k{ng ]n perce[ttages whe~ you said theft the hazard w~ ~reater to men than to women ! Dr. T~.rm-c. You are asking me i$ there wasn't ~ higher incidence of lung cancer among men. S~Nlt~ot" BASS. A~ong JIlel~ Who slnok~. Dr. TEnor. I ~dd [here was. Senator BASS. ThaI~ among women wl~o smoke. Dr. T~s~. Yes, sir ; this is true. Senator B~ss. W~uldn~t cigar smoking have s~me relatinnshJp to tln~t? Dr. Tsar. The evid,mce flint the committee accmnulated indicated that the incidence of hng cancer among cigar s~mkers was only

94 CIGARETTE LAB~L|NG ~D ADyENTI~ING slightly above thag of nonsmokers. So that whether men smoked-- ~l~cl]le,. woirl~n .q~rloked ci~o'ars~ i WOllld n0~ ~x]~lec~ this Oll ~he b~is O~ lhls hl~ornmticu to ~ffeet the overaI1 figures significantly. Senafx~r B~ss. ~o~v m~u~v diflFerent types of e~meer do you know o~ that we refer to ~s m~ or ]~lle~ ? Dr. T~my. ~L~jor kl]lers~ I would think tha~ hel~ ~rB ablaut 10 different t~q~,es of e~ne~r th~ c~ns~itut~ the vas~ majority o~ e~s of e~nc6r. Senator Bass. Wh~ e~uses ~he oth~rs~ Dr. Tv~. I don~t know wh~t cau~ them~ ~ r. ~en~gor BASS. If we earn find ou~ wh~t c~uses ~ung cane~r~ and if we ~lr~ so eonvlnced ~h~t elg~rette smoking ~ses lung cancer~ why c~l~ ~ ~o~ ~nd o111 v~ ~ ~a11~s s~lx~om~ c~n~3er~ ~3i* some <)~ ] ~ o~her nm~r cancers tha~ w~ huve ~o ~tu.e for ! 1)1". T~Rlex- Sir I C~li gssul'e ~r~311 ~ha~ w~ are wll~'~lg V~r~r blind ~O ] l~ ~nfl ne the~ f:lct~ ~I1~ ~v~3 wll m.qk¢~ ~]l~n~ av811~]~ e w l~llever we k~ow ~hcm. Senator lqAss. I~ NI ~ [ workin~ in this area Dr. flx~Im~. Oh~ yl~s, slr, ~pending over $100 m~lllon ~ year in ~e ~]d ~en~lor ]3~ss. Are ~he¥ worldng ill ~JJ1 tv cs o~ cancer research? Dr. T~m~y~ All types ~)~ cancer research/~0~h our own ~*~ien~s~ working in our laboratories as well as s~ippor~ing sclen~ists in lab ~rl~lories ~nd uni~ersi~ies~ medi¢~] ~o[leges ~nd~other ]a~r'~to~'i~s bl~tghoul ~he coml~ry. Senator *qAss. Do their ex ~erl~ agr~ ~c~np]~tc~]y witch ~he ~nd~ng t ~a~ cigarette smok ngs ~ ¢~use of lung c~ncel" ! Dr. T~Ry. I don4t know of any doubt on this uestion among our staff in t he Cancer Institute. There co~] d e,~nee~v~lv be ~ person who had ~ different vlewpoint~ ~ scientist i~ the C~neer l~itute. ~qenr~tor ~Ass. How long ~tgo w~s it th~ we were able to diagnose Dr. T~:~. W~ h~ve diagnosed i~ for raany decades. I think th~ m~n questir)n ~s how ~ee~tr~ely ~nd eompl~rol.7 W~ h ~r~'~ rliag~losed i~. Senator BAS~. We now know ~h~ some of ~e dlse~ses ~h~ used to cau~ dea~ll, tha~ we c~]ed consulnptlon~ TB, or some ~f the other respiratory problems~ we can now diagnose as lung c~meer. "[)r. ThRIll. This is ~gu¢, To SOll~e tl~ ee y~ ~ir. I ",vl/uh~ h~l~rl ~ ~dd very f~'~lkly Lha~ I ~t~l~t ~hink t~,h~t i~here is enough differene~ to make up for the (I~fferen~e in the occurrence over the years. ~e~a~or I~AsS, Are you s~tlsfled the', we really know ~s much ~ we. l/or ~ milch gls we ~hollr d or Waill~ to Irfll~ ,~- ~ bu~ ~.e ¥olx collv~llced th~ we ha~-~ re~l di~guos~i~ ~b~li~ b~ dh~gnosh~ ~11 of tile e~ne~r problems, whether they exlst or nol~ ~ Dr. T~m~y. ~y no means sir. I would J~oL eoil~nl~ ~o ~-ee~mmand to tb~ Congress the appropriation of I~rge s~ms of money ~o con- tinue working on the diagnosis of c~ncer if I thought we ]lad ~11 ~he answers already. S~ru~'o~ ~r~Ast~. Do y~u Icnow c*f ~lnV ~hr~r colilrllodit~ ~}l~t ~1~ on ~h~ m~rkel, now th~ you ~re ree~tmendlng labeIir~g tha~ e~use ~l~Crdr ~ Dr. T~.~ay. We have no spedflc recommendations in that respect ~sol~f~i¸ as I ~ ~ ~r~.

CIGARETTE LABELING .KND ADYLW£ISL'qG 95 Sealator B~. W]Ia~ ~l~>ut ~ir t~,]]ution~ y~rious connnodihies tha~ pollute the air ? Dr. TzB~v. I have admitted in testimony here l~ev ouslv thld thcr(~ is a higher incidence of lung cancer among the m~an dwellers as corn pared to rural dwellers. The evidence suggests that this may he due, at least [rLLps ~rt to air pollution. I would'go back co the point I&at insofar as dm committee's evalu~- tlon of rite nnportance of air polintioJ~ and ~)dmr £actors. as corn area1 with eigarett~ sm]oking~ they still came o/l~ with the statement t~at in their opinion that cigarette smoking was thu prlnclpal cause of lung cancer in this country. Seamtor B~ss. What ~s the major cause of cirrimsis of tim tiver~ Ilr. 'l~R~w, T don't know what the major ca~se is. There lwe many factors that participate in it. And I am sure that there are combflm[1 factors in cel%ain instances. Senaior B~ss. What is one of the ma or cau~es~ Doctor ? Dr. TERey. There is a high degree of ausoci~t on w th akx)hohsm~ ~nd particularly ~bronic persisten~ Me~holism. Sermt~r BAss. h{al,e that stutement about cigarette smokil~g and lungs. There is a high degree of association ! Dr. TF~v. ~t here is a high degree of association. Sem~tor B~ss. Im~'t that just ahout what i~ the actual fact as far as (:i r~reh e smokln g is concerned, u iligi~ degree of assoc~ ~tlon gDr. T~R~. Let me say it this way sir : There was such a high de[me of association that our advisor)" committee fet that t was lush/ted in reachiz~g the conclusion that this w~s a eau~ ~mc] c~ff¢~t relationship. Sem~tor Bass. IIas any test ~nhnM tes~ or a~y other test, of in- haling tobacco, ever shown conclusively that it would cause lung c~ncer ? Dr. T~v. I think tixis is questionable in terms of tests, sir. Changes have been produced in the lining of the membr~mes of experimental animals which arc clo-~ly simi]t/r to Ihoae that are produced in man. ~nr thertrmre~ I]lese subst a~tc~e~ Senator B:~ss. You are talki~g about lung infections and respiratory probiems. Dr. TrR~. I am not tlrIklng about infcetlons ~s much as T am toxic aetiort or~ the li~dn of t he m n(~ms mel~brane. Seualor B=xss. And ~fis toxic action is wh~t produces the tumor? Dr. Tnrmr. I think there is a general belief that this toxic action as it goes along is a forerunner of and instrmnental ht {lie production of lung c~ncer~ yes, sir'. Senator B.¢ss. Do you tlfink thaL future tests will actually prove this? J)r. T~m{v. I expect that we will accumu]at~ more information as our research goes along yes sir. Sonar r Bass. Yo a 'e COllVineed Blcn thI~6 oll]ee]ay w~ wiIl }lave definite clinical proof lb at smnki n~ will cause lung cancer ! Dr. T~lmr. I £~>n't k±~ow exactly what would satisfy yon or would satisfy the statement of definite clinical proof~ sir. Selmtor Bass. We use a~lim~l~ Ln te~t!ng v~ciot}s era,see of d,saaa~s. We know that we can produce tubercuk>sts ] n an ~mnnab Dr. 'l'ss~y. Yes, sir.

96 CIGAREqq'E LABGLI2~G .a2ID ADVERTISING Senator BAss. We know tlmt~ don't we ~ Dr. Txa~y. Yes, sir. Sea~tor BAss. We know that we can produce pneumonia. W~ know that we caa produce certain heart diseases m animals. We know that ini usangu • ¢ertaln elements and certain products that wc caa produce dise~e~ fllneo-ses that cause de~tll. But Doctor the dh~ct question that I am asking you today i~ have we ever defufitel proved that cigarette smoking will eau~ a e~n ¢;er if u~ under c~rta~n c~ndislons over a certain period of time Dr. Truer. Producelt h~ wha4~ S~nator Bass. I11 ~ knman being or in ml anhrrmh Dr. TFaay. I think the evidence is coa¢lusive that it does produce lung cancer in moax sir. Going ba~k to your ~Xl)erimental atiimals~ you injt~t tubez~losis bavilli or oxpose animnis to TB h~il]i. Not all of thos~ ~nknals will become in~e~ted. The mel~ fag that not all of them become infected is no roof that you are not producing a disease in a c~r tain number, tlm n u lit~Je r whieb do become infected. S(tlIILIX}r BASS. BHt we htlv[~ pl!l~hi('l~d ]unj CILIi(~[" hi t~.l'dly any animals with these experimeaxts, if I undel~gnd the experiments that have been going on. l)r. 'i'z~w¢. I thtak th~ ther~ have bee~l effects definitely roduced which support the fact and in addition to the fact th~ ¢t~r t3'p~ ~f tumors are produc~l with mate~dal from cigarett~ smoke. Senator BASS. W]~t par~ of the eigaretts ~)r, T~,r,R~. What~paarC of the cigarette ~ It varies. Various sub- stances lmve been isolated from the cigarette smoke. Most of it ]IKs be~n the so e~led hydroearbons~ eheaniaat eompem~ds. Senator Bass. ~hat t~bout nlc, otlne ? Dr. ~. Insofar as we know~ nicoVme has no effec~ on the px~- duGion of tumors, either in experimental animals or msn. Senator BASS. But tar¥ Dr. 'l'~aar. T~r is a different thing. Tar s~d its various compo Itl~lt [;S ll~k~ ltr%ldll(~d tll~Ol~ ill eXpel*illlenL~l Itrli mal~. Seaator B.~ss. What ~bout tumors? Let's get aw~y fmrn snuff dipphlg. Mo~t of the smoke s~ays in the mouth mol~ than any other place. Wh~t about cancer in the mourJa Dr. T~r~. The~ is a de~hfitely higlle~ incidence of caner of th~ moulh ~lnOlag slrlokers than aalmng nonsmokers. The same is tl, ae of,the larynx, the• voice box. T%e sa~ae~ thhlg is true of the lm~gs. SenaWr Bass. ~.hat abeut the n'ach~a. Dr. 'lYmph. Not tl~e trachea. At least J: don't know that there is any conclusive evldea~ee there. S¢~Ittor BA~. ~Oll st~e~ I ~ITI IIot O~ CC~]]P~ ~1~ x¢~rsed /is yoH are, and not m~ informed either as K layman~ as you are in your profession. To m~ there seems to still be some area of doubt as to wI~thel" tobacco smoking, tobacco uses, whether hi cigarettkq or whether in cigars or whatever, is ~ definite cause of cancer. )Dr. Tg~v. This is where I would disagree with yon, sts~ t~eanse I ~lml fll~tt tll[~ evldimla¢ I Oll[~hls~v~ly shows tbat 5t is one o~ the oaltse8. Our committee stated it in their opinion as being the p~;mcipal cause of hmg cancer in this country. I would not at th~ same time say that it is the only cause.

CIGARE~I"£~ LABEII~TG ~ND ADVERTISING 97 ~enator BAss. ]~aat axe the other causes? What e~]Jl we go about itl if we are-- Dr. TF~ltv. We have a feeling d~t some of it is ~la?cd l~ air pollu- tion. If we can clean up all cf our air this would be a ulce thing. Semd~w ]BAss. What are we going to do? I am ~ c~mntry ~ooy. I ~m for0mdevelo mentofruralarea~. Whye~twepu~outmgnsm t e c t es say~lg iT~ou ~'ant to live hel~ you m~y do it at your own risk butymlmay ¢tlungcancer. If~estartdoingthat~withthebigcity boys~ they wfl~ say this is none o f your b. siness. Dr. T~r~v. I don't think th~ b~ cid ez~ce is that much higher to jus~i fy that sert o~ action. Senator BASS. I am being a little facetious. Dr. TJ~mt~. I realizeyou at% sir. S~ .~tor B,~ss. i am "esting. l)r. 9~v. Being ~acetious vr no% I think, b~mal]y there ~s not j us0fication even robe ~acetious to that deaTee, m r. Senator B~ss. You are convb~e~d that cigarette smoking can~es lung cancer. V~u~t is the re~ponsibillty o~ the Govemxment~ You say you h~ve b~at i~t Governmen~ "23 ~-ea~. ,'ks tl~e elfi~f health offieer~ wh~L do you think your responslbfflty to the people of the Nation is ? Dr. T~v. I thi~k mv l~sponsibfi~ties fall into tbre~ generM areas. One, lo accumulate and ~mke avell~ble to the pufil is :u~d to the medical prdession any scientific related in%rm~io~ on tll~ sub ect, in other words, education and mforml]thm. Two, as d~c pthnfipM research ann of the FederM Government, I believe th~ we haw IL Ve~T definite responsibility ?o extend adapt, a .d foster resemrch in this field to answer some of the quest ons t m~ are Tt:~e, I bel eve t s my r~ponsibi]iby to coma befo]~ the Congress ~,he]~ l~ws i~rc pro )o~etl ~nd to give them n~y best advice on it. Senator BASS. ~o yon he]ieve that putting this sign on a pacbege cf cigarettes is gelng ~o curtail the use of cigarettes to any great deoTee? ~:. Tr~Ry. I thi]fl~ it will have some very definit (~ t~ffect, ye% mr. Senah)r]B_~ss. Angvoujust wan?it oncigaretbes? You dolFt want if on snuff or cigltrs or pipe tobn c~) ? Dr. Tc~r. We bew~ nol ma~e auy proposal with rega~<l to cigars, pipc~ or pipa tobacco: or snuff. Senator BAss. I am a cigarette smoker. Dr.T~x. Yes sir. lwas~or25yea~. Sellu~or BASS. ~o. werafor25years Dr. Tluut~. ]r~s~ sir. Senat~rB~ss. tIowoldat~ on? Dr. Tm~. I am 53 years ¢1~. Senator ]B~ss. You smoked for ~Ohyears. When dld youqu%? Dr. T~v. Aleut a year and • b ~lfago. Senator ]BASS. Did you h.~ve ~ cough? Dr. T~RV. Yes sir ; I certainly did. Se:~ator ]Bass. That is one of t~e main reasons you qu t~ wasn't if ? Dr. T~. Yes, sir; it was. Senator B~ss. That iswfiatI thought. It wasn't renlly fl~cfi~t~rof Dr. T~mr. It was ~ c~)n,bin.£~on of f~mtom, sir.

98 CItIA[I~DDI] L~Ei,p,G AND ADVERTISLNG Seaator BAss. H'hat about yore" assistants? How many ef them smoke Dr. TI~'Z. Dr. Itundlev here did smoke for raany years. He quit 1~2 or 2 yeai~ ago aml does~mt smoke now. I doJa:~ know abo~l~ Dr• Honi. Dr. Holm'. I qui~ in 1953 when th~ dala stalw*d to pour in oi~ our p~spee~Jive epidemiologioM studies of smoking and health/and it was very clear that tlm d~th r*~fie of packm-day smokers was about twice that o~ tLe no~smoker~. ~enator BASS• What aiyou~ the ex~unse[ ! 3~r. EnL~XBOO~. I have smokexl off and on, stopped, off ~md on. I haven~g smoked for 18 ~r ~0 veers. Sen,%U)r B,~ss. You were~ pl~tty well hook~d, I guess, Doctor, Dr. 'i~mRy. Just in c<~lmectlon with your earlier questien about the consmnptdon of rarions tobasca prod~ct~, a rerie~ ~rom 1900 ~o 19~ on the consmn, p~tion of tobacco pl•oduc~s, for instazicx~ as ib ~elares to snuff, in pounds per l~rson oer Year i as sl ow~ a decrease in rece it },e~ rs T e g e.s lnotdene~ was al0r, in 1920 1980 Since 198~1 lie e lms been ~ ec*uslstorit decrease in ~e alnOll~ of SllU~ consump tacit per pe~on in the United StaVes, Senator Bass. Per person! I v be fll~ fht~ p~ul~tion inel~-e, h~s bee great enough that ,e tohd amolln I, of snu ~ eonmm~ed as greaieL Senator BAS.~, Doctor you hmw wo hi, re in~ny things th,~t we know are injnrious o hot lth, ~u d vl 1 cause dea£h in I1 free society sn~ h ~ts we G%ve, and allowing eople to !ire as they wan, to~ in etht!r ~olxls driving automobiles, although ~ c.)tddldt lUd c~ro~honea on themt we know J~ey ara drmgormm. We don't m~ke thera siKn e~rtifi~ate~ "~s th~s trap roal]y n~z:e~n~x'y~" Most of the automobile geeidem% I am ~old by people that I h~ve dlsm~ssed it ~4th are caused by people who are really just out. on a a ' , not ~he ma~or tmvder wltd is r w~,velhag in his business, ~nd this SOrt of thing. People overeat. They gm to t}l~ ]t~ll tfi~;ro and have a ¢guple of ~harg(~. and ovm~at• . They, . go, t fat and you kn w they. aa~e cart d~se~se and this sort of tllm~, Do.YOU th nk we. are. beln~ far to a ma'orj ndnstrv• t ~,. lTnited. States wheal we ust single out one and ~%y tlll~l~ i~ sollle O~ldene~ ~at ~vid~nee, if you want to l~ut it that w*~ fha~ tho r~d~*ct that you .,r~ prndlming and t~IIh~g ~s injurious to health ~ ~ it £air for us just to slugle out this industry and say we ~re go ng to do e ,err- thing we can to knock you out of business( and let, ,ll ~he vesl, of thegn Dr. T~r~v. In the first pb~ I &m'f ihhtk t]mt the fact tha~ the ~[ah ment t Mfl w~ ba~e singled it out i~ entirely true. Sel~ator B~ss• ~aat is th~ biggest killer in the UnSt~l States toda 5 ? Dr. T~Rr. Heart disease is the bigcest killer. Senator BAS~• What is the ~% or cause of heart di~s~ D • I~RRy. ~theroscleroszs of the ooronrwy ~r ~ncx% or h~rdemng ~f the aa~erie~ and blocking them off. Coronary ha~ru disease. Senator Hiss, Have yol~ lookud intt~ wh~t caused that~

CIGARETTE LABELING A~D ADVEETI~ING 99 Dr. T~tY. W~ certainly have. We aro spt~lding millions of dol ]l~J'~ (1~ yell[' rnonl!y t~rl~ rni[tt* oil r(!st~lr0h. Sl!nIfl,llr I]A~,~. H~Lveylln llul]~dle]~on ~nylll~llg? ]')r. 'r~l~Ry. No~ slr~ bt.e~use w~ h~wc~t such e~n~lu~ive ~vid~neB it.s to ~iu~]e ollt ortt~ ~ll~to~, t~l~l~ Js so r~spon~lll]o. ]zJllt if IL~II~ Whel~ we ~lo~ f thM/ be tb~ first, on~ to Jn~ke that rceomnlondati~n, ~r. Senator BAss. F~, people have heart dlse~se much mor~ than sl~m people~ don% they? D~, T~R~. fh~t is rigllt~ sir. And w~ haw done ~ great¸ de,~l of research ~'ork ~nd education act~ vity in this field of ~b~s~ty ~nd heart disease. ~enator ]3A~s~ Are w~ going ~ put it on oIeom~garine~ or beef f~r~ ~nd thi~ ~or~ ~ thln~ ? Y)r. 'f~eay. We h~w not felt their the evidence ~bu~ ~1,' is ~,~h thM w~ ,!an inorin~in~t o so core p~etely any ~ood prowl uct ~s to ~ly~ 'q)o not ~,~t this pl"oduot~ WT~ ~rtaiuly edvise p~oph~ s~ongly ~g~inst o~erwei~ht. Se~tor BASS, Doot~r, I don~t want to beI~bor the poinu I can% ~n~wer qut~tions wht~hei" cig~r~tLt~ Shielding et~tl~eS lullg ¢/Llll!er~ I c]o1~'~ kno~. ~'~]I I c~ul ~o oil u~'e J'ac/~ ~o]ne doefot~ ~] me ~hey lhlnk it does. I ~o to on~ doctor ~nd he tolls n~ that I ~h~ld e~t dow~ oll nly ~qn/l~l~. I ~.n~t ~et f]zle ~.Etswer ~ ~o wha~ is excessive sm~kin~ and what is no~ exce~ive smoking, I think you either h~ve to qui~ smoking or .~n~oke ~l/ you waist to; this i~ my histo~ ~s ~ ~mokel~, ]Jut I ]lesJ(4tfo fu eo~n~ tt~ ~lld s~2/ we h~,ve ~o ln~tny poopl~ dying{ b' ean~er~ ~ud we t~ nk tt t maybe ~ ~m~l] pe~ent o~ ~era are caused by cig~retto s~aokin g. We have an aadustr~, that is so irnpor~n~ in the economy of ~h~ N~t~on t~day, it is rL~th[.r d~magh~g to me a~ ~ United St~te~ ~en~tor, to ~y that we ~u'e ~oing to pick ~1,~ th~s ir.h~t~3r ~Lnd put them o.t of bu~ine~. I)r. TE~. I don't think this c~u~e ~nd-0J~ect rel~tionshlp e~n be 4i~missed ~ ~s~r~l]~' or ~rel~tively insignifi~ntd' I think i~ is • very I~rge f~ctor. ~r~tor B±ss. Thai m~y b~ true. As I ~v, I can't ~nsw~r the med- ical reasons l'~n- iL. T usl i]llll~ llo]il~vl~ ~hllt ~t[t]o~s yOU c~.n-~ tlp ~tnd S~y we ~r~ juSt gO~ ~o stop growin~ tob~e~o~ ~nd st~p Sol]in~ it ,]- togetheI--i thh~k you are ~rving ~o injure ~nd damage ~n h~str~" th~ 1 don~l believe is ~oing ~to prodttce the re.~ults that you think Jt l.~ jtlnn to produo~. .Or. ~EP~y. ][ II~VO n~t i'~l!oTnml~n~ed (~iSOOllL]ntt~tl~o~ o~ the ~to~l JIl~" o~ ~'otl~coo 11o1" b~ll~lin~, it.s sr~le. I Ii~v¢~ no~ lnn¢]t~ %~o~1 ~,ooTnlne/~l~t Senator ]JASS, ][ realize th~. Dr. T~,~Ry. On the o~h~r h~md where such ~n important health ~,~ctor is ev~l~l~ l do no~ see how I earl ~tl ~s the Surgeon G~uerM of the Public IIealth Service. to brJn~ thi~ t~ ~h~ pnhhe's alten[iou ~nd ~ o see th~f it is repea~ed] v broil ~h~ to their ~t tesltlon. S~l~t~r B~ss. I think yell did tl~e greatest job of that when you h~d your pI~ss conference up h~'e. Th~s w~ one ef the ~.e~tes{¸ bits ~f promotion I hav~ ~v~r knc~n~ ,~nd T ~u~ ~]~d ~olL did it~ beo~u~se I w~n~ everybody to know it. I wan~ to "l~'~w lt~ even though I ~nl

100 CIGARE~E LABELI~C AND ADVERTISL~G continuing to smoke. I want everybody to know this. I want them to know this. This business of stopping tl~e advetsish~g cf cigarettes or tobaccos and labeling and ]putting the crossbones on then~I don't lhink is the answer at all Doc~or. i think if skis inforn~atioa is described in the ~cience lJoaks that are published throughout the United States~ textbooks, if the infoi'mation is properly distributed ~o the people~ let them have a choice. If I w~r~t to smoke and I lnmw i~ might be injurious that is my busi- ness. I don~ think that you can eont~,ol th~ u.se of it by label ngt ~nless you are going to gi:~e a prescription for it. When~you ge~ into drugs, whleh we aMmlnister: that is something else. But when people use something for sport and pleasure ~adi lu~/ry, and I don't know wh~t pleasm'e we get out of it but i do anti it is my own bushless~ and I may lmvc lung c~ncer today, bttt I dort~ bhink 2,o/t ar~ go ng to stop my lung cancer and I don't thh~k you ~l~e going to stop me getsin lung cancer by putting this ~quib on a ~aakage of eigKrettes. Dr.~Y. I fully subscribe to the fact that you should make that decision. But I thilsk it is my responsibility to do as much as I can to see that you make that decision in light of all 02 tbe inform~tlon that is a~ailahle, q'bon it is ym~rs. Fortm/ately~ {t doesn't involve anyone else. It is not like so~e other pz~oblems of being a danger to soft±eerie clue. It is urely an individual danger. So that our whole attitude is toward t~at of giving the general public the m~sl~ infer marion that we can so sh~t each indi~ddus 1 ~m~ make h is own decision. St~mm*r B,us. Dr. Horn~ in Lhis sm'vey tirol you m~.l% did you ask the question were ~hey ~ware of the fao~ that cigarette smoking would cause lung cancer ~ I)r. l:for m Yes, sir ; we did ask that question. Senator BASS. ~rhat percent answered in the a~rmati~'e! Dr. HO~N. 66 percent. Senator B~ss. 66 pereon~ of them knew that it would, and the other ,3i t e "co ~ did not have any information on it Dr. Itog~". 18 pel~ent said they didn't know, and 15 percen~ said me. they didu~t shmk it was. Senator BASS. in other words~ lg percent disagreed with the premise, and 60 some pe t~enL said it worl~ ~nd 18 percent didn't have any informntbm a~ ~ll is shat it ! Dr. Ho~-. They were unwilling to hazard a sta~emeut on t})a . Senator BAss. ~What I mean is, were they awaiu of the t)o~bdttyi Dr. tIorn¢. Oh, yes. Twc~thirds of them. Senator B~ss. Two-thirds of them were aware ? Dr. lto~m Two- gtsh'ds of them shought that smoking was the cuuse of lung ea~mer. Se~*ator Bass. Were they only smokers that had this information. Dr. Hoax. More nonsmokers beheved tlu~ tlian smokers. Senator BAss. i am not talki~,g aboat the ones wbo believed it. How many had the blf~rlm~tion ? . Dr. Ho~. This is an exp~mss~on of behef. Senator B.*ss. You dlcht~t ask them whether they In~cw an~%hlng about the Surgeon Genez~ags repor~ ? Dr. Iffo~r. Yes, we did ask theft. Senator Bass. ~;'hat perce~ttage of them kamw sha~ it w~ hltzardo~s~

CIGARETTE LABELING AaND ADVERTISING 101 Dr. HeRa. I can get for you It s~atement ~s h) the])ercen~a~e that believed tha~thl~t ~hought t]~t tim Surgeon GeneraPs r~porl stated that ]tmg cancer wa~th~t cigarette smok~n~ caused tung cancan'. I don~t h~.ve that fig11~ h~r~. But I can get that~ Senator. '*'Ills was om~ cff the questions asked, ~'ellether or not the~ }rod heard of ~he Surgeon General's repo~t was on~ question ~l~ q11est ons wel~ a so ~sked as 50 wh~tt they thought was in that report. , ~en~tor BASS. And only 18 percent of theal ac~ua]]y tho,Jgh~ it wa~ correct! Dr. HORN.*~O~ no, E , I ~,~,. lJer~nt~ raferred ~o the pe 'ce ~age--- when they were llsked the ques[lon ~ro~Id you sa~ that mg~ret~c sleeking is ~ major e~us~ o~ ]I/~g ca1~e~r! 66 percent sa]d that I~ either de/iuitely ~a~ or probably was ama or cause 15 percent said that it definite]y w~s no~ or p~u)babl~ was not ama or eause~ and 18 pereent--~8,8 perc~ealt, which is closer to 19 gereent--said thnt ttmy didn't know. ~nator B~ss. A~td you think re pnt ~ l~bel ~n the eigaratt% more of them would think it. is ~ major cause ! Dr. IIo~-. You are asking my o inion ~n that~ sir. I d~n~t thhlk theft t s so much a p mz ng of £ In'ell on the cigaret,te i~ thi! me~mbl~ of no~ having a label o~ the cigalette. 'l'he fact that no label exlsts onth~clgaretL~todayis~nterprevedb many eop]etolne~nt}mtthis s a 1 erfeet y safe anc~ 5easonab] y h atrr~ess profiler. Senator ~Io~o~-. ~% ould ~he'Senator ~rom J'onnessea~ yield! Senator Bass. Yes. Senator I%~O~I'aN. From the first part of your uestlons you brought out the diffet, e~e ]mtween statistics and dlnlc~ approach. Do you rea]ize that in my polt cal pa~tv there ~re peep e ~ho say sta~isticallv we have won the ~lection ! " ° = [Laughter.] I happei~ to hgve ~en L~ [*<h~n 1:~ &t ne-q .)"ot~rmon Sworn i12 or~ the steps of tile ~,~pltol~ SO I lure w that it wasnq so. S,mator Bass. I think I read that statement somewhere. Senator Morerox. g7 rail]fen e~n't be wrong. Statistleally we wm~, right. SenatorBass. Thatisright. T~enty sixmi]][on ~:asn~titi . . Senstor Momo~. I am not going to a~gae w th you over a m~ mn vot~q. [Laughter.] It was bad enough. SenatorBass Doctor, ~,0u* eartyo mavberght Luugh~er.] ~¥1ll you tell me how to q nit ! What did you do. Demeter ! Dr. 'l~z~Y. Just quit. I &dn% quit entirely. Actually ~ still smoke a pipe. So I s-till smoke. Senator Bass. g m~ sti]] smoh. SenatorDass, Dove slnokt a~;muehasyouu~ex]to! Dr. T~n~z• .No. sh:; l~ot as lnuch. Sometimes I gru~S I approach it. Senaior B,xss. You should have brought ,our pipe with yon. D~ yo11 re~l]IV holt{re [ W~ITIT 3~()u to ~iiswer l~le this question" clo yf~u reMIx' helleve Ihal t}m e]~r~rette wl]l produc~ moire of the cancer-zl},w- ing e]emertts than a dga~:or pipe ?

102 CIGARE'fTE L~-BELI~G A~'D ADVEI~TISLNG Dr. '~r. Let me say it this way : All of the e*idonce fildicates to nay conviction that the person smoking ,~ eigaretLe will get more of the cancer produeh/g substance than wi[1 the cigar or pipe smokers. And the reason I hedge on this, sir, I tlink that a significan~ factor may very well depend upon how people smoke cigarettes as opposed to cigars and pipes. I think that there is a great ~eal more tendene3- for infiMation and deep inhalation of cigarette smoking than there is of cigar or pipe smoking. This may be a sigaigcant factor. I don't think we lmow the answer to it~ SenaLor BASS. Tlm~c is sometixing tile5 just doesn't make sense to me. Psmokeelgat~tLes. IsmokethemwJLhatiponthem. duscdto. l didn% ~anoke them xdth a tip on them tutti] I [hougltg it stopped m:r coughing a UBle. llut I can't see hm~, elkdcally, there is any more tar or any more nicotine or ~ny more whateger it is, that does the damage m a eigal~ett% th~x fllere is ip ~ gi~at bSg old hmg cigar that ha~ as much tobacco in it as two packs of these eigarettek Dr. T~n~v. I (hink i[ ~,11 depends or~ where the tat" Senator B~ss. And they smell. Dr. T~rmx. VChere the tar and other substarmes get in your bed ". It makes ~ lot of di~ereace ~hether the materials get down deeply into your tratheM bronthial tree and intA> young lungs. Senator BAss. Do you cough less with a pipe thaa with cigarettes! DI'. T~nutv. Ye.% sir, Senator BASS. Do you think thab the coughing and indtation it produces iu the throat have any effect oil the producing of cancer in the lm~ss ! Dr. TEm~y. There is one prominent study which suggests very strongly that the cigarette smoker who has a cough, and t, a relathe degree the nmre severe the emlgh the greater the d£nger throe is that lm will gel lung cancer. Fhat is a reimt'~ "Milch is the belief of one of the sdendsts working h~ the field. I don't thklk it has been ade- quately substantiated. Senator Bass. This is stall ~lical i~f0rlnation ? l)r, 'Pnn.v, I am lint sure whether it is statistical or individual eon~ tel ion 0f [lie perso, who published ihe ieport. Senator B~ss. Thank you~ Doctor. Dr, Tr:~mx. Yes, sir. Senator HA~T. The Senator iYom Colorado, Mr. Dotnb~ick. Senator Do~ro~. I have Im questions. Senator Ita~T. PIaving reh'.%ined durh~g rite veriod P was here, let mg ask ol/e qtl~St ion. With refer, once to page 2 of your prepared statement--I noticed it this motmisg before I was obliged to leave~you descriZed the 10 years that have hatervened shoes the filing of the first of these two reports. And you comment tb ate- Cigarettes and ashtrays have become such commonplace accoutrements of life that cigarette smoking, for many, has become a deeply-rooted habit, and for other~, youngsters, a habit to be desired. Much was learned in tho~o 10 years from 1951 to 1964 but hundreds of thot*~ sandus of lives were needlessly l~st, Just what do you mean by tha~; ! Dr. T~sm'r. I mean by thls~ Senator~ that the cortt irmatton of smok- ing, as it has over the past 10 years, has in our opinion resulted in the

CIGARE~'£E LABEL~0 AND ADVERTISI~rG t03 death of hundreds of thousands of people who would not have died had they Not been smoking cigarettes during this period, aml prior I f) il;. Senator H,~m'. If my arithmetic is correct~ then you aCh'ihule at leas~ 20,000 deaths to each of those 1O ~'eax~ because they were smolnng ? Dr. T~:rmT. ~es~ sir. And I tlfink this is probably a conservative estimate, sir. Dr. tLurr. Thank you ver~" much, Dc~tpL q~lmnks to all of yon. Sell,~t or ]~ .~RT. O[]r nl!xf w IIxtesL¢~S I behev~ are gI)I)fia3112~ as spokes men ~o ' the National Tnleragency Council on Smoking & Health of Ncw York City. T3~e committee welcomes the ehail~nan of that Interag~ncy Councfl~ Emerson ]~oot% and its vice cdudrmmb Ih'. iIarold S. Diehh STATEMENT OE EMERSON FOOTE, CHAIR~IAN~ AND DR. HAROLD DIEML, VICE C~IEMA~, NATIONAL INTEI~AG]~NOY COUNC~ ON SMOKING AND HV~LLTH :vfr. Foo~. Thank yeu~ Mr. Cl~irman. My naule is Foote. Tlds is Dr. Diehh Dr. Diehl~ as you have said~ is vice chtdrmua of the council. He is also~ perhaps more nnpor tantly~ senior vic~ px~ident of the American C,ncer Society ~or medical af- ~Mrs ahd research. iII may, sir, i will go first. We very much a ~ ireeiate being here. The National Interagency Council was organized last year by 13 private and 3 Federal agencies. These include the American Heart Association: the American Cancer Sceiety~ the National 'iuhcrculo~is Associa~ion~ the .~neriean Public Health Aasoeiation~ and the lhS. Public Health Service. A complete llsg of the orffanizing members of the National Interageney Council is appended to this statement, (The list follows :) Mr. ~so~ Foo~chairman Dr. ~A~.~ S. Dze~,nce chairman American Associaticm for Health, Physicai Education, and necrea~ion. hmericau A~ociation of School ~n3im~strat or ~. American (3ancer N~miety. American COllege Health 2~soclatien. American Dental Assoclatloa. American Heart Associati~m American phazmaceutieal A~sociation. ~merica~ ~tlhli~ Health Asscvlat~e~ Inc. American School Health Assoc+iation. A~sne]s tl~n of ~tgte and TerrItor~al I:~e~l ~ Officers. U.S, Chitdr en's Bureau. Department of Classroom Teachers. National Cor.~e~s of parents and Teachers. National '£ubercul~ A~sc~iati0n. U.~ O~of Edlleation. U.S. p t~blie Health Service. £~'F/t IAT~ M~M~EB

104 CIGARETT~ LABELING A~D ADVERTI~L~G ~r. Foo~. Ollr basic purpose is improving health and preventing premature (l¢~ath by reducing the consmnption of Mga~re~tes. I anl hele today to e~dorse certain proposals ~kich nornia]lv v~ry mu~]l ~gMnst the grain of any Ame~'iean~ that is, v~.~.m~n~u(~ ~ label on a paekag~ which ~s in~nde~ to reduw the ~lo ~f the i~em p~kaged~ ~nd recommending warnlng messages in th~ itdv e~'l~isin~ of • pro~ict-- al~ intended ~o reduce the s~l~ of that produc*~ ~hes~ ~1~ a~ions witho~t precedent eoncernin~ any product a8 widely sol¢~ t~ are cigarettes. Th ~ ~m]~. r~ason w~ ar~ ~uppor thL~ e g S a~e. act on o .01ace. warn Jng ]:~b~ls oI1 ~lg~,l~ett~ pae]~age~ aD¢] warning me~sa~es m elgltr~tt~ ndvertlsing is that..¢igttre~te smokin~ l~presezlts ~. tot~Hy unique ]~e~cetlme h~zar(1 to hfe ttnd hem h. ~o one will ever see a ci ar~tt ~ ldll ~ ma~. ~s w~th a gun ; an d it will never b~ po~s~bl% as has ~n pMn~d 6u~in the ~urgeon Gen~rul's 2{epor~ o~L ~moki~g" a~¢7 H~th~ ~o accura~eJy ¢ompuee th~ humbler of pre~ur~ deaths caused by cigarette smoldn . it is ~oer ~e~fly co~ec~ however~ and ~iea~ifie~ly so~ln~]~ to broadly ~pp~oxlm~t~ tlns hazard, 1Not to d~ ~o is, i~d~c~ dange~u~ because it m~y ~re~ in ~he minds of some p~x)t ~ d~ tha6 c gaieties "ki nobody. It ~as b~en ~oneluded by responslb/~ scien~ili¢ authorities who have ~nt 2~r~ study'~mg the problem ~hat cigarette ~mok~n~ is re~pons~ble for at l~as~ l~5,0~eaths p~r year in this cogent t'y mid that the tlgure may be ~s high as 800~00~p ~r y~aT¸. National pr~t~ he~16h ot'g~l~iz ~ions~ ~th which I haw b~e~t a~ c~te~l ~or illor~ th~ ~ y~rs. p~aee th~ .~n~J death ~I1 i~'~l~ ~i~ ~re~te ~m~ldng in the nelghborhood o~ ~,~0.000 ~ year. l~ut d~atlx is not the ~nlv thing. It is ~von~ doubt tha~ there are millions of people who su~r wryin~ degr ~ o~ d sab ~v brougl t on by ci~areLt* smoking. This death tolJ ~nd this health ~oll ~re slmply too great not t~ r~quire ¢x~raordim~ry a~oI~ to ~roLee~ the people. A~ I have ~aid many times bethre~ at some point in Lime th~ respon~ alble peo le of this e~nantrv J~l~ve g~ t~ d~eid~ which is more Im- portant : ~uman lives ~nd hl~nan health or economic interest. Though ~t may well b~ thtLt ~remainre de~ths ~nd di~abil!t ~ :aused by e~garett~ ~oki~ ~!ll]ie~ ~m ec~ ol~lJ~ Jass ~Jeb ~al' eql~ ~l' or excee3 the e~t~re ~onOmle vaine 0~ th6 tobacco indu~ry~ I~ is 511o~i¢~1 a~d, worse than th~ d~el~us lo compare ~garette smoking with other hazards to life¸ such .~s ~h~vin~ automobile~, takin ~g baths, eating c~rlahl kinds o~ food~ o~¸ drihking ~ertain kinds b~ver~ges. Thee hazards result in c~amage thro~lgh o~reless or ilo_mo~r~Lt e use. ~u~ with eig~t~s the ~v~rage or mod~t~te u~er~ven ~]~ per~n w]~o ~Inok~s f~wer than 10 ¢igarette~ a d~ ineur~ t~ gr~ve rls]~ to bi~ ~ealth. as I have salcI a ~otall~ tml~ue ~eaeetlm~ health lm~rd; ~a~d the plo ~ctlon of the people o~his ¢olln~l'v demands special and ex~r~ordina~ ~' st~ps. • Th~ eounc~ J, however~ does no~ reeofnm~l~| ~i~er the i)robib~on of etg~i.e~t~ or th~ prohibition of e.igarette e~d~er~i~g. L~ ~e:~ le~l~m

CIGARETTE LABELI~NG .4~D ADVERTI~NG 105 meted a clear health warnh~g on ciga*~tte packages and in all cigarette advertisb~g, The Natlo~,:~l Inleraffeney Council urrges your support of Senate Bill 559 sponsore, l by Senator Magnns~m and Senate BiN 547 sponsored by Senator Neuberger. Thank you. Senator H~v. Thal~kyouverylaueh Mr. Footc. Perhaps the eo.~ mittee would prefer to hear the statem~it of Yh'. Diehl before we ques- tlon either witness. Doctor, why don't you make your statement, a~ld then we will question both of you. Dr. lY~z4L. Thank you. I'had a prepared statement, of 11 p~ges~ [otrt.~ ...... Ih( r ~ ilh p~gesa - of. rep~ductaon o~ the.statements by various reed,ca al~l health ¢~rgamzanons on rids. I tl nk ~ns is ava lalle to t]lB ~)mluiil~e. I have howe ,er sum nat zed this for purposes of ~'ev tv Senator H*~r. i'hank you, Doctor. 1he re~ ~d ~ 11 c~n am your sL~tem~lli; ill ]']111 as well ~s ~'ollr summary. (Th e st a~ement fol]o~ s :) CI{]XR['Vi£~S, BY ~:5~A~OII~ S. ]~IE]KL, ~,D, Mr. C~Xn~A~: Fh.st of all, I wmh to express ~ you ,~nd to year eotm~lltl~e my appr~-iatlvyt 2or the privilege of testifying wit]~ Mr. ~lmel-~lil I0oote. chair man of the National Interagency Council on Smoking alld HeaIth~ eonem'ning these bill~ whmh relate w the labelir~g and advertising of clga±x~tLes, In so doing, the first [101~ that I Wallt to make is ~hat ~he m~n~mental and authoritative study of ~11(' U,~* Public Health ~Y qi¢~2 firmly e~tabli$1tt~ the f;ll~ £]Rt~ clh'21r,~fte ~l~ok~/g ]$ a s~rioE,~ hazard to heaKh, 'these bale obviously ~- ~nnl~, that t*~ be ~rne. However, ~l~ hearings on sbnEar biI]~ l~l~g :[nne before thf, ~[o/15~* Committee on ~Ilt~l~lt¢ a~l~ ~oreig~t Commere¢' s.ool~esme~l for the tobat'co hldnstl'y attempted to d~sqredit the nntlnimons coIlvllls~otl$ of ~he ]() distingui~lled ~e~er~tl~t~ who comprised the Surgeon ~en¢*raI's Actvisory ('ore. mitt~e on Smoking and ~tk~t2o~t(,[a~[ol]$ which after further study were accept ell a~ the ¢~£[114al ])~si£[~n o~ the U.S. ]2 t]bli¢ ~eo]~h Service The 12]e~ho(I n~ed to ~ry to discredit these ~one]ll~]flns was to bring pllyaicial~s before fl~e committee who stated that glthollgh [}Icy h~d di~lgnllsell F*Ial t~at/d larg~ nnmbers of ]:~llents with lun~ can~'et t~leY w~re not ~Qll~i(lee(] that eiga rett~ smoking had anything to do with It TI/( ~c' llhysi/dans, alLIIo'3gh facile and impressive sp~ke~& i~re~ented no e~'~dtnee to refute the ~dotlc/[l~,ion$ of the ,% ] ] r ~e/in (~eneraPs Advist}ry Colronlt tee ~i~her that "c[~a~ ~q te ~oking is ~,a u.%~ ] ~y rehzr~d to lung *2anvcr [/1 mvll ; tile magnitnde of the effect of cigar~,tre smokinx far outweighs a]l olh~r faeLors," or that "O~arette smoMng is a ]]e~]]th hazard **~ s/tl~ h,llt impol.talwe h~ the Untied Statt~ to ~srr~tl~ nDpr~}priate i,e?nt~(lia[ re'thin.' A~ sn illctivirlnaL any physician has the right to tlls~grt, e with majority O.qiIliOIl ll~ foct, pbySilians can t~e l'ound who WOlll(I disagree wltt~ essentially anything hi tile, field of ruedicine al~d public health, k is imI~3rtant, ther~:,~ore, to realize that the phy s~¢lan sl ~)kesmen for the toi~a Cc~ industry repr(s~r t a very small seg~lenf of medical and scientdfie ~pmlon In filet ex, ery medical aid he~Kh organization il~ ~lli~ conntr~ al/d shrolld th~tfi llg~ S~ldl(,(I El~i~ s /b.iellL has concluded zhat ~dga re ~te SIt~ok]n~ 1~ H ~erio~l~; health ha~a ~d A~ ~¥id('Ilf~ rtf this, ~r, C}laiI*tlllZ[l* I ~0tt]{1 like to snbmit fc>r tits record several t~a~e, of state,s.eats by medical ~,(1 lleal~h 0F~8]/ix.qti011S Oll t~lis sqbject (~h~. are atiac'hed a~ the en4 of this s~atemen~ ) As yon will nee, this list inctulles the Alnerican (ar/cer ~o~lety; the American H~art A~sociatPm: tt,¢~ American P~biic H~alth St~soeiat km ; the National ~nllel~nlosis ASSO eifl tioll ~ the .~.meri~ an XI e¢~c al ~ss ocia~ion ; the Society of Thor t] eie Sur~e~n~ ; Lhe Ameri¢ au Asso¢i/l~il}rl fill- ~hor~clo ~llr~l,y: thg Aytie£~c~12 ('oEeg~ o]~ C]/ecG Physic an~; the ~3~teri~K~l School Health ~'~soelatlon; the Soeiely <I~ 8rate' Db'eet~r~ i~'r Health, PhyslcM Education an4 Recreation; tile American College lIealth As- soelatlon; tile S~rgeol~ Gelleral of the, Uniteri States Public Ilealth Service: the

---

CIGARETTE ]~A~ELIN~ 2kND ADYERTISL~G 107 emphysema, though little llnder ~toexi, is much more important than lung cancer as a ~ause o]~ 0.i~abflity ~111d is rftpi(]lS, ~lpprllalq£[n~ ]tlllg CallC~r as ~ c.lll~e c*f death Emph~v~eI~l~ i~ ~1 ehl'o]~l~ ]ull~ dJBea~, fr~quelltly asso~iat~l with bl*on~lti~ fn wh~h Dlng tis~l]e i~ de~lr/lyed. The FeS0lt i~ ~ ~rog~e~si~-e shortness of breath wltb increa~ag di~bil~Ly aud wJCh many victims spen~ling ~e later ye~lrs C~f their livin~ literally struggIin~ I/~ breathe. ~ coInmon s2~mptom of the be~l~ing o]' e/J~phy~ell/~ is wh~ is ~l~tlal~v ca/led ~t~ ~eq~ently ~smi~e(1 ~.s Ci~a~te s~oking i~ not the only cause ~ emphysema but it is ~n impor rant ~a~e. In fact, the ratio of excess (leath~ smon~ c~reite sD~oke~s as ¢om])~red to iloitsmokers has be¢ou/e as ~re~t for emb~hyse~a (8.~ ~i]~es) a~ for lu]l~ caacer (~.8 times}. I~l ~edi~al ~or/¢l New~ of Al~gust 1~ 1064~ Dr. Edwav(1% (~n~l~v~ ~ll~dli~ probltwn ~ow ~nt~ predicts thst emphysem~ win 1~ ~¢~sl)~llsll~le fOl" ~e di.~bil~ abd~l~t 20 mi]]i(m Ameri(mn workcr~ in ~ years t]mc. A~oLher special article i~ Medics/ Wor]d Ne~s of ~ebruary 12, ~965, entitle~i ~.kIar~nin~ p~i~. i~l ~m~hy~nl~ ; ChlLlleI~ge t~ rh~sll~a~s~' slates : I~eil~rted emiihyse~m~ deaths ro~e from 115 i~ 1035 to 12~5t) in ~04~, the last y~ar fo~ which ~oznillete ~llres ~re ~v~itabt~ At this moment, the~ ~re m~ro emph~V~('l~ ~i~ti~ns in the United ~t~e~l million, at a eonseivatiYe ~timat~t~li1 the ~'on~bined t~t~l iif hlI]~ ~Q~l~er ~l~d tl]hezettloMs j~atit'nts Eml~llysem~ SC~l~llnt~ for m~lre social sel~llr[ty dfst/bility Dt/ymoIlr~ to Worker~ a~'e~l 50 to f~4 lhQll ttlly o[h(,r s~]2gle (lI~or(l~r except heart disease, • * * On~ imt)olt.~nt rea~olt--fo~ tile r~pid increttse in emphysenl~--i~ that long- time ~mok~:~s ~ro just now ~=¢omln~¢ of a~,~." For the first tiIne, 1)r. ~oht~ H. hI<)(~]enlet~t, ~hi~ (,f th~ C]lost ~orvice at New ¥ork'~ Y~ellevue IIos][~tal, points o~t "the a vel-age man of *%ge 65 h~ongs ~ t]~at ~r~llp of Alner ivan men who huve heetl smoking ~i~ror~(s flbr 40 years. ~L~e ~mphystln~ i~ r~re ill llOilSmoker~, we e~ol now e~]poct to ~rld an In~rea~ng Incidence In ye~n smokers o~er 44) years of ~e Actor d]n~ to Dr. Oscar ~erb~eh of the ]Dust Oral~ge Veter ~lns' ~dmi*fistrz~tlon llo~lital, vi~ib]e microscopic evE~eIlC~ of (lama~e to t~ae ltln~S from c~trette smllkin~ i~ll!,s in the hln~ of I(h9 ]~r~eut of lneu w;oo h~¥e ~1~I~ re~lll~r ~rette ~inok~r~. [~ Ilo~lsn~kers he fil£ds 11~ evidence ~f £dmil~r d~In~g~. The ~hiEtl llOint that i wo~ld Iike ~0 emph~iz~ ~ tl~ .~ ~ov~J~u~e]lt whleh perinit s the ~le and tile* ,~td ve~ t ] s] n~¢ ~£ a prod/let which causes so mu~h damage to health h~s a respon~dbility to eollt~r~uou~ly iaform ~nd impress upon ~he publiC" the health hsz~c~ t(* which thc*y ~tl~e expllsin~* the~llse~t~s wheI1 t~]e~ ~moke c~ret tes A~ ~t~tl~le o~ '*[Uh¢. I~vo~l~on ~ F~o0 nncl [Irllg ~,aw~~ in the Jo~rIlal of b~t education 1~ no~ ~no~h'* ~nd a~k~a wh~the~ ~ason ~tlone C~I ever ~gmDet~2 wi[ll humall i~ltJaility fo~ ~reetl ~lutl frilly. ~ deino~rati~2 ~oc[ety nct~ds ~{l I.%ws ar~d a governmellt wit]l the w~ll a~d the i~togrlty to implement and enfol~c~ them C~ress est~shed tlle Food ~tnd Dr~l~ /kdnl]~istr~tfOil to protect the ]~t~hlic ~rom l~te~t[slly toxic 9~lbs~an~ ~ foods, (l~ug~, eh~n~ls, and othe~ Dre~a- 1,~tIo~, ~nel ~r~lted the I'eder~tl Traele Commission ~¢* protcgt the pub]i~ against ll/].~leadJn~ advertising, (Dig~r et[e ~m~ke is no1. ~ fo~d bt~t its e~ects upon £h~ body ~r~ ~ll{iu~:s tic a~hly due to the drll~ike attic1% o~ ~tlb~tallces which cigarette smoke *2oll[aJ~l~: Whether these- ]~e ~icot ine, earboi~ mo]loxi~e, ~ydro¢~rbor~. or eanee~ pr educing" ov e~cer stiralll~tin~ ebo~]o~ls i~ the ~/rs w)}ioh result from~ ~he eonlbusti~n of tobacco. Labels On ~i~:tl~tt~ D~a~e~, th('reforo, sholil~] stt/be £hat I't~e t*ontLu~led $~Oklll~ of ei~arett~ is a se~loll~ he&lth ~a~rd," ~nd should ~a(]~i~at e ~ho amoont of t~ ~n~ Ili¢otlne whleh the smoke ~ozltains. ~.~]vertisement$ Of cigarettes also sIl~lld t*arr2~ t~o¢~ war~2il~ ~h~[ "£he ¢on t~ued SlllOkll]~ of ~iRIlrettes is • se~i~s he.~lth hazard." t*l~eSi(l~i~t I~orll]ed~" ~n ~l ~,~po~]a] mess~e to t]~¢* ~oust* ¢*~ ~epresentafi~es iI~ 1~62 on ~tren~the*nillg of Pro~ra~n~ fo~ Fl~t~.,tion of ~n~lmer I12berc.sts, era. pb~l~[ze~I ~bat anlollg the basic rights of the ¢Ol/Sll~ J ~r ~re : {1) The right o safe ~-- o bel0ro~ecte~ ~tgaltts~ t]~ nlarketi~g of goods which ~t~e haZal~IO~s to health or life,

---

CIGARETTE LABELIX~G 3~,'D ADVERTISIXG 109 eaneei~. Breathing poIlu~t~ city air may al~o add to the riz~ of lung ~aneer. ~l~ pres~itt Klethod Of tt'eat~ tobfleoo or filter1319 [ll~ ~maoke ]3~t$ DCell p~ve~[ 03 reduce the harraftll offo~ts ~f eiga~ffL0s smok~g; up to now, these harlx:~l eff~ts can De avoided only by n~ smoking ~iga~lLeS. All persons should De ~ivei1 these I~et~t. P~re13ts, toft~h~ arid pD~s~i~xls have ~l sp~[al (@tl~l~tllnl~y ~nd a du~y to w~rn onr youth of ~he~e facts before th~ cigarette smoking ]labl~ ~s b~ome est~li~It~d." Approved b.v ~ho Nathm~l Tuberculosis Association Board of Diree~or~, F~b ~- ary 27,1960. "~VD.~r ~,~ lung ealt c-~r L~ a ra~i~y iD2r ~a slzlg lanai t]i~laa~o * * • ~tnd Wh~re~ts sei~n~ilic @viden~e ]~as ~ab ~hetl h&~ exces~iv~ cigarette ~okill~ J~ a major ~c[<~r i~ th~ ~ti~s~, ~ntl "Whereas, publi~ heath o~ eiaL~ iu th~ l~Id~3d St~t~s ai~d nlaDy other coun~rie~ h&ve t:oi~ted ollt thtx 1-~lg~ion~hlD I~oD~e~n ~I~TL~ ~mokill~ ~n~ lUD~ es~¢~r, Idlerefort~ b~ i~ "~ol~le~,, ~'h~t the Altz~rivfl~ p~lie H~Lh As~l~i~tioll e~ll UDOXt ]$~1]~11 ~tho~'~l~l to undf:rbak~ a bl~d ~dl3~ati0Ilt~l el~ort, ~)eciAlly ~lmffll~ .vo~ng peoi~l~, to ~)l~V~ll~ eight r ~o s~mokirAg, af~d b~ i~ fu~h~r Jiles~ LO ~,ol[~hor~t~ ~th ~rohllit~r~ h~]th Or~ani~l~oYl~ ~lld WJ~h ~0ttt.~ttioIlaI ~uthorlti~s i33 tilts ol~orl " .~¢3o~ b5~ t},~ A3nerJc~il ru~ll~ Ff~tll~h A~,~,~J~[~on~ 87t'a tll~nl~&I me~Ilg, Ut~ APH.~ m~mb~ to ~ovlO~ l~td~hJp hz ~[tl~a~ollal ~etivit~e~ to J~- ~lil,at~ t~l~[. ~e ort~PiiL level ~ smokaDg ~ii~tJFurfss~ a seriolls health hfl~lr0 Ol~*r APHA SU~l~6~L ~o t~ Pu~01i~ H~t~h ~rvice, ot~er 0 f~c~.] an~ ~oluntary ~e&~th a~ll~es, an(] pl,~f e~ionttl hoaIth organi~ t 1o13 s~ ; ~d t~ s/qaolll~ ~hlI ~Lh~r eomDzun~y tt~eneie~ i~ i~i~xatill~ pl~nrtil~g~ ttl/~l Imi~lom~ni~r~ ~n e~/l~ttXon~ program, a~d ~ullD~r~ c~ or.h~ m~a~llz'~ ~h~g lll~t~z ~ devi~l ~o d~tl with ~lis X)r o1~1 ~ra. l~e ~h~ lol~ao2i/ irldu~Ll'~, adV~l~Lis~lg ~ervicesr ~d Che Na~Dal A~il~tioi1 of ~roat~cast~r~ ~o ~/LLinue ~o take. v~l~n t ~t t~ ~1~ to control ~g~re~ ~t~] verdi S Urg~ l~i.~l~[ve bother] ~tnd [~llr~us~ ~1 empow~l'eO. ~o r~uht[~ ~'ig~r~ C~ll ~or ~n~nu~<l re~reh and d~molzsil'at[oll of educ~tiol~l al3d a~.~or~ lira- gram ~ ~scs~ on re~ in m~Lhods o~ d~ter riI~g yo,mg i~Ol~[e from beginning to s~a~k~ ~n0 of eneout~tgillg adulL~ [s~ giv~ u~ ~ cu~ tlown on gmoki~g. AdOpted Octol~er, 1~, bY gov~rnEn~ eoullei/ 91st annt~al meowing The t.~ ~e~rt ~o~t~o~ "The lf~,~ ~d h~ Comml~ on Smoking aZld Calxtiovas~ular Diseases T~ttOl~1 * * ~ on ~ly ll~ 1~ * * * ~a~ ~,r~ ~ ~U~ f,~ J~g~il~e ¢~ Lh~ htt rill f~l e~.O~[~ Of c[~ar~[e ~0klng oll health I.o warran~ diseollra~ilz~ teerla~er~ from d~'~elopill~ th~ habi~ of ~1~. ~ho ltrinlarb- evld~x~e~ of the ll~l'inf~ll eft(cot of eig~tl'eit e mmokiil~ r~laills ~Ile stati~i(-~l r~la tionshiii b~ee~ ~m okDlg an~ ~al~ty f~l Coronary artery 01s, e[tse~ l~llt a n~r~ber of t~qc411~ry ~P~t~llr~% t~r~ also ~3glliZt~l~ in~ hl/|ing eff~t~ in [~l~Dhyc~al£t, perlph~l~tI va ~3al~l" ti[~s~ ~xtd i1 ~f~ t~ 13@ o ve~k~, th~ r ~t~gJ~*Ii~.hiD ~o ~ft 3:~noma of th~ Iu33 ~. A~t'or ding] y, th~ eom~n~/~ recom~d~ thai ~ho N~t t~onal O~/~ Of ~h~ Al.~riea 11 H~r~ A~- eJal4on, as ~¢1~ a~ af~liate and ehaot~r h~a~ a~ciat~ons b~ ~rmi~ed ~o joi~ ~vith ~t~er ~'~htlltAl~ &t~d ~flfiei~l health t~g@nqies in ~lU~a~ional pr~gram~ f~r ~ll~rs ~ltltive ,~ ¢igar~tt~ ~rn~kin~ The t~mlmitt~, furf~h~r r~omm~Ild~ til~tt ~td"on~ enoii31I~l~em~n~ ~ g[oIt smaoki~g, illld~l~ Ill~l~l&~t ~llD~l~lslon, 13~ ~i~exl pt~pl~ who httl~ t~ hJgll ri~k of d~lth atitl il]ltc~ frc~lxa eorftna~ artery disease ~nd ~yo,.~rdial in£ar~tion, namely, th6se ~ith high blood ~re~ur~, h~gh "~l,~l ~ol~teD311 overt ~i~ of l~ardeilJll~ ~ ~he tt~ie~I a [amlly his~or3" c,f 11~ ~ ~r~ eke; ~zd 8tr0k~ in middle age, or It ~ombi~ ~ioI~ of ally ~f th@se. "$h~a]ly, ~he eoromi~tee ree~mnlentLs tha~ ~xita~d~d l~iologic~al and medical re~esrcl~ "c~ ~olldtl~ed ~1 gh~ rel~@~ ~ sr~o]¢ing ~ ~h~ 0~rdio~tllar dis F~II1 ll~po~ ~d~pt~d by the American H~art Assc~d~on [~oard of DIre~ors

]10 CI6:~2~ETTE LAB}'I,~NC A'~D ADVERTISING 1. IIu~ng rewiewet~ th~ ~iolls ~,£ ~e Ho~e of r)~legat~ of the Ara~rie,A~ ~etli~ [ ~o~[a{ion, ~vailable D~mted in~rn~a~ion, ~d very excellent testimony }*~fo~ ~ ~eferen~ ~)mml~ese, it ~aJme e~ideill to vcJ~l~- coramilte~ tha~ th~ Ame~d~ ~edica] J~socJatiol~ i~ Oil r~or~ &nd ~e~ r~o~n}ze a s~gnifica nt l'~]a t~ sl~Ii~ bet v#c-e~ ~i~ret~e smo.ki~ &lid the illcid~cJe of [tlll~ ¢~cer a]2d ~ert~i~ ~her diseases. ~n~J ~hat cigarette smoking is ~ selJo~s health hazard. 2. The AMA i~cognizes ~he ¢~tributio~ o£ the Surgeo~ Ge~e~al'~ coramit~ee i~ it~ ¢om]~re~e~ive l'el~nv~ In ]~ee~ng with ~* Of the rec~mm~Ii~n~ Of this r~p~r~, the Am~r~[l~ ]~I~d] c~l] As~i~t[Jorl ~1~ the iN~thln~] T:~]2~lo~ AS~O advpted a re~lu~[on urging element~lry and secondary sch~l~ ~o i.clade pro- grams ~n ~ki~g ~d health In theJl" ~]t~ #2dllca~lon cllr ricll]~ W~ r ec~Dll~ ~11(] ~h~[ pr~r~s he (level~e~J t~ tl]s.~mimite thi~ vital ll~lt]l ~ll~i~l/ m~teri~t] ~ the hazard~ of smoking to ~I] ~e grOllps fllr~lgh ~ll available meal~ of con:J~]lIlica tioll. ~. I~cIu(] e~] in f~he materl~] ~v~il~ hie to yo~lr comh~Jttee ~as a~ ~a,~ A l~l~ph] et eiltitl~d "~mo]~ng; Fact~ y~*ll ~hotlld Kr~ow," pre]pare~ ~r pllb]~c di~ribut[~ln. y~r reference committee critically r~view~d the tn}ti~ ] ~c]J~xl ¢J~ ~ ])a m21hle~ and believe~ tba~, in the ]igh~ of ~cumula~in~ knowlcdge, the ]~mphIeL is L~ ~eed of modifl¢~lo~ in its revishlm. 4. ~Phe /kmeric~n ~edi~a] A~s~.~at]O~l Hou~,~ o~ I)eIs2g~es, in a policy stat~ ~ne~L ~ ~tllle ~9~ ~e~o~iz~l th~ d~let~rlol~s effects i~ ~obao~ o]a hmman hc ~lt~ ~nd il~dic~te~ that extei~si~'e ~esearc]2 i~ nece~r~ to ¢1~1~ i~ e~'~ ~]~on- ship to h~t|th. BeO~UZe o~ thi~, yollr r~ference committee ]~elieve~ ~lot ~]u" AMA t~[~l~,e o1" l)e[e~,~te~ ~nd the ~o~r~ ~f TrUS~ ~hl~nl~] ~k~ gr~lt prlt~o i~ tl~ ~b/i~hme~t ~f ~ research i~ro~&m ~hat i~ ~n~" cs~rri~(] Out ~y t~ Am c ricai~ .~o~ical A~s~o~aL}.gil ~]d~2ca~r~ ~nd Re~e~rcl~ ~lJll~/~ion ~der ~be dlrectiol~ ~ • commi~ee ~ fiv~ ~]cien~ists, tl~r~ ~ whom ~r~ memb~r~ ~ the ~llr~el~ (]ener ~tl'~ com~J~it t ee. ~ ~peaker~ hJ ~h~ ¢,r~in~o~ ~ y~r ~efere~ c~nllni~tee, the ~ove ~lcm(nl t~ll~J:i~u~e~ fi COncise lind ~l'~te st~t~mellt of pl)lic~v by th~ ~.~IA with ref~ C~C~ to [o~aoco ~ a health baird. U~animo~sly ~l~provcd by the H~USC of DeJcgatc~ Ju~e 19~d. The Am~an CoII¢ffe o~ Chesl Phy~a~l~ "W]lereas. the weigh~ of scientific ~vidence ~i~tanct!y indica~e~ th~ cigarette ~moki~ ~.ild the inh~Jatio~ of o~her ~l~aOSph~i¢ I~olIIl~a~ts ]a~ve an a ~,~¢,ci~.ion r~ion~hip ~hi~h ~tr~ngI~" ~gge~f~ ~ ¢allse ~d cf[~c~ (,o~necti~n ~i~ ~:llrO~l~C caJ~c¢.r ~f tllc ]t~g, ai~d W]lcl.e~s, f~bcre is incr~ing ~cic~il~c cv~ncc ~a~ ~r~es and o[lz~r ~eu~$ ~Jtil] [o b~ ~elhled may ~a?; a r~le ~11 tho e~ioIo~y of c~cer, ~hc~efore, b~ ~l r~olv~d, %~a~ th~ board o£ re/~n~ ~2 the ~eri~a~ C~leSe of Chest physicians t~r~e all Of it~ menlbers ~ ~@ th e ~(~ic~] pl.~fe~ll in g~ler~l to i~el~if~ t~'~oir ed~l~,atJO~l~t] Caml~ig~ ~]ire~ted toward ~he pl][~]ic in g~lor~l ~d ~h~, yot~th i~ p~r~Icnlnr rel~lti~ to the ~e~I~h ha~lrd~ Of ~n~lil~ * * *,, ~ron/ ~ re~o]n~io~ ~rllv~ IJy ~le B~ar~ ~f ~44~11I s, JUEe 22~ 1~}2, "Wher~a~r ~ l~re~der~ce of scientific evi~lence /wit]~ ~C,~ coll~er ~i (levite} indivates an ag~o~i~ttion relati~Ii~iI) a~d sl]gg~ ~ cal]~] r(~Iat~I~ship be~en cigarette ~mo~ing ~(] ~on~e ~li~ense~ ~nd '~Wher~ the ~]g~re~tf~e ~moking h~lbit i}fl~n is ~CCltLirell nl~w by yO/]l~g peopl~ ~]~]l~r no]' ]~ ~ef0r~ ~h'~y c(~rllm~ilc~ c~lege, Or whil~ ~l~ey at(' ~t~endin~ clllleg e, ~'Wher~ ~ e~] ] ~e:~ ~nd llni~crslt[~ ar~ in ~ par ti/~l~rl.v ~dv~nta~eo~s ~ osi~ion ~,kL~g ~ ~) ll~e ~t I~de~l~S~ £heref~re be i~ "Re~OD~ That the ,km(.rlcar~ ~olle~e II~alth A~o~JJll~, rei~giJ[a~ lhe ~b~ve.me~Fl~n~el ~la~On~bJI)~ b~twe~n cigar~ ~moki~g and s~e diseases, ~rgc~ }t~ ~'tir~ raem~le~hip bo~h ~n~lituti~al aml ]l~d]~du~ atlempt, in ~.hatever Wa,v.~ considered[ m~ ~tli~bI~, to di~cdlura~ ci~reF~ smoking by Adol~ecl by tJ~e council ~f the a~cvl~tlon. Apl~l ~7, ~9~,L~

CIG~'~I]TT~ L~BELINC &ND ADYE]~TI~]NG lll rrl]¢~ pra~i~ of ~ enlIorse,m~r~ of t~b~ Rlld ~mOkll2g ~y ol2t~diIIg atblete~ in p~b]ic nlediu ~ldvert]~]n~ wit]~ ]t~ i~lvJou~ ~O~llOf~tloll$ l'e~&rdillg healr~ and physical ~tnes~, undoubtedly affe~t~ ~he at~itn~s a~d behavior og Lm~r essionable ~ehool.~go youth. The Am~vlc~l ~ehool Health As~r~clRtion, re~cogniziug ~lle evid~nc~ lilfi~ng t~b~eeo w~h imt~ire~ ~erforna~nee, health, ~ild longevity, ~J~]d(~ fl~e use ~f tobacco advertising i~ tLo ath½tic se~ing a~for ~ athletes of ~e~o~n as ~o~sly n~Jsleadi~g ~d a ~aindt~nee to the pl~per health ed ~¢atio~ of our y~th. Th~ a~s~ia~ioR co~demu~ the pracliee and urge~ ~tl]letes to refrai~ from the e~£~'aIly i~f~asib]e u~e ~f t~eir ~ame~. Approvecf by [he ~overmng co,nell, ~tt amaRal meeting, Kansas City, ~do., o~ November 10, 19C~. th~ I~lbli~ ~:I~l~h ~rvie~ ~o ~:~n~inl~e Rnd inf~I~Jfy ~h~h" e]~or~, to edl2~'~e young people abou~ smoking, l~tilizin~ all aDl~ro]:r~ate me~hods, inducing the wide d[sLribu~o~ ~ ±~tcrla]s, and Im it ~urther "Re~o/v~d, That the ~orActy of S~ate Direel~rs o~ tt~alt~, physical EducatioR, &nd ~ereafioi~ go ~n re~'o~d ~ ~avoring~ a~ i~t~llsi¥o program of e(fuca~on ~qua±~ young i1~oi)1~ wit~ ~ll~h $1~eRtifie ~/lfoyma~ion a~ will h~p therc~ tm~ler~Lan(~ ~e h~m~l~l el~ez~ts of ~i~ar~(" slll~k~ ~u~ will ]~sd $~l~m flw~y ~rom th~ ~e Of ~O~3aCCO+~' eo~izRneo of th~ i~crea~ llazards of tl~ b~lcl~/~o~nic (~ ~¢]~ ~r~, T] ~ir~o~rF ~TrkI)by~em~ ~nd ~heir rela~oI~f~bip ~o ~ret~ ~m~l~in~ ~]lll l}l~d~cal prof~i~ll be il~fiJrmed ~hrough al~opri,~ p~lic~.~ion~ ~nd t~l~t L]~ l&y [~ubl[l~ be il~gor reed thro,~h f~le lay pres~." P~ssed b,~ f~ ~meri~n ~s~o~i~tion for Thoracic ~urgery, ~pril 10, 1~ ~o~i~ty ~ Thora~c ~Ur~VO~ ~'~Vhor~. ~[ellt]fi~ e~idel2~ ~Ll'Ol2gly llldi~ate8 .'1 re]~til~l~shi[} h~weel~ eig~- e~trd[ov~t~]~r disease a~ll c~l~ecr ~ ~h~ I~ng ~ ~ "Wide'reds. ~he bl]lk ~ this evidelJee ~Rs ~¢¢nmUlated from ~h~ observation physlcia~s spec]aIizin~ i~ ~lm~nary a~ eardiova~cula~¸ d~ease~ ~nd "Wheref~, the ovetw~,lmin~ ~v[de~ee ~ t~ ~l~rmin~ increase ~ ~igar(~te~ e~l~e~ diseases and di~ab~ Iity is ~nost Rp~arel~t f~ ~)~or~I~ ~] ~'~on ~ ~ nn~ "~r~R~ f~h~ other br&llcheq of m~di~in~ ~ml ~]2~ I~tlbl]~ look ~o t]2or~ei~ ~lr geo/2 ~ ][or l~&dersh~p in de~li]~ wi~h ~hi~ vast i~bli(~ h~]tb pr ob[e]21 'L~IIc~for~, b~ il ~ol~d, Tl~I tb,~ ~e~e~ o~: T]q~ ~aci~ ~r ~eon~ urge all oJ' its members, esD~ci,~II~v ~e el~c~,)~l officers, ~o SUl~port ~n etkueatlOl~l ¢~mp~i~4~ dire~2t~d toward the i~bIic in general, ~I~d .~o~th in p~r~i~ll]~r, rel~t~ive t~ the h~alth h~ar ¢1~ of smokin~ ~ a~0. i~ de[e~es o]~ ~ Ameri~R /kled~Rl AS~Oeift~iO~ ~%lld to ~h~ ~tLvgeo]~ GCl2~r~I Of the U,S. P~dh~ Health ~r vi<~." r'a~ed by SoeieLy ~ ~:l~o~ei~ ~lrg~ons~ J~nB~r5~ 2~, 19~5, ~ff~o~ ~ler~I ~ the ~li~e~ ~la~ l>~lic ~al$~ ~r~i~e ,,~ ~ * the ~.igh~ of ~vi~ene~ J~ i~/~g~ ~oii~t]n~ iu one dlreerioil~ ~hat "~l~e weight ~£ evid~e ~t i~resenL imt~Iie~ smok[Ilg ~18 f]~ ~rinl~ipal ~ill logical Iaetor in th~ ]}/c~ea~ed i~e N]~I ~" o~ lu/~g ~llcer.~ t"rom ~he .Jo~rn~t ~ ~e ~n~eri~alt ~le~£~l AS~O eia~)~--~. W~k/y publ ~'aL~un ~lume 171, pages lS~1887. :19~ ~ ~ ~ On th~ b~i~ o~ prolonger[ stu~]~ ttnd ev~.llia~ion Of m~y li~es i~f ~ol~'rgin g ~vid~.n~ ~he ~l~it~ee m~k~$ the :~ll OWil2~ ~el~t :

C~GAp*ETTE LABELLNG ~XD AD~RTISTNG "Cigar~ ~moldng is a health I~a~ar4 of ~i~nt iml)ortance in ~e United S~L~ t~ w~aJx~ ~.]apr opri~te reme~l action" From ~moking ~nd H~lth ; ]Report of lhe &dvi~ory Com,mi tree ~o I:h~ ~ urgeon ~3enerai of th~ l~u~lie ]~|th ~er~iee---Aeee!oted ~t~ the Of~eL~l po~i~i~u of ~h~ ]~ubIie ~ealth Serried, i964. ]?ulmona r2z dJ ~, ~a r diov~L~lDlr ~fl~, ~., ~n nO longer I~ Ig~Or~. ~h~ Surgeon G~nera], U~AF, ]ln~ t~ke~ a ~m ~t~d on ~hi~ issue and h~s informed th~ t0bfl~o eompanl~ fll~ ~(i]'t ~i~r et ~ ar~ ~o ~o~g~r ~c~p~abl~ "2 TO ~llow ~he fre~ dl~tributlo~ ~ eigar~ in our ho~pit~l$ and in flight Iunl~hes sugh~e~t~ to our l~'~nuol ~h~t ~e Air FO~'~¢3 ~o1~a1 ~q~rv~ in eff~ c~do~ ~ig~t~ smoki31g. TO do SO l~ to r ~!~/~d$at e th~ o~ ~r w~elml~g ~v$ d~ll(~ o~ many mcd2eal research teams wor~ing in~I~ndently on a worldwide basi~. ,~ lto~a~e~or~h, KIJ'~ dg~ra~to$ W~ll not b~ ~ceept~ ~or fr~ dl~'ibut~on b0 patients ill 13~ ho~pl~a]~ ~or will tl~ b~ p]~(~¢] ~n flight lull~h ~c)~x~" ~om a~ order of I~ ~ ~oh~n~n, Major General, USAI~, ~0, Chle~ ~ ~ta~, SepL~mb~r 17,1962. J~y~i~l~r~, ~om~i~si~ o~ ~rl D~?,~ Ca~l~l¸ a~.l ~llrol~e ,, ~ * * q~l~ (~ommi~ion stro~gl~ ~l~(Ior~s th~ ~m(l~io~s a~d r~ml~ ll~en(~ation$ Of the Sur~oll (~e~ral~8 Advisory Co~mi~t~ ~1 ~m~ki~g a11~ H~lr~ wbi~, in acidi~ to e~nfivming l~r~i~llR repo]'t~, ~ta~ ~h~.~ ~m~l~ng ~s A s~rio~s hair4 to h~a]t~ an0 indi~r~A th~ ~fl for m~r~ aggre~iv~ prog~&m$ "~t ~e~m~ &~pa~r~ tha~ ~:a~ I~Uet[O~L ~ CJgal~tt~ smoking Offers g~a~ po~lbi~l~ fo~ ~he l)~ventic~ of illness, disabiIity, ~nd proraa~ore d~atl~ in t~li~ ~01~ntry~ ~ith t~&rd ~3 ~ot]~ ~an~r filial ear6iovct~elll~l" di~e~sa * * *.~, From Rerm~, volume 1 page 4~ ~inled ~t bril~illg 11rider ~ntrol th~ 11~it o~ ~g&r~0 ~moki~ag~ th~r~b~ It~- pro~g the he:d~h a~d we|lbeing of ~he pa~ple of th~i~ ~tate~ b~ reducing ~kn~, sufforiug~ ~o~ o~ ear n~ ]aow~r a~a0. ~r ~lat~ death. '~lat th~ ASTI=IO give t~lt support to ~he ~rg~ General in ]a~ efforts to ~i|~t proj~.ts aimo~ at bringing imd~r ~o~atl~i ~h~ habit o£ elg~r~Ll~ 8~uok~ag anal there~ improving th0 haattJ1 and eaonom~v ~ the l~al~on ~.v r~lu~i~g "That s~mei~nt fund~ be lmovld~l to She ~H~ ba develop a program in the arc~ of smoking an(1 h~alth antl ~o provide the I~ader~hip n~ary t~ iusare t~a~ St~t~ a~l 1~ programs may be eax~ie~l out ~ffe:ti~e]y." pas~ed b~ The &sse~iatlon c~ ~a~ and Territorial ]~lth ~c~s, November 13~ 1~$A~ (~aI~[or~i~ ~ale De,arChival of PubZ~ ~ealll~ .* * • th~ ~vi~l~n~ ]~o~b from o~lr ow~ r~rc~l fll2d t~ o~ ~fl~r ~ h~ I~om~ ~ol2~u~v~ ~h~ ei~a r ~tt e ~m~ i~ ~n importa~ ~a~tive ~cor in l~g can eer. It is pOsSlb/a that research now in 10r0gI~ may d~lnitely ~mplieata ~di~ ~i~al £~et~r~ /dowe~er~ th~ w~ight o~ e~d~co ~dth regard t~ eI~L~I~ ~i~ki~g as a gao~o of lung c~r i~ now so gr~ that th~ depart~l~a~ m~s~ I~ ri~ the ir~t ~r to t]~ fl~en ~J on of ~ flu] ~l~e.'* ~t~t~lnant of llJr~'~or, Which ~t~l~0.r~ ll~ (~tl~oyoJa'~ H~Ith, official bl- m~mtb]y i)ublieaglo~ of the Cal~r~da ~ta~a l)~lx~rtm~a~ of Public ~ealt~h, ~huue 16, pag~ 16~162,1959 ~a~orn~a ~ta~e Boarc: o~ ~e~RI~ BaseCt upo~ a white ~aper, "C, igar~ ~moklug ~d ~Iealfl~,'I ~hmitce~ by the Depa~fment of Health to ~h~ Sta~a board of h~tl~h indio~tting the rel~io~- Ship Of eigaD2t~ S~2O1~ to l~g ~n~r ~ntl th~ t~0~ i~ i~reas~d ~l~i~r~c~ of lui~g ~l~c~.r ~nd o~her chro~d~ ~8~9~a~ the board ~ ~e~Llth adoIY~e~l th~ "Therefore, be it resolved that the ~e l~oard of health ~a~or~ ~ltiat~o~ of a s~wide campaign ~o ~atrol elga~ze ~making ~o~g ~he line~ o~tlined in the abov¢-m ~ntioncd wilit~ pa~]'.~ Adopted ~ ~he St~e board ~ hea]th~ July 19, 1963.

CIGARETTE LABEL~G A~ ADVERTISING 1~ "~ere is now no reasonable doub~ on ~ ~rl Of authoritative heal~ ag~ndes ~cern~ wlt~ ~cer that the ~e of ~ObRC~ acts in ~ome Way to increase the ~'r~m Heal~ News, offi~al monthly p~li~n of th~ ~ew ~ork ~t~ De- ~ar tment of H~th, V~]~e 35, ~9.9, ~ges I~I~, 195~. '~e~o~, Tn~ the 0r~g~n ~t~te ~rd of Hea1~ g~ on ~o~ as ~vo~ an ~uea~nal eam~ p~ent~g smokin~ and heal~ ~s to the p~o~ of Or~in, nnd be it ~l~h~r ~'~o~d, ~l~at ~ O~II S~R~e ~]~] Of H~|fh eO~l~£e W~th ~er age~i~ and Drofe~io~al g~u~ in ~11~ti~n of ~he pllb]i~ ~bo~t ~e h~l~f~l ~fl'ects ~ ciga~t Lc smoking on health.~ Ado!~ted by the 01~u Sta£e ~oard of ~kh in Aprn 1963. appro~i~[~ ~mI~i~ee or ~mm~s~n ~i~ti~te ~i~d ~iu ~n edn~±ional p~am d~gned to in~u~n~e young p~ODIe ~ to st~r£ t~e h~t of ~moking el~re~es." A ~p~ M~y 1964. "R¢~OI~, ~h~t ~]Io A~zon~ ~edi~l Assoein~n ~ On r~'ord as ~v~atin~ th~ ¥~lu~iy gi~ng ~p ~ ~i~t~s ; ~nd be it fur~er ~e~, That ~he A~z~a ]~edi~l Asso~iRtlon ~comme~d that ~ysicia~s adenine regarding ~h~ d~gexs ~f cigarette smoking in £h~ir healLh eo~s~li~g ~nd ~omm~y educa£ion ~deavor~, parti~lar~ among the t~nag~ g~1~" ~dop~ed ~p~l ~9, i~ at the a~al ~tlng, Arizona Medial Ass~ia~n. "~;~d, 'l~ha~ the A~O~ O~op~thic ~i~l A$~OCL~OU go On ~urd a~ ~o~adng the voluntary givin~ up of eigare£~es by th~so ~Iready ]l~.bi[u~t~d; an~ b~ ~ further '~vlw~, That the A~zon~ Osteop~bic Medici Association ~0~n~ t~at phyt~i~ian~ advise re~rdiI1g the ~rs ~f ~i~rette smoking i11 their he~Ith ~o~$~i~g and comm~ni~ e~tlon ~voI~1 l~r~llla~ly am[ing the t~nag~ Adopted ~y 3, I~, at the m~nual mee~illg o£ the A~Ja 0~o~ ~dic~l A s~iation~ members to l~d~take 8n educational e~rt ~ ~i~ ~eir ~i~nt~ Of th~ hea] [h ba~s ~ the ~e of ~ba~ ~nd especially with yo~]Ig ~I~le~ £o V:a~ against a ~quirin~ ~he habit of ei~ r e~e ~moking. h~Ip diss~minllte this i~or~ation £o t~ ~oublic, ~I~ieu]arly to young people Who ~ro d~ding wlle~her or ~ot ~o adopt the ~rette smoking h~bit" Ado~t('d May ~ 1~. ~Iv~d, ~hat the CMA ~k~ S~el~ on ~ storewide basis ~ Dll~iei~ ~ar~icn- Ad~e~ by l~eu~e of De]eg~s, [)2d a~n~al r~e~l~ March 27~ I~3~ 'q~, ~e ~ r~solv~. That the Cal~orniu A~d~my ~f General pra ~c~ as a~ ~r~ni~n and through individual e~rts utilize all r~ason~.bl~ l~i~ LO dis~ra~ ~le fro~ smoking,

CIGARETTE LABELT~G AND ADVEI~TI~LNG "A~ ~ i~ ~rlh~ I~eso ~o~ Tha~ the CaliforIlia ~kead~my of G~l~l*al pr~ ctlc~ ReleaSes to the Azior ~¢~II ~¢~.d~m~ of G@]l~tS.l practice b~ lll~r1~etod to eniii~11r~ a~ a(] o~tio~l of tll~ s~me r~sollltio~." Atlol~t~ annnal meeting October i~63 Colorado M~Ca~ ~4o~ly "The Col~ta0o Medi~l ~iety rclterat~ its former ~s[tlon fl~at the imhal~ o~ tob~coo sm0k~ es!e~clally 1~m e~areLt~S, i~ hal'm~ul to hl~ma~ h~a1~, It ~rge$ ~11 p~re~t~ ~r*oh~ wfllm~iry h~Ith ~ig~ni~ies, o~: in~s~ed !o~rson$ and ~11~.i~lly its ow]~ m~m~r~ to ~(~ ~v~zy t]]iu~ l)t~bl~ to diseottrage smo b:ing a~ d ~I~'ially to (llseour~ you~ ~0pI~ f1"oln ~t~g 0~ smok~. It llrges ea(~h Indivithlal so~ety ulc~ber ~o eonsid~ whether h~ or sh~ ~.~ affor~ ]lOt r~ ~<*t an examifle for an other ei~zens om ~his Impol%an~ sl~b~t~" Ado~te~l by ]~Iouse of Delegates, Sep~m~ I~ 19t~ /~e~oli~0~, That th~ (~Ilne<-~c~t ~t~t~ ~dic&l ~o~1~ty go on rei~or([ ~ a~ivo~ (~a t ~ g the giving ~p ~If ¢~g~l~t~ smoking b v ~o~e al~ady habi~&~ed ; ~nd b~ i~ further ~oI~!~ That th~ Conr~eticu~ ~ ~i~dieal ~oci~y further ~ om r(~or0 as ~d~ocil~ing tho~ ~i~ ~outh ~ Our ~t~e b~ eneour~d ~lot to acq1~re th~ t ~b~ o~o habit fc~r h e~lOl r ~so~ ~ ; and be it f~r~he~ /¢~o~'~ Tha~ th~ (~o~¢¢~i¢u* ~tate ~.Tedieal ~oe~y offieial~ o~dor~e l~ZO~ gral~s Of t~ae]~ng th~ dangers ~o li~Ith from smoking to ~ gr~tle and hi~ ~ho¢~l l~vel ~outh of OUr ~t~te, and ~t a ¢OI~y cff ~hi~ r~sO]ll~loIl ~e ~n[ Lo th~ Oomanais~on ~ of EdUcation for ~o ~ ~s t~. of ¢~ nn~¢'tii!ut. Adopt*tl by l~OU s~ of Defeat e~, Dec~mb~z 11. I~ D~el o~ Columbfa Me,col ~o~et~l :~o~. Tha~ hh~ District of Columbia l~fe(]ical ~ei~ty go On rc~d a~ adv¢~.ating ~h~ volmata~r giving ~p ~f ~ig~l~tte ~mokin~* by ~ho~o ~Iread~V habittl~d : ~Ild be it ~ur th~ "Rc~oIII~, T}lat the I)i~rii~ of (~ol~IAbi~. ~it~i(~al ~i~eLy eoopera~ ~i~h the A111~rie~ Csu~ ~ii¢~t.v~ DiStlle~ o~ ~Inl~ia Div~sioa. ~ it~ edue~[onai pro- g~'am to influ~c~ y~llllg ~oIfl~ ]Io~ ~ ~t~rt ~he hahit~ ~ smokiIlg ~ig~rett~s.'~ Adopted i~ ~h~ ~x~t.u~d v~ bo~r.l. ~ay 11~ I~3. "l~e~ol~e~. That the florida Medical A-~so~ati0n go on r~o~d ~s advo~aflug the voltn~tary givl~g up of ~iga r ~f ~e ~i~]llng ~ t2aose ~ow ~In~Idug, and be ]~ fur thor "R~ o14)~. That th~ }~oriIla ~edle~l ~o~iatilm, thr~Igh al~ ~pprop~i~te Com- mit ~ h~]~ d~v~l oI} n~w, wh~r~ nolo ~.xI~t~ an(] su]~I~ ~nd ~l~our~g~ ~xi~ting cdue~tion~1 I~ro~urns d~igued t~ infiue~¢e young 1~eople ~ot to start the h~lit ~f smoking, and be iL ]'uz~h~~ introdu~ ~ si~iL~ r~Iution to t~e Amaeriean M~(]le~on A~iati~ at ~he ~U~I lu~ti~Ig, ff~ i~.~' A.t] oi~e~I by llouse of Delegs tes, May 10.196~* 1~wai~ MeScal A ~ocg@~Io~ "~e~oI~ed. T]~a~: ~h~ H~w~ii hi ~fleal ~sso<-i~ioll, ~ware ~s it i~ of itfl <111t ~ to &IcrL th~ ~i Li~en~ of Ilaw~i ~o O11bl~ h~a[th l~rd~ wishos ~ ai~owle~.g~ th~ CaL~al r~l~ion~hip be~w¢~l ¢igs.ret~ smoki~.~ a~l lll~g C~I]~C~', ~ltd th~ ~rollg st~tlstical assoe~t!otl betw~n h~tlvy elgart~tt~ smokil1~" ~d coroualy artery d~e~se, ~ud be it f~l~h~ "Re~o~e~ That thi~ ~osoelr~ fl on wisll~ to ~nvoul~a~ di~semina ~ion ~f i1~formt~ tion t~ th~ Imlil~ r~g'~rding th~ rela[ion~l~!0 ~f ¢igc~te smkI~l~n~ to th~o two Adopt~ed by the ~[~t~e of Delegate~ Ma~v I~J3. "~/lh~re~ore, b~ it ~o~ea~ That [hi~ ~Iot1~ ~f Del~at~s Of th~ Idaho ~te ~e(lieal ~s~0ei~tion 11~ the local ul~lieal ~oeie~ies to in~tla~ a l)rogram ~ 01~llna~on of ~]~orm~tlon eoii~rn~" the llazmful e/~c~s o~ t~}bac~t) o~ all llody ~yflt~m~ In ~I~r ~t li~]~ with ~xi~till~ health orga]~izatlon~ "

---

CIGAI~T~ ZAB~I.~'~G lt.WD AD~2~TIGT&TG The Mt.d{oul l~oe{e~y o~ 2gew deraey I~eso~ed, That the Medical Society of New Jersey nail Lziu)n the peOld+ ot ~ew Jersey to rec~gnlze the intimat~ eo~uecttou between ~us~ained eig~reLL@ rooking and lung eane~r, and encourage ; 1. Th~ individuals who do not moke eigarettas never to iniLiate ~he habit of smoldng ; and 2, Those fndlviduaL~ who do ~moke cigarettes to iJbandot], or ~estriet, their Indlllgence. Adopted by board of ~rustees December 186~. ~'e~ Me~ivo Med~eta ~oedet# "Whereas, it is now ~.eaa(~mahly established thai there exist~ a correlation be L~veen the ~lse of ~bac~ an~ Lhe i]lL~ideBce of eoA0eer of t]3e lung e£tr dinv a~2ular &L~e~ and r eSpll~tOr y dI$~ase~, an~ * * *. "There/are, be $tr "¢*0gced, T~mat ¢he New ~Mlexl¢o Medicnl ~0r~ety acknowledge the exlstcl~ee of thLs correlation, an(l that ~he society enilor so any ap!0 roved pro gram de~ned to reduce the incidence of this disease." Adopted ~t the al~ual rae~ting of the house uf deleKateu, Apri[ 24,1963. Medical ~ociety of th~ ~t~te o~ ~Ve~ york "Re.~ol~ed, That the ~edieaI 8~'le~y of the fitate of New York go ou reeor~ as a dvoeat~ the voluntary tgiving Up of cigarettes by those already hsbituated; and bei~ fttr [her "~*3~e~, That the Medical Socte~ ~f ~he ~¢atc of t#ew ~ork mm"ommo~d t~at ph y~icians advise regarding the dangers of heavy cigarette $~king [~ Iheir health co~seling a~d community educational endeavors, pavticulnriy ~mon~ the tee~ag~ gz~np." A d opt eai hy the HOOS~ of D~Iega~es, May 17, LgM. ~or~h Dakota ~tate Mtdiea~ Aeeociation %VOid, th~'efore, be ~t reaolveg, ~hat the North Dal~ota State Medical Asso elation advocate a voluntary giving up of ~m~khlg of cigarettes hy these ad/llLq who have b~coIn~ h~ hitaan~x~d, Oktd '*Be ¢t ~trth*~ reaolved. TIIa~ the North 1)a~tota State Medical As~[~:ia~on llarEMtDatn in ~he e0.ueatlnnal p~ogram of our y0Xith to encourage them to anoint smoking, a~d • "~'e id /'~;rl&~r reso/*)ed, "I~a~ a copy Of t~is tt~ohltivu b¢~ fi~l~ardtcd ~;o the Smgc~n General of the United States I~lblle Health Service. and a COpy pr~ seated to the House of Delega~e~ of the AmerioAIn M~dienl £s$ceia~ion. * * *" Adopted by th~ House of DeMgutcs, May 7,1903, Ok~o ~ta~e De~t~I Assoc~alivn "Reso~*,ed+ Thai the Ohio State Z)e~al Assodation ~al] u~n and encourage it~ m~l~hers to ~nd~rLtlke an ~ucatiollal effort to D~form their Imiient$ 6f the l~alth hazards o2 the ~e of tobacco3 anO. esi~di~ 11~ with yo~mg ~*pie, ~ warn ag~aus~ acquiring t~ habit of cigarette smoking, an(1 be it f uz~her "*l,'e*olveg, That ~he Ohio Stat~ I)enml A~S~clation intr¢lduO~ a r~OhltinIL ealii~ UpOy~ the Ameri~ Dental &~so~tion to es~ab}ish a~d make known to dentist ~ and the public at bilbo a l~ltcy on the USe of t obaeC~ and its feint km ~r~ ~st OBIIO anti Oral health." .~4optnd by the Hou~ o£ D~logates, September 1D~. pem~yle¢~a MediCal ~oelety "Resol~md, That tlle pomu~ylvania 2¢ledical ~Iety go on ~eeord ss advoC~%ting the volunk~t y g~vlng rill of eigaret I~, ~aoking by those already habituated ; and he It fur t~er "/~e*o~e~, That ~he Pennsylvani~ Medical ~oeie~ through all appropriate (~mmit t~" or colamission initiate and maintai~ aa edacal ional program d~sigr~ ed to i~fluenca ~ou~g ~ple no~ to s~rt tho habit of ymoking cigarettes?~ Adopted at the annual reacting of *he Hou~ of LMlegates~ October 19@2, So~tb D~ota ~tate Medical A~aoefut~ "~qle South l~allota St~e X~edienl A~0eiatfon endorses the l~xzitlen of the Amer~c~a~ Heart Asso<dafl<m and tffao ~l~elffc~an CanCer SordeV¢, ou the effects of tobaOeo ou the humml bod.v and x~mmends to tile youth of the Sta~e that they abstain froln adopting t~e smokZng h~bit because Of known add l~tential physical (~ ngers." ABopt ed a~ ~he amaual mooing, JXltl~ 9,1~.

---

CIGApET~ LABI]LIi~ AND AD~'EnTI~G *'The Intentional Co~n~ of Women Heal~h Commi~ee u~ge~ the IIealtL Com~itt~ of the ~io~l Counclls ~ ~Vomcn t~J int~n~y their ~ducatlonal efforts to inform th~ ~ublle in g~n~l and yol~g ]p~ple in ~Icul~r r~Irdlng Ad~e[i by th~ ~ener&l A~semb!y of ~e Intern~iiln~l Council of Women~ June ~. Cerned, be~e ~ o~r o~i~, i~ ke~p~n~ with t.bat of ~any other medical men an~ ~ie~ti~t~ ~h~ugho~ ~he world ~hat, beyond reasonable doubt, ~garet~e ~nokin~ is ~ important cat,satire f~or in ~ ~ease~ "NOW ~refo~e, ~e ~I ~o~, ~h~ the l~a~ c ~o~wes~ ~a~iolOgical Society m~[ke i~ & matter of public ~l~rd c~ its i~incer~ a~ut health ~3~ f~ill ~e ~mokI~1 ~nd fiJr[]]er ~e~ its m~m~er~ t~ e~o~r~e i~ ew,~ way ~ that W~I I~(i ~o the volunt~ r~Inc~ ~n ci~.n~e ~m~ki~ ~e~ol~ti~n adOl}~ .~" 11, I~, a~ ~e~g h~]~ in Vane i}llve~ ~, Clln~d~. "~o ~F ~ ~l~ly ~gr~l ~hat ~er~ w~s no reach t~ m odif~ the availa~ tod~y w&$ ~easona~y in~er ~r e~ed ~ i~dicaLi~K~ ~l~ c]g&relt~ ~moki~ is a Yn~or ¢~tive ~c~or in the inc~as~g i~nc~ ~ h~ c&rc~ll~ o~ the l~" ~rom W~r~ ~l~h O r*~a~i~ati0n Technical ~eDor t Series i~o. I~, 19~. The UICC~ i~ which ~ ~o~s ~r~ ~i~re~ted, h~s a~ line i)~ its n~jor obj~il,g~ ~e prev~ti~l of c&u~-r. T~ ~ion acc~i~ ~h~ overwhel~n[~g ev]- t~e~, ~hat a re1~tion~hiD exits between ~allCe£ ~ Lhc ]~n~ all(l the ~mok[~g of ~gal~t ~e~ ~h~ ~nio~ t~lerefore 11rge~ ~ re~p~ble ~t~rities in all na~ons ~ tak(~ a~ te mea~ re~ to ~u~o t}~e un1~e~y and J1~ct ~a~in~ lOSs of life from ~e~l E~flvc Gemmi~ U~CC FebrUary I~12. 196~, ~exico C~y, "~oke~ ~d l!ote~tia~ smok~rs hilly ~e~ the advice of t~it lu~cal ~ra~ ti~i~er s o~ ~is ~i~er, ~d (lle co~nli~e~ b~ve~ that ~ D~of~s~ion ~ ~ ~io]~ has a ~Sl~n~ibi~t y ~ ~]~o~I~ ~hem < ~mok~ ~i~(I ~t ent~l smokcr~) of the extent ~II ~is feted medic~ i ]~r acticioners i~ ~u~ A~ra~a to '([~ w ~e ~e~ion shiI} between he~y ~l~oki~ aud the inclden~ of l~ng ~am~e~ has n~w been Public ~]~ucafio~ ~I~ of An~canc~r 0o~Cll of Vic~o~a ~notes fOllOW. in~ ~temen~ of ~ledical ][~.e sea~l Co~l of (~reat Brit ~in as poli~ : '~E~ide~ fro~ many inve~ti~,ons L1a ~er~nt ~o~t]~e~ in@i~9.te~ that a i]~ajil~ ~art nf t~h~ }~cr~as~ (i~l lung eal~c~) is ~so~ted with tlib~cilo ~mokf~, D~P~cul~ly I~ ~he fo~ of dg~e~, in ~ ~don ~f the ~u~ciL the inost reasonable in~erpreta~on of this e~deucc is ~ha~ t~e rcl~tlo~sh~ i~ one of direq[ ¢~so and c~ect." d~ of I~ ~C~ tha~ h~v~ llongmoker~ ~ the i~ inc~s wlth ~e

C[(~AIIE'IV±E LAB~I.I~ AND ADX~ERTISIN~ IJL(~ Ua~ada--Do~inio~t Co~nciZ o~ H~altll o~ ('a~ada "The Dominion ~ull£-l[ of Health hal eve~ "~hftt. in ~'i~w of the T)ro~.reg~i~l! ~ere~se ill the IiIImber o~" l~ng OR tieer dOOth~g IIl C~lllada, rhel.a is jl~t~fie~titm f~lr the f o]lowin~ st~tern~n~ on ~he he,is of nnmcrou~ ~tlld[es : 1. Overwhelfnizlg eVl(lellee Show~ a I]iree~ l'elfllionglllp }letw~?.ll eigar~t[( smoking ~Ud lung oaneer 2. The risk of Itmg cancer increases in proper flolx to f]te mlmber of cigar('tt.~ smoked daily and the n u mbm. of year~ cig':±rettcs hay/ ~/l~ i~ i~cd. 3. E~ldell(~ in(]ieates ~ lesser darlger fr~m~ the ~ls~, ~ I bueeo [n eigarg and pipe~. 4. Diseo~rlRuanee of sI~ol~ng ev~rl after ]ollg use red~ees the risk of llmg ofllv~.r. 5 To dalx~ aLtcmpt~ by £1tcrlng cigarett~ smoking to remove ilt~uriotls mlb stances do UOL appear to be sa~sf~c~ory~a false se~l~c of s~ri~y wo~/d appear LN) ~Q ~1~1/~ wJ Ill LIly El t~ ~t]~ lilrers ft. Further. since smoking is a f~rm e~ addition, the m~t I)~ ac~ieal prerenta~i~'e measure, is t~ encmlra~e yoking ~p]e n ~ to ¢ol lille]ice the habt o~ ~moking" April 19(]2. 'That the nll~ionRl (~f~c~rs inform the Canadian ~edleal .~.sso cia glen ~n~ L'As s~iat~n des l~.[t d~zin~ dc Lallgne t'~ancfli~e du (~R~dfl ~hst Lhe (~r&r~d (~)l~]~e/l and l~,oard oj' Oi~,eCL~,s o~ O~ C~a~lial~ Cancel. ~*;eieLy desire zo see a broad ]lragr~mme Of pRblie duration oll ~£. ]~blem of ~ung cancer And smokln~ in ilia ~1 ~hrough the medi~ J ~he { anadian Cal]cer 8ociety, tile Cam'tdlan Medlc.al A ~ei~ tlol~, L ~o¢-lttl~ ~ de~ Mode* ~ de La~e ~ re,raise ~l~ Canada and sn~-h Other orgll niga~ilm ~ de~l~ing in i[l~l tt t*rs of pl] hlil¢ he ~ lrll as nt/kv ~o inr( r / ~zcl]." I~ewllm ilm ~doi t~ii by b~)ar d of dire( t~ ~une !~ I~6~. Canada~Ca*~ad~a~ ~lh.d~c~l As~oo~ati~t* Adopted a s*rics of resole ~io~s e~llill ~ go]" r eco~ttiol] by tim Federal Govern- ~c~ent of the problem O~ ci~.~retl~ ~ral/klng and i~ c~ll~al reMiion~hip tc~ lall~ (.RIR~er ; wider ~roft~sitqla] ~]nlql~ion ; fllrther ~/]die~ of th~ etlidettli/fiogy RIIll ~hc.r aspecLs of lmlg ¢a1~c¢ r : broa& r tmbHe ethleatian on the c&n~l] r elat[o~hip ol~ o~garcti~ :~mJ~l~lg fll~d hl//g ~-tlll( ~ r : a~ld o]her atrl ions R~e~lutions adop~d by G all~ral Council Cauudia~ ~edicol As~oci~l~o~ Jut~e ~2, 19[;3. Ca~lad~N~ 13~u~cick Medicttl ~oc cty ,~ * * ~rll~reas i~ has heen ~*ientifi(~l]y de~ u)nstvat~d and a~e~t~d by re¢~ t~g~iz(~l antlmrJ~ie~ rhttt there Is a ~o~l~l~ erlOll bet waelt ~ruol~iE g RRd fin ii eregl~I~g i~[deug(~ o£ £~t~l diseaees o~ the c~e~[, heart, and arLerl~l ~y~te~. ~¢ it resolvt, d, 'l~l~l Lh~ -New Brunswick l~edic~l ~o(,i~y ~oe~ on l'eCo£~l gig reeom receding ±o tho~ o~ this Province ~hal~ ~mol~i~lg ill any £m~m is a dangerous ii E~IJIL*~ Proclaimers ~ N(~" ~r t~ irk Ik~edical ~oc~e~y, 1962 atmual meetlag. "~he e~ide~ee h~klllg cigarette smaking wi~h ~he ~llh~eq~lertr do~.lopmenr of lung C~c~r is {~oncIugi~ • ~ * "It i~ coIl~[dered * ~ * th~L me.a~£es desigmd fo di~conl.age yallng p~t)ple from smoking 81e considerably handicapped by lhe wide~I)read a~vertisillg of cigarettes, * * e ,.~]nc+* the ¢llssel~inatioll o2 ~c]l in f ormatioll is con ira i\l to t)le ~u blic ~lter~st. t]~ ~a~h:±lOlexx~ln Calleer (]omlllis~ien ~rcmg[~ r~ol~ends thac ate0 ba [slcer~ b~ tile apllr~plSate a~thoritie~ to prl)hibi~ the aflverti:,ement o~ cigarettes by all media." Fro~l minutes of g~ lneetil~g o~ Lhe Saskatchewan (':~n(er Con~rO~lcm Sn~I~,~ fr,an, ~ ebrultry 23 196~ ])c~t~l~ ~oil~I (~om~]ittee Of t~e ]3a~d~l~ Natlo~al f~ olth S¢l~.~e. Da~ith "The joint committee haviu~ s~udi~d ~v~il~ble ~esu]~s of e~;perimen~n an(1 lnveatiglltin]}s, a nulr~ber O2 £~views, [s (onvineed ~l/&t the ori~dnat eli!dee! 0/merwl~on~ 02 un &s~oeia~io]] between the smoking of tabae~, p~rtic,fl~,r y eigI~ret es, and brol~¢hia] carcinoma ha~ beea ~atistically ~erI1]~,L Th~ eo~/ niit~oe is vf file opinion lhat the association in causal ill /l~tll~e" Re~o, ~ o[ the Ioln~ commit~m= an the ~.i.la~ion 02 tobacco { earleeialiy ¢,ig~rll es) to c~aeer o~ tile lun~ Mflreh ¥~ [9~

---

CIGA[~ETTE LA~LING ~D .~DVEI~TI~II~'G 121 I~l~/m( • lra~l~ti0~ oI • ~1o) "Senate of the ~epubll~, IlI Legislature---No. 177~-~ bi~ ~pproved by the 14th I'er~anent Comn~i~s~on (t[v~ene and l~LlblJc IXealth) ~f t~e C~anlber o~ Dei~ut~e~ ~Pliblielty adverlJ~ing uJ' anp tobacco ]product. n~tiO~al ~r ~or~ig~, is ]0~¢hlbited.' ,, l~ee~me law Aibril 10~ 1~2, NO. 165, Dubii~hed in Ol~i~l G~ett~ NO~ 111, of d~l~ril 80,1062. "~x~e~slve ~kin~ s~ould be fough~ 7~y utilizLn~" all medl~ for p~blJc inform&- don to i~ral~l~ ~.boUt he.~lth haz~rd~" .* * • it ~ the v~ew ~f ~he Cotm~il th~ co|l~tive c0mple~cl hlw~£ion~ J~di('~ tTaa~ stlbst~t~s Jn £6.baccc~ ~moke con~lqlte, hi all p~ot0~bdit~ ~ es~n~J~l f~etor l~ th~ ~curr&nce of certain ~ype~ of lt~m~ e~Ilcer.'~ ~rom ~rlinsl~rill£ o~ ~tatemell~ ~o the Kitt~ OD "The Irtves£~gQ~o~ ly~d~ b~v the S01te Mc~lic~l Rese~l~h (~ounc~l in'~0 the t~iologi~[ ~nd l~di~nl EIrce~s of To- bacco ~moki~g," 1958. Dr. I~EHL. I~y role iS tO supp]emen~ the testin~ony o~ ~lr. F~ot% and Jn ~o doin~ ][ would like t~ m~ke thr~!o pomt~. T}m ±i~ i~ fli~Lt it h~s been firmly established L}i~ cigarette smoking is injurious to health. Th~ ~w pIl}si~i~l~s who were spokesmen ~or th~ t~bacco industry continue to dispute th~s but tlle~ physicians represent ~ very slnall s~g me~t o~ med~cM ~nd scientific opinion. In f~c~r ewr7 inedited ~nd heMth organization Jn this e~ul~ry ~nd ~bro~d t ~a~ ~ ~tud ed th s roblem h~ come to th~ ~me conclusion ~s the U.S. Public Ile~]th ~r~'ioe ll~m~]v~ that tl~e continued ~n~okJng of cigarettes ~nvolves ~s ~vklenee of t s i hive submkted in my formal tn~im~mv ~n~ rn~n~s by '20 medical hc~I~h or ~mzallons m the Umted ~t~tes including th~ U.S. P,~b]i~ Heallh ~e*wice, ~nd the Amer c~n Medica- tion Assocn~lorl, s ~ltenle~lts by 21 ~e raedlc~l so¢ietl~ lnd by ~ he~l] Ih organizations in o~her comet ries. AddkJ~n~! evidence o~ m~ie~l opinion on ~hJs sub ect indicates substantial decre~ of eig~rett~ ~mo~i,g ~,~m~ phys;ci~I~s. A sllrvev Ing~de on this sl]~l (.l:~ ll~lltu[, ~ ~e~r [~go broils}it rep~iss frOl~l ~'~,(10() ~1}~ cans. ~ena~or ~eub~rg~r referred to this e~rlJer. Of these 6"2.000 phy~iCans, only ~§ percent st~ed that they now smoke cigarettes, ~nd ~h~t is espee~elly si~nific~ nt~ only ~J/~ percent o~ can~16 }e~o~]~L (,f p~hoIogis(s and 17~ percent of r~di~]ogists ~t ated that they n~w smol~ c ~c~rett es. In other words cigarette sm~Jng h~s decreased rnor~ ~lon~ physJ- • l~S~ w 1o ~re ooItSt~Yit y n ~ouch ~. th t lJs prob elll~ ~ lall ~lnon~" the geJ~ra] population ~nd h~ d~¢~s~/] nlo~ ~rno~ those p}l~=si¢i~ns who specla]i~ Jn ~le di~gno~i~ ~nd c~e ill ll~t~en~s who s ul~e~ fr/~nL diseases ~ttrJbl~bleto~i~l'eJ~e~llol~Jn~. Fmthei~ore~ ~n ~mw~r to ~ qll~tlon ~s ~o whether they be]JeT~ that ci~re(te stroking Js • health h~zard, 9~ percent o~ the ~,000 physicians rey~ied ~es. 0nly ~.8 p~rcent replled no; ~2.4 percen~ did 1~o~ replay. Th~ ne~tlv~ r~p~ie~ r~n~ed ~rora ~ high o~ 5.~ p~rcel~t of Noi~h C~*'o]i~l~ p}~yskdau~ ~o ~ |~w o~ 0.4 percent of Colorado physici~s. 4~ ~7~Smpt. i--9

CZGARF/I~E LABELI3qG AND ADVERTISING My second point is that cigarette smoking is ~ health hazard o$ veD" great importance. Several studies mentioned in my testimony con dude that at least a quarter of a ml]lion deatLs iu tb;s ~'ountD amtually are attributible to smoking. Another study simws that for m~m age 85, I he dmnc~ of dying before 6a are 9~ percen~ for nonsmoker~ am141 percent for clgal~ ~ ~mloker s of two or more panics a d,~y. In other words, the chances of ~ man dyh~g c~tu,ing the p~ak years of his career and his family respmlsibill- ties are almost twice a~ great for a he~vv cigarette smoker as for a lloDsirtokel% Also Dr. Theodor Abelin of the Harvard School of Public Health lms just reported a study wlfi~ cve ~ldes ~bat the i6e expectancy of American men 40 yeal~ old in 5 1 years les.~ f¢:r all cigarette sm¢:ker~ than for nonsmokers and is 6.6 ~,e~Ll~ le~s for tbose wile smoke mot5 tilan l we packs ,~ day. F n'thermore, a Wear fo]]owup study of 400,000 men shows that men bet~elt ~) alld 69 years of tiny wbo ~loke two or mo*~ packages of cigarettes a day are aanlJt~ed to3mspitals 50 percent more b'eqnentJ~ th~n ilo~s]llok~l~s. _ilso, emphvsemu It chronic und ~m'ious lung disease which is r~re in ncmsmc&m~ and is just as hlglflv related to cigarette .~moking as lung can~er is increasing so rapidly tbat a distinmfished Boston phvsi clan p~dlct~ that within 5 ~ears emphysema will be responsible~for the d[sabilit5 of 9~0 million American workers. MY t~fird l pint is tiiat a (~overnmen~ which permits fbn sale ~md the ~[dvertising of a product zb~t causes so much d:Hm~e Io health has ~ ~sponsihilit), to con~iuuousb impress upon the public the health hazards to which the). ~re exposing themselve* when they smoke cigarettes. (%n~e~ est~blished tbe Food ~nd Drug A<bni~fistratl on to protec~ t|m puhlh~ ftxlm poieaii~lly h)xg! stlbs~az~l:es in fo~xt~ dl'llg~1 chemicals and other p~*oarations; and created th~ Federal Trade Commission t~* protect the public against misleading advertish~g. Cigarette ~moke is not a food but izs effects ~ )on the bo(ly are 3m questionably due to the drag like action 06 stlbsbul,u~, pl~marfly mco- line,lad l~ r~, ~bh91 i:ig~,reI {e snmhe I!onI nins. President lCenm<lv, in a special IYI ~'SSIl ~X' tO tb~ I{ollse of Bepresen ta tires iu 1962 on SIr~eh~hening of Pro;~ams for Prote~tiou of Con- shiner In~eresis, emphasized that auionff the basic rights of the c~nsumel are. 1 ~Ibe mght to ~afetv. [o he protected agemst t.b~ marIcet[ng (if ~,xl(~(ls w]~i~ii ~t~ httz ~rd~)tls lo bealtb or li~ (9~/ The rigbt ~o b~ b~ f m'm~d : Tr~ be protoct~/i n ~ninst trandnlent, deceit fuh or ~rossly la~sleaclln~o inform~thm, ndvel'tislng, ]abellng or other pra¢ rices, and to be ziven tile f/~s lie needs to n~ake an b~ormed choice. The Naticmal Inferager)ev Corn,all on Smoking a~Kl IIe~]th be!~m es t}lrd the OlllOie bl~s a r~tll lo It/is Di'cd¢~etion a~-~nsf tbl! }/ay~artls o{' e~r/,tfa smcgdng as we]i as agab~st p~#entia~ lmz~r~s ~n our ~0ods ,'~ i~ (l druffs, To provide tbi~. labels on cizllrette pack/~.'cs shouhl state that "~be eontimmd smohing o~ e~gerettes is a" serious health bazsrd" and shouh] h/dh!atl~ the I~lnoltrlt (If tar :lrl(1 nieotbm which the smoke contains. .~.d advertisemenis o~ eigarelles shouhl carry a walu~i~g~ that ~t}/e continued smoking of cigarettes is a sericms health hg2~rgfl:

CIGAIRETX, B LABELING AND ADVERTISLNG 123 To fail to rovlde suctl warllirtgs permits smokers t o raClm/a]ize and encourages c~dldren to believe ttlat if smoking is really bg~d for you~ the GovernmenL would say so and would not permit thB kinds of adverLisements of cigarettes to which ~hey are oxp,lsed every day of their lives. We believe that such warnings will disc otu'a ge sm oki~g~ par ticu] arly among some of the boys and girls who ha~ e not get become lmbltuated to cigoa'ettes. Your committe% tkerefor% app~il~nily J'~.ces • b~sle, issue as to whether in a democratic capiialisiic soeiet bmnan llfe said health tan be given precedence o*er ['nmneiM g~]n ~ror those who produce and sell a product which tim higkest health authority in our Governmea~t states is inj~trio us t o health. SChiLler HA~,r. Thank gou~ Dr. DiehI. Senator }of orlon ? Senntor ?*Iol~'m,~ MI'. Foote~ in your statement you tell the corn mlttee, "What is scientifically sound." Have you a~y backgrolmd as ~ scientis% ? Mr. Foocer~. It seems to me tkat I have the same right as any ad~o- sate, ()r ~gturney~ l*~ quote the scientific figures, if i quote them ae cut.rely. I notice tic hesiiancy on the part of the membea's of tiLe Colmxdttee who are laymen t c~--- Se~mtor Mo~To~. I don~b ques(ion that at all. I merely want to Jill() kV ~011 are a scientist. Mr. FOOTE. N(h sir 1 am a hlyman I ~m only quoting sehmi,isl~, Senator Mvlt~x. ~ks ~ matter ef fact, in Adw~rtising" Age se~lr±e tir~m ago you are quoted as saving: "1 )tin not ~ seientlst; I am not a scientific authmdty; I am a t~ropagandlst." I have nothing against tl . e e ", becau~ to be in polities "~ou have to be a little hit of p~apagandist. " . So you don~t presullle to speak ~s a scientific all~korlty blJ[ ItS a pttbllc relations man who carries the wcigh[, of what the scientists say to the peopIe? }ffr. Fooax. perhapsalittlemorel~,'mthat sir. Ipresmnetospeak as the folaner ehuirm~m r)f (he executive eolian tree of the .:kmer can Cancer Socdeiy and as the ek~irrimn o~ l]~is council. I presume to speak for the meniners o~ this cmmcil~ both seientlsts and b~y pe<)plc mr. It is u little more than public relations. Senntor Moa'mx. Your b~mkground prior to your present asset's tion w)~s in the ad vei l~sin field? Mr. Foo'r~, Yes, sir; }got ahou~ 331/2 3'ears. Senator Morn:on. With a very good firm. • ~Ir. Foo~. I think so. ?¢icOu -For ekson, and one called ~'oote, Cone & Belding, ~ddeh is now on the big board. SeJ~aiof ~fcmq~c~. Did MeOann-l~3rlckson have art ac~oun~ ~i~)nl Durham, N.C. ? ~Ir. Fooam. No; but they had cigarette accounts armmd rim ~mbl and I was one of tkeir ]~r a-eel stoel~holders. 1 trove been to Durham. Seamtor 3fo~o~¢. Dr. Hmm. who w~s htm~ ~ fe~ moments ago, read ing from ilie New York Tinles. of Fehrn~w lg o~ this yen', tic said. quoting you as his authotlty "Al ]easf 1~5 000 prem~ture deal!re [!~s year are caused by snmkmg." ':/ins mteresls me~ that Ihe 8elent18~, the doctor, should be quoting vml, the advertising agent. I SUplmse

CIP~3.RI~TTE LABELING A~rl) ADV~TIBI~G youquob~hlm. Tl~t is the way thls thlng gets going. ThaysupporC each other. ~r.Foo~. ~bsolutelynot~ Maylcorrecttheimpressioncreated? enutor MoR~. C~rtainly. Mr. Fow:s. Wouldyou~iketoknowwher~Igotthos~figures~ Or would you care ? Senator Mo~o~. I would b~ glad to h~ar wher~ you got the~_~ures. I am m~rc]y sa~ng 01 at Dr. lionel ks now quoting you a~ the authority ~or thesB figures. ~Ir. Foo~. I~ he quotes me, that is fin~. I did~'~ ask him to quo~ me, ~nd I am not tho authorit~ Ioz the figures. Wolfld y~u c~ know whero I got the figures Se~r MO~T0~. Ceratlnly. It~[r. ]~oc~. I got them from the U.S. Public Iiea]th Service. And they had plenty o~ tSm~ to check file figu~'es over. Senator .~*~aa~a~. I~ is i~e~s~ing Lo i~ote ~h~ vkal st~isfics ~r tlt~ l~f~ited S~ate~ ~or 19~12--tI~ is the l~t~sfl on~ oub----s~vs ~h~t 18~866 deaths were reported ~s being c~u~ed by lung cancer which ori~nated ~n th~ hng~ and ~,417 deaths were reported as re~ultlng ~rom cancer of th~ l~rynx. ~his would m~ke ~ to~a~ o~ a littl~ over ~i,000. ~ad your f~ures ~i~! ~rom I ~25~000 to ,~)0~{)00. l~r. Foco~. S~n~or Moron sir are you s~riously implying that, I ~ d those deaths were lung cancer cleath~ I cm~t bel ~w t. ~en~tor Mo~. Does smoklng cause a Io~ of other things. Mr.~oo~. Of co rse~td~. Y~udon'~knowthat? Sen~ti or ~)R~. I kno~ t,]~ a~ this rel-~)r i~ ri~hI; l~er~ suys~ ancl I use [}~ word ~i~tt u~l~]~ ~ IIOL ~Ca~llall~ Lll~r ¢~ i~ Iio Ctt u~ll slgl]J ~ ~ EIt~ ~tw~It c~r~narv and smokln~. ~r. l~o<rrE. You dldn'~ read the whol~ thing, Senator. Excuse m~. S~i1ator Molcro~. I h~ve re~d ~is statement more than you have. ~ot just a~ much. Mr. Foo~1~. l~5,y I s~y ~his sir: The figures that I hu~ given are no~ only [~ opinion cf ~he Publ c l~e~l~h Serv ce. Dr. l)iehl on my right is ~ medical otlicer ~itl~ tl~e Amerlcan Cancer Society. ~sk hhn. His figures ~r~ the one~ I mentioned the h~gh~r o~. You will get tes~inlony during this week 5"ore sch~mi~ts with the hlg]leet i~pule, whos~ ~gm~s will ¢~nfim w~a~ I I~'~ sald. ,Q~n ntor l~a~,ox. And I feel sure. ~r. I oobe, tll~ we wfl] hear teat~- mon~ tl~ I consld~r o~ th~ hJ ghest rel~ute from scientists w}l~ mlgh~ ha~en to d~s~ree w~th some ~f your conclusions. Mr. Fo~. M~y I say one i]~ing S~c~i'~ I lhink tI~a~ this com- mittee and i~de~] ~II ~f ili~ Con 7re~s, ]ms got to decide whether i~ is goln~ tO bas~ l~ws to protec~ therewith of the people of this cou~Ir~ ~n th~ overwh~hnlng majority of medical oplnw~ or ~pon t~c medlc~l oD~Yllon Of w~a9.1~ lYm~ b~ regarded, f~ a rat~t~' ~tr~in~ microscopic ,~e~n~r M~ l~rr~. I L}~nl~ it is mor~ t}L~ ~ mlcroscopl¢ ~ra~ment. Bu~ T win sa~ thi~ that ~s I said ~t th~ outse~ of the he~ring~ ~his moraine, wlt~ one or two ~raendmeu~s I can uccept tl~ Chai~n~n's bill. Iamperfect]ywillingtovot~orabilllnthlsare%e~en~ou h I do come from ti~e biggest burley tob~ceo-l~roclu~ing Stat~ in ~e c~untr~¸. I will ¥ot~ ~or ~ biU~ bu~ Y ~l~n~t wart to "¢o~0 un~:~irly the iu cll~t r~ out o~ l~ine~s~ a~¢l I am sure yoll (lon~. ~r. l~oar~. Thank you~ sir.

CIQARN'I'I'E LABELING AND ADVERTI~TNG 1~0 S(mator ~ron~n. )fr. Chai~nml, I will leg my ~arJ:uer h'iend from Tennessee take over. Senator IL~T. Suppose we let the lady from th~ west coast ask firsl;. ~[I~./geuberger ~ Senator NEvmmaEm I find it difficult to question anythinff the t~o witnesses have sald wben I am so in agl~emeni ~vlt h it. I iu~ve read die rel,l~rts that Shese seem to be based on ant| the ~vid~nee co]~tlnues to pile up that the overwhelming number of scientists by that I mean docto~pardcuJar]y--substantiatetkereportwehave us~heard. But I ~ enid llke at this time ~o comment on a report 1 am particularly ill- ter~te~i in 21~ln my m~n S~at~. The Cancer 8ocietv~ represented so ~eJl by Dr. Diehl hero, carried on a sfiudv in my State and Dr. 3Iedlan dird:lor or mt.Ait:*d 4u] .cm;i(m for ~he (~ood Samal~ta~l llospital in ]4orlla~d~ reported the results of tiffs. I am perle(fly willing to quote polls, storeys restfits of gues- fiormaires, because i believe a lot o~ the information we have today 5omt ~ this way. This sur~ey g~rnered n~p]ies from 90 percent of our doctors num- bering almost o~.000., Thirty-~hreo. peraent of Ore~m~s~ . 7)hvsiaian~ bag never smoked. 2 * pe~vent have stopped smokmg~ 16 pereen~ smoke ~m]v pipes or eight i% and ~3 percent smoke ci~aret tes. The sm'vev ~hows that ~5 doctors ~mong ~hose who have stopped Sl¥1°kil/g O11~ ~tllO]{~l(] twoI°aeks a duo.. Only one thoracic ~ur_~e~n= in the ~tata reported dla~ he smoked mKareltcs. Tiffs is a gn'oup of people, I think, that are most closely connected wi~h the ]~lat [(reship between smoking and d]sea~se, and therefore sur- rays and reports of their activity in this field earW a great deal of weigh~ with n,e. This ru~ul~ would indicate that there must be peop]~ wbo reeo~dze tha value of tim 1~ )err o~ tim Surgeon General. qke industry is really worlSng, I think, to see ~l they c~m (sine up with something to r~luce a safe cigarette. I heardl3 support anv- I,hi ~g that the~; wou~d do in this fi old. I wmfld li~e to ask tl~e repres~t~tive of th~ Cancer Society, ])r. Diehl. what do wm 0,1nk ~d)out a label on a ei~rette package? You mentioned wha~ it should be. ~Ve all krmw it isn't going to slop PCOlde ~xnokin~. What is the value of it ~ Dr. Dream. As to the type of Jabel I think that it should be ffi con- formity with tim evid(m¢~, and in my ~egfimony I suggesv that the paekagm might state something as follows: That the continued smok- ing of cigarettes is a serious health hazard m~d indk:at~ the amonnt of tar ~d nicotine wh ch f contans. Poss bly some better ~or(lh~g cmfld he suggested. Senator Nr~nneo~. I agte% and it is in my bill: something similar to that. Do you tlfink it will have any effect on young )eorfle. or will they Jcstpaynoattention~ DotheyknowiMsond~ere~ ~Let'smkesmne- thlng that l~ in mw medlelne closet or at home. ~/¢ are in the habit of picking Ilm bottle off the shelf. We don't stop to read it. Do you th~k it has an~ salu~arv effset, that ]t warns that use of this product is dangerous to health, o~ s(uxm ~ther kind of poison ? Dr. l)~nn. I am ~{ot art eypert in behavioral peychol~o.w. Bn~ I fo~] that a statement, a warning, o~ the package would have an effect on probably u (urn siderable number of youngsters starting to smoke.

CIGARE'I~E LABEIc[~NTG AxND ADV~31~ISLNG I a~n svze i~ wouldn't deter n,~*ny of them, partiou]aHy if the a~'er- tishlg cent irlue~ t~lz~strictcd. Senator NE~Rom~. Yo. I,hink though, that the Govel~nlent has the resp~naib itv t~ at ~,Ls~ w~'n peopl~ I~ they want to go ahead and smoke, hl~t ts lka.'llldlwdual choice. Thank you. Senator hio~Tos. Th~s question of star~ing to smoka~ don't mos~ ]rids do it oct of just sheer l~isch~ef? I was told wl,ea ~ was a hid it would stunt n~y grow~lu And look at my br¢dher. I wish w~ had started hini slnokinlg.. I~le would hi,re hewn ~ lot more comfert~ble in an upper bet~th t~t~xy, I wit] t~/] you tlm%. Senator B.~ as. He ~ z~fen'/ng" to his brother; who is 6 f~'t 7. • Senator ~[o~ro~. They told us when we ~vera k~ds ~q~e ~t smoka, it w]U stunt your growth, it will make you shor[ winded, You ca~'t play basketball,~ or this or that. Most'kids ~.umoke just because they ate told not to, ~ thin~:. I thlnl~ puCtin a s]ulll and crossbone~ ou ~ package of clgarettas ~/1] not stop k~s from smoking. Fr~n]~]y, I wish it would. I am not an expert ~u beh~%vioral psychology etcher, Doctor. Mr. Foote, ][ l~ow you have seen ~i~is artJelet c~l]ed ~l~est F~t6 k'orward," which appt~rl~d i. Barron's .National Business and Finan- cial Ygeeklv. Mr, Foo~',*. Y~ sir. Senator Mollie". I would Jibe to pu~ this in ]~he record and give you the right, any time you want. to file ..y statement in rebuttal to this artlcle, because ~;n~e of n,v co]ieagues have be~n somewhat an~us~d by it. h~r. Fo~. Tha~k you, S~nator )~0~TO~-. I thought ~ Was pr ett~* gc~d Senator IIa~e. If there is no objection, it w Ii ~ paeed in the record and the record will be h~Id open ~or Y[r. Footers ~eplv. ']~he article a~d a statemenl il ~ ~plv by Mr. Foote follow~) ]3~ F00TE F0~W~ With al~logies to prof. C. Nortlleote ~'ar kiB~01, whos~ word is invariably law* we wo~lld like to advance the follo~lng tentative thesis: "r~e ef£ectivell(~ of ~dver£isi~ men wries J~]yersely ~vf~h r]]ei]~ dislailee froth ~la~iI~]] ~iv~nBo, In support of the l~ropositillu we might cite Me~.~rs B0ntan & ]~owles, ~¢hcme ~Ol'lliJilnce ill the Iltt~ of ~muni~atlon and S~l~m~iBSh]ll 4[mm~d Oil OaDitot ~lll, and. I'egilr ding the Amb~tssador to india, v~n£~he(~ altogether in ~be sh[t¢low 0f the T:~j ~IahaI. :Last week in Washington a reeentl7 retired htlekster, ~ame~l ~l//~r~oi1 ~oot~, I]¢~aD/~ Illl ovelt I}/ore (,ompe]]i~ig ~a~ in point. Mr. FOOte once l~la~]e hill] as by petal ad I~g [9o9~'2e *0 ~ y l~I02~y ~ -iA~ ; ~o~rev~r, ]ll~ ~v~p~:s- ~le@ I}i£~h ~gain~t slnokiO.g, though delivered in a $~miofficia] eill~'%ei~y Illl(]. With the full end0r~pn~en~ ~f the De]p~lr~mellt of l:lealth, Edlleiltion, Ilnd ~Ve[~ar e. lefl Il nationwide @lldie/lee 0oh|. ~I@ ran it nO lhe l~0gpol+:, so [o speak, a~.4 ~obody sainted. Widespreild indifl'erenca £0 the blandishme~ts of th@ Nafiom~l Inierilgen¢%2 COlIII~I 0II ~moi~ing ~d ~:[eill£h (which Mr. Ifoo£e ~ves Ils eh~tir~0an) ~nily ~efleet nothillg ~o~e than the wellknow~ ]Oevver~il:~ of ]lllm~t~klBd, A~ the 0011nell's leading light, a ref0rmc<l ehRin ti~loket l~mself, w$1s qllOted as s~yiI1g, '*~.I%yc~n~ V¢h0 f]~8~l~r~ ( s l~a~ ]'6~ks it~ his head ,, Thfit.~ Il 1)re Lty hard line ~'c~r a n~ail wllo llse~l to w0rk on th@ premise that ~he c~istomer is always right, and it's ~qUall*v wide of (J~ mark. T~e d~I~l~)intin~¢ r~9~or~@e to the l~test h@alth ~ar~--on ~illl ~t~tet eigar~t Stocks aetuilIly *'ose---mily be expl~lIled ii~ Other ways. D~Iflte widespread advance ~)ubHcity, which hipped Ilt stilrtling dis- from ]Kadlson A~enue ought to know. people rar~ly get excited abou~ reruns.

---

128 ClG~'r£E L-hBI~L~G ~D AOVF, RTISE~G tl~e sllrvey dat~ Ill the ~urgeon General's report and, all t~dngs ~nsldeved~ may well be th~ lea~t pl ~u$1bl~ • * ~ Wh~t w~ ~re dealing wLth is ~OL S(~ mu~h ~cientI~ ~.et hod a8 s~eIltl~.c gll~w(t~k • * * ~.ues~ m~ l~av~ ~J~er~L~ alld m~y ~ ~i~le$ flil~ ~y ~o~ud~ ~ioil ~o~ pu~li~ policy.~ B~yond ~he issue oi smoking, last w~k's extravaganza eanno~ fail to raise disi~r])i~ doubt~ abo~lt ~he C~o~ernm~a~'~; rol~ in ~ele~ce~ /.llder Dr ~,~lthe~ Te~ry~ the Publi~ Health ~ervice h~s made ~ rac~ke~ry ~ ~he ~eio~title metI]od. It rejects the e~e~e of ~Ti~v~ vTith its crltic~ ; it t~ .'~e ~ 1inbound p~oe~d~re~ ; ll" ~nceals the limit~tion~ of its findings. Finally, ~o ~udge by the up~ointment o~ ]Emerson F00~e~ it places the stride~Lt claim~ o~ the l~i~Jam~ ~head of the un ohtrll~ve q~e~t f~r trll~h Dr~g3~ ~v ~okc he~d]~e~ ~ it ~a~n~)~ ~oster i~TJ~n'~ We~r~ or ll~alth. Dr~ ~o~ ~NIIRON : At ~h~ he~xing on t ol)aee~ legi~alion, bef~re ~o~r commiLt~ on ~oilday of thi~ ~veek ~(:~la0)r ~v~L~]~ ~t ~to ~e record a~ edito~'i~l apI~al'il~ i~ B~[rro~$ o1~ Jall~ry I5, 1(~5 At the s~ti~le ~ime, ~en- ator ~lo~a yery ~acio~sly Ief~ the r~co~4 oi~ a~l said that I mi~lzt file ~lZ all~-ez- to thl~ ed~tomal if I wishe4 to do ~o. TJal~ lette~ i~ for ~h~t tHlrpo~. ~f the £ront pag~ o~ th~ ffanuary l~h Issue o~ that pub~lca~on, is b~d ~ ~o begin wit~, ~e ediCo~al makes the poin~ tl~u~ the January llth meeting o~ ~he i~ttional Inner.getty (~on~il on ~l~okin~ ~IZd 14ealt~ '~left ~ natio]~- ~c~ ~lldl~nce c(~ld" ~nd tha~ there w~.~ '~w~dc~l)~e~ in4i~'ere~'~ t~ ollr of it A~d while w~ ~l/~ n~t ~serihe t~ ~ elipIfi~ ~rvi~, I know that [he Ja~- tl~ry ~ m~e~io~: o~ the ($ol~nd~ ~(1~ tl~ ~r ~nt 15~ge~ ~f the ~ew york ~l'imes, t~e ~n Fr~n(qseo (~hroniele, ~ Ho~on ~h~o~iele~ and w~$ extensively ~ i)~d ~hrOugho~t ~h~ ~at~on'~ presu. This h~r dly s~ell~s like 'widespwad ind.. ~rence/' A~ t9 the ~'~ lnC0~ premise, I~r on'~ ~u~te~ ~e ~s ~ying : '~aIly~ WhO ~Jis~s ha~ rocks in his head~. ~rroil~S ~(ppare~Lt]y ~c~d thi~ IlI~ ~'rom ~he ~-~ york ~:~er~ld rffrib~n(~ whie~ b3d q~t~ m~ on Jal~t~flry 1~r ]965 as ~ylng: ~'An (~ ~lny~ vTho ~[~m gre~ ~lt~ n~ 7q~ ro~ in l~is h~d." Of o)l~r~, i~ I h~.~ $3J~ thafi ] ~o~d ii~t blame ~ar~'o~'s f(~r fi~k~ll~ me ~o fia~k. ~ufl I dhl ~l ~ay it. and tl~re l~ abs~Iute pJ~f ~ha~ I did not. ~r~e be~ way I can flln~trate this i~ to quot~ i~ full ~ l~tL~ I wrote to Wouldn't you think ~hat any ~er~)n who sai4 t~0~t w~ 8. r~th~r ~or~ 5~et t~t i~ p~ci~y ~[le st~t~l~e~t ~ttribut~I ~ m~ as a (~Lv~ q(~o~ af tb~ Nal~ooal In ~e~agen cy ColmeiI o~ Smi~ki~ and Yieal [h ll~ld i~ ~sh- Hal)p]~y I didn'~ ~ay that, and Imppi]~ what I did say is a ~aa~er of by ~e~ra] ~a~io networks ~11cI ~.y tl]~ U.S. rll~olic He~l(h ~e~i~e Itself. V~II~ I did say--~l~s is ~(~m ~]1(. tape l~aeov~l~lg W~ thi~ think, ~, ~1~ I~ t~ al~)l~ely a~nr d for 12 I~y ~ple to be a~keff by anyon~ ~ F~f]~r~l ~o(~g~ or Who~lo~r, Do del'id~ after (~n~ week of hearil~g L~$~i~y, w~cat h~ been (I~cide4 I~ ~e ~11~geon G~ller~l'~ Advisory Co~ni~e ufl~er 14 ~onth~ ~)~ ~dy. I lhi~k this is ~ ~rave~ty, O.~d ~body wllo pay~ ~ten~ion ~o ~ ha~ ~oeks in Ja;l~ he~.d, i~ my opi~lo~r

---

---

CIGARZX~rE LABELING AND ~DV~SCISING 13] I don't lhink alW real gain will be made on the beLdih front troll1 yea m~ke the advext~si[/g self-dgfeating. Senator}, o Tox Willtbegentleman~deld~ Do you think the ~Ldvertlsing should b~ self-de fearing ? ,~[r. F0OT~. Yes~ sir, Scn~dor_MoRTO~" Whoisgqngto~ v ~se f sselfdefe~ting! Mr. Foc¢~. I hope n4c~dy will Sen~gor Moswo~. flint is the answm'. Mr, Fo~r~. ttmvever, 1 wish t~) say~ sir. we dm?t believp Llm[ q lmn on advertising is lhe ~ght way. I thJ,~k thai is un A., r,(~'m. Sensbtor Mom~m Ab~n on t~dveTtMngis un-Amm+:~ux? ~gr. Foo~E. Yes. Senator 7vh mrrox. And hake the adver islng self dc4eafing, and that is American ~Ir Foo~en. I think not to carry t~ fa r w rn lff message in this ~eat serions sltuatlon is mLwise. Senator ZfoRwox. Mr. Foote, yeu h~,~e been in one of tha most sop ~ s cared businesses ill tlfi~ (:onntl~y--agverLis[ng. l ]m~e gotten my sh"re of k ek ~ a "o~ nd from is by havhlg it 3sgd fl,ai our p~rty &:al'£ ~'~ilh Madison Avenue. If yon want to s(. ~ good advcrt[se~ ~l£t]Dai~I~ look at lhe Democrati~cn.lpai~m in 196~. I don t uee how vou can s~ "~hnt 1/( MU]I~ to ]nfi~e ~lle a(!verl[slng self defeating beca~ ~ that is the Ame • ( ~ ~ way, and k is u~ ~ mcris~m to eliminate advertisb~g. You are too sophistica~'d in [his ~ea: Mr. Foote, to ~2 Lhat. l~{r. Foo~. May I repe~t ~h~t ? Senator N[(mTox. Certainly, 5Jr. Foo'rn. To me. a ban. ns in I3vitain. a ben prohibitino: the right o~ ~1 advert se' to }uv space or time iz not rlghL, it violMes the ah'eedom o~ the )reds. BuL ia ~h~s great emergency whmh we.r~us~ reldiz(~ ~e l'~ee here, to require ~ warning me~sagv m the a(kver~,l~ln~ is something else again. This is not just my view. it is Paul Rand Dixon's view as well as out' coulldl men/beF& Mr. Fom~. Thank you. Senator Momo~ Do,on mean t~) tell me t]nt[ fl}e Coca Coh* Co. would, buy adverti~ I =q f t were self e ~i ~ rhey would quit ovemli~ht~ O~ nOEl'S6. Mr. Foo~. IImowrmilxin~abou~coca cola. ~e]laiof I~*%RT. The as ect of the prob]em o )(!ned Up bv tll~se seris~ of last few qnestlons is ~oth intercstir,g and ~elpful. because we are confronted w th a sort of sehisoIgwenis position berg. The only reus~ it would make seas% I take it, to pt~5 in a w~u.nln.% would be th ut the ~ arnlng would deter. As Senator }*[ortoI~ poln~s ollt. ~his SeemN ~ ake rio sense if yO1[ look ~t it from the producer's s~de of Ihe table. The commiLtee is concerned to try to balance tbe~ competdnff interests and rights in 9~ fashion that will Lrea5 fair]ythepublic. • npologise for ]ldmTnpting. I doubt f we will have any(me more experl in the field than Mr. Foote on tim stand. Sen ator Domh~iek

132 Senator Do~i¢K. ]~r. Ohah~usrt, I am interested in going back to this c~ttaquy betwee31 Senator M~.'tan and Mr. Foot~ earlier ~n wlfich Mr. Foo~e, as I understand him, said that he was no~ ~mpl~4ug Chat 125~000 c]eachs per year were attrlbatabl~ to cancer. ~r. I~oov~. I¢~ght. ~er~tor Dominic,. But yo~ are attributhig a~ least 1~5~000 deaths te clgaretta smoking Mr. Foo~,. Ye~sir. Sem~tor Do~xc~. I don~l. -know what klnd of cIeaths you arc talk- big ~bout, automobl]es or whataver it muy be, if a person tries t~ ]ight oil~ while driving. ~ On pa~[~ ~25 e~ the Surgeon C~eneral~s ~por t, i~ says~ 500 0O0 ~eop]c in 196~ m tile United S~tes died e~ arteriosclerotic heart dlsease~ principally ~tonary ~rt~ry disease~ ~1,000 disA o~ king cancer, ~uld 1~00~) ~ied ef bral~l~itis ~ud ~mphy~em~.'~ If we take th~ 41000 and 1500(} t~gcther an(I a~¢l them 11p yv~ ha~e 56,0(]0 dying o~ cancer~ or ell]pb~,se~r,s or bronelfi~is-~hing (li~ ease. The 500~000 t~mt they refer t% the hearl, ~|i~ease, they say later on on 10age 3~ t~at there is no eausa~ re]ationshll~ b~tween ci~¢rare~e ~noking and heart c~ ~ca~. So w ~e~ does your l~.~000 c~me from ? Mr. ]?oeT~. Senator I)ominlck, the report sa~ there is ne proe~f of ~u~ ~t~tt~n~hlp~ but it say~ is sta~n~in suspects it~ a~L(~ ~t thhfics che people should ~ct o~ the assumpt o t]~cre s a causal relat onshlp, ~f you read the whole t bln~. Sem~t or ])o~1 ~-~ic~. I am trvh~ to t~nd olll~ ~th ~r'e your 125~000 came from ~ir. Foote. I ha~e no'knowledge ~n these kolds a~ ~,11. I am looking for infm~ tlon. Mr. Fcam. First o~ ~ll~ Senator ~inicl~ I didn't make up ch.~ fi~e~ [ t~l~ y~u I g~t tkex~ ~r~ th~ Pt~hli~ Health Service. This est]mlJte of the 1~5~000 was r egarclecl~ I may ~y~ as exceptionally low by m~st other I did not Supply che £gures. I do know~ ~!~,ll~e I am bec~oln]n~ $Olr,~tkillg o~ ~n ~mat~l~r epl dem o ogls~ nai| o~ this~ that coronary heart disease aceounl~ for pa~ of it. wo~lld lik~ to refrr this to ~)r. Disbl~ who is the scientific man here* partra~nt is resi~onsib]e for ~e ~gures l~e go~ I wonder ~f we could /ind out from t]~e U.S~ Health l)epartment where these figures cam~ from Senator Mo~o~. yes. ~¥~ ~ound out b~fore you got hel~. They Laughe~r.) Senator IL~. Dr. Horn, l ~rl told, is still here. Perhaps at this point the recordl~fi b~ he cinri~ied. hir. FOOTL Could 1 Mr. C!./ismal~ give this intormation before you c~ll on him, because I chink ch s s es~-nt~a]. I aaked tim U.S. Public Health Service to give me what $.heir esli mate was, thlnhin it mlghe be hi the same neighborh~;l of tim .~erican (~ancerg~ol~ie~y~s figures, tto~e~'er m~ contact ~ Dr. F~ugea~e Guthris, secretary of lbe Int~rag~ney CoimciI, and also cbtef of Ihe chronic disease division of ~he Public Health Service.

CIGAI{EX~I'E LABELING AND ~VBRTIBL~G 133 Dr. Guthrie talked with hL~ owT~ seieufists whom ). do not kllow, bug he had quite a bit o f time to work on th s, and he fnnlished me with these figures, I would also like tolp.olnt out that I bad tbc~ in my speech which was cleared with ~ number of physic ~ s in the Pub c Hearh Serv co, and thatI used the figures in front of 9 oul of 10 of she members di Dr. Terry's advisory committee, to whom early in tim nmet fi/g" I said, "If you don't like any figures mentioned today, plesse speak up." They didn't speak up. Senator HXRT i wonder if Dr. Hera has an3 figures be would like to stance at this point. Dr. I~om~. The figrtwe of 1~5 000--which is a very low esthnate of the total mnal~,r of death~w]~ich represents the excesz numl~r of deaths, Occur in cigarelt~ smokers over wh~t would b~ve occurred if they were to die at tim same rut~ ss pcoIfie who had never smoked cigmrette~ It consists of applying the 198'2 dcstb rates to the diseases ul which ~ causal relationship has been indicated. Tlmse include coronary heart disease, lung can cer~ bronchitis and e lllphyF~Ifla~ e~neer of the oral eavit3% cancer of the esvlikagus cancer of the ]arynx~ and cancer of the bladder. I anl h~debted to the origlna] set of figures ber% xddeh 1,~.vo ,tp pcared m sto~ements of the Pnblio Ifealth Service ~s long ago as last Augllst, and to Dr. Levbb who has published these figures ~ul is~ I believe:sebadnled o es fy o no 'row. The number of deaths h'om coronary disease, s~hich is included in that, is approximately 80,000. The nlnnber of deaths frota lm~g cancer is g8,500. The number from bronchitis and emphysem~ is 18~500. Cancer of the oral cavity, esv hagus, larynx and bladder, ad up to 8~000. This totltJs 188,000 w~idl is's little bigher than the orlglna estimate of t25~000~ hub s based .n ~pplying these to esti~ m~ted 1085 deaths from these c~uses. This 6g~re is obtMned by applying ~ates only for these specific diseases ~md onJy to men, Mn~ce the ~ulh of the epidemiologieal studies which h we be~n done lmve beer, done on men. Senator MO~TO-X. May I ask Ibc Doctor or~e question ! Senator IKam?. Yes. Senator hfo~t~o~*, qam~layman. What has e~ncer of the b]adiler go~ to do with smoking cigaret tes Dr. ~fosN. There is a ,,rear deal of epidemiological evidence indi- eating ~h~t cancer of dm b~adde~-- Senator MoR~OX. I am g<dng to quit right now. Dr. I:[ORS. IS higher among cigarette smokers. I th~nk you will find in the history of carcinogenesis that the bladder is gn organ of the body that frequently concentrates carcinogenic material before it is excreted, Therefore, 15 is particularly susceptible ~o ~cdvity by e~rcanogenfe subst,gd~ceK Senator Mo~To~r. I ml sure getting an education out of this hearh~g, I will guarantee you that. Sel~t~tor HAzy. Seaator Dorulnick. Senator Do:~zmc~. Mr. Foote~ I have really quite a lot of prohlem~ with these ~gure% bub I dim:t know th.t his re~ lvm ik~ very m~ cb difference.

CIGAP~ETTE LABELING AND ADVERTI~Il~G ~What we are i~olIy talking al~ut is not figui~s~ but thB fact fl~t tohac~'*~ is, the foi~a of clgggret t~ smoking is harmful and therefore you think something should be put on the packaging so denominating it. Mr. Foo~. Yes~ sir. Senator Do~a~.~icK. Do you feel that this applies to othex articles tkat are also h~rrnful to humarts Mr. I~OOT~. I do not kava, o~ aay other cas'es~ SeHaLor. P caa~ think of anything else iR the whole scheme of things where there wa~ such an al~rmkRg number of pcoplB in proportion to the total In ot ler words I woukhl't put it on oi~ar8 plpcs I wouldn't put it on wh sk~y. I am speaking, now a~ sn ,~d~du~l. But I do not l~low of ~nv ocher product whmh W0uId lmve said ill my statement, it goes very much a¢alnst m~ ~min to recomlnend such a tbSng~ hut I feel t must ha don~in t 1 s I".Lr lcu ~r C0,Be, Senator Do:~ax cK Le me lake ~ ~,lple o£ tJnngs that aren t food drink or sm~k,ng: (Ymustm~s tree 4ecoratmn~. Many of them are veryinflammahle. Mr. F om~.. How rm~ ny deaths are caused by it ? Senator Do~a~ezoK. I don't have any idea how many death~ ~re cal~svd by il, That, istl'l, my point, They are dangerous to people, so l say. And most of fliem ~ay "Inflaramable" on them. Yet, they ate adverti~d constantly. And, o£ course, sold, ¥~'hat is your attitode on tl]at ~ Do gsu th nk we st,ould ~top those, or restrict t~,e advertising J~fr. Foo~. Not st all. On the olher hand~ if a reliable scientist turned up who ~vc yo a figure of 1~5 000 or ~50,000 or 300,000 death~ c~usrd h Chrls~nas tree deeorations~ I think that you a~d I both would thin~ .omethirw should be done aho~lgit. ]tlsaquantitatlvematter. ~ Senator i)o~tm. You ~re then saying it L,I a matter of degse~ of d~l~ger. ~s theft correct Mr. FoorE. Yes, I do~t think we can liv~ our l~v(,s wrap ed in ~e]'ile gauze. We have to h~ve ,~ little f~n\. Tl~e are two prolong. It ~s quar,titgtive and ldso, because ~omethmg seems f~ happen to the lno<lerate smokt~,' as well ~s the exeesszve smoker. Sen~ltor DO~CK. V¢ould you say that once raore ? ~Ir. Foo~a. It is be~asse the evidence is~diesles Dr. Dielfl ! am sure you will bacl~ this up--that people who smoke as little as few as 10 cigal'ettes s, dflv~ h~ve tl higher Ihorfalil~" r:~te than ~nc)nmnok~rs. Is that ri~ht~ slr ! Dr. ~)rm~L Ye~. My, ~octrE. Therefore, it is not just the careless or ircmlod~rate user wh o gete in froub e: if~ is tim or~]inary ~ner. Senator Do'sT~I¢~. ;o you ~re • purls~ o11 thi~ ~*1~1 shouldn't ~fr. ]~oc~. I think tlmt ~s an indlvidual's ehnice. I don't e~'en ask my friends not t~ smoke. 1 thlnk ~ nm~ should know what the htcfa ~Pe ~nd lnP* ~e ~liv; iiw[l fleci~io]~. Senator Do'al~,'~cm. Mr. F(~te, when did you hi, come chairman of ~his organization ?*Ir. ~oezr~. Oa Dece~ber 1, ] 964.

CIGARETTE LABELLNG AND ADVERTISL'NG 135 Senator Do~tL~1Gx. Did )oll leave your udvertising firm at that t ir~le! Mr. Fourth. Yes. I left the day before, ttowever when I ~sigaed froln the advertising £t'm~ Z dido~t know Z would b~ offered this job. That came later. Senator Do~r~i(~J(. '1"hat is ail that I h~lve~ :~'[r. (J}l~iL'm~ii. ~enator SA]~r. rifle ~ell~tor fro/it T~/l~le~(~. pag~ 7. that T)r,. D~l:n h. T]qls i~ the complete st~tcmel~t ! ~enaior BAss. Yes. YOu ~a~'~ ~Ci~arette ~lokirlg i~ an iml~ort~nt cause of en~p]~ysc~ll~.~ Y~t lhe Sur~eoi~ f3el/et',al~s colrimi~tee stated~ "~t has n~ been establishe<l ~hat th~ ietationsllip is cl~lsal.~ Do ~'ou have i:l~orlna~ioJ 1 ~]~at t]~e}~ do not haw~ i ])r.Vl)ZEHL. The evi~l~e in tl~ls al"ca i~ i~l~t'~'~sil~K. I sald t]lat c}~'ol~ic lung di~t'~se is ~reque~tly ass~d:lt ~d with bronchltis~ in whlcI~ hng L~ssu~ is destl'ovccl. The res41t is a I)rogrt~ssive shortness o£ rea , t ncreas ~g disgbili y ~n~l with i~a~v vi('ti~!~ st~e~ldi~~ the later year's o~ their lilies literl~E[¥ str~gglil~ to breat]~e. A c~oll~non ~v±~ ~Lol~l of t~IC ]~eginllin~ of e~lLp}l~elfia is ~at is IISU- ally ¢~lled al~d ~re( IlCl~tlV clismls~d as a "ci~garette (×~uglx. ~i~a~'ette ~lnokin~ is not tile o~h" ~.~lse cfen~physcm~ but it i~ a~ Jlriportant taunt% ][I/ f~(!~ ttl~ rfttlo o2~ ~:t~.,~s de~lt)t~ al]~o13~ ~l~a~t'~t(' si]lo ~ers as coll~pa~<l to n ~ ~ ers as b~,~ ~rl~" a~ ~l'c.~t~ for elnl)12v~ ,~'~nl~ ~.~tiirles ~ls~llr]uilgcalacer 7.Stimes). Sc~/ato~ B~ss. ~]~at Z am saying, your ~i~te1~le~t is clifferen~ from t]~a~ of the S~lrgeon @elleral's report. Tl~ey say it ]~g nr)t been estab- lished, the relationship has not beel~ estabiis]lZe~l a~ ca/~I to ~mph~¸- T)r, DII~[I[. l~lllpll~,r~:t!r~l~ ]llcrBaseS wit!~ tllt~ ~mO/±I2~ O~ dg~rt'tte smoking. IL i~ notVthe only cause o£ el~pllysqll~a. As l~as been l)oi~ted, out~ ~t~ ~'requcncy in sal~okcr~ is vastly hl~her than in rton- srllokers. S~ @ore ~ publi~ ]~ealth pci~t o~ view the ©nly ~LLiLude o~e can I ak~ i~ ii is cal/se ~t~td ~fi'ect tl2"~lt's~ [rl~vl~ (ll]~erwis~. S(~na~)r B~ss. Is mnphyHe~nls f~l! Dr D~KL En~phy~ema is frequently fat~l~ although many of the 1~1~13~13e~ o~ d~,'~ths ~roEtl elnp~yBem~, ~l~lV~ beel~ lnl!l'e~sin~ et~o~'mous]y i~l rece~lt years. Dr. D~E~ No. ~enator ]3ASS. Is it ~ ~*0rl/l of c~ncer Dr. DIE~IL. NO : i~ iS not. l~ i~ U condition in which t~le tul~gs 1o~ th[~ir ~l~lsticity• The lung tissue is d~,~r~)yed. So ~ha~ people ~:~sp The victims of emphysem~ often die, ~ctuaIly the death often cccurs from tle~lrt f~li]urc, from i~abilit~y ~'pu~lp the blood through ~lxese lungs theft lost ~lleir ability to expa~d. ~:r~li~hy~na is • horrible disease• Sei~atoi" I~A~$. Doctor. roll ar~ all ~lut]loI'ity or~ carl~,r I a~,~ui]le. For ~15~ ow~ edificatlon~ why is it ~at we overlOOk cancer i1~ w~mei~ at~tl irtos~ o~ the ~form~tion I~ha~ ~ve ha~-e deals |~cre with ~a~cer ill l£1e/i!

136 CI6ARETT~ L,k~ELING AND ADYBRTISIi~(] V~Tnd, is the difference~ Why !s it if cig~Lratte sn}oking !s a ca.se Of~l(~l. iNmell, wh isN~tit~1$~]OrearlseofCaIlOerlnWOlmrt? ONr lm/o~ are prlmar~ v t~e s~me. I assume. Dr. DmHL. Tl~'s right." The ]tings are. We f~Icl !~ffercnt sus- ceptibility between the sexes in different diseases and in different types of cflal0~l', b'tll%hermllt.t~ wolrlBn lie.re not been 8mol~Jng n~rly ~s 1ol}~ nor ink s,ling .~s much as men. Senat or BAss. Tbey lmve ~or the p~st 80 years~ doer or. Dr. I)I~L Not in the amotults ~hat the men hgve been mnoldng. ~engtor Bass. ~r]lat about other cancei's~ as fl~t' gs ~onl~N ~Nd 11]~I~ are 0oii~1~iled, who h~ th~ n]o~]3 ~al1~Qrs~ iL~en i~i w o133 ~ii Dr. I)~mEL. It wries Senator ]3Ass. How many deLtlhs per year pcrcentagcwlse? I~ow D~. ]0Im~. it varies with different organs. Cancers of th~ brc~sl~ c~necr of the genital tract are v~st/y more frequent in women. Senator BASs. What e~use~ can~l" of I}e ~'ea~t~ Jlr. 1)i~m. I wish weknew. Senator ]3~ss. Is it more prondnent with smokers or nomsln¢kers? Dr. DIrndL. Smoking does not affect career o~ fl~ breast. Senator D~ss. Ihve you ~al any statistics on it to tirol oui.~ Dr. D~L ~Vell~ we have ru~ studies sho~ng the different types of diseases among snlokel~ and nonsmokers, and cancer of the breast shows no difference. Sena~m B.~ss. Y%qmt about the other trae~s you talked about ? ~)o you ~17d more with nollslnokeis Ol- nloro wi~h slnokers! Dr. D~mHL. in certain types we find more with smokers than with noitsmok~rs. Senator Bass. Do more smokers have other ty[l~4 of cancer other than hmg cancer, or is it just lung cancer ! Dr. Dr~ i.. No; it is no~ ust lung eaneer~ cancer of ~he bladder. Senator BAss. What about women, do they ~ave as much bhrdder cancer as men d~, who slrlok~ Dr. DI~m. I don't have that figure in miud, ltm difference between Nlen and women ~s f~r os b]0dlhtr cnncer is cimcerNed, St!tinter BAss. WImL disturbs me~ I NOtiCe that Dr. Horn in his tesdnmnv, and yon in your testlmon , and the Surgeon General's report, lhey see~ to stress the fact $~at me~ are more susceptible to this thal~ women, and that wolneat have other hinds of cancer, but that cigarettes are not ~s dangerous for women as it is a man. I thl.k ~hat we all breaflm the same kind of mr. Our lungs are constx~acted the same. I dent mtderstend this difference. Dr. DI~I There is a difference in incldene~ of v~Lrlous diseases between th~ sexes. The evidextce indicates that long" continued smok- ing usually precedes the development of lung cancer. Women h~ve net been smokin~ as heavi]v nor as long as men. In recent veals the rate'of increase in lung-cancer dcatbe ,mmng women the rate of increase hm~ been ust a~ great or grc~ier t!m~l ~hat of men. Bu¢ there could s~i]l be a se~ ~ fference. There is sex difference in many discase~. Senator B*ss. You mco~ the female hormon~ wl]] take care of that t,~r, ~ h~re ~]le male hormones won't ? Dr. I)~n~r~. That may be an appropriate int¢~Tretatiom

CXGAI~,ETTt~ LABELII~-G AJfD ADVERTISLNIG 137 Senator BAss. Statisti~Mly that is a fair statement, is it! ]Dr. D x~w. ~hat tlm hm~lones, the sex hotmlo,es have an effces. Senator BASS. Let's lle i~ to something. Let's get l~aek.to Mr. Foote, talking about, advertising. I can't remember really cigarette ads on televislo --I an sure you see them as I do--one of the most pr~n~inent on~ is do I dare ofl~er a woman a cigar. You h~ve seen h~t one. •avon:{ you Mr. F~ow. Yes, sir ; the Cigaril o, Scnalor BASS. I dichl% want to nmnt]on it. It is not e~hieal ~or us Io endorso products. Mr. Fo~r~.. I see. I am sorry. Senator BASS. I haven:t seen un5 women star~ smokirlg those thirtgs. Mr. Foo'r~. • havert~t~ ~Jther. Senator BAss. So maybe, ,h s adver is ng as far L~s we a e talk. I~g about do~s Imt kicrea.~e the number of smokers. I on v dlstnbu e~ the brands o~ peep ~ I really don% know that advertls]ng a brand of a cigal~lt~ wou!d eno)urage peopl~ to smoke. I reaIJy hesltat~ to accept that pren/~se. I know people who probably a certain brand o~ eig'~rct~mig t get ~ different part o~ the market , Bu~ T dtmC know t]at t encmtrag~s t e use of tobacco and I dent knml ti]at because flmre s ~ ' advex~islng on cigarettes ~s the reason people smolm mm'e cigarettes than they do pipe.s. Or small cigars ~i" large kfr. Foo~. Yolt might be right, sir. All I am te]hng you is whal I •now from my t~xperiealco of expei~s, hke what thcv th~mght abo~ Ytm might be ri hr. It is your opinion. Sea or BAss Dr.~iehI, do yon know of m~v (~Lher can~ of cancer that you have th~ ide~ of reeomm,mding the eur~Mhnei~t of ~e use of or th~ advert s ng of? Dr D m L ~ d~n'b Io~w of any other eanse of oane*r wh;ch is so spedfiea]ly p npo t~d ~ a habit ~hat is common, tI~at, i~ wide- spread and tJiat is c~nt reliable. Senator Bass. Is m~g cal/ox~r OllC of he m~Ljor killers •1 the cancer field? Dr. Df~l.. Lm~g cancer is the major type of e~lleer~ fatal cancer, a~nong irish a?~(1 is inar¢~tt~lng anloJlg wonlen, Senalm" B~ss. What is the next major type o~ cancer ? Dr. D~m. In women 1 Senator B.ass. In both sexes. We ~mt to protect the women just as we do the men, Mthough ¢hey outlive ~s now. What is the next major center ? 1)1'. DIEHL. Tile nl~jor cancer among men s cancer of the hmg. cancer of the colon al~d l*ctum--of the it~testinM tract !~ gc,mrM: Senator B*ss. Do we lmow rite causes of tlmt? Is it a (u rlaki ~ype of feed that we are eating that goes ki the intcst i r,~l tract ][)r.]-}I~L. ~Vedo~tknow. Iwkhwedld. Senator B ~ss. If we can find out tI~at cigarette smokkig is a definite cause of cancer of the lungs, why can ~ we find out these ot•er t•kig~ Dr. I)I~. I wish we h~d the iead t4 stady it. Seawater BAss. Do we need more money ? Dr. l)Hn[l. We need Senator BAss. Is the Government doing u]l it can do~ Do you recmmnend th~ (3ovei~meat spend more money ix] this field ?

138 c~s_~E LABEL~Q A2~D ADVERTISING Dr. Dm~. Well, the GovelTmlenfs research grants ia the field of cancer have bc~n inci~ac~d alld are being increased by the Congress There is ~ grea~ de~I we do~l:t know about. Selmtor ll~ss. Do you l'e~lize how much money the tobacco illdustry and tile Government has been spending in this area ¥ The tobacco industry you kIlow hazy beei~ con~'ibuting quite s, bit~ has been spending a lot o~ mol~ey oil ~ds ~ ez'y cause o~ cancer. You m~de ~* st~t enlent here that doeteT.~ ~nd scicJltists who disagree with. the conclusions of the Public Heallll Servh~ al'a ~pokesme~l ~or the tobacco indu~ try. Dr. Dx~au~. V~ l~bt is this l SemLtoi' BAss. Yv'her e is it ? Ser, atm'R'~l,n~G~. 1)age'2 Idfinkyoumustbereferringto. Senator ]gAss. You say "It is important~ there~oi~ to realize that the pbysician-spokesmen for the t~h~mco induSt~T." A~e t,I~n s:~vh~g tha~ people in ~o~tr professi,m would be s )e~sking ~nd representing ske tobacco imh~s~ ry i~s~d of giving tJ~eir views as to whether clgare~te srnoklag causes cancer or emphysem~ or these other diseases Dr. Dm~. I say tbey represent a very small se~ent of yaedicaI a~d ~ientific opi~don. Senator ~ass. You~ ~y they represe~t the physician-spokesmen. What 1 am fryhig to say is, Doctor~ I be]isve that tl~e tobacco ~ndus%l7 in recent years and I happen to l~uv~ so~ne figures on this--they- have spm~t a cvnslderahla amou~tt of money in rr),ll]g to eslablisb whether cigarette smoking per se is the cat~e o~ cancer. i am not a physician. I am not ~ scientist. But t~e~ sccms to be still some area of doubt its to wh l~l,cr elg~lrctte smok hlg is the major cause o~ long cr~nc¢~r ht the United S~tes because malay people die with lung" e~oer annually--you a~d I bot~ know tbis is true~n~a~y people die with l~mg cancer snnuatty that never saloked g eig~ret, te. Is that true? Dr. I)~L. Them }~ro some people who die f~m !un~ cancer tbab have never smoked. The medioal wnfi scientific opimon zs that prob- ably I d~m~t k~tow of any figure lower than 80 percent of lul~g ceneer deat]m agtribut~ble to smoking. ~ hey run ~rom that up to more than 90 percent of lung e~ncer deaths attributable to smoking. Senator BAss. Is cancer hm~ditazh~ ? Dr. D~L. Ca~(x~r ist general is net believed to be heredit cry. Senator BASS. Buc statistics show that there is some heredlta~T ~m i] eney (hf¢~ ea~21~ e~Ileer. Dr. Dn~L. ~'e~'y little. Certainly I know of nothing to ~u~gest that Iune caacer or any Of these cancer's we are tMking abont I,aw~ any her~itar~ influence whist.soever. ~enater N~s~a. ?~Iay ~ comment on the statement made by the Sexiator from Tennessee ~ I thi~tk you read something out of context ~'rom the Smy_,eon C~el~eral*s report on enlphysema. Would yo~ mi]xd quoting ~hat whcbe i)aragraph. SenatorBAss. ¥0athave~topen. Goaheada~dquoteit. Senator Nnrm~u(cma. ~Cigaie~ta~ umokh~g is the mcmt ilalpol't~t o~ the causes of cbrc~de bronchitis ~11 the United States and increases the risk of dyhxg from chl~nlo b~nchltls and emphysema." You took a sentence out of context here. Senator B.~ss. That is normal, isn:t it ~

Senator NxcB~aoxm No; I just think we ought to call attraction to that, that the Surg,eon General's re~ort~ Senator B.~ss. :~ ou didn't read all of it. Senator NscB~m:~m "A relationship exists betwccn elgarett~ smok- ing and emphysema but il: ll~ts not been established ~*t~l ~he relat~ons}~p is I~a usuaL" You only read Bm la~ part. Senator Bass. I only I'~d the resu]h Senator N~tm~(mR. "Studies demorLsh'*tte tlmt the f~talit]es from this disease are infrequent among nonsmokers." I ~hink that we must k~el~ the record straight on thL~. 8met d ~m~artieularly ialeres~ed in advertising and you brought this out the tobacco lndust.rv nmst feel that adverhsmg is effech~e m Im~moting dm salc~ of this ~roduct, because it spends $~0(I million regal., at least, for cigarette adverllslng, and ~ceordlng 1o Advertising Age, which is the trade magazine of tile industry. "The tobacco in- d~,T bas doubled spot q'V t*dvezti~ing expemI~In~v.~ i~ 1964 over 196~." Somebody will qllOl e that there ha~ heen an increase in ~he consump ti~n of t~*b~eeo in th~tt time. It ~*ould indicate that the5 mu~t think, if they spend that much nlonev that it dyes som~ good to eneourao-e !nore peop e t~ s noke, I ~ere~o[e, I object to bh~ t~Ol) lllU~d fl vet{is mg of tobacco without health hazard w*u'ning sla remoras. ~enator BASs t wmlld like to say to my distinguished conea~ue ~llgt we ~u]d go 11[(~ other al'e~,s r*f Itdvel'~lSlng, 15qe clo~]te~ ~ an example. There ~e j*~st nd]lkms and millions of dolhtrs spent evm'y day on advert sing clothes. But it is n~,t necessari], y getting, us to. wear ~ny more tie/lies. We era] only wear one zm~ a~ a t~m~. It as only to be sure that this particular brand of suit gets I:heir corner of file market. Phat Js wha~ I am trying to say. I don't say that the adve "~ s ng will not s~u "e someo e gvtt ng his p~rt of tbe'mttrket. I don% tbhtk Ilmt .%dvertlsing neeessarl]y in- creases tile eo]lsumption of ~ product on the markeh I think ~l~t cIothlng~ sboe~, hats. women\~ bats, and this ~ort ~f Ihing, g thin% know wh~t. is the tre}td • advertising is prlm~rily by. a ~,,iven eoneelna, and I behove that Mr. ~ oo{e will beltr me ou/on this~ of trying to see th~.t they get n pnrt of tim a~vailable market. Mr. F~m~',e. I* certainly is Seni~tor BAss. Isuk thi~ tile *lmjor cause of ad~ er ti~ing ? l%ir. FOOT~. It has a dual role, Sen~tof • would shy tlu~l; you 1rove to take k both ways, really I do. Yo~ are tryb~g m gel as m~ch of the market as you can a~d~zou are hopi] ~rr hat ..roll ~. d..y°ur colnpell- tors will expand the m~u'kel. '] Ills ls the normal this is the orthodox. I m~y say, the classic point o~ view of the adver tislng trade. SenaeorB.~s~. Thisnlavtletrue. Therelsonlyace~ql~i,, anmunfo~ ~ts~ge. We will say the automobil~ advertisers. The ~ntomobile ad%ergisefs~ of O~tlr%% n/~y i]lcrt~l~t! llm number of e~l'S per f~mily if flmv have a pecu ~r tv e f mobile. ]ut I thh~k there the ~dver[i~hlg is prgnaril¥ t~ get their part o~ tbe consumer m~rket. • dm~t think tba~ they i:eall:g increase the number of automobiles that :,re used. Of co~rse~ mv distin~n,ished colleague f/v)m Mie~hlgaa wouId be mor~ of an authority od tlmg than I would. But I thh~k that what they are tryi~ g t~ do is ~o see that a partlcu]ar type or myle of a~t omobile is being nsed by the ,*m ~het.

140 CIGA~ L/DI~L~N~ A~D AD¥~IITI~N~ Mr. FOOT~. ~enator I don~t think anybody in the ad business thinks tbat there would be 75 minion cars on the road Lot ay f it hmdn ~ heed ~or ~dvcr~s~ng. I think the toLa] h~s been affected. ~qenator BASS. I think this would be ~s many automobiles on the road now as the dollar v~due e~n afford. I don~ think th~ advcr rising has increased the u~ of tim a ut erectile. ~ir. P'OO~. You denk ? f~nator Bnss. lqoi I don~L think the ~ds'ertJsinhi h~s increased the tt~a of the ~utomobile a~ all. I Lhlnk ~dver tiring has ~/ven the people tll~ choice of the automobile because t}l~t'e are still certain ~ypes of cars Lhat don~t go on the markeh ~e c~,n remember certain ideas. I (lon~ think t}mt the use of [he aufmmob~/e h~s [g~n particularly increased just because of beinK advertised. Mr. Foou~ We juet h~ve rl*spemt ful differences~ sir. Sen~tvr 1L~ET. We are none of us expert in this field at ull except ~h~t we do h~ve some ~dvertisdng experience r~s a J.esul~ of c~mp~igua- i for office. I suspect that we seek to not alo~e act some of tha other ~e~ow's vote bu~, ~o perstmde l~ople to come out generally, At ]east, thatis mylmnpi r~ion. I suspect that is wha~ kfr. Foote is trying to ~elI ns is true of cigarette adi,, ertising. • Senat~r Biss.. I think that this is an imports ~ )at5 of H ere. hear- rags ~nd I I,bmk that we need more mformaaon ~f w~. are ~olng to ~1~ to leglslale. I tlfink it is an important pert o~ the legDiation because I believe tlmt the bill of the S~m~tor from O*~con specil~cally includes some restriction on advertisln~. I thild~ that ~s ~ very important art of it, Bu~ I lush/~n% be led to believe thut when you say smoke ~olm Dee Cigore~tes, instead of smoking Jo~ Blow's C~g'~- otter tlu~t it is going to necessarily increase the num'ber of people who would later lm{~orno smokers if they h~d never seen those sds on te evlslon el' in the newspaper or he~d it on radio. I thbxk it might encourage you to alloke a eertaln tvgo of eigorette, whether filter or nonfilter, er menthol or noanmtdh~d, But this bnqiness of st~rtin to sumk¢--I will boo you can call 180 kids in ]mre ted*~y lind they won~ say I sttwtod smoking because I saw i~ on television. " They did i~ l~- ca use their roomn mft~ ht college was doing i% or because theirgu'rl ~tuenhi h~xd. e~ p~.ck~g~ of cigat~l,~ and they smoked them out or his d~ddy l~ad a packtlge of e g~ ~ettes, or h s thor ~*d t]3ev pu~it in the bach- room ~nd started smoking. I know how I used to hide my tobacco undar ~he front porch. ~ynen I merit in I ~ ~dd have to t~ke it out. ~\~hen Lt r~ixted [ h~d to go out and see about it. ] didn't st ert smoklng because I s~w it on television, because we dldn% have I:elevision. Just ~s many klds srso~ed in school when I wgs going to ~heol ~s they do tony, T ,tin surc~. But I think thin is u proper p~rt of tbe~ heuring~. }fr. Feaze. I suggest yo~ c~ll some more gd peop]e~ slr~ ~nd ask thong. Senator ]BASS. 1 think wa are going ~o lmve to call some more ad people. I think flxe ~ 1~ wh~ ~r~ spending the mansy ought to know wlmt is the fact. T~i~ oull~wlng o f ~rdvertising of a commodity is in my opinion ~ very serious a most serious pr~gositien for tI~e Congoess to enter into. It i~ praetle~lly a new field.

CIGARE~I~rE LABELING AND ADVERI~[SING ]~l Senalor Hawr. I think we all shal~ the concern voiced by th0 Sena~ tot from Tel~uesse% that when the Congress writes gerund rules and spe~,ifle% Lhat we had better be sure. I would assume that by tile time he he~rmgs that are scheduled are concIuded we ~il] have ~rHved at an expression as to this point. ~fr. Foo~. A{a~" I say~ MI*. Chainn~n, as we M1 know~ this is now the party lhm of the ~%~mcics that the whole p~rpose is mot to ~nca'e~se total s~le~ Senator B~ss. I dkhPL und~r~tand that. 2,fr. Foolm. J~st like Mr. Hfll ~mcd to ho~st of the fac~ that ~dver- Lishag h~creased .....clgure~t~ sM~ m*w prr~Lic~th" everybody. . I ku~ who ~s still working m the aelhng of elgarette~--I ~till h~w a few frierLds in the busines~they all new mchlt aln it doean't h~ve • thing to do with hLcreasing sales, Jus~ hear lids in mind ~hen you be~r .~o~4r ~it ne~ses. Sel±ator ]B~ss. I agree with them. (Laughter.) Seawater Ilkar. Mr. Fochb htt.; t]]eir copy changed to reflect a differ- ent puz:pose th~n whenyou wez~in it ?. . Mr, Fooa~. i don' see much d]fferenc% s~r. Senator I=Umw. AgahlIttmnkyoux~eiTnmuchfor yourpatienee. The commlttae has scheduled and because they are from out of the city I think we do wan~ to ~ceornraodate them--several additional witnesses. Th~ fi~t such statelnenb I think is ~ behalf rd the Amer- can P ~h c tiea h Asset at on, and it s to be pi~se.~d by Dr. Ler¢~v ]~urney of T~mple University, and the former Surgeo~ Gtmm~f; and Dr. ~Iorl on ]bevin, of Re,well Park Blemor al In$htute. STATEMENT 0~ DR, L~0Y ~, BURI~EY, VI~E pRESIDENT OF ]tEALTH SCIENCES, TEMPLE ZrlWfV~IkqlTy, I~]tXZADEIIKIA; AqCOM~ANIED BY DR. MORTON L. LXVIN, g]ilF~, I~I~ARTI~E4~T BU~TAL0, N.Y. Dr. B~m~y. Mr. Chairman and members of th~ commktee: Pea.- ~ne.l[[7 ~nd six ]~it~lf of th~ Axa~ric~ Puhll¢ fIeulth A~ci~tiou, I ~houlc~ llke to express our phmaure and gratitude for the opportmlity to present the concepts of the American Public Health Association to you and the other distinguished raeanbe~ s of this committee. Dr. Levin and I represent the Araerlc~ Public tIeaJ{J, Assoeiation, which is ~ ~roup of abo~t 15~000 professioual health workers, el.l/- posed of individuals who a~ members of the teaehinng professions n~ health wh~ are workin~ b~ red, earth activities, and who are members of ofik~ ~ and vo untary health ageneles throughout the 50 States and Oanadm. We havep]repared a brief stntement on behalf of the aaq~ch~thm which has been pres~ut~d to you. This emhodies two r~solutions whi~.h, have been. adop;ted unanimously, bv the associafAon, one in 1959 ~n~l ~ther m 196Z. m ~h~th hea~ ,s ~ ~t~tement re utm~ to d~e public health hazard ef excessive and pro] on~cd s~noklng of cigarettes, urging an. intensive, educational program .... and offering the set ¢icc~ ~f the Amelucan Puhhe PIe~rlth AssooAatxon to ass~s¢ m much a program.

142 CIGARETI'E L~BELING A~ND ADVERTISLNG Then in 1968 a mor~ detailed resolution suggests a number of gctlons which mlg t bB taken by professional activities end drganizatlon~ ]if I ,ugh~ ~ad thB We recommendations of lids one ~eso utlon, Mr. Chairman : 1. Urges itz~ members hi their profession~tl ~ctivities and by Fvivat~ example to Drovide leadership in [ho Nation and State~ and in their individual t~Lu- ~auu~ ties in educational #ctivi~iPs (m the fact that the level of efgarct~ smoking in the United $tat~s eanst2tutv~ a serious hoalth hazard. 2. Offers ta the Surg~m Goneral ~f the t.S. public tte~lth Service. to Qlher crucial and volun~ry healLh agencies, and professi~I~al health organizations, to schools and other eoralut~i~y agencies, the support of the a~oeiation in initiating, plsnning and implementing an educatinnal program and other measures ths t m~:] be devised ~o deal wi/h this problem. 8. ITrges the tobacco lndns~y, ~h~ir advertising serviceg, and the I~'utional Association of Broad~stexs, to contin~ taking voluntary ste~ for lhe control of cigarette adver ~isl)~ ~ in print media, and on ~leV~Ion aml radio, partietdarly but not exclusively that dir~t ed at young Imo[fle. 4. Urges those legislative bodies unll bureau.~ that have appropriat~ functions to eo~der taking oetlon witJ~in their legal power to regulate the adver~sfug of e/g~ rette~ that by its content or imlAi~gt~ons oortmty cigarette sine*king as ~el]a$ a wholesom~ or safe activity. 5. Urges continual research and demonstra{ion of edllc~ltional a,qd actJoI~ programs in schools and conanonltle~ based on ~:esearch in me,hods of deterring young people from begTllrdng the smoking habl~ anll/'or oneom'a~ing afhllts to give uT) or cut down on their s~0king. A~lopte~ by the ~P~% in 19~:~. I~ I may close Mr. Chah'man, hv reading tile last paragraph of the prepared statcinea{, ~} ch was suhn~ tied o you. Scnafor ~2A~ v. Tidal stabement will be printed in ball in the ~cord, as i~ read. (The statement follows.) TE ~f P~E uxr~ ~T~ It was during ~ tenure as Surgeon General of tl~e l"nblie ~e~tth Servie% as ~c*nle of you may remember, that file first re~.sonabiy de~nitive report im /he reIation~hlp between smoking and health was made p~]bliv. In ~llly 1958~ the la~e Dr. Harold F'. 1)or~}'s paper, entitled "Tobacco Consumption and ~%~ortality froul Coercer and other Diseases" ~temon~trated that a sl~Gstleal relationship ~xis~ed between death rates ~nd smoking. ~etween July 1958 and -~'o~mber 1959, staff membeis Of th~ Public ~lealth Sewice uriderto~k a re i~v~ of the then available studies of the problem; and in the November 1959 issue of the Jo~l of the A m~ie~n Medical A~ecintion, I w.s ~ble to st~mmarize the r~ults ef this study. It was ~uy ¢~mclasien then, thnt unless the use of tobnncll could be mad~ safe, the i!ldivid~Fs ris~ ef Iung cancer could best be reduced by eliminating s~cic*klng. '/his judgment and the supporting dat~ were sire/lllsl~eons [y n~ade avat table +~ ~he pnhllO by the :Publl~ ]~ealth Service ~nd the l)~partmellt Of IIealth, ]~llaeaticm, and Wel£al~,. I offer thiR small segment o~ the history to demol~strate both the dnratlen of ~he prob- lem within the Public Health Service and my oxen eoncer*~ with it as Surgeor~ General. The American pub?it Yl~alth Ass(~cla~iol~ which Dr Levi}* nn(i I ate repro- en ng here ~y s a i~refes onal society of over ~5.000 members whose w e~t~on is with o£[~ei0.1 a~d yol~lntary h~lth agone es. 'the as~(~,ia~/on, ~arollg~ its 93 years of existence has forcefully attar[ pted. In seizer(lance with erie of its basle, t~nets, ~o prevent illness ~nd death from disease. The healfh prllblems resUlting from cigarette ~nllking illel~ding principally ln~ cancer and ether respiratory tract Illnesses, has ~1~erned onr ~s~cLafi~m for a nllmber of years In 1959, w~en faced with irr~fntvble statis~ieal evidence and ,~ ht, n authoritatt~ epldemiolo~i(~I prognostications inchea~ed that more ~b~n i inillion sehoolehi] dr~n would die o~ lun~ eam~r before ~aehing the age of 70 year% out govern

CIGARETTE LABELING AND ADVEttTIF, LNG ~3 ing coui~i] by Fe~(fl~ti~/n Urged ~ br~d ed~ tional effort esl~elally among yl~l~g ~eople to prewent cigarette smoking and fnrther c~]led upon health ~Elt~oritie~ ~Ohlllt &r y health organizations, ~nd ~d~cational ~Ilt horitie~ to Wo~l~ co0per ~iv~ly to this end. Again in 1963, the gove~ing o~¢il of the ApIt& unanimously ~pprove@ a resotution dealing with the problems of cigarette smoking and health~ This resoIution Dointed ol~t that the l~llg calleer ln'Ob]em in the U~t~l ~t~teg w~s ¢Jf such ~it ude as t~ warr3nt i~plement~ t]~n of any and ~ll Dveve.~ve measures ~t ]2~ve a reasonab]~ pro~j'~eet of e~]rlli~g the dige~ Also, ~]~at e'~ide]~oe ~diea~d oi~rette ~n ilkin g to be ~1~ im p~l~ ant ~ etor Jn the etiology of sq~/aiilo~s e&r ~iu~m a of tile l~ng ~rg] tb~£ th~ nlo~ re~l ~mn hie ~xpl.~ t~on for tho increase in th~ ~eque~lly i}[ ~his forln ~ ea!l~er ~!neo 1~0 is the i~ere~%e in eIgflrt~le ~moklng that b~ oeeurrod since th~ date. It further ~t~ted that there is evideDee that cigarette smoking is x~soe]a~d ~th iuere~tsed ~sks Of ~evera] o~er diseases, Ilartieu]arly Coronary heart disease, Chronic regpi~aLory di~e~s~, ~nd ca12eer of th~ urin&ry bl~dder~ It is o~r I~siti0n~ &g sta~ed in ~]~i~ re~l/I tion, t~Jat &dditil~n~] i~ fo2mation is ~eeded on the n/eehanisms whereby oig~r~tte ~mokin~ inere~ ~us~Dtibili[y to these disorders; bU~ u~tll these meehanisins are identi@ed anc~ prove s~scep£ible to l~anipulation, preventive action ¢~n onl~ he ~i~2¢ted at a reduetioL of the total amouilt of ~ig~tre~fe ~m~killg ill the popula. tilln Five ~peel~e eetlon~ ~ere re~?ommended ~ ~nDe with ~}]i~ problem, i~ ~lud]n~ prlva~e examiile by members iff the xssllei~tillil, in~re~d le~ler~]llp f~ro~gh their ~ofessiona] aetivities, and educational acd~iti~ to reduce th~ amount ~f ei~ret~ smokin~ wifhiu ~he papul~ion. The se¢on~l re,?(ll~imen(Ea- t[oIl, ~i~lted to the ~urgeoll Genera] ol¸ the L~. l~ub~e IIe~lth ~crvice ~nd to other o~]~ oi~] and w~untary health ng~n~ies, profe$~io~l hoal~h ~gei~c~es, ~ehools, ant[ in f~et ~o all e~l]:~nIli~ a~(~ies~ liras ~llBl~rt of lint ~sslmi~ilm in initi •ting, ]~lanning and h~l)]el~e~t]ng ed/leatioJla] programs ~Ild i~[~l~r ule~ures LI~ de~l ~ith the problem. WO fnrther ~rge ~]?e ~b~o ind~3sto~ tlle~r ~t]~elti~]llg servlee~, aiJd the N&tional A~sod~tion of ]~ro~tdcaste~s to ~ol~finue ~o~ntitry ~lon~ aimed at ~he control of eigareLte adver~i~in~ in 7~ri~l[~d m~dia ~nd ~n ~elevlsl~71 alld l'~dio~ p~rt~ellI~rly thst ~]]reete~ nt ~nng p~=. ~e~rth, we IWge eo~tint~ed rese~treh ~lld den~llstratJon on edu{~io~l Rn~ Roti~,n p~ogram~ in se]2ools and eomlnRTli~les base~ on reses~ch in ~e[hods of deterri~lg young peeple from b~in~ing the smoking habit ~r en¢o~rag~l~ ~dull~ tll e]imhiate or • edlice tlleir own $mokin~ P~rt~eul&rly ilortine~t to thi~ hearing was that ii~r~ ~f t~e resohlt~on which ~rge8 legislative bodies ~1~4 bureal~s, where ap i~rx~[iri~t~ to oons[d~r &eti~n wit bin thor legal power to re.late the ~llvez± isb~z ei~lretteg tl~a£ by th~dr ~mtei~! lit imD]i~sti~ns l~rtr~y~ eig~tte sm~!king ~J~ ~ehlg ~ wholesome or g~f~ ~lll] vi~. You w~I notice [h~l t!l~ lhr~t Of {ho reeom~.el~d&ti~ of ~11~ A]~HA ~Iate Drimarily if not almos~ exclusively to vohm~ry ~etio~s, Otlr Stssocia~ion ill no ~&y 8tlbseribes to fhe desirability o~ prohlbltioll ~f ~igarettes, We are con- vinced however, th&t fho dangers inherent in the smoking ~f ~garet~es m~st be ~rcefully presented to all ~kmerica~ citixen~, particularly to the youn~ ~lo~t ~eY~&lll]~v appropri~t~ s~p~ m~st be t3ken ~o that a~ aceura~ portrayal Of ~e pain f~l~ even ~ead]y, oons~qllenees of cig8 rette smoking Will bal~.ee ~he 1)~etl~r~ ]~rese~ted by hJdustry advertisln~ which infers that s6ol~I ~ee~p~o~: I/e~uty, ~ascul]nity, economic ~teeompI~llnen£, ~r ronlal~de $ucc~s i~ s~tlow aSSO ~iat~ with the ~nloki~g of a ]91trtic~lar 7Jrand of ei~&rettes, Dr. ~N~. Y~uwillnoticeth~tthelhrusl~offl~r~u~mmendMions of the APHA ivhtte primarily if not ~Imost exclush,ely to volmltary itc~ons. Our association in no way subscribes to the dc~ir~bi]ity of prc, hibil ;on of cigarettes. ~'~e m'o eoll~ inked, lio~ ~ver. that [ le dan~rs il] lel'ent in the smoking o~ cig~rettes must b~ ~orcefully prc~entcd to all American citizens~ particuhlr]y to the yolm ~. ~*fos~ certain]v appropriate steps mnsf be t~keu so that an ~eCul'ate po~ruyal of the painful-,,~e~ en deadly consequences of c~ garefte smohin~ vdlI bahmce tl~c pietnr~ pi~sent ed by inctu~trv "tdver isin~ which infers that ~lal ~ecept aline? belmty, niasellhlllty, econonllo accomphshment~ or rom,%lltl¢ SIlc~esg lS So[Ilt~l]Ow .sseeiated with the smoking of p~wlicular brand o£ d g~regtes.

144 CIGARE'ITfE LA~ELLNG A~D 2*DVERTISTNG Ire closing, W~r. Chahman~ the as~cla~[on endorses in prlacipis ~he conic t~ of th~ two b Is, w thout n~k~ng any spegific l~commenda- tlons on ~ith~r o~ the pieces of lcglslst~on. SenaO)r ]=[ART. Thank vou~ Doctor. The committe~ has been filr- nished by Dr. Levin a s m!cm~nt which also will be printed in full in lhe record as though give n, together with the sevel~] appendixes and dIscussions. ( Statement ~dlows.) S~'ATE~ISX ~ or T~ A~EE/CA~ P~m~o HZ~LTI~ &SSC~ON. O~ ~ 547 ~I~D S. 559 ; ~W~ Pagx I~R }XOP/AL I~ITUTm sml D~" ~[ort~n L Levin of /~uffalo, N.Y. I ala here ~o testify on behgif <~f the Amer~ca~ l'ablic Health Assoclatioa regardl~ S 547 and ~ 559, I am a doctor of medicine with a postgraduate degeee 0f r~oor of publ2e ~leldth. In 1~ I first beeflnlo interested in and started a s~udy of the relation of smoking to eanec*r I was at that thn~ assistant director and st~bse~uentkv dlt~-cfor of ±he Division of Cancer Control Of t3ae New York Stat~ ] )soar tment of l~eaith. ~rom ~947 ~o 1~59, [ wa~ a~[s~nt (~BamI~si(~ael" Of health it, tile fg~w Y~rk ~ts~e D~i)tlrtl~ellL of Health, and sln~ 1960 I have been chief of ~he department of eDidemtology at Re)swell Park Memorial Institute., which is the cancer res~rch hospital and institute of the ~New York State Depa~0nent of Health, 1 have puMJ~be~, a~ senior or a~a~ author, 12 palm~ o~ *~e relation of smo~ag to ~'ail('~r, 2l detailed list of my ~xpeldenee and publications is attached to ~ay s tfl tern ent fried with the ¢or~mittee. The Ameriefll% ~n[}] [~ ]:~ealvh Assist toll is n lice Ional or gS,niz ation eOlnprised Of ~rofes~i~nal Workers yrimarily concerned with plY*lie he~llth and the pre- vention of dlsea~e. The heal¢~ hazards uf continued i.igatet~¢- sm(iking have long b~a the subject ~f Study by members of tile association. The association is ¢ompZ:~d aJ~ public health eiflcl~lls u~d related p6r~yi~e~ Who aye ¢!haZged bF law to ~valuate new m~thods for the prevention of d~sease al~(] to advise the pt~blie regarding i'he advisability and ilnl~of~/nee Of ndoF,~ing ~lleh lnevzhods In 195~, the i'ub]ie Health (3sneer Association, an at~liate of the American Public ~e~Ith Aegis/toil, adopted a r~llltiO~ ettll[llg attell~ion to cig~ret2e sr nok[~*£ as the major ea~e of lun~ cancer &rid UrgiI(g dh;l~ the yonth of America "~mt the cost" ~f~w starting fo ~(tke. In 10~9, t~o govel~g ~?~ru'il *if the Al~l~riean pI2bli¢ liealth AssQciat~on adopted a similar resatutlon, eidng the probability tha~ more than 1 million Dissent schoolchildren wouhl deveh)0 l/l~ ean~r ~]lri~g their |if¢'timo ~f present trend~ eontinlle The l'~SolUti~n llrge(l thIlt health tLu~hor]tles undertake a bl~d edtleatio]lfll elYort "~o prevent cigarette Sl/~ok[ng" In 1~, ~he (~mc]/ c~|led attoIdon to the increase(] ri~k of/~her diseases, such as coronary arrA'ry disease and chroolc: l~slara~Qry dl se~e assoeia~fed with eigarott~ smoking and prolms~l that cdneOiioulll aeOvities I~ co~duc~ed based "on the fsct that t21e levee of ei~ar@tN, smoking in ~he United States ec*nstit ut~ a s~r~ou~ health hazard." ~yne resohltion a~u~ urged Ie~isIative bOdies "to eonsillele ~flkIl~g a(,tioi~ to re~Olflte the advo~t[slng O~ ei~retfos" ( £1opic~ of t herd, reSOlutions are atta shed, appendices A and ]8. ) Sines 1954. a lvrge number of oth~r Dr o~essio]sa[ heu]th or~nizat to~s, lnedieo| saeletles, voluntary and ~orerumeatal health agcneiew, and ~searvh organize tlon~ in thls eomttry, Canada and abroad, have reviewed the evidence on the e fleet Of si;~oking on health (Appendix (~ }. This evidence inch]des data gather~l from chemical a]~alyais of tabaceo smoke, animal exporinlents on the cancer producing effect cW various ehemleMs contained in tobacco tar and of whole tobacco ta~, the ~ecl of smoking on hum&n [lln~ tinselS, stlldies Of Ir~rsons iU with c':]nl~r and ~ther diseases, studies of well persons tD determine ~ubsequeat ineidcne~ of disease Lu relation to Smoking habits and olher dharac~erzsfies, and ~tal slatlsties r~gal<llng (~anges ill the mol'ta[ity and inc.ide21ee of disease. All the re.lows of ~h~u evid~aee made by th~e homer ~encies have col~elnded that cigarette smokilS g is an imDorla nt h,~s ltfi hazard. HOW ~r~at is this health 11sza~d? One way of gaging its mag~dlude is by es im~til~ tile e~css deaths a~n~,itg male cigarette smoke~: i.e., the deaths ~n~,ng ~'i~arct&~ ~moker~ i~ ~xOe~ Of the ~110~li?y exi~'f~ettee Of not~moker~

---

CIGARETT~ bA~EJaLNG A~ ~D~TISING Ap~NDI~ A ~er~s~ lllllg oanoeF lg II rllpldly l~crea~ing faDll ilL-ease whack ~ow kills raore ~lan 25,0~ l~-~Iile in Ule united States ~ach ~ea~ and if present trends ~ontinll~ will i~laim Ihe llvO~ o~ moro ~an 1 million present s~ool childrell in thi~ c~antry be fel~ Lhey reach I~a~ age of 70 yea~, and ¾r]l~reas, ~cien~c ~vld~n~e has es~ab]isl~ed ~ha~ e~ce~sive cigarette sm~kill~ is a major A~¢ f~r in ~he disease, and ~ereas, public health o f~e~als of the Uni~d ~tlDes ~nd maly ~ther countries h~.v~ p~in~d o~1~ ~a~ relaUonship De~w~l~ el~a~t~ smoking ancl ~ll~g ~ancerl Tl~erefor~ ]~e i~ I~o~oh;~. Tha~ th~ American p~blie Health As~ia~on ~aE upon health au ~o~'itie~ to ~nt]er t~l~e a ~r oi~ tl e~]l~'~l J~n a] effort, ~pe~ lly ~B~ yewlg ~eOlll~ to pr~wn~ ~a~fte smoking ; and b~ l~ further /~s~'~. That f~ American public Heallh AssoeiaUon ur~ h~al~h a~thoritie~ ;to ~lI~orate w~ ~eh~nlAr~ Leal~ or f~ni~tlOllS &ll~l wlLh e~l ~c~io~aal ~.ut htari- !~e~ in thi~ ef£~r[. Adepte~ by ~he A~-~ Govern~g C01~acJl On October ~1, ~. qJhe size Of ~he llI~ co.n~r F~obl~l in this ~nli~ t~y at t~a pr~t tina~ L~ Stl~ as to warrant urgent impl~menJ.aLiol~ o~ any and ~lI pr~v~ntlv~ m~l~ ~ha~ have reasonable prospe~ ~f ~eess. E~fi~lene~ l~li~a~s ~ha~ t~a~e smoking J~ sn ~l~l~'~ilf foct~ ~n the e~iolo~ of squanloll~ c~r~hlO~aa ol ~ht~ Iu~, o~ll(l ~ha~ th~ m~st re~so~le expla~io~ for th~ increase 1~ ~be ~requency o~ tbi~ ~ozm Of car~c~r sl~2~o 1D~O i~ the i~ crt~se ~ c~aret~e sraokin~, thRt ha~ o~uzr t~ i1~ thta ~me ~et~oll. .~or OOV~ t3ae tl~Jr~bili~ Of p~bli~ heal~l~ a~tio~ ~ ~e~ ~o~ tql cigarette sraokin~ is a~a~tl~ll ~ e~de~e thi~ cl~aret~ ~3~ol~lng Is ~s~o- ~i~ted Wi~h ~er~ase~ risk o~ other dis~,as~ st~te~, in ]p~llar coronary ~c~r~ ~ise~se, chroni~ re~ratolT dis~a~c an/l cant~ of ~he ~rinal~7 ~lallder. Aclditio~al ir~orln~fitJ~ is ~etle~ o1~ ~a~ ll~hu~2~m ill" ~.~hani~lll~ ~her~by idg,~r~tte smoking i~a~as susce~i~lity to ~hese dit~rde~s. But ~n~il ~he~e ml~hani~ a3-~ i~nti~tl ~ild are show~ ~o be ~a~ep~e t~ maniD~l~iOl~, preven[i~ ~ction ~ar~ be dir~3t~d only ~z rod~ctiOll o~ f~le total ~mo~nt Of ci~re~e smokill~" prewle~t ~ ~he popu]atioIl. J3elieving ~t ~h~ al~e ~ens~deraUo~ re/lllire immealiate and ~z~J~s ~ct~@n to re~uee cigarette smoki~ by O~e Amer ic~ln l~epl~ ~h~ Ameli~n public ~1 ~lt~ A~ocTafion : 1. ~r~e$ i~s members, na their plof~sional ac~ivifies and by p~ivat~ eI- ample, to provide lea~rSbil~ in the ~ lion, the Sta~esl and in ~heir individu~I ~ommtlni~es i~ ed~l~tIonal acridines ~a~ the fa~ fh&f the l~v~l of ci~aI~tt~ sraoi~l~g 1~ ~ United ~tatcs at the l~resent time ~on~i~l~s a serous hea~th ;a~zard, m ~bools and ~er ~om~r,~n~ o~en~ie~, the s~p~otL t~ tb~ Ass~i~IOn in inithl~n~, planning a~(l Jlaplemenlh~g a~ e~h~afional ~ro~ram, alcl other measures fha~ may be devised lo deal ~i~ thi~ problem, ~ Ur~g th~ toba~o in~I~stl~ thor adver~isin~ se~ices, and the NO. thmal Association3 o~" ~ro~(io~s~r~, ~o C~nti~e l~kJ~ vol~n~ry ~tel~ for Lhe c~n Lr ol ~ cigarette ~dver tlsln~ in Drint m~li~ aull on ~1~ vision tL~d r~a clio, particularly bu~ no~ ~clusi~ly I~L dir~cLed ii~ young people. ~. ~rges tho~e legislative Dodie~ trod DUl~U~ ~h~ h~ve al0propri~t~ ~a~c- ~ions to ~.~I~Sider ta~ng a~ioI~ ~f~in their logal powe~ to ~ulate ~e ~lllver tl~lng Of ~ g'a r e~i~s that D~ i~s content or i~pli~.~io~ ~ pot tr~ys cigarette ~. Ur~ e~ue~t res~a~h a~(I ~emo~str~tion ~f cdt~eutiem~l an~ ~ion prograra~ in ~ebools ~d COlZUn~ni~i~s bas~i on r~$c~rch in lU~h~d~ of de~er~ youn~ people from ~ll~n~ Ole ~mo~n~ h~ ~ d/~r e~cou~i~ ~d~ll~ t~l give l~I~ or e~ do~ on ~a~ir sn~oki~ ~dl~edl by th~ APHA Goveznin~ I~euneil orl ~-ove~aber 13, ]~.

---

CIGARErI~F~ LABEZING AND ADVERTLSL~G 1~* Internatlot~&l ~Tni0n Agfllnst Cancer, Subcom~littee oi1 Tobacco and Air pullution 26. Joint l~berc~l 0~ig Council o£ Gr~a~ Rr]~in 17. J~t edicaI Resea r c~lt CottC~l of Great Brit~tin 18. National Cancer ln~titule ~ Can~d~ 19, Ne~herlands Ministry of Social A~air s, 1957 2D. l~aeifie Kor~hwe~t ]~adJol~cal ~c~esy 2,1. l~e~earch CODiCil of Sweden 5. Royal C~llege of plly~lcians, London, 1962 23. ~e~ nd Depar t me~t of I~eal~h ~1. Swediv~h Medicrat Research Gou~c~ 1958 '>~. Worl~ Health Organia~ion, S~ial Study (Jr o11I~ 1£~0 ~e~s ~e@~h$ ~g ~c~E~ ~gafe'tte Smoker8 ag~ I8 ~t~ ov~r~ ~v~d ~gat~: i~6~ I~aCtm~ ~m d~ta of ~ro~ctlve [studies: Smokers' (11St~bmion, ic~5: U.$. p~ation; 19~ E~CC~s ~at~ over nm~ber e~xr~ct e~ frm~ no~mcker~, mo~ht y ex~r ~. Senator HA~T. DocLorI you l~I'C wcieo]]]~ l0 read tlt~ ~ta@el]t]~]~t or sumnmrize it as you seeli~. Dr. L~x, I would be glad to en,LerLl~h, qu~s~ ons if the committee wishes at tiffs point, without any further discussio~. I would like to point out that I have beenpe~ona]ly interested i~ this ~ubj e~t since 1939, when we first started the study of the possible relat]onslnp bet'~'e~lt ~mok b,g and lung etu~eer~ and I have published s~ ztumber o~ apers on that subi~![ sin<~ thel]. I think t~e most s~ rlkln~- develcpment wlfieh has oeem'red since that time h~s bee~ the expansion of the appareng hazard to health which the ttse of cigarettes has contlimous]y p~*sen~ed. A~d I don~t think ~[r. Chainnan~ Ill:ti. wt~ hi, re rc~.che~ th~ end of ol]i' l~owled~e as to the possible relationships. A6 ]~;~sI; I ~hln![ thh/k we 8holl]d itt4~llli]~ that we have reached the end of our knowledge ~s I~ thes~ possible relationships. ]h', Rurally i~ferl, ad to the resohttion passed bv the American Public Health A~d~tion. t would like to point o~u[, a~ Dr. Dielfl did, that since 1954~ a~ le~ st 64 other professional health orglmizl],~ions~ medical societies, ~nd govel'lllll~fl~,'~l II~I~l± k~g~ll(~i~ alt(t ressaroh Ol'~azffsations in this country and abroad have l'e~dewed the evideilce regmrlli~g the relationship bet~veen smoking lung cancer and other diseases; thai tlle evi~e~t(~t~ hlcludt'~ dlt~a gathcrtM ~vom chemi~d analysis O~ tobacco ~li¢)k{!~ fl.¢ml allimgt] experi]~)ellts~ from th(~ ~cc~t of ~nokb~g on various tissues and in the case of hmg cance~- m lm~g* tissue.

CIGARETTE I~BELING AND ADVERTI~IN0 ]49 I believe unother witness wi]I present ~tudiss of persons ill with cancer and other diseases and sLtuties of well pet~oi~ te d~emnine subsequent n~ deuce of d seasc n rclat on to smok ng habits ~nd other characf~rlstiss~ as well a~ vlLM shrListiv~, ttbouf which a great d~l lms ls~n said today rc4~LI'ding changes J,t mortality and ktcldenc~ of 41~tst~lst. All reviews of evideme~q made by J.hese l~ealt.b agen¢fi es have c~ncluded that cigarette smokhlg is an important health hazard. One way of ~agl'ng approxilaa~ely the extent of this health hazard is to estimate ~s Dr. Horn stated awhile a~o the excess de~ths among male c gazette smokers, tlmt is, the nm~er of deaths ~mong p~ale ~igax'ette smokers in excess of what would h~ve beext their experience m a siugle year had they bed the same morLMitv as nonsmokers. The~pe &rr~ ~lrc awilabis frail1 the prospective s~uil{~s i, eportc~l in the S~r- g~(m Crezic~ral's AdvisoJT Committee ~.port. We have made such an es~ima~ based upon tla pc~pul~Jon of tbg United Stat~s and the mortality among males 18 vea~ of age and over for the veer 196'2. I present tns as ~m appromma e indication of ~e magmtude o± the heMth haz~rd of cigarette smoking as a cause of deavh. ]" hope ilm~ tim committee will note that I ~m not sta,ing il~a~ file causM and crchor sibnfifie~ce of eacb cause of death ~s tb~ ~me. be~ cause ~verything we have learned about rehtionship indicates ~hat there xs more thin one way iu which tobacco influences health and that in m~nv of tl~e forms of dise~*se and cause of mortah~y we haven't fully explored the mechanism, We are not fully certah~ as to wha~ type of can~rl relafionsbip, ~f any, exists• I would hke to poh~t out theft, wlxere ~zou haw a toxic s,A~st~nce such as t~bacc% avtd you observe a sizable mcrea~ in mortality, amount mg f~ over ~//0 003 deaths I @i~rk it was only prudent not to ~ume ~hab any of the~e ~re neeessaribs witbout si&maficanee until all have been steadied very t horouglily. This ~ e ha~e not done as vet. The most hnporl~mt practical mwpecl of the health bs~,rd of ciga- rette smoklrlg is h~ its pe'eventlx~ p~ssilfiiitiss. Numerons stediss b,uvo sho~n that persons who stop smoking cig~ettes exp3erienee~ withhl 5 year~, a redaction of over 50 pe~x~ent in the risk of developing hmg canclw. Recent studies reported by Doyle and his assoclates--which Senator Neuberger cited show that ~hei, eas medemte ~, bcz.vy cig~- rette smokers observed over ~u~ 8- to 10 year period experience three times as ~mmy attacks of coronary ar e~g d sease, persons who bad stepped ~nxoking had no greater J~eidence of he~r~ a~tacks than did nonsmokers, indie~.lin~. ~ th .... V there is a definite preven~ vs effect $~opplng smok~l~ which IS c{Hlte mar (ed lit f ll~ On~ d sense, At resent there is little tha~ c~n be offm'ed meAisal]y ~o counterac~ the e~ect of cigarette smoking other than preventio/{, bF stopping smokhlg, smoking le~. or bs- reducing the anlotmt of t~r retake. To adileve ~his r t~luis~ ~ idesl{read public educ~ttion in order to provide ir~di~dduals ~ith sufficient ~r ot,ivation to change ~heir ~okh~g l~bits or not acquire tbem. Enactment of the proposal legislation now tm~bsy consideration would tend to provMe s~ch motivatlon, in our opal lfJn.

CIGARE~PrE LABELING AND ADVI~I~TISIN~ Air. Ch~irm~m I will Skip over the dst ailed discussion of the reasons why we think the proposed legislation is dssirab]e, a~d simply close with f]m ]ast paragraph which states : St is Oar ~Dw that enactment iif tim proloosed legisla~io~ would eonsdtnte a mod~rate, even minimal, but nonetheless effective response of the C0n~eess in att~mptin~g to counter the continued drain on our hm~an ~esources lmSUlting frc*m the widesl)rOad use of c4g:uset~es by our poptfiatioll, The American Public iiealth Association accordingly m'ges faxor~be considmmti0n of ~he pt<,po~d ]egisiatXon, p~rtlcularly S, 559. It is my undsrstlmdirt thal~ ehactanenl; of S. 559 would leo~ve to llm Federal Tr~.dc Commlss~nl tke authority to take action regard in~ rer~flation of clgmrette adveltlsing which I consider to be an mLpor tent element m combating the health effects of clg~roitc smoking. Thank you, Mr. ChaDm~n. Senator HART. Dr. Levln~ thank >ou very much. I think timt the vender of the record will he im nx~ssed by the hreadsh of the experi- ence which y~ui have deve oped n rids partlcu ur field over ~ long period of time. S~mtor Neuberger ? Senafor l~lm~Ram~. Thank y~u, Mr. Ch~hmaan. Dr. Levin, you conic firm the Rosweg Perk lnstitu*e~ which has a great reputation for doing quite a lot of work~ I think, with the huh~vioral problems of m~mkers. I wish we had time to ask you ki~ about thi:% because I think it is an area that some of the rest of us havelFt explored as much. Could you tel1 me briefly wh~t kind of work is g~)ing on in t h at ? Dr. l~vr~. For the p~st ~lnlost 2 yea,~ wc have been conducting smoking withdr~*~a clinics to which people come whe want to g~ve up smoking bul ~ho feel that they need som~ hell). We help, try to help the_~ people by a variety of methods. Pardy by the use of various medicants, pai* of ~Idch ar~ real] medi~nts endIn~t't of whlek are hmowa as placebos~ tt,ut is~ ~hey look like the real thing but aren't. We provide odui!l/tillnll~ hl~h]l'l~ we show tkef£1 lliotiol~ pictures and s]kit~, trod ~e al~s~er qu~s¢ions, and we try to help supporfi them during the period whc~ they ~ppalx,nO, v need the gi~test lmlp ~hil~ i:hey ar~ gi~dn~ up smokhtg. ()he interesting bypr(!du(~t of [his cxper±euce in which ~e have now ~ried to help sorm~ 70(I individuals, between the a~es of uhout 19 and 65, nnd almni~ (~luall> dividsd between tomes m~d fem~ie~% is th~i one of t.he mos~ frequent questions we are asked is "Since smmking is such ~r uerions health h~zard, why hamFt the Federal Govt~rnment done something?" . . It is our imp r e.~sinn that file f~m~ tl~at up to ~h~ in.sent tlrne, desl)~ Le ~hep b c* o of eSur on(~enel-al'sAdvisoryComm~ttce~)ort~ ihe Federal (~overmnent ~as not done anything h~s httd a serious effs<:~ in htihlencing many people with rega~,d to their- ud~ent as to how serious file health hazard really is, If enactne of the legislation embodied in ycmr bill ~ena[ov N~lllu~rgq~r~ and in Senator Magnuson'.~. would do no~hmg lnore ~[ntI~ ss n e of h s c~ ntry of the genuine c~ne~rr} of the Congress ~garding tim health hazards of this tltx3dltet~ 1[135 in ~tself I think woifld/~ worth while.

CIGA]~ETTE LABELING AND ADVLI~TISL~G I~i Senator NE~mmm¢, I {bbd{ it is a very good point. The fact th,~t the Government has taken steps to ~ntro water poilu/ion and air pollution show~ I]lt~ ~overlllnent s ecmeern ill that Al'e~. alld ~0111eOlle has said I,h~l mr~oking cigarettes is creating your own personal air pollution. 8o ~ e could do solne~hing ttbeu~ it` I ,,-~rs ~ardoulgrly )leaseA1 with t]te St~ttelnellt {llag ~=l)ll riled% ~llie~t I thought was a ~o~poinl about wlmlber labeling will reMly do an}' fioc~l or not. Though I am an advocate of it. it is sort of a beginning step: and I cloak suppose it s go g o tdutnfie tl great ma~*r habits that people h~ve developed. ,,, " In 3'0 r s~atement err page 5, you say. l'he ~ost of a product-sca]e public edueatioual, p re g~'amre g~ [i,dhl/s~r,obln~ on a sea le compar~bleg ~ , to tile I~upelldltlll~S for mgarette IltlVel'ttSllllA" ~I0111d be ~t'e~t. '][he {vpe o~ ]abellng proposed 3n these bll]s would be ,~m effective, less c5stl~. ..-dr hotiMt~_ ~arfiM m~lxs~itute for such a= educat om 1 progra, , . " I trlnn k that maybe m why Seamt or Magnuson and I bare mtrodut t~*l sadt legislation. It is a sugge~%n tha~ evetD" time yott ve}tch for it1 you should flfink about it, i~ remintls me, din'ms nly o~.rt ahmtion cltrnpaign~ ~ben I invested beavi]v in som* bumper slrips ['or people to put on tbei~ ear, to advertise m~, mane as a candidate for the U.S. Statute. I don't believe iu bil]beards. I doiPt believe in defacing the public hia'lmays, even if it is in a g~od cause lik6 my own ean~hhtev. Also, [he3 al'~ very expensive and I didnk want ~ny bi]ff~m~ls. But if )eople would ')' v rs "ts, s~ sue e~se~tlvkin~ofbillboard rulverdsmg. We know dialpower of suggestion. That is w}~y I ~I~Lnk .tirol we should m~ke an effol% a start: ~ thls kind of hd~el InK l~lglattoll, I lmve no more questions. Tha,k you. Stmab:tr H~T. Doctor I l~±ow it is late: but i wast to ask a ~lnes tion~ this in all likelihood being the first day and bst filet I will be able to sit ~md hear riffs t~imonv. Tbe otter committee on xvIdch I sit is instructed to be~in disctmsio~ of the ~oting rig~ts bilI tomorrow morning, I am the Ialber of a large family. Eight of then~ The oldest is about 17. At Roswell Park ao'x)rdh~g to Senator Neuberger, you ale discussing motivation and identifs'ing it. If vc>u were persuaded as you ar6 that this is ~ d~mmg]lag pt~aedce. and ~ h~d habit, how would yo~ resent, the ease to a, boy o~ 15. Dr. lmw~. Aet.ually Senator ~]alt that is one of @e que*~tions we are trying to answer. "Whg~t is tbe best way of presenting th9 a~ sx~ and not oaly to a boy of 15~we ar~ conducting school educahonal pro- gTams m eonjunefiol} with pnrlnt-% The I~bihlr~tt luld parents llle~ together and hear the Saline leetul'e. This i~ really an experimental program, to try to find ont what is Irms. effect re. Up to ~ ~e present about the on]} thing, that I can say 18 Ihat apparently wlmt ltas tile most relti effei't on eluldl~n ahont the ~ge of 15 are pie[u,'~s of met,m] dLseases produced by smddng. That is whal l'erdly seems to get to them. The~," can ]istm~ to statistieM analyses~ and ~pidelrdol~gieal discus sions "and tbey can heat' you talk about it but if they see ~ pie~ttrer provi deal it i~ft too gm7, which has art opposil~ effex~t, this appa~ ently~ judgiug b~ what the) teJl us, ~*nllv getsmld~r t21eir skin~

CIGARE'I~YE I~ABETdl~TG .4~D ADVERTL~I~O The other material apTp~a~ntly is sort of shrugged off as something too remote in time to realt~ be of sigulflc~ee to them. They must se~ it in graphic form. Sertator tL~T. Is the~ liberal are or pictures of rids sor~ ~vailablo for such use? Dr L~wx Yes The*~ is ~xte~cive llterature We actually have catalog of cdllcat~onal m~,teria]s which ~7~ have deleloped, whlch ]s ouly a fraction of th~ educational materials devclol, ed by other ~g~ncie~ throughout the cotu]trv. There is a ~airly extensive c~)llection of color¢~d slides, film stri~7 of n~otion pictures. We have ~ serit~ ¢d 50 different pesters designed 4o send tho messag~ in a humorous ffJrm. "We have even designed matoh ccv~r~ wEh some relatisnship to the smoking ~nd health hazer& Senator II.x~v. Doctor if ssible I tlm~k is would help if you could ~urnish ~or the committee's " "~e ~ typl¢~l material. Dr. L~w ~. Would you like the whole rangs of materiM Senator SmmLor Y[~gv. I sen~ that we would be as l~','ng ~or a great deal if we asked for eve~3~hing tha~ you published. Some of ~ he more effec~ tire pieces of mater} M to as I say~ present the ca ~. . ] aSSUlI~ iIlelll]3t~l'8 of thfi COHII~lt[~ WOU d be desirous of ~elllg tlfi~ materiah Dr. Lm~. I will be fflad to do that, Senator. Senator HAgv. Thar~k you wry much. Dr. ]~v~x~z. Thankyou. Se ate' HAg% The i~ma~nh~g scheduled witness for today is ha*m ?}m A~uerivun Heart, A~ciatton. I unde~t,~nd beeu~l~ of the ]ate- n~ of the hour one of the witnesses wa~ nSlUi,~'d to leave. For this I aan sorry, . . )r George W~k~rlm~ medmal director of the Amenca~ Hea~ In- stitute, I am t~dd has been able to stay. Doctor~ will you apoloff}7~ to l)r. Katz for us, We were so long delayed in getting to you. STATE~IF~T 0~ DR. LOUIS N. KATg, DI1L~CT0]I OF TH~ CA~Dlff- VASOULAR ~I~STITUT~, ~II~II~EL ~$E HOSPITA~ AND I~DI- ~AL CENTEt~ g~IOAG0, ILL., ACC0~IPANIEB BY DR. GEORi~E WAKERLII~, M~DICAL DIREgTO~, 32£ERICAN ~ART ASSOCIA- TION Dr. W,~X~:~L~. Senator. Mr. Katz was sorry to leave, lie had a 5 o~c]ock reservation to Clficago. ]~e char±ge~ it to 6:40. in order to catch tbe phme he left a fi~w mh~utes a~o, 1 have hi~, statem.nt. I als(, haw iris qualifications, his curriculum vita~ s b b ographv~ which I will offer in support of his ~stlmony. Senator HA~T. At the appropriate section that will be mad~ a part of the rece~xL Dr. ~V~ r.~L~x. Mr. Chairman. you have 75 copies, I believe of the siatement which he would ]mve read had he been bere. In v e~ of the lateness of the hour I would be governed by your wishes. If you wi~h me to read this st,%t~maent (m his behalf, and on behalf o[ the American Hca~ A~odaiion~ I will be pleased to de so. If you ~,~ould ra/]~er that I simply fi]~ it ~or th~ reoord on behalf of the

CIGARETTE LABBLING AND AD~,I]RTI~ 153 American Heart Aseoc~atlon, and Dr. K,~tz, I will also be pleased to so act. Senator H.~RT. Doctor the statement will be printed in the l~cord n fu 1 as though g ~en,,~ w t]~ the ~xp anltt on that you presented it on behalf of Dr. Katz. Senator Neuberger and I would be glad to have you ~ad i~ in full or make such summary as you desire. Senator ~'EU~EROEI~. I am agreeable to have it p~t in the rexx)ta] but I would like r,o Dsk questions since we talked so much ~bout callcer and not about heart. Senator HART. 1 have no obj eetion. (Statement follows.) ~TA'~]~M~T Ot. D~. I~I~I t~ N. K~T~, DII~E~,31~ O~lI[qov.~ C12LP.K IK gTITTJTI~, ~t~C~[,~F~I 2~EE~E HOSFITAL a~l~ ME~IOAL CEh'TZR, C~HIOAOO, IhL., .~N9 PAST P~SI~ENT BUTT TO R~/3U~ATE ~IIZ ADVERtiSING AND ~II~O or ~IC~ABz*~TI~t~" By ~tl~s, I~r~l~ BBRO~ AN~ M~. ¢~LAaK ; A~D S. ~50 : "A BILL TO BEG UI~T~ TM~ L&~N~ OF ClO- the MR. ~tOSS I am Dr. Louis N. Kat~ of Chicago, Ill,, and apl:~ar before the ('ommltt~e oD Oottunerc'~ fie testify on behalf of the Amaerioan Eealf _etssociafio~ wifh r~f~- erce to 8. ~o47 and 8, 5¢J9. I am director of the Cardio~'aSeular Institute and attending physician of the Michael Reese Hospital and *Medical C~ent er, Chica~'o, i11 (19,~ ) andpra3f~ssorialle~turerinph.vsiologyattheUnivet~tTof('hicago (1941- /. I am past president of the A~mrican I~eart As~einfion (3~51~2), :~ormel* chairman (194~1) and member of its reeeareh committ~e t1919 Vg~) and chairman of the A/rL% ad hoe Commlttc~ oil Smoking and Cardiovascular Diseases (19,-~,&*0). : area also past president of the Ameri~,an Soclety for the ~tud.v of A~terio~el~rosls. of the Amer~tctn physiological Strictly, and the Insti- tute of Met~cine of Ch:c~go. ho::orary president of the ln~r American Society of C~rdlolOgy, pas~ treasttter of tile l]]ternatSonal St~iety of Cardiolo~g ~uad ~eeretare-treasurer of the NatiOnal ~¢~iety 2or ~iediea I l~a reh I have served as editor of 12 journals in the fieldS of cardiology, pl y~iology, slid medicine, and am the author of 7 boors and more than 500 seien tSfie articles, prf oeiI~lly in the ¢~ardiova~]ar field A &ta}led ll~t o~ my qualifications is attached h) my ~tatement filed v*ith the ~ommit t ee. ~I~ Alll~i*ieayi H~art Ag~i~tion ~U]~]~ the- standards Oll~ I:eqllireme~ fop th~ ]~bellDg ar}d ~dvert~sqng of cigarettes and other ~vislons o~ ~. V~47, except the as~-~ctatlon recommends tha~ "~l~tlon ~abituaI Oigar~Lt~ ~ll]0kin~ Is InJurlous to t~calth" (see, ¢;, b(1) and e(1) ) be changed to read "Cautio~ Habitual Cigarette ~mokil~g Frequently Ctms~'it ut es a Set lou~ ltazard to Health." With this change, the a~soc~ation strongly recommen¢Is approval of the bill by the <~mmlttee and passage by the ~ongre~. The American Heart .ets~ci~tio~ al~o ~UDparts the labelin~ requirements and Other provisions of ~ ~i~ hat ~grets the ubs~n¢~ ¢~2 cigarette ~¢iver ~ising r eq~tir e- meets fr0m this bill If lhe e0rmm~ttoe doe~ not approve S. ~:~7 (raodIfled as ]~reviouMy suggested) the a~oeiat~on reeonlmenas approval nf ~ ~,~f/. In th]8 ~V~*llt, th~ fl,,4.,coeiaflort i~lk~ fetward to future legislation by the Congress requiring a health warning with each <.Lgar et ta advertisement. Th~ reeammendatlons are eonMste~t with the present p~sition ~f the Ame~l can ]FIeart Assoeia~ion ill regard to cigarette smoking and cardiova¢~'ular dis *aaes, a yosilion whh.h is the result of tl*e association's tat ~rest and stndy extend ing oFe£ a iltlmboy of year~ 'l'hus, in 19~. the as~ocqation stated time cigarette* smoking is harmfnl in certaln dlsa~ases of the peripheral blood Yes.Is o~ th~ arms and legs and that sc~e indiv~dual~ with ~lr0nar2., artary disease may be harmed hy smokh~g In If~ the association reported (1) that a ntmaber of smoking and increased mortality and morbidity frvm coronary artery disease and that although this does not prove u taut'at r~l~tlonsb/p, available data ~79 ~6~ pt :~l

154 CIGARETTE LABELL~G AND ADVERTISING strongly suggest tba~ heavy cigarette smoking eonte]bn~s rn or ae{!~lerat~s devel0pment or coronary artery di~ea~ ~lld i~ ~2,~plie~tion~. In JaOe 1~, th8 board Of directors of the as~oeL~ltlOJl apI}r~vcd the rel~lr~ of ir*~ 1,~8 lid h00 Committee on 8rooking ~d 08rdlovasClllar Diseases. which ~ta~ed th~ recent developme~lt~ confirm and ~npp[em~nt the findings 0£ the AHA Report of 1960, Our board of dlr~tors also emphasized t~ m,,la~m~hlp of heavy cigarette smoking to ehrot~i¢ pul~lonaIT dl~t'fls, c- ~nd i~lnc~r of th~ lu~l~ &nd ~taf~ []]at the~ i~ ~ flid~ e~i d~C.n c~ of th~ ha rml~l[ e~,~ Of e~gal'~t~e sl~loking t/~ warraLt the association and its affiliates a~d ellapters Joining with other health age~¢ie~ in e~e~t~onal progv~r~s to di~,l~llWn~t~ e~lref~e smokhl~ by [1~ ~12eral pBbli~ With sl)c~lal ~112~81s On $~gers and on high ri~k ~and[da~% ~r ¢orona~: Rrtely dlsea~. A~ a c~ns~lttunee the ll~£[onal OI~C~ Of Cae Amerit~an H~rt A~ocigt~on an~ u~a/D¸ o~ [~ a~i~tes ~nd ehapt~l% are n~w en~ao~ in &~'tive pllbli~ education pr~gia~ to di~t'ollrage ¢i~treLt~ sl~toking, freQ~lel]t~7 in eo]laboratioB with the Au~rl~0]2 ~}lcer ~o~iet~7 and the National Tuber(~llosis ~o.~eiation 3nd tb~r aflflliat~ and eha!0ter% Ms well a~ the U.S Fllblic He~l~ Service. and state and b~al departments Of healtb. In 1964~ A~[A bt:~a m e ~1~ or~ nlzln~ m~mb~ iff the new ~at]ollal Inbersgency COE~I or* ~r~c*king ~1] He~al~ ~t~)~ed of ~ l~&Li£~nal ¥(*hln~ary &nd o~clal health and education 0tgazflzatlons. The primary funedon of the colmcil is to ~tlmula~ and ¢oordinste ilublie ed~t'aLIOll progr~ to diseollr~t~e eigaret~ smoking, Tho ¢o~m~ ~eCell%ly sponsored t]}e Janltary 1~ ]~ Anniver~l*y Confere~oe orl ~moking ~Ild kI~lth. 1 year following the report ~ the ~u~eon ~era['s .~]visory Committee¸ The /klne~iean Heart As~0~Rtl~n is pleased t~ note t~a~ tho N~tiona] Interagency Council an~ 0tber member ~gencie~ of the council are offering testimony in beh sll" of S. ~7 and S. ff~. ~oday ~Bd t0nx0r~w, The I~heling and adver~sillg r 2qllir¢~] e]~ £~ o1" ~ ~7 or t~e la'0eling r equir ~lle:n~ of S. 5.~9 wl.l[d i~lslit ut e a s~i~ct/]l L fo]~wacd step in p~lb]ie ed~leatlon relative io the l~alth hazards Of clgal~e sn~oki~. U]ti~te elimi~atio~ Of eigRrett~ smokhlK ~rot~h ¢~fltec~¥~ p~blic ed ~leatio~ Of a~ltflts and teenagers would ~ ~he saving e~¢/~ year of ~ome 2~0,(}~0 A~aerie~ns from p~etnature death ~l~ls~ by or ~ss~-'iated with eigal~t~' stroking. Ai~prorim~tely o~e half of those ]~r~ • l~lat tlI e death~ r e~3~t from lll]] g ~l~cev, other pll]mon~ W2 di~e~ S~S ~n~ other forIll~ ~f cancer. The other half Of the~ l)~lnRtttre ~e~ths 3s~od~ltc~ ~vitb eigaiet£~ Smok hk~ ar~ dUe to efl2dio~a~olar dl~,~e$, ~¢~r ticul~rly coronary artery d[s~&se /h~art attacks), as wei~ n~ eercbrovascular 41~ase (vtrokc), and peripheral vascular disease. Enac~cment ~f S, ~17 (or as a minima,,¸ S. 559) into law would lllean impor[allL pro~rt~s £oward ¢¢*ll~er~ati(*n o~ ht~uan health &Ild life in th~ UnI0sd State~, which in it~ potential e~¢eeds that of any other public health measttre aow readily &vaRable to ~he A~aenean ~ople. I)r. WAKr~am~. May I make one brief comment'and that is that e~rdiovascular disease accounts for at least 50 percent of the excess pren*ature deaths associate4 with cigarette smoking, so that i agreee with Senator Neuberger timt this is a Ir~mendoll~]y imporhm~ iield which up to recently, I don't till ,k l!~s had s,flh~ien~ r ezogniti0n. ~enator N~t ~m~. TI~ is %hal I w~n. ~vV laL s th~t statistic again? Dr. Wax~rg. The Americ~x Heart A~soclation statement says that the association believes that the~ is a total of approximately aS0,000 ex<ess premature deaths associated witil cigarette smoking e~mh year in the United S~.~es and Ihafi of fh~e at.}ut 125 000 are assoc{ated with c~rdiovascu]ar disease principally corona~T heart disease~ or he~t attacks~ and a small nmnb~r~ s~rokes, and a still smaller number, perinphera] vasca]ur disease. Senator ~v~m< I ~'as particularly interested because I just had occasion *~ently to be with a ve*3~ p~'ominent doctor in Lhe Bos ton community connected with Tufts University, and im is ~ ¢ard~ ologist. He said to me "Senator, you are always talkln~, about emphysema and cancer. He~ disease s st II th~ ma n k ~r. He m~xI~ a st~te-

CIGAI~ETTE LABELING AND AD~'EETISI~G 155 meat that I hated to quote because it seemed to me so omlrmoos, of tho number of smokers who die of heart dbease, who don't¸ need to die of he~ disease, because of the smoking and because of fill, effect upon t[~ he~r~ ,%nd arteries. I ust w~nt to b~ sure that I hed this ~tgain from ~omeon~ like you~ t]l,%t you fee] ~her~ i~ a elo~ cilltn/.c[iou ]/et~ll hermit dlse2,se ~Illl sl~lo/~lIlg. Dr. WA~R1,rN. W,I t]~ in re]~ion to atherosc]el-o~is~ or coronary' artery disease~at]l~rosch~T~sls a~ app]ied to the heart vessels. ~re do not have t]l~ ~villenc~ that¸ thi~ ~s a c~us,%] rela~ionshi~ bul wo have Jlo ~=id~]~ tb~tt 1~ i~. not ca~lsfil, ~ h~tv~ ex(~Ilent evld(,nl~ lhal heavy cigarett~ smohh~ a pack or more a day, par[icularly~ ~t~e]erates atheros¢lero~i~ alld ~lf~lltU~tss its £~1~t5 lnlth~s it worse. Thls ,qo~3Oll]lt ~ ~or t]l~ hlOr~it~ed pl-e/~l~ltUl-~ ({e~tth~ ~]l~tf ai,(s a~sc~ t%~l] with clgarette SllIol~il~g ~ far ~S cx~ronal'V aYh~t-y diseage is aonce~led. Sen,~t or N~mc.~. Would you thiI~k ~t a s~l f~ ~1.~ a]izatlon to say t]~at m~mv doCtol~ would urge heart I~aticnts t~b fl.it smoklng~ I)r. ~V~;z~ix. Yes, indeed. A~ • irmller o~ f~tl!t~ a~ you kIlow, our present¸ P~'esid~n/ of Ihc United States, and one of our past }'rcsi d~nts, both ~eI~ i~/s/rm~t~d to stts~ smokb~g ~fter the, lind }~e~lrt at tae'ks, aud they both haw stopped smoking. I cant ~h].~ of any Senator ~:~:R. Thank you, That is a11, ~el%ator HART. i lL~tic~ t/~t Ihe h~nr~ dis~lse th,qt wtsit ~o~l ~y~ ~;ir, ~n~ T~tisell ~ll~!ifil~ll]y by ])r. Levin ~uld Dr. ]Bll~ley~ ju~ before you, ~lml in a table att~qehed to Dr. Levin's statement, we ~ee ,~ bzvahdo~ n identifvin~ the he'~rt 'l~ the most ~ g fi'an of de~l I~s atlributa e oi, ~- 1 ~ 1 ~ wou d ~% D i~$t r were ~he re~3ll o ~ .~ f ~1~ ~]~1~'. ~)r. ~V.~Kl:llllN We l~llll~¸ *Qen~lor ?~llller~er~ t]~.at when cigarettes ~li~ slYto]~d that tl]~re is ~tll in¢l't~lsell se('r6~Oll of e iJll£*)brllll! ~LIL~ norepinep]u'ine by lhe interior of or tile llle~ulbl ~f file ~([rl!nlll ~l~nd. Thes~ ar~ t~o of the stress hormones of the body. Tl~e~e h:~ve the effect of incr~,~sing tl~e heari rate. incrcledr~ t[lt~b]ood p~l~re in- cre.~iug the ~ork ~f the Iic~11~. 1Phe~e effects are aot clesi~h]e ~n patient wi~h col'ol~rv ~lrrerv di~/se whose h~rt mu~]e bloocl supply i~ illlp~l h~!/|/te~/ise/~f the 1~ r i~J~ve~/~orol~tt ry ~tr[~rie~. .4~ one phv~i('i~ln ll~s pllt it rto dll/~fl/r would l'e/~oiilln~ii~t lh~ an~" phr]lle or llOi'eplnel)hl'nl~. He wotlld [l~wE~l! n/~ ~tll~l:.e his p~tleY*t~ ~o smolce _90 clg~i~te~ • day, Senator HA,~'. Th~Jfl~ vo~ for b~ing patient with tb~ committee¸ Wo apolo~iz~ to y~u and¸to othev~ for the long day. I krlow th~ each one ~ho came he~ ~o ~estify be]ie~es it is important, and, th~T'c ~re, the time ta]ccn. I ~tnl sure, they wiI1 regard as not having bL~en w~ed. Dr. W~lJl~. Thank you very mn~ o~ b~l~]f o~ the Ame~c~n tIe~rt Assoei~tion~ ~m bel~alf of Dr. Katz ~md myself, Seu~tor tIart W0 l'ealize thst you and Senator Neuberger are s(ill here al~o. Senator tI~T. TIle comrnitte~ has scheduled for tomorrow the, • ~ilerican ('a~xcer S(miety, by Dr. Thomas (~arlile, tl/be tretompallied by Dr. ()sear Auerbach. The Tub~ rc fl *sis Ass,~i~li~m, represented b~" ]Dr. Daniel Jenkins: of Ba)lor. ~unl ~lle Na/io~mI Congress of P~zrents and Teachers, whose

156 CIGARETTE LABELING 3AqD ADVERT~S£NG te~imonv will be given bv ~ member of [heir Natlon~] ]'~eglslCtive Committ°e~ Mn~. Thomas I~o~zes. We are sd 0urned to resom~ at 10 o'¢]ock tomorrow morniilg in this room. (Whereupon) at 5 :~5 p.mz, th~ Colml~ittee ad outuled~ to reconvene at 10 a.m., Tuesday~ Murch '2~ 1965.

CIGARETTE LAREL[NG AND ADVERTISING TUESD&y, 3g~L~0OH 23~ 1965 COSII~[Iq'rEE O~- ~)y*~IF 1 LC g~ Wc~M~gton, D.C. The committee nae~ ~t I0 .'20 a.m.. m room 5110, N-c~w Senate ONce Building, the 1ton. ~Varren G. Magmlson, Cl,ait~lal~ of the committee~ presiding. The Ca.~m~-. The ~mmi~tee will come zo order. Our first witness this nmm~ing is art old friend of the Chairman' s~ Dr, Caa']i]e of th~ Mason Clb~ie of Se~ttJe, Yle ~iJl be ~*'eompaaaied by ])r. Oscar Auerbach, a pathologist from New d~rsey, th~ Eas~ Orange V.% He~pital. They .m speakhlg for the Amemean C~neer Soeie~3.,, Iris~cod ~o see lJotb .f you here. Y)r. (~arlile i~ chairlna~ of the tob'acco lind culteer section of the American Cancer Society and a pas~ preMden(. He has been very active over file years hi cancer work m,t only in the clinle~ but the Amer can Cancer Society. We are glad to ha ve you here. ST&TEMENT fi~ DR. TH0~IAS C/LELILE, M.D., S~ATTLE~ WASB~, 0ILRIXl~IAN, CO~3~ITTg21g ON TOBACCO AND ~AlgONR 0F T~E fM'ERICAN CANCER SOCI~TY AND PAST ]?RE$ID~I~/ fi~ THE AM~EICAN CANCER SOCIETY; ACCOET~ BY DR. 0SCAE aU~U~BACH Dr. Carmllm. Thanky.ou,Mr. Chalrnmn. I am Dr. Thomas Carli]e of Seattle~ representhig the 2uneriv0m Cancer Seater "~ and ~ might s.y thus il is a unique privilege f~)r me to be here wit~ the S~natz~r from mF own S,ate and the Senator from the neighhorLng State fTOm the Northwast. i am partleu]arly proud of the ~act th~ the~" are responsible for inlreducfi~g what we m t~he _~*lilerlefiat Cancer SOelet3 coILsl(ler 111(~,[ SI~III~eA~II~ ]eglslatloL that shvuld have a strong imim <i,. mn health if it ~s adopted. I would like {,*~ ~:~l fram my prepared stateraen~. The American Cancer Society is a national vohmtary health agency. with 2 million volunteers~ orgaafized into 59 divisions and composed of 8~000 units throttghout the United States. Since 1948~ the s~ietv ha~ beea dee ly concerned with ~he croblem o~ lung cancer its ~har lnCtUas% an~ the relatim}ship o~ mgaregte smoking to health. Tee have conducted m~5or epMemiologica] studies in this field and have supporled laborato~% clinical, and pathological l~search.

CIGARE~E LABELING AND ADVERTISfl~G In 1980, our board of directors took the position that-- evl¢] enee presented by the many studies roper t~l in recent years Indicates b~yonll reasouab]e doubt that cigarette smol~mg is the major cause ~f tlllttreeed~utett increase m Iung cancer. ~lTe beg~n all intellsi~'e progTam o]" edueathm. ~fimed st two groups: At teenagers who either had not begum to smoke or bad nlg yet I~en finuly gripped by the habit and at phvsicmns ~ho ~e 5elt were the key educational influence on health in th~ United States. Our viewpoint was strongly confirmed by the report of the Advisory (~ommittee to the Surgeon {]eneral on Smoking and Health, issued oll JanualT ll~ 1964, which made the central recommendation to the U.S. Public Health Service that cigaratte srtloklng is a health hszard of sufficient im]~lrtance t~ warrant allpro priute l~13~dlal action Our hoard of directors hailed the Surgeon GeneraEs report as a kandmart: in the history of man's fighL against disease. reaf~rmed its pcultionage all/st prohibiiiou ~f cigat'eta~s and Jointed out timt while the individual must make his o~n d~'isien on smoking-- he mss~ have ,'~mplete and true in~or~atloll ghent the health haznr cls of cigarette smoking. Thls.brhxgs me to the first I)otnt thaL I ~eel is of vital imp0t4a~tee : The evidence that has developed sinc~ 1948 estat~]ishe~ I~eyond reason abl~ doubt the ~act that cigarettes are a threat re our Nation's health. I~owevev, over the years ~ skillful campaign has sought to blur the evidence with a smoky cloud of confusion. Each new piece of re- deareh, each new s,munary of evidence has lx~en attacked with what se~ms the intention of plan~hl doubt of leaving the individual frae J~ to smoke on the grounds that scientists could not a~ree. . The teclmNue has been to use with gI~t pubhc t, elatmns effectave- hess a handful of phvsieian~ who ~tre uot convinced by the evidence against ciga~lt~. Tide is the right of those who disagree. Just as wh ~ould not )rahibi~ elg-atx, ttes, just as we would no~ prohibit ciga- r.S'i(* adverl sug, so we would n( t prohi~blt or inhibit in any way the rights of cigarette Sln~k~'~!e~ to s ~th a~ul organize and lobb . it is important, howe~er, that 't~e public know he fttcflg~ t~t the mblie reMize that the over~vhelmlng b~xl of evidence makes it clear Ihttt henry cigarette s~mking is a most ~Yangerol s persona h~b t M~re Ihatr ~5 reports from 10 countries, here and ahroad~ have warned ~,gg net e ~ette ~lokg. ~ flltelll.ild in~dl •'81 see cries l~ronghout th~ ~-orId have gone on record, pore ]ng to the rtsk o~ e rette smoking. l~a~ thls ~xmntry, the Amevlean Medical A~sociatten, th~'ough its IIouse of Delegates, apln'Ov~xl a statement las~ June deelaring~a~td I quote-- that cigarette smoking is a serious health hazard. V e heard about thin yesterdaj- and there appeared to be some ques- tion about whether they actually had gone on record, Mr. Chairman. They have. and very emphatically, that etg~rette ~amking is a serious heMth hazard. In England and h~ Italy there have be~,n im ~ortuld governmental eontruls ~;f cigarette adverilslng est~b ished. Extens ve govetmmeut-

CIGARETTE LABELING 2aqD ADVERTISING 159 flnance~ programs of educat on the danger o; eiglm~lte smoking are being carried out in England in Swe<lgll, in IZiu~-da, and in the lgetherlands--to nanm n ft'~ of the count rles. ~re fee] ver" ~tronglv that the time for the arglmlellt over the evi- dence is pa.qse~ ~ (ml) t)le qmkesmen fer the tob~l(~:o industry ate in- terested n romping life into this argmnent. Tod~L,], we must take action to warn t Im e agMnst cigarette smoking, I ~m ~peaking m)l em]y for the i~nerie~m Cancer ~odety but as a physician and a nMiMogi~t, chMrman vf the Depflrtmenl, of R~diology of tim Mason, Chine, , m Seattle, Wash. 1 w .s f r ua ~, ~vear'e-'-. ~lmos~ al) ~t ]ma~v smoker. I stop]Dog v, belb In 1 W'~k lit 19~9, [ had to examine th* chest X-rays of two of iny pavtnm% both of wbgm were heavy smokers both of whom had htng { aneer, I~)th of wkom died of their ¢hsc,~se within t~ period of 6 men hs. I ,~l~ stopped bec~ se I haxe dll~ee c4]lld ren. I took up smoking in 1930 when the cuyrtml altitudes and ~dvertls ing • }preaches and tobacco industry posih,ms were being formed. At that time there ~xas no dear evb'kuleue that cigarettes weir" $1ucll I~ serious threi~t to health. But no~ there is that evidence and r,m~ p~r~nts must make the ohmt serious st tmggle thab is ~luired to break a Iv g estab ished habit. I found it very hard to gq~e up cigarette smokb;g but, I could not ~ace my childre~ brad go on s~t tlng them an example that I knew would s~0e~k f~r louder than any words, nor could I appear on a ~]utform wPuming against c~garettes when smokeA them myself. W th m~ today is Dr. (}scar Auerhach semor medical irtve~tlg~tor for tb~ Vehwans Administration II~sp~tal m East Omnga, ~.J., ~uul rofe~sor ~>f pathology a~ New York Medial (.o]lege m New ~c ork ~ity. Dr. Auerbaeh has been conducting a ~asdm+tlng research pro - eet. in cooper ttion with Dr. A. P. Stoat formerly professor of pa~.km ogy of Columbia University College of Physicians and Ut~rgaons; Dr. E. C. Hammond, dir~tor of sl atistica] ~ ~seareh ~ct ion, American (2sneer Societ v, and Mr. L. Garfinkel, chief, fiehl and special ptx~jeots+ statistical res,:~, ,'oh sa.t bin, American (#racer Scaler y. S in¢'t~ hlit~ eltlleel, occIIl~ in the bror~cbial rubes, t h e~ scieniisis hnve be~n ~sngagad ill exten ire studies of changes in tim~ tub(.s, ~s seen 1111 d~r the lnielx~Scope III 1~] R~iOll ~0 ~112 eking hllbi{ 8 Ill 3eople x~bo have died of ]tmg cancer rind various other dlsease~. In this immense study la~ing 8 vea~:+ he and hia a~iat t.~ ]l~tvl~ exmnined some 100 000 slides of bt'atlch~a{ ep~tbelmm frmn 1 o'2~ l~rsons. I]m labot,ttotT finding suplmrt in detal] Ihe findings of epademidogists with wldch you are now familiar. They are an important link in the chain tha~ ~onvict th0 cigarette as a serious tin'eat to heMtb. Tbe degree of hng da,r age fonnd increases greatl:,l with the I~tunb~i of eigaietles *anoked aud sxlvaneing ago. On the other hand, if a person h~s ~topped smok- ing ]mfor~ lm &welops lung cahoot, file body e'radual]y repairs the ¢binla~e Itnd i i Stl a]l~- retun~s to rtormah Mr. Chairmau, I think this is a fact lhat has been lost sight of in Inud~ of tb0 evklence, the importance of the fact tka~ stopping oi smoking ~n lead to re~versible changes xvit hba the lung and within the bronchial tree, and diminish the risk of canver and mine o~ th~ other diseases that we are concerned with.

160 CIGARETTE LABELING AND AD~TERTI~ING In a few ,ninu~t~ I will ask Dr. Auerb~cl~ wiCh your petm±ission, sin~ I,[~ pin, eat some of tins evidence. I would lik~ to speak briefly on ~ few of tl~ iJa]nts that the Araer- lean C~ncer Soclcty has be~n concerned with in its decision that beyond re~son~blt~ cloubt circle#re sm,~l~ing is ~he m~jor causr~ of the increase in lung cancer. I would re fer to two polnts : (1) About 43,000 ger~ms d~e of lung ~ne~.r in the Uinted Steres annually. Note ~h~t was i. 1963. I. 1965 we anti~ipate tb~l~ 47~(XX~ patients will die. When I fia~t, storied t~lklag ~bout this suhjcct it was '27,000 p~ieRts in 1956~ and in 19~1) it, was only 3~5C0. (~ Lung c~ncer is increasing" m(.~ ~q>idly tha~ any other cancer 11 ltl~ body ~lld tll(~ tnq.lre0Eed ]ncl(]~ll/!E~ [lltrfll]5]~ ,h~ e~l[np iorl of cigarettes. Some authorities h~ve wen refelu~e~] to Ihis as an ~pidamic. (3) Prol(mged exposu~'e to c~rtain chemic~l s~bs:t~nces, called c~r- cinogel~ c~u proc[uce cancer of v~rious ~isslle~ in ~x~oer~mer~L~l alll- vials l~n(l i/l man. Such ~ubst~llces are~ l±resent ilt C.lg~lret~ smoke. In fact. ~m(x* r h~.~ hccn produced repea]ed]y b)~• ¢]~ ~tpp]icatinn of t~r condensed ~rom cigare~l~ srrml~c to the skin o~expelurnen~a] anm~a]~. (4) Cig~ret te smoke also cont~i ns ~r~da chemicals l~lown as coear cinog~ns. T.~se' w~ e ~¢ ~ de~g~ n h ns(~ v ~ Jnc~'ol~e th~ ~oot('l/~y of carcmo~i.lll~ gub$ allo~s. Ill Cl~r~t(¢ SII~DI~]II~ Silo i ~O('nrCTlll3~'PJ/~ ~U~" a~ in conjtmctlon with cal'cinogens cnn~ained in cigalmlte ~moke or in o~berwise polluted air that is ia]~a]ed in everyday Hying. (5) The bronchial t,,t~s are equipped with a mechanism which oedin~rily protects them from ro]onged expostlre ~o ~n~tevla] inhaled ~nte ]mlge. Exp~rlmcntal evidence indicates ~bet cigarette smok~ im- pairs ~his proLectlve mel~h anism. (6) Lung cancer can be ,rod~l,~e~ in human beilhO;s by prolonged in. halation o~ at lettst severa 4iffel,~llt substances; s~lc}~ as dust conl~in i~g radioactive materla] ~hrornates or incl~e]. Thlls, it is cl~r that lung ca.ccr is nc¢ purely an hereditary, hormonal, or infecS~us disease. (7) Cevtete progressive changes in the cells of a tissue antedate the appe&rallc~ of h~wsive c~rclnonla. Such pt~)gre~sive changes have been found in inlcroscoplc studies of ~he lining of bronchial ~ubes of c garette.~a°kers as compared, with nonsmok~m. . The <]~J~rex~ oi' such. ch~llge~ lncre~ses with the amount of ¢lgaret~e smol:nrff; but 1~ din,h~ishcs if cigarette smoking is discontinued before the develop- (8 The pl~babi]ity of dawh) )i,,g (~}ncer when exioc~sed to a C~l"ei aogenic agent is roug]~l y proportional h, ~he d~sage~ sllch ~s~ uhe con centratinn of the agent and ~be duration ()f ~x ~osure. Th~ rate of o~x'urrence of brollchogeni~ carcinora~ iRcroas(~ w~lh d~re~ of ex- po~u~ Lo ci~gtarette mnoke as ine~icated bo~h by number of cigarettes smoked per day sad the degree of inhalation of the snloke. 9) Lung ¢~ncer death ratc~ ~re lower in e~ clgare~te smokers than in persons who continue ~o sm~ke ~ig~lrc~tes; ~nd the decre2~e is rough3y proportional to th~ length of l Jrnc since hast s~noking. This closely parallels microscopic fiadings in LII~ linin of the br(~nchia] tubes of the lungs, g

CIGAREI~E LABELING AND ADVERTISING 161 (10) Except for individuals who have had prolonged occupational ex posm'e to cert ~,in carcinogenic dusts, ftl/lle$~ or gases, lung cancer is raise in persons who have never smoked cigarettes. What to do about the whole problem is not an easy question-- for you in the Congress~r for us m the American Cancer Soeaety, . We are deeply cognizant of the major contributions which adverusmg and advertising men have made co the American Cancer ~ociety. After the reorganization of the _Mnerican Cancer Society ia 1945 araong the leaders of the business world who ))lined dm scs'iety and played a decisive part in its emuraordinary gr~wth~ ~ development that I think has contributed to saving many ]lees, wet~e four melg. active or largely ti~ined in advertising, T think of Alber~ D. Lasker~ of Elmer H. Bobst. of James S. Adams, of ]gnlerson Fo6te, from whom we heard yester(tay. The support that, large advertisers and eom- munlcation media have giveAl to tile society ~n our public education and our fmtd-r alsix~ pl~grams has been magnificent, and I hope that nothing that I say will be regarded as critical of advertising as such. It is a great instl~ament for corumunications--because it is so Jacket, so influential so deep in its impac5 we must ask that the cig~u'etie ndustry accept a share of respons b ty for protecting the public's health. Now I have jus~ been reading a bulletin i~ued bv Reynolds & Co., members of the New York Stock ]~xchgnge, whlc (concludes tha~ the stRtistical attractiveness of cigarette stocks considei~dbly outweighs the rl~ka~ After a summary of the various scientific reports indicting cigaa~t t on, the sto3k broker publication say~ It ~hould be borlJe ill mind that flap effoctiv~nes$ of all the above de$~nrls in large part on she publicky value of being opposed to smoking. If pllblie al,~lthy sets in once agaiv, the actions, speeches, mileS, and organizations will tolld tr~ witttPr away. We n~.od hardly looint OUt that apatl~v is a most UMClUltOUa ~rak. Gentlemen. I hope that apathy will not triumph over the very real need of thepeople for warningagainst the risk of cigarette smoking. All of wlfich brings me to the pending legislction: We in the American C~ncer Soemry feel that C~ngr~ional action is as hnper lgr, t as the findings of our scientists. I would like to again congaatu late Senator Warren k~. M agauson~ from ~Vashkagt on, wh~ I]~/~een a leander for maa%v "ears in the fight g~dnst ¢!aneer. He was on(', ~the c~sp~,ns(}rs in 1937 of the .N~ational Cancer Ae~ which led to the -~ational Cancer Institute. Speaking for 5he Ameri can Cancer Sceiety~ in addition to supporting Senator }*iaanusort~s bill we w an, t to record our support for Senator Maurine Neu~erger's bill No. S. 547. If this is enacted ve~3" important ste *s will make it elesr that th~s Congress wishes toIwotec t lhe health of our people: Cigan~t h~ p mk~tgx~ will have prinle~t on them a warning chat habitual smoking uf eigaoe~les is injurious Io he~hh. Our society in its work with leen,~gers has o*~nized many State confereuces of student lead- ers to discuss the question of cigarettes, Again and agaln~ these voungst ors have rMsed the question : If a cigarette is dangerous to my health~ why doesnt the Government require a warning on the package ? We hear this repeatedly.

162 CIOARETTE LABELING AND ADVEIVI'ISfMq3 Thexe are SIl(QI ]VXI31]llgs fin a variety of dllllGl!FOIl~ firodllelS from odine up and do~n the spectrum. There shauld be a warnhig on ei,~arette a~kagas. I ca*mot see how we e~n expect success in our e~oz.s to ~uild sound behlwior putterns on dgal~tle sruoklng amonG the younG unless th~ ConGress takes this step--and demonstrates the G-overnmen~'s reco~fifion of the dan~r of ciFal~ette smoking.~ • hIay I emphasize the fact that we feel in the American Iancer Society that gorerlrrneatal recognition official recogMtion of this problem1 is critically impol~ant ~nd this is one of the things chat htbeling will u (~xmip]ish. *'ow in flm two hills we ilrp discu~inG there is ~me diffl~lme b, tbe addibieual m~terial ~ddclz is to be added on dga~tt~ pad(ages. S. 547 refers to "inerimhzated a~er~t" and sa~'s fl~at the average ~,zeld of each as determined by. the F~eml Trade ~ol~mfission to contribute to the medical hazards of smokinG musl be listed. S. 589 l~rluires a st alemeJl~ of tile trverag~ tiar and nicotine yield. Either of tbe~ provlsmns ~em to m~ excellent. I do w~tn~ to make it clear that for 5 yeI~rs the American Cancer Society has urged that tile tar and nicotine content hi the main sti~am of ~obecco smoke be labeled. Our thinkinG is as follows: ~Tnfer~mialelv there are m,ny people now so strOnGly addicted to cigaa~et te Slnokihg that they find b~ iuttm~il~le to give up the habi~ even though they ea~e~ntly desire to do so. These people wish to smoke the least harmful cigarette available o~ the market, and I think the filter sales Imve veGected this. At the prt~Serlt time there is no ~tisfae~orv waly for Ihe eonsulner to udg~ the role:tire merits of different bran'ds of tigarette.q from the oomt of view of tar m~d ni~x~tine. Xnd tbtwe bar been a change in lh~s situa tlon recently ~ith the development ~f effective t~.~s that b~ve been accepted by the Bureau of Standards as I>ein~ reliable indiet~.lions of tar and n k'otine content However, there is ovid eul!~ from the Cancer Prevenlaon ~tudy of the Aanet~can Caylcer Society, hi which we are followhiG 1,100.000 persons for 6 years the peep e who smoke c G" arctics lo~ in nicotine and t~r content cough less than people who slnoko cigal~ettes idgh hi r/bx~tine nnd tar. A continued CouGh. we ll~l~r~ fourid~ is a danGeel" slgrial rJlot ltlay [tllill~ to ]lUI~ {~IIII(~F. A number of s~ientlsls ~eel thai it is likely /hat h/w hit', ]o~ nlcoliue cig'a~ttesmaybelessseriouslyitarmfifl the o ~e'c G~re es I can see no sound reasen for not requirhi~G cigarettes to give the tar and nicotine ixmlmnt and I see many po.mible advantages. We re- quire lab~linG of content on a great ~tdsty of produets~'why no} on e~ rettes ? ~owever. the label on packages is not enough it is imperafive~ as this bill p~vides~ that every radio and telev sio~ comme "ci~ ~ e~ery a dvet~isement, carry a statement llke this : C allt loll tff~bitIial Gigal,ett ~ ~rn Oking is Injurious to }I~atl []1. This explanatory tag for comcneivia]s is uot ttrdike that reqifired today, on political advertisements wheal hidivldmds are rumfin~,~ fin. public of~ee. 'l'h~l~ is a differ~aee ill the degree of dsuger invcived, ho~,~vel.. [LauGhter. A pmto~tive advertishi label ~ill put the indi~qdua on the Mer~ reminding him ~gaht ~m~ ag~ ~ of the serious tlR~eat to health in

CIGAR$~T~E I-ABELTNG AND ADVERTiSInG 168 cigarette smoking. The warning messaLge will not prolfiblt advel%is- iug of ¢igarettecececececececececesIaS h~s been done in Gre~t ]3ritaln and Italy but it will make dear to all consumers the se~dous risk tha~ they ran in smoking cigarettes. There is no disagreement ~mong sociologists or olker obser~-~rs~ I think that. aclvertisln has been ~ m~jor ~et0r in the growth o~ the cigarette industry an~ that adver[ising has helped convinc~ young reel1 ~nd women Of ~he D]ez~sures of tek~ng lip ('ig~r6tte 8111okiog. On!~q~ ~h~ h~lbit he~ been formed~ ~dvertising c~ntributes milch to its How~ver~ c~mdklly, I do net see that ~n advertisin~ warning wl]l imme~lL~te]y reduce the consumption of cigarettes by tl~u~e who ~moke. Its main v~lu~ like the ]~be] on ~ ~acke4,,e will be ~o ~]er( ~hose w]to ~re no~ cigarette smokel'~ j[~nr~i~tll~rly ~}le I~]l~rs on w]lonl there are so many pre~ures to take u~ clg~rette smoking, ~nd again to give official gavernmenta] recogaitlon of the h~zard of cigarette sa*okiug. N~w, while I h~ve been gratified by the s~eps taken ~lder the, ~ew cigl~rette c~d~ I c~nn~t see how ~nything short of an ~dvertising warningtos~oke~wiI]pro~ideade~u~te ro~ecCionforyowngpeople. It ~s good that pro~e~iou~l alhletes no ~lgcr ~d~ci~isc cigarctte~. The tehac~o, in(~ustrv~ now em~h~siz e~. . lha~ ~ig~tr~,ftc •~moki1~g is ~lT~ adult h~blt--I recognize go~d mtentmns here--but the fac~ remains that young pe~21e s ~n'e~test wish is to become adults, If cigarette smoking is • smgzl of maturit~,~ of adulthood, it will h~ ve ~ stron~ t~[/pe~]. ~,e can help cotm£er~c£ Lh~t a[I ~e~l, I ~hlrl]<~ ]~F onr educo. tional progr.~ms b,~ w~ nc~d also the ~arnh~g tag on adSer~ishlg ~u~d ~igarette packages. IIence may I ~ut mvsel~ firm]y on record as opp~ing th~se *~e~sures that would directly or indirectly prevent the ~!'eder~l Trade Commig~ion from acting to protect the i~u~]ic b~ tbe s. erv]sion of ~dvertising! ~efenders of doing n~hiug ~bo.t ~ig~rctte sm~l;ing s~y s~me~hing like tki~: ~an we ]nterfer~ w~h every habit that causes lmppiness ju~ be~3t%tt~ l]qer~ is 0, remote risk~ IIow ~boul, co~e and ~¢~ ]]~v •bout aI¢ol ol iow ab~ t c~rs. '¸ " H~w a}x~u~ then] indeed ? There is uo s~entific evidence that alco- hol causes ~l~t J }~.~nd disability comparable to ~hat surrounding cig are~es, ~n~ p~rtlcu]ai'lv wheu used m the amounts reoommend~d by the producers and the ~dvcrt~se~. ~Cnd, there ~re rigldl~' enforce~l laws ~galn~ th~ sal~ of 7~quor to ~.oullg~ters. Alc~hol~ ~bu~ed ~s d~ug~rous, but cigarettes smoked even in moder~ti~n~ and actor/ling to recommended amount s~ ~re s~ill d~nge~ous. T]~e c~n ~/rison be~wekn c~rs a~d cigarettes is ~l~e: If ~he ~u~o mobile imlu~i ry tried to per~a~le you to cfriv~ ~ car ~0 miles-~tn-}/our thr~ ghT e~q ~'~ tkeru~h• h~ur ~hepub]i~ wou]driseuI*in l)ro~t. T~/1s is wks,[ wl! lll~ t]~ln~" i1~ ~/dve, z~tlllg ~h~ ln~rease~ cc, n- sumption of cigarettes. Act~0,]]y dr~ving is ~ ]mbir that is survonnded by public warnings against spe~Ming by "S~op" s~gns by cautions-- ~uld wi~l~ the enthusiastic cooperation o~ tl~e in(Iustlw itself. ~iga~ette ~ok big should be surrounded by just as m~ny c~uti~ns. In ~nc]u~ion~ may I say a ~ ord ~bout tile ~riousness o~ the prob]em we face ? The~ is ~ tel/~encv to believe rh~ only a few smokers are • ffe~ed, ~h~t afLer all, this is ~ot ~ m~j~r problem. L~dies and gentle

16~ CIGARETTE LABELING AND ADVERTISING men, don% be mislod. Ciga*~tte smoking is the decisive factor ha the premature death of stone 500 porsons each day: h~m cancer, h'om haart disease arid from other cigarette 1~] atod diseases. The Artier can Pub ic Heath Asso¢ at o1~ has estimated that if ~nokln~ putterns of the sixties continued, a "m Ilion youngsLey~ now alive will die of luLn~ cancer. If we add heart dl~ase and resplxmto*T troubles to c~alcer~ t]m laumber of our children now living threMened by cigarettes is several million mor~. . . . Ia addisiol~ to causing death elgaxette smoking is *~s *onsflde for mass disability from e~lphysemg and chz~n e in,me ~ t, s. T m death rate in the 40 to 69 bracke~l)e~k years as fltr ss o~reer and family responsibility ar~ concerned--tu more thin1 t~fice as high for heavy cigarette smokers as for nonsm okez~. Cigarette smoking is an extremely serious problem, and one which we must ~c~)gniT.~ Mr. ChMrman. I would leave it to your discretion whether Dr. Auerbe~h shmild present his mat~ri~l now, or whether there should be qu~tinns now. The C~IR~t~. I thii~k maybe tbe committee wouht like t(, ask questions- Or would you ilke ~o hear from Dr. A ue~ach ? While we have it {wesh in our minds~ w~ udght ask ou some qu~stions~ at least two or tln~e things~ and tbea go to Dr..~uerhaeh. Going from page 10 backwards, ou say "professional athletes no longer advertise ¢iga~tte~" Is t~act due to t2~e tobacco industry code? Dr. Ca~ILe. Would yoll repe~t tbe qut'~ion ? The C~I~. You s~lv "It is good ~hat prof~sslonal ~thletes n~ ]¢mger udve~ise cigex~ttes-" Is the reason for that due to the tobacco indust code orwh~t? Dr. ~A~LI~S. I t ~ nk it is ~rge y due to the efforts of I r. H~vold Diehl, whom you he*rd y¢steedgy~ who startt<i a per~mM c~rr±p~ign among pro f~ssion athletes to let them see the bnportu~lce of what-- what~ The C..~m~a~. It is ~ vohmt~ry matter ? Dr. C~nm. Yes, sir. The C~ir~rA~. I won't go into this in detail. You discussed the question ~4 putiinng a ~xarning o~ the pa~k. Of course it would no~ be any prc~tive advertising w~t clung unless they shotved the pack in the ad*ertMing. If lhey showed Ihe p~ck in their advcrtisemen ts~ I suppose I hat wohld be a question of how big the type would be. Dr. C,~ m~mr~. It e~uld be very small, couldn:t it ! The C~r.~.~. Nevertbelcss. if ou advertised your ciKaretle on television, or in newspapers and be~ the pack up bin!aunt this is the best affirmative m~t hod of ~dvei~isi.g "Smokc Br~ind A," there would be a. ind i re~:t w~.'n hlg in adver tishag if tbe pa~k ~tas used, would there Dr. C=~ra~LL This is true. Asyoupolnt eut, lfiswer~legiblyseea~. The CHAIlL~IAN. X~eS. You say on pag~ 9 t]mt you are following 1 I00 000 perso~s for 6 years that is the society is doisg this that peo de who smoke cig* attires low in nku)thm ~u(l tar" cough less than people who smoke those ~ith high content. Is the nicotine content of a cigarette out of a given pack~ the same as tim z~st of them in the pack, or s there a

CIGARETTE LABELING ~D ADYERTISING ]~ -ar~a ion in each individual cigarette? I never eotfld ~ u~ic under- staled how they could say that eve1T cigarette cents ns X number-- don't know ]~ow you measure tar or Mcotine, hut whatever the measurement be ~*Vouldn't the clgarett~ thnmse]ve.~ vary~ Dr. CaRL~LL First~ Mr. Ch~irnlan, I claim no competence in this field. It is my understanding that ymJ are cort~t that there is some degree of vari~ttion within lot s aml balche~- But wlt bin an individual package, or on individual c~st~ or ran'Ion of cigarettes1 there wvu]d be a reasonable eonform!tv, depending u~lon the products that went into it. However, if 3- "ou gd from role montll to another within a particular eompany~ I suspectthat you would find differel~.Ce.~. Wbeu tbe "tar derby' was on a lmmber of years ago tbey individu allI did label certain hatche~ and a]intments with their n cot ne ¢ ollte21L. The CKalRX.~N, I suppose it would vary, t¢o~ with the crop, wouhl i~ not? Dr. CAr~U~LE. I U ould sus[0~t so. The (:~,~m~,t~'. So that if this were to be done, it would h~ve to be aol~o a5 the IIl~tItUfRC~/irl/lg ella and they would have to take as you say, ~ hatch or a certain rnn, And that would contain a fairly eonstal~t ratin throug'h all the eigax-ettes tlmt were maria out of that batch. That is robab]y the was" it would have to be done. ~)r*~LILE. /woul~a~sumeso. Itbmsl?eX'uhlt~ing. ~he C~AIR2,IAN. HOW Wollld yolt IIICRSUI~ ttt¢' ~lllll nicotine. Dr. CamuL~. Hm'e agMn I ~m~ in a field outside of my own competency. The CHan~.~x. Maybe I shouldn't ask 2,'ou that. I ~raght pick up a package c.f cigarettes aud say this contain~I don't know how yo. lneasure it--0.100 of tar, and this em~tains 0.110 o~ nicotine. That is fine, but i don't know whether theft isin~ or high or edmt itAs. Idonk know how we are going re do thbe I expect we had better get some experts oit this. Dr. CA~. T1 sulet~ethe erm tarde~by cameln, ltlnfers there is a race to diminish these amouuts. Hopefully~ hlrelligent buyers of ci~u~ettes wmlld compare one with another ,~nd select those th~.t al~ lowest. The C~v~x.a~. You will htu'e to tlavu a breaking tmint of what is the high c~ntent and what is low~ and work ou~ something. I don't know how you are g~ing to measure it, /~ost of th~ witnesses h~we mentinnd eertaln tests in this resist. Is there any one single test or are there several tar and nicotine tests ? Dr. C~n/aral. q his has t~!en a problem, and led to the initiltl /lhg~ll dolllllell~ of the labeling i)f Ith~OtLflg ttrld Tier because severM ),ears ago tile Bui~eau of Standards felt that there was no res]mnsible test that COuld be wusted. In the last several years the Cambridge test that we heard about yestet~lay has been accepted by the Bureau of S~and- ar~s~ ]L is lxty lntdor,~fandingI as being tl~ll~lt~ ancl~ furthemnore~ r~ produmbin so that Ild~ would lurve meaning ~dmn u~d by diffm'anl companies rather Ihan applying a variety of Jests in different 'a'a2,'s. Tile CH.tlR2t~AN. Ill other words there has been a fairly general acceptance, as I ge5 t ~e ten mony~ of t ~e so ca ed Cambridge test. Dr, C~u'~Hn~. This is my unde~'st~nding~ ~ir.

CIGARETTF~ IARELING A~D ADVEI~TISI~G The C+l*m~.x~-. We will go into some of tile t~ults of the tesl that were made h~" DI'. Auer~lch on his research. • You mentioned 25 ~eports ~roli1 10 countries. I suspect that tllc Cahcer Society will have thc~ reports, ~oultl Ihey *lot! Dr. C*~LILE. Yes~ sir; we do. The CHAnC'~. I think tim comndttee wouhl like to have those Fe l,t~, ~. CAm.iui:. We will ~ tkat tho~ are hltrOdllced, The (!HAn~MAS. That iS for dm record. They are quite significant. A ]t~fT~tl' flX~ll] Dr. Diem refemdng to the~ reports follows. The leports ~re prlnta] in ful hi t ~e Append x. ~* ew y c~ k, ~L Y., March 80,1965. The H0[L ~6"AR~m G, ~.|Au~llsox, U.~. ~enate, WasMnglon, D.C. D~ S~m~l~I; X~A~X~0~ : A% Dr rl~lo~as Carlile'~ ~lues~, I nm ~,ndhlg you here~ ith & sel~tion 02 the rel~rts to which he refelTi~l II/ hls t~t [molly before the Commerce Committ~ on the Dlseing of health warnln~ on cigarette track- affe~ and in cigarette adveriisLn~. You t~sk.M L]lat this matetffal be sent to your (~ommi~te~ The rei~)rtfl ]3ere deal with epidem/91ogy, ~Rh labol'atgry aud elhaieal I%~areh, /lith studies of the effe~:t ~ of elgatewe 8mokimg on the cells of the bronchus and n ckl arv ac ion with animal research and with the analysi~ of carcinogens and c(~al~eil~offellS i~ cigar etiea~ ~ht~ ~2 r~DOI'ts ¢oIY~e from the fol]~wil]g 1~ CIAI~i~: Al'gentin~ ~r~nce Ner/~ ~y AuStralia Ger~uauy Polan(t Canada Oreat B~it ain Denm~.k Xalmn Fi~dand Netherlands l'~e~ have boen sel~ted from the very extenslv~ r~eai~h t~at has b~n ~ ond(~ted in man.v @onI~ies We have not ineltlded in this muteris] the re~)rt Lo Lhe Snrg~n General of the Ad~.isory Colllmttgeo Oll ~mokillg anti H~kh nor the RepoI~ o2 ~he l/oyal ('ollege of Physicians on ~mllkbag in relaglon ~o ~llCel' of the llltl~ alxd other diseases, since we asmll~e they are already ~Ja your files, I£ ~e call be of further held vle~e call ~pc.n me. ~ost si~cer ely, IIABOLD ~. DIEI[LI M,D. Secondly~ y~u mentioned, at least you hnplied by your testimony ToYuI that %Ve shou d h ve Fede 'a le~isla o 1~ /t'y h~Lll a lllyriad O~ State reguh~tgry matters in this fiahh Dr. Ck~l,in~:, Yas. The C~AI.~ZA~. Is that your b~t opin{on ! Dr. C*su~m Yes sir. As you know, there is in oar own State leg~s" lation pendimg in the le~lsinture at Ol~-mpi~ that is being defe~Ted to see what will happen. The (]I~Am~AN. ] thi~d~ they a~" i~ndlng in most leg/slatut~s that al~ now meeting. That could be very in~ ractical that a )preach to the thing, and it could ~nd up with possib~ 50 different regulations, or a gi'e~{I number of them. I assume that the society ~ild yourself and others interested feel that it is the better par~ of ~ prae{ieal ap p~nch to this matter to have Fedemd ]egisln~km whioh wouJd be uilifoi.i)l throughout the eOUlltry. Dr. C~u~J~. Yes. I doll~t watlt to get into the problem of States' rights. Nevertheless, rids is a ve~5' practlcal p~int. Artkles of inter-

CIGARETTE LABELIiN-G AND ADVERTISING ]67 st~e commerce should come under it nalional labeling act rather than those of loom origin. The (b A R~ x ] speak pn~eticallv~ leo, that it would be very d,T~ cult because ¢igorettes a*~ made in i few States and they are ~ent Lo every Stat~ in the Union, and they ~m in interstate commerce. A s r bu o. O~ a ~ller of fobIL !c( %~ o iIo, e to open evel'~, l)aeka g6 0r open eveD" calvert to see thM it complied with its partisl]lar law, ~nd this ~oul4 cause u gru~t deal of confusion, too. I)r. CA~LI~. Yes. sir. Tie CE~ m'~a~" The Cancer Society has begun ~n islensive pro gram of education. You mentioned tl~at it is armed first ~tt/~enag~rs w ~o have not begun to sinoke, who have lm~ yet been fitanly gripped by th~ habit, and at physicians. Vghat is the m~ture of lhal program ? What is the out line ()f it ! Dr. (buu.li~. For many years the Cancer ~(mlet ' *Ierked alone el essentially a one n s re z boca tse of our e.rlv reco~fization of the ]mzsrd. ~Vo developed /tlatel'is]s filmsI tel%eher ~_¢uide% ~e worked with tht~ State de ~artments of instruction, we worked with Superin tendent I~runc) ixt lVas ~ ng~on, n seeing that health materials xveT~ avMlable. First, we started rather naively at the high seho(fl bvel, then at, tbe junior high seh(x)] level and now we llr(~ at e]elllent~ry schools. Th~ C~Lem~t ~. Y¢]W do you say nMvely ! Dr. Cxmm,~. We a~sunled thlt the high schoM student ~as the t~rget, that it was then that the yvuu&~,ters started smoking. We foun4 out diiferentlv. ]3 = the fourth and fifth grade ma,y of [heln hi,re started smokiest ~n~ ~re committed. So Time we a~ ~orking at that level now. Vge have dm~wn l/pOll lIlf~iI)' Of 0111" n/eTflb@l'S o~ board o~ ~ir~!bOr~ of ~he Cancer Society in the a£vertising companies to help us design effective Imtter{a]s tlmt will reach these different age levels. In lhe[),I~st %'e'l r, o* two par(icHhtI ]" ~lnee die advent of the Sttr~eon General s report tbere has been a very credlt@le flar~ of cnthusmmll on the part of others to oin us in this educ~tmnM effort. Now in some 30 States in tbe country ~e :u'e ~orkin~ with inter agency eoum:ils so ~hat ~ are correlating these educational efforts, by the Kationa] Tuberculosis Association the Heart Association the State Health dffioal'unent% and odmrs. :~%e are working together so we can he as efficient and economical as possible in developing effecdv~ tools. The CHA ~{)rA~ Isr ~ tre no t~ ~ • Io mnc you do o{ t]lis~ which is a ve<v ]audible thii~g th;~t vo/~ nre never gohaff to reacl~ the ~enL ~umher of people who }~lieve that if there is something harm- ~11 about cigaredte slnoklng1 that ~he Federal Government would fit/ something about it, and untd they do somedfing about it they itrvn t going to believe it is true Dr. Cam.in~. I could not ~ree more. The C~.~m Are /here ~u,y questions~ Senator (ottvn ! Or do you w~n t r*) hear from Dr..~uerb~ch Go rigbt ahead. Dr. Auerbach will ~ive us some of the l~snlts. Senator C(~rrem. I will wait. Senator ~,Io~.ror~. It is hleorporateg in his statement. '].'he O~a~A-~. All right.

168 CIG&REX~7~ LABELIZ~G AND ADVEIUI'ISI~G Dr. Auerbacl~ we wi]l Im lad to hear fl~m you because much of your rese~,rch the resltlts o~ yotlr re~e~,rch I understantl ai~ 11~ corporated beg nning on page 5 of Dr. Car les statemeat. Is tlat correct ! ]Dr. A.rm~cH. Yes, sir. Tho CtZAI~A~. Y0U may proceed, then. Dr. A~}m~ClL Thank you first for the privilege of being alinwod to a pear b~ore your committ~e~ ~enalor. ~ls study was begun in 195~ i~ an almost innocent manner. We bad an individual wh~ had died of lmlg cancer f~llowing a long ex posure 50 ~]l~lne t~e~inll. As we kliow~ rilromate~ t{re substances, chemical substan~ cap~hh~ of producing hmg cancer. At that time ther~ had appear~ in th~ literature two s~lis~,ic~l surveys, epl demlolagic~l surveys~ on~ from Great Britahl bZ Doll and I~ill, and ~]x~ other ~rom the American Cancer ~ocint v by Ilammonc[ and Horn. ]n b~th studies the cigarette smoking was i~np]ic~ted as an important faetorb~th~p~d~ctinr~oflun cancer • . g . . • . We st~ed the~ lhal if cigarette sl/loknlg- is an lmt3ortallt ~aeSor m thB production o~ hm~caucer~ then we should be able to see in indi ~'idaals who die of [tmg c~ncer all o~ the stages which may be ~onsidered as the prellmlnary steps t o the development o~ ]un cancer. Then if rigarette smoking wer~ a f~ctor, we should be able to see th~ sam~ changes in individuals who die of causes other thait lun e~tl~el'~ l~ltd we should see them proportional to the amount cl arettes which they smoke. ~hus ~rom 1954, for a period of 8 years, w~ did thle~ individual surveys, in an attempt. . to answer beth of th¢~ namel~ one. in indi vlduals who die of ltmg cancer (lo we see tile preimam~ry stages leading to th~ de~e]opment of tung cancer ~ld the second hypothesis, is that¸ if smoking is a fac:or ~he~ we should be able to see the same changes in the beonehi~l tubes of me~ who die of o~uses of her than lung cancer, a]ld we should see them prol~or~ion~l ~o the amount of c~ arett~s whinh they smoke. ~uring this pet~od o~ time we had to first find out what was the llormal bronchial lining, the lining of the bronchial tubes, and what were the changes that would be considered as the preliminary stages to tile de~elopnle~t of tlle ll~n e~ncer. ~e also wanted to nmke ~is study as ob ective as possible so that th~ smoking histories were t~ken bF trained obser~ers, and we were given numbers. We did not know what the smoking history was. During this period of timo we found that the normal lining~ as you ~an se% is composed of two rows o~ ceils. On th~ other han~l~ ab norma~ c~lls begin to increase in nmuber vary in siz~ a~d sha e, and eveneually it ends up in this type of development in which al~o~ the li~ling becomes that whlch we see in cancer. Since we wai~ for this to extend into th~ underlying tissue, we cal] this a precancerous lesion, and e~entually the~ do bt~ak througi~ and. they cause ]tm~ cancer. ]D~ring th~ period of time we did these three surveys tbe ~han6es were report~d.~n sheets, the degree, ex~e~lt was recorded ~lualitatlve and ~u0ntltatlve degrees were recorded. We knew notlung of the ~moklag histories. Then Dr. IIammol~d a~d Mr. Garfiltkle had them punched on IB~]~ c~rds. When th~ study was ~ver~ we were thez~ givezl the results.

CIGARETTE I~ABF~LTNC~ ~ ADVERTIS~G 169 Tile results show several interesting and important factors. That the nonsaTtoker ill oUr Series of cases shows n0 evidellce of a pre- cancerous lesion; that this precancerous lesion increnses witit the amount of cigarettes smoked. And so in a chart like th~s ~nl see that the nonsmoker and the occasional smoker shows none, 11 ~li~ht iner*aB~ in the lightmthat is an individual who smokes less ~hnn ~l half pack a day; an ind~vldual who smokes between a half and one shows more; a gre~t rise in the group where the habits are those of :t heavy s n~oker~ on~ pack of ¢ garet e~ a day and stilI heavier ill the wry lleav~ two pa~ks., or m~l~,• and the gre~est z~umlJer in th~ l~hck lille,• whel~ the individual dle~ 0f ]un cancer. AS a result of all o~h~c shJdies ~ ~ dt~w several conclusions. On% that we were able to see all of I]~e prolhnlnaD~ stages to the develop- m~nt of lun cancer in i,,divJd,ml~ who died of lulg cancer. That is~ we saw t~e beg~nnblg stages~ Oll to the early mvasiol~ ~nd ~h~ development of Inn g e~ncer. In th~ second hypothesis i:l individuals who died of e~uses oLher than lung canccr~ we ~oun~ the least number of ehnngt~s m Ihe npn smoker and ~. progressive ~nerease Jn these changes as the smoinng habits of th~se individuals im,re~ed. This orlglnal study was don~ on men and we drew the conclusion at that time that ¢igarett~ snmking today is the single most lmpert ant factor in thep~ roduetinn o~ Iung cancer m men. The other ~etors are the chemical agents which we kn~1 such as chromates and uranium. But rbcy form a very small lninonty. ~ro wer~ a~ked a mmlber ~tf ~leslinns by indi~daals when we pres~nte~l our findings to the medical soc et es~ and on~ of the most lmtlortgP, t--there w~te s~veral-~ne of th~ most iinportan~question8 w~ were asked is, "Is it too fate fo stop smoking? ~Tl~tthappe~s to me when I ~top smoking ~" Other questinas tha* were ~ked doas it make any difference if I switch to a pi ~t Or is i~ better to smoke a pipe or a mg'ar? Are ~here dl ffel~nees be~weml men and wemen ! "W~ answered all of those questions by putting together there wine over 750 cases all of these que~,ions were put together, and ~he slide~ we~ randonfized. Just ~r thi~ morning~ bee~u~se of time: one of the most import~nt~ things that we did s~, and intermingled among them is wlmt happmls re an individual when he gives up the smoking habt. W~ found--and we didn't know at t let me we ',~'ere exam ning tl~e slides w~ found in thase that the nuclei, the e~lls, were dis- integrating" and disappearin~ and their place w~m being ~ken ~ the nolTfl~] cens tha~ w~ st.(. il~ chiJdren~ or w~ s~e ilk nollSlflok~t.s. Here ~u see th~ e~idettc~e nf ~h~ e~mtraetiltg ~ disint egr~ing or di~appear- m nudei. ~¢ f~und in all categories when we eomparedLaud th~s wa~ a matched study in which there were 7~ men~ same ag~, same locality~ s~mc oeeupatmn, matched with individuals who had smoked for at least 10 years and had given u ~ l],e hahit for 5 and tile r~ason ~har this arhitral"y figure of 10 years was taken is that nobody couldtlues- tion the fact that thi~ man had been a habitual smoker~ so that nobody could que~inn th~ fact that he had given up the smoking habit and was an exei~arett,~ smoker 5 years o~ bein~ off cigarettes was con $1der~d ~ being ~ sll~¢ ~I1~ t m~.

I70 CIGARETIIE LABELING 2*~NrD AD~*~RTIS~G In all categories the lease nunlber of changes were folmd in the nonsmoker. Aprecipiwus drop in all of the changes when the man had given up the habit~ a~td the largest number of changes were present¸ in individuals who had continued to smoke. Two of the dramatic changes were in the presence of these pre- cancerous e ells~ a drop of ~oraewhere. in the vicinity, of. 40 time~ wh~t he wou d have had if he had contzrtued with sm~kmg~ and also pre~ii)itous drop in the number of precancerous lesio~qs` When this study was over, and we were looking for other fields, sln~e there was ~ greaL deal of discusston~ we started to study the hng~ the effect of smoking on tile lungs. We did • preliminary ~tudy the routine examin~tlon of mievoscople slides ~nd we had" a~ this time over 1.800 cases where we had four lobes of The lun g~--there are five. usually--represented. We fom~d these four importarlt changes. There were scarring of the lungs: secondly a rupture artd a tearing of the Mveoll dentis so that the sacs became enlarged. We found also a thieke~dng ot the small blood veeeels, and ~ thickening <ff Lhc 1 a rge bhmd v¢~k~ds, ltet% to% we dichllt know the smoking h~stories. Ahd we found that in all smoking categories in all four times~ that the nonsmoker had the least number of changes: the llgbe mere; the moderate mm'~; the hear still more; and the very heaK~ the greatesfl nttrnber. ~v~at is of interest is time we began now ~t blrg[~r study in which w~ examined tile whole lullg. Of interest is Omi if you ~ake a non smoker--and you can tell. a nonsmoker immediatelv trom a hew smoker--you see tha~ m the nonsmoker~ on my , eft, the lung" Is normal: there is no scat~ing there is no evidence o~ tearing of the alveolus sacs. This is tile hug of an individual who sn~obed heavily for many years. T]ds is a lur~g crippled. This is a tna~ who needs an ox5~en tent withwhlch tohreathe. So that you wont think this is an infrequent ocznrrenee~ P have only taken some of them~ the study is still in progee~s. Y~ ou se~ here the heavv smoker on the ]eft and t e other on the right.. The ~'~udy is still in pro~gress. We have somewhere in the. vmmtty of close to 40g e:~s~s. ~ will not complete the s~ud~ unnl we have at least 1,500 esses so tila~ we mm ~t all of th~ smoking categories. We will be able to see what happens to individuals after they have given alp the smokizh~ habit~ and we will be able to test the cigar" and pipe smoking. The C~ ~n~m~. What is tlmt last statelue~t ! Dr. A~m~acm "6rhen th% smoh~ cig~r~ and pipes we will know what happens to those iadividual~ The CdA~a~*~-. You don't knmw yet ? Dr. Av~.s4cm Ye~ we do. We know fl~m the p~¢liminary stud- ies that pipe smoking-- Dr. C.~L*L~, I don~t think he wants to hear. [Laughter.] Dr. Av~sm~c[~. Pipe smoking, if one has to s~uok~ I ~hink we fonnd tha~ ~e se~ th~ least, nllmlmr of changes in the pipe smoker. I aln vezT ha~xpt~pv to see some of the Senators smoking a pipe. The Cg*m~A~r. ~'nat ~bout cigar smoking ? Dr. Av~rm.~cm Cigar smoking a little bit more than pipe. But no- where near as dangerous to the bronchial epitbelhim, that is, the

CIGARETTE LABELING AND ADVERTISING 171 hronehi~[ tubes, or nowhec~ neur as dl/ngetx)lls tx) the hmg as is eig~ rette snioklng. Senator COT]X)N, T]mt is because cigar and pipe smokers do not inhale, is it? Dr. XVER~XCH. Senator, I don't know what it is. Mine is merely based on tile examination of human materia]~ and what it actually is I am notrp rep~red to say. TII~ C14AIR~Ak%r, ~lTon -wD1]ld have3 ~o inhaZe~ ~ s(ip]~)os% (c~ get ]lie smoke down into the lungs. Dr. AUEI~AC~, ye~. The CJ~an~1A~. If Ille sm~ddng never got to the lungs you e~uldn't ha~c~ :tny stleh m~sults as {hi~. BEll 1 suppose that maybe you will )mbablv find I dent l~o~ I am a layman--that an cigar or pipe smoker,~tber~ is a certain alnount that is apt to go in. ~ut it wouldn:t be inlmhaiou, it ~ouldl'uSt be down there becam~ i~ drifts down. That would be a ~,eI5, small amount. What ~bont che~ ing tobacco ! Dr. Aw~mtc~. ]'here ~eren'~ enough individuals theft ~e e~)uld st udy and get ~alid I e:>u]is. The C~.~m~.u~-. There weren't enough tobacco chewem. I~F. AUI*~RBAC][. Ther~ wel~ SoIlleI bnt they were also cigar ~mokers and they were not included ia cLe s~tudi~s be(ause this w(mhl then the question would be raised, is it the ei~r smoker or is it the chewing 0 f Iohae~,~. So [he~e ~ ere ex(~] u¢led. The Cn~u:a.~. Cigar smokers are ast~,dly chewers of tobacco Dr. Av~B.~C~. ¥e% sir. baught~r.] The CH~Ir~f~.z~. Thez'e, is a fine 1 lle their> Dr Auxin*Acre I would like to add one t]dn~g from the. p<olnt of ~ie~ of ~hat ~e see. ~*Ve heHe~ that this. the problem of emphysema, is much move dangerous ~or several reasons. The indi~ddua] who develo[)~s lung cancer is dead very fl~,~ently within a period of a year after the onset of the s)'mptoms, l'his poor mdividaul lives for m ~ny years, as hls diflicultieh o~b~eathin g inere~. When he reaehe~ the stage cf n hmg cripple he can only liw with the pre~sence of oxy- g~/n anll lhl~s for'l~ Iongp~z'i¢)d of time. . . The C]~,~ra~,~t¢, Dr. C~rlile has come to several conclusions I~m ning oa page 5 of his statement Purfl of thc~ conclusions fit into you{ conchsions ~rom this research, do they nvf? Dr. AV~BXOH. Yes sit'. The CHATR)[AN. ~[~tiS l$ ~Vllll~ yell ~11~ expl~il~ing to US~ how you arrive~I hcth of yen. ~lt thes~ conclusions which are listed h~re ell pa~:es5and6ofDr. Car esstatement, stlatcon'ect r , Dr..~U~RBACH. ~ e~ ~lr. Dr. CARLZLE. That is right. The C~Am~a.~. Senator Cotton ! Senator CO~Tr)~. Pulsating the ei~i ~par and p{ e matter not just be cause I :un a dpe smoker there aredetrimer±ta] effects from all kin~l~ O~ sfflok ng 17~ t /e ~ 1 ro~*~t, ~lt'e ther~ not Dr. _~IT¢~RBACH. ~ es sir. Senator Co'm'o~, So t mt ~tll kinds of smokers could be creating a good, ~a~ or.ble (:llmale for ~hroat cancer, rlght ~

172 CI(]ARI~TTE L~ELL~T(~ ~D $~DVERTLSI~(~ Dr. AUF~ACH. Yes. There is a definite re]atioushi]3 betweea smok- tog and the larynx~ the esophagus, aad the mouth. ~re completed a study on the esophagus. We fouad a l~lationship between smoking and chang~ in the esophagus, not as dramatic, net as oxteusiveI and probably tile l~eason, w6 feel th6 reason is, is that the lining of the esopha~gu, s i~ much thicker than is that of the bronchus. '13ae bronchus lias only two rows of cells where~s the linkig of tile cso1)]lagus: the lining of the mouth, is a thick layer. And it isn't as omily 1)t~letrable as ~lr6 tho bronchial tubes. SDI/~I~I)y C[)T'i~)N. As I] yOHH~ HD£11 I sn/I)~ed tiers Go]lstan~lyI alld I was constandy told by nlv grandfatker~ who Was a clergyman~ I was c~nsfnntly ~eminde~ that Genera Grant died of ~hroat cancer because h6 was such a constant cigar smoker. I dokit suppose you ever treate¢l General Grant. Dr. AL~aP~CH. NO, sir. [I~ughter.] Senator C'cn~o~-. Is ~hot just a le¢zend Dr. A~R~xcrr. No, sir, it is not a legend. There are cases of lung cancer in individuals who smoked cigars only. There are cases of carcinoma of the laL~qx: carcinoma of the tengllle~ and carcinoma of the membra~les of the mouth related to cigars. ~4ut hy far the overall important agent is the eigat~et t e. The CH.tmMA:¢. Could I ask one question ~ Has nny,me found any t'clation hetwcgu slnol¢i[l~ I£tll] couslant silnJS trotlble because ~lnok6 zets up there? Or. A~BACH. Whether there is that relationship? We haven't axamlned the sinuses, so I ha~'e no atlatem~c.~ The CHAmPiON. Smoke 3[ suppose gets up tbaI~. It is an irritation, I would suspect,is it not ? Dr. Cubist. 3[ would like to comment. I think there has been, in a general w~y evidertce of tkis ,mtnre and it is not unc~m!~lon for physicians to advi~ 1)ntients with sltms (t'oubl~ to stop smoking ia the ho )e that that will relieve it. Bu~ I would l~l~e to ~,eemphasize what Dr. Augrb.'wh has ~ d. A thong ~ we are fu y aware of the in- craased incidence of cancer in many other areas related to cigars and pipes, we feel statistically it is not as importaut as the cigar, otto. This one big factor of ventilation we have to come back to agsin, is t.he prinmrv factor which produces the changes as Dr. Auerbach shows ~md it does not hal)pen a~ often w~th cigars and pli)es. So:tutor C(a'ros. Generally s1)ealSng it is the dry,wing of the smoke int~) the hmgs which cigarette smokers do and pipe and cigar smokers donot that makes the big difference ? Dr. CARL~. Yes, s r. Senater Co.¢'~ ~-. I anl not asking this question as ind i,~'~li!lg defense of smoking~ hut there are ~,r,e ndvantag~s in smoking~ I d~scovered. I stopped smoking some ysa~-s ~go and didn¥ smoke anything for 5 vear~. During that 5 ~,ears I gained between 30 and 40 pounds. I found that wheu I dldn~t smoke I was hungry all the time. When I reached the time, which ha~ existed now for ~nany years, that I have to di~t more or less consistently, to hold my ".wright within reason~ I purposely, resumed, my. pipe smo]dng bezause it made ~t sx) much e~t~l~g tO 1Y~ f l~ln h~m overeat,rag.

t, . • • . . t]mle are, are there not--lt is not )'our spe~lalt~ there are a large nunlber of people whose lives are shot taned from overeating as well as overweight~ as well as those whose lives are shortened from smoking. Is that a reasonabl~ assumptiou ! Dr, CaRLyLe. YeS, sir, that is a reasonable s~ate*nent, ft, is a prob Iem, and you can t deny it {hat m~m~ people including nlvs(df, have beeI~ faced with the pl:ehlem of zn i{lcrease in wei ht ~hen you stop smoking. I thDdc tlm~ it z'oflect~ partleul~rly oa ~ ~oxlc n~tare of tobacco thmlgh in keeplag one's weight down. We h~ve to acex~pt this asa systemic effect of toha~x~ when ~t hap pens to appe~Lr in the appetite inetaboli~m of food. This is ~ problem I h~ve Be nns~er for. The CI~.Xr~MA~. Food tastes be~er edmn you don't smoke, gout" tast~ buds ~re sha ened. Dr. AU~RP, aOH .r~es, sir. The Cm~m'~Am Yon go ~ those gourmet dinners and they don'l n,ant you to srnok~. I h~ve known ~iple to quit smok~ and they say f~d tastes so much better, that there is a more distlnelne~s of taste, and ~lte~forg tlmy eat lnol~. I done know if cha~ is tke re.'mon. Dr. Ca~raL~:. Tlmt is one of the reasons. '£het~ is a substitute fvr nibbling when you don't have tJae eig~rett a habit. Senator Cc,rro~-. I found th~ by ~esnming pipe smokh~g t/~t P didn'g have that cm~stant desin~ hetween meals to eat a chocolate bar or some pe~nuts, this NIIS[~lI~ hunger. I don~t ad~oeltte Snlohing for tl~t~ reason. I. my c~tse I took it up deliberately after I had com- ply(ely b~,ken ~lle habit because I found I could not control m2~ weicdt~ and did ~mt have enough will power perhaps mfles~s I dulled the e~ of my appetite: and quk nihhling by smoking. Ilowever, I waslx't trying t,o get in r~ pl for the smokers. One reasott I became ~ pipe smoker walsU~[ tat when I was in eoll~ge ther¢ ~'as a peri~l, it must lmre been temporary, when we (xdlege students thoughg a sig~l of maturky ;gas to smoke a pipe. A cigarette, , wa~ supposed, to be a young man's lmb~t tht~t if yon. were i, ally *wse and pentlfical and ~c m~ture erson you smoked a p~pe. Some of us forced .ourseh,eg even thong~ we got pipe sick several tllnes, to be eolrte p] p~ $mokei*a~ J[sn ~t rh ttre a chalice to weall ~]le A~lllerl~ gn gouLh if they muse smoh% on to some other form of smoking by that ldnd of psyeholegy ? Dr. (JaaL~. This is partially tI~ae, d think fhe~e is el* element of sophxst~eation, passShlv~ ~bouv pie smoking by yo~ang college boys, The Csar~*Ax. It i; • mess}, hn~it, though. [Laughter.] Dr. C:~ULX. The inteIesLing comment that we run into Senatm" Cotton, is tl ~ r de t~d friends wlth whom we work in the Cancer .S°e~etv' n~k. u~. nor t en.p asize IP~i es and cigars fieeanse the~- see the creased mmdenct~ of hp aild mouth and t~ngue elmer assrs31ated with plpe. smokin g. . There lS ,a inn]or difference between thc.~o forms of cancer in the op~nions of many of us. In the first plne~ t~my ,~v ,ec~ib/e and relatively easily diagnosible. Secoudlv they r~'~ more curable tha~ hmg cancer, fthink in tins human exisfenct:of ours we are constantly making a choice of evils n.yway, rind tidal pipe smoking and cigar smoking ~1 o/tld be better dlan cigarette smoking.

174 CIGARETTE LABELING A~q) ADVEBTISING

CIGARETTE LABELING .~-D AD~,T~RTI~ING 17~ ~,oung people, and theTefore t*e ]lave not carried any request beyoml hat point. , . Setm or' CtlTrox. This ]s not an entermff wedge. You do not at present contemplate aski~lg f~t' flint sort of thing in eonneellon wlth cigars and pipes~ Dr. (LtrntLE. I have heard no suggestion that this be included in any proof ~l~ Senator COTrO~,. Would you also feel that.perlmps it: ~ould be a g ! g o o e,x end it to e~g;u~ and pipes because if as you • se ne of yo ~ phrased it. if a person lrlus~ sm~ke, you would boiKt Ih~V Ilolx~d smoke ei~,~ll'~ or pipes r~tflter tbalb idgarottes, SO tlta~ lher~ is a eerraln advantage m not pushing too [}tl" Ioward the pipe and c.igl, r field ! Is that correct ? Dr. C.XmaLE. ¥es~ sir, i wouldlft ptlt it hi the n~ture of ,32 beer, butwearege ngcos~totbat possibl~. Senator Coau~Jx. Of eourse t,]le gt e~lt drawback and tllere ia not}lin~2" v of s ~ do .l~.ll it, is that a warning primed on a p~tckage of ci~lt'ell~s mttv be quite noticeable for a ~itne~ but there enmes a time lbenpeoI e e se obee n~(ousofit iustasthesign~ibelieve over every gasoline staLion indieabelg ]l.ow nmch you pay per gallon is Feden~l t.x or is S~ate tax. We drwe do ~ n and 5].l up om gas tanks, the Amer can peep r do~ and I doltt beheve one m a hundred e~e o ces o ' p ys n nv aitentioll re it, or is reminded of the fact ~hat be i5 paying a certain propmtbm of what he pays for t~ gallon of gasoli~le in f edei'al and State taxe~. There is dmg~r that that 9atae thing would [ske pbll~ with a sig,'ll on a pack ge of eigare~t es is Ilmr~ not ! Dr C~I~L~ Ye~,sir'Itlfit~kso. tit nk ewouds011ae co lish an exc~lingl~ u~eful purpose. I etm picture the situation wbm~ a parent can show tlfi~ label to a youngster who is beginning to think of smoking and where ttK~ehers elm use this. "iVe b~ America ih~ce a grea~ tletul of faith iu the stand of om Gover21n/edlt. '111~ fact t lat T lgt~ is of~eial (}OVel~lllleltt l~c~gnltlOlL re ~eated agair~ and again and aguish, is critieMly brtpoi~ant ~'e~ haler (h~ t'ro~. It would seem re 1110 that because of thaG however, e m~ er of dealhlg wi~h advertising--]" sit ~nd look at telexdsion, and it seems to me that I SL~ii and w t~ti cigarette advertising llntil b t saturazed x~iih ~t and wish tllat it ~ere at legist briefer. " ~rdL it ~ullv as impog[anL to do somethiitg about the advertisdx~g as it 5s t Im label on the package f -o e s~andpolnt of trying to stem I)[" I!Oll ['[)] lie habit, Dr. CagLIL~, ~re think it is sir. _ks Emerson Frmte stated rester d v, tere S ~lle opiIlio~1 ill l[l~ ll~lin~ O~ IIl~/llvl l/tfll)) people that the present sales of cigarettes are dependel/~ lnl:gely upon the extreme effectiveness of advertising CKIllpalgTff,. [~ OIq~ (N~lllll illtlIoduee ~ 8it uat loll izl which tbere ]lad to be a c~u~iol/ upon advertising, it alight temper the advertising ~tnd it might even tend to cllm hiisb ~t to some extent. ~ell~.~ol (~O'I~fON. dust one more question, nnd 1 w~m't fab e any rllore of your ~ime. l~ast vettr, I think I read in the lter~ler's Digest a col~- deu~ed ver~icm o1" an'artkrle which appeared in seine ot laer puta]ieat iozl, tbI, L gave a llst of rn ~e,~ of cigarettes, and gave, i don~t think i~ ~ent

176 CmA~TT~ LABELING A~N~D ADVERTISING lute tar% but ~mlt into ti~e nicotine conteIlt--gave the l~wccntage in ear, h one, AI~ you familiar with that ? Dr. CA~ISL~:. I ~nemher it. iqot in derail But I remember it. Senator CoTrox. Was il authentic ? Was it accurate, do you kllo~ ? ]~l~ (~ARL1LI~, .~.S ~ re4~allI this wtlB a ffonstl~fflersI report~ Or consumers~ research or consumers' dlge~t i-~l)Or~ ane] I Rill speakuig from memory and not ~vi~h total accuracy in wMch an h~Sependent hboratorv ha~l done thes~ studie% rather tharl lhe ¢obacA:0 eo,lp~nles or ~nyone e[se~ llnd there were recoliall/endatlOll$ L~ised upoll [lllf~[~i, (iF ~sslllYifl~ Th~ flgeI~s wez~ reliable, wllich one~ had the lo~e~t n ~,~ nc lutd tlu' cm/teut. Senator Co~on. Thank you~ Mr. Chairman. The C~I~A~-. I ]lope ~e will get some tes~hnonv on that because I think it is going ~o be difficult. It will haw very little effec~ to put it on the page that wit*is contains 0.8 milligiums of ~mething and 0.t0 milligrams of something" if you don~t kno~ whether Llm~ is tot) much or too little. "x'ou have to have some comparimm to In~,ke. It could be almost fatal but how would I know whether it w~ a low percentage or a hi h gercenta ? (g)f course [~em cigarette advertising will take on tht~t my cigarette has lower conten~s fban yom~. Thence is no line as to wl~ich ~s had. All of thezn may be had but o.e is lower thart the other. 1 think that ]s geh~ to be a teH,nicui problem that we will have to wor~ OUL Dr. Auerbaeh, I ~sk tkis question, whlcb is not quite per:ine±~t to this, bu~ I h.ppon to have the resJ~OnsiMlity up here o1" handling the Veterans Admlnlstr~tion alYprroprmtions for the hospitals. Are these tests being conducted in tbeVA hospitals ? Dr. A~c~. These tests axe being conducted in a labo~'~tox)., in the VA hospital in East Orang% N.J. ] would like to make it olear~ Se~mtor, that i h~ve reported these as an h~dividus I~ with the Ve/eraus AdministraLion giving me complete academic ~reedom. The C:~r.~*~. I wan~ to commend you on the use of the % etera Is K ~tals becausa I think ~h~v fu~ish Lhe greatest laboratory pot en~l ~er°St~is sort of thing and for" cancer as a whole t]mn any place in the world. ~re hi,re been tr dng to encourage the research~ ~ you know. I have quite a diffieu{t t~me with VA research. Every- year we have added a li~rle to it~ a l~trle m~re than ~he budg~. And lo ¢n4 l~h~/d every year they eom~ bac~ and SOme of the great ac~)mplishmen~s in VA research has been because they haw had this litrle bit of extra m~eYTB, for example. X want to say to t!le conllnittee fhat the startling thing is ~h~t ~vexy oth~r bed i~ %he ~ A hospi( ~Is today is nmntal case. Ev~[~ other hed. I want. to comphraent geu on using this re'dole tha~ can be used for all ~dnds of d~seases of mankmd~ ~au~e we hcep constant records. ~Vo }lave them the*~, I compliment you for using the VA bc~pltaffs ft~r this put'pose. Senator ~*eub~rger ~

CIGAREI'rB LABELII~G AND ADVERTISTNG ]77 Senator N~t~Elm~. Thank you, Mr. Chainnan. I testified lest year in the House side on this same sub oct, and 1 listened with intei~ to other witnessee. Ob ectin~ to the leglslation that I had irttl~)duced and supported was Dr. M1 ton Rosenb at. I woud like to recall to 3,0 u what he said at that time and it is in the record, because it pertains particularly, I)r. &uerbach, to your findings. Quoting h'om Dr. Rosenblat, who represented the viewpoint more of the hldustry thalt of my viewpoint : in hl] flt~Itll)I tO snbstailtIate ~he statistical ¢.orrelatlons. tile report of ~he ~td i ig(u.y i~)nmlit ~ec h~s acceptr~ the result s of certain ]~a t holOgiea[ ~tndics pur- porting to show tile deleterious e~eet of smoking on the lining of the bronchial tubes. The pathological ellangg4$ described in these studies have been observed in all type~ of pulmonary brOnchial changes attributed to smoking, are non- sl)~] fl(% }l/l(l their relaLi~n to lung cancer is highly sI~etdative. There are ccrLahL patholOgical changes in tile oeri~*heral parts of the lung that have been u~c~[atet! wilh Lung eanc.~r, but these were not founct in the stu[lies m~ntioncd in the report. The freq ue~t oceurzence of localize4 areos of eanoer in ¢hc bronehii ~f smokers in the studieu cited is nullified by the results of 11 uther 8tudie~ which showed tha~ localized bronchial cancer is a rarity, except in Datient~ "~:qo netually have cancer of the lung. Cany'ou comment en that ? • Dr. AUERnACE. Senator N eul~rger let m¢ firsL say that the Surgeon GeaeraPs Advi~)ry Couuniliee had two famou~ pathoIobu~ists~ Dr. Fu~¢h at the College (d Physicians and Surgeons, and Dr.Emanuel Father, professor of pathology at the University of Pittsburgh. Dr. Stout and I *~ere asked to appear before this Commi~tee~ al~d we spent 3 horn's in showin ~hem our microscopic slides. Subseqnen y ~[~2 Farber came to our laboratory ~uld ~xammed all of these slides individually So the bm~is of his rep~)rt was ~ot taken from the Hterature, or what we had published, bl]~ rather from first- h and knmwledge. Secondly, fl~e~ ~sn't anvthlng in the literature vhat has appeared sin~x~ our publlcndon which has done cmy~hinng but confirm our srudles. So we st arted out with two hypotheses. ~i'~e knew nothiz~g about tbe smoking hist ories or from wha£ cases they came. These a~'e *he results So ~hat we feeI tbat based on scientific evaiuation the~e at~ our renult s. Anybody may say I don't believe, but wc wo~dd lik~, Senator ~-en- lncrgrl~r~ for some seien~ifia cvi(]en(:~ d()ne ~ n ~ colnp~l~able nlanner which willsho~ lh~l ~mr ~e~b s aI~ ~ t~mg. Sinc~ thelh in ~he literah~re~ the reports have verified o~r results, and not contradicted them. Senator ~nu~guo~m Thank you. We would like to have those for thecommittee. Dr. Av~mnao~. i would be very happy ¢o. ( The re follow e opi~ of dm l~eports referred to. ) Eaa$ Orange, ~'.J., A~r<l 2, 1985. 6*bairn}an, t~noI¢ Comnwrt~ Co~gtlt~ittee. U.~. Senate, Washi~gt~ D,O. D~a~ ~E:~a~os Mn~r~vso~r : Enclosed is the materl&l I was asked to send yon Thank you again for the privilege of appearing before your eommiztee. ~iLeerely. Senior Medical l~e~t~galor.

CIGARETTE L~BELI~G A~D ADVERTISING Duration of Bronchial Squsmous Metaplasla Produced in Dogs by Cigarette Smoke Coflden~te t 2 DALE L. lIPTON, M,D.," ~,~ T. 11MOTHY CROCKER, und Jl~ t~e~att~ of M~i(ine. IJnl,erslty of C~li~nlcr SU MMARy---~ig~rct~ ~mok* ¢Qndenlat % O.O5 to 0~1 ml, we. a~lPcd o. of 3 da~,,i, 5, Q, 11,14, a~d 18 w~t~ after ~ Ja~, tar application Ti.~, bl~ek~ w~¢ I~kcm ffc~m tbw t~ down to rh~ lobar brc~nd~i ~n ~. un- bmk®n s®rie0 eo I~lt Ikll ~tlr¢ ar~ ~:o~ld be scanned hi~c, lo ~i~al~y. AI 3 dcs~l, *~ u=m ¢)u~ ractap~io ~iende~ ~om I~® t~r~inal trachea Into th*¢ It~t malr~t m/~¢onel~us wll~ som~ iplea,~ ~ t~ right sld~. By ~ week~, t~¢ squamc~us m~l~la~ia ~a¢~ dlc~ined a~ Ih~ maic, r ab~r~nality, a.d ~ ~;ansi- I~nal lyp~ ~t e~,;ik~l~u ~ ~as most prami~ent At 9 w~ks nnal, tl~,~ I;o~al, and ~y~pl~t;~ cp~l;um ~c~urred i~ ~q~ol fie~n©y. I'fy~ pl~d~ p~domin,~t ~'d at 11 ~ek~, t~o~h th~ Iranslt;onol ~lat~ p~n;~ted in alt~m ating ~th nodal epi~li~cm. By 18 wceJ~s es~entiolJy all eplt~e[i~ m W~ nc~rn~l, l[kase rlsull~ ¢~®m~n:l~lt~ IIt~t square,us mcta~a~ia ~an be indwcd rol~idly in dog: by ~a~,;le sraokt eo~d~t~le. R ~,¢~r~] ~,c~u~ed in g I¢~lvcnc¢ e~ dbn~l ep~thellal ~ta~ oF d;Ifec~nt;~t;on w£;©h, ~c~g~ ~'ogr ~J~ly morn ~acza~l, d~d nol r~a~ ~rmal ~nlil s~wra] divisions ~[ ~ml ©ll~ wcr~ p,~ ~ ~Q h~® ac©u~reJ. The ~uly~tlo~ Is mad~ ~ ~ If~e I~r ~r~ indicates ~t ~m ¢®~1~ were ~ nl~tre~ ¢~¢ to pe~d~ce ¢~a~r ¢ell~ wl~ic:k ,~il ~,d to diff~entLat~ norrnally,~ Nal Cance¢ ~n,¢; )3: 4~ 7-495, , ~d M~h 1~. 1964¸

CICARETTE LABELING AND ADVERTI~G 179 SQL AMOUS M F~FA P~S [A m a pachoJo~c ph~ n~r~coom w~¢vcr it ~ found in thc ~¢hc~ br*nch Jal tree, I¢ ~&~ ~f ~ ep~e~mo~ ~,~ Iomat i0n ~ the ~rmat pscu~u~w~L~d ¢~[u,~ ~thcllum ~nl~inia~ c,l~e ~d ~o~e~ ce~ accompany ~qua~ao~ mc,~pla~ia and ~Fear to ,,b~nd,, i~ it, but t~ ~q~,m~ ~t,,te ~ gco~aIly ~cknowIc~cd ~ ~e n,~ ~ dc~atmn fr*m Sq~an~ ~et~pta~m in man ~ m~t ~Ul~,,~nly h~v~ ~i~a~t~ ~rcokers~ Th~r~ ~s a d[~ct ~d~ tlo~hip bct,*cc~ th~ ex~en~ of ~quamou~ met~ pla~a a~d the ~mm,nt ~ du~a~ior, of c~g~r~tt~ 'l~r~ ~s d~bat~ ~ to wh~th~, ~,,~mm~ mesa me~apl~ a~d cp~d~ carci,~m~ ur ~ re~ tb~ ~spJraLory tract h~s ~n p~ ~r~a~ {1, 2, 8, I0) ~d~rmu~d ¢~rc~l~s ba~ beer, found in ~r~ of r~ark¢,~ tact ap~i~ (/~ t~}~ ~r.d c~ ~ave ~q~irm~ ,~t apl~sia to ~pid~r me~d car~i~om~ (~ ~ F~t~r ev~e o[ th~ ~a~at~n is pre. ~f ~q~ou~ metap~ia, carolina m ~#~, and mva~e cp~dcrm~d ca~iuoma by th~ tc~,~q~ of topical ap~ka~er~ of ci~r ~t c ~mckc ~dcn~ ~ar~c~ ,:,~p]~i~ may ~ ~r~u~d ~. p~iment ~ly by various [rr~ta~, m~,~y o~ which p]~si~ m~y ~c a ~mR~ i~ th~ d~v~lopmem ol ~eop]~cm of the n-~p~ato~ ~a~t, h may a]~

180 CIG~ETTE LABELI-N~G AND ADVERTISL~G

CIGARETTE LABELING AN]) ADVERTISFNG I~] o~ a~l~!~ca~o~ ~ ih, i,r I~ 21>) H~r,,rF,~,~ tr~n~i~i,,T~l mctap~1

182 CIGARETTE LABELING AND AD~TRTISING T~X~ 2 D~,a~ &aw~ ot ~achcob~anch~ ~ i.61~ z~ thchal ap~¢~ ~te ~e4 m d~ ~lt~d ~ 4 w~ek. a~er ra. ~ ~t ~#~

C~GA]~ETTE LABE~IKG AIND ADVERT]~3ING 18~

CIGARETTB I~I~ELING AW~ A~VE~TI~L~To n~cz~ ~fth¢ n~t ~ia,Lt c¢:1Lypc I~v a [~ d~v[~m on~ and ~,~Jty rcpl~cm~m b~ nornl~[ ~,,]~,,~,r ~[]s 1[ ~ath ~L~]' in Ehi~ Eequence required ihe ~a~er then defecfi~ d~ugh~er cc~ wer~ bclag ~e.x~.cL~ d~ri~ one or n~rc drwsion~ ~( basal c~]~s o~cnrring ~f~er ¢~ss~t~on ~t t~ ~pp]ic~tlo~ alteration su~clcm 1o pcod~cc dcfccdw d~u~],~r c~]h througl~ several ~n~r~t~om The a~tlon w~s t~a~tory, ho-~ever, ~lce th~ daugh~r ¢~]~ produced by i8 wccg~ ~,c~c r.o~ma( columanc ccJL~ c~h: Top.cal ~imn~ arc pl~,~um~ to kill ~rf~c~ not ,,adert~k,n in thi~ ,a,,dy In a co~derat~.~ of ~he possi~,fli~ d~z ~n carlton mc,~ t~L ~aet~r (i~ ~hi~ forxu or d~ffe~et,tla~kg ccl]~ Jchstc ~d of kfl]ing tl,em, ~b[¢ Let ~ ags~tn~ that dlfl~r~nliada~ cc~s ¢raer?bag durln~ th~ period nf ~c app[t,~ don wer~ ~o dc~ccted ~ro~k d~e normal co~r~e o~ matut l~fian a¢ to beeorn~ ~qua mous eels ar tv acquire ~thcr atypical Jor~,~; h,~ ~hc ~ ~xtm~,~ior~ end~ Ia ~hr. actual pra~,~s or ~ge~rafla~ of a aocmaL ep~c ]ium, thtsc abnorm~] tc]h ~0u]d be doa~-hed, widl pr~zcm to ~nf{ucnce the .¢~ celia, t~e should d~ d~c~on uader (~), it ~ ~vid~n{ that ab~ou~al c~]h ~iau~l to appear i0~g al~r the oHglaa]]y ~e~apb~c ~I]~ H~ould have d~cd ~r*~ h~a re phced~ p~babLy c~r iyi~g ab$~r~ ~ ~ wkh ~hem I~ B noI Hkdy that ne~Jy fWmed c~lls d~T~r~nuat mg in thc ab~cacc o[ fard~cr exposure ,o t~ cm~ld a~m tr,~ ~he ]o~g persL, h-nce of abnormal Thin dl~ssl~ t he~Io~ sclcc~ the ba~ cc~ ~$ the p[hnary ~¢ o[ action b~ do~s ~ot e~lud~ ~he 6a~g cells wa~ ~tsponslbl~ 1or file ~ap~d ¢~rly fornmuon o~ ~quam:~ mere p]~ia. a~sm~t A~r bach ~ al. (7) d~duc~d Ilmt m~ta pL~a o~ t~e l~lphratory I?~ct ~s a r ~ve~lb]c condklOn b~c~u~ ~e~tra~ ~i~ectly tha~ t~,baccv ~t~ndu~¢d d~r~t~ a~ t,~nuoa ~o b~] ¢¢][~ ~s one i~len~i~a bit ~itc CA ~be~ ~ ~h~ tob~c~a smoke c ~ndcr~sat% mad ,~cus~ tbc possible a!l~ o[ ~r oa differ entiatlng REF[I~N~[S

CIGAHF, TTE LABELII~G AI~!D ADV~[ITI~II~G i~,~ THE EFFECT OF IOBACCO TAP. ON THE BR.ONCHIAL MUC()~,A OF DOGS H~ ~,lrrt,~vE ~,idence [or the r~latiE,n T~hlF between cigarette ~mc~ktug ~,~d hm~ c~,n~cr ~ ba~cd f~r th~ J;io~ par~ ,,n ep~,lem,t, t (rbac~,~ t~r It,, 0~e ,kin ,,t ,r,,¢~ ha~ hccrl ~o/~ ~:~c~ (Fig ]) The [~rtk~]a~[~ ~dva~:=em,~ when :~ c.~l,cl~, ot br,a~h,,~,ope ~ pa~c,I ,h~,,i,~ ma~ bc.~crformod IhroN~h tbc~e rt,~ine Hy(]ro~h/o~Lde) Tobacco t;~r ~ ,]~ retied and ~fde,~ol d~r ~'~C ~UrL'CC O[ ~ F''Ch

~ ~,,nE,,,, ,~d,,,~, ~,l,U~,~ Ln,~L~ ,i ~:~ :; ,,~

CIGA]RETT~ LABELING AI~D ADVERTISIi~G ~7

C~IGARETrpE LAI~EL~N~ A~D ADVERTISIJ~'G

L~ ~J t~ LT L~ Q~

eld~er b~) nr ~to ~ction~ T]~c ~i~nJf~ ca rice c, f ~i~ *lnhloe ~ge "~. be con~kICl~ ~ ~T, t),~¸,li~u~sioIz to ~ollow TJ~is pi~o~ ~TU~I ]~a~ de0~onsz~atcd ihc ~r~c L[0,z, oE L,~L ,~la L~,~;I~S ~' tEZ~¸ br~r=chlai n,~,~u ne.~ t~atheal ",vlndow ]n ~he ~e,ro~ ,~L ~hJ~ pilot sEudy. ~b~r~o t~r ~ d~nlon~zr:~led ~o changes in tile m/~ Tll~ ~ec{~cit~ ol to b~or~ t~r Ja tb~ l,~l~rd was, o~ ~ur~e, noi e×~tl]ined, ~nd zhe Ob~i¢,n~ m~y si~llply . eHcct a ra~her ~lous~;hc re,eL;on ~o L~iLan( injllry Ext~mion (~F ~he lecbn=qu~ ~ olhe~ ir~i~n~ and to know~l po]~c~llc I/y,i~oc~rl~n c:.=~,~.g~.ls Js canendy onder w.,y ,,~ c,*.si,lera~[e hlZe~st The blo~¸ ~e, ull, an,] the a~ LO p~iC~ on ~c dog~ that dic~/ ~ari~ h= the c~perlztlent ~l~on~tra~ed ~e r ap~d~t~ GROUP I SHORT TERM TREATED 2/2 2/3 6/15 17/25 G~UP If LONG TERM TREATED 9~176 117/210 GROUP III CONTROL 1O51168

C~GA~ETTE LA~EZ,~,r¢3 g2ED kDVERT~L',TG 1~

CIGAI~ETTU LABELING ~D ADVEBTIg]~O ~¢~i~.¢d Jtom ~h¢ ANNAI~ OF TH¢ R~fAL COLLI~g O~ SCrRG[ONS OF ENGLAND ~a~w, 5a ~f~; I959 Pages 323 330 H~ PERPLASIA AND METAPLASIA IN THE BRONCHIAL EPITHELIUM As llllm ~ort om re,arch work I~lag carried out by G. d; Ctmal~tim and Dr. D. P. Wi u fabtllley Delmrimem of pIOleI¢~, Royal Col~ of Surgeons of Engtand INTRODUCTION T~ m t tH IS ~teadily gaining ground that most cases of carcinoma of the hro~hu~ ~r¢ due to the action ol'noxious substances in the inhaled air u~,n the bronchial epilhelium If this is true. then it is to be expected ~hal malignanl change ~vould be preceded by epithelial hyper plasla similar In thai seen in experimental carcir~ogenesis. Such changes raight be looked tor irt the lungs of established cases of bToachial carcinoma, in tile parts remqte from the tumour, and also in the fitng~ of p~rsons dying lhom o/hey causes who had nevertheless been exposed lt~ atmospheric pollution and ~igarcl I¢ ~r~loke Yhi~ rel~wt de~cribes the results of a histological survey of materi~l of the~e kinds 1 he first object was to define and classify the abnormalities in the i~ronchi~li epithelium, anti next to determine their relative t'cequcn¢y, their distribution within the Iung and their connexion with chronic bronchitis. Lastly, an attempt has been made to assess their relation to the smoking history. REVIEW OF PREVIOUS WORK Squamous metaplasia was the first abnormality to attract attenfion. It was described as a sequela of influenza (Askana~y, 1919 ; Wegelln. I942) and in connexion with bronohleetasls and other chronic inflammatory conditions. Lindberg (1935) found transitional (stratified) epithelium in a series of cases of bronchial carcinoma and regarded certain epithelial downgro'~ths as potetatially precancero~as. Niskanen (1949) doubted whether ".quamous metaplasia fins a precursor of cancer. Valentine (1957) ~3efieved tliat areas of squamous metal~lasia might undergp transformation In[o carcinoma in-situ. Wdlekind and gtrtider f1953) divided epithelial rnetaplasia in chronic bronchiti~ into two types ]-he changes they describe do not conform to those met with in the pr¢senl work and their classification has not been found to be applicabJe. Weller 11953) distinguished two kinds of change--sq/mmous and transitional metaplasia and divided both into dormant and proliferative types. His criteria for proliferative activity are very similar to those used b) other writers Ibr careinomadn-sfhJ, bvt he saw no metaplastic focus which be was able to diagnose as premahgaant, earcinoma-in-situ, or minute carcinoma. Auerbacb et aL (1956. 1997), ia the prefimimlry report of a large s~aie investigation, were the fi~st to describe basal eefi hyperpla~ia and intro-

C~OAR~'I~I,E LABELING ),_ND ADVERTZS~G I9~ duced a new classification of the abna~m.1]it fes seen in bronchial epithelium This classification is an advance on aaything prevlous[y proposed and the present work has been based upon it. They found a remarkable parallelism between the incidence of hyperp[astic changes and the cigarette coasump~ tion and they diagnosed carcinoma~in-situ in a surptisingly l~rga propartion of their cases. Hamilt~ et aL (1957), in a small series of post-morlem cases, reached conduslorts similar to those of Aucrbach et al. Chang (t957) fatreduced a methad ol¸ examJcing whole mounts al' the bronchial epitbeli~m and also cut conventional sections. He drew attention Io the frequency of abnormal nuclei in hygarplastic areas, a finding also noted by Bassermann (1957) in smears ill brllnchiaI mucus MATER]rAI~ AND METHOD~ Most of the pc*st*mortem specimens have been obtained at necropsies carried out for H.M. Coroner ; a few were derived from hospitals, No ~electfon has been exercised ; it has, in f~c~, ]~een dif[icult Ill secure arL edequatc amount of wcii preserved material because of the rapid posl~ mortcm desquamation of the bronchial epithelium. Fi×a~ion within tv, elve hours of death is esse~Jal; whea necrop~ has ta be deferred beyond thls time the bronchial tree ]~ filled with formalin inj~led through the cticothyroid membrane. The lobes ~f the lung are separated from o~ another and tilted at r~gbt angles to the segmental bl'onehJ ~uethach el aL (1956) c~t the entire bronchial ~rce into blacks over 200 in all--but we belfev~ thg.t a $1naller n,ambcr (nJitcteen) provides ~ representative samplE. Of the forty-four post-mortem ~pecimen~ so far exaininexl, thJl'ty-on,e were $Ul~lcietltly well ~resctvcd ~o ~/~crit inc]/l~ion The surgical material consists o[[u~g~ or ~btgle lobes reseeted for cancer of the bronchus¸ Prompt fixation erasures good preservalion of the epithelium. Up t~ the present, sixty-nfae specimens ha~e been examined ; smoking histories are avallab[e for forw seven of them RESULTS Before deserlbfog the abhor malilies met with in the bronchial cpiLheliu m i'~ is necessary to mention the cases in which ~o abnormality was dis- cgvered (Fig. 1). Nine o~ the thtlty one po~t mortem specimens canle under this heading¸ One of these was a child of two year~ : four were old *,~omen who were lloil-smokel'S o~ whose smoalJig h~blt$ wcr~ lll]k~own and four were old men who had all been smakers. One of the men had smoked 1.wemy cigarel[es a day up Io his death at eighty from spheroidal cell earcinom~t of the bronchus. "[w¢~ of the others smoked five and sixteen cigarettes a day, while the last, who had given up smoking forty years ago~ bad an ~ndJffer~ntialed bronchial carcinoma, Of the for ty-seve~ surgical patients whose smoking histories are known, seven meil had normal bronchial epithelium, "[heir ages ranged from forly-nin~ Ill sJxzy-sJ× years. "[hree.of¸ them had smoked over ~wetlty cigarettes a day for many years.

]94 CIGARETTE LABELID~G A_~/D ADVERTIS2~G F g. ]. A wortma of slxty-$even who~ smoking habits Are not known. S~Jon from the Icft main bronchus. FI. and E ~< 500. Normal bronchial epithelium with oa~ to two I~y¢~ of ba$~l C~lis. The abnormalities ia the bronchial epithellum are classified as fullows : 1. Ba~al cell hyperp]asia. 2. Squamous metaplasia. 3. Stratification or transitional change. 4. Epithelial irregularities and carcinoma-in-situ. L Ba~l cell hyperplgsia Multipliealion of the layers of the basal cell zone is a common finding (Fig. 2). Although the ce~ls do not lie in regular la)crs and an exact count is not possible, a usezul approximation can be arrived at. We follow Auerbach's (1950 grading : 3-4 layers -- mild i 4-6 layers moderate • basal cell hyperp~.asia 7 or more layers advanced t In the deeper layers tbe oval nuclei retaln their laoraaal perpendicular orientation. Near the surface they become paler ~tld mof¢ $oullded. Tbesc variations are comparatively slight lind there is no ehallge in the nuU2ar-cytoplasmic ratio. Mitoses are very scanty but giant nuclei, usually about twice the slze of normal nuclei, are sometimes seen. Giant cells are occasionally ftrunel with up to four nucIei of normal size, packed together inside the cell without much increase in cytoplasln. They may occur in comparatively normal epithelium and are not always associated with other nuclear irregularities or with disorganized epithelit]m. Basal cell byperplasla o~urs in all pans of the bronchial tree, though it is more frequent and usually more advanced in the larger bronchi. It may be confined to small patches or it ma~, spread uniformly round an entire bronchus.

195 / F g 2 /% man of sixt who ~m~,k¢~ twenty to thirty cigarettes a da . SeCtion from the ~rachca. Pcriodlc acid.~h~ff. × 500. Advanced basa call ~'perolas~ (up to eighI layers of cells) w~ih ~urvivJog goblet cells 1lear the surface Of the thirty-one post-mortem cases, nine had a mild degree of basal cell hypcrplasia. Unfortunately, a smoking history is a*~ilablc for only one of these, a woman of seventy-five who smoked one or two cigarett~ a day, Anmng the four cases with moderate basal cell hyperplasla were a ill.ttl o['sever~ty-eight who srrtoked ten cigaret! s ~ day. and a woman of sevemy-seven, a non:smoker. The three cases with advallced basal cell hyperplasia were elderly men who smoked sixteen, twenty and twenty to thirty cigarettes a day respectively. Basal cell hyperplasia of some degree was fl, und ia twenty-one of t fie furty-seven surgical cases. In five of them il was mild. in nine moderate, and in seven severe. No correlation witll smoking fiablts was apparent. 2. Squamot~ metaplasia This char~ge is quile different froh~ basal cell hyperplasia. The entire thickness of the epithelium is involved and as a rule il resembles Ihe t~ormal stratified squamous epfihe]iuna of the mourfi or oesophagus, The cells arc comparatively lurge and flattened. The nucleus is large, pale and vesicular. Intercellular bridges are eotlspicuous and constitute a 0iagnostic criterion, but keratiuizafion fias not been observed. The metaplasdc epithelium is often many layers thick and sometimes has papillae wfiieh project [oto the lamia~ propria. It is more resEstanl to post-mcrtem des- quamation than 1normal epithelium. In distribution squamous metaplasia shows the same centripetal tendency as basal cell hyperplasia but it often occurs in sharply localized

196 CIGARETTE L~I3ELI~ft AND ADVERTISING Fig3. Amanofsixr/-sln--asmokcr. ~ttonfromth¢[~ftuppcr[ob~broncbus. H. and E. )< 500. A I~a1~scd patch of s~USmOLtS m~tapla sla, sharply demarcated from no~mal cpiIhc]Jum. patches (Fig 3). h is sometimes confined to the spurs of hifurcalions and the crests of lon~tudinal ridges. The boundaxy between metaplastic epithelium and the adjacent normaJ epithelium is often quile abrupt. The lamina propna beneath patches of metaplast/c epithelium oftea shows evidence of chronic inflammation : fibrosis, infiltration with lymphocytes, and in¢¢e.ascd vasctllarity. Squamous mctaplas~a was present in ten of the th[r ty-one post-rrior tern cases. No correlation With age, severity of bI"onchit[c changes, or smohoig history is yet apparent from these small numbers, but it is noteworthy that in the three cases with ~vcrc ba~aI cell hyperplasia squamous met~- pla~ia was found in addition It was p~cscnt in twenty-five of the fo~ty-scwn surgica[ cases ; in some of these it was very mild. Three of them were pipe smokers ; the cigarette consumption of the others ~angcd from six tc fifty a day. Most of them showed mild hronehil[c ch~.nges, but there was no obvious as~o¢ia~on between squamous metaplasia and chxooic bronchitis. 3. Transill0nM change Certain intermediate typ~, difllcoit to classiC, are founfl oi a few cases, in these thccpithcl~um is scwral layers thick, the superficial layers be~g stratified while the deep layers rctaln the usual characters of basaI cells. The columnar cell layer is abscnt: this point can bc verified by staining with periodic acid-Sch}ff to reveal any remaining goblet cells. Son~cti~/cs the appeaea~ce oi" urinary epithelium is close]y simulated, l~terc¢]lular bridges and other features of squamous cp~thellum ate lach[n~

CIGARETTE LABELING AIX-D JLDVERTISING ~97 The nature of this change is obscure• In some cases it probably repre- sents basal cell hyperplasia in which the calumnar cells haw been lo*t In others it I~]ay be a precursor of sqLtamous i~lctaplasia, T~ansiticnal change of this type has been observed in six of the post- mortem cases, usually only in small areas, No correlation with the factors pre~Jous[~ considered is apparent. It has be~n observed in ten of the surgical cases, in cctntlnuity with areas of squamous metap]asia, 4, E#thellttl irregularitie~ and cartinoma-in-situ Disorganized epithelium has so far beet1 observed in a llew cases, m none of which it f~lfils all the criteria of carcinoma-in-situ (Fig. 4). |n t~ur examples the i~u¢]ei ate bypercbeomati~ and vary irt size and sga, pe, hut lhere is still some cellular differentfation and only a few mitoses ar~ apparent. Sometimes multiple nuc[eoli arc present ; the sigrdfi.cance or this change is not clear.

198 CIGARETTE LIBELING AND ADVERTISING The bronchial epithelium may be perfectly normal in heavy smokers, even in men who have smoked from adolescence and reached a con- sumptlon of forty cigarettes a day. It is also clear that the epithelium in the nelghbourhood of a bronchial carcinoma may bc normal. Nevertheless, epithelial abnormalities are common in both these conditions and it seems possible that a more detailed search might reveal abnormalities which arc overlooked if tml~ a lkw blocks are taken. Basal cell hyperplasia is a common and conspicuous change. There is often a similarity between the hyperplastic basal cells aad the cells of oat cell carcinomas, Whether this is more than a suoerhelal resemblance remains to be proved. We h v found nothin to contradict Auer 's (1956) suggestion that basal cell hypcrplasia is connected with cigarette smoking. ~frequeney of squamous metaplasla has long been recognized and our obsl~vadons have so far provided nothillg new. We agre~ with Weller (1953) that patches of squamous metaplasia vary in acflxi~y, some being dormant while olbers show vigurous proliferative changes. It [s Possible that the latter may he precancerous. Basal cell byperplasia and squamous metaplasla tend Io be centripetal. In ninny specimens these changes are most ndvanocd at the carina, rather less severe in the main bronchi and progressively less intense in the lobar and segmental bronchi. This palrern is in accordance with the work of Macklin (1956) who showed that although Ihe entire tr~zheobtonchial tree is vulnerable to noxious substances in the air, the parts exposed to the most concentrated and sustained attack are the large bronchi near the carin~t. We have saldom observed changes which could be regarded as inter- mediate between basal cell hyperplasia and squamous metaplasla, and we have never met with appearances which we interpreted as indicating a transition from one type to the olhar, As a working hypothesis, we regard the two types of change as differing in kind and not merely in degree. In the hope of rhrowh~g further light on the differences bet'~een them, we are paying special altenfion to nuclear structure and applying histoebemical methods to some of our material. The nature of transitional change is still obscure, but the absence in epi~elial activity makes Jt unlikely that it plays any important part in the genesis of cancer. We c' confirm Auerbdch'~s~findings on the. fLefluency o[ carcinoma-in-sill. We have found areas shewing~nse proliferative ch a nges~bu~ l~n none of t he~a','e~ e e~n sat I~£~ed t----hat al~ tha criteria o~f carciuoma-in-situ bave~l]--ed~iqeV~Tfl~order-line cases the dia~![osis ix t~pen to differed_and ~r di'~greement is probably o~retation rather than observali~ l-'l-'l-'l-'l-'l-'~¢on~pparenl that the respons~ of bronchial epithelium to noxious stimuli are comparatively restricted and we have

CIGARETTE LABELING ~D ADVERT~I~G 19~ reached a stage ir~ ~he work at which we expect to observe no new histolo- gical abnormalities. Our ~rnalning task is to collect enough material Io enable us to analyse the changes in grc~ler detaU and to extend out observat/ons by ce/talrl his~oc~cmic~ ~echn~q~2es ; t~e,se ~,re a/ready under trial. ACKNOWLEDGMENTS We wish to express our thanks to Sir William Bentley Purchase. Dr F. E. Camps, Dr. G, T. Alien, Dr. Horace Joules, and Dr. R. A. B. Drury for their help in obtaining material. We are also grateful to Drs. K. R. Stokes and E Nassau, of Harefield ttospital, for permission to make ~tse of surgScal specimens. The work of one of us (D, P. W.) has been suppor~l by a grant from the imperial Cancer Research Fund. ]RE]~RENCES AS~ANAZy~ M (1919) Korresp-B1 schweiz ~z 49, 465. G. E. KA~S~U~V D. Y,, and ST ~or, A P (1957) New Engl. J. Med. ~. 97. PIIT~ICK, T. G., S~trr, A. P.. ~*~AI~IN~R, A. L , ~ UEHSAM, G. F, ['O~AN, J ~., and G~gE. J, B. (1955) Cancee (Phitadh 9~ 76. B~SE~^~N, F. J 1957) Tho~'chir 4, 464. ~G, S C ]9~7i Cancee 1"hla~.h 10, ]246 14A~Ll~t~. J. B., SEpt. A, B~O~'~, T (7., and ~¢DON~D. F. V,~ (i957~ Ca~a~. m~. A~S. J. 77, ]77 L~t,~£~G, K. 119~1 Arl~ path¸ l~rst Unlv HeTsl~gf. 9~ ~ M~KLI~ C.C. t956 J. thoroc. Sang. 31 238. ~ISgAN~N. K O 949 Acla. path ,~ crobJo • scat~d.~ Supp • 80. V~L~XI~, R H (19571 CancerlPhllad.), 10, 272. wr~l IN, C. 119421 Sch~,eiz m~d, Wschr. 72~ 10~3 WI~TEKT~n, D. and S~n~, R. (1953) Fra~k]urt Z pat~ 64, 294, 405

CIGABETTE LABELLNG AND ADVERTISING A Study of the Tracheobronchial Epithelium And Changes Related to Smoking K I~ CROSS¸ MD~ DONALD V. W,ALZ M.D., G KEI~H P~.LMER MD ~nd L ~ WARN~. /~D IOWA Clr~ ~L,I,~ ,n~,~[~,J~ in t~J 1~ ~1~ Ih~ ,,,el

CIGARETTE LABELING AND ADyERTISL'qG ~01 ~t,L,~ [I~ ,i~hl ,~,lqE~llL. I~., ],,,1,,,hl,~ i,~ ~,i~,¸ ., ,I ,J k~ ~,~, h ~ ~ ,~,~h TI,~ L~~ ,,,~, h,.J ~ (,m N,r~I ,4] A~p,~p~,~pr~,i~ TOTALS ~

CIGARETTE LABELING .a,~ND ADVERTISI~G

.11 ~. ~i~ ~i,ii.,ii~ ill r~ ~.i~.~ L~,~, ill, • i i~, i • i,,~

2O4 C[GARETTE LABELING AND AD~]RTISING

CIOAIt~I~E LABELING AND ADVERTISING ~0~

® L~ L~ L~ ~7 r~

CIOARETr~ LABELING AND AD~rERT~ING ~07 PERCENT OF SLIDES WITH LESIONS SHOWING 60Jr OR MORE ATYPICAL CELLS 9=1 349 t.~"4 (.gnat PERCENT OF SLIDES WITH CARCINOMA -IN" SI TU il,4 1 43 NO. Oc¢o=l~rWl ~'ll2Pa¢k I/2 IP~ck I-2Packl 2~. p=¢kl SmOk~rl Smoker ~ boy • B=~ A Oc=y • D~y 150 I.u.~ Ganee~

PERCENT OF SLIDES WiTH 8JS~L CELL HYPERPLAS/A ( .,~ or more ceU roets j r6. 3 6~v 4c~3 ?$6 LW~ S~aator iq~l~Gna. Dr. C~rlile~ ).u found tha~ your work in the C~ex S~ei~ fo~ th~ pr~tic~ of ~!~¢¢~ ~mok~g addi~ioa sho(~ld go below ~he juulor high school le,~ ~, and you g~ve a st~rtllng statement ~h~b ~ is nece~ ~o sthrt in th~ fl ffth gr~d~. Onc~ ;~ a vrhi[¢ I h~rr~m people ~-ho s~/e th~L tledr smoking~ th~~y ra~o~liz~ off~e~ h~art tr~u]~l~ they ~ight h~ve bec~u~ f~ ~Lress ands~rain~ that this c~us[~ them t~) relax. Do you find that fi~]] radars ar~ under ~ g~t de~l o~ strew? Dr. C~R~ng. I think fi~h ge~l~rs p~t their p~nts vnder raor~ st;zes~ tilth they ~re under t~)~emse]~,~. I do~t f~nk it i~ a stress factor. ] th;nk this ]~ an emulation ~actor~ Lr~ing ~o a<:hiL~v~ sL~t~q and accept~no~ au(] ~ry~ng to emul~to the ~:hdt~ ~heoA of them.. Senator ]q~o~. I ha~ be~n i~te~ed in the discusslons we ]l~v~ hoA. pro an~ con h~re ~[~out l)l~ L~r ~r~(~ llicotitl~ conLent~ be~pm$~ T am espec~a2ly concerned ¸with t~q~l. There w~r~ some compa]~ies t,h~ wcr~ pu~ting on their p~ck~ges wh~l ~h~t c~ten~ was. But ~s result or the tobacco indusLry~s sel~-poIi~i~lg o~ ~dvertis]ng, they fo~md i~ neccssa~ t~ wi~hdr~w that ]a~l]ng bex~.~ they felt¸ that Dr. CA~L~JJ~. YeS~ ~ ~|o. A~ th~ ~]me this w~s withdva~'n~d thero ag~i~ was refer ted to as th~ Lar d~bv~t th~ ~ixne it w~ request ed b~ o~ of ~h~ Federa| regu|a~o13; con~r~li~io~% I be]ie~e the Fed- ~r~l Trade C~ral~io~l~ i( w~ requcsL~d t~t, t~h~ ~top ad~erLied~g t~r and n]cotino (~)n~nts b~caus~ there w~ no u~l]v~Iy ~c~pL~d m~thod o~ ~mllsu~ng i~. And this is the ]mporLance of the z~ere,ce do ~h~ Cambridge raethod.

CIGARETTE LABELING AND ADVERTI5IIqG 209 The CHA~A~. This was my point.. It doesn'~ m,~Ln anyflfinff tO the average individual, that this contains so n, uth Jar, because they ll3ve no ec*Inp~IfSOlL Dr. CA~IL~. I wo~tld like to elaborate o~t thai, Mr. / bah'man. In the first place., at the time that the prohibiticm of advertising cigarette and tar c0n~ellt we3L iTlto effectI it wfl,s co th~ basis that there was lie accurate nleLhod of mea3urlng 1~ and tht~refor~ each corn ~any could devise its own uldls ~nd measurcments~ an¢ it was absoutey meaningless. Lika other things like exposme to radiation and other risks and threats to life: we do nov know w mrs lhe l.,reshold is beyond which one is totally safe. Just like radiation wa fe~l that the least one gek% the better off one is. Thar~fore tbe rat and nicmhte content on labeLs the least one gets, th0beiteroffoneLs~audwedontk3owwtel~t ierea s~fe eve is. The CHAmMAN. BUC the leas~ oi1e may be toh~lly dangerous itself. Wo have no way of knowing. Dr. CAnLXLr: precisely. There is an hnprovemen~ in th~ sltuation ll~ )r011. gO fr0IIl lnol~i~ [,o le~s yon S8~. Th~ C[[AIR~[A~* ~XC]]SC Ill~. I dldll~t want to filt+~l~Up~, Senator h-Ev3~o~. Evidently the smoking public feels that there iS SOlile conlleetiol~ hetwe~n ~1/~ fllnount of ~1, and ~(llcotin~ and the danger to their own lungs because of the great prollferation of fi fi~r cigarettes, and tha~ hasnt been mentioned very much here. Dr. C,t~LIL~ XO; i~ has not, but it is eerminJy a rttflet:Lkm of the attitude of the. public, and their acuaTlance and seeking of filler eig al~ttes. 1 thlnfi it 1s about 70 percent el ,he total marke~ now that zs filtered. Senator N~:H~mt~rl~. Age~n we denff know. do we? Do you people, workLs~g in thLs area~ know wbolfier a flhdr is effective, or ~s it a psy~'chologlcal thing ? Dr. C.~r~tL~. l~ is not fully known at the pt~seut tim% but the~ are ~me studies underway of the e~,ahation of fillers. One of the oh e~-tives of the American Cancer Society in looking al th s overall problem s the ~a] st e apprec at on of fb[~ fo ) ~ of ill In~n natul~. We are as inte~e~Lml in lhlghlg safe cigarettes a~d safe filte~ as we are in wanting labels and other thirt~s o~ this nuture. Senator Nscu~so~. P tbhrk we have had pretty avod cooperation from the t ob.qcco industry iR this area~ and I hope when their people come to testifl: before us they win sfiow a constructive approach to this~ tfia~ they are conee,med with the danger. I ~hink tfiey a~ doing ~)me real r~sear:~l: iu the5 ai'~ of filte~, ~lll{l Ihe ability of a filter tc remove ~l,al migl/t be tb~ barmful c~-mtents. Z certaiifly would like to see a cooperation between the industry and the Geverrrrnent or indl- viduals in that we ~11 recogqfize that we are still eying to fia~e people who sffloke: reg'ardl~. On this lar stud nicotine thing, I would like to comment on the state.merit of Dr. Wynder, ef the SIo~m-Kettering Insthule when he testified last year. He sa~d-- I am in favor of in 4i~ing tile ~tr an¢I nicotine eon~ent on all packages ~f r.iga - rettes. I believe it i]l~lS~ [le nmndatory. A COll~i~D~ should not h~re ~he choice of pllttil~g tlle tar and nicotine cont~lt OIl po cka ges of ~r ta h~ t y p(~4 of cigar~rtfis, which ar~ lOW in ~ar all¢I lal¢~irl~, and e]illlintlte i~ from that whil.h fire hlgll,

210 CIGARETTE LABELING A~rD ADVERTISING evell though the low tar and nio~tin~ cig~l~tt e sell~ very H~tle and the hlgh tar a~tl n[z~otine cigarette b~s large sales. I thl~k by I~ald~g this ma~dat~ry we will ~ncotlrage the indtl ~t t7 t~ lower the tar and n~c~fi~ eortte~t of ~e variolls cigarette~, This is ,~oxn~tbJng w~ ought to comment on here, Ihat even as we know that a label on a cigarette is nol~ always going to be a c~m~dei~ det~rrent~ it is a waaming in tl~ ~tme way that maybe tTds ~il] ]mve a salutary effect on the industry to help in ~hls whole area. We have resolved today, I think~ tlmt the tar and dieotlne level ig inlpo~tant, and tha6 there is a shortcomhag in the standardiz~tlon of the to~t in 6hls area. I would like to compliment Dr. Auerbeeh on the wry-graplfie pres- entation here. We are reminded that one pictm~ is wort~a a thousand words. I know tla~ audielme in tllis hearing room didn't get to see all of those pioture~. I wish you ~ ould h~tve them on the inbl~ la~er ~o they could. It rominds me that I had a cancer operalinn 4 yeaxs ago a radios] opera~ion. Only this year, when I wenL in for my checkup, did my doctor say to m~ Did you ~wr see a plctu r~ of yc41r co2aeer 2 I sah~ No, I am just content to know it is out and gv~e. IIe showed me ap~ ietur¢ of it. I will never erase it £rom my mind excepg to think how luck71 am that it is gone. Dr. Arrxmac~. You at~ to be congmtuldied, too. Dr. C~L~L~. Mr. Chalrman~ may 1 comment on one remark that Senator _Neuber'gev~made, in which i am ~fraid she mlsunder~oed me. The ~on for a33andonin g labeling of tar and nicotine content s~ et~l y~ agc~and this wt,~ po~hly- 5 or ~ y~,rs ~go mm that beeaus~ ~d, ~hat ~imt~ th~r~ were no ~tisJ~aet~ry te6~. Tbe But~eau of Stand ards now feels that there are satisfacfory tests, and this makes an ira rant chango in our attitude about in ~en~ator N~vaE~r~. I am glad you brought that out. When repre seutstaves from the indnStlT eomo wo wiE be glad to qut~tion tlmm about their usage of those wh ch are ~u~q~f~d by tlm Bureau of Standa~t~ Dr. C~mI~L~. Thank you. The CH~r~. Dr. Carlile, we have talked a gtvat deal hem about industry self-regulation, voluntary. But we have never gone into the ~ubject, and th[~ is a very ~ppropri~te week to go inw it, with the National A~ocintion of Brc,~de~sters mee0ng lmre thL~ week, about the possibility of COOl~ratlng vdth tim American Cancer Society and oth srs~ o¢ some volun f~ry agreements on acceptance o~ advertisements. This has been gone in some other fields. £ guess you people realize that you never see a hard liquor adve~:Jsement on TV, be~'aus~ they have volunteered and agreed.not to accept any hard liquor adverti~ ments~ even the finest bourbon from Kentucky is ilever on TV. Sem~tor ~¢~oa~uN. That had its inception in ~eJJ'polJclng by the distilling indi~stt'y. T~m CHAm~A~. Ye~, and also TV. Senator Mowro~. The industry st the time o$ mpest made that a policy. Abe) on radio. There was no TV tlten.

CIGARETTE L.~ELIN~ AND ADVERTISING 211 Tbe C.A.~A~. Se*~nd, and I was hlvMved in this most people dolt't, rca]ize this editor you n~vBr see anyohe take a drink of b~r on TV, or wine. It ~dmtmt looks like it. They get t r ght t 1ere, and you smack your lips hut it never happens. Hem is an example to point it out wbAch the distil]ing industry started. No matter wbut we do ~n Congress there is a great field le~t for the industr~ for the mediums ef commuldcation~ to do a lot of ~ oltmLal~" things hi this field as our re_cearchprog~es. Sen~t or IIARTXE. Will the Ckaixm~n yield? The CHAmg~. Yes. Senator tIAI~TKZ. Has ~hat cut down on the whisky consmnpllon! Th~ (~HAII'~AN. I don~t know. That wou]d be a ~peculative ~!]nt~ ve tlfing. There probably would be mor~ consuraption if th~y would have free rein on TV. ~enator -XE~ERO~m £ would lik~ ~o comme~all testimony has brought out tha~ the u~ of wldsky in moderation doesn't cause harm to health t~lat the u~ of cigar~L~s in moderation do~s. Th~ C~AI~X~-. This wa~ mMnly as l r~member the distilling in dus-L~" because wo ha~l us~ come back after prohibition. He~ were two or three generations of young peoplo wbo had no eonnecllo~], except maybe d~rough, dex ious wa~'s under prohibition and ~hi~ ~as mainly to se~ if flaay could make more temperato two or thr~ ne~ g~eraLions that grm~ up d uring prohibi~iou d~ys. here is a big fleM iiere tha~ ~e ar~ talkin~ about for a los of volun fai5" efforts, cou )led ~ith the educational efforts you are talking about ntheCancerSocietyandothe~,todoagcod o]~ ntis ed. hope we will bring that oa~. One other thing. ~)r. AmR'tnt~!h. h,ow can you stop pe~p]o fronl smoking? Scarethcrutode~0~? ls~batyouranswer! Dr. *~UF.IO1ACU. ~ella{~l'~ l Wolll[] llhe'voll to kltov¢ that m., st/tdies al~ purely on hush, an beinlls. The nfinute I become a Kospel preacher I diminis~ ~he e~ a]uadon of my results. The only thing that 1 fee[ from mv point of view--that this information sl'~otfld bc whhdv dis seminated that people ~aou]d know wha~ tile d~gers arl~ a12t(~ it, i~ up to tim other iadi~iduals to go on like th~ American (-*ancer $ociety~ American Heart A~oelatlon. The C~,~a~t~,. This is a subject which is qui~¢ varied and quke con]ol~x. I have one more thing abou~ ad ver~ising. There are two hills before the commi~ee, hi ont3 of lllem advertising has been ]eft out for Ula.y, many l'easons. I don~ need to go hl~ o t hem ~11, One of them is ~ba~ maybe thm~ could bu a volunta~T effort h~ tlte whole field. The second one is that when we label other hazantous product~ take Lvsol as an example or disinfectants that are poisonous fihe praetie'~ has been to Mlow the advertising 6f tbese prodncls for what they are used, to say "Ly~o] is a g~-~at autlseptic in your home." Nofldng is said on th*re about its being poisonous. But when yo. buy t }to pro~hlel ~ t ht~lt ~her~ i~ i)n file h~bel such a stu tenlent, f see some paralleI to tho matter of adverfisll~g in cigmrettes and tobacc'o. I may [~ wrong abou~ it. I want to assure ~'ou geop]e rbat the two bills il~ llere, there is no pride of auth,!~rship in either one of thellt~ alld We re ry ug o art" ve e bes way t(} proceed ill this

212 CIGAR~TJ~E LABELI~rG ?,~D ADVE~TI$~G lrmtt~r. ~v'e have the trl%0 [lleaSlll~ ~ emts[der~ I want that for the record for your information ~enator Morton. Senator MoR"ro~. Dr. Carlile, I take it fl~ml roar sL~tement lltat you think there is only a handful of ph sicians who are no~ eonvinerd by the evidence against eig~l~ttes, and t~t t}/e time for argument over the evidence is pas~l. I quoze from you : Only ~he s];oko~men for tlJe tolmeco industry ul~ interested in vumNag life into this argmuent, That is your assmrtption ? Dr. CAm~rm. That's correct. Senator Mo~vo:~. Do you know Dr. Hue ~r while Chief *~f the Eavironmental Cancer Section of tire National Cancer Institute under the presen~ Surgeon (~enerM, wrote an t~rticle in which he .rod-- TO charge 81uoklllg with being "the ~r ovel/ pr e(~olMllarl t cause" of lung can0er is "scientifically unsound and s~,iologiealh irrespoxmible." You wouldn't call Dr. Hueper o~ spokesman for the tobacco industry. Dr. C~aLE. Whet/d~d he write that st atenteatt ?. ~enat~r MORTOI¢. ~lnee the appearance of the Attorney General% r~13~rt. Dr. C,umi,m, Will yon reread the exact descript2on of the statement, the terminology, so that I may got il ,gain Senator Mogror~. Yes. IIe s~id-- • o charge ~m~ oklnff ~th bel ng th~ and these are his words proveEt pl~L~J.oEa[l~an~ CoXll~e of Iulag C, KnZ'~2~" i~ S~loll~tl~f~lly 1112~Ulad 0~t~ fr~-IoIo~'~r eally irr~pomslbte. This was p~hlished in • German technieM journal, Arnzeimittel Forschund in July o~ 1964. Dr. Camx~. That s nteresting. That is in a Ge~Taan--is that a German journal, I believe ! Senator Mor~o~. Yes. Dr. C~amx~. That is ~ntet~sting. Is tlds Dr. H-u-e-p-n-e r~ of I]to Institutes of ]~IeM~h ? Senator MO~xON. "W. C. H-u-e-p-e-r. Dr. Ca~i~. Yes. 1 do know that there are some irtdivlduals who still deny this existertce~ ~nd as we have stated in our present~tien, they ~re entitled to their right to dis ag£o~. I would stillp,oinl out, tlfis is a smMl haadfnI of physich~n~ who ho]d this attitude. By far the pt~dominauc~whcn I say predomi- ~tance I think that in addition to ~he gerteral physician p@ttlation at l ~rge, where zhere is 95 percent acceptance, there Js 95 percent or more accapt:m~e an.rag tim l'dlysiciuns sud* as Dr, fl~tter~leh ~u~d o/hers who ~ork in this held. I do ~mt drink zhal there will ever be a situalion in this conntry o~ ours where we will have D)0 percent unanimity of vphfion. Senator 3fom~)~-. I have here a rather substantml llst of pJ~0mlllent people who don% accepl all these statistics as necessarily doctrinal )roof. Dr. H~rold Stewai~ while Chief of Pathology of tl,e National ~anc~r ln~titnte, ~rving under the pre~,~nt Surgeon (~enera]r pointed

CIGARETTE LABELING .~qD ADVEETISING 21~ out--and this faet was brougl~t out yesterday in tht~ ht~at611gr-, that expos~Ire ~o inhal~[iOll of s~loke from cig~tt~ttl~s or {~i~at.e~h~ fobaee(J ms fa ed [o uee u g ca, eer ;n a wide v,H'ietv of susceptible experi- mental animals. H0 cerzain]y is not a spokesman for the hldustlT. Dr. KelmeLh Endio)tt~ Director 02 the Nati()na] Cancer InstltnLe, February 1964~ s~id ill a statement submitted to a subcommittee of the House Oommittee oll Appropriations ETer~ tho/lg]l a ~moker Ig at a gl'~h~t~ I]~,k o~ llUXg caIl¢~r and q)ther t~iseases than a nonsmnker this eoneliiMon however does not in iise]f Drovide the anSWel. tD Ole probleix of smoking aild Cancer. It only iJ£ovides a plemise for the development of working hypotheses for further study. ~te goes on-- FI~m the research standpOlnL we u~my consider that ~he invest/ga~ion of en vironmental c~ndition~ relating to lung cancer has h a rd].v begun. Dr. J¢,hn B IIickam~ n member of the Surgeon CTenentl~s Adv]sol5' Committe~e was qnoted in th~ Charlotte Observer as saying T~l~ AdVi~lry C01ntalftee report may have been a hi~ s~rong. The more Wo looked at ~he si~ua~lon ~hc more di~elllt ~e (2onI1ecLioll llas to ur~dclsland. With re~ard to heart disease he said Sm~3k~]g is just part of th~ pietllre i~ eo~nary heart disease. The polnt I an~ gettin. . g at you s~v everyone who may appear at these. he,flings and disagree ~xlth some of the s~atements you made here today is e~gaged in~ to use your wol'ds~ a skl]]ful c~mpai~,n~ to blur the evi de~i(~ with a ,u~t oky cloud o~ confusion. I Lake i~ Lhat muans what it says. Dr. OamJlm. It does, sir. (The ~o]lowing letter was submitted ~or the record by ]Dr. John B Hiekam:) d'ollI~ 13. l:[i~lIA M, ~.D., HOsL WAII~E~ ~I~N~J~O~, Chail'man, ge~ts 6'emunemv ('om~ittee, ~.~. Oonyre$at, IVeAhielglo~l 1~ C [)NAIl ~E N A'fOII ~ 4~NT'~4ON : It has been hl~*ught to my attention ~hat t~stimony before your eomulittee dealillg WRh the D roi;osed leglslathm on hll~lillg ~ obae~2 o products has indicated that 1 may have changed r~v mind about the fmdh~g~ of the Nllrgef~n General's Commitf~e oil Smoking and Health since tl~It rvpol~ ~as IJub lished. I ,~ish to respect f ulkv req aes~ thaL IL be made a part of the record of the cam- I]li~ ~e Ilearings tha~ I ~greed completely ~l£th the ~epol't of the Surgeon GeneraFs Commk~ee at the time it wa~ issued and that I continue to agree comple~ely with the findings ef the report Sincerely, Senator Mo~x. There is substantial medical and scientific opildon in this country that is uneonviuced by tb~e cbarges tl.~t lnt~e beeu m~,le. I don't think you can call peop~le like Dr. ,h)scph Berks(m, former ebief ttedil!al shttisli+dan ~1 Mayo Clbdc, or l)t. g. H. Rigdon, patholegis6 rd tim UnL',~rsiL~ of TexaN Dr. Thomas H, BurforcL thon~cic surgeon at the ITn~versity of St. Louis, Dr. Harry Greene, head of tbe Department of Pathology at the Yale Medical SehoM spok~qmen for the tobacco industry. CertainlY not. Yet they have all expn, ssed seine misgivings as t~ th[~ conl~lus]lms yem h:l~e r(~aehed,

214 CIGARETTE LABELING AND ADVERTISING You made tile sttstement, Doctor, that d0,000 persons die of hmg can cer in tile United States ammally, l)5d you mean that these peapt.le had cancer that started in the lungs! Or did you include ill this fig ure people who had cancer tlmt started elsewhere in file body and then spread to the lungs ! Dr. C.~II~. No sir. This is primary lung cancer. S~imtor MoR~N. In 1962. the U.S. Bureau of V tal ~tat st ca, under Cblssificatinn Ks. 16~ list~l 18,860 deaths from primary cancer of the hmg. They have another cla~si~cadon which showed 22 0(}0 can cers in the lung, hut it was not specified as to ~cheLher it was ~%.c~ndar y or primary. Dr. CaRLILE. YOU used thls riga]re yestelxlav and it puzzles me he- cause it is totall.y in ~nflict with oth~r publiSa~]ons of tlm U.S. Gov- ~l'21nlel2t ~ with the Surgeon Generals report. ~ald other bulletins. I am. no~ familiar with wh3'' this. discz~pancv, a~pears. I am totally. c~rtam that the figure of 43,000 m 1963 and 47.000 expected dea~he in 1965, is a valid figure~ and not the. 1S 0O0 which, you referred to. I tifink that there s some l g he "~ ~ htch doe~u ee I e eye, and that I am not familiar with. Senator MO~TO~, I certainly don't want to give any misrel)resenta- tion h~r~. ])r. C~LILE. I am sur~ you don't. Senator ]MOR]~)~. I will see that you get the volume to which I refer, and perhaps Jlmt~e is an explanation of this diffcrance. Dr. C.~RLII~. Yes. I think flmre i~ Senator Morzrol¢. You also said in your sratement that-- Lung eao~r is in~Teaeiag more rapidly Lhan any c~h~r ea~cer In the body and the increased incidence l~L~tllels the consumption of cigarettes. That increase a/so p~mllels a lot of other t]Jings dcemft it I For example, the tremendous growth in urban living. ~re deal with t]ae problems of urban livi here on an almost daily basis in fire Con- gress. The*~ are mo~n~aetories producing air l~ollufion, more cars and tamche on the highways producing erezx more pollution, more and nmre in¢finer~tom and power plants polluting the air we use more additives in food% more chemical insecrXeide~ on crop% more radiation ~rom years of weapons tesLing. ~]l of thes~ things have increased in recen~ years. Isn t e~ery one of them at least a suspect in cancer Dr. Car~. brans of these axe not only suspect, but they are known causes o f e~moer in d~ffer~at situations. I think we have to di~inguish between Ihe fact. that you ¢~rn tinct consider tha~ a large element of Ihe population is uniformly exposed or bathed in these elemenls and we can average these out to some extent, bui there is one factor in which the work such as Dr. Auerbach has done, Dr. Hammond has done in which you can relate specifically ti~e imidence of lung cancer to the lmbit of smaldng. This does not apply to any of thes~ oltmr things £o the extent that it does io clgarette smokiug. Let me reemphaslze a statement that I ha~c made and read from, that we do not ~ that cigarette smoking is the sole or exclusive cause of ealicer.

CIGARE~E LABELING AND ADVERTISING 2I~ The do~t]lll611h that ,,~as l~feiTed to vest~rda~ ~bou~ envh,oninenla] exposure being a factor in inere~ex] i*{d(lenex~ m ~ ~meer is snmethir~g tbat has been blown fur a long perk.1 of Lime. We do not deny this. We do not say that rids is nut signific~nt: and hopefully should be con~eted. But the cigarette is one of the principal c.au seA% hut not the ~)[e cause. Semttor Moavo_'L In your statement ~'ou pointed out that you were impressed with the tobacco tarspr roduc]ng cancer of the skin in mi~e. Are you disturbed by the fact that you haven% been able to prc~luce lung cancer in mice through the inhalation of smoke Dr, CARLIL~. Not particularly. It would be nice if we could, be cause it would eli~ninate this argument. But i don~t think it is ~ artleularly fallacious line of reasoning. There are di~inet differen~s ~ween animals and hmnans as we all l~aow, One of them, very superficially, is that mice, dogs axld other creatures are four fueled ~ufirml.ls lind ~heir puhnon*Li'y physhflogy is tliff~rezfl llmn the two-feoted animM% a~ we al~. Thei~ are otker distinct species differences that we recognize. We deliber~tteIy seek oat in dm investig-ation of other diseases certain spe~ige type~ of animals, who are kllow/t to be ~ensitive or known not to be ~ensmve to certain disease processes and we design our expire m~llf~% ~ronnd them. This is not mfique and this is m~t a criticism or should not be used as a crltieism of the ~ela~i,mship between clga*~ette smoking and ¢~tl]e(~r in huffl an~. Senator MO~To~. Tbe ~cord might mehlde tins quotatDn from Dr. Terry on Janua~" c29, 1964, in testifying before a suhl!omnlistcc of the House Comm t ee on ggricultur.. I qut~te Dr. Terry : We need t~ know much mere Kb~ll[ ~he substances in tnbaceo smok~e which prOduce the health hazards UDtil we know mote in this area, we ~ffll be ha*~lloappo2 itt our efforts to remove the hazard. It is di~c~llt to desigh ~. metho~t o; removing something if you don't km*w ivkat it is. For example the knc~vn substances in tohacc~, ~nmke can aceom]t for ~]y & small porvion of Its caneer~prod~cing l~wer. You do recognize the fact that hereditary and hormonal and ~ven infectious dise~tse, because hmg c~mcer is not pm~ely on~ of [in~sl,, c~uld be a factor in lung cancer ? Dr. ,CAR~n~. Yes~ sir. Senator MORTOn-, Yon tell us lhat eiga~'atte snmklng is the decisive factor in the pt~matu*~ de~rl~ of some 500 pe~v, ons each day from cancer from he*art, h'om otber cigar~tt ~-related diseases. The Surgeon G~erah in this st,%tement to which I have ~efet~ed. in speaking pa~ieularl~) about the eerona~T artery disease, st~tt~ that ~he Committee was unable to teach a finn conclusion as to the role smoking plays in causing or I~r~ipitating a de~th from thi~ disease. We nee*2 to. find out for sure whether smoking is a factor in this disease ~v whether it sbou]~i be exonerated. I:[e further said on that occmnion that ~e lla~e nl~ Deal clue ~s £o what it is in (~baeco that ~nfl~lences corollary ~rtery disease, if indeed it does, [ don% thh~k thab his stabemen/s accord with yore" s~at~ment of 500 deaths a day, The Surgeon General tells us "th,%t he can't flnd

CIG.~ETTI~ LABELING ~-ND ADVERTISLNG wh~ it is about smoking that has ~l:y ~mpA.et on he, tit d~se~se, and s~y~--- y~ r~cT to find 011t for s~t~ wh~th~r ~J~loking i~ a factor in this fli~eage, or whether It 8ho~3 ld be exonerated. Then he goes on t~ say tha~ disg~¢~, if iIld~l i~ flees. Thes~ or~ the words of the Surgeon General olt January 19, 1964. Dr. CAm.m~:. A lot has hap e~ed ir~ tlmt tirae~ sir. I thiuk if you rez*~l] you were her~ when ~r. ~rakerlh~ spoke for rite Am6vi¢~ln IIe~ rt, Asmeiation late last evening, whoa he we~t. into this p~rtieul~r f~tor. The tIeart Association, and other agencies dealing with th? problem o~ heart disea~e~ ha:re bec'olyie. S:l'Ollger and st:~nger in their cony:o- rion tb~t th~x~ is a relatimxshlp betw~n eig~yette smol~hlg a~d co:~a- nl~l'v heart disease and other ~orI,ls of heart dtsease--th:s was brought ou~ r~ther st:xmgly las~ night--sine~ th~ Sut'gevn Genel~d s l~port of Juttuary 1964. b[ay I point out the conelusi¢ns reached then wer~ based upon the literatnre that ha~ aeeumul.~tad during the yea~ prior to January 1964. Much ha~ happened since tha~ nine ~n the .albany and Fran~- ingham studies ~nd in other areas that have demonstrated th:~ rela- ~}ship which most now accept. ~en~tor MO~TO~. You also commented in your statement~ implying th t there is ~ direct eonnectian betwee~ cigarette smokh~g anff em physem~. I take it that the progress~ which was not ~n the Surgeon Ge'::ergI's re err I take :t from what you have just responded to the question of t)~e~rt disease, that perhaps this progre~ has been nmde ~lso fil the last few years. ]~r, Cxl~lt~. I~ you :,emember~ sir, ht~'t eveublg, beaterday a~ter noon~ you a~d Senator Neuherger were quoting frmn the same para- graph and d fferent ~rL~ of it~I am s~>rrv. 1~ was Ser~ator Bas$~ in which we explo~e~this polnt in which there is, even m the Sur- geon Genera ~s re ort~ the~'e is an association between thes~. Furthermore ~r. Auerbach here this morning sbowed s~m~e ~[~e~ mens of lungs in which emphysema is clearly d~ .,¢mslrated m an inm'~',ed incidence ~n pe~pqa who smoke. ,~nator Mo~x. I c~n ~Kt'ae with you that the public wants corn pl~to and true in~rmatlon, but I must empbasize the point tJtat thew ur~ m~ny who ~re not spohetanert ~or the tobacco industry who an~ eminent in their field who t~ke exception to some of the v~mdusmus which yeu heove reached in ~-our stalement delivered to ~xs this meriting, Thatls all Mr Cha naa'a Tb~ (2~mz~,~I~ ,~enatot" ]~ass~ do you we ~Ily questlonsl SenatorB~ss Oneor woq~mstlons. . . You stated, Dr. A~zerbach~ that ~¢ou had been working stmctly wflh h~ h~mmn experiments on tlfis thlllg~ or hemaan behh~s. In m~t of the l?r~vious cancer res~az~h h~ven't w6 used m~imnls in Ill/lily o~ the tess n trying to predueo ~ eer ~:~d h~ t r ,i~g ~ <ti~'¢~ver ~ e~tre for it ~_. y . . . I)r. AUE~*C~t. Thai IS xerv tru% ~ellEtof The ammal is used m an attempt to be ~ble to fin(| the elemer~ts that praduee e~neer ~nd to I~ able to faxd what drugs will tre~t it. 13ut I kn:ow of no better

CIGARETTE LABELI]~G AND ADVF, RTI$1NG 217 experiment th~L the one Lhat we hays in the il}ug~al being. The C*7 cannot be l~alsexl dlat aRlm~|s ~l~ not human beings. ~ e have tkls eapvrimeat to show that in the human belng~ as you continue to smoke era oD.g period of time and as your smoking hablts m~l~as% there is a progresdve increase in these eha~ges wlth the deve/opment of lung cancer and emphysenm. A in~ if you were to do that s,umo expernnent on an anmml~ remov~ the ~ment and that was regl~sing~ yt)u would sexy thls Is an excell~it experiment. The sa*ftc thing ha pens m hunmn beings. R~inov~ ire agent the eignrett~ smoke.and ~ere Is a regl~smon. No One Can saY this is done on annnals~ show It to us m htunan beings. Senator B,~ss. You say there is a regreesmn. O{ com~ I am no c~ne~r expert, hut accord[ing to the information I have, we have never been able to diagnose a cancer before it actually e~xls~.s. Is this true ? Dr Awr~Acg. For the reason that under the microscoo~ ~ we.have he~ able to see the ehan~es before they ]~come ehnmaHy evldent. When they ~l~ [~l h~icaHy ewdent in the lu~ you have gone to tbe point O~ no r~turn. Senator ]3Ass Is my infox~natinn cvr~ci~ that there is no test that you can perform ell a potential cancer Gainer or p@,tlent or po-~e~sors whichever way you ~anL to put i% that s~vs now you are going to h~xo C~tlt<!i!r~ ~*~r8 have never been able to show that. Dr. Atr£~BAOIt. YOU Call take a piec~----- Senator BASs. ~Val~ • minute. Have we or have we l~ot~ Are we able to diagnose cancer befo~ it exlsts~ I)r~ A~mmACn. Oh, yes. Befo~,e it becomes invaslve. We know the ~amous Papanicol~ou test of the cervix. You rake a sneer. ~f you g~t the presence of c~ncer cells you will fred an arcs ~f precancer- ous lesions as we see is the bronchus. S~mtor BAss. And you can stop the owfh of them I Dr. A~S~CH. Yes sir. This has ~e~a one of the greatest ad- vances in medicine tod~y~) the development of theverifie~ P~ amcolapu test, the ability to make the dm&mosis on the rehear, in the hm ~sy, remo~ e the cervical epithelium or if necessury remove t!~ enth~ uterus and prevent that indlvidmtl Senator BASS. This is an iseluted typ~ o~ oaRc~r you are t~]king ~bout. Generally speaking~ cancer-- IDr. AUERBACH~ Sir, that is ~ very important cancer, and i~ is im portent to the one indinidllal who develops in Seilai~)r BASS. I ttrtdcrs(#tlld ~bat. They are all dangerous and the)- are u]] impor<~nt. Let's take other tyes. Are we ahis to dingnose the start or t~e gD>wth of the cancer? Dr. ~ImAO~L Let US say this. If you were to take a b[o~)~')'~ ~ nlove • pie/2~5 of tissue ~r~ifl the hror~e}]ns~ l]jtd yell hllve HI tll~tt~ bronclms all of the eh~u~g-es which I showed on th~ slide you ean-- ther~ are lm clinical si6ms to te]] this ~ndividual--tell this mdivldual that if he stops smoking his chances of not developing cuncer ~re ve~3. good, provided thez~ has not bee~ au Jnv~ioll already. ~ella~Of ]CISSS. (~atl YOU say Ef ho doeq r±o~ stop smoking chat h~ definitely is going to ha~'e cancer ? Dr. Av~ac~z. I think, Senator the important thing is this: %Ve suffer from the 1 us on that when ~n ind v dual smokes there s no d5 ~h7~6S pt. t 1~

218 CIGA~ETT~ LABELING AND A~VERTI*qL~G change ia the rest of tile b~vuehial tul~s. The enti~ tracheal bron- chial lining is damaged, His lanlg is damaged. So I tiffnk it is important that when h~ stops smoXdllg, we Imve seer ~ re~Jslo~ back t~ward nozTaal in the vast ma ority of ,in s't ance~. Senator ]ghss. The question the initial premise or question I wanted answere*t is Ihis: if we have MI of these testa of human beitlgs - an mas have been used in )ther succes~u te~ts in the d ~cowry *d i'aul'ar wh~ is it that smokb~g has n~w~r produce*l c,.~u'~ Tin,re is no Jesb [h~lL shows that smoking produce.n Caile~r in a~dlnlll~, ]Dr, ArmRBACii. *qenala~r. Lhei~ i5 evidence []l~ii cl~Ii(5~y ht£8 be~ll [}l~-- clueed by the ndx~uxe of far*. and there are now the r~ason that thel~ 11~8 h+en r*o sllcoesS*eli1 wa~ Senator Bass. In the lu~tg% DccLor Dr. ArnU1~ACTI Y¢~ In the bronchus, or the bronchial tubes. Th~r~ has been m~ s/Jc*u,~sf'/N way uI to now oI ~effSng F~ I.cg an tmrI tha~ ) m c:tn smoke long enough, comparabh~ to r~le hunmn being, so Lha~ y ~u Call develop the cancer. Tbel~ are seve~'al experiment~ thug are now lmderway. I tidld~ they may tun~ out t~ be ~he answer ~o yota 1" qtlegt lO1~. Senl~tor B~s. If Lhe~re ].~ all ~n~wer to it 1 hope thai we can have it. ~c~y hlforTflgt]o]l q h~l 11 ~C* ~hi8 ~ )litIF we i~J%~! Jl~,~[~[. [~(~n ub] to produce a emlcer o~ the lung in nn animal by the inhal~ion o~ c~ga~tt e smoking. Is this true * Dr. Au~m~t¢~. ]gut we have been able to n~0duee i~ in the human being: and tiffs is the best a~finm] that we have with which to work, ~3kllg I doll I Hle~ll t~} he fa~(~io~ Sena~M)i'. This I5 serious. The (~.~I~I~AX. That is ~ nmLfi{~r ~f op]nlon, ] )eater. th~g I~l.z~ sum!- meat. }lgybe you want t~ehan~,~,he ~t*~txl. Dr. A~r~. This is my ~pmi0n~ S~n~tor. Senator liars. Ha~'e you started with ~ hmmm bein~ who dlchx% smoke and sf~*,d him sineS<inS and plx~duced cancer 1 ~t that what you mr~ g~y ngg Dr. Atmm~Ac~., ~Vhat I am saying, Senator, isth[s'Thagif yo. don't.. smoke, you have very few clmnges m your btonetu aI £ubes. Senator B~ss. ~v~n inpo~lluted areas? Dr. A~c~. Even ~q~er¢ ~bere is a~r pollfltion, Senator. We have oO/flp~l'~d l~/'bl~n Itnd ~irn] al~sS $/Id we h~verl~t ~ol/~id the chancres, ~2~1~ h~V~I~L*~, f~MiHd dht~lll ill II~e1 W~ have~l~ ~0und then1111 i~l~[ll]~t~- tlon. As the smohi~rg h~blts of fltese individuals h±cre~se, thews changes increase p~)~s~ive]y. AJ~d I c~q~ldn't think of a better tr~I for expei~ment th~n this one that we have with human beings. .4rod we haw th~ gdditinnal factor that nobody can s~y you can't transfer ttiese fred rags to llie human l~ing. "~% e h~ve t~m right in the huynaR being. And when they stop smoking, bptmtor, there is ~ rcgr~ion. Senator BASS. IIow l'ong dc, es it f3rhe to no[ise it ? Dr. A~.xcn. We use I0 years of prc}gt'esslve smoki ~g and b years of being an ex-mnoker. Se,a~r B~ss For instarce if I shake the habit, how long will i¢ be befe~ )ot~ notice a ehange ! ]Dr. Atmi~n tc~. We lu~ven't gone int*o tile exact time, ~V~ coal te]~ you ~ha~ at the end of b ye/~ ~ your br~ c n linin~ ~*i11 sho~ s g~at number of regressive chantys. Senator BAss. ~Vill k be r~st~red ?

CIGARET~fE LAEELIN(J AND ADVERTISING ~]~ Dr. &,~,nn~crr. It rim3, be after more sam more years. But at the vud of 5 years there will be a great chsalgm. Se ate" I ~ss Hf~ve you worked in the s afisdeaI st~d~ a~a? Dr. A oxsz.xcH. Senator, I am ~ patholo~gls'st by vocatiol~ and avoe~, tio~, I am ex~mpletely strsalge t~ tim field of s'mtisd@. For that r~ason Dr. Ilammond, ~lao is a,qsociafed with tim study does all of the st ~tistieal al±alysc~ of our fl ndm~. Senator B*s~ H~ve ~e run ~ny tes~--I haven't been able to fl,d th~l]l--Oll g~l~ }~r-c~* )fia Consunlp/ioIl of Ci~gl~bt~e lllcl.e~l>~ lor e.,kam pie an cerl~il* areas or eerh% n ~tates~ its they nmreL~s~ the ilteidence I u lml~ cancer increases pi,vporCionutely ' I)r. ski IIIlUACIL ~OR k±loW~ buck ixl lhe ~SJllnor terrih~r~% ~g/m kite/'* Iht~ It wldPil~U~ D~ hlll~ c LU(~F lb; F;~ [ ¢5. ~'0U also kllOW ilt [ee]dYtd. l~¢fore thlt Alueric~tllS (~lllm ln~ the3 li&FL fiitd R]P.- evidenex~ ~,f lun~ eal~eer. With the habit bec~omh~g prevalent, the~ found a lnctu,asmg tluniber Of eggeg of ~l~j/g eaDcaar. ~o 1Y~ ha~[~ two i ~r} good a/'ogls re answer your questiom ~ellat~l' B~sg. Hav0 you looked at ~ttllel- Clllrlg~e~ ~0al, a!X¢ ~1/1] ar to tho~e? What uts/ut for ext,mple the gre,lt ?~iozlnon concen/rst tot~ u~ta~,Jbeleve. Istlmre~sln ~ll'~l~til~fJlgI lasgnt at, web, thor ~ortditions and so finch that you comlealed it with { Dr. _&t Va~IACl~, I hltv~ not, "1 ou asked 1 a e there line ~lllile~ Tiffs is all I krmw, and I know from tale lftemlure, hi) own work has bee3~ limited to the mate~ml ~t the Vj~ ho--!la[ iu Ea>~ Orange~ l~IId to [[ other hosplc0,ls llx *Ne~: York ~tsce wllieh {,~a~pe~lued wittl us in thi~ sl udy. Senator Bass. Doetm', my qnestions~ I am askilt_~ for information I don't want you t~o think that I sin qeesraorung any ff volr work becsuse you are doing great work. [ )r, ,kv~ex~ac~:L Tha~k VOtt. Senator B*ss, Mv fath;~r died of ~areer at an e~riv sr~g~. If any one is interested il~" H~iug Ii~ lhnl out, flm cause ~trll) cure oJ" (~lncl!r, I am one of ~hem. Hc dhtn't die wisk lm~,g e~ll¢~r. He srnokik[ l?lOSf of his life. lie quit the latter paa* of it. J:Ie died witli what is called a sarcoma calmer. Do ~ou Ilndersff end Dr, Ar~e~,ac~. He di&Ft die of sarcoma cancer. IIe died of Sat C, Ol fl~t. Senator B ~s. ~Vhat ~stha ? Dr. A~emacm barcoma~ there are h~o lypes of 1 .ing. One is what we call fl~e epithelium liMng, tim linhlg, the coverh~g ol the sk. it the.. lining of the larynx, tim esol~hagns, '1't±i ~ ls cancer, eplthe lmm hnmg: and emteer f~rms from tk~s. ~ilen ~i~l~ i8 cornealive tic, tie. lrlUgC]% ben% connective tissue. V~'hen a tumor deveh,ps, tt mMi~mann tumor d~velops, it is eMled sgreoma, ~,lf~ consider ib as a n/~fig~DJiL tUll~or when t~le tl]lnor e~c- te ds beyond the original ~ite and travels to other parts of ~ e bod~ eft hm" by" con tin uiiy or by ,~'~ of eha~mMs of ske body "~ .enator Bass. Ha~e you ~omld any w~y to dlagno~ the poss]bfl t~ of this type of cancer? Dr. Av~rmactf. Sarcoma of tim l~m~ is ~q paze as hert's teeth. Senator Bass, Outside of the lung arm~ I am talking of othe~ forms of experiraents with cancer. Dr. Au~AOu. 'l'her ~ are certain experLme~ts-----

CTOARLW~E LABELING AND ADVERTISING ~en~tor BAss. As an example my father% calmer started with a knot on the baok of his neck. ~n we deteminm by taking certain tests in the human lwdy that this is a potentlai cancer ? Dr. A*r~¢H. Probably at the time that this lump was noticed in our f~tlmr's neck this was already in its mallun~er~ant state and a Y blopsy~ a piece of tiss~s taken out and examined the mlolwscope~ gave the diag~aoais and tlm prognosis. Senator BAss. Is there any way for us to find out at this stage of cancer experimentation that there is a likely possibflity~ befor~ the lump comes-- . . . Dr. A~P~ACH. Senator, you are talking of that in two lmpostant ~reas. One cetwieal and two~ the brollchlai ep]thehum. If we examhm ~iffs tissue under the misc~x~scope and see that all ehan~es look like oancer~ but it has not yet invaded tlu~u h its un~lerlymg memiff'~ne7 we can say there is a pote1~tlal for ~iis mdlvulual to develop lt~lg e~neer 011 the oile hand~ or ee, rvlea] eano~r on the other. Seaator Bass. Lct~s get to what we should do, as the Congres% as the Gowrnment~ or as nldividual% to try to discover at an earle stage ~vhatewr kind of cancer we have how we can prevent it~ and exactly what we should do to educate tba people as far as she lmzards are concerned. Do you thh~k that the labeling of a package o~ cigarettes or the advertlsiffg approaoh is the best ~ roach to thls ? Dr. Au~am.~CH. Senator Bas% ~Pdon't know what the best ~pproach is. But I do know that the info~atlon now available ~hrough every means should be widely disseminated tOCarli~jthe opaiaimn~ youn~K and old. What the approach i% I think Dr. lms made a study of tiffs and he is in a much better p~-~4tion to speak of this than I am. I do think the pub]h~ should be edu~tod comphtsty, both to its dangers and what can help. Dr. ~,LUm. I belisvo that labeling is one o~ the tldugs that can be done to actively keep the problem o~ lung eanoer before the eyes of the ublic. It is not the total answer to it but ib is one of ths th~mgs t~at can be doae ~o help us in gaining control of this problem, Senator B~as. No tin'thor questions. Se.ator PmSTO~. Doctor. you may have c~vered thi% but I would like to ask the question direstly. As against tlm uo~smoher and the smoker who ends up with lung ca~cer al~e thence certain definite common oharacterlst es in the aancer of the smoker as agam~ ht~ cancer in the lung of the nonsmoker Dr. A~m~CH. Senator~ there are two forms of cancer that are closely associated with smoking. The words tba~ are used, one is the oat ce]l~ and the other is i~ ~uamous cell or epldermuld~ meaning a sheathlike epltheliunb or hml~% that covers the skin, and that wh~sh norm~Ily likcs the nmuth. . . . Senator p~svoP~. On that paint, is there a d~ver~nee of opmmn of clew withik the medical profe~sion~ or is that a ~roven f~act ~ . Dr. A~c~. I would say that the vast malor~ty of ~be medmal profession is of the view that cigarette smoldng and the development of these ~orms o~ cancer are very c osely r~lated. On the othee hand there is another ~orm o~ cancer which is ca]Ied glandular cancsr. ~his does not show the same *~]atlonshlp.as de bhe other two forms. So that the latter is capable ef c~urrmg m

CIGARETTE LABI]LING AND ADVERTISING 2~I the nonsmoker; the other~ a r~e ~urrenee~ indeod~ i! it ever d~ oee~lr without ~mokin . ~enator PAgro~. ~ould you describe, for the purpose of lhe record, a little more gmphleally the charaeteristie~ or the appearance of the brolmhiai tubes of az~ individual who is a habitual smoker as sgainst one who ~s not ! Dr. A~l~o~. Ye% sir. i cannot only describe i% Senator--I don% think you wel~e here at the tmJe I showed the slides-- Senator P~Tor~. Have you shown themt • Dr. A~cg Yes aln But I will be ghd to show them to you~ Senator. We se~ here th s s what a normal bronchial lmmg lc~ks like. Two rows of ceUs. ~krmnged tmiformly, the cells ~'e of the average slze and sh~q~e~ and have the same staining sh~racter]stie.. 0u the other hau~ when a man begins to smok% he shows an m- erca~e Ins ead of there being two rows there ar~ f~mr Lo mx rows. You notlce that there i~ an irregular folnilai.mn of the eel]s, Senator V~sro~. Is that a common sh*~r~%tic that you find in every case ! ..... Dr. Aux~u~om Ye~ s~r. And th~s is the m~portan~ thmg~ that ]t doesn't jos~ oe~ur in the indirlduaI who develo s l~g cancer, but occurs in smoke~. ~d there i~ the great ih~°erenc~ between the mnoker and the nonsmoker. And then, ff he goes on, here is what eventually may happen. Ibis is'tbo p~eanc~r~us lesion tlmt Senator Bass and I were bdking aL~u~. This is the one where the membrane is stillupre~enL And so we e~l] k precancerous in that it has not yet penet ratt~l. Senator PASrO~m. Is that a common ch~rae0eristie ? Dr. A~CH. Ye~, sir, it is a c9~rmmn sharactel~Sllc. And not only t I~ut~ but if you w~re to l~ke th~s area out ~f context and submit it loa p~tholog~st and not tell him there is a memin~ne bore~ he would mortt k~toyou~eaneer. ~ut we call it precancerous because the membrane is still inteet and it is still confined within the s. perfioinl surfaee. Senator P~sron~. Did you ever smoke cigarettes Dr. Am~n~OH. yes, sir~ I eer~ainll flld. Senator P~s~o~ Do you ~noke e~garestes now ~ Dr. A~ACH. I smoked clgaa'et re% Senater~ until I saw the results of the flint report, and that was the last cigarette I ever had. Senator PAs~o~m. Tha~ leads me to th~ next q~testion. Has a po]l ~ver been taken of doctors who, themsehes~ stopped smoking c~ aret~es after the report of 1964! ~r. ~u~w~. I am not in po~[iou to I~ow. I am sure that there have been r~porl~ But I ~dll tell you rids Senator: I have been t alkilt/~ on thls subject for a long tlme .wkh ~octom. Usually at the beginnmm~ when Ip~resented thin nmterml and walked into the ~om~ everybod~y was smoking. And at tbo end of tim ~lk aftor they saw the]a~ alld% nobody w~s sunokhig. That dldn~t last very long. Many of them con tLuued the next day or the next week. You walk into a medical audlenee today and ou may find about 20 percent or 80 percent smoking, and mo~t of t~em smoking cigars or pipes. So that the medical profe~sinn as a whol% in support of the statement that Dr. Carlile mad% the vast majority of dcctors are Ik~lly aud firmly convinced by ~lm evldenee~

---

CIOAI~ET'TE LABE*LI~G AND AI)VERTI~LNG 223 X%'}~af do you ha~Bt~ say to that I Dr. AUERBACH. Senator~ when the maj r ty of tlle Senate passes l~w~ it f.hen becomes the law of the land because die majority did. IJ, the debates~ which a~'¢ often aerim~m~ous~ you get some real threats ~11 arotulcl the line, l~ut when 7{) percent or mo~ o~ the med~caJ pl~fesslon becomes convinced~ I i~hlllk you haw ~n~re tha~ ~trffieient evider~ce that there xs somethtng t~ khat. Senator I>~SToR~. In your est mony you ~I]V re~ ze what i~ at ~t~ke here, econol~l~cally ! Dr. A~J~m~ca. Senat~r~ I took the o~th of IIippocra~c~, and ~]~at is t~ pr'~ i~:t ~}Le he~ltll of t~t¢ hunmn being~. This ~s lny o~ [:~ conc~l'n. Se11~/~l~- PASTOIqE. Doct~r~ I W~ll~t tha,~k roll v~ry~ vt~rv mllc~l, Senator I4~rtke ~ Senator II~l~. Doctor, I think you ~r~ • very per~n~sive witness. No question ~bout that. Dr. A~±<!H. i ~n~ persu~s ve ~fl~r 1~ years o~ study~ day and 3~ight~ over this l)~'ia<l of time. Tl~e evSdence is overwhelmint,~. I n~ver di~eus~q lt~ Scnll~l)r, ililless I [/m asked • question. I do no~ as ~ou probably k~ow~ ~tt~mpt-- Sena or IIA~T~. On one situation, ][ havL, n~t stop ~ed slnok~ng~ so that puts us in a diiferc~t c~le~ory for the vei~ simple reason that I never started. Yet T w~s it~l!d Lo ctlt down oll lny smokill~ by a ~t~tfth~'i" ~f t~e qn~(li~Iprofession~ter~hysica}examin~tion. ItoIdhimIcottlclnt 3~ecaus¢~neverlmdsmokec'[inmyllfe. Sol uno~a ~ormedaddlct, This skillful camp~i~ who is tmlllng on the ~killfuI c~mpalga ~h~t you ~ferI'od to Doctor? I)r. C A ~r,J T~l,~. Th~.s~ I~f IJ~ w 1o are concerned ahout ~e health of th~ ~N~t ion. Senator I~R~KE. This is the revers% as ~ under~t~d it. Dr. C~R~. The other ~ide ? ~ep.~tor IIAI1TW~,. I~ iS O~ )~Lge ~. YOgi r~t[d~ ~IIow~v~r, over tllfz ~y~tr~ ~ you llbl,~tu Vi)ll h~tve a ski 1~11 ¢~Illpai~n~ too Dr. O~rmr~E. This is---- Senator HA~v~. We have ~wo skillful c~mp~i~s go~n~ on, r~ht ? ~*~ho conducted this skill fu] campaign on pa~ ~ of your st~teinent $ D~, CARgill. I thin~, wi~houl ~l doubt~ tltat it ~s the ~obac¢o indus- "~enator IK,~. Andyo feolthat theyare usin~pubIiarela~ions .effoctlve]y in thelr ~i~or~s to overcome tbis~ Can you exI~h~in w]lttt tecln~ques for examp]e ~ Dr. ~A~LILE. ]~V thi~ I metln if Villi l~ld the o~tlt'~ coI~t~ts-~ I ~m r~ferrin~ to th~ ;~d~ e~'tlsin~ professlon employed by t}~e tob~cc:o industry. ~he cxl~n~lltllre o~ I think the figure is, $,940 mill±on a year ~ow. ~u the utillz~tlon of the~e modern ~echni~lue, of persuasion that ~re being developed in this co,retry. ~.d ~hey ~re ~slng them to se~l ~heir pro~,]c~ which ~'E~ i!~m~ilh!r |l~tI'frl~u|. Se~l~tor H.~rKE. Im~mde~tood. It ought yon i~eant that thev hacl a skillful cal~lpaign ef plan~ing doubt, no~ • cmnl)~i~n to ~dvcrti~ their product. I understood it w~s----- D~'. C~ra~. I mc~n both, sir.

CI~AIa.~2~ LAR~L~tG AND ADVERTI~I2qG Senator I~. In combat Dr. Camblt~ ¥~s. ~enatol, FLA~. This is what I had r~ference to. I am not tgI1dn about advmgising itsd f. Because, mfl~ I raised your ~tem~t, ~ gathered this was th~ skillful eamlmlga that you had reference to: "the teelmique 11~s been to tlSO with great public relations effeetlvmaeas a Imn~al of phy~a~s who are not eotl~need" and so ~or th. Is this the sole skillful campaign tlmt the tobacco industry is using ~ Dr. C~ILe. This is the context in which I used it here. Let me go b~k ~xtd readis: However, ovex the years a sklllf 111 ¢~Itlpalg~ h~ ~ollgh$: to blur *11e evlde~ce with ~ ~maok~ cloud of conftlsto~. ~a~]a ~ew pi~ o~ r ~al~h, each new gUltlEfl~ry ~ e'Nden~, has been art ricked ~t~ what ~e~a~ IJ~e ~ton of ldm~.g d~t~ot~ of leaving t/le l~dlvl~ual ~e¢ to smoke o~ the gromads thRt sei~ntlsLs coMd not Se2h~t or H~T~!. H~S this been a promotional campaign, an adver- tising cumpaJgn ~ ~]t~l'e is it ? Dr. C~I~. In a se~se~for instm~ee, there is a bulletin that is mailed periodically by the tobacco industry to every phy~isinn in tla~ cotmtry which deliberately seeks, in An~eris~n literature and forelg~ literature, through ever] conceivable piece of evidence that might b~ contrary to the a~oclattou o~ clgare~t~ smchhl~ a~ld lung cancer, and tends to magafi fy this and present it in such a way tha~ iS a~umes more Lm ortanc~ tlma it ucta~Ily dld in ske original artinis. ~°~ator II~; Is this that "~aoky cloud of confumon"? I~a't there also mat~al going out on thresher side in your ski]lI~fl cam- pmgn, if you wan~ to U~o those materials, to show exactly that ? Don't you mail out publications to the medical profession ? Dr. C~LIL~. O~ course we do. Senator H.~r~. Is this a cam~p~aign, is youm a e~mpaign to create conf~mion on the other side of the fence Dr. CARUlX~. ~, sir. It is a campaig~x to neutrai~e the confusion that is heing cre.ated. [Laughter.] Senator l=~A~vm. Do yea mean we have confusion to neutralize confusion Dr. CARIZ~X. I thlnk f]xevo ~s only con fusion on one side: Senator tIARZ~L Really, this m somethintg which is noS so lmW, where ytm be.re advocates on both sides. Really you accuse your optmnenfs of k~ving a scheme, and you have a plan. This is not m~common~ is it~ Dr. Cax~im~ Not at all. Senator Iff~R~x~. What you are saying in substanc~ is that the tobacco peo)piele have a scheme and yours is planned. Yours is based on faats, and ¢heir~is bosed On imagination. We are trying to ~tn'iv~ at the f~et~, and this is th~ taring vchich I ~n reaEy concerned about ~isntific medical ~aets, as best tlxey can be ex- pl ~hie<l 4n ordinary lav~nai~ terms ~or the members of this oommi~tee at 1.east, ~o that we can make a dec~sinn. . . 1'o accuse thsm of • skillful c~rnpaign,, to blur the in:fprm~tmn and to eonfus~ the ~a~t~s thc~8 in and of themseaveO at~ inflanmmtory statements az~d do exact y the sam~ t ~kug t~$~ ~o~ aro accu~ag them of debug, aren~ they ?

CI~ARETT~ LABELING 23~D ADYERTIS:I2W~ ~5 Dr. Caaux~. Po~ibl ,. I think that we are playing for big stakes her~. We ar B play/rig ~)£r l,he Iive~--- Senator lt~Rr~. Not playing. This is not, a game for me. This is real, s~rinus business. As I said, as far as [ am c~ncerned person allp~ it won't make me s~o)e one more or oue less c~arelte~ because Ihavenoint~nt,onofmnoking. Ineverba~m Iam]ustnevergomg to s~;arl;. t have seven elfildren azld not one of I~hem smoke--as far ~s I know. NBitimr does my wlfe. As to v~m elgaratto industry~ they wiJl net maheaper~mly out of us. Wouldn't we be better a~lvie~xI ba take all of thes~ side ~nes and push them asid% aad come down to what I thought ws.s informative to stay wifll the fuels. Let him present his situation. I~ therB is a decor who has an oppos~to view based on facts, lot him p~s~nt his c~nclusions. I ee~1 nothlnff to be gained by putfi:a~ on skillful campaigns on o~e side or th~ other. I would hope that ia the ~utura the witne~ses, as far a~ I ~m~ eom~nmd~ wouhl axoid the nc~essity of h~ving to constantly brh~g tkls up. Dr. C~r~s~ I balm, sir, yau raise this issue with the tobacco witnesses. $e~mtor H~a'~. I well raise it wkh anyone. ] don% think I saris fled th~ ~obacco people completely yesterday either. 1 am not in- t~r~shid in trying to satlsf~..I, am trying to ~nd out emmgl~ factual reformation from the autlmr~t~es in this situution to either make a d~c/sion to affirmatively take action, not to take actio~h or to take, i£ Y ou are going to take so~e action, what it isg~oing to be what shotfld be done. That is what we are interested in doing het~ I hope. Yotu, statement on p~ : It is iml~rmnt ~or the public to know the facts. Tim whole context of the first two page~ leave me with the impre_=sion that for ~n~e raise2 you had to discom~t what #hey were goj~ to ~y, Aa~d t would hope that fl~e people on th~ other side would avoid doing the same thing. L~t me ask you on p~g~ ,B~ you ~y : T~e thn~ ~or ~at o~er the evldenc~ is ]aagsed~ouly the spol(e~men for the tobacco industry are interested ia pumping life hate thia argument. Would yo~l really wl~llt ~.o s(~l~d 0rl t~ll~t statement~ on ~be word a~x[y~? Thewordlqmly"isave~r~nimportaz~t word. Dr. C~m,~m. I agree, sir. I thh~k that the word "e~dv" is probably out of place there~ because I thb~k that we have to e~ne~ede ff~t there are todl~ idlmls ruth d intea~tto;a s~d sound conviction who are ~o~ spokesmen for the to~ industry, who do hold this ballet. I thlnk your commotion i~ justified. However, I do feel tbat the preponderance of activity ~n this dlrec- glen doe~ axpected/y come from the tobacco) indust~ and when it s found, it is nurtured, it is supporttM, t s en~ ched n an effort to make it as effective as possible. Neaator ~I~. iIoctor~ wouldn't it he letter, cencerning i~ost of us~ if you wou]d perm b us to make that dec sion as t~ ~ }iaL personal ax anyon~ might have tog]rhld, ~r what pei~onal enl'ichm~nt or wlmt personal backgrom~d might be tim basis of hie decision and permit us to make this declsion~ After al[ you at~ aa organization which

CIGAI~ETTB LABELING .~FD A'DVERTI~INq iS intere~t~ in ¸human h~ith and the care and tre~tlnenb ~td" eh~nafion of can<~r. Dr. CARL*~. Right. Senator IIA~T~. We are nol here ~o tr7 to heJp the tobacco in- durra, or to halTn the ~ob~cco industry.¸ We are trying to do some- thblg'abou t cancer, is that right Dr. CAurXhn. Right. S~nator HAm'az. ~o at least that rdon of it is t~,t.ter off for tim sak~ of those witl,a~s~ whq are not ~ffe;r% it m~y at Ie~qt be modifls~], or fhe ~ ord ~oul v" .~ rlckon, is I ha~ true ? Dr. C~m~i~.~ ~ wotdd aeeep~ the strlkh~ of the word %nly." Senator HAn~. LeL% se4~ if ttmt is al~ w~ should strike, dmug'h. Let's see if it reads well: Tho time for arg~hig over th~ ovld~a~ is l~s~4 The ~poke~nle~ for the ~oba~0 ill~lll~Lr$, I1~ interested 11~ DUmDing ]if* irlto *hzs arg't~ement Today. we m u~t take act3o~ to w~in rile public agaLnst cl~nir v~r. ~mOklDg. Th~ is ~he context of that paragraph. I~6 ycm svi]/ fltink ~ha~ tha~ is a lil,I le st tong Dr. Caraai~. If an "thing. sir, 1 don'~ thluk it is ~trong eno h. . S?nator IG~. ~ou ~i',t spc~lMng for the AmerlcanU~aneer ~ocmty, arrd as ~ physm an and radiologist. And you split w~mt ~o go' ahead and say~put the. tobacco, industry, in a poslblon, wlle~ .you feel that wb ~t dm~ are t*Ting to do Is to solely pump life into ~he aa-gument rather than finda etu'e ~or cancer ? Dr. CARU~. I do Senator II~J~. Thoso ar~ sll d~e questions tha~ I have. '1"}~ ~IL~II~IAN. If ~heDz ~re 11o fllrTh~ cpt~stion,~ Dot:~or. w~ apl r t, elate both of you being here. V,% will hear tod~y Dr. Daniel Jsnklns. dhx.ctor of the Natlo*m[ Tubemul ~i* Association. ~ro will },ear f~m Mrs. Thnmas Ko~tze~ nexL S~A~I~£ Ol~ DANIEL E. ~ENKINS. DE~ECTOIL NATIONAL TUBERC~£OSIS ~SOCIATIOI~ vey ro you the expressmn of ~pimon of ~he Natumal Tut~rculos~s Association, and my owl\ feelings. .... I am a tloctor of medicine, spec~ahzmg m pulmonary d~soasos an& profe.~sor m medichm ~t lJaylor University (k~lleg~ of Medicine at IIouston, Tyx. Ta)r±classifiedin~his~roaasateacher, aninvesti tor, xI~d racrz~Jo!aer. Iamh~r~eerlainlyonbchalfoftheN~tiouai~ber- :H 0sis Association. I am • lllOA~lh~r o~ t9 boart of d ~ctors an( have bee, n for the past 7 years. ~['his or tII/za~l on also Ires a medical section kaown as the .Klller ie &n Pboraeio ~{t)ciel y. I h~ve had the privilege to sop vo as a pa~t pre~klemJ~ )f thag orgauiz,~tion, and I ~ln c.rrently the ehai*~sn of its ad hoJ corn*rot ~ee on mnoking and health. Since 194. I here been chief of tl~ puhnon~rv disease ~oction Jefferson Davis Hospital, ha Houston, Tex. ~h~ce)949. I haw been cor~sultan5 inLJ~ulmonary disease to the Veterans' Admlnistra~ion hospitals in /4ousf~n ~nd in qemple. And sinr~ 1952 I hgve been :onsu]tunt ~n medi~dne at Brooks ~krmy Itospital in San Ant*mi(x Tex~

CIGARETTE LABEI~ING ~ND ADVER'I"I~I~ ~'~ A detailed list f~f my qua3iflcations is attached to Lne sratom~n~ filed w~llt Lhe ~omrnn*ee Cert y s p* nclples embodisd in the text, of th. 16~islation pr<q,os~d in bills S 547 and 559 ar~. ht the [ipinioli of tbe National Tubel~aulosis Association: and in my humble ~)~lt definite opinion, certainly sound, and are fairly alld dearly dil~ected toward serving tile best 3n|e1~sts of the pop alauol~ 0 f t his eotutt ry. . The National f'ubereulvs~s Asst. ±at±on is r£is N~tmns oldes~ na tinnM voluntary |mall,h agency. It ~as ol~anized in 190g, Its prt mary ob e~,t vc~ an~ lhB cr axlicatinn of tuberculoals and the pzevcnt bm and eonU'ol of [11 her I~splrn~oKy diseases, Policy is determined by ~oinntccr [~grrd of direetors--lll leadll~g citizens from a]l over the Natkm The Nat o al T ~beroulosis Association has a broil t prograIh of ,ublic education l inform vhe people about TB a~ld other re-viratory ~iseases To improve ~la~ Nation% health NTA also cooperates with other voluntaLy and G o~ ernm~nt ?g~ncies.. . The ~N atiolt~l Tttbet'<A11f~sls Association p I'O ~rldes lelld~r sh Ip for 8o111 ~ 191)0 ~ub@cul~G ~goclallorrs working in the 50 States. Tlu~e Stai~ and local associations carry out NTA ot~ eat±yes in tbeir ~,wn loc~dkles. A medlcal arm the Ara~rlcan Thoracic Soeiet~ bas close to b,0~0 mem~rs--prhacJpally chest speci~llsts and if6 ~tate .~nd *~gmgai ~eetJon~ Thr~mgh ATS. the ~Nauonal Tuberculosis Assoc~aL~cu~ stimulates aad su ports medical education and research ~elat3n~ re tuberculosis and ot~r *'cspiratoD" clist~ases. . Our" infe~es~ l/l (igarotte s[nl,l~llig ahd m LI~. ~muk±ng probl~tn generally dates btmk to £1m 1950's. .~t tlla~ ~ime sufllcien~ ~vldence httd M*ead~ accumulated to seriousb implicate cigarette sna~,k ng m number of respiratory di~ases. By 1964, when the Surgeon General's A dvis~rry Gt)lfllr±lDOe on S~q~1¢ in~¢ ~and /~I~akl* made its report that im di(',~Lion imd be~n amply corroborated. In substance, here ai~ [he facts about clgarecte smpk- ing IInd l~'s )irlrtol%" d ]se~ ~,~h~t elf±erie ~'on] tlle zoPOrt s exhauslive.]~ ~ L Cigarette smoking ~s a major cause of chronic bronchitis and Iung cancer u9. Thes~ aides, as kill Inllny ]lll~ iI]Ol~ Cl~ar~[[~ ~/lloker$ ~bal[ l~(Jli~,]l Iok~ ~b 8. Cigarette smokin is aIs( ll~ked wibh ptl lnonar~ euql vsonla and is associated with ~¢ath from emphyser*,m. ¢ 'lhese findings ~f the Sur~oi* Qe±m*'al s Advisory Committee are fulql.~r ,'in/~ll..'lltcd by an(Aher ex]taustive study re~sently ¢oncluded by the American Thoracic Society. Its repor~ will soon be made public, and corroborates ascent±ally in impo~a~t details the findings Of tile ~ tR~r~Ol% ( ~ ~neral~s Q~ol illnl~lse~ Tim Cn*tR~L~. D~d you say dm Findings of the S~rgec, n (}enerals Advisory Con~aittee llave been corroborated by this study and ~t will soon be'made public? Would k b~ fair to ~av, for the purpose of this testimol~y that generally s aking you a~e in agreement ~ith the burgeon General's Adviso~:y ~eo~rait~ee report ? Dr. drN~LWS. Yes sir, thaL is co~rec~. The Or~Am~az,~ Its findings

CIGttRETTE Z, ABEL1NG ~D ADVERTISING Dr. Jm~l~l~S. Yes sh', that is oorrect. The CHAnOIA~. ~l~nk you. One otimr que~ion. Your internist in cigarette ~nokblg dates back to the 1930% IS that because in respiratory cases and diseases a slclaa usually advises the person not to maoke or irrtiain ~ny con- ~ith~mmn( tha~ may exist t~a ~ te that usually the case ? Dr. J~s. I think our hilea~est TheCg~a~az¢. Ofalltyl~ypesoof diseases. Dr. Jr~NS. Yes~ I think that is true, and I think our interest on the pa~ o~ the ~Lmlml organization stems from iks£ f~t that i~ was very clear to us then and is now t~at cSgal~tLe smoking makes wom~ many respiratory illnesses. The C~n~A~. I suppose smoking is an indtant ~ny way you look at it to hmnan tissue. Dr. JE~JZ~S: I~. The C~R~. W~nereas the C~lccr Society got mer~ interast in this since the studies have been coming out~ although it wm~ founded w~y back, the National C~neer Institute founded in 1937. I don~t like to remember back that far, but I was the author of the bUd. That is a lo~g time ago. Beea~ of the type of w~rk you are in~ T SUpl~Se that you would generally prescribe.re .Pe°~le who hadJ).rab[ems of any irritation smoke, nit types of ~vrltatlonsi that smoking would not be good for tim patient. Dr. J~s. Tlfis is true, particularly wi~h regard to the respire tory tract. The C~targ~aw. Go right ahead. Dr. J~r~z~s. The respiratory diseases associated with cigarette ~aoking represent a major threat to the people's welfar~ They a~iet man millions of our citizens, often resulting in long-term disability ~at is suve~ and eos~ly. Disability payments for emp}iy- serna alone--the third leading cause for whish Social Security dis-. ability benefits were paid in 196~---amotmt to an estimated $60 mi]llon a year. The CH~A~r. Will you put in the record for the benefit of every- on,your beet medle~l description of ephysema. Dr. Js~s. Yes~ sir I will be happy to do chat. The ~m~.]~. For the ]~yman. We men6on t a the time. I think it is a lltt!e unclear to a lot of people jus~ how much i~ covers. - Dr. J~s. Emphysema is a distention or enlargement of the terminal Mr spaces of the lung known as alveoll or alveolar sacs and a breakdow~ or destrae[inn of tim walls of th~se sacs. So that it carries, th~ two thoughts: Enlargaraent and destrustion. Is that clear? TheC~t~. Yes thaflisclear. Is ~bare a ~ur~ for it Dr. J~cza~-s. Once the inng sacs ~1~ destroyed they ar~ i~wevoeably destroyed. There ~s no cure for emphysema. The C~a,x~i~. All right. Dr. Jsze~s. In 1968, emphysem~ caused well over 1~,000 deaths. Two decadt~ before~ tifi~ disease was ~pr~ctically uni~mwn. Another 3 00O deatlm a year a~ due to Chronic bronchitis, a sitm~t~on clasely a~soc ated with and oftentimes occm~ concm~entiy with emphysema.

CIG~mETrB I~ABgLINO AND ADVER'rISING ~20 However these statistics are deceptive. Mortality figures are based on primary cause of death they give no clue to/he number of deaths attributed to orJmr causes to which these ohs~ructlve puhnonary diseases Lave eon~rlbu~ed. But sample studios indicate that chronin bronchitis and emphuysema may be implicated in at least Iw]ce as really deaths as ~corded. In addition deaths from elgaretto-related i~spiratory dlse~ses are increasing. .4 comparative study of merta]ity figures for two psrind~195,F~57 and 1960-OPt-completed shortly after release of tho Surgeon Genet~l's repOl~ s~ows a sharp rise ilx average annual de~ths from chronic bronchltls~ emphysema and respiratory cancer. Deaths from chrcllic bronehltm went up 51.4 pe~ent. From emphy~ sema 130.3 percent, ~AJad from respiratory cancer~ 31.9 perce~t. Deaths from all these c garette-relatod respiratory disea.~s corn, bined went up 44.7 percent. I would al~) lik¢~ to bring to tho atteatlon of the eommitteo as a physician who pr~-tices, m~ prsctlcB being ]argely in • consultant capacity to practicing physaciaIls I would like to cmptmsize certain featui, es of chronic bronchitis alld emphyseala ~s I ~ Jhem. Senator HaaT~m. Mr. Chairing1. The C~. Senator tIartke. Senator IL~xmm. I wonder if the witness wouM read ~he par~ of the paragraph rtdi read, on which I would like some clarifieataoll on9 ~nd that is ?he following: rAhis increase was so marked that it overshadowed a remarkable dC~21~ c-- with the word "decline" ~nderlined-- in the same period in death~ from eommua~ub]e l'tspiratory diseases---roach a~* ~carle~ fever down 66.0 vercent~and rvli~lowa 94.4 percent. There is no eontentinn Doctor ]s there thatpolio is down for ex- ample beca uss of ally factor other than tJae simple thing that we haw idellti~ed the cause and have formal a way of immunization? Dr. Js~z~s. h think thi~ i~ very true. i would go along wlfl~ tl~s alters? her. Sella~or I~m,~. Then le~ me ask you~ why put that in here ? Dr. Jz~zNs. I think tha~ you are right in-- Se~lator H~x~. Do you mean we cou2d find a cure for c~acb~r~ an hnm.niz~tion for cancer? You would h~ve a l~anarkable decline of cancer. So wha~ ! Dr. J~NK~S. Quite true. I think the stat~me~lt is innocent and contahmd here for comparativ~ purposes only. . . Senator H~srr~x. What does it compare ~ It coml)a,~ ~mmun]zs¢ ?ion against nonimmunizathm~ ident,iiie~bion againot, no~fidelltificgtiom It compares apples and (}r au~es. Dr. d~s. I think the common deno~nina~or here is perhaps those two diseases can be classified as communicable dlsesses whieh i21*olv¢~ L?m I~qpirat(nT *rm:l,. I tilink this is the olfly comparison. I agree with you, implicitly, that polio is down largu]y because them have heell-- Senator HA~. And scarlet fever is down becanse of tlm miracle dm~g% right? Dr, 5~-~INS. Right,

~tor IL~. Wh~t J~ ~a ~l~ng t~p find ~ut ~lcetor~ is wha~ bs~ib~ .e he|p ~ t a~ Vo t~e~ • comrrdtLe~ and ish~. i 0~ ~e eo~trarv~ Is it meant in ~his sche~ Ll3at w~ wer6 ta]khag ~bou~ a while ago-- ~ot ~ sch~n~ b~ ~his sk~ll I~11 campalgn--lt is a~ a par~ of a ski~l~uI Dr. ~S. I tb33ak thor~ are skills in the f~J~ e~p~ssed in ~ae ~ that these dls~ weat d~wm i ~enator 3[L~xTX~. rheso st~ti~ies Which meai~ absolutely noth~g. to ~onfuse ~ b Dr. J~.L'Cs. S~r, Lho ~mp~rf~lC~ which i at~ae~ to this was e~earl~' fought ou~ hi ~!~ ~ac~ that I omi~te~ the pa~gra ~h~ ~nd yo~ brought it to ~ny ~Lentiul~. : Dr: d~K~S. Ium happy t~ Omit iL. Send'or I{~R~E. I am no~ ~kh~g you t~. I am ask~lg you¸ d~ ~ou wan~ ~b. I)~ C~r]i]~ omi~t~l¸som~hmg ~rom ~i~ ~tement. 1 want to find oL~ li~w much ~ ~h~se st~temen~ which ar~ p~pared and ~abmi~ed ~o tho comznit t oe~b~o~s~ td] Lh~ meml~l~ aren~ ~e~e--~how much of ~ sho~dd be om~t~*~], in of~er word~ i~ t33~re ar~/~Ifs t~f it wl~ich ~o~fld~'~ hi~ b~n in in ~he ~pta~l~e~ 0a~d you wan~ taken ~ut y~u can tal¢i~ it o~. I~ you want it k~p~ i~ it, ca~l be kept in. Dr. J ~ Kl:~s. Its oral ss~o~x ~r in¢ u~]~n w~ i not deter ,~r~m the m~in ob~e~ i~os of the r~p~I% i will re~om~.u~ • ll~ ~H~II~LXI~. I ~hiI~k tirol wl~ tile witn~ ~s tryitlg to do is ~ show ~h~ we ~vc m~d~ some ~i~ p~gress in ma~Jy di~e~s ~ lr~lkh~d, ma~ifl/~ maybe ~here is a hope that ~v~ ~fll make some pr~r~sii ~l~i~p~rtiCularproblem. Ire ~s a ~itt~e modest, be~aus~ h~ e~L t~lk abou~ T]3, in which w~ ha~e~n0~le l~tpr re~. ~tor ~x~Ir. ~ha~rm*m, wi~h ~n due defer~Lc~ ~o the wm- ~om of the c~alrma~ and his interpr~tatlon of wh~ tha wimess has saicl ± fred only one word in this ea~ir~ ~ate~ent that is ~lderlin~d and. i~ ~s lmderllncd i~ this paragraph.. ~o this m~ mean that it Js intended to atta¢l~ som~ specm| slgnlfiean~ as ~ar as those of the eom- ~n~ttee who would read it. ~bmit~e~ ~ the ~ommltt~ either l~ave s~g~ti~ue~ or (lo~ have s~ i~eanee and ~f ~hey h~e sig~iilc~ne~ ~nd are intended to [~ ~ ~9 our special ~t~ntlon by mlderllning~, then there n~u~ be some ~on ~or 1~. '~ow w~ ]ia~ ~ome to ~e Conclusion I tlffllk~ between th~ ~wo o~ us ~ |e~L~ thut fills is not a f~ir o~m ar~o~, mid i~ which the d~t~r I~ ~indlcatecl it 0~ul~ b~ om~e~. ~h~ll thet~ is ~ good c~le~ o~ m~sleadiug heir. ~ ~m no~ ti~ng to be espe~i~lI~z ¢ritica3 but I do ~hln~c again t~t~ if W~ ~r~ ~h~lved ~n s "ldllfUl ~c~mp~f~ ~n two side.~, that we ~r~ tkn~ mor~ o~n~usion ~h~n i~ evld~ltly all~g~l to b~ exlst~iig aL ~ae moment. Ttmnk 3~ou~ h~r. Cb~i~n~al. Th~ CLI~L~. GO r~ght ahea~L

CIGA~fT~ LA~ELINO ~L~D ADVEIITIglNG 231 Senator H~mTK~. IS the ~tement omitted or included! 1 am wonderhlg. The CH.~m~L~N. I think thB statement ought to stay as explained by the ~enator from Indiana and the wm~n~. Senator ~IARTKZ Does the witness wahl the sLaremen~ to b~ ~Icluded Dr. J~NKI~S. I viii be lmp~p~y to recommend, then filet we ke~ ~ th~ s~ateinen~ in .A_s I stated b~-foz'e. I don't thhlk thi~ will hamper ~}m The C~M.~'¢. I thhlk it has het~n Itdequal~ly explalned by the S~i~ator from Indiana. 3Viii y~m prccec~L Dorior ? l)r. J~xrws. ] would ]ike to tak~ u[ ~itlt the e~mmltfe~ one or two eomm~nr* which ar~ not m~d~ in the body of the repels. As a ph~siriaa who practice% I think i} is impmWant to bring to the commiri~ that lit |he living pafiellt, chronic bi~0nehitis and emphyse~n~ ~re indeed }lard to separate. I~ is a relatively e~sy matter a~cr death because, as Dr. Auerbach pointed out, the brag and t}m ht~lnchm] tre~ ean be e~nmined ~nt] ex~mh~t sep~l~tely. So lh:~t, l. some sense we h~ve to consider these two dise~e.~ together iu the living pa~menr. Disability from ehronh bronchitis ~ald emphysema laken together. 1 wish to ~laphssize, is a prog~'~ssive situation. It is slowly crippling. I~ pr~l~ a great Heal of hlnnan suffering. And dm <¢~pt ores tl~at are a~=oriated with it are those of eough~ of expeetor~tion of sputum, shortness of breath or breatlll~e~% reeurrm~ episodes of ~sp~t'ato<} infection, oftentimes pneumonia, and in the mote sevex~ and unre- mitting ¢a~eG lung failur% which results in meatel derangement ~a~d coma and in death. It is also clear ~'om studie~% many of wh~c}l have h(~,n conduetpx] in th~s country and in other countries notably (~remt Brltahl tlmg f2qese symptoms are ~ssoc ated in cross seefionM prevalence studies with smoking, and are vastly mor~ prevalent among sznokers than among nonsmoker% Furthermor% they inere~%s6 widl tl±~ anmunt smoked. Also I ihinh it is w~]] to menfion lhat in ~!elei'[~n~ }h~[df, ls n ~d I mn associated with a Veterans tto~pkal, vidl two of them in fact, where I eonsult~ertaln]y chronic bronchitis and emphyse~m today is a very prevalent and serious aihnent among our veterans. ~e ate seeing a continuous rise in these dls~ases not only in };heir incidence hut as cause of de~th among vefcmtns that ~r~ admitted to Veteran~ ~ospit a]s ~cross the COllnt r.v. Fu1~e~n~o r% I thi~J~ as Dr. Auerbach has hron~ht ou% pos~ mor~em examlnahons of patiente who die of these diseases bring oub sever~] ~hlngs : T}mt pure chronic bronehit~s is c/retract erized by changes in the h~mohii pure emphysema, characterized b} ¢ban&~es ]~l Iile air sacs, m~ w~ pc nted out but in a high})~..ercentage of incidences these two dlse~k~e6 eo~xls , and n){ Ity ollr ahi]ity to ~e]3arat~ them on~ fro]n t le other ~n llfe. whe3~ thev ere pr{~scnt pm~icularIy in limited form, m dlgieult. I think this ~s perho~ps one of the r~asons for ~om¢. colifu- sion in this area. As time goes on and sophisticated methods of h~quirv diagnosis, become befL~r and inlprov~ our abiilt}es to do fhi~ I th~k will ~]so

~ ~IGAR~FPE LABEt~NTG AND AD'~SRTISIN~ improve. That is, to separate these two diseases. But we mush I ~bink, consider them tog~thar for out:purpoSeS today. All of these alarmin~ ~ac~ts th~ I have pointed out hs, ve made it dear thag public education on the ~langers of eig~i~tte smoking must be an b~te~al ~ of ~y prograra aimed at preventing and control- ling res~pliratoW dlsease~, particularly these, 'l]xat is whLit has been a steadily growing par~ Of the program o~ the I~atlon~l TB Assocla- tinn ever slne~ 1960. In 1960 the National TB Association began cooperating wlth the American C~n~" Society ]n efforts to edUo~te)tha public about, these matters. Shortly we were "omed by the Amen0an hteart Assocmtmn and the American Public ~ealth ]~soeiatio~. ~.nd n~% we m~ all working tog~the~ with 18 other voinninry and government agencies -- as part of t~ l~dtisnal tnt~ragen%~ Cotm¢~] o~ Smoking and IteaJt h. To all of us it has become apparent that tim first prterity of our educational effort must be to warn the youth of this z'/~tionmbefor~ the cigarette h~bit ha~ become established in our ~ou~h. Today there are more than 75 million young people in tl~ Umted State~ under the age of ~0. This ~uraber t~pres~x~s almost 40. percent of the total pulatinn. Buel*y day, ~ 000 children tz:¢ smoking a c~garette for tha ~t time. It has been eat mated that over ha f our 18-year-aids are confirmed smokers. These fi~ures I thh~k cemo from several sources and studie~ carri~ out~ for exampl% in our hl.gh schools. Coavmcmg ehildrm~ that c~g~tette smoking m dangerous .and un- desimb1% thou, is important 'inlt ~t is no simp]~ matter, Da~Iy, they al~ exposed to many saht]o pressures to mnoke; the whole f~bric of the soczety they like in is permeated Wi~h cigarette smoke. ]'hey are alto subjected to extremely clever allures earefuJly developed by the advertisers. Cigarette companies spend, as you know, more than $200 million a y~r on advertimng ~lone---to promoto the im~g~ of the cigarette as a social a~-set. And ~hat ~dure this has for Children ] Social acceptability was singled out by the SUrgeon General% Advisory C 0mmltte~ as the maj or ~orce promoting smoking. Their repox~ says-- Social stimulation appoa~ to lflay a maJar rol~ in a youag person's early and firsL ex!~rim£-~t s With ~aok~g. lVhat e]~ildren learn about smooldug" in school-~r even from the newspapers--is not enough to counter~his appeal. ~any young peo- ple, reacting to news reporLs on:elgarotto smuldng and health~ ask: I~ e~a~tte~ ~tre go ~o~s, ~hy ¢l~,e~*t ~h~ G~verma~nt do som~tbiDg? Their reaction is not surprlsing. Why sll0ifldnk they ba cor~fused ~ The Gove~wmaent recluireS packa~es~o~ d.~gm, ous d~gs and chemicals to ean'y a wa~-mng. Why n0t c~t~.. The Gove~ent requ~r~ packages of foods ~hd drugs to lis~ ~d~eids. PYhy not mgarc~tes ? We cannot expect children to believe s~isn~fd[is ekide,ce published by the Government when the sai*m ~overnraellt does not 8ven apply ~ts own standards to e igareft~. Adwrtislng may be even more eonfusihg. Children have ne!flmr ~h~ exp~rlence nor the sophistication to rec0ncJJe thdgmlamor depzctcd !n the ads with the somber facts reported ~n the press. Their confusion ~s 0nly compounded by the Government% in~ctmn m th~se ureas.

CIGARETTE LABELING ~ ADVERTISING 233 For these reasons, the National Tuberculosis Association is c~n- vkiced that decisive action by the Federal Govelmmen~ must be pa~ of the corn rentmnsive effort to rsuade ohildz~n ~hat mgare~te smoking is more ~aug~rous thou desirable. That is why we favor Federal legis- lation on elgarette advertisinlg and on p~ckagn labeling and so testified last year before both the ]~ederal Trade Cmmrdssinn and the House Conmfittee on Interstate and Foreign Co~mnerce. Today~ we are suppoi'ting S. 559 and S. 547, The National ~1~aber- culosis Association is in favor of any eFeetive means of ref~uh, lng cigarette packages and all cigarette advertising to carry a warning that states simply and clearly tha~ cigarette smoking is in uri~us to health. ~Ve also favor the requirement that cigarette packages he.l, cc!l~rdely labeled, specifying average amount of incrinfiimll~l material in each ci a~fte. ~n sumrnazT: then: the National qhd~cr~mlo~is Association believes ~}lat such decisive aet}oa by I]~c Federal Government must be part of dm comprehensive~ naLinna] effort to inforra the public--hal especially youth--that cigarette smoking is dangerous. The C~AI~A~. Thank you~ Doctor. Senator ]ffartke~ Senator H^lt'ra~ Doctor Y hate lo take your time but Is 1~ your content on thaC c ga~ite smoking has a eausa z~latinnship to emphy- sema! Dr. J~'CK~S. ZIy personal opinion~ sir, is that it does. Bu~ the fan~s I tl~dnk as were presented eandronted with them today leave tLS in a position where we canno~ say th~ eignrette smoking actually is a causative factor in emphysema: Vie can s~y tkis in relation to chronis bronchitis. But I don~t think we are able ¢o say tiffs in rela- tionship to emphysema. I personally believe it is bud f don:t believe tl~t th~ lacts altogether su por~ ~lds. ~enator H.~r~. It is not your contention that the Surgeon Gen- eral's ~port contended so ? Dr. J~s. I think the Surgeon @e~er~'s report states the evi- dence pretty fac~uall and clearly. The), link it with emphysema but they don'~ put it in t~e role of being entirely causative sirnply because the whole epldeminlo., glcal profile..el the studies does not at this time warrant tha~ position m their ~pmmn. Seaator HAaz~. In faot~ they s~y jus5 the contrary~ do they not? They say i~ h~s not been ~st~b~ishcd that the. r~]attenshi l~ is. causal.. Dr. gs~¢s. Yes. However, the conelus~on~ state that it is h~l~ed. This, I believe is appro ~ate to the language. ~onfttor I-~I~TKE. ~at Dr. JE~J~s. 1 say their conclusions stele /hat it is linked, ~bat cigarelle srn~&~ug is liuhed wi/h emphysema and I would tbink-- Senator H~R~. Tht~ words are * ass~ci~te~ with nereased risk o~ dying.:: Ilas there been an increased number of c~ses o~ emphysema in the United States in the last i0 years, say or 15 years Dr. J~'~r~s. There has very definitely. I e~n s~v this as a pra~ ti~ing physicinn~ I can say rids ht terms of the mortality ggur~.~ which I uo~d m tlm ral~ort. qsenator H.~T~. Isn't it true tha~ there were very few diagnoses of such a slta~tio~ prior to 1950 & 45 979--tl,~--Dt. 1--16

234 Ct(]AR~'I~fE LABF~LING ~,~WD ADX~E, RTISZN~ Dr. J~xxs. l~el~tivcay ~ew. Senator ~lA~a~x~. lsn~ the ti,ath of i~ tha~ mo~ of I[1~ ~ituathltls ~f tkis kind ~I~ ~odad uut hi Llic au~ps~ ~ • Dr. J~,~i~s. S~mLor, I believe tha~ emphyse~aa is qui~ dlagnos~hle in life in advanced stage~. It is in ~he limited ~nd e~rly ~ta~ tia~t we h~w difficult3 in recognizing it: Senator ]I~x~. Other reasoI~S for th~ increase4 number of cases really, are the f~¢t tlmt it was hardly ever used a~ all ~ a caus~ ()~ death prior to 19~0, was it ? Dr. J~N~s. I thi~: this is a reasonably ~m~ statemc~t, tha~ it was not the preva]e~t disea~ tha~ i~ i~ today for on~ re~son, ~%ma~or IEartke. We t~dnk tha~ i~ h~ increased since igS0. Senator H2m~K~. Is this eorrect~ :By what percentage? Dr. JE~X~XS. In term~ of the ilgares that I gave you in the x~por~ I would have to ro]y on these because ~ think ~h~y arc th~ b~% ones that w~ h~w. Tim hl~re~s~ in Lhc two p~rlods thaL I me~tlprmd, ~hich w~r~ 5 ~.e~rs ~p~rt, has been ~ron~d 130 percent. Senator HAawxx. ls th~ smoking percent i~creas~ 130 pe,~e~~, . I)c. J,.:NKLXS. Duri.g *a~t period o~ ~im% IJa~ iacre~se in smoking wa.~ n(~L I]L~.L abl~upt. ~enitor IIaR~x~. So at least we cart argue either w~v ~s to wh~t really caused th~ in,teas% whether it was increased (li~gnosis or whatever it might have been. We really don't k~ow, do w~ ! Dr. J~x~s. ][ th~nk w~ know certain ~c~s about this yes and I would lik~ to bring those ~cts up perhaps a 1 ttle more c ear~ thaxt I have. Ther~ is ~ factor o~ increasing recognition by tilephysician w~o signs the dea~ cer tifica~e that emphysema is ~hc cause o~ death, This is certainly on~ o~ ~he reltsons why we haw an incl~ase ill file ~tlreS as stated. This h*~s perhaps gone u ~ b~t more sharp|v thtm h~s an increas~ in cigai~te eanoking. Bu~ t~i~ does not mean ~hat they ar~ not indeed related in my opinion. Se~l~tor I4~v.~. T la~ i.~ not Ihe opinion n e~e~ri y of the Surgeon Gtu~el~l's report~ is ~? Dr. J~KI~S. The opinion of the Surg~n ~eneral~s report is that the~" ~ linked, I bellev~ This ~ the language used. Senator tff~a~rKE. I 4on't wan~ ~o h~ve ~ play on ~erms. You want to u~e ~he word ]ink~d. The book says ~associ~ted with a. increased risI( oi" (]y]n {rmn {)uhnon~ry ~mphy~mll~.~ Let me asgk you another question. You ~r~ in ~he National Tuber culosis Association ! Dr. Jx~KlXS. Yes, s~r. ~en~tor HA~. There h~s been ~ re~o~rk~blB dccli~m iri the num- ber of c~ ~e~s o~ d~h ~m ~1 b~reulo~i~ h~su~ there ? Dr. ffEx~i~s. T]~re h~s been. Senator I L~zTx~. This has no re] ~tlonship to sm okin~ or not smok ing isa't that true that dro ) ? Just like ~olio ~nd scarlet ~ewr.I I)r. JE~. T~I~ulosi~ is ~ 4isease m which the ,~]~tion~l~p to ~moking c~r~ainly does not cxi~ in any Clcar f(n~a. I th~nk these same ~L~emen~s apply to sc~r]~ ~cver ~nd pol~otl~eli~is.

235 Senator II.~,rrK~. To d,aw any mncinslon from the fact lhat tbele has b~ea a drop in tnh,~re,~losis 1~n re]~tlon to smokm~ wouhl Imve no more ~alue and gel, yo~" orgenizat on stil is pur~ mg methods of ~]eterrmnation of e~tJ~s of tubercu]osls. Wh~t perc~nt~g~ of your annual¸ budget ~ i~sed in re~earcb ]Jr. Ji,:~Ki~s. Apl)roxirnatel~¸ 13 percent of our rmnuM h1~dget is n~l fnr re~ea*~h. P might say ~hat the m~e~a~h that is conducted by tim national component of our orgauizaLion is 1 pereellt of the budge~. Senator IIAm'K~. 1 perc~m ! Dr. JExxi~s. Of theNIAl ul~t. Senator ~rK~!. Howmuchdoyouuseforeducatinn? Dr. J~x1xs. I tMnk a fair statement of this would be about 85 to 40 perceut~ Senator H~u'rK~ In o~fier words, dependin --35 Lim~s ~ roach fm e.ducatb>n. You a~) a great belisver in edllc.~tlgzh isght ? Dr. JIIN~INS. That's gOll~Ct, S~aat ar H.~:~n. But in tfiis field agein~ yon h ax:e not m~de any l~a[ in depth r~sear~h. In ~)Lfier w~ls y~m haw not spent an awful l~t of money on it, have yon, doll~r wis~ or percent ag~wi~ Dr. ,l~,~s. ~nator, I ~ ould humbly invite ¥ou~' ~ttention m the fi,c{. I hai. approximately !5 percent of $'27 million "is a eonsidei'able sum of money, A~t¢l that this is tim tot~l amount spent, las~ year for re- search b~" the total org~tizaLiou~ tl~t is th~ N~tinn~l the State, a~d ~fie va~'iou~ loeM associations ttffoughonf the cmmtry, SUI/SJ*cll" I{XR~K]~. ~-0111' emphasi~ is still gz,eater on Nlllr~ti(]iI. 2klld I am nat in aa~y way playing down the role of edueatiom But the truth of it is, in tuberculosis educatkm, aboa~ having chest X-rays, is ~ vervlmportant t fling. EduCation about polio other Ll~an having the immunization, there isll~t all aWflll lot you call tell a man~ for example, i~lt~t thllL t~% in education? In oth~r word~ you can't just put down education per se~ l~owing about d]seases ~.a beirut a way o~ stopping a man from getting the disease, because you have to (*onsider what the actual ail- ment o~ th~ human body is befor(~ you can make that dete~main~tinn, isn't that right Dr. JE~-KINS. | think that ~sa reasonably ~a r statemege 0~ course in situations ix~ wbich prevention is an imgert~n~ clcmrgtg in the control o~ tl~e disease, education becomes highly important. I think thi~ is where our em hKbis hag Been. In tuberculosis fix t!~a~ v~spiratnry ailmein% ~his~ we have oraphasized today ~ve~- tr(m ~ exeeediggly flnportaat in eventual control and er~dlcatisn. We feel it is important to educate the public in these xnatte,'s. Highly important. Senator Halve. k'he point about it i% D(~h)r, still ~f yo~ had spenf the inoney tfiat you are spellt~ ng on educe, on to tintl the cause of pulmonary eInphysema~ you migt come up with an actuM lh~ding Then. as that p]aee, ~ou could make a determinatior~ whether it was a matter of edi~catio/~ or ~d~ethev the ed~teation wus unnecessary'. Isn't that true ! - I)r. J~m~'s. i think that this might b~ tree. I wo~ld llke aln) to point out that mn(h o~ (mr effort in the educatb/nal field i% let us say~intl,efieldof ezl ca eclueaton.

~GARE'I~E LABELING A~D ADVElITISI~G We have for many yea for exampie, sponsored a full,time mcdleal specialist in all the medica~ sckoo]s in tfiJs conntrv~ realizing that ~uch a per~on~ so st r alegicall] plaee~l, wil/conduct programs of rese~rck in the ssttlng of thB medical school. This in turn will feed back into the area of researsh which you are emphasizing. This has been, I wodid feel, a very highly successful effort on our par% became today many otmg men not only from the field of medical educntlon, bat in t~e field of medical resea~zh~ indeed had their humble beginning in this sponsorship. Senator II*ma3~. X am not trying to play down the neceezity of educatlon~ medical education or public edueasion. But the thing that concerns me in this whole presentatien is the f~et t2~at in the fdilowlng paragraph lonowing thls st atement whJsh we have decided is going to be kept in the record~ which has no value to the record, i.~ this statement : ~dl thee alarming facts have madeit el~ar that public education on th~ dangers of cigarette mm01dng m~ b~ aa integral par~ of any such program aimed, at prevent ins ~nd c0ntTolling respiratory diseases. All of these alarming fasts on educating the public abeut tfie ease of polio have ~bschltsiv no,hint whatsoever to do with it as to the cure. The only t~ling'the~ is to be sur~ that they have their im~ munlzation shots~ and tlmt is the sole net necesHity tlmt you need. You d0n~t need any label on ~ny packages or any prohibition against advertising or anything else because ther~ is no contention that polio is caused by tobacco. What Imn saying to yolh Doctor is wonldn~t we be better off if we kept to the fact o~ what we ~ave ava she n ~ront of us --h~stL.ad of s~ying these are alalaidng facfis-- and tlm~ i% that ther~ is a decline xn eommunlcshle res~irato~T diseases whish is eonside~l by your statement here as an alarming ~aet, and does nothing hut lead to more confusion in a field in which there is prshshly enough confusion at thf~ I]]OIT t~0t. Dr. J~ICX~CS. WelI~ sir, may I beg your atfieil~ion to another pnln~ here, which came out pretty clearly in our st~cly of the literature and preparation of our own ad hoc co{malt tee on smoking and heaIth, the report of which is not yet published. It is q~ri~e apparent to us~ after looking into the medi¢~l lit~rature~ thatjpeaple liave in many instanct~ ..... conducted inquiries into points relative to whether or ne~ s~nokm~ has had a statlShCnlly s~gnifie~nt effect u]3on communicable respiratory d~seases m~sh as the ones men- tioned here, and pneumonia and vlrns infec~isns also have been included. I think that in these areas there has not been any important a~ocia- Lion betwden smoking and these diseases. So fhat I think the decline in these diseases may indeed regeet this i. par~. Mentionln~ this in the ~port is simply a comparasive item. Once again I wou~'d not feel tha~ ~t was impostant one way or the other to tfie main emphazis of our report. S,na~or Harv~x. I have no fur ther questlons. Senator li'~vm~n,:~. Mr. Chairman, I would like to ~mmen~, since the Senator from India~ur raised ~]m poin~ sb~mt the Surgeon General's

CIGARETTE I~BELING AND ADVEI~TISING ~ report on emphysema1 that I think maybe w6 should read the entire paragraph which says : Cigarette smoking is the m~t importsnt of the causea of chronic bronchitis in the Tlnlted States and i.cr~s~ the risk of dying from chronic bronchitis and emphysema. A relationship exists betwecm cigarette ~moking mad er~hy- sema, but it has not be#n established Chat the relationship is causal Studie~ domon~rate that fatalitie~ f~m this disease are fufre~lU~at amo~ nonsmokers. The CHAIa~r. Thank you. We apprccla~ your co~ning. Now we ~i~l hear from Mrs. Kouzes. She Is appearing for )Ira Myron 1~. Blee who is the imtlonal chairman on leglslation of 5be Na- tona] Congress of Parents and ] each~r~ She has a ve~T short state- ment. I will be g]ad to haw you read it. STATEM~,NT O~ ~S. MY~0N ~. BLEE, NATIONA.T~ CH~RMAN, COMMITT~ ON ~ISLATION, ~NTED ~Y ~RS. THOMAS XOUZF~ ]~.2~B~R OF THE WASHINf~TON~ D.C, COMMITIT.E ON LEGISLATION, NATIONAL CONG~S OF ~ARENTS ~ TF~CHERS Mrs. Ko~zrs. Mr. Chairman and members of the committee: I am Mrs. Thomas Kouzes~ member of the Waslfing~on Committ~ on Legislation of the National Congress of Pare~h~ and Teachers (na- tional PTA . I have been authorized by the chai[~an of our co~n- nli~t~ (m legislation to affirm our sup o~ for isgisl~tiv~ bllis S. 5~l, s~o~sm~d by Senator Neuberger, an~PS. 559~ sponsored by Senator 2~a~llnSOIl. The National Congress o~ Parents and Teachers now compslsln ~g approximately 12 million me~d)ersh]ps in 50 States~ the District of Columbia~ and the European Congress of A]neriean Pa~nts and Teachers, has consistently supported le " lation coneld~r~d helpfl~l in the protection of the ~ealth and wel~a~ of children and youth. Of increasing concern to the National Co~re~s of Parents and Teachers is the established health hazard o~ cigarette smoking~ par- ticularly as it affects children and youth. The report of tlm Surgeon General's Advisory Cnmmit t~e on Smok~ ing and Health has given dat~ showing that among men who beeg~an smoking when t~enage~ the death r~te was abeu$100 percent higher th~n it was among nonsmokers whereas among tho~e WhO began after they were 25 the death rate was only about 35 per cc~t higher. ~oneenth~g deaths ~rom hmg can~er~ the r,~port g~ves the following specific conclusion : Cigarette smokh/g is causally r~la~ed to hmg e~n~er in men~ the magnitude of the effect of ci~tre~ smoking far outweighs all other ~aetors. The data for women, though less extensive, poln~ In the same ~rcetion. Lung cancer, acco~llng to th~ American Publlc Health .~ssocIatlon, will kill a~ e~timat~ 1 million schc~lage children now ~]ive befvre they reach 70, i2 !~¢esent tren¢ts contin~le. T~nder the mandate of resolutions adopted at the 1963 and I96~ national conventions~ the National Congress of Parents and Ieaehers has pa~elpaled actively in programs related to smoking ~nd health. Tb~o resolutions~ concerning (1) education on the h azaeds of smoking~

238 CI02~RE'I~L'I~ LABE~I~I~ A~D ADVERTI~LN~G and (2 the adve~,tislng of ~ob~cco andits use by minors are beit~g suhuntt ed w Lh this statemen I. keeping with ira ;~solution to "make awry p }~-ible effort ~ eoopet~t~ in Pducation of childr~n a~ldy-curb regardm~ tim hazard~ of smoking," the National Congress of Palt.nt6 and Teachers was amo]tg the 16 organlzlng. ,membet~ aT the ~eently f¢~rmed National Interagenev COuncil on Smoking ~nil ~lealth. 'The Imrpose of thl~ (}ras,nizatidn is to combat smoking as g ?~alrJa ht~z~zl. ~ks ~ ]~ember;d~ the/nterage~my Co~lr, eil and ms ~ spokesx~an ~or our own membership, the N~tmnal Con~greN m of Parents and Teachers wishes to express ~wng snpport for tbe Kills before your committee- S. 547, sponsored by Senator N'euberge~5 ahd S. 559. sponsored by Sen:tLor ~Iagrnls on. We support the bill S. 547, which provides for specific and m~nda- tory w~m • messages on cigarette packages ~s we:l] as !n all c~g~re~e allverPl~lll~gb£~guse we $tr~ COllVlllCol:[ ~,b~,~ W~oI'll~R~S 111 ~11 clg~rette advertising offer tJ~e most effe~tlve rnt~ns of keemng the American public, p~rticularly vouz~u pe~Id~ await:of tlm health h~zards of Although S. b59 which a]~ propo.os labeIh]g o~ p~a~res dc~s not refer specifically to advertising, it would be a clear rec£~Rion Congress that cigarette smokhig is a heMth haznrd anti would ~e~Cfore bB aBommendable~action. At n i.eceut conference on cigarette smoklnW and youth, it wa~ famed tha~ tho m~jority of students do believe tl~ smoking ca.ses h!.g cal~e~r. And it was found that the most BffectJve factor iulhmncmg" teenagers~ smoldng habits was ~ thorough ~xi)osure to the ~dentifie facts about the effects of smoking. The N~tional Congress of Parents ant] Te~zher.~g~fided by the ovea'whelming weiffhl of seientflc evidence impllcat~n~ cigarette smok- ing ~s a llNjor prcghlcer or prolrlottor of various diseases such as lung c~neer~, bran{ :tills. em p hysema~, coronary heart--respect full,v. .. ~i rge~n this Committee and this Co]tgreP.s to enac~ le~elanon reqmrmg e~u rionary labelin~ and ndvertisinff of cigarrth~ :~s ,rop{ned m bills S. 547 and S. 5~). ~Ve fBBI thttt this is ~ neoesSal'y fm~ctmn of Gover]t ment ha ~iew of th~ evidence now flasher ed on tiffs health hazard. T]l~nk you very much. The C~am~Lt,~-. TImnk you. We will put the two resoh~tio~a ir~ the record, passed by your (~ongross. (The resolutions follow :) N~TI?0XA~5 I.'0~BE~N O~ ~ABNNTS 2~D ~PA C~ERS (]IIlC~k~0. ~I~ {Adopted by ,~he deletgalions at the 1963 national condition) Whereas, the n~e of tobacc~ by minors is of great c~eern to paxents al~~ tear,hats : Therolore be it p.eeaz~:ed, q3~at the NaNo~l Cangres~ Iff Paront~ mad ToaeJaers wiffa IL~ State e~n~re~l~, dis~riets~ con?aegis, a~d lC*2aI ~ltitB |ntplls~fy elTorf~ tn st~)~gfllg~ hCulth (~luc~ttion prugrams relrtt~M to the use of ¢ubaeeo by mluor~; and be It further /¢eeol*'e~, That the National C~ngress of pa~f8 ~iI~ ~'he~ lnvit~ ropr~- sentatives from the t0b~tcc,0 iI~dttstry, th~ advertising field, and the ma~a media ~e meet ,~ith repr~sentatlve~ of the Natlo~aI Co~gr..-~s to co~sidor the eff~<.ts of glall/oriz@d tob&cc¢* Rd¥or t isling dix~*~ed to teonagers.

CIGARETTE LABELING .~D ADVEI~TI~L~TG ~ ~'ASOX~I ~O~6BE~ OP ~ AREh'T~ ANB TEACH ERB~ CHI( A($O, I[~L RE~OLITTION (~O~OE~I~U E0U~&TION OK IIAZA~ OF SMOKINO {Adopted by &he I~ eonventio~ delegate) ~Vher~s, the U.8, Surgeon General's repor~ has de~ned the health hazards ef sm~kh~, and Whereas, young people a~ esp~ially suxce!~t fl~le t9 ~up Dr~ssur e rogarding ~king ; ~el~f0re be it /~eao~d, ~at the National ~ongr~s of ~'arents sm~ Teachers make every. po~siMe e~ort ~ coopeza~e ~ the ~duca~on o£ ehfldre~ and youth regardin~ th~ hazards Of smoking. The C~2~m~x. Are there any questions ? Senator N~m~mGEX. l~o questions but a comment. ][[as your orga- nization taken recognition of the report of Dr. Horn th,~t the example set by parents about smoking is very kapor rant in influencing children b~ smoking? Mrs. Kovz~s. Yes we have. As you[m]rhaps krmw~ there are edu~ cational progral~ through the Plea in the elementary and secondary sckools on tiffs s~b! ect ~a~d we hope, ~,,~ith the passage of such a bill as t i s~ t iat w~ ~ttl~ elelt put IIloI'~ el[~l) ins S oil t tlS lyre o~ ~]t ug0~tion lit the schools. The C~rAm~.¢~. The PTA's h~ their local organlzatimls~ I tlfink, on a campaigm that yea call e~lueation, have been able to use some of the reporls, the American Cancer Society pamphlets and ~bing~ of that kind for distribution in tbeh' own meeth~gs~ m~d I ga~ in schools, ~oo, if Om l)rhlcipa] allo~l s snch dis~ribll~ion. A~ the grFA meetings you have been able to discuSS this matter and you have been able to use ~ot (rely the Surgeon GeneraPs report bu~ the other pamphlets ~hat have been produced by thc~ ovgt~ ilaza ~loils. Mr. Ko~ms. "Yee, and i~ wa.~ out o~ these ~Iiseussions that these twc~ resolutions ~ere passed ~n the two recent convocations. The Cn~u~.x~. I suspect when we get through with this bearing we will have some more m~*~terial for you that will generate ~ great deal of discussion aL lt~al PT_k meelJngs. Thank you vm'y immh. Mrs. Kovz~s. Timnk yeu. The OI~XIIi2~N. We will rece~ ltutll tomorrow aaloinh/g, Tomof {~w we x~Jll hear from a l~presentative o:~ the industry, Mr. Bowman GI~V and l)r. Hurford, of St. Louis and other s~atisti~ians, a~d Dr. "~lo an, of Da xill ~ ~*n. I'onor]ow will I e devo~ed~ I suspect~ by locking at the llst o~ wltnessee, to the other side of the question. Then we will go o 1 ~thm'sdav ~ith some fui~l er wltnesses ~re would like to contimle these kcat:ing~ ever~ into l~riday to get t hro~gcb with rim witnesses who want to testify. Tke eommltte~ ~a,~l] recc~s~ ]mti] tomorrow mmndng at 10 o'clock. (V¢lxereu~on~ at 1:3~ p.m., the committee adjourned, to reconvene at 10 a.m., ~Vedr±esday, Mar~h 9~, 1965.)

---

CIGARETTE LABELING AND APVERTISING WED~F~SDAY, ~ 24, 1965 U.S. SI:~A~, Cos~rrrEB o~ COMMI]RGE~ Wa~hingta% D.C. Th(I COlmniLtee met at 10:20 a,m.~ in room 5110~ ~ew Scnato O~ce Building, the Honorable Warren G. ~fagnuson, chairman of the committee, presiding. The CUAn~A~. The committee will come to order. We will pro- ceed with the first w~t~ css. Senator MORTON. Mr. Chairman, before the first witness prcmeeds~ could I take 2 minutes to clarify a paktt made yesterday~ The CHAIRMAN. Yes ; go righ~ ahead. Senator Mcm~t~. Mr. Chalrman~ yesterday there seemed to bca question about differ.eat sources of figures. • quote ~mm yesterday's tran~ript, ~n questioning Dr. Carlile : Yon made ~he statemenL Doctor, that 40.000 persons die of lung cancer tn the United States anmlaI[y Did you mean that ~hese people have cancer that started in the lungs? Or did you include in t~is figure people who had cancer that started elseWhere in the body end then spread to the lungs? Dr. OARraLm. h'o, sir, ~prim~rylungcancer. S~na~or MO~TO~. ~n 1~62, the II.S. Bureau of Vital Statistics, trader Classifi- cation No. 1(~2, listed 18,860 dealhs from primary cancer of th~ lung. ~hey have another classification whloh showed '2"2.000 canvers in the lung, but it was not specified as to wh~ther It was secondary or primary Dr. CAa~n.~- you used this fi~tr.~ yestelxlay, and it puzzles me h~au~ it ]S totally in caviller with other pubticatio~s of the U.S. Cmvernment, with the Surgeon O~neral's r~port and other bulletins I am not familiar with why this discrepancy appears. I am totally certain that ~he figure of 430J9 in 19~., ~nd 47,(}~0 expected deaths la 1965, is a valid flgl]re, and nr~t the ~&000 which yau reIerred to. I think that there is something here ~hich doesn't meet the eye, and that I am not familiar with. Senator MO~ON. I certainly don't want to give a~y misrepresentation hera. /)r. CA~r~. I am sure you don't. Senator Yfo~ro~ I will see that you get the volume to which I refer, and Farhaps there is an ~xDlanation of this difference. Dr. CA~ Ye& Itha~thereL~ • Now, Mr. Chairman, I hav~ here Vita? St~isdo~ of Ihe lYnited States 1962 rob]me 2 Mor~alit.y )art, i. It happens to he pub- lished by the U.S. Department ~f Ifealth Education and Welfar% Public Health Service, NationM Vital Statistics Division. On pag~ I 10~ of this volume, item 162 says : Of bronchus and trachea and of ltU~g specdfleCL as primary ( d~lt hs by cancer ) 18,866. Of lung, u~Loecified as to wh~ther primary or secondary, 22,510. This volume is the property of the Library of Congress and I have to re~urn i~ there. The volume is HA-20~ A~2, 4~hh sec6on, and it 241

CIGARE~E LABELING .~ND ADVERTISING will bts I,val]at,Io th~ for ])r. Carlile, but I Ilavp nmde a Thermofax of th~ p~es to ~hlch I Imw ~3feel~,d arid fhc veforerme amt ][ will hand t]lal l~ a member of thc staff so th~l~ he will ~ ttmt Dr. CarI~]o gets it. And I ask, Mr. Chail~nan, tmanimous eonsen~ that the record re maia open at this point for Dr. 0arll ~ to comment, if he cares to, on this subject. I thank the ch~irnl~n, The C~Am~xA~-. Without ob ectlou so mxlered. (The hffm'm~t on rcf~rred to foI ows :) U.8. *~nate. ll~nlber o£ pz~mary br0neh0geB[e ~l~]lo~]as raised ak y0ar ]leafing i~ii I~[II$, ~. 547 vml ~, ~9, on Tt~s~lay, and again on Wc~m~m.v, ~ai~,h 2~ and 24. 1 und~rstamd tha~ ~ena for Mor~ou a~ked thai a page ~rom the 1962 vital ,'~tatigties Tho statistics *2epartme~¢ of the 2~nl*rieal~ ~anc~r ~ool~ty has llrepar~d tlle following, which ~ h~|le rosy I)* lil ~ho re(oral zt~ ~ ~sw~v ~ Senator M~r~on*8 Tile illt~rnatic*Ii~l Hst of I*a/18e8 of dl~tll~ a~i~t~8 th~ fol[o~ing ~l~mb~rs to oancer~ of th~ long ; 16~ronchogmuc ~are~aoma, varcmoma of t]~o bronvl~tts ~t~ ~rs~e~: or malignant ne~ptasm of the ltmg, slated re* be prll~ary. W~q R a g, allt neo]p a~m of r]~o -ae e orga ~ ull~pevified f prl~x~try or ~ceondary. 165~Mallgua~ n~0pI~Slll O~ tholucle organs, spevlfied hn be se.:ol dary. Th~ rea~olt that thi~ classi~cation was a~opt ed in the 1920's is that a good many m~t~gnan~ t~mons m~ta~,tasi~ to the lungs an~ it was hOp~ to be able to keep ~h~s~ can~ sep~ rs t t~ fr6m the i~rlm~ry ltl~g ¢s ~r~. [t wa~ also ~opeci that phymem~ wolfld be t~- m~t re w~te ~.~neho~e.nl~ caret ~Iollla~* or '*primary ¢a~Inoma of the ]ullg on desth eerdi~cu]es to bt~ ~bl~ ~o tlls~lI~gl~lsll the p~Imarv from the met~asized lung ~neorl Unfortunufely in ~1~ linked Sta/os, l~al~y physlclans still do write th~ more in~xae~ doslgna~lo]l...¢arcxlloma o~ th~ lung on ~h~ ~lea~h certifieat~ and c~de clerks must eod~ ',] 6g,, for these certificates I~ ~i4~, the last year for which w~ ~Z.V~ ~. IllT~ff ~t~e~l" T~lb121atl@IiS by flie~e ela~li~et~t|ol~ tile tOt/al~ 20r ¢~tt~gories 16~ and 1~,'~ irate #S fC*HOWS ................................. Thus. on~v 46 ]~el'¢~ t o~ all ¢~se~ are cI~t ssifled as ~pnma~ ea~einomR o1' the l~ng ~nd bro~chl~s." [~|i~ H~lth o~ol&ls ~d ~l~idemiolo~lsls Mare lol]g l~O~Jz~ ~at mosu of th@ ~a~ ill oat~r~ ]~ wer~ prl~ ¢2r- einoma~ of th~ l~n~. aD~l h~Ve melu~Pd ]mth ~/tte~orie9 1~2 and 1~ in a~v de~h ~l~lfiea~e a~Iy~e~ of the d~ath~ dli~ ~ tlr~m~ry ]~ln~ ~n~. ~'lllfam H~enszel o~ th~ N~tion~l ~z~c~r I]*~tltl~te verilied th~ ~v~rai Unite] States and ~r~ti~g to the ~e:tlfying pl~sici~r to 00r~flr~ wbeLher or not ~he Career w~s t~a~ in tlie [llllg. It[is r~tfl~ 'tabl~ i tndleah~ that o~]y ~9 l~rc~ut a2 the t~tal l~v_ ~ g~mp were no~ I~rnmary ha the lung.

CIGARETTE LABELING ~D ADVeRtISING ~ iLt OI/E .~Dler~&~ Cft~er So~e~ ~llr~nt prllsi~<~ve study, afar F, .~ears ~lLewup, we have moro ~b~u 700 ma~ dea~h~ with ~ar~noma of the lung indicated on the deaLh certifle&te~ teaLe~o~es 1~2, and 168)+ We w~te th@ Ce~lfy~l~ physicia~ for confir~tir~ of the p~ma~ site of e~tncer, and the hist~Jo~m d/a~osim, if any, ~d r~ved a redly from G75 of them s~ far+ Table 2 shows the resets ~f this ~a~ms+ 46 perc~t of the ~5 de~ eerti~cat~ were ~o~d 16.~, very muc~ a~ t~e total U.~. statistics i~dic~te ~BLIt £he impotent Eaet Was that ahoY1 ~ the S~ percentage pr@ved to he ]~Lfl~A~ ]l/~g ~eer, r~ardl~ if I~ OP 16~ were ¢o~(~ orlginal]~ F0rty-thr~ cas~ (6.4 ~ercen~) ~rue~ ou~ ~ot to be l~g cancer; hut we ha~e ~0 cas~, ~de~ other ~an lung cancer on the de~h certificate, whieJ~ proved on do<~or's ~e~or t to be ~ma~ l~ng ~ncer, Ot~r e~ti~te lhf~t ~g c~tn~r snd by this w~ m~n ~ri~ry br0n~ho~n]c Ca~'Q~o~ a~ in~rpret(~ i~ NO. 1~ abov~iL1 de?>~-oy 47,~ p~r~o~s the U@ited S~aLe~ m 1~ i~ a(~r~te. Tabl~ I and 2 a~ at~ch~d : ~CIL, Nos+ 16~, 1~ of 6~ tev~t~) ~n~ Um~ 8tat~s e~ Io~ and ~M~, ~e~ 19~$; Jpz~d to b~ l~v Pro~ t~ b~ ~ot lung ~r ~ dE~t~s ]m~ ~r ~n doct~'s N~mb*r L~r ~aa~ Nu~aLe~ ~n~ I~ ........ : ~ ~ ~,0 ~ 79 if w@ ~all be of E~t her help i~ the@ o~ any related m~t~r, ~lea~ Ca~ l~n ~s. ~ineerely, l ! o U J~Am+f+~+. AlJ right, ~Ve h+ve as our first witness 31r, Bow- man (h'av. +++ha is ~:hairman of the I~)ard of the R. J. tleynolds 'lo- lyaceo Co. Aud ++o ~+~+ gl+d ++ ha+ +yott hm'+, ),{r. . (+Ira},. . At~d you lmv+ a stamm+nt ++~(1 your te+~mony, of ,ores+ 18 ¥+ry impor+an~ to have +he viewpoint of th+ people you t+present p~ emnte<l tc, thi+ cam mlt [e@ ~114 we wi] ~ +08 ~Ja d to ~1o~ r t"1o]o] you.

CIGAR~q3D L~BE~ ~D ADVERT~S.~G STATemENT OF B0~ GRAY, CHAIRMAN OY THE BOARD, R. ~;: REYN0~DS TOBACCO ~0. Wr~TON~SAL~E~, N.C:; ACCOMPANI~D BY ]~ H, RAMM, YICE pRESID~4T AND GEI~EItAL COUN~L, R. ~. I~9LDS TOBACCO CO. ~r. G~r. Mr, Chalrm~u, me~nbors of the committee. I should llke first of all to express my ~pproel~tio~ to ~he eo:~ttee for giving me this opportunity to t~sti~. As the chairm0al said, ! am with fl~e Reynolds Tobacco Co. and I am here as a s©oke~l~Ut for the mallufactUrgl~ of ~rtoa]~y all clga~ rctt~s produce~ in tins countl~. Th~ compan~ haw ~sk~ tha~ I pz~ca~ to Lins conar,ittee their views with respect to the pending M~Is relating to cigarette iabelteg and advertising. Tl~e names of these companies are [he American Tobacco (3,0. Bro~Ul & WilliarnSon ]dbacco (30 ., Larus & Brother Co,, Inc, L = gett & Myer~s Tobacco Co., P. Lo°i~r d CA)., philip }2[orris, inc., R.~. Reynolds ¢lobac~o 0% Step]lane I3rothers~ Inc., and Uulted States T~bacco Co. I believe it £air to say tlmt the pending bills z~nk among the most important legislative proposals w~th r~spect to [~le vobacco industry ever to be considered by a songl~es~ional cormnittee. 'l'h~se bills il ealaeted~ will have a profound m~pact upon this gr~tL industry. ~nwlse leglsiation in this field could produce l~*pel~us- sions which would be felt throughout the country's e~nbmy. I am confident ~Imt the Congress will exerel~ grt~t care befvre taking ~ny action winch could Sel~ously d~rupt thi~ imuportant industry. The hills before th~ committee are pointed at the merchandising ~lmC~ ces of the cigarette industry--sp eelfically, riley pro~ ids for reg~ aelon~ in one wa or ~nother~ of cigarette labalin~ attd advertising. It is proposed t~at a e~utinn notice as to the health impticatioxts of smoking be pl~eed Oll eigarctt~ packages by ~he manufa~turer~ and that cigarette mauuf~lurers be r0qmred to state tar and nico~lIte 35~ldsonth~paekage. Oneofthependinghil]~.5~7 wouldcrm~- el ~ warnin~ notice ib be laced in all eigs ~e o d ver~ising. We are strongly ol)pc~to thes~ inlls. ~ e ~!e not belleve that auy gowl~rae~tal ~t]o~ m necessary or called ~or w~th respect to ¢~ga~tte ~d ~erL~smg or labahng. However~ if such action is to be token we believe i~ shonhI be t~ken by tba Congress--~nd by no one else. Stat~ and municipal govern- r~ealts ai, e certain] not t~te agencies w~o should take ~etion in tiffs m/~tter. Tile pl~oh~em is n~tiona~ in scope; it is clearly not looM. Oiga ~ttes are advertised to a large extent on national media~over net,~ork television and network r~i% and in magazines which elf culate throughout the country. Cigarettes arc sold in every State in the Union. A multiplicity of St~d~ or municipal laws in tffis field would roduce chaos. . . Siln(~aZr v~ we do not hel eve that a Single Feder~l a(inunlstratlve a~ovncy s the proper body to take such action.. A great dlversity.of interests is involved in this l~tt~r. .Any legislation or l~gulutlon affecting eigarett~ ~dvcrtlsing or ]abohng has far-reachlng re~

CIGARET~PN LABELING ~D ADVERTISING 245 slons for farmers and growers other suppliers, proeessom, distxibu- ters~ and l'et~I merchants, as well as the cigarette manufacturers. The tax r~venues of tile Federal Government and ~0ractieally MI of the States are s~riously affected. Az~y such legisl~ugn has impel tant implications for the countr ~s mass media advertlsma. It is wholly iaappt~priat% ~refore~ for a dcelsicn o~ this scope to be made b~ the Federal Trade Commia~ion, or by ~ny other single Federal administrative agency whose jurisdlc~ion and experti.ce are co*dined to ono particular phase of tlfis compilex problem. I repeat; Tlds matter should be handled by the Congress and by no one else. Let me summarize at the outset--very brlefly--the premises which goFven~ what I shall say. irst~ the tobacco industry is profounfily conseious of the qucstlons conccrnhlg snmkiag and baalth. At the beginning of 1954 most of the cigarette manufacturers, as well as a number of organizations representing growers of leaf to- bacco, forrnefl the Tobacco Industry Research Commltte*~ now named Th~ ~ounell for Tobacco Re~sc~treh U.S.A.- -U) finan(:e rese~cch in n,~i ters relating Ix* Ixfimc~o and health. Thro~ugn h its Scientific Afivisory Board composed of emlnent ~nd independent medical scientists, zrmlts for research have been made to- taling over $7 million to some 240 scientists in more th~n 100 hospitals ,ml wwsitia~ ~nd r e~ceal~h iaslit utions across the eounlry. In addition companies individually have given substanSal support to ether reee~rc ~ n the area of stuck ng and hen th. Further, in January 1964, the six ]arges~ ci arette m~ufactnrers pledged $10 million to the American )~eflica] ~ssoeiatian F~dueallon ~nd R~seareh Fovndatlon for research into the posslble relatianshlp between smokintr and health. As of the endof January this year, this foundation had ap roved 35 grants for research involving estimated expenditures oI~ over $~2,900~000. I am neither a dearer n or a se~entlst al~d I am therefot~e not qualified to paltieipate in a debate on the medlcal or scientific questions relating to tobacco and heMth. ~Iany dlstln ithefl scientists, however, are o~ the opinion that it has not been es~b~Uh'shed that smoking causes lung can c~,r or any other fiisease. I ux~derstand tlm~ some [ff these experts will appear before lllls commhtee during the course of the ~resent hearthgr. I believe that nearly everyone ~amiliar with these cl]fficuI~ problems will ag~e that there are large and basic areas where knowledge is ]ackiag that there is a ve~T high degree of m~cer~ainty, and that a great deal more re- search is necessary before definitive answers can be given. Second, I thb~k k is important to bear in mind that the ma~orltv of men and women in this country are ci~garette smokers. It~illion~ of persons throughout the world fieriae pleasure and enjoyment from smoking-~and have done so for centuries. The advisory committee to t~e Surgeon General recognized that there are "si-~mifican~ beneficial effects of smoking primaril in the area of mental health." How~ver~ the advisory eommitte~ f Jr that it

12$G~.~I~TTE LA~IIq(t ,~D ADVEF~TI]WI~(~ could not measure these benefits,, and it did not ace ca'd them b.n:~ weigh~ in reaching its o~t~call ConcluSion 1 thin~c it is ohv ons, however tbaf n~l l~q~hm sh(mld be Iaken wi!,lL re=gpe~:t to sraokir±g bY the Congress wishou£ gi~ing ~a~t and alYpr~ pl'iat e wet glut to tim "beneficial effects of smoking.'! T ~rd s unnecessa v ~or me to dwe at e~JgOl befoi~e this com- mitt~e-- upon lhe il.portanee o~ the tofiacco fi~d~stry to the whole natin]ls ecor~omv, The tobacco business is shis cofint 's oldest in- dustry, and mfl~ioas of persons depend, directly or ]n~'llectiy, upo~ lobate() for shelr livelinc~d. In 1964, some 511(l:004) fl~rms appro×imate]v 7006)01) faim faro: flies product~d l(~ax:co whk~h had ~ cash v;flue ~f ,~ er $1.3 billinn. The im ortance of tobacco ~o our ~orei~ cv~mnefee and to o~r balance ofP6rade h~s been poin~efl out ~teq.uentty. Exports of le~f tobacco and tobacvoorod~¢cts m~alefl mor~ than $544 ~illinlt in 196¢. Indeed, ~he valu~ el tobacco ~xports iz equ~t to ulmgs~ one fif[h o~ tiffs ¢ounN'y's haluuae o f p~yment s del~cit> Federal "State, ~nd local governments derived afiou~ $3 3 billion in tax rove mrs from e'garettes in fiscal ~964. ~[ fie tobacco "nds ry clearly a vital sector in thiz cotmtrv's economy. My'point simply is that all the~e teeters ~oint n .misi~lkably to this (~onch~sis~: Extrdme car~ should be exerc~sefl before any ac~inr~ is takeu wl~infi could seriously dizrupt thiz important industrp. WiCa shes~ factors in mind: I should like to d~se~ss tb~ specific Iegisis tix~e prope~als pend big befoh~ fh c committe~. We do not believe that a caution notice is necessary either on ciga: trite packages or in advertlsinff. . i I assume that the principalpurpos~ of a caution nottco ~s to aler~ the corrsumer to possible hazards associate4 with the use of a praduct. Wish respect to cxgorettes~ however, she public has b(~m inundated for more than t~ decade with reports that smoking may be injurious a) health. The report o~ the advisory con~raltiee to the Surgeon General was intensively publicized in ~,ll ~ued{a. Tha smoking and health i~ e i~¢eives continuing publicity. It is a rare day whom the matter is not diselmsed in the daily newspapers. I doubt that any person who can read or listen has not been made aware of the contention tLat smoking may be injurious to the healsh of some persons. In [hose oireums~.cmces~ a caution notice would appear to be unnecessary. If in spite of the~e e~msideratinns -the Congress should conclude £fiat a cauCinn liotlee on she package would se~-e a usefifl purIx~% I he e it will conslder the ioll0wing points. ~irst any such legislation should make absolutely clear that the congoessinna statute preempts tbe field: It wofil~ be intolerable if the S~:~ies aitd Federal ala~n cles were to remain free to l~a~ conflict- ing laws Or to impose conflicting regu at ons on this m~b]t~i. If there is to fie a cautloa not co, ts exact terms she ~ d be pro~ccrlbed by the Congress, and the caution should be uniform among all mana- factu~ers and nationwide hi scop~.

CiaA~E~rE LaRmaN6 AN~ *nVERTfSm0 2~IT Second, the required ¢~ution should be phrased in a fMr a~; faclual manner. It certMnly ~hould not reflect an ex mmi~ a.d docLrinaire viewpoint. It should be stated ill a w~y whn~l/ reflects the l~ck of definitive clinicM and laboratory s~icrdifi~ evidence of tile relatiol~]np betweer~ smoking ~md healtli. Th rd if a w~,T'i~i~/g is t;o be requh.ed on th~ puek~ge, it should ~o~ 1)~ required in cigare~e advertising. AS t ]mve in4ica{~d~ the public is aw~m of th~ eAa rges that smoking m~y be injurious to health. 'l'h~ knowled~plus a caution notie~ on eve~ packag% shonld this be required would make a 5' f rther Warn ng n ~( vez~imng t~tallv lnl]lecc s~R r y' The insistence upon ~ ~arning in adveff]sing in additi6g to the .... ; ; r, demand for a warmng on lgbels is pu]lllA% e 1TI lll*tlll tL [ b(~ Ii~'hl td) advertise an essenlial coi~xmercJgl right~is v mua/y desaoyed f a m~nufaetm'er is required in ew~W adverdseanen~ to disparage tile producL ,ks a )ractiea] matter. ~he requiremen~ sf a waraing in advertising could well result in elin~inat on of alc gaJ~tt~ advert s rig. l'here little doubt fliat some persons advocate a warning in eig,~rette ndv(~r rising precisely bceausc tlqey feel it win l~stil6 hi puttm,g an end to sxteh advertising. One {,[ tim industr?/s severes~ cHtlcs has publicly acknowledged that ~ wand n ~' message is expressly design ed to "raMie cigarette adver rising self de~oating. (Transcript of interview of Emerson Foote b~" Tex McCl'arv oil Radio Station WOR, New York Feb. g, 19650 1 have no doubt ~hat a ~trt~ighttorwt~d ~top,~sl to proldbi~ ~ll ci£.- al~eLte adveriislng ~ otdd l~cei~ e short sh'i~ ire the C6ngress ; the same result shou]d not be permitted by indirection. ][ am confident tha~ file Congress will ~e eet this extreI~e proposal. I am, of course, aware that the British Lal)or Governmen~ recent]y took steps to prohibit cigarette advertising on the commercial tele- vision network in Great Britain: But that action fmnishcs no v~lid p~x.e~den~ for the pt~dposals pending l~fc.'~ this ezmamittee. I do no~ tMnk it. inapproprmtc tc a]x~e~ ve tha~ views concernin the: role of Government with respect to mass advertising media, suc~ as television and the proper relation of Gove~ament to busiuess differ in~ the two eountzde~ ill mlpor tant respects. For example until recem~ly rlld]o nnd h~levlsioit were gOVeHm]ent ]nonopol[es in ~n~bind lind tim L~hor (}oveltlrqent~s action ll/128~ h~ considered in light of that fact. ]¥ith respect to advertising in tbis countr~ the indushT itself has taken affirmative action to meet criticism voiced by various pe~o~s. The corn )anies have agreed to adhere to a Cigar{~itc Advertising Code which became effective a{, tim he~nning of the year, I have a copy of tb4 cvde with me, and I should like to request tlmt it be incorporated in the record. The C~{a~s~a~,. Withoul objection, that will be done.

Cf~TTE LABE~G AND ~D~TISI~G (The Cigarette Adver~sing Ood~ follow$ :) CIGaREtTE ADyERTISINO CODE Tire ptlrpoBeB Of thiB cede 1ire to establish uniform standards for cigarette adv~rtiging an~l to provide means whereby eomaplianev with this code can be ueertalned promptly ~n~ fairly and on a eo~lsteut ba~ S~TIOI~ 1. ~Advertislllg" (a) Means a~ for~s of adwrtteln~ in, or p~hmarlly dtI~!eted to, the United SLates, pue~o Rico, any ~errltors or lmssessi~u of the United States. or any military instal~t~n of ~he United States, Including, but not Umiled t0, radio, ~levl~on ~nd ~inema ~0mmcr~a~ of all types, ~sp~l~r and magazine a~v~r~isem~ts, binboard~, posters a~d ~ ~ubway ~nd r~il or bll~ car eardlg ~tutomobile £Ltld trlack d~cflls, posters ~llld s~gl~s, e~lor~dflrfl, pamphlets, h~ndbill~, matchbook ~verUst~g, and point of ~]e display mat~rl~l of all ty~s ; (b) InCludes any vvr~au ~oat~rial or ar~el~ or exc~r~ therefrem, not otherwise adver~ sing, when used for promotional ~arp~ses ; It) IneJudes L~bellng~ n~me]y, the display of writfau, ~r~n~l, o~ grsl~hI~ refitted" lapon airy ]~ol'tioIl of the ]~el~g~v ~at.toi2, 01. Other co~t~n~r in ~vhi~h ciga~e~t ~ ~I~ l~C~o~rd ~r shipF~d by th~ m~nuf~'~lr or ; ~uf (d) Does no~ Include the entertalumen~ pot tio~ of any ~ete~iou or radio prc~rnm. ~g¢: 2, "Cigar~Lt.e" mvems any roll of tobacCo wrapped in 1)ap~r or In any lzab~anee other than ~oba~Cu, ~. S, ~'R~I~eS~ Cation" raeans any statement, re~erenee, or elalm, express or ~apl!ed, direct or it:gl~r oct, whether in oral, Wl'l~t~ pr~od o1" gl~phle ~orra, or In any eombinatiotl of ~aeh forms. S~I~ ON 1. There ~]mU be a code admlulst~a~or who shall b~ a l~rson of repot- nixed independc~re, ln~it~ n~d lnt~II~etual ~hl~v~ment to fhe end ~h~t d~- cislon by him shall command l~ublic cov~ld~v.ce and re~c~t. The admiI~trator shall hav~ ~lll of the powers ~ld authorif~ laee~sary ~i~ci pro~ to etX~hle to discharge effectivety the re~ponstbllitles entrasted to him by this cod~ ~. ~. ~'he a~atalstrator shall have ¢~mplete and ~a~ authority to d~ter- mine whsth~r ¢~gar~te ~lv~slng eomplt~s w~th th~ staU~rds of this code and to enforce this code in all other rester s. S~o. 3. The admini~trator shall appoint a staff adequate a~rI eo~pcfe.n~ to ~sis£ him in di~char gi~g his ¢lutl~s. S~. 4. Neither lbe admLuis~ca~or nor ~v member ~ ~s staff shrill Le an ome~r, dir~e~or, emp~eyee or stockholder of any m~uf~eturer of ~o~cco ~rod- uet~, nor shall ft~y ~lch ~erson h~ve any fl~aan~l~l lll~re~t In the btmlne~s of auy such man~eturer. S~c. 5. The administrator is authorized to convene scientific advisory panels to e~able him to carry ou~ hia duties, perso~ selected for saeh po~els shall be off lndei~ndence, integrity and competence in thor 1~AttIcular ~reas of sc4entifle discipline. In selecting ~neh persons, the ad~duistrator may eon~ult with ap- propriate gov~i-nm~at atl~~. pri~flte ~ge~cie~ ~ch as ~he U~. Departmaeng o~ Health, Education, and "W~i~are; Natio0a~l Academy of Sciences; ~a~Io~al Re- searoh CoHne~l ; A~erieaz/ Medi~l ~qsociatio]2~ ~etonti~c A~isOry ]~Oal~ O~ ~C~e Counell for rl~lmc~o R~se~re~ThS, A.; medical and ~eientiflc ~ieti~; colleges and uulveraities ; and mmproflt re~areh tnstlmtes. ~SEC. ~. rl~e administrator shalI by ~egtll~tlo~ establish proc£~os for th~ ftdminist~ation and el~oreement of thi~ oOde includh~g, without llml~ltio~, pro- (a) The ~ubmission ~o him ef proposed cizarette advertising which, to- ge~her with a~y ~npporting datq or docnr~er~ts, ~all be ke~ eonfid~ntl~l,

CIGAREttE LABELING .~D ADVE£t~ff~ING ~4~ ¢~ce~t as ~t h e~vise provided in a~c1~ IV, ~cc~i~n 4, oI' this code or a~ ag~eecl t~ by the s~bmi~ing pnz~y : (b) ~Phe snbmi~ion ~ pr0t~ts by pRr~ie~ ~ubject ~ thi~ ~e c~bncerning ~ny determinatioD by him ; (C) Hearin~ In C~l~'tJOTl wi~h ~tJ] ~ll]Imi~siIln~ ~n~ p~otes~s ; a~d (cl) Reconsideration b~v him I~ an~ of h[~ d~r~m~at[on~ A~rI~g O~aranee S~c~o~ I. No ci~tr~te advertising shall be used unless s~h advertising shall first b~e been ~ubm~l~ed to ~he udminis~ator a~4 determined by him ~ be in ~omplia ~ with ~he s~d~trds Of t~is coC~e ; p~o~d~d th~t~ ~y • ~%~la~ion pr o~tl~]- ga~ed bY the ~d~ist~or s~ed adye~r~g ~ay be e~c~pted ~'rom the tLe s~Rudards ~ this code. ~dwrt~g ~rds ~'Ixo~ i. All ciga~t ~ a(Iv~r tl~g a~ promot~o1~al actlv J 51c~ ~it all be ~bje~ t~ the ~l]~wing : (a) Ci~rette advertising shall no~ apr~ar (i) On ~levision and radio ]~rog~ms. or i~ p~bliCa~lOnS, directed prima~ ~ l~'rso t~ under 21 yeRrs o£ a~; (ii) i~ spot annotIRCe~len~g dUrillg ~II~ progr~ br~Rk in, or dl~ri~g the lq~ra~u llr~k it~it~ediat~ly pl~ccd]~g Or ~o[low]l~T, R ~]~i~inn Or ra(tlo pro~r~n~ dLrcc~ ]p~a~[y to ]p~ ~n~l~r 21 ~c~r~ o~ flge ; (ili) In sc'im~1, collcgc, o~ uni¥crsli~ media (including aLhle~, ~eRLrlcal ~ti~d oLhe~ pro~aln~ ) I~v} ~n ~ic boo~s, ~ c~i~ s~l#plemeD~s ±o n~wsp~pers (b) ~zRpl~ ~e~t~ slt~ll ~ot be distributed t~ pe~SORS under 21 ~e~t~ of age dllc~d on ~h~l~ ~l]e~, ilr imiversi~ (~tml~Ses~ (~r in thor ~RCl]I~I~S, or ~r Rt ~r~i~- or ~rori~y houses (d) ~igtlr~c 4dv~Ptisin~ ~hlL]l n()t ~e~nt ~t dgare~te smoking i~ es se1~ ~ia~ ~o social p~on~1~tlCC, dist i~c~il)R, s~ci~es~, ~ s~x Ral ~ttac~ion. (e) ~at~ral persons depicted as s~okevs in cigarette ~td~er~ising shall be ~t [~R~t ~5 ~e~$ O~ age aII~ shall ~ b~ ~t~ssed or ot he,wise I~ade ~o ~pp~ar to be less tDan p.~ y~ars of agv- ]~i¢ titio~ S I~z~ons ~o depicted in t]~ ~or~ Of dr awin~ ~1~e~ch~ or ~ny other m~nn~r ~h~]] ~1~tr f~ b~ R~ l~ 25 yf~r~ (~) C~ga~tt~ advertis~ ~ 11~e R~c~iv~, ]~ea]~hv lool~ing models, or provided ~ba~ there is no s~e~tf ~ that their ~ttr~ct~ve ~l)pe~r ~nce ilr ~lod health is due ~o ci~eLt~ ~ m~ki~g. (g) -No cJ~RYe~r~ ac~verti~i~g ~hall ~in ~t pict~r~ r)~ ~.n iJillst~at£oll O~ pcr~0~ Sl~ ~i~g i~ aR ~xagge~at ~d ~u~ner. (h) Ciga~et~ advertising shall not de~c~ as ~t slq~]~er any pers~ Well ]cn~wn a~ b~ng, or ~nv[~ bee~ nn athlete. (1) CIg~rctt~ advertising sh~l not d~1~ict a~ a ~moker al~v person l~ei ~ating in, or obviously having Ju~ paytleII~t~ i~, phy~cal ac~vit ~ rcqulrlng ~tamina or a~hl~i~ c~ndi~ioI1ing beyo~c~ ~h~t ~ n~r~al recreation. (j) Testimonials from a~h]e~s or ce]~ri~es in ~la~ e~rta~ment w~r|d, or t e~i~ c,1~ial s from o~hcr L~rSO~S W~O m the j~dgment o~ the a~m~]s~r~tor, W~uld ]lave spqci~l ~p][~al to ~h~ l~rsons l~d el" ~I ~-~t r~ ~ &~, shall not be ~SCd Ill clgar ette ~ clver Li sin~. S~C. 2. NO ~g~tc ~dv~r~Islng WhlCh tank,s a r~pr~ntn~lon w~L r~sp~1 to I~) The ad~)Jni~t~t~o~ shall ha¥~ d~b~tqlli~ed ~),~tt ~ch re~res~nt~tioll is sJgnifican~ in terms o~ he~It]i and is b~s~d on a~t~qua~e re]ev~t and valid scientific ~ ; or (b) I2 the administrator sha~l have dete~m£ned it to be a~prop~£ate, a discLRimer RS ~o s~gnificRnce in ~rms of health shRII be set 2o~ in s~ ~tdver~ising ~n ~ubsta~e ~d ~orm sat~$~ to ~he ~is~ra~o~'; or

250 CItdAI{ET~E LABF~LLXG ~*.ND ADV~RT[SINC. {e) LCJ~e admlnistzator shall have dete2minetl th~ the representation with rcz~t to he,tibia jr~ .41]eh ~ldvertisin~ is Ii0t m~tter[~l. ~. ~. The iP.elnlliOll ]~ dgavette ~[Ivertising ~ referexlee~ to tire pre~enee OF ~tb~seilee of a filtor~ Or the ~6erlptioll Or depie~i 011 ~ ~. fd~er. ~]a&ll It~t be deetlled gt l~ple~elltRtiOll ~vlt~ recollect to h~cL~h nu]ess L[~*a a(lverti$ilkg inelndillg such reference, deserll]ti0n, or deldetiou, sh&ll ~e deter~aLaed b.v the ad~inistrato~ to con~tit tl~, throllgh 0m]s~]lli~ or Jn~l~ S]Ol~ 0. represe~l~a~i0u with re~I:~2t to he~t/th. ~he fldmfnfstrat~" sllall I~w ~L~le~mi~ed t&at such advertising ~s~i~utes reprc~sexl[~tlOlX wi~la i;e~t ba he&[tb, the ]~o¥isIo~s o~ see.~oxl 2 of this nrtiele '~]l~ll ~]]l[lly. ~gg. 4.. iqo eigare~t/~ &dver~]~]l~g shalI be ii.~d W~eh refers to the rell/Ovfll or t110 l'edueti~ ~ a]2~ iBgredien~ in the tnainst~eaxa smoke of ~ eig.tt~t~, exee]pg Lh~.~ it ~h~]l be pex'l~is~ble go m£tke & relaresenta~ot2 ~ to ~he qlmi~t~ty o~ Rn ~algredieuL Dre~eu~ In the na&iilstrettm ~maoke or ~s ~> tile ~emov&l in [oto ~ a~ illgredletlt from £h~ main.strestm sl2ac.ke~ or ~ ~o the ab~ellee ~ aaa il%grexliellL I~all~ ~resent ill the m~il~streaI~ suloke, /~: (a) ~he adi~li~t~£r~lto~ S]~]I h&ve de~ernl~tlec] that such rellresen~atioll i~ significant i7~ tevrn~ of health read i~ "00.B0d On ~dequate relevg~l~ and v.-~lid ~eielltifie d~tti ~ Or (h) A dis<!lailal~ a~ ~u si~ ifie~al~C~ in terins ~ ht.alth shall be set forth In sue'0, advertisin~ i~l BUbgL~lee *l~d form satisfa~torg to the s dlll]idstr ti~01" ; or (e) The *ldlza[lli~LrAt0r sh~li ~a~-e cl~elmim*d that a~ ~l~l~lmer i~ uilnee~ health im~lic~&tion 01• t]%~tt sl~eh imQ]k*atlon ~. n0t nl&[er]a[; al~d (d) rJ~}/e qti~l~tI~T of mleh ll~grediel:.t is detelmaiIled and expre~e<I itl ti¢c~d 8 lice will ixzdt'oi~ll ~l&)ld~rds adopter[ ]~y the 2lcimi~a J st rq t ~. flit ]~ea~- 11rI21g ¢~e {lutii~i~24 ¢)f Lhe il~grediel~t pre~ellt i~ lhe ll~!n~treai~I Sllloke, ~rovid~ thai., ilntil ~uelI u:a~o~ s~Lndard i~ so ~doplet~ tile <lllanLi~y of ~eh il]gred[en~ ma2~ be determiner[ &nd explm.~et~ in ~ellor~laIlee with Stay ~ecogl/ixed ~ei~-l~tlficqlllv va [i(1 rq ethllcl d [g.e[o~l to the -&~lm]n[~.Lr a [ 0.* with0tlt tiny ieqn/a'ement o~" eolt~d~rt~{l[ tre~l~enL ~o ~. ~ILY tidvertI~lng rietermin~{1 by th~ Admillj~tra~l" ~o be in conforlrits" with ~hc eocle mnv lnelnfle tlle following legend; '~h~s advertising (la~el) e~>~ fc*rlxas £0 g~e Bgazld~t~-da$ of tlle (3i~e~t~ ~(lv~rti~in~ (3ode." &Xl.iCL~ ~. ~.t*y pr~vislu21 c)f Lh~ co4o, shall, in the disc.reti0~ of t]~e Adm[n]~at0r ~vlth r ~£.zt ~c. e~eh ~aeh violation, pay b~ the o~aee ~ t~le A rhllini~t ra LOI. &~ li<luid&iL~l dAmaRv~% alld la~c ~$ a Den&fLy. a $u111. not to exeo~d oue htin(lred thousai~d ~la~ ($100,{RY4), as d~e~ined by ~h~ &dmild~ra(~r a£Ce~ eoas[deral]~m b.V him of ~ lx.[e~a~t faeL.% q'he Ac]nain]~t2-~toz ~I~Pll e~t~bli~ regu!atiou~ for the (le~l'llln~l~hln i~ sln~l ~'i~la~t~a uud f~r Lhe assessment an~ ~ayment of slllh ([&mRge~% ~r*) ¢1.anc~i~u 81Jail be ~nDosed with(.n£ af[ordin~ g~ ~l~rir~ to ~he &Ileged vi~l~ter. Upoil wl~tten r~nest ~'l-~m t]*e *&(lmil~istwloi% zln ti]]egetl v~oIa/o~ ~f Lhe oade i£lalt promptly deliver ~ the _~.dro ] n~r rn~or aIly iz~,q~er i~1 aild dc.etlmer~s in ~ ~essiorl WhiCh ~re r~evtin~ tind nl~tler[~] to a deternlJn&ti~la ~ke Adr~n i a~ea~. ~s to whr't he~ the code hs.~ been riot ti{~]. ~1~'. ~. ]X-~l~hirlg ll[.l*eill eont&iiled ~h~]] be eoIlstr~led to ~ive &n~ pe~on~ ~]rm o~ eOl~Orstl<m, oth~ Ll~tin the #-dlU~nis£r tit o~. ~ny ~ll~e Of ~eti~rt ~}l~. ~. In tl~ ev~lL ~ a violat(on of this eo{]~ lhe 2kdmi~ai~tr~ltol" In his dis- e~e~ioll ~u~ make Dllb[i~ the fae~ of stwh vi£dti£1~ll in s/mh lutitllaez a8 ho nati~ deOl~ sl)proDr[ft~. -~{r. G~,~v. This ced6 prescribes cert'~ia Stm]dards for clg,%rette ad= vm~ising. The shmdards ~el~e primari] , I~ d~o areas: Advertishlg wldeh has an uppe~l to ~oung pe~pl% and advertising which contains health rqm~l!nf~tiim~. ~'or exanai)fe,, tim, comte p~'ohlf~ffs ci£~ar ~tte.~ . adverti~h~ ~ in school . ~M college pubhcatlons. I~ hans ~estm]om~ls fm]a athletes or ~>lher eelebriiies who might have speoi~l appeal ~o 3oungI~e~P]e. Ill addl- ~o]~ the code provides flint no representation m~y be m~cle with re-

CIGARETTE LABELING AND ADVERTISING 25~ Spect to heMth unless it is si~aifieant and is based on adequate, rele van~ and valid scieRfi fie data. U~Lder tile code all tight,eKe ~Jvel'dsirrg mus~ be submi(led to the &dmlnistrator bcfore it is used. i'he Atbulnlst~[or is ful]y empow ered to del ea'mine whether advenlsinff complies with the st ~ndards of tim code. If ik does noL~ he will veto its use, Any eompmly whlch;, vie ]~tes the Adm6fism~tor% ruling may be requh'ed to pay up to $100~!/o0. I'he former Govel~or of .New Jersey, file Honorable Robin% lb ~[ayner~ is the code Admlnlstr~tor. The selection o~ ~ man of his s~ture and ~bilities~ man who has hexer had any connection ~Gth tim industry--is evidence of the intent and de~ire of the industry to have ~ meardngful code. GO,eliOt/fresher in e/ommenting on his ~elc, elion stat~A : They have rtsb,d me to ~erve as an impartial, objective adminis~lator of a ~triet code r~guladn~ aH advertiMng" in the industry. 1 cow,sider mFself, in this ~en~e a dnly appointed judge. I will do ~ny utmost to enforce ~his eod~ honest l.v anti fairly. The c~>cle represents l~ sincere attempt/<v the industry to respond to c','iti~isnb ~hi~h has been voiced in some qmwters, of tim indu~ry's advertising. I~ is ~m taznest effort itt inchlstry s~df-l-~llation. ~av I comr-~en~ briefly on the p~oposal~ubod[ed iu S. ,%9 that , ]gmly~trx3 ruanufaetu~ be reqnired b~" law to stzte tar anti nic~thle yields on the package. This issue lm scientific implications wMeh l do not feel eolnpeten~ to discus% but whici* I under~t;tnd will be ~t'e sent~!d to the eommdtee b ' qualifle*t exp~erts. I simuld l~ke, ho~eveb to state the position o~ the'cigare£t e tnd~str~ concerning this proposal, W~ ar~ firmly opposeli ~o any such l~eqmrement. Tlmre appeal~ to be ~ considerable amouRt of lnismlderst~mding and confusion about. t]li~ suh I~{ m~d I boliele Llmt if Ihe evidm~le i~ viewexl oh el!dvelv and bl ~ f~ir minded wa~, iL ~ill b~ clear dm~ tbe~c is no legi~hna(e reason for a li~w ~quirlng • s~aternent of nieotble and tar yields, .~Vifh •respelt to nmot nle~ the l%eporb of the S u r~'oort~ @ealera] s Ad vlsory Comrultt~ points ou~ that "There is rio aece )table e~idence thltt. Pl~l°nged oxpo;sure .... io 1/icotirle eit h~r ~*rl%it es dane.eroli~• flirt<' ~lolml Ill~ul~'c~ o£ Im ob]eefue n~ttul'e or degenerauve disease, ' and Ihe report goe~q on to ~tato tlm~ nicotine "probably do~ nol nepresenl sign~ific~i~t health problem." (Repoi"o of tbe Advi err C~onnn~ tee lo th~ Surueon Geuerai on ~mokln~ ~nd P~eMth pp. ~75 106~ .) Tn fhese OltCLtCUSLI~Uces we belmve tbaL It ls ]lot onlv pomt]ess bul ~01~ ~ /e m s ead I1~ to i'eq]dro t~ Klqtolfllgnt as ttt nic;Otille Oll []le package. Similarly, we believe that there is no* valid selentifie basis for re .b'i.g It statem~n0 on tile label witli respect to tat'. The word "tar': saP. unfo~xm;tte one lo ~se sil~e~, there is no tat" as reich m { iga~ette Sll~Oke. h~igal.et~e alllt/kt~ ll~ hc~n c]~c,ril~d US a abelero~eneou~ mix ture of gases, uncondensed vtpors and liquid partknflat~ ma~ter." Wlm~ ~s me~ut by the word "tar" in all probabilit.¥, is the eonden ~tt~ m- solid~ collected from smoke by labor~torv lnetnods. I under- ~hieh h~ve not even been blendfied. ~ve/t tllo~e persol/s who lnai]ltairt ihve~ Slfloklng }l~S ~zdvl)l,~O e#'e(!ts lmvo not been able to es~ah]ish that any pal'deular ingredient or corn pound i. eignrette smoke is the cause of illuess.

CIfftAP~2TI'E L~BELZNG ?*~ND ADVEBTIf3~D However th~ implications of ~ gatuf~ry requirement tilat anypalar- fieu are emenL be stated wouhl be that Such an element has ~een scientifically established at ~ cause ef disease. I ra~peet£uJlr s~2lmd~ ~,ila* it weuhl be w~t~ for the Go~'ez~amen~, to take IL stap which "a ould le~d the public to believe that the l~ductlmt or ttbet~nm~ tff ~ p~l~icular iingreddent in eiga~tte sln~k~ }ltts ht~dtil slgnHbnmt~ when conclusive scientific proo~ of that £~, is lucking. Mr. Chrdrm~n, I notice ill his testimony in his prepared st~tem~nt ozl ~e/zday~ Surg~oa ~et~eral Terry had tilis to sey snd • q~ce: While it seems ~J~ letLs~ plall~ible that eigarette~ with lower tar and nl.otine ~ay prc~en~ [e2ser h~l~h h~z~vds, there is pr ~s~lt IF n~ l~roof that this Is ~o, ~his goes oll wii h the th~%~ I ha, re ust sMd here. I]* this cen- ~lec:l,inn, I ~holfld llke to potat o~t Lhat--¢ontr~rv to the imp~iOll c~t{~cl in ~ ~rious qua~¢ei~ the Cigsa~tte ~_dvor~'ising Code dc~ not pro]ublt a sr~temeat on the lal~l eon~rnlng t~r and ~licotiine. The c'(xte n'ovides IIn~l, a ~presentatioa ,%s to fi~e quantity of an tagredient ..... present, in Llt~ smoke may be made if either a .f~e. Code. .%¢ilmm~tralor detel2nfftes tha~ s~eil repl~ealI~tlon ls slgmficat~ m reims of ileMth and is based on adequate re/evan5 m~d vMid seisntifie d~t~.or [/ ]f~dis~taimer~stosi~mifiear~ceintel~nSofh~lthisset forth a th~ advertisement, a ,~ttl~SkLnm+ ~nd torm satisfactory ~ tlte Admmisu-~mw. The pm~ isisns of the e~le in this ~egard ~r~ very ~imJ]ar t~ a rule proposed by cho B ederal Tr~le (Jommiss~ on/it ifs l~leaso d~ted danu- arb 18, I964. The C~mmissinn staled, and q qu o~ : A (lll~a~i~t/i~e di~qo~*tlre Of cigarette smoke illg~eillents Is a elalm colxceri/ill~ file health consequences of smokm~ ~l/e adv~r tlse~i t)rand, The proposed i'ul% in the abaenee of • dischdmer as to health rig nificanco ~ould have prolfibitad such dis~,]osure prior to slthstanziat- in e%d~nce as to tire sifi~ifi~ull:c of the s~atemea~! in terms of health. ~ilis is ta substane~ wh.l tJ~e code provides. ~l he rnembet*~ of th~s eommir~.._ will a ~'e~: I believe, tim± tha provisions of the a)de ta this reg~ vd. rt no~ o~]~ r~asonable but are in the pubIS,z ~ntt~n~ ~. Fhml]y, I ~hottld llke to say jnst a word ~,bont the brade regulation rtde with respect t~ cigarette ]M~c.ltag ~nd ~dvertlstag wtfieh wan aa nounced by th~ Federal Trade C~mmission last June. The Trade Canto/isaiah rule would requir~ ~, st~temen t~ ill ILll II(1V~tJSiSill~ OI~d 011 OVOI~ t)~t~k, T~*~. Ea~ll. Or other i~olttsiflel" ill Whi~,h o~garettes are sohl to the consuming pllb]ic that cigarette smokillg IS dallh~rous t~ health s nd m~3" onus2 ~] ~a t]a iron can~ er ~iltl other diseases. This yale is presendy s~qteduh~ to becom~ effe~live 3"u]y 1, 1965. Our ,,It~az~eys have advlsed us thai ~he Commiu~ion does not have the authority to issu~ this trade ~'ogu i~tion rule. We opposed ~he is~u an~e of rids ruling during the cour~e of *lie Commissioh~s proceedings. If ne~ e~az3' we shah ¢~ppos~ i~ in the courts. We oppos~ it l~uss we beb~>ve die Commissmn acted without sh~tutory *u~flhor~sy. We opp*~t~ it because we believe til{s matter should he resolve4 by the Con~r~s~ and ~o~ by ~ Federal agency. P,% oppose it beo~ase we bellows, s ChMrman I)i~on acknowledged before*heIIouso(%nlmittca~nlnterstateCommerca(]lmal'in~o~ b~for~ House Coamaitteo on Inflerst~re Foreign 'Oommeree 'Cig~retta L~beI- ing and A clve~tishxg, 88th ~ong.~ -od Sess., pp. 85~q7 ( 196~ --that the

---

254 CIGARE~£rI'E LABELLinG AJ~ AD%rERTISIING I prestune you sugges~ that would be a proviso in any s~tht~ we ass. It has been ~ggexted here, however, by iJaose t]mt have te~i[- ~ed for the bills and eve~ some that have opposed the bill~ and some that probably have no opinion definitely one way or another that w~ might, if we de~ided to do this, turn it over to some appropriate agency. It co~d be th~ IIealth. Education, and ~Ve]f~re, i~ eo~d be tha Fede~d Trade Co~md~ion, or ~ome o~l~r ag~l~, aud glee ~em seine flexibility. Th~ l~eason that w~s suggested was that there was ffreat heope e expressed by some people that the re~earch yea in]k about th~ the indu~ry is doing might be abin to come up with a e~garette or tobacco product that would ~e as close to being [,armless as is h(umauly pos- sible to get and therefor% although a warning on the package might h~ve a wording today of some sigulficanc~ thlags ~my e},ang~ and sc,mehed~ ought ~o ht~ve the ~ uLhomty to m~l~e this adjustment ~nd should have some flexibility. What do you haw to say to tha~ I pl~smne tha flexlbility they were talking about would be downward and not upward~ Iea~ s*nngcnt and uot more strip, gent. Mr. Ga~'~. Mr. Chaiz~man~ I fee1 that ¢1~i~ matter is one of such ha~portance to so many peopl~ in this country e]~gaged h~ the indus- try in i~s various pham~ th~t it is ~ matter which should be resob~d and bundled and administer eA, if you will, by the Conlgr*ess and the Oon~q'ess alone which is the elected represdnt~rive o~ the citizens ~*f th~s country. T}ds is a ~z~" serious matter. I do not belier5 or se~ why the same flexibility as to the wordi,g or the t~qulrement could not be a*:hieved in a similar fashion, shouht the f~ts be as clear ~s they wouh] h~e Io l~ umle~ these elreun~stanc~ to ermble a d~w,glUding~ • l"escinding~ if you wil]~ of tiffs notice. I am strongly convinced, slr~ that fl~s is shnply a matter for (Jon- gre~, for th~ people who ~ h~re elecded by tl~ oit:zens o~ ore' co:retry. The CnAn~. You su ~'~-~ ~},~t the Co.g,'e~% if they ar~ ~ing ~o pass such a s~atute as t~s~ should provide the wor~ing, a:d~that would be cJear and that would b~ file only wording~ at least in the beginning. 3It. GRAy. Yet sh'. The C ,~,n~r~n, I think tI~ nil of us or ~. lc~t speaking for my- self are in general agreement with your thesis in your testimony that i~ this matter s to be attended to, that it shou d be on a Federal level rather than a loeM or Sta~e level.' Tiffs is for very praetdcal reasons, along with othc, r r~:~,sons. If there is one producer tha~ is coml)lct~ly in ir,~ers~ate commerce Ka¢I move~ izt intwist ate commerce ~fi is t~hacx'o. [~ is grown in very few States and shipped M1 over to every Sint~ h~ the Union evetw ~(ounU" hi the world and. therefore, it would make it highly impract]~cal and ~ thhth a burden ripen interstate eom~ m~x~ in tills ,~eld should you have all kinds of ~gu] ations in w~ri~,us S~ al~. Man} of tile Sta~ ]egislat~w~ ~we now meethlg ~nd ~}mrlt ~r~ ninny very seriolls propo~],ls ]rl Sllll~t h~ishflnrl~s (m I~lis snbject. Ia my own St~%~ and in ~z's. N¢~uherger~a ~qtaxt~ which I am very fatthIiar

CIGARhTrE LABELING AND ADVERTTSING ~5~ with they have I thi*Lk used a great deal of wlsdom on dfis leglsla- ion in ~-x[g~• eat "~.¢ to. the •State le~isll, t urc~ ~ a e~ do no ~. e a 5 definitive action until tlmy see wba~ the Fedend Govel~nmnt Is going to do in this *rmtinr. So 1 think we are ~dlolly in ag~ment it would be a serious handi c~p upon business h~ inLe.~t~in cK*nll~5I~ if~" '0U had Lo open 6very oartol aud every I)ackng'~ and look ~t the label ~nd do all sorts of things aad I tbi~k it would disrupt the very import~mt feature or t m obac(~ iledustl~, in the amount of taxes it contributes to all 0)rms o£ governmenq St~te~ local, and Federal. So i think t]ua, ~e az~ in agt~eemeut on that. . . £N~OW I hl~ve llO furt]~m- que~%iolls. I ~gaa~l colnlrmnd you [)/1J~)l'~ ~mting the industry's position ia one very comprahcnsL e and d tbmk well t hougM ou~ bit of testimony. Senafox: Neuberger ? Senator NBtmFmq~. I in~ve no questions bllt I have ~ ~tatement t~ make at this time. Hinderer, if the o~her members ~omld like to quest io., I ~ill ~ uit. T]~e (J~IA~A~. Senlxtor Domlnick~ Senator Do~*i>*~c~. Thank you, ~h'. Cl~uirmsn. I wani. t*) say belie to l~r. ~ra~ whom ~ hgve knowll for some tilxm. )dr. @m~. Nice l~ sc(, you. S~nator Do~I~ICK. I tll~ak it might be l~elpful to the ~oi~, ~tic. Gray. if ~-ou could give us some idea of the number of Sb~tes tha~ are directly revolved in the tobacco industry, not onl3 in growing, but, in r~cessing or in warehousi ng ? ~r. GRAY. I wo.ld have to stop gnd count, dt is about ~ that huve It lured in gl'o ~ illg rebate% s~r, Senator Do~xxtCK. 8o we are in f~-ct dealing with s~mt thil g wi~±clx s ve~5' w despread n the count*w di~'~t/y affiliated w~Ch the industry as a ~'ho]e. Secondly I would like to ~sk ou 0dr: It.is m understanding that some o£ tile articles wh ch are a~:)ert sod Jmt on~ y on leev s on now carry with them precautionary codes in otiier words, riley are re( /lit'etI to s~ate if it is a drug, 'T~ke only on pr~c*iptio*L o~ ~oa;' d.etur," vr something of rids kind. Or "PoiboD, when tnlan interna]iy.~ k good Jnaal , of dl~se h~ve thmn on the bottle but don't have them in the edvm~J/b~g. Some of them have it in the advertising ~,nd not on the bottle. Could you tell me in a little more detail, if you can, if Conm'css ~ee]s tl±a~ it i~ iraport~nt to put tills pre4mution on tlt~ h~v~ itr ~iuired in the advertising? Mr. (may. Yes, six': as I said i~t here. I will go inin ~ little mor~ deta, . It x~ou., d : ~rvetbep rpcsoeo~acompanv, for. amanufae-. turer adverOsmg his produce in 5he hope of leaving ~ favorable ra ~r ~ssion of his ~?l'odttet or ill this oasp, thc sill ok[!r s Hl[II(i [hi!It I / [FIllil~ :tround ~tnd re]ling binl tIlt!t'(~ is ~onleibillg wrong with it, Th s wou d ne~'ate the whole force of the advertising. ~iore specifical]y sir ~n our business, many of ~s are fac, d ~iih the S.~Xlle )roblem. We have ill R xreI7 )()~er~Lll ?rledilll0 lO(Igy~ rc[o- ~ision~ Ihrce types ~f advertising conl'~I/(~I'(~i~ll5 So fat" a~; le/IgLh I:d the owmmerchd is center*rod and the time it is Mred. Titese are 60 seconds, '~ei'y few 30 seconds, and ~0 second% down to ID's, which are~ 8 seconds. In all~ save the ,~0-second commercial,

256 CIG~RETTE LABELING AIqD ADVERTI,qLN'G I believe any caution required in the same ad would t~ke up most of I,h~ lir~m ~F tim ~0 se~om]s i~erl,alnly ~]] of the lime of the 8 seconds~ and you wou d lav~ no thne for prod~c~ identifical on~ l~Oth~ng to say about it. Senator DO~L~¢~. On the other hand~ if you advertised to increase lb~ sales al~(~ then show on e~hpaekag% Jf you sraok~ il~ it is goh/g to ]~urt your ~a t you are ki~ d of defeating yourselves there, toc~ aren~ y~u? • Ir. G~Y. If you adv~tiso with this thing it is like one of Four witnesses for tbo other sic[e saicl~ this would tond to elimmat~ aclr~ tising~ and I think it will tend to. l can~ ~peak for us as ~n ind~.ry. I think we as a ~lrL~afly~ i~ I ~Ilav Sfl~l¢ f(ir lll~ ~,wlb woul(I bav~ Lt) seriolls|~ ~]~sid~r dlsconsiIl~t~ anc~ o~ a(~vert~h~ o~ its product under such c~r~umst~nces. It does ~u~t ne~oat~ th~ w[~ol~ impact of tll~ advertising, i do~l beli~w il wo~ld be proper to continue under such circu~ia~l~. ~enator D0~gK. Would it be proper ior rac to ~sk ~r wo~lld you have the ~nformalion on hand as to bow trreat i~ to~ms of dollars is the amoun~ of ~elevls~on ~r visual advertising carried ~ut by the corn paulesllsted ~ the first page ~ your statemen~ Mr. G~. i ~on~l havt~ tJa~ exa~t figures~ ~enator. Let me put it thi~ way~ may I spe~k f~r ray ow~ compa~y~ a~d I a~me t,]l~ w~u]~l he fair] rcpre~cn~a~iv~ o~ ~e ~bors ~nwlvc~t. tha~ mbre than half of the dVollars we spent in ~dvertlslng in recent years have ~ne into telerisi~n. Th~ (2ir~lm~N. Th~ ii~o~r~ wa~ xx~e~ ve~erdav of $~00 million ~/ ~rtising by the indust~T s~ dividhtg t~al it ~:buld be $100 m~lllon tn ~cl~vi~ic~n. ~r. G~ay. I th~nk th~ would bc ~air~ sir. Th~ CH~-X. I w~l] correct this excuse m~ for ~n~rrup~ing, I think it s $135 million tha~ is u~d m ~sual adverlis i~g by tobacco ~. CxRAr. Th]~ ~l~mat ~ ba~ been macl~ by an agency. ~e~nator ])o~.~J~. ¸]:hat ~lo~s ~ot bmlude billboards ~r things of that natnwe, ~Ir. GRAy. You simply were speaking of ~elevisiou w~re yo~ not? All ad~ er ~i~in~ l~ a d~gree~ ex~el)~ ra~ti~ i~ v~ual~ bL~ I was c~)~ fi~ing m~ answer ~ally t~ the lsiev~sion area. ~Th~ C~r~MA~z. I am ~pea]vi~ o~ TV onl~z ~(] ~o~ newspapers or billbo~rd~. It is a tremendous ~tount. Arid I m~ht a¢l~l that ~inc~ lhe~ bills have been introduced and sb~ce the ~ur~on (~cller~l~s R~port ar~d~Lnc~ this ma~ter has been bandied ~round ~rc in lh~ last ve~r an/1 a t~al~ th~ i~l~nll~nl~ hll~ve ~l~lbl:f ~c~a~ed .h~l~~ Tx¢ ad~crtisin~ of ~ba~co~ ~ w~I1 g~t the ~res~ • Mr~ G~¥~ I~y I ~]~e~k ~ ~ own c~mpan~" ~ilb respect to t~t~! ~r~ G~ O~r ~lvcr~isi~g e×p~di~ures ~ y~r were up over 1963~ Pa~ of ~hat~ a ~ ~ ~e~]~s~ ~ a part ~f tbal was due to th~ i~r~ ~n the ral~s be~g ~barg~d by ~h~ rnedi~, which w~ wer~ ~sin~ ~ver~thing si~wenlup ~bcy w~t ~p:• l~ e ~n~roduc~d one new br~n([ last ye~r~ Thi~ ~ a ~cy exp~slv~ l~posi~n for a companw You b~e l~ sp~¢l m~ll~ons ~f dollars i~ t l~ introd~cli~ ~ ~ new b~,~d~ T~is ob~iousIy would ~rease th~ ~dv~rt~ing buelget~

CIGARETTE LABELING Ah-D ADVERTISING 257 I saw som~ reference to the nu~nber of spots being se~n and in our sore tony again if I may speak W that, we found~ I suppese iJ~ was in ~ l~ smnmer of 1963~ a condit on where we fe ~, t,ha~ we would be using our dollars more produotively in television by discontinusnce of some of the reg~llarly sponsvred shows~ the half hour: or hour pt~>- gralns~ and using that money ht spots so that we did increase our spot televismn, ag~ it w~,s I:~rgely I~ ~he cost of SAc regular network programs whidh you lind to commit for a very Ioag dine. You goc more flex [bi] Ey h'mn d~e spots whicll are locally plaS~t and ~o~ could put them ~he~ you wanted and take them out when vo~x ~xanted. Thb had a rather noticeable effeot. Senator Dom~ic~. Mr. Gray-- l'he CH.*m'~ax. Excuse me, I d 1 't inca± o nt~rrup< I he, re the figures here of the top 100 ncLwork TV adverlls~rs for 1964 versus 19~3, which i will put in tbe record. Soap beat you oul,, aml detergents aad American home produexs. that is aspirins *rod things o~ that klnd~ and General Motors and d~en the mbaeeu companies. Senator Nx ~x¢axm At that point, eouJd we jua add R. g Reyn okls Tobacco spent $~2~158~00 iu 1963 on TV spots ~md gl 495 009 in 1964. The tAIAID[AX. [ nil]st ss,y for your company, on TV you spen~ ~5 million is ]9C~S and S29.9&g,000]n ~9~A. ~r. GRAX+ ~ am ne~ sm'~ of the figares~ Senatar Neul~rger re~7, tha~ is spo~ TV; is it not Senator N~vsr~s~s. Spot TV. ~¢i'. (}RAY. T]lis is right, th~re w+~s a ~hif~ in Chat, 9on see. Semrtor Do)ii~icg. Mr. ~l'ay~ peru ~fer~xt to ~me of tbe beneficial a~p~cts of smoking in your sCatoment jusi in generali~ies and ~ little bzt m co~meetion with men~gl beakk. Conld you lye me any otlur facets of it ! I am one of those ~ ho from time to ~ime has g~ven up smoking myself and go back w it .o~ with ..v ferocious degree, but IvhIIt, ~£I't~ S(}IIX[t {1~ [}l'~Hl~ l~'Pl~J~eio.I aspects ~lJ~tt'yoll refer tot ~fr. Gm r. ~enator I s~d era'bet I am not c~mp~ent m the/dcld of medicine. X would prefer not to get into any discussion of these medical aspects of tkis because I jus~ Imven't got the hackground Lo discuss it adeguatoly. Senator Do~_~t:J<. Let~ me aak ).ou tills questmn, f I may. I have not had the oppor~unlly of going into detail through tI~e e~tii¢ Sin" con General's repot% but I am sure that people in your company ~ave Are there any references to these in thaL repose a% all Mr. G~ar. I had oia~ ~ terence, sir. Senator Do,auxins. I saw one whc,r~ pregnant women h~ve babies of lower b~rthweight which I uaderstand is somethhxg now medically desirab!e as X0n@RAT. ,1,~isas it is not ~oo small. Mr. wg~ on page 7, sir, of the siat~ent. ~enahn' DO'~ItNICK. ~Vol][d y<]lI }lt~v[~ the samt~ ob.iee~hms if die wording of any w+nJi~g on a package or mdvertising should read eome+hmg hbe this, and I take this fmra page 7 o~ the repot±: Warning, excessi'Te smoking is believed to be one of the ctmsative fach~rs in ]~e~ain tim words %xee~Mv e" ullcl a Js believed to be" ? Mr. Gs_<Y. One quick objccd0% Senator Dominick, would be that ~he length of ~he thb~g would take up even more ~ime, space, than dm

CIGAR~R~J'E LABELING AND ADV~IITISING one which has been suggested in some of these bill% and I ]~lst don% believe that it is necessary. I think the public has been inh.'mod aad eel"~ainly is going to continue co bs iuformcd as to =~ number of people who believe tha~ smoking ean bc in uri.us to some poe fie% health. If thiscaution ison thopackagc ][ ,sl~zee no eartMy use that ihwould lm in ~u]verJisb~g. ~t is going l~J be in every persoa% pocket every time he picks up a package. Seuator Doximc~. If you put this on smoking products, do you think it a/so should be put on liquor products ? Mr. Gsar. Sir thatlsout.ofmvfield. [Laughter.] Se~ls~tor DO~INICK. That s a], ~fr. C xairman. Thank win. Tim Cit*m~rAN. At least on TV, th~ liquor people vols,ca~ily don% advertise. ~mllLt~ir T)O~rI~TCK. ~hat~ The CHaI~tax. They don't advel"tkse at alL ~oluntarily. Senator Pearsom Senator Ps~aRso~. Mr. Gra~. I understand and concur with our p(sil i,m fhah if any ~Em, cw of ~G[wnment .cts in this field, it oug~it m Im Jdm Fedet-M G~>vern,.ent rather O,an rile States ~md local Lmiis. I cau aloe m~derstar~d holding the conviction 3,~)u do abotl~ bhis scien- tific a~d medical question that perhaps the FederM Trade Commission }~s issued a regulation you cane agree with, but I note in ),our testimony tdmt the Lobacco illduelr¥ ~md its various components are spending some $7 million a,xd some P~0 ~ientisls are working on this prublem. ~+V~ lke in an age of a schmtific lou~wIedge ,~xplosion. Don% you think thaC ~dth the eha~gs in inhwmadon and new informa- tion tlm* we haw% and perhaps tlmt being iu your favor, this could he more properly regulated through an agency raiher tkm~ to have it exclnsiv~tly uuder a statutory action of Congl'ess ? Ic tgkc:~ sx~me time to )a~ laws up here al~d to repeal and to amea~d. .~r. @~r. Senatoi% riffs quesdoa was asked ~hile you w~re no~ hi the room sir. My sa~swer is simply ~his, iha.i this is such a great, such ~n imp~ormnt question, thag I feel very sh~eet~ly tha~ it is a matter which should be handled ~hrough the (lengwass by the *~pressulaLives of the people who are elected t~) these offices tuld not by an agency. ~Tow as h, tim flexlhilil,v ~t~blem tbe he leh0 bl~akltn'oughs in medieval krmwledgc* and s~:~entifi~ fact~, shouI~ that, develop, and the ~ arcfing Toe in position to be downgraded or changed, it would seem to me the Congres can act on it i{ they have the itwefntable f~mta which would be necessary for such a change. This w~uhl be neees~ sary for an agency as well as for the ConKress to have Lhis hffoLroation if iG is he~ unequlvoeallv. I li~ink Lhai Lhe Congress could change thls without tx~o much 8ifficulty. I~ would no~ be a quesfior~ of opinion, riffs would be a question fl~en of basic fact. Senator P~asox. I want to joiu the Chairman in commending the ~ngus~ry on d~e institution of tidq code ~,nd the research you are doing. Your suggesLh);i t]la6 I;his legislation ough~ to s~peelficatly sbti~ Ihe size and fl~ [~sitlon of any wa~i~g ~s a good one. i hope I'm not being unfair in drawing axk infet~we from your t~sdmony, but I do g~t the impression that while you are stronglp opposed to this. you do foresee the pos~qibilitv of some Iegi !alien and som,~ h&eli~g legl~h~tio~i. Mr P,~RAy. I mnel, recognize the possibility.

CIGARETTE LABELING ~D ADV}~RTIS~C~ 2D9 Senator Psmxso~. 3{r. Gray if you were on this eomlinLtee a~/d you were ii1 the minority and some laimlhlg act migb~ be a part of the legislation, would you ~lave any longuage wb hd, you *inght suggest that you think would be fain in *~gard to you," indusgry ! ~Ir. G mxr. This does not hav~ ~aly suggest e<l langnl age in it. l'he C~A~I~A~. ~%~r. G~t~.~ 3oll are going to h~ve to talk a lltt]e bit louder. Mr. Gmx~. I wins looking a~ my s~ltement. I did not think I had ht my stat~ ,uent al±v suggested language and I wanted to be sure it as not in. Senator PEa~so~. You wouldn t concur with the Im~guage lit any ef these bHIs. would you ~Ir. G~( Unfortuna!.e!y, I do ~xot kn~ Lheln in front (~f me. One, I am sure I would no~. ~bis one [indicating] h~p ~eus to be a H~!use bill. Amlont oforderin m~mlk~ulnga Housebilllntheb~nate! Senator P~so~. No; I don~l think so. hir. I~-. T}ds is ~he one submitted by Congt~ssmsm Roger~ of Texas. It.II. 3014 and his bill carries this sngges~on: "Cammn, cigarette smoking may be hazardous to your health. ~ This i~ simple ~i~d I think quite unr]ers~andt~ble. TI,e Chaharmrgs bill has "Warn- ing (~Oll~llill~ld ~lgareL[e ~lnOk[l~f, lllatg be bazardot/s to 3~ollr he~lth. ' Both of these are Mmple gnd I tblnk direct. They say what ap ~ar~ ent]v some people wan~ to sag. If it has go~ to be tborl~ I don't Ihink I w~uld have great ob ec[inn to either of these. S~nator P~*l~sox. I was look ng for thc~ angua~q~e. I dont' have it n(*~% tlutt Dr. Terry proposed ~nd since that is not available ~o n~e at Ibis point-- Senat r Do~ INICK gi 1 you yield ? Senat or Pr.A~sox. Yes. Senator DO~[~N-~CK. If we put that iD, shouldn't we put in automo- bie advert sing, %ont nued driving may be dax~ei~ us fll 3o m' heal[ h.~ hir. G~Ar. Sir, I sm not kx the automobile business. The C~T~,~',~.. I Ihink it would b% %ontinuous driving." [Ls.nght er.] Senator PxA~sox. I thank the ChMr. , , • v T e C~AI~- I th nk e Chair w~lld hke to s~:,~ Mr. ~r~o ~ that there are se~nerg/ suggested wording~ here and I dolgr kllo~ which is II*e hes~ ~ne r*r ~}l;~l~s Ilia one thnt shonld be put cm p~e]~ages ]f the Congress shonld p~ a bl]l~ but I gm sure you will find this committee and ]~[embers of Congress trging to use some eom~nen sense aud to be fair about whatever might be suggested and ge~ ghe best ~ording we can and ~s brief as we e~n. hlr. GRAY. Of that, I am cert~ b~, Air. Cb ..i rm*m, ~nd I am per [e~ [ly bappS l~ leave il. to ~tle good udgrnent of the eolnmlttee. The C~m~r.x~. I suggested, wa*z~ing~ continual cigarette smoklr,~ mty he hazardous to your healthJ' Somebody might want to ch~mge that or make it briefer Mrs. Neuberger has Shllila~ language art<l the t{~>ust~ hills ~dso ttnd ~ thinl~ we llr~ ~lll tr:ying Io ;i;~i~e ai, ihe same thinff. Senator Morton. Senator ~{o~ros. i jus~ w~ L to say that I apo of.dze to you, 3{r. Chairrnan, and the very able witness for having to ]ea~e~ but I bays l o ,m~kc an appea~ a,1 ee gt the Fin m~e Cormrdttee and it is tso bad you llg~-e to be at two pl m~ a f ~ce.

CIGARETTN I~ABELING AND AD~RTIS]2~G The CHamarA~c. Why don't you aa~k him how much t~xes they pay to the Federal Goverm~ent ? Senator ~[ow2on=. They pay plenty. I thi~d¢ that point }ms be~n well covered. The U~Ara~Aw. It is ~;~ billion plus taxes paid by tile tobazeo in~ dustrv ~o all governm(,~ kq : ~,~te~ local, and Federal last year, Mr: Grc~r. Tlmt is rlgkt. Senator Mo~o~. Herin known Mr. (}ray for m~ny more )'ears th~n either of us cares to a~nit, since we went to school ~ogether when we were 14 years old I have asked him ~ let of questions ~bout m,ny things and I have ~eKw higi± regard for his judgment and Fm not g~fing to burden the 1~ecord at this point. The CKamMAX. Thankyou. ~emdor Ba~. SerLa~or BASS, ]~[r. (}ray~ let 111~ commend you on the. staten]ant you have made before the committee, I did not et to listen to it, but 1 ~ad it very hurriedly. Mr. ~lovton talked a~out old tmac~ 1 am a folmler employee of your company. [Laughter.] The C~car~M~. ThLs is goin~ a little too fur he~. They are all eltber kkffallh roommale~>, or empinyees. [Luught~r.] S~a,~Lor NF,~.rox. Mr. Chati'nmn ~f the Senator will yield after the next ~leetion~ will Mr. ~ray n eke a comm traent to take you back? [Laughter.] Senator B~ss, if any of those things should hmfortunateIy hap en-- 'P~e C~r~-. air. B~% 1 .,.st p.t myself on I~he fringes, f don't know Mr. Grnv very ~el], but I am a very close friend of your brother, @ordo±h so g am go~ing to be in the same class. MoutOn% you are tim onl one who is shlent. ~enator ]~*ss. This i~ old home week, Mr. C2minnan. g did work for the eomp,mv 'l'k~t is wlxere I got m v social seemdty number with the ]]. ,l. l~nyn~flds Co. But at, tlm~ tll{le, I think we were working Illld~i" tiLlS lllaX~lnul~± wage o~ ~5 eents an hour in the warehouses of tobacco down Tennessee and your company- has an illustrious p~st and d think it has contributed a great deal a~ the ~eemorny of the countvv. We appreciate kaalng that t~use~.iatio~ wltl~ you in our tobaee~ indust~w in Ten nessee, f want to say. Mr. Chairman, and Mr. Gray that a~+~;r v~ualing your adxertlsin Ct~le iaere, I l~ow of no of,h ~;r indu~l~.~ in ~he lTnlt al States and I ~oubr in tke world, tl~at has done the kind of job that you have done in policing your oyv~ adver- tising. I believe that it would he a~ .%gt'oltt [0 free advel~?s/ng~ fl~e enterprise, and to the great economic gysteln that we have in the United States if we in the Confess we~ to come along and say that we cau develop a bett~r code which would protect the people 2zorn a commodity th~ mi*.ht be in~rlous because the code tha~ you are followlng in your T~dvertising, your radio and newspaper ad~'er tisdl g. in my opinion, is as ~r as we could possJhly ask 5ou to go wath- out phssing punitive legislation against one industry. That ~s my feeling. = . . Nc,w T don'~ think we need any legislation, that is Ir y opm]ma, f dont behove we need labeling leffmlation. I knew we don't need udvertisin~ 1 otis] ation because ~f "~e get i~to this I~elg in one iln dnse~w, then tl~e Congress is going 5a have to 13~ a police dog taking apn~ every p]eex~ of a dvertising ii~ the Crnll~=xl g~ates, l think we need more

CIGARE'I~E LABELL~IG AiND ADVERTISING 261 policing ~n political ~dvel~is]ng than we do on cigarette advertising. [Laughter.] S~ mg~)r BAss. I bdlve tile policing job tl~t you are doing now is in foTlnin~ the _A~lerlcan poe ]e about your industry musk more fa¢~ tutdiv l ~ mue I more e~ cful~y than we are lit any other lrldustry that I lm;~w of includin our own political situation." So I hope that the generM t)ablic wfll~oe able to have your stateJn~lL ~nd i hope that it will be given wide circulation. I h@~ tlmt lhe eod~ tffs~ your industry has developed will he called t~ the aLtentinn of the American public. 1 behove that if tt~ is a hazalY1 involved, education, public edu- cation dis~rnbJ~flod not only by dm roper units of government but by your ~n industry, whisk is spending millioi~ of dollars ill ~oikg this, will be adequate~ Mr. Grav~ let me com~lend you for the job timt you are doing in ~illty°Ur ir~du~'t~ Yin, vol~ ed inin tl~ist rving inst a~lce,t° car~- ont ~hat appears t~ be the responsi 5~r. 0~x~. Thank you ~nator. May I point oat one ~ldng in this connection, Mr. Chairman, that the code i~ an .~ttempt at self-regu- la~ion, us you well ur, dersfand. This does not in an~r way impinge on the respm~sibillty of tl~e Federal Trade Commission m the adverbasing fie d such as t has hem~ effectively operating ~or many Veal'S that is, false and misleading adwrfising. I commend the ~%dcr~il Trade Co~mniKgon for timir ~ctions in ~his type of ayes. I dd ~k ikey are doing a good job wit.h the powers as~gnod io them by- tlns Con~'es~. I~ dcK~ not inter~m~ onu way or allother, This is implementation in different at~a from wher~ the FaderM Trade Compression presently operates. Senator Bass. I would like to ask a uestion about ativortlslng. I~ wasraise.dhci~yeshrffsyorthedaybe~rc. On~ in3ourtulvet~ising, y(mvgenci'~l intent istotgy to etyourproportiom~teshareor ~gq'c~t v]~am ~.q you c~n of tlm mm~et tl±~t eMsts, i~ax't that your general ~skeme of advertising ? Md'.~s,r. ¥e~.slr. hIaylelaborateonthat! Senator B~ss. Yes. sir ; h would love for you to do so. Mr. G~,~Y. l befieve testimony or ~ s~at.~'~teYlt waB mad~ on Monda~ and tlm ruJ~el~lee was in c~ll*qect iol~ wi~h ~ former presiden~ of one o~ my eompe~tltors whom I did not have the pleasure of k~owing--he was a little bi~ older tl~n I--stud he sat4 that advertlsi~g of dgaregtes in those day% ~d tiffs I suppose was 40 years ago m' close t~ i~, ]tad • two-fold raison : on% t~ get peoplo to smokei ~w% to get °ohem ~w~v from the other fellow on to your brand. I imve no quarral with that s~tement ~L the time it was m~de: Sena- tor ~ass. Tt~t was when the cigarette business w~s in its earB- s~ages and it dldn't have millions o~ easterners as we itave today a~'ul have had for aome years now. I e~m mul~'at~nd why hit. I~11 f~It that xNag ab(l/lt g. I~( iwtw(! v~ {~t! ['1 ~li[I] y ill tile ]asI ~(1 yeal% lllO rg LIZRII ti~i1 mii]ions more people have made tiaeir choice to smoke, have become araokers and are enjoying it. More than half of the people, I sup- pos% in this cou~t ry today are smokers a~d so the need or the integer= to cry to encourage more k~ild IllOge people ItS such to Slil/dre~ as ~ iek~Eoll for ndvertising has become g~atlv lesse~ed axed toffs3,, as you say sir. th~ reason I am speakikg now ~'or myself, bu~, I believe tltis is true of all eompanles--is that we want • little bit more in our share o~

262 CIOAIIETTE LABF~LING AND ADVEWPISI~O [ha~ husin~a~ and we are going to try to convince the man wh * is smoking or l.he girl who is smoking that our p1~duct is belier tasung~ mors Balls f~c~otT* mor~ attractively p~ekagnBd~ snd the v.rmus thina~s s you talk about ~'here a*~ very few things you tml l~Bi~nitt~d to £~I~[ about to try to take his husine.~s ~Lwsy from him. My ~ompetitors ai~ all geiidem~h~ thBv are nice peo Ie~voU know some of them bul they are still competltol~ and I woll~d like t~ have a ]]iIll~ Ium~ of their 6usine~ if I can get it and that is the purpose {}f advertising {o e~ some of their business aw~y if I c~n do if. ~ealator ]3ASS. ~is is our system of flee enterprise. The CIL~.~. Mr. (~ray~ the Ch~irmlln is going to have to iBltve and I will ttum tlm meeting owr to 8emLh}r Neuber~er~ who also *~a3 want to ask ~ couple of ilU{~qtltlim, but ~ walit to ask ust one quesIlon. Tim Fe~/er~] Tn*(]e CInnlmssinn~ ~s you know l]as promulgated ~n (wder on skis subject and the llrst or~er pertained to Dart I, puitmg on tlm pack box. and container sold ~o the c~nsux~[cr public skit cigarette smoking'is dangerous to health ~lld m~y cause de~t]l fronl etmcer and other dis~a.~s. Tken they Bugges~ tha~ except w±~h }~ spinet to nd verllsh~ the ~u]e ska]l become effective on January I, 196~)~ wlfieh was Ia~5 January~ and this, of com~ would be on the package. Mr. Gm~r. ¥es~ sir. The C~[~zRxix. Then as a result of hu~u'h,~g~s i11 ~hs House ~he Fed- eral 'Pr~de ConnDission issued ¢% notJc~e ~ll S~ptsklber :*% w]2toh they provided that hotll would tak~ effect in July of 1965. The CHAIIX~[~N. i ~oll]d like ~he industr5 %0 81~swer w}let~16r i)r not you would r~ther have the (3engross proceed ~iLh legisl~ ~inn and pos- slhly ermct legislaion prior to this or whether sea wonld rather that we would not~ as you Stl~ge6B~ hsve an}" legis] a! ion and let the Federal Trade Comlri%~ilnl rule t~ke effe0t or a re~)lution sta34ng the I'll]e, which is another allorl~ative~ I think you better {hhLk about that and put tile answer hl the record. h~r. GP~x. I appl~eei~t e the oppor~unltv to do it. q~he C~i.4N. l%iavbe yo~ ~ou]d llk'e to ~n~wer it right now. SBntlt~l- BASS. Mr. ~}lah'rl]~n~ let In~ nlak~ just a short sbaterlumt The ~mx~m~A~. Let idm answer. Senator BAss. Go ahead. Mr. G~. I thought you ~aid I euuM beve a little time to find out "~VllClllBr l]2y VieWS ~I'B ~8o bt~h] by ot}l~rs, The C~x]~.~r. ~ive as your views then. N[r Gr~" Of the first ~v)o~ sir; I see lithe to a~Nn~e there. In either event~ as I understood your question, lb~we will he labeling, The CH~rg~a~. T]u~{ is righB. Mr. G~r. IhM nk I made ~B clear I would like to do so, if I tmw not~ tlmt if there is to be ~ label: I believe so firmly and I .an convinced skit it should be done by the Congre:~ and Congress alert% sir. The C IAIT~A~AN k~ou lmve answered my ques~un. 0I course~ if a bill skould )mooed llu:ough the legisla~iw processes of Congtx~s and we get near J~e Ju]v 1 dale and it has ~ot been enm~ted~ then o~ eourse~ you would still be faced with the ~'ede ~1 Trade Cola- ~1/~%~1Oll lude. Mr. GmxY. ~ would hope, sir; that if it wt~ in the process of b~ing erme~t het~ intlm Oonge~s: that the Federal Trade Commissinn

CIGARETTE T~ABELING AND ADVERT]S~TG 963 would recognize that it should delay ~gain uati] t]m Congress had re,~dve d the issue. T to Cm~l MAX, That o~ course, would have to bca matter of policy for the C~)mmission to confer with the Congr~s *~t fllac time as legd~- ]atlcn ply<eerie or fails ~o pivoted. I drink the incbmtry should con- s de • th s and ~ive us the bcimflt of [heir eeeling ~bout this ma~te~. Mr. Gravy. l~zbcm is miy coatr~ feeling ~o ~)h~t I have 8aid~ s r; it will be tl~nsmittod to you. ScnltWr BAss. ]Kr. Gray, the statement I want to mak~ is fills. I he o tba~ Ihe industry itself will be very e~rcful in comin.~ before h~ eomlmttee ~nd accepting any kind of p~fiti~e legis] ~tion~oec~u~, ll~I'lc my words, ulc]ess my ~ei)uhllc/m colleague ilww here @esn t ~et his wish and i retrain to ehe Cong~,~ as r~ M~mber of t!~e Sez~at~ ~ron tl~e State of Tenncs~%~e and I live my nmznal span of h~e, 1 will ~e the time when ll~ere will be h~gislati~rz before riffs c~)lnmittee or some other comx.ittee in ihe C(mgt~ss t9 p~oldbit th%r%imng lind the proecssin~ o~" tobaccos. Tiffs thing is g~ll~g m paD1C1 I[ IS gO1?Ig ~o bl~ p:m]~ dtuat%-'x before it i~ over and ~e are going ~o find m~r~ebes in dxe same iosltion tlm~ my predecessors f, mnd when they started tMking ,~ bout too prohibitimi ,~mendment and i~ is coming and I hope that the imhmt rv itsel~ I~i]l co~xtlnue to police itself as fnr as neces zry ~lld ~, c~yIW otlt its code. I dent Want to sit here today ~nd say tha~ I lmlisve :my legislation is necc~sary to prohibi~ ~he proper ~qlh~g and r~dverdsing a~d dlstr{- b<tion t f t~>baceo ~rodaets eea ~e ~ s rm only t l~rge econo]nlc ~ac" tot an th~s c;mnttw, 1!~ 1~ worldwide. Iill8 WaS the OIl~ll~lt[ Illrl~Ilt,~ o~ th~ I hired Sta~es 350 years ago when we snorted ~radis~ in tobacco with th~ British Empire. I attended th~ 350th annivet~ar'y of irade with ]]/'ilair~ in London b~twetm Mdte men m~d before thai. l think ~e can look a~ ~ome of ~]lC~ ~O3"O~L~ ln(~l llk izistorv who hay e coil sum~d l~ig~ portmn~ of ~obacco and, for exmnple, • Great BritI~in cid~(n wile pa~sed o]~ just a feu weeks g~r<. a ei ~.r was his sd,mboL We ha~e seel~ it m our ew~x indnst~ 'I do~[~t dffnk it is a, ny time ~o panic in this situation at M1. Mr. Gmt~. Thank you sb. Samtl,or Nmmea~s~ (presiding~. Senutor Cotton. S~tor CoTro~ I m sorry I didn't he~r yo~lr whole s/~temenl, but I hope I am not a*ki~ smnething that was cove~d. ]rmiden~Miy, i am u brew I~ngland Y~nkee, so i ean'l~ claim ~ny relatlor~ship to you and you would)~ w~.tt any relationship to me. Do most o~ th~ cigarette coulp~n h!e ~flso mrmulacturo and se]I other forms of tobacco su(~b lia )ip(~ tobn cl~ and some o~ t]~elia ('igor s Mr. G~AV. Some of tAem m~nufaeture e g~rs, tmt is righ% Mr. Sea,tot Cca'ro~. What is the proportion of the sales if 5ou have a e,~ll~3r~I i)ropo/~ton between smoking tobaeoo :mcl ('i~'~rettes l Me (*mt~. idortth~ve hos fig ~ ~hme, Senat~r, of[h~nd, ][ Lbink lms~ ye:~r l,he~r~ wa~ abuut 70 million pounds of t~)baeco so]d ~ sw~oking tobaccos. Tha~ is u ve~T very small proportion of tile amount of tobacco used by the American mamffaeturer~. The bu ~ of i% of course is in cigarettes. Senator Oc~t'yo~. II~ve you ebserved sb~c~ this public agitatiou ~nd reports and discussi~u ~bout the injurious effecl s of cig~,ret to smoklZlg

264 CI~AREq~FE LABELIN~ J~D AI~VERTI~XNG has beengo oing on whether the sale szLd distribution of other forms of tollac~(~ (uglu'~ ~md ~nokinLg ~lbaeco h~ve hloreased~ Mr. GnA.-. They i.e,~aso(1 *cry di~.s%ls,~dl.~ in the months immedi- alelv followh~g the ~lease of the advisory comnfittee's report~ sir, smdking t~,ha~:o and cigsrs. Smoking tobacco has not retai~ed all of the gains k made dtudng those mouths, although sty guess is that probably the Department of AgrlcultuCe fig~l~s whicl~ ai~n't very eutwent~ would show that. My frelil~g is it is still ahead of the rate of sale 'in December 1963, as an example. Sfl*dlarly with cigars, although I am not very famlils.r with the cigar business beeat~se we don't make eigal~ and we b~u,e a lot of other things m think about al~d I don't pay any a¢tention to them. They are nice people. Senator Cobra's. I don't want ta ask a trade secret so if it i% j~st disregard this question bug on the basis of the same amount does the sale of ci~¢u'ettes ca~xv substantially more profit than the sale of smokin~ tobaeeoq~ ~l[r. ~rtlay. f llTrl trying to r~memtx~r wlmI Ille sbe~bs hmk like, sir~ and I am ha~ing a little trouble Mth that. I believe in our owa~ case, and I know notbing ~bout the other manufa~ture~ t~e pexren~ge of profit per dollar sale in smoking tob~ccx~s is slig~tl3 larger xhan it is on eigacette"~ but I say tbat I believe that, sir as Imn not at all eeEain, it is it fah'ly close i~lationship per dolJae ~f volllmt~. S~M~n" Cm',(m. However, if, is probeble and il is my oIJselwation-- I ln~ ~pen t~ b~ a pi m smol¢~r that ~eo fie wbo ~nske cigarettes con- sume cons der~bIy more tobacco than people who sn*~ke pipes. }Voud you agree that is "robably so ? Mr. Gm~'. I t~rck it entirely depends on how many pipefulls a day ~md bow lsrgc tfie pipe is as eompm'ed with how ma~y eig~m~t,les day and wlleth~r t,bcy .r~ king sbe~ or regubw siz~ 1 don't h~±ow. One thing, I am n,~ a~.~ains[, Ihe matcb indush'y, bnl you know yo~ burn a lot more matches when ~-ol1 sinoke pi~es than yell d() ~l[el~ yell srtt~ke cigar et has. Senator Cov~-. d w~s going t~ a%y it has been my observation most pipe smokers smoke matches because the pipe goes out and the~ hold it in tluir mtmth ~ad then light up ~gai~ and n~ tb~ ~md of the day, the5 probably haven't consumed much tob~o. But, I was inter- est~:d Jn the statement thatys'oa quoted from a clgarette company oxen- rive of many yea~.'s ago. When I was a boy and a very )oung inan, almost everyone smoked cigars anti pipes and elgaa~ttes were in tliea' iufu~m~. A,Id~ ~s a retorter of fact, they had ~ httrd time gs~ling ] • . , started because I recall there were al ldu~s of old w~va~ talas at thnt time about the paper being impregnated with some kind of drug, that is. the wrapper o~ the e~g~reLt~ ~nd also that it was effeminate to smoke cigarettes. The men felt that way so ~p a*~nt, ly ~ lot of work bad to he do~e to huild ,~p and mak~ aeeept~,ls to tt~ mblic • the eig~uette.< "~ ~ . ~Th~ I gather from wbat you already have testified, ~[s. ~p~Y. Th .~t: was part of the problem. Selndor Co/3ox• I watch tele~dsion a good deal ~u~d I quile frm quen~l~ see diffenn t fimuds of eigsr~ adverfbsed but I ra~ely, if ever~ see ~noldng tohax~c~s pipe tobaccos advertised or* television. %Vhat I am gstth~g at is thi% and it may be a little far fetched~ but if there

(XGARET~£E LABEIAJVG AND ADVERTISI~/~ 2~ is h~zz~rd attendant on cigarette smoking that is ]lot attendan~ or at least not a~ywlhere near the same degree o,1 pipe sntokillg~ I v.'ollder if in view o~ that fact the cigarette corapanies might no~ one of the~e days decide that t3~ey would advcrtis% push aud e~courage the sale once mine of pipe tvbaec~ if therB is anywhvrt~ ne~r tim s~me eoml)at~ hie profit to be gabled fl~om the sale. Has tips ever beea considered so f~r ~ you know ? Mr. (~m* r. We tmve not disconLhmed tho promotion of pipe t obmc~, sir, ~tud it is propmtionate to the sales generally and I ~mL sorW :,ou h~veu'~ seen ~nv advertisements. ~re must not be doing a wry good ob, but our con~apar±v as well as o~hel~, does have television ¢ommer- ciMs oR our smoking ~obacco. Now ~hey are not as numerous, cer tainly, as eiLg~arettes, but neither are pipe smokers as numerous as cigxcrette smokers, in proportiom Seal~tor Ccyrrox. The only e~mmerciaI on televismn I s~w on pipe t~ha cc~s is one I see quite frequently now about a cer~ahl pipe t~bacco that d~ey ~re putting maw clg~ttes. Mr. G~Ay. l am familiar ~ itlL ~hgt. 8mmwr Covrom That is a competitor. I was careful not ~o mentkm th8 u~] rile. ~r. G~xv. ~bonk you. ScapuLar Corrox. I was curious about that. ~ould i~ be a difficult melter for you to bare plrmezl m fl±e record if ~hp cIh~lllllan ar)[Jro~ ~: ~t some l~ter (late some comparable sh~dsiies ~l~m~ Om sale ~f c ~tt rl*ft~ ~nd pipe t c~lllml~l ~ Mr. GKxv. Comparable by pounds or by dolla~ s, sir l Senz~tor Co'~-co~-. By dollars• Would you object to doing rb~t! Would it be dilIieult to get for us ? ~Ir. G~Y. The P)e }artment of Agi'isul/are sir. has the figares by pom~ds. I am ~orried about gett ng ~ ton'cot figu{'~ n dollars becau,~ ipe tobsecos sell by thepackage and ~here are variances in weights. pl If I can furnish tlle hg~re by pounds, we will eer t ai~dy do that. Senator 0ovw~. Just for'geg it, If we ~h'ea dy h~ve the hfforraafion from fl~e Deparr~nent of AgTieulture i~, [Iottllds dou~t~ go I~) ill;d, troubh~. It is not rh~f impiwtanl. I was emuous aboul~it, fhank you. Senator Nmos~o~R. I h~ve • few qu~tlons, Mr. Gray, but I do have some h~forma~ion I would like to put in lbo record at ~hms t~mc. Since 3ou have just referre4 to ~he Report of rlm I leper tmen~ <if Agri Hfltum on Tolmeeo, I think it ~pt>r,opriate ~tl read i~ in~o ~bo record: The ]~4 ¢~nsnm|ltlon ~f (*i~.~r~ ~lld c,lg~tvi/Ios by lJg. smokers is estimatotl at 8.9 biUion or over ~ fifth more thlm in 106,~ and above the prevkms re~'ord 02 8.5 billlon in 1920. Tile sharpest i~crcases have occu~red in cigarillos, but cigars in all price brackets Mmw sigJdfieant gaines over a year earlier The number of cigars coming from puerto Rico conUnues to gain and may ltccmn~t for 8 Dercen~ of %oral c~gar c~nmlmgtilm this year O~tput of snmll <igars rosa st rJMi3~ly in the first hal~ o2 1!)64 1964 conmlmDlion WUl Drobabl~v be the lligh ~ s t in half • century. Production of smokiDg toba¢'eo in 3~gl4 1~ o~t/maced at ~3 mlllion i~m~. ~R i~.rcen~ nb~vo ~ ~n6 probably ~he larges~ in 10 yeats. ~olpoI~ {}f 8/320l~32g ~0~0~CC0 hdyf, gained sharlfly and ms:, accoull~ f.ov 8 perlent o£ total smoking tobacco etmmlmllthlil in 19~d4, Tlds discussion ~e ]us," had abeut pipe tobecco reminds me that one of tile issues ~,t slake here is about advertising of cilgare~tes. The tact that my honorable colleague from New lIampshire kasiP~, seen as much advertising of pitl),e ~obaeco ~ cigarettes and the f~t thl]t k's~ pipe t**ba¢~o is used evidently than cigarettes wou hl indieat~ that there

CIGARETTE I,ABELING AND ADYERTLSING is a definite colmee~inn [KCwe~n the ermsnmpf]m~ of cigarettes and advex%isiug. Ttha~Msoh~,nsug'gest~lthat thisisnottbroughyour tast.inmny, but v~qterday or tAe, day befm~perhaps the real pm]~e of advertlsl~ff ires been to nrfluence brand ~ ectJon rat ier han to stimulate the amount ~ gross s~fles. Yet we see a decided increase in the ammm~ of money spen~ for cigarette advertising ~tl~ hc Sur geon General's report, if the {xmtentinn i~ idle tlmt. advt~r u sing does not affect gic~s consumption then there, would be .o haiku in putting a abel on bec.ause evex'ybody WOllld b~, 0,~c~ect~x] tim same. ~o ~ ~ ouldn't~ aff~b I hat basic, oompedtlom Sine~ we ar~ speaking of labels, I might say. I trove thought, ef a very go:xl hbel for che industry whmh would be m keeping wRh the spiri~ with which they are attealptin¢ th police themselves. Tlmy trdght say "()igare~tes are no~ ~ dire ~'~r c~neeb.:' Or. if w~ wan~ a reMh' shor~ one, if rdhll~ is th~ trouble, lb i~,i we ~ x~Id jus$ ha~e the word "I)~r]ge~" on cig'a~et,t0 labels. One )ai$ of the stateme~ll, which 3ira Gray put iu th*, recent e~rlier this morning dealt wi~h the phe~omena. that e~en with all the widespread [~u blie attenlion given re the S ~zg~on ~eileraF~ l'~po~ ~n tt]~ Lls(~ Of (! gtli'l~[~t~; and [}l~2iF ~onne~Lion wlt]~ diseases~ people ~tre still srnokl.g. I flhink flhag our gloat Govezmnent has cer6ain sins of omission a~ well as sins of eonnnissinn, if it has any sins. One of ~} e s ris s th t, we have not warned the ~mblic enough that there is a .'elnthmsldp ,between smoking and disease. Thb is what. we hope Io 1 elp redr@s wilk die leglsl~fl)on /~f,n'e us. I~lmedint*d) after the issuance of the S[lrgeo]l ~D~FII]!S 13!IIQI~ Lberl! Was a d~lnhlutbHl irk ~he "~ilno[ln~ ~,f cigarettes smoked wlndi shows up in the excise collections for cigarebtcs. The total excise collection for eig~lettes in tlm li,'~ 6 moll ths of 19(;4 was $~'0.8 nlillinn ]e~s thin hi tlm same tmriod of 19@3. Bu~ in the las~ 6 months of 1964, the t~tal excise col eelX(m for cigarettes w~a $10.8 million more tinfoil for tl,~t perbd *~1' 19(;8. I thwk that this ~mws immediate decided ~ffeot on the public when the @overIl- ment at last i.'~ued ~ report that the peopIe h;~d confidence in because it md representat yes from he tobaccoindusti3' al~o. In addition, our ~ove.r~ncut is further taking steps to warn the t, op]e. A~ ~]t]~; time ]uthcs re~a,d • ~mfld like I~ read a statement from the Natinnal Program to Conquer Hear~ D ~: Cancm', and Stroke ; ICecanse public information and (xlucation are p mar ~ ~s r ]m(ntg for ~lle a~tacli on this l~roblem, the Commission recommends ~h~l~ ~he $tDJo of ~10 million De appropriated to the PuPIls Itealch Servibe over a 3 ye~lr [t~NorI for t~ tqdlny~te hensire national pregra~a of eauca~mn and public ill[Orlil~rioI1 regarding the l~azards of c~garette smosmg. The i~rogr~m tdmnIrl D0 f~ime($ a~ th~ t~lueation of elkildrell, a(l/lltg' physkeial)s' aDil ¢<lneatcwg wi~h the assi~can~/, of State and Deal eomnltlnity ~tg~ m,i~. A network of sine]dug ¢0nmol c]hllea sllo/ihl h~, prll. virl~l r~) assist those who desire to ~dve u~ smokhlg. New and mor~ eff~:~fiv¢~ educational material should be developed. I thi~k that for tim first thne our GoverrtmexlL is showing an affirm- ~rtive~ aggressive~ and progressire program in th!s field o~ c~lu :aCinn and no ~{oubt some of the statements mede b l~fL Gr~y's tes~nnony earlier could certainly be borne ou~ and we l,ave h~e~ cxmcerned with it. But we ll0~v~ ~lso S~I1 ~1 il~erol~se kl ltulg c,mlcer ~b this t'lrte: as I am s r doc¢o "s follow g a d doetm's previnus]y have test~fil~d. Tobacco seems to present a peculiar peoblem in his eountry~ herin to do with hazards. I wrote (lomm]~aioner Larrlek of the Food an~

CIGAI~ETTE LABELI~-G AND AD~ERTIS~IG 267 Drtlg AdmiTdstraticn 2 ~ears ago asking if we didn't already h~le suf~eient legislztion to include tobaccos ~s ~ hl, zsrdmm suhst~mce. Itis -eply was tl/at he dldn t thulk so. Yet no,~ a rqu~slntam~e of tl c industry; sug~4~ts dmt nmybe ~e could b,vc :l label which says, "gig- aretles are hazard<ms to ileMth.' .M~o. to .sk Jhe Federal Trade Com- mission to bypass tobacco seelas a p~ulb, r ~de~l ~ o me. Why is tobacco freMed differently from any ether product thtt mightccmaeunderlbepurvicwoftheP'ederMTradeCommi~ion? W~ ~llvc~a% had the ~aol industry bore ob eetlng to the fact that thl~ FedelM Trade Commiss~oll l~stricted or pron}lfigated wophl be. a beit~r w~rd ~ules affecting the adveriislng of wo()] btllnltg sm~s hat are ~ade n m~ State. I am teriihly sen~d )e t~) that one Tobacco seems ~o w~mt to sit a )ar~ as not hei ~ ~t ~azardous Sn~fit~nee, It S • Yld of JKi~ ~[0 lf~lXllned s /u) [i w llle~l sits exit there in ha~ lleb~tlous ar~--it is neither food no~ a drt ~. 3"cw we are bsh~g asked to strip the Fedel'M Trade Ocmrcisslon ~<~ its auL]mrity m this ~ret~ of ud~ er6sing m ,d k sea-ms to me that this bears t~king J,ot ~'. AGo we imve had comment almut poliMn~ of the industry by itself• ~ln~ %~ry zyl/leb h!terested in thin l)l!~¢lls~ 1 ~ol]feE['od with (]oveErl~r Meyner a ~aat ded nnd also with representatives of the industry rcg ~rdin~ lht~ir self poJicino" and l am interested in iL. Bul the only exam ~le ~e have is in the ~istilling industry ~ n~l ~ ~ind tbar~ wI}at I consider n±ore of a~elfpchoinm~ Tim d~sl~l g nd.brew. ~ag. ~- dtlulr$, ill it~ wigdom has seen ~ t!v(m lo promo e model ~tlOll li~ drink- ing. They ~(htrtis~ Itmi± product~ not on television but at the a, me t;i [m i h ~! , d o I ell i~ot en ~if~l eus£ol~] ors ~o practice model~tion. Flu reminded of the adve't semen s 0rot we aJways see uroulld Christmas E~e and New I e~a' s eve which say, "~D~en ii~ is one for the roI~d, make ~t coffee. p ]19~V$ llO fUl•[h w st ~ellt~t}~. l)r~s ~lly illell~ber of the c olrllllit t 8e ! Senator ]3xss. If my good ~rielWl will allow rn~ list (~lle ¢01~llxlent on her stateme~t, ir~ talkLr~ abom th¢~ Federal Trade Commission and a owing ~ob{cco Co get in 1~ world of its own. the responsibility of the Fl(h r*d Tnt lle ( ommission il~ policing advertising, in my opin ion is ill the area ~f mMeadin~ ad ,or s ng ~o c ~ a'e at any adver- tkqlng Is L~lll)l£" ~}je t Pil~h./tot llllsJ ( tl(hHg the )uhb c. i know of no ad vertisin~ fl~at is being done by tim tobacco industry Iolhky Ibat is misleading so what we are asking and what the p~o ou ~.nts of this legMatioa are asking is ~ eg~ative actmn by [he Federal ~rade (]ommission, llot affirmatiw action to prolecL the publlc~ but negat ve act o I to pen m]iz~ an b~d ast ry. Senatoz N~Em~. AS [ snld before. I think the Govcrmnent ires sill of olnis~ion as w~ll as colrllD.isslon, Senaior B~xss. i donrt think ~e have too really sins Senator N~t!~zRc~m. If ther~ are no other questiolls* I call oil Dr. Tb<>m ~si~urferd, ltarnesHospital SI. Louis.M0. ~r. Gl,~y ~I~ :~ conlp()Hi/eI wbio}~ is necessary ill the t ob~eeo indus- ~rv, and ]±e took less thall 2 hours, third:, in courtesy to all of those who ve come to testify today, with the direction o~the chairman, Senator Magnuson~ wc plan to go right on II~ough, so :~way we go.

CIGABE~IW~ T~%BELIbTG AND ADVEIITISIk~TG S'~ATEMENT 0]~ Dlk THO~ ~IFRFO~D, ~A]~ HOSpITAI~ 600 EIN~ HIGK~AY, ST, I~UI~ M0, Dr. B~ORD. Mr Cbai~laD~ merabers of the comlu~ttee, i too wou d like to express my apprec arian 2or the "pr vilege of appearihg here. I are Thom.s /¢I. Burf0rd of St. Louis, Me. l am a doctor ot~ medici)~e spt~clalizing in thoracic surgelw. I am pro~sar of thoracic surgery id, W~shinginn Univei~ity ht ~t. I,mfis, and was a founder mt~!nber o2 the board of thoi'acic surgery. ~inc9 1954 1 have been chief vf the ch~ surgical service ~t Barnes ~Iospltal and the Washing~m~ U2~Jversity School of Medic)he in St. Louis. From 1946 until IB54 1 was ~ssoclate chief under ]Dr. Ev~rts GrelmI~l who ~a8 apioneer in the surgical treatment o2 ~ancer of the Image. k dstakled list of my few qua]i~cablons ~s attached to my st ateln~nt filed with the ceramist te~. My Inkier inLe*~st has been the diagnosis a~d tt'ea~men¢, of 1Llllg cancer. ~*Iy ex ~rience in the fi~hi has been si~r,i~cant, I have se~ and tr~at~I uv~r 4,0(]0 cms~ of lmlg cancer durmg ths p~r[od. I a~ no~ a ~cer r~searcher and I am DOt a FEat]s~ieia~, ~fy opi~dons ar~ ha~ed on r~ I a/'~e ~bnical e:cpe fiance, ell a thln~lugh study of the scientgbc liter~tureep~rtaining to l~mg can:~r ~md on an objective evaluation of publish~research and st~tistica sxud~es. I do no~ believc~ that ltmg cancer is caused by cig,aret;t ~ Slilokht o" and 1 do not hebe.v~ ~]mt smoldng is responsibl~ for any shortening ~ life. The o~t-q~toted s~a~ic8 l>IIrporting to prove tbt¢l;~smohin@" doe9 c~ I~a ]Img ¢auc<~r or do~ shol"~e~ human ]i:[~ have done notldng more th~ll porha[!s established cerSmh star ~t cal aa~ociatlons winch ~gain, In my opinion fall far ~horL of proving a causal conneotion. ( anc~r is a profound biologic phenomenon aud ~l; is nly opimon t,hl~t caa~gr is th~ sam~ disease and is veT.y Drob~bly cat~sed by th~ salhe ag~ll~ or a ~Ili;s regat~II~> of what organ i~ affe~ts. I~ is stret~hin~ Cl"cdtdiLy beyond reason to b~lieve that, the afore- mentior~cd si~liStlCS and ~hese assotlations have h~m t~ast>onsible for disvo verin~- the causes of disease tl~t lruve thwar ~ad the efforts of the bt!M £/tYeStl~'3,tOt~ ~or generations. . . Cancer o~ the upper w~idpqiFe or traclm~ ~s one of &~ ra~ &s- 0as6$ al~d yet th~ ~l[)pt, r wlndplpe~ which receives a gre~ter exposure to tobacco smok~ t]lan the other par~e of the windpil~, is tile same f~om the ~trn,at~ral and ~}te miomacopiet~mtin~ of vtel~" as the ~her major w~ndplpe$, iueludmg t~e ~najor bt:onehl wllere most lung cancers a~ sa~d to develop. This is a definite lneo]m~stency and one theft in~ns re*T imlmmm~ in my mind at tease, in the whole problem of lung cancer. In th,. e~rl i~,c studies aIie ~ "ng statistical . associat, inn between anold ~g and cancer of the bronchus tt was elm,ned that cancer of the bronchus vccurr~ in descending order o2 f~luency ~rom the main to the smaller branches. A re~uC importan~ s~udv has shown tl~t many tumors vc~enslbly ~rimary in the lazg~ bzvne'hi have aetuMly arisen in a ~nxller more distant b~onchus and involve the later one by diz~ extension. M~ny of us are now couv-inced that 13m majority of eases ,>f lung cancer arise in a small bronchus rather than a msjor bronchus.

---

CI(~ARETT~ L~LIN(~ ~ND ADVERTI~L~G Iron, J. 0., "~e place ~i ~ a hhem~ti(~ ~n medical a~4 biologist stat~t~cs - Journal of the l%oSal Ntatistiea~ Society, Series A, i~ (I~)~ I~, ~, Neyman, J., "~t~tisti£~ervant of all sci~n~s," Sc]en~; 122 {I~G~}, 401~. 4. ~erks~n, J., "~rn0~g and ]~ c~ncer: ~ome ob~ervfltloDs ~n two r~t report%" Jouro~l of the Aim ~rie~n ~t ~t~¢~ll A~soi!~a ~ oI~. ~ lI~)~8), ~8+ ~. ~rks~n. &, "Smoking and lung canr~r," A~rle~n Scat~s~ci~n~ 17 ll~l, ~. Yule, G. Y., "The f~m~on of ~e~fie meth~l in s~ientLf~c iavesti~n,'* Industr~ Fati~u~e l~e~ar ch Board i~epo ~ 28 ( 1924 ). 7. i~her, ~ir R~nai~ Let(er to the Editor, Nature, 13G (1985~, 47~ 8. ~Xsher, ~ir l~onald, Le~er t~ the ~di~or, ~rit~sh Medi~I Jo~r~al, 2 (i~7)~ ~. ~sh~r, ~Lr Ron~l~l, "Car~r ~u~ s~no]~ng"~ Letter to the ~r, ~&tltrG 18~ (1958), 59~ 10. ]~riberg, I~ Kaij~ L, ~}en0ker, ~ ~I, and R~nsson, ]D., ~m~]iing habit~ m~nozygotie ~ii~ dizygotie t~in~'~ Br~tish MedJ(~l Jollrn~l, 1 11~3~)~ 11. I~a~hou-Niel~-n, ~, '!~mok~ h~bl~ in txvL~s", Danish ~i~dh~ Bulletin, 12. ~e1~r~ 0flrl ~.~ "MorDholO~ ¢~t~Li~n and ~ioki~g~" Jo~nM Of the Amebean M~Iieal As~oeiation, I~3 (IDa3), ~ ~. Ey~enek, H, J., T~I>I>~. ~., Woo]f, ~i. al}d N~Iglan~, L,, "~oking ~nd pel~ ~ona y," Br ~sh ~ edical ~ ou~mal, 1 { 19~0), i45~0. 14. ~erushaltny, J., "~t~i~tie~l considerations ~Ind ev~l~!lon of ~)ide~i~logi~I evid@~(+e,'' in ~me~q, ~irgG fl~d ~0~e]~th~II, Theodor% "T~b~.~@ all~ Health" ~p~n~eld : C~arles C. Th0m~s, I~6~ ~0+ I~. H~mm~nd, E. C~-ler, "~oIi]ng in i~lat~on to m~rtal[ty a~d morbidity : Fiud[ri~ hl first 34 monU~s ol follow up in a ~ro~ectiVe study s~ar~eO in 1959.,' ~au~al ~ez~rch ~ectiou, ~ed[e~l ~ffsirs Depaltolent Of the ~meriean Gan~er ~c~i~ty. I(;. ~erushalmy+ J, and pa~olel', Carroll ~.~ ~Or~ the meth0~ol0~ of investI~- tion~ of etiologi0 fag~r~ in ehr ~ni~ dlS~Q S~," gour~l of (3hl'~oic Di~a~s, 10 (I~G9), 27~0. Dr. B~oI~. Thai& you. The CII~R~,~. -~ny quc~tinli ~ S['rll]i/Ir B~i~u ~ ~eillltor iJAlaS, T)olthlr~ ][ was ]ooki]l~ ov~,r )o[lr cr~d~ntlals [i]lc[ t, red] s } crc, lln l I would ]m~ to say that you ~ppear lo be an expeim in tht. field aud we have had befm~ us for the ~as6 2 days, Monday and Tuesday~ in par ticu]ur~ ~ome ~minent: men it[the field of medicin~ who f~k~ a contradictory view to wha~ You do. This on|y pohl~s ~ql the fm:[. Ih~, I ~hfl~k ~ lere ]~ sill] sorm~ doubt as ill the i~l~!t l~u~l Ill lux~g cancer and i~s to w ~at c~ tr[b tion smo~g mlghl have. i~+ow~ as a surgecn~ in pei~orrflil~lg an operation can you tell the difference., without P~0 owing and hx~king a~. a hm~. eo~dd ~o~ t ~ dl~r~]l~31 ~S }t s]lr~e0 L ~ ~o wh()bh~r ~t i it ~ll~o~F~ or llons]fto]~er when you ot~r t~te oil [$~e ] ~ng ? I)I'.~WaFO~D. No, sir; I cannot. AsIhavesaid. anddidsavb~m~e the IIouse commitu~e, it is rar~ now a-days in ~n ad-alt to ~ld the so called virgin hmg. 'l'hel~ arc so mnrty envn'onmenta] factors ~ow that th~ patient in Ihe cm~cer age, who comes to ~h~ oper~tlng ro~m, is very apt to have a lung tha.~ J~ no~ lhe pink ]nng of the inf mr. Ba~ ~ f~w as t~b~x:o smoldr~g or cig~retle ~moking s eifieal!v 4s e~neerne~l and if~ infiuenea it leaves ~rom the out Sd~ and rll~ in~id~. ~ far as I ala co~cerncd, no e~'idence which an experi~ne6d ~lll'geon Cll>rt l~) ~lize a]ld say-- here is a smacker, anti here is ~ nonmuok~r.

CIGAII~I~TTE L.~uB~LI~G ~D ~DVERTIe, I~G 271 I think this might be ~ g~od s6ady to have cer$~in bliad studie~, to h~ve cel~n exp~rlenced sur~co~ls w~]k hl~ someb(w]y else~s operat- ing room and s~v, "does this m~l sraokc~ or doesll~t he !" I think mos~ of us wo~lld flunI~ completely. Seil~tor ;J~gs. fl.~u,'L]I¥ ~ ~t sll~'~re~n~ I ~/elieye i~ vollr ~te~ient ]~% you l~w ~een ~n~J trea~ed over ~00 c~l~ of ]lln~ c~leer il~ ~li~ ~l~ ~ B~tracs I [o~it~] in S~. Lvuis Se~l~or B~s. Knowi±~g t~ ill~rlnati(~ that ]~w~ be~ ~l~nlat~ ~md re]~ to the c~use ~lld effect ~ of c]~ri~te slno]~]ng on ~h~ ]Im~, even s~bc~n~iously, a]nlOSt, yo~ woul~l have ~o ~]ve ~ome notice to this in :gou~ wor]~ J~ tlyi:~ to ~ter~ni~lc if thes~ ~acts were [rue ol~ fa]~ wonldn't you Dr. I~ltl~Ol'~. I ]~Ve. md~cd~ and I certainly had gre0~er imp~ ~]~1~ kllow, is o~e o~ ~]~ l)i~lieer~ ~ l~l~s I,~tsine~ 111 ~ai~t]n~ ~rom statistical l~i~lt c~ v~ew~ /~n(~er ~f !he ]uit~ aIld cigarette s~oki~g'. 0n~ ¢o~!d not be associated, par~ic~l~lriy ~ p~oleg~ of l~v~s Gral~a~l~ without being cow,st ~u~tly reminded of thi~ p~blenl evc~¸ day. I only rnea~ to imp]-~ th~ I ]lav~ ~lot s~u~lie~l thi~ qu~io~l from visual experle~ce ~rou h~'e h~l in thls ~1(1~ d0n~t you beliew that if u fa~ really existed a~d if th~ grea~ d]ff~nce was bro~lgh~ ~b~Lt by cig~r~t to ~moking, you wo~ld h~ve observed Jt ? S~n~tor l~s. :Doctor, ~his one q~cstion t~o. of wurs% yo~ h~v~ said that~ ~ou b~vc/1~ bceI~ ~n t]~c w~r~ of cxl~m~nt~l~]on~ ~1~ don~t yo~ believe t]mt if ciga~tt~ smoking w~s ~s gre~t • c~use ~f ]u~g ca~- ~r ~ts som~ of th~ proponents of ~his le~sl~tion seem ~o believe~ that i~ CO~ll~[ h,~vc bee,1 d~v~]op~d ~r~ e:~peI~l~len~s o]1 z~liJm ~ls ]1~o~'~ ~h.%n We~ h~v~ seen h~ ~le pas~ ? ]Dr. l%r~Fo~. Y~ ~ir~ ~ do~ t~l'~Jclll~r]y in t}le pr]m~e~t]le monkeys ~nd so for~ h. Se~or B~ss. And a~ you know, ~her~ }~ve b~en several ~pc~'i- rnenta in ~i~ ~rea. • r. ~. r ~. , ;' ~r~ ~1~ b~ll Ilo lung ~¢[~leer pl~Odl]~/] ex~)orlilie~l Senator ~. At ~his tim~ I woul~ lik~ to rnak~ u ~tatem~nt for the re,~o~'d ~hat the Ochsner Clinic in L~isi~in,~ reporte~I ~1~ 1960 ~Jn thl~ 870 cases ~bey h~d seen in the last 1~ veers ~f ]~n~ c~ncer. This no~l c~:.~w c]inie h~ only s~n 870 cas~, and here we h~w test]m/~ny J!~trocluced in ~h~ reoo±~ ~f Ii /]/~/~llr who is nl/~ i~ c~naL~r researcher of tl~wsment o~ over ~ 000 ca~. I h~ question ~rmes tll~ no~ beln~ ~ st~t~s~l~lan and of not ~emg e~ncer re~rcher would indio~t~ ~hat perhaps th~ conclusions h~ve bee~ dr~wn frvm less ~h~n file Ol~hlL~ sci~ltific co~tr~ls used thes~ ~ ~'oll don~ research somethlng~ I ~lon~t know how ~11 a,~n r~]lv dr~w ~ conclusion. People, whose sl~eci~ltv it is to no~e sucl~ ~hln~s~

272 CIGARE'£TIt L~BELI~G AIqD ~DVE~TISI~G have found Im ~nerease in inng cancer2 and st~ti#ics and the 29 ~lat is~i~i~ns who were consulted in the Surgeon Gea~rM~s Report ]u~ve differealt, findings. Therefore, it is incorrect to say that any numerical m~re~,~ m 1~ c~llcer may be due to the agin of our population in~cau~ stutlstl- cians use a simple teelmlque o~ age a~lju.~t,,ent which corrects for this ~hmlge. The bibliography is in, prog~v~ of die work done by Dr. Burford, Mdmugh I only fiud that of all of the titles of publication% four of tilem, that J% "L3 tlaeiv title~% sug~oest that chest tumol's are Lmdgr ~onsider~tlon, and on~ dea]s mostly with tr o~t~n~nt not wt,h dmgnoszs~ as I note. I would just question thp a plienbHi~v of some x~at~rlal tm]ess we have more specSfie or ~%*~ m t a~a ~P~'~d e~c~ ~]~an ~s presented he*~. _Now i reoog,~z,s ~hat Dr. Bur ford is a thotxcic sur~n who differs frolrt ill,her LhOl~Ci6 surgeons who testilied in this ~rea. ~%nd 1 ]lope I ~ai we wl]l hf~ve SOl]~ebody who is COlU~ecind wlllx heaI~ re.~e~.re]~ to ~,O1]llrJ~nt Oil this s~ al~. I have no questions ~td will call ~he nex~ wltnes~ ~[t" Alan Donnahoe, statistidan~ and executive vice president and ~s~i~Laat publlsh~r of t/~ lqichmond 'rnnes-bisp~t~b and ~ ]~ichmond _N'ews Le~d~r. STATEMY2~ Or AL&N S. DONN~0~, STATISTI~IM~', ~£~Tl~r~ VI6*E P!~IDY~T AND A~I~T/~IT PUBL1RKE~, ~Ib~H~0ND TIME~ DILATOR AND TI~ I~IC~M0~ I~WS I~2dlEl~ RIff~0ND, VA, 3it ]io~u~o~. ~dam Ch~n I am Alan S. Donnahoe of l~ishmond, Va. I ~m~ the executive v~ce president and assistant pub lish~r of il~e Richmond Times I)islmtch and the l~ichmond N~ws Le~der. In addition to my npws~per wo~'k~.I have spen~ a good m~nv years in the practical apphcs tmn of statistical ~}o~hocL . 1 have been a ]ecturer on stati~ti{'~ at the 17niver~sl~y of Richmond. • , . ~2 h~ve served ~ts ~ member ef the ~on~lttee on Business ~tat~ *~ U.S. ~lmmher of (:olnrnerce; the Bu~ines~ Advisor~ Co~mlli~tee~ L~.S. Bu~\~u of the (~ensus. I am ~ member of the A~he~ican St~tlstlcul A~mciatlon and have serve~l on its Conm±il/~ on Monographs. I h~w • real int,~rest in mblic health and have been a member of th6 exeeRtivo c~mrn ~t.t~ of f~e Virgin [a Tuberculosis Association. I ~ish f~ thank the committee for ~his opportunity to appe~%r ~nd Inake this sl.%l~nl~nt in eollnect io~l with the subj~t under oonsldep~Uon which is of com~ of g~_a~ in~re~ ~md importance t~ the l~ople in m section of th6 cotmtlT. ~en the t~por~ of ~he Surgeon GeaerM s .Advisory. Committee was released last ),eat" it h~.~ nae the responsbillty of our n6wsp~per to give 4}llr readel~S ~tn intelli~ble ac~ol~n~ of ]ao~ on]y £h~ ~o]3~]usioilS O~ tho ropom, but also the ~ets and d~t~ ~ldch fo~md ~ho basis for those ~onclusinns. I fo~md the report to }~ I~ fornlidable do~ument~ bristling w[l,h star stica table% hard to underal.and~ and even more difficult to sum- marize aa~d ~'port. B¢~u~ of this it is quite understaat~h]~ tha~ lnaIty llewspn[~en~ rc, helt flhltos~ entirely on either Lh~ solnr0~,l~" pro-

CIGARE~E LABELI2qG .~D ADVEKTISII~G ~7~ vldd for the press or on tho cont~luslons sl~ltezl in ihe ~poi% itself as t]Jo bll sis ~or their II~ws slorie~. Sim~ the c~O;l~h~sions ~f l,h~ z~por~ seemed to b~ ba~ed prlroarl]~ on st~fislics: ~ felt t,h~t I shou]d undertake a Inore ~e~rching analysis of ii, for d~ m }~EI~G J, o~ our readel'~ I was ~mprised to laid ~hat de~plt~ the ~rm conclusions statecl in the report, the text rovealed rn~Ily ~r~ilt]e,~ and inconsistencies in th~ ~nderlying stat]~i~al data. I think it is ~ fair ~teanent tha~ the publich~s little knowledge of the~ deficiencies and the extent to which they qu~li/7 ~he conclusions drawn in th~ r~pox¢. In this e~imection, it is signifiean~ that one member of th~ ~t~rgeon (~ner~l's ~dvisory C~m~nltt~ h~ subsequently implied that th~ C onll~it ~ ~* m~y Ilot hlLv(- bt'~ii IL~3 fli ijli3, C(.ivinl~'~t o1" ~t i~n ~ ~,~1 i!OTt~ e¢ Dr. John 13. I~cl~:~m~ in ~n ~d4~s~ t~ ~,he ~qorth C~r~Iin,z IIe~rL ~k~soeiatlon is reported by th~ Associated Press to ]~'~ ~id: "The mor~ we looked at th~ star sfics, th~ more d~fl~¢u t ~ was to under~t mad. Th0 picture is no~ ~t a]] as c]~" as the numbers appear a~ tir~t ." When t0he Congress of th~/Jrfit~cl St~s i~ ~f~I~ril~ ~l~]~ b~sed ~1 ~ib the report of the Surgeon G~ner~]'s Adv]~o*'y Committee, i fe~l tha~ ~ should ~1~o be a~z'e of t ~e d s~rep~n¢ e~ n t/~ ~tat st[c~ dat~ which raise serious que~ti~n as to the validlty o~ th~ conc]u,s]ons re~ched. [r~ ]~lrop~ llntyiy tv~llr~ ~ It sfrlln~ col-rl~]~lf ]Oll ~ ~>b~luved l~ ~een the con~;/llnp ±olt of corn and corn l>I~thlct,~ all(1 th(* in.ida, lice O~ peZhtzl'~t. It~ w~s ~vid~Iv o.ssllroed l]~t o11~ ~r~s the callse of t]lo other, a~ ~hls assumption r~zul~ed in ~ gre~t redllcti~,n Jll the growh~g of corn ~.nd the use of wheat as ~ dietary substit ute. ~3ve~u~lly it wa~ tfis-~overed tha~ ~l/a~er~ i~ th~ result of • nu~rl- tion de~ciea~cy~ which e.~n be ~upplied by nfilk ~nd gn'c~ns, ~1~ th~.t stat]~i¢~l ~sso~iation, From this and many other example% wc are led to recognize that sc]entil~c truth is a~crishab]e• commodh¥.~ and thaL theories in~• og~e todd}' m~y L~ ou~ of fllshl~n t~morr~w. TT is i~ this collt6x[ [~ seem~ [o me: ~}ltt ~ we must ¢on~il] ~'r fh~ }{~illl ['1 ~f t ~e Adv s~>~y Commi~i~ to thc ~lrgeon G~ner~l on ,qm~ z~g and I~ow c,~n one ~pproach .~ny subject o~ this kind~ W~ c~u~, a~ ]ea~t, it~ s ~ea~l s to me, ~t[ill~ ] 11 ~h~se t~rm~ : Firsf~ i~lles ~hl~ ev]ll~nc~ on ~,vhich [~ theory' is [l~l~] ~t ~j~e~u" [o be ~alid. I Ihink we J~:~ ~werv ri~hf ~ be sL~spi~iou~ of ~nv findi~ based on erroneous e~idel~. ~f, h/~I~d ~hat ~}~oul(t bc ~h~ ~s~. ,~°2°nd'• 1~ tllt~ theory ¢,olopi.elle~l~l ve 111 ..... the sense o~ ex )l~lllln~ illo~t ?~ th~ knowL facts. ~ partial ~xp]~ln~tlon ]~ dlsturb~n~ t~ rno~t of u~ ~11 [ ry] n ~r r ii ill~d~l~t ~nd any Sllbj ~ct. Thirt~ is th~ thc~ry ~Tl~i~n f, in tho st,~ s~ theft if is ~I~L ~ r~,l] i~e~l by any of ~h~ ~v[dencc on which it is bast.d or ~ny other k~ow n f~t. Fol~r th, does the ~heo~ me~t the f~ of re~ott~b]ea~ess. Not lnn~:h is said ~bo~t this but 1 ~rr~ quit~ certain that this is the firs~ te~L a pp]ied b3T al~ prac~icin~ statisticians. When unreason,~b]~ re~u]t ~ are obtnin~d hi ~ ~u~vey~ there i~ ~ s~ro~g suspicion ~h~l sol~10~}linp2 went wron~ som~wher~ in ~ tee.)~nique applied.

274 CIGARETTE LARELI~G +~ND ADVE~gISING F~nal]y. is anv ~hernath,e/heory av~ilablu~ c~mlsisien5 with known fact which m@ be equally or ~vcr~ mon~ i~lausible as ~ t~ntative exp anation_ Let us tumt first to tile questhm o1" consistency of the inform2~tion said to ~how a e~nne~tion betwe~m <dgareit~ smoking and disease. A story is Bold in Virghli~L aIpout a schooheacher man years ago who a~H;lieA for a job in one of ~ur rural counties an~as bekLg intmwm~ved by members of the schsvl board. "l~ieh theo~w de 5,)~1 teach " s~id one guch member, "that the world is round or+that the world is flat P~ ~Wel], sir," the teacher replied e~u'ne~i.ly~ "IqI t~]] yore I c~ te~h it 6ith6r ~ ay." " • We may have somewhat the same fee]h~g a/~)Ub the Surgeon Gen- evM's report when w~ discover that some of the evidence u~ed to row ~he (~[)[IIHN!~][}II he J.~ eeil cig~ ~tte smoking and ]u]lg 59 liter civil tI ~)~o hi" used perhaps with c~lu~l cog~]eyi to prove thaV Omre is ~o such OOilneot o~1. For example rhe repro% shows that Holl.nd Swiizerland Finland and G~a~ Bmtam have a lower per ca[ula consumption o~ cigarettes than ~he United ~tatcs, hnt tha~ all h~ve highea' mortality from lung cancer. IndeX, in the c~se of Great BriUdin. ~he mortality r~te is more than double t]~at o~ th~ "United States. Sh-aila~]2 Csm~da AustrMia and Demnark have about one-hMf the Unit(~l Stales~l)er eap~t~ colxs~ropt on of eig~u'e~t~s, bu~ show about the s~me mortalXty late fz~lu lung I~atlci~t". AImtJzcv ex~n~ple calt he ~md iu ~he rati~ o~ male-to fenl~de de~ths from lung cancer. Notwithstanding the rapid growth b~ cigarette smoking amo~g womelh this rath) lm~ incrensed from 1.5 in 1930 to more than 6 ut ~he present time. This trend wlmld certainly seem to be totally inconsls~enL ~ith tl~c eigaretto causation th~n'y. 'l'h~ same ~atiaLict~l ovido~c% used by the comm~tte6 to bolster its cone) us~on on e~gare~e ~2nok~n~ a~ld J~ ea~c~r~ ~hm~'~ thll~ e~garet ~e ~Jfflo~e[s have a ~0 p(~rccnt gre(tf~l" l~lOl~a~i~.* fh~n "~or/~rKokers from stomach cancer. Yet, over the years, fffm mortality rate ~'om ~f¢~ naeh cuncer has de- clin~:h Precisely the opposite o~ wlmt wtmld be expected if statisticM • ~SOl!illti()n IIll!~lJl, (~aliS~JioIL o ~lere~res~Flot]exstrangep e~o ezla ~ be~ rgc Gea]erals report. For example: I~ appears tha~ once men re~eh the ripe age o~ 70~ if vhey smoke c~'4~ttes at all, the more they smoke tile better, in ierrr s o~" ~rthe~ li~e expo~taney, l~de~d ~rom 80 Io ~9 Ihe hes.vy cigarette smoker has only one tmlf the m~)rlalil,y ~te of the nons aoker IrL still another of dm surveys used hy the coJnmittee~ the me~t ,Mm ]~ad srn(N~d eigare tes ~or less than 15 years had • slightly h)wer mortality rat(~ th~ nonsmokers. ~ eol'dl]~ to tlic. repor~ lb]~ e~e iipe Hi,in ~¢ (OIII~H)Htlds whlc]~ Ga~I il~- dllC~ cIlIleeY ELI~I~[IO~/S1 )Ill fill ) II blIl/£~l lllllllbe~' of them can he fourul i~ t0})a~eo SmOl~% liHd Ihes~t ill llli~u~6 q~t~/~it~os. ~ven so~ the I~los~ otnnt of the~e is said to be behzapy~ene aaxd tim conmfittec i'¢~ ~orts t~at there is 10 ~imes as much of it in pipe tobacco as in cigarette tx)baceo. "i~t ptoe ~nokc.l,Sl-~ven those who smoke moIe thaI~ 10 o~oefuls per day, and thos~ who have smoked for more than g0 years---have death

CIGA]~ETTE L42dELING ~-ND ADV~:RTISI~ 270 ra~es no ~liffer ent from t~lose of nonsznokers~ accordil3 g to fhe st ~*Ysti~3 higher mortality r~te for for~ler 1)ipe smokers th~n for either smoke~ or nollsinok~rs. in brief if these st ~rSs~ics can be ~e~ieved it is quite safe to s~noke loi e. but highly danb~erous to discontinue the practice, ~]~es~ ar~ strange f~cts i~ ]igh~ of ~le eoncl~iol~ of ~h~ S~'ge~ {~nera]~s ~c[lort. Is it ~1ot • curious form ~f scicniili~ ~±e~ho<| t~a~ ]3errai~s us to e~ipl3asize only ihose fgc!s that sup[lo1~ ~ gi~'(~i~ hypo th~sis~ ~lld i~ore all others of a contradictory nlL~u~'~. ]~ll~ I~t ~i~ no~v ~u131 ~o our ~ond t~t. ~ I]o~7 i~ITi~[gr~hell~iv~ i~ this smoking heal~ th~o~ Jlow ~u~l ~l~ms id ~plain, and how ~uch does it ]eaw nnexplained? A[~hIIu~}I ~tlllisti~s iTL fl.~ I'C! ii}r~ hhow ~i~tLret~ ~Iiilk~rs ]l~v~ ~Jgh~r o~Ter~]] ~nM'~iI~ty ra~c~ ~)ther factors are cltc(| ~h~t saem quite imp~r~illl. For ~x~impl~: (~ig~rctt~ snloker~ who take llca~'~¸ exercise h~ve a lower ~ncrtah~y T~3 thay~ llonsrtlol~r$ who f~k~ Etoll~. ~retf~ s~ok~rs ar~lon~ married men h~v~ abont th~ ~ii~i~ ~L(I~'- ~vith shor~ived ~nI~es~ors. Corn n~ b,~ck, o ~h~ ~ue~tlon• of lung c,~n('~r• itself,• • ~he report sows There is sI~a1"~ v~l~,i~tion frorfl o%1~ r'i!~ii~ [I~ ~iil~l~her. TNB r~t~ In ~v yol.]~ (~'itV J~s b¢¢i~ ~]~ii~i~ll ~s ~ollr tiln~s ~]l~ r~l~ ill lo~'a, h~tion to their smoki~g ]~ab~s. T]~ere is ~ ~tron~ inverse relillion~hip ~vith in~om~ ]i!vd. Low in ¢oT~e m,q]es, for ~x~Im~]% h~ve li3or~ t]31~i! llOllll](! I}~! ]LIll~ c[~n~3~r i~t~ o~ hi~ incom~ males. Iirirrligr~lllt,~ r~l t~i~ i~iiilll~l~!¸ ~v~ ~ ]llr~ c~l]c~r r~t~ ~bollt olI~ ~I~ir(~ Fnr~]ler, for th~e i~u~Hgi'an~s, the incidence of ~nc~r by ~te wrie~ ~¢,~ordlng ~ the ~olln~-~T ~f origin : An~orlg ~he l~ish, hiogh d~th ccstry, a~d ~et, a~ ~,e have jus~ seen. all of these things seem to h~ve a strong inI1uenc~ o~i the risk of c~tnce ~'. ~iost ~ lls~ qllit e p1"op~I~] y~ h~ws g c~,3-c ~ t 1"e]11~f ~nce io i~' b~'oad c~n- c]usions frown fra~entary and incen~i~!ctc cvideP.ce. ]ff~v let us t~n~ ~o ~h~ t~ of r~sonableness which, as i h~ve said, i~ ~h~ li~ ~es~ ap~ied in pra~h~l ~urve~y ,work ~f al~ lrind~. Wl1~r ~ ~llng or sl~ sv~y proccdures~

CIGARETTE LABBL]I~-C, AND ADVERTISING Tiffs leads us to what is. in many ways. the most rema,.k~ble findb~g in tM emh~ report. The astonishing fact if we are to believe the statistical evidence cited by the commi~te~ i~ thai. lung cancer ac cereals for only about 15 to 20 percent of the excess deaths among eigarrtte smokers. About half of tha exeass deaths is tn be fotmd in heart dise~se~ and the rema nde : tm~ s ' ~ me g about everT o~her t~pe of disease k[l~W Ii, This no± only st~ggel~ the imagination but apparently it s~aggered the committee as ~ ell (h~ mcst of these diseases, the typlcal comgalt t~ c0neh$iolt was that "the datD. are not $1l~¢iellt to 8up][iort a (tit ect or causal con~e~tion" with elgarette smoking ; a~d in tlm e~ of some of dm chronic diseases, that ~ho elplanaL4otx * * • ts llot dear. I)r. Joseph tCerlv~on the distinguished nmdlc~l ststistialan of the :MaSo C1 m% h~ commented on ti~s p mnomenon as follows: q~he Idea ffa~t eigarett~ ~moking ea~e~ a~ ~hC~e maw deaths teem aR these t~ically knower phSXl~laeologic or physical exptanatio]2 ~or so widespread and multifarious san effect, If w~ ex~rapOlat e the reso[ts to ~he general impnla t~m "¢¢~ mus~ believe th~r~ are some 2,~,0~0 deaths mamlally from ~moking-indueed dlse~se~, withou~ ~ny of them baying beert indiVidUal]F ]no~ed as sueh ~:rom ill~epemlent ¢Fmi<al or pat~elOgie ~videnCe. Onkv by their numbers are they known. With findh~gs o~ tbis type~ it is mandatory thst survey p~,cvedures b~ reviewed wiflt vigorous ~are; because, in actual practice~ whon such findings occur~ they almos~ invariabI • tum~ out t~ be the result of ~aultF technique somewb~ along t~e line WLich may make tl~e entire survey unreliable. Wh~t we*~ tim procedures used by the eo~md~teo in co!letting da~a Th~ answ, r is tb~t tim commitdex~ nself did no original research, but relied whaliv on tlm work of o~hers. With thi~ total reliance o~ secondaEy materials~ the quality of such evidence must be closely examined. Th~ great mass of" ~vidence before the commlgtee evalved from seven surveys, of various population groups, by vs riot,s agcncles. One surrey involved Brihi.~h doctors; another included men in California in ni~m occupations where there was some ivason to expect high incidence of hn~ calmer; another involved Califomtiu members of the American Legion; s~]]l another was restricted to Cltrta ha Pensioners of three wars a~d so on. In view of figs, it is no} sur- prisin g that the committee said "None of thep opu b~tion was des~ ed~ in partmular~ to be l~pre~enia~lVe of ~he U.S. male popalatloh" and tl~at to project the results to any opulatinn of men "mus~ involve an element o f unverifiable udgment.~ But this s not a . In five of the stud es, th~ pcl~J/.ftge of non- response ws.~ 15. 3g 39 43. and 4~ percen~ i~sl3e~livelv. The commit- tl~o ]tsttlf rl~f~rt'~l to thl!sP as I 8izllb]f3 l)IIlj~)l][~lOll8!10~ nm~response. ]gven more serkms to a statisgieian are the conditions under whld~ the other two surve~-s were conducled. Ii± tim language of ghe com- mRtee : In the two An~m'ican Canc,~r Society s tllaies it ts not l)Oss~ble ~ Irfeseltt mea~- £n~u1 perc~ntages~f noDzespo~s~silme each research volu~teer set~cLed her

CIGARETTE LABI~I,IING P2qD ADV~RTISYN'G 277 Tliese two studies repl~sented 57 percent of the total replies in all seven studies: The majority of ~ll cases studied; and for these, cer- tMnly it can only be concluded that there wad not the slightest pre- tense of scientific s~mpllng. Indecsl~ if there is tm~ way not to sample sqientifically, it is to pea.nil t ladies to select respondent~ from within their en'~le of aCtlmLmb~umes, ~nd then include only those who ~re inclined to par~ielpalu. ~N~nen we ¢onslder all of this: the f~ct thut no one can tell what population was reMIy belay measured; th~ further fact of lfig'h non r~sponse in s~me surveys and of h~phazard seleettoD of respondents i~ the others; the result is a st~ sl aa mela~tgo of unknown a21d unk]mwabis reli~bliit~. To be certain of this we ntu~d ~eek no further altt hority than the one ~tatlsti¢ian who serve~t on I,lie conmfittee. In tlie second edition of his book on saJnpllng, publithed a couple of years ago, Dr. William Co~h ran b ~d tl~is m s~y on the subjeet : The fOLIowiDg are s~me common types of noaprobablli~ sampling : ~ Ttle ~tt~at~Ie is ~sgl~ieted. to a p~ o£ the ]~oD~llttioll tl~t is ~ea(lii~ accessible. 2. The s~ple is selec{ed haphazardly 3. ~he st%mple eO~sists e~sentiaU~ of vOllln~eers, in s~utlle~ [/i wlli~.h tile measllring Droeess ig llnple~l~;ant or troublesl*me to the persoll being meas~lred. t{ow valid are surveys of this ~yl/e ~ Dr C~oc ran goes on to say : • kbout the only way ~f examiRing Y~ow good one of fhem ma.v be Is to find ~ ~it t~a*ion in ~vh~eh the reslllts are known, eighel* for tile whole I)oDuI~tloll o1" for a Drobability SamDle. mid mtlkC, eonll)arl~ons. Even if ~ me~h~l api~ears to do well in one ~ueh eoml~tlriso~ this does not g2zs~r~.nte~ that iL will do weU ullder tufter ellt eir ~ums~ailt'es. In other words, what T)r. Coehran is saying is tltat snrveys of this khld are no~ very helpful; that you really cannot tell whether the results me~lx anyt hli~g or not~ un]ees you can compare thean with Imox~ n ~ets; and eve then t ere can be no certainty as to oTher res~lts obtained, Wen s% et s tnk~ ~he erlter~a suggested by ])r. C~thran. Let us see if we (:~tl iontp~/'~ the results hi tlieso seven ~llrveys wlfh knol~!l fact~ to so~ if they coincide. Let us do this witli the nlo~t critical element of M1 : The~mor t ality ra~e. I{ere we find another as~onis}dng s~tm~lion : In mosl. inslanees th~ age ~djusted mor[~lity r*~te lil ~hese se~en surve~'s is far below the knowu mtllonld i~w~rag~not only for nonsmokers, but of{on for lie~vy eiga~t te smokers as well. Iz~ three of the seve~ studie.% the mortalit~ rate for he~ cig- aretl~ sn/okers ;~as lox'~er th~n the average for all ~ml~s itt the U.S. popnlatiolg and ill one sllrvey was olmos~ ,30 percent below the ntliisna] ~ver~ge 1 On this, the committee comments as follows : ~$ is ~:lear that the ~l.ell * * * S~lldles [l~¥olve popl~Iatlons Lhgtg aro healthlel. than U.8. mflles a* a whole. After polntlng OU~ that the exclusion of seriously ill li~di~dduals raiglit ~ceount ~or some of this *arlatlon, the eon~n~tte* still admits that "the sizes of the differences appear surprising." I~emeraber that wo are dealing here with a ~ype of sur~ ey that has tto itmer test of reliability, which e~m only be tested by c~mp~u'ing

278 CIGARETTE LABELING .41~D ADYERTySI~;G results with known factG and that we h~ve ~lst found that ~l±e results do not coincide with known f~ ill tel'InS of mortMity ~atG the luos[ vitl,[ elelnent of UI/. Wh~t sort of wcdght should be attadled to eQdence of ihls kind: To surveys thnt fsll to m~t the rain hmlm staJ~dKvds el soi~nLifm sam plin~; 1o statistical data ~o which no e,rot limits c~n be assigned; w findings tlmt ~re eonu'adictol~" to known ~dct Is th s the, kl d of material from which to wo~ve new und ch'amut/c scientifi~ tMory~ with far reaching m~plieafions iu the fl eht of public policy Cmffronted with these hard question% it is logic ~I to look for ~ller- nllte theories rimt migl~t explain the various findin~ with a ~omewht~t level" t'~$ Oil our IimiL of m'tulul]lv. ]~[I)m~ spceifleal[y, there s.rc. two sets of conditions thal~wiih no tram e. u~ll] connection b( Iwt~( rl am<fl{ ing Emd h~lth~ould still genei'ate surwy findings of the type w* have se~n. The first is spurious correlation. If, for' ohvio~ reasons, we a~sume (1) that smokers a,',~ loss 1}k0y them nonsmokers to p~rticipate h~ a survey of this kind; and (f?) thaL seliOlmly ill ~eoillc will ruih ~artbd p~te; then we can produce survey reskits with strong em'rel~tio~ be- tween smoking and dise~s% eiren though thm'e is no correlation what- soever intM population ~t bzrge. O~ page 1 16 of the cow mitre~ rq>orL there ci)pe~rs a tz~ble prepltre;l by Dr. ~el'Ix~Olt sho/~hl}¢ I~ll aetuld Ilritht letieal eKamllh, ¢if ho~ these assmnp~ions can generate high eorrehfion ir~ sm~ey da~a. from zer~ corn-elation in the popuIatlm~ as ~ whole. dt is highl,y significant, in my mind~ that the committee agreed tI~t • r. Berkson s ~ssumpt ion. were b~sicMly com'eet. , ~nd disagreed ~d~h Dr. l~erl(son only m the degree to whmh they actually ocm~rred: ~ distinction ~Qdch f~lls into the a~ea of puze s ~ ~mln?im*. Closely ~lated to this is another type el" s,n'~ey error. Consider the method by which the eoImfdtt ee mes.snr~.l the reIati~mshlp behween s*~mking ~md rations dise~qse.s. For o~ch such disease, the moK~lity rate mI~o~g sumkm~ was divided by the rate among nonsmokers, to ge~ a relative measure tlf ~hl! d] gereneo, ]~llt~ a8 W~ hftve ge~ll~ Idl of t]tt~ ~ll F%;I~ ~rS %%'(~p1!. qllib II[y ple~] dr± [el'Ins of known,In°r£I'~llfv. ~ l'.%~es ,%11d ~)argi¢ll]a~rlv. . -so ,'ln]ozl~ ]~oI~Sl]/okers. Tho commltiea S stattm~ent on this ponlL is comme~/dab y c~mdld: The low death rat~s for llcm~moker$ ~IA~R~L th~ gsa.~IJDilit~ Lha~ tile s£nclies; recruited ImUStla13.y healthy ~'o~p~ of nonsmokers Now, if w~)l~ve aztificially low rates for mm~aokers, which is eoneedeA to be ,rue. and we divide these into normM l'~tes for smokers, ~t~rt do we get ! ~lo*~rly~ we get wl.~t ~ ~l~eI~z'~ to b~ high men~aliLy for 8Irtol<ei~s~ ~ellel~l~t] i~lm]]y fl'oln sl~,mp]ing h]~. ilut I~part from hie s and spurious co n'elM ion still snother condition car/pt'ovkle ~n explanation of the survey r~ulis, dt is possible that the correlation between cigarette smoking ~nd vat'[oils <[ise~s¢~s is re~l, but wit hour ca tt -~ l sig~fifle.qn ee. Th~ would be the cgse fop example if both smoking ~tnd disease were COl'lx~laved ~aikh other hidden f*lclln~ sl I~h as psveimlo~ical or physiolo66cM diffm~nces which exert she t,wo ~a~sal'force ~m each ~mse There a~'o ma~lv reasons to believe that lhis ~ki/g'ht be so, And it is possible }>f course that M1 of these o0nd[tions micht ht~ opel-a t ing al, fl m same tizrm : l.i em~mts of b as and spin" <ms c~m~a~at on,

CIGARETTE LABELING AND ADVEETI~ZNG 27~ and ~lemeId~ of no~ctms~tive correlation. T [ ~% if~ would b~ very. easy indeed ~ obtain the given survey resnlts, wiLh no cau~al comw~tion 1)ehae~n cigarette SlYtOkiI~g ~l/d ]llng CUIIGI~£ or any of tho other diseases. Further if these factors operate at ~11, k is likely that they would opera e n all sur~t*s of tLis type thus generathxz the ~ame gype of reSll_t ~ iD ~tl ('h ,'lild [lie aD )eaPatlce o~ ~crl'eaL lrk for n LV._ n t $ r S[ But I ~ imp~r~ar~t i~t tmt emerges from a this is tha~ tl ~ smok- i.g mul health hypothesis is only one of sgveral possiblo eAid~mtions of lhe survey d~ta in thc Surgeon Genera]'s r~pm',, and, all tlfings considered, may well be the leas~ plausible of tb, lot In Fortune magazin~Febrttury 196~Dr. William Cochran, the so e stat st~cian on the Surgeon General's Advisory Committ~ is re o~zed as having ex x~s~d Jllt~ view that purely statistical ~nMvsi~ o~Pt he problem has itsl~bnit.li~m . and that the oily w~y to prove ~hat Sliio/<inc~ l tu~es hln,~ U'~IIt~F Z¢ tO~J)erloi'ttt Y~ ~ L ~iC expe "iln¢ [d t fit v~Otlld llrovo tlm cxts~ente of • bloIOgl¢~l l~eellanlam. 'Phi~ ~il~es on spc;dal signi/ic,~nce when w~ z~me.,hcr that th~re has ~,nd that o:~ the eonlr.ry of the n,an) nttompts to induce brag ca?~cer b " slft okil] g i]l ~xpt~t ghent al alfii mls a]lwithgJut exception ]~¢ve ~alled. • In eouclhsiou, il, ~ou]d seem f~ir to say that. the ~moking ellncttI h)'pothesis ovolves ahr~ost 611tirely drotli stat]stmn] [~)/.[.~lallcn, which a best c: n only suggest but n~er ~r~ve c.usali¢)i} based ill tlliS hl- stance on statistical data of hlgMy dubious quahtv, collected by a variety of age~eics b~r methods t a~ can only be described as hap hazatYl an~. uu~clei/tinc~. Tltt~k~ daLa as might L'~ expected ale inte~3~}lly im:onslsl~nt, lead [o llllrcasonabl~ imldi~atDns elld ar6 eorgrlrdlch)r.y not only "vtth o~t£eI" ~sear¢~ o~ l~ Col~p~n5 ]~a[lllT~1 bli~ also ~iLh other :[~eIs~llowI~ ~o he true. i~ :~ word, the moldn~ 1 ypotl osi~ is as we~k as !ts ~'kltnco ~ shaky : ulid ~& lint v'e tie deal!rig with 1S 3~ot SO lillleh ~l{311~tI ( lnelhod as i~ is scientific ~messwork are E poor s$~stitut~" for selerltltlG lt/~lceduros! tl~ g fllmsy ~Ollndll lion for publio policy. All []tai Sf!f'lf~:~ ~li1v~llere n¢~l- O~l'~l~.lil fl£ this l~[lOlilellt is tlltl~ 5%E~ ccmtinuc to lmve c~ crhi~al need fox" futfiher rcs~ ~rch h~ thi~ field• Tld~ was admirably ~wnmar'zed in a jcmrnal editorial of the Vir gil~i~ ~,[edieal Soliely in ¢I[I(~ st'tlIell~ lb~t Ill~ly ~iso serve RS l~ll f~I)t COliC] ~sio~l ~o [ills Si[/~Dlil(!III 1 odtly ; This--Surgem~ t~cneral's roDort bears ont what physicians have known for l~llff thee nazl~ly. Ill,it the va/lso$ ~f cancer are com~Jex, al~d the present survey ha~ don o I It~ln to clarify Lhe s ubJect. i thank yo~. Madam Chairman. Scn~l~r N~r,~ror~. Senator Bass~ S~mMor BAss. We]l I can see tha~ you ha~e done a great deal of Stlld% 011 thc' repot% arid ~O]lr 5t~texxl~r/$ ~S ~ery ~Oll]pl'l~]ll~llHi%~ ~alld contab~s a lot of infor~lmtion, I think, which we all sbonh] ]latl~ on th~ SUI'~ ~ I V~tS ~l[[lng here [hill] 113~ [IS VOI] WSF(t t'~acllllg abott~ ~ orld "['[ ~i If. ~ bnppcm o bflvp ]i~ld ~ll ]nyli,f%tlOll F~ ~Y%'¢ ill t I~G 011¢~ to ~% leh

280 CIC*AIIETTE LABELINC~ AIgD AD~TRTISFN-G I responded and I remember all of the bo3~s were given all of the cigai%tt~ they wanted, d wonder what would happen now if we had another conflict and llLe boys called for cigarettes. Do you think with all of this going oIb llml tll~ services would out- law the use~. of cigarettes to the ,men " ~aad the p pcole back homo weuld get more mgarettes than the soldie~ dtd. Mr. DextrosE. I saw it happen Senator. I was ik Belgium in Word War II and we gave out of eiAmrel.t~s for ~ p~r od of a ~)ut 2 wseks and k had a very dBadly effect on morale, T (:an assure ~ou. Senator BASS. I ~hlnk it nligh5 he wis~ U~ ln~vt~ Lhc~ siati~%ics. I wonder if an~ on8 has ever run a s~tisllcal su r vey to se~ i f the~ people that stayed home hl }Vorld War II }karl any more lung cancer thaa thc~se who went to w~*r. H~ve you heard of any statistics to that ~A~E. D()~NA~II)E. ] hD,v61 no~b Sdrl~t~r, Sonic of these Slll"Ve¥~ are based on veterans and peqliOners and I don% kimw wh~Lbdr this is quit~ a typieal safftnplis or list, I quite doubt it. Semator BASS. The Ones they base it oi% are those who have the dis- ability to st%rt ~dth a~d those who have bee21 in the veterans: hospitals. ]~Ir. DO~AHO~. 01~e of the~ sttrvevs was confined to people who wom~ ~q *ppnsec] to to.re unusual 8~l~pt/bifi Ly %o lung cancer by re, mOll of occup~tlon and I believe they showed up as ha idng the lowe~ mor- tality rate of anybody in M1 of these seven sui~-eys, so these must be wry healthy occupations th~ lhev picked. Senator BAss. Of ('ou~'~e~ b~in'g an expelf in the field of statis%ie~ such as you sa~ you kllo~ you e~n ~rove a/most an3~hhlg by ~fis- tics~ I husK4 )f yon ehc~se Try. I ¢] ont put an ~ ful lot of eredei]ee Jn statistics. The only oli~ I ever palyaarty ~tent/oft t~ are thc~ which are certified after the voteis over. [Laughter.] ~lnd i~ the}' didn't prove ~o me to be ~ winner I wouldJ*~t believe it in the first place, I would tili~h ffornebody d~d somet/dllg w~mg~ bttb lids is good hlfornmilon to have. I won't belabor the stat[sLisld report~ and I sat± sure that Senator N~uberger wiB have some~hh~g to say. ~c hope that you will be able to enlighten us on a~ythblg that nl]ght be .¢~d hi ~ ~a~ion to ~.n3Tllillg that comes O~lt in ~llls report. That is all I }~ve, Senator. Senator iq~o~m~m. If t/te~ ave )lo Ipll~'til)rlS~ We ~ri]1 htwlr from Dr. ~(oran at lllis tiln% pathologist ~rom the ~morlM Hospital, Dsnvill% Va. S~ATEM~NT fll~ DI~ THOMAS I. M0]~AN, PATHOLO(~IST, ]~EMORIAL HOSPITAL, DANVILI~ VA. Dr. Mos_~m S~nator, I would llke to ask penaission to have a minute to ~et up a projeotor, l flare a few slides I wou/d like to show. Senator Nxu~a~:~a. That will he fine. ] roight armolln{x3 while waithlg ~,tltl,~ SonaLor Ba~q ~ld ][ ]lave ag~'~ed that we will (~mlinuo ri'lght on tlu~ugh the noon hour. %~re tb~Ve 4)ne filer e ~v,r [ ~le~ after Dr. ~[Ol'an. Dr. ~{oran, will ~our prep}~re d s%atemenh be in addillon to the lidos, or with it ~ How are you gomg to hsmdle it ? l)r. I%IOUAN. I will g/re most. of the prepared s~atolnent, flr~t~ t]lell show (}to ~ides. 'I*hNl lltdsh llo~ gl a~ement.

L~ L~ t~ ~d L~

C'IQARE'I~P~ LABELING ,~ ADVERTI~G the hljection of the chemical into the lung: in !i~}rer cases by bcginn/ng ¢ortisonB t~e~traent at different tbne inL~rwrls before the injeeti0n o2 tlle chemical into the lu*Lg. In many animals a picture resembling hmnan lungcancer was produc~. 13owever, irl animals stud~od for long periods of time, both tha lesions resembling ean~-r and those resexchling theplcture in human lungs of heavy smokel% gradually disappeared, rlmvc attached reprints of several of my published rel~rts of ~lfis ~ot~ to ~bis statement. ~IGA~J~'I~E ~feEKING ~L) ~etK~x%r~]~T ~c~E2~IT D~EE-~a~1 COMBIS~D E~p~RI~01~ 0~' ~IL~ 2~m~Ny ~mu F~At~I~t÷IL~M B~T~IZS (Josl'ph T. Doyle, :M:.D.,: Thomas R. Dawi~'r ~I.D.,~ V¢llliam I~. KanneU, "~ l>,' i. ~ndra HesUn= ~S.,z and tlarold :i. Kahn, ~.AJ) Although ~h~ Importance ~f c~garet~e smoking in causing lung cancer Is dis- puted • z ~lez~Ztl[t~ frtm~ ~11 ¢~uses i~ substantially in,'reas~ in heavy ¢ismrette smol, er~2 ' ~ Mo~t of the e~cess maoptaligy is du~ to eu~ry he~r~ d~ses~, par- ticularly in the ~erican expemenee. With the excel~ion o~ the reI~3~ts frbm th~ Mbaay Cardiovasc~ar ~ea~ Cen~er attd t~e ~'mmingham ~tudy2 ~ ~liable inforn~atlon reiatil~g morbidit~ fl~m t~r o~ary heart dl~4~sse to the u~ of t~baeeo has ne~ yet been published. The data £rom he,ll studlgs hsve snggested that a x'elaci0R exists, btlt the populations studied have been too S~lall tl~d 5he [olto~ up 13eriod too short t~ permit a d~finitiw asses~ent el the aplmXent ~ffe~ of ~bacet~ habit on t~e incidence of cbrona~ heart disease. ~n spt~e b~ centare ~mpormnt diSl)arD£~'~ be£weeu the Albany and ti~e Fra~lingham lr~pnlatio~s in temns of ~x(~/lt..gl~i01l, e/]J]~i~ baek~r~'.lnd, and prt~babl~v mar~v othe~~ a~ yet unqual~txted ehara~.reris~ies, the independently observed ~ends in both studies are t~mark- ~bly similar. Xt ~e~fore ~me~l d~h'a ble to eorabime.t~e m~o~-~atlo~ o~ smok- Lug habit an~ inehlenc~ of diSeaSe in mese two large prospective st,ldies. 'rhi~ ~ole i1 experience Is eousldore¢l to be par~ieqflarly signiflc~tnt sine9 the siz~ of tile sample has been almos~ doubted a~ldp 01' ev~ greate]. Impor~all~ the ¢linl~l magnoses of ~vronat y heart eisease are believed to be com~derably more accu~'at¢ than t~e nor tat/ty studies. In 19[~ the N~W York State tteal~h Department ¢~tablished a~ ~he Albany ~eddeat C~lle~e ~ proslmotlvo study of d~generative eXrllitWoseular disease in a gronp of 1.~X;~ m~le ci~l servant~ ~[9 thrOllg~ 5-3 y~rs of age a~d wor~lng in Albax]y. TD~ voblnteer~ wer<. 8~ Vere~nt of tht toLal group w~e met the~e spcciltcatlon~ At the first e~amina~ion a (le~lil~ lif4time ]~]ctll ~lsto~'y was ~aken, add a complete physl~:~ I ~ xaralnatq~n ~'~s d,~ne In addlrhm to a e0~pre- hensb e battery o~ D~ beta lla'y te~t~ a]~ el~c~roea r(li~graI~ was r ec~l'd~ ~f0re a~t~ afte~ an exercise test. An ~TaI ~i~o~y 3]~f~ a COllll]~l,~e physiC:al examlilari~n were re,marcel annually. UnleSs eol~traind~cated an ele~rocatx]tog~a];,hie Stress test wad done at every o~ber ~xamination. 2-t the lllost r~ e~l~ml~lioll • ct~rte~l h~,re, 85 percent 6f D~e 0rlginal res~C*adonts ~eturne~l Over a @~etr Ocr~od of observgtio~ fe~'~r than ~ I~rcent ,,~erc ¢otnpletely l~st to f¢lla*vup s~udy. Limited i~omatlon (~ncer~ die z, amai~ing 14 perc~n~ Js available.' In 1949 the t]$1 PnhUe H~tlth ~er~iee establJstmd in Fran~agham. X~a~s., a ~)r o~l~erIve $~nd~ Of ¢orongry ~lr~ E~] s o~1 $¢ ill g4~ I/l~]~ ~k WO332ell 30 ~ P(lllffh 62 years of age. The rest~ents constituted ~9 l~±'ee~t ef a ran4omLv ,Mqeete/l iFr~ the Cardiovascular Health C n r Alba~ ltledlcaI Collage. and th~ ~¢atIonaI I~art Institute N~t~o~a In~tlU/tes of I~e~lth, Public IIaal~h Serv~ca, ITS. Dc~r~ment o~ Hea~t~, Educauo~ .n~ Welfare, Heart Disease Iepid~mlolog, Stud % Frara~ Wm ~a~.*s p~sented ~a par~ at ~he :~4t~ annual ~cicutifie ~ssiuns o~ lhe AmerlcRn I~r~ ASSO¢I~ Profe~sar of m~dicinc and director, Cartqo~asetEar ]len2th Center, A~b~tp ~eS~cal ~% l~ta.~ alrceet~r, Healt D~se ~lder,~olog~ StUdy. ~a~$~nal ~:lenrf ln~ftu~c Ass~e~te blos!9~lztleia~ ~¢ow York st~tte Depa~m ~t ~£ 1~ tOO, ~ ~ 1 8 a 4t)~/~a ~ oza¢ ne ~ee ~= Na o~a /ff~ la~ e l~felelw~s n e~ a[~penr on pp. 28~ ~80.

0~

CIG[AR~3~PE ~AEE~A]~G AND ADVERrJ~]~G RF~ITIm~ TRbI~ I elassIRes tho A~bRny ~tnd ]Pr~ingha~ ~qle l~pu]tt~ions acco~g to ~ge an~ smoking habiL In Ll~e g~u~ from 40 to 4~ y~ars of age there is a sligh~ sLati~ti~811y slgnifie~ al f~ongh ~ReXDI ai~ed RreD0nderallce of cigaz~te smokers in l'zamlngham. ~he l)~Oportlons ~ h~ smokers, howewr, are identical, ~Okt~ c~te~ry ~eve~ ~k~d: A~y. ........................................ Albany. .............................. yram~o~m . 57 Fr~amg~R .................................. 82 A1b~n3, .................................... r~ss that ~ y,~r d~: 2~ r~r d~y~ ~b~ .................................... ~, Mb~ny. ~ ~amm~ ...~ ........................... TOb~ h~t ~y ~mowm; . ~ ............. ~ib~y ............................. ~8 i-- --I---- --I= ----I---- 176 1 208 ~0,3i 7~ ..... I 894 .... l-- l.~S [ ".42 1,808 TabI~ ~ ~o~ Rverfg8 ftnl~uff] itlcidenee rflt~o for V~lt~OIIS mstlif~at~oyts of ~oron~ry he~r~ ¢]i~ ~tmordin~ to S~OIL~Og hsbi~ ~ thi~ s8111e grOUD o~ mal~ 40 to 4~ ~ears oId, ~l~lle total deaLh ra~ Is 93 [aere~nt higher in ~mingham than ~n Alboz~y fqr reo~o~s ~ot pr~eu~Iy aI~are~k ~ix~ pero~ o£ tke Xlbatly percen~ in ~ramingilala, '£Ja~ death r~t~s aseribcr3 i~ inc~rnaraonal li~ r~b~c 4~0 (aru~rioscler~tic ]aeart disease), however, ~ identitY1 ~ th~ two groups¸ r£'l~e are ~I~tergro~p differ euces in the frequency ~ ~ngLt a~ pector~s azzd ~ non l~th~l myocardial lr~aretlon, disowned below, In each p~Dul~t~o~ th~ lnd(~cnc~ ~lt~ @f ~lyoea rdi~l ~nf~r ¢tloil i~ mRtrly thre~ ~lya~ grea~er, ~h~ ~otaL ~a~h ra~e o~ fiv~ t,i~m~ ~ gr~tter~ an(~ ~e de.a~ rate from cOrOlla ry b~trt dis~se five tim~,s greater In ~oker~ th~L~ f~ i~oD~kers. ~'he i~eideilee r&t~ Of at~glll~ 13~etorl~ • ~a2~ai~hlum is nea~l,y twice a~ high in ~ok~rs ~ in non~0aokers wher~ls irt Albany the rRte is ~ear]y Elr~ ffm~ greater jn non~o~rera Th~se discordant ,dat, R h~a~v ~1~]~ ~r~to the ~a]l nuznber Of ~as~ b~t (~r~n].v ~g~ t~t

CIGARETTE LABELING AND ADVEETISLN(t ~85 cigarette smoking ha~ little ~ffect on the incidence of angin~ Fec6oris. The ~li~ll t fe~tur~ ill botl~ ~£qldi~s i~ the slgnlfieY~llt ~xces~ of may ~rd~ll I IJl/'~l~t ion and of deatlL ~roll~ ~11 ~a11~o~ lllell]ding ooton~ry h~rt di~a~, 111 e[gar~te ~moker$~ ~0 to ~9 year~ o? a~e T~ble 3 ~elate~ death8 from all csu~o~ for all age grouI~ in both s[u~es to ~moking h~tbit. The Ilot 8~blo f ~a tll~e~ are a. ~wofol~l greater iu~r t~lity ~ll ~lgar~t ~ ~mokors an~ a ri~iug gradien~ of xuortality with i~er~asing consmnption a~ e~gaz-~,£ L~ $ ln~ [l'~t ed by a ~hree f old iner e~ in heavy smt*kt~s q~he mortaM~y in cigar, pip~ and former cigarette smokers is not greatly different from tha~ ~PA~T,~ 3. Det~t~ ~ro~ all eagles ~mong ¢nCn ~ree o~ (~i~ea~e ~ ¢~rff ~ta fh~ 0b~wed number 01 I Ratio ~f obs~r red ~ exl~ee~ed n~m. I daalhs bet 0~ deaths ~mokI~ eatc~cI~ i Albany TO~I ao~e~r erie ~Lok~r~ Never v~o~e~l ...... i FOrmer ~raoker C~'o pv my ........ ] '£° L~I e~gale ! ~° sm°ker s " i-- 4~ T~SS ~l,rm ~n ~er da5 B More ~han ~ Per ~1~5, 19 --I m hk~-I Aiba~: ~'r~m~ I~mbt~ mI r i--i--- ~ ~ ~ZOI ¢~2 i~ io~

CIGARETTE LABELING AND ADVERTISING Table 4 is iden~ico I in ~nstruotioD t~ table 3 bllt is con,,~rne~ only with deaths ascribe4 t~ corollary he~rL disease (International List fabric 420), A ~wofldd higher d~lhh rate in cigarette smokers, which inerea~c~ {~) ovce threefold in ~he h~vy ~mokers, is showil, The morality ox'~firl~nee In ilOllSmokers, former ¢4garett e smackers ~nd cigar add p~pe E~a oker ~ In very ~imilar. TA~I.~ 4. De~t~ fron~ eo~o~grV ~eg~ ~$eea~e ~'to~g ~en :re6 ol ~i~ea3e at Smo~ml~ eatery ['ot ~ noncom r~t t~ smo~z~ ...... Fvr,~er ~E1~ker ................ Cigar ot l>J2~ oal~... Tota] dS~i~ ~mo~er~ ~or~ than ~ per day .... Ob~ed nm=bef of deaLL~ l 0 2 iI ~00I ObSc~ved to e~,d~d ~ttm. bc~ OE deaths ~amtug { C°mb~ Albany ham ~55i ~51 ~7 01 ~0 E ~oted ~un:~er of event a ba~J o~ ~I a~,l~ ~{fic z~u~ ~or tOtal Dopu~t lon wlthoul re~-~d to Table ~ r=how~ the occu~'~nce of acute myr~ear*lia~ infarction in relatign to mnolring habit in both studio-% Once again it is obvious that this eoml~oatLbn occurs two and a half tim~s more frequently in eI~¢aretle ~mokerS than iv non- ~lnokers, ~.ormer cigarette ~okero or pipe and cigar smaokers. It is also evidel~t that more acu0e Inyoeardlal infarcvions ~r in hea~y cigarette s{uokerS ~an in light cigarette smokexs or in nonSmokerS TAa~ 5. ln(~ens* of myooa~ cT~al t~farot~on a~rm~ m~ free of ~sa~e al eat~ in cat e~or ) ~ Sxgmfi~.mt ~ 6mer~m from O0 ~t 0.~ level Table ~. wllieh {8 silllll~lr in orgaldzotlola to the preceding t]~re~ t~bLes* Im~Les ~agiu~ ~t~r~s io ~l~ok~ng habit. ~avre is a ~ubst~nL~al diff~l~nce betwoea the rate o£ diagnosis of ~his manlfestatio,~ of coronary hear~ disease in Fr~min~ham and In ALbany. In Ileither is there a significant difference be- twe~ii hh~ ob~rved oz the ~xp~tL, d ilurober of cases i~ al~y ~ok~ag ~*. egory.

CIGANEq'TE LABELING ~'~D, ADVERTISING ')~7 Table 7 ze] 11 t~ sr~okiu~ h~blt to the average annt~t I IncidenCe rate~ of s~igi11 a pectoris, of m y~e~rdial ~Rfar orion ~nd ~ de~th ~rom cor0~xy h~x~ d~ease in the c~bin~4 sPudd~s Im ~e~ ~0 to 4~) years of ~e st the time ef ~i~st exR~*~IL The f*r~t ~ttlues at~ the t0~l or e]'tlde ]'ato~. ~he seeoI/d val~/es have bet~ Colu- p~d by Cla~ii~atio~ ~f the ~ul~k~s ~d the ~ozmm~kezs a~or(]ing to ~ood ~ur~ ~nd eho~:~e~c~[ le~ su~ relative ~od~" w~ight. ~5i~ ~rOTZf~ ~V~re de- r~¥etl by ~h~ sep~r~iln Of ett~4h Of the three VRriab]e~ i~to high or l~w ct~te~olles. The avez~ ge or Rdjn~d in~i~ilce r~te~ ft~r ~e~s ~*d non~oker~ s2~ ~ ~izuDle a~'ith~aeti~ ~er~ of Lhe eight rates. This iB ~q~i~t~ lent to R.q ~" ~ ~Qual nun~- be~ ef ~ig}~ e~ ~e~- ar~e~l-bleO0 pr~.~re, relapse De~y ~&,ht ~nd ser~rn t o~i eh ol estexo] ~ea sure~ ~ s i~ smoker s ~fl ~n ~ ~nsmqk~r s. Ci~vet ~e ~m~k{~ in ~he grOUl~ from 44) to ~9 ~rs of ~ge are found after adjustment to have a hlzhl,v qi~nifi~]st ~xcess i~ii~nce Qf my~.'d~:d[a~ iRi~r~[Jon of ~,~ per 1,000 per pe~Oll ~r. ~urthermore th~'e is an excess in~de~ of lethal r~yoc~rl]i~ infaretio~ of 2 per 1,000 per pe~n year. On the ~ther ~Rd ~i~arette smo]~i~g do~s no~ sh~w th~ s~lue si~ni~t ~is~t £ioR with the de%~ell J]J]~en£ o2 ali~i~ ~ D~.t~[s~ Average ,d ~ r~, b~s~d OU ~b~ ~ar]o~is h~b 1~w con~ ~nati~ns of ~hoI~Z~[uL ~ b~, ~nd blO~d pr e2~l~.

00

CIGARF~TTE LABESING ~-D ADVEBTISII~G 289 i. 1~'isheF, ~ A~ "Smoking; ri'he caneeF ~nt~o~er~y." ~ pp. I3dinIl~h: Oliver & Bond, 1951k 2. ~erksom, J. ~moking and ~ne~r of l~zJng, proe. ~taff l~leet., Mayo Clin ~. i)olI~ It., and Hill, AII. Lung eaYicez ~Ind other eai1.~es o~ de~th in re]~ion t0 ~moking ; m~omd repot ~ ~n mor~ali~ ~ 33~tish doctors. I~ri~. l~[.J. 2 : ~ 071 i081, 195~ 4. ~mmm~nd, ~. C., mud Horn, D. Stooling and d~ath r~t~r~or~ ~n ~aon~2as ~f follOwup of I~7~P~ me~, L '£otal mortal~ty. JA.M.A, 3 f~l : I15~ 1172, I~. ~mol~g and death mates ~el~ on 44 months ~ followup I~7,7~ mere. II. Death rates I~ cause. Ibld, l(~tl : 12~-130S, 19~8. 6. Dvyle,~ T. H~lin, A~ S.,Hilleb~,H.~,a~dF~rniel,~ l~arl.v diagnosis O~ ischemic h~mc dl sease. ~ew ~3n~ J. ~e~l. 261 : 109~ll01, i~9. Kammel, W ~., IJawb~F, T. R. ~gan, A_ Revotskie, N., an0 ,~toke~ • llI Fae~rs of risk In the develoDment of ¢omon~y hearer dise~s~y~ar f ollo~,up exl~rlene~: ~amingham study. Ann. Int Me~, ~5: .q~ 5f>, ]981. ~. Hi[lebo~, H. ~ James, ~., tlnd I)oyle, J. T, Card[Ov~scl~l~r Health Cgn~. L P~eet ~e~ign for public he~l f3u rc~ar~. Am. ~" pub. 3H~al~h 44 ; ~I~6.9, 9. Dawber, ~ R., Meadols, G. F., and i~Ioo~, F. E. Jr. ~3D~deml~l~gie~ al~ ~h~s to ~ar~ dlsease~ b'ramim~h ~m study. Am. a. p~b. ~e~Ith ~i : 2y~- I~. '*1%~i~-~ ~ tho C0n~renee on I~ng~Pudln~ Caz~ilovase~lar Studies at ~h~ ~[o£~ ~.e~c~n~fi~|d.~' Br~idine, ~d..l~., edi[ed by T. P*, I)awbel~ l~rf~a~e|y Ii. Ccmmlt~ on C~if~ria for ~3ia~o~i~ of Disease and Olinical ~valuation. Am. J. Pub. 3~ealth (~nplx) 50 ~I0) ; 2¢~2y, October, I~60. ~2, HA~e~cn amd coronary h~rt disease: classification and c~teria for epldemlolo~al s~Udie~. ~eh. ~I~. World HCaltl~ Organ, 16~; I 28, 1959~ of un~ and ~n~Dl~ned d~h : a uto!~y shady fm0m ~L J.A-M.A, 174 : 881~88, I~0. 14. ~delson, Iz, and Ho~m, W. ~udden ~ath ~om coronary disease : rela~ed to 3eth~l me~b~nlsm ~r~ing independently of v~c u]ar ocdusio~ or m~eardL~] 15. pearl, R. Tobacco smoking and longe~ty. ~lence ~7 : ~;I(~ r 193~. ~i £~b~.k of !o~r~#~lo~, t~x~o3~gy, and therape~tles fol" phyr.i ~tl~ s ~nd medical ~tu~n~," S~nd ~iti0n. l~l pp. ~ew ]3ork: i~facnillla~, 30~. 17. £~gamet~ sraok~ and esr~l~c~aseular disease: r~ort by ~meric~ ~fear~ 18. I~srgexon~ ~ I~.~ ~r, et. al. ~eet of ci~aret~ ~Okillg- O~ coronary blood ~ow and myocar~l m~abolIm~ "~nlatlon" 15 : 25] ~7,1 ~7. I{~ Regan, T..~., Hellemm% H. I~., and Blng, ~. 3~ffect ~f eigaret~ ~m~rJ~g on ~rona~ ¢i r ¢ul~tlo~ a~d ¢~di~ w~rk in ]~ t ieIlt s wi~h ~r £~rii~elerrl~ic heart disease. Amn~ New ~o~3~ Aead. Be. 90 : 18~I~, I~0. ~. ~att~, I~ T. Effect of n~tine and smoking om ~gr~ti~n ~f ellnephrine. ~ium. l~v y~ Acad. Be. ~ :7~i~80,196~ 21. I~u~ ~, ~. H. Ae~on cd' nieo~ne om ~e~r t. Ann. ~ew york Acad. Se. 90 : ~(3~, 1960. ~ ~b, W. 'IIlormon~ ~d ~eurogenlc Card]ov&seular Disordera~ ~h~doc~ine a~d neul~endocrL~e factors In l~thogene~is and ~aLent" 722 ~op. Bald- m~r~ : William s & Wilkins. 1958. ~. 2~-I :;. ~N'ew ¥ork Acid. S e. 90 t I~)0198, 3960. 24. Cannon, W. I]., amd (]ray, H. ~a~o~ aff~ng ~agnlation ti~e ~f blood, 313~ HaShing or r~La~0ing of coagulation by adrenalin im~ec~ions. Am. J. ~yslol 34 : 2~I~, 19] 4. ~. Mo~n~ A ~. ~The pat~o~m~is of C~r~nary O~elu~[o~s," wl[h ~ foreword ~hn B. Dugu~d. I~ p~. Springfield, IIL : Thom~, 1957.

---

---

CIGAREq~T~] LAB~L~G ~ AD~ERTISING B]aod ch~]c~rol, ~tty aclds~ and t~ql ~t ~Rlues w(.re mftrked]y in~e~ ; 16 ]~er~cnt of the birds snc~umb~ to ~nfe~i~n~ wldch ~u~etl ga~t~Jlt e~/~i~ ~d i~lmollia. A ~ ~r ol fl~ck of ~erfvd~ sedentary geese were Lake~ on~ ~ t:n eir co~nemen~ a~ter disease haft b~n p~v~u~d. They wvre ~d~a~]y ~¢r~ised by c;na~ng th~ ~ce ~iLv and permittlng "~hem ~ ro~m over the farm. They were ~i~e~ focal ad libid~m, I~ut ~ longer ~e~i. Within 6 week~ their weight wa~ al~ pr ~zim~t~y that of the con~ol n~rmal ~'o~p. ~t au~I~y 0nly minimal evidence Of disea~ wa~ fOUnd in some of the bird~ This i~ve~igat~on gav~ s~tisfac~l?~ e~ide~ce t:na~ ~i~erim~tall~v [D(ltlc~d ~th~l~v~gis ~n ~e ~IT(~r~d ~nd $o~1~ in~a~c~ ~ev ~r~ed UII~I~ ~x~r~l~ 811d re~n~ die~ /6/. |~ L~ n~ew~rthy, that ~t similar g~p o~ ge~e w~ w~re al]~we~] ~} I.xcr~i~e a~ will ~n~ ~ven the ~reedo~ o1" the farm, gai~ed weight following s~uffi~g, but di~ ~ot develop fatty i~ltrn~oa of t~e liver, h~morrh~gic dia~e:~is or a~er- ~ntcrcllr~i~t infe~lll~l~. ~I~L~ provide(i ~ur~t~ p~f t]~t ~er¢ise pr~t~te~. ~h~ blld~ ag~ln~t the ~ov~eeding" ~T~r~ A~ W~ ~I~¢.W~ t~ne c~ilI~t ri~ play a v~y u~ive i~trt I~l mai~]ilii~ ci~t~a ti~m ; they are n~ p~$~. ]~ ~ CO~ necttolt ~ ~rogh*~ ob~r ~tions ~t ~e ~e~t i~- 1)ortan~ (71. I~ ~ou~d ~0y actual count, tha~ the rela~ve par~cit~ation of the ¢#p[llar~e~ 1~ g~li~e~ pigs ~; S~ I~r ~[tre millimeters in r~ting rtlll~.le a~d ~,~0 in c~nt~aet~ mttScle. These ca~]l~rlc~ can Only be kept at ~hclr hlgh+~ degree of effi~ ~ncy by W~king all ~h~ musclc~ ~ the lily. ~1~ i ~ l~ the ~nly w~y 1~ keep ~iiova~cttl ~r f~uct ~on ~t th~ h~ghc~t dcg~c~ o~ ~mcion ~v, ~any cii~icia ~ ~ ]~ve ~oi~ted out ~h~ b~n~ficial ef~ec~ ~ ~ r('~ ~e in the pre- ]?omroy and Whl~e (8) ~mmari~e~l ]~e~ltl~ rccortls ~l~i~g ~0 years of 3~5 ~er~ Who had ~ played fo~b~. C~uze of d~th wa~ ascertained in 87 ca~es. ~ora~try he~r~ ~i~e- was rcI~l~ed ~n 2~. ~t was ~und that Jhe c~r~ry group ha~ ~gage~L i~ le~ vig~rot~ physical ~xe~cise ~han ~he others~ No~e Of th~ ~udlv~dll~t] ~ Who ~¢1"$i~ ed in ~ h~vy ~x~cIse ~o~r am ~ e~elo~d cor~m~ry ~li~ea~ The continuum i~ ~tg~i~ well warran~e~ that v~gor~s ph~l~l ~c~ivit~' tend~ to ~r o~ct ~aiD~t coro~try ~r~er~v di~ e~. I~ tbi~ c~nnecti~ the frc~ll~ntly ¢iil~t~l work of ~I~rrI~ a~ ]~ls g~oul~ (9) ~t ow~ ~at tile rt~mbe~ ~*f ]2ear~ ~t ~cl~ ~trll ~g $~ede~t ~ry ~vo~ke~ is thr~ LD~ gTea ter a~ aw~oil~ t~-~ W~qO ~re i~ys~coJ~' ~t crime. R~b (10/ pc~inted out tba~ lack ~ e×ercI~e impairs ~rdlac re~nlar~ry f~n~ tl0~ ~d inc~ tl~ ~ ttln~r~blli~y of the he~r~ muscle ~o emotional a~d ~ex I)uri~g amnu~tl exan~tio~ ~ Sedentary e~n~iv~ ~ a large ln~us~ri~ pla~t, ~ve found ~ther0s¢lerosis i~ 23 ~ercent~ de~'ml~c~ by roen~u~I~gic e~- ~matlon o~ the abdominal ~orta a~ ~e ]~e arteries (11) £~fde~ XI1~, X~F XIV--Yt~entge~ol~c appearance of normal a~r ta. X~.~--~e~t~e~o]ogi~ appe~ra~e Of ~±lle~sclero~c cI~ang~ 1~ ~1~ • bdomin~ aorta~ ~$ co.hi,areal to 4 pe~n~ i~ ~nt~&l~ce ~e~ of c~mparab~e ag~ l~el, ~'n~ d~[ie~ req~ire~ heavy ~ysic~l wor~-. Simila~ r~entge~ologic c~mi~t~ms o~ ~ad wcrk~r~ betwe¢~ 4~i ~d ~ y~r~ o~ ~0 pcrc~'nt o~ wh(~m v~e<i !~icks [m(] ~ov~l~ ~howed no evidence Of :l~h~ro~clerosi~ o~" ~e ab~lomiu~l aorta a~i t~e large ~e~els (12). On t~e lm~l~ of ~/~ch c[i~ic~d observ~i~rn~, we insti~ted a dt~p~r~ne~t o~ p~y~ic~l e~u¢~ttion fo~ ou~ ~r~ii~tc ]~t(~e~t~ ~tt tI~e V~tlley For~ Me~iic~tl (~e~ a~d/tear t ~o~pi~al ,~Fe~ XlzI, XVII, X~JIT~r ~'nc~e ~rdiac l~t~en~s al~ ac tlvely partlcipatI~ in the hospi~al'~ I~h ysic~ll ~uc~tt~on pr0~L~o. EVo~ the~ ~x~rci~e~ ~e c~o~l~I~Iere~ by some ~xl~r~ i~ l~r ~t ~l'~e ~t e~llc~me to be too mild ~d ~o~pa~ ~e|y l~stl~cien~. Excel0t for ~11o~ with ~c~te ~rnn~ry ~omb~i~ ~r coll~S~lv~ he~t £~illlre, a~d ~n0se in ~cute ~r c~ronJc ~ecti~ms st~es, ]0~ tic~t~ are ~co~raged ~o ~Valk st~ir~, ~rt ex~r~L~e Wldclt We ~n~ve ~o~Dtl be~cia] for ¢aTd~ac~ (13). ~h~ lmtl~nts ~e ~t~t~C~i to dO ~hl~ a~ a graduated pace i~ k~I~in~ with ~e~r

---

6~GAI~ET~f~ L~.B~'L]NG AND AD~TI~TISIh-G These a£;s[e~.~ will he reexamined pf~odlc~lly. Such lif~,lo~g ~eeor<Is vdll fuznlsh Its with in~n~allle clhl|c~ m~terial which will ~alidRte n~0re Lhan e~e~ before the ~e~efleia[ ~h% of ~or0us phy~ic~l ~ctivitv. [fhi~ b~Iv of knowledge Wlll [d~o shell flew li~t o]~ the ~e$£ fornls .]:~ tzaiD3"n~ not (,Ti]y fo~ th~ p~rpose of acbieviug outs~indi~g p~f~rmance, b~ for ~he ~ua~n~ of health. 11upro~eraent of ~i~o~, ~d prolon.~stion of It~'~ ~m0n~ th~ l~pnlatlo~ ~deqnate trai~[n~ or eo~di£~onin~ ~or ~h]etit ~%]ide~ivors~ i~ i:~ju]'iou~. It i.~ expected, ~or ~]~s~%nce~ that athletes f~'o/~ th~ low~Ids, ~;h~ will ~olu~t~ in the 19C~ O].Tn~pics in ~xleo CIty. will l~e p~im~]y e~nditi~ned to with~and ~he str~i~ ~ ~n~c~us~I~nled altitude (;,~ feet ~.l~ve sea le~¢l) by tra~nin~ a% coml~rable ~Ititudes fo~ 2 ~o d ~ce/~ l}ri~r ~ ~L~ flames. High altitude~ ~iil~led 9;ith yJg~'ou~ eXel~iSe~ h~9ose ~ddltion~l s~r~ss on peopl~ ~ho ~re n~t flc~llma~ed. C~rdio¥~(~ul~ ~*apacity for erfurt is dlm~shed ~]~]~ ta relatd~e TO ~r even£ ~rdiovaSeul~r di~e~ se in l~ter life, ~Fol~e~ £~31.~I i ti~ni~ IJ~S~ be~in in ck~Id~oOd, ~t long ]ast~ more ~nd If~or~ d~l~rtmet~ts ~f uIlysiea~ ~d'a~atlOl* in the S~hOO]S are Wo~kl~g ~1~]]d in baud ~iLh physicians i~l £~e ~eld of preven t~e re,divine ~Ind for ~9hys~c~1 ~tnes~. TO conclude, ample ~r~rimen(al ~nd di~*i¢~l e~idence in~11~a~es %~h~l~ con t~]2n~ ¥i~i~[*~ ~hysic~l e~-~r¢i~e pI~ys ~ i~ortant ~le i~/ ~h~ p~v~u~ion of ca~di~ss~ulSr dlse~ses. O~r ~" ~linical insu~h~ can be pu~ te ~*l'k t~ [~e- ge~%~rations. i. ~e~y~, H. ; ~2%~IIIaI Repor£ o~ ~tr~ss.~' Actm, In~.~ l%~d. p~i~hers, l%[<~n- ~re~l. 3 ~-SL 2. ~as~i~owL A. L.: "I~flue~ee of S~me ~'~eto~ o~ ]gevelcpmel~t o~ Ex~erl- ineld~l Cho~e~te~l ~It~aeros< lera~Is~ ~h'~-ul~tlon 17 ; ~)~. 19~ ~ XV~rn~, ~N~ ~., Cbl~'~on. T, ~.~ S[even~n I~: '~f~e~t ~f ]~ereise o11 /~iood ~ils~ulat~ 'Pime ~nd ~th~r~l~rosls ~ Chilleste*'ol~ed C~c~er~i.~." Circula ti~ -~e~eh 5 : ~i78, i~17. ~. ~/ODI oye, ~. J., ~a£~ H'/SS, W. ]9. ~ewer, W. ID ~fan~s, ~ ill. 0~so~/, .~[. A, ~o]~ey~ ~ Ol~6~n~ H ~ "Th~ ~]ffeet of ~ xer eise on ~%loild ~ol~sterol i~ ~|ddle- Aged .%[a~" Aim. $ourn. of Clinical Nutriat[on, 7: i~9, 19~9. ~5. ~ch~e~sing, ~,, Dee~ R.: ~]e Effect Of Tr~i~iug oI~ ~tsJ' ~edi~ ~d ~Dezt i, Berlin, 196~L in (],ee~t. possible l~e~ers~i~i~ and Clini~l Implie~t/o~." Jilnrn. c~I Gero~- t~l~gy 7: 18-23, ~952. 7. Kr~h, A. : "The Amat~nkT and Phy~iol~ of ~he C~pill~Ir[es~" The ~i|l~- ~n l~ctur ~, ~ew Ha~en, 19~, Y~ UniYer~i~y Pr ~, 8. Fomroy~ W. ~, ~hi~e~ P~ D, : ~(~ilr~u~ry Heart ]D[se2se in For~l~er ~o~Ebflll players~ J~%.M.2.. ~ 67 : 71~ TI~ ~une 7,195~. 9. MOZl/~, J. }[.~ Hesdy, I, A.; "Mo~tallty in Re[~ion to the p]~sle~l Ac[~ ~i~y ~f W~k ~ ~ ~Telim~ary ig~te on Ex]~erienee in l%I~dd]e A~" ~t J. ~nd~st II, Wolffe, ~. T~., ~ie~l. ~ L : "X-]?.ay of the ASdomin~l Aort~ in ]Dot~ou o£ A£her o SOl e~asi~.~' Cli~Ic~l ~gediciue, voL ~.9. ~o. 2, ~ebruazy I ~9.. 12. W~lff~. ~ B: '~he~sderotie S~no~i~ ~f the Lower Abdi~llnal ~o~t~" ~3. ~Z~olffe. J. B.; '~2he [~e[~ti~nshi]D of Heal~ ~nd Exercise," pi~sented n~ ~he 44t~ Annual -~tlonal ~r~efl~on Caner ~s, Sep~embe~ 19~Z. 14 ~modl~ka~ ~I~I~ : "In~wll T~sining in Heart Disease." '2he ~. Of ~9()rts ~ed. aud Phy. ~I tn~.~a~ vol. ,~, NO~. 2 ~, pp. 9~i00, J une-S~ptember 1963. I~. Wol~e~ ~'. ]8,: "~rea~n. ~.di~ii~e ~nd the Hllmanities." rfl~ird ~1~h- c~ l~fflonal Institute o~ Hospital ~eere~tio~; University e~ ~or~h Carolina, CbaI~l Hill N.C,I ~prfl 1957. ~6 Dor ~d'~ IE~S rated "~ edi¢ al Die~o~ary 9~d Ed t(~ ; p. C~iT. ]7~ ]~elIerowicz ¥~ }K. ; "U~r d~ Oek~nomlerp~inzl~ In Ar bei~ und Le~tun~." Ar~hl f~erKr~sl~uf~orseh~ng, Band~i,]~left ~,~e1936.

CIGAEE'f'I'E L~,BEIINfi /LN-D .@VEI~TISLNG 295 (By :lose~h 1~. WollZe, M.D., FACC)1 Situlltiolial stresses ~ey~nd ~he in~i~idual~ ability to ¢~p~ with s~cc~fully~ are comn~on ~nvironme~tal ~uscs of Dla[Kv ~C ona anal organi~ f~rms of ~r~iovaseuL~r ~i~ase, It ~l~ ~U~ ila~)r~sio~ tl~at i~ W~ the pretloinii1Rt~ f~ct~r ill mR~/y pafl~ll~ i~f th~ y~ll/l~Ll• age g~oup st~f~eriIl~ ~l~Om ~rollary lll~(I 111 this ~Olll~e~till~ ~ gur~ ~h~ m~dic~tl i~eo~ds of 102 ~3ati~lGtS in ~he yolln~eI~t ~leca d~ 8~ t~ 411 y~81"s ~ tI~e* WIlO~ hist o fie~ altd e!ect~o~ar~]]o~r aI~hic ~n(]lllgs ~eveale(1 evid~n~ of n~yo~a~di~ ~d/or cor ~13¢ dis~ase~ r£11~ personal hi~torics Of 2~ w~ ~linica]ly ill~(lequ~£~ l~owev~I*, ~h~ C~t~ of ~itllatio~] s~r~ on ~ae I~tient C011IKi be @VRISRte([ J~rlllll tile r~o]:ds of the remalning 78 (T~ males and ~ females)¸ Judging from the r~entge~- gr~phi~ gYadic~ of the large arteries a~d parti<~ularly of ~he a~elOnli~al aorta (11 of this gr~p, onkv 42 showed the 1at esenee of a~her~s~l~rosis. Tile ~ pati~n~, whos~ recoils ~O~llp~is~ ~11~ ]~a~ig of ~bi~ pr~st'n~i(~n, w~t'~ car~fu]]y inteIr~ated £o~ n~ less than six daily D~riod~ during tllei~ hosp[t~ll sta.v. ~I~lu~ o~ tllelr immediate f~lmi]y wer~ a]~o inf~ylcw~d, All evalust- tl~)ii wl~ LaSde O~ tlleir sr~ci~], economic, ~1 par~icul~r]~ ~llelt" lllterlael'soll~l re]a~ionshi[~ ~i~l~ t~ose ~vJrh Wh(~m ~h~ir lives were ~los~ly in~erwovell. Fif23~-~wo of this group (appro~m~ely 6 percent) r~vealed l~fe dramas and ~itl~tion~ in whic:a t~ey w~re irrctI£~v~b]y caught in R nutcracker ~ll~e~e between two OpDOSID~" f~lr~ eJiLra]~pad withollt respit~U: hoIn~* ~nd w(irl~. MOSt o£ tllCl;q h~d ~I ll[gh s~e o~ r~s]ao~sibili~y ancl ~ll~i(l~fl fla~ir Sf~tlls iJa thc ~oIaI~llni~ Of ~r~t importance T]ae ~ype ~f ~[~lla~l~na[ ilntla~s v~ri~l f~(~nl o11~ illKliviflll Rl ~0 ~nother~ TO ~it~ bll~ a f~w e~r~ pl(~ 1, ~ ~utlll oi" 40, w]~o ~l/ou~h~ himself ~gi~g, was Rc~ing Q~ vI~e l~iesi~entm~ll ilame only i~ a large firm owned by hi~ ~li~('%~fUl f~t~r illlaw, Who ~on- s~a~tly cotza~erra~I}d~d his ord~r~ a~cl ~l~k~d tll~ yo~l~" m~n's u~dertaking~. ~l~e fathel-.in.]aw (lirl no~ limit Ills gp~iLr~ of inlltlenco to ~h~- £a~tories, b~t ex~elGde~l i~ t~ his d~lt~llter'g l/ona~ and ~llildr~l~ ]'he p~tient ~vas tt'&p]~ between the need of eco~le sc¢~rify an ~h@ one iaand, ~nd, o~ the ot~r, ling inability to asser~ hi~ ri~h[~ul positi~ in his home. O~1~" after • number of all(] C r l~iei~m ill m~ o~¢e and ~ str allger ~ my OWl~ hrgme.'~ ~. ,k hahn, 4~i ~ears Of ~e, Well establlsbed i~ his COnl~l~Illty ~nd ~,hurch, escape~l from "marital incomlaa~bility" by beeomi~g dee~l.v ~nvolv~d in a~ extram~rita~ relfttioz~ship. I~ discovered thRt h|~ teenuge da~hlxr w~s pro- mid.oils, S2d sh~ ill reSD0~S~ tD /~l~ ~IlgZ'y censure iJoillte(l out the exam]pie he set. [lnwilling to ~ive I~I) whaf h~ ~olls~l~]'~(l his "~rtly l~v~l~~ Itll(I Kl~e~ed bY hi~ inef~pct~al fa~b~r-d~llghter r~Iat~ollship ~d his e~t~a~geme~t at h~Zae, he, t~m, was ~light in ~ n~tl~r~l~k~ sltuaL]oll, 3. An lmd~rpaid account~at in ~ busy o~ was expected to flou~ the law to ~lve f~qxes for the ~i~e clients, ii~ hRd pangs ~f ~ns~Kence be~a~ ~his, but in addition W~ ~ornae~te(l by l~ck of RpI)r~ci~tfio~ froI~ both ~,lien~ a~d ~lrlployer ,,'I~JS is Da(i ~nou~h,'~ he S~I, *'bllt I a121 RlSO ~ery llnlZap~y ~t ~aome. M~" WiI~ by a2~io~ ~nd worci~ ~eli~l~q Ill~, rllbS It l]a~ filld tells lue I h~ve no gu~s ~, I~ ~arely occurs ~n~l it would no~ he exp~ed ~llat t~ae patient will ~a~Iily disclose such intimnt~ ~xpertcn~s d~ri~g ~heir ~rst ~n~erviews with th~ physi- ~iall, The ~llilure ~o reucSilv r~l~tc sll~]a ~ll~i~on~le~J~al ~resses Was eft~ ~1~ t~ i~rml1~l~e as t~ tla~ir relevance ~r ~ r~lucf~nt'e to reveal wh~t t~e i~t.ient~ co~idere0, t~ ]a~l'sollal* Th~ gI~ll]3 of patie~s~s ~d~l" disc~ls~ioll ~xl~l~i~ll~'e~ great diffi¢l~[ty [~ v~'rba]izin~, ~esp]te Lhe fact fha~ they w~'e articlllR~. ~Without e~Cel)tion all o~ the ~2 pacifists in WIIolll IIOXIOUS ~tUtltio~l L~I- ]~l~'t~ played f,n iraportan~ role ill their illlleF3 h~d Syll/l)tOEaB ~ei~r~lJle f~l other IK~iy sys~elns as ~v~Ll as tile heart. xFr0m ffae ~epartment of ~le~iel~e. ~al]ey Forge ~I~eal Center ~s~ ~art ~Io~plfa], ~Nor~town. pa. an~ ~h ~I~e ~a~plta], Philadelphia, p~. Presen ed at th~ ~Jrst nt~n~tJon~ ColLfereae~ on preven ve Car~ ~gy, U~i~ ~lty

296 CIGA~ETTE LABELLNG ~D -t~DVERTISING The eoncep~ ~f EplJin~r a~d H~s~ (2~ 9f ~a~nia an~ sympathleotr~l~a w~s s~r~ingly borne ouL f~oll~ the ~is ~ our ¢SS6S. I~ '~7 ]~a~ien~ man.stations ~Jel~ l~dic&tive of l~rasympathe~c hyi~rirr~billty, In 19 of sym~atllet[c hyl~rlrrltabiE~y, ~nd in ~; it was di~cult to determine clearly d~in~tl a ~it o~it)l£~ic l~a ~w~vs of ~xpr 6ssiols. ~e ~r~ympath~eo~o~ic group complained 0f bou~ ~ nervou~ ~i~ion~ ii~sor~ ni~, (I ~r~i~t~s~ v~mo~or rhi~i~l~, v~rious a L~er~i~, 0c~1oI1a I ~e~h 6~ Ss~ symp~om~ of ~el~t~ u~o~r ( eigh~ of these h~d either a~ti~e Or he.led ~Icers shown roentgenolo~l~v~ abdominal cramp~ due to hyperirrltab~li~y of "the colon; ~nKI m~d diarrhe~ wss encou~t~re~l to S greater exten~ among ~llcse than among patients o~ ~h~ average hospital popul~rJom Fgor in this group had a~ta~]Ks du2 Syi~h~al. Ma~¸ w~re co~scio~s ~f eetop~ beat~ a~l ~ome felt a ~low poundin~ in ~he ~hes ~ a~d/or ~ ~Io~ t I&r ~bblng ~n the neck. The ~ysmpat hiQ~ ~onic gro~pl in the m~ll~ h~l I~Od ~Io~ With a t ~nden~y to d~pr ~ sion, fr~q~(~ut he&da~es, episodes of h~r~ ¢ons¢io~n~s~ ~nd o~a ~ional &tt~ks ~ p~roxy~lll~l ts~y~r@Jfl or n~r~cul~r 1~bri]Isti~n. E]e~l~ll Ill bloo~ pressure w~ se~ in ~his gro llls inore frequently ~iQn i~ th~ ~r~yln~t~[cotonic {r~ Were ~he lUo~t common. ~ome of ~h~ patients were tr~t~ ~ v~riou~ tinle~ for either ~rf]io~m~ ~m of th~ ~O]li~l~er of Od(~i, hi~t~l herll~rt~ chile- cystitis, ~h~li~hi~sis ~nd ~on~tipaJlon as ~ res~l~ o~ ~te~tlnal atoP~y. ~Veiss ~nd English (3) in a ~Udy ~f ~ I~Icn~ ~n~erlng fro~1 myoc~rdlal ~nfarct~o~ found that 21 (~9 percent) ~howe~ gra(~ua]ly mounting ~si~ ~f o~loL[Ollal ~r~glu fo~ ~J~(lls an(] ye~ ~i~ to ~he o~s~ Of coro~lary o~l~sion. Ann]yzi~g 6he inci~enc~ of graKiual]y ~lo~tirtg ten~io~ i~l di~erent age gro~p~ in m~11, ~h~y f~l~d that it ~irr~ in *2 o~i of ~ (~ l~r~n~) ~ve~ the ag£~ 60, but in 18 ou~ of ~ (67 percent) undex th~ age o~ 60 ~owever, ~hey f~imd ~o ~ ~ideD¢~ of ~o~ting ten~ion prior to ~h~ n~t ~f I][n~ in ~ c~nt rol gI~Ul~ Our ~n~ings of the myo~Irdi~l ~nd coronary grollp c~mparcd favorably ~vi~ t]~eir~. Th~ term "n~cr~cl~er ~y~ome," i~ you will psrdon lhe cliche, is i~tr0duce(l r~not~ ~ ch~l of ev~I~ ~e~It~l~ £rom superflc~all~ ~upl~leS~ed, c~ashi~, ~iYonme~l ~c~mg~a~ce~ from which the p~e~It ~not extric~t~ h~mself. He i~ ~ght in a di~er~ma bet~veen what he ought to ~o an(I what ~r~uras~nc~ ¢omp~ him ~o d~the ~raD~ ~f t~e "~hol~]d~ ~v~r ~h~ *~wo~Id.~' The ~I I~ ak~ ~nt~ndecl to focus &it~I~on ~ the v~ried mauif~t~Jo~ i~ such ~trc~s~] r~ll~os. ~tho~g~ i~ thi~ group of [~a61e~19s ~ l~tIs r~ino~ r~i~t~nti~c w~s ~]le c~rdio~asc~r ~ys~m~ ~h~ ~y~i]~t(~ms wer~ m~ach m~re Widely di~ril~u~(~. The m~nism in v~hi2h ~ox~ou~. ~motio~l ~tre~ses ~ive rise ~o ~n~t~on~ ~nd ~r~et~ral ch~n~ ]las ~ot s~ y~ be~n fully work~l Ollt~ fll~hoU~ll ~ grit (I~al of ]~n~vled~e h~s ll~n ~c~Y~l~t~ ~n ~he past few ~C~ d~. ~e~l~ Inv~t]g~on~ inflic~t~ th~ only the ~erebr~l cortex ~I~vs an im- portant l~art i~ ~p~reclati~g ~tre~sfu] e~perlen~. It I~ c~bl~ of ~ord~ng, ~u~lyzDJg and ~il'Ling ~h ~xperienc~ throu~ ~hu~ f~r, I~sk20~ l~athwS~v~ to ~ff~ct ~I1favor~bL~ wh~t M~1~an reJ~er~ to RS the ~'vi~r~l br~n." (4) Ii i~ ~onceivable th~ ~i~ ~ turn gai~ ~pr~s~i~n thrO~ the hyF~t]G~l~mug anti ~ffe~s the ~til~ v~g~ive ~ystem~ PrOducing ~oc~l or 8y~t~mi(~ ~a~e In the vu]~r~ blc ~n(~iv~dl]s I. Th~ c~ct ~f ~tr~s~ i~ lhe ~y~1~t~l~ti(2 Com~I~IL o~ the a~toma~c n~r~o~Is ~y~em h~ b~ widely sta(~]~l. Emoti~n~[ ~s Is ol~t~n a~ with an adrenergic re~pon~e yet, ~he ~It~J~ri~y of o~r gr~u~ ~f !gs~ienL~ ~hilwed a pRr~s~vml~hetic response ~ ~ r~lllt o~ contilHlO~ 0~'~rftlr~ S~l| ~l~d ~umerous an~ varlou8 ~a~i~t~. )lo~t ~f them had b~n ~oi(I that their ~V~ ~r~ i~ agr~emen~ ~i~h many c[~n~i~a~s who ~I;~ e~Ycep~i~n tt~ ~ term "psyehosQm~t~c dist~rb~(9.'~ ~hs~n~n i~ ~I~]~" ~I]'eS~C~ i~ S~S ~LI~ws: ~ * -]~cho~om~i~,~ ~mbil~ie~ ~e ~o~l~t ~ th~ lU~ter]al "psyche'~ in~t~sd ~ ~ "~rsin~ The mind {ii~yi!]~e~ ~Jo~ directl[~ ~en~ imi~ul~

CIGARETTE LADELLNG AI~D ADVEI£TIh~kNG ~ The sequence of the two porlions Of the word "psyehosom~tic~" is Often t~ken to Lulpiy that a (]ist~rban~ of the l~yche is ~he initial or eve/] the only determining f~c~or and that the ~omafle dlslurb~nee Is the conse- quence. -q'he aecor~Dl]shr~e.ts of p~chosom~c medicine ~re noteworthy," ~fly~ ~tl'eCkel% (6) "I[s o~ective ~mifi~ent~ b.~ t}~ n~rlte iillforlu~tl~. ILs comi~ra~ive recent us~ ~2~kes i£ sound iik~ the ~n~unc~rfient of m~rriag~ be~wmen ~l]e body and the mind with subdivis[on~ o£ mediciue and psych Jlltrg in lh~ brid~l l~r ~y," I%eeznse Of th~ fr~qllen~ nlisin£erilreta~[on ill" the £e~ "~y~h~o~}a~c" [~ is ~0~ unu~u~tl to I/e~r ~ dls~ressed patle~/t ask~ 'JAm ~ re~l~v men~allv iUlI' ~fter being told their hi~ symp~ol~ ~re psye]2oso]21ati~ ill ]2at~/~e. 0]~ ~h~ other llaD~t when W~ explained t:sat environl~e~ta~ $tyesses might be res~nsible or con- tribute to his i]]n~,~, it beca~ne ~ders~audahle because there was nothing ]l~z- zIi]2~ abo~It it. The Datle~/t Would the21 ns~a]l~v cooperate in a m~tual search ~or the possible ~a~ses of %he st~e~Sflll sitB~ion ~n(I ~ wa,~s and menns to arne]i0rate them, Members of the filmily often ~ide[l, ~t least hl r~le~s~ng t~ emotional nut2ratker T]lis, howtver, 19r~ed ~ be temi~o]'~ry nnle~s nl~lj~Jr adj~m~i~ ~r~ flffcuLt~d. 1~ w~ surpri~iI%g, n~¥erthtless~ tha~ after a few I]2£er~[ews, Lhe i~deu~ w~s relleve~l of ma/ly Of ~ synip~om~- &~d only i~ ra1~ Instances ~as i~ neeesssry to refer him to a ]~y~hiatrist for evaluation and therap/~. l~ollowiIlg a detailed history ~d ~ tho1~gh ~a~lin~Ition D1~hl~/ing Lqdieated ]nb0ratnry stl~ies, the choice ~f drngs f~r s:vmptil~nflr~ therapy w~ gilvern~t], ~:here~er p~s~ib]e, by the rifle ~hi~h either i~omp[i~len~ ill ~]i~ ~n%onlbmiil D~rv~s ~:~em played Jn ~ ~.~iven fui~utliJnl~l or org~%~/c dlsLuxbance. IL is o~e l~te~e~L that mosl o~ o~r ila[~en[s in t[d~ group h~td symlJL~l~s a~l ph~s[c~l signs suggesli~e of parasylnpa~heti¢ hype~'rit~bi[~t,v, Ill this c0nnectionl We were impressed wit/~ the pr~sing ~tct ~f antih~s~rn/l~i~ ~gents w~ich po~ses~ ~nti~ho]inergi¢ p~pettles, ie, A.~a~o]ine, vartlc~r]~ in correct[D~ ~bnor~n~ i c~rdi~ impulse fo~£i o~ and conduction¸ We found that vig~l~nls phy~eal ~et~vlty Is ~n~t ~s i~nD~r~sut ~ p~rl~ ~mpathi~ and ~mgathicemlmeti~ dr~g$ or tr&nqltiIi~ers ill rile £re~i~n~i;t of these patie~ts~ Fun6amen~al adjustments by the patient, either ~ inodif.~ing, aecept~r*~, Or re2eclin~ the stressful life situations are hnperative in oDtainir~g (~eflire~ results, esDecial]y i~ ~he prevention of Irreversible ~ardJo~a~eular ~]ise~u~e. ]D]: ~ormnn A. Welsh (7), ]ir~sident of ~ A}[~ in his innngur~] ~dress WiSely ]~ol~Lell i.t~ %hltt '~hi~ i.it~rldirlg ilrdl~r~ In medicine ~is evidenced ~y incr~ss~ sl)e~ia]~on constitutes une o~ the crucial pr~b[e~.s of our times." ~e ~Iso qnilte~ from Dr. l~l~Cio C~e~ez' ad(Irtss at ~ ~hlr~ WolJd CongI~SS Of Cardiology (~) ~hen he warned ,*~ ~ * th~ s~l~i~lizati~n can ~e~n ~raglDe~t~ion, ilarti~l ~isilm~ and lJmJ~ion Of ~nr horizon Wh~t E~ ~al]2ed In dept]/ is lost in ~rea~th." ~e ¢o~¢ll~des ,,* * * thst pi~minenc¢ o~ spte~1~zat~iln J~ fert~[~ i]/ vs][1~ble ~lel]ieve]2le]It~ bl~t also Dre~fll~I!t with 15sk~," We as c~rdiolog[s~, mu~ ~pply ~ hoI1st]c ~DDro~cII ~o OUr pa~iellts' problems. I. 'f~e "n~t~r~ek~r ~yndromC' is ~au~ed by ~he t~os~fire of en~ironnle~t~d ~t r esses. ~. ]~e~son$ ~th a vuhlela~le e~r(liov~c~l~r system may deve]oD nonv~ cular or va~cul&~ royoc~zdial (l~as~ if Lhe $it~[io~l s~s~es ~re n~t ~eHeved ,~. ~an~fo]d s v~/pt~ms Jnv~iD~ ~al~OUs [>ody sFstems ~re ch~a~teris%ie ~f tll~s syndrome, 4. Fu~e~iou~] d~sturl~ee~ precede 1~e devel~D~nen~ of orgy.it d~se 5. The holistic ~Dprollch ~o the ~tlen~'~ i~r~J[l]em sh~Id prove ~n importS'hi S~D in the ~r~e~!tlon ~if irr~l,~r s]ble ca rd[ova~c~nl~ d J~e~%s~ In connection with the question of a po~sibIe causM rt4~dion~hip betwefa~ ci~¢arette smoking and cancer of ~he lun~ I ~hvu!d like to submit, the followlag three conchsions and a brief discnssion of my reasons for arr}vln~ ~t ~hese cone1 usious : L Statistical evidence acciunulated fl~us f~tr is strrm~ enoug"h t~ suggest the pos.~ibility of ~ eorm~ctim bet~o~n cig ~ralte sine*king ~cI 46 87f+ 116 pt. • '2~

298 CIGARETTE LABLL/~rG ~D ADVERTISfXTG cancer of the hing. This posslbillty should be investig~te() fur thor by eli available scie~ltific methods including further clm~ca~ studies, statistical dat~. chemical analysis and animal experiments. 2. The evq(leilce submitted thus far by proponents of the theory that hing ca. cer is caused by smokinLg --inchidln available tbe ceramist ee appointed by the Surgeon @ChOral I:o analyze data on the subj~ does not eonstit iv scent tic proof of this theory. Acceptance of this theory is not only mlsclealtifi¢ but dangerous, shicq acceptance o~ this ¢beory will lead to complacea]cv concnrnil~g the cSJologv of tlus &sease and mlght well prevent fruit~l investi ation ninng other lines. 3 Existing research programs shoul~ be coutinued and new ones dewloped in an attempt to detez~alne the cause or causes of all cancers ineludl.g Ihose of the lung. Among some of the possible causes of lung cancer needing Jhartber s~udy are viruses, h~d~s[~al or ocr~lpa: lionel exposure, atmospheric polgution, aud chronic inflammation and scarring of the lung such as occu~'s after iIl~Uenz% brol~eldt]s, hron- ( llle~t~81S, and mKllV otll Ir ben i~ll l tlrl ~ ( olldltlon8. "~'[v rea~oDs for ~onelusinn ntunber two, that it has not been scie~l- tifically proven ilmL cigarelte smoking causes cancer of the lung~ e~n be Hil fl ll31~lriz~d I%s ~o]]ows : The evidence quoted by proponents of ¢he "cigarette smoking hing cancer tl eorv" s genertdly of Ibree types (1] statistieal or epi- demiological; ~ snlmxd experiments ,3 him]an c!inic,~l and at~ ~op, y .~ s {~dle~. It is my. be ef that the ony st2onglv~ s~gn~live ovkh nee that s]nokmg may be a fa~tor m lnng cancer hes in the ~eld of e~ddomiolog:y~ i~t other words the ~'~atistieal evidence. There are a l]~m~ber of "~ deIy quoted studies s/~gges~ing that )eopl e with :x hj story of prohmged and excessive eiga~x~tte smoking have a higlmr incidence <if lung ca~lcer them t]~e genera] pop~lhtion. IIowever even among epidenfio]ogists and statisticians tber~ are mlme~mus differences of opbfion and various interpretallons o{ these studies. In a recent analysis o~ 1 ~99 lung cancers at the Uhivcrslly of Bonn in West Germany~ay Poche. M]ttman and l<~e]h~r, fl~e authors found no connection at all between srnokhi,- o~nd cancer of the lung. They divided the patients with lung cancer into tbre~e group~nonsmokers, light smokers, and heavy smohers, and ~om]d the same incldenc~ of luna cancer in all three groups and the aver~lge a~e of oeeurrence o~ thecancer in all three grou s was exactly the s~une. Of the different factors ~,ey statdled, (s3eupation was the ordy im- portant positive factor, suggesrdng to them that indJastrial exposure may be relatewl to hmg csnc~r, This s~tdy dealt Xvltl~ all ~orrrs of lun¢ cm~c~r, bul, especlallv with the squamous cell or ep~dermo~d type. whi~:b is lhe one ~nost ~zequently e ed n he repo -is by proponents of tim smoking-lung cancer lh~:. Since I am not art epi(lcinlol~gist or s~ati~ician, I will not attempt to analys.e the sP~tistical evidence crltlcall3 or in detail, b Will list, however some rd the nmre important genera] objections io the s~afistlcal eonclnsinn that smoking Ls a cause of l~ng e~kacer. These ob ections have been recognized in many statisllca] s~udies. 1. Over 95 percent of-smokers inch]cling heaxy- smoke~o not develop hirg cancer. ~. Lung canc¢~ Of all ~ypes, including sqnamous cell or ep~dermo~d type, occurs in nonsmo~m~.

CIGARETTE LA~LLN-Q 2~ND ADVERTISING 299 3. There is relatively little i:~lteer of the moutlx, nosa~ ll~oat~ or tr ea~ 0~ t]lolln,h tlle~# greas ill.e ]flOI ~ ~gpo~ed to (:lgt/lette smoke t ltlB tim lmlgs, and i~e incidence ~l f career in these o~gans is nol iaereasing. 4 Lula cancer occur~ mllCll lllOi.e frequently tllllOI]g hlt~ll thtill ~ omen a~d t e dispamly is ~,'owillg~ although smoking ~mong women has been ¢OlmnOll now for *qho/l~ 4(} yl~ftI~ and SlflOkil±g among Woln~l] as been inereas ng rapidly during that peiiod. 5. The inzidemet~ or lung canoe' va 'les wide]y bBtween different loealitie~ ~s for ex~mlple between the St~{es of N w York and idaho and th~ e ies of Naw Orleans alld Atlanta. There is also a higher nc denee of hmg meer i~l urbgn populations as ~?ompgred to rurah 6. ~l'here is more lur~g cancer n Jgng and thrm n this country~ despite the f;lel, Ih~t hear smoking is more common in tbis eomttry 5{eny other er iclsms, ~oth of metbodelogy ~nd interpretatma ~d the staHstical surveys, ].ave beel~ made by qualified sta[ist~e,llns ~l/ll ep den olog sts The second type of evi ene~ quoted by those who belime ~hat c~- arette smoking eRIlSI!S lallg cancer is ~il]ll]a/ t~xp0rinleillt~[i01/" r]O rne the exper a ev deuce presented rims far b as lk~le or no apph eat on t e rob ell, of ]Ul~tan lung c~nc'~r. It is tlue that some sk ea~cers ~ve been produced by ~)~iication of lke s{Halled tobacco tar ~o the skill of ~[llllOf susceptible allllllal8- I~OW(~¢I!I', Sllftl- I~r egneers can be prod u~ed in tbe skirt of sensitive animuls by pa'inling the s ' a variety of substances, nleltld]ng ~l)It~e, ~O]ilXI301' fo~ds. NO t)11~ has ~roduced lung cancers in expel]In'lira] Ilnllrials by expos- ing them ~:o ~igare e smoY{e altbm~gh this ha.s been tried by many resea "oh woi'kels 3Ild lllUlly 3 nn~ s have been kept 111 ,~n ~tmo~pllere ied ~ikl ei~al~ett.a smake for prolonged periods. Th~se ~illnlals develo ~ {~eHuin ehange~ in she bronchial epithc]it. ~ similar to those seen h~ the u gs of be~ .y smokers at autopsy, lIowevez, none of the ~nimMs vith tl ~e e antes have deve]op~ut lung e~neer and when lhe anhnals are removed from the eig.retke smoke the changes gradually disappear. O t eot er band cancers of d~e lung have been produced m anhnn]s by inoculation of viruses (Rabson) and by ]nhalatmn of v£1-11se8 and aerosols of hydrocarbon% wl/ieh 81re substances presen~ in hiffb eoneentration in gasoline francs (K~?tin). C~anges similar to those se~n b~ human lllrtg8 o~ heavy smokers and changes even mo~e suggestive tns~o]ogica]ly of ca~aeer can be produced in a vm'ietv of ;~ays in experln]erlfa] mlilr±als. For example ~n my e~vn experimenls which I have mentioned in wh eh rabbt nng~ were, dtLililtgPll b~ a chemical agent s~ eb as gastric j uiee, hydrochloric acid. *alcohol, or mtrze acid and espee~M]y in sever.1 gro~zps wbhq~ we±~ preireated by gdministration of eortiso~m~ Ihere ~ere striklr~ changes in the bronchial lining ~iml~ar to bat m~re sever~ tban thos~ described in hlllnall-811lokers~ lungs. Pfowe~.er. none of the~e }nimd.~ developed lung .ricer and a]tbougb the animals ~-ere studied for long period~ ~ff lime after expomt~'e to lbe chemicals the eblul~es ~radu~dl disappeared. The importance of thes~ observations ~s that il ]s no~ alwu v~ possible to predlef bio]a~ie bel~avior from histvlogie ap ?ear.ne~, ~nd in the case of he changes described in human smokers~ lungs, I do no~ believe it is ~roper to ca]l these m~digrnnl or pt~emali~'aant lesions.

CIGARET~ LABLLIN~ AND ADVE~.T~G They occur iu leo rnlmy be~dgn conditions. In brief, animal experi- ments have contribnted nolbing dil~ctly applicable to the px~blom of cigar ett~ ~raoking axtd human l~ug ~t~oar, The third type of evide~lc~ q.ot~d by )roponents of the "cigarette smoking causes ]mlg c~c~r" theolT is in a geaeral group of chnisal and autopsy studlas. Ilere agMn the clinical evidence is statistical and the st atls~ics are snb~ec~ to th ~ same d~ls and ob cctio*~ already described. The autopsy evidence quoted is ~nfine~l largel2 t~ several studies carried out by Auerbaeh a~d others ht which eet'lairl eh~Jges in the lining epitheliura were described in tiae in~l~os of heavy stool ci~r~. "Fht~e changes have been interpleted as premahgnant or as lemming to lmlg cancer. Thel~e is no solid evidence to sllpport this elainL The cbanges are not speeiftc for smokers ; they may be seen in a varie~ of benign conditions and they may be produced experhnentall~ bot~ in lungs of animals exposed to cigarette smoke and a Valuety otothee mareri ahs without ever leadin to Imlg cancer. In experimental animals~ ~e~ can be shown to disappear ~.fter the irt-it~nt has been removed. This as J'al" as I a121 eOllcerl!ed~ ehlfnnate8 the application of th¢~e observations to hmn~ lmq~ cancer. Nu~ [ ~fld lik~ t~ ~how u fe,~v ulid~ Mdcl~ b~r nut my l;oit~t, I l~lighL lnl]ke ~ preliminary ~ll]laenr. ~ou~g of ibig wor!< t)~r tieularly refers t~ Dr, Atlerb~ch's thesis, and dmt thesis is tlmt in lds studies of human auto ~sit~ ~rtain chants were eo:Lsistently demonstrated in the lungs of smokers and tidal }here ellan~e~ showed r~ p~gzessive development ix) cancer through the ~)llowmg stages: hyperpl~sia meUq)lasia~ carcinoma in-sltu, and inrush/r, cancer. I wouir] like to sta~s~ of court% that these changes wet~ not tel lowed by Dr. Auerbech in sln-(d~:~d specimens ia one petaeat. Ihcy were not seen continuously in t~e livlrt~ pathmt. Tilese ~e*~ all ob- served at autopsy. So that it is quite di~lieull Io ;.t~.' m~t tlmm lind to say that a is,ca lesion seen at autopsy ]lecessarJIy will prog~s u~ another gi vea~ ~iion see~x in ~umther sub eel zt autopsJ~. Other p'athologls~i~ h~'~ a~so [¢u~d ~u in~r ea~e~ incidence of s(lua mo~ metaplasla among smokers, hut have no~ hmnd the incklcnce of ca~(:hmma m situ reported by Auet-b~eh and do not agree ~]lh b~s eorleluslon~ tJt)~t tittle e~l~nges develop into hlvasive carcinoma. The follow~ngslide,~$re g*~ig~md to show severzlthin~: 1) Nor mM lung and in'onchlal epitbehum: (2) squamo~s metaidasi~, of the l~i)e described b',' ~uerbacb hi smol~ez-s~ in p~op]o wh(~ }rove Ael,er snmked; (3) resomhbulee of cancer of the lm~g ]n a nonsmoker to cancer o~ the lung ht a samk(~r and the rd~emhl,~ce o~ each of tbe~ to a cancer of the lal~mX h~ a nonsmoker: (4) metaidastie ehang~ ~n antrum lnngs~reseml~llag Auerbauch's el±m~ge~ except thug they ~p- pear histologically more rnagg~mnt--in which long lerm expedment~ have slmx~a~ l/tat these clmnge~ do not progress to eNII~/, I will t~y m point on[ these eb:mges. Tld~ i~ th~ first s~ide. This slide is taken from a 10-month-old baby aim died of meningitis with no involvolll~nt~ no lmlg dlse~se whatsoever. This shows I~t~ normal hm~ struetu~. These are the airspaces her% through ~ddcb ~e bre~tbe. This is where the ah" comes into the lungs.

CIGARETTE LABELING A_'~D ADVERTIS~G 301 The next picture, which is tL slightly Mgher mug[tifieation, again the same 10-month old I~,by who died of memngltls. The normal air sac is here. This is the alveolar lining. These are capillaries. These orb zed blood c~lls in he~. This is where the air coming late the hmg brings in the oxyTgen~ which diffuses through this narrow membrane her8 into the red bloed cells wher~ carbon dlox-i&~ p~sses out. Thisisa erfectlynorm~lpic~ure. The next sli~ is from the same baby, 10 months old, no damage to th6 lungs, showing the bronchial tube or the bronchus which isads to dmse air space~ ]=[t~mt yl)u see ~Iltt supporting wall o~ the bronchus. This is lize IinJ ng epil helium, and this is the ~re~ in which there has been so much controversy over whether some of these changes which occur repl~nt hypetTlas{a meL~plasin c~mcer~ whether they are mverslb]o and so forih. This is the nol~nal lining epithelium here~ The material along hero are the cilia. Those are th~ processes ?*h~t tcmo~ e foreign m~i~ri~d. AIi of tlfis so far is n ol~nal lhlmg. This slld~ is fronl a 62 year-old woman wish a disease called bmr~- ¢hiectasis, which is an inttanmation of the bronchial hlhcs. This woman had never smoked in her lile. Sli~ sledws u lot of htfiamrau- tion along hem. This is tl~e air Sl),qz~ hexe. This is the norrnal lin- ing, coming along h~re. and up in ther~ Here is th~ change that has been described by Dr. Auerbach and mun:~ other peopl% which ls called or referrec] to as sctuamous metaplam~. Thug is ~ very early change of squamo~ls me~.p] asi~ in the lung. ~ext slide, pleas~. This is a ~qncer of the lung, of a mart who lind smoked at ]~st aek of cigarettes z~ day for many~ many years. I think you can see ~rst of ~ H that ~l~era is t~ ,~om~)lel~ h~s of th~ nolalml arthi~t~ra of the lm~g. ]5,. do not see the ~lr spaces ~nd you do not see the bt~nchinl tubes in this ar tis~lar secfioa. Instead. t~e lung is replaced by fl~ese peculiar looking calls which se~)m to g:t'ow in sort of solid sht~fs andnests ~nd ~pl~c~ the lung tissue. Thls is th[~ ::h~tucteristie cell of the squamous cell or epider- mold cancer of the lung. ihe next l)lCmi~ ~ a slightly higher magnffieatmn of the same hmg, the ~amo person with cane, e: of the lung who hoxt smoked ]'or lna~y vc~r~. You c:m se~ ~flmv pink st~hlmg eytopla~m. This is the {mcleus, for example. This is a cytoplasm. You cue see these cells in ~ dls~)z~erlv pattern throughout~ The next s~ide is from a 54 year old man who h~d never ~noked, ~howing ~m idell~C~d l)is~uce a, squamo/ls c,e11 carcinoma of the Illng~ ons which ~o~fl4 b~ clearly rec~gnisable and which is indistlnKalsh- abis in ~ppca~nce ~rc~u tlm tumor fltat we showed in the last sllde. You can see the ]~rga model and tlie pfi~k-staining cytoplasm and replacement of sllsets and n~ts rcplmclng tim hmg t~m~. This mm was presented at cur tumor clinic just several months ago. Because o~ the inter*st lit this subjec~ and the s~atement of some people that epidemneid cancex or s(lm~mou~ cell cancer does not occur except in people who smoke~ we had three differgnt doctot~ ,hock this mo~n's tfist~ry with him, and M1 of them checked it vetT c~fully. There

GtGAtlETTE I.ABELIN~ .~:ND ,'~DV~,~ ISIN(I ~as no question that he h~d no¢or smoked~ y~f he has thin squamou~ cell c~ilcor. X~ th s saloe I~/eetinK w~ had a young doctor pr,~elBt ~dlo said. flint wastt't surprising to hint be~'~lme "his father h d j s md a dl ~gnosls of squ~mous cell cancer of the lu.g mm]e m Ne~ York, bud b~eu qler- ated on. ~nd he h~d never ~mokt~l m ]ds life. S ~ w~ h~d two examples ill Oll~ ~1] I1~ Or ¢,1 hli[~ thfLt molciing. NeW slidc ph~se~ This ~s ust another 1tea. Mth • slightly higher magnification sl±m~ - in~ the replacement of the lung by thin malignant nlmor in • man who h~t n.ver smoked. Next ~lide ple~. 1his i~ from h ,YI y~lr-old womml widl c~rcilmma of t]~e ]sm'nx. Thi~ I¥¢~I[/all ~l~l~ I~eV~l" s]~]okf.d. W~ll~ i~ fdso at ~llfI1]:IOHS C~I. {*fir elm)m~. Az~d I OIh~k even to an unmdnod eye ycm can s~e the r semblance in this slide as compared to the oae with fl~e en~eer of the lun~ in the smoker and th~ cancer of the lung in the n c,nmnokor. The ~re}Ktectuto is r~ph*~ced ~md ~*e haw thi~ pink-smininK eplthe]]um and nest~ ~nd si~eets of solid tmnor. The same ~hing i~ true of the esophagus or wherever it occurs, as an identical p~ture, and ~] ere i<: no w¢~y of t~lli~g ju~ from th~ ~ppe~rauee of the ftauor or fie or .~:t~ of th~ tumor that is the primary site. wh~tl,er t e n~tlent hud eve_" smoked or not, hext ~lide. This i~ from a (;~ ve~m' old worn~n with a disease called ~]erode~um~. S~.h~roderma is a d~sea~e of the supporting st~:uct ure of the lmlg. Th~ woman Ii~d never ~.moked.. ~3he did not ha~e ca~±eer: but sh~ hacl as i)~r6 of the di~.e~/se in s(~eror]~rmn, ~I hlvolvcmwnf {d thl. lune', and she h~td a g¢~od b t oF ehroaic~ irdta.m~aa~ion. Here are .~ome of the sh ~.1.~ of sep~ a~mus me~aplasia veils tlfis ch~er of cells here. here, :rod om~ her~ So lere is quite severe squamous metap]asia in a 6~ year-old wolnall who h:,: never smoked. Ncx¢ slide. This is an examlOiv whish ~s ~ven n~ure ~e~ere. T/is i~ a 45 ye~r<~]d woman who hod a histo±y u~ rhm~m~toid arthrliis f~r many years, hem~ confined t, bed nd ~had deve opod lung nfec~inns. These eelb. made up of squamous cells and q~ite good sized dusters and nest~, err suporficiel examinasion could eaaih; be mistaken for cll~'i,umm, yet these ~}'~ diffusely pr~ser±t throl~ghont the Ira/Z, h[l~ -rl~ 6rue c~mcer is present. Tlm~(! It,I~ ~ood ex~nlp]~,~ ttf ~v~t'o sqll~lOllS ll]#u~tph~[a.~ s~vei~ cbange~ in tl~e ]tmg~ of people who never smoked, who r~cv.r inlm]e*l ~nvtI±h~g into the hln~ m the wa'~- of tobacco smoke at le~t ~hwh cofild be irritating. Ne×i slide. This is from u 14-ve~r-old boy who died of ~ disease called Cu~h- ine's dlse.~se, and wh~ had never smoked, showing a nes~ of squamous naetaplasia here. IIcre are ~me of ~h~ differe~t cond±tmn~ we e~m ha ~e which are benign as far as tumor is eon~rned, ard whk'il sh)w 5, fs~'pr t~ Sq]l~lllOl~ iftt~l~ ~hl sk~. N ex~ ~llde. please.

CI~AIlI3TTE LARELL~'G 2~\D ADV~]If£I~IN~ 3O3 Thes~slMesfi'omnowonaEcgnim~dslkles. The~e are flora some of ,. r, . • , . . • . < lay own exget ll~ents. ~h]s is ~ rabbib hmg ill which we had in eetc i small amoont of weak nitric acid in order so pi~duce chemical dam age to the lung and to study the repair of th~ lung. These animal~ had tdso he~n given ~ortisone hec~ns~ we llad observed some dt~nges which seemed so ~e~ere that they might even resemb]~ ~ tumor. ~ wer~ ~r2fmg to ~e if we could produce tumors in this animlll by these methads, This shows~ its you saw in the cancer itmgs, a replacement o f the normal ~rchit ~ure hy the~ cells width are quite simih~ t' hi appe~r- anoe7 and which ar~ cerlainly squamous met~plasi.~ mind tile loss of archltevt~ro of the ]u~ ~md t}le arrangemen~ m ~h~f~ts. Next slide. This is anether rchbii~ lung shcming ~ somew hat lar~er nodule very similar in a Jpea r~ nc~ ~chich eertai~fly eouM be mistaken for cancer on snp~rfic al ex~]n n~tion. The next slide. 'I'h[s shows ~ higher power of o.e cd these areas showing the ~]nk s~r~ining cytoplasm, ths laPg~ rmclci, ~chlch are he~ ~nd this is ~ mitotic figure. ~Iitosis is one of the indexes w~ have ~or deterinhdng histologic ro~ligmutcy. This is an exam fie of i,n acLive lesion very active lo~king ~md act iv~ly growbtg, ~ hie~ cou]d eas ly be mist M~en fo'r O~llc(~r~ ~e~ llOlle o~ LhI's~ anilnM~ e~er d~velop~d c~tll¢~r, Next sllde, please Th~s is another zachh lung, treated with we~k nitric ucM and c0rti sone~ in which the arrang~moat of the ~ypicM cells is s~mewim~ dif- ferent. You can see tlmt these individuM cells are arranged in sort of ri~~s' or ch.eles ....or ovMs. Thia is an s~ppe~rahce, slmilar, to wh~t ~e, ~e in ltd~n,de~lleel" o~. g]anctlthtI canoel. With ths teol~nque ~," ~e e able to demonstrate ~ m~mber o~ cha~%,~s in the hung w ~ l could e~sily be mistaken for cm~eer b~t which are not, ~][ay I have th~ lights, pl~e. I ~llink ~la~ lol]owing conclusions ia~y bo ~ha~n from the slides pre~mted : (1) O~neersof silnilar typ~ssuch as squamol~s eel] aaneeror adeno e~neer look and behave Mike regardless of the site of ~rigdn in tile body lung, ]ar:~tlX~ esophagus~ uterus et cetea'a and reg~rdless of whether the pal lent had a history Of smoking or not (9) (,h.nges of ~uano~ts n etaplasia such as those described i~ lung~ of ~vbe~a are also seen in m~ny peo pie who lmve never smoked These changes are associa f~d. with a large variety ~f ingammatory and. r~parl,tlve ohange~ 111 []~e hmg t~nd are not to he eons~dei.ed ~s im~Xl v nan~ ~t' Ixem aligoaartt or as part o~ a series of ch*mges ~thich eventna]~)" ]~ad to Im~g.cancer. Dr. Auevhach's th,s~% theeI of ~ progression O~ Gh0.Ilg~S in Slliok~r~~ llll~ ]elhdhlg ~O l]~v~s1ve o~tll~£,r IS ]lo~ subetantinted. (8) In animM experh,wnts ch~mges resembling those described in much wors~, a~e not ~et~[allv prema]ig~ant leslons and d(~ no~ develop Into cancer, Tlds demon,[rates th,t the biological behavior of given lesion cannot Mways be pro~id ed ~rom i~ histologlc appm~rane~ and that these changes ~re u~t :~ stage in the development of cartcer.

3O4 CIGARETTE ~kBELI~G AND ADVZRTISI/~G Ill sltrarnary, I wish to sL*bmib I~y ophdon thut there exists eaough evidence of u statistical ~ss~!inf.ion b~wcert e~g~/rette smoking and Iung cancer to justh% considor~hle addil~ol~] research in this arc~t, but that ~ae cause or'causes o~ ltm~ cancer as a]] inJman t~lJll~cr~ ]~as not ~et been scientifically established ~nd research into its caus~Lion alon~g all posslble avenues of approach is urgently needed. l'hanik you very much; Senalor NJ~v~RO~. /'hankyo~. SenatorB~ss. Sc¢~llt or BAss. h)oct~)r, th~nl~ you for your testlrt t)ny, and ~or br ng- ing th~ ~inleH with you. " Tho~ s]ide~e, ~p you ]la~'B fhem in such s]lape that they c~n he inc]udrd in the re~ord ~or i~s~.c~;i~l Dr. Mo~.~. I ca~ have th~n d~ ~]]e~f~d~ yes, sir. I~ do not h~ve extra cop e~ at th s moment. I can h~w thena dupllcated ~nd sent to Se~a~r BASS. I ~'¢~]d ]i]~e to hav~ ~hexn placed i~ ~h~ record. • think that so many member~ o f the ~o~lmittee, not being here, it might he well ~or ~hem t~ have an 9pport~inty to sL~l~]y them If l:hc Cki~ir- ma~l will give us that pcrmis~son. Se~lat or ~ ~cx~. Certainly.

o A t~ H~ 4~

CIGARETTE LABELIIXG AND ADVEI~TISI~G

CIG~RI~TTE L.~BELEqG AND ADVEttTISL~G 307 NO6 CkNC~a[~ LUg% ~OKE~ INC. 7.~A~ ~. ~F LU~I NOnSmOKER

CIGAI~I~71~I'E ~ABELI~G ~D ADVERTISING No. ~. eAgeR OF LARNYX, NONSM£~

P 'I ~J L~ t~ L~ t~

cIGARF,T~E LABELING A~ND ADVERTLSING I"4O. I~2~ ~C~UA~O~ M~TA~,A~TA, 14 y~A~ OTV I~Oy, NO~B~O~:R NO. 13~RARI~T LIY~ 0, NITI~I0 ~0ID A~D GOR~ISO~ E

CIGARErfffD ]JAB]2LrJ~TG AND ADVERTI~T2~G ~11 No. ~4 RABEII' D~Nt? ~ESg)dBLIN~ ~IAN(~ B T ~ENIGN. NITRIC ACID AND CORTI~ONE. CORI~ISONE

C,C.A~ETTE LCl~ELL~qG AND .¢A)VEI~TISL'NTG ~o+ ~ ~A~I]IT LUNG ~E~,EM~flLZN(} CAN(,ER i~13T BEC-IGI~. NI"I~ A0[o A[~D COB~rSO~£. Senator B~ss. In reading ~ou[' firsL conth]sio~% oll page 2, you st~t% Statistical evl~one~ ~ecumulated thllS f~r IS g%r01ig enough to ~est tile possibility of a (~Imaecti~n between cigarette sln,)king an4 cancer of the lllllg. Thee in your conclusion you recommend that further study b6 made in this area, ctinisal study. As a pathologist ax[d ~:le who }ms bcc~ workinLg in this field ow~r nlany years~ I gather that you~ in 2?onr testimony, t~]~e cx~ption to the strong ~tatements by Dr. Auerbach that ther~'is absolutely no doubt in his mind that sm0kin•gp reduces lung cancer ., ~)r. ~[011AN. ~ es. I think we can say li~at we disagree m the rater prct~atiorl of his fin~lings. SOllator BASS. W~ seem tx~ hax~c a great deal of dish greement in this area. Inmost scientifiepro eets de'~ling w~th medical science, haven't we been able ~o l~each almost a unazllmous opinion in most other e~per!- merits dealing with a given disease, cause of disease, and the die.smears of m~eh ~ I Dr. Mo~N. ~in, sir; ] would not, say thai. I tbinh that there are maay areas in medislne ~dld other ~ientific disclpiines where agree- merit has not bee~ reached. The ones that we ~cogdize best, for example TB we k~xow is ca.used by I ub(~rclc baeilins~ and that controversy has been sett]ed many yea~s ago. Them~ ,re ma~y other areas in medical science in whlth there not unanimity of opm~on. This hap.lopeens to be one of them. Senator BASS. Of those diseases which we have u definite eUl~ for~ there is a unanlmo~ ag~ment in most of them, i~'t there Dr. MottaN. Yes~ I think so.

CIGARETTE LABELING AND AD~rERTISING 313 Senator B.~ss. ~hat impl~sses me then, and the conclusion that I reach as u layman, is lhat fl~ere seems to sti]l be a g~'eat deal of doubt as to the cause of captor. Dr. ~f or~,~¢, yc% slr, tha~ is correct. Senator BASS. Azld as to whether cigarette smeking~ per se, is a dire~t c a 11~¢~ o~ ] [lJlg cancer. r i , ir Dr. MoaA-*. lhatmscorrect, yes~s . Senator B,~ss. Were you questioned or ~aterrogated or advised by ~n - o~ the people on ~he~Advlsory Committe/~ I.ha~ wrote the report ~r~IORAN -NO1 S r Semat or BAss. But you h~e ~.en in tiffs work experimenting in t~li~ area for many ye~tn~ !*aven~l you ? Dr. MoJl~N. Yes~ sir. Senator B~s~. It is my understanding--I meant to get this infmml~- tioT~ from the doctor frown St. Louis, Dr. Burford~ • few moments at% who sad he u'eated over 4,000 cases of lung cancer. I he]love in the fie]d of ]un~ cancer I don t believe tkat he ~as asked for may- opinion before e ~urgeen (~eneral's ~ epor t w as published. Dr. 3fom~s. I ~ s " ey asked many peop]e and it wouldn% be poa~ible to ask the o inions of evezD'bodv in the c~u~lO'v who had some nteres inth!sfi~d, ldon'tthinl<thhl, wmddbesur[Jrising. Senator ]g~.sg. Getting Mink ~o yo~t ~s • ]gvman. not as a pathologist, having dealt with thi% ~h) ~ou thb~k thai th~ cvidebee is strong enou h al~ i:his point that tbe C{ zigress should pass legish~ion lestrieting ~e se of tobacco, ~estricting the advert s g f obaeco.. . Dr. k~o~N. I ann ~frald ~h~t as ~ sub ect ~vilJeh tile ~oxlgFess w~ll have to decide. 1 am simifly tPclng to ire nay ophaJon on the presim~ status of the s~:hm~i~c *~or~ in this fie~. It is my opln~on that this s~bject lms not bee// del]nltely settled, thaL clv~rMte smoking ( auses cancer of the tun,*. Senator B~ss.~ suggested btst ~ear to the (.~mgress. and we passed legislation and I will further su,~gest, and I think ihat tMs migh~ concur with your opinions as you ~aye stated he~e~ what w~ should do is to continue our experiments and if l~ ~ake8 I IOF[~ lnolle~ or what- ever i~ takes~ cout hue to experiment in this al'e0, to be a~ohttely sure if it is or is not before wc go into the field of saying, based on partial experil~lellt~ tit rtt it is • direct cau~ ~nd to outlaw the use o~ ~OIltP~lllg. ~[s that a fair statement at this pohit ? ])r. ~doIIAN. I got a tittle ndxed up Inm a[~id. I think I c~n ust repeat that it is nlv opinion ttmt ]f Ires not been ~oven lkat ciga- rette smokinff canse[~ ~ [1 l/[![!1' {ll lb~ 1 U]I~"1 ~rl{] ~,~*" h a 'b (~llgr es ~ should~dO abollt labelin~ of pack,gee or something of this sort is somcflnng I don% feel qualil'~ed to pass on. ~ena~or 13ASS. Of com~e we are all hlvllle/l wh0]l we start m.~kJng tfiese decisim~s, and we like to hav*~ tim a~lvice, and P am glad to have )'our staten e here as an expert, In the field~ m g~ving your views to [he e(3 I~lDlir~ ~. Madtm Chairman I have no ]!~r thor question~. Se~ator _N%ui~¢m Senator ]~flSS* ill rclathm Io ~our )el'Ii2issiolt ubou s des, we ld yo g ve ts prom ~ n to ka~e Dr, kuetbachs slides, too? Selmtor B~ss. I t nk t ~ey were paced n yesterday weren'v they 45 9~an--Dt i--~1

314 CIGA~ETTE LABg~LING AND ADVERTISING Senator B~ss I thought they were. Theft is the reason 1 asked fnt* these slides. That would be fine. Senator N~maP~. For the membcl~ of tlu~ ~xm,miLt ee, I would like to say that since file opening gun in this ].uLsing on tbeee twv bills bdfor(~ us a great ilt~ld of r~l*eK~llee has been made as to whether or no~ statissi:s s co bi sad Aga , the pre~nt w tness, Dr. Mm-a~l, h~s indicated hc is not a statlssician, y~t he uses stafisrScs freely: Which I am very sympathetic with t)!e use of .~tatistlcs, because tb.ey ara nece.csai~- for mncll of our SCl~ratlfiC rese0.rch~ sllch as aeronautl¢~ and spae~ exploration. ~hme I don't have a written copy of the last part of yoer statement, where you s~id %tatistics show," would you re~d that hack to me~ Many members of the committee question wllether we have the right to use st atistics h~ this. Dr.~Iu~. I , no s reif hi~islh~oney~nleferredto, Isay: In ,~ummaary, I WIgh to ~bmlt my ¢lllniml that ~her8 exists 6tto~g~l evir~enee of s a~atistieal association between cigarette smoking and hmg eanc'~r ~o jt~fify considerable ad4ttlanal research in this area. ~nator _N EI]nEIRE]tC T~I~IIk ~'o/]. The next witness is Prof. K. X. Brownlee, who is an assceiate p~- fessor of statistics at the University of Cificago You may p~ceed~ Mr. Hrownlee. STATE]KENT OF PR0]~. E~ A. BR0~HLFff~ ASSOCIATE ~ROFESSO]~ OF STATISTICS, UNIVERSITY OF CHICAGO, CHICAGO, ILL. ~fr. ]3Ro~v_~i~. I am grateful for the opport~mitv to appear before this committee. 1 am K, Alexander Brownle~ ~ince 1956 I haw ser~,ed as associate professor of statistics at the Univ~rsily of Chicago. ~'rom ] 95~ to ] 956 1 wlus research a~llciafe ( assis~anl, profe,~or } at that ins~itusion. I received the M.A. de~ree f~om the Unbiersity of Cambrlc~ge i~ England in 1943. I was teclmieal assistant to the director of ordnanc,~ factories (exl)losi~es) of the Ministry of Supply of Great Britain h~ 1941~45; statistician wilh the research de *~rtment o~ the Distillers Co, Ltd.. of Grail Britain h~ 1945~8 ; biometriclan with the Squibb In- stitute for Medical Research, New Brunswick. N,J., in 19~9-~I • and Cbief, Test Design Branch, Dugway Proving Ground of the .~rmy Chemical Co~rl)s in 1951-5~. I am a meml~er of the Institute of Matbcm at]c:. I Sta~ i slics, a member of th~ 13iometr~e, Sociely a fellow of the Royal Statistical Society of London, and a felIow of the Amcrlcan ~tatlst h:al Association. I }rove acted as a st afistical consultant in m~ny areas of science, and served on the Statistical Advisory Panel to he H gbw~v Hc~c~Lr'ch l~o~rdofth~ National AendemyofSciencesin 1955 61. I have ~ritten ¢~o widely used stafistic~I textbooks. "Industrlal ~xperlmentatlon" published by the British Government's Hi.~ now Her Maiesty's Stationery 0~c% ran through four editiol~s hi 1916 to 1948. I he second text, "St atisticM Theory and Methodology," was puh]isimd in 196t] and ~ ~eeon d edition will appear in 19~;~. I have had 16 )apers published in 10 diJrereng scientific journals. These nelude two ~v ew articles~ invited by the editor of the Journal

CIGAR~TTE LABia]LING AND ADVERTISING 315 of the Americ~m Statistical Association, one on the 1954 Polio Vac~iim Trials and another on the Fhlai Repel% of the Ad, isory Committee to Congress oil Weather Controh A third review article invited by that Journal but not vet published, is on '~Smoking and IIeulth," alld repor~ of The Advisory Co*nmitl ee I o the ,~ Ul'¢e o~I General of lhe Pllb h e He~111 h Sel ~me, The repor~ "Smokhlg and Health." [ 1]. the repor~ of ~he Advisory Committec~ to the S.r~eon General of the Pnhlic IIealth Service. ~p pears to bc~ receiving acceptance as a ga~d r~solu [iozl (if til~ coniroversy over the ass¢~ci~ lion bexw[~n smokinR nnr] nlnll(~rol] S disell ses~ ir f'] udil]g cancer of the lang. I wls]~ to presel~ to the committee a n~unber e)f eollsi(h r ~th)ns th~tt b~dlc~te tha~ any claim to a solution of these questions is grossly premature. It is 12 years or so since st atistlei,uJ~s geneial]y became a~vare of the possibility of al~ association between cigarette smoking and ]nng cal~- ccr, and 10 5,eai's since this was exte~ded vo virtually sJl c~nses of death. The sampling procedures u~ed to establish this as~eikti~n were by no means as r~gorous as statisticians like to see as a baMa for sclm~tific inference. The main diffie¢~]ties ~vet'c that in those studies in which there was t~ clearly dt!fint!d pl/ )lllllt]oll the percentage of imr~resI:,onse ~ws se riousJy high, of the order ,,f 30 {*eiveni, *~u,l in Ibose studies in which there was ~() clearly de, fined opu]a~ior± ther~ was c]ea~lv Seh(~l]~h~. It is notorious that these d e~ects can, and usual] v do. produce serio{is biases and fl~erefo~e delicate and highly speeul}~tlve calculations of the p~obablc bound ~ of these1)')ossible biases az~ Ilecessarv. The f~ollserisus a~}Dears to ~be that though the ass~e{atioil betwee~ cigalette smoku~g ai'~d nacre:tsed dentil rat~ ~s ,r~,bahly ,)vet sh~ted as regards the gencz al population, nevertheless it t]oes ~.~ish This association between cigarette smoking and hmg cancer has t~en interpreted by man~" ikcluding the authors vf "~moking and Health.' as ~d cat nga caus0.t ve relationship. One might have expected tha~ this brilliant and impo*~ ant dlscove~' l*ould have been wldel~ ~lIihrtcd by Lhe statistica[ professiola ~s an exam)Ieofthepouer~[ndntilitvoftler. I : ~ . ee. q es,. . It is tllere~fore eI~rlOUS that the statist]ca] profession ha~ heull Inrgely silent on this issue, For exam )le J. O. irwin [2] in his 1969 presidem a a( ¢ m~qs to t le Hoya] Statistical Society of London corn- monied on the exis/e]~e of tt,e cox~troversy, and the difgcult~es in re-~o]vinglt,but carefullyexpressed hoop n onont Likewisel J. Neyman 8] in a paper i. "Seiermo," pointing out pos- sihlc fallacies in this area exnphaslzed tl~at he was dealiDg onl with the mell ~dological issues and not expressing al~y opinion on the s~b- stantive question. Ve~T few p~pers ha*e t~n published on this topic in the %Iom~al of ths American Statistical As~oeb~liorb" or the "American Statisti- cian," and no'worthy among them are etmtrihutions bv Dr. Joseph 13,~rkson, of tl~ 3iavo Clinic, vigorc~slv disputing lira ;tlh~i.. ~ es al> lishment of. eai~sat~ve ~'cIatiohship [4], [5]. lCefet¢~ces in te~ api~ar oi~ page 821.

CI(~ARE'I~ LABELING AND ADVEIqTI~G • think that this ab~entlon from comment on the part of tile st~tis tical pro lession is due to the fact that experienced statlsliestns are well aware of ~m dldiculty well expressed 40 yc~ two by one of the most distinguished statisticians of his generation, G. ~udney Ynle [6] : "you can prove a~yt3aing by statisties" is a e0mme~, gibe. Its eolxtrary is ~aore nearly trtl~you can never prove a~.~thlng by statistics. The ~F~li~tieie2a i~ dealing with the mo~t complex eases o~ m~|tLple eallsatlom fte ma:+ ~how that the faicts are ia accordanc~ with this hyr, othe~is al, that. Bat it is ~aite ~.nc)thicr thing to show that all other possible hypoth{nses are excluded, and that the facts fie not admit Of any other lrltnr~retation ~han the partita/at 0~ Sir R(m~ld Fisher, 30 yeal~ ag% expressed the same ide~ [7] : For the logical fallacy of b~llevhag that a hyOothesia has been prayed to be tmae, mor~.ly because it is not contradiete4 by the available filets, Ires no mo~ ~ight tu insinuate itself ~n ~ot~istieal thma in other kinds of scieat [fie reasoning. These remarks of ~h~ and ~our decades a~o bear on tb~ weakes~ point of the report "Smoking and Health." ] t is (llear that the authors of the report recognized that to establish the hypothesis that amo]dng causes lm~g cancer the~ had to eliminate competing hypothese% iu particular that put ~m'ward by Sir i~onald Fisher [SJ : that cigarette ~moklng and I~ng icm~icer, though not mat ~tlly causative, are ~oth i~fluenc~d by a common cause, in ~hls e~sa the i~adSvidual genotype. There are several it~tns of information dmt m~ke the genetic hypothesis plg~sible. 1) S~veralworkers,]qsher [9],Friberget ah [t0J, aml Rauschou- ~ielsen ]1 ~ have iltdependeutky assemble<[ dau~ showing tmt iden- timbal ~whis more frequently ha~c the same ~moki~g habits than de nonidentical twins. o date th~ d~th are not very extensive, but aI/~ cer tmnl~ sn gesture of l]le h3-pothe~is lhuL the taste for tobacco Jn its v~rlotm forms is genetically linked. (~) Data ~smmbled by Sehzer [1~] suggests dmt ~ou~ok~rs~ eig- axet~e smohca's e~ ce~ela: differ in several morpholoi41cal indices. ~l[zBr lne~.sUre~ VOUlXg mexl. I•ax yard uiider~'ad lilies and th~n ase~r - t~ined their smoking habits ill i)l'fl ~l] ~]] 1v~ years later. Me found tllt~t smoking ha~01ts in the mklthi~ties werc ~sociated with physical hu]hl at ~20. The natural hiference is dn~t /]tey are l#~&ed genedca/Iv. Foreign-b~)iax immigrants be the United States differ in their ¢~ncer de~t x ra~es n really way~ frolit hal vt~ ho~*iI I~,S. e t Zell¢~. I~ may be contended bysomc that some of the differences migh~ bi~ duo~ for example, to malnntrithm in early life but 1iris does no~ seem plausible explan~Cion for such a disease ~s cancer'. (4) This iaidieation ~s strongly rei~storce4 by the obselwaL~oa in the report+ The several etlmic groups Ia the Unite,1 States ~A~play their own ehar~ctexistle patterns of suiceesses a~d deficits t~ risk t,y site. (5 Datg of Eysenck [18] show that smokers and nonsmokers differ psychologically, Very si~mfllcanl:Iy, a dose response relation ship w~s observed, heavy smokers IsdrLg more extroverted than medimn amokem, and also pipe smokem resembled xonsmokers in beisg h~sc

CIGAI{ETTE LABLLI'qG A_~-D ADyEHTI~:LNG ~i~ extroverted. Wh~o re]atio~hlps are the same as those observed betweel~ smokin • and death rat e~. Agaln~ it could be that smokin~ influences the pm'sonality or that the pel'sonality influence~ tile sm61dng hsh s but n my vew they ~,~ ~robably ointlyassociatedwitha~enetietr~!~. (0l I~ is well Idaown that cerinin cancers Imxe very stre~tg genetic associ~tion in some laborer eke animals. 7) Yerushalmy 14] has presented data showing that whet}mr or not the husband smokes is associated with the ineklenc~ of prema ture births in the wife. [the husband's ~neking not the wif~'s ~mok ing: is a~ociated., with this inc[deace of premat 1 "e st s n. he wife This might be caused by tlle cigarette smoke hemg m the mr around the homo~ but it doesn't so*mr likely that that would cause such an e ffes.t. It is more ] ikel - to be a genetic trait. (8) H~u,lmond [15~ gives data showing ilmny odd features that cml best be interpreted, in terms of the ~enetle hypothesis.. . For e.xa n ]e, lus data show that the increase m age-ad]ttsted death rate for m~es associated with the use of tranquilizers ]s ahnos~ ~a gf'eat ss that associated with cigarette slim]dng. Furthermm% the two appare~lt effects l~ro approximatel~ l~ddiLive. The ,~l~ ~ io,~ in~erp*~lation o~ this "m that people in such slmpe that the~ need ciga~'~ttes or tranquilizers are going to have an increased death rate, and it does not laake much difference wldch they turn to: azM if they are in such shape that they need both cigarettes and tran quilize~, then their death rat~ hicre~sc~ still further. I~alIIIII(IH(I!H (la~a ~th~(t sho~% ~ very strong association of death rate wish the ea~ing of fried totals. Rat tier suYprishigly~ thos~ who ~bst~h~ have a much hi~her death r*tte than those who eat fried foods about four times a weel~. Like everything else in this area, it could be interpreted many ways. This could be interpreted causatively: I sup]pose that one could hypothesize that those who abstMr* from fried foods suffer from some uidrnown n.trit~o~al defieieaey. But f regaled it as uldikely that nu~rithmM d~fiedmdes ~re at ~tll ~Uqme~iahle in Hanmmnd% popula- tion because this was largely middle and upper class people selected by volunteer workm's of the A~mrlc~n Cancer Society fro*a among their own acquaintances. This assuciatiol'~ (If death rate with fricM food eat.ing I regard mq a surfnc~ mani fe~t~dion of so, lie genetic proper ty of the human organism. 9 IIammond% data show the well&hewn d]ffm~l~ce in death rates between man'ied, single, widowed, and divorced persons. Attempts have been made in the past to k~t~rl~ret these Phe/lOlflena e~llSlttive]3~ : F,.' t~xam fie hachelors may he m~b coted m grtmIet" sl re~'~ tha]~ mar red men ~eeause they have no w fe to cook d ruler for them, or some thi~Lg. But no matter llow plausibly these attempts at eonst~matinz causative hypotheses start out, they always end in a tangle of ulrsnrdities. (10) J-Ta/nrtlm/ts dlit{I also show a mltrhed as.~aild~[on Ill dedh rate with height wlgch is most probably a genetic effect. (11 Harrmmnd% dat~ also show a marked association between death rate and longer ty of parents and gra~/dparents, obviously a genetic effect. aefer en ee~ In %~t appear oi~ page ~21

mutt~ suq 's'~d~a~ ~od~.t °K~ qa!q~- '.to0u~a ~unI s~st~ga Zu~outs )oat~ o ql~tD sm~q oddq ~q! "4rod ~no qtqod o~ o'dK os[~ pUtox~ i. • " ,'l~ly;qrl p au ~ u ~'(otu.sn 4aotloa e q~ ~q so odd o on~x~ ~[~ jo UOllea~toa ~'4) 'oao~ea~q~ *ld~oo¢ ~oau,aa I "a~ti~a~'~Is~vSd 05 uaoc~ u*aq p~q ~q~ 1~ a~au~a zun[ ~o ~l~!a uttl ur~ o'~ o~*tAatts aA~q :lou pItto~ oq~ 0so~ £[o~.t'e[ dl~ae'tt act ~tua qaotIoa 006I P~'D ~t p~*ao~qo ao.mwa mmt }o ~dsuo $o a~qt~ttu ~ *%~sI XIOa!~[~a oq,I, a~ql ~q P~}a~ulmlI° e0m.~ oqa~ .~t~t[J~om.. etD s~oph [au[ ~,a~qo a a~tt~o~ aq~ oatas '0~ ]b 0~s oq} ;'s ~aoqoa 6~t oq~ vuoa~ uo:~iadod ~n~ao~!p -[oa }rioa aaI)l~tl 9aOLU OaOm. ~OS'aogtp poo pla i~um~tp~a~ aq3 osn~c~q X[qmansaad aasso[ ~u ~q uo~.w.~ qP[' " s~ u~oaed s~ at ~ ~oa~d ' - ~u a~ " ~ o ~q osoq~: ~o uot o~a~ a~I q~pu~ 0~61 m 05 Jo ~ etD p~t[a~s0a ~006I a! 'ao}e[ gmoA O~ uaoq o ~ aaue~ oqd, sttm~;rota pmo ~ p'~-~ o~ io ~unoaa~ uo ~.[a~as[ .qq,~xm~soa4 ~axuF, s~l ~a'a s~sa~ guea~p 3 rl 4 R P g • . • ~u!taodoa oqq. JO ~a'a~t!la~s ug £[q~sqoad s[ os~au, lqSO -uolsrq aum~ddu oq~ ;o aa'sd o~a~[ ~ ~aogua~q& "srso naasqat vs p~sou ~ mp'oaa~ :e.>avvaz ~tq ~o ~s~a £o~tu alqsqcud ~a* ~STSa s~d,(~a,~a • "~'ad o~au L '~ ~zitt OSLU L[!~ s!sou -~latp ~o q, lq'~q pws uotq~'s~[ -sanboit[o~'I Ot'lsot*~lnp ~a~)l:l Jo ash pt~gads -ap{~oguf!mL~npoaEEtm" !D ku}°q18~°ups~s~U~lPJ°X~rn°'°'s at ~sgeaodz st~opuo, oag ~ u~oq s~g oaoql saso£ O~ qsgd~eqI uI (t) • .Mutatt~roaun ~ aopuoa t[attDl ~atsom~lsea oa~a s~q ~uotr~t~a~ stq& • aoou~a ~ulq ut es~so,{out p0agos(io otD aoJ ~unoao sot sag~K 01" 4sud o ql tu £DUO apaas p~u~tia s's[I [ood a 1~u~,~ ~q~ ].~tl j ~[a~t*Unl s~: 'I~ 3~lvt I g~ ~ -qJodRt[ ap, auo~ uq* ~uDou[aa .tog soa~ aaod~,~ ~RI no,par puoo~s ~q.L "o:osqoa ao~ o¢s*g to s~uao~ suo~a's;t ~tD opnto~q ou o "ug'~xo dvhoa £ [}aaom a[utslaea asoo~ Sl opoo oDou~*~ oq~L 1 PIP I q. • .~stu~aOmmlnqOq~o~oDaodoad a~V3 ~o ~o:~-ut ~tllosa~'g tru [)uls ' t aoi os pro, '.w'~( 'l/[)[s go aotoa sv aus ~]tlg~40ta'tttO~ ~rtc~ aqo aq~ 'sttuoJ gltOlag~- ~0 X~tltq¢ ~snaaa[lUtU~ ~q~tot['g/~ss~ pt~q %sd~s~p ~ 1[ ilUa £glg 0u0 g~ ~ao~ ~o~.t u~ %~*oq~!p s's ~aas s~gastp a~aods ao~ so}~z q~'a~p ~ !m, rsz Ra~e u! ~aauo4oB~p £a~tp~aoq [ua~uo~ "umldxa ol s~q ST~qaO~.tt{ o/:tauo~P ozD ~sq} ~a~R io i "eou~D~ut oql olndStP anq Ra~ko auto* £:~aau O~D ]un,~ I " q . . .q~ao~r os p~trs '~tq~q Oqa UnUylUOOS~p oq~ sao~iotus o~a*Bta ~a*~IOVas as~!a pu~ ~!d asa~t.'it~tt~ ~a~a~£!a -¢/~'~q ~sam[ot~ o~oa~[a aauaapotu '~a~_~[omsuon uaa.~q saanoao~p u!'e[dxa o) po "sat dmoo ~q o~ ~q s[sau$,o~IKt[ otqu~la~ aq:~ ~Iq, s! qsag oq, no &~ 8l .qal'SOH pu~ ~u[ om~,, 9odoa a a ou!t~ux~ ~sn~ o~ pu~ ~[q D_%IgI&~XMI~" (INv 9~,i2IaaVq aJ,~I}Ivolo ~[~

CIGARETTE LABELING A-~TD ADVERTISING a19 (1 The r~pvrt quotes one of the criteria, of wha% it ¢~lls th0 epi+ dem o]ogle method as "specificity." It uses swo definitiorLs of speci- ficity. The first is-- the p~ecision with ,~,h:ie h one compc*x~ent of an a~ciatx~d pair can be ut Hiz~l m predict the ¢~.eurr~nce of the oiher. Tile report a~imi~s that ~he a~oc:;Mi~n of cigarette ~n, oking ,~'kh Inngeancerimse~renmlylowsp~wifieit5 inthlsse*me. 1nether words, enormous nuIabers ~fp eop]~ srcmk~ cigarettes and never dcx elop hmo clmc~r. The second defimtmn of specificity is similar o ~hat o~ YerushMmy luM Palmer [16]: The basic asstlmptmn of such a test for sl]ec:iflcit y is that if the characteristic is not related to the 6ise~se i]a a Causal wa~, then the relationshiv sholl]d ilot be restricted to the disease under ~tud~" but ~h0uld also be I)rese~t ~xirh (Jlher (li~as'~ eulities, ff the ehar~lrt~.ris¢lc Ca~l be zhowa ¢o ~e rel~d 0nl~ ,lr lnos~ to the rlis~as~ Under study and not to m~ny o~b~v disease en~ities, ~lell 011r eoofid¢nc~ that It Is a eau~earz¥int( ~eet or for that disease is greatiy iuer e~se(l* The *<~port 'Smoking and lIealth" states (page 185) : Ti~e number of disease~ in ~hloh the raLios remain Mguific~tly high~ a~t~r ¢onsicteration of the hOme,spouse I/i~s. is ~OL g~-eat enough to east serlcms ihlubl on the causal h.V~othesis. This is really a p~posierong statement. Table ~6 of the re)err (pages 1¢l!~ 110) tabnhlt(~ the mor~alky rattes f~r "25 /'at~es of Ilegfh ~or the 7 nlajor pr(~pee~ive s~uctlc~ aItd ~he3- lifo all e~)ns]stenl in showing ghat Ihe mo~:dlty ratio is ~'re.ter lha~l 1 for ~drtnally all causes of death. In the light of the consistency of the seven studies there is vireuallv no d*lu gt ~t*a~ in almose every )nstance the m,.'l~digy ratio is "si~fifle~mtly high." It is/rue Ilmt for'l out of the ~5 eause~ o~ deMi~ ~lm mortali[y rude is less than 1 beh~g 0.9, hut thi~ is fvr a cause of de~t;h with rehtiveh, sma expected number of deaths and h~nce with a high s:~rnplin~ (~tro¢. gra therefore see fha5 th~ assoclatiolt between cigarette smoMl~g and Iungcancer is nlonlune t~l vnonspe~ e Vet e repor "~ ok g and Hea/fh" slates that i~ has~a~ high deg~iee of s ~ecideity," My only eonanent cn this is that it is a splendh] example of Ihe technlque'of l~atlp denying th~ existence of an i~monVelfien~ ftct if you enamor explain it away. It is perfoc~h7 clear in my opinion th~L th~ assoclat on Imlween clgar~t te smold¢~g and vir t t¢al]v all causes of death ha~ t~ be exp] ainext on physlca]-chemical a~d bielog~cal gronnds i~ th~ (ausat~ve hypoth- esis is to be accepted. Tim protagonists of tlm eauaativc hypothesis hate had at leant ~0 years ~o wrap up this part of the problem bnt have so far lailed~ evr,n ~s regar cls 1 m~o- cancer. The m~st potent c~rcinogen identified h~ cigarette sllmk~ is beuze a~- pyrene a~d it is pre~nt in mucth hwger qu~!ntlty th~n ~my of the other carcinogens." (~]zar ~moke hr~s almost 4 tm]es as much benza (~) - i~yrene, ~tnd pipe smol~e about ]0 times a~ much benz(~) )luene as (~gar~te smoke, vet pipes and cigars have been p~tiy well e~on~r~ted by th~ Surgeon GeneraPs AdVisory Commh t*.~ of any charge o~ caus lug hmg cancer. I~fer~nces ap~e~ on pag~ ~1.

320 CTGARET~2~ LABELING AND ADVERTISING Apart from the above measureme~tts on s~noke: the difference be- tween cigarettes on the One hand and cigars and pipes or, t~e otfmr is a plLzziing and unexplained fcgte re of t, be indielment of tohe,~o, it eouki be of course that the variety of tobacco used differs signifi¢~li~t l~ that the tobaccos u.t'e cured dlfleL ently, ~hat cigars aud /~ /es nlay h*rn ~t different temperatures from thM of cigarettes, tbet pipes and clo'ars do not include poper, or tha~ come cigarette smokers are s~ppose~ to inl~afe ~}mreas few pipe or cigar smokers do. But if inhalation was the crucial factor, ~hen anltlyses differentiat- ing between inhalers ~lld noninhalel~ of cigarettes should have dis- closed this, whereas these analyses have reache4 inconsistent results and have been wry confusing. ']Th~ hypoOmsis tfmt ciSa~et[~ ~mhin~ causes lung cancer would be substantially more ¢oltvtn~h}g i~ exp~rllflerff, s tA) ind*~n e ]tulg et~llC~r by cigarette ~moke in laid, rater7 anlnmls lind proved successful, but ~x> far only negative results have been reported. While explar, ations for a causative relation between cigarette smoking and luJ~g cancer are still t<r~ally unsatisfactory after a decade of research, the sl]ua tion is even era tier for the other causes of d[~ath. The report ~Smoking and H,u~]fl~" uses Ihe apparent historical liter-ease of ]tlng ~2ncer and the hlstoricM increase re cigarette smok ingas an argumen~ tv buttress its eon¢Iusion of causation, tt()~ever, af ] statisticians, and almos~ everybody sis% too. know that the presence (*f a )l)siSive zero nr nt!gativl~xH...e'labion he~een two variables ob- s,wved ~er thec ln~s been lhe basis of more llldieroll8 ~Ol~enge tllftr~ any other st atistiea] technitq~ne. ]~or exampl% tile inci(fence of cancer of the stoma(h has bees declining for m~ny v-ears, but only a madi~m~ would infer froln this that the h]ercased s~noid]lg has c~ttsed the decreased cancer of the stomach. The ~p~r b "Smelting ~nxg IIealfll" also attem )te to use correlations between different countzie.s in the same way~ and th s s equa y abs~rd. To mm~ u , firstly t~ere are qu tea few diffieulties currently p~esent Io bedevil ~e hvl~bhesis that c~garette sanoklng causes lung cancer. Future re~earel(mav ~larif~7 the altua~ioll a~d dispose of thera~ but this ~ma~ns to be seen. Secondly, the genetic hy o~hesis is very much in the running. Th]rdly: the hypothesis ~ctat cigarette smelting ¢~mves lung cancer cannot be accepted as est~blished~ even if its vw~ dilgeuit~es are dis- pl/~d of~ until t,h~ ~tmetic hy Io~hesis ha~ beau proven false. Ti~e~e- fo~ to reael~ a decision at ti~ time is completely unjustifiable.. For the reasons I have given I do not believe that the existing statistical ex idence i~ sufficient ~o justify any scientific conclusion 13~at, cigarette sgl~ o]~il/g sallies (.aneel*. ~¢fr. PJhah'tnan~ I wt)uhl like to add ~ comment to the prepared statement if I may. TheC~AIX~X~. Certa ~ v. Mr. Br0owzc~m. I read'i~ s~me of the prepared statements which werede vei~dbullecznmfi6te~rtt]~ ast day or two, stat~mentsof the type %~ga~te ~amldng is responsible for'at least 195,000 death*q per year in this country, and this figure may be as high ~s .~00,000 per year."

CI6La~ETTE LAI3ELI~G 4~D 2~I)VEF, TI~tNG ~21 I would llke to exnph~size that the~ st~0ements are based on the remlse that cigal~tte mnoki.g em uses :rlmost all dlsea~s ~,n extrome]~ ~ar~ assumption itmL goes 5tr beyond an?- assmnptioa made ill the report "Smoking and liealth." "Smoldng and He,It " cc c uded the as~oc ~t on was cuusa tl ~ e only m the c~se of 1111~ cancer, and t,b¢ wh ale purport ol my etatement is to demonstrate ~kat overt ~his ehtim of proof ]~ mL~u(:e Kuble. So statements ~chcse >remi8( i~ [ba[ 81] ¢kR{]lS ~1~5 eatised by su~oking ar% in my oifiahm, wildly specuh~ti~e and far, far beyond [myth ng t e Advisory Committe~ ~ltempn~d lo make. ~ GfWNCES 1. "Smol¢lng arzd H~Lth," ~])ozt o£ the Advisory Commit ee to the Surge(m GenerM of the Publ£e ltealth ~ei~,lee ~dublie Health Service publication NO- 1103, Umlat ed. 2. Irwin, J. 0. ';The Place, of Mat hematies in Medical and Biologn o~l I Statistical" JouIDal of the ~oya[ ~tatistlCal Society, aries A, /28 (1962), 1~. 8. N~ymau, ft. '*St atistie~- S~r vast of 2d/Nelences," Seien¢ e, 122 (1955), 401~ 4. 5terksom J., *'Smoki~ and Llmg Cancer : Some Observations on TWO Recenl l~oor ~S,'! d oul~l of tile A m~riean S~/~i~ie~ I Associatlnn, 5~ (1~38), 2~38. 5. Berkson, J~ "81ucfl~ing ai~d Lung Cantor," American Statistician, 17 (1963), 15-~ 8. yule, G. Y.~ "['he Fnuetioll of ~ienti/]c Method ia Seiol~ific Iltvestigation," I~4u~t rial Fatigue I~c~es rt'h Board Report, 28 {1924) 7. Fisher. Sir ]~nnald, "Letter to the Edilor," N~ture, 13t3 (1935), 474 8. Fisher. Sir r~muld, "Letter t~ the Editor," British Medlea] d carnal, 2 (1957), 2978. 9. Fisher, Si~ 14Onald~ "Cancer and l~m~khag," "Letter to the Editor," Nature, 182 (1958), 5f~. I0 Frlbe~g, f~. KalJ, L., ])e~vk~£, S. J., ~nd T0r~sson, ~, "Smoking lhtbit~ Itl ~'~iono~ygotic an4 Dizygot ic Tw}r~s." I1 rit Luh ~iedie a] J ourl~al, I ( 1959), 10f~0 2, 11. Rau~heu-Ni.lse~x, N., "$mOkil~g/:[abit s in Twin%" 13mnish i~iedlcal Blllletin, 7 (1969), 82 S. I~. Seltzer. Carl C+, "Alorpholo~ie Constitlltion ~nd ~noking," Xolar~l of the American Medica[ Association, 183 ( 19~g¢ }, 53~45. 1~. Eyseig.k, It, J. Tal"rant, ~I., Woo/f, M., and ~]glanrl. L., "Smoking algl ~er sollalit y." T~ritlsh ~ediesl Joul~al 1 (1960 )~ 1456 6;0. 1~. yeru~ha]my, J., "Statistical Considerations al~d Evaluation of Epidemiolog- ica[ ~iden(~." in James, G ~orge, u~]d R~senth~d, ~i£~odo£~, "Toba¢oo s.nd ]/ealt h." ~pr~ngtield : Charles C. Thomas, 1962, 208~,0. lb, HaIlllnOnll, ]~. Cayler, "Smoking ~a Rolation to ~or~llity and Morbid]tT: Findings In First 34 Mon~hs of Followap in a Prospective StUdy Started ill 195!k" Statistical llesea~ Il SeCtit~n, Medical Affairs I:)epartm~nt of the Anler~can C~I ileo]i ~oclety. J@ Yer~tshaloiy, J., and p~lm~r, CarroII E. "On the ,~iet hodolog~ of I~7~stJ~u- xions of EtiolOgic I~acfor~ in (~hronle Diseases," Journal of Chroni~ l)i~,ases, 10 (1959), 27~0. Senator ~-nv~m~l~. Sena0>r Bass ~ Se~mtor B±SS. ~o cluostions Senator N~vnm~m For the retard. I would like te a~k the ~ble stat~stlclan. MI'. Brownlee, to annotatg a number of page% be,'uuau I am sure I would irm]ian him if I a~sulned that nil the rote±once £o genetics had to do witt~ r~ftler things th~n smoking. As I read the re mrl nn~l fc, l]ow ~t along, i~ talks a gre~t deal about f~a-n etie traits und ),e~, no~x lle~ does it say that these pl'em ut ure bit Ilcs are (tue to a genetic trait cannon,ted with smoking. I wouM be ~lad lo, after the laearb~g, sho~ you where I have ~ glost question illu)i]~ t~olY/~ of them.

392 C~G&RETTE LABELING AND ADYEETISING For the mern~rs of rile committee, I would lSke to e~L]l at~nbi~l agahn to the us~ of the word "~t atistics', because we starled out in this h~arin withth~questionoftheuseofs~ti~,ics. Testinlonvjustgiven by Mrlgl~rownlee points out thas eVeal st~t istlelans s~y you e~an't depend. oil gi~tistics. I hopg Lilat we don't islet h'om this'that our slo~n is "down the s~atlstie~3~ But examples giwn on page 4 of the testmmny would htdieate that. Mr. B~owm~. Conld I na~ke a coimn~nt on ~hat Seuat or ~-E~aFa~. ~Lr e S. .Mr. J3aowm~r. The fundameutal point is that St was Sir Ronald Fisher~s ~reatest eontributioil to the science of statis~i~ tllat, if you run all experimm~t on a slttmtion, you can introduce ai~ifieial eorre]~ ~ior~ randomization and that has the pr~Klerty of desgreying all these concealed eorreLlioxis flint ma5 bc~ n the hack• c~ro . d. If you can7 out phvsmMlv the act of ran om zat on you can c~ar- antee with mml~nOus probab~ity that you have destroyed these c~orre- lat]0ns. Therefore, hi experimental w~ork done properly r~t~domized, we h~re eomp]~te confidence in ~.hat. But ebservahonal work ~li~r~ we have no~ indulged in randomina~inrL we are ~bs~hltely in a sinking" be the ~hole time. ~ha~ quot~tion~ refer t~ ohservatlonal work aud they ~etually were I~sed ,~t inasg hi~toricMly befo~ Fisher had introduced raatdomizatinn. In this field Jt i~ difficult to carry out experiments on human popula- tion. That is ~hy we are so a~xious to see e~perimenL~ on auimal Neuator N~ca~r~. Followi.g ~dm~ff wilb Lhe genetic material, I often wondered why~ before anvhody knew ~boug tobacco or anybody had ever smoked il, soma of th~e evonts and d seases occun'ed. Yet, we keep falkbag about a genetic li~k. This is the part l don't ond~r- ~tand. I think that I am probably wrong in this. ]7or example, the z'efet~rw~ mad0 ~o the ~vcb~linn of death rate with the eating of fried foods, I C doesn't -~tv whether the death rate from eaucer, sgsx-ifically lmlg e~ncer was ar~soeiate¢l with the eatinN of fried foods. These are the things I thi~k would make the report mucL more vallc]. I will insert in ~te re~ot%l 1 will do ig righ~ ak lhJs tim% verbally-- p~rt of an ar~isle which I find very inte~,e.'l"ng. ~dx. I3rownlee refers to the fact }hat he was mvit~t by the editor o~ f/tr~ ,)'OUl'nal of the AmerieaI~ Statistical Association to e¢lmmen~ or submit a paper, I g~aess it is. on the 1954 v)ello vaccine t,,iaN. This is tl~ las~ paragraph, written by Mr. 13ro,~lee: To summarize, ~9 p-rcent of the trial was wcCthleSS because of the lack of ad~uate ~oll~rolg, The r~maining 41 percent ~ctay be all ri~ but contains il~ta"l~al evidence t~f bias i~ ~avor of the vaecinato~. There was hope that an iadeDendent trial woll]¢l be ~ in GreaL Bri~ai~ Bnd~r the au~piet.s of the ~edical Research (Jcmnc-il, bnt this has been abanaoned since they oOItol~ld~d that t~e vaedne was too dangerous= This re~iower may seg~a too skeptioal in fvoling the need for &n IndollO~dent coufi~m~tion of a tti~l run on the scale of the present one. but he would point o~t that gamma globulin was trjtZmDh~utly proolatmed effective b~" the Natioual F(mnda~Jon after ~1 ~1I~22~r ~'Jal, B~t ~OW, 69~Ndefltble ~1¢~1}1~ Oxl~ ~ to tllo eorro~lll~g of thls ~olloI~ion. That completes the Mtness~s we h~ve for today,

CIG?ARETTE LAIIKLING AND ADVERT/SLN'G 328 Smmtor BAss. Wou]d ~he witlmss want to c~mment orL t~haf article ? HB was looking for something to see if he did. I don't waalt him to feel~ M~: BROWXLEE. I stand by it. Seaator Bass. I saw him IvokirL~ for something, I didll't want to cut him off if he had a statemel~t. Thank you. Senator NE~aEI~. '£he carmnRte~ will reconven~ at 10 o~clock tomorrow morning. We now strand ad ommed. ( Whel~upoa, at 1:55 p.m., ~he cmmaittee was I'e(~d~ to reconveim ~t 10 a.m. the following &ty. )

---

CIGARETTE LABELING AND ADVERTISING TIr0"~F£DAy~ ~5 ~ 1965 ~NI~ ~I~ STA~S S~NATL~ COM311~E ~ C0~c~ Washlngtvtb D,C. The committee ]net at 10:~7 a.m. ]n room 8110, New Senate Oface Buildh~g the Honorable Warrea G. Ma~uson chairman of the com- mittee, presiding. Tfi(~ CI [AIRbT A N. The c~m mit tee will eorae tr, order We flare this morning six withe:see. I netice Lhey are M1 lis~ed as decCors. I ~.vilJL call [hem in the order 1hat lhey al~pear on the wit ness list, mEess some of them wahl to be called for convenience ahead of tlme. ~Ve will staI~ out that v, ay. The first is Dr. Tmuis Clerf of St. Petersburg, Fla. We wiJl be glad to bear from you~ dool on STATE~EI~I? Or DIl. LOUY8 H. CL~', ST. P~T:EIISBURG, ~Xdl. Dr. CT.~s. Mr. Chairm~n~ slmll I proceed with my statement The CHAre&ZA~. You go ri~ilt ahead. You have a ~ritfen stah~- ment. Dr. CrBRS. ~es Jr. I am Dr. Louis It. CIer~ residing m St. Peteis mrg, k a. 1 am pl~/fe~sor of aryllgo ogy and broae to-esoph- agolo~v, emeritus, Jefferson Me, Ileal C~llege, and was head of tlla~ de arti~an{, geffei~son Hospital, Philadclphik, Pa., from 1930 to 1954. ~am a member of and held ofl~ces in all Ihe medhM soci~ies cover- ~mgmy specialty hmluding sa, reiary~ editor, and president eft the merican Laryngological Association and the American Broncho Esophag(~]ogieal Assoiiation president of the Triolegical Society a fellow of lhe American College o~ Surgeons a~d American Co[]egge of PhyssiclarlS am(ing otll~rs fllld a ln~mber (~ ~lt(~ hoard of exalllirlel's in oto]aryngology. ~ have attached to my prepared staCemeng addi tional per[bleat dicta and a llst of 180 contributions to medical litera- ture. • My experience i~1 cancer of/he ~Lir passages began in I9~9 when I ]oined the Chevalier .[ackson Broneho~.opic Clhdc in PhiladeJphia I succeeded Dr. dac'~on as professor and bead of tim de ~arCment t ~e Juffersou Medical College mid Center in 19:~0 and cm~t lined n that capacity until my retirement in 195~. You may know ]Dr. J~lk son perfected Ihe b~mehoscvpe and was a pioneer irt the field of dlag- nosls and treatment of ea~l( ~ t. ~>f the laryllX alld in d]~rllOSiS of cancer of ~he lung, The American Bronehd Esopha~logic~ Asseci .iwl es~al>lished a Chev~ller Js~b=son Award in his hnnor ~tnd i~ was my good forLune to be the tlrst recipient. 325

CIGA[tlSTI'~; LABELING AND ADVERTISLNC- YOU ~ I ' be hdel*sted to know that the first l,JSitive dlagae~ls of cancer ~f ihe lung by bronchoscopic biopsy in a firing patient was made in the Jefferson Hospital Clinic in 19'24. [n 1945, Dr. Peter H'erbut and I reported u method of , raining bronchoscoplcalIv re- moved s0credons fzom cancer cells )mem ~id in early dia_an~as~s of lung cancer. Th~s method ~'l~s provdfl to 15e a vahable ~ttgr/~tle aid. /luring the period from 19~ t o 1954, I observed over 4,000 eas~s of cancer of the larynx *~nd thresh and treated over 1,800 of these by surglcM mea~s. My interest in eaneer of the hmg w~8 conc*rned with diag~osls as m~r clinic did only bronehcx~copie studles. Daring the g2 years at the Jefferson Medica;I (hinter ~tlld 2~ years as brc~ ehologi~t at the RadiologieM Clinic of the Philadelphia GenerM Hos- pltal, and feur other Phihulelphia Hospitals I examined by bron ehoseopy ov(,r 3,000 cases ~f cancer of the lung, My interest, there fore, was in the patient suffering wit/, cancer. While I have done no ex )erlmental stuc~e~ on<animals I have maintahmd an a~t[ve interest n Work diredted towards findin g th~ cause of ranter. The s at st eat findin~ contained in the i, eport o~ the, Advisory Commi tee to the Snr~pmt GenerM, U.S. Public IIealth Service, in- d ~to h)~t ,t slatisticM associatio