Tobacco Documents Online

4 5 6 7 B 9 10 11 12 14 15 16 17 18 19 20 ZZ 13 2~ 2S S~IOKING AND ~ALTH P~S5 CQ.~FE~NCE by JULIUS RIC~0~D January 12, 1981 MODERATOR: -- ~e~.ical di=ector ~F that o.~fice. Seated over to the left are Dr. David Bur~s, U~versity of Cali~-ornlat San D~ego; D~. Ell~n Gritzt University of Cal~fornia School of Ha~!clne; D~. Jeffrey Har~s cf M~T~ and Dr~ John Holhrookj Un/verslt~ ~ ~tah, ~iI of whom w~ra con$~itlng $clen~/f~c editors for the i 81 ~eport. ~t should ba -~ an~ De. Rich~ will rea~ it an changed. Thirty~three parcent -- in th~ first para~Taph, ~3 percent a~d ~5 milligra~. ~re you ~ady n~? Dr. Ri~d. • DR: RIC~OND: Good mo~ni~. The i~sua o~! !cwe~ ~ar a.~d l~e~ ni~otlna clga~e~e$ has become a" majo~ public health i~sue ove~ the past f~ yaa-"~. Ci~r~-tte $moker~ by the million5 have been turnln~ t~ these new ~duc~s o.~ ~he assumption that t~ may ~eh~ o~! • other reduce t~e ~isks of the/~ sm~k/n~. So~e 3~ ~e-~cent ~f all clga-~et~e s~okers today ~mo~e ~ga~et~es wi~h ~'eld~ cf le~s than 15 mi~l~_ams of t~. The p~D~se of ~he report we a~'e £~u/ng this m~.~i~q is t~ assess the ~cienti-~i~ ~lidity o~ t~..$ ~remlse. A~L A.~CCIAT~, InC.

1 I 3 4 S 6 7 8 9 10 11 12 14 IS 16 17 18 19 10 ll 22 23 2$ 2 The report alsa replies ~o two Congressional directives. One requires ~ t¢ repor~ annually on the health consequences of s~klmg. The other calls upon us to study a~d repo-~t on ~he relat/ve health effects of smoki=g cigarettes with vaEylng yeilds of t~r, tricotine and carbon m~noxide, and the health risks associated with s=~klnq cSqarettes containing a~y suhstanc~-s co.only added to co~ercially manufactured cigarettes, For at least 25 years, we have known that ~gare~.~e smoking is a m~Jo= cause of disease and death. Th~ evidence S~pp~rtiDg this is ovsrwhelming and public response to this i~ormation has been encoura~_ng. Per capita consumption of ui~arettes is n~ lower than at any time since ~he 1950'st and the percentages of both adult and 1~unger smokers are ~h declining. Almost everyone is convinced ~hat sm~klng is hazar~aus. As many as 90 percent of people who still smoke wo~Id q~i~ if there were an easy way to do so. Yet a tb/~:d of O~r pop~l~o~, some 54 ~illions Of people, con~:Lnue to USe ciqarettes. The c~nseq.uences are quite ter_-ible. $5,000 smokers will die in 1981 from l~g c~nce.~ alone, contracted as a result of smoking and l~.ng C~-nce-~ ks no~ only or eve.~ the major ca,lse of death assoc~zted with c/garet~es. Even lar~er numbers of Americans will di~ pr~m~-turely A~L AI~AT~S. In~.

I $ 6 7 0 9 10 11 12 ~3 14 I$ 16 17 18 19 2O 21 23 2~ 2S 3 of cardlovaseular disease because of clga.~et~ smo~=n~. The public heal~h ser'zlce has sp~n~ =a~y ~onths in making this assessment of I~ tar an~ low yield clga~ett~s. A confe-~e~ce of scie/%~.is~s .has bee~ hel~. The worldJs li~ematuxe has been searched, add scientists from a half a ¢Iozen dlsci~llnas rocrult~ from w~h~n add ou~ido %ho government have r~viewed t~hi~ llte.-a~ure. Their workt in t~xn, has been care~ully a~l c=i~ically rQ~ewe~ by their p~ers. ~h~ ~v~dence which indicates ~iga=e~ ~m~kin~ as a cause ~ il~ness a~d death remai.~s ~e~hmlmlnq. Informati~n on the re1~tive ri~ks af high an~ i~ yial~ cigarettes is l~ss ex'.enslve. In ~roviding these ¢o~lu~ons, we,are s~a~-ing wha~ the state of the art permits us to say a~ this¸ time. What are repoxt' 8 ~a~clu~ion$? They a=a not mu~h di~fe~n~ from the ~ud~,~n~s arrived at by the PUhllc ~ealUh Service in 19~6 rei'.e~ated an~ rafined mos~ r~ently in 1979. There is no such thin~ as a 0ale ciga.~atte. In the case of lung c~nce~, sore8 Cigarettes appe~ to be less h~zardous th~n ~the~s~ although the reduction in risk is mi. ~nimal and limltsd. ~o s~ch conclusion ~an be reached f~ ca-~dio- vascul~ disease, ~phvsema, br0nchiuis ~r precnanc~ ef.~e~s. Smokers who a.-~ t~-;~il!ing or '~nable ~o q~it

! Z 3 4 5 6 7 8 9 i0 11 13 14 15 16 17 18 Ig 2O 2l ~2 ~3 2~ Z$ 4 will be well advised to switch ~o lower yield cigarettes as long as ~hey do.~'t com De~isate for the lOW yields by smmking more, inhaling more deeply, closinq off ~he f/iters, or c.hangimg 5heir smoking exp. os~re i~- other ways. But they will be best advised to quit entirely. These, then, are the major findings of this report. They call for response by government, by the scien~iflc co,unity and by public and private health and educational agencies. In transm/tui~g the report to Congress, the secretary has called for an end to the •present 8talema~-e on the issue of cigarette additives. A~ present, we do no~ even know what these additives are because we have no means of obtaiuinq t~s information from the I~a~ tt~a ~LtT e r S. I h~ve sUqqest~ to the industry tha~ we Wo-~k together to confront this issue. ~ believe a method c~ be worked out so that oo~pauies can tell us what substances they use and that we can protect ~he confiden- tiality of those da~a. I think a mutually agreed upon ~es~ing pro~Tam ~nd review program is necessar-.~ to determine possible acute and lonq-te.~n tDuic a?.d taratoqer~c effects ¢,f eKch s~bstanoe ~sed so ~*hat t~hos~ ~o~r~ to be a ~.hraat A~ AS~OCIAT'~, I~.

! 2 3 S 6 ? 8 9 10 11 12 13 14 15 16 17 19 ZO 2~ 23 2~ 25 5 to health can be r~-~oved. We would ~refe.~ to have no new $ '~bsuancas in~rc~u=ed ~-~l this renew process is complet-~, ar~ the~ ~-y thosa suhs~an=is whose possible health effacts have been evaluated, Tbls protocol, incidentally, is n~t ~tn~ t-hat n~ in effe~ in Great Britain to which American companies selling clgarett~s An that cou~ have subscribed. ~ka many of he= pradecesso-~s as s~c=etary, ~. Ha==is ~s aske~ that ~eps be taken to give th~ consumers ~o~e infor~atlo~ about the ci~ette p=oduct. At least level~ of tar, ~coti~e ar~ oth~ incrimina~ve substances¸ should be listed in all ~dvertisements a~d on all packages. The ~=re~-ary ~$ called upon ~ove~ent amd pzlvate agen~es to inc~easa th~ educational e.=for~s ~o ramin~ the public of the hazards of smoP~n~ a,~ to assist ~hose who do smoke to qui~ and to persuade yo~g pe~pla not t~ take u.~ the habit in the firs~- place.. The wisdom cf these re~endat~ons a~peam¸ to me to be sel.~-a~d~. T,his report finds that ~:wer ta=, lower nicotine cigarettes appear to provide $¢,m~ s~al~ protection to the smokar, ass~ the ~s~¢:e of changes in the smo~nq behavior. We ca~ accept ~.~s as reasonable a~ce t~-, the i~div~dual $~ke-~, b~ we ca=~ot ac=ep= t~s a~ A~L ~O~ATES. X~.

| 2 3 4 $ 6 7 $ 9 l0 11 12 13 14 1S 16 17 18 2O 23 23 24 25 6 Societal ~er to ~.~a s~g i~sue. Only by r~duclng the n~mbe=s of smokers in our popular/on can we hopa to reduce significantly the illness and death which smoking brings about. We must continue and do better in helping present smoke~s to give u~ the habit, We must also continue and do much better in encouraging young people not ~o start* That ¢on~l~s the state~nt. We will n~ take questions. Yes. (0uestion from the audience. ) DR. RICBMOND: The q~estion is how we would charac~rizm the ir~%~stry's .DOS~%~e in relationship tO ~he requests ~nce1"~ing addihives. ~as i% be~21 foo%- drag~-ng? I can he descriptive, and you can fo~ your ~n judgements. Toward the mn~ Of the s~e; -. it may have been the early fall -- we addressed a comunication to all of ~he tobacco fir'ms that manufacture ~ga~ettes in this country asking them for such information. The response was ~enerally to pro~/de us with i~for~atlon which is gemerally in the literature. ~n o~er words, w*kich is already in the p,mblic domain. W~ were not, however, provided with any infor-ma~.ion concerning WP~ Specific additives are i.n specific clgare~.tes. SO that whil~ we do ~%-e ~he entire lis~ of A~L AK~IAT'=S. Inc.

S 6 7 8 g lO 11 12 13 14 1S 16 17 18 lg 20 21 2~ 2~ 2~ 7 addi',ives which may be used in ciNarettes, we dc not know precisely which of those really ~e in Cur.-ent u~e. We foll~ed this rip. wi~h another c~mm~nication to the tobacco firms, and subsequently had a maetin~ in response ~.o ~hat c~u~cation with Mr. Carne~e, the presidant of the ~obacco institute, and t~r general counsel, to ~alk about ways by which w~ migh~ learn more about tbese additives so tbet we, in t~, can £nf~rm cons~ers more appropriately. SO tha~ i~ the ~ta~e a~ which we are at th~ present time, ar~ we are n~ anti~ipa~,i.~g so~e resp0~se from ~hem. (~u~s~i~n from the a~n~e.) D.~. RIChmOND: Well~ in -- oertai~ly our fac~.~ to-faoe mee~n~, I think the~ took very seriousl~ 0u~ request, and I think ~hey ~ook very seriously o~r concern about the pot~nhial role of a~ditives in public health. Yes. (Ques~on from the audience.) DR. ~If~0ND: Well, we ca~'~- an~e~ tha~ q~estio~ very effectively, A~ you knc~, th~ r~l~ Of the non- s~ok~_~ i~hali.~ s~oke, so-oalled side-s~re~ s.~ok~, is no~ as clearly understood as we .~ou!d like, in ~eneral. We h~ve had recent i~dica~io~s tha~ there ~ro

f l 2 3 4 5 6 7 8 9 1o 1i 12 14 ~5 16 17 18 19 2O 21 23 2~ 2~ 8 somg signiflea~t mffe~ts o.~ p~i~onary f%~ion, in particu- lar, for ~on-smokers who inhale slde-stream s~ke. The potential role of addltlves An this ks something which needs ta ~e studied, bu~ Obviously we can't study that ve-~ well if we don't k~ow what the compounds are so that at the present time, I can't answe: your question ve.~y directly. (Question from the audiex%ce.) DR. RICHMOND: X think it's fair to say ~/ult we have a rathe= good approximation, yes, At least all of those which the tobacco farms say are curren~.ly used. (Question from the aDdienGe. ) DR. RICHMOND: No, I doni~ have any reason to be~ieve that at the ~ment. (Question f=om the audience. } DR. RIC~OND: Well, we don't k~ow precisely what the additives are t~ heqin with. (Question: But yo~ 5ald you have a list of --) DR. RIC~OND: Wellr but we don't know wha~.,s in any given cigarette. I~e have a llst of hundreds of compounds. They're not all in eve~ cicare~te. See, wha~ we don'~ ~-~4 is precisely what is !~ each bra~d-.~Ime cigaretten for ex~/~ple. {Question from the audience. )

I : I Z 4 5 6 7 8 9 lO 11 12 13 14 15 16 17 18 19 20 21 Z2 2~ Z5 9 DR. R-TC.~-O~ND: B~ we have no q~antitative data, se=-. We don't know precisely wha~. a/~ou.~ts of these substances. Yes, we do have a g~od deal of iJ:formation about various of these co~u~ds. FOr e~plew the.~e's shellac in -- as one compound that has been lis~ed. We don't know to wh~t extent that appears in any ~!v~n cigaEet~e. ~-~pelica rote extra,t, ~riethylene ~lyco, o~e ¢ou~ 9o on lis~ing hund.-eds of compo~u~s. (Question from the a~di~ce.) DR. RfC~MOND: Well, ~'ve just mantion~ a (Quest/on from the audience. ) DR. RIChMOnd: Well/one ca.% talk about glycero, c~erin, eu~enal, gyocol, s~a~s -- if yo~ wa.%~ to look¸ at thQ lis~ which the Bt/tish have published fairly recently -- the Hu.~e= C~mmlttee report -- it's a ~ist of some 300 ¢ompo~uds. (Question from ~he audience.) DR. RIC~MO~D: Yes, we can ~ake so~e j~cm~n~s. Sure, we ~n~4 wh/ch compounds a~ !~ast on the basi~ of ~ast scLentifi¢ track r~c~rd a.~e ~ore c~rci~ogerC~.-~ potent/ally, th~n ouh~rs. But the point is, we don!t know w~hich of those c~mpo~nds are currently being used i.~ a~y qiven cigarette. iQu~s~lon: S~a of them are carclno~c?) A~ AbS~C~T£S, I~.

I 2 10 11 lZ 13 14 15 16 17 18 19 20 21 ~3 ~4 ld DR. RIC~0ND: Oh, ~'es, yes, yes. Let's get some othe." people. (Question from the audience. ) DR. E/C~MOND: That's precisely why we want to know mDr~ abo~t ad~itlvest see, but ~ can't an~e-~ your ques~£on dire~ly. They po~entlally could be m~re carcinogenic, h~~. we ~o~'t have any data. Yes.¸ [O~stlon from the ;,.edie:ce, ] DR. RIC~0ND: Well, various s~lentists at ~lous timas, as they have s~died the carclno~e.~¢ effects of compounds have stu~/Qd many of these, ~: can't off the top of my head ~ive you the p=ecise deta/is of each of these com DO'%LndS bu~ .- (0uestlon from the audience. ) DR. RICHMOND: Yes, many of these are knc%rn to be, that is particularly the products of comhus~ion of many of these com~_o~u%~s are ~own to he Carc~-noI2enic, a~d yo~ have to really think of this in at least ~-%ro stages. Some of these compounds are knOWn ~o be poten~lally carcinogenic in and of themselves. But the prod~ct~ of combustion, in addi~,ion, D~ay be carclnogenic. (Queshion from the audience. ) DR. RICE40h~: Well, we are telling them that we are concerned, and we wa~t to ~w. ABL AS3~A~,~, I~.

l Z 5 4 $ 6 ? 8 9 10 11 1Z 14 15 16 ,17 18 19 Zo 2] ZZ 23 Z~ II (Ouest~c~ from the a~ianct. I DR. RIC~O~: Well, if you look a~ SecretL~ Harris' letter of t~ns~ttai, sh~ ln~oa~es ~hat i.= we ~annct, on a ~i~n~-~ bas£s, le~n more abou~ what is ~ei~ added to ci~re~tes, th~ we would seJk such le~s~on -- that is, we would red--end ~ee~g such legislation. (0uestion from ~he audience.) DR. RICB~O~D: Yes, because we n~ do not ha~e any direct authority. (Question from the a~lence. ) DR. R~CBYDNDz Well, I thi~k a reasonable time woUld be ~%easured in several weeks, Z would think, since i~'~ been a few weeks si~ce we ~e5 with theJ~. (~estion from the audlence. ] DR. RZC~0ND: I thirLk In a @-ireu"~ way, yes. That we specifically Eequeste<~ ~hat infoln~a~lo~ from but' Z can't speak for all of my p.~edec~ssors. no~ been done early in my tense. (QUeStion from ~he audience. ) ~R. R~C~MOND: Well, ~res~a~ly t~ make the cigarette ~re acceptable, and additives w~id ass%~e ABL ~SCCIATE~. ~. (0ues~i~n from the audience.] DR. RIC~OND: NOt to the 5est of my kn~ledge, Z~ had

i 2 3 5 6 ? 8 9 10 11 17 13 14 IS 16 17 1B zo 2-" 12 a more pro~inamt place as th~. t~s ~d ~i¢otiDe levels drop. Many Of ~hese cigarettes now contain c~nsiderably less tobaoco than they once c3ntained, and obviously the manufactu/ers are intsres~.ed In maintaining th~L hiphes~ iQvel of acceptability for their cigarette-';, ar~ we think that additives axe probably being u~e~ more extensively than mlgh~ have been the case in earlier years when T.he tohacco c~nte~t ~f ¢/gare%~es may have been conslderahly higher. {QL~estion from the aud/ence.) DR. R~CL"4OND: Well, certainly greater ed%!cational effort, greater research effor%s and ce~tinly more clinical observation of the effects Of the ~ga~et~;e as it is now baing produced in the smmker. ' (Question from the at~lience.) DR. R~C~OND: Irm sorry, this pmrson has not had a ch~ce. (Question from the audience. ) DR. RICI~OND: Wells t~hat's a i/ttl-~ difficul% to say since the n~ admiais~-~a~ion will have to s:leak for itself. But we will leave ~hem with all the documenta- tion that we have acc~ulated. The timing ~f this repot, I would call your attention, is the customary timing of the annual report which Congress .has direc~.ed ~ to SU~T~ ~ •

13 3 4 S 6 7 S 9 10 11 12 13 14 1$ 16 17 15 19 2O 21 2~ 23 24 2~ We have ~radlticnally submluued the repo;~ on the a~-~versa.-y of the Sirs% SUrgeon General's report in 1964, so this is the 17th anniversary OS the first surgeon Seno--al's report. That Sate is ordinarily January 11. Since %,%at was a Sunday, we put the date of presenting the repo--t ~:o you over to today. SO we will, of course, co~uricate all of t~his Information to the incoming Secretary, ar~ I can't predict precisely what his actlons will he. {Question fro= the a~ience. } DR. RXC~OND: I was not asked by the transition tea~ for any infoz~ation on this specific issue. N~ ~2~ey we-~e up an~ dow~ the depa--tme.nt speaking with people in ~rlous agenc/es SO ~ could not vouch for the fact that they may not have spoken to some of oux scientists, hut X can vouch fo~ my exchanges with them. And it didn't i~clude any co~unic~ltion o~ this subject. (Question from uhe audience. ) DR. RIC~OND: Well, we thi.nk there is a process in motion. (Question from the audlenca.) DR* .~IC~MOND: Well, ~here is ~ process in motion. We thi.nk t.hat there may be some real possibility of acquit-rig this in2orm~tio.~ if it isn't available,

I l 4 5 6 ? 8 g I0 II 12 13 14 IS 16 17 18 19 20 21 23 )4 2S 14 since this info~-matlon ks generally ragardad to fall within the pu~ew cf trade seoretg. W~ woul~ then need legislation in order to ~ke t~ha~ kln~ of infom~ation accessible ~Q ttsl Yes? (Question fru~ the audiemce. ) DR. RIC~OND: My r~co!!ecticn is that it will be at about 52 billions totally. That's not all for education. Milllo~s -- millions. That's not all fop educ~t/on. A good deal of tha~, about 36 milli0ns, will go for research. The remainder is for demonstration progr~s and educational effort~+ X think, john~ what were we at~ 49? ~p from 49. Yes~ (Oueshion f=o~ the ~udience. ) DR. RIC~OND: Well, ~ think the p-~ogress ~n this field iB one thatls chaEactehized by 51~t steady acc~mulatlon of data, and I think that one of the ~roblems we have in thi~ .~ieldl it's on~ which was ralated to ~e fact that it took us ~o long tQ recognize ~he carci.no- go.nit effects of tobacco smoklng~ is the probl~ of t~e lon~ itemcy perlo~ between the £hitiation of th~ i.~estion of a subs~anc~ a~ the appeara~ of the pathology Or th~ ~se~se. ~o ~ha~ ~ thi~k i~ ~e~e.-a!~ one ne~ds long- ABL ASS0CIA~.S, In~.

• • k• j- l 2 3 4 S 6 7 8 9 I0 II 12 14 15 16 17 18 19 20 21 Z2 Z3 2~ 25 15 term ae=~ulation of data, and ~ think your charscterization is probably a ~ood one -- that ~here is no one stricklngly new f£n~ing. Yes? (Quest/on f-~om the audience. ) DR. R~C~OND: Yes, an~ this lllust=ates the dlf-~icul~y ~n a~c~ulat/ng ~at~. This study was published in '76, but ~h~ cu~-of~ point in ~e~s of the collect!on of data was 1972. ~ at tha~ time, c/garet~es tha~ were on the market had higher tar a.n~ hico~ine l~vels than som~ o.* tha so-calle~ very low yleld uig~:ettes at the curreat t/me. This is one Of the problems. We're dmaling with a changing pradu~. And it takes a long ~i~e to accu~ulatB da%ao Yes~ (Question f=om the audience. ] DR.R~OND: The question ks whether we consi~e~ In~us~ry's position con~ernlng ~ra~e soc.-ets as ~ .~easonahle one, an~ if ~he i~omln~ a~ministrationqs post~e ks one of as bein~ more r~sponsive to -- you used the wor~ "big busi~ss~" What k/nd of a probl~ ks ~haping ~? Is "that a fair chara~er~z~tlon -- I do~.'t want ~o put wo.-ds An your .~¢~h tz~ng to ~ha-~a~terize ~he que-.~iOno We thi.~k we Could ac~--ulre, i~ we were in a position to acquire the inforr~tlcn concer.~ng so-~-:a!led trade secr-°~-s. We ~.hink ~hat we cc~id, with t~t ~.nd ABL ASSCCIAT~, I~.

1 Z 3 S 6 7 8 9 10 11 IZ 13 14 15 16 17 18 ig ZO 2| ZZ Z3 16 of information, conduct approp=ia~e evaluaUions ~nd ~tudies ~o make be~a.- ~u~gment5 about the publ/c heal~h hazards that the additives represent. We think tha~ the trade Secrets issue can be ~ealt with effectively. We can, I think, respect tha~. without £mpairi~g our c~nce-~n for protectin~ the public heal~h. I think we ce--tainly would k~uw bet~e-~ ~f we had more sp~Ific ~ata, what kinds of next steps would he appropriate in order to learn mora about¸ the effects of thosa compounds which are ~wn as ad~itivas. (Quest.on fz~m the a~l.e~ce. ) DR. ~C~O~D: The gt~y has cost ~ appro~tely -- well,• I shoul~n't say approximately -- by ouz cal~ul~/o~s, $227,000 and a few -- (Q~.~s~on f=om the audience. } D~. RIC~OND: This is ove~ a ~e~lod of -- we we~ ma~a~ to do ~he stay by Con~.-ess £~ 19T~ ~e it's in a ~erio~ of about 2-i/2 years. (Q~s~o~ ~=um the a~ie=ce. ] DR. R~CHMO~D: Wel~, no, we h~ve ca~-efully reviewed the data which a.-e available. Yea~. [Question from the a~die~ce.) • DR. RiC~OND: Well, ~di~ives, fi.-st of ~:ii, are not the o~ly issue. The ~ajor issues tha~ we've A~ ASS0C~7~, Inc.

1 2 5 5 6 B g i0 Ii 12 15 15 !6 17 18 ig ~0 21 Z2 Z5 ~S 17 bee~ concer.ned wi=h over the gears have been the ~f.=ec~s of sm~klng generally o.n he~-luh. T-t took us many, many years to a=c~!ate thcse data, I'l~ are con~,inui~g ~O acc~--~!ate data, ~nd it is ~ot t--we ~hat there are .no new studies. We don't, ourselves, do all Of t-~se s~dies end, indeed, the TDbacco Ins~tu~e, to its g~eat credit, has invested a ~:~-~t deal of money -- some $15 millions -- that it gave at one point to the ~.mexicen Medical Association' educational a.-~ resea2ch committee. N~w, out of all of those studies, we see some ve--y distinct public heal~h trerls. Now~ the Tobacco ,'z.dustry. expends s~me $900 millions in promotinq, adve~.isinq ciga~e='.e s~oki~q, a.~ we t~nk this is a ve~ ~odes~ inves~ent in ~he p,ubli= heal~-h in order ~o keep the ~erizan people as well informed on the hazards o~= cigar~tt& s~oki~g ~s we C&~. A~other re.--Z important reason, of co~se, is that ws are ma.-~a~ed by Conqress to make a~nual reports, b~t also i would say it's a very ~odest i~ves~me~.~, indeed, when ~ne conslders ~--~s the major public health issue that is really s~b~ect to preventlo~. ~.%at is, scma~nq that somebody can do ~ometi"--~'nq a~ut. The distiz-~shad epide~ole~_st at the .".arvard Schoc! o~ _~u~ii~ Hea!~h, Dr. Z.~-an McMann, h=-s .-e~etitive!y said, "}~o one t~i.~.g would babe=it the he=-!zh 3i th_= A~e.~ica~

7 $ g i0 II 12 13 15 16 17 18 19 20 Zl Z2 23 Z~ 2S 18 people more than the cessation of smoking." That's becauss of the very large burden of il~eDs ~d m~rt~ality that 19 the consequence of so~s~hing that is entirely preventable. (Ques6~ion f-~o~ the audience. ) D~. EIC~MO~D: NO, we also -- I sho ~u!d 9o back to the fact that we ~hav~ assembled Borne 62 experts to present thelr e~_ertise and thelr reviews, a~d to dev~lop for the nation a conc~nsus of the expe~m. (0uestion f=om the au~ie.~¢e. ) DR. RICHMOND= Yes, aed a r~po~t tO the ~=~e-~ican people, which is very important, an~ which thin American people pr~s~ably wan~. B~ ~'s something w.hlch ~e A~erican peopl~ wanto We don't have any options. ~e w~e di=e~ed by Confess, bu~ I think -- I jus~ happen to think tha~ Congress was very wise in dlre~in~ ~ to do this. If this was the maJo= public h~alth probl~L~ that the nation faces, why ~ot? "~es? (Question f.-om ~h audience.) DR. RIChmOnD: Well, I'll try ~o ~o that ~nd be b.~ief because you've asked me • .~athe~ f~-~midabl.e question. ~ think in te~s of what we have ~o¢omplished I ~hink I wo~id gay first Of alll o~e of our v~.~" ~gh prlori~ies h~s be~n ~o t.~y ~o provide services ~0 ~he A~L ~S~IAT~S, Zn~

1 2 3 4 5 6 7 8 9 i0 ii 13 la IS 16 17 18 19 20 23 :5 19 underse=ved populations of this nation who, .~cr either economic reasons or geography, do not have ready a=:=ess to ser%~, cos. We have ~ore th~n do~bl-~d the ntmbe.-s of people served through o~ co.unity health Ge~te.~S a~ O~ miurant health ce~ers. 0u= National Health Service Corps, which is de~'~ned ~o meet the needs of people in ~erse~ve~ areas has been ~pand~ ~ns£dexably, a~"~ we have p!am.ne~ addle-lena! expanslo~, In addition, we tDink that Medicaid and H(dloare have b~e~ ver~ user111 in maklnq services more avail~Lble. SO I have felt that that has been a very important .~Irecti~n. wogld Couple that wi~h the fact that X thi:Lk there still remain less than l0 percent of our population-- psxhaps somewhere he.~ween 18 ~-~ 23 mil~ons Of people -- who ~ay not be the reciplents Of the kinds of health Services tha~ we would ~ke to see th~ have access to so that ~.hat job is incomplete, ~l~hou~h we h~w! doubled the nudgers who are served by OU: direct prDgrams, should also mention that when we lock a~ the data in te-~ o.~ se.~¢ices f~r l~er i.~:ome people, ~.ha~ by and large, -.he visits that !cw-income _~eople axe making to p-~o%~deL's Of various kinds is n~ jusu abou= az the s~e level of the more affluen~ popul~uion. Eo~ever, ~ha~ still ~$ nor as fay=table a

i . 1 Z 3 4 S 6 7 8 9 lO 11 12 !3 14 15 16 17 18 19 ZO 21 Z3 ~S 20 st=-~istic as it so'~nds be=a~se ~zny of ~he !c~-inco~.e pec~le a.-e using Se.-~ces more frequan~lF because ~hey hav~ mo.~ illness, The Seco~ ..~a~o~ dirac~ion £n w~-~ ch I thi~ik we have made sigr~fi.-a.~ accomo!ishm~nts is in ~h=. wh~1~ area of prevent~or.. Part of wha~ we are ~a!kin~ about here ~hls mornln~. It seems to me that we have, firs~ Of allJ ~s~abllshed preventlon ~s a vQry high o~iori~y on the na~on's health agenda. ~n Connection with ~h~ im~'u-nization c~.p~%~ fo-~ ~.pl~t th~ we %z~dertook whe~. w~ c~me i~o office a]=~ost four ~ears ~o, that i~m'%mlzation c~mpaign f¢~ children has b~.ouqht us a .-emarkable yi~l~° Firs~ of all, du~-n~ th~ cour~ of these fc~ years, we've h~ ~.he World ~ealth Or~a~za~io~ On a mor~ global basis, ~eclare th~ worl~ enti~-=ly f.'ee o~ a great sco'~o of ~nkindt s~,~llpo~. ~n ~hls coun~-y we not only some years a@~ e_~radic~d s.%allp~ bu~ ~e thl.~k as a co~sequenc~ of o%1r i.~u~.-~ion c"-m~ign, w~'r~ on the v=..'~ o~ ~i~inat£~q ~eas!e~ ~s an i~di~eno%is disease in t.~s ~.3~.~ a~d as a pe.-son who s.o~-.~.~ a c3cd oar~. o-= his ~_a.~ly car~e.~ takln~ ca.-e o.= c~id--~ wi~h meas!es &n~ ~he ~ev~s~a~inc co~.~czui~ns of ~ha~ disease, ~. ~eel ve.~i~ k~=-~l? ~-h-=~ ~.h~ ~.as been a si~r..~fican'- ad~an~e, A3L AS~CL%T=-S, I~.

l 2 3 S 6 ? 8 9 10 II 12 14 15 16 17 ~g 2O 21 2-" Z3 l! O'~ staff at the C~nSer fo= Disease C@ntrol in Atla.nta feels that within the nex= gear, we can compl°.te the task but wa h~ve gone some weeks in ~.~s coun~.'yy when as f~ as 28 cases of measles have bee.~ reported for the entire nat~on. Ws ~blnk that the efforts not iri~iated excluslvely by us toward the control of high blood pressure and c~rdlovascular disease are notlinq short of sp~ctaculazl something that would no~ hays been predicted 15 years ago. The ratchet sharp decline In mortality from heart disease by 23 percent over the past ~ecade, and the dGclina in mortality by stroke by 36 percen~ over the past decade we think are remarkable achievements. We think the anti-smoking campaiga and we t.~nk %he high blood pressure dete~ion campaign -- ~he ~mphasis on more wholesome diets, all of these things have been slgnificans. ~-~ X think tha~ ~ would also ~uat ~en~ion in te~s of o~ a~i-smohing efforts, that there is a steady d~eLine. ~er ~eplta, the~-a is a l~er co~s~ptlon (I~ ci@arettes than anyti,~e since ~he early 1950's, erd cer~ainiy ~ong adult males, ~mcng whom we were ak~o~t having an epid~mio of heart disease, we've seen a decline from 51 pe.~oent "-~ uhe time of the first Surgao?. General's repor~ to ~7 percent of adulz .~,a!es smok/ng. ---or the AEL AIgOCL~T£S, In~.

/- I Z 3 $ 8 9 I0 11 1Z 13 14 15 16 17 18 19 2O 21 23 22 overall population, we've ~me :~rO= roughly 40.2 percsn~ to 32.3 ~e-~cen~ so that we have hal ~.h/s .~a~he." s~ead~v decal.he. X would lastly turn to ~he araa of ~eseax~h° I ~hi.nk all o~ the ImDr~vad $er~-ce~ that we look ~o~wa.~ ~o in this co~t~y and which waive bae~ the .~Qhiplen~s of in the past an~ the im~rove~ efforts at preven~Qn relate to OUr 8~p.~Qrt Of research and o~ achievements in bic~edlcal research and behavioral reI~a~c~ in ~.~Is ~ount=y arQ esteemed around the world~ and we thi~k i~ has been im.~=tan~ to ~ry to sustain ~he su~po~ fo.~ ou~ resaarch effort.s, an~ I woul~ ho~e ~ha~ ~ucceedi~ admi~s~a~ions woul~ continue ~o make such e~or~s. And we ~ that ~he C~n%ras~ional £n~.e.~ms~ has been high an~ in general, has be~n ve-~y, suppcr~ive, Bu~ in timss of fiscal cons~a!n~, ~ would ~phas~e ~ha~ i~. is e~.-em~iy imp~.-~ant ~ha~ a~. aime~ of c~nstrhin'., 5~cause this is a discretionary expandlture, that w~ no~ bl my~ic ~d ¢u~ iDordi.~a~ely into resea.-ch .~or i~. is ulhima~ely ~h~ugh ~esQ~=ch tbet we see ~h~ 1on~- t=..~m imD~ov-~ent i~ health t~ke place. SO I C~ go o~ a.n~ ont b~ ! ~.hink ~hat ~h~se, ~he disaDDoi.~t~en~st as ! see ~hem. Y~s?

I 2 3 J S 0 7 9 10 I1 12 13 14 lS 16 17 18 ZO 11 2~ 23 23 (QueI~ion f_~om the a~lence.} DR. RZCS~40ND: ~e!l, m~chine is *.he mechar~cal way of ~r~-nf to ~easu/s, a.~d wha~ has been ohserv~ as people go %0 lower ta= an l~wer n/coti~e yield c~gar~t~ee, not unco~-~Dnly is that they may smoke ~ore cigarettes. They make s~e them down to a shorter st~b~ They may inhale moEe dQe.~ly. They ~ay lea.-n eith~ consciously or ~ntui~ivsly to black off ~.he alr ~nts in ~be filters so there arm a va~ety of ways ~het people can inc=ease the .~_eld ~-~d ~he quest/on that ~ou're ask/ng, really, goes ~o th~ haa=t of the difficulties in ~eally quantifying the whole =at~e~ of smoking because ~here is ~0 much subJectlva co~po~en~ ~ It, {Question from the audlen~s. ) DR. RIC~OND: NO~ ~hs~e is ~o requi.~emen~, add i~deed, I~ th~ advertising, one Of the points of confusion is tha~ there is ~o standardization, Wha~ is defined as lOW, l~w an ~l~ra-l~w is really a ~a~ter fu~ ~he ~anufau~u~er ~o ~ake a Jud.c~,ent about in his a~ver~Isln~. Yes7 IQues~lon f.-om the au~i~%ce. ) DR. RICHMOND: ~es, $~r, (Question from the audience, ) D~. Rv-C~--40~D: ~es, ~hey a~e awar~ of their e:f0r~s, and I "..~nk they are ~.or.in~ri.ng ~ha~ i', is

2 3 4 5 6 7 8 9 I0 11 12 13 14 IS 16 17 IS 19 2O 21 2~ 21 2~ 24 weirs trying to do. (Quez,~,i~n from the audience. ) DR. RZCr~-OND: *-n some qeneral ways• Non- tobacco ciga=e~e$ genmxally contain some o~'ga.~ic s~bst~n- ce$, he=bs of va~~ious kin~s, ~e~erally, that &=e no~ classified as tobacco. I think we have eve-~y .~mason to think from some of tba ds~erm/nations that have hsen done of some of these that they do have tar yields. The fact that they are not ~.oba~co doesn't mean ~hat they would not ha~ tar. And if tar is a significant carcinogen in cigarettes, It's reasonable to ass%~a that some o ~he non~Qba¢co cigarettes may, indeed, also contain some potencially ha_-mful substances. They've not, ObViously, been sh~led as extenslvely, but if they continue to come onto the ms.-hat, Z ~hlnk that they me=it such stndy. Yes? (0~stlon from the a~dience.) DR. RICF~Oh'D: Well, all we can ~o in a.~ ¢~uca~iona! ef~or~ based on sclentifi= data as it hec~mes available is to info.~ people so that they can make the ~os~ ~ppre.D-~la~ judgments. A~ as ~ indicat=.d Just a re4 ~oments ago, we've been ~a.k!~q sseady progress. One couldn't c~•ll i~ d~a~,a'-i~ c proq--ess, but it'~ *~'e.'~.,' steady progress. Only one-=h!rd of the ad~!~. pop~latio.n s~okss ncw. ~ ~L ASS~A~-S. Inc.

l 2 4 5 b ? 8 g I0 11 12 13 14 1$ 16 I? li 19 20 23 2~ 25 • ~sed to be 40 per=en~ and if one looks at wh~t has bean happeni.%p to ten, ages, some groups, for example i.n some unlvsrsl~ies, the e~e~,~g f.-es~n st~ents who, a decade ago, we=e s~king a~ 50 pe=cL~ of e.~te-'!n~ s~u~en~s, some of those s~hools are n~ repoK~.Ing ~c tQ flve percent of ente~ng streets as s~okers so tha~ ~ tb~nk we have some reasons tO hm enco'~Ta~ef. Yes? [Question from the audience.} DR. RIC~OND: Well, at the moment, of course, An the adv~,~is~en~s of ~ha various clgarettes, ~he firms a.-e trying to provlde ingor~a~Io.n Con~e-~m!n~ the tar con~en~-. ~t's jus~ ~ha~ ~he packages -- ~he package you recelve ~oesn't contain that information. Wa think ~ha~ t~hat ~s somewhat ~efu! Info~nation,and we ~h~mk it ought to be made available. ~-~ t.ha~ i8 why Sec=etazy ~.a~-TiS has been pa~t~icu- la;ly keen on want/ng people ~o ~ve more adequate infoLmatior so tha~ they can make ~re app.-opriate choices. ~-nd tbat~s why we wo~d.~--efer ~%at ta-~ and r~coti.'~ e.~-~ carbo~, mmn=xide yields as a ~--~nim~ be on the cigarette packaqe for the information of the smoker. (~uesti=n ~.om ~h. au~.e~.ce. ) DR, RZC~¢OND: ~n r~lationship to additives? NO, we couldn't ~.~k~- a.%'.~ Suate.-~n~. a~ the prese.-.u time. Yes? ~2L ALSC~IA~-~ In~.

I I 3 4 5 6 7 8 9 10 11 12 13 14 lS 16 17 16 19 21 L" :3 >' 15 26 (Queen, ion f.~m thl audience. } D.~. RZCEMOND: Well, I havL~'t said wetre p=apared to make ~'-y ag=alment. NO, not no, I have said that as long as we have a legal ob!i~atlon to respect trade sec.-ets, wmlre not goinq to violate ~he law. ~ut we would like to ~ow ~o what extent there a.-e puhllc health risks involved. A~ when I say a~ee~ne~s, we will do wha~ the law requires and at the present time, We mus~ respeut those trade se~et$. what, Over tim6e our position would be as we learne~ more is something we would have to make a ~udgment about a~ ~hat tlm~. (0uestion fr~ the audle~ce. ) DR. RICHMOND: It's an assumption a% the present time. Yes? {Q~estiom f=om the audience. ) DR. RICHMOND: Well, if there a;e e~ner~ency situations, we, i~eed, can propose some action in general. Of co~se, we also c~ use pQ-~vevlng of public i.nfo..-mation as a very., re:T im4~r~a.n~ ki~ Of tool. ?hat is, when we know somttP~g is a health risk, we have an obi!~a~io.~ ~o inform -.he public, and ~hat!s a pretty pouent inst=~-~e~, as you ~c~. (Question f.-om ~.he audien=e. ) DR. RIC--~O.~: Well, we dO n~t have a.'.y daze ~3L ASS~qA*-BS. In~.

I 2 3 4 6 7 8 9 10 11 12 14 I$ 16 17 18 19 20 2! 22 2~ 2~ 2~ 27 indicating tha~ in ~.e~ o~ cardlovascu!a.- disease, tha~ ~he=e is a =isk r~uction. The 8~ rel~'.es ~-o pq~mo.~.~y dis~aset an~ Qe.~alnly in rel~.io.%ship to pr agnancy ~u~comQ~ ° And w~ hav~ no re~son a~ the pr~sa.n~ ~i~e ~0 believe tha'. thQ_~ Is a Eig~f!cant red~.ion a~, for that reason, wa do no'. Bay ~ha~ ~ing ~.o the~e Iowe.- yiel~ .clgare~e~ will n~cassary improve ~n~'s chan~es in relation~hlp to those spec£fi~ ~isorde.~$. But, a~ai~, I would i.ndi~at~ we nee~ mo~e long- te~m ~a~a because we have no~ ~oo~e~ a~ those Issues over th~ longar ~rm ~ea.-ly as well as ~hould be~ Yes2 ThatI~ ~i~e correct. IEnd o~ p~$s aonf~-~ence of Dr. Ric~c~.} .