Tobacco Documents Online

MEMORANDUM TO: FROM: SUBJECT: FEB 1 0 Robert F. Gertenbach Leonard Zahn American Public Health Association Washington, DC, Nov. 17-21, 1985 January 30, 1986; CC: WDH SCS "Kalser Frederick III of Prussia suffered from an agonizing illness and his untlme]y death in 1888 at age 57 probably changed the history of Europe and the world. He died of larynx cancer that occurred in 1887 and was misdiagnosed by the leading pathol- ogist of the time {Vlrchowl. Hls wlfe was the eldest daughter of' Queen Victoria of England, and he was a strong Anglophile who Dad strong democratic ideals. If he'd lived (his father lived to age 921, it's unlikely World War I would have occurred, add perhaps we wouldn't have bad the Second World War. His death made hls son Wilhelm head of the German state and that led to World War I and terrible consequences. "His exact smoking history is unknown though it is known he smoked heavily during some pears. But larynx cancer is so indica- tive of smoking that in all probability be died of smoking and hls death changed the history of Europe and this century." The speaker is EEIMERT 8AVENNOLT, a long-tlme foe of tobacco. Me continues (paraphrasedl: "It was only in 1985 that I realized that cigarettes probably were responsible for the strokes that killed Franklin Delano Roosevelt and Robert Louis Stevenson. If Roosevelt had lived out his fourth term -- he was 63 when he died -- perhaps there would have teen fewer Cold War disasters such as the Korean War. And who knows what other masterpieces Stevenson might have created had he not teen a cigarette smoker and died so young (in 1894 at age 44). While it's commonly believed Stevenson dged of tubercu- losis, the actual cause of his death in Western Samoa~ according to a British consul's descriptlon~ was sudden cerebral hemor- rhage." We cite these remarks by tbts famlldar antlsmoking activist to show that many llke him -- health professlonals for the most part -- are exceeding their frequent irresponsible claims and are now maklng the wildest sort of statements about smoking. What Relmept said may seem extreme, if not somewhat nutty. He gave hls own .twisted version of history and perhaps of science too. And the sad and dangerous thing was that hls peers who listened applaud- ed rather than questioned. The setting for Relmert's bombast was perhaps tdeall the APBA Presldent-glect's session on "The Brown Plague: Tobacco." If that ~0~ Pu~uc RILATION~ ¢~NSE~ n J-ZflandAs~ciot~lnc , 13 LINCOLN ROAD • p,O. BOX 223 *QREAT NECK, N,Y. |1022 • {5161482.5715

title sounds a blt juvenile or theatric, note that it was chosen by tbe then Presldent-Elect of APHA and now it's president lhe took office at the end of the meeting), WILLIAM FOEGg. With this session, plus some previous background maneuvering, Foege is seeking to propel the APHA into a vastly heightened ef- fort against smoking. He is, of course, not alone in this effort, and it's certain the APRA is supporting him fully, its Executive Board has approved the hiring of a staff person Just to work on antttohacco activities. That this effort is not a temporary exercise is seen in tbe fact that Foege is widely recognized and respected by his peers in the public health field. He was Director of the U.S, Centers fort Disease Control (CDC) in Atlanta from 1977-1983, and clearly has great influence: his ascension to APHA's top elective office came after he'd been an APHA member only since 1977. He was a ma- Jor figure in the world-wlde program in the early 1970s to eradi- cate smallpox• He currently is special assistant for policy de- velopment at CDC. There's also the fact that the new APHA Presldent-Elect is another familiar antltobaeco figure, RUTH ROEMER, a lawyer who is adjunct professor of health law at the University of California at Los Angeles and author of a 1982 World Health Organization publication tltied "Legislative Action to Combat the World Smok- ing Epidemic." She'll take office at the close of the 1986 APHA meeting. It's clear, therefore, that one of APHA's top priorities will be legislation to eliminate tobacco advertising/promotlon. This WaS one of the things that Foege stressed during his campaign for the organization's presidency. Other active areas will be tobacco taxesj the "tobacco subsidy," nonsmokers rigbtsp passive smoking, etc. APHA certainly will try to work closely with the Coalition On Smoking OR Health in Washington. Foege was no more scientific than was Ravenholt. opening the session by likening the "Brown Plague of Tobacco" to the Black Plague of Europe and saying that tobacco was far more lethal than AIDS. The APHA wants "redress" from the tobacco I ndustPy whlchp be said. mskes "a mockery of the concept of civilization" and is "killing for profit." He also referred briefly to something he'd said earlier in 1985 at a meeting on prevention: there should be a boycott of nontobacco products of cigarette companies. Ravenholt, who is chief of the epidemiology branch of the FOOd and Drug Administration (apparently a recent appointment), spoke on "Tobacco's Human Costs." go far this century, he said, smoking has caused 2,250,000 lung cancer deaths and a total excess mor- tality or more than 10-million. "It is likely,' that tobacco caused more than a half-milllon deaths in 1980 in the U.S. At one point, he said it was noteworthy that the first four recipients of artificial hearts had been cigarette smokers and that the mother of "Baby Fae," the infant who received a baboon heart in

• 4 • - 3. 1984, was a heavy smoker (sic)! Here are Ravenholt's closing words; perhaps he was trying to inflame hls audience, or perhaps he was himself inflamed with the sound of his florid language: "During the 1930s and 1940s, the Hitlerlan Holocaust consumed no more than 10-milllon Europeans -- victims of a malevolent dic- tator with an unbridled lust for power. During thls century, the Tobacco Holocaust has consumed more than 10-mlllion Americans -- victims of another unbridled human passlon~ Greedl A combination of greedy tobacco manufacturers, greedy advertising agencies, greedy publishers, greedy shopkeepers and, not least, greedy pol- itlclans, has conspired to keep the Tobacco Heast unchained, de- spite overwhelming scientific evidence of its kllling powers, while promoting and selling their neBarlous addlcbive and poison- ous products to the young, the ignorant and the gullible. "Against this greedy tobacco combination, the American Public Health Association and its allies now must wage all-out warfare. Not just occasional skirmishes and battles, but aggressive, unre- lentlng warfare by every means within our power, untll the public health of this nation is rescued and securely protected from the Tobacco Beast which unbridled greed has loosed upon our citizen- ry." Other higlights: I. DOBOTHY RICk, former bead of the National Center for Health Statistics and now a professor at the University of California, San Francisco, spoke on "Tobacco's Economic Costs." She offered a confusing array of figures, the upshot being her claim that in 1984 smoking cost the nation a "staggering" $54- billion ($36.5-billlon in morbidity; $17.2-billlon in mortality). The @stlmate is conservatlve, she said~ and does not include costs of passive smoke exposure [which can't be measured), ciga- rette-caused fires, etc. 2. Other speakers at the session included ALAN BLUM, editor Of the New York State Journal of Medicine, and RICHARD DAYNARD of the Tobacco Products Liability PrOject of Boston. Blum gave hls standard talk, managing to maintain his enthu- siasm and glibness as he attacked the tobacco industry and its overt [government, agrle~iture) and covert allies (insurance com- panies, media, religious groups, sportsj etc.). Daynard urged that more lawsuits be filed against tobacco com- panies for damages from smoklng~ be asked the audience to tell people to go to lawyers or to his group or to other such groups. Me also urged that APHA oppose any Congressional legislation that would protect the tobacco industry against lawsuits.

P 4. 3. Studies of different groups -- men, women and children-- have led KAYE KILBURN of the University of Southern California to conclude that exposure to air pollution in the Los Angeles area for at least 10 years causes lung diseases of various kinds. After considering such factors as smoking, OCcupation, etc. p Kilbumn tentatively concluded that the reason for lung dysfunc- tion in long-time residents is the result of airborne oxidants. 4, The first major ~ummary of data about Mexican-Americans in the southwestern U.S. was presented at the meeting as a result of the Hispanic Health and Nutrition Examination gurvey. SUZANNE HAYNES, of the National Center for Health Statistics in Hyatts- rifle, MD, reported on cigarette smoking patterns derived from information learned during the survey which covered about 3,935 adults aged 20-74 years in the 1982-84 study period. [A coauthor was NBRNICECOHEN.) Preliminary data indicate: A. Mexican-American (MA) males are about twice as likely to smoke as (MAI females; by 1990, the pmo. portion of MA adults who smoke should be reduced below 25%. B. Smoking mates are higher in MA males and in non-Hispanic white males~ the former smoke about half the number of cigarettes smoked by white males and females. C. MA females are less likely to smoke than are non-Hispanic white or black females; D. the smoking status of MA females varied by the level of acculturation while that for MA males varied by educational level. The higher the educational level, the lower the prevalence of smoking. (Nearly 12,000 people participated in the study: about 7,500 Mexican-Americans in Texas, Colorado, New Mexico, Arizona, and Californla~ 1,364 Cuban-Americans in Dade County, FL~ 2~846 Puerto Ricans in New York City. The survey began in duly 1982 and ended in December 1984.} 5. Speaking in what he called the context of the economist's market model of free enterprise and individual liberty, KENNETH WARNER of the University of Michigan at Ann Arbor discussed re- strictions on smoking. As was expected, he supported them• His comments were somewhat familiar: consumers aren't getting . complete information about what's in tobacco (additives, e.g.)~ cigarette labeling should be strengthened to include carbon mon- oxide, at least~ smoking is addictive, kills some 350,000 people yearly; passive smoke exposure leads to lung cancer and heart disease. And so forth. He raised the question of whether the .iL.~ government should accuse the tobacco industry, or parts of it, of antitrust activity: two of the six cigarette companies control two-thlrds of all cigarette sales in the H.S. 6. SAMUEL EPSTEIN of the University of Illinois Medical Center in Chicago seemed to revel in the attention as he gave his famil- iar speech to a standing-room-only crowd (but it was a small room}. Smoking is a major cause of death, disability and disease, he said, but the chemical industry uses smoking as a cover-up fom

5. all the cancers its products cause. And more~ The lung cancer rate in nonsmokers doubled in 1984 over the previous year~ About 30% of all lung cancers Occur in nonsmokers. The smoking-l~ng cancer statistics of Doll and Peto are all wrong; they excluded all over 65 years of age (and blacksl when most cancers develop. The incidence of cancer has increased about 30% in the last 10 years despite denlals by the National Cancer Institute and the American Cancer Society and the reason Is Chemicals. Session chairman RICHARD CLAPP of Columbia University, New Yorkt Sald he agreed with ¸Epstein's comment~ regarding Doll and Peto. He also said DEVRA DAVIS of the Environmental Law Institute in Washlngton, DC, would soon publish a critique of the ~oll-Peto cancep-causaLion document of a few years ago. Davi~ had been scheduled Lo speak at the sesslon but did not appear. 7. MICHAEL STOTO of Harvard University, Cambridge~ MA, is e~- gaged in a smoking behavior study that is trying to determine~ In part, what has bee~ happening in the last three decades durlng which the number of male smokers fell from 52% of the adult popu- lation to 35% and the number of female smokers rose from 25% to 34~ and then dropped back to 29%~ More must be learned about the characteristics of people who Start to smoke or stop smoking so that antismoklng program~ and policies can be properly establlshed. Also, the informatlon will ~elp specify targets where antlsmoklng efforts will be most ef- fectlve. 8. A study of health education behavior among doctors was re- ported by IRENE RAYMAN of Empire Blue Cro~s ~nd Blue Shield of ~ew York City. It covered 3~I respondent~ Prom a rgndom sampling o~ physicians in the city's five boroughs and focused on knowl- edge, attitudes and behavior regarding seven risk factors for heart disease~ smok~ng~ elevation of cholesterol~ ~yperte~ion~ 1~ck of exercise~ diabetes, family history of he~r~ disease, and obesity. Some flndings: 68% of the doctors cited profe~slonal Journal~ as by far the m~Jor source Of informatlon, w~th colleagues and patient~ tied for second but far behind. 85~ of t~e sample read either or both the "Journal of the American Medical A$sociatlon~ Or the ~INew E~gland Journal of Mediclne.i~ However, readershlp v~rled acco~d- Ing to type of p~act~ce~ Primary care doctors were much ~ore likely t~an non-primary care doctors to read publ~catlons that deal mai~ly wlt~ everyday practical aspects of medicine, ~uch as 11~dlcal World News,i~ I~ospltal Practice" and ,Medical Let~er~ On the other hand, the high prestlge Journals a~tract an equal pr~portlon of both specialty groups. Of the seven risk factors studied, three were accepted without reservation by almost the entire group~ hypertenslen 19~%It dia- betes (90%) and smoking 18951. Two others, family history of

6, heart disease (76%) and obesity (66%) were accepted by the major- ity of respondents while the remaining risk factors, cholesterol elevation (47%) and lack of exercise {42%). were accepted by less than half. 9. MICHAEL MARTIN of the University of California, San Fran- cisco, reported smooth sailing in the first 10 months of that city's strong legislation regulating smoking in the workplace (adopted in 19831. There were only 102 complaints and all were resolved without fines or litigation. No extra employees were hired and no special funds were needed. A coauthor was MERVYN SILVERMAN, former director of the city's health department. 10. At a session on dental disease prevention, GREGORY CONNOLLY, director of the dental health division of the Massa- chusetts Department of Public Healtht delivered a strong but famillar talk on smokeless tobacco as a serious threat to the oral health of young people. During the meetlng, the APHA Governing Council adopted a resolution calling for health warnings on smokeless tobacco packages and advertising, and for imposition of a "dedicated" tax It also urged action against smokeless tobacco products from APHA affiliates and educators and athletes. 11. Two reports related to smoking and reproductive health, both given a few months ago at a conference on the subject {see ou~ memo of Dec. 27, 1985) were repeated at the ArEA conference. ARLENE FRANKS of the Centers for Disease Control reported data that found no increased risk of ovarian cancer from smoking. Even heavy-smoklng women with a long history of smoking had the same risk of the disease as did nonsmokers. ELIZABETH HOLLY of the Northern California Cancer Program, Pale Alto, reported preliminary results from a pilot study that found a relationship between smoking and mutagenie mucus in the cervlx of smokers. The results were derived from small numbers and were net adjusted for factors that might be associated with mutagenlc cervical secretions. .~ -END