Tobacco Documents Online

i # i• l [" :hi;-3 i . ) , , . ~: ~7•~ i ...... •~ d d.~.' 1 .! ,3 BY CLIFTON R. READ* lear-reaching recommendations to end the upward ~piral of cigarette sales,, lung cancer, emphysema, and ¢ardlovas~ular disease were made by the first World Conference on Smoking and Health at the Waldorf Astoria Hotel in New York, Sep- tember 11-13. More than 500 government lead- ers, educators, scientists, epldenfi- dogdsts, psychologists, broadcast. ors, editors, phYsicians discussed cRaleal, laboratory, and behavioral research, epigemiology, publi~ ~?u- cation In lehools and colleges, gov- ernment action and legislation• • elgareile withdrawal clinics, the medla and advertising, exemplar laon-smoklng, the manufacture of fes~ harmful c|garettes. Many ]leeds were stressed at the Conference but perhaps the mos~ significant was the importance of eotttinulng the exchange of ideas, plans, and experience, Speakers and work groups made a number of =~uggestlons for a solution of tile ~Mr. Read is Vice PteMde~ll ~o~ P'lltdie fn]or~lm~iolt, t!lller~can C~n. ¢e¢ 2~ocletg, and geereta~ib Plannin9 Conimlflee, World CouJercnee on ~niokhlg & llealgl. WINTEg 1967 i£olatJon $0 13]any $CJPDtJsIs *~l~d educators feel, 1-1ere are some ~f the proposals that w~>uld lead to an ~nteI'nat~onal. regional, and local eross-~ertifiza- tion of idea~: --A working committee inter- national and interdiseipIlnary, to ~ol~olv t~p on the many suggestlozls for behavioral research lnetudlng standardization of instruments alad dednltions of criteria gathering of baseline da~a in each country. fullest exchange of InforrO&tlon and t'ovlew of fiterattlre. --A conference of experts on the physiological, psychological, and pharI~acologIeal aspects of drtlg dependence fo review scanty know1- eggc on tobacco dependence and to outgI~e research proposals. --Establishment of a multi- disoipNned group within art appro- ~ai£* research organ~xatIon to hl- sure effective studies on cigarette dependence. --A work grot~p of physicians and ~eienli$~s to rnee~ 8,t thre~ month fntervals on development of a less hazardous olgarett~ lit Is hoped ~ci~nl~fic directors of tbo to~ baee~ industry ~dll ~oin~ --*~ series of conferences ~n smoking an~ health on a worldwide regional basis for teachers, to be financed by governmental and prl- "care ~genc[e~. -- Each university, medical s~hool and hospital should estab- lish a committee to review policio~ Bad praoilro~ a~d to TheRe TeooD% mendauons to reduce health haz- ards by eliminating cigarette stuck- --A task force undpr the l~a- t[onal lnteragert~y Council o~ Smoklng and ~lealth to review data submlited at the World Conference on withdrawal, and prepar~ a sum• mary for tho public, --~stablishrae~t of a research institute on to~aeeo ~nd h~a!th to be ~u~d~d h~ voluntary ~gen~ie$ s~eb ~ tbo American Ca~er ~o~ cJetp', the American ;Ieart Assoeia. lion, the National Tubereulo~is As- sociation and the National Clear- Inghouse on S~.lo~lng aad Health. Among those participating were top pU~iC health o~ceP3 and/or ~'esearohers ~rom Ar~ntlna p=Ug- tralia. Brazil. Canada. Chile, Co= Iombla, Czeehoslovat;i8 DelLmar~ ~Jnland, leranoe, Germany. (~recce, Hungary, Iceland, Ireland. Israel. ~a[y, Japan, Netherlands Norway= Peru. Philippines. Poland, Per tugal, RLlmanla gwedPn. Switzerland Thailand, Turkey, United Kingdom¸ ~enezuola. Yugoslavia, and ~'o~ d2 stat~s of the Unlt~d States. Senator Robert F. Kennedy was ~che~uted for the opening day as luncheon ,peeker. but then l(~arned that he hag to be on the floor of the Senate at g p,m. that day. Plans were shuffled, programs realigne~ and Senator Kennedy gave the 3

i ". marBlng's opening address. He was followed by ~ report on th~ impact on life expectancy of cigarette smoking and a sorie:~ of analyses on ~ere ,a~ stand ill retmarch on blgareBe smoking and cancer, h~art disease, and nor~-rnallgnant ptob~ ferns of the lungs. On the second nlorning the aehle%remenl$ and needs In the be- ]~avioral field were reviewed. Work grOUps reported their ~ecemmetId~- tioTl$ the lesl ofterfloon, and a dlsting~/ished panel commented on what society must do to meet the chalienga Of cigarettes. Half Of each day was spent in work groups of 30 to 40 persons Ineusing on speeldc problems and programs. ~bairrnan of the Conference, Luther L. Terry, i%BD. presided over the three general sessions with good humor and tact. Only diffl- curly came when an observer began to Inake a speech on lettuce ciga- rettes and had to be dealt wlth firmly. In closing, Dr. Terry urged delegates to carry hack the re~m- me~daBons of the Conference and its work group~ to their own coun- trIQs and eitlcs and towns and quoted a Chinese saying, "When you plant for a year, plant vege- tables; when yeu plant for ten )'ears, plant trees; when you p~ant fop a hundred years, educate the people." Chief challenges to the Confer- anna Plan~ing Cdmmitteo. which had e~even ~ersons from eight na- tlonal agancles and five clties/were to build ~n excilillg program and to limit invitations in some 500 persr~ns who could contribute most through their exp~rienco or their pos~t/~n. Invitees ~vel~e nominated by member aganelcs of the Na- tional llltcraficncy Council on Smoking and Health, by Ministries of Health and Education, and by the World Health Organization. There wa~ correspondence with 60 countries and in se.:eral eases let- ters wellt to a dozen advisers seek- ing the names of valuable people. Pre-ConferetIcc disetlsslons wore had In Geneva and London. In the final list of participants, Africa was not represented at ~fi and Al~la had only five delegates. The Planning Commltt~ sohzw] its probJems in eight well-attended meetings held from August 2, 1956 to September 7. 1967 under Soi ~. Baker. M,D., Chairman, ACS Committee on To- bacco and Cancer. The Planning Committee, in ad- dition to Dr. Baker, included Dr. [fokn Cooper, Associate Extcutive ~u~retary, American Association for Health, Physical Education and Recreation; Nathanlel H. Cooper. M,D., Director, Community Pro- gram, American H0art Association i Thomas R. Dawber, M.D., Associate Professor of I%[edicine. Boston Unl- versity Medical Centeri Dewitt C. Daughtry, M.D., IE[iami, Fla. ; Ha~ old ..~ DJeh], fi~[.D. Vle$ Presldetlt, ACS. and of 16teragenC"d Council; Dr. William Ellena, Associate See- retary, American Association o~ School Admi~Islrator$"i De. Dargo[ • Horn, Director, National Clearings house on smoking & H~alth; Sal Lifson, Director, Education, Public ReiaBons and blaterials Develop- ment, Nadonal Tuberculosis Asso- ciation; Clifton R, R~ad, gear,- tar)'; and James L. 'rroupln, M.D. Director of Pro~esslonal Education, the American Public Health Asso~ elation. Emerson Foole, dormer adverfls. ing executive at~d forraer head Of the Interageney Council, presided at the first luncheon. After c]reu- latittg behind the dais to ask each of the guests of honor--representing 34 couutrles how his or her name was pronounced, he introduced them all with remachabie accuracy of accent. Dr. Diehl presided over the second luncheon and as he stood to speak, flropp~d the cards identi- fying the 24 persons at the head table. After a muttered, desperate "oh my. no" whiok rafig eat over the loudspeaker and brought a roar of laughter, Dr. Diehl recovered his cards, quickly put them back in AOfi Presidm~t Dr. Ashbel G. Williams ~" t ": . "; '< C. :. :)-<- . 4 Dr. ~l'erry % :-. r:..(, '- ' Jx -7.= -7 CANCER~

i :. • :' "~der, and made his introductions without a mistake. D The Confertnce grew out of eD forts under Atton Ochsner, M.D. longtlme pioneer against ciga* ettes, to set up an international congress. Originally a cong*ess was sched- uled for gune of 1966 and later for June of 1967. Finally the or- ganialng committee headed by Dr. Oebener sought the support of the American Cancer Society, which agreed to manage the meeting, with the National Interapency Council on Smoking and Health as |p0ns0r, The Conference was S- Lanced by the American Cancer St~iety, The American Heart As- sociation, the Bays Club of Amer- Ica, the National Tuberculosis As- sociation, and the U.S. Public Health Service, Department of Iiealth, Education, and Welfare. Sixty-one reporters tram mesa- alnes, newspapers, television and radio covered the meeting. Daily and weekend stories, and many magazlne articles, appeared throughout the country and abroad. Delegates from Individual coun- tries held press conferences for their owl~ national journaIists. The Columbia Broadcasting System, the • National Broadcasting Company, and the American Broadcasting Company covered large segments of the meeting under bright lights I & WINTER 1967 that were the despair ef many delegates. ABC's "Issues and An- swers" did a final roundup. One of the early goals, to locus public gttengon and to create news on cigarette smoking, was certainly realized. Joseph Clark, ACS Press " Chief, handled the press room. Remarkably effective was a dis- play of 950 anti-cigarette posters from 25 countries arranged by Robert Thorpe. The meeting was strikingly styled in blue and whit~ with large posters, cheers for pro- grams and lists, and flags all built around a world symbol, arranged by Ralph DeUi-Bovt. Thorpe Is the retiring and.Delg-Bovi the incom- Ing ACS Graphics Director. A demonstration of the value oi conflict and ~urpeise in capturing headflnes occurred when ~t young lawyer, Joseph F. Banzhaf, Ill, who was an lnvitee to the Confer- ence, brought a fiery attack on health agencies into the pressroom on the morning before he delivered It in one el the work groups• Re- porters and TV cameramen were fascinated as he flailed at the health agencies and the National fnteragency Council. Banzhaf had been the plaintiff whose letter to the Federal Com- munications Commission became the occasion for the ruling that the fairness doctrine be extended to advertising, He attacked the healtli agencies because they did not fol- low his advice to go to court on behalf of the FCC. Health groups argued that their business was edu- cation, research, service to patients, not law suits; but the independent young lawyer casting his adjecti- val rocks at the large health agen- cies had the headllnes that day. Generally ignored by the media was the/act that the Federal Com- munications Commission's owr~ strong law department and the De- partment of Justice seem able to defend the fairness ruling without help from voluntary ageneles. Administration, which included supervising travel from many countries, seeing that foreign guests received promptly their ex- penses, that complex lists of par- ticipants (by work groups, by al- phabet, by nationalities) were put together accurately and on time, that secretaries to handle materials during the Conference were at typewriters, that desks were prop- erly manned for registration and information all this was super- vised smoothly and effectively by Leo Allard, ACS Dep~rtment of Information administrator, and an extraordinary team of assistants who worked through evenings and weekends. Conference summary Is being edited by Henry Gaodman~ Exec- utive Secretary, Council for the

Adver[]sen~ent 01 Science Writlvg, and is expeet*fl out early in 19G8. ~Nventy-flve thousand apples will be prlnled ~dzd duneMons included a pleas- ant and crowded opening reception, AS the guests of Emerson Foote, ~lrs. Albert ]9. Lasker, and Sol Baker. M.D.. at the Car~negie En- dowmeof International C~nter, op- posite the United Nations, aud smaller c0oktall parties for those from out~lde the United gtate~ given by Mrs. Lester D, Robbins and Mrs. WllIism G. Maguire and the New York Heart Association, A meal suecess[uI bog tour o[ New York was organized by Mrs. Merle A, Guhek for wiws of visitors and a luncheon for them was held at Equitable Life Assurance Society of the United Slates. Mrs, Rpbbins, Mrs. MaguIre. and Mrs. CulIek are VOlunteers with the New York City Dlalsion of the American Cancer $odety. Language problems were sur- prisingly infrequent. After much discussion, the Planning Committee decided ~o go to the considerable expense of making available im- me4fate translation of the assembly proceedings into French. This was needed it developed, by not more than four of the &l~gates, but throughout the meetings the low- keyed intense voice of the youhg lady transMtor tralMd a few wo~s behind the speakvr. Only one work group position paper was presented In Frer~h. At the social functions and In the work groups there was little ¢Igaretle smoking. ~[;t the crucial meetings ash l.rays were removed by ConferenCe request. Reporters and photographers fotmd them. selves escaping embarrassedly to the press room or the street when they want~I to smoke. ]Much effort was made to have a good representation from the Soviet Unlon. but at the last mo- ment three physicians who had ac- cepted sent their regrets. Each of the large American tobaeca eozn- panis$ was invited to send its ~elentIfle director or a research selentish but only P. LoriIisrd Co. did. Representatives from tobaoeo companies In England and Portugal also attended. tIt ,%IZI?S OF • IEPO 7S 8D~ERNMENT ACTION AND LEGISLATION A principal role for government, a chief exemplar, was seen by all the work groups who looked to their governments for more gene- Ious gnancial s~pporl for ¢lgarelte control and research, and for scien- tific and polltieal leaderthip. Among the spedfle areas for gov- ernment action were the following: Development of low tar and nicotine tobacco, ouflawiug of overiength cigarettes, research into ~Itratio~. Study by government Instlrers of their life table data and eon- ~ideratlon of premium Implications lot smokers aI~d non-smo]~r~. Restriction ~ smoking in public bnildings, hospitals, transportation, £nfarcernent of regalati~ns against sales to minors. Educatlon for the public and spe- cial groups, inriuding the mllPm~. Differential taxes o~ the basis el tar and nicotine content, dis- Mnguich[ng betvceen various brands of cigarettes &nd cigars or pipe tobacco, eonsld~ration of a ccIltral levy of cigarette taxes. Agrleultural l~olicy to discourage cultivation of tobacco and encour- age eonvcrslon ot tobacco land to 'other purposes. Promotion abroad v~ cigarettes to he ended. Th~apy to assist smokers to break the smoking habit. Research on all aspects of this problem, Ine]ttding the degrees of effectiveness of efforts to curb cig- arette smoking, MEDIA While the present considerable public knowledge about the risk of cigarette .=.mobl.ng is dt~o Very largely to the ~tews media, efforts to red'dee cigarette smoking are now critically hampered by rnas- sive cigarette advertising. A final objective Is the elimination in all media of such advertlslng- Immediate steps should I~ taken to e~d c~ga~ette advertisSng that appeals to young people agfl to re- quire cigarette aflvertl~lng and packages to carry dear ghd ade- quate warnings and to list the tar and nicotine content o~ Individual brands. In the United States theNational Interageney Council and lt~ mem- ber agoI1ciss must exercise every means at their disposal to sustain the extraordinary and Important ruling by the Federal Communica- tions Commission requiring broad- ~¢asters to give fair time to mes- sages on the. health hazards of cigarette smoklng. Citizen monitor- ing groups should be organized to assure the deeislon is obeyed by networks and local elations. The persuasive talents of the advertising industry should be fur- ther encouraged to enlist in the creation of materials for educa- tional campaigns on the health risks of cigarette smoking. gCHOOL$, COLLEGES, TEAOHER$ Since cigarette smoking is one of the major health hazards facing youth, schools, colleges, and t~aeh- erz play Important roles, the child Is to be encouraged to ~ake his own decisions on health on the basis of ~eientl2~oally accurate ln- $ormation presented to him by teachers who have Been specially trained in the risks el cigarette smoking by qualified health edu- cators. Enueatlonal efforts should be concerned with the thdiv/d~a]'s well-being--t~ot Just threats to health. Teacher, school and eollege ae- CAggg~ NEWS

• ' tJv!ty'should aim at roakblg ciga- the teacher's responsibitttp as an r~tte l~mokfng s~cia[ty undezirablc exemplar and the effect of hls suede hirp to consider quitting, behavior. Student leaders at2d o~- smoking habits on pupils. " gal~[Zalions must be Involved. Health agencies provide Important t~tourees: the Interagcney ap- proaok to sebeols and col)egos holds advantages and does not threaten the Integrity of individual agencies. Assistance to students who wish to stop smoklr:g ~hoald be provided by sshool and college authorities. Restarch into cigarette smok- trig should seclude peer group fn- fluen~s, evaluation of co]]ege COUrSe content on smoking, rela- tion of knowledge to behavior. why Some begin and others quit Ilno~ng, importance of easy re- cess te cigarettes, influence of [ac- utt~ ~'noking or not smoking, how to involve students and foeulty In proglama a~d research, how to make research findings and knowl- edge about cigarettes widely avagable In schools and eolleges. Teacher tralnlng ~hould be hosed on latest thlnldng about attitude change and teaching practice. Re- intereemeut of the teacher by home and health agency Is Impor- tant. Training should omphaslTe i" ] t :i ? "! •q ii /i F i/ t !: SEHAIqOR • Smoking, its begJnnteg, cessa- tions, and support for non-stunk. ins is a many faced and complex beha~iora[ problem. Eff~etlve~es$ of aetio~ programs ~s enhanced IS the problem iS coneeptuatized in its complexity and action is to- cased on each of the many focets aS the problem• Priority should be given to those programs which appear to og'er most chance for st~ceass: suteess with a portlola of the population ~II[ alt~r the so- cial eJimate and increase the ]lheIJ. hood of success with others. Research on,~n{tlation o~ smok, i~g ~hoald covet" the influence of p~ers, parents, teachers; tbo habit. forming process from first desire to smoke, early experiments, and final style of smoking; differentia[ charaei~'isties of smokera and non. $lfioker~, Research on eeaaofion o] co,ok. ins should have as a goat getting the adair ~oker to ~ecept the habit as a personal problem; per- help him to quit, eve0 for a short time; and kdp sustain hlm In his ~lew habR of non-smoking. . InformStion should be collected from millions who have sueeess- lully ~topimd smoking, with era- . phasls on how they stopped; how they remain non.smokers. Smokers ' and smokihg situations should be elassif~d as to social and personal variables to help educational plar~- ning. Factors which help keep peo- ple who have stopped from i'eturn- InS to smoking need more attention. A n~mber of areas that relate to eessati~t oi smoldng must he studied: communications patterns and advertising techniques, Includ- ing why attention it paid to what health m~ssages by what groups: learning theory; motivation to correct action and to Inaction; lmz mediate effects of smoking and their value in producing behavior change; Influence of environment change (on ~moklng areas) 1/1 mak- Ing smoking socially unacceptable; ~'elation to behavior of i~reased Cost of cigarettes, cultural and so- ¢qal role 02 smoking through ttud-

%= Dr. Oodbee |es of whoi~ ¢ommunitle~ ill differ- ent countries; relation of Imoklng to accidents. Better ways should he developed through r~seapsh of heipin~ people give t~p smoking who already have ~splratory disease, cancer, or heart disease, Study is importan~ Of whether it Is passible to produce |ess gazardous Ways of ~moking %vlshOtR lnterferlng with efforts to Set peopla to stop smoking. AODICTION, HAEITATION, PHARMACOLOSY The Wot~ "depeildenc~," not giv- hlg priority to either psychological or bloehereieal factors, is preferred to describe those who show a ¢on- llnuing need ~ smoke• (WHO Ex- pert Committee on Drug Depen- dence). In dependents where psycho so- clal factors predominate, stopping smoking is relatively easy and withdrawal ;m~ns are slight, fn Others dependence Is ranch strong- er, seems to have pharmacological element and the dependence per- sists In the face of knowledge and expertenc~ of harmful effects. A revolution in the attitude of administrators, ph~'siclans, and re- ,earth workers is reqtfired if pres- ent gaps in our kno~IPdge of de- pendence on cigarettes are to he filled. Studies are essential of ~mokers' reacSous to nlcoliae and Of the nature and duration of clga rette deprivation syndromes. ' 8 Mr. Foote £XKMPLARS Those "~hom others copy (par- en~i~ teac~Brs. ~ysleJa~s ~overn- ment readers• etc.) should nox smoke. Smoking control programs ml~st Involve aIIi~d medical professions• civllJan and military, allied educa- tional professions; youth ~crvlee pro~s~[ons; and prominent Indl- viduals such as athletes, TV per- sonalitles, publle officials. Exem- plars shonld themselves in general not smoke, certainly not when ad- deas~ng you~g*ters, Medical, d~ntal and allied health soeipties should adopt resolutions citing the health hazards of ciga- rette smoking, should encourage their members to stop smoking, and should apply smoking control methods wherever posslbie. Materials for physicians and other heahh counselors should seres6 the knowiedg~ ~h~t 1or sD~e smoking withdrawal is not ~s diffi- cult as generally believed, the shorL as well as long terI~1 belie- fits of giving up cigarettes; the faei that It ls better to switch to cigars or pipes if a patient cannot give up entirely; the role of com- munlty resollrces. The transportation itlduslry sh~d be urged to give t~p the practica of freo cigarettes and rc- strlctions on smoking shoeid be enforced. ~ovio and televislon fa- dusteies should be persuaded to elimlnabc, where possible, smoking by characters in films, ~tc. TOWARDS g LESS HAZARfiOUS gI8ARETIE Adequate means are stow avail- able co the tobltceo industry for practical lowering of tar, nicotine and gaseous levels. TSe i~dustr.v Should be eneou~. aged to product a less harmful . cigarette by establishment of reg- ulatory standards for use o~ the term "filter" cigarette, for limita- tions of the yield of tar and nice- tine, for listing on all packages Of tar and nieo~tee content. Filter and non-smoklng overlap should not be less Shah 30ram. in leagth and design Ot ¢dgarettes to reduce inhalation should be stinl- ¢dated, The ultimate proof for a less harnfful cigarette must be th human experience; essential Is a surveillance system In hospitals where smoking habit~ (by brands) of patients with c~garette-re]ated diseases can be recorded. EPIDEMiOLOGY Iaternational collaboration is es- sential Countries should perlodl- ca|If collect data on tobacco con- sumption bY age and sex and on symptoms and diseases in relation to toha~ ~o~sttmpt[on. Case control sludl~s of coronary heart disease and other diseases should he undertaken in countries with widely differing risks to ex- plore the r~n~ and vacation el she association with smoking his- tory and ~tber ~ac~ors. Additional prospective studies in countries with requisite technical res~urees are important. • Studios of the eff~ots of stopping ~mokh~g az~ essential as Is the evaluation of th~ results of anti- smoking campaigns ~nd the trends of mortality and morbidity in those who do and do not change their ~mohing hab~ts.~ Studies of the relationships b0• tween other env[ronrnonte[ factors (as air pollution) should mane allowance for stnoking habits be- cause of lheic ot,er~olming effect in causatten of luiag canotr and chronic respiratory disea~P. CANCER N~?!S

.. r QUOTES ; '*The period of uncertainty is over. There is ~o longer any doubt that cigarette smoking is a direct threat to the user's health . , , to- d~ we are on the threshold of a /2~=~z spa, a tl~e o~" actlo,% ~ IkzZe dor public r~nd private agencies, commtlnlty gaoups and individual cltlzenl to work together to bring this hydra-headed monster under ¢ontroh" Luther L. Terry, MD,, Chairman ~ the World Conference on gmokln~ and Health, end el the Natlonal Interafeney Council 1or ~mcdc~n~ a~d Health¸ A BATTLE WHICH BAN BE WON "lEve."y year ei~rette$ kgi rnore Americans than were kiUed in World War I, the Korean War, and Vietnam combinedi nearly as many as died in battle in World War ]L Each year cigarettes kfii five times I~ore Americans than do traf~c accidents. ~ng e~lneer alone kili~ as marly as die on the road. The cigarette Industry is peddgng a deadly weapon. It is dealing In • people'~ lives for flnanclal gain .... "Tirs~, what about cigarette ad- vectlslng? Nearly Sfg0.million a year is spc~t In the United States ~one o~ television, radio~ and ~ews- p~per efforts to st~ct young people smoking and continue others in their habit. We cannot seriously ex- pect to make major inroads In people's smoking habits while $300 r~l]]ion a year is being spent to in- crease the rtumbers of thosE- ad- dicted. Action ls needed to limit I~nd counteract this massive on- :aught .... "Short o( onactlng a ban on ad- WINTER 1967 vertislng, which does not seem likely at the moment, what might we in Congress do now~ We can enact the tar-nice tee bill proposed by" Senator Magnuson--who has ~ed the figh¢ on smoking a*~d heallfi in Congress: This hill would require ~isclosure oi tar and nicotine con- .tent on packages and in advertis- Ing. ] believe the bill wiIl eacouraga a constructive 'reverse tar derby/ and I think it should therefore be @tractS---now.... "In addition, I plan tomorrow to t~troduee two bills relating to ad- vertising. Tha first is a strengthened version of Senator Neubergar's bg! to require a warning in all adver- tislng~Warning: Cigarette Smok- ing is dangerous to Healtfi and May Cause Death from Cancer and other Diseases.' While the 1965 labe]gng law was a small step forward, it has not reduced smoking appreci- ably. It is time the warning require- ment was extended to advertising. The second bff/ would authorize the Federal Communications Com- mission to regulate the S~es a~d types of programs on which ciga- rette advertising may appear, and the over-all volume of cigarette ad- vertising as well• These are the self-regulatory steps l have caged for from the industry, but the Fed- eraI Commt~JcatJoDs Commission should have power to impose them If tha industry does not act .... "And that is why I will intro- duce a third bill tomorrow to as- tag:fish a sliding scale tax on ciga- rettes. The current rate--S4 per ~OPO cigarettes Would Ter~al~ O~ cigarettes with less than 10 milli- grams of tar and ,8 milligrams of nicotin0, Others w0uld he taxed at higher rates, with a rate of $I5 per thousand imposed on cigarettes with more than 30 milligrams of tar or f.g milligrams of z~tcotine. The RoswelI Park figures show that ).f brands would fall in this cate- gory, as would most nf the 100 millimeter cigarettes--new since the RosweIl Park study was re- leased. Th~s legls]ation would speed the development oY low tar, low nicotine cigarettes, and enable the public to spot the more dangerous cigarettes by their higher prices .... "Still, we must be equal to the task. For the stakes involved are nothing less than the lives and health of millions all over the world. But this lz a battle which ~an be won---and with the commit- ment that is demonstrated by this ~fere~c~e; with the ~mmitment that all of you show in being here and in your work at horne~I know it is a battle which will be won." genalor Robert F. Kennedy, ~Vezp Yor~, LiFE EXPECTANCY AND cIGgRf'tTgg "Twenty-five year old men who have never lmoked regularly have a remaining life expectancy of 48.6 years. In contrast those who smoke 40 Or more cigarettes • day have a remaining life expectancy o~ only 40.3 years. This is a difference of 8.3 years. Lighter smokers survive longer than heavy smokers, but even smoking I to 9 cigarettes a • day shortens life expectancy. "In the ega range 35 through 68, men who smoke and continue to smoke dO or more cigarettes a day, have ~d% to 26% less years at life remaining to them than are re- maining to their friends who never smoked regularly. "There has been a haft century of tremendous advances in medi- cine, pug:lie health, and the Ameri- can standard of living. The sulfa drugs and antibiotics were devel- oped; infectious diseases, pneumo- nia and tuberculosis were brought trader control, and new miracles of surgery were introduced. As a re- suit, ilia expectancy iner~ed by d,O years for white males and 5.2 for non-white males. "During this same period ciga- rette smoking became popular and increased by leaps and bounds. It is estimated that approximately 3.4 years el expectancy are now l~t due to the habit. This loss is not far short of the net gain from half a century of scientific and social prog- ress. Were It not for this, it appears that gte expectancy of American men wonld have been lr~reased by about 7,d y~ars ~or white n~aIes and 8.6 years for non-whRe males. "Most distressing is the fact that the life expectancy of American men has shown nn improvement sfn~ 195g-61. Substantial improve- 9 :ti ........

w.cnt Will be difFmult to aehie~'e ~v.l~ss eL ~httiort is found to the problem of cigarette smoking." E. C~uZer tlammorzg, Se.D., Vice- pre*ident for Epideralology a~d Staff*tics, A~lerlcan Cancer SocletB MORE F'LEASANT, MORE GRATIFYING "Cigarette smokthg gives millions of peo~e a gratJgcation which Ls very dimcuit--if not Jmpo~sibie-- to subslltute. Zt has become part of our ~mo]~z| $~ucttR'e, az~d that m~n$ nothing more and nothing less than part of millions of human minds like a cancer ~ rfte~st~s . . . It we shall succeed the first condi- tion to my mind is that fighting the health hazards of cigarette smok- tog is made a norm~I, integrated part of the public health service of the country.., we must also build into the system an automatic fune- t3ozHng source of fii~anelng these operations . . . producers of elga- ¢attes Izre also citizens and must be made to feel their responsibility to a much higher degree than now •.. if ~w~ are to succeed the cam° palgn must be carried by a spirit zzot of ¢ondemnallon, reproa~ and threats but by the positive spirit of m~ing Itin more pleasant, more enjoyable, more gratifying--and longer.- Ka~ Eye,g, M~D,, D~reetar Gene~l, The Health Services o~ Normau, The Roy~ Norwegian Zdinistrd o~ Social F/~ie~e, Oslo. A DIRTY AND DANGEROUS HABIT "The ~ltlokel" ChOOSOS for his own gratification to introduce into his owl1 personal micro-environment the ngent that will do him harm. What we are trying to do is to per- • uad~ him that that voluntary act is not only a inng term threat to his tuthre, but also an inducement to others to adopt th~ same folly. We are in gape asking for ~n almost infinite number of acts at self- abnegation so that a dirty and ~ngerous habit can be eliminated from o~r soeloty~~ S~r GeoTge E, Godber, M.D., Chlet Medical o~iepz, Bzld~ M~Ilt~ry o] Healt B~ London. I0 LOOKING FOR LEADERSHIP "In short people are deeply inter- ested in this problem--l~ot superfl* ciaIly Imcause it involve~ the dramv. of controversy among governr~ent, industry, agriculture, televlsion and ~tdverlising, but personall~ becaL~se it tnvelve~ lives. They know It. The~ are looking for leadership .... "For the tobacco industry and its advertisers there are & number Of Productive courses at action await- ing only the decision to help society cope with a problem that cannot be wished away . . . a sincere and wholehearted effort tO develop a cigarette that i~ both as low in hazard ~d as aeeeptith]e to the • srn~er as science and technology can make it, willingness to state for~H~htly, in beth labelthg a~d advertising,, the tar arid nicotine content of each product.., a wlll- tng~ess to re~ove ~'rom th~ me,keg- place those products such as the 100 millimeter cigarette that repre- ~ats a long step backward in the e~ort to reduce dosage and dam- age: a wlIlthgne*s to do what other industries have voluntariIy done in stressing mogePation: these and mttny more. The door to coop~ra- tion has always been open. It re- l~lal~l s open," WiRiam H. Steteart. M,D., Su~geo~ General, Pubic lfest~h Service, U. 8. Department o~ Health, ~doe~llo~. and We.re. COMPLEX PROBLEMSREQUIRE COMPLEX SOLUTIONS "Cigarette sn'toklng may Wall represent the largest single h~alth problem lbout which we have it in our power to do $ome~ing ltnme- diately.... "We mu~t ¢oaCe up to the ~act that the cigarette caught hold be- cause it fulfilled eertaIh functions that needed to be ]ulfill~l for a great many peopl~ The cigarette offered an accessible, inexpensive way to deal with a variety at prob- lems. Perhaps not a very effective way, since th~ effect does not last, yet, if there were 11o bltrmthl con- ¸sequences it would have served mankind well. We have simply had the rotten bad Pack to have discov- ered after all these years thai the harmful effects are overwhelm- lng .... "Since the problem is beltavloeal in origin, much of the solution will have to come from a behavloraI approach. The values thai are im- por~r~t to noq-sraoking must be " str~tsed ov~r those which are met by smoking; clear and accurate perception of the threat must be achieved; pspchaloglcal r~eeds and gratifications must be achieved through appropriate substitutes; and the weight at scala| forces,-- lrol~ personal forces to imUtutional forces--must be ~quarely in sup- port ed our effort~. "Our task with the elgai'ette con- suming public is clear: 1) We must get people to stop ignoring the problem. 2) Then we must get them to trdtlate the aetiob to stop--th~est the energy It wlll take to alter their way of behaving. 3) We must maximize the el~o~t term suecess--thtd the ways to help them through the initial period wRho~l elg~rottes; firm substitute gratifications withotlt serious side effects; individualize therapy. 4) We mt~st maximize long term success by establishing a climato In which the ex-smoker has rio desire to return to his former habits• "The problem is complex, a~d complex problems require complex soluitons. The problem wlll not be solved by an ingenious gimmick, A variety of humtn reactions are tied up in the smoking habit, and a variety of control methods will be needed to solve it.'~ Daniel Hor~, PB.D~ Director, National C~esT~nggou#e ~or gmoking ~nd Heallh, USPHS Volun® ~] Numb©r 2 Wiate~, 1957 ~*ubliuh©d aem I-uaaooify American Concer Soc~eh'~ ln¢. 219 lost 4~nd Street New y~r~. N. ¥, 10017 td;tor: Herbezl Schworlz Ad Director: #~ohlq. A, ~llne CANCER NEW,.S~