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TO: FILE FROM: WENDELL L. STONE (x2508) DATE: OCTOBER Ii, 1988 RE: FIRST NATIONAL CONFERENCE ON NICOTINE DEPENDENCE In Minneapolis on September 22-25, I attended the First National Conference on Nicotine Dependence. This conference was co-sponsored by the American Medical society on Alcoholism and Other Drug Dependencies (AMSOADD) and the Minnesota Smoke Free 2000 Coalition. The AMSOADD is a physicians group dealing with a range of dependence issues. The Minnesota Smoke Free 2000 Coalition coordinates a number of health, business and civic anti-smoking groups working toward the goal of a smoke free society by the year 2000. During the first half of the conference, the several hundred attendees met as a single group for overviews and updates of different aspects of smoking and nicotine (e.g., trends, econ- omics, health consequences, pharmacology, diagnosis, withdrawal). The remainder of the program was organized for smaller groups, and was somewhat more targeted to clinical and activist issues -- e.g., delivery of treatment of tobacco dependence, coordination of tobacco dependence treatment with other chemical dependence treatment, developing and implementing smoke free policies. The conference presenters were united in the position that tobacco use involved a pharmacological dependence on nicotine, and that as such tobacco use should be treated in chemical depen- dence units with as much seriousness as is alcohol and other drug use. I detected no notable dissent from this position on the part of the attendees. Maybe the most notable aspect of the conference was the attention which the new RJR cigarette "Premier" has generated. As noted in the following comments regarding individual speakers, several of the scientific presentations commented on it. A main theme was that it was a nicotine delivery device, and as such should be regulated by the FDA. A program for the conference is available containing abstracts of most presentations. The following comments are CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION TIMN 338150

Memorandum Re: First National Conference on Nicotine ~pendence October ii, 1988 Page 2 restricted to items of potential interest from several of the major presentations. Ronald Davis Dr. Davis is Director of the Office on Smoking and Health. He provided a very broad overview of smoking behavior. Dr. Davis opened by noting that "tobacco historians will look back on 1988 and say it was a very good year." The notable reasons for this were: (1) the First National Conference on Nico- tine Dependence, (2) the Surgeon General's Report on Nicotine Addiction which he described as a "landmark," (3) because of the Cipollone case which was decided in favor of plaintiff. He con- sidered it significant that Rose Cipollone was found not wholly responsible for her disease in the jury's verdict; (4) the two- hour smoking ban on airline flights and Northwest Airlines' full flight smoking ban. Dr. Davis also discussed the RJR "smokeless cigarette," adding that "RJR doesn't like to call that." He said that the FDA is expected to make a decision concerning that cigarette in the next couple of months. Davis expressed the view that he wanted it off the market because its presence implied that smoking could be made safe, and therefore kids might be more likely to take up smoking, and others might be more likely to relapse or not quit. He showed slides depicting the construction of the RJR cigarette. John Slade Dr. Slade is Assistant Professor of Clinical Medicine, University of Medicine and Dentistry, New Brunswick, New Jersey. A central theme of Dr. Slade's presentation was "nicotine delivery systems" which he described as "devices to keep people addicted to nicotine" while giving them some sort of assurances that they are taking care of their health problems. He discussed "Favor" (the now defunct "cigarette" which was not lit but from which a nicotine vapor could be inhaled) and nicotine gum as examples of nicotine delivery devices. Dr. Slade also discussed in some detail the new RJR cigarette ("Premier"), which he described as a "nicotine inhaler," despite that RJR prefers to call it a "cleaner cigarette." Dr. Slade said that RJR's stated or implied advantages of "Premier" are that it: (i) was safer to use, (2) produced negligible tobacco smoke pollution, and (3) was fire safe. He also discussed that FDA had been petitioned to regulate "Premier" as a drug. CONFIDENTIAL: - ~ " MINNESOTA TOBACCO LITIGATION .... TIMN 338151

Memorandum Re: First National Conference on Nicotine Dependence October 11, 1988 Page 3 According to Dr. Slade the major concerns about RJR's "Premier" cigarette were: (1) its addictive potential, (2) its toxic potential, and (3) its appeal to: novices, current smokers and former smokers. Thomas Schelllnq Dr. Schelling is a Harvard economist. His central theme was that the economics of smoking could not validly be put forward as the major reason, or even a significant reason, for the desire to reduce smoking. He commented that the largest cost from smoking is the loss of life, but that the economy, i.e., the GNP, does not notice if a person dies. This is mainly because the loss of pro- ductivity is balanced by the loss of consumption -- i.e., most people would have consumed approximately as much as they produced. Dr. Schelling also put forth the argument that although there is a high cost for smoklng-related illnesses, since smokers die young, they do not incur future medical expenses which the more long-lived nonsmoker would incur. The smoker dying early also loses other cash benefits (e.g., Social Security; pensions) and these greatly outweigh the medical costs. Thus, there is no valid argument that smokers cost nonsmokers. However, Dr. Schelling was quick to add that the opponents of smoking do not need this argument, because there are many other good arguments to reduce smoking. In a discussion of advertising, one of Dr. Schelling's points was that the competition among the companies (e.g., for the low yield market) has been very effective in getting across the health message. In particular, Dr. Schelling used the "Quit or Smoke True" ad campaign as a good example of how advertising could put forward the message that cigarettes are inherently unsafe. In short, it was his position that we "have safety competition in cigarette advertising to thank" for the widespread acceptance of health messages. Dr. Schelling also talked about the new RJR cigarette. It was his position that it was hard to predict its impact, but he did suggest that it would be very hard for RJR to advertise it without hurting its main business, i.e., "real" cigarettes. He suggested that it was "a godsend to the anti-smoking campaign." He further cautioned that anti-smokers (including himself) should at least look twice at something (such as the new RJR cigarette) which was unable to deliver carcinogens, before making a blanket condemnation • coNFIDENTIAL: MINNESOTA TOBACCO LITIGATION TIMN 338152

Memorandum Re: First National Conference on Nicotine Dependence October II, 1988 Page 4 Ma~ Schneider Dr. Schneider is the immediate past president of the AMSAODD, affiliated with St. Joseph Hospital in Orange, California, and is on the faculty at the University of California at Irvine. Dr. Schneider gave an unremarkable review of the health consequences of tobacco use, but also commented on other miscel- laneous issues. For example, regarding Third World tobacco sales, he suggested that the government's efforts to "push" tobacco on the Third World may be even more damaging than selling armaments. Concerning treatment of tobacco in chemical dependency units, he hoped that eventually a motto would be that "a person is not clean and sober if he is still using tobacco." ~.~c~.~ o.~.~" Jack Hennlngfie.!d '/: "iii i~ Dr Henningfield is chief of the Biology of Dependence . ......~, • !i.i ~ " ~i i~i~, and Abuse unit at the NIDA's Addiction Research Center in Baltimore, :~ .: i~. ~ Maryland. .... . ~,~.~ ~, Overall, Dr. Henningfield's presentation was similar to ~._~. ~: ~) other presentations he has made in recent years. He opened by commenting that the research techniques used for nicotine are the same ones which have historically been used for other drugs. if': . ~ One of Dr. Henningfield's themes was that drug dependence, ,~ ........ ;-' including tobacco dependence, is influenced by the delivery system. i.~ ,,~,~ !i ~ It is in this context that he showed slides of RJR's "Premier" ~ii ~!'~,,i~i ~ cigarette. These slides showed the cigarette's components. He ~ ~,~',~ referred to it as a nicotine delivery system, which was "impressive" from an engineering point of view. He also suggested that the new ~ ~ O RJR cigarette could be used for other drugs -- namely, it could be ~ <~ used as an "easy portable crack-dispensing system." Dr. Henningfield also quoted an unnamed Philip Morris researcher in supporting Dr. Henningfield's view that the cigarette was a nicotine delivery system. This quotation referred to ciga- rettes as the ultimate nicotine delivery system, and that the cigarette was not the product, the product was nicotine. Dr. Henningfield characterized cigarettes as basically the "crack" form of nicotine delivery. CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION TIMN 338153

Memorandum Re: First National Conference on Nicotine Dependence October ii, 1988 Page 5 John Hughes Dr. Hughes is Associate Professor, Department of Psychi- atry, University of Vermont. Dr. Hughes discussed tobacco withdrawal, which he char- acterized as an important clinical syndrome. Nevertheless, he made several comments indicating the weakness or absence of physical symptoms. In particular, he stated that there has "not been shown any discrete physical symptoms" during tobacco withdrawal. He further stated, in the context of discussing a chart comparing nicotine, opiate and other drug withdrawals, that nicotine is different from other drug withdrawals in terms of its "absence of physical symptoms." WLS/tks 10004558 CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION TIIVIN 338154