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- p Meeting ofAd Hoc Committee on Smoking and Health National Cancer Advisory Board Bethesda, ]Maryland June 17, 1973 J PRESENT: Dr. Philippe Shublk, Chairman Dr. Charles Kensler Dr. Umberto Saffiotti Dr~ Gio Gorij Secretary Dr. Luther Terry (ex-Sargeon General) Dr, Emerson Foote Mr. Milt (Late Arrivals) Dr. Kenneth Krabbenhcf! Dri Frederick Seitz The meeting was delayed for at least half-hour by the Chairman in hope of other members of the Ad ttoc arriving. During this period, Shubik corn-- merited on his embarrassment that in a public meeting of this committee in N.C.I. rooms with no smoking signs, one member (Kensler) still persisted in smoking. What appeared to be humorous comment became led to Kensler extinguishing his Shubik then started the meeting by expressing his extreme disappointment • at poor attendance of the NCAB representatives for such an important subject NCAB..He recognized that the original brief was limited and he had done committee could evaluate the total

Shubik wanted it clearly understood that the recommendation of the committee not to set maximum levels was in no way indicating a lack Of belief in causality, but nnerely that there was not the evidence to back up the assumption that reduced level produced reduced risk. He indicated that the committee's recommendaiions had been approved by the NCAB, 7 but tliat his great fear was that nothing would he done• (This speech was a plaintive one, and appeared to Ine to stem from some 'behind the scenes' discussions st NCAB, etc. ) Shubik then went on to discuss some of the Pecomnlendations (Items 3 and 4 on the Agenda attached ~o this document): Item 3 He asked the committee their views on means for surveilling " future research and action in the Smoking and Health field• He thought thai possibly a small group (super-structure) should b9 set up fop this purpose, or possibly the T~VG (because of likely affiliation between INCI and NIILI) could be the body. To generate concern for the subject, he also thought of suggesting that at all NCAB meetings, members should stand in silence for ~f~ five minutes for all smokers that died of cancer. This practice ~.& should continue for one year. ca o

(- 3 ( Gori K~nsler Shubik thought that the TWG would be a good vehicle for the surveillance, and could undertake to meeting within the NCAB two or three tinges a year to up-date. ~. asked whether the meeting was following the agenda, or was the Chairman selecting those items of interest for debate. indicated that he was choosing %hose items which he thought the Ad Hoc could assist the NCAB. [-le felt that on the subj oct of surveillance, the NCAB might wish to set up another internal sub-group for this purpose. The discussinn degenerated into questions of how the NCAB operated and brought forward its agenda for meeting. As far as I can judge, this period of discussion achieved nothing and to some extent was irrelevant. When the discussion returned to surveillance, both Gori and Kensler supported the idea that TWG was probably a good vehicle for this. The addition of a NCAB member to TWG for liaison purposes would be useful. O~ In answer to a question by Foote, some discussion took place on the role 0 of TWG~ the .Clearinghouse, etc. AJ Ca Saffiotti thought the addition of a NCAB member was useful, but hoped b'~ ˘D that the Board would exert influence on the priority of the TWG program.

-4- ( Foote wished io know the members of the TWG and Gori replied• Terry wanted to know who was chairman and to whom he reported. Gori in~icated he was chairman and probably would report to both Rauscher and Cooper because of the interrelationship between NCI and NHLI. Some discussion then occurred on funding of research and the difficulties of obtaining n%ore money. This led to the suggestion that Rauseher should put for\v~rd for NCAB approval, the need for and amount of additional funds required. Shubik thought that %he education side of anti-smoking was as important as the research side. Krabbenhofi then raised his usual queslhin of government support to lhe farm industry. Gori and Kensler answered and countered with the extent of tax revenue achieved by the government on tobacco. Returning to the question of surveillance, Shubik proposed that the Committee recommend thai the NCAB meet regularly with the T~VG and that a Board member be appointed to the TWG as a liaison. This was agreed. ~a

Item 2 Shubik -5- of the agenda was then discussed and l%tllt informed the committee tbat a bill was in the House to level tar and nicotine on cigarette packs. asked whether the committee agreed with the Lasker proposal• The members agreed with Kensler raising the question of handling nicotine differently from tar, since there was lack of scientific evidence on nicotine. Milt indicated the FTC recommended labelling; this was supported by both the ACS and the NCAB. Consequently, there was no need to discuss further. Thus, the Lasker proposal (Item 2) Was carried. The meeting to this time had been disjointed and on occasions almost aimless. then asked if he could speak. He indicated that the NCAB was in a war against the cigarette industry, so what was needed was a millitant board. It was apparent that members were not attending the Ad Ploc meetings, therefore, it was up to Shubik to achieve the support he needed at the NCAB level Foote suggested that the present committee should be closed, and a new permanent committee of the NCAJd be sct up. He had confidence in the scientific side, but the question was a wider one. It was a matterof communications and people. He reiterated that the i~CAB needs a committee to fight the tobacco industry, since its i%~

Saffiotti -6- ( responsibility was to protect the health of the American people against the cigarette industry. This he included in his view of the NHAB roles of protecting people from all forms of cancer. liked Foote's approach and thought it could be wigened to a re-evaluation of all the operations in the Smoking and Health field, including TWG, etc. He felt that the TWG had served its purpose and po~=sibly could be reformed. Milt Foote in an aside, thought this had advantage since it could lead to an avoidance of tobacco industry representatives. liked gafiotti's idea. !-le ~eferred to the v~lue of the Tobacco and Cancer Committee within the ACS. He ihoughi this operation was an excellent one. Shubik indicated he preferred the concept of Board representation on the T~VG. Tart_ y Saffiotti- thought Foote's suggestion was a good one, since it provided a mechanism to allow the NCAB to recognize problems and means of action. continued to attack the TWG and repeated that there was value in asking NCAB to reform the thinking etc. under new terms. ~.~

-. ~ -7- k Could not this Ad floe Committee recommend a thorough examination of the mechanism to identify the problem areas in smoking and cancer• That is yet another group to start fl?om scratch. Foote repeating, indicated the mission of this new committee was to plan policies and actiens, to examine scope of progress and funding. This %vould meet Safiotti's point on the position of the current status of research. Shubik Foote said he was at a loss as to how to express the discussion in a concise form for the NCAB. Foote indicated that Milt who was good with words had wriflen a statement, and he (Foote) would read it: To set up a committee, within NCAB, to recommend to the Board all policies and actions in all areas concerned with Smoking and Health . suggested that rather than make a recommendation to the NCAB, he would ask Shubik to report faithfully and fully all that had been said at the NCAB meeting (,Tune 18-20th). o

• , • _ 8 - Qori raised the question whether this form of recommendation was in contradiction to the one already agreed on; namely, the TWG would be the liaison group with the NCAB with a NCAB member as full-time liaison on TWG. Foote Foote thought not; they represented two approaches which the NCAB could choose• then ~uggesied the meeting had done its job and could be concluded. In fact, he inferred that the Ad Hoc had completed its job. The meeting dosed. REACTIONS I. Obviously, the outcome of Foote's suggestion with its implication, depends on the degree of urgency given by the NCAB during its three-day meeting (June 18-20th). 2. It seems to me that the presence of Foote, Mitt and Terry was planned, with the purpose of "putting teeth" into what some anti- smokers must see as being an innocous outcome to the Ad Hoc deliberations. 3. The move of Saflotti to try and reform TWG can be a dangerous tiling for the industry. 4. If, indeed, a new permanent committee is set up it cab lead to nothing hut problems for the industry. ~q IWH:ef Attachment

i; ( AGENDA Ad Hoc Cor~ttee on Smoking ~nd IIealth ,~1ationa] C~mer Advisory Board 2:00 p.m. June 17, 1975 National Institutes of Health Building 31 Conference Room l0 'i. Discuss the approval by the National C2alcer Advisory Board of the recor~nendations for researGh and action in m..lOkJmg mud health, as formulated by this committee at the last meeting, ~rch 25, 1973. Discuss action on legislative proposal reco~nended by the NCAB (Lasker) : Lhat all cigarette packages be required ~o carry a label oŁ tar and nicotine con~en~s. E 3. Discuses methods to ensure continuing NCAB surveillance of researd* and action in smoking ~nd health. - Conmlents On dismissing the S~aoking and Health Co.7~nittee of the NCAB.