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Comprehensive Smoking Prevention Education Act of 810000 Hearing Before the Committee on Commerce, Science, and Transportation United States Senate Ninety-Seventh Congress Second Session on S.1929 to Amend the Public Health Service Act and the Federal Cigarette Labeling and Advertising Act to Increase the Availability to the American Public of Information on the Health Consequences of Smoking and Thereby Improve Informed Choice, and for Other Purposes 810510 Serial No. 97-123

Date: 10 May 1982
Length: 144 pages
521048897-521049040
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U S Govt - Cigt Labeling & Adv Act Hearings - Hatch Packwood Re: Cigt Warnings (S. 1929)
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COMPREI~NSIVE SMOKING PREVENTION EDUCATION ACT OF 1981 HEARING CO~ITTE~ 01~ COMMERCE, SCIENCE, AND TItANSPOKTATION UNITgD STATES SENATE NINETY-SEVENTH CONGRESS ~COND SESBION ON S. 1929 TO AMEND 'PHB PUBLIC EC~ ~kL'PH SERVICE ACT AND ~H]~ FK'D- ERKL CIGARETTE LABELING AND ADVERTISING ACT TO IN- C~A~]~ TH~ AYAILA~ILIT~ '~0 THE ~ERICAN pUBLIO O~ INFOR~AT~OI~ ON TH~ H]DALTH CON~EQLrEN6~ES OF STROKLNG AND THE[tI~I3y URp~ROVE LNFO~R~D CLtOIC~, AND FOR O~/IER PURPOSES M~y I0, 1982 Serial NO. 97-123 Pzlnte4 for the Bse of the CommttteeonCommerce, Science, aJ~d Tran~ortation ® ~g~01 D ~TJfl, O0~ PR~TI/qG OF]~IC~ WA~B/N~TON : 18S~
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COM~ITrEE ON CO~, SCIENCF~ AND TRANSPORTATIO~ BOB PACKWOOD~ Oregon. ~ BARRy COLDWATEE~ Arizona HOWARD W. ~ON. Nev,&a HAERISON H. s~rrr. N~w Me~i~ RU~SELL B. LONG, Lou~isna JOHN C ~A-NFORTH* Mi~o~rl ERNEST F. HOLLINGS. ~th Czr~Iina NANCy LANDON KAS~EBAUM, Kansas DANIEL K INOUYE. H~vali L~.~Ry pP~SSLER, South Do~ot~ WENDELL H. FORD, Eentucky $LADE GORTON. W~hing~on DONALD W. R~GLE. J~.. Mi~ TED ~TEVENS. ALack a J, JAMES EXON. Nebraska BOB KAS'I~N~ Wisconsin HOWELL HEFLIN~ Alabama (H) % ~J1
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CoNTENTs pag~ Opening ~tatemeilt by the Chairman.. _.... ..................................................... 1 Opel~iag statement by Senator Ford .......................................................................... 2 Openllug ~tatement by ~enator Gorton ........................................................................ 4 Tex~ orS. 1929 .................................................................................................... .............. 6 LIST OF WITNE~E8 Harri~n, Dr Donnld C,ptm*ident, American Heart Association ......................... 16 Let ~er of May 13, 19~2 ............................................................................................ 29 Horrigan, Edward, oh~arman, executive committee, Toba~.~a InstiLute; Roger D. B]ackwell, professor, Departmont of Marketing, Oh~o 8tat~ U~{verslty;, Larry Light, ~xecutive vic~ president, Ted Rat~q & Co, Inc; Joel Cohen, director, Center for Consumer Research, University of Florida; and Charles Sharp, Charles Sharp & A.ssDclate~ ..................................................................... o~ Prepared statement of Dr. t]lackwel[ ................................................................. 63 Preparod statement of Dr. Light ........................................................................ 68 prepared statement o£ Mr. Cohen ...................................................................... 71 Letter of May 12,1982 ................................................................................... 75 Prepalred statement of Mr. Sharp ................................................................... 78 Ruhln, Eric, Outdoor Adverti~htg Association of America; and Da~d h{inton, counsel Magazine Fublishers A~ociat ion .............................................................. 97 Prepared statement of Mr 1Clinton ...................................................................... 10l Water~oa Michael, research director, Advertising A~sneintion, representing £he American A=cso¢iat on of .A-dyer fi8 ng .~ge ne Bs, Amer can Ad~ sr£is ug Federation, and Assodation of National Advertisers; and Michael Daube, Departmen of Community 5 edlclne. Un ,ersity of gdinb6rough, Edinbor- ouch, Scotland .................................................................................................... ......... 29 p~pared statement of Mr Watez~an ................................................................... 82 Prepared sLatement of Mr. Daube .................................................................... 36 ADDITIONAL ARTICLES, LETTERS, AND STATEMENTS American Medica] Association, s~atement ........................................................ t ......... 12g American Scclety of Preventive OncologT, statement .............................................. 122 At~tin, Glenn, M.D., Americ~l Academy of pediatrics, letter of February 9, 1982 .................................................................... : ........................................................ 125 ~akezT, C~n fectionery & Tobacco Workers International Union, statement . 120 Bra~dt, Dr. Edward N., Jr, A~si~'~ant Secretary for Health, Depar~mel~t of Health and Human Services, statement .................................................................. 109 Davis, Jetl}rson C., M.D., president, Americm~ College of Preventive Medl- cine letter of Feb~ uary ~8, ~982 ......................................................................... 1~6 garley, Arthur E, chairman/chief executive officer, Me drum & Fewsm th, Inc., letter of Mary 11, I982 ..................................................................................... 133 Ernster, Virgiifia L. M,D., assist~n~ professor of epidemiolo~D, University of Calh'or nla, Ietter of April g7, 1982 ............................................................................ 131 Olmltz, S'~an~an A., Pb.D., ~reasurer, C.a]ifc)lnians Car N~nsmokers' l~igh~% letter of February 12, 1982 ......................................................................................... 125 Hatch, Hon. Orris, U.S. Senator from Utah, statement .......................................... I09 IIuttcr, ~ober~, V. p., M,D. president, ~nerlcar~ Cancer Society, Inc., letter of Februa~T 26, 1982 ............................................................................... 127 t[olle~ pa~rlci~ A., deputy executive directet, American Nurses' A3~eciation, lne, I@tter of Ma~b 16,1982 ..................................................................................... 128 IHII
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006~0~ -I
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COMPREHENSIVE SMOKING PREVENTION EDUCATION ACT OF 1981 MONDAY, MAY 10, 1982 U.S. S~ArE, COM~IT~F~ ON CO~R(3E~ SCIF~TCE~ AND TR&NSPORTATION ~ Washington, D.C The committee met~ pursuant to notice, at 10 a.m., in room 285, Russell Senate Office Building, Hen. Bob Packwood (chairman of the eommlttee) presiding. Staff members assigned to this hearing: Richard L. Perlmutter, Lawrence Feilerton, staff counsels; Amy L Bondurant and Loretta Dunn, minority staff counsels. OPENING STATEMENT BY THE CHAIRMAN The CHAIR~IAN. The committee will come to order, please. We are ~ssembled today to invesfigafe a produe~ that is linked with over 300,000 deaths per year and one of the most heavily ad- vertised, and promoted. ~az~hict s. in .the world. Not only is the tobac- co busmess a big business m tins country and throughout the world, but cigarette advertising expenditures alone approach $I bil- lion a year. This is the second of two hearings on the Comprehensive Smok- ing Prevention and Education Act of 1981. In March 1982, Senator Hatch held a hearing on this bill which focused on the health-relat- ed issues. Today's hearing will focus on the advertising practices of the tobacco companies and the impact of the hill on that industry. We have assembled three panels of witnesses who will discuss the effectiveness of European programs in cigarette labeling and consumer education, the advertising of cigarettes within the United SLates, and compliance with the rotational warning scheme in the bill. With the release of the 1964 Surgeon General's reporL linking smoking and cancer, the United States assumed a leadership role in informing the public of the health dangers associated with smok- ing. In recent years, however, many European countries have far exceeded the United States in their sophistication in furthering public awareness of the adverse effects of smoking. The program of rota¢ional health warning labels which is pres- ently under consideration by this committee is a program that has proved successful in European countries. I would like to emphasize that we have proposed a system that has already proved to be suc- cessfuL (1) i
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2 I am very concerned about the extent of advertising of cigarettes in publications that are directed at children and women. In fact, there is a relationship between the dramatic increase of cigarette advertising in women-oriented magamines and the number of women afflicted with smoking-zelated diseases. In addition, I am COnCerned about the targeting of young perso~ts throarougth advertisements that create role models of smokers as being ]aealt hy, well-respected, and successful Most important, we are examining this issue today because the American public is suffering from a lack of knowledge concerning the health effects of smoking. Even if this program succeeds in in. forming just a handful of teenagers of the link between smoking and numerous diseases, then our efforts would have been well worth it. I am looking forward to hearing from the witnesses who are scheduled to testify today. Senator Ford? OPENING STATEMENT BY SENATOR FORD SeDatar FORD. Thank you, Mr. Chairman. Today the commiftee is considering S. 1929+ I wart to reiterate what the chairman has said, that we are here today to discuss ad- vertising because the Labor and Human Services Committee has already discussed the health issue. This hearing follows one held by the Con~nistee on Labor and Human Resources. The Senate recently voted overwhelmingly to pass an omnibus regulatory reform bill, S. 1090. The main thrust of H 1080 w~s to require agencies to do an ana~sis of the costs and benefits of poc- posed regulations. I believe an examination of the costs and benefits of this legisla- tlon should be undertaken. What benefits would S. 1929 produce with its requirements of rotational warning labels? Thts question really has two parts: No. 1, is the public aware of the research con- coming the possible harmful effects of smoking; No+ 2, if the public is not aware, will the scheme mandated by S+ 1929 create that awareness? To explore the first question, how knowledgeable is the general public about the possible effects, tim Federal Trade Commission staff report on cigarette advertising released in MaLy of 1981 stated that studies have found that 90 percent of the public were aware that smoking may be harmful to your health. That staff report ac- knowledges that it is possible that a small portion of consumers are unreachable on the issue of hazards of smokteg. I would cite many other example~ of the exceptionally high level of awareness that the public bas concerning the specific effects to which the rotational warning labels are addressed. I think the sta- tistics found in the b~ staff report show something we all suspect, that the public is quite knowledgeable about the possible bezards azsoeiated with smoking. However, even if we were to assume that the public was unaware of any possible harmful side effects, would the requirement of rota- tional warnings in S. 1929 raise the level of awareness? Testimony in hearings before the House Committee on Energy and Commerce
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9 from advertisers indicate that the scheme proposed by S. 1929 would not work and in reality would be counterproductive. Let me repeat that. The advertisers indicated that the scheme proposed by S. I929 would not work and in reality would be counterproductive. Advertisers follow a simplle creed which I will paraphrase: "Keep • it simple, kee,~ it clear, do it often, make it consistent, and be single-minded. Changing labels frequently will not increase aware- hess. It will merely confuse and alienate the reader. I believe the reason we have such a phenomenal public aware- hess, 90 percent, is due to the fact that the warning label bus basi- cally remained the same since it was instigated in 1965. The American people are bombarded with information on smoking. Groups such as the American Heart Association and others effec- tively disseminate information about smoking through print, radio and television. The American public is welt aware of the research done in file hazards of smoking. Whether that knowledge flows from the warning label or from otber sources or a combination of all this information, the fact re- mains that only a small percentage of the American public is not aware of studies that indicate smoking may be hazardous. And that small percentage may reflect, one, smokers who refuse to believe there are dangers; or, two, that small portion of consumers the FTC staff cites that are unreachable. I do not agree with some of the FTC conclusions and the implica- tions in S. 1929 that portray the American public as too ignorant of the risks that have been associated wit~ cigarette smoking. The warning label new used was originally devised as an alert. If you test any random group of consumers, I am sure they will indi- cate that they are alerted to the risk of smoking, whether or not they are a smoker, but they are incapable of providing the precise knowledge required by the FTC. The level of awareness is astonish- ing lyh',n~Jh, I think at some point the American public can become jaded, and it is time for the Government to use health hazard warnings ~vlth caution. You can overwhelm the public and I believe we have reached that point. Every night the news media reports some Gov- ernment or independent finding on the hazards of salt, cholesterol, rich food products, coffee, sugar substitutes, red meat, wine, beer, and whisky, and the last three will help eliminate the malaise of the above, Why then do we need S. 19297 In this era of deregulation, why do we need more burdensome requirements imposed on an entire in- dustry? I see little benefit flowing from this bill. What I do see is a misguided attempt to prevent educated consumers who wish to smoke from smoking. This bill would not accomplish that purpose and no legislation will. Its estimated cost, $40 million to the tobacco industry alone. It places unnecessary regulatory burdens on an industry which con- tributes more than $57 billion to the gross national product. In Kenthcky alone, tobacco means income to 164,090 farm families. It means 81,000 jobe and $48 million in taxes to that State. The American tobacco industry is now involved in a highly com- petitive attempt to provide the consumer with low tar, low nicotine cigarettes. Consumers receive information on these new ultralow
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4 tar products through advertising. £ think it is an encouraging tread that low tar brands account for nearly 50 percent of all cigarette sales in 1980 compared to 2 pe~ent in 1974. The 1980 Surgeon General's report concluded that smoking ciga- rottss with lower yields of tar and bicoVme poses a lower risk than smoking other cigarettes, prodding there is no change in the smok- ing habits. We should be encouraging the development, production, and marketing el' new ultralow tar cigarettes. One last pebit~ Mr. Chairman. We have a report based on ques- tionable data and the bill wl~h is presumably based on that report, and I have many unanswered questions concernin~g the FTC staff report. There are also many unanswered questions concerning the effects of this bill, the costs of compliance both to the industry and to the taxpayers. Mr. Chairman, if this bill, S. 1929, is drafted from the FTC's staff report~ I feel we need an additional day of hearings on this bill to talk to the FrC and get some of the answers. I would request at this time, Mr. Chairman, that the committee schedule another day so that the Senators of this committee can hear from the Commis- sion. I hope that we might agree that the American public does not need or want Congress to initiate cosily programs of little or no benefit to the people. S. 1929 is a perfect example of yet another Federal solution to the problem that does not exist. The CHAIP~AN. Senator Heflin~ Senator HEFLIN, I have no comments. The CHAIRmAn. Senator Gorton. OPENING STATEMENT BY SENATOR GORTON Senator GORVO~. Mr. Chairman, there can no longer be a serious question that cigarette smoking is the single most important pre- ventabis cause of illness and premature death in the United States. Estimates of the number of deaths related to smoking exceed 300,000 per year. Columnist George Will recently reported that more Americans have been killed by tobacco than have been killed in all America's wars and traffic accidents. Smoking is a major cause of lung cancer, other cancers, emphyse- ma, and chronic bronchitis. It is one of the major risk factors for heart disease and is also associated with peptic ulcer disease. Ma- ternal cigarette smoking may result in miscarriage, premature birth, and retarded fetal growth. Happily, the prevalence of smoking is declining in America. I be- lisve that this is attributable in large measure to public education on the hazards of smoking. However, a recent FTC staff study clearly showed that far too many smokers still do not have sufil- alent specific information about the relationship between smoking and some of its most serious health consequences to make an in- formed judgment about the nature and extent of the risks involved in smoking. For instance, the FTC found that nearly 50 percent of women do not know that smoking during pregnancy increases the risk of still- births and miscarriage. Also, more than 30 percent of the public
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5 was found to be unaware of the relationship between smoking mad heart disease. S. 1929 is designed prinmlily simply to Fill this in£ormation gap, This is especially important with our young people. In the previous hea~g on S. 1929 before the Committee on Labor and Human Re- sources, testimony on behalf of the American Cancer Society re- vealed that by the ages of 17 and 18 the incidence of smoking Lu young men is over 19 percent and in young women over 26 percent. Young people are attracted to smoking by advertising, peer pres- sure, and imitation of peers and adult~. At the very least, we must make certain that they have the best specific information about the health risks of smoldng readily available, so that they have the opportunity to make an informed choice. We are speaking here of a program of health promotion and illness prevention. As Senator Hatch has eloquently stated, this is the most cost ef- fective type of health program possible, not only in terms of dollar cc~ts but also in tomns of human costs. Mr. Chairman, for these reasons I am pleased to cosponsor S. 1929 and to partisipale in these hearings. [The bill follows:] 0~
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H 97T~ CONGRESS S. 1929 To amend the Fubli~ IIealth Service Act aud flt~ Feder~,l Cigarette Labvlh~g and Adver t~tg Act lo increase the a~filabili~y ~ the Amexiean l~ub~i¢ of idor- ration on the health ¢o~qu~n~ of smoklz~g and there~ ~mprow inYormed choke, ~ncl for other pteeposes. THE SENATE OF THE UNITED STATES . D~O~MBI31~ 9 0eg{sl~tive d~y, NOVEMB~ 39), 1981 Mr. T4"~'roI (for hlm~elf an¢~ Mr. pAC~'WOOD) intrcdl]ce~ the fnllov~g bflh which Was read ~wiee and referred jointly by tmaninloua e~nsent to the Conrmitt~es on Comcmeres, 8e~noe, aud Trai~l;m~a~[on a~u[ Labor and Hunlan l~esouroe$ A BILL To amend the Public Health Service Act and the Federal Cigarette La'~el~g and A~vertlslng Act to increase the • avsilability to the American ]mblic of information on the health consequences of smoking and thereby improve in- foim~d c, hoiee, and f~r other ]mrposes. 1 Be it enacted by t~e Eena~ a~d House of Repre~ent~- 2 ~i~ of l~e U~ited States of A~aedca ~n Cang~ a~mbled, That this Act m~y be cited as the "Comprehensive Smok~ug 4 Frevention E~ucalion Act nf 19li1". f.~ ~e,...~--'Y$_
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2 1 FINDINGS 2 SEC. 2. The Congress finds tl~t-- 3 (1) cigarette smoking is the largest preventable cause of illness and premature death in the United 5 States, and is associated with the unnecessary deaths 6 of over three ]tundxnd thousand Americans annually; 7 (2) smoking is the primary cause of lung cancer fi and emphysema in the United States, and is assoehted 9 with other cancers; 10 (8) heart disease aeco]mts for nearly one haft of 11 thP deaths in the Udi.ted States, and one-third of the 12 ' deaths attributable to heart dlsea~e are assoeiatnd with 13 ~noklng; 14 (4) the risk~ of ndsearriage, stillbirths, premature births, and child weight deficiencies for pregnant 16 women who smoke are higher than" for pregnan~ 17 women who do not smoke; 18 (5) certain occupational hazards, in conjunction 19 with smoking, increase substantinily the risk af disease 20 and death; and 21 (6) present Federal, State, and private initiatives 22 have been insufficient in conveying to the American 23 public the information contained in clauses (1) through 24 (5) of riffs section and other hilorinatiou regarding 25 smoking. i
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8 3 1 PURPOS:~ 2 SEC. 3, It is the purpose of this Act to provide a new 3 strategy to educate and provide ]nfom~tlon to the ~raeHcan 4 public that will allow indtvidaals to make h~ormed decisions 5 conceralag smoking. 6 SMOKING RNSE2~RCtt, EDUCATION, AND ~FORMATION 7 S~c. 4. (a) Title XVII of the Public Health Service Act 8 is amended by adding at the end thereof the following new 9 section: 10 "SMOKING AND HE A]/2H 11 "Ssc. 1711. (a) ~ Secretary shall establish and carry 12 out a program to inform the pchllo of the dangers to health 13 from cigarette smoking. In carrying oat such program, the 14 Secretary chall-- 15 "(1) coordinate all activities of the Department 16 which relate to smoking and he effects en health, in~ 17 eluding research and demonstration projects an~ edaea~ 18 tlonal activities; 19 "(2) through the Interagency Committee on 20 Smoldng and Health estchlichec~t undar ~ubsecllon (b), 21 coordinate the activities referred to in clause (1) of this 23 suhre~lan with all other activities of the Federal Gov- 23 ernment which relate to smoking and its effects on haalth; S* 19~-4m
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4 1 "(3) through the Iuterageney Committee on 2 Smoking and Health established under subsection Co), 6 eoor~natB th~ activities of the Federal Gcwrmnent re- 4 fcrred to in clauses (1) and (2) of this subsection with 5 similar activities in tim privste sector; 6 "(4) conduct research and develop new raetho~s 7 for informing the public of the effects of smalSng on 8 health, either independently or in conjunction with the 9 private sector, for use in a national effort; 10 "(5) eolieot, analyze, and disseminate laform~ffon, 11 studies, and other data related to mnaldng and its el- l2 fee~s on health; 13 "(6) make available, through speeffzc publications / • 14 and bibliographic and raleronee materials, jhionuation 15 on research efforts relating to smoking and its eflcots 16 on health; and 17 "(7) undertake any other add~tlonal informational 18 and researab aotlv~tles whiab the Secretary dotermihos 19 necessary and appropriate. 20 In carrying out the requirements of this subseetien, the floe- 21 retary shall seek to develop methods of communication with Federal, State, and local e~tit~es, as we~ as w~th the privaCe 26 sootor. 24 "(b) 1 To carry out the activities described in clauses 25 (2) and (,~) of subse~ffon (a), there is established an Inter- 8, I~t9
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r 10 5 1 agenvy Committee on Smoking and H~alth. The Committee 2 shall be composed of-- $ "(A) represontatlve~ from eppreprlate instltutBs 4 and agencies of the Dv~Lment, which may include 5 the National Heart, Lung, and Bleocl Institute, the N~- 6 tional Cancer Instlmte, the National Institute on Chld 7 Itealth and Devalepment, the Itoalth Scrvlces AdmSn- 8 istration, the Health Resources Admiulstration, and the 9 Oenter for Disease Coutral; a~d 10 "(B) at least one represeutat~ve from the Federal 11 ", Trade Commission, thv Department of Education, ~c 12 Department of Labor, and any other F~leral agency 13 designated by the Secretary. 14 "($) The Coramlttee shall meet at least four tlmos each 15 year. 16 "(c) The Secretary shall transmit a report to Congross 17 aot Iater than Janua~ I of e~h year wh~ab shall contain- 18 "(1) current iaformatlon on the offocts of smokfog 19 on health; ~0 • ,(2) an overvivw and assessment of Federal actiw 21 itles undertaken to inform the publle of the effects of 22 • • smokleg on health; 2~ "(8) leforn~tlon rngard~ th~ activ~tles of the 24 private sector with respect to the effects of smoking on ~5 health; au~l
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11 6 "(4) such reeormaencl~tlons for legislation as the Secretary rna3, consider appropriate.". (h) Section 8 M the Federal 0igarette Labeling and Ad- 4 v ertisfog Act (15 ILS.C. 1337) is amonde~l by striking out 5 subsection (a)and by striking out "Co)" befor~ "The Federal 6 Trade Commission". 7 ()IGARETTF~ LABE LZNG 8 S~c. 5. Section 4 o[ the Federal 01g~retto Labeling ~n~ 9¸ Advcrtlslag Act (15 U.S.C. 1838) is anlended to read as fel- l0 lows: 11 '%~LI~¢O 12 "8mc. 4. (a)(1) It shad be lmlawhtl for may person to 13 manufacture, import, or paabage for sale or distn?outlon 14 within the United States, or advertise may cigarettes, the 15 package or a~Ivortisomont for whlab fails to bear one of tko 16 following statements: 17 "(A) 'Cigarette Smoking is Dangerous to Your 18 He~dtfo For Information on the Speelfle Heath 0onso- 19 quenees of Smoking, Write: Surgoon General, U.S. 20 Public Hcnith Serwec, Washington, D.C., 20201.'. 21 "(B) 'WA]/NING: The Surgeon General has De- 22 tem~hmd that Cigarette Smoking Causes Emphysema, 23 Lung Cancer, and Other Cancers.'. ~. 1929-1s i
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12 7 1 "(C) 'WA]~NING: The 8m'gec~a General has De- 2 termi.cd thu~ Cigaretf~ Smoking Causcs Heart Dis- ~a$~.~, 4 "(D) 'WA~N]NG: The Surgcon General has De- 5 termined that Cigarette Smoking by Pregnant Women 6 ~I~ Resul~ in ~iscarr~ag~. Pr~ma~twe ]~ir~s. or Child 7 Weight Deiicicacles,'. 8 . "(E) 'SMOKERS: No Matter How Long You 9 Have 8rooked, Quitting Now Greatly Reduces The 10 Ri~s To Your B'~al~h.'. 11 "(2) The labclkng statements specl/'md in ]~ara~aph (1) 12 of this subsection shall be rotated on the packages of each 13 brand of ~igarettes ~d the advertiselaents for each brand of 14 cigarettes in a manner ~t assures that each of such Iab~llng 15 stat~n~a~s appears an equal, ntun~)er of tiraes on each brand 16 of cigarettes and all s~mh ~]~erti~ement~ within the/ifteen- 17 mon~ I~erio~ b~g on the effective d~te of tl~ ~ubsec- 18 tlo~ an~ each succeedlng fffts~n-month p~rio d. 19 "(3) Any h~beli~g statcment reeluired under this subsec~ 20 tlon shall be located in a consp~cuou~ place on every cigarette 21 package and in each advertisement for cigarettes, and shall a1~l~ezr in con~;¢uou~ and legible t)Te in contras~ by ty~og- rai)hy, l~y~ut, or e~lor with all other 1)rinted ma~cri~ on ~c 24 package or advcrtisement, 5, l~J--[s
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13 8 1 "(4) In accordance with the provisions of section 553 of 2 tltle 5, Udited States Code, ~e Fe4eral Trade Commission 3 shell establish by rule a system to ensure that labeling state- 4 ments required under titis subsection are rotated in accord- 5 ante ~ith the provisions of paragraph (2) of this subsectinn~ 6 and that at any time each of the five inbeling statements 7 appears on at least 15 per centum of aU cigarette p~ckages 8 and advertising. 9 "(b)(D It shall be unlawful for any person to manufac- 10 tare, imporL, or peekage for sale or dlstrlhaLisn within the 11 United States any cigarettes, the package of which fails to 12 disclose the level of-- 13 "(A) tar; 14 "(B) nCeotlne; mid 15 "(C) carhan monoxide, 16 eontalnad in SuCh c~garettes. 17 '!('2) Such tar, nicotine, and ~arhon i.onoxlde levels 18 shdil by hased on the results of the most recent tests of clga- 19 rettes by the Federal Trade ConunlssiolL The Federal Trade 20 Commission shall perform such tests at least on an annual 21 basis. 22 "(c)(1) It shall be unlawful for any person to manuine- 23 ture, import, or package for sale or distribution within the 24 United States any cigarettes unless such person has provided 25 to the Federal Trade Commission and the Depertment of 96-~I 0 82--2
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14 9 1 i~eMth and Human Services a ¢omplste lis~ of each ehemieal 9 ad~tive u~e¢l in the m~ufaeture of ~uch ~igarcttes aml the quantity of such ~Iifive. "(2) The Federal Trade Oommlssion and the Depart- 5 ment of ITealth¸ and Human Scrviees and ~ny officer or era- 6 ployee thereof shall not dla~loso to ao~" person outside the 70ormn[ssion or the Depaxlmen~ any informatlon reeelved put- 8 sua~t to paragraph (1L 9 "(3) l~or purposes of section 559(b)(43 of ¸rifle .5, Unite0 10 States Cod6, and section 1905 of fiti~ 18, United State~ 11 Code, any information received by the ]~e~ral Trad~ 0om- 12 mission and the Department of 1Tealth and Human Services 13 pvxsuant to paragraph (1) ~hall be considered to be a tra~.~ 14 ~ec~eL". 1~ p~EMPTION 16 S~o. 6. S~ion 5(a) of ~o Federal Oigarette Labeling 17 amt A~Iver~ing Ae~ (15 U.8.C. 13~4(a)) is amend~d-- 18 (1) by striking out ~'stateraent" each place ~ ap- 19 ~ears a~ in~er6ng in lieu Lhercof "s~atcmcnt~"; aad 20 (2) by in~er~ing b~fore the period the following; ~1 "or in any cigarctt~ advertising". S~o. 7. (a) E~co~t a~ provided in subsection (h), tho pro~'islons of this Ac~ shall take effect on the date of enact- 25 men~. i-~
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15 (b) The amendments made by sections 5 ancl 6 of this 2 Act shall take effect upon the expiration of the one-year 3 period beglnvlng on the date of the enactment of this Act. 4 During such.one-year period, tile Federal Trade Oom2nlstion 5 shall promulgate such reg~latlons as may he necessary to 6 implement the amendments made by sections 5 and 6 on 7 their effective date.
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16 The CHAIRMAN. We will adhere to our normal conuinttee rules on the testimony this morning. All of the testimony will be put in the record in tote, and the witnesses will be limited to 5 minutes apiece so that we will have time for questions. And I can assure you that we will have a number of quesLiens. I have had a chance to read all of tbe testimony tbat was submit- ted as of the weekend and I found it most illmalneting. We will start this morning with Dr. Donald Harrison, president of the Amerlcan Heart AssoCiation. Dr. Harrison. STATEMENT OF DR. DONALD C, IIARRISON, PRESIDENT, AMERICAN HEART ASSOCIATION Dr. HARRISOW. Mr. Chairman and members of the committee, I am Dr. Donald Harrison, William G. Irwin" Professor of Cardioiegy and chief of cardiologyaat Stanford University, and at the present thn~ president of the Ametican Heart Associatier~ I appreciate this opportunity to testify to your committee on behalf of the National Interagency Council on Smoking and Health, composed of 27 national organizations, and the Coalition on Smoking or Health. composed of the American Cancer Society, the American Lung Association and the American Heart Association, to ether with the Intoragency Council. ~e share a common concern about the health consequences of cigarette smokie~ and are attempting to bring issues relating to the prevention of smoking, especially among children, to the atten- tion of the public and legislatures. We strongly support smoking prevention and research on smoking abatement. Today we testify in strong support of S. 1929, the Comprehensive Smoking P~eventien and Education Act of 1981. Our written testi- mony has been subnfittod and I wlsh to enlarge on several specific poinLs. - Initially, let us review the health consequences of smoking, as you have already done this morning. First, cigarette smoking has been unequivocally linked to lung cancer, emphysema, chronic bronchitis, coronary heart disease, and other medical conditions. Second, during his testimony on March 11, 1982, Assistant Health and Human Services Secretary Brandt reemphasi~d the specific jusVffickiion for cigarette warning labels and his support for those similar to the recommendations in Senate bill 1929, and seven points in his testimony. Assistant Secretary Brandt stated specifically: No. 1, cigarette smoking is the largest preventable cause of ill- ness and plemature deaths, and is associated with the unnecessary deaths of over 900,090 Americans yearly;, No. 2, cigarette smoking is the No. 1 cause of emphysema; No. 3, cigarette smoking is the No. 1 cause of lung cancer and chronic obstructive lung disease; No. 4, cardiovascular deaths number nearly 1 million, nearly, and it is estimated that one-third of those are attributed to smok- ing~o.-- 5, cigarette smoking is one of the mojor risk factors for coro- nary heart disease, that is, heart attacks and sudden cardiac deaths;
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17 NO. 6, pregnant women who smoke are at a higher risk for spon- taneous abortiolm, still births, premature births, and child weight deficiencies than women who do not smoke; No. 7, cigarette smoking is addictive and in a major way it in- jures hsalth. Third, in February 1982, the Surgeon General report entitled "The Health Consequences of Smoking~ancer," found cigarette smoking w~ a major cause of cancer of the lung, larynx, oral cavity, and esophagus. It was suggested as a contributory factor to bladder, kidney, and pancreatic cancer. Senator FOR~. Mr. Chairman, f do not want to stop Dr. Harrison from his testimony, but we are here trying to attempt to determine advertising issues and health issues already on the record. And Dr. Harrison, I hope you understand why I am saying this. We want to addre~ advertising, labeling, and the findings in S. 1929. I do not think that the opposition to your statement will be here today, and therefore I hope you would 1Lmit it to advertising and what we can do through the labeling process. The CHAIRMAN. Wendell, if you would look at the last four pages of his statement. Senator FORD. Well, he can get to those, Mr. Chairman. The CeAIPd~AN. Well, he only has 5 minutes, so he'll get to them soon, I am sure. But the last four pa~es relate to the bill, to label- ing and consumer information. Dr. HARRmON. 1 will turn to that chortiy. Fourth, widespread medical and scientific evidence agree on the health hazards of smoking, and yet the tobacco industry maintains a controversy exists because a handful of scientists still do not accept these conclusions. The 30,000 scientific studies amassed since 1964, with the release of the first Surgeon General's report on smoking, demoastrate overwhelming acceptance by the medical community. I maintain there is no controversy, only public relation tactics to confuse and create doubt in the public mind. Now let us turn to the need for warnings on cigarette advertising and packaging. Again, I do not believe there is a controversy. Public opinion overwhelmingly supports the idea. Professional ad- veetising groups have attempted to discredit the rotation of disease- specific warnings in prior hearings. Personally, I would llke to see the entire warning for alI points printed in each ad and on all packages, perhaps as a wraparound at the hs~iom mad the top of each package. To me, the rotational plan is a compromise of what is really needed. Second, thep~resent genel~i warning is kuown by 90 percent of Americans, as has been stated. It is worn out and has reached the point of diminishing returns. We need a new, more specific set of warnings expressing the facts dearly aud openly, such as "The only safe cigarette is a nonsmoked one." The administration continues to support the major concepts in this hill. In a letter to me dated April 5, 1982, Ms. Virginia Knauer, Special Assistant to the President, wrote: The administration is deeply concernedDyb the compelling evidence linking ciga- rette smoking to a wide range of illn e~ses. The administ rntlon believes the warning ~=~ g~ 00
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18 ]abels Mer~g ~he puh~ ~ the~e baz4~ ~ entlrely appropriate ~tI that the pr~ent w~rn~gs could be sLr en~hened. The administration is still studying" the relative efficiency of the disea~e-specillc labeling scheme. On all other polnts--the over- whelming scientlflc evidence, the appropriateness of warning labels, and the need for stronger warnings--the administration and the health community are in complete agreement. What wilt these new warning labels do, is the next point that I want to address. They provide information to the consumer at little cost to the Government or iilduetry, since wardi~g labels are al- ready required. Second, they are health information labels to provide the public with information they need to choose be~veen smoking and not smoking. They are Government aids te protecting the Araericm~ public. Third, since tobacco and tobacco products have been exempted from all health laws enacted by Congress, namely the Food, Drug mad Cosmetic Act, the Consumer Product Safety Act, the Toxic Substance Act, the ttazardous Substance Act, and the Fair Packag- ing and Labeling Act, this type of informational message is the only type that is remaining to convey to the American public the scientifically documented health hazards of smoking. This responsi- bility must he accepted by the Federal Government, for no other ~gFency in society can do the "oh. l iaally, for a few personal observations. As my curriculum vitae will indicate, 1 am not an advertibing exper~ and I do not come here today to address the technical aspects of advertialng~ But I am exposed, as are all American consumers, to the large mid colorful cigarette advertisements which appear in such profusion in maga- zines and billboards. There are some fundan~entM questions wifieh have occurred to me as a physician and a concerned citizen as I view this ad'¢ertlse- mont. First, i have heard the argument that the cigarette adverti~ bag is not aimed at getting people to start smoking, but rather in ettibg current smokers to switch brands. From ads I have seen, I ~nd it difficult to believe that these clever, highly impressive lay- outs are net totondod to induce nonsmokers to start smoking. Millions of Americans, including hnpre~tsnable yeunng peoopib-- and I have three such--see cigarette smoking associated with the active, healthful, excitirLg lifestyle. They see smokers depicted as attractive young people of both sexes, dressed at the helghi of fash- ion, and portrayed in glamorous and heauil fu] settings. Let me show you a few examples. This advertisement for Virgh~- ia Slims stresses their campaign theme, "'You have come a long way, baby." In all of the ads in tS-ds campalg~ the object seems to he to show in a flip, humorous way the unacceptable conditions ul~der which unliberated women are forced to live. This ad clearly says to me that young, chic, liberated women prove it by smoktog. I hciibve that tiffs would t~nd to ~nduce young women to get with it and take up the habit of smoking and ulti- mately the health hazards associated with it, Another ad just says that if you smoke more clgarettes you will be "More satisfied." We are told that by a slim beautiful woman with a clear complexion and a stylish hairdo who is dressed n the
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II I I II IIII II ,%2104891S
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20 Senator FORD. Oh I understand that. But if you put all labels in the bi , it would be a terrific amount. It is almost llke labeling a can of beer. You would have to have a quart in order to get the wording on it. Dr. H~so~. I would think that the wording could be pared down to be small and be much more specific and be very promi- nently displayed in the ads and I think that that could be done. Senator FORD. Can you beat 90 percent? Dr. tlaRRXSON. Well, that leaves 5~400,000 of them 1lot knowing about the risk, and I think that the risk of heart disease perhaps stir is 50 percent that do not know about it, They may know about cancer, but I think that nearly a million heart disease each year, that it is a greater risk in the long term from that standpoint. Senator FORD. But Doctor, you say that rotating the content of the warning label is a simple matter. Since we have not had the benefit of FTC's testimony on this procedural matter, I was won- dering if you would ad~se the committee on how you reached this conclusion. Dr. HA~L~SON. AS I have pointed out, I am not an expert in ad- vertising, mid I will leave that question to your next three panels. Senator FORD. But you have arrived at a conclusion here tedas. You endorse this legislation. Dr. HAm~ON. Yes, I do. Senator FORD. Then how did you arrive at that conclusion? Dr. tL~RmSOI~. Even, sir, if it costs several nCfllicns of dolling, as l think you pointed out in your testimony, it seems to me that the warning to the American public is desperately needed at this time with the terrible toll that ~moinng has extracted from our public health problems of today. Senator FORI~. Well, you stated that this legislation seeks only to provide information to consumers at no cost to Government or in- dustry. Unfortunately, there will be costs associated with this bill, costs to carr~ out provisions that the Secretary of Health and Human Serwces conduct research, develop new programs, collect, analyze, and disseminate information, make publications, material, and information available. I think it must be made clear rigrht now that there wilt be costs to the Government associated with t~nis bill, that there will be costs not only in setting up this program but in administering and monitoring the rotational warning system. Again, this committee and the previs~ two committees that have held hearings on tins bill have had the benefit of testimony as to the cost to the Federal Government of this bill. No one really knows how many supervisors, how much surv(fllance, how many dollars that is going to cost the industry. Can youpA,lease tell us Do. Harrison on what you base your statement that rotating labels are a simple matter and there wfl be no costs associated with this bill? Dr. HAPmISON. Well, in my prepared testimony it said no cost, but even sir, let me point out that cigarette smoking in this coun- try costs $13 billion in medical care costs each year, $25 billion in lost economic productivity, and $8.8 billion at this time for medi- care and medicaid, and in my previous testimony on the NIH ap~ prepristinn legislation, I ~ointed out that the chronic health care costs hi this country are mcrea~mg rapidly and medicare costs are
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21 being driven up so rapidly by diseose6 which are largely feinted to smokthLg that it seems to me even if there is cost, that we must invest this to abate this preventable disease that we have going on at this time. It seems to me that it is time that our Nation looks at this as our No. i preventhble health problem in the count~ry, and even if" it does cost, we should take this quite seriously and begin to work with it. Senator FORD. We had an administration that believes in getting regulation off your back--and the bell rang. so I will come back. The C~R.~. Senator Hefiin? Senator HE~. Doctor, you are an outstanding specialist in the field of the heart. 1 wonder if you have gathered any statistics yourself and in the event you have not, whether there have been any statistics that have been gathered by various educational or as- sociations dealing with heart d~sease which would indicate in sever- al types of categories, first, these that you have treated or those that have been treated by other doctors but still in the statistical study before they have heart disease where the doctor has warned the patient that the smoking is injurious to their health. Then I would put it if possible into certain categories like one, two or three packs a day, and what percentage of those that you have told this have stopped smoking. Dr. H,~ISON. Senator, I do not have the exact data that you are asking for, but there are numerous studies, and the Framlngham study from Massachusetts is perhaps the most notable study point- Lug out that with increasing number of cigarettes you smoke, the increasing risk of heart disease, and that is almost a linear in- crease, going up to multiple fold increase after a number of years of smoking, it is also know~ that if you took the curves that are plotted here in this b~klet showing the total cigarette consump- tion since 1900 to 1979 in this country, if you plotted the coronary heart disease death rate, you would have a curve that would almost superimpose on top of that curve. Senator HEI~7~IN. I am asking you about warnings that you have given to patients, and how many of them have complied with your request that they stop smoking? Have you made any figurc~ yourself, personaIt~t That is before they have heart disease. Then I want to ask you after they had a heart disease, what per- centsge respond to your oral warning? Dr. PLA~RISO~. I would say, sir, that in my e~perience, about ~O percent of the people that ave given all of the information and warnings that have not yet had some major event wfiI stop smok- ing and net start again. Senator ttEFL~. IS this before they have heart disease? Dr. HAr~LSON. That is right. Senator H~FLr~. NOW, what about after they have heart dise~e? Dr. PhR~SO~. The most convincing thing hi terms of getfing someone to stop smoking is to talk to them after they have had open heart surgery or coronary bypass surgery. I have a very e~sy tune of getting 70 or 80 percent of those people to stop smoking. Senator HEFLIN. That is after? Dr. HAm~ISON. That is after a major heart operation.
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]1 II I I II F
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22 Senator GORTO~r. Even beyond labeling, I take it that if you were able to set public policy for the United States, you would take fur- ther action in connection with the prevention of smoking, is that correct as well? Dr. H~RISO~. I think we need major health education and health prevention messages to the public in a broad way, looking at the change in lifestyle and behavior that can affect our health in a m0ajor way. I think the progress we have made in 10 years with the -percent decline in cardiovascular deaths has been a very impres- sive one, and I believe that we can continue that and that many of the illnesses that ravage the aged population in this country and ultimately stand a clwnce of bankrupting our medicm~e and medic- aid systems c~n be prevented. Senator GORTON. Am I also correct in saying that your te~tlmony in favor of this biII is not conditioned upon a finding that it will be of no cost to the tobacco compaki2~ or to those who smoke, that even if there were a significant cost which in fact raised the price of cigarettes, you would still feel that this was an investment very much worthwhile? Dr. HARRISOn. Absoluinly~ and quite strongly. Senator GORTO~. Thank you, Mr. Chairman. The CH~RMAN. Senator Stevens? Senator STzv~gs. Doctor, your testimony indicates 90 percent of the public know or believe the content of the warning now, and yet you say you think that current warning has reached the point of diminishing returns. Why is that? Dr. HARRISON. Sir, I think that the warning as it now reads says "Warning: The Surgeon General Has Determined That ~lgarette Smoking Is Dangerous to Your Health" is not nearly as effective as saying it causes lung cancer, heart disease, chronic obstructive lung disease, and so forth. Senator ~r~vzNs. If 90 percent of the people know of the warning and still smoke, what good is it goteg to do no matter what you say? Dr. HARmSON. I think the warning labels, sir, are aimed more at preventing people from starting to smoke than smoking abatement or stoppin~g people from smoking. People are addicted to nicotine, and we need more research on how they are addicted in nicotine to be able to rgckie that problem. My concern is the young people starting smoking. I think very specific warnings are much more effective than the general warn- ing that we now have. Senator SrgvENS. What has your research shown as to what causes a young person to start to smoke? Dr. HARRISOr~. Again, [ will demur from that. I am net in adver- tising, but I think that from a personal standpoint I believe that ads such as this that depict beautiful lifestyles with smoking ciga- rettes causes young people, particularly in their very early teens, to start smoking. That is my personal opinion. Senator Sesv~Ns. Did you ever smoke, Doctor? Dr. HARRISON. I never smoked, sir. Senator STSVENS. Do you have any children that smoke?
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24 Dr. HAR~SOU. No, sir, none of my children have smoked. I have given them the message from very early childhood not to smoke. Senator STEVE};S.. Then are ~ou.not the living proof of the. answer that the problem is communication from pa~ent to child and not advertising or public progran~s or government interference with the lives of people, but having the families teach the children the lifestyle that they ought to follow? Dr. ~so,~. I am a living example, but there are 54 million people who arep<otential parents who smoke, and it is very difficult I think to take that approach. Senator STEw,s. Maybe you have been trying to give them a message, their children a message through advertising, and you should ask them tog~'ve a message to their children themselves. Did you over thinkof that? Dr. HARRISON, I think that is a very good point. I hope that more people do that, in fact. Senator SrgvgNs. Thank you very much. The CH2,m~N. Sevator Ford? Senator FoPm. Doctor, you say you want to stop people from smoking or not let them start, which would probably be your main gosi and you are commendably concerned about educating youth on t~e potential health risks associated with smoking, particularly those youths who b_ave not yet decided to smoke. How is a label printed on a cigarette package stating that the Surgeon General has determined that cigarette smoking by preg- nant women results in miscarriage, premature births, or child weight deficiency going to deter a 12-year-sial bo)y from taking up smoking, or for that matter convince a 30-year~oldman from amok- Dr. HARRISON. I do not think that the pregnancy one is going to be as helpful as the one that warns about lung cancer and chronic obstructive lung disease. Senator FORD. I asked you a question about--this is one of the proposed labels in the legislation that you have endorsed, and I asked you how it would prevent or help to step a 12-year-cid from smoking. Dr. HARRISOn. Sir, I am afraid I do not know the answer to that. I think he might be concerned with his ftlture life if he is a very perceptive 12-year-std. Senator FORn. He beats 12-year-olds down on Yellow Creek Key. I will tell you. You state in your testimony that there is no agency in our soci- ety other than the Federal Government which can inform the public as to the poten~ai health risks associated with smoking. However, in your opening remarks you state that the newly formed NICSH seeks to provide a cooperative and independent force to inform the public that 27 national organizations actively support that council. In these times of fiscal restraint, increasing reliance on volm~- teerism and reduced Federal regulations, it seems to me that NICSH has the ready organized resources to be able to step ibr- ward and volunteer on a public information campaign at truly no cost to the t~xpayers. Am I wrong in that?
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25 Dr. HARRISOI~. I think that is the firm resolve of all members of the NICSH and the American Heart Association to continue this. I think that the only group that has the ability to regulate this and require it is the Federal Government. Those ageheies are mounting mass campaigns of education against cigarette smoking at the pres- ent time. Senator FORD. Well, if your express purpose is to deter children from smoking by providing them with health information, how will publishing such information on a cigarette package in the form of labels help to inform a nonsmoker,pmarticuiarly children? Dr. HARRISON. I think that this kind of advertising is viewed by everyone. If there are 17 advertlsements--- Senator FO~D. I do not think you saw this advertisement. I want you to be sure to see this one. I think maybe you missed this one [indicating]. Dr. HARP~SON. However, I think if there are 17 such ads in one issue of a magazine directed at teenage and young women, I think that they are very illrely to see the labeling on there. Senator FORD. Well, doctor, I have another one just ]Jke this, if I can lind ti~ from an antique show that shows him sending every- body that he knows a carton for Christmas. If I get that~ we will insert it in the record. Dr. HARRISON. He looks a good deal younger there in your pic~ tilre~ sir. Senator FORD. But you recognize him tight off. That is ilt,'e 90 rcent of tim people recognize the label on a pack of cigarettes. pe~ They recognize the picture on that ad. Therefore 90 percent of the people understand it. Doctor, wouldyo ou agree that usage of marihuana by yo ung people in the United States now exceeds the usage of clgarettes7 Dr. HARRISON. I do not have the statistics on that. Senator FORD. DO yOU want me to give them to you? Dr. HARRISON. If yOU haVe them, yes. Senator FORD. What do you think, though? Dr. HARRZSON. I doubt it, that it exceeds the cigarette consump- tion. Senator FORn. Some 25 million youths aged between 13 and 19 use marihuana, and 6 million use cigarettes. Dr. HARRZSO~. But they have used it only maybe once or twice in many of those cases and not smoked 20 cigarettes a flay. Senator FORD. Yes, hut that is unadvertised. There is no adver- ffL~ement for marihuana out there, and there is more smoking marihuana than there are cigarettes between that age. Therefore, there is not one single line of advertising in favor of marihuana. Every line you read is in opposition to it. So I just wanted to bring that to your attention. Dr. HARRmON. I wanted to make sure that I put on the record I am in opposition to it, too. Senator FORD. Well, if you are going to regulate that, the farm- ors want their allotment quota. One last question. I see I have my caution light. You hidicato that this legm" latian will subetantiailly affect publis awareness. I disagree that the American public is still too ignorant of the hazards that have been associated with cigarette smoking,
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26 and I can think of no health claims in the years that I have served in the Congress that has l~ceived more intensive media coverage. Warning labels are also reinforced by an~mmoklng advertisements on radio, teleelaion, and magazines. What other ways can you con- trol behavior short of making the product illegal? Dr. H~mRISON. I am not for making it illegal. I think everyone has a right to choose his behavior or lifestyle. I just think that glvi~H them the best health information available is essential at this point in our society. The EHA~r~AN. Senator Heflin? Senator ~N. I am curious as in what are the anticipated re- sults of getting more reading of warnings fi" rotation occurs than a single general statement which might have added to it a little bit more of the diseases? ls there something about rc4gslen that causes more reading? Dr. ttARRISON. I will leave the specific~ of that to the advertising people who will be talking later. I personally believe that a strong- ly, much more strongly worded warning statement that was promi- nently displayed might be the better of the answers. This is a com- promise position in some ways. but you are going to hear about how this has worked in some of the European eouutries in your later testimony from the advertising people. Senator HF~FUN. YOU are, of COUrSe, familiar with warnings that occur on medicine, and the warning that I have freguently known about is the warning to keep out of the reach of children prescrip- tion medicine or patent medicine and things of ttmt sort. How well has that worked? Dr. ttAR~SO~. I think it has worked. There are eertah~y fewer poisoalngs with aspirin now, which is one of the bigones where this has been used. But they have also made a cap for the hattie that is more difficult to remove for a child. So I cannot testify to how effective it is, but I think that people will call and ask about some of those things from time to time when there are warnings on medication. Senator H~LIN. Was the idea of going toward this shildproof bottle and that sort of thing, was thnt as a result of the inadequacy of warnings to accomplish their mission? Dr. HAaamON. Yes, sir. I think there is no question that warn- ings, as we are talking about them, ~vill not accomplish the mission that I am here talking about today. I just ffmnly believe that it is one way that we must approach this problem. It is not the only way. There are many other ways that this problem needs to be aP- proached. We are not going to solve it with warning levels. Senator HEFU~, DO you anticipate that m~ a result o[ rotation warnings that you are going to have a decrease from those that presently smoke in their smoking? Dr. HAI~ISON. I think that as I have said earlier, to get people to stop smoking completely and stay a year is difficult because I be~ lisve that the major problem is nicotine addiction, and that is one of the very most powerful substances causing addiction, and I be- lieve that in fact the rotation of labeling being very specific will help, and that more disease specific labels would definitely be a countermeasure, a measure that would be accepted as welt. i
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27 Senator HEFLIN. How much do you really think that the rotation is going to affect smoking by those that presently smoke? Dr. HAR~SO~. I am now giving you a personal opinion. I think not a great deal. But I hope that it would be very effective in pre- venting some people from starting, particularly those young smok- ers. Senator H~FLI~. In other words, you do not think, on those that resently smoke, that rotation of labeling will have much effect, ~gs it is those that-- Dr. HARRISOn. Those that have not commenced smoking. I think in this whole problem that is where we must commence. It is not with people who have been smoking for 20 years, but with the people who have not yet started to smoke. 2"he CHAIRMAN. Senator Gorton? Senator GolzTo~'. No further questions. The CHAIRMAN. Senator Stevens? Senator STEvgNs. Do you think any smoking is harmful, or just smoking cigarettes? Dr. HARPaSO~. I think any smoking is harnfful. Pipes and c'~tgars, which have been reported not to cause us high an incidence of lung cancer, have been shown to cause cau£er of the oral cavity and the lip. And again, most people who smoke, at least my experience is that they do not inhale cigars and do not get the same concentra- tion of tars and other things in their lungs. So I think that for that reason cigaraltee smoking is by far the most hazardous of the ones we are talking about. Senator STeveNs. i~y staff tells me that at one time you en- Sersed a cigarette called Free~ is that right? Dr. HARra~oN. NO. This was a substance that had no tobacco in it. I did not endorse it. I worked with it and tried to do some tests. It is no longer available at t}fis point in time. Senator SrEv~r~s. Is it the nicotine cigarettes that you think causes this problem? Dr. HAm~ISON. I think it is the nicotine that causes the addiction to saaloking. I think that the idea with Free was to provide a way out of the nicotine and hopefully to discontinue smoking complete- ly. It was a remedy to get people off nicotine, as I viewed it. And because of financial reasons, that has not continued~ Senator Svzv~.~s. [ understand that the rotational concept of these warnings would require five separate warnings to be placed on aekngas, and they would be rotated in advertising and on the ~c~ges; is that the plan? Dr. HARRISOn. That is the plan as it is envisioned. Senator S~v~s. That is sor~ of llke Exxon having five logas. Dr. HARmSON. Well, before they broke up Standard Oil into Exxon and ~dl the others, there were five different parts of Stand- ard Oil. I guess it is the same thing. Senator STEX~SNS. The whole theory of warnings, is it not, is to have the same warning so people understand it, and when they see it they know what it means, like the warnings on any other kind of labeling? Why would we want to bury something that has worked? If 90 percent of the peo*ple know what this is and realize that there is a problem, why would we want to change the warning?
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28 Dr. HAI~ISON. Well, I would argue that the warning as it now exists, "The Surgeon General has determined that cigarette smok- ing is dangerous to your health," is not as meaningful as "Ciga- rette smoking has been shown to cause lung cancer, heart disease, and problems with pregnancy." I think that that is a much more specltic and much easier to understand label, whether it be rota- tional or whether it be in a single label that is disease specific. Senator ~r ~vraes. Thank you, Mr. Chairman, The CZ~AZRMaN. Senator Ford? Senator FORD. A couple of items here. The FTC report that ap- parently we are going from now, 75 percent of the pubic is aware that smoking may relate to heart risk. That is a pretty high per- centage without doing anything else. And you just said yourself, doctor, that the labelldg in your opinion would not help, particular- ty those ~vith smokers. Now let me read to you a testimony given by Carlton Turner, senior policy adviser for drug policy, office of policy development, February 24 of this year. I think we can use the tesFlmony outlin- ing a more promising approach to drug and alcohol prevention to emphasize decisionrnaldng, peer support, confrontation, and family, schodi~ and conmmnity involvement. "Programs that seem to be the most effective draw on the resources of business and labor, the religious commtmlty~ the vast array of volunteer organizations, and are designed and executed by people who are closest to the poten- tial user." Now, is that not what we need to be getting to? Is that not the approach or the philosophy of this admldistratldn, that we not get into more regulation? You claim and just stated in your testimony that Labeling would not work, and the group that you formed prob- ably would have greater effect. I just said a moment ago that marihuana is never advertised in any kind of publication, ads or anything else, and you have Mmoet five times as many users of marihuana between i3 and 19 in this country as you have cigarettes. So, are we not maybe going after the problem, as you see it personally, in the wrong direction? Dr. HARRISON. Senator, I endorse all of the conununity action propositions that you made about trying to influence behavior, and we of the I~teragency Counci and the American Heart Association are doing all we can hi public education to try to warn of the haz~ ards of cigarette smokhlg. You mentioned a figure that 75 percent of the people know about these health hazards, even the ones as to heart disease. That etfll leaves over 50 million Americans who do not know, and I think that what we de in terms of putting labels, specific labels, on ad- vertisldg that is so widely shown will help some of those 50 million Americans to appreciate the problems of smoking. Senator Form. Well, Mr. Chairman, I will stop there, I guess. I will prchch]y think of something else. The CRMR.'aA~'#. Senator Gerten? [No response.] The C~ArRMAN. Senator Stevens? [No response.] The CHAIRMAN. Doctor, thank you very much. i 0S
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29 [The following information was subsequently received for the record:] ~IERICAN H~ART A~O~A220~'~ Waahingten, llC, May 18,188~ Hen. ~BERT PAt:~WOOD, Ch awman, Cbmmiltee on ~bnlmer¢¢. 8cleave. and ~#o~atiol~ ltS. Senat~ War~gng$o~, D.C! D~R S~NATOR PACKWOOm &S yOU may recall, on May l~th, I testified before the Cc~amittee on Comraerce, Science, and Tra~portatlon in support of S. 1929, "The Comprehensive Smelting prevention Education Act of 1981." I would like to clarity for tile record the American Heart Association's formal lmm ~tion on $. 1929 and in particular, on the "rotatiolm]" scheme of the bill ~ it e~sms that my te~tlnlQny h~ been misintorpleted t~ metal tlmt we e~ldorsed a 'glngle" warning label as opposed to "multiple" rotational warnings, The line of questioning in which I stated that 1 would llke to see a hbei with a~ the health consequences noted on it ~ws not intended to concern i~self wlth the pros and cons of the rotational system but rather with the need for more dvtai]ed specific health in for matlan so that consumers wiU have at their dlspmal all of the information on the health hazards of c~ga~tte smoklug. The American Heart Aes~;iation, ~he Na~iona~ /n~erageney Co,moil on Smelting and Health, the Coalition ou Smoking or Health haw always considered the rots- tional scheme ~f S. 1929 as a critical and essential aspect of the legJslatlon. On behalf of the American Heew Association I would l~ t~ commend you for your leadership and support of S. 1929. The American Heart Association stands ready to assls~ you and your committee in emy way it can in ensuring ~ha~ thls im- portant le~dslation L~ eaac~d into law. Sil~eerely, ~ON~L~ ~. H~RRISON, ~res/de~ t. The Cm~mMAN. It would be my intention to run this hearing right through the lunch hour until we finleh all of the witnesses, rather than coming back this afternoon. Again, let me emphasize that your entire statements will be in the record, if you summar~z~ them and limit your case to 5 minutes we would appreciate it. We will take a panel of Mr. Michael Water- son and Mr. Michael Daube. Mr. Waterson, do you want to start? STATEMENTS OF MICHAEL WATERSON, RESEARCH DIRECTOR, AD- VERTISING ASSOCIATION OF ENGLAND, REPRESENTING THE AMERICAN ASSOCIATION OF ADVERTISING AGENCIES, TOE AMERICAN ADVERTISING FEDERATION, AND THE ASSOCI- ATION OF NATIONAL ADVERTISERS; AND MICHAEL DAUBE, DE- PARTMENT OF COMMUNITY MEDICINE, UNIVERSITY OF RDIN- BOROUGH, EDINBOROUGH, SCOTLAND Mr. WATERSO~. I am research director of the Advertising Associ- ation, based in London, a member of IJae British Council for Na- tional Academic Awards, a founder editor of the "Journal of Adver- tising," and the author of more than 80 articles and monographs relating to advertising. Senator Fo~9. I have a hard time understanding your English. Mr. WATF~SO~. I have a hard time with American. Senator FORg. I will talk slower, thou~h. Mr. WA'IERSON. The function of the Advertislng Ass~cletion, the organization I work for, is to see that the interest of manufac~r ers, advertising agencies and the media are represented in the United Kingdom and European parliaments and to assure that issues such as the one under discussion today are debated fairly and in the light of all available research eaidenee. We have worked
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very closely with the EEC Parliament, for example, the British Government, and with consumer groups on questions concerning the adveetising of alcoholic drink, advertising for children, and the incidence of false adver klsing claims. In short, the Advertising Association tins gone in considerable lengths to win a position of respect in Europe and it would not jeopardize this position by defending a doubtful cause. I do believe that there are very good grounds for rejecting th~ measures proposed in S. 1929. My reasons derive entirely from the research evidence available which shows that restrictions on cigarette advertising do not lmve an overall effect on cigarette consumption. Restrictions do, howev- ca', slow down the transfer of smokers to low-tar, low-ulcetine brands. The evidence ranges from econometric studies which isolate the impact of factors such as price and health campaigns on consump- tion through to appraisals of perception of cigarette ads and antici- garotte ads, through to comparison studies of different markets. A lot of information can be got from th/s data, since the position varies greatly from country to country. For example, in Switzerland there is ag~reat deal of freedom to advertise fo]lowlng a recent referendum, irn Sweden advertlsiug is severaly restricted and 16 health warnings are rotated on cigarette ~eks, but no effect of the adverting restrictions or of the intre- notion of the warulng~s can be seen in total tobacco consumption, In Norway a masslvehealth campaign h~s accompanied a ban on advertising; yet, per Capita cigarette consumption has hardly varied over the 5 years bstbre the ban or the 6 years since. In Finland the main effect of an advertising bml bad been m slow down the transfer of cigarette smokers to low-~ar brands. In Poland, cigarette consumption has risen by 25 percent since a fuli advertising bau. In Italy consumption has risen by more thim 3 percent a year over a 20-year period since the ban on advertising. Yet in the United Kingdom where clgare~te advertising is al- lowed, cigarette consumption has fallen since 1973. I must at this int reiterate that I. am telki~ about facts. Other. claims have. ~e~n put forward which contradict some of the pamte I have just made, particdiarly in relation to Norway and Sweden. Such claims are, however, seriously flawed since they depend on the results of asking people what they do rather than what they do, wbleh is the basis of my testimony. For example, one recent report by Paul Noraaren, an informa- tion officer of Sweden's Anti-Smol~Ang Association, claimed success for his association s policies on the basis of a fall in smoking among men from around 50 percent in 1970 to 31 percent in 1980. Were this claim true, it would of necessity also follow that the consump- tinn of those who smoked throughout this period rose by more than 50 percent, a ludicrous figure. Mr. Nordren conveniently forgot te note in his report the fact that people often do not tall the truth when answering interview- ers statement about their smoking, drinking aud other habits. And antlsmoklng campaigns, whatover else they appear to have done, have significantly increased this tendency. Surveys of smoking be- havior are therefore a highly unreliable guide to actual behavior.
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21 Actual behavior as reflected in the national smoking statistics I have supplied to this committee. The research evidence based on actual behavior shows clearly that the governments that have tried to reduce smoking by re strloting tobacco ads have not been successful. The reason is very simple: Cigarette ads do not sen the idea of smoking;, cigarette ads sell brands, and most importantly low-tar and low-nlcotine brands. Further evidence of this ic seen in data available from Eastern Europe. A complete advertising ban has existed in the Communist bloc countries for several decades. Poland is the exception, with the ban enforced only for the last decade. One would expect that if ad- vertising were a contributing factor to existing smokers to continue to smoke or to nonsmokers starting to smoke, and through these to the growth of total cigarette consumption, one would have seen either no growth or more specifically a decline in consumption in these countries where advertising has not existed for such a long period. This is not tim case. Consumption has outstripped population growth in every one of the Communist bloc countr~s. The evidence from econometric analysis backs up this common- sense view that adve~islng does not influence total cigarette con- sumption. This explains why health messages on packs do not work. It is relatively easy to introduce a new brand. It is virtually impossible to make people smoke more cigarettes or use more gasc- llne through advertising. Similarly, modifying the behavior of smokers not to smoke is extremely unlikely to result from the health warnings on packs ~ in ads. The fact is that other parameters, such as income and price levels, are far more important. For example, in Britate cigarette consumption fell massively last year due entirely to a price rise, a large price rise. For these reasons, it is my view that S. 1929 will not contribute to a decline in cigarette consumption. If it is enacted into law it could, however, contribute directly to a fall in the rate of conver- sion of smokers from bach- to low-tar brands. The research evi- dence shows that countries such as the United States and West Germany, where cigarette edvectisfa~g is permitted, have experi- enced a more rapid conversion rate to low-tar cigarettes. The C~nm~AN. I will have to ask you, Mr. Watorson, to con- elude, please. Mr. WAT~SO~. I am sorry, I have been reading slightly slowly because of the accent problem. Just to finish off with a quotation from one of the most recent studies produced by a nmjor research organization in Germany: "Every country in the worm that has tried to zeduce smoking by restrlctin~ tobacco advertisements has been unsuccessful. The ex- periment has been tried and has failed." In all probaEflity, however, if enacted the bill would have unfor- tonato and unlookad for consequences of a serious nature. Th3nk you, gentlemen. [The statement follows:] "~.t.'~-~- i.a-
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I I i rlF 11 Im ii
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83 The ~e~e~reh evidence suggests ol~rly mat of the goverm-nonts that have ~ed £o reduce smoking by restrfc~g tobacco ads or by inore~L~g the number of health wm mugs, none has been successful. The reason is ~imple, cigarette ads do no~ sell the idea of ~moklng. CigareRe ads sell brands and mast importantly, low-tar mad low-nicotine brands. The evldenee flora properly conducted econometric onal)~is backs up this c~mmon sense ~w A large nttmber of such studies have now been conducted Europe on :iga~tte and similar markets None show ads exertibg any influence other thou at the brand level. partly explains why health me~o~s on packs don't work. It is relatlvely o~sy to introduce a new bra~d. [L is virtually impceslb/e to make people smoke more cJ~aret~ or use more gasoline through advorfisL~g. Similarly, modif~fing the behav- iour of smokers not to smoke is ex~mely unllkely to result frgan health wm nh~gs on ~eks or ~a ~ds. In addition t~ this aspect, health w~r~ings are shown by research evidence to be igno~d because they are messages smokers don't want to receive. For example, a study subroitted to the United Statcs Federal Trade Commi~mon in 1980 "A Survey of Adolesc~t and Adult At~/tudes, V~uos, Behav~o.r, lntention~ and KnowIedg~ Related to Ogaret~e Smoking" contained the following coneiu$iol~; "Factual Enowl- edge about the health consequences of smokhag was not found ~o b~ slgaificontly related to current ~o~g bobav~our. No more differences between knowledge ]ovels of smokers compa~edwJth non-~mokers w~ fonnd to he slgnifiemat at the 0.05 level tha~ were to be e~pected by chance," Similarly, in the United Kingdom, it i~ almoot h~x~sslble to fired a smoker who do~n't know +he health h~ard. A parallel exampl~ is provided by the sale of marijua.a. Dsspits the it/egaligy of this product, widespread publie:ty as to the dangers of its use, and of course, no ad- verting, Time magazine reporLed rec~ly ~a~ 25 million A~er~cans ave regular users and spend 25 percent more on this habit than do cigarette smokers, For the~e reasons, it i~ my view tha~ $. 1920 W~]l no~ in any way contribute to a decline in cigarette consumption in the USA. If it is emoted into law, it ~ould ~on- tribute directly Lo a fall in the ra~e o[ ~onversion of smoke fl~ from high to Iow-t ~tr and low-lxieothle brauds, The research evidence shows qu~t~ ~learly that countries sud~ a~ Fial~d and Norway with cigarette adver~slng bans or countries wher~ ~Iverfising m highly ~- s/ri~d, have a smaIl*r proportion of the population smoking low-t ~r and low.nio> tln~ c/g~ret #~ Countries such ~s the USA ond West Germa.y where cigazette ad- vertieing is permitted have expe~enced a much more rapid convemion rate to tow- tar clg~re~tes, A~y int~ffe~nce with ~ha effe~iven~ of hr~d adversities. ~uch o~ that proposed by S, 19~, frill certainly ~low down this conversion pr o~s. Ther~ is also evacuee which suggests that the process of converting smokers to lower tar and nicotine products is more effectively ear~ed out by colztmer cia] adver- tieing ~han by subjecting smokers to heo2th messages. This evidence reinforces my belief both i~l the ine~1~ctiven~ of govcrni~nt health warnings, aud in ¢h¢ 1a¢1¢ of validity of the theory that a decrease in the amount of effectiveness of brand adver- tts~g for low tar e~gar ettes ~uld be substituted or offset by a~ inereaee in govern. merit publicity. Finally. I world submit that S. 1929. if passed, will set a dangerous preoedent. In every country in Europe where elga~ett e advertising is restricted or banned, the im- posi~on of regalat ions has sitgnalaled the starL of fresh &mends that the advertising of o~hor produo~ groups should b¢ restricted. I would suggest that if S. 1929"is sucoessfuL it will form the basis for demands for the resh~ctlon a~d re~ . a~on eft the advertlsinlg for many other products in common usage today. As such tt ~crike~ at the heart of the market system of the USA. To canclude, 1 believe that ~. 19~ will no~ succeed in i~s aims h" passed. To quote one of the most ~nt studies on the subject, t~rodueod by ZAW in Germany, con- cerifing data from 14 cca ln~:ies "every country in the world that Ires tried to reduce ~moklng by res~Tic~i~g b~bae~o advertisements has been unmteee~sfu[." There is* therofoi~e, no reason for the United States Oovermmont to expel~ment ha the area. This exTer~ent ha~ already been attemt~ed in Western Europe without succ~s. In all ]probability however, the bill, if enacted. Would have unfortmlate and unlocked for consequences of a serlovs r~tt~xe, such as discouraging ~Les of lvew low.tar prod. uct~ I'll be happy to answer anyqg ueztions, but hefor e t do I would like to request that ¢oples of my ~port on thi~ subjec~ be h~sel%ed for the Regard, ~nd made avaxlable for members of the Comvni~tee. l will be happy to supply the Committee with ¢opaes of any other research evidence I have referred to. Thank you for your time. ¢,q
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8 ~G~O~ Q ,, , i II1 II
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95 How effective are the warrdngs? Little can be gaged from the impact or lack thereof of weak warnings accepted by the tobacco lobby only on the well-researched assumption that they ~ll have little effect. Strong warnings have normally been introduced both to demonstrate govermnental concern and as part of a comprehen- sive long-term program of which individual components cannot easily be evaluated in isolation, particularly as these programs are aimed primarily at young people and intended to be effective in the long term. Norway, Finland, and Sweden are of special relevance, and my longer paper gives much more information on each. The Norwe- gian Tobacco Act included a ban on tobacco advertising, a strong and informative health warning, and was complemented by public education programs. The Norwegians stress that they seek long-term, not short-term impact~ and it is foolish to seek immediate short-term impact. Even so, since the Tobacco Act was publlstzed and passed, surveys show that the male smoking rate in Norway has droptped significantly, the increase among females has been halted, the public is much more aware of the dangers of smoking, there has been no popular oppcaltion to the act and there has been a marked decline in smok- ing among school children. A nationwide survey of smoking habits of school thildren pub- lished in 1981 showed that, while in all ago groups smoking rates increased between 1957 and 1975, the year of the ac% by 1980 smoking by both boys and girls had fallen to well below 1975 levels. And that fail is reflected in all age groups. A survey of adult smoking habit~ in I976 included a question to test public awareness of the health warnings. Despite the fairly complex warning, daily smokers, who are more fraguantly exposed to the warnings, scored d~mlfmantly higher, with many smokers also giving a parfflaliy correct answer. Even in the shorg term, this warning has clearly had some impact. And this committee will I am su*~, be interbred to know that the Norwegian Government has recently declared its intention of adopting a system of rotathig warnings based on the Swedish ex- perience. The Swedish act requires a rotating system of 15 different warn- ings, together with information on brand tar, nicotine, and carbon monoxide. The act is complemented by a public education program. The warnings have already been changed once and will shortly be changed again. I have submitted dam on trends in Sweden to show that the de- cline in smoking which started in 1970 has been accelerated. There has also been a sharp decline in smoking among teenage boys and glrl~ and before and after surveys specifically to evaluate the warnings found that they had increased knowledge and had been in part responsible for people giving up, and had encouraged smok- ers to switch to lower tar brands. The Finnish Tobacco Act was passed in 1976 and implemented in 1977. It includes an ad ban, education programs, and health warn- ings. There was a rapid decline in juvenile smoking. For example: "Two years after the enforcement of the Tobacco Act, the preva- 0~ ~o
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36 lence of daily smoking anlong 14 y~,r olds was only 8 percent, when 6 years earlier it was 19 percent. ' My own view is that the next step could well be to provide smok- ers, through the warning, with advice on methods of giving up. Pervading the testimony, I think, of the tobacco lobby is tim brand share argument, the elann developed by tobacco manufactur- ers since evidence of the danger of smoking surfaced, that their ad- vertising has no impact on the overall size of the market, affects only smokers, has no impact on smokers other than to persuade them to switch brands, and has no impact whatever on children and other nonsmokers. This argament has been frequently rebutted. My favorite rebut- tal of it or comment on it is from one of Brit~n's leading advectis- Lug men who says "It is so preposterous it is insulting," while the present Prime Minister of Ireland, Charles Haughey, has described it as "useless, idle, silly and nonsensical." In conclusion, sir, f can reassure this committee that European and other international expa~ence in smoking control supports wholly the premises upon which this bill is based. Comprehensive smoking control programs have achieved encouraBing results in the short term, are particularly im~luentlal in reducing smoking among children, do not infringe individual hbecty, de not cause smokers to smoke high-tar brands, and are acceptable to the public at large. It is to be commended because it is based on solid research, re- flects the experience of other countries, and looks not to a single measure in isolation, but legislation complemented by an education program. A 19th century British Prime Minister Benjamin Disraeli said that the first concern of any government is the health of the people. This act will give a lead not only to your country, but also to the governments of many other countries. f congratulate the proposers of this act for their initiative, which can on be beneficial to the public health and to young people in partis~r. I siteply want to make the point that it is sometimes argued that the public is fully informed about the real health consequences of smoking. Smokers may he broadlly aware that the health authori- ties consider smoking to be harmful, but they have little concept of the extent di the risk, the nature and range of the diseases in- volved, the economic and social cost, the certainty of the evidence, or that a smoklng-relaled disease may strike them rather than someone else. Smoking is massively our largest avoidable cause of death and disease, and that is why exceptional action is required on this topic. Thank you, sir. [The statement follows:] ~TAT~NT OF MICHAEL DAUBE j SENIOR LECtURe, DI~PARTM~r OF ~OMR~UNITY 1. It ~s a privilege to have the oppor tunlty of testifying before tltls committee irL support of the Com. preventive ....... Smoking Prevention Ednc~ti~n Act (S 19~9). Those of u~e who are active in campa~gluIlg to reduce smokm~ welcome the important lllltia- ~=~
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38 gn"am t~m Will b* gradually ph mqad ~n: it would be abstlrd to oppose introduction eta slng[e eompone.t on the grounds that it alone v~l[ not aehleve instant miracles 9 The Norwegian Tobacco Act was introduced on the hams of a seminal repo*l~ ("Lufluencing Smoking Beha~6o~r") wbAch sffressed that national action on smoking must to be effective consist eta throe-part progran~na: education and information, legislation, and cessation (help for would-be quitters), The Norwegian Tobacco Act was passed, in 1978 and implemented in t975 as a result of action taken following publica~on of the 1964 U,S Surgeon Goner*d's Report Nca way is only one of sever- al countries to pro~ide ample ovldgn~ that far from hplng in any way ma extreme or exaggerated rcspDns~ to the smoking problem, the Comprehensive Smoking pro. vention Eduoation Act is a relatively modest measure likely to be opposed sor~ot~ly only by the tobacco lobby. Even in Norway, where the tobacco hldtmtry h~ not power- ful, there was some illdnstlT oppo, ition to the Tobacco Act. Dr. KJell Djartvei% a former Minister for Itealth and currently Chairman of the Natlonl C~ancil on Smoking and Health p[dnr~ out "1 wou}d be much more worried if this had gone through without any resistenc~'~ "But", he continues, 'q think the o~ppc~qition h~d an effect--for us! l~ helped to draw public a~ention to flue Act and to the dangers of sinoking." It) With traps* allolled irresponsibility tlle totm~eo hxdust ry still seeks not merely lo deny the evident* on smoking and disease, ba~ even to persuade the public that smoking is not indeed a potentially lethal habit. The tobacco industry a~d its agents also L~evitably o101p,ose a.y attain to reduce smoking: it would he surprising ff this were not so, and tile strength of ~he oppostlan to S. 1929 is o)nvincing testimony to its likely offeetlveneB~. The ~zbaceo companies' arguments are sopea~uasively mis- leading as were their advertisements in the past, all the more so because they use lmlf-traths and anti.orbs which can appear eonvmomg ia ~ho ab~euso of a pohat~by point ~buttal. To take one example, a bootket by Mr, M. J. Waterson (see also para. 81) entitled "Advert L~tn .... ~and Clearer te C~nsumption', t~ ubllshed by t he (UK) Adver tlsing Asas-. matlon in 1~81 make~ much of an ncrea~o m c garotte sales m Italy since the 1962 cigar ete advertising ben there. 'Une report lhils to mention flint: It) The Italian advertising b~ was ill,seduced no~ for health reason, but to pro- tect the State Tobacco Monopoly against international ¢ompanie~ tvith large adver- tiskug budgets; Cll) There has been no complementary public education programme on the dan. gers of smoking: indeed, health educazion in Italy is on many ioaues aImost aonexio- tent; (iii) Italian sales ff~at~s are n~otiou~ly unreliable: much tobacco sold in Italy is smuggled in; (iv) The advertising ban is not implemented Fines--when imposed--are small: t~ bacco companies have in fact treated the Law wi~h disregard, and advertise regular- ly in Italy! Similarly, the same publication cites the Polish experience-without referring to the vast cultural dlffer~nces between countries wh~re, as in the lyK and the U,S., advertising is almost all-pervasive, and tho~e such as P~land where there is in any ease very little advert~fing, where health education is d~eldedly limit ed, and wher~ the absence of eonsmnor ~oods results in the public havlng little else on which to spend its moray. Mr. Waterson cites France as having a long-term advertising ban: this i. simply untrue. He wvltes of Norway that, "the constant effect of the adverLising ban since 197fi has had no diseeznlhle effect on consumption". The Norwegian authorities stress both ~at ~h~ decline in smoking date~ not flora 1975 bat i~om the period during which the Tobacco Act was debated and pub]lcised and that they seek pri- marffy a long-term effec~ NonetheIess, smok/ng is of course on the dgeIine in Norway both among adults and more importantly among childrem I attach (~aras. 25-30; Appendix 2) further data ¢~nflming this. 11. Like many of my colleagues I have given very caref~l thought to the t obacvo indust ryes sn~g~mst£on that we s~ek to curtail freedom My conclusion is that set out in the t97fl W~O report: "Freedom should be seen not as the freedom of the manu lacquer to promote a known health hazard but rather as the freedom and ability of society to ilngienlett t public health measures. It win be many yea~s before final "proof' of the value of smaoking control mess- ura¢ is available, and the means and oxten~ of implementation, as ;Yell as the combi- nation of measures used, are likely to vary so much from country to country that it may even then oniy be possible to assert, as oI~e cax~ now, that he ease for the tat re- duction of such measures is ~ver~vhelr~i~g, that they m~ke no infringement on indi- vidual liberty beyond what is acceptable in an organised society, tha~ there is good
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4O quances to s~Lety at ]algP, and that a Fmaoldn~related dlsea~ may strike them-- rather then ~omebody elsa. It would take a smgt~arly oynlc~ appr~eh to ~ert that the publi~ 18 adequabsly in furmed about the dangers of smoking. 18. The perspective l can provide from other countrie% mad from Eur~pe in par tic- ular, is one of gradual progress in smoking coatrol and smokiag con~rol legislation. There is univer$~ opposltion to s~ch progress from the tobacco indus~y, b~t ~l~ ~po$1tloa ~ clearly at its strongest in countries such a~ the US and the UK where e in6u~ry is particularly Imwer ful. (All of the world's s~ven premier tohe~ com- panle$ are bassd in the US and fh~ UK) Progress i~ always stubby.step. Each ~p h~ challenged on the grounds ~hat: (i} Smoking is not harmi~l to hetdtb; ('~) The ~hacco indust~'y is resi~nsible ~Itd will act voIml~rtly to obviate the need for legisla~on; (ill) The tobacco industry is b~neflclal to the ~nomy; (iv) The proposed measure will ir~Enge ~ntlal freedoms; (v) The proposed memsure will be effective in isolation. In almo~ every country where r~rlous governmeng~l octio~ i~ thi~tened the ~o- Imeuo industry offers a voluntary ~gr eement~ or engages in protracted nogotiatiens with government, ~r adopts beth co~rses. Voluntary a~eement~ a~e ]nvark~bly weak, loosely phrased, mlulma~y pollee~ m2d meffe~ive. Ever where such a~:ee~ ment~ or partial ~gislatiou (e.g. on sebs~ted forms of advertising) ob~n the ~iga- rett~ manufacturers hav~ prov~ adept a~ c~rcumveno~on, as with the mOVe i~to sport~ s~on~or~hip ..... to replac~ TV adver~sing. The industry h~ prove~ equally ad~pt at drawing out its negotiatlon~ wtth government~, often for many y~ar% and will under~standably not agree voluntarily any lnea~ure that mlgh~ reduce sales. 19. Cigarette smokir.g line been gr adu~dly declining in ~ever al countries, hut the declln~ ha~ genorsJ]y been very slow, m~d confined plimm~ly to middle.lass middl~ aged man. Around the world clfildren m~ s~r t~-g to smoke ~tt evor earlier ages, ~md the public is understandably con fu~ed by the appar~m~ ccnl]ict be~reeen goven~men- t~I posture ~ud policy: on the one baud ar&nt rholori¢ about the d~ngers of smok- ing, on the 01~aer hand hck of serious action and a continuation abreast Ul~mpeded of toTo~c~o promotion. The gradual d~cline in smoking in countries such as the U~ is more than welcome, but it sho~d not he treed to abjure the fact that with gr eater governmental commitment to education and legi~latlo~ the decline mlgh~ have been muvh more impressive. PAL Appr oxima~ly 87 cottntrics require hcalSh w~rn J~g on cigarette packe~ ~7 by legislation, product h~fornmtmn (tar, nicotine, c~rbon lnonox~de) ~ ~qui~ in 12 ~nt flea, 8 by ]eo~J$la~ion 21. With~ Europe 12 countries have legislation bannL*~g ci~are%te advertising: Bulg~rM, C~echoslov~kh, ~inlen~, F~m~ Cmrmany, Hungary, Iceland, Italy, Nat'way, Poland, Rumania, the USSR, and yugoslavia. Health warning~ and/or pru~uc~ hfformatlon on p~cks or adwr~i~ement~ ob~dn in i5 E~ropeat* countrie~ In 8 (Demnark, West Germany, and the UIO the informa- tion appears tlmough a vuluatary ag~ cement; in ~e rest (Amstria, Belgium, Bulgar- ia, Czechoslovakia. ~nland, France, Hungary. Ireland. the Netherlands. Norway. $wed*n~ and 8wi~rland) th~ is legislation (the Austrisn warring is to be hl~ro- duped from July~ 19~2~ The Swedish system of sixteen, rotating warnin~.~ is unique. The. UK,. England, and Ireland have re~nfly introduced sys~ms entailing ~hr~e warnum~; implemen K~tlon h~ token $1mo, ~ono of thee three sys~m~ ha~ been fully evaloated. 2~. If ~*igar et ~s were freshly introduc~ on~ the market it is inconceivable cha$ any ad~r rising would be ~*~rmit ted, or that ~ny packagh~ff ~v~uld be Sold other Sh~n under the ~tr~ct~t of ear, trois ~nd with prominently placed and forcefu[ warning notices. Instead, the b~l~h warnings in most countr~e~ where the tebacco industry is strong have in common that they ar~: (J) Weak, o~Jt~ng any mention of d~h or g~ctual l~formstlon about d~se~t~es cau~ad by smoking; (ii) Sm~ll. badly I~d, aad scarcely noti~able, oRon irt dire~'t contrast wkh gov- ernment' origlnal~tentlons; (flu Unchaog~ng. so teat the smoker becomes accustomed to overlooking them; (iv) Impersonal~eaeralisix~g about smoker's, and not directed to the indkddual ~eker; (v) Complicated by unnecc~sar y,, ,. verbiage such as 'q-IM Goverrmaent ,,Health De~ par¢:menl~ Wa~ning , . . or Hie Surgeon General has determined . . , ; (~d) Oufitted from maJay advertisements that ~e in fact clearly intended to pro- mote cigarettes (eg advertisements at and for sponsored events).
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41 23. FI~m 1971 to 1981 all UK eigaret.h~ packs and advertisements carried the notice, '~Warnlng by HM Government. Smoking Can Damage Your Health" or "Packets Carry a Government Health W~rnin~': this was complemented from the late 1970s by a statement as to w]~ether the brand was "Low Tar", Low-tc-Middle Tar". etc. .Since 1981 a system of three (rotathlg) warnin. ~:s has.been introduced. The .ew warnings were agreed only after len~hy negotiations w]%h the industry~ and are less than compe]~ag; the tobacco industry has comslst ent]y refused to accept the GovernmenFs own warning which appear~ on o fi~cial tar and nicotine tables stating DISeASE.SUe u Jvoca/ly* "DAk% C-ER: CIGARETr E~ CAUSE CANCER, BRONCI~TIS, I~EART 24. The 1979 W~IO Repart pointed cut, ~'... Although voluntary agreement would in normal e~reums~ees be preferable ~ leg~lafion, ~xperienee has shown-- as wlth tobacco promotion that tobacco manufacturers will nat in general wlun- t arily agree to i~ar nlngs that reflect adequately the views of health authorities and that they will make every etlbrt to mlahnlse the impact of such warnings". 25. Health warnioge should not, as has been stressed above, he seen as more than a slngbe component in a comp~ehenslve progranmne, but they serve the foUowillg purpose: 6) Te draw public attention to the dangers of smoking; ~i) To demonstrate a government's commltment to the smoking and health care- (m) To complement health education pratt ammos; (iv) TO ptovid~ product in forms%ion, reflecting where aplymprlate change~ in prod- uct ~ontent or scientific knowledge. It is manif~s~ tha~ none of the above objectives can be attained if health warnings are unchanging and use WOl:dS acceptable to cig:ar ett e manufacturers. 26. The impact of Ieglsla~on ~n health warmntgss, as of o~her smoktn~K control leg- £~3afion, can be expected to haw four phases of effectiveness: (i) Publlc~ generated when the intention to le~slate is announced by gover.. ment or le~atot s; (iD Publicity generated while the measure is being discussed by legislative assem- Blies; (iii) Immediate ~pac~ of the 1striation (and concomitant publicity) when imple- mented; (iv) Long-term ~ffect of legisL~tlon as par% of a comp~ahenslve smoking control programme. 27, As Lancet ed above, it is simplest to divide countries int~ two cate~orle~: those with a strong industry, and those wath a weak indu~s%ry. 6) Where there is a strong industry, waRnings normally ~mply doubt, uslng words ~oh as "can" and "may", make ne mentll~ of death or disease, and ~nvey ll~lle I1 ency. For example: r~apm*: For the ~ake of your health, do ne~ smoke too much. Malaysia: Wvxlxil~ by the Goveri~aent of ~lalaysim smoking can be a health hozar& Me~dco: The HeaI~ Code has dot ermine: this prod~ct may be harmful to health. New Zealand: Government Warnlnng:. smoking can endanger your health. Canada: Health and Welfare Canada aclv/ees tha~ danger to health hlereases with amount smoked--avoid inMing, UK: one off Danger: Government Health Departments' Warning. Cigarettes ca~ ~er4ous]y damage, your hcaItb. Smol~ag may e~t you more than money. The mere you smoke, the more you Nsk yo~r health. Think fu'~--mo~t doc~m don't smoke, Think about the health r~k$ before smoking, (£i) Where the industry is weak, strong~r warnings have been introduced. For ex. am ]e: ~ul wait: Smoking is the main vau~a of cancer, hmg, heart, end ar~ry disease. Ireland; Smokers dle younger-Royal College of Physlciams, (Sgexette~ can cause cance~Government Warning. Smoking seNously damages your health~overn- merit Warning. Iceland: Warning: cigarette smoking can cause lung cancer and h~rt disease. Finlalld: ~lllokillg is dmlger ous to your health--National Board of Health. To~ac- co is dangerous to your health--National Board of IIealth You'll }scathe easier if you don't smoke--National Board of Health. Norway: Warning from the ]~rectorat e of Public I~ealth: Dally cigarette smoking endangers health. It may lead to s~rious d~seases, including lung uancer and coro- nary heart disease. The risk inc~e~ses vhth consumption and is ~n'eat er when srnok. big begins at an early age. Giving up smoking reduce~ the r~k of d~ea so. Lq
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42 Sweden: 16 rotativg warninga, changed zegularly. For example: O out of 10 pa- tient.s with cmlcer of the oesophaga~ are smokers. National Board of Health and Welfare. ][Iear t attacks before the age of 50 nearly always occur in smokers. Nation- al Board of Health and Welfare. Preg~qant womenl ~moking during pregnancy may harm. your ~hlld. National Board of Health and Welfare. 28. HOW effecti'*e are heMth warnings? (i) It ~ virtually imPOssible to evaluate the effectiveness of health warn~ L~ iso- lation, Little ev~ be gauged from the impact (or ]aek thvreoD el" weak health wa~n- m~in which have been accepted by the tobacco industry on the assumptlon th~ they will be ineffec~ve f3trong warnings have nor raaily been introduced as part of a cam- pr ehenslve, long-term. ~rogrEam., Individual components, of such programs, cannot ~tlsi]y be evaluated in 18olatlOtl. Ful~her~ comprehenswe programs are intended to be effective primarily in the long term, end are aimed particularly nt yova~ people. (iiJ Thres ¢ountriva are of particular ~vlev~xge, 1. NORWAY The Norwegian Tobacco AeL was implomenbed in July, 1975, follo~sdng extensive parliamentary clLscussion and pub]ie debate. The act comprises: (i) A totol ban on all advertising of tobac~ products (il) A requirem~lt that vii packs are labelled with a symbol and text pointing out the dar~ers of c[garrette smoking OlD A ban on the sale or handing over of tobacco products ~ those under sixteen (iv) Per~fission for the MinistlT to issue regtflations concerrdllg ~n~t (i.e. gaY, r~icotine, CO yield, e~¢.), Welght, Flit e~ etc. The Act was complemenLed by a pugiie education progv~mle. In any at~mpts compare the impact of the Norwegian legdslat~on with proposed leg~:Qafion else- where it should be noted that the level of adverH~ing banned in Norway was much lower than ~hat obtaining in the U.S. or UK. Norway has never experienced the kind of lnas~ve h~Erect cigar ett 8 ad~:ertL~i~g (spot ts sponso~hip, o~e.) that prevails in many other countries. Wen cl~ect ndveI rising before the advertising b~a~ was le~a ex~ensive in Norway: in 1974 (the year before the Tobacco Act) direct cigarette ad. vertising e~endi~ur e gi~ 1974 vatue~) per inhabitan~ was: Norway--$0.fi9. LrK--$1.00. U.S $1.14. AppendLx 2 presents information on Norwegian trends and conclusions, including a]ysp~ ~ya sr b Dr. KjeII ~jarCveit dealing with some of the tobacco [obhy's argumenf~ h~brief, it may be concinded that since ~he Tebacco A~ was paq~ed by f~e ~tert- in~ The mille smoking rate in Norway ban dropped signlf'l~matly 60 The flacr eas~ among fen~l~a has been ho2t cd (ii~) There has been a marked dee]in~ in mnokallg aniollg ~¢hooleh[ldrvn (iv) The pub]i¢ is much more aware of the d~g~as of smoking (FoIlowlng tax increases implemented after much of tb~ attached data was coL~ecb- cd. a ~ar t her su~ant ial decline may be anti,pared.) A survey of smoking habit~ in 1976 included a ques~on to test the public's aware- ness of the health warning. The Norwegian warning, introduced th~ pre~eus year, m" ht be thought le hy and tom lax. However, 44 ]percent of the sample gave a fult~ correct answer~i~hcSfylng h~ lung ...... d .... ry heart disea0e) but daily smoke~s, wile were more t]requently exposed to the warning, ~cored signifi~a~lt~ ly higher at 52 percent, with a further ~'2 ]~r cent of smokers giving a partially ¢ol~ rect answer. Ewn m the shor~ term the wotnhag has clearly hod some £ra~act. • A l~atlonwlcle BUrVey 0 fsmol~n. ~ babit~ amol~ schoolcI~dren aged 13. 15 was pUb" lmh~l in 1981, and compared w~th those of pr~n~leus y~ars. II1 all age grouI~ the prevalence of daily smokin~ had risen between the 1957 and 1963 surveys, and ~galn between 196~ and 1975 the year of the Tobat~o Act. The 1080 surrey showed that in all age groups the percentage of daily smoke~ had fgi]en we[[ b~low 1~}7~ levels amongst both boy~ and gh'ls. The Norweg]za~ Governmen~ [l~s r~eently decl~xed i~ ~ten~on of ehangLqg the health warr~-g and ado • a s stem of ~tating warnings, much ~s in Sweden. hon d be im em£ m 2. SWedEN The Swedish Tobacco Labelling ACt was p~ssed in December, 1975 mad in~roduced on January isb 1977. As a result of the Act~ c'~m~tte packs e~rry sixteelt different health warnings together ~i~h information onbramd t~r nicotine and carbon men-
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i~iii Li~il iiiii ii[!i ii~ii r,, iiiii i{iii ~ilii iiiii ~iiii
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44 29. Thus, it i~ clear that the S~a~dinavlan Tobacco Ac~ are working: ~oklnlg is declining among adult, and even in the short term has declined markedly in chfl dren, The most encouraging tribute to the irapact of ~ueh legislation has corae from two senior executix~s in the Norwegi~ tobacco industry. Speaking in October 1980, at the launch of a marketing campaign for chewing gum~ they said; "Since the in. troductlon of [he ban on tobacco adver tlslog, new thinking h~ b~ome a necessity. With reference to the forceful anti-Brooking campaign we have to take into ae~aunt tha~ there will be considerably fewer new smoker% and that in the ]ong run the consumption will probably go down". 30. No s~ngle h~aith warning or system of warn~ugscancan be ideal for all count rle~. It is clear, howewr~ that the best system thus far d~Ssed entails a seri~ of clear, well.presented, sizeable, per sonedlzad, rotating h~]th warnings, str e~ing the harm- fol health consequences a~d the benefit~ of giving up My own view is that the next step could welJ be to use the warning to provide ~mokers v~th advic~ on Iaeth0d@ of glviu g up. It ha~ aJso been ~ugge~ted that warnin~ could be printed on indlvldual c~garettes: this might provide a usvftfl means of ensuring that the warrdng is fr~ quenfly seen. 31. No one seriously involved in salokitm and health avtiviti~--not even the Nor- weglans or the Fim~--would claim that any country has yet implemented a pr~ gramme that fully meets the requirements of the racomraendatign$ set out in the 1979 WTIO report. In most cot mtri~ tb~ pov~r of the tob~eo lobby has restated in progr~mmes falling far short of these ~cemmendations although they have been e~dorsed by ~hese countrles at the World Health Assembler. The tobacco industry then argaes that because an emasaulated programme has been uun~ucce2~s~u]" i~ loglva]ly f~llows that a eomprehendve programme wo~ld be un~uc~ful. G~ven also that in most ~ountries h~lth edttcaticn pr og~unme~ are grotesquely under-funded in comparison with the thousands of billions of dollars ~pant worl~dde on adver tru- ing and promoting cigar ettea, it ~s less than serrslble to claim that limited anti-smok- ing mea.sur~s are "ineffective: ~ecause they fail instantaneously to achieve rn~ive sl~fts in human behav~our." 32 It would be imlmsS~ble to summarise hriefly the v~ range cf education prc~ grammes that have b~n dtr~ted, nslng alm~t everT po~ible medium and a]~ proavh, towards communities and specific target grou]ps from schoolchildren to preg- nun~ mothers. Health education is in som~ x~ays still in the hors~-and~arg era, and c~relbl evaluation is all ~oo rare. NoneLheless, some school education programme$ are new showing some promise, as are progran~mes ainied atspp pciflc target gr~uF~ and discrete communities (e g. the N~rth Karelia Pr o~ect in Finland) While consist- ent editorial cover~l~e ]ii the media depends on the existence o~ active eompai~ers, mes~ countri¢~ have some experience of mass media onfi.mnoldng advertising cam- paigns. It should be noted, h~wever, t~ha~ ihnds tbr such campaigns are invariably mod~t: even in the U~, where all anti-smoking advertisements are Government- funded, total such ~xp~Ddlture amounts to approximately one million pounds p~r annum as opposed to expenditure annua]]y of one hundred times that amennt on b~bacco advertising and promotion. Pre-~s~ir~ and evaluation of publ/c educa~n activities sh~w that many have been ef~etlve hi the short term, and have the poten- txal to be effective in the long term also but lack £he adeqmate funding that is the prerequisite of any successful advertising eampalgn It is also the common ~xpcri- once e~ those repsons~blv for conducing antl.smoklng co~mpvigr~ ~hat their work weald be considerably eased by the absence of tobacco pz~modon avd with the back- ing of firm governmental action, Anti-smoking campaigns have $uo~eeded prlmari~ among the better~ducatedi for further progress additional measures such as health ~vat r~i~ g@~ and advertising ~an, etc, are clearly required 33. I have r~en~ly ~e~ the ex~donco ~ubmi~d before the House Subcommittee on Health ~d the Environment of the CommiL~e on Energy mid Comme~ze by Mr. Michael Water,on of the UK Advertising Assosiation, te$~if~ng ~n b~alf of the American Advertising Industry ~arch 5th, 1982~. I amperturbed that mf~lea4mg testimony- ~nould have been presented m ~he Unlt ed SLates Legisla~ur e from the Lrl(, alb~iL by a spokesman for the ~ob~o lobby whose previous pub]icatiol~ have been luls]eading (see p~ra. 10), and I l~qe~ that it should be necessar%, to correct thi~ ~ome of the hsl~tr u~h~ in [~|r. Waterson's t esdmony have been covered el~ewhere in tlds ~apvr. A full rebuttal would be extremely lengthy, I would wi~h ~ deal here w~th a iu~her six points (i) Mr. Water,on claims that advertising restrlct[ens slow down the transfer of smokers to low-tar brands. This coDelusion is z.inched only by highly selective com- parisons by ~iatortlons o~" the evidence and by making unwarranted assumptions as to (a) the e ff~ct of advertising on ~he move ~ lower-tar braids, and (b) poss b e de~ i
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!
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46 high tar b~lds, and are acceptable to the public at lal,g~ Individual me.our e~ ha- iL,lement~:l in isolation such ~ t~ bac~szes or promotional curbs--have some~ 6mas contributed to a decline ~n smoking or a deelining rate of increase, but are invariab~v far le~ effective than they would be o~ part of a comprehensive pro- gramme. 'l~he tobacco industly has opposed any ~u~h legislagloa both because it ~1l affect smoking ra~es and because the decision t~/rnplement such legislation deanon- strafes yet again gevernm*ntal recognition of the magnitude of the smoking prob- lem Co/in%r~ %V]lere only ~eg~xlres ~cc~ptable to the ~ob~cco ~ustry ha'ca been im lemented have been uniformly unsuccessful in reducing 6moI~Sng. ~1929 is to be commended because i~ is ba~ed on solid research, reflects the e~pe- fiance of other countries, and leeks n~t to a single measure in isolation but to legi~ lation complemented by a puhilc education programme A ninetcentheentury British prhne Minister, Bci%jamin Disrae~, said that, "the first concern el auy Goveramel~t is the healfl~ of the p~)ple"; ~11]~ Act will give lead lint only to your country but a/so to the G~wt~naents of many other comet ties. I congratulate the proposers of this Act for their Luitiative wldch can only be benefi- eiv] to the publlc bealtb. The CHArm~AN. I am curious. !Vir. Waterson, Mr. Daube's state- ment says in essence that the law in Itely is flagrantly violated and thag there is tobacco advertising. Is that true? Mr. WAa~RSOr~. I am not aware of the precise situation in Italy. I do know that they are considering allowing cigarette advertising again, after a 20-year ban. The CHUmMed. Well, it is not a question of allowing cigarette ad- vertigtog. Mr. Daube's statement says that the advertising ban is not implemented, f-rues, when iMpoSed, are small, and tobacco com- panies have in fact treated the law with disregard and advertise regularly in Italy. Mr. W~so~. I am not aware of the situation. It may be cross- country advertising which he is referring to, which is a problem in Europe. The C~ArgMAN. Mr. Daulle. Mr DArns. Yes. In Italy the advertising ban was introduced in 1962 to protect the state tobacco monopoly, not for health reasons. And it is always a misleading example to cite, because in Italy--- The C~M~. Wss the local tobacco monopoly allowed to ad- vertise? Mr, Daub. No. I bate to say this, sir. It was the American com- panies they were particularly worried about. They wanted to pet rid of' that advertising, which was competing with the state tobacco monopoly. The IinEan ilgures are also misleading, of course, and notorious- ly so, because much of the tobacco sold in Italy is smuggled in. As I said. there is no complementary public education program. Not only are citge arettes advertised i,n Italy wish virtual impunity; they are even advertised in children s comics. So I think to look to Italy as an example of a country with an advertls~ng ban is somewhat misleading. The C~Am~A~. What is the hemal experience, to the best of your knowledge, w~th advertising in countries that have tobacco monopolies? Mr. Waterson says, that the purp~oso of advertising is to attract smokers to different brands. Therefore, it would appear that a company in a monopoly situation in a country, would not bays any need to advertise for brand purposes. Mr. Dgu~. Yes. I think the best example I can cite there is Kenya. Kenya is a country where until the midseventles a single company had a monopoly of the market, but they were still report-
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47 edly that country's fourth largest eommercinl advertiser. Now, they could hardly have had an interest in brand share. They certabtiy did not have an interest so far as I know in lowering tar yields there at that time, because when we were involved with tar testing for cigarettes they were considerably in excess of the tar yields of cig~arettes sold in this country and in Britain. So a company with a monopoly of the market was advertising cigarettes slzeabty. The same thing happens in countries such as Austria where there is a state tobacco monopoly. The C~Ax~¢. Mr. Wat~rson, I am curious. If the purpose of ad- vertlslng is for brand identifiegeinn, why would you have any ed- vertisinag in countries that have state monopolies? Mr. WA~RSO.~. I am obviously not aware of the reasons behind particular state monopoly advertising. All 1 would say is that if' ad- vertising bans even in these countries, where the purpose of adver- tising is less clear, even if advertising bans are not useful in these countries, then it must be the ease in this country that adveaCisteg is brand oriented. We have evidence from all over Eastern liurope, from all over Western Europe, solid factual evidence. This is not my opinion, as a great deal of Mr. Daube's testimony is opinion. This is simple re- search evidence from all over Europe, which shows that advertising bans do not work and their interference with the market mecha- nism is deleterious to the process of converting smokers to low-tar cigarettes. The CHAIRMAN. Mr. Waterson, I want to go throJugnh with you again the Norway statistiss, because you and Mr. Daube obviously come out at odds. You come out at adds not only on the number of people who quit smoking, but maybe as to the mason they have done so. Would you comment on what be said? Mr. WATgaSO~. Yes. It is very simple. Mr. Daube's evidence ~s based entirely on survey evidence, which I tried to show in my paper is completely faulty. If you ask people questlons about their smoking behavior, you will get replie~ which simply do not square with the truth. You can confhnax this fact by asking your national tax people. If you add up survey evidence of how many cigarettes are smoked or bow much drink is drunk in any country in the world, you will come out with an overall f~ure which bears no relationship what- ever--it is always much lower than the figures derived from na- tional taxation statistics. The only figures which you can go on which are reliable are the national cigarette consumpfion figures. In Sweden the other example I quoted, which is completely rep- licated in Norway, the population simply is not telling the truth. This has to be the case. Otherwise, you get the situation, the crazy situation where half the population has virtually stopped smoking and half the population has almost doubled its consumption over the same period, which clearly does not make sense. The C~N. So you are saying that all surveys on this subject are irrelevant? Mr. WAVrmSO~. f am not saying that all of them are irrelevant. I am simply saying that the vast majority of them do not appear to make sense. The C~A~R~AN~ Do not appear to make sense?
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48 Mr. WAVERSON, They do not square off with the things that we know about smoking behavior. The CHAiRmAN. Then the surveys are irrelevant? Mr. WATERSO~. In certain instances they may be useful to people who have done them for particular reasons, but the ol.es that I have seen are irrelevant. The Cm~mMAN. Mr. Daube~ do yen want to comment on the situ- ation in Norwa~y~? ~r. DA~Z, Yes, if I might. I am disturbed by the dismissal of all survey data. Of course there are bad surveys, and of course there are badly conducted surveys. One thing surveys can do is to show you trends, and that is important. Nobody claimS, I think, that sur- veys are spot on to the nearest decimal point. If I can, firmny~ just take in Norway, I think the best testimony, the best evidence comes from the Nol~veglan tobacco hidu~is'y. In October 1980 the Norwegian tobacco industry very wisely decided to market chewing gum, and two senior executives in the Norwegian tobacco industry said st the launch of their marketing campaign for chewing gum, and 1 quote: Since the introdactisn *f the ban on tobacco advertising, new thlnldng has b~ome a necessity. With reference to the forcefu] antlsraolfing ¢~mpaisn, we h~ve t~ take int~ account that there will be ~ollsi¢]orab]y fvwer Dew smokers, aud that hi the long run, consumption wi]] probably go ~own I am content to stay with the Norwegian tobacco industry as my backup. The CHAIrMAn. Wendell? Senator FORD. Thank you, Bob. Mr. Waterson, have you read your colleague's statement? Mr. WATERSON. I am afraid I de not have a copy of the testimony el" Mr. Daube. Senator FORD. Well, it says: I have recently seen the ovldenee submitted before the House Subcommittee on Health and the E.~'ironment of the Committee ca Energy and Commerce by Mr. Michael Waterson of the U.K. Advertising .%ssoc/a~ion testEylng on behalf of the American advertislng mdustry on March 8, 1982. I am perturbed that mhslesding test~aony should have been presented to the U.S legislature from the U.K., albeit by a spokesman fee the tobacco lobby whose previous publications has been mislead- ing See paragu~ph 1O I regret that it should he necessary to correct thi*. Some of the hal~rnths in Mr Waterson's testimony have been covered elsewhere ~n th~ paper, and a full rebuttal would be extremely lengthy. Do you want to comment? We may have something good going here. Mr. WA~RSON. I have been aware of Mr. Daube's statements on a variety of aspects of health policy for a number of years, and it is my opinion that the comments he has written apply to himself with far greater truth than they apply to me. I have based my re- search, my evidence completely and utterly on evidence which is as close as possible to factual evidence of actual smokers' behavior. Mr. Daube and others base their views on evidence which obviously and clearly is nonsense. Tbat is all l have to say, I am afraid, Senator FORD. Well, one is half-tsath and the other is nonsense. Let me ask you a question. You talk about a monopoly, Stats- owned, fourth largest industry in Kenya, is that right? Mr. DAUBE, Fourth largest advertiser.
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49 Senator FO~D. Fourth largest advertiser in Kenya, and what is its income, based on other Lndustries in that country? Mr. DAUBE. That I would not know. Senator FORD. Are you familiar with advertising of those that have basically a monopel in this country? Mr. DAUBE. I am not ~amiIiar with the advertlskig--i would not claim to be familiar with the advertising situation in this country. Senator FORD. Are you familiar with A.T. & T.? Mr. DAUBE. I have heard of the name, yes. Senator FORD. I hope so. All right, what about C. & P. Telephoue Co. in this area? You cannot get a telephone unless you get it from them, and boy, you see them on TV every night. What about the gas and electric companies in this country? You cannot get auy ga~ or electricity except from one organJzatlon, and they advertise almost nightly. Is there anything wrong with that? Is anything different or un- usual? Mr. DAUBE. I am not aware, sir, that gas and electricity in this country is the ]ar'gest avoidable cause of daath and disease. Senator FORD. Iunderstmld that, but we are talking about adver- tising here. We are talking about advertising. That is what we are supposed to be talking about, and that is what your testimony is supposed to be about here today. Mr. DAUBE. If I may respond on the specifics, sir, there is a dif- ference between gas and alectricity, that yon need them for your everyday life. Cigarette smoking is not essential for everyday llfe. Senator FORD. But we are talking about a monopoly. We are talk- ing about a monopoly. And yet they were the fourth largest adver- tiaer, and that is part of your testimony. It is in the record. So I just tell yea that A.T. & T. where you get your telephone, adver- tises daily, nightly, anytime, in the newspapers, whatever. The Washington area gas and electric, you do not get any electricity, you do not get any gas unless you buy it from them~ and they ad- vertise elmost nightly. Arey,ou familiar with State liquor stores7 Mr. DAUBE. I have seen them, yes. Senator FOHD. Well, they do not advertise one whir, do they? And yet they depend on the industry and their advertising to bring them in the door. Mr. DAUBE. As I understand it, Senator-- and I am sure you can correct me on this--there is a considerable amount of alcohol ad- vertishig in this country. Now, if there is not, then I would defer to your comment. Senafor Form. Well, they do, butLy*ou have a monopoly by that State that you cannot purchase alcoholic beverages unless you go to the State-owned liquor store. Yet they benefit from the advert£s- in of the industry itself. ~V~at I am getting to here is that we are getting ready to say to an industry that is doing everything it can to educate the public, and spends a lot of money, and brands is absolutely correct, in order to get them to the low tar and nicotine cigarettes, and where we had 2 percent in 1974, you have over 50 percent today. Would you say that is not a pretty good improvement?
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5O Mr, DAUBE. I would deny absolutely your statement that the in- dustry is doing everything it can, sir. I am conscious that when my 14-year-old nephew in Massachusetts last week picked up tins copy of Sports Illustrated there were 14 pages of cigarette ads in it. I think the industry is quite possibly, and sensibly from its point of view, doing everything it can to assure that there is a flow of new recruits into cigarette smoking. Senator FO~D. How many magazines were issued and sold of Sports I]instrated? Mr. DAUBS. I did not understand that. Senator FO~D. How many magazines were sold? What is the dis- tribu~4on of Sports Illustrated? Mr. DAUb. That I do not know. Senator FORD. DO you know the most popular magazlne in tins country? Mr. DAUaE. No, I do not. Senator FORD. Its distribu~tsn is a little over 1 million, and I be- lisve the magazine is called People. That is 2 million magazines out of a opination of 220 nil]lion. ~V~in is the turnover of magazine per individual? Mr. DAUSE. I think, Senator, if you are asking me to demonstrate specifics from one single magazine, then that is not my position. My position is that we are talking about a billion dollars worth of advertising in this country each year. We are talking about the massive advertising, not the impact of specific advertisements. But I am sure that speakers on later panels will also have specif- ic points to make about that. Senator FORD. 1 will get hack to him, Mr. Chairman. The CnAI]~MAN. Senator Stevens? Senator STEVENS. What kind of system does the United Kingdom have, Mr. Waterson, in terms of labelh~? Mr. WAtt.ON. It has three pack warnings which rotate. Senator STEVe. Is this a mandated wal~aing requirement on labels? Mr. WA~RSON. Yes. Senator STEVenS. Has it worked? Mr. WAWE~SON. It is my experience and my view, based upon, iagain, I must stress, research evidence, not on personal opinion as s the c~e with other witnesses, that every shred of evidence shows in the United Kingdom that the labeling has not worked. There has been done in the United K~ngdom a inll-scs]e econometric survey amongst other things, winch showed that the health educa- tion program as a whole did not appear to be too effective. It has been shovea that in the last year tJaere has been a massive decline in cigarette consumption based purely on a price rise which has outweighed the decline, the entire decline of the previous 7 years. It is my view for that and other research-based reasons that the pack warnh2gs have had no effect whatsoever. Senator STEVm~S. Is there any other factual data on the use of a rotational system anywhere else that you are familiar with? Mr. WATEI~SON. AS I have said, from Sweden and from Norway-- I am sorry, from Sweden, rather, 16 rotating warnings--it would appear that total cigarette consumption has actually gone up~ Sorry, it is certain that total cigarette consumption has gone up,
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51 The claims that are made about the effectiveness of the health warnings depend entirely on survey evidence which is grossly unre- liable. The only thing that may have happened in Sweden is that people have turned to snuff in an amazing way. There has been a 46-per- c~nt increase in snuff taking since the warnings came into being, or since before the warnings came into being, in fact, but I do not reeily think that has anything to do with the warnings. Senator STEWNS. Do you have any statistics of a comparison of use of marihuaua in the United Kingdom as compared to this coun- try? Mr. WArE~ON. I have no direct evidence because it is not a legal product and it is not one w~th which I have any connection. I do not believe that there is any evidence at all that is worth speaking of, but I do know that the usc of the drug is very widespread. Senator STEVENS. Mr. Daube, what do you say about those rota- tlonal systems in the United Kingdom and Norway and Sweden? Mr. DAURE. Well, I think we have some common ground in the United Kingdom it is certainly true that we have recently intro- duced the system of three rotational health warnings. It is equaUy true that a year after its introduction it would be absurd to make any assertions as to its impact. It is also true that those warrde~s were agreed by voluntary agreement, by voluntary negotiation and agreement with the tobac- co industry, and it is my experience that the tobacco industry is unlikely voluntarily ever to agree to any warnings that mention words llke death or cancer or heart disease, and nor would you. sir, if you were ~art of the tobacco industiT. SO the British warnings are weak warnings, and it is certainly my position that weak warnings will be less effective than strong warnings. And I wish that Britain had the same system of warn- ings as they have in, for instance, Sweden, or as is being introduced in this country. It is true that in Britain there have been substantial fax in- creases in recent years and that cigarette sales have fallen, and it is my position and it is the recommendation of the World Health O anization and other bodies that when you look at a program to rUe~uece smoking, price is important, if you can get it, and so are a series of other measures. We are not looking at specific measures in isolation. We are lookla~ at a series of measures. It is also my experience in surveys I have had done afLer tax in- creases have been enncted, about 50 percent of those res~p Lngondi said that they had given up, to a large extent, because vfheaIth reasons. Now, it was not the sole effect. The budget may have been a trigger. It is intriguing, too, that when you have a tax increase that is deferred, the drop in sales comes immediately when the tax in- crease is announced rather than when it is implemented, in other words, publicity about the dml~rs of srnokil~g ~s importvnt. So I hope that makes my position ree~onably clear, that I am for strong warnings, that the relatively weak warnings we have in Britain are an improvement but are not what I would like to see. Senator STEVENS. DO you take the position that advertising of to- bacco products should be banned?
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52 Mr. DAUEE. In Britain I would certainly take the view that--and it is a recommendation of the World Health Organization--that all tobacco advertising and promotion should indeea be banned. Now, I understand that in this country there may be first amendment difficulties there, and that makes it all the more im- portant that on such advertisements as appear, proper health warnings and product information should be provided. Senator STEVENS. Have you had any experience in terms of facts. Mr. Watorson, as to what impact advertising really has on the new smokers? Mx. WATE~SO~. Every shred of evidence there is suggests that it has no impact at all on new smoking. There are a number of fac- tors which affect people when they are young. Every piece of evi- dence I have seen repeats over and over again that it is peer group behavior and parental influence which are the two key factors in formulating you~/g people's actions, but not advertising. Senator STSVENS. dust one last thing. Is the new smoker primar- ily the young smoker in those statistics? Mr. WATERSON. I believe so, yes. The C*n~R~N. Mr. Daube, Senator Ford was questioning you about monopolies and mal~ng references to American telephone, gas companies, electric con~panies and whatnot. Without getting into the argument as to whether AT. & T. is a monopoly, they are certainly prevalent in this country. Is not the purpose of its advertising or any anonopely's advertis- tog simply to increase the use of the product? Mr. DAUBE. SO I would imagine, and I would add a rider to that, but I cannot speak for American corporations, but I would add a rider to that. The CHAIRMAN. That ls why the tobacco monopoly would adver- tise. Mr. DAT2BE. Yes. It advertises partly to increase sales end partly also to halt a decline to sales. Given the evidence on smoking, you would expect a fairly sharp decline. In some countries there has been one. And companies are looking to increase sales. They are looking to halt a decline in sales. Of couzse, they are also competi- tive. The CHAIm~aN. But it certnh~ rebuts any argument that brand switching, is the principal purpose to which, advertising of ciga- rettes i~ directed. In that ease, a monopoly would not advertise, nor would A.T. & T.--if they are a monoply--advertlse for brand switching. They are looking for increased customers. Mr. DAU'B~. If A.T. & T. were advertising solely for brand switch- ing, then I would imagine that most of the executives would be fired overalghf~ The CILXmMAN. Mr. Watorson. do you think that if we have these increased warnings on cigarette advertising, that the ciga- rette advertising will diminish? Mr. W~.WEaSON. That is a difficult question to answer. I personal- ly believe that any increase in regulatory activity is likely--I do not want to make the thing too fism~ut is likely to decrease the effectiveness of brand advertising, and therefore to lead to a de- cline in it. G0
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53 If you impose giant regulations, giant warnings on packs or in the advertisement, clearly you should expect to ~ee less advertising. The CHAZRMAN. Would you agree roughly with the statement that as a practicdi matter, the requirement of warning in advertis- ing could result in the elimination of all cigarette advertising? Mr. WATERSON. I think that depends entirely on the circum- stances in which the warnings are imposed, and I would Rot like to comment firmly on that as a statement. The C~AIm~AN. Before this committee 17 years ago, that state- ment was made exactly, and I am quoting: As a prac4iea[ matter, the r eqsixeraent ~f warning in advertising will result in the eliminatian ofsil eigai~tf~ adverfftslng. And that sininment was made by the then chief executive officer of R. J. Reynolds Tobacco Company. So I think the idea that the warnings were going to cause dirdinishment certainly has not proven to be true. When you testified before Congressman Waxraan's subcommit- tee, Mr. Wainrson, you said, and I am quoting, If the bill is enacted, it will contribute dke~ly to a fall in the rate of conversion of smokers from high to low tar brands. I am curious how you arrive at that conclusion when our bill will require that all cigarette companies list the tar and nicotine levels of their cigarettes. Mr. W~:J:I~RSOI-I. Any increase in regulatory acsivlty, in my opin- ion, will diminish the effec41veness of brand advertising since lnOSt---- The CaAmMAN. Say that again. Mr. WATrmSON. Will diminish the effectiveness of brand advertis- ing in this country. Tbe C~m~ar~, Any increase in what.? Mr. WATmtSON. In regulatory activity, in other words, the change from one to five warnings. The CnAmMAN. Will diminish the-~-- Mr. WArm, SON. Efficiency of brand advertisin~ in this country. The C~AmMAN. Why? Mr. WATEI~SON. Because it increases c~utt~r, it increases the dir~ parity of the message on the pack~ if you liks. If you are selling low tar cilg~aret~s and pushing the idea of low tar as against high f~c, any clouding of that message will necessarily lead to an interfer- ence with the message and therefore with the effectiveness of the advertising message itself, and we have clear evidence that inter- fering with the number of messages about low tar cigarettes will interfere with the number of low tar cigarettes smoked. It will lead to a decline in the rate of conversion, in other words. The CnAmMAN. You are simply saying that if you have so much diutter on the package, the relevant information about tar will be last? Mr. WATERSON. Well, I have no idea what sort of size warnings you intend to impose. If you change the shape and the size or in- crease the size of the warnings, that could have a severe effect;for exalllgie. The CnAmMAN. Wendell?
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= 54 Senator FOH. I am curious just a little bit, Mr. Waterson. How were the labels determined to go on packages of cigarettes in other countries? Who was consulted and how aid they work out the do termination of the wording, the size, the print, et cetera.? Mr. WAT~lSON. I am afraid I cannot answer that question. I do not work for the tobacco industry and had no party to negotiations that took place over such warning labels. Senator FORD. Would you know how the decision was arrived at? Was it through a commission, agreement, a negotiated agreement on what kind of language should be on it? Mr. DAUnE. There are normally two ways, and obviously I cannot give you chapter and verse for each country here, but there are normally two ways. One is that where there is legislation, a gov- ernment is empowered to decide on the words of the warning, and that has happened in Norway and Sweden, and that also means that when new information comes to light, for instance, the Norwe- gian Government can decide, mq it has done, to adopt the Swedish system of rotating warnings because it is impressed by what is hap- peidng in its neighbor country. The other method of agreement on words of warning is what you get in a country llke Great Britain where there are negotiations be- tween Government and the tobacco industry, and the Government, as tends to be happening here, starts off in one position and the tobacco industry starts off in another, and they try to reach a com- proralse which is probably acceptable te neither. So in Britain, the Government requested the tobacco industry to adopt the warning, which is printed ea Government offldid literature, and that reads, "Danger. Cigarettes cause cancer, heart dlsettse, bronchitis." The tobacco industry refused to adopt that, a~d eventually a much weaker warning was negotiated. Senator Form. Well, are you saying that the labeling was im- posed by regulation and not by law in the Unltad Kingdom? Mr. DAUBS. No; the warning has bccn reached by voluntary agreement in the United Kingdom. The reason for that is that the Governmegr, as at present, has preferred to reach agreement on the label on cigarette packs and advertisements rather than legis- late. The tobacco industry has accepted that because obviously they fear that it" they do not accept ~ome kind of warning, legislation will follow. So it is a voluntary agreement. Senator FORD. So it is a voluntary agreement. Do you think that is the proper way to go rather than have gov- ernment interference? Mr. DAUBE. First of all, sir, if I could take the point about gov- ernment interference, because I think that is a rathe~ important point. I think that the government has the right to interfere with cigarette advertising when the lives of so many people are at stake. The sort of opposition to what you term goven~ment interference now ks reminiscent of the opposition that there was in Britain in the 19th century to the great public health legislation when the London Times thundered, "Every man is entitled to his own dung heap." And, they wrote, "We prefer to take our chances of cholera and the rest than be bullied into health."
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56 not have the figures for the States. I have not had time to work them out--that cigarettes kill approximately four time~ as many people as the total killed by drinking, drugs, murder, stdcide, r~d acsidents~ rail accidents, ah" accidents-- Senator Fo~. That is in England. Now, do you have any statistics on this country? This is what we are trying to work out, what happens here tn America, not what happens in the United Kingdom. Mr. DAUBE. Sir, I can assure you that the figures for thls country are analogous, and I can also assure you that I am distre.~ed at-- Senator FORD. How many people entered the Houston Trauma Center last year, or Chicago or Miami, how many were shot in this country? You know, how many were disabled? What did that cost in automobile accidents? Mr. DAUBE. You will Pad, sir, that if you add them all together they do not amount to anything llke the number killed by cigarette smoking. Senator FORD. I do not know that they are killed, that is where you and I may disagree a little bit. You are getting into a different field, and you say that is the reason that we limit the speed limit. Well, the peoplv break it, they get caught, you know, and so they have to allow them the opportunity to break it. Otherwise we would not need a police force, we would not have to have tickets. Mr. DAUBE. I am sure, Senator, you would not be encotn'aghlg people to break the law, but I would certainly want to stress, and I really want to come back to this because I am wormed that we may have shifted the focus of attention. Little that there is a substantial difference between smoking and other products. That is why I feel that this measure as a public information and education measure that does not infringe anybody's liberty is an excellent ~neasure. Senator FORD. What about alcohol? Mr. DA~rBE. Alcohol is a very substantial public health problem, also. I have tried in ray testimony to make my position abeolately clear because I do not want to have any misunderstanding that I believe that again, measures that do not infringe the freedom of the individual, such as curbing advertising, are desirable for alco- hol but ! would if you press me say that cigarette smoking is over- whelmingly the largest cause of avoidable death and disease, and I think that the ease for action o~ snicking is the pr~raler case in terms of preventive medicine in the Western World. Senator FORD. Well, we have drug and alcohol abuse, and we have an educational program, and the Government has stayed out of it, and they seem to be performing very well. Would you not like to give us an opportunity to try that rather than impose Federal regulation upon industry? Mr. DAUBE. I am looking, sir, for a complementary program, and 1 stress that, for education and for other measures. Perhaps I CaR draw an analogy. A complementary program entdiis not only cap- turing South Georgia but also landing on the Falklands. You cannot capture the Falklands simply by landing on South Georgia, and you cannot have a full smoking control program that does not include what I have referred to very early on in a seminal Norwe~
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57 "an report, education and information measures, legislation, and ~e~lp for those people who wish to give up. Senator FoRe. Well, your best ship in the Navy was sank by a 20-year-old missile, and you want to not go on with any other addi- tlvnal research and development? Thank you, Mr. Chairman. The CmURM~N. To that you do not need to respond. I have no other questions. Gentlemen, thank you very much. Oh, excuse me. Ted, I'm sorry. Senator STEererS. I just wondered, Mr. Wate1~on, I asked a ques- tion about children. Do you have any statistics about the impact of advertising on children commencing smoking? Does that have any relationship? Mr. WA'r~RSON. We have a number of pieces of evidence which suggest that there is absolutely no impact at all, that advertise- ments are not the factor which leads children to take up smoking. The factors which lead children to take up smoking are factors such as parental and peer group influence, educational measures, and this sort of thing, tt is quite clear in my mind, and the evi- dence is ovel~vhelmh~g and pointing in one direction and one direc- tion only, which is that it is not advertising which is the problem at all. Senator STEVENS. So if the eas~ were made toward a new smoker, advertising would be practically immaterial as far as the new smoker? Mr. WATEmSON. It is my bailer, based on the research evidence I have seen, that advertising would not be of much use in that sitna- ~iou. Senator STEVENS. Ttmnk you. The CI~AIRMA~. Gentlemen, thanky*ou very much for coming. Next, we will take a panel of Mr. Edward Horrigan~ Prof. Boger Bfackwell, Mr. Larry Light, Prof. Joel Cohen, and Mr. Charles Sharp. Why don't we start with Mr. Horrigan7 Are you ready? STATEMENTS OF EDWARD HORRIGAN, CHAIRMAN OF THE EX- ECOTIVE COMMITTEE, THE TOBACCO INSTITUTE, ROGER D. BLACKWELL, PROFESSOR, DEPARTMENT OF MARKETING, OHIO STATE UNIVERSITY; LARRY LIGHT, EXECUTIVE VICE PRESI- DENT, TED BATES & CO., INC.; JOEL COHEN, DIRECTOR, CENTER FOR CONSUMER RESEARCH, UNIVERSITY OF FLOR- IDA; AND CHARLES SHARP, CHAI~LES SHARP & ASSOCIATES Mr. ttORmGAN. Y~, sir, Mr. Chairman. My name is Edward Horrlgan, and I am appearing here this morning in my capacity as chairman of the executive committee of the Tobacco histitute. I also seTve as chairman and chief executive officer ofR. d. Reynolds Tobacco Co. Joining with me on the pau21 this morning are Dr. Larry Light, executive vice president of Ted Bates, along with Dr. Roger Black- well, professor of marketing at Ohio State University. Before presenting my prepared, brief statement, I would like to digress just for a moment in connection with a development here this morning. That is, on behalf of our industry, I would like to ~x- ~5
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i i Illfl t n I| .L al N r[
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'//, 69 THE ]~FF~ OR~A~ZATION, INC, MarcA 10,198~ HO~ HENRY WA~AN~ Chairman, Health Subcommitlee, Cornmit2ee o~ Energy and Commerce. US Ho~tze af Repr~sentatL~, W~hi~t#n, D.C DEa?. Mm ClCm/l~; It is my under stolldil~g that you Subcolnlni£O~e is cur~ntl Y holding hearings on H.R. 5653. Tiffs is the bill that imp]enmnts the cigarette I~belo inK requirements recommeded in the Fede~l Trade Commission Staff Report On The Cigarette Advertising Invcstigatioll, dated M~y 1981. At least two surveys conducted by the Roper Organization are cited extemsively in tlmt staff• reDmt in support of the reporUs cgntentmn that str Oll~er and more varied cigarette warnings a~ required both on cigarette packages and in cigarette adver- tising ORe of the studies so cited {s the l~port of a private survey we conducted for the Tobacco Institute in 1978 which was subpoenaed by the ]~TC and stlbsequently pub[ic[ialy rale~ed by the FTC. The second w~ a survey we conducted spco[fle~l ]y for the FTC in 1980. In its staff report, the l~fC does not d£re~tly attribute the conclusions r~ched (name]Ly,, that stronger and varied warnings z~e requlred) to out" organization. Flow- ever, th~ frequent references to oar data carry the impli~tlon that the R~per stud- ies support the report's co~clu~ions. I haw no ob~ctisn~ to thv way the FTC staff reported the results of our mtrveys. TO th~ extent kha~ I have checked these facts, they are correct. I do hvwever, strongly disagree with the conclusions the FTC staff reach~ based on those facts. Because the FTC report relies so strongly on Roper data a~d ~0ecause I disagree wlth their interpretations of that d ~tt~ } re~pacgf~]ly request that this letter he in- eluded in the transcrizp~t of your hearings, The FTC staff concludes, based on o,~" and other survey data, tha~ the 9ublie is inadequately infermcd aleut the dangers of smoking. Using exactly the saum data on which they base their concluslon, I would conclude almost exactly the opposlte~ that th~ public is highly aware of%he reported d~ngers of smo~ng~ In our 1978 survey--condnctcd for the Tobacco Institute, not the Federal Trade Commlsslon--we dzew up a balance shee~ }n o~r summary of the survey's findhlg~. The first two "liabi] Ries" we cRed ~ the industry% po~iti~n were as follows: "L More than nine out of every ten Americans believe that smoking is hazardous to a smoker's h*~ll~. "2. A majorityof Americans believe that i~ l~ probably harmrdoos to be around people who smoke, even if they sl~ not mnoki~g themselves." I would submii that thi* hm'dly repr~n~ unawareness of the problem. In dealing wxkh our 1980 survey conducted for the FTC, the staff report notes on page f~40: "Despke. the dangers of carbon monoxide, I/lall~ p~oplc are Ilnaw~D'e of its pi~- en~e m mgarette smoke, in ~he 1980 Roper study, 53 percent of ~he tots[ sample and 56 ~ercent of smokers did not know that ~garet~e smoke eont~tins caxhon monox- ide , %Vhile I do no~ quarrel wi~h this finding I do quarrel with it~ iroplicatlon, l would submit that many also don't know that carbon monoxide is dangerous to one's h~vlth. = fundamental quarrel with the B~C's contentiOn is that they are ¢~pecting the public to possess a high level of detailed, rather technical information that it £s who]l.~" unrealisdc, to exI~et and that can. ~r°bahlY .... never be nchleved by nny eduea- tlonalc~Ipmgn, no matter how ~b~nslve l'b is~ or of wh~ dur~[tlOn it ~s. An analogy: I would sub.lit tlmt mos~ Americans know their cars have a~ pollu- tion equipment installed in them that ~uhstantially fewer know have eatalyi~ic con- vet%ere, and that very, very few Imow those cat~ly~c converters contain platinum, Dove this mean we need a campaign to acquaint people wi(h tile pce~ence of plati nun} ~n the. catal ie converters that constitute a major portion of the air i~llution eqt~pment m theist cars? Onp~gea 5 21 of the FTC ataff report, the folloMng statement app~rs based on our t~8 survey for the Tobao:o Institute: "Sixty~ne percent of those palled and 69 pereen l af the noa-sraokera pol~ed favored the p~op~gd Itew wacnlng. Only 34 per- cent of tbcse polled and 26 percent of the nee-stackers favored the cul~ent '.valn- ing" The implication of this citation is ~hat tkia shows the need for a stro~tger warning. TO me, it shows fhe rever~. Six~oDe parent woulc[ not l~tvor ~t stronger warniItg tmless fll~ey were a]readay aware of the danger. Many Jthe l~£C staffs ~nclu~ions ~hat the public is unaware of speci~is dangers resulted from the incidences of "incorrect" ar~wers~r gue&~on multipleehoi~e
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o~ 09G~OT~ ,,,It .......
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61 We also believe that the requirement for disclosure of "tar," nic- otine and carbon monoxide levels on packages and in our advertis- ing is unwarranted. Smokers who choose their brand on the basis of tar-- The CkfAmM/~'~. I am going to have to ask you to conclude rea- sonably soon. Mr. HOR~'IGAN. Mr. Chairman, if I may, I was assured by Mr. Pexlmuttsr that I would be given l0 minutes for my testimony, not 5 minutes, and this represents a significant change, sir. Tbe CmlJmach~. All the panelists were told 5 minutes. Mr. Hero, mAN. The letter I have and the statement I had from Mr. Perlmutter--I am terribly sorry. I was told 10 minutes. I would not have craftsd such a statement if I were tom 5. I would have respected your wishes. The C~xA~x~. In that event, go ahead. I will not quarrel with yoM.. r. HostaGes. Thank you. I appreciate that. And nicotine levels have been able to readily obtain this information since 1970. There is also no purpose to be gained by the publication of carbon monox- ide y~elds. Scientific evidence does not establish that exposure to carbon monoxide from cigar~cin smoking is hazardous to health. A provision requiring disclosure of ingredients is also um~ccessary for the industry has just recently agreed to make available the neces- sary information on ingredients te the Department of HHS. We are aware that there have been some efforts to build s~pport for this bill with claims that industry advertising and our promo- tional practices are intended to encourage youthful smoking. The written submissions of export witnesses which have been provided to this committee clearly show that this is not the case. Our indus- try's position continues to be that smoking is an adult praciSce to be considered only by those mature enough to make an informed decision. The avaiiabie evidence clearly shows that our advertising is not designed to attract new smokers of any age, and it is not having that effect, because in fact our own government reports show that the percentage of smokers in this country is decliaing. In conclusion, Mr. Chairman, it is our firm belief that the weight of aI1 the available evidence demonstrates that this bill represents bad legislation. It does not have a valid scienffdic basis, because the findings used to support it will not stand unbiased scientific scruti- ny. It is unnecessary because the present Surgeon General's wal~- ing has created unprecedented public a%areness of the Mleged as- sociaison between smoking and health, and it is counterproductive for two important masons: First, acceptance of the scientific statements made in it could well deter much-needed research into the causee of chxoaic disease, and second, it could leseen public awareness of the issues with regard to smoking. But I think more importantly this bill is bad legislation because it seriously erodes the principle of free choice in our society. It im- plies that those who do not conform are uinndirmed~ and that they cannot be allowed to reject opposing views regarding the use of to- bacco products. 96~0I 0 89--5
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r i, i IIJ I II II I[ [~ II
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63 quences of smoking, simply because many consumers choose to con- finue to smoke. The FTC Gaff reports several times that smokers are not as well informed as nonsmokers, impl~ng that such infor- matisnal dlfl~rences are responsible Ibr the decision of whether or not to smoke. But that conclusion, and there is some evidence on this--we hear so many times there is not any evidence, hut there is a conclusion based on evidence that flatly refutes it, and that is from the 1980 Chillon Study. and the conclusion reached by the Chflton Study is as follows, and I quote from page 22: Factual knowledge about the health con~e uences of smoking was not ~'ouud to be ~gngicantly related to current smoking hq~avicr. No more differences between knowledge levels of smokers ~m arod wgh re.smokers were found to be slgnifi can~ at the .05 level than were to ~ expected b2 chance. This important finding that consumer knowledge has no relation- ship to smoking behavior refutes the notion that people who smoke do so because they are not informed. To conclude, I would say that as an analyst of consumer behavior and as a person who is a nonsmoker personally, I am quite COn- cerned that what would happen is that the people who might find the warnings more personidly relevant would be older people, and people who would fad them irrelevant because they are about di~ eases for elder people would be the young people, and in a sense, passage of this, while the intention might be quite laudable, Sena- tor Packwovd, would be to hurt the very people who we might want to be most concerned about, the young people of the Nation. and I would say that tiffs is not desirable legislation if the gsul is to help the general population, and especially smokers, become aware of the health hazards that are alleged to occur from smok- i~. [The statement follows:] STA~M~I,4T OF D[~* ~GEl~ ~, BL~ C K ~Y~LL My name is Roger D. B]ackwell. i am professor of marketing at the Ohio State University~ spevializl~g in the analysis of buyer behamor and development of mar- keting strateh~t My Ph D de e was ~rned at Norbhwestern University, ~Ath concentration in consumer be~ea~P'or I have authored or coauthored 14 hooks and over gO ar~cl~ published in professlunal ~r business jou~nal~ gmt report r~earoh ~hat I and o~hel~ have oondust ed ¢encel~ling ~he ~om~unlcati~/l$ preens, consultant doeS.ion processes involved in buying and using goods and services, and variables involved in marketing strut e~gy . One of m ~hc most recent bobks is the fourth editlnn of C~nsumer Beholder, published thi~ year, book describes psychological prln~ples iavolved ir~ buying a~d consum tlon oald is ~he mos~ widely adopted textbook in ~he field. A complete li~t of my pub~ca~ion~ is subn~it ted with this statement. This is my personal statement and should art be construed [o reflect the views of ~hn Ohio State University or any otl~er ins+Atutlon with which I am or have been affiliated. l have been asked to mx~lyze section 5 of S, 1929, which would change the present labolin~ requirements for cigarette packages and advert~s~men~& The rotational system of warning statements proposed b sectlon ~ of the bill Js similar to a reeom mendat~on made last year by the Staff o~Yt he Federal Trade Commission in a roper t on cigarette advel tislng, and I have evaluated the Ymdiogs ~ld coi~c[usions of tlmt Red,oft ~ well ~nmy opiuion, the change in the warning statement proposed by sectio~ 5 is fun- damentallv flawed, First, the ]abelh~g pr o~dslons of section 5 would replace a highly success ful ]program of informing consum~r~ about the claimed health ri~ks of smok- ing with a program of tmknown and l~t entlat]y coul~t erpreductive co~seq.ences, All of the studg~s conducted about c~nst~ner awareness of smokin and health issues lead to the conclusion that peop]e are unlver~ally aware of the c~a~ms tbafi smoking is hazardous to health. WILv ab~mdon tiffs program Jn favor of n course tha~ is not
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66 An init~l study for the Frc Staff was undcrtnken in 1980 by Walker Research to assist in file se]~tion of specLffc warning giat omen[s, while another study conducted by Burke Marketing Research examined coasvmerd recall of various war ni.gs. Im- port~stly, neit her study exmained the impact of such warnings on consumer aware- nose There are accordingly no data to indicate that a rotational system such as that proposed by the bill would meet the objective of provldi~ consumers with "sufl-l- cient" awareness about the claimed consequences Of ~mokJng. par~imilarly ff suffi- ciency is gaged by the very detailed measure used in the surveys clhed by the FTC S~aff. Xffhat the studie~ do demonst rat~ i$ that consumcr~ are likely to discount warn- ings that link smoking to specific health pr obl~ms. In its Summary of Key FindiDgs, for example, the Burke F~as Group Study states: "The me~sag~ relatred to birth control pills and heart attacks tended be confuse the pnrtlcii~nts, who did not thoroughly understand the synergistic effects which form the basis of the message. These two statements relating to oral contracept~l tiros olsQ had the least personal relevance and were rather easily dismissed ~ being intended 'for someone ebsg." (Emphasis added.) The Study thus ¢onclude~: 'fit seems that the birth control messes could have relevance to a highly select group of people who could be best re~ched through very spevlf~c media. The m~s~ge ml ht be lost to the population as a whole." (Burke Focu~ Group Study Ann]ysis at That same eoncluslon appears to apply with equal vMid£ty to eac~ of the specific diseas~ warnings contemplated by S. ).9"29. Thus. ~n the prelilalnary research that has been done tends to suppol~ the ¢ou- cluslon that the p~3posed ro~tional ~¢arnings would be cons/doted /n-alevanc by ~ne cougumers, as compared to thepresent warnlnlg~statement that announces to avery consumer the Surgeon General's conclusion that "smoking is dangerous to your health," These findings are paitieularly slgniflc~mt L~ view of one of the major premises of the FTC staff report, and presumably of the present bill: that consumers should per- ceive information concerning smoking and health to be personally relevant 8ince it is basic to human nature to conclude that risks apply to "t~e other person," specific warnings that might be more pew~nally relevant to some consumers would by deft l~itlon be personally i~eIevant to most other consumers. For the individual who sets th~ dise~e'~ as unlikely to occur personally, then the proposed new warnings would be less relevant.. Such Llldivid U~. are particularly likely ~o be ~oullg eunsuul-. ors who may be m~klng the de~islon Of whether ~o smoke m- not. While the dectslon to ~moke i~ ~ot related to adverth,ing, at least in the present zitua~ion parents or eers e~n say ts people who are deciding to smoke tha~ "the Surgeon C.eneral hs~ P determined that smo~g is dangerous to your heath." Under the proposed new warnh~gs, the logical conetusion would be that the ~urgeou Geueral has no longer determined that smoking is generally unhealthy, bu~ only unhealthy for certain oldor segments of the population or for Negna~ t women. AS an analyst of consumer behavior and dee~onmaklng, I am of the opinion that 8.1929 may well have the opposite effect of that wl~ch appears to be intended by its sponsors. I am concerned that S. 1929, no matter how laudable the intentions of ~he sponsors, Is not desirable legislation if the g~al ~s to have the genera/ population, and especially STnoker~, aware of the halth hozards that are alleged to occur from Smoking. The C~z~N. Thank you. Dr. Lighk Dr. LIGHT. Thank you, Mr. Chairman. As a member of the edver- ~;ising community, I see no justification for tim provisions la S. 1929, which call for rotating warning notices in cigarette advertis- ing and on packages. There is no evidence that there would be any benefit from this technically complex and cumbersome proposal. The labeling and advertising proposals included in this scheme ap- parently stem from the conclusion that public awareness of the claimed health consequences of smoking is inadequate, but this conclusion is wrong. All evidence indicates that the level of public awareness of both smoking and health is high. Surveys show that awareness of these alleged dangers is over 90 percent. This is an
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68 not adequate explanations of behavior. There is little chance that the proposed rotational scheme will increase overall awareness. There is no evidence that the proposal wifi affect beliefs. There is no evidence that the proposal will afl~ct behavior There is no justl- ficat~on for implementing this complex, burdensome social experi- ment. There is no justification for a proposal which constitutes no more than continued harassment of marketers of a legal product. Few Americans today Would endorse the policy of legislation by haphazalzl, capricious experimentation. This seems to be an exam- le of a policy of "pay now and pray later" for some benefit. Hope- ~ly, that philosophy of government is behind us. The current ad- ministration and the American public do not support such haphaz- ard legislation. There is no evidence of any benefit associated with this complex program. It is a program which is an unreasonable appropriation of a mark~er's advertising space for a perfectly legal product. The proposal contained in Senate bill i929 is completely unwar- ranted. I strongly recommend that it not be adopted. [The statement foIlows;] ~TATEM~I~r OF DR LARRy LIG/-~, ]~ECU'I~VE VlCE PR~I~EN~, TED BA~$ & CO., INC~ As a member oi the advortising commur.ity, I soe nv justification for the pro'~- s[otls in S. 1929 which call for rotating warning notices in ciga~tte advertising and o~ ~o~g~ W~@r~ Is no evidence that there w~l be Ray benefit from this techrdeal- ]y complex and cumbersome proposal First, I wish to address ~hat appears ~o be a basic hy°pot h~k~-c~gavette ~dvortis- lllg somehow eDcourag~ people ~ smoke. A rewew of ava~J~ble l.ese~r ch alld ~np-at tieular a de~aiIec[ ec~nomet ric study of 20 years of data lead to one conclusion "Aclver tlsi~ doe~ not stimulate or maintain consumption levels" (Waterzon, 1~1) In addition, this z~v]ew ex~mine~ the ef£~cts of cigarette advertising bans An analysis ef data from 14 ~untrles concluded that "every country Ln the world that has tried +~ reduce smoking by res~rict~4~ t~]a~o ~dvertisemen~s h~ been tm~ucces~ful" (Watt.on, 1981). The evidence m cIem'. There is no correlation between levels of tobacco advertising and cigarette coi~sump- tlon Now, let us examine the ro~atlon~l warning system proposed in S. 1929. A vota- tloIlal warnil~g system u~iv-g sLxteen dbffervnt mes~ es has been instituted in Sweden. There is no evidence that ~hls scheme has h~c~any effect on sales To my Icnc~vIedge, there is no evidence that the ~ osed rotatiolm] scheme would work in the Unllsd Stabes, either. Hmwever, the ~CPStaff s posture seem~ to be 'qet us tr~ it and see what happens," 2]als is llimsy logic for a compiioated cumbersome experi- ment The labeling and advertising proposals in S. 1929 apparently stem from the con. ~u~on that~ublic awareness. . cf the claimed health consequences sf smoking ]s in adequate. This conclusion IS wrong. All evidence indi~ate~ that the leveI of public awareness about smoking mid hearth is high, by any stander d The exist h~g Surgeon Generol'~ statement warns of the alleged daug~rs of smoking Surveys show that awareness of these afiege~ dan- gem is over fl0 percent. This is an extraordinarily high number In a ~ecent letter to the Hous8 subcommittee, Dr. I~per observed that the FTC ~aff has mLsL~terppeted his ~urvey results, The proper conclusion ~s ti~t awallOUe~S is high, not low This extremely high awa~eness of the warning me~sagee is not surpr~ng. I do not believe that there has been a single message that has had the le~'el of advertising support that the Surgeon General's v~rn]ng has hnd. Since 1971 the warnLng has appemed in hulIdreds of nfillions of dol/ar~ of advert/sing. When I speak of "awareness," I ~o not mean that people memorize specR]¢ words. Whatpe~pIe do remember i~ overMI imp~ssions C~nsumer s have registered the in- mndedne4 impr e~sion of the Surgeon General's warning statement They have do~e so because the statement h~s met the live lund~mental advertising principles to produce effective messages: keep the message simple; make it clear; say it often; be consistent and be sJng]eminded. Thus, not only h~ there been sn extraordinary amount of do ar suppor~ for the present statement for over 0 yea~, but s~nnd
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69 principles of good cammunica~on have been followed, oz well Therefore, ~gBJn, I am not s~r prls~d th~ w~ have the~e ext racrdln~rlly h~h awareness levels. The Staff of the FTC scem~ to ]0e concerned tha~ the warning may have "worn cut." Tbay apporen~ly believe the old ellehe, "familiarity breeds contempt." lu ad- vet tieing, just the opposite is ~rue. Familiarity breeds trust Consist eney breeds con- fidene~ But, mat~aliliarity breeds uneer talaty And, inconsistency breeds con fusign. Marketers rec.~co~am'ze the v.due of co~teney We are ell famELar wlth the consist- ent symbols whieIa represent "~ea~ola," "Kodak," "Shell," "McDonald's," "Green Giant," among many. We remembex thccgreleat care ~he ext entire reeeareh and the obv~ons planning associated with StandardOfl's change firom '~" to "Edzxon." No ccmFany capriciously flbmadone an asset it has built aver many years and at great expense. The present warning s~ateraent in its white box, ~th its consistent type style, ~td it8 cQnsistent set of words has apl~ in the s~roe form since 1972. It is now the Surgeon General's logo. The value of this consistent asset has been demonstrated. The warning is instant- ly recognized and understood. Thin ~ so evma when it is printed ha a language for- el ?o most AmeHe~n~, l~e propasal in S. 19'29 seems ~o be based on a simple premise. Since people are continuing to smoke, they must not be adequately i~formed abe~t the elamaed health consequences of smoking Of course, this premase is wrong. All of us have eye.day experiences w~th ides~ about which we are aware, but because of other information in our personal men~ eomputar~ we vhc~e not t~J h¢- lieve them. Awa~cnc~s and belief are very distlnet concept& Analys~ of the I~C Report suggest that the Staff consistently confused the concepts of awareness mad belief. The FTC's stated objective is ~ increase awareness of smoking and health issues. ~ey b~lieve that if awareness wore increased, smoking would de=rea~e, But advertisers know th.t many, many factors detetralne ul~JmaO~ behavior b~- sides awareness. People do not fasten their eaibty belt~. People litter city parks. People walk when the signal dearly ~ays "don't walk". Is the problem lack of awareness? No--it is no~, It ~ a simple fact of human nature that awareness mad knowied~,~e are not adequate expleat atioas of behavior Even ff it were reasonable to expect a slgrdfmant increase ha awareness beyond the current extremely high le~zels, it is my opln~on that thepr~oposod rotational warning system would he unwarranted. There are no cmpir~eM data, no ~heoret~cal bases, no pragmatic cvldence, nothLng at all which support the proposition Lhat the proposal in S. 1929 wuuld ach~ve its intended objeehves. There is little ¢l~lee that the 1~t atlon~l sche~ne wi~ increase owr all awareness There is no evidence that the proposal Will affect beliefs ~r b~h~vior. There is no ustification for implementing this social exper!ment. There ~ no just Lfieation for a t~po~a[ whleh eol~titutes no more than continued h~rassmen~ of marketers o~ a ~atl product. Ir public policy d~ctatss that the information set forth in S. 1929 should be broadly comramaieated, there ar~ a mul~ftude of educational vehicles which can be used a~d are being used righ~ now beth by government and private health agencies, such as brochures posters, films, roaterial supplied to ~chools publicity mad so on It seems to me that the government has full, led ts respons bll ty oltce t h~ ll- forlla~d the coast~ler. 2q2e govar rtrnent has the right to in~brm. Thell, ~l~e consumer has the zSght ~o ehe~. The right tu freely choose what to believe. The govern- meat's responsibility is ~o inform; it is not mind control. Few Amp'icons today would endorse theploliey of legl isigtlon by hapht~ard cxp~ri- m~ntatign. This se~ms to be a poUcyof, "Pay n~v. pray later." Pay new for the cost Pray lair for some henefit Hopefully, that philosophy of government Is beldnd us. There is no evidence ofa%v benefit ~sociat~'~ wit]i ~his comple~ program. A plo- ffcam which is an um~easonable appropriation of a marke~er's adver tieing space for a perfectly legal px~duct. The proposal contained in S. I929 is completely nnwarrmated. I strongly recom- mend that it not be adopted The C~AmMAZ~. Professor Cohen. Mr. COHEN. Thank you. I am Joel B. Cohen. I am delighted to have been asked to present my views on this bill by the National lnt~xagency Council on Smoking and Health. I am currently chair- man of the market~ng department and the director of the Center
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70 for Consumer Research at ~he UDiversity of Florida. The center carries out an extensive research program in consumer behavior, and has focused particularly on the psychological processes in- volved in consumer information p~cessing and deeisfonmaki~g. f bare had a long history of professional involvement within the American Marketing Association, the Arnericmx Pssylchologlcal As- soclation, and the Association for Consumer Research, which is the leading interdisciplinary association of consumer behavior re- searchers. I was the first elected president of the A~ochitibn for Consllmer Research. I have published extensively on cognitive processes involved in consumer decisionmaking, as well as on attitude formation and change in both marketing and psychology journals, and am fre- quently asked to review schalarly research in theee subject areas for leading marketing and psychology journals. My research on consumers psychological reactions to smoking warning information dates back to 1965, when we studied consum- ers' responses te the Surgeon General's report on smoking and health. I served a~ an adviser to the National Academ]v of Sciences panel on the Impact of Information on Drug Use and Abuse. Over the last several years, I hove looked at cigarette advertising and the provision of ~v~rning information in several capacities, First, at the request of the I~. J. Reynolds Tobacco Co., I carried out an analysis of the psychological mechanisms underlying changes in cognitions and attitudes within the context of rigarette advertising. Second, at the request of the Federal Trade Commlssio~, with Prof. Thomas Sruli, I provided a detailed assessment of information proc- essing issues involved in the communfoation and retrieval of ciga- rette warning information. Much of the criticism of this bill seems to be of two types. One, people already know that smoking is dangerous to their health, so nothing more can be gained by providing this type of information, and two, pr ovidli~g a specific set of rotated health warnings will not be effective, and might actually have the oppesi~ effect, and there- by lead to increased smoking. These are two critical arguments, and they need to be addressed. In looking at the first issue, what do people know, others have focused on data from several surveys. I think it is important to avoid getting lost in a largely methodological analysis of survey re- search procedures and data. The imporinnt thing to note is that survey data hearin~ on what smokers know or do not know can only provide an estimate of the upper limit of information poten- tially available to them. Survey data cau be very ralsleading if used for any other, purpose.. Survey questionnaires, assess :prompted or cued recall m which people respond to spec*fic questions or cues. This situation is not at all identical to one in which a person must spontaneoueiy recall information about a particular brand or prod- uct class. Advertisers implicitly recognize this when they provide in~store cue~ that are intended to help peopis retrieve previously acquired information. In general, memory researchers typically make a fun- damental distinction between availability and accessibility. Once information is fully comprehended and coded into long-term memory, it is thought to always be available. However, only a
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72 coasumezs' responses to the Surgeon General's report on smoking and health, I have had extensive involvement in Burney research as well, end in this cormection served as Vice-President and Director of the Social and Behavioral Science Division of National Analysm,bs, a leading survey ~rch or ganlz~C£on. I served as an advisor to the National Academy of Sciences panel on the Impact of Information on Drug Use and Misuse, Over the last several years I have locked at cigarette adver rising #mR the pr ovi~ior: of wazxl~ in fslmation in several capacities. Fizst, at the request of the R. J Reynolds Tobacco Company I carried out an analysis of the psychologi- cal mechanisms underlying changes in cognitions ~d attitudes within the emalext of cigarette advertising, Second, at the request of the Federal Trade C~mmlssion with Professor Thomas K. Sru]l I provided a detailed osee~mont of information prcceqsing issues involved in the communication mad retrieval of cigarette warning information. I understand that the repor~ by profemor Srull and. myself has &]ready been L~tradaced into Lhe r~ord, and I intend b~ base much of my testimony on its cont@nts. First, however, having now z~d some of the pr evlous t est~ony dealing with both cigarette advertising in general and the proposed labeling end adverfishig require ments contained in this bill, I mn compelled to make a few more g~noral Imint~. Much of the critieL~n of this bill seems to be of two types: (i)people already know that smoking is deuterons to their health, so nothing more can be gained by provid- ing th~s ,t~o of information, and (2) pr o~ddlng a specifio set of rotated health warn- ings won t be effective oxM lalght actuall~y have the oppceite effect and thez~by lead to increased smoking. These are two eriti¢~d eagtunent~, ~ld they need to be ad- c~ressed. Having seen seine of the pro,claus testimony, presumably addressed to the f'trst point, ] think it is irnpcrtont to avoid gotthag lost in a largely methodological analy- sis of survey research procedures and data. I hope I shall be able to convince you that the survc~y data bcurlng on what slaokers know or don~t know can only provide an estimate of the upper Iitolt el information potentio]l:L available to them. Survey dam can be very misleading if used fo~ any other purpose, and I shall shortly ex- plain why. A second general point that I would Eke to make at the outset is that no matter whose e~timate of the health and economic casts of smoking we take as valid, it is clear that we are dealing with a major nations] public health problem. Accordingly, it d~2s not sccm sensible to evaluate this hill as to whether it will, in slid of itself, completely renx~iy tke problem or to requ£re in advance the type of absolute proof that call only come after a prelim has been put in place and gt*:en a chance to work. I do Rot see this bill ~ a panacea A combined pregr ~a~ involving improved warnhig Informatio11 ~ o@nstxraer cducatlen, with special atten~on to those ust considering whether or not to s~art mnoldng would be even more effective. In the commeats that fo ow d like to address the broader and be eve far more critical) consumer information proce~shng issues that lie at the hear~ of rhls bill mad not the la cgely tactical issues involved in monitoring each specific proposed warning to insure that it is olpttlmal I would hope that the Office of Smoking and Health or the Federal Trade Commission could be ohnrged leith that continuing r~ sponsibillty. i, CONSUM]glL~' E~L~22NG K~qOWL~ 0~ SMOKtNG HAZAR~ E~x|~er I made tile polx~t that surveys can only give US ~n estimate of the Rpper level of m foi~mtion Dot entially avsdlable b3 consumers. This ts h~ause survey qnes- ~ionaalres assess prompted or, rued reca~ in which people respond to specific que*- finns or cue~. TbLs situation is net at all identical to one in which a pereon must spent ancously re~a]l informRtlon about a p~tleular brand or produce cI~s. Adver- tisers implicitly recognize this when they provide in-store cue~ that are intended to help people retrieve previously acquired information. In genera], memory t~se, arch- els typi~lI~ mak~ a fmadament~] distinction hetwee~ "availabilitgi' and "accessibll ity" Once m formation is fully comprehended and encoded into lo~g-term memory, it is thought to ~ays be "avaiLable." That is, there are I~ychalogical m~clmnisms hi the brain that permanently store and r et~in such info~aztation in the absence of some profound effect on specilXed regions of the brz~n. However, only a small por- tion of the vast quantities of [uformation that we learn is "acc~sslble" at any given th~. That is, we at~ only capable of retr~evlng a fraction ~f the total information we have available More importantly it is widely recognized that information tha~ is accessible in one context or in response to a particular cue or prilne will not be ac- ce~sible in another. There is a great deal of inforloat/m~ tha~ people m~ able to re- trieve when provided with specific cues that they are unable t~ retrieve in the ab- sence of eny cues. This means that responses to survey qucstlo~ indicating that
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75 It is a great de~l easier ~ project oileself into the plcPare~ of happy people enjoy i t~ ~,~ms*l~'es in a typical cigarette od (and thor eb.y encode pr o-~nopAng ird~a. tien m terms that are pet sonally relevant) than tt m to f~nd personal relevance in the present abstract warning. A number of recent studies have dEmOnstrated highly $~fiftcaut effec~ of making information personally relevant. Concrete [nlbr marion is more eaaily ~4sualized and related to one:s life experiences and is therefore nlol~e personally relevant, per*anally relevant ixfformation is attended to more readily ~ndpr~roces~ed more easily than pemenaUy ~relevant ~ferma~on and it is better recalled. Personal relevance, then, will be enhanced by having the watm/ngs refer to particular illnesses, since the consumer is more a~pLt t~ bring ~ mind specific in. stances and other information regarding Imth the ilhaess and people who have sut: fared from it. It L~ also important to include amonL~ithe rotated wac~dn~ one which pro~ade~ concrete mformatmn regarding the benefits of quiting smoking. There is a conBiderable omoun~ of re.earth on motivational factors in persuasion that indi- cates that Stelm to "solve the prob[em" shouId be inoluded among the information given to alert people to the fact there t~ a problem. Otherwise it is ~co easy to evade the problem andput it out of mind eitbpr because it is "toe hie" or became "there ~s nothing I can do about it." In summary, the more attention getting, concrete and personal~ relevant the w~rr~n~g, the more it is ]ikoly to be thought about and the ~t~ier it will be to re. trleve from memory. The importance of irL~Or ma~oD ell~Dg to sLIb~8~Ren~ retriev- al cannot be stressed t~o much• It is pc*sible to encode a stlmulu~ even ml adver tls- ing slogan or a health wanfinng,, without extracting much information or elaborating the ~ontsnt of tile mes~ge. The gaeater ~he peraonal relevance of the message, the deeper will be the proce~x~g and the greater the ~laboration of (or thlnkln * about) the message. Thi~ produces a far g~eater number of asso¢4ations available in menl0~ Each ofth~ ~an a]~o pl~y an ~orten~ funetlo~l as a t~t rleva] aue. T~ue, getting a Demon to think about the personal impli~ations of information is a ]pa~ ¢ieularly effectlvo ~ategy to enhmx~e ~ubsequen~ ~ziew~l of that information. There is no question in my mlnd that the p~posed warnings are a s~g~liflcant ira- provement over the emoting warmng and that they are in kee in with well estab- lished findings in psychology. Given the rotational scheme, I ~ln~t believe there is any basis whatever for the cMim that these warnings are more likely to be viewed by consumers as relevant onLy to othe~ and irreLevant ~o oneseh". In addition to the inElusion of a more specific version of a geueral warning which could apply to anyone, other warnings refer to specific illnesses whose incidences are high enough that personally relevant instmaces a~ likely to be brought t~ mind. In short, I think this is a m~Jor and long overdue step in the right dirEE~iOn COLLEGE OF BUBINE~ hnM1~ IBTRATIO~, UNIVEV~IT~ O~ ~'LO~IBA, Gainesville. Fla, May 1~, 1~82. ~on. BOB PACKWOOD, Chairman, ,~nate Committee on Commerce, S~ience, and Transportation, Wcshit~ to~z, D.C. DEA~ MR. CI-IAIXM~: UnfOl~L~lr~t~l~ there w~ a~l inadequate opportunity in l~Ionday's hearing to counter some serloa~ 8rrorB in the ~stilrtony ~iVeD r~o~ardlog the Comprehensive Smelting Pveventlon Education Act of 1981 by several !ndtmtry witnesses I ~h~nk it is imI~rmn~ for me to call your attention ~o ear.in informa- tion which I believe will be helpful in settiug the record stnght. 1. Industry witnesses continually talked about figures in the ranp;e of 90 percent when ~eferrmg to [he level of peoples' awareness of varmus health hazards Such estimates are of course, extremely imprucisE since ~herE are a number of health h~z.ardb and ~he levels of knowledge differ somewhat for e.ac I (see the FTC staff report), l~or~ inlpor~ant]y, I helie~e I have demonstrated that reliauee oa cued surve~ research questions (eg Are you aware/do you helleve that smoking causes ? ') are very mlslcading. If I were to survey people and asked whether they thought oxygen was important to their health I'm sure we'd ge~ about 100 Fercen~ a~reemenL. If, instead, we asked what things are impor tm~t to their bezdt b, oxygen would simply not come into their minds This information--which is known and therefore available--is simply not accessible in the absence of the right cuea A good deal of harm is probably done ~o the e~vironment to others and to themselves by people who at one level "know be~ter" hut who~ ~mless it is brought to their specific ~f~tiOU~ ~luply do tint take such hafort~a~Jon into co~*ideratien. Another way to put it then, is that there is much information pe~pie have which is not at a level of awar~nes~ and therefore requires opec fie cues to elie t The or)de=no ~a~ this i~ t~ne for h~alt h h~z~rds resulting from smaking eem be found in peoples' l~spo~ses to open-end survey questions where there are fewer cues i= ~q
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76 given (Le., Note, though tlmt there ,nay still be cues transmitted e~rlier in the sur~'ey wh~h give ri~e to e~zpect a~ons about what the researcher hater~st ed in). For example, eu page 3 80 of the FTC staff report we eee that about V~ of the sample in the 1980 P~per study did not know that smoking causes heart, aCmeks when an aided re~ll question was used. Howowr, "about %'s of the sample dld not respond 'smo]rd~g' when a~ked to nvxne all the cause~ they coLfld think of few heart attacks?' Thus, vo~ only have the industry wit nc~c~ been extremoly imp~ec~e in theirlrxlgfi - ures regarding upper [imits of consumer kunwledge, but by focusing on aided fecal] data in tbv first place a toLally misleading img~eion i~ created ~ to what informa- tion people are really aware of and Lucorporat~ into their iudgmen~. /~nkly, ff ople were asked ~omethfi~-g Iike the above unaided op~n-vnd survey question '~'~Cld" g.e. so that no cues ~f any ld~ld were created e~rlier ha the queationnaire) it ~uld be ray opinion tha~ the aumber of people who stated +hat smoking cause~ heart attackz would be significantly lower than 33 pereent~ 2. Mr, Light emplmsized how impoitant consistency is in presenting a~.wrfising me~sa~ Te 91u~tra~e ~his he produce~ a~ 8n exhibit a cigarette ~zl in Japanese but containing the white box (which contains the warning in formation) that people haw a~scc~atsd wi~h eigszette advertising for some time now. ]-]'e then reported that American consumers who saw the ad responded correctly when asked whag in for~a- tlon was in the b~x. Mr. Light ueed this to argue against changing ~he present warning men,age because he claimed that vwitching from the tried and ~rue mes- sage would only confuse eonstumers. But his own e~ample atgne~ for the opp~ite conclusion It is enough to retain a cons/sfent p~men~ation s~rategy. The box in a cigar et+~ ad now functions a~ a superb ~ymbol to alert people to a health warning contained ~ithin. h~ £ae6, the raes~e cou2d even b~ in a foreign lanlgu~age m~4 people w~uld still recognize that it w~ a heaIth warning. S~ the unmistakable con- cLu~don that should have been drawa from the evidence he introduced t~gether with my OWn carefully documen~sd ~es~mony is tha~ theprinciple of adver rising eonsis~ e~cy (eg., "fantil~arity breeds trust..~gnfidenee"l can be inet by i'et ai~ng the symbol of the whi~e b~x (or perhap~ even nat the out]h~o of a box in a cigarette a~), and th~ crqci~l importance of message noveD;y conet-~ne~, a~d personal i~levance to at- leution, elahorat~on and subsequent retrieval of the infor~aticn car be achieved ~. using the proposed system of ro~ated warnilnNs. There were a number of other points that] would have liked to make in an effort to clamfy the overall record, but 1 consider these of sufficient importance that I am c~llkng your ahentlon to these il~ order to eorree~ an o~her~vlse very misleading ~et of te~tlmony. SincereLy, JOE~ B. Con~a~, ~°rofex~or and Cl~i~ ma~, 1)irectar, Conter far Consumer Research The CHAm~N. Mr. Sharp. Mr. S~ARV. Mr. Chairman, my name is Charles Sharp and I am appearing here today te testify in support of S. 1929, the Compre- hensive Smoking Prevention E~ucation Act. I am currently president of Charles Sharp & Associates, a man- agement consultant firm which specializes in locating management and creative executives for top advertising sgenctes and marketing firms in this country. I have worked in the advertising industry for more than a decade. For close to 7 years I worked as an account executive for the Tracy-Locke Advertising and Public Relations A~ency in Dallas, Tex., where I was responsible for accounts such as Frlto-Lay and Texas Instruments. I have also worked as an account supervisor for Bozell & dacobs Advertising & Public Relafions, Inc. and as a vice president and management supervisor for Ogilvy & Mather, Inc. While with Ogilvy & Mather, 1 was responsible for the Matte1 Electronics and Shall Oil Co. advertising accounts. In 1978 the "Come to Shell for Answers" campaig~ which was developed under my direction was awarded the American Market- Lug Assoclation:s Effie Award, the American Advertising Feder- r~ -J
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>
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78 sonal image, an advertiser will attract individuals who do not cur- rent]y use that product but who want to identify with or emulate thai lifestyle and project the depicted image. Thus, ads which effec- tlvely associate smoking with the latest trends or ideas or with so- phistication, sexual, social or athletic success and happiness will at tract smokers and nonsmokers alike who want to be like the people in the ads. This phenomenon is particularly applicable to young people be- cause advertisers are well aware that young people seek to emulate the most modern trends and project an image sbnilar to those images projected in many cigarette ads. I notice my time is limited, so I will skip ahead and try to hit just the highlights of the other two points in my argument. First of all, the warning rotation of the cigarette advertising as proposed in S. 1929 does not call for a major change in advertising principles or practices. I think this bill calls for the changing of messages within the existing format and physical dimensions of ex- isffmg framework of cigarette advertising. Thus, I could only con- clude from basic advertising prindples that we are not changing the campaign, we are providing more information from which to make an intelligent decision. Also, from my experience in the advertising business, the ad- ministration and the accommodation of this bill does not present a slgnificant encumbrance upon the cigarette advertising industry or its adver~sing agencies in administering the program or even ac compHshing the program. In concIusion, I believe that S. 1929 does not represent harass- meat of the tobacco industry but an effort to allow the members of that industry to further demonstrate good corporate citizenship by providing the American pubic with precise, important and new in- formation concerning the health risks associated with cigarette smoking. Thank you. [The statement follows:] STAT~ENT OF ~AR~s ~N~AW SIX~Rp OF ~HAI~ SH~l~ ~,~ ~SOCIATES Mr. Chairman, my name is Charles Sharp and I am appearing here today to tes- tify in support of ~ 1929, The C~mpr ehen ~i~ Smoking pr eveuti~ Educati~ Act. ] am currently the president of Charles Sharp and Associates, a management consult mat f'~m which specializes in lccating ]i]a~gemellt executives for the top advertis- ing and marketing agencies in this countly, including Foote, Cone and Belding, McC~nn-ETicksee, Doyle, D~ne ~md Birnbae~ and th~ J Walter Thompson Adver- tinslng Agency. I have worked in the adver tlslng industry for more than a decade For close to seven yeals I worked as a broadcast media supervisor and account ex eeutive for the Tracy-L~cke Advertising and Public Relations Agent in Dallas, Texas where I w~ responslbl~ for accounts such as Fr~to-Lay and ~exas Instru meats I have also worked a~ an accoun~ super~,qsor for ~zell and ,lacobs Advertis- ing and Public Relatione* Inc., and as a Vice-president, Management Supervisor fDr Ogilvey and Mather, inc. For O~dlvey and Mather, I had primary r espon~ibil~t y for handling the Mattel ~lectronics and Shell Oil Company accoun[-s In i97~ the "Come tc Shell far Auswers~' campaig~ which was developed under m~ direction was awarded the prcsti~us "David Oglivey Award for ExceIience.' The now famoUS Dorito advert~shlg c.~npeign developed under m) direction for Frit~-L~y in t~Re eally 1~70'S iS widely acclaimed as one of the mdustry's mast successful adver- tlsing effor£s in ~xpandlng ~ exisfin product's market. I want to thank the Chairman ann~ the members of the Commerce Comi~Jttce for ask~l~g me to present my views on ~he need for and thB merits of S 1929. IR my t~ony I Would like to focus on three basic issues. First. adverthsmg plays a sit-
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6&6~0¥~'~
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r r
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81 number of packages at a single time. To c~mply with S. 1929 a manufavtumr ¢c~Id simply use a plate which contains ~II af the ~varn~ng m~ages aud wldch would stamp ont appraximatply the same number of packages with ~ach warrdng at the same time. If the hnplement allen of S. 1929 gave these pr h~te~s sufficient time so that ~hi$ new pdtttL~g plate could be introduced a~ the time the eJld one ~ears out, the coat of compliance would be mha~mal. In ce~cl~ivn, I st r~ngly support S. 1929 as an e~ecfive, n~d~d low cost ll~thod for communic~t h~g the health ~ of smok-lng to the Axaericau public. The CH~RM~. Mr. Horr~gan, do you think the present Surgeon GeneraFs warning works? Mr. HORPJOAN. Yes, sir, I do. The C~RMAN. DO you thiak it should be kept? Mr. ttOZRmAN. We believe it should be kept. The C~R~m~. Dr. Light, let me ask you the same question. Does it work? Dr. LrQ~rr. As I understand the objective of making people aware of the alleged correlatisa between smoking and health; yes, Tar Ch~mMA~. Should it be kept? Dr. LmHT. Yes. The CIZAIm~AN. 1 am curious that when this was originally passed, both the tobacco and the advertisis~g industries opposed even the present warning. Mr. Horrige~? Z~c. HOmUGA~. Mr. Chairman, I was not in the tobacco industry at that time, but if I were to go back and trace the circumstances, and in Borne ways those cizeumstances have not changed today, the bas~, I think, ~br being in opposition to the imposition of a warn- ing notice was that in the opinion of the industry and tbe research availabis to it, there was no scisntific basis for such a warnlng notice to be on our product. By the same token, our industry recognizes that there is indeed a controversy. I think it was on the baals of that that the Surgeon General's warning went on the pack. I think the indust~5~s position remains unchanged today in op- posing the imposition of these new hibcls hecause there is still a scientific debate. There is no scientific basis for the Isnpositisn of the proposed warning labels. The CHAmMA~. IS there any scientific evidence at all that there is any harm from the smelting of cigarettes? Mr. HOt.mAN. There is a great des] of statistical evidence, but there is a multitude and abundance of scientific data that chal- lenges that which has been used against the tobacco industry. The C~AIm~A~. In that case, why should we keep the warning? Mr. HORmG~-N. Because in our belief 90 percent or more of the public is aware of the controversy or the alleged health effects of smoki~. However, as a restmnslbis manufacturer, a responsible in- dustaT, as long as that controversy exists and there is Isgis]afion requiring this warning, I think we must act responsibly. The Cn~Rr~, But that controversy existed at the time of the initial Surgeon General's report, and yet the tobacco industry op- gesed even this warnhig. Mr, HORRIG2kN. That is correct. The C~R~a~. Why didn't a responsible industry at that time support it? Mr. ]-IOR~IGAN. Repeat that question again, sir? I am sorry. 01
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82 The CHAIRMAN. The tobacco industry has opposed this warning from the beginning. If there was a danger, if there was some reason to believe after the first Surgeon General's report that there was a danger~ why the opposition of the tobacco industry then? Mr. Hor~R~GAN. I think I said earlier that the opposition was on the basis that despite the publicity, the data and the reports, the industry maintained that there was not a scientific basis to put the warning on. The CHAmMA~. Is that still the industry's position? Mr. HO~RIGAN. Absolutely, sir. The CHAIRMAN. Then why should we have the warning now7 Why have you changed your position? Mr. HORmGAN. Because as a responsible industry, if in fact this has been decreed by Congress that there is a controversy existing or a belief in the minds of many people, then as a responsible in- dustry we believe that we should honor such decrees and put that on our pack. I think that is being responsible. The CHAmM~N. If I understand your statement, the evidence was not adequote at the time of the th'st Surgeon General's report and it is apt adequate now in terms of whether there is any danger to health. Have the circumstances not changed between the first Sur- geon General's report and new? Mr HoRam~x. The circumstances with regard te our belief on this issue have not changed. The CHAIRMhN. Then I do not understand why now you say a re- sponstble industry should put this warning on when there is no evl- dence to justify it in your mind, while 17 years ago that was not the position of the industry. Mr. ttOm~GAN. I mentioned earlier that ! was not in the industry at the time that th~ issue first arose, and I would have to say as a businessman who has been involved, I think, in the marketing of responsible products in other industries over many years, if I had to go back to those first days, I think the industry perhaps should have taken a stronger stand with regard to it because there was no scientific basis. Be that as it may, it did happen, and if it is on the pack and there is tbJs concern, then we would conthaue to respect those wishes. The CHAIRMAN. Dr. Light, why was the advertising industry op- posed to the present warning before and apparently you support it now? Mr. LZGHT. The issue is not whether we would support or oppose the warning. The real issue is that it seems unreasonable as a matter ef principle to me that advertisers should be asked to adver- tise against themselves. If public pohcy dictates that the infoln~m- tion set forth in this bill at this throe, were then, and at that time to be broadly communicated, then I think the ibdustry's position was then and should be today that there are a multitude of more appropriate vehicles which can be used and are being used right now by both Government and private health agencies, things such as brochures, posters, films, and materials supplied to schools, and publicity and so on.
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83 Now havln~g said that, I believe that principle is just as valid today. The fact is that we have a warning on the pack, and that by itself changes the circumstances. The CH~aRM~W. What do you mean by that by itself changes the c[r ctttnstances? Dr. LIGHV. We have a warning. You have as a matter of public policy dictated that a certain amount of advertising space will be appropriated to communicate a certain message. The C~'~. I want to make sure I understand the answers you gave previously. You indicate that that message is effective and it should be kept; is that correct? Dr. LmHV. What we have indicated is that the intended message that is in the warning has been communicated. I do not know what role the warning by itself has played, but what we do know is that by a combination of brochures, pesters, films, materials, publicity, public reintions, speeches, coverage of hearings like these, a mes- sage has been communicated. Ninety percent of the people are aware of the intended message that is carried in that warning. All the research suggests that not only are they aware in general terms but that over thl~ee-fourths of the public are rernarkabty aware of specific diseases alleged to be associated with smoking. Eighty-seven percent of the people are of the view that smoktog can affect in some way the smokers baby if she is pregnant. Over 90 percent believe that heart disease has been found to be associat- ed with smoking. I am not saying that thoee two particular impressions came spe- cifically from the warning statement, but I am here to say that it would seem, given all that, unnecessary, against common sense, and silly, if you ask me as an expert, to now imagine that abaanglstg the warning statement would make that "90 percent" into a"109 percent." The ~IAtRMAN, Senator Ford• Senator FORD. You go ahead. The CHA]~M~. I still do not understand your answer. You would keep the present label, or would you net? Dr. LIQHr. What I am suggesting is that if public policy dictates that there be a label, we should keep the label as it is. The CHAIm~AN. Of course, yOU would if the law requires it. What do y~u advise about the law? Should we repeal the law or keep it? Dr. LIGHT. I am not here as a lawyer. I don't know how to advise you on that• As an advertising expert, however, I would say tbot if an advertising campaign theme achieved this kind of awareness, we would be very careful and very cautious about capriciously and arbitrarily adopting a cumbersome scheme in the hope that 9g per- cent may become 92 percent. The C~talm~A~. What does that mean, translated? That if we had a successful warning label that has worked for a long time, yea have 90 percentp,enetration, don't break up the Yankees? Dr. Lm~. Well, there is an expression I have learned from Mr. Horrigan in the South, apparently. "If it ain't broke, don't fix it." And there is ao evidence that this one is ~broke.'~ The CH~RMAN. Except that had we followed the advice of the ad- vertising industry initially, we never would have had this at all. 5¢
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84 Dr. Libra'. I don't know that that is true. The C~MA~. Well, they opposed it in testimony before this committee when we initially held hearings on it. Dr. LIG~. WeE. I was not here, but I don't know that we would not have had these same numbers. I do know that there is a high level of communication of the intended message, and now to com- muulcate in an inconsistent, random way would certainly violate commonsense and good advertising practice. The C~L~. Mr. Horr~o~, you inid Congressman Waxman's subcommittee, and I am quo~ng, that smohing is an adult practice. What do you mean by that? Mr. ~ORP~G~. It has been our position, Mr. Chairman, that we believe that smoking is .an adult practice. There are certain prac- tices or pastimes for which people should wait until they are mature enough to make certain decisions, and we have maintained all along that that was our position with regard to smoking and that a person should wait until they are of, say, an adult age and mature enough to make an informed decision. The CH~R~N. If there are no adverse health effects associated with smoking, why wait until you are an adult? Mr. HORRmAN. The point that we make is that there are many, let's say, pastimes, such as drinking, and then the controversy and the effectiveness of the G~vernment and antismokers in their cam- paigns to create a climate about our product. That being the case, then as z~esgensible manufacturers, we would prefer that people wait until they are mature enough to make that decision. That is our position, and our programs, I believe, support that, Mr. Chairman. The CHAm~AN. What do yon mean by that? Mr. HORR~GA~r. Continuing programs. I can take the pas~---- The CHAMMY. Do I take that to mean advertising is not aimed toward the young? Mr. HOaI~IC~AN. That is right. If I may for a moment, and certain information I would put forward here is in a sense proprietary, hut to take you into the marketing of cigarettes, we have said, despite people who take issue with us, that our advertising and our mar- keting is designed to compete within the present marketplace, which is growing at a very, very slow rate right now. But we segment the marl~et, and the segmentation that we use hi our marketing to develop marketing strategies, I will make a point very clearly here that not one of those segments, and there are many, is the youth segment. And as a marketer, if indeed we were to be markethng to youth there would be such a segment. Our segments are divided ~y brands and brands that compete against each other for a certain kind of consumer. The CHAIRMAN. Have you ever had any discussions in your com- pany about targeting an advertisingp]rogram specifically inward youth? [ want you to think very carefully before you answer this question. Have you ever had any discusslons in your company about an advertising program targeted directly toward youth? Mr. IIOnRmAN. The basic advertising that we have, first of all, we talk about young adults for certain brands. I also am aware, I helie~Te, of a report that came out, mad I have forgotten the year now, to be honest, there was a report that came up, I think, as a ~q
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85 result of an FTC review of this i~sue, and there were some market- ing statements in there, but i~ fact there was never an executed campaign based upon this repark That was 1977. The C~xm~. I am talking about your company. Mr. HO~rGAN, I am talking about my company. The C~m~. There was a discussion ct' an advertising pro- gram aimed toward youth, you coaslde~d it, and for whatever reason~ you say you dismissed it; but you considered it. Mr. HORRIGAN. We need to be careful when we say we considered something, Mr. Chairman. You have a staff. I have a large organi- zation, and many times different subjects are brought up for differ- ent reasons, different motivations. But the key is hnplementation or execution. And il" you are asking me about implementation and execution, then there is no such case that you can make on that here this morning. The CI~. Wendell? Senator FORD. I think I will start now. Mr. Horrigan, let's pursue the questioning a little bit of Chair- man Packwood. The FTC report outlined five possible remedial op- tions, including a voluntary industry self~regnlation. However, they dismissed this option, saying that the industry has not dcvstnped mul i~ not likely to develop effective mechanisms to disseminate health information in cigarette advertising. What voluntary step~ has the industry taken in the past, and does the indus.: anticipate any voluntary action in the future? Mr, HOI~IC~AN. I started to answer that question before and I ale luwed myself to move off the subject, but I would llke to take the past, the present and also the future in answertag your question. With regard to the pa~t, I think we've demonstrated an ability to be saigl~gulating and to be aware of the pressures and perceptions about our industry. We can put forward, for example, our cigarette sampling program, and the industry has a self imposed, self-regu- lated cigarette sampling program. And f would add that because of the competitiveness of our in- dustry, we watch each other very carefully for any infractions or mistakes that happen in the distributions of such samples. Sam- ples, tbr example, are not distributed to anyone under 21 years of age, and proof is required if there is a question. That is No. 1. No. 2, speaking again about the past, and this relates to the pres~ eat, in our advertising we have a rule that no one appears in our ads unless they are 25 years ctd or older, and along with that, in casting for those ads we no longer use celebrities such as the gem tlemao that was put forward in the Chesterfield ad this morning, nor do we use the sports g~ures that peagin might revere. Third, and this is very ~cent but if could very well develop into another extension of our commitment and demonstration that we are self-regulating, ob~ousty as we are here this morning there are many perceptions and charges against our industry and we feel the need, just as our anti's or zeMots feel the need to inform the public, we feel the need also to air the other side. We have a campaign of six ads and they are running now in major magazines, and they address the most tYequentiy asked ques- fleas about attitudes towards smoking on the part of smokers and
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86 nonsmokers. One of those ads, I think, might be available in larger form. That is: Does Cigarette Advertising Cause Kids To Start Smoking? Tha/, nd clearly sfa+~es our position. The ad has been carefully researched, as have the other ads in the campaign. And looking ahead to the future, Senator, if as a result of this we see a need for our industry to exhibit ta some other way a commitment toward our position about youth and ad- verfising, we would in fact commlt to such programs. We have hi the past and we will in the future. Senator Foal). Mr. Horrigan, you have stated that advertising by the individual tobacco companies is aimed at brand preference and brand switching. My knowledge of the industry is that the brand preference advertising is very competitive. Would you explain for the committee why the current advertising on behalf of tobemco companies is not ahned at encouraging new smokers? Mr. Ho~'(. Because of the basic industry position that we be- lieve it is an adult decision, and therefore advertising is very com- petitive head to head for brand competition as opposed to any appeal that would bring in youth. There are no sampling, there are no promotional devices that would develop a marketplace ~vithin the youth segment. Senator Fo~. Mr. Horrigan, there have been several references in these hearings about the amount of money that the cigorette manufacturers ssp~end on advertising and the large increase in that spending after che industry ceased advertising on radio and TV. How many brands are now on the market? Mr. HoaRmaN. In excess of 200. Senator FOI~D. And what is the average expenditure for advertis- tag for each brand? Do you have that figure handy? Mr. I-IoaRIGAN. I have it in a different way because fhls came up at another hearing, Senator, because when people throw around the $1 billion, that is typical of ad agency execs who love to see those kinds of billings from any company, but I think we need to put it in perspective. There were about 120 brands back in 1968 when the ad budget in the industry was in the range of $~00 million. Now our total is $1 billion, which is correct, but against over 900 brands and brand styles and takiz~g into consideration inflation, the rate per brand in 1980 is equivalent in the rate per brand in 1968. So there has been no dramatic escalation on a per-brand basis in support of our busi~ iless. Senator FonD. Would you clarify what you meant when you said the rotating warnings are technically unworkable? The language in the bill in section 4 is confusing to me, as it must be to you. Just what does it mean to require that all warnings "appear an equal number of times in all brands and all adver tisement~s ? Mr. HOg~AN. Happl~ily, I am the chairman of the company, Mr. Senator, and not in charge of the media department, because my point is that with regard to the clurzZstaess of this plan I think we have a panel assembled here following us that is tar more experi- enced in the nuances of this, and they will elaborate very clearly on how unworkable and how clumsy this plan is. i
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87 But I can only say that regardless of marketiJag sophistication, computers, et cetera, there ig no process by which we could pin- int precisely the needs and requirements of ~ bill and not pOl leave ourselves dangerously exposed becalme of this legislation. Senator FORD. Let me shift a little bit, if it is all right, Mr. Chalr- I:fllln. Dr. Blackwsil, the FTC report stated that less than 8 percent of adults exposed to cigarette ads read the warning label. Yet 90 per- cent of the public is aware that smoking may be harmful to their health. It would therefore appear that warning labels are not the most effective means of giving information to the public. What do you believe would be the most effective means? Dr. BLACKWELL. The most effective means is probably parents and peers. And one of the things that the current warning does by making a very direct state~, ent that "The Surgeon General has de- termlned that smoking ts dangerous to your health" ts allow par- ent~ to talk with thein children very specifieally. When we add great complexities we cloud the issues. And more sspec sifically, if we add issues about heart disease and cancer and things that mostly refer to older people, because the mortality rates are dramatically higher there, then we are making it much more diiffeuB for parents to sit down with their children and say, it is dangerottS to your health. At the present time, we have a statement that applies without equivocation and the present one works, as we said, with 90 per- cent or whatever the number may actually be. But any change in that causes the possibility for young people and many older people to say, well, that is someone else, and human nature is to say, well, that applies in somebody else, not me. So I believe that the proposed changes would in fact he counter- greductive. Senator FORD. Well, so you would say that this piece of legisla- tion would drastically reduce the impact of the warning statement, then, to yomlg people? Dr. BLAOgWELL I am not SO sure I would go so far as to say it drastically reduces it, but it certainly does not help it, and it does raise some risk tha~--- Senator FORD. Let us leave out the word "drastically." You be- lieve thhs legislation would reduce the impact of warnlag state- menis to young poe~pl le? Dr. B~CI~WE~. Yes. I think so, Senator Fo~m. Do you believe the report is flawed in that it ex- pects total knewledLgee of s~atlstiss relating to smoking? Dr. B~C~:WELL That is a basic flaw in that study. In my written statement I give a number of examples of that, but the FTC has nlissed the difference between belief and awareness. In one partieu- inr instance, for ~xample, in the 1980 Burke Research Focused Group study, there was this quote at page 4: "Further doubt about the direct relationship of smoking and cancer seems to be related to the fact that these persons had known smokers who had lived long lives wlthout cent racking cancer and nonsmokers who had suf- fered from that disease." In other words, a person could say, yes, I am aware that those statistics exist, but I do not believe them because I have seen
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88 people who do not. My wife is now stfffering from cancer and ln7 father has had a heart attack, and neither one of them are smok- ers. And it is hard to say that just because you read the statistics that you accept them. And in fact, the FTC report had many statemenle about that and others which I demonstrate in there that just because something is said by the Government does not necessarily mean that people be- lieve it. Senator FORD. You would not buy a used car from the Govern- ment? What is your opinion of the Chilten study used in the FTC reDcort? Dr. BLACm~m. The Chilten study has, llke all surveys, weak- nesses and strengths. I believe the study does reveal some interest- ing facts. The quote that I mentioned indicates that there really is no difference in behavior based upon, statistical sigulflcaace in be- ha-~or, based upon knowledge. The problem is not so much with the Chilten study as the way the FTC interpreted it, which is a problem with a lot of studies, of cour~. The Cream}nAN. Mr. Blackwell, as I understand--and I think it is your parisian too, Mr. Light--thst the present Surgeon General's message has been reasonably effective and people are used to it and we should not charge it. Do I phrase your position roughly cor- rectly? Mr. He.mAN. Yes. Dr. LiGHT. Yes. The Cm~mMAN. I would be curious, Mr. fiharl>--you are in the advertising business--~s to your comment on the theory of the value of the COnsistency of the message over and over and no ch/~nge, no rotation. Mr. SHARF. I think there has been a certain amount of confusion expressed here in associating the warnhig message with that of an advertising campaign. I think that by just using one ad as an illus- tration what this bill proposes is nothing more than the rotetion of message units within this area devoted for the warning. In my opinion that does not constitute any type of problem in interfering with the advertising of cigaretees. In effect, it is, as stated earlier, a basic compromise on the overall intent of those who support this legislation. I think that this is a good illustration of how a simple message has to fight with a much more massive unit encouraging people to take up smoking or to switch a brand. The CI~AIR/~AN, DO you have any illustrations or any experience with how advertising of tobacco products has been targeted to spe- offic groups? Mr. SHARe. ! think that any one of these ads that I }*ave here could be held shown to attempt to attract young people. A case could be made for the identilicatlen of the model and ~be fashions that the model is dressed in. They are trying to emulate or to depict a certain type of lifestyle to which a particular brand is trying to draw identification. It is something that Mr. tlorrigan, I think, alluded to earlier, as brand segmentation. I believe that in most modern marketil~g situations when a new brand is introduced it is done so through extensive research. Mar- 0D
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91 Senator Fo~n. Let me make a point here. I think Mr. Horrigan ought to stop you, because he said after this and then the survey of that that they would go even further. And to flaw the original ad, I think, and to comment on that after the statement of Mr. Horrigon is not quite fair. Mr. Co~N. I do not think what I said was intended to be urdalr. It was to point out that it is fairly obvious that young people do not smoke because they are kids and it is going to turn them off. If you are trying to provide informulion to these people a~d say do not smoke, c~nslder this carefully, and gou put "Kids" ta the h~ad]ine, you are not going to--- Senator FORD. BUt that was basically, I think, said to someone who could read it and answer it and come back tbr information, and that would lend itself to the parent, which I have beard from all five of you here today that that is where the communication ought to start. And ] think that the tobacco industry probably is on the right track with that direc~on. l~lr. Sharp, you stated that th~ advertisement would be no sub- stantial cost to the industry, is that correct? Mr. S~v. That is correct, The adnfinistratlon or the accommo- dation of a rotation of messages. Senator FoRm. What would it cost the Government? Mr. SHARP. I Cannot estimate that because I have no idea what form of programs for adm[nistrat[ng or regulating or overseeing the program--- Senator FORD. Have you read the bill that is before us today? Mr, SHARP. Yes; I have. Senator FORD. Are you aware of all the various items that are required of the Federal Government as a result of the passage of this legislation, in addition to the cigarette labeling? Mr. S~-L&Rp. Generally,yes, I am. Senator FORD. What about the reports, the surveillance that 15 pel~ent of all the cigarette packages would carry each one of the five? How are you going to be able to count all of those and be sure they are right? Who is going to--are you going to let it be peer review or industry self-discipline? Mr, Sn~ I think it could be a combination of many factors, Senator. I think that the industs~rv has demonstrated an effort on their part to be self-regulatory ann I think that if the provisions of this bill were passed and since the industry has shown compliance with previous m~ures, it would probably comply in this matter, too. We are not talking about a terribly cumbersome program to im- plement. I think that if a company such as R JR or Phillip Morris is a good corporate citizen they are going to administer this program on their own and Government regulation and Government over- sight of it would be probably at a minimum. But the point I Would make is that, what difference does the cost make in the regulation if you are sav/ng lives? Senator FORD. Well, we hear a lot about the budget today. Let me ask you, then, an page 4, section 7 of the smoking and health section, 1711, how much you think that is going to cost, when it automatically gives to the Secretary to undertake addition- al informational research activity which the Secretary determines
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92 necessary and appropriate? Anything he wants to do, he can do. How much do you thLnk that one ]istle parvgraph is going to cost? Mr. S~P. I have no idea. Senator FORD. How about page 5, (a) costs, (b) costs. Section 2, ad- ditional costs. Section 3 would be additional costs, Mr. S~P. In my opinion, Senator, the costs would he relatively insignificant compared to the cost of lives, the medical--- Senator Fo~. We are talking about advertisement now and the cost of that advertisement and the ability to get that t~ the general public. We have had the hearing on health. Mr. S~ARP. OK. I think tarot it would be fair for me to say that if the costs of producing this ad, this one single ad, were somewhere in the neighborhood of aromad $10,000, it would probably cost no more than $10 to change that message so that the next time that ad appeared it would appear with a different warning message. Does that answer yourquestion? Senator Form. Well, $10. Those who are for it give a low figure and those who are agaillst it give a high ff~re. I will divide it in two and come out in between, because your figures do not even come close to the FTC and I think they are low. :Mr. SHARP. I think perhaps they suggested that the change be implemented immediately, and I think the proponents of this bill--- Senator FORD. No; the change is not immediately. It is 15 months, if you read the bill. Mr. SHARP. I read the bill and 1 cannot understand how a pro- gram such as this, where all we are cbanglng hi the advertising is just a block of copy and the cigarette labeling packages, how that would cost $40 million. I thil to see that aRogothvr. The CHAIRMAN. Dr. Light, the Federal Trade Commission esti- mated $1.2 million additional cost for the rototlon in advertdsing of the labels. This is not on the cigarette package, but the advertising. Does that strike you as a reasonable figure? Dr. LtGHr. Well, there will be someone t es~ffgiD g after me on this question. I do not know the exact cost~ but as a matter of ~udgment that would seem unreasonably low. The CUre, MAN. Well, I will wait tmVfl the person comes after you. Dr. BinckwelL let me ask you this. I am not quite sure I follow your logic. You stated, and 1 am quoting here, "Under the proposed new warning, the logical conclusion would be that the Surgeon General has no longer determined that smoking is generally un- healthy." Do I take it you reached that conclusion in the following manner. One of the warnings that appears says, "Warning: The Surgeon General has determined that cigarette smoking causes era physema, lung cancer, and other cancers." You believe that some- one may come to the conclusion that smoking is not generally un- healthy, or that the Surgeon General says it is not generally un- healthy, it just causes these kinds of diseases. Dr. B~CKWELL. Referring to a specific ad that only mentions that, if the general ad had heen replaced and someone had learned that and it was replaced with a specific ad that only mentioned em- physema or only mentioned pregnancy problems, then a person
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93 might conclude that the general w~rntag had been narrowed to only very specific thing~ ill reading that particular ad; ye~. The CHAIN. And you think even when these warnings were rotated and some related to pregnancies and miscarriages and others related to emphysema--and you know the five we are talk- ing about--that people would think there are 22 miscellaneous dis- eases and problems that cigarette smoking relates to and it does not relate to any others; whereas now they would come to the con- clusion that smoking is generally unhealthy? Dr. BI~CKW~LL Well, I wouldregard the present system now as primarily a basis to be able to talk about this topic with parents and children, with heart associations and other groups, and have an unequivocal statement, but with the proposed change we would be forcing people to look at very specific statements which cloud the issue and cause confusion. The CHimMAN. What do you mean, forcing them to look at them? Dr. Bniczwri~. Well, one of the studies indicated that--it was the Burke study that the I~TC cites--it indicated that when people look at a number of diitbrent rotated statements, they tended to be confused about what the claim was really all about. In fact I will read the uom, and this is from tim Burke Focus Group study that the YTC ~tod: The messages related to birth control piIis and heart attacks t~mded ~ confuse the participants, who did not thoroughly understand the ayner#s~ic effect.~ whie~ formed ~he bas}s of the message. These two sL~temenL~ relating to oral c~ntracep- tiv~ also had the IO~L pursonal r~lovanee and were rather easily dismissed a~ being m~nded ~br someotle else. Now, if a person reads only one or two or some of them, rather than a total, then he could conclude that we are narrowinglit down. The interesting thla~g is that the statistic has been said tbat only ~ percent of the people read the labels currently, which i~ really an indication of the success of the present report. It is sort of llke going to buy coffee. You do not take Maxwell House or Falger's and say, well, before I buy this I 3vant to re~ad the label first. If 90 percent know the information, you do not need to read the label. They have learned the present message today. It is success- fuh The Ca~ARMAN. Wendell? I have no further questions. Senator FORD. Well, I have a few more and I wilI try--are you through? I will just go right through, I might create some interest here. Mr. Sharp, in geur statement you hadicated that when advertis- ing depicts a )reduct as an integral part of a hJghly desirable life- style and personal image, young people are particularly drawn to the ad because they seek to emulate the most modern trends and project an image similar to those images projected ha many ciga- rette ads. Other than billboards, I do not believe that many young peop±Ie have much access to magazines that cigarette advertisers use. Do you have any numbers, Mr. Sharp~ to substantiate your statement of how many youth regularly read "Time," "Newsweek," "U.S. News & World Report," and newspapers? ~q Q~ ~O
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94 Mr, SHARP. Not at my imme~ato disposal Senator. But I think that ~ven an ample opportunity, ! or any member of the staff could supply you with sufficient evlden~e that there is teen reader- shl in every publication that is considered mas~ audience. ~enater FORD, i want that for the record. Could you get it for us, say in the next 7 to 19 days? Mr. 814ARP. I certalnlL[y could. Senator FORD. All right. We would like to have that. I thhlk when you get to it and ff your figures are accurate, it will be sur- prlsingly tow. Let me ask you tins. We are talking about the billion dollars and you would like to have the account. Apparently you do not have an of them. ~. S~RP. I am not in the advertising agency business. Senater FORD. Well, you do all these other good things. Inflation, does it net have something to do with the increased cost of expendithres? Mr. SH~F. That is true. Senator FeRn. What is the percentage increase in advertising rates since 1975? Mr. SHARP. I do not have that figure. [ will make you a gues~ I would say that since 1975 all the media combined has escalated due to inflation at a rate of somewhere around 10 to 15 percent per year. Senator Fo~n. You say 10 to 15 percent per year. So since 1975, you stated in your statement that between 1975 and 1979 cigarette advertisers doubled the amount of money spent on advertisements. So you take 1975 and 15 percent and 1976 in percent and I977 15 percent and 1978 i5 percent and 1979 15 percent, and they are almost spending less today in real dollars than they did in 1975; would that not basically be correct? Mr. SHARP. I do not think I would agrce with that e~ample, no, sir. Senator FORD. But you said 10 to 15 percent every year, and you said that, in your statement, that they have doubled the amount of money spent on advertisements. Yet you say it is 10 to 15 percent each year. So you have 5 years times 15. That is 75 net. Mr. SHARp. So they have increased it 25 percent over a base of 1975. Senator FORD. No, no. You take 75--and I hope you do not keep your own books, because what you do is you have 75 plus 15 per- cent, and whatever that Sgure is you add another 15 percent on that. You have to factor that in. So that is more than 30 percent net. It is 15 percent of an increase of 15 percent. Mr. SHARP. If the point you are trying to make is that the rate of expenditures of advertising this year compared to 1975 has not in- creased significantly, I would say that, yes, you are right, that in- flation has created a tremendous bump in the expenditures of ad- ver tisln~. . . Senator FOr~D. So you would agree vnth Mr. Horngan, then, that basically there is no more expenditure per brand or basic increase other than inflation? Mr. SHAr~. I would not agree with such an absolute statement without---- f.1
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86 Mr. SHARP. I have not elated i~L I think that ~arette l~hellng is the only means of getting to these people. Senator FORD. Well, I asked you to devise a strategy, and you did not even mcnLion increased labeling on a package of cigBretses. How much would it cost to redesign the cover or a pack af ciga- rettes, the packaging of a cigarette? Mr. SHARP. [ think it would be a relatively low cost. I have an example here of a common way in which printing of cigarette pack- ages occurs. It is a process known as gang printinlg. In this case, there are five different rows of package d~signs, andin each case a different label could be incorporated in the printing process, so at the time packaging is printed for cigarette manufacturers, all five messages are go'omg to be printed. Senator FORD. But this is your design. The ultimate design is going to bare to be coming from somebody else, and they may have to redesign the whole packaging structure of the industry. Let me ask you this question, and you can answer yes or no. If you have to redesign a package, what does that mean then to the expense of an industrrw ? Mr. ~HARP. I do not believe that question has a yes or no snswer, because as I understand--- Senator FORD. If they had to redesign a package, the packaging, ~he design, and so forth, would that cost the industry more money? Mr. SHA]~P. Yes, it would. Senator FORD. That is good enough. That is all I wanted to know. Mr. SHARP. May I elaborate? Senator FOR~. Let me just say this. You are not going to elabo- rate on it, because you do not know what the Secretary is going to do. You do not know what they are going to imnpose upon the indus- try. There is no way if this legislation is passedto say emphatically what is going to happen. So theretbre, the only thing you could do as a smart and prudent businessman is not think the low side. You can make all kinds of recommendations, but that does not mean that is what the industry has to be prepared tbr. Mr. SHARP. I understand that. The point I wanted to elaborate on, Senator, is that I believe that as it stands now, the proponents of this bill do net believe the packaging would have to be rede- signed. I think they are talking about simply abang/ng the type of the message in the current warning box. The redesigning of the package does not seem at this point to me to be a necessity. Senator FORD. Thank you. We got it in color. Dr. Light, one quick question, and then I am going Co quit. There have been many assertions that an advertising agency mapped out an ad campaign for Viceroy on how to attract teenagers to mnok- i~g. Was the campaign ever a~ed by the company, and can you ex- plain the ever~ts surrounding these allegations? Dr. LIGHT. Well, there have been some allegations. Unfortunate- ly, the FTC staff quoted seversl things out of context, and made what I baltsve are some misleading and irresponsibts accusations. They quoted some research as Bates research and Brown & Wil- liamson wesearch, and in fact the research was not conducted by either the agency or B~w~ & Willtsmson. The analysis and the report were contracted by an outside research company. Their con- clusions or observations were derived by the researcher of that
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97 company~ a company called Mar]~, although I do ~lot kl~ow the ~lame of the researcher. It is true in my opinion ~hat the ¢onc111- sion~ were i]~correct. LTI my opil~on, l~he observat ~o11~ were mlsguid- ed. This happens, especially in a slt~l~ltioll where the people-- m~ybe it was a youllg, inexp~rlenced researcher, I hav~ n~ idca-- pi4eptll~ed a r ~pc~Ft arid ca]he to e~'r OFleOU~ con~]usiorl~. I think it is wrong, misleading, and irresp~lslble to characterize this report as reflectillg eltl~er the policies of the advertising agency or the ad~,ertiser. As we kno~r, ~le same thing can happen in a~ly large company, especially wb.en c~ealiJ~g with a sl~bcontrac~ tor~ [11 a newspaper~ for example, a reporter may prepare some m~- terlaI which is inappropriate. The key ~n any case i~ ~rhe~her there i~ a system which exists for catzl~llg any mistakes, for corre~ing any errors, or for ir~l~£Tlg against inappropriate action being taken, a~d such a system does exist in the advertising indus~y. In this case, the system worked, No ad was ever produced based. o~1 this ~lnalysis. No ad was evcr procluced b~lsed on that i/ecomnie~- d~Ltion. 1~0 ad w~hs ever run based on ~ha~ research. It seems ~ncor~ rec~ to me to condemn a company or an industry because o~ t~L~ apparently misguided behavior of some indlvidual who, iI~ th~s cas~, was no~ even employed by the industry. For whatever r~son, it seems ~errible and unfair to characterize the industry as direct- ing ~ldvc~slng based on ~l s~raLegy when no adwr~ising was in fact based on that strategY. If a~lythln~, I do riot thi~lk criticism is due. I believe praise is due, even in ~I~is case because ~he fact is, the systenl worl~ed. Thc C~IAII~M~. We have no further questlolls. 'l~h~llk you very much. Mr. Sharp~ would you remain? I may want to ask some more questions in reI~ttlon i~o the next pal~el. Mr. HOI~F~IGAN. Mr. Chairman, if I might, it was our understand- il~g thal~ Mr. Sh~L~I~ might appear ~n that panel. His comments that we have he~lrd go f~tr bey~nd ~]le mechanical numlces, and he lau~lches a~'aln into m~trketlng strategies and ptliloL~opliles. That bei~lg the Case, since it was iYlr. Perlmul~ter's inten~ to liven tip this session ~his mornil~g, I wauld suggest or reques~ that Dr. Light appear o~l that parle| as well i.r you arc~ gc~ing to gc~ into ~hose areJ~. The CHAII~MAN. I have no objection. Senator FOP.D. l~r. Chairman, whell you dismiss it, I have some written ql~e~ion~ ~or Mr. S1~arp, it~ you wou~d allow th~tt at ~t later daJ~. So, I~Ir. Sharp, you can e×pec~ some written questions from me based on your testlmony ~odayk The C~tAII~IAN. We will take l~r. Eric Rubin ai~d Mr. David Mint~n. Mr. Rubin, go right ahead. STATEi~ENTS OF ERIC II~UBIN, OUTDOOR ADVERTISING AS~OCI- ATION OF AMEI~I~CA; AND I} AVlD MINTON, COUNSEL, ~Af~AZINE PU]BLISHERS A$SOCATION Mr. RUBII~. Good evenlng, Mr. ChairmEtnk ! am ¢o~l~sel to tile Outdoor Advertising Association of America, the OAAA. The OA~l is the ~Lra~ie association of the standardized. outdoor ~dve~'tising indust~-y. In the OAAA's view, the quf~s~ian of C~
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52104899S
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100 The manufacture, distribution, and sale of cigarettes and the con sumptisn of cigarettes is not subject to Federal or State regulatlon or prohlbltton, and so, e,'en though some of our member magazines, one being the Reader's Digest, which is the most widely circulated monthly magazine in the United States, do not accept cigarette ad- vertising. Our members are very strongly" of the opinion that un- necessary Federal regulation of adver~islng in magazines should not be enacted. Forthnately, the Supreme Court of the Unltad States has taken a somewhat similar view. In Central Hudson Gas v. New York in 1980, which is the general judicial guideline today, the Supreme Court ruled that commercial speech, meaning advertising, purely commercial speech cannot be unduly regulated. Justice Blackmun said, and I would like te quote two briar lines from it, "The regala- tlon may not be sustained if it provides only ineffective or remote support for the Government's purpose. If the Government's interest couId be served as well by a more limited restriction on commercial speech, the excessive restriction cannot survive." The first witness this morning, Dr. Harrison from the American Heart Association, said in response to Senator Ford's inquiry that he did not think that the cigarette war~ing labels cum'entl~ in effect or those proposed to be in effect would be partlealar!y effec- tive. Yet, you are considering enacting legislation wkAch imposes further restrictions upon the freedom to advertise in the United States, and it is our position tha~, although your bill may not be unconstitutional, it certainly raises legitimate questions in that area. We believe that your biS should not trove to fall the test of constitutionality in order te be an inadvisable piece of legislation. Generally" speaking, the American public, for reasons which are obscure, do not pay all that much attention to warning labels. I cite in my- testlmony that Rolalds has a 65-word warning label, but Roger Staubach never mentions the 65 word warning label on the side of the product that "everyone knows how to spell relief." People do not pay attention. People do not pay attention to the instructions of a stewardess about what to do if you need oxygen in an airplane. People pay very li~le a~tentisn to any kind of' warning labels except when there appears to he a direct and imminent threat to life, such as Lhe Three h~ile Island incident, or the Love Canal incident, or strontlum-gP in milk 25 years ago. That kind of ominous threat to the existence of life on Earth appears to attract people's attention; but tha~ you do not take someone else's medi- cine is probably the most fbequently violated law in the United States. We feel that if there are, and we believe there are, more effective remedies to provide information to the public as to the conse- quences of using cigarettes, then the Cow.grass should pursue those other remedies. We know that you have in the past. You have en- acted legislation to establish a speed limit, and durinlg the period that that speed limit was enforced, the mmaber of people who were killed on American highways declined dramatically. The response of the public not liking to drive 55 mile~ an hour, resulted in this achnlifistratlon and this Congress failing to approve appropllations for the enforcement of the speed limit.
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i01 The same thing was true of' the automatic seatbelts. When you are dealing with people's personal habits, and particularly what they eat and whaL tl~ey drlt~k and wha~ they do~ they simply do not respond to warnings, and if greater education is needed in order to apprise then*, we recommend that you pursue those remedies rather than restricting advertising. Thank you. IThe statement fullows:] S rA,i,EMENT OF DAVID l~ Y/~ 69 NI WI~SHINGTON COUNSEL, ~A~AZI~,IE pUBISHER$ ASSOC~ATION The Magazlne Publishers As~ciatio~ is an organization representing 188 United Sta~es publishing i]rnls which publish nearly 800 consumer magazines, i%lPA lepre- sen~,~ Weekly news and feature magazines, journals of literatule and opinion, special interestplublivations in practically every aspect of human behavior and a variety of other subjects. T]~e American people subscribe to 250 miI[ion copies of e~ch issue of MPA magaz~nem As ~. organlza~ion, MPA has t ~t filed he fol.e numerous ¢ongr essiotml committees and administrative agencies on subjects of general and specific concern to the pub- hshlng industzy, and ~,e hope that our contriblltion to the legislatlve and adminis- trative process has been COnstructive Today, we appear to prcsen~ our v~ews on the issues in S, 19Z9 which relate directly to the publishing industry. Section 4 of S, 1929 requires tim purchaseis of ci%~a-~ t te advertising £o include spe- cific statements of health war~mgs in each publicatloa of the adver~lsing This re- quirement is not new the Federal Iobeling requirement for cigarette packages became effect ~ve January 1, 1986, and the addition of the warninglabeI to advertis- ing began in 1972, Since 1972, there has been no legislative eonsidera+/on of ex~smd- ing the requirements of the present magazine advertising label. The rotating warn- ings proposed Ln this ]egis]atlon is a far broader requirement than th~ ctlrr ent sta%e~ meat, howevex, and comes after the Supreme Co[*r~ has more clearly construed the constitutional limlts of permissible gnvenlment regulation of commercial speech under the First Amendment. It a~so come~ after subsr~s ~l~ial experience and research in m~ae~ring the ~flbctiveness of warnillg labels, iacludLng those applicable %0 ¢iga- lettes Tl~s experience plays a paz~ h~ detez~r~ining whether, government control of commercial speech is constitu~ionelly pelmis~ible. So, in a sense, this is a fresh at. mosphere for considering the issue, and we hope that the committee ~ill weigh carefully the principles involved [n light of thOSe developments. I'he Magazine Publishers Association *ppose~ seceion I for two reasons: we think it exceeds the permissible limit of government ~uh~tlon of advert~sizlg as that limit has been established by the ~ulreme Cour~ of the United States~ and we think that even if it were nut unconstitutional, it ~vill nut uchicve the goal y~u ;~ppear to be pursuing--persuading people to slop sn*okiltg. If there is room to dit'fer as to tim correctness of our object*on to the bill on consti~utlonal g~ounds, the evidence indi. caring that ]abelin. ~ is not likely to h~lp achieve your, objectives slmnld lead you ~o refram from Imposing the restraint upon f~e speech in the first place, We are sure that the members of thls committee hold dear the cor~t[tutJonal rights of all citizens, and would llot risk an iit fring~ment upon those r*gh%s without clear and compelling e~ idence not only a~ to the rightness of the cruse, but also the wi~dom~ of theplrecedent. . of the infrlngement,. ~at tien/ar]y h~ ligh~ of. current pz~s sures to enact l~glslatlOn or approve constlt~it~onal amendments desexed ~o regis- late the behavior el citizens or overcome a Supreme ~urt decision "Commercial ~peech'* is a term used to dRTerentiate bet~veen speech wl~ch relates to economic h~terests and speech which does not The Supreme Court in Volet~t;ne vs C~resl~¢ven, decided in 1942, held that the Constitution did not extend to negate a Now York statute prohlbit~ng the distribution of bsndbil/s "or other adver~islng matter" in any "public place/' 'file Coult ~aid, "we are equally clear that the Con- stitution imposes no such [F*rst Amendment restraint as respects pure] • commer- ciaI advertising" t A similar conclos]on was reached in Brea~d w AIexar~drla, in- volving dco~te4oor aalz~men peddling without a permit. But since Breard, in 1951, the Court has not denied prot~-ction to commercial speech on that basis alone, and, in the wo~Js of .~Ir. Justice Douglas, the C]irestense,z rule "has not su~ved ref]ec- tion', Vale,. t i~*e vs CI~,vst e~s~* ~16 U S 5~ ~1942) Br~arc: vs. Alexandria, 341 U.S. 82~ (1951): Just ]¢~ De~gla~'~ ¢o nm*ent is fumw/ in Cam~a~ cr~o vs Uait¢~l Stale~ :~5~ U~* 5~4, ct 534 (1989}
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~o0~o~
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103 re]parle and by the television oews pl ogr~ms. Time magazine de~oted a lengthy arti- cle to the Surgeon General's ]{eport when the report was issued in ]~te ~ebvtlary Second~v, ~ver$ FTC oI judicial ca~e used by the (3ornnli~sioll ~taff to support ~£s claims of deception ~nvolved advel~isenlents of a very dlffetent sort, all of which made affirmative clainTs "Wonder Bzead builds healthy bodies 12 way~." Huue~hokl Finance I~aakes "Inst~l~t Tzax }~e~lrldB " That [$ a positive claim of something goo~ that wl]l happen if you buy Wonder Brefid or take your tax Fetllrll to Ho~ehold In taut, the claims were false; so the advertisements were ordered to be ~Jthdrawn. (]igar~tte advertising" does not make affirmative c]alms in re~ard to the effect of ~moking upon heaIth--whlch is the unl) rea~n e~ther ~he ~J~ o[" t~e (~o~g~e~ i~ involved in this matter The only mention o[ hea[Lh in ~ig~arette advertisement is the declalatlve statement "WarIling; The Sulgeon General ~-~aB Determlned Tha~ Cigarette ~moklng Is DanBerous TO Your I1ealth." C~ar~tte a~'cert~ing plctn~s things cowboys, pretty girls, ~d so on; but th~e ~s no claim. There are s atements of" pertinent fact: tlicoti~e and ta~ co~tent~ d ete~'mi~ed u~der FTC, ~tandards. There are also claims that the brand advertised "tastes better," whlc~ is a matter of" opin- ion. In recent year~, tar Rod n[co~ilxe couL~lt havo become ~ major adverfi~Jn~ feB. ture for m~t brands, and perhaps a r~on for switching brands. Th~ in itself den onstl'a~$ public awareness. Cigarette i%~lll~acttll~r~ no lollgeF @Llver~ifi@ tho ~i~- rette~ which ~ older generation remembers. Not a dime is @pent oli plain old C'~m els, buckie% oc ~heBterfie]ds, although people who prefer those brands continue to }]uy them. An ~dvert~sement which makes no afflrmnt~ve claim to anfih~ng nnd which ha~ a health warning in plain sight and plain words Js not deceptive, and therefore is wlthhl the boundary of protection for coi~tmer¢ial s~eech pre~crlbed by the Supreme Court, The ~altd issue ~s whether the r~meclv proposed is likely to be effective, or whether the vesul f s w~ll he ~lae f£ective or r~roote, thereby failing the Co/*rt'~ strand. ard e~tablished in Hud~n Gas The FTC .t~fl co.cludBd that the current cigare~te label is the f fectivB, apparently because evmybody hasn't qui~ snloklu~. Sk~ce i~ appe~s fh~t th~ go~d is the elimi- nation of cigarette ~moking E~ the Ul~ited State~, thele [~la}- be rna~y programs which ~otlld faJ] to meet the sLa f~'s test. Adve~ti~i~ig l~bels may be o~e of tbenl, but the claim that the public is not aware defies common sense and the Surgeon Goner al's most re~e~t report. The 1982 Report of the Surgeon General zhowed that today ~3 million people sluoke, about the sanle number as 20 years ago. That is a $igtfifi cant decline in the percentage of the population There were about i80 million people in the United States in 1962, and th~r~ are about 2~0 million todaty The per- cenL~ge of adair smokers ha~ dropped from 42 percen~ to ~ percent. Public atti. tud~s have changed; m~dical advlc~ has changed. Radio ~nd television advertising is no longer available. In t~ting wll e?her ~. 1929 complies witll *Jne stmldards set out in Hudson Ga% ~he relevant question is whether increased restrlvtiol~s wiII have a direct impac~ upon achJevil]g the ledislative goal. We believe ~hat ~he correct answer is either "no' or "nobody know~ , iu either case, we believe that ~he prudent advocate of cold,irra- tional freedom shullld lefrahl flora restraint Upon free s]peeah rather than impose further questionable re~lSetionB. ~eeent studies of tile e~l'ec£Jveness of warning advertisements ~md labeling show that the public tends to ignore them. It* their November, 19~0 l~epo~t to the Presi dent and the ~ongrees, the Departments of the Treasurry anti Health a~d I-ItlmaU Services found ~hn~ 'the public generally is 'over warned' by the Government" and that th~ ef1"~ctlvel~ess of walllln~ dec.[illes as t[l~ tlegree and lreqt~ency O[ warnings increase pelsonal attitudes, expelJence, and habit play a highly ~igllificall~ role ill deternlining whether a person pays atteniioil to Warnings, ~'egardles$ of the oanse- queuces. The Report specif]cally found thn~ "fear statements" me "general]>" not as eff~ctive . . . and may cause the audience ~e feel ever]y threatened and, as a result, screeu out the message." ~ The "~ize" of the problem is related to the effectiveness of the warning~ too ~lany eople switched from ~urocarbon spray cans to carbon dioxide spray cans when a~e~rted to aerosol's threat to the level of ozone in the stratosphere. ~esiden~s tlear 'I'}~ r e~ IV~il o Is]~id rnov0d out q~icldy. The widesproad fear of st¢ontiam 90 in cow's lni]k was a si~liflcaxlt factor in public support fOl ball nlng nuclear t eating ill the atmosphere Thc~e ~re big threats~ 8]rnost incompre- hensible proportions.-whlch appear t~ threaten life on earth. As Eepresent~t{ve ~e oft to the Pres~de.~ and the Con tess o~ IIea~th Hazards A~0ciat ed with Alcohol ~nd Me h~s m Inform th~ ~enera] Pub} e ~grho~e ]~I~r d , U~ Depa truant o~ the Treasury ~nd U~ Departmen~ of Health amd Haman Becwees h'ovemher, ]980. w* ~D C~
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104 Lrdol[ rell/arked at the tmle Of Three Mile Island, chorales you can't see, feel or htar. arvm~ ~ far deeper f~ar than other~ When it comes down to the persona] level the offectivcncs~ of warning is slgnifl uantl~ lower. The regulation el personal bt, hav[or, parSeaL~ly perseus] habits, is ext~meis dgficulL Mauy manufhcturer waI*fin~,'s or hlstructions do no~ appear to work Controlled ~xpmlment s ilium%rat e the problem. On~ recent experiment used in the HHS Study involved the use of hammers the tool you ¢lrive nails with--whlch had been ear efulis labeled to warn of d~ger, ar to instruct the user not to Use ~he leo] st all. One h~ndred high school and college students were asked te use the bammer~ t~ drlw 9alia in piec~ of wood They all did, ~nd fuIlewlng the e×pe~ m~nt* all were asked what the labels said. Not one oat of 100 hod ~wn notlcod the I~ls2 Everyone knows how to spell relief Not everyone kz~ws that the label of that f.~med over-the-eotlnter antacid colltain$ a 65-word warning ~ to the dangers in~ volved in eating that t~q~y rniu~ Obsmwe passengers o~I any flight and see how many pay oily art eil~ioll whatever to the verbal safety ]nstrucLions ul llight attendants. In actual ~mergencles involv- ing the n~ce~ity for using oxygen rnssks, passe~%gecs gen~*'M ly are at a los~ includ- ing b~ines~ travelers most frequently exposed to the iils+ruetlon. People ~implF ~orB warmings t is all interesfing problem Automatic seat belt.% required on all American eaz* hi %h~ ~d~l~TI)'s, wer~ so *~npop~/lar with %h~ ~6*m~rlcan p~ople that Congress ~- pealed the requirement, despibe overwhelmingly evidence a~ to th~ eff~ctlvene~s of the belts Perhaps we all believe in our own indestructibility, our own immortality on earth Whatever the ~e~on, in personal matters--don't smoke, don% drive whea you're dr~king--adme~itions as to the eensequ~nog, regardle~ of the evidence, den*t have much eff~t ]~l the speci~e instfinee of the Government's I~ year osm p~n ~o persuade people to quit Smoking, the 1980 Treasury/HHS Repor~ ooncluded t} a~ , it is impossible aL tl is ~ilne to isolate the impact of any speci~c commutfica t~on t~chl%iq~o OIl SllIOkiIlg b~havior~' rl'O ext~ I~r£her restrletiol~s %lpoll the freedo~ll o ~dve~t sea e0n rood £~ t e manufacture, ss/e, and consumption ef ~h~h is legs] ~n every State in the Union doe~ ~ot,, i~ oilr udg~tent~, do l'u'stlce to the rule of/aw~ part[clll~rly, i~ the preserlee of evide~lce fhat this ]e~iislstlve remedy weuk~ not be slfectl~ze The~e are other ares~ of concern where Ie~s]a~/en would prove effective. Shou~d £!Dn~e~ require n ? the Admln~t atlon to en fm~e the 5o mil~per hour speed limit Ther~ is overwhelm- ing evidence of the direct rolatle~sh~p of speed to traffic deaths, Fifty thousand pr~ple died in traffic accidents lastyear, mo~t of them as the d]ve~t result of speed. yet Cx)ngress appropriated no fimds i~ fiscal year 1982 ta enforce the statutory speed limit. That very res] problem involves no const[tu£~enP/ quiet[on. The ~u- prom~ Co~r~ h~ prescrlbed no rtll~, But ha the ease of furiher r~s~r[~tion~ ~lpun counner eial speech, the .Court I~, aud in our opinion S. 1929 trm]sgresses that rule. We hope tha# you will reconsMer. The CHAirmAN. ~fr. Minion, your conclusion is, this bill may or may not be constitutional You are not arguing that. You are saying it is certainly unwise? Mr. M~NTON. We think it is unwise, Mr. Chairman. It rs/ses le- gitimate ISSUES, as the court has considered in more than one case, and in the case I cited, the court has come down against the regu- lation. The C~Am~AN. Is that Hudson Gas? Mr. MIP~rON. Yes. The C~Amt&~h-. My experience on issues that are borderline con stitutional is that ~he argument can always be made ~o defeat legis- lation in Congress. This is a smokesereen that can he thtxawn up oftm~. I do not mean that in a bad sense, but we are facing the same debate on tuition tax credit% is it eanstisutionaL is it uncon stitutional We will not know if this legislation is constkutional until we pass it. We can argue until we are blue in the face about J0urn~l of products Liabiltt , 1~77, yak !, pp. ~55" 259. Treamlry/HHS R~po,t, p g~ O
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105 its constitutiomality. Therefore, your comments do not get to the merR~ of the legisla~n. I think your poin~ as to whether it would be challenged is prob- ably right I would be very surprised if when we pass it~ if we pass it, it is not tested some place along the way. Mr. MXNTON. I would reverse the arguraent onyet u, if I may, Sen- ator, and say that when Congress in 1962 enacted leglslation which prohibited the importation of any Commtmist political propaganda to be sent through the U.S. mails, those who rejected that imposi- tio~ upon the freedom oi" speech ~aid, well, thi~ bill is ancons~tu- tlonal, and the author of the bill, who is no longer a Member of Co~gre~, ~aid, well, take that al~ to the courts, and |~t them test it there, which they did, and the law wa~ declared un~n~tltutional. The C~A~R~AN, Are you ~ugg~ti~g that Congress should become the arbiter of constitutionality? Mr. Mn~To~. I think Congress is the arbiter, in mo~t ca~es, ~f what is const~tufJonal. Those who ]~ave the money and the time ~c- c~ionally win an appeal and ~est a cm~e in ~he Supreme Court, The Ch~A~A~. You are mi~slng the point. Are you seriously ~aylng tha~ we sl~oul¢l pass or not pass leglslatio~ in Congress be- cause $omebo~ makes ~itx argument ~hat it is or ~s not constitu- tional, a~d wc ough~ to say, well, ~0 perce~t think it is unconstitur tio~al and 40 percen~ do not, ~o do not pass Mr. ~Vh~ToN. ! think you are electecl to make judgment, and whatever your judgment i~, is sub~e~, in some cases to review. The C~R~A~. In your case, your judgment on this, you are n~ all that sure that it is unconstltu~ional? Mr, MINvo~. No, I am not all Lhat ~ure it is unco~stltutlonaL I do think that it legitlmately ra~es the i~ue that in ~his morain~s tcs~mony was so clear in all of the witnesses I have llstenec[ to. There may be better ways to do it than by riskh~g ~u~ ilnpositi~i~ upon ~he ~eedom of the advertiser, a~d in our case the magazine publisher, to publish ads to do business. The CH~IRM~. I have no other questions. Wendell. Senator FORD. Mr. Sharp~ I do not want ~ haw asked you to stay over without asking you any questlons~ but I am not going to ask you any. Mr. Minion, I a~ked a question earlier abou~you repre~en~ tl~e magazine publishing industry. Mr. MrNTO~. I repr~e~nt the associatlon which includ~ many magazines. Ser~ator FO~D. What is the percentage of youth that receives Newsweek, Time, tho~e sort~ of book~, and would be readlng ~hose? Do you have any sort of statistics that you could give us? Mr. MI~ON. Only general~, Senator. Young people tend to su]~ scribe, to receiYe a~ ~heir own home, at |eastmmy personal experi- ence as a parent would indicate magazines which tend to be air~ed toward youth's in~eresf~, like Boy~ Life, Scoutlng. Sports Illustrated hal~pens ~o be a mag~ine that is ~ometirne~ sub~crlbed ~o by youn- ger people, 12, i~, 14, 15 years ~id. My ~wn l,%ycar-old children subscribe to Sport~ lUu~trated, Some of the~e magazines carry ad- vertising which appeals to that age group.
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107 The CH~R~AN. I am not quite sure what you are driving at. Senator FORD. Well, you have findings here that say certain things, and that cer~in occupational hazards in conjunction with smoking increase essentially the risk of disease and death. What are the occupational hazards that we are finding here that we are saying unequivocally that Congress is approving? The C~AmMAN. YOU are asking about health issues, and that is not in the jurisdiction of this committee. Senator FORD. Wait a minute, now. We are going to propose a finding here, and we are going to support that, and this committee is going to be required to make a judgment on a finding. The CHAIRMAN. WendeII, this is a jointly referred bill, as you are aware, to the Labor and Human Resources Committee for the health aspects, and to this committee for the advertising aspects. I am going to be very careful about not overstepping our jurisdiction. Senator FORD. Well, as a cosponsor of this legislation, can you telI this Senator what that findteg means in your sponsorship and drafting of this legislation? The CHAIRMAN. Wendell, I am not going to get into that with you here now. The conunittee is adjourned. [Whereupon, at 1:35 p.m., the committee was adjourned, subject to the call of the Chair.] -5
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ADDITIONAL ARTICLES, LETTERS, AND STATEMENTS ~I'A~MF*Nr OF H01% Ol~I~ ~H, U.S. S~A~0R FR0~ UTAH It is a pleasue for me to join Sen. Packwood, mad other colleagues, for this Com- rner~ Corm]ait~e he~rlng on S. 1929. We j0dntly introduced this bil|, the Compre- hensive axe eking Pr~ventSon Education Act last December. in an effort to enhance the public's knowledge about the health effects of c~garette smoking. Since ~hen, I ha.~e been impre~secl with the strong supI~rt for thin bm from health pyofessionu] organizatior~ ~d voluntary health agencies. In fact. over 30 such organizations, r ep~senting thousands of acien~is~s,physiciaos, nurses, health educators ~nd con- cerned citizens have strongly endorsed our effort, This legislat2on was also comple- mented by the report of the Stlrgeon Gpneral. Dr. C. Everett Keep, released in FeL- ruary of this year. This report, entitled The Health Consequences of Smoking, makes the s~ronge~t statement yet from ~be federal government regarding the harmful effects nfclg" arette smoking. On March 16. 1 chaired a full Labor and Huam~ Resources Commlt~e heaFmg relabed to S. 1929. At that time we heard ample testimony from represen~ti~es of the A~hninistrafion, from physiciau~cientlsts, and ~m the three ]argest voluntary health agenelcs (the Ayneric~ Heart Association, the American Cancer Soeiety, a~d the American Lung Association), all of whom vuppottecl this legislative effort. The consensus wa~ that the problem~ directly related to eiga~'et~e srncklng ~re of such magnitude in terms of human suffering premature deaths and cost that a major new pub ic hevlth effort is essential. In my opinion, this legislation is timely zmd necess~. I-~owever, we also heard testimony from representatlvcs of the Tobacco Institute. who are very. mu~h. opposed to this bl]L They sald. our citizens alread:/ know ciga-. ~ette smoking ts harmful Furthermore they qus~oned whether multiple w~rnmg labels, designed to specify health consequences of smoking, would bare any imvact on smelting behavior. I tmdprstand their point of view and recognize that shncere scientisL~ mlght debate these issues for years on end. In fact, Tm not certaLn that the multiple Warlllng labels we are prvpo~ng be placed on c~gare~te packages and adver dsemeuis will result i~ an immediate and drzamt~¢ de,reave in tl~e smoking habits of our citizens. But I mm sure we must do e~erything we cem to inform them of the dangers. To simply advise them *hat ciga~ette smoking is dangerous to health is no longer enough. This legislation, S. 1920, is simply an effort to provide additiona~ in f~rma- fion. It pro~ides a new opportunity to better inform aIvd edu~at e the public (particu- larly smokers, the individuaIs at rlak), about the health consequences of seaok/ng This bill requires the ~haceo industry to sha~ hi this edueatlon effort. And it en courages ~he volunkmtary ageneics and private sector to help. I'm confident this legis- lation could be very effective mad result in hnpt~ved health for thousands of Amerl- cans. I'm very pleased that Sen. Packwcod dined me in cosponsoring S. 1929 ~nd l~ok orwaM to hearing the test many presented today. ~J~Aqr I~M ~;]q qr OF DR. ~]~I,~*A~JD L¢{. B~, fiR., ~t~ISTANT ~ECR~q~A]~y ]*OR HF~AL~, ]~ L~A viq'M ~ NT OF ~FAb~ AND [IUMA~ ~RVI~ I am pleased to s~bmlt this statement of the Department of Health and Human Scrod.s on S 1929, a bl]I which among other lequirement~ would strengthen and make more specific the health warning which now appears on ci~areRe packages. The Chairman of tiffs ConmxRtee was pr~eut on March 16,1982, when I appeared before the Corm~ittee on Labor an~ Human Resources. My statement here will closely parallel the testimony I presented at that time. As I said then, our :position on the need for cigarett~ health warnings ha~ been long established. We hellene that warning labels alerting the public to the hazards (109)
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~!!I OTOB~OT~ i I FI I II ~1 I IIII¸
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111 on Tobacco and Health. Important contributions have been made to basle medical ~cience as well a~ to problems asso~fiated ~th tobacco ugage. Valuable information has 10een obt~ned relating tu di~t ributioo, metabolism, excretioi~ a~d toxicity of ni~- othle absorbed by Lhe human b~dy v~a clgar~t t~ smoking, In the area of car~ nogen~ sis, the Committee ~tr~cted the n~rnber of awards because cancer research w~ being generously ]i~anced by the NafAonal ln~tltutes of Health and oth~r agencie~ Neve~eIe~, the demonstration of l~l~nt co-carcino~nB Lu lob a~.~ tar and the pc~ ~enti~d value of the measure of inducibility of aryl hydorcarbun hydroxyl~e o~ a det e=~3z~ant of ~ceptibillty to lulig c~lcer represent some of the more s~uifi~nt contributiolls in this area. ~lph~is ~,'a~ placed on the impacL of ei~te ~mo~ on the p]~y$~ology of ~}le car diovaseuLs2, ~e~pi~atory and cent r~l autonomic ner~o~s syst era~ The Committee believes that the bulk of re~sarch sponsored by this project suppocta the conten~ that cigarette smoking plays an important role in the devel- opment of chronic olx~t i uctiv~ pulmo~tary dlsea~es and constltutes *t g~x.e dex~ger to individuals with preexisting d~seases of the coronary oxteries. On ~he cen~ra~ and auto~omlc nervous s:cstem important find;a~gs were made related ~o effect~ on be- havior and on biochemical medLators e]icited by nicotine. Gastrointestinal tract studies i~elude ~ew mechanisms by which nicotine may influence p~duc~on of peptic uIce~ In studies in reproduction important insights were gaine~ into ~he ~e#hanisms of l~gher center control of releasing factors for pituit~ry he.mane." The research of ~}le American Medlca] Association's committee summarized he~ was carrled onprr~or to 1974 and t~presents only a small part of the total z~search carried oD in lh~ field of tobacco and he~l~h Since then. addltlonal research h~s ncctlrnulated Our most recent repor~ on the health consequences of smelting, which we make annually udder provisions of the Public Health Cigarette ~mokln~g Act, considered th~ relationships ~0e~ween ei~ret~ smoking and cancer. ] woul~ co~. elude my focnm] t ~[h~ny by describing tke salient concIu~ion~ of thle report. Cancer was the ]]rat disease to be associated with ci 'g.~rette smoking; repor~ ]ink- ing smo~g ~ixd Iung caIlcer beg~n app~aring" in the scient J fle literature as loog Os 50 yeurs ago. In 1964, when the Sttr~eon Gelxer oJ's Advisory Commi~ee's report ,~,as issued. [~n~ c~Cel in men. ~tld chronic brolle]xi~ in men and Wel~en. were the only ~wo di~e~es which the Comnxlttee iflenthqed as being unequivocably caused by cigars L~e ~mok~ng Ottv 1982 report summari~d the l~sul~ of additional hurdma ~xperlence since 19~4 and nnol'/no~ arnount~ of new reee~rc~l In eonclnde/~ thai; c]p=~re~t~ snlo~ing ~s a major cause of cancers of the lung, larynx, ornl cavity, and esopkogu~, and ~hat it is a contributory factor in the developmcn~ of cmacers of the hl~dder, pancreas, and k~dney. [t p~[n~d ot~t that l~lng ~ncer az¢ounl.s for one out at ever~j four oau~r de~th~, and that 85 p~rc~tt of ~hese are due t/o ma~oklng. Ovei-al], [t rcporb~d that approximat ely 30 percent of all cancer deatlm are at~Yihut abie ~ smoking, L~ng c~ce$ ~ the ~najor ca~¢ of cancer de~th ~m~ U.~ rn~]es, A cigarette smoker is 10 times mo~ likely to d~e of this disease tlian a nonsmoker. This risk inere~se~ with the number of cigarette~ smoked, exhibiting a direct de~c-re~pon~e relatSonshlp Former omakerz who quit for 15 y~rs or longer have a lung cancer mortality rate o~y slightly above tba~ of no~smokers. Since 1950 ~he ag~adjusted [U~ c~ncer e~ eatb rate ~*r ,.var~ell hes inc~sed o~er ~0 ]p~DS~nt The raost st r ]lxing aspec~ of [his trend is the aceceleratio~ ~a the rate of increase which has been oI~ servcd, It ho~ averaged 6.6 percent a ycar between 1868 and 1977, compared to ~lighlly over 1 perc~t i~l tile period 1950 to 1957; ~b/s increasing death =ate wit1 result in a d~th rate i~om e~ucer of tim lung which will soon exceed b~ast cance~ ets the In,or c~Icer cause of deatll for women, For the first ~ime, as pointed out in ou 1982 Surgeon GEneral ~ report two pre- liminary epidemiologle studies have stlggest~d an in~d ri~ of ltl21g c~tncer in nozL~naoklng eaves of husbm~d~ who smoke, implicating sidest~am smoke ~ a cancer rLqk factor. A third study shows a trend in ~bls d~re~tioi~, but the r esu[ls are not s~at[sticn]ly significant More evlde~ce is needeg on the carcinogenic ris]~ to "pa~ive smnker~"; in ~he me~tlme, it wu~t he considered a poteu~Aal publle he~l~ problem It would be po~sib]e to pre~en~ furiher details on the cancer.cigarette relationship, borr owl,41 from the 19~2 report's compreheneive, criticel review of the literature. It ~lso would be possible fo pre~en~ similar evidence ]illPAng cigaret~ smoking to cor~ nary heart disease; We expec~ t]li~ to be tlm topic of the 1985 Sur~ou General's report an the health consequences of smoking. There couId be additional testimony tv the iLuk betveeea c~arette smok[n~ a~d chronic lung disease and other d~seaaes. However, I do not be~eve that add[rialto] in for matiai] is necez~ary in order ~o justify
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112 the need for further study of cigarette labelling mid the need to alert the publ]~ +o the hazel's of smoking. ~rA~HSNr OF IL~gOLD M~ND~Om¢, P~. D., Umvznsl~ or D~V~ I am a social psyohol~t~ and since 1962 have b~n Professor in the Deparrtment of Ma~ Commttnicat ion~ at the University of Denver and Director nf the ~nlversl- Ly's Cen~ar for Ma~s Communications Research and Po]icy. From 1970 through I978 I also was Chairma~ of the Department of Mass Communi~t~or~ For over 35 years 1 have conducted research and published in the fields of social rela~.ons, attitudes and public opinion, communications, public health and the sociology of pollti~. I have authored or co-authored four books and numerOUs monographs, c~mmJs~io~ed policy paper~, mad book re~iews. Att~hed to this statement are my b~c4~r aphy and a lls~ of my publications. I have examined in detail various documents that alplpear to provide the ground- ing for the "ci~ar e~e labeling" proposal contained in Section 4(a) of S. 192~ I have #yenparticular critical a.alytlc attention to the May 1981 FedPral Trade C~mlmis. sion "Skiff Report on the Cigarette Advertising Investigatlon." AddhionM[y, 1 have reviewed, from the perspective of an exp~rt on communlcati~ns effects and public ophllon surwy research, Lhe principalpublic opini0R surveys ~d effects studies on which the key conclusions of the p~rc ~taff F*epor t apparently ar~ based. Finally, I have exma~ined fhe skatement made by l~r of~sor s ~oger D. Bleckwell of Ohio Brute University and Yora~ J. Wind of the University of Pennsylvania in con.ectian with a rotational warning proposal in HR 5653 similar to the proposal in S. 1929. 1 am in total agreement with ~heir ~,aluatiens, both generally as well as in the slaecific, and I ~11 not repeat their insightful criticisms here I shell focus my observation on the scien~iflc bases for rejecting the rot~tionaI warning prop~al set forth in S 1929 and the FTC Staff P~ort Pub. ~ce~nctly, that proposal is nm~ecessary because p~ple already here the reformation so~g~ht to be provided, and misguided because it assumes that telllng people more about the claimed health h~zalds of smoking will affect their smoking behavior 'l~hat a~suml~ tlon, which is iaher eat in both the FTC Staff Report nod the present bill, is a pxime exampl~ of wishful thinking vnthout basis in fact. The premise that the Am~ricm~ public laekz su fficleut i~formatb~a about smoking and heaith claims i~ utterly unsupported by the F123 S~eff Report. That Report relies on a handful of dispara~e, iSOlated and unlnr~gra~ed "studies" and pubhc opinion poll~ that bear no intellectual, metho~legicat or scientifi~ relationship to each other. They do not relate to any recogxflzable theoretica] body or tradition; they do not emerge from any sc~ent/~¢ model; nor do ~hey reflect any system of in- tegrated hypotheses or hypotheses-~estL~g that are g~em~ded m sc~eutifie empirl- ci~m Public policy should never be based on such s~ngular, isola~d, and unhategrat - ed ad hoc "studies " Moreover, the Report pr~enta a~ an authoritative "data h~e" n handful nf dlep a. rate public opinion polls (erroneously misinmrpreted as tes~ of public informatian levels) plus a ~o~al[ed focused ~ntervlew s~udy (again erroneously misi~terpreled as a carefully ~n~rolled experiment} based on highly eelected, biased "intemept" sam- ple~. rather than on representative area probability sample~, the only sciontlf~ca~ly accepKab]e sampling procedure for public opinion surveys. IIenee the data base on which the F~rc Staff based its recommendatlons is s~ seriously flawed that it cannat pass even the most minimal scientific muster. The Repor t~s "findingg" are without value as a grounding forpub]i¢ olivy formation. These fundamental defects a~tde, the FTC 8taff'~ elatm ~ha~ slgmflcaat sectors of the population are uninformed about ~he dangers of o~garo~m smoking has no basis in fact. Data from the v~ry s~udies the F$C Staff" selected to cite in their Report indicate just the contxarT, as does the I~7S Surgeon General's Report: "The public health campaign against ~igaret~es has produced notable changes in publlc awareness of the health consequences of clgare~te smoking It appears that the dramatic changes noted in adult smoking, especially among mlddlc-aged malc~ and certain prolh~ionol groups can be attributed largely to lhe effectiveness of it~for marion and ~duc~tional cgmpa~Ins sit~ 196~. Moreover, Warner has estimated that the effect of specific 'events,' s~eh as the 1964 Surgeon General's Report, ou cig'a- rette constw.ption (mean number of cigarettes consumed per day) may appear small and t vans~ory, but that the cumulative effort of per~/stent puhlie~ty eppear~ to have reduCed consumption by 20 to 30 percent below its predicted 1975 level." 1979 Report at 19 9 [It alic added.] ga
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e~
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114 women may result in miscarriage, premature births or child weight deficiencies" im pli~ that smoking ~ potentially hazardous only to pregnant femo~e~ rather to all womem By inference, this label actually saDctlons cigarette ~aoklng for MI women so long as they me not pregnant. Further, we all have witnessed women who smok~ and who give birth to perfectly ~orr~al infant~ o~ v/eli ~ the rex,erse, no~sr~ok~rs who u~ort~n~tely prodtiee off. spring with a variety of defpe~. How will the proposed labeling cope with these re- giltles? Women who know otl~r women who smoke and ye~ give birth to healthy children wouM he lil~Iy to di~r ~ard this warning. 5. The proposed warnings are based prlmar}Iy on the appeal to fear Label m~ sage r ~ip Jei~ts would be to]d by inference ~hat the)" can avert the d~l~gel~ of cat 1~, hearL dise~, birth defects and so on only if they do no~ mmoke cigaretles. Otto, when consumers encoun~r suzh s~ror~g or oxaggerated fear appecd~, they b~ome immobilized t~ Lhe Fetal wherP they resort to "defensive avgidanoe" rather than to t aking a t 8¢omraended action, 6. The mc~t useftfl and productive function of health w~nlng labels is to reirdbr~ and to set~e as a retninder for what consumers alreac]y know. For thin ~soi1 alol~e, tampering wi~h the ctlrre~l~ well-kno~v~ bSlrgeon ~eneral's warning s~Itemen~ would appear ~o be impr ude~t. It is aplpsarent that current public ivformationprograms in the cancer and allied health field~ i~ in embarrassing disarray In~ipld~legans frequently a~ offered in place of facts and precise ins~r~tions for acting appropriately. Gimmicks like the "Great American Smoke-Out" substitute for integrated and ~ustalned sober coramu nicatlons and educational progq-amz of demonstrated merit. And troly iush~meu*al infm~cmtion regarding, for example, the identity of the best cancer specialists in toga is quite consciously 'Mthheld from comcerned pub/ic~. Added to this state of affairs are the ineonslsteut p~siti~na that the health establishment itaolf takes i¥om time ~ t~me wiLh r~e~ard to such coll~t!ll~nlAal rr~t~er~ ~ the effilfacy of ~lilual screenings for cancer of the cervix/uterus; the dang~r~ of ca~ly or frequen~ mammogruphy; the ~arei~o~enlc charac~r of food additiw's; t~ p~ifiw/nc~tiva at~ ribute~ of cho]~dt or el; and con fileting clalm~ ~ ~o whether most c~n~i~3 are envi- ronmentMly rather than geim~izally or vlrally induced. The purpose of information should be to enlighten by ~drtue of its ability to reduce uncertainty. Cvmemporary public health efforts apl~a~ to be dging just the opposite--adding to the public's uncer taiaty--by virtue of the iraprecislo~ obf~ea- fion~ gimmickery, clutter, inconsistency a~d avoidance of emb~-ra~ing and dlf~,fl~ truths. Under such c}reums~ances the publle's beliefs in the efficacy of actually pw- venting cancer and hearL dlsea~e is undergoing sawra tos~ing Small wonder that the laeLrile and colfee enema d~ensers flourish h~ today's gimmick laden pubhc corn~Junieatio~s at i~ospher e, For ~h~" Federal gov~r nmont ~o con£ribut e to t]2is sorry situation with its own groundless gfimmic ket y, such as the rotational warnings pm- po~ed by S i929, will make mare sober and prom~mng hegifll eduCation effor~ i~ the fnture all the more diffmult to carry out ~th ~u~ess. ST~TKMENT OF ~I~R~ W. ~Pg~, ~AIP~AN, ~HE ROPER ORG~TION, ~C. Mr, Chairman, Timnk you for providing m~ the opportunity to appear be loire )~u and yoL~r CoI~lll~i~t ee. We have conducted extensive opinion sttrveys over a perlcd of years for the b~bac- co industry and we also ~nducted a survey on the subject of smoking and health for the Federal Trade Cor~miss~on in 1980 The bill you ate consider~l~ would imple- ment the cigarette labeling requirements that were recommended in the Federal Trade Commission Staff Report an the Cigarette AdverLising Investigation, dat~d Ma, 198i. While that staff report cites various opinion survey ~sults, two IIopor surveys are cited extensively m support of the report s contention that strmlger a~d more varied cigarette warnings are needed, both on cigarette packages and in ciga- rette advertising. One of the studies so cited is the report of a private survelrwy we conducted for The Tobacco Institute in 1978 which was ~ubpoenaed by the FTC a~d ~ubsequentty publicly released by the FTC The second was a survey we conducted specifically for the FTC in 19~0. The staff report does not directly attribute the c~nclu~io~s they reach--that stronger and varied w~cnings ar~ r equi~d--~o our or gall[oat ton. Nor do I have any objections to the way they have reported the facPs in our sur~ys. At the same t h~e, if I were to remain silent, I think a reader of the FTC staff report would be justified in assuming that we concur with the conclusions reached by the FTC
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115 I do not agree with their ooactuslons fllat stronger and more varied wat nln~ are needed. The FTC staff concludes from our and other survey data that the public is mad- equately informed about ~he dangers of smoking. From the same and other daha I would oon¢lvde almost exactly the appetite. In oiher words, that the publlc is highly aware of the reported dangers of sm~klng more aware of ~hem than they are of ~est th~ngs in otlr s0clety. In our 19'/8 sum,ey--t he ~ne eonduoqe<l for The Tobacco Institute but later subp~ naed and released by +.he Federal Trade Commission--we drew up a balance sheet of the ~arvey% findlngm We listed a~et~ on one side oftba pace and liabilit~e~ on the oi//er side. The thst two liabilities to the hJdustry% 10o~ition that we cited w¢re, ~d I q2"l~.t [~ or e"~ than nine out of every tel~ Americans believe tlmt ~moldng is hazardous to a smokeFs heaKh. "2. A majority of Amerlca~ believes that it is hazardous to be around people who sraoke ewn if they are not smoking themselves." I would suhmlt that th~s hardly represents imawarene~s ¢d" the problem In one of our regular ROPER REPORTS su~eys, in March of 1978, The Tobacco Institute commissioned us to ask a question that Cambridge Research. then headed by president Car~er's pollster patrick Cadell. had previously asked. That question was: "Pairing all types of the dlse~e ~cer te~her, wha~ do you think is the major ¢au~ of car:cer today~ The ~in~l¢ most fl eqt~ently given ~swer to ~hRt ques- tion was smoking c~garett es Nearly twice as many said smoking cigarettes as gav~ the next highest answer which was food ad~tlves, chemicals, and preservatives in food. More than twice ~s mrmy rmswered smoking eigarette~ ~ g~ve the third b[gh- ~t ~er which Was air ~011ution or ~hemi~Is in the air we breathe. TO be sure: only one in thra~ named smoking cigarettes as the primary cause, whlsh might seem ~o imply that 68 percent ware unaware of any link between smoklng and ~cer. ~nat WOtLI d be a m~construet~un of tll~ rear,Its, however, for ol0~a~nded or free hand qtte~ions S~lch as this do no~ ~urmally tap more ~han one or two Of a respondent s thoughtS. This zs particularly true in this question where r espondent~ were asked for the ~ajor caDs~in ef~c~: one atmwer. The fact that awareness of the llnk is substantially higher than one-tlfird is shown by +/~ 197@ study I cited earlier. In ~hat survey we asked people whether each of a number of thlngs make "a great differ ante, some diff~ren~ or almost no di[fel~ence" in "how long a pots~n ]~ves." T]]ese we*e s~ch things ~s ~f a person ]s ~0 pounds overw~h~, or ifa person drinks 8 or 4 highbtd]s a day. The fifth condition asked ~bont in this ~ l.ie s w~ ~'if a ile~on s~lok~ a p~ck of ¢igarett~ a day," Fif£y percent said that makes a great dill'~r ence in how 1nag a person lJ~es. Aaother 40 percent sa~d it makes some difference. Thus, nine out of ten think cigarette smoking aff~fs, to one d@gree or anothef, how long a person lives I contend that nine out of ten is extremely h~gh awareness of the ri~ks, n~t low swRreness ha that same survey people were also asked the follo~ing question: "I£ has hewn said thaf cigarette smokePa have izlore of certain ~]lness than non~mokera. Wou]d yon say that this is de flnit ~ly tra~, probably true, of not ¢r ue?" Only 11 percent said ~t was not true and only 4 percent s~dd they didn't kncn,,. Thus, 85 percent think there is some degree of ~r utfa %o the fact that smokers have mere illnesses than non- smokers. And the largest single portion of that 85 p~rcent th~nk it is definitely true I cite theze two questions ~o put in perspective the openended question I men- tinned in which 32 percent said cigarette smoking was the major cause of cancer. The slgnificaace of that restflt is not that "only" 32 percent ate aware of the danger. The remalts 1 have Just cited show that awareness is at the 85 or 90 percent level. The sig~aificance of the 32 percent is rather that nearly twice as many cite cigarette snlok[ng as the major cause of al~ cancer--not just lul*g cancer-~s cite ~he second most frequent cause. There are various specific conclusions in the FI~ staff report that I could take issue with, but in the interests ,f time I will only cite one ~f them. On page 5 24 of the FTC staff re.pearL, the following statement appears based ~n ot~r 1978 survey for The Tobacco institute; "Sixly~ne percen£ of those polled and fi9 percent of the non.smokers polled fa- vored the proposed new warning. Only 84 percemt of those polled and 26 pe~ceat of the nan smokem favored the curr ~nt warring" The implication of this citation is that this shows the need for a stronger warning. To me, it shows the rever~e, Sixty~ne percent would no~ favor a stI~nger warning tlnle~s they were already aware of the dangers. ~n
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116 In our study f~r the IB~C, we ~ked a number of multiple choice qu~i~ns. For exomplel how m~ly t~mes mor9 l~l~]y ~1 smear WaS ~]~lrl ~1 non~moker ~,~ to gi~t di~e X--"le~ tb~n ~wlce ~ likely, t~ce ~ likely, five times ~ l~ke]y, ~en ~es likely, or g~ tiIaes as likelY?" Most l~ople did n~t cite wha~ ~he ~ regards the cozrect answer, le~i~ the I~0 to the conclusion that lm~l~le ~e ill inf~ed. However, the g~at majority of people did answer m~re likely, even i% not the exact number of times more l~kely, which le~ds me to the conclusion that in terms of basic information most people are gener Mly pretty well informed. ~e~den~]y, th~ is not the first ~ime I have expre~e~ the~e views, I e~ th~ to ~ngTess~ H~ary Wa~an in a letter dated March 10 of t~ year. i a]~ expressed them to our center at the ~ st~ff lepo~ ~ ~ued. Th~ was in a letter dated December 5, 19g0--a letter I feel ~m~rtable attscl~g m th~ s~.t~ m~nt~ SinCe ][ ~ tol(] i~ h~s sub~eEt ly been m~ke ptlblic. When we we~ doi~ the su~ey f~ f.he PTC ~nd we ~zere o~sct~g to ~ome of the quc~o~ they wante~ uB to ~k, I gave an ~n~l~" to an ~'rC lawyer. I stud that if I were to a~k you if ~he sun i~ a l~t £~her from ~he each them the moan ~, or a little farther fi'~m ~he earth ~Ima ~e moon ~, or about ~he same di~ f~nce from ~he ~h ~ the mo~n is, you ~ubl have li~t~ t ~uble ~werz~ that it ~s a lot ~]~r, thus ~cati~ a h~h general awareness of the ~letlenshlp of the mm ~nd moon to the ~h. But if I were to ~sk ya~ whether the sun ~ 43 times a~ far from the e~rth es the moon is, or 122 time~ a~ far, or 2~ times as ~r, ~r 389 time~ as ~r, it i~ ~ib]e you would not ~el~t ~he correct ~swer. ]}OBB CaB 1~¢~ that ~eople kno~ the sun ~ :~ lot ~r the" aw~y th~ the mo~ ~ean that they are well informed, ~r does thv fact that few l~ople said 389 time~ as far mean they are poorly informed? The~ e~. ~ tim f~d~ntal ~fference between my ~nte~retati~ and the I~'C~ s intez~z~on~of th~ very Same d~t~ I Wollld n~ ~r~lle that mor~ ~v~ ~lld v~icd warnings would lessen public undemtan~ng of the da~ers But I wouId argue tl~t tlmy a~e ~lJkel~, to incre~e ~he awaren~ much, ~r it is already at a wry high level In cl~ingl [ would l~ke to add just ~ne personal concern about focusing on c~a- ltet~ ~ the cause o~ c.~l~eer t~t $~el~ to me to have d~rous iml~atiol~$ The more emphasis f~P~t i$plllt OZl "ci~ll'el;~ ~i~olzlng is th~ cause of c~ee~', th~ m~ I think it will m~ze to ~ure public, ~eramental and med~l at~ntlon f~ other health d~g~'z ~d e~her c~u~e~ of c~nc~r that could be ~:~u ~]ly ~eriom~ ~r pr~slbly ~re ~eriol~s. W~ c~11 s~p worryin~ abeu~ a~r pollution besau~e we all know f~a~ it cigarette~ that csnse cancer" We can ~p ,~,orrymg al~u~ radiation becat~se "we .~ll kn~ ha~ it i~ ei~aret~ thnt e~use cancer"¸ We ~ sf~p wo~ abol~t ¢~1~- ~ls ~s~nse "we ~]knoW that ~t i~ e~arett~8 ~ ~n~ r~cer" Le~ me no~ be misunde~toed. I am not s~'g~t ~ th~ clgaret~a smoking is~p - iologically goal for a person, even if it may b~ l~yche~ogi~lly ~ f~r some people, I am nc~ ~zen suggesting f2r~t cigarette smoking is v~t hout ]~sk. What I ~m sa~ng is two things, people ~ about as aware of the r~I~ ~ I ~hink it is llk~Jy to m~k~ them, ~d eveY~bess of ~hat rlsk runs the ~]anger of diverting people from o~ ~sl~. ]glma[ly, let me reitemate my purple in being here t~day. It is not to di~iaf~ ~v[f from the survey ~f~ eif~l in the ~ ~t~l~¸ ~epor t. It i~ to dissociate myself f~m the FTC ~s conclusions that the public is unaware .nd u~Jnl~rmed. Thaak you Mr Ch~rm~m ~AT~MENT 0t" pROF. yORAM J. WI~D I am Yoram (Jerry) Wind. Since 1875 I have served vs professor of MvrkeLing at the Wharton School of the University of Pennsylvania, and am the past editor of the Journal of@,'~arketln.q I have been on the faeultl~y at Wharton since r eceivSng my doctorate degree from Stanford University in 1967. My specialty ia marketing re- search, with par tiealar emphasis on the analysis and measurement of ~nsuyner be~ heeler, Daring the pasL fifteen years I have served a~ a ~vseareh consultant for var- ious goverllment ag~n¢ies mid ahou~ 100 compmfies and lmve published extensively in many areas of m~cketir~g A r~sum~ of my educational baek@Tound and profes- sional ec~/vlt ies, and a blb[/ography of my publications, are attached to this stat~- me21t. I lmve been ~ked by The Tobacco Institute to present my views, as an expert in m~rketlng and cer~umer behavior, on the theoretical and f~ctual support for cer- tain of the pr ov~s~oas of S. 1929. My testimony wUl deal with the proposed f~ndln [mgs ~hat exAst2~g gove~am~t m~cl private programs, includillg tim ~urgeon Oeaorad's
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117 warnillg statement, have not adequalely informed the public ~out smoking and health issue, and the pro~1 to r~place lhe current warning statement with a re- taflonal ~y'stem of five dLff~r~nt warnlttg statements My comments are based nn an evaluation of a document i~ued in May 1981 "oy the Staff of the Federal Trade Com- mission entltlcd l~port On the Cigarette Advertislr~g Investigation, ~vh~ch 1 under- stand was submitted to Congres~ and was l~asod on a rationale ~hat appears to be ~ilIXilar to t~lat ut~derl3ditg tile la~eling procistoxt s of the presenl; bill. I also llaVe re~ viewed the co~xam~r stuch~,5 ~d surveys that are prmclpally r~ed llpon ill that Re It. ~y conc]uslon can be ~tated in one sentence: to the extent tl~at the ]abellng and odvertisEng proposala contained in S. 1929 are based on the recommendations and conclusions ~e~ forth in the FrO Staff P~por t, those proposals are without factual or theo~ti *"""""""""~l supper L and are unllk~ly to ac}fieve the bill's objective. I ba~e that cotmlusi~n on two key polnt~ First, the level of public awa~an~ about various arnn]dng and health issues, as demonstrated by the studi~ and surveys clued in tbe FTC Staff Report, is ex~raor di~ narBy high--much higher than one wauld expect to r~ult from normal advcr tlsing a~d marke~h~g methods. The efforts of the ~ Staff to re~nimiz~ the ex~nt of public awareneas on th~a issues are hosed on misinmr pretat~on and ra~sus~ of the studie~ cited in the Report and a ruxtdameu~a~ catlfusion betweeu awareness and belie f, Th~ coadumon presented ill the bill that "present Feder el, State, and private ini~atives have been insufficient in conveying to the Amebean Publm" infer matron abaut the ~erted health effects of smok~n~ng (Sas. 2(6))~ is ~ot eonslstent with the findings of the ~tud~ ~lied upon by the FTC S~aff Report. Sgcond, there is neither theo~tlcal nor em~p~rical support for the propcsRion that the rate,anal warmng system propc~d hn 8. 1929 and r~ommended by the FTC Staff would haw any positive impact on the |e~l of public awareness abeut smok- h~g told health issues, l~placement of the current warn~r~ Statement With five dif- ferent rotatioaa] warnhlgs ~hoa would be to~ally arbltr~ty. I would llke to elaborate on each cf th~e points W~th respee~ to the existinglcvc] of pubhc awareness the FTC Rei~ort begins its a~Jysls with tl~ adr~ion that "mc~ p~ple are gea~rally awar e--of the ¢lairf~s abou~ ~noking and h~Ith. The report cltos a 197} Gallup Op]nlon poll, which ix;¢l~. cares that more t)~an ~0 percent Of the pubhc he,eves that smoking is ~azardous to health Similar high percentages r~I~md affirr~afiveig to mar~ specific issuem over 90 percent of the public hell.yea that h~rt disease has beel~ found to he asso~int ed with smokmg; almost O0 per cen~ believes ~bat smoking dtlrh~ pr ogn~acy can affect the smoker's baby ~? percent of sd~lh~ are of the view that smoking has been found to be associated with cancer of the mouth and with chroa£c bronchitis; wel ov~r 80 percent either "think" or '~know" that smokers are many more times as likely to ~MwIop lung cancer as nonsmokers. Thase ~spoimes are r emarkable. Natiooal surveys and pol~s consL~t~ntig idantify substantial segments of the American public who are unaware of major publ c i~ues and fact~-- he energy crisis~ the iden+Aty of ~he President and other public lee£der~--the e~mp[es ore ~ul~erous. , ,, . ,, i - A ir~e~ured level Of 90 pe~2ent awa~css can he Cmmldered de~¢ler~ oilly f It is compared to a standard of perfect awa~eness. But it should be ob~ous that such ~t s~nd~rd is both theoretically ~td practically impossible The limits of human cognl- tire abilities and selective perception mechanisms insure that 100 percent of c~y group will never be aw~ of or in agreement abou~ any fact or J~ue- T~a~ is why there is a distribution of responses in anly test, particularly a test invoIvlng multiple choice questions such as the studies tit edin the FTC Staff Report. An e~p~ally important defect is the FTC Staffs fundamental miaint er pretatlon of the results of the consumer studies on which it relies, Six major misinterpretations can be identi~¢~. F~rst~ the ~taff improperly focL!.ssed on response~ to specific questions~ rather tha~ on patterns ef responses. The St~ff assumed throughout its dlscu~ion of public awareness that if a nth~ber of peopl~ a~ ~ot aware Of a S]~ciJ~C t]etail about ~he smoking a~d health issue--for example, the claim that the s~loking during preteen- increases the risk of still birth and m~arrlage--tbose people a~e not aware of ~e general proposition that encompasses that detai1--~hat is, ~he assertion that mnokhlg during pr egn~cy increases the risks of adverse effuses on the [)aby. ~ais assumption is contrary to the acttla] results of ~hu ~udleS clt~2d In ~le r upoit, WhiCh sh01v tha~ r~f~% i~ople are aweu~ of all of the sig221flcarl~ claims O~ou~ smok. ing and health. It al~o violates l~Itdamental prh~ciple~ about rae~urement of ]mow edge or awareness, which e~a]l for the d~velopment of an overall lmo~led score or scores based on response to roulttple inns. Can your knowledge of a suP-
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121 states (California. Illinois, KentuckY. New Jersey, New York, North Carolina, Ohio, Pemtsylvania, Texas) would be more tha~ 10200 jobs and more than $170 million ill wages. One-faith of this Ices would come f~m tobacco farming, manufacturlng, retall sales, and suppliers; the remainder would ~ult from th~ ripple effect on the re~t of the e~nomy Fmther economlc hardship woutd r~ul~ from the loss of ex oft markets and of American ~6s that depend on exports. Thi~ bill goes far beyon~ existing legislation by requiring ~arnlng labels on cigarot ~ produced in this country fur ~xpor t. Could American cigarettes carrying a health warning label compete with cigarette~ which bear nc~e? Can +here be any doubt of the result on sales and on American jobs? The American Cancer Society. a ma'oI'~ lobbying, fo~x:e for tbi~ legislat lea, wants *o cause more than a one percent drop m smoking. Several ycm~ ago, they launched their Target Five c~mpaign, aimed at a 25 percea~ decrease in smoking in five years, And, ig must be l~co~ized that in Swe f~en, the source of this bill, the govern rnent '~ stated ~al is to achieve a smoke-free nation by the year 2000. We seriously question the wisdom of buying the Swedish import for Americans. We seriously question the wisdom of disrupting a healthy industry and creating mere onemployment in a recession. We question the wisdom of setting up a new antbsmeking bureaucracy with unspecified spending authority whcn other esential health and so~ial pt og~ runs are beiltg 6lashed, Mr, Chairman, we do nlore than "~ rlously qustion ~he w~sdom" of this bill--we reject its folly. N~w, let us mrn to the second major ~ound for our ~pposifion. Section 8 deals with so*called fincUngs. These blame every major chronic disease on smoking, and thereby create a ~moke.sc~en for the occupational and envlron* mental factors involved The very first one states that "the Congress f'mds that cigarette smoking is the largest preventable cause of illness a~d premature death in the United States and is associal~d with the uo/lee~r~ deaths of over three hundred thousand Americ~ms ~nnually." At fimt glance, it is difficult to conceive of a statement more alarming, more com- pel ling. move demanding of remedial action. It calls for noflfing short of outlawing tobacco. But on reflec%ion, %h~s finding is curiously phrased; the words have an Alieedn- Wonderland quality. Their meaning is hard to pin dew~l, F~r ena~nple, il cigarette smoking i8 the "largest preventable cause of illness" what are the second and third largest preventable causes'? What are the "non-preventable causes"? Is smoking "preventable" while envirenmontal pollution is not? If these statement~ of findings had to be subst an'~iat ed, as the I~fC requires adver- tising statements to be. i doubt they would survive. The bill says flatly that smoking ,.is associated oath" over 300.000 deaths a year. Yet. the fhst Surgeon GeneraFs Report in 1964 stated: "The total number of excess deaths causally related to ciga- rette smoking Ln the US. popular lea Cannot be accurately estimated." The Committee which wrote the report considered the possibility of trying to ~ake such calculations, but rejected the ~dea because "it involves making ~o many assumptions that the Committee felt that it should not attempt th~s..." That restraint is as needed n~w as it was then We believe the findings [11 this gin are unsuhstant~ate~ and w~ll be misused to ~he detriment of millions of worker~ ~x osed to occupational hazards. We oppose ~his bill told its findings to show our sol~arlty wifi~: Coal miners whose black lung disease has been blamed on smoking, Textile workers whose brown lung disease has been bl~m~ed on smoking. Asbest~ workers where lung dmeases have been blamed on smol~g. And the li~t includes uranium workers, chemical workers, metal workers, ship- yard workers, and many others puMie Hea~th Service ¢md the voltmtaW heatth or. gani~atiens should, honestl. ~' abandon the blame~the-victim approach and get at the truths of wha% m caumng disease. Nor ller this year, the Congress heard testimony Ikonl two scientist~ who reported that "at least 11 percent and more likely 21 percent" of lung cancer in the US, can he attribut"d t~ air pollutioo They netted that the proportion of adult smoker~ has decr~sed and that cigarettes now contain half the far content of 20 years ago. yet lung cancer rates continue to climb, 'To us this indi~ that something else is at work," the scien%is~ said But to the supporters of this hill, it's all clgarette smoking Recently. the Natlo~a] Wildllfo Federation ruporled that "rcspensib[e s~ientists believe air pollutlon is responsible for about 50.000 excess deaths, seven million sick days. and i~ million d~ys of restricted activity per year." But to supporters of this hill, R'S all cigarette smoldng.
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1 ~0~0~
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124 rel*t general health ~varning found on cigarette package* ~J~h seven specific health warning*. One of the seven specific health warnings would be required on all ciga- rette packages and in adver~sements. Tl3e warnings would be rotatsM among br~.ds so that each brand would use all warmngs wltlxln a {ffteoa-month period. S. 1929 would also requlre the "tar," nicotine and carbon monoxide lewis to be disclosed on packages and advertisements. Cigare~4e manufacturers would be required t~ ptevide the Federal Trade Commission with a ]]st of the chemical addltives in cash of their br~#s of eigamt t~, This information ~ould be protected a~ a trade secDat mad used only for research proposes. COMMETqI'S The United States Surgeon General stated in his recent report, "The Health Con- sequences of Smoking," that "cigarette smoking . . . is the chief, single, avoidable cause of death iv our soclety an/[ the most important pubile health hssue of our tJlne" A dse~ion Oa smoke should be made w4th the knowledge that increased health risks are ~ssociate<l ~ith smoking, For this r esL~on the AMA i~ supI*r t~ve of efforts to ~nerease pub]is awareness el the hazards. The AMA has been involved in mmly efforts to Laero~ the public's knowledge of the const~quenees of smoking. The AMA receives and answers many requests lbr smoking information. In 1978 the AMA publiahed "Tobacco and H2alth," an account of the oomp~rchenslvc research program conducted by the AMA A a~s ~renhlet called "Smoking: Facts You Should Kn~w," a copy of which is attached, w~dely dista ibu~ed along with two anti-smoking posters. Physicians are urged to alert stuck- em t~ the risks ~sociated with smoking. .Our eommoents addresss only the rotational labeling provis[ovs. We fred it very dmturhmg if, a~ a recent FTC staff report alleges, approximat ely ten percent cf the population still do not know thaL elgarette smoking is harmful, Believing a more detailed warning would better in foxam the public of the ha*~a of mlloking, the AMA House of Delegates adopted a report encouraging Cong~a~ to requixe a more explic- it warning on ciga~x~tte ackages hi te~tifgit~ b~fore t~a SubCommittee on Health and Scien~flc Rese.'~mh of the Senate Committee on Hurna~l Resources in I978 on a simiIar labeling pI~vls~on con Lalned in S. 3115, (95th Congre~) the Diae~se prevention and Health Promotion Act of 1978, the AMA endorsed the rotational labelh~,~ warning concept We recommend a~ file time tha~ if adopted the rotational labeh ' should be evaluated after a period of use to see if there has been any substantial difference in the public's awareness of health problems $zsociated with c~garette smoking." We still ~elieve the ~ff~ctiv~- hess of the l~}~els should be evaluated A more explicit warning, whi]e an improvement, will not he a complete solution. The 1SS0 Surgeon C*snera]'s Report on Smoking and Women r~vea~s that smoking is inereaSino~elieveam°ng teenager~. The AMA is concerned abou~ ten.ego smoklnng and does a change in the warning alone will fully deal with the v~olem. Educational programs that emphasize the harmful aapeet~ of smoking from a teen- ager's point of view should be pursoed, and the use of "role models" in e$~mt~e advertisements should be elmllnat ed, Issues of concern to an adult, like a decrease in life expect anc., may not influence a teenager's deci~ion to smoke. More iuforma- tion is needed on youth smokinff, such as why lh~y begin to smoke, why ~hey quit slacking* and what method is moat effective in urging teenagers to quit smoking. Once this information is available efforts to reduse teenage smoking can be better directed. Even those who are aware of the dangers of smoking nm have difficulty qultting because of the addictive qualities of cigarettes The recent ~nrgeon General s report shgw~ that up ~o 50 percent of thasc who quit smoking on their own wilI stay off cigarettes. Assistance nlust be pro*ided to the remaining 5(} percent if smoking is to he decreased significantly. The AMA is developing an ~udlovisual presentation on how to quit smoking that will seen be available for physicians to use in assisting patients desiring te quit smoking. If adopted, a change in the warning Iaay create more awareness ef the dangers of smoking, and mote smokers will wmlt to stop smoking, prog~anls to as~dst these who want ~o quit smoking will be needed even mare in that case. ~ON(JLUSIOIN- The AMA supports efforts to increase public awarenesa of the hz~ar d s ~f smoking We belie~ e that the best method to dem~ase smokiug is to help people avoid sLart ing the habit. One method to discourage smoking would be a clear indication of the #.
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125 health hazards of ~mokl.g. Thus. the AMA supports a more exgi[cit warning on clgazx4t~ patkat.~ mad in advertisements. AMBRICA~ AC&DE~y OF PEDIAT~I~S~ Evanston, Ill,, February 8, i~82. I-Ion. BOB PACKWOOD, Hon. ORIGIN O. HA~, 5%nate Office Building, Wo*hington~ D~ DEA~ 8ENA?OR PAOKWOOn AND SEaWATeR HA'con: On behalf of the American Acarl. emy ef Pedlatri~ I am pleased to supper2 S. 19Z9, the Comprehensive Smvking Pre- vention Education Act. The human heal~ix ~a~equenees of eigarett~ ~moking have been studied more thoroughly t}mn thee of any o¢her envlronment ~1 exposure. As wo~ noted in the 1079 Surgeon C~ne~al's Report, "Smoking and I~t~," $1~cific mortality ratios are directly propoxtloaal to the years of cigarette smoking, mad are higher for persons who started smoking at younger age~. As your legislation indicates, Smoking con- tributes to mortality from lung ¢~ncer, cardiovascular disease and increases the risk of cancer from exposure to other carcinogens. Birth weight and fetal growth are a/so adverse[~¢ affee~d ....... bY smoking during pr o~mney. Thus *t ~ particularly alarmmg to pedlatr*cla~ that despite our efforts to edu- cate young patignt~ abou~ the dan~ero of ~raoklng, the ineidenc~ of eig~we~te smok i~g is ac~alig in~r eo ~ing 0xaong ~dolescent female, ~lld ho~ not decreased in young ma~e~ The Academy appIauds your initiatiw to eoml~a~ this egcalathag problem and leaks forward *o a~si~CSng in whatever way you s~e fit Sincerely you~, G~gN~ AUSTIN, M.D. ~bI~RICAN ACADEbVg OF O'/~LARYNGOLOGY--HEAB ~ N~CK SUROE~y, Iiqc., Washington, D.~, February 10~ 1$8.~ Hen, BOB PACKWOOD, Chaiman. Cornmiltee on Comraeme, Scien~z, and Transpor&ztio~, ~ Ser~t~ W~hlrc~on. 172~ DEAR ~ENATO;~ PAf~iWOOD: I'm pleased to report that at its most recent meeting, ~ho Beard of Directors of the Ameri~ma Academy of Ob~]aryngology Head and Neck Surgery, Lag. voted Co suppo~ Senate BiLl 1929 which would amend tim Fublie I~eldth ~ervic~ Act alld tile ~eder~l CigareL~ L~belil~ and Adverhsing Act to in. crease the availability to the Amellean public of information on the health conse- quences of smoking. This support is particularly appropriate inosmuch os the mere- bets of the American Academy of Otolar~gology are those medieaI ~peei~IisM who have primary responsibility tad expcrd~e in the di~as~s of the mouth, throat and appendages of the upper airway. Maily of tile lethal eortseqaenees of smoking tobac- co appear first ha the head and neck regzon. W~ thus have an enormous experience with thee dlfFlcU]t and tragic problem& I am plea~ed to report thL~ ~etJon to you Very sincerely yours, Hamay W, Mc~v~a~, M.D., Executive Vice Preside~ CALIFORNIAN~ ~B NQNSMOK~XS' RIGH'rS, Berkeley, Cain, February 1~, lg82. Hen. ~OB ~&CKWOOD, Senate Office Building, Washing~n, D.C. Dm%R S~NATO= pACKWOOD: On behalf of Californians for Nonsmokers' Rights, I would like to thankyou for introducing S 1929. Californians for N~nsmokers' Rights is an erganization with more tha~ 25,000 contributors that grew from the two recent il~itiative campaigns en the question of ~moklng hi publh~ ~)lacos. Wo are gont [r tuhng to work on issu~ r~lathlg ~ nol~s]nok- ers' r~ts in particular ~ad ~moking and health in gen~ral LIirough the political proea~s aL all levels in Califoruia. 9~10 82--9 = •
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126 Since it bears so directly on your bill. I am enclosing, for your in[ormafio~, a copy of a le~er I recency sent f.o the Feder~ Trade Com~iss~n endorsing the conclu sinns and recommendations in tbelr "S~ff Report on the Cigaret~ Adver t~sing In- vestigatlom" I am also enclosing lettem from faculty of the U.C San Francisco aud Stanford Mediczl Schools that ~tte~ to the s~ren~h of the condusior~ in ibis report The nifty change w~ suggest in ~ur bill is that the ~tem of rotational warnin~ be exp~ed to ~nclude one or mo~'e war~n~ to educate the pubilc that smoki~ harms nonsmoke~ ~ ~,e]] &q smokers, such WARNING: You~ smoke hurts people with heart disease WARNING: Your ~noko hurts nonsmokers WARNING: Ynur smoke htttt.~ your childi~n WARNTNG: No~smokem inhale poison~ from y~ur smoke My Ict~ t~ ~hc FTC ouflin~ ~he ra~onale for these su~cstions in more de~/l. Although our or ~izati~n is primarly c~ncerne3 with local and state wide le~sla tlon ~n ~alffornla, we were pleased to see that you in~roduc~ S 1929. I am also ~rit~ng to Senators Crans~n and ~ayakawa asking that they support your bill. If we can do anyLhing e~s~ t~ help secure its p~e. plebe let me know. 8inc~r ely you~. ~ERICAN pEBI~ ]~L,~H ASSO~IA~ON. Wash~t~glot*, D.C, February 18, 1882. ~on+ BOB PACKWOOD Ru.~ell Senate rice Build~ng, Washlngto~ D.~~ ])EAR NENAX'0R PACKWOOD; The American Public Health Assoclafion is pleased t~ su~por t S. 1929, the Comp~hensive Smoking Prev~ntlon Education Act. ApHA reeogluz~s the health hazards associated with ~mok~g and ha~ over the years participated in ~ffor~ to ~l~sc~urage and elimina~ smoklng. I~ formally, £be ~s- sociation accepts no tobacco advertising in its publicatioa~, hold~ no investments in firms which have a major Lntet'est in ~obac¢o products, and a]lo~ no Sl21okillg a~ ~J~y of its meetL~gs or public function. In our recent comments in response to the Federal Trade ~mmi~ion's Staff Report on the Cigarette Advertising Investigation, we concurred w~th their findings that the public needs additional information about the health hazards of smokDg. We agree that the cur~nt health warning is no longer effective. APF~A 8upport.~ your proposal to change ~he si~ and ~hape of warnlng~ on cigarette a~ver ti~ing ~nd packaging and to provld~ rotational warnings. We f~el $, 1929 is an iml~rtan~ step toward inere~ing public knowledge about the adverse heMth eflbcts of smoking~ We look forward to working wi~h you nnd your staff'irt su por~ of dlis legislation, Very tr~ yours, ~gt~' J. ~, MS, PresideM. Wavhington. D.~, Febr~e~, I~, i$8~ Hol~ BOB PA~WOOD, R~sell Senate Office Buildill~, Wazh~ngtot~ D.C. D~ S~vo~ P~c~woom I am ~rlting to expre~ ~he cndor~ment ~ the Amerb can College of Preventive Medie~ne of S 1929, a bill you have introduced together wi~h 8en~or Eatcb which would help ~o provide information to ~he Arnerican people on lhe day,gem of c~ar~e smoking, By anyone's e~timate, ~he annual cost of cigarette smoking to society and to lnd[- vidual~ is enormot~ yet a great trmny ~mokem are ouly v~.$ue[y aware of the con- sequences. The decision to smoke is Ode that an individual has a right t~ mak~in order to rationally make that d~i$ion, however, confiners must be p~ovlded addi~ tiona[ information on the known h~ards of the habit. ODce g~vea that information they will be be~ter able to excrete their freedom of c]mi¢~,
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127 S. 1929 goes a long walyl in providing balanced information 6:} those who may be unknowingly oxp~ng t~ernsolv~ to tr~raem~.ouB hazards, We aI~ ~hsreibre~ giea~ed to lend our support to thi~ legislation. Sincerely, J~rvu~soN C. DAVm, M.D., Pr~ident. A~OCrATION OF TR&CHE~S OP PREV~IV~ ~DICI~, Wa~hi~glo~, D.C, Februar:, 25, 198~?. ]~OIL BOB PACKWOOD~ Russell Senate Office Builditlg, W~shin~on, D.C D~A~ SeWATOR pAC~VOOm I am W tit L~ ozt behoIf of our organL~afion to express 011r endorsement o~" S. 1929, a bill you have in~roduced which would change current labeling rcquiremen~ for cigarettes and Would make certain pregraru chal~ge~ ~it hln HI-~ ba enban¢~ the Department's anti-smoking effolts. AS the Surgeon ~eneral ~ust this week reported, the dangers from smoking ate far more e~tensive than we reallzed ~u~ a f~w shor~ year~ agt~. The vonc~mitant health care c~s associated with smoking are equally staggerlng. For the~ and o~her reasons, American consumers must he provided ~th far more fa~ than they currently are regarding the hazards of this habit. Your bill would make a sub~/an- t]a] contribution in providing consumer~ with vital information they need in eaer cSs- ing £hei~ freedom of ~hoice to smoke or no~ to smoke. We are pieced ~o lend out support to th~ legislatior~ aimed at ultimately curtail- ing the "chief preventable cause of death" in this country, Sincerely. AMERIC~ CAN-CER ~O~I~y, Ih'c., C]~irman, Commeme~ Committee, Dir~ne~ Se~ate Office Building, Washington, D.C Ds^a S~a~oa Pac~voov; The Amorlc~n Cancer Society, the war id'fi largest wl- unary h~¢}i organization with over 2 million aetiw v~[unteer~ in the United b'tat~s, s~rong[7 endorses the ~sic pttvpose~ andpI r on'ions of ~ 19~9~ The Compr e~ henslve Smoking Prevention Fatuo~tlon Ac~ of 19~1, ~nd urgs~ it~ e~rly ¢opsidera- t~on and passa~sa~!e by th~ Comme~ Commi~a~ ~ld by ~he fhll Senat~ eves 300,00({ prevented*Is deaths occur cecil year in this country because of c]~a- rette smoking. Smoking is responsible f~r millions of hours of ]c~t praduct pcit¥ cc~t- fog our economy over $25 billion a year. It is a l~Or cause of lung, larynx, ova] cavity and b]adde~ cancer. A recent FTC study shows ~hat despite efforts at education, the majority of our fellow citizens are basica][y unaware of the dangers of smokLng Educatmn to the ha~rd~ of cigarettc smoking, especially eduga~on effo~ alined at our~ otto ~ people~g who [lave not yet started to vmokv are. thervfore, vi~l]y ]mporta~it. S. 1929 would take us a long ~ay towva~i a coordinated, int ensure effort a~ educating the Americ~ consumer r~ the actual dan~ers of smoking. While some would questmn the efficacy of warni~ ]abels, the ~TC staff ~port made it very 01ear that no~ enougll in ~ol'mation was gettingto the public about the danger~ of smokL~g The secticns of S 1929 which provide for five rotating warning labels on all cigarette brands, ]abels which ver~ specifically spell out the health has- ards of smoking c~uld wall bo the answer ~o thin problem and must be ~ried. The Society is pa~icu]arly plea~ed that S. 1929 contains a provision requiring li~t- ing with the Secretary of ~Iealth and Human Services ~f all additives in each brand of cigare~te~, SneLl a requirernent could give scientists Lhe oppot~unlty to studl~lthe effects of burning oa~d inhahng such ~iditives on th~ health of cigaretle smokers whl]e sttl] ~ro~ding the tobacco induatry with pr ot~cLion against revelation of trnde sec~ef.q re gardircll~g quan~[tles ~d types ca~ these ;~vor ]Ilg~, ~He AC~ is m basic accord wi~h most of the provisions el S. 1929, we would prefpr to see a formal Office of Smoking ~md Health as par~ of th~ package ~d we ~rge you and member~ of yolky Committee t~ Consider such an ame~draent to the legislatlom
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128 We wish to commend you for your leadership and fQresh~ht in ~fferlng ~ 1929 and to ~altk you for year ¢ol~a~i~mellt to use cdtlcaflorL and rc~r¢]l ~S a too[ to i educ~ the national smoklmg habit thereby greatly reducing the nulnber of preventable ~ancer de~ths ~lCh year. The American C~ncer Society considem passage into public law of S. 1929 to be a major MgLslutlve priority. Thur~for~, ~ w~ can be of any assistance ~ you during the consideration of thi~ legislation p]ezzse do not be~itate to ceil] upon u~ S]ncere]y~ R~a~T V P H~a, M D., Pres/d~nt ~RICAN NUI~gE$' ~SOCIATION, INC., Ka~a~ City, Mo., Mar~h 16,1~8~ Hori. BOB PACKV¢OOD, U.~ Sena re, DEAR ~BNATOII PACKWOOD~ The Alllc, llcall N'llrses' Association applauds your action in sponsoring 81929, the Comprehensive Smelting Educa~on Act of 19~L This b£]l i~ an important ~tep in strengthening the ~'deral and private sector educat~onsl activities of one of ~he m~Jor public health problems hi the U.S.--Cigaret to smoking. The Amer ~an Nurses~ Association, as the plx~ fessiotml orgmlLzation of the largest group of health care p~vider s. most of whom aue women, are espe~ia]Iy concer~ed about the aI~rm]ng increases in smoking among young women. We encorage nurses to became informed about the he~a]th hav~r ds of smoking and to be acutely ~nvoIved in health education programs, Imrtlcularly those to prevent the young from becom- ing ~mokers, The increased labeling requirement for cigarettes, as outlined in your bill, can help to meet the need for incr~sed public awareness ofEae ~evastatlng effects of ¢ig~retr$ stacking Wi~h increased knowledag~e of the hazards of snicking, the con- sumer can ma~e a more informe~ decision whether to smoke or not smoke. The ensstment of S1929 will provide a much needed impetus to preventive heolt h programs and stlxnulate new efforts to foster public awareness of the danger of smoking. We look foraord to working with y~a on your smoking prevention effort. If we can be of further help to you, the st~ff of our Washington Office will be happy to ~ssist you Sincerely, PATRICIA A. JONES, ]2ep~*by Executive Direc~n STARE OF (~ONNECT~CUT, D~PAR~MEN~ OP HEAr:P~ SERXnCF#, Hartford, Conr~, March 2~ 198~ I~on Bo~ p~C~WOOD, Ri~ell Senate Office Buildin~ Wm~hi~tor~ D.~ D~^~ S~NXvO~ P~c~w0om Qa behalf o~ the Association of State and Terrltorial Health Officials (ASTHO), I am wrltln~ ~n support of the pl o~Jsions of S-I929. The issue of tol0a~co smelting and its health end social consequences must he addrez0ed as a nations] problem The results of tobacco u sage in our country are tragic and in most cases pre~entable. This bill Lo important ai~d worthy of support for a number of rensons Tile most important being that it is a eomprebwnsive smoking prep,entice package. The bill hm~ several major components that should be commentcd on: 1. It would est~bllsh on Interagenoy Committee on Smokil~g and Health. This pr~ vision make~ good s~nse due to ffa~ complsxlt} of the problem. It would enable more ~gencles and organizstlons m remain up to date on the issues and the current smt~ of the ~rt in prevention 2. It would require the Surgeon General to transient an annula report to C.ongess Reports of this nature are extremely important and often are considered bench- marks of progress, as in the case of the 1964 mpor£ on 81nddng and Health. 3. It v~uld ~equ~re eigareute companies to place health warning messages on each pack of cigarettes I strongly support the rotating health m~ssage provision The current health warnings on cigarette packages are not as effective as they could be 00
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i29 I believe that expzalded educational efforts must take ptace a~d a system of rotating me~sng~ should be undertaken. A recent survey taken in the State of Connecticut indicated that 88 percent of raudom samples of 500 state re~iden~ knew that snmkmg was harmful to health. Only 88 percent, however, recognized that smoking was a major risk factor for heart dLsea~e, which is the leading cause of death in Connecticut and the nation. Resesr eh has indicated that people wilt take preventive health actions when they perceive a proD[Sill as ~e~el~, consider Lhemsolve~ susceptible, arid o~k~owlodge a benefit from a ~medlal action recoramend~l (Becker, L97,I ~). ~ne strengthen label. llng provisions acldre~ all of the necessary steps kn the initlati~n ~f behavior change. . . . Fhao]ly, tobacco smoking is the ntmaber one publm health prob/ein m Ameraem It ~s e]earJy the larges~ preventable caaze of death in ~bJs c~untry. Th~s issue mu.~ be addressed as a national problem. S-1929 ~ldres~es the teplc at the natloRa] level and is a comprehensive ~ett thought out approach, I u e the committee and the C~ngr~ss to supper t the bill. r~in~rc[y* DOUa~AS S. LLOYD, MD., M,p H, FEDEIIAL TR~E COM~NION, Wa$hit~gton, DC, April 7, 1~89 Chairman, Commlttee o~ Cor~eme, ~v~en~ and Trar~por$at~o~, ~ZS. Senat~ Washington, D.C DSA~ 1~ CHAm~Z¢: This ~r ~vespo~ds to yams ~eq~e$~ for ~$t clara reg~rding a ro~atlonal.. , warning, system ..in Clg" arette, advertising.. Duringlthe Federal. T~ade ~lnmx~ tO~l s cigarette advertising invest iga~lqn, we worked clOSely wlth an adver tmmg agency, Keenan & ]~[c~aughlin, Inc., to understand how c~garet~e ~dver ~islng is crated. We were concerned with how--a~d at what cost--rot~ti~Jg the hesJth warning in cigare~t~ ad~ WouId affect the way in wh~b clgarette~ are advertised Using information from Keenan & McLa~at~hl[l~ and a number of asSUmptions that I will spell out in this letter, we have ~ncluded that fhe quantifiable total annual costs of a r~tatio~ml warning system wauld probably be loss than $1 million. Before discussing actual /lgures, I need o oxplah~ briefly how cdgaretf~ ads are roduexed. ~¢[o~t cigarett8 ads ~re printed ~he advertiser designs ~it &el o~d crates a P "meehanic~]," which contains all the artwork in fine ad including tb~ warning The "nlechardcal" se~ve~ a~ the b3~k~ for production material used in prlntSng newspa- per and maga~ixe ads, outdoor and transit posters, and point.f purchase and pr~ motional matedale. The particulars vary by lnedia, bat not tbe basicprocess. In newspapers and magazines, the advertiser prepares an ini~LaI set of pa~duction ma teria]s for each adver tis~inent ~d dup]ica~e~ for all of the publications in which the ad will appear, The vests of ohanging a warning message vary according to whoa in the prOduc- tion pro~s the rhange occurs, If the adverttser has to change war ning~ only when new ads are introdu~d, the increased production costs from rotational warnings would be t ritual. Costs are greater if changes in the wsrning must be iucorpoorated into adver~isiilg that J$ a]x~ady produced, When there is a change only in tl~e rues sa . without ehanghag the size or shape of the warnillg, the cost Ls low.~' ~he message can be changed by usng "~atches" for the artwork contain~ajg the warning message without affecting the rest of the adver ~isoment In newslmper s and magazlnss, when ~he advertiser creates the patchl~rk, there ~s a hi~her eo~t for the first set of meteriaLs and a lower cost fur the duplie.ate artwork. Separate artwork must be sent t~ each publication in which an ad with a thronged w~ing appears. In newspapers and most inaga,zine*, if the ~dvertisement runs for long'or than the designated rotational period, then the ca~t of changing ust the Inessage within the current rectangle is $1~o0 for the first fist of produc~.~en materla]s and $40 for each duplicate. 1o those few newspaper supplen~ents and magazines that use a slightly tBeeker, M, cd The [ffenlth B~li~f Model and personal Health Beha,qor Health Education Mono~'aphs, 121 19~4, ~24~178 ~Our cost estimates assunm t~t ~he size and shape cf the w~r nin~ dO nOt el~ n~e. If SUCh eha~ges are rcqulred, the ¢~tire ad~Prt~sement, and not ust the message within the recla~g]e would be affected. It would cost between $600 and $45tRJ b~ make such a change in au casting ad. ~f a chalice 11~ the wan~g's torrent w~re ph ~ ~] in with ~ew advertising, hoz~ ever, increases in production costs would be trivial.
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130 different ~d more expensive proceos known as i~togravure, the r eBi~Eve ~tB ~ro ~2d~ ~md ~60. It should be reenlph~slged here that if the w~vnhlg is interpolated ~nto new advel~i~in~ ~,g it is pr~Ltced, inel eases ill pro~tLc~lon C©$t~ WoUld b~ ~l'iv. ial. Our eM~mate of the tutti pr odu cleon eo~ts of a change in tl~e warning is ~sed on the levels of eigBl~tt~ advertisio dollars in ~oh r~ediH~a and orl reaso~ab)e a~ suml)tio~ nh~ut the nunaher of a~s that would ~ave ~o be eha~g~ed at an~ one time. For magazines, the production COBt per change is approximately $29,0(]0, For news. papers, the estimate is ~81,000~a Because l~ewspaper supplement~ commonly use the more ~xponsive rotogra~ are process, it would co~t propoztionally more to eilauge the n~ ~&q zig e 61 that ly~ediuxrl, Our rough estimate or the total eos~ ]per challge if $~,000. Our estlmate of the total per chan~e cost for changing the warning in all of the prin~ rue~ia~ therefore, is $69,000. In most of the poster media (printed biIlbuar~s ~md transit post~r~), th~r~ would be no appreciable increased preclusion e~t~. Such po~ter~ are routinely eha~ged monthly. To change the warning me~age, the printer would mealy claan~e that BI]IB£[ segment of tile aY~work *6a.t h the x~rning and produce poster~ with the new language Thus, chapges ill the wam£ng could be incorporated into new printing rnn$ act a~l i~l ~i~i~c ~lt extr~ cost. IR C~]¢ula~iug the total productiDn cost--using a generous over estiroat¢ of the to~al txtl~her Of po~t~r and tr~t ads that would have to be changed at any one tim~we conohlded that the maximum ~ueh a change COUM cost would be $16,000s painted billboards would he much more expensive to clmnge The~e billhoards~ katown ~ buJletlns, ace desiglled to last for a year. If the warrd~g h~d to be changed dRt~g thgt~ year a palltter would have ~ travel to the ~ite to pa~Rt oT~ new Iz~ll g~oge. Although we do not have precise e~timat e~, these cost~ Could ~e su'ost,gJlt~L A system wlfich reqlaired a new war txia~g to be placed on each bflILoard when it is painted would impo~ 11o in~rct~ed COSTS. On th~ ~ssllmptien ~lat SUCh ~ Syst~ Would be the one adopfed, we have made no allowance for cost~ of ehm~g~ng exCstlng painted bfllbsards. Flexibility is also the key to ho}dlng down ~]ae production costs for point~fAale ~nd other promotional materials These i~me have an indefinite useful life. There would be much waste from requiring rotatlolml warnings on these rnatel'ials. In stead, if the language of the waI rdng were to be determined by the date the item was ordered, eventual~y all of the messages would a~pear and production costs would incr e~e only tri',JatLv. In addition to production co~ts, the administrative costs of cigarette advertising with zotafing warnings wotfid be higher for the cigarette manufactu~r~ and their adver tis~ng o~eneies b~ause of the need for increa_md monib~ring to ensure compli suace w~th wlmtever lotationa[ system is adopted It is difficult to estimate how great thls cost would 1#~. The advertising agency thact staff" consulted estimated the total adminLstratdw cost of monitoring a change in message to be $5zi5 fora~pa ~ ecific advertisement (regardless of the number of publications in which it appeared). Pro- sumably tl~s figure, which the od agency belleved to be on the high side, would d~ *v~/e e~leulf~cd ~hnb f[gxl~ ~ re]lows We know flora I~ad~n l~ati~ncl Advez~iser~ (L~A~ that $k~37 nullion were spent on magazlne c~gar~tte ads in 19@{) ~'e also know from that ~,~me so~r~ ~hat Lwellty ~hreo lll~[~eB ao0oRtl~ for $250 RdUion o~ that total B~ raking a random ~smml)l~ of eleven of tho~ ~wenty three nmg~ines and ¢o~#ing the ntmlbcr of cigm'¢t te ad~ in -each, *~ concluded lhat thele were an ~verage of e ht ads p~r r~0 ~0 zine er ~ssue M111tiplyin~ ~he n~mher of ~ds by the cos#~ of chan&dng eae a~ gives ~n estimate o f°$~7,~00 fur c~magi~Ig cB~h ad in the~ 2B m~gazincs, or about ,01 penni of tetol clg'arett~ adye~slng in these 23 magazlnes~ Applszng thi~ percenta~igo ~tl] ~a~zin~ B¢IVe~b~i~i~ results m ~he $29,000 es~imat e. b!m~ First, ou~ ~gmI~ t~ a~ over @st ~rmlUo~. ~or purposes of cnlc~llailon, we t i~at~ every ~d as dmtmct In z~ality, of coulse, at any one tlme m~ny ads are d~plicat ca, Alsc~ some ads axe pro~ ~bly new rl~ COSt of chat~glng a dupllca~ is o~ly o~-thlt d the co~t of chm~mg an o rigi~ ~o&t ~ ~ (Jll~ n~e iIx ~i IIB~r ~Id i~ Z~z*J, rl~U3, ~l~ F~ i~ probably mz over~matletL L]NA indiemte~ that g310 million were s1~nt in ~ewspapel s Given the similarity bctwcvn the medla, in t~hn~lo~y a.d in em~e oF Mterahon, we a~sunmd that the percentage of total adve rc/~ i~g dollars thai wooJd go Into ¢}lailghtg the w~rntog woLQd be roughly tl~ sa/f~e To ohtoxo a newSpzl~r estimation, we multiplied $810 mdliou b .0] percent • LNA figures for l~eW~])a~ supplement~ t~tal ~SB million. T* ~otmt for the more ex~ B- slv~ proce~, th~ ¢oe{ficlent e~d W~ 018a pet sent t~ther thml 01 percent This repre~nta the prop*gr t ionR1 d~ t~t ~H~ }~t w~etl $1~0 t~ild ~@. The figures used in this e~dcula£ion are rough, but became ~e consciously oveI~slunated, thsy are unlikely to Le too low. We ~mumed that there would never be more than 400 separate ads an average of two rot each of the 200 ~arieties of cigar ettes tested by the FTC~ aml we multiplied ,100 by 40. th~ ~st * chang~nR the artwork for each a~. i
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131 crease ov@r ti~¢ ~ th@ industry becanae more familier w~th the systen~ We earl. laate that the maximum (and wkat we feel to be a significan~ overesttmat2on) amount that would be ~pent in admknLstermg one change in mc~saffe is $218,000.~ Thus, the total quantifiable costs, in both production and admlnls~ratlon, of a rw rational warning system would be no more than $308,000 par change, If there were only one change required annually, the remus[ co~t to the oigar etbe industry would be abou~ $~00,000, if the warl~ings wer~ changed each quarLer the raa:cimum cost to ~he cigarette industry would be $I.~ million. As noted above, g~ven sufficient flexi- bility the actual costs should be much lower Expressed ms a peroentage of cigarette advert ising expendkures the enst.~ of a rotational warning )vonld vary between .88 percent a~d .1 percent of ~ntml adver t~smg dollars dcpendmg upon the number of times the warning is changed.7 Qual~erig change~ in the warning would therelbre cost [e~s tha~ four thousm~dtbs of a cent (084 cent) per pack• tf 3'ou have any additional que~tions~ please do not hesitate to contact me. ~ineereig ycur% TIMOThy J. ]~Ul~i~ ~i?~tor. UNIVERSITy OF CAL[I~RN] A t ~AN FRA ~CIS~O, San Francisco, Ca~i~, Aprll ~7, 1982. Dear Sit~: This statement is written to call atteRtion to the iUlpOt~ance of $,D, 1929, the Comprehensive Smoking Education Act, to the he~Jth of Amerlcml women. I am a ¢~a~cer epidemlolcgist on the faculty ~f the School cf Medicine at the Uni- versity of Calh'or nia, San Franclsco. Through my work ] am familiar with the cur- rent statistics ~hat show an epidemic of smoking-velat ed diseases among women in the UDited States. it is expected that lung cancer w~ll soon s~Tpa~s breast cancer ~he number one cause of female ~anccr deaths. This trend is atmo~t entirdy due to cigarette smoking, It is not only lung cancer that h~creased dramaticedig among smokers compared to non.smokers, but also cm~cers of the ]m rex, esophagus, kidney bladder, and pancreas. Other nonilmli~mnt but frequently fatal conditions are more common in smok~.rs, includin~ heart disease, emphysema, and ar teriosc er eric peripheral vascular dise~e The.~e risks are, of course, sh~red with men, but smokin~g poses unique risks for women because it is tIsey who become pregnant and use sra| contrat~ptlve~, pregnant women who smoke have a grea~er ]£ke]ihood of having spontaneous abet tlons~ of having babiss born prematurely nr of lower b~rth- weigh~, and el having oll~pr~ who dte in the permata] period titan do pregnant women who do not smoke. P~tticuIarly araonff women 8~ years of age and older, oral contraceptive use is c~ntra~ndlcated in smokers based on their excc~mve mortality. Ironically, e~g~rette salver tieing dit~d at women h~ grown in invel~e p~opor tion ~o the weight of the, med~¢.d evidence regarding the hearth hazards of snacking. One of nly research projects iltvolv~ an e~aminatlon of trends in ci~¢r ett e advel~s- hlg it] leading women's magazir~es since the £980s. By l~s own ~d~t~SlOl~, the c~ga- retie industry hos recently focused on women as a vn[nerable ~rou, tP for i~ ad c~na paigns. In a frontpage artieIe entitled "Women Top C~g Target, A~ver~sing Age of September 28, 19~L quotes Gerald H. Long, prealdent a~d chief executive offl~r of R.J. Reynolds Tobacco ~Jompan~ he d~rlbes the women's market as "probably the largest oppor tunlt~ for lleynoLds " In 1981 appz~xll~t~t e[~ $64 mflllon was spent on d~arett8 adve~sing ~n seven of the eight rn~or women s maga~ nes alone, ranging ~rom 1 f~ 6 pages per sane. This ~a~re wa* derived by muRip]ying $~4~ ~u~es ot~ estimate of 400 separate ads at any ~le time. 'fire figure is high for two reasons, First, there are probably not that many different ads And second~ the ecs~ probably would not in~re~~b $545 for each ad. ~e e~ima~ is based ~I~ the ~n~o~nt of ~[me it w~id take V~ri~us ~e~ple at the c@r~Dany alld the adv~rtisin~ a ncy to monitor the new syar~m Th~ m*mmum tlm~ for ~ach task wa~ calca]a~ed ~ one hwr I~]k U~k o.e hour t~ cheCk a schedule for one ad Inn ~veresfimare), thee it ~Ir ely woukl .or take two h~t~rs to cI~¢k two ads or four hours to cheek f~r ads Final] ~ the t~t~] amount Sl~nt in administratlvn is a reaction ~f ~he r]g~dlty of th~ s stem. A fle~le approach t~ retatDn would keep ~he admln~s~rattve cc~a to a minimum. , There ate, however, other cc~¢s to a ~tational s tern that ~e imp~s f01e t~ q~tify. ~[%c t otekionai wa~nlngs, to the extent that they 0~upy t~ veadeFs attention more than t]~e co{refit Warnin, will distract attrition fl~m the ad~er tiaeFs bra~d m~ssag~ ~]latever this c~ is, It .not ~e quantltle~ "J~et e is also the potential cos~ of fo~Ing the ci~atct te advertiser to cvn- ~der moze iach~rs ~n dedgning media and adver ~sing plans Finally, th~ i~ ~@ma inc~a~ in ~h~ ¢~Jst of ~[aIing m~uges ell p~C~S~ ~vhlg I~ jur~- diction over packages, we did not ask our consultants for any iaformatl~n oa their ~st~. We have ~veiy t ~c~ ~ h~Heve tha~ the C~L~ will a]s~ be small, pm~'ictxl~r]v ff ~lexi~i[ ~t~v is ~I lowed.
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132 (Ordy one of these eight top women's publlcafion~ Good Housekeeping, refu~e~ to accept ci~'ar ot:t e ads.) The paodoIs featur~ in khe~ promoti0ns are young, attractive, athletic, and independent n style. Tile tens of mllllons of women who ohc~e to read t'a~e magza2ing~ for their oxtictas on childcar e crafts food preparation, health lash- on, andhome improvement must turn page after page of cigarette promo~ons, whose positive support for smoFdng is ha sharp concras~ to the clearly negative medl- eal consequences of dgarette use. This winter R.J. Reyuold's sponsored women's fashion events in 18 major shop- p£ng centers around fl, e United States. At these events, publicity for their "More" bra~d of elgat~tes included free shopping bag~ designed like the dgarette package, flipr~ fpamrlng mod~ls with cigare~e~ in hand, and raffles ~¢ith the prize-winning drawn from an oversized ~eplica of a cigarette package. A ha]k I give to Lhv public on this subject L~ billed: "Mixed Me~.qogcs for Women: Cigarette Advertising and the Health Risks of Smoking," Not only as a e,i~ntbst but ass female ¢onsumer. I ara dismayed by the irab~arsce hetw~n the lavish and t~qul~s e~e~lltur¢~ o1~ the part of the tobacco mdt~tlT to pr0mot~ ciga~ and the relatively small araotmt~ of money none]able to hea/th agencies to adequate- ly broadcast the dangers of dgavette smoking. $8. 1929 is of" particular impnrtauee to the health of Amerlcnn wom~n because t~-o of the proposed cigarette package warnings deal with the slmeia] dangers ciga- rette ~nokhlg I~3s~ to wollle~ o~" reprodu¢~ve age* ~.e., Warning: Cigai~tte smolc2ug by pregnant women may result in b~rth defects or spontaneou~ abet t~on. Warmng: The $~vgea, General has tleterrMned that ~bgare~te smoking by la~eg. =ant women may result Ln m]scarrlage, premature blr~hs or child weight defieien- ei~y$. My seven-year-old daughter knows not to tree cigarette ads foe any school projects that require magazine eut-ou~, explalning 'q'h ay wmana make yoR ~h~k cigarettes Will make you beautiful but they really just warms make mcme~y; those ads are dumb because cigarettes make you die." I wish all children--ard adults--were shni- larly aware. The Comprehenslve Smoking Education Act is a step in that di.~tiou. I urge its passage S~ncarely, VIRGI~']A L. ~flNff~ER~ pH. D, Assistant ProYa~sor of l~putemiolo~y. N W AyI~R INC., New York, 2~LZ, May 4, 1~82~ SENATOR ~OB pACK,gOOD, Chairman, Committee o~ Commelve, Scgenee, and Tra~portation, Washington, D.C DZA~ MR. C~Am~tA~: Pleace enter the following statement into the Seaxate Hear- ing Record: A~ Vic~ Chairman and Worldwide Creative Director of N WAy~er Incorporated, the oldest advertising agency in the Unlt cd States and amongst the largest in the world, I vehemently p~oteat the introdtmtion, ¢onsidera~on a~dpo~ ~iblo pas~ of Senate Bill (S. 1929) entitled "~e Public Health Service Act and the Feder~ Ciga- rc4te l_~belinff and Adve~ing Act." introduced by Senators Orrin Ilatch and Bob IMe&wood It is our firm, consddered opinion that such lo~islatlon wOUld be haxmful to the advertising industry, industry in gcnoeal, the eoonomy mad the pocketbook of the .a~ner~can taxpayer, In addi~ioz, it wou~d cTea~e precedent wklch could re~ult in fur th~ F~trm ~o all the above interests if applied to other se~tor~ of huMness~ the econ- omy and adve~g . The. regulatory, I~aee-'er k:) attitude ..... towards industry exhibited by the preached leg- relation could have a highly nega~ve effect ~n advezLmmg and m dusk~y if ex:tended to other s~turs of the Amorlcaa business communlt:¢. Such exter~on could well in- volve unconstitutional in frlngen~ent of the 1st and l~th Amendments. It is very importan~ for Lhe welfare of the United S~ates, both ~ocJally end u ~nlically, that eom mercia] speech and~ due pr t]ee~s and fair mad equtil t realrment of the Laws be ptescrved and be applied even-handeflly, With this kind of le~sia~" lation we run severe risks that these t~asured and inalienable rights ~ be dffuted or emaaseulat*d. When we pass special leglslatloa designed ~ have a negative effect on one indu~- tlT unch as the cigarette industry, which manufacture~ a lawful product, and is le-
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/.' 133 golly advertised and distributed in our count , we open ourselves to the pressures of every'parochla], spccla] interest group in tr~e Unlted States. If the precedent L~ set far cigarettes then ~t can easily he extended to products eonteining dairy ingr~db enl~ and dlet foods~ to name ust a f~w of many. We c~nnot and should not allow this to happen, for the go~d of the tJublic ~ a whore. At a time when a concerned effort is being nmde by both Democtats and }~epubli- cm~s t~ reduce the bt~rdelt of government, reduce bui~aucracy, deregulat/e industry, create efficiency, reduce government costs and make American industry more prc. ductlve and e f~m~oetitive on a worldwide baals, t he~qe prop~ed bills wmlld have the oppc3it~ effect without the neee~nu/redeeming values or benefit. In net r~sult, the ~r~p~sed ]egfisla~oa in its most iavored light, creates more harm than g~d for mermen as a whvle and ~raate~ a dangerous and uneall~d for precedent. But beyond that, we have the follo~ng additional ohje~tions to the proposed learn- lotion: L There is no conclUSive scientific e,~denc~ for the health-related Congresslonal "FLndlngs" upon which the bill is predicated Such "Findings" are essen~a]l~ a rehash of charges made against clgarettc smoking by ~he anti.smelting lobby ~nth- out qualification or presentation of balanced or contra scientific evidence. 2. More bareaueracy a.d concomitant bllrdens woldd be c~e~ at a time when we are trying to do the opposite. 3. The proposed rotatiog schedule el" health wandngs Would add ~o the coat of elgarette~ and further fuel inflation without a reasonable or verified benefit to the public. There is no evidence that the presen~ ~varning notice on c~gare±tcs Ls inad- equate or ineffc, ctive in c~uveylu~g to the consumer ~he potent/u] dungers uf smoking, 4. Litigation is encoui~ged in th~ private sector which would appear to be redm~- dent and which world further clog our court calendars. This would ~]so el~te financial burden on the economy w~thout any apparent or countervailing benefits ft. Advertisements arc sales messages, not educational vehicles and are innppro- pr~ate for carrying- ant~-product messages. 6. The ~equin~ment that cigarettes to be ezported carry a warning ~tatement cre- ates a harmft0 plecedent It utlduly petaa[/zes Amel.~C~l industl7/ and makes i~ less competitive overacts both immediately via a vis the clg~rette industry and potential- ly as st~ch think{ng is applied to other sectors of American industry 7 The $e~ate bill requirement that cigarette manufacturers provide the Federal Trade Gzmmis~on and the Department of Health and Human ~erv~ces with a full list of ~'ach chemical addliive and th~ quantity thereof in cigarette~ violate~ the con- fldenti~lity ~d trade secxet ~pects ol individual eigoxette nl~ulacturers without any omponsating public benefit. We do not believe that once such informatSon Ls provided to the government ageneie$ thz~t there is any way the information c,an~ from ~ practlcal point of vlew, be protected from p uh]ic disclosure In conclusion, for ~]le ~v~oas SLR~ed, we believe the proposed legislation ilt ~he ~natc to be harmlhl to the genera[ public and to industry Inot jus% the cigarette industry), e~ eatin~ burdens and precedents that c~nnot be justified today. We r e~qpe~tively urge that the pro]po~ed ~enate bill not go forward Cordially, J~RRY SlA]~O, VI~ Chairman and Creative Director Worldwide. ]~ELDRUM & F~SMITH, IN¢, Cleveland, Ohio, bray 1/, 1~8~. Sc~ator BOB FAC~WO0~, Dirksen Senate Office Buildin~ Washington D.C DgAR $~0~ PAcgwoon: I unders~nd tha~ the Senate C~omraerce Committee hearing's on S ]929, The Federal Cigarette Labelio41 and Advertising Act cam m~Ane~d on ~ay l~ in W~shin~t0[l. I am enclosing an m title, by lined by this w~-it or, which appeared on the OP-ED page of The Pla]~ Dealer, Saturday, May 8, 1982. I'd Like this "Advertisers' rights are on the line" added to the testimony of The ~nate Commerce Committee hea~ ings on th~ bill. Noue of us wish to encourage any non'smoker to take utp snmking. I am con- vinced, however, that this current legislation is tilting at windmills. There is no evi- dence from any direction that rotating labels or any other restriction on aflver tSsin g will produce the doalred result. On the contrary, there is lvts of evidence that such restrietion~ reta~xl switching to low tar brands and then ther~ is the hidden free-
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134 market threat of restriet[on~ on advertising for other p~duet categories. Europoan ~x erienee~ cer ¢zirdy supporcs this pubentia]. '~e simply cannot let high emotion over this cigarette/health issue endangor tile right to advcr tis~ products that are legal to sell Sincerely, AR~IL~ E. F~RLE¥, C~irm~/Chlef Eoceeu~ve Officer. TB~ AMERICAN COLLEGE OF C~J~TL~I~AN$ ~ GYNECOI~t~IS~ ~ May 12,198'2 Hen. ~t]n PACKW()OD, Chalrrrlan. Colnmi~ze on C~mr/~ercp. S¢i$~ ~tld ~z'~a~sporl~llo~ W~shingto~l, 2).(2 DEAR C~R~AN PAC~WOOD: The American College of Obutetrleiana and Gynecolo- gists tske~ this opportunity to comment on your efforts %o increase public knowledge of the potential ~nd SeldOtls health hazards associated vdth cigaret[e smoking. Rep- ~s~nting over 23,000 p~'aeticing obstetricians and gynecologists who care for a sig- nificant prc~poltiol~ o[ the smoking population, tile ACOG is very concerned about the harmful effects of smoking on both wom~n and their offspring. Apregnant woman who smokes 20 clgarettea s day will inhale ~hacea smoke up- wards of 11,00~ times during an average gestation end may spend 10 percent of her waking day snmking. ~¢ien~ifi~ evidence indica~e~ %hat snioki*~g in pregmmcy in. c~ases the risk of fetal death or damamege in utez~ zaid pred~p~se~ the mother to increased risk of pr e g~, ahoy-related eomplieatlons. In light of similar findings by t}le 1982 Surgeon General s R~port on Smokin g and the FTC staff report that indicates ar, increasing number of women mad teenage girls he~,in and ~ntlnue to smoke without adequate l~lowledge of the risks ~hey bvhlg to themselves and their off- spring, the ACOG endo~es the concept of rotational label warnings as proposed ~m S. ~929. PrLntod war nlng slatoments on cdgaret0e paekoges and salver ~i~emenhs eonsfStute only o*~e aspect of the public health cmnpsi~ that must be waged ffwe m'e to suc- cessfully educate the publ2e. Our efforts must also be specifically t~xgeted at the teeueg~ population who are susceptible to peer pressure and the at~etlve role models so often found in cigarette advertising. In addition, more research andplrc- granle are needed ~o help rhone who choose t~ #op smo~ng to do ~o belbre ~hey eacou~ter a seriou~ med2e~l experience tha~ mandates tha~ they quit ~r f~e a lif~ threat ~ debilitating illness. In short, concerned ind~dna/s and groups whether in the public or private scorer--have a responsibility to do all ~hat is posslbie and new,scary to sucoassfu]ly reduce the nation's smoking habit and p~ven¢ young people f~nl failing vie+Am to the se~i(]llS~ prevent~hle health hazards ~f smoking Sincerely, ]~nw~ E. NIo~o~, M.D., FACOG, ~tor, ~¢t~ce Activities CONFERENCE OF STAT~ A~ T~RnlTOI~/AL DIRK~TOP~ OF P~C H~ALTH ~DUCA2~ON, May 17, 1882. Hon. ~OB PACKWOOD, 6"lzuir~na~, No~le C~mn~eree, Seierwe, and T~po~tion Committee, Washington, D*~ D~aa S~NA~OR PACKWOOD: On behalf of the Conference of State and Territorial Directors of Public He~/th Education and with the enforsemeut of ~he Association of State and Territerial IIeaRh Officials, I write in sappor% of S. 1929, the Comprehen- sive Smoking far evention Education Act, Tobacco smoking is a roajor publle health problem in the United State& Signifi- cant eflbrts ar~ necessary to ensure tlaat An~erieans are prop~r~v informed about the hualth hazards of smoking to assist them in making their personal deeisior~s about ~wklng behavior. The CSTDpNE believes that rotating product winching laban will contwlbute to this edueatlcam[ effort for several reasons. Warnin labels on cigarette pacl~agez provide a meeh~nisnl for communicating di racily wi~ eonsuulers and +heir families and. the* efor e. contribute %o the consum- ers' information base. Labels ~ith varying health messages may provide a deterrent 1,4 ~O
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FL i~5 to children considering smoking c[~rettes It ~ also possible that children win use ~abel in formation in their efforts to influence their ~nq~j b~h~vlor. In light of the consequence, every channel available to convey the hazards of smoking should be used, The proposed la~llng will convey a hazard warning that is ~pe~ ~d r~[nforced in the ~¢e of ~tinuou~ adve rl, isiI~g which presents $rdok- ing as glamorous and rewarding ]~tatmg label messages and the format ir~ which they are displayed ~$ a me~ of ~rll~]a~ing ~d r~in~reing co/~u~er int~t jr* those messages. This is a ~ue~ful technique used in product advert~slng which should also be apo]~ed t~ product ~a~ety. In reviewing the proposed m~sage~ it is ~It that M~ (E) "Smokers: No blatter How Long You Have Smoked, Quitting Now Greatly Reduces the l~.~ks your Health" i8 a powerfully positive ~age It does not rely on ~ "scare" or "d~s. ease" approach ~ stimulate interest but privies ins~ad a m~s~ge that posJfiw action will have~s~tlve ~ult~ MeSSage tA) "L~g~re~ Smokh~g is Dangerous to Your Health. For Information on the Specific Health Consequene~ of Smoking, Write: Surgeon General, U.S. Public H~ith Service, Washin~o~, DC. 20~I" is strong too sln~ it pro~des ~he ~nsum~ er with an e~il r accessible means for ~ecuring information. H~r, gi~n th~ reading level of the I~pu~a~on as a whole, the phrase "Specific Health Conse. quenees o[ Sr~okJ~~ might be rephr~ed "Hazards of ~moklng" with no real less of intent Me~a~e ID) m~ght also be rephrased to make the me~ing of "Child We~ht De~e~ci~~ eerier b~ und~rs~nd, i.e. "babies ~0orn too smalL" In summary, the C~TDPHE, with the ~dor~ment of the A~T~O, SUpl~rts the use of rotating warning lab~Is oa eigaret~s for the purpose of p~moting inlbrmed decision m~klng, and to meet, ~n some small way, the government s r~ponsibil~t y to inform the public about a known health h~z~rd The fact that the government sUbSl. dize~ tb~ growth of the tobacco ~m~ in c~gare~tes is in itsel f a comI~]l~g argum~n~ for supporting every pos~le m~ms Of providing information on th~ health cons~- qnencee of ~okir~ and ~uca~ion programs ~r smoking pr~v~Ii~iolt and smoking Sincerely yours* ~o~A SALiSbURY, EDD., ~iden~ NATIONAL N~AP~R AB~OCIA~ON, June 2. l~SZ Hen. Roe PA~KWOOD. Cha il r~utl, Committee on Comraer~e, ~.ienc~, and Tc~rusportatioz~ L~ Senate, Washington, DC. D~AR Mm CHAmMAN: The National Newspaper Assoeiatlon appreciates the oppor tunity to submit a statement for the r~eotd con~rning S. 1929. the Comprehensive Smoking Preventioll Education Act of 1981. NNA is a non-profit trado a~soeiatloa consistillg of more than ~,000 weekly and daily community newspapers located throughout the United Sta~s Our members are eoncer~od with leg~lative initia- ti~-es which may ha~ an impact on any aspect of the First ~n~endment~ including eommerelal ~peech Mr. Chairman, NNA i~ concerned w~th the adver rising ro~ulrements pr~r~bed in ~io~ 4~a) eI" this bill tram sever~J standpoints primarily, we beIiev~ that mandat- lag such a pervasive regulatory scheme rals¢~ ~ome constitutionally troubling que~- tion~ We aide believe that a statutorily imposed labelling system ~rr~es with ig an implicit statement ofp~nblie policy that cigarette adveftisi~g is deceptive Per so. a view i~dth ~hich we do uot agree, l~hmlly, lye question whether the available evi- dence demons~iates ~hat xxew a~d additional warnings are neces~a ry as a masher of practi~/ effectiveness. Section 4(a/would require five new specific ivarnhlgs to be placed on cigarette ad- vertising ~d rotated equally during successive fifteen-month periods. The clear trend over the past decade in Supreme COtllt decisions eon~rnlng eommerical ~peecl/ has been to increasingly limit ~hepolwers of governm~rtt to in,rude upon commercial speech rights.~ While not accorded all the protection of mn-comroerc!al speech, nonet leJess tile go~l'llnl~a i~ required o ~how a eol~tpelil~ need teor lt~ intrusion as well as that that intrusion is mirfimal and not overly broad. i ~[olu v VirRfnla 4Z[ U~. ~9 1I~7~k VitgDlfa ~ta~e Board Of Pharma¢ V ~t ~ ~lfl. zenz Cotwume~ CO~CH, 425 US 748 119761; Bal¢~ v, State ggr of Ar~7ona, t'~ US. ~ (19,9}, Central tfu~L~vn and ~[eelrb, Cot~oratio~ v l~lhlie .~vlce Commr~slon o~ Nero ~k, ~7 U ~. 55'/IIbSOI and In Re RM.J 56 US.LW 41~5> ---- lJ.S. ---- (19~21
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136 In Cpntml Hudson a~d Electri~ Corporation, v. P~bli¢ Scrvi~ Ceramlss~on of ~¢w Yort~ 447 U.8. ~7, 566 (1980), the cuurt set ~ut a four-part t~t f~r determ~n[ng when gov~r nnlent may re~lat~ commercial speegh: "In comraere~al speech cvses, the, a four-part analysis has developed At the outset, we must dotelmline whelher the expression is prefected by the First Amend- ment. For eol~mer c~ speech to come withLn that provision, it at lea~% must col~cer n lawful activity ~nd not be misleading. Next, wv ask whether the asserted govern- mental ~nte~ is substantial. If both inquiries yleld l~J~tive answers, we must d,~ termine whether the regnlation directly advances the govea~lment al interest assert- ed and whether it i~ not more extensive than is necessary to serve ~hat interest " Appl}'ing this ol~a[ysls to S. 1929. it i~ appo~ent that the advertising of cigarettes is lawful and that it is not misleadLng. Thus, it is protected by the First Amend~ meYlt. I~NA, of colL~se~ ~recs that the gcJvernment ~s intorest in thJ~ s]tuatiorl, the public's health, is ~ubst an~ial, With posltlve re,pal)sos to the first tw~ inquiries, the f~¢us shifts ±o the last two parts oi the test, which we believe S. 1929 may have grouble sat~sfylng. l~rst, with respect to whether the five new iot~ted warnings will "directly ad. v~rlce the gover~llT~el t~al LVltel~SL asserted," we ~ubr~i~ that thi~ is operl to con ~[der- able doubt and argument There has been an exp]ie}t health warning requfred On most cigarette advertising for approximately a dec~de. Thez~ h~s also been an ex. telIsive educational proces~ about the dangers of smoking. To what extent has i~ ~een proven that the new war rmags wotfld sigl~fieantly improve the pub] i~'8 aware- hess of smokin~ s h~L~I ds? Fr ¢~mably, the ctlrro1~t wazlzi~g h~$ slr e~*dy e~hane~d. dSreetly the government's public heahh interest. In our opinion then evider~ce of a most signi:~Ic.~t i~prov~lae~t llpon the current warn'iing~ effeet~v~oess must be shown La order to ~bli~h that tl~p new w~rnil~ge wo~ld l~cremc~t]y d~e~ly sd vance the public health in~ereet. If the effectiveness would be merely comparable, ~hen ~ae me~hod ~ merely hsve been substituted for another with no measurable gain Ibr the govet ztrnent's interest, 8rid hence, no advance. The quit]on of e ff~ctlveness rea~y spl/l~ OVer i~to the ]sst ~art of the Supr e1~e Court's te~t which deals with overbreodth. If the effectiveness of the 6re new war~* ing~ is not significantly greater than the current warning, then Congress will have imI~qed a regulatory scheme far broader than is ne~sary or justified. Absent evi- dence showing that enhancement of offectiven~, then, the system of five new war~gs wotlld seem to be l~lOr e oxtensivo Lh~al is necessary to s~rve the illterests el" public health. Aside from file eonstit u~ional c~nslderation~, NNA is concerned with covgression- a] subscription to the thesis that cigarette ~dver tlsing ~ per se deceptive_ The Feder- al Trade Corn Inlsslon st~ff in its report el~ cigarette advertising advocates a thecey of decep%ion by omission. However. ±hi~ appears b0 fly in ~hc face Of the ~e~ t]la~ there is a clear yard conepie~otl~ health warrtlng already in most eigaret te adver ~s- iltgS. ~#[or~ver, w~le there a~ ~o*qoe ~atrary ~ends i~l Some specific caf~gorJca[ of smokers, the overall percentage of the ~opulace smoking d~lmed from 42 n to ~3 percent beL~ve~n 1964 and 1978. This can hardly be the re~ult of decepti~ , by omission or ot hen wise, as to health ri~k3 in smoking. It must raise questions ~ to %~e wisdom of este.b]ighing a public policy which effectively char aet~r]~ ci~a r ella ~mok[ng as per se deceptive, NNA ~rge8 you wad yovx ca)mmitte~ Mr. Cha!rnmn, t~ earefltl ]y look at the un- derlying st~ti~ite~, data as to whether the rot#ttlon~l sys~m of five new warnings trgly is more effective than the current single waramg. Moreover, we would urge you to ]~ok c~ze fully to see wb~ther fllere even is room lel~ for stthsta~/ial imipr~'~- ment Perbap~ ~r~her s~l~die~ or surveys may be neec~m~y t~ nCqLdre this ~nfoma- tirol. In Seal, iVir, C~airi~an, I~NA i8 eoi~cerlxed that Co~/gr ass is considering imposing commercial speech requirements upon a ]awl'u[ activity when the reo~d may not nee~s~rily be adequate t~ justify such intrusion. We urge you to move ealltiot~s~v and deliberately before you impose requirements that will Imvu an adverse inlp~e~ u ,l~, n the rights of adver risers of elg~ttos, lheatk you ibr eoi~sidering our eolurnents. Respectfully submitted. W, ]~VIN STRKK~, Executive Vice l~esident. ]i~ St~/£ Reporz on C~gare~/e Adwr~is~ e~ 4 17, et ~q ,x
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137 UNI'r ~D ,~r Aq~ F~S (~I~NZa~A~ A~C~OUN%XN~ OFFIOE, Washington, D.C., June ~. 19~ Hen. BOB pACKWC~D, Chairmar~ Committee on (h)mmerce, Science, and Trar~portatio~ [L~ ~'eaate. DEAR MR. CHAm~m AS reo.uested by your algae on April 14, I982, [ am submit- ting for th~ record th~ result of our r~view of (I) an ]~C-ccmmissloned report anti- +led "Cigarette Warning l=*r eject ," dated May 1981, preFar ed under o0atract to FTC by the advertising firm of Keenan ~nd McLaughlin, Inc; and (2) a letter addressed to you from FTO's Bureau of Consumer Protection 4~ted April 7, 1982, that contains their estimate of the annual t~mpliance e~s~$ associated with a newly proposed he~dth warning regulation for cigarette advertisements. Both items were developed in response ~ proposed legislation (S 1929) *hat would require all cigarette pack~g~ and advertisements to dlsplmy one of five pessibM warning messages. Furthermore, it wo~ld require that each bwnd rotate the mrs. sages on ~ts packages and advertisements within a 15.month period, Also, the Seoate bill wou]d require FI~ to establish regulations that would ensure the after- Live operation of the rat ational health warning intbrmation ~ystem. The Kee~n ~nd McLaughlin repor~ providesi ~ wi~h ~imat es of the incres.se in production eo~ts, by media ty/~a and reproduc¢ion process, cairned by replacing only the health wurning m e~q~e in a continuing cigal~t~ a~dwr tL~ment. Addltion- lily, they e~Lhaat ed the hourly administrative ¢os~ imposed OR cigarette companies and advertlslng agencies arising from monitoring these changes in health warning messages. Although we did not conduct an audit of the basic cost data conLained ~n the estimates, the detailed itemizing of costs, the variety of media formats consid- ered, ~d the contractor's flrsth~d knowledge of adverLising u~dustry p~actices strongly suggest that the cost dat~ are sufficiently reliabJe ~o form the basis for the FTC'S annual con~plla~oo cost estimabo. Using the cost data developed by Xeenan and l~IcLaughlln, FTC prepared on esti. mate of the manna[ compliance co~ that a quarterly rot~tiortal heahh message system would impose on advertising agencies and c~garette manufacturers Table 1 summarizes FTC s estimate Esttmat*~d maximum annual eompllano" costs (1980 dollars) for a quarterly rotating war~ing m~$age ~tem Magazines .................................................................................................... ............. $29,000 Newspapers .................................................................................................... ........... 31,OOO Newspa~r supplements ........................................................................................ 9,000 Outdoor advertising d~sgiays ................................................................................. 16,000 Aclnxlnlst r a~ive costs (private) .............................................................................. 2£8,000 Cost per quartezly change .......................................................................... 303,000 Estimated maximum atmual compliance cases, $i~ mil~ion Below we review FTC's a~sumptions and methodologt¢, and other considerations. l~.~s ~%~SUMI~IONS FTC made the following assumptions about the kind and frequency of heMth warning message: Thal the ~ing ~yr~bol rerao~ms totehangc¢~ Both a warning symbol {such as a rectm~guizr box draw~l around a message) and the warning mess~ge itself can change at the ~llle time, or only the me~.~age e~n change, FIX3 estimated costs based on the uncimng/ng symbol option, concurring with Keenan and McLaughlin that rotating both the symbol and the message would gDeat Iy increase ~ts while not necessarily making the messago more effective That each advertisement ne~ds original artwork Production costs were developed for each print prc~ss for both original artwork and dupilcate artwork, According to Keenan and McLa~ghlin once the artwork is created for an advertisement, that same advertisement may appear in several tonga. zincs a~d/or newspapers Advertlsers do not need to make up separate artwork for each magazine or he~spaper Instead, original work ~s duplicated for a small frac- tion Of the original setup cost s~ However, to be conservative. ~]~ assumed o~¢h ad. vertlSenl~nt requirc~ an original materials setup. ~q ",5
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188 That mea~e mt~tlon oe~gr8 every 3 monthg A rotational health message system could it*elude the option of having mtatien 0ceur when the advertiser decided to place an er~tirely new advertisement. If this occurred, the extra ]production co~ of a rotating me,sage,would be negligible But FTC's cost estimate ~sumed a fi~ed quarterly r .t atlona/ schedule whleh would not caineide wltla the length of a munufaetur~r's normal advertising run. p1~3's METHODOLOGY Using tlle az-&umptlorm described above, FTC estlmated separately preductlon costs for magazines and ~ewspapere, outd~r advertising displays, and adrnhlistra- tire c~s~s. Magazinez and new~papers determined horn advertisizlg iadustry publications that 23 magazines ac- counted for almost 90 percent of all magazine c~garette advertisement billings in 19~0 A "randnm sample" of 11 magazines w~ selected from thefts 23 magazlnes. These 11 magt~i~ h;~d an average of 8 cigarette ad~ per magazine. Changinig a message Lq off~et or l~tterpress artwork was estimated by Keellan and MeLaugidin to cosg $150 per change (assuming no duplicate artwork, which is less costly !~er change), Therefore, the production coats f~r cha~ging a message in the advertiss- ]~ents in a tycp~cal rnsg~zine WOUI~L CO~t about $1,20(} The OLJSt Of a Oile-L~rne i~e~ss tge chm~ge for 2~magazines therefore would be about $2%600 ($1,200 × 23). The ratio of estimated produetioit ~sts to annual hilling in the 23 magazhle~ was one on~- hundredth of one percent. Frc reasoned that this percentage could be used t~ ex- trapolate an estlmate ~o include ~he o~her 10 percent of magazine billings not repxe~ sent~t in the snmtple of 23. Thus, FTC calculated that given 1980 mag~ine cigarette advertising of $287 million, maximum production cost~ for a one time change in a warning messagu lbr all magazines would be $29,000. The produc~ort cost ~f~a~es for ~tew~pa~e~ artd newspaper $11p~leruel~ were estimated by apgi 'ing the sam~ ratio of prcductien ~sts ~ total billings for elga- retie adver~isement~, plus an adjustment tbr higher artwork costs in the rotograv- ure pr ogess n~ed for newspaper supplen~en f~. The ~tt~o ll~etho~.o[o~gy' used by FTC fer magwlne~ and n~w~papers is an accept- able procedure The underlying assumption is that productuon cas#~ of a sm~pie of publication hear~ a pro]partienal relationshi? to the t~r~l advertising billings The rain derlved is then applied to all publleatlona which carry" dgarette advertising. That production costs bea~ an alypr oxhnat e direcl relationship bo billings seems sen- sible Ogtdoor display advertising Outdoor dis lay advertising inolude~ prlrtted billboards, transit posters, and paint- ed billboards. ~ combined printed billboards a~d p~sters for cost es~iroatlng pur- pose~ hecavse they both are typically changed monthly This industry advertising practice means that r ot :~ien.d health warmng messages can be incorporated ~llea these mo/ithl , change~ occur. [~I*C computed the applicable unit cost to be the negli- gible extra cost of duplicating otugina artwork With respces to painted billboards, Fq'C wotlld modify" the requirement of quar t¢r- ly message rotation and require a me~sage change only when the advertiseraent is changed. This wenld net involve any extra costs. PI'C ~lleved requiring repainting billboards quarterly would involve a substantial cost relative to the exposure infer, tahoe of pained billboards in to~al outdoor display adver fi~ing. Other adtwrtlsing mvdia p~t .of-s~l e slid p r omot iot'~al l~a~eria~ w]~ich have irldefiltlt e l~ves were ~so con- sider~ }~y ~ I~ ~ncltlded that iDgarporatiIl~ a rotational war~ag ~e~age on these items w~ not f~ible. Tht~ no e~t est LtnRteS w~i.e 12lade. Admin~trative cysts Fhmlly, FTC estimated the administrative cc~s imposed on the eigaretle ¢empa, vies and the advertising agencies ~o be $218,000 per message change. FTC a~rivcd at this estimate by relying on the Hourly admln~strative cost estk~mtes of cigarette manufhc~urers and their advertising agencies prepared by Keenan and ~V~cLaugh lin. We reviewed these estimates and have ~o reason to question their appropriateness. ~ON~LIJDIN(; ORS~I~VATKINS We conclude tha~ FTC's $L2 million estima~ for e~mpliance with the mta~ing ~essnge ~eqtlirement ill cig~ebte adve~i~me/lts ~hould be viewvd as an upper 6~
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