Tobacco Documents Online

THIS DOCUMENT SUBJECT TO CONFIDENTJAUTY AGREEMENT. COMMITTEE ON COMMERCE UNITED STATES SENATE NINETY•SECOND CONGRESS eECOND ea66IO. ox S. 1454 TO AMEND THE FEDERAL CIGARETTE LABELING AND ADVER• TISI\G ACT TO REQUIRE THE FEDERAL TRADE COMMISSION TO ESTABLISH ACCEPTABLE LEVELS OY TAR AND NICOTINE CONTENT OF CIGAREa'TES FEBRUARY 1, E, AND 10, 1972 Serial No. 92-82 Prlnted for the a.e of the Committee on Commerre C T R ~N 0 14 '~1~

THIS DOCUMENT SUBJECT TO 88 CONFIDENTIALITY AGREEMENT. However, I think we will proceed now, andr if Senator Cook does not come in a very few minutes, why we wilj have to decide what other prooedure to take. Our first witness will be Dr. Sheldon C. Sommers, who is chair- man of the Scaentific Advisory Board of the Council for Tobacco Research, from New York City. We are verc glad to hace you, Dr. Sommers. and if you would be seated at the table, you may prooeed with your presentation. 6TATF.MEAT OF DR. SKELDON C. SOMMERS, CHAIRMAN, SCIENTIFIC ADVISORY BOARD TO THE COUNCIL FOR TOBACCO RESEARCH- II.S.A., NEW YO$K, N.Y. Dr. Sommries. Thank you. sir. Dfy name is Sheldon C. Sommers. I am a phcsician specializin; in p~athology, director of laboratories, Lenox Hi:ll Hospital. New York. N.Y. 1\i~• academic appointments are clinical professor of pathology. Columbia University College of Physicians and Surgeons, and clini- cal professor of pathology, University of Southern California School of Medicine. In April 1969 I appeared as a.oitness before the U.S. House of Representatives committee that held hearings concerning cigarette labeling and advertising. Dfv curriculum ritae and publications are appended in the record of these hearinE*s. publication serial number 91-13, 1969. pages 1055-1093. Updated publications now number 235. and there are new committee, consultative, and editorial responsibilities. For the past 5 years I hare served on the Scientific Adrisor% • Board. the Council for Tobacco Research. 6f which I am currently chairman. For nearlc 3 rears I hare been research director. The Council for Tobaeco Research-U.S.A. is funded by tohacco companies with about $3.5 million annually. This is e:pended for research grants and contracts awarded on the basis of decisions of the acienttfic advisory board which considers the competitive sciezi- tiBc merit and relevance of the proposals received to smoking and health problems. The board includes distinguished authorities in carcinogene: i=. Drs. Andervont and Huebner; in heart disease, Dr. Bing; in chrum: respiratory disease, Dr. Loosli; and in other scientific disciplines. Our efforts are directed to helping fund investigators who ma}• discover the causes and mechanisms of diseases claimed related to smoking tobacco, in particular cancer, chronic resgiraton• disease=e and coronary heart disease. I wish to cornmc\ briefty on progress in and the present status of research in this area. , First, however, as a citizen I wish to point out something serious that has happened in the way our government deals with our people. This consists of selective release to the press and media of certain technical information and conclusions while withholding the evi- dence and sources of the material. One example is "The Health Consequences of Smoking 1971." which I received in printed form only after the press release of tho 10 i2 report. ' i '` CTR HN 014'e""I"

id if Senator Cook does -ill have to decide what Sommers, who is chair- ie Council for Tobacco rs,andiffouwouldbe . presentation. aerxMAx, scrExrrFIc roBACCO xES»c$- i.-sician specializing in 1 Hospital. Xe.v York. ~rofessor of pathologn•, d Surgeons, and clint- Southern California ,re the t'.S. House of{' + concerning cigarette )pended in the record r 91-12, 1969, pages r 235, and there are . nsibilit'ies. ! Scientific Adcicorr chich I am currentl~• h director. ' is funded by tobacco Chis is ezpen ded for basis of dec'isions of ,ie competitive scien- 1, ed to smoking and s in carcinogenesiR. Dr. Bing; in cbt%io, cific disciplines. - estigators who may - claimed related to respiratorc disease=, -iefly on progress in t something serious als with our people. d media of certain thholding the eri- moking•••19741." )res.s release of the 4-- 89 THIS DOCUMENT SUBJECT TO CONfIDENTIALITY AGREEMENT. Sweeping statements about carbon monoxide in the 1972 report are not subst,antiated by the detailed exposition in the basic docu- ment which is on1)- obtainable in typescript cppies passed hand to hand like the "samizdat" in Russia. Budgetary restrictions, inertia, and inefficien~v cannot excuse a 1- year delay in receipt of this governmental publication supposedly sent to all physicians. . Other examples may be cited such as a press release concerning oral hvpoglycemic drugs for diabetics based on an unpublished and unavailable research study later reported as not above valid criticisms. Diabetic epec ialists have used petition to the Government as their only available means of redress since various appointed officers, com- mittees, commissions, bureaus, and so forth, are apparently extrale- gal or supralep1. In a technologic age, to announce medical and other nonmilitary discoveries and decisions, keeping restricted or secret the basic data and their source, is dangerously- nondemocratic. IN7iere are the traditional checks and balances? Where is the informed electorate or the informed 1e~sslator? Now to consider problems of smoking and health. In respect to lung cancer, a focus of attention, the newly published standard American textbook of pathology, 6th edition, IN. A. D. Anderson, editor 1971, hSosby Co., St. Louis, includes this statement by Dr. 1faz Ilillard, page 964: "The close relationship between certain types of lung carcinomas and cigarette smohng has been made well L-nown, as has the lesser relationship to cigar and pipe smoking. Whether or not a csuse-and-effect relationship has been proved is a blend of logical. statistical. and emotional argument." Note the omission of mention of biological evidence or scientific proof. I leave aside the emotional involvement. Presumabl}~ by logical argument is meant t~he idea that smokin~ ought to be harmful, whether it is so proved or not, originated b}• King James, and a moot question ever si.nce. There remains the statistical e%-idence to consider. Association does not mean causation and, in 1940, on this basis, the main cause of lung cancer was considered to be tuberculosis, Statistical mathematics so far developed deal successfully largely with random populations. Since smokers and nonsmokers are self-sc- lected, no randomized~rtoups exist to oompare. The application of inappropriate mathematical formulas thus cannot provide a valid result when smokers and nonsmokers are com~ pared on a one-to-one basis. The errors in death certificate diagnoses used in most such studies are estimated at 25 percent to over 50 percent. Bias and the missionars zeal of some investigators who have refused to release their datn for review cast a pall on their conclu=ion=. The Royal ColleFe of Phssicians' report, available in 1971, consid- ered statistical evidence oi the increased disease and death rates among British doctors who smoked cigarettes as the strongest indi- cation of their harmfulness. , CTR HN 01417 11. ou

• THIS DOCUMENT SUBJECT TO ~ CONFIDENTIALITY. AGREEMENT. In iLanoet, the current danuarv 1972 iseue, is an art.icle by Dr. Carl Sehzer, Harrard School of Pablic H.e.ihh, pointing out criucal defects in these comparisons and aoncluision8. Last year's strongest statistical evidence' appears destroyed this year. I salute the edtbmial board of Lanoet for this eia.mple of Eng- 1'ish fair play. One doubts that Dr. Seltter would have been allowed to pnblish this paper in a comparable U.S. medical journal. The kev point is that in a new and unoertain acaentific diecipline, still deve)opmg its teehniques and a better understanding of the bis+es in~•olPed, neither reliance nor decisions based on the etatistical epidemiolog-.r of lung cancer appear warranted. LunF cancer research in animals has progressed little in two years. We still search for a reliable animal model inhaling whole fresh amoke in a natural way approximating huaian amoking. The reports of cancer in tracheototnized dogs appear generally discredited. The importanoe of genetics and the viral oncogene in lunF tumors is increasing, based on findings in onioe, hamsters and in tissue culture. Genetically pure cell lines exposed both to an onoogenic Tirtis and a chemical irntant transform m tiewe culture into neoplastic-type cells where neither agent alone produoes transformation. The cells are of connective tissues, the tumors are sarcomas and there is no current relevance to human oarcinomaa which are eom- posed of epithelial cells. HoRever, the amazing technical advances in viroloRc in the past 2 years provide hope that similar viral genes in epithelial celis may turn on and initiate some animal qr human catcinomas.. L'ntil at least this is achieved it is premature to implicate or to exclude various chemical substances, including whole tobacco smoke pondensate--so-called tar-or its fractions.. _Nicotine, of course, is not carcinogenic. For bre%-itv, other less spectacular adrances in cancer research are omitted. In respect to chronic piilmonary diseases, particnlarlv emphysema and bronchitis. a slow advance continues in the techniques of demon- atrating clinical, phvsiologic, and pathologic indicators of these conditions. So long as pathologic emphysema means something different regardinR its presence, type, and eztent microscopically to each of nine different experts in the field, as reported recentlc, a consensus concerning causes and developmental stages cannot be eipeeted. Important new information has come from sputum cytology. Tis- sue•digestinlr enzymes ag ecting the lung are genetically eontrolled nd explain some emphysema. The curious absence of emphrsema in most hegtces, regardless of environmental and other factors, deserves more inquirs. To blame cigarette smoke, condensate--so-called tars-or nicotine for bronchitis-emphysema is simpl~ to accept a delusion in our cur- rentl.• earlv stagr of understandinF these conditions. Coronars heart disease is the most common and serious disease claimed related to smoking and thus the most important public health problem. When a condition affects to snmo degree, based on clinical tests. nearly half of middle-aged and older men, and when a majority of CTR H~~ ~~~<~~~

. ieeue, is a-n article by Dr. Gealtb, pointing out critical u& ioe .ppears destroyed this t for this esample of Eng- r would bave been allowed medical journal. *rtain screntiSc discipline, eter understanding ef the ons baeed on the statistical ited. greeaed little in two years. xlel inhaling whole fresh uw smoking. ed dogs appear geuerally Lnd the viral oncogene in s in mioe, hsmsters and in to an onoogenic virus and tlture into aeopla3t.ic-type naforwation. -tmnors are saroomas and ircinomas Khich are oom- es in spl !ithelial toelli may xrcinomas. , nature to implicate or to iing wbole tobaooo smoke . ces in cancer research are particularlr cmphrsetna I ~the techniques of demon- ogic indicat.ors of these _ :ans something different icroecopically to each of ted recentl~, a oonsensus ; a _. nnot be e=pected. ,m sputumc~tolog;v. T5s- -~ :re genetical ly oontrol led st IN-egroes, regardless of ire inquiry. )-called t.ars--or nicotine pt a delusion in our cur- d itions. mon and serious diwr•e . most important publi ~.: , based on clinical tests and when a majority ol I THIS DOCUMENT SUBJECT TO 91 WNFIDENTIALITY AGREEMENT. these men among other things smoke, it is a very difficult problem in multifactorial statistics to sort out the oontribution • of a single factor. . Evidence claimed to show a dose-response relationship of cigarette smoking to heart attacks, based on the earlier cruder statistical methods, is too uncertain to be conclusive. Now that both a nutritional and flonnutritional coronary circula- tor-v flow pattern are recognized, better understanding of rather par- adozical find'uigs of either increased or decreased total coronary 8ow after nicotine ma~ be possible. EfTects of nicotine on tissue metabolism in coronarn• arterial walls are being studied. The question is as vet unanswered.-Tobacco smoke condensate seems of no practical importance in this field. Finally, to comment on carbon monoxide, information available for S to 3U years scarcely justifies emphasizing it is deleterious to t1.e smoker. Headache is a simple indicator of increased blood carbon monoxide. The basic information that a nonsmoker confined 8 hours in a<< unventilated smoke-filled room shows increased blood carbon monox- ide is scarcely surprising. Traffic tunttels and auto exhausts are more everyday exposures tn , ercess carbon monoxide. Traditionally, those who spend eight hours in unventilated amoke-filled raoms are politicians which sug~g s the possibility that politics mav represent a health hazard. (Laughter.) Senator 'Moss. At least I agree with your last statement, doctor, and perhaps that is one of the reasons I am anxious to get the smoke-filled rooms ventilated, so we won't have headaches. Your argument, as I take it, Doctor, is that there has not been a medical fLidtng of the precise cause of carcinoma, and therefore Nxe uaght to disregard the statistics that shorv there is some relatioiisliil, that aauses it: is that right? Dr. So3tactt,. 11-e11, sir, I make no argttment. I attempt to review the field in m}• own experience and come to the conclusion that the canse of cancer in general and lung cancer in particular is unknown and, therefore, to impute any specific cause other than ionizine radintion is probably undesirable at this time. Senator Moss. Well, you do not dispute these random statistical figures that are assembled, do you? ' I)Y. .~(At~ITkS. Well, sir, in commenting on the statistics I would like to point out that there has never been made a studv of random human beings with respect to smoking. This would be difficult to achieve; the statistical studies quoted in the smoking and health reports are based upon older techniques, manv of them on a one-to- one basis, and the mathematics we have availeble and what we have learned about statistics in the meantime render these conclusion: 1 think unreliable. Senator '.lfoss. How do you explain that there has not ever been anv contrarv set of figures published showing that those who smoked had *an equal dentli rnte, an equal incidence of the,4~ vnrious diseases.1 mean the British, Isruelis,Japanese, and all tLe otheiai! . Dr. SuLUFns. Yes, sir. - CT R H 14 0 147 "2~

THIS DOCUMENT SUBJECT TO • 92 CONFIDENTIALITY AGREEMENT. In respect to early death, I would like to cite the book predicting studc in the Veterans' Administration lon~e.it} by Rose and Bell, a in Boston, still going on, of agrouIi of veteranS ~1'lien the}• examined ear)v death in these veterans, using the simple statistics, one•to-one comparison of smokers and nonsmokers. they found, as had other studies, that smoking was the number one prndictor of early death from an~ cause. Then when the~ applied ne~er and more sophisticated comrari- Bons, they found that cigarette smoking completel.• dropped ofl thP list as a predictor of early death. It vras somewhere beyond the thir- tieth factor that they haa identified. So. I believe that was one of a number of studies that do nnt stip- port the idea that cigurette smoking is a cause of overall incrcA=:•d earlv death. I~can cite serie.Q of stttdies of smokers in respect to coronary di=- ease in which the cigarette stnokers had either no increased coronarN dicense, or in some cnses had less coronarc disease. Senator'.1foss. Well, if you have any such studies, I would like tp bave them to include in the record. If it can be shown that smoker~ are equal to or hace less dPath knd di-ea--e than nonsmokers, why, I think we ought to have that in the record. I have spent a numher of Tearg in this field and held a lot of 4tearinp, and I have never seen any information of that sort. And I wonder about the medical profession itself. after the re,)ort of the Sur¢enn Genernl, the use of ctg,irettes by ~1.D.'s dropped dri- hiaticallT and has remained down dramaticallc. Don't * }•ou think the medical •profession •generally is convinred there is a caiisal connection ? Dr. t(1>I~1F.H~. Clr. the medical profession generally Fe!s tl~~Pir information sernn~lhand like other peorle in the communit~•. and they are susceptible to propa~anda like other members of the oommunitv. In respect to the citations you requested. they begin on page 1nnc, when I am being questioned by \Sr. Eckhardt, and there are also some inclnded at the end of thet same volume of the l;'.S. Hoii--e of Representatives Reports, when the chairman, Mr. Staggers. askrd me to respond to a letter from the then Surgeon General. And that begins-piirdnn me-that begins on page 1414 of thnt same volumr. serial number 91-12. enator Moss. Page ]414 f S S Dr. Sox.tcRs. Yes. page 1414, sir. It is divided into sections, sir, and in reference to coronary hcart , disease, that part is on ha;*e 1416. Senator N1naa. Yes, I see it. Are you familiar, I)octor, with a paper entitled Smoking nnd Lung Cancer Recent Evidence, and a Discussion of Some Quectior.s utthnrod b}• Jerome ('ornfeld et. al and published in the Journal of the \atinnxl Cancer Institute in 1959. IDr. Sn)t3tERE. Yes, sir. Senator '.kioac• Ikiesn't it answer rirtnallc all the dnestinnr that have been raised by skeptics about the health hazards of smoking? j CTR H~~ 0 1 ~~~~1

, to cite the book predictinF t 1'eterans' Administration rans. these veterans, using the ' smokers and nonsmokers. )king was the number one )re sophisticated com')ari- ompletelv dropped oft the imewhere berond the t1dr- ,f studies that do not sill)- :!nuse of overall increased i respect to roronar}• dis- her no increased coron;iry 7a se. h studies, I would like to ial to or have le-- death we ought to have that in field and held a lot of :ion of that sort. on itself. after the retort c be'1jD.'s dropped dra- 1 generally is convinced on generally gets their in the communttc. and other members of the :hec begin on page 1096, 3rdt, and there are also ne of the L'.S. House of in, \Ir. Staggers. asked •eeon General. And that 14 of that same volume, >rence to coronarc heart entitled Smokin~ and =ion of Some t;neqtior.s i:hed in the Journal of all the qnestinnc thnt azard~ of smoiin~ ? THIS DOCUMENT SUBJECT TO 93 CONFIDENTIALITY AGREEMENT. Dr. Soxxims. Well, sir; in a question, the ansvers' to which is unkno.rn, and in which an article is subtmtted, that dm not over- throw the whole sittution o[ medical tbin~. Senator Moss. I wonder if vou could aupply for us, as you did for the House Cominittee, discussion and answer, a detatled answer, to the materials in this paper that I refer to by Cornfeld T Dr. 5oxxEns. I will be pleased tQ. Senator NIoc.s. Thank you. We will place that in the record, and that srill help us with our background studs•.' Jenator \Iosb. I think, Dr. Sommers, when you testified before the House Interstate Foreign Conuanerce Committee, you stated that you were one of several members from non-A..'tLA- and nongo vernment groups appointed to a subcommittee, which was to establish priori- ttes for research in those areas Rheree there were deficiencies in knowled-e re •ardin-smokinR and health )- 11'onltr cou suppfr us the t•eport of that committee, which you stated in April 1969 Rottld be ready in about a month ( I)r. Sointra•. Yes, sir. The committee was organized under the Secrrtan• of IIF11'. Cohen, and then St+ct•etarr Finch. It consisted of representativee of the ANLk, Research Foundation Committee on Tobacco and Heaith, of inenibc•rs from the \ationnl Institutes of Health: and members from the Scientific Advisorv L'onrd, Council for Tobacco Researcli. We were asked to develoh a document dtat would explain the t 1>s in knowledge in the smokute and health field and rrioritir: tor filling these gaps. We held several mectinrs. a number of drafts were prepnred of what was to be a joint statrtneut. As it turned out, we could not reach art•rement with the represent- atives of \lII on various parts of this document because amoi:g other things, they insisted that we accept 'as proved that lung cancer is due to cig-arettc smoking. We then agreed to delete from tlle document everything on which members of the subcommittee disatreed, and only to have a docu- mcnt that would include tlle gaps itl knowledge *and priorities for filling them on which everyone agreed. But this was unsatisfnctorv to the NIH representatires, and conse- quently, no joint document has ever appeared. . We have the fiunl drnft of thc document prepared by Dr. Loosli, and m~•self. for the Council of Tobacco Research. ~'ou are welcome to a col,c of this docttmeut. 11'e liave met with that same group subsequentlc. we hare e:changmd itifurmntion on grants that are funded, and the wny the field is developiu~, and we hope for more meetings. But mifortu- natel~•, a,'oint document has never resulted. Ot,e otl~er reasun Rhv it Itas not is the KIHpeople alw•a}•s had a budget page in their ti•et•siott of the document. •it appeared that the other groups in essence were helping them to develop a•budpet hro- gram to be submitted'to the Congress to help programs within the NIH. I .«. ,.,.. 4;0 3n.! : 2.,. ~~, ~,,~~~014722 ~- 4.y ~ l~. E 1 E"~

THIS DOCUMENT SUBJECT TO 94 JANfIDENTIALITY AGREEMENT. Senator D1osa. Would you provide the committee with a list of the acientific papers published in the last 10 ;ears which 'you think should have been considered in the preparation of the reports that were not oonsidered / Dr. Soxx¢rea. In the reports of the Surgeon General, I will gladly do so, sir. . Senator Dfoss. All right. I That will be made part of the record' Senator Moaa. I think you stated vou are a patholoFict. doctnr. and therefore you work in the field of examination of bodies rather than prexribing for those who are ill. Iw onder if one of your colleaJtues came to you and asked ~ou whether he should recommend to his patients thai they smoke. would you suggest to that physician that as far as you were concerned, there is no reason that the patient should not smoke, if he felt like it? Dr. Soxxxs. Sir, I do not prescribe and I do not advise people on most subjects. It is not a part of my personality, and in particular, I do not ad- vix people to amoke. Div position is that as people become adults. they drive aatomobiles. flv airplanes. drink aloohol. smoke tobacco. engage in sexual intercourse, and I don't advise them to do these thmgs, but they do them. Senator Moss. That was not the question. Would you counsel your physician friend who asked you that as far as you were concerned, there is no reason why the phvsician's patient should not smoke if he felt like itY Dr. Soxxxs. I would advise him that in my opinion there is no serious significant health hazard for the average person who smokes in moderation. In this field, moderation is never mentioned. Senator Moss. Well, maybe that is the key word we are looking ' for. moderation. You do think his smoking ought to be done in moderation ? Dr. Sox^xitc No sir. As I say, I cannot advise people how to behave. I think some. for reasons unltnoRn, feel the need to smoke more than others. and some ~ i ll ' garettes at a , like myself. And I don t frrl feel no need to smoke c in a position from my training and experience, to tell these people what to do. Senator Dioss. I am not ea3-ing we are going to compel anTbodr to do anything But I come to a physician and I ask him for advice about my health. And presumably I pay a fee for the advice, and I espect him to advise me. He is not going to compel me. A physician might tell me never to touch another piece of bread and butter and that would be his ad- vice, although it would not compel me to Jo so. Dr. Soacaa.us. Sir,-I think that the health problem has been ocer- emphasized with respect to tobacco smoking, and particularh• ciga- rette smoking.

. >m.mittee with a list of the 0 years which you think ration of the reports that Surgeon General, I will are a patholoFist. doctor. mtnation of bodies rather ne to vou and asked vou :ts that they smoke. would r as cou were concerned, not smoke, if he felt like id I do not advise people n particular. I do not ad- as people become adults, k alcohol, smoke tobacco, advise them to do these id whar asked You that as ason why the'phcsician's n my opinion there is no •erage person who smokes !d. ,kef word we are looking e in moderation? behave. I think some. for ore than others, and some myself. -And I don't feel ience, to tell these people )ing to compel anTbodc to md I ask him for advice fee for the advice, and I an might tell me never to ind that would be his ad- so. :h problem has been orer- ig, and particularly ciga- 1'HIS DOCUMENT SUBJECT TO , 95 C.pNfIDENTIALITY AGREEMENT. I leave to the individual physician to decide what ad%-ice he gives to the individual patient. Senator Afoss. Do you think this mattei• of moderation that you mentioned might have to do with the eztri particulates that the one who is immoderate and goes beyond and it gets into his system rather than being moderate and not.getting as much 4 Dr. Souia:res. Sir. my belief is that these are different kinds of people, psychologically and neurologically. Tou can't compare them .crth each other as if thec were the same kind of person. Senator \foss. Well, I*agree. Everybody is different. But I still haven't been able to get you to say what was modera- tion. You would not advise them to smoke beyond moderation I Dr. SomwExs. No, sir. I really would not advise a person with re- gard to smoking. unless Tou wished to qualify that and give me an example of a sick person who is seriously or mildly ill, and in cer- tain circumstances I would think smoking would be belpful to the patient and in certain other circumstances, I think it would be harmful. • It is impossible to answer without more detailed information. Senator '.%Ioss. When cou testified in 1969, you said that as far as Sou were concerned, there is nothing new in regard to smoku>g and carcinogenesis in the 5 -rears since the original Surgeon General's re Mu cou still agree with that now 9 We have extended it sometime now. Dr. SoaMcns. Sir, there is always more new information. I think .;h,u was mennt was that there Rere no new basic findings or revo- lutionary findinFs. Whit I find tntcre5ting in the last °Tears, as cited in mv state- ment, is the indication that viral partScles concealed in cells make the-e cells more susrel>tible to transform into neoplastic-like ce11=. when there is exposure to quite avarietc of substances, and also radiation. I think that is exciting. Senator Moss. \Ce11. on the basis of Your testimonc. are we to con- clude tljat the medical profession in Canada. Britain. DenmarL. and Sweden. and Israel, Japan, Poland. and ninnc other countries, are all on the wrong track becau~e they have come out with reports con- nectiiig eigarette smoking with the diseases we have talked of. and have rrc•oaunended to their governments various programs for less- ening smoking 1 Dr. Sc».%tt:R. Sir. I speak onh• for myself. These organizntions have reviewed the published evidence, nhicl) is largely statistical. They have accepted it, to my mind overenthu- siaCticull~•. at a period .~f~ere this part of science is sti.ll developing, and the~• have come out with resolutions. If th~re were i>oR a controversial problem, it is doubtful that reso- lutinns would be in order. There is no resolution that I know of that poliomcelitis is caused by the polio virus. So we.have here a resolution ol organizations, 1 C°(°F~ HN 014724

96 ONFIDENTIALITY AGREEMENT. oommitte.es, and governments. Medicine is'a very individual thing and medical research and its advance are based upon individuals. I think if you .vill contact the individuals actively working in the 8eldd lung canoer, emphss+ema, bronchitis, and coroiiarf disease. you will find no such unantmtty of opinion. Senator Moss. VFell, there ma}• not be a unanimous opinion but the vast preponderance of opinion in the medical profession now is that there is a causal connection and that not onl}• that smoking causes these diseaeQS, but that high tar content in the tobacco smoke increases the incidence, and, of course it is based largely on epide- mioloFical data. That is the way to measure it as far as human beings are concerned. I don't suppose we are going to hook any indi%-idual up to n ciga- rette-smoking machine to studc him. Dr. Soacattsa Sir, statistical mathematics can never prove cause and effect. All they aboR is a relationship requiring further stud~•, usuall~• experiments in animals, to find out the meaningfulness trio- logicallc of this relationship. I really believe that among the active researchers in these fields, there is no great preponderanoe of feeling that cigarette smoke is carcinogenia Senator Mosa. In your stat,ement, you quote the Standard Anieri- can Textbook of Patholog,r, sixth edition. Is that an extensive book, and bow much of it is devoted to lung cancer nnd cigarette smoking? Dr. Coxattxs. It is a two-volume work. I believe it runs at le:.st 1,500 pages. The new chapter bv Dr. Millard is an eztensive chapter. V}~ mem- orv is that there are at least five or six pages, double culumti. that deal with lung cancer. Senator Moss. Are You acquainted with Dr. \iillard ? Dr. Souxzns. I have never met him. Senator Moss. I intend to w-rit.e a letter and ask him to further e=pand this statement about cancer and cigarette smoking. and I will include whatever his answer is in the record, if Le will respond to mv inquiry. . He is wstructor in pathology at the University of Miami, is that oorrect ? Dr. Soxacntts. My memory is, he is associate professor of pathol- 0 nator',foss. I see. Thank cou verr much. Well. I'regret [hat Senator Cook has not come. Since Senator Cook should have an opportunitc to ask anvques- tions he wants to. I would ask you. Dr. Sommers. if vou Rould re- main and perhaps return to the table if Senator Cook veould like to question you. Thank you very much. I appreciate it. Dr. Soxxxs. Thank you. Senator Moss. Our nett witnees. will be Dr. Robert C. Hocl--ctt, Associate Scientific Director of the Council for Tobacco Research. Dr. Hockett, Rill you come forward, please. CTR HN 0 1 472S