Tobacco Documents Online

~nN f i The production olOClal says Tlderock, the public relations agency, ordered 607.000 copies. In addltlon, Ave tobacco companies eay they bought a total of 449.000 eoptes from 77ue. btt. Harnard denfes, hoxerer, that True got. payments from any Industry sources. The promotional ads for the 1Yue article were paid for by lndividual lobeeco aoat- pr.nfcs throufb Tiderock, according to Reg- (neld H. \letts, esccuth•e Tlce president of the agency. Mr. Wells eays Ttderack !s ax- ptoryag varlous ways "to get the tobacco In- dustry's side before the publlc ^ The tobacco Industry reported record sales and protts l:st year. but per caplta con. awuptlon of clgarets declined for the ttnt year since the Surgeon General's report was lssued In 1964. • IDcraBrr4 cHr or HrAtrH, Eovra7tora, WSIo Wairsax, Pusuo REa.TSt SmveCa• Bethesda, ydQ., March 22. t968. Hon. Wasas,v O. IMAa*4uson. Chairman. Committee on Commerce,, D.S. Senate. Washington. D.C. • Draa IUR. Cwamatan: Thls respan,s to your letter asking for comment on an article crit- lcal or the evidence littking cigarette smok- • 1ng to health hazard. I am pleased to send you here our t:omments on the article by Stanley Prank which appeared In the January 19881ssue of True magazine. As you will see. we believe the,artlcle pre• sents much lnformavon not consistent with the known facts. Our main crltlctsm of the article 1s thet !t presents a biased picture of what Is actually cont'dned In tL'e 1964 Report to the Surgeon General. Further, It ts atls- leadtng in aeaming to make the Surgeon Oen- eral and the Public Health Sendce the au- thors of this R.eport tvhen In tact it tras terlt- ten entirely by a panel of distinguished non- govermttent scientists whtMe selection tvae approved In advance by the cigarette tn• d I~. important thst Information on medi- cal matlers be presented In as accurate and unbtased a manner as possrole and when controversy exists that tt be thoroughly and Impartlagy a(red. This is espocialiy te•ue In an article on amoking and health. Thya article . falled to do so and tce fear that it may -en- ccurage peorle to cent!uue smoklrtg who might othcraL•e quit. ..e encourage people to begin smoking wha mlght ytherwlse have rtot started. To the :kxtcnt It does so yt (ncreases the risk of dyse+lse and death In out• popu- Mtlot6 Sincerely abttn. Wn,tteat ti. Srawsar, Surgeon Qencrai, Poettc ytFat.TSt SeAVtcs Rtrom' oU Teus MaoAthis Aa79eLe ox SatoxLWO ANoHEALTtt Massive distribution has been made of an article whleh appeared 1n the Janua.y 1969 lssue of True Magazine attacking the sclen- tl6o evldenee indicting cigarette smoking as a health bazard. The attlcle, "To Smoke or Not to Smoke- That Is StUt the Question," is by Stanley Prank, who ctamrs to have found contradtc• ttons and Inconelatettcies In the evidence and concludes that the "hazards of cigarette smokyng may not be so real as we have been lea to bellova." Reprints of the article hnve been sent to ph: alelans, lah•yers, school teachers attd other opinion Iendera throughout the country. At• tached to the reprint, redesigned from the orlCinal article to Include additional lllus- traUons. Ia a note frotn the tnasaglne edltors stating. "As a leader In your professlon and eommtnNty, you w911 be Interested In readtng this story. ... about one of loday's most eon- troverslnt Issuett." The President of the Amerlean Tobacco Company has also sent reprints of the a-tlcle to stockholders of the company with an no- CONGRESSIONAL ItECOItD-SL•NATE ntt:rcle $7, 19p8 companying letlor 1n which he says, "DCspite hot the creation or the Surgeon General. , the many years of Irttenslve medical and Whea htr. Frank retera to °coactutlons biological research In America ond elseahere, reacbed by Dr. Terry" ar.d p~. Terry's the allegaLons of the antltobacco critics re• abrupt dtsmlrsal of other pornble csrau of rnatn s,ietttl0cally unproved' • lung cancer." as he does later In the aruck. The prlnclpal target of the magartue ar- be d:storta the rele of the Suraeon Generai tlclc's attack Is the 1964 Report of the Ad• 1n the preparation of this study. visory Committee on Smoking and Health The Report was the work of an Advlst:ry to the titea Surgeon General of the U.S. Committee of ten men, drawn from a list IPubllc Heatth Senlce, Dr. Luther I. Terry, of 150 scientists and p7tyalclans repreeenttng ' Attacks on ttte Report are not a new phe- a0 tlte pertlnent sclenttfie disdpllnes. Tae nomenon. Many of them, as Dr.'ferry said tobacco (ndustry, among other groups aad three years ago, "arc repetitious and cleverly oreanlrattons, nas given full opportunlty to manipulated !n a continuing program to veto any mf the names on the list, oo reasons sirake public confidence in ttse Repors." being required. ' i7te True art.cl¢ conforms to this pattern. After more than a year of careful study It is the effort of a layman to dlscredlt the nnd erafuntlcn of the eatlre body of aaf.d validity of a scientific report and to question data on smcsing and health, or,d after re- the integrity and the Impartlallty of scyrn- viewing evidence fram many u•Itnesses, pro tlsts and physicians who spent more than a and con, including those trom the tobaeeo year ret•letiing all available evidence. industr,v, and after consulting experts on Tbe artlcle ignores a review of more thaa e~ery• t:icet of the prdbletit; 'the 6dt•Irop ~' 2.000 additlonal reaa arch studies accumulated Committee concluded that cigarette smoking since the 1964 Report and presented fn a n•as a health hazard of aulildent Intportance second Report sent to Congress 1n June 1967. to warrant appropriate remedta( actloA It Th1s Report, "The Health Conaequenees of Is emphasized that the 9na1 Report mb• _ "' Smoking: ' eongrms and strengthens the con- mltted to the Surgeon peneral by these men cluslons of the earlier Report. represented their independent and beat-ron- The 1Yue artlmle's subtitle bogins with scrl- aldered cohecuve judgment. ous mfast.itements. yt says: One member of the Commlttek Dr. John "Are cigarettes really 'harardous to your g• Hlckem, was cited In the True article n heoltt}' like the package saysP Nobody knows. having some reservauons about the ReporR In any case. Americans ata smoking more 8ut we are not told that Dr. yflekam, aware than ever and, curlouslt, worrying lem:.° of rumors to this eftect, told a Congressional That smoking Is a bazard to health is COMmlttoe In Aprl( 1960: known by practically everybody who has "I wlsh to respectfully requsat that It be ' studied the subject. In this country, L.t over- made part of the record of the committee whelming majority of physicians, the Amcrl- can Medical Assoelatlon, numerous other pro- fesstonaf organlsattons, and the Congress of Ure United States have accepted the evidence that amoking Is a health hazard. To our knotvledge, no medical or sclentl9a body !n the world baa taken •the position that yt is not. Are Americans atnohing more' Alth ~::oh to- tal ctgaretGe oonaumptlon Inireases as popu- latlon lnereases, the rate of growth of the report has been seriously c•utalled since the evidence on the effects of smoking was first brought to the Public's attention in 1959. If the average annual rate of lnetrcase !n per capita consumption of cigarettes that existed from 1947 to 1955 bad eontlnued through 1966, the total tfs. consumption of cigarettes would have been over 700 billion In 1966. fnst.ead, the Department of bgrleutture re- ported an actual figure of 541 billion ior that year, a red'~ctlon of nearly one-fourth over what might have been expected. yn the 11 years fravs I9SS to 1906, the number of adult elgarette smokers Increased by one-slxth, from about 49 nt1111on to about 49 mt111on, During this rame time, the number of sue- eeasful ex-amokers more than doubled, from less than S million to about 19 million. Afore• ever, Amerlc.tm continue to give up smoking clgarettes at the trate of about one million Commlttee was e:rare that the mere estab• hearings that I agree complelety tyith the re• port of the Surgeon General's comnolttee at the time It was Issued end that I eontlnue to agree completely with the findings ot the report." htr. Frank's assnrtlon that the Report did not cause smoking to dccllne overlooks the dra•aatlc decline In cl8arette t:onsump.tton In 7964, a drop of more than 12 blltloa cigarettes during the year the Report tras Issued. A!- though overall eonaumptlon agaln Inueaaed In 1906 and 1966, per eaplta consumption de- cllned In 1967 and stlyl rcmalns below the all time high of 1968. The burden of the charges In the True arttcie appears to center on there polets: 1. The evidence against cigarettes Is etatts• tlaat, and cause and effect association caunot be proved by statistics aione• 2. The eau.e of cancer ts unknown. 9'here 1s no proof that cagarettes eause lung cancer. 8. M¢d(cal opinion is divided " the rels- tlonshlp of smoking to bcalqr. Flrst, ns to stattstlaf. The article says on this subject: • . "StaUatlcs alone link dgarettea q•tth lung eancer, a correlation that Is not accepted as sclentdfic proof of the cause and effect. Thts w'as admitted In the oponing of the rerort by the Surgeon Gencral's Commltteee 'The-• a year. Rshment of a statlstler 1 correlation between ~ Are Americans w•orrying 1ess4 The fact that the use of tobaeco and a disease, Is not filter elgarettos account for about SO percent enough. The cnsual (ale) slgnlfirsnce of•the - of all cigarettes now sold in the Unlted Statea, use of tobacco In relation to the dlsease , eompared to approximately 9 percent told In (s the etucln( questlon:" 1954, suggests tttat smokers who are ttnable' This tontenee ts out of context and omlts or unwilling to give up smoking are using the Important sentencea adjoining 1:. The filtera In the espectatlon that they are paragraph from nttlch AtY. yTank excerpted thereby rcdueing their exposure to the h.trm- the sentence (the omitted eentcneca are ful Ingredients In tobacco satoke, 1ta11clred for emptraala) reads !n full: _ The author of the True article states !n "Soch of thr5c ttncs of elYdenes (anftnal +' lho opening psragraph: ' erpertmarets clinical and autopsy atadtea and tVhen the Surgeon General of the United popu(atfon studtes) was et•ahtatcd and thea Stntea leaued hle report In Jannary 1964 In- ronsiderrd Icycthcr ht dratctnp eotctustons• dleung cigarettes as ttte chief cause of lung Tte Committee was anare tttat the ntere ca' cattecr. It figured that smoking would de• tabllsltmettt of a s.atlstlcal assoclatlon be• ctlne, tobacco prlcea would drop and cigarette tween the use of tobacco and t dlsease Is not contpnny atocka would do poorly on the ex- enou fh. The causal significance of the use o( chattges " tobaeCo ltt rolatlon to dlsnaso Is the crucial Ne tlteh obsewcs that aono of this oo- queatlon. For Sach Judgmenta all taree tines ettrrM• ' of eetdcnre are rernltal as dtacuaacd tn more Ftrst, It should be made clenr-senee the detatl on pages 2g-2P oJ this Chapter and m attlele does not do so--that the Report was Chapter

D1ezt'ch 27, 1968 COyO1tI:SSIONAL RI•CORD -SETiATEH K 10 1 T 1 ' ) ..1 ;k S 3417 ~ - i e These were the Advisory Committee's criteria for Jndging eauaallty. They were re- stated serernl tirnea throughout the Il^pvrt. Flre pa5es eartt:r than tire quote ased by Att. Pronk appem ra the follasing: "Statlstlcat mrthods cann;at cstablish prcof .of a causal mintlonsitl? In an atroc!atlon. Tde tauaal elgnlficancc of an ataorlatlon Is a m:.tter of Jerdemettt which gors b:yond any slntement of et: Ust!cnl prob+btllty, To Jrrdse or evaiuate the causal s:gnlficance of tlto as• soelatlon betwrocn the attrihulo or agent and the disease or eflect upon health, a number of criteria must be utilized, no one of which Is an afl-eulgdertt basis for judgment. These erlterla Include: a) The cortststeaey of the easoe!ntlon, b) The strength of the assoela- tran c) The speclflelty of thc assoclatlon dl The tempoml rclaaonslrtp of the aeso:latioa e) The coherence of the assoetaUon. '77sese crltu:a trere utllls^d In varlous sections of this Report. The most extensive and Illutr:tnating account of their utilization ts to be found in Chapter N In the section entitled '8vafuatlon of the Association Ee- taeen Smoking and Lung Caneer:" All this notwilhstanding, the dissenters continue to ehnrge the erldcnce In all statls- tlcal ai:d "slatielies do not prove there Is a health barsrd." Assuming that the evidence were only atatlatlcal, which It clearly Is not, the case against olliarettcs would still be strong enough to act on. Statistlcs have bcen uscd end ere essentlal In crery branch ot medical sclenee. The distinguished sclentlst, 1Yarren Weaver, satd in Science Magazine that "It ls shocking to note that vanous groups. In order to ahake public confldence In state- meats which they find uncomfortable, ttre taking the position that It Is sllty to be Im- preased by evidence that ls 'only statlstlml' ., the automatic dlsearding of evidence be- eetua It la statistical ls unsclentltlc and mholly unwarratited .. ° The statistical essorlatlorrs Involred In the 7064 Aepora to the Surgeon Oeneral lndl- cated that smoking 1s a likely suspect and led dheotly to tnrther Investlgatlons a•hlch resulted In the Indlctment of cigarettes ss a health haaard. In other lypes of evidence such as pathology, mleroscoplo examtnatlon of lung tissue of clgarette amokc-s has shotcn that the degte~ of lung damage and prccan- eetous cellulnt chnnges Increase greatly with the aumber of elgarettes smoked. A second maJor theme In the article pur• porta to reveal lnconatatencles In the evi- deace hnking elgarette smoking to lung ean- eer. After conceding that atat!slles on nror. tallty rates "&eem to Indicate that elgarettes were a mence." the author then writes. "8omerer, lt !s d1/1eu1t to understand 11ac- tor Terryi abrupt dtrmissal of ether possible eauscs of lung cancrr. S:ores of surveys hat•e shown tha: the ma: t171ty from the disease In rural arces Is Icss than half the rate tn urban eotntnunltles, tot etnokers as well as non•. smos:era. Many t.cperts attribute tl•.Is varla- tton to air pollutlo:t Ir, lnduatrial eenters, and It hardly Is a nex theory. In 1:7b a London ettrgeou, Perelra 1 Potta. (sic) reported a high Inddetrcp of cancer antong dt!mney mecps. 1n recent years e^mp+igns to reduce a!r pal- lutlon hat•e been ep_rred by the strong sus• pldon that components In coal arrd gas funtes , ere caneer-lndttelnsa;cntsU ixperlatc:ets with anlntale also ao~gest that the orercror:ding typlest of uv9::y etmdttlons In cities produeea atrcucs that cotttrlbute to cancor." Dr. Terry, as Indh•ated earl'er, lrad no power to-^dismiss" any of the crldcncs re- pottqd by hls Adrlur)Cee.nnl'tca The Cen+• Cnlttee dhi pat say dgnette smoking a•as tho only cause of lung eancer, bnt that it a•as the ~ prlnctpal cause. Air pollution la apparen J,ly a rlsk taetor slnce staidtes bare shown that luno cancer occurs more trcqtetntly antoug people who live 1» elt:es titan amonl thoss who Ih•e In the cottntry. Thls was st,tted Itt the Report. Roa'l.@r, th!s Inerease Is not nearty as significant as that existing between amol:crs and non-smokers. In Icdand, which bas some or the purtst air In Europe, luqg ecnccr, once a rare dl"se, hes risen with the Increase In el5nrette srno:Ung. In bls discussion of causes of lung eancer, it is not clear why the author cites the report In 17:5 of Perclrall Patt on the Incldence of eancrr among chimney ewrelA. It aas not lung cancer that was involved but cancer of the scretum, and It had nothing to do with alr pollution. L•e. Frank's charge that the subJeet of alr pctlutlon and other poastble eauses of cancer in the enrlropment are "mentloned only In one sentence burled !n the -:port-" There Is in fact an entire aectlon dealing w lth "Other >:tlofogle Factors ar.d Confounding Yarl- abler ° it concludes that "clgarette smolpng is easncily related to tung cancer In mcn; the magnitude of theeTeetof dSarettesmolt- 1ug far outuelghx sst other factors:" The True article also makes no mention of an equally detatled scotlon of the report on tpte -RelaUonshlp of Smoking, Enriron- ment.ol Factors, aad Chronic Rerp[ratory Dis- eaae.° He:e, the Advisory Committee reported t.ltat: 'Fbr the bulk of the population ot the United States, the Impartsnoe of cigarette emoking as a cause of chronic bronchopui- monary disease I.s much greater than that Vf atmospheric polluUon, or ocaupaUonat exposures." A number of statements In the article aralnly concerned with lung cancer are lu- acuratc. FUr example: The author ands it odd that although there has been a tremendous Increase In women amokera, lung cancer Is rate /n croaten, and t5at their death rate from this disease has remained 'almost steady". The lung cancer death rate for uvmen has In= creased over tt0s ln,the past 14 years, and lOp:o since 1930. When lung cancer appcan. says Mr. I1ank. In the orerWhelming maJotlty of oases It !s In the lower part of the lung, which Is never reached by amoke. Thla Is mrong on UPo counts: (1) tt'hen smoko is Ir,haled, lt ctr. eulates, like alr, through all parts of the lung and (2) Most lung eancer'In smokers occurs !q the upper bronchial tubes- ' Z,tr. Frank snys that most heavy sthokers do not contract lung eancer, end a minority who do not smoke also.get the disease. If emoiang causes lrng cancer. ha reasous, heav.y smokers should conlraet It earlier than non-amokers, and tlsey dosr't Accord- ing to the best erldence, al1 cigarette aankcre don't get lung cancer becsueo ecr,a emokars are more susceptible than others, same may not have smoked long enough to develop the ditease, and other smokers die or ocher causes before they are stricken. Cigarette smokers develop a different kind of lung cancer tYan fong cancer victims who do not smoke. By tnr the most common lung eane?r-bronchoger.te, or aquamos cell car- otnoma--oecurs aimost entlrely among olga- rette sarokers and rarely In those u,ho have never smoked. Studies hare shown a ete-Zr relaltcnshlp betwecn the antount of elga- rettes smoked and the,rlak of dying front luna cancer. Itr eontpatlson with non- amokera, ti,e etcrage male emol:ers of elga- reiles hare ap proxhnately a 9-10 fold Hak or dylt.g or lung cancer, and heavy smokers at Ieast e 20 totd rlsk, Tttcra Is more bensopytcne-a cancer In- duetng agent-ln ctgar otid plpc smol:e than In clgarettes, yet, r.ta d[r. Frank, elR.sre and pipes are eald to be ca'cr than clgatot:ra, The degree ei inhalation Is Importint ts the risk factor, and tt arenta elt::ar that the sarol:c from cigars ahd pipes Is rarely Inh.iled. The artlclc Atys aincc 19ad cl;arette-eon- aumptlon In t.;to Vclted Statts has Inrrersed 200 told, but the Incidence ot lnng cancer ),as not Inc:eased nearly that much drsplte better dlcgnostlo ntelhods and a greater aKarenesa of thr disease. 77ierefere says the author, the current mortality tate of 26.0 per 200.000 population could bo lmatJy greater It cigarettes acre guilty as charged. In reality this la exactly what has happened. Per capita cigarette consumptton has not Inereascd 200 told, but about 17 told and during the same perlod--Srom 1014 to the present-lung cancer mortality hns Inereased atrout 32 told. In 1914 lung cancer pmrtal- Ity was 0.7 per 100.000 and It Is aosr 22.7 per 107,000 (not 26.6). Some of these arguments against the ert- dence have been advanced by experta whom Mr. Frank mentlons In bls article. "Surprls- ingly." Ite writes. "3D of the 49 medical au- thorltles and statisticians who testified (at Congressional hear:nga concerning legisla- Uon) dlsagroed vigorously with the report and-ehargcd Its Hndln3a were distorted. Only two of the dsseattng experts were connected with the tobacco Industry ° Dr. Thomas J. bforan, one of the dissenters, mld during testtmony that the Report "was a very fair one,-e comment which can hardly_ be construed ng "vlgorous dlsagrcometlt." It la no reflection on the professional In- tegrlty of the dissenting exports to polnt out that In response to a questlonnalre later sent to them by Senator Daniel t3. B:enrstar of Itaryland, all Indicated that they appeared at the request of the tobacco Industry and that five o: them Indlcated they -ecelved payment from tobacco Industry represeata- ques for their testlmony and the tlme spent In preparing It. It ahould also be pointed out that while the dlsseuting eaperts spoke for a enuJl nrinority, and usually for tltemselves elone, other w'Itnesses, speaking for the major pro- tesslonal groups and voluntary health orga- ntzatlon, clearly represented the consensus of medical thinking throughout the United states. That there a-e some experts .cho are akep- taool of the evidence sgalnet tobacco ls not surprising. There has never been unanimity on major mcdlcal }nd scientific qucstlons. lt was so /n the case of vaccination and In the IatroducUon of otber anestheai.a for the relief .of paln and for most other mnJor derelop- menta In medical history. It Ia true In smok- Ing and health. Tha facts of the matter are that In the present state 'or our knoerledge, tI•c health eonsequences of clgarctte arnoklMg accurntefy can be summarized, as stated In the 106T . Rewportt aa follows: "I. Clgarette •amoi:ers hare substanttally higher ratea et death and disability than their nonamoking counterparts In the popedetlon. This means that cig.'trexte amokcre tcnd to dle at earlier ages and experience moie days of disability than comparable Itonsmoken. "2. A substantlal portion of ear,ller deaths and e:ccess dlsabatty would not have occur- red 1t tlsose artecraW had never amoacd. "3. yf It were not for clgarette smoking. ptaettenlty none of the earlter deatRs lront lung cancer wrould hat•e occurred; no: a aub- stanttnl portlon of the earller deaths tlom drronlo bronchopulmonary dleaases (cotn- monly dtngnosed as chronic bronettltla at pulmonarg emph}sema or botlr); nor a por• Uon of the earlier de aths of cardlorascular origln. Sxcess dlsab:llty ' front chronic pulmonary and cardlovoscular dlseases would also be leta. 1 "4. Cessatlon or apprrclsble reduction of elgarette e:»oking coltld delay or avert a sttb- . st'tnttnt p.rllon of dca:hs which occur from lung eatacer. a attbatntttlel portion Of the eatller deatha and excesa dlsablllty from chronic b:onchoptamonary dla~ases. and a portion of the earllrr deaths and exoe;s dls- abltlty of eardloratcerlar orlgin." 9hua hfAa.esMn a.ro rars Ctoacarre trr- DtlaraY-A CoataraYr PrtMt rtte A?tratct%' Cateern Socesrr Phyalctans, la:t~yers, selewt teaclerrs, and miny others hsre rccetred cop lcs of a ntaga- rlne nrtlcly dnlnring that "there fs nbsahttr:y no proof that atuoking causes hunenn canrer,"