Tobacco Documents Online

74 classification of disease, and that now lists cigarette smoking as a drug dependence process. There have been additional reviews held jointly by the National Institute ell Drug Abuse with the National Academy of Science, and by the American Psychiatric Association establishes the offi- cial nomenclature which defines drug dependence in this country, all these reviews have reached the same conclusion. Mr, Bia~v. Dr. Pollin, have these occurred since 19817 Dr. Por~Jw. They have occurred over a period of time that spans the past five years, Mr. Bliley. Mr, BtJLCy. Since 1981 specifically. ' Dr. POLLIN. Some of them have and some of them have preceded that. Mr. BuLzy. Dr. Brandt, what is the difference between caffeine, or nicotine, and heroin in their effects? Dr. BaANDT. I think that it is severity or extent of the effects, Mr. Bliley. l don't think that the effects are particularly different in themselves except to the extent that they occur It is an extent rather than a simple change. For example, all of theoe are in fact psychoactive, but they are psychoactive in different ways., Mr. WAXMAN. The gentleman's time has expired. Mr. Shelby. " Mr, SHELBy. Mr. Chairman, thank you. As I see the bill, at least parts of it, you are talking about an aspect of advertising. You are talking about rotating the advertis- ing. I think we all realize that advertising per se is effective other- wise a lot of us wouldn't be here on the panel today, up here but maybe not down where you are. It bothers as to why. You are advocating, I suppose, that the Amerisan public is net aware of the h~zards of cigarette smoking. As I said in my. opening statement, I don't smoke, l quit when I w~ about 19 or 14, and that was before they put any warnings on anything. No one in my fatally smokes that I know of, maybe my teenage boy is slipping around. In any event, it seems to me, and I would llke in have the statis- tics, if you have them, of the effectiveness of the warning label that you have on cigarette smoking and tobacco products. It certainly disseminates to me and a lot of people t2xat I know, I am not de- fending the tobacco growers. Would you like to respond to that, Doctor? Dr. BRANDT. Yes, it is a whole series of questions, Mr. Shelby, Q~ and I will try to respond to them. One is, 1 think the issue of regulation of tobacco, as the chairman ~ painted out in his opening statement, is something that Congress has reserved in itself, and we do not within the Department have ¢.~ the authority to regulate nor are we seeking such authority. k~ IIence, the decisions about labels, et cetera, are decisions that the Congress has reserved to itself, and with the exception of the . regulation of advertising which is under the FTC and which we have suggested should stay there, we are not involved in the deci- sion, You get mixed reperts about the effectiveness of labeling. :It raises the whole issue of what the purpose of labeling anything, Im I 75 whether enforced by government or done voluntarily I th nk one has to start with the ~sumpt on that t is informational. The purpose of laheiing is to give the public some information that will somehow assist them in making a decision about (a) whether to use a particular substance or (b) how to use it in some way or other, So we label poison with a skull and cross-bones, or some other mechanism, wldch is to alert them to those kinds of things. Mr. SltELBy. Most poisons that we label, they kill fast, don't they? Dr. BRaNDT, Some do and some don't. It is a dose related thing ordinarily, so that you can take a long time to do it. The issue as to whether or not the current label is effective, L- think, is dependent in large part on who you mean by ef[bctive. Most studies have indicated that people are aware that cigarette smoking can be dangerous or detthn~ntal to your health. There are a number gf surveys to indicate that people are aware of that, On the other hand, there have been other studies which have indicated that when you look at specific health hazards that people ace less awnre or may not be aware. In general, the ev dence is that people tend to be aware of the risk of lung cancer but not necessarily of heart disease, certainly not of the risk in the unborn child from the mother smoking during pregnancy, and so forth. So I think you get misreadlngs on the effectiveness, Mr. Shelby, depending really upon the question you want to ask. Mr SHS:Lny. Do you have any slat sties, or l guess a marketing survey would show what groups do not know that smoking is harm- fui to them, that do not realize that a pregnant woman shouldn t smoke, and so forth. Do you have statistics like that? Dr. BItANDT. There are data like that. I~t me ask Dr. Luote if she would respond. Dr. LUOTO, I would hesitate to give these as exact results because ." I have not looked at them recently. /vlr. Slinky, Would you furnish them to the committee chairman and to the members after you look a~ the]n9 Dr. LUOTO. We certainly will provide ti~em The staff report of the FTC that was issued in the spring of last year, I believe it was, cited several studies, nc udlng one done by the Gallop Or anisa- tion for the b~l?C spee flea y on the question of knowledge o~gspecif- ic health risks. Mr. SHrubBy. Doesn't that go to the very heart of the advertising, whether or not the knowledge is out there, and has it been dissemi- nated? Dr. Luoro. Yes, and information indicated that the largest amount of knowledge or awareness ex sted for lung cancer specifi- caliy, l believe the figures were that 20 percent stated that they did not agree or did not be eve it. F r heart d sease that figure was larger. I believe it was one out'of t~ree people who did not know cr believe that cigarette smoking was a factor in heart attacks per se. For effects on pregnancy, the figure was considerably larger, it was 80 percent unaware of risk. Again, I will provide those exact fig- ures for you. [The following information was received for the record:I

! ;~¢ 76 ~me of the existing empirical measure~ of k~nwledg~ of the h~lth risks aasc~ia~ ed with Og~trette stooling are printed here, abstracted from the Federal Trade Commission ~taff Re *art on the Cigarette Advor tieing Investigation rele~ed in May 19~1 The R¢l~rt w~ ~ ~n rno~e ~ka~ ~ 4trze~ ~tudies ~f c¢*n~a~r ~'~ ~etl~, The Roper, C-allup, Chilt~n and Shor organiz~.tions reported the following survey findings: / " • . ~ gt.lt DI~,/~tJl,~lR lat~*klll~ i The Gallup Poll, released in August 1981, reported that: Only 74 pe~ent of the current survey population believe smoking to be a cause of heart di~e~ (60 per- eenF1998, 68 pereenM977)~ 2fi percent of the eunent survey population did not identify smoking to be a cause of hearl disease (40 p~rceat.19~8, 82 percent-1977) ; • J , ~ANCER The Gallup Poll, released in Aui~Imt 198], reported: 19 percent ~f p~raons sur- vey¢.d did not answer that smoking i8 a cause of lung cancer, 83 percent of the c~rrent survey ~pulatlon perceive smoking as a cause of lung can~r ~ i pereetlt in 1~ I) The 1980 Roper Study reported: 43 percent of the populaiton and 49 percent of smnkers did not know that ~moklng saunas most ea~es of lung cancer. ~5 percent of all re~pondeat~ failed to mention smoking when a~ked to name tbe ~l~ber one e~s~ of ~g cang~r 62 percent el the population and 65 percent gf smokers did not know that smok- ing cause~ most ease* of cancer of the larynx. The 1979 Chilton 9urvey r0ported: The majority of all persons surveyed under- e:~ ~l~a~, a~d mor~ ~mokfcr ~ $~ ~onamnker~, ~n~er e#,im~t~ ~e perc~*n~ r~ I~ng cancer caaefl caused by smoking whetl pre~ent~d with four gholces 10 i~rcent, ~ percent, ~0 percent, a~d 85 percent 56 percent of teens and 54 percent Of adults underestimated the percent of cancer ~as~ gIXW~ ]a~ ~v/~ki~g Am~t~g ~mokera (~ I~rA of %eenage~ ~t~ r~ por~ adults tlndetesthnate~! 75 percent of adults and 62 percent of teens did not believe oigs~tte mlloking w~ ass~c~ted with Nadd0r cancer. • , ' EHRONtC OE~'rlIUL'?IV~ LI~N~ DIS~A~ The 1980 geper Study reported: 59 paint of the population and 63 percent of smokers did not kmow that smoking eau~ mo~t eases of emphyBema• whiJe ~4 per- cenf and 39 erceut of sntokel~ did riot know thllt $ tllokiIIg cau ae~ man), elas~8 The 1979 ~hilten Sarvey rel~rted: I~ percen~ of tsens and 13 percent of adult~ did nnt know that chronic broneMtls i~ o.~o:iated with mnoking , i 20 percent of teens and 9 ~rcen~ of adults did not believe that smoking is anneal- ated with emphysema. , , ~ ~' IIMOIUNO ttNI) pFAgUN&~" . r I The ~gO ~per ~A~dy r~p~r~d: d~'I peve~rA ~f ".~m~ ~]p~ngenta did, n~t k~ that: "]f a woraan sr~oke~ during pregnancy, she significantly imereoaes the risk of Iosmg h~'r baby before or during birth." The 1979 Chilton Survey reported: 41 percent of all ¢~enager~ *rod 4~ pe~erit of adults d~ tl¢, know ~b~L tl~e rink ~f mls~rr~ [r~i~ va~ter~a~ em~ki~ duru~ pregnancy 44 percent of teens and 48 percent of adults did not know tlmt smoking during pregnancy increases the risk of still birth, with smokers less knowledgeable, exhibit- i~g klgb~r pe~e~tag~s, 4~ per~nt ~d 57 per~nt of ~e~ms an4 ~dults, r ~sl~ect~ety. ~,#~ "he Shor Stud " in 1980 indicated: 78 percent, or almost three-fourtl~, of college students did not [now that smoking during pregnancy increases the risk of spontan- neons abortion or miscarrlage. ¢ ..... , , Mr. SHELBY. I would llke that. : .... • Mr. WAY.MaN. ~Phank you, Mr. Shelby. ; I believe Mr. Nielsen arrived next• I will recognize you at this time, Mr, Nll~LSON. Thank you, Mr, Chairman.. ': ~. ' 11 77 Mr. Chairman, you were asking about section [2] of the bill and certain findings, and you asked about 7, and l want to ask about No. 8 from Dr. ltenney I believe it is No, was, Present l, ederal State and private mtlat yes have been insufficient in conveying tO the American people information on the adverse health effects of smoking." That is a followup to Congressman Shelby's question I was wondering, have there been surveys as to exactly what they know and also what the believe. I see stone reference to where they were some doubtful, and some of that nature, but are they really geared to this question do they know wha the hazards them?are' and if they know what they are, do they actually beheve Dr. B~A~OT. Mr. Nielson, if l could respond if ou don't m rid, and then l can ask anyone else. 1 think it is re atedYtO the question that Mr, Shelby jnst asked us. " There have been a number of polls and the genera result of those polls has been that the public is aware of the hazards oI" ciga~ rette smoking, I think one need only look at the inereasirffg laws passed in various places to limit cigarette smoking and those kinds of things to indicat~ public awareness. There are, however, mixed readings about specific hea th hazards from ~n~oklug cigarettes, and "~'e will of course, provide you w th all the survey dnta that we have, including Gallup and ether polls that have been taken. I think the question therefore, real y comes down to what your expectations are about th~ re e of advert ~ing, or what you expect tbe public to know. Mr. NI~I.SON. I have another uest on for Dr Henney. This is fol]owup a so of Congressman Bli~ey s comnlent~, a First of all. we have a possib ity n statistical stud es to assume causation, because of correlation and that is one po~sihle hazard your policy may b~ km [ty of The otber one is cMled in debate terms ~.~t hoc ergo proctor hoc. because A follows B, it is there[ore " caused by B. It seems to me that over the years you have had time to look at comparative differences and things of this n~ture va actuali t~ke two groups and really evaluate those who do not smoke, an~those wbo do smoke, and track them. My guess is that what you have done is taken those who are al- ready smokers compared them with tbose who are not smokers and assumed that because there is a d florence, t is caused by the smoking. Could it also he caused by the nervot~s tension, or what- ever it is that makes People smoke? Could that be the cause rather than the smoking itselF? Have you been able to separate thee two out? Dr. HsN~V. With regard to the latter twist tO your question, I don t know that any of the studies have looked at some of the habits that might be related to wha~ is the addictive nature of ciga- rettes, or what makes sepia keep stuck ng With re~ard to the ~ody of your question there have been bo h retrospective and prospective epidemiologleal surveys of people who smoke~ versus people who do not smoke and these have taken a kinds of ~artations, not on y looking at the factor of cigarette stuck tag.

680573~05

O~ 80 Dr. BRANIff. Yes sir. ' .... Mr. WALO~N. So if we take yours and add it to the voluntary that would be the total display. Dr. BRANDT. Yes. Mr, WALORSN, YoU don't know if anybedty else tracks the total? Dr. BRANDT. I don't know whether anybody else tracks the total. It may be that there, is an industry organization that attempts to track that, I just don t know. Mr. WALGREN. IS it just an intuitive feeling on your part that if there is a checkbook behind'some of this advertising that there might be less initiative to donate the time to other groups and to yourself? ~ " " : Dr. Bm~N~rr. Yes; the a~swer to your question is, yes, it is an in- tuitive feeling. Mr. WALaRSt~. Thinking generally about the lines of questions that have been pursued earlier, part of any judgment I an] sure is just the sense or the downside or the cost of being wrong versus the benefit that would accrue if you are rlghL If you have any degree of uncertainty, you would want to measure the uncertainty against the benefit of being right versus the cost of being wrong. I suppose you have two parts of the equation here, one is lives and the second is medical costs. Admitting that the lives would have ultimate value, are there any estimates of the medical costs that mlght be associated with the more effective warning or the de- crease in medical costs that might be associated with a more effec- tive warning? .' Dr. BRAN~r. No, we don't have any e~timates of the costs of that, although we can supply" you with evidence of the decreased cost as- sociated with decreased prevalence of smoking in the country. I think we can provide you with that kind of evidence. Let me point out, too, that I think the smoking issue, as impor- tant as it is, has to be taken into the total perspective of preventinn that we have underway. Therefore, the issue of attempting to get people to stop smoking is also related to getting people to lose weight, getting people to take advantage of therapy for their hyper- tension, getting exercise, doing all those things. We have attempted to structure our response with those thoughts in mind as well. We will provide you with some of the estimates of cost saving as the rate of smoking goes down. Mr. WAt~R~N. If I might, Mr: Chairman, just to think about that one point, Is the idea that if you were to project past rates of smoking, you could then put a cost on 'the increased medical bill that we would have to pay? In other words, how can you get a handle on that? Dr. BRANDT. That would be the approach, yes, it would be to try to look at it. We have a fair idea now of the medical costs that are being paid, including those out of medicare and medicaid, for those diseases that are related to smoking, If we can decrease the number of smokers thereby decreasing the incidence of those dis- eases down the road, I think we can come up with it, It is going to be crude measures, because you have to make a lot of assumptions about the increase in cost and the delay in reducing illness and various ether things I think we can give you some fig- ures that might be of vadue- ,~ q Im tl 81 [The following information was received for the record:] In 1978, Lace and Schweitzer INew England Journa of bed c ne March 9 1978, 298~10): 5G~-5711 estimated the cos of health care due to cisarett~ smoking to be $8.2 billion, or 6.~ percent of al~ health care costs at" the Nat~on for that year In I981 the National Center for Health $tatint~co (NCHS~ applied the Lute and Schweitzer model to data for 1980. and derived a cast eati,nate for direct medical expenditures of $13 6 billion, which includes $~8 billion Ibr Medicare and Medicaid cost6 Using the same model the NCHS estimated the value of indlrect ~la, or pn~due. ticn losses in 191~0 t~ have been $25 S billion. This yields an eetimat~ of ann real total sot,oral cost due to eigaret W-re~ated disrobes of $394 biltion Discussion ~as held abou pro'coting he deviine~ n medical oats with declining prevalencefs) of smoking. It wou~d be reasonable to assmne that a gaven deeres.~e in the prevalence of smoking won d resu n a linearly propneiionate decrease in deaths and disability Th s as u p on. hnwever, is complicated by he varlati~n in tit~e intervals before discern b e improveme Is n health risk occur. That i he ,~ tSsk of death by r~sidential fire d op~ immediately while t e r sk of death [rom heart di3ease drops s[gnJfieantIy in one year and continues to dec]Jr*e, as does the ~xroc~erl;ql ~ o f .... for ye~, while chronic ~b~r tlctive lung dis ........ ly ..... Insufficient data exist to permit a soles fie aaaIysis of auff~e en reliability to be presented to this Subcomm e~ Too many assump one and es~imate~ wou;t b~ n- col ed, lncluding the fallow ng ° (i) Estimates of the percentage of t~ew erases of a g~ven d ~u.sc attributable to smoking may differ over time, due to: ing(21changes,Changeswhlchis tllecanc garelead to:e product' resulting fr~ra manufacturing and o flavor- (~) Changes over time ia he y e or pa er i of smoking (Jr, frequency and depth o[ inhallation, dMIy number o c garettes, etc,) which aftert the actual expusure of indNiduals to di~ease~producing constituents of cigarelle smoke, and (4) Unpredictability of e change n the luture cost of medical treatment among other Mr. WAXMaS. The time of the gentleman has expired Thank you, Mr. Wa]gren. Mr. Whittaker. Mr. WH I'/q'AKE R. Thank you, Mr. Chairman. Dr. Henney, one of my colleagues on the panel earlier asked you a questio!~ or made a reference that, isn't it true that 90 percent cf the smokers never develop cancer 1 think I would like to start f from there and inquire if that has some statistical validity that would suggest that 10 percent of all smokers will develop cancer. Is that in fact a statistical likelihood? Dr. HE.racy As 1 reca the question that I answered, it was not specifically stated that way, because I believe what I said was that there are smokers who do not develop cancer, lung cancer being one of those types of cancer. I don't believe that t was any~vhere ar 90 ercem. If that is the way that was stated Mr. Wmrraxz~. It wasn't you that stated it, it was one of my col- leagues who made the statement to you. You are correct in your resp[inse. I am just curious. Have there been studies done to indicate what Dr H~ n to suggest that ~t m 1 in 20, I in 157 . ~¢N~y ~hat has to be ¢~ol~d at in many different ways. It has to do with duration, and number of pack years You really have to look at the population that you are talking about to see that one out of so many may develop ung cancer and that there increase their risk with the number of cig*rettes they smoke, and the time period over wh ch they smoke the cigarettes.

W l ? i : : g2 ::~':;i :~ " You'donPt have any nformatiotl to suggest that !:~:i Mr" W~rrrer'~s~ a ca nry that for the duration of their hfe- °n ,d, 2 on,inuo doko, that there is a s istio l fac r of their percent of contracting lung cancer? Dr. HENN~Y, We know that the mortality rates due to ung cancer is 15 to 25 times greater in thOSe who smoke than thee who don't smoke. ~ there is such a factor if you want to look at the overall group of smokers. Mr. WHIVrA~zR. It would he infatuating ~ have that worked out. The reference has been made in earlier testimony or earlier questioning that oftentimes death ocetlrs from lung cancer wh~ there raay have been o~her causes that could have accounted for that death ' Do you believe that rne~y peopte may develop fang cancer and osslbly dis from other causes before they contract it? P Dr. HENNEY. There are certalnly ~ther health hazarda from lung cancer which I think have been ~tated and it may be that you could die of a heart attack before lung cancer, Lung cancer dc~s fake a perled ~f time t~ develop, so that could be an accurate state- ment. Mr. Wm~'~. The ~tatistlcs oauld even be worse than they ar~r' HENN/~y. Absolutely ' Mr. WIU'm'A~ I. Dr Drandt I think it would be somewhal]nn~e for anyone n this room to not acknowledge that the tobacco try and lobby are a very p~werful farce ia national politics and m many State ~overnments as we]h Can you identify, please, for this panel if there is any other health risk substance tbat has not been either legally prohibited or utlawed or at least regulated by the Federal Food and Drug Ad- ~inis~r arise, as a drug or hazardous substance, other than tobacco? Dr B~DT. Certainly there aren't any that I am aware o[, Mr. Whittaker. l think mu~t of the substances that have been identified to be either carcinogenic or having a significant health hazard are either outlawed or are regulated. Certatn~y non~ c~me to mind, cer- tainly nothing that would come within our purview of regulation. t i~, canoe yah e that there is something out there but i cert~uly can t think of anything. ' ' ~ Mr. B~L~V. Would the gentleman yield on that point? Mr WH]~rA~:~. I would he happy to ydeid to my friend and col- league. " Mr B~L~V Dr. Brandt what about alcohol? ' Dr B~r. Alcohol, sir, is regulated m mos~ States by alcohol re ulatory commissions, lnc uding setting the age of purchase of ai- co~ul and various ~ther ~e~rlctioas that are pinsed upon alcohol at the State level: :. one State has some labeling requirements. Mr. BULr~. There are no label ng requirements, ~re there? ' Dr BaA~r there are none at the Federal level. I think at least Mr. BuuzY. The~x it is really not an accurate statement to say that every other subst~ulce that is a hazard to health m regu]ated by Federal law. CertmulY alcohol 1~, ~qt reentered as much ~ to- bacco. 88 Dr. BRANDT. Alcohol is not regulated at the F~deral level; yes sir, 1 would agree with that, and 1 would amend nay answer to include that Mr. B~LE¥, Mr. Chairman, 1 ask unanimous consent that my col- league I~ve g addisionai minutes since [ u~ed ~me ~i his time. Mr. WAX~A~. IS there any objection to that request? Hearing none, the gentleman is yielded to for 2 additional min- utes Mr. W~t~rA~ZR. Thank you, Mr. Chairman, and thank you, Mr. Bllley. I only have one question. Mr. W^xma~. Would gc~ yield to me befor~ you get i~to your question? Mr, W~ITA~II. Yes, f will be happy to yield /'" Mr. WaXMAN. Dr. Brandt, you have made the statement that al- cohol is not regulated That is not an aecurat~ sfatoment, is it, aftor air a~coho[ is regulated by the Federal Government There may not be warning labels imposed by the Federal Gowrpm~nt, but alcohol is reg~la~d by th~ Bureau uf Alcohol, T~buec~, ~nd Firl!~rn~s. Dr. B~ANDT. Yes, it i~ regulated from the standpoint of the tax Mr. WAXMA~Z. Don't they also have authority to require ingredi- ent labels as well? Dr. B~'r. Yes, they do. You are right, [ am sorry It is Rot something that we reg~lato, and that is why f am a littts confused. Mr. Wr~rrrA~U Dr. Brandt, I have heard reference, hut I have no validation of this and I guess that is why f am asking it. I have heard the reference that the cancer risk of the chemical disxin, which ha~ recentlybeen in the news very sub~tantislly witb EPA, is on ~he order of less than one.tenth of 1 percent as serious as that ~f the ea~,eer risk through cigarette smokfag. W~uld you Care to comment on that? Dr. ~RANtrr. 1 have not seen that data, so ~ ean'~ comment on it ~.~. intelligently. Mr. W~IVrAK~. Does any panelist this morning have any recent information ~n the healt~x risk to nonsmokers from having to breathe the smoke of people that do smoke? Dr. BRA.~r. We are submitving, hit, Whittaker, a report on that topic for the record. It wa~ prepared by Dr. Luoto, and she may wish to comment on it. Dr. LUOTO. That question, of course, is a highly visible one and one of great in~port~ncv to the Public Health Service. In the sum- mary c~ncl~,sior, ~f the ~tatement ~ubmisfad for the rec~rd, it sfate~ that in the interest of preventive medicine, prudence would dictate that individuals minimize their exl=~Sure to other persons' smoke. There is a rationale for suspecting that there would be long term chrcnis disease and adverse effects in adults. The evidence for ad- verse effects short term in infants is more extensive and bit more firm tha~ cer~afaly ~omethtog.[ike*inng cancer. As far as now evidence beyond tha~ presented in the lggt chang- ing cigarette report, there have been no new studies released to my knowledge. I am aware that the Heart, Lung, and Blood h~s~itate and the Cancer Institute are in fact involved, and we are involved

84 now with investigating where we might go with m~swerlng some Vf uestlons that rema nun that. the q he ant eman's time ham expired. . Mr. W^XMAN T g " I have 1 odditmual mtRttto for '~ Mr. NIF~LSON. Mr. Chairman~ may one fullowup quegt~ou? ...... fr. WAXMAN. There is a' unanimous consent raquest that the ge~ntleman from Utah have ~n addittQnal minute, is there any ob- jection? Hearing none, .:the gentleman from U~ah ia ylalded another minute, tbotical situation If t~- r NnZLSOU Dr. Brandt, l have a hypo M , e a brandnew product being introduced for the very first bocce wet d our de artrnent, under the pre$ent ~ystem, allow ~t to time. ~oul y P be put on the market• " Dr. BRA~DX At the presant tlmo, M~. Nielsen, we would not have thor t not to allow is. ' any au Y "n that ou had the authority to say what Mr, NIZL.SON. Assum~ g Y t was bad. woud you drug ma~ avadahis, what was good ~nd who allow it at the present time? B~NW We would h~ve to make the assumption that we haDvr'tbo evidence that we currently have, and if we were regular- ' s as we do some other items, i think the answer would be oo.t ,o ld to eo.h ico that don, ha o that authority. Mr WAXMAN. The goat|croon has completed his minute. Mr. Wyden. • yDEN. Thank ou very much, Mr. Chairman. . Mr BWrandt, I have sYome questions for you I am particularly con- rned about the issue of additives in e garaltes. ce . ' ~ know absalutel nothing about My understand lg xs that klnd of additives go into c garettes, and for ~l we know there what ' ' n ltrsenie All of ul be osonous pesticides, rodent remains, eve , . . co dp thinP~ co~Id he go Itg tute clgarettes, and I don t Be elanz ~tvll e tha~the American people would know very much aoo.~ • co denc . 't kn~. i am co~vmped that the tobac am denounced that we don m anles don't want to tell us. . ee* ¢o p . " • ome uestmn~ ~bout the agf d hke to expLore w~th ~ou s q . • melt~°t~at the Federal Government and tobacco industry have en tored into in this are~. As 1 understand it. the tobacco manufac~ur- • e ~ecretary all cigarette edditive~ ers are reqmred to report to th the additive. Is that eo~ ~uly ff three cigarette mmmfacturprs use Feet? ' ' ' and I would like in point out, Y voluntar" y, ver been an opportum- ty for the at the c aretto manufacturers u~e in thaLs own ad- the first time in the history that there has e Government to know what has beef added to cigarettes, other than wh g ¢'~ ver~islng monl used edditive as one t~ ten a ement defines tt corn Y The writ gre a~xles (The industry has agreed i used h three or more cutup • that s ~ n additive used by fewer than three europa informal to include a es " nies wbict~ is u~ed m large quant!~m~nt if only one manufacturer . W'I~ So, under th gr . , of Mcigarettos has a dangerous pestlc:de n ins product, the tobacCO g5 industry wouldn't have to report this additive to the Secretary. Is that ~orrect? Dr. BaAutrr. That is correct. ~r. WyDEN. The same would be true if two manufacturers use an additive. Dr BI~ANDT, That is correct, Mr, W'~D~. I ha~e th tell you that I think that the policy is an absolute joke. I think that it is an outrage. I think you know that there are only six cigarette manufacturers in the entire country. T*o of them, Phtlip Morris and R. J. Reyaoldl, central 65 percent of the market, and sell over 400 billion cigarettes annually. The only other question I have for you is, can yea tell us how; in any way, the public is protected by this sweetheart orrangemenC ~- between the Federal Go~ernment and the tobacco industry? I think we are getting ~hnookered. I think the pubfic has the right to know what kind of additives go into these cigarettes I would like you to tell me one positive benefit of this ogreemeat that has been entered tote, becaus~[ see absolutely nothing in it that helps the American consumer. Dr. BRAND'r I am sorry yOU feel that way, Mr. Wyden. I think the issue of baying access to the Bdditives is one that has been pur- sued and hm~ teen debated in the Congress since 1976, and this is the first time, that any opp~rtuntty to gain access in that informa- finn has ever come about. Rather than cad it a sweetheart deal, as you have referreCl to it, I think it is an opportunity that we have; that it is something that ou ht to be pursued and that we falIy intend to pursue• ~r. WYuss. Let me fallowup on that because, as I understand it, the tobacco industryhas made the information avallable to the De- partment and the JJepartment has not even looked at it. Is that correct? • Dr. BRAU~r. ,The Department. is in the ~rocess,. of [ooking at it right now, I think. I wall take full respons~bthty for the fact that when we negotiated this agreement. I seriously onderes~imaled the scientific task that was before us. We have taken additional time, brought in outside consulinnm and others to ussLst us in determin- ing what we are going to do with the information. Let me point out to you also, Mr. Wyden. that what we are talk- ing about is a different kind of toxicological problem than we are ordinarily faced with, because we are talking about chemical sub- stances that are beln~g thhaled at higb temperature. Very little in- formation is known about that. It is quite possible that substances that are othel~vLse toxic might be rendered nontoxic under those circumstances. It is also posslhLs, of course, that sRb~tances that are ordinarily nontoxic might be rendered toxic. It turns out that thie tokes somewhat more of a scientific exami- nation than I had origlnally, tho~ght~ and I take full resIvonsibfliCy. . for the fact that thin has been <~elayed, I make no excuses for it other than my own Failure in judgment On the other hand, however, I am perfhctly willlng to defend the fact that we do have an agreement for the first time. Let me again emphasize that people have been trying to do this for a long time, and it has Finally occurred,

• ' 86 Mr. W~ro~N. Mr. Chairmanl~if t may proceed for 30 additional I]eCol2ds. I just want to tell you, Dr. Brandt,¸ that you haven't convinced me that the public gets anything out of ~ arrangement that we have today. Mr. Chairman, I want to' thank you for including this feature in your hill. I think you ¸know that the committee accepted my amendment in thi~ area to give consumers full disclosure of ~ha ad- ditives. I am ~ery dissatisfied w th what the Federal Government is doing in thb~ area.¸ I want to praise you for your leadership in in- cluding the additive seotior~ in your bill because now the puDlic can realize the right to know what kind of additives are goteg into these cigarettes.¸ l thank you.! ~ Mr. WAXXlAN. The gentleman's time has expired, Mr. Luken. r • Mr. LUKr, N. I have no questions, : ": '" Mr. WAXMAN. Mr. Sikorski, do you have a questiola? Mr. SIKORSKt. NO, ¸thank you, l~r. Chairman. ' ' Mr. WAX~IA~. Dr Brandt, Dr. Lenfant, Dr. Lipsett, Dr.¸ Luoto, Dr Follin, mad Dr.¸ Henney-~- : ' , Mr. B~y. Mr. Chairman. ,: ~i l~r. WAXMAN. Dotlrt leave.¸ t ~ ~ ~ Does any member wish a second round? ~ !, Mr. Bratty. i do. • ..... Mr. WAXMAN. Mr. Bliley is recognized for 5 minutes. Mr. Bratty,. Dr. Poll[n, why dld you ch~m~e to release your new smoking pamphlet this weekend? ' Dr. Pontiff. Mr.~Bli~ey, the ¸National Institute on Drug Abuse did not release it,¸ the¸ Public Health Service did. Had we plannad to attempt the release so that it would hl any way coincide with these hearings, the timing of which we only learned about 10 or 15 days agol it would be completely¸ naively optimi~tlc to beiieve that we could have planned it this welL There was no such plan. Dr. BI~DT. Mr:¸ Bigey, indeed, the date for publlcatfon was ap- proved by the Department on December 15,¸1982. Arrangements were then made on January 27. The decision was made to release the pamphlet on March 7. ¢othcidtag with¸ the printing order and the ~availabillty of the pamphlet.¸ It was unrelated on ~ur part to this hearing, :¸ ~ J • • I • " ' Mr. Bt~L~¥. However, | am not fully convinced. You embargoed your pamphlet for release Qn Monday, yet several of the wit~esses refer te the amphlet in their prtated ~tatements that arrived here Tuesday. DI~ they" write the~e statements on Monday afternoon, or did they have access to the pamphle~ before it was released? Dr. BI~ANlyr. All the statements, of course, from various tempo-¸ nents of the Public Health Service, all of those statements that I have submitted for the record, !come from the Public Health Serv- ise.,They ta faot dld have access t~ that pamphlet and have had access to it intermittently, lndeed~ that pare hlet, sir, was~ taken from testimony made a year~ago before the U.~. Senate. Mr. BLIt~y. I was ~ot referring to your people. I was referring to other witnesses wh6 will folfow you hefgse this Fanel today, they refer to it in their statementS. The statemsnts arrived here Tues- 'l # 'l 87 day and you embargoed Jt until Monday, Did they either do it Monday afternoon, or did they have access to it beforehand? Did anyone outside of the Department have access to it before the embargo time? Dr. BRANar They had access to it, although it was embargoed. The voluntary health agencies had access to it. It was embargoed so that they wouldn't release it. Mr. BLI~:~. H~w te, ng did they have it? Dr. BRANDT. I don t know when they got it, but it wa~ about a week. Mr. B~a~zv. Why wasn't it releascxl earlier, then? Dr. BRg.'e[rr. Because the date h~d already been set and fixed aC the time. It is not an uncom~non praotlce to re[ease information • and embargo it fur a particular date. • Mr. B~LEV. In this town it certainly isn't, especially when hear- mg~ are scheduled on ssues that are direCtly affected. It has been all too comn~on in the past. Dr. BRA~T. I can assure you, Mr. Bhley, that fyo~ are a~using me of settaig the stage--~e Mr. B~u~v. 1 wouldn't accuse yo~ of anything, Dr. Brandt. Dr ERANDT. All right, sir. Mr. fiLI~¢. We will just let the facts speak for theraselv~s. On what information, Dr Pollln. was the pamphlet based? Dr. POt.L~. As I mentfoi~ed before, Mr. Bllfoy, we held a fongth series of scientific reviews over a period of years, which have i~y volved the National Academy of Svieuces. the lnstltuto of Medicine, the National Advisory Councg on Drug Abuse. The pamphlet re reser~ts the .consensus of a large body uf scientific research an;d multiple rewew In coordmatlon with-- Mr WAX~A~. Would the gentleman yieId to nm because I think we ought to have a clarification. Evidently n~y colleague is critical of Dr. Brandt and others in the Department of Health and Human Services for the timing of the release eft their statement in relation. skip to this hearing. 'finis hearing, not at their request nor in any way dealing with their timing, was geared to coincide w~th the release of the r report. It was our tlmi~g because we thought that when the report came out, it ~voald be very timely to follow it with a hearing of the subcommittee. . 1 dld want to defend the Department of Health and Human Serv- ice% they ~vere not in collusion with as. It was our determination to have both events in a close timeframe. Mr. BtaLz~. Is it not a fact, Dr. PolHn, that one of the prtacipa] documents upon which the pamphlet was based is a study that was conducted well over a year ago, Dr, POLH~. There have been multiple stud es, Mr. Bliley. I don't bkn~wo~hcioCnhtlonenSpecil]ca!ly you are referring to. There was a large Y g sc~ent fic rese~rc'h and multiple reviews, so you would have to identify which one you are referring to Mr. BaILXy. It was an Adv sor~ Council on Drug Abuse• Mr. Chairma~a, I request 2 namutes additional tlme because you used part of my thne for yourself. Mr. WAXMAN. Under tho~e circumstances, 1 will n~t oh;~et

89 Getting back to the lln~ of questioning that my colleague from Utah was pursuing. One question was, have there been ~ny ¢~ntroI ~tugle~ on ani~als with smoklstg that you are aware of? Dr. Bl¢~or. There have been control studies of animals and smoking, yes. Mr. BL~L~Y. Has ]qHS done any control studies with anlma~s? Dr. BRA~)~. I don't know if we have specifically done them right off the bat, but there are some that have been supported by ~ls through the NIH. Mr. BLIL~Y. Don't you think that that would be helpfuI? Dr HRANn~. Yes, Mr. WAX~A~. Tbe gentleman's time has expired. We have other witnesses to come before us today• I do not want to preclude alerts- ~ hers of the committee, hut i do want them to be aware of that fact• Doe~ any member of the subcommittee wish to eogage in a second round of questioning? [No response.) Mr. WAXMA~'. We thank you very much for being with us.. Witlmut objection, we will keep the record open for the informa- tion that has been r~luested by the v~rious m~mbers of th~ corn mltt~e. Oar next panel represents a broad spectrt~m of medical and scl- entJfle expertise. Our witnesses are medical pmfesslonals who are active members of the American Cancer Society. the American Heart Association, and the American Lung Association• Dr, Wil/inra Cuban is attandkig surgeon at the Memorial Sloa~- Kettering Cancer Center in New York City• Dr. Anbanfo Gotto is chairman of the Department of Medicine at Bay]or College of Med~- vlne in Houston, Tex Dr. Edwin Fisher is on the faculty of the De- partment of Psychology of Wa.shingCon University in St, Louis, Me. Without objectlon, your prepared statements will be made part Or the record. If each of you w~uld kindly summarize your statements, we will have an opportunity for questions and answers, which wlii be helpful to us. Dr. Cahan, we would like to call on you first. ~TATEMKNT~ OF W|LLIAM G. CAllAN. M.D., MEY~IRKR, AD |IOC COMMITTEE ON TOBACCO HAIItTU&TIOM AMERICAN CANCER SOCIETY; ANTONIO M. G[YI~O. JR,, hI.D. D, PIHL. PRESIDENT- ELECT, AMERICAN HEART ASSOCIATION] AND EDWIN ~. FISHER, JR., PH. D,, CHAIRMAN, SMOKING AND HEALTH COM- MFrTEE. BOARD E~EMBRR, AMERICAN L1]ND ASSOCIATION Dr. C^~mN. Thank you, Mr. Chairman. 1 feel quite honored to appear before the committee. It has been 1 year ~ince I have been here and fral~kty I had hoped that this return visit would vet have been necessary. In addkion to the tltles that you read about me, I would like to tell Mr. BHley that I have worSed"on aninm] research in cancer and this may lead you to some questions you aske~ the previous witD~s~e~ I w~uld like to suhmi~ a printed statement for incltls[on iR the record. In addition, I would Iike to have incIuded an editorial of mine to which l will make reference later.

G~05~8411

92 azine next month. The title of it was) "You)re Come the Wrong Way) Baby." The editorial is directed at this horrendous dilemma in which women have found themselves, by having emulated the male and adopted the habit of cigarette smoking. No other biological fact, no other environmental explanation can justify the grim figures we see of the prpcipitous rise in smoking related cancers in women. Permit two wry observations on this same subject. When I was slated to come down here, I thought that perhaps it might be wise to get a quote from some of the more famous women athletes. After all, athletes are famous for not indalging themselves in cigarettes, because they believe that it would cut down their staralna and their wind. Some of the more famous ones are tennis stars. So I called some- one who werks with them. Hc sa~d: "I am terribly sorry', we can't g~t anyone for you. They are all in the Virgtaia Slims Tourna- ment" Thpn, when 1 audibly winced, he remarked; "After all, look at what wonderful things they have done for professional women's tennis!" The second observation concerns the Metropolitan Museum in New York City, which currently has an exhibition of the art of the Vatican, This has been made possible by a grant from a very famous tobacco company. This funding is not unlike some of the grants that the same company and other tobacco companies have been making, or attempting to make, to scientific institutions, to do research on tobacco. I would say that these institutions usually are stalwing for funds, and are not unlike certain religious institutions who gain their chief sustenance from the Madam who has a house around the corner. In other words, accepting the devil's money to do the Lord's work. The fact remains that this is a cynical exploitation of arts and sports, and the artful dodging and the political maneuvering of tc- bac¢o interests, have to be recognized for what they are. By constantly opposing cigarettes, I can be said to be trying to put myself out of business. If I could abolish cancer of the lung, and instead, remove appendixes, hernias, and other simpler things, I would be the happiest man in this world. Remember: Tobacco in- terests are there only to maintain tobacco interests. The people of this country feel that there is an urgent need for your leadership. You must really step the slaughter of the innc~ cents. 1 am not saying that one label will make the difference, but it will become part of a climate, an enviromnent of constant re- minders. It will be the only daily reminder they may have. If it is eff~ctive~ there ore millions of people, whom we have never seen and whom we will never know who will be grateful. [Dr. Cahan's prepared statement follows:] q 93 TESTIMONy On Behalf of THS AMERICAN C/~qCER SOCIETy MR. CUAIP34AN. MI~BERS OF THE COMMITTEE, It is an honor t~ be here again today to testif~ on bshalf O£ the~eric~n Cancer Society, a voluntary health agency W~th over 2~i/~ million active volunteers. ~ professor of Surgery at the Corn~ll ~n~versit~ Medical C~llege, an~ s~v~ a~ atten~in~ surgeon. The Thor&cic Severe O~ Memorial ~O~pital~ i~ the Memorial Sl~n-K~tt~ring Can~ Center. I am a ~nq-time active volunteer of th~er~can C~ncer Society. I have ~erved as a Member o~ ~he committe~ ~n T~bac~ an~ cancer of th~ Society'~ ~at~o~l Board ~f Director~, a~d currently ~erve ~n the $o¢~ty,~ Ad Hoc Com~a~ttee On Tobacco Habituation. As a ~lin~c~l researcher, ~ ~cted some ~ the early research e~per~. ment~ i~ animals which helpe~ to estabIis~ the causal relati~nships between Smoking and cancer. I Would like to start out by cem'~end~n@ the Chaigman and ~ever~l m~ber~ ~f hi~ C~m~itte~ Including Mr. Wyden, Mr. Whittaker a~d Mr. Sitter wh~ hav~ so f~ith~ully w~rk~d for the p~ssage Of ~h~ leql~latlon ±~ th~ las~ year. I ~in~erely hoped last y~ar when I wa~ h~r~ that I w~l~ not have to testify ~n t~i~ lagislatlon again, ~ot because I believe it to be ~Dyth~n~ but a priuilege to ~ppear bef~r~ this Committee but, because I h~ hope~ the last Co~gress would u~derstand the impor- tance of this legislation and pass ±t~ Sin~e they d£~ not, appreciate the opp0~tunlt~ to once agaln express ~y view~ and those o~ my ~ellow members of tha Can~er Society on B.R. 16~4.

94 % ~ here %oday to ~pre~s the ~tror~ support of the American Cancer Soclety for th~s legislation and for educati0n on ~ok~ng. 54 mllllon Americans light up cigarettes every ~y an~ we know that that act will ¢ontrlbute to the death of over 300~00D of th~ this year. 440,000 ~e~icans will die of cancer this year; 129,00D will die of ~okJng-related Cancers. The Surgeon General ~ays that 85% of th~ i11,0~0 1~ng cancer deaths this year .will be ~moking related. We know from the Surgeon Gener~l'~ report that the overall c~ncez death rates of male ~mokers are approximately ~ouble those o~ non~okera and for f~ale ~oke~s the death rate is app~xoimately 30% higher. The higher cancer ra~es for men re~lect the fact that in ~he pa~t, more men ~an women ~nok~d, an~ ~oke~ mo~e heavily. ~o re."en~ yeara, however, the gap b~tw~en mal~ and female ~nok~o9 has been na~0wi~g. 25 million women now ~oke and b~cau~e of that before the end of this ~ecade ~t is estimated that fun9 cancer will surpass breast Can~er as the n~ber one can~e~ kill~r o£ wo~en. The ~nly possible way to avoid this eventualit~ is to drastically reduce the n~ber of women ~ok£n~. The Surgeon General found that ci~ette ~okin~ waa a major cause of lung, laryngeal, oral cavity, and esopha~e~l ~a~eer. It was al~o fo~d to be ~ contributory factor to b~adder, ki~ney an~ ~ancre~tlc c~nce~. In ~dditlon~ be noted thnt epid~elO~ical ~udie~ ~ugge~t a~ a~ocia~Ion between oigarette ~oklng and stomach cancer a~ • ~os~le association between ~ek~n9 an~ uterine and cervi~.l ~nce~. 95 ~hat ~ eveo worse, th~6e ~aneers most ~l~ely ass~i~te~ with ~igarette ~oking {lung, eG~p~ageal, laryngeal, o~al ~avlty and pancreatic ~ancer)~ ~n b~ th~ most ~ifflcult ones t~ tre~t, the cancers with the lea~t hope far ~urvi~ah FOr ~ample, ~he overall five.year survival r~te f~r lung e~ncer ~s only 10%; fo~ ~a~oer of the esophagus, 4% ~nd for cancer ~f the p~ncreas~ 2%. There aze those wh~ would s~y tha~ none of thi~ i~ true, ~ha~ clga~ette ~k~ng does not ca~e e~neer. Th~s is no~senae. EVeZy surgeos ~eneral ~or the last twenty ye~r~ has ~a~d that cigarette ~okin~ can~es long and other c~ncers ao~ has backed tha~ stat~en~ up wlt~ considelable d~ta. As I ~aid e~rl~er~ I ~self conducted a~me smoking st~die~ an~ I know ~om f~sthand ex~rience wha~ the f~nd~ng~ ar~. Cigarette ~okin~ is the leadi~ ~ause ~£ lung cancez and tha~ simply cannot be disputed, ~f o~r opponent~ say that we do not kn~exactly what triggers a uancereu~ co~di~on in the cell ~ ~a~ o~ly s~F that ~hep are rl~h~ about that. ~het is important, ~owev~r, i~ that we know that whatever ~he mechani~ is foc turning ~ normal ceil into a malignant cell. cigarette ~oklng ~gger~ that mechanism in ~nd 129,00D ~er~cans e~ery ~x. If o~r ~ppo~eots e~y thiB k~owl~d~e is ~ed on ~pi~l- ological s~u~ie~ I must admit that ~a partially true an~ I mu~t also sa~ ~ ~ not an epid~lolcg~t. ~ ~now that the ~t~dies done on smoking are not tha~ different than the ~tud~es done on • ~bestos and o~her su~stance~ whieh have been widely aeeep~able as being ~arcinogens. FUrth~e" Could cigarette~ survive the

96 Delaney te6t if they were ¢ovB~ed ~n~er the Food, Drug and Co~e~i¢ A~t? I ~ubmi~ the~ could not. r L The plain ~nd simple truth iB smcklng oao~es ~ance~. I ¸know It, my fellow ThO~aLO lur~eonB kn~w It~ and Z believe those In the industry it too., The only q~ion that shoul~ be of Intero~t to thll panel then i~ whether this bill will ~ e~foutlve. I ~ no ~dve~tlslng¸ expert* However, ~ have aee~ ~ome information ~n the R~ope~n experlen~e wlth ~ab~lin~ ~h~t ~ think is pretty Convincing. For ex~cple in Swede~, which adopted a rctatiov~l w~rn~g syst~ with 16 dlffere~t ~peci~Ic heal~h warnings in 1977, the ~erce~a~e of ad~l~ male ~oker~ ~roppe~ £z~ 43~ in 197~ to 31~ i~ 1980. The percentage of female od~it ~oker~ decreased f~m 34% to ~5%. O~ even greater i~tere~t, ~he percentage of 13 ~e~r-old children w~o ~oked wa~ nearly cut in half b~tween 1977 a~d 1980. A major ~t~dy ~one for the Swe~i~ gove~e~t oft~ the implementation Of ~his ~otatio~l wa~n~,~ ~y~ con~lud~ that ~ot only had th~ w&rning labels been not~ce~ and understood, they bad had a direct l~pac~ ~n both the public'~ ¸know edge of the health hazards of ~ok~ a~d th~ r~ucti~n i~ th~ percentag~ o£ peopl~ who ~oke. $1~lar experiences have,occurred in Finl&~d and Noway.. D~rln~ al~o~t that sam~ pezLo~ cigarette ~oking am~n~ yc~n~ £~ales age 17-i~ in o~r own uoun%~' ~nu~od. A~ ~ doctor ~ can- ~ot e~pre~s how ~trongly ~ believe tba~ if ~he~e labels ~ccom~anied by vigorous publ~c education Can atop J~sh l| of ~ur children from • tarting to ~oke Or i% :of ~ur¸ ~olt~ ~rom ~i~hting up they are worth every ~enny of ~ost t~ th~ Ind~t~ or to any of ~s aske~ to 97 AS for the provlaion of this legislation on ciqarette aOdi- tivn~, the Cancer ~oclety ~eel~ ve,y strongly that these snctlons mus~ r~ain |n this b~11. As ~ 8clentist I em ~tra~ed that an ~ndust~y that pr~d~ce~ a ~rodect that ki11~ i~ p~rm~tted t~ k~e~ Secret the additives Of that pro~uc£, ~ny of tho additives, even ose, from ~e~pons~ble p~hllc health ~ffi~i~is. ~e know t~at Ingr~dient~ ~$e~ t~ flavor c~garette~ s~ch a~ de~rt~ng~e and cocoa buena u~ha~n ~ub~tance~ which arc carcinogenic. Thet we do not know.Wha~ e~e in ci~arette~ is a cercinu~e~ c~us~ me ~re~t ~iatress. That we ma~ never know /eaves me discouraged and fearful ~o~ all the ~atients I w~ll ha~e in £ut~re years who will needlessly die. ~ Mr. V~nittaker said at ~h~ t~me this l~gislatio~ was ~ntr~ d~ced, "An~onn who has ~ver h~ t~ watch the physical deterioration of a £r~d o~ ~elativ~ euff~r~n~ from lun~ ¢~nce~ knows there ie noth[nq glamorous ~bout cig&r~tte ~oking,- I ~ave had to watch th~s misery i~ ~h~ands of parlance, in recent years, increasingly In women, Last year when I came I~dfore this Cora~tt~e I showed you an ~-ray o~ a woman patient of mine wh~ had lun9 Cancer and wh~ was teminel. The woman had ~noked -- pauk~ ~f ~garette~ ~ day fQ~ years. ~ would like to 6how yea ~ that ~-ray gain. This time I am showing ¥o~ the x-ray Of a fomer p~tlent, The woma~ died. She died of lung canc~. S~e d~ed of smoking. CC~IAN ~'4BELLISHES AB0~" HER ~ZL~ AND ABO~ HE~.) Mr. Chairman, I ~m at your disposal whe~ it COmBe tO this leglala~on. TO ~e here tode~ I left two ~ati~nte in Hew ~ork w~o ar~ in ser~ou~ trouble. Both ar~ women. B~th ar~ ~ok~. Both " %

98 99 Mr. WAXMA~. Thank you, Dr. Cahan. Dr. Gotto. STATEMENT OF ANTONIO M, GOI~TO, JR., M.D.. D. PHIL Dr. Gol"ro. Thank you very m~ch, Mr, Chairman and members of the subcommittee. My name is Dr. Antonio Gotto, and I am here in my capacity a~ p~esident-elect vf the American Heart Association I aise serve as the chairman of the Department of Internal Medicine at Baylor College of Medicine. and chief of the Internal Medicine Service at Meth~ist Hospltah For the last S years, Dr. Michael DeBakey and 1 have directed the National Heart and Blood Vessel Research.and Demonstration Center in Houston. m',~ I appreciate the opportunity to appear today before this subcom- mittee on behalf of the American Heart Assoclatiom The American Heart Association is a nonprofit, vo[~tntary heart association of over 120,000 members, and almost 2 million other volunteers, The prhnury objective ..... of our ~s~clatlon is the red.orlon of p~e~ature death and d~s~b]hty from cardmvascular diseases. Cardiovascular diseases reraa[n the No. 1 cause of death in the United States, and will kill approximately 1 million Americans each year. The pertinence of our testimony to this Subcommittee ~a Health and the Envlr(~nmeat i~ the fact that there are three known mt~jer risk factors to cardiovsscalnr disease. Most cardiovas- cular disaase is caused by arteriosclerosis er atherosclervsis, in lay terms, hardening of the arteries. This is basically arterial disease. ] wanted to refer to C~ngressman Bliley's earlier remarks in that this is a multlfactorial disease. Hew is cigarette smoking, how i~ high bloed pressure or kypertension, how is the high level of cho- lesterol identified on the basis of it~ c~ntrihution +~ premature death from heart attacks and cardiovascular disease? There is a multitude of eviden0e frnm various d~scipline~ on *~% these risk fa~tors, but the major evidence as far as cigarette smok- ing is concerned continues to come from epldemiolo~ic studies, from multivaried analyses. That is, if one lool~ at a population of indlviduals, and separates out all of the other k~ow~ and ide~tifiuble risk factors for early heart attack, or an early stroke, cigarette smoking remains one of the three m~jor associated factors. ~f y~u are a heavy cigarette smoker, your chances of dying of a heart attack, or early e~rdiovas- eular d~sea~e are incre~ed about three times compared to th~ risk of a nonsmoker, You may s~y this is statistics and this is epidemlology, and this is ~at an e~tahlisheg causal relatlonshlp. The anly response t caP- make is that I wouldn't wast to be the smar~st man in the grave- yard " ttow does cigarette smokJt~ p~vmote'atheroseleresls and coro- nary artery disease? A number of ways have been identified. One is through the reptecement of oxygen in oxyhemoglobin with carbon monoglde,~ which decreases the delivery of oxygen to the wail of the artery.

.J ~J lOO Sccond, traction of the smooth m~¢le cell iB the arterial wail, and i~elf has bcen shown to be toxic. Third, there are other substances m c~rette smoke that evoke an aIler~c reaction against the arterial wall, and virtue of contributing to an diler~c of the a~nal wail. r correlated with a re- There good kind of cholesterol The klnd of cholesterol ~ called the high density cholestero thehghdensity poprotenfam~. ' • Females have higher levels of high'density lipoprotoins than do T males. Exerciser~, people who rutL 12 m~des a week or more, trove | higher levels of IIDL, and for reasons that wc don tyet under- stand, people who smoke cigarettes have lower levels of high densi- ty lJpoprotelns, the factor most strongly associated with protection against coronary disease. You asked ~ question about alcohol. To the best of ou~ knowL edge, alcohol is not a risk factor for atherosclerosls or coronary dis- ease. It has many other toxic elf~cts to the body, The Amerisan Heart Association does not, and certainly I, as a physician, do not recommend to our patients that they consume alcohol, but as far as coronary disease or atheroselerosis is concerned, there is no evi- dence that alcohol consumption is a contributing factor. Perhaps most significant is the fact that when people stop smok- , ng, their risk of cardiovascular disease gradually return~ to normal. The risk of fatal and nonfatal heart attacks among exsmokers is s m lar to nmxsmokersdn abo~t 10 yearS. . . In a study recently completed in Norway, a combination of diet and cessation ~f cigarette smoking produced a ~ignificant decrease i~ the incidence of both fatal and nonfatal heart attacks. Dr Day d B ankenhorn at'the University of Southern California in L~ Ange es has a few limited studies with arter ography in which } e shows that by stepp ng snmking and by the reduction of cho estoro, he was able to demonstrate a reversal 9f a~her~sc~ero- sis in a small number oftedteiduais. S~ there s at east some evidence accumulatin in men that stopp sg smoking will: reduce the incidence of fat~ and nonfatal heart aLtaeks. " , :~'!! ' : ' ' " In spite of the overwhelming evidence linking clgaretta ~moklng to cardiovascular and other diseases, as we have heard this morn- ing, ~ver 54 million Americans continue to smoke. Two-thirds of all of these smokers would like to quit, and most of them have tried to do so. Many of them,,followtag an unsuccessful attempt to quit, have switched to the so-called low-tar/low-bscotlne e~garettas. The most recent studies that have been carried oat and pub- l~hed, however, have shown that the low-tar cigarettes do not de- . ere,~e the risk of eardiovascniar disease. So the risk of cardiovascu- lar disease is not overcome, is ~o~ obviated by switching to the lowr tar/low-nlcotlne cigarettes, ,: . , ~, . ~ A few years ago, i presented testimony to thin subcommittee on the i~te ~f whether sacche.rbs shouLd he removed from the market as required under the Food, Drug, and Cosmetic Art, because it had I01 determined in a study in Canada that saccharin possibly caused cancer in second generation rats. It took an act of Congres~ to cause sacgharin to stay O~ the market. With saccharin, we were confronted with limited studies and it determined that ~clentlfic e~idenee Wtx~ sparse ~nd inconebs- behalf of the American case with tobacco The ca~e aga~t ~igarettes is clear. It is selentifically substantiated. in fttct, if tohaa~o and ~dohaeeo products ~ere Teguiated under the Food, Drug, and Cosmetics Act. in rny opinion the Delaney clause would probably have required the removal of cigarettes from the near ket long ago. The provisions req~lirlng rotation of the three new warning state- men~ on clgarette packages and in advertisement are an e~sentlal element of any comprehensive educational effort if the public is to be better bsf~rmed ~f the ~9eclt~¢ daBge~ of ~mokiI~g. The ~der~l Trade Commission (FTC) has recently concluded that the current warning statement that hm~ been used on packuges and advcrt~s~ moots since 1972 is ~verexpo{ed, and its effectiveness is very limit- ed, About 40 pe~ent ~f the srnt~kers ~n the ~3ni~ed ~tates, according to the FTC report, are unaware that mnohing has any harmhd elfe~t en the cardiovascuhir s~stom or is a potential ca~ ~f heart attacks. The cencl~ion of the ~'rC wee supported bn part by stud- ies by Starch ]%~-ssa~e [leper% ~ervice, which found that only %A percent of a~nits cx~ed to cigarette ads e~cn read the Surgeon General's warning. This should come as no surprise since any mes- r.a~e presented exactly' the ~txie ~a~ ~it! ~I~ bez~r~le (axIiii~z,r and, therefore, will lose its effectiveness. A 197~ staff report of the Federal Trade Commiss on on ¢ garette advertising concluded that there are slgnlt]eant gaps in consumer knowledge. A substantial proportion of the population does not know how dat~ger~us cig~trette smc~knig is a~d they ~tre x~nawar~ of the danger of cigarette smohing in relationship to specific disease entities such as cardiovascular disease. "~'e are pleased to see that the bill has incorporated the use of a circle and arrow format for advertisemenL We believe that the use of this forumt ~vill significantly enhance the notice~bilky of the warning, The American Heart Association would recommend, however, that the size of the warnin letters measure at east 25 percent of the maximum brand name ~etters and be of the same proportion in detail to improve ~nd iBs~re ~isibifi~y. The so-called brand advertislng goes on st a eve of over $1 bil- lion per year, Regardless of the intent, nonsmokers and children are heavily exposed to this advertising, It would be very d fficu t to argue convincingly that some nonsmokers, and especially children ~nd teenager~, are n~t ~ffected J~y the constant portrayal of smok- ers as being young, attraetlve, qaeaishy physically active, enjoying an adven urous and p easurshle fifestyle, One of the most offensive ads to me is the Kent ed displa ed here showing one man perhaps in his m d-th r es He has)ust ~n- iahed e~erelslng, perhaps playing tennis or rackethaih l-le m in ex-

102 ercise garb. The relationship between a young man who has just been engaging in heavy, vigorotm, physical activity and cigarette smoking escapes me. I personally find this form of advertisement offensive. . ' " Last year. this subcommittee heard testimony both from the ad- ministration and other public witnesses about the addictive nature of cigarette smoking and I will sklp over that since it has been dis- cussed earlier today. But the American Heart Association is pleased to see inclusion as part of one of the new warning labels a specific reference to the addictiveness of cigarettes. The American Heart Association has made and will continue to make elibrts to better inform the public about the hazards of smok- ing. However, we do not beliew we have adequatp access to the media to fully inform the public. Our ellbrfs will have a greater chance of success if cigarette advertising contains an effective warning• The warning is yet another way in whicb the Federal Govern ment can effectively assist the private sector in educating the public about the hazards of cigarette smoking. It is not the only means of education, nor is it the sole answer to the problem, but we believe that it is a critical part of the effort, and we conunend this subcommittee for its efforts on our behalf, Therefore, the American Heart Association strongly endorses H.R. 1824. We hope that ~ subcommittee will move rapidly to insure its enactment.. Thank you. [Dr. Gotte% prepared statement follows 103 TESTJMON~ OF ANTONIO M, GOTTO. dR., M.D, PRESIDEnT-eLECT AMERICAN H£ART ASSOCIATION Mr. Chairmam ~nd rno,~berl of th~ Subcornralc;al~ on H~alth and £nv[ronmen~, my name i~ Or. Antonio M, G~o, Jr., Pr~srde~t.[l~t of tho American Heart A o atlon I ~m aJso th~ B~b ~nd Viv[am Smith Professor and Chairmam'of the Departroent of Madl=[n~ at BaV[or Golleg~ o~ M~c~i~ime ~md M~thod~t [ appr~cia~ tha o~portu.jt,f to appear be¢or~ ~his Subc~mmltt~ ~ behal{ ~ the American Heart As~oclation tm testi~y In stron9 =upport of the *Compeohe. msive Smokin9 Prevention £ducaiion Act of ]9~3," The American H~rt ~SS~. ciaUon is ~ nonppo(i~ VOlufltary heaJth ~rga~izat~o~ with over 120,00[} rlernbees • nd almost 2 rliUion other volun~eer~" 7h~ primary objective o~ t~e as~¢:¢ia~ion ~s ~he ~educUo~ of premature d~ath an(~ disabi[av fro~ Cardiovascular dissases, Cardiovascular di~eas~~ kill nearly one m IJJ~n Am~rJcams each year• Thi~ J~ moro than ~11 other ©~us~s cornbJn~d. H~a~ attack. %he ~ati~'s mumbor ~e kllrar, clalml most of ~h~se lives. Thi¢ y~r, a= mar~¥ as 1,5 m[lllo. Americans can be expected to h~ve a heart attack and ~bou% 550,000 o~ ~/~m will die, T~O lurvivor~ wi~r j~in over 4 ¢nillion Amerlcans who have a ~i~toty m¢ Th~l ~igures hav~ • . ~Pe=lal ~lgn~jcanc~ b~cause ¢l~rett~. smoki~9 ~ be~n f~rmIv implicated a= • major rl~k Ca~tc~= ~or~h~art attack, ~u~d~. d0ath amd pe pheral ¥a~=ul~r dlsea~ an~ it 9reatlV aggravates other ~orm~ of

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109 Antonio M, Gotto, Jr,, M.D, o= American Heart AssociatJon .. 3/9/83 Gotto, Jr., M,D. o° American Heart As•eel•teen .. 3/9/83

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112 Mr. WA~X~^N. ThaNk you very much, Dr. Ootto. Dr. Fisher. STATEMENT OF EDWIN B. PISIIER, JR., PH, D. Dr. FISIIER. Thank you. It is a pleasure to testify before this cora- l am Edwin Fisher. ] am here representlng the American Lung Association. I 8m chairman of the Lung Association's Smoking and ~lealth ~mmittee, Bad ~is~ ~ board me~B~T ~)f the Lur, g Associ- ation, and I hold a similar position in the local lung association in St. Louis, Mo., where I live. In my professional life, I am an associate proi~sor of psychology at Washington University in St. Louis. I an] also directer of the be- havior therapy clinic in the department of psychology there• l am : ~Jso a~socLata direcwr of our federally funded diabetes research and training cartier i~ our medical school, ! In the behavior therapy clinic which 1 direct, we have run a number of programs in health educati~ ~er the past 5 year~ ~or ::' weight loss, nutrition management of diabetes, smoking cessation, and a variety of other problems. So I have substantial clinical expe- rience [n helping people to cimsge problems such as smoking. I would like to focus on a couple of aspects of the bill before us First of all, as background, ] would llke to review briefly the Fed- e~ai T;ade Commission report ~hich was published ta May 1%1, which has been ref.renced several thnes this morning. As a behavioral scientist. I ant impressed by a particular aspect of this report• That is that a number of surveys, La~erview studies, and focus panels conducted by a variety of researchers in the pri- wte sector and uniwrsity-based departments and Government cir- cles have all come to a similar set of con¢iusions about severe • knowledge deficits in ~he public regarding the specific health risks associated with smoking This s~rt of replication of findlng~ across studies is the hallraark of high scientific respectabiliLy, I think that this replicability is de~ ~rving of our attention. I wouId like to highlight just a couple of areas of this research that are par ticularly dist ressin]g tous. " Dr. Gotto mentioned the risk associated with heart disease and smoking. It is a fact that heart disease seems to account for most of the excess ~eaths among smokers in this eottr~try, yet 32 po~ent of the public does not know that smoking causes heart disease, and 37 ~g causes heart di~.ase. Similarly, smoking causes 70 percent of chronic obstructive pal monary disease; this is fanccy talk for emphysema and bronchitis a~d a few other dise~ses, Yet 34 percent of the public does not know that smoking causes many cases of emphysema, and 39 por- c~at of smokers do not lumw this Strai~ariy with bronchitis, 55 per- cent of the public at large and 60 percent of the smokers do not k~ow that smoking causes many cases. Tngether, cancer, heart disease, and obstructive pulmonary dis- e~me account for 62 percent of the deaths in the United States each year according to the National Center for Health Statistics figures.

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116 Every year, the vohmtary associntion~ and the Government t~ gether spend somewhere between $50 and $100 million informing people about the risks from smoking. The $I00 million is certainly a very optimistic estimate, the exact f'~aure is no doubt much closer to the $50 million. • In contrast, every year the tobacco companies spend over $1 bil- llon, marketing in this land, what has recently been called the most widespread example of a deadly drug. Your children, my children, all of our children are not free to grow LIp In a country in which those seeking the consumption of such a widespread deadly drug are out spending those trying ~o fight this consumption by a ratio of l0 to 1 Whan~ you very much. [Dr. Fisber's prepared statement follows:] vzte gos9 I p I 117 Tnt~7 vf gtoa ,% -%

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. i~ 120 121 W~X~N. Thank you very much, Dr. Fisher, Mr.Bliley, I wiH recognize you first for your questions, Mr.BI~Y. Thank you. Mr. Chairman. Dr Cahaa in last years testimony a number of witnesses dis- that any causal connect on had been est~hhshod and cancer. On what do you b~e your claim of a causal connection? Or. CA~A~. We kn~w, Mr. Blitey, that excessive ~unlight cau~e~. skin cancer. We don't know exactly why, but it does, and I am sure you will ag~ee to that. We know that excessive radiation expoosure cause~ ranger, hut the exact mechanisms are not known. In the $ame way, we do know on a clinical level that cancer of the lung is largely caused by cigarette smoking along with the other cancers I have t~iready mentioned On an experimental level, I worked out a system about 20 years ago in res )onse to a point of vie'x of the tobacco industry that cancer provided by painting of cigarette tars on the bricks of ani- mals was not a duplication of the human smok g exper ence it occurred to me that an experiment be constructed in wh'c~ dot's were made to smok~. As h eonsequenge, an experiment wa'~ ~et up using 97 beagles, liy using a pump at~d tracheostommy, these • animals smoked from 1 to i2 cigarett~q a day over a period of 1 to years. In that period they were autopsied at difihrent intervals. Indeed, some lung cancers appeared although not in every be~gle. In add t on there were coronary arte changes in these animals :; ~ we as evidences of emphvsema si;leai~ar to humans. These animals do not spontaneously get such pathology. None of them were under undue stress~ so I don't think that atress w~s a f~cto~ ia the initiation of the cance~. Dr. Oscar Auerbach and 'others had reported these findings in the Journal of the American journals as well are many other experimental e~idences invoiVlng t~e use • of animals• For example, there was the experiment where exhaled : smoke was blovo~ into the cages of animals--mice--and these de- :veisped lung tumors. So that there is laboratory as well as e]inica| evidence Mr, percent of cancers are u claim are related to 8meg. ing? It looks awfully close to the ~umb~r of ~dult smokers. Flow do you e~xplaln the ~l percent of cancers ~ot ~elatod to all in nonsmokers? know that cancer is not just a black and white aft"air. There are individual resistances and there are individual the genetic basis of which is now a very imlportant f belie cancer research. The satire exposure on one inaividual the same effect in another individual. So this c~n explain some of that data. We will know more about it in time. - Mr, B~L~. Do you believe that r~tating the labol~ wilt he m~r¢ effective than the current label that wg have, which according to the Gallup poll over 90 percent o~ the people will know? Dr CallAs. 1 would say right now as has been mentioned by our that that label we presently have has become lay si- think it is a wrist slap. I think we need more than that. I will defer to my Payehologi~t friend and colleague for his opinion.

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Gq ~o 0~ 124 Mr. NmLSON. Dr. Cahan and Dr. (]otto both referred to the De- fancy test, they didn't think that the cigarettes would pass the De- laney test 1 asked a witness on the previous paget if thls w~ a new substance and he had the control to see whether it should be put on the marketplace or not, would it pass. He thought, no. You both have stated that it would not. Do you have any evidence for your rather strong statement that it would not pass the Delaney test, either of you? Dr. Gee-re. One basis for my statement is that in Britain ~ome analysis has been carried out of the addltmves to mgarettes, and there are over 100 of these. Of them, at lea~t some 30 or 40 of them would fall under what we consider in this country to be drugs an3 which are either suspected or kimwn to have some toxicity. That is the basis for my opinion that I doubt that they would qualify to pass the De]aney test. , As I understand it stone tobacco products are specificall Y exempt, not only from the Food, Drug, and Cosmet c ACt, a though many of these additives are drugs, for example, nicotine. They are also excIuded from the Consumer Product Safety Act. They are ex- ceded from the Fair Packaging and Labeling Act. They are ex- cleded from the Toxic Substance Act. They are excluded from the Federal Hazardous Substance Act. yet, we continue to sbAp tobacco overseas under the food-for peace program. So there appear to me to be some discrepancies m our • Mr. NIEI~ON. I am not asking about tha thconsi~tenc ares. I am ust asking you what evidence ~ve for yottr statement that t would not pass the Delaney test, what specifi0 evidence. ~ ,,, Dr. Gee're. Drugs that have been found as additives in the : United Kingdom; Mr. NmLSOn. One other question, if I may. Dr. Cahan, you mentioned you have done a lot of r, animals, tests on animals to verify that cigarette smoking does in fact have a causal relationship. What sort of ex erimenis are they? Are they statistically designed so that you can ~ok to the evidence and see whether or not the d fferences are significant or not? Dr. CAHA~. The one I am identified with is the one that I de- scribed which was the smoking b ,----------------c~gle experiment in which, indeed, . we divided the beagles into nonsmokers and smokers. We per- formed the same tracheotemy on controls as well, this wa~ the avenue through which smoke could be inhaled. One set, of course, smoked, and the other, the controls, went through exactly the same motions: They climbed up on the stand where the smoking was to take place, hut did not smoke. Therefore, we had a very excellent control experiment over a 4- ear period and we could compare the pathology of the lungs in ~th instances. Mr. NIeLseN. Are these data available for me to look at? Dr. C,XHA~. Absolutely. : ~ " Mr. NmLsot< l would llke to ~ee them please. ' ; You may have guessed that I am a statistics professor, and I am trying to get hard evidence on the statemenis you h, ave made• There have been a for of allte~!atlon$. [ ~a~rs°nally don t smoke. I don t believe in smoking. I belmve it is for you. But I would 125 like to see some evidence for the rather strong statements that were made. Thank you, Mr. Chairman• Mr. WAXMAN. Thank you, Mr. Nielsen. Mr. Dannemeyer. Mr. DA~EM~YZR. Thank you, Mr, Chairman. I would like to ask Dr. Fisher, if the ALA has taken a position on whether or not the sole of cigarettes in America should be banned or lent? Dr. FISHER. The American Lung Association has traditionally been opposed to any sort of a bantling or proscrihing approach to these things. We are interested in informing the public and helping individuals to act in accord with the decisions that they make for their own welfare " Mr, DANNEMEYER l don't question the causal relationship be tween cigarette smoking and lung cancer, or the incidence of cancer in humans But I am a little bothered by my colleague, Mr. Shelby, about ~he probability that, if we pass this legislation, setting up new st~iad- ardu for h~beithg evm'y pack, ib will r~ake a noticeable change in people buying cigarettes and then smoking I heazd your position on that and maybe you can help me with that problem. I guess we will never find out untess we try it, but if we try it this industry will be plagued with the cost. Is it rational to do, that is the problem. Dr. P3slt~ 1 think what is important is to understand your hill as it currently stand~. It is not just a bill for rotating warnings. It i~ a comprehensive smoking education bill. I think that is exactly what is needed. In Norway, Sweden, and Filfi~nd, in which such comprehensive smoking edacafion has been carried out, a substan tial reduction in the percentages of smokers among adults and among teenagers were realized Let me just give you examples from each of those with regard to the teenagers, because that seems to be one that we are particularly interested in. In Sweden, the percentage of 13 year-oids who smoked was cut by nearly 50 percent between 1977 and 1980. Mr. DANNEMgYER. When did they start their education? Dr. FISHSR. I don't have the data with me. We can furnish them when we furnish the survey data that Mr. Shelby mentioned eadier. In Finland, the percentage of secondary students dropped from 27 to 13 percent between 1973 and 1979. In Norway, the percentage ef males hetwem~ the ages of 15 ~d 2t dropped from 4Z to 30 per- cent between 1974 and 1980. Mr. DANNEMEYER. You claim these reductions were the result of ecineati~n? Dr. FmH~R. These reductions fgllowed the incorporation within each of those three countries separately of a comprehensive ap- proach to educating the public about the ri~k of smoking. Mr. BLILZY. Would my colleague yield on that? Mr. DAN-~M~:Y~R. I will yield. Mr. B~aL~Y. IS it also nat a fact that the cigarette sales in those f countries has not fallen. It is the same today a~ it was?

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130 Mr Watorson warned you last year that if this legislation p~ed, and I quote him, "It will form the b~ for demands for the restriction of the advertising to many other products in common usage today, as such it strikes at the heart of the market system in the United States." Mr. Chairman, I think we see the ubiquitous domino theory striking again. The fact is that the sale and marketing of other unsafe but far less hazardous producis are already subject to strict controls, as you pointed out. The dominoes, Mr. Chairman, should fall in the opposite direction. It is time that the marketing of ciga- rettes begins to b~ treated by the Government with at least as much serlousne~s a~ other even less dangerous consumer products in this society. The proposed legi~m~lon m a significant step in that direction Thank you. Mr Chairman. :Testimony resumes on p. 143 Mr. Pertschuk's prepared statement followB:] i • 131 STAT~21~"/~" (tF MI~ PE~SC~I3K CCeU( I S S I O~rER ~DI{R~L TRY.DE ~ISSION Mr. Chairman, one day early last year, I received a cBll £rmm an old E~iend I hadn't heard from IS ~everal menth~. "Well I took yo~r advice," he began, his voice w~ak but spirit~d~ "i took your advice and switched to low-tar cigare~tes, NOW my doCtorS tell m~ ~ have th~ cleanest lungs in the cancer ward." S~ve~al montha a~o I spoke with him again. ~e was ~etermined to marshall all ~f his re~aininq e.e:gy to ~ai~e f~nds for a n~tlo~al newspaper and magazine adv¢~tlsing c~pai~n to alert othe~s to the ri~k he hadonly dimly perceived. He also wa~ted very m~ch ~o t~sti~y before this CeP~11ittse to express his anger and out~ag~ at the bill~0ns of dollars that are spent and eon~i~e to be spe~t in the p~0motien 0~ cigarette sales. Nolm Halllda~ was not yo~r ordinary consumer a~vocate, I~ a distinguished ¢aree~ in Washington he bad ~epresented electric ntilltle~ ma~azlne publishers, and gzeetlng ~ard ma~efactu~e~s, and had ~e~ed as tbu ~izeetet of congressional relations for t~e Poet Offl~e. He w~'~ be here. On January ~6, N0r~an Halliday died of lung cancer. M~ Chairman. yo~ should know ~hat y~ur leadership a~ your ~erslst~c~ qave Norm Halliday hope. AS you k~ow~ I speak for mysel~ this ~ornln@. as a me~ber c~' the pederal Trade Commission, but not necessarily fo~ t~e ~o~a~ission, Though tho f~ll COmmission has yet to act on our staf£'s ~ecommendation that It~ndc~se you~ b£11~ H.R. 1824, the Comprehensive Smoking ~reve~tioo E~ucat~0~ Act, I ~ote for the

L 132 133 ,%

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136: ~nowled~e apd behlvio~ ~n ~n~ihutLng~o the decisions o~ millions o~ ~e~lcan~ to giy~ up smoking ~lnce tDe ~ geon General's l~itial hea~th ~arn~ngwa~ issued in 1964, How~veff, oven ~E the~e was evlde~ce ~hat ~h~ v~st ~o~l~y of ~eople wo01d ch~os¢ ~o ~moke afte~ the ~LskS,o£ s~kin~ were adequately conveyed t~hem. ~he prlnclpla o~ the consomer'~ ~igh~ ~m an in£ormed choice wOold still dickate ~he inclusloo O~ adequatl The industries a~feeted by the bill would p~ofe~ ~o~ ~o know the t~th a~out ~he~nlqu~health hazazdspC~ed by cigarette m~oKi~9, but would ~athez bog ~h¢ Committee down ~n an essentially unanswerable se:ie~ of e~pi~ical q~e~ons abou~ the Impa~t OE advertising. , The wi~ne~s ~or the clga~e~te oompanles~ Mr~ Ho~r~ga~, a~e0 be£o~e ~o~last ~ear that the c0r~e~t ~an~a,to~y wa~ni~g has been so s~eoe~a£u~ that no changes a~e needed. • We think ¥ou~ S~g~on ~eneff~l's warnin~ ~s wo~kln9 On th~othe~ ha~d,~the ~d~ertls~n9 t~ado as~ocla~on~' don't wor~.I ~n p~h~r Wo~s, ~he wa~olo~s have werke~ pe~octly O~ t~ey ~aven't worke~ a~ all. ~nei~De~ case, we don~t nee~ g~e o~ 137 For ~ears £he ~obac~o industry has aeaused ~he American CanCel SoCiety o£ manipulating st~istics to|ta~k th~ ~cienti~ic deck against smoking. Well~ the~e are some £~nny n~mbe~s in the data cited by t~¢ opponents o~ this leqislation to ~rove ~bat comprehensive 9o~o~nme~t smokin9 edu~atio~ p~ograms don't ~o~k. the~e is no evidence to ~u99est t~a~ either lhe Impo~itLon of ~'h healt~ wa~n~ngs~ or i~6~ed massive stat~ c~mpmlgns against smoking as ~n NOrWay, has h~d any Impact on total level~ Of ~." lemphas£~ added) ~Acc~dlng to the S~edlsh government," said M~. Horrid'an, 1~igar~te~has ~Isen ~he~e ~nn~ally ~i~e tho ~ew system wa~ i~plcment~d in 1977." ~e~phasls added] The~e are, o~ course, ~eve~a~ w~ys ~O measure "the con~0mption OE ci~a[¢ttes.' It i~ not s~rp~i|ing to find that the total numbe~ of cJgar~e~ sold in a country wl~l rlae ~hile p~p~latlo,s of ~ost c~qntries are g~owi,g. • h~s %he~ ~e mO~e cigarettes s~ in t~i~ c~n~y, than ev~ befo{e. Bot ~he percentage o£ smo~¢~s i~ the United ~tates has declined f~om 42~ OE the population in ~9~4 to a~oond 301 during tb~ peeled of time that p~bl[c i~forma~ion about the cis~ o~ ~moki~ ha~ ~een p~ovldeO to t~eAd~¢~ican people. Conk~ary to Mr. ~orri~an'~ ~nd M~. Wate~on's ass~tlon~, th¢~e ha~ bee~ ~ dzam~Ic d¢~llne in the~Of Swedish adults ~n~ yo~n~ people smoking s~nce the ins~itutlon o[ a comprehensive p0b~ic ~duc~tlon p~Og~am in tha~ country in the ° q

138 139

.,~ ~*~x L~=.,¸ . k r ~ .~ ~. ~ .~,~ ~ .... 140 141 gation of better informing the ~e~iean public about !:the potent a ly lethal ~a m o the products they sell. Fin~ll~, M~. Wate:son wacned you last yea~ that if this lislatio~ pas~ed~ ~it will form the basi~ for de~ands ~o~ the strtction of th~ a~vg~tising ~or gany other p~oducts in co.on le today. As such it strikes ~ the ~ea~t Of the ~arket stem o~ the United States." The ub~gultous ~domino~ theory str£kes again. The fact is sale and ~a~k~tlng o~ ~the~ unsafe bu~ ~ar less hazardous products are alr~sub~e~t t0st~ict controls, The Chalrman, should fall in the cppOslte dlcection. t's time that the m~fketin~ o~ cigarettes beglns to ~e treated I~ t~e 9over~nt at lea~t as ~eriously as othe~ dangerous in tb~s ~oelety. Thaproposed leglslation ~S a ~:~ignlf[cant step in that direction. M~. Chairman, yo~ have two pola~ ~dels to choose f~o~. I ~,baa the 0ppo~tunity 0£ participating in a National Smoking and i ~ealth WOrkshop in Sa~tlago~ Chile o~ the smoking education ~0grams is ~hat ~ountr7. As you know, Chile ha£ often been ~ted as the r~odel of a free and unfettered ~a~ketpla~e. Indeed anyone ~ho i~ nostalgic fo~ ~n ea~lle~ e~a of unfette[ed ~igarette ~dvertisln~ can ~ind aggressive, romantic cigarette ads ifi abundance on ChLlean television -- even on the p~blleally hannels. In Chile public health programs o~ s~oking and hea~th a~e earnest, a~d slowly growing, but they ~e ~eeble ~0mpa~ed to t~ose here an~ ~n Europe, And ~n the most ~$eent |t~dy o£ smoking a~o~g teen~ge~s in Chile, a leading ceseagc~er

142 'i # II k 143 Mr. WAXMAN. Thank you, Mr. Pertschuk. Mr. Sharp. STATEMENT OF CHARLES CRENS]|AW SIIARP Mr. SH^R~. Mr. Chairman, my name is Charles Sharp, and I am appearing here today to testily' in support of H.R. 1824, the Com- prehensive Smoking Prevention Act ~f 1983. 1 am currently president of Charles Sharp Associates, a manage- ment consultant firm in Los Angeles which specializes in counsel- ing advertising agencies in various management capacities. My clients include companies from the top 50 advertising agen- cies in the country. I have worked in the advertising industry for over a decade in various management capacities. 1 have dirtwted the advertising campaigns of several major consumer products that are nationally distributed and known widely. I want to thank Chairman Waxman and the members of the sub- committee for asking me to present my views on the need for and the merits of H.R. 1824. In my testimony, I would like to focus on three basic issues, First, advertising plays a significant role in not only maintaining but also expanding definite market segmente for cigarette smoking in this country. Second, from the view of basic advertising principles, the current trend in cigarette advertising, the capitalization on the growing in- terest in physical fitness in this country, is counteractive to the current warning message, and the proposed rotational scheme in H.R. 1824. Third, the system of rotational warnings will not impose a sub- stantial administrative or financial burden on cigarette advertising. First, I would like to discuss the role of cigarette advertising in this country. In 1980, cigarette advertisers spent approximately $1.2 billion promoting their products. Between 1975 and 1980, these advertisers more than doubled the amount of money they spent on advertisements in newspapers, magazines and billboards, which en- abled them to become the dominant force in all three media. As the chairman of the Board of R. J. Reynolds recently told se- curity analysts at a November meeting, and I quote: "The tobacco in the United States but around the world as well. R, J, Reynolds will continue to actively and ag- and the rest of the Today R. J. Reynolds and Philip Morris, the two giants in the in- dustry, are fighting for fractional market share points which trans- late into millions of dollars in sales. Collectively, these two compa- nies own two-thlrds of the cigarette market in the United States. More than $750 million were spent i~ 1981 by these two companies alone to advertise their cigarette products. ' According to a recent article in Tobacco Marketing, Author Mar- garet LaRue, a tobacco industry observer and a reporter for Adver- tising Age states: "Old fashion price competition has gained new importance in brand extensions and new product introductions. The tobacco companies are outdoing each other with coupons, tw~- z,h

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5I 53 53 146 Te~ ~ Icr~ny Ct C;41~.LES C~L~NS[~q $~IARP of Charles 8hB~ Ino AIs0~lat#a 147

149

150, 151 While boxed ~aneer marnlng I~ t~e right hand ~otner him stained ~e snow yellow• The refl~tlv~ pleasur~ of t~b~n@ pe~vld~s the ad. It unLfies the desire ~or m ~r~eet Chrl~tm~ WJt~ the eKperlen~e ~f smoking, Th~ ~ur~eon Gener~l h&I no e~mn~e ~ga~nst thL~• In ennttm•t, the di~e~s© sp~IfJe ~ota~ion•1 w,~Lng syBterit pr0pGsed b~ H•R•IS~4 I• ~h f~J~e likely ~o ~e effeetlv~. Th~ ~•e of ~everal w~rnings wl]l decrease the llkellho~ that ~n~ Qf the ~r~|s~es W~II "we~ Out=• All ~| the prnposed war.iNgm •~ b~ both not~ed and per~elv~d ~s belng persQ~lly reJev~nt. I am ~vln~ed t~st t~e~e ~•rnin~s wlll ba e~leetJve In ~or~m~ni~ati~ lheLt Jrn@Qrtanl Inf~rrnatl~n~l me~s~es• Finall~ ] woul~ li~e ~0 m~dre~s sn~ o~ the ~r,eti~al taken b~ the bill In permitting Bdv~lisers Wi~e latltude in hOW ~hey 0ar~¥ nut t~e rotJt[on~L wernlng requlr~m~n~ as ton~ as e~h wa~nlng appear# an equ~l nun~ee nf times on e•~ brand ~f ~1~ettes and in all ~h ~dvert~emcnt~ within • twe[¥e n~nth Bnd the te0hnlca] ~bLems ~od the ~Ini$~rative b~rdenB no.- exJuL~nl. ~en ~e warning is ehmn~ed ~t the ~me time t~ ad is reade~ ~he id will no~ ~st ,my r~ore to produce than it w~uld ~t th~ present t~me. This I~ is li~nifi~ant be~ ~dvertisea~ ~re ~h~n~n~ ~er¥ freq~ent!~ ,~d • •In~le ,d first never tuns unehange~ ~o~ /r~fe than 6 quarter of a year, 7hus~ in thl v,$t maJ~[y of t~e ea~e$~ the ~d~pti~n oC H,R•I824 will hBYe N0 e~teet Whatsoeve~ O~ the ~o~ O~ ~rodu~i~g elgirette idv~rtlser~nt•. ~ve~ i~ t~ ri~e ~se In Which ~ W~nlh~ WOU]d ~e eh,n~ed in

162 an existi~ 8dI no pPoblema are pos@d. Te~hni~mlly i~d [Pom The 8tundpDJ~ of co~t~ t IS a 8Lrap e nmCter to rA~l~ee what il pFln~0d i~ ~he ar~n]l ~rCULSFj bla~k ~nd white box ~ontaining the health warnLng. As a~o~tt~r Qt f~tl sdvertJser~ Teg~lJr]y rae~e changed Jh ong¢ing ads. In nta~y instane~r one advertlse~ WLI] make ~bange~ ~n u ~i~gle ~ Whl~h ~p~a~ in a single Issue o~ hatLon~L ~ew~p~per, such ~s Time or N~ws~eek. to ~est ~rget differsnl geographi~ f¢~Io~8 of the country. A~in, ~h~nging the heaLIh w~[~g st lhe a#~w~ time the a~ ~s being ch~nge~ for ~om~ ot~er p~r~ose ~mpo$~ no ad~i~ion~] cost or ~ur~e~ Dn ~e adverli~er. The same i~ ~rue l~r outdoor ~ove~lSLng and elgarette p~a~es* There ~ ~w~ ~a~]~ forms of outdo0r 8~ billboards ~e f~o~ poster piper aria ~nt~d bilLboards. I hay0 worked exzen~]Vel~ WLth ~Jl1~oard adv~r~Lng. ~OS~ bJil~Oa~ ~onCr~¢ts cell I~ billbca~d~ m~de from a htm~ber o~ 8~i~el o[ ~oster ©nsnge~ sz least every I~ TO aZX wee~s. Rot~tlon o~ the he~Ith w~rn~ng s~ t~e s~r~e zJme ~ poster ~per la ~elng ~hanged L~ szmpl~ ~ lqv¢Ive~ n~ eo~. I~ addltlon billboard ~ontraets also often requzre ~b@ bJ~Ib0ard oomp~n~ to rotate dl~erent sds ~J~ong J@v~ral bLl~bQar~a ~o increase their e~p~sure, ~h0~eby, [urther ~er~)n~rstlng ~e eaae with w~Lch the rot~tLonil w~r~Jng ~¥sL~ ~ o~ L~le#~P~nt©d. It s~ould aLSQ be ~oted [hat ev©n p~nt~ bil[boi~ds sre repL~nTe~ no le~s ~an ~wo ~o three tzme~ a year ~nd ~mpllan~e W~th L~ requlrements o~ palnteg b~l]bo&~d~ shoUl¢ po~ ~o problemS. To unce~Jtan~ how ]l~lle pro~)ernH*R*lS~4 poaes |o~ ~e 158 t~nu~a**lur~.~ Qf aJgSF@lI0 pscka~c~Sp il [i ~elpt~] to undc~Fstlnd how the~e p~knges ~Fe p~inte~. PscksSe~ ~re not ~rinCed one it • t~me. T/~ey are ~l"Jnted b~ • ~]~te which ~lim~ o,~| s L~[~ nm~oer ~,~ packages 8t ~* 8Ingle ~lw~. TO ~01y wJlh HJt,]824 m~nuf~etuter ~o~ld aLnk~]~ uae• ~l&Ie wi~ich eontnin* all o~" t~o warning rae~s,*ges and ~leh would ~t~onp out ~pgroximate]~ the ~ number of packages With each walntng st the s~m~e ilm~. II the Jmg~len~nI6~Jon of H*R.]8~4 gave these printe~a su~II~Jent ttme so that t~i~ new prin~ing plate ~ould be J~tro~uee0 at the ~irne the #~ o]~ one wea~* out, the eogt o~ eompHanee woul~ be ml]li~[. low ~osl rr~ho~ **or e~un/e~ting t~e heallh b~ald8 ~f smoking to the American p~blde, : I wi[] be h~ppy ¢o ~nswer ~y que~tio~. Mr. WAXM~N. Th~nk you, Mr. Sharp. We will have questions after each member of the panel testifies. Mr. Wat~rson. • STATEr~[ENT OF MICHAEL J, WATERSON i Mr. WATZRSON. I am the research director of the Advertising As~ soclation located in Londom I am a member of the British Council for National Academic Awards the founder and editor of the Jour- na of Advertising. ~nd the author of more than 90 ~rtieles~ mono- graphs, and books relating to advertising, particularly in this area. I would llke to submit my Full curriculum vltae, together wlth a copy of my latest book, "Advertising and Cigarette Consumption", "~ for the record. The function of the Advertising Association is to see that the in- terests of manufacturers, advertising agencies, and the media are representing in the United Killgdom and European Parliaments, and to insure that issues such as the one under discussion today are debated fairly under the light of all available research ew- denee. We have worked very closely in the past with the European Eco- nomic Council (EEC), with the British Government, and with con- sumer groups on questions concerning the ~dvertislng of drit~k, ad- vertising for children, and the i~cidence of false advertising claims.

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186 reduce smoking by restricting tobacco advertisement has been un- s uccessfu~. The experiment has been t~ied an~ it h~ ~il~." I wou~d alsQ like to read you a quote from The Times Moscow correspondent about a different hut exactly parallel area. This i~ talking about I{ussla, "In spite of a campalg~ and stricter ~aws on the sale of drink, in the press, at school, on the factory floor, the R~s~a~ appear powerless against a wave of vodka and wine that is washing over the country." In all probabllity, ladles ~md gentlemen, ! think that if this bill Fhank you. Testimony resume~ on p. 183] [Mr. Water~n's prepared s~a~ement ~ol~ows~ y. 157 TEST~O~Y OF ~I~L J, ~TEP~O~ FOR T~E E I~E~TRE V~IrTEE 0 E~ER Y k~ C~KRC~ Ka~h 9, ~983

159

160 Advertising and Cigarette Consumption by M. J. Waterson M. A. Research Director The Advertising Association o, Published by The Advertising Association 181 This booklet is oneof a series of occasional papers produced by the Advertising Association. The Association hopes that it will form a useful contribution to the continuing debate. Comments on the views expressed in this paper are welcome and should be sent to M, J. Wuterson, Director of Research, The Advertising Association, Ahford House, 15 Wilton Road, London SW1V 1NJ. First Edition Published August 1981 Second Edition Published March 1982 Third Edition Published December 1982 ~) The Advertising Association 1982 All Rights Reserved ISBN 0 902878 32 6 ,%

162 CONTENTS ; A r (% , , ,, ~) Summary of Conclusions , , , ,, I hdraductlou 6 11 The Re e of Advertising ~ 6: Conversion to filter cigarette~ ' 7 Conversion t o low.t~r brands 8 Other consequences 8 III Adve~tislag sad Cousumption , Research Evidence Evidence from Advertising Bans Evidence from other Markets Conelusion IV Referenda V Appen~e~ 10 11 12 16 21 24 1, 163 SUMMARY OF CONCLUSIONS A cigarette advertising ban would deprive consumers of impor t slat product informatlon, Research evidence shows clearly that countries that have imposed a ban on cigarette advertising have a much higher proportion of smokers who smoke non-filter and high-tar brands than countries where product advertising is allowed. AdverL~s~ng does ~,ot stimulate or malntai~t cigarette consumption levels. "Research evidence shows tha~ the influence of ud'- vet ~ising expenditur~ on large mature consumer marke~ i~ negBglbie, ~tber tba~ a~ t~e bra~d teed• In particular, detailed econometric studies of the UK clgarette market show that advertising expeJadlture has not had a significant influence on the total size of the cigarette market ~r the past, 20 years• , This evidence is reinforced by other studies of the effects of the cigarette advertising bans tllat are currently in force in a variety (if countries. The most recent study concluded "every country in the world that has tri~ to reduce smoking by restricting tobacco advertising has been unsuccessful". Hence a cigarette advertising ban would be both futile and damaging to the interests of consumers, in addition to infri~glng seriously the 'right of manufacturers to inform the public about legal products, and the right of consumers to full ininrmation about freely available: products. 5

164 : :! I~,INTRODUCTION' : : The advertising of tobacco products has been critic[sad by the anti-smoklng lobby in recent years on the grounds that ad- vortising not only sel]~ brands but also supports and expands the total consumption of toba~co products• . , This paper attempts to clarify the impact that advertising has had on the market for clgarettes in both the ~K and in overseas markets for which data is available. ~ , , : II THE ROLEOF ADVERTISING ,i The market systems of the free world are dependent for their effectiveness upon the existence of competition between nlanu facturers for markets. Research studies11~2~ have shown in recent years that denying product information to consumers Iwhich effectively limits competition) Fan adversely affect tim functkming of the market system to a very considerable ex- tent. Fur [her evidence comes from those economies, mainly in totalitarlan countries, where advertising is prohibited. Such economies are notorious for the absence of choice, poor quality and the genera] low-a yailabllity of consumer goods. Experience of the de-regu arian of advertmmg in certain markets [a the USA has also demonstratcd vividly just how important to the consumer the freedom 'of the producer Lol advertise really is. For' example. The Economist (9/12/78 comnlentmg on the effect of the ending of an advert s ng ban in the United States. ~tated: " : "In the legal profession (in the USAI. the use of un- polished and homemade, advertising by nQ more than three per c~nt of lawyers h~s been e~ugb, to start a small. revolution in tha;practlce of law. Prices for simple' procedures, sucb as wills and uncontested divorces, have been cut by halL" ~ .... 6 5 ~5 165 The importance of advertising to the'functioning of the marke~ system has also bead demonstrated ill tile speeif/¢ case of the tobacco ind~lstry. Several coulltrles have banned cigarette advertising in recent years, and analysis of con- sumpt~on data from such count ries shows clearly t hat.nit hough total consumption trends appear to remain unaffected, the lack of prodllct information does have a major impact oil consumer behaviour in tg(t~ identiflab[e respects. Coaverslon to [liter clgare ties First. it is obvious from the dat,o tha~ an ad¥~r tlshlg ban slows down the rate of conversion of smokers frnm plain to fdten~d cigarettes• Table 1 below shows the proportion of filter cigarettes smoked by consumers in countries with ion~ standing advertising bans contrasted with other countri~ where advertising is allowed. The proportion of smokers smoking filtered clgare~tes in the countries banning ad- vertlslng is on uverage¸ar0und 65 per cent whereas in otiler countries where advertising ~s still allowed, the proportion is o~t average over 99 per cent. Table 1 Countries wilhlong- % Filter Other % Filter term adver tisiag bans 1979 Countries 1979 Italy 89 Japan 98 Norway 81 ' Australia 97 Hungary 70 Canada 96 East Germany 70 UK 92 Poland 44 USA 91 USSR* 30 West Germany 88 *excl. papyrossi Source: Lehmann Brothers Kuhn Reasearcb New York. Maxwell Estimates, 7

............. ~ ....................... ,1•. " 166 Conversion to low-tar brands ~ r The second main result of •denying consumers product in* formation on the tyl~s ~f ¢ig~ette ~vailabte, is to stnw down the rate of conversion of smokers from high-tar to, low-tar products. The development in;recent years of the low-tar cigarette market hss been led by the tobacco industries of the U K, the USA and Germany. In the USA some 50 per cent of the cigarette market is now accounted for by brands with a tar delivery of 15mgs or lower; in West GermaNy the figure is nearer 70 per cent. In the UK, in 1971 there were no brands on the market in the low-tar group, but brands with a tar dellvery of 16rags or lower now account for more than 28 per cent of total sales. Full details of the changing structure of the UK market over the past decade are shown in Table 2. There car~ be no doubt that changes of the magnitudes shown in Tables 1 and 2 could no~ have occurred within such a short time span in any of these countries witbout advertising support, There can therefore be little doubt that a ban on tobacco advertising would have consequences whigh are gnnerally ~greed to be unde~ir ~ble. . ~ , Other Consequences One further imp~vt.aat coaeequer~e ~f a (~bacco advertising ban is that such a hen would ahnost inevitably lead to a build- up of pressure to ban advertlsJng on a wide range of ~ther products thought to be potentlally damaging to consumers. If ~ tobacco advertising is banned, an extension of the same dubious logfo might lead to a ban on, say, car advertising (since cars are associ0ted with 100,000 deaths and serious i~uries each year in the UK afoneL ¸' The logical conclusion of a cigarette advertising ban would therefore be ~he ending of the freedom ~o promote pxvducts , ~ecountitlg for a very large proportlon of ~onsumers' ex- penditure and consequently a massive reduction in ~he el-' ~ecttvsness o f our market system. ~ 167 k P ~g ~ u m ,,,o

168 Ill ADVERTISING AND CONSUMPTION Many books and articles have been written analysing the role advertising PlaYs inl,stiraulating the sales of individual products and brands, and much research effort has been devoted over the years into attempts at determining the ef- fectiveness of individual advertising campaigns. However, very little serious effort has gone into analysing the impact of all advertising expenditure on total sales of all products, either at the level of large sectors of consumers~ expenditure (such as total sales of tobacco products or alcoholic drinksh or at the "tetalecouomy"levei. : i: :: Over the last few years this lack of knowledge has' been partially rectified by a number of studies, one of the mo~t important of which is an analysis of the impact of advertising on aggregate consumptlon by A~hley, Granger and Sch- malenseeqzb. This study suggests that correlations found between advertising expenditure and total consumption levels in some countries, are more likely to reflect the fact that in- creasing "wealth" leads to more advertising expenditure by companies competing for a share ~f the enlarged market, ratber than the suggestion that advertising expenditure is a major determinant~ of total consumers' expenditure. ,Other analysesldJ~* -- and indeed common sense -- back up this view: if it were true that advertising expenditure determined con- sumers' expenditure, then it might appear logical lif futile) to argue that poor countries should merely increase advertising levelstobecomericher. " " - [f advertising expenditure in total is not an important in- fluence on total consumers' expenditure, it is likely that many individual mature consumer markets within the overall economy are also not affected by advertising expenditure levels. In other ~ords it is probable, from a theor.tical point of view, that in a developed country such as the UK, total cigarette advertising does not, or certainly does not necessarily, influence the overall level of cigarette cow sumptinn. 10 I Since all cigarette advertising is brand orientated, this theory is who y plausible but does sometimes cause confusion in the minds of people unaware of conunercial realities. It is often claimed that, if advertising does not expand the total merger for cigarettes, it is obviously wasteful, and should be banned for economic reasons. This view ignores the fact that it is the competitive process of striving for market share that is at the heart of our market system. As someone said many years ago, "the Russians have fantastic athletes because they compete, and awful cars and fashions because they don't". The view that cigarette advertising does not necessarily stimulaLe cigarette consumption, and that handing ~dvertising will therefore do little to reduce cigarette consumption, is backed up by a variety of evidence |rein a number of product markets from all over the world. Research Evidence , , The main work done in the UK was published in October 1979 by the Metra Consulting Group1% Metra's approach was first to reappraise the limited previuus work in this field, par- ticularly McOulnness and Cowlin~71, second to construct new econometric models of the cigarette market covering a twenty- year time-span, and third to apply an alternative analytical procedure. Into tli~ir analysi~ they built ~ r~nge of variable factors including product price, coupons, disposable income, advertising expenditure, and government anti-smoking ad- vertising expenditure. Metre coneludvd that no evidence had been fouad of a algniflcant ~ssor~a~lon between the total level of media advertising and total cigarette sales. A variety of other studies have been produced in recent years which attempt to assess the effects of cigarette ad- vertising bans on cigarette consumption. For example, Hamilton~ at the 3rd World Conference on Smoking and tIealth, outlined a study in which the effects of cigarette advertising hans on per capita consumption in ten different countries were statistically measured~ Overall the author 11

170 concluded that in none of the countries exanllned had the aaver~Jslng bans achieved any measurable stl¢cess in t~rrns of reducing the level of pcr capita rigal~¢~e constlmptinn. Other similar studies by Levitt'~ and Bergler"° have arrived at idcn tical conclusions. Bergler for example states: , " "A}I the available data ~]nt ~o one conclusion, and one ' conclUSlOn only. Imposing a ban on cigaretta advertising -- Jrrespective of the media forms to which it applies and irre.spect[v~ of the time v~hen it comes into force -- is not an effcctlve way of s[owing down the rise in cigarette ~msulnption. still Jess a mealls of pFoduc~ng a dec]in~ in ~onsumptinn. The available evidence tends to suggest Lhet any deceleration in the growth of consumption is ~ore ]ih~]y to be due to changing public awareness in matters of health, and possibly also to the effects of anti- smoking campaign~ Finally, the most recent survey of allL'~', produced by ZAW la f~d~ration of advertising industry trade associations in (~rlnanyl, ~Jv~r[/l~ Qa~a from 14 cotln~rle~, concluded that "ewry c~untry in the world that has tr~ed to ~oduce smoking by restricting tobacco advertisements hes been unsucce~sfol". Evidence from Advertising Bans L One of the most interesting areas for researching the effects of ~igar~t tc hans is the Communist Bloc. where all countrlcs have a comp]~t~ anc[ eff~ctivv G~vcrnincnt imposed bun upon all forms of above and below the line advertising and baw bad so for a long period of time. (For example, in the U.S.S.R. for over sixty years.~ The most recent ban was imposed in Poland in 1972, although 'even heforc" 1972, rcstrictivns were con- sidorahle. Most of these countrles cnnsum~ other tobacco products besides manufactured c[garettes:'However, in all • Pase~, cigarcttcs are the predominant formof tobacco con. sumptlnn and a~e the best indicator of that consumption. Although accurate statistical infdrmatinn upon the Corn- muinst Binc is cliff/cult to obtain and. d~pending upon the 12 O 0 o 171 ~om ~mm ÷÷+t++++ 13

172 source, dces vary Itobacco information is no exception to this J, reliable information upon' population and total cigarette consumption is available from a variety of sources, Small differences may exist between=the data shown in Table 3 and data published at. other times in other documents, but the differences do not effect Lh6 issue because whichever data is used, the ~refids and Conclusions from them are the same. It can be seen from Table 8, that in every country shown, there has been a significant increase in cigarette consumption between 1970 and 1980, ranging from a low of 12% in U.S.S.R. to a high of 74% in Bulgaria. If oae examined the situation over a twenty year period, ~he pattern is the s~me. The average increase in cigarette consumption over the per J~l is 23 % but, if one omi6s the U.S.S.It. where supply problems have almost certaluly depressed consumption, ~he aversge increase for the other eountrles is 49%. |n comparison the increase in cigarette consumption in the 'Free World' over the same period is 95%. which is lower than the increase in five of the eight Communist countries although greater than in three countries. In other wurds. ~b~cc~ c~mp~io~ ie almo~ Cer taltlly ~owlng faster in the CommunisL Bloc where therelsn't any advertising than in the Fr~ World where thereis. It can a]$o be seen¸ that in "~very Communist country, cigarette ~sumptlo~ has 5roan at a slguif~untly higher rate than total population -- on average some three times higher -- a fact which is reflected by the continuou~ increase in per capita consumption figmres. Finally. Table 3 also shows that the filter penetration of the~e countries varies from 30% to 97% with an estimated average of 49%. This compares with an ' average penetration level of 86% in the Free World in 1980. No detailed information is available upon the tar and nicotine delivery levels of cigarettes in these Coun~rle$. However, from various analyses done by Western manufacturers, it is likely that delivery levels are significantly higher by up to 100% in some instances. The penetration of lower delivery cigarettes -- 15mg. of tar and below -- is insignificant within the Com- 14 179 munist Bloc, whereas such products account for over 20% of consumption in the Free World. Other evidence comes ~om individual marke~a in the Free World where advertising has been banned or par tiaUy banned. For example, in Itaiy, a total ban on cigareL Le advertising of all for~ was introduced in 1962 to protect the domestic industry from import penetration. The consumption figures are shown below in Table 4 ~The data is also shown in graph form in Appendix I). The 78 per cent growth evident in ~he market since the advertising ban was introduced certainly dues n(~t suggest the ban was successful. Table 4 Year 1958 1960 1961 19626-------~advertisin 1963 1964 1960 1968 1970 1972 1974 1976 1978 1979 1909 Italian Cigarette Consumption Manufactured Cigarettes~ ImilHons~ 44,906 46,313 51,864 ban -)55,626 57,154 58,828 64,645 fl8,454 69,534 74,165 67,590 89,790 88,800 96,760 98,600 Fulther evidence comes from Norway where a law, brought ' into effect from 1st July 1975, prohibits all forms of tobacco 15

174 Table 5 Year 1970 1971 ,- 1972 1973 1974 1975(----advertimnghan------)l,755 1976 1,720 1977 1,957 1978 1,851 1979- " " "" 2,042 1980 ~ ~' , 2,227 Norwegian Cig~ret t e Consumptlo~ ' Manu/'d Smoking ' Cigarettes Tobacco ImiLlions} (tonnes) ' 1.831 • 4,042 1.782 4.004 1.862 4,334 1,842 4,975 1.735 ' 4,493 4,580 , 4,997 4,401 4,188 4,335 4,427 advertising and promotion. In addition an anti-smoklng ad- vertising campaign (equivalent to date to the expenditure of approximately £20m in the UK) was launched. Trends in this market are complicated by the prevalence of hand-rolling tobacco which accounts for some two-thirds of total units smoked and which is an element made volatile by tax increases. However it can be seen from Table 5 that fluctuations in consumption over the past ten years have been very small. In other words, the market in Norway, having reached maturity by 1970, five years before the Tobacco Act, has. like many other fully developed markets, largely Battened out. The constant factor of the advertising bml since 1975 has had no discernible effect on consumption. Evideuee from Other Markets All these statistics and studies suggest that advertising bans do not affect total consumption levels in mature tobacco lnarkets. Further evidence comes from other markets such as 16 175 the drink markets where examples of advertising hans occur. and from other types of research aimed at pinpointing reasons why young people st~arL InJ smoke. The following references give some idea of the vdry large anmunt of evidence now available. For example, Smart and Cutler"~' in a review of the data deriving from the total ban on alcohol advertising in British Columbia concluded: "The data presented lends little support for the view that the British Columbian advertising ban reduced alcohol consumption. Both the yearly and mm]thly analyses of beer, wine or liquor show no substantial effect of the ban". Ogbourne and Smartc~' considered the effects of restrictions on alcohol advertising in Manitoba, Canada and hi the USA using statlstlcal data on alcohol consumption. They concluded: "It is unlikely that re~itrictlons on advertising will red~ce eonsumpt/ml." Pigtman and Lambert"4' in a massive review of available literature and evidence concluded that advertising has not been found to have any significant impac~ on the behaviour of either youths or adults vis-a-vis drinking. On the other hand. they did find evidence that advertising influences the brand preferences of those who are already beer drinkers. For example, they quote a 43 per cent gain in barrelage of one brewer in 1976 ill a year of extremely small growth in the US beer market• Another illustration of the ineffectiveness of banning ad- vertising comes from France, where the advertising of whisky has been prohibited since 1957. In that year imports of Scotcb whisky were 157,(]00 proof gallons. In 1979 they totalled 6,294,000 proof gallons. Whatever iL was ¢bat caused the in crease it certainly wasn't advertising, Detailed econometric studies back up these observations. For example, a variety of studies show that advertising ap- pears to have little impact on large sectors of consumers' expenditure in a variety of different markets. One of the most 17 ° b,

176 O5I i¸¸, extensivesurveyswasdonebyLambm, coveringl08br~nds arid 16 classes of product~ in ~5 markets. The author con- eluded that advertising seldom increases th~ primary demand for a c]ass of products. A number of other major studies, for example by GrahowskiII~p, have arrived at similar conclusions. Many studies eoverlng individual industries are also available. For examp]e, Walerson and Hagann~in a detailed review of 20 years~ dat~ covering 1959-78 concluded: "The results from the ana]ysjs strong]y suggest that advertising has no measurable effect oil total edcoholl consumption, and therefore that it has not beBn a factor in the alcohol market Kcowth of the past two¸¸ d~c~des." Duftyel~ in another detailed econometric exercisecovering the factors affecting demand for beer. spirits and wine in the UK found that "there is notfong in either the results of our sl~tis£ic~l research ~r m ~hose ~f ~ther ~e~tigaLi~s i~ this area which could cause anyone to predict with even a modest degre~ of confidence that a reduction in drink advertising wouJd produce anything¸ more than the most marginal rcduc lien in per capita consumption of drink in this country". SchweiLzt~r, InlrdigsLor¸ and Salehl.tlgJ in an econometric model¸covering American data, found that "a prohibition of advertising would lead not to a general reduction in alcoholic beverage consumption, but rather to a shift ~nm beer con- sumption to spirit~ consumption". Other Research Evidence •. ~ it i~ also worth menLioning the fact that the assumption is often made by those who propose eigsrette advertising bans, thu~ advertising retest ir~fitae~lce y~ng people ~ ~mQke. Research conducted since" the issue arose and bans were enacted, however, does not support this argumellt. On the contrary, an overwheimfog weight of evidence indicates that advertlsing is not a significant intfoence on the decision to smoke by young peopie. For example L~vitt~°~ concluded: 18 177 "Fifty thousand school children from the fifth to the tweIfth grades constituted our toteI sample. Almost nine thousand youngsters who smoked gaw us their reasons... A majority stated that they smoked for pleasure, for emotlonal improvement, or because of the influence of their friends, I cannot recall a slngle respondent who suggested that he had been influenced by television advertising. This is generally in accord with earlier findings. ...it must Ipe/ admitted that the available surveys furnish no evidence that television cigarette commercials influence smoking behaviour a mong young people." Kaplant~" arrives at a very similar conclusion: '... there ~ 'nsulhctent psychofogicai evidence.., tha~ cigarette advertising is a significant factor in inducing young people to smoke... A great deal of evidence points to the conclusion that advertising is one of the least signilicant factors inducing teenagers to smoke." Similar results derive from studies of other industries, For example, Strickland,12~j using a rather sophisticated methodology, found "advertising was shown to have meagre effects on the level of consumption, and these effects rarely translated into effects on alcohol problems,,. In contra~t to the advertising effects, a set of interpersonal influences, especiaUy differential peer association, was shown to have significant impact on both consumption levels and alcoholic at)use hehaviour... Reduci~g the amount of advertising.,, is hkely to have.., virtually no knpact on the prevalence or severity of alcohol problems among teenagers.., and suggests that advertising restrictions will be even less likely to influence abusive drinking behaviour in the general population", ~ t~'¸

i certain parts of the USA soft drug usage by young people now exceeds usage of cigarettes. Even in the most liberal of US States it is of course ngt possible to advertise soft drugs. In addition to these indivldua] studies, several academics have attempted to summarlse all avaiIable evidence, and to derive conclueion~ from the balance of evidence relating to the im pact of advertising on mature markets, such as the alcoholic drink" and tobacco markets. Concluding one such study. Weisli'~:~J found that "restrictions on publicity and advertising are not judged likely to have a major impact on drinking or even on the recruitment of young people to tho drinking population." Van Iwaarden'~4~concluded "a ban on commercials will not have any dlrcct impact on the overall u~e of aIcohol. Even in the long run the effects probably would be hardly substantial". Chlplin, Sturgess and Dunning/z~J in the most recent of all studies, concluded "the causal relationship between ad* vertlsing and aggregate demand is still a matter of con- siderab[e controversy, hut the Invest careful research using sophisticated estimation procedures does tend to suggest that any causal effect is rather weak. Thus it seems to remain unproven that advertising has led to any~marked increase in aggregate demand in general, pr in the demand for either tobacco or alcohol products... It must be recognJsed that advertising could well be the wrong target in seeking to curtail consumption o~ products such as cigarettes and alcohol.., it dues appear that sd far there is little convincing support for the ar~ament that elianges in total consumption of ~kese prodpcts are caused by advertising. Indeed, advertising ap- pears to bare gurprlsingIy littie effect on the total con- sumption of both cigarettes and alcohdl." 20 . 179 Conclusion Despite the gr~at deal of propaganda produced by the ant,i- smoking lobby on the questlon el cigarette advertising, it is clear that any impartial analysis of the vast mass of evidence available suggests that advertising bans simply do not work, There are good theoretical grounds why advertising bans should not work, and this theoretical basis for rejection of advertising bans is backed up by a great deal of empirical evidence from both the UK and ~broad, and from the tobacco and other large mature markets. IV REFERENCES 1. CADY, JF.. 'l~estricted Advertising and Cbmpetltlon,' AEI Pt~b[~c P~iicy Reseat oh, kV'~shi~ gt~n D C, 1976. 2, LEE BENHAM and YALE BROZEN, 'Advertising, Cam petlti~ll, and the Price of Eyeglasses', Journal el Law and Economics. "v'c 1. I VI2), October 1972. 3. ASHLEY, R., GRANGER, C.W,J. and SCHMALENSEE, It., 'Advertising and Aggregate Consumption: an Analysis of Ca~aseiity', Economet~ca. Vol, 48. No.5 July 1980. ST~JRGESS, B.T., 'Dispeillng the Myth: the effects el total adver rising expenditure on aggregate consumption' Journal of Adt)~fli~i~g, Vo].l. No.3 pp 2012212.1982 5. KYI,E, P.W. 'The impact of Advertising on Markets' Journal of Advertislng, VoI.1, NO,4,1982. 6. Metr~ Consulting Group. 'Tha l~elationship Between Total Cigarette Advertising and Total Cigarette Consumption in the UK', October t979, 7 MeGUINNES~, A. and COWLING, K., 'Advertising and the Aggregate Demand for Cigarettes', European Economic l~eoiew, 6, pp, 311-328,1975, 21

,180 8, HAMILTON, J.L. "The Effect of Cigarette Advertislng Bans on Cigarette Consunlption~ Smoking and Health. Proceedings of the 3rd World Cola erence on Smoking and Health, New York Ciby. Vol II, pp, 2-5, 1075. ' 9. ' LEVITT, E.~,, 'The T~J Cigarette Ad Ban: Ur, e~epecte~ Fail. oat ' World Smoking and Health, 2, ppi4-8, 1977. 10.' RERGLEIL R. 'Ad~.~tlslng ~.nd Cig~retA.e Smoking: a psychologlca] study' translated by Rasmussen, B.. 1981 Item : , . . t. s the original e&tton Z~garcttenwerbung und g;garettenkan um puhlished by Hans Huber. 11. Zentralusschuss der Wetbewirtschaft EV, Postfaeh 200647, Villiehgasse 17, 5300 Bonn 2, W, Germany. 1981 -- Quoted in Campaig~ 27th March 1981, 12. SMART, R C, and CUTLER, R,E,, 'The Alcohol Adv~rt2sing Ban in BriLish Colombia: Problems and Effects on Beverage Consumption'. The British Journal ofAddietlo~, Vol. 7, pp. 13- 21,1976 13 OGHOURNE, A.C* and SMART, HG.. 'Will R0strietions o~ AIcnhM Advertising Reduce Alcohol Consumption?', The ~ntishJournal~fAddictlon, VoL 75, pp. 293-296, 1980. 14. plTTMAN. D,J. and LAMBERT, M.D., 'Alcoho~ Alcoholism and Advertising', St- Louis, Missouri. June 1978. 15. LAMBIN. J.J.. 'Advertising, t_bmp~tltlon and ~,larkat Con. duct in Oligopoly Over Time Nort~.Holland/Americaa Else~%r, 1976. 16. GRABOWSKI, H.G.,'TheEffectsofAdvertisingonthelnter" ~dus~,ry Distrlbution of Demand', Exploraffons in l~canomi¢ Beaeurch. VoL 3. No.I. 1976, pp. 21 75. 17, WATERSON, M,d.:and HAGAN, L.W., 'The Relationship Between Alcohol Advertising and Consl~mptlon', a report prepared for the Independent Television Companies Assoclat!on, May 19tI~1. , 18. DUFFY, MARTYR, 'The Elfects vf Advertising on the Total C~5~rapt~ ~f Alcoholic Drinks in the UK: Some Eco o netric E vid~nce' JournalofAduertising Col. 1 No.2. pc, 105-1 ] ~, 1985. 19. SCfIWEITZER, S.O., INTRILIGATOR, M.D. and SALEHL B., "Alcoholism`• An Econometric Model of it$ Causes, its ~f/eels and i~s ControF, a paper presen~d at. tb,~ Alcohol 22 9E UL O 9 181 Education Centre ¢onferonce on Economic Aspects of the Use and Misuse el Alcohol, Wivenhoe, Essex. November, 195L 20. LEVITT, E.E., 'Reasons for Smoking and Not Smoking Given by SehC~l Chil6r~n', The Journal of Public Health, Fel~r~ary, 1971. pp. 101-104. 2t. RAPLAN, E.d.. AS Qnoted JR; Lev[tt~ E.E, 'The TV Cigarette Ad Barn Unexpected Fallout; World Smoking and Health, 2(2}: Autumn 1977, pS. 21~. STRICKLAND, D.E,, 'Advertising Exposure, Alcohol Con" sumption and Misuse of Alcohol An Empirical Analysis', a paper presented at the Alcohol Education Centre eonierence on Economic Aspects of the Use and Misuse of Alcohol, Wive~flloe. Essex, November. I981. 23. WALSIL B,M.. 'Drinking in Ireland', The Economie and Social Research Institute ~roadsheet No 20, September 1980, 24. VAN IWAARDEN, M,J~ 'AdvertlMng, Alcohol ~bnsumpt~n and Policy Alternaffbes, a paper presented at the AlcohOl Education Centre conlerence on Econolnlc Aspects of ~he Use a~d Misuse of Alcohol, Wivenhoe. Essex, November, 19dl. 25. CHIPLIN, B, STUROESS, B. and DUNNING, J.lt,. "Economies ofhdv¢rtlsing'. Holt, Rinchart and Winston, 1981, 23

90,0¢¢ 80.OOG 7~ 182 / / J / / J / POLAND (ADVERTISINO BAN l N FORCE SINCE 1972~ yom 68 69 70 7{ 7~ 73 74 75 76 77 7~ 24 7g 80 lgg Mr. ECXART [presiding]. Our next witness will be Mr. David Minton representing the Washington Counsel for the Magazine Pubiisbers Association. STATEMENT OF DAVID MINTON Mr. Mit.'m~N. Thank you, Mr. Chairman• You have our written statement, and I have incorporated within it, ~ince we are doing again this year what we did last year, that my previous statement on the legisiataln which was considered last year• I ~sk that be made part of the record. Tbe provisions of this bill, which the Magazine Publishers Ass~ci- atitln opposes, is that part of section (4) which would require adver- tish/g in rntlgazine publications to include the new rotating warn- ing labels. We oppose this for three basic reasons, two of which are '~ related and are related to the rule of law as enunciated by the Su- preme CAmrt in recent eases• Tbe law as the Supreme Court describes it, is that the Freedom of Speech ..... in commecial advertising not pohticai apeach, but l~urely commercial advertlSl/lg, m protec ed. Commercial advertl~4ng is protected against government regulation unless (l) tile goverrtment is exercising its authority in a legitimate area, which you are, the protection of the public health, and (2i unless the method ~hleh you are using has a reasonable relationship to the goal that you seek to achieve. There is no evidence, according to the FTC, the Department of llealtil and Human Resources. and according to most of the studies that have been alluded to today and last year, that labeling and cigarette advert/Mng will achieve the goal of causing people not to smoke cigarettes, if that is your goal, and it appears to bs your goal• Therefore. it is an unreasonable restriction upon the publish- er's right to publish as he pleases. One of the ways the publishers please to publish is to publish the articles that have been mentioned in this heoring today. The ]lead- er'* Digest, which does not accept cigarette advertising, run~ arti- cles frequently on its editorial opinion of cigarettes• The St. Louis Post Dispatch, a newspaper rather than a maga- zine, ran an article this week on the Public ttealth Service's most recent report on the possible addictive nature of cigarettes. So did other newspapers. I imagine that the weekly magazines will pick it tap. Last year, when the Surgeon General's report happened to occur at the same time that these hearings were conducted, both Time and Newsweek, which carry cigarette advertising, ran extensive ar- ticles on the Surgeon General's report• That is the job of a free press in a free country, to report the Surgeon General's report, or your findings. We object to the Government extending regulation to the pub- lishing industry. We believe wd ha'C'e a constitutional right that '.he Government shall not i~terfere ia our editorial and businesa pelt- ties unless you can demonstrate that the gool you are attempting to achieve and the rBanner in which you are attempting to achieve it meet the test laid out by the court~.

184, Even if there weren't a Supreme Court rule, or a series of cases that I cite in my prepared testimony, it is our view that this kind of regulation ia bad policy. This Congress and other Congresses has had before it numerous proposals for constitutional amendments and laws related to the activities, people and businesses. We be- lieve that, at least in the area of the First Amendment and the free press, you and all Americans are better off refraining from regula- tion. We will publish the news. We will publish advertising that is le- gitimate advertising, and that is not deceptive. Cigarette advertis- ing meets that test. We oppose Government additional restrictions upon the freedom of the publishers in this country m publish as they ptsase. • Thank you [Mr. MJntsn's prepared statement foliows:] " "" • J = . ,r • 185 TESTI~:)N¥ OF THE ~',~,C:AZINE pUBLISHeRS ASSOCiaTION ~EF0~ ~ ~U~C~IXTTEE OH [IE/~L~H ~ND ENVIIIQNNNNT H.R. 1821 Mr. Chairr~n, ~ am O~vid MintQn, W~hington Counsel for the Magazine Publishers Association, a a~tional organization ~ep~e~en~in~ appro~iA~a~l~'200 publishin~ fims whieh publish appzoximately ~00 consumer magazines. Mo~t of ~he weekly and monthly publica~±o~ ~hi~h ~h~ .~erioan people read ~re members LaS~ ~ar, when you held hearings on siil~lar legislation, MPA appeared in opposi~iosl ~o t]lose p~ou~sio~s o£ the le~islatlon Which Would h~y~ imposed ~peciflc wernln~ label r~q~irem~nt~'on all cigarette advertisln~. Ia ~he ~ntc~e~t~ of economy, ~ ask your permission to have included in the record a ~opy of that ~e~in~n~, bo~au~e thc provisions of that bill rel~tin~ to ci~ ar~ advertising ar~ similar in purpu~e to the ~rovi~ions of ]I.R, 1824. our position on your new legislation i8 ide~tioal to our position on las~ year's b£1i~ ~e oppose ~over~nt regulation o£ advertiain~ if the adve~tisin~ is not deceptive. Cigarette a~er~isitlg is not d~cep~iv~ .. it ~]~kes no agf~mative claims -- and therefore ±~ entitled to the protections of the FirSt gl~end- "~ ~nt a~ outlill~ b~ tll~ SU~r~ Coult In several recent uases.

187 Mr. ECKART, I thank the witness. Our last member of the panel is Mr. Eric Rubin, counsel for the Outdoor Advertising Association of America. Mr. Rubin. STATEMENT OF ERIC M. RUBIN Mr. RUmN. Thank you, Mr. Chairman. I am counsel to the Outdoor Advertising Association of America, the OAAA. ] am also an owner of two outdoor advertising business- cs located in Lynchburg, Va., and San Antonio, Tex. I am testifying today from that dual perspective. Today, as you have heard already, more than 9 out of 1O Ameri- cans believe that smoklng is hazardous to a smoker's health. In the true sense, the Sulgeon General's warning has pervaded our cul- ture. The sponsors of this bill contend that the Surgeon GeneraVs warning is inadequate. They concede that the public is overwhelm- ingly aware of the potential healLh h~ards, but argue that ~he warning fails to fully inform the public about the speeifle diseases that may be involved. • . There is a superficial appeal to this argument, but it ignows the fact that when tested in other countries, as Dr Waterson has indi- cated, these and other more severe warnings or advertising restric- tions have failed to appreciably ~ffect cigarette consumption. Moreover, there is little to suggost that new detailed warnings are going to increase public awareness when better than 90 percent of the public already understand that cigarette smoking is health he~zard. A panel of advertising public ~pinion experts testified before this subcommittee last year well emphasJzed this point. Parenthetically. I might add, they all debunked the Y*FC survey data as well, and commend the testimony of Drs. Wind and Max- well of last year to you. In fact, Mr. Roper wrote directly to Chairman Waxman last year stating that it is wholly unrealistic to expect the public to possess a high level ~f rather detailed technical information. He concluded "~ that that probably can never be achieved by an educational cam- paign no matter how extensive it is or what its duration• Although there is little to suggest that the rotation warning scheme proposed by this bill will accomplish ostensible informa- ttsnal goals set forth by its sponsors tbore is a good deal to suggest that these advertising restrictions will it make far more difficult and perilous to advertise. One of the more extraordinary aspects of this legislation is that it would install the Department of Health and Human Services as the principal agency charged with regulating cigarette advertising• The truly bizarre nature of this jurisdictional alinement is self.el- dent. The bill further compounds this probism because it would also preserve the FTC's parallel authority to regulate cigarette ad- vertising under the Federal Trade Commission Act. The OAAA s oppo~ition t~ H,I~. 1824 extends well beyond the issue of bureaucratic jurisdiction. In fact, what is billed as a simple advertising labeling measure is in reality a complicated advertising control. Section (4) of the bill requires each advertiser and advertis-

188 ing medium to incorporate the circle and arrow format to advertis- ing Copy in a manner that is legible and conspicuous. Those are the words that the s[atute says, but the bill provides no other guidance on how this is to be achieved. The pena ty for guessing wrong is a crlminal conviction and $100,000 fine per viola- tion, which means per ad. In essence, the bill invites the adver- tisers and the advertising media to play blind's man bluff with tim First AJalendment. I can illustrate best how~difficult the compliance problems are, Mr. Chairman, by your own exhibits teday. If you will take a look at your chart over on the left sh~wing the arrow and circle format, it is incorrect. It does not comply at all with the statute. I am not s~ying that to be facetious. Perhaps Congressman Waxman recog- nized that and switched roles because of the $100,000 penalty for a violation involved. This is not, however, a "ustification for inserting HHS in o the void to decide what woul~ constitute conspicuous and legible. In effect, this would give HHS de facto control over the general con- tent of future cigarette advertising by virtue of its authority to con- trol the size and placement of the warning. Let me show you what the result would be when the circle and arrow warning format is adapted to a standard billboard utilizing the print size and type style specified in the current FTC consent judg~nents whisb the control the dissemination of the Surgeon Gen- eral's warning• This is an actual warning that would appear on a standard poster size billboard• It stands 7 feet high and almost 7 feet wide, and when placed on a billboard, with conservative num- bers, it effectively occupies 25 percent of ~he actual surthce Section/4t of the bill also requires the Secretary of HHS to estab- lish a rotational system which assures that each of the se-called la- beling statements appear an equal number of times in the adver- tisements for each cigarette brand over a 12 month period. On the most elemental level, the Secretary of HHS would have te determine hew many Time magazine ads are equal to a billboard campaign, or whether one placement in the Washington Post equals a placement in 10 weekly newspapers in the Midwest At a minimum, this invites media scheduling nightmare in which the only safe route for an advertiser is prior approval from HHS of its media tens. Mr, ~inten has gone into details about the law. I will only sum- marise it here. ' This subcommittee is aware that the law does not favor Govern- ment telpose~l restraints on speech. Under the first amendment, laws which dictate Government mandated speech are regarded as ~1 inherently suspect and less tolerable. H.R. 1824 represen~ such an escalation of Government control. Restraints on commercial speech are only permitted to the ~exlent that the regulation advances the directly governmental in- terest asserted and only when it is no mere extensive than neces- ~sary to serve that interest. Neither of theae astifications exists ~here. " - , .... The advertising provisions of H.R. 1824 are fatally defective. More specific warnings will not incre~e thelaL ubfic's already high level of awareness of the hazards of smoking. Testimony before this 189 subcommittee last year is replete with experts testifying to that fact. The sponsors have not presented a sound basis for coneludin~ thl~t,tvhl~ Pr~epo:~ed~ :::n:ncgiS,Wib~:ptp~°:le~guSte°tP:~i°lk~grYetdt!! least for these warnings. It will create a media scheduling problem that only a computer could love. It will also invite what l regard as a successful challenge to its constitutionality. II.R. 1824 deserves to be rejected by the Congress. Thank yo~. [Mr. Rubin's prepared statement follows:]

190 - TESTIMONY CF ERIC M, RUBIN LDUN$~L DUTDOOR ~VERTI$I~G A$$OCIATtlIN OF A~RICA. BEFORE T~E SIr~COP~4I~EE ON HEALTH AND THE EHVI~ONMENT, C~MI~E[ ON ~NEI~Y AND CO~RC£ BEGAEB[~ H.R. IBm4 THE C~4P~EHENSIVE ~DKIMG pREVENTION E~IGATIOI~ ACT OF lgB1 I O~ counsel ~0 the Ou~toOr Advertls~9 J~sC~lation ~f k~erlc$ IOAK~I. ~ 15 the trade association ~f tl~ itan~r~lzed outdoor edvertl$1ng f~d~stry, I a~ ~so a pa~t o~ne~ ~f ~ ~utdvor advertlstn~ b~$1nes~e$ ~oc~Led In Lynchburg, V~lnia ~nd ~n A~OMo, T~xas. I am testlfyl~9 before ths Subcomltt~e ~d~y reg~r~ln9 the a~ertlsln~ rest~'l~tlon$ th~ ~o~1~ be Imposed on cl£~re~e a~ver~lsin9 by H,R. 1~24 and ~ ~ate ILs opposl~lo~ to ~hose provisions. L~Le a]] Other" megla, ou~oor edver~lsti~ Is p~ches|~ b~ bot~ netlona] and Ic~1 ~ver~iserl for all ~yp~s Of com~e~tal. ~l~tical end social messages. In 191~G, autdoor a~vertl$1n9 rep~egente~ ~g of ~11 ~e~]~ expend$~ure$ for edv~tl~in9 of the t5 leedl~ cigarette b~and~.~/ Bu~i~g "ch~t sa~ ~1o~, cigaret~ e~ver~tslng ........................ ~/t~ee61~9 National Advertisers, ~e~ta Decl$1oni* O~ober* 1981. page ]75, i 191 ~pre~ente~ ~ppe~x~m~ely lSg I~ 20~ ©~ al1 |dver~sln9 ~lsse~inated through th~ It he$ bee~ ~r¢ ~ha~ ~¢n years since ¢19a~et~e ¢~rclals uere ee~ve~ fec~ teleYIslon and radio, Sln~e then, evep~ ¢19~ette p~ck~ge an~ e~v~r~$er~cnt ha~ carried Lhe "Surgeon G~eral~s" ~eal~h ~arnl~, A vigorous public ~elaLIo~s c~mpa~9~ has ~]so bee~ ~ag~ to Infer~ the public ~bou~ ~he p~ent~al hazards of ha~aedo~s ~ e ~,~Ker's heelth. In ~ true sense the ~urgeon General's wa~nln9 Geneeal's ~rnln~ IS Ina~equ~, They ¢o~ce(ie thet "the public I~ o~e~helmlngly a~re of ~e poLentI~l he~h h~za~d f~o~ ~klr@, bu~ ~gue ~hat ~be w~r~ln~ f~l~s f~11y ~Io~ ~he publ~ ab~u~ ~he specific diseases ~hat ~" b~ ~nvolve~. A~ a remedy ~he s~n~r~ of H.~, 1~Z4 pcopo|e the ~poslL~o~ of ~ se~I~$ ~f ~h~e very extensive ~nd detailed ~ar~lngs for d~se~lna~ton 1~ cigarette adveetSsln~, There IS a ~uperf~clal appeal to ~h~s argument. ~ut 1~ Ignores ~he fac~ tha~ when ~es~ed In otheP countries, ~bese ~n~ ~ven more ~evere ~dVe~t~slng restrl~- ~lo~s have f~iled t~ ~pp~ecl~b~y affec*~ cl~a~e~e cohs~,~p~lon. Moreover, there ~ l~ttle ~ ~u99est tha~ n~ de~alled ~arnl~gs ~r~ 9o1~ *~0 increase public aw~enes~

192 ~h~ h~Lter th~n 9~ of ~bt pub1~ |Irea~v believe that ¢Iga~ette s~kln~ lJ • , ~p ldve~I$1~ and pUbl~C ~I~(0~ expQ~S ~O ~$~I~ ~ ~$

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5q 5~ k-% 196 Mr, ~KART. I thank the witnesees for their testimony. Perhaps before I ask any questions, I had bettor consult the Jus- tice Department as to my legal rights having succeeded to the Chair at this point. Let me first, having not heard all the testimony, defer to Mr. Bliley for 5 minutes of questioning Mr. B~L~y. Thank you~ Mr. Chairman. Mr. Pertschuk, I know that Mr. Waterson can defend himself, but I have looked carefully at his tostimony from last year, and I am fairly certain that the context of his statement on health warn- ings not working was in regard to the rotational warnings proposed in this legislation. It is hardly a contradiction to say that the cur- rent warnalg works, but that a rotating system will work. Mr. PgRVSCaUZ. I am afraid I don't understand your question, Mr. Bliley. I am sorry. ..... Mr. BLILEy. Isn't the point that the current warning is working in getting the message across? Mr. PERTSCHUK. YOU are referring to my testimony? Mr. BLmEy, Yes. ~1r. PERTSCHUK. It seems to me that what Mr. Waterson was saying is that no waral~lgs work, but perhaps I misunderstand his testimony. Mr. WAWRSON. I was merely trying to make the point that since everybody knows everything there is to know about cigarettes at the moment, any warning now is wholly and utterly irrelevant. You cannot tell people more than' they already know as we have heard so many times from so many dilIhrent people. Jnst about everybody in the population is aware of the fact that cigarettes kill you. Just what else can you tell them. Most people don t know what emphysema is, so te]hng them that doesnt add to their total knowledge. ~[r. PERTSCblUK. ~xcuse me, sir. It is your Mr. Waterson's testi many that warnings do work to inform people of the hazards of smoking, but now they are fully warned so the rotating warnings cannot add anything to this knowledge. Mr. WATEaSOU No. My testimony so far is quite simply that for one reasnn or another, people in this country, and indeed in the rest of the world, know what the health hazards are supposed to he. It is my contention that the ]ittis signs on the bottom of packs are now who y rre evaut , Mr. PERTSCHUK. But they worked. Mr. WATERSON. l don't think that it was the packs. I think it was the general overall publicity which convinced people. I think the media space devoted to cigarette advertising was infinitely and more effective than the cigarette warnings have ever been. l do think that it may have played a part some years ago, but not now. Mr. BLZLZy. Since we are traveling on my time, let me use what is left of it, Mr, Pertschuk, do you know the rave of decllne of the population of Sweden? Mr, Pr, RTSCHUK. I do not. Mr. Bu~v. Then why do you try to lead us into helieving that population increase is the cause of continued smoking? 197 Mr, PERTSClIUg I think that it is here in this country. The fact that the overall sales have been flat in this c~untry does not mean that cigarette smoking among populations has not declined in this country Mr. BL~LEV. YOU were talking about Sweden in your testimony, The apparent contradiction between the nformation you used about the percentage of drop among youngsters and adults as con- trasted with the fact that tbe total consumption has remained the same. You said that this was probably due to increased popu]atisn. Mr PERT$CHUK. tn sonic countries. I was not ref.rring speeifical ]y to Sweden In some countries there truly has been an increase in overall sales reflecting an increase in overall population, while the percentage of the population smoking h~s declined. Mr. BI.II.E~. You can't say that about Swedt n? r Mr. PEaTSC~W~. I simply don't know, sir, the population o~ Sweden, Mr. BUL~V. Is it your opin on t at this bill inchides aggressive restra nts on advertising? Mr. PEIITSCHUK. No. Actua y th s b would repose a ve'y m n - real disclosure wh ch wi have the desired effect, if I may~espend to the connnent at least from nay own perspect re, of persuading people net to smoke From the Federa 2rade Commission's point of view, I th nk speak for the Director of the Bureau of Consumer Protection, the object is not social engineering, it is simply to recog- ntse the right of consumers to know the facts about the products advertised to them, so that they can make their own choices, even if they should decide to smoke. Mr. BLILEy. You have no concern about first amendment conse- quences'/ ~V~r. PURTSCHUK. No~ sir. Mr~ BLILEy. HOW do you der ve your figure of $1 billion per year in compliance costs? Mr. PeaTSCnUK. Ihat was based upon a study done for the Feder- al Trade Commission which I will be happy to submit for the" record. I do not have that with me 'that is personal knowledge, but it is from a study done for us and refirred to in some detail in Mr. Mur's' ]ertor, wh oh I am a so submitting for the record. [Sc~c p. 208.] Mr. BLmsy. Industry people ~ere contacted? Mr. PERTSCnUK. I know that there was an advertising agency ~:ieh was a consultant to the Commission in the preparation of at study, sir. Mr EcK~n'r. The tinge of the gentleman has expired. The gentle- man from Alabama, Mr. Shelby. Mr. SH~LSy. Thank you, Mr. Chairman Mr. Watorson in your testimony a few minutes ago you had some ntoresthig statements. One, i th nk, you talked about Poland and the large consumption of cigarettes there. What about in the Soviet Union, there is no advertising there either, is there? Mr WA~ERSON. ThroughoUt'the Communist bloc--it is not the absolute level of cigarette smoking wh ch is important, what is in- teresting is the fact that the consumption of the cigarettes through- out the Eastern bloc has risen throughout the postwar period. Mr. SHZ~Z. IS it some of the hear est n the world?

k

200 The s stem of otatlng warn ngl nflueneed the smoking behavior the Swedish DopulatlYon beneFl~iMis, both by ¢~atrib~tlng an incre~s~ ia the number of people w o had ate smoking and b enconta~ng Ielr*~inl~g ~Ii~kees ba change to th~ Z~Z~.~h ant6mloking campalgn. Of wh,eh the labe!~ng 'y~tera " an po el@me.t, n so $ "In Swedel% no ess than 16 health warnings Mr. Waters(} y , J . rotate on clgarette ~acks,'but no effect can be detected. He fur ther stated that the tote consumption had r sen m Sweden. ' Those are not consistent Mr. p~r~cli~l~, { am ~ot mt original authority. I am relying upon the publish~ reports from others concerning Sweden and Chile. Mr. N1LI~OI~. Pm yo~ ~,gvee with M~ Waterson's statement that if the percentage of smokers has gone dove] and if the total smok- ing has increased that tee smokers are smoking heavier now than they were before? ' ' ' Mr. pBRVSC~UK. Actually, the report does deal with that issue, the one that I have referred to: It says that: The dee}ins in smoking a~ been reflected n a sales i~Ka~ f~r t~baec*3 ~r~v~il~ du n~ recent veers Alfbough riga e twe ~ales for example, are now cle~Jy~o~.~ rms of we 1~t the number of clga~t~ sold ]s ~ualLy aachen ed. unere L# one ~t~Tx~]~ana~,~nl~n ~£s m~.y he that the dwlndl~ n~.mher of ,m~er~ nonotheles~ Brooke more clgarettee ~ p[ev!ousis. As you 'know: ithere have been some recent stadtsa which raise concern---- Mr, NmLSON. Do we conclude from that that the ones most kely to get lung cancer will get it faater because they will increase their consu~ptlon, , I Mr. P~RISCHUK. I thmk y0u.carl .conclude that those who ~witched to low tar and nicotine 3held mgarettes may be mereas ng their overa] consumption of cigarettes. Mr. N robsoN. One other questlort if ] might, Mr. Chairman. Mr Shmp and Mr. Mtaton had vet conll!cking testimony lmMtro. why this wa~ or wasn't go ng to be a ~ardsh~p oa advertisers.... Sharp indicated that there would be no probtem at aJh no narasmp for those he represents, but both Mr. Miaten and Mr. Luht testified that it would be a considerable hard~hlp. W~uld either ef you llke to elaborate or further corroborate your remarks 1)ecause they are .te ,i °PP~rSl S[IAR~. I" wilt go ahead and elahor ate first.' ~/~at [ we~ re~e~: r ng to was the development of advertising materials at the des gn stage, f, for exarople you would !o0k at this .sheet of caretta packaging, this is the fiormal way m whmh a cxg~retcm gae~gga~ ~vou d be printed at the printing press,, than a chan-e in The rotation of the messages Is n0tnlng more type, from one rowte another. As the prmtmg process or tee design process begins, the different messages are accommodated by simply placing the different messaged on the press, and thereby you have the economy of printing al~ of the messages at urge tu~, Se0ond, qn the creation of mgga~'ne advert'S'~c~a:nt~r~aLas y warrdng message appearing m this white box can "g m b ,stripging in alternative messages. ]t does not.reqmre a ~ - p~etely different ad. At the time that this ad m demffaed, any num: 'I P 'l 201 hers of messages could be stripped in at at the time the materials are made. The materlals, the publication, would receive would al ready have that warmng label m ~t, I didn't understand the testimony from the Magazine Association that they would be r~ntuired to carry the message, because in fact the raatorlaIs come from the advertlsi~g aget~ey or advertiser, Theretbre, the co~t really is borne at the design stage. In actual dollars and cents, production experts have told me that the ~ccom- modati~n of three different ads, the o~ly difference b~ing three dlf- ferent messages in this block, would come to approximately an ad- ditional $200 per ad for production costs. Mr. NmL~OS. Thank you, Mr. Chairman. Mr. ErranT. Mr. Sharp, and I will le~ Mr Minten get his re- sponse in. How does this whole debate answer the claim kimt 25: percent ~f the advertising space wiE be taken by this new message, and is there an alternative, other than thi~ suggested design? Mr. SHARP, Tht~ i~suo of whether or net the rotatlcnal message xvould be sift*tire, as it is graphically depicted in the example here in outdoor, is truly debatable. The principles of outdoor advertista say that generally messages of over seven woed$ are ineffective. I1 yo~ think about the situation in which you view outdoor advertis- ing, the time of expostlre is probably less than 2 seconds on an average basis. So in my own professional opinion, I would say that ~he actual wording of this warning message is not going tn be noticed, but the graphic design wSl communicate just as effectively over time as the skull and crossed bones have became synonymous with a poi- sonous product. Mr. ECI{A~tT. What you're suggesting in that r~speet would be a logo. Mr. SIIARP. Exactly, a symbol Such symbols have bc~cn developed for other industries For example, in most real estate advertising now, taere is a requirement that the developer of the advertising entll,~y carry the symbel Ibr equal housing epportunity. I think most people reee~,mise now what that symbol indicates. There are going to have to be certain exceptions in outdosr ed- verkislng, because of the limitation of the medium in itself, and the fact that as you are driving b~ at 30 or more miles an hour, it is very ditlleult to get all of the reformation that weutd be contained in these warning labels. However if that graphic design were associated with a warning label or a warnintg message, I believe it would reinforce the infor- mation that wouIdbe contained in the print advertising, as well as other forms of educational programs.. Mr. ECKART, People having gotten used to seeing a shape, and the message that that shape conveys, upon seeing ~omething for just 1 or 2 seconds, without reading the type, would still reeognise that message. Mr. SnAae. I think it would be ~-¢ein forcement, yes, I do Mr. EcgAl~r. Mr. Mintan, ]ou would certainly like some equal thne on this? Mr. MINTON. Yes, I do. Mr. Nielsen, 1 did not mean to convey the impression that we an- ticipate an economic hardship as a result of the changes. We are

i P 202 worried about our constitutional rights, not our money. Whether it would have an economic impact or not, I dent know. There is debate on the subject, but that is not the thrust of our testimony. Our testimony is that we have a right to carry the advertising. Mr. SHARP. Mr. Chkirman~ may Imake a comment on that.9 Mr: ECKART. Yes, Mr. Sharp. ' ~ .... ~' Mr, SHARP. I don't understand how the constitutional rights of the publications are endangered here when in fact it is the adver- tising material, that they accept for rather large sums of money, that we are talking about. We are not talking about the acceptance of free press. ' We are talking about the acceptance of advertising material that would contain a warning message or information relative to ciga- rette smoking, Just as Reader's Digest and several other publica- tions have decided not to carry cigarette advertising altogether, I fail to see the connection to the endangerment of first amendment rights. ' ~ , ' Mr. ECKART. The gentleman from Minnesota, Mr. Sikorski Mr. SmORSKL Mr. Chairman, I apologize for travelling between committee meetings this morning. At this point, I have no ques~ tions. Mr ECKART. I have a question or two. (~uld either Mr. Minton or Mr. Rubln explain the legal status of the current warning notices on cigarette packs. Was the warning notice challenged either at a district or appellate level? Mr. RUaIN. I can explain it. The current warnings in advertising are the result of an FTC consent order that goes back to 1973 with the cigarette companies. In 1978 there was a compliance and en- forcement proalsion with certain aspects of it. The sum total is that it is a consent judgment. Mr. ECKART. Thus it W&S not challenged. Mr. RUBIN. No, there was no law suit. Mr. ECKArT. Mr. Mkiton, or Mr. Rubin, did I hear you raise a constitutional que~tlon about the proposed language in the Iegisla- tion? Mr. MI~erON. First of all. I would point out from the standpoint of chronology involved, the Supreme Court did not begin to recog- nize the first amendment protection of advertising until after the consent decree regarding cigarette advertising. The general consensus of ]~rC and others is that the current ~, warning label is not partbcalarly effective so they want to change. They want to step farther. ; If you converL the present ineffective lago intoa different logo, ~,1 ~kieh rings the same bell in the purchaser s or the reader's mind, • ~then you really ......haven't done anything. All you are going to do is to cause a reminder that that m the cxgarette label warning, whmh the complaint that Mr. Pertscbuk and others have today. So you go a step farther. But each step that you take, from our standpoint, is ~an invasisn of our constitutional freedom of the press. "~2 Tkisindialdualstepwon'tbetheendoftheworld, butuntil;liyoour objective is attained--that everybody quit smoking or everybody is thoroughly aware, as a medical expert of the possible consequences of eating food or smoking cigarettes or doing anything e]se~you won t be happy. We say that we have a protection that the Consti- t Iw '1 203 tufion gives us to stop you short of that point, and that is why we are here today, Mr. ECKART. Mr. Rubln, go ahead. Mr. RUBIN. Let me add one thing. I found Mr. Sharp's testimony extraordinary, his comments extraordinary in one regard. He says that you need to implement this forma in order to develop some symbolic representation el the warning. it seems to me that given the number of years that the rectangle h~.s been incorporated in all cigarette advertising, its my guess that if you showed the average person a cigarette ad and there was a box on the left-hand side ofi and you said, What is tha~? ' I think they are going to answer it. i th nk you would answer t that way. ssueIf whats u readyMr" Sharreso~vod.is arguing br s a g yph, I think that that/- M " ' ' • r. ECKART. What I can t escorts n iron the dlscusmon with the two counse] now is at what point are you allegin the we trans- gress the bounds of coast tutionality, and why ~oes the current system not do ~hat7 Mr. MINTON. The Supreme Court had 2lOt enunciated t e rule protecting advertising at that time It has s uee Today we~ave a constllicnal protection which we did not have in 1973. ' Mr. ECKART. Maybe this simple Cleveland lawyer does not under- stand the point yet. IVlr. PERTSCHUK. Mr. Chairman, i think you do. Mr. MluroN. Since 1973 tim freedom to advert sea wide variety of commodities has been recegnisod by the Court whereas prior to 1974, the Supreme Court had sa d, no, advertising is not protectsd by the first amendment The Supreme Court than ed its mind. Mr ECKA~T. Heaven forbid that the Supreme ~urt should ever change its mind on that. Let me pursue something that may only be a logical extension of where we are today. I am just interested in giumblng the depths of the w nesses' mind. Some imaginative attorneys have brought suits against tobacco eompaales alleging unsafe products were made available to their clients, now deceased, and therefore, have attempted to attach some sort of negligence or at ie&qt cent nge t a ty on tobacco companies for the sale and marketing of unsafe substances. To what extent does a national warning system undermine such lawsuits and does the warning label relieve cigarette companies of potential liability? Mr MINION. I re resent the pub shers and not the tobacco corn panics, so i do not ~now the answer I think that is an unlitigated question at this point. Mr. PERTSCHUK I think the knowledge h m been used as an as- sumption of r sk defense. To the best of my knowledge there has not been a single successful personal litigation. Mr. ECKAr'r. It has no,t gone the distance. Mr. P~RTSCHUK. I don t believe sg. blr. ECKART. No. I just wonder, depending on what side of the case l might be seated, about whether or not I might find it advantageous to say that something that l opposed in the Congress is now, however, the reason why I ought not to be found liable, or something that Iop-

P J O9 2O4 posed now, however, in fact, precludes liability. I think that it is the kind of sword that can cut both ways. '" I am not suggesting that anybody ought to go out and conduct that kind of lawsuit. I am just simply saying that I am not sure how it fits into the process of people, further reso.rting to the courts to settle untested claims in the marketplace, ' " :' ' If there are no further questions of the panel.~J ~ ~ ' Mr. BLIL~y. Mr. Chairman,'I would like a second round. Mr. ECKAaT. Mr. Bliley, 1 will be happy to have a second round. I will be happy to protect other members'? rights under that provi- The gentleman from Virginia may proceed. : ' , Mr Bu~v. Thank you, Mr. Chairman. ' ' " Mr Pertschuk are you aware of the growing ~alls for restriction and advertising warnhig labels on alcohol? Mr. PERTSCItUK, ~ am aware that there is some interest. I guess Senator Thurmond has introduced a bill in the Senate calling for warnings in advertising. It is not an area that 1 am particularly familiar w~th, sir.': ..... ' Mr Bur£v.'Do you think that the Frc has not been doing a good job in its cigarette law? : ..... r ~; ,'" ~' ..... Mr,~ PeaTsc, uK. 1 think that the FTC probably has the authority to require the warnings in this bill through rulemaking, but I think it would be politlcal suicide for the Commission to attempt it, Mr. Bur~y. Since you support the bfli do you ~dvocate switching to HHS? ' "' ' ..... ' Mr. PERTSCHUK. . ~r .... That rea y is a decmmn for.the Chmrman, and I really don't have'partlcularly strong feelings about it. I am sure that if the Commission is assigned the regpensibilJty we will carry it out witbcompetence and T]HS the same, sis~ , , ~,: , . . Mr. BI,ILEY, Thank you. ~ ; ' Mr. Sharp, have you evdr handled any cigarette advertising ac- counts? ~ , • ,, , ! , Mr. SHARP. No, mr, I have not. Mr. BLIr~y. Then how are you qualified to say What their adver- tising strategy is? .... Mr. SaAUP. I have personally been involved in the selection of not only management but creatlve people as well, whose primary role was to come n and:work on a c garotte product with a major advertising agency. : ' The principles of marketing and advertising for a cigarette are very similar to that of other consumer products from a superficial point of view and it doesn't take a very astute thinker to examine the advertising materinl that you can see in any magazine and de- velop a hypothesis of what strategy the marketing and advertising program is. " . Mr. BL~LZY. You answered me, with a hypothesis. : Mr. SHARP, Certainly. Mr. B~LEy. But you don't know it as a fact? Mr. SHARP. No, but as an expert witness I an] willing to stake my reputation on what 1 have stated as opinion. " Mr. BLII.Ey. Since you have not had any accounts, there may be some question as to whether you are an expert witness in this case. I P '1 205 I,ast year, Captain Kangooro and other expert witnesses said that peer pressure, not advertislng, was the maln reason teenagers smoked. Are you aware of any psychological or survey research that would indicate otherwise? ' Mr. SHARp. I would hardly c ~slfy Captain Kangooro as an expert in advertising, I would hardly classify anyone who s in the entertainment industry as an expert in advertising. The second part of your question is, no. I am not aware intimate- ly of any psychological study that correlates smoking among young people with the advertising material. Mr. B~J.zr. Thank you. Mr. SHARp. Now~ ma7 I respond to your first questkia? ' Mr. BLILEy. In a minute, if I have tlme, because I have somep. other questions that l want to move on to. You stated that cigarette advertising was the dominant force in outdoor advertising among other media markets. Yet Mr. Rubhi says that only 15 or 20 percent of his members advertising is for tobacco. What is your measure of dominanee~ Mr. S~Aap. The figures that we supplied are from the magazine Advertising Age which s recognized generally as an expert or a reliable source of spending for the advertising industry fhe figures are from a report on 1981 advert s ng expenditures and are broken down by advertising medium. The amount reported for aH cigarette manufacturers represents over 15 percent of file total outdoor ad- Per tisikg revenuos Mr. EOKART. Mr. Sharp would you care to make a response to the initial question of the gentleman from VIa 'nia7 Mr. SHARp. Yes, I would, gl . l am quothig the script from the Golden Leaf program that was broadcast over the CBS te evls on network Tuesday, September 14 1982, in which an agency employee, a person who would be titled as probably an accounts executive, responded to a question: How de Vou reach the lower part of your target market, fl~ose 28 to 21. "It is very difficuIt because of restrictions all the advertisers agree to, Obvinusly, we would love to be on college campuses and so woud Marlborn, but we can't because the advertisers' code." t How do you solve this problem? "There are always ways to reach he audience. We have to be aware of where their lifestyles take them Sports ustrated is very impertont to us as well as the Vil- lage Voice and the Ro]ltog Stone. We have to use our creativity. It is difficult to get them so young. We sponsor a car race, for in- stance, and sample cigarettes a~ rock concerts. Do you use macho mode s n your ads because be is somebod young people can identify with? The answer was: Exactly. Y Mr, BLzl,z~. You are talking about 28 to 2I, and they are not chil- dren. Also, you are re yJng on hearsay because ou are us n th scrip~ and you don't know whether it was edited, and how g w~ edited before it was put on, do ou~ Mr. S~A~p. I have no idea ~t~a~, no. Mr. BLILEY. Thank you Mr. ECI~ART. The time of the gentleman has expired. Mr. Shelby. Mr. S~t~. I have just one quest on. I wonder if you could ex- plain the high consumption in the Eastern countries, the Soviet

r, ~J C¢ 206 Union a people where there is no advertising at all, either for or against it. Mr. PERTSCHUK. I have some modest knowledge of it, but don t~ pretend to be an expert, because l did at one point, a paper:on! smoking in China. ~ ~ ' .... Mr. SIIZLS~. Iwas speaking just of Eastern Europe, not China) Mr. PZaTSCHUm If nn one has any real data on it---- ' , Mr. SHELBY. Where there is no advertising in the Soviet-bloc countries, there is a very high consumption of cigarettes. Mr. WATERSON. I think the crucial thing is that there are many,! many different pieces of information that we have, and none of them is perfect. We certainly don't know, I don't think anyone in the world knows, why cigarette consumption in any one country is very high and in another very low. We know that throughout the world 30 to gO percent of the popu- ]atisn tend to smoke W]mt we do know most clearly is that wher: ever it is, wherever the piece of information we have, there is no evidence that would suggest that it is advertising which does it. The Psi sh evidence fits precisely wish that general thesis. There is no evidence pont ng n the other d rect on There s enormous ev - dence which peints in the d!rectisn that whatever it is, it is not ad- vertising Mr. SnAae, May I respond? ~ ' Mr. SHZLny. GO ahead. : Mr. SHARP. I believe f wnuld like to at this point'interject that Eurot~can advertising generally is very different flora that of the United States edvertismg. I can only speak from a fairly distant fa- miliarlty with it, in the fact that some of the clients that I repre- sented when I was in the agency business had worldwide activities. The ability to advertise in European countries is greatly restrict- ed ~s compared to our country. Also the sophistication of market- ing expertise, that is the introduction of products, is greatly differ eat in the United States than it is in the European bisc. I think another hypothesis that might be submitted at this point is the emulation of Western lifestyles is sonlethlng that the Euro- pean countries are experiencing now because of extensive media coverage. I think that perhaps the incidence of cigarette smoking in some of the European bloc countries where there is no advertis- ing may he as a result of their exposure to Western lifestyles through other media. Finally, I would like to point out that there is a difference be- tween advertising restrictions and a ban on advertising. The fact that what this bill calls for is the dissemination ef useful informa- tion as opposed to restricting advertising. - Mr. S~EI.RV But would this bill do actually what is the intended purpose of the sponsors, Mr. Waxman et al., disseminate the infor- mation, when the statistics show that 90 percent of the people in the United States know that cigarettes are harmful to them and they don't react to it. 1 am coming from the perspective of a non- smoker. ,. , blr. SHARp. Let me see if I can give you some analogies that would make you understand why the 90 percent, although may be in fact true, is meaningless when you look at facts like this. '{ ~, ,{ 207 We all know that the speed limit in the country is 55 miles an hour and yet we spend a great deal of money to post speed limit signs every so often to rum nd us of the fact. Furthermore, we have police officers who will remind us with even more severe proce- dures if we exceed that speed limit. We have been told from the day that we learned how to drive that exceeding normal or safe speed limits can greatly increase the statistical inference of having a wreck. Yet, we proceed to drive fast and to have car accidents. Those of us who travel a lot know that there is going to be a warning, or some form of information given at the beginning of a flight, that tells us how we are going to buckle up, and where the exits are. l believe that even though there is a certain amount nf awareneas, that the message bins become worn out. /-. The last point I would make, if the analogy were true, if 90 per- cent knew it why then would the cigarette companies continue to change their advertising if, n fact, one advertisement were suffi- cient to gain the awareness of their brand. Mr. WAY.Uses. If I could reply. Yes, I think my fellow expert demonstrates profound lack of knowledge of Europe and Eurhpean conditions, f also think that his analogy is one of the falsest I have ever heard used. Speed limits vary across the country, and I don't think that the health warning does. Mr. SHELBY. Thank you, Mr. Chairman. Mr. ECKART. The time of the gentleman has expired. There being no additional witnesses, this hearing stands adjourned, subject to the cMl of the Clmis. [Whereupon, at g:55 p.m., the subcommittee adjourned, to recon- vene at the call of the Chair.] [The following letter from Mr. Pertschuk lbllows:]

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230 • i •' "i APPENDIX [The following mnterials were submitted for the record:] State~en~ ~f THE ~4ERICAN ~L~E~E OF C~EST PF~y31CIAN~ Su~r~i~ ted by Wi o~Id Reiner, H.~. p~esident University of Colo~do Health Sciences C~nt~r. I am ~IUO th~ p~esi~ler~t o~ the Ame~£c~ C~lleg~ of Che~t .o~y~£~i~ns, ~ p~o= fes~fon~l medic~l spc~f~ity s~c~ety of more th~n II,000 pby~i- the hear~, lung, ~¢~ ~i~cul~tory ~¥ste~. ~t is £n this t~te~ ~pacit~' that ~ expres~ ou~ s~p~o~t for I~.l~. 182|. "Tlle CUmp~e~ beehive Smoking P~ev~tlon Ed~cat$~n ~t o~ 198~*u puZmon~' ~nd ca~folo~y ~ec£~liSt~ we have ~e~n £i~t- ~nel th~ slg~i££cant l~e~l~i p~o~lems ~ssoc±~t.ed ~£th sr~c)king an~ ~eco~ni~e ~ha~ ~e ~re in a uniqu~ position to influence o~ l)~tientS to ~orego ~m~.i~ i~ the f~st place and to s~p ~co~ £n9 whe~ health c~ndition~ s~ ~¢~£re. ~d£ngly. a~ a ~o~£I et¥ c~mmi~ed to po~t ~ad~ate ~ediu~3. ~ducatio~, we h~ve vle~ecl th~ ed~catlon o~ p~ysici|n~ Iwho in turn educate the£~ p~fent~l ~ th~ ~Oklng pr~bler~ ~S o~e of Q~ h£~be~t Drio~iw t~es. I~ 1966~ ~he College~ S~pOE~ed in ~j~uti~n w£th the National CZea~in~ Hou6e £o~ Smokin~ aud Heart.h, a na~ioi~&1 £or~m On o~fice m~na~ement ~f ~okln9. Tile procedures Of this confe~eh~e were l~ubllshe~ in CHF.~T, tl~ official jo~na~. ~f

! I 232

234 : o ~ The o~Qnoml~ co~ts ~f ca~diov~s~ula~ disease8 to the • , oacnin@s and health costs, both F~d~zal and private. gravated by the d±~ect inhalation o£ cigarette smoke, inc~udin~ ~ls, bronchie~tasi~ ~nd otho~ ~iso~do~s. Ove~ 16 million ~me~lcans suffe~ f~om these diseases. •., The wo~t salient characteristic o~'the s~king problem i~ that not smokin~ o~ ooaslng ~okln9 16 ~ means of p~eventlng or dolayin~ the onset of the above mentlonod l~ng and cardiQvas~u- far diso~dor~, This Co~itteo has boon a~pri~ed o~ n~merous • tudie~ that ~emon~£~ate increased life expout~nc~ in indlv[- ~uals who stop smokln9 ao compared to those who oontinuo~I to do 1525-1536, ~976) of ~ve: 34,000 phy~i~ions in G~e~t B:itian ohc~ed that deaths from ~hronic obstructive l~n~ diseases ' , f~om lung cancer foc khoso who continued t~ smo~o wa~ 16 times hi9her than non-smoke:s; afte~ 15 ye~'o£ abstinenco bZ S~kO~S thoi~ ~eath ~ato from lun~ oance~ fell to only twice th~ ~ate of non-~mokor~' Mo~t recently, an ~er~oan Study (American R~view of R~spi~ato~ DIsoaso~, 125:14~-51, 1982) ~ocumont~ that cigarette ~mokln9 in adults la the ~t l:aLent p~dlcto~ of obst~uctlvo airways ~i~oaso aod its cessation significantly reduces the future 4ovelopm~nt o~ the '~isea~o~. The u~o of a simple apir~gram (pulm~nacy fun~tlon test] 4 - 23G markedly onhance~ the ability to p[odict Ob~truotl~e airway~ disease. ~othe~ ~t~d~ ¸(Now England Journal of Medicine, 300:213-217, 19791, ~howed that i~lvi~uals with ~o~unary artery disease who contlnued to ~mc~ h~d do~th ~atos 3.95 tlme~ individu~ls in the study 9roup of ove~ 4,000 men and wo~n who ha~ ~t~pped smokin9. It is not n~co~ary to £u~tho~ ~cite the plethora of st~dio~ do~onstratJn~ the pro~lom~ associated with smoking. Do~pi~o Lhe ~laims of t~e tobacco industry tha~ there does not yeL exist a ~cientific causal link between ciga~ott~ ~k~g and ~ajo~ ca~diopulmonary h~al~h pz~bloms, the evidence i~ quite cle~. Government ~n~e~ention in the marketplace is desl~ablo when the p~oblem i~ on~ U£ national ~cope~ when th~ coshs of regulation are olea[ly outweighed by beno£it to society, an~ when the government can porfor~ a £unctl~n not • s~ble by the p~ivate sector. A visible governmental ~m- mitmont °. or ze~o~itment ~- to Lhe orad~caLion ~£ smokin9 is oloraly roqui~e~. We bell~v~ that the passage of H.R. ~24 w£1~ ~o muoh to assist we praot~tionozs in ~uoating the public to~ding health ~isks Involved with Smoking c~ga~ottos. We ~ul~ like to focu~ on eaoh of t~o maJ~ p~ovisions contained in this legislation. 1. Th~ establishment of a ~u~nont Office ~f S~kl~g and Health to ~iniste~ th~ program i~ a basic an~ necessary ~om- ~onent o~ the bil~ because it provides an independent, noni~li- tical ~do~al focal point for education activities. The volun- $ -

236 tary ~6ctor cannot beaE th~ entire respons~billty fo~ educating the publlc on the ~Isks of s~klng. ~e h~gh cost o£ adverti~- Ing and the volu~ an~ $~£1u~nue of cigarette adve~t~8~n? are major deterre,t~ to voluntar~ effort~. The establ~hmen~ of in ln~eragency C~m~ttee on Smakin9 a~d Health to uo~rd~na~e ~esearcn ~nd eduati~na~ ~ffo£ts o~ th~ Feder~l Gcvern~nt and private s~ctors will } ~p ~ avoid dupli~ation of zese~r~h al- ~d~ bein~ con~ucte~ by NIH o~ u~her Federal agencies. The b~ll should sp~ct~ ~nac ~.e NH~] and NCI ~e represented on ~h~ Int~r~en~y C~£ttee. smok~n~ ~n~ ~ts hea1~h pr~bl~m~ are ~oo ~gnlflca~ ~ De ~U~JCa~ ~O ~n~ economlc or p~llt~Cal :1~ma~e. The Off~c~ ol ~na~e~nt and ~u~gu~. ~n lus ~ffort to reduce ~om~st~ spend~ ~ng. has tr~e~ ~o zerc-f~ ~ne O££ice ~w1~. Thanks ~o ~ne efforts of former Secretary ~hw¢~er and tn1~ CO~tt~e ~ne O~f~ce has retai~ it~ s~en~ and ~nL~r~y. A Congres- slonal ~ndate for the Offlce w1~l assure continuing publ~¢ education on the haz~rd~ ~ smoK1n@ and wlll d~onstrat~ CO,- gress co~rmen~ ~o ~ h~alth~ ~e~ca. 2. ~e ~iso support tn~ pro~;~on ~a~ w~uld r~qu~e r~a- tlon of three new war~ing labels to appear ~n c1~ar~e p~c~ ~g~ an~ in advertising. The F~d~ral Trade Co~i~$ion recentl~ determined ~hat "~ur~ent ~igar~t~e a~vertisin9 pract~es ~y • i~le~d con~umer~ by o~t~te~i~ facts¸ about the heal~h ~i~k~ u~ s~Jn~.~ ~e Ee~o~t ~n~icated that consu~cs do not know ~nough abou~ the harm£~l e££~¢ts ~£ ~ok~n~ ~nd uften un- derestimate the ~isks of ~tter1~g from health prp~l~ms related 237 t~ smoking. The cu[rent warnlnq label is overexposed and too nons~ulflc as to the health haz~rd~ of ~cking. We feel tha~ ~he l~bel~ contained in H.R. 1824, the di~ease-~pecific warning label ~nd the label ~ail~ed to pregnant worn. will ~e ef- £ectively £n£~;m ~on~u~r~ ~bout the he~tlh proble~ a~so~t~tcd with smoking. The r~quir~m~nt tha~ limits the use of one label on any b~and and its ~dvertising du~ing a twelve month period will aid in efforts t~ ~e~ mo~e up-to-date information to the pub~iu in the future. V~ried warni.qs will also promote greater dialogue between physicians and thief patients regard lnq smoking. 3. We strongly Concu~ ~hat advertising in£o~ma~ion and ~i~arette ~ackag~s ~houl~ be required to J~entify ~he carbon m~noxide ¥eild of cigarette sm~k~ ~s well ~ th~ contea~ o£ t~r and nicotine. C~rbon monoxld~ is one of the most ha[mfu~ ~n- g[edlents o£ cigarette ~moke in that ~t reduc~ the blo~d's ability ~o carry oxygen to the c~ll~. Carbon monoxide is pa~ ticul~rly harmful ~o ~r~qant wome~ and may ~]~ ~e a Critical facte~ in coronary he~ disease, suddcn death, athe~o~lero- sis, ~hd chronle respi~a~o[y diseases. 4. I~c~a~ng the civil pen~ltie~ for violation ~f ~he new l~bel~n9 requlre~ents outlined in the bill i~ d~si~able to bet~ ter insur~ compllan~ by cigarette manufacturers. In conclusion, we feel that the evid~n~c ~f the need f¢~ a n~tional education effor~ on the hazards ~f s~oking is ove~ wh~lmlng. Study ~fte~ study has e~tablish~d the link b~tween s~king ~nd lung c~nc~r, cardiovascular ~isea~es and many oth~ . 7 -

239

240 p,~p~Dct fulIY su~ll c:~a: ~ HEMORAICDUM ~ TO: ChaJ~an ~e~cy A. ~xm~

242 243

244 ~S~UL~O~9 245

246 *r. e.~ ~Zt.~ a~(~ WO~ for the " I! 7 H, 'i} i~

248 (~ March of Dimes ....... I~I~ lO, 19B3 249 American Council ..... on Science and Health ~J'~ Febr~a ry 10, l~) Congressman Waxro,~n ,q oor,, 2~18 Rdyburn HOU~ B,~ild[ng '&'ashlngton, O,C. 20~15 ~ear Con~r~ssmto~ wJ,,x mam ~he ~,~rgeDn G~n~,r al of ~he L,nJ~d Sta~,s, Dr. C, ~ver~t ~ ~oop ~o ap~ly put it du,i~K ~'e ,,vo ul~ IJ~e to cmnmend yo~ ~or your efforts and ledd~'sh~p Ln deal~n~ ~,ifl, tld~ ~r J~us heaLtrZ hazard ,~d p~r tlcularly for ~he [ntr u~tjon o~ ~e "Comprehensi~ 5moklr ~ P,e. /z~o t~ ~o Jer~d our naroes ~d our energies n ach ~v~g that c~jech~.

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Mayo Clinic La~n~W D~aot~ M D Academyo[ Pediatrics ~o man le~4 ~nll~l~ mud A2~ ~r,~r ~*r~ ~'~ 258

254 ® Coalition on Smnking OR Health NATIONAL IN1 [~ ACFNCY ED uNCiL ON SMOKING AN~ HF ALTH 419 Sevenlh $treet, N,~r ,I SUII~ 40]J V~lhl~l~lOn, ~C, ~0a~ (202) 393~6 255 ~n~um~.~ k~wl~g~*, T~e ~ t u~lie~ a~e~ed ~1 {~ Reporl represent ~ sub~lti~l ~ °f data e~noe rnl~lg p~e ev, eren~ ~f ~he ~a~ of ei~t t~ sm ,~kin~. Tna surve~ elt~ ~lled more t~n 6,0O6 r~d~nt~ and ~ked h~dre~ °l quest ~a on vir t ue~¥ ~]1 Of the p~babi~it~ or e~ror ot ~J~ hne been r~duc~ f~et ~eea~e the ~t udle~ el~ ploy0d ~ Wide v~r[ety o~ ~°eept ed surve~ ~e {h~ F~ a~d beeeu~e ~ revJe~ of the ~e~t~ indicate° ,~ ~aLhL T~ ,l~ta ~re~ented ~f aphic~ U~ ~nd old,fly iLl~r~t es tl~e p~hll macle by Dr. The ~t~ p~sen~e~ ~g~ t~t ~y ~or~su~ers ~o ~ ~ow en~,~$h ~bout Lhe A~,prox~malel~ ~0~ of those ~d Oo ~Ol ~low a~'ou t t~ cel~ tiorShi~ ~weea sin°king, The data nlso ~n~J~ ~e ~ sub~t~tie] nu~ber~ uf ,~,~nsu ~ e~a ~er ~°,,~t¥ m~u.~derst~d ~nd unde~e~tJl,,~t e t~ I,iVr e~ea r~ of ~ffer~n~ ~,ese he~tLh ptobl~n~ t~e res~t or ~okm~, ~ e~mple, ~l~l ~ur~,~~ ~la i,~i,~ te ~at over ~U~, ~ ~hose p~l]~d dv not k~t~)w kh~t ~mokh~ ceu~e~ ~ {~%) e~e~ of l~ng cancer ~n~ ne~rl~ I]4 of snlo~mg ~elate~ M~ rnore °Ol~umerR ~,,rio~ly ~dere~hnat~ t~e ~e~er~ ~. i~.~r ~ a~d ri~ of ~ng fr0r~ the~e ~mo~i,,~r eL~ t ~,~ ~lh~e~e ~. For ~X~ mple, ~ 3~ ye~ 01d ~eeon~r C~pt e~ V. S~cHon Zt of ~he F,T,~2. ~epor [ eont~ms the m~ s~rviec ~moune~ mel~t~ 0~1 ~h~ health ~,~d~ ~f ~moki~lg ,~ h~ch ~°~e r~ing .~ the ~tme foun~ U]at th~ mejori~ of the ~a~as~ ~f t~e~e ea,rlpuJg~ t~k ph~ce a~ter mid,1 h~. w~i~ o~1~ o~e ~howJng in t~le previo~ tw~ month~ laking pla~ during prime th,,0 ~11~ ~,~ t ~m~ki~$ w~re L*r~e~t during p~,,~ time, Amr)n~ th~ m~jor m~rket~ without prJm~ ~lme ~t were ~o~on. ChLa~go, Uet~tt, ~oustoo, Los ,~ageLes aJ~d

2M

258 SW£DE~ LAUNCIIES NEW ANTI-SKOK]BG 0FFENS]VE= G~VERRMENT-AppLIINTED CONNI$~ION pRESENTS ~I~N pLANS FOR A 25=yEAR pROGRS~M BY PAUL NORDGREN pAUL ~ORDGRE~ IS THE INFORMATION OFFICER ASSOCIATION, III The ~uthor a]~n~, la re~n~i~ IOt tl~ opi~i~ ~xprI~d NO 216[~]~~ 8,*lden 259 T~e 5~ed£~ ~u~sr~e~t b~gan i~s ant~.Imokin9 ~or~ in ~6~, ~herl ~nds ~e~e a~p~opr~ted For ~he flrs~ ~ to p~ovide £~for~et~ ~n t~e harmful efflct~ of ~0b~eeu. A moro a~bi~ious I~ ~er~ progr~ ~nvulvl~g ma~y different tFpes ~f ~¢~£vJ~es ~S presented J~ ~ 197~ repo~ f~m s Ipe~iel research ~roup on t~bscc~ ~ithln Lhe NatloP~1 8o~d ~f l~alt~ ~nd ~elFDre (SocJ~Isty~isen), ~alnst ~king," ent~lled ~ ~aJ~r intInSlFicati~n ~f inro~t£oP~ ~urk ~n the harmful ~ff=cls OF tobacco, It ~]s0 cusuI~e~ J~ Ic~is]s~nn requlcln~ ~lle p~e~e~en~ o~ ~a~9 te~ts and declaret±ons oF c~tents o~ ~ob~cco ~uk- ~t ~he natL~nal level, ~,~urmati~n on tobacc~ has ~r~murily been ~he re s~,~ns£b£1~ty ~f t~o b~ies: t~,e ~at~o~l Bosrd nF lle~]tl, aP~ He]fare and th~ N~ti~l 5Jnuk~ ~d Heelt~ ~soc~iti~n (Natiunalf6re~li~qen f~r upp 1~ll~g om tob~erl~ ~kadeverkni~r, NTS), NI~ is ha~ked up by more tr,~,l by u~her ~overnme~t ~gencies, such as ~le NatiOnal ~rd ~r Educ~LLon 15k~1~vers~yrelserl~. AL the rog£or*~l level, [hey are hendl~d ~y ~h~ c~untF ceuncils a~d are ~art ~f ~he~r p~eventlve healLh car~ efforts, 1~p~r~a,,L 9an~z~ti~u, mo~t notaM~ the S~edis~= Cancer Society ~d ~ qr~s-ro~ts non.sm0~ers' a~u~i~i~n known as ~IS[R (vi som 1~e r~ker ~ ~e w~ d~rl'~ "~ i~uk~je~s CI,il~hOD~" is ~he ~utt~ for il~Formationll ~nrk ~imud it pre venting children i~d yuun~ people from ~tartJng t~ smoke* fro~ the tlme they first .7J~1~ ~bear J~cal ma~ernttX ca~e cen~er, future partln~ ere *xposId to £n?ormah~ on ~be harmful ef'fect~ of smaki~g in c0nnectlm, .ith p~eurlaney ~nd e~l~]dblrth, lh£~ £nFor~tton is offered ~- ~t~e~ ~it~ ~Pogrlms designed to help Orople ~up ~m~kin?, E~eh c~ontX council organizes it~ o~n anti-s~itly eetivit~es, but in recent y0ats t~e N~tlar,ai Boarl of Health al~d Welfare has srrnn~e~ ceeionaZ advanced

260 A~ioe ~rom the "par~tal traJnlng" ©n [ob~cco-~e~d J~gu~ pravidBd in teLeted ~ues to Bta~F m~s w~hln thB p~b~e child C~ ~e~, i.e. mainly within t~e ~ch~Ol ~ylt~. I~truc~l~ in S~ediBh ~chool~ ~ gove~oed prlmarlly b~ l~l~ ~rl~enta OF ~l~ uFF~ux~l ~urr~cu~ issu~O by th~ C~birl~t ~nd ~r~ia~ent. ~ e~l~ ~ ~ ~1~, thB ~choal aurrlcul~ the~ in fo~c~ ~n~lud~ ~ctiono On how ~o t~aeh abaut ~ohol, n~root~, n~ t~ba~eo. At pre~ent, ~ ne~ ~FFleJ~l ~u~iou~um i~ gol~q into ~FFett. In ~hl~ co~text, r~vi~ ~a~ ~nd~rt~en not onl~ o~ instru~ti~ ~g~kr~ ~C~, ~ut af th~ ~n~i~B ~o~jec~ a©ee In ~hich tobacco %~ l~luded m health ~duc~tlon. 5 ~ ~ ~ Bo~ of EdLJcat ° ~P~~oved ~ ~e~l program on ,l~e~lth Eduu~t)~ in ~he fich~ol~.' Th~ p~n~r~m ~t~t~ that th~ ob~ctlw of ~hOOl health ~du~atio~ ~ to persuade 9~owing c~lld~n ~d tBena~er~ to ad~t habiL~ ~hi~h p~o~o~ good hea~Lh. To a~o~p|i~h thi~, ~ ~ide r~r~e should increa~ pupi~' ~re~ of hn~l~h matt~rn. ~ part ~f this, Lh~ d~re~t ~nnect~ona ~t~een P~lth ±~su~ a~d ~i~l ~nd env~ror~ntel C~÷ Health edu~ u i en n rB pa~ of n~t~uctlon in ~he ~ch~ol~. It sh~uJd t~ke du~ ~¢~nt of ~h~ plJp~l~I ~lt~m~D~, ~p~h~ht~e~ ~nd bB~k 9round. It c~ ~e a part ~f ~l S~YOJ~. ~IL ~ho~l ~fF me~ber~ ~h~Uld collaborate zn heBlth ~d~c~tiDn. In te~hing thi~ ~bj~ct, xL ~ ~1~ ~ t~l t~ cooperat~ ~±th other ~[~lLJl!~rl~ out~id, th~ ~h~l ~etez. A~ove all, ~d ~o~]aborat~Dn with the pop~l~ hom~ ~ ~ ~e~qui~±~e fo~ ~h~': aucc~B of h~alth ~due~tl~ w~k Z~ th~ ~ho~l~. Th~ ~w pcu~a~ ~ill le~d ~o ~ redoublin9 oF efforts et bQth n~%~al and ~he ~t~onal Bo~r~ of Educullon will devote l~ere~ed e~er~ t~ providing• • ~ ' tC~Ch0~ ~lth ~dwn~ed tr~lnir~ on h~alth m~Lt~, dl~t~lbuLxll~ d~scu~ hal ehd informational i,,~L~a~ to the ~hool~, ~d pe~su~dlng ~du~ti~n~l loc~1 l~wl, e~ch s~ho~l ~B ~ b~ng a~ku~ Lo e~tabll~h Lt~ O~n oper- ational plan, ~n~luding ~ ~ocui ~t~oo pru~aln ?or h~a~th education. The ?~ct that a piogrB~ fo~ health ~d~l~n ~a~ rec~ntl~ ~pp~oved do~ r,~t, of course, ~ea~ that mu~h activltl~l ~e~e p~evio~l~ ob~ont from the scho~l~. 8o th~ ~on~t~y, Iwr ~i~e the be91nn~n9 oF gow~E,,~r,L~p,~.~ored to~co i~Fo~mBtion, For ~rl~rl~e~ ~ ha~ ~n ~ irp~t ~t£~ t~k F~r NTS ~nd other org~nlz~t~o~ to llT~d~ce te~ehing ~nd informational ~ ~t~ NTS ~ubLlChed 1~ 1780. Called "T~h±~g Ab~u~ l~b~cco" (Art unde~i~ ~ tobak], it co~ta~ pr~t±~ll t~ps on way~ or ~nc~u~ng ~ i~l~ted ~su~ i~ ~ho~l l~t~uctio~ z~ I variety OF different subj~t~. Un da instruction an~ ~?~ ~W ~f ~t~[~ t .......... fu~lc~~ ei~ent~ in the ~,l~-~okt~g work o~ th~ 5~edl~h ~choo~ ~kom ~o~, OF cuu~e, ex~ude ~]~o ~rr~gJng ewtra c~pai~n~ Bnd Bp¢cl~] s~b3~t d~ ~ ~t~ ~ anti ~mok~n9 heine, o~etlr~ OUt~¸de ~×p~L~, ?~ ~n~t~n~ ~gul~r t eachet~. SD & 089 261 Ta~acco~el~ted ir,f~rm~tl~n to yo~n~ peopJe is ~1~ provided ~ut~id~ thg ~ch~l~, FO~ ~mple i~ ~rJ~w y~u~h ~lub~. V~S~R ha~ a ~epB~at~ ~D~Lh 10aque~ uurrent~y with abouL 1~,~00 me.beta in ~ch~ol clu~ throb,out the country. 0u~ing the p~t ~h~e~ y~r~ m ~pe~o] ca~p~9~ h~s ~J~o bee~ tLve" ~ ~,ne~h~n9 ~w, ~uU,~ul, ~d modern, A ~ep~te o~g~ni~t~on h~ be~n Fo~ fo~ thi~ c~mp~z~jn. ~,~u~n a~ ~he Foundatio~ f~ a N~n-S~okzng r,at~onal ~d rc~ior,a~ qowr,lr,,~nL aq~a~e~, ~n~ur~r,~ comp~nl~ n~ oth~ enterp~z~B~, eto. U~ing ~utdo~r pe~te~, ~dw~t~Jng Fi~r~ ~n ~evie h~t~ ~ck eor~t~, ~nd o~her ,,,o~e~n ~a~oting t~hni4u~, the ?ound~t~ ha| m~d~ it F~hlonmbl~ nat to ~,~ke. hFo~m~L~u~l a~L~vltie~ ~e ~l~o th~ m~t ]~po~tnrlt elem~rlL oF c~p~§nB a~ain~t th~ tobacco habit ~n~9 BduIL~. But on[y a ~m~ll p~,~rt~Dn oF ~hi~ u~gBnizat~ to ~he p~l~ B~ l~e. c~ wa ~n~n~F,9 tuxt~ ~n tD0~co p~k~ge~ ~d i~ tobaccD adve~ti~ul,,~nt~. Both the N~ti~n~l Board ~f Health ~nd ~e aHd N;S, ~ ~ell a~ oth~ ot~a~z~i~n~, al~ p~odu~e ~e~e~,~ ~nfotmath,n~] mate~Bl ~n th~ for~ ~F ~hi~h w~ di~Lribut~d Free oF eh~9~ v~a a~] pha~ie~ ~,~d po~t of F~ce~ 07 ~uz~, televised,n, d~ly ~le~pBp~, Bnd ,~her ~,edla son~etimcs ~ond~ct ~n~o~=aLior~ ~psigna ~bout ~nlOkin9 un their ~r~ inlti~tive, ]~ ~he FBJ] e?Fe~ts oF ~moh~n~, ~th the ~hemB ',Sn,ohc ~, Live." IL wa~ il]uc~ra~a ~lh pzctu~e~ by the F00~d ~dzsh 0,~d~J ~hot0g~aph~t LeOFI~ N~1~0n* ~nforl,latlon to ~he pob]~c ~1~a ~some~ ethe~ fD~I ~ch ~S wh~ 1oe~l BUt @r~eral ~r~Fo~BtJon i~ ~ot ~ufFiclunt arld crucial in ~eLually per- ~U~d~F~q ~eo0]~ tD SLU0 ~mok~n~. FO~ thlz re~u~, th~ org~izBt~o~ h~ cho~r, ~o ~llot ~,,r~ FUH~ tD buildi~ up progn~,~ uF local i~?o~mati~n, Th~ Jde~ ~ th~ eH ~v~kera io a 9iu~ vJ~olty ~houJd be ~bl~ ~o ob ~o~ inFD~mntlo~ o~ ~mok£n? ~S ~]t ~ help in qul~Lin@ the h~bit ~ Foe ¢ente~ or ~ith ~eopl~ at th~i~ o~n ~ork~]ac0z~ AF~ l~po~u~t ta~k i~ thu~ ]~cal b~. ~o~ ~ r,ur,,ber of y~ar~ th~ NaUt.,01 8~d of Health ar,d ~e~ f~r~ a~ ~l~ a~ many cou~iL~ councils here tra±~ed "bbacco Jnfo~l~io~ oF~." lhe~ ~re p~ople who -- by vi~tt~ ,~F their po~tlen aS teBch~rs o~ ~ nf flclalu of trade unions, ~tud~ aSSOCi~ti~,~, "or u~h~r "pap~]~

262 sessions, fmr lnstence in study ci~]e fo~. es pert o? their dei~y work. Right n~ NT$ ie prepe~ing e treining progra~ for doctor~ and nur~e~ in o~c~p~tional hoolth c0ntor~ ~nd for e~fety delegatee, eo th.t they c.~ provide information at w~rkpl~c~. ~nd help people who Wahl to quit 8~ok- lng. For ~ number of year~, the S~edieh Carloer 5ociety ~s worked on the issue of e~kin0 *ithi~ tr~ ~a]th ¢.re delivecy ~a~ e~n9 ot~ ~hin~s ~ that sll ~octore e~ othe~ ho~lth c~r~ por~o~el ~ill ir~]ude , ~b~c~ in,oration and he%p peopl~ ~uit the habit as p~rt of their ordi- nary cont~ct~ ~ith ~atie~t~. Th~ '~k~y ~ereon'* ~y~tom ie baee~ on the conce~t thet meny ~moke~ ~n~ ~o ~it ond c~n do eo on their o~n, ~rovided thet they receive si~ in?or~ion on ho~ ~o do ~o and can ~l~o ob~n p~r~on~ ~uppo~t ~nd en- ~o~.ge~e~t f~om ~heir immediate e~viro~lt du~ing the lniti.l, dlffi- oult period. 5~mp]e ewer~day ef~ort~ c~n ~ie~d ]arge re~u~s, if the~ re~ch m~ny p~o~le, Some emoke~s ma~ hew such gr~t difficulty in quitting ~h~t ~hie "~i~,,ple* progrsm i~ not ~ffieient. ~o de~l w~h t~ need~ o~ ,,t~h ~e~,,, ~ec~l quit sm0kin~ ~lini~ have been eetablished by ~ n~be~ of county eo~ils. ~h~re ~e~ .l~o ~i~il~ pri~tel~ run ~linic~, The clinie~ u~o SeWF~I di?- fere~t method~, i~ludin~ ~edi~atio~ co~wr~i~l therapy, hy~n~i~ e~e* 5~eden h~ ~I~O pe~ed certazn le~isletion deelin~ ~lth tobacco. It~ ~ur- po~e i~ to provide inFo~m~tio~ end to Influence the ettitudee ~ ~'~0ciei cli~at~" ~h~t ~ur~0und ~moking, l~ on labeling oF tobacco prod~te e~eci~ie9 tha~ all ~o~cco peckege~ mu~t c~r;~ e ~erni~ ~ex~+ ~ig~re~te pmck~ge~ ~ce required ~o eho~ on~ of r~ce~t ~eries of t~×~s ~ appcoved i~ the spcln~ of 1981 ~nd ~ill ~o into ~e no leter th~ the ~gi~nin~ OF ~82+ ~ig~rette peck~ge~ also di~pl~ a declaration of contents, It ~t.t~s th~ qu~ntitie~ ~f c~rbo~ ~no~ide, ~ar, ~d niootlne in th~ ~k~ from ~ ciga- rette oF the brand i~ ~ue~ion, In ord~ thet the consumer m~y 3~d0e ~hether e ~articul~ ]ewe~ Is ebove or below sverege, the ~eclar~t~n ~ls~ includee the ewre~e for ell brend~ sold in 5~dsn. Fo~ ~ractic~l reesons, o~her ~o~acco product~ be~i~es cig~rette~ ~re ~ot required ~o ~rry ~ ~ecleretion ~F e~ntent~ includirz~ ~he obove-m~nHoned quantities, On tho other hmnd~ al! tob~oco ~ok~ge~ mu~t b~ f~rni~hed ~ith • ~rn~n9 t~xt, A l~ ~on~ernir~ reetri~tions on tob~oco .dve~tleing etl~uletes t~et ,,per~ tioula; moderation" ~u]d be observed in m~r~etlng tob.cco pro~uct~, Thi~ b~ei~ rule implie~, ~n~ other ~in~, th~k ~dve~ti~ere mo~ ~ u~e ~et~ ~hlch eFe ,,obtr~slve or a~gre~we or ~hich ur~o the UOO o~ tob~ooo.'r In practice thi~ m~n~ th~ n~erous types of ~dverti~i~g m~y n~t ~e ~ed fo~ ~ob~cco, T~ ~pes ~h~t ere ~o~lete]y b~e~ are dire~t edve~tisin9 (e.g. in m~ilboxe~)~ o~g~ni~ed di~ributiu~ of free samplee, p~ize con~es~., outdoor adve~tisin~ and tho like. (~dio end IV com~rc~als d~ n~t exiet in 5~edon). Tobacco a~ ~re still ~llo~d in ne~pap~r~ ~nd magazines, but 263 1976 ~977 I~?U 197~ 1980

Tab1+ 2. Smo+<|+l~ navies, ~960. b+ +g+ Ir~ minx, Ln p¢l+~e~t ~I ~ l~,~~Pa~-o~ tobacco p~duc~ ~in~ re~nt ye~, ~t ~thou~rl cigaretke ~l~s, ~or ~5 o ,

266 267

69Z :6sosTzs6o L, J~ " • - , , ,,, •

O~

---

2?4 ¢1¢ It, '.~l.hh,,~l*~l~ ,.l,tlL . 0 ,.i, l ! ilii;l!!l-Zl' ,: -- .... Pllilit, v',,, • t ~h " t[[ h t ~,~= ~"/5 PX~EI~T$ I'~O~ ~T[M(3"~'¢ (3}" ~ICHAEI, ~. D~.I)BE BE~O'~ FZ THE $~'~A~E ~ O ~fl ~A [T~IZ ON ~ ~1 ~EIi~, ~]E~I~Z f+NZ) T~AN~PORTATION MAT i0, I~82 ~,/ name ]a M]chae~ DeuCe. ] am ~e~ior ],e~urer ~n ~A ~a~ ill ~dueotlvn in ~e nep~r t mei,~ of ~d[~ine at th~ University of Z di,1~ur gh [~ ~co~l~nd, w~ere ] ern ~tso AcLion ~n 8mokLng a~d Heal~h (ASH}, • ~h ~it ,/ e~t~bti~hed in I~71 t~y ~he RO~I Co~lege T.TI¢ Gov~enf~eat r)¢por trnen~. I am n,~w a raemt~er of th~ C~oun elL o[ A~H+ I ~i,i n member of the World ,~ ~at ~h Or ~ni~tlon,s ~xpet t Ad~mor y l~a nel on on ~ruokinz t,~ ~HO, I wa~ ~ n advls*r to the I~73 ~xper ¢ C~,r~m]tte~ on $rnokF~ C0at r01, and In p~r tleul~r drafted the e~pter o~ Leg[s]~ti0n an¢l lle~trLet[~e ~easurws ~n m~ ~79 C~,neer { UTGC), and Deput~-C:h~=r man of the UICC's ~p~¢Jal Fro)ect ~n 8111r)k[z~ Cor=trol, "Guic[e]Jn es Ior $1~ok~nE Co~Iro]", a~l a f =~rn~er o[ ~he I~t e~na~[o~a] T,ia]~on Corn mi~t ee o~ ~l~ok~nZ *~nd }{~a[~[t~ a~d have worked ~n 5mo~n~ ~nd healIh in so;ha ~ we~t ywl[r=e dev~0pJng ~nd devel~pe~ I wiGh tb pr ¢~ent two ~hcme¢¢ first, ths~ Smok~nK oan ~e reduced b~ Comprehensive pro~um rues w~h do not ~nfrin~e the fiber t~r eI the ind[yJduo]

277 Bu;g~la. Czech~sl~akls, FJ[i}a~d, ~t Germany, ]In.easy, I~elandl Italy~ Norway, Po[and~ Rumania, ~ ~S~R, a~d ~ug~la vi~. 15 ~urO~all o~u~N~. In 3 (Denmark. We~ Oer m~ny~ and th~ UK) the inf~r~Lioa SwiCzar]ar~d) tl~ere i~ l¢gislat [on (~h¢ Austriaa wa~ni.~g ~ to ~ IntroduCed ~ron~ Ju~, I~32).****- [*NORWay ThU *~ or w e ~i~n Tob~ccu Ae~ wa~ im~]~me~t~ in 3uly~ 15~5, {~woiag Cxtensi~ P~lla me.ta~ ~J~us~ion and publi~ d~te. The Act ~o~ipr~s*

~8 ! ~79 " ~W

280 90~£~0~9 281

'~82 ~ ,., ~ .,, ~, IN&~/ SWEDE~ LAUNCHES NEW ANII-SMO~)?IO OFK~SI~E: N~N pLA~ FOR A 2~'¥EAR pROGRAM ~¥ pAUL NORDGRE~ ~UL NORDG~N IS THE ]~FORMATIO~ OE~ICEq ASSDC[ATrO~, The ~U~hor ~ran~ I~ ~p~n~l~e for ~ ~i~o~ l~xpress~¢ a 5,r,oke nPea~i~ally 0 7 ~ B fll 10 9 7 10 ~ Oon'ts~ok~ ~ 59 52 60 51 56 53 61 ~ 66 K~, reply ~ 0 0 ~ 1 0 0 0 0 0

( O'~l- c ~ 11 .... ! ~ceom - : r ~,~i"~:~,~,~-'~:7~,:(~'-~.~-~.~,~'~ .,.._ : ~. ~ ~...~ ... ...........

C LL- -- f+ r ~ fir ~. --\ --J ,N3~ Og-~Z61 ~(~gJS 0~I~ C 5~3~ ~ N[ ~gH5 JoN ll1~ X~A~ IQN I~I~ ~1311~rJ3Q ~H~ J~l ~.~Od3u DHM k+ • I$ N3~UM ~ i~' \ ,, . J • i , + 7 r /'-,~ + ++ -4 -4 O~ ~ ~ 4 ~

2~ .-i 7o~- ~t Education Percentage~ of daily smokers~ Percenta~ms of persons s~kln~ • or~ tha~ 9 c£~ar~ttes a day 1973 ~977 1979 1981 ~973 1977 1979 198~ Secondary ~¢hool 26" I~ I~ 13 11 6 ~ ~£~n~X ~xa~nin9 ~ ~ 33 36 22 ~ I~ ~ ~o ~a~1~n or 48 44 ~3 46 31 26 25 27 traln~ng aftec i. )

( ( C4 ~z u . ,z, , ~L s/e][ooB~ou sJaq~ om ~qa, c~ ,~f ~ a"L~ lq~Z "~r'q4 '0~ "~ '0 "/ • pros tOU Z~Op ¢~J~ ~aH )JAZZ p,~Za~ ~ mt ,~¢R pzq 30ZZ p~p. ue^o~dun seBaoq3 A~uouBei~j/'6up}o g~ z--~ ~ ~1~ ~=~ #o o ~ =

292 American Council o( Life Insurance W65N~t~D C 2~ April 4, %983 The H~nQrable Henry A. Waxman Chairman Sub~tec o~ ~e~lt~ and Envi~o.al~nt Hesse Energy and CoLm~e~ce committee ~415 Rayburn IIouse Office Building Washington, D. C. 2~15 De~r Mr. Chair~an~ ,, On b~half ~£ the A~e~ican C~unc±l of Life I~suran~ and its 573 ~mb~r llf~ insurance companies, £ want %o add ~ur ~u~o~t for l~g~slat±on to ~trengthen warnings ~n cigarette p~kag~g S~ ~ m~ans of m~r~ ~f~vely c~utlonlng the publio on th~ lead~n~ cause of death in Am~rlc~. The ¢ounc±l'~ Board of Direct~r~ at it~ J.~e~i~g on March 10 approved a ~esoluti~n to ~hl~ ~f£~ct ~s a ~on~ ~uen~e of ou~ ~ndustry's commitment t~ health ~remot~on i~ge~ral and to smokin~ ces~atxon in particular. • oum~y be interested t~ know, too, that as a ~e~ult of ~trong recommendations frem our indu~try's A~isory Council on Education fo~ ~ealth Ic~pos~d of so~ of the ~st p~mincnt professionals in the field of health ~du- ~ation and wellness), our companies are b~ing dsked to establish ~mo~in~ cessation p~o~ra~ ~ po[i~ie~ ~n~ their employ~em and s~b~equently work with #hei~ group policyholders ~o thi~ ~nd. I a~e~closing ~ome hr~f ~aterlal on~ wor~s~te Campaign. SxnceZely, Kich~gd g, Schw~ike~ Enclosures i r " • 293

"Smoking-rerated diseases are such important causes of disabil~y and premature death in developed countries that the oontro} of cigarette smoking could do more 1o improve bea~ and p'deng life in these eoun?Jes than any other single action in the who!e field af preveni~ve medicine." r~

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2~ £T£1~&£O~9 299

¢,¢ elq o~.u~'AaJd *~e6JOI eq! S~ 6ul>loms. uoqon~J e pue q~lea~ s~ -u qlle~q alq~nle^ e~ uJe,~ ~R~e mo4 s~ e~o~pJe~ ~ dwnI ~o~ ~U~lo JO ~s~io JOS ez~B~o l!~dd ~u ,~uo ~! sdnoJ~ ~ Mooq ~oqd e ~o

3O2 American Council of Life Insurance/ Health Insurance Association of America Advisory Council on Education for Health RoberJ [,. Johnson ~ ~ ROI~I L Levy, M,O, &nn~ R. ,~m;~ r 8 Pmsi~rl VicO Pr~i(Jer~t for ~ai~ pmfes~ App~ra0hiar~Rog;orlal ~ ~ Scie~e~ University of Me(Jicine ~nd HL,S Vii al~ Dean~ SchOOl c~ Medicine Ocnl4st ~ of New Jofsey-- Cha ILe8 A, ~erl*Fi M,O, Tu~ Univers4y Ru;gor~ Medlcal School Chai,u~an ~lh~n M,~¢o~y, Ph,D, Ar1~lur Ul~ne, M,D. Nat~ona~ Fou ndat4on 1or ~ ector Med,cat C~l~Sultar~l pruvent~n ol Dl~a~e In SLILU~e for Communicati~ NB~s T~day ~h<~w Usle C. car t£~", JZ. R~oa[ch [3onaM C. Weg mltl~r pr e~d~l~~ ~tanford Un~versJy Pre~ de~t Unlv~r si~y of the Di~Mct Ol LOlS G. Mlchael~ Healtr, Central ~ Co~umbi~ Dl,~Clc~ Ml~nea~lis TheOdOre Cc~p~=r. MD. Health Ed~catir~n C~nter E×ec~tive V~ce Pres de~t Pitls~)~ r 9h The d~john C~pany E~r,a O~ Nl(l~ti~ gal~, M.D, Pre~ ~enl l~Stl~ut e o~ M edi¢ir~ Nati~a~C~[er ~or HeaJ~h Nati<:~a~ AcaGem~ ~ r : Jonath~in E, Fioldin ~, MD, J. H~nry ~m~th - UCLA Cc[1:0t ~or H~a~tn T~o ~a;tablB Lifo AS~ur~ce Enhanc~n~nt ~,:~:ie ~ o~ th~ J B03 ~oci~t y o~ inte~l m~dicin¢ kprll I~. 1983 ~d~cine The Soclet~ Is a~ar~ tha~ c~are~te s~kln~ ~ th~ I~rg~st p~e,~nta~l~ caus~ of 111ne~ ,rid ~,,atur~ de~h In the Un~e~ ~tates. ~e a~ al~o ~ar~ of the ~tag~erln~ ~con~c ~u~den *hlch ~n~ relaL~d ~e~s ~n~ d~a~llt~es cause ~ue t~ l~,~ ~r~ prod~L~it~, The ~o~ of Lr~at~n~ of d~seases r~lated to ~i~aret~e s~k4ng fs ~ f~etor ¢o~tr~ut~n~ ~o t~,e ~en~ crisis ~ ~e ~el~e~e th~ Lhe *C~p~nsive ~nlok~ng P~eve~tlon E~ucat~o, ~ct of 190~.'~ ~.R. I~Z¢. ~h4c~ you ~n~ro0uced. ~uld ;n le~ent e ~ ~r ng prog~a~ ~a ~cu s ~ c~nt ~ ,ncre~se pr~enL af~o~ts to ~rn s~kers of the h~aar~ ~ttend~q~ to th~4r ha~l~. The ~oc~e~y'~ po~it4or~ ~lrl~e o~r last ]ette~ to ~ou on thi~ sabjecL. dated ~ugu~ 2, ~9~. has not ch~n~ed~ In feel th~ ~ST~ ~ous~ or ~lega~e~ re~se~t~ng ~nte~,~s~ leade~ ~r~ *hroug~out t~ co~nLr~ • ~uld ~ndaLe s~roq~ Oa~ka~e ~belin~ On al] toh~c£~ p~. dest~uc(l~ to he~Tth~ ThJS ~ul~ be ~n keeping ~h A~H's o~er~;] objective ~ ~dlfy~n~ ~ose ~estruc~lve aspec~ of an ~dlvidu~] ]~fes~]e tha~ ~a~ eventually ~e~u~t In se~4~us a~d costly ~llress ~f ~ ca[, ~e of f~er a~slstance ~n a~ ~. ~nte ~]ach, M~ President

,~ ^ SMOKING PREVENTION EDUCATION ACT : TBURSDAY, MARCH 17, ]983 [-~O U~ OF ~EpBF~ENTATIVE$, COMMI~EE ON ENERGY A~D COMMERCE, SURCOMMI~[*rEE ON ~EALTK AND THE BNVIIIONMENT~ W~hi.gton, D.C The subcommittee met, pursuant to notice, at 2 p.m,~ in room 2128, Rayburn House Office Building, Hun. Henry A. Waxman (chairman) presiding, Mr WAX~AN. The meeting of the subcommittee wili please come to order, . This afternoon the subcommittee wilI contimJe hearings on H.R, 1824, the CompreherL~ive Smoking Prevention Education Act. Since the legislation s introduction on March 2, 43 Members of Congress have jokied as cosponsors of this important public health initiative Last week we heard from some of the Nation's most re* nowned physicians and researchers who emphasized that cigarette smoking is the single most preventable cause of death and ilkicss, that cigarette smoking is addlctive and that the role of cigarettes as the cause of diseases ranging tbom cancer to heart disease is ir- refutable, 7he legislation does not call for prohibition, but it doe~ work on the premise that Americans who smoke should be encouraged to quit and that potential smokers be discouraged from starting. To accomplish these goals, H.R. 1824 proposes to promote greater public awareness ~f the health ris~ in ~moking This afternoon we will hear from witnesses that will give us a different opinion o~ this legislation. We are ptsaeed ~ weloar~e ou~ afternoon witnesses and all our guests today. 1 apologize to those of you who are crowded together We were bumped from our previously scheduled meeting room by another : subcommittee that needed to continue its hearings into the after- noon With those apologies I hope you will be as comfortable as p~ssible. ~! Mr. B iley Mr. BULEy. Thank you, Mr. Chairman. : Last week we discussed several aspects of this ]egislation includ- :!ng its effects on international trade and the effectiveness of rotat- ing ~arnings as a method of promoting public a~arene~s. I have two statements which are relevant to these points. , One ts a letter t~ the ehair~la~ of'this Buheommittee from tho U.S. Trade Representative outlining his objections to this bill. :. The second statement, which [ referred to ledt week, is a report :: to Congress on health hazards a~oeiated with alcohol and a la05l

30g method to inform the general public of these hazards submitted by the Department of Health and Human Services November 1980. Although this report deals with alcohol the conclusions it draws with re•peer to rotating are applicable to this legislation. I therefore request unmumotm consent 'that the sentative's letter and the report eectien dealing ings be placed in the record at an appropriate point. Mr. WAXMAN. Without objection, that is ordered. Mr BULEY. At present• Mr, Chairman there uals and organizations who are interested m this leg~stetton. have not had the opportunity to appear before the subcommittee. 1 would therefore e~k the chairman to hold the hearing for 2 weeks after close of today's hearing for the ditional corrLmente on the bill. ~" ; Mr. WA:OXA~q. Without objection, we will hold the hearin open for 2 weeks for eay further commenr~ anyone wishes to this legislation. - Mr. BLII~y. Thank you. Mr. Chairman The materials referred to by Mr. Blfley follow:] ~,v :' ,, e ~b L ,!d r~o;;, '. 307 f-'~,

Report to the President and the Congress Oil • ~ Health Hazards ' ~, Associated with Alcohol .~. Methods to Inform the General Public of these Hazards .... ~ :~ U.S. ~" --~eparmaent of the xreasur~ , and , @ U.S. Department of Health and Human Services ' ,

311 ~te first evaluated previous Federal efforts designed to provfde the p~bl~c with health thforr~ation about o~er ~otentl~llb" h~z~r~ou$ prod~¢~$, Because the Con~re~ and ot~er~ have ~ho~ p~rtleul~r irlteresL ~n w~rnln~ labels as a i~a~ of ln~orm~ng the public. ~ ~nel~d~ in th~s review ~n ex~lnatioN of evidence regarding the ~ffectlveness of the healL~ warning On cigarette package~ and pro0~ct$ eo~tathln9 s~c~h~rln, an evaluaLien of" he,Ith W~r~9~ geoer~]]y, ar~ on analysis of a~Tantage~ ~nd disadvantages of an ~leohol ~,~rrl~n9 ]abel. Th~ 0epart~erTt$ also cen~idere~ ~ ~lde range of possible co~uN~¢at~on ~echn~ques that could be u~e~ to carr~¢ health related ~e~sages about alcohol. Statements as a t4ethod of Infor~lo~the P~bl~c The 0epart~nts con,#dared m~y ~'~tor~ befor~ ~rr~v~g ~t ~e~e~datton ¢oneetnthg health ~rning$ o~ alcohollG beverage containers. These Included: ~ ~leral rec~p~.lv~ess of the public to ~ov~rrclent-inltla~ed health ~rning$* The type of health warnln9 ~lfch 15 %Ikely to he ef~tive In conmuhleatlr,~ thfoematl~n and lnflue~ciog I~h~vior. o The me.ads through ~lch war, trigs con be effeet~vel~ and credibly p re 5 ~/it ed, The Oub]~¢'~ right to know, and the nature Of the Federal goveen~n~'s obligation to inform the public about scientifically es~bllsheO h~a]th hazards. Public ReC~tivene55 Se,lei'al ¢~uoleatlon$ experts cautioned Lh~t ~he public generally Is feeling "over ,¢~rned,, h~ ~he ~over~'n~t. Dr. ~llitai ~t~io~l. foe ex~p]e, ~r~ote Wthat growing ~me~ts of the pIIbli¢ l~nore a~re an~ flare of ~uch (~l~verr~nl~l~) '~ar~llngs ~ause the2~ feel they cannot heed the recent aw]anche ~f ~l~lng$" (4). People s~eln to par~.lculael~ resent h~lng ~'~arnedW ab~lt ne.~at~we consequen~e~ I~kely to result frD~n USe Of Oroduc~ which they enjo3~ con$~nl~tgI ~,~teh r~ I~pear to relieve stress, af~ abo~t ~lch they fe~] p~rso~l~II~" keowled~eable and comfortable. Th~ reaction 15 helghten~l w~en the~ are few or no c~parahle substitute products, a~ th the case with alcohol, or $~cch,~rin ar~ clg~r~tte~. In these instances, a coaster Is formal to ~lve up a ha~l~ or Lhe USe ~f ~ t~pe of pr'oduet ontlrel~ rather than the less d~fficult a¢~ of" ~wltching to ~ C~arabl~ 5ull~ltu~e. For exrlrlple, ~any consumer~ ~witeh~,d readily to n~n. ~ro~l~l ean~ ~,l~en warned of the i~otent~al danger of fl~or~aeb~ to the env~to~en~. • The ~eneeal se~e of being ¢~ver-w~led m~ not ~xten~* ho~'~ver+ ~o product use stat~.r~en~s ~,h~ch a~aar on a wide ra~e of item':, ~ncIiidir~ po~r ~0~1~, ]~lln~r$, hff, l~hold c]eane~ and p~ser~ion ~nl~s, to helle b~t ~

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m 318 Mr. WAXMAN, Mr, Wydon. ~1~, WyD~N. Mr, Chairman, I very, very mueil appreciate your holdlng th s hear nff today it g yes us a chance to t~Ik to the rep- resel~tatives of the indus ry an¢] others about aurae critiea ssues, and one that I feel ~ery s~rongly about, Mr, Chdirm~. it is the ublic's right to know what additives there are in cigarettes he- Pause the fact of the matter is today in the United States we don t know what is in cigarettes. For all we know it cou d be pestle des rodentlcides, or chocolate. We | ave no den what s n cigarettes. One of the things that col1 cerns me most, is that if cigarettes aren t bad dr you, Ibe the fife of me I can't t~tgut'e out why the industry is so unwilling to let us know what ingredients go into them. The fact of the m~tter is that cigarettes are the only things we put into our bodies that we don't klmw what ingredtsntu aetudily go in the product. There is nil agreement no~, you know, Mr. Chairnmn, between the tobeceo industry and the Department of Health and Human Services fimt ~ays th(lt the Department ef Health and Human Services will he informed onl:* about the presence of thee ~dditive~ used by three or more c~garette manufacturers. I just think that agreement is a joke. It is a sham. The fact of the matter is two cf the companies sell most of the c~'aret es n this. cotmtr, y and I am very anxious, to hear ~fr°m rep rose tat Yes of the in ustry today why If clga~¢ette~ are~ t had for )ou, the public can't be told whab kind of ingredients make them t~p. I very much appreciate your holding this hearing, Mr. Chairman, and your leadership. Mr. WAX:nAN. AS our first w ~nes$ tod~, ~ are plea~~¢d to weL- come a colleague of ours, Congressman Rogers, t}om the State of Ke~¢tucky. I would ]ibe to recognize him at this time for any com- ments he wishes to nlake, Your prepared statement wi]I be purl of the record in full. STATE.'dENT OF HeN. iI,~*ROLD Rt)(;ERS, .~- REPRESENT?*TIVE IN EON(~RESS FROM Tile STATE OF KENTUCKY Mr ROCERS Mr. Chairman I would like to thank you for the ely pcrtudity to appea~ befare )'our subcomm tee I am here today to voice my opposition to the Comprehensive Smoking Prevention Education Act. . • f ~ou d like to m~ke it clear at the outset that there is no one in ~th s body fbr whom I have a higher regard than the chairman from ~'~Ca ifarnia Today I mn here to talk to you about the facts, ditt~ T e first fact is that Americans already know there are he ~.~risgs associated with smoking. A Gallup Poll confirmed that 90 per- • ~en~ ~f th~se questloned bel eve that stunk ng is hazalx~ous. These ¢.,.Scesdits were confirmed by the Chilton and Roper Pos along with ~%~i] the other atodies aboat consumer awareness. They have concluded tha~ Amerlcan~ are nearly ~n~er~aiiy ~aware of these health risks. The second fact is that add vna labeling would not have much impact on how much Americans smoke. Sweden, Fin and, and 'l t' 'f S i $19 Norway have tried rotating labels and even bans on advertising ~nd the results are now in, Mr. ChairmarL even the most stringent restrictien~ on cigarette advertising and ]abeSng have had iittfa or no effect on cigarette colm~tmptlor~. Mr. WA~AN, Will the gentleman suspend. Please, may we have order in tile room. It will be difficult far us to hear the testimony if there is conversation in hack of the r~om. Mr. Roc.~l~s. Mr. Chairman, even the most stringent restrictions on cigarette advertising and labeling have had little, if no, effect on cigarette eonSuglptloIL Do.ring the last Congress more th~n thre~ dozen behavior ~nd medical experts presented criticism of the la- beling bills in the House and Senate. Their message was clear. People smoke far a wide range of rea ~ns. Since it already has been demonstrated timt nearly every ~ingle American knows about the health risks, we have absolutely ~o factual iodicatlon that more labeling would have any effect at ~i o~ h~ muth they smok~ in th~ future. Tile truth is that Americans are in danger of becoming jaded ms result of uverwarning. H~rdly a week goes by without some ~ew health sca~es s~veepillg the country ~nd the supermarket counter 12ew~pap~r~, Americans ar~ yearned aleut e~ery~hb~g under the sun from ~er- osois, fluorocarbons, ~accharlne, caffeine, sale, cholesterol, jogging, even synthetic sheen. ~t i~ no wonder the3 are not listening to warnings any more. The answer to overlabeling simply is not more labels, Mr. Chdir- p.lan. Tile third fact is in our ~r~ s~ciety Amedcan~ make free choices every moment of every day, wh~t~ they get into thei~ cars they ~re taking a calculated risk and the5 decide it is worth it. When they walk onto an airplane they know they are increasln'~ their vulner- ability to plaue cra~he~- by 10(} per~eut,- but they °keep right au flying. .- We wouldn't dream of restricting sales of automobiles and we wouldn't stick warning labels on dirl)lane wings, I don't thlt~k Americans know the rL~ks they are taking and in our free country they decide whether or not tha~ risk is worth it. I am here today to tell you that it simply is not worth it to sla0 more w arnin~s on cigarett~ packages. It is not worth it because it wouldn b work, It would not accomplish your o~m ~ools, and, even more importantly, it is not worth it when you consider the price we would he paying in our civil liberties for the sake of this faille ges- ture. There is a substantial body of legal evidence, Mr. Chairman, that the first amendment appI~es not just to individual ~peech, bu~ t~ commercial speech c~ well and the courts have gon~ one ~tep fur- ther. This freedom of speech does not only mean the freedom to speak but it means that we can't be forced to say something we don't ~hoo~ to ~axy.. In the Virginia State Board of Pharmacy v. Virginia Cilizens Consumers Council, the Supreme Court noted you have to be a will- ing speaker in order for your constitutional rights to be fully prc~

320 tectod. Requiring specific labeling is going one step further in forc- ing manufacturers to say something which they may not agree with or don't choose to say. Incidentally, even the best of intention does not justify this en- croachment on our constitutional liberties, In other decisions the Supreme Court has indicated that even when the goal is to achieve an important Government goa , th s does not justdy interference with the flint amendment right to the free flow of commercial information. It is essential to our free econ- omy for this flow of lafurmutlan between manufacturer and con- sumer to continued, Mr. Chairman, today I am not just here on my own behalf. I am here on behalf of about 40,000 people in my district who grow to~ becco, These are smMI farmers who depend upon the one acre of tobacco they grow for the only cash income they have i~ most c~ses with which to pay thelr mortgages and send their kids to school and pay the doctor and the like, More than those 40,0110 people, however, I am here on behalf of r~ilfions of Americans who have never seen a tobacco plant Cen- turies ago Amer.. ca s fuught fir their liberty 2'hey fought aga st I~r nay, :lee d ng that, exen though It w~s benign, even w len they were told it was for their own best interests, that tyranny in any form remained intolerable Mr Chairman I am deeply concerned w th the whittling away of our American liberties, albe t for the best of intentions, and in this ease we are talking about whittling away our freedom of speech for the sake of a program that will probably not be effective. It is not necessary in vlew of the already high awareness of the health risks of smoking and when it will likely fail to accomplish the very goals you have in mind. I am concerned, Mr Chairman, that if Americans lose their lib- erty, it won't be with the crash and thunder of guns and mortars. It will be done with a whisper, it will be done right here in the marble halls of the US. Congress where we regulate and legislate until we }lave whittled our American liberties down to the bones, t down to a mere skeleton I urge you and the members of this subcommittee to think care- fully, away from the flair of these television lights, and consider whe:ber this further erosion on our bert es s worth it, whether it is worth it Ibr this futile gesture to take another swing at tobacco growers My friends, it is not Amer'cas } ealth that IS in danger of going up in smoke It is our constitutional freedom. Mr. Chairman, I tlmnk you tbr the opportunity to be with you today. Mr WAXMAN. Thank you ve,y nluch Mr. Ragers. We agprecmte ~you r mmny. lest ~.~ Let me ask you one question. In light of your comments, do ynu think we ought to re ~cal the warning label that is already on t e ~cigaretto packages? , L%; Mr RoG~s. I don t think they are being effective, as I indicated ~n my testimony, according to all the polls I have seen and heard Ninety percent or better of the American people are fully aware of the dangers of smoking and I dare say they didn't learn it from :! 821 warning labels, but learned it from television, radio and newspa- pers and all the publications that we read constantly. I don't think it is effective, if you asked the smokers of this coun- try, "How many of you read the warning label on the cigarette package when you buy it or durlag the ccmrse of time you have tile package in your possession?", I bet you better than 95 percent ~'fil say, "No, I never noticed it." If they don't notice the one that is there now, I don't see that a change in the content will make any difference. Mr WAXMaN Would you recommend that we no longer require a w~lrning ]abe]? Mr. ROC.EaS, As I have said, I don't think it is worth the money that is paid to put them on. Yes, I wouldn't reco~nmend that even. Mr. WAXMAN. Thank you for your responses. Mr, Bliley. Mr. BmL~y. No question,s, Mr. Chairman. I just would like to thank the gentleman from Kentucky for com- menting and giving us his testhnony today. Mr. WAXMAN. Mr Wyden. Mr Wvnnr~ Thank you, Mr Chairman I appreciate the remarks of our co]league and fellow sop}mmore. The first thing I want to point out is Dr. Poliin, Head of the Na- tional Institute on Drug Abuse, to~tified that the data shows that 40 percent of the high school seniors who were polled in 1982 didn't know smoking poses a serious health threat I think I might take exeep¢lan to your comment that everyb~)dy is aware of it. I think that Dr Pul]la of tbe Institute on Abuse gave us some helpful evidence. Another question follows up on the poiut I am mos~ concerned about which is the public's right to know what ingredients go into cigarettes. Dues the gentleman think that the public has a right to that in- fcrnlation? Mr. ROGERS. ] really haven't given that much ~hought. You knc~, f think most people know wha~ is in cigarettes. They knew it contains nicotine and ta:s and the like. Mr. WymaN. How do they know that? How do we know what goes into it. Unlike thod, drugs, and alcohol, as far as I know consumers and the Government have no idea what the additives are in ciga- rettes. That is one of ~he reasons that the ladus~ry has golle to such ]ength to enter into an agreement with the Government so that maybe people won't find out. Mr. RO~ERS. I probably have the same inquisitive concern about cigarette content as I do about Coea Cola. If you are going to make cigarettes prto~ their content, perhaps we ought to rc~!ulre Corn- Cola to reveM timir ingredients. Mr. WYDEN, We know what lagredien~s are la Corn-Cola, Mr. Ro~sas. I don't think you know. You know the general in- gredients, but you don't know the trade patented ingredients that go into the syrup. Mr. WV~eN. The tobacco ladustry said ~hey don't want to disclose the additives that have been trade secrets for decades. We know I IN I

822 the ingredients in Goca-C~la, yet the flavor has never been dupli- cated. In fact, we also know the chemical compounds that are in drugs. I very much appreciate bringing up the Coco Cots example because we know what the ingredients are in Coco-Cola today and we do not know what the ingredients are in cigarettes. I think the publle i has a right to know, Mr. ROGrI~S. I beg to differ with you because the Coca-Cola ingre- dlents are protected by patent and are the target of lots of cam- paigns to learn the ingredients of this very mysterious syrup out of which Coca-Cola is made. So, we do not know the exact contents of Coco Cola. You may know the generic tit~es of the materials that make it up, but not the parllsu]ar formula. Mr. WYD~N. That makes my point. We know she ingredients, but we don't know the formula. I think the public has a right to know in the case of cigarelses what the ingredients are. Mr. l~zas. I can show you on the farms what they are made of I can show tbe poor farmers growmg the plants. I can t tell you the chenfical makeup of the tobacco stalk and leaves except it is tobac- co. Mr WYD~N. The additives are not grown on the farm What con- cerns me is after it leaves your farm. ] anl concerned with what happens in the stream of commerce after that. Thank you, Mr. Chmrman. Mr. WAXMAN, Mr. Nielsen. Mr. NIEL.~ON, NO questions. Mr, WAXMAN, Mr. Shelby, Mr, Saat~y, Thank you, Mr. Chairman. Mr. Rogers, I know you come from Kentucky and I know of your interest here because you do have a constituency interest and that is wily you are appearing, among other things, today. In Alabama we don't grow any tobacco 1 am sure they smoke a lot down there and probably chew it too and evt.rything else. My concern here is one not of labeling, but where will tbls lead us, the regulatory philosophy behind this. In other words, one of the members of the panel, Mr. Curtis II. Judge, in his written testi- mony says, "The regulatory philosophy embodied ia this legislation if k is allowed to contlnue, will be used against industries." T~,at is what~ I said last week, other industries such as food, beer, ~, wine. alcohol, everytldng So where are we going to stop on govern mental regulations'? I know we are coming from different direc- tions philosagbically as far as tobacco is concerned because I don't ~'1 s noke and we don t grow it and we don t process it in n y area, but ~,~ I am concerned about more governmental regulations, If 90 percent of the American people--I figure it should be bigber then that but 9(} percent is pretty high--know that tobacco ~ts harmful to your health, that is a pretty high people, ratio of If tbey want to smoke, it is all right with me, although they don t do it in my closed car or around me; but the regulatory phi- ]osophy i~ what concerns me about this, because I don't believe even if we pass legislation like this where we have requlsement~ to rotate the labels, that ~hat is going to cut down on the smoking. 'I ~ '1 4 323 I believe if people are going to smoke, they are going to smoke, I know you can argue it both ways. I just thought I would make that statement Mr. ROGERS. I think you are exactly correct. That also concerns me. I might add parenthetically that in my district there are no tobacco manufacturers or processors I represent growers. But this really is art issue that probably affects the cigarette manufactarer~ for more than fin growers I have in my district Ifowever when you are setting up a Government agency, as this bill would do, which not only requires specific words to be pr nLed in the form of propaganda on a commcrcial product, but also estab- lishes a Government agency in Wa~hingten to buy radio and televi- sion ads, printed ads, trying to convince the American people that they should not do something or should do something else. tf. smacks to me of propaganda and Government control of e ple s mental attitudes. I really worry about the American Government trying to tell the American people what they should do or should not do in their own pel'~vna] lives That really scares nle a lot more than anything else about Ihi~ bill. Mr SU~:LRY. Thank you, Mr. Chairman. Mr. WAXMAN. l~fr, SikorskL Mr. SIKORSKL NO questions Mr. WAX?dAN Congressman Rogers, we are pleased to have had you with us to hear ),our point of vitw on the bill. Mr. ROGE~ Mr. Chairman, thank you very much for your cour- tesy ~uad the courtesy of all your members. Mr. WAKMAN. Our next witnesses this afternoon will testify as a panel. Curtis H. Judge, president of tbe Lorillard Cigarette Co, i~ accompanied by his company's general counsel Arthur Stev(ns Als~ tostifving is Roger D. Blackwell, professor of marketing, Ohio State University; Harold Ivlendelsohn, director, Center for Ma~s CommUlticnttsns and Policy; Larry Light, executive vice preside~,t of the Ted Bates Advertising Agency in New York City-" I would like to welcome you to our hearing today. Without ob ection your prepared statements will be made a part of the record in fu I woud ke to ask each cf~ou fyou would! please summarize your remarks in 5 minutes so that we can l~ave an opportunity for questions and answers. STATEI~IENTS OF CURTIS Ib JUDGE, ACCOMPANI~H) 1~¥ ARTHU]~ STEVENS. GENERAL COUNSEL; LARRY I*IGIIT. PILD,; IIAROLD M~NDELSOHN, PH.D4 AND I~OGER IILACKWELL. ]PILD.. ALL ON BEtIALF OF TIlE TOIIACCO INS'ITfUTE Mr, JUDGE, Mr. Chairman, it was our understanding that we had an allotted amount of time. My statement will be longer than 5 minutes if that is satisfactory with you. Mr. WAXMa~. However you have chosen to allocate the time. Mr JUDGE, Thank you, Mr. Chairman. Mr, Chairman and members of the committee, bcfiwe l go any further, I want to thank the chairman for the brief delay you granted us--altbongh 2V~ hours today and par,~ of a panel ]as~ week severely restrict the ability of our industry ~ witnesses, ind,~

6S057352S

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33O brands.¸ Clearly, such advertising neither is designed for, ~.or h~ the effect a~ Jncreasiag ~he nuziiber of people ~'ho smoke. In liffht of these facts, it is not surprising that in testimony belbre the H~use Committee on Commerce in I~69, the thea Chair" man of the }~i~C acknowledged that cigarette advertising is brand adve~ising. And in hi~ I~9 Report on Smoking and Health. the 8urgeoa General said the following: "As the cigarette illdustry has a~serted, the major action of clga- retie advertising now seems to be to shift braad preferences, to alter market shares ~r a particular brandy The provisions of ~e~tion 5 of the bill--requiring all companies to report "a complete li~t of each chemical additive used in the mar~u- lhcLure" of cigaretteg to the Secretary of HHS--and the Secretary in tur~ to report lhat list to Collgressmconlpletely ignore the exist- ing disclosure agreement worked out last year in good ~ith bc~ tween t~he cigarette manufacturers and IIHS which agreement Secretary Brandt praised during his testim~y before this commit- tee ]~t week. Pursuant to tha~ agreement, ~he manufacturers have made avail- able ~ HH$, with suitable safeguards t~ protect this highly sensi- tive coulinercial information, a i{st of l~eir commonly used i~gredl- ents--a~d ~hose i~gredlents ~d in large quantities by any single l~nufa~Dlrer. I waIlt ~o emphasize thaL ]as~ point, Mr. Chairman, because hl response to a question a~ the March 9 hearing, Secretary Brand~ inadw~rtenLly s~at~'d tha~ ~he list of ingredients made availab]e to HH~ iacludes only ~ho~e used ~ three or more ¢/garette manu~ tklr~rs. I~ fa~t, in add[tlfm to such c~mmonly used ingredients, the fist shown to HHS includes all ingredients used in large quantitics by even a ~[Ilgle ¢ompally. By contralti to that agreement'~ careful balanclng of the Secre- ~nry'.~ i~teres~ i~ ~tai~ing i~]brn~a~i~n ~b~ t]~e~e in~,rredie~ts and the manufa~tucers' interest i~l c~nfidentiallty, this bill is ~n open iavitat[on to reveal trade secrets No~ only w~uld ciffaret~e ma~afacturers be required ~ provide Lhe S~cretary with a list of ingredients, but the Secretary would have br~ad authority to subpena a~ly re~ords relating to the~e in- gredients that ho "d~termiI~es is n~¢e~sary." Yet the ooly confidentiality requirement imposed on the Secre- tary is that he is not to divulge ~'in any report" te ~3ngre~ the individual used. in bra~d of ci are~tes by ingredlents ~ny or ~iny specific ma~ulacturer vr imi~rter of cigarettes, ~hls grudging llmi tafion does little to r~duce the risk that there~ will be u~a~thorized ~[ discl~sure t,o the public of trade secrets, for which n~ penalty is provided. Finally. I want to register our sLrong objection t~ the proposed ~I tenfold increase in the c×is~ing penalty provision. The proposal, to increase the fine fo~ violation of the labeling requirements ~om $I~,000 to $I00,000 is a slap in the f~ce of an industry that has pro- duced some 525 billion packages of cigarettes since 1965, every one of whlch has boen in compliance w~th ~he law. This industry's contribution to our Nation's economy i~ enor- mou~--~ore than $57.6 billion to ~he 1979 gro~s national product, 331 according to a study by the Wharton Applied ]Research Center at the Ulfiversity ol- PennSylVania. l'his amount wa~ ~.4 percemt of the GNP for that year. That c~ntribution generated the e~uivalent of" over two milli~l jobs--and some $21 billion in taxes of all kind~ to F~eral, state and local go~rnmeuts. I would remh~d you, Mr. Chairman, that ~ince t~e Federal excise tax was doubled on January I of this y~ar, toba~co'~ tax contribu~ t[on wi[i be even greater. In addition ~o being an ~con~mlcally strong ~egrn~nt o[ the pri~ v~te sector, this indl stry has a so been a responsible m~mber of our soc ety. Since 19M the industry has ¢omm}tted some $111 mil- lion for unrestricted, independent re~earch see~mg answers to ~he continuing questions regarding sm<~king and health. In fact, during the Ias~ 10 years, our ~oil~rlb~tio~ has been f~r gre~er tha~ t}lo e~mbined expenditures for similar research of all the v~lun~ar~ agencies who testi~ed before this committee last week. For almost 2~} years~ this industry has worke~ to avoid having i~ brand advertising reach young peoI~[e. Most recently~ we have ¢on- ducked an adverhsmg Campaign which ha~ already rea¢l~,ed 1~2 I~iIIion Americans. On~ o~ the ad~ asks, "Do cigarette ~empan~e~ want kld~ to smoke?" And it give~ our answer: "No As a ma~er of policy. No. As a in~tter of practice No. As a matter of fact. No." ~vo other ads also make the same point. Here are the three ads I ask that thoy b~ made part of the record Thes~ ads have ap eared in such m~or publications as T/me, Newsweek, U.S. News and W~r d I~epor~, Sports Illustrated, Peop e and TV Guide lo Ilai3~ & ~w Mr. Chairman, let me conclude my statement by emphasiz[n~ ~ome major p~n~s which should be ¢~n$idered by th~ committee 1~ [~s d~llberations on this bRL Fif~y4hree million Americans cl~l~tinue ~o ~moke. Thirty million Americans are said ~o have q~i~ s~nQking. Virtually everyone is fu~!y ~ware of the as~er~ions about the h~-~ ~rds of smoking. The decision to smoke or not is an informed ¢holco made by indi~ viduals as a matter ol" right. Therefore, ~re governmental regu]atlon of IPee~om of ch~i~e by leglslation is unwarranted, imprope~ a~d unnecessary. Even thougl~ the question of smoking and health i~ ~r~ open ques- t on, t is ~[so a high y erm tional su~ect publi~ p~iicy, however, mus~ be b~lsed o~ more than the passionate advocacy m~l ~he heated claims of¸ those wh~ oppose smo~ng. We ask only that you consider all the fact~ and a~l t~e ar~ menL~ bcfore y~u cast aside tha present law which i~ functloning ~l well in ~be interest of all Americans. Thank you, Mr. Chairma~ and members of ~he committee. lTest[mony resumes on p. 354.] [Mr. Judge'~ prepared ~tatement follows:]

332 STATEMENT OF CURTIS H. JUDGE ON HR 1824 BEFORE THE SUBCOMMITTEE ON HEALTH AND THE ENVIRONMENT OF THR COM~I'2TEE CN ENERGY AND COMMERCE l~rch iT, 1983 I a~l Curtis H. Judge, President of Lorillard. & dlvlsloll Of Loews Corporation. I ~m al~o the Chairm&n of the Execu%ive $o~mit~e~ of Th~ ~oba~co Institute, an a~s~c~a~lon of tobacco m&nuf&~t~rer5 with headquarters in W&~hlngton, D,C. ~ testify here today on behalf Qf ~ur inda~try, Wit~ me today oh this panel are Dr. LarP¥ Light. Professor Roger D. Blackw~ll and FPofessor Harold Me~del~ohn, ~ am al~o accompanied ~y A~hur J. ~eve~s, ~enor&l Counsel of Lorlllard. Before I go any further, I want to thank the Chalrm~n for the brief delay you granted u~ - _ althouEh two-and-a-hal~ hours today ~n~ part of ~ panel l~t ~eek ~everely re~tri~ th~ ~bili~y of e~r ~d~t~y~s ~%~s~e~, Independent ~clentlf±~ witnesses &nd other~ who oppo~ ~he b~L to appear. Consequently, many of those who ~ish ~o ~es~Ify will have to do so by means Of filed ~tateme~t~. 333 IZ will come ~s no surprise to ~o~ Zh&t we are hero to ex~r~s~ o~r s~on~e~ Oppo~ltio~ to ~[R 182~, Despite the appearances o~ ~ood ~ntentiuns. thi~ i~ bRd ~eElsla~lo~, I~ i~ ~d, o~ c~r~, for ~r business. ~Iore tha~ that it set~ a bad precedent for m~ny o~her businesses, But most £~por~l~, l~ is b~d for ~r free society an~ i~5 citlzen~1 We oppose ~hls bill because of~he fundamental 15~ue i~ raises of whether this country will have a ~atlonal pollcy Q~ ~olc~ o~ of ~om~islon, of pu~lic Infor~&~i~n or ~ publ~ ~onformlty, In the view of its ~ponsor~, th~ measure of effectiveness o~ fIR I~2~ ~il! not be the degree to ~Ich the public is aware of official warnings, but r&ther the exten~ of public~i~h them. The g~al of ~R I~24 i~ no~ an i~cr~ased 1~v~l ~f Rwarenes~ abOU~ tobRcoo and health, but a reduced level ~f $~ok~. TO ~hlft national pol~cy, ~ ~hL~ ~ill propose~, i~ u~necessary, unwlse &rid unfair. I~ fact. £t i~ a ~lan~ step down the roa~ te prohibition.

334 Mr. Chalyman, the "new strategy" of HR 1824 seems also tQ have p~odu~ed a new voe&bulary as old fam~lla~ wore8 bake ~:~ new meanlng. Take the word "informed" fop example: The pvese~t policy of CongreBB a~d the purpose of the p~e3ent la~ ~s to establlsh a Federal pru~w~ Whereby ~he publ~a may be adequately %nfomned that c1$a~ett~ smoking may be hazardous ~o health, We euD~l~ ~h~t this has already been aeeemplIBbed* The evidence 3hews ~ha~ ove~ 90 pePcen~ of the ~Jme~ean publ1~ Is aware of the clalm that ~mok~n~ i~ harmful - . an unpr~es~en~ed level ~ aw~renes~ that has b~n l~ed b~ a Secretary o~ HH~ and b~ the $u~eon General* There i~ als~ w~de~pread awareness ~f ~pe~f~e elalms. MoPe ~a~ 90 percen~ of ~he p~blle~ for example, is aware of ~be elai~e~ a~ocla~lon betwee~ 3~oki~ ~n~ bea~ dlsea~. Equally high percentages ~r~ ~epor~ed for awarenes8 o~ ~lalmo about smokin~ and lung ~an~er and ~m~n~ and pPe~ane~. Thls bill erodes the coneep~ cf individual decision making. It declares that the new p~ppose i~ to m&ke ~be publ~o "m~e ~ware~ so tha~ ~he$ r'm~ 335 be adequately informed about the adverse health effects of clearer te s~e~i~g... " In o~her words, the people are really considered to be "In~ox~od. ~f - _ and onl~ If - _ they ~nfo~ to the official ~ov~rr~en~ li~e a~d ~top ~mokin~. I wonder, Mr. Chairman, if anything short of ~ new VolsZea~ A~t w111 satls~y ~he ~n~i-~mokln~ lobb~. N~upally, the immedla~e Impac~ o£ thl~ legislation would £all On ~be ~obacco ~d~tr~, ~ i~ workers and on hundreds of th~ndo ~ tobao~o ~ower3. It al~o would b~ve ~ ser~o~ impae~ ~n ~he a~soclate~ ~dvert~Ing an~ marketing Industries, as well ~ th~ new~paper~, magazines a;*d other media ~h~ c~rr~ the~e ~dvec~i~g me3~a~e~. Bu~ tb~ long te~m damage ~ould be ~oPe w~e~p~ead. Tb~ re~l~ory philosophy e~bedled In th~ leEi~lation, ~f %~ is allowed GO ~ontlnue, will be used &ga~n~ o~be~ Indu~t~leB - - ~ood, bee~ wlne, al~ohol, ~cnfeo~lenery, cosmetics, over-~e-eoun~ew drugs &~e only a Fe~ o~ the obvleu~ t~r~e~. The anti.business ~pIrlt that In~pi~es tn1~ bill ~onvlnees me th~ ~he h~ llst will ~xp~nd. Today~ Tobacco - - tomoc~ow, ~h~ know~? A

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340 study. ~he Department of Me~l~ll and ~m~n Servlces also 0ppose0 warning ~ta~ements. Indeed. H~S reJe~te4 a sp~flc w~nlng label for pregnant women because, it said~ "singllng ou~ ~ ~pe~Ifi~ health i~sue...may cause consumers to dls~oun~ the Importance of ether slgn~fieant alcohol related health hazarcs." The Department furthc~ poi~t~4 out th~ roLatl~g warnlng la~els ~two~ld confuse the public" ~d "po~e potentially ~ifflo~l~ admini~t~ative a~d e~[orcemen~ problems.~ A ~eneral w~rnln~ l~b~l, it ~Id~ "would ~o~ convey new In2or~a~on %0 mo~ o£ the p~bli~." Finally, ~H~ no~ed !~s conc~r~ that "~he public is b~so~in~ Jaded over governmen~ wa~nln~s~' and that ~he ~overnment s~ould use such Warnings Wl~ caution. Gentlemen, it is high time for the Uen~eess and HHS zo apply ~hese c~ent concerns evenhand~dl~ - _ to stop ~Ingllng ou~ tobacco - - add to stop ~l~g smokln~ as a scapegoat ~or all of ~he m~n~ fa~or$ a~oslated wi~h disease. Testimony offered to both House and Senate C¢~mli~tees during the 97th Congress clearly Oemonstrated tha~ ~hi~ proposal for ro~t~ng w~rnlng~ ~s an attempt to ~oive a problem t~a~ doenn't exist by a me~hod tha~ doe3n't ~or~. 9 egL O 9 341 The problem does no= exist becaus~ - _ as % poln~ed ou~ e~rller - _ yi~ually ev~ryon~ is aware Of ~he ~ove~nmen~'~ ¢l~Ims abo~ ~m~kln~and heal~h. The contrary premise on whlch this bill ~ based i~ sup~orte~ by no~hlng other than the tortured argument~ eQntaln~d in the 1981 FTC S~aff ~eport On Clgar~tte Advertising, i~ which ~he ~aff erroneously concluded t~a~ anyone who does no~ b~llev~ the official llne on smoking and hea~th mu~t be unawar~ of the fact3. Th~ StaffJs faulty premise was de3erlbed in a le~er last year to ~his committee from Burns W. R~pe~, wh~ crg~nlzatlo~ conducted one O~ th~ ~rv~ys princlpally rolled up~ ~y ~he ~f. I~ hls letter, Mr. Roper c~i~i~Ized ~e Staff's misinterpretation of t~e s~rvey data, saylng: The FTC staff concludes, based on o~r and other ~ur~eF 4ata, that the public is inadequately InformeO about the d~Ii~u~ of ~oki~. ~s1~ exactly the ~a~e da~a o~ which they 5ase t~elr concluslo~, I ~ould ~cl~¢ ~Imost exactly ~e ~po~i~e -- ~hat the publls i~ hlghly aware of ~he reported dan~er~ of ~mokln~ A~ the moncl~ion of my statcment~ experts in consumer ~e~avlor w~ll testify in mo~e de~a!l ¢oneernlng the flaws in ~he premises underlying ~he FTC Staff Report ~n~ ~[R i~2~. In ~ddi~i~n, because the p~oponen~ of this Dill have placed

342 such emphasls on that Report, ~ would llke to s~bmlt for ~uboom~nlttee ~evlew and for the record, The Tobacco Institutet~ Comments on the FTC ~taf~ Report, which w~re s~bmlt~ed to the FTC in December ~981, Chapter one of thos~ Cc~nen~s ~ebuts both the reasonlng and eonc~slons about aw~rcnes~ ~e~ ~o~t~ in the Report. Before ~urnin~ ~rom this $ubJeot~ Mr. Ghalrm&n~ I want to note that in your remarks $nZroduoing this bill on March 8. you state~: Opinion poll8 confirm tha~ substantial number~ of the public awe not aware o~ the 3~okln~ ~±~k. L~e n~unbe~ do not b~l~ove tba~ they wlll personally 3u~fer t~e health ¢on~equeneea of smo~±nE. With all due re~peot, ~hose remark~ exhlbi% the same l~ck of understanding of the d~atlnct~on between belief an~ ~wareness tba~ unde~mlnes the FTC $~&£~ Repo~t, A poll of peeple'~ b~iIers ~bo~ ~mokln~ and h~al~h sa~s noth~ about ~heir ~wBreness of clalm~ ~ha~ ~mo~g i~ h~rm~ul. And ~he ~C~ ~at people do no~ belleve ~hese ol~Im8 does no~ mean ~hat they are unaware o~ them, but ra~he~ that ~hey ~e not prepared ~o conform ~o gov~n~n~ views on ~mok~n~ ~d people ~ro~ smoking, b~ ~ ~re~ p~ovides no snppo~ PC~ I+i iii! + 343 the claim ~hat peopl~ need to know more abo~t the ~overnmen~*~ pos~en on ~h~ 1~oue. There ~i~o is ~o reaso~ to believe tha~ the p~oposed Potati~ warning ~ystem w~ll &c~ompl~h i~ 3po~o~' goal, There is, ~n £ac~ a~pl~ experience ~o ~emons~ra~e tha~ ~uoh a system doeBn'~ wo~k, Despite ¢~&Ims to the con~rary~ ~he 9act is tha~ in ~weden . - ~he country whloh or~glna~ed ro~atln~ labels - -- pep capita ~are~te consumption ha~ increased, in 1977. anti-~mo~In~ mea~u~ - - Wei~ into ef~¢~ in ~wedcrl, ll.~ bllllon elgaret~e~ were ~oked. In 1982, l~.l b~ll~o~ ci~are~te~ w~re smoked in S~eden, a 6 pero¢~t increase over the year Vo~Ing labeling ~e~an. Elsewhere In Europe there are ~i~ns that the Ide~ of mu|~l~ warnln~ s~a~cmen~s i~ one Whose ~$~e has come ~n~ ~o~e. ~l~d, ~ter ~eve~al ~ea~s Of ti~ wl~h ~hree ro~atln~ w~nln~ h~ o~ b~ck to one g~eral w~n~ much llke ~he s~t~men~ ~oq~i~ ~n ~hi~ country ~oday, an~ ~le ~iffe~ent f~om ~h~ a~a~eme~ ~ng~a~d 3ta~ted o~t w~th in 1971. The~e ma7 ~¢ a better le~on fo~ ~h~ Commlt~ee ~n ~he ex~cP1~ce o~ the ~i~Ish, ~ ~eopl~ ~Io~ t~a~lons of -%

344 ~vernment and Indlvldual freedom ~e more ak±n ~o ours, than in ~hat of th~ Swedish, whose gove~nmen~ mandate~ so~lal ~gi~1~ and behavioral mo~Ifi~tlo~. Z Although ~o~atin~ labelin~ ha~ no~ worked where It has been t~led~ it will most certainly ~e~¢ a r¢~latory nlgh~ma~e of coI~luil, o~flIct~ ov~ap~In~ Ju~isd~e~ion~ and a ho~t of lo~istical ~obl~m~. FO~ example, the bill w~uld ~equi~e each e~ ~h~e~ wa~nlng s~a~emen~ to app~a~ annually "an equal numbe~ o~ ~me~ on each b~and of ~1~a~te~ and in the adv~s¢~:~n~ o~ ~cn b~a~ o~ Cigarettes.lr Toda~ there a~e mo~e tha~ ~D cigarette b~a~d packln~s p~od~ced dome~tlcal~y. ~ew bra~d~ a~ introduced and old on~ wlthd~awn~ There al~o ~e ~cb D~an~. In ~hese circumstances, ~quallzln~ ~he ~p~a~ce of three d~f~e~ent warnln~ s~a~emen~a on eve~ b~and ~ould be a lo~tlc~l ~mpo~slbil~ty. 182~. without in any way dlmlnlahlng the ~TC's claimed autho~i~ to reg~l~te clg&~e~te adver~lalng~ wo~ld, at th~ same tlm¢~ ~p¢clf~cally empower the Secre~ar~ of ~$ ~o re~la~e the rotational ~et~m o~ W~nln~ ~tatement~ and the 845 fQrma~ ~Qr dlsQiQsure of "~ar." ni0otine and carbon monoxide levele on olgarette pa~kage~ and ~n advertlslng. The tobacco Ind~y would inevitably b~ ~a~ht in the cros~fi~e of ~ b~r~ra~10 ~urf wa~ between H}I~ a~d FTC. Beyond ~ha~, i~ makes no sense ~o give such autho~$y to ~, which ha~ ne expertise ~a re~uletin~ consumer adve~tlsln~. As Se~et~r~ ~andt made clea~ in hl~ te~$1mony befoce this ~ubcon~li~tee, fIR 18~ would fo~ce Jurlsd~c~ion ov~r o~a~ette labe~In~ and adver~l~Ing on an a~eney that doe~n*t want it. The bill w~uld c~eate problems ~t onl~ for American ~1~rett~ at hom~ b~ In~e~nati~nall~ as well. It wo~Id e×por~ ~be U~. ro~a~In~ wa~nln~ System ~o ~±i count~s in which Ame~$ean manufactured cigarettes are $oi~. A~ ~om the pres~mp~uou~n~ of ~r ~ove~nmen~ di0ta~Ing to the r~ ~ tb~ wo~l~ tile wa~nln~ ~tate~en~ to De i~c~d~d ~ ~l~a~ paeka~e~, th~ ~xpor~ p~ov1~1on would pla~e Am~rle~n ~anu~a0tu~ers a~ an unfair eompetltlve disadvantage. ~n some ~eun~rle~, fo~ example, the ~ale e~ e~aret~e~ be~rln~ ~ny warnln~ s~ate~ent otne~ than that ~equi~ed by local ~aw i~ pro~Iblted - - ~hus effectively b~n~ U~S. c~ret~e~ C~r~y~ng the warni~ ~a~e~en~ ~ forth ~n th~ bill. In o~e~ ~unt~le~ ~ha~ requi~e

346 ~pecific warning statements, U.3. cigarettes would have to ca~r~ t~a or more ~u~h statements. The problems inherent la a rotational warnln~ requirement are ~@vere enough wlthout the a~dltlonal burdens that wou~d re~ul~ from extending the ~equlr~m~nt to exported clgarcttes. In addition, the bill could a~so ~ffectlvely ba~ the ~l~ of cigarettes Imported from countries ~hich do not use the U.S. method of "t~r~n n~c~tlne ~nd ~arbon monoxide tesfiln~. Wittingly or unwlttimgly, MR 1824 would, in its provision affecting the labelin~ of exported cigarettes, create ~onf~on~ chao$~ an~ ~ompetltlve dls~dv~ntage for American products in man~ overseas markets. !~ would also, we ~boi~, ¢onflic~ wltb exlstln~ federal export law ~nd pol~¢y by ~ttemp~ing ~o regulate an AmoP1~n ~X~O~ for a reason wh£ch ha~ nothing to dowlth American security, foreign . pollcy or dome~tlc shortages. The bill's requirement for dlsclosure of 'liar," nicotine an~ ~bQn mono~d~ levels ~n oi~bt~ packages or ~dv~t~In~ 347 ~i0o is unneoeasaey and un~usblfled. The public is ~on~inu~ll~ made aw~e ~f ,,~a~- and nl~o~ine levels, which ~he ~Ig~r~t~ man~facture~a have volun~aril~ dl~clos~d ~n their adv~t1~In~ ~nce 1971. Disclosure of csrbon monoxide levels would serve no ~git~mate purpose. The~e is not ~ufficien~ $cien~lfic ~v~en~ ~or ~h~ ~on~lu~l~n ~hat exp~$ur~ tu ~rbon monoxid~ from cl~ar~e ~mok~n~ c~u~e~ ~l~e~e* There ~ ~lso no generally accepted method of me~u~n~ ~8~bon monoxide in ¢l~a~ette ~mo~e. T~e likelihood that s~ch an acceptable m~thod c~ld b~ a~hiev~d £~ furth~ red~ced by the fao~ that thl~ bill ~ould t~an~fe~ responsibility for test~n~ ~arbon ~o~ox~e levels from the ~C, which ha~ very ll~le ~e~tise Or ~x~e~le~ 1~ this are~, be ~ ~h~ch h~ n~ne. This p~oposed ~nsf~ is ye~ &nothe~ insbanGe ~n ~h£ch the p~ovl~iona of H~ 1824 are opposed by I~. All In all, the ~abelin~ and restrl~tlve advertlsinE p~ovi~ion~ of ~ec~1on ~ pla~e ~h a ~ve~ bu~en on a~ve~b~ing as to dls~ourage the use of thls legal method of m~r~ti~ a legal produeb. We suape~t ~ha~ ~h~$ i~ ~ un~te~ pu~po~ Of the b~ll. +

348 A~ you beard last wQek frPm ~h~ OUtdoor Advertising As~oclaZion wltnessp Up to 25 peroen% of the o~tdooP advertl~In~ space t~a~ we buy Wo~Id be devoted ~G a di~&~n~ statement in • disfiguring deslgn- Would aDy public offlc1~l ~ning fo~ election ~pend hi~ campai~ funds for Bdver~Islng if he had to give one-quarter of the purchased s~8oe to h1~ opponent? ~e doub% it, Th~ l~b@li~g propossls of SeebloN ~ appear ~o be based O~ ~he f~l~e pP~mi~ tha~ olgarette advertisln~ ~n~ou~age~ youn~ D~ople and no~$mokers to ~moke. ~be f~t~ ~r~ th~ ci~re~ a~ver~Is1~g Is brand ~dv~rtibi~g, In~ended to encourage ~mokors t~ swltch from competltlve brand~, i~ ~he p~st deoade, the p~en~e ~ ~he Dogul~t~ who ~mok~ ha~ deollnod, while d~r~ng the ~ period the ~mber of cl~are~e brands and brand s~yles ha~ ~ubst~ntlally Increased. Cigarette man~fac~u~ePs mus~ advert~ ~o g~In o~ mai~in sh~res of the ~urre~Z 8mokln~ m~k~ for e~h of ~he~e ~ompe~Itlve ~rands. Clea~ly, ~ch a~vertlsi~g nelth~r IB de~i~ned for, ~o~ ha8 the effeot ~, i~creaaln~ ~he In light of these rac~s, it is not surprlsin~ that in ~est~m~ny before ~e House Oo~i~tee ~n C~mm~cce i~ 196~ 349 the hhen Chairman of ~he ~TG acknOWledged that clgarette advertising is b~and advertising. And In h&~ 1979 Re~or~ on Smoking Bnd Health, the ~urge~n General ~ald the followl~: Aa She olSsre~te industry hSS assor~ed, ~he major action of ~ig~t~ advertising now aeems ~o be to ~h1~t brand preferences, ~ altev mar~e~ shares fop a particula~ ~rand. The provisions Of Section 5 of the bill - - requl~In~ all ¢o~panle~ to ~eport "a complete flat Of e~ ehemleal a~Iv~ ~d In th~ m~nufacture" of o1~are~te~ to the ~ecretary Of ~S - - and the ~e~r~tar~ In t~r~ to repot5 ~hat lisb to CongPess - - compleL~ly Ignore ~he exist~ cisclos~re ~gr~smen~ worked out last year ~ ~ood falt~ beL~een the C~e~ manufacturers anc H}IS - - whlch a~reeme~t Secretary ~andt pr~i~e~ d~rln~ h~ testimony before Shls ¢onlm~$t~ las~ week. Pur3uan~ to ~ha~ agreement, the ~]~nufactupe~ have made available ~o}~S, with sult~bl~ ~afeguards $o protect t~l~ h~ghly sensitive oommcrcial inform~zlon, a llst of ~hei~ ~OW~,OnI~ ~d ingredients -- -- ~nd tho~e In~ed~ent~ u~ed ~n ~~iii~nufacture,. I wand DO emphasize tha~ last polnt, MP. Chairman, ~e~ause In response to a q~e~ion a~ the M~rch 9 hearing, Seore~ary Brandt

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352 independent research seekln~ answers to the continuing questlons re~a~dln~ Smokl~ and health. In fact. durlng ~he laB~ ton yesP~p o~P colOr,button haB be~n far ~r~aSe~ than the ~omblned ~xp~Itur~a fop ~imllar ~e6earoh of ~ll the volun~ar~ a~enclas who te~tlfled before th1~ oo~l~ee las~ weak. For almos~ 20 years, thla industry has worked to avoid having lt~ brand advertising reach ~cun~ people. Mos~ pece~tly, w~ have conducted an adveP~i~In~ campa~g~ which has already ~eached 122 million Am~Ican~, One of the ad~ a~ks~ .'Do cigarette companies w~n~ ki~s to ~ok~?" A~d ~t ~ves ou~ answer; "~o. ~3 a n~tter Of pollo~. NO. ~s a matte~ ofp~ac~l~e. No. ~s a matter O~ ~a~t. ~o." TWO other a~s also ~ake ~he same poln~* Here are th~ ~hPee ad~. Z ask that they be made pa~t o~ ~he record. These ads have appeared in such maJo~ publications a~ Time, New,week, U.S. Ne~s and World ~, ~po~t~ Illustrated, ~eo~i~ and ~ G~ide - _ to n~e a few, Mr. Cha~m~ I~ ~e conclude ~y ~tatement hy empha~izin~ ~ome major ~o1~ts whl~h should be coasldered b~ ~he Co~It~ee i~ ~t~ delibc~tlons on this blll. E &COS9 i ! 353 Fif~y-$hre~ million Americans ~ontlnue to smoke. Thirty million Americans are Said to have quid smokln6. ViP~ally everyone is f~lly awa~ Of the aa~ertlons abou% the hazard3 of ~moklng. The dDcialon ks smoke OP not 13 an Infocmed choice made by indlvid~als as a matter cf cl~ht. Therefore, more governmental ~egula~ion of freedom of c~olca by le~latlon I~ unwarranted, Improper and unnecessary. Even ~hou~b the queszion of smokln6 and healZh is an opea question. It Is also a highly emotlonal subject. Pu~li~ policy, however, mu~ be ba~cd on taste hha~ the p~s~iona~e advosac~ and ~he heaZed ~la~ o~ those who oppose ~mo~in~. We ask o~ly that you con~lde~ all th~ ~act~ and all th~ a~uments be~o~ ~o~ ¢a~t aai~ She ~re~ law ~b~h Is f~0~ionln~ ~o well i~ the Interc~ of all Ameri~a~s.

U~ ¢¢ ¢¢ 354 Mr WAXMAN Thank you How do you plan to proceed? Mr. JUDGE. Dr. Light will proceed. STA'I'E~| ~NT (}F LARRY LIGHT, PII.D. Dr. LmHT. Mr. Chairman, my name is Larry Light, and I have an M.A. and a Ph.D. in psycbology from Obio State University, I have been working in advertising since 1966 and have taught at New York University and at the Wharton School, University of Pennsylvania My e×per race inctades market research, management science, advertising planning, and adwwtistag execution, l anl eurrel}t]y an executive vice president at Ted Bates advertising, tbe second larg- est advertising agency worldwide. As an expert in advertising, I have been asked by the Tobacco Institute to present my views on the advertising and labeling por- tions el lhR. 1824 I see ne justification for the provisions in H.R 1824 which call g}r new rotating warning notices in cigarette advertising and on packages. There is ne evidence that there would be any benefit from such changes. The iHbeilllg arid advertising proposals seem to be pr[mlisod en a ~iew tbat pub]is awareness of the alleged hazards or smoking is in- adequate. The stated purpose of the bill is to "provide a new strat egy for making Americans more aware of the adverse bealth ef- fects of smoking." The premise is wrong. The proposed strategy ks wrong All evidence [ndicates that the level of pub]is awareness about smnking and health issues is extraotdinargy high, by any standard A 1978 Gallup survey cited in the 1981 I"YC Staff Repert on ciga- rette advertlsblg b~d[cates that over 90 percent of the respo[ldents are aware of the ctatamd hazards of smo]~ing. Dr Brandt, in his testimony before this subcommittee last week, agreed tbat "most studies have indicated that people are aware cf ~,* that cigarette stunk ng can be danoerous to your health, lbe sug- gesfion has been made tllat this general awareness is not accampa nird by more specific knowledge, Tbis is also wrong. Well over 80 percent of the public think that smokers are many more times as likely to develop lung cancer as non-smokers lb'oper]. The awareness of the claimed tie of this dread disease t~ smoking is undoubttdiy higher, as I am sure even Dr. Luoto of HHS would acknowledge, In addition, more than 9(} percent of the public bebeve that heart disease has been found to be associated with smoking [Chi]ton] Almost 75 percent of the public believes that smoking greatly in creases the risk of a heurt attaclI [Rtlper] Nearly two out of three people belleve that any amount of smoking is harmful [Roper}. Almost 90 percent of respondents believe that smnkillg during pregnancy can have an effect on the smoker's baby [ChiRcn]. Eighty seven percent of adults agree that chronic bronchitis and emphysema have been found to be associated with smoking, Remember that these data were collected 3 to 5 years ago, So these are the minimum levels of awareness which exist today. 355 Professor Yoram Wind noted before this subcommittee last year that these levels of awareness are "remarkable." He pointed out that a level of 90 percent awareness "can be considered 'desoient' only if compared to a standard 4of perfect awareness." Such a standard is totally unatta noble. It is conceptually unreachable. It is lmpc~sslble. The labeling and advertising previsions of tLR. 1824 seem to be based on a simple premise: Since some peep e are smoking, they must not be adequately informed about the a egations concerning smoking arid health. OF course, ibis premise is erroneous. All of us have everyday experiences with ideas about which we are aware, but we are lhee to choose not to believe them. We are also free to believe something, but not act upon that belieE But analysis of the FTC staff report, upon wh ch hese proposais~, are grounded reveals that the au hers nconsistentl and hopeless, y confused t ~e concepts of awareness and beile£ ~nd this confu- sion has been carried into ILR. 1824. Mr. Roper, in a letter to the PTC, indicated that the staff mis- used, misreported, and misinterpreted the results of his survey. This same view was confirmed last year by Professor Wind. I do not disagree that American consumers ha~e a right to make an informed choice. But, the data dearly suggest that the consum- er is informed. I do disagree with the principle that if consumers do not behave as you behave, then they must be uninformed. If the), do not choose as you would choose, tben they must be ignorant. If they do not believe as you believe, then the', must be unaware. The stated purpose is to form ~ut the real purpose seems to be to influence behav or. T~e title of the bill says ' education", and it should be changed to "propaganda" because the tea purpose of this bill seems to be behavior modification. The bill proposes that the Government move from the business ~f education into the bm i ness of propaganda. The title should be"rhe Comprehensive' ' Prc- paganda Act of 1963," T " t'~ he only ewdenee ttmt people are supposed y not aware is that ~hey are exhibiting what some ]egisla[ors be eve is undesirable be awor and this bill sets out to produce behavior which comporls with the standards ofit~ sponsors In my nptalon, while the Government has the r ght to nfnrm he bile of its views on smok ng, it shou d not engage in n~ind or be buvior control. The consumer has the right to choose, and the evi- dence indicates that the American pubhc is well informed about the claimed risks of sn',oldng. The rotatlonai warning idea apparently generates from a con- cern that the current warning statement ma2* have "worn out." Some peo~dc seem to.beheve Omt old cliche, "Famifiadty breeds contempt. In advertising, just be oppasite is true. FamiliarRy breeds trust. Consistency breeds confidence. And inconsistency breeds uncertataty We are all £~miliar with the co s stent symbols whicl~ represent Kodak, SheII, CBS Green Giant, and the American flag, Marketers recogmze the value of consistency Mar eters do change symbols. But, they do so with care, No marketer capriciously aba!~dons an asset that bas been built over many years.

356 The present warnlng statement in its consistent white box, with its consistent type style and its consistent set of words has ap- peared in the same form since I972. The value of this consistent asset has been demonstrated The warning is instantly recognized and understood. This is so even when it is printed in a language foreign to most Americans. iWhen [ speak of "understanding", I do not mean that people memorize specific words What people do remember are overall hn- pressions. Consumez~ have registered the intended net impression of the Surgeon Generals war g statement. It has become the Surgeon General's symbol or logo, and it obvlous]y communicates an important message on its own. Where is the evidence that the present warning statement would be more effective if its message were communicated via a conlplex rotational scheme? The fact is, there is no such evidence. Last week, in his testimony before this subcommittee, even Dr. Brandt was uncertain as to the value of the proposed r~tativnal sy,"vm. PeHmps he was thtaking, ~s I have been, of the familiar and ubiquitous stop sign. Does anyone believe that because it has been around so long it has therefore worn out? Would anyone recommend that each stop sign include inibrma- tion about a specific risk associated with going through the inter- section vathout stopping? Would anyone also recommend that these risk specific warnings be rotated using a legislated rotational scheme? Of course not. The fact is that the proposed rotatlonal system which nmudates detailed information violates recognfized principles of common svnse, advertising experience, and knowledge of con sumor behavior. Mr. Sharp, in his testimony las~ week, commented that the pro- posed warning statements would not likely be effective in outdoor advertsiug. According to him, "messages of over se~a words are ineffective" People simply would not have the time to read the specific Jniermallvn required by this bill. It was also pointed out tbat outdoor advertising is a significant proportlon of cigarette ad- vertising expenditures He is right about outdoor. A sinlilar obser- vation about simplicity is true about all cigarette advertising and labeling. As I have noted, the most effective warning symbols are simple in design and consistent al execution and content. There is a limit to the amount of information you ,can communi- ~'~cae via advertising I)xcessive information doesnt lead to in {~)crea.sed knowledge, it leads to what psychologists call "information ~overioad." lalbemation overload m advertising leads to reduced ~,rlrecalh it ]~ads te lower awareness; is leads to increased confusion. • ,~ Last year I pointed out we bare o simple, memorable principle in ~sdvertising, it is calied K LS.S. That stands for "Keep It Simple ~'~,,St,upid ' T s .Ye r, I.would like to,, add a nov,' principle: KICI) .... ~,~ Keep It Consedcnt, Congressmen. If public policy dictates that the information set forth in IIR. 1824 should be broadly communicated, here are a nu rude of educatimlaI vebis]es which can be used and are being used right now, such us brochures, posters, films, material supplied to schools, '1 1' '1 357 publicity, educational programs, dissemiaatisn of studies, and so on. But, this bill goes beyond these programs. It proposes an in- creased appropriation of a tobacco nmrkeeer's advertising space for public purposes, so as, in effect, to ca~e fire seller of a perfectly legal product to advertise against itsel£ There is no evidence that this unjust appropriation will produce a significant increase in overall awareness beyond the current ex- tremely high levels. There are no erc*pirica] data, no theoretical bases, and no pragmatic evidence that the warning statement changes which H.R. 1824 wou!d mandate will achieve its stated ob- jectives. It seems to me that there should be some burden on the Govern- ment to demonstrale both public need and proven benefit for a pro- ~" gram which could appropriate up the 25 percent of an advertiser's paid space, which would cause the redesign of long used packages and cartons, and which would disrupt the advertising and package produc~iozt processes of an entire industry. 1 also have concerns which go beyond knowledge ~f consumer be- havior and the workings of advertising This bill extends jurisdic- tion over advertising to HHS as well as the I'~I$l Thus, the tobacco industry would have to deal with two bureaucracies, instead of one. If llR 1824 becomes law, the Secretary of HHS will have unacceptably broad discretion to mandate the size, color, and luca- t!on of the warning statements on all cigarette packages and on all c,garct~, advertisements. One does riot need a crystal ball to fore- tell the mischief which w~ll be wrought on the cigarette companies when such power is exercised by their leading Government antago- nist. Mr. Chairman, it would appear that the real purpose of H.R. 1824 is to harass the marketers of a legal product I submit Lhat the proposals contained in the bill which I have discussed amount to an unwarrantt, d and excessive intrusion into the marketplace, w" f strongly recommend that ilR. 1824 not be adopted, Mr. WAX~tAN. Do you want to introduce your next witaess7 Mr. JU~E. Professor Harold Mendelsohn. STATEMENT OF IIA}tOLD MENDELSOIiN, Ph.D. Dr. MI:NUI~I£O~IN. Thank you, Mr Chairman. I am grateful [br the opportunity to appear before this subcom- mittee, l am a Phi) as well a~s a fellow of both the American Fsy- chological Association and the American Sociological Association. Since 1962 [ have been professor of mass communications in the de- partment of m~kzs communications at the University of Denver, and I have served as director of the university's center for mass com- munications research and policy. From 1970 through 1978 I also was chairman of the department of mass communications For over 35 years I have conducted re. search and published in the fields of social relations, attitudes and public opinion, communications, public health and the sociology of politics. I have appeared for the Federal Trade Commission in several cases as an expert witness on the effects of product advertising. I

358 have authored or coauthored four books and numerous mono- graphs, commissioned policy papers, and book reviews. Attached to my ~tatelllen£ are my biography and a list of my publications I ha~e examined in d(~ail various documents that appear to pro- vide the grounding for the "cigarette labeling" proposal contained in section 4[a] of H.R. I824. 1 have given particular critical analytic i attention to the May 1981 Federal Trade Commission "Staff Report on the Cigarette Advertising Investigation." Additionally, I have reviewed, from the perspective of an expert on communications effects and pubtic opinion survey research, the principal public opinion surveys and effects studies on which the key conclusions of the FTC staff report apparently are based. Fina]Iy, I have reviewed the prepared witness statements submit- ted at the March 9 hearing on H.R. 1824 and a transcript at the March 9 hearing on H,R. 1824 and a transcript of that hearing. 1 would like to focus my observations on the scientific bases for rejecting the rotatiolml warning proposal set forth in H.R. 1824 and the F'TC staff report Put succinctly, that proposal is unneces- sary because people already have the inlbrmadon sought to be pro- vided and misguided because it assumes that telling people more about the claimed healifi hazards of smoking will aflbot their smok- ing behavior. That assumption, which is inherent in both the FTC staff report and the present bill, is a prbne example of wishihl thinking with- out basis in fact. 9 he premise that the American public lacks sufficient informa- tion about smoking and health claims is utterly unsupported by the FTC staff report. Tbat report relies on a handfu] of d sparate, isolated and unintegrated "studies" and public opinion polls that bear no intellectual, methodological or sclentifie relationship to each other. They do not relate to any recognizable theoretical body or tradl- tion; they do not emerge frmn any ~cientific model; nor do they re- flect any system of integrated hypotheses or hypoifiesPs testing that are grounded in scientific empiricism. Public policy should never be based on sucb singular, isolated, and unintegrated ad hoc "studies". Moreover, the report presellts as an authoritative "data base" a handful of disparate public oginion polls (erroneousl nlisfl]terpret- ed as tests of public information levels) plus a so-ca~led focused in- her"low study (again m raucously misinterpreted as a carefully con- ~'~ trolled experiment) based on highly selected, biased "intercept" samples, rather than ¢n representative area probab ty san p es, tk? only scJent,ifically acceptable sampling procedure for public opinion ~urYe!~'s. data base on which the YFC staff based its recommen- ktenee the dati~,ns is so seriously flawed that it cannot pass even the most minimal sclenLifie muster. Phe report's ' findings are without t"l value as a grounding for public policy formation. r~ These fundamental detbcts aside, the FTC staff's claim that sig- ~'l nihcant sector8 of the population are uninformed about the dan- gers of cigarette smoking has no basis in fact. Data from the very J The blb[iogr a phy a~ llst of puhliv~tion~ m~y bo fi~und in the ~ub~ommil t,~ fil~ '1 In '1 359 studies the FTC staff selected to cite in their report indicate just the contrary, as does the 1979 Surgeon C~eneral's Report: "The public health campaign against cigarettes has produced no- table changes in public awarene~ of tile health consequences of cigarette smoking. It appears that the dramatle changes noted in adult smoMng, especially among mlddle-aged males and certain professional groups can be attributed largely to the effectlvenss of teformation and educational campaigns since 1964 "Moreover, Warner has estimated that the effect of specific 'events,' suck as the 1964 Surgeon General's report, on cigarette consumption--mean number of cigarettes consumed per day--may appear small and transitory, but that the cumu]ative efflx't of persistent publicity appears to have reduced consumption by 20 to 30-percent below its predicted 1975 level." 1979 report at 19-9. As a promotional effort the hazards-of-smoking campaigns in this country together and cumulatively have been remarkably success- ful in informing the largest possible number of Americans of the claimed dangers of smoking cigarettes Still, many Americans choose to smoke cigarettes. They do so not because they are unaware of the health hazards that are claimed to accompany such behavior. Smokers choose to smoke cigarettes despite their awareness of claims that risks to their health may be tevolved They do so for a myriad of reasons other than lack of'ifi- formation The motivations to smoke or not are manifold and complex In- formation about smoking and heultb claims alone must be viewed as just one possible relatively weak factor anmng such powerful causal factors as personality; socialization experience; learning ex- periences; beliefs and values; peer pressures; physiological, meta- boIic, and chemical balances and imbalances; religious background; loci of t~ersonal control and such The scientific literature sngt~e~Ls that above all conformity to group norms is the most powerful rn~tivifi[onal factor in influenc- ing smoking behavior--not exposures to advertising or other con> munications. This very point is confirmed by the testimony submitted to this subcommittee by Dr. Mortimer B. Lipsett, Director of the National Institute of Child }lealth and Haman Development. Dr. Lip~ett ifiere stated: "The most forceful determinants of smoking are par- ents, peers, and older siblings."--page 7. Thus, even if every man, woman and child in the country could score l{}O percent on any test of information regarding ifie possible hazards that may flow from that behavior, it is unilkely that the current rates of cigarette smoking would be afft, cted significantly. Perhaps the major reason for this dichotomy between awareness and behavior is that the latter is far more a function of what we are willing to believe than of what we appear to know, And since beliefs serve emotional as well as intellectual functions, often si- multaneously, they may not always be logical or consistent. Thus, without discomfort of any sort we often hold, and hold on to, beliefs that appear to be simuitarmously contradictory and irra- tional-for example, the belief in science and the belief in astrol- ogy.

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¢0 G1 368 Mr. WAXMAN Thank you for your testimony, and for presenting your views, Dr. Blackwell and Dr. Mendeisohn, you are both academics who have studied tbe impact of marketing and how people are affected by marketing decisions. Do you agree with the idea that a repetition of a theme is helpful in convincing people to behave in a certain way? Dr. B~CKW~LL. That is one purpose of, a common purpose of ad- vertising. Mr. WAXMAn Do you think that advertising encourages con- sumptisn of a product or purchase of a product? Dr. B[.ACKVJELL That is one purpose of it, yes, sir, Mr. WAXmAN. Do you think that the advertising for cigarettes encourages people to purchase the products? Dr. BLACKWELL, it encourages people to prefer one brand rather than the other. That is the primary purpose Mr. ¥~IAXMAN. That is one purpose Do yon think a consequence of tbat is that more people wifi buy oigarette~ than otherwise would be the case? Dr. BLACaW~L It is a well debated topic I have entered into dis- cussion of that at ]engtb and there are people who honestly believe it doesn't and there are people who belisve it does, I think that you would ha~e to conclude it has some positlve influence on total con- sumption, although there is the opposite view which is articulated as welb Mr, WAXMAN. It iS interesting to me to make the observation that the Tobacco Institute, represented by Mr, Judge, was very con- cerned that they have an equal amount of time oil ibis wh~de bill. Ev dently equal time meant the opportunity to present the case. Now, what i am suggesting in the legislatioll is that the public ought te have some ktad of equal opportunity to get a message about tile dmlge~s fl'om cigarette ~moking, compared to the bom- bardnlent flley get from the very expensive advertising paid for by the industry. I make that as an observation, i wonder if Mr Mendelsohn can tell me, as an expert, wbetber the information that people get about the dangers t~-onl cigarette smoking is as clear a message as tbey get from all of the advertising promotions about cigarette smoking? Dr, ~fENDEL~qOHN. I believe there is a debate about information, For me information is factual information on a relatively smafi balance of ¢oatrovertabiIity altocbed to tbat. hl[ormattsn which really becomes issues oil which there is considerable disparity of opinion clearly is not information. So I w~mld thtok that there is a combination of a good deal of factual material, there is a good deal of speculation, and there is a good deal of aheer ignorance out there and somehow the public bas to came through that and come away from it with the impression that there is a possible danger there That is abou~ where we are at at this point Mr W^XmA~. When Mr. Judge's company, Lorfllard, spends a great deal of money on advertisements, with a certain style and theme, is that information that is being communicated to attract 'l I' +1 369 people to buy that product or does it only convey a milieu or at- mospheric feeling? Dr. ~fEND~I~OHN. I thick we get into semantics here because I don't think any commercial advertising represents information per se The purpose of advertising is persu~ion. It is not the purpose of commercial advertising particularly either to enlighten or to edu- cate the public. Mr. WAXMAN. That is what I find so amazing. We have heard at- tacks on this legislation because we inform people of scientific statements. We have heard from experts that cigarette smoking is a leading cause of heart disease, cancer and emphysema. But the dissemination of this information is restricted. Yet we have no re- striction on the amount of advertising that is intended to convinc- ing people to purchase the product. I don t deny that the proposed warning labels are dirccted to con- ~* vince people that they are taking a serious risk wlth their own health when they, decide to smoke. That is the purpose of the egis lation from those of us who see the costs, human and financial, when people are aftBcted b these diseases Dr. L gt t, you mak~ a distinction between education and propa- ganda. Do you think education and knowledge about a subject or a business or opinions by experts should and do in fact affcct behav ior or do you think because it affects behavior it becomes propagan- da'? Dr, Lm~lT. I think it is possible when people are informed they may then choose to behave based on that reformation. M,'. WAX~IAN. When the information is given by sonic with a hope that people will act upon it, does it at that point become pro- paganda? ~¢Ir. LIGHT I don't understand the question• Mr. WAXMAN You use very emotionally charged words and you • . ~cr said educato i Ls one tamo and prop.+ganda Is a other. Now, I am wondering if that distinction is based on whether people are to act upon the information given them. because you also said that this legislation is aimed at convincing people to quit smoking, You seemed to think that was a bed idea. Where does the distinc- tion between education and propaganda lie in tmr mind? Dr, LIGHT. 1 believe thai if the propose of ~e bill is to persuade or convince people to behave in a way that some government has decided--excuse me, the Government has defined behavior ~ ap- propriate and find an alternative behavior as iimppropriste and for purposes of the hill is to persuade people to behave in an appropri- ate way. and appropriate as defined by the Government, then I would label that as propaganda, Mr. WAXMaN. As you define it. wouldn't advertista by the in- dustry to convince p+.>ple to smoke a particular bran~ and which may influence their decision to smoke at all, be propaganda? Dr. LIaHT. No, I think propaganda comes when a government chooses to legislate and define behavior as approprla~e and then uses advertistog to persuade people to behave in accordance with government's defiued behavior Mr. WAXMAN. Just one quick question and I would like a yes or no from elther Mr, Blackwell or Mr. hfendeIsobn.

50 5~ 51 37O Do you agree with the idea that propaganda is only when the overnment uses information to affect behavior as opposed to use ~y a private party? Dr, ]~|ENDELqOHN. No. Dr. BL&CK'*VELL I have seen it defined that way, but it is a matter of semantics, utterly. Mr. BHLEY, You stated that you appeared as an expert witness on a proposal protesting warning statements on aisoholic bever- ages Could you tell me whether in your view there is no reason why Congress should req~uire such rotating warnings for cigarettes if it rejected the proposal for such statements on alcohol'? Dr MENDELSOHN AS 1 said. 1 think they represent more or le~ parallel situatbms, but I wouldn't go s~ far Io say that because the proposal was rpjected in one case, it automatically ought to be re- jected in another case• My position is that the principal involved in labeling is such that it makes for a very, very weak communication vehicle overall If we are really toLert ~ted in promiittog welfare of people via in[or- matMa, giving that information. There are more powerful means of dotog so than labeling. Mr. BLILEy. in testimony before this committee last week, Dr. Mendeisohn, b~,cretary Brandt el HI:iS tamped together caffeine. nicotine and heroin as addicting substances, differing only in the extent of their effects As an expert in public health communication, do ~ou think warnings from the Government that equate caffeine, cigarettes and heroin are likely te be ~iewed as credible by the American public? Dr M .Na • ~o N. "~ Ii. I cannot testffy to the scientific evidence regarding addiction This is out of my field But I would certainly say that any kind of inf~rmatlon given to the public that Imnps to- gether matoiials and ideas and concepts., that really relate to diflbr- races rather than to shared slmHarlties among certakl phenomena, probably adds to people's disbelief and confusion rather than to their enlightemnent Mr. BLILEy. Dr. Blackwell, would you care to answer that ques- tion? Dr BLACXWenL. l think it would he a serious mistake to lump them together For knowledgeable, well-thinking people there would be a credibility problem that would hurt it. A~ I said, with young preteens and I have listened to my teen- ager's friends and it is amazing the kind of things that they want to ingest in their bodice just because they are bad or taboo. Tbore was a soft drink brought out that had a very small fraction of alco- hol in it al~d Jt was an instant success because it was forbidden and taboo, but accessible. While cigarettes are not supposed to be accessibhL they are a lot inure accessible than herohl and eoeaiDe alld you have a problem tbere of a forbidden taboo. Mr. Bi.mey. Dr. Blackwel], I understand that even the vrc staff concluded that over 90 percent of the public is aware and I believe you menttoTmd tbat in your testimony Are you familiar with any study showing that higher level of awareness or of an:,' other fact or issue? q Ij q 371 Dr, BLACgWELL. No. ~fr. BIALEy. In your pro~esslona] opinion then. is it possible to aciltove a higher level of awareness? Dr. BI.~CKWELL. Theoretically it is possible, but not practically p~ssible, Mr. BIALEy. Do the studies ciLed by the FTC staff overstate or un- derstate the level of awareness about smoking and health claims in your oplnion? Dr. BLACKWEnL. Well, the facts are there if you dig them out, but their conclusions usually are self-serving rather than as accurate as I think they should be and as I hoped to show in my test many, Mr BLILEV. Dr. Light. has it ever been alleged that some brands of cigarettes cause diseases and others don't? Are any of you aware of any? Dr. LIGHT. NO. Mr. B~L~V. If the only thing we are interested in from a health perspective are thf~se ingredients which are in all cigarettes, other- wise disease, disease would show up among different brands, would they not? Dr L~GaT. Possibly. Mr, BLILI~y. Are you aware of this: 1 have opened one or two wine bottles in my life and I am not aware of any additives that are shown on the label of a wine bottle, are you. Dr. Lmnr. No. Mr. BLH.~y. Thank you. iVIr. W~SN. I imve a question for.you, Mr. Judge. Every other industry, f~od, alcohol and drngs speeifieally, that sells products we put into our b~dles, have to bz accountable. All of these industries seem to accept the principle that the public has a right to know what i~:gredients go into these products that they put in their bodies. Why not the obacco ndustry? Mr duo~ Well, I believe, Mr. Wyden, that you zre fatal]tar with the agreement reached bet~,-ae.~ tar ' dustry and the Score " tary of HItS in which each company wilI supply to Covington & Burling, the law iirm in Washington, a list of all ingre~ient~ which they add to tobacco. Covington & Burllng then digest this list into a list which shows these ingredients used by three or four manufacturers, that is three or more manufacturers, and any ingredient which is used in large quantities by as little as one manufacturer. So that an agreement was zeached and Dr. Brandt praised the agreement and he said that in his judgment it was a major step forward, It was a very complicated area, and 1 believe that be urged the committee to let HHS and the industry get on with their cooperation. Mr. Wv~. I don't find that an answer to my question• I think the public h~s a right to know, and I would like to go a little fur- ther with respect to your views on Dr. Brandt's statement last w~ek. You said that he misstated the og-ceement on March 9 and you feel in fact that a manufacturer will let us know what ingredients are used in large qua~titles.

6~ 5~ 5q b2 372 My question to you is: Who determines what is large and how does the Government verify it? I think you know that it takes in many instances only a small quantity of an additive to be injurious. How does that pnJtect the public, that statement that the manu- faotmer will let us know about large quantities? Mr. JUDGE. The agreement between the industry and HHS was reached as a result of a statute, as I understand it, and that statute called fur commonly added ingredients. That has been done. The industry and the Secretary negotiated and discussed this for a period of time and the Secretary has just in the last period, I think since March 8, reviewed this list and they have begun to work on it. l think it is a major step forward as does Dr. Brandt. Mr WYDEN I Call only say what I have said earlier. I think the policy is a joke Timre are only six cigarette manufacturers in the country, two of there, Philip Morris and R. J. Reynolds, that have 65 percent of the market, selling over 404 billion cigarettes annual- ly and I think it is unsatisfactory and that is why wc need an amendment in ibis bill tbat gives the public the right to know. The next quesBon I would like to ask of you is, does your compa- ny test for tbe bealth effE, ets of the additives in your cigarettes? Mr. JUV(;E We have an ongoing and continuing program for all ingredients and flavorin4s that are added Lo our cigarettes. Mr. WYOEN. IS that in house or d~ you send it to an outside lab~ Mr. JUDGE. It is a very--that is proprietary inlbrmatlon and I prefer not to discuss it. Mr WYDEN That really answers my question. 1 am sure the chairman would work out some arrangements, but that inf~wma- lion would be very imlpful t*~ this committee I ttfink that is the kind of information we need to know. That is what our constituents are asking. They come to me and they say, for all we know there could he pesticides in cigarettes Mr du~ul The agreement anticipates what I bcliew~ you are asking, Congressman, and that is this: The industry has g~ven a letter to the Secretary which sags that if they have any ditficulty analyziag or evaluating any of the ingredients which are on the list, that they can come to the companies and the company will give them all of the information which they have about that ingre- dient. Mr. W~U~N. Could I ask one additional question and it is a very short one. My understanding is the industry spent $1 billion last year on a ]veltising cigarettes, is that correct? Mr. du~E. i don't have an exact figure for 1982. Mr. WYDEX. Would one of your colleagues have that~ Mr. JUDGE. To my knowledge, there are estimates. Mr. Horrlgan testified last year that in 194I riley expended approximately $840 million. That is basically cerrec¢. I would suspect that it was up 5 or 4 percent in 1982. Mr. WODEN Thank you. Mr. Nl~bsoN. 1 w(mld like to ask Dr. Meadelsohn a question. He asked you about your rotating levels on the alcoholic bever- ages. Do alcvhoBc beverages now have a warning on them? Dr. M/£NDEI~OIIN. NO, sir. '1 II I 373 Mr. N[zuso~. So yours was net whether they should be rotated but whether they should be put on. What was the decision? Dr. MENDZLSOnN. The decision was not to have them put on. Mr. NIKUSON So it had to do with whether ]abels would be put on or not and not whether they would be rotated? ]Y)r MEND~c:I*~OIIN. That is correct Mr. Ni~i.sor~. I wanted to make that point, f have another ques- tion. Mr. Judge, you mentioned that 90 potent are awarq that smok- lag is injurlous to health and a later ~itness indicated, Dr. Black- well, that 80 percent were aware of diffPrent things, and so on. Have you checked these studies out very carefully? Are they sci- entlfic? Only one is a recognized pofiing organization. Are you aware of studies other than the Roper poll that give you'~ actual percentages? Mr. Juoa~. I believe that these professionals in that area could give you better information than I can, but I am certain that any statements that 1 have made are documented. Mr. Nml.~oN. Last week we had the witnesses from the various public heallil agencies, and none of them gave any figures other tbaa that 90 percent figure. None of them, for example, talked about the percentage which caused heart trouble or could cause it, and none of them mentioned the poszible ill effect on miscarriages and yet we have studies today which I am not aware oL Could you document them, Dr. Blackwe]l? Dr. BI~CKWELL. Those studies are all in the FTC report. They are studies commissioned, almost all of them I think, by the FTC. I can give you the specific documentation on those it'you would like. Mr N1~:,~ON. l would appreciate that. I asked a question last week of the other witnesses a:~d l asked the same question of you. Perhaps iL would h¢ hetur to ~]sk this: In the 30 years that your kldustry has been k~rgeted by the Institute of ]IeaItb and o~hcrs, when indications were that the Surgeon General report would be~ adverse and even prlor to that when they were suspecting there were some problems wish tobacco, have you done anyfifing in she last 30 years to ~cientifically show tha~ there are no such eflgcts? In other words, have you been able to take any scientific st~tit- stisal experimental design studies which for two groups, one with smoking and one without show that the differences are not signifi- cant? Mr. JUDGE. The Council for Tobacco Research is an independent organization and its grants ave made by a scientific advisory board. We do ntfl have any control ow!r Lhat at all The exact structure of studies like you mentioned, Mr. Nielsen, and I am not a scientist, please let me say that, and I am not a statistician, but I think ~he best study was the MR. FIT study that f referred to in my state- meat where the multiple risk factor in the intervention pro4ram, wh~re large groups of people, the so called risk factors of smokieg on blo~)d pressure and eilok.stero] were controlled, or tbere was i~ terven~ion in one group and not intervention in the other group, there was no signRcant difference in deaths from heart disease in either of those groups. That was the Federal Government study.

r | r, Q~ 53 51 5~ 374 You asked do I know of any smoking or not-smoklng study and that is the closest on that that comes to nfind immediately. But when our scientists came on later I think they could give you a better answer to that. Mr. NIE~ON, Wouldn't it have been to the advantage of your in- dustry or a particular company to have had some scientific data to dispel the Surgeon General's report, if you believe it not to be col rent? Mr, JUDGE. I think the scientists can talk to you about this much better than I can. Mr, NanSeN This is not a scientific question. Mr JUDGE You mean ~ould it he to our advantage? Absolutely. Mr, NI~oN. Wotdd it be to your advantage to have investigated and done some of these things? Mr JUUG~, Where I was trying to go, Mr. Nielsen, was this: Not being a scientist, it is my undersmndlng that it is very difficult to go out and prove by science and experiments and clinical work that somethmg does t do somethmg Mr, NIElseN. Cotl]d t have one more question? Dr Light, you were very emphatic about this being a propaganda move rather than an educational approach. Other than the fact that you comphdncd about, the rutatiDg aspect, which I agree with, do you [gel that a large ad. nlaybe one-quarter of the space, which would list all of the things in these three labels, would that bc more effective rather than one that rotates? Dr. LasT. No, l think it would be equally iJmffective. Mr. NIELSEN, Your objection is not to tile rotati~g as much as it is to the message involved, then? Dr. LIGIIT l beheve that the essence of adveriislng, as I said. is simplicity and consistency so there are two problems with the pro- posal One is increased complexity and the other is inconsistency Mr. NIELSEN, ] am just suggesting one warning which incorpilrat- ed all of them Dr. LIGHT, It v*'ould be a more complex, longer message as I un- derstand it You are saying that it is 1, 2, 3, 4. 5, and 6. Mr. Nt~uaog. No, I would lave only ffiree statements. Dr. LXaST. If ~e were to do advertising, we would reduce it to one statement of the o~erall danger. I do not believe advertising is the appropriate vehicle for communicating inf~rmatlon that is this specific. 1 think there are metbods for getting that blformatlon act'OE : Somebody mentioned last week I think it was, that, for example, in outdoor advertising you shouldn't have more than seven words. Mr Sharp said that, but as a generality [ think file principal of sbnplicity applies not just to outdoor advertising 1 don't think an ad that makes a lot of what we called copy points is effective advertising. We recommend to our clients that the best is to be single-minded. Mr. NIELSEN Thank yen, Mr Chairnmn. Mr WAXI~I.XN. Mr. Wa/gren is next, Just a minute Would he yield to me file time he does not have for one question? Mr WAIg~REN. Yes. '1 P '[ 375 Mr. WAXM;tN. Dr. Light, you seem to say that if one wanted to get that message across, and I don't think that you are all that in- terested in getting that message across, but if you had the job as an advertising export to get that message across, how would you do it? You say to keep it slmp!e. Well, we have here examples of the simple messages that are being Bent out to encourage people to con- sume cigarettes and the messages are not all that complex. That is Satin there and people looking so attractive and rugged and so on. Sex undertones many of the advertisements. Now, 1 gather if:at is eitbctive, If~'ou had the job how wouldy,ou commun care a message to people that they are killing themsetves if they smoke cigarettes? We couldn't afford you, hut if someone could afford you, what would you advise that client? Assume it is a private agencg so it is not government and therefore it wouldn't be propaganda. Dr LIGHT. I would recommend whatever information you chose to communicate that you view it as a total communication proo~am and not ust as an advertising assignment. I think the b cot ect y ta ks about a program and uses that ~old. The key thing or the issue that I anl concerned about is what should the role of advertising he within that program and what burden sh(m]d it curry. Our judgment would be in a total communication program is that the role of advertising is to advertise the headlines, to commu- nicate a net overall impression and to make people aware of the overall implications of your program. In this case that is what the Surgeon Gen rat s warl mg Is deslgned to do Now, in addition, you have available to you all kinds of other ve- hlcles for commualcal.ing more specific and more detailed informa- tion. If you were buying an automobile, advel%ising that you see may conl]nu~licHte or should cortlmunic~tte one relevant aspect of why you should prefer that brand of automobile, if you v.ish more detailed information and file aut(Jmcbi]e m,~nufacturer wishes y.u to have that information, he relies ol~ c.~tai~gs he relies on br~" chures and he re es on the satesman You have educational pro- grams there. Mr. WAXMAN, You sap it is all overall presentation that would communicate that message most effhctively? Dr LIGHT. And the message would be what you have now, ¢he message that you have now in the Surgeon General's warning. Mr, WAXMAN Aren't you contradicting yourse]l? O~ file one hand you say the currcl]t warning label is sufficient. In fact, you almost picture it as having some sanctity in and of itself. But as an advertising expo*t you are telling us you nccd an overall campaign to get a message across. Dr, LIGaT, No, Imn saying if you wish to communicate this lung cancer, emphysema, heart disease, addiction, miscarriage, and pre- mature birth, it seems over 80 percent are aware as we spoal:. If you say you wanted to increase that to 85 percent I am saying to rely on a warning statement in advertising to try to accomplish !hat objective is an unreasonable burden to place on the advertis- mg Mr. WAXMAN. HOW many people do yo}a think know the name of Virginia Slims?

I i 376 5q ",3 5¢ 5~ 5~ Dr. LIGHT. I have no idea. Mr. WAXMAN. DO any of you know? Dr. LIGHT. No ]glr, WAXMAN* l wonder why they continue to advertise that name. I think a lot of people have heard of it. Gentlemen, thank you. Are there uny more questions? Mr. WAIX] REIN', Thank you, Mr. Chairman. I take it that the underlying message here is that 90 percent of the people are aware of the harmful effects of smoking, and that therefore lurther advertising is ineffective in changing their degree of awareness. Is that what 1 hear, particularly what the advertising exccutises and the social scientists are saying:* Dr. MENDELaOItN First of all, I agree with my colleagues that the 90 percent isvis is tremendously high and one can't imagine really trying to achieve a level beyond that But it is very important to sustain that isvei by reinforcement. We want to sustain the level we have achieved by continuing whatever seems to be winking . . . not to tinker with it simply for the sake nf gimmickry, Mr WALaaZN. Do you believe it is important to increase ~hat level? Dr. MZXnSkSOHN. I think ideally yes But praciically I can't see how we can really achieve much beyond that. I tlinlk you will get about five percent of the public no~ evell knowing about Sanla Claus, so there seems to be a ceiling to how far process in the puts lic% kno~vledge levels can be made. Mr. WALGREN. Has there been any thought given m what the actual ceiling is? You say 5 percent wouhl not know. The diffiqaltv I have is that on some level we have nil obligation, I think, to Indi- viduals and not to numbers. When you are dealing with a very large population the slighteut increase in numbers nleans that you have eommualeated with a tremendous number of individuals to whom we may have a respoa- sibilty. It is 90 percent? How about 91, or 90.5 percent? Dr. MENDEt~O~N. I would press for 190 percent, Mmwing that that can never really be achieved. I do not mean to imply that we shouldn't try' to do that I certainly would agree that we shaald oonstandy try mid raise the knowledge levels of the public. But from a prac{ical paint of view I think to be pessimistic about achieving "only 90 percent" is ¢o he quite unrealisLic. Actually, that isvei of public knowledge is quite remarkable and achieve. mont. Mr. WALnREN. You would suggest that if we could find a mecha- nism of communication that would have a greater impact or a wider recog]:ition or whatever, that we should seize it and mine with it? l)r. M~NnEt.~OSN. Yes. Mr. WALC*eEN. Let me ask one other level of this That is if we are concerned about individuals, we talk about these people being aware, are there different degrees of awareness? Dr. MENDElsSOHN. I believe so. Not only are there different da crees of awareness, but there are different facets to awareness. '1 # q 377 Some awareness is simply that. 'q have the information." Some ~wareness develops into motiviation to act on that information. And some awareness prevents action . . . "I know my dotter will tell me had news, and won't get aphysisal." It is very complicated. Mr. So we i outd eally he jad .g whate.er isg s)stem or whatever warnings the Government legitinlat~ly~ dis- tributes in the light of these differenl: degrees of awareness? Dr. MENDELSOHN. That would be my point. Mr. WArReN. And that would be especially so when the indivld- ua]s are awash literally with messages that are really designed to alfect behavior, as advertising is. I would imagine then you would have individuals that would react very differently and other individuals who would be aware, but overwhelmed b)y the advertising, and others would be aware, but not so impacted by the advertising and able to act rationally, mid others having a different reaction to their awareness, i guess tha¢ is really what we are talking about? l~{r, M~NDELSOHN. Yes. Mr. WAIoaRE~I And individuals would array themselves across a spectrum that would mean that you would probably find great numbers, literally hundreds of thousands of people in each level of that spectrmn? Dr. MgNDeLSOHN. That is quite a possibility. Mr. WALGgSN. And we should he asMng ourselves what our obli- concerned about individuals? gatisns to each of those individuals is across ~he spectrum if we are Dr. ?,~ENDEI~OIIN. I would agree. blr WALO~EN. Thank you, Mr. Chairman. Mr. WAX~A~. Are there any other questions? I Mr WVnEN. I will he brief. O~herwlse we are going to be here until breakfast time tomorrow. My understanding is that the British Government uses about 60 additives in cigarettes My question to you is: Are these additives ~" lbat have been banned from Britain currently used in the United StaLes? l~lr JUDGE, I am not equipped to answer that question. My com- pany has not been involved in the international business for about 8 years. I have vague or very spotty information about it and I am really not qualified to answer that. Mr W~em~. Let me ask you this: One of the firings I am con- corned about is cocoa. Studies show that cocoa in its natural state, + o~ course, isn't harml~M and yet when it is burl~ed it is carcinogen- ic It is tha~ is used in American understanding cignr~ L~es my Cocoa and it has been banned in the manufacturing of Bridad cigarettes. Do American manufacturers use cocoa? Mr JU~E I previously said, Mr. Wyden, a moment ago, that we i have supplied to the intermediary, the Covington & Burling firm, that infurmatisn. That list then, as I told you, has the llst of what the companies are using. Beyond that I am not prepared to say what is or is not in our products. ]~lr ~rYDEN. I have one other question. It looks to me horn the charts on the wall that we have several violations ¢f bath principle 3 .nd r .'i..ciiA~ 4 of )cur vomntory code on advertising. P~ineipal 3 says cigarette advertising should not

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38O Mr. WAXMAN. Would you share that with us? Mr. STEVENS. NO, sir~ 5ecause my opinion of the consequences of the repeal of the warning notlce wu~Id nuturally be the subject of irLy advice as counsel ~/J my client, and as such it would be pnvl- leged, and | hesitate under those circumstances, slr, to violate that privilege. Mr WAXMAN. Mr Judge. our coIlea~le, Con~re~rnan Rogers, testi~ed earlier today that he thinks we ~ught to repeal the warn- ing label that is there¸ He argues it ~ unSdr to ask you to have to ~ay for that warillng label and there are many people who will subscribe to that p~iti~n. If Col~gress were to accept that posiHon, would that offend you in any way? Mr. JuuGl~. I am guing to defer to my counsel. Mr. WAXMAN. He won't talk to us. Mr. JuuuE. Tha~ is why I ~in de~errhlg it to him. Mr. WAXM~ It i~ ~ legal ri*~ttcr, but the ~nly sense i get, is tha~ you are w(~rried that if you didn't have that warning ]abel, you might have liabili~ ~oln injuries ~u~tained from }'our product Mr Sr~VE~S. I d~n't believe Ibr a moment that you are sugges~ i~'!~ tha~ our re[~¢t~i~ce to breach the attorney~client pdvilege is any indication on our part of a concern about it | am sure that that is not what y~u had intended the record tu mean and it is n(~ what we intended to communicate by our unwHlhlgness to ~hare 9ur position. -: Mr. WAXMA~. Mr. Judge, do you think we ought to repeal the pre~ent warning label or not? Mr. Juu~. ! am g~ng [o defer t~ Jny counsel. Mr. WAXMAN We haw had an opinion tha~ we ought not to have these ~t}ler ]~*~m]~, a~d ~lu~t n~t to spend money to tell people about the da~gers, and I would like to know wha~ the hldustry I~o- sition would be on wh~ther to repeal the present warning label. Mr. S'r~v~Ns. Except that the opinions you have r~c~ived thus ~r with rcsp~ct to Lhe various aspects of th(! warniI~ ]abel have not Seen in ~he context ~f a que~tiull phrased in terms o~ its in, pact upon i~y company's product liability. While Mr. Judge appears here ~n behalf of the industry, it ~ certainly no~ my prerogative to express legal oplnions [or the rest of the cuml)anies in the inilustry. Mr. %VAXMA~. I am asking what the industry p(~sition is as a rec- ommendation to the U, S Congress, should we repeal thi~ labc| or not? ~rr STEVENS I don't think we should be in the pc~iti~n ~f sug- g~ting to the Congress whether it ~hould be repe~led or whethcr it ~hould r~peal a warning notice when you place the question, sir, in the contc×t of ks impact upon our product liability litigation. Mr. WAXMA~. Let me put it this w~: it may ¢~r muy not affect product liability, and that is a question theft an attorney and cHent have to decide [or themselves. Is it u~l~ir to have the industry pay money in a~ert]sen~ents to warn the p~l)lic about t}le fact that ~he Surgeon General has deler- m~ncd that ¢~garette sm~king {s d~n~erous to people's h~a]th? I would like to know what this industry thinks of this as a p~licy question. 3Sl Mr. STEVENS. | r~spect~[[y suggest to yOU, sir, that ! am not able to separate the policy aspects, the legislaHve aspects, and their con sequences fo~ product liability litigation. Iv~r. WAXMA~. That is the ~n1~ answer ! am going to get I~]r. NIELSO~. | think Dr. Light can answer that question. He ~a[ked about ~h~ con~titutiun~l rights and the new l~hels an/ the rotaCiun would infringe upon the constitutiona| r~ght. D~c~ the present label infrhlge upon your constitutional r~ght~? Mr. WAXMAN. Would yuu encourage us to repeal the p~sent ]abel? Dr LIGHT. When I came here preparing for this bill as proposed, • thcy did not a~k us to think about the implications of that, and so ! The industry posltlon has been, and was at the tEme that the original warning was proposed, an ~idvc~tiser in general and not "~ just the cigarette industry, an advertiser, sh~uhl no~ be a~ked ~o adve~Lise against hhns~H¸ Ibr a perfectly legal product. Ni~w, the Govi~rnmcnt h~s the right and exercises the righ~ to sa~" that while that generally is true, or not, in thls case we believe there is some social bei~eI~t to ~ppropriate a piece of the advertis- i~ bud~et to conununic~te. Mr. WAXMAN The question is not whether we can constitutional- ly do it. I am askh~g y~Ju your opinion whether y~u think we ~h~uld repeal it. Dr. LI~I~T. I don't know how to separate ~t f~nl whether you can ¢o~stitutk, nally do it Mr. BULEY. Mr. Chairman, | don't believe Dr. Light can answer th~it question for the industry¸ Mr. WAXMA~ Do y~u ~pc~l~ fur the industry? Dr [,II~tIT. NO, y£*~ arc. ~l~hl~ [i~ to Colhment on-- Mr W~x~A~. Do you have any reconllnelldati~ns t~ the C~I~ gress; evidently y()u d~nlt? Dr. L[GIIT. I am hl no p(~sitlon to make recon~[nendatlon~ wheth- er you should repeal s~nlethhlg that you decided f~ir s~me reason to d~. I an~ n~t ~nliHar ~th the te~tlnl~i1~, that lod y~u to conclude th:~t you should have the warning. Mr. WAX~AN. One ~n]~ht have read your ~estlmony a~ having sLron~ persona[ feelhlgs. .~Ir. M~UI!U~OHN I have no opinion ~n ~hat at a]l. Mr. I3L~CKWELL. I believe the current bil] is ~n a sense the skull and crossbones ~f Inodern-day advertising i think you hav~ some ~estin1~ny by one of your w~tnes~e~ that solneb~dy said, "] instantl recog!~ize as s~methhlg o~ the skull and crossbones ~n Et", and th~ wal'n*11K ha~ cstabl~sh~] that. I am no~ able to look at the scientii~c evidence. In fact, it is a lithe bit appalling to have MDs talking about whether rotation~l warnhl~ wou|d work. But the Surgeon General has made an cstab- lishlnent of a policy and we have ~mple~neut~d the modern day skull and crossbones, which works¸ Mr. W^XMAN. Do you kn~w whether the public equates the ¢ur- r~nt health warning with the ~kull and crossbones symbol? Mr BhACKWEI.I.. It has the effect of instantly communicating a warnlng. Mr. W~XMA~ IS !}~is your person~! ~lin~

382 ]'dr, Bz.cCgW~LL It is a petsotm] /ee]ing. Mr. WAXMAN. We must be.leaving because we have another pa~lel, but you have been very kind to be so generous with your tes- timony and recommendations, and t~ be with us to answer the~e questions I do want to thank each of you for being here today. ~'l'e~tinlc.ly res~Jmes on l), 406.] [Tile following information was received for the record:] Tal Oh ~ SLa~ U nJ,~ralv/ ~ Facu~ ~ M~t~ 1775 ~lt~gt Road ~rc~ 28. 19~3 p~an~d144~.~06 Th~ Honorebl~ Howarci C. Nielson 122~ Long~orth H~US~ Dfftce Building Washington, ~.C. ZI)515 Dear Representative Nielsen: A¢. the ~rch 17 hearing o~ H.R. 1824, ~ou asked m~ t~ provide supgorl"ln~ ~iocurnent~t~ot~ ~¢" ~y tes'.~mony S~l~'~zt~g the levels o~ public ~r~nes~ of va~l(~us spec{~ic ~]a~a~(J h~]~ ~o~Begu~tlces of Smoking, In r~pon~e to that request, l ~m e~clo~ln~ relevant p,~5 fcor~ ~ach of the ~urv~s alld OpiNIon p~]]~ t~t I ~lted it~ ~O~ ~e$~ltcon~., a~ ,~elT~: S~ate~.en~: ~1~ be]Jeye $1r,~ki~!l c~use$ lung cancer. Support: Ga]lup 1978 ~tudy result cited by 1981 F~C "Staff Report On The Ligarette Adver~lsln9 It~vcstigation" a~ pa~e 3-19. Statement; ~4% believe thai: sta~kel's ~re mary more ~ime~ likely ~o develop Ibng cancer t~an Supp~r~ Roper ~9~0 s~udy, question ~3QK. S~atement; 92.5% Believe trot S,~oki~ causes a~ lea~ Support; Roper 1980 ~udy, question $2~J. St~t~n~: 9~.J% ~F teenagers ~nd Z5.292 ~f a~v~ f'~ believe that. SlnOki~g can ~r%)d~ce lung ~ama~¢ %A teenager. Support: C~]tDn 19~0 study, que~io~ #38C. star.end: 79.7% of teenagers and 90,7% Of adults a~are Qf the as~oc~atic~ ~et~vee~ $fl)~i~ an~ emphysema,

Support; Chi]ton I~BO study, question #42C, 85+2~ believe that smoking causes at least so~e cases of e~hyse~a. Support: Roper 1980 study, question #2gG. 3, Heart Ois~se~ S~at~t~ 80% believe that s~king ~auses at leas~ Some Cases of hearL ~ttack, Support: Roper ]~80, qu~st4on #290. 90.2~ of teenagers and g0.7% of Adults a~are of the assoclatto~ between s~kln~ Support: Chi]ton 1980 ~tudy, question ~42E. Statement: 73.2~ of t~enag~rs an~ ~0,4% of adults b~llove ~mokin~ i~ a ma~or cause Of h~art disease. Support: Chilton 19~0 study, question ~5~. Stat~ent: 898% of teenagers and 89.7~ of adults ~g~ee t~ $~kln~ ca~ h~v~ ~n effect on bab~. Support: Chil~n1980~tudy, question#39, StatemenI: 5~% of teenagers and ~l,~ of ~dults believe smoking enhances likelinoo~ Of ni~arria§e. SupporC: Chllt~n 1980 ~tudy, question #40A, State, end; 56.4% of teenagers an~ 51.6~ of adults believe smoking enhance~ likelihoo~ of ~illborn. $u~porC; Chilton 1980 5tud~, q~estlon #4DO. i ~5 Stat~ent: BO.6~ b~IIeve that s~klng significantly Increases risk Of 10sin~ baby. Support: Roper i~80 stu~y, que~o~ #30E, ~s I me~tlone~ ia ~ ~esLi~t~Y, Che above s~wy$ and opi~io~ polls were commissioned or relied upo~ by the FTC Staff itlelf and were hT~hII~nted in its Report, which provides the basi~ for ~he rotatin~ warning proposal in ~R. 1824. A~ I al~o m~ntfon~ C~ng [ set forth in ~r~ d~t~il in ~ writte~ ~a~emen~ to your C~a~mit~ee) those ~urve~s and polls suffere~ from certain ~ethodolo° gical deflciencie$ an~ ~efinitlonal prob~s that, in my opinfon, ~e$~l~ in an understatement of the actual level~ of ~war~ne~ abou~ t~e ¢lai~e~ h~f snaking. Thu~, I ~lleve that the abov~ figuresr which ar~ In any even~ q~i~e ~igh, ~efle~t virtually u~Iversal public awaFe~ not onl~ Of the ~eneral C]ai~ the% smo~in~ Is dangerous to hea]th bu~ also of th~ specific health hazards attributed ~o $~okfn9. I hope this materla] I$ ~e~po~sIve to your cue~i~n. I would be pleased to provid~ a~y f~r~her infor~CiOn or Cou1~nt$ chat .vo~ feel Would ~e helpful ~o ~our deliberations on ~he hi11. I ~]so would appreciate ~o~r ~eeing to i~ C~a~ this response is i~cluded in the ~earing r~cord. ~0 t~t t~e ~o~ord ~ill ~ef~ect that I have complied wi~h~3" under,aXing to ~uGp1~ thi~ ~laterial to you. Very truly ~ours~ ROB:k~ CO: The Honoraale Henry A. Waxrmn

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(0 406 Mr. W^XMAN. Out final panel this afternoon will be composed of five wRnoss, Dr. Sheldon Sommers, scientific director for the Coun- cil fur Tobacco Research; Dr Theodore H, Blau. clinical and child psychologist; Dr. Hiram T. Langston; Dr Hans d Eysenck,profes- sor, institute of psychiatry; and Dr. Edwin R Fisher of the Shady- side Ilospitol I welcome the witnesnes who are here, We will make your pre- pared stotemenis a part of the record in full. We would appreciate it if you would please summarize your testimony in light of the lateness of the hour. STATgMEN'IX~ OF EDWIN R. FlgfiEB. M.D. PROFESSOR OF PA- THOLOGY, UNIYEItSITY (IF PITTSRUI1GII SCIIOOL OF I~IEI)I. CINE, AND DIRI~X]TOR OF LAROI1ATO[IIEN AT SllADYSIDE IIOS- PITAL; TIIEODORE H, BLAU, Plh D., CLINICAL AND CIIILD PSY- CIIOIA)GIST, TY-31PA. FLA.; SIIELDON C. SOMMERS, M.D.. PA- TIIOLOGY PIIYSI(IAN. UNIVERSITY OF SOUTHERN CALIFOR- NIA SCIIOOL OF 311,;DICINbJ, LOS ANGELES. AND COLUI~IlIL't [)NIVI'3RSITY C()I,I.EGE t)l" P[IYSICIAN~4 AND SURGEONS, NEW YI)IIK; II. J. EYSENCK. Plhl).. I).SC., PRI)I"ESSOII (IF PSYCHOLO- GY, INSTITUTE OF I'SYCIIIATIW, UNIVgRglTY OF LONDON; AN[) IIIRAM THOMAS IANGBTON, M.I)., SAVANNAII, GA. Dr. FIsn~:r~ My stotcment is not hmg. Mr. Chairman and members of the committee, I am Edwin R. Fishm of Pittsburgh, Pa. I am cmreatdy professor of patkslogy at the University of Pittsburgh School of Medicine and director of lab- oLutvriss at the Shedyside tlospital in Pittsburgh, Pa. In addition, I am a consultant in pathology ac the Veterans' Ad- ministration Ihmpitg in Pittsburgh and the Brov, nsville General Itospital of Brownsville, Pa. I am a 1947 graduate of the University of Pittsburgh School of Medicine. I received postgraduate tledning at the Cleveland Clinic, Cleveland, Ohio, and the National lnstb Lutes uf Itealth, Bcthcsda, lqd I was certified by the American Board of Pathology bl both ana- tomic and clinical pat ao ogy 952 I an a member *ff lhe honor- ary medical society Alpha Omega Alpha and Sigma XL the honor- ary society for scientific advancement. I was the recipient of the Parke-Davis Award in Experimental Pathology in 19G3 mad the Man of tbe Year in Medicine in tfie City of Pittsburgh in 1966. I am ~ member of man5, scientific societies, including the Ameri- can Association of Cancer Research and the American Society for the Study of Arteriosclerosis 1 am the author of 491 scientific publications in American and international journals and textbooks. 1 have served on the editorial boards of the journal Cancer and of tl e A nerica l dour al of Cli ical Pa~l elegy as well as tim Board of Scientific Disecto~s of Ellis Fischel Cancer Hospital, Columbia, Me.. and the Board of ge~iswers for the American Society of Atheroscle- rosls and am the project pathologist for the National Surgical Ad ju~ant, Breast and C~dsn Projects of the National Cancer Institute. i should first like to direct my remarks to personally conducted experiments concerning the possible atherogenic effectz of nicotine i 407 i per so. Atherogenesis is the process that results in the disease which we commonly regard as hardening of the arteries, technical- ly called atherosclerosis, We have also conducted such experiments with actual cigarette smoke which of course, nc udes t e relationship of carbon monox- ide to the atheroselerotic process. Repr nts describing these exper - meats are be ng submitted as part of this statement. Ia these exp'eriments it was clearly demonstrated in the rabbit that realistic doses of either nicotine or cigarette smoke failed to initiate, exacerbate, or otherwise influence the atherogenic process in tfiat species. You will notice that I used the designation "realistic doses". F think that is very important. There have been some studies that have exhibited minor or questionable changes with the use of aR INuivalent dose of 5gO or more clgaret es a day in man This is such a large number that f th nk man wen d End it difficult to ffild the time to smoke them. Another point which I would like to emphasize is this, One could justly say you found nothing n the rabb t, but can the experisncc in the rabbit apply to man? What the scientiBc experiment in the laboratory can do is indicate where we should look and perhaps what we should look fur in the c! ca setting, With those two points in mind, I should like to continue. It might be well to emphasiso Hint there s no p armaco ogc ero her study uf any sClentE1o validity or acceptab y to me that nd cares t a nicotine adveisely affects coronary bleed flow, hldsed, me~t of the • studks reveal that this agent actually accentuates and enhances coronary blood flow. Within thc last month, The New England ,Journal of Medicine reported a study that dsa t w th my~ardian infarction--common y cal cd heart attack--and the nicotine and carbon monoxide levels of cigarette smoke. Incidentally, the study also ex,nn ned the "tar" yields of ciga rettos in relation to heart attack, but did not report these data be- cause, according to the authors, ,esult~ for tar paralleled those f for nicotir~e, The authors found--col t'ar o what they expectod--tfiat the niso ne and carbon monoxide ~evels of cigarettes dld not affect the risk of heart attack. This find ng support.s the view that neither nicotine nor carbon m~noxide as found n c garotte smoke, causes or contributes to coronary heart d sease One n gh see then the experimental model I have reviewed the scientific literature on the subject of core- imry fieart disease and smoking and find other studies that support this view. For example, studiss of workers exposed to carbon mon- oxide over long periods of time find that the exposed workers do not have an incleased incidence of atherosclerosis compared to ths generM population. Other studies raise serious questions about the smoking causa- tion hypothesis. For example, studies of twins in Sweden are very illuminating on this subject. When the researchers looked at monc- zygotic twins (i.e., idenBcal twins), they found that thcre was no in- creased rate of coronary heart disease in the smoking twin as com- pared to the nonsmoking twin•

G80573S70 L L T L

410 Cigarette Smoking and Cholesterol Atherosclerosis of Rabbits mm-SLd~t y ~d Z~LL~y fz~m i~ ! i: JT ' : i; ~ ~1r *~,~..~, ~ ~,~ ~ t~t~I ~d Ind~ La ~ I~n~ , n :3 ] 411 ¢~u~'~*~tf=~,~.,au*=~w= a=l~u wu di~ ~*~ ~d ¢~om~o~.'C~,~,~¢,~ eoz~= ~ d~m ~ f ~, ~onau~- p~m~m= m~d ~sa~ ~V~laL ~1 ]In ~,~ ~ ~,~ ~,~4~c u~ ~. o~,~ ~. ~>'~ ~ ~ ~ D~ ~" r *, J

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414 ! i : i 415 Neonatal Gastric Perforation Not Caused by Congenital Muscular ~wNm ,n m~ ~or~ ~D be ~t ~mmen Ce~.~ T~ ped~a~a L~ tho ~o,~r~ Brady, de~e4 ~pLm ~ • a~,a~e~ m~u¢~b~ def~ H~b~, in La4~ ]n r~nt=~aL+ In ~ud,SD~S~ In l~ ~f p~mc ~v~ m p.~ee l~d R~d of i C~H Defects ;

::i i 41? Influence of Nicotine on Experimental Atherosclerosis and Its Determinants • '~'= • • ~" ~ "~'~,~'*~ e,~,~ ~e~ ~,~ from ~* m~,~,,n,,~ In

L lncm~ i~*r imQ~n~ ~th~ ~]~m,~ ~ ~'L~,~' ~ ~ 418 I ii 1 t~e~t~,e memb~n N],~ane hM ~ [i~ II ~c~tLne or pr~a,~ ol h~er t ~n~:n~n .r ~,Lh hid no ~ect en [Ee~ 41,9 :, i I I I i ! i ~ ,t v~,,~ nI ~1~, I]a~ ~ a~ i i ~ i~ , ~i~L~~ ~ta~r~,~ ~p~,~i I ! I 1

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422 i i i [ V

m | ¢n go 00 424 Mr. WAXNAN. Thank you very much. Dr. Blau. gTATEMENT OF THEODORE II. 1| LAIL Ph. D, Dr Bl~u. In 1957 1 was president of the American Psychological Association and I am currently past president of the American Psy- chologlcal Foundation. 1 am also a member of the Evaluation lge search Sec ety Mr. WAXMaN. We do have your copy mad if you could get into a slxI~mlary of your testimony, that would b~ helpful. Dr. Bunu. I will cut out some parts, but they are on the record, but will take more time. Thank you. Fo ' severn years 1 have been involved in an evaluation of the research and current state of knowledge about the psychological as- pects of cigarette smoking. This evaluation includes a thorough review of historical factors, current theories aad research, quality vf the research and publlcatlon~ pertaining to dependence, addic- tion, and applied research and cultural aspects of smoking behav- ior In addition to this literature review, I have also communicated with active researchers working in the area. I have lecently writ- ten the s~tlon cntlt]ed "Smoking BehavioF' that will be published in the Wiley Encyclopedia of Psychology. 1 have reviewed Huuse bill 1824 and feel that sub~ection (7) of the Findings and Purpose section misrepresents current scientific under~tandfag of smoking behavior. As a consequence, it is my belief that the provision of the proposed bill that mandates a warn- fag on cigarette packages statfag that "cigarette smokfag is addis tire" is clearly unwarranted, i must note at this juncture that I have reviewed the recent pam- phlet published by the Department of Health and Humav S~twices entitled "Why People Smoke Cigarettes" Frankly, I am disappoint- ed in its lack of scientific objectivity As I et~ ted at last year's hea~ing, askil~g people at the National Institute of Drug Abuse or the Public Health Serwce whet mr smoking is addictive is akin to asking the goat to guard the leLtuce patch Those people have already concluded that smoking is addic- tive and scck to prove it by emphasizing only the research findings that are consistent with tha~ view. I need only point out that the vast majority of the !~-called sup- p~rfing references in the new pamphlet ar~ publications by ~r re- eased under t le auspices of Government health departments. Yet these disclaimers by our most imminent stunk ng ~c entlsts are not mentioned in the pmnphlet. I hasten to add that I am not criticizing anyone's motivations. R gh y or w~0vg y cigarette smoking gas becon~e an emotional i~sue in recent ~c,~rs ~nd this cm~ result ~ over-e~thus asm even in the scientific arena. I have also ~mted that th~s DIIItS pamphlet was "developed" from Dr Po n's testimony for a 1952 Senate bill with provislons similar to tho~e in ltR 1824 B~ed nn the positions stated thereto, 1 am forced to conclude that the affiliated organizations, the Na- t~aa In~t lute o~ Drug Ah~e and Office on Smoking and Health, are anything but unbiased And, while these organizations have 425 every right to maintain a view that ~mokfag is an addiction, 1 must disagree that such a view is ~ctentificaliy established.¸ To iIlustrata this point, recall ~hat Dr. Pollin's testimony earlier this mo~th began with reference to a claim that the American P~y- chiatric Association included cigarette smoking a~ ~ f~rm of "drug dependency". While tile APA's Diagmostic and Statistical Manual 93rd edition IDSM-III/ does include a category named "tobacco de- pendence," does this necessarily mean that such a category i~ medi- cally ~r scie~t.iflc~lly justil~d7 Certainly not. In fact, many pro~ssilmnls within the psychiatric and psycho- logical fields disagree strongly with the diagnostic scheme outifaed in DSM-III. As an example of s~ch a view, allow me to provide a relevant commentary which appeared shortly prior to thg issuance of DSM-IIh "Th~ ilroc~ ~hereby P.~w ~.teg~ld~ of dis~rb~P.~ ~,r~ iP,~r~ ducked into psychiatric nosology is clearly not a s¢ienti~c one. No recognizahln~ process of selentifie discovery is evident with regard to the scores ~f new disorxters in DSgI-Ilh land this w~)uid include %o- bacco dependence'/. . • The processes whereby (tile new disordersl have come to occupy a a~w place in psychia~rlc no,elegy are social and p~li~ical, ~ot ~cie~tific, i~ ~at~re." (.\IeP~eyn~ld~, lg'lgd These are not in accordance with usual ~nd acceptable common , • • + prtocip]es One doesnt develop science by vo e. In rlly vmw Dr. Pol- fin's testimony provides a good ~xamp[e of tl~e perwsive definition: ~d hopscotch characterls~c of discussions in this are~. According to my training, the word ~'addietien" is a meddeal term re~rr~g ~pectt~eafiy ta the u.se of psycl~ue~i~e 4ru.~s t~ [n~e~sh~g- ly escalating doses due to tolerance to their effects, and motivated strongly by the avoidance of medically consequential withdrawal symptonls fallowing abstinence or an~i~o¢ial behavi~r. Ye~, aitbough Dr. Pollin initially describes his Yestimony as having to do wish "~he addictive propc~tles of tobacco smoking", he goes on to dlseuas the more ~morphot~s &n(t (~u~io~bly ¢eie\,~[d~ +. concepts of "dependence" and "ubuse liability" h~ost~ revealing is Dr. Poitin's own admission that "evidence is not yet conclusive as to whether or lint there is physiologic depend- once or whut type of withdrawal syndi~me is ±~/~iated wfih ciga- rette smoking¸" If such evidence is lackir~g, as l a~so befiove it to be, it seems to f~llow that legislating a medical label of "addiction" as applicable to cigarette smuktag is no~ scientifically justified. For almost 400 years the smokfag h~bit has been an issue never fackklg proponents as W¢¢ll as Opponents Some ~.¢ho smoke seem unabIe to give up tile cigarette habit at leas~ durfag certain stages of their lives. Others can quit with apparent ease. Few specific areas of ~ppiied psychological re~earch have l~e~ celved greater attention than ti~e cigarette smoking habit. De~plte this intense ~elentific focus on the behavioral as welt as physlologl. ~al aspects of cigarette slIlokfag, no general agreement alzlong s~i- enlists exists ~ to the question of whether cigarettes or their con- tents are addictive. Ia a carefully definitive study, articles that appear regularIy ~n the scientific area exist as to the question of whether it is addis= tire. The behavior and responses of cigarette smokers are quite dlf-

fdl 426 ferent than those observed in individuals who are addicted to heroin and other substance~ that are demonstrably addictive, This is not to say that s¢ierttilic literature ha~ faih.d to provide use~ld inibrmatipg l~ tho~e of us working in the behavioral scl- ences Vi~rious vestigative find ngs have been reported that relate to sl~xeklng behavior. I, or example, there apparently is little differ- ence in the severity of cessation responses between klght smokev~ and heavy smokers Research also has suggested that these effects are felt more ae- verely by those who reduced, but did not stop completely than by those who abate ned totally, A third aspec repot ed by various researchers is that smoking cessation effects are relati~'e[y alt/d and in some cascs ~one~istent. The are eta nature which migh he expected to follow" the loss of Y r from an loved object to which a person was Fsych~t~eat rewa ds . Y ¢once veal of as form ng a part long accust ned and which could be st" the individual self image t ha~ been reported that malw smokers ate able to refrah~ from smoking for re]at vcly long periods of time for practical, s~fety or re i 4oos re,ha as and to d~ so w thout ~ppareut discomfort Some exan es are coal miners who may riot smoke a~ the pitthee, Ortbo- [ " ~ktu at sundown on Friday and cease do~ ~]ews who gl~e k~p ~I~ g v or smoknng until sundown vl~ Saturday, and so forth. Such beha doe~ not lit eouvenliamd views of addlct~on, Whereas the effects of use and wJthdra~al are relatively consist- ent ~md pred ctable with known addictive substances despite a wide range of uses, reported descriptions of tobacco effects are extremely varied and inconsistent. In this regard, tobacco use is mere like the use of caffeine rat3mr than alcohol or opiates. It has beetl reported that he contlntlar~ee of smok ng rs more re ated to a wide range of psychosocml motives such as pleasure, stimulation, sensory motor manipulation, d reduction o~ uegat, ve affect than an addiction factor• al~Research also h~s focused on vai:ious hyp])t~le~e~, relating to ~h~ "sel~.tdministratmn methodolog,as,,~yh'le ot,!~er~ei[nert, eofre- jeets have employed the concept of tltrauon • N h ~p search as produced convincing Findings In f~et a recent review paper (Kumar and Lader) described the state of the art ;~s l'ollows: "In su m~y very litte s known about the nature of the phar- macological re~ard~ that are sought by novice smokers or about • , . . , , the mamte~tanee el the habtt in established smokers. Smnlarty, the p ys O OE ca[ changes that facilitate relapse ia abstaining smokers t'I SO renlai[I obscuFe/ Tho National Institute on D~yg Abuse and O[fic~ on Smoki~eg and Health are apparently eonwnced that the reason people sine e i~ because st' nicotine. Bat consider the following view: " t has :*el to be established that smokers do indeed smoke for the phar nacological effects of nicotine rather than for nonpharma- ¢ologlcal reasons. /Eus~etL, 1979) klm~'u tbr h ~ antismoklng v e~s and often • • Presumably, NIDA is aware ~f this and other views, and if so, ~hy 'I l* "I ~7 does it continue to label dogmatically smoking v.~ an addiction, with all of the attendant pharmac~ogical overtenes? There are a large number of quotes from the very documents ~ited m the afbremeulio~ed I~amph½t, which are ava~able ~ the Committee which I will no~ descrlbe at the moment¸ The smohing eessati~o datu that have been reported by both b~- havioral researcher's and ~ommercial ciinlcs arv highly variable and, frankly, not very helpful in assessing the stren~h of the smoking habit. What 1 do find tetrlguing i~ a United States Depart- ment of ItEW report in 1977 that 95 percent of thosc,people who quit smoking do so on ~helr own. Ninety-~ive percent or more of tho~a people who quit smoking do so on ~.heir own. Tlfi~ i~ certainly in keeping ~itb. what we ~ce i~ general practice. Thls is not only a phenomenon in sharp coatra~¸r¸ t~ experience v~ith de~l~strab~y addtctlve substances, but ~ac which remmas to be explored and unexplained¸ N~ ctiaicmtt wilt tell~ou that 95 percent of heroln addicts, am~ phetamine addles, or alcoholics quit spontaneously without exten- sive professiolml help. Clearly, many aspects of Sl~lokiDg behav{or ace as yet tlnexplored ~ncluding why some people ~moke very hvavi/y and some do no~. Promising work with primates has been reported ~uggesting lhat it may be possible at some point to study cigarette smoking in properly controlled laboratory se~ting. As diseassed above, research examlning the role of nlcutine in the c~garette smoking habit ~s on- go~ug. Som~ re~varch~r~ have ev~I~ em~as~ed l~;~tng theory t~ their studies of smokers wh~ have great difficulty in quitting. ~ de(~nitive a~s~er~ have not bec~ t~ud aud emot~na[ c~- clusions to the contrary serve no legitlnlate scientist purpose. As I discussed belbre aud material th.~t I provided the commlttee wii]~- out eolnment, research exan~i~ing ti!~ rol~ of nicotine ill file clga. retie smoking babi~ is ongoing. At thi~ time, gentlemen, the ,~c~en- tilic data do not su~!)ort the slatom~nt that cigarette snlokhtg i~~* addictive 1 would now liks to discuss very b~ief]y my clinical experience with smoking During the pa~t 30 years, I bare worked and ccntil~ ue 1o wc~k ~vith peDple who s~no~ cigarettes¸ In re%e~tng r~y ex- perience with the thousands of people that I have seen pro~sslon- with stress, and ~nm qui~ with }ittle or no stress. These patle~ts in no way acted like the patlent~ ~ilat ~ have seen who str~ggle ]o be released from the addictions of opiat~ or alcohoh Cigarette smokers are very atL~ehed to their smoking bei~avior. ]'hey are of~e annoyed or ~istes~ed when they are not ~nowed to ~moke. However, I have noted equally strong attachments in my adolescent and adult patien~ to certaln activities llke jogging, and to other people, especially those of the opposite sex. lion, sleeplessness, irritation, depression and other uncomfortable ~mptoms l mention these am~lo~ies ~et t~ be facetious, but to em- hasize that the s:lm~~ behavior~ responses one sees upon discon- tinuance of smoking ar~ quite shnilar in duration and intensity to those that occur after removed of a variety ~f things.

428 If one thing from my clinical observations strikes me as certain, it is that the motivations for smoking are diveme and involve a panorama of psychesocial factors far beyond anything I have seen w[~h the genuinely addictive substances. Interestingly. instead of helping me to better define the reasons for smoking, my clinical work has at times made me include even more possible explana- tions for the habit. l, myself, smoked cigarettes for 24 years--two to three p~lckages day [or tile last 10 years of the habit. I stopped at the age ~f 35 and have not smoked since. 1 was somewhat uncomfortable for a short peried of time, but was never highly uncomfortable. The craving never reached the level I have experienced or observed in medical weight loss program. In short, although cigarette smoking is a common and pervasive habit, I can find no convincing basis in the scientific legislature or in my own professional clinical experience to justify labeling it or treating it as an addiction. [Dr. Blau's prepared statement fullows:] 429 STAT~4ENT OF THEODORE ~. ~LAU¢ PH.D. Presented Befo~ SUBCG~IITTEE ON HE.a2~TH ,~MD THE ENVI~NI~NT HOUH~ O~ BEPRESENTATrVES Thank you t~r. Chairman £O~ th~ oppoztunity o~ appe~ing before your $~bcog/aitt~e. My n~u~ ~S T~eodore H. Bl~u. I hold th~ Doctorate i~ Psychology, ~c~ived from t~e Pennsylvania State University Of 1951. ~ have been in indep~n~nt practice ~ ~lin- ical psychology and ~onsulting psychology ~n ~a~a, Fl~rida, since I953. Fo~aerly, I w~ Professor of Psychiatry at the Med- ical School of the Oniversity ~£ South Florida. I ho~d a Dlp- Iomate ~ ~li~lcal ~sych~logy from ~he ~erican Board of prc~e~- s~nal ~ych~lo~ as w~ll ~s th~ Diploma from th~ ~rican ~oard of Forensic Psychology. am a m~mb~r and ~ast President ~f ~he ~erican p~y- chologic~l Association and the ~erican psych~loqical Fo~datlon. I am also a ~ember of the Ev~i~ation Research Society a~d hava c~nd~cte~ evaluation Gtudi~s ~or privat~ e~rporations as well as evaluation research for various branches of the ~.Z. ~ilitazy and th~ ~ve~nment. I ~n the author of on~ book~ a nu~er~f chap- ters ~nd approximately fifty articles. ~or several yea~s, • have be~n involved in an evalo- a~i~n of the r~r~h and curren~ state Of knowledge aho~t th~ psychologlc~l aspeehs of~ci~are~te ~oklng. Thi~ ~valuation includes a thorough rev±ew of h£storlcal factor~, c~en~ ~h~- ori~s and re~ea~eh, q~ality of the research and ~Uhl~ca~£ons

6S05735S1 0~

432 "The ~roc~ss whereby ~ew categozles of d~s~ turbanc~ are IDtroduced into psych~atri~ nosoloqy is c~early not a sc±entifzc One. NO recognizable pr0ce~s uf scientific d~scov~ry dlsord~x~ in DSM-XII. IAnd thi~ w~uld include *tobaccQ de~endencu'] . . . Th~ processes whereby Ithe new disorde~T have come ~o occupy a new place in psych£atr£~ n~olo9¥ axe ~ocial an~ p~lltical, ~ot scientific, in n~ture," (Mc~eynold~, 1979) Yurth~re, ~n my view Dr. ~oll£n's testi~y provldes a g~od ~ample of the perva~iv~ definitional ~0psc~h chara~- teri~ti~ of ~is~ssio~s in this a~a. Acc0rdi~g to my train£n~, the use of psychoactiv~ drugs in increasingly es¢~ia~n9 doses ~ue to ~oler~n~e ~o their effects, am~ m~tzvated stron~lyby ~he avoidance of medic~lly ~n~eque~tial w~thdraWal symptoms foll~w~ ~ng ~s~in~nce. Yet, although Dr. Pollin inlti~IIy d~crib~ ~£s testlmo~y a~ having tp ~o with "the addictive prop~t£es of ~bacc0 ~m0king," he g0~ ~n ~ di~cu~ the m~re a~orphou~ and quest~ahl~ r~vant ~on~ept~ ~f "~pe~ce~ ~ "ah~e liability." Most revealing is Dr. ~llin's ~wn a~is~ion ~hat ~evid0n~e is no~ yet cQn¢lu~ivo as t~ whether or not there i~ ~hysiol~gic dependence ~r what type of with~rswal syndrome i£ ~$socla~ed with ~igar~t~e s~k£n~." If ~uh evidence is lacking, ~s I al~o bslieve it t~ b~, i~ ~ms to follow that /e~slatin9 a med£cal label of "addict±on" as a~pl~c~hle t~ cigarette smuki~g FO: almost 40D years th~ s~klng habit has been an issue never lacMing proponents as well as opponents. Some who ZSDR D089 433 l smoke seem ~n~ble £a give up ~e cigarette habit mt least 4urlnq ce~taln s~ages uf their l~ves, 0the~ can ~uit W~tl% ~re~t eass. Yew gp~clfiu area~ of applled p~ycholegical re~ea~c~ have ~e~i~ed gre~ter att~t~ ~han th~ ~Iga~tte smoking habit, D~sp~ this Intense ~i~ti~ic foc~s On the hehavi0ral as well as physiological aspects of ~iga~Qt~ smoking, no g~n~ra~ agree- ment ~g ~Gient£ste ~xi~ts as to ~he q~estion of whether elga- ~ette~ ~r ~r ~ontent~ a~ addle~£ve. The ~ehavior and r~- sez~2ed i~ in~ivld~al~ wh~ a~e a~di¢%¢d to heroin a~d othe~ sub- ~t~n~ee thah arc de~nstrably addictive* This is a~ to say that scient~fi~ literature has faile4 to p~0vlde useful Infoxmatlon to th~se ~£ ~s w~rk~q i~ the ~ehavi0~l sciences. Va~i0u~ £nve~i~ati~e ~indin~e have been r~po~ted that ~e~e ~ ~kin~ b~or, For ~le, there ~ppar~ntly is li~le d££~erenc~ in the s~ve~ity of ce~s~tlon r~pon~es between il~h~ ~moke~s and he~ ~m~ke~s. Research al~e has suggeste~ that ~hese e~fe~ a~e felt m~e severely by thmse wh~ r~4~u~d b~t dld ~et stop c~m~letely ~han by th0~ who abs~aine~ ~taZIy. A third a~pect ~epo~ted by vari~a~ researchers i~ that ~mokin~ cessation ef£e~t~ mre ~elat£v~lY mild and in ~me cases n~e-e~isten~- The~ are ~ a nature which m£qht b~ ¢~p~eted t~ ~li~ the io~ of psychnlcgical rewards ~m any I~V~ Ob~ec~ te which a person wa~ long ~ccu~tume~ an4 which could be ~n~e£ved ~f as fPrmlng a pa~t of the ind£vidual sel£-£mag~

434 It has been reported that many Smokers are able to refrain from smokinq for relatively lonq periods of time for practical, safety or religious re~sons and to do so without ap~ parent discomfort. Some ex~ples are Coal min~rs who may no~ smoke at the pitfaoe, Orthodox Jews who give up smoking at sun- down ~n Friday and cease sm~kin~ until sundown on Saturday, and SO f~rth. Such behavior d0e~ not fit ~0nventional views of ad- diction. Wherea~ the effects of use and withdrawal are ~elatively consistent and predictable w~th known addictive substances despite a w~de range oE ~S, ~e~or~ed descriptions of tobac~u ~fests are extremely varied and ~aeon~stent. In this regard, tobacco ~se is more like the use of c~ffeine rather th~ ~lcohol or opiates. ~ has been re~orted that the u~ntinuance of smoking appears more rela~ed to a wide range of psTchosecial ~tive~ such as pleasure, stimulation, sensory ~to~ manipula- tion, and reduction of ~egative affect th~n an addiction factor. R~arch also has focuse~ on varioas hypotheses relat~ £ng to th~ role of nicotine in t~e smoking habit~ Studies in animals have used "self-administration~ methodologies while others in haman subjects have employed the concept of "titration" Neither type of research has produced c0~vincing findings. ~n fact, a recent reviawpaper (Eu~ar a~d Lader~ de- scribed the state of the art as full~w~: In s~m~ar~, very llttle is known about the nature of the pharmacoleg~c~l rewaxds that . 435 ! ~ are suught by novice smokers or about the maintenance of the hab£~ in establi~he~ smokers. Similarly, the physiological ~ha~ges that facilitate r~lapse in abstalnln~ smoko~ a~o re~in ~bs~ur~. The NatlQnal Institute on Drug Abuse and O££~ce on Smoki~ an~ Kealth aie apparently convinced that the reason peo- ple smoke is because Q~ nicotine. Hut consider ~he following view~ "~t has yet to b~ est~blished that s~oker~ do ±ndee~ smoke for the pharmacological e~fect~ of nicotine rather than for noapha~mac~logical ~eason~.N ~sussell, 1979) This st~temen~ w~s r~ade by M.A.H* Russell, a person well kno%rn for h~s a~ti-smoking views and o~ten associated with NIDA." ~re~ably, NIDA is aw~r~ oZ this and oth~r views, an~ £f e0, why does ~t continue to label dog~atically sDokln~ a~ an addicti~n~ with all of ~he attendant pha~ac~Io~ieal c~ertene~ The smoking ~sation data ~hat have been reported by both behavioral researchers and co~rcial ~linic~ are highly variable and, f~ankly, ~ot v~ry helpful in assessing the strength ~£ the smok~n~ habit, what ~ do find intriguing is a United S~ates Department of H.E.W. report in 1977 that 95 percent of those people who qui~ s~ok£~ do ~o on their Own. T~iS is ~o~ o~ly a phenomenon in ~harp~ontrast to ~xperie~¢e w~th demon- strably addictive substances but one whic~ remains to be ex- plored. Clearly, many aspects of s~oki~ behavior are as yet onexpl0red including w~y some p~0ple smoke very heavily and some

436 do not. Promising work w~th primatss has been reported • ~ggestlnq that It may be p¢~slble at so~ point to study cigarette smoking in a p~ope~ly cont~olled laboratory settinq. As discussod abovQ, ~arch examining the rol~ of nicotine in the cigarette smoking h~bit is onqoinq. Som~ res~archer~ have even emphasized learning theory in ~heir s~udi~s of s~ok~rs w~o have great d~fflculty i~ quittinq. But de~initiv~ answers have not be~ founa and emotional conclusions to the c~n~rary serve no leglt~mate sciBntlf£~ p~rpo~e. And ~o. gentlemen, a~ this time the scientific d~ta ~o not s~pport the stahement that cigarette smokin~ ~S addictive. I would now like to discuss very briefly my clinical experience with smoking. During the past 30 years, I have worked and continue to work with people who ~oke cigarettes. ~n reviewing my experience wi~h the thousands of people that I have seen profes~ionally, many of whom are heavy smokers, some continued, ~om~ q~t with ~rcs~ an~ $omc quit wi~b littl~ or no stress+ Th~se patients i~ ~o w~y acted li~ the patients that I have seen who struggle to be released fro~ the addictions of opiates or alcohol. Cigarette smokers ar~ very attached to ~helr ~moklng behavior. They are often ~nnoy~d or distressed when t~ey are not all~ed to smoke. However, ~ have noted equally stron~ attach- ments in my adolescent and adult patients to certain ac~ivities llke jogginq, and to Other p~ople, ~p~ially thos@ o~ ~h@ 437 opposit~ se~. Hemoval from ~h~s~ activ~tie~ ~d pe~son~ can ~esult in agitation, sleeplessness, i~i~at~n, d~pre~sion a;~d other u~comf~rtable symptoms. ~ m~tion these analogies no~ ~o be facetious, bu~ to emphasize tha~ ~h~ ~ame h~havio~al responses one sees u~on discuntlnuance of ~,ok~ng are q~itc similar iz~ duration ~d inLensity to those that Occur after ~m3val of a variety of things. ~f onc thin~ from my ~lin~ca~ o~ervatioa~ strikc~ ~e a~ calL.in, it is that t~e motivations ~ s~oking axe dJvcr~e and involve a pan~ai~a o~ p~ychosoc~L facao~. Interest±n~ly, instead of helping ~e to bett~r defin~ the rea~on~ ~or ~aokin~, • y clinical ~k has at ti~e~ ~ad¢ me include even ~ore pu~ible e~plaz~aLions fo~ the h~b~t ~, myself, ~Ja~ke~ c~g~ett~s ~ 24 y~a~s ~ two ~o th~e p~k~g~ a d~ for ~h~ l~t ~n y~ of the h~b~* s~opped a~ the age uf 35 ,~nd ~ve no~ sm~ke~ since, i w~ so~- wh~ u~l~l~£~table £o~ a ~h~t perlcd of ti~e, but wa~ n~vex highly uncu~for~b~c. The cloying ~; r~a~ed ~ leve~ ~ have ~F~ri~nc~d or ob~e*v~d ~n medlca~ weight 1o~ ~ro~±am~. In short, although cigarette sm~k~nq ~ a co--on and ~.~vasive na~ X c~n £i~ ~ conwncxng ~s in ~ne ~l~nt~c ~ltera~ur~ or ~n my~n pr~f~.~i~n~l clxnx~a expar~encc ~ 3u~t±[~ labeling ~u o~ ~r~a~ng 1~ ~¢ an add~ct~u~.

488 Dr, SUMMERS. Dr. Carl Seltzer of tlarvard University has pro- sented a statement and it is requested it be included in the record. [See p. 771bJ Mr. WhxtaaN Without objection it will be included in the record. STATEMENT OF SIIELI)ON C. SUMMERS, M,D. Dr. SUMMERS. In the last issue of the American Medical Assoei alien Journal of March 18, 1983, startlag with page 1,435, there ale three pages of letters to the editor concerning the "Mr. Fit" pro- gram and permission is requested to include them la the record Mr. WAXMAN. Without objection, those will be included in thc record as well as additional information which may be submitted concerning the "Mr. Fit" program. [See Appendix. p. 712] 1 am Sheldon C. Summers. a physician specializing in pathology at the University of Southern Caliibrnia Sehnol of Medicine, Los Angeles, and at Columbia University College of Physicians aud Surgeons, New York, as well as consultant in pathoio~y at Lenox IIill HuspitaL New York I am chairman of the New York State Mental ttygiene Medical Review Board l am past president of the New England Pathob/gi- ca] Society and the New York Pathological Society, and am now president of the Arflmr Purdy Stout S:rciety of Surgical Patholo- gists. For 47 years, except during service la Woild War lI, I have en- gaged in cancer research and have bcen associated in it with Dr. Shields Warren, Dr. Jacob Furth and many others My publications number over 300, and include articles dealing with patholagis stud- ies of lung mid pancreatic l'ar{'h]omas. I anl co-edkor of Pathology Annual and Diagnostic Gynecology and Obstetrics, and am on the ediladal boards of five other medisa[ journals I provide this statement vohmlatily, as an individual and not as a representative of any organization, it is based on 47 years of study, lavestigation, diagnostic experience alld personal contacts wiLh other researchers in experlmenta] pathology. I have been par- ticularly interested in lung and esophageal cancers for over 80 yea~s. During the past 18 months, I have served as Scientific Director, ~'~ Council for Tobacco Research USA, Inc. This organization, funded by the major U.S cigarette manufacturers, supports bm~ic and ap- plied biomedical research related to smoking and health. The current 1983 budget is $7 75 million for research grants Over the 30 years of its activity, flu)re than $80 million has been expended ibr research about two thilds in cancer research• ~'~ The donors of the money and the Council for Tobacco tesearc tL~ give complete sisentific freedom to the grant recipients in conduct- I~ lag their studies. The grantees are free to publish their findings and report them at professional meetings. in 1983 the council has received the largsst number of app]ica- tior.s for funds in its history. Compefilisn is very keen for medical research funds and fellowships, and the Council's Scientific Adviso- ry Board, with outside scientific consultants, makes every effort to '1 439 insure that funds are granted to the best investigators in the best lastitutions ' . ' vent on and in Web- The bill as I read it menttoned smoking pro are the meaning of ster's Dictionary, prevenhon and prohtbltlon sh • ow. occurring. As a c tizen I gather }l}is ts stopp ng sornethmg fr . . ou h the era of proh b tmn, 1 the latent of the bill. tlawng Bred thr g hope this never happe~ag~int: r~urtC°eU~rY'wlV~e~b;~i;fthe d~oon; gross, most y younger t , Y permanently to the fhbric of society, respect for the laws and for the Oov=rnment. " ur ore, re event to this hill H.R. 1824, to comment on It is my p p , edical and scientific knowledge of certain the current status of m • d there n The bill characmrizes cigarette n2Pllt io[le , . condltmns . . . rcventablecauseofllinessandprematore smoking as the lalgest p . death in the United States . P" n m ex crience in New york--where I practice 1 Based u y . I]. not the case. Premature death has no medi- assure you that this is ca mea ng exce/t as app ed to some 1,nfanla born te~ It~amactUr2 to survive The original Surgeon General s report s~a g rette smokers as a group did not live ~s long as nonsmokers. The same aport alsu stated that pipe smokers lived longer than non- sm~)ket~ It is now understood that the creasing i~pulati°n of okers from 910 to 1960, and the concommitant de- c arette sin . or* Thes~ are called crease n p pe smokers exp[aIns the phenomen , secular changes and have no health relevance. ' los ha~e re erred a ~tatistical associahon beiween Some stud ,P, auses These stud es, however, do not smoking and death fron all c . • establish that this association is causal. Other studies, including Scandinavian studies of twlas, indicate that a genetic or ccns~itu" tional factor may be a better explanation for this association than smoking. - ' n studies the researchers found m le m the Scandmavla , For ~xa P ~ r( was no d that in identical twlr s, only one of whom smoked, the ference in number ~f deaths from a causes " " , s one a preach to nvestigatlag h.uman dise.~'e/~ Ep dem oog) . P ~ " ve an ex ermtenta group causation Epldemiolagtcai ~tudles meal P - rol rou For a valid comparison the gloups must he and a cant g a~p ass b e in all re~pects except for the factor aike as henry P • • belag investigated. In studies of cigarette smoking, smokers ~nd nonsmokers were matched by sex and age. The assumption that the ~]f!!crolutPSd~ere compartLb e. however, m not true. T!lere wez~e s g . ., bu d extroversle or lotroversmn, marital h~story, enter m body . . cations oboe records mfl- alcohol use. use of non-prescription reed . P itary records and other aspects. The fallacy of one-t~one comparisons of smokers and nonsrnok- • s oct to matte ity was demonstrated by Rose and Bell !n err w~th reap . ~is- in war veteraos m 1971 They studied prod clots of lunge Yne-on-~ne comparmons were reexamined at intervals. O Boston, who " No 1 a~ red ctor of early death, as ha~e placed mgarette smoking - P other studies, , ~ however dropped smok ng to • mal statlstlca anal3s , " • Multlf~ct~ ' nd dissatisfaction w~th ~ob became below No, 30 as a pre&ctor, a

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' ' ' i 442 I : ~ Cigarette smoking during pregnancy is assodated with smaller babies who are healthy, and not weight or otherwise deficient. The babies develop normally. Most studies in this area fall to take ade- quate account of the lower soeioecononfic status, alcohol use, di- : etary deficiencies, increased infections and other salient differences between the smoking and control groups. Multifactorial statistical studies fail to support the statements in this portion of the proposed hill. This field is controversial, still de- veloping and the evidence in the literature and at these hearings cannot be regarded as conchmive for U.S. women. In the field of ssipnce, knowledge is gained through experimenta- tion and interpretation. In the scientific nmthod, a theory is pro- posed. Thereafter, erperhnents confirm or refute it. If the latter, a new theory is developed. It is a continuous evolutionary process and needs a critical and open mind. One must be constantly alert for surprises, as Lewis Thomas has written. in summary, 1 have reviewed and carefully evaluated the pur- ported "findings" of H.R. I824. In my opinion, they are unsubstan- tiated and misleading. Cigarette smoking has not been scientifical- ly established to be a cause of chronic diseases, such as cancer, car- diovaseular disease or emphysema. Nor has it been shown to affect pregnancy outcome adversely. Rapidly accumulating new basic sci- entific discoveries and reports in the medical literature render the simplistic statements in the proposed hill invalid. Mr. W~XMAN. Thank you very much. Our next witness is Prot: Hans d. Eysenck. STATEMENT OF B. J. EYSENCK, PtL D., D. SC. 5 Dr. EYSENCK. I am Hans J. Eysenck, professor ofpsychology at , the Institute of Psychiatry, University of London and psychologist ,, to the Maudsley and Bethlem Royal hospitals in London. , I received my Ph.D. in 1949 and my D, So. in 1964, both from the University of London. I was Senior Research Psychologist at I Mill Hill Emergency Hospital from 1942 through 1946. In 1949 and 1950 I was a visiting professor at the University of Pennsylvania in Philadelphia. Between 1950 and 1954, I was a Reader in Psychology at the University of London's Institute of Psychiatry. In 1954 1 was a visiting professor at the University of California at Berkeley. 1 am a Fellow of both the British Psychological Society and of the American Psychological Association. I have founded and edited three psychological journals, and I am ' on the editor ai boards of some 15 other international psychological journals, 1 have written or edited for publication approximately 85 technical books and over 69g articles dealing with various aspects of the psychological field, particularly with respect to personality, ' intelligence, behaviour therapy and behavioural genetics. I have conducted research in the area of smoking for over 20 : years and have autbered two books, themost recent ofwhmhmen- ! titled "The Causes and Effects of Smoking," as well as numerous actlCles on this subject• In n y book I have been concerned w th an exam nat on of the two major theories of the relationship between cigarette smoking ] and disease, in particular lung cancer and coronary heart disease. , 1 I ~! In I! 443,[ i F ' i j ' i , The causal theory asserts that cigarette stunk ng is in part re- s ons h e for these diseases thus go ng beyond reports of a statisti- ! , ca ~reationshlp between smok~g alld disease. An alternativei theory suggests that the observed coxTelations can be exp a ned in~¸ terms of common genetic factors, underlying both the propensity to.¸ smoke, and the probability of developing certain diseases, i My own work has been concerned mainly with the issue of the origins and the maintenance of the smoking habit, because these ' questions are vita to an understand ng of the evidence concerning ; these two theories. Workin together with Professor Linden Eaves, a geneticist for- merly of ~xford University, and now at Richmond, Virginia, I ad- m nistered special smoklng and ~ers0nafity questionnaires to vat-: ious samples of the population, msiuding over 1,000 identical and fraternal twins; 340 fostered children and 230 pairs of foster par- ents; as well as a variety of familial relationships/parents and chil- dren, ~randparents and grandchildren, uncles and aunts, nap]~ews and meces, first cousins et cetara), making a total of 2,469 individ- uals. • • Appropriate statistical analyses were made of the date and in many ca~es new statistical methods had to be developed for this purpose. The major principle used was to set up specific theories or models and test these against the empirical data, increasing the complexity and sop istication of the model until an acceptah!e fit • was reached. As regards the onset of smoking, genetic factors seemed to play tt e f any part The data support the hypothesis that taking up smoking was argely due to environmental factors, particularly the influence of peers; thls factor emerged as far more¸important than other factors tradit ona y cited, such as the smoking habits of par- ents, which we found to exert little influence on the or g ns of the smoking habit. ~ • Equally, the results are not readily compatible with a theory which would assign advertising any marked¸ influence on the taking up of smoking. These results have been verified by direct studies undertaken by Professor C Sp e berger of the University of South Florida; he foundthat social pressures particularly peer in- fluence, exerted a very strong effect on ~,oung people taking up smoking, whereas the influence of advertising was negli~ble. As regards the maintenance of the smoking habit, our data indi-¸ cata the powerful influence of genetic factors, people who give up smoking are tatermedlata between those who have never smoked and those who persist in smoking; this finding is imlmrtant, as it " demonstrates that giving up smoking is in part determined b~' ge- netic factors so that peep e who give up, and thosv who continue, are different types of people genetically. . .. i As regards the amount of tobacco consumed, it seems that the ge- netic factors determinin thts are i rather • different from .those , which influence a persoan~B becoming, or not becoming, a smoker, nonsmokers are differentiated genetically from smokers along quite • a distinct dimension from that which discriminates between the different degrees of ci arettte consumption among smoker~.¸¸• ' On the whole, we ~us find iistle evidence of genetic determina- tion for the taking up of the smoking habit, whlch seems te~be,

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m ~J t~ t~ 446 though the women, who took up smoking much later than men, should have shown thc~e chan~es at a much later date than men. If the causal theory is true, then we would expect a dellnite dose- response relationship; in other words, the heavy smoker should be stricken with cancer earlier than the light smoker. Yet th9 amount smoked makes no ap*preclable difference to the mean age at which the person is reported flrst to the c]inlc. Again, inhalation should make lung calmer much more likely than smoking without inhaling, yet the figures show, if anything, an opposite trend. Indeed, in the most recent study (published in 1982 in the Journal of Epidemiology and COmnlunity Health) lung cancer rates were higher overall lhr noninhalers, particularly in groups of hea~y smokers. These two observations are difficult to reconcile with the causal theory of smoking. What is often claimed to be the most impressive evidence for the causal theory has been the report tlmt physicians who gave up smoking showed less lung cancer than members of the general public who ccmtinued to smoke. Thus, it might appear that giving up smoking has saved the lives of those who did so But this proof is only acceptable if those who continue to smoke, and those who later on give up smoking, are es- sentially identical adth respect to their health before some of them gave up smoking. Clearly, if those who later on give up smoking are already much healthier than those who later on continue to smoke, then the final differences in health may be due to the already existing differences before anyone gave up smoking, ra her han to the ccssatma of fins habit But there is good evidence to show that smokers and exsmokers already differed with respect to their health record be.%re the ex- smokers gave up smeking. Similarly, there is evidence that from the point of view of personality and genetics exsmokcrs are differ- eat from continuing smokers. Thus this alleged proof is based on all erroneous assulnptlon. n2hese objections to the causal theory, and others made in my book, do not prove the ~heory to be wrong; they simply argue that it is still only a theory, not a scientific law. More convincing proof is required befure the theory can be accorded a mot~ advanced status. But further than that, there are numerous facts suggesting an al- ternaLive theory, and these fact~ cannot easily be integrated with the causal theory. Yet a proper theory demands that attention be paid to all relevant facts, and thus again the causal theory is found wanting The alternative theory, first suggested by the eminent geneatisist and statistician Sir Ronald Fisher, suggests that genetic factors are important in causing lung cancer; that genetic factors are active in causing people to maintain the smoking habit; and that possibly the same genetic factols may be involved in both tkese trends, thus producing the obeervad corre]atten between smoking and cancer (insofar ~s such a correlation is real). There is evidence that genetic factors do play a part in the causa- tion of lur~g cancer; this is not in doubt~ A~ already mentioned, 1 l~ave brought forward evidence (in addition to already very con- 'i 0 '1 '\ 447 vilming evidence produced by many other peep e) to show that g.~ netic factors are relevant to the maintenance of the smoking habit. Thus there is evidence for both the assumptions on which Fishe.~'s argument was based. My own contribution has been to suggest that the mediating factor between cancer and smoking may be the persoa ity of the people involved. Thus t is a~sumed that people of a certain person- ality are more likely than others to die of lung cancer irrespective of smoking. it is also assumed that people of a certain personality are more likely to smoke than others. There is evidence for both these prop(> sitions. My original work with Dr Kissen, an eadnent British oncologist, showed very marked personality differences between lung canc~- patients and patients suffi, ring from nonmalignant tumors, ad!~ the personality assessment made before diagnos s. Since then, n ]arge-scale study fil East Germany has re ca e our findfilgs (themselves replicated in another study by ~issenl, and h,~s fuund similar personality traits to those characteristic el lung cancer pa~ientu in women with cancer of the breast. Other studies, also indicating a relation between lung cancer aml personality, are cited in my book In a similar way, my early work with Tarrant and WooIf estab- lished a correlation between per*Jcna]ity and smoking, and man)' studies in different countries have since confirmed our ladings, and added new ones. We may thus say that the fundamental assumptions of Fish~r's genetic theoiT have found empirical support, and we may add that there is also some modest support for my o~n attempt to integrate these two major fields Unfortunately, there has been too little work along these unusu- al and somewhat unerthl~lox lines to say that the results are an5- thing more than suggestive, and the theory linking them is still in a very elementary stage; nevertheless, as far as tile fii:dlngs g% they support the genetic rather than t,l~e causal theory, althoug they do no necessarily contradict the latter. It seems unfortunate that the premature crystallization of spurt ous orthodoxies has prevented the genetic theory from attracting sufficient research gr&nte to worh [t out in sufficient detail, and to carry out the research necessary to put it on a more accept;d!~ footing. Recently some progress has been made on the theoretical devel- opmen~ of the genetic hypotkesis by linking it with research on stress, in particular the differential effects of chronic and acufi, stress, and the "inoculation" theory of sress Hog, ever, in the absence of large-scale research into the refine- monte of this theory, and more widespread familiarity with and criticisms of its details, not too much should be claimed for it other than that it presents a viable alternative to the causal theory. In relation to the causal theories of coronary heart disease [CHDJ similar criticisms apply as do in the case of lung cancer. There are considerabIe unre[iabiIitles in diagnosis; there a:. large numbers or" the!ors other than stunk ng wh c have been asso- ciated and wh ch are not usually controlled for in studies of the el-

448 I :r facts of smoking; inhalers do not on the whole differ from nonin. halers in disease proneness; the statistical relation between ¢iga- zette smoking and CHD disappears in many countries, for example, Finland, Holland, Yugoslavia, Italy, Greece and Japan; there is an absence of dose-r~pense relationship, i.e, there is little or no rela- i tion between duration of heavy cigarette smoking and risk of myo- i .[ cardial infarction; and the correlation between number of ciga- rettes smoked and CHD is not linear; exsmobers in some studies appear to be safer than nonsmokers; some types of CHD. such as angina pecteHs (which comprises some 20 percent of CHD in men) fall to show even a statistical correlation with cigarette smoking; some types of smoking (cigar, pipe) fail to show even a statistical i correlation with CHD; et cetera. ' In the m~t recent study from the Mayo Clinic (published in the May/June 1982 issue of Atherosclerosis/, over 15,000 patients with coronary artery disease, proven by arteriography, were studied. No positive correlation (indeed, in some subgroups a negative correlation) occurred between the arterlographic measures of dis- ease and the cigarette smelting history (ever or never, number of : pack-years of smoking, duration of cigarette smoking, a~d peak daily cigarette consumption). I These are anomalies or failures of the causal theory which demand an explanation before the causal theory can be accepted. Some of these facts are much more readily explained in terms of a genetic-personality theory; thus the differential effects of cigarette versus pipe/cigar smoking may find an explanation in terms of the known differences in personality type associated with these differ- ent smoking patterns. The general conclusion would seem to be that in the case of CHD, a~ in the case of king cancer, proof for the causal influence of smoking is still lacking. Such evidence as exists is by no means as clear-cut and decisive as is often alleged• There is evidence in the case of CHD for genetic factors, and there are published correlations with personality; here, too, there appears an important element of stress determining the appear- ance of CHD. and stre~ ie intimately linked with personality. No formal theory of genetic determination of CHD has yet been put forward, but it seems likely that such a theory is needed a~ an alternative (or perhaps as complementary) to the causal theory for an explanation of the many gaps and anomalies in the latter. , It is interesting to note that if one were to use the same stetistl- cal type of argument of correlation as favoring a ca~al relation. ~.~ smoking would seem to protect against certain illnesses. Thus, colorectel cancer in women is found significantly more f~- ~ quently in nonsmokers; so are primary central nervous system ne~ plvsms, Parkinson's Disease, trigeminal neuralgia, diabetes and al- cerative colitle, There are other curious relationships between dlsemles which the smoking causes cancer h)~pothesis does not begin to explain; one of them is the almost complete absence of lung cancer among schi- zophrenics, in spite of the high degree of cigarette smoking preva- lent in that group. : i : ! i tl II ' 449 "'~ : " One important function of the o~enet c theory has been(that of ex. p/a n ng the reasons why people smoke and to link these re~soni with their different a personality patterns. " : ~i ~ Another important function 'of the geaet c theory has beba~to : suggest better designs for research m this comp ex field a good ex.- ample is the use of the dmcordant twm method by Cederlof. Lund-~,~ man and others i e the nvestigat on of the llness patterns 0f[~ identical twins of whom one smokes, the other not. ;Lt!~i If this type of research had been carried out on the large and in. ternational s~ate required, instead of investing in the redundant ; and scientillcal]y not very valuable replication of correlational studies, we would know far more about the relation between smok- ing and disease than we do now, . . ,,~ Such studies allow us to look at environmental factors, mcluding those of smoking while controlling for genetic factors; this is essen.~'~ tim if any convincing results are to be ach eyed. : In summary, 1 would like to state that the causal theory of smok- ing as being responsible for lung cancer and coronary heart dls- ease, while it has found many supporters, is far from being estab- lished, and has many gaps, anomalies mad contrary findings to con- tend with; these are too frequently glossed over and dismissed as ualmportant, when in reality they may be found to discredit the causal theory in whole or in part. ' . : An a ternat ve theory, based on genctic~ and imphcahng peronai - llty factors, is much less well developed, more complex, and a present not too well known to oncotegists; nevertheless there are ! many well-establlshed facts which suggest that in part if not in'. whdie it can account for the major findings. At the very east, th s alternative theory suggests novel research methadio]gies which would serve to overcome the difficulties of the older methods and remedy their lack of proper controls. The possibility has also been raised that the two theories may be comp ementary, rather than opposed to each ether; this passibility too, should be looked into from the experimental point of view. )~ What is certain is that at the moment no final decision can he made about whether, or the degree to which cigarette smoking may cause lung cancer or coronary heart disease, how it interacts with other factors (stress; personality), or how we can best protect the health of our citizens in relation to these diseases. . "In ignorance, abstain" warned the famous French Scientist, Claude Bernard; hasty action on the basis of partial knowledge is unlikely to be in the best interests of those most concer~ed, namely : the prospective victims of lung cancer and coronary heart disease. Thank you, Mr. Chairman. , ..... Mr W~x~.~. Thank you very much. Dr. Langston. ~. i ' ,: :~ STATEr~IENT OF HIRAM T. LANGSTON. M.D. ,~, ~ ~ - ¢ ,'; : Dr. LANC.S~ON. I am Hiram Thomas Langston. recently retired' from the private practice of thoracic surgery. I am a clinical Pro- fessor [emeritus] at Northwestern University Medical School and a" : former cha'rman of the depart~.~ant of surgery at Sti Joseph's Hos- pitel in Chicago. i I ~ ~ " ~ : " I

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I 452 Whereas I cannot directly challenge the statistical analysis used to obtain these associations, I have been able to consider another aspect of"dose reuponae" age at diagnosis. The age at diagnosis of lung cancer does not seem to be related to the age at which a person started smoking, nor how long he smoked, nor even the number of cigarettes he smoked per day. I have observed this in my own patients, and indeed I have found it to be confirmed in the literature. 6. Lung cancer seems to have a very peculiar and chaxacteristic age distribution. Most series of lung cancer patients show that lung cancer occurs most oft-en between 50 and 70 years of age, with the peak at 60 The literature also rexeais that a certain generation Rhese born before the turn of the century] may have higher lung ca .cer rates than other generations. Intrigued by these findings and the possibilities that they sug- gested, I reviewed approximately 3,756 lung cancer cases spanning 39 years at the Veterans' Administration Hespita[ in Hines. Ill. All cases carried the diag~nosis of lung cancer supported by nficroseopic evidence i found that [1] the gencravion horn between 1890 and 1900 had colLsistently contlibutsd the largest number of cE~es; [2] if this trend continued, this generation would perforce fade from promi- nence due to old age; ]0] the younger generations did not appear to be replacing Ibis generation in cancer production Given these paints, 1 predicted that the number of lung cancer cases at the VA Hospital in Hines would decrease. In a subsequent investigation of cases through 1978, I discovered that the contribution of the generation which had earlier produced tile greatest numts!r of cancers at Hines had in faut decreased sig nii~cantly, In addi~ton, the total number of cases at llines in the period 1968 througb I978 had dropped approximately 17 percent. This seems to be a r:~lher significant change which supported my earlier predic lions, This study now spans 45 years a~al encompasses approxi- mately 5,500 case~. 7 Lung cancer is a dynamic disease in the sense that its occur- rence patterns and clinical make up ]cell type] are ever changing. For e×atnple, tlwre appears to have been a decfine in the rate of increase of lung cancer, particularly in the younger age groups. Indeed, lurtg cancer incidence ma~" have, in fact, crested. Other investigators, including some who believe that smoking causes lung cancer, seem to concur with this observation. For instance, in his address befl~re ine ttealth Congress in EngIand in 1977, Sir Richard Doll said "it is encouraging to find that the total death rate t~om lung cancer to men decreased in 197~, albeit very slightly, for the lt~ first time in 50 years." Perha ~s what we are seeing in the case of lung cazmer is what is called fie natural history of this disease, Natural history has f t] been succinctly described by a British thoracic surgeon as the "long drawn-out process el the devetopment and the decllne of an indivld- ual disease " lf:cou bare tlouble acceptfi~g the idea that a spontaneous decline in lung cancer can occur, 1 remind you of the documented decline in stomach cancer. The spontaneous decUne in stomach cancer over I ~ 'I 453 the years is a decline f~r which no convincing explanation has been offered. Improvements in nutrition or food storage, or diagnostic refine- ments, or changes in the general health of the population do not adequately explain these changes, What explains the change~ in lung cancer rates? As Dr. Belcher has pointed out, the decline in lung cancer's rate of increase started betbre changes fil the cigarette occurred. Is this simply an- other example of the poorly understood natural history of a dis+ ease? Clearly, no simple explanation for these lung cancer changes appears to be forthcoming. Many hnportant questions about cancer causation remain unan- swered. For exampts, precise causal mechanisms have not been identified, Many theories have been proposed, but none have w~- universal acceptance. In summary, therefore, I cannot agree that cigarette smoklcg is the major cause of lung cancer, because l believe very strongly that we do not know the cause or causes of cancer of the lung. Charges that smoking causes lung cancer are so familiar that very fi:w people may realize that there is strong evidence to the contrary. I find that evidence to be persuasive. Ia my estimation, vhe smoking hypothesis is an oversimplifica- fion. I, therefore, cannot support legislation such as this bill based upon such a questionable hypothesis. I thank you. Mr. WAX,~AN, Do you see patients, Dr. Langstcn, t~day? Dr. LANGSrO.~. 1 am retired as of the first of the year, Mr. WAXMAN. What do you recommend to your patients? Do you recommend that they stop smoking:' Dr. LANGSTON. Oh, sure, I don't advise anyone to smoke, no Mr. WAXMAN I gathered that this panel does not believe that the warning labels continued in the hill are scientifically valfil Ynur testimony made that clear. Do you believe the current label which states thor cigare smoking is dangerous to your health is scientlfically valid? Dr LANGS'I'ON. Based on what was believed or was believed at the time that the label was put on. Mr. W~.XMAN. Do you Blink it is a scientifically valid statenlent'? Dr, hANGSTON, That it might be injurious ts your health, I don'~ quarrel with that. Mr. WAXMAN. YOu don't think it is scientifically valid to say that smoking is dangerous to one's health? Dr. LANGSTON. NOt that it is the cause of cancer vf the lung, to be specific. Mr. WAXMA.~. Ilow about the current warning, is it a valid state- ment? Dr. LANGSTO~. 1 have not found that a problem, no. Mr. WAXMAN. Dr. Eysenck. Dr. EYSENCK. I would agree with the previous speaker, I tb~nk that it may be injurious to health, Mr. W~KMAN: IS it a valid statement that cigarette smoki~g is dangerous to your health?

1 g gJ 454 Dr. EYS~,NCK. l think it is an unscientific statement as it stands. It does not carry any specific message. You can say that smoking causes lung cancer, is that true or not? The answer will be we don't know. But such a very wide and genelal statement t wouldn't like to comment on, really. Mr. WAXMAN, Do any of you have a different opinion to express? Dr. FlSr~ER. It should be "may be dangerous to your health", would sit better with me. Mr. WAXMAN. Isn't it a meaningless statement, thnugh? It is so broad and general that it doesn't tell you anything it ,nay be true and it may not. Dr. E~/SENCK. The suggestion is to people that there may be ace> thin danger ill smoking and there may very well be. If you make it stronger than that, the scientific evidence fur that is not available. It calls for an interpretation Mr. WAXMaN. Dr. Sonnets, you are Executive Director of the Council for Tobacco Researcb Dr. SOMME~S. I am Scientific Director. Mr. WAXMAN. That is funded by the Tobacco Institute? Dr. SOMM~aS. The major dgarctSe companies donate the funds. Mr. WaXMAN I know you have testified before us in the past. Do you have any idea of how many times ynu have testified before Congress on this issue? Dr. SOMMEas Once be/bee the Senate, and this is the third time before the House of Representatives Mr. W~XMAN. How about the o~hers? Have any of you testified before any Committee of Congress before? Dr. FISHZm Yes. Mr. WAXMAN. How many times? Dr. LANGS'fON About three times Dr. EYSENCK, OllCe. Dr. Fisltgil W~'lee Dr. BLAU. This is my third time. Mr. WAXMAN. A camera from the Tobacco Institute is filming the hearing. I assume that they will review the film footage fi'om the hearings and I presume maybe they go over and try to improve the testimony presented. Have any of you ever looked at films of your previous testimony? Dr. SOMM~nS. I didn't know that they were doing it. Mr. Bt~u. I didn't know it was from the industry. Mr. WAXMAN, Well I appreciate your testimony before us and 1 think it has been helpful. Mr. BLILEY, Dr. Sommers, in your opinion has it been scientificaL ly established that cigarette smoking is the largest preventable cause of the death in the United States? Dr. SOMM~a~S. NO, sir. Mr. BLILP, Y. I am always giving you a series of questions and, Dr. Sommers, in your opinion has it been scientifically established that cigarette smoking in the United States is a major cause of cancer of the lungs, larynx, oral cavity, esophagus and contributing cause of cancer of the kidney and pancreas? Dr. SOMMERS. No. q II II 455 J~Ir. BLILE¥. Dr. Sommers, in your opinion h~ ~t been estabfi~fied scientifically that cigarette smoking is a major cauue of chronic bronchitis and emphysema in the United States? Dr. SOMMEaS. No. Mr. BLILEY. Dr. Sommers, in your opinion has it been scientifical- ly established that cardiovascular disease is caused by mnoking? Dr, SOMMER~, No. Mr. BLtL~Y. Dr. Sommers, in your opinion, has it been scientifi- c~l]y esteb[ishcd that preg~mnt women who smoke have an elevat- ed risk of miscarriage, still birth, premature birth and birth weight deficiency? Dr. fiOMMERS. No, slr, Mr. Bza~v. Dr. Sommers, we have heard the claim that smoking causes over 300,000 deaths a year, Can you tell me the origin of this stat*~ment? "~% Dr. SOMME~S, Congressman Carter asked a question to this effe, in the 1979 hearings, and as a result of investigation as near as can be determined, Dr. Daniel Home in 1963 stated the best guess was that 300,000 to 500,000 deaths were caused by smoking. He later dropped the 500,000 and then afterwards said that there were prob- ably less than 300,b05. Since then the ori~nal Surgeon General's committee said that too many assumptions had to be made in order to decide how many deaths might he attrlbutcd to smoking But the Surgeon General Terry did not take their advice and he again came up with 3{J0,~hO, and 240,000 men and then from somewhere, the basis not under- stood, 60,000 women. As late as I978, Secretary Califano in January said there wore 350,000 deaths and there were 220,00(/of them due to heart disev~se, but a month later in an appearance at u hearing, they had l~sl 40f100 deatbs from coronary disease due to smoking. So it went. Dr. Rosenblatt ha~ testified that he believes this is a fantasy of extrapolation and it has no basis in fact and it has become imbed- ded in the hearings and in tfie bill. z--,, Mr. BLILEY. Thank you, Dr. Sommers. Dr. Sommers, as far m~ you know, has lung cancer of the type dahned to be related to smokJi~g ever been produced in an expe~i- mental animal? Dr. SOMMEr~S. NO, tIowever, single cases have been found in one animal in experiments that go back a~ far as 30 years. Mr. t]aita~z. Thank you, Dr. Sommers. Dr. Fisher, do you think perhap~ people are looking for simplistic solutions to these complex chronic disease problems? Dr. Ftsn~m iVIy simple mmwer is to make comfortable people, and I don't know if they are looking fur it, but the sbnple solutions make comfortable people. Unfortunately, scientil]e results some- times make a lot of uncomfortable people. Mr. BLm~. Doctor, we hear a lot about blood pressure as a risk factor for cardiovascular disease There is a retationship he,we A smoking and blood pressure? Dr. Flsmm. There is no direct relationship whatsoever. Indeed, some studies show that a cigarette smoker may have a lower systo- lic blood pressure.

456 Mr. BI.H, eY. Dr. Fisher, ]lave there been statistical studies leak- ing at the relationship between smoking and stroke? Dr. FISHER. Yes. Mr. BLILE¥. What are they related to? Dr. FlSHEm There is no relationship. Mr, BLJLEY. Are there epideminfegical studies showing that they I do not find a relationship between smoking and cardfevascular dis- ease? Dr Flsll~l~. Certainly. • Mr. BLtLEY. Dr. Blau, you mentioned the new public health serv- ice pamphlet released about 2 weeks ago. It is no concern of )'ours. but I am stlll upset with the "coincidental timing of that release", and i registered my l~elings. Ii¸ I understand your testimony correctly, you lmve serious prob- lems with the substance of the pampl~fet? Dr BLAU. Yes. Mr. BtaLEy. Would you care to comment further? Dr BLAu. Yes, s~r. I reviewed that pamphlet as carefully as l cou!d in the limited time I had available, and I found that it essen- tially seemed to have six purposes. Evaluation science essentially looks to the merit of research and ~3 I sought the research on which the statements were made and in each case looking no further than the documents referred to as the reference sources for that pamphlet, 1 found considerable num- bers of contradictory statsmellts by the scfentists who were re- tained by the Government to produce the original NIDA boc~klets on curretlt status of research ~lnd smek tsbt fa!havior. For instance, we found such statements from the scientists in these NIDA pamphlets which were the source of the pampiet, "Thus in addition to the few focta~ influence on the tobacco with- dr~wal ~yndrome which are known, there are many other poten- tially iml~ortant variable~ whose effects rernata to be determined " Dr. Domcr heu, one of the distinguished scientists, stated, "Much evidence for the role of nicotine as the primary reinforcer in clga- i retie smoking is circumstantial." Norman I(rasnager, the distinguished editor of NIDA volumes that were cited for the i)aml)h]et, stated in these volumes, "fiein- tively little scientific research has been conducted to describe and analyze the cigarette smokfug habit itself or the factors which are responsible for its initiation, development, maintenance and cessa- tion,'~ ~19 I:urther, "n tl e n os~ recent review, f quoted by Kumar, "The evl- ~tenco for n cot e abst hence sy dr me rema n~ nconcins xe~ I could provide more of these to the committee, but ti~e answer to your question is that my inspection from an evafuative scientific point, of view shows thut the documentation behind that pamphlet was very selectively reviewed in order to support preconceived no" I~l tions. Mr. WAXMA~ We will hold the record open so you can be more complete and full in your answer Mr. NtEt.SON, I would like t~ ask Dr. Sommers a question You are the scientific director of the Council of Tobacco Re- search, and 1 know you haven't had that position long, but why, in 457 our opinion, has not the Council for Tobacco Reaearch in the I~L ~0 years, why have they not made some studies to show that the are no statistical differences? You cite a few cases where the difference was not significant, but have there been any experiments any dieectly designed ¢o pruve the converse of what the Surgeon General tried to prove in his? If so would you supp y those to the comte ttee? Dr, SOMMEaS. AS po nted out by a previous witness sclentificaUy it is ver difficult to prove a negative. Mr. ~ELSO.~. It is not difficult to prove the absence of an effect. tIave you done that or tried to do that? l)r. SOMr~EmS. I don't tlnderstand ~he question. Mr. NmLSON. The allegations that smoking causes cancer and it is fairly easy m design an experhnent and then if there is nu s, n ficant diiferenee between those smoking and thuse not smoktag, i~ is rather easy statistically to prove within 95 percent probability" theft there is no difference. It is just as easy to prove that and it is easier to show than the converse. I wonder why in the 80 years you haven't done more than that'? Dr SOMMrmS. In the an real experimer, t referred to in my state- rnent where all possible confusing factors were accounted for, and where these mice srn~ked cigarettes to maximum tolerance their whole hte. no cancer resulted. That is a negative experiment Mr. NlcUSolv. But s a 40-month period ia a mouse comparable with a 40-year period in a malt'? Is a 40 month period with mice comparable to a dO-year habit, say, for an adult man? Dr. Sob:~l~l~s. It is more than comparable, sir, and it would be may le equivalent to a fJ0 or 70-year exposure Mr. NII~tSON. You are missing my point• It may take cnger than 40 months to develop a cancer and it may take a period of yeats and you don't have animals who have longer lifespans to compare direct y ]dave you done it with primate aninlals? Dr. SONIMNRN. Primates have never been available in sufficient r ~-- numbers that we cou d hope or s atlsttca y significant d herenc among groups of 10 or 12 gfr NIEI~ON. Have you tried any animal which has a llfespcm anywhere near comparable with that of man? Dr. ~Ol~It~lERS. We have sponsored experiments on the standard aalmais that through their normal lifespan go through all uf the aging ctanges that human beings go through in their ]ife.~pan . As a b ulngist, I don't believe that that v, ould be very convincing to the scientific public because ~e know that tbey dove op car, eers in a finite number of rnonti~s Jf appropriately stlmulated, nnd they didn't devefap it from the cigarette smoking Mr. NIElSeN, I W fo OW up with Dr, Langstan. Both of you refer to stat st ca ev dents and both of you I think, correctly pointed out that correlation may not imply causation, i made that point last wee • with the other witnesses who were here and I agre~• with that point, but my question on th s is that you mentioned the twins study, How was that designed statistically? Did you happen to find them in sutllc~ent numbers? Would you please supply that infermatfe-~l?

i i 4 ' 458 ! : - Dr.'EYs~NCK; There iwas a complete record of all twins born in the country. Mr. NmI~ON. How did you induce one twin to smoke and the other not to? i Dr. EYSENCK. They were not induced to smoke. It was simply found that there were a number of pairs of identical twins where one was smoktegand the other one was not. Mr. NmLSON. This was a fortuitous situation? Dr. EYSENCK. Veg. ' Mr. NmLSON. I have one other question, i Since it would be to your advantage to sbewl and I am taSting'to Dr. Summers, that there is no relatlonsidp,, it would seem to me that the thrust of your argument ought to]~e to show that the dif- ferences do not exist• Now, the thrust of all of your speeches today, and they are all good, is that it doesnt cause lung cancer and it doesn't cause heart trouble or it is not addictive and you each had a point. Each of you did very well. My question is: Would you object to a statement, and I am just asking your personal opinion, if the questions were hr " " " " p used may cause rather than dues cause and most of these statemento in the bill are that it causes or it will do this. If the question were stated "mary cause" or "may do this," such as the current label does, would that make any difference in your attitude? Dr. SOMMZRS. If the question is addressed to me, only the truth would be to my advantage and I wou]d Bccept anything that was scientifically proved, whether it was as you might say for or : against cigarette smoking. Mr. NIELSON. Neither you nor the other people have proved either side to my satisifaction. There is a presumption of associ- ation and that is why "They may be hazardous" is on the label. Until I can be shown that it does not or that it does, Imn not will- mg to accept either view. Mr. BULZV. Would ~ou yield some of the time you don't have? We could also say it may not cause heart teoubie or may not cause lung cancer. Mr. N~hSON. Would the softening of the language make any dif- ference to you? Dr. SOMM~IZS. As the other panel members stated, the current warmng, if it said "may be," rather than "is," wou d be a tte : more acceptable. If you break it down to the subsets of cteLmed dis. ease relationships, it wouldn't be as gross y ncorrect as to make a fiat statement that is the cause of A, B, C. and so on Mr. NmLSON. I would like to make sure that these documents are made available to me on these experiments and I will use my former skills to go over them to my satisfaction. Mr. WAXMAN. 1 think we would all benefit from your evaluations and I hope they will be made available to the committee mxd to ~f{: Congress, Mr. Neiison. f~ Mr. Dannemeyer, do you have any questions? ~ ' f~ Mr. DANNEM~YER. I am just interested to know if any of you five smoke cigarettes at this point, or have you in the past smoked ciga- l~ttes? Dr, L~NGsroN. I don't now, but I did. ' ' 1 ! I rl J 459 • I "~: i Mr. DAI~N~a~XER. Why did y0u' quit? ,.."*' .,~',x J 7: ,~ ! : Dr. LAI~GSTOI~. In .1954 1 didn't find that f enjoyed it and I just quit. [ Dr. EySKNCK. I quit in 1955 when I came back from California to , England, and I wasn't going to smoke any more because of the prose. Mr. DA~NEMEVER. 1 thought! maybe it W~ something you found out in California that caused it. It is the source of all wisdom, as you know. i Dr. FISmZR. 1 do smoke. . i I , I , :, , Mr. DANNEMEYXR. Clgarettos?,:., , F ~.i:i.,~ i Dr. FlSHER. Yes. , ; , ~', ,I '': ~,,' Dr. BLAV. I smoked three or more packs a day Until I was 35 and then 1 got this fantasy that I could become efficiently athletic, audit I gave up smoking. ,; Dr. SOMMZRS* I never smoked cigarettes, and they do nothing for me and I don't like cigarettes. - " - Mr. WAXMA~. Let me ask, Dr. Summers, your evidence is that the scientific evidence isn't in on whether smoking is a m~or cause : of lung cancer. This was your conclusion in 1976 when you testified before the Senate on this subject. Are you suggesting we just don't know anymore in the test 7 years? How do you explain the testimony we received last week from the National Cancer Institute that the lung cancer rate: among women seemed to be skyrocketing? , They seem to explain it was due to the fact that women have. been picking up the cigarette habit in greater numbers. , Dr. SUMMERS. In preparation for the testimony, l reviewed about 3()0 abstracts that I write on cards and in the last 2 years there were about 30 that dealt with lung cancer. Now, many of these pointed out occupational exposures, the nickel and smelting industry, woodworking and shipbuilding in northeast Florida, portions of Los Angeles where there are oil re- fineries, and in several of these smoking extracted from the eensi~ erations still left a significant increase in lung cancer. So, the thrust of the recent literature is that occupation is a seri- ous background situation in lung cancer. So we are eontidua]iy learning something. The new evidence is not uniform and for ; myself it tends to weaken rather than strengthen the idea tlmt cigarette smoking is the causative agent. ' Now, with respect to women, remember that they have a very low incidence of lung cancer, one-thlrd to one-~ixth in different series compared to men, so then a relatively small increase can sta- tistisally appear to be relatively large. There are studies of Chinese women in Singapore and in San Francisco, Mexican women in; Los Angeles, and other groups in! which the majority did not smoke, but they had a high incidence of lung cancer. This s the newer: nformat on that has come along in the last 2 years. Mr. WAXMA~. NCI said that inn cancer was going to surpass i breast cancer as the leading cause o~cancer in women. :~ ' , Dr. So~as. Dr. Fisher and I have had a lifelong interest in the l pathology of breast cancer. He knows more about it than I do. , ~ [

. i i ~ i ~ i!I'~ 460 :I Mr. WAXMAN. The reason I raise that is because I want ques- tion whether it is a Sraali incre~se in ~ung eemeer that me are seeing. Dr, ~E~s. I ~uld not agree With that extrapolation to the future, hut I think Dr, Fisher can perhaps give more information. ,i Mr. WAXM~. Do you agree with the statement that lung cancer i is increasing? - : Dr FmHEP~ I visual ze no basis for anyone making that state- ii ment. i Mr. WAXMAN. Dr. Sornmers, can you give me the name of a single medical or scientific association not associated with the to- bacco industry that shares your view about the relationJhip he- Dr, SOMMm~. I woaldn t ]~xow if they did and I know some that don't, and that is the best answer I can give• I wouldn't he likely to know if they shared my opinion. gfr. WAXMAN. I am talking about scientists and professional medical associations that have come to the same conclusions you have Dr. SOMr~S~S. All l can give is an indirect answer. I suspect that the International Academy of Pathology, a large organization, has an open mind oa causation regarding cigarette smoking. I believe the same to he true of the Arth~tr Purdy Stout Sectary of Surgisal Pathologists, I know that the American Association of Cancer Research has a policy against smoking. , Beyond that, I simply don t know. Mr: WAX.'aArL Why do you think the American Medical Associ- ation has views so contradictory to your own? Have they b~n pro- pagandlzed? Dr, SOMMgRS. In reviewing for this testimony, I found an article in the American Journal of Medicine pointing out that doctors know little ahQut and cannot use statistiss. Therefore, they are the subject of statlstisian's information• Most doctors in practice have only seeondhaed evidence. The secondhand evidence is widely publicized by the Government and the Surgeon General's report and is thus persuasive to those not involved in the research field. Mr. WAXMA~'. You think the doctors have bean misled by the statisticians who have jumped ~ e~nclusions based on what they seem to thlnk? Dr, SO~dMFa~S. Not misled, I think the statistics before and at the time of the original Surgeon General's report would now be regard- ed 25 obsolete methods. I have no brief for people smoking or not smoking. I see no reason a physician can t tell his patients they should not smoke. Beyond that I have no position. Mr. BLILSy. Professor, or Dr. Eysenck would you care to com- ment on the validity of epidemtslogisal studies that report that peep e who gave up smoking live longer? Dr. Eyszrrcg. I think there is very little validity to that for the simple reason, that poeopJle who ~'ve up smoking, at the time the7 give up smoking, are already very different from pealde who don't give up smoking, both health-wise and personality-wlse and genetically• II II II d61 ' : "W ! Some studies show that they are not comparable from the begiii-'; i ning and therefore the later rate of death is not necessarily pro;~- duced hy the giv ng up of smoking but the fact that they werel ,hea thier at the time that they gave up smoking. : Mr. But~v. Is it not possible, Dr. Eysenek, that factors :such as i stress and other ersona ty factors may cause a person to smoke I and cause dlsease~ ' ! Dr. E~sz~c~. I thrak at ts very hkely. ' Mr Bu~£. Dr. Langston there is one medical questlon that I, would like to have answered, i ; : The statement is also mad~ that the lungs of smokers are much darker than nonsmokers, and pathologists see this every day. In ' your experience, Doctor. as a chest surgeon, have you noticed th~ d florence? ~ Dr. LA~CS~ON. I don't th nk you can tell by looking at the lun~ I whether the patient is a smoker or not. The color of the tung determined by the amount of carbon that he ma have inhaled and the source of carbon is coal or atmospheric poI~uttsn rather than any d rect relationship to smoking. In order to make that statement orae would have to hav~ two poop e, w thout outside pollution, and one a smoker and the other a nonsmoker. From a practical standpoint, I don t th~nk we could recognize the smokers by looking at them on the table, i Mr, N~z~so~. Y~u mentioa ia coaneetion with Congressman Bli- ley's uestion that perhaps other factors may cause it and you an7 swere~, "Very likely". Are you using a doub e standard with us today? It is very likely you could have cancer from a genetic factor and not likely from smoking. You are u~w ng to admi the possibility of diseases being caused by smoking cigarettes htlt now it is very likely that they can be caused by other factors• A~e you se oct ve y pinking what ts hkely and what tan t hkely, Dr. EYSRNCK. There is good evidence for a genet c ea~sat factor in cancer. Mr. Niz~so~ That is not my quest on. M question is: You are quite w ng to agree with Congressman B~fley s question that it probab y was tlke y and y~,t cagier you sad the~e is no evidence and no possibility, or I don t think you said it quite that strongly, but you implied that while this seems like a reasonably good idea and a good poss b ty: a go~d cause-and-effect relationship, you are ~tnw tng to accept that kind of reasoning on the Surgeon Genern: al'~ part. ' ' i ~ ; Dr. E~ssr~cz. The Surgeon General is projecting from a statistir cat basis to a causal one. Mr. NiztSo~. Weren't you doing exactly thesame thing?: . : Dr. EyS~NCK. 1 am saying there ts a posmbfi~ty 9r prolmblhty. Mr. Niz~so~. You said t is quite ]ikel . , , Dr E£SZ~CK That there is a probability, and I didn t say it waS cest.aht. Mr. NIZLSON. 1 am n~t askiaag that• l am slmp y saying, I get the impression, not only from this group of witnesses hut every group we have had, that they are h~oking at data and they are coming to cone usions and the group hem last week was saying because we haw these things f~llowthg cigarette smoking they'are c/used by'

462 clgarettes~ and I think you are saying ygu can't go from causation to rea]izatlon. ,, . . I am wondering whether yot~ aren t gmlty o£ the same thing as the Surgeon General is? I am just testing the doctor ia little bit, if I may, and I am won- dering if this isn't the case. Dr. FmHER, We don't like people who use the term "likely" as fact, that is the difference between the scientists and the others. Mr. NI~hSON. I am trying to make a point and I guess I don't have to make that point. Dr. EY~NCK. I think the real point is whether you want to base any practical action on what you are saying. I am saying there ks a re at onship of the kind I mentioned, and I would like to go on ' from there to further research to make t more firmly estob]isbed. [ I would not want it to enter the realm of the legislature. Mr. WAX~AN. Are there any other questions by members of the subcomm£ttee? I think we haw exhausted that. Mr. DANNEMgVER. I wasn't here f~r the entire time. I have been : intrigued with the causal relationship between diet and cancer. ! Are any of you in a position to comment on that as to the possi- bility or probability? If so, I would appreciate hearing it. , Dr. SOMMERS. ] Will make one statement which boa been deleted ' from my statement, and that s that vitamin A and re ated sub- i , stances ewdently may reduce the incidence of the most common type of lung and esophagus cancers• Widespread cllnical trials are new underway to test the validity of this hypothesis. Dr, FmJlEa. The prob~em-solvlng method, the scientll'm method of problem solving is the clinical trial. That is the only way. There has been only one randomized clinical trial on the smoking or risk- factor problem in this country, and although $150 million sounds llke a lot of money, it was worthwhile to do, even though there are certain errors in their design which are inherent in most cfialcal trials. But the interesting thing is the results which indicate to me that maybe it is time, it is likely that it is time that we surrender this eb~esslve preoccupation with smoking and some of the things we have been led to believe and get down to issues which may be more im ortant. ~e have run up against a stone wall as far as I am concerned• Here is $150 million, and not poorly spent, but wisely spent, and the intent and idea was correct because that is the only way yon ~lve a sclentlflc problem. Yo~ s~lve a problem ~elentifieally m {~ clinical way, by the randomized clinical trial. ; • Now, some people say it is unfortunate that the results didn't i come out the way we wanted them. But you know, that is like look- ing at a picture beauty is in the eye of the beholder. A scientist ! ~.~ d~esn't say, "I didn't expe~t these results. ' ~le puts results ~n the ~=~ table so you can analyze results and, come up with your conclusion, : Congressman which is that it dldn t shOW that cigarette smoking I ~ and lowering the bloo~ cholesterol 12 milligrams, which is a drop I ~' in the bucket had any effect on mortality from coronary heart dis- i : Thereforel although this possibility maybe should be further put- :sued 1 would llke to see giving up a little bit on this nhsessive pre- I l| In II [ 63 occupation with smoking. In my 85 years, it is too much. There ar preoccupations that se¢m excessive in my career, and one of them happens to be this. Mr. WaXMAN. Why do you think we have this obsession? Dr. FISHER. It has been with us a long time. Mr. W^XMAN. You seem to be d~turbed about it. Dr. FISHE~. Only from the standpoint, Mr. Waxman, that I~ might lead us away from investigating or taking up other leads, l think ff we accept all of the material that has been presented to us, that this problem is solved, then it requires no further investiga- tion. Yet, we know that there is a great variation in mortality whether they stop smoking or they don't stop smoking. What I fear is that this can be misleading. Mr. WAXgAN. We spent $1 billion a year of the public's money for the National Cancer Instltuta for research and the cause ann effective t re~bmento of cancer. Do you think they are only working on cigarette causation? Dr. F~SHER. f know that they are not. Mr. WAXMA~. You fear we are not pursuing some leads that are promising? Dr. ~z~. I don't ~anb ygu to mlsunder~ba~d. I am talking about cardiovascular smdies Mr. WAX~AN. You personally feel that we have been obsessed with the whole idea of cigarette smoking being a cause of heart dis- ~ase? Dr. F~s~m The number-one cause of heart disease. I d~n't see the evidence to support it and I think we have ~ guard ngaln~t this preoccupation Mr. WAY~AN. Since you have told us you are a smoker, for your sake, if for no other reason. I hope you are correcL Dr. F*sn~m Thank you. Mr. WAXMAN. IS there anything further? If not. the meeting is complete for today and the subcommittee now stands ad eurned. [Whereupon, at 5:50 p.m.. the subcommittee adjourned.]

t t H APPENDIX [The following materials were received for the record ] COi~$ OF "i~ TOBACCO INSTI~i~ ON _ . ~C STAFF P~PORT O~ ~ CIGARETZI~ ADV~RTI SING INVEST~ GATXON T}~LZ OF_C0~S 2, 3. 4, 5. CONCLUSICN ........ CON~'~'T 5 I* p~LIC AW~ES~ OF ~ SHOKINO A. ~l ~£1c Is Highly &ware of ~a Claim8 P~o~t ~he A~na~ted Hea~ Hazar~B of Cigarette Smukin~ ....... 19 B. Ne~er ~o Report N~r ~e $~die~ Upon ~ich It ~Ile~ D~mona~ra~ P~li¢ I~ Unaw&r~ of ~ 5pecl£1¢| ~nd the 5evorl~ ~ ¢~e Alleged ~ODUCTION, S~Y ~ CONCLUSION ~ 3 of t~e Alloged Healt~ Haza¢dJ of Smoking Chaps 11I "a~d IV{II)) Is ~vndaman~alxy De£ectlve ................... 3 ~ha "FaC~S" ~at ¢~e Staff "Claims Hava ~eo~ DA6covered ~ ~e ~lleged Healt~ Hazards o£ Sm~kI~g Chap. I} Have N~t Been Es~blAshed as Yacks .......... T~e 5~aff s Discussion o£ Cigarette ~dve~t~sing (CJ~ap. XI) H±ss~ates ~e ~pose a~d Effoc~ of S~Ch Advertising . . . ~e S~a~ Legal ~alyBl8 [Chap. IV - Is IncompleCs ar~ l~correc~ ........ 11 ~'h~ Staff's p~oposed "Remedl~s",{C~ap. V) Ace Ill-Considered ~d Inconsia~ WltJ~ 15 ......... 18

II, II1, IV. i i I ! i 466 I i : l i. ~ ~ ~taff Mlsintelrprets ~d rl Mlmu~e~l the S,~u~ies T~ Und~r- sta~-~ Awareness ........... I 22 Aw~renlss Wi~ pt~lic I~ellef ..... 26 ~ SMOKING ~3 ~L'I~t ~N~OVNRSy ....... 30 / A. The S~affrs ReVlOW O1" ~:he EV~den~ ~n $~e~kin~ aP~i H~al~ i Is Biased ................. ~ 30 Smoking'~ Alleged Cormecti~n Wi~h Spe~:[fic Health H~za~S Is ~ia~ecl .............. . • . 32 ~. The ~aff*~ D~s~nlgle~n ~£ ~'~e Tobacco indu~y'll posi~:lcn Wit~ Respect ~o tlle ~kln~ an~i lteal~ Controversy ! ADI/NRTI~ING ............. • , . . . %4 A. C,~a~ette Advertlsir*~" I~ ~ntended ; i TO ~ell a Particular B~and of C~qare~te~ ~o ~m~ker~ .......... • 4~5 ~. Ciqare~e Advertls±r.~ Ha~ Not H~I ~ of People ~o Smok~ .......... , - I 48 C. Ci~raze~;'~e Adve~lseme~.s Are ~l-~ld i I p~omo~onaI and 14~k~ No Expl.~.~t or J ~ Con~res~lcna~. P¢licy ~n~ by It~ ! i the W~r~ii~g Statement ......... . • 56 1. ~'~o S~afE'o pr¢~o~al TO Chan~e to Cor~J~es~*l¢~al l~olicy ..... i.~ ~ 56 V. Wa~ng $~a~emen~ Is Contrary ~o 1972 Co~s~n~ orde=~ E~er~d I~ B. Cigarette ~Ycr~lsln~ ~S Nc~ ~ $T~ K ~OPOSED P~IE5 .......... 5~ ~9 ~ ProSe~ ~arnxn~ I~ 69 i~ef~ec~lve ...... . . , 2. The= ~£f HaZ ~al~ed To Likely Tc Be ~r~ Ef£ec~ve ,71 C. The Re~o~ Mlsc~r~¢~erlze~ ~X , 1964 - 1979~ Tb~ Con~In~i~ Controversy (i~79)

468 INTRODUCTI ON The ?TO Staf~ R~pgrt on the Cigar~t~ A~vertl±~ng inv~s~lq~tion ("Report~) c~lminat~ a fiv~-ye~r investigation ostensibly directed to ~he purpose ~d ~e~ of cl~r~tt~ advertising, y~t de~l~e ~v~r 30Q ~ge~ o£ t~t~ with numerou~ Zootn~te~ and appon~i~, ~h~ R~port do~ n~hin~ mor~ than ~o~£irm what ha~ long b~e~ ~p~ar~n~: th~ F~ ~ta~ doe~ u~t approv~ ~ ~i~aret~e smokin~ and will ~ind ¢lg~r~tt~ a~v~rti~l~g o~jectionabi~ as l~n~ a~ ~nyone con~uos ~o s~ok~ The ~s~.nce of the ~eport i~ t~ claim ~ha~. d~l~ the S~r~e~n Gen~ra~ ~rn~nq, which ha~ ~ppe~d ~n i~s pre~en~ ~orm ~n ~very cigarette p~k~ ~ino~ 1970 and in every cig~-~e~t~ advertiseme~ ~in~.~ 197~, ~ig~rette ad~ert~ln~ l~ ~ceptiv~ and misleading b~cau~ i~ ~s not ~lngl~ ~ut ~rtain c~aim~d health h~zards that ~he ~T." S~f~ ~ttribu~ to ~m~king~ Lack o£ such ~pe~lfic~t~ rend~r~ the w~rn~n~ ~a~em~nt ineffective, the ~ta~f claims, T}~ ~ep~r~ u~erly £alls, ~owever, ~ ~upport th~s conclusion. The ~ruth xs that ~h~ ~moking and health controv~r~ is ~iliar ~o virtually everyone; th~ warninq s~a~em~n~, mandated by C~n~res~ to i~£orm the public abcut this i~u~, has £ul£!~l~d l~ ln~ended function. Th~ Toba~c~ ~n~i~u~e ~bml~ ~be~e Co~nt~ ~n ~hal~ O~ ~he major m~nufacturer~ o£ ci~ar~~ t~ point ~ut th~ most T~ American Tobacco ~mpany, A Dlvl~n of American ~rand~ In~. ~ Br~wn & hill ams~n Tobacco Corp~r~io~; Liggett & Myers T~a~ Com~an~, Inc~ ; Lo~ill~rd, A Division o~ Loew'~ Th÷a~r~s, I~c,; Philip Morr~ ~n~or~ora~e~; and R~J. Reynolds T~ba~c~ Company. 009 & 0 9 469 - 2 - ~mportant deficiencies of th~ R~port Supportinq materl~ls £or e~ch ~g the point~ su~ariz~d b~law ar~ ~nc!ud~d in the t~bbe~ ra~h~r lt~ l~ng~h and dxs~or~l~n~ ~ic~at~ th~ length ~ the tabbed s~c~on~. Al~ou~l~ th~ Kep~r~ pu~r~ %~ ~naly~ publl~ awareness ~f smoking ~nd health ±~su~s~ ~he s~aff'~ primary ~n~rn i~ with publi~ behavior. T~e ~flz p~si~lon l~ r2~4at t~e w~ninq state~en~ ~ "~n~c~iv~I' n~t bec~u~ too f~w pe~pl~ ar~ awar~ ~ ~he me~o~qe oonveye~ bu~ becaus~ despi~e th~ warning ~tatem~nt mor~ p~opl~ ~ntinu~ to s~ke than th~ at~ re~!~ory attitude. The warning sta~emen~ t~at th~ S~aff ~ritioizes a~ i~£v~ is in~l~de~ in all oiq~r~t~ advertisin~ precisely beca~ th~ ~TC ch~s~ in 19~2 to re~o~v~ ~ ch~r~ that cigarette ~dv~r~i~ing wa~ deceptive by enterin~ into n~goti~ted Con~nt ~rder~ that pr~vid~ ~or ~e inclusion o£ ~h~ ~rn~nq ~atemen~. In Jul~ 1~, t~o month~ aft~ th~ Staf£ issued l~ Report* ~he Co~ion entered into an overall se~tl~m~n~ o~ ~lvil penalt~ actions that it brought aqains~ ~h~ ~ajor c~g~r~t~ manufa~tur~r~ f~r a~l~ viola~i~n~ o~ ~he 197~ Con~n~ Grd~rs~ A~ part of the se~le~,ent, pursuan~ to wh~ch ~he c~ar~ manu~a~ur~r~ agreed ~o place the cu~en~ warning statement f~ the ~i~t t~m~ on v~din~ m~chin~ and ~Is~wh~r~, t~e ~o~ie~ion agreed to entry o~ Consen~ Judgm~n~ which

470 . 3 . ~t~te~ent "shall ~emaln in full force ~nd ~ffect." These c~nsen~ Judgments fore~l~ ~he $taf~'~ recom- menda~ion~ ~or a change in th~ w~rnin~ statement. T~e law procl~d~ ~ c0~i~sion from u~i1~t~rall~ repudiatin~ ccn~en~ dec~e~s. M~recv~, public policy ~tr0ngly ~av¢~s th~ r~olutlon of di~p~e~ by negotiated s~t~lem~nts ~uch ~s ~hat already ente.~d ~nto b~t~en ~he Co~ion ~n~ the ~i~ ~hi~ ~oll~y w0~i~ De f~tr~t~d if, within ~ few ~n~s ~ enterin~ into ~on~en~ Jud~en~ re~ffi~minq the 1972 Consent Crde~s, t~e C~i~sion ~epudiate~ t~e cu~enu warning ~tatement ~nd ~ug~t to imp~e a t~t~lly differ~n~ ~et ~ r~irement~ ~n the Giq~r~t~ ~nlu~try. In ~¢t, ~e Commission cD~fi~ed ~he exis~inq re~l~tory ~pp~o~ch after ~h~ s~aff had a .~ll o~¢r- tun~ tc challe~g~ %h~t ~p~o~ch Th~ ~tr~ is entitled Jul~en~s. i. T~ staff's A~alys~ o~ p~blic Awar~nass o~ t~e A11ege~ ~e~h Hazards o£ ~mokin~ (Chaps¸ II~ a~d IV~II)) IS F~d~l~&li¥ ~e~tlve. insistence that ~e curr~n~ warninq s~atemen~ in cigarette advertisements i~ ~'ineffecti~e" because it ~oe~ no~ ade~atoly inform the ~ubli~ of ~lai~e~ 'Inew fi~ngs" and specific ~ha~ about bhe ~se~te~ rela~±onsh~p between cig~e~t~ 471 o 4 . sm~kln~ an~ healS. Th~ Sta£Z'j ~tt~m~t t~ d~m~nstr~m this thesis by revl~win~ various u~nJ~er surveys a~.d ±tudils simply s~ows that ~o~e p~opl~ d~ no~ see eye to eye wi~h ~he S~aff about th~ all~d hazards ~hat the S~f~ attributes ~o ciqare~te smokin~. Trim ~epo~t tre~-.s the w~ni~ ~ta~emen~ mn ciga~e~te pac~qes ~n~ in cl~ar~e adv~r~isin~ ~ ~l~uqh i~ were the only "sufficientn mean~ to convey ~o the p~Dlic a~ert~¢ns a~ut the he~l~ hazard~ of c~rette smoking. In f~c~, ther~ is con~nt ~±~erati~n in m~y different media an~ arenas of the an~l~m~kinq view o£ ~he ~mok~nq and h~ai~ controversy, an~ exten~ ~cu~on of thi~ view ~re~en~y a~ar~ in ~ne print an~ electronic m~dla an~ ~e~ea~dly ±~ st~mula~ by a variety 0~ group~ b~ ~ov~r~@ntal and private. B~t ~l~ from thi~ problem, ~e Kepor~'s conclu~_~n~ ~out publl~ ~a~nass are flawe~ in a~. ie~ two critical respects, The S~ff ~a~ ~no~-~d the fact that the present ~l~vel o~ ~ubli~ swarene~ ~f the ~mokin~nd health c~nt~ove~ ~1o a~ q~ne~ally aware" o~ ~he claim ~a~ ~mok~ng ~ h~ardou~, ~e~ a~ 3-5, that ~ion is, ~o say th~ l~st~ an u~der~ta~e~n~. The £ac~ ±~ that mor~ p~ple are awnre th~ "th~ Surqeon Ge~l ha~ d©te~in~d that ciga.~e~te ~mokinq • ~ danq~o~ t~ you~ health" ~han are ~ o~ virtually any o~e~ public l~su~, Thi~ p~in~ is amply illustrated by the

472 . 5 . 1 ~e~e s~udie~ and the s~a££1~ ~i~o ~£ th~ ~at~i~s they ~es~a~ are disc~d in detail ±~ Tab 1 ~ ~s~ 473

474 k • . 7 . I ~,B Surq~n General has a~lttad, for ~za~l~, ~t: "E×perime~t~ o~ the ~f£e~s o£ ~co~ne oz carbon m~nozide on expe~£mental a~e~genes£~ in an~mal~ have pro~c~d ~onfl£c~lng resulte and are ±aco~clus~ve~' 11979 Rep~r~ a~ &-lg}; "[T]he~e are ~o p~lish~d sta~ie~ ~!lat acceptably ~how ~n ~ ~nSmal smoking" 11981 Report at l~2j; "On~ ~£ ~e qrestes~ ~iml~t~ons ~f much ~pid~miolo~i~al a~d b~hav~oral re|ear~ on h~n Con~ec~en~ly, ~e re~earch l~ i~er~ly Gorr~atlonal rs~er than e~peri~s~al+ ~rrelatloz~al research u~n ~escr~be a~o- ~la~ons ~e~we~ va~i~es, bu~ it is o~t~n uonfoun~ed by - 1~' 475 - 8 .

476 . 9 . 477 - 10 - Il ~ t~ ii

478 o£ ~1 cigarette sale~ 1~'198Q, compared to 2 perc~l~ Just ~lg y~ars earlier. TodaF ther~ are more than 180 different b~ds or brand ~Fl~ ~pmp~in~ f~r market share~. Th~ ~s a m~rke% development ~h~ the ~ itself ha~ lon~ ~u~ht. Tho ln~e~¢ in~lr-br~d co~p~tit~on ~h~ this fund~e~aL ~rket ch~ge ha~ ~r~to~ £~ ~rob~ly unparalleled 1~ a~ ~r ~n~ry. ~$ a practical m~t~r, ~eref~re, cigar~tt~ ma~fao~ur~r~ m~ ~lm their¸ ~dverti~ng at the r~ai~tic and l~mit~d cbJ~c~iv~ o~ sw2tchinq th~ ~amd pr~f~reac~ uf e~l~ting ~moker~. ~tt~ adv~r~is~n~ ha~ ~ot been showq t¢ qall~ n~n~oker~ to t%k~ u smokin . Th~ ~taff ha~ ~ited no ~v~d~nc~ ~.~ adv~tl~n~ l~ a~ important i~lu~c~ ~n ~ausin~ p~le to start ~m~k~n~. T~ ~h~ ~o~r~r~, gover~e~t ~ources ~tlm~te ~a~ ~er~ &re ~0 ~o 3~ million fewer sm~ker~ i~ the c~un~y tod~ than ther~ would have b~en had th~ pr~-~96~ tr~ cp~i~u~d. ~o 1979 Sur~eo~ ~en~ral'a ~eport, Fr~ac~ at vii. A I~1 Gallop poll survey rcporte~ that th~ p~rc~ntag~ ~ th~ ~op~la~on ~at ~ok~ is ~ lowest r~c~rded in 37 year~.¸ about ~ pu~pos~ and ~ffe¢~ of ciqar~te adver~ising. :s I~comple~ and Incorrect. ~e ~e ~p~ ~i~s~ cigarette ~d~er~iain~ re~o~ond~d in dg9 "r~medies" a~cat~d in the R~port, a~d ~±~s~ates an~ mi~aDpl£~ ~e 1~ a~Li~abl~ to d~cept2v~ ~d mi~l~adin~ advertising. L ~nal ~¢t!~l and ~olic7 preclude the ~TC from ~dopting ~ny of ~ propOSals ~nta~ned l~ the g~p~t. S~n~. ~ orLgl~al 5~rge~m Ce~eral'~ ~port was issued in L96~, CongreSs ha~ ~k~ a preemptive r~le in r~±ng ~h~ warn~ ~ta~m~nt. In tha Federal Ci~r~e L~li~g a~ ~N Adv~rtisi.~t of 1965~ 15 U.$.C. § 1331, Congress m~ndated w~rn~n~ statement ~u in_~orm th~ ~ublic w~ r~e~t ~o ~h~ a~leGed ~ai~ co~sequencee ~f smok£~g. When C~nqr~ss determined ~a~ th~ ~rigin~L warning ~a~l~nt ~equ~re~ by ~ 1965 Act ~houl~ be uh~ged, i~ ~ded th~ A¢~ in 197~. ~ Ac~ as am~n~e~ thu~ represe~ a Con~r~o~al ~otermina~i~m ~h~t ~ pre~em~ warnimg ~a~ment is a~e~te to in£o~ ~ p~l~c abcut ~h~ SL~r~on G~ra~'B V~WS r~sp~c~lng the ~rt~d fllctin~ ~pproaches to r~gul~on of advertising wl~h respect comprehension ~nifo~m p~l~cy, ~ f~rmula~ed ~n~ ~rticulat¢~. D~pit~ annual overtur~s b~ tho ~C ~l~ 197~, Co~gre~ ha~ sho~ no ~£~sati~facti~ with ~e p~esen~ w~rni~ Co~i~s~n ~lLato~l~y ~ ~a~l~ any chan~ in ~1~ warning Sme Tab ~ fu~ • uomplete ~naI~sl~ ~f ~h~ S%aff'~ di~us. 09 .q059

48O - 13 . ~tatement .. whoth~r t~rough ad~u~icatlon or rul~mak~ng -- w~id vlolate tho clear pollGy o£ Co~gr~s~, _The $~a~f~r~posals are contrary tc and precluded by recent actlon taken b~ the C~i~i~n its~l.# with r~spect to the warnln~ sta~mun~, A~ RO~ ~ar~i~r~ in J~y ~f ~i~ year ~h~ C~sslon en~red in~ C~nsent J~d~ent~ with ~e m~j~ cigarette m~uf~t~rers which e~b~ied the c~ntinu~d use of the current warning ~tatement In cigaret~s advertl~em~nt~. ~&vi~ ~ m~n~ ~o e~pressly reaffi~d that warning ~t.ltement, ~t w~uld b~ legally impe~i~Ib~e (~s we~ a~ c~n~rary ~ maund ~Zicy and ca~on s~n~a) fo~ ~hm C~i~si~nI t~ repudiate it~ a~re~ent aad im~ou~ n~w ~rnlng s~at~m~nt~ or ~er retirements on the cigarette m~nufac~urer~. The Supreme Co~r~ lon~ ag~ e~tabliahed float a cun~nt de~re~ ~ b~ ~h~ged onl~ upon ~ clear ~howlng of ~r~vo~s wrong evoked by new ~d ~n£~r~se~n co~ditlons." Unl~ed States v, ~ft & C~, 286 U.S~ ID6~ 119 (1~3~) (~mphasis ~uppli~d)~ All o~ the p~ortedly are based W~ icng ~ince kno~ to the F~C ~% the time it ch~se t~ r~afflrm ~e e~i~in~ w~ni~g a~a~emen~, ~ is thus ~ear that the Report c~uld no~ ~rovi~ even ~ ~nima~ly • d~a~ ~a~i~ f©r ~a~i~fyinq ~e Swif~ s~n~rd+ ~e~i~t~ ~otlc~ ~eque~t!ng ~o~ent o~* ~I~ ~eport, ~he Co~i~s~o~ concede~ ~ha~ "b~cauae of the nature of the ~ue~ p~ed by ~uch a ~y~tem, r~tational w~rninq proposals are ~ar~!cularly a~pr~rla~ f~r C~n~=~si~l c~id~r~tl~n.~ ~ ~.R. 3O7O1 909 & 0S9 481 There is no lena[ support for zhe $~aff's pro~osltlon ~h~t cigarette advertisements ~re ~ec~ptive within th~ ~a~ of 5~ctloz 5 ~f the FTC Act Th~ 5ta£~ arg~ent that cig~rette a~vert£sln~ i~ d~eptlv~ within th~ meaning u~ S~tlo~ 5 ~f the ~TC A~t ±~ b~se~ on the pr~mi~es ~t consumers are ~n~w~re ~f spec~fic~ ~£ the ail~ed he~l~ haz~rd~ ~ ~m~ilin~ and tha~ cigarette m~n~£a~urer~ h~ve • £eg~1 du~y t~ in£~m ~n~r~ about ~ho~e a£1egati~n~. A~ w~ dem~n~trat~ £~ ~se Corinth, however, cons~u~ers clearly are aware of specifics ~£ the smoking and h~al~ contr~versy~ ~oremve~ deception under s~ction 5 arise~ only when an adverti~mont mi~Zo~d~ ~n~or~ ~o~t ~e e~£~ct~ o~ t~h~ product advertised, Ever~ cigarett~ advertisement carr£~ t~ Congressionally ~and~d war~i~g s~a~ement~ ~nl~k~ al~h~l~ bev~age~, halt dr~ers, and c~s~,e~ics ~hat als~ have beln clalm~ by var£~us ~v~r:~eat a~:~ies ~o c~tr£but~ to var~ouB heal%h hazards I~ view of this a~£irmativa statement, there ~ n~ ~g~l basis f~r comp~linq clgarette m~nufactur~rs to provide in ~dv~rtislng the FTC Staff's views cn smokin~ and hea~t~. The Staff ~l~ mlssta~es the law when it implies¸ ~a~ ci~ar~e ~dver~isln~ ±~ deceptive ~e~ause consumers allegedly do net "spontaneously" and 11~o~cicuB!y" r~ t~e wa~nin~ ~a~em~n~ ~ ~he ~me they make pur~ha~ decisions, Rep~r~ a~ 4~9. We are aware ~f n~ ca~, andre Re~rt ~tes n~n~, ~at holds ~n ~v~rti~er re~pon~ibl~ ~or the failuro of c~n~ars tm r~tain ~e m~a~ in ~n adver~£sem~nt. Ths

482 - 15 - ~ Consent Order~ e~tered into in 1972 between the F~C and ~e sig mA~or el~a~et~e c~mpanies re~l~u ¸only di~lo~re of th$ w~r~in~ statement In advertising; no provision ~f these Orders relates in ~y wa~ ~o ccn~er reca~. A~ ~lre~d~ n~te~, moreover, eveL~ ~Q $~£f ¢~ncedes ~hat there l~ ~lmos~ univer~a~ pt~lic awarene~ o£ the ~t~ce of ~e Congressionally many,rod warning statement. 5. The Staff's prop¢~ed "Remedies" (Chap¸ V) Are Ii!-Consi~re~ an~ :nc~ns~en~ Wi~ , ~ ~'e Repor~ ~n~ludes b~ urging a variety o£ "~emedie~" ~or ~he ,deception" ld~ntified by ~e ~af£ ~h~ a~ c~mpletoly beyond ~e ~C'~ authority, ~ ~1~ course ~£ rs~h~nq thews c~nclusion~, the St~ff inaccurately describes p~ ~ndu~ry =~tion ~l~h respect ~o advertisz~. ~e Staff als~ fail~ to de=on~r~t~ tha% lt~ proposal to ch~n~e the size, shape, ~n~ ~on~nt ~f the warnin9 ~a=eme~t wo~l~ lead to an~ ~ncrease in the pr~n~ extraordinarily high leve~ o£ public awareness. M~reover, th~ Sta~'s pr~p~ed Mrem~ie~" w~u~d violate t~e First ~en~en~ ~r~tB~tion £~r co~er~ial speech, L Th~ ~ur~on General'~ w~rning has a~peared with exact un~£~rm±~ ~n ~ pro~vn~ £~ and wording ~ 1970. It is, ~t~ ~terally, a~ ~er~=an institution, ~ll~ar to all. The deletio~ ~f the re~er~n~e t~ t~le Surgeon General, as ~ S~a~f rec~end~, would al~r ~e basi~ ~hara~ter of ~ warning statomen~ wl~ unpredl~le effect. * Se~ ~a~ 5 f~ £ur~er di~us~n o£ ~e StaSf's proposed remedies. 09 & 059 483 . 16 - The RepOr~ reveals that the Staff has given n~ ~hough~ t~ the p~tentiai conse~en=es ~f l~s prpp~sa~. ~either has ~he 5taf£ m~de any effor~ ~ detezmine whether the w~r~ngs it is now proposing are likely to be mor~ "effe~tive" than the ~rnin~ statement that th~ St~f now f~n~s to De ~ef~ci~nt. Accordingly, ~here is n~ ~eason to assume that ~h~ S~f£'~ reco~en~e~ "remedies~ will sere ~ny purpose, TO the c~n~rary, i~ is a~parent tha~ ~he S~a£f'~ proposed "rem~die~" ar~ ~erely another installment in its l~ng.~tand~g c~paign ~ ~is~r~ge, 1£ not prohibit, p~ople from ~moklng. S~nce lg~4, ~he ~TC perio~lcal~¥ ha~ attempte~ to impo~ res~iction~ on cigarette a~ve~ising ~nd p~cka~in~, Congress h~s ~wice, in ~9~5 and 197~, moved t~ rein ~n ~h~ agency, preempting ~he ~TC's claimed power ~n the ~tter o~ agency.proposed warni~gz. "¥~, t~ay, ~he FTC $~a£Z's basic measure o£ the "e£fe~lveness" ~f the current w~ng state~en~ ~d ~he "deceptiveness" ~£ clgare~te advertising rcma~n~ wh~ther peo~i~ ~re p~ompted t~ s~op ~m~king. ~o ~e ~ regulatory p~er ±r~ecen~ in ~h~ staff~ ~bjec~ive ~£ altering =on6u~er behavior l~ ~ ~u~tl~s exercise ~s well. pro~e~r Wil~i~ Wilkie, £~ his June 1980 report to ~e FTC ~n a£firmat~e disclo~ure ~r~er~,~ analyzed the rang~ b Wilkie A££irmat~v~ ~iscl~ur~ A Su~voy and Evaluation ~f yT~ Or~e~ ~sued From 197C-77 11980 . ~h~ Keport c~lts any mention of ~hi~ st~d~.

484 -17, ~£ potcntial ~b~ect~ves underlyin~ the ciqare~e ~ll~lng ~tate~nt, £r~m ~hanging can~u~er awareness abo~t smoking and health to chan~ actual smoking behavior, snd concluded that ex~lnatfon ~ uhe objectives inv~lvinq changes in persQna~lzed belief ~n~ b~havi~r ~sugge~t~ T-h~t it ~lll be v~ry di~lcul~ £¢r any ~lscl~ure ~o a~hie~e these sorts ~ ~fects in the real world." ~i~.kie a~ 58~ Similarly, the 1980 Chilton ~tud>,~ cc~i~iotled by th~ sta£f a~.~ c~e~ ~requently in ~ Report. ~and unequivo- cally tha~ "[£]ac~uaI k~vw~edqe ~b~ut the h~alth cow.sequences ~ smokiest" is ~t z~lated either to current smoking behavior ~r intentions t~ ~m~ke in the futur~ Chilt~n Study ~Z 22-~, In~ed, recenz e~ud~ee reveal zhat a ~ub~nt±~l pro~r~ion o£ i~format~o~ ~a~ the St~ff wa~t~ to d±~sem~nate ~o the entire population, continues ~ smoke ciga~ezzes.* 1 Chilt¢n Research Service~, A survey ~ ~d01es~ent and Adult ~i~u~es. Val~e~, Behavior, In~e~tl~ns and ~wledge Rela~d t~ Ciga~et~o Smeking (19S0). The Burke Fo~u~ G~up StudT, for ~xar,ple, rep~rt~ "almost complete agreement" among th~ participa~t~ that peop~ whu Burke M~rketing Re~arch, E×p~ora~ry ~r~n~ ~o~us ~r~ups. Analysis at 3-4 (198~), Other Dis~es, 3~(1] CA~A Cancer Journal f~ Clinicians 29, 34 (198~) (reporting that almo~ one-third o£ women in ~he health prafessi~n~ ~m~k~): Di~ken~ ~ex goi~, Sra~kin~ a~d Smoking Cess~tion. ~(3) J. Health and Soc gehav. 3Z~, 33~ (19781 {21 percent ~f male phystelan~ and nurses and ~9 per~en~ ~f femal~ physicians and nu~es smoke), 485 - i8 . ~n short, givo~ ~ f~ct ~ha~ virtually everyone is aware that smoking ~ alleged to be h~rardous ~ l~ealth, an~ given th~ fact ~hat more detai~ed ~arene~s about ~mok~ng a~d he~l~.~ ha~ no demonstrable e~ec~ ~n smoking ~ehavi~r, the St~££*s ~ff~rt to alter ~¢n~um~r behavior by the course ~f action pro~o~d i~ the Kcp~ ~s n~ only improper bu~ pointless. T~h,. ~f'~p~sed "r~r~d-u=~ are ~n~on~l~nt %lth ~e U$~'~:~¢~ The Supreme Court has ~ec±~ive~y r~j~cted "the 'h~ghl~ p~ernalistic' view =hat ~over~en~ ha~ comp£ete ~owor ~u ~up~r~s~ ~r re,!late =o~a~rcial speech." hzldln~ t~at co~merc~l ~p~ech may be r~gulated only i~ the re~la~±o:~ directly ~vances a s~b~ta~al state Interest and is n~ more e~te:~ive ~ is ~ecessary ~o ~erv~ the ~L~t~ lateresz. Co~t~.~i~ f New rut11. 447 U S~ 557. 562~ 566 (19@0) ~he Court str~ed t~t amy r~med'/ affeczir.~ comme~ei~1 speech "must be designed car~£ullF to ~¢hiaV~ tb~ $~e's goal"; "may n~t be sustained i~ i~ pr~vid~ onl~ i~e~e~ive or rcmot~ suppor~ ~or the g~ver~'s purpose"; and m~y ~%~t be "e~ces=iv~." ~CNCLU~ ION ~he ~ep~r~"s reco=~enla~iuns a~d c0nclt~sl~ns ~h~uld b~ r~jected by tho Fe~erll Trad~ Comm±~ion. I~o~eove~ ~thl;~ in t~e ~ep~rt warrants ~ic~ my ~gre~s o= ~ ~n~v ~the= ~enc¥ o~. the fetler~l g~v~r~e:~t I! r,,

486 . 19 . pUBLIC AWARENESS OF ~ SMCKIIIG AND ~EALT~ - CO~R~VERSY ' A. Th~ Public I~ Highly Awar~ of the C1~1~ Abo~t the Asser~ H~al~hH~z~rds of C~arette S~okinq The $taE~ ~ece~arlly uon~edes that 'rmo~ people are generai~y aware" o~ ~he claim ~at sm~klnq IS hazardous. ~por~ a~ ~-S. ~ha~ concession, h~wever, minimizes ~nd under. states b~th h~w w~des~read and h~w ~pe~i~ th~ awareness is The 1978 Roper S~udy for The ~bacc~ Institute, cited in the Report, ¢on~ludea that "the b~i~£ th~ sm~kin~ is hazard~ua to health is now ~lmost totally accepted b7 ~ri~an~." 1978 Rope~ $~u~y a~ %7. ~i~ilarly, the 1978 G~llup opinion Index cl~e~ ~n th~ R~por~ i~i~te~ tl~ 9Q ~rcen~ of ~h~ respon~ dent~ believe Uha~ ~moking ~ hazardous ~o health.~ This widespread belief ~ce~ w~ll behind mere gener- alities N~a~Ly 2 ~ut ~f 3 pe~pl~ b~lleve ~hat any am~u~t o£ ~m~king iB harmful, and h~lf ~f th~ population believes that ~m~kin~ m~kes ~ gre~t de~l o~ di~£erence i~ i£~ ~pan. 1978 Raper Study QI~. ~ Alm~ 75 percen~ ~f ~h~ respondents in ~h~ l~SQ R~per Study con~u~ted f~r the ~TC believe ~hau ~m~kin~ ~rea~y increases ~he ri~k ~f heart att~c~. 1980 Roper Study Q30. ~ eq~ivalen~ ~r~pcrti~ ~E the population beli~ve~ ~h~ • Indeed, the or~gina~ warnLn~ phrase, ~ . • ~y bm h~- a~dou~ to ~r haal~," h~ pa~sed into the l~n~a~e and l~ he~r~ ~lly in ~ne ~on~ex~ ~r another. [or ~xamp~ a r~cen~ N~w Y~rk Time~ mr~icle bog~l~ "That s~ea s~ b~tin~ ~ro~ the nex~ ~par~men~ ~nd all thos~ ~ther min~r irritants in lif~ may be hazardou~ ~o ~our h~al%h" New York Times, July 1, 19~1 a~ AIg. 487 . 20 - claim that "~ 30~e~r ~1~ ~ar~on reduces hi~ llE~ expectancy if h~ ~moke~ a~ ~ea~t o~*e pack~ d~." On~÷third ~f ~he~e people s~y that the reduction in life i~ si~ ~r more years, s~ beli~vin~ tha~ it i~ over ~en year~. 19HO Roper $~ud~ Q~0. 31. A m~ority ~ the ~ubl~c be ~ves %l~e cl~lm tna~ [ J ~0 year ~ld smoker has a ~re~er chance o~ d~ing ~lthln ~h~ ~ha~ ~ ~0 year o1~ n~-~moker ~ 1980 Roper StUdy Q30~ Well ~er 80 p~rce~t either "~l~l~k" ~r "knaW" ~la~ s~oker~ ~re "many ~ore ~m~s a~ likely to ~evel~p lung ¢~ncer" as no~m~ker~ ibl~. Th~ 19~O Chil~n $~u~ c~nduct~d £~r ~ ~TC £~un~ the% m~e than 90 per~ of th~ publi~ h~Liev~s tha~ hear~ ~i~e ha~ been ~und to be associated wltn c~-~ re~%o ~moking~ 198~ Chi~ton Study Q42Ie/ The Ch~It~n Study als~ £~un~ ~%a~ ~mo~t 93 p~rc~nt ~ th~ re~p~e~t~ believe ~at ~m~kin~ during pregnancy can have an ~ffect on ~he smuk~r's b~by, a~d al~os~ ~hree ~rter~ bel~ev~ that l~ a ~man ~mc,{~ an~ ~ses birth c~n~rol ~£I~, she l~cr~es h~r ch~nC~ ~f l~vin~ ~ n~r~ a~t~ck~ 19~ Chll~n $tudy ~39, 53~ A~ di~u~sed b~l~w (pp, 26-29). ~l~s~ h~gh percent- ~Rlng and health; the perc~ta~ of ~h~ p~b1~c ~,~nre o~ ~uch c~im~ is ~ce~.r~y even hig~er, ~nd o~t~rip~ public a~r~- follawin~ re~p~nse~ ~ variou~ n~tion~L p~l~ (1) Only 2~ perc~n~ ~ the p~pul~ion know wha~ ~he First ~uen~en~ ~ or

488 - 21- what It de~l~ wl~; (2) one ~ar~er of ~6 p~ii~ h~ novgr hea~ or re~ ~Q~t the debat~ as t~ wh~ther the C~ncorde should bQ ~itte~ t~ land ~ the United ~ta~es~ (3) one third of the public do not k~ow Whe~Jcer t~e fede~l budget is b~lancBdt (4) 16 percent also do not know whether enough oil ~ produced in this country ZO meet present enerqF needs; and (5) 8 percent of t~e public are not even sure whether they have eve~ take~ item£~ed deductions on ~e~ federal income ~a=~ ~ese responses to major, wldely dlsc~esed issues lot in r~e lae~ case, to th~ ~pond~t'e o~ pa~t action, s) lea~ inevit~ly to ~he conclusion ~ha~ ~f ~ny~,Ing is better : ~n~o~n to the public than ~ clai~ t~at emoking i~ h~z~rdou~ ~o health, includlng the specific health hazards rJoat ~e Staff ha~ attrlbuted to s~okln~* iz has not beea demcn~ratod, ~either t-~e Repor~ ~er ~h~ Studies Upon k~nich I% Rmlie= De~ol~$%rate That a ~ig~i~ica~t Portion of the ~u~ic I~ Una~are of the Spe¢±fi~s and rd~e Severity of the Heai~ Hazards That the ~ta£f Attributes to $~okinq. Althou~h tile s~atisclc~ ~ote~ in ~h~ Report it~el~ demonstrate ~ exZrao~dlnarily hl~h lev~ ~f ~ublic awa~enes~ o~ virt~ally all fac~s o~ ~e smokl~ ~nd he~ir~ controvers.v, These respon~ are taken f~om, reepectlvely: The ~a~lup Opinion Index No. ~74 (January 1960) at 25~ 5(51 Current Opinion (M~y 1977) at 52, q~lot~ng the Gallu~ Pol~, E~ch at i17~; ~he ~all~p ~oli* public Opi;lion I~7~ I19~0) at I~8; 5131 Worl~ Opi~±o~ U~ate (Eay/,I~ne I~i) ~ 81, ~otlnq ~h~ Harri~ S~rvmy~ ~aruh ~7-A~ri~ ~ 19~I. 0 9 & 059 %,, 489 the ~ as~er~ r~p~ate~!y ~ha~ s~gnificant n~a~ers ~£ ~eople do not have the r~qui~te information. ~h~t a~er~n ~ ba~ed on the S~f£'s misuse ~n~ misinterpretation o~ the ln~o~at~on ~on~ln~ in ~he various ~u~y~ and studie~ cit~ by the ~ta£f, an~ the Sta££1s con~u~ion o£ p~lc a~are~s~ with p~l!~ belief, the Studiee ~ Un~c~te Awa~enes~, r~p~eent ~hoae who ~re "u~a~a~" ¢~ variou~ ~pe~iflce o~ the uarel±~le ~ t~ the ~ta~f'~ £~lty ~e/initloa ~£ tho~ ~ho ar~ "unaware,~ The S~a~£ l~p~ ~qe~er a~ "unawav~~ ~oae Underestimate on a ~u~iple ch~ce ~t±m~, o~ answer '~on't ~o~~ ~ '~ncerz~ln~'" ~e~rt at 17. ~ ~f *~he~e ~ive ~he S~a~ a~mume~ thrcuq~¢ut l~ di~ou~on of claim ~at ~kin~ ~uring pregnancy inc~ea~ the ~is~ o~ • til~bir~ ~d ~iscarvia~e), tilos~ peopi~ ~re not sufficiently awa~e of ~e ~eneral ~op~itioa tha~ enc~as~e~ tha~ ~etail ~*e ~lsk o~ ~dver~e e~£e~ts on the baby). ~hia a~tl~ is ccntn~ry t~ th~ ~tua~ ~es~lt~ e~ t~e ~tudi~s ~i~ed ~y the

480 - 23 - StAlE, which uniformly demonstrate that peopl~ ~ener~lly ~re awar~ Q~ %h~ hoal~ d~nger~ ~at ~he Staff as~i~e~ wlt~ ~l~okin~. even if they ca~o~ respQnd wi~ preuise medical ~ta~lstlcs. Moreover, r~.e Staff's assumption ~at a person UaT~Qt be aware of a general fa~t ~e~ he is awar~ o~ • peci~lc application of ~at fact clearly ia wrong as a matter The Report ~l~u mi~us~ ~ re~ul~ o~ th~ detai~ed ~es%lons ln~lu~d in ~e ~t~!e$. Re~ponden~ wer~ asked every h~re~ ~eopl~ wh~ ~et lung ~anc~r, how m&ny dl~ £rom it?". Acc~rdin~ ~0 ~he Staf£, ~yo~e Who answers ~lth other than the "correct" ntunber ±~ ~aware of the ~eneral fact to wh£ch ~ n~er re!ate~. But as ~ Rep~r~ £~self a~lt~, u~ of ~ ~pecl~i~ figure . . . in T~e q~esti~n ra~er ~ rea~ consumer m~u~de~and~ng." ~e~r~ at 3-22, In £~c~, none o~ the ~e*~±on~ req~irin~ ~he ~electi~n ~f • specific number, ~a~lo, or percentage can be ~onsidered an accurate indication of p~li~ aw~ene~ ~ou~ a mpecific health problem.* in ~ e~ampl~ given, ~r~ the C}l~lton Study, ~nly 11 6 percent o~ tee~ s~d 10 8 percen~ ~f adult~ ~&ve %he $~zf£'~ c~cec~ answer, 9~. A~mos~ 75 p~r~en~ ~f ~e~na~e~ and adults, h~ever, ~ns~eced either 45, 75, or 95, Chilton 5~y Q2~. ~, ~he ~eport's conclusion tb~t ~many people ~o not ~ppreci~t~ the ~ever!ty c~ lung cancsr" (Report at 3-23) unfairly mimrepresents ~he £a~ tha~ the v~ majority of people are aware %hat lung can~er is all~d to have s high ~rta11~ ra~ ~f a~ leas~ 1 of every 2 o£ those su£~erin~ £rom the ~isoa~e. 491 . 24 . ,he S~a£f al~o ~ro~sly misln~erprets the stati~tic~ by ~ari~in~ al~ responses o~r th~n ~he one dee~e~ c~rect by ~ho Staff, including ~'don't know" ~n~w~r~ and ~esson~bly ¢IOS~ ~s~£ma~es, a~ r~?r~sen~ing peopl~ wh~ ~re uompleteLy unawar~ o.r a ~articular s~teme~. S~ch re~n~es, however, are ~ally s~sceD~ble t~ the int~rpre~a~ion ~n~ ~he responden~ is generally aware o£ a statemen~ Put is unsure of /~i the precise number involved. In th~ previously d~scrib~d ~xample, a person who believed that ~O~U p~ple w~th lung c~nc~r die from that disease, b~t w~ not ~ro whe~hor th~ correct proportion is ~0, 95, ~r ~7 o£ 10Q, m1~h~ fall in~ ~he "don't know~ ca~y ~nd ~e~eZore wouL~ erro~sl~ be ~iC~r~d by the Repo~ as person who is ~n~ware o~ ~he severity ~f lung c~c~r. In addi~l~n, so~ of the respons~ deemed "incorrec~'~ by the Sta~ co~ ~±mD1y have r~flected 1~ck of understating o£ ~tho ~estlon. Consider, for e~pl~, Q~e~ion 16 from the Chil~on stu6y: "HOW many ~ricans living tod~y ~i!I even~ually die from dlsea~s relate~ to ~mukinq clgare~e~ (RE~ LIST) ~-~ (CI~CL~ ONE A~NSnER) 1 One out o~ ~o 2 0~i~ ~ut of ~i~ 3 one out of ten, ~r 4 One ou~ ~f 10C 5 DO NCT Don't ~ow R~AD Does ~h1~ c~lon -- rea~ ~o ~he respond~ by "~er~can~~ whether or no~ they h~ve ever smoked? ~e Staff

492 . 25 . claim5 ~at hea~ di~e&se is "rela~ed to ~m~ktng cigarettes, M b~t million~ ~f ~ri~an~ who have n~ver ~m~ke~ "will eventu~lly die" ~f heart disease, It ~s ~urprlsing, in light o~ th~ ~i~i~y Of ~ ~tlon &rid the five alternatlve answers, ~at 35 ~er~ent of the respondents ~ave the "correct" ~wer ta ~e abov~ q~.s~iQn, SQm~ uf tho ~B~ti~n~ ~at were ~ked are wir~ally imp~sstb~e t~ und~r~tan~ ~n any conte×%. The ~e~tion from ~ Shot ~tu~/ ~ted in ~e Report (at 3-16), for example, ~nd aw~ar~ ~hra~ingz "In i~u~tr~aliz~d nations, c~gare~te smokin~ is ~le ~rea~est ~in~l~ ¢~u~ ~£ Ix~e~s murbi~y ~nd mortality £ro~ i~ng and o~er ~ancers, ~r~m heart attacks, and als~ ¸from emphysema ~n bo~ men ~*~ wom~n." Th~ S%aff's ~isus~ of ~ ~u~ey ~tatistic~ ~n th~ above ~pect~ demonstrates that ~ staf£ ~a~ ~r~ interested in providing ~pp~% ~r a for~gon~ cc~lu~ion ~h~, ~gagi~g In an ~b~e~ive ~u~m~ ~£ the ~ve~ o£ public aw~r~ne~ ~£ turbin~ ~idence tha~ ~he S~aff wa~ mad~ aware of aom~ ~f ~hese problems prlor t~ ~e i~suance of i~s ~epor~, ~n a fetter to ~ S~if~ d~ted D~c~er 5, 1980, Burn~ W. Roper, Chalr~n ~f th~ R~per Organizatlon,¸ ~tated a~ foll~ws with respect t~ ~h~ re~it~ of "i~ StaZ~'~] t~ck-on ~stion~" to ~ 1980 ~oper Study~ 498 26 . "lilt i~ our ~oin~ o~ln~n that ~le resul~ ~how a high general awarene~ of the dangers 0£ ~m~king on h~lth ~h~t the ~er~- merit, the Cancer $uciety ~d others h~ve been prom~ing .... ~y ~t I m~an ~hnt ~hil~ n~¥ p~op!~ glv~ technicaLLy ~onq n~ericaL rela~ion~ip~~e. ~ '5D t~me~ mor~ l~kel¥~, '10 ~ime~ as ~ik~, '50~ gre~ter', '6 tD 8 year~ les~', ~t~.), mo~% s~y the~e is a sl~ll~ic~ntly gre~t~r chance of X, ~r a s~g~lificant reduction in e~pecte~ ion~evity, etc . This lette~ wa~ produced by the C~ission in r~ponse ~o a Vreedcm ~ In£~m~tion AC~ K~que~t ~h~it~ed ~n behal£ o£ The TObacCO Institute. Although the r~st ~as granted only in pa~, the R~pe~ letter an~ ~er ma~rial~ raise ~eriou~ question~ about ~h~ fai~ o~ ~e Sta~f'± inves~iqa~ion and ana~y~i~ o£ "p~llc awareness."~ 2 The Staf~ confuses 2~blic Awareness ~ith FubZic ~e~ie~. • T~ m~st ~eriou~ ~isinterp~etati~n, an~ on~ ~u undermlne~ ~h~ ~ntire Kepler. is the 5taf£'s c~nfusion between pu~li~ awareness an~ b~li~£. Th~ ~-u~i~ r~li~d ~p~n by the S~a££ ~o ~eman~trate I'~warenes~" did not ~£ne ~a~ ~u~ ~ ~9S0 ~op~r S~udy, ~r ex~pi~, ~on~i~ in lar~ part of a~kin~ peopl~ "how ~r~ you ~er~onalty ~inM~ a par~i~alar s~em~n~ l~,1 Respondents wer~ permi~ ~o answer ~nly in a letter to the ~op~r 0rg~niration d~te~ 0~tober 16, 1980, ~or example, th~ ~C'S As~ls~a~t Director f~r Advertising ~ac~i~es requ!red tha~ ~he "£$n~Z wor~i~g ~nd nu~&ber ~f ~e ~tioner ~as to introduce the~e q.~est~n~ a~ ~moking a~d h~lth, and ~r each ~e I'd lik~ ~u to tell m~ helief~ abo~ h~w ~e the ~tat~ment ~S." ~oper Study Q3Q (Kmphasis in origl~zal). % ~ ,

494 - 27 . 495 - 2~.

. 29 - 497 . 30 .

498 . 31 . ~ , l H~aring~ ~ Cigarette Labelln9 an~ AdvQr~i~1~g Befo~ th~ E~h~vior, Natzcnal I~ . 17 ~Dece~er 1~771 a~ 263.

500 • mokin~', I ~nc~ ~h~red that view, b~ Aav~g new ~died the evidence !n more de~il aad • from new inql~s ~ feel un~bl~ t~ reac~ a definit~ve conclusion, apar~ from re~ectinq the 'pur~' causal the~ry~ Acc~cd~n~i~ i f~nd ~y~l£ forced back t~ Fi~her'B (19~9~ ea~l~ V~rdi~ 'the da~a ~o far ~ not warra~ th~ c~ncluul~n~ ba~ed u~n the~'."~ ~on~ the many ~her e~ple~ ~£ th~ s~af~'~ bi~s ~n ~is ia~u~~ is ~t~ ~s~erti~n ~at 'l~w]ith all ~ther variable~ h~ ~on~tant~ t~e more cigarettes they ~m~k~, the note ~ea~s t~ey ~m~k~ ~r the yo~n~e~ ~h~ ~re whenthey start ~moking~ th~ m¢~e l±kelM [~oker~1 ~re %~ ~velop l~ng cancer." • Repoct at 1-~0. The S~af~ ±gnores s~udie~ cond~ctedin the Un~t~ 5~a~m~nd ~ritain which have ~h~wn tha~ the ~ o~ incidence oZ l~q can~r ~o~ n~ depend ~ither ~on th~ aq~ a~ which ~m~k~ng co~enced, th~ ~ti~n o~ ~kin~,' ~r even whe~he~ ~r n~ ~ne ~m~ke~.' According to ~ne ~xp~rt: "Tha~ b~th ~ ~ of starting to ~k~, and %he ra~e ~f ~mo]~ should have no apprecl~le influ~nc~ o~ ~h~, average age ~f ~n~t ~£ BU~Ch, $m~kin~ and L~ng Cancer: The problem ~f ~n~rring Cause, A141(~) Jk K. Statist. Soc ~37-477 (1978). ~ Th~ numerous ~n~ances of S~a£~ bias w~th respec~ ~o th~ question ~f ~mo~ln~ and cancer ~an b~ ~e~n by ~o~paring ~he di~u~on of ~m~in~ ~nd cancer ~n the ~p~r~ with the dl~ cu~s~n ~f ~he ~e ~ubject in ~he A~pen~ix ~o these Co~n~. I Herr¢ld, S~rv~y ~f Hi$~ulo~lu Types ~f Prlma~y 5un~ Cancer In U~. VIteran~, ? Pathol. Annu. ~5.79 (~72}; parley, Some Problems ~ L~ng Cance~, Lancet II: 107-112 (JulM 21, ~862), • H~arin~s ~n Cig&r~tt~ ~ab~l~ng and Adver~i~in~ Befor~ ~h~ 769-774 (i~69}. 9"i:9[tt., 059 t 501 ! - 3~ . I~ c&nc~ greatly tax~s, if ~t doe~ n~t destroy, any causal 0th~v ~xa~ples Of the Staf£~s bia~ ~ou~d. C~nsider, f~r ex~pl~, ~e f~ll~w~ng editorial abou~ ~m~k~q a~d heart disease p~bll~he~ 1~ the ~rican IIear~ J~ur~ ~f Se~te~er ~980~ which sta~e~ ~Ac~d~n~l¥, it ~s ~eas~nable to b~[ieve ~h~re ~s n~ proof r~a~ ~ppln~ [~moki~] ~d w£t~ r~pec~ ~o smokin~ an~ pregnancy, • recent editorial ~ppear~n~ in the Lancet, May 1~, 19~1, co--ended a~ f~ll~WS ~n a ~u~ of var~les identified i~ a ~tudy ef i~w b~r~ weight bab±~s~ ~A~ first sl~h~ m~ny of the a~ov~ factors r~e hope~ of preventive m~a~ur~ ~uch a~ family pl~nnlng, restriction o~ ~mokl~q and alcohol c~n~mp~i~n, ~ a~propriat~ die~, an~ exercise. ~u~, ~u~ing that women wer~ ~repared to m~d~f~ their beh~v~ur ~nd tha~ ~h~y had access t~ sa~ ~n~rac~p~lun and tha~ tobac~ promoti~n~ w~e bann~ ~n~ ~m~kinq an~ ~rinki:~ ~u~in~ pregnancy d=~ ¢~urage~ .. c~uid we pr~mlse a dr~p ~n ~ret~rm d~liverT? T.~ ~n~;~r mu~ein ~he~t~ve. ~o ~J~/l~t o~ ~a~hem~tlcal manip~lat~vn can ~how that ~uch associations are directly cau~al rather than p~rely indicative m~ a certain %l,;e ~ person." IEmpna~ls ~up~lie~),~ / B~rch, Smoking ~nd Cancer, Lancet I: 1315-1316 (June 9, 1973), i0~{31 Am ~e~rt J 275.280 (Sept. 19~), ~rec~rs~r~ ~ ~re~erm ~e~ivery, Lancet ~r I~87~1Q~8 (May 16, 19~1). ,k

5O2 - 35 - £ 9R£ 0 9 503 . 36 = Cor~sponde~e~ Brain~ Federal T~a~e C~m~i~iOnr ~0 B~n i~59. Ii~65}. ~ 7 Ii~68),

5~ - ~7 - rull r~qulrlaq "t~r' and nicot~n~ listinqs in ~i~rer~e ad~er° ~isln~. In respense t~ this action, c~rette m~n~f~ctur~r~ "agree~ voluntarily t~ disclose the "t~r~ and nicotine content of clgarett~ ~n all a~v~rtis~ng. Thi~ plan wa~ ac~e~ted by the C~i~si~n. in i~7~ ~hen ~n~r Moss, n~ friend ~f smoking, sald~ "3everal c~gare~e marketers a~ w~ll ~ the publ~c H~ithS~rvlce h~ve made significant effort~ to promot~ low tar a~ ~icot~n~ ~o~tent. That a~ivity is to ~e c~mmen~ed since much of it ha~ b~n ~one in a ~airly ~es~ons±ble manner.H~ ~early $Q ~e~n~ ~f ~i~arette~ ~o~d t~day ~re in the "iQw ~a~~ ~m~nt ~ th~ mark~ (15 mil~iqr~ms or less). F~ some ~im~ it ha~ ~een acknowledged that the ~v~rage "t~r" ~n~ nicotln~ c~nt~n~ ~f cigarettes ha~ been re~ce~ b~ over 5O percent ~inc~ th~ i~50's~ In fac~, ~al~s-w~ighte~ av~rag~ "~ar" cont~nt ha~ ~ropp~d ~arly tw~t/lirdu .. ~r~m 38.4 year he Re~ort, in i~s ~nlver~l cund~mna%~n ~f tobacco, ~ownpl~?± ~A~ infantry's reduction ~f ~r~ and n~in~. Tni~ is in sharp c~n~ra~t ~ ~he "s~ron~ly" ~ugqes- reduction of "tar~' and nlc~in~ c~nten~ Hear~nqs ~n FUhl~c ~e~ith C~gare~t~ Amendments mf 1971, g2d C~ng., 2d S~5., ~ 2 (1972). • C. T]I~ St~f'~ Dlsdussion ~f th~ T~bac~ The Staffr~ ~tack (at pp. 1-58 ~hrau~h 1-65) on the po~ition~ ~et forth &n a 197~ review ~f th~ ~mokinq ~n~ health controversy by The T~bacco Ins~l~ut~ reveals the e~ten~ ~ ~he S~a~'~ bia~ an~ the conze~en~ ~lawu in th~ Report's review of the evidence concernlnq smoking a:~ h~lth,~ Thus, for e~mDle, ~ St~ff attempts t~ re~ute the position that ~pidemi~lo~lcal studl~ ¢a~ e~t~lish c~us~- tion, ~nd~ doing so reveal~ ~ basic ~i~u~derst~n~ing oi ~pi~mi~lo~y and its legitimate ~as. COn~ider a ~ew scien- tific Cor~en~s on ~%e subJ~ut: "iTlhe elementary but highly seductlv~ fal~acy ~ 14ent~fyin~ auso~iation wi~% causation continues to p~agu~ man~ ~tudies."' "In medicine, much mor~ ~an correlation is necessary t~ e~abl~sh causati~L."* "~p~demiolog~ca~ studies, evsn prospectivs cnms llke the Seven Countries Study, can*~ot prove ca~e and-e~fect when the end-polnt, 'ef~e~'. i~ an outcome ~f ~ chr~±~ noncom- municable c~nd~tlon .... ep~dem~ologic~l The Tobacco Institute review al~o ~m~nstra~ ~hat ths 1979 Surgeon G~neral's ~eport (heavily relied upon 5y th. Staff) its~l~ f~i~4 a~q~a~ely to report on ~he sta~e of ~he scientific llteratur~. Burch, Pa~hol~gy, Inference, an~ Carc~n¢~enesls, ~athol An~u. part I~ 15=21.&4 (19S~)+ ~o[ton, Statistic. in M~ic~ne (1974).

5O6 - 3g - ~vid~nc~ can b~ cited only as b~ing con~is- t~nt, ~r inconsistent, wlthth~ hypoth~si~ in Di~tln~ulshed scientists c~nti~e to adhere to th~ ha~Ic pr~mi~i asserted hy Fishe~ Be~R~n and others that ~t~tisti~al ¢~mpariscn between ~k~r~ and n~muk~rs ~annot ~sta~li~h cau~ and effect z People s~if-select whether ~hey will ~mok~ or aot, h~w ~u~h they will s~ke and wh~er the~ w~ll ¢~it. Thi~ remains as t~e today as it was a quarter. century ago. Th~ ~b~ ~ndu~ry ~s n~t "a~tacking" epidemiology ~n pointing ou~ the~¢ limitat~ons Ra~he~, it is ralsin~ a legitimate cri~iclsm of r~e ex~rapol~ion and decision-making that can ~ccur when ~uch limitat~cns are i~nored. The Staff -- ~nx~ous t~ ma~e a point .. has ignored It al~ has ~±~reqarded ~e many shortcomings of epidemi~logi- cal stu~!e~ u~ ~±ns~ ~moking While the ~ep~ ar~tlc±zes the ~obacco industry £or challenging "r2~e d~sign arid m~hod- ~logy ~f the ~tu~e~ relle~ upon t~ sh~w ~ h~a~ hazards of smoking" (Re~rt at I-~3), ~h~s cc~en~ simply i~l~strates the Staf~'~ unwil1~n~n~s~ t~ ac~lcwl~dge ~ ~eszionable ~ality * Keym, ~o Dis~ and All-CausQs D~ath Rat~ in th~ Seven C~untrie~ St~y, L~ncet ~ 58-51 (July 11, 1981)¸ • Fisher, Smoking. ~-~ C~ncer C~n~r~v~rsy (1959)~ Berkson, Sm~kln~ ~nd Canc~ o~ the Lung, 35 Pr¢c~ings o~ th~ St~££ Meetings of t.h~ Mayo Clinic 267-85 (Jun~ 22, ~960); Butch, The Bi~1~ ~f Cancar. A New Approach (1976)¸ 8T9 & O 9 of many p~latlon s~u~ism- ~t would ~ har~ to believe, £or example, ~t ~he Staff has n~v~r considered the w~rk of Dr. AlV~n ~i~t~in, Pro~essar of Medlcine and Epidemiology a~ y~le ~nlv~rsity. Dr. yeins~ has described rcpeatedl¥ how detection bi~ (~ooking harder for ~ung cancer in ~moker~ ~nd ~heref~re finding i~ more often) can dis~ort ~tati~i~al data ~ou~ ~moking ~ lun~ ~n~r.L ~¢ $~aff s!mil~rl¥ has ~mit~ed mention of Dr Th~odor S~erli~g, an ~xp~rt in ~o~ut-¸ ~r~zed h~th in£~mat~on, ~h~ has reviewed the ~t~ from ~W~ larg~ ep~dami~log~cal studies freq2~n~IY cited a~ "proof" ~lat smoking c~u~ dl~a~ In ~n~ such stu~y~ h~ ~ound basle error~ in cl~±fyin~ peopl~ accor~q to t~ei~ smoking habits z In %h~ ~r, he ~o~d ~h~t certain disea~ patterns in th~ study population (~, br~a~ can=er, lung ~an~r emphyzema) wer~ ~on~d~r~blY higher ~h~n in th~ U S. p~pulat~on ~ ~s ~uppos~d ~o r~prasen%-' Gover~e~t s=lentists haV~ also c~iti- ,%~le several 51~nifiaa~t ~tudieS had cized ~he~ ~tudi~S: Fei~st~in Cigarette ~mok~ng a~d Lung cancer~ The probi~ ~f "D~tect~on ~i~s" in E~dem~ologlc Kate~ ~£ Disease, 22(3) 974 ~in~tei~r ~uo~d in smokln~ Clin. ~s 535A (Apr~I~ i ~ no~tlc ~±~, ~m~l~ Pra~¢~ L~nk to LUng Cancer T~.m~d D g C~nC~ The ~r~b c. ~. ph~Clan~ 18D--85 Rates ~ Dzse~s~, 87 Tr~S- Asso i1974] L~g After an Impor~an~ Kepcr~ }{a~ ~e@n ~ubl }e~ore ~h~ ~rican Statistical A~i~tion ~%ual Mee~Ing, Washing%~a, D~C+, Au~t 16~ 1979. cal K~a sessment of the Evidence~e&ri~ o~ SmoklnQ a~ th ~aalt~ 9~9-95~ (1975).

5O8 / ~y were f~r ~he most part n~t ba~d ~ ~c~lt!fl~a~ly designed ~rob~l~ty ~mp~, and were therefore mQre subject tc ~he criticism ~at ~h~ ~lndinq ~o~ld n~t be genQr~lized ~o the total p~ul~ti~n. ,~* ~he S~Z~ al~ ar~e~ ~ha~ ~o~clus~ons about causa- tion can be ma~ w~th~u~ understanding the biology o~ how a d~sQase ±~ ~a~Bd, Rep~r~ a~ 1-61 and ~-62. T~J~ att~pt to doW~play b~ologic m~ch~:llsms is predictable. The ~taf~ wan~s t~ ~aw ££rm c0nclu~ns ±n~ £a~e ~£ ~mer~u~ q~e~tions ~a~ remain i~ ~ ~rea o~ basic s~n~. ~or example, whii~ "no W~ll.d~igned and well-conducted ~xp~r£me~ts have sbow~ tha~ c~a~t~ ~m~k~ qa~es ~ cance~ ~n animals,~'~ ~he ! Report ~ta~ly ~gnores t~e ~mpl~ca~ns o~ s~h ne~t£ve The Staff's argumet*~ ~a~ biologic mechanisms ~re • n~gn~can~ is ~l~ hard t~ tnk~ s~riousl¥ in light of ±t~ discussion ~f h~rt disease. ~he $ta~ h~st~ken a "~u~tion m~ ~asy" ~pprs~ch t~ heart ~sease~ it stat~s tha~ ~mck~ng £s ons of the ~h~ major r~k £ac~s f~r h~n~t attack, and t~en conclude~ £~ the ~ezt ~ntence th~ ~king accounts ~or Wilson, S~t~ment. ~ational C~.£~s£~n f~r Smoking &nd Pt~l~c p~licy, Phi~adelphia, Pennsylvania, June ~. 977. ~inst~n, ¢~ents in "D£scu~si~n" ~f ~esenta~lcn b~ Butch, Smok ng and Lul~ Canc~: ~;~ Problem ~f In~rr~ng C~us~ (With Di~c~s:$nl, AI~ll4) J. R, ~tat~, @oc, ~37-~77 /1~7~)• 509 . 42. o~e-~h~r~ o~ all de~ths ~r~m ~o~nary hQart ~meas~, RQport at ~-1~, Thi~ ~onclusion comple%ely ign~re~ several we~l k;19wn £acts that contradict the ~aff's p~s~t~o~: (1) %he major ~u~es on he~r~ d±~ase list f~r mor~ ~n three r~sk factor~, (2) r~$k fa~ors are a~t necessarily cause~, ~d (~} meaningful £i~res ca~ bo Obtained by div£~n~ the n~ber o£ coronar~ heart dis~ ~a~Sby th~ nt~er of ~l~d ri~k Devel~m~ ~n research ~ ~her~scleros~ i~lus- ~ra~ ~a ~mpor~nce of bioloqical mechanis~. C~r~n animal research ~ As~rup ~d co*workerB h~s been ~£~ed ~or th~ p~s~ fifteen y~rs ~s ~reo~" ~ha~ ~h~ ~schanism ~ which SmOking in ~he 19~0's. doubt was ~xpr~ss~d ~c~t ~h~ A~t~p fin~in~ Finally, ~he A~rup ~ro~p trie~ ~o reprod~c~ ~eir earlier re~ts ~nd £~un~ ~ha~ "no ~ign~£can~ morpholo~i~a~ ~h~n~es wer~ present ~o d~scr~m~te between ~xperi~ent~l &rid ~an~ro~ L As~ru~, ~an~ing In~lu~e o~ C~bon Monoxide ~n ~he D~v~l~p~n~ o£ Ath~r~ma~o~±s in Ch~le~terol~e~ R~hbi~s, 7 J. Armature, ~e ~££eqts of C~rbc~ Mon~d~ ~n ~he Dev~lop- men~ o£ At~r~l~ros~ in th~ Wh~t~ Carne~ pigeon, 23(21 Ather~s~l~ro&~s ~33-344 (lg7G)~ T~eodore, T~x£~l~q~ai ~valu- ~tlen o~ ~rb~n M~n~±d~ in ~m&ns an~ Other M~mma~*~n Sp~c~e~, ~as phas~ C~n~tl~e~t~ ~ T~bac~ ~m~ke ~n th~ Kabbit, ~ ~t~ac~ o~ t~ ~ourth w~rld C~nr~renc~ on Smoklng an~ H~lt~, Steckh~lQ. Sweden, JU~ 18-21~ 1~79,

510 - 43 . e~p~riencl, th~ ~cn~bout h~ghl~qh~s %hQ n~i~ Qf sur~ti- n±zing ea|y answ~r~ and e~ph~sizin~ bi~o~±c m~han~ms, 1 Tha $~ al~o is ~=~nvlncing in it§ a~e~pt ~ dl~c~e~t the con~itution~l hyp~i~ ~hat ~kers a~e mo~ pr~ne to ~Ls~ase th~n ~on~kers btcau~e of c~rtaln ~mderly~ng ¢~st~tut~nal ~£fer~nce~ b~tw~en ~h~ groups, R~po~ at 1-&~, ~-6~. Man}, etu~e~ have £o~ ~h~u sm~ke~± as • grou~ di~r Zro~ n~ns~okers, Cigarette ~kers ~ay ~nd ~o be m~re active, ~e extroverted ~- ~d more pr~n~ ~o T~e A ~ehaViOr -- ~ nonsm~kerl ~en such gene~l~ and l~es~yle differences r~p~t~dl~ occur, ~s it not rsa~o~ble ~o study the h~ethe~la ~t ~lffe~en~s in disease patterns ar~ ~l~te~ to factors ~e~ than ~moki~? The t~ba~o ~%ry d~s~ no~ m~n~a~n th~ a ¢ons~itu~nal/s~ress %h~or~ is ~ explanation, it glV~ t~ al~erna~v~ expl~atl~ -. co~sideration ~t c~t bo accomplished in the pre~n~ of ~o~atic ~r preordained ¢~n¢luslon~. 511L . 44 * ~II. ~ ~A~JRE AND pURpOSE OF CIGARETTE A~V~TI~ING ~1~¢ ~e Report ~s ~suribed a~ th~ r~ul~ ©f £~ve-~ear lnvest~a~o~ of ~gare~te ~ver~n~, ~t m~ be s~pec~d ~h~ the $~ w~uld devote substantial and c~re~ul attention ~ ~h~ ~ubje~ 3~s is not ~.~ ca~. Th~ d~s~u~- s~ in th~ ~eport of t~e n~t~r~ an~ ~ffect ~f ~l~arett~ ~dver~lsing ~t~nd~ ~ut a~ ~he briefest ~nd ~t ~uper~cial. A The RIp~rt ~l~gs single-mindedly t~ the ~nfo~n~e~ ~t~ii that c~gar~t~e a~ver~i~lnq l~ ~me~ at luring n~er~ ~o t~Re up 6m~k~q even ~ough ~t is ~pparen~ that t~ objective ~f ~lg~ro~t~ a~ver~is~n~ l~ t~ ~11 a par~¢ul~z b~and of ciga- rette~ t~ Smoker~. The £undam~n~&l weakness ~f this ~ec~i~ ~f ~e R~p~r~ ~s ~hat it ¢~ntains n~ ~vidence ~ ~ven ~nside~n of c~ns~ p~rcept~ons of cigarette advertising, but ~ther of ~u~h adv~r~i~i~. Thu~. £~r example, th~ Rep~r~ ~ates. presen~ information ~ou~ smokin~ 1~ ~ highly e~f~ctlv~ manner" Staf~ has ~mple~y ~vlrlo~k~d the fau~ ~h~ ~h~ie ui~are~ adver~i~ment~ pr~s~n~ ~e ¢~n~um~ with num~ou~ conf~icti~g me~sa~es ~b~u~ ~.~ r~tive attr~c~lvenes~ ~£ ~az~lcuilr bran~ of ¢~are~e~, ~v~ry ~rtisem~nt, regardless ~£ b~nd, c~rr~es ~h~ ~e ~na~ous wa~n~ng J~at~men~. Given I¸

512 bus~nes~ re~r~ progr~ z~veal tha~ a. o£ 1975 %h~ c~a~ette ~ve~ti~lng ~x~ure~ ~ a p~c~nt~q~ ~ ~ales, an~ was f~ ~stri~p~d by ~uch ~ndus~rl~ as ~r~prietary d~u~, cereals, an~ pe~ f~od~, S~ A~v~tiv~n~ Agv 42 (o~ober lg, 1~81}. ~3 - 46 - ~i~arette ~ve~g h~s been ~h~p~d by ¢$rc~- st~es. R~m~val ~ ~lga~tt~ adve~tis~ ~r~m the bro~cas~ m~ia re~it~ ~n l~s ~o~£ine~ent to th~ print ~nd ~utdo~r m~dia. A~ ~ussed ln~e ~969 ~C Ci~a~etta B~port (~t ? • ~ 1~, r~dio and ~l~v~l~n accounted fu~ ~r~ ~ ~t~° fourths ~f all ciga~ette ad%'e~i~ exp~ntit~ras in tha year~ pre~e~in~ ~be broad~a~ ban. Si~ 1971. a~al advert~iL.~ exp~nd~e~ byte cigarette c~m~I~i~ adjusted £or in~la- ~O~, have averaged ~ver $100 m~li~n l~z than il~ the ~ur At the sa~ ~e, cigarettes ~re changing, and • bran~ w~re pr~l~fe~a~in~ ~n an ~np~eced~nted man~e~. The clg~r~e ~arket ~ in ~h~ m~d~ ~£ e~pe~enc~ng, a~d a~ti~ t~, a ma~r ~hif~ ~n s~ker~' preference in f~vor of ~owe~ "t~" ~l~are~s. Low "~ar" br~n~B accounted for nearly 50 p~rce~t ~f all ~iga~e~ sal~ In 1980, ~mpared t~ 2 pe~¢en~ ~ ~lx years ~rll~r. Today ~her~ are more th~ 180 dlf£e~ en~ bran~ or brand ~yil~ co~pet~n~ for marke~ ~ha~e~ Thi~ is • m~rke~ dev~l~en~ ~hat~e yT~ ~ta~lf ha~ lvn~ scu~h~ "Tn~ C~lssi~n hoFes tha~ the ~r~pu~al to di~cl~ ~a~ an~ nicotine ~ntent in c~r~tte ~ve~isl~g m~d~ by elg~t m~nu~- tu~e~s . . when l~ple~e~ted W~I le~d those ~k~s wh~ are unable to ki¢~ ~be habit to ~rea~er Snt~el~ in ~b~inin~ ~ 1~ tar a~d n~otin~ ~gar~tt~, and resultant competition am~n~ th~ ~i~arette ~m~anles ~ mce~ ~t interest." 1970 ~ Ci~a~e Kep~r% a~ 15.

514 515

516 . 49 . mPerhaps ~he mos~ dram~t±~ change in ~t~n¢~ u~e now t~king place among ~erican young people ~s the ~h~rp drop ~n re~lar cl~tt~ smoking, (Dally ~se dr~pped 4~ this year to 21~ ) The rat~ of de¢lin~ appear~d ~ aucele~a~o ~i~ y~ar ~monq b~th males a~d £~m~l~. We are ~n~lin~d to ~, ~t~i~ut~ thi~ chan~o t~ a lung-term ~ncre~ in youaq poopl~la health conce~n~ ~bou~ ~okinq a~ well as to a sharp decrease in th~ perceived pe~r acce~tanc~ of smoking."~ The National Institute found tha~ the proportion ¢£ high-~cl~l ~lor~ wh~ ~ay their peer~ woul~ di~approv~ o£ their sm~kin~ ha~ risen ~rom 55 p~rc~n~ in I~75 to 74 percen~ l~ 1~80, an~ =he p~opor~io~ of them w~lo e×p;~s~d p~rsonal dl~pprcv~l of pack-a-~ay smokin~ has incre~se~ frcm 66 perc~ in 1~77 ~o 71 percen~ in 1980~ (~. ~ 97,), Th~ Surgeon Gen~al~ ~979 Ke~ort (a~ 17-15~ 17.16/ says that "=igarette a~s are perceived by te~nag~r~ ~s hypocr~tical an~ are listed as 'leas~-i~~ .... . In ~ r~l worl~ in recent years ~here hav~ bee~ dr~atic changes in m~rk~ ~h~r~s ~nd rankinq ~ng ~he ciqa- r~tt~ m~nu£act~r~r~ an~on~ branda, plus a sDectac~lar ~ltiplication Cf brands, witho~ signific~nt increase in growth o~ th~ n~wer, low-"~r" c:qarett~ b~ands ha~ been at the exDense ~f th~ ~ld~r, "~uli-~av~r~ bran~, scmm ~f Which have a~i but di~app~are~ from the market. Th~ ~ac~s strongly ¢onfi~u the view generailyheld by all but the FTC Staff ~la~ i National in~i~e on DrUg Abus~. Hi~hligh~ E=om Stu~en~ 517 . 50. both ~ purpo~ ~n~ ~he e~feo~ ~ cigarette advertising 1~ l~ter-brand competition. C~ga~tte Advertisements A~ Br~n~ promotional ~d Make NO Explicit o~ I~!ic~ ~ealth Claims. ~n ~riticizin~ the ~hem~z an~ i~ag~ co~only u~ed in cigarette ~ver~lsinq, ~he ~£ ~il~ to recognize ~ha~ such ~e~ are simply c~m~on bran~°ide~lti~c~tlon ~o~le The content of o±garette a~ver~i~in~ l~ not d~ect~d ~o nonsmokers. but r~her is completely consistent wi~h the ~o~1 o~ int~- " brand competition. C!g~re~es are adv~is~ and sold ~xclu- sively o~ ~e b~si~ of brand identification, with vir=uaily ~u re~eren~ ~o t~e ma~act~rer's identity. Each adver~i~men~ ex~oLs the vir~ue~ o~ a p~rti~ui~r brand; none promo~e~ a parttcula~ ~m~any's ~tab[a o~ bran~s ~r the notion tha~ ~moking in g~neral l~ desirab~, The in~ereDc~ draw~ in the Repor~ ~hat adu portraying a~tr~ctive ¥oun~-adu!t models a~e ±mpllcitlF ~akia~ health claims is base~ou~, Ciga~e~t~ a~v~ti~emenrs ~re ~ dl~£eren~ in ~s r~ct ~a advertisements for ~ch cons~m~ ~r¢~ucts ~ s~£t drinks, b~er and cosmetics, The Staff finds implioi~ health ~lalm~ ~nly when ~ne product advertised ~s c~g~e~tes ~h~ Staff complains that cigaret~e a~ve~ti~i~lg portr~s smokinq as ~mp~ible with e wl~e range of athletic an~ healthful activities. Report at 2~13, But many te~i~ players, ~urf~arders, pro£e~i~al ~hletes. manual ~abore~ a~d ~t~srs wh~ ~n~ in a~etl¢ or o=her physical an~ health- ful a~tivitie~ ar~ also smokers. In fact, s~udies reported by

518 . 51 . trio Surg~o~ G~neral Ghow t~t s~k~r~ ten~ to be m0ro e~tr~- v~Fted, ~oc~ab~ ~n~ c~re-free than ncnzmoke~s 11964 Report at 365-366; 1979 Repor~ at 18-5 t~hro~ 18-7). an~ some stud~s hav~ ~hown~a~ smokers t~nd ~o p~rticipit~ mor~ o£~e~ In spo~ts ~nd pllysl~a~ a~tivity and ~o have larger bo~y dime~. s~n~ ~h~n non~ke~s. /1964 ~eport ~t 37~-373, 385-38~). C!~a~ly, there is no bas~ ~r the ~ta~'~ implications tha~ the models ~nd se~tin~s used £n c~ar~tte ~dver~ising ar~ not £~lrly ~presem~tive o~ c~n~umers. Most persons in their twentie~ and thirties, wh~h~r smokers o~ not, look perfectly normal ~nd h~alth~, The ~odeis ~a~d ~n cigarette ~dv~rti~i~ • ~ not ~ore ~tt~a¢~v~, healtAy o~ ~uccessful ~ooking ~an ~ mode~s ~d in most a~ve~i~ing.~ The Staff applies the ~ s~ra~ned anal~i~ to all ~lg~rett~ a~v~tlsin~, ~o mac~e~ who ~Ae m~e~ o~ what the ~e~t~n~. Men~l ~garette advertisements ofh~n ~eat~re ~reen ~olors, ~afy ~lades, snow-capped m~nt~in~, wat~r£alls ~nd ~ot~ln~ ~ould b~ m~e appropriate. S~h ~m~eB,ar~ ~niv~r~al~y ~sed to represent ~h~ cool sensation O~ m~nthol ~r mi~ in ad~r~lsemen~ ~0r prod~¢~s ranging ~rom ~nd~ to shaving Moreover, ~inc~ l~&~ th~ ~iqare~t~ manufacturers h~v~ • ~r~ voluntarily to a ~aret~e ~dv~rtisin~ ~ode that pro- hibits, smong other thin~, ~h~ ~ o£ achieves, Celebrities, ~r p~r~n~ wh~ ~p~ar to be ~ess th~n tw~y-fivo y~ars o£ ~ ~n cigare~te a~ver~l~c~enta. 519 . 52 - c~B~, bu~ the Stazf somehow finds bidden health mes~a~s when the product ~ cigarettes. The u~ of ~aso~al theme~ is also considere~ ~ubv~r- ~ive, a~ ~v~enc~d ~y t~e Report's denunciation o~ a "Christmas advsrti~emen~ for m~r~boro't that allegedly portrayed the "r~l~t~ve ~l~a~ure o~ t~bacco'~ ~nd unified "t~e ~e~i~e for a ~r~e~ Chri~a~ ~ith tJ*e ~xperien~e of smoking." ~ep~rt ~t % ~2 and ~-3. The S~a~ fai~ed to ~en~io~ ~at Clement Moo~ empl~y~ ~h~ ~m~ "anx~y-relievSn~" ~o~e in his zu~ve~- ~ve portrayal o£ ~ wreath of ~ok~ ~ncircl~n~ ~he h~ad of a pipe-~k~n~ $air.~ ~c~ ~ he p~u~d by ~he fireplace T~ Rep~r~'u cr~i~sm o~ ~he ind~s~ry's vigorous ¢0mp©~tiv~ promotion o~ Low "tar" and nicotine cigarettes i~ e~all~ ~r~i~d and mor~ ~h~n a l~ttle disingenuous in it~ st~pt t~ create the ~pr~on th~ it is th~ ~bacco ~n~- ~r~, r~t~er ~han -~he gover~ent i~self al~ng w~th private he~lt~ agencie~, %h~ h~s activ~l~ pu~i~zcd and prcmoted ~e l~e~ tha~ low-"ta~" cigarettes ~e "le~s hazardou~ t~ health. ,, A~ stated ~rl~er, when th~ ~T~ ~e~d~d in 1959 ~J~at "~ll ~epr~en~atl~n~ ~ low or zed~ced tar . . . w±ll b~ construed • s health ~laims,~ the industry v~l~ntar~l~ ~g~eed ~ ~minate all re~e~en~e~ ~o "tar~ from ~t~ advertising. It wa~ tJ~e FTC ~ed a ¢~p~l~ that resulted ~n the industry~s acceptanco ~ ~e Oo~eBion'~ request ~hat all cl~ar~ adv~r~isinq ~c~ ~r" and n~co~e c~ntent. ~ow th~ ~d~try is

52O . 53 . ~akan ~o task ~r ~vertiaing precisely what ~h~ ~i~ re~ired it ~o a~veztime. ! ~i~ u~diacriminating a~d ~r~lentl~g cr~icism o~ any c~qarette a~vectisin~ ~em~ is not n~w; ~A~e ~por~ is ~r~ly ~h~ l~t~t £n ~ lonq ~r~d rep~luiou~ ~inv ~f FTC a~ual r~por~ on cigarette advertising ~hat h~a £oond e~ch and every "±~agv~ e~plo~ in any c~gare~t~ a~vertisement to ~ "a~so~ia~l~g ¢lga~v~e smoking ~i~ ±ndi~daals, g~oup~ ~r Cigar~tt~ ~e~ort a~ ~. Thus, the cu~r~ Report complal~ ~b~ ~ use o£ imag~s of a~ve, OUtdoor t~cz, a~ well ~s about sophisticated women in ~ve:~ing ~r~s, ~¢~t i~9~ ~f l~., whit~ c~are~tes and ~li~, brown ciqare~e~. ~epont ~riti~is~ images o£ a ~eriou~, work.shir~ clad woman,, and other ~'d~pi~t~on[~1 of w~en in ~or~ ~ituat~vn~" (~97~ ~epor~ ~a~ l~ a b~ines~ suit and t~8" I~ at 51; ~fashio~bly attired, ~onte~pora~y ~o~ea" ~d "a feminine lmag~ . • . which ~eat~re~ £~ora~ arr~ng~ment~ as a b~ck~round" (1971 Re~o~t ~t gi~ick~~ (lb1~.1; "cho~ men a~d wo~en ~ho ~won~t settle f~ lv~s"u (ibid.); • cou~l~ ~l~lng in a ~adiu~ in the ~ain who d~n"t "co~ ~ut" Ii~ld. I; I~lndivi~ual men ~ womvn, a~ well a~ ~o~ples, relapsed du~in~ ~erous 'L~ ~oments'" (lb~d.)~ "m~n 521 - 54 . of ~b~ ~ea" (1970 Report gt 8); ~'stFlish y~ung £e~ale models in such ~l~morou~ s~t~l~ as a ca~l~, a ~ailbo~, and a ~ercoda~ road~" ~-~. at 9)~ 1"an inten~ youn~ coupl~ who st~red ~trai~h~ ~ead, with a ~o~e~hat ~oc~n~ lo~k ~n their lnt~ligant, ~tylish £a~e~" (~. a~ 10); co~ples ~epi~ted ~n gouger ~d sto~e~, ~n£1~i~hed f~rni~ure shop~, a~ ~ home in ~$r o~ flower ~ar~e~, d~la¥ing ~heir sophisticated ~rap.~round shades" iLbld)~ ~ "n~ce" L~k p~ople, Il~uch wo~k-a-d~y folk a~ ba~ers. ~ailocs, housewives, phot~gr~phez~, secr~tar£~, weekend ~lfer~, and p~l~er players~ ~how~ l~ setti~g~ that "are definitely ~ai~le cl~s ~n~ usually not I~ s~, it is clear that li~l~y any advertising t~ene ~r i~lus~ra~ion that • cxgare~e manufacturer may ~hoose to us~ will be criticized by ~1~ $~a££ no matter how gr~at ~e etrain ~n credibili~y. T~a~ is because ~h~S~aes qare~te ~dve~ti~l~g o£ any ~=rt. ~e i~70 ~TC ~eport ¢on~ ta±~ed'~ penetrating cbserv~ti~ that ~all cigarette advc~- rising ~rve~ to date p~e~ent~ ~ a~v~r~i~d br~d in ~avo~abl~ light," ~r.d ~en pr~c~ded w~th ~l~e ~ollowin~ criti- a~ o~ ~hat pheno~endn, disclosing ~he $~£'~ v~w o£ how ~ ~±g~rette co~anl~ o~gh~ t~ a~ve~t±~e ~elr prcdac~s: J'In addition to th~ g~neral tendency u£ ~11 cigar~t~ ad~,ertis~ng [by it~ me~e e~i~- ~l~h, many ~pec£~ic adve~t~s~ent~ ~nd cam- ¸, patgns h~lp ~elieve a~xzeties by the 0cene~ ~ey d~pi¢~. ~en people are displayed,

522 , ° 55 . wba~r their a~, ~uya~i~ or a~ivl~lea, ~ey are happy, and apparently h~althy ~ple, ~ Marlboro ~owboy ~s seen galloping thr~u%h t~ rain ~r sitting around ~ ~p~re, not occ~yl~9 a b~ in ~ emphyzema ~a~d, ~r even a lo~¥ bunkhouse. An "L~t mum~n~" n~Ver , , . ~ak~s place on ~he step~ o£ ~ ~h~ch i=~di- at~ly ~f~e~ ~ IUneral, ~:" an~he~ near a hozpl~a~ . ~, at IL. T.~i~ relentlessly ho~il~ a~ ~unl%ive approach to co~r~ial adv~r~i~in~r ~iv~rced from any s~mbla~e o£ obje~- well. and s~d~antl&lly un~rmine~ the Staf£'s ~i~cu~i~n a~d co~ciusion~ ~t ¢lga~ ~dverti~lng, & 9 &gO 9 - 56 . IV. T~ P3gPORT'$ RECC~IONS ARE CONT~L~¥ TO LAW A. The C~mmisslon I~ ~arred by Co~g~iona~ Poli~y and by I~ ~wn Previou~ Actions From Alterinq tl~e Warninq Statement. The Staff'~ ~r~p~sal To ~ange ~he Warnin~ $~a~ent I~ Contrary to ~n 1970, after ~n ~ten~ive r~iew of ~h~ en~ir~ ~moMin~ an~ heal~c~ntrover~y, ~n~ludin~ the ~C'~ rvl~, Congress passed ~ ~3~lic ~alth Cigarette Smoking Ae% o£ lg69, 15 U.S+C. § 1331 ~t~, which ~nde~ th~ original ~de~al Cigarette L~b~Lln~ a~d A~vert~in~ Ac~ o~ !955 (the h~n~i~ Federal program to ~1 ~lth ~i~ar~ttl l~ling and advertising." 15 U.$.C. ~ L~31. ~,~ c~nter~lece o~ the ~compr~h~lv~ F~eraL p~g~a~, that Con~ ~ev~l~ped was ~h~ warr~n~ ~%~temen~ %h~t ~ r~lre~ o~ a~l cigarette pack~g~. con~e~s pre~cribe~ ~he ~x~ o£ ~ wa~ning wi~eat ~peci- thorough Con~r~L~la~ r~vilw of th~ sclen~fi~ opinion p~i¢+ ~.R, ~p. ~o. ~89, 91~t Cong.~ l~t $ess, 2.6 (19~9); ~o. 897, 91~t C~n~.. 2d sel~ 4-5 (197~) in reachin~ ira con- c~l~n i~ to~ appropriate warnin~ s~a~men~ ~ be r~q~i~d

524 - 57 - on cxgarette packages, Conq~e~ rejected the FTC's pr~pose~ w~nlng.¸ ~. Rep ~o, 5~6, 91~ ~on~ , l~t S¢~. ~ I19~91 ~nile se=tion 7 o~ ~e Ace (15 U.$.C, § 1336{~)) recoqnizes the co~tlnu~d j~rle~iction of the ~TC to ~-eg~late ¢igar~tt~ adverti~In~ ~n a~p~opria~ cl~¢um~cances, i~ is ¢lea~ tha~ CongreBs expected ~he Co~mis~io~ to e×~rciEe that ~tho~ity in • man~r co~slsten~ wi~h t~e basic regULatory a~proach em~odie~ in ~h~ A~t. ~n this ~0n~o~tion, Sectzon 2 ~ the A~ s~es ~h~t efforts to l~fo~ the pu~l~ ~o~o~t the nor~nifo~:~, and ~onfusln9 ~i~aretta l&belin~ a~ adve~lain~ regulations , . . ," indicating Conqre~ion~l in~e:~t t~ impose a uniform and con~ister.t r.~tional policy in ~his ~ea. 15 U.S,C, ~ i~31. Moreover, ~der Section 8 o£ t~ A~t, ~he Ccm~ mlsszon ~ ~e~uir~d ~o eubmi~ an e~u~l report to Congress o~ uigare~ ed-¢e~tiaing which in~lu~s "~u~h recommendations for [e~i$1at~on ~s it may deem appro~i~te.a ~5 US.~. § l~?Ibl, T~8 obvious purpose of ~ia ~rovim&on is ~o O~s~r~ that CC~- ~ress~ Ill i~ fully a~p~i~ed of ~he contents of ciqar~t~e a~ver~i~ir.~. Izll has en a~ple o~poctunlt~ t~ determine whe~he~ new sub.rant!re approaches are ~ee~d, a~d ~II may ~erc~se i~ authority t~ ~ormu1~e a pollcy cons~mtent wit~ those need=. , "I The 197~ Consent Orde~z~ which ~nco~porate in ciga- rette a~vertlsln~ ~a ~re~ie~ warni~9 statement that ~on~ess h~ al~y re~i~ed in cigarette l~belin~ are noc i~o~Is~e~ . 58 . with the poliuy of unif~l~ em~odie~ in z~e AcZ. It i~ ~n • e~ire~Y differen~ m~t~r, h~wever~ £Q~ the ~T~ to ~eek on ire ow~ to dev~e a new w~rnz~ ~ta~eme~ t~at Co~gr~ ~a~ o~ither a~optad no~ approved. ~en Congres~ de~e~Ined that th~ o~i~i~ ~i~ ~tem~t ~Di±r~ ~' the 19~5 Act shoU~ be c~nq~d~ $~ ~m~ded the ~¢~ ~n 197~. The Act a~ ~mc~d~d thu~ ~epresen~s a Congressional determ~n~~o~¸thn~ ~ ~es~n~ a~zerted rel~t£on~n~ be~w~z~ ~mokln~ and l~eal~. Th~ ACt ¢onflicti~~ ap~oa~e6 t~ ~e ~ul~t~on of ~r~~a~ a~d t~at tl~er~ ~ilou~d De a com~he~iVe un~fozm pollcy~ ~isla- a~ti~lated Since ~h~U time, C~ngre~e c~nsi~en~y h~ taken a~ i~ive interest In all ~att~ rel~i~q t~ ci~rcu~ adve~tisz~ ~d ciqare~~e~,L an~ despite faction ,~i~ the prc~en~ wa~nzn~ ~t~nt, ~£the~ ±~ packaqing ~dj~dlc~t~on o~ r~lemak~ng -- wo~1~ vlala~e t~ ~le~r ~o~zcy of COngre~~- " , ~g7S, the O~±~ed s~at~ Dictator ~or examp~e~ wnen in~olu~ia ruled ~hat ~h~ Co~ume. c~r~ for t~e D~t~1¢t o~ ~ lu~isdlo~i~xz ove~ ~zq~t~es ~roduc~ £a~ety C~1~0!on l~d Conq~e~ a~en~cd ~a~ Ac~ t~ m~ke cl~r th~ the CP~C h~d 15 U.S~- § 12~Iif)(2) {I~75)- ,

525 - 59 . Tho Co~£ss~n itself has long ri~gnized ~e primacy ~£ Con~r~Bs~onal authority in ~lB ~r~. I~ ~65, durinq Congressional he~r~ngs lea~Jng to ~e ad~ti~ o£ the Fe~ral Cigarette Labeling and A~vertts~g ~c~ and ~he ~lr~t w~r~i~g ~tat~m~t, then ~2C Chaf~an~Di~ ~s~lfied ~ foll~ws: c~sz~e~in~, ~ha~ you are ~onsiderin~ right her~. t~e lanOua~e a~ ~o ~ warning is in ~t~ti~n. There is no choice here~ You ~ it tl~l~ l~h~w~y it i~ qoinq ~ be. I h~v~ said t~ you ~t if y~u pass what ~s re~ired ~ ~ label, = will ae~ure y~u ~e Commission wzll ~dopt the s~m~ lan~ge ~or lt~ enf~r~em~ ~f Zts adver~isin~ requlre~ Cha~an Dl~ repeated ~hl~ ~o~t~o~ during Con- gre~s~al hearings in 19~9, ~a~ln~ ~ "l~Jcrt~lnl~ w~ have no Issue with ~ wisdom of Congress in aFrivln~ ~ wh~t is an ~de~ato warning," Hearings on Cigarette L~el~n~ ~d Adver- Co~er~, ~lst Ccng ~ ~st 5~ s~r. 91.25 ~t 172 {lg6~) ~i~ stat~r~r~t w*~s ~cl~oed b,~ then Cor~ll~sioner ~¢I~tyr~, Who te~lfi~d t~'qa~: th~ ~l~Lection ~f a warr~l~ statemenl" "l~ a ~aatt~r ~f what ~hould be the el~Llehed lls~ez~" o~ p~zblic policy ~ tl~e p~culi~*r ~rer~gative ¢£ the Col~gr~s~ ~f tile [/nited ~t~te~, The Federal '~r~:le Col~u.ls~l~n, ~F ~ He,lrin~ on Ci~r~tt~ L~b~lin,~ ~nd Aclvert~ln~ B~or~ th~ 11965) (emp~aeiJ eupp~led).¸ ~ee ~lso Hear$.~g~ ~n Cigarette Lab~l~r~g alld Adverl.i~:.ng ~e~ore tlze $~a~e Co~l. on Cu~ercll, 69th C~n~.. ls~: Seas., pt. 1 ,it 45,1 {1965) 527 ° 60 - carrie~ ~ut that policy. It does not e~ablish th~ poli~y, l~ for y~u~r' Id~ at ~?~. When ~he Co~is~ion e~t~red ~nt~ Cons~n~ Orders with the major uig~rett~ maz~£ac~rers in 1972 ~ re~ir~d inclusion ~f t~ Congressionally mandate~ ~arning s~atement in all ~r.e ~opti~ ~f ~.~t warn£ng s~ate~t ~a~ aimed at "c~nsis~en~y ~, wl~ Congressional pol'~cy. " G. ~ain, F~C A~t~rney, quoted in ~all ~tree~ J~rr~, July 2, 1971 at 4~ I~e~, in the F~deral the C~ssi~n a~itted t~:~t "beca~sa of ~e nature o£ th~ ~seu~ po~ed by such a s¥~c~, rotational ~rn~nq ~r~o~als are particul~rly appr~pri~t~ fo~ C~ngressi~n~l ~¢nsid~r~Li~ " ~6 ~R. 30701 (J~r,e 10, 19~1). The Etaf£'~ proposal To Change the W~rning S~tement ~ C~ntra~y ~o ~ Lg~l C~r~nt Jud~ent~ and 1972 C~ent Orderz Entere~ ~n~o ~v t~l~ ~TC. ~ ~ta££'~ ~rl~cipaL complaint ~lnsn pr~t ¢lg~rett~ a~v~r~lein~ ~ r~ the warning statement pre~=ribe~ l~y Co~gre~s does n~ contain th~ Staff's claims reg~rdlz~ alleged h~ hazar~ ~f ~m~kl~g. Report mt ~-20, ~ut the war~l~q statement i~ inbound ~ all ~igare~te adver~z~g p~e~l~ly because ~h~ ~TC ~.~ in 197~ t~ re~olve l~s charg~ that ~re~te ~rt~ing wa~ ~e~pti~e by en~erin~ int~ n~gotiate~ C~nsent Or~r~ ~hat ~g~ir~ the l~zlu~l~ ~ ~he

- 61- warning state~¢~%. Lori11~rd et ~I.. 80 F.~ ~. ~3 (~g72).i MQ~Ve~. as the R~p~rt note~. ~n 1975 ~he F~C ~rou~ht a~v£1 penalty &ct~on~ ~gainst ~e major cigarette manufacturers £or ~llcge~ V~Q1ation~ u£ the 197~ Co~sent Orders. Repo~ at ~5 R~port. th~ Cou~i~s~on ent~ed int~ an OVe~ll ee~tl~en~ ~ ~o~e a~io~e.~ As part ~f tha~ ~et%l~mentr t~e Commission agre~ ~o ~.~ en%~y o£ consent Judgments tha~ in~erp~e~ an~ ~rpo~zedly clarify ~he 1872 Con~n~ O~er~ and p~ovide ~at the or~gfnal Orders ;e~ect±~ ~ warnin9 ~ta%e~e~t "shall remai~ in £~Ii force and effect."~ ~arnin~ sta~n~ e~odied i~ the ori~i~a~ c~n~en~ Orders. ~e FTC ca~o~ unilaterally ~pudf~te Ire agreement ~I i;apo~ new ~ ~taff ha~ s~ggest~d b~at the Co~auission ~ 1972 con. clu~ed ~a~ ~i~re~t~ adv~rtisin9 the% lacked a varnlng ~t~te- ~ent ~s d~c~ptlve ~his ~as ~ot th~ case, NO hear~g~ we~ held ~n the Staff asee~ti~s ~ deception, no fi~±~ oa ~he ~s~u~ were me~e. a~d ~he ~af~'~ que,tio~a~le le~a£ theory that advezti~Ln~ co~i~ ~ ~ou~d ~ecept~ve ~or failure to di~ck~ in£or;~tion o£ c~mo~ public knowledge w~e never pu~ ~e action against R.J. ~e~old~ Tobaaao company re~n~ pendir.~ bu~ only ~ ~o ~h~the~ pe~a tiee will be imposed. Z~ Conse~ Judg~n~ also provi~ ~:at. In~er ~lia: %he w~rnln~ s%a%e~mnt wi1~ fo~ the first %~e appear ~n vending ~lal. a~d certai~ additional ~n~in~-o£-~al~ ~t~ria~ the w~n~ ~t~em~n~ w±1~ appear ~n a ~±~91~ 1±ne ~c~s t~e botto~ o£ billbo~rd~ in ~on~iderably larger let%~ing; ~n~ ~h~ ~zni~g ~t~%em~nt will be ~i~clo~e~ i~ the ~a~ ~or~i~ lan~p~a~e ae ~ used in an~ forei~ la~ge adver~i~e~e~ 0 9 & 089 529

1 531

532 . 65 . advertiser h~s no dutF to "educate'q th~ public mr cc~ter Merrone¢~s" p~bli¢ b eiief~ ~ut the e~f~cts o~ its product unless ~s~ beli~fa have been fostered by the adver° tiger's repre~entatious. F~r e~a~ple, inky. FT~, lS2 Ccur~ of App~ls explained: "Ne th±nk ~ha= neither the p~rpose n~r the te~ms ~f th~ [;TC Aot] a~e ~o broad a~ the encour~gem~ o~ the inf~ative function. ~ purpo~ ~n~ t~rms are ~o preven~ £alsi~y Co~ion ~oe~ b~,tcn~ tha~ puruose ~nd en~ec~ a~ve~tisin~ wblch it deem~ p~o~erf]~info[~- ~ive~ i~ e~cee~s i~s a~tho~l~,].TM 181 F.2d a~ ~9. (Emph~£~ ~upplied). Tl~e FTC reached the s~e ~onc~u~ion ln~TT Continen~al ~akinq Co., ~ F.T.C. 865 {~973). ~ ua~e involved adv~rtisemen~s ~t claimed ~a~ ~ostess ~nack c~ke~ offered "~aod nut~±=lon" ~ecause ~hey were enriched with v~t~fns and minerals. ~e Staff c~ntended that the ~qo~d nutrition" ¢lai~ was ~is~ead~ng because th~ advertisement failed to disclos~ ~h~t Hostess ~n~ck cakms c~nt~ln l~rge ~unt~ ~5 sugar. ~n rejecti~q ~he Sta£f a~g~ae~t, the Ccm- mission stated: "[I]t would be unrealistic to impose upon the advertiser the heav~ b~cden of nu~rit]mnal eduzatl~ .... In ~he fin~l analysis, ~he ~es~lcn whether an advertisement re~ire~ ~tu~e and ex~en~ o£ ~e ~rit~onal claim ma~ in ~¢ advertiseme~%. ,, ]~. a~ 965. {Emphasis ~upp~ied). 5~3 ThUs, i~ ~e absenc~ ~f affirmative ~la£ms tha~ ~e~ t~ be r~medied, ~he FTC c~nnot leq~lly ~ompel ~Ig~ette aompani~s t~ di~cl~ss ~peaffic h~l~h in£orm~tion in t~ei~ advertisements. Although the $taff m~y a~ert ~bat co~snmers w~h ~ ~ec~ive much information,* ~e C~i~i~n has nu p~wer ~o obligate adver~Is~r~ ~ pr~vid~ ~i~ p~tentlally ~ntere~tinq ~n£~rma~ion reg~rdln~ the£r p~od~cts. ~o ca~e br~ugh~ ~nder Section 5 of which we ~re aware i~ co:~t~ary to this cenclus~on. All involve e~p~s~ health, safety, pricing an~ other clai~ that were ~ound by the Co~on to be likelF to deceive a s~an~ial poztlon o£ the buylag p~llc. For ~xample, in ~erica~ Medic£n~l ~r~ductz I~C., 52 F.TC. ~378 (1941), affld k36 F.2d ~26 (9th Cir, 19431, the only case c±ted by the Staff in su~Ror~ o£ its contentlcn t2,~ ~here l~ pr~cede~t {or requiring specific heal~w~nin~ (~epor~ at ~-2~, ~-29), the r~pondents had a£fir~a~tiv~ly ~epresented that ~ thyroid ea~ra~t product, ~e-Duce-Oi~s, was a tune ¢~ remedy for o~esiEy an~ ~n$~ltuted a sa~e, ~ompetent a~ effective treatment. In light of the~e speei£1c reRresen~ations, the ~C required that f~ure adve~- ti~ement~ contain a full ±is~ of hazard~ potent!ally resulting from ~e ~f Re-Duce-Oids, ~nd ~s disclosure tha~ Re°DuCe-O±ds ~h~ld Cnly be ~sed u~der competent m~dical supervision. * in f~t~ a=cordxng to the 1978 ~oper S~udy clted by the Report at ~-7, 7O per~en~ o~ the ~,esp~n~ent~ -° ~er~ and n~nsm~ke~ ~like °° fee~ that they ~l~eady "... know en~h ~" aboat this wh~l~ matter of sm~kinq a~d head'A%.TM 1~78 ~op~ StudF Q68~TM

. 67 . ~h~ fae~ ~ tha~ and ~i~ilar eases are cle~ly dis- tln~ish~l~ ~rom ciga;ette advertising+ In ~er~can Medicin~l ~roduct~, Cons~er~ wer~ urged %o bu~ a product ~laime4 to be a cure or treatment for a spec~flc health proble.~ and repre- s~n~sd as safe; these 4irect and affirmative h~al~/~ represen- tations were found to justify dlsclomure of the healt/n ~f~ects of use of the product Cigaretteg, h~wev~, are not advertised am h~al~h ;emedles, ~d ~o Gons~er b~yB uiqar~tte~ f~ the cure or trea~ent ef a health problem. The warning statement contai~sd i~ every ci~are%ze a~v~r~i~ement insures ~ha~ nu ~ons~r ~d b~ mimled and aside ~/%at beneficial healt~ eff~ct~ are cla~m~d for ~iqarettes. ~ne ~epo~t, ~n ~act, ~oes no~ serlous~y ~ispute t~is poln~, b~t inste~ contends %~aZ Cigarette a~vertisements ~arrylng ~he Con~r~!onal~y manda~ad warnlng statement are deceptive becausm ~ey do not s~t fort/~ the Staff's claims. As tl~ese Co~ents have demonstrated, the Szaff's premise ~ consumers are unawar~ ~£ thsse ~l~ima clearly is invali~ ~n ~y event, however, an ~dvertisem~n% cara%o~ be considered deceptive wi~/~i~ ~/%@ m~n~n~ of Section 5 i~ it ~ail~ to dis. close information ~ou~ which cQns~ers m~rely ~re unlnformed; deception m~y o=~ur only When cons~ers are mlsin~o~ed ~u~ %2~ ~ff~ ~f ~e prg~u¢~ &~ver%i£ed. ~"~at proposition is e~t~llshed by one ~f th~ very ~es re~le~ upon mos~ heavi~ by %/~e Staff, Simeo~ M~naqement Co~p V. ~TZ~ 57~ ~,~d 1137, ~5

~6 . 69 - V, ~STAFF~S PROPOSED~fES The "Remedlal Action" proposed in the Re~rt l~ Unneoes~r7 and Ill-Advised. The Staff H~s Not 5hewn That ths ~ele~t w&rnlnq State~ent Is ~nef~ctive. threl reasons in Buppo~t of ~t~ bel~et that ~ o~r~ent varn~n~ tive~e~ are nece~a~y~ (i) "~he current w~nlng refer~ to the hl~Ith 1~ard o~ ~ohln~ ~nly in th~ ~o~t ~ene~l~ed way, ~h~ ~arnln~ doe~ n~t co~unlcate i~£e~mati~n on si~iflca~t, - ep~c!fic r~sks ~hat hav~ ~ac~ntly been (2) ~te~ ~a~l~ • ~e~ad~ ~he current w~nlng ha~ been ~v~Rose~ ~d ha~ i ~m~i¥ worn o~t • . ~il~ cigarette a~ pre~ent t~ei~ ~a~e in a variety o~ £r~quentl~ ch~n~ing, attention ~e~ting abBtr~ct warn~n~ ±~ ~e ~am~ ~c~an~lar share h~ appeared unchanged in every l'Th~ £~il~r~ ~f the wa~ing ~O p~oVi~e B~clfic h~elth infor~atio~ ~d th~ which ~he~ it difficult ~or co~u~er~ t~ r~lat~ th~ w~r~,~ng to t~emeelv~B, c~ntribute to ~t~ i~e£f~ctivene~s." ~e~rt ~t 20. ~o~e ~ ~eee ~ts~e~e~t~ Is ~up~or~ed b~ ~h~ remainder of t~o Report. ~£r~t, the Staf~ h~ presented n~ evidencQ'to ~e~on- ~r~e ~at s~ec~f~c infor~t±o~ on ~ ~lleged rf~ of ~k~n~ w~l~ ba ~orl ~e£~o~iv~" ~han the current ~n~ral ) ii! !i ,!i i

538 . 71 . t~ ~hem~elve~," A~ h~s b~en pointed out e~rl~, tJ~ St~ff'~ compa~ of "freque~ly changinq . . . per~nalized'~ c~ga- retie a~vertisemen~ wi~h~he "unchanged , , . ~bstra~" warnin~ s~atemen~ i~ misleading. The ~orm~r m~ achieve c~s~er recall~£ a particular brand among numervus ether br~ds~ all of ~h~h pre~en~ c~pe~ing and ~n~l~n~ mea~ages, while the ~tt~r ~pp~a~ consistently t~ th~ ~n~tt~er in every advertisement ~n~ ~n every pack ~f ci~rettc~, An~ ~e~ha~s m~ ~t~l~rtant, c~g~ret~e ~dverti~eme~t~ ii~i~ed ~ ~he print media a~e the only me~o~ b~ which cigarette manufacturers can the sur?~ G~nera~'~ war~ing i~ only one Cf nu~rou~ means by which ~n~ttmers are ~xpos~ in ~1~ ~ed~a ~o the claim by q~v~n- ment agenc~ a~ private an~i-~kin~ ~r~up~ ~a~ cz~are~e smuk~ng ~s haz~rd~u~ ~ health. Yet, ~ h~s been seen, th~ w~rning ~teme~ h~s been rema~kMOly e~£e~ve in pr~m~in~ p~±c ~arene~s of the ~m~in~ and h~l~h c~ntr~versy. 2, Th~ Staff Has ~±le~ To Demonstrate That the proposed ~otati~n~l War~in~ system Is Likely TO Be Mor~ ~ff~lve Th~n ~he Curren~ Warnin~ Statement. Aside £r~ ~he ~a~t tha~ the R~port pre~en~ n© problem for which remedia~ a~i~n ~ ~pp~opri~e, t~ Sta£f ha~ ma~e n~ ~f~ ~ de~ermine wheth~ l~s favored pr~p~a~l, be ~u~ e£~e~t~ve tha~e w~rnin~ s~atement that the S~a~f now f~nds t~ b~ defx~len~. Indeed, ~.e $~a~'~ 1'evidence" ~f ~9 . 72 . the likely impact ~£ ro~ti~tal war~ing~ £~ ~mited ~o "~me prel~minar~ research" ~n Sweden*~ rotatio~l warn~n~ system. The evidence ~he ~f£ has be~n shl~ to mar~hal~ in ~up~ort of rvt~t~onal warn~n~ £~ meager an~ lnc~n~lu~ive~ ~-h~ Staff a~it~ a~ much whe~ ~ ~once~s ~l~a~, ~spite the "~r~iminar~¸" r~earch ~e~ul~s ~ which i~ ~e£er~ la~d which are no~ ~ecif%~ll¥ disclosed or ot~erwl~e discu~e~ ±n the ~epur~), "the Zw~ish [rotational] ~ystem's long.te~,m lmpa~ cannot yet b~ ~leasu~ed .... ~ Report at 5-33. The S~a£f • 1~o appa~-~n~ly £eels co~pe~e~ to st~t~ tha~ "there ar~ a n~ber o£ ~ere~e~ b~we~ ~h~ U.$. and Sweden ~ha~ make it • mp~ss~b~e t~ ~%ato ~ha~ ~i~~ e~erie~e wi~ r~ational warnings w~l~ be ~o~p~r~ble ~ ours ,I ib~,~t ~p~te the~ ~n~e~i~ns, the 3~aff ~onclude~ that Swe~n'~ brief experianc~ with rotational ~arnln~ "[n~ever- the~es~ . . . xs inst~ct~ve.'~ ~b£~* Th~s remarkable c~n¢lu- • ~n, with its sxn~lar ~a~k ~f basi~, r~veal~ at ~nc~ the ~eed, the Sta~£'s rellan~e ~n Sweden as a ~e mo~el for ~e~lator¥ ~¢tion in t~s countr~ is not w~h~u~ ~ub~t~n~ ~ial irony. ~l~e S~cd~h Gove~r~ent n~s g~e £ar beyon~ a~l ~he~ Western g~ver~aen~ ~n ~he area o£ atte~pt~ behavio~ mod~£~c~t~n a*~ in i~ !n~ru~i~n ±n~ private sector activi. ~e~ ~t th~ ~p~n~e o~ ±nd~v~a~ ~re~d~m aad ~slf-rel~ance, ~n~re is a qro~ing bo~, Cf evidence c~n[ir~,~g the high Zet~ezbe~, Th~ Le~l~a~y ~r~is of ~he We~far~ S~a~e and V~ ~urin~ "¢h~ A~i~u~e in Sweden, Vi~n 43 (M~¥ 1976). The S~aff's approva~ ~£ the S~di~h ~y~el~ ~f r~a~al warnings s~mply ~n£irm~ t~e Staff'~ ~nterest in ~lterin~ c~n~umer behavior r~ther ~han ±n~r~aslnq ~on~u~er ~wareness .. a wh~il~ inappropriate r~ula~ry ~oal.

840 - 73 ° 541

542 . 75 . remi~g because it ha~ not fully ~ed wi~h the S~f'~ po31- tion on ~mokinq aa~ heat~, ~y objective review of past industry ~ tio~ will r~$pact to advertising reveal~ ~a~ the p~ition, of ~ t~bacco i~d~s~-ry h~n bee~ a r~sponsible one, $i~c~ Zhe S~r~eon General's initial Report ~n 5m0kin~ ~n~ He~l~ was ls~ue~ In 196~, the tobacco industry ha~ ~aken a n~er of ~ign~ficant ~t~p~ to modify it~ ~dvertL~ing and promotional pr~ctice~, ~z~ecia~y ~o avol~ ~nfluenc~ on ~n- a~er~. I~ ha~ ell~i~d ~dv~r~lsir~g i~ ~t~ent publications and ~e d~t~ibuti~n o£ cigarette ~ples on ~ampu~e~ ~r ~e~r scho~l~ It ~as e!im~nated the use ~f t~zmon~ls bY a~lctes and p~ll~ £±cy~r~ ~n ciqar~tte advertising, and h~ re~lr¢~ ~ar all mo~l~ used ~n cigarette adverti~ln~ be, and appear ~o be, 2~ o~ older. I~ ~u~ported ~9 ban ~n brca~cast adv~r- ~i~ir.g cf c~gar~ttes. ~en, in 1959~ ~e FT~ ~£dc~ ~a~ "all rgpr~z~ta- ~±on~ ~Z low or re~u~d tar or nicotine, wb~ther Dy f~tra~i~n or o~e~l~e, ~'lll be c~nst~ad as health ~a~ms," th~ ~ndustry voluntarily a~re~d ~o elimin~ a~l ~e£eren~ ~ "tar" and nicotine ~r~m ¢i~te a~v~rtl~in~. A f~w ¥~ar~ latch, When the CC~l~si~n rever~c~ ~S p~i~lo~, ~ ~n~stry a~c~d~d to l~ requc~ ~ ~ga~te a~ver~isin~ d~s~o~ "tar" and nicotine cont~n~. In ~972 ~ ~c~ers of ~he l~dustry agreed ~ ~e Con~nt Order. re~lring the warn~nq ~tat~men~ in ~1~ ¢l~arett~ ~dv~r t!sin~. & 9U& O 9 Th~ indast~y to d~t. h~ committed mor~ than $~I scientific an~ medical research on smoking an~ healt~l qaes. ti0n~. I'rn~.~ ~A:s v~ews on smo~xng an~ h~al~h queatl~n~ d~./fer from ~ho~e ~f the FTC Staff, ~t doe~ not u~ cl~arettl adver- ti~ements~ t~l ar~a~ thoa~ views or t,a di~cr*~l~t the Surueon Tb~ ~ndu~ry will cen~inull to mais~tain a re~I~on~ibl~ adver~'lsing poi~y* It wil~ not, however, s~lbmit to each annual fl±gh~ of £an~y I=y the FTC Stal~ff.

~44 Smokinq and Rl~lth 19~4~g79 THE C ON T I ~ U ~ ~G C ON T R OV E ~ S ¥ T ~ E TOBACCO INSTITUTE 187S [ S~re~t, ~. ~., ~h~tou, D. C. 20OO6 Sa~a~y 10, 1979 $ 9 & 059 T~ble of Co~e~ts P~eface 54~ 1 ~3 3~ 71 87 I03 t~9 ~39 :This ~olume ~ ~ublishe~ by The TobacCo Institute re~ea~ch. i/£

547 • ~e~ ~he~ ~o~ or, ~ ~s ~ |~e ~h~, ~ c~ ~lde~t~ The ~ob~co I~c~te J~y 1Or 197~ v~

548 d Ov~vLiw °. S~o~t~2 ~ 8ealch ~97S O~9~&~Og9 dl~s~ In nona~oke~s,

551 a~v~le o~e¢~s ~ chL14reu. Eov~vs=, q~tio~a ~avl beau The ~ of ~uI~ fcom fl~ed ~lon ~udie~ =~ho~s ¢~Z estsb~ah ~ ~ r~lat~o~?...'~

552 ~conmJ~teat flnd~n~ Erom stcd~e~ vf ~mok~n~ ~ • n~ Lb¢l~ Ch~ldr~ ~ak¢ l~ ~m o~ble to dra~-¢on- ~rm ulu~ 0uc omm ",~n~ m~d E~rl~ He~vpaus~ ~icB~h ~h£ch ~pp~l ~ ~d~cmt~ tha~ ~mokurA 5~3 2

554 ~omg~ s~ Lun~ ~Anc~r ~ c~nc~r l~ ~e ~ork Pls~ 555 Lu~ C~ucer ~o~z~£zy ~ ~s ~u~y b~ b~ ~ke~ b7 ~o~ to ~e

5~ • I~llrdlovoecular Dll~l~ql ~ .

~h~o~i¢ ~bat~u~ive rqlmonR~v DiRemle ~ • • , [ LJ~ C~I~Q~tO~J ~O~J£~B t~ ~£~I~ ~11 ©0 bl p~I~1~ bS~U*. ~ ~r~ ~d.~S ~n~ ~ • ~o~ ~7 ~ ~ ~e ~,~'L f~

A ~oc41z ta~bnlquJ o~ |ona reBma~¢~ere hla bgQ~ B~4ee ~m~ ~I~ of ~t~oppiu~ mo1~Qu'r, ~ue ~b~ iod •

563

p~Ly~'~mo~, a~ ~ ~g~r~ ~£e~t~en (~1, 19

567

569 .... '

571 25

li. 573 I

~f 5aokiug; 1~75, ~.5. ~ep~t~ea~ Cf ~lth. ~uca~lna 1957. 575 29

30 577

5~9

T~4 une ~f r~e~tn ~m ~e~ed p~p~la~lou ncu~llm i: 581 e~me~8~e as ~vun~offi~n.

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584 39 555 t~o~ wl~ £ucrelsed Ln~ldl~Ce ¢| • dlm*ae* [0~ dea~hl, re~oVll Auothe~ p~obl~m vl~ t~ ~aTn14~ug ~urv~F ~1~

OCLIB ~ 1~7 ¢14imm of bll~ mO~ttl£©y ~a~lOa a~d£or ex~lme de~Chl ~n Bwakm~ ~m ~hm ©l~uful Cave4~ v~ttt~ 5~ • ato thm ~rwL ~g~ ~1"1 rlpo~c b7 L~l auCh~l. h~ ~ ¢o~ ~a ~ C~e~ $~e~7 ~c~ • ~ ~bQ ~r flc~rl V11~ h~v~ ~nl7 • ~al lIp~¢~ 42

,, . r~ 43 "= ,i i ;' , ~i i~ I , :

If. &~c~= ~w~ ~ecs~el of deuouu¢l~g a~kius snd ~I~1:~I ue~, ~u~-~moklnK or~zs~Loua ~¢ lu ~8~= y~ lau~ ~ape~= ~r~ t~ vh~ EE~ h4o ~a~l~d -~he imokl~K.ee~l~e~ = ~ • • ~lz&ble ~C£O~ o~ the ~ 1577-78 ~O~C =o Ca~.

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5O i'I ~ ,!~i~"~ ~ ! 595 bsby la~ ~t ilall. Rut [~l] S~Q~2d D~ ¢1a£~ ~lwk to Ilf~~ $~o~t1~*ous A~ortlo~ In the 1973 ~ rlpQrt ~ Congreso, th~ l~t npeci~1- ~o £Ir~ ~OnC~U~£~ a~¢ ~ae "~U~~' cf ~e re~a. 51

596 {17~. ~2 {

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56c ~i, ~ a~9~os~ 60i! i: ! u~ ~ ~o~ ~k~'~a ~o~e~t~ln dl~£~ C~7 ~ ~ ~ • i~ n 57 ii! ~ • i i~ i ,

58 i~ Smok~ and E~I~ Ke~op*~*~ ~Q~zg~ minoDs~a~ a~£~r ~hln n~*~e~j {401, ~=o~dlu~ =~ s~gg**~ cn~ ~h~ aenop~u*~ ~ an~ e~ on the

Ii i~ !i 6O5 ,, • T~ p~$ s~u~y ~1s¢ p~n~ld ~a • ~ace C~SC ham his© C~C ~*an vom~ ~au~r~o =e~op~e Tha 2aa~u*s~ factor (47-~91. &~=~ p~rso=w ~b¢ d£1apprcve o~ e~lsrec~ sm~ln~ ~=~a nzv~ =e~or~d[~ ©~e~

GG9 63

6O9 2ef~eacea fdr ~mea a~d ~o~n~ Ob. ~¥~ ~*~l ~/~1 1. 27. Fab. ~5. ~9~8. i ,L. 65

66 611

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619 Tabl~ 2 51~od-fo~m~R a~aa~, pir~e~~ " k ~8~ ke te 79 ~O.ISC 77 2OO 8C 8~ "lk~C 7OO 76

tmao¢~a~loa of Dma~xng ¥L~h :i : i I i I : : i

79 623 GO

8~ i i'r ~5 D~. H~epI~, unosm ~p~1onal r~sea~n o~ ~smc~ r~ o~ o~up~toua~ ~z~o~ ~. t~ ~1o~ o~ d1~x~.~ T $2

6~7 84

628 L L~E • 629 ~h~ £1l~ure to ~o~l~e~ erotically 1] ~13~can~ e~l~ ~ud I~em~a~&r~ m=p~a~a~tons o~ ~u~ ~er ~lus4~£~, but Ion| c~a~e~ m¢~1£~7 ~|© ~k~ l~t~ s~©~ :haole| ~z

' ~ . 631 ~owlrd ovQrd£1~aam~|'o~ ~he dlg~ama ~ ~bl baols o~ ,~ T~B~do 1~ P~a~h ~*~ ~ 9mokln= Pae~eep~*; I~gmoa© O~ ~he pop~ll~io~ ~o~t wus~p~lble ~o ea~=e; [~ht a~td)

~2

634 ~ ~alf-Jl~e~lal -- Tbt ¢o~w¢~ut~ual B~P~h~l~m .. • ~ ~976p ~ho ~C$ lutlrprleld a~ f~m L~l 25~|La~m ~ ~ ~| ©~ ~ ~ ~ ~ ~ ~o~1~o 92 ,~-~

636 • 4 r, , ~'he Changblg HlstopatllolOgy 1 . Of LUng C;~nGer T . . .~,r 94 'L~ L ' i I

~6 ~9~&~0~9

des4~s~rac~d (30). g~

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716- 717 $TAT~4E~ By: Edward ~. I~p|edt. Jr.. H.D. ~$~lsta ~ ~ecr~ ary for ~alth on ~h relea • of flail frem e i , ~lt p ~ A ~ F ct~r nterven on Trial ~¢IT] . , , ~teaber 16. 1902 l~e N~tion ffear~ Lung and o~ ~nstTtu~e of t~e ~tlo~al ~f ~ t~ od y released ~he flndfn~s o1' ~ nm Q~ S P~ te Fa¢ ar nterventTon Yrla[ /$RFITI. The itvd J ~udy* the Hultip e ~ $~ le en~ f~r th~ hea th of Americans. ~ resu] s contal~ I~orta the Tbf$ ¢1~cal ~rl I. la[tl~ted 10 yenr~ o9o~ k~s ~$1~ne~ to demon r he e;~tent to ~h C ~r~ent ~r ¢ ~ ti ~e to be td~resse~ W~L~ d a fec deatE Le ~u~ to or~nary Interve~tfon~ Mhlch t~JY. 0~ ~hn . about 6.500 received "$pe~fa~ |~clu~¢~ dietary mOdlf~c&~l~n. ant~yperten=lon tre~e~t. an~/~r ¢oun~eHn9 for sm~k~n~ cessatlw. ~r~the~ 6.$00 mfd~le.aqe~ ~o~te ~B~ ma~e$ ~er~ a$$1~ne t~ Lhe "osua] ~re- ro~ t~ter~entfon hey ~cvfv~d ~s ~ el d~ enPe That Is. tee level of c~re or. the r v~n ~fvl ea ~nf~e$.r9 y p nt ¢~ ~tie quality of care In a = ~ ~J~ of $~ yver$. Each of t~e~e v un eers ~s ~ ~e~ f~r The resu]~ ~f ~iffi ~rlaT. re|ea~e~ tooay, confim ©U~ SUCCess In re* ~Cln9 de~t~ ~ate$ from cardiovascular ~ ease Ln t~S ¢O n y. ~h 9r UV$ of =en ha~ f~r f~ ~ car~low$cu ar ~ aths than ~ere ae Ic pared ~nd Lh~ differences between t~ pec a~ inter entfon ro~p and the usual ~re 9r~uv ere not con fder¢~ st~t stfca]ly £19nlf ¢aat, I~el) *~le stu~ ~$ p14r~e~ a larger 41ffere Ce ~ ~rr~ ~y W $ Ant C ." ~. patg*d. ~,t the ~ar~ t ~le~ t ~a$ ne~ an~Iclpa ed ~t the red~C 0 $ ~n the threl risk fa~tvr~ un~e~* $~j~y you d be $o 9rear in *.~e =u~u4 ~; re" r0,j , //~ ~d&t ~se~atlon is quite important, for It e~pha$izes t~a~ the "~Su~I c~- 4fforde~ ~ f~erl~ens results l~ reaece~ rl~k I~ac~r~ or ~nlerlcaa ~len. re~o~nl=ln9 the I=p~r~eflce o risk ac ~r r~uc ~on I~ve vet $e to ~e so Or ~th ThiS $ an m errant vb erv~ fOR This stuoy a~aln sPow~ the va,ue of ~ucfn9 ~ne's ,I~k~ of coronary h~ disease FOr ex~pTe. the de~th ~ata for t~o~e sine qu t ~r~klr~, even for O~ year ~a e~ ha f t t th¢~e ~ho d]~ no~. T~at h~u d st]~ ]ate = dd e-a~ed ~ale ~kars to i 1~. The ~a~ we have f~ ~FIT Is I~pre$~]ye; ~y ~re re~]t$ ~]11 be less~n$©°mfng o~tto °fe~r~.the computer in the r~on~ ~D C~re. Tiere tre more ~por~n~ Let me $9~In ~ha$~ze ~hat ~o ~ 9~up$ reduced the t~ ee r k ~r~er study and ~oth rcq~s exper~enee~ a ~r~a]~t ~cto~ y rate cops d rab]y less

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735 • ((]t~T 6) . Another potnt [ wee]d like t~ make ls that i;he cost to ~hls cogntry ;eer Oo;*on~Lny ~e~l~'~ ~[se~.~e Is over~J~]~|og. ~ell G~er ~.~1~.030 ~e~e~ce.~$ ~ve I~nK attacks eac~ year. rbe Bnnua; ¢a$~ a~SOClatee wl~o heart disease In ~he ~lted States Is yell over 25-blZlio~ dollars. If one InCluded Indirect cas~s. I~¢~ ~| tno~e assDClated wI~ tgs~ p~D~ctlvlr~I [;he e~lGl~tt~ would ~ ~ce~- ~,ere around 50.billion do]Ions lace year. IIt~ tha~, I wautd 11ke to I~troduce to you, CT, ~lllfa= Frledewald. Dr. |rle~wald IS ~$oelate I~lrec~or for ~l~n|c~ll /~DllCattons 0nd Pneve~tloo fn He~rt and Ya$cIJlar Diseases, tie Is also the s~nloP Institute ~l~o ha~ been lnvalvsd in L~;~S ~or ~tu~y. ~e ~111 Tntroduee ~1 0~, Lenfant men~fonea, t~e ffeca~a~datlo~ to I~p]e~ent the tlultlple Risk F~ctor ZnLe~ventten Trial (HRF~T) ~as ~de by the 1970 Ta~ ~fce oo ~er~o- |¢ie~Is, ~ctually, their f~r$~ considered?on ~s the passlbl]f~ Of ~%e- ~tlf~ ~ nstlonal $~Jdy af dleta~ Inter~efltlon $1one to ]:est t~e dle~-I~a~'t f~eor~, rhl~ was rejected, gowcver, as t~ot being f~asl~Ie, It w~$ felt ¢Mb ~he sa~]o size ne~ed ?o- such a st~c~- ~de It u~ancep~ab]y eXpe~S~VO, ~ there Was co~sl~ova~le doubt whether ~ole c~uld b~ fMuced to ¢~ke n~cessa~y dietary chaages wltoou; 1.relying other chang~ In ]lf~Cyle, I¢¢h is s~kl~g. From ~ese dell~ra~lo~s ~;~ tile ~r~osa] that a ~1t1- • F~cCor study be Initiated, ~e r|S~ factor~ selected for Intervention • ~: 5~gh blood pressure, eTevatod CholesCerel levels, and cigarette M~rt disease, stud~ of the S~Ze of ItRF[T obviously reo~lr~ ~ ~lc~fo~ ~f ~t Inv~tl~ato~ and t~efr ~t~ffs at pa~t?clpat~g cIl~lcal centers as ~eT1 is blos~tlstlcal ar~ ~aborata~ Ce~te~. There ~ere Z8 centers f~volved ~. this trlaT. P~prese~C~t{ves from =hose Ceoters, Including tony of th~ principal ~estlgat~r$, are with us tod~y and ~ave been engaged in i series gf I~tlngs have Been BO cling ~ d scus$ f~e ~F~T ftnd?ng$. ~e~r c~n~rlb~tlot~ over ¢P~ years tO this ~tuay have 6ee~ enor~us., O? ~ual contr~bu~|on was t~e p~rtlctpatton of a~t ~3,~ valun~s ~g pers~s~ ~lth US for ~W yeats. I¢4~y, ~te af~ fortunate ¢o have with us, Dr, t~le~by paul, the Chal~n of ~e p/~F~ St~r~n9 ~ftt~e* I~d £¢, ~e~ah ~e¢ on= of ~h~ p~tc~p~l Ir~ttgator~, to help )fes~qt t~e ffndla~s ?Po~ ¢J~s ~aJor sbJd¥. ~'. Paul I~11 explain the particular go81s and the dcs~g~ ~f the S=UOy; I ~tll dis. fIMf~gs~ ~', P~uT wt11 Couch on the ~n~eroretat?on$ end ~mvllcatlon£ Off the findings. Then* ~e will eotert#~[n ~ur eueftTons, ~. ~ ~ould 1(~ to ~ntfoduce ~, Paul ~o, In addition to ~lng Chairman of tJ~ HP~£T $&eertng C~ttoe, ~s Professor of ~d(cfne, E~erlt~s at 118~ar~ • dlcal SCl¢01, i ,

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, . .- ~ ~ . - , 3 • • = • - < •H .... ~ - DEATH RATE FOR ..... - ' ~= • • ,--~ .-- " ..... ...... ~ CORONARY HEART DISEASE :-~-[~ i ...... " ~250 * • " ~"1511 ~AII persons 2OO tEO - -- • I ~ - , O0 100 I I i I i 1 -- 1940 1945 1950 1955 1960 1965 _ Year - MRFIT - - .... • DECLINE IN CORONARY HEART . • DISEASE SINCE. 1968.., . . : -0~. 0 . - 10~ 10 g . • - ., . = i ~ I I I 40 - 196919711973 19751977 1979

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p,. • MRFIT'I OTHF.R OBJECTIVES " * TO determine Impact on: cardiovascular deaths ~- deaths from all causes -~- coronary heart disease incidence • To evaluate impact on sub-groups • To determine undesirable or toxic effects LOCATION OF COLLABORAT|~G CENTERS O1

£,. RFn" DESIGN FEATURES ,, Men, 35-57 yearn of age = Free of overt CHD o High risk of CHD Volunteers o Informed consent o Excluded extreme levels of BP or cholesterol ® Randomized ~ Special intervention to lower risk factors Controlled -- usual care = Extended follow-up . . MRFiT SELECTION OF PARTICP~,i~TS First screening " 361,662 • • • • • = • • | i Second screening ...... 22,(~80. Randomized .......... 12,886

gO c.# ~RPIT EXAMPLES OF RISK FACTOR LEVELS IN ELIGmBLE MEN 60 , 100 100 8O 237 2O 22O 0 CIG BP CHOL C[G BP CHOL " CIG BP CHOL_ Man A Man B Man C KEY: [] ,~o~ [] ~a~ Bp, ~rlJm ch~e~(o~, mtl~ ~ ~oC~4II ef MRFiT BASELINE COmPARiSONS Age White (%) Diastolic BP Serum cholesterol Smokers (%) 6 yr. CHD risk (%) SI UC (_N = 6,428) (N = 6,438) 46.2 46.1 92.8 92.8 91.0 90.9 253.8 253.5 63.8 63.5 3.12 3.15

Q p- c0 ~3 ~IRFIT iNTERVENTION GOALS • Level of Risk Factor Risk Factor at First Screen Anticipated Percentage Reduction SI UO Serum cholesterol -> 220 10 0 (mgldl) < 220 0 0 Diastolic blood -> 95 10 0 pressure (mm Hg) < 95 " 0 O Cigarette smoking 1-19 55 15 (cigarettes/day) 20-39 40 10 _>40 25 5 or= INTERVENTION METHODS Cholesterol: Dietary advicel modified fat. Weight reduction. Diastolic E]P: Stepped care drug treatment. Mild salt restriction. Smoking: Counseling for smoking cessation. Behavioral modification.

p- ~3 £- MRFIT INTE3VENTION RESULTS: CHOLESTEROL Serum Cholesterol 27C - ~ .~25c -.o..u2_.~....° E 24£- 23£ F I I t t 1 /2 3 4 5 $1 I Year of Follow-up 270" 260 25O '240 230 6 MRFJT iNTERVENTiON RESULTS: BLOOD PRESSURE 100, E 8O Diastolic Blood Pressure 100 90 %% ;k'o... UC I f I ~..r.__,j~ 1 2 3 4 5 6 Y~ of FoIIow,~up ¢J] ¢.¢* $1

i~i,~F|'~" - INTERV NTION RESULT,5;: SMOKING Reported Thlocyanate-Adjusted Cigarette Smoking Cigarette Smoking 70 -, 70 70 ~ 70 60 .. - 60 60 ;~---o UC 60 50 \ "~"--o-....o. - 50 50 - \ "--o.... 50 o/°40 ~=.__: .~_~._~40 °/°40 S~~~I~" 40 30 SI - 30 30 30 I I I I ? I I I I I 1 2 3 4 5 1 2, 3 4 5 St Year of Follow-up Year of Follow-up MRFIT CAUSE-SPECIFBC ORTAUTY SI UC DIFF. Coronary h~art diseasa 115 124 7.1% All cardiovascular disease, including CHD 138 145 4.7% All causes 265 2~0 -2.1%

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7 p,. L~ MRFiT • SUBGROUP. ANALYSIS H No. Participants SI UC Hypertensive, Not on Treatment at Entry_ Diastolic BP CHD Deaths 81 UC 90-94 . 1,157 1,181 17 12 95-99 830 846 ~ 19 19 2.100 771 739 16 22 MRFIT SUBGROUP ANALYS~S ~! No. Participants CHD Deaths s_.j__l uc- sl uc Non-Hypertensive Resting ECG abnormalities Absent 1,817 1,852 ' 24 30 Present 592 583 11 15 Hypertensive Resting ECG abnormahtias Absent 2,785 2,808 44 58 Present 1,233 1,185 3,3 21

~9 SU ARY OF R SULTS ® SI-UC risk factor differences moderate but significant ® No significant overall difference in CHD, CVD, or total mortality , Positivelnegat~ve mortalitY findings in subgroups i MRFIT POSSIBLE INTERPRETATIONS Overall intervention program does not affect CHD mortality • intervention effective but benefit not observed • Combination of favorable and unfavorable effects of the intervention program

"3 MRFIT PossIBLE INTERPRETATION: - .... • - MULTIFACTOR INTERVENTION • . ~ NOT EFFECTIVE Considerations: • Na definitive demonstration Of effectiveness o Animal, clinical,, and epidemiological evidence = Results of single factor trials (e.g., HDFP, Australian Study) Oslo) trials (e.g., o Findings of multifactor MRFIT POSSIBLE INTERPRETATION: INTERVENTION EFFECTIVE BUT NOT OBSERVED , Considerations: • Low~ UC mortality (260 vs. 442 expected) • Considerable risk factor change in UC • Seven years' follow-up to allow for lag ® Prot)abHIty of having "missed" large overall benefit not great -4

p. MRFIT .. ' POSSIBLE INTERPRETATION: . . - COMBINATION OF FAVORABLE ,AND UNFAVORABLE EFFECTS Considerations: C = Findings suggest lifestyle changes beneficial (smoking cessation, dietary modification) = Possible adverse effects of antihypertensive drug treatment in some subgroups (e.g., abnormal resting ECG) • Benefit in other subgroups of hypertensives: IVIRFIT . UNJUSTIFE~ I~TEF~PRETATIONS O No benefit from reducing serum cholesterol • No benefit from quitting cigarette; He benefit.from treating high blood pressure

~,~ ~FIT "~ P;~RCI,NT CHANGE IN CORON,~.RY HE= ;RT DISEASE* LO MORTALITY ~SATES FROM 1966 TO 1980t " " - " "!- '""- " "<- -10 • " ' - 10 ,.. ,, ,. -20 .,, ~ . -20 -30 35-44 .... ".. ~ -30 d5-54---- -. 55-64 ---- ". 65-74 "" - -.. -40 75~.4 .... . -40 .. -50 -J-50 I I I I 19~J 1970 1972 19;'4 1978 1978 1980 ICDA Codo~ 41D~13. ~'-~-~ ,~ ~..~ ~ ~ ~ ~ ~ ~.~ ~,~,~ ~,~.~ ~,~.~,.~,.~.~ ~ ..... L __ NHLB! RECO , , IENDSi " DON'T SMOKE ° CONTROL HIGH BLOOD PRESSURE REDUCE ELEVATED CHOLESTEROL LEVELS

IT I 774 ,:v 775 i : : I~ITJ~*~I~ OUJ~ ~E~'ET4U[~ HAV£ RUN ~*OPRI~XIP.e, TELY I~ MILLION DOLLARS ~ELOk~ LAST y~JiR'$ PROJECTIOr(s, S0 Y{~U S~. ,~r,'y AUTION THAT YOU . TA~GE WHICN AESULTS IN R£~UCIN6 TRE MARKET FOR OVR TO3ACCO CROp , J ,,, ; ! gr ': ..... I t, , • ~ I ,,,1' ~1 ~ I ~ i ' ' MAVIN5 P~S~T~ THE ECONOMIC $19E OF tiY AP~Ut4F~; [ , r ~-., ~'OUL~ LIKE TO TURN ff¢ .~TENTIO~ TO SPEGIFIC PROVISIONS I~ I&,R. l~I i ' I TH~ C~PRE,~DtSIVI~ %~40KIIfS pRL'VEfffION E~LrC~TXON ACT IS ' ~$I[~ O~ THE P~/41SE THAT THE PUBLIC IS UNkWMAE OF THE REL*4TIO'/SHIP TI~E CURSE%&T LABELING STATD4FJ~T ON CI5~MATTE P#,CKA~E,~ llk%~ BF,~ ~ i; .... PUJ~LISH[~ PIOR[ TRAN 325 ~IU.ION TIHE~ IN THE ll~]T~ STATES. .~CC01¢- ~ ]'iS TO $~ATISIZC$ PROgUCC~ ]By R~$PECT~ PUBLIC OPINION R~$~RC~E~ - , i " ISSU~ ~Y TH~ GOV[P~t4g~f. THE MACT Tll~T O~E THZR~ OF OUR #~D~LT I '*' .°OPUIJ~TION CONTINUgS TO ~'9)I~OE: sSS~EST~ TO r4E THAT THIS ,~ECI$1ON 15 ~A~E 1~ ~PllE OF A~ AG~RES~IyE P~BLIC AWaREnESS C~PAIG~. THE ' , , ~ I ?i IIEC [$10~ JO SROK~ I$ A/~l~f~ Of pfJ~O~AL C~IC~, [ D~ ROy BELIEVE ' ~ 4,, ~T WE ~VE ~Y ~SON TO ~ TMAT ROTATING WA~I~G~ O~ ClGAR[T~IE ~AC~E~ N kOVE~TlSlNG ~T~R]AL I~ GOIN6 TO ~ESULT [~, INCR~$IZ]O ,, , :. ~LIC AWkREN~$~ O~ ~ C~I~ ~L*~B RIStC~ ~S~X-TI~ ~0~ g~II%g ~R THE P!ODIFIC~TI~ OF £,FmOKING IIEllAyI~, I WO0~ SUGGEST TO YOU ~llAT THE ~!(~R[ lI,mdZLY RESULT 15 T~T WE TSRN LA~EL$ I~TO T~OKS. ! , • , ' i T~ P~URPOSE.I THE p4~RPOSE IS SI~LY TO MAil THE USE OF TOBACCO IN THE , i ~ ' i U.MIT~]) ST~TE~," T.~g GOAL ls NOT ~o INFOR,~ NT R~THE~ T~ pROlllJ~IT, , I , I'~ filvffs TffE SECR~ARY OF ,gF.4LTI~'~*&I) MUi4,~&N S~RVICE$ THE ~]~ ! &LrI~l~ ~ T~ ACTIOt{S W~4IC~X Wi~ gLTII4AT~Ly P.EglmLT |~ ~,I~p~I#~ "~ i : i ~a~At~ A~V[RTI~ING ~ T~E OP, I)EP, Ly F, ANK~Ir~G OF A LEGAL PRODUCT, Z SUB~IT TO YOU, ~SE W~O TRULY BFLI~VE IN F~[~OM ~ OF C~IC~, MUST VOTE AGAI~T THI~ ~URi{, I ~EJ~RE URgE yOU ~. '~ L~X B~'IME~ ~ tlt~Es O~ I~I$ ~ILL ~ RF.r.OG~IZE ITS BID~F~ • ~ ~0TI~ES A~ CAST YOUR VOTE *4CCO~INSLY, l :TNANX YOU V~Y MUCH,

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813 ~mok~n~ add Health vhich Buggelted ~he, need fo~ deflniti~ ~ne rela~io~ hlD ~twee~ czgaret~ i~zn~ and pu~l~na~¥ , e~m~hyse~s Z). Although elgb~ ~f the author'~ ~ubl~ca~ions w~r~ ~ntioned in the 1957, 1968, 1959 and 1971 Surqeun G~ne~ll*~ Repo~. ~he covezag~ wa| ~rle£ ~ ouu of ~o~cexc 3-~ . O~ ~r~ of n~s ar~les on ~[ gane~te smo~zng and ovec • h~ndr~d ar~£cles published in ~he l~?O'=s ce related mub~ecns ~re ~ot ~ntlo~ed. Tn~ governmen~ ~r l~ers .~annnc ~ c~i~i~Lzed en~izely~ ~ow~ver, ~caus~ ~ney hav~ c~en e~am~nlng only "smoking and ~ealth" ra~ner cnan conducting a ~lobal revzew of all suspected =~s~ facto~ ~o{ :n:on~c b~on~hi~|~ and e~nyse~a. Yet ~t~ i~olated ~na~is on o~e ~acto~ ( c1~a~eut~ ~nq ; na~ L~mited ~n~ ~s~f ~iness of &. Exprl~ental PUlmnnar~ ~physema In the Doq. The t981 re~rc ~f the ~urgeon General ~7~ scares ~nac "there acn ~0 p~li~h~ ~tu4~e~ that a¢ceptabl.y ~now zr an animal ~od~l nnac the develop~n~ of ~pny~ema ~s induced ~y ~zgaret~e ~king, .,. One study ~n which do~s ~eceived smoke di~e¢~ ~ro~gn ~hronlc cr&~neoccm~es re~ted =he develo~enc of empnyse~ [Auerbaoh. ~mmcnd* K~r~, G~rflnk~1 and Sto~t (1967~]. T~e lesiona were not ~nclusive an~ the r~sults have ~o~ ~en conflrm~ ~y ochers."

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819, ~ntrlb~te to the pl~Og~neBIB of em~pnyse~. ~. prot eolvti~ lun~ ~w~e. Th~ ~ypot~esls ~aac e~gare~te n~ oauses a proteesa-ant1~ro~ea0e Im~lanc~ and ~n ~Ir~ ~ota~tlally lead~ CO p~non~ry ~phys~ ~e beBed o~ a grou~ oE Selected op~e~vlcz~s. ?here ~e no dlscuasion am ~o ~¥ ~ne h~ocees~s n~s aec oeen qenerall~ acoep~d. ~urino 37 tn~ first ~sear~ne~ co snow ~nat ~roteo~ytlq enzymes £n~uence ~ne pulmonary ~ehan~cs In v~vo, na~ suosequently note~ [laws i~ one nypothesi~ cna~ ~pny~em~ I~ eao~ed oy ~ne Imbalanc~ OE prQt~a~e an~ anclpro~easez . "A~ Inconsisten~ ~or ~he ~rimary ~ole of e1~stln altezatlon as a ~chanlem £or in~uclng pulmonary ~pa2ae~ has oeen a failure re de~Ons~rat~ a1~eratlons In ~last~n concede o~ oompo~ItLon ~o n~n ~pnysemal M~rpholo~le~lly~ elast~n ~Ibe~s hav~ appeared ~i~upted an~ ~im~nlshed, ye~ ~e ,data ~om n~n L~n~ JOhnson ~ And~es ~970J Pi~r~e ~d B~cott I~60~ ~r~ plec~e et al 1961) .... wi~h ~he exception of ~aa~ Of Brlscol ~d LOrlnq {195B], have ~n~n ~ ~a~tlon o~ ~a~enchy~ ~laet£n ~onte~t by ~rav~me~z~ cecnnzquee."

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! i Marc~ ~ 1983 !, i i!~

826 an~×~mla i~t the he~Z~-lun~ an~ ~nt~=t dog prep~tlon. Arch Envir~ ~e~l~h, ~96~, ~2, ~5-71~, ~. ~. Folle ~, Samanek Mr Aviado DM~ Cardiopulmo.~ry eff~c~ of tob~c~ a~d ~elat~d ~ubstan~e~. If. ~otonary v~c~la~ e[~e~s o[ ~igarette smok~ ~n~l ~l~c~t[lle. Arch Envl;~n Z{ea%th, ig6~, 12, ~2-716, /. 14. 5m~al~ek M, Aviada I~NI cardiopulr~c~nary elements og t~acc~ ~nd g~l~ ~tlllstall~ol~. ill. pulmu;~ar~, va~eul~lr efguct~ of ci~a~'et.t~ smoke and nicr~ihe. Areal Envl_ron Health, 15. ~viad~ DM, !~alaCek F: Pulmonal-y efgec~ ol tobacco and r~]ated s~b~tance~. I. ptllrl~nary c~;~pliance ~nd fe~isganee in the an<.s thetized dog. Aicll Er~vil'on ljealt~, lg~7, 15. 187-].93. yaXacek F, AVL~IO DM~ pu]gt~na~, eff~c[s of tc~h~cco and relate~l sul~t,lnces, lI. Comp~lrati~e affects r~g elgarette smTke, nluo~ine and gls~amlr~ or* tll~ ~r~e~the~ize~i eat. Arch 15nvtro.~ ilealth, 1967, 15~ ~94-2~3. 17. ~alac~ll~ F, Oskou£ It~ Aviaclc~ ~M~ ?ulr~onary eIfec~s o~ tobacco a.d relatel substances. Ii~, inhibition ~f ~yn~he~ls o~ histarnkn*l in ~ario~s ~l~CSes. Arc~Environ 18. pa~.~ek F~ P~lecek~va M, AViado DMI Emphysema in i~ru~a t ,a i" ~ ~-at~ : eondltiol~ t~t odu~d b~, t gacheal constgietlo, and papai~, Arch E,mron H~aleh, 19~7, 15, ~r~kol "~x~e~imenta[ ind~ction and use ~ bl:~nehut~ila~mrs lm I:at~. A~ch E~Viro,I [~e~lth, 1968, 16, g~g~B6~*. ;~vtacIo r~, Wat~nabe "rI FU~etionaI and biochem~ea~. ~fff~lcts on ~1~1 ~.u~g f~]~low[n~j ~nhal~tion of ~iga~ette ~.'oke ,~nd consultants. Nigh- i~nd 1o w-nicot l.ne ci~gl~et~es ~n ~nst [tuent$. II. Skato%e, A~rolein, and A~al~leh~de. ~oxlcol ~,pp~. Pharmac~l~ Ig~4, 30, 201-~0~.

22* ~to H, Wata~be TI Shor~ $R, Avi~do DM: Fu.Ctt~n~l a~d ~ntit~yps~n and b~¢nchom~tor ~e~po~se~ i~ ~hs. ~xi~ol 9, ~. B~ r~n~e~%~k ~t~t~n ~geacy: Air ~ual~t~ ~r it e=ie fo= olo~ and o~ocoche~I c~l daI1t s '-- . Vol- i and II 1978, EPA~00/8~78-O . 24, ~. s. Envlco.menta~ Protection Ag~ney~ ~ =~iteri&" ~or O~id~ o£ i11~roqe~, VQI ~ to IV. 197B. 251 ~. S. Environmental PrOtection A~e~cy~ A~ IV ~leaiBh Effete. gS0~ 26. ~at~on~l Ac~d~ny ~I s~len~es= P~i~ es for ev~l~in ~orld Healt~ Organization: ~s aI~d ~ethods for e~mi~i~l~ l~vels n Occu a~lg~ai~ex o~ce to h~l~f~l 33-36. curv~ b~athzng air o= hellu~ oxygen: an ~nalys£1 of bias, di~perslon, ~nd co~relati~ in i0 indices and a B~~, 1977, i~ ~6P 97P. 30. Chin~ DJ, Dee ~: Within- ~nd betwecn subject vari~billtF of in~ices from ~he clo~ing vo~am~ and ~low ~43 249. I I 829 Sep~a,~a,A~ C~mpa~i~on O~ d~f[ereat kia~$ ~f te~t~ in th~ evalu~t~o~ of lunq function amon~ healthy smokers and nonsmokers. Ann Cli~ Re~, 1~77, 9, 27S-2~. 33. .~cbt CL~, DS KOC~ ~ Va~ Wyk Kot~e TJ, p~near ~3, ~te~. pG,¸ Vid De Wal BW, verm~ak JC, Weigh HFH: ~. Cp~emLo~ogi~al ~tud¥ o~ the ~iffu~e obstructive p~lmcn~r~ Alb~t ,~E. Peterso, I~ 3r,* Bohi~ ~E, Llppman. HLI ~ho~t-t~m ~f~ect~ of cigaret~o ~moklng ~n bronchial ~learan~ i. h~J~. ~rch E~lvi~o~ ~eal~, 197~, 30, 3~. Ca~,n~r P, ~tra~b~rq K, ~hilip~o~ K~ ~ncrease~ muc~ciiiary transport by adre~erq~¢ Itim~iation A~C~ 36. Mos~ou~ E, Phi~p~on E, C~ner ~ TraCh~obron~hial cI~azan~e in ~atient~ wi~h emph~sem~ associat~ with a~p~ ~a~t~t~ps~n ~f~cien¢F. Scan~ J R~s Dis, l~78~ 3?. Chrzan~wski PU, TUCln~ GM: E~pe~imental e~ph~s~ma ~eptB ~d q~e~as. ~~. 1977, 13, 471-477. KUh. C, YU Sy, C~raplyvF M. Linde~ BE, Sen~or I~: The induction o~ e~hyse~a w[~h ~last~0. i~ Changes in connective tissue, ~ub ~ve~t 1976, ~4, ~72 380.¸ pro~eolFtlc en~y~ activlt~ i~ pulmonary alv~ola~ mac~ophages and blood l¢~k~cyt~ In stokers an~ no~m~k~:~. ~ 1975, ~11, ~79 58~. 3g. Leb~w~t~ ~D~ BUrrows T~C~O~I ep~de~iolosic ~t~dy o~ obst~uctive lunq d~ea~e~ I~, ~£~c~s of in~[~r~io~ tactots o~ the ~c~valen~e ~f obstruct~ l~ng dis~e. 40. Waolcoc~ AJ~ L~ed~ SR~ Armstronq JG. peat JK, C~a~ M~ Cu~lcn KJz Th~ s~le breath nitrogen ~est~ in rural an~ urban ~mok~r~ ~nd noa~smokers. ~l~ Eur ~'h,,s[~

52. ~b~wlt| MD~ Re$plratory ~ymptomse amd dlseas~ zela~e~ to alcohol conl~mp~1o~ and ~m~ng. ~, 1977¸ I06. 248. 53. R~i M~l A1Oohol.~nduced pulmonary ohanges in r~e, ~, 1975, 31, 573-57~. 54. Palmer DLI &1~oho] consumption end ~eilulaz ~mun~ompe~ence. Lar~n~0scope Sup~l~ 1978. 88 Part 2. 13.17 .. 55. H~rley DS: InEe~tiou~ c~mplle~£ion~ ~ ; al gOhollsm. ~, 1977. 6, 160-162. 56* Borlan~ ~"DR. Chamberlain ~T, ShIpl~¥ ~J, ~19enbetta~ T~. Rose ;: cn~ CQ in cigarette ~mok~ a~soelated ~. ohronlc ~rflow 0~s~r~et~on or ~scnaemlc heart ~s~ase? ~llmlnar¥ ~roceedxn~s of th~ Inte~at~o~l Conference ~n~ent end Lun~ D1~ease~ ~aormioa, ~taly, M~ren 57. Weln EW, Fabiano BL~ The r~evalee~o, of t.e ~ol~ OE ca~on mono~xd~ ~n production of a~gravatlon ~f cardiovascular disease proee~. 519-525. ~, 1982, 24. d ,

{

835 by O~ivar G11ber~ ]~raok~, I[,D, F~CI~ Dep~c~e~ ~f Ch~d E0a~tb ,~ndo~ ~ 1.7

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March 25, L983 S~ATEMENT k ., KOD~T CASAD HOCKETT ";" Re~a~Ing H.~. 1824

County Council, ~e pgrcentage of hmg cancer to total eartce~ Wa~ 25 in 193~ end 27.I In 194~'.~. The attempt to lmpllo~te ~obacc0 WU fJral made in thL~ country ~y AdLer/n ]9~2. [rmsrn~h a~ etgarette smakJ~g ~ad noc yet ~te~feved popt~a~lty, ~e ~ ws~ p~eed m~ mgars. With t~e ge~eter consumption of elgar~ttls in later years, the. blame was gradually ~hifted to mgarettes flnsDy culminating in the ~ent barrage of $£a~;Lstieal epldemiolog[eal studies ~ondueted on the gT~u~d ~t~q~ lo~d ~.~ A statl~tlc~ asso~iation does ~o3 imply a cause S~d effect Pehtlon~lhip, P~[eulaely when the ~va~dl~y of the eonelt~dons L~, lerzot~ que.~ttoned by such responsible ~tathticians ~s JOseph ~erk~m of the ~yo C]]nie cr E~wa~d +,. ri: ~•

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"8, ~6 potential candidates fo¢ tung =aneer. ~'he total numb~ of east~ is ln~reaslng but the rate of ~,qcc, el,~lj ~ $~OW~ng down ~G wm evont uatlS' be ita~tlzed ltk~ laryngeal ~" ' other "upper resplra~ry ~aneers in which dh~gl'~Io netnw~ ~ave beer= long establ~heG." The'nasopPary~x an6 'Lb, e l~r3'~x ~e ~eatl~ e~t~ to ~Q~,¢co predators and if tobacco is a ~ar¢lttQ~en f¢4' the lungj ~t $hOtl]d also act us t~e upper respiratory :~sge. However, no statistical asaoeiatlo~ ~ been demonstrated cetwe(m |fle~ea~ed corruption of olgaret~es s~d INcreased ineld~e 0I" Uppe.r resp~*atcry eanee~'. ~.l~.~. the United State= deatr= rate from l~ynge~ ~aneer w~m kI per lO0,O0(J and in ~ [950. i'~ w~ Lg per 100,000.~ I I,

upon ~ha public g of the present labels, lot a~one the ! i,

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~%. ¢~e4.~ , ! 859 i eat, as ~ii as e~po~re to backgEound radlatlon to which &~ Co~ti~o~y at Eisk. ThOBe ~f ~S WhO have take~ oaEe ~'tleat~'~il of Our professional lives have see~ cancer of ~e lu~, ~o~h* larynx~ kldney and bla~deE ~evelo~ in people ,i ~i :.I wnul~e vary mu~h opposed to se~t~ng up yet anothe~I C Or~anlzatlon that might impair the effectiveness ; v~ious a~en¢les, such ~s the National Hesrt~ ~ng and BlOOd :~ational Cancer Institute. They have been a good Je~.-Fu~thermore, I have a £1rm bel~ef that if bill, ~.~:+~824, were ~o pass it would be detrimental ~o ~ause of e~ence. We are beglnni~g th~ second revolution • b~olcgy and medicine. The p~ogress has bsen ~he~menal. A that ~ta~es, "Congress ~t~d~ %hat ~i~ar~tt~ ~moki~ is the ~ause of illness, ~tc," m~ht well hav~ ~fect of reducing ~he ~ulentlflc interes~ in ~eseazchlng ' unknown ~aeet~ relating to the c~uses of the dlsease uestlon, %'neE~fo~e, we do not w~nt to slow down ~esear~h lJor p~oblems. We wan~ the research to iac~esse ~n Ii

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887 Yhe |O¢la~ 9~adiw~t |~ reprOd~Eiv~ p~r~or~ane@ cou~ hav~ ~n~ Bams nut~l~|onal oas[8 as cna~ ~o~nd in ~Zea~F • alnu~i•h@d wom•n ~eca~se the ~oore~ •o~£•I g~oup~ 4~ ~nown c~ ~ave some n~r~ona~ ~rlcien~xes. Slne~ mate=n~ smo~lng is ~epoxted to be stat1~ically a~ooiet•d W~th a higher incldenc@ n~x~lo~az de~i¢/encxe~. I~ [• mor~ ~£k~y th~ the -epoz~e~ "higher incidence o~ ninth de~e~c•, ~caneou~ 4o~oo~ "and ~re=atu:I~y zn some mother~ wn~ smoke |n ~egnancy ~ould" a~o ~av~ • nu~=~zonal cause. CO~C LU~XON [~ cOoclnelnn, ~c has not been |c~enei~iCall~ ~tabli~hed :na~ ~m¢~g ~ a ¢a~e o~ ~ep=~du~tlve problems Ln • o~@~ who smo~e du~n~ p~e~nsn~, ~thermo=ee or•aCing ~uch~ ~nprown c1~Ims as sczenCl[i¢ ~a¢~ may do ~ar= to one mothe=s . concerned, ~eCaUSS 1~ ~ve~ts th~ ~t~ention o~ ~he pUbll~ ~d- t~e ~lene~[c commu~z~y t~oa ~ha real' "causes o~ these ~ap~OdUCtlV~ ~obl~s wn~¢n can only so~ved oy De~ter ,, prenata~ car4 o~ ~n~ ~ot:he[ Wlth ~i•~ a~n~on co nec

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908 "~, : i 2~ L,a ,,t 909 ; .: '. Charles t3 Splelberger, , • • Gerard A Jacobs, ' ' Rosc~rlo S Crone ., ,., - I ' ~: and Stephen FRussell ~ : ....... i .... On the relation between family smoking ,: • habits and the smoking behavior at , . college students , .... , • , • , • : The controversy on smoking and health has stimulated extensive in- terest' in identifying factors that Influence the initiation and ! maintenance of smoking behavior• In reviews of resc~ch in this fi~Id (MatarazzO & Mat~azzo, 1965; WohiforCL & Giamm~na, ! 1969; Evans~ Henderson, Hill, & Raines, 1979; Levent hal & Cicary, 19go) so~a~ influence ",~aiabint ~u~ a~ parental smoking habits and I~¢r-group pressures have been repeatedly identift~i with the initiation of smoking, but relatively little is known about the fac- tors that maintain the smoking habit, "" Positive r¢latlonships between the Imoking habits of parent~ and the smoking behavior of iheir children haYh been repoixed In eight studies (Banks, Bewley, Bland, Dean & Pollard, 1978; Borlal~d gudotph, 197~ CMtggett 1968 Horn Court~ Taylor &Solomon 1959; Merki, Creswell, Stone, Huffman, & Newman, i970; Paimeb 1970; Saiber & MacMabon, 1961; Wo~ifotd, i970); ~ly one study,' which was base6 on a very small sample of college students, failed to find any relationship between these•variabl~ (Straits & Seehrest~ 1963). Ahhough ~n empiriCal reintlorlsblp bet- w~en parental smoking habits and children's smoking behavior ! seems flrmJy es ab shed, t siaot c ear wile her th s rein onsh p ,, ! environmental or constitutinnal-genetic influences (see Eysenck, 1980). • ' : ~ ~ ~" ! i ~ , i j r International R~I~ of Applied Ps~lwlogy ~AG~, Lo~doa, Bomb" FRfL* aad : N¢¢~ D~M), Vol. 32 (1983), 53~9 i Y ,T i, L I ili I! i

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91S Fami~ senoklns/~@@ar$ a~d J~uaeff~ x~a~l~g @e~avto¢ • TABLE [ / - "P~'eltlsge oit m~fle ~nd fern=l© salokees sad ~ort-smok¢~ two s~tmples el undergradu=te college ~udcnts SRm,de I Combined $11mp~ [I lmmpfe T~M~umber 46O ~9~ 955 Females f~; 2~ 309 60S Smokers 4g% 50~ 49% Non.staok~¢s , 52% ~B~, 5[% Smokers 35~ 39% . L~.r 33% • Results In evaluating the r¢latlonshi~ between faxnily smoking habits and the inltialio~ Of smoking behavior, stktdents classified as Current. OccasionM and as-smoker s were :onsld~tcd 'Smokers'. an© were treated as a single group in the statistical atmlyses• It* cxamintng t~e relation betweeo the sraoking habits of parents and older siblings and the maintenance of smoking behavior, the students who were classified as Current, Occasional and as-Smokers w:rc Ireated as separate lndepetxdent groups. In a~l of the statistical ,analys~,: students who reported racy had ~eve2 s~nokefl were cl~',$ified as 'Non-Smokerg'. Students who indicated they had exocrimented, briefly with c~Baretres belt bad never b¢~ome either regtiMr or occ~-, sional smok¢l$ were a]~,o included in !be Non-Smoker category, The Percemages of roam end fema]~ students da*sifled as Smokers or Non.Smoker~ in the two samples am reported in Table LSM~¢ these pcrcenlag¢~ were quite $1tn/la~, the data for the two samples were combined., For the combined sample, the per¢¢n-, cage of gettlai¢ ~okers (49¢/¢I was substantially [grgtx than the Fercentage Of male smokers (37%j; the diffextnce betw~n these percentages wag ~tatisticatiy significant (X~==12.94. dr=l, P<.0OIL k

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-ll~--+~ lllaliOn/hlp btlwe~ the smokinl hab ts ol parenls and Older gbllngl-" . + "~ ~ 7 t~i " ~ and the smoking behavior of collegt s/lidenl~ ; -- . ~ - 7 " ~.~-- - N° older ~IblloI imokid~ ~; ; (~llifl ~rOlllll lind/or silllr sIIriQl(ld .. . Neilhir (~lt . ~lil - ~ ~ "~¢ilhcr_ . One . RUlh • , . - "- ~ ll/~l l~lif ~lrfnL1 . ~ll,~lll ~ - ~lr~ll C - IRIS - s~llOll~lJ SrliilI.L*ll IlllOllti - ~ . $11i~lkl%l Slfl~lki~i srll@kcd ~l $mo~e~ ~ 22% • ~ 4~I- 445% ~- 55% ~ ~ = 65%¸ % No,~Smokcrs . 78% ~3~1 ~4% ~rl 35171 ~'u/e~rNJ i~ - 75 10] . . 2~ 48 -- IPl Smokcn - - i j% 37% ~3% 6~1 ~4% I~l Nnn.$mokcn 87% . 63% 67% . ~8% 46% 10~ 43% 59

92O 64 ~t,~etoer~er et a~ TABLE 6 Rela0anship between Ihe smoking habits ~f older sihgngs and Ihe mainlenance of studenls' smoking behavior Nedhrr 'IOIB b~olher nrnLheC Bnblhet number n.~ gnu ~[ stsl~r ~ttler slsner end jeers mmokeG intoked smngea Femo/e~ INJ 193 46 108 39 • J Current ..rod k ¢~1 43~0 37~o 48~,~ 36~e ~o Occasional s~okerl 27o/0 ~3~0 24~ 18~0 Males (Nt Bn 26 5 ~*0 Cqrrenl srfloker~ 30~7o 39~70 18e~ ¢A~?~ o/e Ocea$iozqal smoger$ 35°/o 42~o 37g'~ l~o ~o E:/.smokcrs 35~0 ]9e~ 45~¢ Z7'% basis of the smoking habits of their older siblings (XZ-3.07, dr-4 S nee he number of males wilh older brothers and sisters : who smoked was ve y si~a] , Ihls group was conlblned with the r , males whose older brothers or sisters smoked. No significant dif- " : terraces were found in the percentages of Current, Occasional and Ex-Smokers for the combined group as compared wnh males who had neither older brothers nor sisters: Wind smoked (XZ~ZL20, ¢ " i dr-2 .~ ; ' , '~ T t LL, '' ''~'' , [I ' [ DisvussiOn ~ y ~ ,, ;, ,, Of the 955 eollege students who participated in the presem study, 49 percent of the females were classified as Smokers as compared to only 37 percent of Ihe males• In commenting on recent trends tn smoking behavior Evans et m. (1979) observed: 'The rate of snlok- ing is decreasing among adult males, adult females, and male teenagers wJtff the only increase -- a noteable UP among femaes n heir teensaadearlytwenties' p. 204: finding in tbc present study that the percentage of smokers was~ significantly higher for females than for males appears to be consls-. tent with recent trends in the smoking habits of young adults. Positive relationships were found as predict ir~he 921 Faud/v*#lokinghabitsff/ldstade~lemokilzgllehavlor 65 ~iil, evidence that older sisters may have a greater impact on the smok~, mg be~!avior of lheir younger sisters lhan [heir younger brothers, whereas older brothers appear to have a similar ini]uence on the smoking behavior of younger siblings of both se~es. These results were generally consistent with Bunks et al.'s (1978) filading that high school students with siblings who smoked were more likely to take up smoking than students whose siblings were non-smokers, and with the mounting evidence that peer group pressures are perhaps the single most important influence in the initiation of smoking (Eysenck, 1980; Levitt & Edwards, 1980; Matt hews, 1974; Merki etal., 1970; Palmer, 1970). ' : When the combined effects of the smoklng habits o f parents and; siblings v,;~e evaluated, older siblings appeared to have a 'i I i:i study between the smoking behavior of students and the smoking habits of their parenls. If one or both parents smoked~ their sons : and daughters v~ere more likely to be smokers than if neither parent smoked• These findings were generally consistent with the results. reported in six previous investigations (Banks etaI., 1978; Bofland , ;: & Rudolph, 1975; Horn ¢tal., 1959; Merki etal., 1970~ Palmer,' i 1970; Salber & MacMahon, I961). Posilive relationships dave also, been reported for females (Clauson, 1968) and for males (Wohtfurd, 1970) in Iwo additional studies. ~L Positive relationships were also expected between the smoking habits of fathers and sons, and of mothers and daughters, but no evidence of same-sex parental modeling was found. A possible ex- planation is that the college students in the present study were older : than the junior and senior high school students in previous studies ' ! r~ (Horn etal., ] 959; Salber & MacMahon. 1961 ; hanks etal., 1970) : i for whom evidence of sex-linked modeling of smoking behavior ~11 was reported.4 Thus, sex-linked parental modeling may influence f some children to begin smoking at an earlier age, but this relation- :~! ; ship may he attenuated or masked as the number of smokers in- creases during the high schoo[ and college years due primarily to p~er group pressures. Consistent with Ibis interpretation, the Surgeon General's report on Smoking and Health (1964) has sug- gested, '...that parents' influence affects the age at which children start smoking much more than it affects the ultimate taking or not taking up of the habit' (p. 370). in the present study, students whose older brothers Or sisters smoked were much more likely to be ;Smokers than those whose older sibIings did not smoke (See Table 3). There was also some'. , I

I 922 i r J i ~ 65~ , , } Spidbergeretat : ' stroi/ser ~iilf]uenc¢ on the smoking behavior of their younger slb- ' lings than did their parents. The students whose older siblings were Smoker's were more likely to take up smoking ban those whose older siblings were non-smokers, and parental smoking habits • . seemed to have no added influence oa tile smoking behavior of • tpa~etstudeats [S¢¢ Table 4). Students with no older siblings, or wi h o der sibtings who were non-smokers were less likely to be ,, " , • Smokers themselves but these students were more hkely to take up "" . : smoking if one or both parents smoked, than if neither parent smoked. " NO differences were found in the smoking habits of the parents / of Current, Occasional and Ex-Smokers in the present study, nor in ' * the smoking habits of tbeir older siblings. Thus, there was little "evidence that family smoking habits influence the maintenance of . the students' smoking behavior. • : At the time lhe data for the present study were collected, the ' Nat ona nstltule of Education ~N|E, 1979) of he U.S. Depar - , meat of Health, Education and Welfare initiated a major investiga- tion of patterns of teenage smoking. In this study, a sample el 2639 . : American teenagers were interviewed by telephone to oblaln mfor- marion about their smoking habit~ and Ihe smoking behavior of ' thetr famdies and friends. Although no staiistica] anal>ses were repotted, the findings in the NIE study for high sehooi students were similar in many respects to those obtained foI college students in the prcsem study. For example: . ] , 1. The dala from the NIE study indicated that the percentage of r girls who smoked was larger than the percenlage of boys, wbereas a • , , decade earlier it was found that the percentage of boys who smoked • was higher. 2. Tile NIE study found that if ong'or both parents smoked, their children were more likely to smoke, as was he case n be pre- 4 sent study. There was also little evidence of same-sex modebng, , 3. A positive reladonship was found between the smoking g habits of their older siblings similar' to the relationship for college studems ltl the present study., When the combined effects of tbe smoking habits of parents and older slblblgs were evaluated, older siblings had a stronger in younger siblings than did their parents, ,~-~ . Taken as a whole, he esu of heNIEstudyandthepresentln-~ vestigation indicate that family members influence students to take~i ~'~@lIB~" smoking. The fac hat he smoking behavior of the students is r 92~ Fmtli/r smck~ne habits ondslud~m sn~x~nR r, enaw~r 67 more strongly associated with the smoking habits of their older sibbngs than wlrn parental smokttlg bablts suggesls [nat en- vironmental influences are more important than constilLltional. genetic factors in the initiation of stun king, The findings in the pre-~" sen~ stuffy t/lat file percentage of smokers tellded to o~ nigher for s[utlents wan reporleQ ii]ai erie 13aren~ smoked thail for tbose who reported that boil parents smoked¸ and that family smoking habits have ht{le or no impact On the maPlterlance of smoking oenavior. provide fktrtber ~upport for the impact of environmemal influences on smoking behavior. Notes I. ^ copy or th~ SBQ may )e ootamea t~y writing to the first attlhor 2, Approxlm~tteh iwo weeks oefare ihe et~d OF the terlr. Ln~ slwlcnt~ were a~Ol~t ted of ale t]aL¢~ anti t~rn¢$ for ~h~ feedback session ~ ang were encouraged to* attena ~, Th~r~ W~ts no evldenc~ of a t¢la[lon~nlo b¢[wt,,tl~ LI~ ¢o m tli~c,d t~fl~en¢~ o[ tn~ smoking habits of ~}~t~¢rlt E angt oilier Slt~llng~ on in¢ raalnt~nance o[ smoking tmhavlor of I/~ Sluacnt~ who aar t~cla~lled Ln this st ~dy. as ~valuated in 3 :< 6 Ch: ~quttre analy~¢s sJmllar to those ¢omput ~d for Tabtc 4. a Wohlford tlqTG reoortco a ~ostttve relaucm~n ~ 0¢lw~n the srlloRl~g natltt~ of falh¢~$ and sons for (;ollege stttuents, but no[ for mothers ann aaugnter$. Ii snoul[l g¢ nOlet~ f~tlwever, mat tats rC+latlon~nl~ was aaseo Oft a r~arglnally ~lgnJ~- can{ correlation [p<.06) ttl "clgar~tt~ ~mokmg frequency' for fathers and so~s. ratl~¢r than an crab,alien or a corresoonQen¢¢ in t~¢ prevalence or smoking bcllavior. Dir fcr~n¢~ in Woh~ord's ti~gl~ngs ~nd tho~¢ of the prc~©ot $1~zoy mlgrlt also t¢flt¢{ changes in in¢ smoking patterns o~ young aau ts tna~ n~v¢ occurrea owt the past decade E [i

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927 i Y~ h i)i"t

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I i! IV 2* 6~ ~z 930. q ! PersonMIry and SrOok ng Behavior ~_ = - _ ~_~ "[[ 931'~: C, D. SPIELB~RGER ar~ G. A. JACOBS 401 Se£ main effect and Ihe Groups by Sex measure reiL-cted Ih¢ fact thai C~rrenl I ~ntefaClioll for trait a ffhx iety, T~¢~ i']nd. ~mokrr$ had ]ower anxiety scoff~ thorn ! ing~ reflected the lift that f~males had highlr al~.iety scores than male& and thai female Smokers had higher anxiety scores tb.an ]NonsFaokers. whfrea~ malt than Nortsmoker~. No signtllcatnl die. ferenres weir fo~d for either sex in the separate analyses of the STPI scale~. Mainle~ance of ~moklug B~havior The raean EPQ an~I STPl scores o[ the red, tie and [~ale Currenl• neon- Table .$. Assoeiat i¢~5 belween the main- lenanre of sf~oklog behavior o~d each personality measure were evaluated in 3×2 [actorial analyse~ of variance in which Groups lCutrent. Oec2tsionaland I~x-Smokers) at*d ~ex were the in~t- Ogc~tsional and I~x-Smokrrs• - , : I . Dl$ctttsiun b ]n the present ItudyI SmGkers $ eol'~d bJghe~ Iha~ Nor;smokers on the EPQ. E~traverslon. Neurndelsm ~nd Psy- rhoticitm scales• a~d ]qonsmoker$ hat~ higher Lie scores than Smokers. While these findings wcr¢ generally consistent with re U~ts previously reported by uth¢ investigators (Brackenndge & Bioch. ]972i Gupta et aI.. ]976; Power1 et at.. 1979). this is the first study to obtain i such reJali~ns~Jps lot an Amctlcaa i sample The differtners obs~rvcM between Smokers and Nonsmokers on the EPQ sc~l~ were in 1he same direeIion for bot~ s~xes, but these ~iflrre~¢es w¢tc ; lar get i~ maguhuUe for t he females. The per*dent variables. Summaries of these findings in the prelent sludy thai t¢- ana[ys~s are also reported in Table ], males scored higher than r~ale5 no the ~tlong wilh I~¢ ~rldJ~g~ ~n t~c sef;~ral~ Plruzolic~sm an~ Lie sealc~ ~ln~ 1ow¢£ OU Ps~ehotic~sm, were cor~istenl wilh the results repoIIcd for ~ntish subjects ; in the EPQ rest Manual (Eysenck & [ Eysenrk. 19751 In evaluadng the association brew©ca ; the STpI ~ales and the initiation o[ smoking, it was found thai female Stunk. er$ had ~lg~Ier anxiety S0OreS than NO~. smo~cco, whereax ma~ St~ok¢~ ~ad Io~er a nx~ety scores than HnnsmokerL~ The resul~s for the fema]es are consistent l with fir*dings reported by several previ- ous investigators that smokers scored, higher in anxiety than nonsmoker~ ( HoustOn & Schneider, [97:t; Schneider & Houston. 1970). and support Matlb razzo and Matarazzo's (1965) rune[u- s/on that there are, ~'.,.a slighdyMgh¢r number of... 'neurotic', and 'tense' in- ' di~iduals among smnkels a~ compared '! to the nonsmokers" p• 3?7 . The fin~° lugs in the present study of a 0us[tire ~lsoclalloa between smoking and aug. iety for females and a negative assncl. ation for males points ep tie Stupor. Lance ~af ~klng 1he sex of the subject inlo account i~ In ineesdgacioa of t~¢ i relatior*shlp betw~n ia~oking an~ ~ef- soaalky. analyses of the dala for female and matt students. There ~ere no ~tatlstlcalty ~ignifica~t Group (~if[¢rtng¢$ ~r* the overall analy- ses of the EpQ scores, but s~x main ef- fects were found for the Neurodcisrtl and psyebotlcism measures. The females ~cared higher on N and lower on P than mates, g~ w~s aolect in t~,e precedlag anatys¢~. Occasional Smokers of both sexes also had lower Lie scores than 1he Currem and Ex-Smoker~, who were quLt~ similar on this scale, In the sepaarate analyses tot females, the Current ~mok- ers had lower Neurotieism scores shall Ihe Occasional ar~ Ex-Smokers, In the analyses of the data for the STF[ scales, the stalistlea[/y slgni6carg Groups effect for Trait Curiosity zeflcct- ed the finding that Ex-Smokers of b'~th sexes had hlgher scores on thi~ measure than Current and Occasional Smokerl. A slgniGeaut Sex main effect was also [ound for Trail Anxiety, s~ hleh indicab ¢d that femaLes had higher anxiety scores on this scale than males, as ".~as noted in the preoedlng analyses. In Ih¢ sepatal¢ analysez for females* the significant Groups eif~t for [he STPI exalt anxiety i

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My name £| Boa J, van den Berg. C~£entlz, I Sm di~ho~ o~ ~e Child .Health and Developmen~ Studieb research un~ of ~nl ~O~OOl of Publl~ H~alth of the Unlvereit~ Of ffa~fornia ~c Berkeley* I I ~eo~l~e~ ~ mid~l ~e~e~ ~n ~be ~the~lands and ~n 1965 IJJoined ;~ Ie~zu~ staff e~ one Chll~ Health a~d Develnpm~ Studl~g which WBS deSlgn~ an~ ~ented ~y ~ne l~e D~. J. ~e~|halmy~ p~O~@SSO~ of Slos~llticg a~ one unlversl~ o~ ~liforn~a a~ ~8~ele~. My cucrl~Ul~m v~iB aoaompanle~ m~ Bt~temnn~. I am wc£ting ta expregJ my concern a~ou~ ~ne ~tan~enns ~ade In H.R. I~24 ce~ardin~ ~n~e&l~d tz~ ~ '/i!

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B?,CW~ ~ ~ILL~AHSON - LOUgEViLLE DCC~JHE!]T CONTROL PR,qJECT PRCTOCOPYT~G VARIANCE ~NEET AT THE TIME ~E REPRODUCTIQH, THE FOLLOWII¢C NOTAT~O~IE VIERE :,~ADE~ DCCUMENT COPIES ARE IN THE SAME SEQUEHCE AS THEY APPEARED Nq THE ORIGINAL, [ ) DUPLICATE DOCUMEi'~TS APPEARED IN TNE QRIG;NAL. ./ (J PACE NUtCiBEI~(~ MISSING IN THE O~IC~NAL. [ ) POOIZ QUALITY ORIG;NAL. OVERLAY ITS4 COULD NOT BE REMOVED WITHCUT DAMACE TG THE ORIGINAL, NO DOCU%IE:qTS Y/EP.E FOUND VIITH~N THE ORIGINAL: ( ] FILE FOLDE~. [ ) REDROPE EXPANDABLE FILE. ( ] HA,~C~NG PELE. [ ) ENVELOPE. ( I QT~4ER. (SF-EC:~Y) DCCU~NT CQP!ES ~RE ~EFKCCUCEC {~ COLOR TO ~E~lT CORRECT INT~KP~ETATIO~. ( OENER VARI~IICE [~KPLA[NI:

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JES~bc col 3, $. ~Clev, d,*L 961

962 ,~ wlved Jn i~l~J~ ~anls~ cccurr~ ~S pert of cancer deve~o~ent. While ~e nave learnml a geeBt dee1 ~Dour a#o~J~st~ tean~fo~m~TO~ b ~ tee ~v~ of tu~or tills In b~O 9 ¢~1 systems, m~a or animal, we are $t111 a~ ~ 1o$~[ to ~X lal~ wha~ Cau e ~&tty ncers 8 d h~v cancer can and ! t bl ;h e aJ a ~ras te ~n ~ ~1o7~fc~7 ly~t~. R~search ts ~- [lnulng to ad~ zmall ~leces of Infection tc our k~owledge of cancer. • ~e F~ nC ppears c e r C~n ep ot ne o ~ ~a y d e~ses. It t5 e15[~ [~U fB~tor I ~i h perhaps t~ultlple mac ~n m ; to de~e la~Icates h~t gene~Ic ~"cha~ ~,% r~,~ ~cas ~f growth Resesrch - itg~n~ ~nd ~ny o f c~r ~re ~ro~bly lnvolve°d~ in ~ch~lsnt$' vl~l e, ~he ~athoge~s,s Of ....... ,or exam,le, it h~, been estg~:~SedaSt~11 ene~c ~re are # ~por~ In e em nln~ rea~tIvl~y ~o a V~rlety of $tlm~ &n~ t pre¢isoos o~ to er~In es of me 0 ~hese re is, t~P cancer t hnk~d to There are, he.ever a no t of questions which are still ~n werea end .umer~us unc~r~ ar~$, AS re~earc ~ns~ers to i. e u a wered h con~,Inue~ in fl effort ~o p~6vl~e questions, ~e should be c rofu not to dPaw hasty Cancluslons abuus causatlve agents on Lhe basil vf ep~d~i~l~fcal end s~a~Tst/cal stuoles. Ques~i~ns continue to be ~alse~ a~ut cl~a~e~te sm~K. In9 ~c~use of ~pl~e~lo~olfca] en~ s~atlstlca~ $cu~le$ a~ a result ~ ~1$. much Iffort n~s Dean oev~ ~# ErFI~ CO d~r~fnc vnu~ner ~ .ause.effe~ ~elattonShl~ exists ~l~eea c~gerette S~K~ng ~h~ C~et In ~Pite of a ~ealth of d rna= has bee appearln~ in e~ent fl( ~t~ra t~e c~rcetn. t~I~ Issue ~o ~a~e. I m.y Opi 1o~, ~ as not ~e~n s¢lertlfically es~abIlshed [nal cancer of any ~ype Is caused by Clg~rEe~e 5Bg&ing+ [he • 1~aloglcel and s~al. I~a] ~.zu~e~ ollI~ pof~t Co re|$ r'er f r C~lnlcel and laboratapI wor~. Utner : 963 ; • I !~ , ST~T~T O~ ~I£HARD 3, BIRGr ~,9, ,r ! j • i • , : i 'Z, ;z~/©ha~ #* Bile,' ~,#,, am cur~entZy ~re~eseo¢ io~ ~e6|ol~e ~e~ltuB ~¢ ~he ~ve~l~ o~ ~OU~be~n CaZ~#~ni~ ~ Dl=ecter o~ Ex~erl~enta& Cardiology ~t the ~ntington,Hediael ~ea~aroh Insti~utel in ~a|adeea and Vlatti~ A~oclate at ~he C~&ifo¢~ia ~n~itute of ~e~hnolegy i~ ~as~6e~a. i ~ , , , , - ~y ~e~e#t£~ic C&tee~#Ommence~ a~ #~e~ocketeller ~ns~itute ~h ~eW yozk W~er~ I Work~ W&th C~a~lea Lln~be~h ah~ Aleal8 Cancel on the £1r~t ~ti£iclal ~eart ~o keep organs alive O~t~i~e ~he bo6y, S~b~equently, I we,Re6 at Columbiaand New~o~k ~11ve~slt£es, at the John~ ~pki~ F~tal*Ithe t~ive~sity 0£ ~abama~ Washlngton Unive~s&ty and aa <~ai~an of the Department e~ Medicine at Wayne State Unlver~ity in Det~olt, ~ have bee~ a ~ember o~ the 8cienti~Io Advisory aoard of the Couaoll fo~ Tobacco Research s~nce the early 19~O's, -: , t; , rr ~ , i p'r J ~ !?i 4 I;: ;I

965 plate~ts,! ~usceptibility to ath*~osc~erosis, ~nd al~er~t£on~ in prop@rti*a o~ en~thellal ~lls of blood ~n~Ly'spas~ of the coronary arteries has bee~ . i i ~dded ~8 a factor. Tns omuse o~ azt~ri~l ~pasm is not known. •hsss ~r~ ~¼s~ a few of the mechanisms which may constitute ~he ba~is for ~ev~l~pm~n~ of ¢o~onary artery ~ease. FrOm scientific point o~ view ~it would therefo~ be unwise ~o :r escrlbe a slm~le cause to this mnltifecetsd dlaord~, ~: , i We have learned ov~ the years tha~ eagh of th~e ~isk factors ha~ a multiplicity of underlyln~ causes, many~f them not yek f~lly understood. ~lah~t~ is an example: we know that" thisc~sdlt~ ~es~t~ i~ the d~velopm~nt of ¢oro~ary~artery disease.:ye~ we ~o no~ even comprehend the etiology of: :i !!: i dlabe~es.' Z~ Is ~ ~salc m~Itlple e,~ocrlne factors. ~nd~atan~ why dla~s~es causes ~o~Qna~y artery dlsease.~ ~f geneticI immunological a,d Equally we still do not fuliy~ [! I

4¸,~1 ~ t 967 $~ample, ~a=bon monoxide (CO), an~ important uonstifuent of~ ~obac~o smoke, when qive~ to monkeys for~2 ~onths~ does not fesul~in ¢oron=~y ~tery dlssase. (We g~ve 200 to AO0 ppm*s half hours daily forl~ mon~hs.) In short, in my oplnlo,.~ ~her~ i~i no ~ llnk betwesn the p~o~uutlon, of ha~e~ngof the ¢o~ona~ a~tezies {oo~ona~y athe~os~le~osls) and saoking* ...... ; • ,[. I have restricted my remarks primarily to exp%=iments! and cllni~1 ob~efvatlons.¸ The purported "fln~in~s',~et forth ! ~n H.R. 1824' with .ze~a~d~ to cardiovascular dise~e~tem,I pclma¢ily ~¢omBeme,but 80t mllepldemi~logieal studies, i yet, ~here is ~o ~ pEOO£ that Bmokir~ , causes ~the~Os~le~QmlS, ~o¢~n~z~ s~t@[y "dlseas~ o¢ ~ongestIvs h~a~ ~ailu~e.~, It is es~ent~1 t~ ke~p:i~ mind ,the, dlffers~cs between the epldemiologi~al spp¢oaah and.~he experimental and ~linlaal: , !¸ Epi~amiologieal studie~ ¢$iy on

989 B~i~ntlfi~. Overslmp~i~at~os h~s nevez lea to ' the ~o~n~ti~n Of smlent~ic'truth. ' , The thought I wish to convey is that as a scientist an4 physi~la~ I have lea~,8~ to beware of ovezsi~pllfi~atlon. O~ly a~ lh depth [~vesti~atlo~ of a disease much as ~oronary a;~ery dlseame can hrln@ us close~ to the t£uth. AS a pnyslc~n an~ ~clen~ist I feel that the Sci~ntiflc A~vlsory Boa~d of ~ne Counci~ for Tobacco Research U.S.A.~ ~nc. ha8 ~ecognlz~ ~n~ varied spectrum of biologlcal orlgins of ~i~e~su. The ~oa~ has justly focused on the mosaic cf biological fa~bors underlying various dlseasls. The members of ~ne BOa~ have been matlvatsd by $£~i~t scientifio consi~e~atlon~, Thu~, effo~ts have bean mad~ over the years to study the underlying mechanism5 o~ ~osonary artery dis~as~ and ~o Inv~tlg~ ~nem by a variety of strictly s~le~tlfIc approaches. On~ fundamental fact has emeE~ed f~om these ~t~d~eal tne~a is a wi~ ;pe~t~um of underlying ~Is~u~bances of [I

q~ i iliI ~r, • Z6O~OT~ peT~dde p~ ~e~u~=epu~ uT =UOT~nTo~ ~UeTU~AUOD OL6

conf~tencDs on Inorg&NIQ 4nd Nutritional Amp~-c~t$ ~l Can~er d~rl~g tha pa~t aLx ¥earB. uo~,~upon H.~ 1~24 ~ ~ne "C~mprehens~ve S~O~ng Prevention E~at~on,;~t". I~ my opinion, ~ne~ ~B ~o~ ~u~ficient s¢lentif~o ~v~dence ~ustl~y ~ne pcopoeed "f~d~gs" ~egacdiag ~anceCJ SQt foct~ a¢ p~e 2 ot ~ne ,b~ll, T~OSe I~nding~ a~e baled, large ~ct* upon U~w~r ~an~e~ extra~l&~lon of a~biguou~ ep~d~ologica~ d~a. ~ose ~ cl~l~ s~o~ln~ ~a~B cance~ ~ely u~n red,ted statistical ~ss~c~a~lons ~ ~gno~e the lnco~sl~enc~ea ~ one ~cKzn~ ca~tlon t~eory de~¢r~ed ~een abl~ ~o pr~uoQ lung c~nce~ In labora~o~ animals¸ thcoug~ VSS~ ma~o¢l~y O~ Imoke[s neve¢ d~ve~o~ l~ng cance¢ and ~ece

I ,~L , ai~azette 8~oke pzeviou~ly ~o~ to be totally la~k~ng In OaEainogenlQ r Activity ~ nave ~cently Dee~ ~ound to DO ". ~nt~a~no~e~lc whe~ ~pplied w~cn ccue Ca~lnogen~ lr tea~ ~r~ C~n~e~ |s a~ ~xtce~ely complex~ ~ultifacto~al ~8~6e,~rStudies cep~ t~at ~any factoe~ ~the~ than 8~n~, a~ R~at~stically assocl~te~ w~ ~aN~e£. Some u£ c~e~e ~actotl a~e familial p~ed~po~i~lo.t exposuce to tumor vl~usee and:ot~e~blolc~c&l agen~~ expu~e to ~©niz~n9 ~a~latlon and l~Bt~al "cacciDo~ens,, ~tet~ exog~noui ehVlrOn~ental factors ~T~ ~the~, ~t~d~es indicate chat ~ ~D~K 0£ agent~ n~ll~'p~e~ent ln~o~ ma~ ~avl'&~l~&tlng effe~B on t~Qt virusesLa~d that ~e~ ~B sn &Bio~on ~etween lun~ ~ahce~ 975 ~ea~oods* It ~1~o has De~n s~egt~d that th~ ~OhS~mpt~o~ of dlet~ t~ ~n pco-v~tam~n A i~roce~et ~y n~ve lun~ :~ce~ AS ~z as cancers ~ t~e oral caw~y ~t~ co~oecned. ~n~ect~on~ and ~ll-f~tttn9 dentu[es as l~po~ant factors, determine~. ~e e~l~logy of can~e~ of ~e ~s~p~agus ls &l~o malnutrition and alcoholism ~re conal~ece~ t~ De ma~o~ a~u~s ~alnst c~a~et[e ~moxlfl~ as Qa~saclve,

I W L! In lu.marv ~n~r6 io ~a~ I~f~L~l~n~ .c~tLtl~ e~ldE.©, ,f TaaSTAtlOFpr~a~,. • nffi cxx,=o~ ~,.l~v oE ~omiT,*, ,i,, c~,.~. ~,~ ~ ~.~t~ ~...~ ~e~ ~ ~ ~,r.,~

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....... 980 ...... f ~ i i i ~Department of Agriculture Mz~oh ~5. 1~83 wm~ |a~L o~oe~t~rw [u~

Fzcm the field ~an~ ~o ~ha ~I£t¥ ~ntrol eng~nee~ ~ the nelgh~rho~ bus~nea6mmn wh¢ set11 tohacc¢, some 46.0@0 Geor~xa ~bs depend ~ thl f~e ~uzed t~ba~eo =top. The5 zepre~en~s ~.~ percent o~ 6ur state's t~Lal employment. Enfor~emen~ Cf ~.R. i~24 w£~ ~ts many restrictive =~as~z~s ©n labelln~ ~nd adv~rtis~ w~Id const~tu~ ~u~i~es~ ~,e l~es ~ sal~s and ~o~ and a ,~ fed~ca~ w~y. s~rely. c~ ~e~r e~ry ~lock c~essm~, ~en*T ~ Suh~x~nitt~ on ~e~ith a~ ~l~t W~hlr~e~. D.C* 20515 D~a~ C~ Wa~n E Pursuant ~o the Suhc~m/t~ ~n ~ealth and En~/x~men~ hearings ~ H.R. 1824 Cc~ehens~v~ S~Dk~n~ ITe~cn E~ucaticm ~-t- ~ched~led for Maruh 17. 1983. x~ ~s o~r ur~rstan~ ~ ~m~ ~ere ~ mode ~tn~ses zeq~ £ime fc~ c~al ~st~. than ~ allotted~ Therefore I s~dt this brief written ~tatm~nt o~ t~h~f ~f ~u~ m~mh~x~h~p who ha~ a ~o~ ~nzeresr in a s~zong tceaoco After ~ateful s~d~ and ~ ~f H.R. 1824 in~r~d~-e~ ~xch ~. 198~. t~e v1rginla Farm Bureau ~tb0~ ~m~st ~gpose the find~gs s~t forth Ln n~e b~ll. speclflcally poL~ts i-~ ~ot~ in Section 2. pa~s 2~3 um tho fe11~ tasks: i. ~lect ~ the ei~ polnr~ ~r flndi~ as set f~ in the bill a~ a m~a~ to ~etab1~ the allu~ "fa~ o~ f~cts". It would he rash fur a Con~ to ad~ by ma]or~u7 ~e C~nCI~S~ wnxcn tner~ x~ a s~x~m ~ro~sy amon~ m~ic~l a,d sci~ntlfl¢ ex~er~ ~ 2. Giv~ aut~Ity tn an ag~ ~f g~Tm~,~ ~ealth a,d ~, ~s ~t not ~ t~ Federal ~ade C~mu~n haz~ The p~iceo~y of t%is bill ~ in ~irec~ ~I~c~ w~h the m~ ~f the elec~ate. ~e ~ecple ~mt less q~verraent, r~ mDr~ : derc~ulatlcn. no~ m~e requlat~ca~ ~nd certai,~y ~o~ m~ ~n~ ~ ouzel ~[e u~ ~o ~t WdSh/n~l ~ mzgn~ ue ~C~ for ~h~. 3. ~t in, Its the Lntelli&e~ce Of the ~ms~minq ~p~!ati~n ~f th~ thlted Stat~* ~ustlf1~ati~ ~±~un f~r th/s bill is that the p~bl~ i~ ~Tu~aze ~f ~ relatlo~ixp o£ smokL~ and health. The fact i~ that ~any ~t~die~ ~ that mor~ than ~0 percent O~ the public ~ what the ~rnmen~ has been telli,~ t~ for y~ar~. SinCe on~ of the adult ~op~da- ~ con~n~ r~ mmo~e dc~s r~t ~ ~r~es~ of ~en~ rep~. but indicates tndi%rld~al decis~cr~ to sTr~e cr nc~ to ~m~A~e.

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