Tobacco Documents Online

M INUTES- NCAB Subcommi ttee M-eeti ng November 1 3 1974 - - Members of the -S:ubc-ommi ttee Dr. Jonathan E. Rhoa-ds-,-CHAIWiAN, llniversity_ of-Pennsylvania- Dr, Gio B.- Gori; Executive- Secretary-,- I'lational Cancer Institute Dr. Cuyler Hammond, American C-ancer Society Dr. Daniel Horn, ii'ational Clearinghouse for Smoking and Health- Dr: Marvi-n S-chne-i-de:rman,-_ National Cancer: Institute __ Dr. Phi 1 i ppe -Shub i!:,. Eppl ey I nst itute for Research i n Cancer Dr. Jesse Steinfeld, Veterans hd~ministration-Hospital - Gal3fornia Dr. Ernst Wynder - American Health Foundation Purpose of the meeting, which - said.Dr. Rhoads - was being taped, was to prepare a draft document for consideration by the National - Cancer Advisory Board at thei:~_Ncvember 18-20 meeting, responding to the recent request by President_i:erald Eord far documentation and clarification of scientific evidence in_supbort of the recommien- datioris for regulation of tar and nicotine of cigarettes, as out':.indd in the latest NCAB report to the President. Dr. Rhoads read the pertinent excerpts from this Annual Report, as well as the letter he reyeived -from President Ford, and invited comments from the n,embers, thei'r suggesti ons for assembl i ng the necessary scientific evidence, and their opinion of whether the - recommendations should restrict to lung cancer, to cancer in general, or to the entire spectrum of smoking-dependent diseases. Dr. Hammond present-ed data from work he previously published as well as unedite-data.- Death rates and lung cancer mortality were linked to the number of cigarettes smoked per day, to the degree of inhalation, and to the age at which smoking started. Data also indicated that lung cancer mortal i ty rati os woul d vari ous ly decrease- i f peopl e stopped smoking, depending on how many cigarettes they used to smoke. Lung cancer mortality ratios also were dependent on the type of cigarette smoked and generally-Were decreasing for decreasing yields of tar and nicotine. Dr. Hammond also recalled that-the types of cigarettes used in the inhalation experiment by Dr. Auerbach at the Veterans Administration i:ospital in East Orange, New Jersey were not dissimilar from cigarettes used for human consumption in terms 0 ~ ~ 1 1U

(2) of Lar-and nicotine yield,_and noted again the striking difference that those experirnents- showed for emphysema and lung neoplasia between- fi l ter arid non-f i 1 ter ci garett-es. He al so showed graphs i ndi cati ng that, although the number of cigarettes-_smoked per capita may have slightly increased between 1945 and the preser.t-time, the per capita consumption of poun:ls--of cigarette tobacco actually decreased.. This, as sonic other of his graphs -indicated, lead to a decrease from 175 to-approx-imatel;, 75 grams of tar, and from 10 to- approxiniately 5 grams of nicotine consumed per-capita,per year in the-~;r_ited Statess-over the sanne period of time. In relating-this decrease to the incidence of smoking associated disease it is necessary to r~al-ize thay=the shape of trre dose res~onse curve i n man i s not= }cnol-rn :-i n other terms it is possible that even the-lower doses of today may_sti-1l be part of a high plateau in the dose response curve. In concluding Dr. Hammond suggested that a-decrease of_-tar=and nicotine of con-niercial cigarettes shoul d be acco,a;;l i shed gradual l; , parti cul arly when deal i ng ~r i th the present high tar- and high nicotine cigarettes, because cutting back too suddenly could increase appreciably cigarette consumption.= Dr. Shubik-expressed unhappiness=because=these data of Dr=. hannniond had not been presented in this detail at the meeting of the Board Smoking and Health Subcommittee in March 1973. Dr. Horn recalled ti,ro meetinJs sponsored by_the National Clearinghouse 'for Sm.oking and Health in 1955 and 1969 to determine a listing of undesirable smoke components in order-of significance. He-recalled how these meetings-resulted in recommendations for a progressive and simultaneous reduction of all rnajor noxious substances in_smoke. According to Dr. Horn's data, a'lthough young people are starting to smoke in increasing numbers, their preference is for low tar and nicotine cigarettes, while high tar and nicotine cigarettes are primarily smoked by men 25ove 45 years of age. Other tables presented, indicated that the trerds observed have been always to,::ards reduction, not-increase of intake-, in virtually-all groups of smokers. The massive decrease- of nicotine and tar contents of cigarettes between 1966-1970 produced a slight increase in cigarette consumption in certain groups of smokers, but far below the levels required-for quantitative compensation of tar and-nicotine intake. On the basis of the evidence available Dr. Horn also suggested that any step-wise reduction of tar-and nicotine of con-,merciai cigarettes should not exceed a difference of more than 30; in each step, to avoid compensatory increase in cigarette consumption.

11-r. Wy~nder reca11 ed the hi stori ca 1 background and epidemi ol ogi ca i- evidence of tlie causal relationship of smoking and cancer of -the lung;. other for!ns-of cancer, cardi-ovascular and respiratory -diseas-es. He alsd recal l-ed the gener al reduction of tar and -nicotine- in-corartiercial cigarettes in the last tatenty years and the decreas-e of specific- ac}ivity of the tar: by s-4:in painting standards in niice, the-tar of today's-cioarettes is'nearly 2511, less-active-than c-omparabl.e-tars of 20 years ago.- This indicates a profound change in cigaret_te- tecnnology=resulting ina lov,ler_ intake of tar and -nicotir,e-in today's smokers. De agreed that today young people smoke low-tar and low nicotine ciga-retzes-4nd-recalled his studies-indicating that filter smokers have l o;fer ri s k-than smoicers of nor;-fi l te.r ci garettes. Dr. ldynder felt z.:hat re7ulatory action should cover the entire spectrum of smokiny_dependent diseases and tha-t if the i974 average tar and . _ nicotine contents of-ciaarettes-(1£3.4-milligrar,is and 1.27 milligrams res~ectively) are acceptable to the majority of sn;oi;ers, there is no reason-ti~rhy_they-should not be acceptable to all sn;okers-.- The labeling of cigarettes with-a precise--tar and nicotine conter.t may not be specific~lly-clear to the consumer, arid a qualitative-label of ° 1 i ght" may- be al l ot•;ad for- al 1 ci garettes- bEl old 12 m%l l i g.rams- of - tar and 0.8 mj_;ligrams-of nicotin4, hoping that the consui::er would find a-more immediate signal for his-choice. -Dr. Wynder also reminded the group that in the-long run it ti°;ould be necessary to look for quantitative as v:eil as qualitative changes, with the kind of research that i s nc°~;1 bei ng conducted b'y the Tobacco Ulorki ng Group and the Smoking and Health Prograri- in the Plational Cancer Insi.;itute. Dr. IJynder-also voiced strong concern that legislative atteapts at ci garette regul a-ti on wou l d have l i ttl e chance of bei r,g- approved , and expressed his-fUvor for rec-on,nrendations to encourage voluntary regulation by the cigarette indust.ry. Dr. Schneiderman stated that the reduction of tar and nicotine is - desirable and stressed the necessity of including cardiovascular and respiratory diseases with cancer considerations. He then presented- some data sho4-:i ng decl i ne of emphysema, bronchi ti s and asthma, probably-as a consequence of the publication of the first Surgeon General's report and the attending changes in smoking habits. ihe comparable decline in-iu-ng cancer incidence may be too_early t-o detect, because of the long latent time of this disease. Cardio- vascular disease mortality also declined and it is possible to think that at least a factor in this decline might have beern the public awareness against smoking since the initial Surgeon General'-s- report.

(4) Dr. Shu=ri i: f el t t-hat the resol uti ons of the 1-9731 S,noki nn_, and-11ea1 th- Subco i, ti i tce of the RCAD_ t,,er,e not- prQci sel y in accord ti•:i th tho =-- - language of the- l atest tiCaB-report_ tD-the- P-resj dcrt- on t=ne- sinoki ng and heaith issue. ;Wliiether one should prefer_volurrtary compliance kas recc;rtnenued bv that SubcIo;,,t,ri ttee ~_ or coiapul sorv by i nditstr%f ?egislativ_e action was still an=opcn question in his mind. )Ie- %!;as concerned that the-certification-of upper limits for tar and nicotine may induce the s1floker to cot~sider-those levels as safe. -He-rec3lled that the 1973 Smol: ing and 1jcal th- Subcomnli ttee of the- NCAB had gather ed most of the available evidence to y,fiicl;-very little could be added today. TIie Board - _Dr. Shubik-suggested -- should urge the-President- tb personwi lv: reqaest- the ci_curette industry to put fort,,rard thei r best efforts i n recuc i ng tar and- rii coti ne and othrer undes i ra-b? e_ smoke coi,iponents; this muy be vastly ~?refer~:ble- to the setting of s~~ecific tar and_ nicotire ~evels through the confl i_cts and intricacies of arbitrary regulat-ory procedures, the legal basis of which is very uncertain. He concluded-tJith the hope that all this new public interest and the President's involve;r;ent.on--t~~e -issue of_sn;o;:ing and health may result in-benefioial public health action. Dr. Steinfeld recognized that pubTic education had_not been as effective as one mi ght hope and al so-fel-t that the del i berati on-s of- the NCAB should not restri-ct to cancer alone. He enxphasized the need for a balanced approach to the situation and the need of not wasting this pa,r_ticular opportunity to regulate the cigarette-indusiry. The American public, felt Dr. Steinfeld,-is intel?-igent enough to realize that the setting of maximum tar and nicotine levels does not imply an endorsement of safety.- . -Dr. Rhoads read President Ford's letter again and suggested that the deliberation of this group, and of the NCAB, should be specifically concerned with cancer, but that a recommendation be made to the President to seek specific advice from the National Heart and Lung Institute on the possible regulation of other smoke constitutents that may be responsible for cardiovascular and respiratory diseases. The group then discussed a working draft of possible -reconnendations that the-Qoard should consider at their meeting of tr'ovember-18-20, - in reply to President Ford's request. The draft document which the group formulated is-appended to these minutes. ~ -The meeting adjourned at 5:45 p.m. ~ ~ ~ CA G. D. Gori , rxecttti ve c^.^rn*,r.,