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;~IINIIiES Ad Iioc Co^nrrd.ttee on Smoicing and Health Meeting June 17, 1973 Members Present Dr. uor c Cnairrnan) Mr. Foote Lh:. - Gor; (Exec. Sec. ) Dr. Kensler - - Dr. Krabbenhoft_- rir. Saffiotti Dr. Seitz Dr. Tel. Members Absent Invited Observer Lrf. Cooper A~':r. M? lt Mr. Giimore Dr. Horn Mrs. Las ker Dr. henfaht Dr. Rhoads Mr. Rockefeller Mr. Schnidt Dr. Wynder Dr. Shubik noted with regret that of all members of the NCAB invited to this meeting, oniy-himself, as chairman, was present. (Lr. Krabbenhoft and Dr. Seitz-later joined the ;neeting.) He hoped that this would not be an indication of the lack of interest and concern of the Board in smoking ?nd health, probably the single most important area where action ~ of immediate benJfit to man can be planned and carried out effectively. Of all cancer sa_es, smoking anu~ lu.nQ cancer represent the only- causative associa~ion tha~ is so ~~ell doc«nented and lends itself to immediate preventive measures. The Smoking and Health 5ubcommittee initially met to explore the possihility of legislation to-reguiate maxim;zn limits for tar and nicotine in cigarettes. Since then, and through the lively discussion that chhrac4 terized the first tim-meetings, the scope has become much larger and the cotrmi.ttee has performed well in identifying major areas iviiere action is needed, as indicated in the minutes of the last meeting.-_Dr. Shubik wished again to be on-record that his support for a voluntary compliance proposal for liriitatiorn of tar and nicotine levels rather than a legislative approach does not represent any leniency towards the current problems that the smoking interests imnose on the American publics but rather his deep conviction that, in view of tt?e limited scientific evidence now available-, legislation at tl'~is point may encourage complacency in the smoker by engendering confidence that legislative limits could be taken as "safs" limits, and therefore result in a deplorable increase of- the habit. The purpose of this last meeting- of the- Smokir.g and Health Subcommittee was to ensure that the recommendations it made on INiarch 25, and that the Board passed Lmaniraousiy, were implemented. He felt that some way must be found to focus the attention-of the National Cancer Advisory Board on the issue of smoking and health. The Board cannot continue to G

c2) ignore the situation. Dr. Shsibi.k proposed that perhaps fivc minutes of silent prayer at °aci: Board ,:eetin-, in memor-y of all the ^,r.ericaiis-that died as a result of cigarette smoking might-stop the NC.AB in actions in this area. He asked- then fer_suggestions fr2m-the membership on how best ,to insure that the NCAB were kept alert to the problems of smoking and health, the develop-ii,ents of research, and their__continuinQ needs-. -He asked whether this could be served-best by the fornation - of a committee within the NCAl3. Dr. Cori suggested that the Tobacco ti`;orking Group l-Las r.ow expanded to include experts from the Heart and_ Lung Institute, and would be competent to provide -a scientific and public action -program, the needs and progress of which could be p-resPnt-ed to the Board at regular intervals. Dr. Shubik felt that_ in order to avoid any difficulties in presenting this program to the Board, a standing subcommittee perhaps would be needed. Dr. Kensler supported the view of Dr . Gori. - Howe-ver Br.. Shubik felt that *,he_ research pro;ra.-i presented -by the TitiG may not be cor~rehensive enough, for -instance;- i;- does not -co~iaider i~~depth public edt:catian needs of the smok;:r.~ and health program. Dr:Geri reminded Dr. ShuDik-_that traditionally these aspects of- the smoking_ aild-health campai gns -had _ been carried ou~ _ by the National Ciearinghouse for Smoking and I-:ealtli and had beenn fu-~ded separately by , Gozgress ; Dr._Gori felt that befare-the National Cancer Institute enters heavily into public education ca,~aigns in-the smoking and health field, the appropria~^^^~~J V L ^+ ~ ~aou:g so should obtain broT)er clearance fr,~ Con rF'ssionc.l ~Vll\ J ~j Appropriation Gennittees,-less it may cause some iater difficulties. Dr. Saffiotti suggested tnat a solution ?s to suggest that a member of the Board be appointed on a permanent basis to the-Tobacco Vorking Group. Discussion on the topic among the participants followed and as a result Dr. Shubik felt that the suggestion of Dr. Saffiotti should be followed and that recorsnendations and appropriate measures should be taken so that a member of the Board would-be permanently appointed to the Tobacco Working Group and would repe-rt on a regular basis on its activities to the full Board membership. Dr: Shubik asked whether-*.he research program.-forn:ulated by the Tobacco Working Group was indeed covering all aspects of research rea.uired--- such as development of-models, in vitro testing and lung carcinogenesis _ at the cellular level. Dr. Gori sai t t work on respiratory carcino- genesis research was being carried out adequately as part of the general carcinogenesis program that Dr. Saffiotti is funding. llr. Saffiotti concurred that m.i;h of the required work on biological models and lung cancer pathogenesis would be produced by the- '- outsi& of the activities of the Tobacco htorking Group.•

Dr. Shubik again-asked whether -the activities of `thv-T,JJilcco ~t'orking Croup as developed LIP to_ i.3v; sr,ould- be_ nnich more cx-Vandea iri scone. LiJcussion foll_o,Kod, and Dr. .:ensler- suggested trat= the 'fobacco ,•;orki ng Group as now constituted, provides the best expertise- and advice available in all areas of smoking and health except for the public education field, which for the reasons pr-eviously-mentioned by p-r•.' Gori has developed separately from. the activities of the Tobacco ti1,or-king `rouir. Dr.- Shubik then asked what steps -had been take:i to -ir.sure funding of the programs as approved by the National Cancer Advisor/ Board at the last - meting. - Dr.- Gorii said that he had-been in touch with Dr. Cooper of the Nationa3, lieart and iuns Ins ti-tute who ;_ad given verbal assurance of his interest in=smoking and health; he intended to participate in the funding as soon as bills now pending in Congress give him this _ authority. Appropriate steps- had been talcen- also with- Dr. Rauscher, who had given assurance that within a short period of -tin° he would bo- able to make an appropriate assign~ment of fun aw- to the smoking and health program. Dr. Shubik asked the- group -for suggestions on how to insure= that appropriate funds were made available for-this program. After- discussi-or.9- '_-~r. Kensler fo_rmulated -a proposnl= that the h'CAB -be asked to reco:nmepd-to -Dr. Rauscher to- expedite vigorously the funding of the smoking and health program in coordination with the National Heart and Lung Institute. Dr. Shubik suggested that a-reco= en:ation should be made to ensure the Cancer Control Program, take cognizance of the association of smoking and lung cancer and promote appropriate- cuuc4tion Lfforts i~i this a,-ea, in coordinatic, ;:ith the- current public efforts of the National Clearinghouse for Smoking and Health.- I1r. Shubik then opened the discussion on"the motion_by Mrs. Lasker approved by the NCAB, namely that legislation be sought-to require that all packages of cigarettes carry a clear labelino-of tar and nicotine levels. Dr. Gori said that steps had been taken within NCI to study the administrative requirements for such legislation. Mr. Milt of the ame-rican Cancer Society said that there is now a bill pending-in the House proposed by Congressman I2eb.man and that ~ the Federal Trade Cormission was in favor of such action. Dr. Shubik suggested that a copy of the NCAB resolution on the-Smoking and Heaith- Committee recommendation should be transmitted to the- Federal Trade Commission. Mr. Foote recommended that the NCAB should have a permanent subcommittee to consider policy in the aiea of-smoking and health. Dr. Saffiotti felt that this committee s; ould review the wdhole approach of NCI in the area of smoking and health, including the research as well as the review system and administrative setup of the current program. Dr. Shubik agreed that this was a good.suggestion but that the prior suggestion that one member of the Board should be permanently present ~ on the Tobacco Working Group was also unportant.

C4) Dr. Terr}r said-that t~he mechanism previously reco~,_endcd in the r.reting,- name=ly, of having a Board r-e;,reseatative anpointvd pe-i:rent.iy to the Tobacco 1':orkina i~roup, !r.iGht -~~e suf€icient i n sensitizii:g- the goar d_ by close sur~reilla.nce-and regular reporting. Dr. Saffiotti- indiczted years and that the Tobacco Working Grour had beer:-actbve for over five that it was too large to . furction effectively as a single 1•rorkirig- group . He suggested a reco„=.endation to the NC:1'~ that the hoard-should undertake a full-review of-research priorities in the smoking and health progr-am_ by taking a new-look and fresh s tart siflce -the Board may not necessarily want to- retain the prese;-it- system using the advice of the Tobacco tv`orking Group because of potential serious - conflict of interest, since seve ul TIQG members are alyo -coritractors . Dr. Seitz and -D-,:. Kensier, afte.r some - discussion by the group, i oined in suggesting tfiat_ recoranendatien should be ; iadc to the \C{u'3' for the _ establis:-.i-iiPnt -o€- a smoking and health subce;im:ittee as Mr. Foote °suggested, namely, a committee to reco:end to the NG"E3 policy and action -in all areas concerned with tobacco and health~ Dr. Shuhik thanr:ed, all-the rnembers for their participation and contribution in the three meetings -o?= the Ad Hoc Co;iNdttce on Smoking and Healthy which had carried out- the -assigiunents given to it by the NCAB and, with this last mc>eting, was now-dissolved. _ _ A