Tobacco Documents Online

A'~I ~tT11:5 Ad 11oc Cohi~aittee on Smoking and ilealtli February 14, 197? Invited Prese, Members X-)scnt Cbservc-rs 1)r. ShL:Li l: (Ciiairn1 1)r. (;cjri (l:xec. Se ,1n ) Dr. c. ) 1;r. Cooper Foote Dr. Bond•ara;it Mr. 1hi_,rlis ;)r. liorn: Mr. Ci hr;or:: Mr. Milt 1)r. 1:ertsler _ 1);-. Lcr.fa.nt (Coope Dr. l l : r,~;~nd (Foote Dr. r) Mrs. ) Dr. i:rabbcriioft - la.:a:er PhcaL-ls (Ex 0fficio) Dr. Abses 1)r. saif iotti Dr. 1•;ynder Mr. Mr. Dr. Dr. Rockefeller Schmidt (Ex Otficio) Sei tz Terry Dr. Shudbik opened the mee tina with an introductory s yatement pointing out that it was the ui~zsi:;~,~ous •View of the National Can--er Advisory iloard that cigarette smo;cir_.g was a mmior factor in the occurrence of -lum,an lung cancer. ,31c prirlaly purpose of this com mttce not to discuss this point but rat'ier to consider poFsible auproaciIcs to the_ preve:-Ition ar.d control-- of t?~,.; di s~~<.~~et said to be ussoc.ia ted iitli ci garette s;:'c~-i nb , felt there ti•,as sonr Dr. Shu'aiK ~' J hep,p tiiai pub~.~c ,• euucati.^ y ventu<.j.ly prove to ... he tJ1e i;iost effective control r,:vasure in vie;or of ti;e derionst-.rated association bc-tl•;eell educational level <'.end cesS?.ti(?n of- sTTIo}:3nJS holie\'er it .i~1F;ht be as :ruc31 as a ce:1t11rY before this ccul.tL have a,najor efS:cct. Most hopeful af all is the clearly demonstrated dose-response relationship between cigarette smoking and cancer. It would secm, therefore, that tiere is a logical basis for prevention and a prii~ia facie case for =-ecolnr.endino cig,arettes with less tar and nicotine. It has been alleged that filter cioarettcs are associated with a decreased incidence of lung cancer; this question is a ke.y poin*__ which neec3s to be confii-med durin- this ri-c'.etinb. Cigarette smol:e conta;ns knoi•m carcinogens; i-f- fetuid in food additives these 1•:ould ir,,iediatelv be prohibited by current lerislation. G}•clr.vntes, for which the etridence of carclnogelilclty is rrnach less stro;it;er t}-iUn for m1ny corrponents of cigarette smoke have been banned. Carci»o-enic poiycyclic-aie:r.atic hydrocarbons occur in cigarette smoke Plid in polluted air. Legislation now exists that limits these aromatic O pol)•cyclic hydrocai-bo;is in air, based on the assLmption that they may 0 lj~b be harriful to man: this evicience is less strong tilan zhe ovei~•:heLiung W evidence of the deleterious effects of cigarette smoke. In the Soviet M Union steps have beei: tai:en to establish li;^its for benzopyrene in the ~ the atomsphere. Could similar steps be taken for ci~arette smoke? - Q At worst this could result in an over-reaction, at best it could prevent a number of disastrous diseases.

l;i;,ci,lcr cancer wid cardiovascular and respi.rat9w cli-seases arc associatcd Wiql: cig:rcttc~ s,~.okin~ ;iie \~2tion, 1 1lcart .~nd I:uiy irstitutc_ is represented at this i,i^eting, to-discuss their interests in thcse problc:r.s. ;l,e ~e;.r~ittcc has bec~n: asi:ed if limits for tar and nicotine in cigarettes ~ s;ioulci_ i~c ir.i?o5i~~, and Jf so which a;ency could en~:orce thejn rrol~? 1'crhahs m*re eq):-tasis should be given to dcveiopino a lesss haz2rdous cil;aret>>c, pcriiaps niore to convince people to stop smoking. Clearly, the .\at:ionUl Ccnicer ~^d,~isory Board c~u3~~ot ignore tl,e oiiby ~,~el-1 docun,c;ited clue to causes of amajor portio.:--of hu;ian -cancers. Dr. Shubik asked Dr. 1;~,,ndcr- to orien discussion on curren t evidence that less tar and nicotine is ben; facial in Jowarhig the rates of luiig cancer and oth_ r sm,oke re' afied di seases. In ar. i~ynder` s vic~,r, prevention is tJ;e ultinjate we~zaoa for controlling cancer an-l cancer of tiIe lu:ig in -Ia.Lrticulr.r. lie then revic;•.ed e>>idemiological eviderice on the dose-resp onse bet'+:'een smoi:1T:g and l:.L?ls cancer. Tar wnci nicotine levels of conr-iercial c i;arettes have been dr-ai!ati cally reduced irl the past 20 yeurs, folloi:ed by an obser:~ed reduction ia the rate of lung cancer - incldence. Ilo':oxver, the nuli'.~Jer of wo1Ti;P, s~~iokers is increasing and prelin:inary-evi.d.ence indi c.ates -ths.t lung cancer incidence =among t.o:nen is also increasina, although wonsen °s-,ioke less` and- smoke mo?~e` fi lter - cigarettes than -men do, and overall show a lower incidence than- man: Also a cleLur cut reductioii can be shoi~n in those thsat have stopped smo}:in;;, Today -Dr. 1;}Tdar statcd that he had ousel aed a decrcaJe of -M in the-rate of cancer incicl--nce in male cigai~ette sriokc:rs as coq)ared v-ith his-eariier studies. lh•. Ha~rnond reported that dogs -ir:i}aling filter cigarettes gave consistently lower pathologic and 1,,mg cancer end- points than those smoking non- filter cigarettes. However, i t~~ould he difficult to kiot~ whether this had resulted in a reduction of lung cancer incidence for the entire human populat,' on at this time, Studies by l14mder, Bross and Hammond give only an indi cat.ion of what -trends can be expected by- reducing tar and nicotine in cor~~~ricai cibarettes, but cannot give a precise qu.vitification of- it. 'Ihe Office -of Vital Statistics- does not yet sha,r aew-crease- in mortality for ltnig cancer, a.lthough a more -effi.cient reporting at the-present time could mask an effective decrease in the _ population. ;:irar-ettes which may be less hazardous for lung cancer might co;rpound cardiovascular and respiratorj, diseases: this possibility should be borne in mind when developina less hazardous cigarettes. linphyscma in man -is a diFficu1t paraneter to r;casurc; however, in dog inhalation experiments non---fi lter ciparettes_ (la.-e dramatic em,)hysema ~ while- almost none was observed with iiiter cigz:rettes. 11ie sane could 0 be said about r;yocardial atheritis, atherosclerosis and infarction. ~ rurther studies in man are required to conclude with irrefutable M evidence that reduction of tar and nicotine is bci:eficial. In dogs C1T this is u-ell demonstrated, in nun a~ua?r_i tative evidence is not ~ yet available. Dr. Iiajunond agreed «i th Dr. liynd^r on- the necessity off better fundinb for the development of less hazardous cigarettes, but expressed thc hope that institutions other than the Federal Government could be iriduced to apply their resources in this area.

Tr, }.cilsier sustained tl1C nC'eCi for redUC]Il}; 1~'~late!'er h~i1111ii1l conl7on~~nts_ of s1n~~i c c.Ll be idcntific d. Lat~l ~~e~ ~li~i cl~,:) thut he and Dr. 1V, Iiates O:j}'c,+htt .::it} mVeI's,-- Ihc._) CO1P•,I?IleCi, show t31_si1: 111- N'5+, 9l7 '0- of the ---- per cc~n.r~°rci~~Z cih:lee+tes vlclded betl•:cen 3U_t~l 45 1r~illigl•ans of tara cig°u-cttc; in 1960 ohlN15° ~tierc abo~~e "5 miZli~r~JnS-of t-ar, the m,jority were 1)C1C';: °jS I :S ; in 1967 110.1C !~'e,C ot er .50 nll.i-11gr:1P-1s IlIld- t.~le i:.~ iori t~ ~:ere b clotr "l.-j 1ai11iC1r, rls : in ?973 the na;orii}~ are bclolr 21-22 ijer:cigarcttc: lhis is aun- inrlre4sive record of what an cOiIcztior,;ll pr-Cgr~LT, c<vl do to establish a trend, and sur,ge4ts that a 1•olwltary cffort should be prcferred over a compulsory one. L1n.douhtcdly, tile researc?1 eff orts sponsored through the ".•ollacco Working Group will result in-less hazardous cigarettes. lubli ~ ec:a.cat:.on on the smakin~ hazards is obviously a necessi~; but (11i",)ha~:is .~~ust be given to- a coprc:in~.~ted intc~:disciplin-ay progran for ~1 je:;S hazslrC1p11s = cig~rCtte, to Inl`OZi"C all 1ns tltLite~ oau agencleS 1•Jith cxl~crtlsc and interest in differeflt-:~sp~cts of this plohleill, ])r. Shubin asked Dr. Kensler whether he cd;lcurred with the viow expressed hy L'rs. iiyncior and i Iannonci, -that yoluiltarZ= rc:duc tion of tar ald= nicotine has -reduced lung cancer ircideace -in mUll,- and lchethe: he would _sugOe;t that at tile present statiLs of technology la.~er limits of tar aIid riicotine an- commercial ci.garettes -are obtaiilable oa-_a volunta:;' basis. On a pllar,,lacological basis- the dose-response rei atiunship mah, s sense g1'E'Ori 14i th Dt. Har.1.GI1d t};nt evid•"°?lce for a rnid 1)r :;Flls ie r, }1c, a d~xrease of lua, cancer incide;lce in man is not doannenta'ele as - c,esirahlc•. Pel;laps better evid^lice can be obtained in prospective cpidenuolonical studies, by follo::ring current young snlokers for the next several vears. Dr. }lamnolld concurred on the necessity of this approach although it-would require considerable time. He again felt the r'-duction of over 40% of tar and nicotine in the last 20 years did not have -sufficiently strong elfccts to lower national r:nrtali.ty from 1u:13 cancer. Tiorcovcr a decrease of hnng cancer incidence would be affecte~l by a variety of factors, ,a;~ono which the age at l:hich s;ac':ing s,a..~ started, the quantity of cii,arettes sn,ol:ed, ilie smokine, h;:bits, tlie cllange in tar and nicoti.ne, and for those smokers who quit, the time from smoke cessation. F.eturllinb to the second question by Dr. Shubik, Dr. Kensler thought t}lat trell~ls- of tar and nicotine reduction in convnercial cigarettes seeminF 1), approach practical lower limits in terms of consumer acceptance. Iksl~ever, the inge-nuity of indusiry may devise further methods to lower -current levels and still satisfy t11e smoker.

-4- Tr. Dr. i°,W~rder`s- viei~;_ educational. prograa;~~ have ,obvio.~fily i~cejt, successful. , , t - r j.ii ~ ioric , ~ ~~ut fr-o:u r ,crsp:.ndi~rc ,.rc i: rLortan t nlcT~cTlt i te controlling -disca.sc is the modification- of tr etiolor;icns fa;.tors; _in this casc ;:,odiiisat.ioTr o1=- the or;arctte.- Regrettably, mortality_statistics in this cou~rtrr~ are at-lcsst* five years late- over current ::reirds, anG ;.hca-efore practical]y L~seless as a basis for pu'ulic-=1ie^lth af-tion, as suj~ocstecl by-. llr . Ilzmur:ond..S an ndditional _ zactor in tl;e case for a close-response relationsh;p, i<omen today have less than h~lf the lt;ng c;uice,• risk of m1n, and they sr,o}:e I-ess= than hal f the qu•alltity- of cjharettes and inore filters proportionately than men do. -_ Multi- factorial studies--rre i:.q3ertant: - i: coronary disease, for instance, IlpeIllla, blood pressure and _s11aI;In'- are rtiell h1o:~:2 to be the maj('i2r con-tributin<= factors. In-sirokilg and_ heal tl! there_ is_ neeu- for inter- -(Iis4i1)1 in~;:-y-aotion- alid a-closelv coordinated effort het„een the C:u.ccr Institute, tleart. -and Lun T Institute alyd-the ii?pa:•tn,cnt- of AgricuIturc= under the strong leadership of a central authority. -- 7his re-corinenda=tion-rtias vigorously sirpportcd by Dr. = Kensler. Dr. -llorn suRgested that the hAst_epiden,a=ologic=al -cohort for_ ohser-vinfi an eY:~~4ual c'.-3cliiic in it:nry cnncer incide-nce is that of recp1c = born- bet«een_ 1910 and -:! 935: °Belmeen 1964 and l-966, this _ colrort has reduced_ _of 10 o their smoke inta;;e foliow-i-ng the impact of the first Sur-oepiL General `s Reports. ile also raanied that in any study of dose-resl~onse rel~lticnship, I)ar'c;:P,eters other t}:'?n the -P;ener 11 Ce:3teni: of the tar ~^J1C1 nlCQtlne of such as tire- dcpth of inhalation, the th_^ ci varette :, uSt Le CoI1s1C e? f i, frequejicy and vo.la::e of the puffs, -etc. Dr. 1'`'ensier agrecd wid C.Nq;resse.d the op inion that the da=aitatic reciuctian of tar and nicotijie of co:,mr..rcial cigarettes over the last 20 years -shou.ld have beneficial effects in those diseases where this effect could be negated if smokers were not instructcd in the less hazardous r:etllods of smoking cigarettes, i.e. li,;ht inhalers may become deep -inhalers if tar and nicotine levels drop. It should be recalled that deep irrlialers get as much -a_s_ ten times the tar and nicotine dose as non-inbalers. Dr. Saffiotti testified to the importance of skin prainting experiments and su;rested- that L-etter attention should be given to ingestion and inhalation studies. lie also reported that short-ter,n carcir.ogenicity studies riay be soon available to greatly iniprove the search for a less hazardous cigarette. Dr. -I~enfant expressed his pleasure for the expansion of the Tobacco liorking Group to inc3.uc;.e specialists in cardiovascular and respiratory diseases. lle reassured the contr:ittee of the high interest of the N'ational Heart and I.urg Institute in smoking and health. A Task Force on Respiratory Diseases recently completed a report in ;drich great enlnh~uis-`,as placed on the need for research and action in this field. According to Dr. Lenfant, it is difficult to say which component of smoke is responsible for heart and lung problems; beyond tar and nicotine other components of snbl:e should receive close atte:~tion.

il; . C,)r i nave a;bi°icf accotlrlt of -t,:e "'obacco_'orkin.g Groui~= ('fWGl L its cza f~altiz.lt:on and atter,3jry research pro;;rasn: -Majoriiiteiests are tlle 1cii:Iltificatlon oi- risl. {aGtors and or mcans fol- ..hclr control, wnd-the C~e1'eloj':;!C11t of ?._E'SS hazal'doLt3_ i.learettCS (lJ1i.). - -SPro1~ers (alaracteris tlcs illld- eli a J-It)nrvlltal factors -:.1) -t may lead tC3- 111t_ ) caseil rls}._ suC11 as t,Clieti c alld ps-N`~holort ica'l cl<<fccts, -concur rent di s_eases ; occupational ,Ind soC1al C 1I CtJ'~i=aIlCe :, _ etC. , are 1~C:.:11~ illa-•e`,tlg.it-ed. 1)rl.l"s-- and --- l~otivai.ional r:etliods that could help liigh rislc snti;cer-s are being studied. ~~ _are hezr;, sou~li t 'uy it L~al'ia~' of aI->>~ o<lc}ies : ne~,~ al;rono~ni~ai IJ' _ 1 " toiiac.co vari_vtie:;, _lo•,' . nicotine types, engineer-ing <uid=to€razco -_ fi-ite,:s, etr.-- The evaiuation of hilC requires adequate h;e-;~:~;ay ITM thod! t~nd conside.-able research ~s lieii~g directed at d; ~elo>>ing ilalatioi: i-ecluiplogies and other bior~s.ty apprcaches suitabie f oi° l.jrge scaic scree:.:il.d. '!?Ic current prog-rwm is filnded near $2. S million, but adeEluate plaris== exist that woui:; reQui-l e t7i~ice this funding il 'niediatcly, mid a coalsiderable_ increase in the neXt. fel•, years. lnvi ted by Dr. Shubik, t~fr. 1S~r1 is acl~olaled~ec~ the considerahle ,evidence- fa~~er.~lig volu:it~_1-)= co ;pli_Ince towards 1EJss tar ~=)id-nicotine in cormlercial ciP, zarcttes. (Ybvi=ously tiie filter cigaa•ettes share_ of the market has- UCCIl lncreas1]?g in tlle 1?st- few years and liua exceeds 9010 of the total +1 nt tr.R nat~ i ~~ i tl R~ . Tilr- c.~~:.cii=i; aliuustr•; ~:I:;:s ~..u~ ~... ~~.,,.~,.~r s_ t_ ~ 1 Voiu,_lcV ahare of the odv,i~itages of smnl:iiig a]o;.; tay and nicotine cigarette, as sau,il: by_ tllc jntroduc t 7A1; of low tc.r and nicotine branus after the ban of cigarette television advertising. Legislati.o,n is being reintrociuced -~Yhis year by Senator itbss to.:ards lilaitin` tar a.nd nicotine contents_ of cigarettes. However the gaMe could liaci:fi.re, as too low lu;lits for tar and nicotine may increase consiullption of cisarettes. Inz)etus for new legislative efforts will have to come fionl nela and better scientific evidence that the National Cancer Advisory Board Inay endorse. Dr. liynder again recoTznended that the To')acco -Workino Group activities should be expanded to interdisciplinaiy and inte-,°agcncy activities. ® 11iis in his advice would be better served by subdividing the T1VG ~ into three major areas: one interested in cancer, one interested-in ,A, eardiovascular and respiratory diseases, and one interested in ~ , motivational alld phan;iacolo,ical approaclies. For an effective program, the NC:I and other-age;lcies involved should find expeditious ways C~f for i'unding high priori-ty research. ~ Dr. Kensler agreed, and deplored that the work of the I1t1G insofar had been restrictedd by lack of funds. Besides shortage of support, =continued llr: ltiynder, it has -ail.titys been c]ifficult to Inotivate yoting researchers _ in the field of snloking and health, a~id Dr. lialln):ond con£irnled that the American Cancer Society receives extremely feltit grajitt applications in this area.

-G- I~fiCr the 11_i1C~: rCGCSF191, ::7~C~ ]n ~'iely of- ~hL'. ITlorll3.l1~ di~CUs:~ion., 1). ",imui ~k stztc4ct ~ as n~. ^ces,ar)' _ that '1;hC `g.roi1p nlvct aoa3n-dti'ltll the = tri^bci•s ahsc;Gt s oc?av,- prior fio- tllc nc;ft t.>>eetir_(z of the National Cancer Allt'7. -~U_?)' B(5::rd ln NI:1rG11_. -- : t• this nC?Ct tnCGtll1g, C-L~I1sidCT'a1,:~r)il-s 11C'•LilC1 = l,e "iwil to a ChA:>;ic•d plan for research and action in =m.ol:inn wid he,ilih cl~.horatc,.] with the ,i_1vicc- of tlie Tobacco l'orking- Groupr to be suliaiitte;l ivit1:- re~co:anendations for aiditional funcls- to the National Cance r Actvisoiy` DcLa rd- AS a L;ollicll]Slo?:=-of toliay 'S- nCetirs-, Dr._ (]aITLncmnll c31-PllaSrZCd t]"1C groilp shoi1ld- srroilp?;: ~tate full st:i~port= of ~=11e=aotiviti~:s=of the Tobacco l~ori:i=.izc, Group and reco,arrenl.' that addi t~.o:izl ~ cti:Pitios in this- area- he E c)o]'!li natcd 4:1 th the Nati ciial ]]ea-rt ana i=u^g in_>iitute and the lk~p.jl ement of ABriculture. :d-l t,'-le-;ne;r:-,crs concurred witlr Dr. liampnond--- In refer-c-nce to flhe general proclivit;• off the cor;rn:ittee for voil:ntary carpliwlce trnY<:rkIl lo:•.er tnr- and nicofiine= lir;its, iir. •1`iilt stated -that the 7u11 I:aecutive Board and the Sr:;ol:inn and Iaealtll Comnittec of tlle An.^ri c: n Cariccr Society hati•c gl.ven maild_.te to the Society to continue actloll tot:arcis leo?sl,ati on estr:l~Lishinn ~naL_ii:.nn linits on tar an d ni.coti,le in co:n.rivi-cial cigar=ettes; the= ACS consi ders -ffie present= scielitific eti'idence_ for_ sucll action over:.:heL-ning, -alzd will colitinue- to scc}: legislation as s tat::d. lll l.J.li:~lll'~~, l;Jl~ )Iltib, -_L1. i iuUlt~ Jl..~iLi;U li.i11., rem;1rl:.ble hccorll of inliustl°; in reducin;; tar and nicotine contents of coM,:ercial cigm-ettes ov;;r the last twenty years, a volun'c.,iy effort t encouraging further reduction z1pp:~ars likely to be more productive than co:r;pulsory letiislation, the fran,e.•:ork of which would be extremely difficult to assess equitably at this time. :his whole subje ct however, will be resubmitted to- the full meml?ership of the corutittee at the next meeting, tentatively set for March 25, 1973.